Objective To investigate the correlation between coronary heart disease(CHD)and cognitive impairment in rural populations aged 40 and above.Methods From October 2014 to March 2015,all residents aged 40 and above from two villages in Huyi District,Xi'an,were selected as study subjects.Information regarding their demographics,lifestyle habits,medical history,family history,physical examinations,and biochemical tests was collected.The participants were categorized into those with and without the history of CHD.Cognitive function was assessed using the Mini-Mental State Examination(MMSE),with scores below the cutoff(illiteracy≤17;primary school≤20;junior high school and above≤24)defined as cognitive impairment.Chi-square test was used to compare the prevalence of cognitive impairment between the CHD and non-CHD groups.Multivariate Logistic regression was employed to adjust for confounding factors in analyzing the relationship between CHD and cognitive impairment.Results A total of 1 833 subjects were included in the analysis,comprising 735 males(40.1％)and 57 individuals with CHD(3.1％).Among them,234 participants(13.3％)met the criteria for cognitive impairment.Univariate analysis showed a higher prevalence of cognitive impairment in the CHD group compared to the non-CHD group(24.6％vs.12.9％,P=0.016).Unadjusted binary Logistic regression analysis indicated a positive correlation between CHD and cognitive impairment(OR=2.199,95％CI:1.185-4.084,P=0.013).However,after adjusting for confounding factors such as gender,age,education level,hypertension,diabetes,dyslipidemia,stroke history and BMI,the association between CHD and cognitive impairment was not statistically significant(OR=1.265,95％CI:0.656-2.441,P=0.483).In the stratified analysis,among diabetic patients,CHD was significantly associated with a high risk of cognitive impairment(OR=4.191,95％CI:1.464-12.000,P=0.008).The prevalence of cognitive impairment significantly increased in patients with CHD combined with diabetes(OR=4.712,95％CI:1.651-13.449,P=0.004).Conclusion This study did not establish a direct association between CHD and cognitive impairment.However,this study suggests that the presence of CHD and diabetes mellitus is significantly associated with an increased risk of cognitive impairment.Future prospective studies with larger sample sizes should be conducted to further confirm the relationship between the two.

Objective To analyse impact of low-dose CT on radiation dose and image quality of ankle fractures in children.Methods 600 suspected ankle fracture children admitted to Hangzhou Children's Hospital were selected as the research subjects from January to December 2023.All children needed to undergo conventional dose CT examination and low-dose CT examination.Image quality,radiation dose,diagnostic accuracy,and diagnostic efficacy of conventional dose CT and low-dose CT examination were compared.Results No significant difference was found between conventional-dose CT examination and low-dose CT examination in objectivity image quality index(P＞0.05).Effective dose,dose length product,and volume CT dose index of low-dose CT examination were all lower than those of conventional dose CT examination,and the difference was statistically significant(P＜0.05).The diagnostic accuracy of low-dose CT examination and conventional dose CT examination showed no significant difference(P＞0.05).Low-dose CT examination compared with conventional dose CT examination,there was no significant difference in diagnostic specificity(P＞0.05),while there was significant difference in diagnostic sensitivity and accuracy(P＜0.05).Area under the curve of effective dose,dose length product,volume CT dose index alone and combined diagnosis of ankle fractures in children were 0.899(95％CI:0.880-0.918),0.934(95％CI:0.918-0.950),0.928(95％CI:0.911-0.945),and 0.934(95％CI:0.918-0.950),respectively.Conclusion Low-dose CT examination technology has high diagnostic value for ankle fractures in children,can reduce radiation dose,and has little impact on image quality and diagnostic accuracy.It is worth popularizing and applying.

Objective To investigate the antimicrobial resistance of clinical isolates from elderly patients(≥65 years)in major medical institutions across China.Methods Bacterial strains were isolated from elderly patients in 52 hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program during the period from 2015 to 2021.Antimicrobial susceptibility test was carried out by disk diffusion method and automated systems according to the same CHINET protocol.The data were interpreted in accordance with the breakpoints recommended by the Clinical and Laboratory Standards Institute(CLSI)in 2021.Results A total of 514 715 nonduplicate clinical isolates were collected from elderly patients in 52 hospitals from January 1,2015 to December 31,2021.The number of isolates accounted for 34.3％of the total number of clinical isolates from all patients.Overall,21.8％of the 514 715 strains were gram-positive bacteria,and 78.2％were gram-negative bacteria.Majority(90.9％)of the strains were isolated from inpatients.About 42.9％of the strains were isolated from respiratory specimens,and 22.9％were isolated from urine.More than half(60.7％)of the strains were isolated from male patients,and 39.3％isolated from females.About 51.1％of the strains were isolated from patients aged 65-＜75 years.The prevalence of methicillin-resistant strains(MRSA)was 38.8％in 32 190 strains of Staphylococcus aureus.No vancomycin-or linezolid-resistant strains were found.The resistance rate of E.faecalis to most antibiotics was significantly lower than that of Enterococcus faecium,but a few vancomycin-resistant strains(0.2％,1.5％)and linezolid-resistant strains(3.4％,0.3％)were found in E.faecalis and E.faecium.The prevalence of penicillin-susceptible S.pneumoniae(PSSP),penicillin-intermediate S.pneumoniae(PISP),and penicillin-resistant S.pneumoniae(PRSP)was 94.3％,4.0％,and 1.7％in nonmeningitis S.pneumoniae isolates.The resistance rates of Klebsiella spp.(Klebsiella pneumoniae 93.2％)to imipenem and meropenem were 20.9％and 22.3％,respectively.Other Enterobacterales species were highly sensitive to carbapenem antibiotics.Only 1.7％-7.8％of other Enterobacterales strains were resistant to carbapenems.The resistance rates of Acinetobacter spp.(Acinetobacter baumannii 90.6％)to imipenem and meropenem were 68.4％and 70.6％respectively,while 28.5％and 24.3％of P.aeruginosa strains were resistant to imipenem and meropenem,respectively.Conclusions The number of clinical isolates from elderly patients is increasing year by year,especially in the 65-＜75 age group.Respiratory tract isolates were more prevalent in male elderly patients,and urinary tract isolates were more prevalent in female elderly patients.Klebsiella isolates were increasingly resistant to multiple antimicrobial agents,especially carbapenems.Antimicrobial resistance surveillance is helpful for accurate empirical antimicrobial therapy in elderly patients.

Objective To investigate the antimicrobial resistance of clinical isolates from elderly patients(≥65 years)in major medical institutions across China.Methods Bacterial strains were isolated from elderly patients in 52 hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program during the period from 2015 to 2021.Antimicrobial susceptibility test was carried out by disk diffusion method and automated systems according to the same CHINET protocol.The data were interpreted in accordance with the breakpoints recommended by the Clinical and Laboratory Standards Institute(CLSI)in 2021.Results A total of 514 715 nonduplicate clinical isolates were collected from elderly patients in 52 hospitals from January 1,2015 to December 31,2021.The number of isolates accounted for 34.3％of the total number of clinical isolates from all patients.Overall,21.8％of the 514 715 strains were gram-positive bacteria,and 78.2％were gram-negative bacteria.Majority(90.9％)of the strains were isolated from inpatients.About 42.9％of the strains were isolated from respiratory specimens,and 22.9％were isolated from urine.More than half(60.7％)of the strains were isolated from male patients,and 39.3％isolated from females.About 51.1％of the strains were isolated from patients aged 65-＜75 years.The prevalence of methicillin-resistant strains(MRSA)was 38.8％in 32 190 strains of Staphylococcus aureus.No vancomycin-or linezolid-resistant strains were found.The resistance rate of E.faecalis to most antibiotics was significantly lower than that of Enterococcus faecium,but a few vancomycin-resistant strains(0.2％,1.5％)and linezolid-resistant strains(3.4％,0.3％)were found in E.faecalis and E.faecium.The prevalence of penicillin-susceptible S.pneumoniae(PSSP),penicillin-intermediate S.pneumoniae(PISP),and penicillin-resistant S.pneumoniae(PRSP)was 94.3％,4.0％,and 1.7％in nonmeningitis S.pneumoniae isolates.The resistance rates of Klebsiella spp.(Klebsiella pneumoniae 93.2％)to imipenem and meropenem were 20.9％and 22.3％,respectively.Other Enterobacterales species were highly sensitive to carbapenem antibiotics.Only 1.7％-7.8％of other Enterobacterales strains were resistant to carbapenems.The resistance rates of Acinetobacter spp.(Acinetobacter baumannii 90.6％)to imipenem and meropenem were 68.4％and 70.6％respectively,while 28.5％and 24.3％of P.aeruginosa strains were resistant to imipenem and meropenem,respectively.Conclusions The number of clinical isolates from elderly patients is increasing year by year,especially in the 65-＜75 age group.Respiratory tract isolates were more prevalent in male elderly patients,and urinary tract isolates were more prevalent in female elderly patients.Klebsiella isolates were increasingly resistant to multiple antimicrobial agents,especially carbapenems.Antimicrobial resistance surveillance is helpful for accurate empirical antimicrobial therapy in elderly patients.

Objectives:Comparative analysis of the beagles acute-phase electrocardiographic,hemodynamic,left ventricular flow field status,and energy consumption characteristics of pacing at different sites of conduction system may help to elucidate the scientific mechanism of left bundle branch pacing(LBBP)as a option of physiological pacing therapy.Methods:Eight healthy adult beagles were used in this study.Initially,an active fixation lead was implanted in the right atrial appendage,followed by implantation of another active fixation lead at the right ventricular apex,distal His bundle,and left bundle septal branch,respectively.After connecting a dual-chamber pacemaker,electrocardiographic and acute phase hemodynamic parameters under sinus rhythm,right ventricular apex pacing(RVAP),distal His bundle pacing(DHBP),and LBBP states were collected and analyzed.Three complete cardiac cycles of standard apical three-chamber color Doppler dynamic images were acquired under vector flow mapping(VFM)mode.Offline analysis was performed on obtained parameters including isovolumic contraction period,rapid ejection period,isovolumic relaxation period,rapid filling period,atrial contraction period,and left ventricular intracavitary energy consumption.These parameters were compared under pacing at different sites and the linear correlations of major parameters were analyzed.Results:The QRS duration of baseline intrinsic sinus rhythm,RVAP,DHBP and LBBP were(45.0±4.0)ms,(98.4±6.2)ms,(50.0±4.5)ms and(62.0±4.7)ms,respectively.The LBBP-QRS duration was significantly wider than intrinsic sinus rhythm and DHBP,but significantly narrower than RVAP(all P<0.01).Compared with baseline AOO mode(the pacing rate was performed at 10 beats/min above the intrinsic heart rate),the change of acute phase maximum left ventricular pressure rise rate(LVdP/dtmax)in RVAP,DHBP and LBBP was([-7.89±5.67]% ),([0.74±2.05]% )and([-0.14±3.59]% ),respectively.There was no significant difference in LVdP/dtmax changes between DHBP and LBBP(P=0.667),but both pacing modalities were significantly better than RVAP(all P<0.01).The average energy consumption of the left ventricle under RVAP was significantly higher than that of intrinsic sinus rhythm,DHBP,and LBBP in isovolumic contraction period,rapid ejection period,isovolumic relaxation period,rapid filling period,and atrial contraction period(all P<0.01).However,there was no statistically significant difference in energy consumption among intrinsic sinus rhythm,DHBP,and LBBP during the above five phases(all P>0.05).DHBP and LBBP did not show a significant increase in the number of left ventricular vortices,vortex area,and circulation intensity compared to intrinsic sinus rhythm,and LBBP did not show a significant increase in vortex area and circulation intensity compared to DHBP.Conclusions:Although LBBP canines significantly prolonged the paced QRS duration,it showed no significant differences in acute phase left ventricular hemodynamics,left ventricular flow field status,and energy consumption compared to intrinsic sinus rhythm and DHBP.Performance of LBBP was superior to RVAP.This study may contribute to revealing the theoretical basis of LBBP as a feasible physiological pacing therapy.

Objective:This article aims to investigate effect of information-knowledge-attitude-practice(IKAP)theory-based health management mode on rehabilitation effect and quality of life in patients with coronary heart disease(CHD).Methods:This randomized controlled study enrolled 160 CHD patients admitted in First Depart-ment of Cardiovascular Medicine,the First People's Hospital of Wuhu and first received,transradical artery percu-taneous coronary intervention between August 2022 and February 2023.They were divided into control group(n=80,routine health management)and intervention group(n=80,IKAP theory-based health management mode),and both groups were intervened for 1 month.Visual Analogue Scale(VAS)score,frequency of pain attack,scores of Hamilton Anxiety scale(HAMA),Hamilton Depression scale(HAMD),World Health Organization Quality of Life BREF(WHOQOL-BREF)and Activities of Daily Living(ADL),and incidence of complications were com-pared between two groups.Results:After intervention,compared with patients in control group,those in interven-tion group had significant lower VAS score[(2.15±0.34)points vs.(3.99±0.44)points],frequency of pain at-tack[(1.37±0.30)times/d vs.(2.31±0.33)times/d],scores of HAMA[(9.21±0.65)points vs.(12.87±0.63)points]and HAMD[(8.87±0.52)points vs.(13.57±0.92)points],and significant higher scores of ADL[(78.32±2.95)points vs.(68.54±2.86)points]and WHOQOL-BREF[(311.54±10.73)points vs.(251.38±10.30)points](P＜0.001 all).Incidence of complications in intervention group was significantly lower than that of control group(15.00％vs.31.25％,P=0.015).Conclusion:IKAP theory-based health management mode could effectively improve the psychological state and self-care ability of daily living,reduce frequency of pain attack and incidence of complications,and improve quality of life in CHD patients.

Objective To investigate the correlation between coronary heart disease(CHD)and cognitive impairment in rural populations aged 40 and above.Methods From October 2014 to March 2015,all residents aged 40 and above from two villages in Huyi District,Xi'an,were selected as study subjects.Information regarding their demographics,lifestyle habits,medical history,family history,physical examinations,and biochemical tests was collected.The participants were categorized into those with and without the history of CHD.Cognitive function was assessed using the Mini-Mental State Examination(MMSE),with scores below the cutoff(illiteracy≤17;primary school≤20;junior high school and above≤24)defined as cognitive impairment.Chi-square test was used to compare the prevalence of cognitive impairment between the CHD and non-CHD groups.Multivariate Logistic regression was employed to adjust for confounding factors in analyzing the relationship between CHD and cognitive impairment.Results A total of 1 833 subjects were included in the analysis,comprising 735 males(40.1％)and 57 individuals with CHD(3.1％).Among them,234 participants(13.3％)met the criteria for cognitive impairment.Univariate analysis showed a higher prevalence of cognitive impairment in the CHD group compared to the non-CHD group(24.6％vs.12.9％,P=0.016).Unadjusted binary Logistic regression analysis indicated a positive correlation between CHD and cognitive impairment(OR=2.199,95％CI:1.185-4.084,P=0.013).However,after adjusting for confounding factors such as gender,age,education level,hypertension,diabetes,dyslipidemia,stroke history and BMI,the association between CHD and cognitive impairment was not statistically significant(OR=1.265,95％CI:0.656-2.441,P=0.483).In the stratified analysis,among diabetic patients,CHD was significantly associated with a high risk of cognitive impairment(OR=4.191,95％CI:1.464-12.000,P=0.008).The prevalence of cognitive impairment significantly increased in patients with CHD combined with diabetes(OR=4.712,95％CI:1.651-13.449,P=0.004).Conclusion This study did not establish a direct association between CHD and cognitive impairment.However,this study suggests that the presence of CHD and diabetes mellitus is significantly associated with an increased risk of cognitive impairment.Future prospective studies with larger sample sizes should be conducted to further confirm the relationship between the two.

Objective To examine the changing prevalence and antimicrobial resistance profiles of Burkholderia cepacia in 52 hospitals across China from 2015 to 2021.Methods A total of 9 261 strains of B.cepacia were collected from 52 hospitals between January 1,2015 and December 31,2021.Antimicrobial susceptibility of the strains was tested using Kirby-Bauer method or automated antimicrobial susceptibility testing systems according to a unified protocol.The results were interpreted according to the breakpoints released in the Clinical & Laboratory Standards Institute(CLSI)guidelines(2023 edition).Results A total of 9 261 strains of B.cepacia were isolated from all age groups,especially elderly patients.The proportion was 11.1％(1 032 strains)in children,significantly lower than the proportion in adults.About half(46.5％,4 310/9 261)of the strains were isolated from patients at least 60 years old and 42.3％(3 919/9 261)of the strains were isolated from young adults.Most isolates(71.1％)were isolated from sputum and respiratory secretions,followed by urine(10.7％)and blood samples(8.1％).B.cepacia isolates were highly susceptible to the five antimicrobial agents recommended in the CLSI M100 document(33rd edition,2023).B.cepacia isolates showed relatively higher resistance rates to meropenem and levofloxacin.However,the resistance rates to ceftazidime,trimethoprim-sulfamethoxazole,and minocycline remained below 8.1％.The percentage of B.cepacia strains resistant to levofloxacin was the highest compared to other antibiotics in any of the three age groups(from 12.4％in the patients＜18 years old to 20.6％in the patients aged 60 years or older).Conclusions B.cepacia is one of the clinically important non-fermenting gram-negative bacteria.Accurate and timely reporting of antimicrobial susceptibility test results and ongoing antimicrobial resistance surveillance are helpful for rational prescription of antimicrobial agents and proper prevention and control of nosocomial infections.

AIM:To investigate the role of BRCA2 and CDKN1A interacting protein(BCCIP)in gastric can-cer(GC)and elucidate its mechanism in mediating cisplatin resistance.METHODS:The BCCIP mRNA expression was assessed in GC tissues(n=415)and normal tissues(n=34)using The Cancer Genome Atlas(TCGA)database.In an in-ternal cohort(n=36 for RT-qPCR;n=5 for Western blot;n=30 for immunohistochemistry),BCCIP expression at both mRNA and protein levels was examined in GC tissues and paired adjacent normal tissues.Human GC cell lines AGS and HGC27 were cultured in vitro and treated with cisplatin in a dose(0,2,4,6,8 and 10 μmol/L)-and time(0,6,24 and 48 h)-dependent manner,followed by Western blot analysis of BCCIP expression.Stable BCCIP knockdown cell lines(shRNA#1 and shRNA#2 groups)were generated via lentiviral transfection,with empty vector-transfected cells serving as controls(vector group).Flow cytometry and colony formation assay were performed to evaluate the effects of BCCIP on apoptosis and colony-forming ability of GC cells treated with cisplatin.Western blot was utilized to detect the changes of BCCIP protein expression levels in the cytoplasm and nucleus of GC cells after cisplatin(2.5 and 1.0 μmol/L)treatment,as well as the effects of BCCIP on the expression of DNA damage marker γ-H2AX and apoptosis-related proteins cleaved caspase-9 and cleaved caspase-3,and the activation of checkpoint kinase 1(CHK1)after cisplatin(2.5 and 1.0 μmol/L)treatment.Immunofluorescence was conducted to observe the effect of BCCIP on γ-H2AX expression in GC cells treated with cisplatin(2.5 and 1.0 μmol/L).RESULTS:The BCCIP expression was significantly up-regulated in GC tissues compared with normal tissues(P<0.01).Cisplatin induced up-regulation of BCCIP expression in a dose-and time-depen-dent manner.Knockdown of BCCIP significantly enhanced cisplatin-induced apoptosis(P<0.01)and reduced colony-forming ability(P<0.05)of GC cells.Knockdown of BCCIP promoted the expression of γ-H2AX,but inhibited the activa-tion of CHK1 after cisplatin treatment,with increased protein levels of cleaved caspase-9 and cleaved caspase-3(P<0.01).CONCLUSION:Cisplatin promotes the expression of BCCIP in GC cells.BCCIP confers cisplatin resistance in GC cells by suppressing apoptosis through modulation of DNA damage response pathways.

Objective To examine the changing prevalence and antimicrobial resistance profiles of Burkholderia cepacia in 52 hospitals across China from 2015 to 2021.Methods A total of 9 261 strains of B.cepacia were collected from 52 hospitals between January 1,2015 and December 31,2021.Antimicrobial susceptibility of the strains was tested using Kirby-Bauer method or automated antimicrobial susceptibility testing systems according to a unified protocol.The results were interpreted according to the breakpoints released in the Clinical & Laboratory Standards Institute(CLSI)guidelines(2023 edition).Results A total of 9 261 strains of B.cepacia were isolated from all age groups,especially elderly patients.The proportion was 11.1％(1 032 strains)in children,significantly lower than the proportion in adults.About half(46.5％,4 310/9 261)of the strains were isolated from patients at least 60 years old and 42.3％(3 919/9 261)of the strains were isolated from young adults.Most isolates(71.1％)were isolated from sputum and respiratory secretions,followed by urine(10.7％)and blood samples(8.1％).B.cepacia isolates were highly susceptible to the five antimicrobial agents recommended in the CLSI M100 document(33rd edition,2023).B.cepacia isolates showed relatively higher resistance rates to meropenem and levofloxacin.However,the resistance rates to ceftazidime,trimethoprim-sulfamethoxazole,and minocycline remained below 8.1％.The percentage of B.cepacia strains resistant to levofloxacin was the highest compared to other antibiotics in any of the three age groups(from 12.4％in the patients＜18 years old to 20.6％in the patients aged 60 years or older).Conclusions B.cepacia is one of the clinically important non-fermenting gram-negative bacteria.Accurate and timely reporting of antimicrobial susceptibility test results and ongoing antimicrobial resistance surveillance are helpful for rational prescription of antimicrobial agents and proper prevention and control of nosocomial infections.