Objective:To analyze the short-term hospital-based transmission characteristics and gene variation of Carbapenem-Resistant Klebsiella pneumoniae (CRKP) by genome-wide technique to provide evidence for transmission control. Methods:The experimental strain was derived from all the CRKP isolated in Affiliated Hospital of North China University of Science and Technology from October 2022 to December 2023. Strain identification and drug susceptibility were tested with VITEK 2-Compact automatic bacterial identification drug susceptibility analyzer or disk method, and the results were interpreted through whole genome sequencing. The ST type, carbapenem resistance gene, virulence factor, and O serotype of the collected strains were analyzed.Results:Among the 115 strains of CRKP, 94 strains were isolated from the intensive care unit (ICU), accounting for 81.7%, and 21 strains were isolated from the non-intensive care unit (NICU), accounting for 18.3%. The 115 strains of CRKP can be divided into 11 ST types, of which ST11 type was the most (54.8%, 63/115), followed by ST15 type (22.6%, 26/115) and ST5492 type (15.7%, 18/115). Type ST5492 was a new clonal group in the region. The 115 strains of CRKP could be divided into 7 O serotypes, most of which were O2a type(32.2%,37/115), followed by O5 type(30.4%,35/115) and O1 type(27.8%,32/115). The resistance genes of carbapenem antibiotics showed that there were 107 strains carrying the blaKPC-2 gene, one strain with the blaNDM-1 gene, and one strain with both the blaKPC-2 and blaNDM-13 genes. Virulence genes were detected in 55 CRKP strains (47.8%, 55/115), among which six strains detected peg-344, iucA, iroB, rmpA, and rmpA2 virulence genes (5.2%, 6/115). Four virulence genes ( peg-344, iucA, rmpA, and rmpA2) were detected in 34 strains (29.6%, 34/115). Three virulence genes ( iucA, iroB and rmpA) were detected in two strains (1.7%, 2/115). Three virulence genes ( peg-344, iucA and rmpA) were detected in one strain (0.8%, 1/115). IucA and rmpA virulence genes were detected in 12 strains (10.4%, 12/115). KPC-2_ST11_O2a, KPC-2_ST15_O1 and KPC-2_ST5492_O5 were dominant clones, and their distribution was mainly in the intensive care unit. The whole genome sequence analysis showed that there were three dominant clones, among which ST11 clones were subdivided into three dominant O serotypes, all of which were mainly in the intensive care unit. Conclusion:The popular strain in the hospital of CRKP is a KPC-2_ST11 clone group carrying iucA, rmpA/rmpA2, with cross-department transmission and mutation. ST5492 is a newly-launched clone type. The intensive care unit of hvKP carrying five virulence genes, including peg-344, should be alert to the epidemic risk of CR-hvKP outbreak.

Objective:To analyze the short-term hospital-based transmission characteristics and gene variation of Carbapenem-Resistant Klebsiella pneumoniae (CRKP) by genome-wide technique to provide evidence for transmission control. Methods:The experimental strain was derived from all the CRKP isolated in Affiliated Hospital of North China University of Science and Technology from October 2022 to December 2023. Strain identification and drug susceptibility were tested with VITEK 2-Compact automatic bacterial identification drug susceptibility analyzer or disk method, and the results were interpreted through whole genome sequencing. The ST type, carbapenem resistance gene, virulence factor, and O serotype of the collected strains were analyzed.Results:Among the 115 strains of CRKP, 94 strains were isolated from the intensive care unit (ICU), accounting for 81.7%, and 21 strains were isolated from the non-intensive care unit (NICU), accounting for 18.3%. The 115 strains of CRKP can be divided into 11 ST types, of which ST11 type was the most (54.8%, 63/115), followed by ST15 type (22.6%, 26/115) and ST5492 type (15.7%, 18/115). Type ST5492 was a new clonal group in the region. The 115 strains of CRKP could be divided into 7 O serotypes, most of which were O2a type(32.2%,37/115), followed by O5 type(30.4%,35/115) and O1 type(27.8%,32/115). The resistance genes of carbapenem antibiotics showed that there were 107 strains carrying the blaKPC-2 gene, one strain with the blaNDM-1 gene, and one strain with both the blaKPC-2 and blaNDM-13 genes. Virulence genes were detected in 55 CRKP strains (47.8%, 55/115), among which six strains detected peg-344, iucA, iroB, rmpA, and rmpA2 virulence genes (5.2%, 6/115). Four virulence genes ( peg-344, iucA, rmpA, and rmpA2) were detected in 34 strains (29.6%, 34/115). Three virulence genes ( iucA, iroB and rmpA) were detected in two strains (1.7%, 2/115). Three virulence genes ( peg-344, iucA and rmpA) were detected in one strain (0.8%, 1/115). IucA and rmpA virulence genes were detected in 12 strains (10.4%, 12/115). KPC-2_ST11_O2a, KPC-2_ST15_O1 and KPC-2_ST5492_O5 were dominant clones, and their distribution was mainly in the intensive care unit. The whole genome sequence analysis showed that there were three dominant clones, among which ST11 clones were subdivided into three dominant O serotypes, all of which were mainly in the intensive care unit. Conclusion:The popular strain in the hospital of CRKP is a KPC-2_ST11 clone group carrying iucA, rmpA/rmpA2, with cross-department transmission and mutation. ST5492 is a newly-launched clone type. The intensive care unit of hvKP carrying five virulence genes, including peg-344, should be alert to the epidemic risk of CR-hvKP outbreak.

Objective:To summarize and analyze the results of the individual dose intercomparison in which province-level health institutions participating, and explore the role of ability intercomparison in improving the detection capabilities of province-level health institutions.Methods:From 2009 to 2022, the results obtained by the province-level CDCs and occupational prevention and control institutions in the individual dose intercomparison countrywide for time periods of 2009—2020 and 2021—2022 were summarized. The intercomparison results were analyzed and compared for three regions of east, central and west China divided according to the method from China Health Statistics Yearbook 2022.Results:A total of 24 province-level CDCs and 14 occupational prevention and control institutions countrywide participated in the ability intercomparison from 2009—2022 for 13 times. Number of participating institutions increased from 26 in 2009 to 37 in 2022. The qualified rates of the intercomparison results among the province-level health institutions in the three regions were maintained at higher than 85% for 37 times and 100% for 28 times. The pass rate and excellent rate of the three regions were higher than the overall level at whole country level (2009-2020) and national level (2021-2022) in the same period for 9 and 5 times, respectively. The excellent rate of province-level health institutions in central region were higher than that of the other two regions in 9 intercomparisons.Conclusions:With the improvement of the intercomparison standard, the province-level health institutions in various regions have maintained a relatively stable and high detection capability. The ability intercomparison effectively improve the detection ability and the quality control of the province-level health organizations. Many province-level agencies have listed the ability intercomparison as the regular work.

Objective: To improve radiation testing institutions’ ability and levels of personal dose monitoring for external exposure and standardize monitoring work. Methods: According to Testing Criteria of Personnel Dosimetry Performance for External Exposure (GBZ 207—2016), the intercomparison programme was made, the 2021 class-based personal dose monitoring intercomparison were organized by the National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention and provincial monitoring institutions. Results: A total of 150 institutions participated in the 2021 national intercomparison of personal dose monitoring capability. Of them, 143 (95.3%) passed the assessment, including 51 excellent institutions (excellent rate, 34.0%), and 7 (4.7%) failed to pass the assessments. Conclusion The 2021 national personal dosimetry performance intercomparison showed great improvements in the pass rate and excellent rate compared with previous national assessments. However, still seven institutions failed to pass this assessment, including four institu- tions with class A qualifications. The testing institutions need to find out the reasons to increase their testing ability. This class-based intercomparison improved the point-to-plane relationship between the organizing and testing institutions, help- ing the organizing institution focus on improving the testing ability of provincial testing institutions and class A radiation health service institutions.

Objective:To investigate the changes of quadriceps femoris thickness with the length of stay in intensive care unit (ICU) in patients with sepsis, and to evaluate the diagnostic value of muscle changes in mortality.Methods:A prospective study was conducted, and 92 patients with sepsis who were admitted to the ICU of the Affiliated Hospital of Jining Medical College from January 2020 to December 2021 were enrolled. The thickness of quadriceps femoris [including the quadriceps femoris muscle thickness at the midpoint of the anterior superior iliac spine and the upper edge of the patella (M-QMLT), and at the middle and lower 1/3 of the patella (T-QMLT)] measured by ultrasound 1 day (D1), 3 days (D3), and 7 days (D7) after admission to the ICU were collected. The atrophy rate of quadriceps femoris was calculated 3 and 7 days after admission to the ICU compared with 1 day [(D3-D1)/D1 and (D7-D1)/D1, (TD3-TD1)/TD1 and (TD7-TD1)/TD1, respectively]. The demographic information, underlying diseases, vital signs when admission to the ICU and in-hospital mortality of all patients were recorded, and the differences of the above indicators between the two groupswere compared. Multivariate Logistic regression was used to analyze the influence of quadriceps femoris muscle thickness and atrophy rate on in-hospital mortality of septic patients. The receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of quadriceps femoris muscle thickness and atrophy rate on in-hospital mortality of septic patients.Results:A total of 92 patients with severe sepsis were included, of which 41 patients died in hospital, 51 patients discharged. The in-hospital mortality was 44.6%. The muscle thickness of quadriceps femoris in severe septic patients decreased with the prolongation of ICU stay, and there was no significant difference between the two groups at the first and third day of ICU admission. The muscle thickness of quadriceps femoris at different measuring positions in the survival group was significantly greater than those in the death group 7 days after admission to the ICU [M-QMLT D7 (cm): 0.50±0.26 vs. 0.39±0.19, T-QMLT D7 (cm): 0.58±0.29 vs. 0.45±0.21, both P < 0.05]. The atrophy rate of quadriceps femoris muscle thickness at different measuring positions 3 and 7 days after admission to ICU in the survival group was significantly lower than those in the death group [(D3-D1)/D1: (8.33±3.44)% vs. (9.74±3.91)%, (D7-D1)/D1: (12.21±4.76)% vs. (19.80±6.15)%, (TD3-TD1)/TD1: (7.83±4.26)% vs. (10.51±4.75)%, (TD7-TD1)/TD1: (11.10±5.46)% vs. (20.22±6.05)%, all P < 0.05]. Multivariate Logistic regression analysis showed that M-QMLT D7, T-QMLT D7, (D3-D1)/D1, (D7-D1)/D1, (TD3-TD1)/TD1, (TD7-TD1)/TD1 were independent risk factors for in-hospital mortality (all P < 0.05). The results were stable after adjusting for confounding factors. ROC curve analysis showed that (TD7-TD1)/TD1 [area under the ROC curve (AUC) was 0.853, 95% confidence interval (95% CI) was 0.773-0.934] was superior to (D7-D1)/D1, T-QMLT D7, M-QMLT D7, (TD3-TD1)/TD1 and (D3-D1)/D1 [AUC was 0.821 (0.725-0.917), 0.692 (0.582-0.802), 0.683 (0.573-0.794), 0.680 (0.569-0.791), 0.622 (0.502-0.742)]. Conclusions:For septic patients in ICU, bedside ultrasound monitoring of quadriceps femoris muscle thickness and atrophy rate has a certain predictive value for in-hospital mortality, and a certain guiding significance in clinical treatment and predicting the prognosis of sepsis.

Objective:To investigate the relationship between the arterial blood lactic acid level after entering the intensive care unit (ICU) and the 28-day mortality of patients with septic shock.Methods:The clinical data of 303 patients with septic shock hospitalized in the department of critical medicine of the Affiliated Hospital of Jining Medical College from April 2015 to June 2019 were analyzed retrospectively. According to the blood lactate (Lac) level, the patients were divided into <4 mmol/L group ( n=203), 4-10 mmol/L group ( n=69) and >10 mmol/L group ( n=31). The baseline characteristics of the patients were analyzed. Multiple logistic regression analysis was used to analyze the independent influencing factors of the 28-day mortality of patients with septic shock. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of the Lac level after entering the ICU for 28-day mortality, and Kaplan-Meier survival curve was performed according to the best cut-off value. Results:A total of 303 patients with septic shock were included, with 179 died in 28 days, and the total mortality was 59.08%. There were 203, 69, 31 patients in Lac<4 mmol/L, 4-10 mmol/L and >10 mmol/L group, respectively. There were significant differences in Acute Physiology and Chronic Health Evalution Ⅱ (APACHE Ⅱ), Sequential Organ Failure Assessment (SOFA), oxygenation index (PaO 2/FiO 2), abdominal infection, the proportion of vasoactive drugs use among the three groups ( P<0.05). Multiple logistic regression analysis showed that the independent influencing factor of the 28-day mortality of septic shock were age, SOFA, use of mechanical ventilation, lactic acid (Lac). ROC curve analysis showed that the area under the ROC curve (AUC) for predicting 28-day mortality of patients with septic shock was 0.604 5 (95% CI: 0.540 8-0.668 2). When the optimal cut-off value was 3.55 mmol/L, the sensitivity was 0.508 4, the specificity was 0.733 9, the positive likelihood ratio was 1.910 3 and the negative likelihood ratio was 0.669 9. According to the best cut-off value of entrance Lac, patients were divided into high Lac group (≥3.55 mmol/L) and low Lac group (<3.55 mmol/L), and their 28-day mortality rates were 73.39%(91/124) and 49.16%(88/179). Kaplan-Meier survival curve showed that the 28-day cumulative survival rate of the high Lac group was significantly lower than that of the low Lac group ( P<0.001). Multiple logistic regression analysis showed that after adjusting for confounding factors, the 28 d mortality increased to 1.22 times for each increase of 1 mmol/L of Lac [odds ratio ( OR)=1.22, 95% confidence interval (95% CI) was 1.08-1.37, P=0.001 4]. The 28 d mortality in high Lac group was 3.53 times higher than that in low Lac group ( OR=3.53, 95% CI was 1.36-7.09, P=0.000 4). Conclusions:In patients with ICU septic shock, the arterial blood Lac level after admission was associated with 28-day mortality. Patients with septic shock whose arterial blood Lac level exceeded 3.55 mmol/L within 1 hour of entering the room had a significantly increased risk of death.

Objective: To compare the test results of domestic and imported eye lens and ring dosimeters, and master some dosimetric performance indexes of eye lens and ring dosimeters. Methods: According to IEC 62387—2012 and GBZ 128—2019, the performance of the eye lens dosimeters and ring dosimeters with the domestic thermoluminescence detectors were compared with the imported thermoluminescence detectors in photon response. The dose response deviation of the im- ported eye lens dosimeter and imported ring dosimeter was studied under the same irradiation condition. The difference of linear response between imported ring dosimeter and domestic ring dosimeter was studied under the same irradiation condition.  Results: The same dose was irradiated to domestic and imported thermoluminescence detectors in the imported eye lens and imported ring dosimeters, and the linear correlation coefficient all met R2 > 0.999. The maximum response devi- ation of the imported eye lens dosimeter and ring dosimeter was less than 10.0% for the same dose. Two kinds of imported ring dosimeters and one kind of domestic ring dosimeter were irradiated with the same dose, and the linear correlation coefficient all met R2 > 0.99. Conclusion Both domestic detectors and imported detectors can meet the needs of monitoring re- quirements. There was no obvious difference in linear response between imported ring dosimeter and domestic ring dosimet- er. The repeatability of imported eye lens dosimeter and imported ring dosimeter met the performance requirements of the dosimeter.

Objective In order to improve the personal dose monitoring ability of radiation health technical institutions, and standardize the detection methods and procedures. Methods Develop adetailed assessment plan according to GBZ 207—2016 “Testing criteria of personnel dosimetry performance for external exposure”, organize a national assessment of personal dose monitoring capabilities in 2020, analyze the problems arising from the assessment, and strengthen supervision and training in the future. Results A total of 457 institutions participated in this assessment, of which 421 were qualified (including 74 excellent institutions, with an excellent rate of 16.2%), and 36 were unqualified, accounting for 92.1% and 7.9% respectively. Conclusion The number of institutions that participated in the assessment this year reaches a record high, with a passing rate 4.08% higher than that in 2019. The overall monitoring capacity of the country has been greatly improved. However, some institutions still have problems such as irregular symbol writing, unupdated detection standards, and large deviations in testing data. It is necessary to improve the ability of loboratory detection and data analysis, standardize the operation process, and ensure the quality of assessment.

Objective:To enhance the capabilities of individual monitoring technology services for external exposure.Methods:The intercomparison results of the national individual monitoring for external exposure during 2015-2019 were presented, together with a summary and analysis provided of the main existing problems.Results:By 2019, 382 of individual monitoring technology service uints, from 30 provinces, autonomous regions or municipalities, participated in the individual monitoring intercomparisons results, involving disease control and prevention centers, occupational prevention and control institutions, research institutes, universities, nuclear industry, medical institutions, and companies. Except for slightly low in 2017, the pass rate in the other four years was above 90%. The excellence rate increased with the years.Conclusions:The capabilities of individual monitoring service units can meet the concerned requirements and provide standardized monitoring report for the period of 2015 to 2019, but with some being unqualified. These service units should carefully analyze and identify the reasons for the failure, standardize the quality control of laboratory, and improve the level of measurement and the ability of data analysis.

Objective To compare,through experimental measurements,the differences between four kinds of single and double dosimetry algorithms recommend by ICRP 139 Publication in estimating interventional radiology staff's effective dose,with aim to realize the applicability of algorithms for cardiovascular interventional diagnosis and treatment in China.Methods Measurements of organ doses were carried out with an anthropomorphic phantom equipped with thermoluminecent dosimetry and dressed with lead apron and lead collar.The effective doses were calculated using the tissue weighting factors.Meanwhile,the staff's effective doses were also obtained by the use of four kinds of single and double dosimetry algorithms.The later four effective doses were compared with those obtained with phantom methode.Results The effective doses were 0.581 mSv for phantom method,0.667 mSv for Swiss ordinance's algorithm,0.484 mSv for McEwan's algorithm,0.485 mSv for von Boetticher's algorithm and 0.726 mSv for Martin-Magee's algorithm,in ICRP 139 report respectively.The relative deviations to the results of experimental measurement were 14.8％ for Swiss ordinance's algorithm,-16.7％ for McEwan's algorithm,-16.5％ for von Boetticher's algorithm and 24.9％ for Martin-Magee's algorithm,respectively.Conclusions There are great differences between the effective doses of the first operator obtained by four dosimetry algorithms and the simulated result.From the point of view of radiation protection,it is recommended to use the Swiss ordinance's algorithm to carry out individual monitoring of the first operator in the cardiovascular interventional procedures.