Objective:To investigate the effect of elimination,combination,rearrangement and simplification(ECRS)management combined with risk assessment on reducing the incidence of multidrug-resistant bacteria infections of patients who received mechanical ventilation in intensive care unit(ICU).Methods:The management mode of prevention and control for multidrug-resistant bacteria infections of patients in ICU was optimized on the basis of ECRS management combined with risk assessment.A total of 600 patients who received mechanical ventilation in ICU of Jiuquan Hospital of Shanghai General Hospital(Jiuquan People's Hospital)from January 2022 to December 2023 were selected.According to different management methods,these patients were divided into a control group and an observation group,with 300 cases in each group.The control group was managed by using the risk assessment management method,while the observation group was managed by using the ECRS management on the basis of risk assessment management method.The indicators of respiratory function,patients'satisfaction score,stay time in ICU,time of mechanical ventilation and incidence of multidrug-resistant bacteria were compared between the two groups.Results:The mean value of the ratio of forced expiratory volume in one second(FEV1)to forced vital capacity(FVC)(FEV1/FVC),and the FEV1 level in observation group by using ECRS management combined with risk assessment method were respectively(78.69±4.65)%and(1.58±0.24)L,both of which were higher than those of control group,and the differences of them between two groups were statistically significant(t=16.483,11.742,P<0.05).The average scores of work efficiency,emergency response capability,professional ethics,isolation and resettlement,and overall patients'satisfaction in the observation group were respectively(23.12±1.20),(23.34±1.08),(23.65±1.10),(23.80±1.05)and(92.24±4.37),all of which were higher than those in the control group,and the differences of them between two groups were statistically significant(t=22.176,27.903,22.373,31.364,13.963,P<0.05).The average ICU stay time and the average time of mechanical ventilation were respectively(14.15±1.60)and(9.15±2.13)days in the observation group,both of which were lower than those in the control group,and the differences of them between two groups were statistically significant(t=16.872,15.410,P<0.05).The incidence of multidrug-resistant bacteria was 0.33%in 300 patients of the observation group,which was lower than that of the control group,with a statistically significant difference(x2=4.561,P<0.05).Conclusion:The application of ECRS management combined with risk assessment in the management of ICU for patients who receive mechanical ventilation can protect respiratory function of patients,and decrease the risk of occurring the infection of multidrug-resistant bacteria,and reduce ICU stay time and the time of mechanical ventilation of patients,and improve patients'satisfaction.

A case of secondary pulmonary infection in a patient with acute exacerbation of chronic obstructive pulmonary disease was admitted.The patient was initially giren piperacillin-tazobactam combined with levofloxacin for anti-infective treatment before the pathogen was identified.lafer,the HRZE anti-tuberculosis regimen was added,but the patient continued to experience high fever,yellow purulent sputum,and dyspnea.Subsequent,bronchoalveolar lavage fluid pathogen metagenomic sequencing revealed Nocardia terpenica.Clinical pharmacists,based on the patient's condition changes and in accordance with relevant guidelines and literature,suggested using various antimicrobial agents,including compound sulfamethoxazole tablets,linezolid glucose injection,amikacin injection combined with imipenem-cilastatin,to manage the patient's intolerance to sulfonamides and the bone marrow suppression induced by linezolid and to provide medication suggestions.The clinician adopted all the suggestions.Through the collaborative efforts of physicians and clinical pharmacists,the patient's condition improved,allowing for discharge with medication.Post-discharge,medication education and follow-up were conducted,leading to successful recovery.In this case,the clinical pharmacist reviewed domestic and international literature on Nocardia terpenica and the characteristics of antimicrobial drugs,and utilized their expertise to assist clinicians in treating rare infection cases,realizing their professional value.

Objective To understand phenotype conversion in patients with first-episode depression over a 7-year period,to explore the longitudinal disease characteristics and functional outcomes of transitions and non-transitions,and to further analyse the relevant factors affecting transitions.Methods A total of 346 patients with Hamilton depression scale-17(HAMD-17)score≥18,aged 18-60 years and a single episode of major depressive disorder were included in the study.They were follow-up for 7 years to assess their natural history including demographic data,disease characteristics,whether transitions to manic occurred,treatment status.At the end of the 7-year follow-up,treatment emergent symptom scale(TESS),medication adherence rating scale(MARS),and global assessment function(GAF)were used to evaluate adverse reactions,compliance to medication,and patient's overall functional level.Patients were divided into two groups based on the occurrence of mania or hypomania episodes during the 7-year period:the conversion group(those who developed episodes)and the non-conversion group(those who did not).Results A total of 138 patients were followed up for 7 years,including 54 patients(39.1%)in the conversion group and 84 patients(60.9%)in the non-conversion group.When the first episode was enrolled at baseline,the age of first episode was earlier in the conversion group than in the non-conversion group[(27.63±9.63)years vs.(41.20±11.92)years],and there were differences in marital status(unmarried 40.7%vs.7.1%,first marriage 53.7%vs.85.7%,remarriage 3.7%vs.2.4%,separated/divorced 0.0%vs.2.4%,widowed 1.9%vs.2.4%).The proportion of patients with precipitating factors was lower in the conversion group(29.6%vs.48.8%)and shorter duration of untreated psychosis(DUP)[60(15,90)d vs.90(30,180)d].The treatment method in the conversion group had lower only used antidepressant drugs(61.1%vs.81.0%)and more antidepressant combined with mood stabilizers(31.5%vs.16.7%)(all P<0.05).In the 7 years,total number of episodes in the conversion group was more than in the non-conversion group(4.33±1.21 vs.2.70±1.25,P<0.05).By the end of 7 years,the GAF score was lower in conversion group than in the non-conversion group(66.57±8.22 vs.69.21±7.20,P<0.05).Dichotomous unconditional logistic regression analyses revealed that age at first episode(OR=1.109,95%CI:1.058-1.161,P<0.001),DUP(d)(OR=1.005,95%CI:1.001-1.009,P=0.017),was an independent influencing factor on conversion over a 7-year period in patients with first-episode depressive disorders.Conclusion The rate of conversion over 7 years in patients with first-episode depressive disorder is 39.1%in the present cohort and converted patients had relatively earlier age of onset,more pre-onset without inducement,shorter DUP(d),more recurrence,higher the rate of combined treatment and worse overall functional outcome.

A case of secondary pulmonary infection in a patient with acute exacerbation of chronic obstructive pulmonary disease was admitted.The patient was initially giren piperacillin-tazobactam combined with levofloxacin for anti-infective treatment before the pathogen was identified.lafer,the HRZE anti-tuberculosis regimen was added,but the patient continued to experience high fever,yellow purulent sputum,and dyspnea.Subsequent,bronchoalveolar lavage fluid pathogen metagenomic sequencing revealed Nocardia terpenica.Clinical pharmacists,based on the patient's condition changes and in accordance with relevant guidelines and literature,suggested using various antimicrobial agents,including compound sulfamethoxazole tablets,linezolid glucose injection,amikacin injection combined with imipenem-cilastatin,to manage the patient's intolerance to sulfonamides and the bone marrow suppression induced by linezolid and to provide medication suggestions.The clinician adopted all the suggestions.Through the collaborative efforts of physicians and clinical pharmacists,the patient's condition improved,allowing for discharge with medication.Post-discharge,medication education and follow-up were conducted,leading to successful recovery.In this case,the clinical pharmacist reviewed domestic and international literature on Nocardia terpenica and the characteristics of antimicrobial drugs,and utilized their expertise to assist clinicians in treating rare infection cases,realizing their professional value.

Objective To understand phenotype conversion in patients with first-episode depression over a 7-year period,to explore the longitudinal disease characteristics and functional outcomes of transitions and non-transitions,and to further analyse the relevant factors affecting transitions.Methods A total of 346 patients with Hamilton depression scale-17(HAMD-17)score≥18,aged 18-60 years and a single episode of major depressive disorder were included in the study.They were follow-up for 7 years to assess their natural history including demographic data,disease characteristics,whether transitions to manic occurred,treatment status.At the end of the 7-year follow-up,treatment emergent symptom scale(TESS),medication adherence rating scale(MARS),and global assessment function(GAF)were used to evaluate adverse reactions,compliance to medication,and patient's overall functional level.Patients were divided into two groups based on the occurrence of mania or hypomania episodes during the 7-year period:the conversion group(those who developed episodes)and the non-conversion group(those who did not).Results A total of 138 patients were followed up for 7 years,including 54 patients(39.1%)in the conversion group and 84 patients(60.9%)in the non-conversion group.When the first episode was enrolled at baseline,the age of first episode was earlier in the conversion group than in the non-conversion group[(27.63±9.63)years vs.(41.20±11.92)years],and there were differences in marital status(unmarried 40.7%vs.7.1%,first marriage 53.7%vs.85.7%,remarriage 3.7%vs.2.4%,separated/divorced 0.0%vs.2.4%,widowed 1.9%vs.2.4%).The proportion of patients with precipitating factors was lower in the conversion group(29.6%vs.48.8%)and shorter duration of untreated psychosis(DUP)[60(15,90)d vs.90(30,180)d].The treatment method in the conversion group had lower only used antidepressant drugs(61.1%vs.81.0%)and more antidepressant combined with mood stabilizers(31.5%vs.16.7%)(all P<0.05).In the 7 years,total number of episodes in the conversion group was more than in the non-conversion group(4.33±1.21 vs.2.70±1.25,P<0.05).By the end of 7 years,the GAF score was lower in conversion group than in the non-conversion group(66.57±8.22 vs.69.21±7.20,P<0.05).Dichotomous unconditional logistic regression analyses revealed that age at first episode(OR=1.109,95%CI:1.058-1.161,P<0.001),DUP(d)(OR=1.005,95%CI:1.001-1.009,P=0.017),was an independent influencing factor on conversion over a 7-year period in patients with first-episode depressive disorders.Conclusion The rate of conversion over 7 years in patients with first-episode depressive disorder is 39.1%in the present cohort and converted patients had relatively earlier age of onset,more pre-onset without inducement,shorter DUP(d),more recurrence,higher the rate of combined treatment and worse overall functional outcome.

Objective:To evaluate the long-term outcomes and predictors of coronary atherosclerotic lesions deemed functionally non-ischemic (quantitative flow ratio(QFR)>0.80) and deferred from intervention.Methods:This study is a post-hoc analysis of the FAVOR Ⅲ China trial, which enrolled 3 825 patients with stable or unstable angina pectoris or with myocardial infarction occurring at least 72 hours prior to screening, between December 5, 2018 and January 9, 2020 from 26 research centers in China. Coronary vessels with QFR>0.80 and without interventional treatment were analyzed in this study. The primary endpoint was 3-year target vessel revascularization. Vessels with revascularization (revascularized group) during follow-up were matched 1∶1 using propensity score matching to comparable vessels without revascularization (non-revascularized group). Multivariate Cox regression analysis was used to identify the risk factors for target vessel revascularization (TVR).Results:A total of 6 212 functionally negative vessels with deferred intervention were included in the final analysis, among which 153 vessels (2.5%) underwent TVR during a 3-year follow-up. Prior to propensity score matching, 6 059 vessels comprised the non-revascularized group. At the vessel level, compared to the non-revascularized group, the revascularized group exhibited a significantly higher proportion of males (79.1% (121/153) vs. 70.2% (4 253/6 059), P=0.018), higher body mass index ((25.6±4.0) kg/m2 vs. (24.3±5.2) kg/m2, P=0.003), and a higher prevalence of hypertension (73.9% (113/153) vs. 65.1% (3 944/6 059), P=0.025). And 152 pairs of vessels were successfully matched. Multivariate Cox regression analysis identified in-stent restenosis lesions ( HR=2.59, 95% CI 1.28-5.23, P=0.008) as an independent risk factor for target vessel revascularization. Conclusions:Coronary lesions classified as functionally non-ischemic at baseline are not entirely stable and may progress to lesions that requiring revascularization over time. In-stent restenosis emerges as a critical independent predictor of revascularization.

Objective:Investigate the impact of calcification on the long-term outcomes of patients with coronary chronic total occlusion (CTO) after percutaneous coronary intervention (PCI).Methods:A retrospective cohort study was conducted. Patients who underwent PCI and had at least one CTO lesion at Fuwai Hospital between January 2010 and December 2013 were consecutively enrolled. Calcification was evaluated by coronary angiography, and patients were divided into two groups: moderate/severe calcification group and non/mild calcification group. Clinical follow-up was completed up to 5 years. Incidence of PCI-related complications and immediate procedural outcomes were compared between two groups, and the primary endpoint was the target lesion failure (TLF) at 5 years after PCI. Clinical follow-up endpoint events were analyzed using Kaplan-Meier survival analysis with log-rank test, and Cox multivariate regression model was used to evaluate the relationship between calcification and TLF.Results:The study included 2 659 CTO patients with an age of (57.2±10.5) years, of whom 442 (16.6%) were female, and among whom 13.5% (360/2 659) had moderate/severe calcification. Compared with the non/mild calcification group, the moderate/severe calcification group had a higher incidence of PCI-related complications (43.2% (156/361) vs. 32.5% (772/2 374), P<0.001) and procedural failure (34.3% (124/361) vs. 24.3% (577/2 374), P<0.001). Additionally, the moderate/severe calcification group showed a higher risk of the primary endpoint event (TLF) during the 5-year follow-up (19.8% vs. 15.3%, log-rank P=0.028). Higher incidence of cardiac death was observed in moderate/severe calcification group (5.7% vs. 2.7%, log-rank P=0.003). Cox multivariate regression analysis revealed that moderate/severe calcified plaques remained an independent risk factor for 5-year TLF after CTO-PCI ( HR=1.34, 95% CI: 1.01-1.79, P=0.043). Conclusion:Compared with CTO patients with non/mild calcification, those with moderate/severe calcification have higher procedural failure and complication rates, as well as poorer long-term prognosis, mainly due to an increase in cardiac death.