The " no-accompany" service is an important measure to meet the patients′ needs for comprehensive, continuous, and high-quality diversified care and to enhance their medical experience. Starting in March 2024, the Second Affiliated Hospital of Zhejiang University School of Medicine launched a pilot " no-accompany" service in the breast surgery and dermatology wards. The hospital established a working team led by the nursing department and involving multiple administrative departments such as the medical affairs department, medical insurance office, and logistics management department. And the hospital has successfully advanced the implementation of the " no-accompany" ward program by establishing a multi-department collaborative management mechanism, standardizing the management of medical caregivers, developing a tiered fee scheme for the " no-accompany" service, and improving relevant service measures. The acceptance of the " no-accompany" service by patients increased from (3.93±0.83) in the second quarter of 2024 to (4.69±0.59) in the fourth quarter, and overall satisfaction rose from (4.18±0.73) to (4.50±0.54) (all P<0.001). The job competency of medical caregivers also improved significantly from (64.80±3.49) before starting work in March 2024 to (94.00±2.40) in the fourth quarter ( P<0.001). These findings provide a reference for the implementation of " no-accompany" services in public hospitals.

Objective To investigate the current status and barriers to implementing non-accompanied care services in medical institutions in Zhejiang Province,and to provide a basis for the improvement of standardized management of such services.Methods A self-designed questionnaire was conducted from September to October 2024 among all secondary and tertiary medical institutions in Zhejiang Province to assess the implementation status and barriers to non-accompanied care services.Results A total of 397 questionnaires were distributed,with 389 valid responses,yielding a valid response rate of 97.98％.Non-accompanied care services were implemented in 118 institutions(30.33％).Among these,90 institutions(76.27％)had established management systems for non-accompanied wards;71 institutions(60.17％)had a medical nursing assistant-to-bed ratio lower than 1∶5;41 institu-tions(34.75％)provided tiered training for medical nursing assistants;93 institutions(78.81％)required patients to bear the full cost of the service.Compared with secondary medical institutions,tertiary medical institutions have more complete management system for non-accompanied care services.The main obstacles hindering the development of non-accompanied care services include an imperfect management system for non-accompanied wards,a shortage of medical nursing assistants,a lack of standardized training for such assistants,inconsistent charging standards,and low acceptance among patients and their families.Conclusion The promotion of non-accompanied care services in medical institutions in Zhejiang Province has achieved initial success.However,challenges persist,including incomplete management systems,uneven development across hospital tiers,and imperfect charging mechanisms.It is recommended that relevant authorities strengthen policy support,enhance standardized training for healthcare nursing assistants,refine cost-sharing mechanisms,and improve the quality and sustainability of non-accompanied care services through multi-party collaboration.

The " no-accompany" service is an important measure to meet the patients′ needs for comprehensive, continuous, and high-quality diversified care and to enhance their medical experience. Starting in March 2024, the Second Affiliated Hospital of Zhejiang University School of Medicine launched a pilot " no-accompany" service in the breast surgery and dermatology wards. The hospital established a working team led by the nursing department and involving multiple administrative departments such as the medical affairs department, medical insurance office, and logistics management department. And the hospital has successfully advanced the implementation of the " no-accompany" ward program by establishing a multi-department collaborative management mechanism, standardizing the management of medical caregivers, developing a tiered fee scheme for the " no-accompany" service, and improving relevant service measures. The acceptance of the " no-accompany" service by patients increased from (3.93±0.83) in the second quarter of 2024 to (4.69±0.59) in the fourth quarter, and overall satisfaction rose from (4.18±0.73) to (4.50±0.54) (all P<0.001). The job competency of medical caregivers also improved significantly from (64.80±3.49) before starting work in March 2024 to (94.00±2.40) in the fourth quarter ( P<0.001). These findings provide a reference for the implementation of " no-accompany" services in public hospitals.

Objective To investigate the current status and barriers to implementing non-accompanied care services in medical institutions in Zhejiang Province,and to provide a basis for the improvement of standardized management of such services.Methods A self-designed questionnaire was conducted from September to October 2024 among all secondary and tertiary medical institutions in Zhejiang Province to assess the implementation status and barriers to non-accompanied care services.Results A total of 397 questionnaires were distributed,with 389 valid responses,yielding a valid response rate of 97.98％.Non-accompanied care services were implemented in 118 institutions(30.33％).Among these,90 institutions(76.27％)had established management systems for non-accompanied wards;71 institutions(60.17％)had a medical nursing assistant-to-bed ratio lower than 1∶5;41 institu-tions(34.75％)provided tiered training for medical nursing assistants;93 institutions(78.81％)required patients to bear the full cost of the service.Compared with secondary medical institutions,tertiary medical institutions have more complete management system for non-accompanied care services.The main obstacles hindering the development of non-accompanied care services include an imperfect management system for non-accompanied wards,a shortage of medical nursing assistants,a lack of standardized training for such assistants,inconsistent charging standards,and low acceptance among patients and their families.Conclusion The promotion of non-accompanied care services in medical institutions in Zhejiang Province has achieved initial success.However,challenges persist,including incomplete management systems,uneven development across hospital tiers,and imperfect charging mechanisms.It is recommended that relevant authorities strengthen policy support,enhance standardized training for healthcare nursing assistants,refine cost-sharing mechanisms,and improve the quality and sustainability of non-accompanied care services through multi-party collaboration.

Objective:To explore the correlation between triglyceride-glucose (TyG) index-body mass index (BMI) product (TyG-BMI) and hypertension.Methods:Based on the cross-sectional survey data of adult hypertension prevalence in Hunan Province from June 2013 to May 2014, 4 012 subjects aged ≥18 years with complete key data were included. Binary logistic regression analysis was used to analyze the correlation between TyG-BMI and hypertension, and receiver operating characteristic (ROC) curve was used to compare the ability of TyG index and TyG-BMI to identify hypertension.Results:A total of 4 012 subjects were included in this study, with an average age of (54.6±12.6)years, and males accounted for 40.98%(1 644/4 012). The prevalence of hypertension was 38.33%(1 538/4 012). Logistic regression analysis showed that elevated TyG-BMI was an independent risk factor for hypertension ( P<0.05). In the fully adjusted model, each 1/4 increase in TyG-BMI was associated with a 1.017-fold increase in the risk of hypertension ( OR=1.017, 95% CI: 1.014-1.019). Compared with the lowest quartile group (Q 1), the higher quartile groups (Q 2, Q 3, Q 4) of TyG-BMI had a higher risk of hypertension, with OR values of 1.841, 2.265, and 4.386, respectively. Restricted cubic spline plot showed a linear dose-response relationship between TyG-BMI and the risk of hypertension (overall trend P<0.001). In subgroup analyses stratified by age, gender, smoking and drinking status, TyG-BMI was positively correlated with hypertension. In addition, ROC curve analysis showed that TyG-BMI had better diagnostic value for hypertension compared with TyG index. Conclusions:TyG-BMI is an independent risk factor for hypertension. Excessively high TyG-BMI or gradual increase of TyG-BMI will increase the risk of hypertension, and TyG-BMI has higher value in identifying hypertension compared with TyG index.

Objective:To explore the correlation between triglyceride-glucose (TyG) index-body mass index (BMI) product (TyG-BMI) and hypertension.Methods:Based on the cross-sectional survey data of adult hypertension prevalence in Hunan Province from June 2013 to May 2014, 4 012 subjects aged ≥18 years with complete key data were included. Binary logistic regression analysis was used to analyze the correlation between TyG-BMI and hypertension, and receiver operating characteristic (ROC) curve was used to compare the ability of TyG index and TyG-BMI to identify hypertension.Results:A total of 4 012 subjects were included in this study, with an average age of (54.6±12.6)years, and males accounted for 40.98%(1 644/4 012). The prevalence of hypertension was 38.33%(1 538/4 012). Logistic regression analysis showed that elevated TyG-BMI was an independent risk factor for hypertension ( P<0.05). In the fully adjusted model, each 1/4 increase in TyG-BMI was associated with a 1.017-fold increase in the risk of hypertension ( OR=1.017, 95% CI: 1.014-1.019). Compared with the lowest quartile group (Q 1), the higher quartile groups (Q 2, Q 3, Q 4) of TyG-BMI had a higher risk of hypertension, with OR values of 1.841, 2.265, and 4.386, respectively. Restricted cubic spline plot showed a linear dose-response relationship between TyG-BMI and the risk of hypertension (overall trend P<0.001). In subgroup analyses stratified by age, gender, smoking and drinking status, TyG-BMI was positively correlated with hypertension. In addition, ROC curve analysis showed that TyG-BMI had better diagnostic value for hypertension compared with TyG index. Conclusions:TyG-BMI is an independent risk factor for hypertension. Excessively high TyG-BMI or gradual increase of TyG-BMI will increase the risk of hypertension, and TyG-BMI has higher value in identifying hypertension compared with TyG index.

Objective:To analyze the antimicrobial resistance and genomic characteristics of Salmonella typhimurium and its monophasic variants isolated from human and food sources in Hangzhou. Methods:A total of 186 Salmonella typhimurium and its monophasic variants isolated in Hangzhou during the period from 2017 to 2021 were subjected to antimicrobial susceptibility testing and whole-genome sequencing, and the genomes from public databases were downloaded. Multilocus sequence typing and the identification of antimicrobial resistance (AMR) genes were performed using the sequencing data. Phylogenetic tree based on the single nucleotide polymorphism (SNP) sites in the genomes from Hangzhou and public databases was constructed. Results:The multidrug resistance (MDR) rate of the monophasic variant strains in Hangzhou was 95.4% (103/108). The MDR strains harbored ≥3 classes of AMR genes simultaneously and the most common resistance genotype was blaTEM-1B- tet( B)- sul2- aac(6′)- Ia (44.7%, 46/103). The MDR rate of Salmonella typhimurium strains was 75.6% (59/78), and 52.5% (31/59) of the MDR strains harbored ≥10 AMR genes simultaneously, with the most common resistance genotype being blaTEM-1B- qnrS1- tet( A)- tet( M)- cmlA1- floR- dfrA12- sul2- sul3- aac(6′)- Iaa (40.7%, 24/59). All of the 186 strains were positive for AMR gene aac (6 ′)- Iaa, and three monophasic variant strains which were resistant to polymyxin E was positive for mcr-1.1. ST19 accounted for 91.0% of the 78 Salmonella typhimurium strains (except for two strains belonging to ST34, two strains belonging to ST1544, and three strains untyped), and ST34 accounted for 96.3% of the 108 monophasic variant strains (except for four strains untyped). The phylogenetic tree showed that the ST19 strains dominated by serotype typhimurium and the ST34 strains dominated by monophasic variants were divided into two clades. In the ST19 clade, strains from Hangzhou were mainly clustered with the strains from other cities in Zhejiang Province as well as other provinces and cities in China, such as Jiangxi, Shanghai, and Shandong. Strains isolated from pig, duck, and chicken were the ones that were clustered with clinical strains. In the ST34 clade, most strains from Hangzhou were clustered together, and some strains were clustered with those isolated from other cities in Zhejiang Province as well as Beijing, Guangdong, Shanghai, etc. Strains isolated from pig and chicken were the ones that were clustered with clinical strains. Conclusions:The MDR rate of monophasic variant strains is higher than that of Salmonella typhimurium strains, and the latter is prominent by its harboring multiple AMR genes. The epidemic of Salmonella typhimurium and its monophasic variants in Hangzhou is mainly caused by the spread of ST19 and ST34 strains, respectively, and the clinical infection may be closely related to the consumption of pork and poultry meat. While transmitting locally, cross-region transmission of the two serovars in Zhejiang Province and cross-province transmission in China may also occur.

Objective:To analyze the antimicrobial resistance and genomic characteristics of Salmonella typhimurium and its monophasic variants isolated from human and food sources in Hangzhou. Methods:A total of 186 Salmonella typhimurium and its monophasic variants isolated in Hangzhou during the period from 2017 to 2021 were subjected to antimicrobial susceptibility testing and whole-genome sequencing, and the genomes from public databases were downloaded. Multilocus sequence typing and the identification of antimicrobial resistance (AMR) genes were performed using the sequencing data. Phylogenetic tree based on the single nucleotide polymorphism (SNP) sites in the genomes from Hangzhou and public databases was constructed. Results:The multidrug resistance (MDR) rate of the monophasic variant strains in Hangzhou was 95.4% (103/108). The MDR strains harbored ≥3 classes of AMR genes simultaneously and the most common resistance genotype was blaTEM-1B- tet( B)- sul2- aac(6′)- Ia (44.7%, 46/103). The MDR rate of Salmonella typhimurium strains was 75.6% (59/78), and 52.5% (31/59) of the MDR strains harbored ≥10 AMR genes simultaneously, with the most common resistance genotype being blaTEM-1B- qnrS1- tet( A)- tet( M)- cmlA1- floR- dfrA12- sul2- sul3- aac(6′)- Iaa (40.7%, 24/59). All of the 186 strains were positive for AMR gene aac (6 ′)- Iaa, and three monophasic variant strains which were resistant to polymyxin E was positive for mcr-1.1. ST19 accounted for 91.0% of the 78 Salmonella typhimurium strains (except for two strains belonging to ST34, two strains belonging to ST1544, and three strains untyped), and ST34 accounted for 96.3% of the 108 monophasic variant strains (except for four strains untyped). The phylogenetic tree showed that the ST19 strains dominated by serotype typhimurium and the ST34 strains dominated by monophasic variants were divided into two clades. In the ST19 clade, strains from Hangzhou were mainly clustered with the strains from other cities in Zhejiang Province as well as other provinces and cities in China, such as Jiangxi, Shanghai, and Shandong. Strains isolated from pig, duck, and chicken were the ones that were clustered with clinical strains. In the ST34 clade, most strains from Hangzhou were clustered together, and some strains were clustered with those isolated from other cities in Zhejiang Province as well as Beijing, Guangdong, Shanghai, etc. Strains isolated from pig and chicken were the ones that were clustered with clinical strains. Conclusions:The MDR rate of monophasic variant strains is higher than that of Salmonella typhimurium strains, and the latter is prominent by its harboring multiple AMR genes. The epidemic of Salmonella typhimurium and its monophasic variants in Hangzhou is mainly caused by the spread of ST19 and ST34 strains, respectively, and the clinical infection may be closely related to the consumption of pork and poultry meat. While transmitting locally, cross-region transmission of the two serovars in Zhejiang Province and cross-province transmission in China may also occur.

Objective:To analyze the antimicrobial resistance and genomic characteristics of Salmonella enterica serovar Derby strains isolated from human and food sources in Hangzhou. Methods:A total of 60 Salmonella enterica serovar Derby strains isolated in Hangzhou during the period from 2015 to 2020 were subjected to antimicrobial susceptibility testing, pulsed field gel electrophoresis (PFGE) typing and whole-genome sequencing. Multilocus sequence typing (MLST), core genome multilocus sequence typing (cgMLST) and the identification of antimicrobial resistance genes were performed using the sequencing data. Phylogenetic tree based on the single nucleotide polymorphism (SNP) sites in the 60 genomes from Hangzhou and 379 genomes from public databases was constructed. Results:No significant difference was observed in the drug resistance rates between the clinical strains and food strains in Hangzhou. The multidrug resistance (MDR) rate was 76.7% (46/60). All of the 60 Salmonella Derby strains were positive for the antimicrobial resistance genes aac(6′)- Iaa and fosA7. The 60 strains were subtyped into 46 molecular types by PFGE and 53 molecular types by cgMLST(HC2). Except for one strain belonging to ST3220, the other Salmonella Derby strains were ST40. The phylogenetic analysis showed that some strains isolated in Hangzhou were close to the strains in Southeast Asia, suggesting the possibility of cross-border transmission of ST40 strains, with the main food sources being pork and fish; other strains were close to those circulating in Beijing, Guangzhou, Hubei, Chongqing and other provinces, suggesting the possibility of cross-province transmission of the strains, with the main food sources being pork, beef and chicken. Conclusions:The epidemic of Salmonella Derby in Hangzhou was mainly caused by the spread of ST40 strains and MDR was common. Clinical infections might be closely related to the consumption of pork, beef, chicken and fish. There was the possibility of cross-border transmission of Salmonella Derby between Hangzhou and Southeast Asia and cross-province transmission in China.

Objective:To investigate any anti-aging effect of repeated transcranial magnetic stimulation (rTMS) and explore the relationship between the effect and relief of clinical symptoms in patients with Parkinson′s disease (PD).Methods:A total of 108 PD patients were randomly divided into an rTMS group and a control group, each of 54, while another 54 healthy counterparts were selected to form a normal group. In addition to anti-PD drug therapy, the rTMS group was given daily rTMS treatment, 5 days a week for 4 weeks, while the control group received sham rTMS treatment, with no treatment of the normal group. Before the treatment and after 4 weeks of treatment as well as and 1 month after the ending of the treatment, the subjects′ clinical exercise symptoms were evaluated using the Unified Parkinson′s Disease Rating Scale (UPDRS), a timed exercise test and the 10m re-entry exercise test. Non-exercise symptoms were assessed using the Hamilton Depression Scale (HAMD), the Hamilton Anxiety Scale (HAMA) and the Mini-mental State Examination (MMSE). Fasting venous blood samples were analyzed to quantify the serum levels of tumor necrosis factor (TNF), interleukin-6 (IL-6), interleukin-1β (IL-1β) and matrix metalloproteinase-3 (MMP-3).Results:Four weeks and 1 month after the treatment, the average UPDRS scores, exercise test times and 10m re-entry exercise test results of the rTMS group were significantly better than those before treatment and significantly better than those of the control group at the same time point. The rTMS group′s average HAMA, HAMD and MMSE scores, as well as its average P300 latency and amplitude were also significantly better than those of the control group at the same time point and significantly better than those before treatment. After 4 weeks, the average MMP-3 content in the rTMS group was significantly lower than the control group′s average, and after a month the average levels of TNF, IL-6, IL-1β and MMP-3 of the rTMS group were all significantly different from those before treatment and those of the control group. The TNF, IL-6, IL-1β and MMP-3 levels were all positively correlated with the average UPDRS total score.Conclusion:High-frequency rTMS therapy can change the phenotypes related to cell senescence, and thus has good therapeutic effect on motor and non-motor symptoms of PD.