OBJECTIVE To understand the epidemiological characteristics and change of drug resistance of Klebsiel-la pneumoniae strains from a hospital so as to adjust the use of antibiotics and control the transmission of hospital-associated infection caused by the K.pneumoniae.METHODS The K.pneumoniae strains were isolated from the patients who were hospitalized in The 305 Hospital of PLA from 2018 to 2022.The data of drug susceptibility tes-ting were exported by using WHONET 5.6,the clinical data and changing trend of drug resistance were retro-spectively analyzed with the use of SPSS 25.0 software.RESULTS Totally 9157 strains of bacteria were isolated from the patients who were hospitalized from 2018 to 2022,1502(16.40％)of which were K.pneumoniae,and the isolation rate showed a downward trend(x2=15.054,P＜0.001).Sputum(77.16％)was the major type of specimen;the strains were mainly isolated from intensive care unit(55.26％).The patients aged more than 79 years old were dominant,accounting for 65.58％.The result of drug susceptibility testing showed that there were significant differences in the drug resistance rates to the commonly used antibiotics from 2018 to 2022(P＜0.05).The drug resistance rates to aztreonam,ertapenem and tigecycline showed upward trends with the years(P＜0.05),while the drug resistance rates to the rest of drugs such as cefoperazone-sulbactam,ceftazidime and amika-cin showed downward trends(P＜0.05).CONCLUSIONS There is significant difference in the clinical distribution of the K.pneumoniae strains in recent 5 years.The key populations and departments should be attached great im-portance to.The drug resistance rates of the K.pneumoniae strains to many types of antibiotics show downward trends,but the situation of drug resistance is still serious.It is necessary to continue to implement the prevention and control policies for drug resistance and reasonably use antibiotics based on the result of drug susceptibility testing.

OBJECTIVE To understand the epidemiological characteristics and change of drug resistance of Klebsiel-la pneumoniae strains from a hospital so as to adjust the use of antibiotics and control the transmission of hospital-associated infection caused by the K.pneumoniae.METHODS The K.pneumoniae strains were isolated from the patients who were hospitalized in The 305 Hospital of PLA from 2018 to 2022.The data of drug susceptibility tes-ting were exported by using WHONET 5.6,the clinical data and changing trend of drug resistance were retro-spectively analyzed with the use of SPSS 25.0 software.RESULTS Totally 9157 strains of bacteria were isolated from the patients who were hospitalized from 2018 to 2022,1502(16.40％)of which were K.pneumoniae,and the isolation rate showed a downward trend(x2=15.054,P＜0.001).Sputum(77.16％)was the major type of specimen;the strains were mainly isolated from intensive care unit(55.26％).The patients aged more than 79 years old were dominant,accounting for 65.58％.The result of drug susceptibility testing showed that there were significant differences in the drug resistance rates to the commonly used antibiotics from 2018 to 2022(P＜0.05).The drug resistance rates to aztreonam,ertapenem and tigecycline showed upward trends with the years(P＜0.05),while the drug resistance rates to the rest of drugs such as cefoperazone-sulbactam,ceftazidime and amika-cin showed downward trends(P＜0.05).CONCLUSIONS There is significant difference in the clinical distribution of the K.pneumoniae strains in recent 5 years.The key populations and departments should be attached great im-portance to.The drug resistance rates of the K.pneumoniae strains to many types of antibiotics show downward trends,but the situation of drug resistance is still serious.It is necessary to continue to implement the prevention and control policies for drug resistance and reasonably use antibiotics based on the result of drug susceptibility testing.

【Objective】 To estimate the prevalence, associated factors and patterns of multimorbidity of non-communicable diseases among adults in Shaanxi Province so as to provide evidence for the prevention and control of non-communicable diseases. 【Methods】 We used the data of adults aged 18 years and older collected in the baseline survey of Shaanxi Project in the Regional Ethnic Cohort Study in Northwest China. Multinomial logistic regression was used to explore the associated factors for multimorbidity. Exploratory factor analysis was used to extract patterns of multimorbidity. 【Results】 The prevalence of multimorbidity was 10.7% among the 44 442 participants. Age increase, being males, urban residence, and being overweight or obesity were positively associated with multimorbidity. Compared with women, men had a higher risk of multimorbidity. The OR and 95% CI was 1.25 (1.12-1.39). The risk of multimorbidity increased with age among adults. Compared with participants aged 18.0-34.9 years, the ORs and 95% CIs of those aged 35.0-44.9, 45.0-54.9, 55.0-64.9, and ≥65.0 years were 4.73 (3.47-6.46), 15.61 (11.60-21.00), 41.39 (30.76-55.70) and 90.04 (66.58-121.77), respectively. The primary multimorbidity patterns among adults in Shaanxi were cardiovascular-metabolic multimorbidity (5.4%), viscero-articular multimorbidity (1.0%), and respiratory multimorbidity (0.3%). 【Conclusion】 More than one in ten adults in Shaanxi Province had multimorbidity, and the predominant pattern of multimorbidity was cardiovascular-metabolic multimorbidity. The prevention and control of non-communicable diseases should be reinforced in middle-aged and older people, males, people living in the urban, and overweight or obese people. More attention should be paid to the prevention and control of cardiovascular-metabolic diseases.

【Objective】 To evaluate the dietary quality with the dietary balance index (DBI_16) and the association between dietary quality and bone mass among middle-aged and elderly people in Gansu Province so as to provide evidence for improving dietary quality and bone health status of Gansu population. 【Methods】 Based on the information of the type and quantity of food intake and the bone mass of middle-aged and elderly people aged 35 years and above collected by the Gansu Project in the Regional Ethnic Cohort Study in Northwest China, DBI_16 was used to evaluate the intake level of cereals, vegetables, fruits, milk, beans, fish and shrimp, eggs and other foods, and the degree of inadequate, excessive and unbalanced dietary intake of the participants. Multiple linear regression was used to evaluate the associations of three component indexes of DBI_16, high bound score (DBI_HBS), low bound score (DBI_LBS), diet quality distance (DBI_DQD), and seven single indexes of DBI_16 with bone mass. 【Results】 Analyses of the dietary and bone mass data of 11,840 participants showed that 44.8% of participants consumed excessive amounts of cereals compared to the dietary recommendation. 96.3%, 90.6%, 90.1%, 71.9%, 95.1% and 60.3% of participants’ intake of vegetables, fruits, milk, soybeans, fish and shrimp, and eggs, respectively, were inadequate. 47.7% participants consumed less than 10 types of food. 2.3% participants’ DBI_LBS levels were appropriate. 54.7% participants’ DBI_HBS levels were appropriate. Only 1.2% participants’ DBI_DQD reached a balanced level. The bone mass level in the study population was (2.5±0.6) kg [(2.8±0.5) kg for men and (2.3±0.5) kg for women]. After adjusting for sociodemographic characteristics, lifestyle, total dietary energy intake and body mass index, DBI_LBS and DBI_DQD were negatively associated with bone mass [β and 95% CI was -0.002 01 (-0.003 62--0.000 40) and -0.001 76 (-0.003 09--0.000 43), respectively]. 【Conclusion】 Dietary intake imbalance is common among middle-aged and elderly people in Gansu Province, and the more severe the dietary intake imbalance, the lower the bone mass level.

Objective:To investigate the gut microbiota composition in subclinical hypothyroidism and euthyroidism patients with Hashimoto′s thyroiditis, and its relationship with clinical indicators and inflammatory factors.Methods:A total of 48 patients diagnosed with Hashimoto′s thyroiditis and 28 healthy controls(HC group) were enrolled from Henan Provincial People′s Hospital from July 2019 to March 2022 in this cross-sectional study. According to thyroid function, 18 patients with Hashimoto′s thyroiditis were divided into subclinical hypothyroidism group(SH group) and 30 patients in euthyroidism function group(Eu group). Fecal microbial composition was detected by 16S rRNA sequencing technology, and peripheral blood was collected to test clinical indicators and inflammatory factors.Results:Compared with HC group, there were significant differences in α and β diversity of gut microbiota in SH and Eu group( P=0.045, P=0.037). At the phylum level, Firmicutes, Bacteroidota, and Proteobacteria were the dominant phylum in the three groups. At the genus level, the abundance of 4 bacterial genera increased gradually in HC group, Eu group, and SH group, including Streptococcus, Comamonas, Elizabethkingia, Achromobacter. However, the abundance of the other 9 genera decreased gradually, such as Subdoligranulum, Coprococcus, Oscillospirales_ UCG-010, Clostridia_ UCG-014, Oscillospiraceae_ UCG-002, Alistipes et al. In addition, the level of serum B-cell activating factor was positively correlated with several bacterial genera such as Achromobacter, Streptococcus, Intestinibacter et al. Conclusion:There are differences in the gut microbiota structure of patients with Hashimoto′s thyroiditis in different thyroid functional states, which is correlated with inflammatory factors.

Objective:To investigate whether FcγRⅡb rs775 single nucleotide polymorphism confers susceptibility to Hashimoto′s thyroiditis and its impact on expression of FcγRⅡb protein on B cell surface.Methods:A total of 187 Hashimoto′s thyroiditis patients(HT group) were enrolled, including 46 males(24.60%) and 141 females(75.40%), with a median age of 43(32, 53) years, and 187 healthy controls(conrol group), including 62 males(33.16%) and 125 females(66.84%), with a median age of 41(31, 51) years. The peripheral blood of two groups were sequenced, genotype and allele frequencies distribution of FcγRⅡb rs775 T>C were compared with clinical parameters as strata between the two groups. At the same time, the expression of inhibitory receptor FcγRⅡb on B cell surface was detected using flow cytometry.Results:Compared with control group, the mutant homozygous CC genotype was obviously enrichment in HT group( OR=3.321, 95% CI 1.175-9.386, P=0.018), and the proportion of CC genotype increased in male of HT group( P=0.076). However, there is no significant difference in genotype and allele frequencies between control group and HT group after stratification by sex. In addition, the percentage of FcγRⅡb on B cell surface decreased significantly in HT group( P=0.029). Conclusion:There was no significant correlation between FcγRⅡb polymorphism and the down-regulation of FcγRⅡb protein on B cell surface in Hashimoto′s thyroiditis patients, and FcγRⅡb can be a predisposed factor for Hashimoto′s thyroiditis.

To retrospectively analyze the efficacy of intravenous deep sedation for uncooperative pe-diatric patients undergoing oral treatment in outpatient clinic.The uncooperative pediatric patients,aged 2-10 yr,with an expected treatment time＜2 h,who underwent oral treatment in outpatient clinic from No-vember 2015 to October 2018,were selected.Dexmedetomidine was delivered via nasal spray,midazolam was taken orally or delivered via nasal spray,and sevoflurane was inhaled for sedation before treatment.Propofol was administered by target-controlled infusion during treatment to make patients achieve deep seda-tion.A total of 251 patients were enrolled and successfully completed oral therapy.Sedation before treat-ment: 154 cases(61.4％)received dexmedetomidine via nasal spray delivery,14 cases(5.6％)received oral midazolam,3 cases(1.2％)received midazolam via nasal spray delivery,and 80 cases(31.9％)in-haled sevoflurane,and ideal sedation(Ramsay sedation score≥4)was achieved in each pediatric patients.Temporary interruption of oral treatment due to physical activity occurred in 39 cases(15.5％),coughing occurred in 39 cases(15.5％),transient hypoxemia(time＜ 30 s)was found in 32 cases(12.9％),and these conditions returned to normal within 30 s through pausing the operation,deepening anesthesia,oral suction,lower jaw thrust or inhaling oxygen,etc.Only 1 case developed emergence agitation(Riker seda-tion-agitation scale score 5)during stay in the recovery room.No patients developed complications such as sore throat,vomiting,aspiration or obstruction of the upper respiratory tract.Intravenous deep sedation technique can be used for oral treatment in outpatient clinic in uncooperative pediatric outpatients and raise comfort of medical treatment for pediatric patients.

To retrospectively analyze the efficacy of intravenous deep sedation for uncooperative pediatric patients undergoing oral treatment in outpatient clinic.The uncooperative pediatric patients, aged 2-10 yr, with an expected treatment time<2 h, who underwent oral treatment in outpatient clinic from November 2015 to October 2018, were selected.Dexmedetomidine was delivered via nasal spray, midazolam was taken orally or delivered via nasal spray, and sevoflurane was inhaled for sedation before treatment.Propofol was administered by target-controlled infusion during treatment to make patients achieve deep sedation.A total of 251 patients were enrolled and successfully completed oral therapy.Sedation before treatment: 154 cases (61.4%) received dexmedetomidine via nasal spray delivery, 14 cases (5.6%) received oral midazolam, 3 cases (1.2%) received midazolam via nasal spray delivery, and 80 cases (31.9%) inhaled sevoflurane, and ideal sedation (Ramsay sedation score ≥4) was achieved in each pediatric patients.Temporary interruption of oral treatment due to physical activity occurred in 39 cases (15.5%), coughing occurred in 39 cases (15.5%), transient hypoxemia (time< 30 s) was found in 32 cases (12.9%), and these conditions returned to normal within 30 s through pausing the operation, deepening anesthesia, oral suction, lower jaw thrust or inhaling oxygen, etc.Only 1 case developed emergence agitation (Riker sedation-agitation scale score 5) during stay in the recovery room.No patients developed complications such as sore throat, vomiting, aspiration or obstruction of the upper respiratory tract.Intravenous deep sedation technique can be used for oral treatment in outpatient clinic in uncooperative pediatric outpatients and raise comfort of medical treatment for pediatric patients.

Objective To investigate the efficacy of rosuvastatin combined with silibinin capsule in treatment of hyperlipidemic patients with nonalcoholic fatty liver disease.Methods One hundred and nineteen hyperlipidemic patients with non-alcoholic fatty liver disease admitted in hospital from January 2016 to March 2017 were randomly assigned into two groups:60 patients received rosuvastatin(10 mg,q.d) and silibinin capsules(70 mg,t.i.d.,study group) and 59 patients received starch tablets(10 mg,q.d) and silibinin capsules(70 mg,t.i.d.,control group).The blood lipid,liver function,inflammatory factors,liver CT value,the specific CT value of liver and spleen were compared at baseline and 6 months after intervention.Results Compared to baseline values,the levels of total cholesterol (TC),triglyceride (TG),alanine aminotransferase (ALT),γ-glutamyltranspeptidase (GGT),TNF-α,IL-6,and CRP were decreased (t=2.44,2.04,2.48,6.95,2.38,2.78,3.97,all P＜0.05);and the levels of HDL-C,liver CT value,liver/spleen CT value ratio were increased (t=5.44,2.26,2.08,all P＜0.05) after treatment in study group.The improvement of TG,LDL-C,ALT,GGT,TNF-α,CRP,liver CT value,liver/spleen CT value ratio were more marked than those of the control group (P＜0.05) (t=1.92,2.65,2.02,5.62,2.11,2.20,2.22,2.08,all P＜0.05).The effective rate of study group was higher than that of the control group[98.2％(55/56) vs.85.7％(48/56),x2=2.05,P=0.04];the adverse reactions were similar in two groups.Conclusion Compared with silibinin alone,rosuvastatin combined with silibinin capsules is more effective in treatment of hyperlipidemic patients with nonalcoholic fatty liver disease,which can significantly improve the blood lipids,liver function,inflammatory response and aliphatic degree without increase of adverse reaction.

Objective:To investigate the dose-effect relationship of Xianfu ointment and its decomposed recipes the 1-chloro-2,4-dini-trochlorobenzene(DNCB) induced chronic eczema in mice, and confirm the median effective dose (ED50) of each formula and the synergetic effect by compatibility. Methods:DNCB was used to induce chronic eczema in C57 mice. The mice were treated with gradient dosages of the Xianfu ointment (11.71-11 662.50 mg?kg-1?d-1,k = 0.316), Anemone flaccid (0.53-530.12 mg?kg-1?d-1,k = 0.316), Xianfu ointment without Anemone flaccid (11.18-11 132.40 mg?kg-1?d-1,k =0.316),respectively. The pathological features were observed after hematoxylin-eosin staining. The volume ratio of epidermides and the number of lymphocyte infiltrated in dermis were analyzed with morphometry. The serum levels of IL-2,IFN-γ,IL-4,and IL-13 were detected by ELISA assay. The ED50was calculated by non-linear regression with various slope using Prism-5.0 software.Results:The effects of Xianfu ointment and its decomposed recipes on chronic eczema showed a dose-dependent tendency. The dose-response curves showed"S"shape. The efficacy of Xianfu ointment on chronic eczema was the most significant among the three formulas, which was demonstrated by decreased epidemical thicknes (ED50= 377.90 mg?kg-1?d-1), reduced infiltrated lymphocyte number(ED50= 153.20 mg?kg-1?d-1), increased serum IL-2(ED50=608.90 mg?kg-1?d-1) and IFN-γ (ED50= 205.50 mg?kg-1?d-1) levels, and decreased serum IL-4(ED50= 198.70 mg?kg-1?d-1) and IL-13 levels (ED50= 117.60 mg?kg-1?d-1). And the dose-effect curves of Anemone flaccid and Xianfu ointment without Anemone flaccid groups were both right shift when compared with that of Xianfu ointment. Conclusion:Xianfu ointment and its decomposed recipes can effectively treat chronic eczema. Anemone flaccid has obvious compatibility synergy in the whole formula. The effects of Xianfu ointment is most significant.