OBJECTIVE To analyze the influencing factors of voriconazole trough concentration and adverse drug reactions （ADR） in renal transplant recipients. METHODS Data from inpatients who received voriconazole and therapeutic drug monitoring in our hospital between January 2022 and August 2023 were retrospectively analyzed. Patients were divided into renal transplant group and non-renal transplant group based on transplantation status. A 1∶1 propensity score matching （PSM） method was used to balance differences in baselines between the two groups. Voriconazole trough concentrations， target attainment rate， clinical efficacy， and ADR were compared between the two groups. Multiple linear regression （backward） was used to analyze the factors influencing voriconazole trough concentrations in the renal transplant group. Univariate analysis and binary Logistic regression were used to identify independent risk factors for ADR in the renal transplant group. RESULTS After PSM， 48 patients were included in each group. There were no statistically significant differences in the mean voriconazole trough concentration， target attainment rate or efficacy rate between the two groups （P＞0.05）. The total incidence of ADR was significantly higher in the renal transplant group than in the non-renal transplant group （P＜0.05）. Multiple linear regression analysis showed that age， average daily dose， pulmonary infection， total bilirubin during medication， day-1 loading dose， use of the original drug， concomitant immunosuppressant use， and the occurrence of ADR were factors influencing voriconazole trough concentration in renal transplant patients （P＜0.05）. Binary Logistic regression analysis showed that abnormal direct bilirubin during medication [OR＝7.747， 95%CI （1.334， 45.005）， P＝0.023] was an independent risk factor for ADR in renal transplant patients receiving voriconazole. CONCLUSIONS Age， average daily dose， pulmonary infection， use of the original drug， day-1 loading dose， total bilirubin during medication， concomitant immunosuppressant use， and the occurrence of ADR are the factors influencing voriconazole trough concentration in renal transplant patients. Furthermore， patients with abnormal direct bilirubin during medication are more susceptible to ADR.

ObjectiveTo explore the medical experience of caregivers of adolescent depression. MethodsIn-depth interviews were conducted with 35 caregivers of hospitalized adolescents with depression undergoing treatment， to explore their experiences and feelings during their children’s medical treatment. The Colaizzi phenomenological seven-step analysis method was employed to summarize and extract themes. ResultsA total of five themes were extracted， including the transformation of attitude towards the disease from denial to acceptance； the treatment process failing to meet expectations； complex emotional experiences featuring the coexistence of hope and disappointment； negative feedback regarding communication with medical staff； difficulties in accessing medical services， and the expectation for more assistance. ConclusionCaregivers lack sufficient knowledge about the disease during their children’s medical-seeking process， the disease treatment process fails to meet expectations， and there is negative feedback regarding communication with medical staff. Overall， medical experience is complex， and current medical services still have deficiencies. It is urgent to pay attention to the medical experiences of caregivers， enhance their disease cognition， standardize the diagnosis and treatment process， improve the effect of doctor-patient communication， expand multi-channel medical-seeking methods， and further meet the needs of patients and caregivers.

Objective To compare and analyze the application value of brain black blood technology three-dimensional BrainVIEW(3D-BrainVIEW)and conventional three-dimensional turbo field echo T1 weighted imaging(3D-TFE T1WI)in brain metastases of lung cancer.Methods A total of 60 patients with pathologically confirmed lung cancer were selected.All patients underwent brain enhanced MRI using 3D-BrainVIEW and 3D-TFE T1WI.The signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of the two groups were compared and analyzed,respectively.The diagnostic efficacy(including number,size,and location)of the two groups of images in detecting brain metastases was evaluated by two experienced radiologists via double-blind method.Results The diagnostic consistency between the two radiologists was excellent[intraclass correlation coefficient(ICC)=0.998,P<0.001].There were significant differences in SNR,CNR,and the number and location of brain metastases between 3D-BrainVIEW sequence and 3D-TFE T1WI sequence(P<0.05),and 3D-BrainVIEW sequence was significantly superior to 3D-TFE T1WI sequence.In addition,the number of brain metastases detected by 3D-Brain VIEW sequence was significantly higher than that detected by 3D-TFE T1WI sequence in lesions with minimum diameter(Dmin)<5 mm(P<0.001).There was no difference in the number of lesions detected by the two sequences in lesions with Dmin>5 mm(P>0.05).Conclusion The SNR and CNR of 3D-Brain VIEW enhanced scan images are significantly higher than those of 3D-TFE T1WI,which has higher detection efficiency for lung cancer brain metastases,and can effectively reduce misdiagnosis caused by microvascular enhance-ment,which has high clinical application value.

OBJECTIVE To observe the effects of measures dominated by intensifying link quality on prevention and control of carbapenem-resistant Klebsiella pneumoniae(CRKP)among general ICU patients.METHODS The conventional intervention measures were taken from Jan.2016 to Oct.2020,which was assigned as the pre-inter-vention period;the intervention measures dominated by enhancement of link quality were taken for the general ICU patients(the study group)from Nov.2020 to Oct.2021,which was set as the intervention period,the inter-vention measures were taken for the neurosurgery ICU patients and the surgery ICU patients(the control group).A two-group interrupted time series of a quasi-experimental study was analyzed,and whether or not the intervention measures could reduce the incidence of CRKP hospital-associated infection among the general ICU patients was evaluated.RESULTS A total of 23 713 case-times of patients from three ICU wards were enrolled in the study.The incidence of CRKP hospital-associated infection among the general ICU patients was 4.49 cases per thousand patient-days during intervention period,3.71 cases per thousand patient-days during pre-intervention pe-riod,and there was no significant difference(u=-1.412,P=0.079);it was lower than 7.06 cases per thousand patient-days during nearly one year before the intervention period(from Nov.2019 to Oct.2020),and there was significant difference(u=3.128,P=0.002).The result of analysis of the interrupted time series showed that there was significant difference in the slope change between the study group and the control group after the inter-vention(P=0.035),indicating that the intervention measures could reduce the incidence of CRKP hospital-associ-ated infection in the study group,and there was significant difference in the changing trend between the study group and the control group.CONCLUSIONS The prevention and control measures for CRKP dominated by the link quality management can effectively reduce the incidence of CRKP hospital-associated infection among the gen-eral ICU patients.The prevention and control strategies may provide reference for prevention and control of CRKP in ICUs of other medical institutions.

Objective:To analyze the epidemiological and clinical characteristics of respiratory pathogens in China.Methods:This study was a cross-sectional study, which encompassed 19 core units of the clinical pathogen network and established a three-tiered clinical pathogen surveillance system. Thirty respiratory samples were collected every two weeks from various units from January to December 2024, and the clinical and pathogen diagnostic information were gathered. A total of 11 864 samples were tested using this system. The tier-1 clinical pathogen surveillance system covered influenza A virus (Flu-A), influenza B virus (Flu-B), respiratory syncytial virus (RSV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The tier-2 clinical pathogen surveillance system focused on 18 key respiratory pathogens. The tier-3 clinical pathogen surveillance system further clarified whether any emerging infectious diseases had occurred.Results:The tier-1 clinical pathogen surveillance system showed Flu-A predominated in December, Flu-B predominated in January, SARS-CoV-2 peaked in March and August, whereas RSV circulated sporadically throughout the year. Geographic trends were broadly consistent across the seven major regions, although Flu-A detection in December was notably higher in Northeast China (48.1%(111/231)) and East China (36.2%(148/409)), and RSV detection was concentrated in the Northwest and South China from January to March. Data from the tier-2 clinical pathogen surveillance system indicated that Streptococcus pneumoniae, Mycoplasma pneumoniae, rhinovirus, and adenovirus were detected year-round, of these, Streptococcus pneumoniae and rhinovirus showed elevated positive detection rates from August to September, while adenovirus peaked in January. Legionella pneumophila was not detected throughout the year, and other pathogens fluctuated throughout the year without a consistent pattern. The predominant etiologic agents of pediatric pneumonia were Mycoplasma pneumoniae (35.0%(105/300)), rhinovirus (25.7%(77/300)), and adenovirus (17.3%(52/300)), whereas adult pneumonia was mainly caused by Streptococcus pneumoniae (10.5%(29/277)), Staphylococcus aureus (6.9%(19/277)), Mycoplasma pneumoniae (6.9%(19/277)), and Flu-A (6.1%(17/277)). The tier-3 clinical pathogen surveillance system did not identify any emerging respiratory pathogens. Conclusion:Respiratory pathogens in China in 2024 exhibit distinct temporal and spatial distribution patterns and vary among different populations.

The study selected various advanced training programs under the professional technical talent knowledge updating project implemented by Peking Union Medical College from 2021 to 2025 as research subjects,analyzing the organizational structure,key practices,typical cases,and participant satisfaction evaluations of these programs.The results showed that the comprehensive evaluation rate of trainees regarding faculty quality,teaching effective-ness,and service management exceeded 99%,with an excellent satisfaction rating also surpassing 99%.The re-search indicates that the professional technical talent knowledge updating project serves as a crucial pathway for medical professionals to maintain competitiveness and achieve career development.

Objective To explore the solution of local water-fat separation swap artifacts(WFS-SA)on nasopharyngeal T1WI-itera-tive decomposition of water and fat with echo asymmetry and least-squares estimation(T1WI-IDEAL)enhanced examination images.Methods Thirty-seven patients with obvious WFS-SA on nasopharyngeal enhanced examination using the A group T1WI-IDEAL param-eters were collected.Scans with modified parameters B,C,and D groups were subsequently performed based on the A group parame-ters.Subjective ratings of image quality were conducted on the four image groups,and the image signal-to-noise ratio(SNR)of the posterior wall of the nasopharynx and medulla oblongata was quantified.The total number of artifact slices(TAS),total artifact area(TAA),and maximum single-slice artifact area(SSAAmax)of the WFS-SA in the four image groups were recorded.The consistency of image quality ratings between the two technologists was analyzed via the intraclass correlation coefficient(ICC),and one-way analysis of variance or rank-sum test was used to compare the SNR,TAS,TAA,and SSAAmax among the four image groups.Results The subjective rating for modified B,C,and D groups of T1WI-IDEAL images by two technologists was deemed satisfactory(ICC=0.721-0.928,P<0.001).Significant variations in image quality ratings were observed among the three groups(H=45.131,P<0.001),with ratings for C and D groups surpass-ing those for B group(P<0.001).The TAS,TAA,and SSAAmax exhibited a decreasing pattern on T1WI-IDEAL images across A,B,C,and D groups,with statistically significant variances observed among all groups(P<0.001).Moreover,the SNR of the medulla oblongata layer in D group displayed a notably higher value compared to A,B groups,with statistically significant distinctions(P<0.001).Conclusion By combining the reduction of the echo train length(ETL)to 2 with the implementation of a double shimming,the occurrence of WFS-SA on nasopharyngeal T1WI-IDEAL enhanced examination images can be minimized and the overall image quality can be enhanced.

Objective To explore the solution of local water-fat separation swap artifacts(WFS-SA)on nasopharyngeal T1WI-itera-tive decomposition of water and fat with echo asymmetry and least-squares estimation(T1WI-IDEAL)enhanced examination images.Methods Thirty-seven patients with obvious WFS-SA on nasopharyngeal enhanced examination using the A group T1WI-IDEAL param-eters were collected.Scans with modified parameters B,C,and D groups were subsequently performed based on the A group parame-ters.Subjective ratings of image quality were conducted on the four image groups,and the image signal-to-noise ratio(SNR)of the posterior wall of the nasopharynx and medulla oblongata was quantified.The total number of artifact slices(TAS),total artifact area(TAA),and maximum single-slice artifact area(SSAAmax)of the WFS-SA in the four image groups were recorded.The consistency of image quality ratings between the two technologists was analyzed via the intraclass correlation coefficient(ICC),and one-way analysis of variance or rank-sum test was used to compare the SNR,TAS,TAA,and SSAAmax among the four image groups.Results The subjective rating for modified B,C,and D groups of T1WI-IDEAL images by two technologists was deemed satisfactory(ICC=0.721-0.928,P<0.001).Significant variations in image quality ratings were observed among the three groups(H=45.131,P<0.001),with ratings for C and D groups surpass-ing those for B group(P<0.001).The TAS,TAA,and SSAAmax exhibited a decreasing pattern on T1WI-IDEAL images across A,B,C,and D groups,with statistically significant variances observed among all groups(P<0.001).Moreover,the SNR of the medulla oblongata layer in D group displayed a notably higher value compared to A,B groups,with statistically significant distinctions(P<0.001).Conclusion By combining the reduction of the echo train length(ETL)to 2 with the implementation of a double shimming,the occurrence of WFS-SA on nasopharyngeal T1WI-IDEAL enhanced examination images can be minimized and the overall image quality can be enhanced.

OBJECTIVE To observe the effects of measures dominated by intensifying link quality on prevention and control of carbapenem-resistant Klebsiella pneumoniae(CRKP)among general ICU patients.METHODS The conventional intervention measures were taken from Jan.2016 to Oct.2020,which was assigned as the pre-inter-vention period;the intervention measures dominated by enhancement of link quality were taken for the general ICU patients(the study group)from Nov.2020 to Oct.2021,which was set as the intervention period,the inter-vention measures were taken for the neurosurgery ICU patients and the surgery ICU patients(the control group).A two-group interrupted time series of a quasi-experimental study was analyzed,and whether or not the intervention measures could reduce the incidence of CRKP hospital-associated infection among the general ICU patients was evaluated.RESULTS A total of 23 713 case-times of patients from three ICU wards were enrolled in the study.The incidence of CRKP hospital-associated infection among the general ICU patients was 4.49 cases per thousand patient-days during intervention period,3.71 cases per thousand patient-days during pre-intervention pe-riod,and there was no significant difference(u=-1.412,P=0.079);it was lower than 7.06 cases per thousand patient-days during nearly one year before the intervention period(from Nov.2019 to Oct.2020),and there was significant difference(u=3.128,P=0.002).The result of analysis of the interrupted time series showed that there was significant difference in the slope change between the study group and the control group after the inter-vention(P=0.035),indicating that the intervention measures could reduce the incidence of CRKP hospital-associ-ated infection in the study group,and there was significant difference in the changing trend between the study group and the control group.CONCLUSIONS The prevention and control measures for CRKP dominated by the link quality management can effectively reduce the incidence of CRKP hospital-associated infection among the gen-eral ICU patients.The prevention and control strategies may provide reference for prevention and control of CRKP in ICUs of other medical institutions.

Objective To compare and analyze the application value of brain black blood technology three-dimensional BrainVIEW(3D-BrainVIEW)and conventional three-dimensional turbo field echo T1 weighted imaging(3D-TFE T1WI)in brain metastases of lung cancer.Methods A total of 60 patients with pathologically confirmed lung cancer were selected.All patients underwent brain enhanced MRI using 3D-BrainVIEW and 3D-TFE T1WI.The signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of the two groups were compared and analyzed,respectively.The diagnostic efficacy(including number,size,and location)of the two groups of images in detecting brain metastases was evaluated by two experienced radiologists via double-blind method.Results The diagnostic consistency between the two radiologists was excellent[intraclass correlation coefficient(ICC)=0.998,P<0.001].There were significant differences in SNR,CNR,and the number and location of brain metastases between 3D-BrainVIEW sequence and 3D-TFE T1WI sequence(P<0.05),and 3D-BrainVIEW sequence was significantly superior to 3D-TFE T1WI sequence.In addition,the number of brain metastases detected by 3D-Brain VIEW sequence was significantly higher than that detected by 3D-TFE T1WI sequence in lesions with minimum diameter(Dmin)<5 mm(P<0.001).There was no difference in the number of lesions detected by the two sequences in lesions with Dmin>5 mm(P>0.05).Conclusion The SNR and CNR of 3D-Brain VIEW enhanced scan images are significantly higher than those of 3D-TFE T1WI,which has higher detection efficiency for lung cancer brain metastases,and can effectively reduce misdiagnosis caused by microvascular enhance-ment,which has high clinical application value.