Objective To investigate the effect of Yiqi Huoxue Tongluo Decoction on microRNA-126a-5p(miR-126a-5p)and vascular endothelial growth factor(VEGF)signaling pathway in cervical spondylotic myelopathy model rats.Methods Thirty healthy male SD rats were divided into the sham operation group,the model group and the traditional Chinese medicine(TCM)group by random number table method.Cervical spondylotic myelopathy models were prepared in the model group and the TCM group.The TCM group was given intragastric administration of Yiqi Huoxue Tongluo Decoction,while the sham operation group and the model group were given intragastric administration of normal saline for 12 weeks.After intervention,the threshold of mechanical stimulation and retraction time of thermal stimulation in each group were measured by behavior tests.Rats were sacrificed to collect intervertebral disc tissue for hematoxylin-eosin(HE)staining and observe the number of vascular buds in intervertebral disc.Rat intervertebral disc annulus fibrosus cells were subjected to terminal dexynucleotidyl transferase-mediated dUTP nick end labeling(TUNEL)staining.The miR-126a-5p and VEGF mRNA of rat intervertebral disc tissue were detected by real-time fluorescence quantitative polymerase chain reaction(RT-PCR).The expression of VEGF protein of rat intervertebral disc tissue was detected by Western blot assay.Results Compared with the sham operation group,the number of vascular buds in intervertebral disc was decreased in the model group and the TCM group.The cell destruction of intervertebral disc annulus was obvious in rats,and apoptosis was high and cell density decreased.Mechanical stimulation threshold decreased,and mechanical stimulation threshold decreased.The level of miR-126a-5p was decreased,and the expression levels of VEGF mRNA and protein were increased.Compared with the model group,the number of vascular buds in intervertebral disc was increased in the TCM group.The destruction of intervertebral disc annulus cells was alleviated in rats.The apoptosis of annulus fibrosus cells in intervertebral disc decreased and cell density increased.The threshold of mechanical stimulation increased,and the retraction time of thermal stimulation was prolonged.The level of miR-126a-5p increased,and the expression levels of VEGF mRNA and protein decreased(P＜0.05).Conclusion The mechanism of Yiqi Huoxue Tongluo Decoction in the treatment of cervical spondylotic myelopathy may be related to the up-regulation of miR-126a-5p expression and the down-regulation of VEGF expression.

Objective: To construct a prediction model for preterm birth risk among pregnant women, so as to provide the reference for screening high-risk population and preventing preterm birth. Methods: Pregnant women who received antenatal examination and delivered at the Women's Hospital, School of Medicine, Zhejiang University from January 1 to December 31, 2019 were selected as the study subjects, among them, 80% were included in the modeling group, and 20% were included in the validation group. Demographic and clinical information were collected. A multivariable logistic regression model was used to analyze the predictive factors of preterm birth risk in the modeling group, and a preterm birth risk prediction model was established based on the OR values of predictive factors. The model was validated with the data from the validation group. The Youden index was used to determine the critical score for predicting preterm birth risk. The prediction performance of the model was evaluated using the receiver operating characteristic (ROC) curve. Results: A total of 15 197 pregnant women were surveyed, including 12 131 pregnant women in the observation group and 3 066 pregnant women in the validation group. There was no statistically significant difference in age, education level and gravidity between the two groups of pregnant women (all P<0.05). Multivariable logistic regression analysis identified the number of pregnancies, education level, place of residence, hypertension, diabetes, history of preterm birth, twin-pregnancy, placenta praevia, and gestational hypertension as risk prediction factors for preterm birth risk among pregnant women. The risk score system for preterm birth was established as follows: >2 pregnancies (2 points), high school education or below (4 points), college degree or above (-4 points), rural residence (5 points), hypertension (7 points), diabetes (11 points), history of preterm birth (11 points), twin-pregnancy (28 points), placenta previa (19 points), and gestational hypertension (12 points). The total score of the preterm birth risk scoring system ranged from -4 to 99 points. When the critical score was 8 points, the Youden index was the highest at 0.480, with an area under the ROC curve of 0.749 (95%CI: 0.732-0.767), a sensitivity of 0.610, and a specificity of 0.886, indicating good prediction performance of the model. Conclusion The preterm birth risk prediction model established in this study based on demographic and clinical characteristics of pregnant women can effectively predict the risk of preterm birth among pregnant women.

Objective To explore the value of non-contrast CT findings of acute ischemic stroke(AIS)for predicting early prognosis after mechanical thrombectomy.Methods Data of 161 AIS patients from clinical center 1 who underwent mechanical thrombectomy were retrospectively analyzed.The patients were divided into training set(n=113)and internal test set(n=48)at the ratio of 7∶3,while 79 AIS patients who underwent mechanical thrombectomy from clinical center 2 were retrospectively enrolled as external test set.According to the National Institutes of Health stroke scale(NIHSS)scores 7 days after thrombectomy,patients'prognosis were classified as good(＜15 points)or poor(≥15 points).Pre-treatment non-contrast CT images of patients were reviewed,and CT findings were comparatively analyzed.Independent predictors of patients'early prognosis after mechanical thrombectomy were obtained with sequential univariate and multivariate logistic regressions,and a predicting model was established and visualized as a nomogram.The receiver operating characteristic curve was drawn,and the distinction was assessed with the area under the curve(AUC),then calibration was assessed with Hosmer-Lemeshow goodness of fit test,and the net benefit was evaluated with decision curve analysis(DCA).Results Alberta stroke program early CT score(ASPECTS),hyperdense middle cerebral artery sign(HMCAS)and basal ganglia calcification were all independent predictors of early prognosis of AIS after mechanical thrombectomy(all P＜0.05).The predictive model was established combining the above 3 variables and then visualized as a nomogram to predict prognosis of AIS after mechanical thrombectomy,with AUC of 0.776 in internal test set(χ2=6.052,P=0.417)and 0.800 in external test set(χ2=2.269,P=0.811).DCA showed that the nomogram might provide clinical net benefit within certain threshold probability ranges.Conclusion ASPECTS,HMCAS and basal ganglia calcification were all independent predictors of early prognosis of AIS after mechanical thrombectomy.The nomogram originated from predicting model combining the three could be used to somewhat accurately predict poor early prognosis after mechanical thrombectomy.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％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)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed 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 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective To investigate the association between serum alkaline phosphatase (ALP) and type 2 diabetes mellitus (T2DM) with nonalcoholic fatty liver disease (NAFLD). Methods A total of 599 patients with T2DM who were hospitalized in Department of Endocrinology, Affiliated Hospital of Jiangsu University, from July 2016 to December 2018 were enrolled as subjects. According to the presence or absence of NAFLD, the patients were divided into NAFLD group with 286 patients and non-NAFLD group with 313 patients, and according to the results of abdominal ultrasound, the patients with NAFLD were divided into mild group with 111 patients, moderate group with 105 patients, and severe group with 70 patients. General clinical data were compared between groups. The independent samples t - test was used for comparison of normally distributed continuous data between two groups, and an analysis of variance was used for comparison between three groups; the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison between three groups; the chi-square test was used for comparison of categorical data between groups. Pearson correlation analysis and Spearman correlation analysis were used to investigate the correlation between ALP and clinical indices, and a logistic regression analysis was used to investigate the influencing factors for NAFLD. Results Compared with the non-NAFLD group, the NAFLD group had significantly higher proportion of patients with history of hypertension ( χ 2 =7.864, P < 0.05), systolic blood pressure ( t =-2.226, P < 0.05), diastolic blood pressure ( t =-3.800, P < 0.05), body mass index (BMI) ( t =-11.842, P < 0.05), waist circumference (WC) ( t =-9.150, P < 0.05), fasting insulin (FINS) ( Z =-6.173, P < 0.05), fasting C-peptide ( t =-5.419, P < 0.05), serum uric acid ( t =-4.957, P < 0.05), low-density lipoprotein cholesterol ( t =-2.702, P < 0.05), triglyceride ( Z =-9.376, P < 0.05), total cholesterol (TC) ( t =-3.016, P < 0.05), Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) ( Z =-5.794, P < 0.05), alanine aminotransferase (ALT) ( Z =-6.737, P < 0.05), aspartate aminotransferase (AST) ( Z =-4.389, P < 0.05), gamma-glutamyl transpeptidase (GGT) ( Z =-7.764, P < 0.05), and ALP ( t =-2.833, P < 0.05), as well as significantly lower age ( t =2.184, P < 0.05) and high-density lipoprotein cholesterol ( Z =-5.273, P < 0.05). The severity of NAFLD (mild, moderate or severe) was positively correlated with age ( r s =0.140, P < 0.05), BMI ( r s =0.239, P < 0.05), WC ( r s =0.222, P < 0.05), FINS ( r s =0.191, P < 0.05), HOMA-IR ( r s =0.218, P < 0.05), ALT ( r s =0.188, P < 0.05), AST ( r s =0.279, P < 0.05), GGT ( r s =0.202, P < 0.05), and ALP ( r s =0.361, P < 0.05). In the patients with T2DM and NAFLD, ALP was positively correlated with HbAlc ( r =0.149, P < 0.05), fasting plasma glucose ( r =0.146, P < 0.05), HOMA-IR ( r s =0.132, P < 0.05), TC ( r =0.151, P < 0.05), ALT ( r s =0.210, P < 0.05), AST ( r s =0.192, P < 0.05), and GGT ( r s =0.297, P < 0.05). The logistic regression analysis showed that ALP was an influencing factor for NAFLD in patients with T2DM (odds ratio=1.013, 95% confidence interval: 1.004-1.023, P < 0.05). Conclusion Elevated serum ALP is a risk factor for T2DM with NAFLD and is closely associated with hyperglycemia, insulin resistance, and hyperlipemia, and ALP may play a role in the development and progression of T2DM and NAFLD.

Objective:To explore the predictive value of lipoprotein-associated phospholipase A2 (Lp-PLA2) combined with systemic immune-inflammation index (SII) for coronary heart disease risk in patients with type 2 diabetes mellitus.Methods:A prospective study was performed, 130 patients with type 2 diabetes mellitus from May 2018 to May 2021 in the People′s Hospital of Pengzhou were selected. All patients underwent coronary angiography examination, and 49 cases were complicated with coronary heart disease (coronary heart disease group), 81 cases were not complicated with coronary heart disease (non-coronary heart disease group). The clinical data were recorded; the white blood cell, monocyte, platelet, neutrophils, lymphocyte, hemoglobin, total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose, C-reactive protein (CRP), glycated hemoglobin and Lp-PLA2 were detected; and the SII was calculated. Multivariate Logistic regression analysis was used to analyze the independent risk factors of coronary heart disease in patients with type 2 diabetes mellitus; the efficacy of Lp-PLA2 and SII in predicting the coronary heart disease in patients with type 2 diabetes mellitus was evaluated using the receiver operating characteristics (ROC) curve.Results:There were no statistical differences in white blood cell, hemoglobin, TC, TG, LDL-C, fasting blood glucose, glycated hemoglobin and CRP between two groups ( P>0.05); the monocyte, platelet, neutrophils, Lp-PLA2 and SII in coronary heart disease group were significantly higher than those in the non-coronary heart disease group: (0.55 ± 0.22) × 10 9/L vs. (0.40 ± 0.11) × 10 9/L, (227.84 ± 40.76) × 10 9/L vs. (205.81 ± 39.04) × 10 9/L, (6.78 ± 1.45) × 10 9/L vs. (6.30 ± 1.18) × 10 9/L, (240.67 ± 41.48) μg/L vs. (214.83 ± 36.35) μg/L and 1 245.76 ± 383.08 vs. 929.84 ± 260.27, the lymphocyte and HDL-C were significantly lower than those in the non-coronary heart disease group: (1.26 ± 0.17) × 10 9/L vs. (1.41 ± 0.19) × 10 9/L and (1.15 ± 0.14) mmol/L vs. (1.23 ± 0.21) mmol/L, and there were statistical differences ( P<0.01 or <0.05). Multivariate Logistic regression analysis result showed that monocyte, HDL-C, Lp-PLA2 and SII were the independent risk factors of coronary heart disease in patients with type 2 diabetes mellitus ( OR = 1.812, 1.013, 1.013 and 2.004; 95% CI 4.430 to 6.801, 0.992 to 1.013, 1.001 to 1.026 and 0.004 to 0.855; P<0.01 ore <0.05). ROC curve analysis result showed that the area under the curve of Lp-PLA2 combined with SII to predict the coronary heart disease in patients with type 2 diabetes mellitus was significantly larger than Lp-PLA2 and SII alone: 0.783 (95% CI 0.702 to 0.851) vs. 0.681 (95% CI 0.593 to 0.760) and 0.744 (95% CI 0.660 to 0.816), and there was statistical difference ( P<0.05). Conclusions:Lp-PLA2 and SII are independent risk factors for coronary heart disease in patients with type 2 diabetes mellitus, and their combined detection can improve the predictive value of coronary heart disease.

In December 2021, in order to effectively solve the economic burden and payment difficulties of the elderly or disabled elderly and tumor patients in the promotion of " Internet plus nursing services", Ningbo included three home medical care services, namely, peripherally inserted central maintenance, urinary catheter care and nasogastric tube care with large patient needs and high frequency, into medical insurance, and could be paid at home(hereinafter referred to as: " medical insurance home payment" ). The author introduced the relevant concepts and service processes of " medical insurance home payment", and summarized the effects, problems and further improvement measures. After the implementation of the policy, the number of three nursing services included in " medical insurance home payment" reached 7 953 in 2022, with an increase of 105.29% over the same period in 2021, no adverse events occurred, and patient satisfaction was high. Ningbo " medical insurance home payment" could reduce the economic burden of patients and provide a reference for the medical insurance payment and service charges of " Internet plus nursing services" in China.

Objective:To explore the relationship between personality characteristics, social psychology and satisfactory rate in people undergoing facial cosmetic surgery.Methods:People undergoing facial cosmetic surgery who were admitted to the First Affiliated Hospital of Naval Medical University from February 2021 to February 2022 were seclected. They were asked to fill out the Big Five Inventory (abbreviated version), social psychological factors questionnaire before surgery, and the surgical satisfaction scale 2 weeks after surgery. According to the results of surgical satisfaction, they were divided into satisfied group and dissatisfied group. The distribution of personality characteristics and social psychological factors was analyzed, univariate analysis and logistic multiple regression were used to analyze the personality characteristics and social psychological factors affecting the satisfaction result.Results:There were 217 cases, including 9 males and 208 females, aged 18-45 years old with an average age of 26 years old. According to the operation satisfaction survey, 174 cases were satisfied and 43 cases were dissatisfied. Among the personality characteristics of 217 cases, low agreeableness, high responsibility, high extraversion, low openness, and high neuroticism accounted for the majority; there were statistically significant differences in agreeableness, extraversion, openness, and neuroticism between the satisfied group and the dissatisfied group( P<0.05); but in the comparison of responsibility, there was no statistically significant difference between the two groups ( P>0.05). Among the psychosocial factors of 217 cases, female, aged 18-28 years, with a bachelor’s degree or above, a vocational student or employee, urban registered residence, with a medium income, with a history of plastic surgery, following the doctor’s advice, moderate expectation, surgery suggestion with family members account for the majority; the results of univariate analysis show that the satisfied group and the dissatisfied group were compared in terms of age, education level, monthly income, surgical cost, previous plastic surgery history, and expected effect, the difference was statistically significant ( P<0.05); however, there was no statistically significant difference in gender, marital status, occupation, nature of household registration, choice of surgery, surgery recommended by family members, and consultation in multiple hospitals ( P>0.05). The results of logistic regression analysis showed that low agreeableness, low extraversion, high neuroticism, low age, high education level, and high expectation were independent risk factors affecting the surgical satisfaction( P<0.05). Conclusion:Personality characteristics (low agreeableness, low extraversion, high neuroticism) and social psychological factors (low age, high education level, high expectation) are independent risk factors of surgical satisfaction in people undergoing facial cosmetic surgery.

Objective:To explore the relationship between personality characteristics, social psychology and satisfactory rate in people undergoing facial cosmetic surgery.Methods:People undergoing facial cosmetic surgery who were admitted to the First Affiliated Hospital of Naval Medical University from February 2021 to February 2022 were seclected. They were asked to fill out the Big Five Inventory (abbreviated version), social psychological factors questionnaire before surgery, and the surgical satisfaction scale 2 weeks after surgery. According to the results of surgical satisfaction, they were divided into satisfied group and dissatisfied group. The distribution of personality characteristics and social psychological factors was analyzed, univariate analysis and logistic multiple regression were used to analyze the personality characteristics and social psychological factors affecting the satisfaction result.Results:There were 217 cases, including 9 males and 208 females, aged 18-45 years old with an average age of 26 years old. According to the operation satisfaction survey, 174 cases were satisfied and 43 cases were dissatisfied. Among the personality characteristics of 217 cases, low agreeableness, high responsibility, high extraversion, low openness, and high neuroticism accounted for the majority; there were statistically significant differences in agreeableness, extraversion, openness, and neuroticism between the satisfied group and the dissatisfied group( P<0.05); but in the comparison of responsibility, there was no statistically significant difference between the two groups ( P>0.05). Among the psychosocial factors of 217 cases, female, aged 18-28 years, with a bachelor’s degree or above, a vocational student or employee, urban registered residence, with a medium income, with a history of plastic surgery, following the doctor’s advice, moderate expectation, surgery suggestion with family members account for the majority; the results of univariate analysis show that the satisfied group and the dissatisfied group were compared in terms of age, education level, monthly income, surgical cost, previous plastic surgery history, and expected effect, the difference was statistically significant ( P<0.05); however, there was no statistically significant difference in gender, marital status, occupation, nature of household registration, choice of surgery, surgery recommended by family members, and consultation in multiple hospitals ( P>0.05). The results of logistic regression analysis showed that low agreeableness, low extraversion, high neuroticism, low age, high education level, and high expectation were independent risk factors affecting the surgical satisfaction( P<0.05). Conclusion:Personality characteristics (low agreeableness, low extraversion, high neuroticism) and social psychological factors (low age, high education level, high expectation) are independent risk factors of surgical satisfaction in people undergoing facial cosmetic surgery.

Objective:To explore the curative effect of Buyang Huanwu Decoction combined with suspension exercise training for the patients with cerebral infarction combined and lower limb hemiplegia.Methods:According to random number table method, 94 patients with cerebral infarction and lower limb hemiplegia meeting the inclusion criteria were divided into the control group and the observation group between January 2017 and February 2021, 47 in each group. The control group was treated with suspension exercise training, while observation group was additionally treated with Buyang Huanwu Decoction on the basis of the control group treatment. All were treated for 6 weeks and then followed up for 3 months. Before and after treatment, the Traditional Chinese Medicine (TCM) syndromes scores were recorded. The severity of nerve function injury was evaluated by National Institutes of Health Stroke Scale (NIHSS). The lower limb function was evaluated by Fugl-Meyer Assessment (FMA). The balance function was evaluated by Berg Balance Scale (BBS). The activities of daily life were assessed by Barthel Index (BI). The whole blood high shear viscosity, plasma viscosity and hematocrit were detected by full-automatic hemorheology analyzer. The levels of plasma total cholesterol (TC), triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) were detected by full-automatic analyzer. All were followed up for 3 months. The prognosis of patients was assessed by modified Rankin scale (mRS). The adverse reactions during treatment were recorded.Results:After treatment, scores of TCM syndromes and NIHSS in observation group were significantly lower than those in control group ( t=5.35, 4.54, P<0.01), while scores of FMA, BBS and BI were significantly higher than those in control group ( t=3.40, 3.10, 7.57, P<0.01). The whole blood high-shear viscosity, plasma viscosity and hematocrit in observation group were significantly lower than those in control group ( t=2.94, 3.81, 4.23, P<0.05 or P<0.01), and levels of TC, TG and LDL-C were significantly lower than those in control group ( t=4.10, 4.27, 3.61, P<0.01). The differences in good prognosis rate between observation group and control group were statistically significant [74.47% (35/47) vs. 51.06% (24/47); χ2=5.51, P=0.019]. Conclusion:The Buyang Huanwu Decoction combined with suspension exercise training can relieve clinical symptoms, recover lower limb function, improve activities of daily life and prognosis in cerebral infarction combined with lower limb hemiplegia.