Objective: To analyze the association between drinking behaviors and anxiety symptoms, with the mediating role of insomnia symptoms among college freshmen, so as to provide a reference basis for reducing the occurrence of anxiety symptoms in college freshmen. Methods: From October to December 2021, 31 856 freshmen were selected by the purposive sampling method in 22 colleges across 11 provinces (Fujian, Jiangsu, Guangdong, Henan, Anhui, Hubei, Shanxi, Jiangxi, Shaanxi, Yunnan, Chongqing) in China. The Semi quantitative Food Frequency Questionnaire was used to investigate college freshmen drinking behaviors. The Depression Anxiety Stress Scale 21 and the Insomnia Severity Index were used to assess anxiety symptoms and insomnia symptoms in college freshmen. The generalized linear model was employed to analyze the association between drinking behaviors and anxiety symptoms in college freshmen, and the structural equation modeling was used to assess the mediating effect of insomnia symptoms on the association. Results: The detection rate of anxiety symptoms among college freshmen was 28.2%, the detection rates of the mild, moderate, severe and extremely severe were 6.6%, 15.9%, 3.2% and 2.6%, respectively. While 23.6% of college freshmen reported drinking in the past month, the rates were 39.8% among boys and 15.9% among girls. After adjusting for demographic variables (ethnicity, education, major, etc.) and confounding variables (self evaluation of learning burden, number of close friends, screen time, etc.), the results of generalized linear model analysis showed that beer consumption was associated with anxiety symptoms in college freshmen( β =0.09, 95% CI =0.04-0.14), girls( β =0.14, 95% CI =0.07-0.21) and those aged 19-20 years ( β =0.12, 95% CI =0.05-0.19)(all P <0.05). Red wine consumption was associated with anxiety symptoms in male students ( β =0.13, 95% CI =0.02-0.24, P <0.05). Alcohol and beer consumption were associated with insomnia in college freshmen[ β (95% CI ) =0.22(0.08-0.36),0.31(0.23-0.39),both P <0.01]. Insomnia symptoms partially mediated the association between drinking behaviors and anxiety symptoms among college freshmen with a mediating effect value of 0.05, accounting for 50.49% of the total effect. Conclusions Insomnia symptoms partially mediates the association between drinking behaviors and anxiety symptoms in college freshmen. Measures should be taken to simultaneously intervene in the drinking behaviors and insomnia symptoms of college freshmen to prevent the occurrence of their anxiety symptoms.

With the rapid development of artificial intelligence(AI),how to digitize the teaching of Medical Immunology is a new challenge posed by the times and education.This study is based on the advanced teaching model of Medical Immunology,which includes lectures-PAD class-flipped classrooms-expert lecture.By introducing knowledge mapping and AI teaching assistant into the entire learning process,the students not only deepen their understanding of the knowledge system of Medical Immunology,but also ex-ercise their ability to apply immunological knowledge to solve practical clinical problems,enhance their self-learning ability,expres-sion ability,communication ability,on-site performance ability,and cultivate a spirit of unity,cooperation,and exploration.The practice of empowering Medical Immunology teaching with digital intelligence achieves the integration of theory and application,the linkage between in class and out of class teaching,the connection between commonalities and individualities,and the union of abili-ties and qualities in Medical Immunology teaching.It also provides practical basis for exploring the implementation path of digital intel-ligence empowerment in Medical Immunology teaching.

Objective:To explore the expression of CD14 in peripheral blood monocytes to predict the prognosis of patients with severe COPD complicated with pulmonary infection.Methods:A total of 122 patients with severe COPD and pulmonary infection diagnosed and treated in East Lianyungang Hospital from January 2019 to February 2022 were selected as co-infection group,127 pa-tients with severe COPD were selected as COPD group,and 62 healthy subjects in physical examination during the same period were selected as control group.After 30 days of follow-up,patients in co-infected group were divided into death group(n=16)and survival group(n=106)according to prognosis during hospitalization.Membrane CD14(mCD14)related parameters of control group,COPD group and co-infected group were compared.Dynamic changes of mCD14 related parameters were compared between death group and survival group at day 1,3,5,7 and 14 after diagnosis.Cox proportional hazard regression was used to analyze the independent risk factors of death in patients with severe COPD complicated with pulmonary infection after 30 days.Predictive values of CD14%,CD14MFI and CD14IND on prognostic death were analyzed by ROC curve,and the area under the curve(AUC)was compared.Ka-plan-Meier method was used to draw survival curve to compare the survival of patients with different CD14IND levels.Results:Com-pared with control group,CD14%,CD14MFI and CD14IND in COPD group and co-infection group were significantly decreased;com-pared with COPD group,CD14%,CD14MFI and CD14IND in co-infection group were significantly decreased,the differences were statistically significant(P<0.05).Expression of mCD14 in survival group increased steadily during the whole monitoring process,while expression in death group fluctuated at a low level.COPD grade,forced expiratory volume in 1 second/forced vital capacity(FEV1/FVC),forced expiratory volume in 1 second as a percentage of predicted value(FEV1%pred),CD14%,CD14MFI,CD14IND were all risk factors for death in patients with severe COPD complicated with pulmonary infection(P<0.05).CD14%,CD14MFI and CD14IND were negatively correlated with mortality and COPD grade in patients with severe COPD complicated with pulmonary infec-tion,while were positively correlated with FEV1%pred and FEV1/FVC(P<0.001).With CD14IND≤74.36 as cut-off value,the sensi-tivity and specificity of predicting death reached 91.22%and 95.51%respectively.The 30-day survival rate of high-risk group was 68.42%(26/38),which was significantly lower than 95.24%(80/84)of low-risk group(log-rank χ2=10.067,P=0.002).Conclusion:mCD14-related parameters are expected to be the prognostic markers of death in patients with severe COPD complicated with pulmo-nary infection,and the sensitivity and specificity of CD14IND are better than those of CD14%and CD14MFI.

Objective To Analyze the projects funded by the National Natural Science Foundation of China(NSFC)in the field of gout and hyperuricemia from 2014 to 2023,explore the hotspots and current status of basic research in the past decade in order to provide references for future research in this field.Methods Data were retrieved from databases such as The NSFC official website and so on,with the search keywords being"gout" and "hyperuricemia",covering the time span from 2014 to 2023.Establish a project database and clean the included keywords for statistical analysis and visualization.Results In the past decade,a total of 203 projects have been ap-proved,with a total funding amount of 84.588million yuan.The funded projects include 5 types,involve 4 faculties,include 27 first-level disciplines,and the first-level discipline with the largest number of projects is Traditional Chinese Pharmacy.Shanghai has the lar-gest number of projects,and Qingdao University has the largest number of projects and funding amounts.There are a total of 178 research-ers,and 21 of them have received two or more grants,among which Li Changgui from Qingdao University has the largest number of ap-proved projects.The researches focus on the pathophysiological links primarily centered on"inflammation",signal pathways and key tar-gets,pathogenic genes and the discovery of new genes,multi-system damage,studies on traditional Chinese medicine,new technologies and new methods.Conclusion It is hoped that in the future,the NSFC can increase the funding support for projects in the field of gout and hyperuricemia.Researchers should employ more cutting-edge technologies and innovative methods,carry out interdisciplinary re-search,integrate the essence of Chinese and Western medicine,further explain the disease mechanism,and provide new ideas for the clinical diagnosis and treatment of gout and hyperuricemia.

Objectives:This study aimed to investigate the impact of quantitative flow ratio(QFR)-guided revascularization on outcome of elderly patients with coronary artery disease(CAD)undergoing valve surgery.Methods:We retrospectively analyzed 750 consecutive patients with angiographically confirmed CAD(≥50%stenosis)who underwent valve surgery at Zhongshan Hospital,Fudan University,between January 2016 and December 2021.According to the patients'ages,they were divided into the younger group(age<70 years old,n=532)and the elderly group(age≥70 years old,n=218).Revascularization strategies were evaluated using anatomical(angiography-based)and functional(QFR-based)criteria.Anatomical complete revascularization(CR)was defined as bypass grafting for all lesions with≥70%diameter stenosis in major coronary arteries or≥50%stenosis in the left main coronary artery.Functional CR referred bypass grafting for all lesions with QFR≤0.80.Incomplete revascularization(ICR)was defined as failure to meet CR criteria.According to the anatomical and functional definitions,the younger group and the elderly group were further divided into the incomplete revascularization subgroup and the complete revascularization subgroup respectively.Major adverse cardiovascular events(MACE),including death,myocardial infarction,repeat revascularization,and stroke,were assessed as the composite endpoint.Results:Over a follow-up of(3.7±1.8)years,the overall MACE rate was 13.3%.The younger group exhibited significantly lower MACE rates than the elderly group(10.7%vs.19.7%,P=0.001).In the younger group,anatomical ICR did not increase MACE risk(HR=1.46,95%CI:0.81-2.62,P=0.164),whereas functional ICR significantly increased MACE risk(HR=2.27,95%CI:1.24-4.15,P=0.001).In the elderly group,neither anatomical ICR(HR=1.22,95%CI:0.62-2.41,P=0.540)nor functional ICR(HR=1.52,95%CI:0.78-2.96,P=0.172)was associated with increased MACE risk.Conclusions:In patients undergoing valve surgery with CAD,functional ICR correlated with adverse outcomes in the younger group,whereas neither anatomical nor functional ICR significantly affected prognosis in elderly patients.These findings suggest that a moderately conservative revascularization strategy may be more appropriate for elderly populations.

Objective:To explore the relationship between positive affect and flow experience in college students.Methods:A total of 193 college students participated in a 14-day diary study.Positive affect and flow ex-perience were assessed daily using the Positive Affect Scale and Short Flow State Scale(SFSS).Dynamic struc-tural equation modeling(DSEM)was used for analysis.Results:At the within-person level,the positive affect scores were positively correlated with the SFSS scores(r=0.50,P＜0.001).At the between-person level,the positive affect scores were positively correlated with the SFSS scores(r=0.47,P＜0.001).The two-level DSEM analysis showed that the flow experience of the previous day positively predicted positive affect on the next day(γ=0.12,95％CI:0.06-0.18),while positive affect on the previous day did not predict flow experience on the next day(γ=0.00,95％CI:-0.06-0.06).Conclusion:In this study,daily flow experience in col-lege students positively predicts subsequent positive affect,but daily positive affect does not significantly predict subsequent flow experience.

Objective To investigate the distribution and antimicrobial resistance profiles of common pathogens isolated from cerebrospinal fluid(CSF)in CHINET program from 2015 to 2021.Methods The bacterial strains isolated from CSF were identified in accordance with clinical microbiology practice standards.Antimicrobial susceptibility test was conducted using Kirby-Bauer method and automated systems per the unified CHINET protocol.Results A total of 14 014 bacterial strains were isolated from CSF samples from 2015 to 2021,including the strains isolated from inpatients(95.3％)and from outpatient and emergency care patients(4.7％).Overall,19.6％of the isolates were from children and 80.4％were from adults.Gram-positive and Gram-negative bacteria accounted for 68.0％and 32.0％,respectively.Coagulase negative Staphylococcus accounted for 73.0％of the total Gram-positive bacterial isolates.The prevalence of MRSA was 38.2％in children and 45.6％in adults.The prevalence of MRCNS was 67.6％in adults and 69.5％in children.A small number of vancomycin-resistant Enterococcus faecium(2.2％)and linezolid-resistant Enterococcus faecalis(3.1％)were isolated from adult patients.The resistance rates of Escherichia coli and Klebsiella pneumoniae to ceftriaxone were 52.2％and 76.4％in children,70.5％and 63.5％in adults.The prevalence of carbapenem-resistant E.coli and K.pneumoniae(CRKP)was 1.3％and 47.7％in children,6.4％and 47.9％in adults.The prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)and Pseudomonas aeruginosa(CRPA)was 74.0％and 37.1％in children,81.7％and 39.9％in adults.Conclusions The data derived from antimicrobial resistance surveillance are crucial for clinicians to make evidence-based decisions regarding antibiotic therapy.Attention should be paid to the Gram-negative bacteria,especially CRKP and CRAB in central nervous system(CNS)infections.Ongoing antimicrobial resistance surveillance is helpful for optimizing antibiotic use in CNS infections.

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 Analyze the projects funded by the National Natural Science Foundation of China(NSFC)in the field of gout and hyperuricemia from 2014 to 2023,explore the hotspots and current status of basic research in the past decade in order to provide references for future research in this field.Methods Data were retrieved from databases such as The NSFC official website and so on,with the search keywords being"gout" and "hyperuricemia",covering the time span from 2014 to 2023.Establish a project database and clean the included keywords for statistical analysis and visualization.Results In the past decade,a total of 203 projects have been ap-proved,with a total funding amount of 84.588million yuan.The funded projects include 5 types,involve 4 faculties,include 27 first-level disciplines,and the first-level discipline with the largest number of projects is Traditional Chinese Pharmacy.Shanghai has the lar-gest number of projects,and Qingdao University has the largest number of projects and funding amounts.There are a total of 178 research-ers,and 21 of them have received two or more grants,among which Li Changgui from Qingdao University has the largest number of ap-proved projects.The researches focus on the pathophysiological links primarily centered on"inflammation",signal pathways and key tar-gets,pathogenic genes and the discovery of new genes,multi-system damage,studies on traditional Chinese medicine,new technologies and new methods.Conclusion It is hoped that in the future,the NSFC can increase the funding support for projects in the field of gout and hyperuricemia.Researchers should employ more cutting-edge technologies and innovative methods,carry out interdisciplinary re-search,integrate the essence of Chinese and Western medicine,further explain the disease mechanism,and provide new ideas for the clinical diagnosis and treatment of gout and hyperuricemia.

Objective To investigate the distribution and antimicrobial resistance profiles of common pathogens isolated from cerebrospinal fluid(CSF)in CHINET program from 2015 to 2021.Methods The bacterial strains isolated from CSF were identified in accordance with clinical microbiology practice standards.Antimicrobial susceptibility test was conducted using Kirby-Bauer method and automated systems per the unified CHINET protocol.Results A total of 14 014 bacterial strains were isolated from CSF samples from 2015 to 2021,including the strains isolated from inpatients(95.3％)and from outpatient and emergency care patients(4.7％).Overall,19.6％of the isolates were from children and 80.4％were from adults.Gram-positive and Gram-negative bacteria accounted for 68.0％and 32.0％,respectively.Coagulase negative Staphylococcus accounted for 73.0％of the total Gram-positive bacterial isolates.The prevalence of MRSA was 38.2％in children and 45.6％in adults.The prevalence of MRCNS was 67.6％in adults and 69.5％in children.A small number of vancomycin-resistant Enterococcus faecium(2.2％)and linezolid-resistant Enterococcus faecalis(3.1％)were isolated from adult patients.The resistance rates of Escherichia coli and Klebsiella pneumoniae to ceftriaxone were 52.2％and 76.4％in children,70.5％and 63.5％in adults.The prevalence of carbapenem-resistant E.coli and K.pneumoniae(CRKP)was 1.3％and 47.7％in children,6.4％and 47.9％in adults.The prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)and Pseudomonas aeruginosa(CRPA)was 74.0％and 37.1％in children,81.7％and 39.9％in adults.Conclusions The data derived from antimicrobial resistance surveillance are crucial for clinicians to make evidence-based decisions regarding antibiotic therapy.Attention should be paid to the Gram-negative bacteria,especially CRKP and CRAB in central nervous system(CNS)infections.Ongoing antimicrobial resistance surveillance is helpful for optimizing antibiotic use in CNS infections.