Objective　To analyze the clinical distribution of carbapenem-resistant Enterobacter cloacae (CR-ECL) and changes in carbapenemase enzyme types in Ningbo and to provide a guide for the rational application of antibiotics in clinical practice. Methods　Clinical isolates of CR-ECL were selected in a hospital in Ningbo from 2012 to 2022. Bacterial identification and drug sensitivity testing were performed using the VITEK-2 COMPACT automated microbiology system. Strain confirmation was conducted using the VITEK MS mass spectrometry system. The presence of CR-ECL was confirmed using the E-Test method. Carbapenemase production in CR-ECL was determined using a rapid carbapenemase detection kit and polymerase chain reaction (PCR). Results　A total of 1 428 isolates of ECL were detected in a hospital in Ningbo from 2012 to 2022, of which 36 strains were CR-ECL, accounting for 2.52%. The top three sample sources of CR-ECL were sputum (52.78%), urine (19.44%), and bile (13.89%). The patients were mainly from neurosurgery wards (22.22%), general surgery (13.89%), and ICU wards (11.11%). The separation rate of CR-ECL showed no significant difference between different genders and age groups. The resistance rates of CR-ECL to ertapenem, imipenem, and meropenem were 94.44%, 58.33%, and 36.11% respectively. The resistance rates of CR-ECL to third/fourth generation cephalosporins, aztreonam, enzyme-inhibitor complexes, and quinolones were all above 69.50%, significantly higher than those of non-carbapenem-resistant Enterobacter cloacae (NCR-ECL) strains (P<0.05). For aminoglycosides, CR-ECL and NCR-ECL both maintained low resistance rates (0% and 0.22%, respectively). Among the 36 CR-ECL strains, 31 strains (86.11%) were carbapenemase producers, including three types: NDM (28 strains, 77.78%), KPC (4 strains, 11.11%), and IMP (2 strains, 5.56%). The other two carbapenemase types, OXA-48 and VIM, were not detected. The consistency rate between the rapid detection of carbapenem enzyme type and PCR detection was 100%. Conclusions　The detection rate of CR-ECL in a hospital in Ningbo showed a trend of fluctuation. CR-ECL strains are distributed across different departments and various samples of hospitals, with no differences in distribution observed between genders or age groups. Clinical isolated CR-ECL mainly produced NDM-type carbapenemases, but the enzyme types such as KPC and IMP have also emerged in recent years. The rapid identification of carbapenemase types can play an important guiding role in the clinical treatment of CR-ECL infection.

Background Cumulative risk index (CRI), as a commonly used approach to estimate the joint effects of multiple air pollutants on health, has been used by few studies to construct an air quality health index (AQHI). Objective To construct an AQHI based on the CRI of air pollution in Tianjin and evaluate the validity of the AQHI. Methods Daily data on air pollutants, meteorological factors, and non-accidental deaths during 2015–2019 in Tianjin were collected to create a time-series object. Descriptive statistical analyses were used to describe the characteristics of the data. To determine the best lag day and indicative pollutant, single-pollutant and two-pollutant generalized additive models were fitted to construct the exposure-response relationships between air pollutants and non-accidental deaths. After that we evaluated a CRI of air pollution using multi-pollutant models and constructed an AQHI and its classifications based on the CRI. Finally, we compared the exposure-response associations and coefficients of the AQHI and the conventional air quality index (AQI) with non-accidental deaths, and evaluated the health risk communication validity of the AQHI using generalized cross validation (GCV) values and R² values. Results We selected lag1 as the best lag day and PM_2.5, SO₂, NO₂ and O₃ as the appropriate pollutants according to the unqualified rates of pollutants and significant statistical results. One μg·m⁻³ increase of PM_2.5, SO₂, NO₂, and O₃ was associated with −0.00002, 0.00079, 0.00015, and 0.00042 increase in effect size b of the non-accidental mortality, respectively. Based on these coefficients, we calculated the CRI and AQHI. According to a pre-determined classification scheme of the AQHI, the air quality of 63% study days was low risks and that of 34% study days was median risks. The associations of AQHI and AQI with non-accidental deaths in different populations were evaluated. The results showed that the excess risks of non-accidental deaths in total, female, and male populations for per interquartile range (IQR) increase in AQHI were higher than the corresponding values of AQI. The GCV values of the AQHI model (2.694, 1.819, and 1.938, respectively) were lower than those of the AQI model (2.747, 1.850, and 1.961, respectively), and the R² values of the AQHI model (0.849, 0.780, and 0.820, respectively) were higher than those of the AQI model (0.846, 0.776, and 0.817, respectively). Conclusion Compared with AQI, the CRI-based AQHI may communicate the air pollution-related health risk to the public more effectively in Tianjin.

Objective: To investigate the usage frequency of radiological diagnosis devices in ten hospitals in Tianjin, China, and to provide a basis for the survey of medical radiation frequency in Tianjin. Methods: Ten hospitals from the ten districts in Tianjin were enrolled as subjects by a convenient sampling method. A survey was conducted to assess the general information and radiological diagnosis device information and usage frequency in those hospitals in 2016. The radiological examination frequency in Tianjin was estimated. Results: A total of 610 458 patients received radiological examinations in the sampled hospitals in 2016. In those patients, 371 882 received X-ray examinations for imaging and 238 576 for computed tomography (CT) ; there were slightly more female patients than male patients, suggesting a relatively equal gender distribution; patients older than 40 years accounted for 65.53%, which was the highest among all the age groups. Different types of radiological diagnosis devices were mostly used in tertiary and secondary hospitals. In Tianjin, the estimated frequency of X-ray examination for imaging and CT scanning was 451 and 188 per thousand people, respectively, in 2016. Conclusion The frequency of radiological diagnosis is relatively high in the ten hospitals in Tianjin. The investigation of medical radiation in Tianjin needs to be improved.