Background and purpose:Tumor microangiogenesis is an important basis for tumor growth and metastasis,and its characteristics include angiogenesis,increased vascular permeability and abnormal capillary structure.Microangiogenesis not only affects the blood supply and metabolism of tumor,but also is directly related to the invasion,prognosis and treatment response of tumor.Dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)is a non-invasive imaging technique.By quantitatively analyzing the distribution and dynamic changes of contrast agents in tumor tissues,it can reflect the microvascular density(MVD),permeability and blood perfusion of tumors.The purpose of this study was to further clarify the application value of DCE-MRI in the diagnosis and treatment of rectal cancer by in-depth analysis of the relationship between quantitative analysis parameters of rectal cancer and microangiogenesis,and to promote the popularization and optimization of this technology in clinical practice.Methods:A total of 348 patients with rectal cancer who were scheduled for surgical treatment in Xinxiang Central Hospital from January 2021 to June 2024 were selected,and rectal cancer tissue specimens and adjacent tissues(＞5 cm away from tumor margin)were collected.This study was approved by the medical ethics committee of Xinxiang Central Hospital(approval number:2021-144-01K).The quantitative analysis parameters of DCE-MRI[Rate constant(Kep),volume transport constant(Ktrans),volume fraction of contrast agent in extracellular space(VE)]and MVD in cancer tissues and adjacent tissues were compared.The quantitative analysis parameters and MVD of DCE-MRI in rectal cancer patients with different differentiation degrees and clinical stages were compared.Spearman correlation was used to analyze the correlation between DCE-MRI parameters and differentiation degree,clinical stage and MVD in patients with rectal cancer.Results:The values of Kep value,Ktrans value,Ve value and MVD were higher in rectal cancer tissues than in adjacent tissues(P＜0.05).The Kep value,Ktrans value,Ve value and MVD of patients with low differentiated and middle differentiated rectal cancer were higher than those of patients with high differentiated rectal cancer(P＜0.05).The values of Kep value,Ktrans value,Ve value and MVD of patients with low differentiated rectal cancer were higher than those of patients with middle differentiated rectal cancer(P＜0.05).The Kep value,Ktrans value,Ve value and MVD of patients with stage Ⅱ,Ⅲ and Ⅳrectal cancer were higher than those of patients with stage Ⅰ rectal cancer(P＜0.05).The Kep value,Ktrans value,Ve value and MVD of patients with stage Ⅲ and Ⅳ rectal cancer were higher than those of patients with stage Ⅱ rectal cancer(P＜0.05).The Kep value,Ktrans value,Ve value and MVD of patients with stage Ⅳ rectal cancer were higher than those of patients with stage Ⅲ rectal cancer(P＜0.05).The Kep value,Ktrans value and Ve value of rectal cancer patients were negatively correlated with the differentiation degree(r=-0.683,-0.743,-0.721,P＜0.05).The Kep value,Ktrans value and Ve value of rectal cancer patients were positively correlated with clinical stage(r=0.764,0.703,0.814,P＜0.05).The Kep value,Ktrans value and Ve value of rectal cancer patients were positively correlated with MVD(r=0.812,0.754,0.835,P＜0.05).Conclusion:DCE-MRI parameters are related to the differentiation degree,clinical stage and microangiogenesis of rectal cancer.

Objective To investigate the antimicrobial resistance of clinical isolates from elderly patients(≥65 years)in major medical institutions across China.Methods Bacterial strains were isolated from elderly patients in 52 hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program during the period from 2015 to 2021.Antimicrobial susceptibility test was carried out by disk diffusion method and automated systems according to the same CHINET protocol.The data were interpreted in accordance with the breakpoints recommended by the Clinical and Laboratory Standards Institute(CLSI)in 2021.Results A total of 514 715 nonduplicate clinical isolates were collected from elderly patients in 52 hospitals from January 1,2015 to December 31,2021.The number of isolates accounted for 34.3％of the total number of clinical isolates from all patients.Overall,21.8％of the 514 715 strains were gram-positive bacteria,and 78.2％were gram-negative bacteria.Majority(90.9％)of the strains were isolated from inpatients.About 42.9％of the strains were isolated from respiratory specimens,and 22.9％were isolated from urine.More than half(60.7％)of the strains were isolated from male patients,and 39.3％isolated from females.About 51.1％of the strains were isolated from patients aged 65-＜75 years.The prevalence of methicillin-resistant strains(MRSA)was 38.8％in 32 190 strains of Staphylococcus aureus.No vancomycin-or linezolid-resistant strains were found.The resistance rate of E.faecalis to most antibiotics was significantly lower than that of Enterococcus faecium,but a few vancomycin-resistant strains(0.2％,1.5％)and linezolid-resistant strains(3.4％,0.3％)were found in E.faecalis and E.faecium.The prevalence of penicillin-susceptible S.pneumoniae(PSSP),penicillin-intermediate S.pneumoniae(PISP),and penicillin-resistant S.pneumoniae(PRSP)was 94.3％,4.0％,and 1.7％in nonmeningitis S.pneumoniae isolates.The resistance rates of Klebsiella spp.(Klebsiella pneumoniae 93.2％)to imipenem and meropenem were 20.9％and 22.3％,respectively.Other Enterobacterales species were highly sensitive to carbapenem antibiotics.Only 1.7％-7.8％of other Enterobacterales strains were resistant to carbapenems.The resistance rates of Acinetobacter spp.(Acinetobacter baumannii 90.6％)to imipenem and meropenem were 68.4％and 70.6％respectively,while 28.5％and 24.3％of P.aeruginosa strains were resistant to imipenem and meropenem,respectively.Conclusions The number of clinical isolates from elderly patients is increasing year by year,especially in the 65-＜75 age group.Respiratory tract isolates were more prevalent in male elderly patients,and urinary tract isolates were more prevalent in female elderly patients.Klebsiella isolates were increasingly resistant to multiple antimicrobial agents,especially carbapenems.Antimicrobial resistance surveillance is helpful for accurate empirical antimicrobial therapy in elderly patients.

Objective:To investigate whether herb cake-insulated moxibustion affects the expression of cholesterol metabolism-related protein 3-hydroxy-3-methylglutaryl coenzyme A reductase(HMGR)and inhibits the development of atherosclerosis by regulating the exosomal miR-223 expression.Methods:Thirty-six male New Zealand rabbits were randomly assigned to a normal group,a model group,and an herb cake-insulated moxibustion group,with 12 rabbits in each group.The model and the herb cake-insulated moxibustion groups were fed a high-fat diet for 8 weeks to induce an atherosclerosis model.Following successful modeling,the herb cake-insulated moxibustion group was subjected to bundling and herb cake-insulated moxibustion intervention,while the other two groups were subjected only to bundling without moxibustion.After 8 weeks of intervention,hematoxylin-eosin(HE)staining was used to observe aortic morphology;the serum levels of total cholesterol(TC),triglyceride(TG),and low-density lipoprotein cholesterol(LDL-C)were detected using an automatic biochemical analyzer in each group.Exosome morphology was observed using the transmission electron microscope;Western blotting(WB)was used to detect the protein levels of serum exosomal CD63 and CD9 markers,as well as liver HMGR;additionally,real-time fluorescence quantitative polymerase chain reaction was used to quantify serum exosomal miR-223.Results:HE staining showed thickened aortic intima,lipid infiltration,foam cell aggregation,and structural damage to the arterial wall in the model group.Meanwhile,after modeling,the serum levels of LDL-C,TC,and TG increased significantly in the model and herb cake-insulated moxibustion groups compared to the normal group(P<0.05),suggesting successful atherosclerosis rabbit model preparation.The serum exosomes of rabbits in the model group exhibited a saucer-like or semi-concave spherical shape with diameters of 120-150 nm.WB detection results showed positive expression of the exosomal markers CD63 and CD9.After 8 weeks of intervention,the miR-223 level in the model group was significantly lower than that in the normal group(P<0.01).In contrast,the herb cake-insulated moxibustion group demonstrated significantly reduced serum levels of TC,TG,and LDL-C(P<0.05),increased miR-223 expression(P<0.01),and decreased relative liver HMGR protein expression(P<0.05)compared to the model group.Conclusion:Herb cake-insulated moxibustion may alleviate the progression of atherosclerosis by up-regulating exosomal miR-223 expression and down-regulating HMGR protein expression,thereby inhibiting cholesterol anabolic metabolism.

Objective To examine the changing prevalence and antimicrobial resistance profiles of Burkholderia cepacia in 52 hospitals across China from 2015 to 2021.Methods A total of 9 261 strains of B.cepacia were collected from 52 hospitals between January 1,2015 and December 31,2021.Antimicrobial susceptibility of the strains was tested using Kirby-Bauer method or automated antimicrobial susceptibility testing systems according to a unified protocol.The results were interpreted according to the breakpoints released in the Clinical & Laboratory Standards Institute(CLSI)guidelines(2023 edition).Results A total of 9 261 strains of B.cepacia were isolated from all age groups,especially elderly patients.The proportion was 11.1％(1 032 strains)in children,significantly lower than the proportion in adults.About half(46.5％,4 310/9 261)of the strains were isolated from patients at least 60 years old and 42.3％(3 919/9 261)of the strains were isolated from young adults.Most isolates(71.1％)were isolated from sputum and respiratory secretions,followed by urine(10.7％)and blood samples(8.1％).B.cepacia isolates were highly susceptible to the five antimicrobial agents recommended in the CLSI M100 document(33rd edition,2023).B.cepacia isolates showed relatively higher resistance rates to meropenem and levofloxacin.However,the resistance rates to ceftazidime,trimethoprim-sulfamethoxazole,and minocycline remained below 8.1％.The percentage of B.cepacia strains resistant to levofloxacin was the highest compared to other antibiotics in any of the three age groups(from 12.4％in the patients＜18 years old to 20.6％in the patients aged 60 years or older).Conclusions B.cepacia is one of the clinically important non-fermenting gram-negative bacteria.Accurate and timely reporting of antimicrobial susceptibility test results and ongoing antimicrobial resistance surveillance are helpful for rational prescription of antimicrobial agents and proper prevention and control of nosocomial infections.

Objective:To explore the current status and latent profiles of home care needs among caregivers of post-stroke dysphagia (PSD) patients, providing evidence for precision nursing interventions.Methods:Caregivers of PSD patients hospitalized at Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine were selected as the study subjects through convenience sampling from December 2022 to December 2023. A cross-sectional survey was conducted through General Information Questionnaire for PSD Patients and Caregivers, Caregiver Competence Questionnaire for Dysphagia Patients, Zarit Caregiver Burden Interview, and Home Care Needs Scale for Primary Caregivers of Stroke Patients. Latent categories of home care needs among PSD patients' caregivers were identified through latent profile analysis. Influencing factors of latent categories were explored based on univariate analysis and multivariable logistic regression.Results:A total of 168 questionnaires were distributed, with 162 valid questionnaires recovered, yielding an effective response rate of 96.42%. Among the 162 patients, 82 were male and 80 were female, with an age of 78(68, 84) years.Among the 162 caregivers, 51 were male and 111 were female, with an age of 60(52, 68) years. The score of home care needs for primary caregivers was (89.89 ± 15.75) points. Based on the level of home care needs, caregivers were divided into four latent categories: skilled type-low demand, balanced type-medium demand, unfamiliar type-high demand, skilled type - high demand, accounting for 32.1%(52/162), 40.1%(65/162), 8.7%(14/162), and 19.1%(31/162), respectively. Whether the patient had pneumonia, caregiver gender, and caregiver education level were found as influencing factors for home care needs through multivariate Logistic regression analysis ( OR values were 0.10 to 13.88, all P<0.05). Conclusions:The home care needs of caregivers for PSD patients are at a moderate-to-high level and exhibit heterogeneity. Clinical nursing staff should implement targeted interventions to promote the recovery of PSD patients based on caregivers' categorical characteristics

Objective To examine the changing prevalence and antimicrobial resistance profiles of Burkholderia cepacia in 52 hospitals across China from 2015 to 2021.Methods A total of 9 261 strains of B.cepacia were collected from 52 hospitals between January 1,2015 and December 31,2021.Antimicrobial susceptibility of the strains was tested using Kirby-Bauer method or automated antimicrobial susceptibility testing systems according to a unified protocol.The results were interpreted according to the breakpoints released in the Clinical & Laboratory Standards Institute(CLSI)guidelines(2023 edition).Results A total of 9 261 strains of B.cepacia were isolated from all age groups,especially elderly patients.The proportion was 11.1％(1 032 strains)in children,significantly lower than the proportion in adults.About half(46.5％,4 310/9 261)of the strains were isolated from patients at least 60 years old and 42.3％(3 919/9 261)of the strains were isolated from young adults.Most isolates(71.1％)were isolated from sputum and respiratory secretions,followed by urine(10.7％)and blood samples(8.1％).B.cepacia isolates were highly susceptible to the five antimicrobial agents recommended in the CLSI M100 document(33rd edition,2023).B.cepacia isolates showed relatively higher resistance rates to meropenem and levofloxacin.However,the resistance rates to ceftazidime,trimethoprim-sulfamethoxazole,and minocycline remained below 8.1％.The percentage of B.cepacia strains resistant to levofloxacin was the highest compared to other antibiotics in any of the three age groups(from 12.4％in the patients＜18 years old to 20.6％in the patients aged 60 years or older).Conclusions B.cepacia is one of the clinically important non-fermenting gram-negative bacteria.Accurate and timely reporting of antimicrobial susceptibility test results and ongoing antimicrobial resistance surveillance are helpful for rational prescription of antimicrobial agents and proper prevention and control of nosocomial infections.

Background and purpose:Tumor microangiogenesis is an important basis for tumor growth and metastasis,and its characteristics include angiogenesis,increased vascular permeability and abnormal capillary structure.Microangiogenesis not only affects the blood supply and metabolism of tumor,but also is directly related to the invasion,prognosis and treatment response of tumor.Dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)is a non-invasive imaging technique.By quantitatively analyzing the distribution and dynamic changes of contrast agents in tumor tissues,it can reflect the microvascular density(MVD),permeability and blood perfusion of tumors.The purpose of this study was to further clarify the application value of DCE-MRI in the diagnosis and treatment of rectal cancer by in-depth analysis of the relationship between quantitative analysis parameters of rectal cancer and microangiogenesis,and to promote the popularization and optimization of this technology in clinical practice.Methods:A total of 348 patients with rectal cancer who were scheduled for surgical treatment in Xinxiang Central Hospital from January 2021 to June 2024 were selected,and rectal cancer tissue specimens and adjacent tissues(＞5 cm away from tumor margin)were collected.This study was approved by the medical ethics committee of Xinxiang Central Hospital(approval number:2021-144-01K).The quantitative analysis parameters of DCE-MRI[Rate constant(Kep),volume transport constant(Ktrans),volume fraction of contrast agent in extracellular space(VE)]and MVD in cancer tissues and adjacent tissues were compared.The quantitative analysis parameters and MVD of DCE-MRI in rectal cancer patients with different differentiation degrees and clinical stages were compared.Spearman correlation was used to analyze the correlation between DCE-MRI parameters and differentiation degree,clinical stage and MVD in patients with rectal cancer.Results:The values of Kep value,Ktrans value,Ve value and MVD were higher in rectal cancer tissues than in adjacent tissues(P＜0.05).The Kep value,Ktrans value,Ve value and MVD of patients with low differentiated and middle differentiated rectal cancer were higher than those of patients with high differentiated rectal cancer(P＜0.05).The values of Kep value,Ktrans value,Ve value and MVD of patients with low differentiated rectal cancer were higher than those of patients with middle differentiated rectal cancer(P＜0.05).The Kep value,Ktrans value,Ve value and MVD of patients with stage Ⅱ,Ⅲ and Ⅳrectal cancer were higher than those of patients with stage Ⅰ rectal cancer(P＜0.05).The Kep value,Ktrans value,Ve value and MVD of patients with stage Ⅲ and Ⅳ rectal cancer were higher than those of patients with stage Ⅱ rectal cancer(P＜0.05).The Kep value,Ktrans value,Ve value and MVD of patients with stage Ⅳ rectal cancer were higher than those of patients with stage Ⅲ rectal cancer(P＜0.05).The Kep value,Ktrans value and Ve value of rectal cancer patients were negatively correlated with the differentiation degree(r=-0.683,-0.743,-0.721,P＜0.05).The Kep value,Ktrans value and Ve value of rectal cancer patients were positively correlated with clinical stage(r=0.764,0.703,0.814,P＜0.05).The Kep value,Ktrans value and Ve value of rectal cancer patients were positively correlated with MVD(r=0.812,0.754,0.835,P＜0.05).Conclusion:DCE-MRI parameters are related to the differentiation degree,clinical stage and microangiogenesis of rectal cancer.

Objective To investigate the antimicrobial resistance of clinical isolates from elderly patients(≥65 years)in major medical institutions across China.Methods Bacterial strains were isolated from elderly patients in 52 hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program during the period from 2015 to 2021.Antimicrobial susceptibility test was carried out by disk diffusion method and automated systems according to the same CHINET protocol.The data were interpreted in accordance with the breakpoints recommended by the Clinical and Laboratory Standards Institute(CLSI)in 2021.Results A total of 514 715 nonduplicate clinical isolates were collected from elderly patients in 52 hospitals from January 1,2015 to December 31,2021.The number of isolates accounted for 34.3％of the total number of clinical isolates from all patients.Overall,21.8％of the 514 715 strains were gram-positive bacteria,and 78.2％were gram-negative bacteria.Majority(90.9％)of the strains were isolated from inpatients.About 42.9％of the strains were isolated from respiratory specimens,and 22.9％were isolated from urine.More than half(60.7％)of the strains were isolated from male patients,and 39.3％isolated from females.About 51.1％of the strains were isolated from patients aged 65-＜75 years.The prevalence of methicillin-resistant strains(MRSA)was 38.8％in 32 190 strains of Staphylococcus aureus.No vancomycin-or linezolid-resistant strains were found.The resistance rate of E.faecalis to most antibiotics was significantly lower than that of Enterococcus faecium,but a few vancomycin-resistant strains(0.2％,1.5％)and linezolid-resistant strains(3.4％,0.3％)were found in E.faecalis and E.faecium.The prevalence of penicillin-susceptible S.pneumoniae(PSSP),penicillin-intermediate S.pneumoniae(PISP),and penicillin-resistant S.pneumoniae(PRSP)was 94.3％,4.0％,and 1.7％in nonmeningitis S.pneumoniae isolates.The resistance rates of Klebsiella spp.(Klebsiella pneumoniae 93.2％)to imipenem and meropenem were 20.9％and 22.3％,respectively.Other Enterobacterales species were highly sensitive to carbapenem antibiotics.Only 1.7％-7.8％of other Enterobacterales strains were resistant to carbapenems.The resistance rates of Acinetobacter spp.(Acinetobacter baumannii 90.6％)to imipenem and meropenem were 68.4％and 70.6％respectively,while 28.5％and 24.3％of P.aeruginosa strains were resistant to imipenem and meropenem,respectively.Conclusions The number of clinical isolates from elderly patients is increasing year by year,especially in the 65-＜75 age group.Respiratory tract isolates were more prevalent in male elderly patients,and urinary tract isolates were more prevalent in female elderly patients.Klebsiella isolates were increasingly resistant to multiple antimicrobial agents,especially carbapenems.Antimicrobial resistance surveillance is helpful for accurate empirical antimicrobial therapy in elderly patients.

Objective:To investigate whether herb cake-insulated moxibustion affects the expression of cholesterol metabolism-related protein 3-hydroxy-3-methylglutaryl coenzyme A reductase(HMGR)and inhibits the development of atherosclerosis by regulating the exosomal miR-223 expression.Methods:Thirty-six male New Zealand rabbits were randomly assigned to a normal group,a model group,and an herb cake-insulated moxibustion group,with 12 rabbits in each group.The model and the herb cake-insulated moxibustion groups were fed a high-fat diet for 8 weeks to induce an atherosclerosis model.Following successful modeling,the herb cake-insulated moxibustion group was subjected to bundling and herb cake-insulated moxibustion intervention,while the other two groups were subjected only to bundling without moxibustion.After 8 weeks of intervention,hematoxylin-eosin(HE)staining was used to observe aortic morphology;the serum levels of total cholesterol(TC),triglyceride(TG),and low-density lipoprotein cholesterol(LDL-C)were detected using an automatic biochemical analyzer in each group.Exosome morphology was observed using the transmission electron microscope;Western blotting(WB)was used to detect the protein levels of serum exosomal CD63 and CD9 markers,as well as liver HMGR;additionally,real-time fluorescence quantitative polymerase chain reaction was used to quantify serum exosomal miR-223.Results:HE staining showed thickened aortic intima,lipid infiltration,foam cell aggregation,and structural damage to the arterial wall in the model group.Meanwhile,after modeling,the serum levels of LDL-C,TC,and TG increased significantly in the model and herb cake-insulated moxibustion groups compared to the normal group(P<0.05),suggesting successful atherosclerosis rabbit model preparation.The serum exosomes of rabbits in the model group exhibited a saucer-like or semi-concave spherical shape with diameters of 120-150 nm.WB detection results showed positive expression of the exosomal markers CD63 and CD9.After 8 weeks of intervention,the miR-223 level in the model group was significantly lower than that in the normal group(P<0.01).In contrast,the herb cake-insulated moxibustion group demonstrated significantly reduced serum levels of TC,TG,and LDL-C(P<0.05),increased miR-223 expression(P<0.01),and decreased relative liver HMGR protein expression(P<0.05)compared to the model group.Conclusion:Herb cake-insulated moxibustion may alleviate the progression of atherosclerosis by up-regulating exosomal miR-223 expression and down-regulating HMGR protein expression,thereby inhibiting cholesterol anabolic metabolism.

Objective:To explore the current status and latent profiles of home care needs among caregivers of post-stroke dysphagia (PSD) patients, providing evidence for precision nursing interventions.Methods:Caregivers of PSD patients hospitalized at Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine were selected as the study subjects through convenience sampling from December 2022 to December 2023. A cross-sectional survey was conducted through General Information Questionnaire for PSD Patients and Caregivers, Caregiver Competence Questionnaire for Dysphagia Patients, Zarit Caregiver Burden Interview, and Home Care Needs Scale for Primary Caregivers of Stroke Patients. Latent categories of home care needs among PSD patients' caregivers were identified through latent profile analysis. Influencing factors of latent categories were explored based on univariate analysis and multivariable logistic regression.Results:A total of 168 questionnaires were distributed, with 162 valid questionnaires recovered, yielding an effective response rate of 96.42%. Among the 162 patients, 82 were male and 80 were female, with an age of 78(68, 84) years.Among the 162 caregivers, 51 were male and 111 were female, with an age of 60(52, 68) years. The score of home care needs for primary caregivers was (89.89 ± 15.75) points. Based on the level of home care needs, caregivers were divided into four latent categories: skilled type-low demand, balanced type-medium demand, unfamiliar type-high demand, skilled type - high demand, accounting for 32.1%(52/162), 40.1%(65/162), 8.7%(14/162), and 19.1%(31/162), respectively. Whether the patient had pneumonia, caregiver gender, and caregiver education level were found as influencing factors for home care needs through multivariate Logistic regression analysis ( OR values were 0.10 to 13.88, all P<0.05). Conclusions:The home care needs of caregivers for PSD patients are at a moderate-to-high level and exhibit heterogeneity. Clinical nursing staff should implement targeted interventions to promote the recovery of PSD patients based on caregivers' categorical characteristics