Objective:To explore the microbiological and disease distribution characteristics of multidrug-resistant bacteria in patients hospitalized in a critical care rehabilitation ward, and to analyze the risk factors leading to multidrug-resistant bacterial infections.Methods:Microbiology screening data describing 679 patients admitted to a critical care rehabilitation ward were retrospectively analyzed to divide the subjects into a multidrug-resistant group (positive for multidrug-resistant bacterial infections, n=166) and a non-multidrug-resistant group (negative for multidrug-resistant bacterial infections, n=513). The risk factors were then analyzed using logistic regression. Results:Among 369 strains of multidrug-resistant bacteria observed, 329 were gram-negative bacteria (89.2%), mainly Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli. They were distributed in sputum (56.9%) and mid-epidemic urine (28.2%) specimens. Patients whose primary disease was hemorrhagic or ischemic cerebrovascular disease accounted for 40.96% and 23.49% of the multidrug-resistant bacterial infections, respectively. Logistic regression analysis showed that albumin level, dependence on mechanical ventilation, central venous cannulation, or an indwelling urinary catheter or cystostomy tube were significant independent predictors of such infections.Conclusion:The multidrug-resistant bacterial infections of patients admitted to the critically ill rehabilitation unit are mainly caused by gram-negative bacteria. Their occurrence is closely related to low albumin levels and mechanical ventilation, as well as to bearing an indwelling central venous catheter, a urinary catheter or a cystostomy catheter.

Objective:To understand the major cognition, major choice motivation and the relationship between the two of medical students, and provide references and suggestions for the selection of talents in various majors of medical schools and the effective development of enrollment work.Methods:This study selected undergraduates of Batch 2019 from Peking University Health Science Center as the survey objects, conducted a questionnaire survey on their major cognition, major choice motivation and influencing factors, and used principal component analysis and Spearman rank correlation analysis.Results:The study found that the major cognition scores of 640 undergraduates of Batch 2019 from Peking University Health Science Center were clinical medicine (3.24±0.89) > stomatology (2.89±1.00) > basic medicine (2.66±1.02) > pharmacy (2.54±0.97) > preventive medicine (2.29±0.93) > nursing medicine (2.21±0.99) > medical laboratory (1.98±0.95) > medical English (1.95±0.93). Six major motivation factors for professional choice were school and professional strength, professional learning and job prospects, own factors, Peking University sentiments and the influence of others, medical factors, school policies, and the contribution rates were 34.60%, 12.97%, 7.42%, 6.00%, 5.59% and 5.37%, respectively. Major cognition scores and major choice motivation factors were positively correlated with each other to some extent.Conclusions:At present, students' major cognition level of medical majors still has a large room for improvement, and the motivational factors of major choice are more complicated, among which "the school and professional strength" and "the prospects of study and work" are important factors. Medical schools should focus on strengthening major publicity, improving students' major cognition, attracting aspiring students to apply for medical majors from many aspects, and improving the training quality of medical professionals.

Objectives:To investigate the association between normal-weight central obesity with new-onset cardiovascular disease and all-cause mortality risk. Methods:A prospective cohort study was conducted,selecting a total of 93885 participants from the Kailuan Study who had their first physical examination in 2006-2007.According to waist circumference (central obesity:male waist circumference ≥90 cm,female waist circumference ≥85 cm;no central obesity:male waist circumference<90 cm,female waist circumference<85 cm) and body mass index (BMI,normal weight:18.5 kg/m2≤BMI<24.0 kg/m2;overweight/obesity:BMI ≥24.0 kg/m2),the participants were divided into 4 groups:normal weight no central obesity group (G1 group),normal weight central obesity group (G2 group),overweight/obesity no central obesity group (G3 group) and overweight/central obesity group (G4 group);Using the Kaplan-Meier method,the cumulative incidence of new-onset cardiovascular diseases (including hemorrhagic stroke,ischemic stroke and myocardial infarction) and all-cause mortality in different groups was calculated,and the Log-rank test was used for intergroup comparisons.Furthermore,the associations between the different groups and the risk of new-onset cardiovascular diseases and all-cause mortality were analyzed using the multivariate Cox proportional hazard regression model. Results:After a median follow-up of 14.97 (14.55,15.17) years,the cumulative incidence of new-onset cardiovascular diseases in G1 group,G2 group,G3 group and G4 group was 7.62％,10.84％,8.67％,12.91％ respectively (log-rank P<0.05) and the cumulative incidence of all-cause mortality was 12.83％,19.72％,10.65％,16.33％ respectively (log-rank P<0.01).After adjusting for confounding factors,Cox regression analysis showed that the HR (95％CI) of new-onset cardiovascular diseases in G2 group,G3 group and G4 group were 1.14 (1.04-1.25),1.07 (1.01-1.14),1.27 (1.21-1.34),respectively compared with G1 group (all P<0.05).The HR (95％CI) of all-cause mortality were 1.06 (1.00-1.14),0.90 (0.85-0.95),0.97 (0.93-1.01) compared with G1 group,and P values were 0.07,<0.01,0.15,respectively.The results of sensitivity analysis were consistent with the above major studies after excluding overweight/obesity and cancer participants during follow-up. Conclusions:Normal-weight central obesity increases the risk of new-onset cardiovascular diseases and all-cause mortality.

Objective To investigate the effects of different sterilization methods on the quality of Astragali Radix decoction pieces by comparing the properties,odor,fingerprint,sterilization effect,extract and active component contents of Astragali Radix decoction pieces,and to further optimize the best sterilization process parameters of Astragali Radix decoction pieces.Methods The effects of moist heat sterilization,irradiation sterilization and dry heat sterilization on the quality of Astragali Radix decoction pieces were compared,and the best sterilization method was selected.Based on this,taking the content of astragaloside IV,the content of isoflavone glucoside,the total content of the two and the sterilization rate as the assessment indicators,taking the sterilization temperature,sterilization time and material thickness as the assessment factors,on the basis of the single-factor test,the response surface method was used to optimize the optimal dry heat sterilization process of Astragali Radix decoction pieces.Results The dry heat sterilization method was selected to sterilize Astragali Radix decoction pieces.The best process for dry heat sterilization was as follows:the sterilization temperature of 113℃,sterilization time of 5.1 h,and the material thickness of 19 mm.Conclusion Considering the sterilization effect,the influence on the content of active ingredients,operability and cost,selecting dry heat sterilization is the best sterilization method for Astragali Radix decoction pieces,and the optimal sterilization process is stable and feasible,with good repeatability,which can provide scientific basis for its industrial production application.

Vulnerability is an inherent and ineradicable reality, and different contexts can exacerbate or induce different manifestations of vulnerability. By sorting out the meaning of vulnerability and identifying particular manifestations and attributions of children’ vulnerability in talent genetic testing situations, including the inherent vulnerability of children themselves, the situational vulnerability derived from talent genetic testing and educational environment, as well as the pathogenic vulnerability from the protection of minors. It was proposed that talent genetic testing of children should be guided by the principles of responsibility, no harm, and permission, so as to protect children from additional harm during testing and avoid exacerbating their vulnerability.

Objective:To screen the optimal process of ambi-extracting of Xinyi Powder and inclusion of volatile oil.Methods:Single factor experiment was used to optimize the extraction process of Xinyi Powder by taking crushing particle size, extraction times, the amount of water added and extraction time as the investigation factors. L 9(3 4) orthogonal test was used to optimize the inclusion process of volatile oil in Xinyi Powder. Results:The optimal extraction process of ambi-extracting of Xinyi Powder was as follows: the slices were not crushed, 10 times the amount of water was added, and extracted for 3 hours; the best inclusion process of volatile oil as follows: β-cyclodextrin:water=1:25, β-cyclodextrin:volatile oil=6:1, inclusion temperature 35 ℃, inclusion time 3 hours.Conclusion:The ambi-extracting process and volatile oil inclusion process are simple, stable and feasible.

Objective:To understand the incidence of sleep disorder in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients before antiviral therapy, and to explore its risk factors.Methods:200 newly treated HIV/AIDS patients who visited the Eighth Affiliated City Hospital of Guangzhou Medical University from January to June 2016 were randomly selected. According to the Pittsburgh Sleep Quality Index (PSQI), they were divided into a good sleep group and a Sleep disorder group; The influencing factors of sleep disorder in HIV/AIDS patients were analyzed by univariate analysis and multivariate logistic regression.Results:The incidence of Sleep disorder in 200 HIV/AIDS patients before antiviral therapy was 22.5%(45/200); CD4 + T cell count was (414.13±202.16)/μl; 29%(58/200) of patients had CD4 + T cell counts<200/μl. There were significant differences in CD4 + T cell count and the proportion of patients with syphilis infection, comorbidity anxiety and comorbidity depression between the good sleep group and the Sleep disorder group (all P<0.05). Multivariate logistic regression analysis showed that syphilis infection ( OR=4.606; 95% CI: 1.973-10.752; P<0.001), comorbidity anxiety ( OR=2.496; 95% CI: 1.086-5.737; P=0.031) and comorbidity depression ( OR=2.087; 95% CI: 0.915-4.760; P=0.040) were risk factors for sleep disorder in HIV/AIDS patients before antiviral treatment. Conclusions:The incidence of Sleep disorder in HIV/AIDS patients before antiviral therapy in Guangzhou is high, especially in patients with syphilis infection, comorbidity anxiety and comorbidity depression. The sleep disorder of HIV/AIDS patients should be assessed and detected early, and multiple interventions should be taken to improve sleep quality.

Objective:To investigate the clinical experience of different types of femoral perforator flaps in the reconstruction of oral and maxillofacial head and neck defects.Methods:From January 2018 to January 2021, 573 patients with oral and maxillofacial head and neck defects reconstructed by femoral perforator flap were collected in the Department of Maxillofacial Oncology, the Third Affiliated Hospital of Air Force Military Medical University (age range of 21-76 years, with a male to female ratio of 1.23∶1). According to the type of perforator flap, the patients were divided into ALT group, AMT group, TFL flap group and free muscle flap group. The incidence of postoperative complications, wound healing time and drainage volume in femoral area were compared among the 4 groups.Results:The ALT flap was used in 527 cases: 22 flaps had vascular crisis, 14 flaps had infection, 8 flaps had necrosis, 519 flaps survived; the mean healing time of the wound was (14.50±3.19) days, and the mean drainage volume was (49.9±21.3) ml. 28 cases were repaired with AMT flap: 2 flaps had vascular crisis and 1 had infection. All the flaps survived; the mean healing time of the wound was (14.18±2.75) days, and the mean drainage volume was (50.3±23.0) ml. 11 cases were repaired by TFL flap: 1 flap had vascular crisis and 1 had infection. All the flaps survived. The mean healing time of the wound was (14.09±2.66) days, and the mean drainage volume was (54.1±25.0) ml. 7 cases were repaired by free muscle flap survived without vascular crisis, infection and other postoperative complications; the mean healing time of the wound was 14.14±1.86, and the mean postoperative drainage volume was (49.9±21.1) ml. There was no significant difference in complication rate (flap necrosis, vascular crisis, infection, etc.) and repair effect among 573 patients with different flap types. The postoperative follow-up was conducted for 6-24 months, and the donor area was smooth and good in appearance, without obvious scar or functional influence. The repair effect of the affected area was satisfactory.Conclusions:Although there is a certain proportion of perforator vessel variation in the femoral perforator flap, the flap can be designed freely according to different types of variation. The thigh perforator flap has an essential application value in the repair of oral and maxillofacial head and neck defects.

Objective To explore the clinical efficacy of sacubitril/valsartan(SV)in the treatment of maintenance hemodialysis(MHD)with heart failure with preserved ejection fraction(HFpEF).Methods A total of 90 patients with MHD combined with HFpEF admitted to the Second People′s Hospital Affiliated of Hefei to Bengbu Medical College from January to December 2021,they were divided into control group and treatment group according to the random number method,with 45 cases in each group.Patients in the control group tookangiotensin-converting enzyme inhibitor/angiotensin Ⅱ receptor blocker(ACEI/ARB)conventional drugs orally;patients in the treatment group took ARNI orally,the initial dose was 50mg,twice a day,followed by an increase to 100mg twice a day,after 2 weeks.After 3 months of treatment,the relevant indicators of cardiac function,including left ventricular ejection fraction(LVEF),left ventricu-lar end-diastolic dimension(LVEDD),left ventricular end-systolic dimension(LVESD),pulmonary artery pressure(PAP),N-ter-minal pro-B-type natriuretic peptide(NT-pro BNP),6-minutes walk test(6MWT),blood pressure level,serum potassium and the incidence of adverse events before and after treatment were collected and compared.Results After 3months of treatment,there were no significant differences in the clinical data,cardiac function index,cardiac function grade,6MWT,blood pressure level and serum potassi-um between the control group and the treatment group before treatment(P<0.05);after 3months of treatment,the levels of LVEF,LVEDD,LVESD,PAP,NT-pro BNP,6MWT,and blood pressure were all improved significantly compared with the baseline in both groups(P<0.05),and there was no significant difference of serum potassium before and after treatment in the two groups(P>0.05);after treatment,LVEF and 6MWT in the treatment group were higher than those in the control group,the LVEDD,LVESD,PAP,NT-pro BNP and blood pressure were lower than in the control group(P<0.05).There were significant differences in LVEF,LVEDD,LVESD,NT-pro BNP,6MWT,systolic blood pressure and diastolic blood pressure between the two groups before and after treatment(P<0.05).Conclusion The clinical efficacy of SV in MHD patients with HFpEF is certain,and can significantly improve cardiac function,increase the NYHK grade,improve blood pressure levels and exercise tolerance,reduce rehospitalization rates.

Objective:To investigate the effect of the transcriptional coactivator Mediator 1 (Med1) on mouse hair regeneration, and to explore potential mechanisms.Methods:Med1 flox/flox C57BL/6J mice were mated with K14-Cre mice, and the mice with epidermis-specific knockout of Med1 gene, namely K14-Cre-expressing Med1 flox/flox mice (knockout group) , were obtained by using the Cre-Loxp system, while Med1 flox/flox mice without K14-Cre expression served as control group. Mice in the two groups (3 mice in each group) were raised together for 8 weeks followed by dorsal hair removal. Hair regeneration was observed for 12 consecutive days after hair removal. After 12 days, all mice in the two groups were sacrificed, their depilated and non-depilated dorsal skin tissues were resected, and total RNA was extracted from the tissues. Real-time quantitative PCR was performed to determine the mRNA expression of hair keratin genes, vitamin D receptor/β-catenin pathway-related genes, and genes associated with maintenance of hair follicle stem cell proliferation and quiescence. Paraffin-embedded sections of depilated and non-depilated mouse skin tissues were prepared, and immunofluorescence staining was conducted to determine the number of stem cells in the hair follicle bulge. Two-independent-sample t test was used for comparisons between two groups. Results:From days 0 to 12 after depilation, hair regeneration was delayed in the depilated skin area in the knockout group compared with the control group. Real-time quantitative PCR showed significantly decreased mRNA relative expression levels of hair keratin genes Ha1 and Krt2-16, vitamin D receptor/β-catenin pathway-related genes S100a3, Dlx3 and Tubb3, and genes associated with maintenance of hair follicle stem cell proliferation and quiescence including Lhx2, Sox9 and Nfatc1 in the depilated skin tissues in the knockout group (22.09 ± 12.32, 2.07 ± 0.20, 0.02 ± 0.01, 12.36 ± 2.12, 1.75 ± 0.46, 0.39 ± 0.02, 4.42 ± 0.76, 0.44 ± 0.07, respectively) compared with the control group (70.53 ± 9.46, 7.76 ± 0.49, 0.05 ± 0.01, 26.16 ± 2.96, 2.60 ± 0.14, 0.71 ± 0.09, 11.93 ± 0.42, 0.75 ± 0.04, respectively; t = 5.40, 18.64, 3.89, 6.57, 3.04, 6.10, 15.03, 6.18, respectively, all P < 0.05) . Immunofluorescence staining showed that the number of CD34 +K15 + hair follicle stem cells in the hair follicle bulge in both depilated and non-depilated skin tissues was significantly lower in the knockout group than in the control group. Conclusion:Med1 gene knockout may down-regulate the expression of downstream genes of the vitamin D receptor/β-catenin pathway and genes associated with maintenance of hair follicle stem cell proliferation and quiescence (Sox9, Nfatc1 and Lhx2) , and reduce the number of hair follicle stem cells, leading to hair follicle differentiation disorder and hair regeneration delay.