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.

Objective:To analyze the performance characteristics of the energy output of defibrillation device at different lifecycle stages of the equipment,and to improve the level of management,so as to ensure the safety and effectiveness of using the device.Methods:A total of 90 defibrillation devices of using 10 types included 861290 and CardioServ(included scrapped devices)during the period of 2015-2022 were retrospectively analyzed.The detected data of energy output of defibrillation device were analyzed as statistical method,and the error of releasing energy was calculated.A total of 36 defibrillation devices that were in the early stages of use(at the first three years of device use)were divided into the first year,the second year and the third year,and the data of energy outputs of devices among three years were compared.The data of the type A and type B defibrillation devices,which were the largest number of devices in the normal stage of use(the middle stage of use),were calibrated according to the energy release in the three years between 2018 and 2000.The difference of releasing energy at the preseted value of 100J between the two types of devices was analyzed.Finally,the errors of energy releases of 8 devices,which energy outputs exceeded the deadline,in the scrap period between 2015 and 2022 were summarized.Results:In the data of three groups of devices in the early stages of use,the differences at the first and second year of device use among 100J,150J and 200J of the energy releases of the preseted values were significant(t=-0.17,-0.17,-0.58,P>0.05).The difference of the measured values between the first and third years of device use was not significant(Z=-0.70,-0.38,-0.86,P>0.05).The results of variance analysis of repeated measurement of the energy releases of the devices in normal stage indicated that the difference of the energy release at 100J preseted point among different types of 41 devices was significant(F=4.40,P<0.05).The energy release of type X defibrillator appeared constantly high,and the relative error increased with the increasing of preseted values.The repeatability of the device was better,and the relationship between preseted energy(x)and release energy(y)conformed to linear relationship(R2=0.9985).In these defibrillation devices that were using,the qualified rate of energy output of>100J preseted point was 97.68%.Conclusion:There is slight difference in the mean value of energy release between different type of defibrillation devices within the qualified range,and the energy release still is a performance indicator that should be highly focused for defibrillation devices.We should combine with the maintenance and repair data of device to conduct in-depth analysis,so as to grasp the operating status of the device,and optimize the strategy of quality control,and ensure the safety of defibrillator in clinical use.

This study retrospectively analyzed the clinical data of four patients with malignant tumor-induced ureteral strictures admitted to our hospital. All patients successfully underwent ureteroscopic metal stent placement surgery under real-time ultrasound guidance, with a surgical duration of (64±33) minutes. Postoperatively, there was a creatinine decrease of (74±127) mmol/L. Only two cases experienced Clavien-Dindo grade I complications postoperatively. The stents were well positioned in all patients, with a postoperative hospital stay of (2.5±0.6) days. This surgical approach for malignant tumor-induced ureteral obstruction can compensate for the limitations of endoscopic visualization.

ObjectiveTo construct a quantitative differentiation model of traditional Chinese medicine （TCM） syndromes by taking primary osteoporosis （POP） with kidney yang deficiency syndrome as an example， and to provide methodological reference for the standardization of syndrome differentiation. MethodsHigh-frequency clinical features of POP were screened by descriptive statistical analysis， and strong association features of POP were obtained by association rule algorithm. On this basis， a latent structure （latent tree） model was established through latent structure analysis， and the implicit and explicit variables （features） related to POP with kidney yang deficiency syndrome were comprehensively clustered， and the clustering results were interpreted by the indexes of mutual information and cumulative information coverage， to explore the primary and secondary symptoms， and to deduce the categories of POP with kidney yang deficiency syndrome based on the probability of the features appearing in the various latent categories. Based on the categories， the clinical feature scores and identification thresholds were calculated， and the syndrome differentiation model of POP with kidney yang deficiency was initially constructed by combining the comprehensive judgment rules. Finally， the results of TCM professionals' judgment were used as the gold standard to further evaluate the effectiveness of the model in assisting the syndrome differentiation. ResultsThe 32 features strongly associated with POP were obtained， and the Bayes information critedon score of the further constructed latent tree model was -15291.93. Based on the mutual information and the cumulative information coverage， the main symptoms of POP with kidney yang deficiency syndrome were bone weakness， fatigue， pale tongue， clear urine， frequent nocturnal urination， cold limbs， thin pulse， white coating， and secondary symptoms were weakness， loss of libido， loose stool， frequent urination， lumbar and knee weakness， and fear of cold. From the probability of the occurrence of each clinical feature in different latent categories of POP with kidney yang deficiency syndrome， the state was introduced as S0 category （none/mild kidney yang syndrome）/ S1 category （moderate kidney yang syndrome）/ S2 category （severe kidney yang syndrome）. Optimizing the preliminary rules of state identification and refining the state of S1 category， the results showed that among 970 patients with POP， there were 520 patients having no/mild kidney yang deficiency syndrome， 224 patients with moderate to mild kidney yang deficiency syndrome， 81 patients with moderate to severe kidney yang deficiency syndrome， and 145 patients with severe kidney yang deficiency syndrome. During the evaluation and validation process， the correct rate of the model assessment index was 0.8835， while the sensitivity was 0.7181， and the specificity was 0.9437. ConclusionCombined with the latent structure analysis of the association rule， the syndrome differentiation model for POP with kidney yang deficiency could be constructed， and the model shows a good quantitative identification effect， which can provide methodological supports for clinicians to improve the efficiency and accuracy of TCM diagnosis.

Objective:To explore effects of health education based on teach-back method on functional exercise compliance in patients with kinesophobia after total knee arthroplasty (TKA) .Methods:Using the convenient sampling method, a total of 104 patients with TKA kinesiophobia who were admitted to First Ward of Department of Orthopedics in the First Affiliated Hospital of Zhengzhou University from August 2019 to November 2020 were selected as the research objects. Among them, 52 patients admitted from August 2019 to March 2020 were set as the control group, while 52 patients admitted from April to November 2020 were set as the experimental group. They were respectively given routine health education and health education based on teach-back method. Before the intervention and 2 weeks after the intervention, the differences in Functional Exercise Compliance Scale for Orthopedic Patients, Hospital for Special Surgery Knee Score (HSS) and Modified Barthel Index (MBI) scores were compared between the two groups.Results:After implementing the health education intervention program based on the teach-back method, the total score of Functional Exercise Compliance Scale for Orthopedic Patients of patients and dimensions scores of exercise compliance related to physical aspects, the exercise compliance related to psychological aspects and the exercise compliance related to active learning in the experimental group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . The scores of HSS and MBI in the experimental group were higher than those in the control group after intervention, and the differences were statistically significant ( P<0.01) . Conclusions:The health education intervention program based on the teach-back method is scientific and reliable, which can effectively improve the functional exercise compliance of TKA patients with kinesiophobia, promote recovery of knee joint function and improve their activities of daily living.

The widespread availability real-world study (RWS) offers valuable insights into disease treatment, disease management, and socio-economic status in routine practice, as well as cautionary tales and methodological challenges such as the discovery of sample heterogeneity and bias of data and its correction. This paper summarizes the common bias and its control in the process of design, implementation and analysis for RWS in order to promote the standardization and rationality of the implementation of RWS.

Objective To investigate the protective effect of ischemic postconditioning on lung injury in situ during lung ischemic reperfusion.Methods 24 SD rats were randomly divided into 3 groups,sham-operated group(S),ischemic-reperfusion group(I/R) and ischemic postconditioning group (IpostC).IpostC was established by several brief reperfusion-ischemia (30 s,5 cycles) before continuous reperfusion.AKT,p-AKT,p70S6K,p-p70S6K protein expression,apoptotic cells were tested by Western blotting and TUNEL,wet to dry weight ratio(W/D) in lung tissue were determined respectively.The lung pathological changes were also observed.Results Compared with S group,expression of Akt、p-Akt、p70S6K、p-p70S6K and the ratio of W/D,apoptotic index in lung tissue all markedly increased in I/R and IpostC group (P ＜ 0.05).Compared with I/R group,expression of Akt、p-Akt、p70S6K、p-p70S6K markedly increased in IpostC group(P ＜0.05),while the ratio of W/D and apoptotic index significantly reduced (P ＜ 0.05),the pathological injury in IpostC group also reduced significantly.Conclusion IpostC has a protective effect on lung ischemic reperfusion injury via PI3K/Akt pathway.

AIM To analyze the mechanism of the adriamycin induced cardiomyopathy. METHODS The patch clamp technique in the whole cell recording was used to study the effect of adriamycin on L type calcium channel current( I Ca L ) in the isolated cardiomyocyte of the guinea pig. RESULTS The current voltage( I U ) curveshowed the bell shape in the control and in 0 1 mmol?L -1 adriamycin. Their peak potentials were about +10 mV. The amlitude of peak calcium current increased from (-0 93?0 05) nA to (-1 31?0 08) nA( P

Objective:To analyze the radionuclide bone imaging features of spine tumors and its clinical value.Methods and results:Data of radionuclide planar whole-body bone imaging with 99m Tc-MDP were analyzed in90patients with various spinal tumors confirmed by histopathology.In49patients with metastases,bone imaging was positive in43;37vertebra showed strong uptake;30patients involved the whole vertebra with symmetrical enlargement in18;other extravertebral bone foci were seen in29.In17patients with primary malignant bone tumors,bone imaging was positive in12;11vertebra showed strong uptake;and8involved the whole vertebra;3focal lesions had local irregular bulging;other extravertebral bone foci were seen in4.In24patients with benign bone tumors,bone imaging was positive in13;6vertebra showed strong uptake; other extravertebral bone foci were seen in1.Conclusion:Spinal metastases in bone imaging are mainly multiple,strong up-take of whole vertebra and accompanied by symmetrical enlargement with other extravertebral bone foci.Primary malignant bone tumor is mainly single or multiple,strong uptake of whole vertebra without symmetrical enlargement,some with local irregular bulging lesions. [