OBJECTIVE To explore the isolation rates,drug resistance and molecular epidemiological characteristics of carbapenem-resistant gram-negative bacilli(CRGNB)isolated from intensive care units(ICU)of a tertiary hos-pital so as to provide bases for prevention and control of the nosocomial infections caused by CRGNB.METHODS The environmental surfaces that were high frequently contacted by the patients with CRGNB infections[carbapen-em-resistant Klebsiella pneumoniae(CRKP),carbapenem-resistant Acinetobacter baumannii(CRAB),carbap-enem-resistant Pseudomonas aeruginosa(CRPA)]and their hands were randomly sampled from the ICU of a ter-tiary three-A hospital from Apr.2024 to Aug.2024.Multilocus sequence typing(MLST)and detection of drug re-sistance genes were performed by means of complete genome sequencing technique and bioinformatics,and the ho-mology between the CRGNB strains isolated from the patients and the strains isolated from their surrounding was observed.RESULTS Totally 30(7.85％)strains of CRGNB were isolated,23(6.02％)of which were CRKP,7(1.83％)were CRAB,and no strain of CRPA was detected.The molecular subtyping showed that ST 11(93.33％)was dominant among the CRKP strains,and ST2(69.23％)was dominant among the CRAB strains.The phylogenetic analysis indicated that there were clonal transmission tendencies of CRKP-ST11 and CRAB-ST2.The analysis of drug resistance genes showed that the CRAB strains mainly carried ant(3")-lla(100％),blaOXA-23(92.31％)and amvA(92.31％);blaOXA-23 and blaOXA-66 were the major carbapenems resistance genes;the CRKP strains mainly carried the drug resistance genes emrDh,rmtB1,fosA and kdeA(all were 96.67％),followed by the carbapenems resistance gene blaKPC-2(90.00％).CONCLUSIONS ST11 is the predomi-nant molecular subtype for CRGNB among the CRKP strains isolated from the ICU,anf ST2 predominant among the CRAB strains;the carrying rates of drug resistance genes are high.There is risk of clonal transmission.It is necessary to strengthen the monitoring and take comprehensive infection control measures so as to reduce the incidence of nosocomial infections.

Objective This study aimed to explore the effect of liraglutide on estimated glomerular filtration rate(eGFR)and urine albumin-to-creatinine ratio(UACR)levels in patients with type 2 diabetes mellitus(T2DM).Methods Databases including PubMed,Embase,Cochrane Library,WanFang,and China National Knowledge Infrastructure(CNKI)were systematically searched from inception to June 30,2024.According to the inclusion criteria,randomized controlled trials(RCTs)involving intervention of liraglutide in T2DM were identified.Parameters of eGFR and UACR were extracted pre-and post-treatment in each study.A fixed or random-effects model was used for quantitative synthesis according to the heterogeneity,which was assessed with I2 index.Quality of eligible RCTs was evaluated based on the Cochrane criteria.Sensitivity test was conducted by using the standard method.Publication bias was evaluated according the Begg's and Egger's tests.Meta-analysis was performed with Revman 5.3 and Stata 12.0 softwares.Results A total of 10 studies,which included 11 RCTs and involved 657 patients,were ultimately identified after performing a systematic search.Of these,322 patients were administered with liraglutide.The overall quality of eligible RCTs was rated as medium.Compared with control group,no significant changes of eGFR(WMD=4.52 mL/min/1.73 m2,95%CI:-2.79-11.84,I2=88%,P=0.23)was observed in liraglutide-treated participants.In contrast,liraglutide significantly improved levels of UACR(WMD=-13.48 mg/g,95%CI:-22.68--4.29,I2=75%,P=0.004).The results were stable according to the sensitivity test.No significant publication bias was demonstrated after performing the Begg's and Egger's tests.Conclusions The administration of liraglutide prevented the decline of eGFR and reduced UACR in T2DM.These results suggested that diabetic participants potentially benefit more from liraglutide treatment in clinical practice.

Objective This study aimed to explore the effect of liraglutide on estimated glomerular filtration rate(eGFR)and urine albumin-to-creatinine ratio(UACR)levels in patients with type 2 diabetes mellitus(T2DM).Methods Databases including PubMed,Embase,Cochrane Library,WanFang,and China National Knowledge Infrastructure(CNKI)were systematically searched from inception to June 30,2024.According to the inclusion criteria,randomized controlled trials(RCTs)involving intervention of liraglutide in T2DM were identified.Parameters of eGFR and UACR were extracted pre-and post-treatment in each study.A fixed or random-effects model was used for quantitative synthesis according to the heterogeneity,which was assessed with I2 index.Quality of eligible RCTs was evaluated based on the Cochrane criteria.Sensitivity test was conducted by using the standard method.Publication bias was evaluated according the Begg's and Egger's tests.Meta-analysis was performed with Revman 5.3 and Stata 12.0 softwares.Results A total of 10 studies,which included 11 RCTs and involved 657 patients,were ultimately identified after performing a systematic search.Of these,322 patients were administered with liraglutide.The overall quality of eligible RCTs was rated as medium.Compared with control group,no significant changes of eGFR(WMD=4.52 mL/min/1.73 m2,95%CI:-2.79-11.84,I2=88%,P=0.23)was observed in liraglutide-treated participants.In contrast,liraglutide significantly improved levels of UACR(WMD=-13.48 mg/g,95%CI:-22.68--4.29,I2=75%,P=0.004).The results were stable according to the sensitivity test.No significant publication bias was demonstrated after performing the Begg's and Egger's tests.Conclusions The administration of liraglutide prevented the decline of eGFR and reduced UACR in T2DM.These results suggested that diabetic participants potentially benefit more from liraglutide treatment in clinical practice.

OBJECTIVE To explore the isolation rates,drug resistance and molecular epidemiological characteristics of carbapenem-resistant gram-negative bacilli(CRGNB)isolated from intensive care units(ICU)of a tertiary hos-pital so as to provide bases for prevention and control of the nosocomial infections caused by CRGNB.METHODS The environmental surfaces that were high frequently contacted by the patients with CRGNB infections[carbapen-em-resistant Klebsiella pneumoniae(CRKP),carbapenem-resistant Acinetobacter baumannii(CRAB),carbap-enem-resistant Pseudomonas aeruginosa(CRPA)]and their hands were randomly sampled from the ICU of a ter-tiary three-A hospital from Apr.2024 to Aug.2024.Multilocus sequence typing(MLST)and detection of drug re-sistance genes were performed by means of complete genome sequencing technique and bioinformatics,and the ho-mology between the CRGNB strains isolated from the patients and the strains isolated from their surrounding was observed.RESULTS Totally 30(7.85％)strains of CRGNB were isolated,23(6.02％)of which were CRKP,7(1.83％)were CRAB,and no strain of CRPA was detected.The molecular subtyping showed that ST 11(93.33％)was dominant among the CRKP strains,and ST2(69.23％)was dominant among the CRAB strains.The phylogenetic analysis indicated that there were clonal transmission tendencies of CRKP-ST11 and CRAB-ST2.The analysis of drug resistance genes showed that the CRAB strains mainly carried ant(3")-lla(100％),blaOXA-23(92.31％)and amvA(92.31％);blaOXA-23 and blaOXA-66 were the major carbapenems resistance genes;the CRKP strains mainly carried the drug resistance genes emrDh,rmtB1,fosA and kdeA(all were 96.67％),followed by the carbapenems resistance gene blaKPC-2(90.00％).CONCLUSIONS ST11 is the predomi-nant molecular subtype for CRGNB among the CRKP strains isolated from the ICU,anf ST2 predominant among the CRAB strains;the carrying rates of drug resistance genes are high.There is risk of clonal transmission.It is necessary to strengthen the monitoring and take comprehensive infection control measures so as to reduce the incidence of nosocomial infections.

【Objective】 To explore the model of "One Core, Multiple Elements" emergency blood donation volunteer team (referred to as the Model) . 【Methods】 The Nanjing City Voluntary Blood Donation Joint Meeting serves as the core, with diverse entities including party committees, government departments, district governments, social organizations, enterprises, blood donors, etc. Following the principles of "emergency response in emergencies, wartime readiness, combining regular and wartime efforts," and adhering to the framework of the Model, the emergency blood donation volunteer team system in Nanjing was constructed. 【Results】 1) After the construction of the Model (2018—2022), the total number of emergency blood donation volunteers in Nanjing City increased by 191% compared to the pre-construction period (2013—2017), with an average annual blood donation of 20 929, showing significant differences (P<0.05). 2) After the construction of the Model, the number of emergency blood donation during the winter and summer increased by 206% and 185%, respectively, compared to the pre-construction period, demonstrating significant differences (P< 0.05) .3) Prior to the construction of the Model, Nanjing lacked a relatively stable emergency volunteer team. After the construction, Nanjing established a total of 5 relatively stable volunteer teams, with the district-level government and township personnel accounting for the highest proportion (52.96%), followed by medical personnel (23.95%), enterprise team (11.10%), State-owned Assets Supervision and Administration Commission team (7%), and Nanjing municipal government team (4.98%). 4) Following the Model, during the COVID-19 pandemic, Nanjing successfully initiated two Level Ⅱ blood emergency responses, with emergency blood donations reaching 23 041. 【Conclusion】 The Model can effectively ensure the blood supply in Nanjing region during emergencies.

Objective To investigate the relationship between family burden and support for maintenance hemodialysis ( MHD) patients. Methods Family APGAR index scale ( APGAR scale) and disease family burden scale ( FBS) were used to investigate among 126 MHD patients ( selected by convenient sampling method) from July 2012 to December 2013 in one Beijing level three class A hospital. Results The score of family burden was (36. 01 ± 7. 52) presented at 3 aspects of family economic burden, family daily life and family entertainment activities. The total score of family support was (7. 71 ± 3. 01), in which the good family function was 92 cases (73. 1%), family slightly obstacles 14 cases (11. 1%), and family serious obstacles 20 cases (15. 8%). The burden score of family having MHD patients had negative correlation with the score of family support (r= -0. 426, P<0. 05). Conclusions MHD patients′family support has significant influence on family burden. Therefore, the nursing staffs should strengthen the concept of holistic nursing care, pay more attention to the patients′family burden as well as nursing care, so as to perfect the family function, enhance the family support and comprehensively enhance the quality of care for patients.

BACKGROUNDIt has been argued that the benefits of reducing sodium loading may be offset by increased activation of the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system. This study aimed to investigate the long-term effects of an increase in dialysis sodium removal on circulating RAAS and sympathetic system in hypertensive hemodialysis (HD) patients with "normal" post-HD volume status.

METHODSThirty hypertensive HD patients were enrolled in this pilot trial. After one month period of dialysis with standard dialysate sodium of 138 mmol/L, the patients were followed up for a four months period with dialysate sodium set at 136 mmol/L, without changes in instructions regarding dietary sodium control. During the period of study, the dry weight was adjusted monthly under the guidance of bioimpedance spectroscopy to maintain post-HD volume status in a steady state; 44-hour ambulatory blood pressure, plasma renin, angiotensin II (Ang II), aldosterone, and norepinephrine (NE) were measured.

RESULTSAfter four months of HD with low dialysate sodium of 136 mmol/L, 44-hour systolic and diastolic blood pressures (BPs) were significantly lower (-10 and -6 mmHg), in the absence of changes in antihypertensive medications. No significant changes were observed in plasma renin, Ang II, aldosterone, and NE concentrations. The post-HD volume parameters were kept constant.

CONCLUSIONMildly increasing dialysis sodium removal over 4 months can significantly improve BP control and does not activate circulating RAAS and sympathetic nervous system in hypertensive HD patients.

Adult ; Blood Pressure ; drug effects ; Female ; Humans ; Hypertension ; therapy ; Male ; Middle Aged ; Prospective Studies ; Renal Dialysis ; Renin-Angiotensin System ; drug effects ; Sodium ; pharmacology ; Sympathetic Nervous System ; drug effects

Objective To elucidate the effect of bioimpedance ratio in the calf (calf-RBI) for volume evaluation on hypertension in hemodialysis (HD) patients. Methods Bioimpedance in the right calf was measured by bioimpedance spectroscopy (BIS). As an index of volume status, calf-RBI was calculated as follows: calf-RBI =impedance at 200 kHz / impedance at 5 kHz. The range of age-stratified 1SD from mean calf-RBI in the healthy control was assumed as the target range for the corresponding HD patients. The dry body weight (DBW) was stepwise decreased under the guidance of calf-RBI. The changes of calf-RBI, blood pressure and antihypertensive medications were recorded and correlation analysis among indexes was performed. Results The calf-RBI showed a normal distribution in both healthy subjects and HD patients. The calf-RBI was positively correlated with age, but not with gender or BMI. Forty-two patients with (35.9%) calf-RBI beyond target range were identified in 117 HD patients. The percentage of uncontrolled hypertensive individuals was significantly higher as compared to those with calf-RBI within or below target range (59.5% vs 33.3% and 16.7%, P＜0.01). The percentage of uncontrolled hypertensive individuals and the dose of antihypertensive medications was significant improved after decreasing the DBW in the patients with calf-RBI beyond target range (74.1% vs 33.3%, P＜0.01) and defined daily dose (2.00±2.28 vs 2.49±2.47, P＜0.05 ). Conclusions The age-stratified calf-RBI may be used as a useful index for estimation of volume status, and has a good association with clinical manifestations. Recognition and correction of chronic fluid overload based on age-stratified calf-RBI is helpful in hypertension control for hemodialysis patients.

Objective To investigate the association between arterial stiffness of the common carotid artery(CCA)and insulin resistance in hemodialysis patients. Methods Arterial stiffness index β of CCA was evaluated by an ultrasonic phase-lock Echo-tracking system in 80stable non-diabetic hemodialysis patients.Insulin resistance was detected by the homeostasis model assessment method(HOMA-IR).Plasma hemoglobin,serum albumin,total cholesterol,high density lipoprotein,low density lipoprotein,triglyceride,lipoprotein(a),ApoA1,ApoB,CRP,calcium,phosphorus and creatinine were determined by standard methods. Results The stiffness index β was 11.41±4.13 in patients with previous cardiovascular disease(CVD)and 9.75±3.63 in those without CVD(P＜0.05).The stiffness index β was positively correlated with HOMA-IR(r=0.321,P＜0.01),as well as with age(r=0.376,P＜0.01),pulse pressure(r=0.267,P＜0.05),and duration of hemodialysis(r=0.219,P＜0.05).In stepwise multiple regression analysis,HOMA-IR(β=0.228,P＜0.05)and age(β=0.308,P＜0.01)were identified as significant independent variables for stiffness index β of CCA. Conclusions Insulin resistance is associated with aaefial stiffness in nondiabetic hemodialysis patients.The increased arterial stiffness may be the link between insulin resistance and cardiovascular morbidity as well as mortality in hemodialysis patients.