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.

Objective To investigate current situations of emotional labour,career success and psychological resilience among the nurses and to explore the mediating role of psychological resilience between emotional labour and career success,hence to provide a reference in improvement of the sense of career success among the nurses.Methods Convenience sampling was used to select 922 clinical nurses from 15 Gade ⅡA hospitals in Hubei Province between June and July 2021.A general information questionnaire,the emotional labour scale,career success scale,and psychological resilience scale were used in the investigation.Pearson correlation was employed to analyse the correlations between emotional labour,career success and psychological resilience scores.Amos software was used to construct structural equation model to analyse the mediating effect.Results A total of 842 clinical nurses completed the survey.The total scores of career success and mental resilience of clinical nurses were(73.56±15.55)scores and(62.50±17.12)scores,respectively.In emotional labor,the surface acting dimension score was(20.46±5.92)scores.The score of deep acting dimension was(11.05±2.62),and the score of true emotion expression dimension was(11.95±3.48).Perceived career success was positively correlated with psychological resilience(r=0.593,P<0.001)Career success was negatively correlated with surface acting(r=-0.507,P<0.001).Career success was positively correlated with true emotional expression(r=0.481,P<0.001),and was positively correlated with deep acting(r=0.462,P<0.001).Psychological resilience was negatively correlated with surface acting(r=-0.452,P<0.001),positively correlated with true emotion expression(r=0.402,P<0.001),and positively correlated with deep acting(r=0.392,P<0.001).Psychological resilience plays a partial mediating role between the dimensions of emotional labor(surface acting,true emotional expression,deep acting)and career success,and the mediating effect is-0.146,0.108 and 0.112,accounting for 38.02%,32.05%and 37.21%of the total effect,respectively.Conclusion The three mensions of the emotional labor are at middle level and career success of clinical nurses is above the average level,but the psychological resilience is at a low level.In emotional labor,surface acting can directly negatively affect the ca reer success of clinical nurses,real emotion expression and deep acting can directly positively affect the career success of clinical nurses,and indirectly affect the career success of clinical nurses through the mediating effect of psychological resilience.Nursing managers should pay attention to the management of nurses'emotional labor,improve the level of psychological resilience,and then increase their sense of career success.

Objective To investigate the effect of individual exercise training on the rehabilitation of patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI).Methods A total of 81 patients between January 2021 and December 2023 were randomly allocated into an observation group(n=41)and a control group(n=40)using a simple random number Tab.method.The control group received routine post-operative rehabilitation intervention,while the observation group received individualized exercise training as the core component of cardiac rehabilitation intervention.The study compared the effects of rehabilitation,cardiac function parameters[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD)],exercise endurance measures[6-minute walking distance(6MWD)],and quality of life assessed by Seattle Angina Pecina Scale(SAQ)scores between the two groups before and after a three-month intervention period.Results The total recovery response rate in the observation group was higher than that in the control group(P＜0.05).LVEF,LVEDD,6 MWD,maximum exercise load and SAQ scales(P＞0.05),LVEF were higher than before intervention(t=3.345,2.480,3.165,5.016,2.059,4.582,4.443,3.353,P＜0.05),and LVEDD was lower than before intervention(t=3.335,P＜0.05).Conclusion The individualized exercise training-based cardiac rehabili-tation program demonstrates potential for enhancing cardiac function and exercise endurance in patients with CHD following PCI,thereby improving their overall quality of life.This finding holds significant clinical implications.

Modulating Tankyrases (TNKS), interactions with USP25 to promote TNKS degradation, rather than inhibiting their enzymatic activities, is emerging as an alternative/specific approach to inhibit the Wnt/β-catenin pathway. Here, we identified UAT-B, a novel neoantimycin analog isolated from Streptomyces conglobatus, as a small-molecule inhibitor of TNKS-USP25 protein-protein interaction (PPI) to overcome multi-drug resistance in colorectal cancer (CRC). The disruption of TNKS-USP25 complex formation by UAT-B led to a significant decrease in TNKS levels, triggering cell apoptosis through modulation of the Wnt/β-catenin pathway. Importantly, UAT-B successfully inhibited the CRC cells growth that harbored high TNKS levels, as demonstrated in various in vitro and in vivo studies utilizing cell line-based and patient-derived xenografts, as well as APC^min/+ spontaneous CRC models. Collectively, these findings suggest that targeting the TNKS-USP25 PPI using a small-molecule inhibitor represents a compelling therapeutic strategy for CRC treatment, and UAT-B emerges as a promising candidate for further preclinical and clinical investigations.

Objective To explore the impact of the three-level assistance model based on the narrative nursing theory on the mental health status of medical staff.Methods 140 medical staff working in a third class hospital in Xiangyang City were selected as the research object.The three-level assistance model based on narrative nursing theory was used to intervene them from September 2021 to July 2022.The symptom self-assessment scales before and after the intervention were compared.Results Before the intervention,the total score of SCL-90(156.37±32.56)points and the scores of various symptom factors of medical staff were higher;After the intervention,the total score of SCL-90(133.35±43.48)points and the scores of various symptom factors were lower than those before the intervention and the difference was statistically significant(P<0.05).Conclusion The three-level assistance model based on narrative nursing theory can reduce the total score of SCL-90 and the scores of various symptom factors,improve the mental health status and mental health level.

Objective:To investigate the risk factors of initial non-invasive ventilation(NIV) failure and its association with adverse outcomes in very low birth weight infants (VLBWI).Methods:A retrospective cohort study was conducted, collecting clinical data of 2 102 VLBWI who received NIV within 30 minutes after birth, admitted to 18 NICU of Suxinyun Neonatal Perinatal Collaboration Network (SNPN) from January 1 st, 2019 to December 31 st, 2022. According to the outcome of NIV within the first 72 hours, the study cohort was divided into success group and failure group. Univariate analysis and multivariate Logistic regression analysis were performed to identify risk factors for NIV failure and its association with adverse outcome. Results:A total of 2 102 VLBWI were included, consisting of 1 078 males (51.3%). The gestational age was 29 (28, 31) weeks, and the birth weight was 1 250 (1 090, 1 380) g. The initial NIV failure rate was 15.3%(321/2 102). Multivariate Logistic regression analysis showed that smaller gestational age ( OR=0.67, 95% CI 0.61-0.74, P<0.001), maternal hypertensive disorders during pregnancy ( OR=10.31, 95% CI 7.48-14.21, P<0.001), Apgar score at the first minute ≤7 ( OR=1.40, 95% CI 1.01-1.93, P=0.042), grade 3-4 respiratory distress syndrome (RDS)( OR=2.85, 95% CI 1.69-4.81, P<0.001), ≥2 times pulmonary surfactant (PS) treatment ( OR=3.78, 95% CI 2.09-6.83, P<0.001), fraction of inspired oxygen (FiO 2)>0.30 ( OR=2.21, 95% CI 1.64-2.98, P<0.001) were all independent risk factors for initial NIV failure. The failure group had higher risks of mortality ( OR=10.19, 95% CI 6.50-15.97, P<0.001), pneumothorax ( OR=4.33, 95% CI 1.59-11.79, P=0.004), neonatal pulmonary hemorrhage ( OR=8.48, 95% CI 4.08-17.64, P<0.001), moderate to severe bronchopulmonary dysplasia (BPD)( OR=1.75, 95% CI 1.19-2.56, P=0.004), and intraventricular hemorrhage (IVH) ≥grade Ⅲ ( OR=2.18, 95% CI 1.27-3.73, P=0.004) compared to the success group. Conclusions:Small gestational age, maternal hyertensive disorders during pregnancy, Apgar score at the first minute ≤7, grade 3-4 RDS, PS treatment ≥2 times and FiO 2 >0.30 are risk factors for initial NIV failure in VLBWI. Initial NIV failure is associated with increased risk of mortality, pneumothorax, pulmonary hemorrhage, moderate to severe BPD, and IVH ≥grade Ⅲ.

Objective:To explore the methods of improving the clinical thinking ability of clinical medical interns in neurology department.Methods:Clinical medical interns from 2017 to 2018 were selected as the research subjects. The clinical medical interns in 2018 and in 2017 were set as the experimental group (98 people) and the control group (95 people). In the clinical practice of the neurology department, the experimental group was trained in clinical thinking ability, and the control group was trained by the traditional methods. Before the end of the internship, the self-made Clinical Medical Interns Clinical Thinking Ability Questionnaire was used to evaluate the teaching effect. SPSS 14.0 was used for t-test and Chi-square test. Results:The experimental group and the control group had the problems of one-sidedness, appearance, fixedness, passivity, laziness, simplification, confusion of clinical thinking. The clinical thinking problems in the experimental group were significantly improved than those in the control group ( P<0.001). There were significant differences in clinical thinking between the experimental group and the control group in terms of one-sidedness, appearance, fixedness, passivity and laziness ( P<0.05). In addition to language communication and expression ability, the self-assessment score of clinical thinking ability in the experimental group was statistically different from that in the control group ( P<0.05). Compared with the control group, there were also significant differences in the examination results of the experimental group ( P< 0.05). Conclusion:The implementation of clinical thinking training in neurology practice is conducive to cultivating students' clinical thinking ability and improving the quality of personnel training.

Objective:To translate and culturally adjust Decisional Fatigue Scale (DFS) , and test its reliability and validity.Methods:The Chinese version of DFS was formed through the method of double translation, back translation and expert consultation. Using the convenient sampling method, 247 medical staffs from 16 departments in 76 wards of Xiangyang No.1 People's Hospital Affiliated to Hubei University of Medicine were selected as the research objects. Content validity, criterion validity and structure validity were used for validity evaluation, and internal consistency reliability, split half reliability and retest reliability were used for reliability evaluation. A total of 247 questionnaires were sent out in this study and 247 were effectively received, with effective recovery of 100.00%.Results:The total Cronbach's α coefficient of Chinese DFS was 0.933, the half-reliability coefficient was 0.849 and the retest reliability coefficient was 0.838 ( P<0.01) . Both the item content validity index and scale content validity index were 1.00, and the correlation coefficient with the total score of SRF-S was 0.729 ( P<0.01) . One common factor was extracted by exploratory factor analysis and 65.64% of the variation was explained cumulatively, which was consistent with the dimensions of the original scale. Confirmatory factor analysis showed that all fitting indexes were up to standard and the fitting degree was good. Conclusions:The reliability and validity of the Chinese version of DFS in medical staffs is good, which can be used to evaluate the degree of decision-making fatigue of Chinese medical staffs.

Objective:To test the reliability and validity of the Chinese version of the Demoralization Scale-Ⅱ (DS-Ⅱ) in maintenance hemodialysis (MHD) patients.Methods:This was a cross-sectional study. From October 2021 to February 2022, 989 patients who received MHD in 16 hospitals in Xiangyang City, Hubei Province, were selected by convenience sampling as the study subject. The patients were investigated with the General Information Questionnaire, DS-Ⅱ, Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) . The correlation coefficient and critical ratio were used for project analysis. The reliability of the total scale and sub-scale were tested by Cronbach 's α coefficient, split half reliability coefficient, retest reliability coefficient. The exploratory factor analysis was used to determine item pool dimension and scale structure, and the confirmatory factor analysis was used to test the structural validity of the scale. We tested the correlation among the scores of SAS, SDS and Chinese version of DS-Ⅱ. A total of 989 questionnaires were distributed, and 920 valid questionnaires were recovered, with a valid recovery rate of 93.02% (920/989) . Results:The correlation coefficient among each item score and the total score of the scale was 0.679 to 0.777 ( P<0.05) . The critical ratio of each item in high score group and low score group was 21.637 to 30.719 ( P<0.05) . The total content validity coefficient of the scale was 0.984, and the content validity coefficient of each item was 0.875 to 1.000. Two common factors were extracted after exploratory factor analysis, and the cumulative variance contribution rate was 59.844%. The confirmatory factor analysis showed that the model fitted well, and the correlation coefficients among items and dimensions were 0.687 to 0.803. The total score of DS-Ⅱ and each factor score were positively correlated with scores of SAS and SDS ( P<0.05) . Cronbach 's α coefficient of the total scale was 0.944, and the split half reliability Guttman 's coefficient was 0.884, and the retest reliability coefficient was 0.909. Conclusions:The Chinese version of DS-Ⅱ has good reliability and validity in MHD patients.

Major depressive disorder (MDD) is characterized by emotion dysregulation. Whether implicit emotion regulation can compensate for this deficit remains unknown. In this study, we recruited 159 subjects who were healthy controls, had subclinical depression, or had MDD, and examined them under baseline, implicit, and explicit reappraisal conditions. Explicit reappraisal led to the most negative feelings and the largest parietal late positive potential (parietal LPP, an index of emotion intensity) in the MDD group compared to the other two groups; the group difference was absent under the other two conditions. MDD patients showed larger regulatory effects in the LPP during implicit than explicit reappraisal, whereas healthy controls showed a reversed pattern. Furthermore, the frontal P3, an index of voluntary cognitive control, showed larger amplitudes in explicit reappraisal compared to baseline in the healthy and subclinical groups, but not in the MDD group, while implicit reappraisal did not increase P3 across groups. These findings suggest that implicit reappraisal is beneficial for clinical depression.
Humans ; Depressive Disorder, Major/psychology* ; Emotional Regulation ; Depression ; Emotions/physiology* ; Cognition/physiology*