Objective:To investigate the pathogen distribution, temporal trends in the rates of antimicrobial resistance, and susceptibility of bloodstream isolates and comparatively explore the epidemiological characteristics of bloodstream infections in hematology departments across 56 healthcare facilities in Guangdong Province from 2020 to 2024.Methods:A multicenter analysis was conducted to evaluate the constituent ratio of different pathogens isolated from clinical isolate data from bloodstream specimens in hematology, respiratory, and intensive care unit (ICU) departments across 56 healthcare facilities in Guangdong Province (2020-2024), and antimicrobial resistance trends in pathogens with high-detection rate over 5 years were assessed. Carbapenem-resistant Gram-negative organisms (CRO) were randomly sampled for carbapenemase gene detection and in vitro antimicrobial susceptibility tests with novel antimicrobial agents.Results:From 2020 to 2024, a total of 8 968, 6 440, and 25 511 bloodstream isolates were identified in the hematology, respiratory, and ICU departments, respectively, across 56 participating facilities in Guangdong Province, with significant differences in the pathogen constituent ratio among departments ( P<0.001). Notably, the hematology department demonstrated a predominance of Escherichia coli (24.1%), Klebsiella pneumoniae (17.5%), Pseudomonas aeruginosa (11.7%), coagulase-negative Staphylococci (15.2%), and Staphylococcus aureus (5.1%). In the resistance analysis, the rates of meropenem resistance of Escherichia coli and Klebsiella pneumonia increased from 6.7% and 5.8% (2020) to 14.0% and 15.8% (2024), respectively. Conversely, Pseudomonas aeruginosa exhibited a declining trend in the rate of meropenem resistance (6.2% to 1.9%) and imipenem (10.2% to 6.1%) during the same period. Acinetobacter baumannii demonstrated a biphasic resistance pattern to common antimicrobial agents, characterized by an initial decline, followed by a rebound. In this study, the susceptibility rates to conventional antimicrobial agents were significantly higher in Staphylococcus aureus versus coagulase-negative Staphylococci, with no glycopeptide- or linezolid-resistant strains detected. Notably, the prevalence of vancomycin-resistant Enterococcus faecium increased from 0 in 2020 to 23.1% in 2024. CRO carbapenemase phenotypes through active surveillance revealed that 80% Escherichia coli isolates were carrying blaNDM, 90% Klebsiella pneumoniae isolates were carrying blaKPC, 10% Pseudomonas aeruginosa isolates were carrying blaVIM, and 100% Acinetobacter baumannii were carrying blaOXA-23. The results of the antimicrobial susceptibility test in CRO revealed that carbapenem-resistant Escherichia coli (CRECO) demonstrated a 0 resistance rate to tigecycline, polymyxin B, and aztreonam/avibactam, whereas carbapenem-resistant Klebsiella pneumoniae exhibited a 0 resistance rate to aztreonam/avibactam, ceftazidime/avibactam, and imipenem/relebactam. Carbapenem-resistant Pseudomonas aeruginosa exhibited a 95.0% susceptibility rate to amikacin and polymyxin B, with a 45.0% resistance rate to ceftazidime/avibactam. In contrast, carbapenem-resistant Acinetobacter baumannii demonstrated complete susceptibility (100.0%) to sulbactam/durlobactam (MIC90=2 μg/ml), whereas eravacycline showed MIC50 and MIC90 values of 1 and 2 μg/ml, respectively. Conclusion:The pathogen constituent ratio of bloodstream isolates differed significantly among hematology, respiratory, and ICU departments. Notably, although CRO exhibited an escalating prevalence, it sustained high susceptibility to novel antimicrobial agents.

Aortic dissection is a life-threatening cardiovascular disease with devastating complications and high mortality. It requires rapid and accurate diagnosis and a focus on prognosis. Many laboratory tests are routinely performed in patients with aortic dissection including D-dimer, brain natriuretic peptide, cardiac troponin I, C-reactive protein, and procalcitonin. D-dimer shows vital performance in the diagnosis of aortic dissection, and brain natriuretic peptide, cardiac troponin I, C-reactive protein, and procalcitonin exhibits important value in risk stratification and prognostic effect in aortic dissection patients. Our review summarized the clinical utility of these laboratory tests in patients with aortic dissection, aiming to provide advanced and comprehensive evidence for clinicians to better understand these laboratory tests and help their clinical practice.

Objective:To investigate the pathogen distribution, temporal trends in the rates of antimicrobial resistance, and susceptibility of bloodstream isolates and comparatively explore the epidemiological characteristics of bloodstream infections in hematology departments across 56 healthcare facilities in Guangdong Province from 2020 to 2024.Methods:A multicenter analysis was conducted to evaluate the constituent ratio of different pathogens isolated from clinical isolate data from bloodstream specimens in hematology, respiratory, and intensive care unit (ICU) departments across 56 healthcare facilities in Guangdong Province (2020-2024), and antimicrobial resistance trends in pathogens with high-detection rate over 5 years were assessed. Carbapenem-resistant Gram-negative organisms (CRO) were randomly sampled for carbapenemase gene detection and in vitro antimicrobial susceptibility tests with novel antimicrobial agents.Results:From 2020 to 2024, a total of 8 968, 6 440, and 25 511 bloodstream isolates were identified in the hematology, respiratory, and ICU departments, respectively, across 56 participating facilities in Guangdong Province, with significant differences in the pathogen constituent ratio among departments ( P<0.001). Notably, the hematology department demonstrated a predominance of Escherichia coli (24.1%), Klebsiella pneumoniae (17.5%), Pseudomonas aeruginosa (11.7%), coagulase-negative Staphylococci (15.2%), and Staphylococcus aureus (5.1%). In the resistance analysis, the rates of meropenem resistance of Escherichia coli and Klebsiella pneumonia increased from 6.7% and 5.8% (2020) to 14.0% and 15.8% (2024), respectively. Conversely, Pseudomonas aeruginosa exhibited a declining trend in the rate of meropenem resistance (6.2% to 1.9%) and imipenem (10.2% to 6.1%) during the same period. Acinetobacter baumannii demonstrated a biphasic resistance pattern to common antimicrobial agents, characterized by an initial decline, followed by a rebound. In this study, the susceptibility rates to conventional antimicrobial agents were significantly higher in Staphylococcus aureus versus coagulase-negative Staphylococci, with no glycopeptide- or linezolid-resistant strains detected. Notably, the prevalence of vancomycin-resistant Enterococcus faecium increased from 0 in 2020 to 23.1% in 2024. CRO carbapenemase phenotypes through active surveillance revealed that 80% Escherichia coli isolates were carrying blaNDM, 90% Klebsiella pneumoniae isolates were carrying blaKPC, 10% Pseudomonas aeruginosa isolates were carrying blaVIM, and 100% Acinetobacter baumannii were carrying blaOXA-23. The results of the antimicrobial susceptibility test in CRO revealed that carbapenem-resistant Escherichia coli (CRECO) demonstrated a 0 resistance rate to tigecycline, polymyxin B, and aztreonam/avibactam, whereas carbapenem-resistant Klebsiella pneumoniae exhibited a 0 resistance rate to aztreonam/avibactam, ceftazidime/avibactam, and imipenem/relebactam. Carbapenem-resistant Pseudomonas aeruginosa exhibited a 95.0% susceptibility rate to amikacin and polymyxin B, with a 45.0% resistance rate to ceftazidime/avibactam. In contrast, carbapenem-resistant Acinetobacter baumannii demonstrated complete susceptibility (100.0%) to sulbactam/durlobactam (MIC90=2 μg/ml), whereas eravacycline showed MIC50 and MIC90 values of 1 and 2 μg/ml, respectively. Conclusion:The pathogen constituent ratio of bloodstream isolates differed significantly among hematology, respiratory, and ICU departments. Notably, although CRO exhibited an escalating prevalence, it sustained high susceptibility to novel antimicrobial agents.

Objective:To evaluate the effect of urban-rural integrated medical insurance on rural households'catastrophic health expenditure(CHE),thereby proposing targeted optimization strategies for the integration.Methods:Based on the five tracking data of the China Household Tracking Survey(CFPS)from 2010 to 2018,Process Specification Model-Dynamic Integrity Dimension(PSM-DID)was used to empirically test the impact of urban-rural integrated medical insurance on rural households'catastrophic health expenditures.Results:The urban-rural integrated medical insurance system significantly reduces the incidence of CHE in ru-ral households.Mechanism testing indicates that health levels,human capital expenditures,and household asset accumulation are important channels of action.Conclusion:It is suggested to continuously promote the urban-rural integrated medical insurance sys-tem,formulate comprehensive policies for medical insurance according to local conditions,and incorporate catastrophic health indi-cators into the detection and warning indicator system for rural residents returning to poverty.

The treatment of acute Stanford type A aortic dissection has always been extremely challenging. Organ malperfusion syndrome is a common severe complication of acute aortic dissection, which can cause organ ischemia and internal environment disorder. Malperfusion increases early mortality, and impacts the long-term prognosis. In recent years, many scholars have done some studies on aortic dissection complicated with malperfusion. They explored the pathogenesis, proposed new classification, and innovated new treatment strategies. However, at present, the treatment strategies of acute Stanford type A aortic dissection complicated with organ malperfusion are different at different centers and consensus on its treatment is still lacking. Therefore, this review summarized the pathogenesis, classification, treatment strategy, and prognosis of acute Stanford type A aortic dissection complicated with malperfusion.

Objective:To analyze the factors related to the occurrence of electrocoagulation syndrome after esophageal tumor endoscopic submucosal dissection (ESD), thus to construct and validate a nomogram prediction model.Methods:A total of 240 patients who underwent esophageal tumor ESD in the First Affiliated Hospital of Xi'an Medical University, Huazhou District of Weinan City People's Hospital of Shaanxi Province, and Chenggu County Hospital of Shaanxi Province from October 2018 to May 2024 were selected as the study objects. The patients were divided into a modeling group and a validation group using the "createDataPartition" of caret package in R software at a ratio of 7∶3. Univariate and multivariate logistic regression were used to analyze the factors related to the occurrence of esophageal tumor post-endoscopic submusocal dissection electrocoagulation syndrome (PEECS) in the modeling group, and the nomogram prediction model was constructed. C-index and calibration curve were used to verify the prediction model.Results:All data in the modeling group ( n=168) and the validation group ( n=72) were comparable. Univariate analysis showed that gender ( OR=2.15, 95% CI: 1.38-3.76, P=0.004), age ( OR=2.53, 95% CI: 1.39-4.61, P=0.001), surgical time ( OR=5.88, 95% CI: 2.15-8.41, P<0.001) and lesion length ( OR=5.16, 95% CI: 1.85-7.33, P<0.001) were related factors influencing the occurrence of esophageal tumor PEECS. Multivariate analysis showed that gender ( OR=2.94, 95% CI: 1.46-5.33, P=0.011), age ( OR=2.12, 95% CI: 1.20-3.88, P=0.042), surgical time ( OR=4.62, 95% CI: 2.11-7.26, P<0.001) and lesion length ( OR=3.93, 95% CI: 1.78-5.94, P=0.003) were independent factors for the occurrence of esophageal tumor PEECS. Based on the above indexes, a nomogram prediction model for the occurrence of esophageal tumor PEECS was constructed, and its C-index value was 0.787 (95% CI: 0.692-0.863). The calibration curve showed that with the modeling group as the internal verification and the validation group as the external verification, the predicted probability was in good agreement with the actual probability. Conclusion:Gender, age, surgical time and lesion length are independent factors influencing the occurrence of esophageal tumor PEECS. The nomogram prediction model based on the above indexes has high predictive efficacy.

Objective:To explore the efficacy and safety of treating advanced esophageal cancer by implanting the common stent and the radioactive 125I particle stent with endoscope. Methods:The clinical data of patients with advanced esophageal cancer admitted to Jingbian County People's Hospital of Shaanxi Province, the First Affiliated Hospital of Xi'an Medical University, Xijing Hospital of Digestive Diseases of Air Force Medical University and the First Hospital of Yulin of Shaanxi Province from December 2014 to December 2020 were retrospectively analyzed. Patients were divided into common stent group ( n=66) and radioactive particle stent group ( n=34) according to different stent types. The postoperative complications, Karnofsky performance status (KPS) score, dysphagia score, restenosis rate and quality of life were compared between the two groups. Results:The incidences of postoperative retrosternal pain in the common stent group and the radioactive particle stent group were 65.2% (43/66) and 47.1% (16/34) respectively. The incidences of pharyngeal pain and hoarseness were 12.1% (8/66) and 5.9% (2/34) . The incidences of abdominal pain were 9.1% (6/66) and 2.9% (1/34) . The incidences of errhysis were 3.0% (2/66) and 2.9% (1/34) . The incidences of vomiting and nausea were 7.6% (5/66) and 5.9% (2/34) respectively. There were no statistically significant differences between the two groups ( χ2=3.04, P=0.081; χ2=0.40, P=0.527; χ2=0.53, P=0.467; χ2<0.01, P>0.999; χ2<0.01, P>0.999) . In the two groups, KPS scores in the first, second, third and sixth month after operation were higher than those before operation (all P<0.05) . KPS scores of the radioactive particle stent group in the second, third and sixth month were significantly higher than those of the common stent group [ (89.73±7.84) points vs. (82.37±7.42) points, t=4.62, P<0.001; (93.63±8.13) points vs. (88.33±7.28) points, t=3.74, P<0.001; (92.78±6.26) points vs. (87.28±8.73) points, t=3.77, P<0.001]. The dysphagia scores of patients in the two groups in the first, second, third and sixth month were lower than those before operation (all P<0.05) . The dysphagia scores of the radioactive particle stent group in the third and sixth month after operation were significantly lower than those of the common stent group [ (0.68±0.12) points vs. (2.33±0.32) points, t=26.20, P<0.001; (0.82±0.22) points vs. (2.67±0.24) points, t=36.92, P<0.001]. In the third month after operation, the restenosis rate of the radioactive particle stent group was significantly lower than that of the common stent group [5.88% (2/34) vs. 42.4% (28/66) , χ2 =14.27, P<0.001]. The scores of QLQ-C30 and OES-18 scales in the first, second, third and sixth month after operation were lower than those before operation (all P<0.05) . The scores of QLQ-30 scale in the radioactive particle stent group in the second, third and sixth month were significantly lower than those in the common stent group [ (19.12±3.02) points vs. (21.22±2.87) points, t=3.39, P=0.001; (15.04±1.68) points vs. (20.43±2.23) points, t=12.39, P<0.001; (14.38±2.18) points vs. (19.77±3.67) points, t=9.20, P<0.001]. The scores of OES-18 scale in the radioactive particle stent group were also significantly lower than those in the common stent group [ (17.13±2.07) points vs. (20.64±2.11) points, t=7.95, P<0.001; (15.22±1.88) points vs. (19.24±1.76) points, t=10.62, P<0.001; (14.74±2.36) points vs. (18.53±3.27) points, t=6.01, P<0.001]. Conclusion:The radioactive particle stent can improve the quality of life of patients with advanced esophageal cancer with esophageal stenosis, so as to improve dysphagia and reduce the restenosis rate after operation. However, whether it is obviously superior to common stent in prolonging survival time and reducing complications needs to be further confirmed by a multicenter, prospective, large-sample randomized controlled study.

Objective:To analyze the clinical characteristics, examination results, treatment and prognosis of neonates with influenza virus infection in the neonatal intensive care unit (NICU).Methods:Clinical data of neonates with influenza virus infection who were hospitalized in the NICU of the General Hospital of Southern Theater Command of Chinese People′s Liberation Army from January 2018 to December 2020 were retrospectively analyzed.Results:A total of 11 hospitalized neonates with influenza virus infection in the NICU were recruited, including 2 cases of influenza A and 9 cases of influenza B. Ten cases (90.9%) had respiratory symptoms, and among them, there were 8 cases with increased oxygen demand, 7 cases with complicated pneumonia, 4 cases with dyspnea, and 2 cases with apnea.Seven cases showed abnormal body temperature, including 6 cases of fever, and 1 case of hypothermia.Five cases had circulatory system symptoms.Digestive system symptoms and urinary system symptoms were detected in 5 cases and 3 cases, respectively.Eight cases complicated with systemic symptoms, including 3 cases of poor mental response, 3 cases of worsening jaundice, 3 cases of weight loss, 2 cases of hyperglycemia, 1 case of edema and sclerosis.Ten cases were treated with gamma globulin immunotherapy, 2 cases were treated with plasma immune support, and 1 case was treated with Peramivir antiviral.Eight cases were treated with increased oxygen therapy, among which non-invasive ventilator parameters or modes increased in 4 cases, and nasal cannula oxygen concentration increased in 2 cases.The change of noninvasive-assisted ventilation to invasive-assisted ventilation occurred in 1 case, and 1 case developed the change of nasal cannula to noninvasive-assisted ventilation.Four neonates received anti-shock and (or) myocardial contractility therapy.Conclusions:Neonates with influenza virus infection in the NICU are mainly manifested as respiratory symptoms and fever, and the incidence of complicated pneumonia is high.Multiple systems may be involved at the same time, often leading to severe disease status.Comprehensive supportive treatment is necessary.Neonatologists should pay attention to these symptoms, and early detection of influenza virus and timely isolation are the key methods to prevent influenza outbreaks in NICU.

Being a non-invasive diagnostic technique for molecular biological markers, exhaled breath detection has the most latent capacity and future in the diagnosis and treatment of tumors. The National Key Research and Development Plan named "Strategic Advanced Electronic Materials" in 2020 has laid out the application of exhaled breath detection technology in the medical field, and the scientific research project led by Sichuan Cancer Hospital has been successfully launched. For the moment, as a novel strategy for early detection of lung cancer, exhaled breath detection is being perfected further and popularized or put in clinical practice step by step to reduce the mortality of lung cancer patients.

Objective    To investigate the characteristic volatile organic compounds (VOCs) in exhaled breath and their diagnostic value in patients with early stage lung cancer. Methods    Solid-phase micro-extraction combined with gas chromatography mass spectrometry was used to analyze exhaled breath VOCs of 117 patients with early stage lung cancer (54 males and 63 females, with an average age of 61.9±6.8 years) and 130 healthy subjects (79 males and 51 females, with an average age of 63.3±6.6 years. The characteristic VOCs of early stage lung cancer were identified, and a diagnostic model was established. Results    Ten characteristic VOCs of early stage lung cancer were identified, including acetic acid, n-butanol, dimethylsilanol, toluene, 2,3,4-trimethylheptane, 3,4-dimethylbenzoic acid, 5-methyl-3-hexene-2-ketone, n-hexanol, methyl 2-oxoglutarate and 4-methoxyphenol. Gender and the 10 characteristic VOCs were included in the diagnostic model, with a sensitivity of 83.8% and a specificity of 96.2%. Conclusion    Analysis of exhaled breath VOCs is expected to be one of the potential methods used for early stage lung cancer diagnosis.