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.

This study intended to evaluate the efficacy and safety of single Hirudo prescriptions in the treatment of ischemic cerebrovascular disease(ICVD) by frequency network Meta-analysis and traditional Meta-analysis. CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, and Cochrane Library databases were searched to collect the randomized controlled trial(RCT) of single Hirudo prescriptions for ICVD from the inception of the databases to May 2022. The quality of the included literature was evaluated by Cochrane risk of bias tool. Finally, 54 RCTs and 3 single Hirudo prescriptions were included. Statistical analysis was conducted by RevMan 5.3 and Stata SE 15. Network Meta-analysis showed that in terms of the clinical effective rate, the surface under the cumulative ranking curve(SUCRA) of intervention measures was as follows: Huoxue Tongmai Capsules+conventional treatment>Maixuekang Capsules+conventional treatment>Naoxuekang Capsules+conventional treatment>conventional treatment. Traditional Meta-analysis revealed that in terms of the safety of ICVD treatment, Maixuekang Capsules+conventional treatment had higher safety than conventional treatment alone. According to the network Meta-analysis and traditional Meta-analysis, it was found that conventional treatment combined with single Hirudo prescriptions improved the clinical efficacy of ICVD patients, and compared with that of conventional treatment alone, the incidence of adverse reactions of combined treatment was low and the safety was high. However, the methodological quality of the articles included in this study was generally low and there were large differences in the number of articles on the three combined medication. Therefore, the conclusion of this study needed to be confirmed by subsequent RCT.
Humans ; Animals ; Capsules ; Network Meta-Analysis ; Combined Modality Therapy ; Leeches ; Prescriptions ; Cerebrovascular Disorders

OBJECTIVES: To study the application value of transport ventilator in the inter-hospital transport of critically ill children. METHODS: The critically ill children in Hunan Children's Hospital who were transported with or without a transport ventilator were included as the observation group (from January 2019 to January 2020; n=122) and the control group (from January 2018 to January 2019; n=120), respectively. The two groups were compared in terms of general data, the changes in heart rate, respiratory rate, and blood oxygen saturation during transport, the incidence rates of adverse events, and outcomes. RESULTS: There were no significant differences between the two groups in sex, age, oxygenation index, pediatric critical illness score, course of disease, primary disease, heart rate, respiratory rate, and transcutaneous oxygen saturation before transport (P>0.05). During transport, there were no significant differences between the two groups in the changes in heart rate, respiratory rate, and transcutaneous oxygen saturation (P>0.05). The incidence rates of tracheal catheter detachment, indwelling needle detachment, and sudden cardiac arrest in the observation group were lower than those in the control group during transport, but the difference was not statistically significant (P>0.05). Compared with the control group, the observation group had significantly shorter duration of mechanical ventilation and length of stay in the pediatric intensive care unit and significantly higher transport success rate and cure/improvement rate (P<0.05). CONCLUSIONS The application of transport ventilator in the inter-hospital transport can improve the success rate of inter-hospital transport and the prognosis in critically ill children, and therefore, it holds promise for clinical application in the inter-hospital transport of critically ill children.
Child ; Humans ; Critical Illness ; Respiration, Artificial/adverse effects* ; Intensive Care Units, Pediatric ; Ventilators, Mechanical ; Prognosis

Neonatal seizures are the most common clinical manifestations of critically ill neonates and often suggest serious diseases and complicated etiologies. The precise diagnosis of this disease can optimize the use of anti-seizure medication, reduce hospital costs, and improve the long-term neurodevelopmental outcomes. Currently, a few artificial intelligence-assisted diagnosis and treatment systems have been developed for neonatal seizures, but there is still a lack of high-level evidence for the diagnosis and treatment value in the real world. Based on an artificial intelligence-assisted diagnosis and treatment systems that has been developed for neonatal seizures, this study plans to recruit 370 neonates at a high risk of seizures from 6 neonatal intensive care units (NICUs) in China, in order to evaluate the effect of the system on the diagnosis, treatment, and prognosis of neonatal seizures in neonates with different gestational ages in the NICU. In this study, a diagnostic study protocol is used to evaluate the diagnostic value of the system, and a randomized parallel-controlled trial is designed to evaluate the effect of the system on the treatment and prognosis of neonates at a high risk of seizures. This multicenter prospective study will provide high-level evidence for the clinical application of artificial intelligence-assisted diagnosis and treatment systems for neonatal seizures in the real world.
Artificial Intelligence ; Electroencephalography/methods* ; Epilepsy/diagnosis* ; Humans ; Infant, Newborn ; Infant, Newborn, Diseases/diagnosis* ; Intensive Care Units, Neonatal ; Multicenter Studies as Topic ; Prospective Studies ; Randomized Controlled Trials as Topic ; Seizures/drug therapy*

Purpose: Current variability in methods for tumor mutational burden (TMB) estimation and reporting demonstrates the urgent need for a homogeneous TMB assessment approach. Here, we compared TMB distributions in different cancer types using two customized targeted panels commonly used in clinical practice. Materials and Methods: TMB spectra of 295- and 1021-gene panels in multiple cancer types were compared using targeted next-generation sequencing (NGS). The TMB distributions across a diverse cohort of 2,332 cancer cases were then investigated for their associations with clinical features. Treatment response data were collected for 222 patients who received immune-checkpoint inhibitors (ICIs) and their homologous recombination DNA damage repair (HR-DDR) and programmed death-ligand 1 (PD-L1) expression were additionally assessed and compared with the TMB and response rate. Results: The median TMB between gene panels was similar despite a wide range in TMB values. The highest TMB was 8 and 10 in patients with squamous cell carcinoma and esophageal carcinoma according to the classification of histopathology and cancer types, respectively. Twenty-three out of 103 patients (22.3%) were HR-DDR‒positive and could benefit from ICI therapy; out of those 23 patients, seven patients had high TMB (p=0.004). Additionally, PD-L1 expression was not associated with TMB or treatment response among patients receiving ICIs. Conclusion Targeted NGS assays demonstrated the ability to evaluate TMB in pan-cancer samples as a tool to predict response to ICIs. In addition, TMB integrated with HR-DDR‒positive status could be a significant biomarker for predicting ICI response in patients.

This study was designed to predict the Q-markers of Citri Reticulatae Pericarpium volatile oil and conduct quantitative analysis by GC-MS. The common components of Citri Reticulatae Pericarpium volatile oil were detected by GC-MS. The network pharmacology approaches were utilized for constructing the component-target network and protein-protein interaction(PPI) network, followed by the GO and KEGG pathway enrichment analysis to clarify the pharmacological effects of common components. Molecular docking was conducted to observe the biological activities of common components, thus identifying the Q-markers of Citri Reticulatae Pericarpium volatile oil. The obtained Q-markers were subjected to quantitative analysis by GC-MS. The GC-MS analysis of 19 batches of Citri Reticulatae Pericarpium volatile oil revealed three common components, namely, D-limonene, γ-terpinene, and myrcene. The common components were analyzed based on network pharmacology, and the results showed that Citri Reticulatae Pericarpium volatile oil mainly acted on the core targets GABRA1, GABRA6, GABRA5, GABRA3, and GABRA2 through D-limonene and γ-terpinene, with five important pathways such as nicotine addiction and GABAergic synapse involved. The core targets were mainly distributed in olfactory region, cerebral cortex, cerebellum, basal ganglia, hippocampus, and amygdala to exert the pharmacological effects. As revealed by molecular docking, D-limonene and γ-terpinene exhibited good biological activities, so they were identified as the Q-markers of Citri Reticulatae Pericarpium volatile oil. The results of quantitative analysis showed that the volume fraction of D-limonene was within the range of 0.77-1.03 μL·mL~(-1), and that of γ-terpinene within the range of 0.04-0.13 μL·mL~(-1). The prediction of D-limonene and γ-terpinene as the Q-markers of Citri Reticulatae Pericarpium volatile oil has laid an experimental foundation for the establishment of the quality evaluation standard for Citri Reticulatae Pericarpium volatile oil.
Citrus ; Drugs, Chinese Herbal/pharmacology* ; Gas Chromatography-Mass Spectrometry ; Molecular Docking Simulation ; Network Pharmacology ; Oils, Volatile/pharmacology*

Objective To investigate the impact of early health status on the risk of developing child overweight and obesity so as to provide evidences for preventive measures against child overweight and obesity.Methods Three schools were randomly selected from primary schools in Shanghai, and another three schools were randomly selected from 9-year schools in Shanghai.Retrospective surveys were conducted for 1 511 pupils selected from all the Grade One and Grade Two students of the above selected schools, the univariate and multivariate logistic regression analyses were used to analyze the early risk factors for child overweight and obesity.Results The results of univariate logistic regression analyses showed that for the children with relatively high birth weights, asthma, allergic constitution, histories of chronic diseases, relatively good appetite, relatively high ages that had been notified of their overweight and obesity, the detection rate of overweight and obesity was higher (P<0.05).The results of multivariate logistic regression analyses showed that birth weights(OR=2.699, 95%CI=1.097~6.644), allergic constitution(OR=1.498, 95%CI=1.044~2.149), histories of chronic diseases(OR=2.486, 95%CI=1.327~4.659) and appetite(OR=22.011, 95%CI=8.861~54.673) were the risk factors influencing child overweight and obesity (P<0.05).Conclusion Attention still needs to be paid to the body mass control of the children with relatively high birth weights, allergic constitution and histories of chronic diseases.Scientific and reasonable feeding at early stages as well as cultivating good eating and drinking habits may help prevent and control child overweight and obesity.

The sialyl Lewis X (SLex) antigen encoded by the FUT7 gene is the ligand of endotheliam-selectin (E-selectin).The combination of SLex antigen and E-selectin represents an important way for malignant tumor metastasis.In the present study,the effect of the SLeX-binding DNA aptamer on the adhesion and metastasis of hepatocellular carcinoma HepG2 cells in vitro was investigated.Reverse transcription-polymerase chain reaction (RT-PCR) and immunofluorescence staining were conducted to detect the expression of FUT7 at both transcriptional and translational levels.The SLex expression in HepG2 cells treated with different concentrations of SLeX-binding DNA aptamer was detected by flow cytometry.Besides,the adhesion,migration,and invasion of HepG2 cells were measured by cell adhesion assay,and the Transwell migration and invasion assay.The results showed that the FUT7 expression was up-regulated at both mRNA and protein levels in HepG2 cells.SLeX-binding DNA aptamer could significantly decrease the expression of SLex in HepG2 cells.The cell adhesion assay revealed that the SLeX-binding DNA aptamer could effectively inhibit the interactions between E-selectin and SLex in the HepG2 cells.Additionally,SLeX-binding DNA aptamers at 20 nmol/L were found to have the similar effect to the monoclonal antibody CSLEX-1.The Transwell migration and invasion assay revealed that the number of penetrating cells on the down-side of Transwell membrane was significantly less in cells treated with 5,10,20 nmol/L SLeX-binding DNA aptamer than those in the negative control group (P＜0.01).Our study demonstrated that the SLeX-binding DNA aptamer could significantly inhibit the in vitro adhesion,migration,and invasion of HepG2 cells,suggesting that the SLeX-binding DNA aptamer may be used as a potential molecular targeted drug against metastatic hepatocellular carcinoma.

Objective To investigate whether the combination of 4-E9 immunomagnetic beads and epithelial adhesion mole-cules(Epacm)beads can enhance the enrichment efficiency of MCF-7,BEL-7402 and BGC-823 cells.Methods A mono-clonal antibody was prepared and ligated with magnetic bead by a biotin and a streptavidin to prepare an immunomagnetic beads.The enrichment rate of MCF-7,BEL-7402 and BGC-823 cells was detected by the combination of two kinds of immu-nomagnetic beads and two kinds of immunomagnetic beads.Results The encapsulation rate of 4-E9 immunomagnetic beads was 57.8%,and the encapsulation rate of Epcam immunomagnetic beads was 65.8%.4-E9 immunomagnetic beads on MCF-7,BGC-823 and BEL-7402 cell capture rate was(44±5.33)%,(71±11.33)% and(78.3±8.46)% respectively.Epcam immunomagnetic beads on BGC-823,BEL-7402 and MCF-7 cell capture rate was(55.5±8.67)%,(78.88±13.11)% and (84.31±6.83)% respectively.The combination of two kinds of immunomagnetic beads on BGC-823,BEL-7402 and MCF-7cell capture rate was(80.4±8.33)%,(85.125±6.77)% and(93.23±4.33)% respectively.Joint beads group compared with 4-E9 immunomagnetic beads on BGC-823,BEL-7402 and MCF-7 cell enrichment rate were statistically significant(P=0.03,0.03,0.04),and joint beads group compared with 4-E9 immunomagnetic beads on BGC-823,BEL-7402 and MCF-7 cell enrichment rate were statistically signific(P=0.04,0.03,0.04).Conclusion The combination of two kinds of immunomag-netic beads can significantly improve the enrichment efficiency of Epcam immunomagnetic beads on BEL-7402,BGC-823 and MCF-7 cells.4-E9 antibody enrichment of circulating tumor cells may have some clinical value.

BACKGROUNDThe epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) maybe changed by strict infection control measures, and the impact of empirical antibiotic therapy on the outcomes of MRSA infection was not clear. We aimed to investigate the present epidemiological status of MRSA infection and empirical antibiotic therapy for MRSA infection in university teaching hospitals in mainland China.

METHODSThe present study was a multicenter prospective observational study conducted in five university teaching hospitals. Patients who were consecutively admitted to the intensive care unit and signed a consent form from March 3, 2011 to May 31, 2011 were included. Patients with age <18 years or with a length of hospital stay <48 hours were excluded from this study. The following variables were collected or recorded: demographic data, general status, APACHE II score of the patient at the time of admission, infections, and the use of antibiotics during a stay. Primary outcomes and prognostic indicators included length of hospital stay and 28-day and 90-day mortality. The differences between the patients with appropriate empirical therapy and patients with inappropriate therapy were analyzed to detect the influences of antibiotic therapy on the prognosis of MRSA infection.

RESULTSA total of 682 cases were enrolled. Thirty (66.2%) of 88 MRSA cases were treated with effective antibiotics for MRSA infection; only 20% received appropriate empirical antibiotic treatment. The empirical therapy group compared with the target therapy group had a shorter length of stay, but there were no significant differences in mortality rates. There were no significant differences in the length of hospital stay, length of stay, and 28-day and 90-day mortality between MRSA-infected patients who received or not received effective antibiotics. Two hundred and eighteen cases received sensitive antibiotics for MRSA.

CONCLUSIONSThe MRSA infection rates are at relatively low levels in university teaching hospitals in China. The empirical use of sensitive antibiotics for MRSA infection was at relatively high rate, and there is a tendency of overusing in patients without MRSA infection. On the other hand, the rate of appropriate empirical antibiotic therapy for patients with MRSA infection is relatively low.

Anti-Bacterial Agents ; therapeutic use ; China ; epidemiology ; Female ; Humans ; Intensive Care Units ; Length of Stay ; Male ; Methicillin-Resistant Staphylococcus aureus ; Middle Aged ; Prospective Studies ; Staphylococcal Infections ; drug therapy ; epidemiology