Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.

Objective:To observe the effect of combining transcutaneous stimulation of the auricular vagus nerve (taVNS) with modified constraint-induced movement therapy (mCIMT) on the upper limb function of hemiplegic stroke survivors.Methods:Seventy-one hemiplegic stroke survivors were randomly divided into a taVNS group of 24, an mCIMT group of 23 and a combined group of 24. In addition to conventional rehabilitation therapy, the taVNS group received taVNS therapy, the mCIMT group received mCIMT, while the combined group received both for 30 minutes a day, 5 days a week for 4 weeks. Before and after the treatment, everyone′s upper limb function was evaluated using the Fugl-Meyer upper extremity assessment (FMA-UE) and the Action Research arm test (ARAT). Ability in the activities of daily living (ADL) was quantified using the modified Barthel index (MBI). The latency and amplitude of motor evoked potentials (MEPs) were also measured.Results:After the treatment, significant improvement was observed in the average FMA-UE, ARAT and MBI scores. MEP latency and amplitude had also improved. The averages in the mCIMT group were then significantly better than among the taVNS group.Conclusions:taVNS combined with mCIMT can significantly improve the upper limb function and ADL functioning of stroke survivors with hemiplegia. It can also promote the recovery of central nervous system function.

Objective:To explore the potential mechanisms of autophagy suppressing the activation of pro-inflammatory macro-phages.Methods:Macrophage-specific knockout mice(Atg5△mye)was generated by the hybridization of Lyz2-Cre mice and Atg 5flox/+mice.Bone marrow cells were differentiated into bone marrow-derived macrophages(BMDMs)induced by monocyte colony-stimulating factor.The expressions of endoplasmic reticulum stress(ER stress)-related proteins,such as glucose regulatory protein 78(GRP78),autophagy-related marker LC3-Ⅱ and p62,and pro-inflammatory iNOS,were detected by Western blot.GO analysis was performed on BMDMs from Atg5flox/flox and Atg5△mye mice stimulated by LPS.Tauroursodeoxycholate(TUDCA)or ATF6 inhibitor Ceapin-A7 was used to suppress the ER stress in BMDMs.Results:LPS promoted the expression of ER stress-related proteins and the activation of pro-in-flammatory macrophages,while inhibiting autophagy in BMDMs.By utilizing proteomic detection and GO enrichment analysis,it was found that the autophagy deficiency in BMDMs caused changes in the ATF6 pathway,a key downstream pathway of ER stress.Inhibi-tion of ER stress by TUDCA significantly down-regulated the expression of iNOS and the secretion of inflammatory cytokines IL-18 and IL-1β in autophagy-deficient BMDMs.ATF6-specific inhibitor(Ceapin-A7)was used to exculpate LPS-stimulated BMDMs,and it was found that Ceapin-A7 significantly down-regulated the elevated expression of iNOS and inflammatory factors caused by Atg5 deletion in BMDMs.Conclusion:Autophagy inhibits the activation of pro-inflammatory macrophages by suppressing ATF6 pathway.

Objective To explore the value of MR modulated flip angle technique in refocused imaging with extended echo train(MATRIX)contrast enhanced(CE)T1-weighted fluid attenuated inversion recovery(T1 FLAIR)for detecting skull metastases.Methods Forty-four patients with malignant tumors who underwent head MR scanning for screening skull metastasis were prospectively enrolled,and skull metastasis were then confirmed by pathology or imaging examinations,including MRI,CT,radionuclide bone imaging(BS),PET/CT and follow-up.Head MATRIX CE-T1 FLAIR(group A),3D gradient recalled echo_fast spin echo with magnetization preparation(GRE_fsp)CE-T1 FLAIR(group B)and fast spin echo(FSE)CE-T1 FLAIR(group C)images of all 44 cases were acquired.The subjective scores(including images quality and diagnostic confidence)and objective evaluation results of images were compared among groups.Taken BS or PET/CT results as standards,the efficacy of 3 kinds of images for detecting skull metastases was calculated.Results The subjective scores of images quality and diagnostic confidence,as well as signal-to-noise ratio(SNR)in group A and C were all higher than those in group B(all P＜0.001),and signal intensity(SI)metastases in group A was higher than those in group B and C(both P＜0.05).No significant difference of subjective score and SNR was found between groups A and C,nor of SImetastases between groups B and C(all P＞0.05).Totally 102 skull metastases were diagnosed with PET/CT or BS,while 129,151 and 115 lesions were detected in group A,B and C,respectively,with accuracy rate of 79.07%(102/129),67.55%(102/151)and 88.70%(102/115),respectively.Conclusion MATRIX CE-T1 FLAIR sequence could be used to detect skull metastases.

Objective To conduct a multidimensional and multi-level evaluation of the comprehensive clinical value of empagliflozin in the treatment of type 2 diabetes mellitus.Methods Based on the National Essential Medicines List(2018 Edition),dapagliflozin was selected as the control.A comprehensive clinical evaluation index system was established through literature review,focus group interviews and in-depth expert interviews,encompassing six dimensions:safety,efficacy,economy,suitability,innovation,and accessibility.The Delphi method and hierarchical direct weighting method were used to screen indicators and determine their weights.Evidence for each indicator was collected and integrated both qualitatively and quantitatively through literature research,real-world studies,and pharmacoeconomic evaluations.Experts scored the indicators based on the collected evidence,and a total score for the comprehensive clinical evaluation of empagliflozin was calculated by combining these scores with indicator weights,followed by a comparative analysis with dapagliflozin.Results A comprehensive clinical evaluation of empagliflozin in the treatment of type 2 diabetes mellitus was successfully established,consisting of 6 primary indicators,14 secondary indicators,and 41 tertiary indicators.The overall evaluation score for empagliflozin was 90.35,and 89.47 for dapagliflozin.Conclusion The comprehensive clinical value of empagliflozin in the treatment of type 2 diabetes mellitus is slightly higher than that of dapagliflozin.This finding can serve as a reference for rational clinical drug use and related decision-making.

Objective:To observe the effect of combining transcutaneous stimulation of the auricular vagus nerve (taVNS) with modified constraint-induced movement therapy (mCIMT) on the upper limb function of hemiplegic stroke survivors.Methods:Seventy-one hemiplegic stroke survivors were randomly divided into a taVNS group of 24, an mCIMT group of 23 and a combined group of 24. In addition to conventional rehabilitation therapy, the taVNS group received taVNS therapy, the mCIMT group received mCIMT, while the combined group received both for 30 minutes a day, 5 days a week for 4 weeks. Before and after the treatment, everyone′s upper limb function was evaluated using the Fugl-Meyer upper extremity assessment (FMA-UE) and the Action Research arm test (ARAT). Ability in the activities of daily living (ADL) was quantified using the modified Barthel index (MBI). The latency and amplitude of motor evoked potentials (MEPs) were also measured.Results:After the treatment, significant improvement was observed in the average FMA-UE, ARAT and MBI scores. MEP latency and amplitude had also improved. The averages in the mCIMT group were then significantly better than among the taVNS group.Conclusions:taVNS combined with mCIMT can significantly improve the upper limb function and ADL functioning of stroke survivors with hemiplegia. It can also promote the recovery of central nervous system function.

Objective To conduct a multidimensional and multi-level evaluation of the comprehensive clinical value of empagliflozin in the treatment of type 2 diabetes mellitus.Methods Based on the National Essential Medicines List(2018 Edition),dapagliflozin was selected as the control.A comprehensive clinical evaluation index system was established through literature review,focus group interviews and in-depth expert interviews,encompassing six dimensions:safety,efficacy,economy,suitability,innovation,and accessibility.The Delphi method and hierarchical direct weighting method were used to screen indicators and determine their weights.Evidence for each indicator was collected and integrated both qualitatively and quantitatively through literature research,real-world studies,and pharmacoeconomic evaluations.Experts scored the indicators based on the collected evidence,and a total score for the comprehensive clinical evaluation of empagliflozin was calculated by combining these scores with indicator weights,followed by a comparative analysis with dapagliflozin.Results A comprehensive clinical evaluation of empagliflozin in the treatment of type 2 diabetes mellitus was successfully established,consisting of 6 primary indicators,14 secondary indicators,and 41 tertiary indicators.The overall evaluation score for empagliflozin was 90.35,and 89.47 for dapagliflozin.Conclusion The comprehensive clinical value of empagliflozin in the treatment of type 2 diabetes mellitus is slightly higher than that of dapagliflozin.This finding can serve as a reference for rational clinical drug use and related decision-making.

Objective:To explore the characteristics of attention bias and the role of embodied emotion prim-ing in college students with different traits of anxiety.Methods:From 2 310 college students,28 from low trait anxi-ety group and 30 from high trait anxiety group were selected based on the scores of the Trait Anxiety Scale.The at-tention bias index,attention orientation index and attention detachment difficulty index were calculated by point de-tection experiment.By asking two groups of subjects to change their body posture to induce embodied emotion,and then responding to the location of the detection point,the effects of embodied emotion priming on the attention bias of college students with different traits of anxiety were investigated.Results:The point detection experiment found that the attention detachment difficulty index of negative emotional faces in the high trait anxiety group was signifi-cantly greater than 0,and the attention orientation index of positive emotional faces in the low trait anxiety group was significantly greater than 0(Ps＜0.05).The attention bias index for positive emotional faces in low trait anxie-ty group was significantly higher than that in high trait anxiety group(P＜0.05).Under embodied negative prim-ing,the attention bias index of negative emotional faces in low trait anxiety group was significantly greater than 0(P＜0.05).The attention orientation indices of negative emotional faces were significantly higher than that of posi-tive emotional faces in both groups(P＜0.05).Conclusion:College students with high trait anxiety have difficulty in escaping attention to negative faces,while those with low trait anxiety have accelerated attention orientation to positive emotional faces.Embodied negative priming may have a greater impact onattention bias of towards negative emotional faces in students with low trait anxiety.

Objective:To investigate the optical coherence tomography (OCT) imaging features of bullous pemphigoid (BP) and pemphigus.Methods:A total of 23 patients with BP and 18 with pemphigus diagnosed according to clinical manifestations, histopathological and immunological features were collected from Wuhan No.1 Hospital from January to June 2024. OCT imaging was performed in 41 patients to observe the blisters at the lesion sites and their anatomic locations (intraepidermal or subepidermal), intravesicular inflammatory cells and fibrin deposits, dilated vessels in the upper dermis, as well as skin adjacent to the lesions.Results:Among the 23 patients with BP and 18 patients with pemphigus (including 12 with pemphigus vulgaris and 6 with pemphigus foliaceus), there were 20 males and 21 females, and their ages at onset ranged from 20 to 89 years. OCT imaging of blisters in patients with BP showed subepidermal oval to round hyporeflective liquid-filled areas containing highly refractive inflammatory cells and fibrin deposits, with dilated vessels in the upper dermis, while OCT imaging of blisters in patients with pemphigus showed intraepidermal blisters with a few inflammatory cells; the OCT imaging features of both BP and pemphigus were similar to their corresponding histopathological features. The detection rates of intravesicular inflammatory cells and fibrin deposition were significantly higher in the patients with BP (82.61% [19/23], 60.87% [14/23], respectively) than in those with pemphigus (44.44% [8/18], 11.11% [2/18]; χ2 = 6.54, 10.51, P = 0.011, 0.001, respectively). In the OCT images of normal skin adjacent to blisters, subclinical fissures were detected in 17.39% (8/46) of patients with BP and 25.00% (9/36) of patients with pemphigus. Conclusion:OCT imaging could accurately locate the blisters and potential subclinical lesions in normal skin adjacent to blisters in patients with BP and pemphigus, which is helpful for the early auxiliary diagnosis of these two diseases.

Objective:To explore the effect of combining intermittent θ pulse stimulation (iTBS) of the cerebellum with lower extremity exoskeleton robot support on the balance and walking function of stroke survivors.Methods:Seventy-five stroke survivors complicated with lower extremity dysfunction were divided into an iTBS group, an exoskeleton group and a combined group, each of 25, according to a random number table. In addition to conventional rehabilitation training, the iTBS group was given cerebellar iTBS combined with traditional walking training, the exoskeleton group received sham cerebellar iTBS combined with walking training assisted by a lower extremity exoskeleton robot. The combined group received both therapies. The schedule was once a day, 5 days a week for 3 weeks. Before and after the treatment, the 10-metre walking test (10MWT), the Berg Balance Scale (BBS) and the Fugl-Meyer lower extremity assessment (FMA-LE) were used to evaluate the subjects′ walking ability, balance and lower extremity motor ability. Gait and neuro-electrophysiological tests were also conducted in all three groups.Results:After the treatment, a significant improvement was observed in the 10MWT times, BBS scores, FMA-LE scores, stride frequency and stride speed of all three groups compared with before the treatment. On average, the results of the exoskeleton and combined groups were significantly better than those of the iTBS group, and those of the combined group were significantly better than among the exoskeleton group. Almost everyone′s MEP latency and amplitude had improved significantly compared with before the treatment, but the improvements in the exoskeleton group tended to be superior to those in the iTBS group ( P≤0.05). The latency in the combined group averaged (21.25±1.70)ms, and the amplitude averaged (184.17±6.54)μV, both significantly better than the exoskeleton group′s averages. Conclusions:Cerebellum iTBS combined with lower extremity exoskeleton walker training can significantly improve the motor functioning, balance and walking ability of stroke survivors.