OBJECTIVE: To compare the efficacy and safety of intravenous colistin sulfate combined with nebulized inhalation versus intravenous monotherapy for pulmonary infections caused by carbapenem-resistant organism (CRO). METHODS: A multicenter retrospective cohort study was conducted. Clinical data were collected from patients admitted to the intensive care unit (ICU) of 10 tertiary class-A hospitals in Henan Province between July 2021 and May 2023, who received colistin sulfate for CRO pulmonary infections. Data included baseline characteristics, inflammatory markers [white blood cell count (WBC), neutrophil count (NEU), procalcitonin (PCT), C-reactive protein (CRP)], renal function indicators [serum creatinine (SCr), blood urea nitrogen (BUN)], life support measures, anti-infection regimens, clinical efficacy, microbiological clearance rate, and prognostic outcomes. Patients were divided into two groups: intravenous group (colistin sulfate monotherapy via intravenous infusion) and combination group ((intravenous infusion combined with nebulized inhalation of colistin sulfate). Changes in parameters before and after treatment were analyzed. RESULTS: A total of 137 patients with CRO pulmonary infections were enrolled, including 89 in the intravenous group and 48 in the combination group. Baseline characteristics, life support measures, daily colistin dose, and combination regimens (most commonly colistin sulfate plus carbapenems in both groups) showed no significant differences between two groups. The combination group exhibited higher clinical efficacy [77.1% (37/48) vs. 59.6% (52/89)] and microbiological clearance rate [60.4% (29/48) vs. 39.3% (35/89)], both P < 0.05. Pre-treatment inflammatory and renal parameters showed no significant differences between two groups. Post-treatment, the combination group showed significantly lower WBC and CRP [WBC (×10⁹/L): 8.2±0.5 vs. 10.9±0.6, CRP (mg/L): 14.0 (5.7, 26.6) vs. 52.1 (24.4, 109.6), both P < 0.05], whereas NEU, PCT, SCr, and BUN levels showed no significant between two groups. ICU length of stay was shorter in the combination group [days: 16 (10, 25) vs. 21 (14, 29), P < 0.05], although mechanical ventilation duration and total hospitalization showed no significant differences between two groups. CONCLUSIONS Intravenous colistin sulfate combined with nebulized inhalation improved clinical efficacy and microbiological clearance in CRO pulmonary infections with an acceptable safety profile.
Humans ; Colistin/therapeutic use* ; Retrospective Studies ; Administration, Inhalation ; Anti-Bacterial Agents/therapeutic use* ; Carbapenems/pharmacology* ; Male ; Female ; Middle Aged ; Gram-Negative Bacteria/drug effects* ; Aged ; Treatment Outcome ; Respiratory Tract Infections/drug therapy*

Objective To develop a military cross-cultural symptom scale(MCCSS)and evaluate its reliability and validity.Methods The dimensions and items of the scale were determined through literature analysis,questionnaire surveys,group discussions,expert consultations,and pre-experiments.Cluster sampling was employed to collect data from the participants to examine the psychometric properties of the scale.Results The MCCSS comprised 38 items across 9 factors:depression,anxiety,somatic symptoms,misanthropic tendency,sleep problems,compulsions,psychotic symptoms,stress trauma,and defensiveness.Item analysis revealed that the 37 items(except 1 forced-choice item)exhibited correlations from 0.538 to 0.875 with the total scale score(all P＜0.01),with critical ratios ranging from 5.190 to 28.149,indicating good discriminative power.The Cronbach's α coefficients for the total scale and subscales ranged from 0.825 to 0.972,and the Spearman-Brown split-half reliability coefficients ranged from 0.747 to 0.955.The results of confirmatory factor analysis showed that x2/df=3.419,standardized root mean square residual=0.033,root mean square error of approximation=0.073,normed fit index=0.868,incremental fit index=0.903,Tucker-Lewis index=0.887,comparative fit index=0.902,and the scale's first-order 9-factor model fit well.The loads of each item on the factor to which it belonged ranged from 0.597 to 0.954(all P＜0.01).The correlation coefficients between the scale and the scale for criterion-related validity ranged from 0.392 to 0.773(all P＜0.01),and the correlation coefficients between the scale and the scale for convergent validity ranged from 0.257 to 0.519(all P＜0.01).Conclusion The MCCSS in this study has good reliability and validity and can be used as a mental health testing and screening tool for military personnel.

Objective To investigate the factors influencing mood and sleep among special operation personnel,so as to provide evidence for the prevention and intervention of related issues.Methods A total of 600 special operation personnel during their special duty were enrolled by random sampling method.Basic information was collected by a general information questionnaire.Mood and sleep status were evaluated by self-rating anxiety scale(SAS),self-rating depression scale(SDS),and Pittsburgh sleep quality index scale(PSQI).Results Spearman correlation analysis showed that factors associated with anxiety were years of work experience(r=0.099,P=0.016),family residence(r=-0.153,P＜0.001),and sleep status(r=0.199,P＜0.001);the factors associated with depression were relationship with parents(r=-0.134,P=0.001),family residence(r=-0.144,P＜0.001),and sleep status(r=0.122,P=0.003);and the factors associated with sleep were age(r=0.088,P=0.031),years of work experience(r=0.079,P=0.049),and number of children(r=0.083,P=0.043).Binary logistic regression analysis showed that depression was not an influencing factor of sleep(odds ratio[OR]=1.302,95%confidence interval[95%CI]0.759-1.758,P=0.086),while anxiety was an influencing factor of sleep(OR=2.187,95%CI 1.608-4.695,P=0.001).Conclusion The sleep status of special operation personnel investigated in this survey is related to age and years of work experience,and is influenced by anxiety.Therefore,greater attention should be given to sleep issues in the occupational health support of special operations.Additionally,years of work experience,family residence,relationship with parents,and sleep status are related to anxiety and depression among special operation personnel.It is necessary to focus on the mental health of older workers and those with longer tenure.

AIM:To investigate the therapeutic effect of menstrual blood-derived endometrial stem cells(MenSCs)on chemotherapy-induced intestinal mucositis and flora disorders in mice,and to explore the potential mecha-nism.METHODS:The mice were randomly divided into 3 groups including normal treatment,cisplatin(Cis)treatment and Cis+MenSC treatment,with 10 mice in each group.To induce intestinal mucositis,the mice were treated with Cis(2 mg·kg-1·d-1)by intraperitoneal injection for 5 consecutive days.Control mice for normal group were received equal vol-umes of normal saline.For Cis+MenSC treatment,MenSCs(1×106)was transplanted into the mice of Cis treated mice through tail vein.The performances and weight changes of mice were examined during the experiment.After the treat-ment,the small intestine and colon were isolated for subsequent HE staining,the ratio of F4/80 and IL-6 positive cells in small intestine were detected by immunohistochemical staining,and the expression of tight junction,inflammation and apoptosis related proteins was detected by Western blot.16S rDNA amplicon sequencing was performed to detect the diver-sity and richness of intestinal flora in mice.RESULTS:Compared to the Cis group,the MenSCs-treated mice showed sig-nificantly increased body weight,relieved intestinal lymphocytes infiltration,alleviated intestinal villous edema,and or-derly arranged glands in intestinal tissues.Further analysis indicated that MenSCs transplantation significantly up-regulat-ed the expression of intestinal tight junction related proteins ZO-1 and occludin in Cis-treated mice(P＜0.05).Subse-quently,MenSCs transplantation significantly inhibited the macrophages infiltration in intestinal tissues(P＜0.01),down-regulated the expression of pro-inflammatory factors IL-1 and IL-6 and pro-apoptotic protein Bax(P＜0.01),while up-regu-lated anti-inflammatory factor IL-10 and anti-apoptotic protein Bcl-2(P＜0.01).Additionally,further microflora sequenc-ing indicated that MenSCs transplantation prevented mice from Cis-induced intestinal flora disorder,and significantly re-duced the abundance of harmful bacteria such as isenbergiella tayi and Anaerotruncus colihominis(P＜0.01).At the same time,the abundance of beneficial bacteria Lactobacillus apodemi was increased(P＜0.05),thereby restoring the composi-tion and function of healthy intestinal flora.CONCLUSION:MenSCs transplantation alleviates the chemotherapy-in-duced damage of intestinal structure,relieves the symptoms of chemotherapy-induced mucositis and restores the homeosta-sis of intestinal flora in mice.

Purpose To explore the cardioprotective effect of cang-ai volatile oil(CAVO)on rats with cardiac function impairment model under low-pressure and low-oxygen environment in Tibet Plateau based on 7.0T cardiovascular magnetic resonance(CMR)imaging.Materials and Methods Forty SD rats were randomly divided into the normal group,the high altitude model group,the CAVO-treated group and the rhodiola rosea-treated group,with 10 rats in each group.Except for the normal group,the rats in other groups were transferred from the plain(500 m above sea level)to the Tibet Plateau(4 250 m above sea level)for two months,and then administered with the corresponding drugs by gavage for 14 d.The left ventricle function was measured by using a 7.0T high-field strength CMR and myocardial strain was analysed by using tissue tracing technique.HE staining was used to observe the morphology of cardiomyocytes,Masson staining to observe interstitial fibrosis,wheat germ agglutinin staining to observe cardiomyocyte hypertrophy,and transmission electron microscopy to observe the morphological changes of mitochondria in each group.Serum levels of creatine kinase,creatine kinase isoenzyme,lactate dehydrogenase,cardiac troponin T,superoxide dismutase,malondialdehyde and glutathione peroxidase were detected.Intracellular reactive oxygen species levels were detected using flow cytometry.Results The left ventricular ejection fraction of rats in the CAVO-treated group was higher than that of the high altitude model group[(66.61±1.38)％vs.(60.94±3.21)％;t=3.969,P=0.032];meanwhile,the global circumferential strain of the left ventricle in the CAVO-treated group was higher than that of the high altitude model group(-25.68±1.30 vs.-22.84±1.17;t=3.967,P=0.003).HE,Masson and wheat germ agglutinin staining showed hypertrophy and necrosis as well as interstitial fibrosis and ultrastructural disruption of cardiomyocytes in the high altitude model group,which improved after CAVO treatment.The level of cardiac troponin T in the serum of rats with CAVO treatment group was significantly decreased compared with that of the high altitude model group[(314.03±20.05)pg/ml vs.(518.30±18.13)pg/ml;1=13.090,P=0.001].Conclusion CAVO treatment can reduce cardiac injury caused by low-pressure hypoxia in high altitude,and its effect can be detected dynamically and non-invasively by 7.0T high-field strength CMR.

Objective To investigate the effect of Shenqi Yizhi Granules on brain structure and function in prodromal Alzheimer disease（pAD） under hypoxic conditions based on MRI. Methods A total of 77 female Han Chinese patients， aged 50‒85 years， who had at least 6 years of education and long-term residence in Qinghai region and met the inclusion criteria for pAD were enrolled as subjects. They were randomly divided into drug group （39 patients receiving Shenqi Yizhi Granules） and control group （38 patients receiving placebo） for 24 weeks of clinical observation. Related data were collected from all subjects， including clinical information， cognitive and neuropsychological assessments， diffusion tensor imaging （DTI） data， and rs-fMRI data. Results Cognitive and neuropsychological assessments showed that after treatment， the drug group had significant increases in MoCA， AVTL， SDMT， and CFT-copy scores and significant reductions in ADAS-cog and GDS scores（P<0.05）， while the control group had a significantly increase in ADAS-cog score （P<0.001）； compared with the control group after treatment， the drug group had significantly higher MoCA and AVTL scores （P<0.05） and a significantly lower ADAS-cog score （P<0.01）. DTI results showed that the drug group had significant increases in axial diffusivity （AD） values of multiple brain regions after treatment （P<0.05）. The results of rs-fMRI showed that after treatment， the drug group had significant increases in the amplitude of low-frequency fluctuation （ALFF） in the right temporal middle gyrus， the triangular part of the inferior frontal gyrus， and the medial cingulate gyrus and paracingulate gyrus and significant reductions in ALFF in the left cerebellar hemisphere Crus1 lobule， superior occipital gyrus， and supramarginal gyrus， and compared with the control group， the drug group had a significant increase in ALFF in the right dorsolateral superior frontal gyrus （P<0.05）. After treatment， the drug group had significant increases in the regional homogeneity （ReHo） values of the left triangular part of the inferior frontal gyrus and the inferior occipital gyrus and a significant reduction in the ReHo value of the left cerebellar hemisphere Crus1 lobule （P<0.05）， and compared with the control group， the drug group had a significant increase in the ReHo value of the left inferior parietal gyrus（P<0.05）. Conclusion Shenqi Yizhi Granules can effectively improve overall cognition and the function of multiple cognitive domains in pAD patients living in plateau regions by modulating the microstructure of white matter and spontaneous neuronal activity in cognitive-related brain regions.

Objective To investigate the mental health and influencing factors of naval officers and soldiers,and provide data support for formulating effective psychological intervention measures.Methods The 12-item general health questionnaire(GHQ-12)was used to conduct a sample survey among 5 336 naval officers and soldiers from October to November 2021.SPSS 26.0 software,chi-square test and regression analysis were used for descriptive statistics.Results A total of 5 102(95.61%)valid questionnaires were collected.The average GHQ-12 score was 0.55±1.18,and the proportion of high-risk individuals for mental health was 3.06%.Chi-square test showed that there were significant differences in the distribution of mental health status among interviewees with different ages,education levels,marriage status,family economy,family relationship,growing family,history of mental diseases among close relatives,major changes encountered during growth,hobbies and specialties,recent work pressure and recent interpersonal relationship(P≤0.001).Regression analysis showed that age(P=0.006),family relationship(P<0.001),family economy(P=0.010),major changes encountered during growth(P<0.001),recent work stress(P<0.001)and recent interpersonal relationship(P<0.001)were main influencing factors for mental health of naval officers and soldiers.Conclusion The mental health of naval officers and soldiers was generally good,but some individuals still have mental health problems,which are affected by many factors.It is necessary to pay more attention to the mental health problems caused by their age,education,family,growth experience,stress and interpersonal relationship.

Objective To investigate the current status and influencing factors of mental disorders in working women in psychological clinic of a first-class hospital in Shanghai,so as to provide guidance for prevention and treatment of this disease.Methods A cross-sectional survey was conducted on 122 working female patients from the psychological clinic of a first-class hospital in Shanghai.Mental health status was assessed by General Situation Scale,Self-Efficacy Scale,Patient Health Questionnaire-9(PHQ-9),Generalized Anxiety Disorder-7(GAD-7),Yale-Brown Obsessive-Compulsive Scale(Y-BOCS),Hypomania Checklist-32(HCL-32),Patient Health Questionnaire-15(PHQ-15),AIS scale,and individual interviews.Descriptive statistics,non-parametric test,and multivariate logistic regression analysis were used to investigate the influencing factors of mental disorders in working women.Results The scores of anxiety,depression,compulsion,bipolar disorder,somatization symptoms,and insomnia were 12.02±4.29,14.91±5.53,6.09±5.71,7.28±5.25,13.54±6.29,and 10.79±5.27,respectively.Mild anxiety(36.1%),moderate depression(36.1%),and severe somatization(39.4%)were very common in these patients.Additionally,compulsive behaviors were found in 18.0%of the patients,bipolar disorder in 22.1%,and insomnia in 68.0%.Five factors(such as work hours)were related to anxiety(all P<0.05).Six factors(such as education level)were related to depression(all P<0.05).Seven factors(such as workplace relationships)were related to compulsions(all P<0.05).Age and four other factors were related to bipolar disorders(all P<0.05).Career development and three other factors were related to somatization(all P<0.05).Insomnia was significantly influenced by overtime work and five other factors(all P<0.05).Multivariate logistic regression analysis indicated that bad job stability and two other factors were risk factors for anxiety(all P<0.05),low self-efficacy and two other factors were risk factors for depression(all P<0.05),bad workplace relationships and two other factors increased compulsive behaviors(all P<0.05),more housing expenses increased bipolar disorders(P<0.05),more overtime aggravated somatization(P<0.05),and long working hours and two other factors worsened insomnia(all P<0.05).Conclusion Mental disorders in working women have become a common social issue,and are mainly influenced by individual factors(age,marital status,education level,housing expenses,and self-efficacy)and work-related factors(industry type,work hours,overtime,workplace relationships,job stability,career development,and corporate focus on female employees).Effective interventions from personal,corporate,and social perspectives are the key to preventing and treating mental disorders in working women.

Objective: To investigate the current situation and related factors of the ecological environment and health literacy level of medical college students in Shiyan City, so as to propose relevant countermeasures and suggestions for improvement in these domains. Methods: From May to June 2023, 1 312 medical students from Hubei University of Medicine in Shiyan City were selected by accidental sampling to investigate the level and influencing factors of the ecological environment and health literacy among this population. The Chi square test and binary multivariate Logistic regression analysis were performed to analyze the different characteristics and main influencing factors of the ecological environment and health literacy levels in this population. Results: The level of the ecological environment and health literacy level among medical students in Shiyan City was 24.3%. Different levels of ecological environmental and health literacy were observed among medical students by gender, grade, major and ethnicity ( χ 2=5.13, 54.87 , 64.71, 5.99, P <0.05). Higher rates were also observed among public health major students than among students of other majors. The first three classification literacy levels consisting of basic literacy, basic knowledge, and basic skills were 4.6%, 49.5 % and 50.4%, respectively. The possession rates of six secondary classification indicators were as follows:basic cognition ( 53.2 %), basic attitudes (34.5%), scientific knowledge (3.0%), behavioral knowledge (22.5%), cognitive skills (59.5%) and operational skills (48.6%). The results of multivariate Logistic regression showed that ethnic minorities and biomedical majors were negatively correlated with medical students ecological environment and health literacy ( OR =0.61,0.52), while female students, public health majors, sophomores and seniors were positively correlated with medical students ecological environment and health literacy ( OR=1.44, 1.95, 2.16, 2.24, P <0.05). Conclusions The overall level of ecological environment and health literacy among medical students in Shiyan City is low. Schools should popularize environmental health knowledge from different perspectives in order to improve the overall literacy level of environmental health literacy among medical students.

Objective:To investigate the differences in cerebral oxygen metabolism in healthy volunteers at three altitude areas by MR quantitative magnetic susceptibility imaging (QSM) combined with three-dimensional arterial spin labeling (3D-ASL).Methods:From March 2019 to October 2020, Zhengzhou Han Chinese volunteers recruited from the First Affiliated Hospital of Zhengzhou University, Xining Han Chinese volunteers recruited from the Fifth People′s Hospital of Qinghai Province, Lhasa Han Chinese volunteers and Tibetan volunteers recruited from Lhasa People′s Hospital were collected. They were divided into 21-30 age group, 31-40 age group, and 41-50 age group. All the volunteers underwent MR QSM combined with 3D-ASL sequence imaging, and oxygen extraction fraction (OEF) and cerebral blood flow (CBF) images of gray matter, and white matter were collected, OEF and CBF values were obtained, and cerebral metabolic rate of oxygen (CMRO 2) values were calculated. The comparison of various indicators among multiple groups was conducted using one-way ANOVA, and pairwise comparisons were conducted using LSD- t test. Results:A total of 132 volunteers were included, including 38 Han Chinese volunteers in Zhengzhou, 9 in the 21-30 age group, 13 in the 31-40 age group and 16 in the 41-50 age group; 27 Han Chinese volunteers in Xining, including 9 in the 21-30 age group, 8 in the 31-40 age group and 10 in the 41-50 age group; 34 Han Chinese volunteers in Lhasa, including 13 in the 21-30 age group, 11 in the 31-40 age group and 10 in the 41-50 age group; and 33 Tibetan volunteers in Lhasa, including 10 in the 21-30 age group, 10 in the 31-40 age group and 13 in the 41-50 age group. In the group aged 21-30 years, the overall difference in brain gray matter OEF values among volunteers from different altitudes was statistically significant ( P<0.05), with statistically significant differences in OEF values between Tibetans in Lhasa and Han Chinese in Xining, Han Chinese in Lhasa ( P<0.05). The overall difference in CMRO 2 values in the gray matter of volunteers at different altitudes was statistically significant ( P<0.05), with significant differences in CMRO 2 values between Lhasa Tibetan and Han Chinese in Zhengzhou, Han Chinese in Xining, Han Chinese in Lhasa ( P<0.05). In the 31-40 age group, there were statistically significant differences in the overall CBF values of gray and white matter among volunteers from different altitudes ( P<0.05). Among them, there were statistically significant differences in the CBF values of gray and white matter between Han Chinese in Zhengzhou and Han in Xining, Han Chinese in Lhasa, Lhasa Tibetan ( P<0.05). The overall differences in OEF values of gray matter and white matter among volunteers at different altitudes were statistically significant ( P<0.05). Among them, there were statistically significant differences in OEF values of gray matter and white matter between the Han Chinese in Zhengzhou and the Han Chinese in Xining, the Han Chinese in Lhasa ( P<0.05). There was also a statistically significant difference in OEF values of gray matter and white matter between the Han Chinese in Lhasa and the Tibetan in Lhasa ( P<0.05). The overall difference in CMRO 2 values in gray and white matter among volunteers from different altitudes was statistically significant ( P<0.05). Among them, there was a statistically significant difference in CMRO 2 values of cerebral gray matter between Lhasa Tibetans and Zhengzhou Han, Xining Han, Lhasa Han ( P<0.05), and there was a statistically significant difference in CMRO 2 values of cerebral white matter between Lhasa Tibetans and Zhengzhou Han, Lhasa Han ( P<0.05). Conclusions:The cerebral oxygen metabolism of Tibetan living in the plateau is characterized by low oxygen consumption, low blood oxygen dependence and high tissue oxygen utilization. The CMRO 2 of the Han people who migrated to the plateau for a long time is maintained at a certain level, similar to that in the plain area. The effects of age factors on CBF, OEF and CMRO 2 are small.