Objective:To explore the utility of applying low frequency transcranial magnetic stimulation (rTMS) in the acute stage of ischemic stroke in terms of improving upper limb motor function.Methods:Eighty ischemic stroke survivors in the acute stage were randomly divided into a control group and an experimental group, with 40 in each. In addition to routine rehabilitation, the experimental group was given low frequency rTMS, while the control group was provided with sham rTMS. Before and after 4-weeks of treatment, upper limb motor function was evaluated using the Fugl-Meyer rating scale (FMA), Wolf motor function tests (WMFTs), the modified Barthel index (MBI) and in terms of motor evoked potential (MEP) latency and amplitude.Results:There were no significant differences between the two groups before the treatment. Afterward, however, the average FMA, WMFT, MBI scores had improved significantly more in the experimental group, on average, as had the average MEP amplitude.Conclusion:Low frequency rTMS in the acute phase of ischemic stroke can improve upper limb motor function and ability in the activities of daily living.

Objective:To examine the clinical value of rapid detection of drug-resistant bacteria by immunochromatography and the effects of rapid detection on the prognosis of patients with severe intra-abdominal infection complicated by carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infection.Methods:This was a retrospective cohort study. We analyzed clinical data of 73 patients with severe abdominal infections with sepsis or septic shock complicated by CRE bloodstream infection admitted to the general surgery department of Jinling Hospital between February 2022 and February 2023. Patients were divided into a colloidal gold immunochromatographic assay (GICA) group (17 patients) and conventional testing group (56 patients) based on whether a GICA for CRE had been performed on the patients' first blood culture sample during the diagnosis and treatment process. There were no statistically significant differences between the GICA and conventional testing groups in age ([55.9±17.3] vs. [47.6±16.4] years), sex ([16 men vs. one woman ] vs. [41 men vs. 15 women]), median Charlson comorbidity index (3.0[2.0,4.0] vs. 3.0[2.0, 4.8]), septic shock (10 vs. 39), or acute kidney injury (8 vs. 40) (all P>0.05). Both groups routinely underwent traditional bacterial identification and drug susceptibility testing. Additionally, patients in the GICA group were tested directly for positive blood cultures using a GICA carbapenemase test kit. The main outcomes were mortality rates on Days 28 and 90 after the first identification of CRE bloodstream infection in both groups. We also compared the microbial clearance rate, duration of hospitalization and intensive care unit stay, and time from onset of CRE bloodstream infection to initiation of targeted and appropriate antibiotics between the two groups. Results:The rate of microbial clearance of bloodstream infection was significantly greater in the GICA group than in the conventional testing group (15/17 vs. 34/56 [60.7%], χ 2=4.476, P=0.034), whereas the 28-day mortality tended to be lower in the GICA than conventional testing group [5/17 vs. 44.6% [25/56], χ 2=1.250, P=0.264). The 90-day mortality (8/17 vs. 53.6% [30/56], χ 2=0.222, P=0.638), median duration of hospitalization (37.0 [18.0, 46.5] days vs. 45.5 [32.2, 64.8] days, Z=-1.867, P=0.062), and median duration of intensive care unit stay (18.0 [6.5, 35.0] days vs. 32.0 [5.0, 51.8] days, Z=-1.251, P=0.209). The median time between the onset of bloodstream infection and administration of antibiotics was 49.0 (38.0, 69.0) hours in the GICA group, which is significantly shorter than the 163.0 (111.8, 190.0) hours in the conventional testing group ( Z=-5.731, P<0.001). The median time between the onset of bloodstream infection and administration of appropriate antibiotics was 40.0 (34.0, 80.0) hours in the GICA group, which is shorter than in the conventional testing group (68.0 [38.2, 118.8]) hours; however, this difference is not statistically significant ( Z=-1.686, P=0.093). Conclusions:GICA can provide information on carbapenemase- producing pathogens faster than traditional drug sensitivity testing, enabling early administration of the optimal antibiotics. The strategy of 'carbapenemase detection first' for managing bacterial infection has the potential to improve prognosis of patients and reduce mortality rate.

Objective:To examine the clinical value of rapid detection of drug-resistant bacteria by immunochromatography and the effects of rapid detection on the prognosis of patients with severe intra-abdominal infection complicated by carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infection.Methods:This was a retrospective cohort study. We analyzed clinical data of 73 patients with severe abdominal infections with sepsis or septic shock complicated by CRE bloodstream infection admitted to the general surgery department of Jinling Hospital between February 2022 and February 2023. Patients were divided into a colloidal gold immunochromatographic assay (GICA) group (17 patients) and conventional testing group (56 patients) based on whether a GICA for CRE had been performed on the patients' first blood culture sample during the diagnosis and treatment process. There were no statistically significant differences between the GICA and conventional testing groups in age ([55.9±17.3] vs. [47.6±16.4] years), sex ([16 men vs. one woman ] vs. [41 men vs. 15 women]), median Charlson comorbidity index (3.0[2.0,4.0] vs. 3.0[2.0, 4.8]), septic shock (10 vs. 39), or acute kidney injury (8 vs. 40) (all P>0.05). Both groups routinely underwent traditional bacterial identification and drug susceptibility testing. Additionally, patients in the GICA group were tested directly for positive blood cultures using a GICA carbapenemase test kit. The main outcomes were mortality rates on Days 28 and 90 after the first identification of CRE bloodstream infection in both groups. We also compared the microbial clearance rate, duration of hospitalization and intensive care unit stay, and time from onset of CRE bloodstream infection to initiation of targeted and appropriate antibiotics between the two groups. Results:The rate of microbial clearance of bloodstream infection was significantly greater in the GICA group than in the conventional testing group (15/17 vs. 34/56 [60.7%], χ 2=4.476, P=0.034), whereas the 28-day mortality tended to be lower in the GICA than conventional testing group [5/17 vs. 44.6% [25/56], χ 2=1.250, P=0.264). The 90-day mortality (8/17 vs. 53.6% [30/56], χ 2=0.222, P=0.638), median duration of hospitalization (37.0 [18.0, 46.5] days vs. 45.5 [32.2, 64.8] days, Z=-1.867, P=0.062), and median duration of intensive care unit stay (18.0 [6.5, 35.0] days vs. 32.0 [5.0, 51.8] days, Z=-1.251, P=0.209). The median time between the onset of bloodstream infection and administration of antibiotics was 49.0 (38.0, 69.0) hours in the GICA group, which is significantly shorter than the 163.0 (111.8, 190.0) hours in the conventional testing group ( Z=-5.731, P<0.001). The median time between the onset of bloodstream infection and administration of appropriate antibiotics was 40.0 (34.0, 80.0) hours in the GICA group, which is shorter than in the conventional testing group (68.0 [38.2, 118.8]) hours; however, this difference is not statistically significant ( Z=-1.686, P=0.093). Conclusions:GICA can provide information on carbapenemase- producing pathogens faster than traditional drug sensitivity testing, enabling early administration of the optimal antibiotics. The strategy of 'carbapenemase detection first' for managing bacterial infection has the potential to improve prognosis of patients and reduce mortality rate.

ObjectiveTo investigate the resistance to pyrethroids， beta-cyhalothrin and fenitrothion as well as the frequencies of kdr andace⁃1 alleles in Anopheles sinensis from three geographical populations in Chongming District， Shanghai. MethodsThe contact tube method recommended by WHO was used to determine mosquito resistance. The frequencies of kdr and ace⁃1 alleles in adult mosquitoes were determined by PCR amplification. The correlation between the frequencies of kdr alleles and insecticide resistance was analyzed by linear regression method. ResultsThe mosquito population near natural reserve （NF） was sensitive to deltamethrin， and the mortality rate was 100.00% at 24 h. The mosquito population with intensive breeding farms （HX） showed resistance to deltamethrin and beta-cyhalothrin， and the 24 h mortality was 48.00 % and 57.50 %， respectively. The 24 h mortality rate of the mosquito population with urban-rural integration area （AS） with suspected resistance to deltamethrin and beta-cyhalothrin was 84.40% and 86.00%. The 24 h mortality rate to Fenitrothion was 55.67%. There were 3 mutations in kdr gene locus 1014， and 7 mutated genotypes were detected， mainly L1014/L1014F and L1014F/L1014F. The mutation frequency of kdr allele in HX population was the highest （52.68%）. There was one mutation at site 119 of ace⁃1 gene， and three genotypes were detected， most of which were G119S mutation. There was a significant negative correlation between the frequency of kdr resistance allele and the mortality rate of beta-cypermethrin in An.sinensis populations （r²=0.930，P=0.036）. There was a significant negative correlation between the frequency of ace⁃1 resistance allele and the mortality rate of fenitrothion in An. sinensis populations from four habitats（r²=0.996，P=0.038）. ConclusionThe mutation frequency of insecticide resistance allele is associated with the development of mosquito resistance level. Therefore， comprehensive monitoring of resistance levels of An.sinensis in Chongming area should be continued to provide a basis for local mosquito resistance management.

Objective:To investigate the clinical significance and the diagnostic value of detecting kidney injury biomarkers in urine and serum of children with Henoch-Sch?nlein purpura nephritis (HSPN).Methods:A total of 216 children with untreated HSPN, who were admitted in Beijing Children′s Hospital of Capital Medical University from January 2018 to December 2019, were recruited in this retrospective study. Two hundred and sixteen healthy children were selected as the healthy control group. We determined the levels of six biomarkers of kidney injury, including transferrin (TRF), immunoglobulin (IgG), microalbumin (mAlb), alpha-1 microglobulin (α1-MG), N-acetyl-β-D-glucosaminidase (NAG) in urine and cystatin C (CysC) in serum. The data from the two groups were analyzed, the diagnostic value of each biomarker was evaluated and a logistic regression model for the diagnosis of HSPN was established. In addition, 60 children with HSPN, who were admitted to our hospital from November 2021 to February 2022 and 60 healthy children, who underwent healthy check up in the same period were included to validate the diagnostic performance of the established logistic model. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of each biomarker.Results:The urine levels of TRF, IgG, mAlb, α1-MG and NAG and the serum level of CysC were significantly higher in the HSPN group than those in healthy control group (all P<0.05). The area under the ROC curve (AUC) of TRF, IgG, mAlb, α1-MG, NAG and the serum levels of CysC was 0.749, 0.719, 0.810, 0.648, 0.828 and 0.790 (all P<0.05). Logistics regression analysis showed that IgG, mAlb and TRF were the three diagnostic determinants of HSPN ( OR=1.083, 1.105, 1.704,all P<0.001), and the AUC was 0.916 of the established logistic model based on these three biomarkers. The sensitivity was 87.4% and the specificity reached 96.2%. The logistic model was validated by independent cohorts, and the AUC was 0.973, the sensitivity was 95.0% and the specificity was 98.3%. Conclusions:The levels of urine TRF, IgG, mAlb, α1-MG, NAG and serum CysC were higher in children with HSPN. The established logistic regression model based on three biomarkers including IgG, mAlb and TRF in this study has satisfactory clinical value in diagnosing HSPN in children.

Objective:To investigate the relationship of glycated hemoglobin(HbA1c)and brain natriuretic peptide(BNP)levels with clinical prognosis of acute myocardial infarction.Methods:A total of 108 patients with acute myocardial infarction combined with diabetes mellitus, who underwent percutaneous coronary intervention(PCI)from March 2016 to June 2017 in our hospital, were enrolled.According to the HbA1c level, patients were divided into three groups: Group A(HbA1c≤6.9%, n=36), Group B(7%≤HbA1c≤7.9%, n=31)and Group C(HbA1c≥8%, n=41). HbA1c and NT-proBNP levels, cardiac function classification at admission and discharge, the incidence of adverse cardiac events during hospitalization and left ventricular ejection fraction(LVEF)at admission, discharge and 3 months after discharge were analyzed.Results:Among the three groups, plasma NT-proBNP levels were higher in Group C than in Group B and Group A( P<0.05), and there was no significant difference between Group B and Group C( P<0.05). Furthermore, HbA1c levels were positively correlated with NT-proBNP levels in Group C( P<0.05). Cardiac function grading was better in Group A and Group B than in Group C at discharge.During hospitalization, the incidence of adverse cardiac events in Group C was 29.3%, which was higher than in Group A(8.3%)and Group B(9.7%)( P<0.05). LVEF levels were significantly improved in Group A and Group B at discharge and 3 months after discharge, compared with those at admission, while Group C had no significant improvement in LVEF levels and had lower LVEF than Group A and Group B( P<0.05). Conclusions:HbA1c and NT proBNP levels can be used as a joint monitoring indicator in patients with acute myocardial infarctions after PCI, to help prevent and reduce the incidence of complications and mortality in patients with acute myocardial infarction after PCI and improve clinical prognosis.

Objective　To explore the clinical effect of dl-3-N-butylphthalide（NBP）injection combined with antiplatelet drug therapy and the influence on stroke recurrence of minor stroke patients. Methods　A retrospective analysis was performed on 95 patients with minor stroke that admitted to the stoke center of the second affiliated hospital of Harbin Medical University from January to July 2019.It included 45 patients in the combined treatment group （NBP plus antiplatelet treatment group） and 50 patients in the control group （antiplatelet treatment group）. The mRS score，NIHSS score and BI of the two groups were analyzed at 14 days，1 month，3 months and 6 months after treatment. The stroke recurrence events at 1 month，3 months，and 6 months after treatment in both groups will be recorded too. We used multivariate analysis to analyze the factors that might influence stroke recurrence in minor stroke patients. Results　①There was no significant difference in baseline information between the two groups（P>0.05），which was comparable. ②At 14 days，1 month，3 months and 6 months after treatment，the mRS scores and NIHSS scores of the patients in the two groups were significantly lower than that at admission，while the Barthel index were significantly higher than that at admission （P<0.01）. ③In the combined treatment group at 1 month，3 months and 6 months after treatment，the mRS scores were significantly lower than those in the control group （P=0.033，0.031，0.013）. ④The number of the combined treatment group patients with stroke recurrence at 3 months and 6 months after treatment was significantly lower than that in the control group（P=0.033，0.039）. ⑤The results of multivariate analysis showed that using NBP was an independent protective factor in stroke recurrence at 3 months （OR=0.060，95%CI 0.005～0.778，P=0.031） and 6 months （OR=0.163，95%CI 0.028～0.968，P=0.028） for minor stroke. Conclusion　NBP combined with antiplatelet drugs can significantly improve the neurological function and reduce the stroke recurrence of minor stroke patients.

Objective To explore the diagnostic value of five infection markers in bloodstream infection.Methods Randomly selected 110 bloodstream infection patients with positive blood cultures and 30 bacterial infection patients with negative blood cultures.Blood was simultaneously drawn with blood cultures;the complete blood count and C-reactive protein (CRP) levels were measured.The white blood cell count (WBC),neutrophil count (NEU),lymphocyte count (LMY),CRP level and neutrophil-lymphocyte count ratio (NLCR) were compared between the two groups.Results The levels of WBC,NEU,NLCR and CRP in bloodstream infection group were significantly higher than those in control group (P＜0.05),while LYM was significantly lower than that in control group (P＜ 0.05).Among these five infection markers,the area under the receiver operating characteristic curve (ROC-AUC) was the highest for NLCR (0.808) and LMY (0.756);when the cutoff value for NLCR was ＞9.33,sensitivity was 63.6％,specificity was 93.3％;and the cutoff value for LYM was ≤0.97,sensitivity was 58.2％,specificity was 86.7％.Furthermore,the NLCR of patients with gram-negative bloodstream infection was higher than those in patients with gram-positive bloodstream infection.NLCR showed important clinical significance in distinguishing strains of different bloodstream infections.Conclusions NLCR is the better predictors than routine parameters in diagnosing bloodstream infection.

Objective To investigate the effect of tiaozhi granules on the autophagy of HU-VECs in the cell,protein and molecular levels.Methods HUVECs were induced by tiaozhi granule medicated serum,6-amino-3-methyl purine (3-MA) and rapamycin.MTT was used to detect the cell viability after 48 hours with tiaozhi granule medicated serum.Western blot was used to detect the expressive level of LC3-Ⅱ.Immunofluorescence was used to detect change in the numbers of autophagosomes.Results After HUVECs was processed by tiaozhi granule medicated serum,the cell viability had not change,the relative expression of autophagy related protein LC3-Ⅱ increased,and the number of autophagosomes increased (P ＜ 0.05).After HUVECs was processed by tiaozhi granule medicated serum and rapamycin,cell viability had no change,while the relative expression of autophagy related protein LC3-Ⅱ and the number of autophagosomes decreased significantly when compared with the results of intervention with rapamycin only (P ＜ 0.05 or P ＜ 0.01).Conclusion Tiaozhi granules can inhibit excessive autophagy of endothelial cells and promote moderate autophagy in endothelial cells.

Objective To investigate the effect of tiaozhi granules on the autophagy of HU-VECs in the cell,protein and molecular levels.Methods HUVECs were induced by tiaozhi granule medicated serum,6-amino-3-methyl purine (3-MA) and rapamycin.MTT was used to detect the cell viability after 48 hours with tiaozhi granule medicated serum.Western blot was used to detect the expressive level of LC3-Ⅱ.Immunofluorescence was used to detect change in the numbers of autophagosomes.Results After HUVECs was processed by tiaozhi granule medicated serum,the cell viability had not change,the relative expression of autophagy related protein LC3-Ⅱ increased,and the number of autophagosomes increased (P ＜ 0.05).After HUVECs was processed by tiaozhi granule medicated serum and rapamycin,cell viability had no change,while the relative expression of autophagy related protein LC3-Ⅱ and the number of autophagosomes decreased significantly when compared with the results of intervention with rapamycin only (P ＜ 0.05 or P ＜ 0.01).Conclusion Tiaozhi granules can inhibit excessive autophagy of endothelial cells and promote moderate autophagy in endothelial cells.