OBJECTIVE To investigate the current status of etiological submission for hospitalized patients in hospi-tals of a city before the antimicrobial treatment so as to provide basis for the etiological submission.METHODS From Jan.2022 to Dec.2022,a questionnaire survey was conducted for the status of etiological submission before antimicrobial treatment in 32 secondary and tertiary medical institutions of Huaian by Huaian Nosocomial Infection Management Quality Control Center.RESULTS The data from 28 hospitals were analyzed.Less awareness of sub-mission of healthcare workers and incomplete items for etiological test were the major influencing factors for the etiological submission.85.71％(24)of the hospitals have embedded the common names of antimicrobial drugs in-to the medical order system,and only 42.86％of the hospitals had the prompts for etiological submission in the information systems.A great deal of hospitals failed to execute the etiological submission and capture time for use of antibiotics according to national standards,only 5 hospitals met the standards for the capture[executing by scanning on personal digital assistant(PDA)].The majority of the hospitals only carried out'microbial culture and drug susceptibility testing',and there was deficiency in the test items.The diagnosis-related etiological submission rate of the tertiary hospitals was(87.49±10.77)％,higher than(64.45±30.59)％of the secondary hospitals(t=-2.250,P=0.036).The etiological submission rate before the antimicrobial treatment and the etiological submis-sion rate before the combined use of key drugs were higher in the tertiary hospitals than in the secondary hospi-tals,and there were no significant differences.CONCLUSIONS The hospitals vary in degree of execution of etiolog-ical submission before the antimicrobial treatment,and the secondary hospitals achieve lower effect on manage-ment than the tertiary hospitals.It is necessary for the medical institutions to carry out the etiological submission scientifically according to the standards so as to facilitate the reasonable use of antibiotics.

OBJECTIVE To investigate the current status of etiological submission for hospitalized patients in hospi-tals of a city before the antimicrobial treatment so as to provide basis for the etiological submission.METHODS From Jan.2022 to Dec.2022,a questionnaire survey was conducted for the status of etiological submission before antimicrobial treatment in 32 secondary and tertiary medical institutions of Huaian by Huaian Nosocomial Infection Management Quality Control Center.RESULTS The data from 28 hospitals were analyzed.Less awareness of sub-mission of healthcare workers and incomplete items for etiological test were the major influencing factors for the etiological submission.85.71％(24)of the hospitals have embedded the common names of antimicrobial drugs in-to the medical order system,and only 42.86％of the hospitals had the prompts for etiological submission in the information systems.A great deal of hospitals failed to execute the etiological submission and capture time for use of antibiotics according to national standards,only 5 hospitals met the standards for the capture[executing by scanning on personal digital assistant(PDA)].The majority of the hospitals only carried out'microbial culture and drug susceptibility testing',and there was deficiency in the test items.The diagnosis-related etiological submission rate of the tertiary hospitals was(87.49±10.77)％,higher than(64.45±30.59)％of the secondary hospitals(t=-2.250,P=0.036).The etiological submission rate before the antimicrobial treatment and the etiological submis-sion rate before the combined use of key drugs were higher in the tertiary hospitals than in the secondary hospi-tals,and there were no significant differences.CONCLUSIONS The hospitals vary in degree of execution of etiolog-ical submission before the antimicrobial treatment,and the secondary hospitals achieve lower effect on manage-ment than the tertiary hospitals.It is necessary for the medical institutions to carry out the etiological submission scientifically according to the standards so as to facilitate the reasonable use of antibiotics.

In the various diseases of oral and maxillofacial system,the incidence of tissue defects is high and harmful,the reconstruction of the morphology and function is difficult,which seriously affects the physiological and mental health of the patients.Dental and maxillofacial regeneration based on stem cells and tissue engineering technology is a potential way for the treatment of dental and maxillofacial defects,and is also the focus of current international competition.Based on the possible mechanism of stem cells regulating organ development,this paper reviews the current status of dental and maxillofacial regeneration and translation,and proposes future direction in this field in order to pro-mote the sustainable development of dental and maxillofacial regeneration and translation.

Objective:To investigate the study on the diagnostic value of multimodal ultrasound technique for the lesion of extensor carpi ulnaris(ECU)tendon in patients with rheumatoid arthritis(RA).Methods:A total of 175 RA patients who were confirmed by the department of rheumatology of Yantaishan Hospital of Yantai city from December 2021 to January 2023 were selected,and them were included into the RA group.Other 50 patients without RA but with clinical symptoms of wrist were included into the non-RA group,and 50 healthy volunteers were included into the healthy control group.All subjects underwent routine ultrasound and shear wave elastography(SWE)examination on wrist,and then,the characteristics of ultrasound images of wrists and the blood flow distribution of ECU power Doppler ultrasonography(PDUS)were recorded.SWE was used to measure ECU to obtain elastic modulus index(EI)and velocity modulus index(VI).The differences between three groups were compared,and the receiver operating characteristic(ROC)value of RA patients were drawn,so as to confirm the area under curve(AUC)value and optimize cutoff value.Results:There were significant differences in EI and VI of the ECU tendon among three groups(F=61.15,61.28,P<0.05),respectively.The optimal cut-off values of EI and VI were respectively 319.35 kPa and 10.55 m/s in RA patients.In RA patients,age and disease course had significant influences on EI(r=0.19,0.21,P<0.05),and age,disease course,ultrasound score of wrist joint,and grade of power Doppler ultrasonography PDUS of the ECU tendon(ECUPDUS)had significant influences on VI(r=0.19,0.15,-0.16,-0.17,P<0.05).Conclusion:SWE is able to quantitatively and non-invasively assess the stiffness information of the ECU tendon in RA patients.After the supplement of gray-scale ultrasound and PDUS,multimodal ultrasound technique can clearly judge the correlation of the lesions of ECU tendon of RA patients.

Objective:To document the impact of information-based, stepwise, intensive rehabilitation therapy on patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods:Eighty such patients in an intensive care unit (ICU) were randomly divided into a control group and an observation group, each of 40. The control group received routine ICU rehabilitation, while the observation group underwent information-based, step-wise ICU rehabilitation. Upon admission to and discharge from the ICU, the forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, and diaphragm functioning were compared between the two groups. The duration of mechanical ventilation, the incidence of ventilator-associated pneumonia (VAP), length of stay in the ICU, incidence of delirium, and the incidence of deep vein thrombosis (DVT) were also recorded. The number of patients readmitted to the ICU after discharge, and the 28-day hospital mortality rate were recorded as well.Results:Significant improvement was observed in both groups in terms of their lung and diaphragm functioning, as well as in the rehabilitation- and hospital-related indicators. At discharge, significantly greater improvements were observed in the observation group compared with the control group in terms of their average FEV1, FVC, FEV1/FVC, inspiratory and expiratory diaphragm thickness, and diaphragm thickening rate. The average duration of mechanical ventilation and of rehabilitation interruptions was significantly less in the observation group. And incidents of accidental extubation, VAP, delirium and DVT were significantly fewer in the observation group as well. Their ICU stays tended to be significantly shorter without any significant difference between the two groups in the 28-day hospital mortality rate. The control group spent significantly less time in their daily rehabilitation sessions, with the result that significantly fewer of them achieved a grading of 2 or better on the mMRC respiratory questionnaire.Conclusion:Information-based stepwise intensive rehabilitation treatment can effectively improve the pulmonary and diaphragmatic function of AECOPD patients admitted to an ICU, shorten their mechanical ventilation time and the length of their ICU stay, and lower their incidence of VAP and DVT during hospitalization.

Objective:To investigate the impact of human epidermal growth factor receptor 2 (HER2) and C-reactive protein/albumin ratio (CAR) on the long-term survival of gastric cancer patients after surgery.Methods:A retrospective analysis was conducted on 136 gastric cancer patients admitted to Lishui Central Hospital from January 2015 to December 2017, who underwent radical surgery and were followed up for 5 years. Patients were divided into HER2 positive and HER2 negative groups based on HER2 immunohistochemical results, and into high CAR and low CAR groups based on the CAR mean value. The relationship between HER2 and CAR with clinicopathological characteristics of gastric cancer patients was analyzed. The postoperative tumor-free survival rate and overall survival rate were compared between the two groups of patients (HER2 positive group and HER2 negative group, as well as high CAR group and low CAR group). Cox regression analysis was used to identify independent prognostic factors for postoperative tumor recurrence, metastasis, and death in gastric cancer patients.Results:The proportion of HER2 positive patients with large tumor size, low differentiation, T 3-4 tumor invasion depth, lymph node metastasis, and vascular invasion was significantly higher than that of HER2 negative patients (all P<0.05). The proportion of high CAR patients with large tumor size, low differentiation, T 3-4 tumor invasion depth, lymph node metastasis, and vascular invasion was significantly higher than that of low CAR patients (all P<0.05). Kaplan-Meier survival analysis showed that HER2 negative patients had significantly higher 1-year, 3-year, and 5-year cumulative tumor-free survival rate and overall survival rate than HER2 positive patients, while low CAR patients had significantly higher 1-year, 3-year, and 5-year cumulative tumor-free survival rate and overall survival rate than high CAR patients (all P<0.05). Multivariate Cox regression analysis identified T 3-4 tumor invasion depth, lymph node metastasis, HER2 positivity, and high CAR expression as independent prognostic factors for postoperative tumor recurrence, metastasis, and death in gastric cancer patients (all P<0.05). HER2 positive gastric cancer patients had a 1.895-fold higher risk of postoperative tumor recurrence and metastasis than HER2 negative patients ( HR: 1.895, 95% CI: 1.245-4.229, P=0.034), while high CAR gastric cancer patients had a 1.769-fold higher risk of postoperative tumor recurrence and metastasis than low CAR patients ( HR: 1.769, 95% CI: 1.433-3.959, P=0.039). HER2 positive gastric cancer patients had a 2.145-fold higher risk of postoperative death than HER2 negative patients ( HR: 2.145, 95% CI: 1.378-4.589, P=0.028), while high CAR gastric cancer patients had a 1.926-fold higher risk of postoperative death than low CAR patients ( HR: 1.926, 95% CI: 1.564-3.853, P=0.025). Conclusions:HER2 and CAR are independent prognostic factors for postoperative tumor recurrence, metastasis, and death in gastric cancer patients. Gastric cancer patients with HER2 positivity and high CAR have a higher risk of postoperative tumor recurrence, metastasis, and death. This study has some limitations due to its small sample size and single-center design, which may introduce some bias. Future multicenter and large-scale studies are needed to confirm the results of this study.

Objective To investigate the role of histone deacetylase 6(HDAC6)in podocyte injury in diabetic kidney disease(DKD)in mice.Methods 1)The 8-week-old male CD-1 mice were selected to construct the model of DKD with streptozocin(STZ).After the model was established,the mice were intraperitoneally injected with HDAC6 inhibitor CAY10603(5mg/kg/daily)or same volume vehicle as control.The mice were divided into four groups,control(CTL)+vehicle(Veh)(n=5),CLT+CAY10603(n=3),STZ+Veh(n=9),and STZ+CAY10603(n=7).Mice in STZ+Veh and STZ+CAY10603 groups developed DKD,while mice in the CTL+Veh and CTL+CAY10603 groups were served as normal controls.The therapeutic effect was evaluated through urine albumin-to-creatinine ratio(uACR)and renal pathology after the 2-week treatment with CAY10603.2)Human podocytes were cultured in vitro and were divided into four groups as follows:CTL,transforming growth factor-β(TGFβ),TGFβ+CAY10603(250 nmol/L),and TGFβ+CAY10603(500 nmol/L)groups.The control group did not receive any treatment,the last three groups were given 36-h TGFβtreatment at 5 ng/μL,with or without CAY10603 as indicated for an additional 12 h.Western blot was performed to determine the inhibitory effect of CAY10603 on NLRP3 inflammasome.3)HDAC6 knockout(KO)mice were generated and used to create STZ-induced model of DKD.The mice were divided into four groups:C57BL/6J wild type(WT)(n=6),HDAC6 KO(n=6),WT+STZ(n=10),and HDAC6 KO+STZ(n=9).Samples were collected 16 weeks after successful modeling and changes in uACR and renal pathology were evaluated accordingly.Results After 2 weeks of treatment,mice in the STZ+CAY10603 group exhibited reduction in uACR(P＜0.05)and inhibition of glomerular mesangium expansion(P＜0.05)compared with those of the mice in the STZ+Veh group.There was no statistically significant difference in the indicators between the CTL+Veh group and the CTL+CAY10603 group.In vitro cultured podocytes,compared with the control group,NLRP3 inflammasome activation was seen in the TGFβ group.CAY10603 treatment significantly inhibited the activation of NLRP3 in the dosage-dependent manner(P＜0.05).Compared with those of the WT group,the WT+STZ group showed increased uACR(P＜0.05),obvious glomerulosclerosis and loss of podocytes numbers.Compared with those of the WT+STZ group,the HDAC6 KO+STZ group showed effectively reduction of uACR(P＜0.05)and improvement in the renal pathological changes in mice.There was no significant difference in these aspects between the WT and HDAC6 KO groups.Conclusion Inhibition of HDAC6 alleviates proteinuria and podocyte injury in the mouse model of DKD by suppressing the activation of NLRP3 inflammasome.

Objective:To evaluate the correlation between elevated cTnI level and 28-day mortality after liver transplantation.Methods:A retrospective study was conducted in adult patients admitted to ICU after liver transplantation from Jun 2015 to March 2019 at Beijing Chao-Yang Hospital. The cardiac troponin Ⅰ levels within 48 h after surgery were examined. Patients outcome was followed up,the primary end point was mortality within 28-day. Univariate and multivariate logistic regression models were used to look for predictors of 28-day mortality.Results:Three hundred and eighteen patients were included in our analyses. Twenty-six patients died and 292 survived within 28 days after LT. Two hundred and forty-three of 318 (76.4%) cases presented elevated cTnI in the early stage after LT. Thirty-seven of 318 (11.6%) patients presented a moderate elevation of cTnI level (5-10 times over normal upper limit), 75 (23.6%) of them presented severe cTnI elevation (10 times over normal upper limit). Univariate and multivariate logistic regression model shows severe cTnI elevation was the independent prognostic factors associated with 28-day mortality [Odds Ratio (95% confidence interval)=3.151(1.218-8.150), P=0.018]. Conclusion:Early cTnI elevation is common after liver transplantation, and severe cTnI elevation is significantly associated with 28-day mortality.

Objective:To analyze the application of Cho peak value and color doppler ultrasound blood flow score in the early diagnosis of breast cancer, and to evaluate the relationship between Cho peak value, blood flow score, TNM stage and prognosis quality.Methods:A total of 82 patients with breast cyst admitted from Jan. 2015 and Dec. 2019 were selected as subjects for the study. ROC curve was used to compare the ability of color doppler flow score and functional magnetic resonance imaging (fmri) in the diagnosis of breast cancer when used alone or in combination. Logistic regression model was used to analyze the factors affecting the prognosis quality and TNM staging of patients.Results:The breast cancer group’s Cho value and blood flow signal score were significantly higher than the benign breast lesion group, and the difference was statistically significant (Cho value: t=43.977, P<0.001; blood flow signal score: t=22.071, P<0.001) ; The sensitivity, specificity and AUC of MRS combined with Doppler ultrasound for differential diagnosis of breast cancer are significantly higher than MRS or Doppler ultrasound alone, and the difference was statistically significant (sensitivity: χ2=4.514, P=0.016; specificity: χ2=4.858, P=0.013; AUC: Z=5.251, P<0.001) ; Cho value of patients with good prognosis group ( t=3.984, P<0.001) and blood flow signal score ( t=4.213, P<0.001) were significantly lower than those in the poor prognosis group; Cho value ( t=3.612, P<0.001) and blood flow signal score ( t=3.835, P<0.001) of TNM stage 0-Ⅱ patients were significantly lower than those of stage Ⅲ-Ⅳ group, the difference was statistically significant; the Cho value of the MRS scan and the patient’s prognosis quality ( OR=1.837, 95% CI=1.210-2.788, P=0.004) and TNM stage ( OR=1.818, 95% CI=1.224~2.702, P=0.003) was significantly positively correlated. The blood flow signal and the patient’s prognostic quality ( OR=1.906, 95% CI=1.105~3.287, P=0.020) and TNM stages ( OR=1.799, 95% CI=1.232-2.626, P=0.002) also showed a significantly positive correlation. Conclusion:The combination of Cho peak value and color doppler ultrasound blood flow score can significantly improve the early diagnosis efficiency of breast cancer, and Cho peak value and blood flow score are independent factors affecting TNM staging and prognosis.

Objective: To evaluate the clinical characteristics and diagnostic strategies of early hydatidiform mole. Methods: A retrospective cohort study was conducted of 526 women with hydatidiform mole who underwent suction curettage and were confirmed by histopathology in Dalian Maternal and ChildHealth Care Hospital from Feb. 2013 to Feb. 2018, including 484 women with gestational age less than or equal to 12 weeks (the early group) and 42 women with gestational age greater than 12 weeks (the late group). The clinical characteristics between the two groups were compared, and the pathological diagnosis and pre-evacuation ultrasound examination of the early group were further discussed. Results: Compared with the late group, the clinical characteristics of the early group tended to be atypical, and the incidence of vaginal bleeding, excessive uterine size, theca lutein cysts (>6 cm) and pregnancy complications decreased significantly (all P<0.05). The serum level of β-hCG in the early group was significantly lower than that in the late group (Z=-2.382, P=0.017). While there was no significant difference in the pre-evacuation ultrasound detection rate between the two groups (53.5% vs 66.7%; χ²=2.697, P=0.101). Five hundred and fifteen patients completed the follow-up, and 38 patients with post-mole neoplasia were all cured. There was no significant difference in the malignant transformation rate of hydatidiform mole between the two groups (7.0% vs 11.9%; χ²=0.745, P=0.388). In the early group, 302 cases of complete hydatidiform mole (CHM), 179 cases of partial hydatidiform mole (PHM) and 3 cases of unclassified hydatidiform mole (UHM) were histologically diagnosed, according to pathological morphology combined with p57^KIP2 immunohistochemical staining. Compared with pathological diagnosis, the overall pre-evacuation ultrasound detection rate in the early hydatidiform mole was 53.5% (259/484), which was significantly better for complete (78.1%, 236/302) versus partial (11.7%, 21/179) hydatidiform moles (χ²=199.224, P<0.01). There was significantly weak negative correlation between the overall ultrasound detection rate and gestational age of hydatidiform mole (r=-0.211, P<0.01). The gestational age of early PHM was significantly longer than that of CHM (68.0 vs 58.5 days; Z=-8.048, P<0.01). Conclusions The clinical presentations of early hydatidiform mole are not typical. Although ultrasound examination identifies only about half of hydatidiform moles, ultrasonography is still an important auxiliary examination method. Morphological examination combined with p57^KIP2 immunohistochemical staining could effectively diagnose early hydatidiform mole, so as to reduce the missed diagnosis of hydatidiform mole.