Objective:To investigate the correlation between thyroid function and the total cerebral small vessel disease score in the elderly.Methods:This cross-sectional study included elderly people who underwent physical examinations at the Geriatrics Department of Beijing Hospital from April 2019 to December 2020. Participants were devided into 5 groups based on the total score of cerebral small vessel disease: 0, 1, 2, 3, and 4. General clinical data were collected through physical examination reports and outpatient medical records. All participants underwent a 3T brain magnetic resonance imaging (MRI), scan and data were collected to calculate the total cerebral small vessel disease score. Fasting venous blood samples were taken in the morning to measure thyroid hormone levels. Relationships between thyroid hormone levels and lacunar infarcts, microbleeds, white matter hyperintensities (WMH), enlarged perivascular spaces, and total cerebral small vessel disease score were analyzed using Spearman correlation. Multivariate ordinal logistic regression was also used to analyze factors associated with total cerebral small vessel disease score.Results:A total of 545 elderly individuals were included, with a mean age of (75.16±9.18) years, and 505 (92.7%) were male. The number of subjects with a total cerebral small vessel disease score of 0 were 207 (38.0%), 1 were 182 (33.4%), 2 were 99 (18.2%), 3 were 41 (7.5%), and 4 were 16 (2.9%). Statistical significant differences were found in age, fasting blood glucose, systolic blood pressure, triiodothyronine (TT3), free triiodothyronine (FT3), and the proportion of hypertensive patients among the groups (all P<0.05). Spearman correlation analysis showed that TT3 ( r=-0.138, P=0.001) and FT3 ( r=-0.213, P<0.001) were negatively correlated with total cerebral small vessel disease score. Multivariate ordinal logistic regression analysis revealed that age was independently and positively associated with total cerebral small vessel disease score ( OR=1.139, 95% CI: 1.087-1.193, P<0.001), while FT3 was independently and negatively associated with total cerebral small vessel disease score ( OR=0.331, 95% CI: 0.118-0.929, P=0.009). Conclusion:In the elderly population, FT3 levels are independently and negatively associated with total cerebral small vessel disease score.

Objective:To analyze the effect of carbapenem antibiotics on the blood concentration of valproate(VPA)in elderly patients with epilepsy, while also exploring the potential drug interactions between carbapenem antibiotics and VPA, as well as possible solutions.Methods:This retrospective study included patients aged 80 years and older who were treated with a combination of VPA and carbapenem antibiotics in the Department of Geriatrics at Beijing Hospital from January 2017 to December 2022, as well as older hospitalized patients with epilepsy.Data collected encompassed patients' demographic information, details related to epilepsy, information on infection medications, changes in VPA blood concentration, clinical management, and clinical outcomes.Results:A total of 12 patients were included in the study.The average age of the participants was 92±7.0 years.The baseline dosage of VPA was 1 000 mg(range: 650 to 1 250 mg), and the baseline VPA serum concentration was 56.59 mg/L(range: 38.00 to 61.73 mg/L)during treatment with carbapenem antibiotics.Nine patients experienced seizure recurrence during the combination therapy, representing 75% of the total cohort.The VPA dosage was increased in 10 patients, with a mean increase of 522 mg(range: 200 to 892 mg), and the duration of this dosage increase was 8 days(range: 7 to 9 days).All patients exhibited a decrease in VPA serum concentration, with the lowest concentration decreasing by an average of 71.9%±15.69%.The VPA serum concentration during carbapenem treatment was significantly lower than both the baseline and post-withdrawal concentrations, measuring 12.30 mg/L(range: 10.49 to 22.47 mg/L)compared to 56.59 mg/L(range: 38.00 to 61.73 mg/L)( Z=-3.059, P=0.002)and 43.74 mg/L(range: 41.48 to 73.14 mg/L)( Z=-2.803, P=0.005). Conclusions:Carbapenems can markedly decrease serum concentrations of VPA and heighten the incidence of seizures in elderly patients with epilepsy.Increasing the dose of VPA may not enhance its serum concentration; therefore, we recommend avoiding the concomitant use of VPA and carbapenems.

This study investigated the effect of small RNA ncBCG201 on the stress adaptation and intracellular survival of Myco-bacterium bovis.Differentially expressed ncRNAs were screened with RNA-seq after BCG infection of THP-1 macrophages.The ncBCG201 overexpression strain was constructed,and its stress survival,growth,biofilm formation,and intracellular survival were assessed.The ncBCG201 strain showed slower growth and earlier entry into stationary phase.Survival significantly increased under car-bon starvation but decreased under membrane pressure.Biofilm formation capability decreased.Intracellular survival in THP-1 macro-phages at 24 h and 48 h was significantly higher than observed in the control.Therefore,ncBCG204 enhances BCG survival within macrophages by modulating stress adaptability.

This study investigated the effect of small RNA ncBCG201 on the stress adaptation and intracellular survival of Myco-bacterium bovis.Differentially expressed ncRNAs were screened with RNA-seq after BCG infection of THP-1 macrophages.The ncBCG201 overexpression strain was constructed,and its stress survival,growth,biofilm formation,and intracellular survival were assessed.The ncBCG201 strain showed slower growth and earlier entry into stationary phase.Survival significantly increased under car-bon starvation but decreased under membrane pressure.Biofilm formation capability decreased.Intracellular survival in THP-1 macro-phages at 24 h and 48 h was significantly higher than observed in the control.Therefore,ncBCG204 enhances BCG survival within macrophages by modulating stress adaptability.

Objective:To investigate the correlation between thyroid function and the total cerebral small vessel disease score in the elderly.Methods:This cross-sectional study included elderly people who underwent physical examinations at the Geriatrics Department of Beijing Hospital from April 2019 to December 2020. Participants were devided into 5 groups based on the total score of cerebral small vessel disease: 0, 1, 2, 3, and 4. General clinical data were collected through physical examination reports and outpatient medical records. All participants underwent a 3T brain magnetic resonance imaging (MRI), scan and data were collected to calculate the total cerebral small vessel disease score. Fasting venous blood samples were taken in the morning to measure thyroid hormone levels. Relationships between thyroid hormone levels and lacunar infarcts, microbleeds, white matter hyperintensities (WMH), enlarged perivascular spaces, and total cerebral small vessel disease score were analyzed using Spearman correlation. Multivariate ordinal logistic regression was also used to analyze factors associated with total cerebral small vessel disease score.Results:A total of 545 elderly individuals were included, with a mean age of (75.16±9.18) years, and 505 (92.7%) were male. The number of subjects with a total cerebral small vessel disease score of 0 were 207 (38.0%), 1 were 182 (33.4%), 2 were 99 (18.2%), 3 were 41 (7.5%), and 4 were 16 (2.9%). Statistical significant differences were found in age, fasting blood glucose, systolic blood pressure, triiodothyronine (TT3), free triiodothyronine (FT3), and the proportion of hypertensive patients among the groups (all P<0.05). Spearman correlation analysis showed that TT3 ( r=-0.138, P=0.001) and FT3 ( r=-0.213, P<0.001) were negatively correlated with total cerebral small vessel disease score. Multivariate ordinal logistic regression analysis revealed that age was independently and positively associated with total cerebral small vessel disease score ( OR=1.139, 95% CI: 1.087-1.193, P<0.001), while FT3 was independently and negatively associated with total cerebral small vessel disease score ( OR=0.331, 95% CI: 0.118-0.929, P=0.009). Conclusion:In the elderly population, FT3 levels are independently and negatively associated with total cerebral small vessel disease score.

Objective:To analyze the effect of carbapenem antibiotics on the blood concentration of valproate(VPA)in elderly patients with epilepsy, while also exploring the potential drug interactions between carbapenem antibiotics and VPA, as well as possible solutions.Methods:This retrospective study included patients aged 80 years and older who were treated with a combination of VPA and carbapenem antibiotics in the Department of Geriatrics at Beijing Hospital from January 2017 to December 2022, as well as older hospitalized patients with epilepsy.Data collected encompassed patients' demographic information, details related to epilepsy, information on infection medications, changes in VPA blood concentration, clinical management, and clinical outcomes.Results:A total of 12 patients were included in the study.The average age of the participants was 92±7.0 years.The baseline dosage of VPA was 1 000 mg(range: 650 to 1 250 mg), and the baseline VPA serum concentration was 56.59 mg/L(range: 38.00 to 61.73 mg/L)during treatment with carbapenem antibiotics.Nine patients experienced seizure recurrence during the combination therapy, representing 75% of the total cohort.The VPA dosage was increased in 10 patients, with a mean increase of 522 mg(range: 200 to 892 mg), and the duration of this dosage increase was 8 days(range: 7 to 9 days).All patients exhibited a decrease in VPA serum concentration, with the lowest concentration decreasing by an average of 71.9%±15.69%.The VPA serum concentration during carbapenem treatment was significantly lower than both the baseline and post-withdrawal concentrations, measuring 12.30 mg/L(range: 10.49 to 22.47 mg/L)compared to 56.59 mg/L(range: 38.00 to 61.73 mg/L)( Z=-3.059, P=0.002)and 43.74 mg/L(range: 41.48 to 73.14 mg/L)( Z=-2.803, P=0.005). Conclusions:Carbapenems can markedly decrease serum concentrations of VPA and heighten the incidence of seizures in elderly patients with epilepsy.Increasing the dose of VPA may not enhance its serum concentration; therefore, we recommend avoiding the concomitant use of VPA and carbapenems.

To investigate the current situation and demand for specialized development of allergy nursing in 88 hospitals in Guangdong Province, as well as to provide evidence for the management of allergy nursing. From August to December 2023, a cross-sectional study was conducted to analyze the core managers of allergy nursing-related work in eighty-eight hospitals in Guangdong Province supported by the Allergy Nursing Branch of the Guangdong Nurses Association and the Nursing Group of the Allergy Branch of the Guangdong Medical Association. An online survey was conducted using the Delphi method to compile a questionnaire on the current status and demand for specialized development of allergy nursing in Guangdong Province. Chi-square tests and Fisher′s exact probability method were used to analyze the differences in the current status of specialty technology applications and the development and demand of specialized nursing between hospitals with or without allergy specialty departments. The results showed that among the eighty-eight hospitals in the nineteen prefecture-level cities surveyed in Guangdong Province, 17 hospitals (19%) had established allergy specialty departments, all of which were top-tier tertiary hospitals. The establishment duration [ M ( Q1, Q3)] was 3 (1, 10) years. The implementation rates of skin prick test (94%, 16/17), in-vitro examination (82%, 14/17), nasal endoscopy (82%, 14/17), subcutaneous specific immunotherapy (82%, 14/17), multidisciplinary consultation (65%, 11/17), fractional exhaled nitric oxide detection (47%, 8/17), skin patch test (41%, 7/17), and autologous serum skin test (35%, 6/17) in hospitals with allergy department were higher than those in hospitals without allergy department [59%, 42/71 ( χ 2= 7.462, P=0.006)], [54%, 38/71 ( χ 2= 4.717, P=0.030)], [51%, 36/71 ( χ 2= 5.599, P=0.018)], [34%, 24/71 ( χ 2= 13.177, P<0.001)], [24%, 17/71 ( χ 2= 10.505, P=0.001)], [24%, 17/71 ( χ 2= 5.540, P=0.019)], [11%, 8/71 (Fisher′s exact test, P=0.008)], [11%, 8/71 (Fisher′s exact test, P=0.025)]. In the development plan of allergy nursing in the next two years, hospitals that had set up allergy departments had a higher proportion in adding nurses (82%, 14/17, χ 2= 13.177, P<0.001), formulating specialized nurse training plans (71%, 12/17, χ 2= 3.980, P=0.046), formulating group standards or clinical guidelines (41%, 7/17, Fisher′s exact test, P=0.046), and formulating assessment standards (53%, 9/17, Fisher′s exact test, P=0.002). The demand for all aspects of allergy specialty nursing knowledge and skills accounted for more than 50%, and it was not related to whether the hospital set up an allergy department. In conclusion, the specialized development of allergy nursing in Guangdong province is still in its early stages, and there is a great demand for improving knowledge and skills in allergy. Further standardization of specialty construction is needed, along with the training of allergic nurses, to promote the comprehensive development of allergic reaction nursing specialties from point to area.

Objective:To survey the quality of medical care and management for chronic obstructive pulmonary disease (COPD) in Shanghai community health service centers.Methods:A questionnaire survey on the institutional capacity for COPD care was conducted among 248 community health service centers in Shanghai from October to November 2023; the contents of self-designed questionnaire included the equipment, drugs, technical support, information exchange and management of COPD in the institutions. At the same time, a questionnaire survey on the knowledge and skill of COPD care was also conducted among half of all physicians selected by stratified sampling from half of the institutions selected by the random cluster sampling, including the knowledge about early screening, diagnosis, treatment and management of COPD, and related training needs .Results:(1)Survey results showed that the most common equipment for diagnosis and treatment of COPD available in community health centers was pulse oxygen saturation detector (97.6%, 242/248), X-ray radiography (96.8%, 240/248) and nebulizer (96.0%, 238/248), The availability of 6-min walking test system, non-invasive ventilator and rehabilitation training instrument in urban community health service centers was higher than that in rural ones ( P<0.05). The availability rates of common COPD drugs in community health service centers were theophylline (91.5%, 227/248), oral glucocorticoid (85.9%, 213/248), intravenous glucocorticoid (81.0%, 201/248), the availability of oral and intravenous glucocorticoids in urban community health service centers was higher than that in rural ones ( P<0.05). The availability rates of COPD diagnosis and treatment techniques were 95.6% (213/248) for pulmonary function test, 93.5% (232/248) for pulse oxygen saturation test, and 53.2% (132/248) for non-invasive respiratory therapy. The availability rate of pulmonary function test, blood gas analysis, non-invasive ventilation and rehabilitation in urban centers was higher than that in rural centers ( P<0.05). Early screening of COPD was conducted in 85.1% (211/248) of community health service centers, the health record system and referral system were established in 66.5% (165/248) and 62.9% (156/248) of centers, respectively; and the establishment of outpatient and referral channels for respiratory diseases in urban areas was higher than that in rural areas ( P<0.05). (2)A total of 1 873 community doctors, aged(38.9±7.8)years and with (15.5±9.1)years of working experience, participated in the COPD knowledge and skill survey. The survey showed that 79.3% participants (1 485/1 873) knew the concept of COPD, 52.6% (986/1 873) mastered the diagnostic criteria, 41.6% (779/1 873) knew the risk factors and 15.5% (291/1 873) mastered the application of glucocorticoids. More than 79% of the community doctors showed the needs for training of knowledge, skills, rehabilitation of COPD and the performance of pulmonary function tests. Conclusion:Availability of COPD diagnosis and treatment equipment in community health center in Shanghai is different, and the availability of basic diagnosis and treatment equipment and drugs is better. The knowledge, skills and management of COPD need to be improved for community doctors, particularly in clinical application of pulmonary function test and active case finding.

To investigate the current situation and demand for specialized development of allergy nursing in 88 hospitals in Guangdong Province, as well as to provide evidence for the management of allergy nursing. From August to December 2023, a cross-sectional study was conducted to analyze the core managers of allergy nursing-related work in eighty-eight hospitals in Guangdong Province supported by the Allergy Nursing Branch of the Guangdong Nurses Association and the Nursing Group of the Allergy Branch of the Guangdong Medical Association. An online survey was conducted using the Delphi method to compile a questionnaire on the current status and demand for specialized development of allergy nursing in Guangdong Province. Chi-square tests and Fisher′s exact probability method were used to analyze the differences in the current status of specialty technology applications and the development and demand of specialized nursing between hospitals with or without allergy specialty departments. The results showed that among the eighty-eight hospitals in the nineteen prefecture-level cities surveyed in Guangdong Province, 17 hospitals (19%) had established allergy specialty departments, all of which were top-tier tertiary hospitals. The establishment duration [ M ( Q1, Q3)] was 3 (1, 10) years. The implementation rates of skin prick test (94%, 16/17), in-vitro examination (82%, 14/17), nasal endoscopy (82%, 14/17), subcutaneous specific immunotherapy (82%, 14/17), multidisciplinary consultation (65%, 11/17), fractional exhaled nitric oxide detection (47%, 8/17), skin patch test (41%, 7/17), and autologous serum skin test (35%, 6/17) in hospitals with allergy department were higher than those in hospitals without allergy department [59%, 42/71 ( χ 2= 7.462, P=0.006)], [54%, 38/71 ( χ 2= 4.717, P=0.030)], [51%, 36/71 ( χ 2= 5.599, P=0.018)], [34%, 24/71 ( χ 2= 13.177, P<0.001)], [24%, 17/71 ( χ 2= 10.505, P=0.001)], [24%, 17/71 ( χ 2= 5.540, P=0.019)], [11%, 8/71 (Fisher′s exact test, P=0.008)], [11%, 8/71 (Fisher′s exact test, P=0.025)]. In the development plan of allergy nursing in the next two years, hospitals that had set up allergy departments had a higher proportion in adding nurses (82%, 14/17, χ 2= 13.177, P<0.001), formulating specialized nurse training plans (71%, 12/17, χ 2= 3.980, P=0.046), formulating group standards or clinical guidelines (41%, 7/17, Fisher′s exact test, P=0.046), and formulating assessment standards (53%, 9/17, Fisher′s exact test, P=0.002). The demand for all aspects of allergy specialty nursing knowledge and skills accounted for more than 50%, and it was not related to whether the hospital set up an allergy department. In conclusion, the specialized development of allergy nursing in Guangdong province is still in its early stages, and there is a great demand for improving knowledge and skills in allergy. Further standardization of specialty construction is needed, along with the training of allergic nurses, to promote the comprehensive development of allergic reaction nursing specialties from point to area.

Bile acids(BAs)are synthesized by the liver from cholesterol through several complementary pathways and aberrant cholesterol metabolism plays pivotal roles in the pathogeneses of cholesterol gallbladder polyps(CGP)and cholesterol gallstones(CGS).To date,there is neither systematic study on BAs profile of CGP or CGS,nor the relationship between them.To explore the metabolomics profile of plasma BAs in healthy volunteers,CGP and CGS patients,an ultra-performance liquid chromatography-tandem mass spectrometry(UPLC-MS/MS)method was developed and validated for simultaneous determination of 42 free and conjugated BAs in human plasma.The developed method was sensitive and reproducible to be applied for the quantification of BAs in the investigation of plasma samples.The results show that,compared to healthy volunteers,CGP and CGS were both characterized by the significant decrease in plasma BAs pool size,furthermore CGP and CGS shared aberrant BAs metabolic characteristics.Cheno-deoxycholic acid,glycochenodeoxycholic acid,λ-muricholic acid,deoxycholic acid,and 7-ketolithocholic acid were shared potential markers of these two cholesterol gallbladder diseases.Subsequent analysis showed that clinical characteristics including cysteine,ornithine and body mass index might be closely related to metabolisms of certain BA modules.This work provides metabolomic information for the study of gallbladder diseases and analytical methodologies for clinical target analysis and efficacy evaluation related to BAs in medical institutions.