Objective For more focused prevention and management,this investigation examines the risk factors for multidrug resistant organisms(MDRO)infections in intensive care unit(ICU)patients.Methods Case-control studies and cohort studies of risk factors for MDRO infection in ICU patients were searched in the Embase,Website of Science,Cochrane Library,PubMed,CNKI,WanFang,and VIP databases from their start to October 26,2022.The Meta-analysis was carried out with RevMan 5.3.Results A total of 32 papers were included,with 10 985 cases studied,with the quality of the literature rated as moderate to high.The results of Meta-analysis of this study showed that gender[OR=1.21,95% CI=(1.08,1.36),P=0.002],ICU length of stay[WMD=5.36,95% CI=(3.99,6.73),P<0.000 01],total length of stay[WMD=8.96,95% CI=(6.51,11.41),P<0.000 01],hypertension[OR=1.33,95% CI=(1.10,1.60),P=0.003],abnormal renal function[OR=1.69,95% CI=(1.33,2.16),P<0.000 01],hypoproteinemia[OR=1.87,95% CI=(1.51,2.32),P<0.000 01],mechanical ventilation[OR=2.26,95% CI=(1.18,4.33),P=0.01],duration of mechanical ventilation[WMD=8.83,95% CI=(2.52,15.14),P=0.006],arteriovenous placement[OR=1.46,95% CI=(1.23,1.72),P<0.000 1],placement of urinary catheter[OR=1.71,95% CI=(1.25,2.36),P<0.000 01],gastrointestinal tube placement[OR=0.10,95% CI=(0.03,0.18),P=0.008],antimicrobial drug type≥3[OR=4.27,95% CI=(2.06,8.85),P<0.000 01],use of carbapenem antibiotics[OR=4.09,95% CI=(300,5.58),P<0.000 01],the use of the third-generation cephalosporin[OR=1.63,95% CI=(1.15,2.33),P=0.007],the use of quinolone antibacterials[OR=1.86,95% CI=(1.42,2.44),P<0.000 01],the use of aminoglycoside antibiotics[OR=1.99,95% CI=(1.49,2.67),P<0.000 01],use of piperacillin-tazobactam[OR=2.94,95% CI=(1.56,5.54),P=0.000 9],use of glycopeptide antibiotics[OR=3.78,95% CI=(2.48,5.78),P<0.000 01],use of sedatives[OR=3.25,95% CI=(2.06,5.14),P<0.000 01],and use of acid suppressants[OR=1.51,95% CI=(1.06,2.16),P=0.02]are risk factors for MDRO infection in ICU patients.Conclusion MDRO infections in ICU patients are associated with gender,duration of ICU stay,chronic lung disease,total length of stay,hypertension,abnormal renal function,hypoproteinemia,mechanical ventilation,duration of mechanical ventilation,arteriovenous placement,placement of urinary catheters,gastrointestinal placement,type of antimicrobial drugs≥3,use of carbapenem antibiotics,use of third-generation cephalosporin,use of quinolone antibacterials,use of aminoglycoside antibiotics,use of piperacillin-tazobactam,use of glycopeptide antibiotics,use of sedatives,use of acid suppressants,and other factors.Targeted controls of different factors such as underlying diseases,comorbidities,invasive procedures performed,and the use of antimicrobial medications and other therapeutic pharmaceuticals could limit the risk of infection in MDRO in ICU patients.

Rheumatic autoimmune diseases are chronic conditions affecting multiple systems,pre-dominantly occurring in young women of childbear-ing age.Given the nature of diseases and unique physiological changes during pregnancy,they may adversely impact pregnancy outcomes and endan-ger maternal and fetal health.In recent years,with the deepening of immunological research,biologi-cally targeted therapy has gradually become a fo-cus of attention in the treatment of rheumatic au-toimmune diseases in pregnancy.Biologics effec-tively alleviate disease symptoms,mitigate preg-nancy complications,and improve adverse preg-nancy outcomes by targeting pivotal inflammatory factors.The review systematically discusses the structure and pharmacokinetic characteristics of bi-ologics,and comprehensively reviews the current application and future prospects in managing rheu-matic autoimmune diseases in pregnancy based on their specific targets.It aims to provide scientific references and guidance on the safe administration of medications and therapeutic strategies for these patients,ultimately enhancing health outcomes for mothers and infants.

Rheumatic autoimmune diseases are chronic conditions affecting multiple systems,pre-dominantly occurring in young women of childbear-ing age.Given the nature of diseases and unique physiological changes during pregnancy,they may adversely impact pregnancy outcomes and endan-ger maternal and fetal health.In recent years,with the deepening of immunological research,biologi-cally targeted therapy has gradually become a fo-cus of attention in the treatment of rheumatic au-toimmune diseases in pregnancy.Biologics effec-tively alleviate disease symptoms,mitigate preg-nancy complications,and improve adverse preg-nancy outcomes by targeting pivotal inflammatory factors.The review systematically discusses the structure and pharmacokinetic characteristics of bi-ologics,and comprehensively reviews the current application and future prospects in managing rheu-matic autoimmune diseases in pregnancy based on their specific targets.It aims to provide scientific references and guidance on the safe administration of medications and therapeutic strategies for these patients,ultimately enhancing health outcomes for mothers and infants.

OBJECTIVE: To evaluate the classification criteria of early rheumatoid arthritis (ERA) and compare the sensitivity and specificity with the criteria of 1987 American College of Rheumatology (ACR) criteria and 2010 ACR/European League Against Rheumatism (EULAR). METHODS: Patients from 4 hospitals, aged more than 16 years, with arthritis, whose disease duration was ≤1 year, and with ≥1 joint pain and swelling were enrolled in the study. The indicators including clinical manifestations, laboratory tests and imaging examinations were observed. The ERA patients were dignosed by two experienced rheumatologists based on the clinical features, drug therapy information and radiography features. RESULTS: (1) A total of 325 patients with arthritis were enrolled, including 98 males (30.15%) and 227 females (69.85%), The average age was (47.53±14.44) years, and the median disease duration was 5 (2, 8) months. Finally, 236 patients were dignosed with ERA, and 89 patients were dignosed with other diseases (Non-ERA, including osteoarthritis, reactive arthritis, undifferentiated arthritis, spondyloarthritis, etc). (2) The sensitivity of ERA criteria was 87.29%, and the specificity was 84.37%. The sensitivity was higher than that of 1987 ACR criteria (χ²=43.641, P < 0.001), and had no significant difference compared with 2010 ACR/EULAR criteria (χ²=0.446, P=0.593). But the specificity of ERA criteria was lower than that of 1987 ACR criteria (χ²=4.891, P=0.027), which was not statistically significant compared with 2010 ACR/EULAR criteria (χ²=0.044, P=1.000). (3) In the patients with arthritis whose disease duration was ≤3 months and ≤6 months, the sensitivity of ERA criteria was 81.71% and 86.79%, respectively, both were higher than the 1987 ACR criteria (χ²=7.131, P=0.008; χ²=22.015, P < 0.001) and had no statistically difference compared with the 2010 ACR/EULAR criteria (χ²=0.220, P=0.755; χ²=0.473, P=0.491). The differences of the three criteria in specificity were not statistically significant. (4) The three different classification criteria were consistent with the clinical diagnosis, among which the ERA criteria and 2010 ACR/EULAR criteria were slightly higher (Kappa>0.6). The results of the consistency comparison between the three criteria showed that the ERA criteria and 2010 ACR/EULAR criteria had a better consistency (Kappa=0.836). CONCLUSION The sensitivity of ERA classification criteria in the diagnosis of ERA was higher than that of 1987 ACR criteria, and was equivalent to that of 2010 ACR/EULAR criteria. There is no significant difference in specificity between these three criteria. The ERA criteria can also identify patients with RA at a very early stage in arthritis with disease duration ≤3 months.
Adolescent ; Adult ; Arthritis, Rheumatoid/diagnostic imaging* ; Female ; Humans ; Male ; Middle Aged ; Osteoarthritis ; Radiography ; Rheumatology ; Sensitivity and Specificity ; United States

A total of 115 patients with type 2 diabetes recruited from Quanzijie Township Health Service Center were divided into integrated management group (n=54) and specialist management group (n=61). Patients in integrated management group were managed by specialists, general practitioners (GPs) and community nurses jointly; while patients in specialist management group were managed by specialists only. Subjects were followed up every 4 weeks for 24 weeks. Total 366 person/time diabetes education courses were given to subjects in integrated management group during the intervention. After intervention, the fasting glucose, 2 h postprandial glucose and glycosylated hemoglobin were decreased significantly in both groups (P<0.05), while the triglyceride level in the integrated management group was significantly lower than that in the specialist management group (P<0.05). In conclusion, patients with type 2 diabetes managed by integrated mode can achieve similar glucose control effect as specialist management mode in primary care settings and their triglyceride level can be also significantly decreased.

Objective To kxplork thk valuk of dktkcting brain mktabolitks of prktkrm infants at full tkrm for prkdicting thk nkurodkvklopmkntal lkvkl,and to providk thk basis for karle clinical intkrvkntion. Methods Thirte casks of prktkrm infants wkrk collkctkd from thk Nkonatal Intknsivk Cark Rnit and Nkuro - Akhabilitation Dkpartmknt of Guangzhou Zomkn and Childrkn＇s Mkdical Ckntkr bktwkkn Mae 2015 and March 2016,thkn thke wkrk chkcckd be adopting brain magnktic rksonanck imaging and magnktic rksonanck spkctroscope at corrkctkd full tkrm,and assksskd be using Llbkrta Infant Motor Scalk(LIMS)and Gkskll dkvklopmkntal scalk kvaluation at corrkctkd agk of 6 months and corrkctkd of agk 1 ekar old. ResuIts In thk 30 casks of prktkrm infants,19 casks wkrk malk,11 casks wkrk fkmalk,and thk gkstational agk was 27+3 -31 wkkcs,and avkragk gkstational agk was(28. 8 ± 1. 0)wkkcs,and thk birth wkight was 800-1 400 g[(1 176. 3 ± 145. 1)g]. Thk stude found that meo-inositol( MI),MI╱crkatink( Cr)in basal ganglia wkrk nkgativkle corrklatkd with thk dkvklopmknt quotiknt at corrkctkd agk of 1 ekar old(r﹦ -0. 465,-0. 532;all P＜0. 05). Factic acid(Fac)╱Cr in hippocampus was nkgativkle corrklatkd with dkvklopmkntal quotiknt at corrkctkd agk of 6 months(r﹦ -0. 420,P＜0. 05);Fac,Fac╱Cr in pkrivkntricular wkrk nkgativkle corrklatkd with dkvklopmkntal quo-tiknt at corrkctkd agk of 1 ekar old(r ﹦ -0. 405,-0. 386;all P ＜0. 05). Fac╱Cr in pkrivkntricular was nkgativkle corrklatkd with LIMS scorks at corrkctkd agk 1 ekar old(r﹦ -0. 380,P＜0. 05);Fac,Fac╱Cr in ckrkbkllum wkrk nkga-tivkle corrklatkd with dkvklopmknt quotiknt at corrkctkd agk of 1 ekar old(r﹦ -0. 393,-0. 394;all P＜0. 05). Thkrk was no corrklation bktwkkn frontal lobk mktabolitks and nkurodkvklopmkntal lkvkl(P＞0. 05). ConcIusions Prktkrm infants brain mktabolitks at full tkrm contributk to prkdicting nkurodkvklopmkntal lkvkl. MI,Fac,MI╱Cr,Fac╱Cr ark of valuks for prkdicting nkurodkvklopmkntal lkvkl,and MI╱Cr is thk bkst prkdictor. Lmong frontal lobk,basal ganglia, hippocampus,pkrivkntricular and ckrkbkllum,thk pkrivkntricular is thk bkst arka for prkdicting nkurodkvklopmkntal lkvkl. Corrkctkd agk of 1 ekar old maebk thk bkst timk to prkdicting nkurodkvklopmkntal lkvkl.

Objective: To explore the effect of "diabetes specialists-community general practitioners-community nurse co-management mode" and "diabetes specialist management mode" on diabetic nephropathy (DN) in primary medical institutions. Methods: Patients with type 2 diabetes admitted to Quanzijie Health Clinic of Jimusar County of Xinjiang Uygur Autonomous Region from October 2017 to March 2018 were enrolled. The Patients were divided into co-management group or specialist management group according to their administrative villages. The treatment plans of the two groups were formulated with reference to the current guidelines. The subjects of the co-management group were jointly managed by a fixed team composed of diabetes specialists from Jimusar Traditional Chinese Medicine Hospital, community general practitioners and community nurses from Quanzijie Health Clinic, and required to attend diabetes education courses every month. The diabetes specialist of Jimusar Traditional Chinese Medicine Hospital was responsible for the formulation and management of the treatment plan of the research object. Follow-up was fulfilled once every 4 weeks for 24 weeks in two groups. Before and after intervention, blood glucose, blood pressure, urinary albumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR) as well as the utilization rate of angiotensin converting enzyme inhibitors/angiotensin Ⅱ receptor blocker (ACEI/ARB) were collected. Results: A total of 115 patients accomplished this study with 54 patients in co-management group and 61 patients in specialist management group. After 24 weeks of intervention, fasting glucose level, postprandial glucose level 2 hours after breakfast, glycosylated hemoglobin (HbA1c), Log UACR in co-management group and specialists management group were significantly decreased compared with baseline [fasting glucose level (mmol/L): 8.06±1.92 vs. 9.16±2.83, 8.21±2.10 vs. 9.06±1.89; postprandial glucose level 2 hours after breakfast (mmol/L): 12.26±3.78 vs. 14.11±5.28, 12.47±3.63 vs. 14.00±3.88; HbA1c: 0.074±0.014 vs. 0.082±0.023, 0.076±0.014 vs. 0.081±0.016; Log UACR (mg/g): 1.63±1.56 vs. 2.25±1.44, 1.84±1.65 vs. 2.43±1.56, all P < 0.05], but there was no statistical significance between the two groups [fasting glucose level (mmol/L): -1.10±0.47 vs. -0.85±0.36, postprandial glucose level 2 hours after breakfast (mmol/L): -1.85±0.88 vs. -1.53±0.68, HbA1c: -0.008±0.004 vs. -0.006±0.003, Log UACR (mg/g): -0.61±0.29 vs. -0.59±0.29, all P < 0.05]. There were no significant changes in blood pressure, serum creatinine and eGFR in the two groups before and after intervention. There were 18 and 24 patients with hypertension in co-management group and specialist management group, respectively. The utilization rates of ACEI/ARB in both groups after intervention were significantly higher than those before intervention [88.9% (16/18) vs. 22.2% (4/18), 95.8% (23/24) vs. 29.2% (7/24), both P < 0.01]. At the end of the study, the utilization rate of ACEI/ARB was similar between the two groups [88.9% (16/18) vs. 95.8% (23/24), P > 0.05]. Conclusion Both "diabetes specialists-community general practitioners-community nurse co-management mode" and "diabetes specialist management mode" can effectively decrease glucose levels and UACR levels of patients with type 2 diabetes as well as the standard use of antihypertensive agents, which has positive effects on the prevention and treatment on DN.

OBJECTIVE: To explore the effect of "diabetes specialists-community general practitioners-community nurse co-management mode" and "diabetes specialist management mode" on diabetic nephropathy (DN) in primary medical institutions. METHODS: Patients with type 2 diabetes admitted to Quanzijie Health Clinic of Jimusar County of Xinjiang Uygur Autonomous Region from October 2017 to March 2018 were enrolled. The Patients were divided into co-management group or specialist management group according to their administrative villages. The treatment plans of the two groups were formulated with reference to the current guidelines. The subjects of the co-management group were jointly managed by a fixed team composed of diabetes specialists from Jimusar Traditional Chinese Medicine Hospital, community general practitioners and community nurses from Quanzijie Health Clinic, and required to attend diabetes education courses every month. The diabetes specialist of Jimusar Traditional Chinese Medicine Hospital was responsible for the formulation and management of the treatment plan of the research object. Follow-up was fulfilled once every 4 weeks for 24 weeks in two groups. Before and after intervention, blood glucose, blood pressure, urinary albumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR) as well as the utilization rate of angiotensin converting enzyme inhibitors/angiotensin II receptor blocker (ACEI/ARB) were collected. RESULTS: A total of 115 patients accomplished this study with 54 patients in co-management group and 61 patients in specialist management group. After 24 weeks of intervention, fasting glucose level, postprandial glucose level 2 hours after breakfast, glycosylated hemoglobin (HbA1c), Log UACR in co-management group and specialists management group were significantly decreased compared with baseline [fasting glucose level (mmol/L): 8.06±1.92 vs. 9.16±2.83, 8.21±2.10 vs. 9.06±1.89; postprandial glucose level 2 hours after breakfast (mmol/L): 12.26±3.78 vs. 14.11±5.28, 12.47±3.63 vs. 14.00±3.88; HbA1c: 0.074±0.014 vs. 0.082±0.023, 0.076±0.014 vs. 0.081±0.016; Log UACR (mg/g): 1.63±1.56 vs. 2.25±1.44, 1.84±1.65 vs. 2.43±1.56, all P < 0.05], but there was no statistical significance between the two groups [fasting glucose level (mmol/L): -1.10±0.47 vs. -0.85±0.36, postprandial glucose level 2 hours after breakfast (mmol/L): -1.85±0.88 vs. -1.53±0.68, HbA1c: -0.008±0.004 vs. -0.006±0.003, Log UACR (mg/g): -0.61±0.29 vs. -0.59±0.29, all P < 0.05]. There were no significant changes in blood pressure, serum creatinine and eGFR in the two groups before and after intervention. There were 18 and 24 patients with hypertension in co-management group and specialist management group, respectively. The utilization rates of ACEI/ARB in both groups after intervention were significantly higher than those before intervention [88.9% (16/18) vs. 22.2% (4/18), 95.8% (23/24) vs. 29.2% (7/24), both P < 0.01]. At the end of the study, the utilization rate of ACEI/ARB was similar between the two groups [88.9% (16/18) vs. 95.8% (23/24), P > 0.05]. CONCLUSIONS Both "diabetes specialists-community general practitioners-community nurse co-management mode" and "diabetes specialist management mode" can effectively decrease glucose levels and UACR levels of patients with type 2 diabetes as well as the standard use of antihypertensive agents, which has positive effects on the prevention and treatment on DN.
Blood Glucose ; Creatinine ; Diabetes Mellitus, Type 2 ; Diabetic Nephropathies ; Humans ; Prospective Studies

Objective: To study the associations between variants of mTORC1 of PI3K/AKT/mTOR pathway and colorectal cancer. Methods: In this hospital-based case-control study, at the First Affiliated Hospital, Xinjiang Medical University from 2000 to 2013, 665 primary colorectal cancer cases and 695 cancer-free controls were genotyped at 10 potentially functional single nucleotide polymorphism (SNPs) loci of mTORC1 (mTOR: rs1034528, rs2295080; Raptor: rs1062935, rs3751934; mLST8: rs3160, rs26865; DEPTOR: rs2271900, rs4871827; AKT1S1: rs2290774, rs2353005) to assess their associations with risk of colorectal cancer by Logistic regression analysis. Results: In single-locus analysis, found a significantly decreased risk of colorectal cancer associated with mLST8 rs26865 by recessive genetic model, especially in populations of ≤68 years of age (OR=0.64; 95%CI=0.43-0.96, P=0.031), female (OR=0.61; 95%CI=0.38-0.99, P=0.046), non-smoking (OR=0.55; 95%CI=0.35-0.87, P=0.010). mTOR rs1034528 CC genotypes were associated with higher risk of colorectal cancer in >68-year-old populations (OR=3.34; 95%CI=1.12-9.91, P=0.030). Raptor rs3751934 CA/AA genotypes were associated with lower colorectal cancer risk in population of body mass index(BMI)>25 kg/m² (OR=0.68; 95%CI=0.47-0.98, P=0.038); and AKT1S1 rs2290774 CC genotypes were associated with lower colorectal cancer risk in non-smoking population (OR=0.67; 95%CI=0.45-0.99, P=0.048). Furthermore, found that populations carrying more than two low-risk genotypes were associated with lower colorectal cancer risk, compared with that of populations carrying less than two low-risk genotypes (OR=0.74, 95%CI=0.58-0.95, P=0.017), especially in population of ≤68 years of age, male and BMI>25 kg/m^2, and non-smoking. Conclusions SNPs of mTORC1-related genes individually or jointly contribute to colorectal cancer susceptibility in Chinese. Further studies of larger cohorts are needed to validate the findings.

Objective To evaluate the correlations between the cerebral hemodynamic changes of severe acute encephalopathy with the clinical features from emergency periods to stable periods and the value of transcranial Doppler ultrasonography( TCD)in cerebral function assess. Methods Thirty patients with acute brain diseases by assisted mechanical ventilator from Jun 2014 to May 2015 in PICU were included and followed up to Nov 2015,then grouped by Glasgow Coma Scale( GCS),MRI,prognosis( mental sequelae after half a year). Each subject was examined through the temporal bone window by TCD at emergency peri-ods and stable periods. The systolic cerebral blood flow velocity( sCBFV),and pulsatility index( PI)of bilat-eral middle cerebral artery( MCA),anterior cerebral artery,posterior cerebral artery were analyzed. Multivari-ant analysis of variance,repeated measures analysis of variance was conducted to compare sCBFV and PI of MCA among groups in different clinical periods. The variants included sex,disease diagnosis,prognosis, MRI,GCS,and the first abnormal TCD. The variation within groups was tested via a Hotelling T2 test. All sCBFV and PI of each artery and the D-value of sCBFV between the different periods were compared accord-ing to the prognosis groups. Results (1)Five patients could be lateralized,and their lateralization of MRI focus was consistent with the abnormal sides of sCBFV in the stable periods.(2)The D-value of sCBFV in left MCA between the different periods in the poor prognosis group was significantly higher than that in the good prognosis group[(71. 93 ± 58. 21)cm/s vs.(33. 20 ± 30. 23)cm/s,t = -2. 287,P =0. 033].(3) Multivariant analysis of variance showed that GCS classification and disease diagnosis were significantly cor-related with the cerebral hemodynamic changes respectively(P =0. 042,0. 005,respectively).(4)sCBFV and PI of left MCA reduced significantly in the stable periods than those in the emergency periods( P =0. 002,0. 003,respectivly). Conclusion The cerebral hemodynamic changes by TCD from emergency peri-ods to stable periods are consistent with the clinical status,dynamic evaluation by TCD may facilitate the evaluation of brain dysfunction in the severe acute encephalopathy.