Objective:To identify different subtypes of patients with preeclampsia(PE)through clinical liver function index data-driven the cluster analysis,to explore the correlation between liver function of different sub-types and pregnancy complications.Methods:From January 2012 to December 2022,the general data of 2230 sin-gleton pregnant women with PE who underwent prenatal examination and delivered in Fujian Maternity and Child Health Hospital were collected.Using 13 liver function indexes before delivery as baseline variables,all included subjects were classified into subtypes by cluster method.The clinical characteristics of different subtypes of PE patients were compared.Single-factor Logistic regression was used to analyze the risk of pregnancy complications among subtypes.Results:PE patients were divided into 3 subgroups that represented different characteristics of patients' liver function.The first subtype(n=1065)exhibited abnormal liver enzymology index characterized by in-creased alkaline phosphatase(ALP)level.The second subtype(n=648)showed abnormal bilirubin metabolism index with the highest levels of total bilirubin(TBIL),direct(DBIL)and indirect bilirubin(IBIL).The third subtype(n=517)had abnormal liver enzymology indexes with elevated alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels,abnormal bile acid detection indexes with elevated total bile acid(TBA)levels,and abnormal liver synthesis function indexes with decreased total protein(TP),albumin(ALB),and globulin lev-els(GLB).Significant differences were observed among the three subtypes in age,severe PE,anemia,cardiac dysfunction,and renal dysfunction(P＜0.05).Single-factor Logistic regression demonstrated that the third sub-type had significantly higher risks of intrahepatic cholestasis of pregnancy,fetal growth restriction,premature rup-ture of membranes,and preterm birth compared to the first and second subtypes(P＜0.05),as well as a higher risk of placental abruption than the second subtype(P＜0.05).The first subtype had higher risks of placental ab-ruption and fetal growth restriction than the second subtype(P＜0.05).Conclusions:Cluster analysis could be used to subclassify PE patients by liver function characteristics,so as to identify the occurrence of pregnancy complications.The results had significance for understanding the heterogeneity of PE and promoting individualized management.

Objective:To identify different subtypes of patients with preeclampsia(PE)through clinical liver function index data-driven the cluster analysis,to explore the correlation between liver function of different sub-types and pregnancy complications.Methods:From January 2012 to December 2022,the general data of 2230 sin-gleton pregnant women with PE who underwent prenatal examination and delivered in Fujian Maternity and Child Health Hospital were collected.Using 13 liver function indexes before delivery as baseline variables,all included subjects were classified into subtypes by cluster method.The clinical characteristics of different subtypes of PE patients were compared.Single-factor Logistic regression was used to analyze the risk of pregnancy complications among subtypes.Results:PE patients were divided into 3 subgroups that represented different characteristics of patients' liver function.The first subtype(n=1065)exhibited abnormal liver enzymology index characterized by in-creased alkaline phosphatase(ALP)level.The second subtype(n=648)showed abnormal bilirubin metabolism index with the highest levels of total bilirubin(TBIL),direct(DBIL)and indirect bilirubin(IBIL).The third subtype(n=517)had abnormal liver enzymology indexes with elevated alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels,abnormal bile acid detection indexes with elevated total bile acid(TBA)levels,and abnormal liver synthesis function indexes with decreased total protein(TP),albumin(ALB),and globulin lev-els(GLB).Significant differences were observed among the three subtypes in age,severe PE,anemia,cardiac dysfunction,and renal dysfunction(P＜0.05).Single-factor Logistic regression demonstrated that the third sub-type had significantly higher risks of intrahepatic cholestasis of pregnancy,fetal growth restriction,premature rup-ture of membranes,and preterm birth compared to the first and second subtypes(P＜0.05),as well as a higher risk of placental abruption than the second subtype(P＜0.05).The first subtype had higher risks of placental ab-ruption and fetal growth restriction than the second subtype(P＜0.05).Conclusions:Cluster analysis could be used to subclassify PE patients by liver function characteristics,so as to identify the occurrence of pregnancy complications.The results had significance for understanding the heterogeneity of PE and promoting individualized management.

Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2022.Methods:The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of national bloodstream infection Bacterial Resistant Investigation Collaborative System（BRICS）were collected during January 2022 to December 2022. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 software were used to analyze the data.Results:During the study period，9 035 strains of Gram-negative bacteria were collected from 51 hospitals，of which 7 895（87.4%）were Enterobacteriaceae and 1 140（12.6%）were non-fermenting bacteria. The top 5 bacterial species were Escherichia coli（ n=4 510，49.9%）， Klebsiella pneumoniae（ n=2 340，25.9%）， Pseudomonas aeruginosa（ n=534，5.9%）， Acinetobacter baumannii complex（ n=405，4.5%）and Enterobacter cloacae（ n=327，3.6%）. The ESBLs-producing rates in Escherichia coli， Klebsiella pneumoniae and Proteus spp. were 47.1%（2 095/4 452），21.0%（427/2 033）and 41.1%（58/141），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（58/4 510）and 13.1%（307/2 340）；62.1%（36/58）and 9.8%（30/307）of CREC and CRKP were resistant to ceftazidime/avibactam combination，respectively. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 59.5%（241/405），while less than 5% of Acinetobacter baumannii complex was resistant to tigecycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 18.4%（98/534）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of main Gram-negative bacteria resistance among different regions，with statistically significant differences in the prevalence of CRKP and CRPA（ χ2=20.489 and 20.252， P<0.001）. The prevalence of CREC，CRKP，CRPA，CRAB，ESBLs-producing Escherichia coli and Klebsiella pneumoniae were higher in provinicial hospitals than those in municipal hospitals（ χ2=11.953，81.183，10.404，5.915，12.415 and 6.459， P<0.01 or <0.05），while the prevalence of CRPA was higher in economically developed regions（per capita GDP ≥ 92 059 Yuan）than that in economically less-developed regions（per capita GDP <92 059 Yuan）（ χ2=6.240， P=0.012）. Conclusions:The proportion of Gram-negative bacteria in bloodstream infections shows an increasing trend，and Escherichia coli is ranked in the top，while the trend of CRKP decreases continuously with time. Decreasing trends are noted in ESBLs-producing Escherichia coli and Klebsiella pneumoniae. Low prevalence of carbapenem resistance in Escherichia coli and high prevalence in CRAB complex have been observed. The composition ratio and antibacterial spectrum of bloodstream infections in different regions of China are slightly different，and the proportion of main drug resistant bacteria in provincial hospitals is higher than those in municipal hospitals.

Objective:To evaluate the diagnostic efficacy and practicality of the Jaundice color card (JCard) as a screening tool for neonatal jaundice.Methods:Following the standards for reporting of diagnostic accuracy studies (STARD) statement, a multicenter prospective study was conducted in 9 hospitals in China from October 2019 to September 2021. A total of 845 newborns who were admitted to the hospital or outpatient department for liver function testing due to their own diseases. The inclusion criteria were a gestational age of ≥35 weeks, a birth weight of ≥2 000 g, and an age of ≤28 days. The neonate′s parents used the JCard to measure jaundice at the neonate′s cheek. Within 2 hours of the JCard measurement, transcutaneous bilirubin (TcB) was measured with a JH20-1B device and total serum bilirubin (TSB) was detected. The Pearson′s correlation analysis, Bland-Altman plots and the receiver operating characteristic (ROC) curve were used for statistic analysis.Results:Out of the 854 newborns, 445 were male and 409 were female; 46 were born at 35-36 weeks of gestational age and 808 were born at ≥37 weeks of gestational age. Additionally, 432 cases were aged 0-3 days, 236 cases were aged 4-7 days, and 186 cases were aged 8-28 days. The TSB level was (227.4±89.6) μmol/L, with a range of 23.7-717.0 μmol/L. The JCard level was (221.4±77.0) μmol/L and the TcB level was (252.5±76.0) μmol/L. Both the JCard and TcB values showed good correlation ( r=0.77 and 0.80, respectively) and agreements (96.0% (820/854) and 95.2% (813/854) of samples fell within the 95% limits of agreement, respectively) with TSB. The JCard value of 12 had a sensitivity of 0.93 and specificity of 0.75 for identifying a TSB ≥205.2?μmol/L, and a sensitivity of 1.00 and specificity of 0.35 for identifying a TSB ≥342.0?μmol/L. The TcB value of 205.2?μmol/L had a sensitivity of 0.97 and specificity of 0.60 for identifying TSB levels of 205.2 μmol/L, and a sensitivity of 1.00 and specificity of 0.26 for identifying TSB levels of 342.0 μmol/L. The areas under the ROC curve (AUC) of JCard for identifying TSB levels of 153.9, 205.2, 256.5, and 342.0 μmol/L were 0.96, 0.92, 0.83, and 0.83, respectively. The AUC of TcB were 0.94, 0.91, 0.86, and 0.87, respectively. There were both no significant differences between the AUC of JCard and TcB in identifying TSB levels of 153.9 and 205.2 μmol/L (both P>0.05). However, the AUC of JCard were both lower than those of TcB in identifying TSB levels of 256.5 and 342.0 μmol/L (both P<0.05). Conclusions:JCard can be used to classify different levels of bilirubin, but its diagnostic efficacy decreases with increasing bilirubin levels. When TSB level are ≤205.2 μmol/L, its diagnostic efficacy is equivalent to that of the JH20-1B. To prevent the misdiagnosis of severe jaundice, it is recommended that parents use a low JCard score, such as 12, to identify severe hyperbilirubinemia (TSB ≥342.0 μmol/L).

Objective Analyze the implementation effects of the specialized disease management policy(hereinafter re-ferred to as the policy)to provide reference for strengthening operational management and enhancing the integration of business and finance in public hospitals.Methods Patient information of inpatients from a large comprehensive tertiary hospital from Jan-uary 2022 to June 2023 was collected.Four out of ten single diseases focused on by the national tertiary public hospital perform-ance assessment were included in the study group for specialized disease management,while the remaining six were used as the control group.A difference-in-differences model was adopted to analyze the changes in relevant indicators such as per capita inpa-tient expenses,average length of stay,per capita drug expenses,per capita consumable expenses,and per capita examination and treatment expenses before and after the policy implementation.Additionally,the effects of policy implementation were further analyzed based on different medical insurance types.Results A total of 22 457 patients were included,with 5 879 patients in the study group(3 164 cases before policy implementation and 2 715 cases after policy implementation),and 19 741 patients in the control group.The difference-in-differences model analysis showed that after the policy implementation,per capita inpatient expenses for specialized disease management patients decreased by 32.7％,average length of stay decreased by 31.4％,drug ex-penses decreased by 49.5％,consumable expenses decreased by 24.2％,and examination and treatment expenses decreased by 29.2％.Moreover,compared to patients under non-Wuhan medical insurance,patients under Wuhan medical insurance experi-enced a greater reduction in related indicators.Conclusion The implementation of the policy effectively reduces the burden on patients seeking medical care,improves medical treatment efficiency,contributes to hospital refined management methods,deep-ens the integration of business and finance,and facilitates the transition towards leaner operations.

Objective:To explore the impact of the early warning model based on UpToDate on the adverse reactions and disease uncertainty of patients receiving AC-T chemotherapy after breast cancer surgery.Methods:Two hundred patients with breast cancer who received AC-T chemotherapy after surgery in Gansu Cancer Hospital from October 2020 to October 2022 were included and randomly divided into control group and observation group(100 cases each).Both groups of patients underwent surgical treatment and received AC-T chemotherapy after surgery.During the treatment period,the control group received routine specialized nursing care,while the observation group received a warning mode based on UpToDate,with continuous intervention for 3 months.The psychological status,Hamilton anxiety scale(HAMA),Hamilton depression rating scale(HAMD),medical uncertainty inventory scale(MUIS),and European Organization for Research and Treatment of Cancer quality of life questionnaire core-30(EORTC-QLQ-C30)scores and adverse reactions between two groups were compared.Results:After 3 months of intervention,the HAMA,HAMD and MUIS scores of the observation group were 14.39±2.70,10.91±2.22 and 66.36±7.55,respectively,which were significantly lower than those of the control group(17.76±4.15,15.62±3.34 and 76.23±10.31,respectively),and the differences were statistically significant(all P＜0.05).The total quality of life score of the observation group was 81.23±13.26,which was higher than that of the control group(73.69±8.45)(P＜0.05).In the symptom scale,the fatigue,malignancy,vomiting,and pain scores of the observation group were 18.75±3.34,24.72±5.18 and 22.26±3.04,respectively,which were lower than those of the control group(29.03±6.07,35.07±8.15 and 28.31±5.16,respectively)(all P＜0.05).In the individual test,the insomnia score of the observation group was 18.65±3.37,which was lower than that of the control group(22.60±5.24)(P＜0.05).The incidence rates of nausea and vomiting,decreased appetite,abdominal pain and diarrhea,and decreased blood cells in the observation group were lower than those in the control group(all P＜0.05).Conclusion:The early warning mode based on UpToDate can improve the psychological status of breast cancer patients receiving chemotherapy after surgery,reduce adverse reactions and the uncertainty of disease,and improve the quality of life.

Objective:To establish a micro kinetic-chromogenic method and verify its feasibility for bacterial endo-toxin testing.Methods:Establish an addition system for micro kinetic-chromogenic lysate reagent with 25 μL and 25 μL sample,respectively.Methodological validation was conducted by examining accuracy and precision,linear-ity and range,minimum detection limit,and reagent durability.Two methods,kinetic-chromogenic method and micro kinetic-chromogenic method,were used to compare the applicability of the method to 39 different varieties.Results:The recovery rates of three doses of 0.03,0.3,and 3.0 EU·mL-1 in six repeated experiments were(96.19±16.68)％,(92.53±10.17)％,and(89.54±25.84)％,respectively.The absolute value of the correlation coefficient(r)for the six standard curves is(0.997 7±0.002 3).When the minimum sensitivity concentration of lysate reagent is 0.01 EU·mL-1,the reaction time is(3 896.0±279.6)s,which is lower than the reaction time of the negative control.The durability test results meet the requirements by two micro kinetic-chromogenic lysate reagents from different manufacturers.The research results on variety adaptability show that the recovery rates of 39 varieties are between 50％and 200％,the effectiveness of the two methods is the same.Conclusion:The accuracy and precision,linearity and range,minimum detection limit,and reagent durability of micro kinetic-chromogenic method all meet the requirements of method validation.The variety applicability is equivalent to that of the traditional kinetic-chromogenic method,so this method can be used for bacterial endotoxin detection of routine samples.

Objective:To explore the impact of the early warning model based on UpToDate on the adverse reactions and disease uncertainty of patients receiving AC-T chemotherapy after breast cancer surgery.Methods:Two hundred patients with breast cancer who received AC-T chemotherapy after surgery in Gansu Cancer Hospital from October 2020 to October 2022 were included and randomly divided into control group and observation group(100 cases each).Both groups of patients underwent surgical treatment and received AC-T chemotherapy after surgery.During the treatment period,the control group received routine specialized nursing care,while the observation group received a warning mode based on UpToDate,with continuous intervention for 3 months.The psychological status,Hamilton anxiety scale(HAMA),Hamilton depression rating scale(HAMD),medical uncertainty inventory scale(MUIS),and European Organization for Research and Treatment of Cancer quality of life questionnaire core-30(EORTC-QLQ-C30)scores and adverse reactions between two groups were compared.Results:After 3 months of intervention,the HAMA,HAMD and MUIS scores of the observation group were 14.39±2.70,10.91±2.22 and 66.36±7.55,respectively,which were significantly lower than those of the control group(17.76±4.15,15.62±3.34 and 76.23±10.31,respectively),and the differences were statistically significant(all P＜0.05).The total quality of life score of the observation group was 81.23±13.26,which was higher than that of the control group(73.69±8.45)(P＜0.05).In the symptom scale,the fatigue,malignancy,vomiting,and pain scores of the observation group were 18.75±3.34,24.72±5.18 and 22.26±3.04,respectively,which were lower than those of the control group(29.03±6.07,35.07±8.15 and 28.31±5.16,respectively)(all P＜0.05).In the individual test,the insomnia score of the observation group was 18.65±3.37,which was lower than that of the control group(22.60±5.24)(P＜0.05).The incidence rates of nausea and vomiting,decreased appetite,abdominal pain and diarrhea,and decreased blood cells in the observation group were lower than those in the control group(all P＜0.05).Conclusion:The early warning mode based on UpToDate can improve the psychological status of breast cancer patients receiving chemotherapy after surgery,reduce adverse reactions and the uncertainty of disease,and improve the quality of life.

Adenosine monophosphate-activated protein kinase(AMPK) is a highly conserved serine/ threonine protein kinase which plays an important role in regulating energy metabolism of the systemic cells. Under stress conditions, such as ischemia and hypoxia, AMPK can be activated.Then it plays a neuroprotective role in regulating mechanisms such as oxidative stress, autophagy, apoptosis and neuroinflammation and so on. Researches have found that chronic cerebral hypoperfusion may be a major cause of vascular cognitive impairment(VCI).AMPK can exert neuroprotective effects on VCI by regulating the aforementioned pathological processes.Therefore, this article reviews the molecular biological characteristics of AMPK and its role and mechanism in VCI, with the aim of promoting further research on AMPK and making it a new target for VCI treatment.

Objective:To establish a micro kinetic-chromogenic method and verify its feasibility for bacterial endo-toxin testing.Methods:Establish an addition system for micro kinetic-chromogenic lysate reagent with 25 μL and 25 μL sample,respectively.Methodological validation was conducted by examining accuracy and precision,linear-ity and range,minimum detection limit,and reagent durability.Two methods,kinetic-chromogenic method and micro kinetic-chromogenic method,were used to compare the applicability of the method to 39 different varieties.Results:The recovery rates of three doses of 0.03,0.3,and 3.0 EU·mL-1 in six repeated experiments were(96.19±16.68)％,(92.53±10.17)％,and(89.54±25.84)％,respectively.The absolute value of the correlation coefficient(r)for the six standard curves is(0.997 7±0.002 3).When the minimum sensitivity concentration of lysate reagent is 0.01 EU·mL-1,the reaction time is(3 896.0±279.6)s,which is lower than the reaction time of the negative control.The durability test results meet the requirements by two micro kinetic-chromogenic lysate reagents from different manufacturers.The research results on variety adaptability show that the recovery rates of 39 varieties are between 50％and 200％,the effectiveness of the two methods is the same.Conclusion:The accuracy and precision,linearity and range,minimum detection limit,and reagent durability of micro kinetic-chromogenic method all meet the requirements of method validation.The variety applicability is equivalent to that of the traditional kinetic-chromogenic method,so this method can be used for bacterial endotoxin detection of routine samples.