Retinal microcirculatory disorder is a key factor in the occurrence and development of diabetic retinopathy （DR）， and also an important link in the prevention and treatment of DR. The theory of "Gaozhuo" holds that the microcirculatory disorder in DR is based on the deficiency of spleen Qi and is characterized by the obstruction caused by "Gaozhuo" and blood stasis. The deficiency of spleen Qi is an essential precondition for the endogenous formation and accumulation of Gaozhuo， while Gaozhuo invasion is the direct cause of microcirculatory disorders in DR. The deficiency of spleen Qi and the endogenous formation of Gaozhuo mean the process in which glucose metabolism dysfunction induces an excessive production of inflammatory factors and lipid metabolites. The obstruction caused by "Gaozhuo" and blood stasis is the direct pathogenesis of microcirculatory disorders in DR， encompassing two stages： Gaozhuo obstruction and turbidity and stasis stagnation. Gaozhuo obstruction and turbidity and stasis stagnation represent the process in which inflammatory factors and lipid metabolites damage the retinal microcirculation and induce thrombosis， thus mediating microcirculatory disorders. Turbidity and stasis stagnation and blood extravasation outside the vessels reveal the progression to microvascular rupture and hemorrhage resulting from the microcirculatory disorders. According to the pathogenesis evolution of the theory of "Gaozhuo"， microcirculatory disorders in DR can be divided into deficiency of spleen Qi with Gaozhuo obstruction， deficiency of spleen Qi with turbidity and stasis stagnation， and turbidity and stasis stagnation with blood extravasation outside the vessels. Clinically， treatment principles should focus on strengthening the spleen and benefiting Qi， resolving turbidity， and dispersing stasis. Different syndrome patterns should be addressed with tailored therapies， such as enhancing the spleen and benefiting Qi while regulating Qi and reducing turbidity， strengthening the spleen and benefiting Qi while resolving turbidity and dispelling stasis， and strengthening the spleen and resolving turbidity while removing stasis and stopping bleeding. Representative prescriptions include modified Wendantang， modified Buyang Huanwutang， modified Danggui Buxuetang， Zhuixue Mingmu decoction， Tangmuqing， Shengqing Jiangzhuo Tongluo Mingmu prescription， Danhong Huayu decoction， and Yiqi Yangyin Huoxue Lishui formula.

OBJECTIVE To explore the distribution of pathogens isolated from the cardiac surgery children with postoperative catheter-related bloodstream infection(CRBSI)and observe the transforming growth factor β1(TGF-β1)gene polymorphisms and the change of high-sensitivity C-reactive protein(hs-CRP),Smad homologue 2 and Smad 3 levels.METHODS A total of 88 children who received peripherally inserted central catheter(PICC)puncture after cardiac surgery and were complicated with postoperative CRBSI in the First People's Hospital of Zunyi from Aug.2019 to Oct.2023 were assigned as the infection group.Meanwhile,110 children who were trea-ted with PICC and did not have postoperative CRBSI were randomly chosen as the non-infection group.The base-line data,TGF-β1 gene polymorphisms and the levels of hs-CRP,Smad 2 and Smad 3 were compared between the two groups.The distribution of the pathogens isolated from the infection group was observed.The values of hs-CRP,Smad 2 and Smad 3 in diagnosis of the postoperative CRBSI in the cardiac surgery children were analyzed by receiver operating characteristic(ROC)curves.RESULTS The proportions of patients with intravenous cathe-ter indwelling no less than 10 days,length of intensive care unit(ICU)stay no less than 5 days,the frequencies of CC genotypes and C allele at TGF-β1+869C/T locus were higher in the infection group than those in the non-infection group(P＜0.05).Acinetobacter baumannii was the predominant species of pathogen isolated from the infection group,accounting for 24.20％.The levels of serum hs-CRP,Smad 2 and Smad 3 of the infection group were(24.65±7.65)mg/L,(13.54±2.45)pg/ml and(13.65±2.65)pg/ml,respectively,higher than those of the non-infection group(all P＜0.001).The area under the curve(AUC)of the joint detection of hs-CRP,Smad 2 and Smad 3 was highest in diagnosis of the postoperative CRBSI in the cardiac surgery children(P＜0.05).CONCLUSIONS A.baumannii is dominant among the pathogens isolated from the cardiac surgery children with postoperative CRBSI.The postoperative CRBSI may be associated with the intravenous catheter in-dwelling time and length of ICU stay.The C allele at TGF-β1+869C/T locus may be the susceptibility gene for the postoperative CRBSI.The joint detection of hs-CRP,Smad 2 and Smad 3 has the highest value in diagnosis of the postoperative CRBSI.

OBJECTIVE To explore the distribution of pathogens isolated from the cardiac surgery children with postoperative catheter-related bloodstream infection(CRBSI)and observe the transforming growth factor β1(TGF-β1)gene polymorphisms and the change of high-sensitivity C-reactive protein(hs-CRP),Smad homologue 2 and Smad 3 levels.METHODS A total of 88 children who received peripherally inserted central catheter(PICC)puncture after cardiac surgery and were complicated with postoperative CRBSI in the First People's Hospital of Zunyi from Aug.2019 to Oct.2023 were assigned as the infection group.Meanwhile,110 children who were trea-ted with PICC and did not have postoperative CRBSI were randomly chosen as the non-infection group.The base-line data,TGF-β1 gene polymorphisms and the levels of hs-CRP,Smad 2 and Smad 3 were compared between the two groups.The distribution of the pathogens isolated from the infection group was observed.The values of hs-CRP,Smad 2 and Smad 3 in diagnosis of the postoperative CRBSI in the cardiac surgery children were analyzed by receiver operating characteristic(ROC)curves.RESULTS The proportions of patients with intravenous cathe-ter indwelling no less than 10 days,length of intensive care unit(ICU)stay no less than 5 days,the frequencies of CC genotypes and C allele at TGF-β1+869C/T locus were higher in the infection group than those in the non-infection group(P＜0.05).Acinetobacter baumannii was the predominant species of pathogen isolated from the infection group,accounting for 24.20％.The levels of serum hs-CRP,Smad 2 and Smad 3 of the infection group were(24.65±7.65)mg/L,(13.54±2.45)pg/ml and(13.65±2.65)pg/ml,respectively,higher than those of the non-infection group(all P＜0.001).The area under the curve(AUC)of the joint detection of hs-CRP,Smad 2 and Smad 3 was highest in diagnosis of the postoperative CRBSI in the cardiac surgery children(P＜0.05).CONCLUSIONS A.baumannii is dominant among the pathogens isolated from the cardiac surgery children with postoperative CRBSI.The postoperative CRBSI may be associated with the intravenous catheter in-dwelling time and length of ICU stay.The C allele at TGF-β1+869C/T locus may be the susceptibility gene for the postoperative CRBSI.The joint detection of hs-CRP,Smad 2 and Smad 3 has the highest value in diagnosis of the postoperative CRBSI.

Objective To investigate the distribution and antimicrobial resistance profiles of common pathogens isolated from cerebrospinal fluid(CSF)in CHINET program from 2015 to 2021.Methods The bacterial strains isolated from CSF were identified in accordance with clinical microbiology practice standards.Antimicrobial susceptibility test was conducted using Kirby-Bauer method and automated systems per the unified CHINET protocol.Results A total of 14 014 bacterial strains were isolated from CSF samples from 2015 to 2021,including the strains isolated from inpatients(95.3％)and from outpatient and emergency care patients(4.7％).Overall,19.6％of the isolates were from children and 80.4％were from adults.Gram-positive and Gram-negative bacteria accounted for 68.0％and 32.0％,respectively.Coagulase negative Staphylococcus accounted for 73.0％of the total Gram-positive bacterial isolates.The prevalence of MRSA was 38.2％in children and 45.6％in adults.The prevalence of MRCNS was 67.6％in adults and 69.5％in children.A small number of vancomycin-resistant Enterococcus faecium(2.2％)and linezolid-resistant Enterococcus faecalis(3.1％)were isolated from adult patients.The resistance rates of Escherichia coli and Klebsiella pneumoniae to ceftriaxone were 52.2％and 76.4％in children,70.5％and 63.5％in adults.The prevalence of carbapenem-resistant E.coli and K.pneumoniae(CRKP)was 1.3％and 47.7％in children,6.4％and 47.9％in adults.The prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)and Pseudomonas aeruginosa(CRPA)was 74.0％and 37.1％in children,81.7％and 39.9％in adults.Conclusions The data derived from antimicrobial resistance surveillance are crucial for clinicians to make evidence-based decisions regarding antibiotic therapy.Attention should be paid to the Gram-negative bacteria,especially CRKP and CRAB in central nervous system(CNS)infections.Ongoing antimicrobial resistance surveillance is helpful for optimizing antibiotic use in CNS infections.

Objective To investigate the antimicrobial resistance of clinical isolates from elderly patients(≥65 years)in major medical institutions across China.Methods Bacterial strains were isolated from elderly patients in 52 hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program during the period from 2015 to 2021.Antimicrobial susceptibility test was carried out by disk diffusion method and automated systems according to the same CHINET protocol.The data were interpreted in accordance with the breakpoints recommended by the Clinical and Laboratory Standards Institute(CLSI)in 2021.Results A total of 514 715 nonduplicate clinical isolates were collected from elderly patients in 52 hospitals from January 1,2015 to December 31,2021.The number of isolates accounted for 34.3％of the total number of clinical isolates from all patients.Overall,21.8％of the 514 715 strains were gram-positive bacteria,and 78.2％were gram-negative bacteria.Majority(90.9％)of the strains were isolated from inpatients.About 42.9％of the strains were isolated from respiratory specimens,and 22.9％were isolated from urine.More than half(60.7％)of the strains were isolated from male patients,and 39.3％isolated from females.About 51.1％of the strains were isolated from patients aged 65-＜75 years.The prevalence of methicillin-resistant strains(MRSA)was 38.8％in 32 190 strains of Staphylococcus aureus.No vancomycin-or linezolid-resistant strains were found.The resistance rate of E.faecalis to most antibiotics was significantly lower than that of Enterococcus faecium,but a few vancomycin-resistant strains(0.2％,1.5％)and linezolid-resistant strains(3.4％,0.3％)were found in E.faecalis and E.faecium.The prevalence of penicillin-susceptible S.pneumoniae(PSSP),penicillin-intermediate S.pneumoniae(PISP),and penicillin-resistant S.pneumoniae(PRSP)was 94.3％,4.0％,and 1.7％in nonmeningitis S.pneumoniae isolates.The resistance rates of Klebsiella spp.(Klebsiella pneumoniae 93.2％)to imipenem and meropenem were 20.9％and 22.3％,respectively.Other Enterobacterales species were highly sensitive to carbapenem antibiotics.Only 1.7％-7.8％of other Enterobacterales strains were resistant to carbapenems.The resistance rates of Acinetobacter spp.(Acinetobacter baumannii 90.6％)to imipenem and meropenem were 68.4％and 70.6％respectively,while 28.5％and 24.3％of P.aeruginosa strains were resistant to imipenem and meropenem,respectively.Conclusions The number of clinical isolates from elderly patients is increasing year by year,especially in the 65-＜75 age group.Respiratory tract isolates were more prevalent in male elderly patients,and urinary tract isolates were more prevalent in female elderly patients.Klebsiella isolates were increasingly resistant to multiple antimicrobial agents,especially carbapenems.Antimicrobial resistance surveillance is helpful for accurate empirical antimicrobial therapy in elderly patients.

Objective To investigate the distribution and antimicrobial resistance profiles of common pathogens isolated from cerebrospinal fluid(CSF)in CHINET program from 2015 to 2021.Methods The bacterial strains isolated from CSF were identified in accordance with clinical microbiology practice standards.Antimicrobial susceptibility test was conducted using Kirby-Bauer method and automated systems per the unified CHINET protocol.Results A total of 14 014 bacterial strains were isolated from CSF samples from 2015 to 2021,including the strains isolated from inpatients(95.3％)and from outpatient and emergency care patients(4.7％).Overall,19.6％of the isolates were from children and 80.4％were from adults.Gram-positive and Gram-negative bacteria accounted for 68.0％and 32.0％,respectively.Coagulase negative Staphylococcus accounted for 73.0％of the total Gram-positive bacterial isolates.The prevalence of MRSA was 38.2％in children and 45.6％in adults.The prevalence of MRCNS was 67.6％in adults and 69.5％in children.A small number of vancomycin-resistant Enterococcus faecium(2.2％)and linezolid-resistant Enterococcus faecalis(3.1％)were isolated from adult patients.The resistance rates of Escherichia coli and Klebsiella pneumoniae to ceftriaxone were 52.2％and 76.4％in children,70.5％and 63.5％in adults.The prevalence of carbapenem-resistant E.coli and K.pneumoniae(CRKP)was 1.3％and 47.7％in children,6.4％and 47.9％in adults.The prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)and Pseudomonas aeruginosa(CRPA)was 74.0％and 37.1％in children,81.7％and 39.9％in adults.Conclusions The data derived from antimicrobial resistance surveillance are crucial for clinicians to make evidence-based decisions regarding antibiotic therapy.Attention should be paid to the Gram-negative bacteria,especially CRKP and CRAB in central nervous system(CNS)infections.Ongoing antimicrobial resistance surveillance is helpful for optimizing antibiotic use in CNS infections.

Objective To investigate the antimicrobial resistance of clinical isolates from elderly patients(≥65 years)in major medical institutions across China.Methods Bacterial strains were isolated from elderly patients in 52 hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program during the period from 2015 to 2021.Antimicrobial susceptibility test was carried out by disk diffusion method and automated systems according to the same CHINET protocol.The data were interpreted in accordance with the breakpoints recommended by the Clinical and Laboratory Standards Institute(CLSI)in 2021.Results A total of 514 715 nonduplicate clinical isolates were collected from elderly patients in 52 hospitals from January 1,2015 to December 31,2021.The number of isolates accounted for 34.3％of the total number of clinical isolates from all patients.Overall,21.8％of the 514 715 strains were gram-positive bacteria,and 78.2％were gram-negative bacteria.Majority(90.9％)of the strains were isolated from inpatients.About 42.9％of the strains were isolated from respiratory specimens,and 22.9％were isolated from urine.More than half(60.7％)of the strains were isolated from male patients,and 39.3％isolated from females.About 51.1％of the strains were isolated from patients aged 65-＜75 years.The prevalence of methicillin-resistant strains(MRSA)was 38.8％in 32 190 strains of Staphylococcus aureus.No vancomycin-or linezolid-resistant strains were found.The resistance rate of E.faecalis to most antibiotics was significantly lower than that of Enterococcus faecium,but a few vancomycin-resistant strains(0.2％,1.5％)and linezolid-resistant strains(3.4％,0.3％)were found in E.faecalis and E.faecium.The prevalence of penicillin-susceptible S.pneumoniae(PSSP),penicillin-intermediate S.pneumoniae(PISP),and penicillin-resistant S.pneumoniae(PRSP)was 94.3％,4.0％,and 1.7％in nonmeningitis S.pneumoniae isolates.The resistance rates of Klebsiella spp.(Klebsiella pneumoniae 93.2％)to imipenem and meropenem were 20.9％and 22.3％,respectively.Other Enterobacterales species were highly sensitive to carbapenem antibiotics.Only 1.7％-7.8％of other Enterobacterales strains were resistant to carbapenems.The resistance rates of Acinetobacter spp.(Acinetobacter baumannii 90.6％)to imipenem and meropenem were 68.4％and 70.6％respectively,while 28.5％and 24.3％of P.aeruginosa strains were resistant to imipenem and meropenem,respectively.Conclusions The number of clinical isolates from elderly patients is increasing year by year,especially in the 65-＜75 age group.Respiratory tract isolates were more prevalent in male elderly patients,and urinary tract isolates were more prevalent in female elderly patients.Klebsiella isolates were increasingly resistant to multiple antimicrobial agents,especially carbapenems.Antimicrobial resistance surveillance is helpful for accurate empirical antimicrobial therapy in elderly patients.

Objective To explore the correlation between central venous oxygen saturation(ScvO2),blood lactate(Lac),arterial oxygen saturation(SaO2)and mechanical ventilation time in infants with congenital heart disease(CHD).Methods Eighty-four CHD children treated in the First People's Hospital of Zunyi were enrolled between January 2020 and December 2024.According to postoperative mechanical ventilation time,they were divided into prolongation group(28 cases,mechanical ventilation time≥72 h)and non-prolongation group(56 cases,mechanical ventilation time<72 h).The clinical data,score of risk adjustment for congenital heart surgery(RACHS-1),levels of ScvO2,and Lac and SaO2 in the two groups were compared.The risk factors of postoperative mechanical ventilation time were analyzed by multivariate logistic regression analysis,and predictive value of ScvO2,Lac and SaO2 for prolonged mechanical ventilation time was analyzed by ROC curves.The clinical outcomes in the two groups were recorded.Results There were significant differences in age,preoperative pneumonia,RACHS-1 grading,and levels of ScvO2,Lac and SaO2 among children with different mechanical ventilation time(P<0.05).Multivariate logistic regression analysis showed that ScvO2,Lac and SaO2 were independent influencing factors of postoperative mechanical ventilation time(P<0.05).ROC curves analysis showed that area under the curve(AUC)values of ScvO2,Lac,SaO2 and combined detection for predicting prolonged postoperative mechanical ventilation were 0.846,0.863,0.839 and 0.917,and the best cut-off values were 67.64％,1.51mmol/L and 96.06％,respec-tively(P<0.05).The failure rate of weaning in the prolongation group was higher,and stay time in PICU and actual length of hospital stay were longer than those in non-prolongation group(P<0.05).Conclusion The levels of ScvO2,Lac and SaO2 are related to mechanical ventilation time in CHD infants.They are all independent risk factors affecting prolonged mechanical ventilation and can be applied as auxiliary detection indexes to predict the prolonga-tion of mechanical ventilation in clinical practice.

Objective To explore the correlation between central venous oxygen saturation(ScvO2),blood lactate(Lac),arterial oxygen saturation(SaO2)and mechanical ventilation time in infants with congenital heart disease(CHD).Methods Eighty-four CHD children treated in the First People's Hospital of Zunyi were enrolled between January 2020 and December 2024.According to postoperative mechanical ventilation time,they were divided into prolongation group(28 cases,mechanical ventilation time≥72 h)and non-prolongation group(56 cases,mechanical ventilation time<72 h).The clinical data,score of risk adjustment for congenital heart surgery(RACHS-1),levels of ScvO2,and Lac and SaO2 in the two groups were compared.The risk factors of postoperative mechanical ventilation time were analyzed by multivariate logistic regression analysis,and predictive value of ScvO2,Lac and SaO2 for prolonged mechanical ventilation time was analyzed by ROC curves.The clinical outcomes in the two groups were recorded.Results There were significant differences in age,preoperative pneumonia,RACHS-1 grading,and levels of ScvO2,Lac and SaO2 among children with different mechanical ventilation time(P<0.05).Multivariate logistic regression analysis showed that ScvO2,Lac and SaO2 were independent influencing factors of postoperative mechanical ventilation time(P<0.05).ROC curves analysis showed that area under the curve(AUC)values of ScvO2,Lac,SaO2 and combined detection for predicting prolonged postoperative mechanical ventilation were 0.846,0.863,0.839 and 0.917,and the best cut-off values were 67.64％,1.51mmol/L and 96.06％,respec-tively(P<0.05).The failure rate of weaning in the prolongation group was higher,and stay time in PICU and actual length of hospital stay were longer than those in non-prolongation group(P<0.05).Conclusion The levels of ScvO2,Lac and SaO2 are related to mechanical ventilation time in CHD infants.They are all independent risk factors affecting prolonged mechanical ventilation and can be applied as auxiliary detection indexes to predict the prolonga-tion of mechanical ventilation in clinical practice.

Objective To identify the multidimensional care needs for primary caregivers of the patients with spinal cord injury based on a journey map so as to provide a reference for caregivers to develop supportive interventions through the whole-journey.Method A longitudinal descriptive qualitative study was conducted,and purposive sampling was employed to select 14 primary caregivers for the patients with spinal cord injury from a Grade ⅢA hospital in Hefei between March and May 2024 for 3 rounds of semi-structured interviews.Content analysis was conducted to organise the data and to extract the themes.Based on the extracted themes,a journey map of the care needs for primary caregivers was plotted.Results The journey map was plotted based on 3 phases of the patients with spinal cord injury:diagnosis,discharge transition and rehabilitation as the horizontal axis of time,and the tasks,emotions,and barriers during the care-providing period as the vertical axis of tasks.Nine themes were identified and plotted by journey map,including three domains on tasks for three phases(high demand for hospitalisation assistance,urgent need for home care skills and dual role challenge),three domains on emotional conditions for three phases(psychological adjustment,heavy negative emotion experience and positive experience)and three domains on care-giving barriers for three phases(need for disease-related knowledge,lack of medicine-related laws and changes in family economy and structure).Conclusion The journey map of the care needs for primary caregivers among the patients with spinal cord injury is complex and multi-dimensional.Medical staff should accurately devise intervention plans according to the task axis at different stages of disease.This will enable the allocation of high-quality supporting resources throughout the whole care-providing journey,thereby improving the quality of care as well as the outcomes of care.