Objective:To investigate the drug resistance gene characteristics, plasmid characteristics and genome tracing of Shigella sonnei causing a bacillary dysentery outbreak in Shandong Province. Methods:Sixty-five Shigella sonnei strains isolated from a 2021 outbreak in a county of Shandong Province were analyzed using antimicrobial susceptibility testing, whole genome sequencing (WGS), characterization of resistance and virulence genes, plasmid profiling, core genome multilocus sequence typing (cgMLST), and single nucleotide polymorphism (SNP) analysis. Results:All isolates had the same resistance phenotype and genotypes and were multidrug-resistant ESBL-producing Shigella sonnei, carrying important virulence genes. Plasmid analysis revealed a conserved genetic arrangement, pil( M/ N/ O2/ P)-tra( F/ H/ J/ K/ N/ O/ P/ Q)-IS Ecp1- blaCTX-M-14-Tn 903- yub( J/ I/ F/ G/ E/ D), and shared across strains from diverse regions and bacterial species. The cgMLST and SNP analyses demonstrated concordant clustering, with all 65 outbreak-related strains forming a single cluster alongside human-derived strains from Guangxi. Conclusion:The ESBL-producing Shigella sonnei responsible for the outbreak shares a homologous relationship with Guangxi human-derived strains, and the detected resistance plasmids and virulence genes underscore the need to strengthen drug resistance surveillance and genome tracing.

Aim To investigate the effects of acteoside(ACT)on ulcerative colitis(UC)mice from the per-spective of inflammation and intestinal flora.Methods The UC model was prepared by dextran sulfate sodi-um(DSS)drinking method and treated with ACT for 14 d,during which the activity of the mice was ob-served and the disease activity index(DAI)was scored.ELISA was used to detect the expression of in-flammatory factors.HE staining was used to observe the injury of colon tissue.16S rRNA high-throughput sequencing method was used to detect the structure and abundance of fecal intestinal flora in mice,and the correlation between the flora and inflammatory indica-tors was analyzed.Results After ACT administra-tion,the fear of cold and lazy movement of mice were improved,and the DAI of mice was reduced.The in-tegrity of colon mucosal epithelial cells was restored and mucosal damage was alleviated.The expressions of pro-inflammatory factors MPO,IL-1 β,IL-6,TNF-α,TF and PAF decreased,while the expression of anti-in-flammatory factor IL-10 increased.The abundance of harmful bacteria such as Firmicutes and Bacteroides de-creased,while the abundance of beneficial bacteria such as Bacteroidetes and Alistipes increased.Protective bacteria such as Bacteroidetes and Lachnospira were negatively correlated with IL-1β,IL-6 and other pro-inflammatory factors,while harmful bacteria such as Proteobacteria and Streptococcus were positively correla-ted with the above pro-inflammatory factors.Conclu-sions The therapeutic mechanism of ACT on chronic UC mice is related to its alleviation of inflammation and regulation of intestinal flora,and there is a correlation between inflammatory factors and intestinal flora.

Aim To investigate the effects of acteoside(ACT)on ulcerative colitis(UC)mice from the per-spective of inflammation and intestinal flora.Methods The UC model was prepared by dextran sulfate sodi-um(DSS)drinking method and treated with ACT for 14 d,during which the activity of the mice was ob-served and the disease activity index(DAI)was scored.ELISA was used to detect the expression of in-flammatory factors.HE staining was used to observe the injury of colon tissue.16S rRNA high-throughput sequencing method was used to detect the structure and abundance of fecal intestinal flora in mice,and the correlation between the flora and inflammatory indica-tors was analyzed.Results After ACT administra-tion,the fear of cold and lazy movement of mice were improved,and the DAI of mice was reduced.The in-tegrity of colon mucosal epithelial cells was restored and mucosal damage was alleviated.The expressions of pro-inflammatory factors MPO,IL-1 β,IL-6,TNF-α,TF and PAF decreased,while the expression of anti-in-flammatory factor IL-10 increased.The abundance of harmful bacteria such as Firmicutes and Bacteroides de-creased,while the abundance of beneficial bacteria such as Bacteroidetes and Alistipes increased.Protective bacteria such as Bacteroidetes and Lachnospira were negatively correlated with IL-1β,IL-6 and other pro-inflammatory factors,while harmful bacteria such as Proteobacteria and Streptococcus were positively correla-ted with the above pro-inflammatory factors.Conclu-sions The therapeutic mechanism of ACT on chronic UC mice is related to its alleviation of inflammation and regulation of intestinal flora,and there is a correlation between inflammatory factors and intestinal flora.

Aim To investigate the protective effect of Siwu decoction(SWD)on immune injury induced by 60Coγ-rays in mice and the related mechanism.Meth-ods C57BL/6J mice were randomly divided into six groups:Control group(Control),Model group(Mod-el),Siwu decoction low-dose group(SWD-L),Siwu decoction medium-dose group(SWD-M),Siwu decoc-tion high-dose group(SWD-H)and resveratrol positive group(Resveratrol,Res).The drug was continued to be administered 11 days before and after irradiation,with a single whole-body irradiation of 4 Gy,and all in-dexes were detected three days after irradiation.The changes of peripheral blood and organ indexes were de-tected.Serum levels of cytokine interferon gamma(IFN-γ),interleukin-1 β(IL-1 β),IL-2,IL-4,IL-6,IL-10,IL-17,transforming growth factor-β(TGF-β),tumor necrosis factor(TNF)-α,and immunoglobulin A(IgA),IgG,IgM,and complement protein 3(C3),C4 content were detected by enzyme-linked immunosorbent assay(ELISA).B lymphocytes,T lymphocytes,NK cells in spleen and T lymphocytes in thymus were de-tected by flow cytometry.The pathological changes of spleen and thymus were analyzed by hematoxylin-eosin(HE)staining.The expression of Sirt 1 protein in spleen after radiation was detected by immunofluores-cence staining.The protein contents of Sirt1,PI3K,Akt,p-Akt and mTOR in spleen were detected by Western blot assay.Results SWD could significantly increase LYMPH％and reduce pathological injury of spleen and thymus.Flow cytometry showed that SWD could significantly increase the percentage of CD19+B lymphocytes in spleen,decrease the percentage of NK lymphocytes and the ratio of CD4+/CD8+in spleen and thymus.ELISA results showed that SWD signifi-cantly inhibited the expression of IL-1 β,IL-2,IL-6,IL-17,IFN-γ,TGF-β,TNF-α,and increased the content of anti-inflammatory factors IL-4 and IL-10.At the same time,SWD significantly inhibited the increase of IgA,IgG,IgM,C3 and C4 induced by radiation.The results of immunofluorescence staining and Western blot showed that SWD could decrease the expression of PI3K,Akt,p-Akt and mTOR protein,and enhance the expression of Sirt1 protein.Conclusions SWD has obvious preventive effect on immune damage induced by 60Co gamma radiation in mice.The mechanism may be related to Sirt1-PI3K-Akt-mTOR.

Objective:Based on the background of high-quality development,we analyze the operational efficiency of traditional Chinese medicine(TCM)hospitals in China's Yangtze River Economic Belt in 2021 and explore the impact of external environmental factors on operational efficiency,so as to provide a reference for promoting the high-quality development of TCM hospitals in the Yangtze River Economic Belt.Methods:The three-stage DEA model was used to analyze the operational efficiency of TCM hospitals in 11 provinces and cities in the Yangtze River Economic Zone in China in 2021.Results:After three-stage DEA analysis,the values of comprehensive efficiency,pure technical efficiency and scale efficiency of TCM hospitals in China's Yangtze River Economic Belt are 0.976,0.986 and 0.990,respectively.5 provinces and cities,Shanghai,Jiangsu,Hunan,Chongqing and Guizhou,are efficient before and after the adjustment,and the comprehensive efficiency of Zhejiang,Anhui,Hubei,Jiangxi,Sichuan and Yunnan have increased compared with that before the adjustment.Ranking of the average value of the comprehensive efficiency of TCM hospitals operation in the three major city clusters of the Yangtze River Economic Belt after adjustment:Chengdu-Chongqing city cluster(0.998)>city cluster in the Yangtze River Delta(0.964)>city cluster in the middle reaches of the Yangtze River(0.962).Conclusion:The operational efficiency of TCM hospitals in the Yangtze River Economic Zone has been underestimated,and the comprehensive efficiency is mainly affected by scale efficiency;there are differences in the operational efficiency of TCM hospitals in the three major urban agglomerations,and balanced development is needed between regions;the operational efficiency of TCM hospitals is affected by the external environment,and it is necessary to improve the external environment;it is necessary to strengthen the construction of digital and informatization of TCM,and to pay attention to the role of talents in TCM,so as to promote the high-quality development of TCM hospitals.

Objective:To analyze the risk factors for fat liquefaction after surgery for pediatric appendiceal abscess and to construct and validate a predictive model for post-operative fat liquefaction.Methods:The training set collected clinical data from 60 children who developed fat liquefaction after appendiceal abscess surgery and 60 children who did not develop fat liquefaction for comparison.The validation set collected data from 97 children during the same period ac-cording to the same criteria to test the model's efficacy.LASSO logistic regression was used to screen potential diag-nostic factors,and a Logistic regression model was employed for univariate analysis.Collinearity diagnostic tests were conducted among the risk factors.The stepwise regression method using the training dataset was applied to evaluate the importance of each risk factor for fat liquefaction.A multivariate Cox proportional hazards model was used to calcu-late the concordance index of the risk factors in both the training and validation sets.A predictive model was constructed using Logistic regression,and the clinical value of the predictive model was evaluated using ROC curves,calibration curves,and decision curves.Results:Compared with the non-liquefaction group,the liquefaction group had higher val-ues in terms of body weight,heart rate,diameter of the tender mass in the right lower abdomen,degree of appendiceal thickening,body temperature upon admission,fasting plasma glucose(FPG)level,surgical duration,intraoperative blood loss,wound healing time,length of hospital stay,volume of abdominal drainage fluid,and infection status(P<0.05).LASSO logistic regression analysis identified potential factors including body temperature upon admission,heart rate,body weight,diameter of the tender mass in the right lower abdomen,degree of appendiceal thickening,FPG level,sur-gical duration,and intraoperative blood loss.Univariate analysis revealed that body weight,diameter of the tender mass in the right lower abdomen,FPG level,surgical duration,and intraoperative blood loss were influencing factors for fat lique-faction after appendectomy(P<0.05).Body weight and FPG factors were mutually independent with no multicollinearity,while there was multicollinearity among the diameter of the tender mass in the right lower abdomen,surgical duration,and intraoperative blood loss.The risk model combining the diameter of the tender mass in the right lower abdomen,in-traoperative blood loss,FPG,surgical duration,and body weight had the highest concordance index in both the training and validation sets,with values of 0.811 and 0.814,respectively.The Logistic regression model established the predictive model as Logit(P)=-1.136+0.664×(diameter of the tender mass in the right lower abdomen)+0.449×(surgical duration)+0.622×(intraoperative blood loss)+0.200×(body weight)+0.578×(FPG).The area under the ROC curve was 0.920(95%CI:0.869～0.942),with a sensitivity of 93.14%and a specificity of 85.73%.The calibration curve of the predictive model showed good fit with the ideal curve.The predictive model had a high net benefit.Conclusion:Body weight,diameter of the tender mass in the right lower abdomen,FPG level,surgical duration,and intraoperative blood loss are risk factors for fat liquefaction after appendectomy and have good predictive value for the occurrence of fat liquefaction.

Objective:To examine the manifestations and causes of administrative burden among primary healthcare professionals,and to explore its impact on job burnout through the mediating role of role conflict,providing theoretical and empirical support for governance-level burden-reduction strategies.Methods:An exploratory sequential mixed-methods design was employed,focusing on primary healthcare professionals in Shandong Province.In the first phase,in-depth interviews were conducted with 175 participants;in the second phase,a questionnaire survey of 1,096 participants and follow-up interviews with 107 participants were carried out.Results:The proportions of respondents who reported"heavy"or"very heavy"burdens were 62.7%for inspection,54.8%for documentation,51.8%for reporting,and 24.4%for meetings.Structural equation modeling showed that administrative burden had a direct effect on job burnout(0.150)and an indirect effect through role conflict(0.093).Qualitative findings further indicated that administrative burden largely stemmed from public health traceability requirements and medical insurance policies,and operated through both resource-based and value-based conflicts.Conclusions:Primary healthcare professionals face considerable administrative burdens,which may heighten job burnout through role conflict.Governance reforms should optimize inspection and assessment,streamline data reporting,refine record-keeping,and promote collaborative governance to break the chain of institutional pressure leading to burnout.

Objective This study aimed to investigate the correlation of cerebral perfusion and cognitive function status in patients with minor stroke(MS)or transient ischemic attack(TIA)complicated by severe intracranial arterial stenosis or occlusion(hereafter referred to as ICAS-MSTIA).Methods Retrospectively enrol consecutive ICAS-MSTIA patients admitted to the Department of Neurology,the First Affiliated Hospital of Xi'an Jiaotong University,from June 2023 to May 2024.In the meantime,healthy controls were openly recruited.The ICAS-MSTIA patients were divided into two groups based on the side of intracranial large artery stenosis or occlusion:the left intracranial large artery involvement group and the right intracranial large artery involvement group.All patients with intracranial large artery stenosis or occlusion underwent MR scanning within 2 weeks after the first episode of TIA or MS,while there was no specific time requirement for MR examination in the healthy control group.On the day of MR scanning,the Montreal cognitive assessment(MoCA)scale was used to evaluate the participants'global cognitive function and performance in various cognitive domains,including visuospatial/executive function,naming,attention,language,abstraction,delayed recall,and orientation.General information of all participants was collected,including age,sex,educational level,body mass index,and history of smoking and alcohol consumption.Clinical data were collected from both left and right intracranial large artery involvement groups,including cerebrovascular risk factors(such as,diabetes mellitus,hypertension,and hyperlipidemia),National Institutes of Health stroke scale(NIHSS)score at admission,responsible stenotic or occluded arteries(internal carotid artery,middle cerebral artery),degree of stenosis in the responsible vessel(severe stenosis[stenosis rate 70%-99%],occlusion[stenosis rate100%])and non-responsible vessel(no stenosis[0],mild stenosis[stenosis rate＞0-49%]),collateral circulation compensation(American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology[ASTIN/SIR]collateral circulation classification),and responsible events(TIA,MS).General data and MoCA scale scores were compared across the three groups,while clinical data were compared between the left and right intracranial large artery involvement groups.Statistical parametric mapping 12(SPM 12)was used to perform voxel-wise independent samples t-tests on cerebral blood flow(CBF)differences among the left ICAS-MSTIA group,right ICAS-MSTIA group,and healthy control group,with cluster-level family-wise error(FWE)correction applied for adjustment.Multiple linear regression analysis was conducted to evaluate the relationship between global CBF values and total MoCA scores in ICAS-MSTIA patients with left or right intracranial large artery involvement.Results A total of 33 ICAS-MSTIA patients and 33 healthy controls were enrolled in the study.Among the ICAS-MSTIA patients,21 had left intracranial large artery involvement and 12 had right involvement.(1)Among the three groups,statistically significant differences were observed in the proportions of individuals with reported smoking history(P=0.024)and alcohol consumption history(P=0.011).The left intracranial large artery involvement group had a higher NIHSS score(0[0,2]vs.0[0,0],P=0.044)and a higher proportion of patients with internal carotid artery involvement(13/21 cases vs.2/12 cases,P=0.027)compared with the right side group.No statistically significant differences were observed in other general or clinical data across the three groups or between the two non-control groups(all P＞0.05).(2)Statistically significant differences were found across the three groups in the MoCA scale total score and scores of visuospatial/executive function,attention,language,abstraction,delayed recall,and orientation cognitive domains(all P＜0.05),while no significant difference was noted in the naming score(P=0.063).The left intracranial large artery involvement group had lower total MoCA score and lower scores in visuospatial/executive function,attention,language,abstraction,delayed recall,and orientation in comparison to the healthy control group(all P＜0.016 7).The right intracranial large artery involvement group had significantly lower scores in language,abstraction,and orientation domains than the healthy control group(all P＜0.016 7).Additionally,the left side group had a lower attention domain score than the right side group(P＜0.016 7).No other statistically significant differences were found in pairwise comparisons(all P＞0.016 7).(3)Patients in both the left and right intracranial large artery involvement groups exhibited a significant decrease in CBF in extensive regions on the affected side,including the temporal lobe,dorsolateral prefrontal cortex,and occipital lobe.Furthermore,after correction,in the left involvement group CBF was higher in the contralateral lingual gyrus,cuneus,and calcarine sulcus compared with the healthy control group(P＜0.05).While in the right involvement group,no regions had increased CBF compared to the healthy control group.(4)Multiple linear regression showed positive correlation between CBF in ipsilateral precentral gyrus and superior temporal gyrus,and the total MoCA score in patients with left intracranial large artery involvement(FWE-corrected,P＜0.05).In contrast,there was no correlation between CBF and total MoCA score in patients with right intracranial large artery involvement.Conclusions ICAS-MSTIA patients exhibited various degrees of impairment in cerebral perfusion and cognitive function.A significant positive correlation is observed between these two impairments in patients with left intracranial large artery involvement.

The pathological mechanisms and related physiological indicators of acute mountain sickness(AMS)were introduced,and the present situation of wearable devices applied in AMS auxiliary detection and diagnosis were reviewed.The challenges and future development directions of wearable devices applied in auxiliary detection and diagnosis were pointed out.[Chinese Medical Equipment Journal,2025,46(9):100-107]

Objective:To investigate the drug resistance gene characteristics, plasmid characteristics and genome tracing of Shigella sonnei causing a bacillary dysentery outbreak in Shandong Province. Methods:Sixty-five Shigella sonnei strains isolated from a 2021 outbreak in a county of Shandong Province were analyzed using antimicrobial susceptibility testing, whole genome sequencing (WGS), characterization of resistance and virulence genes, plasmid profiling, core genome multilocus sequence typing (cgMLST), and single nucleotide polymorphism (SNP) analysis. Results:All isolates had the same resistance phenotype and genotypes and were multidrug-resistant ESBL-producing Shigella sonnei, carrying important virulence genes. Plasmid analysis revealed a conserved genetic arrangement, pil( M/ N/ O2/ P)-tra( F/ H/ J/ K/ N/ O/ P/ Q)-IS Ecp1- blaCTX-M-14-Tn 903- yub( J/ I/ F/ G/ E/ D), and shared across strains from diverse regions and bacterial species. The cgMLST and SNP analyses demonstrated concordant clustering, with all 65 outbreak-related strains forming a single cluster alongside human-derived strains from Guangxi. Conclusion:The ESBL-producing Shigella sonnei responsible for the outbreak shares a homologous relationship with Guangxi human-derived strains, and the detected resistance plasmids and virulence genes underscore the need to strengthen drug resistance surveillance and genome tracing.