Objective To understand the clinical distribution characteristics and drug-resistance genotypes of carbapenem-resistant Pseudomonas aeruginosa(CRPA)in a tertiary hospital in Shanghai,so as to guide the rational use of antibiotics,reduce bacterial resistance and control nosocomial infections.Methods A total of 94 consecutive and non-redundant CRPA strains isolated from clinical specimens were collected in The First Affiliated Hospital of Naval Medical University between Jan.1,and Dec.31,2019.The distribution of CRPA across departments and sample sources were analyzed.Antimicrobial susceptibility testing against 13 antibiotics was determined using the VITEK 2 Compact automated microbiology analyzer and the Kirby-Bauer disk diffusion method.Polymerase chain reaction(PCR)was employed to detect genes encoding extended-spectrum β-lactamase resistance gene,carbapenemase resistance gene,and porin resistance gene.Homology analysis of selected isolates was performed using kSNP3,a k-mer-based software,for single nucleotide polymorphism(SNP)analysis.An evolutionary tree was constructed to assess genetic relationships.Additionally,multilocus sequence typing(MLST)was performed using the Pseudomonas aeruginosa typing scheme from the PubMLST database.Results Among the 94 CRPA isolates,high resistance rates were observed for carbapenems,including imipenem(92.6%,87 strains)and meropenem(87.2%,82 strains).In contrast,low resistance rates were detected for aminoglycosides,such as amikacin(10.6%,10 strains),gentamicin(20.2%,19 strains),and tobramycin(20.2%,19 strains).The top 3 departments in terms of isolate distribution were the Emergency Intensive Care Unit(9.6%,9 strains),Department of Cerebrovascular Surgery(8.5%,8 strains),and Department of Respiratory Medicine(8.5%,8 strains).PCR analysis of 94 CRPA strains detected outer membrane protein D2(OprD2)gene deletion in 47(50.0%)strains,13(13.8%)strains were positive for blaKPC,4(4.3%)strains for blaVIM,2(2.1%)strains for blaIMP,1(1.1%)strain for blaNDM,12(12.8%)strains for blaTEM,4(4.3%)strains for blaPER,and 2(2.1%)strains for blaGES,while blaOXA-48,blaBIC,blaSIM,blaVEB,and blaSHV were not detected.MLST identified 36 different sequence types(STs),with ST463 and ST274 being the most common,and 2 new ST(ST4023 and ST4024)were identified for the first time.Conclusion CRPA strains carry multiple resistance genes and exhibit concurrent resistance to several commonly used clinical antibiotics.The resistance is primarily associated with the presence of blaKPC,blaVIM and blaTEM genes and the deletion of OprD2 gene.Clinical monitoring of CRPA should be strengthened,and rational use of antimicrobial agents is essential to control its spread within the hospital.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective To investigate the effects of Semaglutide injection on glycolipid metabolism and adipokine levels in the treatment of type 2 diabetes mellitus(T2DM)patients with varying body mass index(BMI).Methods A total of 143 patients with T2DM admitted to our hospital between May 2022 and May 2024 were enrolled in this study.Based on their BMI,the patients were categorized into three groups:the normal-weight group(31 cases,18.5 kg/m2≤BMI<24 kg/m2),the super-recombinant group(49 cases,24 kg/m2≤BMI<28 kg/m2),and the obese group(63 cases,28 kg/m2≤BMI).28 kg/m2≤BMI).All participants received standard guideline-based conventional treatment and were additionally administered semaglutide injections for a duration of 12 weeks.The study compared glucose metabolism,islet β-cell function,lipid metabolism,body composition,adipokine levels before treatment and at 12 weeks post-treatment,as well as safety profiles during the treatment period across the three groups.Results After 12 weeks of treatment,the levels of fasting blood glucose(FPG),2-hour postprandial blood glucose(2 h PG),glycated hemoglobin(HbA1c),insulin resistance index(HOMA-IR),serum triglycer-ides(TG),total cholesterol(TC),and low-density lipoprotein cholesterol(LDL-C)decreased in all three groups.Specifically,the reductions were more pronounced in the obesity group compared to the normal group and the super-reorganization group,and the super-reorganization group showed intermediate reductions between the obesity and normal groups(P<0.05).Conversely,fasting C-peptide(FCP),2-hour postprandial C-peptide(2 h CP),irisin,adipsin,and omentin-1 levels increased in all three groups after treatment,with the greatest increases observed in the obesity group,followed by the super-reorganization group,both of which were significantly higher than the normal group(P<0.05).Additionally,high-density lipoprotein cholesterol(HDL-C)levels increased in all three groups after 12 weeks of treatment(P<0.05).BaselineBMI and total body fat mass(WBFM)were significantly higher in the obesity group compared to the super-reorganization group,which in turn were higher than the normal group(P<0.05).After treatment,BMI and WBFM decreased in both the obesity and super-reorganization groups,but remained significantly higher than in the normal group(P<0.05).The incidence of adverse reactions during treatment was 12.90％(4/31),10.20％(5/49),and 11.11％(7/63)in the normal,super-reorganization,and obesity groups,respectively,with no statistically significant differences among the groups(P>0.05).Conclusion Smiglutide injection can improve glucose and lipid metabolism,islet function,and adipokine levels in T2DM patients across different BMI categories,while also regulating body composition.It dem-onstrates a particularly strong improvement effect on glucose and lipid metabolism,islet function,and adipokine levels in overweight and obese T2DM patients.Additionally,smiglutide does not increase safety risks.

Objective To investigate the effects of Semaglutide injection on glycolipid metabolism and adipokine levels in the treatment of type 2 diabetes mellitus(T2DM)patients with varying body mass index(BMI).Methods A total of 143 patients with T2DM admitted to our hospital between May 2022 and May 2024 were enrolled in this study.Based on their BMI,the patients were categorized into three groups:the normal-weight group(31 cases,18.5 kg/m2≤BMI<24 kg/m2),the super-recombinant group(49 cases,24 kg/m2≤BMI<28 kg/m2),and the obese group(63 cases,28 kg/m2≤BMI).28 kg/m2≤BMI).All participants received standard guideline-based conventional treatment and were additionally administered semaglutide injections for a duration of 12 weeks.The study compared glucose metabolism,islet β-cell function,lipid metabolism,body composition,adipokine levels before treatment and at 12 weeks post-treatment,as well as safety profiles during the treatment period across the three groups.Results After 12 weeks of treatment,the levels of fasting blood glucose(FPG),2-hour postprandial blood glucose(2 h PG),glycated hemoglobin(HbA1c),insulin resistance index(HOMA-IR),serum triglycer-ides(TG),total cholesterol(TC),and low-density lipoprotein cholesterol(LDL-C)decreased in all three groups.Specifically,the reductions were more pronounced in the obesity group compared to the normal group and the super-reorganization group,and the super-reorganization group showed intermediate reductions between the obesity and normal groups(P<0.05).Conversely,fasting C-peptide(FCP),2-hour postprandial C-peptide(2 h CP),irisin,adipsin,and omentin-1 levels increased in all three groups after treatment,with the greatest increases observed in the obesity group,followed by the super-reorganization group,both of which were significantly higher than the normal group(P<0.05).Additionally,high-density lipoprotein cholesterol(HDL-C)levels increased in all three groups after 12 weeks of treatment(P<0.05).BaselineBMI and total body fat mass(WBFM)were significantly higher in the obesity group compared to the super-reorganization group,which in turn were higher than the normal group(P<0.05).After treatment,BMI and WBFM decreased in both the obesity and super-reorganization groups,but remained significantly higher than in the normal group(P<0.05).The incidence of adverse reactions during treatment was 12.90％(4/31),10.20％(5/49),and 11.11％(7/63)in the normal,super-reorganization,and obesity groups,respectively,with no statistically significant differences among the groups(P>0.05).Conclusion Smiglutide injection can improve glucose and lipid metabolism,islet function,and adipokine levels in T2DM patients across different BMI categories,while also regulating body composition.It dem-onstrates a particularly strong improvement effect on glucose and lipid metabolism,islet function,and adipokine levels in overweight and obese T2DM patients.Additionally,smiglutide does not increase safety risks.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective To explore the value of pelvic CT angiography(CTA)digital three-dimensional reconstruction model(abbreviated as"three-dimensional model")in the diagnosis of female pelvic mass.Methods A total of 98 patients with pelvic mass who were hospitalized and operated in Xi'an People's Hos-pital(Xi'an Fourth Hospital)from January 2021 to April 2023 were selected.All patients underwent B-ultra-sound and CTA examination before operation,and the original data of CTA were collected.The digital three-dimensional model of pelvic mass was established by three-dimensional reconstruction software,and the source of pelvic mass was judged according to the blood supply of pelvic mass.Taking postoperative pathological di-agnosis as the gold standard,the coincidence rate between different preoperative diagnosis methods(B-ultra-sound,CTA examination and three-dimensional model)was compared.The receiver operating characteristic(ROC)curve was plotted to evaluate the efficacy of different preoperative diagnostic methods in judging the ovarian origin of pelvic tumors.Results A total of 130 pelvic masses were included in 98 patients,and the average maximum diameter of the mass was(71.61±3.03)mm,including 83 ovarian masses and 47 non-ovarian masses.Taking postoperative pathological diagnosis as the gold standard,the diagnostic coincidence rate of the preoperative three-dimensional model was 72.31％,which was higher than that of B-ultrasound(58.46％)and CTA(52.31％),and the differences were statistically significant(P＜0.001).The sensitivity,specificity,positive predictive value,negative predictive value,accuracy,Kappa value,and area under the ROC curve were 79.51％,91.49％,94.29％,71.67％,83.85％,0.67 and 0.855,respectively,when the three-dimensional model showed that the blood supply of the mass originated from ovarian artery or uterine artery-ovarian branch.Conclusion The three-dimensional model of pelvic CTA can directly display the blood supply source,characteristics of mass,and the relationship between mass and adjacent organs,which can guide the clinical treatment.It has certain clinical value to judge the ovarian origin of pelvic mass by using ovarian artery and uterine artery-ovarian branch.

Objective:To evaluate the therapeutic effects of Yufu ointment for acute radiation-induced skin injury. Methods:We enrolled a total of 104 patients with malignant tumors who developed acute skin injury of grade 2-3 during or after the first course of radiotherapy from June 2019 to February 2023. The observation group ( n=53) and control group ( n=51) received external application of Yufu ointment and Shirun Shaoshang ointment, respectively. We recorded the changes in the grade of skin injury and associated symptoms (such as pain, itching, and burning sensation) and healing speed and time for the two groups. Results:A total of 102 patients completed the study, with 53 cases in the observation group and 49 cases in the control group. The incidence rate of moisture skin lesions in the observation group was significantly lower than that in the control group (62.26% vs. 83.67%, P<0.05). The healing speed of moisture skin ulcerations was significantly faster in the observation group than in the control group (1.67 cm 2/d vs. 0.55 cm 2/d, P<0.05). The observation group had a significantly shorter time to skin injury healing than the control group (10.40 d vs. 14.41 d, P<0.05), significantly different for skin injury of grade 2 (10.21 d vs. 17.57 d, P<0.05) but not for skin injury of grades 2.5 and 3 ( P>0.05). Regarding clinical symptoms, both groups experienced significant reductions in pain and burning sensation scores after treatment ( P<0.05); the grade of itching was significantly decreased for the observation group ( P<0.05), but had no significant change for the control group after treatment ( P>0.05). Conclusions:Yufu ointment can significantly alleviate secondary damage for patients with acute radiation-induced skin injury, by accelerating the healing process and relieving symptoms such as pain, itching, and burning sensation with good tolerability, which deserves further promotion.

In 2021, the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM) jointly released the Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2020 with 93 recommendations. In the same year, the Japanese Society of Intensive Care Medicine (JSICM) and the Japanese Association for Acute Medicine (JAAM) also cooperated to publish the Japanese clinical practice guidelines for management of sepsis and septic shock 2020, covering 118 clinical issues in 22 areas. In this paper, 50 items in the contents of the two guidelines are compared in accordance with the order of international guidelines, including screening, initial resuscitation, mean arterial pressure, transfer to intensive care unit (ICU), diagnosis of infection, timing of antimicrobial administration, biomarkers for initiation of antimicrobial therapy, selection of antibiotic, antifungal therapy, antiviral therapy, infusion of antibiotic, pharmacokinetics and pharmacodynamics, source of infection control, antimicrobial de-escalation strategy, course of antimicrobial administration, biomarkers for discontinuation of antibiotic, fluid management, vasoactive agents, positive inotropic agents, monitoring and intravenous access, fluid balance, oxygenation targets, high-flow nasal cannula oxygen therapy, noninvasive ventilation, protective ventilation in acute respiratory distress syndrome (ARDS), low tidal volume in respiratory failure patients with non-ARDS, lung recruitment maneuvers, prone position ventilation, muscle relaxants, extracorporeal membrane oxygenation (ECMO), glucocorticoids, blood purification, red blood cell (RBC) transfusion, immunoglobulin, stress ulcer prevention, prevention of venous thromboembolism (VTE), renal replacement therapy, glycemic management, vitamin C, sodium bicarbonate therapy, nutrition, treatment goals, palliative care, peer support groups, transition of care, screening economic and social support, education for the knowledge about sepsis to the patients and their families, common decision-making, discharge planning, cognitive therapy and follow-up after discharge. It is convenient for everyone to understand some views in the field of sepsis and septic shock, and deepen their understanding.
Humans ; Anti-Bacterial Agents ; Respiration ; Sepsis ; Shock, Septic ; Japan ; Practice Guidelines as Topic

Humans ; Cytomegalovirus ; Cytomegalovirus Infections ; Antigens, Viral ; Immunity ; Autoimmune Diseases ; CD8-Positive T-Lymphocytes