The influence of renally inappropriate medication on the frailty of elderly patients with diabetes / 中国药房

OBJECTIVE To investigate the effects of renally inappropriate medication （RIM） on the frailty of elderly patients with diabetes. METHODS The data of elderly patients with diabetes mellitus admitted to a third-grade class A hospital in Yunnan province from January to December 2022 were collected， and Beers criteria （2019 edition） and Chinese version of FRAIL scale were used to evaluate RIM and the frailty of the patients； the patients were divided into the trial group （with RIM） and the control group （without RIM） according to whether there was RIM. The propensity score matching was used to balance confounding factors between two groups， and the influence of RIM on the frailty of elderly diabetic patients was analyzed by the Logistic regression model. RESULTS Among the 367 patients， 80 patients （21.80%） had RIM， the drugs involved RIM were spironolactone （82.56%）， rivaroxaban （13.95%） and gabapentin （3.49%）. After reaching the balance between groups using the propensity score matching method， the incidence of frailty was 77.94% in trial group and 27.94% in control group （P＜0.001）； the difference was not statistically significant in other confounding factors between the two groups （P＞0.05）. Results of Logistic regression analysis showed that the risk of frailty in the experimental group was 3.118 times that of the control group （odds ratio was 3.118，95% confidence interval was 1.758-5.530， P＜0.001）. CONCLUSIONS RIM is a risk factor for the frailty of elderly patients with diabetes， which can be considered as an indicator for early identification and screening of the frailty of elderly diabetes patients.

Structure-activity relationship of pyrazol-4-yl-pyridine derivatives and identification of a radiofluorinated probe for imaging the muscarinic acetylcholine receptor M4

There is an accumulating body of evidence implicating the muscarinic acetylcholine receptor 4 (M4) in schizophrenia and dementia with Lewy bodies, however, a clinically validated M4 positron emission tomography (PET) radioligand is currently lacking. As such, the aim of this study was to develop a suitable M4 PET ligand that allows the non-invasive visualization of M4 in the brain. Structure-activity relationship studies of pyrazol-4-yl-pyridine derivates led to the discovery of target compound 12 - a subtype-selective positive allosteric modulator (PAM). The radiofluorinated analogue, [18F] 12, was synthesized in 28 ± 10% radiochemical yield, >37 GBq/μmol and an excellent radiochemical purity >99%. Initial in vitro autoradiograms on rodent brain sections were performed in the absence of carbachol and showed moderate specificity as well as a low selectivity of [18F] 12 for the M4-rich striatum. However, in the presence of carbachol, a significant increase in tracer binding was observed in the rat striatum, which was reduced by >60% under blocking conditions, thus indicating that orthosteric ligand interaction is required for efficient binding of [18F] 12 to the allosteric site. Remarkably, however, the presence of carbachol was not required for high specific binding in the non-human primate (NHP) and human striatum, and did not further improve the specificity and selectivity of [18F] 12 in higher species. These results pointed towards significant species-differences and paved the way for a preliminary PET study in NHP, where peak brain uptake of [18F] 12 was found in the putamen and temporal cortex. In conclusion, we report on the identification and preclinical development of the first radiofluorinated M4 PET radioligand with promising attributes. The availability of a clinically validated M4 PET radioligand harbors potential to facilitate drug development and provide a useful diagnostic tool for non-invasive imaging.

Wernekink Commissure Syndrome With Hallucinations and Involuntary Groping:Report of One Case / 中国医学科学院学报

Wernekink commissure syndrome is a rare midbrain syndrome with bilateral cerebellar dysfunction,eye movement disorder,and palatal myoclonus.Few cases of this syndrome have been reported in China,let alone those combined with hallucinations and involuntary groping.This paper reports the diagnosis and treatment of a case of Wernekink commissure syndrome with hallucinations and involuntary groping,aiming to enrich the knowledge about this disease for clinicians.

Study on the effect of personal radiological protective equipment used in diagnostic radiology / 中华放射医学与防护杂志

Objective:To study the actual effect of the use of personal protective equipment of the examined individuals, and provide reference and basis for the correct use of personal protective equipment and the radiological health administrative law enforcement.Methods:From February to June 2022, the imaging department of Qingdao Municipal Hospital selected 170 patients who underwent X-ray imaging examination (oral panoramic, dental radiography, DR photography, CT scanning), including 25 with oral panoramic and dental radiography, 60 with CT scanning and 60 with DR imaging. The thermoluminescent dosimeter was used to detect the ambient dose equivalent at the point of concern for 170 examined individuals who have used personal protective equipment to cover their sensitive parts, and to analyze the data detected at the same point as above when routinely using the same equipment.Results:There was a statistically significant difference in the dose equivalent at the same points inside and outside the lead neckband ( t=-2.23, P<0.05). There was no statistically significant difference in the dose equivalent at the same point inside and outside the lead collar during dental radiography ( P>0.05). During DR photography (chest PA, lateral and lumbar AP), the examined individuals were wearing lead aprons. Among them, there was a statistically significant difference in the dose equivalent at the same points inside and outside the lead aprons of children′s chest PA and adults′ chest PA ( U=10.00, 19.00, P<0.05). There was no statistically significant difference in the dose equivalent at the same points inside and outside the lead aprons of adult′s chest PA and lumbar AP ( P>0.05). When performing CT scan (chest or upper abdomen), there was a statistically significant difference in the dose equivalent at the same points of wrapped lead aprons( U=878.50, 11.00, P<0.05). Conclusions:The correct use of personal protective equipment is a complex technical problem. It is very important to fully and accurately understand the optimization principle of radiation protection and correctly use personal protective equipment for the examined individuals. The administrative punishment of radiation health on the use of personal protective equipment of the examined individuals should be cautious.

Correlation of cognitive function and clinical characteristics in adolescent depressive disorder patients with self-injury behavior / 中华行为医学与脑科学杂志

Objective:To investigate the correlation between cognitive function and addiction, impulsivity, and anhedonia in adolescent depressive disorder patients with self-injury behavior.Methods:From September 2021 to October 2022, adolescents with depressive disorders who visited the outpatient department of the Qingdao Mental Health Center were enrolled and divided into self-injury group and non self-injury group based on the presence or absence of self-injury behaviors, each with 60 participants.A self-compiled general information questionnaire, the 17 items Hamilton depression rating scale (HAMD-17), the Ottawa self-injury inventory (OSI), the Chinese version of the Barratt impulsiveness scale (BIS-11), and the temporal experience of pleasure scale(TEPS) were used to evaluate both groups.The Chinese brief cognitive test(C-BCT) was used to assess cognitive function in both groups.SPSS 26.0 software was used for statistical analysis, including t-test, χ2 test, Pearson correlation analysis, and multiple linear regression analysis. Results:The self-injury group had higher scores for OSI addiction factors (9.43±8.29) and BIS-11 (67.09±11.48) compared to the non self-injury group (OSI addiction factor scores: 0, BIS-11 scores: 53.70±7.12, t=6.22, 5.91, both P<0.05). TEPS score and C-BCT scores in various dimensions were lower in the self-injury group than those in the non self-injury group ( t=-2.93, -2.01, -2.88, -2.20, -5.35, all P<0.05). Information processing speed was negatively correlated with BIS-11 score ( r=-0.296, P<0.05), and attention score were negatively correlated with OSI addiction factor score and BIS-11 score ( r=-0.303, -0.561, both P<0.05) and positively correlated with TEPS score ( r=0.364, P<0.05), including a positive correlation with the scale of anticipatory anhedonia score ( r=0.318, P<0.05). Working memory score was negatively correlated with OSI addiction factor score and BIS-11 score ( r=-0.312, -0.416, both P<0.05). Comprehensive ability and executive function scores were negatively correlated with OSI addiction factor score and BIS-11 score ( r=-0.308, -0.679, both P<0.05), and positively correlated with TEPS score ( r=0.304, P<0.05). Multiple linear regression analysis showed that BIS-11 scores were influencing factors of C-BCT dimensions ( β=-0.260, -0.592, -0.557, -1.797, t=-2.150, -3.314, -2.285, -5.165, all P<0.05). Conclusion:In adolescent depressive patients with self-injury, cognitive function is correlated with addiction, impulsivity and anhedonia, among which impulsivity is a risk factor for cognitive function.

Research progress in dialectical treatment of premature ovarian failure by Zhejiang TCM gynecology schools / 中国基层医药

In traditional Chinese medicine, premature ovarian failure is attributed to the menstrual diseases such as amenorrhea, infertility, premenopausal and postmenopausal syndromes. The Zhejiang TCM gynecology schools are good at dialectical treatment of the above menstrual diseases similar to premature ovarian failure, especially Gynecology of Xiaoshan Zhulin Temple, Gynecology of Haining Chen Mushan, Gynecology of Ningbo Song's Family and Gynecology of Hangzhou He's Family. This paper summarizes the characteristics and experience of the four Zhejiang TCM gynecology schools in the dialectical treatment of premature ovarian failure, which can be used for reference.

Expression and significance of microRNA-21 and microRNA-181b in peripheral blood of patients with schizophrenia / 中国基层医药

Objective:To investigate the expression and significance of microRNA-21 (miRNA-21) and microRNA-181b (miRNA-181b) in the peripheral blood of patients with schizophrenia.Methods:A total of 100 patients with schizophrenia who received treatment in Shaoxing 7 th People's Hospital from March 2020 to March 2022 were included in the study group. An additional 30 healthy controls who concurrently underwent physical examination were included in the control group. The expression of miRNA-21 and miRNA-181b in peripheral blood was compared between the two groups. The 100 patients with schizophrenia received standardized clinical treatment. Their mental symptoms were evaluated with the Positive and Negative Symptom Scale (PANSS). miRNA-21 and miRNA-181b expression and PANSS scores before and 1, 4, 8, and 12 weeks after treatment were collected and compared between the two groups. The receiver operating characteristic curve was plotted to analyze the value of miRNA-21 and miRNA-181b expression in the diagnosis of schizophrenia. Results:Serum miRNA-21 and miRNA-181b expression in the study group were (2.41 ± 1.12) and (15.62 ± 2.26), respectively, which were significantly higher than (0.73 ± 0.37) and (8.11 ± 0.98) in the control group ( t = 8.07,17.67, both P < 0.05). With the prolongation of treatment time, serum miRNA-21 and miRNA-181b expression and PANSS score in the study group gradually decreased (all P < 0.001). The area under the receiver operating characteristic curve plotted for evaluating the value of miRNA-21 and miRNA-181b expression in the diagnosis of schizophrenia was 0.616 and 0.683, respectively. The area under the receiver operating characteristic curve plotted for evaluating the value of miRNA-21 combined with miRNA-181b expression in the diagnosis of schizophrenia was 0.788, which was markedly higher than that for the detection of miRNA-21 or miRNA-181b expression alone. Conclusion:miRNA-21 and miRNA-181b are abnormally highly expressed in the peripheral blood of patients with schizophrenia. Both of them can be used as objective and effective indicators for early diagnosis of schizophrenia. Combined detection of miRNA-21 and miRNA-181b provides higher accuracy in the diagnosis of schizophrenia than the detection of miRNA-21 or miRNA-181b alone.

The cultivation and enlightenment of mental health nursing personnel in the United States / 中华医学教育探索杂志

The cultivation of mental health nurses in the United States is unique. This article summarizes the educational requirements, training objectives, curriculum settings, teaching forms, and clinical practice of the mental health nursing talents at all levels in America, including undergraduates, masters, doctors of nursing practice, and doctors of nursing philosophy, aiming to provide references for the cultivation of mental health nursing talents in our country.

Breath-by-breath measurement of exhaled ammonia by acetone-modifier positive photoionization ion mobility spectrometry via online dilution and purging sampling / 药物分析学报

Exhaled ammonia(NH3)is an essential noninvasive biomarker for disease diagnosis.In this study,an acetone-modifier positive photoionization ion mobility spectrometry(AM-PIMS)method was developed for accurate qualitative and quantitative analysis of exhaled NH3 with high selectivity and sensitivity.Acetone was introduced into the drift tube along with the drift gas as a modifier,and the characteristic NH3 product ion peak of(C3H6O)4NH4+(K0=1.45 cm2/V·s)was obtained through the ion-molecule reaction with acetone reactant ions(C3H6O)2H+(K0=1.87 cm2/V·s),which significantly increased the peak-to-peak resolution and improved the accuracy of exhaled NH3 qualitative identification.Moreover,the interference of high humidity and the memory effect of NH3 molecules were significantly reduced via online dilution and purging sampling,thus realizing breath-by-breath measurement.As a result,a wide quantitative range of 5.87-140.92 μmol/L with a response time of 40 ms was achieved,and the exhaled NH3 profile could be synchronized with the concentration curve of exhaled CO2.Finally,the analytical capacity of AM-PIMS was demonstrated by measuring the exhaled NH3 of healthy subjects,demon-strating its great potential for clinical disease diagnosis.

A multilevel model analysis of the association between reading and writing posture with myopia in primary and secondary school students / 中国学校卫生

Objective@#To explore the association between reading and writing posture with the occurrence of myopia in Chinese children and adolescents, so as to provide a reference for reducing its prevalence among primary and secondary school students.@*Methods@#Using data from the 2020 survey on the current status of hyperopia reserve in primary and secondary school students from six provinces/cities, namely Beijing, Zhejiang, Chongqing, Shaanxi, Liaoning, and Henan selected by multi stage stratified cluster probability sampling method during November 2020 to June 2022. A total 16 782 students who completed the optometry examination of cycloplegia according to the Children and Adolescents Myopia Screening Standard and questionnaire survey were included for analyzing analyze the association between reading and writing posture with myopia.@*Results@#The overall detection rate of myopia among primary and secondary school students was 45.7%, of which 35.0% were primary school students, 84.1% junior high school students, and 90.4% senior high school students. Poor reading and writing posture was found in 73.6% of primary and secondary school students. Adjusting for confounding factors such as gender, school period, region, outdoor time every day, and whether parents were myopic, the results of the multilevel Logistic regression showed that the following factors were positively correlated with myopia:poor reading and writing posture ( OR=1.17, 95%CI =1.07-1.28), never/occasionally reading and writing with a reading distance which was more than one foot away between the eyes and book ( OR=1.28, 95%CI=1.08-1.53, OR=1.23, 95%CI = 1.08- 1.40), teachers occasionally reminding the child of their reading and writing posture ( OR=1.13, 95%CI =1.01-1.25), and often/always reading and writing while lying down or with the face on the arm ( OR=1.15, 95%CI=1.01-1.32, OR=1.46, 95% CI = 1.17-1.82), always reading and writing with the head in the hand ( OR=1.56, 95%CI =1.20-2.01). Further, a negative correlation was detected between myopia and parents occasionally reminding their children of their reading and writing posture ( OR= 0.85 , 95%CI =0.76-0.96) ( P <0.05).@*Conclusion@#Poor reading and writing posture is a risk factor for the development of myopia in primary and secondary school students, and interventions for reading and writing posture need to be strengthened to reduce the occurrence of myopia among primary and secondary school students.

Intravenous Tenecteplase for Acute Ischemic Stroke Within 4.5–24 Hours of Onset (ROSE-TNK): A Phase 2, Randomized, Multicenter Study / 대한뇌졸중학회지

Background@#and Purpose Intravenous tenecteplase (TNK) efficacy has not been well demonstrated in acute ischemic stroke (AIS) beyond 4.5 hours after onset. This study aimed to determine the effect of intravenous TNK for AIS within 4.5 to 24 hours of onset. @*Methods@#In this pilot trial, eligible AIS patients with diffusion-weighted imaging (DWI)-fluid attenuated inversion recovery (FLAIR) mismatch were randomly allocated to intravenous TNK (0.25 mg/kg) or standard care within 4.5–24 hours of onset. The primary endpoint was excellent functional outcome at 90 days (modified Rankin Scale [mRS] score of 0–1). The primary safety endpoint was symptomatic intracranial hemorrhage (sICH). @*Results@#Of the randomly assigned 80 patients, the primary endpoint occurred in 52.5% (21/40) of TNK group and 50.0% (20/40) of control group, with no significant difference (unadjusted odds ratio, 1.11; 95% confidence interval 0.46–2.66; P=0.82). More early neurological improvement occurred in TNK group than in control group (11 vs. 3, P=0.03), but no significant differences were found in other secondary endpoints, such as mRS 0–2 at 90 days, shift analysis of mRS at 90 days, and change in National Institutes of Health Stroke Scale score at 24 hours and 7 days. There were no cases of sICH in this trial; however, asymptomatic intracranial hemorrhage occurred in 3 of the 40 patients (7.5%) in the TNK group. @*Conclusion@#This phase 2, randomized, multicenter study suggests that intravenous TNK within 4.5–24 hours of onset may be safe and feasible in AIS patients with a DWI-FLAIR mismatch.

Advances in histone epigenetic enzyme inhibitors based on proteomics / 药学学报

As an important component of nucleosomes on the chromatin of eukaryotic cells, histones play an important role in the development and progression of tumour diseases by regulating epigenetic post-translational modifications such as acetylation and methylation. In addition, development of inhibitors targeting methyltransferase and deacetylase provides novel therapeutic strategies for cancer treatment. Mass spectrometry-based proteomics can reveal the global changes of histone modifications under the action of drugs during disease progression, which in turn provides important support for revealing drug action mechanism, drug resistance mechanism, and investigating novel drug combination strategies. This article focuses on the progress and status of proteomic research on a variety of histone modifying enzyme inhibitors, including methyltransferase inhibitors and histone deacetylase inhibitors, which will help to understand the current and further utilization of proteomics in studying histone modifications.

Effect of core muscle motor control training on postpartum diastasis recti abdominis / 中国康复理论与实践

ObjectiveTo explore the clinical effect of core muscle motor control training on postpartum diastasis recti abdominis. MethodsFrom January, 2021 to January, 2022, 30 outpatients with postpartum diastasis recti abdominis were randomly divided into control group (n = 15) and experimental group (n = 15). Manipulative therapy and breathing training were performed simultaneously in both groups. Besides, the control group received conventional core strength training, and the experimental group received core muscle motor control training, for four weeks. Their distance of diastasis recti abdominis, abdominal circumference and waist circumference were compared before and after treatment. ResultsAfter treatment, the distance of diastasis recti abdominis, abdominal circumference and waist circumference reduced in both groups (Z = 3.408, t > 5.927, P < 0.05). The reduction value of diastasis recti abdominis distance was more in the experimental group than in the control group (t = 2.328, P < 0.05). ConclusionCore muscle motor control training can effectively relieve postpartum diastasis recti abdominis, and the effect is better than conventional core strength training.

Study on altered functional and effective connectivity of bilateral precuneus in drug-naïve first-episode patients with adolescent-onset schizophrenia / 四川精神卫生

BackgroundCompared with adult-onset schizophrenia， patients with adolescent-onset schizophrenia experience a high genetic susceptibility， severe negative symptoms， high recurrence rate， poor prognosis and social function recovery. And clarifying the brain functional alterations in adolescent-onset schizophrenia is of great significance for further elucidating the pathogenesis of the disease and exploring personalized and precise treatment. ObjectiveTo investigate the altered functional and effective connectivity of bilateral precuneus in first-episode patients with adolescent-onset schizophrenia based on resting-state functional magnetic resonance imaging （rs-fMRI）， thus providing reliable imaging evidence in guiding the study on mechanism involved in adolescent-onset schizophrenia. MethodsTwenty-one drugnaïve first-episode patients with adolescent-onset schizophrenia who met the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） criteria for schizophrenia were enrolled， and another 21 psychiatrially healthy controls matched on age， educational background and gender were concurrently selected. The schizophrenic subjects were evaluated using the Psychotic Symptom Rating Scales （PSYRATS） and Positive and Negative Symptom Scale （PANSS）. All participants underwent rs-fMRI scans， and the whole-brain seed-based functional and effective connectivity analyses were conducted in bilateral cuneus region. Then the correlation between functional connectivity strength and clinical symptoms of patients was discussed. ResultsIn terms of functional connectivity， the functional connectivity of bilateral precuneus and left middle temporal gyrus was increased in patient group compared with healthy control group ［P<0.01， family-wise error （FWE） correction at cluster level， P<0.05］. In terms of effective connectivity， patient group responded to negative feedback with greater activation of seed region and left middle frontal gyrus than healthy control group. Correlation analysis within patient group denoted that the decreased effective connectivity of bilateral precuneus and left middle frontal gyrus was positively correlated with the total PANSS score （r=0.450， P<0.05）. ConclusionThe resting-state functional and effective connectivity of bilateral precuneus is abnormally alerted in drugnaïve first-episode patients with adolescent-onset schizophrenia， and the decreased effective connectivity of bilateral precuneus and left middle frontal gyrus may be related to the development of clinical symptoms. ［Funded by National Key Research and Development Program of China （number， 2022YFC2009901， 2022YFC2009900）］

Veno-venous extracorporeal membrane oxygenation for a Stanford type A aortic dissection patient combined with postoperative respiratory failure and COVID-19: A case report / 中国胸心血管外科临床杂志

@#During the new coronavirus disease 2019 (COVID-19) pandemic, there has been controversy over whether emergency surgical management should be performed or not in the patients with COVID-19. Stanford type A aortic dissection is a very urgent life-threatening disease, and guidelines recommend surgical treatment for patients with type A aortic dissection in the first instance. However, intraoperative extracorporeal circulation can be fatal to patients recovering from COVID-19. During the pandemic, extracorporeal membrane oxygenation (ECMO) has played an important role in supporting COVID-19 patients with acute respiratory failure. This article reports a successful V-V ECMO treatment for a Stanford type A aortic dissection patient, who suffered respiratory failure caused by COVID-19 after emergency surgery.

Optimization of extraction process and evaluation of the antibacterial and anti-inflammatory activity of blumeatin from Blumea balsamifera / 中国药房

OBJECTIVE To optimize the extraction process of blumeatin from Blumea balsamifera and to evaluate its antibacterial and anti-inflammatory activity. METHODS The content of blumeatin in the extract of B. balsamifera was determined by HPLC. On the basis of the single factor experiment， the extraction technology of blumeatin was optimized by the Box-Behnken response surface method with the volume fraction of ethanol， liquid-solid ratio and extraction time as the factors， using the yield of blumeatin as index. Microdilution method was used to determine the antibacterial activity of blumeatin against Streptococcus pyogenes， Staphylococcus aureus， Streptococcus agalactiae， Streptococcus mutans， Bacillus subtilis and Micrococcus luteus. The anti-inflammatory activity of blumeatin was evaluated by ear swelling test and capillary permeability test in mice. RESULTS The optimal extraction technology was as follows： ethanol concentration of 90%， liquid-material ratio of 15∶1， extraction time of 2 h at 80 ℃； the yield of blumeatin using this extraction process was 1.97 mg/g. The minimum inhibitory concentrations of blumeatin for S. pyogenes， S. aureus， S. agalactiae， S. mutans， B. subtilis and M. luteus were 50.00， 200.00， 400.00， 400.00， 800.00 and 1 600.00 μg/mL， respectively； the minimum bactericidal concentrations of blumeatin for S. pyogenes and S. aureus were 400.00 and 1 600.00 μg/mL， respectively. Blumeatin could significantly inhibit the ear swelling induced by xylene and capillary permeability induced by acetic acid in mice（P＜0.05 or P＜0.01）. CONCLUSIONS The optimized extraction technology of blumeatin is stable and feasible. The extracted blumeatin has a certain antibacterial effect against S. pyogenes and a good anti-inflammatory activity.

Effect of follicular unit transplantation on hair loss of the head and face / 中华医学美学美容杂志

Objective:To explore the therapeutic effect of follicular unit excision on the hair loss of head and face.Methods:From September 2019 to September 2020, 24 patients with hair loss of head and face who were treated in the plastic and aesthetic surgery of Henan Provincial People′s Hospital were used as the research objects. According to the characteristics of the patients′ hair loss areas, hair follicles were obtained from healthy scalp by using the follicular unit excision. After the operation, the survival of transplanted hair follicles, the direction of hair growth, and patient satisfaction were followed up to observe the repair effect.Results:Fifteen cases of partial scalp loss hair, 8 cases of partial loss of eyelashes, and 1 case of partial lack of eyelashes, after hair transplantation, the hair growth in the operation area was good, the direction was basically the same as that of the original hair, and the cosmetic effect of hair coverage was satisfactory. After 9-18 months of follow-up, the hair survived well.Conclusions:The use of follicular unit excision technology to repair the hair loss on the head and face is an ideal treatment method, with less trauma, quick recovery, and satisfactory cosmetic effects.

Feasibility of modified endoscopic anti-reflux mucosectomy for refractory gastroesophageal reflux disease with moderate hiatus hernia / 中华消化内镜杂志

Objective:To evaluate the efficiency and safety of modified endoscopic anti-reflux mucosectomy (ARMS) for refractory gastroesophageal reflux disease (rGERD) with moderate hiatus hernia.Methods:A total of 30 patients with rGERD with moderate hiatus hernia (3-5 cm) diagnosed at the Department of Gastroenterology of Northern Jiangsu People's Hospital from June 2017 to June 2020 were randomly divided into 2/3 circumferential mucosal resection group ( n=15) and 3/4 circumferential mucosal resection group ( n=15) using random number table method, and received modified ARMS of the corresponding mucosal resection range. The GERD symptoms, esophagitis under endoscopy, 24 h pH results, and lower esophageal sphincter (LES) resting pressure were compared before and after the procedure. The therapeutic effect and complications of the two groups were analyzed. Results:In 2/3 resection group, the GERD questionnaire scores (9.53±0.36 VS 11.93±0.57, t=6.874, P<0.001), acid exposure time (19.81%±1.72% VS 31.45%±2.78%, t=8.020, P<0.001) and the DeMeester score based on 24 h esophageal pH monitoring (40.98±4.55 VS 55.33±5.65, t=6.408, P<0.001) at 6 months after the treatment showed a significant reduction compared with those before. In 3/4 resection group, the GERD questionnaire scores (9.0±0.57 VS 12.47±0.68, t=8.650, P<0.001), acid exposure time (20.07%±2.19% VS 29.96%±3.00%, t=7.444, P<0.001) and the DeMeester score (33.67±3.47 VS 51.17±6.03, t=4.973, P<0.001) at 6 months after the treatment were lower than those before. There was no significant difference in the GERD questionnaire scores ( t=0.790, P=0.436), acid exposure time ( t=0.093, P=0.926) or the DeMeester score ( t=1.278, P=0.212) between the two groups at 6 months after treatment. In the two groups, there was no significant difference in the ratio of esophagitis grade C and D (10/15 VS 5/15, χ2=3.894, P=0.063; 8/15 VS 4/15, χ2=2.778, P=0.125) or LES resting pressure [3.29 (2.66,8.29) mmHg VS 3.98 (3.67,9.43) mmHg, P=0.334;5.78 (1.9,8.46) mmHg VS 5.88 (3.28,8.99) mmHg, P=0.125] before and after the treatment. No postoperative delayed bleeding or perforation was observed. The incidence of postoperative esophageal stenosis of 2/3 resection group was lower than that of the other group (1/15 VS 6/15, χ2=4.658, P=0.021). Conclusion:Modified ARMS is effective for controlling reflux symptoms and esophageal acid exposure in rGRED patients with moderate hiatus hernia (3-5 cm), but cannot significantly increase the postoperative resting pressure of LES. Compared with 3/4 circumferential mucosal resection, 2/3 circumferential mucosal resection can reduce the incidence of postoperative esophageal stenosis.

BRICS report of 2021: The distribution and antimicrobial resistance profile of clinical bacterial isolates from blood stream infections in China / 中华临床感染病杂志

Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical bacterial isolates from bloodstream infections in China in 2021.Methods:The clinical bacterial strains isolated from blood culture from member hospitals of Blood Bacterial Resistant Investigation Collaborative System (BRICS) were collected during January 2021 to December 2021. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical Laboratory Standards Institute (CLSI). WHONET 5.6 was used to analyze data.Results:During the study period, 11 013 bacterial strains were collected from 51 hospitals, of which 2 782 (25.3%) were Gram-positive bacteria and 8 231 (74.7%) were Gram-negative bacteria. The top 10 bacterial species were Escherichia coli (37.6%), Klebsiella pneumoniae (18.9%), Staphylococcus aureus (9.8%), coagulase-negative Staphylococci (6.3%), Pseudomonas aeruginosa (3.6%), Enterococcus faecium (3.6%), Acinetobacter baumannii (2.8%), Enterococcus faecalis (2.7%), Enterobacter cloacae (2.5%) and Klebsiella spp (2.1%). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus aureus were 25.3% and 76.8%, respectively. No glycopeptide- and daptomycin-resistant Staphylococci was detected; more than 95.0% of Staphylococcus aureus were sensitive to ceftobiprole. No vancomycin-resistant Enterococci strains were detected. The rates of extended spectrum B-lactamase (ESBL)-producing isolated in Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis were 49.6%, 25.5% and 39.0%, respectively. The prevalence rates of carbapenem-resistance in Escherichia coli and Klebsiella pneumoniae were 2.2% and 15.8%, respectively; 7.9% of carbapenem-resistant Klebsiella pneumoniae was resistant to ceftazidime/avibactam combination. Ceftobiprole demonstrated excellent activity against non-ESBL-producing Escherichia coli and Klebsiella pneumoniae. Aztreonam/avibactam was highly active against carbapenem-resistant Escherichia coli and Klebsiella pneumoniae. The prevalence rate of carbapenem-resistance in Acinetobacter baumannii was 60.0%, while polymyxin and tigecycline showed good activity against Acinetobacter baumannii (5.5% and 4.5%). The prevalence of carbapenem-resistance in Pseudomonas aeruginosa was 18.9%. Conclusions:The BRICS surveillance results in 2021 shows that the main pathogens of blood stream infection in China are gram-negative bacteria, in which Escherichia coli is the most common. The MRSA incidence shows a further decreasing trend in China and the overall prevalence of vancomycin-resistant Enterococci is low. The prevalence of Carbapenem-resistant Klebsiella pneumoniae is still on a high level, but the trend is downwards.

Analysis of research hotspots and frontiers in the training of health management talents in China based on knowledge mapping / 中华健康管理学杂志

Objective:To analyze the research hotspots and frontiers in the training of health management talents in China based on knowledge mapping.Methods:The literature related to talent training in health management was retrieved from the databases of CNKI, Wanfang Data, and VIP Journals from 2007 to 2022. The keywords used for retrieval included “health management” “curriculum system” “health manager” “evaluation system” “health service and management” and “talent training”. The time distribution of the literature was analyzed using Excel. Bibliometric analysis was conducted to visually analyze the research in health management talent training, focusing on authorship and collaboration, research institutions, high-frequency keywords, and research hotspots. A knowledge map was created to outline the research framework.Results:A total of 378 journal articles were retrieved. Over the past decade, there has been an overall increasing trend in the number of research publications related to health management talent training. The highest number of articles was published in 2021 (63 articles). In terms of spatial distribution, highly productive authors were relatively concentrated, and research institutions were mostly universities, with Hangzhou Normal University having the highest number of publications (14 articles). The research hotspots included health managers, practice teaching modes, cross-cultivation, and discipline construction. The research frontiers concentrated on talent training modes, health service and management professions, talent demand, and curriculum system construction.Conclusions:In the past decade, health management talents training in China has received more attention and importance. However, there is limited exchange and cooperation among authors and research institutions, and the research hotspots continue to extend in the direction of specialization and diversification. The transformation from vocational education to academic education and strengthening professional construction are the frontiers of the research.