Objective To gain insights into the biological characteristics of different populations of Culex tritaeniorhynchus within and around the Yellow Sea wetland from the perspective of the occurrence of resistance, we investigated the levels of resistance to deltamethrin and kdr gene mutation in the wetland and its peripheral areas. Methods Specimens were collected from Cx. tritaeniorhynchus populations at two monitoring sites in the Rare Bird National Nature Reserve and Tiaozi Ni Wetland Scenic Area, and also from two populations in Yancheng City and the Liuhe District of Nanjing, and the resistance of these mosquitoes to deltamethrin was determined using the CDC biotest bottle method. For each concentration of deltamethrin assessed, a random subset of exposed specimens was selected for amplification of the kdr gene fragment, followed by Sanger sequencing to identify and analyze resistance-associated mutations. Results The LC50 levels of deltamethrin among mosquitoes from the four populations in Luhe, Yancheng, the Rare Bird National Nature Reserve and the Tiaozi Ni Wetland Scenic Area were 2.048 5, 7.798 2, 3.473 3, and 17.695 5 mg/mL, respectively, with corresponding concentrations of deltamethrin ranging from 0.005 to 5.000,0.050 to 50.000,0.050 to 25.000 and 0.050 to 50.000 mg/mL, respectively. Furthermore, the ranges of the KT50 values were 11.76-107.43, 67.05-216.30,29.77-107.43 and 28.40-329.51 min; the 1-h knockdown rates were 34.58%-99.15%, 9.52%-43.80%, 55.09%-73.01%, and 10.09%-68.07%; and the 24-h mortality rates were 12.15%-67.52%,9.52%-79.56%,13.17%-82.21%, and 11.01%-78.99%, respectively. With respect to kdr gene mutation, we assayed a total of 63,70,59, and 57 mosquitoes for the four populations, for which we detected L1014F mutation frequencies of 14.29%, 35.00%, 20.34%, and 31.58%, respectively, with a majority of these mutations being heterozygous for resistance. In addition, five adult mosquitoes were identified has having synonymous mutations at site 1011[i. e. , AAT(asparagine)mutation to AAC(asparagine)]. Conclusions Our findings revealed the clear resistance of Cx. tritaeniorhynchus to deltamethrin in the Yancheng region of the Yellow Sea wetland, and the resistance phenotype and kdr frequency of Cx. tritaeniorhynchus in the wetland environment were comparable to those of Cx. tritaeniorhynchus in the wetland environment, thereby indicating that the resistance of different populations of Cx. tritaeniorhynchus was homogeneous under the pressure of different insecticide selection within and around the wetland. However, the underlying mechanisms need to be further studied.

Objective:To explore the expression of bone marrow stromal antigen 2(BST2)in advanced non-small cell lung cancer(NSCLC)tissues and its impact on the prognosis of cisplatin chemotherapy.Methods:This study was a prospective study,127 advanced NSCLC patients who received treatment at Shangrao People's Hospital from January 2022 to December 2023 were prospective selected,all patients received cisplatin+gemcitabine chemotherapy regimen.They were divided into survival group(n=85)and death group(n=42)according to the prognosis.The relationship between expression of BST2 and clinicopathological characteristics was analyzed.The survival situation was analyzed by Kaplan-Meier method.Influencing factors of prognosis after cisplatin chemotherapy were discussed by univariate and multivariate COX regression analyses.Results:The positive expression rate of BST2 in cancer tissues(34.65％)in advanced NSCLC tissues was significantly higher than that in adjacent tissues(7.09％)(P＜0.05).Expression of BST2 was associated with tumor TNM staging,lymph node metastasis and differentiation degree(P＜0.05).The 1-year survival rate of patients with high expression of BST2(56.98％)was significantly lower than that of patients with low expression(87.80％)(P＜0.05).High expression of BST2 and TNM stage Ⅳ were independent prognostic risk factors for cisplatin chemotherapy in patients with advanced NSCLC(P＜0.05).Conclusion:The expressed of BST2 is highly in patients with advanced NSCLC tissues and closely related to cisplatin chemotherapy poor prognosis,suggesting its potential as a prognostic biomarker.

Objective:This study was aimed to explore the preference and heterogeneity in community health management service model selection among older patients with multiple chronic diseases,and to provide scientific evidence for optimizing the model.Methods:A multi-stage stratified and convenience sampling approach was adopted.A discrete choice experiment was conducted with 360 elderly patients with multiple chronic diseases from six regions in Jiangsu Province.The Mixed Logit Model was used to analyze service selection preferences and willingness to pay,while the Latent Class Logit Model was applied to explore heterogeneity among patient groups.Results:Patients showed a stronger preference for a service model featuring"twice-monthly visits,medication guidance+lifestyle counseling,and face-to-face consultations,"with willingness to pay values of 170.18 CNY,162.90 CNY,and 112.70 CNY,respectively.Willingness to pay decreased as out-of-pocket costs increased.Heterogeneity analysis identified three distinct preference groups,with statistically significant differences in urban-rural distribution,income levels,and health insurance types.Conclusions and suggestions:Medication and lifestyle guidance are the most valued components of community health management services among older patients with multiple chronic diseases.Patients'demographic and socioeconomic characteristics have a structural influence on their service preferences,highlighting the need to tailor service provision to different population groups.It is recommended to enhance medication guidance capacity at the primary care level,especially in rural areas;promote physical medicine integration to improve the accuracy and effectiveness of lifestyle guidance provided by primary healthcare personnel;strengthen digital infrastructure and streamline service processes to moderately increase the frequency of face-to-face consultations;and improve the integration of medical insurance and public health funding mechanisms to enhance service accessibility and equity.

Objective:To investigate the clinical efficacy of acupuncture aimed at awakening the mind and opening the orifices, when combined with a qi-tonifying and blood-circulating decoction, in the treatment of post-stroke dysphagia due to qi deficiency and blood stasis. Methods:A randomized controlled study was conducted involving 86 patients with post-stroke dysphagia due to qi deficiency and blood stasis who were admitted to the Department of Acupuncture and Moxibustion at Yan'an Hospital of Traditional Chinese Medicine from January 2020 to March 2023. The patients were randomly divided into a control group and a treatment group, with 43 cases in each group, using a random number table method. The control group received conventional treatment, while the treatment group received acupuncture aimed at awakening the mind and opening the orifices combined with a qi-tonifying and blood-circulating decoction. Both groups were treated for 1 month. Clinical efficacy, swallowing function, serological indicators, floating index, and quality of life were compared between the two groups. Results:After treatment, the Standardized Swallowing Assessment score in the treatment group was (18.23 ± 2.04) points, which was significantly lower than that in the control group [(22.52 ± 4.38) points, t = 5.82, P < 0.05]. The Water-Swallowing test score in the treatment group was (2.77 ± 0.55) points, which was significantly higher than that in the control group [(2.00 ± 0.42) points, t = 7.30, P < 0.05]. The level of superoxide dismutase in the treatment group was (147.54 ± 21.03) kU/L, which was significantly higher than that in the control group [(128.31 ± 18.54) kU/L, t = 4.50, P < 0.05]. The Pulsatility Index in the treatment group was (0.72 ± 0.25), which was significantly lower than that in the control group [(0.83 ± 0.24), t = 0.74, P < 0.05]. The cerebral vascular reserve in the treatment group was (42.28 ± 5.69)%, which was significantly higher than that in the control group [(35.45 ± 4.31)%, t = 2.03, P < 0.05]. The Swallowing Quality-of-Life Questionnaire score in the treatment group was (76.33 ± 11.54) points, which was significantly higher than that in the control group [(68.02 ± 12.16) points, t = 3.25, P < 0.05]. The response rate in the treatment group was 97.67% (42/43), which was significantly higher than that in the control group [86.05% (37/43), χ2 = 3.89, P < 0.05]. Conclusions:The use of acupuncture for awakening the mind and opening the orifices, combined with a qi-tonifying and blood-circulating decoction, can significantly enhance clinical efficacy and improve the quality of life for patients with post-stroke dysphagia due to qi deficiency and blood stasis syndrome compared with conventional treatment.

Objective To investigate how interference from motor and cognitive tasks affects the postural stability of older adults during stair descent.Methods A total of 52 elderly subjects were recruited.Using the Vicon infrared motion capture system and Kistler force plate,the kinematic and dynamic data were collected simultaneously during stair descent under three conditions:single task(ST),motor task(MT),and cognitive task(CT).The body stability during stair descent was assessed quantitatively using the margin of stability(MoS)algorithm.Repeated measures ANOVA was applied to compare differences across conditions.Results Compared to the ST condition,both step speed(P<0.001)and step frequency(P<0.001)were significantly reduced under MT and CT conditions.Step length(P=0.037)was also significantly reduced under the CT condition compared to those under the ST condition.In the aspect of anterior-posterior dynamic stability,compared to the ST condition,centroid velocity(P<0.001)and extrapolated centroid position(P<0.001)were significantly increased,while MoS(P<0.001)was significantly decreased under both MT and CT conditions.In comparison to the CT condition,centroid displacement(P=0.011)and velocity(P=0.014),as well as extrapolated centroid position(P<0.001),were significantly greater those under the MT condition.In the aspect of medial-lateral dynamic stability,compared to the ST condition,centroid displacement(P<0.001)was significantly reduced under MT and CT conditions.Additionally,the extrapolated centroid position(P=0.001)was significantly reduced,and MoS(P=0.038)was significantly increased under the MT condition compared to those under the ST condition.Conclusions Older adults adjust their gait in response to dual-task interference during stairs descent by'slowing down step speed,reducing step frequency,and shortening step length'.This adjustment helps maintain medial-lateral dynamic stability,but significantly decreases anterior-posterior dynamic stability,thereby increasing the risk of falls.

Objective To investigate how interference from motor and cognitive tasks affects the postural stability of older adults during stair descent.Methods A total of 52 elderly subjects were recruited.Using the Vicon infrared motion capture system and Kistler force plate,the kinematic and dynamic data were collected simultaneously during stair descent under three conditions:single task(ST),motor task(MT),and cognitive task(CT).The body stability during stair descent was assessed quantitatively using the margin of stability(MoS)algorithm.Repeated measures ANOVA was applied to compare differences across conditions.Results Compared to the ST condition,both step speed(P<0.001)and step frequency(P<0.001)were significantly reduced under MT and CT conditions.Step length(P=0.037)was also significantly reduced under the CT condition compared to those under the ST condition.In the aspect of anterior-posterior dynamic stability,compared to the ST condition,centroid velocity(P<0.001)and extrapolated centroid position(P<0.001)were significantly increased,while MoS(P<0.001)was significantly decreased under both MT and CT conditions.In comparison to the CT condition,centroid displacement(P=0.011)and velocity(P=0.014),as well as extrapolated centroid position(P<0.001),were significantly greater those under the MT condition.In the aspect of medial-lateral dynamic stability,compared to the ST condition,centroid displacement(P<0.001)was significantly reduced under MT and CT conditions.Additionally,the extrapolated centroid position(P=0.001)was significantly reduced,and MoS(P=0.038)was significantly increased under the MT condition compared to those under the ST condition.Conclusions Older adults adjust their gait in response to dual-task interference during stairs descent by'slowing down step speed,reducing step frequency,and shortening step length'.This adjustment helps maintain medial-lateral dynamic stability,but significantly decreases anterior-posterior dynamic stability,thereby increasing the risk of falls.

Objective:To explore the expression of bone marrow stromal antigen 2(BST2)in advanced non-small cell lung cancer(NSCLC)tissues and its impact on the prognosis of cisplatin chemotherapy.Methods:This study was a prospective study,127 advanced NSCLC patients who received treatment at Shangrao People's Hospital from January 2022 to December 2023 were prospective selected,all patients received cisplatin+gemcitabine chemotherapy regimen.They were divided into survival group(n=85)and death group(n=42)according to the prognosis.The relationship between expression of BST2 and clinicopathological characteristics was analyzed.The survival situation was analyzed by Kaplan-Meier method.Influencing factors of prognosis after cisplatin chemotherapy were discussed by univariate and multivariate COX regression analyses.Results:The positive expression rate of BST2 in cancer tissues(34.65％)in advanced NSCLC tissues was significantly higher than that in adjacent tissues(7.09％)(P＜0.05).Expression of BST2 was associated with tumor TNM staging,lymph node metastasis and differentiation degree(P＜0.05).The 1-year survival rate of patients with high expression of BST2(56.98％)was significantly lower than that of patients with low expression(87.80％)(P＜0.05).High expression of BST2 and TNM stage Ⅳ were independent prognostic risk factors for cisplatin chemotherapy in patients with advanced NSCLC(P＜0.05).Conclusion:The expressed of BST2 is highly in patients with advanced NSCLC tissues and closely related to cisplatin chemotherapy poor prognosis,suggesting its potential as a prognostic biomarker.

Objective:To investigate the clinical efficacy of acupuncture aimed at awakening the mind and opening the orifices, when combined with a qi-tonifying and blood-circulating decoction, in the treatment of post-stroke dysphagia due to qi deficiency and blood stasis. Methods:A randomized controlled study was conducted involving 86 patients with post-stroke dysphagia due to qi deficiency and blood stasis who were admitted to the Department of Acupuncture and Moxibustion at Yan'an Hospital of Traditional Chinese Medicine from January 2020 to March 2023. The patients were randomly divided into a control group and a treatment group, with 43 cases in each group, using a random number table method. The control group received conventional treatment, while the treatment group received acupuncture aimed at awakening the mind and opening the orifices combined with a qi-tonifying and blood-circulating decoction. Both groups were treated for 1 month. Clinical efficacy, swallowing function, serological indicators, floating index, and quality of life were compared between the two groups. Results:After treatment, the Standardized Swallowing Assessment score in the treatment group was (18.23 ± 2.04) points, which was significantly lower than that in the control group [(22.52 ± 4.38) points, t = 5.82, P < 0.05]. The Water-Swallowing test score in the treatment group was (2.77 ± 0.55) points, which was significantly higher than that in the control group [(2.00 ± 0.42) points, t = 7.30, P < 0.05]. The level of superoxide dismutase in the treatment group was (147.54 ± 21.03) kU/L, which was significantly higher than that in the control group [(128.31 ± 18.54) kU/L, t = 4.50, P < 0.05]. The Pulsatility Index in the treatment group was (0.72 ± 0.25), which was significantly lower than that in the control group [(0.83 ± 0.24), t = 0.74, P < 0.05]. The cerebral vascular reserve in the treatment group was (42.28 ± 5.69)%, which was significantly higher than that in the control group [(35.45 ± 4.31)%, t = 2.03, P < 0.05]. The Swallowing Quality-of-Life Questionnaire score in the treatment group was (76.33 ± 11.54) points, which was significantly higher than that in the control group [(68.02 ± 12.16) points, t = 3.25, P < 0.05]. The response rate in the treatment group was 97.67% (42/43), which was significantly higher than that in the control group [86.05% (37/43), χ2 = 3.89, P < 0.05]. Conclusions:The use of acupuncture for awakening the mind and opening the orifices, combined with a qi-tonifying and blood-circulating decoction, can significantly enhance clinical efficacy and improve the quality of life for patients with post-stroke dysphagia due to qi deficiency and blood stasis syndrome compared with conventional treatment.

Objective:This study was aimed to explore the preference and heterogeneity in community health management service model selection among older patients with multiple chronic diseases,and to provide scientific evidence for optimizing the model.Methods:A multi-stage stratified and convenience sampling approach was adopted.A discrete choice experiment was conducted with 360 elderly patients with multiple chronic diseases from six regions in Jiangsu Province.The Mixed Logit Model was used to analyze service selection preferences and willingness to pay,while the Latent Class Logit Model was applied to explore heterogeneity among patient groups.Results:Patients showed a stronger preference for a service model featuring"twice-monthly visits,medication guidance+lifestyle counseling,and face-to-face consultations,"with willingness to pay values of 170.18 CNY,162.90 CNY,and 112.70 CNY,respectively.Willingness to pay decreased as out-of-pocket costs increased.Heterogeneity analysis identified three distinct preference groups,with statistically significant differences in urban-rural distribution,income levels,and health insurance types.Conclusions and suggestions:Medication and lifestyle guidance are the most valued components of community health management services among older patients with multiple chronic diseases.Patients'demographic and socioeconomic characteristics have a structural influence on their service preferences,highlighting the need to tailor service provision to different population groups.It is recommended to enhance medication guidance capacity at the primary care level,especially in rural areas;promote physical medicine integration to improve the accuracy and effectiveness of lifestyle guidance provided by primary healthcare personnel;strengthen digital infrastructure and streamline service processes to moderately increase the frequency of face-to-face consultations;and improve the integration of medical insurance and public health funding mechanisms to enhance service accessibility and equity.

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.