Objective To analyze the fairness of human resource allocation in professional public health agency (PHA) in Guangdong Province in 2022. Methods Health technical staff, other technical staff, and management staff from PHAs in Guangdong Province, such as disease prevention and control centers, specialized disease prevention and treatment institutions, maternal and child health institutions, health education centers, emergency centers/stations, blood collection and supply institutions, health supervision agencies, and family planning service centers under health departments, were selected as the study subjects. Data on human resource allocation in PHAs were collected, and the Lorenz curve, Gini coefficient, and Theil index were used to analyze the fairness of personnel allocation based on three dimensions: year-end resident population, geographical area, and regional gross domestic product. Results The number of PHA personnel per 10 000 population in four regions of the Pearl River Delta, eastern, western and mountain area in Guangdong Province was (7.49±3.74), (4.74±0.87), (8.73±1.67) and (10.33±1.80), respectively. There was no correlation between the per capita regional gross dumestic product of each prefecture level city and the number of PHA personnel (Spearman′s rank correlation coefficient=0.43, P>0.05). PHA resource allocation based on year-end resident population was more equitable than allocations based on geographical area or regional gross dumestic product, as indicated by the Lorenz curve being closest to the 45° standard line and the lowest Gini coefficient. The fairness of personnel allocation from high to low was ranked as follows: practicing (assistant) physicians, health technicians, registered nurses, managers personnel, and other technical personnel, with Theil indices of 0.035 0, 0.036 4, 0.044 6, 0.048 4, and 0.053 5, respectively. The differences in configuration fairness were derived from within group differences, with contribution rates of 76.0%, 73.9%, 71.8%, 82.9%, and 92.2%. The Lorenz curve, Gini coefficient, and Theil index were consistent in the distribution of permanent residents at the end of the year. Conclusion The fairness of professional human resource allocation in Guangdong Province based on the distribution of permanent residents at the end of the year is better than that based on geographical area and regional gross domestic product. The fairness of the allocation of practicing (assistant) physicians is better than that of other professional categories. Regional differences are the main reason for the relatively unfair allocation of PHA human resources in Guangdong Province.

Objective:To investigate the biofilm genes and quorum sensing genes of carbapenem resistant Acinetobacter baumannii (CRAB) in the wounds of diabetic foot patients. Methods:This study was a retrospective observational study. The 233 strains of Acinetobacter baumannii were cultured from 177 inpatients (128 males and 49 females, aged (56±10) years) with diabetic foot admitted to the Department of Diabetic Foot of Tianjin Medical University Chu Hsien-I Memorial Hospital from October 2020 to September 2023. Two hundred and thirty-three Acinetobacter baumannii strains were detected by bacterial culture from the diabetic foot wounds of the aforementioned patients. All Acinetobacter baumannii strains were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, followed by analysis of their resistance rate using kinetic turbidimetric assay by a fully automated microbiological analysis system. Ten CRAB strains (from 10 patients, 9 males and 1 female, aged (63±13) years) and 10 carbapenem sensitive Acinetobacter baumannii (CSAB; from 10 patients, 8 males and 2 females, aged (63±9) years) strains were randomly selected, and the whole DNA genome was extracted and sequenced. The antibiotic resistance genes were annotated using a comprehensive antibiotic resistance gene database, and a phylogenetic tree was drawn to analyze the homologous relationship between CRAB and CSAB. The 7 housekeeping genes of Acinetobacter baumannii was entered into the PubMLST website to analyze the multi-locus sequence typing of CRAB and CSAB. All the measured genes were put into the PubMLST website to search for the biofilm genes bap, csuA, csuB, csuA/B, csuC, csuD, csuE, pgaA, pgaB, pgaC, pgaD, bfmR, bfmS, ompA carried by each Acinetobacter baumannii, as well as the quorum sensing genes abaI and abaR, and flagellar gene pilA. The differences in carrying these genes between CRAB and CSAB were compared. The biofilm genes and quorum sensing genes carried by CRAB and CSAB carrying oxacillinase (OXA) resistance gene blaOXA were analyzed. Gross observation was performed to check if there was gel-like membrane-like substance in the diabetic foot wounds infected with CRAB and CSAB, and if so, the microstructure was observed by scanning electron microscope. Results:Among the detected Acinetobacter baumannii, the positive detection rates of CSAB, CRAB, multi-drug resistant Acinetobacter baumannii, and pan-drug resistant Acinetobacter baumannii were 16.7% (39/233), 83.3% (194/233), 95.3% (222/233), and 34.3% (80/233), respectively, and no fully drug-resistant Acinetobacter baumannii was detected. Among 233 strains of Acinetobacter baumannii, the resistance rate to carbapenem antibiotics exceeded 80%; the resistance rate of cefoperazone/sulbactam was relatively low, at 37%; the resistance rates to the other cephalosporin antibiotics (cefotaxime, ceftazimide, cefotetan, and cefuroxime) were more than 80%; the resistance rates to all penicillin antibiotics were greater than 80%; the resistance rates to quinolone antibiotics were all over 60%; the resistance rate to minocycline was only 12%; the resistance rates to tigecycline and colistin did not exceed 1%. The phylogenetic tree showed that 10 CRAB strains were highly homologous, while 10 CSAB strains had low homology. The analysis of multi-locus sequence typing showed that 10 CRAB strains were all the same type; among the 10 CSAB strains, except 1 strain without typing, the remaining 9 CSAB strains had 7 types. Eight of 10 CRAB strains contained complete biofilm genes and quorum sensing genes. The biofilm genes from the strains of CSAB were incomplete and none carried the bap gene. Neither CRAB nor CSAB carried the flagellar gene pilA. Compared with that carried by CRAB, biofilm genes bap, csuA, csuC, and csuD and quorum sensing genes abaI and abaR carried by CSAB were significantly decreased ( P<0.05). The main blaOXA categories carried by CRAB were blaOXA-23-like (specifically BlaOXA-167) and blaOXA-51-like (specifically blaOXA-66), both of which had carbapenase activity. Eight of 10 CRAB strains carried both blaOXA-66 and blaOXA-167, and all of them had relatively complete quorum sensing genes and biofilm genes. The main blaOXA categories carried by CSAB were blaOXA-51-like and blaOXA-213-like. Although they had carbapenemase activity, clinical drug sensitivity test showed that they were all sensitive to carbapenem antibiotics. Gel-like and membrane-like substance could be seen in wounds infected with CRAB, which were biofilm; no gel-like and membrane-like substance was found in the wound infected with CSAB. Conclusions:CRAB and CSAB in diabetic foot wounds are significantly different in terms of multi-locus sequence typing, carrying biofilm genes, quorum sensing genes, and blaOXA gene, leading to differences in antibiotic resistance between the two.

Visual hallucination(VH)is a common symptom of schizophrenia,the underlying mechanism has not been fully elucidated.It has been found that the dysfunction of dopamine(DA)system,the overactivation of α-amino-3-hydroxy-5-methyl-4-isoxazole-propionate(AMPA)receptor in glutamate system and the dysfunction of γ-aminobutyric acid(GABA)ergic neurons can induce VH in patients with schizophrenia.In addition,abnormalities in brain structural and functional networks and visual networks are also closely related to the occurrence of VH.The purpose of this paper is to review the neurochemistry and nerve injury mechanism of VH in schizophrenic patients to deeply understand the characteristics of VH,and make more accurate judgment in the early diagnosis,condition evaluation and treatment plan of schizophrenic patients.

Objective To retrieve,evaluate and summarise evidence on home exercise rehabilitation in patients with stage Ⅱ coronary heart disease(CHD)undergoing cardiac rehabilitation and to provide a reference for healthcare professionals to instruct the patients for home-based exercise rehabilitation.Methods Following the"6S"evidence hierarchy model and a top-down search strategy,a systematic search was conducted across databases of Guidelines International Network(GIN),Scottish Intercollegiate Guidelines Network(SIGN),National Institute for Health and Clinical Excellence(NICE),American Association of Cardiovascular and Pulmonary Rehabilitation(AACVPR),American Heart Association(AHA),European Society of Cardiology(ESC),BMJ Best Practice,UpToDate,Joanna Briggs Institute(JBI)evidence-based healthcare database,PubMed,Web of Science,Cochrane Library,EBSCON,SinoMed,China National Knowledge Infrastructure(CNKI),and Wanfang Data Knowledge Service Platform for guidelines,expert consensus,evidence summaries,systematic reviews,primary study and clinical decisions regarding home-based exercise rehabilitation for patient with CHD phase Ⅱ cardiac rehabilitation.Literature included the articles published on databases from the inception to December 2023.Two researchers independently evaluated the quality of acquired literature and the extracted and integrated the evidence.Results A total of 15 articles were retrieved,including 5 guidelines,3 expert consensuses,2 evidence summaries,3 systematic reviews and 2 clinical decisions.A total of 23 best evidence statements were summarised and further reduced to 5 topics:exercise benefits,exercise assessment,exercise prescription,safety and monitoring,and health education.Conclusion This study summarises the best evidence for home-based exercise rehabilitation in patients with phase Ⅱ cardiac rehabilitation.It recommends that healthcare professionals should consider the clinical context rehabilitation,by taking into account of the needs and preferences of patients and their families,when applying the evidence and developing appropriate and individualised plans for exercise hence to promote the recovery of patients.

Objective To retrieve,evaluate and summarise evidence on home exercise rehabilitation in patients with stage Ⅱ coronary heart disease(CHD)undergoing cardiac rehabilitation and to provide a reference for healthcare professionals to instruct the patients for home-based exercise rehabilitation.Methods Following the"6S"evidence hierarchy model and a top-down search strategy,a systematic search was conducted across databases of Guidelines International Network(GIN),Scottish Intercollegiate Guidelines Network(SIGN),National Institute for Health and Clinical Excellence(NICE),American Association of Cardiovascular and Pulmonary Rehabilitation(AACVPR),American Heart Association(AHA),European Society of Cardiology(ESC),BMJ Best Practice,UpToDate,Joanna Briggs Institute(JBI)evidence-based healthcare database,PubMed,Web of Science,Cochrane Library,EBSCON,SinoMed,China National Knowledge Infrastructure(CNKI),and Wanfang Data Knowledge Service Platform for guidelines,expert consensus,evidence summaries,systematic reviews,primary study and clinical decisions regarding home-based exercise rehabilitation for patient with CHD phase Ⅱ cardiac rehabilitation.Literature included the articles published on databases from the inception to December 2023.Two researchers independently evaluated the quality of acquired literature and the extracted and integrated the evidence.Results A total of 15 articles were retrieved,including 5 guidelines,3 expert consensuses,2 evidence summaries,3 systematic reviews and 2 clinical decisions.A total of 23 best evidence statements were summarised and further reduced to 5 topics:exercise benefits,exercise assessment,exercise prescription,safety and monitoring,and health education.Conclusion This study summarises the best evidence for home-based exercise rehabilitation in patients with phase Ⅱ cardiac rehabilitation.It recommends that healthcare professionals should consider the clinical context rehabilitation,by taking into account of the needs and preferences of patients and their families,when applying the evidence and developing appropriate and individualised plans for exercise hence to promote the recovery of patients.

Objective:To investigate the biofilm genes and quorum sensing genes of carbapenem resistant Acinetobacter baumannii (CRAB) in the wounds of diabetic foot patients. Methods:This study was a retrospective observational study. The 233 strains of Acinetobacter baumannii were cultured from 177 inpatients (128 males and 49 females, aged (56±10) years) with diabetic foot admitted to the Department of Diabetic Foot of Tianjin Medical University Chu Hsien-I Memorial Hospital from October 2020 to September 2023. Two hundred and thirty-three Acinetobacter baumannii strains were detected by bacterial culture from the diabetic foot wounds of the aforementioned patients. All Acinetobacter baumannii strains were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, followed by analysis of their resistance rate using kinetic turbidimetric assay by a fully automated microbiological analysis system. Ten CRAB strains (from 10 patients, 9 males and 1 female, aged (63±13) years) and 10 carbapenem sensitive Acinetobacter baumannii (CSAB; from 10 patients, 8 males and 2 females, aged (63±9) years) strains were randomly selected, and the whole DNA genome was extracted and sequenced. The antibiotic resistance genes were annotated using a comprehensive antibiotic resistance gene database, and a phylogenetic tree was drawn to analyze the homologous relationship between CRAB and CSAB. The 7 housekeeping genes of Acinetobacter baumannii was entered into the PubMLST website to analyze the multi-locus sequence typing of CRAB and CSAB. All the measured genes were put into the PubMLST website to search for the biofilm genes bap, csuA, csuB, csuA/B, csuC, csuD, csuE, pgaA, pgaB, pgaC, pgaD, bfmR, bfmS, ompA carried by each Acinetobacter baumannii, as well as the quorum sensing genes abaI and abaR, and flagellar gene pilA. The differences in carrying these genes between CRAB and CSAB were compared. The biofilm genes and quorum sensing genes carried by CRAB and CSAB carrying oxacillinase (OXA) resistance gene blaOXA were analyzed. Gross observation was performed to check if there was gel-like membrane-like substance in the diabetic foot wounds infected with CRAB and CSAB, and if so, the microstructure was observed by scanning electron microscope. Results:Among the detected Acinetobacter baumannii, the positive detection rates of CSAB, CRAB, multi-drug resistant Acinetobacter baumannii, and pan-drug resistant Acinetobacter baumannii were 16.7% (39/233), 83.3% (194/233), 95.3% (222/233), and 34.3% (80/233), respectively, and no fully drug-resistant Acinetobacter baumannii was detected. Among 233 strains of Acinetobacter baumannii, the resistance rate to carbapenem antibiotics exceeded 80%; the resistance rate of cefoperazone/sulbactam was relatively low, at 37%; the resistance rates to the other cephalosporin antibiotics (cefotaxime, ceftazimide, cefotetan, and cefuroxime) were more than 80%; the resistance rates to all penicillin antibiotics were greater than 80%; the resistance rates to quinolone antibiotics were all over 60%; the resistance rate to minocycline was only 12%; the resistance rates to tigecycline and colistin did not exceed 1%. The phylogenetic tree showed that 10 CRAB strains were highly homologous, while 10 CSAB strains had low homology. The analysis of multi-locus sequence typing showed that 10 CRAB strains were all the same type; among the 10 CSAB strains, except 1 strain without typing, the remaining 9 CSAB strains had 7 types. Eight of 10 CRAB strains contained complete biofilm genes and quorum sensing genes. The biofilm genes from the strains of CSAB were incomplete and none carried the bap gene. Neither CRAB nor CSAB carried the flagellar gene pilA. Compared with that carried by CRAB, biofilm genes bap, csuA, csuC, and csuD and quorum sensing genes abaI and abaR carried by CSAB were significantly decreased ( P<0.05). The main blaOXA categories carried by CRAB were blaOXA-23-like (specifically BlaOXA-167) and blaOXA-51-like (specifically blaOXA-66), both of which had carbapenase activity. Eight of 10 CRAB strains carried both blaOXA-66 and blaOXA-167, and all of them had relatively complete quorum sensing genes and biofilm genes. The main blaOXA categories carried by CSAB were blaOXA-51-like and blaOXA-213-like. Although they had carbapenemase activity, clinical drug sensitivity test showed that they were all sensitive to carbapenem antibiotics. Gel-like and membrane-like substance could be seen in wounds infected with CRAB, which were biofilm; no gel-like and membrane-like substance was found in the wound infected with CSAB. Conclusions:CRAB and CSAB in diabetic foot wounds are significantly different in terms of multi-locus sequence typing, carrying biofilm genes, quorum sensing genes, and blaOXA gene, leading to differences in antibiotic resistance between the two.

Self-organized blastoids from extended pluripotent stem (EPS) cells possess enormous potential for investigating postimplantation embryo development and related diseases. However, the limited ability of postimplantation development of EPS-blastoids hinders its further application. In this study, single-cell transcriptomic analysis indicated that the "trophectoderm (TE)-like structure" of EPS-blastoids was primarily composed of primitive endoderm (PrE)-related cells instead of TE-related cells. We further identified PrE-like cells in EPS cell culture that contribute to the blastoid formation with TE-like structure. Inhibition of PrE cell differentiation by inhibiting MEK signaling or knockout of Gata6 in EPS cells markedly suppressed EPS-blastoid formation. Furthermore, we demonstrated that blastocyst-like structures reconstituted by combining the EPS-derived bilineage embryo-like structure (BLES) with either tetraploid embryos or tetraploid TE cells could implant normally and develop into live fetuses. In summary, our study reveals that TE improvement is critical for constructing a functional embryo using stem cells in vitro.
Pregnancy ; Female ; Animals ; Mice ; Tetraploidy ; Blastocyst ; Embryo, Mammalian ; Cell Differentiation ; Embryonic Development

Objective To investigate the value of D-dimer plus injury severity score (ISS) in predicting the prognosis of trauma patients. Methods The clinical data of 1 592 traumatic patients admitted to our emergency room from January 1, 2014 through December 31, 2016 were retrospectively analyzed. Excluding criteria included patients below the age of 14 and patients admitted over 24 h after injury, clinical death at admission, patients left from the hospital without the approval of attend doctor, detail and complete clinical data of patients not available, patients with history of coagulopathy, primary hepatic function failure, anticoagulants used within 6 months prior to injury, and patients with multiple injury affecting more than two parts of body. Finally, a total of 1 167 patients were enrolled in this study. The 28-day prognosis was used as the endpoint. The patients were divided into survival group and death group. The differences in venous plasma D-dimer and ISS at the fi rst detection between two groups were compared by Mann-Whitney U test. According to ISS, the patients were divided into mild injury group, moderate injury group and severe injury group. The Kruskal-Wallis one-way ANOVA test was used to compare the differences among different groups. Meanwhile, the area under the ROC curve was used to compare the accuracy of predictive effi ciency of D-dimer, ISS and the combination of both. Results There was a positive correlation between D-dimer and ISS, and D-dimer and ISS in survival group were significantly lower than those in death group(Z=-7.777, Z=-6.694, P <0.01). There was a statistically signifi cant difference in mortality among groups (χ2= 70.85, P <0.01); The area under the ROC curve of ISS, D-dimer and both combined was 0.728, 0.765, 0.800, respectively. The area under the ROC curve of D-dimer to predicte patients' prognosis was a little bit larger than that of ISS, but the difference was not statistically signifi cant (Z=1.051, P=0.293). The area under the ROC curve of joint both of them for the prognosis of the patients was greater than that of ISS or D-dimer alone( Z=3.028, Z=2.722, P<0.05). Conclusions The levels of D-dimer and ISS in patients with traumatic injury are correlated with the severity and mortality of patients. The increased D-dimer and ISS score indicates that the risk of death is increased, and prediction effi ciency of combining both of them is superior to either alone.

Objective To compare the accuracy of somatosensory evoked potentials(SSEPs), motor evoked potentials(MEPs), regional cerebral oxygen saturation(rSO2)and multimodal monitoring in monitoring cerebral ischemia in patients undergoing carotid endarterectomy(CEA). Methods Eighty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 46-76 yr, scheduled for elective CEA, were enrolled in the study. SSEPs, MEPs and rSO2were monitored during CEA. The event of intraoperative cerebral ischemia was defined as:(1)SSEP escape latency prolongation of 10% and∕or amplitude decrease of 50%;(2)disappearance of MEP amplitude;(3)decrease in rSO2>20% of the baseline value;(4)When multimodal monitoring was applied, the event of intraopera-tive cerebral ischemia could be defined as long as one variable previously described met the condition. The gold standard of perioperative cerebral ischemia was defined as:(1)the National Institutes of Health Stroke Scale score≥4 at 1, 3 and 5 days after operation than before operation was considered as neurologi-cal dysfunction;(2)cranial CT showed a new ipsilateral cerebral focal ischemia, and postoperative in-tracranial hemorrhage diseases were excluded. Results Five cases developed cerebral ischemia after opera-tion. The sensitivity and specificity of SSEPs in predicting cerebral ischemia were 80% and 83%, respec-tively;MEPs 80% and 80%, respectively; SSEPs+MEPs 100% and 79%, respectively; rSO260% and 93%, respectively;SSEPs+MEPs+rSO2100% and 7%, respectively. Decrease in rSO2> 20% of the base-line value was consistent with SSEP escape latency prolongation of 10% and∕or amplitude decrease of 50%in diagnosis of cerebral ischemia(Kappa value 0.67, P<0.01); decrease in rSO2>20% of the baseline value was consistent with disappearance of MEP amplitude in diagnosis of cerebral ischemia(Kappa value 0.54, P<0.01). Conclusion rSO2has a good agreement with SSEPs and MEPs in diagnosis of cerebral ischemia during CEA; combination of SSEPs and MEPs produces better accuracy in monitoring cerebral is-chemia.

Objective: To identify the prevalence of sleep problems in children with autism spectrum disorder (ASD) and to explore the association with the main melatonin metabolite, 6-sulfatoxymelatonin (6-SM). Method: This was a prospective case-control study. Children with ASD were recruited from Child Development and Behavioral Research Center (CDBRC) of the Harbin Medical University and Harbin Special Education School from October 2015 to April 2017 (ASD group) . Healthy controls were selected from five kindergartens and one primary school in Harbin by the stratified cluster random sampling (control group) . The Children's Sleep Habits Questionnaire (CSHQ) was used to investigate the sleep problems of the two groups. The patients were matched in a 1∶1 ratio for the age and sex, and the urine samples of case-control pairs were collected in the morning. The level of 6-SM was measured by the enzyme linked immunosorbent assay (ELISA). The student's t test was used for comparison between the ASD group and control group, and the Pearson correlation analysis was used to determine the correlation difference. Result: A total of 212 ASD children (mean (±SD) age was (6.0±2.7) years, and 181 patients (85.4%) were male), and a total of 334 healthy children(mean (±SD) age was (5.9±2.6) years, and 272 patients (81.4%) were male) were recruited. Among them, 101 matched case-control pairs completed the collection of urine samples. According to the statistical analysis, the scores of total CSHQ, bedtime resistance, sleep onset delay, sleep duration, night waking, parasomnia, sleep disordered breathing and daytime sleepiness in children with ASD were significantly higher than those in the control group (48.2±6.2 vs. 46.6±5.4, 11.4±2.5 vs. 10.7±2.8, 1.7±0.8 vs. 1.5±0.7, 4.1±1.4 vs. 3.7±1.1, 4.2±1.5 vs. 3.8±1.1, 8.5±1.5 vs. 8.3±1.4, 3.7±1.0 vs. 3.4±0.8, 11.7±2.5 vs. 12.4±2.7, t=3.16, 3.00, 3.23, 2.76, 3.19, 1.99, 3.45,-2.72, P=0.002, 0.003, 0.001, 0.006, 0.002, 0.048, 0.001, 0.007), the level of 6-SM was significantly lower in children with ASD than that of healthy controls ((1.24±0.50) vs. (1.68±0.63)μg/h, t=-5.50, P<0.01), and the total CSHQ score was negatively correlated with the level of 6-SM (r=-0.50, P<0.01). Conclusion The children with ASD were at high risk for sleep problems, and the melatonin metabolite of ASD group was abnormal compared with that of the control group. Moreover, there was a negative correlation between the severity of sleep problems and the level of 6-SM in ASD children. The results of our study indicate that the abnormal melatonin metabolism may be one of the causes of sleep problems in children with ASD.