Objective:To construct a dynamic competency assessment system suitable for standardized training of resident physicians in the department of pediatric infectious diseases, verify its teaching practice effectiveness, and enhance the core competence of specialist physicians.Methods:Based on the Delphi method, an evaluation system was constructed. Through two rounds of expert consultation ( n=20, authority coefficient Cr=0.889-0.895), 5 primary indicators, 13 secondary indicators, and 38 tertiary indicators were established, covering dimensions such as clinical thinking, operational skills, and professional ethics. The hierarchical and progressive design and dynamic feedback mechanism were adopted. Sixty residents were randomly divide into an observation group (dynamic evaluation system) and a control group (traditional evaluation). Differences between the two groups were compared in terms of short-term teaching effectiveness (e.g., OSCE assessment and Mini CEX score) and long-term clinical competencies (e.g., exit assessment pass rate and incidence of adverse events). SPSS 24.0 was used for t-test, Mann Whitney U test, and internal consistency test (Cronbach's alpha=0.89). Results:The observation group outperformed the control group in core specialty competencies and clinical practice outcomes. In terms of core specialty competencies, the observation group had a higher response speed score for pathogen results [(4.10±0.84) vs. (3.60±0.95), P=0.042]. This indicates that the dynamic evaluation system effectively enhanced the ability of trained physicians to quickly adjust treatment plans based on pathogenic evidence. The implementation rate of infection prevention and control standards and diagnostic accuracy were also higher in the observation group compared to the control group, reflecting the advantages of this system in standardizing clinical operations and improving diagnostic levels. In terms of long-term clinical competencies, the observation group showed significantly increased exit assessment pass rate and significantly decreased incidence of medical adverse events, further verifying the continuous promotion effect of the dynamic evaluation system on the clinical competence of trained physicians. Conclusions:The dynamic evaluation system constructed in this study can effectively enhance the core specialty competencies (e.g., pathogen response and infection prevention and control) and long-term clinical competence of residents in the department of pediatric infectious diseases, providing scientific basis for optimizing the training models of specialist physicians.

Objective:To construct a dynamic competency assessment system suitable for standardized training of resident physicians in the department of pediatric infectious diseases, verify its teaching practice effectiveness, and enhance the core competence of specialist physicians.Methods:Based on the Delphi method, an evaluation system was constructed. Through two rounds of expert consultation ( n=20, authority coefficient Cr=0.889-0.895), 5 primary indicators, 13 secondary indicators, and 38 tertiary indicators were established, covering dimensions such as clinical thinking, operational skills, and professional ethics. The hierarchical and progressive design and dynamic feedback mechanism were adopted. Sixty residents were randomly divide into an observation group (dynamic evaluation system) and a control group (traditional evaluation). Differences between the two groups were compared in terms of short-term teaching effectiveness (e.g., OSCE assessment and Mini CEX score) and long-term clinical competencies (e.g., exit assessment pass rate and incidence of adverse events). SPSS 24.0 was used for t-test, Mann Whitney U test, and internal consistency test (Cronbach's alpha=0.89). Results:The observation group outperformed the control group in core specialty competencies and clinical practice outcomes. In terms of core specialty competencies, the observation group had a higher response speed score for pathogen results [(4.10±0.84) vs. (3.60±0.95), P=0.042]. This indicates that the dynamic evaluation system effectively enhanced the ability of trained physicians to quickly adjust treatment plans based on pathogenic evidence. The implementation rate of infection prevention and control standards and diagnostic accuracy were also higher in the observation group compared to the control group, reflecting the advantages of this system in standardizing clinical operations and improving diagnostic levels. In terms of long-term clinical competencies, the observation group showed significantly increased exit assessment pass rate and significantly decreased incidence of medical adverse events, further verifying the continuous promotion effect of the dynamic evaluation system on the clinical competence of trained physicians. Conclusions:The dynamic evaluation system constructed in this study can effectively enhance the core specialty competencies (e.g., pathogen response and infection prevention and control) and long-term clinical competence of residents in the department of pediatric infectious diseases, providing scientific basis for optimizing the training models of specialist physicians.

Objective    To evaluate the preoperative risk factors for acute Stanford type A aortic dissection (ASTAAD) patients in our country by collecting multi-center data. Methods    We consecutively enrolled 700 patients who underwent surgery for ASTAAD in the multi-center hospital database from January 2018 to January 2020. According to the ascending aorta size (AAS), the patients were divided into two groups: a group AAS≥55 mm and a group AAS< 55 mm. Univariate and multivariate logistic regression analyses were used to investigate the related preoperative risk factors for the onset of ASTAAD. Results    According to the exclusion criteria, a total of 621 patients were finally enrolled, including 453 males and 168 females with an average age of 48.24±11.51 years, and 509 (81.94%) patients had AAS< 55 mm. Univariate and multivariate statistical analyses showed that smoking, hypertension, preoperative cardiac troponin I, and left ventricular ejection fraction were related to the occurrence of ASTAAD. The mortality rate of the patient during hospitalization was 13.04% (81 patients). Conclusion    In clinical practice, various preoperative risk factors affect ASTAAD patients, which should be paid attention to. Comprehensive evaluation and an individualized analysis of patients and timely prevention and intervention improve patients' survival rate.

Objective:To investigate the preoperative ascending aorta diameter in patients with acute type A aortic dissection in the Chinese population, compares and analyze the differences in preoperative blood biomarkers, and evaluate the impact of the preoperative ascending aorta diameter in this part of patients on the short-term prognosis of patients.Methods:A collection of 641 patients with acute type A aortic dissection who were enrolled in the " Acute Aortic Syndrome High-Risk Early Warning and Intervention Study" project from January 2018 to January 2020 were collected. Divide the patients into two groups (group Ⅰ<55 mm, group Ⅱ≥55 mm) according to the preventive intervention value of ascending aorta diameter recommended by the guideline for studying preoperative ascending aorta diameter difference in blood biomarkers and the influence of ascending aorta diameter on the short-term prognosis of patients. All patients had CT scans to assess the diameter of the ascending aorta before operation.Results:In this study, all patients with acute type A aortic dissection had a mean preoperative ascending aorta diameter of (46.9±9.7)mm. The preoperative ascending aorta diameter of all patients was less than 55 mm, accounted for 84.1%. Male patients were more likely to have aortic dissection than females; most patients' age was less than 60 years old. The preoperative blood inflammatory index counts were higher in the ascending aorta diameter ≥55 mm group. However, the long-term prognosis of patients with different ascending aorta diameters before surgery was not apparent in this study. The preoperative survival rate and short-term survival rate of patients with ascending aorta diameter <55 mm were higher than those of other groups, but the difference was not statistically significant.Conclusion:In patients with acute type A aortic dissection, the diameter of the ascending aorta is usually less than 55 mm. Moreover, the blood inflammatory index counts are high in the preoperative ascending aorta diameter ≥55 mm group. Meanwhile, patients with smaller ascending aorta diameter have better survival rate and short-term prognosis.

Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.

Objective: To study the effect of Neiyi-Tongjingling on the content of TGF-β1 and Smad2/3 protein in ectopic endometrium of rats with endometriosis. Methods: Atotal of 42 rats were randomly divided into the sham operation group, model group, high, medium and low dose groups of traditional Chinese medicine and western medicine group with 7 rats in each group. Except for the sham-operated group, the rats in the other groups established EMs models by means of rat autologous intimal transplantation. The drug was administered at the 5th week after the model was established. The western medicine group was given 0.5 mg/kg gestrinone solution twice a week. The high, medium and low dose groups of traditional Chinese medicine were given 49.50 mg/kg, 24.75 mg/kg and 12.38 mg/kg of Neiyi-Tongjingling liquid, respectively. While the model group and sham operation group were given the same volume of normal saline once per day for 4 weeks. The volume of ectopic lesions in each group was observed. The HE staining was used to observe the pathological changes of intima tissue. Immunohistochemical SP method was used to detect the expression of TGF-β1 and Smad2/3 proteins in intima tissue. Results: The volume of ectopic endometrium (57.91 ± 13.10 mm³, 48.93 ± 8.15 mm³, 76.21 ± 17.14 mm³, 57.88 ± 15.98 mm³ vs. 141.58 ± 54.25 mm³) in the western medicine group and the high, medium and low dose group of Chinese medicine were significantly lower than that in the model group (P<0.05). Compared with the model group, the content of TGF-β1 (0.08 ± 0.00, 0.08 ± 0.01, 0.10 ± 0.00 vs. 0.13 ± 0.03) and Smad2/3 (0.09 ± 0.02, 0.08 ± 0.01, 0.10 ± 0.01 vs. 0.12 ± 0.02) in ectopic endometrium tissue of three Chinese medicine groups decreased significantly (P<0.05). Conclusions The Neiyi-Tongjingling can treat EMs by inhibiting the growth of ectopic endometrium, reducing the volume of ectopic lesions, and reducing the expression of TGF-β1 and Smad2/3 proteins.

Objective To investigate the expression of sperm-associated antigen 6 (Spag6) in liver cancer tissue and its association with the clinicopathological features and prognosis of liver cancer patients,as well as the effect of Spag6 on the proliferation and migration of HCCLM3 hepatoma cells.Methods Clinical samples were collected from 102 liver cancer patients who were treated in Xiangya Hospital of Central South University from August 2006 to November 2009,and Western blot was used to measure the expression of Spag6 in hepatoma cells,normal liver tissue,tumor tissue,and corresponding adjacent tissue.Immunohistochemistry was used to measure the expression of Spag6 in 102 liver cancer tissue samples,and according to the immunohistochemical scoring criteria,the patients were divided into high Spag6 expression group and low Spag6 expression group.Lentivirus-mediated RNA interference technique was used to silence Spag6 expression in HCCLM3 cells;Western blot was used to analyze silencing effect,wound-healing assay was used to investigate the effect of Spag6 gene silencing on the migration of HCCLM3 cells,and colony formation assay was performed to observe the effect of Spag6 gene silencing on the proliferation of HCCLM3 cells.The chi-square test was used to investigate the association between Spag6 expression and clinicopathological features of liver cancer patients,and the Kaplan-Meier survival analysis and log-rank test were used to analyze the association between Spag6 expression and the prognosis of liver cancer patients.Results Hepatoma cells and liver cancer tissue had significantly higher expression of Spag6 than the normal L02 cells and normal liver tissue.Immunohistochemistry showed that the expression rate of Spag6 was 58.8％ (60/102) in liver cancer tissue samples and 12.7％ (13/102) in adjacent tissue samples (x2 =47.123,P ＜0.001).According to the results of the chi-square test,Spag6 expression was associated with the number of tumor nodules,presence or absence of capsule,vascular invasion,and Edmondson-Steiner classification (x2 =8.360,6.761,4.344,and 7.172,P =0.004,0.009,0.037,and 0.007).Further analysis showed that the high Spag6 expression group had significantly lower 1-,3-,and 5-year survival rates than the low Spag6 expression group (71.5％ vs 90.5％,43.7％ vs 68.8％,19.7％ vs 48.7％,x2 =11.228,P =0.001).Cell assays showed significant reductions in the proliferation and migration of HCCLM3 cells after Spag6 gene silencing (both P ＜ 0.01).Conclusion Spag6 is highly expressed in hepatoma cells and liver cancer tissue,and its high expression is associated with poor clinicopathological features and postoperative survival of liver cancer.Spag6 can promote the proliferation and migration of hepatoma cells,suggesting that Spag6 may be involved in the development and progression of liver cancer.Therefore,it can be used as a reference index for predicting the prognosis of liver cancer patients and a potential target for liver cancer treatment.

Objective: To study the relationship between endoplasmic reticulum stress (ERS) and adiponectin;to explore the role of ERS for increasing myocardial ischemic vulnerability in type 2 diabetes mellitus (DM) mice.
Methods: Type 2 DM model was established by high fat diet with streptozotocin (STZ) injection. A total of 35 C57BL/6J male type 2 DM mice were divided into 4 groups: ①Control group, n=5. ②Tauroursodeoxycholic acid (TUDCA) group,③Thapsigargin (TG) group and ④Normal saline group. The mice in Groups ②, ③, ④were fed by high fat and high glucose diet by injecting streptozotocin (STZ), in the last 3 weeks and respectively received intraperitoneal injections of TUDCA (250 mg/kg), thapsigargin (TG) (300μg/kg) and normal saline twice a day, n=10 in each group. Then myocardial infarction (MI) model was established in 5 mice from each group. 72 hours later, the MI ranges were measured, serum levels of adiponectin were detected, mRNA expressions of adiponectin and CHOP in myocardial tissue were examined.
Results: The MI range in TUDCA group (21.47 ± 2.85)%and in Normal saline group (39.92 ± 4.28)%were both lower than TG group (66.56 ± 8.15)%, both P<0.01. Before MI occurrence, serum levels of adiponectin in TUDCA group (79.25 ± 6.40) pg/ml and in Normal saline group (70.23 ± 4.15) pg/ml were both higher than TG group (62.64 ± 5.70) pg/ml, both P<0.01;serum levels of adiponectin in each group were higher than they were 72 h after MI. In each group, the mRNA expression and protein content of adiponectin in myocardial tissue were constant to serum adiponectin;while the mRNA expression and protein content of CHOP was opposite to serum adiponectin.
Conclusion: ESR could increase myocardial vulnerability in type 2 DM mice which might be related to down-regulating adiponectin expression.

Adult ; Brachial Plexus ; injuries ; Brachial Plexus Neuropathies ; rehabilitation ; surgery ; Female ; Humans ; Male ; Middle Aged ; Young Adult

Objective To determine the drug-resistance rates of bacteria isolated from 7 hospitals located at different areas of China.Methods 1 111 pathogenic strains were isolated for susceptibility test using agar dilution method from Sep 1,204 to Aug 3 1,2005.According to the criteria of guideline of CLSI (2007),MIC50 and MIC90 were detected for antibacterial activity of antimicrobial agents and resistant rate (R%),intermediate rate(I%)and sensitive rate(S%)were calculated based on susceptibility tests.Results The detectable rates of methiciltin-resistant Staphylococcus anreus(MRSA)and methicilllin- resistant Staphylococcus epidermidis(MRSE)were 39.3%and 74.0% respectively.The total resistant rate of penicillin resistant Streptococcus pneumoniae(R%+I%) was 33.3%(R%=5.6%,I%=27.7%). 91 strains of Enterococcus were isolated.The resistant rate of penicillin resistant E.faecalis Was 40.8%.and E.faecium Was 100%.Neither strains of S.aureus nor strains of S.epidemidis were found resistant to vancomycin.No strains of Enterococcus were found resistant to vancomycin.644 strains of gram-negative bacilli were isolated.The most common gram-negative bacilli were E.coli,k pneumoniae,Acinetobacter spp,P.aeruginosa,and E.cloacae,respectively.The ESBLs-producing strains accounted for 38.6% and 26.7% in E.coli and K. pneumoniae.respectively.Meropenem and imipenem were the most potent antimicrobial agents.Cefoperazone/sulbactam demonstrated excellent activity agent of gram-negative bacilli.Most of the gram-negative bacillus still susceptible to ceftazidime.The new fluroquinotones, moxifloxacin and levofloxacin showed strong and broad spectrum activity against the most gram-positive and gram-negative bacteria.Conclusions This surveillance in 2004-2005 together with the surveillance in 2002-2003,were similar in the bacterial resistance pattern and the trend of rising resistant rates for some pathogens.