OBJECTIVE To investigate the independent risk factors for carbapenem-resistant Klebsiella pneumoniae （CRKP） infection， develop a nomogram prediction model and validate it. METHODS Clinical data of hospitalized patients infected with CRKP between April 2020 and May 2023 at Kunming First People’s Hospital were retrospectively collected and matched 1∶1 with patients infected with carbapenem-susceptible Klebsiella pneumoniae （CSKP） during the same period as the modeling group. Using the same criteria， data from patients hospitalized and infected with CRKP and matched CSKP between June 2023 and June 2024 were collected as the validation group. Univariate analysis， LASSO regression and multivariate Logistic regression were conducted to identify independent risk factors for CRKP infection and to develop a nomogram prediction model. Internal validation of the model was performed using Bootstrap resampling， and external validation was carried out using the data of validation group. The predictive performance of the model was evaluated using receiver operating characteristic （ROC） curves and calibration plots. RESULTS A total of 530 patients were enrolled， with 372 in the modeling group and 158 in the validation group. Cerebrovascular disease， indwelling gastric tube， mechanical ventilation， exposure to carbapenem antibiotics， and exposure to β-lactamase inhibitor compound agents were identified as independent risk factors for CRKP infection （P＜0.05）. The nomogram predicting CRKP infection risk achieved an area under ROC of 0.729 and 0.803 in internal and external validations， respectively. Calibration curves indicated a high degree of consistency between predicted and observed probabilities. CONCLUSIONS Cerebrovascular disease， indwelling gastric tube， mechanical ventilation， exposure to carbapenem antibiotics， and exposure to β-lactamase inhibitor compound agent are independent risk factors for CRKP infection. The developed nomogram model for predicting CRKP infection risk demonstrates good predictive performance and can aid in the early identification of patients at high risk for CRKP infection.

OBJECTIVES: To construct an intelligent analysis model for classifying fetal orientation during intrapartum ultrasound videos based on multi-feature fusion. METHODS: The proposed model consists of the Input, Backbone Network and Classification Head modules. The Input module carries out data augmentation to improve the sample quality and generalization ability of the model. The Backbone Network was responsible for feature extraction based on Yolov8 combined with CBAM, ECA, PSA attention mechanism and AIFI feature interaction module. The Classification Head consists of a convolutional layer and a softmax function to output the final probability value of each class. The images of the key structures (the eyes, face, head, thalamus, and spine) were annotated with frames by physicians for model training to improve the classification accuracy of the anterior occipital, posterior occipital, and transverse occipital orientations. RESULTS: The experimental results showed that the proposed model had excellent performance in the tire orientation classification task with the classification accuracy reaching 0.984, an area under the PR curve (average accuracy) of 0.993, and area under the ROC curve of 0.984, and a kappa consistency test score of 0.974. The prediction results by the deep learning model were highly consistent with the actual classification results. CONCLUSIONS The multi-feature fusion model proposed in this study can efficiently and accurately classify fetal orientation in intrapartum ultrasound videos.
Humans ; Female ; Ultrasonography, Prenatal/methods* ; Pregnancy ; Fetus/diagnostic imaging* ; Neural Networks, Computer ; Video Recording

Objective:To investigate the therapeutic effectiveness of double-anatomical plate-assisted reconstruction of a stable triangle in the treatment of chronic distal humerus fractures.Methods:A retrospective analysis was performed on the medical records of 10 patients with distal humerus fracture treated with double plate assisted reconstruction of a stable triangle from August 2021 to December 2024. All patients were followed up for more than 6 months. The cohort included 9 males and 1 female, with a mean age of 54.75±15.15 years (range, 31-73 years). Causes of injury: 4 cases of slip, 2 cases of high-energy fall, 3 cases of traffic accident, and 1 case of crush injury. According to the AO/OTA classification, all fractures were type C3, including 4 cases of C3.3 and 6 cases of C3.2. The operation duration, intraoperative blood loss, and length of hospital stay were recorded. Follow-up evaluations were conducted at 1, 3, and 6 months postoperatively and at the final follow-up. Radiographs were obtained to assess fracture reduction, healing, and implant positioning. Functional outcomes of the elbow were assessed using carrying angle, humeral condyle anteversion angle, modified trochleocapitellar index (mTCI), range of motion (ROM), visual analogue scale (VAS) for pain, Mayo elbow performance score (MEPS), and complication rates.Results:All 10 patients successfully completed the operation, with an average operation time of 221.75±48.73 min (range, 165-310 min), an average intraoperative blood loss of 462.50±215.05 ml (range 150-800 ml). 4 patients received blood transfusion. The average hospital stay was 10.75±2.55 d (range 6-14 d). The average carrying angle of 171.50°±5.37° (range 165°-179°) and the anterior angle of humeral condyle 39.75°±3.96° (range 34°-45°) were all within the standard range. At least one index in the mTCI was within the optimal range at the last follow-up. All patients were followed up with an average follow-up of 10.75±5.73 months (range 6-22 months). All 10 patients were healed after surgery with an average healing time of 4.75±2.05 months (range 3-9 months). At the final follow-up, the average elbow ROM was 93.75°±25.88° (range, 50°-115°), internal rotation was 83.13°±9.61° (range, 60°-90°), and external rotation was 88.13°±3.72° (range, 80°-90°). The mean VAS score was 0.63±0.92 (range, 0-2), and the average MEPS was 88.75±11.57 (range, 70-100), with 4 excellent, 4 good, and 2 fair outcomes, an excellent and good rate of 80%. Complications included one case of periarticular osteophyte formation, one case of transient ulnar nerve numbness that improved with conservative treatment, and three cases of occasional mild pain following increased activity. Conclusion Double-anatomical plate-assisted reconstruction of a stable triangle provides effective and stable fixation for chronic AO/OTA C3 distal humerus fractures. The short-term postoperative outcomes are satisfactory, with good functional recovery and a low complication rate.Conclusions:Double-anatomical plate-assisted reconstruction of a stable triangle provides effective and stable fixation for chronic AO/OTA C3 distal humerus fractures. The short-term postoperative outcomes are satisfactory, with good functional recovery and a low complication rate.

Objective:To evaluate the value of multi-slice spiral CT (MSCT) in the diagnosis of liver metastases with rich blood supply.Methods:The clinical data and imaging data of 19 patients with liver metastases with rich blood supply admitted to the 921st Hospital of the Joint Logistics Support Force of Chinese People′s Liberation Army from September 2018 to September 2023 were retrospectively analyzed, and the number, location, shape, size of the lesions and the images of CT plain scan and dynamic enhanced scan were analyzed.Results:Among the 19 patients, there were 18 multiple cases and 1 single case. A total of 108 lesions were found. There were 62 cases (57.4%) in the right lobe of liver and 87 cases (80.6%) in the peripheral part of liver. The form of circular or quasi-circular, there were 99, irregular shape or lobed 9. The focal diameter was 0.6-6.8 cm. CT plain scan showed that 99 lesions showed slightly low density, and the other 9 lesions showed equal density relative to the background liver. In the dynamic enhanced scan, 108 lesions in arterial stage showed high-density enhancement, 97 lesions showed circular enhancement, and 11 lesions showed nodular enhancement. Among them, 77 lesions had moderate to obvious intensification density. Of the 108 lesions in the portal vein stage, 31 lesions showed moderate to obvious enhancement density, 49 lesions showed slightly low clearance density, and 28 lesions showed continuous enhancement density. In the delayed stage, all 108 lesions showed slightly low density.Conclusions:The main features of liver metastases with rich blood supply are: low density on plain CT scan, annular or nodular enhancement in the arterial phase of enhanced CT scan, and the peak of enhanced density can be in the arterial phase or the portal vein phase. Combined with clinical data, CT can make a correct diagnosis.

Objective:To investigate the therapeutic effectiveness of double-anatomical plate-assisted reconstruction of a stable triangle in the treatment of chronic distal humerus fractures.Methods:A retrospective analysis was performed on the medical records of 10 patients with distal humerus fracture treated with double plate assisted reconstruction of a stable triangle from August 2021 to December 2024. All patients were followed up for more than 6 months. The cohort included 9 males and 1 female, with a mean age of 54.75±15.15 years (range, 31-73 years). Causes of injury: 4 cases of slip, 2 cases of high-energy fall, 3 cases of traffic accident, and 1 case of crush injury. According to the AO/OTA classification, all fractures were type C3, including 4 cases of C3.3 and 6 cases of C3.2. The operation duration, intraoperative blood loss, and length of hospital stay were recorded. Follow-up evaluations were conducted at 1, 3, and 6 months postoperatively and at the final follow-up. Radiographs were obtained to assess fracture reduction, healing, and implant positioning. Functional outcomes of the elbow were assessed using carrying angle, humeral condyle anteversion angle, modified trochleocapitellar index (mTCI), range of motion (ROM), visual analogue scale (VAS) for pain, Mayo elbow performance score (MEPS), and complication rates.Results:All 10 patients successfully completed the operation, with an average operation time of 221.75±48.73 min (range, 165-310 min), an average intraoperative blood loss of 462.50±215.05 ml (range 150-800 ml). 4 patients received blood transfusion. The average hospital stay was 10.75±2.55 d (range 6-14 d). The average carrying angle of 171.50°±5.37° (range 165°-179°) and the anterior angle of humeral condyle 39.75°±3.96° (range 34°-45°) were all within the standard range. At least one index in the mTCI was within the optimal range at the last follow-up. All patients were followed up with an average follow-up of 10.75±5.73 months (range 6-22 months). All 10 patients were healed after surgery with an average healing time of 4.75±2.05 months (range 3-9 months). At the final follow-up, the average elbow ROM was 93.75°±25.88° (range, 50°-115°), internal rotation was 83.13°±9.61° (range, 60°-90°), and external rotation was 88.13°±3.72° (range, 80°-90°). The mean VAS score was 0.63±0.92 (range, 0-2), and the average MEPS was 88.75±11.57 (range, 70-100), with 4 excellent, 4 good, and 2 fair outcomes, an excellent and good rate of 80%. Complications included one case of periarticular osteophyte formation, one case of transient ulnar nerve numbness that improved with conservative treatment, and three cases of occasional mild pain following increased activity. Conclusion Double-anatomical plate-assisted reconstruction of a stable triangle provides effective and stable fixation for chronic AO/OTA C3 distal humerus fractures. The short-term postoperative outcomes are satisfactory, with good functional recovery and a low complication rate.Conclusions:Double-anatomical plate-assisted reconstruction of a stable triangle provides effective and stable fixation for chronic AO/OTA C3 distal humerus fractures. The short-term postoperative outcomes are satisfactory, with good functional recovery and a low complication rate.

Objective:To evaluate the value of multi-slice spiral CT (MSCT) in the diagnosis of liver metastases with rich blood supply.Methods:The clinical data and imaging data of 19 patients with liver metastases with rich blood supply admitted to the 921st Hospital of the Joint Logistics Support Force of Chinese People′s Liberation Army from September 2018 to September 2023 were retrospectively analyzed, and the number, location, shape, size of the lesions and the images of CT plain scan and dynamic enhanced scan were analyzed.Results:Among the 19 patients, there were 18 multiple cases and 1 single case. A total of 108 lesions were found. There were 62 cases (57.4%) in the right lobe of liver and 87 cases (80.6%) in the peripheral part of liver. The form of circular or quasi-circular, there were 99, irregular shape or lobed 9. The focal diameter was 0.6-6.8 cm. CT plain scan showed that 99 lesions showed slightly low density, and the other 9 lesions showed equal density relative to the background liver. In the dynamic enhanced scan, 108 lesions in arterial stage showed high-density enhancement, 97 lesions showed circular enhancement, and 11 lesions showed nodular enhancement. Among them, 77 lesions had moderate to obvious intensification density. Of the 108 lesions in the portal vein stage, 31 lesions showed moderate to obvious enhancement density, 49 lesions showed slightly low clearance density, and 28 lesions showed continuous enhancement density. In the delayed stage, all 108 lesions showed slightly low density.Conclusions:The main features of liver metastases with rich blood supply are: low density on plain CT scan, annular or nodular enhancement in the arterial phase of enhanced CT scan, and the peak of enhanced density can be in the arterial phase or the portal vein phase. Combined with clinical data, CT can make a correct diagnosis.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Ginsenoside Rg5 is a rare ginsenoside showing promising tumor-suppressive effects.This study aimed to explore its radio-sensitizing effects and the underlying mechanisms.Human lung adenocarcinoma cell lines A549 and Calu-3 were used for in vitro and in vivo analysis.Bioinformatic molecular docking prediction and following validation by surface plasmon resonance(SPR)technology,cellular thermal shift assay(CETSA),and isothermal titration calorimetry(ITC)were conducted to explore the binding between ginsenoside Rg5 and 90 kD heat shock protein alpha(HSP90α).The effects of ginsenoside Rg5 on HSP90-cell division cycle 37(CDC37)interaction,the client protein stability,and the downstream regulations were further explored.Results showed that ginsenoside Rg5 could induce cell-cycle arrest at the G1 phase and enhance irradiation-induced cell apoptosis.It could bind to HSP90α with a high affinity,but the affinity was drastically decreased by HSP90α Y61A mutation.Co-immunoprecipitation(Co-IP)and ITC assays confirmed that ginsenoside Rg5 disrupts the HSP90-CDC37 interaction in a dose-dependent manner.It reduced irradiation-induced upre-gulation of the HSP90-CDC37 client proteins,including SRC,CDK4,RAF1,and ULK1 in A549 cell-derived xenograft(CDX)tumors.Ginsenoside Rg5 or MRT67307(an IKKe/TBK1 inhibitor)pretreatment suppressed irradiation-induced elevation of the LC3-Ⅱ/β ratio and restored irradiation-induced downregulation of p62 expression.In A549 CDX tumors,ginsenoside Rg5 treatment suppressed LC3 expression and enhanced irradiation-induced DNA damage.In conclusion,ginsenoside Rg5 may be a potential radiosensitizer for lung adenocarcinoma.It interacts with HSP90α and reduces the binding between HSP90 and CDC37,thereby increasing the ubiquitin-mediated proteasomal degradation of the HSP90-CDC37 client proteins.

Objective:To investigate the therapeutic effect of bidirectional-traction, Steinmann pin poking reduction,anatomic plate and raft technique in the treatment of hyperextension tibial plateau fractures.Methods:The data of 25 patients with hyperextension tibial plateau fractures admitted to Qilu Hospital of Shandong University (Qingdao) from July 2017 to June 2022 were retrospectively analyzed. According to the treatment methods, they were divided into bidirectional-traction group (treated with bidirectional-traction, Steinmann pin poking reduction, anatomic plate and raft technique) and open reduction group (treated with open reduction, bone grafting and two plates fixation). The bidirectional-traction group included 14 patients, with 8 males and 6 females; the age was 50.29±9.23 years (range, 38-61 years). The cause of the injury was a traffic accident in 4 patients, a fall from height in 7 patients and a fall from standing height in 3 patients. According to Schatzker classification, there were 5 Schatzker type V and 9 type VI fractures. The open reduction group included 11 patients (7 males and 4 females); with a mean age of 58.00±10.58 years (range, 48-69 years). 3 cases were injured by traffic accident, 6 cases by falling from height, and 2 cases by falling from standing height. According to Schatzker classification, there were 4 type V and 7 type VI. Preoperative waiting time, operative time, blood loss and percentage of blood loss, incision length, fracture healing time, tibial posterior inclination, medial proximal tibial angle, visual analogue scale (VAS) on the first day after surgery, Hospital for Special Surgery (HSS) score 6 months after surgery were compared between the two groups.Results:Patients in both groups were followed up for more than 6 months. The follow-up time was 7 to 48 months with an average of 22.76 months. There were significant differences in the preoperative waiting time [6 (4, 8) d vs. 8 (7, 11) d, W=114.00, P=0.043], the incision length [15.0 (12.5, 16.0) cm vs. 30.0 (28.0, 31.0) cm, W=154.00, P<0.001], postoperative VAS [4 (3, 4) points vs. 5 (5, 6) points, W=143.00, P<0.001], blood loss [147 (107, 206) ml vs. 267 (191, 362) ml, W=116.00, P=0.033], blood loss percentage [2.95% (2.58%, 5.20%) vs. 6.40% (4.05%, 7.00%), W=118.00, P=0.027] between the bidirectional-traction group and open reduction group. There were not significant differences in the operation time [120 (118, 120) min vs. 119 (101, 154) min, W=68.50, P=0.656], fracture healing time (8.18±1.03 weeks vs. 8.86±1.27 weeks, t=1.49, P=0.149), HSS score (8.43±3.72 vs. 85.18±7.73, t=1.28, P=0.221) and medial proximal tibial angle 6 months after surgery (87.66°±1.53° vs. 86.47°±2.24°, t=1.57, P=0.130) between the two groups. Postoperative tibial posterior inclination was improved in both groups. There was no significant difference in the tibial posterior inclination before surgery, immediately after surgery and 6 months after surgery (-14.96°±6.44°, 5.55°±1.02°, 5.61°±0.82°) in the bidirectional-traction group and -12.26°±2.93°, 7.07°±3.21° and 7.14°±3.17° in the open reduction group, P>0.05). There were no postoperative complications such as acute compartment syndrome or knee stiffness in both groups. Conclusion:The treatment of hyperextension tibial plateau fracture with bidirectional-traction, Steinmann pin poking reduction, anatomic plate and raft technique can shorten preoperative waiting time, reduce incision length, decrease blood loss and lower VAS. It is a minimally invasive, rapid and effective method, which has achieved good clinical results and is worth promoting.

Objective:To develop a cultural competency assessment scale for geriatric clinical nurse specialists and test its reliability and validity.Methods:Through literature research, qualitative interviews, expert correspondence, and pretesting, the cultural competency assessment scale for geriatric clinical nurse specialists was developed. A total of 140 geriatric nurses from 8 tertiary hospitals in Beijing, Guizhou, Harbin, Shandong and Shaanxi from July to September 2021 were selected for the survey.Results:The final cultural competency assessment scale for geriatric clinical nurse specialists consisted of 4 dimensions of cultural knowledge, cultural awareness, cultural skills, and cultural interaction behaviors, with 31 entries, Cronbach α coefficient of 0.953 for the scale, Cronbach α coefficient of 0.875-0.974 for the 4 dimensions, and retest reliability of 0.925. I-CVI was 0.857-1.000, and the average S-CVI was 0.974. The cumulative contribution of the four common factors was 72.51%. Conclusions:The reliability and validity of the cultural competency assessment scale for geriatric clinical nurse specialists are good and can be used to evaluate the cultural competency of geriatric clinical nurse specialists.