Objective To study the etiology and antibiotic resistance of bloodstream infections in low birth weight preterm infants .Methods A total of 95 cases of bloodstream infections in low birth weight preterm infants were treated in our hospital from January 2011 to April 2014 .The clinical data of these patients were analyzed retrospectively .Results A total of 96 pathogens were isolated ,including 57 strains of gram‐negative bacilli ,38 strains of gram‐positive cocci ,and 1 strains of Trichosporon asahii .The most frequently isolated pathogens were Klebsiella pneumoniae (40 strains)and coagulase‐negative Staphylococcus(31 strains).All gram‐negative bacilli were sensitive to carbapenems such as imipenem and panipenem . Streptococcus isolates were sensitive to most antibiotics .Most Staphylococcus isolates were methicillin‐resistant ,which were highly resistant to common antibiotics but all sensitive to linezolid , vancomycin and teicoplanin . Conclusions The most important pathogens responsible for bloodstream infections in low birth weight preterm infants in our hospital are K lebsiella pneumoniae and coagulase‐negative Staphylococcus . Early identification of responsible pathogen and rational antimicrobial therapy are critical for good prognosis of bloodstream infections in low birth weight preterm infants .

Objective:To develop a venipuncture indication system based on an ultra-miniature side-view optical coherence tomography (OCT) endoscopic probe. This system enables real-time scanning and imaging of the tissue around the tip of the intravenous needle, which is used to determine whether the intravenous needle has penetrated the blood vessel.Methods:An ultra-miniature side-view OCT needle probe was fabricated and placed into the stem of an elongated 30G hypodermic needle to make the OCT endoscopic probe. The endoscopic probe was inserted into the stem of an intravenous needle and the tip of the probe was allowed to probe out of the intravenous needle. This allows the OCT endoscopic probe to be driven by the rotating collar to scan and image the tissue around the tip of the intravenous needle. Imaging experiments were performed using mouse blood and non-blood tissues (skeletal muscle and liver) to verify system function.Results:Blood did not produce OCT signals at most locations except for a weak OCT signal at locations near the scanning window of the endoscope probe (i.e., the top of the image). The intensity of the OCT signal generated by it decayed rapidly with the increase in imaging depth. At a depth of 300-400 μm from the scanning window, the OCT signal has almost completely disappeared. Strong OCT signals appeared in the images of skeletal muscle. Its signal intensity decayed with the increase of imaging depth, but a more obvious OCT signal could be observed at a depth of more than 900 μm from the scanning window. The distribution of OCT signal intensity within skeletal muscle was very heterogeneous. The connective tissue embedded in the skeletal muscle showed stronger OCT signals than the surrounding skeletal muscle, while there was almost no OCT signal in the muscle at the spaces located between the muscle fiber bundles. A strong OCT signal was observed in the images of liver tissue. The attenuation of this signal with increasing imaging depth was more pronounced. At a distance of 600-700 μm from the scanning window, the OCT signal had almost completely disappeared. The intensity distribution of the OCT signal in the internal image of the liver tissue was relatively uniform.Conclusions:The proposed venipuncture indication system is able to image the tissue around the tip of the injection needle instantly, and provide a more reliable indication of whether the needle has penetrated the blood vessel during clinical venipuncture.

Gastric cancer(GC)is one of the most common malignancies worldwide.In our country,the majority of patients are diagnosed with GC at alocally advanced stage.Fortunately,clinical studies have demonstrated that minimally invasive radical gastrectomy,particularly laparoscopic surgery,is just as effective as traditional open surgery in terms of both short-and long-term outcomes.Consequently,minim-ally invasive surgery has become the primary surgical approach for patients with locally advanced gastric cancer(LAGC).Advancements in surgical techniques and technologies are enabling even more precise and minimally invasive approaches to GC surgery.Based on recent do-mestic and international studies,this study aimed to review and elaborate on the development of minimally invasive surgery for LAGC.

Objective:The clinical heterogeneity of non-metastatic castration-resistant prostate cancer is high, and precise and individualized treatment is required for different patients to achieve maximum benefits. Three cases of non-metastatic castration-resistant prostate cancer were reported in this paper. One case received apalutamide + leproprillin treatment, one received radical prostatectomy, and one received radiotherapy + abiraterone treatment. After a period of follow-up, the three patients all benefited to varying degrees.

Objective:To translate the health literate healthcare organization 10 item questionnaire(HLHO-10) into Chinese and examine its reliability and validity.Methods:The Chinese version of HLHO-10 questionnaire(HLHO-10-C) was developed by following the Brislin translation model of translation, back translation, cultural adaptation and questionnaire epistemological survey.Five experts and 1 071 medical staff from 24 healthcare organizations in Zhejiang province were selected to conduct the validity and reliability test of the HLHO-10-C.Results:The content validity indices at the item level and total questionnaire level of HLHO-10-C were from 0.8 to 1.0 and 0.96 respectively, and the results of the exploratory factor analysis showed good structural validity.Conclusions:HLHO-10-C proves adequate reliability and validity to serve as a tool for healthcare organizations in evaluating and becoming HLHO. It can also help the implementation of the Healthy China Initiative(2019—2030), which is a performance assessment mechanism for health education and promotion of healthcare providers and health care organizations.

Objective: Based on physical activity (PA) and sedentary behavior (SB) variables on weekdays and weekends, the study aims to cluster the physical activities inside and outside kindergartens and to explore the cluster characteristics of different children using physical fitness indicators, so as to provide new strategies and methods for early childhood education and health. Methods: From March to June 2019, 291 children aged 3-6 years from 6 kindergartens in Nanchang were recruited by a stratified cluster random sampling method. The ActiGraph GT3X-BT triaxial accelerometer was used to measure and analyze the PA and SB levels inside and outside the kindergarten. A twostep clustering algorithm model was employed for cluster analysis. Physical fitness were measured and evaluated according to the "National Physical Fitness Measurement Standard Manual (Preschool Section)". Differences in physical fitness among different clusters of children were compared, and the cluster characteristics of different children were analyzed. Results: The clustering algorithm model indicated that based on six indicators, including PA and SB inside the kindergarten on weekdays, and PA and SB outside the kindergarten on both weekdays and weekends, children could be divided into three categories:active inside (high PA, low SB inside), active outside (high PA outside), and inactive (low PA, high SB both inside and outside). The average silhouette coefficient of the model was 0.3, indicating good clustering results. Both the active inside and active outside children showed significantly higher PA inside on weekdays, PA outside on weekdays and weekends, daily low intensity physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) than the inactive children ( F=157.91, 80.79 , 95.86, 95.52, 124.74, P <0.05). After adjusting for gender and age, the physical fitness scores of both active outside ( 19.03 ±0.47) and active inside (19.11±0.40) were significantly higher than those of the inactive children (17.94±0.31). Additionally, active inside children (3.91±0.14) also showed significantly better performance in continuous double-leg jumps, compared to inactive children (3.45±0.11) ( P <0.05). Conclusion Children active inside and those active outside perform well in PA. Future research should focus on the proportion of structured and unstructured PA time to enhance the overall physical fitness of children.

Objective:This study aims to evaluate the performance of digital PCR (dPCR) detecting multiple and single copies genes of the Epstein-Barr virus (EBV) for nucleic acid quantification and explore their applicability in clinical settings.Methods:Compared the sensitivity, specificity, precision, lower limit of detection (LoD), and linearity for multicopy BamHI-W dPCR and single-copy EBNA1 dPCR systems. Linear regression analysis using the least squares method was employed to evaluate the linearity. Additionally, we analyzed plasma samples from 182 patients with suspected EBV-related diseases between January and July 2022 at the Southern Medical University Southern Hospital, using both dPCR and quantitative PCR (qPCR) for EBV DNA quantification. Linear regression analysis using the least squares method was conducted to assess their quantitative correlation.Results:The dPCR systems for both multicopy and single-copy genes showed excellent linearity ( R 2 values of 0.992 and 0.997, respectively, both P<0.001). The LoD were 188 IU/ml for BamHI-W gene and 358 IU/ml for EBNA1 gene dPCR systems. The logarithmic coefficient of variation ( CV) values for high-concentration samples (1 000 000 IU/ml) were 0.34% and 0.21% for the BamHI-W gene and EBNA1 gene dPCR assays, respectively, while for low-concentration samples (5 000 IU/ml) were 0.98% and 0.64%, respectively. In the detection of seven common clinical infectious pathogens and EBV positive samples, only EBV-positive samples yielded positive signals in the dPCR detection system, with no cross-reaction with other pathogens. In 182 samples, the positive detection rates were 47.80% (87/182) for BamHI-W gene and 35.16% (64/182) for EBNA1 gene dPCR, compared to 43.41% (79/182) for qPCR. Linear correlation analysis with qPCR showed R2 values of 0.837 for BamHI-W gene and 0.763 for EBNA1 gene dPCR (both P<0.001). The BamHI-W gene copy number ranged from 3 to 18 copies per clinical sample, with patient-specific variations. There was a high consistency in viral load trends between the multicopy BamHI-W gene and single-copy EBNA1 gene dPCR systems within individual patients. Conclusions:The dPCR methods detecting EBV multiple and single copies genes showed high sensitivity, specificity, precision, and quantitative accuracy, suitable for clinical sample analysis. The multicopy BamHI-W gene dPCR method notably enhances detection sensitivity and can be used as a supplement to current EBV DNA load detection methods, especially in low-concentration samples. For within-patient EBV DNA monitoring, the multicopy gene method proves more effective, while inter-patient comparisons might necessitate single-copy gene methods or normalize them using the same standard.

Objective:To investigate the status of cognition and clinical management of prolonged mechanical ventilation(PMV) among medical staffs in pediatric intensive care unit(PICU) in China, and in order to improve the awareness of PICU medical staffs on PMV and standardize the management of PMV.Methods:The cross-sectional study was conducted with doctors and nurses in PICUs of the collaborative group as the survey objects from July 12 to September 12, 2020.The questionnaire was issued, collected and checked by the Children′s Hospital of Fudan University.Results:(1) PMV related settings: Nine out of eleven hospitals had established PMV multidisciplinary teams, respiratory techniques such as diaphragm ultrasound and airway peak flow monitoring could be respectively executed in 72.7% and 36.4% of PICU.Pulmonary rehabilitation techniques such as airway clearance techniques, induced spirometer exercise, external diaphragm pacemaker stimulation, transfer bed exercise, balloon blowing, hyperbaric oxygen therapy could be respectively executed in 100.0%, 9.1%, 9.1%, 9.1%, 27.3% and 27.3% of PICU, respectively.(2) The cognitive status quo of children′s PMV: The most medical staffs agreed with the view that PMV referred to the children′s continuous mechanical ventilation for more than two weeks.Sixty percent of medical staffs believed that children with PMV had basic central nervous system diseases, and 62.7% of medical staffs believed that the most common causes of difficulty in PMV weaning was abnormal brain function.(3) The cognitive status quo of the children′s PMV management in PICU: Respondents believed that the most commonly used mechanical ventilation mode was synchronized intermittent mandatory ventilation+ pressure support ventilation in children′s PMV during stable disease.Ninety-two percent of medical staffs performed the spontaneous breathing test when weaning.And 58.7% of the respondents agreed to perform tracheotomy for the children during 3 to 4 weeks of mechanical ventilation.More than half of medical staffs would execute diaphragm function assessment, bedside rehabilitation training, nutritional assessment, analgesia and sedation assessment for children with PMV.(4) The cognitive status quo of the children′s PMV management of transition from hospital to family: 54.5% of PICU provided family care training to the family members before the children were discharged from the hospital.One center established the PMV specialized outpatient clinic.45.5% of PICU would follow up these discharged children one month later.Conclusion:At present, PICU medical staffs have different awareness of children′s PMV related problems in China.And children′s PMV lacks a systematic plan regarding diagnosis, treatment and management.

Objective:To evaluate the efficacy and safety of Qingxuan Zhike granules in improving cough symptoms and shortening the course of influenza (wind-heat invading lung) in children.Methods:In this multicenter, randomized, controlled clinical trial, a total of 240 outpatient influenza patients from 7 hospitals, including the First Affiliated Hospital of Yunnan University of Traditional Chinese Medicine, from April 2023 to December 2023 were collected.The subjects were randomly divided into the control group and the experimental group via SAS software using the block randomization method.The differences between two groups were compared with t test, corrected t test and χ2 test.Subjects in the control group were given Oseltamivir phosphate granules, orally, twice a day (weight ≤15 kg, 30 mg/time; weight >15-23 kg, 45 mg/time; weight >23-40 kg, 60 mg/time; weight >40 kg, 75 mg/time; age≥13 years, 75 mg/time).In addition to Oseltamivir phosphate granules, subjects in the experimental group were also given Qingxuan Zhike granules, orally, 3 times a day (1-3 years old, 1/2 bag each time; >3-6 years old, 3/4 bag each time; >6-14 years old, 1 bag each time).After 5 days of treatment, the medication was suspended for 2 days.The effect of cough, antipyretic effect, clinical recovery rate, clinical recovery time, Canadian Acute Respiratory Illness and Flu Scale (CARIFS) score, traditional Chinese medicine (TCM) syndrome effect, complication rate, and adverse reactions were evaluated between the two groups. Results:Finally, 232 cases were included in the study, including 115 cases in the experimental group and 117 cases in the control group.Before and after treatment, there were no significant difference in CARIFS cough score between the experimental group and the control group (all P>0.05).After treatment, the change in CARIFS cough score in the experimental group [(-1.00±0.91) scores]was significantly higher than that in the control group [(-0.75±0.98) scores] ( t=-1.995, P=0.047).After treatment, the change in TCM syndrome cough score in the experimental group [(-1.69±1.51) scores] was significantly higher than that in the control group [(-0.97±1.63) scores] ( t′=-0.035, P=0.001).The time of complete regression of fever in the experimental group [(44.82±22.72) h] was shorter than that in the control group [(51.35±27.07) h], and the difference between the two groups was statistically significant ( t=-1.966, P=0.050).The fever score showed that the area under the curve between the CARIFS symptom fever score and time in the experimental group was 4.40±2.42, while that in the control group was 5.12±2.44, and the difference between the two groups was statistically significant ( t=-2.252, P=0.025).The clinical recovery rate was 93.91%(108/115) in the experimental group and 92.31%(108/117) in the control group, and there was no significant difference between the two groups ( χ2=0.233, P>0.05).The clinical recovery time in the experimental group [(2.93±1.21) d] was shorter than that in the control group [(3.29±1.15) d], and the difference between the two groups was statistically significant ( t=-2.279, P=0.024).After treatment, there was a significant difference in TCM syndrome score variation between the experimental group [(-12.00±4.13) scores] and the control group [(-10.85±4.31) scores] ( t′=-2.067, P=0.040).No complication occurred in both groups, and there was no significant difference in the incidence of adverse events between the two groups ( χ2=1.299, P>0.05). Conclusions:Qingxuan Zhike granules combined with Oseltamivir phosphate can effectively improve the cough symptoms associated with influenza in children, shorten the time and course of fever, and improve the TCM syndrome score; thus, they are safe in clinical application.

Objective:To explore the clinical efficacy of retzius-sparing robot-assisted laparoscopic radical prostatectomy with retrograde release of the neurovascular bundle.Methods:From January 2021 to January 2022, the clinical data of 113 patients with retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RARP) was retrospectively analyzed. The ages of the optimized group and the standard group were (67.5±6.4) years and (67.7±6.1) years, and the body mass index (BMI) was (25.0±3.2) kg/m 2 and (24.9±3.1) kg/m 2, respectively. The prostate volume was (42.8±15.4) ml and (41.0±17.9) ml, the preoperative PSA was (13.5±13.1) ng/ml and (11.9±16.0) ng/ml, and the preoperative IIEF-5 score was (15.0±4.0) and (14.8±4.2) points, respectively. Gleason scores were (7.2±0.8) points and (7.1±0.9) points, respectively, with no statistical significance ( P>0.05). The clinical stages of cT 2 and cT 3 were 35 and 40 cases in the optimized group and 16 and 22 cases in the standard group, respectively. There were 5 and 11 cases of preoperative neoadjuvant therapy, respectively, with no statistical significance ( P>0.05). The optimized RS-RARP is the blunt dissection of the denonvilliers fascia and forward to the apex of prostate, and retrograde release of the NVB. The operation time, intraoperative blood loss, drainage tube retention time, days of hospital stay, positive rate of pathological margin and incidence of complications were compared. The recovery of urinary continence was evaluated at 2 weeks after the catheter was removed, and the postoperative IIEF-5 score and PSA were followed up at 1 month after the surgery. Immediate urinary continence was defined as the use of 1 pad on the day of radical prostatectomy. Follow-up intervals were no more than 3 months. The log-rank test compared urinary incontinence rates between the two modalities. Results:All 113 cases of surgery were completed, and median follow-up was 16 months. The operation time was (79.7±26.6) min and (149.8±40.1) min, and the intraoperative blood loss was (54.9±24.7) ml and (110.0±83.2) ml, respectively, and the difference was statistically significant ( P<0.01). The retention time of postoperative drainage tube was (5.3±2.1) d and (5.5±2.1) d in the optimal group and the standard group, and the days of hospital stay was (7.6±2.1) d and (8.5±2.3) d, respectively. The positive rate of postoperative pathological margin was 19.6% (10/51) and 24.2% (15/62), respectively. There was no significant difference ( P>0.05). immediate urinary continence was 86.3% (44/51) and 69.4% (43/62) in the optimized group and the standard group, respectively, and the difference was statistically significant ( P=0.033). Postoperative IIEF-5 scores were (13.2±3.3) and (11.0±4.3), respectively, and the difference was statistically significant ( P=0.012). Kaplan-Meier analysis showed that the risk of urinary incontinence was lower in the optimized group ( P=0.02). Conclusions:The optimized RS-RARP might shorten the operation time, reduce intraoperative bleeding, and help the recovery of urinary continence and sexual function to a great extent.