Objective To evaluate the reliability of Vitek 2 AST-N335 card for determining the susceptibility of Acinetobacter bauman-nii(AB)to cefoperazone/sulbactam.Methods A total of 318 non-repeated clinical isolates of AB collected in 2023 were tested for antimicrobial susceptibility to cefoperazone/sulbactam using broth microdilution(BMD),the AST-N335 card,and the Kirby-Bauer(K-B)disk diffusion method.Using BMD as the reference method,the reliability of AST-N335 card was assessed,and the accuracy of K-B disk diffusion method as the confirmatory test was validated.Results Compared with BMD,the susceptibility testing of 318 AB strains to cefoperazone/sulbactam using the AST-N335 card showed categorical agreement(CA)of 87.8％(279/318),very major er-ror(VME)of 6.0％(19/318),major error(ME)of 0％(0/318),and minor error(mE)of 1.9％(6/318),which fall outside of the acceptable error range.In contrast,the K-B method achieved CA of 99.4％(316/318),VME of 0％,ME of 0.3％(1/318),and mE of 0.3％(1/318),all within acceptable limits.Of these,the errors with AST-N335 card occurred within the minimum inhibitory concentration(MIC)range of 8-32 μg/mL.Using BMD as the reference method,further analysis was performed on the 171 AB strains with AST-N335 card MIC values of 8-32 μg/mL for cefoperazone/sulbactam.It was revealed that at MIC of 32 μg/mL,the CA was 0％;at MIC of 16 μg/mL,CA was 5.3％(1/19)and VME rate was 84.2％(16/19),both of which substantially exceeded accepta-ble error ranges.At MIC of 8 μg/mL,the CA was 94.9％(131/138)and VME was 2.2％(3/138),both approaching the acceptable ranges.Conclusion The results obtained with Vitek 2 AST-N335 card in determining for cefoperazone/sulbactam are unreliable when the MIC values fall within the range of 8-32 μg/mL,which leads to an underestimation of the resistance rate to cefoperazone/sulbac-tam.This issue requires urgent attention in both laboratories and clinical practice.The K-B disk diffusion method could serve as a sup-plementary verification approach in routine laboratories.

Objective To evaluate the reliability of Vitek 2 AST-N335 card for determining the susceptibility of Acinetobacter bauman-nii(AB)to cefoperazone/sulbactam.Methods A total of 318 non-repeated clinical isolates of AB collected in 2023 were tested for antimicrobial susceptibility to cefoperazone/sulbactam using broth microdilution(BMD),the AST-N335 card,and the Kirby-Bauer(K-B)disk diffusion method.Using BMD as the reference method,the reliability of AST-N335 card was assessed,and the accuracy of K-B disk diffusion method as the confirmatory test was validated.Results Compared with BMD,the susceptibility testing of 318 AB strains to cefoperazone/sulbactam using the AST-N335 card showed categorical agreement(CA)of 87.8％(279/318),very major er-ror(VME)of 6.0％(19/318),major error(ME)of 0％(0/318),and minor error(mE)of 1.9％(6/318),which fall outside of the acceptable error range.In contrast,the K-B method achieved CA of 99.4％(316/318),VME of 0％,ME of 0.3％(1/318),and mE of 0.3％(1/318),all within acceptable limits.Of these,the errors with AST-N335 card occurred within the minimum inhibitory concentration(MIC)range of 8-32 μg/mL.Using BMD as the reference method,further analysis was performed on the 171 AB strains with AST-N335 card MIC values of 8-32 μg/mL for cefoperazone/sulbactam.It was revealed that at MIC of 32 μg/mL,the CA was 0％;at MIC of 16 μg/mL,CA was 5.3％(1/19)and VME rate was 84.2％(16/19),both of which substantially exceeded accepta-ble error ranges.At MIC of 8 μg/mL,the CA was 94.9％(131/138)and VME was 2.2％(3/138),both approaching the acceptable ranges.Conclusion The results obtained with Vitek 2 AST-N335 card in determining for cefoperazone/sulbactam are unreliable when the MIC values fall within the range of 8-32 μg/mL,which leads to an underestimation of the resistance rate to cefoperazone/sulbac-tam.This issue requires urgent attention in both laboratories and clinical practice.The K-B disk diffusion method could serve as a sup-plementary verification approach in routine laboratories.

BACKGROUND:In recent years,there have been many studies on the mechanism of exosomal non-coding RNA in gestational diabetes mellitus,but there is a lack of the latest systematic review of exosomes from different sources,especially placental sources. OBJECTIVE:To summarize the changes and potential roles of microRNA(miRNA),long non-coding RNA(lncRNA),circular RNA(circRNA),and exosomes in gestational diabetes mellitus to provide potential targets for early screening and treatment of clinical gestational diabetes mellitus. METHODS:A literature search was conducted on PubMed,Web of Science,China National Knowledge Infrastructure,WanFang Data,and VIP databases to retrieve relevant articles on non-coding RNA or exosomal non-coding RNA in relation to gestational diabetes mellitus.A total of 74 articles were included for review. RESULTS AND CONCLUSION:(1)Non-coding RNAs play important pathological and physiological roles in the lifecycle activities,and increasing evidences suggest that non-coding RNAs are involved in the occurrence and development of gestational diabetes mellitus by regulating various physiological functions.This provides a new direction for the research of gestational diabetes mellitus.(2)Exosomes are widely present in the human body.Various cells can secrete exosomes,such as red blood cells,epithelial cells,and placental cells.Non-coding RNAs found in exosomes from different sources have been demonstrated to play a role in the pathogenesis,diagnosis,and treatment of gestational diabetes mellitus.(3)MiRNA and gestational diabetes mellitus:The role of peripheral blood miRNA in gestational diabetes mellitus is mainly to affect the functions of trophoblast cells,pancreatic beta cells and blood glucose levels in gestational diabetes mellitus;placental miRNA can reflect the severity of gestational diabetes and impair the function of trophoblast cells.(4)LncRNA and gestational diabetes mellitus:Peripheral blood lncRNA can induce insulin resistance through the phosphatidylinositol 3-kinase/protein kinase B pathway and may provide new insights for the diagnosis and treatment of gestational diabetes mellitus;placental lncRNA can regulate proliferation and migration of placental trophoblast cells,promoting the occurrence and development of gestational diabetes mellitus.(5)CircRNA and gestational diabetes mellitus:Peripheral blood and placental circRNA can induce the occurrence and development of gestational diabetes mellitus by impairing the proliferation,migration and metabolism of placental trophoblast cells.(6)Non-coding RNA in exosomes and gestational diabetes mellitus:Peripheral blood non-coding RNA in exosomes can affect gestational diabetes mellitus blood glucose levels and glucose homeostasis,and participate in the occurrence and development of gestational diabetes mellitus by influencing placental function.(7)Non-coding RNA has the potential to serve as biomarkers for early diagnosis of gestational diabetes mellitus.Additionally,engineered exosomes can better achieve targeted therapy for gestational diabetes mellitus.These latest findings provide a reference for both basic research and clinical translation of gestational diabetes mellitus.(8)In the future,improvements in the extraction and purification methods of peripheral blood exosomes should be improved,and factors such as race,diet and physical activity should be excluded to improve the reproducibility of results.Further prospective clinical studies are required to explore the clinical application of circulating non-coding RNA and exosomes in the prediction and diagnosis of gestational diabetes mellitus.

Objective    To explore the safety and feasibility of the modified and improved thoracoscopic surgery for esophageal cancer using the concept of "single-direction" thoracoscopic technique. Methods    The clinical data of 65 patients undergoing this modified minimally invasive esophagectomy based on "single-direction" thoracoscopic system between June 2018 and April 2019 were retrospectively analyzed, including 54 males and 11 females aged 62.5±7.8 years. Results    The thoracoscopic operation time was 133.4±28.6 min, and intraoperative blood loss was 61.9±29.2 mL. No intraoperative blood transfusion was needed. One patient was transferred to open thoracotomy (due to severe pleural adhesion atresia). Major complications included anastomotic leak, pneumonia, chylothorax, incisional infection, recurrent laryngeal nerve paralysis and gastric emptying disorders, which were recovered by conservative treatment. No postoperative death occurred. The median number of lymph nodes and lymph node station harvested was 19 and 10, respectively. The median postoperative hospital stay was 10 days. The volume of chest drainage was 1 117.3±543.4 mL. Conclusion    The minimally invasive operation mode of esophageal cancer based on "single-direction" thoracoscopic system is safe and feasible, and has good field vision and smooth and simplified procedure.

Objective: To investigate the genetic characteristics of human norovirus (NoV) among infants under 5 years of age with diarrhea in Chaoyang District, Beijing from 2011 to 2017. Methods: NoV-positive stool samples were collected from 2011 to 2017 in this region. The partial RdRp and VP1 genes were amplified and sequenced. Multi-sequence alignment was performed and phylogenetic tree was constructed using Mega software. Results: A total of 151 samples were sequenced and analyzed. The ratio of male and female was 2.28∶1 with mean age of 1.72 years. Fourteen NoV subtypes were detected, including GII.Pe/GII.4 (47.68%), GII.P12/GII.3 (20.53%), GII.P4/GII.4 (17.22%), GII.P16/GII.2 (3.31%), GII.P12/GII.12 (1.99%), GII.P17/GII.17 (1.99%), GII.P16/GII.13 (1.32%), GII.P7/GII.7 (1.32%), GII.P7/GII.6 (1.32%), GII.P2/GII.2 (0.66%), GII.P21/GII.21 (0.66%), GII.Pg/GII.12 (0.66%), GI.Pa/GI.3 (0.66%) and GI.P6/GI.6 (0.66%). Conclusions NoV genetic diversity was found among infants under 5 with diarrhea in Chaoyang district, Beijing. The subtypes from surveillance and those from epidemics occurred in chronological order. The surveillance should be strengthened for early detection of new subtype for monitoring the epidemic and vaccine design.

Objective: To investigate the genetic characteristics of human adenovirus (AdV) among infants with diarrhea in Chaoyang district, Beijing from 2011 to 2017. Methods: Adenovirus positive stool samples were collected from 2011 to 2017 in Chaoyang District of Beijing. The hexon region genes of human adenovirus were sequenced. Multi-sequence alignments were performed and phylogenetic tree was constructed by Mega software. Results: A total of 64 samples were sequenced and analyzed. The ratio of male to female was 11∶5. The mean age was 1.56 years. Among them, AdV41 accounted for 70.31%, followed by AdV31 (26.25%), AdV40 (4.69%), AdV1 (3.13%), AdV5 (3.13%), AdV6 (3.13%), AdV7 (3.13%), AdV2 (1.56%), AdV3 (1.56%), AdV4 (1.56%) and AdV61 (1.56%). Conclusions Human adenovirus may play an important role in viral diarrhea in Chaoyang district from 2011 to 2017. The current adenovirus epidemic is complex and AdV41 was the dominant strain in this region.

Objective To investigate the effect of evidence-based nursing on postoperative urinary retention in patients undergoing laparoscopic hysterectomy.Methods A total of 45 patients with laparoscopic hysterectomy in our department were as the observation group,given evidence-based nursing to prevent urinary retention.A total of 40 patients with laparoscopic hysterectomy were given routine nursing as the control group.The postoperative urination,urinary retention and urinary catheter removal were compared.Results Autonomous urination recovery time in the observation group was shorter,the first micturition volume was more,the residual urine volume was less,urinary tract infection and urinary retention rate were lower than that in the control group,the differences were statistically significant (P ＜ 0.05).The pain in the observation group was slightly lighter than that in the control group,and the difference was statistically significant (P ＜ 0.05).Conclusion Evidence-based nursing can improve the urination,reduce the incidence of urinary retention and reduce the pain of patients after laparoscopic hysterectomy.

Objective To investigate the effect of evidence-based nursing on postoperative urinary retention in patients undergoing laparoscopic hysterectomy.Methods A total of 45 patients with laparoscopic hysterectomy in our department were as the observation group,given evidence-based nursing to prevent urinary retention.A total of 40 patients with laparoscopic hysterectomy were given routine nursing as the control group.The postoperative urination,urinary retention and urinary catheter removal were compared.Results Autonomous urination recovery time in the observation group was shorter,the first micturition volume was more,the residual urine volume was less,urinary tract infection and urinary retention rate were lower than that in the control group,the differences were statistically significant (P ＜ 0.05).The pain in the observation group was slightly lighter than that in the control group,and the difference was statistically significant (P ＜ 0.05).Conclusion Evidence-based nursing can improve the urination,reduce the incidence of urinary retention and reduce the pain of patients after laparoscopic hysterectomy.

Objective To understand the constituent ratio and the drug resistance tendency of the common pathogens in hospital in order to provide the basis for rational clinical drug use and control of nosocomial infection .Methods The pathogenic bacteria iso‐lated from the various submitted clinical specimens and their drug resistance in our hospital from January 2012 to December 2014 were performed the retrospective analysis .Results A total of 1 325 strains of pathogenic bacteria were isolated ,among them 889 strains (67 .10% ) were Gram‐negative cocci ,284 strains(21 .43% ) were Gram‐positive cocci and 152 strains (11 .47% ) were fun‐gi .The top five of isolated strains were Escherichia coli ,Klebsiella pneumonia ,Pseudomonas aeruginos ,Staphyloccocus aureus and Acinetobacter baumannii .Escherichia coli and Klebsiella pneumonia were highly resistant to imipenem with the resistance rate of 3 .7% ,but carbapenems‐resistant strain(CRE) was detected out .The resistant rateof Pseudomonas aeruginos to meropenem was in‐creased and which to imipenem was decreased .The resistant rates of Acinetobacter baumannii to meropenem and imipenem were o‐ver 44 .83% .The detection rate of methicillin‐resistant Staphylococcus aureus (MRSA ) was decreased from 69 .05% to 54 .05% . Enterococcus faecium was highly sensitive to vancomycin ,linezolid ,teicoplanin and furadantin .But vacomycin‐resistant strains (VRE) were found .Conclusion The drug resistance of common pathogens causing nosocomial infection is serious in our hospital . Therefore ,it is very important to strengthen the monitoring of bacterial drug resistance ,rationally use antimicrobial drugs and adopt the effective measure of infection control to prevent and reduce the generation of drug‐resistant pathogens .

Objective To investigate the clinical significance of serum transforming growth factor-β( TGF-β),tumor necrosis factor-α( TNF-α) and interferon-γ( IFN-γ) levels in patients with pre-eclampsia. Methods Thirty-two cases of maternal pre-eclampsia( 22 cases were mild pre-eclampsia,10 cases were severe pre-eclampsia),30 cases of gestational hypertension and 30 cases of normal mothers were selected as our subjects. Serum TGF-β,TNF-α IFN-γ levels were detected. Adverse pregnancy outcomes in patients were collected and analyzed. Results Serum TGF-β,TNF-α,IFN-γlevels in patients with severe pre-eclampsia were (90. 4 ± 23. 4)μg/L,(84. 5 ± 13. 6)μg/L and(146. 5 ± 13. 4)μg/L respectively,significantly higher than that in normal mothers((11. 3 ± 3. 7)μg/L,(5. 6 ± 1. 2)μg/L and(82. 5 ± 19. 4)μg/L),the gestational hypertension group(( 35. 3 ± 8. 4 )μg/L,( 10. 4 ± 2. 9 )μg/L and( 96. 4 ± 15. 8 )μg/L ),and mild pre-eclampsia group((76. 5 ± 15. 4)μg/L,(26. 5 ± 3. 2)μg/L and(120. 4 ± 20. 5)μg/L),and the difference were significant(F=11. 363,15. 982,7. 431;P﹤0. 001). Serum TGF-β,TNF-α and IFN-γ levels in mild pre-eclampsia were significantly higher than those in normal mothers and gestational hypertension patients( P﹤0. 05). Incidence of preterm delivery in patients with high TGF-β,TNF-α,IFN-γ expression was significantly higher than patients with low expression(7 cases vs. 2 cases;χ2 =4. 037,P=0. 044). Incidence of in patients with high FGR,TGF-β,TNF-α expression was significantly higher than patients with low expression( 6 cases vs. 1 case;χ2 =4. 969,P =0. 025 ). Conclusion Detection of maternal serum cytokines can evaluate the severity of pre-eclampsia to a certain extent and predicted adverse pregnancy outcomes.