Objective To investigate the distribution and antimicrobial resistance profiles of clinical isolates in Xi'an No.3 Hospital from 2019 to 2023.Methods Clinical isolates were collected from January 1,2019 to December 31,2023.Antimicrobial susceptibility testing was carried out according to a unified protocol of China Antimicrobial Resistance Surveillance Network using Kirby-Bauer method or automated systems.The data were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2023.Results A total of 6 621 clinical isolates were collected from 2019 to 2023,including 1 569(23.7％)strains of Gram-positive bacteria and 5 052(76.3％)strains of Gram-negative bacteria.The prevalence of methicillin-resistant S.aureus,S.epidermidis and other Staphylococcus species(except SS.pseudintermedius and S.schleiferi)was 39.0％,62.3％,and 74.4％,respectively.Methicillin-resistant strains showed much higher resistance rates to most of other antimicrobial agents than methicillin-sensitive strains.No Staphylococcus strains were found resistant to vancomycin or linezolid.E.faecium strains demonstrated much higher resistance rates to most antimicrobial agents tested than E.faecalis.The prevalence of linezolid-resistant E.faecalis and vancomycin-resistant E.faecium was 0.9％and 0.4％,respectively.The prevalence of penicillin-nonsusceptible strains(PISP+PRSP)was 5.8％in nonmeningitis S.pneumoniae isolates.The prevalence of ESBL-producing E.coli,K.pneumoniae,and P.mirabilis in Enterobacterales was 48.5％,37.8％,and 47.2％,respectively.Among Enterobacterales strains,K.pneumoniae had the highest resistance rate to imipenem(18.2％)and meropenem(17.9％).Other Enterobacterales were highly sensitive to carbapenems.The resistance rates of P.aeruginosa to imipenem and meropenem were 22.5％and 19.5％,respectively.The resistance rates of A.baumannii to imipenem and meropenem were 65.0％and 71.6％,respectively.Conclusions Antibiotic resistance is still serious in this hospital.Nearly half of the strains of E.coli,K.pneumoniae and P.mirabilis produced ESBLs.K.pneumoniae and A.baumannii showed high resistance rates to carbapenems.Antimicrobial resistance surveillance should be performed appropriately.Relevant departments need to strengthen cooperation to curb the spread of drug-resistant bacteria.

Objective To investigate the distribution and antimicrobial resistance profiles of clinical isolates in Xi'an No.3 Hospital from 2019 to 2023.Methods Clinical isolates were collected from January 1,2019 to December 31,2023.Antimicrobial susceptibility testing was carried out according to a unified protocol of China Antimicrobial Resistance Surveillance Network using Kirby-Bauer method or automated systems.The data were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2023.Results A total of 6 621 clinical isolates were collected from 2019 to 2023,including 1 569(23.7％)strains of Gram-positive bacteria and 5 052(76.3％)strains of Gram-negative bacteria.The prevalence of methicillin-resistant S.aureus,S.epidermidis and other Staphylococcus species(except SS.pseudintermedius and S.schleiferi)was 39.0％,62.3％,and 74.4％,respectively.Methicillin-resistant strains showed much higher resistance rates to most of other antimicrobial agents than methicillin-sensitive strains.No Staphylococcus strains were found resistant to vancomycin or linezolid.E.faecium strains demonstrated much higher resistance rates to most antimicrobial agents tested than E.faecalis.The prevalence of linezolid-resistant E.faecalis and vancomycin-resistant E.faecium was 0.9％and 0.4％,respectively.The prevalence of penicillin-nonsusceptible strains(PISP+PRSP)was 5.8％in nonmeningitis S.pneumoniae isolates.The prevalence of ESBL-producing E.coli,K.pneumoniae,and P.mirabilis in Enterobacterales was 48.5％,37.8％,and 47.2％,respectively.Among Enterobacterales strains,K.pneumoniae had the highest resistance rate to imipenem(18.2％)and meropenem(17.9％).Other Enterobacterales were highly sensitive to carbapenems.The resistance rates of P.aeruginosa to imipenem and meropenem were 22.5％and 19.5％,respectively.The resistance rates of A.baumannii to imipenem and meropenem were 65.0％and 71.6％,respectively.Conclusions Antibiotic resistance is still serious in this hospital.Nearly half of the strains of E.coli,K.pneumoniae and P.mirabilis produced ESBLs.K.pneumoniae and A.baumannii showed high resistance rates to carbapenems.Antimicrobial resistance surveillance should be performed appropriately.Relevant departments need to strengthen cooperation to curb the spread of drug-resistant bacteria.

Objective:To investigate the changes in the severity of mitral regurgitation in patients with large atrial septal defects after surgery.Methods:This study conducted a retrospective analysis using a self-controlled method on 145 patients with secundum atrial septal defects greater than 2 cm who underwent surgical treatment in the Department of Cardiology and Macrovascular Surgery at The First Affiliated Hospital of Anhui Medical University from January 2021 to October 2023. Among these patients, 74 underwent surgical closure, while 71 underwent surgical repair. Data including general information, defect size, number of surgeries of various types, preoperative transthoracic echocardiogram results, and follow-up results from the first and most recent transthoracic echocardiograms after discharge for all patients were collected. The Friedman test was used to compare the degree of mitral regurgitation before surgery and at the first and most recent follow-up after discharge. The differences in the severity of mitral regurgitation in patients before and after surgical treatment were analyzed.Results:Among the 145 patients, there were 25 males and 110 females, with an average age of (36 ± 14) years, height of (163.4 ± 8.2) cm, and body weight of (59.5 ± 10.5) kg. The diameter of the defect was (2.49 ± 0.35) cm. Before surgery, the severity of mitral regurgitation was classified as none, mild, and moderate (including mild to moderate) for 57 patients (39.3%), 83 patients (57.2%), and 5 patients (3.4%), respectively. The average follow-up duration was (324 ± 153) days. At the first follow-up after discharge, the severity of mitral regurgitation was none, mild, and moderate for 50 patients (34.5%), 87 patients (60.0%), and 8 patients (5.5%), respectively. At the most recent follow-up after discharge, the severity of mitral regurgitation was none, mild, and moderate for 30 patients (20.7%), 89 patients (61.4%), and 26 patients (17.9%), respectively. Compared with the preoperative severity of mitral regurgitation, the most recent follow-up showed worsening in 65 patients (44.8%) and improvement in 22 patients (15.2%). The mean rank sums for the three degrees of mitral regurgitation were 1.83, 1.91, and 2.26, with a statistically significant difference ( χ2 = 25.36, P = 0.001). Pairwise comparisons indicated that the most recent follow-up after discharge showed worsening compared with the preoperative severity of mitral regurgitation ( P < 0.05) and that it also worsened compared with the first follow-up after discharge ( P < 0.05). Conclusions:In patients with secundum atrial septal defects greater than 2 cm, undergoing surgery solely for atrial septal defects may result in the potential worsening of mitral regurgitation after the procedure.

Objective:To investigate the changes in the severity of mitral regurgitation in patients with large atrial septal defects after surgery.Methods:This study conducted a retrospective analysis using a self-controlled method on 145 patients with secundum atrial septal defects greater than 2 cm who underwent surgical treatment in the Department of Cardiology and Macrovascular Surgery at The First Affiliated Hospital of Anhui Medical University from January 2021 to October 2023. Among these patients, 74 underwent surgical closure, while 71 underwent surgical repair. Data including general information, defect size, number of surgeries of various types, preoperative transthoracic echocardiogram results, and follow-up results from the first and most recent transthoracic echocardiograms after discharge for all patients were collected. The Friedman test was used to compare the degree of mitral regurgitation before surgery and at the first and most recent follow-up after discharge. The differences in the severity of mitral regurgitation in patients before and after surgical treatment were analyzed.Results:Among the 145 patients, there were 25 males and 110 females, with an average age of (36 ± 14) years, height of (163.4 ± 8.2) cm, and body weight of (59.5 ± 10.5) kg. The diameter of the defect was (2.49 ± 0.35) cm. Before surgery, the severity of mitral regurgitation was classified as none, mild, and moderate (including mild to moderate) for 57 patients (39.3%), 83 patients (57.2%), and 5 patients (3.4%), respectively. The average follow-up duration was (324 ± 153) days. At the first follow-up after discharge, the severity of mitral regurgitation was none, mild, and moderate for 50 patients (34.5%), 87 patients (60.0%), and 8 patients (5.5%), respectively. At the most recent follow-up after discharge, the severity of mitral regurgitation was none, mild, and moderate for 30 patients (20.7%), 89 patients (61.4%), and 26 patients (17.9%), respectively. Compared with the preoperative severity of mitral regurgitation, the most recent follow-up showed worsening in 65 patients (44.8%) and improvement in 22 patients (15.2%). The mean rank sums for the three degrees of mitral regurgitation were 1.83, 1.91, and 2.26, with a statistically significant difference ( χ2 = 25.36, P = 0.001). Pairwise comparisons indicated that the most recent follow-up after discharge showed worsening compared with the preoperative severity of mitral regurgitation ( P < 0.05) and that it also worsened compared with the first follow-up after discharge ( P < 0.05). Conclusions:In patients with secundum atrial septal defects greater than 2 cm, undergoing surgery solely for atrial septal defects may result in the potential worsening of mitral regurgitation after the procedure.

Based on the traditional Chinese medicine （TCM） theories of holism， syndrome differentiation and treatment， and preventive treatment of disease， the concept of whole course management of tumors throughout the treatment process is advocated. The strategy includes preventive treatment before tumor therapy， focusing on protecting the body's vital qi and strengthening the spleen and Qi. TCM formulas such as Sijunzi Decoction （四君子汤）， Shenling Baizhu San （参苓白术散） and Xiangsha Liujunzi Decoction（香砂六君子汤） are used to enhance platelet reserves. The main therapeutic methods during tumor conventional therapy include preventing disease transformation and strengthening vital qi to eliminate pathogenic factor， by invigorating spleen and soothing liver， nourishing liver and kidney， purging fire for removing toxin， and removing blood stasis for promoting tissue regeneration. TCM formulas such as Xiangsha Liujunzi Decoction （香砂六君子汤）， Shenling Baizhu Powder （参苓白术散）， Fuzi Lizhong Decoction （附子理中汤）， Zhibai Dihuang Decoction （知柏地黄汤）， and Qiangen Powder （茜根散）are used to reduce platelet destruction and depletion during tumor therapy and reverse the worsening trend. After tumor conventional therapy， the focus is on preventing relapse， adjusting the balance of Yin and Yang， by nourishing the kidneys， spleen， and lungs. TCM formulas such as Dingkun Pill （定坤丹）and Zuogui Pill （左归丸） are used with modifications to prevent thrombocytopenia. The staged prevention and treatment of tumor treatment-induced thrombocytopenia using TCM can maximize the benefits for patients.

Objective:To investigate the relationship between plasma beta-2 microglobulin(β2M)levels and the total magnetic resonance imaging(MRI)burden of cerebral small-vessel disease(CSVD)in elderly patients with lacunar stroke.Methods:A total of 93 elderly patients with lacunar stroke admitted to the Department of Neurology, Changzhou Second People's Hospital form August 2018 to August 2019 were enrolled retrospectively, all with complete records of cranial magnetic resonance imaging and plasma β2M measurement.According to the total MRI CSVD burden, which ranges from an ordinal score of 0 to 4, patients were divided into 5 groups.Single-factor analysis was used to compare clinical data between the 5 groups.The association between the plasma β2M level and total MRI CSVD burden was analyzed by ordered multiple Logistic regression models.Results:Among elderly patients with lacunar infarction, 19 had a CSVD score of 0, 19 had a score of 1, 23 had a score of 2, 21 had a score of 3, and 11 had a score of 4, with statistically significant differences in age, percentage with diabetes, systolic blood pressure, diastolic blood pressure, glycosylated hemoglobin, plasma β2M, and eGFR between the 5 groups( P<0.05). Spearman correlation analysis showed that plasma β2M level was significantly positively correlated with total MRI CSVD burden( r=0.687, P<0.001). In ordered multivariate logistic regression models, after adjustment for possible confounding factors such as age, sex and hypertension, the results demonstrated that plasma β2M level( OR=5.253, 95% CI: 2.350-11.740, P<0.001)was an independent risk factor for total MRI CSVD burden. Conclusions:In elderly lacunar stroke patients, the plasma β2M level is closely related to the total MRI CSVD burden and can be used as a marker for predicting the severity of lesions.

Objective: To learn the temporal and spatial distribution of abnormalalanine aminotransferase（ALT）and its influencing factorsamong candidates for the high school entrance examination in Beijing,and to provide evidence for prevention of abnormal ALT in adolescents. Methods: The physical examination data of the candidates in Beijing from 2009 to 2018 were collected from Beijing Physical Examination Center. The time,space and population distribution of abnormal ALT was analyzed;the time-space interaction trend of abnormal ALT was described by bubble map;and the Bayesian spatio-temporal model was built to explore the influencing factors of abnormal ALT in middle school students. Results: Among 884 915 candidates,5 354 candidates had abnormal ALT,accounting for 0.61%. The rate of abnormal ALT showed an upward trend from 2009 to 2018（P<0.05）.The rate of abnormal ALT was 0.95% in males and 0.23% in females,5.09% in obese candidates and 0.18% in non-obese ones,0.70% in urban area and 0.48% in rural area,and the differences between gender,obesity and residence were all statistically significant（P<0.05）. From 2009 to 2018,the rates of abnormal ALT among the candidates in Changping District remained the highest;the rate in Shunyi District and Daxing District showed an increasing trend;the rates in Haidian District,Chaoyang District and Fengtai District were relatively high,the rates in Miyun District and Pinggu District were relatively low,while the trend of them were not obvious. The results of the Bayesian space-time model showed that the risk of abnormal ALT increased by 5.706 times for each unit increase of regional male percentage and increased by 8.679 times for each unit increase of regional obesity percentage. Conclusion The rate of abnormal ALT among candidates for the high school entrance examination in Beijing shows a upward trend. The rates of abnormal ALT among the candidates in Changping District,Haidian District,Chaoyang District and Fengtai District are relatively high,and the rates in Shunyi District and Daxing District tend to rise. Males and obese students are the high risk groups of abnormal ALT.

Objective: To investigate the protective effect and potential mechanism of tanshinol borneol ester (TBE) on homocysteine(Hcy) induced rat bone marrow mesenchymal stem cells (BMSCs) damage. Methods: BMSCs were isolated and cultured in vitro by density gradient centrifugation and adherent culture method. BMSCs were divided into the control (normal isolation and culture), TBE-1(10 μmol/L TBE-1 solution with 100 μl), TBE-2 (10 μmol/L TBE-2 solution with 100 μl), Hcy (0.5 mmol/L Hcy solution with 100 μl), Hcy + TBE-1(0.5 mmol/L Hcy solution with 100 μl, and 10 μmol/L TBE-1 solution with 100 μl), Hcy + TBE-2 (0.5 mmol/L Hcy solution with 100 μl, and 10 μmol/L TBE-2 solution with 100 μl), Hcy+ TBE-1+ inhibitor group(0.5 mmol/L Hcy solution with 100 μl, 10 μmol/L TBE-1 solution with 100 μl, and 25 μmol/L LY294002(specific blocker of phosphatidylinositol 3 kinase) solution with 100 μl), Hcy+ TBE-2+ inhibitor group(0.5 mmol/L Hcy solution with 100 μl, 10 μmol/L TBE-2 solution with 100 μl, and 25 μmol/L LY294002 solution with 100 μl). Cell proliferation activity was detected by MTT assay. The T-SOD activity and malonaldehyde level of cells were measured by anthineoxidase method and TBA method, respectively, to evaluate cell oxidative and antioxidative activities. The ultrastructure of cells was observed under transmission electron microscope. The expression level of PKB and NF-κB of cells in various groups were detected with the immunocytochemical method. Results: (1)Cell proliferation activity in TBE-1 group and TBE-2 group was significantly increased compared with the control group (both P<0.01), and was similar between TBE-1 group and TBE-2 groups after 1, 12, 24 and 48 hours treatment.(2)The T-SOD activity in TBE-1 group and TBE-2 group was significantly higher than in control group (both P<0.01), while it was significantly lower in Hcy group, Hcy+ TBE-1 group, and Hcy+ TBE-2 group than in control group(all P<0.01), and was similar between control group, Hcy+ TBE-1+ inhibitor group, and Hcy+ TBE-2+ inhibitor group(all P>0.05). The T-SOD activity was higher in Hcy+ TBE-1 group and Hcy+ TBE-2 group than in Hcy group(both P<0.01), and was higher in Hcy+ TBE-1+ inhibitor group than in Hcy+ TBE-1 group(P<0.05) and was higher in Hcy+ TBE-2+ inhibitor group than in Hcy+ TBE-2 group(P<0.05). The malonaldehyde level was lower in TBE-1 group and TBE-2 group than in control group(both P<0.01), was higher in Hcy group, Hcy+ TBE-1 group, Hcy+ TBE-2 group, Hcy+ TBE-1+ inhibitor group, and Hcy+ TBE-2+ inhibitor group than in control group(all P<0.01), was lower in Hcy+ TBE-1 group and Hcy+ TBE-2 group than in Hcy group(both P<0.01), was higher in Hcy+ TBE-1+ inhibitor group than in Hcy+ TBE-1 group(P<0.05), was higher in Hcy+ TBE-2+ inhibitor group than in Hcy+ TBE-2 group(P<0.05). (3)Under electron microscope, BMSCs showed profound swelling, senescence and apoptosis of cells increased significantly in Hcy group, Hcy+ TBE-1+ inhibitor group, and Hcy+ TBE-2+ inhibitor group when compared with control group. BMSCs in the TBE-1 and TBE-2 groups presented with abundant rough endoplasmic reticulum, and very active cell metabolism signs. Compared with Hcy group, BMSCs edema, the number of aging and apoptotic cells, and cell injury severity were significantly less in TBE-1+ Hcy group and TBE-2+ Hcy. (4)The PKB level was higher in TBE-1 group and TBE-2 group than in control group(both P<0.01), was lower in Hcy group, Hcy+ TBE-2 group, Hcy+ TBE-1+ inhibitor group, and Hcy+ TBE-2+ inhibitor group than in control group(all P<0.01), was similar between control group and Hcy+ TBE-1 group(P>0.05), was higher in Hcy+ TBE-1 group and Hcy+ TBE-2 group than in Hcy group(both P<0.05), was lower in Hcy+ TBE-1+ inhibitor group than in Hcy+ TBE-1 group(P<0.05), and was lower in Hcy+ TBE-2+ inhibitor group than in Hcy+ TBE-2 group(P<0.05). The NF-κB level was higher in TBE-1 group and TBE-2 group than in control group(both P<0.01), was lower in Hcy group, Hcy+ TBE-1 group, Hcy+ TBE-2 group, Hcy+ TBE-1+ inhibitor group, and Hcy+ TBE-2+ inhibitor group than in control group(P<0.01 or 0.05), was higher in Hcy+ TBE-1 group and Hcy+ TBE-2 group than in Hcy group(both P<0.05), was lower in Hcy+ TBE-1+ inhibitor group than in Hcy+ TBE-1 group(P<0.05) and was lower in Hcy+ TBE-2+ inhibitor group than in Hcy+ TBE-2 group(P<0.05). Conclusion Tanshinol borneol ester can promote the proliferation of BMSC, and attenuate the homocysteine induced rat BMSCs damage possibly through activation of phosphatidylinositol 3 kinase/PKB signal transduction and its downstream signal pathway protein NF-κB.

Authors of the paper analyzed the motivation of building the healthy town,and interrelated the scientific aspects of such a town. It was found that this town of diversified resources and advantages had become small but beautiful,special and strong clustering and convergent by means of collecting high-end factors, selecting of essential health businesses and constructing an ecosystem of health industry clusters. Based on a definition of the government role,the paper described the innovation of health policy in view of policy supply.

Described in the paper is the reform made at public hospitals in Zhejiang province,with analysis of its problems and causes. Based on such,the authors proposed the following actions:to accelerate the reform of public hospitals centering on health promotion, and encourage such hospitals to shoulder the health care responsibility on behalf of the government; to proceed with hierarchical medical system and contract-based service focusing on capacity building of general practitioners; to attract private capital into building the healthcare system; and to motivate non-governmental organizations to cater to diversified healthcare needs of the people.