Objective To summarize the isolation and drug resistance rate of Escherichia coliin The First Hospital of China Medical University over the past 10 years,in order to provide evidence for the efficacies of clinical anti-infection treatments.Methods The data was collected from Escherichia coli isolated from patients treated at The First Hospital of China Medical University between 2013 and 2022.VITEK 2 and VITEK MS were used for bacterial identification,VITEK2 and KB method were used for drug sensi-tivity testing,and WHONET 5.6 software was used for analysis.Results From 2013 to 2022,6 845 strains were isolated,including 80.5%from inpatients and 19.5%from emergency and outpatients.The specimens were most commonly found in the urine(57.8%),blood(15.0%),secretions(9.2%),and drainage fluid(8.1%).The isolation rate of extended-spectrumβ-lactamase(ESBL)producing Escherichia coli was 57.2%(54.3%to 61.5%).The drug resistance rate of Escherichia coli to carbapenems was low,at only 1.2%(0.2%to 2.6%).Conclusion Escherichia coli remains an important pathogen in clinical infections,with varying degrees of resist-ance to multiple antibiotics,and the resistance rate is increasing.Clinical physicians should pay sufficient attention to this issue.

Myocardial fibrosis is a common pathological manifestation of various heart diseases,with hidden onset and the possibility of evolving into irreversible heart failure.Currently,there is still insufficient diagnosis and treatment of myocardial fibrosis.Traditional Chinese medicine can regulate myocardial fibrosis at multiple levels,targets,and pathways,and has significant advantages in treating myocardial fibrosis.Its underlying mechanisms are worth further exploration.The theory of"yang generating qi,yin constituting the body"in Huangdi Neijing embodies the meaning of yin and yang,containing a profound outlook on life and disease.Pathological changes in the initial,progressive,and final stages of myocardial fibrosis conform to the yin-yang theory of"yang generating qi,yin constituting the body".Insufficient yang generating qi and excessive yin constituting the body constitutes the core pathogenesis of myocardial fibrosis.This article proposes a treatment approach for myocardial fibrosis by tonifying yang and abating yin.The treatment of warming yang,unblocking yang,removing blood stasis,resolving phlegm,detoxifying,and promoting diuresis is applied to broaden the clinical treatment approach for myocardial fibrosis.

Objective To analyze pathogen distribution and drug resistance in a tertiary hospital in Shenyang in 2022 and provide evi-dence-based guidance for this and other hospitals to formulate antibacterial drug application strategies.Methods In 2022,bacterial iso-lates collected from patients in a tertiary hospital in Shenyang were identified and subjected to drug sensitivity tests based on the require-ments of the national clinical laboratory operation procedures.The data were analyzed using Whonet 5.6 software.Results In total,4968 pathogenic strains were isolated from this hospital in 2022.The top five isolates were Escherichia coli,Klebsiella pneumoniae,Acineto-bacter baumannii,Enterococcus faecalis,and Pseudomonas aeruginosa.The resistance rates of Escherichia coliand Klebsiella pneumo-niaeto carbapenems were 1.9%and 17.7%,respectively.The resistance rates of Enterobacter cloacaeto imipenem and meropenem were 26.7%and 25.0%,respectively.The isolation rate of methicillin-resistant Staphylococcus aureus(MRSA)was 15.6%.The resistance rates of vancomycin-resistant Enterococcusand linezolid-resistant Enterococcus faecaliswere 7.1%and 11.6%,respectively.The resist-ance rates of tropical yeasts to fluconazole was>20%.Conclusion The distribution and drug resistance of pathogens in this hospital differed from those in other regions of China.The drug resistance of strains in this hospital should be closely monitored to understand the distribution and drug resistance of pathogens in a timely manner and to provide guidance for the diagnosis and treatment of infections.

Objective To promote the construction of a standardized informed consent library and achieve standardized management of informed consent forms.Methods The informed consent forms were standardized and classified,assigned version numbers,and structured and content were regulated.The forms were integrated and used according to signing scenarios and surgi-cal types,and electronic signatures from patients were implemented.Results The initiative achieved full coverage of electronic patient signatures across a total of 158 wards in four campuses.The defect rate of informed consent forms found in medical record quality inspections dropped from 25.93％in 2022 to 3.7％in 2023.The proportion of cases with inadequate informed consent in complaints and petitions decreased from 8.9％in 2022 to 4.5％in 2023.Conclusion The construction of a standardized in-formed consent library has accelerated the process of paperless medical records,improved clinical work efficiency and medical re-cord quality,enhanced doctor-patient relationships,and elevated the overall quality of medical care.

Objective To explore the effect of exercise preconditioning on inflammatory response in ischemic stroke brain tissue which mediated by miR-146a in extracellular vesicles in rats with middle cerebral artery oc-clusion(MCAO),and its mechanism.Methods Sixty 6-week-old male Sprague-Dawley rats were randomly divid-ed into a non-exercise group and an exercise group.The non-exercise group was further divided into a sham-operation control group(C,n=15)and an MCAO model group(M,n=15),while the exercise group was further di-vided into an exercise only group(E,n=15)and an exercise plus MCAO model group(EM,n=15).Rats in the E and EM groups underwent 8 weeks of treadmill exercise,6 days per week,30 minutes per day.Then rats in the M and EM groups received MCAO to induce ischemic stroke,while the C and E groups underwent a sham surgery.Twenty-four hours after the surgery,neurobehavioral tests were performed.Plasma was collected to ex-tract extracellular vesicles,and brain tissue was collected to measure the volume of cerebral infarction by using the triphenyl tetrazolium chloride(TTC)staining.Moreover,the Nissl staining was conducted to observe neuronal and Nissl body.Mean while,the content of miR-146a in plasma extracellular vesicles and brain tissue was mea-sured by using the quantitative polymerase chain reaction(qPCR),and the expression of TNF receptor associat-ed factor 6(TRAF6),nuclear factor kappa-B(NF-κB)and tumor necrosis factor-α(TNF-α)in brain tissues were determined using Western blotting.The targeting relationship between miR-146a and TRAF6 was detected by using the dual luciferase reporter gene assay.Results(1)The neurological behavioral scores of the EM and M groups were higher than those of the C group(P<0.01 and P<0.01),with that of the EM group lower than the M group(P<0.01).(2)TTC staining showed that the infarct volume of the EM and M groups was larger than that of the other two groups(P<0.01 and P<0.01),with that of the EM group smaller than the M group(P<0.01).(3)Nissl staining results showed that the neuronal arrangement was loose,the number of neurons re-duced,and the Nissl bodies were lightly stained and decreased in the M group compared with the C and E groups.Moreover,compared with the M group,the number of neurons and Nissl bodies increased in the EM group.(4)The qPCR analysis showed that the expression of miR-146a in the plasma-derived exosomes and brain tissues of the EM and M groups decreased compared with the C group(P<0.05 and P<0.01),with that of the EM group higher than the M group(P<0.05).(5)According to Western blotting,compared with the C group,the expression levels of TRAF6,NF-κB,and TNF-α proteins increased significantly(P<0.05 and P<0.01),with that of group EM signfiicantly lower than group M(P<0.05 and P<0.05).(6)Dual-luciferase report-er gene assay showed that miR-146a had a specific binding site with TRAF6.Conclusion Eight weeks of exer-cise preconditioning reduces the infarct area and the extent of brain damage,which may be mediated by miR-146a via exosomes,increasing the expression of miR-146a in brain tissue,targeting TRAF6,negatively regulat-ing TRAF6/NF-κB,and reducing the expression of TNF-α,thus alleviating the inflammatory response in brain tissue and exerting a protective effect on ischemic brain injury.

To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the treatment of symptomatic giant colonic lipomas (≥5 cm). Eight patients with giant colonic lipomas were treated with ESD at the Department of Digestive Endoscopy, Shanghai East Hospital from December 2018 to December 2021. The complete resection rate was 100% with the mean size of the resected lesion of 6.0 cm (ranging from 5.5 cm to 9.0 cm). The mean operation time of ESD was 41 minutes (ranging from 25 minutes to 80 minutes). Minimal bleeding were all successfully stopped with electrocoagulation and 2 small perforations were successfully sutured during the procedures. No abdominal pain, fever, delayed bleeding or perforation occurred after ESD. The mean hospital stay was 3 days (ranging from 3 days to 5 days). No residual or recurrence was found during the follow-up of 8-36 months. Thus, ESD is safe and effective for the treatment of giant colonic lipomas which can avoid surgical resection.

Objective:To investigate the cosmetic effects of botulinum toxin type A(BTX-A) in the prevention and treatment of cicatrix on split-thickness skin graft donor site.Methods:A prospective randomized controlled study was commenced to recruit patients with functional burns and chronic wounds who were repaired with split-thickness skin graft in the Department of Burn and Plastic Surgery of Zhongshan People’s Hospital from September 2021 to September 2022. Ten days after wound healing in the donor area of the thigh (about 4 weeks after surgery), the patients were randomly divided into two groups: the experimental group and the control group. The experimental group was injected with BTX-A solution at the skin donor site by equal interval injection method 1 and 3 months after surgery, 0.1 ml (1 U) was injected at each point, and the interval of each point was 1 cm. The control group was injected with equal amount of normal saline at the skin donor area by equal spacing method 1 and 3 months after operation. The adverse reactions was observed. Follow-up was performed six months after treatment. Evaluation indicators included the doctor’s Vancouver scar scale (VSS) score (including color, vascular distribution, softness and thickness), the visual analogue scale (VAS) score of the patient’s scar pain and itching degree. Both VSS scores and VAS scores were in line with normal distribution, expressed as Mean±SD, and analyzed by independent sample t-test. Results:A total of 60 subjects were recruited, 30 in the experimental group and 30 in the control group. In the experimental group, there were 16 males and 14 females, aged (32.7±5.4) years (18-60 years). In the control group, there were 13 males and 17 females, aged (31.4±4.8) years (18-55 years). There were no significant differences in gender composition and age between the two groups (all P > 0.05). No serious adverse reactions occurred in the experimental group during and after treatment. At the follow-up six months after treatment, the total score of VSS in the experimental group [(3.57±0.60) points vs. (8.52±0.84) points] and the scores of scar color, vascular distribution, flexibility and thickness[(0.88±0.22) points vs. (2.30±0.52) points; (0.73±0.27) points vs. (2.16±0.40) points; (1.29±0.39) points vs. (2.49±0.39) points; (0.66±0.23) points vs. (1.56±0.34) points] were significantly lower than those in the control group, and the differences were statistically significant ( P < 0.01). The VAS score of scar pain and itching degree in the experimental group was also significantly lower than that in the control group [(1.06±0.34) points vs. (2.92±0.63) points], and the difference was statistically significant ( P < 0.01). Conclusion:BTX-A injection is safe and effective in preventing and treating cicatrix in the donor area of split-thickness skin graft, and also has a good effect on relieving the pain and itching symptoms of cicatrix patients.

Objective:To investigate the cosmetic effects of botulinum toxin type A(BTX-A) in the prevention and treatment of cicatrix on split-thickness skin graft donor site.Methods:A prospective randomized controlled study was commenced to recruit patients with functional burns and chronic wounds who were repaired with split-thickness skin graft in the Department of Burn and Plastic Surgery of Zhongshan People’s Hospital from September 2021 to September 2022. Ten days after wound healing in the donor area of the thigh (about 4 weeks after surgery), the patients were randomly divided into two groups: the experimental group and the control group. The experimental group was injected with BTX-A solution at the skin donor site by equal interval injection method 1 and 3 months after surgery, 0.1 ml (1 U) was injected at each point, and the interval of each point was 1 cm. The control group was injected with equal amount of normal saline at the skin donor area by equal spacing method 1 and 3 months after operation. The adverse reactions was observed. Follow-up was performed six months after treatment. Evaluation indicators included the doctor’s Vancouver scar scale (VSS) score (including color, vascular distribution, softness and thickness), the visual analogue scale (VAS) score of the patient’s scar pain and itching degree. Both VSS scores and VAS scores were in line with normal distribution, expressed as Mean±SD, and analyzed by independent sample t-test. Results:A total of 60 subjects were recruited, 30 in the experimental group and 30 in the control group. In the experimental group, there were 16 males and 14 females, aged (32.7±5.4) years (18-60 years). In the control group, there were 13 males and 17 females, aged (31.4±4.8) years (18-55 years). There were no significant differences in gender composition and age between the two groups (all P > 0.05). No serious adverse reactions occurred in the experimental group during and after treatment. At the follow-up six months after treatment, the total score of VSS in the experimental group [(3.57±0.60) points vs. (8.52±0.84) points] and the scores of scar color, vascular distribution, flexibility and thickness[(0.88±0.22) points vs. (2.30±0.52) points; (0.73±0.27) points vs. (2.16±0.40) points; (1.29±0.39) points vs. (2.49±0.39) points; (0.66±0.23) points vs. (1.56±0.34) points] were significantly lower than those in the control group, and the differences were statistically significant ( P < 0.01). The VAS score of scar pain and itching degree in the experimental group was also significantly lower than that in the control group [(1.06±0.34) points vs. (2.92±0.63) points], and the difference was statistically significant ( P < 0.01). Conclusion:BTX-A injection is safe and effective in preventing and treating cicatrix in the donor area of split-thickness skin graft, and also has a good effect on relieving the pain and itching symptoms of cicatrix patients.

Objective: Plant hormones act as chemical messengers in the regulation of plant development and metabolism. The production of ginsenosides in Panax hybrid is promoted by auxins that are transported and accumulated by PIN-FORMED (PIN) and PIN-LIKES (PILS) auxin transporters. However, genome-wide studies of PIN/PILS of ginseng are still scarce. In current study, identification and transcriptional profiling of PIN/PILS gene families, as well as their potential relationship with ginsenoside biosynthesis in Panax ginseng were investigated. Methods: PIN/PILS genes in P. ginseng was identified via in silico genome-wide analysis, followed by phylogenetic relationships, gene structure, and protein profiles investigation. Moreover, previously reported RNA-sequence data from various tissues and roots after infection were utilized for PIN/PILS genes expression pattern analysis. The Pearson's correlation analysis of specific PIN/PILS genes expression level and main ginsenoside contents were taken to reveal the potential relationship between auxin transports and ginsenoside biosynthesis in P. ginseng. Results: A genome-wide search of P. ginseng genome for homologous auxin transporter genes identified a total of 17 PIN and 11 PILS genes. Sequence alignment, putative motif organization, and sub-cellular localization indicated redundant and complementary biological functions of these PIN/PILS genes. Most PIN/PILS genes were differentially expressed in a tissue-specific manner, and showed significant correlations with ginsenoside content correspondingly. Eight auxin transporter genes, including both PIN and PILS subfamily members, were positively correlated with ginsenoside content (cor > 0.60; P-value <0.05). The expression levels of eleven auxin transporter genes were increased dramatically in the early stage (0–0.5 DPI) after Cylindrocarpon destructans infection, accompanied with various overall expression patterns, implying the dynamic auxin transport in response to biotic stress. Conclusion: Based on the results, we speculate that the accumulation or depletion in temporal or spatial manner of auxin by PIN/PILS transporters involved in the regulation of HMGR activity and subsequent ginsenoside biosynthesis.

Objective:To investigate the effect of methoxyamine combined with target guided fluid in elderly patients undergoing pancreaticoduodenectomy.Methods:90 elderly patients undergoing pancreaticoduodenectomy were randomly divided into methoxyamine group and control group, with 45 cases in each group. The patients in both groups were treated with intravenous inhalation combined anesthesia. The stroke volume variation (SVV) was maintained at 7%-10% and the central venous pressure (CVP) was 4-8 cmH 2O. In methoxyamine group, 3 μg/(kg·min) methoxyamine was continuously pumped, while the control group was pumped with the same amount of normal saline at the same speed. The intraoperative infusion volume, urine volume, bleeding volume, blood transfusion cases, intraoperative mean arterial pressure, heart rate, blood gas analysis results, B-type natriuretic peptide (BNP), creatinine, urea nitrogen level and postoperative exhaust time were compared between the two groups. Results:Compared with the control group, the patients in methoxyamine group had less infusion volume, urine volume, lower postoperative BNP level and heart rate, shorter postoperative exhaust time (all P<0.05), and higher mean arterial pressure ( P<0.05). There was no significant difference in blood loss, blood transfusion cases, PaO 2, PaCO 2, pH, creatinine and urea nitrogen between the two groups (all P>0.05). In addition, the number of patients in the methoxyamine group who used pressor drugs was less than that in the control group ( P<0.05), and the frequency of bradycardia was more than that in the control group ( P<0.05). The proportion of tachycardia and urapidil was similar in the two groups (all P>0.05). Conclusions:Methoxyamine combined with target guided fluid therapy can reduce the intraoperative infusion volume of pancreaticoduodenectomy in elderly patients, stabilize circulation, shorten postoperative exhaust time, and contribute to the recovery of gastrointestinal function.