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Background Cardiotoxicity is a leading cause of mortality among breast cancer patients treated with chemotherapy. Therefore, an early risk assessment is vital for the clinical prevention and treatment of cardiotoxicity in breast cancer patients treated with chemotherapy, although a recognized tool is scant in our country. Objective To develop a cardiotoxic risk assessment scale for breast cancer patients undergoing chemotherapy and to test its reliability and validity. Methods Through reviewing relevant domestic and international literatures, a pool involving items to assess the risk of cardiotoxicity in breast cancer patients treated with chemotherapy was created. Semi-structured interviews with healthcare providers at Jiangsu Cancer Hospital from September to October 2022 were performed by purposive sampling, thus primarily forming a tool of items for the cardiotoxic risk assessment scale. In addition, breast cancer patients treated with chemotherapy in Jiangsu Cancer Hospital were randomly selected for a pre-survey and validation of the reliability and validity of the scale. Ranked by the score of the cardiotoxic risk assessment scale, the top 27% of participants were assigned into the high-score group, and the remaining were in the low-score group. Cronbach's α coefficient was used to evaluate the internal consistency of the scale. Validity of the scale was verified by measuring the item-level content validity index (I-CVI) and scale-level content validity index (S-CVI). Exploratory factor analysis was performed to assess the structural validity. Receiver operating characteristic (ROC) curves were plotted, and the area under tcurve (AUC) was calculated to determine the predictive validity. Results Twenty healthcare providers were included in the semi-structured interviews. After two rounds of expert consultations, a 19-item cardiotoxic risk assessment scale in breast cancer patients treated with chemotherapy was developed. In this study, there were 79 patients in the low-score group and 83 in the high-score group. No significant differences in the history of smoking, endocrine treatment and immunotherapy were detected between the two groups (P>0.05). Correlation analysis showed that the history of smoking and immunotherapy was not significantly correlated with the total scores (P>0.05). Eventually, three items of smoking history, history of endocrine treatment and history of immunotherapy were removed, forming a 16-item scale. The Cronbach's α coefficient, test-retest reliability and inter-rater reliability were 0.739, 0.983 and 0.984, respectively. Content validity results showed that I-CVI ranged from 0.83 to 1.00, and S-CVI was 0.98. Predictive validity results showed the AUC of 0.887 (95%CI=0.827-0.947, P

Objective To analyze the clinical distribution of Klebsiella pneumoniae isolates, screen for the multidrug resistance of Klebsiella pneumoniae strains to commonly used antimicrobial drugs, and provide reference for the prevention and control of hospital-acquired infections and rational clinical use of antimicrobial drugs. Methods Various clinical specimens collected from January 2018 to December 2022 at the Zhongda Hospital Affiliated to Southeast University were cultured to isolate bacteria. The VITEK automated microbial analyzer was used to identify the bacterial species. A total of 3 342 non-repetitive Klebsiella pneumoniae isolates were obtained during this period. Each Klebsiella pneumoniae strain was subjected to drug susceptibility testing using automated antimicrobial systems, disk diffusion methods, or standard broth microdilution methods to determine the antibiotic resistance profiles of Klebsiella pneumoniae. The detection rate of Klebsiella pneumoniae in clinical specimens and its association with specimen sources or department categories were analyzed. Results Klebsiella pneumoniae isolates were obtained from sputum (42.07%), urine (14.81%), and blood (10.29%). The departments with higher detection rates of Klebsiella pneumoniae were Intensive Care Unit (ICU) (35.19%), Neurosurgery (6.28%), and Respiratory and Critical Care Medicine (5.42%). The resistance identification results showed the highest resistance rate to ampicillin (100.00%) and the lowest resistance rate to amikacin (4.22%). Annual analysis of resistance rates to carbapenems in Klebsiella pneumoniae isolates from 2018 to 2021 revealed an increasing trend: 2.94%, 4.66%, 7.90%, and 15.35%, respectively. However, in 2022, the resistance rate started to decrease (5.38%). Carbapenem-resistant Klebsiella pneumoniae strains were predominantly of the KPC type, and there was a statistically significant difference in the resistance rates to commonly used antimicrobial drugs between carbapenem-resistant Klebsiella pneumoniae and carbapenem-sensitive Klebsiella pneumoniae(P＜0.01). Conclusion Klebsiella pneumoniae maintains a high level of clinical isolation rate, along with high resistance rates. Therefore, it is necessary to strengthen the prevention and control of hospital-acquired bacterial infections and surveillance of drug resistance. Rational selection of antimicrobial drugs should be employed for the treatment of Klebsiella pneumoniae infections.

Objective To observe the practice of standard management of outpatient complaints and improve the quality of outpatient medical care. Methods Total of 72 cases of outpatient complaints received from July 2020 to august 2020 were included as the control group, and another 72 cases of outpatient complaints received from September 2020 to October 2020 were included as the observation group. Cases of outpatient complaints in the control group were addressed by using a conventional method, and those in the observation group were addressed by using a standard management procedure. The incidence of medical dispute and patient satisfaction were compared between two groups. Results There were 6 cases of medical dispute reported in the control group. T he satisfaction rate was 98. 61%(71/72) in the observation group, which was higher than 84. 72%(61/72) in the control group. Conclusion Standardized treatment of outpatient complaints not only mediate doctor-patient disputes, but also protect the rights and interests of both sides. The practice of standardized treatment may improve the overall service quality of the hospital and the satisfaction of patients. (目的 探讨门诊投诉规范化处理的实践效果。方法 将2020年7月—8月接收的72份投诉案例设为对照组, 将2020年9月—10月接收的72份投诉案例设为观察组。对照组采取常规方法接待和处理, 观察组严格执行门诊投诉规范处置。统计2组医疗纠纷发生情况, 比较2组当事患者对处置过程的满意度。结果 观察组未发生医疗纠纷, 对照组发生医疗纠纷6(8. 33%)起。观察组当事患者对处置流程的满意度为98. 61%(71/72), 对照组为84. 72%(61/72)。结论 规范处置门诊投诉, 能够有效控制医患纠纷, 保障医患双方的权益, 有助于提高医院整体服务质量, 提升患者满意度。)

Objective: To investigate the effects and mechanism of salidroside(SAL) on model rats of diabetic nephropathy(DN)., Methods: Rats were divided into control, model, SAL(50 mg/kg), SAL(100 mg/kg) and SAL(200 mg/kg) groups. The rats beside in control group were injected with streptozotocin(STZ) combined with right nephrectomy. And rats in SAL(50, 100, 200 mg/kg) groups were received gavage with SAL(50, 100, 200 mg/kg). After 12 weeks, rats were sacrificed and kidneys were collected. HE staining was performed for renal injury, the concentrations of urine protein, urine creatine(Ucr), blood urea nitrogen(BUN), malondialdehyde(MDA), superoxide dismutase(SOD) and glutathione peroxidase(GSH-Px) were measured by kits. Western blot was used to measure the protein levels of Collagen Ⅳ, fibronectin, E-cadherin, α-smooth muscle actin(α-SMA), N-cadherin, Smad2、Smad3, phosphorylated-Smad2(p-Smad2), p-Smad3 and transforming growth factor-β1(TGF-β1)., Results: Compared with control group, the renal injury of rats in model group was aggravated, the concentrations of urine protein, Ucr and BUN were elevated significantly, the apoptosis cells and positive cells of caspase-3 were increased; compared with model group, the renal injury of rats in SAL(100, 200 mg/kg) groups were alleviated markedly, the concentrations of urine protein, Ucr and BUN were reduced, the apoptosis cells and positive cells of caspase-3 were decreased notably. SAL(50 mg/kg) increased the concentration of SOD in DN model rats, SAL(100, 200 mg/kg) increased the concentrations of SOD and GSH-Px, decreased the level of MDA. Meanwhile, the inhibition of collagen Ⅳ, fibronrctin, α-SMA, and N-cadherin and the induction of E-cadherin in DN rats were induced by SAL(100, 200 mg/kg). In addition, SAL(100, 200 mg/kg) reduced the ratio of p-Smad2/Smad2, p-Smad3/Smad3 and the level of TGF-β1(P<0.05 or P<0.01)., Conclusion: SAL can inhibit renal fibrosis of STZ-induced DN model rats, and the mechanism may be related to inhibition of TGF-β1/Smad pathway.

Objective: We screened and identified protease-producing bacterial strains from the Arctic, the results would help find cold-adapted protease., Methods: In total 68 protease-producing strains were screened from the Arctic using the casein-agar plate under low temperature. All strains were classified using the 16S rRNA gene-restriction fragment length polymorphism (RFLP) and traditional phenotypic test. One strain was chosen to be the representative strain from each group respectively and identified using 16S rRNA gene sequence analysis, GenBank database Basic Local Alignment Search Tool (BLAST), phylogenetic analysis and phenotypic features analysis. The enzymatic properties of the representative strains were determined., Results: The 68 strains belonged to 3 groups (54.41%, 42.65% and 2.94%), and strains 6, 11 and 52 were the representative strains respectively. The results of the 16S rRNA gene sequence analysis showed that: Strain 11 was most closely related to Chryseobacterium scophthalmum with 98.24% sequence similarity; strain 52 was most closely related to Stenotrophomonas rhizophila with 98.55% sequence similarity; strain 6 was most closely related to Stenotrophomonas rhizophila with 96.50% sequence similarity, which might represent a novel species of the genus. The phenotypic study showed that: strains 6, 11 and 52 were Gram negative, straight rod-shaped, did not produce extracellular lipase and amylase, possessed strong proteolytic activity. The optimal temperature and pH for the enzyme activity were 55 degrees C and 6.7 for the protease from strain 6, 40 degrees C and 8.5 for the protease from strain 11 and 65 degrees C and 7.4 for the protease from strain 52., Conclusion: The research firstly introduced the distribution of Stenotrophomonas and Chryseobacterium specieses in the Arctic marine water, extended the diversity of the protease-producing bacteria from the Arctic, and provided a useful basis for further study of cold-adapted protease.

Objective: To investigate potential pathogens in waters of Xiamen from Jiulong River, and to provide useful information for the prevention and control of potential pathogen infections., Methods: All samples were spread on Thiosulfate Citrate Bile Salts Sucrose (TCBS) agar plates, and then incubated at 26 +/- 1 degrees C for 24 +/- 2 h. In total 158 TCBS strains were isolated from TCBS agar plates and pure-cultivated on 2216E agar plates. All strains were identified using the 16S rRNA gene- Restriction fragment length polymorphism (RFLP), 16S rRNA sequence analysis, GenBank database Basic Local Alignment Search Tool (BLAST) and phylogenetic analysis., Results: The results show that 158 TCBS strains from the sediments of Jiulong River estuary were classfied as 7 genus, which were Pseudomonas (28%), Aeromonas (24%), Pseudoalteromonas (19%), Shewanella (13%), Bacillus (11%), Vibrio (4%) and Psychrobacter (1%). The composition and distribution of TCBS bacteria groups varied with stations. Non-halophilic or haloduric bacteria groups were dominant in the upper area of Jiulong River estuary, and halophilic and haloduric bacteria were dominant in the lower area, which characterized a typical estuary feature. The salinity played a key role in the distribution of TCBS groups. Vibrios did not constitute a significant proportion (6% - 19%) of the total TCBS strains at different stations, and most of the them distributed at the lower region., Conclusion: There were a lot of potential pathogens in Jiulong River estuary. Aeromonas, a typical genus of halotolerant bacteria, was the potentially terrigenous bacteria contamination to the waters of Xiamen. Most Vibrio specieses were marine aborigines, which was not directly contaminated from the runoff of Jiulong River.

In order to analyze the major factors contributing to malnutrition of children aged under five at 40 inspective spots, a cluster method was used and four patterns were set up in this study. Multiple logistic regression was applied in each pattern to identify the most important factor. The results showed that the problem of child malnutrition in urban areas has been solved, but the problem in rural is still severe. The attributable risk of education level of mother, breast feeding and water supply were the major factors contributing to the nutrition status of children and therefore, the synthetical measures should be take for improving the nutrition status of children.