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 search the best evidence for perioperative nutrition management in pancreatic cancer patients, so as to provide evidence basis for optimization of perioperative nutrition management in pancreatic cancer patients.Methods:Evidence on perioperative nutrition management for pancreatic cancer patients was systematically searched in Cochrane Library, British Medical Journal (BMJ) Best Practice, UpToDate, National Institute for Health and Clinical Excellence, PubMed, China National Knowledge Infrastructure, WanFang Data, VIP, Chinese Medical Association Network and other domestic and foreign databases and nutrition related websites. The search types included clinical decision-making, guidelines, expert consensus, evidence summary, and systematic review. The search period was from database establishment to February 10, 2023.Results:A total of 17 articles were included, including 8 guidelines, 6 expert consensus, and 3 systematic reviews. A total of 26 pieces of evidence were summarized from 6 aspects, including management general principles, energy and protein requirements, nutritional risk screening and assessment, nutritional support, complication management, and post discharge management.Conclusions:The process of extracting the best evidence of perioperative nutrition management for pancreatic cancer patients is scientific and rigorous. Medical and nursing staff can improve the quality of nutrition management for patients with pancreatic cancer and promote the recovery of patients according to the actual clinical situation.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To explore the mediating role of interdisciplinary cooperation ability between the level of hospice care practice and difficulty degree of hospice care for medical staff, in order to improve the quality of hospice care services for medical staff, and to provide evidence for relevant managers to formulate effective measures to reduce the implementation of hospice care difficulties.Methods:This study was a cross-sectional survey. Using convenience sampling method, the general data questionnaire, Palliative Care Difficulties Scale (PCDS), Palliative Care Self-Report Practice Scale (PCPS) and Modified Index of Interdisciplinary Collaboration (MIIC) were used to investigate 362 medical staff in all hospice care institutions of Shiyan City from July to August 2022.Results:The total score of PCDS in 362 medical staff was (40.58±13.44) points, (67.47 ± 12.50) points for PCPS and (108.36 ± 21.46) points for MIIC. There was a positive correlation between the total score of MIIC and PCDS ( r=0.500, P<0.01). The total score of PCPS was negatively correlated with the total score of MIIC ( r=-0.337, P<0.01) and the total score of PCDS ( r=-0.189, P<0.01). The interdisciplinary cooperation ability of medical staff in hospice care had a complete mediating effect between the level of practice and the degree of difficulty (Effect value=-0.190, 95% CI-0.274 to -0.126), and the mediating effect accounted for 98.5% of the total effect value. Conclusions:The practice level of hospice care can not directly affect the implementation of the difficulty degree, but by taking active measures to improve the interdisciplinary cooperation ability, so as to enhance the practice level, and then reduce the implementation of hospice care difficulty degree.

Objective:To explore the application effect of staged health education combined with respiratory function exercise in patients undergoing esophageal cancer surgery.Methods:Using the convenient sampling method, a total of 200 patients with esophageal cancer who were admitted to Affiliated Cancer Hospital of Zhengzhou University from February 2019 to February 2020 were selected as the research objects. The patients were divided into the control group (81 cases) and the observation group (119 cases) according to their hospitalization time. The control group was given respiratory function exercise and routine nursing, while the observation group was given staged health education combined with respiratory function exercise on the basis of routine nursing. The cognition level and lung function of patients of the two groups before and 7 days after operation were compared.Results:The levels of vital capacity (VC) , maximum ventilation (MVV) and forced vital capacity in the first second (FEV1) in the observation group were higher than those in the control group at 7 days after operation, and the difference was statistically significant ( P<0.05) . The cognitive score of the observation group was higher than that of the control group at 7 days after operation, and the difference was statistically significant ( P<0.05) . Conclusions:Staged health education combined with respiratory function exercise can improve postoperative cognitive level and lung function of patients with esophageal cancer.

Objective:To explore the influencing factors of postoperative coping style of patients with esophageal cancer.Methods:This study was a cross-sectional study. From July 2018 to July 2020, convenience sampling was used to select 65 patients with esophageal cancer who underwent radical surgery for esophageal cancer in a ClassⅢ Grade A hospital in Henan Province as the research object. The General Information Questionnaire and the Chinese version of the Medical Coping Modes Questionnaire (MCMQ) were used to investigate the patients one day before the patients were discharged. Single factor analysis was used to analyze influencing factors. A total of 65 questionnaires were distributed and 65 valid questionnaires were returned with the valid response rate of 100%.Results:The results of single factor analysis showed that there were statistically significant differences in the confrontation dimension scores of patients with different ages, education levels, and family monthly income per capita ( P<0.05) . There were statistically significant differences in the avoidance dimension scores of patients with different genders and ages ( P<0.05) . There were statistically significant differences in the resignation dimension scores of patients with different ages, occupational status, and family monthly income per capita ( P<0.05) . Conclusions:Age, gender, occupational status, education level, and family monthly income per capita are the influencing factors of postoperative coping style of patients with esophageal cancer. Medical and nursing staff can take targeted intervention measures based on their influencing factors and guide patients to adopt a positive coping style to face the disease.

Objective:To construct a perioperative nursing planning for patients with esophageal cancer based on the concept of enhanced recovery after surgery (ERAS) , so as to provide a basis for the development of ERAS nursing for patients with esophageal cancer during perioperative period.Methods:From November 2019 to September 2020, a perioperative ERAS nursing planning for patients with esophageal cancer was constructed through literature retrieval, field observation, Delphi expert consultation, and analytic hierarchy process.Results:A total of two rounds of expert consultations were conducted. The valid recovery rates of the questionnaire were 95.24% (20/21) and 100.00% (20/20) , and the expert authority coefficients were 0.89 and 0.93. The Kendall harmony coefficients were 0.25 and 0.34 ( P<0.01) . The perioperative enhanced recovery nursing planning for patients with esophageal cancer included 5 first-level indicators, 17 second-level indicators and 49 third-level indicators. Conclusions:The perioperative enhanced recovery nursing planning for patients with esophageal cancer is scientific and reliable, and can effectively standardize and guide the development of clinical nursing work.

Objective:To evaluate the relationship between perioperative cardiovascular events and serum transient receptor potential vanilloid 1 (TRPV1), calcitonin gene-related peptide (CGRP) and substance P (SP) concentrations in the patients with diabetic peripheral neuropathy (DPN).Methods:Twenty-eight patients with type 2 diabetes mellitus (DM) complicated by DPN undergoing elective non-cardiovascular surgery under general anesthesia, were enrolled in DPN group, and 28 patients with type 2 DM without DPN were included in DM group.Another 28 nondiabetic patients undergoing non-cardiovascular elective surgery under general anesthesia were selected as control group (C group). The patients were 55 to 81 years old and classified as American Society of Anesthesiologists physical status Ⅱ or Ⅲ, regardless of gender.The development of cardiovascular events during surgery and within 24 h after surgery and use of vasoactive drugs were recorded.Venous blood samples were taken at 30 min before anesthesia induction and 24 h after surgery for determination of the concentrations of TRPV1, CGRP, SP and cardiac troponin I (cTnI) in serum using enzyme-linked immunosorbent assay.Results:Compared with group C, the incidence of perioperative cardiovascular events and utilization rate of vasoactive drugs were significantly increased, the preoperative concentrations of serum TRPV1, CGRP and SP were decreased, and the postoperative concentration of serum cTnI was increased in DM and DPN groups ( P<0.05). Compared with DM group, the incidence of perioperative cardiovascular events was significantly increased, the preoperative concentrations of serum TRPV1, CGRP and SP were decreased, the postoperative concentration of serum cTnI was increased ( P<0.05), and no significant change was found in the utilization rate of vasoactive drugs in DPN group ( P>0.05). The postoperative cTnI concentrations in serum were negatively correlated with the preoperative TRPV1, CGRP and SP concentrations in serum in DPN group ( P<0.01). Conclusion:The increased risk of perioperative cardiovascular events may be related to the decrease in serum TRPV1, CGRP and SP concentrations in DPN patients.

Objective:To determine the relationship between transient receptor potential vanilloid 1 (TRPV1) gene polymorphism and genetic susceptibility to type 2 diabetes mellitus (DM) and intraoperative adverse cardiovascular events (ACVEs).Methods:Eighty-six DM patients and 78 non-DM patients (nDM) undergoing elective knee replacement or posterior lumbar interbody fusion were selected in this study.Real-time fluorescence quantitative polymerase chain reaction was carried out to genotype the rs222747 variant of TRPV1 gene.The ACVEs occurred were recorded during operation, and the risk factors for ACVE developed during operation were identified.Results:Compared with nDM group, the TRPV1 genotype G/G ratio, allele G frequency, and incidence of intraoperative ACVE were significantly increased in DM group ( P<0.05). Aging and TRPV1 genotype GG combined with DM were the risk factors for intraoperative ACVEs occurred ( P<0.05). Conclusion:TRPV1 gene polymorphism is related to the genetic susceptibility to type 2 DM and occurrence of intraoperative ACVEs.

Objective To investigate the antimicrobial resistance profile of the clinical isolates collected from selected hospitals across China. Methods Twenty-nine general hospitals and five children's hospitals were involved in this program. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems. Results were interpreted according to CLSI 2017 breakpoints. Results A total of 190 610 clinical isolates were collected from January to December 2017, of which gram negative organisms accounted for 70.8％ (134 951/190 610) and gram positive cocci 29.2％ (55 649/190 610). The prevalence of methicillin-resistant strains was 35.3％ in S. aureus (MRSA) and 80.3％ in coagulase negative Staphylococcus (MRCNS) on average. MR strains showed much higher resistance rates to most of the other antimicrobial agents than MS strains. However, 91.6％ of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole, while 86.2％ of MRCNS strains were susceptible to rifampin. No staphylococcal strains were found resistant to vancomycin. E. faecalis strains showed much lower resistance rates to most of the drugs tested (except chloramphenicol) than E. faecium. Vancomycin-resistant Enterococcus (VRE) was identified in both E. faecalis and E. faecium. The identified VRE strains were mainly vanA, vanB or vanM type based on phenotype or genotype. The proportion of PSSP or PRSP strains in the non-meningitis S.pneumoniae strains isolated from children decreased but the proportion of PISP strains increased when compared to the data of 2016. Enterobacteriaceae strains were still highly susceptible to carbapenems. Overall, less than 10％ of these strains (excluding Klebsiella spp.) were resistant to carbapenems. The prevalence of imipenem-resistant K. pneumoniae increased from 3.0％ in 2005 to 20.9％ in 2017, and meropenem-resistant K. pneumoniae increased from 2.9％ in 2005 to 24.0％ in 2017, more than 8-fold increase. About 66.7％ and 69.3％ of Acinetobacter (A. baumannii accounts for 91.5％) strains were resistant to imipenem and meropenem, respectively. Compared with the data of year 2016, P. aeruginosa strains showed decreasing resistance rate to carbapenems. Conclusions Bacterial resistance is still on the rise. It is necessary to strengthen hospital infection control and stewardship of antimicrobial agents. The communication between laboratorians and clinicians should be further improved in addition to surveillance of bacterial resistance.