Objective:To explore the relationship between the hypertensive snowbirds′ length of migratory stay and their blood pressure control and blood pressure levels.Methods:This study was a cross-sectional study. A population of snowbirds with hypertension was recruited between October and November 2022, and a structured questionnaire was used to collect their self-measured blood pressure and length of stay in Hainan Province. The blood pressure control status is determined based on self-measured blood pressure. According to the self-measured blood pressure to determine whether the blood pressure was well controlled. The associations between snowbirds′ length of stay and their blood pressure control as well as their self-measured blood pressure were analyzed using restricted cubic splines.Results:A total of 362 research subjects were included, 169(46.7%) of whom were male, and their age was (69.7±7.0) years old. The participants′ self-measured systolic blood pressure and diastolic blood pressure were (129.1±16.2) mmHg (1 mmHg=0.133 kPa) and (78.9±10.1) mmHg, respectively. Overall, 174 (48.1%) participants attained adequate blood pressure control. The median length of stay in Wuzhishan City was 7(6, 7) months. There was an inverted U-shaped association between snowbirds′ length of stay and blood pressure control (overall: P=0.023; nonlinearity: P=0.014), where participants with a length of stay of 7 months had the highest rate of blood pressure control. There is a U-shaped curve relationship between length of stay and systolic blood pressure (overall: P=0.001; nonlinearity: P=0.033), and a linear negative correlation with diastolic blood pressure ( β=-1.19, P=0.003). Conclusions:Compared with hypertensive snowbirds with too long or too short lengths of stay, snowbirds who stayed in Wuzhishan City for seven months have better blood pressure control, and systolic blood pressure is also lower.

Background:Crohn's disease(CD)was a kind of inflammatory bowel disease,whichwas chronic and recurrent attacked,seriously affect the quality of life of patients.Its pathogenesis is not clear.Aims:To study the effect of hsa_circRNA_103124 which was highly expressed in CD on its downstream gene expression,and the expression level of hsa_circRNA_103124 and its downstream genes in Crohn's disease.The mechanism of hsa_circRNA_103124 in the occurrence and development of CD was discussed in this study.Methods:Transcriptome sequencing revealed differentially expressed genes inhsa_circRNA_103124 overexpressed THP1 cells which was induced macrophage-like differentiation with PMA.IL4 was used to induce macrophage M2 differentiation in hsa_circRNA_103124 overexpressed THP1 cells.The expression levels of M2 differentiation markers CD206 and CD163 were detected by flow cytometry.The expression levels of hsa_circRNA_103124 and its downstream genes were analyzed by qPCR.The levels of hsa_circRNA_103124 and mRNA of its downstream genes in peripheral blood mononuclear cells of 30 patients with CD and 30 healthy controls were analyzed by qPCR.Results:Hsa_circRNA_103124 overexpressed and PMA-induced THP1 cells showed low expression of FGF18(P<0.01).Hsa_circRNA_103124 inhibited macrophage M2 differentiation and down-regulated the expression of CD206(P<0.05)and CD163(P<0.01).The expression of FGF18(P<0.05)and CCL2(P<0.05)was down-regulated in M2-polarized THP1 cells with hsa_circRNA_103124 overexpressed.The expression of hsa_circRNA_103124(P<0.05)in peripheral blood mononuclear cells of CD patients was up-regulated,and the expression of FGF18(P<0.01)and CCL2(P<0.05)was down-regulated.Conclusions:The high expression of hsa_circRNA_103124 in peripheral blood of patients with CD inhibits the M2 polarization of macrophages by down-regulating the expression levels of FGF18 and CCL2,which may play a role in promoting inflammation in the occurrence and development of CD.

Objective:To explore the current situation of nursing human caring in hospital wards and analyze its influencing factors, so as to facilitate the development of nursing human caring practice.Methods:From July to November 2022, a total of 107 hospitals were surveyed through stratified convenience sampling method, and 4 072 ward nursing managers were recruited to finish the general information questionnaire and the ward nursing human caring status questionnaire. The general information included the region, class and type of the hospital, etc. The ward nursing human caring status questionnaire included 38 items in 5 dimensions of nursing human caring system and process, humanistic quality and training of nursing staff, humanistic environment and facilities, human caring procedures and measures, and human caring quality evaluation and improvement, with a full score of 190 points. Descriptive statistics were used to analyze the general data, independent samples t-test, ANOVA and correlation analysis were used to analyze the factors influencing the current status of nursing human caring in the ward, while multiple linear regression analysis was used to conduct a multivariate analysis. Results:The score of nursing human caring in hospital wards was 156.91±27.78. Whether the hospital had carried out nursing human caring pilot(demonstration) wards, whether the ward had previously been a hospital nursing human caring pilot(demonstration) nursing unit, the type of ward, and whether nursing managers had participated in human caring training were the influencing factors of the implication of nursing humanistic caring in wards( P<0.05). Conclusions:The practice of nursing human caring in hospital wards is at a good level, but needs to be further strengthened. Nursing managers should take systematically strategies to promote the development of nursing human caring practice.

Objective:To investigate the relationship of pks gene islands with virulence genes, capsular serotypes and biofilm formation in Klebsiella pneumoniae ( Kp). Methods:A total of 113 Kp clinical isolates were collected in the First Affiliated Hospital of Fujian Medical University and divided into two groups based on the presence of pks gene islands: pks+ and pks- groups. The hypermucoviscous (HM) phenotype was detected by string test. Five virulence genes ( peg-344, rmpA, rmpA2, iucA, iroB) and six common capsular serotypes (K1, K2, K5, K20, K54, K57) were detected by polymerase chain reaction (PCR). The biofilm formation ability was measured by crystal violet staining. Results:Among the 113 Kp isolates, 46 were pks+ strains and 67 were pks- strains. The detection rate of HM phenotype was higher in the pks+ group than in the pks- group [87.0% (40/46) vs 43.3% (29/67)]. The detection rates of virulence genes ( peg-344, rmpA, rmpA2, iucA, iroB) and K1 serotype in the pks+ group were also higher than those in the pks- group ( P<0.05). The biofilm formation ability of the pks+ strains was higher than the pks- strains ( P<0.05). Conclusions:Kp strains carrying pks gene islands were likely to display a HM phenotype and mainly belonged to the K1 serotype. Most of the pks+Kp strains carried the virulence genes of peg-344, rmpA, rmpA2, iucA and iroB, and had a greater ability to form biofilms.

Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; Logistic Models ; Phenotype ; Risk Factors

Objective:To analyze the salary characteristics of medical institutions and the influencing factors of personnel expenditure as found in the salary system reform of public hospitals in Sichuan province, for reference in furthering such reform in public hospitals.Methods:The data of personnel expenditure, business operation and medical services came from 96 medical institutions in 21 cities(prefectures)of Sichuan province from 2017 to 2020 by means of institutional survey. The average salary level and salary structure of medical staff were used to describe the salary characteristics, and the total salary was presented by the level of personnel expenditure. The measurement data was represented by M(IQR), the counting data was described by frequency and constituent ratio, and the influencing factors of personnel expenditure were analyzed by generalized linear mixed model. Results:From 2017 to 2020, the personnel expenditure of medical institutions increased by 13.04% annually. In 2020, the per capita salary level of medical staff was 151 900 yuan, while the basic salary and performance salary accounted for 16.20% and 54.60% of personnel expenditure respectively. The analysis results of the generalized linear mixed model showed that the average cost of patients per visit( β=0.596), the level of drugs and sanitary materials consumed per 100 yuan medical income( β=0.286), the number of medical visits( β=0.328), and the years [(2018, 2019, 2020) β=0.025, 0.052, 0.066] were positively correlated to personnel expenditure, while the average length of stay( β=-0.693), the proportion of medical service income( β=-0.392), and the balance rate of income and expenditure( β=-0.062)were negatively correlated to personnel expenditure( P<0.05). The proportion of fiscal subsidy revenue, regional GDP and asset-liability ratio were not the influencing factors of personnel expenditure( P> 0.05). Conclusions:In the reform of the salary system of the province, its salary level of medical institutions has surpassed the current wage ceiling of these institutions. As the salary distribution was mainly made based on the workload, the " baton" role of the salary system reform has begun to pay off. However, the basic guarantee role of compensation has not yet been fully leveraged.Further reform is needed in upgrading refined management, and timely dynamic adjustment of personnel expenditure in combination with the hospital's financial performance and cost analysis, and reasonably optimizing the level of medical staff compensation.

Objective To investigate the potential risk factors for mild cognitive impairment (MCI) in the elderly population in the community, and to provide a basis for the primary prevention of MCI. Methods A cross-sectional study of elderly population in communities of Shanghai, China was conducted. A total of 368 subjects including both males and females, aged 65-80 years old, were selected to complete the mini-mental state examination (MMSE), basic information questionnaires, and physical examinations. Logistic regression analysis was used to analyze the potential risk factors of MCI. Results Of the 368 subjects participating in the study, 53 were found to have MCI and the prevalence rate was 14.4%. Univariate analysis found that older age, low education, no folic acid supplementation, stroke, osteoporosis and hyperlipidemia were risk factors of MCI. Multiple logistic regression analysis showed that advanced age [OR=1.146 (95%CI: 1.052-1.249)] and osteoporosis [OR=2.371 (95%CI: 1.042-5.396)] were the independent risk factors for MCI, while higher education [OR=0.073 (95%CI: 0.011-0.478)] was a protective factor. Age influenced all the aspects of MMSE scores (all P values <0.05). In addition, the analysis of the results suggested that subjects with regular folic acid supplementation got higher MMSE scores, especially in the aspect of language and praxis (P=0.002). On the contrary, patients with osteoporosis had lower attention and computing power scores (P=0.022). Conclusion The prevalence of MCI increased with age. Low education and osteoporosis may be the independent risk factors for MCI in the elderly population. Although no association was observed between folic acid supplementation and MCI, folic acid supplementation could improve the performance of language and praxis.

Objective: Analyze the changes of indicator of antimicrobial usage and detection rate of multidrug-resistant gram-negative bacteria (MDR-GNB), in order to evaluate the impact of antimicrobial stewardship program (ASP). Methods: The antimicrobial stewardship program was implemented since December 2011 at the Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University. Intensified effort was made from 2014 to 2017. We divided the program into four stages, one before ASP (2010-2011) and three after ASP (2012-2013 as the first, 2014-2015 as the second and 2016-2017 as the third post-ASP stages). The usage rates in outpatient,emergency department and inpatient, along with the antibiotic use density (AUD, defined as daily doses/per 100 patient-days), the AUD of the third-generation cephalosporins and carbapenems in inpatient were reviewed retrospectively. The detection rates of extended-spectrum β-lactamases (ESBLs)-producing Escherichia coli, ESBLs-producing Klebsiella pneumonia, carbapenem-resistant E. coli, carbapenem-resistant Klebsiella pneumonia, carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Pseudomonas aeruginosa were also analyzed at the same time. The correlation analysis between the detection rate of MDR-GNB and the indicator of antimicrobial usage was made. Result: Among four stages, the usage rates were 55.2% (560 578/1 015 540) , 38.1% (493 554/1 296 336) , 26.8% (378 602/1 411 595) and 23.1% (347 817/1 502 817) in outpatient, 75.6% (429 582/568 230) , 61.4% (382 558/623 138) , 43.6% (265 102/608 071) and 35.1% (218 484/622 397) in emergency department, and 76.0% (30 568/40 221) , 53.7% (30 437/56 636) , 49.9% (37 395/74 895) and 50.3% (35 493/70 544) in inpatient, respectively. All indicators decreased significantly (χ²=297 811.798, 3 155 704.783, 5 592.037, P<0.01). The AUD in inpatient was 38.4,31.8,21.7 and 19.41,and the AUD of the third-generation cephalosporins were 13.83, 11.21, 6.20 and 6.84, respectively, which decreased significantly after ASP (r=-0.878, -0.781, P<0.05). The AUD of carbapenems were 1.94,1.77,1.87 and 1.93, respectively (r=0.123, P>0.05). A total of 11 289 strains of bacteria were collected, including 5 589 strains of E. coli, 2 823 strains of K.pneumoniae, 1 637 strains of A. baumandii, and 1 240 strains of P. aeruginosa.The detection rates of ESBLs-producing E.coli and ESBLs -producing K. pneumoniae in four stages were 75.4% (1 034/1 371) , 66.6% (893/1 341) , 57.8% (834/1 443) , 46.7% (670/1 434) and 78.7% (547/695) , 67.5% (455/674) , 49.3% (421/854) , 32.5% (195/600) , respectively,both decreased significantly (χ²=266.204; 328.805, P<0.01). The detection rates of Carbapenem-resistant A. baumannii were 28.2% (115/408) , 26.7% (126/472) , 24.3% (125/515) and 12.0% (29/242) respectively,and showed significant decreasing trend after ASP (χ²=18.112, P<0.01). The detection rates of carbapenem-resistant P. aeruginosa were 11.3% (40/355) , 18.5% (58/313) , 13.4% (46/343) and 7.0% (16/229) , respectively,with the most obvious decrease in the third stage after ASP. The detection rates of carbapenem-resistant E. coli and carbapenem-resistant K. pneumonia were continuously lower (<5%). There were positive correlations between the detection rates of ESBLs-producing E. coli and K. pneumoniae and all usage indicators (r₁=0.930, 0.974, 0.746, 0.958, 0.842; r₂=0.910, 0.960, 0.765, 0.963, 0.898, P<0.05). Conclusion The antimicrobial stewardship program can effectively reduce both the usage of antimicrobial and the production of MDR-GNB, which has great value to promote rational clinical use of antimicrobials and reduce bacterial resistance.

Objective Analyze the changes of indicator of antimicrobial usage and detection rate of multidrug‐resistant gram‐negative bacteria (MDR‐GNB), in order to evaluate the impact of antimicrobial stewardship program (ASP). Methods The antimicrobial stewardship program was implemented since December 2011 at the Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University. Intensified effort was made from 2014 to 2017. We divided the program into four stages, one before ASP (2010-2011) and three after ASP (2012-2013 as the first, 2014-2015 as the second and 2016-2017 as the third post‐ASP stages). The usage rates in outpatient,emergency department and inpatient, along with the antibiotic use density (AUD, defined as daily doses/per 100 patient‐days), the AUD of the third‐generation cephalosporins and carbapenems in inpatient were reviewed retrospectively. The detection rates of extended‐spectrum β‐lactamases (ESBLs)‐producing Escherichia coli , ESBLs‐producing Klebsiella pneumonia , carbapenem‐resistant E. coli , carbapenem‐resistant Klebsiella pneumonia , carbapenem‐resistant Acinetobacter baumannii and carbapenem‐resistant Pseudomonas aeruginosa were also analyzed at the same time. The correlation analysis between the detection rate of MDR‐GNB and the indicator of antimicrobial usage was made. Result Among four stages, the usage rates were 55.2%(560 578/1 015 540), 38.1% (493 554/1 296 336), 26.8%(378 602/1 411 595) and 23.1%(347 817/1 502 817)in outpatient, 75.6% (429 582/568 230), 61.4%(382 558/623 138), 43.6%(265 102/608 071) and 35.1%(218 484/622 397) in emergency department, and 76.0%(30 568/40 221), 53.7%(30 437/56 636), 49.9%(37 395/74 895) and 50.3%(35 493/70 544) in inpatient,respectively. All indicators decreased significantly(χ2=297 811.798, 3 155 704.783, 5 592.037, P<0.01). The AUD in inpatient was 38.4,31.8,21.7 and 19.41,and the AUD of the third‐generation cephalosporins were 13.83, 11.21, 6.20 and 6.84, respectively, which decreased significantly after ASP (r=-0.878,-0.781, P<0.05). The AUD of carbapenems were 1.94,1.77,1.87 and 1.93, respectively (r=0.123, P>0.05). A total of 11 289 strains of bacteria were collected, including 5 589 strains of E. coli , 2 823 strains of K. pneumoniae , 1 637 strains of A. baumandii , and 1 240 strains of P. aeruginosa . The detection rates of ESBLs‐producing E. coli and ESBLs‐producing K. pneumoniae in four stages were 75.4%(1 034/1 371), 66.6%(893/1 341), 57.8%(834/1 443), 46.7% (670/1 434) and 78.7% (547/695), 67.5%(455/674), 49.3%(421/854), 32.5%(195/600), respectively,both decreased significantly (χ2=266.204;328.805, P<0.01). The detection rates of Carbapenem‐resistant A. baumannii were 28.2%(115/408), 26.7%(126/472), 24.3%(125/515) and 12.0%(29/242) respectively,and showed significant decreasing trend after ASP (χ2=18.112, P<0.01). The detection rates of carbapenem‐resistant P. aeruginosa were 11.3%(40/355), 18.5%(58/313), 13.4%(46/343) and 7.0%(16/229), respectively,with the most obvious decrease in the third stage after ASP. The detection rates of carbapenem‐resistant E. coli and carbapenem‐resistant K. pneumonia were continuously lower (<5%). There were positive correlations between the detection rates of ESBLs‐producing E. coli and K. pneumoniae and all usage indicators ( r 1=0.930, 0.974, 0.746, 0.958, 0.842;r2=0.910, 0.960, 0.765, 0.963, 0.898,P<0.05). Conclusion The antimicrobial stewardship program can effectively reduce both the usage of antimicrobial and the production of MDR‐GNB, which has great value to promote rational clinical use of antimicrobials and reduce bacterial resistance.

Objective To assess the feasibility and efficacy of multi-modality three dimensional imaging reconstructive technology in diagnosing the urethral stricture.Methods Totally,121 male patients,suffered with urethral strictures,were enrolled in this study between January 2012 and June 2017.Their age ranged from 17 to 63 years old.The etiology included pelvic fracture in 71 cases,straddle injury in 16 cases,iatrogenic injury in 25 cases,infection in 9 cases.All patients accepted the routine antegrade and retrograde urethrography.The slim CT scan and 3D image reconstruction were performed in patients with posterior urethral stricture.The 3D ultrasound detection and image reconstruction were used in patients with anterior urethral strictures.The fly-through mode was used in each 3D image in order to simulate the process of endoscopic examination.The length of stricture was compared between that in traditional urethrography and in 3D dimensional image,based on the results from anastomotic procedure and substitution.Result Among patients,71 cases were diagnosed as posterior urethral stricture and 50 cases were diagnosed as anterior urethral stricture.In those patients with posterior urethral stricture,no statistical significant difference of stricture length was noticed between traditional urethrography and 3 D dimensional image [(2.30 ± 1.60)cm vs.(2.18 ± 1.55)cm,P =0.91)].In patients who complained about the urine leakage from anus,higher detective rate of fistula could be seen in the CT 3D image than that in traditional endoscopic examination (87.9％ vs.77.6％).To patients with anterior urethral strictures,no statistical significant difference of stricture length was noticed between traditional urethrography and 3D dimensional image [Penile:(2.13 ±0.34) cm vs.(2.24 ± 0.31) cm,P =0.13;Bulbar:(1.98 ± 0.47) cm vs.(2.13 ± 0.32) cm,P =0.23)].However,the advantage of 3D image could be shown in detecting the lesion of navicular fossa and periurethral pathologic fibrosis.In the fly-through mode,the effect of 3D CT image seems to be superior to that in the 3D ultrasound image,which could show more smooth urethral wall and longer urethral segment.The limitation of those 3D image reconstructive technology was that long time consuming was needed during the 3D image reconstruction.Conclusion Our study showed that the multi-modality three dimensional imaging reconstructive technology can improve the sensitivity and specify in diagnosing the urethral stricture.After some modification,it will become the alternative method in diagnosing the urethral stricture.