OBJECTIVE To analyze the comprehensive intervention measures to raise the etiological submission rate for hospitalized patients before antimicrobial treatment and evaluate the effect.METHODS The hospitalized pa-tients who were treated with therapeutic antibiotics in the Affiliated Hospital of Inner Mongolia Medical University from Jan.2023 to Jun.2023 were assigned as the exploratory analysis phase,the hospitalized patients who were treated with therapeutic antibiotics from Jul.2023 to Dec.2023 were assigned as the first post-intervention phase,and the hospitalized patients who were treated with therapeutic antibiotics from Jan.2024 to Mar.2024 were as-signed as the second post-intervention phase.The related indexes for etiological submission rate before the antimi-crobial treatment were compared before and after the intervention.RESULTS After the comprehensive interven-tion,the etiological submission rate of the entire hospital before the antimicrobial treatment was increased from 28.30％to 42.22％in the first post-intervention phase and 55.86％in the second post-intervention phase.The etio-logical submission rate with respect to diagnosis of hospital-associated infection was increased from 68.34％before the intervention to 85.85％in the first post-intervention phase and 94.58％in the second post-intervention phase.The incidence of hospital-associated infection showed a slight downward trend,dropping from 1.51％to 1.27％in the first post-intervention phase and 1.11％in the second post-intervention phase.The proportion of submission of sterile samples showed a slight upward trend,which was 26.13％before the intervention,29.57％in the first post-intervention phase,28.96％in the second post-intervention phase.There were significant differences in the a-bove indexes(P＜0.05).The etiological submission rate before the combined use of key drugs was increased from 84.71％to 85.95％in the first post-intervention phase and 88.33％in the second post-intervention phase,and there was no significant difference.CONCLUSIONS The etiological submission rate of the hospitalized patients be-fore the antimicrobial treatment is remarkably raised by taking the comprehensive intervention measures,but the etiological submission rate before the combined use of key drugs does not meet the standard,the proportion of submission of the sterile samples is not remarkably raised.It is necessary to continuously complete the intervention measures in the next phase.

OBJECTIVE To analyze the comprehensive intervention measures to raise the etiological submission rate for hospitalized patients before antimicrobial treatment and evaluate the effect.METHODS The hospitalized pa-tients who were treated with therapeutic antibiotics in the Affiliated Hospital of Inner Mongolia Medical University from Jan.2023 to Jun.2023 were assigned as the exploratory analysis phase,the hospitalized patients who were treated with therapeutic antibiotics from Jul.2023 to Dec.2023 were assigned as the first post-intervention phase,and the hospitalized patients who were treated with therapeutic antibiotics from Jan.2024 to Mar.2024 were as-signed as the second post-intervention phase.The related indexes for etiological submission rate before the antimi-crobial treatment were compared before and after the intervention.RESULTS After the comprehensive interven-tion,the etiological submission rate of the entire hospital before the antimicrobial treatment was increased from 28.30％to 42.22％in the first post-intervention phase and 55.86％in the second post-intervention phase.The etio-logical submission rate with respect to diagnosis of hospital-associated infection was increased from 68.34％before the intervention to 85.85％in the first post-intervention phase and 94.58％in the second post-intervention phase.The incidence of hospital-associated infection showed a slight downward trend,dropping from 1.51％to 1.27％in the first post-intervention phase and 1.11％in the second post-intervention phase.The proportion of submission of sterile samples showed a slight upward trend,which was 26.13％before the intervention,29.57％in the first post-intervention phase,28.96％in the second post-intervention phase.There were significant differences in the a-bove indexes(P＜0.05).The etiological submission rate before the combined use of key drugs was increased from 84.71％to 85.95％in the first post-intervention phase and 88.33％in the second post-intervention phase,and there was no significant difference.CONCLUSIONS The etiological submission rate of the hospitalized patients be-fore the antimicrobial treatment is remarkably raised by taking the comprehensive intervention measures,but the etiological submission rate before the combined use of key drugs does not meet the standard,the proportion of submission of the sterile samples is not remarkably raised.It is necessary to continuously complete the intervention measures in the next phase.

Objective To explore the effect of Xiongcan Yishen Formula on ferroptosis in testicular tissue of male rats with late-onset hypogonadism(LOH).Methods A total of 48 male Sprague-Dawley rats aged 6 months were randomly divided into model group,low-dose and high-dose Xiongcan Yishen Formula groups and propionate testosterone group,with 12 rats in each group.An additional 6 male Sprague-Dawley rats aged 8 weeks were set as the normal group.Except for the normal group,the rats were intraperitoneally injected with Cyclophosphamide at a dose of 20 mg/(kg·d)for 5 consecutive days to establish the LOH model,while the normal group received an equal volume of physiological saline for 5 days.The normal group and model group were given equal volumes of distilled water by gavage,while the low-dose and high-dose Xiongcan Yishen Formula groups were administered concentrated decoction at doses of 10.4 g and 41.6 g/kg/d respectively,and the propionate testosterone group received intramuscular injections of 5.21 mg/kg/d propionate testosterone,all for 28 consecutive days.ELISA was used to detect serum testosterone levels in rats,HE staining and transmission electron microscopy were used to observe the gross morphology of testicular tissue and the ultrastructure of Leydig cells,and RT-qPCR and Western blotting were used to detect the expression of ferroptosis-related genes and proteins in testicular tissue.Results The LOH model rats exhibited pathological changes such as atrophy of seminiferous tubules,structural disorder,and reduced spermatocytes in the lumen,as well as ultrastructural changes in Leydig cells including altered nuclear morphology,increased mitochondrial density,and reduced cristae.After intervention with Xiongcan Yishen Formula and propionate testosterone,the pathological changes in testis and the ultrastructure of Leydig cells were improved.Compared with the normal group,serum testosterone levels in the model group were significantly decreased(P＜0.05),the expression of ROS,ACSL4 mRNA and protein in testicular tissue was significantly increased,while the expression of FTH1,GPX4,and SLC7A11 mRNA and protein was significantly decreased(P＜0.05).Compared with the model group,ser-um testosterone levels in the low-dose and high-dose Xiongcan Yishen Formula groups and the propionate testosterone group were significantly increased(P＜0.05),and the expression of ROS,ACSL4 mRNA and protein was significantly decreased(P＜0.05);the high-dose Xiongcan Yishen Formula group showed significantly increased expression of FTH1,GPX4,and SLC7A11 mRNA and protein(P＜0.05).Conclusion Ferroptosis in testicular tissue is increased in LOH rats,and Xiongcan Yishen For-mula can elevate serum testosterone levels and improve pathological changes and ultrastructure in testicular tissue of LOH rats,possibly related to the inhibition of ferroptosis in testicular tissue of LOH rats.

Objective To evaluate the efficacy and safety of a novel intravascular lithotripsy(IVL)balloon—Vesscrack shockwave balloon—for vascular preparation before stent implantation in patients with severe coronary artery calcification(CAC).Methods This was a prospective,single-arm,multicenter study conducted in China from June 2022 to October 2022.Patients with severe CAC were treated with the Vesscrack shockwave balloon for lesion preparation,followed by drug-eluting stent(DES)implantation.Of these,33 patients underwent optical coherence tomography(OCT).The primary endpoint was procedural success,defined as successful stent implantation with residual stenosis≤30％and the absence of in-hospital major adverse events,including cardiac death,target vessel-related myocardial infarction,or target lesion revascularization.Results A total of 170 patients[mean age:(65.9±7.9)years,116 males]were enrolled.After treatment with IVL and DES,the minimum lumen diameter increased significantly compared to baseline[(2.34±0.40)mm vs.(0.95±0.33)mm,P＜0.001],the degree of stenosis was significantly reduced[(13.24±6.60)％vs.(65.18±10.59)％,P＜0.001].Procedural success was achieved in 100％of cases,and device success was 98.8％.The 30-day patient-related cardiovascular clinical composite endpoint(POCE)rate was 0.0,with no target lesion failure,no confirmed or potential thrombotic events were observed.The shockwave energy generator demonstrated excellent stability and ease of use.Among the 33 patients assessed with OCT,after IVL intervention,the maximum calcified area of the lumen[(3.51±1.51)mm2 vs.(2.85±1.80)mm2,P＜0.001],and the minimum lumen area within the target lesion[(3.08±1.04)mm2 vs.(2.02±0.75)mm2,P＜0.001],and after DES intervention,the luminal area of the largest calcified site[(6.59±1.64)mm2 vs.(2.85±1.80)mm2,P＜0.001]and the minimum luminal area within the target lesion[(6.19±1.45)mm2 vs.(2.02±0.75)mm2,P＜0.001]were significantly increased,and the differences were statistically significant.Conclusions The Vesscrack shockwave balloon is effective and safe for vascular preparation in patients with severe CAC prior to stent implantation.It achieves significant calcified plaque modification,high procedural success rates,and minimal complications.

Conventional X-ray coronary angiography using iodinated contrast media is the gold standard technique for diagnosing coronary artery disease and determining treatment strategies,including percutaneous coronary intervention(PCI).However,severe allergy to iodinated contrast agents and renal insufficiency,as well as severely hyperthyroid patients,limit the use of iodinated contrast agents,especially in the face of acute coronary syndromes requiring emergency PCI.Gadolinium-based contrast agent is mainly developed for use in magnetic resonance imaging examinations,and there are few studies on whether it can be used for coronary angiography.We report a case of a patient who had a severe allergic reaction to an iodine contrast agent,and ultimately had a successful complex coronary intervention guided by the application of Gadolinium-based contrast agent combined with intravascular ultrasound.This case and a review of the relevant literature provide new ideas for coronary artery examination and treatment in patients with contraindications to iodine.

Objective:To compare the the cultivation effects of human embryos in dry and humid incubators.Methods:A total of 479 infertile patients who underwent in vitro fertilization (IVF) treatment at Reproductive Center of Guiyang Maternal and Child Health Care Hospital from October 2020 to April 2022. The study was divided into two stages. The first stage of the study was a self-comparative research with 95 cases from the same period and source. The embryos were divided into dry and humid incubator groups to compare the embryo development indicators. In the second stage of the study, the patients were divided into six groups, including 10 μL humid incubator group ( n=64), 20 μL humid incubator group ( n=64), 30 μL humid incubator group ( n=64), 10 μL dry incubator group ( n=64), 20 μL dry incubator group ( n=64), and 30 μL dry incubator group ( n=64). The general clinical data, embryo development indicators, pregnancy outcomes, and the osmotic pressure and pH values of each group at 24 h, 48 h and 72 h were detected and compared. Results:After cultivation of the same patient's embryos in dry and humid incubator, the total blastocyst formation rate [62.3% (162/260)] and high-quality blastocyst rate [24.6% (64/260)] in dry incubator were lower than those in the humid incubator [71.6% (252/352), P=0.015; 32.1% (113/352), P=0.043]. Compared with the other microdroplet groups, the osmotic pressure of cleavage culture medium in 10 μL group of dry incubator at 48 h and 72 h and blastocyst culture medium were significantly increased, the differences among the groups were significant (cleavage culture medium, all P<0.001; blastocyst culture medium, P=0.006, P=0.008). There was no significant difference in pH value among different microdroplet volume groups at the same period (all P>0.05). There were no significant differences in general data among the different microdroplet groups (all P>0.05). Compared with the other microdroplet groups, 10 μL dry incubator group exhibited significantly lower transferable embryo rate (all P<0.001). When compared with 20 μL and 30 μL groups in both dry and humid incubators, 10 μL dry incubator group showed a lower day 5 blastocyst formation rate, lower total blastocyst formation rate, and lower high-quality blastocyst formation rate, the differences among the groups were significant (all P<0.05). There were no significant differences in the number of transferred embryos, the ratio of cleavage-stage embryos and the ratio of high-quality embryos among different groups (all P>0.05). Compared with the other microdroplet groups, the clinical pregnancy rate, the embryo implantation rate, the live birth rate of fresh transplanted embryos and the cumulative pregnancy rate in 10 μL group in the dry incubator decreased, and the miscarriage rate increased, but all were not significant (all P>0.05). Conclusion:Compared with humid incubators, there are no significant differences in embryo development and pregnancy outcomes for droplet volumes of 20 μL or above in dry incubators. However, the 10 μL microdroplet culture in the dry incubator is not conducive to embryonic development, which may be related to the increased osmotic pressure of the microdroplet.

Objective:To discern the association between autism-like behaviors and resilience within the ado-lescent demographic.Methods:A total of 7 063 middle school students were selected to assess ASD-like behaviors and resilience in adolescents using the Autism Spectrum Screening Questionnaire(ASSQ)as well as the Resilience Scale for Chinese Adolescent(RSCA).Subgroups bounded by P5 and P95 of the total ASSQ score,a comparative analysis of the resilience scores between these groups was executed.A correlation evaluation and linear regression a-nalysis was carried out between ASSQ and RSCA scores from all participants.Results:The RSCA scores within the high ASSQ scoring group,were inferior to those in the low scoring group.ASSQ scores were negatively correlated with RSCA scores for the full sample(Ps＜0.01);Social interaction scores on the ASSQ were negatively correlated with the five-factor RSCA scores(β=-0.23,-0.27,-0.11,-0.23,-0.37,Ps＜0.05).Conclusion:There was a negative association between autism spectrum disorder-like behaviors and resilience in adolescents,with more severe social interaction symptoms being associated with poorer resilience.

Objective To investigate the role of the neutrophil-to-lymphocyte ratio(NLR)in predicting the in-hospital mortality risk of patients with acute aortic dissection(AAD)in multicenter hospitals.Methods A multicenter retrospective cohort study was conducted.Clinical data were collected from 2642 AAD patients who were hospitalized in five teaching hospitals:Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Henan Provincial People's Hospital,Fuwai Central China Cardiovascular Hospital,the Third Affiliated Hospital of Xinxiang Medical University,and the Second Affiliated Hospital of Chongqing Medical University between August 2010 and December 2021.According to the quartiles of serum NLRlevels,the patients were divided into four groups:first quartile(Q1,n=660),second quartile(Q2,n=661),third quartile(Q3,n=661),and fourth quartile(Q4,n=660).The clinical characteristics and biochemical indicators of each group were compared.Partial correlation analysis was used to assess the relationship between NLR and cardiovascular parameters.Restricted cubic splines,Kaplan-Meier survival analysis,and Cox regression models were employed to evaluate the association between NLR levels and in-hospital mortality risk in AAD patients.Results The median age of all patients was 54[interquartile range(IQR):46-63]years,including 2096 males and 546 females.Compared with Q1-Q3 groups,patients inQ4group had a lower incidence of smoking history and diabetes history,and were more likely to have DeBakey type Ⅰ AAD(P＜0.05).Additionally,the levels of aspartate aminotransferase,high-density lipoprotein cholesterol,creatinine,and D-dimer in Q4 group were higher,while the levels of triglycerides and C-reactive protein(CRP)were lower(P＜0.01).The results of partial correlation analysis showed that the plasma NLR level was positively correlated with D-dimer(r=0.43,P＜0.01)and creatinine(r=0.16,P＜0.01).The restricted cubic spline function in the Cox model revealed a significant non-linear relationship between the plasma NLR level and clinical outcomes in AAD patients(P＜0.01).Kaplan-Meier survival analysis indicated that patients in Q4 group had the highest in-hospital mortality rate compared with Q1-Q3 groups(P＜0.0001).Furthermore,multivariate Cox regression analysis demonstrated that compared with Q1 group,the hazard ratio(HR)of NLR in Q4 group was 1.77(95％CI 1.33-2.37,P＜0.001),which was an independent risk factor for the primary endpoint events.Conclusion A higher plasma NLR level is significantly associated with the occurrence of cardiovascular events in AAD patients,and this association remains significant even after adjusting for potential confounding factors such as the multicenter visiting hospitals.

Objective:To discern the association between autism-like behaviors and resilience within the ado-lescent demographic.Methods:A total of 7 063 middle school students were selected to assess ASD-like behaviors and resilience in adolescents using the Autism Spectrum Screening Questionnaire(ASSQ)as well as the Resilience Scale for Chinese Adolescent(RSCA).Subgroups bounded by P5 and P95 of the total ASSQ score,a comparative analysis of the resilience scores between these groups was executed.A correlation evaluation and linear regression a-nalysis was carried out between ASSQ and RSCA scores from all participants.Results:The RSCA scores within the high ASSQ scoring group,were inferior to those in the low scoring group.ASSQ scores were negatively correlated with RSCA scores for the full sample(Ps＜0.01);Social interaction scores on the ASSQ were negatively correlated with the five-factor RSCA scores(β=-0.23,-0.27,-0.11,-0.23,-0.37,Ps＜0.05).Conclusion:There was a negative association between autism spectrum disorder-like behaviors and resilience in adolescents,with more severe social interaction symptoms being associated with poorer resilience.

Objective:To explore the trajectory and predictors of depressive symptoms in disabled middle-aged and elderly adults in China.Methods:Survey data from the 2013-2020 China Health and Retirement Longitudinal Study (CHARLS) data of disabled middle-aged and elderly adults were selected to analyze the trajectory categories of depressive symptom in disabled middle-aged and elderly adults and to explore their predictors.Results:A total of 1 844 disabled middle-aged and elderly adults were analyzed for survey data. The trajectory of depressive symptoms in disabled middle-aged and elderly adults was categorized into four groups, including a low-level depression group, a depression remission group, a high-level depression group, and a depression worsening group. Logistic regression analyses revealed that gender, age, place of residence, chronic disease, self-rated health, social participation, cognition, and hearing ability were predictors of trajectories of depressive symptoms in disabled middle-aged and elderly adults.Conclusions:There is group heterogeneity in the trajectory of depressive symptoms among disabled middle-aged and elderly adults. Healthcare professionals can carry out targeted health management according to the characteristics of different categories of people.