Objective To explore the effect of applying comprehensive interventions on promoting pathogen detec-tion before antimicrobial therapy in hospitalized patients.Methods Hospitalized patients who received therapeutic use of antimicrobial agents in a tertiary first-class hospital from January 2020 to December 2021 were selected as the research subjects.Comprehensive intervention measures were implemented from January 2021.The pathogen detec-tion rates,detection classification,and detection rates of key monitored departments before antimicrobial therapy were compared between the pre-intervention group(January-December 2020)and the post-intervention group(Janu-ary-December 2021).Results A total of 10 239 hospitalized patients who received therapeutic use of antimicrobial agents were included in analysis,4 526 cases were in the pre-intervention group and 5 713 cases in the post-interven-tion group.The pathogen detection rates before antimicrobial therapy,before restricted grade antimicrobial therapy,and before special grade antimicrobial therapy after intervention were 94.56％,94.72％,and 96.03％,respective-ly,which were higher than 83.74％,84.47％,and 84.95％before intervention,with statistical significance(all P＜0.05).The detection rate of targeted pathogens after intervention was 64.87％,higher than that before interven-tion(28.04％),with statistically significant difference(P＜0.05).The pathogen detection rates before therapeutic use of antimicrobial agents in departments of critical care medicine,pulmonary and critical care medicine,pediatrics,neurosurgery,and general surgery after intervention were 93.20％,91.17％,92.20％,94.12％,and 91.15％,re-spectively,higher than the rates before intervention,namely 85.00％,82.19％,83.20％,83.33％,and 83.03％,respectively,with statistical significance(all P＜0.05).Conclusion The application of comprehensive intervention measures can improve the pathogen detection rate before antimicrobial therapy of hospitalized patients.Close atten-tion should be paid to the pathogen detection indicators related to healthcare-associated infection diagnosis and for the detection of sterile body fluid.

Objective:To build a data-driven operation and maintenance management model for large-scale medical imaging equipment,and to analyze its application value in medical equipment management.Methods:The data-driven operation and maintenance management mode of large-scale medical imaging equipment was composed of operation and maintenance management mode architecture,equipment health status monitoring management platform architecture,historical data fault diagnosis model architecture and operation and maintenance management.16 medical imaging equipment in clinical use in Chengdu Public Health Clinical Medical Center from January 2020 to February 2022 were selected,and the traditional medical imaging equipment operation and maintenance management mode(referred to as traditional mode)and data-driven large-scale medical imaging equipment operation and maintenance management mode(referred to as data-driven mode)were adopted respectively for management according to different management modes.The imaging effect of equipment image,the frequency of equipment failure,the cost effectiveness of equipment and the satisfaction score of equipment management personnel were compared between the two management modes.Results:The scores of accuracy of diagnosis results,accuracy of patient information,image position qualification rate,image clarity,image pass rate,image quality rate and total image imaging score of the data-driven model were(9.78±1.25)points,(9.88±1.11)points,(9.54±1.08)points,(9.66±1.27)points and(9.83±1.43)points,(9.86±1.63)points and(58.55±1.44)points,respectively,which were higher than those in the traditional mode,the difference was statistically significant(t=4.958,5.268,6.522,4.327,9.765,3.923,21.474,P<0.05).The self-repair and human-made failures occurred 22 times and 10 times respectively in the data-driven model,which were lower than those of the traditional model,and 24 times of long-term use faults,which was higher than that of the traditional model,the difference was statistically significant(x2=4.363,4.294,18.692,P<0.05).The satisfaction scores of radiologists,equipment maintenance personnel,imaging technicians and patients with the data-driven mode were(94.52±6.15)points,(91.19±5.35)points,(89.27±4.93)points and(92.24±5.51)points,respectively,which were higher than those of the traditional mode,the difference was statistically significant(t=6.504,5.534,6.821,9.556,P<0.05).Conclusion:The operation and maintenance management mode based on data driven of large medical imaging equipment can improve the imaging quality of imaging equipment,reduce the incidence of failure,reduce equipment maintenance and maintenance costs,and improve user satisfaction.

Myasthenia gravis (MG) is mainly acetylcholine receptor antibody-mediated acquired autoimmune disease that affects the postsynaptic membrane at the neuromuscular junction. The predominant manifestation is muscle weakness. Extraocular muscles are frequently affected in the early stage of disease with typical symptoms of intermittent drooping of the upper eyelid (ptosis) and double vision (diplopia), which is easy to be misdiagnosed as an ophthalmic disease. When the weakness of the face, bulbar, neck and limb muscles occur, it needs to be differentiated from a variety of diseases. Other clinical disorders can present in a similar fashion and may be mistakenly labeled as MG. This paper summarizes the epidemiology, etiology, pathogenesis, clinical manifestations, classification, auxiliary examination, diagnosis, differential diagnosis, and treatment progress of MG, which can be used as a reference for clinicians and neurologists.

Myasthenia gravis is mainly acetylcholine receptor antibody-mediated, T cells-dependent and complement participated acquired autoimmune disease characterized by impairment of the neuromuscular transmission. The main clinical feature of the disease is the presence of fatigability or muscle weakness. Most patients can be successfully managed with nonspecific immunotherapies such as corticosteroid and non-steroidal immunosuppressants. However, the side effects caused by long-term corticosteroid therapy are still a hurdle in the treatment of myasthenia gravis (MG). Oral non-steroidal immunosuppressants, as add-on therapy, can greatly reduce the relapse of the disease, but some drugs have a slow onset of action and the potential for significant toxicity, and even increase the risk of infection and neoplasms with long-term treatment. Despite these therapies, a minority of patients can be refractory because of incompletely responding or not well tolerated to available therapies. Thus, the need to avoid the use of corticosteroids, or at least reduce their use as much as possible should concern all patients with MG. Targeted immunotherapy is a therapeutic monoclonal antibody or antibody fragment targeting immune cells, complement, neonatal Fc receptor and cytokines. Recently, targeted immunotherapy has completed phase Ⅱ and Ⅲ clinical trials in patients with MG, and some of them have been approved by Food and Drug Administration. These promising biologics showed efficacy in symptoms persistent improvement, steroids reduction and were well tolerated, now evolving into powerful tools changing the algorithm of MG. This paper summarizes the results of clinical trials of new biologics in MG and looks forward to the prospect of MG treatment.

The Singapore Health Services cluster (SingHealth) radiology film archives are a valuable repository of local radiological cases dating back to the 1950s. Some of the cases in the archives are of historical medical interest, i.e. cerebral angiography in the workup of patients with hemiplegia. Other cases are of historical social interest, being conditions seen during earlier stages of Singapore's development, i.e. bound feet. The archives form a unique portal into the development of local radiology as well as the national development of Singapore. A selection from the archives is published in commemoration of the International Day of Radiology in 2020, as well as the 200th anniversary of the Singapore General Hospital in 2021. This pictorial essay comprises gastroenterology, musculoskeletal and obstetrics and gynaecology cases from the archives.

ObjectiveTo discuss the family environment characteristics of senior high school students with psychological problems， and to provide references for realizing management of senior high school students' mental health. MethodsA total of 1 917 senior high school students in Foshan No. 2 Middle School were enrolled， and assessed using Middle School Student Mental Health Scale （MSSMHS-60） and a self-compiled family environment questionnaire. Then the family environment characteristics of senior high school students with psychological problems were analyzed. ResultsThe total score of MSSMHS-60 was （1.83±0.49） in 1 917 senior high school students， and was （2.40±0.36） in 602 （31.40%） students with psychological problems. The detection rate of psychological problems demonstrated significant difference among senior high school students with different status of companionship， household finance， parental rearing style and kinship （χ²=16.951， 38.142， 90.545， 59.448， P<0.05 or 0.01）. Binary Logistic regression analysis showed that the presence of frequent parental quarrels was a risk factor for senior high school students' mental health （OR=3.120， P<0.01）. ConclusionThe detection rate of psychological problems is high among senior high school students in Foshan City， and family disputes is a risk factor for psychological problems.

The Singapore Health Services cluster (SingHealth) radiology film archives are a valuable repository of local radiological cases dating back to the 1950s. Some of the cases in the archives are of historical medical interest, i.e. cerebral angiography in the workup of patients with hemiplegia. Other cases are of historical social interest, being conditions seen during earlier stages of Singapore's development, i.e. bound feet. The archives form a unique portal into the development of local radiology as well as the national development of Singapore. A selection from the archives is published in 2020 in commemoration of the 20th anniversary of the formation of SingHealth, the 55th National Day of Singapore, and the 125th anniversary of the International Day of Radiology. This pictorial essay comprises cardiovascular, respiratory and neurological cases from the archives.

Objective:To analyze the clinical, neurophysiological and genetic features of CHRNB1 gene mutations-related congenital myasthenic syndromes (CMS), and to facilitate the recognition and differential diagnosis of this disorder.Methods:The clinical characteristics and laboratory features of the proband in a family with CHRNB1 gene mutations-related CMS were recorded, and the neurophysiological testing and high-throughput sequencing for the proband were performed. In addition, the response to the treatment and prognosis of the proband were reported.Results:The proband is a 16-year-old female who had bilateral eyelid ptosis at the age of 4, presented with limb weakness at the age of 12. Her father has the similar symptoms and other family members are not affected similarly. Serum creatine kinase and thyroid function were normal. Needle electromyography results demonstrated no myopathic disorders. All myasthenia gravis-related antibodies tests including anti-acetylcholine receptor antibody were negative and she failed to respond to pyridostigmine. There was a decremental response of the compound muscular action potential on 5 Hz repetitive nerve stimulation. Brain magnetic resonance imaging and chest CT were unremarkable. The proband was found a heterozygous mutation (c.865G>A (NM_000747)) in CHRNB1 gene exon 8 through high throughput sequencing. She started a 60 mg/d treatment of fluoxetine and showed beneficial response at one-year follow-up.Conclusions:The clinical presentation of CHRNB1 gene mutation-related slow-channel CMS is similar to autoimmune myasthenia gravis, and is likely to be misdiagnosed. High-throughput sequencing accelerates the diagnosis.

Myasthenia gravis (MG) is an acquired autoimmune disease mediated by antibodies against components expressed in the neuromuscular junction. The thymus plays an important role in the development of MG. More than 80% of patients with MG demonstrate histological abnormalities of thymus, such as follicular hyperplasia or thymoma. Although thymectomy is standard treatment for patients with MG who have thymoma, whether the procedure is of any clinical benefit in patients without thymoma has been questioned for more than 40 years. In the 2016 issue of the New England Journal of Medicine, the results of the first randomized trial to assess the role of thymectomy in the treatment of MG, the Thymectomy Trial in Non-Thymomatous Myasthenia Gravis Patients Receiving Prednisone Therapy (MGTX) was reported. The MGTX trial conclusively proved that thymectomy improved clinical outcomes over a three-year period in patients with non-thymomatous MG, which provided Class Ⅰ evidence supporting the use of thymectomy in patients with non thymomatous MG. However, there are still debates on the selection of patients for surgery, and surgical approaching techniques. In addition, the benefit of the thymectomy remains less clear in other subgroups of MG. In the future, randomized controlled trials are required to resolve those controversies and to maximize the benefit of thymectomy in the treatment of MG.

Objective To study the changes and significance of the frequencies of circulating follicular helper T cells (cTfh) and circulating regulatory follicular T cells (cTfr) as well as the cTfh/cTfr ratio in neuromyelitis optica spectrum disorder (NMOSD).Methods The frequencies of cTfh,cTfr and B cells in patients with NMOSD and health controls(HCs) were measured by flow cytometry.Enzyme-linked immunosorbent assay was used to detect the level of IL-21 and AQP4-Ab in patients and HCs.Results The frequencies of cTfh and B cells,the cTfh/cTfr ratio and the plasma level of IL-21 werc significantly higher in the relapsing patients than those in the remitting patients and HCs(P ＜ 0.05),and the cTfr level in the relapsing patients was lower than that in the remitting patients and healthy population (P ＜ 0.05).But no statistical differences were observed in the above indexes between the remitting paticnts and HCs.There was also no significant difference in AQP4-Ab level between the patients with relapse and remission (P ＞ 0.05).The frequency of cTfh in the patients wasc positively correlated with the level of B cells and IL-21(P ＜ 0.05),and the frequency of cTfr was negatively correlated with B cells and IL-21 (P ＜ 0.05).The ratio of cTfh/cTfr was positively correlated with B cell frequency and IL-21 level (P ＜ 0.05).AQP4-Ab level had no correlation with the frequencies of cTfh cells and B cells,cTfh/cTfr ratio and IL-21 concentration (P ＞ 0.05).Conclusion The changes in the frequencies of cTfh and cTfr as well as the imbalanced cTfh/cTfr ratio may promote the activation of humoral immunein NMOSD and participate in the pathogenesis of this disease.