Objective To explore the clinical application value for calculating the volume of splenic embolization by splenic artery branch diameter ratio method.Methods Data of 20 patients with cirrhosis and hypersplenism who underwent partial operation of splenic artery embolization were retrospectively analyzed.Based on the angiography of splenic artery during operation,the diameter of branch vessels of splenic artery was measured and the percentage of embolism volume in spleen was calculated.CT scans were performed on all patients after one month of the operations.Based on VR reconstruction image,the percentage of embolism volume in the spleen was calculated.Postoperative complications and adverse responses were observed.Peripheral blood red cells,white blood cells and platelets were tested repetitively three days before the operation,and a week,a month,three months after the operation.Moreover,the statistical analysis was performed.Results The difference between the percentage of embolism volume in the spleen calculated by splenic artery branch diameter ratio method ([52.15±3.29]％) and calculated by CT ([49.99±6.02]％) was not statistical (t=-1.630,P=0.120).All the patients had moderate or below moderate pain on left upper quadrant,and had symptoms of nausea,vomiting and fever after the operation.They all got better after symptomatic treatment.Peripheral blood red cells,white blood cells and platelets all had significant differences among three days before the operation,a week,a month and three months after the operation (all P＜0.001).Conclusion During the partial splenic embolization,the application of ratio method on branch vessels of splenic artery to measure the volume of embolism in the spleen is convenient,prompt and relatively accurate.It is worthy to be expanded in clinic.

Objective To investigate the effect of limitation in flow of people on medical care quality in emergency resuscitation room (ERR).Methods This study was retrospectively performed to compare emergency medical quality before and after (October to December,2015 vs.February to April,2016) limitation of flow of people in ERR.Variables included noise level,occupational exposure,adverse event,hospital-acquired infection,length of stay (LOS) in ERR,mortality rate,return of spontaneous circulation (ROSC) rate after cardiopulmonary resuscitation (CPR),the rate of unexpected return to ERR,door to drug and door to balloon time for patients with ST-segment elevated myocardial infarction (STEMI),patients' and emergency personnels' satisfaction level.The data were analyzed with t-test,chi-square test or Poisson Z test where appropriate.Results There were 5 031 and 5 097 patients respectively admitted in ERR before and after limitation of flow of people.Patients' main diagnoses and severity of illness between the two periods had no significantly difference (P＞0.05).After the limitation of flow of people,the noise level in ERR was lowered (P＜0.01),the numbers of occupational exposure events (14 cases vs.4 cases,Z=2.357,P=0.018) and adverse events (18 cases vs.5 cases,Z=2.711,P=0.007) were decreased,the rate of hospital-acquired infection was reduced (1.1％ vs.0.5％,x2=8.111,P=0.004),the LOS in ERR was shortened [(6.3±0.8) h vs.(4.6±0.6) h,t=121.083,P＜0.01],the door to balloon time for STEMI patients was also decreased [(91.2±12.8) min vs.(89.3±8.0) min,t=2.486,P=0.013].Moreover,patients' and emergency personnels' satisfaction level were elevated.No significant difference was observed in mortality rate,ROSC rate,rate of unexpected return to ERR and door to drug time for STEMI patients.Conclusions The limitation of flow of people in ERR can lower the noise level,reduce emergency personnels' working pressure,improve their working efficiency,avoid medical errors,elevate patients' and emergency personnels' satisfaction level.

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.