Objective:To design a special device for limiting position of boat-shape headrest of breast brackets,and explore its application value in radiotherapy post-radical mastectomy.Methods:1 cm plex glass plate was cut as T-shape base plate,and the top of the T-shape base plate was drilled to obtain four holes for limiting position.A 2 mm acrylic plate was cut as horse hoof-shape and strip-shape pieces for limiting position,which were adhered respectively to the top and bottom of the T-shape base plate to form a boat-shape headrest with groove structure for limiting position.Self-made pillars with limiting position were used to connect the T-shape base plate with the backplane of breast bracket,so as to realize rigid connection between conventional boat-shape headrest and breast bracket.A total of 60 female patients who received radiotherapy after radical mastectomy for breast cancer at Changzhou Cancer Hospital during January and December 2023 were selected.They were randomly divided into an observation group and a control group(with 30 cases in each group)by using a random number table.The observation group adopted breast bracket combined with self-made boat-shape headrest for limiting position device+boat-shape headrest to conduct fixation,while the control group adopted rotundity headrest of breast bracket to conduct fixation.Both groups adopted hybrid intensity-modulated radiotherapy(IMRT)technique to formulate plan,and the exposure dose was 50Gy/25 fractions,and patients received radiotherapy as 5 times per week,and the treatment course was 5 weeks.Cone-beam computed tomography(CBCT)was used to conduct verification for position before the first 3 treatments.During the treatment duration between the 2nd and the 5th week,CBCT verification for position was conducted in each week.The positioning error and positioning time on left-right direction(x),head-foot direction(y)and abdomen-back direction(z)at each time between two groups were compared.Results:The positioning errors on x,y,z direction of three dimension at each time in observation group were lower than those in control group,and the differences were significant(Z=-7.666,-11,672,-6.311,P<0.05).The average positioning time at first time and the total average positioning time were respectively(222.4±12.9)s and(212.2±15.1)s in observation group,all of which were lower than(262.9±12.5)s and(254.0±15.7)s in control group,and the differences were significant(t=12.364,27.783,P<0.05).Conclusion:The combination of breast bracket and self-made device with boat-shape for limiting position can increase precision and efficiency of positioning,and improve comfort through individually chooses the type of boat-shape headrest,and set the position of headrest,which has favorable clinically application value.

Objective:To explore the trajectory of changes in electronic health literacy in young and middle-aged patients with coronary heart disease (CHD) combined with diabetes mellitus (DM) after percutaneous coronary intervention (PCI), and to analyze its relationship with unplanned readmission within 30 days.Methods:A convenience sample of 210 young and middle-aged CHD patients with DM who underwent PCI in the Department of Cardiology, Xinxiang Central Hospital, from February 2023 to June 2024 was selected. The e-Health Literacy Scale (eHEALS) was used to assess electronic health literacy at the 3rd day (T 1), 15th day (T 2), and 30th day (T 3) after PCI. Unplanned readmission within 30 days after discharge was recorded. Latent class growth model (LCGM) was used to identify categories and characteristics of electronic health literacy trajectories. Kaplan-Meier method was applied to plot the cumulative incidence of 30-day unplanned readmission, and the Log-Rank test was used to compare differences among different trajectory types. Results:A total of 207 patients completed the entire survey and follow-up, with a valid response rate of 98.57% (207/210). eHEALS scores gradually increased after PCI, with scores of (6.75±1.31), (11.55±3.31), and (15.56±5.75) at T 1, T 2, and T 3, respectively. Two potential categories were identified: persistent low-level type (85 cases, 41.06%) and gradually improving type (122 cases, 58.94%). Twenty-six patients experienced unplanned readmission within 30 days, with an incidence of 12.56%. The proportions of unplanned readmission within 30 days were 20.00% (17/85) in the persistent low-level group and 7.38% (9/122) in the gradually improving group, with a statistically significant difference (χ 2=7.268, P=0.007). Kaplan-Meier cumulative risk function analysis showed that the cumulative incidence of 30-day unplanned readmission in the gradually improving group was lower than that in the persistent low-level group, with a statistically significant difference (Log-Rank=7.683, P=0.006) . Conclusions:Young and middle-aged CHD patients with DM after PCI show trajectory characteristics in electronic health literacy. Although the electronic health literacy of some patients gradually improved after PCI, persistent low-level literacy was still common, and patients in the persistent low-level group had a higher risk of 30-day unplanned readmission, which deserves clinical attention.

Objective:To design a special device for limiting position of boat-shape headrest of breast brackets,and explore its application value in radiotherapy post-radical mastectomy.Methods:1 cm plex glass plate was cut as T-shape base plate,and the top of the T-shape base plate was drilled to obtain four holes for limiting position.A 2 mm acrylic plate was cut as horse hoof-shape and strip-shape pieces for limiting position,which were adhered respectively to the top and bottom of the T-shape base plate to form a boat-shape headrest with groove structure for limiting position.Self-made pillars with limiting position were used to connect the T-shape base plate with the backplane of breast bracket,so as to realize rigid connection between conventional boat-shape headrest and breast bracket.A total of 60 female patients who received radiotherapy after radical mastectomy for breast cancer at Changzhou Cancer Hospital during January and December 2023 were selected.They were randomly divided into an observation group and a control group(with 30 cases in each group)by using a random number table.The observation group adopted breast bracket combined with self-made boat-shape headrest for limiting position device+boat-shape headrest to conduct fixation,while the control group adopted rotundity headrest of breast bracket to conduct fixation.Both groups adopted hybrid intensity-modulated radiotherapy(IMRT)technique to formulate plan,and the exposure dose was 50Gy/25 fractions,and patients received radiotherapy as 5 times per week,and the treatment course was 5 weeks.Cone-beam computed tomography(CBCT)was used to conduct verification for position before the first 3 treatments.During the treatment duration between the 2nd and the 5th week,CBCT verification for position was conducted in each week.The positioning error and positioning time on left-right direction(x),head-foot direction(y)and abdomen-back direction(z)at each time between two groups were compared.Results:The positioning errors on x,y,z direction of three dimension at each time in observation group were lower than those in control group,and the differences were significant(Z=-7.666,-11,672,-6.311,P<0.05).The average positioning time at first time and the total average positioning time were respectively(222.4±12.9)s and(212.2±15.1)s in observation group,all of which were lower than(262.9±12.5)s and(254.0±15.7)s in control group,and the differences were significant(t=12.364,27.783,P<0.05).Conclusion:The combination of breast bracket and self-made device with boat-shape for limiting position can increase precision and efficiency of positioning,and improve comfort through individually chooses the type of boat-shape headrest,and set the position of headrest,which has favorable clinically application value.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective:To explore the trajectory of changes in electronic health literacy in young and middle-aged patients with coronary heart disease (CHD) combined with diabetes mellitus (DM) after percutaneous coronary intervention (PCI), and to analyze its relationship with unplanned readmission within 30 days.Methods:A convenience sample of 210 young and middle-aged CHD patients with DM who underwent PCI in the Department of Cardiology, Xinxiang Central Hospital, from February 2023 to June 2024 was selected. The e-Health Literacy Scale (eHEALS) was used to assess electronic health literacy at the 3rd day (T 1), 15th day (T 2), and 30th day (T 3) after PCI. Unplanned readmission within 30 days after discharge was recorded. Latent class growth model (LCGM) was used to identify categories and characteristics of electronic health literacy trajectories. Kaplan-Meier method was applied to plot the cumulative incidence of 30-day unplanned readmission, and the Log-Rank test was used to compare differences among different trajectory types. Results:A total of 207 patients completed the entire survey and follow-up, with a valid response rate of 98.57% (207/210). eHEALS scores gradually increased after PCI, with scores of (6.75±1.31), (11.55±3.31), and (15.56±5.75) at T 1, T 2, and T 3, respectively. Two potential categories were identified: persistent low-level type (85 cases, 41.06%) and gradually improving type (122 cases, 58.94%). Twenty-six patients experienced unplanned readmission within 30 days, with an incidence of 12.56%. The proportions of unplanned readmission within 30 days were 20.00% (17/85) in the persistent low-level group and 7.38% (9/122) in the gradually improving group, with a statistically significant difference (χ 2=7.268, P=0.007). Kaplan-Meier cumulative risk function analysis showed that the cumulative incidence of 30-day unplanned readmission in the gradually improving group was lower than that in the persistent low-level group, with a statistically significant difference (Log-Rank=7.683, P=0.006) . Conclusions:Young and middle-aged CHD patients with DM after PCI show trajectory characteristics in electronic health literacy. Although the electronic health literacy of some patients gradually improved after PCI, persistent low-level literacy was still common, and patients in the persistent low-level group had a higher risk of 30-day unplanned readmission, which deserves clinical attention.

Objective:To establish a method for determining the sialylation levels of N-glycan profiles based on ion-exchange chromatography in glycoprotein drugs.Methods:The separation was performed in a column picking with anion-exchange resin(4.6 mm × 250 mm,5 μm,or equivalent).Mobile phase A was 20％ acetonitrile solution,while mobile phase B was a 20％acetonitrile solution containing 0.1 mol·L-1 ammonium formate(pH 4.5).The flow rate was 0.60 mL·min-1.Detection was performed using a fluorescence detector with excita-tion and emission wavelengths of 330 and 420 nm,respectively.The injection volume was 5 μL.Results:Within the target loading sample range of 40％ to 160％,the peak area showed a good linear relationship with protein concentration(r＞0.99).The average recovery rates at three concentration levels were 106.25％,100.00％,and 106.67％,respectively.The limit of quantification was 0.03％.Conclusion:This method is suitable for detecting the sialylation levels of N-glycan profiles in various glycoprotein drugs.

Objective:To establish a method for determining the sialylation levels of N-glycan profiles based on ion-exchange chromatography in glycoprotein drugs.Methods:The separation was performed in a column picking with anion-exchange resin(4.6 mm × 250 mm,5 μm,or equivalent).Mobile phase A was 20％ acetonitrile solution,while mobile phase B was a 20％acetonitrile solution containing 0.1 mol·L-1 ammonium formate(pH 4.5).The flow rate was 0.60 mL·min-1.Detection was performed using a fluorescence detector with excita-tion and emission wavelengths of 330 and 420 nm,respectively.The injection volume was 5 μL.Results:Within the target loading sample range of 40％ to 160％,the peak area showed a good linear relationship with protein concentration(r＞0.99).The average recovery rates at three concentration levels were 106.25％,100.00％,and 106.67％,respectively.The limit of quantification was 0.03％.Conclusion:This method is suitable for detecting the sialylation levels of N-glycan profiles in various glycoprotein drugs.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative fatigue syndrome in patients with Parkinson′s diseases undergoing bilateral deep brain electrical stimulation.Methods:Sixty patients with Parkinson′s disease, aged 60-80 yr, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, with body mass index of 18.5-29.9 kg/m 2, undergoing elective bilateral deep brain electrical stimulation, were divided into transcutaneous electrical acupoint stimulation group (TEAS group) and sham stimulation group (Sham group), with 30 patients in each group, using the random number table method. The TEAS of bilateral Zusanli and Sanyin points was performed on admission to the operating room with alternative stimulation at a frequency of 2/10 Hz and an intensity of 6-15 mA. The stimulation was stopped when the neurosurgeon performed the microelectrode recording, and TEAS was continued until the end of operation after the microelectrode recording was finished. In Sham group, electrode pads were only placed at the acupoint with no stimulation. The Christensen score was assessed at 1 day preoperatively (T 0) and 1, 3 and 7 days postoperatively (T 1-3) to evaluate the occurrence of postoperative fatigue syndrome. The 15-item Quality of Recovery scale score, emergence agitation and rescue analgesia within 48 h after surgery were recorded. Results:Compared with Sham group, Christensen scores were significantly decreased at T 1-3, 15-item Quality of Recovery scale scores were increased, and the incidence of postoperative fatigue syndrome and emergence agitation and rate of rescue analgesia were decreased in TEAS group than in Sham group ( P<0.05). Conclusions:TEAS can reduce the development of postoperative fatigue syndrome in the patients with Parkinson′s diseases undergoing bilateral deep brain electrical stimulation.

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.