Objective To evaluate the effectiveness of active screening in improving the detection rate of carbape-nem-resistant Enterobacterales(CRE)in the intensive care units(ICUs).Methods From July 2023 to June 2024,active screening of rectal swab CRE was conducted on ICU patients in 10 hospitals.ICU patients who underwent ac-tive screening from July 2023 to June 2024 were selected as the study group,while those who did not undergo active screening from July 2022 to June 2023 were selected as the control group.Difference in CRE detection rates between the two groups of patients was compared.Results A total of 7 803 ICU patients were included in the study group,744 CRE strains were detected,with a detection rate of 9.53％,out of which 304 CRE strains were detected through routine detection(detection rate 3.90％),3 707 patients underwent active screen,440 CRE strains were detected(detection rate 11.87％).7 561 ICU patients were included in the control group,out of which 250 CRE strains were detected through routine detection,with a detection rate of 3.31％.There was a statistically significant difference in the overall detection rate of CRE between two groups of patients(x2=246.18,P＜0.001).In the study group,CRE detection rate of active screening(11.87％)was higher than that of routine detection(3.90％),with statistically significant difference(x2=264.26,P＜0.001).A total of 17 CRE strains were detected from the study group.The proportions of Klebsiella pneumoniae(80.92％vs 73.41％)and Serratia marcescens(2.30％vs0.23％)in the routine detection group were both higher than in the active screening group,while the proportion of Escherichia coli in the routine detection group was lower(8.22％vs 19.55％),all with statistically significant differences(all P＜0.05).Conclusion The prevalence of CRE in ICUs is relatively high,with a wide range of bac-terial species.Active screening can improve the detection rate of CRE.

Objective Postdoctoral fellows are a crucial force in hospital scientific research and serve as a"talent pool"for high-level young professionals.Exploring optimized pathways for postdoctoral training in university-affiliated tertiary hospitals under the high-quality development context is of great significance.Methods Taking a tertiary hospital in Guangzhou as the re-search subject,this study analyzed the hospital's postdoctoral management implementation measures,recruitment status,scientif-ic research output,and training outcomes over the past five years(2020-2024).Combined with policy and literature analysis,shortcomings in postdoctoral training were summarized,and a conceptual"Trinity"collaborative training mechanism involving the"hospital-department-postdoctoral fellow"was proposed.Results The retention rate of postdoctoral fellows increased to 42％,the number of provincial/ministerial-level and above research projects grew by 1.5 times,and the number of newly enrolled post-doctoral fellows in 2024 more than doubled compared to 2020.However,challenges remain,including insufficient high-quality candidates,inadequate guidance and cultivation by supervisors,lagging achievement transformation,imperfect assessment sys-tems,and incomplete incentive and support measures.Conclusion Postdoctoral fellows are a vital force in hospital scientific re-search.Constructing an effective collaborative training mechanism is essential.Through innovations in management and training models,departmental and supervisor team building,and diversified incentives and support mechanisms,multi-party collaboration and systematic integration should be pursued.Further exploration of the"Trinity"training mechanism will deepen the alignment of postdoctoral training with clinical needs and disciplinary development,thereby promoting high-quality hospital development.

Objective Postdoctoral fellows are a crucial force in hospital scientific research and serve as a"talent pool"for high-level young professionals.Exploring optimized pathways for postdoctoral training in university-affiliated tertiary hospitals under the high-quality development context is of great significance.Methods Taking a tertiary hospital in Guangzhou as the re-search subject,this study analyzed the hospital's postdoctoral management implementation measures,recruitment status,scientif-ic research output,and training outcomes over the past five years(2020-2024).Combined with policy and literature analysis,shortcomings in postdoctoral training were summarized,and a conceptual"Trinity"collaborative training mechanism involving the"hospital-department-postdoctoral fellow"was proposed.Results The retention rate of postdoctoral fellows increased to 42％,the number of provincial/ministerial-level and above research projects grew by 1.5 times,and the number of newly enrolled post-doctoral fellows in 2024 more than doubled compared to 2020.However,challenges remain,including insufficient high-quality candidates,inadequate guidance and cultivation by supervisors,lagging achievement transformation,imperfect assessment sys-tems,and incomplete incentive and support measures.Conclusion Postdoctoral fellows are a vital force in hospital scientific re-search.Constructing an effective collaborative training mechanism is essential.Through innovations in management and training models,departmental and supervisor team building,and diversified incentives and support mechanisms,multi-party collaboration and systematic integration should be pursued.Further exploration of the"Trinity"training mechanism will deepen the alignment of postdoctoral training with clinical needs and disciplinary development,thereby promoting high-quality hospital development.

Objective To evaluate the effectiveness of active screening in improving the detection rate of carbape-nem-resistant Enterobacterales(CRE)in the intensive care units(ICUs).Methods From July 2023 to June 2024,active screening of rectal swab CRE was conducted on ICU patients in 10 hospitals.ICU patients who underwent ac-tive screening from July 2023 to June 2024 were selected as the study group,while those who did not undergo active screening from July 2022 to June 2023 were selected as the control group.Difference in CRE detection rates between the two groups of patients was compared.Results A total of 7 803 ICU patients were included in the study group,744 CRE strains were detected,with a detection rate of 9.53％,out of which 304 CRE strains were detected through routine detection(detection rate 3.90％),3 707 patients underwent active screen,440 CRE strains were detected(detection rate 11.87％).7 561 ICU patients were included in the control group,out of which 250 CRE strains were detected through routine detection,with a detection rate of 3.31％.There was a statistically significant difference in the overall detection rate of CRE between two groups of patients(x2=246.18,P＜0.001).In the study group,CRE detection rate of active screening(11.87％)was higher than that of routine detection(3.90％),with statistically significant difference(x2=264.26,P＜0.001).A total of 17 CRE strains were detected from the study group.The proportions of Klebsiella pneumoniae(80.92％vs 73.41％)and Serratia marcescens(2.30％vs0.23％)in the routine detection group were both higher than in the active screening group,while the proportion of Escherichia coli in the routine detection group was lower(8.22％vs 19.55％),all with statistically significant differences(all P＜0.05).Conclusion The prevalence of CRE in ICUs is relatively high,with a wide range of bac-terial species.Active screening can improve the detection rate of CRE.

Objective:To investigate the alterations in brain dynamic functional network connectivity (dFNC) and their significance in Parkinson's disease (PD) patients with postural instability/gait difficulty (PIGD).Methods:Ninety PD patients admitted to Department of Neurology, First Affiliated Hospital of Nanjing Medical University from May 2016 to August 2019 were recruited, and 54 healthy controls matched with gender and age were chosen; their clinical data and resting-state functional MRI (rs-fMRI) data were collected. PD patients were divided into PD with PIGD (PD-PIGD) group ( n=49) and PD without PIGD (PD-non-PIGD) group ( n=41) according to Unified Parkinson's Disease Rating Scale (UPDRS) scores. Independent component analysis (ICA), sliding window method and k-means clustering were used to analyze the dFNC and compare among groups. Correlations of dFNC alterations with clinical scales were verified by partial correlation analysis. Results:Four repeated recurring functional connectivity states were identified, and PD-PIGD patients had high frequency in state 3 (44%) and state 2 (23%) of the low dFNC. In terms of dFNC time attributes, PD-PIGD patients had longer mean dwell time in state 3 than PD-non-PIGD patients and had lower number of transitions in state 3 than PD-non-PIGD patients and healthy controls, with significant differences ( P<0.05); PD-PIGD patients had significantly higher fractional windows and statistically longer mean dwell time in state 2 than healthy controls ( P<0.05). In terms of dFNC strengths, compared with healthy controls, PD-PIGD patients showed significantly decreased functional connectivity within default mode network (DMN, between medial superior frontal gyrus and precuneus) and auditory network (AN, between superior temporal gyrus and middle temporal gyrus), but significantly increased functional connectivity between sensorimotor network (SMN, supplementary motor area) and DMN (precuneus) in state 2 ( P<0.05, false discovery rate [FDR]-corrected). Partial correlation analysis indicated positive correlation between mean dwell time in state 3 and PIGD scores in PD-PIGD patients ( r=0.450, P=0.039). Conclusion:PD-PIGD patients exhibit specific dFNC, mainly characterized by low connectivity of the brain functional network and prolonged dwell time; local functional network domains often separate between DMN, AN and SMN networks and within the networks.

Objective:To investigate the alterations of amplitude of low frequency fluctuation (ALFF) and functional connectivity (FC) in patients with Parkinson′s disease (PD) with apathy.Methods:From May 2016 to August 2019, PD patients and age-, gender-and education level-matched healthy controls (HC) in the First Affiliated Hospital of Nanjing Medical University were prospectively recruited. The clinical and resting-state functional MRI (rs-fMRI) data of PD patients and HC were analyzed. According to the Starkstein Apathy Scale (SAS) scores, PD patients were divided into PD with apathy (PD-A) group and PD without apathy (PD-NA) group. Rs-fMRI images were processed by DPABI based on MATLAB. ALFF values were calculated and the standard ALFF (zALFF) were obtained. ANOVA and Post-Hoc t test were performed to compare the differences in local brain activity among the three groups. The brain regions with significant different zALFF values were selected as the seeds to calculate the FC values of the whole brain. The associations between FC values and the SAS scores were performed using pearson correlation analyses. Results:A total of 75 PD patients (50 males, 25 females, aged from 44 to 88 years) and 41 HC (25 males, 16 females, aged from 54 to 72 years) were enrolled. There were 42 patients in the PD-A group and 33 patients in the PD-NA group. Significant differences were found in zALFF values among the PD-A, PD-NA and HC groups ( P<0.05). After Post-Hoc t test, compared with the HC group, zALFF values were significantly increased in the right middle frontal gyrus in the PD-A group ( P<0.05) and significantly decreased in the left precuneus in the PD-NA group; The zALFF values of the right middle frontal gyrus and left precuneus in the PD-A group were significantly higher than those in PD-NA group ( P<0.05). Brain regions with different zALFF values were used as seeds for whole-brain FC. Compared with PD-NA group, FC values between the right middle frontal gyrus and bilateral precuneus, left superior frontal gyrus and its medial side, left middle frontal gyrus, left angular, left anterior cingulate gyrus, left posterior cingulate gyrus, left parahippocampal gyrus were significantly decreased in the PD-A group ( P<0.05). Additionally, FC values of PD patients between the right middle frontal gyrus with the left precuneus, the left superior frontal gyrus and its medial side, and the left middle frontal gyrus were negatively correlated with SAS scores ( r=-0.31, -0.30 and -0.34, both P<0.05). Conclusion:PD-A and PD-NA patients have different brain functional activities and connections in the frontal lobe, parietal lobe and limbic system, suggesting that apathy in PD may be associated with the abnormal functional connections of the frontal-parietal cortical circuit and the frontal-limbic-striatal loop.

Objective:To investigate the alterations of brain resting-state functional connectivity in patients with leukoaraiosis(LA), and to explore its neuropathological mechanism of cognitive dysfunction.Methods:From August 2022 to February 2023, 28 patients with LA(LA group) and 30 gender, age and education level matched normal controls(NC group) in Jiangsu Shengze Hospital affiliated to Nanjing Medical University were prospectively recruited.Mini mental state examination, trail-making test, and Stroop color-word test were used to evaluate the cognitive function of participants, rs-fMRI images were processed by DPABI V6.1 based on MATLAB R2022a.Voxel-mirrored homotopic connectivity(VMHC) values were calculated and two-sample t test were performed to compare the differences in local brain activity between the two groups.The brain regions with significant differences were selected as the seeds to calculate the functional connectivity(FC) values of the whole brain, and Pearson correlation analyses were performed to evaluate the correlation between the FC values and neuropsychological scores. Results:The VMHC values of the calcarine fissure and surrounding cortex(CAL) (x=±18, y=-63, z=15), postcentral gyrus(PoCG) (x=±39, y=-27, z=48), lingual gyrus(LING) (x=±12, y=-51, z=-6), middle occipital gyrus(x=±27, y=-75, z=24) and insula(x=±36, y=6, z=3) in the LA group were lower than those in the NC group( P<0.05). The seed points FC results showed, FC values between right CAL(CAL.R) and bilateral precuneus(PCUN), right dorsolateral prefrontal cortex(DLPFC.R) and right temporal_mid were reduced in the LA group( P<0.05); FC values between PoCG.R and left CAL, left temporal_mid and right LING were reduced too( P<0.05). Additionally, the FC value in the LA group between CAL.R and DLPFC.R was negatively correlated with the Stroop C score( r=-0.39, P<0.05). The FC value in LA group and NC group between CAL.R and DLPFC.R was negatively correlated with the Stroop C score( r=-0.48, P<0.001)and also negatively correlated with the trail making test B(TMT-B) score( r=-0.40, P<0.01), and the FC value between CAL.R and PCUN.L was negatively correlated with the TMT-B score( r=-0.45, P<0.001). Conclusion:Desynchronized interhemispheric functional connectivity and abnormal cortical circuit functional connectivity were probably associated with the underlying neural mechanisms of cognitive impairment in LA.

Objective:To evaluate the clinical efficacy of hydrotherapy in the treatment of children with spastic cerebral palsy (CP).Methods:The China National Knowledge Infrastructure, Wanfang databases, CQVIP databases, PubMed and the Cochrane library were electronically searched for reports published before November 2018 of randomized and controlled trials (RCTs) of hydrotherapy for treating children with spastic CP. Two researchers screened the literature independently, extracted data and assessed the risk of bias in the included studies. The meta-analysis was performed using version 5.3 of the RevMan software.Results:A total of 6 RCTs were included, covering 464 patients. It was found that hydrotherapy combined with conventional rehabilitation was significantly more effective than conventional rehabilitation alone.Conclusions:It has been proved that hydrotherapy can improve the symptoms of children with spastic CP, relieve their spasticity and promote better motor function.

Objective:To investigate the disability status of the elderly in medical-nursing integrated pension institutions in Beijing and analyze its influencing factors.Methods:Using the convenient sampling method, a total of 359 elderly people from 5 medical-nursing integrated pension institutions in Beijing were selected from May to August 2019. General data and Elderly Disability Assessment Scale (EDAS) were used to evaluate the disability status of the included population, and univariate and multivariate analysis were conducted.Results:A total of 95.3% (342/359) of the elderly had disability. The single factor analysis result showed that male, low education level, a large number of chronic diseases, history of fall, history of smoking, history of drinking, widowed and elderly people living in nursing homes at their public expense were more disabled ( P<0.05) . Multivariate analysis showed that, history of falls, the number of chronic diseases greater than or equal to 3 and widowhood were the influencing factors for aggravated disability ( P<0.05) . Conclusions:In this survey, the rate of disability of the elderly in medical-nursing integrated pension institutions in Beijing is relatively high and the degree of disability is serious. The focus should be on the elderly who are male, with low educational level, smoking history, drinking history, falling history, comorbidities of the aged, the loss of spouse and those who bear the expenses of pension institutions at public expense.

Objective: To investigate the resuscitation effect of aortic balloon occlusion (ABO) on the traumatic cardiac arrest (TCA) in swine. Methods: Twenty-seven male domestic swine weighing (32.7±3.8)kg were utilized. After 40% of estimated blood volume was removed within 20 minutes, the animals were subjected to 5 minutes of untreated ventricular fibrillation and then 5 minutes of cardiopulmonary resuscitation. Additionally, fluid resuscitation was initiated coincident with the beginning of cardiopulmonary resuscitation. The animals were randomly divided into model group (n=12) and ABO group (n=15). Once cardiopulmonary resuscitation was implemented, aortic balloon was concurrently inflated to stop the blood flow of descending thoracic aorta at the level of the diaphragm in the ABO group. In the model group, aortic balloon was placed in the same position without inflation. During cardiopulmonary resuscitation, the changes of coronary perfusion pressure (CPP), forehead's regional cerebral oxygen saturation (rSO₂) and pressure of end-tidal CO₂ (PETCO₂) were continuously monitored, and the rate of return of spontaneous circulation (ROSC), duration of cardiopulmonary resuscitation, number of shocks and dose of epinephrine were recorded. At 5 minutes after successful resuscitation, the levels of arterial blood gas, lactate and jugular venous blood oxygen saturation (SjvO₂) were measured. Results: Compared with the model group, the values of CPP, rSO₂ and PETCO₂ during cardiopulmonary resuscitation were significantly increased in the ABO group [CPP: (33.5±5.6)mmHg vs. (23.1±5.2)mmHg at 1 minute, (35.3±6.0)mmHg vs. (26.8±7.4)mmHg at 2 minutes, (36.3±6.3)mmHg vs. (28.2±6.3)mmHg at 3 minutes, (40.1±7.1)mmHg vs. (30.5±6.2)mmHg at 4 minutes, (38.1±7.5)mmHg vs. (29.8±5.3)mmHg at 5 minutes; rSO₂: (45.4±5.2)% vs. (39.2±5.1)% at 1 minute, (47.2±3.6)% vs. (42.0±6.4)% at 2 minutes, (47.7±3.0)% vs. (41.5±5.4)% at 3 minutes, (47.0±2.5)% vs. (42.1±5.9)% at 4 minutes, (47.1±2.0)% vs. (41.5±7.4)% at 5 minutes; PETCO₂: (17.0±3.5)mmHg vs. (12.7±4.2)mmHg at 1 minute, (18.5±3.7)mmHg vs. (14.5±2.7)mmHg at 2 minutes, (20.7±5.3)mmHg vs. (15.5±3.2)mmHg at 3 minutes, (18.7±4.5)mmHg vs. (14.9±3.5)mmHg at 4 minutes, (18.2±3.2)mmHg vs. (14.5±4.2)mmHg at 5 minutes] (all P<0.05). The rate of ROSC was significantly higher in the ABO group than in the model group[100%(15/15) vs. 75%(9/12)] (P<0.05). Additionally, shorter duration of cardiopulmonary resuscitation, less number of shocks and lower doses of epinephrine were observed in the ABO group when compared with the model group[duration of cardiopulmonary resuscitation: 5(5, 5)minutes vs. 5(5, 12.5)minutes, number of shocks: 1(1, 1)times vs. 1(1, 4)times, dose of epinephrine: 0.62(0.62, 0.74)mg vs. 0.64(0.59, 2.59)mg] (all P<0.05). At 5 minutes after resuscitation, the level of arterial lactate was significantly decreased and the value of SjvO₂ was significantly increased in the ABO group compared with the model group[Lactate: (9.6±0.8)mmol/L vs. (10.8±1.4)mmol/L; SjvO₂: (50.0±8.6)% vs. (37.9±16.3)%] (both P<0.05). Conclusions In a swine model of TCA, ABO can increase cardiac and cerebral perfusion during cardiopulmonary resuscitation and improve the efficacy of cardiopulmonary resuscitation. It might provide a novel and effective method for the resuscitation of TCA in the clinical setting.