Objective To evaluate the safety and efficacy of a self-developed micro-normothermic machine perfusion (NMP) system (micro-perfusion device) for preserving isolated porcine limbs. Methods Five healthy Landrace pigs were selected, and their left and right forelimbs were randomly divided into the NMP group and static cold storage (SCS) group. The NMP group was perfused with the self-developed micro-perfusion device and polymerized hemoglobin perfusate for 32 hours at normothermia, while the SCS group was preserved at 4 ℃. Hemodynamic parameters such as perfusion pressure and flow were monitored. The pH value, partial pressure of oxygen (PO₂), lactic acid (Lac), creatine kinase (CK) and lactate dehydrogenase (LDH) in the perfusate were measured. Hematoxylin-eosin staining was used to assess the muscle tissue structure, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling was employed to evaluate muscle cell apoptosis, and immunohistochemistry staining was applied to detect the expressions of tumor necrosis factor (TNF)-α and interleukin (IL)-6. A mixed-effects model was used to analyze the effects of time and treatment methods on tissue structure, cell apoptosis and inflammatory factors. Results The device could stably maintain a perfusion pressure of (69±15) mmHg and a flow rate of (117±42) mL/min. The pH value and electrolytes of the perfusate were generally stable, with PO₂ maintained at a high level. Lac was maintained at 5.38(3.81, 6.45) mmol/L, while CK and LDH increased over time. After 32 hours of perfusion in the NMP group, both the myocyte spacing and apoptosis rate were better than those in the SCS group. Mixed-effects model analysis showed that there were statistically significant differences in the effects of NMP treatment and SCS treatment on myocyte spacing and apoptosis rate per unit time (both P < 0.05). There were no statistically significant differences in TNF-α and IL-6 between the two groups, and mixed-effects model analysis showed no statistically significant differences in the effects of NMP treatment and SCS treatment on TNF-α and IL-6 per unit time (both P > 0.05). Conclusions The micro-perfusion device used in this study may achieve 32-hour normothermic preservation in a porcine limb amputation model, maintain basic metabolism and ionic homeostasis, reduce muscle structural damage and cell apoptosis without inducing additional inflammatory responses. This technology is expected to significantly extend the time window for replantation of amputated limbs in disaster rescue and long-distance transportation, providing an important technical basis for clinical translation and subsequent replantation research.

Objective To explore the safety and feasibility of 5G remote robot-assisted thoracoscopic anatomic lobectomy and segmentectomy. Methods A retrospective analysis was conducted on patients who underwent 5G remote robot-assisted thoracoscopic anatomic lobectomy or segmentectomy between July and September 2024. The surgeries were performed collaboratively by Shanghai Chest Hospital, Affiliated Hospital of Yangzhou University, and The First Affiliated Hospital of Nanchang University. Perioperative outcomes were recorded and analyzed. Results Ten patients were included, comprising 4 anatomic lobectomies and 6 segmentectomies. The median age was 61.0 (56.0, 72.0) years. The median intraoperative bi-directional network latency was 52.5 (39.0, 54.0) ms. There were no instances of network interruption, robot-related adverse events, or conversions to open thoracotomy. The median postoperative chest tube drainage volume was 500.0 (375.0, 600.0) mL, and the median hospital stay was 5.5 (4.0, 6.0) days. No complications of Clavien-Dindo grade Ⅱor higher occurred. All patients were recurrence-free and alive during the 6-month postoperative follow-up period. Conclusion 5G remote robot-assisted thoracoscopic surgery demonstrates high safety and operational stability. This technology shows promising potential for clinical application and is worthy of further development and utilization.

To analyze the standard establishment approach and compilation rationale for metallic pharmaceutical packaging standard development in the 2025 edition of the Pharmacopeia of the People's Republic of China.This article systematically explained the background and process of establishing the guiding principles for metallic materials and containers used in pharmaceutical packaging in the Chinese Pharmacopoeia through basic information,relevant domestic and international standards,the establishment of key quality attributes of metallic pharmaceutical packaging materials,and the construction of metallic pharmaceutical packaging material standards.The newly established guidelines,the Pharmacopeia of the People's Republic of China 9625,prioritized product critical quality attributes(CQAs)and real-world applicability.This dual emphasis on rigidity and adaptability enhances drug safety,meets the regulatory requirements,and promotes the globalization and scientific advancement of China's pharmaceutical packaging industry.

Objective To examine the changing prevalence and antimicrobial resistance profiles of Burkholderia cepacia in 52 hospitals across China from 2015 to 2021.Methods A total of 9 261 strains of B.cepacia were collected from 52 hospitals between January 1,2015 and December 31,2021.Antimicrobial susceptibility of the strains was tested using Kirby-Bauer method or automated antimicrobial susceptibility testing systems according to a unified protocol.The results were interpreted according to the breakpoints released in the Clinical & Laboratory Standards Institute(CLSI)guidelines(2023 edition).Results A total of 9 261 strains of B.cepacia were isolated from all age groups,especially elderly patients.The proportion was 11.1％(1 032 strains)in children,significantly lower than the proportion in adults.About half(46.5％,4 310/9 261)of the strains were isolated from patients at least 60 years old and 42.3％(3 919/9 261)of the strains were isolated from young adults.Most isolates(71.1％)were isolated from sputum and respiratory secretions,followed by urine(10.7％)and blood samples(8.1％).B.cepacia isolates were highly susceptible to the five antimicrobial agents recommended in the CLSI M100 document(33rd edition,2023).B.cepacia isolates showed relatively higher resistance rates to meropenem and levofloxacin.However,the resistance rates to ceftazidime,trimethoprim-sulfamethoxazole,and minocycline remained below 8.1％.The percentage of B.cepacia strains resistant to levofloxacin was the highest compared to other antibiotics in any of the three age groups(from 12.4％in the patients＜18 years old to 20.6％in the patients aged 60 years or older).Conclusions B.cepacia is one of the clinically important non-fermenting gram-negative bacteria.Accurate and timely reporting of antimicrobial susceptibility test results and ongoing antimicrobial resistance surveillance are helpful for rational prescription of antimicrobial agents and proper prevention and control of nosocomial infections.

Objective To summarize the changing prevalence of carbapenem resistance in Enterobacterales based on the data of CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021 for improving antimicrobial treatment in clinical practice.Methods Antimicrobial susceptibility testing was performed using a commercial automated susceptibility testing system according to the unified CHINET protocol.The results were interpreted according to the breakpoints of the Clinical & Laboratory Standards Institute(CLSI)M100 31st ed in 2021.Results Over the seven-year period(2015-2021),the overall prevalence of carbapenem-resistant Enterobacterales(CRE)was 9.43％(62 342/661 235).The prevalence of CRE strains in Klebsiella pneumoniae,Citrobacter freundii,and Enterobacter cloacae was 22.38％,9.73％,and 8.47％,respectively.The prevalence of CRE strains in Escherichia coli was 1.99％.A few CRE strains were also identified in Salmonella and Shigella.The CRE strains were mainly isolated from respiratory specimens(44.23±2.80)％,followed by blood(20.88±3.40)％and urine(18.40±3.45)％.Intensive care units(ICUs)were the major source of the CRE strains(27.43±5.20)％.CRE strains were resistant to all the β-lactam antibiotics tested and most non-β-lactam antimicrobial agents.The CRE strains were relatively susceptible to tigecycline and polymyxins with low resistance rates.Conclusions The prevalence of CRE strains was increasing from 2015 to 2021.CRE strains were highly resistant to most of the antibacterial drugs used in clinical practice.Clinicians should prescribe antimicrobial agents rationally.Hospitals should strengthen antibiotic stewardship in key clinical settings such as ICUs,and take effective infection control measures to curb CRE outbreak and epidemic in hospitals.

Objective To characterize the changing species distribution and antibiotic resistance profiles of respiratory isolates in hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021.Methods Commercial automated antimicrobial susceptibility testing systems and disk diffusion method were used to test the susceptibility of respiratory bacterial isolates to antimicrobial agents following the standardized technical protocol established by the CHINET program.Results A total of 589 746 respiratory isolates were collected from 2015 to 2021.Overall,82.6％of the isolates were Gram-negative bacteria and 17.4％were Gram-positive bacteria.The bacterial isolates from outpatients and inpatients accounted for(6.0±0.9)％and(94.0±0.1)％,respectively.The top microorganisms were Klebsiella spp.,Acinetobacter spp.,Pseudomonas aeruginosa,Staphylococcus aureus,Haemophilus spp.,Stenotrophomonas maltophilia,Escherichia coli,and Streptococcus pneumoniae.Each microorganism was isolated from significantly more males than from females(P＜0.05).The overall prevalence of methicillin-resistant S.aureus(MRSA)was 39.9％.The prevalence of penicillin-resistant S.pneumoniae was 1.4％.The prevalence of extended-spectrum β-lactamase(ESBL)-producing E.coli and K.pneumoniae was 67.8％and 41.3％,respectively.The overall prevalence of carbapenem-resistant E.coli,K.pneumoniae,Enterobacter cloacae,Pseudomonas aeruginosa,and Acinetobacter baumannii was 3.7％,20.8％,9.4％,29.8％,and 73.3％,respectively.The prevalence of β-lactamase was 96.1％in Moraxella catarrhalis and 60.0％in Haemophilus influenzae.The H.influenzae isolates from children(＜18 years)showed significantly higher resistance rates to β-lactam antibiotics than the isolates from adults(P＜0.05).Conclusions Gram-negative bacteria are still predominant in respiratory isolates associated with serious antibiotic resistance.Antimicrobial resistance surveillance should be strengthened in clinical practice to support accurate etiological diagnosis and appropriate antimicrobial therapy based on antimicrobial susceptibility testing results.

The traditional medical quality management model has many problems,such as excessive reliance on experience,poor coordination among departments,and lagging supervision,innovating medical quality management models has become an essential issue for the high-quality development of hospitals.A tertiary Grade A general hospital built a"data element multiplier"ecological chain for medical quality management,and established a complete closed-loop management system for medical quality management under the"Internet plus"model.Finally,the mobile medical quality management platform was built.Jointly driven by"Internet plus"and"data element multiplier",the level of lean management has been significantly improved,providing practical reference for hospitals at the same level.

Objective:To investigate the short-term efficacy of transverse osteotomy of the first metatarsal and fixation with Kirschner wires for mild to moderate hallux valgus (HV).Methods:This was a retrospective cohort study. A total of 44 patients (55 feet) with HV who underwent surgical treatment in the Foot and Ankle Ward Two, Tianjin Hospital, Tianjin University from March 2022 to June 2023 were enrolled, including 41 females and 3 males. Based on the different surgical methods, they were divided into a transverse osteotomy group and Scarf group. The transverse osteotomy group was treated with transverse osteotomy of the first metatarsal and fixation with two Kirschner wires, and the Scarf group was treated with "Z" osteotomy and screw fixation. The transverse osteotomy group consisted of 20 patients (25 feet), all female, with an average age of 54.56±3.13 years (range, 50-62 years), including 12 left feet and 13 right feet. Among them, 7 feet had mild HV, and 18 feet had moderate HV. The Scarf osteotomy group included 24 patients (30 feet), 3 males and 21 females, with an average age of 52.43±5.46 years (range, 39-60 years), including 15 left feet and 15 right feet. Among them, 3 feet had mild HV and 27 feet had moderate HV. Observation indicators: (1) The imaging indicators of the two groups were compared before operation and at the last follow-up. These indicators included hallux valgus angle (HVA), intermetatarsal angle (IMA). (2) The clinical efficacy of the two groups was compared, including American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score and visual analogue scale (VAS), as well as postoperative complications. (3) The operation time of the two groups was recorded respectively.Results:Both groups were followed up for an average duration of 6-18 months (13.28±4.42 months). There were no significant differences in preoperative baseline characteristics between the transverse osteotomy group and the Scarf group ( P>0.05). The mean operation time was 28.96±4.10 min for the transverse osteotomy group and 45.37±4.72 min for the Scarf group, with a statistically significant difference ( t=13.612, P<0.001). In the transverse osteotomy, the preoperative HVA was 32.48°±3.9°and decreased to 8.59°±3.06° at the last follow-up, while IMA reduced from 14.53°±1.89° before surgery to 5.07°±1.74° at the last follow-up with statistical significance ( P<0.05). Similarly, in the Scarf group, preoperative HVA was 32.83°±2.33° and decreased to 9.87°±2.66° at the last follow-up, whereas IMA decreased from 13.7°±2.03° before surgery to 5.73°±1.74° at the last follow-up with statistical significance ( P<0.05). There was no significant difference in HVA and IMA between the two groups before surgery and the last follow-up ( P>0.05). In the transverse osteotomy, the preoperative VAS score was 6.0(5.5, 7.0), and at the last follow-up, it improved to 2.0(1.0, 2.0). The preoperative AOFAS score was 48.40±6.04 and increased significantly to 87.36±5.02 at the last follow-up ( P<0.05). In the Scarf group, the preoperative VAS score was 6.0(5.0, 6.0), which decreased to 2.0(2.0, 2.0) at the last follow-up assessment. The preoperative AOFAS score was 50.70±7.31 and showed a significant improvement with a mean of 84.43±3.45 at the final evaluation ( P<0.05). There were no significant differences in preoperative VAS scores between the two groups; however, at the last follow-up assessment, patients in the transverse osteotomy group had higher scores compared to those in the Scarf group, indicating better outcomes ( t=2.610, P=0.012). Postoperatively, only 1 foot in the transverse osteotomy group developed metastatic metatarsal pain, with a complication rate of 4% (1/25). In the Scarf osteotomy group, 1 foot developed superficial wound infection, 1 foot developed metastatic metatarsal pain, and 6 feet experienced joint stiffness, with a complication rate of 27%(8/30). Conclusions:Transverse osteotomy of the first metatarsal and fixation with Kirschner wires is simple, effective, and fast. It can effectively relieve pain, quickly restore function, shorten operation time, reduce soft tissue trauma, and minimize complications, demonstrating good clinical efficacy in the short term.

Objective:To retrieve, evaluate and summarize the best evidence on the use of bedside ultrasound by ICU nurses to assess the lungs of adult critically ill patients, and to provide a reference for clinical practice and the construction of related processes and protocols.Methods:Based on the "6S" pyramid model, a computer-based search was conducted on relevant computer decision support system, guideline networks, professional associations, and domestic and international databases, the search time limit was from the establishment of the database to June 5, 2024. The panel members who had been trained in the evidence-based course evaluated the included literature with corresponding tools, extracted evidence according to the theme.Results:Twenty-five papers were finally included, including 6 guidelines, 8 expert consensus, 2 expert opinion, 3 clinical decision-making, 3 systematic evaluation, and 3 randomized controlled trials. A total of 35 pieces of evidence were formed from 4 aspects, including personnel training, operation specifications, clinical application (including dyspnea screening, intervention implementation, efficacy evaluation, diaphragm function evaluation) and precautions.Conclusions:The best evidence for lung assessment and intervention in adult critically ill patients based on bedside ultrasound can provide a reference for the adjustment and decision-making of nursing measures for adult critically ill patients. In the subsequent process of evidence transformation, attention should be paid to combining clinical practice and the joint cooperation of medical staff.

Objective:To investigate the short-term efficacy of transverse osteotomy of the first metatarsal and fixation with Kirschner wires for mild to moderate hallux valgus (HV).Methods:This was a retrospective cohort study. A total of 44 patients (55 feet) with HV who underwent surgical treatment in the Foot and Ankle Ward Two, Tianjin Hospital, Tianjin University from March 2022 to June 2023 were enrolled, including 41 females and 3 males. Based on the different surgical methods, they were divided into a transverse osteotomy group and Scarf group. The transverse osteotomy group was treated with transverse osteotomy of the first metatarsal and fixation with two Kirschner wires, and the Scarf group was treated with "Z" osteotomy and screw fixation. The transverse osteotomy group consisted of 20 patients (25 feet), all female, with an average age of 54.56±3.13 years (range, 50-62 years), including 12 left feet and 13 right feet. Among them, 7 feet had mild HV, and 18 feet had moderate HV. The Scarf osteotomy group included 24 patients (30 feet), 3 males and 21 females, with an average age of 52.43±5.46 years (range, 39-60 years), including 15 left feet and 15 right feet. Among them, 3 feet had mild HV and 27 feet had moderate HV. Observation indicators: (1) The imaging indicators of the two groups were compared before operation and at the last follow-up. These indicators included hallux valgus angle (HVA), intermetatarsal angle (IMA). (2) The clinical efficacy of the two groups was compared, including American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score and visual analogue scale (VAS), as well as postoperative complications. (3) The operation time of the two groups was recorded respectively.Results:Both groups were followed up for an average duration of 6-18 months (13.28±4.42 months). There were no significant differences in preoperative baseline characteristics between the transverse osteotomy group and the Scarf group ( P>0.05). The mean operation time was 28.96±4.10 min for the transverse osteotomy group and 45.37±4.72 min for the Scarf group, with a statistically significant difference ( t=13.612, P<0.001). In the transverse osteotomy, the preoperative HVA was 32.48°±3.9°and decreased to 8.59°±3.06° at the last follow-up, while IMA reduced from 14.53°±1.89° before surgery to 5.07°±1.74° at the last follow-up with statistical significance ( P<0.05). Similarly, in the Scarf group, preoperative HVA was 32.83°±2.33° and decreased to 9.87°±2.66° at the last follow-up, whereas IMA decreased from 13.7°±2.03° before surgery to 5.73°±1.74° at the last follow-up with statistical significance ( P<0.05). There was no significant difference in HVA and IMA between the two groups before surgery and the last follow-up ( P>0.05). In the transverse osteotomy, the preoperative VAS score was 6.0(5.5, 7.0), and at the last follow-up, it improved to 2.0(1.0, 2.0). The preoperative AOFAS score was 48.40±6.04 and increased significantly to 87.36±5.02 at the last follow-up ( P<0.05). In the Scarf group, the preoperative VAS score was 6.0(5.0, 6.0), which decreased to 2.0(2.0, 2.0) at the last follow-up assessment. The preoperative AOFAS score was 50.70±7.31 and showed a significant improvement with a mean of 84.43±3.45 at the final evaluation ( P<0.05). There were no significant differences in preoperative VAS scores between the two groups; however, at the last follow-up assessment, patients in the transverse osteotomy group had higher scores compared to those in the Scarf group, indicating better outcomes ( t=2.610, P=0.012). Postoperatively, only 1 foot in the transverse osteotomy group developed metastatic metatarsal pain, with a complication rate of 4% (1/25). In the Scarf osteotomy group, 1 foot developed superficial wound infection, 1 foot developed metastatic metatarsal pain, and 6 feet experienced joint stiffness, with a complication rate of 27%(8/30). Conclusions:Transverse osteotomy of the first metatarsal and fixation with Kirschner wires is simple, effective, and fast. It can effectively relieve pain, quickly restore function, shorten operation time, reduce soft tissue trauma, and minimize complications, demonstrating good clinical efficacy in the short term.