Objective:To investigate the drug resistance gene characteristics, plasmid characteristics and genome tracing of Shigella sonnei causing a bacillary dysentery outbreak in Shandong Province. Methods:Sixty-five Shigella sonnei strains isolated from a 2021 outbreak in a county of Shandong Province were analyzed using antimicrobial susceptibility testing, whole genome sequencing (WGS), characterization of resistance and virulence genes, plasmid profiling, core genome multilocus sequence typing (cgMLST), and single nucleotide polymorphism (SNP) analysis. Results:All isolates had the same resistance phenotype and genotypes and were multidrug-resistant ESBL-producing Shigella sonnei, carrying important virulence genes. Plasmid analysis revealed a conserved genetic arrangement, pil( M/ N/ O2/ P)-tra( F/ H/ J/ K/ N/ O/ P/ Q)-IS Ecp1- blaCTX-M-14-Tn 903- yub( J/ I/ F/ G/ E/ D), and shared across strains from diverse regions and bacterial species. The cgMLST and SNP analyses demonstrated concordant clustering, with all 65 outbreak-related strains forming a single cluster alongside human-derived strains from Guangxi. Conclusion:The ESBL-producing Shigella sonnei responsible for the outbreak shares a homologous relationship with Guangxi human-derived strains, and the detected resistance plasmids and virulence genes underscore the need to strengthen drug resistance surveillance and genome tracing.

Objective:To construct a continuity of care plan for adolescent fixed orthodontic patients based on the theory of timing, and provide systematic and standardized nursing interventions for adolescent fixed orthodontic patients.Methods:Guided by the theory of timing, preliminary plan items were formulated through literature review and questionnaire survey. Using the Delphi method, 15 experts were consulted for two rounds to determine the continuity of care plan for adolescent fixed orthodontic patients from October to December, 2023.Results:The effective response rates of the two rounds of questionnaires were 15/15, respectively. The expert authority levels were 0.93 and 0.94, and the Kendall harmony coefficients were 0.28 and 0.38, respectively. The differences were statistically significant (both P<0.001). The final established plan included 5 primary indicators, 23 secondary indicators, and 47 tertiary indicators. Conclusions:The continuity of care plan for adolescent fixed orthodontic patients based on the timing theory is reliable and scientific, and can meet the continuity of care needs of patients at different stages, providing reliable clinical basis for carrying out continuity of care.

Objective:To investigate the drug resistance gene characteristics, plasmid characteristics and genome tracing of Shigella sonnei causing a bacillary dysentery outbreak in Shandong Province. Methods:Sixty-five Shigella sonnei strains isolated from a 2021 outbreak in a county of Shandong Province were analyzed using antimicrobial susceptibility testing, whole genome sequencing (WGS), characterization of resistance and virulence genes, plasmid profiling, core genome multilocus sequence typing (cgMLST), and single nucleotide polymorphism (SNP) analysis. Results:All isolates had the same resistance phenotype and genotypes and were multidrug-resistant ESBL-producing Shigella sonnei, carrying important virulence genes. Plasmid analysis revealed a conserved genetic arrangement, pil( M/ N/ O2/ P)-tra( F/ H/ J/ K/ N/ O/ P/ Q)-IS Ecp1- blaCTX-M-14-Tn 903- yub( J/ I/ F/ G/ E/ D), and shared across strains from diverse regions and bacterial species. The cgMLST and SNP analyses demonstrated concordant clustering, with all 65 outbreak-related strains forming a single cluster alongside human-derived strains from Guangxi. Conclusion:The ESBL-producing Shigella sonnei responsible for the outbreak shares a homologous relationship with Guangxi human-derived strains, and the detected resistance plasmids and virulence genes underscore the need to strengthen drug resistance surveillance and genome tracing.

Objective:To construct a continuity of care plan for adolescent fixed orthodontic patients based on the theory of timing, and provide systematic and standardized nursing interventions for adolescent fixed orthodontic patients.Methods:Guided by the theory of timing, preliminary plan items were formulated through literature review and questionnaire survey. Using the Delphi method, 15 experts were consulted for two rounds to determine the continuity of care plan for adolescent fixed orthodontic patients from October to December, 2023.Results:The effective response rates of the two rounds of questionnaires were 15/15, respectively. The expert authority levels were 0.93 and 0.94, and the Kendall harmony coefficients were 0.28 and 0.38, respectively. The differences were statistically significant (both P<0.001). The final established plan included 5 primary indicators, 23 secondary indicators, and 47 tertiary indicators. Conclusions:The continuity of care plan for adolescent fixed orthodontic patients based on the timing theory is reliable and scientific, and can meet the continuity of care needs of patients at different stages, providing reliable clinical basis for carrying out continuity of care.

Objective:To analyze the differences in clinical outcomes and toxicities between postoperative radiotherapy alone and postoperative radiochemotherapy for soft tissue sarcoma (STS), as well as the related factors affecting clinical prognosis of STS patients.Methods:Retrospective analysis of patients diagnosed with primary STS admitted to Zhejiang Cancer Hospital from May 2012 to May 2019 was performed, who received adjuvant radiotherapy after surgery, combined with or without postoperative chemotherapy. A total of 100 patients were enrolled and divided into postoperative radiotherapy group ( n=52) and postoperative radiochemotherapy group ( n=48). The median follow-up time was 65 months (24-124 months). The local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), overall survival (OS), and treatment-related toxicities were recorded in two groups. The survival rate was calculated by Kaplan-Meier analysis. Log-rank test was used for univariate analysis, and Cox model was used for multivariate analysis. Results:In multivariate analysis, the maximum tumor diameter was an independent predictor of local tumor recurrence ( HR=4.80, 95% CI=1.16-19.85, P=0.031), distant metastasis ( HR=4.67, 95% CI=1.53-14.26, P=0.007) and OS ( HR=4.10, 95% CI=1.35-12.48, P=0.013). In addition, the degree of myelosuppression in patients in postoperative radiochemotherapy was significantly higher than that in their counterparts in postoperative radiotherapy group ( P<0.001). Conclusions:In the limited number of patients, radiochemotherapy has no advantages over radiotherapy alone in distant metastasis or survival rate. Besides, it increases toxicities, but the overall tolerability is favorable. It is necessary to conduct prospective randomized studies in a large population and subgroup analysis of histological subtypes, aiming to obtain results with better reference value.

Objective:To explore the application and effect of flipped classroom in community clinical pharmacist training.Methods:Seventeen pharmacists trained in 2017-2018 were used as the control group and received traditional teaching mode. Fourteen pharmacists trained in 2019-2020 were used as the experimental group and received the flipped classroom teaching mode. Finally, the teaching effect was evaluated through the trainees' graduation examination results and satisfaction degree. The SPSS 25.0 was used to conduct the t test and chi-square test. Results:The task performance, prescription audit scores, clinical practice scores, and total scores in the experimental group were significantly higher than those in the control group ( P<0.05). However, there was no significant difference in usual performance between the two groups ( P>0.05). For satisfaction survey, the total score of Likert scale in the experimental group was (20.1±3.4), which was significantly higher than that in the control group (16.9±3.4). However, there was no significant difference in the satisfaction of clinical practice and teachers' level between the two groups ( P>0.05). Conclusion:Flipped classroom can improve the enthusiasm of community clinical pharmacist trainees to participate in learning, increase the level of the trainees' theoretical knowledge and professional practice, and is conducive to the cultivation of high-quality community clinical pharmacists.

Alzheimer's disease (AD) is the most common form of dementia in the elderly, and there is no specific treatment to stop or reverse its progression. Mild cognitive impairment (MCI) is an important entry point for early diagnosis and prevention of AD. More and more studies have explored the risk factors and biomarkers for conversion from MCI to AD, and a series of risk prediction models have been established. This article analyzes and summarizes the different predictors and risk prediction models so as to provide basis for early identifying the high-risk group of AD, managing the controllable risk factors, and providing references for the selection and improvement of these models.

Difference of chronotypes makes influence to cognitive performance of individuals in routine duties. In this paper, 55 subjects with different chronotypes were subjected to continuous sleep deprivation for 30 h by using the constant routine protocol, during which core body temperature was measured continuously, and subjective sleepiness self-rating and the performance of selective attention were measured hourly. The results showed that the phase difference of core body temperature has no significant difference, yet the amplitude and term difference among the three chronotypes are significant. There was an advance in phase between subjective sleepiness self-rating and core body temperature, and the self-rating sleepiness of evening type came the latest, and the self-rating sleepiness of morning type dissipated the fastest. The response time of selective attention showed a 2 h phase delay with subjective sleepiness self-rating. And the analysis of core body temperature showed that the later the chronotype was, the greater the phase delay was. The correct rate of selective attention of different chronotypes were inconsistent with delay of subjective sleepiness self-rating and core body temperature. We provide reference for industry, aviation, military, medical and other fields to make a more scientific scheduling/ shifting based on cognitive performance characteristics of different chronotypes.
Attention/physiology* ; Circadian Rhythm/physiology* ; Homeostasis ; Humans ; Sleep/physiology* ; Sleep Deprivation ; Sleepiness

Objective:To explore the best negative pressure standard of sputum aspiration in patients with severe craniocerebral injury, so as to achieve the best sputum aspiration effect and maintain relatively stable intracranial pressure.Methods:Totally 120 patients with severe craniocerebral injury admitted to the Department of Neurosurgery of Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January to December 2019 were selected by convenience sampling method. According to the random number table method, patients were divided into 4 different negative pressure sputum aspiration groups: 75 mmHg (1 mmHg=0.133 kPa) group, 100 mmHg group, 150 mmHg group, 200 mmHg group, with 30 patients in each group. The levels of intracranial pressure and SpO 2, sputum cleaning time and mucosal injury were observed and compared in 4 groups: 1 min before sputum aspiration, 1 min after sputum aspiration and during sputum aspiration. Results:Comparison of intracranial pressure and SpO 2 in sputum aspiration among the four groups: intracranial pressure in 200 mmHg group was (22.23 ± 4.80) mmHg, which was higher than 75 mmHg group (16.33 ± 2.71) mmHg, 100 mmHg group (17.70 ± 2.32) mmHg, 150 mmHg group (17.20 ± 2.11) mmHg ( q=8.29, 6.58, 7.23), and SpO 2 was 0.906 ± 0.048, which was lower than 0.956 ± 0.013, 0.946 ± 0.018, 0.952 ± 0.023 in the other three groups ( q=7.81, 6.08, 6.69), with statistical significance (all P<0.01). There were statistically significant differences in intracranial pressure ( F=10.55) and SpO 2 ( F=36.57) among the four groups 1 min after sputum aspiration ( P<0.01);the 200 mmHg group had the highest intracranial pressure (15.63 ± 3.64) mmHg; the 100 mmHg group was (12.50 ± 1.48) mmHg and 150 mmHg group was (12.60 ± 1.00) mmHg, which had lower intracranial pressure than the 75 mmHg group (14.03 ± 2.86) mmHg. The sputum cleaning time was (35.53 ± 5.71) s in 75 mmHg group which was the longest and the shortest in 200 mmHg group (24.27 ± 3.22) s, with statistical significance among the four groups ( F=47.81, P<0.01). The incidence of airway mucosal injury in 200 mmHg group was 33.33% (10/30),which was higher than that in the other three groups, and the difference was statistically significant ( χ2=15.41, P<0.01). Conclusions:For patients with severe craniocerebral injury, artificial airway sputum viscosityⅠ-Ⅱ degree, suction negative pressure of 100-150 mmHg can better maintain the stability of intracranial pressure, control the decline of SpO 2 and prevent the damage of airway mucosa, and effectively reduce the adverse effects of sputum aspiration on patients with severe craniocerebral injury.

Objective:To explore the best evidence-based nursing plan for the prevention and management of peritonitis associated with peritoneal dialysis, and evaluating the effect of its application.Methods:BMJ Best Practice, Up To Date, Cochrane Library, Joanna Briggs Institute (JBI) Evidence-based Health Care Center database, UK National Clinical Medical Research Guidelines, PubMed, CINAHL, Embase, Web of Science, Physiotherapy Evidence Database, BMJ-Best Practice, SCI, Google Scholar, Europe PMC, Research Gate, NCBI, Yomitong, Mmes, Clinical Practice Guide, CNKI, Wanfang, Chinese Biomedical Literature Database, VIP database involves allguidelines, expert consensus, systematic evaluation and other relevant evidence on the prevention and management of peritoneal diaperis-related peritonitis at home and abroad from establishment to June 2021. The quality of the literature was evaluated and the level of evidence was evaluated. Finally, evidence was extracted and summarized.Results:After repeated check and multiple screening, a total of 13 articles were selected, including 5 guidelines, 2 expert consensus and 6 systematic reviews. At the same time, 19 pieces of best evidence were collected five aspects of peritonitis prevention, peritonitis diagnosis, peritonitis treatment, peritoneal dialysis patient training and management, and healthy quality of life.Conclusions:The prevention and management of peritonitis can effectively reduce the occurrence of peritonitis associated with peritoneal dialysis. According to the clinical situation of the department and the will of patients, standardized nursing procedures are formulated for clinical nurses and personalized nutrition guidance is provided for peritoneal dialysis patients, which is convenient to further improve the quality of life of patients.