Objective:To report the nationwide surveillance results of pathogenic profiles and antimicrobial resistance patterns of Gram-positive bloodstream infections in China in 2023.Methods:The clinical isolates of Gram-posttive bacteria from blood cultures were collected in member hospitals of National Bloodstream Infection Bacterial Resistant Investigation Collaborative System（BRICS）during January to December 2023. Antimicrobial susceptibility testing was performed using the dilution method recommended by the Clinical and Laboratory Standards Institute（CLSI）. Statistical analyses were conducted using WHONET 5.6 and SPSS 25.0 software.Results:A total of 4 385 Gram-positive bacterial isolates were obtained from 60 participating center. The top five pathogens were Staphylococcus aureus（ n=1 544，35.2%），coagulase-negative Staphylococci（ n=1 441，32.9%）， Enterococcus faecium（ n=574，13.1%）， Enterococcus faecalis（ n=385，8.8%），and α-hemolytic Streptococci（ n=187，4.3%）. The prevalence of methicillin-resistant Staphylococcus aureus（MRSA）and methicillin-resistant coagulase-negative Staphylococci（MRCNS）was 26.2%（405/1 544）and 69.8%（1 006/1 441），respectively. Notably，all Staphylococci remained susceptible to glycopeptide or daptomycin. Staphylococcus aureus demonstrated excellent susceptibility（>97.0%）to cephalobiol，rifampicin，trimethoprim-sulfamethoxazole，linezolid，minocycline，tigecycline，and eravacycline. No Enterococcus exhibiting resistance to linezolid were detected. Glycopeptide resistance was uncommon but more frequent in Enterococcus faecium（resistance to vancomycin and teicoplanin：both 1.7%）compared to Enterococcus faecalis（both 0.3%）. The detection rates of MRSA and MRCNS exhibited significant regional variations across the country（ χ2=17.674 and 148.650，respectively，both P<0.001）. No vancomycin-resistant Enterococci were detected in central China. Institutional comparison demonstrated higher prevalence of MRSA（ χ2=14.111， P<0.001）and MRCNS（ χ2=4.828， P=0.028）in provincial hospitals than that in municipal hospitals. Socioeconomic analysis identified elevated detection rates of both MRSA（ χ2=18.986， P<0.001）and MRCNS（ χ2=4.477， P=0.034）in less developed regions（per capita GDP

Objective:To report the results of bacterial resistant investigation collaborative system（BRICS）on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2023，and provide reference for clinical tretment of bloodstream infections and prevention and control of bacterial resistance.Methods:The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of BRICS were collected during January 2023 to December 2023. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 were used to analyze the data.Results:During the study period，11 492 strains of Gram-negative bacteria were collected from 60 hospitals，of which 10 098（87.9%）were Enterobacterales and 1 394（12.1%）were non-fermentative bacteria. The top 5 bacterial species were Escherichia coli（50.0%）， Klebsiella pneumoniae（26.1%）， Pseudomonas aeruginosa（5.1%）， Acinetobacter baumannii complex（5.0%）and Enterobacter cloacae complex（4.1%）. The ESBL-producing rates in Escherichia coli， Klebsiella pneumoniae and Proteus mirablilis were 46.8%（2 685/5 741），18.3%（549/2 999）and 44.0%（77/175），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（76/5 741）and 15.0%（450/2 999）；32.9%（25/76）and 78.0%（351/450）of CREC and CRKP were sensitive to ceftazidime/avibactam combination，respectively. 94.7%（72/76）and 90.2%（406/450）of CREC and CRKP were sensitive to aztreonam/avibactam combination. Furthermore，57.9%（44/76）and 79.1%（356/450）were sensitive to imipenem/relebactam combination. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 64.6%（370/573），while more than 80.0% of CRAB complex was sensitive to tigecycline，eravacycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 17.0%（99/581）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of important Gram-negative bacteria resistance among different regions in China，with statistically significant differences in the prevalence of CREC，CRKP，CRPA and CRAB complex（ χ2=10.6，28.6，10.8 and 19.3， P<0.05）. The prevalence of ESBL-producing Escherichia coli， CREC，CRAB complex and CRKP were higher in provincial hospitals than those in municipal hospitals（ χ2=12.5，9.8，12.7 and 57.8，all P<0.01）. Conclusions:Gram-negative bacteria are the main pathogens causing bloodstream infections in China，and Escherichia coli is ranked in the top，while the trend of Klebsiella pneumoniae increases continuously with time. CRKP infection shows a slow upward trend，CREC infecton maintains a low prevalence level，and CRAB complex infection continues to exhibit a high prevalence rate. The composition and resistance patterns of pathogens causing bloodstream infections vary to some extent across different regions and levels of hospitals in China.

Objective:To report the nationwide surveillance results of pathogenic profiles and antimicrobial resistance patterns of Gram-positive bloodstream infections in China in 2023.Methods:The clinical isolates of Gram-posttive bacteria from blood cultures were collected in member hospitals of National Bloodstream Infection Bacterial Resistant Investigation Collaborative System（BRICS）during January to December 2023. Antimicrobial susceptibility testing was performed using the dilution method recommended by the Clinical and Laboratory Standards Institute（CLSI）. Statistical analyses were conducted using WHONET 5.6 and SPSS 25.0 software.Results:A total of 4 385 Gram-positive bacterial isolates were obtained from 60 participating center. The top five pathogens were Staphylococcus aureus（ n=1 544，35.2%），coagulase-negative Staphylococci（ n=1 441，32.9%）， Enterococcus faecium（ n=574，13.1%）， Enterococcus faecalis（ n=385，8.8%），and α-hemolytic Streptococci（ n=187，4.3%）. The prevalence of methicillin-resistant Staphylococcus aureus（MRSA）and methicillin-resistant coagulase-negative Staphylococci（MRCNS）was 26.2%（405/1 544）and 69.8%（1 006/1 441），respectively. Notably，all Staphylococci remained susceptible to glycopeptide or daptomycin. Staphylococcus aureus demonstrated excellent susceptibility（>97.0%）to cephalobiol，rifampicin，trimethoprim-sulfamethoxazole，linezolid，minocycline，tigecycline，and eravacycline. No Enterococcus exhibiting resistance to linezolid were detected. Glycopeptide resistance was uncommon but more frequent in Enterococcus faecium（resistance to vancomycin and teicoplanin：both 1.7%）compared to Enterococcus faecalis（both 0.3%）. The detection rates of MRSA and MRCNS exhibited significant regional variations across the country（ χ2=17.674 and 148.650，respectively，both P<0.001）. No vancomycin-resistant Enterococci were detected in central China. Institutional comparison demonstrated higher prevalence of MRSA（ χ2=14.111， P<0.001）and MRCNS（ χ2=4.828， P=0.028）in provincial hospitals than that in municipal hospitals. Socioeconomic analysis identified elevated detection rates of both MRSA（ χ2=18.986， P<0.001）and MRCNS（ χ2=4.477， P=0.034）in less developed regions（per capita GDP

Objective:To report the results of bacterial resistant investigation collaborative system（BRICS）on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2023，and provide reference for clinical tretment of bloodstream infections and prevention and control of bacterial resistance.Methods:The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of BRICS were collected during January 2023 to December 2023. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 were used to analyze the data.Results:During the study period，11 492 strains of Gram-negative bacteria were collected from 60 hospitals，of which 10 098（87.9%）were Enterobacterales and 1 394（12.1%）were non-fermentative bacteria. The top 5 bacterial species were Escherichia coli（50.0%）， Klebsiella pneumoniae（26.1%）， Pseudomonas aeruginosa（5.1%）， Acinetobacter baumannii complex（5.0%）and Enterobacter cloacae complex（4.1%）. The ESBL-producing rates in Escherichia coli， Klebsiella pneumoniae and Proteus mirablilis were 46.8%（2 685/5 741），18.3%（549/2 999）and 44.0%（77/175），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（76/5 741）and 15.0%（450/2 999）；32.9%（25/76）and 78.0%（351/450）of CREC and CRKP were sensitive to ceftazidime/avibactam combination，respectively. 94.7%（72/76）and 90.2%（406/450）of CREC and CRKP were sensitive to aztreonam/avibactam combination. Furthermore，57.9%（44/76）and 79.1%（356/450）were sensitive to imipenem/relebactam combination. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 64.6%（370/573），while more than 80.0% of CRAB complex was sensitive to tigecycline，eravacycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 17.0%（99/581）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of important Gram-negative bacteria resistance among different regions in China，with statistically significant differences in the prevalence of CREC，CRKP，CRPA and CRAB complex（ χ2=10.6，28.6，10.8 and 19.3， P<0.05）. The prevalence of ESBL-producing Escherichia coli， CREC，CRAB complex and CRKP were higher in provincial hospitals than those in municipal hospitals（ χ2=12.5，9.8，12.7 and 57.8，all P<0.01）. Conclusions:Gram-negative bacteria are the main pathogens causing bloodstream infections in China，and Escherichia coli is ranked in the top，while the trend of Klebsiella pneumoniae increases continuously with time. CRKP infection shows a slow upward trend，CREC infecton maintains a low prevalence level，and CRAB complex infection continues to exhibit a high prevalence rate. The composition and resistance patterns of pathogens causing bloodstream infections vary to some extent across different regions and levels of hospitals in China.

Objective To compare the efficacy of transversus fascia plane block combined with rectus sheath block(TFP-RSB)and transversus fascia plane block(TFP)in alleviating postoperative pain and in-flammation in patients with type 2 diabetes undergoing gynecologic laparoscopic total hysterectomy.Methods A total of 90 patients with type 2 diabetes who underwent gynecologic laparoscopic total hysterecto-my in the Second Hospital of Shanxi Medical University from December 2021 to September 2022 were ran-domly divided into the TFP-RSB group(n=30),the TFP group(n=30),and the blank control group(n=30).The TFP-RSB group received ultrasound-guided TFP-RSB for postoperative analgesia,and the TFP group received TFP block after surgery.The drug was 0.375％ropivacaine.Both groups received combined with pa-tient-controlled intravenous analgesia(PCIA)and those in the control group were treated with PCIA only.The efficacy of perioperative analgesia,postoperative sleep quality and Visual Analog Scale(VAS)scores at 6 h,12 h,and 24 h after operation were compared among the three groups.The levels of IL-6 and Apelin-13 were measured before surgery and at 6 h,12 h,and 24 h postoperatively,and blood glucose was measured at 6 h,12 h,and 24 h postoperatively.Results The blood glucose levels at 6 h,12 h,and 24 h after operation in the TFP-RSB and the TFP groups were lower than those in the blank control group(P＜0.05).The blood glucose in the TFP-RSB group was lower than that in the TFP group at each time point after operation(P＜0.05).There was no statistical difference in the dosage of sedatives and analgesics used during surgery between the TFP-RSB group and the TFP group(P＞0.05).VAS scores at 12 h and 24 h postoperatively were generally lower in the TFP-RSB group compared to the TFP group(P＜0.05),as well as compared to the blank control group(P＜0.05).There was no significant difference in VAS scores at 6h postoperatively between the TFP-RSB and TFP groups(P＞0.05),but both were lower than the blank control group(P＜0.05).The con-sumption of sufentanil at 24 h postoperatively was slightly lower in the TFP-RSB group than in the TFP group(P＜0.05).The PQSI sleep quality in the TFP-RSB group was better than that in the TFP and the blank control groups(P＜0.05).The levels of inflammatory factor IL-6(at 6 h,12 h,and 24 h postoperative-ly)were generally lower in the TFP-RSB group compared to the TFP group and the blank control group(P＜0.05),with no significant difference between the TFP group and the blank control group at 24 h postopera-tively(P＞0.05).Apelin-13 levels were lower at all postoperative time points compared to preoperative levels in all three groups(P＜0.05).Serum Apelin-13 levels at 6 h,12 h,and 24 h postoperatively were lower in the TFP-RSB group than in the TFP group(P＜0.05),and both were lower than the blank control group(P＜0.05).The incidence of postoperative nausea and vomiting was lower in the TFP group(26.6％)than in the blank control group(50.0％),but the difference was not statistically significant(P＞0.05).The incidence in the TFP-RSB group(3.3％)was lower than in the TFP group(26.6％)and the blank control group(50.0％),P＜0.05.Conclusion Compared with TFP block,TFP-RSB block has better postoperative analge-sia effect,less blood glucose fluctuations,and more obvious inhibitory effect on inflammatory response in dia-betic patients undergoing gynecological laparoscopic total hysterectomy.

Objective To compare the analgesic effects of ultrasound-guided adductor canal block(ACB)under different concentrations of ropivacaine combined with lateral femoral cutaneous nerve block(LFCNB)after total knee arthroplasty(TKA)and their influence on the knee joint function.Methods Ninety patients un-dergoing primary unilateral TKA under subarachnoid block were selected and randomly divided into three groups:0.20％ropivacaine(group A),0.25％ropivacaine(group B),and 0.30％ropivacaine(group C).All groups conducted ACB+LFCNB preoperatively.Postoperative visual analog scale(VAS)scores,sufentanil consumption at postoperative 24 h,time to first rescue analgesia,postoperative range of motion(ROM)of the knee joint,quadriceps strength and postoperative complications were recorded.Results Compared with the group A,the resting and moving VAS scores at postoperative 4,8,12,24 h in the group B and C were de-creased(P＜0.05),the sufentanil consumption amount within postoperative 24 h was decreased(P＜0.05),the first rescue analgesia time was prolonged(P＜0.05),ROM on the operation day was increased(P＜0.05).The above results had no statistical difference between the group B and group C(P＞0.05).There were no statistically significant differences in knee ROM on postoperative 1,2 d,postoperative quadriceps strength and complications incidence rates among the three groups(P＞0.05).Conclusion In the application of ACB+LFCNB in the patients with TKA,compared with 0.20％ropivacaine,0.25％and 0.30％ropivacaine could improve early postoperative pain and facilitate the postoperative functional recovery of the knee joint.Additionally,0.25％ropivacaine could provide the same analgesic efficacy as 0.30％ropivacaine.

Objective Sequencing depth is a key parameter in next generation sequencing,which is closely related to the accuracy of sequencing results.Forensic biological evidence examination requires extremely high accuracy.It is crucial to scientifically and reasonably set the sequencing depth analysis threshold for forensic next generation sequencing testing.Methods This study used targeted sequencing data of microhaplotypes from 50 samples with known genotypes.By calculating the accuracy,precision,recall,and F1 score of each locus under various threshold conditions,two types of analysis threshold setting methods,which were based on fixed read count and fixed sequencing depth ratio,were studied extensively.Results The results showed that false positives were observed when the analysis threshold was set at 50×or 100×.When the analysis threshold was set at 200×,false negatives were observed.When the analysis threshold was set at 1.5%,3.0%,or 4.5%,false positives were observed.This study further proposed a third type of analysis threshold setting method,which was based on sequencing depth ratio scatter plots.With this method,no false positive or false negative was observed in the results.This article then explored four factors that lead to significant differences in the sequencing depth of forensic next generation sequencing experiments,compared with the analysis threshold setting method for capillary electrophoresis technology,and discussed the correlation between analysis thresholds and the ability to distinguish mixed DNA.Conclusion Employing the sequencing depth ratio scatter plot method to set analysis threshold has significant application value in next generation sequencing-based forensic genetic marker genotyping.

With the progress of science and technology and the increase of clinical demand, medical robots have developed rapidly and played a important role in promoting the medical cause. Service robot is a branch of medical robot, which is mainly oriented to medical service and assistance needs, and has been applied in many medical scenarios and achieved demonstration effects. This research first describes the development of medical service robots, and then summarizes the key technologies and clinical applications of robots. Finally, it points out the challenges and directions that medical service robots face at present, and puts forward prospects for their further development in the medical field.
Robotics ; Technology

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

Objective To verify the reliability of novel 3D classification of intertrochanteric fractures by comparing the consistency between conventional and novel classifications.Methods Included for the present study were the preoperative X-ray and CT images of 189 patients with intertrochanteric fracture who had been hospitalized at Department of Orthopaedics,Beijing Chao Yang Hospital,Capital Medical University from 1 January,2017 to 1 January,2019.The patients' intertrochanteric fractures were classified by 6 orthopedic surgeons independently using Evans classification,Jensen classification,AO classification and novel 3D classification,respectively.One month later,the original images of the 189 patients were renumbered and classified again in the same way.The Kappa values between observers and within observers were calculated for the classifications of intertrochanteric fractures based on X-ray and CT images.Results In Evans classification,Jensen classification,AO classification and novel 3D classification,the interobserver Kappa values of X-ray films were 0.54 ± 0.03,0.53 ± 0.03,0.45 ± 0.03 and 0.63 ± 0.02,respectively,and the interobserver Kappa values of the CT images were 0.49 ± 0.03,0.49 ± 0.03,0.44 ± 0.04 and 0.63 ± 0.03.The intraobserver Kappa values of the X-ray films were 0.53 ± 0.02,0.54 ± 0.03,0.44 ±0.04 and 0.65 ± 0.02,respectively,and the intraobserver Kappa values of the CT images were 0.52 ± 0.03,0.52 ±0.03,0.41 ±0.02 and 0.64 ±0.03.In the novel classification based on X-ray and CT images,the interobserver and intraobserver Kappa values were both significantly higher than those in Evans,Jensen and AO classifications (P ＜ 0.05).Conclusion The novel 3D classification of intertrochanteric fractures is more reliable than the conventional ones.