ObjectiveTo analyze the drug resistance and the molecular typing characteristics through pulsed field gel electrophoresis (PFGE) of Campylobacter spp. isolated from patients with infectious diarrhea in Baoshan District of Shanghai, and to provide a basis for Campylobacter spp. prevention and control and clinical medication. MethodsCampylobacter spp. was isolated, cultured and identified from stool samples of diarrheal patients collected from medical institutions at two monitoring sites in Baoshan District from 2019 to 2022. Antimicrobial susceptibility testing for 12 antibiotics was conducted on the isolated Campylobacter jejuni (C. jejuni) and Campylobacter. Coli (C. coli), and molecular typing was performed using PFGE. ResultsA total of 179 strains of Campylobacter spp. were isolated from 1 786 samples of diarrheal patients, with a positive rate of 10.02%. The highest resistance rate of C. jejuni was to ciprofloxacin (98.63%), followed by tetracycline (97.26%) and nalidixic acid (89.73%). C. coli was completely resistant to ciprofloxacin and nalidixic acid (100.00%), followed by tetracycline (90.91%). The multidrug resistance rates of C. jejuni and C. coli were 89.73% and 100.00%, respectively. 142 strains of C. jejuni produced 122 PFGE bands, while 33 strains of C. coli produced 33 PFGE bands, and the distribution of the bands was relatively dispersed. ConclusionFrom 2019 to 2022, the detection rate of Campylobacter in diarrheal patients was relatively high in Baoshan District of Shanghai, the multidrug resistance rate of Campylobacter isolates from diarrheal patients was relatively serious, in addition, the drug resistance pattern was complex, and the PFGE band pattern displayed a polymorphic distribution.

ObjectivesTo investigate the molecular epidemiological characteristics of HIV-1 infection among men who had sex with men (MSM) in Taizhou City, Zhejiang Province, and to provide a scientific reference for acquired immune deficiency syndrome prevention and control efforts. MethodsThe research subjects were all newly reported MSM population in Taizhou City from 2020 to 2023. Blood samples without antiviral therapy were collected. The HIV-1 pol gene was amplified and sequenced, and the sequences were submitted to the Stanford University drug resistance database to identify the mutation sites and drug resistance. MEGA 11.0 software was used to analyze the nucleic acid sequences, construct phylogenetic tree, and calculate genetic distance of gene sequences. The molecular transmission network diagram of HIV-1 was constructed using Cytoscape_v3.10.1, and the influencing factors of network entry were analyzed by logistic regression. ResultsA total of 363 newly reported HIV-infected MSM patients were included, with a median age [M (P₂₅, P₇₅)] of 34 (26,47) years old. The majority had an educational level of junior high school or below (55.65%). A total of eight subtypes were found, mainly CRF07_BC and CRF01_AE. The primary drug resistance rate was 10.47% (38/363). The optimal molecular network gene distance was 0.019, with a network access rate of 42.70% (155/363), and a total of 47 molecular clusters were formed. Multivariate logistic analyses showed that compared with the CRF01_AE subtype, the clustering risk of CRF07_BC subtype was higher (OR=1.916, 95%CI: 1.191‒3.109), cases with drug resistance had a higher risk of cluster formation than those without drug resistance (OR=2.011, 95%CI: 1.006‒4.080), and recent infected patients had a lower risk of entering the largest molecular cluster than long-term infected patients (OR=0.376, 95%CI: 0.137‒0.928). ConclusionThe newly diagnosed infections among the MSM population are active in Taizhou City, Zhejiang Province, with a high level of primary drug resistance. Individuals carrying drug-resistant strains are more likely to cluster. Drug resistance monitoring should be strengthened to prevent further spread of drug-resistant strains in the network.

The silent lung that occurs during the perioperative period is characterized by rapid onset,rapid progression,and high mortality.This article reports a case of a 62-year-old patient with a left lower lung nodule who underwent lower lung segmentectomy under thoracoscopy and was assisted with tracheal intubation using rocuronium.21 minutes after the first administration,the patient presented with increased airway pressure,difficult ventilation,a"steel lung"feel,and symptoms similar to silent lung.Subsequently,80 mg of methylprednisolone and 50 μg of epinephrine(in divided doses)were injected intravenously,but no relief was observed,and the blood oxygen saturation decreased to 38％.In this case,after giving another 1 mg of epinephrine,the airway pressure gradually decreased to 33 cmH2O,and the blood oxygen saturation gradually increased.Considering that airway spasm might be caused by multiple intubation stimulations,additional rocuronium bromide was added to allow for reintubation.However,the patient again experienced increased airway pressure and difficulty in ventilation prior to intubation.The clinical pharmacist conducted a correlation evaluation of this adverse event and considered the result as possible.The mechanism,rescue and prevention of silent lung induced by rocuronium was also discussed in the case report.A thorough anesthesia assessment should be conducted prior to surgery,and an appropriate anesthesia induction plan should be formulated.Once an adverse event occurs,it should be promptly identified and treated.

Heart failure(HF)is the end stage of almost all cardiovascular diseases,including coronary heart disease and structural heart disease.For end-stage HF,medications and cardiac assist devices have limited therapeutic effects,and heart transplantation is associated with donor shortage and immune rejection.Alginate hydrogel has the ability to mechanically support and induce cardiac tissue regeneration and repair.In March 2021,we conducted the world's first transcatheter endocardial alginate-hydrogel implantation in patients with end-stage heart failure,and explored the safety and feasibility of the treatment.Given that patients with heart failure who had undergone cardiac resynchronization therapy defibrillator(CRT-D)were excluded from previous studies,this paper is the first to report a case of transcatheter endocardial alginate-hydrogel implantation in a patient with heart failure who did not respond to CRT-D,with a significant reduction in the number of visits to the doctor and a significant improvement in the quality of life during the post-procedure follow-up,which may expand the indications for the use of this technology.

Objective To understand the distribution and changing resistance profiles of clinical isolates of Enterococcus in hospitals across China from 2015 to 2021.Methods Antimicrobial susceptibility testing was conducted for the clinical isolates of Enterococcus according to the unified protocol of CHINET program by automated systems,Kirby-Bauer method,or E-test strip.The results were interpreted according to the Clinical & Laboratory Standards Institute(CLSI)breakpoints in 2021.WHONET 5.6 software was used for statistical analysis.Results A total of 124 565 strains of Enterococcus were isolated during the 7-year period,mainly including Enterococcus faecalis(50.7％)and Enterococcus faecalis(41.5％).The strains were mainly isolated from urinary tract specimens(46.9％±2.6％),and primarily from the patients in the department of internal medicine,surgery and ICU.E.faecium and E.faecalis strains showed low level resistance rate to vancomycin,teicoplanin and linezolid(≤3.6％).The prevalence of vancomycin-resistant E.faecalis and E.faecium was 0.1％and 1.3％,respectively.The prevalence of linezolid-resistant E.faecalis increased from 0.7％in 2015 to 3.4％in 2021,while the prevalence of linezolid-resistant E.faecium was 0.3％.Conclusions The clinical isolates of Enterococcus were still highly susceptible to vancomycin,teicoplanin,and linezolid,evidenced by a low resistance rate.However,the prevalence of linezolid-resistant E.faecalis was increasing during the 7-year period.It is necessary to strengthen antimicrobial resistance surveillance to effectively identify the emergence of antibiotic-resistant bacteria and curb the spread of resistant pathogens.

Objectives:To investigate the clinical value of contrast echocardiography in the detection of right heart space-occupying lesions. Methods:The imaging and clinical data of 39 patients with right heart space-occupying lesions confirmed by surgery,pathology and clinical treatment in Yanbian University Hospital from January 2019 to January 2023 were retrospectively analyzed.All patients underwent contrast echocardiography and cardiac magnetic resonance(CMR)examinations.The contrast echocardiography features of right heart neoplastic from non-neoplastic occupying lesions were summarized.The diagnostic efficacy of contrast echocardiography and CMR in right heart space-occupying lesions was compared. Results:Among the 39 patients,12 patients(30.8%)were confirmed as thrombus and vegetation,6 patients(15.4%)as benign tumors and 21 patients(53.8%)as malignant tumors.There were 8,4,4 and 17 patients of thrombus,vegetation,benign tumor and malignant tumors located in right atrium,respectively.Contrast echocardiography was used to diagnose thrombus and vegetation in 12 patients(30.8%),benign tumors in 5 patients(12.8%),malignant tumors in 22 patients(56.4%).CMR was used to diagnose thrombus and vegetation in 18 patients(46.2%),benign tumors in 5 patients(12.8%),malignant tumors in 16 patients(41.0%).The Kappa coefficient between contrast echocardiography and clinical diagnosis was 0.956(P<0.001).The Kappa coefficient between CMR and clinical diagnosis was 0.754(P<0.001). Conclusions:Contrast echocardiography can dynamically observe the degree of vascularization in the lesion tissue in real-time,accurately distinguishing the nature of the right heart space-occupying lesions.

Objective:To investigate the value of soluble interleukin-6 (IL-6) receptor (sIL-6R) level in predicting ultrafiltration insufficiency in peritoneal dialysis (PD) patients.Methods:It was a prospective cohort study. The patients who received continuous ambulatory PD and regular follow-up between November 2016 and July 2018 in the PD Center of Renji Hospital, School of Medicine, Shanghai Jiao Tong University were enrolled. Enzyme-linked immunosorbent assay was used to determine dialysate sIL-6R and its appearance rate (AR) was calculated. Patients were divided into high sIL-6R AR group and low sIL-6R AR group according to median value of sIL-6R AR and prospectively followed up until death, PD cessation, or the end of the study (December 31, 2022). Multiple linear regression was used to analyze the related factors of sIL-6R AR. Kaplan-Meier method and log-rank test were used to compare the survival rate difference of ultrafiltration insufficiency between high sIL-6R AR group and low sIL-6R AR group. Multivariate Cox regression and multivariate competing risk models were used to assess the risk factors associated with occurrence of ultrafiltration insufficiency.Results:A total of 198 PD patients were enrolled, including 115 (58.1%) males, with age of (54.9±13.7) years old and PD duration of 22.5 (6.6, 65.0) months. The sIL-6R AR of the cohort was 2 094.7 (1 672.4, 2 920.9) pg/min. Compared with low sIL-6R AR（<2 094.7 pg/min）group, high sIL-6R AR（>2 094.7 pg/min）group had older age ( t=-3.269, P=0.001), higher body mass index ( t=-3.248, P=0.001), proportion of combined diabetes mellitus ( χ2=8.890, P=0.003), 24 h glucose exposure ( Z=-2.257, P=0.024), 24 h ultrafiltration capacity ( Z=-2.515, P=0.012), 4 h dialysate creatinine to serum creatinine ratio ( t=-2.609, P=0.010), mass transfer area coefficient of creatinine ( Z=-2.308, P=0.021), IL-6 AR ( Z=-3.533, P<0.001) and solute glycoprotein 130 AR ( Z=-8.670, P<0.001), and lower serum albumin ( t=2.595, P=0.010) and residual renal function ( t=2.133, P=0.033). Multiple linear regression analysis showed that body mass index ( β=0.194, P=0.005), serum albumin ( β=-0.215, P=0.002) and dialysate lg[IL-6 AR] ( β=0.197, P=0.011) were independently correlated with sIL-6R AR. By the end of the study, 57 (28.8%) patients developed ultrafiltration insufficiency. Kaplan-Meier analysis showed that high sIL-6R AR group had a significantly inferior ultrafiltration insufficiency-free survival rate than that in low sIL-6R AR group (log-rank χ 2=5.375, P=0.020). Multivariate Cox regression analysis and multivariate competing risk models showed that high dialysate sIL-6R AR (>2 094.7 pg/min) was an independent influencing factor of ultrafiltration insufficiency ( HR=2.286 , 95% CI 1.254-4.165 , P=0.007 ; SHR=2.074, 95% CI 1.124-3.828, P=0.020) in PD patients. Conclusions:Dialysate sIL-6R level was associated with body mass index, serum albumin and dialysate IL-6 level. Dialysate sIL-6R may be a predictive factor of ultrafiltration insufficiency in PD patients.

Objective To study the predictive value of hemoglobin(Hb)decrease for the occurrence of necrotizing enterocolitis(NEC)in preterm infants with late-onset sepsis(LOS).Methods Clinical data of 93 LOS preterm infants were collected for retrospective analysis,among which 16 infants developed NEC while 77 infants did not.Based on the decrease in Hb levels from the most recent Hb measurement before LOS occurrence to the initial Hb levels during LOS,the infants were divided into three groups:no Hb decrease(n=15),mild Hb decrease(Hb decrease<15 g/L;n=35),and severe Hb decrease(Hb decrease≥15 g/L;n=43).Multivariate logistic regression analysis was conducted to explore the predictive factors for NEC secondary to LOS,and the value of Hb decrease in predicting NEC secondary to LOS was evaluated through receiver operating characteristic curve analysis.Results The incidence of NEC in the severe Hb decrease group,mild Hb decrease group,and no Hb decrease group were 26% ,14% ,and 0% (P<0.05),respectively.Multivariate logistic regression analysis revealed that a larger Hb decrease was an independent predictive factor for NEC in LOS preterm infants(OR=1.141,95% CI:1.061-1.277,P<0.001).Receiver operating characteristic curve analysis showed that the area under the curve for predicting NEC in preterm infants with LOS using Hb decrease(with a cut-off value of 20 g/L)was 0.803,with sensitivity and specificity of 0.69 and 0.78,respectively.Conclusions Hb decrease can serve as an indicator for prediction of NEC in preterm infants with LOS.[Chinese Journal of Contemporary Pediatrics,2024,26(2):145-150]

Objective To investigate the incidence rate,clinical characteristics,and prognosis of neonatal stroke in Shenzhen,China.Methods Led by Shenzhen Children's Hospital,the Shenzhen Neonatal Data Collaboration Network organized 21 institutions to collect 36 cases of neonatal stroke from January 2020 to December 2022.The incidence,clinical characteristics,treatment,and prognosis of neonatal stroke in Shenzhen were analyzed.Results The incidence rate of neonatal stroke in 21 hospitals from 2020 to 2022 was 1/15 137,1/6 060,and 1/7 704,respectively.Ischemic stroke accounted for 75％(27/36);boys accounted for 64％(23/36).Among the 36 neonates,31(86％)had disease onset within 3 days after birth,and 19(53％)had convulsion as the initial presentation.Cerebral MRI showed that 22 neonates(61％)had left cerebral infarction and 13(36％)had basal ganglia infarction.Magnetic resonance angiography was performed for 12 neonates,among whom 9(75％)had involvement of the middle cerebral artery.Electroencephalography was performed for 29 neonates,with sharp waves in 21 neonates(72％)and seizures in 10 neonates(34％).Symptomatic/supportive treatment varied across different hospitals.Neonatal Behavioral Neurological Assessment was performed for 12 neonates(33％,12/36),with a mean score of(32±4)points.The prognosis of 27 neonates was followed up to around 12 months of age,with 44％(12/27)of the neonates having a good prognosis.Conclusions Ischemic stroke is the main type of neonatal stroke,often with convulsions as the initial presentation,involvement of the middle cerebral artery,sharp waves on electroencephalography,and a relatively low neurodevelopment score.Symptomatic/supportive treatment is the main treatment method,and some neonates tend to have a poor prognosis.

Objective To conduct a systematic study on the potential impact of long-term specialized golf training on the three-dimensional structure of the spine in adolescent children,and to reveal the biomechanical adaptation mechanism of children's spine,providing a theoretical basis for preventing potential sports injuries caused by golf training.Methods A longitudinal observational design was adopted,with 15 male adolescent children from a golf training center selected as research subjects.Three-dimensional spinal image data were collected using digital radiography at baseline,3 months and 6 months,and dynamic monitoring and analysis were performed.Results Golf training led to a series of adaptive changes in the three-dimensional structure of children's spine,mainly reflected in significant changes in pelvic tilt distance,vertebral body offset,vertebral rotation angle,pelvic rotation angle,and pelvic torsion angle.These changes exhibited a time-effect characteristic,indicating the strong adaptability of biomechanical system of children's spine.Conclusion Golf training can cause adaptive changes in the three-dimensional structure of children's spine,highlighting the need to maintain biomechanical balances of the spine and pelvis,and to take intervention measures such as symmetrical training to prevent sports injuries,improve training quality,and prolong athletic careers.