Objective:To investigate the drug-resistant gene characteristics and core genome characteristics of carbapenem-resistant Enterobacter cloacae (CR-ECL) in rural residents of Weifang City, Shandong Province. Methods:Fecal samples were collected from rural community residents in Weifang City, Shandong Province in 2017. Drug-resistant strains were screened using a carbapenem-resistant enterobacter chromogenic medium. CR-ECL positive strains were acquired via Matrix Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry(MALDI-TOFMS) analysis. The antibiotic resistance phenotype of CR-ECL was determined using a microbroth dilution assay. Whole genome sequencing (WGS) and analysis were conducted, along with an examination of the immediate vicinity of the blaNDM gene and phylogenetic analysis of the strains. Results:A total of 628 fecal samples were collected and tested, of which 6 were CR-ECL positive (detection rate 0.96%), all exhibiting multiple drug resistance (MDR) phenotypes. Six CR-ECL strains had four MLST genotypes (ST), all of which carried multiple drug resistance genes ( blaNDM-1, blaNDM-5, etc.) and virulence genes ( acrA, acrB, entB, fepC, etc.). There were mobile genetic elements ISAba125, TN3-IS3000, TN3 and IS5 in the genetic environment surrounding the blaNDM gene. The phylogenetic tree showed that the multi-locus sequence typing of the core genome (cgMLST) was consistent with the single nucleotide polymorphism (SNPs) results. The cgMLST results showed that the allele differences between strains 2BC0101B and 2BC0251B, 2BG0561B and 2BI0221B were 2 and 1, respectively. The SNPs results showed that the above two pairs of bacteria also clustered together. It was found that the strains of chicken fecal samples in the National Center for Biotechnology Information (NCBI) database were located in the center of the evolutionary tree, and the local sequences could be traced back to American human sequences. Conclusion:Multidrug-resistant CR-ECL is detected in rural community residents in Weifang City, Shandong Province.

Objective To investigate the temporal properties of dynamic functional connectivity of brain networks and the variability of network topology in patients with end-stage renal disease(ESRD).Methods Data of 30 ESRD patients(ESRD group)and 33 healthy subjects(control group)were retrospectively analyzed.Based on cranial resting-state functional MRI(rs-fMRI),dynamic functional connectivity(dFC)and graph theory analysis were employed,and the abnormalities in network topology and dFC in ESRD patients were assessed through comparison of groups.Pearson correlation analysis was used to observe the correlation between abnormal dFC indicators and clinical variables.Results Compared with control group,temporal scores and the mean residence time in ESRD group were significantly higher under state Ⅱ but significantly lower under state Ⅲ(both P＜0.05).The abnormal functional connectivity in ESRD patients under states Ⅱ and Ⅲ distributed mainly within and between default mode network,sensorimotor network,subcortical nuclei,execution and attention network,visual network and cerebellum networks.Network density and bilateral superior temporal gyrus nodal degrees in ESRD group were all significantly lower than those in control group(all P＜0.05).No significant correlation was found between the abnormal parameters of functional connectivity and graph theory attributes in ESRD group and clinical indicators under states Ⅱ nor Ⅲ(all P＞0.05).Conclusion ESRD patients had abnormal temporal attributes and network topology of brain dynamic networks related to cognitive impairments.

Objective To indentify the cognitive status of Chinese patients to acne and the influencing factors to theirs' cognitive status,so as to provide solid evidences for the prevention and treatment of acne.Methods A self-designed questionnaire was made to conduct this survey of 16,156 acne patients,who seeked to the treatment in the dermatological departments from 112 hospitals in China.The survey consisted of several parts,including the general status of patients,the patients' cognition of occurrence,development and risk factors of acne,whether the first choice was seeking treatment at the hospital when the patients had acne and the condition of selection of skin care products.The factors were analyzed,which could impact the cognition of the patients' behavior of treatment,how did the patients' cognition to influence their medical behavior and skin care as well as the consistency of assessment of the severity of acne by doctors and patients themselves.Results The acne patients studied had the best knowledge of "acne is a skin disease","it not only occurs in the period of adolescence" and "the disease can be prevented and cured",which accordingly accounted for 80.65％,69.16％ and 65.49％ of the total patients respectively.However,the awareness of acne patients to heredity,high sugar and dairy products as risk factors for acne was insufficient,which accounted for 48.72％,42.40％ and 18.25％ of the total patients,respectively.Gender,age,educational level,occupation and health knowledge were the main factors affecting the cognitive level of patients;the survey also found that men,patient with educational level of junior high or even lower educational condition,occupation of labor workers or farmers and patients were lack of health education with poor knowledge of the genetics and dietary were risk factors for acne;patients with age over 36 years or with mild illness had poor knowledge of dietary risk factors for acne;the difference was statistically significant (P＜0.05).The analysis of the influence of cognitive status on medical treatment behavior and skin care showed that the better the cognition,the higher the probability of patients would choose medical treatment as the first choice as well as choosing functional skin care products;the difference was statistically significant (P＜0.05).The consistency of assessment of the severity of acne by doctors and patients was poor (Kappa value ＜0.4),and the assessment of severity of acne by patients was more serious than doctors' assessment.Conclusions Patient's cognitive status will affect their medical behavior and skin care,and there is also a phenomenon that patients have a more serious assessment of their acne condition.It is suggested that health education for acne patients should be strengthened in clinical medicine so as to improve their knowledge of acne as well as preventing from acne effectively.

Objective To preliminarily understand the current status of medication safety management of medical institutions in China. Methods Medication Safety Panel in China Core Group of International Network for the Rational Use of Drugs (INRUD) and Chinese Pharmacological Society Professional Committee of Drug-induced Diseases jointly established a research group. Basing on the voluntary principle,members (medical institutions)of the group did medication safety self-assessment using the questionnaires of "2011 ISMP Medication Safety Self Assessment? for Hospitals (Chinese version)", which included 10 key elements,20 core indicators,and 270 assessment projects. The questionnaires were handed out on August 17,2018 and needed to be completed and submitted within 2 months. Results As of October 19,2018,67 hospitals of 16 provincial administrative regions in total had submitted their questionnaires,including 61 (91. 0％)3A hospitals and 6 (9％)2A hospitals. The average value of total scores of medication safety self-assessment in the 67 hospitals was 58. 9％ (7. 6％ -90. 0％). None of the 67 hospitals evaluated the key element Ⅵ(medication device acquisition,use,and monitoring). The scores of the other 9 key elements from high to low were 67. 6％,66. 2％,65. 1％,64. 8％,64. 1％,58. 2％, 54. 5％,54. 4％,and 52. 5％ respectively for element Ⅶ (environmental factors,workflow and staffing patterns),element Ⅳ(drug labeling,packaging and nomenclature),element Ⅸ (patient education), element Ⅲ(communication of drug orders and other drug information),element Ⅷ (staff competency and education),element Ⅴ(drug standardization,storage and distribution),element Ⅹ (quality processes and risk management),element Ⅰ (patient information),and element Ⅱ (drug information). Conclusion The data of medication safety from 67 hospitals of 16 provincial administrative regions were obtained through the first national self-assessment questionnaire survey in medical institutions,which initially reflected the current status of medication safety in medical institutions in China.

Objective To preliminarily understand the current status of medication safety management of medical institutions in China. Methods Medication Safety Panel in China Core Group of International Network for the Rational Use of Drugs (INRUD) and Chinese Pharmacological Society Professional Committee of Drug-induced Diseases jointly established a research group. Basing on the voluntary principle,members (medical institutions)of the group did medication safety self-assessment using the questionnaires of "2011 ISMP Medication Safety Self Assessment? for Hospitals (Chinese version)", which included 10 key elements,20 core indicators,and 270 assessment projects. The questionnaires were handed out on August 17,2018 and needed to be completed and submitted within 2 months. Results As of October 19,2018,67 hospitals of 16 provincial administrative regions in total had submitted their questionnaires,including 61 (91. 0％)3A hospitals and 6 (9％)2A hospitals. The average value of total scores of medication safety self-assessment in the 67 hospitals was 58. 9％ (7. 6％ -90. 0％). None of the 67 hospitals evaluated the key element Ⅵ(medication device acquisition,use,and monitoring). The scores of the other 9 key elements from high to low were 67. 6％,66. 2％,65. 1％,64. 8％,64. 1％,58. 2％, 54. 5％,54. 4％,and 52. 5％ respectively for element Ⅶ (environmental factors,workflow and staffing patterns),element Ⅳ(drug labeling,packaging and nomenclature),element Ⅸ (patient education), element Ⅲ(communication of drug orders and other drug information),element Ⅷ (staff competency and education),element Ⅴ(drug standardization,storage and distribution),element Ⅹ (quality processes and risk management),element Ⅰ (patient information),and element Ⅱ (drug information). Conclusion The data of medication safety from 67 hospitals of 16 provincial administrative regions were obtained through the first national self-assessment questionnaire survey in medical institutions,which initially reflected the current status of medication safety in medical institutions in China.

Objective To compare the T-lymphocyte subpopulations,complement C3,C4 and HBV-DNA in the peripheral blood of patients with chronic hepatitis B under different liver function.Methods A total of 136 patients with chronic hepatitis B were selected,the patients were divided into improved group and deteriorated group according to the changes of hepatic function.T-lymphocyte subpopulations,complement C3,complement C4 and HBV-DNA in two groups were determined.Results A total of 72 patients were included in improved group,64 patients were included in deteriorated group.CD4+ in deteriorated group was significantly decreased,and CD8+ was significantly increased compared with those in improved group(P<0.05),CD3+ had no statistical difference between the two groups(P>0.05).Complement C3 and complement C4 in deteriorated group decreased compared with those in the improved group(t=12.124,P=0.003;t=4.041,P=0.010).However,HBV-DNA had no statistical difference between two groups(t=-2.598,P=0.793 ).Conclusion Compared with T-lymphocyte subpopulations,complement C4 and HBV-DNA,complement C3 has a better sensitivity to reflect the damage of the hepatic function in patients with chronic hepatitis B.

Objective To analyze the diagnostic value of fluorescence polarization assay (FPA) for human brucellosis.Methods From April 2013 to August 2014,240 positive sera of brucella patients were collected as case group and 287 normal sera as control group in Heilongjiang Agricultural Reclamation Bureau General Hospital.Four milliliters of venous blood were withdrawn for separation of serum.Fluorescence polarization assay was used and the consistency,sensitivity and specificity were compared with those of four classical serological methods,including rose bengal plate agglutination test (RBPT),standard tube agglutination test (SAT),Coomb's test and cysteine test.Results The results of FPA were complied with those of the four conventional serological methods,Kappa ≥ 0.75.The sensitivity of FPA (89.17％) was higher than that of RBPT (87.08％),SAT (85.00％),Coomb's (74.17％) and cysteine test (75.83％).The specificity of FPA (94.08％) was higher than that of RBPT (89.90％) and Coomb's (81.53％),but lower than that of SAT (98.95％) and cysteine test (99.30％).Conclusion FPA can be used as a laboratory diagnostic method for human brucellosis,which is worthy to be widely used.

Objective This study aimed to discuss the different assessment of pain among medical and nursing staff and cancer patients and supply reference for proper analgesic precept for clinical application and nursing measures. Methods We collected the assessment of psychological pain and physiological pain by 55 hospitalization cancer patients, 40 physicians in-charge and 55 nurses in-charge in one week by Johnson inventory. The assessment results were compared and at the same time the relevant problems of the attitude to cancer pain by patients was also investigated. Results Improper recognition existed in cancer pain treatment by most cancer patients. The physiological pain was higher than the psychological pain assessed by both patients and nurses (P<0.05). But the pain assessment by patients was higher than that by the nurses (P<0.05). The assessment of psychological pain was higher than the physiological pain by doctors and both aspects were lower than those by patients, but no statistical difference was seen (P>0.05). The assessment by doctors was more accurate than that by nurses. Conclusions Routine establishment of pain assessment inventory for patients could instruct patients how to record the degree of their pain. We should strengthen the standard training about pain management knowledge and give timely communication with patients' cancer pain.