Objective To understand the characteristics and the predictors of the distribution of exercise behavior stages in COPD patients after discharge from the hospital,and to provide a reference basis for the implementation of the whole process and continuous rehabilitation care decision-making.Methods Using the convenience sampling method,380 COPD patients who were hospitalized in the departments of respiratory medicine or geriatrics in 2 tertiary-level hospitals in Chongqing from February 2022 to February 2023 were selected for the study,and were followed up until 6 months after the patients were discharged from the hospital.Questionnaires were administered using the self-designed General and Disease-Related Information Questionnaire,Exercise Stages of Change Scale,Exercise Benefits and Barriers Scale,Exercise Self-Regulatory Efficacy Scale,Social Support Rate Scale and Hospital Anxiety and Depression Scale.Characteristics and predictors of exercise behavior in COPD patients after hospital discharge were analyzed using univariate analysis and ordered multicategorical logistic regression.Results The included 380 COPD patients of post-discharge exercise behavior were 53 cases(14.0％)in the pre-intentional stage,97 cases(25.5％)in the intentional stage,103 cases(27.1％)in the preparatory stage,75 cases(19.7％)in the action stage,and 52 cases(13.7％)in the maintenance stage.The age,monthly household income,daily chores,sleep,exercise habits,and history of the current inpatient rehabilitation,number of acute episodes in the last year,whether home oxygen therapy and regular use of medication for respiratory diseases,degree of dyspnea,perceived exercise benefit/impairment,social support,and depression were the main predictors of the distribution of the stages of exercise behavior in COPD patients after discharge from the hospital.Conclusion Most COPD patients did not develop regular exercise behavior habits after discharge,and the level of their exercise behavior was affected by a variety of factors,including individual characteristics,disease factors,decision-making balance,social support,and psychology,suggesting that healthcare professionals should develop personalized early exercise interventions according to the characteristics of the behavioral stage in which the patient is located in order to increase the long-term effects of the intervention.

Objective:To explore the characteristics of type 3 secretion system and biofilm of Pseudomonas aeruginosa in diabetic foot wound, and to analyze the relationship between these factors, as well as to the antibiotic sensitivity.Methods:Thirty-three strains of Pseudomonas aeruginosa were collected from the foot wounds of diabetic foot inpatients in Tianjin Medical University Chu Hsien-I Memorial Hospital from February 1, 2018 to December 31, 2018. Thirteen strains of Pseudomonas aeruginosa were collected from non-diabetic wounds. All strains were tested for antibiotic sensitivity. The virulence genes exoS or exoU of Pseudomonas aeruginosa and the ability of biofilm formation were tested. The characteristics of exoS or exoU and biofilm of Pseudomonas aeruginosa were analyzed. Patients′ clinical outcomes were also analyzed.Results:Pseudomonas aeruginosa with exoS gene was the major pathogen, 90.9% found in diabetic foot group and 84.6% in control group, with no significant difference( χ2=0.54, P=0.46). The drug-resistant strains of Pseudomonas aeruginosa with exoS accounted for 16.7% in diabetic foot group and 18.2% in control group, also with no significant difference( χ2=0.18, P=0.83). There were 5 strains of Pseudomonas aeruginosa carrying exoU, 3 strains in diabetic foot group, of which 1 was resistant, 2 in control group, no resistant strain. Pseudomonas aeruginosa increased the ability of biofilm formation in diabetic foot group, accounting for 57.6%, and for resistant strains, 83.3% of them increased the biofilm formation ability. Two kinds of Pseudomonas aeruginosa produced different biofilms, but they were effectiveless for carbapenem antibiotics. The times of debridement ( P<0.01), time of antibiotic use ( P<0.01) were more in biofilm wound, but the healing rate reached 75%-90%. Conclusion:Pseudomonas aeruginosa secreting ExoS is the main one in the diabetic foot wound. The ability of Pseudomonas aeruginosa to produce biofilm in DF wound is increased. Biofilm is one reason for its antibiotic resistance. Multiple debridement combined with sensitive antibiotics is an effective method to remove biofilm.

To investigate a new teaching model so as to improve the teaching and learning efficiency of pharmaceutical analysis, a total of 61 undergraduates who majored in chemistry (pharmacy) were chosen as the trainees. The teaching reform based on Aalborg PBL model was conducted from such three aspects as teaching contents, teaching manners and assessment methods. Under the new teaching model, students' learning interest could be improved significantly, and their knowledge understanding, mastery and application were enhanced. Besides, the students' abilities of team work and communication were also cultivated.

Objective To evaluate the value of proteinuria in predicting acute kidney injury (AKI) after cardiac surgery in elderly patients.Methods To retrospectively analyze the perioperative clinical data of elderly patients (age 60 or older)undergone cardiac surgery with cardiopulmonary bypass at Guangdong General Hospital from January 2005 to December 2010.Target patients were divided into two groups according to AKI defined by the KDIGO criteria.Data for those two groups were examined by single-factor analysis,and then logistic regression analysis was used to further determine independent factors of AKI after cardiac surgery.Results Among 848 elderly patients,AKI occurred in 524(61.8％) participants,including 39.2％(n=332)at AKI stage 1,16.6％ (n =141) at AK I stage 2,and 6.0 ％ (n=51) at AKI stage 3.A total of 15.9 ％ of patients(n=135) had preoperative proteinuria,including 12.4 ％ (n =106) with mild proteinuria,and 3.5 ％ (n =30) with heavy proteinuria.Logistic regression analysis showed that proteinuria was correlated with postoperative AKI.With the increase of proteinuria,the risk of AKI also increased,and the OR values of mild and severe proteinuria were 1.758 (1.020-3.029) and 4.758 (1.326-17.077),respectively.Conclusions Preoperative proteinuria may predict the occurrence of AKI after cardiac surgery in elderly patients.There is a gradual increase in the risk of AKI as proteinuria becomes more severe.Early institution of therapeutic interventions may be used in elderly patients with preoperative proteinuria undergoing cardiac surgery to attenuate the risk of AKI.

Theory of treatment from spleen is being widely applied in in the process of Chinese medical therapies and had already shown its clinical efficacy. The purpose of this paper was to explain this theory in the fields of the theoretical contents, physiology, pathology and clinical practices.

Objective To investigate the serum expressions and clinical significance of Dickkopf-1 in patients with rheumatoid arthritis (RA). Methods The clinical data of 139 patients with RA were retrospectively analyzed, including the disease history, tender joint count (TJC), swollen joint count (SJC), platelet, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-nuclear antibody (ANA), antikeratin antibody (AKA), anti-perinuclear factor (APF), anti cyclic citrullinated peptide antibody (anti-CCP), Dickkopf-1 and radiological (X-ray) staging. The disease activity scale (DAS) was evaluated, and the ESR and CRP levels were included. The relationship between Dickkopf-1 and the clinical data of RA, DAS44 score was analyzed. Results The serum level of Dickkopf-1 in patients with RA was (2.70 ± 0.46) μg/L. There was no relationship between serum Dickkopf-1 level and gender, age, course of disease, CRP, platelet, ANA, AKA, APF, RF, radiological staging in patients with RA (P>0.05). The serum Dickkopf-1 level was significantly associated with TJC, SJC, ESR, DAS44-ESR score, DAS44-CRP score and anti-CCP (r = 0.200, 0.291, 0.178, 0.222, 0.199 and 0.278, P = 0.019, 0.001, 0.037, 0.009, 0.028 and 0.012). Conclusions The serum Dickkopf-1 expression level is closely related to the occurrence and development of RA. Dickkopf-1 may contribute to diagnose the disease activity in patients with RA.

Objective To investigate the effect of polyphenol of salvia miltiorrhiza polyphenols combined with collagen sponge in the treatment of diabetic foot.Methods A total of 115 patients with type 2 diabetic foot were randomly divided into treatment group (55 cases) and control group (60 cases).Salvia miltiorrhiza polyphenols and collagen sponge treatment group were treated with conventional treatment plus type 2 diabetes treatment of salvia miltiorrhiza polyphenol combined with collagen sponge;4 weeks as a treatment course, observation of 8 weeks, ulcer and other adverse reactions were recorded and compared.Results After 4 weeks of treatment, 17 cases (30.91%) with 30% or more reduction in foot ulcer area in treatment group,33 cases (60.00%) after 6 weeks treatment and the number of cases with 30% or more reduction in foot ulcer area,49 cases (89.09%) after 8 weeks of treatment, and the number of cases and the proportion of cases with 30% or more decrease of ulcer area in the control group after 4, 6 and 8 weeks were 12(20.00%), 22 (36.67%) and 39 (65.00%).There was no statistical difference between the two groups for the healing time of foot ulcer at three time points.After 8 weeks of treatment, the cure rate was 38.18% in salvia miltiorrhiza polyphenol combined with collagen sponge group. The effective rate was 50.91% and 45.00% for the two groups, the difference was not statistically significant; while the total effective rate was also significantly higher(89.09% vs.65.00%,P<0.01).Conclusion Salvia miltiorrhiza polyphenol combined with collagen sponge has a good effect on diabetic foot treatment, especially it can improve the cure rate, which is superior to the routine therapy.

Objective To investigate the possible mechanisms of glucagon-like peptide 1 receptor agonists (GLP-1Ra) protection against hyperglycemic induced beta cell apoptosis through depression of NOX2-dependent ROS production. Methods The rat model of type 2 diabetes (T2DM) was established by injecting small doses of streptozotocin (STZ) fol?lowed by 8-week high fat diet. The experimental animals were divided into three groups:normal control (N) group, diabetes (T2DM) group and GLP-1Ra group [treated with liraglutide 200 μg/(kg · d)for 12 weeks]. The blood glucose levels were compared before and after modeling, before treatment and 12-week after treatment with GLP-1Ra. The level of glycosylated hemoglobin (HbA1c) was detected by high-pressure liquid chromatography. Automatic biochemical analyzer was used to de?tect levels of aspertate aminotransferase (AST), creatinine (CR) and urea nitrogen (BUN). The apoptotic rates of islets were determined by TUNEL method and cleaved caspase 3 was detected by immunohistochemistry. DCFH-DA fluorescent probe was used to detect reactive oxygen species (ROS) levels of islets. Levels of NADPH oxidase (NOX) catalytic subunit (NOX 2) in islets were measured by immunohistochemistry. Results At the end of the study, glycemic control (average blood glucose/week and HbA1c) and lipid situation were improved significantly in the GLP-1Ra group than those of N group (P<0.05). TUNEL staining and displayed thatβcell apoptotic and cleaved caspase 3 level were significantly decreased in GLP-1Ra group compared to those of T2DM group (P<0.05). ROS levels were significantly decreased in GLP-1Ra group than those of T2DM group before treatment with Apocynin, but no significant difference between GLP1-Ra group and N group (P>0.05). After application Apocynin for inhibition, there were no significant differences between three groups (P>0.05). The level of NOX2 was significantly lower in GLP-1Ra group compared to that of T2DM group (P<0.05). Conclusion GLP-1Ra can inhibit apoptosis ofβcells in diabetes rat, and the depression of NOX2-dependent ROS may be one of the important underly?ing mechanisms.

Objective To observe the effects of high glucose and anoxia on Amot expression in vascular endothelial cells (VECs),and explore its role in angiogenesis.Methods VECs were incubated with different glucose concentrations for 48 h,and then cultured at normal oxygen concentration or anaerobic condition for 24 h.The protein expressions of p130-Amot and p80-Amot were detected by Western blot.After Amot expression was downregulated in VECs by siRNA,wound healing experiments and angiogenesis experiments were performed to test the effect of decreased Amot expression on angiogenesis.Results pl30-Amot protein expressions in low glucose (5.5mmol/L) plus normal oxygen group and low glucose plus anaerobic group were higher than those in high glucose (30mmol/L) plus normal oxygen group,high glucose plus anaerobic group,middle glucose (15 mmol/L) plus normal oxygen group,and middle glucose plus anaerobic group (all P＜0.01).Compared with low glucose plus anaerobic group,p130-Amot expression was higher in low glucose plus normal oxygen group (P ＜ 0.01).However,the expression of p80-Amot showed no statistically significant difference among different groups (P＞0.05).Compared to the normal VECs,the cells with decreased Amot expression by siRNA exhibited an attenuated cell migration in the wound healing experiments and a lesser tube formation in the angiogenesis experiments.Conclusions High glucose exerts a more significantly negtive effect on the Amot expression than anoxia in VECs.The downregulation of Amot expression inhibits migration and angiogenesis of VECs.

Objective To investigate the clinical features and antibiotic susceptibility of osteomyelitis infected by Gram-negative bacteria (G-) in patients suffered from diabetic foot ulcers (DFU). Methods The clinical data of 91 DFU pa-tients accompanied with osteomyelitis (DFO) were retrospective studied. These patients hospitalized in the Tianjin Metabolic Diseases Hospital were divided into two groups, Gram-negative bacteria (G-) group (n=44) and Gram-positive bacteria (G+) group (n=42), respectively. The clinical features were compared between two groups. Logistic regression analysis was used to determine the risk factors for Gram-negative bactreial infection. The Gram-negative antibiogram was summarized. Results A total of 112 pathogens were isolated from 91 patients. G-bacteria were the most frequent pathogens (48.2%), following by G+ bacteria (47.3%) and fungi (4.5%). Pseudomonas aeruginosa was the majority of the G-bacteria. Comparing the two groups, the rate of antibiotic use within the previous 6 months was significantly higher in G-group (75.0%) than that of G+group (52.4%, P<0.05). There were no significant differences in the other indicators between two groups. The Logistic re-gression analysis revealed that the history of antibiotic use was the independent risk factor of G-bacterial infections in DFO patients. Antibiotics susceptibilities reflected G- bacteria were more prevalent to resist to cephalosporins and quinolonem, but sensitive to imipenem, ceftazidine and cefperazone-sulbactam. Conclusion Gram negative bacteria were not only the main pathogens isolated from DFO patients, but also frequently resistant to several popular antibiotics in China. The proper bacteria culture and antibiotic sensitivity test are especially emphasized to patients with DFU.