OBJECTIVE To investigate the inhibitory effects of silymarin （SM） on glioma in vivo and in vitro and its potential mechanism. METHODS Human glioma cell line U87 cells were randomly divided into control group， SM low- concentration， SM medium-concentration and SM high-concentration groups （50， 100， 200 μg/mL）， protein kinase B （Akt） activator group （SC79 20 μmol/L）， high-concentration of SM combined with Akt activator group （SM 200 μg/mL+SC79 20 μmol/L）. After drug treatment （except for the control group）， optical density （OD） value， clone formation rate， apoptotic rate， the expressions of proliferation/apoptosis-related proteins [proliferating cell nuclear antigen （PCNA）， B-cell lymphoma-2 （Bcl-2）， Bcl- 2-associated X protein （Bax）， caspase-3]， the phosphorylation levels of Akt/mitogen-activated protein kinase （MAPK） signaling pathway related proteins [Akt， p38 MAPK， extracellular signal-regulated kinase 1/2 （ERK1/2）] were detected in each group. The xenograft tumor model in nude mice was established by injecting U87 cells subcutaneously via the right armpit， and then divided into control group， SM low-dose， SM medium-dose and SM high-dose groups （25， 50， 100 mg/kg）， Akt activator group （SC79 40 mg/kg）， high-dose of SM combined with Akt activator group （SM 100 mg/kg+SC79 40 mg/kg）， with 5 mice in each group. After drug intervention （except for the control group of nude mice）， the tumor mass was weighed and the tumor volume was calculated. RESULTS Compared with control group， the OD values， clone formation rates， protein expressions of PCNA and Bcl- 2， phosphorylation levels of Akt， p38 MAPK and ERK1/2 in SM groups， tumor mass and volume in nude mice of SM groups were all decreased significantly， while the apoptosis rates， protein expressions of Bax and caspase-3 were increased significantly， in a dose-dependent manner （P＜0.05）；the trend of changes in the above indicators in the Akt activator group was opposite （P＜ 0.05）， and Akt activator could significantly attenuate the inhibitory effect of high-concentration/high-dose SM on glioma in vivo and in vitro （P＜0.05）. CONCLUSIONS SM may promote the apoptosis of U87 cells， and inhibit its proliferation， clone formation and tumor growth in xenograft nude mice by inhibiting Akt/MAPK signaling pathway.

Objective:By studying the gait changes of patients with knee osteoarthritis (KOA), the study provided a theoretical basis for the quantitative indicators obtained from gait analysis to the diagnosis of KOA. And it provided a gait reference for the clinical diagnosis, treatment, rehabilitation, prevention and efficacy evaluation of KOA.Methods:A total of 30 patients (KOA group) with KOA hospitalized in our hospital from May 2021 to October 2021 and 30 healthy people (control group) were compared for gait changes. The t test, Mann-Whitney U test and Fisher′s exact test were used to compare differences between groups. Results:The KOA group were greater than the control group in terms of step time [(642±81) ms and (548±62) ms, t=-5.01, P<0.001], gait cycle [(1 284±168) ms and (1 076±114) ms, t=-5.61, P<0.001], double support time [(531±125) ms and (331±51) ms, t=-8.10, P<0.001], double support time period proportion (0.417±0.063 and 0.309±0.023, t=-8.50, P<0.001), total support time [(914±135) ms and (678±107) ms, t=-7.52, P<0.001], total support time period proportion (0.711±0.027 and 0.627±0.044, t=-8.87, P<0.001), and left static standing time (55.7±8.4 and 51.5±2.2, t=-2.65, P=0.012), for which the differences were statistically significant. The KOA group were lower than the control group in terms of single support time period proportion (0.287±0.030 and 0.334±0.013, t=7.80, P<0.001), right static standing time (44.3±8.4 and 48.5±2.3, t=2.65, P=0.012), step length [(36±8) cm and (52±5) cm, t=9.97, P<0.001], stride length [(70±16) cm and (103±8) cm, t=10.00, P<0.001], velocity [(0.60±0.18) m/s and (1.05±0.19) m/s, t=9.54, P<0.001], left knee range of motion [(42±17)° and (63±4) °, t=6.49, P<0.001], and right knee range of motion [(37±18) ° and (62±3)°, t=7.54, P<0.001], for which the differences were statistically significant. Conclusion:Gait analysis can quantitatively evaluate the condition of patients with KOA, making it possible to transform the diagnostic criteria of KOA from qualitative to quantitative.

Objective:To discuss the medical support strategy by summarizing the experience of medical support in Dongfeng landing site.Methods:According to the current situation of medical support at Dongfeng landing site and the practice and experience of previous medical support, a retrospective summary study was conducted.Results:The main methods were summarized: (1) formulate a feasible plan; (2) strictly screen skilled personnel; (3) provide reasonable medicinal materials and equipments; (4) complete the modification of the rescue carrier; (5) attach importance to the training of first aid techniques; (6) strengthen political and ideological education; (7) carry out physical fitness training; (8) seriously participate in actual combat training. Three points of experience were put forward: (1) the importance of thinking and action is the premise of completing the task; (2) the cooperation between training and actual combat is the basis for completing the task; (3) equal emphasis on education and management is the bottom line for completing the task.Conclusions:The medical support experience of the Dongfeng landing site is summarized to provide support and experience for the long-term in-orbit operation of China's space station and on-site medical rescue after the landing of the manned spacecraft.

Objective: To understand changes and health equity of low vision in children and adolescents in Chongqing, and to provide reference for student myopia prevention and control. Methods: Using longitudinal studies, all school students in grades 1 to grade 12 in Chongqing were examined for visual acuity during 2018 to 2021, and the prevalence as well as changes of low vision were analyzed. In 2021, stratified random sampling was used to evaluate the health equity of uncorrected visual acuity and diopter(spherical equivalent, SE). Results: The prevalence of low vision for children and adolescents in Chongqing from 2018 to 2021 was 54.12%, 58.17%, 60.03% and 58.20% respectively. Low vision showed an increasing trend in the first three years and decreased by 1.83% in 2021 as compared with 2020( χ 2 trend =13 870.45, P <0.01). The difference in the detection rate of poor vision among students in different grades was statistically significant( χ 2=17 396.36, 2 093.95, 771.87, P <0.01). From 2018 to 2021, the detection rate of low vision in girls was higher than that of boys( P <0.01). The Gini coefficient was 0.054 57 for uncorrected visual acuity in urban area, higher than in rural areas (0.035 94). Meanwhile, the Gini coefficient of urban and rural SE was 0.065 82, higher than the country (0.049 30). The results showed that myopia in children and adolescents was more uneven in urban areas. Conclusion The adjustment of myopia prevention and control strategies in the late stage of the novel coronavirus pneumonia epidemic is related to the reduction of the detection rate of poor vision in children and adolescents in Chongqing. Low vision varied by grade and gender, suggesting tailored myopia prevention and control strategy. The detection rate of poor vision in cities is more uneven than in rural areas, and different myopia prevention and control measures need to be implemented according to regional characteristics.

Objective:To evaluate the effectiveness of ear acupoint pressing beans in the treatment of diabetic peripheral neuropathy (DPN) by Meta-analysis and provide reference for the treatment of DPN.Methods:Randomized controlled trial studies on ear acupoint pressing beans for DPN in Chinese and English databases were searched by the computer. The search time was from January 1, 2006 to December 16, 2021. The quality evaluation criteria of the Cochrane manual was used to evaluate the quality of the included literatures, and meta-analysis of the overall effects of the results was performed using RevMan 5.3 and Stata 16.0 analysis software.Results:A total of 24 randomized controlled trials involving 1 773 patients were included. The results of meta-analysis showed that ear acupoint pressing beans could effectively improve the symptoms of paresthesia, limb numbness, muscular atrophy and weakness caused by DPN ( RR=1.30, 95% CI: 1.22-1.38, P<0.01) , increased median motor nerve conduction velocity (MNCV) ( MD=3.46, 95% CI: 2.74-4.17, P<0.01) , median sensory nerve conduction velocity (SNCV) ( MD=1.81, 95% CI: 0.89-2.72, P<0.01) , common peroneal MNCV ( MD=4.71, 95% CI: 3.82-5.59, P<0.01) and common peroneal SNCV ( MD=4.68, 95% CI: 3.30-6.06, P<0.01) and decreased glycosylated hemoglobin ( P<0.05) . Conclusions:Ear acupoint pressing beans can improve nerve conduction velocity and clinical symptoms of DPN, which has positive clinical significance.

Objective:To summarize the relationship between the clinicopathological features and prognosis of immunoglobulin A nephropathy (IgAN) after renal transplantation.Methods:A total of 34 patients with IgAN after renal transplantation confirmed by renal biopsy were enrolled. And another 34 patients with primary IgAN confirmed by initial renal biopsy were adopted as controls. Clinical and pathological features of two groups were compared to explore the relationship between clinicopathological features and prognosis of allograft IgAN.Results:As compared with primary IgAN group, renal function in allograft IgAN group included serum creatinine [(158.5±75.9) vs (84.8±26.8) umol/L], urea nitrogen [(9.7±6.1) vs (5.2±1.4) mmol/L], uric acid [(406.7±87.8) vs (359.0±92.6) umol/L], estimated glomerular filtration rate {(57.4±25.4) vs (91.2±28.6) [ml/(min·1.73m 2)]}. All were statistically significantly higher ( P<0.05) while other parameters showed no differences. Pathologically, the proportion of T1 type (50.0% vs 17.6%) of renal tubular atrophy/interstitial fibrosis was significantly higher in allograft IgAN group than control group ( P<0.05). Furthermore, univariate and multivariate Logistic regression analyses were performed between various pathological parameters and prognosis in allograft IgAN patients. It indicated that the degree of mesangial hyperplasia of patients with transplanted IgAN had a significantly negative impact on the prognosis. Conclusions:The clinicopathological features of patients with allograft IgAN show no difference from those of patients with primary IgAN. And among patients with allograft IgAN, those with severe mesangial hyperplasia often have a worse prognosis.

Objective:To study the effects of enoxaparin on osteogenic differentiation of bone marrow stem cells (BMSCs) and the exosomes derived from BMSCs.Methods:After the BMSCs from 4-week old male SD rats were cultured, their surface antigen and multilineage differentiation potentials were identified. Subsequently, the BMSCs were incubated with osteogenic differentiation medium containing 10 IU/mL enoxaparin for 14 days. After the exosomes derived from BMSCs (BMSC-Exos) were extracted by the kit method, their structure was observed by transmission electron microscopy and their surface antigen CD63 detected by Western blot. Alizarin red staining was used to analyze the osteogenic differentiation of BMSCs. Osteogenic proteins including OCN and BMP-2 in BMSCs and exosomes were detected.Results:The spindle-shaped BMSCs isolated and cultured showed a uniform spiral pattern. They expressed highly the surface markers CD29 and CD44 but lowly CD34 and CD45, indicating that the majority of the cells were BMSCs. BMSC-Exos, in an oval shape with a diameter of about 30 to 80 nm, expressed CD63. Alizarin red staining showed that the number of mineralized nodules in the enoxaparin treatment group was significantly lower than that in the control group. Western blot analysis indicated that enoxaparin inhibited the expression of osteocalcin (OCN) and BMP-2 in BMSCs. ELISA results showed that the protein levels of OCN(48.81 ng/mL ± 8.23 ng/mL) and BMP-2 (311.45 pg/mL ± 27.59 pg/mL) in the BMSCs treated with enoxaparin were significantly lower than those of OCN (80.43 ng/mL ± 10.74 ng/mL) and BMP-2 (399.23 pg/mL ± 32.25 pg/mL) in the control BMSCs ( P<0.05). The contents of OCN (1.45 ng/mL±0.15 ng/mL) and BMP-2 (18.47 pg/mL ± 0.54 pg/mL) in the exosomes from BMSCs treated with enoxaparin were significantly higher than those of OCN (1.00 ng/mL ± 0.12 ng/mL) and BMP-2 (9.07 ng/mL ± 0.36 pg/mL) in the exosomes from control BMSCs ( P<0.05). Conclusions:Enoxaparin may inhibit the osteogenic differentiation of BMSCs. The mechanism of this might be related to its direct inhibition against the expression of OCN and BMP-2 in BMSCs and its indirect reduction of OCN and BMP-2 in BMSCs through the exhaust of the above proteins in the form of exosomes.

Objective: To explore the resistance mechanism and gene type of carbapenems-resistant Klebsiella pneumoniae (CRKP) in burn care unit. Methods: A total of 27 CRKP strains were primarily isolated from 22 patients [20 males, 2 females, aged (42±16) years] admitted to burn care unit of Institute of Burn Research of the First Affiliated Hospital of Army Medical University (the Third Military Medical University, hereinafter referred to as our department) from January to December 2017. After identification of bacteria, the months of detection and distribution of sample source were analyzed. Drug resistance tests of 15 antibiotics were conducted. Polymerase chain reaction was used to detect the drug resistant genes. Pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST) were used to analyze the gene type of strains. Results: (1) During the whole year of 2017, CRKP strains were mostly detected in August (8 strains), September (6 strains), and October (5 strains), with no CRKP in January, March, June, November, and December. Five strains from bed units were detected in August (2 strains), September (1 strain), and October (2 strains). (2) Twenty-seven CRKP strains were derived from blood samples (40.7%, 11/27), wound exudate samples (18.5%, 5/27), deep vein catheter samples (11.1%, 3/27), sputum samples (7.4%, 2/27), urine samples (3.7%, 1/27), and bed unit samples (18.5%, 5/27). (3) The 27 CRKP strains were detected with drug-resistance rates of 100.0% to 7 antibiotics including cefoperazone/sulbactam, piperacillin/tazobactam, cefazolin, ceftriaxone, cefepime, ertapenem, and compound sulfamethoxazole, no drug-resistance to tigecycline, with drug-resistance rates higher than 81.0% to the rest 7 antibiotics. (4) Detection rates for resistance gene bla_CTX-M-10, bla_SHV, bla_TEM, bla_CTX-M-14, bla_ACT, and bla_KPC were all above 92.5%. (5) According to PFGE, the 27 CRKP strains had 6 types (A, A₁, A₂, B, C, and D). Strains of type A were mainly detected in February, May, and September, with detection rate of 37.0% (10/27). Strains of type C were mainly detected in July, August, and October, with detection rate of 48.1% (13/27). Strains of types A₁, A₂, B, and D were scatteredly detected, with detection rate of 3.7% (1/27) respectively. According to MLST, the 27 CRKP strains had 6 STs. ST11 was the most frequent type, accounting for 74.1% (20/27), which was detected in August to October. The detection rate of ST395, ST2230, ST215, ST260, and STnew ranged from 3.7%(1/27) to 7.4%(2/27), and the strains were scatteredly detected. Conclusions The main source of CRKP from burn care unit of our department was bloodstream. All the CRKP strains showed high drug-resistance rate and complicated resistance mechanism. There were small scale outbreaks caused by CRKP of type A, type C, and ST11, which should be paid more attention to in clinical treatment and infection control.

To dynamically investigate the distribution and antimicrobial resistance profiles of bacteremia pathogens isolated from different regions in China in 2011, 2013 and 2016. Non-repetitive isolates from nosocomial bloodstream infections were retrospectively collected and detected for antimicrobial susceptibility tests (AST) by agar dilution or microbroth dilution methods. Whonet 5.6 was used to analyze the AST data. Among 2 248 isolates, 1 657 (73.7%) were Gram-negative bacilli and 591 (26.3%) were Gram-positive cocci. The top five bacteremia pathogens were as follows, Escherichia coli (32.6%, 733/2 248), Klebsiella pneumoniae (14.5%, 327/2 248), Staphylococcus aureus (10.0%, 225/2 248), Acinetobacter baumannii (8.7%, 196/2 248) and Pseudomonas aeruginosa (6.2%, 140/2 248). Colistin (96.5%, 1 525/1 581, excluding innate resistant organisms), tigecycline (95.6%, 1 375/1 438, excluding innate resistant organisms), ceftazidine/clavulanate acid (89.2%, 1 112 /1 246), amikacin (86.4%, 1 382/1 599) and meropenem (85.7%, 1 376/1 605) showed relatively high susceptibility against Gram-negative bacilli. While tigecycline, teicoplanin and daptomycin (the susceptibility rates were 100.0%), vancomycin and linezolid (the susceptibility rates were 99.7%) demonstrated high susceptibility against Gram-positive cocci. The prevalence of extended-spectrum β-lactamases (ESBLs)-producing Enterobacteriaceae were 50.6% (206/407), 49.8% (136/273) and 38.9% (167/429) in 2011, 2013 and 2016 respectively; carbapenem-non-susceptible Enterobacteriaceae were 2.2% (9/408), 4.0% (16/402) and 3.9% (17/439) in 2011, 2013 and 2016 respectively; The prevalence of multidrug-resistant A. baumannii (MDRA) was 76.4% (55/72) in 2011, 82.7% (43/52) in 2013 and 87.5% (63/72) in 2016, respectively. The prevalence of multidrug-resistant P. aeruginosa (MDRP) was 9.8% (5/51) in 2011, 20.0% (7/35) in 2013 and 13.0% (7/54) in 2016, respectively. The prevalence of methicillin-resistant S. aureus (MRSA) was 51.9% (41/79) in 2011, 29.7% (19/64) in 2013 and 31.7% (26/82) in 2016, respectively. The prevalence of high level gentamicin resistance (HLGR) of Enterococcus faecium and Enterococcus faecalis were 43.2% (48/111) and 40.9% (27/66), respectively. The predominant organism of carbapenem-non-susceptible Enterobacteriaceae was K. pneumoniae with its proportion of 57.1% (24/42). Among 30 tigecycline-non-susceptible Enterobacteriaceae, K. pneumoniae was the most popular organism with 76.7% (23/30). Among 39 colistin-resistant Enterobacteriaceae, E. coli, Enterobacter cloacae and K. pneumoniae were constituted with the percent of 43.6 (17/39), 35.9 (14/39) and 15.4 (6/39), respectively. The Gram-negative bacilli (E. coli and K. pneumoniae were the major organisms) were the major pathogens of nosocomial bacteremia, to which tigecycline, colistin and carbapenems kept with highly in vitro susceptibility. Whereas, among the Gram-positive cocci, S. aureus was the top 1 isolated organism, followed by E. faecium, to which tigecycline, daptomycin, linezolid, vancomycin and teicoplanin kept with highly in vitro susceptibility. Isolation of colistin-resistant Enterobacteriaceae, tigecycline-non-susceptible Enterobacteriaceae, linezolid- or vancomycin-non-susceptible Gram-positive cocci suggests more attention should be paid to these resistant organisms and dynamic surveillance was essential.

In October 2016, the CPC Central Committee and State Council issued the outline of Healthy China 2030 Plan and put forward two main principles, namely integrating health into all policies (HiAP), and adhering to co-construction and co-sharing and mobilizing the whole society to participate.Based on this view, after analyzing the main contradictions in the social governance of China's health field, this paper points out that the synergistic design of social governance and the common governance by the whole society are the key issues to the implementation of China's health policy.This paper attempts to build a health-centered social governance mechanism that puts forward the focus on opening up the channels for citizens to participate in health policy, the formation of a unified health common value, the in-depth exploration of establishing community health services model that integrates medical resources with pension resources together to participate in the building of healthy China.