With the widespread use of antimicrobial agents, bacterial drug resistance has become an increasingly severe issue, posing significant challenges to global healthcare. Traditional Chinese medicine (TCM) has emerged as a research focus in the field of bacterial resistance due to its broad sources, high safety profile, low toxicity, and antimicrobial mechanisms distinct from those of chemical drugs. Studies have shown that various TCM herbs, such as Scutellaria baicalensis, exert antibacterial effects through multiple pathways, including disrupting the integrity of bacterial cell walls and membranes, inhibiting nucleic acid and protein synthesis, and impairing energy production and metabolism. Additionally, certain TCM herbs, including Scutellaria baicalensis, Coptis chinensis, and Fritillaria thunbergii, can reverse antimicrobial resistance by eliminating resistant plasmids, inhibiting bacterial efflux pump function, and suppressing β-lactamase activity. TCM holds promising potential for antibacterial applications and synergistically reversing antimicrobial resistance, though systematic analyses remain limited. This review summarizes the mechanisms of antibacterial action of TCM and current research on its synergistic use with antimicrobial agents to reverse drug resistance, aiming to provide insights for developing novel TCM-based antimicrobials and addressing bacterial resistance.

BACKGROUND:Diabetic ulcers are a common complication of diabetes mellitus,which is manifested as foot ulcers complicated with infection,long treatment cycle,high disability rate and mortality rate,and brings a heavy burden to patients and social care. OBJECTIVE:To review the mechanism of action and the latest treatment progress of traditional Chinese medicine(TCM)in the treatment of diabetic ulcers,and to provide a basis for further theoretical research and clinical application. METHODS:CNKI,WanFang Database and PubMed database were searched for relevant literature using the keywords of"diabetic ulcer,medicinal herb,inflammation,interleukin-1β,interleukin-6,tumor necrosis factor,hypersensitive C-reactive protein,γ-interferon,interleukin-4,interleukin-10"in Chinese and English,respectively.The relevant literature in recent years was searched,and finally 75 articles were included for review. RESULTS AND CONCLUSION:The high glucose environment of the body will increase the level of pro-inflammatory cytokines,so that diabetic ulcer wounds are in a state of chronic inflammatory response for a long time,and difficult to heal or even not heal.TCM has summed up a lot of experience in the long-term struggle with diabetic ulcer.At present,TCM divides diabetic ulcers into four syndrome types:dampness and heat poison syndrome,blood and blood stasis obstruction pattern,heat poison injury Yin pattern,and Qi and blood deficiency syndrome,as well as representative prescriptions for treatment.According to their clinical characteristics,diabetic ulcers can be also divided into three stages:primary,middle and late stages.Different treatment methods are proposed:"clear method,""warm and clear combined use"and"maintenance method."Under the guidance of dialectical typing and staging of TCM,TCM monomers,extracts and compounds inhibit the inflammatory response and promote the healing of diabetic ulcers by down-regulating the expression of pro-inflammatory factors and/or up-regulating the expression of anti-inflammatory factors.Compared with modern medicine,TCM has significant advantages in the treatment of diabetic ulcers.There are many TCM monomers,extracts and compounds for the treatment of diabetic ulcers,such as angelica,curcumin,improved Chonghe ointment,Sanhuang blood exhaustion prescription and sore-ulcer I.formula,etc.It has been found that TCM for the treatment of diabetic ulcers is mainly heat-clearing and detoxifying,invigorating blood circulation and removing blood stasis,and amassing sores and muscle-building drugs,and the frequency of use,treatment scope and therapeutic effect of TCM compounds are obviously better than those of TCM monomers and extracts.Among them,the most commonly used are the Sanhuang blood exhaustion prescription and the sore-ulcer I as well as prescription for the treatment of damp heat toxicity syndrome and Zizhu ointment for the treatment of non-ischemic diabetic ulcers.However,there are also some shortcomings in the treatment of diabetic ulcers with TCM.First,there are few clinical syndrome studies on diabetic ulcers.Secondly,there are a wide variety of TCM monomers,extracts and compounds for the treatment of diabetic ulcers,and the relevant research is insufficiently in-depth.Finally,the research on the mechanism underlying TCM treatment of diabetic ulcers is still in the preliminary exploration stage,and the mechanism of action still needs to be further explored.In the future,it is necessary to strengthen the research on the pharmacology of TCM and the clinical syndrome of diabetic ulcers,analyze the potential targets and related signaling pathways of TCM in the treatment of diabetic ulcers,give full play to the therapeutic advantages of TCM with multiple targets,multiple pathways,multiple levels and multiple systems,and develop TCM with significant efficacy,active ingredients and clear targets.

Objective:To investigate the prevalence and risk factors of hypertensive retinopathy (HRP) in a non-diabetic population over 30 years old during routine health examinations.Methods:This was a cross-sectional study of a non-diabetic population over 30 years of age. The study was conducted during routine health examinations at the Tongren Hospital, Beijing, from January to December 2020. Fundus photographs were taken, and data including medical history, height, weight, and blood pressure were collected. Routine laboratory examinations were performed. The study population was divided into hypertension, transient hypertension, and non-hypertension groups. The prevalence of HRP was compared among the three groups. OR and 95% CI of HRP risk factors was estimated by binary logistic regression, adjusted for age and gender. Results:The prevalence of HRP was 4.3% in the non-diabetic population over 30 years old. Adjusted for age, gender, and systolic blood pressure, the prevalence of HRP in hypertension and transient hypertension groups, was both higher than in the non-hypertension group [ OR(95% CI) of 3.11(2.25-4.30) and 1.72(1.21-2.45), respectively]. The proportion of grade 1-2 HRP was higher (76.2%). There was no significant difference in the prevalence of grade 3 HRP among the three groups. Adjusted for age and gender, systolic blood pressure and creatinine clearance rate were independent risk factors for HRP in the hypertension group [ OR(95% CI): 1.22(1.01-1.48) and 1.66(1.12-2.46)] and transient hypertension group [ OR(95% CI): 1.48(1.10-2.06) and 1.95(1.03-3.46)]. SBP and DBP were independent risk factors for HRP in the non-hypertension group [ OR(95% CI): 1.68(1.07-2.63) and 1.61(1.06-2.44)]. Conclusions:There was a high prevalence of HRP among the non-diabetic population over the age of 30 and there was still relatively high risk of grade 3 HRP among the normotensive population.

Objective:To investigate the status and the influencing factors of influenza vaccination during the COVID-19 pandemic among community-dwelling elderly in Shanghai.Methods:A questionnaire survey on influenza vaccination among community-dwelling elderly was conducted in Shanghai Taikang elderly community in November 2020. The information on demographic characteristics, reasons for refusal of vaccination, and measures for increasing vaccination rates were collected. Multiple logistic regression was used to analyze the correlation between influenza vaccination and sociodemographic and health-related characteristics.Results:Among 520 respondents, the vaccination rate was 30.58% (159/520). Compared with unvaccinated group, elderly in vaccinated group was older ( t=16.04, P=0.003)and more educated(χ2=8.16, P=0.043). The elderly with comorbid heart disease, chronic obstructive pulmonary disease, tumor, asthma, Parkinson′s disease were likely to have vaccination ( OR=1.45, 2.16, 1.23, 1.64, 5.83; all P<0.05).The reasons for the elderly not to be vaccinated were concerns of side effects (46.26%, 167/361), lack of doctors′ recommendations (24.10%, 87/361), and unnecessary for people with good health conditions (19.39%, 70/361). The independent factors of influenza vaccine awareness rate were healthcare providers′ recommendations ( OR=9.18, 95% CI:5.47-16.32), vaccination at home( OR=11.79, 95% CI:6.87-21.66),vaccination available in community( OR=8.08, 95% CI:8.08-15.45),the mandatory requirement ( OR=4.61,95% CI:4.61-10.11),free of charge( OR=7.48, 95% CI:4.08-15.12). Conclusion:Influenza vaccination coverage among the elderly in Shanghai is still low even during the COVID-19 pandemic. Policy interventions, awareness education and strengthening the primary healthcare resources may contribute to achieving a high influenza vaccine coverage rate in the community-dwelling elderly

A total of 159 patients with Streptococcus milleri (S. milleri) infection were diagnosed in our hospital between January 2014 and January 2019. The demographic data, underlying diseases, infection sites, laboratory tests, and prognosis of patients were retrospectively analyzed; the clinical and microbiological data were compared among different age groups. Of the 159 patients there were 103 were males and 56 females; there were 19 patients aged<18 years [(8.1±5.3) years], 113 patients aged ≥18 and < 65 years [(45.5±13.1) years] and 27 patients aged ≥65 years[(74.7±8.6) years]. The incidence peaked in the 34-55 year age group (50 cases, 31.4%). Streptococcus anginosus was identified in 97 cases (61.0%), Streptococcus constellatus in 55 patients (34.6%) and Streptococcus intermedius in 7 cases (4.4%). The abdomen (44 cases, 27.7%) and the chest (19 cases, 11.9%) were the main involving sites. For patients younger than 18 years and those aged ≥18 and<65 years, suppurative appendicitis was the most common condition[12 cases(12/19) and 21 cases(18.6%), respectively]; while in patients aged ≥65 years, chest infection ranked the first (9 cases, 33.3%). All 159 patients were treated with anti-infection therapy alone or anti-infection and invasive procedures with a favorable prognosis, 2 patients died with a overall fatality rate of 1.3%.

Objective To investigate the risk factors for postoperative cognitive dysfunction (POCD)after gynecologic laparoscopic surgery in elderly female patients,and to establish a risk model for prognosis.Methods Mini-Mental State Examination(MMSE) was used to evaluate the cognitive function of 280 elderly women who underwent gynecologic laparoscopic surgery from April 2014 to March 2016 in four tertiary-level hospitals in Hubei Province.Thirty-two cases were excluded due to withdrawal or loss of follow-up,and 248 cases with complete and valid data were collected for analysis.According to the degree of cognitive impairment on the 7th day after operation,subjects were grouped into a POCD group and a non-POCD group.Logistic regression was used to determine risk factors and establish a prognostic model for POCD.Results Of the 248 subjects enrolled,62 (25.0％) were diagnosed with POCD on the 7th day after operation.Multivariate Logistic regression analysis showed that American Society of Anesthesiologists(ASA) grade(OR =4.578,95％CI:1.156 ～18.139,P =0.030),age (OR =1.465,95％ CI:1.230 ～ 1.745,P =0.000),and duration of anesthesia(OR =1.030,95 ％ CI:1.005 ～ 1.056,P =0.017) were independent risk factors for POCD,and intraoperative administration of dexmedetomidine (OR =0.069,95 ％ CI:0.508 ～ 14.094,P =0.011),dexamethasone (OR =0.135,95 ％ CI:0.200 ～ 0.928,P =0.042),and maintenance of deep anesthesia(OR =0.761,95 ％ CI:0.630 to 0.919,P =0.005) were protective factors.A prognostic model was established based on the principle of logistic regression equation.The receiver operating characteristic(ROC)curve determined Y=4.291 as the best risk value,and the expected sensitivity and specificity were 90.3％ and 97.8％,respectively.Additionally,another 50 independent cases were included to verify the predictive efficacy of the model.It showed that the overall correct rate was 86.0％,and the sensitivity and specificity were 81.8％ and 87.2％,respectively.Conclusions Increased ASA grade,advanced age,prolonged anesthesia time are independent risk factors for POCD,and intraoperative administration of dexmedetomidine,dexamethasone,maintenance of deep anesthesia play a protective role.The prognosis model of POCD has certain clinical value.

Chronic hepatitis C has become a serious public health issue around the world.In recent years,with the development of pharmacotherapy for hepatitis C,it may be possible to cure hepatitis C.With reference to the epidemic status of hepatitis C and the advantages and side effects of conventional standard therapy (pegylated interferon plus ribavirin) and various oral direct-acting antiviral agents (DAAs),this article summarizes the advantages and disadvantages of different combinations of DAAs in the treatment of chronic hepatitis C with different genotypes and briefly introduces the World Health Organization recommendations on the treatment of hepatitis C.Hepatitis C is expected to be eliminated with the development of pharmacotherapy for chronic hepatitis C.

Objective To investigate the prevalence and risk factors of diabetic retinopathy (DR) in a Beijing population during routine medical examinations. Methods This was a cross-sectional study during a routine health examination at the Tongren Hospital of Beijing,from March 2014 to February 2015. Fundus photography was conducted by experienced ophthalmologists.Medical history,height,weight,waist and hip circumference,and blood pressure were recorded.Routine laboratory examinations were performed. Logistic regression models were used to estimate the odds ratio (OR) and 95% confidence interval (CI) of diabetic retinopathy for each risk factor,adjusted for age and gender. Results The prevalence of DR was 7.0% among diabetic individuals.The multivariate analysis showed that disease durations[OR(95% CI),2.1 (1.564-2.752),P<0.001],fasting plasma glucose[1.2(1.093-1.273),P<0.001],body mass index[1.8(1.010-3.100),P=0.046],and triglyceride[0.794(0.638-0.987),P=0.038]were independently associated with DR. The prevalence of diabetes mellitus (DM) and DR significantly increased in populations aged>30 years. Conclusion Fundus photography (nonmydriatic) should be recommended as a routine screening method for people 30 years and elder to effectively prevent occurrence of visual impairment and blindness.

Objective To evaluate left intra-ventricular diastolic blood flow patterns and fluid dynamics in pre diabetics using vector flow mapping(VFM),and to explore the value of left intra-ventricular hydromechanics characteristics assessment of intracardiac flow by VFM with more sensitive indexes.Methods Forty four patients with type 2 diabetes,twenty-eight pre-diabetes patients and thirty-three normal volunteers underwent VFM to determine the left ventricular(LV) diastolic blood flow patterns and fluid dynamics.The two-dimensional color Doppler flow images data were acquired in standerd apical fourchamber view during 3 complete cardiac cycles.These images were analyzed using a dedicated off-line workstation.At different level (mitral annulus,papillary muscl and apex level),the diastole blood flow parameters of LV including flow velocity and volume,velocity gradients (△V),pressure gradients (△P),diastole flow volume,vortex intensity ( Ⅵ),vortex area ( VA),vortex radius (VA) were derived.Thedifferences of the above parameters were compared among the three groups.The correlationship between diastolic function parameters and LV hydromechanics indexes were analyzed.Results ① Compared to normal group and pre-diabetics group,the LV diastolic function parameters E/A and e/a in diabetics group were lower( P ＜0.01),with no differences for E/e( P ＞0.05).There were no significant diffrences of these indices between diabetics group and pre-diabetics group( P ＞0.05).②)Compared to normal group,the intraventricular peak flow velocity at basal level,△V and △P in diabetics group and pre-diabetics group were lower( P ＜0.01),but there were no significant differences of these indices between diabetics group and prediabetics group( P ＞ 0.05).③Compared to normal group,the diastolic positive volume at basal level in diabetics group and pre-diabetics group was lower ( P ＜0.01 ),but there was no significant differences of these indices between diabetics group and pre-diabetics group ( P ＞ 0.05).④ Compared to the normal group,the Ⅵ in diabetics and pre-diabetics group was decreased,but there were no significant differences ofthese indices between diabetics group and pre-diabetics group( P ＞0.05).The VA and VR in diabetics and pre-diabetics group were increased,but there were no significant differences of these indices between diabetics group and pre-diabetics group ( P ＞ 0.05).⑤ There were no correlationship between diastolic function parameters and LV hydromechanics indexes.Conclusions There is the same LV diastolic blood flow patterns and fluid dynamics existed in pre-diabetics as diabetics.VFM could be used as a new methods to demonstrate the early left intra-ventricular fluid dynamics damages in pre-diabetics patients.

Objective To investigate epidemiological and clinical features of human ehrlichiosis.Methods The epidemiological, clinical, laboratory, therapeutic and prognostic data of 21 clinically diagnosed cases of human ehrlichiosis were retrospectively analyzed. Results The epidemic regions where the ticks' activity was high located at the boundary between Hubei and Henan Provinces. All cases were farmers. The median age was 50 years ranged from 19 to 69 years. The male female ratio evident history of tick bite 1 week before the onset. The common symptoms included fever, diarrhea,cough, nausea and vomiting, abdominal pain and expectoration. The complications included hemorrhage, toxic encephalopathy, acute renal insufficiency, secondary infection and respiratory failure. The common abnormalities of routine lab data were thrombocytopenia, hypoeosinophilia,elevated lactate dehydrogenase, creatine kinase and aminotransferases, leucopenia and proteinuria.Nine cases were tested with peripheral blood smear and intracytoplasmic inclusions in neutrophils were found in one case. Seventeen cases were tested with serological assay and antibodies against Ehrlichia were positive in five cases. After doxycycline, symptomatic and supportive treatments, 14 cases were recovered and seven died. The average age of the deaths was 56 years. Conclusions Human ehrlichiosis is an acute tick-borne zoonosis and multiorgan could be involved. The older cases prone to develop complications and the prognosis is poor.