OBJECTIVE To observe the characteristics of outer membrane vesicles(OMVs)of 1 strain of hypervir-ulent Klebsiella pneumoniae(hvKp)11492.METHODS The hvKp11492,one of major clones of hvKp that were i-solated from patients with bloodstream infection in the First Medical Center of Chinese PLA General Hospital,was chosen as the research subject.The strain was identified by means of matrix-assisted laser desorption/ioniza-tion time of flight mass spectrometry and whole genome sequencing.The hvKp1 1492-OMVs were separated and purified by high speed centrifugation in combination with polymer precipitation,the morphology and particle size of the hvKp11492-OMVs were identified by transmission electron microscopy(TEM)and nanoparticle tracking a-nalysis(NTA),the proteomic characteristics were analyzed through bicinchoninic acid assay(BCA)and liquid chromatography-mass spectrometry(LC-MS)series technique,and the virulence genes were detected by PCR.RESULTS The hvKp11492-OMVs were displayed differently in size,round or oval,and complete double-layer membrane vesicles on TEM.The result of NTA showed that the average particle size of the hvKp1 1492-OMVs was 270 nm.The protein content of hvKp11492-OMVs was(2.448±0.975)μg/μl.The result of subcellular lo-calization indicated that the protein included plasmosin,intracellular membrane protein,periplasmic protein,ex-tracellular membrane protein and nuclear region protein,which were found,by the annotation of GO database,to participate in the biological processes such as oxidation-reduction,interpretation,and metabolism.The hvKp11492-OMVs contained various proteins such as GDP-L-fucose synthetase,iron ion transporter protein and ferritin that were associated with pathogenicity.In addition,the hvKp1 1492-OMVs carried with iutA,iroN,iucA and rmpA virulence genes.CONCLUSIONS The morphologic characteristics,size and proteomic characteris-tics of the hvKp11492-OMVs are identified in the study.It is concluded that the hvKp11492-OMVs carry with va-rious proteins and genes that are association with the virulence and pathogenicity.

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Objective This study aims to explore the collaborative governance model of medical and elderly care integra-tion to promote the participation of medical institutions in integrated services and provide policy recommendations.Methods Based on the perspective of welfare pluralism,combined with the practical experience of an A hospital-managed nursing home in Guangzhou,the roles of different welfare subjects such as the government,market,community,and family in the medical and elderly care integration service system were discussed.Results The integration of medical and elderly care faces issues such as inadequate government guarantees in terms of space and medical insurance,insufficient vitality of social capital participating in medical and elderly care integration in the market,weak linkage between integrated care institutions and community organizations,and heavy burden on elderly families in accessing integrated services.Conclusion The government should improve top-level insti-tutional design,the market needs to optimize the supply of medical and elderly care integration services,the community should play a pivotal role as a platform,and families should create a supportive environment for respecting and caring for the elderly.

OBJECTIVE To observe the characteristics of outer membrane vesicles(OMVs)of 1 strain of hypervir-ulent Klebsiella pneumoniae(hvKp)11492.METHODS The hvKp11492,one of major clones of hvKp that were i-solated from patients with bloodstream infection in the First Medical Center of Chinese PLA General Hospital,was chosen as the research subject.The strain was identified by means of matrix-assisted laser desorption/ioniza-tion time of flight mass spectrometry and whole genome sequencing.The hvKp1 1492-OMVs were separated and purified by high speed centrifugation in combination with polymer precipitation,the morphology and particle size of the hvKp11492-OMVs were identified by transmission electron microscopy(TEM)and nanoparticle tracking a-nalysis(NTA),the proteomic characteristics were analyzed through bicinchoninic acid assay(BCA)and liquid chromatography-mass spectrometry(LC-MS)series technique,and the virulence genes were detected by PCR.RESULTS The hvKp11492-OMVs were displayed differently in size,round or oval,and complete double-layer membrane vesicles on TEM.The result of NTA showed that the average particle size of the hvKp1 1492-OMVs was 270 nm.The protein content of hvKp11492-OMVs was(2.448±0.975)μg/μl.The result of subcellular lo-calization indicated that the protein included plasmosin,intracellular membrane protein,periplasmic protein,ex-tracellular membrane protein and nuclear region protein,which were found,by the annotation of GO database,to participate in the biological processes such as oxidation-reduction,interpretation,and metabolism.The hvKp11492-OMVs contained various proteins such as GDP-L-fucose synthetase,iron ion transporter protein and ferritin that were associated with pathogenicity.In addition,the hvKp1 1492-OMVs carried with iutA,iroN,iucA and rmpA virulence genes.CONCLUSIONS The morphologic characteristics,size and proteomic characteris-tics of the hvKp11492-OMVs are identified in the study.It is concluded that the hvKp11492-OMVs carry with va-rious proteins and genes that are association with the virulence and pathogenicity.

Objective This study aims to explore the collaborative governance model of medical and elderly care integra-tion to promote the participation of medical institutions in integrated services and provide policy recommendations.Methods Based on the perspective of welfare pluralism,combined with the practical experience of an A hospital-managed nursing home in Guangzhou,the roles of different welfare subjects such as the government,market,community,and family in the medical and elderly care integration service system were discussed.Results The integration of medical and elderly care faces issues such as inadequate government guarantees in terms of space and medical insurance,insufficient vitality of social capital participating in medical and elderly care integration in the market,weak linkage between integrated care institutions and community organizations,and heavy burden on elderly families in accessing integrated services.Conclusion The government should improve top-level insti-tutional design,the market needs to optimize the supply of medical and elderly care integration services,the community should play a pivotal role as a platform,and families should create a supportive environment for respecting and caring for the elderly.

ObjectiveTo understand the serotype distribution and drug resistance of salmonella contaminated in commercially available food. MethodsSalmonella detection， including the serotypes， was conducted in food products sold in Pudong New Area from 2020 to 2022. The antimicrobial susceptibility test of 15 antibiotics was conducted by the broth microassay. ResultsA total of 118 salmonella strains were detected in 2 497 pieces of food， with a total detection rate of 4.7%. The dominant detection categories were poultry meat， livestock meat and aquatic products. The 118 salmonella strains could be divided into 24 serotypes， Salmonella enteritidis （26.4%）， Salmonella Typhimurium （16.2%） and Salmonella delpy （14.4%） were the main dominant types. Salmonella had the highest resistance rate to ampicillin （63.6%）， followed by tetracycline， chloramphenicol， cotrimoxazole and nalidixic acid. Among the three dominant serotypes， the multidrug resistance rate of Salmonella typhimurium was the highest （89.5%）， followed by Salmonella delpy （70.6%） and Salmonella enteritidis （61.3%）. ConclusionLivestock， poultry meat， and aquatic products are seriously contaminated by salmonella with diverse serotypes. The livestock meat is mainly contaminated by Salmonella typhimurium and Salmonella delpy， and the poultry meat is mainly contaminated by Salmonella enteritidis. The drug resistance spectrum is wide and the multi-drug resistance rate is high. Different from the livestock and aquatic isolates， poultry meat-derived strains have high tolerance to ampicillin， nalidixic acid and polymyxin， and carry certain potential food safety risks.

Objective To explore the effect of ultrasound guided percutaneous dilatation tracheotomy in critical ill patients.Methods From January 2016 to January 2018,95 critical ill patients who were treated in the People's Hospital of Quzhou were selected.According to the random number table method,they were divided into control group (n =47) and observation group (n =48).The patients in the control group were treated with traditional tracheotomy,and the patients in the observation group were treated with percutaneous dilatation tracheotomy under ultrasonic guidance.The operation condition of the two groups was observed,including operative bleeding volume,operative time,incision length,extubation time,incision healing time,hospitalization time and so on.The postoperative complications and mortality were recorded in the two groups.Results The operative bleeding volume,operative time,incision length and incision healing time in the observation group were (12.91 ± 1.36) mL,(10.05 ± 1.14) min,(1.46 ± 0.32) cm,(5.48 ±0.39)d,respectively,which were lower than those in the control group[(38.54 ± 3.47)mL,(27.43 ±2.29) min,(3.25 ± 0.68) cm,(7.64 ± 0.72) d],there were statistically significant differences between the two groups(t =40.098,39.616,13.888,15.381,P =0.000,0.000,0.000,0.000).The extubation time,hospitalization time in the observation group were (14.19 ± 1.14)d,(20.17 ± 1.85)d,respectively,which in the control group were (14.23 ± 1.17) d,(20.26 ± 1.89) d,respectively,there were no statistically significant differences between the two groups (t =0.142,0.198,P =0.886,0.843).The incidence rate of postoperative complications in the observation group was 6.25％,which was lower than 21.28％ in the control group,there was statistically significant difference between the two groups (x2 =9.515,P =0.002).The ICU mortality and hospitalization mortality in the observation group were 2.08％ and 4.17％,respectively,which in the control group were 10.64％ and 12.77％,respectively,there were no statistically significant differences between the two groups (x2 =2.937,2.277,P =0.087,0.131).Conclusion Ultrasound guided percutaneous dilatation tracheostomy can improve operation condition,reduce hospitalization time,and has less complications,low mortality,which has good clinical value in critical ill care.

Objective:To explore the calvarial critical size defect (CSD)in rats with type 2 diabetes mellitus(T2DM).Methods:T2DM model of SD rats(weighted 300-320 g)was induced by high fat and high sugar diet and low dose intraperitoneal streptozotocin (STZ)injection.The rats with T2DMand the normal controls were divided into 4 groups(n=3)respectively.Defects with the diame-ter(mm)of 2,3,4 and 5 were made on the central calvaria of each rat.General observation,X-ray examination and histological study were performed 8 weeks postoperatively.Results:In the T2DM group,only the defects of 2 mm diameter were healed completely,X-ray resistance and new bone formation were observed;the defects of 3,4 and 5 mm diameter were unhealed,X-ray transmission was observed and newly formed bone was insufficient.In the control group,the defects of 2,3 and 4 mm diameter were healed completely, X-ray resistance and new bone formation were observed;the defects of 5 mm diameter were unhealed,X-ray transmission was ob-served,newly formed bone was insufficient.Conclusion:The calvarial CSD of T2DM rat model can be defined as the defect with the diameter of 3 mm.

Objective To investigate drug resistance mechanism of aminoglycoside-resistant Acinetobacter baumannii by detecting 16S rRNA methylase gene and three common genes of aminoglycoside-modifying enzymes in Acinetobacter baumannii infected patients at EICU. Methods The 48 Acinetobacter baumannii strains were collected,and antimicrobial susceptibility tests were performed by VITEK automicroscan. The MIC was detected by 2-fold agar dilution method,and genes were analyzed by polymerase chain reaction( PCR) . Results Among 48 strains,28 were highly resistant to aminoglycosides and 20 showed lower resistances. The 16S rRNA armA,APH(3')-I,ANT(3'')-Ia,AAC(6')-Ib genes were detected in 71. 43%,60. 71%,82. 14%, and 53. 57%of the 28 highly resistant strains,but only present in 0. 00%,0. 05%,0. 05%,and 0. 05%of the low-resistant isolates(P<0. 01). Conclusion The aminoglycoside-modifying enzymes and 16S rRNA methylase were frequently found in Acinetobacter baumannii clinical isolates,which is closely related to the high-level resistance to aminoglycoside antibiotics.

Objective To research the therapeutic effect of vitamin E in prevention and treatment of anemia in premature children.Methods We investigated 90 cases of premature children admitted to the neonatal ward of our hospital from December 2010 to December 2011.According to hospital successively order these premature were randomly divided into control group (Group A),high-dose group (Group B),low-dose group (Group A).Group A including 30 cases,subcutaneous injection of erythropoietin(EPO) from the 7th days after admission,750IU/kg weekly for 3 times,for 4 weeks.At the same time,plus iron 6mg/(kg·d).On the basis of the above-mentioned control treatment,oral administration of different doses of vitamin E was in the treatment group,for 4 weeks.Group B including 30 cases was given vitamin E 15mg/(kg·d).Group C including 30 cases was given vitamin E 2.5mg/(kg· d).The changes of each group during the treatment in hematocrit (Hct),hemoglobin(Hb),red blood cell(RBC),reticulocyte(Ret) and the changes of serum concentrations of vitamin E before and after treatment were observed.Results Hct,Hb,RBC,Ret in group B,group C patients were both improved.The improvement of the indicators was better than that of group A (P ＜ 0.05).There was no significant difference between the improvement of each index of Group B and Group C(P ＞ 0.05).Serum concentrations of vitamin E after treatment in group B and group C patients were significantly higher and the difference was statistically significant(P ＜ 0.05).Serum concentration of vitamin E in group A didn't increase obviously.Conclusion Additional small doses of VitE should be given during EPO prevention of anemia in premature children.