Objective To construct a nomograph model for predicting the risk of renal damage in patients with essential hypertension based on pulse parameters.Methods 518 patients with essential hypertension who were hospitalized in Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine and Cardiology Department of Shanghai Integrated Hospital of Traditional Chinese and Western Medicine from August 2018 to June 2021 were selected,and were divided into hypertension without renal damage group and hypertension with renal damage group according to the evaluation criteria of essential hypertension with renal damage.The general data and blood biochemical indexes of the patients were collected,and the pulse parameters were detected by SMART-I digital pulse analyzer of traditional Chinese medicine,and the differences between the two groups were compared.Single factor and multi factor logistic regression were used to analyze the related parameters;The nomogram model was constructed by R Studio,and the model was evaluated by the ROC curve,calibration curve,and Hosmer Lemeshow goodness of fit test.Results The age,serum uric acid,serum creatinine,urea nitrogen,cystatin C and homocysteine in the group of primary hypertension with renal damage were significantly higher than those in the group without renal damage(P＜0.05).The pulse parameters H4,H3/H1,H4/H1,H5/H1,T1/T4,W1/T in patients with primary hypertension and renal injury were significantly lower than those in patients without renal injury(P＜0.01),and As/Ad was significantly higher than those in patients without renal injury(P＜0.01).Age,current diastolic b1ood pressure,H4/H1,T1/T4,W1/T were independent risk factors of renal damage in patients with essential hypertension.The nomogram model was established based on the above independent risk factors,and the model was tested.The area under the ROC curve was 0.703(95％CI:0.625-0.781),and the calibration curve was well fitted with the ideal curve.The Hosmer Lemeshow goodness of fit test showed that the nomogram model had good calibration.Conclusion The nomogram model based on pulse parameters can accurately predict the risk of renal damage in patients with essential hypertension,and can provide a reference for clinical prediction of the risk of renal damage in patients with essential hypertension.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

Methods To investigate how the timing of cooling therapy affects organ injuries in rats with exertional heat stroke(EHS)and explore the possible mechanisms.Methods A total of 60 adult male Wistar rat models of EHS were randomized into model group without active cooling after modeling,immediate cooling group with cold water bath immediately after modeling,delayed cooling groups with cold water bath at 5,15 and 30 min after modeling,with another 12 mice without EHS as the normal control group.The changes in core body temperature of the mice were recorded and the cooling rate was calculated.After observation for 24 h,the mice were euthanized and blood samples were collected for detection of interleukin-1β(IL-1β),IL-2,IL-4,IL-6,IL-10,and interferon-γ,followed by pathological examination of the vital organs.The rats that died within 24 h were immediately dissected for examination.Results The number of deaths of the model rats within 24 h increased significantly with the time of delay of cooling treatment.The delay of cooling was positively correlated(r=0.996,P=0.004)while the cooling rate negatively correlated with the mortality rate(r=-0.961,P=0.009).The inflammatory cytokine levels presented with different patterns of variations among the cooling intervention groups.All the rat models of EHS had significant organ damages characterized mainly by epithelial shedding,edema,effusion,and inflammatory cell infiltration,and brain and renal injuries reached the peak level at 24 h after EHS.Conclusion EHS causes significant nonspecific pathologies of varying severities in the vital organs of rats,and the injuries worsen progressively with the delay of cooling.There is a significant heterogeneity in changes of serum inflammatory cytokines in rats with different timing of cooling intervention following EHS.

Methods To investigate how the timing of cooling therapy affects organ injuries in rats with exertional heat stroke(EHS)and explore the possible mechanisms.Methods A total of 60 adult male Wistar rat models of EHS were randomized into model group without active cooling after modeling,immediate cooling group with cold water bath immediately after modeling,delayed cooling groups with cold water bath at 5,15 and 30 min after modeling,with another 12 mice without EHS as the normal control group.The changes in core body temperature of the mice were recorded and the cooling rate was calculated.After observation for 24 h,the mice were euthanized and blood samples were collected for detection of interleukin-1β(IL-1β),IL-2,IL-4,IL-6,IL-10,and interferon-γ,followed by pathological examination of the vital organs.The rats that died within 24 h were immediately dissected for examination.Results The number of deaths of the model rats within 24 h increased significantly with the time of delay of cooling treatment.The delay of cooling was positively correlated(r=0.996,P=0.004)while the cooling rate negatively correlated with the mortality rate(r=-0.961,P=0.009).The inflammatory cytokine levels presented with different patterns of variations among the cooling intervention groups.All the rat models of EHS had significant organ damages characterized mainly by epithelial shedding,edema,effusion,and inflammatory cell infiltration,and brain and renal injuries reached the peak level at 24 h after EHS.Conclusion EHS causes significant nonspecific pathologies of varying severities in the vital organs of rats,and the injuries worsen progressively with the delay of cooling.There is a significant heterogeneity in changes of serum inflammatory cytokines in rats with different timing of cooling intervention following EHS.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

Objective To construct a nomograph model for predicting the risk of renal damage in patients with essential hypertension based on pulse parameters.Methods 518 patients with essential hypertension who were hospitalized in Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine and Cardiology Department of Shanghai Integrated Hospital of Traditional Chinese and Western Medicine from August 2018 to June 2021 were selected,and were divided into hypertension without renal damage group and hypertension with renal damage group according to the evaluation criteria of essential hypertension with renal damage.The general data and blood biochemical indexes of the patients were collected,and the pulse parameters were detected by SMART-I digital pulse analyzer of traditional Chinese medicine,and the differences between the two groups were compared.Single factor and multi factor logistic regression were used to analyze the related parameters;The nomogram model was constructed by R Studio,and the model was evaluated by the ROC curve,calibration curve,and Hosmer Lemeshow goodness of fit test.Results The age,serum uric acid,serum creatinine,urea nitrogen,cystatin C and homocysteine in the group of primary hypertension with renal damage were significantly higher than those in the group without renal damage(P＜0.05).The pulse parameters H4,H3/H1,H4/H1,H5/H1,T1/T4,W1/T in patients with primary hypertension and renal injury were significantly lower than those in patients without renal injury(P＜0.01),and As/Ad was significantly higher than those in patients without renal injury(P＜0.01).Age,current diastolic b1ood pressure,H4/H1,T1/T4,W1/T were independent risk factors of renal damage in patients with essential hypertension.The nomogram model was established based on the above independent risk factors,and the model was tested.The area under the ROC curve was 0.703(95％CI:0.625-0.781),and the calibration curve was well fitted with the ideal curve.The Hosmer Lemeshow goodness of fit test showed that the nomogram model had good calibration.Conclusion The nomogram model based on pulse parameters can accurately predict the risk of renal damage in patients with essential hypertension,and can provide a reference for clinical prediction of the risk of renal damage in patients with essential hypertension.

To analyze the correlation between trace element levels and carotid atherosclerosis（CAS），explore the risk factors of CAS. Methods People who underwent physical examination，and performed carotid artery ultrasonography，trace element detection and inflammatory factors detection were collected from January 2020 to February 2022 in the Physical Examination Center of the First Hospital of Jilin University. 325 cases were selected in strict accordance with the inclusion and exclusion criteria，the subjects were classified into two groups according to carotid intima-media thickness（IMT）. There were 146 cases in the normal carotid artery group and 179 cases in the carotid atherosclerosis group. Chi-square test，t test and rank sum test were used to compare the differences in basic information，serum trace element levels，C-reactive protein（CRP） and blood biochemistry between the two groups；Spearman correlation analysis was used to explore the correlation between carotid IMT and trace elements，CRP and inflammatory factors；multivariate Logistic regression was used to analyze the risk factors of CAS；all tests were performed on two sides，and the difference was statistically significant at P<0.05.Results （1）The age，waist circumference，carotid IMT，systolic blood pressure，prevalence rate of diabetes，the ratio of smoking，drinking and male in the carotid atherosclerosis group were higher than those in the normal carotid artery group，and the difference was statistically significant（P<0.05）. （2）There were statistical differences（P<0.05） in the contents of CRP，iron，zinc，LDL-C，FBG and UA between the normal carotid artery group and the carotid atherosclerosis group. The contents of CRP，iron，LDL-C，FBG and UA in the carotid atherosclerosis group were higher than those in the normal carotid group，and the zinc content in the carotid atherosclerosis group was lower than that in the normal carotid artery group. （3）Carotid IMT was positively correlated with age，waist circumference，systolic blood pressure，diastolic blood pressure，iron，CRP，triglycerides，LDL-C，fasting blood glucose，uric acid，while negatively correlated with zincand ratio of zinc and copper. （4）Multivariate Logistic regression analysis of carotid atherosclerosis，the results showed that age，gender，the ratio of smoking，the ratio of drinking，CRP，zinc，LDL-C，and fasting blood glucose were risk factors for carotid atherosclerosis，and zinc was a protective factor for carotid atherosclerosis. Conclusion Trace element iron is positively correlated with carotid IMT，and the higher its level is，the higher the risk of CAS；the trace element zinc is negatively correlated with carotid IMT，and the higher its level is，the lower the risk of CAS is；zinc is a protective factor for CAS.

Objective:To explore the effect of cognitive-behavioral therapy on fear of hypoglycemia and self-management behavior of patients with steroid diabetes mellitus.Methods:A total of 76 patients with steroid diabetes mellitus from August 2018 to October 2019 in the First Affilated Hospital of Nanjing Medical University were selected and divided into experimental group and control group according to the admission time, and each group contained 38 cases. The control group recieved routine therapy and nursing care, on the basis of this, the experimental group was given cognitive-behavioral therapy for 8 weeks. Before and after 8 weeks of intervention, the effects were assessed by Chinese version Hypoglycemia Fear Surgey-Worry Scale(CHFSⅡ-WS) and Sumary of Diabetes Self Care Activities (SDSCA), respectively.Results:There was no significant difference in the score of CHFS Ⅱ-WS, SDSCA before intervention between the two groups( P>0.05). After 8 weeks of intervention, the scores of worry & fear and total CHFS Ⅱ-WS scores were (6.61±1.66), (8.75±1.73) points in the experimental group and (7.60±1.44), (9.69±1.77) points in the control group, the differences were statistically significant ( t values were 2.678, 2.247, P<0.05); in addition, the scores of diet, exercise, blood sugar testing, medications in SDSCA were (20.36±1.91), (11.86±2.27), (7.19±1.56), (6.86±0.99) points in the experimental group, and (18.51±1.50), (9.89±2.29), (5.71±1.45), (5.31±1.18) points in the control group, the differences were statistically significant ( t values were 3.644-5.983, P<0.05). Conclusions:Cognitive-behavioral therapy can effectively alliviate fear of hypoglycemia and promote self-management behavior of steroid diabetes mellitus patients.

Objective:To investigate the effect of Roy adaptation model-based intervention on fatigue and posttraumatic growth in patient with malignant lymphoma during chemotherapy.Methods:A total of 110 malignant lymphoma patients who undergoing chemotherapy were randomly divided into study group and control group, with 59 cases in each group. The control group received routine nursing method, the study group carried out Roy adaptation model-based intervention. The post-traumatic growth inventorynventory (PTGI) and the revised piper fatigue scale (PFS-R) was evaluated the effect of intervention, respectively.Results:Before and after chemotherapy, the new possibilities, relating to others, personal strength, appreciation of life, spiritual change and total PTGI scores were (8.90±1.00), (17.27±3.66), (15.11±2.63), (15.23±4.19), (4.16±0.87), (60.45±6.49) and (9.64±1.38), (21.49±4.43), (17.78±4.17), (19.31±5.82), (4.95±0.89), (73.16±8.85), in addition, those index scores in the control group were [(8.74±1.40), (17.13±3.86), (15.46±3.55), (15.80±2.81), (4.26±1.15), (61.43±6.93) and (9.14±1.86), (18.44±4.31), (16.34±2.77), (17.97±3.18), (4.74±1.07), (66.63±6.68)]. There was no significant difference in PTGI scores between study group and control group ( P>0.05), however, relating to others, personal strength and total PTGI scores were significantly increased in the study group compared to the control group ( P<0.05). Before and after chemotherapy, the sensory, emotional, knowledge, behavioral and total PFS-R scores were (5.68±0.82), (4.80±1.06), (4.27±0.81), (4.16±0.47), (5.05±0.74) and (2.43±0.73), (4.27±0.61), (2.44±0.45), (4.07±0.73), (3.89±0.77), in addition, those index scores in the control group were [(5.73±1.23), (4.85±0.64), (4.37±0.74), (4.17±0.38), (4.98±0.82) and (4.48±0.72), (4.90±0.75), (3.45±0.53), (4.23±0.81), (4.60±0.57)]. There was no significant difference in PFS-R scores between study group and control group ( P>0.05), however, sensory, emotional, knowledge and total PFS-R scores were significantly decreased in the study group compared to the control group ( P<0.05). Conclusion:Roy adaptation model-based intervention can effectively alleviate fatigue and promote post-traumatic growth in patient with malignant lymphoma during chemotherapy.

No abstract available.
Gynecology* ; Obstetrics*