OBJECTIVE To observe the detection and drug resistance of carbapenem-resistant Klebsiella pneumoni-ae(CRKP)strains causing hospital-acquired infections(HAI)and community-acquired infections(CAI)in recent years so as to provide bases for prevention and control of CRKP infection and reasonable clinical use of antibiotics.METHODS A total of 3444 patients who were diagnosed with Klebsiella pneumonia infection and were hospitalized in the 2nd Affiliated Hospital of Fujian Medical University from Jan.1,2017 to Dec.31,2023 were recruited as the research subjects.Totally 230 patients with CRKP infection were chosen based on the result of drug susceptibility testing,73 of whom had HAI,and 157 had CAI.The isolation rate of CRKP strains,popula-tion distribution,specimens sources and drug resistance rates were observed and compared between the patients with HAI and the patients with CAI.RESULTS The total isolation rate of CRKP strains was 6.68％(230/3444).There was no difference in the sex of the patients with CRKP infection between the HAI patients and the CAI patients,however,the isolation rate of the CRKP strains from the patients aged between 18 and 45 years old was higher in the HAI group than in the CAI group(P＜0.05).The isolation rates of CRKP strains causing the two types of infections increased year by year,showing a remarkable increasing amplitude in 2022-2023,with the HAI increasing from 9.33％to 20.67％,the CAI increasing from 5.54％to 15.03％.The lower respiratory tract,urinary tract and bacteremia were the most common infection sites,the detection rate of soft tissue infec-tions was higher among the patients with HAI than among the patients with CAI(P=0.047).CRKP strains cau-sing HAI showed the highest isolation rate(33.33％)in catheter specimens,and the isolation rate of CRKP strains in pus specimens was higher among the HAI patients than among the CAI patients(P=0.011).The isola-tion rate of CRKP strains in sputum specimens of the CAI patients raised four times in 2023 as compared with that in 2022.The drug resistance rates of the CRKP strains to 25 types of antibiotics were relatively high and showed upward trends;the drug resistance rate of the HAI-KPN strains to imipenem was 48.78％,higher than 7.09％of the CAI-KPN strains(P＜0.001),and there were no significant differences in the drug resistance rates to other carbapenems between the CAI-KPN strains and the HAI-KPN strains.CONCLUSIONS The isolation rates of the CRKP strains causing the HAI and CAI are increasing year by year.The clinical invasive procedures and community-acquired respiratory tract infections are the key points for prevention and control.It is necessary to in-tensify the hospital-community cooperative prevention and control system based on the isolation rates and drug re-sistance rates of the CRKP strains,and take comprehensive prevention and control measures so as to curb the transmission of the drug-resistant strains.

Objective To investigate the relationship between pre-treatment collateral circulation and long-term clinical outcomes in patients with acute vertebrobasilar artery occlusion(VBAO)undergoing endovascular treatment(EVT).Methods A retrospective analysis was conducted on 129 VBAO patients who underwent EVT.Patients were categorized into short-term(90 d)and long-term(1 year)outcome groups based on follow-up duration.Clinical data were collected,and the posterior circulation collateral score(PC-CS)based on magnetic resonance angiography(MRA)was evaluated.Inter-rater reliability of the MRA PC-CS was evaluated using Cohen's Kappa coefficient.The predictive value of MRA PC-CS for outcomes was analyzed using receiver operating characteristic(ROC)curves.Multivariate logistic regression analysis was employed to identify independent predictors of long-term outcomes.Results A total of 109 patients were included in the long-term follow-up,with 78 survivors and 31 deaths.The MRA PC-CS demonstrated high diagnostic efficacy for predicting long-term outcomes,with an area under the curve(AUC)of 0.85[95%confidence interval(CI)0.78-0.92,P＜0.000 1],with an optimal cutoff value of 5 points.Multivariate logistic regression analysis revealed that age[odds ratio(OR)1.07,95%CI 1.02-1.13,P=0.005],admission National Institutes of Health Stroke Scale(NIHSS)score(OR 1.08,95%CI 1.02-1.14,P=0.01),occipital lobe infarction(OR 3.96,95%CI 1.25-12.56,P=0.02),and MRA PC-CS≤5 points(OR 0.23,95%CI 0.06-0.84,P=0.03)were independent predictors of long-term outcomes.Conclusion The MRA PC-CS can independently predict adverse long-term functional outcomes in VBAO patients.

OBJECTIVE To observe the detection and drug resistance of carbapenem-resistant Klebsiella pneumoni-ae(CRKP)strains causing hospital-acquired infections(HAI)and community-acquired infections(CAI)in recent years so as to provide bases for prevention and control of CRKP infection and reasonable clinical use of antibiotics.METHODS A total of 3444 patients who were diagnosed with Klebsiella pneumonia infection and were hospitalized in the 2nd Affiliated Hospital of Fujian Medical University from Jan.1,2017 to Dec.31,2023 were recruited as the research subjects.Totally 230 patients with CRKP infection were chosen based on the result of drug susceptibility testing,73 of whom had HAI,and 157 had CAI.The isolation rate of CRKP strains,popula-tion distribution,specimens sources and drug resistance rates were observed and compared between the patients with HAI and the patients with CAI.RESULTS The total isolation rate of CRKP strains was 6.68％(230/3444).There was no difference in the sex of the patients with CRKP infection between the HAI patients and the CAI patients,however,the isolation rate of the CRKP strains from the patients aged between 18 and 45 years old was higher in the HAI group than in the CAI group(P＜0.05).The isolation rates of CRKP strains causing the two types of infections increased year by year,showing a remarkable increasing amplitude in 2022-2023,with the HAI increasing from 9.33％to 20.67％,the CAI increasing from 5.54％to 15.03％.The lower respiratory tract,urinary tract and bacteremia were the most common infection sites,the detection rate of soft tissue infec-tions was higher among the patients with HAI than among the patients with CAI(P=0.047).CRKP strains cau-sing HAI showed the highest isolation rate(33.33％)in catheter specimens,and the isolation rate of CRKP strains in pus specimens was higher among the HAI patients than among the CAI patients(P=0.011).The isola-tion rate of CRKP strains in sputum specimens of the CAI patients raised four times in 2023 as compared with that in 2022.The drug resistance rates of the CRKP strains to 25 types of antibiotics were relatively high and showed upward trends;the drug resistance rate of the HAI-KPN strains to imipenem was 48.78％,higher than 7.09％of the CAI-KPN strains(P＜0.001),and there were no significant differences in the drug resistance rates to other carbapenems between the CAI-KPN strains and the HAI-KPN strains.CONCLUSIONS The isolation rates of the CRKP strains causing the HAI and CAI are increasing year by year.The clinical invasive procedures and community-acquired respiratory tract infections are the key points for prevention and control.It is necessary to in-tensify the hospital-community cooperative prevention and control system based on the isolation rates and drug re-sistance rates of the CRKP strains,and take comprehensive prevention and control measures so as to curb the transmission of the drug-resistant strains.

Objective To investigate the relationship between pre-treatment collateral circulation and long-term clinical outcomes in patients with acute vertebrobasilar artery occlusion(VBAO)undergoing endovascular treatment(EVT).Methods A retrospective analysis was conducted on 129 VBAO patients who underwent EVT.Patients were categorized into short-term(90 d)and long-term(1 year)outcome groups based on follow-up duration.Clinical data were collected,and the posterior circulation collateral score(PC-CS)based on magnetic resonance angiography(MRA)was evaluated.Inter-rater reliability of the MRA PC-CS was evaluated using Cohen's Kappa coefficient.The predictive value of MRA PC-CS for outcomes was analyzed using receiver operating characteristic(ROC)curves.Multivariate logistic regression analysis was employed to identify independent predictors of long-term outcomes.Results A total of 109 patients were included in the long-term follow-up,with 78 survivors and 31 deaths.The MRA PC-CS demonstrated high diagnostic efficacy for predicting long-term outcomes,with an area under the curve(AUC)of 0.85[95%confidence interval(CI)0.78-0.92,P＜0.000 1],with an optimal cutoff value of 5 points.Multivariate logistic regression analysis revealed that age[odds ratio(OR)1.07,95%CI 1.02-1.13,P=0.005],admission National Institutes of Health Stroke Scale(NIHSS)score(OR 1.08,95%CI 1.02-1.14,P=0.01),occipital lobe infarction(OR 3.96,95%CI 1.25-12.56,P=0.02),and MRA PC-CS≤5 points(OR 0.23,95%CI 0.06-0.84,P=0.03)were independent predictors of long-term outcomes.Conclusion The MRA PC-CS can independently predict adverse long-term functional outcomes in VBAO patients.

BACKGROUND:In recent years,the application of exosomes of periodontal ligament stem cells in periodontal tissue regeneration engineering has been widely studied,but the effect of exosomes on periodontal ligament stem cells derived from inflammatory environment is still unclear.OBJECTIVE:To investigate the effects of exosomes secreted by periodontal ligament stem cells from healthy and inflammatory environments on the proliferation and differentiation of periodontal ligament stem cells from inflammatory environments.METHODS:Human periodontal ligament stem cells from healthy and inflammatory tissues were isolated and cultured by enzyme digestion method.Exosomes were extracted from two kinds of periodontal ligament stem cells using ultracentrifugation.Passage 3 periodontal ligament stem cells derived from inflammatory tissue were selected and cultured in three groups.Cells in the blank group were cultured routinely.The healthy exosome group was added with exosomes secreted by peripheral ligament stem cells derived from healthy tissue.The inflammatory exosome group was added with exosomes secreted by human periodontal ligament stem cells derived from inflammatory tissue.Cell proliferation and cloning were detected.The expression of alkaline phosphatase,the formation of mineralized nodules,and the expression of mRNA and protein of genes related to osteogenesis were detected under osteogenic differentiation.RESULTS AND CONCLUSION:(1) CCK-8 assay and clonal formation test showed that compared with the blank group,two kinds of exosomes could promote the proliferation and colony formation of periodontal ligament stem cells from inflammatory tissue (P<0.05),and the effect of the healthy exosome group was stronger than that of the inflammatory exosome group (P<0.05).(2) Alkaline phosphatase and alizarin red staining showed that compared with the blank group,the two kinds of exosomes could promote the expression of alkaline phosphatase and the formation of mineralized nodules in periodontal ligament stem cells from inflammatory tissue,and the promoting effect of the healthy exosome group was stronger than that of the inflammatory exosome group.RT-PCR and western blot assay showed that compared with the blank group,the two kinds of exosomes could promote the expression of alkaline phosphatase,RUNX2,and type Ⅰ collagen mRNA and protein in periodontal ligament stem cells from inflammatory tissue (P<0.05).The promoting effect of the healthy exosome group was stronger than that of the inflammatory exosome group (P<0.05).(3) The results showed that exosomes secreted by human periodontal ligament stem cells could promote the proliferation and osteogenic differentiation of periodontal ligament stem cells derived from inflammatory environments,and the promoting effect of exosomes secreted by human periodontal ligament stem cells derived from healthy tissues was better than that from human periodontal ligament stem cells derived from inflammatory tissues.

Objective To investigate the effects of different contrast injection schemes on the image quality of triple-rule-out com-puted tomography angiography(TRO-CTA).Methods A total of 691 patients with acute chest pain who underwent TRO-CTA exami-nation from multiple centers were prospectively selected and randomly divided into mixed group and unmixed group according to dif-ferent contrast injection methods.The image quality of aorta,pulmonary artery and coronary artery in the two groups was evaluated subjectively and objectively and the radiation dose was calculated.Results There were no significant differences in subjective image quality scores,aorta and coronary CT values,signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)between the two groups(P>0.05),while there were significant differences in pulmo-nary CT values,SNR,CNR and radiation dose between the two groups(P<0.05).Conclusion The utilization of a mixed contrast injection scheme in TRO-CTA can satisfy diagnostic require-ments while ensuring a low proportional dosage and reduced radiation dose,which has clinical application value.

Objective:To evaluate the effect of the degree of neuromuscular blockade on the intraoperative surgical conditions and postoperative recovery quality in patients undergoing lumbar interbody fusion.Methods:In this randomized controlled trial, 100 patients of either sex, aged 18-79 yr, with a body mass index of 18.5-35.0 kg/m 2, of American Society of Anesthesiologists Physical Status classification < Ⅳ, scheduled for elective lumbar interbody fusion at the Affiliated Hospital of Xuzhou Medical University from August to October 2024, were allocated into 2 groups ( n=50 each) using stratified randomization based on the number of lumbar segments: deep neuromuscular blockade group (group D) and moderate neuromuscular blockade group (group M). The intraoperative post-tetanic count was maintained at 1 or 2 in group D, and the intraoperative train-of-four was maintained at 1 or 2 in group M. The scores for surgical conditions, duration of operation, blood loss, length of incision, occurrence of severe hypoxemia after extubation, requirement for rescue analgesia in post-anesthesia care unit, 15-item Quality of Recovery scale score and length of stay were recorded. Results:Compared with group M, the scores for surgical conditions were significantly increased, the rate of rescue analgesia in post-anesthesia care unit was decreased, 15-item Quality of Recovery scale scores were increased at 3 days after surgery ( P<0.05), and no significant changes were found in the duration of operation, blood loss, length of incision, incidence of severe hypoxemia after extubation and length of hospital stay in group D ( P>0.05). Conclusions:Compared with moderate neuromuscular blockade, deep neuromuscular blockade can provide better surgical conditions and improve the quality of early postoperative recovery for patients undergoing lumbar interbody fusion.

Objective:To explore the differences in sociodemographic and clinical characteristics between pa-tients with unipolar depression bipolar depression and to establish a nomogram for identifying bipolar depression.Methods:Using data from the China Mental Disorders Cohort Study,the sociodemographic and clinical characteristics of 2 643 patients with unipolar depression and 250 patients with bipolar depression diagnosed accord-ing to the criteria of the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5)were includ-ed to compare their sociodemographic and clinical characteristics.These characteristics included general demograph-ic information,disease-related information,clinical examination results,and the severity of the disease assessed with the Global Assessment of Functioning(GAF)and Hamilton Depression Rating Scale.Logistic regression analysis was employed to identify factors influencing bipolar depression,and a nomogram was constructed for its identifica-tion.Results:The risk factors for bipolar depression included being male(OR=1.48),being employed(OR=1.38),having non-melancholic features during episodes(OR=2.33),a Body Mass Index ranging from normal to obese(OR=2.48,2.49,4.65),psychotic features(OR=2.14),mixed episode(OR=9.36),comorbid physical diseases(OR=2.47),four or more depressive episodes(OR=1.67),earlier age of onset(OR=0.95),longer ill-ness duration(OR=1.03),and higher GAF scores(OR=1.02).The nomogram model achieved an AUC of 0.81(95％CI:0.78-0.84).The Hosmer-Lemeshow test result was x2=6.96(P＞0.05),indicating good model fit.The calibration curve showed good performance.The decision curve analysis revealed that the nomogram pro-vides significant clinical benefit when the risk of bipolar depression was within the range of 0 to 0.9.Conclusion:The nomogram established based on the identified sociodemographic and clinical factors can accurately assess the risk of bipolar depression,providing a useful tool for early identification and intervention.

This study analyzes the legal application of a dispute over employer identification in a case of occupational heat illness caused by part-time work to clarifying matters related to employer determination in occupational disease diagnosis using a case analysis method and factual reconstruction. The analysis is based on relevant civil laws and regulations, occupational disease diagnosis laws and regulations, and jurisprudential theories. The occupational disease diagnostic institution identified the part-time employer as responsible for the patient′s heat illness, which was both reasonable and lawful. This attribution safeguarded the rights of the worker, the primary employer, and the part-time entity. In occupational disease diagnosis, attention should be paid to de facto employment relationship, and the principle of "accountability lies with the actual employer at the time of the incident" should be followed to standardize employer identification. The health administrative department has supervisory responsibilities over occupational disease diagnoses. Workers′ compensation rights can be protected through the advance payment mechanism for work-related injury insurance. It is recommended to further improve internal procedures for occupational disease diagnosis, strengthen the dissemination of relevant laws and regulations and enhance the capabilities of occupational disease diagnosis physicians, to further protect workers' occupational health and their associated legal rights.

OBJECTIVE To analyze the manager post competency evaluation scale in central sterile supply depart-ment based on the iceberg model and test its reliability and validity.METHODS A pool of items was constructed based on literature research and semi-structured interviews.The scale was further refined through expert meetings and a pilot survey.A convenience sampling method was used to select 362 managers from central sterile supply de-partments in medical institutions at various levels in Hunan Province in Jan.2024 as survey subjects.Question-naires were administered,and the reliability and validity of the scale were tested.RESULTS The final version of the scale encompassed five dimensions:personal traits,management abilities,professional abilities,other abili-ties,professional knowledge and skills,with a total of 39 items.The item-level validity coefficients of the scale ranged from 0.83 to 1.00,and the content validity index was 0.93.Exploratory factor analysis revealed a Bartlett's test value of 4 723.828(P＜0.001),a KMO test coefficient of 0.937 and a cumulative variance explanation rate of 74.34％for the five common factors.Confirmatory factor analysis results indicated that the root mean square error of approximation(RSEMA)was＜0.08,the root mean square residual(RMR)was＜0.05,and both the incre-mental fit index(IFI)and comparative fit index(CFI)were＞0.9.The Cronbach's α coefficient of the scale was 0.977,the split-half reliability was 0.955,and the test-retest reliability was 0.952.CONCLUSIONS The manager post competency evaluation scale in central sterile supply departments developed in this study demonstrates rela-tively good reliability and validity.It can effectively evaluate manager post competency and provide references for improving related evaluation systems and optimizing training programs.