Objective:To determine the prevalence of Salmonella paratyphi C phage ( SPC-P1 ) in dif-ferent Salmonella serovars and to identify the integration sites in host genome. Methods: Based on the complete genome of SPC-P1 in S. paratyphi C RKS4594, 6 pairs of primers were designed and used to amplify the fragments of SPC-P1 in 11 S. typhi, 11 S. paratyphi A, 12 S. paratyphi B and 23 S. para-typhi C strains. At the same time, 100 complete genomes of Salmonella including 20 serovars available in National Center for Biotechnology Information ( NCBI) database were downloaded and aligned by Mauve 2. 3. 1 to determine the prevalence of SPC-P1 in these serovars. Primers were designed according to the integration sites of SPC-P1 in the genome of RKS4594 , and used to amplify ten strains having SPC-P1 in the genome. The PCR products were sequenced to investigate the integration sites of SPC-P1. Results:SPC-P1 was widely distributed in S. paratyphi C genome. In the study, 14 strains had all 6 fragments and 2 strains had 3-5 fragments. All the amplified fragments showed expected sizes. In contrast, in the ge-nomes of S. typhi, S. paratyphi A and S. paratyphi B, no or only 1-2 fragments could be amplified, and the sizes were smaller than expected. The results from Mauve showed that only in the genome of S. choleraesuis, which was a close relative of S. paratyphi C, there existed an almost complete genome of SPC-P1. The insertion site of SPC-P1 in all the ten S. paratyphi C strains tested was between pgtE and yfdC genes. Conclusion:SPC-P1 is a unique virulence factor of S. paratyphi C. It may play roles in the host range and pathogenicity of S. paratyphi C.

There are problems in traditional medical education in China. It is important to cultivate medical talents who are adaptable to social changes and medical advancement. However, the scientific quality and innovative medical students have long been neglected. This paper discussed the essence of scientific quality and innovative talents, and introduced the experience of the program of "long term clinical medicine education" at Peking University Health Science Center. We here delineateded the key points of the scientific quality and innovation education that may provide new ideas for the training of the medical talents.

Objective To establish an effective and stable rat model of skin-infection for evaluating the therapeutic effects of topical anti-infection drugs.Methods SD rats were subcutaneously injected with cyclophosphamide to induce immunosuppression,and then surgical incisions were made on both sides of the spine.The rat model of skin-infection was established by applying methicillin-resistant Staphylococcus aureas suspension to the incisions for two consecutive days,and evaluated by analyzing infection status,pathological changes and healing time.Results The development of pyogenic infection was detected in all of the rats.Compared with the non-cyclophosphamide treated group,the cyclophosphamide treated group showed a more severe infection both from the visual inspection and the microscopic observation,moreover,its healing time was delayed more than 10 days.Conclusion The skin-infection model was successfully established in immunosuppressed rats induced by cyclophosphamide,which could be applicable to the efficacy evaluation of anti-infection drugs for external use on skin infection.

Objective There is a lack objective methods for the diagnosis of postoperative cognitive dysfunction (POCD).This study aimed to investigate the influence of propofol or etomidate anes-thesia on the postoperative cognitive function and serum S 100βprotein level in infants . Methods This study included 100 hernia infants aged 1-3 years treated by laparoscopic herniorrhaphy under propofol (n=50) or etomidate anesthesia (n=50).At 1 day before and 3 days after surgery, we assessed the cognitive function of the patients using Bayley Scales of Infant and Toddler Development ( BSID-Ⅲ) and further divided each group into a POCD and a non-POCD sub-group based on the results of diagnosis made according to the Z-scores.Using ELISA, we measured the levels of the serum S100βpro-tein in the iliac venous blood drawn preoperatively ( T0 ) and before PACU ( T1 ) and compared them between the POCD and non-POCD groups. Results At 3 days after operation, POCD was observed in 10 cases (20.0%) in the propofol group and 9 cases (18.0%) in the etomidate group, with no statistically significant differences between the two (P>0.05).The level of the serum S100βprotein was markedly elevated in both the propofol and etomidate groups at T 1 as compared with that at T0(P<0.05), and so was it in the POCD in comparison with that in the non-POCD group (P<0.05), with no statistically significant differences between the two groups at T1(P>0.05).A significant correlation was found between the postoperative S 100βlevel and POCD at 3 days after surgery in both the propofol (r=0.842, P=0.001) and the etomidate group (r=0.821, P=0.001). Conclusion Propofol and etomidate anes-thesia can induce different degrees of postoperative decline of cognitive function in 1-3 years old infants .The post-anesthesia elevation of the serum S100βprotein level is positively correlated with early postoperative POCD and indicates various degrees of brain damage .

Objective Ticagrelor-related dyspnea may affect the medication adherence of patients with coronary artery disease.This study aims to assess the impact of ticagrelor adherence on 1-year cardiovascular outcomes in pateints with stable coronary artery diseases (SCAD).Methods This study includes the patients with SCAD from Fuwai hospital who discharged with ticagrelor between Jan.2015 to Jun.2015.We collected data of clinical characteristics and ticagrelor adherence from these patients by reviewing the electronic medical records and personnel interview.Follow-up was performed at 6 and 12 months by telephone interview or office visits.Results A total of 155 patients with SCAD were enrolled,of whom 122 (78.7％) were males with a mean age (57.0 ± 10.0) years.Among them,50 (32.3％) patients have a history of myocardial infraction and 106 (68.4％) patients had angiographic confirmed left main and/or multivessel disease.Forty-six patients (29.7％) with SCAD prematurely stopped ticagrelor within 12 months,while 25 (16.1％) patients switched from ticagrelor to clopidogrel.Hemorrhagic events and locally unavailable ticagrelor were the major reasons causes of the premature discontinuation of ticagrelor.Univariate analysis showed age,body mass index (BMI),hypertention and locally unavailable ticagrelor as relative factors for early ticagrelor discontinuation after discharge.Multivariate analysis revealed unavailable drug locally (OR 0.25,95％ CI 0.09-0.69) and elderly patients (OR 4.13,95％ CI 1.40-12.19) were risk factors for low persientence or premature ticagrelor discontinuation.Conclusion This study showed poor ticagrelor adherence in patients with SCAD after discharge.Locally unavailable ticagrelor and elderly patients were strong predictors of poor ticagrelor adherence.Discontinuation to ticagrelor prematurely may not have impact on adverse cardiovascular outcomes.

Diabetes is the most important comorbidity of cardiovascular disease, and cardiovascular disease is the main cause of mortality and disability of patients with type 2 diabetes. In order to standardize the diagnosis and treatment of patients with diabetes and cardiovascular disease, the National Health Commission Capacity Building and Continuing Education Center organized the experts from the field of cardiology and endocrinology systematically reviewing the research progresses and expert experiences of relevant disciplines from home and abroad, and formulated this consensus. This consensus covers the diagnosis, drug treatment, and risk factor management for patients with diabetes and cardiovascular disease (including atherosclerotic cardiovascular disease and heart failure) from the perspective of cardiovascular disease and diabetes management aiming to strengthen the comprehensive management of patients and ultimately to improve the prognosis of patients. The management of cardiovascular diseases mainly includes the management of blood pressure, blood lipids, anti-thrombosis, anti-myocardial ischemia, anti-ventricular remodeling and so on. Diabetes management mainly includes lifestyle intervention (including diet, exercise, weight loss, etc.), anti-hyperglycemia therapy (including drugs and insulin), blood glucose monitoring, and hypoglycemic prevention. In addition, specific clinical recommendations are given to patients with special health care needs such as diabetic nephropathy, elderly (>75 years), and cardiovascular critical illness.

Objective To investigate the clinical treatment strategy of large and giant pituitary adenomas invading the cavernous sinus.Methods One hundred and nine patients with large and giant pituitary adenomas invading the cavernous sinus,admitted to our hospital from January 2010 to December 2018,were chosen in our study.Four patients with prolactin-type pituitary adenomas received oral treatment with bromocriptine;the remaining 105 patients received surgical treatment,and choices of surgical approach were based on classification of pituitary adenomas.The clinical data and efficacies of these patients accepted different treatment approach were retrospectively analyzed.Results Of the 105 patients with pituitary adenomas,63 (60％) were of type Ⅰ,15 (14.3％) were of type Ⅱ,18 (17.1％)were of type Ⅲ,and 9 (8.6％) were of type Ⅳ.Single extended transsphenoidal approach was used in 75 patients,transcranial approach was used in 26 patients,and combined extended transsphenoidal and transcranial approach was used in 4 patients.Gross total tumor resection was achieved in 86 patients,subtotal resection in 17 patients,and partial resection in two patients.Ten patients had new cranial nerve palsy after surgery,including 7 with oculomotor nerve palsy and three with abductor nerve palsy;two patients with preoperative neurological paralysis were aggravated,and both of them were oculomotor nerves;transient insipidus was noted in 19 patients and electrolyte disorder was noted in 23 patients;no permanent insipidus,cerebrospinal fluid leakage or intracranial infection,and no new or aggravated visual field vision disorder were noted.Conclusion Reasonable clinical treatment strategies and appropriate microsurgical approaches can achieve good therapeutic effect in patients with large and giant pituitary adenomas invading the cavernous sinus.

Objective:To analyze the effect of long-term care insurance on the incidence of falls in old people with disability, and the modification effect of different living arrangements.Methods:Based on the discharge diagnosis records of the hospitalization in urban residents who applied for long-term care insurance in Chengdu from July 2014 to June 2021, those who received long-term care insurance were selected as the intervention group and those who received no long-term care insurance were selected as the control group, the changes in the incidence of falls before and after the long-term care were analyzed using difference-in-differences method, and the modification effects of different living arrangements were explored using stratified analysis.Results:Long-term care insurance significantly reduced the risk for monthly incidence of falls in older adults [average treatment effects on treated (ATT) = -1.21% (95% CI: -1.82%--0.60%)], and the effect increased over time (ATT=-1.26%, 95% CI: -1.93%--0.59%). Long-term care insurance had a significant effect on reducing the incidence of falls in old people living with spouses/family members (ATT=-0.92%, 95% CI: -1.47%--0.37%) and in nursing facilities/hospitals (ATT=-2.10%, 95% CI: -3.81%--0.40%), but it had no significant effect in those living alone. Conclusions:Long-term care insurance can effectively reduce the incidence of falls in old people with disability, showing a positive effect. Living with family members or in nursing facilities/hospitals has a modification effect of the implementation of long-term care insurance policy. It is necessary to pay attention to key populations in the future and expand the coverage of long-term care insurance.

Conjunctival sac rinsing is one of the most common and important operations to prevent eye infections in ophthalmology department,as well as one of the major ophthalmic techniques to ensure the surgery successfully. This paper will report the creative design and clinical application of water collector for conjunctival sac rinsing,which can improve patients′ comfort,decrease the douche spillover and the time of conjunctival sac rinsing operation for nurses.

In the middle of December in 2019, a pneumonia outbreak caused by a new coronavirus, 2019 novel coronavirus (2019-nCoV), emerged in the populations in Wuhan city of China. The epidemic spreads rapidly and has been disseminated throughout the country and to 13 other counties in Asia, Europe, Oceania and North America. To accurately and deeply understand the biological characteristics, epidemiological features and pathogenicity of 2019-nCoV and related immunological characteristics, microbiological examinations and public protection measure, this study reviewed 2019-nCoV and 2019-nCoV pneumonia based on the newest relevant literatures and the newest version of National Diagnosis and Treatment Scheme of 2019-nCoV pneumonia.