Objective To investigate the characteristics of changes in blood uric acid(UA)and detection rate of hyperuricemia(HUA)among officers and soldiers during long-term maritime missions,as well as their related influencing factors.Methods A total of 100 servicemen were randomly selected from 240 officers and soldiers who will participate in a long-distance voyage mission.Their general information,including age,education level,administrative position,years of service on board,and department,was surveyed.Their annual data of physical examination were retrospectively analyzed and compared with the results of another 335 shore-based servicemen during the same period.On mission day 10(D10)and day 50(D50),the venous blood samples were collected from the participants to synchronously measure blood UA level and body composition indicators(body fat mass,BMI,fat percentage,fat mass,muscle mass,and muscle percentage).Additionally,on D50,Self-Rating Scale of Sleep(SRSS)and Symptom Checklist-90(SCL-90)were employed to survey their conditions.Seventy service members were randomly selected from the 100 participants to engage in aerobic exercise.The changes in UA level and detection rate of HUA among the mission personnel were analyzed,along with their influencing factors.Results The UA level and HUA detection rate in long-term navigation personnel during concurrent annual physical examinations were significantly lower than those in shore-based personnel(P<0.01).Compared to pre-voyage physical examination results,the UA level and HUA detection rate in long-term navigation personnel were significantly increased from mission day D10(P<0.001).Compared to the values at D10,the UA level and HUA detection rate at D50 showed significant decreases(P<0.05),and then essentially returned to pre-mission examination levels(P>0.05).Aged<32 years was an independent risk factor for new-onset HUA at mission D10(P<0.05).<32 years old and aerobic exercise during the voyage were independent influencing factors for HUA outcome(P<0.05).Conclusion Serum UA level and HUA detection rate among officers and soldiers participating in long-term maritime missions are relatively low before departure,but in significant increases during the early stages of the mission,particularly among those aged<32 years.Scientific aerobic exercise during the mission period helps reduce UA level and HUA detection rate,playing a crucial role in guaranteeing physical and mental health.

Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.

To analyze the impact of salt reduction interventions on the knowledge, attitude and behavior regarding the salt reduction of students′ parents based on the home-school interaction model. In April 2021, parents of students in grades 3-5 from three primary schools in Yichang City were selected as the target population using a cluster sampling method, and the parent population was divided into an intervention group and a control group. In the intervention group, a comprehensive home-school interaction salt reduction intervention was implemented, and in the control group, no intervention measures were taken for students′ parents. Baseline and final surveys were conducted before and after the intervention period, which included general information, previous salt reduction interventions received, and salt reduction knowledge, attitude and behavior. Difference-in-difference (DID) method was used to compare the knowledge, attitude and behavior status of two groups before and after the intervention, and stratified analysis of parents with different literacy levels was conducted to assess the net effect of intervention implementation. The results showed that 740 parents completed the baseline and final surveys, with 231 in the intervention group and 509 in the control group. After propensity score matching, there were 231 (33.33%) in the intervention group and 462 (66.67%) in the control group. After the intervention, the proportion of the intervention group who obtained salt control spoons and pots, as well as salt reduction knowledge and advice through school, was 87.45%, 86.58% and 75.45%, respectively, which was significantly higher than that in the control group ( P<0.05). After the intervention, the proportion of parents with a high school and lower education who obtained salt control pots was higher in the intervention group (89.23%) than in the control group (74.49%), with significant differences ( P<0.05). The proportion of parents with a college degree or above who obtained salt control spoons and pots, as well as salt reduction knowledge and advice through school, was higher than that of the control group ( P<0.05). The results of DID method showed that after controlling for monthly income and other factors, the scores of parents′ salt reduction-related knowledge and low-salt behavior in the intervention group increased significantly higher than those in the control group, with DID values (95% CI) of 1.18 (0.15-2.21) and 0.62 (0.16-1.09), respectively, indicating a significant net effect of intervention implication. After stratification according to the education level of parents, this difference still existed in the college degree or above group, with DID values (95% CI) of 1.39 (0.13-2.66) and 0.76 (0.16-1.36), respectively. The home-school interaction model for salt reduction measures can improve the salt-related knowledge and low-salt behavioral choices of students′ parents.

Background:Acupuncture(AP)is widely used in hospitalized patients.However,high-quality evidence supporting its use in patients with sepsis-induced gastrointestinal dysfunction remains limited.Objective:This study aims to conduct a systematic review and meta-analysis to evaluate the effects of AP in patients with sepsis-induced gastrointestinal dysfunction.Methods:PubMed,Embase,Web of Science,SinoMed,VIP Database,Wanfang Data Knowledge Service Platform,China National Knowledge Infrastructure,and the Cochrane Library were searched from inception to March 10,2024.We included randomized controlled trials(RCTs)that focused on adult patients with sepsis receiving AP and compared them with a control group.The primary outcome was gastrointestinal indicators.Sensitivity analysis,subgroup analysis,and assessment of publication bias were conducted to explore the potential heterogeneity among the included studies.Results:A total of 23 RCTs involving 1603 patients were included.Overall,AP significantly improved gastrointestinal indicators,including intra-abdominal pressure(mean difference[MD]=-1.97cm H2O;95％confidence interval[CI]:-2.77,-1.16;P＜0.00001),bowel sounds(MD=0.91 per minute;95％CI:0.66,1.16;P＜0.00001),and gastric residual volume(MD=-46.94mL;95％CI:-83.45,-10.43;P=0.01).These findings were corroborated by subgroup and sensitivity analyses.AP also showed significant benefits in inflammation indicators(procalcitonin,tumor necrosis factor-α,and interleukin-6),gastrointestinal function indicators(D-lactate,diamine oxidase,intestinal fatty acid-binding protein,and motilin),disease severity scores(Acute Physiology and Chronic Health Evaluation Ⅱ score and gastrointestinal dysfunction score),clinical prognosis,and other critical clinical outcomes(total effective rate and time to achieve target enteral nutrition)(all P values＜0.05).Additionally,the mortality rate in the AP group was comparable to that of the control group.Conclusion:Our findings suggest that AP significantly improves gastrointestinal indicators and other clinical outcomes in patients with sepsis and gastrointestinal dysfunction,indicating its potential as a promising therapeutic option.However,due to the small sample sizes and substantial heterogeneity among the included studies,further high-quality,multicenter RCTs are needed to validate these results.

Background: Acupuncture (AP) is widely used in hospitalized patients. However, high-quality evidence supporting its use in patients with sepsis-induced gastrointestinal dysfunction remains limited. Objective: This study aims to conduct a systematic review and meta-analysis to evaluate the effects of AP in patients with sepsisinduced gastrointestinal dysfunction. Methods: PubMed, Embase, Web of Science, SinoMed, VIP Database, Wanfang Data Knowledge Service Platform, China National Knowledge Infrastructure, and the Cochrane Library were searched from inception to March 10, 2024. We included randomized controlled trials (RCTs) that focused on adult patients with sepsis receiving AP and compared them with a control group. The primary outcome was gastrointestinal indicators. Sensitivity analysis, subgroup analysis, and assessment of publication bias were conducted to explore the potential heterogeneity among the included studies. Results: A total of 23 RCTs involving 1603 patients were included. Overall, AP significantly improved gastrointestinal indicators, including intra-abdominal pressure (mean difference [MD] = -1.97 cm H O; 95% confidence interval [CI]: -2.77, -1.16; P < 0.00001), bowel sounds (MD = 0.91 per minute; 95% CI: 0.66, 1.16; P < 0.00001), and gastric residual volume (MD = -46.94 mL; 95% CI:-83.45, -10.43; P = 0.01). These findings were corroborated by subgroup and sensitivity analyses. AP also showed significant benefits in inflammation indicators (procalcitonin, tumor necrosis factor-α, and interleukin-6), gastrointestinal function indicators(D-lactate, diamine oxidase, intestinal fatty acid-binding protein, and motilin), disease severity scores (Acute Physiology and Chronic Health Evaluation II score and gastrointestinal dysfunction score), clinical prognosis, and other critical clinical outcomes (total effective rate and time to achieve target enteral nutrition) (all P values < 0.05). Additionally, the mortality rate in the AP group was comparable to that of the control group. Conclusion: Our findings suggest that AP significantly improves gastrointestinal indicators and other clinical outcomes in patients with sepsis and gastrointestinal dysfunction, indicating its potential as a promising therapeutic option. However, due to the small sample sizes and substantial heterogeneity among the included studies, further high-quality, multicenter RCTs are needed to validate these results.

The randomized controlled trials (RCTs) regarding acupuncture direction published from January 1st, 2013, to November 7th, 2023 were searched in China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, and VIP Chinese Journal Database. As a result, 21 RCTs were included. The problems identified included conceptual misunderstandings regarding acupuncture direction, incomplete selection strategies, confounding research factors, and inaccuracies in reporting. Based on the findings, four strategic approaches for enhancing therapeutic efficacy through acupuncture direction were summarized: aligning needle direction with the meridian pathway, directing the needle toward the lesion site, orienting the needle toward adjacent acupoints, and targeting special anatomical structures. Two additional strategies were proposed for optimizing the procedure: simplifying acupuncture operations and directing the needle toward safe anatomical sites. Recommendations were made to improve the rationality of research factor settings and the completeness of acupuncture operation reporting. Furthermore, three methods for reporting acupuncture direction were discussed: reporting the tip-pointed position, reporting the insertion angle and orientation, and reporting azimuth and polar angles, aiming to promote greater standardization and completeness in acupuncture practice and reporting.
Acupuncture Therapy/standards* ; Humans ; Acupuncture Points ; Randomized Controlled Trials as Topic ; Meridians

Objective To investigate the value of machine learning models based on contrast-enhanced CT radiomics in differentia-ting renal oncocytoma(RO)from chromophobe renal cell carcinoma(chRCC).Methods A total of 65 patients with RO and chRCC confirmed by pathology with complete clinical and imaging data were analyzed retrospectively.The patients were randomly divided into training set(n=45)and test set(n=20)according to a ratio of 7︰3.The tumor boundaries were delineated on the preoperative CT images using 3D Slicer software,and radiomics features were extracted using the Radiomics plugin.Univariate analysis,recursive fea-ture elimination(RFE),least absolute shrinkage and selection operator(LASSO)algorithms were used to select the best radiomics features.Three machine learning models were constructed on the training set and the grid search method was used to select the best combination of hyperparameters.The receiver operating characteristic(ROC)curve,calibration curve and decision curve were used to evaluate the performance of each machine learning model on the training set and test set.Results Random forest model,logistic regres-sion model and support vector machine model can better identify RO and chRCC.In the training set,the area under the curve(AUC)of random forest model and support vector machine model were 0.950[95%confidence interval(CI)0.901-0.998]and 0.955(95%CI 0.908-1.000),respectively,which were higher than the AUC of logistic regression model 0.882(95%CI 0.806-0.956).Statistical differences were found by DeLong test(P<0.05);In the test set,the AUC of random forest model,logistic regression model and support vector machine model were 0.876(95%CI 0.758-0.993),0.883(95%CI 0.768-0.997)and 0.883(95%CI 0.768-0.997),respectively.There was no significant statistical difference in the AUC of each model by DeLong test(P>0.05).The decision curve showed that all three models had significant net clinical benefits.Conclusion The machine learning model based on contrast-enhanced CT radiomics can effectively distinguish RO from chRCC.

To analyze the impact of salt reduction interventions on the knowledge, attitude and behavior regarding the salt reduction of students′ parents based on the home-school interaction model. In April 2021, parents of students in grades 3-5 from three primary schools in Yichang City were selected as the target population using a cluster sampling method, and the parent population was divided into an intervention group and a control group. In the intervention group, a comprehensive home-school interaction salt reduction intervention was implemented, and in the control group, no intervention measures were taken for students′ parents. Baseline and final surveys were conducted before and after the intervention period, which included general information, previous salt reduction interventions received, and salt reduction knowledge, attitude and behavior. Difference-in-difference (DID) method was used to compare the knowledge, attitude and behavior status of two groups before and after the intervention, and stratified analysis of parents with different literacy levels was conducted to assess the net effect of intervention implementation. The results showed that 740 parents completed the baseline and final surveys, with 231 in the intervention group and 509 in the control group. After propensity score matching, there were 231 (33.33%) in the intervention group and 462 (66.67%) in the control group. After the intervention, the proportion of the intervention group who obtained salt control spoons and pots, as well as salt reduction knowledge and advice through school, was 87.45%, 86.58% and 75.45%, respectively, which was significantly higher than that in the control group ( P<0.05). After the intervention, the proportion of parents with a high school and lower education who obtained salt control pots was higher in the intervention group (89.23%) than in the control group (74.49%), with significant differences ( P<0.05). The proportion of parents with a college degree or above who obtained salt control spoons and pots, as well as salt reduction knowledge and advice through school, was higher than that of the control group ( P<0.05). The results of DID method showed that after controlling for monthly income and other factors, the scores of parents′ salt reduction-related knowledge and low-salt behavior in the intervention group increased significantly higher than those in the control group, with DID values (95% CI) of 1.18 (0.15-2.21) and 0.62 (0.16-1.09), respectively, indicating a significant net effect of intervention implication. After stratification according to the education level of parents, this difference still existed in the college degree or above group, with DID values (95% CI) of 1.39 (0.13-2.66) and 0.76 (0.16-1.36), respectively. The home-school interaction model for salt reduction measures can improve the salt-related knowledge and low-salt behavioral choices of students′ parents.

Objective To investigate the value of machine learning models based on contrast-enhanced CT radiomics in differentia-ting renal oncocytoma(RO)from chromophobe renal cell carcinoma(chRCC).Methods A total of 65 patients with RO and chRCC confirmed by pathology with complete clinical and imaging data were analyzed retrospectively.The patients were randomly divided into training set(n=45)and test set(n=20)according to a ratio of 7︰3.The tumor boundaries were delineated on the preoperative CT images using 3D Slicer software,and radiomics features were extracted using the Radiomics plugin.Univariate analysis,recursive fea-ture elimination(RFE),least absolute shrinkage and selection operator(LASSO)algorithms were used to select the best radiomics features.Three machine learning models were constructed on the training set and the grid search method was used to select the best combination of hyperparameters.The receiver operating characteristic(ROC)curve,calibration curve and decision curve were used to evaluate the performance of each machine learning model on the training set and test set.Results Random forest model,logistic regres-sion model and support vector machine model can better identify RO and chRCC.In the training set,the area under the curve(AUC)of random forest model and support vector machine model were 0.950[95%confidence interval(CI)0.901-0.998]and 0.955(95%CI 0.908-1.000),respectively,which were higher than the AUC of logistic regression model 0.882(95%CI 0.806-0.956).Statistical differences were found by DeLong test(P<0.05);In the test set,the AUC of random forest model,logistic regression model and support vector machine model were 0.876(95%CI 0.758-0.993),0.883(95%CI 0.768-0.997)and 0.883(95%CI 0.768-0.997),respectively.There was no significant statistical difference in the AUC of each model by DeLong test(P>0.05).The decision curve showed that all three models had significant net clinical benefits.Conclusion The machine learning model based on contrast-enhanced CT radiomics can effectively distinguish RO from chRCC.

Background:Acupuncture(AP)is widely used in hospitalized patients.However,high-quality evidence supporting its use in patients with sepsis-induced gastrointestinal dysfunction remains limited.Objective:This study aims to conduct a systematic review and meta-analysis to evaluate the effects of AP in patients with sepsis-induced gastrointestinal dysfunction.Methods:PubMed,Embase,Web of Science,SinoMed,VIP Database,Wanfang Data Knowledge Service Platform,China National Knowledge Infrastructure,and the Cochrane Library were searched from inception to March 10,2024.We included randomized controlled trials(RCTs)that focused on adult patients with sepsis receiving AP and compared them with a control group.The primary outcome was gastrointestinal indicators.Sensitivity analysis,subgroup analysis,and assessment of publication bias were conducted to explore the potential heterogeneity among the included studies.Results:A total of 23 RCTs involving 1603 patients were included.Overall,AP significantly improved gastrointestinal indicators,including intra-abdominal pressure(mean difference[MD]=-1.97cm H2O;95％confidence interval[CI]:-2.77,-1.16;P＜0.00001),bowel sounds(MD=0.91 per minute;95％CI:0.66,1.16;P＜0.00001),and gastric residual volume(MD=-46.94mL;95％CI:-83.45,-10.43;P=0.01).These findings were corroborated by subgroup and sensitivity analyses.AP also showed significant benefits in inflammation indicators(procalcitonin,tumor necrosis factor-α,and interleukin-6),gastrointestinal function indicators(D-lactate,diamine oxidase,intestinal fatty acid-binding protein,and motilin),disease severity scores(Acute Physiology and Chronic Health Evaluation Ⅱ score and gastrointestinal dysfunction score),clinical prognosis,and other critical clinical outcomes(total effective rate and time to achieve target enteral nutrition)(all P values＜0.05).Additionally,the mortality rate in the AP group was comparable to that of the control group.Conclusion:Our findings suggest that AP significantly improves gastrointestinal indicators and other clinical outcomes in patients with sepsis and gastrointestinal dysfunction,indicating its potential as a promising therapeutic option.However,due to the small sample sizes and substantial heterogeneity among the included studies,further high-quality,multicenter RCTs are needed to validate these results.