According to the principle and current domestic and international construction processes of core outcome set(COS) and the characteristics of post-stroke aphasia, this study built COS with evidence-based support for traditional Chinese medicine(TCM) treatment of post-stroke aphasia. Firstly, a comprehensive review was conducted on the articles about the TCM treatment of post-stroke aphasia that were published in the four major Chinese databases, three major English databases, and three clinical registration centers over the past five years. The articles were analyzed and summarized, on the basis of which the main part of the COS for clinical research on the TCM treatment of post-stroke aphasia was formed. Secondly, clinical doctors and related nursing personnel were interviewed, and important outcome indicators in the clinical diagnosis and treatment process were supplemented to form a pool of core outcome indicators. Two rounds of Delphi surveys were carried out to score the importance of the core outcome indicators in the pool. Finally, a consensus meeting of experts was held to establish the COS for clinical research on the TCM treatment of post-stroke aphasia. The final COS included a total of 268 studies [236 randomized controlled trials(RCTs), 21 Meta-analysis, and 11 clinical registration protocols] and 20 open questionnaire survey results. After two rounds of Delphi surveys, a total of 14 outcome indicators and their corresponding measurement tools were included in the expert consensus meeting. The final expert consensus meeting determined the COS for post-stroke aphasia, which included 9 indicator domains and 12 outcome indicators.
Humans ; Aphasia/therapy* ; Stroke/complications* ; Medicine, Chinese Traditional ; Drugs, Chinese Herbal/therapeutic use* ; Treatment Outcome

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

Aim To investigate the expression of Foxos in human umbilical vein endothelial cells(HUVECs)with insulin resistance(IR)induced by high glucose and high fat(HG/HF)stress and its significance.Methods First, the IR model of endothelial cells was established by HG /HF stress.The differential expression of Foxos gene in normal(Ctrl )group and HG /HF group was observed, and the subtypes with the most significant changes in Foxos were screened out, such as Foxo6.Next, Foxo6 was silenced to observe its role in endothelial cell with IR.Finally, whether the mechanism of Foxo6-mediated IR was related to the interaction of NF-κB signaling was investigated.Results The expression increase of Foxo6 was the most significant among Foxos under the IR condition induced by HG/HF.Using a small RNA interference and plasmid transfection technique, we found that the silence effect of the siRNA3 fragments targeting Foxo6 was the most significant among the siRNAs.Moreover, the further study showed that silencing the Foxo6 gene could significantly reverse the endothelial IR induced by HG/HF, and the mechanism of the reversal effect was related to the interaction between the Foxo6 and NF-κB signal.Conclusions Foxo6 mediates the endothelial cell IR induced by the HG /HF stress.The underlying mechanism is that Foxo6 can interact with NF-κBp65 and activate NF-κB signaling pathway.Silencing Foxo6 can improve the IR of vascular endothelial cells induced by HG /HF stress.

Objective:The study was to explore the nipple-areola complex(NAC) blood supply model in Chinese breasts based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and to provide the blood supply knowledge for mammaplasty.Methods:Breast DCE-MRI images of breasts without masses in 245 patients from March 2012 to October 2019 in Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology were included retrospectively. The breast vessels images were obtained by image subtraction in the Siemens workstation. Axial, coronal and sagittal maximum intensity projection(MIP) images were evaluated, and all vessels supplying the nipple-areola complex were identified by 3D MIP images. Blood supply to the NAC was classified into 9 zones, and vessels of each zone were counted and analyzed. The maximum distance from the vessel to the skin surface of the breast was measured. SPSS 19.0 software was used for statistical analysis. The chi-square test was used to check for significant differences in the distribution of zones between the left breasts and the right breasts. The mean, standard deviation and 95% confidence interval of the distance between vessels and skin were calculated. Using ANOVA to compare the distance between vessels and skin of zones. P<0.05 was statistically significant. Results:There were 490 breasts in 245 DCE-MRI images, of which 97 breasts were found to have masses in 97 DCE-MRI images. The remaining 393 were normal breasts as study subjects. The patients’ ages ranged from 23 to 72 years, with a mean of 43.7 years. 637 source vessels (311 left, 326 right) were identified in 393 breasts (200 left, 193 right). Of the 637 vessels, 269 (42.2%) were in the superomedial zone and 180 (28.3%) were in the superolateral zone. The proportions of vessels in zone medial (57, 8.9%), inferior (37, 5.8%), central (30, 4.7%), inferomedial (25, 3.9%), inferolateral (25, 3.9%), superior (11, 1.7%) and lateral (3, 0.5%) were less than 10%, respectively. The chi-square test showed no significant difference in the distribution of zones ( χ2 =6.4, P=0.602) between the left breasts and the right breasts. Except for the central zone, the mean of maximum distance from the vessels to the skin surface was 0.91 cm, with a 95% confidence interval of 0.86 cm to 0.96 cm. Conclusions:DCE-MRI can clearly show the blood supply to the NAC. Superomedial or superolateral source vessels supplying the NAC were predominant, and the vessels run at a subcutaneous depth of about 1 cm.

Objective:The study was to explore the nipple-areola complex(NAC) blood supply model in Chinese breasts based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and to provide the blood supply knowledge for mammaplasty.Methods:Breast DCE-MRI images of breasts without masses in 245 patients from March 2012 to October 2019 in Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology were included retrospectively. The breast vessels images were obtained by image subtraction in the Siemens workstation. Axial, coronal and sagittal maximum intensity projection(MIP) images were evaluated, and all vessels supplying the nipple-areola complex were identified by 3D MIP images. Blood supply to the NAC was classified into 9 zones, and vessels of each zone were counted and analyzed. The maximum distance from the vessel to the skin surface of the breast was measured. SPSS 19.0 software was used for statistical analysis. The chi-square test was used to check for significant differences in the distribution of zones between the left breasts and the right breasts. The mean, standard deviation and 95% confidence interval of the distance between vessels and skin were calculated. Using ANOVA to compare the distance between vessels and skin of zones. P<0.05 was statistically significant. Results:There were 490 breasts in 245 DCE-MRI images, of which 97 breasts were found to have masses in 97 DCE-MRI images. The remaining 393 were normal breasts as study subjects. The patients’ ages ranged from 23 to 72 years, with a mean of 43.7 years. 637 source vessels (311 left, 326 right) were identified in 393 breasts (200 left, 193 right). Of the 637 vessels, 269 (42.2%) were in the superomedial zone and 180 (28.3%) were in the superolateral zone. The proportions of vessels in zone medial (57, 8.9%), inferior (37, 5.8%), central (30, 4.7%), inferomedial (25, 3.9%), inferolateral (25, 3.9%), superior (11, 1.7%) and lateral (3, 0.5%) were less than 10%, respectively. The chi-square test showed no significant difference in the distribution of zones ( χ2 =6.4, P=0.602) between the left breasts and the right breasts. Except for the central zone, the mean of maximum distance from the vessels to the skin surface was 0.91 cm, with a 95% confidence interval of 0.86 cm to 0.96 cm. Conclusions:DCE-MRI can clearly show the blood supply to the NAC. Superomedial or superolateral source vessels supplying the NAC were predominant, and the vessels run at a subcutaneous depth of about 1 cm.

The historical evolution， fermentation technology and key links of Sojae Semen Praeparatum （SSP） were sorted out by consulting ancient books and modern literature， and the influencing factors and control methods of quality were analyzed and summarized in order to provide reference for the quality control of SSP. After analysis， it was found that in the fermentation process of SSP， fermentation strains， miscellaneous bacteria， temperature and humidity were all important factors affecting the quality of SSP. The condition control of "post fermentation" process has been paid more attention to in the past dynasties. In addition， the delicious SSP recognized in ancient times should be made from mold fermentation， and the breeding and application of fermented mold may be the key point to solve the quality problem of SSP. Therefore， based on the evaluation indexes of SSP in the past dynasties， it is of great significance to study and optimize the technological conditions such as strain， temperature and humidity in depth to improve the quality of SSP.

Objective:This study aimed to explore the use of magnetic resonance imaging (MRI) to measure breast volume and gland volume to guide reconstruction of breast reconstruction with silicone gel prothesis following nipple-sparing mastectomy (NSM).Methods:According to the inclusion criteria, the breast cancer patients admitted to Wuhan Tongji Hospital from September 2018 to June 2019 were selected to undergo breast reconstruction with prosthesis after NSM. Preoperative MRI were used to measure distance from the tumor to the nipple-areola complex and the skin, and estimate the volume of breast and mammary gland. The data of breast volume measured by MRI, gland volume measured by MRI, volume of prosthesis and specimen weight were compared. The data were analyzed using Prism 8.0 software. The paired student t-test was used to compare the difference of two groups. P< 0.05 was considered statistically significant. Linear regression models were used to obtain coefficient of determination ( R2), and R2>0.8 was considered statistically significant. Results:A total of 15 breast cancer patients, aged 28-45 years, with a mean of 35.5 years, were included. There were 13 cases unilateral and 2 cases bilateral. The clinical stages of stage 0, Ⅰ and Ⅱ were 8, 5 and 2 patients, respectively. The average distance o from tumor to nipple-areola complex was (3.1±0.8) cm. One patient suffered postoperative bleeding and was promptly reoperated through the original incision, and the patient recovered well after surgery. All patients felt sensory disturbance of the nipple and areola. There was no complication such as infection, seroma, capsular contracture, prosthesis rupture, and prosthesis shift. At 4-12 months postoperative follow-up, all breasts were basically symmetrical and no tumor recurrence or metastasis occurred, which satisfied the patients. The mean values of the volume of prosthesis, specimen weight, breast volume measured by MRI and gland volume measured by MRI were (471.10±45.60) ml, (244.60±29.14) ml, (243.60±31.16) g, (244.30±16.63) ml. There was significant difference between the breast volume measured by MRI and the specimen weight ( t=10.37, P<0.001), while no statistical difference was found between gland volume measured by MRI and specimen weight ( t=0.20, P=0.847). Similarly, there was significant difference between the breast volume measured by MRI and the volume of prosthesis ( t=5.19, P<0.001), while no statistical difference was found between gland volume measured by MRI and the volume of prosthesis ( t=1.74, P=0.104). The coefficient of determination between gland volume measured by MRI and specimen weight ( R2=0.98) was higher than that of breast volume measured by MRI ( R2=0.82). Similarly, the coefficient of determination between gland volume measured by MRI and the volume of prosthesis ( R2=0.71) was higher than that of breast volume measured by MRI ( R2=0.54). Conclusions:Preoperative MRI can provide guidance to breast reconstruction with silicone gel prothesis following nipple-sparing mastectomy in breast cancer. The gland volume measured by MRI is closer to the specimen weight and the volume of prosthesis than the breast volume measured by MRI.

Objective:This study aimed to explore the use of magnetic resonance imaging (MRI) to measure breast volume and gland volume to guide reconstruction of breast reconstruction with silicone gel prothesis following nipple-sparing mastectomy (NSM).Methods:According to the inclusion criteria, the breast cancer patients admitted to Wuhan Tongji Hospital from September 2018 to June 2019 were selected to undergo breast reconstruction with prosthesis after NSM. Preoperative MRI were used to measure distance from the tumor to the nipple-areola complex and the skin, and estimate the volume of breast and mammary gland. The data of breast volume measured by MRI, gland volume measured by MRI, volume of prosthesis and specimen weight were compared. The data were analyzed using Prism 8.0 software. The paired student t-test was used to compare the difference of two groups. P< 0.05 was considered statistically significant. Linear regression models were used to obtain coefficient of determination ( R2), and R2>0.8 was considered statistically significant. Results:A total of 15 breast cancer patients, aged 28-45 years, with a mean of 35.5 years, were included. There were 13 cases unilateral and 2 cases bilateral. The clinical stages of stage 0, Ⅰ and Ⅱ were 8, 5 and 2 patients, respectively. The average distance o from tumor to nipple-areola complex was (3.1±0.8) cm. One patient suffered postoperative bleeding and was promptly reoperated through the original incision, and the patient recovered well after surgery. All patients felt sensory disturbance of the nipple and areola. There was no complication such as infection, seroma, capsular contracture, prosthesis rupture, and prosthesis shift. At 4-12 months postoperative follow-up, all breasts were basically symmetrical and no tumor recurrence or metastasis occurred, which satisfied the patients. The mean values of the volume of prosthesis, specimen weight, breast volume measured by MRI and gland volume measured by MRI were (471.10±45.60) ml, (244.60±29.14) ml, (243.60±31.16) g, (244.30±16.63) ml. There was significant difference between the breast volume measured by MRI and the specimen weight ( t=10.37, P<0.001), while no statistical difference was found between gland volume measured by MRI and specimen weight ( t=0.20, P=0.847). Similarly, there was significant difference between the breast volume measured by MRI and the volume of prosthesis ( t=5.19, P<0.001), while no statistical difference was found between gland volume measured by MRI and the volume of prosthesis ( t=1.74, P=0.104). The coefficient of determination between gland volume measured by MRI and specimen weight ( R2=0.98) was higher than that of breast volume measured by MRI ( R2=0.82). Similarly, the coefficient of determination between gland volume measured by MRI and the volume of prosthesis ( R2=0.71) was higher than that of breast volume measured by MRI ( R2=0.54). Conclusions:Preoperative MRI can provide guidance to breast reconstruction with silicone gel prothesis following nipple-sparing mastectomy in breast cancer. The gland volume measured by MRI is closer to the specimen weight and the volume of prosthesis than the breast volume measured by MRI.