Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.

Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.

Humans ; Urinary Bladder Neoplasms/pathology* ; Carcinoma, Transitional Cell/pathology* ; Genetic Markers ; Biomarkers, Tumor/genetics* ; Urothelium/pathology*

Objective:To investigate the etiological distribution of hydronephrosis caused by upper uri-nary tract obstruction in adult patients and to improve the diagnostic accuracy for this condition.Me-thods:The clinical information of adult patients with newly diagnosed hydronephrosis in Upper Urinary Tract Repair Outpatient Clinic of Peking University First Hospital from May 2020 to May 2021 were pro-spectively and continuously collected.Patients with ureteral calculi or upper urinary tract tumor were ex-cluded.A total of 767 patients were involved.The underlying causes of upper urinary tract obstruction were identified by senior urological surgeons according to symptoms,medical history,physical examina-tion,and a range of diagnostic imaging techniques including ultrasound,computed tomography(CT),magnetic resonance imaging(MRI),retrograde pyelography,antegrade pyelography,radionuclide reno-gram and ureteroscopy.Results:Among the 767 patients,359(46.8％)were male and 408(53.2％)were female.The median age of these patients was 37 years(range,14-84 years).Hydronephrosis was observed at left-sided in 357 cases(46.6％),right-sided in 251 cases(32.7％),and bilateral in 159 cases(20.7％).The causes of hydronephrosis were classified as follows:(1)Non-iatrogenic factors were found in 464 cases(60.5％).These included urinary malformations in 355 cases(76.5％),infec-tion in 29 cases(6.3％),pelvic lipomatosis and/or cystitis glandularis in 23 cases(5.0％),ureteral en-dometriosis in 18 cases(3.9％),retroperitoneal fibrosis in 15 cases(3.2％),trauma in 7 cases(1.5％)and other non-iatrogenic factors in 12 cases(2.6％).Some of these patients had multiple non-iatrogenic causes.Among the 355 cases with urinary system malformations,252 cases(71.0％)had ureteropelvic junction obstruction.(2)Iatrogenic ureteral injuries accounted for 210 cases(27.4％),including 112 cases(53.3％)of urological surgical injuries,51 cases(24.3％)of radiotherapy for malignant tumor re-lated injuries,34 cases(16.2％)of gynecological and obstetrical surgical injuries,and 13 cases(6.2％)of general surgical injuries.(3)The cause of hydronephrosis remained unknown in 93 cases(12.1％).Conclusion:Hydronephrosis in adults due to upper urinary tract obstruction has a diverse range of cau-ses,with urinary malformations and iatrogenic ureteral injuries being significant contributors.Urological surgeon involved in upper urinary tract reconstruction should be familiar with these potential causes to fa-cilitate accurate diagnosis and effective treatment.

Adult ; Antibodies, Viral/isolation & purification* ; COVID-19/virology* ; Feces/chemistry* ; Female ; Humans ; Intestines/virology* ; Male ; RNA, Ribosomal, 16S/genetics* ; RNA, Viral/isolation & purification* ; SARS-CoV-2/pathogenicity*

Objective :To study therapeutic effect of irbesartan combined amlodipine on aged patients with diabetes mellitus complicated hypertension .Methods : A total of 94 aged patients with diabetes mellitus complicated hypertension ,who were treated in our hospital from Feb 2015 to Aug 2016 ,were selected .Patients were randomly and equally divided into amlodip‐ine group (received amlodipine based on routine treatment ) and combined treatment group (received irbesartan based on amlodipine group) ,both groups were treated for 12 weeks.Levels of blood pressure : SBP , DBP ,fasting plasma glucose (FPG) ,fasting insulin (FINS) and serum 25‐hydroxyl vitamin D3 [25‐(OH) D3] before and after treatment ,total effec‐tive rate and incidence rate of adverse reactions were observed and compared between two groups .Results : Total effective rate of combined treatment group was significantly higher than that of amlodipine group (91.49% vs.74.47%) , P＝0.028. Compared with before treatment ,after treatment ,there were significant reductions in levels of SBP ,DBP and FINS and significant rise in serum 25‐(OH) D3 level in two groups ,and significant reduction in FPG level in combined treatment group , P＝0.001 all.Compared with amlodipine group after treatment ,there were significant reductions in lev‐els of SBP [ (144.02 ± 11.24) mmHg vs.(129.75 ± 10.07) mmHg] ,DBP [ (85.20 ± 7.27) mmHg vs.(75.72 ± 8.13) mmHg] ,FPG [ (7.14 ± 0.47) mmol／L vs.(6.72 ± 0.51) mmol／L] and FINS [ (19.28 ± 3.24) μU／ml vs.(16.18 ± 2.39) μU／ml] ,and significant rise in serum 25‐(OH) D3 level [ (26.37 ± 3.87) μg／L vs.(32.48 ± 4.22) μg／L] in combined treatment group ,P＝0.001 all.There was no significant difference in incidence rate of adverse reactions between two groups ,P＝0.712. Conclusion : Irbesartan combined amlodipine possesses significant therapeutic effect on aged patients with diabetes mellitus complicated hypertension .It can significantly and effectively control blood pressure ,improve glucose metabolism with good safety ,which is worth extending .

The purpose of this study was to investigate the effects of salvianolic acid A (SAA) in systemic lupus erythematosus (SLE) induced by pristane in BALB/c mice. Lupus mice were established by confirming elevated levels of autoantibodies and IL-6 after intraperitoneal injection of pristane. Mice were then treated with daily oral doses of SAA for 5 months in parallel with mice treated with prednisone and aspirin as positive controls. The levels of autoantibodies were monitored at monthly intervals and nephritic symptoms observed by hematoxylin and eosin (H&E) and periodic acid-Schiff (PAS) staining. Western blot analysis of renal tissue was also employed. SAA treatment caused a significant reduction in the levels of anti-Sm autoantibodies and reduced renal histopathological changes and pathological effects. SAA treatment also significantly inhibited the phosphorylation of IKK, IB and NFB in renal tissues of lupus mice. In conclusion, the results suggest that SAA alleviates renal injury in pristane-induced SLE in BALB/c mice through inhibition of phosphorylation of IKK, IB and NFB.

Objective To clinically observe and verificate the advantages of treating infantile anorexia of spleen-dysfunction in transportation with infantile massage and Chinese medicine based on the thought of “invigo-rating spleen and nourishing qi”. Methods Multi-central large-sample randomized controlled trial was carried out in Guangzhou, Shenzhen, and Foshan. Five hundreds cases of infantile anorexia of spleen-dysfunction in transportation were randomized into infantile massage group, Chinese medicine group, infantile massage combined with Chinese medicine group and Western medicine group and two sessions of treatment were required in each group. Separately, during the enrollment, after 2 sessions of treatment, infantile anorexia signs and symptoms scale , the related therapeutic effect criterion from clinical guideline of new drugs for traditional Chinese medicine, the expression level of hemoglobin and blood zinc were adopted for efficacy assessment. Results A mong 4 groups , the recovery rate and the total effective rate of infantile massage combined with Chinese medicine group were better than those of other groups (P < 0.05). The expression level of hemoglobin and blood zinc of 4 groups both increased obviously (all P < 0.01), but more improvement was found in infantile massage combined with Chinese medicine group (both P < 0.05). Conclusion The treatment of infantile anorexia with infantile massage and Chinese medicine based on the thought of invigorating spleen and nourishing qi has a significant effect.

Objective To study the value of focused abdominal sonography for trauma (FAST) used by emergency doctor in emergency department. Method It's a prospective,double-blinded and controlled study from June 2008 to October 2009. A total of 97 casualties with severe multiple trauma, 72 male and 25 female aged from 14 to 88 years old with average age of (41 ± 16) ,admitted to emergency department were enrolled, and the bedside focused abdominal sonography for trauma was performed by emergency doctor. It was diagnosed as positive if free fluid was detected in abdomen or pericardium. The severe injury scores (ISS) were from 14 to 38 with average score of (23.2±9.3). The criteria of inclusion were age over 14 years old, injury happened within 12 hours and casualties admitted directly into emergency room. The criteria of exclusion were death of patients within 2 days without CT scanning of abdomen and exploration of abdomen with laporotomy, and operations directly determined by using FAST without conventinal sonographic examination. The FAST was compared with CT and conventional sonography judged by the findings observed during operation. Results The examination with FAST was completed in (3.18±0.79) min, whereas that with conventional sonography was (16.63t4.62) min(t = 28.61,P ＜0.001). The FAST was positive in 11 cases and negative in 86 cases, whereas the conventional sonography was positive in 13 cases and negative in 84 cases ( P = 0.5). There were 4 false negative findings in FAST resulting in 73% sensitivity, 100% specificity, 95.3% negative predictive value, 4.6% false negative rate, 100% positive predictive value, 0% false positive rate and 95.9% accuracy. Conclusions The emergency doctors are able to operate the FAST well for casualties with multiple trauma in emergency department after proper training.

Objective To analyze infarcts distribution and vascular malformation in patients with multiple infarcts in the posterior circulation and to investigate their correlation with the disease prognosis.Methods Thirty-four patients who had more than one infarct in the posterior circulation as shown on MRI were enrolled in the study.The digital subtraction angiography (DSA) of aortic arch and whole brain were performed on all patients and the images were analyzed and re-evaluated by two senior clinicians respectively.All the patients were assessed using Modified Rankin Scale (MRS) at discharge and correlation of infarcts distribution and vascular malformation with prognosis was evaluated.Results Infarct lesions most often involved pons (22 patients) and the middle (pons and anterior inferior cerebellum) plus distal territories (rostral brainstem, superior cerebellum and occipital and temporal lobes, 12 patients).Vascular abnormality was found in 76.5% (26/34) of the patients.The common vascular lesions involved vertebral artery (14 patients), intracranial vertebral artery (13 patients) and basilar artery (7 patients).The incidence of poor prognosis was 20.6% with 17.6% the severe disability rate and 2.9% the mortality rate.Patients with multiple lesions in proximal, middle and distal territories or basilar artery were likely to have poor prognosis.Conclusion Vascular abnormality is the main etiological factor for multiple infarcts in the posterior circulation.Infarcts distribution and the location of vascular lesions were key factors in predicting prognosis.