Objective To analyze the risk factors and clinical outcomes of cognitive impairment in elderly patients with heart disease after surgery.Methods A total of 156 patients with heart valve diseases undergoing coronary artery bypass surgery admitted to the First Affiliated Hospital of H ainan Medical University from October 2021 to December 2023 were prospectively recruited.At 7 d postoperatively,Montreal cognitive assessment(MoCA)scale was used to assess their cogni-tive function,and based on MoCA score＜26 or not,they patients were divided into a cognitive impairment group(n=61)and a control group(n=95).The clinical features were compared be-tween the two groups,and the risk factors for cognitive impairment were analyzed.All patients were followed up for 1 year to compare the outcomes of the two groups.Results The cognitive impairment group had significantly advanced age,larger proportions of concomitant chronic respiratory diseases and sarcopenia,increased ratio of undergoing open heart surgery,and elevated incidence of intraoperative hypotension than the control group(P＜0.05,P＜0.01).Multivariate logistic regression analysis indicated that age,chronic respiratory diseases,sarcopenia,open heart surgery,and intraoperative hypotension were independent risk factors for postoperative cognitive impairment in elderly patients with heart diseases(OR=1.081,95％CI:1.007-1.161,P=0.030;OR=2.538,95％CI:1.062-6.066,P=0.036;OR=2.650,95％CI:1.174-5.985,P=0.019;OR=3.104,95％CI:1.391-6.929,P=0.006;OR=3.478,95％CI:1.298-9.322,P=0.0013).There was no statistical difference in preoperative MoCA scores between the two groups(27.90±1.40 vs 28.20±1.40,P=0.195).The MoCA score at 7 d and 6 and 12 months after surgery were obviously lower in the cognitive impairment group than the control group(22.90±1.27 vs 27.73±1.08,P=0.000;24.72±1.66 vs 27.73±1.23,P=0.000;25.48±1.73 vs 27.62±1.22,P=0.000).Age was identified as an independent factor affecting the outcome of cognitive function in the patients(OR=1.168,95％CI:1.035-1.318).Conclusion The incidence of postoperative cog-nitive impairment is relatively high in elderly patients with heart disease.So,relevant risk factors should be addressed to strengthen the prevention and management.

Objective:To explore the relevant factors affecting the accuracy of scanning glucose monitoring (FGM) technology in critically ill patients.Methods:A total of 53 patients who were admitted to the Intensive Care Unit (ICU) of the Second Affiliated Hospital of Soochow University and used FGM glucose monitoring from September 2022 to December 2023 were selected by means of a convenience sampling method. The paired data of arterial blood glucose and FGM glucose were analysed. The accuracy of FGM blood glucose measurement in critically ill patients was evaluated using Bland-Altman analysis. The blood glucose data were divided into two groups: the FGM monitoring accuracy group and the FGM monitoring non-accuracy group.. The t-test and χ2 test were used for the comparison of one-way analysis of arterial versus FGM accuracy among critically ill patients with different demographic characteristics. Logistic regression analysis was used to analyze the factors influencing the accuracy of FGM. Results:The results of Bland-Altman analysis of the 53 patients indicated that the mean bias value of FGM blood glucose was elevated at 1.215 mmol/L in comparison with arterial-blood gas analysis blood glucose values. An incidence of exceeding the upper and lower limits of the range was observed, amounting to 6.349%. The discrepancy between the studies was found to be statistically significant (95% CI:1.0394~1.3908, P<0.001). The effects of the changes in height ( OR=0.877, 95% CI:0.780~0.987, P=0.029), changes in leukocyte counts( OR=0.917, 95% CI:0.868~0.969, P=0.002), changes in C-reactive protein( OR=1.009, 95% CI:1.002~1.017, P=0.016), changes in albumin counts( OR=0.986, 95% CI:0.974~0.999, P=0.031), and whether or not sepsis ( OR=3.937, 95% CI:1.192~13.008, P=0.025) on the accuracy of FGM had a statistically significant. Conclusion:The mean bias value of the accuracy of FGM was relatively higher compared with that of arterial blood gas analysis blood glucose values, and the influencing factors involved height, white blood cells, C-reactive protein, albumin, and whether or not sepsis was present. With the development of science and technology, applying the FGM system to critically ill patients has an absolute advantage in determining the overall glycemic trend, and the application value of FGM technology deserves further study.

Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.

Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.

Objective To analyze the risk factors and clinical outcomes of cognitive impairment in elderly patients with heart disease after surgery.Methods A total of 156 patients with heart valve diseases undergoing coronary artery bypass surgery admitted to the First Affiliated Hospital of H ainan Medical University from October 2021 to December 2023 were prospectively recruited.At 7 d postoperatively,Montreal cognitive assessment(MoCA)scale was used to assess their cogni-tive function,and based on MoCA score＜26 or not,they patients were divided into a cognitive impairment group(n=61)and a control group(n=95).The clinical features were compared be-tween the two groups,and the risk factors for cognitive impairment were analyzed.All patients were followed up for 1 year to compare the outcomes of the two groups.Results The cognitive impairment group had significantly advanced age,larger proportions of concomitant chronic respiratory diseases and sarcopenia,increased ratio of undergoing open heart surgery,and elevated incidence of intraoperative hypotension than the control group(P＜0.05,P＜0.01).Multivariate logistic regression analysis indicated that age,chronic respiratory diseases,sarcopenia,open heart surgery,and intraoperative hypotension were independent risk factors for postoperative cognitive impairment in elderly patients with heart diseases(OR=1.081,95％CI:1.007-1.161,P=0.030;OR=2.538,95％CI:1.062-6.066,P=0.036;OR=2.650,95％CI:1.174-5.985,P=0.019;OR=3.104,95％CI:1.391-6.929,P=0.006;OR=3.478,95％CI:1.298-9.322,P=0.0013).There was no statistical difference in preoperative MoCA scores between the two groups(27.90±1.40 vs 28.20±1.40,P=0.195).The MoCA score at 7 d and 6 and 12 months after surgery were obviously lower in the cognitive impairment group than the control group(22.90±1.27 vs 27.73±1.08,P=0.000;24.72±1.66 vs 27.73±1.23,P=0.000;25.48±1.73 vs 27.62±1.22,P=0.000).Age was identified as an independent factor affecting the outcome of cognitive function in the patients(OR=1.168,95％CI:1.035-1.318).Conclusion The incidence of postoperative cog-nitive impairment is relatively high in elderly patients with heart disease.So,relevant risk factors should be addressed to strengthen the prevention and management.

Objective To understand the current situation and influencing factors of kindergarten teach-ers'participation in training for preschool sex education in Luzhou city,and provide a basis for improving the sex education literacy of kindergarten teachers in the future.Methods A multi-stage stratified cluster sampling meth-od was adopted,and a questionnaire survey was conducted from December 2021 to January 2022 on the knowl-edge,attitude,and practice of preschool sex education among all the teachers in 24 kindergartens in Luzhou city.Results Among the 461 teachers,43.0％had participated in lectures/courses/training activities related to pre-school sex education;99.1％hoped to participate in lectures/courses/training activities related to preschool sex education;82.6％learned about child sexual knowledge through school education;75.5％expressed the hope to learn about child sexual knowledge through expert training.The results of multivariate Logistic regression showed that except private kindergartens as an inhibiting factor(OR=0.57,95％CI=0.37-0.87,P=0.008),high monthly income(OR=3.52,95％CI=1.13-9.30,P=0.011),more ways to know about sex education knowledge(OR=2.87,95％CI=1.76-4.70,P＜0.001),and social support(OR=1.58,95％CI=1.04-2.38,P=0.030)were promoting factors for teachers to participate in the training for preschool sex educa-tion.Conclusions The kindergarten teachers presented a participation rate but a high demand for the training for preschool sex education.They mainly obtain the sex education knowledge from school education.The nature of kindergarten,monthly income of teachers,social support situation,and ways of understanding sex education knowledge are the key factors influencing the teachers'participation in the training for preschool sex education.

Background:Ischemic colitis is a gastrointestinal emergency caused by intestinal wall ischemia,and in severe cases,it can even be life-threatening.Currently,there is a lack of reliable detection methods for ischemic colitis.Clinically,there is an urgent need for a specific detection method to improve the early diagnosis rate of ischemic colitis.Aims:To explore the values of serum vascular endothelial growth factor(VEGF)and plasma D-dimer levels for early diagnosis of ischemic colitis.Methods:A total of 40 patients with ischemic colitis admitted from June 2021 to June 2023 at the Affiliated Jinhua Hospital,Zhejiang University School of Medicine were served as the experimental group.Meanwhile,51 patients with acute enteritis were served as controls.The clinical manifestations,as well as the laboratory,radiological,and endoscopic results were compared between the two groups.A binary Logistic regression model was employed to analyze the risk factors for the onset of ischemic colitis.ROC curve was used to assess the diagnostic performance of serum VEGF and plasma D-dimer levels for the early diagnosis of ischemic colitis.Results:Compared with the control group,the proportion of patients with abdominal pain accompanied by hematochezia,and the serum VEGF and plasma D-dimer levels in the experimental group were significantly increased(all P<0.05).The results of binary Logistic regression model indicated that serum VEGF and plasma D-dimer levels were the risk factors for onset of ischemic colitis(all P<0.05).ROC curve analysis showed that the area under the curve(AUC)of serum VEGF and plasma D-dimer for diagnosing ischemic colitis were 0.93 and 0.88,respectively.The combination of these two indicators could further increase the diagnostic specificity and the AUC.Conclusions:Serum VEGF and plasma D-dimer levels can be served as early diagnostic markers for ischemic colitis.The combination of these two indicators can greatly improve the early diagnostic performance.

Background:Ischemic colitis is a gastrointestinal emergency caused by intestinal wall ischemia,and in severe cases,it can even be life-threatening.Currently,there is a lack of reliable detection methods for ischemic colitis.Clinically,there is an urgent need for a specific detection method to improve the early diagnosis rate of ischemic colitis.Aims:To explore the values of serum vascular endothelial growth factor(VEGF)and plasma D-dimer levels for early diagnosis of ischemic colitis.Methods:A total of 40 patients with ischemic colitis admitted from June 2021 to June 2023 at the Affiliated Jinhua Hospital,Zhejiang University School of Medicine were served as the experimental group.Meanwhile,51 patients with acute enteritis were served as controls.The clinical manifestations,as well as the laboratory,radiological,and endoscopic results were compared between the two groups.A binary Logistic regression model was employed to analyze the risk factors for the onset of ischemic colitis.ROC curve was used to assess the diagnostic performance of serum VEGF and plasma D-dimer levels for the early diagnosis of ischemic colitis.Results:Compared with the control group,the proportion of patients with abdominal pain accompanied by hematochezia,and the serum VEGF and plasma D-dimer levels in the experimental group were significantly increased(all P<0.05).The results of binary Logistic regression model indicated that serum VEGF and plasma D-dimer levels were the risk factors for onset of ischemic colitis(all P<0.05).ROC curve analysis showed that the area under the curve(AUC)of serum VEGF and plasma D-dimer for diagnosing ischemic colitis were 0.93 and 0.88,respectively.The combination of these two indicators could further increase the diagnostic specificity and the AUC.Conclusions:Serum VEGF and plasma D-dimer levels can be served as early diagnostic markers for ischemic colitis.The combination of these two indicators can greatly improve the early diagnostic performance.

Objectives:To explore the association of interleukin-19 gene polymorphisms with susceptibility and clinical phenotypes of Crohn′s disease (CD) . Methods:A retrospective case-control study was conducted. Eighty-three CD patients and 120 healthy people in Jinhua Municipal Central Hospital with matched gender and age as controls were enrolled. Allele and genotype frequencies of interleukin-19 gene rs2243188 and rs2243193 loci were detected by Sanger sequencing. The differences in allele and genotype frequencies of rs2243188 and rs2243193 loci between the two groups were compared, and the association between gene polymorphisms of the above loci and disease phenotype (disease site and disease behavior) and drug efficacy was analyzed. Results:The allelic and genotypic frequencies of the rs2243188 and rs2243193 loci differed between the two groups (all P<0.05) . Compared with control group, genotype CC+CA of rs2243188 frequency was higher in patients with ileocolonic CD (86.67% vs. 60.00%, OR = 4.333, 95% CI: 1.891-9.929, P = 0.001) , allele C of rs2243188 frequencies were higher in patients with terminal ileal CD (44.44% vs. 37.08%, OR = 5.589, 95% CI: 5.378-5.918, P = 0.019) and ileocolonic CD (50.00% vs. 37.08%, OR = 6.589, 95% CI: 6.378-7.918, P = 0.018) . However, genotype GA+AA of rs2243193 frequencies were lower in patients with terminal ileal CD (55.56% vs. 93.33%, OR = 0.089, 95% CI: 0.020-0.399, P = 0.002) and ileocolonic CD (75.00% vs. 93.33%, OR = 0.214, 95% CI: 0.085-0.540, P = 0.001) , allele A of rs2243193 frequencies were lower in patients with terminal ileal CD (50.00% vs. 70.83%, OR = 0.809, 95% CI: 0.724-0.908, P = 0.023) and ileocolonic CD (47.50% vs. 70.83%, OR = 0.132, 95% CI: 0.008-0.502, P = 0.018) . Furthermore, compared with control group, allele C (49.28% vs. 37.08%, OR = 1.607, 95% CI: 1.397-2.927, P = 0.021) and genotype CC+CA (84.06% vs. 60.00%, OR = 3.515, 95% CI: 1.676-7.374, P = 0.001) of rs2243188 frequencies were higher in patients with ileal lesion, allele A (47.83% vs. 70.83%, OR = 0.742, 95% CI: 0.709-1.741, P = 0.015) and genotype GA+AA (72.46% vs. 93.33%, OR = 0.188, 95% CI: 0.077-0.458, P = 0.002) of rs2243193 frequencies were lower in patients with ileal lesion.Compared with control group, allele A (50.00% vs. 70.83%, OR = 0.243, 95% CI: 0.352-0.679, P = 0.014) and genotype GA+AA (66.67% vs. 93.33%, OR = 0.143, 95% CI: 0.030-0.680, P = 0.006) of rs2243193 frequencies were lower in patients with penetrating CD. Moreover, the rs2243188 polymorphisms were not associated with disease behavior (all P>0.05) , the rs2243188 and rs2243193 polymorphisms were not associated with the efficacy of corticosteroid and infliximab (all P>0.05) . Conclusions:The gene mutation of the interleukin-19 gene rs2243188 locus may contribute to an increased risk for the CD with ileal lesions. But the gene mutation of rs2243193 locus may contribute to an decreased risk for CD with ileal lesions and penetrating CD.

Objectives:To explore the association of interleukin-19 gene polymorphisms with susceptibility and clinical phenotypes of Crohn′s disease (CD) . Methods:A retrospective case-control study was conducted. Eighty-three CD patients and 120 healthy people in Jinhua Municipal Central Hospital with matched gender and age as controls were enrolled. Allele and genotype frequencies of interleukin-19 gene rs2243188 and rs2243193 loci were detected by Sanger sequencing. The differences in allele and genotype frequencies of rs2243188 and rs2243193 loci between the two groups were compared, and the association between gene polymorphisms of the above loci and disease phenotype (disease site and disease behavior) and drug efficacy was analyzed. Results:The allelic and genotypic frequencies of the rs2243188 and rs2243193 loci differed between the two groups (all P<0.05) . Compared with control group, genotype CC+CA of rs2243188 frequency was higher in patients with ileocolonic CD (86.67% vs. 60.00%, OR = 4.333, 95% CI: 1.891-9.929, P = 0.001) , allele C of rs2243188 frequencies were higher in patients with terminal ileal CD (44.44% vs. 37.08%, OR = 5.589, 95% CI: 5.378-5.918, P = 0.019) and ileocolonic CD (50.00% vs. 37.08%, OR = 6.589, 95% CI: 6.378-7.918, P = 0.018) . However, genotype GA+AA of rs2243193 frequencies were lower in patients with terminal ileal CD (55.56% vs. 93.33%, OR = 0.089, 95% CI: 0.020-0.399, P = 0.002) and ileocolonic CD (75.00% vs. 93.33%, OR = 0.214, 95% CI: 0.085-0.540, P = 0.001) , allele A of rs2243193 frequencies were lower in patients with terminal ileal CD (50.00% vs. 70.83%, OR = 0.809, 95% CI: 0.724-0.908, P = 0.023) and ileocolonic CD (47.50% vs. 70.83%, OR = 0.132, 95% CI: 0.008-0.502, P = 0.018) . Furthermore, compared with control group, allele C (49.28% vs. 37.08%, OR = 1.607, 95% CI: 1.397-2.927, P = 0.021) and genotype CC+CA (84.06% vs. 60.00%, OR = 3.515, 95% CI: 1.676-7.374, P = 0.001) of rs2243188 frequencies were higher in patients with ileal lesion, allele A (47.83% vs. 70.83%, OR = 0.742, 95% CI: 0.709-1.741, P = 0.015) and genotype GA+AA (72.46% vs. 93.33%, OR = 0.188, 95% CI: 0.077-0.458, P = 0.002) of rs2243193 frequencies were lower in patients with ileal lesion.Compared with control group, allele A (50.00% vs. 70.83%, OR = 0.243, 95% CI: 0.352-0.679, P = 0.014) and genotype GA+AA (66.67% vs. 93.33%, OR = 0.143, 95% CI: 0.030-0.680, P = 0.006) of rs2243193 frequencies were lower in patients with penetrating CD. Moreover, the rs2243188 polymorphisms were not associated with disease behavior (all P>0.05) , the rs2243188 and rs2243193 polymorphisms were not associated with the efficacy of corticosteroid and infliximab (all P>0.05) . Conclusions:The gene mutation of the interleukin-19 gene rs2243188 locus may contribute to an increased risk for the CD with ileal lesions. But the gene mutation of rs2243193 locus may contribute to an decreased risk for CD with ileal lesions and penetrating CD.