Objective:To analyse the distribution and antimicrobial resistance profile of clinical bacterial isolates in Anhui province.Methods:Surveillance data was collected from 83 members of the Anhui Antimicrobial Resistance Surveillance Network（HuiNet）during October 2022 to September 2023，to analyze the resistance of major bacteria to commonly used antibiotics and the detection of clinically common drug-resistant bacteria. The data was analyzed using WHONET 5.6 and SPSS 25.0 software.Results:A total of 201 647 clinical bacteria isolates were collected，with Gram-negative bacteria accounting for 74.8%（150 847/201 647）. The most prevalent Gram-positive bacterial strains were Staphylococus aureus（32.8%，16 648/50 800），followed by Staphylococcus epidermidis（14.0%，7 098/50 800）， Enterococcus faecalis（10.7%，5 458/50 800）， Enterococcus faecium（9.1%，4 613/50 800）and Staphylococcus hominis（7.4%，3 778/50 800）；the most prevalent Gram-negative bacterial strains were Escherichia coli（28.9%，43 577/150 847），followed by Klebsiella pneumoniae（22.5%，34 006/150 847）， Pseudomonas aeruginosa（14.7%，22 171/150 847）， Acinetobacter baumannii complex（9.4%，14 194/150 847）and Enterobacter cloacae（3.5%，5 235/150 847）. The prevalence of methicillin-resistant Staphylococcus aureus（MRSA）and methicillin-resistant coagulase-negative Staphylococcus aureus（MRCNS）were 39.5%（6 442/16 325）and 75.7%（12 343/16 312），respectively. No vancomycin- and teicolanin-resistant Staphylococcus were detected. The prevalence of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis were 0.5% and 0.6%，respectively. The prevalence of carbapenem-resistant Escherichia coli and Klebsiella pneumoniae（CR-KPN）were 1.9%（805/42 956）and 11.7%（3 950/33 761），respectively. The resistance rate of CR-KPN to tigecycline was 3.9%. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CR-PAE）and Acinetobacter baumannii（CR-ABA）complex were 18.4%（3 936/21 447）and 62.9%（8 649/13 744），respectively，with low resistance rate to polycolistin B（6.9% and 1.7%，respectively）. The detection rates of MRSA，CR-ABA complex，third-generation cephalosporin-resistant Escherichia coli（CTX/CRO-R-ECO）and quinolone-resistant Escherichia coli（QNR-ECO）in northern Anhui were the highest（50.3%，72.9%，59.2% and 55.6%，respectively），which were higher than those in central and southern Anhui（ χ2=112.734 and 575.069，132.747 and 233.885，93.986 and 471.209，60.062 and 230.669，all P<0.001），and the detection rate in central Anhui was higher than that in southern Anhui（ χ2=278.671，29.219，207.395 and 80.267，all P<0.001）. The detection rates of CR-KPN and thirdgeneration cephalosporinresistant Klebsiella pneumoniae（CTX/CRO-R-KPN）in central Anhui were the highest（15.5% and 33.3%，respectively），which were higher than those in northern and southern Anhui（ χ2=156.237 and 325.533，76.928 and 180.686，all P<0.001），and the detection rate in northern Anhui was higher than that in southern Anhui（ χ2=32.202 and 25.539， P<0.001）. The detection rates of CTX/CRO-R-ECO and QNR-ECO were the highest in the elderly（55.2% and 55.8%，respectively），which were higher than those in children，and young and middle aged adults（ χ2=23.906 and 120.575，376.404 and 196.612， P<0.001）. The detection rate of CTX/CRO-R-KPN in neonates was the highest（57.1%），which was significantly higher than that in children，adults and the elderly（ χ2=46.141，38.843 and 32.093， P<0.001），and the detection rate in the elderly was higher than that in children and adults（ χ2=13.604 and 13.471， P<0.001）. The detection rates of MRSA and MRCNS were the highest in children（42.8% and 77.8%，respectively），which were higher than those in adults（ χ2=21.766 and 10.704， P<0.001）. Except MRSA and vancomycin-resistant Enterococcus faecium and faecalis，the detection rates of major drug-resistant bacteria in tertiary hospitals were higher than those in secondary hospitals（ P<0.05 or <0.01）. Conclusion:In 2023，the situation of antimicrobial resistance in Anhui province was serious，especially in northern and central Anhui，and targeted drug resistance control measures should be taken according to the monitoring results. At the same time，it is necessary to pay attention to the bacterial resistance in the elderly，newborns and children，and strengthen the rational use of antibiotics by clinicians to curb the spread of drug-resistant bacteria.

Objective:To establish a prompt based feeding process for premature infants and explore its application effects.Methods:This study was a quasi-experimental research method. Firstly, the best evidence of prompt feeding for premature infants was systematically searched and summarized, and the expert consultation method and clinical practice were used to finally formulate a prompt feeding process for premature infants. The process was applied to clinical practice. A total of 82 hospitalized premature infants in the neonatal intensive care unit of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from October 2021 to March 2022 were selected as the control group, and routine feeding management was implemented. A total of 86 hospitalized premature infants from April to September 2022 were selected as the observation group. Feeding management for premature infants based on the prompt feeding process was followed, and the feeding efficiency, transition time of full oral feeding, and days of gastric tube retention, hospital stay and the incidence of feeding related complications in the two groups were compared.Results:The effective recovery rates of the two rounds of expert correspondence questionnaires were 100%, and the authoritative coefficients of expert opinions were 0.863 and 0.875, respectively. The Kendall harmony coefficients of expert opinions were 0.156 and 0.202, respectively, and the significance tests were all P<0.05. The total oral feeding rate of the observation group was 59.84%(5 256/8 784), the mixed feeding rate was 12.26%(1 077/8 784), and the tube feeding rate was 27.90%(2 451/8 784). Compared with the control group′s 52.20%(4 698/9 000), 14.68%(1 321/9 000), and 33.12%(2 981/9 000), the difference was statistically significant ( χ2 = 105.21, P<0.05). The transition time of full oral feeding, number of days of gastric tube retention, and hospitalization time in the observation group were (5.14 ± 1.67), (6.13 ± 1.62), and (12.77 ± 1.37) days, respectively. Compared with the control group′s (6.22 ± 1.59), (7.17 ± 1.55), and (13.72 ± 1.72) days, the differences were statistically significant ( t = 4.206, 4.26, 3.97, all P<0.05). The incidence of milk choking, hypoxia, and vomiting in the observation group were 9.30%(8/86), 6.98%(6/86), and 11.63%(10/86), respectively, which were lower than the 23.17%(19/82), 19.51%(16/82), and 34.15%(28/82) of the control group. The difference between the two groups was statistically significant ( χ2 = 5.99, 5.80, 12.16, all P<0.05). Conclusion:The application of prompt feeding process in premature infants can shorten the transition time of full oral feeding, promote the feeding process, reduce the complications caused by poor feeding, and ensure the feeding safety of premature infants.

Objective:To construct and implement an evidence-based practice protocol for the prevention of surgical site infections (SSI) in pediatric patients undergoing orthopedic implant surgery based on the best available evidence, and to evaluate its effectiveness in a clinical setting.Methods:Adhering to the standard procedures of a continuous quality improvement model based on evidence, evidence was transformed into clinical practice through four stages: evidence acquisition, current status review, evidence introduction, and effect evaluation. Totally 301 pediatric patients who underwent orthopedic implant surgery from March to December 2021 at Guangzhou Women and Children's Medical Center, along with 79 medical staff involved in the project implementation were selected by convenience sampling. Patients were divided into three groups according to the time of admission for baseline review (from March to May, n=106), first-round review post-implementation of the evidence-based protocol (from June to August, n=110), and second-round review (from September to December, n=85). Comparisons were made regarding the incidence of SSI in pediatric patients before and after the application of the evidence-based protocol, the knowledge level of medical staff concerning SSI associated with orthopedic implant surgeries in pediatric patients, and the execution of review indicators before and after the application of evidence. Results:Following the implementation of the evidence-based protocol, the incidence of SSI in pediatric patients undergoing orthopedic implant surgery reduced significantly from 8.49% in the baseline review to 0 in the second-round review ( P<0.05). Furthermore, there was a statistically significant increase ( P<0.01) in the scores denoting the knowledge level of medical staff on SSI associated with such surgeries, from (75.91±11.19) to (96.42±7.13). Comparison of the execution of review standards before and after evidence application revealed statistically significant differences ( P<0.05 in all cases) . Conclusions:The initiation of this evidence-based practice project can standardize perioperative diagnostic and nursing behaviors of orthopedic implant surgery in medical and nursing staff, effectively safeguard the safety of pediatric patients, and reduce the occurrence of SSI.

Objective:To investigate the effects and the possible mechanisms of Neiguan(PC6)and Gongsun(SP4)on the hypothalamic-pituitary-adrenal(HPA)axis in rats with functional dyspepsia(FD),thus to provide a theoretical basis for the clinical application of the Eight Confluent Points.Methods:Forty specific-pathogen-free Sprague-Dawley rats were divided into a blank group,a model group,an electroacupuncture(EA)group,and a Western medicine group by the random number table method,with 10 rats in each group.Rats in the blank group did not receive modeling or intervention.Rats in the other three groups were subjected to the FD with mood disorder model using the compound etiology modeling method.After the successful modeling,rats in the model group did not receive any interventions,rats in the Western medicine group received deanxit and mosaprid intervention,and those in the EA group received EA intervention on the ipsilateral Neiguan(PC6)and Gongsun(SP4)for 21 d.The sugar-water consumption rate was measured before the experiment and before and after interventions to assess the emotional status.The gastric emptying rate was measured after interventions to assess the gastrointestinal dynamics.The expression levels of hypothalamic corticotropin-releasing hormone(CRH),pituitary adrenocorticotropic hormone(ACTH),and adrenal corticosterone(CORT)were measured by enzyme-linked immunosorbent assay.Results:Compared with the blank group,the sugar-water consumption rate and the gastric emptying rate were decreased(P<0.01),and the hypothalamic CRH,pituitary ACTH,and adrenal CORT expression levels were increased(P<0.01)in the model group.Compared with the model group,the sugar-water consumption rate and the gastric emptying rate were significantly increased(P<0.01),while the expression levels of hypothalamic CRH,pituitary ACTH,and adrenal CORT were significantly decreased(P<0.01)in the EA group and the Western medicine group.The differences between the EA group and the Western medicine group were not statistically significant(P>0.05).Conclusion:The Eight Confluent Points Neiguan(PC6)and Gongsun(SP4)can improve the mood and gastrointestinal dynamics in FD rats,which may be achieved by down-regulating the hypothalamic CRH,pituitary ACTH,and adrenal CORT,as well as by correcting the HPA axis hyperfunction.

ObjectiveTo investigate the factors that influence the first CD4+T lymphocyte counts in newly reported HIV-infected cases aged 50 and above in Dehong Prefecture of Yunnan Province during 2016 to 2021， and to understand the patient immune status and disease progression so as to provide scientific basis for HIV prevention and control strategies in the future. MethodsData was collected from the national HIV/AIDS information system. Multivariate logistic regression was used for the analysis of factors affecting the first CD4+T lymphocyte counts. ResultsA total of 642 cases of HIV infection were newly reported， among them， 571 cases had CD4+T lymphocyte counts and 200 cases （35.03%） had CD4+T lymphocyte counts <200 cells·μL^-1. Patients who were in the 50-59 age group， male， divorced or widowed， and less educated were more likely to have CD4+T lymphocyte counts <200 cells·μL^-1. Compared with active testing consultants， forced reeducation through labor or drug rehabilitation cases were less likely to have CD4+T lymphocyte counts <200 cells·μL^-1. ConclusionThere is no obvious upward trend in newly reported HIV infected persons aged 50 years and above in Dehong Prefecture during 2016 to 2021. However， the situation of CD4+T lymphocyte counts <200 cells·μL^-1 is still serious. Attention should be paid to the key groups： male， Chinese nationality， farmers， Han nationality， married or divorced， junior high school education or below， and heterosexual transmission. It is necessary to strengthen the intervention in people aged 50 and above and improve the detection efficiency.

ObjectiveTo investigate the distribution of traditional Chinese medicine （TCM） syndrome types and influencing factors of protein-energy wasting （PEW） in chronic kidney disease （CKD） undergoing maintenance hemodialysis （MHD）. MethodsAccording to diagnostic criteria， 164 patients with MHD were divided into PEW group and non-PEW group. The clinical data of all patients were collected， including general information such as gender， age， height and weight， disease characteristics such as course， cormobidity， and haemodialysis duration， laboratory indicators such as blood routine， liver function， renal function， electrolyte， blood lipid， grip strength， and the four examinations. Logistic regression analysis was used to find the influencing factors of PEW by taking the clinical indicators with significant differences between the two groups （P＜0.05） as the independent variables， diagnosis of PEW as the dependent variable， and normal values as the reference. ResultsOut of 164 patients with MHD， there were 96 （58.5%） cases in PEW group and 68 cases （41.5%） in non-PEW group. Compared to the non-PEW group，PEW group had increased age， ratios of bedrest， deep vein preservation， edema， and low grip strength， percentages of comorbidities type 2 diabetes， cardiovascular and cerebrovascular diseases，infections and anemia， and levels of alanine aminotransferase and permine amin aminotransferase， as well as decreased body mass index， self-care ratio，internal arteriovenous fistula， red blood cell count， hemoglobin， serum total protein， serum albumin levels （P＜0.05）. The PEW group had significantly higher frequency of poor appetite and digestion， abdominal distension， fear of cold and preference of warmth， weak breathing and fatigue， poor appetite， oliguria， nausea and vomiting than non-PEW group （P＜0.05）. The incidence of both yin and yang deficiency syndrome and damp-turbidity syndrome were significantly higher in the PEW group than the non-PEW group， while that of liver-kidney yin deficiency syndrome and stirring of wind syndrome were lower （P＜0.05）. Logistic regression analysis showed that low BMI （＜22 kg/m²）， inability to take care of oneself， low grip strength，low serum albumin （＜38 g/L）， infection， older age， fear of cold and cold limbs，and poor appetite were the risk factors of PEW in patients undergoing MHD （P＜0.05）. ConclusionThe root syndrome of MHD-PEW patients is both yin and yang deficiency， concurrent with damp-turbidity syndrome. Low BMI， low serum albumin， infection and older age may be the influencing factors of PEW in patients undergoing MHD.

Endoscopic data of 108 upper gastrointestinal elevated lesions caused by vascular or hemangioma compression by endoscopic ultrasonography (EUS) at the Second Affiliated Hospital of Soochow University, Changshu No.1 People's Hospital, Kushan Hospital of Chinese Medicine and Traditional Chinese Medicine Hospital of Changshu from December 2010 to June 2019 were retrospectively summarized. The results showed that lesions were mainly located in the esophagus [50.9% (55/108)] and stomach [47.2% (51/108)], especially in the middle [40.0% (22/55)] and upper esophagus [36.4% (20/55)], body [66.7% (34/51)] and fundus of stomach [31.4% (16/51)], respectively. The major etiology included splenic artery and aneurysm compression [29.6% (32/108)], aortic compression [23.1% (25/108)], isolated esophageal venous aneurysm compression [13.9% (15/108)] and gastric submucosal vein and venous aneurysm compression [12.0% (13/108)], with diverse endoscopic presentation. The above results suggest that elevated lesions of upper gastrointestinal tract caused by blood vessels and hemangiomas are mostly due to external vascular pressure outside the lumen, but ectopic submucosal arteries and isolated phlebangioma are not uncommon. The lesions are widely distributed with different gastroscopic manifestations. EUS is important for definite diagnosis, and can be combined with color Doppler technique, CT plain scan and angiographic reconstruction if necessary.

Objective:To explore the construction and effect of biobank in biological research in nursing field.Methods:Through the establishment of a biological research plan for nursing in Affiliated Jinhua Hospital, Zhejiang University School of Medicine, the biobank in biological research for nursing was constructed from aspects of biological samples, instruments and equipment, operating software, biobanking team formation, personnel training and standardized process formulation.Results:In August 2020, the Nursing Department and Central Laboratory of Affiliated Jinhua Hospital, Zhejiang University School of Medicine established a biobank for biological research in the nursing field, formed a biobank team, conducted personnel training and formulated standardized procedures. From December 1, 2020 to June 30, 2021, biological samples were collected from 264 gastric cancer patients and 56 healthy controls, mainly including whole blood, serum and urine.Conclusions:The construction of biobank for biological research in nursing field can collect abundant biological samples, which lays a foundation for subsequent independent biological research in nursing field.

Objective:To determine the effect of prolonging the interval of flushing on ports′ function and catheter related complications for cancer patients after completing chemotherapy.Methods:A prospective randomized controlled trial was conducted in 190 patients who undergoing ports-maintenance in outpatient clinical, the First Affiliated Hospital of Sun Yat-sen University, after they finished the chemotherapy from April 2017 to February 2018. According to the random number table, the patients were divided into 4-week group, 8-week group and 12-week group after completing chemotherapy, then returned to the hospital to maintain the port every 4 weeks, every 8 weeks and every 12 weeks, respectively. Then evaluated the function and complications of catheter among different groups.Results:After completion of chemotherapy, the rate of catheters′ patency of tumor patients in 12-week group was 98.5% (66/67), while that in 4-week group was 98.1% (53/54) and in 8-week group was 98.6% (68/69), there was no statistically significant difference on catheters′ patency among different groups ( χ 2=0.48, P>0.05). The rate of catheters′ asymptomatic thrombosis in 12-week group was 18.9% (10/53), which was not significantly different from that of 4-week group 27.0% (10/37) and 8-week group 14.0% (7/50) ( χ 2=2.33, P>0.05). Conclusions:Tumor patients maintaining port every 12 weeks after completion of chemotherapy can ensure the safety of patients using the port. It is favorable for application and promotion of port in cancer patients.

Objective:To retrieve relevant evidence on exercise assessment and exercise training for children with congenital heart disease at home and abroad, and to summarize the best evidence to provide reference for clinical medical staff.Methods:UpToDate, National Guidelines Clearinghouse (NGC), Registered Nurses Association of Ontario (RNAO), Scottish Intercollegiate Guidelines Network (SIGN), National Institute for Health and Care Excellence (NICE), BMJ Best Practice, American Heart Association (AHA), Cochrane Library, Joanna Briggs Institute(JBI) Evidence-Based Health Care Center Database, PubMed, CINAHL, China Biomedical Literature Database, Yimaitong, Wangfang Database, CNKI were searched, related evidence on exercise assessment and exercise training for children with congenital heart disease. The search period was from the establishment of the database to March 2021. Clinical decision-making and recommended practice used retrospective evaluation methods for quality evaluation; guidelines used the 2012 version of the clinical guideline research and evaluation system (AGREE Ⅱ) for evaluation; systematic reviews used the systematic evaluation tool (AMSTAR) for evaluation; expert consensus used JBI (2016 version) evaluate the authenticity evaluation tools of opinions and consensus articles. Two researchers independently evaluated the literature, combined with the judgment of professionals, and extracted the literature data that met the standards.Results:A total of 15 documents were included, including 2 clinical decisions, 4 guidelines, 1 recommended practice, 5 systematic reviews, 3 expert consensus, and 22 best evidences. Including related personnel, exercise evaluation, exercise monitoring, exercise classification, exercise training, and exercise follow-up.Conclusions:This study summarizes the best evidence of exercise assessment and exercise training for children with congenital heart disease, and provides evidence-based evidence for clinical practice. It is recommended that children with congenital heart disease undergo exercise assessment and formulate a personalized exercise training program to promote the transformation of the best evidence into clinical practice.