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 explore the effects of an intervention strategy based on dyadic illness management theory on dyadic coping level, supportive care needs, and patients' disease symptoms with chemotherapy-stage ovarian cancer patients and their spouses, and to provide reference for improving their disease coping ability and quality of life.Methods:This study used the method of randomized controlled trial. Seventy pairs of ovarian cancer patients and their spouses who received regular chemotherapy and their spouses from Obstetrics and Gynecology Hospital, Fudan University from July 2022 to June 2023 were selected using convenience sampling method. They were assigned to the control group (36 pairs) and the observation group (36 pairs) by the random number table method. Participants in the control group received routine nursing care and the observation group received the intervention strategy of dyadic illness management theory. Data were collected and compared the differences in dyadic coping levels, care needs, and disease symptoms between two groups of patients and their spouses before intervention (before chemotherapy) and after intervention (after the end of the chemotherapy cycle). SPSS 20.0 software was used for analysis, and t-tests, χ2 tests, and Wilcoxon rank sum tests were used to compare the two groups. Results:Finally, 36 pairs were included in the control group and 34 pairs in the observation group. The age of the control group patients was (52.03 ± 9.44) years old, while that of the observation group patients was (53.41 ± 10.14) years old. After the intervention, the total score of dyadic coping level in the patients and their spouses of the observation group were (113.50 ± 8.03), (114.62 ± 10.59) points, respectively, which were higher than (106.64 ± 10.06), (108.78 ± 10.89) points of the control group with significant differences ( t=-3.14, -2.27, both P<0.05); the total score of care needs in the patients and their spouses of the observation group were (89.65 ± 8.29), (95.12 ± 7.25) points, respectively, which were lower than (100.25 ± 10.82), (110.11 ± 7.58) points of the control group with significant differences ( t=4.58, 8.45, both P<0.001); the total score of disease symptoms in the patients of the observation group was (20.09 ± 4.70) points, which was lower than (31.53 ± 6.08) points of the control group with significant differences ( t=8.77, P<0.001). Conclusions:The model of dyadic illness management can improve dyadic coping level and supportive care needs of chemotherapy-stage ovarian cancer patients and their spouses, and alleviate patients′ disease symptoms.

Objective:To explore the different reaction patterns among family caregivers of patients with advanced gynecological malignancies, and to analyze the influencing factors of different profiles.Methods:A cross-sectional study was conducted with 210 family caregivers of patients with advanced gynecological malignancies from Obstetrics and Gynecology Hospital in Shanghai from January 2022 to December 2022. Data were collected by Caregiver Reaction Assessment, Mishel's Uncertainty in Illness Scale-Family Member Form and Perceived Social Support Scale. Latent profile analysis was used to explore the different reaction patterns among family caregivers of patients with advanced gynecological malignancies. The influencing factors of caregiver reaction were identified by multivariate Logistic regression.Results:Totally 208 questionnaires were effectively collected. The family caregivers among patients with advanced gynecological malignancies included 163 males and 45 females, aged (53.89 ± 12.61) years old. The reaction characteristics of 208 family caregivers among patients with advanced gynecological malignancies were divided into three categories: low burden and high benefit group (24.5%, 51/208), moderate burden and benefit group (30.8%, 64/208), and high burden and low benefit group (44.7%, 93/208). Compared to the low burden and high benefit group, caregivers with lower levels of social support were more likely to be classified as moderate burden and benefit group, high burden and low benefit group ( OR = 0.563, 0.407, both P<0.01). Caregivers with moderate burden and benefit group, high burden and low benefit group had higher levels of disease uncertainty ( OR = 1.328, 2.064, both P<0.01). The caregiver′s age, monthly family income, education level, and co-caregivers were also influencing factors regarding to care reaction among family caregivers of patients with advanced gynecological malignancies ( OR values were 0.207-6.422, all P<0.05). Conclusions:The care reaction of family caregivers among patients with advanced gynecological malignancies has obvious categorical features. Healthcare professionals should implement targeted nursing interventions according to their reaction characteristics, so as to reduce the care burden of family caregivers and improve the quality of care for patients with advanced gynecological malignancies.

Objective: To investigate the impact of immediate cessation of antiviral therapy on postpartum liver function and the factors influencing postpartum abnormality in mothers with chronic hepatitis B virus infection. Methods: A retrospective cohort study was conducted. One hundred eighty-eight pregnant women with HBV DNA level > 2×106 IU/ml were enrolled from June 2014 to June 2018. Demographic information and clinical data of liver function and HBV DNA load during gravidity, intrapartum and postpartum period were collected. According to the antiviral treatment recommendations during pregnancy, the women were divided into three groups, namely, tenofovir (TDF), telbivudine (LdT) and control group. Liver function abnormalities among the three groups were compared within 6 months after delivery, and the factors influencing abnormal liver function were analyzed by unconditional logistic regression. Results: Of the 188 cases, 72 cases were in the TDF group, 80 cases in the LdT group, and 36 cases in the control group. Pregnant women in the TDF and LdT groups received oral TDF (300 mg/d) and LdT (600 mg/d) from 28 ± 4 weeks of gestation till delivery. Among the 188 patients, 30 (16.0%) had abnormal postpartum liver function abnormality. The incidence of postpartum liver function abnormality [alanine aminotransferase (ALT) > 2 × upper limit of normal (ULN)] in the TDF, LdT, and control groups was 19.4%, 12.5%, and 16.7%, respectively. The postpartum peak levels of ALT (median, range) in the three groups were 34.5 (12.0-946.0) U/L, 37.5 (12.0-733.8) U/L, and 39.0 (7.0-513.0) U/L, respectively. There was no significant difference between the two indexes among the three groups (P > 0.05). There was no statistically significant difference in the degree of postpartum liver function abnormalities between the three groups (P = 0.944). Most of the liver function abnormalities were mild to moderate (2 × ULN≤ALT < 10 × ULN), and usually resolved spontaneously or by treatment. Univariate and multivariate analysis showed that baseline ALT level during pregnancy was an independent factor associated with postpartum liver function abnormality (OR = 1.031, CI 95%: 1.005-1.058; χ² = 5.340, P = 0.021), whereas age, antiviral therapy, HBeAg-positivity, baseline HBV DNA levels, gravidity, parity, preterm delivery and delivery mode were not significantly associated with postpartum liver function abnormality. Conclusion Cessation of antiviral therapy after delivery did not significantly increase the risk of postpartum liver function abnormality in pregnant women with chronic HBV infection. The ALT level during pregnancy is a factor influencing postpartum liver function abnormality.

Objective To explore the effects of complex decongestive therapy among patients with postoperative lower extremity lymphedema following treatment for gynecological cancer. Methods A total of 40 patients with secondary lower extremity lymphedema resulting from gynecological cancer treatment received complex decongestive physiotherapy (CDP) by oncology nursing specialist in the lymphedema rehabilitation clinic between March 2016 to February 2017.Before and after CDP,patients were evaluated by circumferential measurements and multiple frequency bioelectrical impedance analysis. Results After CDP, lymphedema volume decreased from (8 668.30 ± 1 909.23) cm3to (7 599.81 ± 1 297.45)cm3, and the percentage of excess volume (PEV) reduced from 14.10 (5.82-66.86)% to 2.95(0.38-28.56)%, the differences were statistically significant(t=6.909,Z=-5.511,P<0.05).The accumulated edema fluid in tissue decreased from(6.11±1.63)L to (5.06 ± 0.88) L and the rate of extracellular water decreased from (41.15 ± 1.86)% to (39.51 ± 0.88)%, the differences were statistically significant (t=6.336, 8.295, P < 0.05). Percentage reduction of excess volume (PREV)was(77.33±14.55)%,and was correlated with duration of lower extremity lymphedema. Conclusions CDP was effective for lower extremity lymphedema secondary to treatment of gynecological cancer.It is a set of safe and noninvasive technique. Patients with lower extremity lymphedema should be encouraged to undergo CDP, even when it is mild.

Objective To establish a three-dimensional virtual deformable mandible model used for individual reconstruction design of large mandibular defect.Methods A virtual deformable mandible model has been established by a 3D animation software.The model could be used for preoperative reconstruction design of large mandibular defects cases.According to the temporomandibular joint fossa position,maxillary dental arch,the normal relationship of cranio-maxillofacial profile,and the morphology of the residual segments of mandible,the virtual mandible model could be scaled and adjusted and a virtual mandible with individual features was obtained.Three normal skulls have been used to validate the adjustment ability of the virtual deformable mandible model.The preoperative reconstruction design process of 1 typical large mandibular defect case was demonstrated.Results The deformation matching ability of the virtual deformable mandible model was very good.The registration between the design model and the orignal mandible was over 90％.The design effect of the large mandiblar defect case was satisfied.Conclusions Virtual deformable mandible model is a new feasible method to aid preoperative reconstruction design of large mandibular defects.

OBJECTIVETo investigate the effects of Matrine on apoptosis of fibroblasts and the expression of apoptotic modulation related protein in the hypertrophic scar.

METHODSHypertrophic scar was produced on the ear of 24 New Zealand white rabbits, which were employed as the model, and were randomly and equally divided into control (CC) and Matrine (M) groups (12 in each group). Matrine (50 g/L) was injected into the ear scar in M group and with normal saline in C group once every four days. At 2, 4, 6, 8 and 12 weeks after the injection, the apoptotic fibroblast count in the scar was determined by TUNEL method, and the expressions of apoptosis related modulation proteins p53, bcl-2, bax were detected by immunohistochemistry method.

RESULTSThe apoptotic fibroblast count was much larger in M group than that in C group at all test time points (P < 0.05). Furthermore, the bax expression was increased and that of p53 and bcl-2 was decreased significantly in M group. In adding, the scar became flat in M group.

CONCLUSIONMatrine might obviously enhance the fibroblast apoptosis in rabbit ear hypertrophic scar, and up-regulate the expression of apoptosis related modulation protein bax and down-regulate the expression of p53 and Bcl-2.

Alkaloids ; pharmacology ; Animals ; Apoptosis ; drug effects ; Cicatrix, Hypertrophic ; metabolism ; pathology ; Female ; Fibroblasts ; drug effects ; Immunohistochemistry ; Male ; Proto-Oncogene Proteins ; analysis ; Proto-Oncogene Proteins c-bcl-2 ; analysis ; Quinolizines ; Rabbits ; Tumor Suppressor Protein p53 ; analysis ; bcl-2-Associated X Protein