Objective: To investigate the current status of benefit finding among young and middle-aged patients with type 2 diabetes mellitus (T2DM) and analyze its influencing factors, so as to provide a reference for improving the level of benefit finding in this population. Methods: From November 2022 to May 2023, young and middle-aged patients with T2DM aged 18-59 years hospitalized in the endocrinology departments of 2 tertiary hospitals in Hengyang City, Hunan Province were selected as survey subjects by a convenience sampling method. Basic demographic information was collected using a general questionnaire survey. Benefit finding, resourcefulness, and stigma were evaluated using the Benefit Finding Scale, the Chinese Version of the Resourcefulness Scale, and the Type 2 Diabetes Stigma Assessment Scale, respectively. A multiple linear regression model was used to analyze the influencing factors of benefit finding among young and middle-aged patients with T2DM. Results: A total of 305 young and middle-aged patients with T2DM were investigated, including 222 males (72.79%) and 83 females (27.21%). There were 231 cases aged 45-59 years, accounting for 75.74%. The scores for benefit finding, resourcefulness, and stigma were (42.86±6.06), (75.12±11.30), and (41.20±10.10), respectively. Multiple linear regression analysis showed that young and middle-aged patients with T2DM who were male (β′=0.088), aged 18-<45 years (β′=0.083), absence of diabetes complications (β′=0.124), and had higher resourcefulness scores (β′=0.679) had higher levels of benefit finding, while patients with higher stigma scores (β′=-0.097) had lower levels of benefit finding. Conclusion The level of benefit finding among young and middle-aged patients with T2DM was moderate, and was related to gender, age, diabetes complications, resourcefulness, and stigma.

Objective The aim of this study was to investigate the microbiological characteristics and antimicrobial resistance of Nocardia isolates in Hebei Province during the 9-year period.Methods The medical records of all hospitalized patients from whom Nocardia was isolated from 2015 to 2023 were analyzed retrospectively.The isolates were identified to the species level by amplification and sequencing of 16S rRNA,secA1 and ropB genes of Nocardia.Antimicrobial susceptibility of Nocardia isolates were tested by microbroth dilution method.Results Of the 162 strains of Nocardia,128(79.0％)were isolated from respiratory tract specimens,followed by skin and soft tissue infection(25/162,15.4％).Most of the patients with respiratory tract infection were elderly(＞65 years old).Most of the patients with skin and soft tissue infection were middle-aged and elderly(＞45 years old).Twelve species were identified among the 162 isolates.The most common species were N.cyriacigeorgica(36.4％,59/162),N.farcinica(25.3％,41/162),and N.otitidiscaviarum(9.9％,16/162).The most common Nocardia species isolated from the respiratory tract was N.cyriacigeorgica,followed by N.farcinica.The most common species causing skin and soft tissue infection were N.cyriacigeorgica,N.farcinica and N.brasiliensis.All Nocardia strains were susceptible to linezolid,followed by 98.8％susceptible to amikacin and 98.1％susceptible to trimethoprim-sulfamethoxazole(TMP-SMZ).Conclusions Nocardia is mainly isolated from respiratory tract,skin and soft tissues.N.cyriacigeorgica and N.farcinica are the most prevalent species.TMP-SMZ is the first choice for treatment of nocardiosis.Combination therapy may be appropriate for moderate and severe infections according to the results of antimicrobial susceptibility testing.

Objective The aim of this study was to investigate the microbiological characteristics and antimicrobial resistance of Nocardia isolates in Hebei Province during the 9-year period.Methods The medical records of all hospitalized patients from whom Nocardia was isolated from 2015 to 2023 were analyzed retrospectively.The isolates were identified to the species level by amplification and sequencing of 16S rRNA,secA1 and ropB genes of Nocardia.Antimicrobial susceptibility of Nocardia isolates were tested by microbroth dilution method.Results Of the 162 strains of Nocardia,128(79.0％)were isolated from respiratory tract specimens,followed by skin and soft tissue infection(25/162,15.4％).Most of the patients with respiratory tract infection were elderly(＞65 years old).Most of the patients with skin and soft tissue infection were middle-aged and elderly(＞45 years old).Twelve species were identified among the 162 isolates.The most common species were N.cyriacigeorgica(36.4％,59/162),N.farcinica(25.3％,41/162),and N.otitidiscaviarum(9.9％,16/162).The most common Nocardia species isolated from the respiratory tract was N.cyriacigeorgica,followed by N.farcinica.The most common species causing skin and soft tissue infection were N.cyriacigeorgica,N.farcinica and N.brasiliensis.All Nocardia strains were susceptible to linezolid,followed by 98.8％susceptible to amikacin and 98.1％susceptible to trimethoprim-sulfamethoxazole(TMP-SMZ).Conclusions Nocardia is mainly isolated from respiratory tract,skin and soft tissues.N.cyriacigeorgica and N.farcinica are the most prevalent species.TMP-SMZ is the first choice for treatment of nocardiosis.Combination therapy may be appropriate for moderate and severe infections according to the results of antimicrobial susceptibility testing.

Summary of nursing experience was conducted in a case of emergency liver transplantation during the second trimester of pregnancy complicated by acute liver failure.The key nursing points are as follows:preoperative participation in multidisciplinary discussions and emergency plan desktop exercises;preparation of preoperative equipment and supplies.Intraoperative fetal protection at critical stages,prevention and management of hyperkalemia,correction of coagulation function,maintenance of circulatory stability,implementing anticipatory surgical coordination to curtail operative duration,and prevention of perioperative hypothermia under a proactive nursing model.Through multidisciplinary team collaboration and meticulous nursing care,the patient recovered well 8 days postoperatively and successfully delivered a female infant via cesarean section.The patient was transferred back to the general ward 8 days after the cesarean section and was discharged 47 days postoperatively.Follow-up for over 2 months showed good recovery for both the patient and the infant.

Objective:To analyze the etiological characteristics, serotype distribution, drug resistance and molecular typing characteristics based on data collected by active surveillance of foodborne diseases in Shanxi Province from 2021 to 2022.Methods:Fecal and anal swabs for foodborne disease tests were collected from 17 sentinel hospitals in Shanxi Province from 2021 to 2022. The pathogens included Shigella, Salmonella, Vibrio parahaemolyticus and 5 types of diarrheagenic Escherichia coli ( E. coli). The positive strains were identified by mass spectrometry or systematic biochemistry. Salmonella and Shigella were serotyped by slide agglutination, and diarrheagenic E. coli was typed by multiplex fluorescence PCR. Vibrio parahaemolyticus was tested for tlh/ tdh/ trh virulence genes by multiplex fluorescent PCR. All strains were also tested for drug resistance by the microbroth dilution method. Molecular typing was performed by pulsed-field gel electrophoresis (PFGE). Results:A total of 4 481 samples were collected from patients with diarrhea, and 555 target strains were detected, with a detection rate of 12.39%(555/4 481). Among them, there were 365 strains of Salmonella, 175 strains of diarrheagenic E. coli, 15 strains of Vibrio parahaemolyticus, and no Shigella. There were 32 serotypes of Salmonella, and the dominant serotypes were 158 strains of Salmonella senteritidis and 124 strains of Salmonella typhimurium. diarrheagenic E. coli classification: 79 strains of enteroaggregative E. coli, 72 strains of enteropathogenic E. coli, 23 strains of enterotoxic E. coli, 1 strain of enterohemorrhagic E. coli, and none of enteroinvasive E. coli. For Vibrio parahaemolyticus virulence gene carriage, all strains carried tlh; 11 strains (73.33%, 11/15) carried tdh only; 2 strains (13.33%, 2/15) carried trh; 1 strain (6.67%, 1/15) carried both tdh and trh genes; 1 strain (6.67%, 1/15) did not carry these two virulence genes. Antimicrobial resistance tests presented that Salmonella had the highest resistance rate to ampicillin (85.21%, 311/365), followed by naphridic acid (66.58%, 243/365), and multi-drug resistance (78.63%, 287/365), resulting in 135 drug resistance spectrums. The resistance rate of diarrheagenic E. coli to ampicillin was the highest (81.71%, 143/175), followed by tetracycline (67.43%, 118/175), and multi-drug resistance (72.57%, 127/175), resulting in 81 drug resistance spectrums. Vibrio parahaemolyticus had the highest resistance rate to cefazolin (93.33%, 14/15), followed by tetracycline (26.67%, 4/15) and multi-drug resistance (20.00%, 3/15), resulting in 3 drug resistance spectrums. A total of 158 strains of Salmonella enteritidi, 124 strains of Salmonella typhimurium, 13 strains of Salmonella london and 175 strains of DEC were typed by PFGE. Among 470 strains of PFGE typing, 6 strains of DEC were degraded by DNA, while the remaining strains obtained effective PFGE band. Salmonella enteritidi were divided into 64 PFGE band types, Salmonella typhimurium were divided into 115 PFGE band types, Salmonella london were divided into 13 PFGE band types and diarrheagenic E. coli were divided into 165 PFGE band types. Conclusions:Shigella is not detected in the active surveillance, and Salmonella is detected most frequently. Salmonella and diarrheagenic E. coli have the highest resistance rates to ampicillin, and Vibrio parahaemolyticus has the highest resistance rates to cefazolin. The PFGE classification is polymorphic, and the dominant band type is not obvious. The evidence of multi-drug resistance suggests further strengthening monitoring and management of drug resistance.

Summary of nursing experience was conducted in a case of emergency liver transplantation during the second trimester of pregnancy complicated by acute liver failure.The key nursing points are as follows:preoperative participation in multidisciplinary discussions and emergency plan desktop exercises;preparation of preoperative equipment and supplies.Intraoperative fetal protection at critical stages,prevention and management of hyperkalemia,correction of coagulation function,maintenance of circulatory stability,implementing anticipatory surgical coordination to curtail operative duration,and prevention of perioperative hypothermia under a proactive nursing model.Through multidisciplinary team collaboration and meticulous nursing care,the patient recovered well 8 days postoperatively and successfully delivered a female infant via cesarean section.The patient was transferred back to the general ward 8 days after the cesarean section and was discharged 47 days postoperatively.Follow-up for over 2 months showed good recovery for both the patient and the infant.

Objective:To analyze the etiological characteristics, serotype distribution, drug resistance and molecular typing characteristics based on data collected by active surveillance of foodborne diseases in Shanxi Province from 2021 to 2022.Methods:Fecal and anal swabs for foodborne disease tests were collected from 17 sentinel hospitals in Shanxi Province from 2021 to 2022. The pathogens included Shigella, Salmonella, Vibrio parahaemolyticus and 5 types of diarrheagenic Escherichia coli ( E. coli). The positive strains were identified by mass spectrometry or systematic biochemistry. Salmonella and Shigella were serotyped by slide agglutination, and diarrheagenic E. coli was typed by multiplex fluorescence PCR. Vibrio parahaemolyticus was tested for tlh/ tdh/ trh virulence genes by multiplex fluorescent PCR. All strains were also tested for drug resistance by the microbroth dilution method. Molecular typing was performed by pulsed-field gel electrophoresis (PFGE). Results:A total of 4 481 samples were collected from patients with diarrhea, and 555 target strains were detected, with a detection rate of 12.39%(555/4 481). Among them, there were 365 strains of Salmonella, 175 strains of diarrheagenic E. coli, 15 strains of Vibrio parahaemolyticus, and no Shigella. There were 32 serotypes of Salmonella, and the dominant serotypes were 158 strains of Salmonella senteritidis and 124 strains of Salmonella typhimurium. diarrheagenic E. coli classification: 79 strains of enteroaggregative E. coli, 72 strains of enteropathogenic E. coli, 23 strains of enterotoxic E. coli, 1 strain of enterohemorrhagic E. coli, and none of enteroinvasive E. coli. For Vibrio parahaemolyticus virulence gene carriage, all strains carried tlh; 11 strains (73.33%, 11/15) carried tdh only; 2 strains (13.33%, 2/15) carried trh; 1 strain (6.67%, 1/15) carried both tdh and trh genes; 1 strain (6.67%, 1/15) did not carry these two virulence genes. Antimicrobial resistance tests presented that Salmonella had the highest resistance rate to ampicillin (85.21%, 311/365), followed by naphridic acid (66.58%, 243/365), and multi-drug resistance (78.63%, 287/365), resulting in 135 drug resistance spectrums. The resistance rate of diarrheagenic E. coli to ampicillin was the highest (81.71%, 143/175), followed by tetracycline (67.43%, 118/175), and multi-drug resistance (72.57%, 127/175), resulting in 81 drug resistance spectrums. Vibrio parahaemolyticus had the highest resistance rate to cefazolin (93.33%, 14/15), followed by tetracycline (26.67%, 4/15) and multi-drug resistance (20.00%, 3/15), resulting in 3 drug resistance spectrums. A total of 158 strains of Salmonella enteritidi, 124 strains of Salmonella typhimurium, 13 strains of Salmonella london and 175 strains of DEC were typed by PFGE. Among 470 strains of PFGE typing, 6 strains of DEC were degraded by DNA, while the remaining strains obtained effective PFGE band. Salmonella enteritidi were divided into 64 PFGE band types, Salmonella typhimurium were divided into 115 PFGE band types, Salmonella london were divided into 13 PFGE band types and diarrheagenic E. coli were divided into 165 PFGE band types. Conclusions:Shigella is not detected in the active surveillance, and Salmonella is detected most frequently. Salmonella and diarrheagenic E. coli have the highest resistance rates to ampicillin, and Vibrio parahaemolyticus has the highest resistance rates to cefazolin. The PFGE classification is polymorphic, and the dominant band type is not obvious. The evidence of multi-drug resistance suggests further strengthening monitoring and management of drug resistance.

Objective:To investigate the efficacy of the intelligent version of the Montreal Cognitive Assessment Scale(MoCA)in identifying mild cognitive impairment(MCI)in elderly inpatients.Methods:Seventy-five patients diagnosed with mild cognitive impairment(MCI group)from the Neurology and Geriatrics Departments of a tertiary hospital in Changsha City, along with 195 patients with normal cognitive function(normal control group), were selected between July 2020 and December 2022.Both groups underwent evaluations using the intelligent version of the Montreal Cognitive Assessment(MoCA)and the Mini Mental State Examination(MMSE), and the results were analyzed.Results:The MCI group showed significantly lower total MoCA scores and MMSE scores[(19.73±2.42) vs.(24.8±2.33)]compared to the normal control group[(24.47±2.02) vs.(26.50±1.65)], with a statistically significant difference( P<0.01).The optimal cut-off score for the MoCA was found to be 23.5 points in diagnosing MCI, showing higher sensitivity, specificity, and kappa value(96.0%, 82.1%, and 0.690)compared to the MMSE scale(90.0%, 62.6%, and 0.428). Conclusions:The intelligent MoCA has a high screening accuracy for identifying MCI in this population, demonstrating superior sensitivity and specificity compared to the MMSE.

Objective To address the challenges of poor performance and lack of interpretability in existing models,the SHAP algorithm is used to develop an interpretable machine learning model that offers a novel approach to wound age estimation,Methods Based on the previous discovery of the expression of 35 wound age healing-related genes in contused skeletal muscle,the woun age estimaton model was constructed using four algorithms,namly,Multilayer Perceptron(MLP),Random Forest(RF),LightGBM(LGBM),and Support Vector Machine(SVM).The SHAP(Shapley Additive Explanation)algorithm was used to rank the importance of genetic features,eliminate redundant attributes,and optimize the model for accurate wound age estimation.the genetic features of the optimal model were analyzed using SHAP's local interpretation capabilities.Results The best results were obtained using model of MLP(area under the curve(AUC)=0.99)The wound ages were classified into four categories:4～12 h,16～24 h,28～36 h,and 40～48 h,using only 15 gene features.According to SHAP analysis,Fam210a was identified as the most relevant gene.Local analysis revealed that high expression of Fam210a contributed to an increase in the predicted probability of 4 h～12 h,while high expression of Rae1 contributed to an increase in the predicted probability of 16 h～24 h.Additionally,low expression of Tbx18 contributed to an increase in the predicted probability of 28 h～36 h,whereas high expression of Tbx18 contributed to an increase in the predicted probability of 40 h～48 h.Conclusions The combined MLP and SHAP model can be used to predict wound age.Using the SHAP interpreter can better understand the degree of contribution of feature genes to the model prediction,and lay the foundation for further in-depth study of wound age estimation.

Objective:To understand the current situation of early mobilization in elder patients with acute ischemic stroke, and to analyze the influencing factors of early mobilization in patients with different degrees of neurological deficits, aiming to provide evidence for promoting early mobilization in patients with stroke and for formulating intervention strategies.Methods:Patients with acute ischemic stroke admitted to the stroke centers of two class A tertiary hospitals in Hunan Province between January and December 2021 were enrolled.The degree of neurological impairment, activities of daily living and muscle strength were evaluated within 24 hours after admission, and patients' performance of early mobilization was recorded.Based on whether patients performed out-of-bed activities such as sitting at the bedside, standing or walking, transferring from bed to chair within 48 hours after admission, they were divided into an early ambulation group and a non-early ambulation group.Univariate analysis and Logistic regression analysis were then used to examine the influencing factors of early ambulation in patients with mild to moderate neurological deficits.Results:Among 257 patients with acute ischemic stroke, 60.7%(156 cases)conducted early mobilization.The rate of early mobilization for patients with moderate neurological deficits was only 12.9%(12/193), significantly lower than that for patients with mild neurological deficits(87.8%, 144/164)( χ2=139.571, P<0.001).Univariate analysis showed that there were significantly differences in the level of activities of daily living, stroke history, strength of the upper and lower limbs of the affected side between the early and non-early ambulation groups with moderate neurological impairment(all P<0.05), and there were significant differences in the level of activities of daily living between the early ambulation group and the non-early ambulation group in patients with mild neurological impairment( χ2=11.907, P<0.001).Logistic regression analysis showed that requiring assistance in daily life( OR=4.189, 95% CI: 1.724-10.668, P=0.002), muscle strength of the affected lower extremity ≤ grade 3( OR=9.605, 95% CI: 2.627-35.113, P=0.001)and moderate neurological deficits( OR=8.585, 95% CI: 3.216-22.913, P<0.001)were the risk factors of early mobilization in stroke patients. Conclusions:The rate of stroke patients with moderate neurological impairment performing early mobilization is low within 48 hours after admission.Activities of daily living ability, limb muscle strength and degrees of neurological deficits are influencing factors of early mobilization in stroke patients.