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 explore the effectiveness and safety of different anticoagulation strategies during continuous blood purification (CBP) treatment,providing a reference for anticoagulation strategies in critically ill children undergoing CBP.Methods:A retrospective study was conducted,including children admitted to the PICU of Children's Hospital of Fudan University from January 2019 to December 2024.According to the anticoagulation methods used during CBP treatment,patients were divided into the sodium citrate group and the heparin group.CBP was performed using continuous venovenous hemofiltration or continuous venovenous hemodialysis filtration mode,with a blood flow rate of 3-5 mL/(kg·min),replacement fluid rate of 30-50 mL/(kg·h),and dialysis fluid rate of 20-30 mL/(kg·h).The filter lifespan,28-day all-cause mortality,total length of hospital stay,PICU stay duration,adverse events,and associated costs were compared between the two groups.Results:A total of 221 children were included (105 in the sodium citrate group and 116 in the heparin group),with a cumulative use of 666 filters (284 in the sodium citrate group and 382 in the heparin group).(1) There were no statistically significant differences in general data,including age,sex ratio,underlying diseases,the ratio and duration of invasive mechanical ventilation,vasopressor scores at baseline,and indications for CBP between the two groups (all P>0.05).(2) The filter lifespan was 20(14,32) hours for the sodium citrate group and 21(13,35) hours for the heparin group,with no statistically significant difference between the two groups ( P>0.05); the proportion of accidental downstroke was 2.8% and 6.5%,respectively,with a statistically significant difference ( P=0.029); among the 221 children,86 died,with 38 deaths (35.2%) in the sodium citrate group and 49 deaths (38.9%) in the heparin group,showing no statistically significant difference.(3) The sodium citrate group had a higher incidence of metabolic alkalosis,hypocalcemia,and sodium citrate accumulation (44.4% vs. 1.6%,32.7% vs 9.4%,7.7% vs 0,all P<0.01); the heparin group had a greater proportion of bleeding (6.0% vs. 2.9%) and was more likely to develop heparin-induced thrombocytopenia (10.2% vs. 0, P<0.01).(4) The total hospitalization costs for the sodium citrate group were significantly higher than for the heparin group (200 327 yuan vs. 152 077 yuan, P=0.05); costs related to the use of anticoagulants and monitoring indicators during CBP treatment were also higher in the sodium citrate group (2 479 yuan vs. 682 yuan, P<0.01). Conclusions:Sodium citrate is a safe and effective anticoagulation method for critically ill children undergoing CBP,which can reduce the risk of filter clotting compared to systemic heparin anticoagulation.

The traditional teaching model centered on courses has disadvantages such as interdisciplinary barriers, repetitive learning of content, and students being unable to enter clinical practice early. The Human Body Overview I is a core course at the basic stage under the integrated curriculum system centered on "organ-systems" at Chongqing Medical University. The course deeply integrates interdisciplinary resources and reconstructs the contents of systematic anatomy, embryology, and physiology under the traditional teaching model. The "Three in One" curriculum ideology and politics are implemented to assist students in their comprehensive development. By strengthening the cultivation of clinical application abilities and empowering with virtual simulation technology, the teaching effectiveness and quality have been improved. The teaching practice of the Human Body Overview I suggests that the teaching reform of integrated curriculum at the basic stage has broken interdisciplinary barriers, avoided repetitive learning of contents, and promoted the cultivation of students' interdisciplinary integration ability and clinical application ability. It can provide a reference for the teaching reform of integrated curriculum for other colleges.

The traditional teaching model centered on courses has disadvantages such as interdisciplinary barriers, repetitive learning of content, and students being unable to enter clinical practice early. The Human Body Overview I is a core course at the basic stage under the integrated curriculum system centered on "organ-systems" at Chongqing Medical University. The course deeply integrates interdisciplinary resources and reconstructs the contents of systematic anatomy, embryology, and physiology under the traditional teaching model. The "Three in One" curriculum ideology and politics are implemented to assist students in their comprehensive development. By strengthening the cultivation of clinical application abilities and empowering with virtual simulation technology, the teaching effectiveness and quality have been improved. The teaching practice of the Human Body Overview I suggests that the teaching reform of integrated curriculum at the basic stage has broken interdisciplinary barriers, avoided repetitive learning of contents, and promoted the cultivation of students' interdisciplinary integration ability and clinical application ability. It can provide a reference for the teaching reform of integrated curriculum for other colleges.

Uric acid is the final product of purine metabolism and an important endogenous antioxidant.Uric acid plays different roles in different malignant tumors through its antioxidant and pro-oxidative effects,and is closely related to the occurrence,development and prognosis of various malignant tumors.There are few reports on the correlation between serum uric acid and head and neck tumors,such as oral cancer,larynx cancer,nasopharyngeal cancer,thyroid cancer,etc.In this paper,the correlation between serum uric acid and the occurrence,development and prognosis of head and neck tumors is reviewed to reveal the value of uric acid in the prevention,diagnosis and treatment of head and neck tumors.

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 explore the effectiveness and safety of different anticoagulation strategies during continuous blood purification (CBP) treatment,providing a reference for anticoagulation strategies in critically ill children undergoing CBP.Methods:A retrospective study was conducted,including children admitted to the PICU of Children's Hospital of Fudan University from January 2019 to December 2024.According to the anticoagulation methods used during CBP treatment,patients were divided into the sodium citrate group and the heparin group.CBP was performed using continuous venovenous hemofiltration or continuous venovenous hemodialysis filtration mode,with a blood flow rate of 3-5 mL/(kg·min),replacement fluid rate of 30-50 mL/(kg·h),and dialysis fluid rate of 20-30 mL/(kg·h).The filter lifespan,28-day all-cause mortality,total length of hospital stay,PICU stay duration,adverse events,and associated costs were compared between the two groups.Results:A total of 221 children were included (105 in the sodium citrate group and 116 in the heparin group),with a cumulative use of 666 filters (284 in the sodium citrate group and 382 in the heparin group).(1) There were no statistically significant differences in general data,including age,sex ratio,underlying diseases,the ratio and duration of invasive mechanical ventilation,vasopressor scores at baseline,and indications for CBP between the two groups (all P>0.05).(2) The filter lifespan was 20(14,32) hours for the sodium citrate group and 21(13,35) hours for the heparin group,with no statistically significant difference between the two groups ( P>0.05); the proportion of accidental downstroke was 2.8% and 6.5%,respectively,with a statistically significant difference ( P=0.029); among the 221 children,86 died,with 38 deaths (35.2%) in the sodium citrate group and 49 deaths (38.9%) in the heparin group,showing no statistically significant difference.(3) The sodium citrate group had a higher incidence of metabolic alkalosis,hypocalcemia,and sodium citrate accumulation (44.4% vs. 1.6%,32.7% vs 9.4%,7.7% vs 0,all P<0.01); the heparin group had a greater proportion of bleeding (6.0% vs. 2.9%) and was more likely to develop heparin-induced thrombocytopenia (10.2% vs. 0, P<0.01).(4) The total hospitalization costs for the sodium citrate group were significantly higher than for the heparin group (200 327 yuan vs. 152 077 yuan, P=0.05); costs related to the use of anticoagulants and monitoring indicators during CBP treatment were also higher in the sodium citrate group (2 479 yuan vs. 682 yuan, P<0.01). Conclusions:Sodium citrate is a safe and effective anticoagulation method for critically ill children undergoing CBP,which can reduce the risk of filter clotting compared to systemic heparin anticoagulation.

Objective:To revise and enlarge the specification of pharmaceutical excipient denatonium benzoate in the Chinese Pharmacopoeia 2025.Methods:At present,only USP-NF 2023 in domestic and foreign pharmacopoe-ias includes denatonium benzoate.This quality standard is subject to standard research in accordance with USP-NF 2023,the fourth general rules of the Chinese Pharmacopoeia 2020 edition,and other relevant requirements.Results:According to the quality of the product and the actual application in the formulation,the quality standards for the pharmaceutical excipient denatonium benzoate will be studied.At present,the quality standard of denatoni-um benzoate for pharmaceutical excipients has been disclosed.Conclusion:The established standard will fill the domestic gap and provide the quality guarantee for the application of denatonium benzoate in medicines.

Objective To establish a quantitative analysis of multi-components by single-marker(QAMS)method for the simultaneous determination of 11 components in Fazhi Banxia Qu(including Pinelliae Preparata,Fritillariae Cirrhosae Bulbus,and Exocarpium Citri Grandis),and combined with grey relational analysis(GRA)and entropy weight-technique for sequencing by approximate ideal solution or technique for order preference by similarity to ideal solution(EW-TOPSIS)analysis to comprehensive evaluate the quality of Fazhi Banxia Qu.Methods The Shimadzu C18 column was used,and the mobile phase consisted of acetonitrile-0.5%glacial acetic acid in a gradient elution manner,the flow rate was 1.0 mL·min-1,and the detection wavelength were set at 254 nm and 290 nm.Ethyl-p-methoxycinnamate was used as an internal reference substance to calculate the other ten components'relative correction factors(RCF),after which the content determination was made.The GRA combined with the EW-TOPSIS model were used to evaluate the comprehensive quality of Fazhi Banxia Qu.Results Eleven components of Fazhi Banxia Qu showed good linear relationships within their ranges,and the correlation coefficients were greater than 0.999.The average recoveries were 96.94%-100.12%(RSD<2.0%,n=9).There was no significant difference between QAMS and external standard method(ESM).The relative correlation degree of the GRA model was 0.290 3-0.618 7,and the relative proximity in the EW-TOPSIS model was 0.211 4-0.634 3.The comprehensive evaluation results of the GRA and EW-TOPSIS models were the same.Conclusion The HPLC-QAMS method is convenient and accurate,and can be used for quantitative control of multi-index components in Fazhi Banxia Qu.The GRA combined with EW-TOPSIS models can be used to evaluate the comprehensive quality of Fazhi Banxia Qu.

Objective To investigate the impact of Pseudomonas aeruginosa(PA)infection on the function of pulmonary vascular endothelial cells,and explore the mechanism of this bacterium in exacerbating lung inflammation in mice.Methods Two hours after human lung microvascular endothelial cell(HULEC-5a)were infected with the PA strain PAO1,the mRNA levels of autophagy-related gene 5(ATG5),6-phosphofruc-to-2-kinase/fructose-2,6-bisphosphatase 3(PFKFB3),and calcium adhesion protein 5(CDH5)were deter-mined by reverse transcription real-time fluorescent quantitative PCR(RT-qPCR).The protein levels of ATG5,PFKFB3,and vascular endothelial calcium adhesion protein(VE-cadherin)were detected by immunofluores-cence.After the expression of ATG5 and PFKFB3 was respectively knocked down by small interfering RNA(siRNA),RT-qPCR was employed to measure the mRNA levels of ATG5,PFKFB3,and CDH5,and immunofluorescence to detect the protein levels of PFKFB3 and VE-cadherin.In addition,the lactate assay kit was used to determine the level of lactate in the cells.After mice were infected with PAO1,lung inflammation was assessed through his-topathological section staining.Confocal microscopy was employed to capture and analyze fluorescence-labeled PFKFB3 and VE-cadherin in endothelial cells.Results Compared with the control group,the HULEC-5a cells infected with PAO1 showed up-regulated mRNA and protein levels of PFKFB3(all P<0.05),down-regulated mRNA level of CDH5(P =0.023),disrupted continuity and down-regulated protein level of VE-cadherin(P<0.001),and elevated lactate level(P =0.017).Compared with PAO1-infected HULEC-5a cells,knocking down PFKFB3 led to the up-regulated mRNA level of CDH5(P =0.043),lowered lactate level(P =0.047),and restored continuity of VE-cadherin;knocking down ATG5 led to up-regulated mRNA and protein levels of PFKFB3(P =0.013 and P =0.003),elevated lactate level(P =0.015),and down-regulated mRNA level of CDH5(P =0.020)and protein level of VE-cadherin(P =0.001).The HE staining results showed obvious red blood cell leakage,inflammatory cell infiltration,alveolar septal widening,and partial detachment of vascu-lar endothelial cells in the alveoli of PA-infected mice.Immunofluorescence staining showed up-regulated expres-sion of PFKFB3 and decreased fluorescence signal of VE-cadherin in endothelial cells of infected mice compared with normal mice.Conclusion PA may regulate the PFKFB3 pathway via AGT5 to disrupt the function of pulmo-nary vascular endothelial cells,thereby exacerbating the inflammation in the lungs of mice.