Objective:To investigate the effect of elimination,combination,rearrangement and simplification(ECRS)management combined with risk assessment on reducing the incidence of multidrug-resistant bacteria infections of patients who received mechanical ventilation in intensive care unit(ICU).Methods:The management mode of prevention and control for multidrug-resistant bacteria infections of patients in ICU was optimized on the basis of ECRS management combined with risk assessment.A total of 600 patients who received mechanical ventilation in ICU of Jiuquan Hospital of Shanghai General Hospital(Jiuquan People's Hospital)from January 2022 to December 2023 were selected.According to different management methods,these patients were divided into a control group and an observation group,with 300 cases in each group.The control group was managed by using the risk assessment management method,while the observation group was managed by using the ECRS management on the basis of risk assessment management method.The indicators of respiratory function,patients'satisfaction score,stay time in ICU,time of mechanical ventilation and incidence of multidrug-resistant bacteria were compared between the two groups.Results:The mean value of the ratio of forced expiratory volume in one second(FEV1)to forced vital capacity(FVC)(FEV1/FVC),and the FEV1 level in observation group by using ECRS management combined with risk assessment method were respectively(78.69±4.65)%and(1.58±0.24)L,both of which were higher than those of control group,and the differences of them between two groups were statistically significant(t=16.483,11.742,P<0.05).The average scores of work efficiency,emergency response capability,professional ethics,isolation and resettlement,and overall patients'satisfaction in the observation group were respectively(23.12±1.20),(23.34±1.08),(23.65±1.10),(23.80±1.05)and(92.24±4.37),all of which were higher than those in the control group,and the differences of them between two groups were statistically significant(t=22.176,27.903,22.373,31.364,13.963,P<0.05).The average ICU stay time and the average time of mechanical ventilation were respectively(14.15±1.60)and(9.15±2.13)days in the observation group,both of which were lower than those in the control group,and the differences of them between two groups were statistically significant(t=16.872,15.410,P<0.05).The incidence of multidrug-resistant bacteria was 0.33%in 300 patients of the observation group,which was lower than that of the control group,with a statistically significant difference(x2=4.561,P<0.05).Conclusion:The application of ECRS management combined with risk assessment in the management of ICU for patients who receive mechanical ventilation can protect respiratory function of patients,and decrease the risk of occurring the infection of multidrug-resistant bacteria,and reduce ICU stay time and the time of mechanical ventilation of patients,and improve patients'satisfaction.

Objective To assess coronary microvascular obstruction(MVO)after percutaneous coronary intervention in(PCI)patients with acute ST-segment elevation myocardial infarction(STEMI)and to investigate its value for patient prognosis.Methods We enrolled 97 patients who were hospitalized for acute STEMI at Wuhan Asia Heart Hospital from May 2021 to June 2024,underwent emergency PCI during hospitalization,and completed cardiac magnetic resonance(CMR)at a median of 7(5,8)days after the procedure.Patients were classified into MVO group(n=58)and non-MVO group(n=39)according to the results of CMR.Cox regression was used to analyse predictors of adverse events after PCI.Patients were followed for a median of 11.5(8.5,24.5)months for the occurrence of major adverse cardiovascular events(MACE,a composite outcome including readmission for heart failure,recurrent myocardial infarction,target vessel restenosis,target vessel revascularisation,and cardiac death)and secondary endpoint events(left ventricular remodelling,non-cardiac death).Results MVO was evidenced in 58 patients(59.79％).Multifactorial Cox regression analysis showed that MVO(HR 7.024,95％CI 1.408-35.027,P=0.017)and the proportion of inactive myocardium to the left ventricle(HR 1.066,95％CI 1.014-1.121,P=0.012)were the independent predictors factors for the incidence of adverse events in STEMI patients after PCI.The median follow-up time was 11.5(8.5,24.5)months.There was no statistically significant difference in the incidence of MACE between the MVO group and the non-MVO group(P=0.347).However,the MVO group had a higher incidence of secondary endpoints(32.76％ vs.2.56％,P＜0.001)and a higher incidence of left ventricular remodeling(29.31％ vs.2.56％,P＜0.001).Kaplan Meier survival analysis showed that the prognosis of the non-MVO group was significantly better than that of the MVO group(Log-rank P＜0.001).Conclusions MVO after PCI in patients with acute STEMI is a good predictor of clinical prognosis.

An analysis of 24 144 norovirus sequences from Asia and Russia deposited in GenBank between 1995 and 2023 was conducted,to understand the temporal and spatial variations in norovirus genotypes in these regions.Norovirus sequences from Asia and Russia were downloaded in FASTA format from GenBank for the years 1995-2023,and analyzed in Excel,R language,and GraphPad Prism for data visualization.The number of norovirus sequences submitted to GenBank increased annually from 2004 and peaked in 2015.Notably,China and Japan contributed 62.3％of all submitted norovirus sequences.These sequences encompassed 31 capsid genotypes(C-type),with GⅠ accounting for 9％and GⅡ accounting for 90％.Additionally,49 polymerase types(P-type)were identified,along with 68 combinations of CP types;among the analyzed recombinant sequences(4 460 entries in total),approxi-mately 41％belonged to three predominant recombinant strains:GⅡ.2[P16],GⅡ.4[P31],and GⅡ.4[P16].This analysis provides valuable insights into the distribution characteristics of norovirus genotypes across Asia and Russia over time,thereby supporting vac-cine design and evaluation efforts.

Objective To investigate the relationship between serum programmed cell death 4(PDCD4),platelet-derived growth factor-BB(PDGF-BB)levels and atherosclerotic cardiovascular disease(ASCVD)in patients with type 2 diabetes mellitus(T2DM).Methods A total of 238 T2DM patients admitted to 3201 Hospital from January 2022 to August 2024 were selected as the T2DM group,and 120 healthy volunteers who visited the hospital for physical examination during the same period were selected as the control group.T2DM patients were divided into ASCVD group(82 cases)and non-ASCVD group(156 cases)according to the presence or absence of ASCVD.The serum levels of PDCD4 and PDGF-BB were detected by enzyme-linked immunosorbent assay.Multivariate unconditional Logistic regression was used to analyze the relationship be-tween serum PDCD4 and PDGF-BB levels and ASCVD in T2DM patients.Receiver operating characteristic curve was used to analyze the predictive efficiency of serum PDCD4 and PDGF-BB levels for ASCVD in T2DM patients.Results Compared with the control group,the serum levels of PDCD4 and PDGF-BB were signifi-cantly increased in the T2DM group(P<0.05).The incidence of ASCVD in the 238 patients with T2DM was 34.45%(82/238).Compared with the non-ASCVD group,the ASCVD group had significantly higher serum levels of PDCD4 and PDGF-BB(P<0.05).Hypertension,hyperlipidemia,high glycosylated hemoglobin,high PDCD4 and high PDGF-BB were independent risk factors for ASCVD in T2DM patients(P<0.05).The area under the curve of serum PDCD4 and PDGF-BB levels combined to predict ASCVD in T2DM patients was 0.873,which was larger than 0.790 and 0.780 predicted by serum PDCD4 and PDGF-BB levels alone(P<0.05).Conclusion The serum levels of PDCD4 and PDGF-BB are increased in patients with T2DM,which are independent risk factors for ASCVD.The combination of PDCD4 and PDGF-BB has a high predictive efficiency for ASCVD in patients with T2DM.

Objective:To investigate the prevalence and risk factors of overweight and obesity among Chinese children aged 3-18 years from 11 provinces, antonomous regions, or municipalities.Methods:This national cross-sectional community health survey utilized a multistage stratified cluster-random sampling method to recruit 193 997 nationally representative participants from 11 provinces, autonomous regions, or municipalities between January 2017 and December 2019. All participants underwent physical examinations, and their caregivers completed questionnaires assessing participants′ dietary, lifestyle, familial, and perinatal information. Multilevel multinomial logistic regression models were employed to identify the potential risk factors.Results:The cohort comprised 193 997 children (102 178 boys, 91 819 girls),aged (10±4) years. Overall prevalence rates were 30 574(15.8%)overweight children and 17 217(8.9%) obesity children. Boys exhibited higher overweight and obesity rates than girls (17.0% (17 368/102 178) vs. 14.4% (13 206/102 178), 11.3% (11 553/91 819) vs. 6.2% (5 664/91 819), χ2=249.12,1 578.69,both P<0.001). The detection rates of obesity in Tanner stage 2 and 3 were the highest in boys and girls, with 13.4%(2 231/16 665) and 8.6%(880/10 221) respectively. Risk factors for obesity included parental overweight (paternal OR=2.34 and maternal OR=2.29), annual household income of 100 000-200 000 yuan (compared with<100 000 yuan, OR=1.04), higher paternal education (compared with below high school,high school and a college education OR=1.09,1.14), birth weight >4.0 kg (≤5 and>5 years old OR=1.74, 1.44,respectively), and western food consumption≥1 time/month (compared with<1, 1-2, 3-4,>4 times/month OR=1.36, 1.30, 1.67(≤5 years), 1.19, 1.16, 1.15 (>5 years), respectively) (all P<0.05). Conversely, coarse grain intake≥1 times/week (compared with<1 times/week, every day, 3-4, 1-2 times/week OR=0.74, 0.80, 0.71 (≤5 years), 0.75, 0.87, 0.90(>5 years), respectively, all P<0.05) was associated with reduced obesity risk. Conclusions:Obesity epidemiology in children demonstrates significant heterogeneity across age, gender, geographic regions, and pubertal stages. It is necessary to establish a personalized prevention and control strategy.

Objective:To evaluate the sample preparation proficiency and storage proficiency of 11 clinical biobanks in Beijing through simulated experiments, and to establish an assessment method for the quality comparability of biological samples.Methods:An exploratory research design was adopted. In November 2023, artificial composite serum quality control materials containing six recombinant human protein markers—recombinant human alanine aminotransferase (rhALT), recombinant human aspartate aminotransferase (rhAST), recombinant human creatine kinase (rhCK), recombinant human creatine kinase-MB (rhCK-MB), recombinant human B-type natriuretic peptide (rhBNP), and recombinant human troponin I (rhTNI)—were distributed to 11 clinical biobanks in Beijing City. Sample preparation and storage followed the standardized operating procedures. Proficiency differences were assessed through statistical analysis.Results:Three-way repeated measures ANOVA revealed all six protein markers showed a declining trend over storage time in ultra-low-temperature environments ( F values 11.68-4 179.66, all P<0.01). However, neither long-term/temporary refrigerator types ( F values 0.01-1.23, all P>0.05)nor placement locations within refrigerators significantly affected the stability of these six proteins ( F valus 0.03-1.47, all P>0.05). The biases in detection results for rhALT, rhAST, rhTNI, and rhBNP at different storage time points were within the allowable bias limits for each item, supporting their use as markers for protein stability in biobank samples. All 11 institutions passed the storage proficiency assessment. In the preparation proficiency assessment, deviations were observed in post-preparation sample results, with a notably high out-of-control rate for rhCK (36.36%). Conclusion:Sample preparation proficiency can serve as a quality control metric for clinical biobanks. Future external quality assessment systems for biobanks should focus on sample preparation rather than storage processes.

Aim To investigate the effects of rosavin on hepatocellular steatosis and its mechanism of action.Methods AML-12 and HepG2 cells were induced to undergo hepatocellular steatosis by free fatty acids(FFA),and the optimal inducing concentration was determined by oil red O staining and CCK-8 assay.The cell activity was detected by CCK-8 assay after ro-savin treatment,and the lipid droplet accumulation was observed by oil red O staining.The levels of triglycer-ide(TG),total cholesterol(TC),glutamic oxalacetic transaminase(AST),glutamic pyruvic transaminase(ALT),superoxide dismutase(SOD),glutathione per-oxidase(GSH-Px),and malondialdehyde(MDA)were detected by kits.The potential targets of rosavin in non-alcoholic fatty liver disease(NAFLD)were ana-lyzedby network pharmacology and molecular docking,and the expression of core candidate targets before and after the rosavin intervention was detected by real-time fluorescence quantitative PCR.Results Hepatocyte steatosis was induced by FFA,and the intervention of rosavin(25,50 μmol·L-1)reduced the number of intracellular lipid droplets in hepatocytes in a dose-de-pendent manner,also lowered the cellular levels of TG,TC,AST,ALT,elevated the levels of SOD and GSH-Px,and reduced the levels of MDA.Network pharma-cological analysis and molecular docking yielded five core candidate targets:NOS3,MAPK14,PPARG,TNF-α,and IGF-1,and real-time fluorescence quantitative PCR showed that the action of loxavir significantly re-duced the gene expression of TNF-α and PPARG in hepatocytes after FFA induction.Conclusions Rosa-vin can attenuate the inflammatory response,oxidative stress level,and lipid accumulation in hepatocytes by modulating TNF-α and PPARG,thereby ameliorating FFA-induced hepatocellular steatosis.

Objective:To explore the the application and outcomes of microscopic vocal cord shortening with retrodisplacement of anterior commissure in voice feminization surgery.Methods:We conducted a retrospective analysis of 296 patients(including 3 cases of pseudohermaphroditism and 293 transgender women)who underwent this procedure at the Voice Center of Nanjing Tongren Hospital of Otolaryngology-Head and Neck Surgery between November 2014 and August 2023. The patients, aged 18-50 years (mean age of 28.3±14.5) underwent feminizing laryngoplasty via transoral microsurgery, involving resection of the superficial lamina propria of the anterior vocal cords and subglottic tissues of the anterior commissure, followed by vocal ligament plication to achieve vocal cords shortening and anterior commissure retrodisplacement. Patients adhered to a1-month voice rest postoperatively and subsequently underwent speech rehabilitation training. Subjective/objective voice analyses, aerodynamic evaluations, and stroboscopic examinations were performed at 3, 6, and 12 months postoperatively to assess the effectiveness of voice feminization.Results:All surgeries were performed successfully and 94.3% (279/296) of the patients reported satisfaction at the end of the one-year follow-up. For effective cases, fundamental frequency (F 0) increased by 57.42±16.72 Hz compared to baseline. Postoperative acoustic/aerodynamic parameters and stroboscopic findings of vocal cord mucosal wave motion remained within normal ranges. These results indicated that this voice feminization surgery combined with postoperative pronunciation training achieved natural and feminine vocal characteristics. Conclusion:The combination of vocal cord shortening and anterior commissure retrodisplacement, along with postoperative pronunciation training, represents an effective surgical strategy for achieving a natural feminine voice.

OBJECTIVE: To evaluate the clinical efficacy and safety of Yangxue Qingnao Pills (YXQNP) combined with amlodipine in treating patients with grade 1 hypertension. METHODS: This is a multicenter, randomized, double-blind, and placebo-controlled study. Adult patients with grade 1 hypertension of blood deficiency and Gan (Liver)-yang hyperactivity syndrome were randomly divided into the treatment or the control groups at a 1:1 ratio. The treatment group received YXQNP and amlodipine besylate, while the control group received YXQNP's placebo and amlodipine besylate. The treatment duration lasted for 180 days. Outcomes assessed included changes in blood pressure, Chinese medicine (CM) syndrome scores, symptoms and target organ functions before and after treatment in both groups. Additionally, adverse events, such as nausea, vomiting, rash, itching, and diarrhea, were recorded in both groups. RESULTS: A total of 662 subjects were enrolled, of whom 608 (91.8%) completed the trial (306 in the treatment and 302 in the control groups). After 180 days of treatment, the standard deviations and coefficients of variation of systolic and diastolic blood pressure levels were lower in the treatment group compared with the control group. The improvement rates of dizziness, headache, insomnia, and waist soreness were significantly higher in the treatment group compared with the control group (P<0.05). After 30 days of treatment, the overall therapeutic effects on CM clinical syndromes were significantly increased in the treatment group as compared with the control group (P<0.05). After 180 days of treatment, brachial-ankle pulse wave velocity, ankle brachial index and albumin-to-creatinine ratio were improved in both groups, with no statistically significant differences (P>0.05). No serious treatment-related adverse events occurred during the study period. CONCLUSIONS Combination therapy of YXQNP with amlodipine significantly improved symptoms such as dizziness and headache, reduced blood pressure variability, and showed a trend toward lowering urinary microalbumin in hypertensive patients. These findings suggest that this regimen has good clinical efficacy and safety. (Registration No. ChiCTR1900022470).
Humans ; Amlodipine/adverse effects* ; Drugs, Chinese Herbal/adverse effects* ; Male ; Female ; Hypertension/complications* ; Middle Aged ; Treatment Outcome ; Drug Therapy, Combination ; Adult ; Blood Pressure/drug effects* ; Double-Blind Method ; Aged ; Antihypertensive Agents/adverse effects*

OBJECTIVE: To evaluate the effects of Chinese patent medicine Huatuo Zaizao Pill (HTZZ) on neurological function and limb motor in ischemic stroke (IS) patients during convalescence. METHODS: This is a prospective, open-labelled, randomized controlled trial. Patients with IS were recruited from the Neurology Department of Xiyuan Hospital of China Academy of Chinese Medical Sciences from May 2021 to June 2023. Eligible participants were randomly assigned to the HTZZ (40 cases) or control group (40 cases) at a ratio of 1:1. The HTZZ group was treated with oral HTZZ (8 g, thrice daily) combined with conventional treatment, while the control group received only conventional treatment. The treatment duration was 12 weeks. The primary outcome was the change in Modified Ashworth Scale (MAS) score from baseline to week 6 and 12. Secondary outcomes included changes in scores of National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment (FM), and Barthel Index (BI) from baseline to week 6 and 12, as well as lipid indices after 12 weeks. All adverse events (AEs) were recorded and liver and kidney indices were evaluated. RESULTS: A total of 72 patients completed the study (38 in the HTZZ group and 34 in the control group). Compared with the control group, the HTZZ group demonstrated significant improvements in MAS, NIHSS, FM, and BI scores following 6 and 12 weeks of treatment in both intent-to-treat and per-protocol analyses (all P<0.05). No significant differences were noted between groups in lipid indices, AEs, and liver and kidney dysfunction after 12 weeks (P>0.05). CONCLUSIONS HTZZ alleviated spasticity and enhanced neurological function and prognosis of IS patients during convalescence. However, further evaluation of HTZZ's effect on IS outcomes is warranted in clinical trials with larger sample sizes and extended observation periods. (Trial registration No. NCT04910256).
Humans ; Drugs, Chinese Herbal/pharmacology* ; Male ; Female ; Ischemic Stroke/physiopathology* ; Middle Aged ; Aged ; Recovery of Function/drug effects* ; Convalescence ; Extremities/physiopathology* ; Treatment Outcome ; Prospective Studies