Objective To study the effect of Ditan Decoction combined with aripiprazole and olanzapine in the treatment of schizophrenia and its influence on serum inflammatory factors chnage.Methods Seventy-seven patients with schizophrenia meeting the requirements visiting the outpatient department and hospitalized in Dazu District Hospital of Traditional Chinese Medicine and Dazu District Mental Health Center from July 2021 to March 2023 were selected as the study subjects and divided into the observation group(n=38)and control group(n=39).The control group was treated with aripiprazole and olanzapine,and the observation group was combined with Ditan Decoction on the basis of the control group.After 8 weeks of treatment,the TCM syndrome scores,Positive and Negative Syndrome Scale(PANSS)score,serum inflammatory factors(IL-6,IL-1β,IL-17)levels were compared between the two groups.Results The total effective rate was 97.37％in the observation group and 84.65％in the control group,and the difference was statistically signifi-cant(P＜0.05).The TCM syndrome score of each item and total scores after treatment in the observation group were lower than those in the control group(P＜0.05),the PANSS positive symptoms,negative symp-toms,general psychopathology and total scores in the observation group were lower than those in the control group(P＜0.05).The IL-17,IL-6 and IL-1β levels after treatment in observation group were lower than those in the control group(P＜0.05).Conclusion Ditan Decoction combined with aripiprazole and olanzapine has significant clinical efficacy in the treatment of schizophrenia,which could further reduce the symptom score of the patients and improve the serum inflammatory factors levels.The treatment is highly safe and worthy of clinical recommendation.

Objective To investigate the distribution and antimicrobial resistance of Enterobacter cloacae complex(ECC)isolated from a tertiary hospital in Shanghai.Methods Clinical ECC isolates were collected from 2018 to 2020.Antimicrobial susceptibility test was performed with broth microdilution and agar dilution methods.PCR was applied to detect five carbapenemase genes(blaKPC,blaNDM,blaIMP,blaVIM and blaOXA-48).Results A total of 222 ECC isolates were collected from 2018-2020,including 36 strains(16.2％)from general surgery department.The strains were mainly isolated from sputum(41.0％)and urine(20.3％).MIC results showed that the isolates were highly resistant to trimethoprim-sulfamethoxazole,the second-and third-generation cephalosporins,aztreonam and quinolones(31.1％-71.2％resistant),but low resistance rates to tigecycline,amikacin,mecillinam,and ceftazidime-avibactam(0.5％-9.0％resistant).About 9.5％and 10.4％of the strains were resistant to meropenem and imipenem,respectively.A total of 34 ECC strains were carbapenem-nonsusceptible strains,of which 23 strains were resistant to carbapenems.Among the 34 carbapenem-nonsusceptible strains,25(73.5％)strains were susceptible to mecillinam,including 15 strains producing metallo-β-lactamase.PCR assay identified carbapenemase genes in 21 of the 34 carbapenem-nonsusceptible strains,including blaNDM(14 strains),blaIMP(5 strains)and blaKPC(2 strains).Compared with the strains isolated in 2018,the ECC strains isolated in 2019 and 2020 showed significantly higher resistance rates to imipenem and ceftazidime-avibactam(P＜0.05),primarily associated with the production of NDM.Among the ECC strains resistant to third-generation cephalosporins,20.4％were resistant to imipenem and meropenem,while 4.9％and 8.7％were resistant to amikacin and mecillinam,respectively,and 9.7％were nonsusceptible to tigecycline.Conclusions The ECC isolates in 2019 and 2020 showed increasing resistance rates to carbapenems and ceftazidime-avibactam due to the production of metallo-β-lactamases.Some of the metallo-β-lactamase-producing ECC isolates were susceptible to mecillinam.

Objective To explore whether remote ischemic preconditioning(RIPC)can prolong the time of ultra-intense exercise(110%VO2max)by increasing the maximum cumulative oxygen deficit(MA-OD),and the specific ways of energy supply of the anaerobic metabolic system.Methods Twenty-four racquet athletes(22.2±2.0 years;174±9 cm;67.1±12.4 kg)completed three supramaximal intensi-ty tests on a treadmill at 110%VO2max intensity to exhaustion separated with Control,Placebo and RIPC interventions.RIPC was induced on the limbs on both sides(5×5 min alternating bilateral occlu-sion 220 and 60 mmHg for Placebo and RIPC interventions,respectively).Moreover,all groups under-went a fourth test with incremental load,and a fifth test with constant load at 40%,50%,60%,70%and 80%VO2max.Results The time to exhaustion and the MAOD of the RIPC group were both greater than those in the Placebo and Control groups(P<0.05).However,no significant differences were found in the average alternative maximal accumulated oxygen deficit(MAODALT),lactic anaerobic metabolism,alactic anaerobic metabolism and parameters of excess post-exercise oxygen consump-tion dynamic curve of the three groups(P>0.05).Meanwhile,in the RIPC group,the average MAOD was significantly higher than MAODALT(P<0.05).Pearson correlation analysis showed a significant rela-tionship between the improvement of MAOD and an increase in exhaustion time after RIPC interven-tion.Conclusion RIPC can improve supramaximal exercise performance of racquet athletes by enhanc-ing their MAOD,and the enhancement of glycolysis energy supply and lactic acid elimination is a po-tential intermediary of the improvement of sports performance.

Objective:To analyze the improvement of patients with basilar invagination and atlantoaxial dislocation that treated by anterior or posterior surgery.Methods:50 patients with basilar invagination and atlantoaxial dislocation that underwent simple anterior or posterior surgery from 2009 to 2021 were included. There were 34 females and 16 males with a mean age of 45.04 years (range, 18-65 years). All patients underwent thin- slice CT scan of the neck. Preoperative and postoperative measurements of atlantoaxial joint distance, atlantoaxial joint angle, atlantoaxial joint displacement, Claus' Height, atlas-dens interval, space available for the cord, cervicomedullary angle, C 0-C 2 angle, and C 2-C 7 angle were measured. Then, the data were analyzed by independent sample t test. Results:25 patients (7 males, 18 females) were included in the anterior surgery group, and 25 patients (9 males, 16 females) were included in the posterior surgery group. The mean age of the two groups was 45.24±9.86 years and 44.72±14.06 years, respectively, showing no statistical difference. The mean last follow-up time of the anterior and posterior surgery group was 6.48±3.14 months and 7.04±2.87 months, respectively. The odontoid distance, atlas-dens interval, space available for the cord and cervicomedullary angle in 2 groups were significantly improved after surgery ( P<0.05), while there were no significant differences in the above parameters between 2 groups ( P>0.05). In the anterior surgery group, the distance and angle of atlantoaxial joint were increased, and the atlantoaxial joint displacement decreased significantly. While in the posterior surgery group, only the atlantoaxial joint space increased ( P<0.05). The C 0-C 2 angle was significantly increased and the C 2-C 7 angle was significantly decreased in the anterior surgery group ( P<0.05), but there was no significant difference in these parameters in the posterior surgery group ( P>0.05). In addition, there was no significant difference in parameters between the two groups at the last follow-up compared with those immediately after surgery. Conclusion:Both anterior and posterior surgery can improve the compression of the spinal cord in patients with basilar invagination and atlantoaxial dislocation. Anterior surgery may be more adequate for the extension and reduction of the atlantoaxial joint space, however, excessive enlargement of the lordosis angle in upper cervical may lead to the reduction of the lordosis in lower cervical.

Objective To explore CTA and MRA characteristics of persistent trigeminal artery (PTA)with vascular disease. Methods 54 patients diagnosed as PTA by CTA and MRA were collected retrospectively,whose classification,variation and associated vascular disease were analyzed.Results There were more females than males in 54 patients,whose average age was 59.72±16.32,and the incidence of left ones were higher than that of the right ones.Type Ⅰ of Weon classification was 16 cases (29.63%),type Ⅱ 7 cases (12.96%),typeⅢ 16 cases (29.63%),type Ⅳ 1 1 cases (20.37%),type Ⅴ 4 cases (7.41%).The lateral type of Salas classification was significantly higher than that in the middle type.There were 16 cases (29.63%)with aneurysm,in which 3 cases (18.75%)were rupture.3 cases were with moyamoya disease (5.56%).39 cases (72.22%)were with basilar artery dysplasia.There were 33 cases (61.11%)with the postembryonic cerebral artery.There were 29 cases with cerebral infarction (53.7%),4 cases with cerebral hemorrhage (7.4%),3 cases with subarachnoid hemorrhage (5.5 6%).Cerebral arteriosclerosis with different degrees of stenosis was showed in 1 7 cases (31.48%). 2 cases were accompanied with trigeminal neuralgia (3.7%),and only 1 case was with ocular nerve palsy (1.85%).Conclusion CTA and MRA could be used to display the anatomical features and radiographic classification of PTA ,and also clearly display and evaluate PTA associated with vascular disease.

Objective To investigate the resistance profile of Klebsiella pneumoniae isolates in Huashan Hospital, Fudan University. Methods The MICs of fluoroquinolones were determined by agar dilution method against 112 clinical strains of K. pneumoniae. Multilocus sequence typing (MLST) were applied to 48 K. pneumoniae strains. The characteristic sequence type (ST) associated with antibiotic resistance was identified by PCR. Results Lower percentage (＜40％) of K. pneumoniae strains were susceptible to fluoroquinolones. Majority (86.2％) of ciprofloxacin non-susceptible K. pneumoniae strains belonged to CC1 (ST11), ST494 or CC4 (ST15 and ST655), indicating the potential of clonal dissemination. ST494 (18.8％) was the second commonest sequence type, next only to ST11. ST494 strains harbored the genes encoding beta-lactamases, oqxAB, qnrD, aac-(6')-lb-cr and armA and had a single point mutation in gyrA. Therefore, ST494 strains were highly resistant to cephalosporins, fluoroquinolones and aminoglycosides and 22％ of the strains were resistant to carbapenems. However, all the ST494 strains were susceptible to tigecycline and tetracycline. Conclusions ST11 and ST494 are the commonest STs of K. pneumoniae conferring multidrug resistance in this hospital. These STs may contribute to the high resistance rates of K. pneumoniae to fluoroquinolones. The susceptibility of ST494 strains to tigecycline and tetracycline allows us to consider the promising potential of such drugs in managing K. pneumoniae infections.

Objective To predict the epitopes of Mycobacterium tuberculosis Rv2657c protein, to understand its immunogenicity Methods The T?cell and B?cell epitopes of Mycobacterium tuberculosis Rv2657c protein were predicted by DNAStar software package. The homology of Rv2657c amino acid sequence with the human protein sequences was prepared using Blast method, then the CTL epitopes were predicted using SYFPEITHI supermotif method, BIMAS quantitative motif method and NetCTL prediction method, and the Th epitopes were predicted by RANKPEP and SYFPEITHI supermotif prediction method. Results The prediction using DNAStar software package showed that Rv2657c protein had 5 B?cell epitopes and 6 T?cell epitopes. The protein had 6 CTL epitopes and there were 38 Th epitopes. Conclusion Rv2657c protein has both B?cell epitopes and T?cell epitopes. It may be a candidate target antigen for the studies of vaccine and diagnosis of tuberculosis.

Objective To understand the associations between extremely low and high air temperature and the years of life lost (YLL) due to diabetes deaths in Chongqing and Harbin with different climatic characteristics in China.Methods A double threshold B-spline distributed lag non-linear model (DLNM) was used to investigate the lag and cumulative effects of extremely low and high air temperature on YLL due to diabetes for lag 0-30 days by using the urban meteorological and diabetes mortality data of Chongqing (2011-2013) and Harbin (2008-2010).The effects were expressed as relative risk (RR).Results In Chongqing,the cold effects on YLL due to diabetes were delayed by four days and lasted for three days (lag4-6) with the highest RR of 1.304 (95％ CI:1.033-1.647) at lag5.The hot effects were delayed by one day (lagl) with RR of 1.321 (95％ CI:1.061-1.646).In Harbin,the extreme cold effects on YLL were delayed by four days and lasted for seven days (lag4-10) with the highest RR of 1.309 (95％CI:1.088-1.575) at lag6.The hot effects were delayed by one day and lasted for four days (lagl-4) with the highest RR of 1.460 (95％ CI:1.114-1.915) at lag2.The unit risk for cold and hot effects was 43.7％ (P=0.005 5) and 18.0％ (P=0.000 2) in Chongqing and 15.0％ (P=0.000 8) and 29.5％(P=0.001 2) in Harbin,respectively.Conclusions Both extremely low air temperature and extremely high air temperature might increase the years of life lost due to diabetes in cities with different climate characteristics.Health education about diabetes prevention should provide information about the effects of extreme weather events.

Objective To explore the diagnostic and differential diagnostic points of patients with rheumatoid arthritis (RA) complicated with fever.Methods Full clinical analysis was performed for a 62-year old patient with RA and fever.Results Hemophagocytes were found in bone marrows smear.Significantly increased ferritin level (74 299 ng/ml),decreased hemoglobin (67 g/L) and platelet (33×109/L),decreased fibrinogen,increased serum soluble CD25 (sCD25),positive cytomegalovirus (CMV) DNA,positive CMV-PP65 antigen,were found by laboratory examination.Decreased activity of NK cells was detected by flow cytometry.Positron emission computed tomography (PET-CT) revealed splenomegaly and pulmonary inflammations.The clinical conditions were recovered with the treatment of corticosteroid,VP16,cyclosporine,anti-CMV virus therapy.Ferritin level was significantly decreased and platelet was normal.The patient was diagnosed as hemophagocytic syndrome associated with CMV infection.Conclusion The possibility of hemophagocytic syndrome should be considered in RA patients presented with fever.

Objective To investigate the profile of antimicrobial susceptibility of the Mycoplasma pneumoniae (Mpn)strains isolated from pediatric patients with respiratory tract infection.Methods Antimicrobial susceptibility testing was conducted with a total of 112 Mpn clinical strains by broth microdilution method.Sequence analysis of full 23S rRNA genes was performed for all Mpn strains.Results One hundred and twelve Mpn strains were isolated from January 2009 to March 2011. Of these clinical isolates,98 (87.5%)were resistant to erythromycin and azithromycin.All macrolide-resistant Mpn strains harbored an A2063G or A2064G transition mutation in domain V of 23S rRNA genes.Mpn isolates were still very susceptible to the tetracyclines and fluoroquinolones tested.Conclusions The Mpn strains from pediatric patients are highly resistant to macrolides.The mechanism of macrolide resistance may be associated withthe transition mutation on 23S rRNA gene.