Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective:To explore the effect of the hospital discharge readiness plan based on deep integration of medical nursing and rehabilitation in children with cerebral palsy.Methods:From January 2020 to September 2021, 60 children with cerebral palsy and their 60 parents admitted to the Children's Rehabilitation Department of Anhui Children's Hospital were selected as the research object. The children and parents were divided into the observation group and the control group by random number table, with 30 children and 30 parents in each group. The control group was given routine nursing, and the observation group was given the hospital discharge readiness plan based on the deep integration of medical nursing and rehabilitation. On the first day of admission and the day before discharge, the effects were evaluated using the Chinese version of the Chinese version of the Readiness for Hospital Discharge Scale (RHDS) -Parent Form, the Chinese version of the Quality of Discharge Teaching Scale (QDTS) -Parent Form, the Activities of Daily Living (ADL) Rehabilitation Nursing Rating Scale for Children with Cerebral Palsy.Results:After the intervention, the scores of the observation group were higher than those of the control group in terms of readiness for hospital discharge, quality of discharge teaching, and the differences were statistically significant ( P<0.05) . Conclusions:The hospital discharge readiness plan based on deep integration of medical nursing and rehabilitation in children with cerebral palsy can effectively improve their discharge readiness, the quality of discharge teaching and the ADL of children with cerebral palsy.

Thioredoxin reductase (TrxR) is one class of the most important antioxidant selenoproteins and is involved in regulating tumor genesis and progression. It has been reported that naphthoquinones can target and inhibit TrxR1 activity therefore produce reactive oxygen species (ROS) mediated by TrxR1, resulting into cellular redox imbalance and making the naphthoquinone compounds to become potential antitumor chemotherapy drugs. The purpose of this work is to explore the interaction between TrxR1 and menadione using biochemical and mass-spectrometric (MS) analyses, to further reveal the detailed mechanisms of TrxR1-mediated naphthoquinone reduction and inhibition of TrxR1 by naphthoquinone compounds. Using the site-directed mutagenesis and recombinantly expressed TrxR1 variants, we measured the steady-state kinetic parameters of menadione reduction mediated by TrxR1 and its variants, performed the inhibition analysis of menadione on TrxR1 activity, and eventually identified the interaction between menadione and TrxR1 through MS analysis. We found that Sec-to-Cys mutation at residue of 498 significantly enhanced the efficiency of TrxR1-mediated menadione reduction, though the Sec⁴⁹⁸ is capable to catalyze the menadione reduction, indicating that TrxR1-mediated menadione reduction is dominantly in a Se-independent manner. Mutation experiments showed that Cys⁴⁹⁸ is mainly responsible for menadione catalysis in comparison to Cys⁴⁹⁷, while the N-terminal Cys⁶⁴ is slightly stronger than Cys⁵⁹ regarding the menadione reduction. LC-MS results detected that TrxR1 was arylated with one molecule of menadione, suggesting that menadione irreversibly modified the hyper-reactive Sec residue at the C-terminus of selenoprotein TrxR1. This study revealed that TrxR1 catalyzes the reduction of menadione in a Se-independent manner meanwhile its activity is irreversibly inhibited by menadione. Hereby it will be useful for the research and development of naphthoquinone anticancer drugs targeting TrxR1.
Catalysis ; Drug Development ; Oxidation-Reduction ; Thioredoxin Reductase 1/metabolism* ; Vitamin K 3/metabolism*

Objective To analyze the effects of fertilization methods and sperm sources in intra‐cytoplasmic sperm injection (ICSI) on the developmental capacity of surplus embryos .Methods A retrospective study was carried out to compare the blasto‐cyst rate of the surplus embryos from 2 697 patients .According to the fertilization methods ,the embryos were divided into IVF group and ICSI group .According to sperm sources ,the ICSI group was divided into ejaculated group and testicular sperm group . The rates of blastocyst formation and good quality blastocysts were compared between different fertilization methods and sperm sources .Results There were 8 426 embryo developed in 2 697 patients .The blastocyst formation rate of surplus embryos was high‐er in the IVF group(n=1 048 ,53 .18% ) than that in the ICSI group(n=1 378 ,49 .27% ) ,but with no statistically significant differ‐ent(P> 0 .05) .The rates of blastocyst were not statistically significant different between the IVF group and in the rescue ICSI group(P>0 .05) .The rates of blastocyst were not statistically significant different between the ejaculated group and the testicular sperm group(P>0 .05) .Conclusion There were not statistically significant different of the rate of blastocyst between different fer‐tilization methods and sperm sources in ICSI .

Objective To investigate the effect of astragalus polysaccharide (AP) on proliferation and apoptosis of human acute myelocytic leukemia cell line KG-1a and the underlying mechanisms.Methods Human acute myelocytic leukemia cell line KG-la was cultured under 37 ℃ and 5 ％ C02,when appropriate cell passage and cryopreservation were performed.After treatment for 48 h with different concentrations of AP,the proliferative activity and apoptosis rate of KG-1a cells were examined by CCK-8 assay and flow cytometry,respectively.The expressions of p-Akt and bcl-2 protein in AP-treated KG-1a cells were evaluated by Western blot.The expression of PTEN mRNA by quantified real-time PCR.Results The proliferative activity of KG-la cell was obviously suppressed by AP treatment,and the inhibition rate increased in a dosedependent manner.The flow cytometry showed that,compared with the control group,the apoptosis rates of KG-1a cells were significantly increased after treatment with AP for 48 h.The early apoptosis rates were (1.98±0.16) ％,(12.60±0.48) ％,(16.31±0.73) ％,the late apoptotic rates were (3.11±0.19) ％,(17.17±1.40) ％,(21.17 ± 0.81)％,the differences were statistically significant (P ＜ 0.05).Western blot showed that the expressions of p-Akt and bcl-2 protein in KG-1a cells decreased significantly after treatment with AP (P ＜ 0.05).In contrast,the mRNA level of PTEN increased (P ＜0.05),which was shown by real-time PCR.Conclusion AP could repress cellular proliferation activity of KG-1a cells,which could be attributed to inhibition of PTEN-PI3K-Akt signaling pathway.

BACKGROUND:Embryo viability assessment is directly related to the selection of embryo transplantation and clinical outcome of assisted reproduction.
OBJECTIVE:To summarize the assessment methods for early embryonic development.
METHODS:The first author searched PubMed database for relevant articles published from January 1990 to
December 2013 using the keywords of“assisted reproductive technology, art;pre-implantation embryo;embryonic development viability;evaluation methods”in English. Final y, 63 articles were included in result analysis.
RESULTS AND CONCLUSION:In the embryo quality evaluation, the most widely used method is morphological evaluation method which is characterized as rapid, non-invasive, and simple. With the development of assisted reproductive technology, the morphological evaluation combined with time-lapse imaging analysis system has been recognized in embryo selection. Recently, targeted-metabolic analysis has been proposed as a useful tool for assessment of embryo development potential, involving pyruvate acid, glycometabolism, amino acid, and embryo-derived cytokines (soluble human leukocyte antigen G1, platelet-activating factor, etc.). Furthermore, the pre-implantation genetic screening method targeting gene and chromosome abnormality is expected to find more effective markers for evaluating embryo developmental potential.

BACKGROUND:Since the first frozen embryo transplantation succeeded in 1983, embryo cryotechnique has been an important component in human assisted reproductive techniques. It is controversial which embryos and blastocysts after cryopreservation is selected.
OBJECTIVE:To compare the birth outcomes and neonatal status of frozen thawed embryos and blastocysts.
METHODS:In frozen thawed embryo group (n=1 273) and frozen thawed blastocyst group (n=471), we compared pregnancy rate, abortion rate, ectopic pregnancy rate, premature delivery rate, average premature gestational weeks, term yield, average ful-term gestational age, newborn sex, birth weight, birth defects and so on.
RESULTS AND CONCLUSION:There were frozen thawed blastocyst thaw cycles in 478 cases, 471 cases of transplantation period (including 7 cases without blastocyst transfer were canceled), 236 cases of pregnancy, 201 cases of delivery. Delivery number was 251, including 140 boys and 111 girls. The third day embryo thawing cycle of freezing and thawing appeared in 1 280 cases, 1 273 cases of transplantation period (including 7 cases of no embryo transplantation were canceled), 415 cases of pregnancy, 343 cases of delivery. The delivery number was 431, including 225 boys and 206 girls. Rate of pregnancy was significantly higher in frozen thawed blastocysts compared with frozen thawed embryos. No significant differences were detected in rate of miscarriage, ectopic pregnancy rate, premature delivery rate, average premature gestational weeks, term yield, average ful-termgestational age, newborn sex, and birth weight between frozen thawed embryos and blastocysts. There was no increase in birth defects between frozen thawed embryos and blastocysts. Results suggested that no significant difference was detected in birth outcomes and neonatal status of frozen thawed embryos and blastocysts. Nevertheless, pregnancy outcome is better in frozen thawed blastocysts than frozen thawed embryos.

Objective To compare the effect of three different fertilization modes of frozen-thawed embryos and blastocysts on the pregnancy outcome after thawed transplantation .Methods 3 586 cycles of frozen embryos transplantation (FET ) treatment in our center from January 2012 to December 2013 were retrospectively analyzed and divided into 3 groups according to the fertilization modes .The group A adopted the conventional in vitro fertilization (IVF) of frozen-thawed embryo transfer in 2 008 cases and blas-tocysts transfer in 954 cases .The group B adopted intracytoplasmic sperm injection (ICSI) of frozen-thawed embryo transfer in 361 cases and blastocysts transfer in 129 cases ;the group C was given early remedy intracytoplasmic sperm injection (r-ICSI) of frozen-thawed embryo transfer in 87 cases and blastocysts transfer in 47 cases .The recovery rate of embryo and blastocyst ,pregnancy rate ,abortion rate ,ectopic pregnancy rate were compared for determining whether the differences among the indexes existed . Results The thawing recovery rate ,pregnancy rate ,abortion rate and ectopic pregnancy rate in the three different fertilization modes of embryo and blastocyst had no statistically significant differences (P>0 .05) .Conclusion Compared with conventional in vitro fertilization and intracytoplasmic sperm injection ,early r-ICSI is one of effective treatment means .

Objective To investigate the expression of marrow-derived thyroid stimulating hormone β (TSHβ) splice variant in thyroid of mouse with autoimmune thyroiditis induced by thyroglobulin(Tg) immunization,and to analyze whether TSHβ splice variant participated in the pathological process of autoimmune thyroiditis.Methods Using random number table,forty-eight mice(24 females and 24 males) of 7 to 8 weeks old with body mass 20 to 25 g were randomly divided into 4 groups(12 females and 12 males in each group) based on body weight and gender.The control group:fed with deionized water; the Tg-treated group(TG):fed with deionized water,and immunized subcutaneously with 0.1 mg Tg at 8 weeks old,boost immunized twice at 11 and 15 weeks old,respectively; the high iodine-treated group (HI):fed with deionized water containing 0.05％ sodium iodide (NaI); the Tg combined with HI group (TG + HI):fed with deionized water containing 0.05％ NaI,and immunized the same way as the TG group did.Peripheral blood was collected after 8 weeks treatment,which was used for determination of total tetraiodothyronine (TT4),free tetraiothyronine (FT4),total triiodothyronine (TT3) and free triiodothyronine (FT3) with chemiluminescence immunoassay (CIA); thyroid glands were collected to examine the expression of TSHβ splice variant with SYBR Green fluorescent quantitative real-time PCR,and frozen sections were HE stained for observation of histopathological changes of thyroid cells under light microscopy.Results Under naked eyes,the thyroid gland enlarged significantly,and looked dark red in HI and TG + HI groups.Under an optical microscope,thyroid follicular epithelial cells presented cuboidal,with abundant cytoplasm,presented abundant glial in follicular cavity,without lymphocyte infiltration in the control group; in TG group,the thyroid follicular epithelial cells presented cuboidal,with some single scattered lymphocytes; in HI group,colloid volume expansion appeared in thyroid follicles,thyroid follicular epithelial cells presented low cuboidal or flat,with few single scattered lymphocytes; in TG + HI group,most colloid accumulative large follicles presented in thyroid,thyroid follicular epithelial cells presented flat,some destructive thyroid follicular structure and infiltrating lymphocytes appeared.The differences of FT3,TT4,FT4 and TSHβ splice variant between groups were statistically significant(F =4.00,12.54,31.92,214.29,all P ＜ 0.05).Compared to the control group,the serum TT3(nmol/L:0.92 ± 0.07 vs.1.30 ± 0.33,t =-2.24),TT4(nmol/L:1.30 ± 0.33 vs.95.60 ± 14.10,t =-3.02),FT4(pmoL/L:54.07 ± 3.67 vs.154.80 ± 0.01,t =-54.87) and the thyroids' TSHβ(× 10-3:4.11±0.32 vs.8.38 ± 0.22,t =-19.11) were higher in TG group(all P ＜ 0.05) ; the serum TT4(nmol/L:67.75 ± 11.91 vs.45.50± 3.85,t =3.55,P ＜ 0.05) was lower in HI group; the serum FT4(pmol/L:54.07 ± 3.67 vs.139.46 ± 30.00,t =-5.65) and the thyroids' TSHβ splice variant (× 10-3:4.11 ± 0.32 vs.5.33 ± 1.47,t =-5.95) were higher in TG + HI group (all P ＜ 0.05).Conclusions High iodine has aggravated thyroiditis of BALB/c mice induced by Tg immunization; the level of thyroid TSHβ in mice with autoimmune thyroiditis is higher; all of these results indicated that TSHβ is involved in the pathogenesis of autoimmune thyroiditis.

Objective To investigate the clinical and cytogenetic features of myelodysplastic syndrome (MDS) ,and to investigate the application of the International Prognostic Scoring System Revised (IPSS-R) in myelodysplastic syndrome .Methods A retro-spective analysis was conducted on 112 patients diagnosed with MDS on basis of French-American-British(FAB) and World Health Organization(WHO) criterion .Conventional cytogenetics are performed to investigated the cytogenetics changes .Results Karyo-type abnormalities are found in 46(41 .1% ) patients .Cytogenetics subgroups are devided into 5 groups according to IPSS-R criteri-on :very good ,good ,intermediate ,poor ,very poor ,which account for 2 cases(1 .8% ) ,48 cases (42 .9% ) ,41 cases (36 .6% ) ,10 ca-ses (8 .9% ) ,11 cases (9 .8% ) ,with a median survival time(MS) 59 ,36 ,15 ,10 month respectively ,except for very good .Conclusion It is of great guiding significance of IPSS-R criteria for prognostic stratification .