Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

Objective:To observe any effect of cooling on the amplitude of vibration-induced sensory nerve action potentials (SNAPs) in human digits.Methods:The middle fingers of 15 healthy adults were either cooled to about 22℃ using an ice pack or kept at about 32℃. A vibrator was applied to the joint connecting the middle finger and the palm vibrating with an amplitude of 2mm at a frequency of 60Hz. The amplitudes of middle finger SNAPs before, during and right after the vibration were recorded.Results:The SNAP amplitude at a given temperature was lower during vibration than before it, but it immediately returned to the pre-vibration level after the vibration ceased. The middle finger SNAP amplitudes at 22℃ were significantly higher than those at 32℃ throughout. The decrease in amplitude at 32℃ (61.7±15.1%) was significantly greater than that at 22℃ (24.1±7.0%).Conclusions:Cooling significantly reduces the effect of vibration on the amplitude of digital SNAPs. That suggests a way to protect the sensory nerves in hand-arm vibration syndrome.

Objective:To explore the effect of combining hand-brain perception training with hand-brain motor training based on mirror neuron theory on the recovery of upper limb function after a stroke.Methods:A group of 105 stroke survivors with upper limb dysfunction were randomly divided into a hand-brain perception (HP) group, a hand-brain motor (HM) group, and a combination (C) group, each of 35. In addition to conventional rehabilitation treatment (including exercise therapy, occupational therapy and physical factor therapy), the HP and HM groups were given hand-brain perception training and hand-brain motor training respectively, while group C was provided with both. Before the intervention and after 4 weeks, the upper limb motor functioning of all of the participants was assessed using the simplified version of the Fugl-Meyer upper limb motor function scale (FMA-UE). Sensory functioning was quantified using the tactile Semmes Weinstein monofilament examination (SWME), and the modified Barthel index (MBI) was used to quantify the participants′ ability in the activities of daily living.Results:After the intervention the average FMA-UE, MBI and SWME scores of all three groups had improved significantly, with group C′s average FMA-UE and MBI scores significantly better than the other two groups′ averages. The average SWME score of group C was then significantly better than that of group HM.Conclusions:Hand-brain perception combined with hand-brain motor training based on mirror neuron theory can further promote the recovery of upper limb sensory and motor functioning of stroke survivors., Such therapy is worthy of clinical promotion and application.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

Objective:To investigate the correlation between serum uric acid level and hyperglycemia.Methods:A medical examination cohort of the staff of our hospital was constructed. From February 1 st, 2011, to December 31 st, 2011, 3 937 staff members without hyperglycemia were selected, and baseline data were collected through a questionnaire survey, physical examination, measurement of blood lipid and blood glucose, assessment of kidney function, and other laboratory tests. The subjects were followed up during the annual physical examination for 7 years, from January 1 st, 2012, to December 31 st, 2018. They were divided into four groups according to serum uric acid level: uric acid<360 μmol/L, 360≤uric acid<420 μmol/L, 420≤uric acid<480 μmol/L, and uric acid≥ 480 μmol/L. With the occurrence of hyperglycemia as the outcome indicator; uric acid level as the observation index; uric acid<360 μmol/L as the control group; and gender, age, body mass index, smoking, hypertension, dyslipidemia as confounding factors, Cox regression was performed before and after adjusting confounding factors to analyze the relationship between different uric acid levels and the incidence of hyperglycemia in the entire sample, in the male staff, and in the female staff. Results:The 7-year cumulative incidence of hyperglycemia in the four groups were 15.7%, 34.0%, 38.8%, and 43.8%, respectively ( Z=148.94, P<0.01). In the male staff, the 7-year cumulative incidence rates in the four groups were 23.4%, 29.9%, 34.7%, and 35.8%, respectively ( Z=11.17, P<0.01). In the female staff, the 7-year cumulative incidence rates in the four groups were 14.2%, 42.5%, 52.2%, and 65.0%, respectively ( Z=141.84, P<0.01. After adjusting for gender, age, body mass index, smoking, hypertension, and dyslipidemia, the risk of hyperglycemia in the 360≤uric acid<420 μmol/L, 420≤uric acid<480 μmol/L, and uric acid≥ 480 μmol/L groups were 1.73 (1.39-2.15), 1.86 (1.42-2.45), and 1.95 (1.34-2.85) times higher than that in the control group (all P<0.05). Among female staff, the risk of hyperglycemia in the 360≤uric acid<420 μmol/L, 420≤uric acid<480 μmol/L, and uric acid≥ 480 μmol/L groups were 2.18 (1.62-2.94), 3.41 (2.24-5.20), and 3.02 (1.69-5.40) times, respectively, and were also higher than those in the control group (all P<0.01). Conclusion:With the increase of serum uric acid level, the risk of hyperglycemia in medical staff increases, which is mainly manifested in female staff.

Objective:To explore the effects of visual feedback training based on the mirror neuron theory in upper limb function reconstruction in stroke patients.Methods:From June 2017 to June 2018, totally 61 stroke patients hospitalized in the Rehabilitation Medical Center of the Second Hospital of Jiaxing were selected by convenient sampling and divided into the observation group ( n=31) and the control group ( n=30) according to the random number table. Patients in both groups received routine rehabilitation therapy, while patients in the observation group underwent visual feedback training on this basis. They were evaluated using Barthel Index , Fugl-Meyer Assessment (FMA) (upper limb) , and the latency and amplitude of N9 and N20 were detected using somatosensory evoked potentials (SEP) before and 8 weeks after rehabilitation intervention. Results:After the intervention, the FMA score of the upper limbs in the observation group was (47.91±6.92) , higher than (40.31±7.87) in the control group, the Barthel Index of the observation group was (77.33±11.82) , higher than (66.79±12.31) in the control group, and the differences between the two groups were statistically significant ( P<0.01) . The SEP values of the upper limbs of the hemiplegia side in the observation group were better than those in the control group, and the differences between the two groups were statistically significant ( P<0.05) . Conclusions:The visual feedback training based on the mirror neuron theory can improve the upper limb motor function in stroke patients with early hemiplegia, improve their daily living activities, increase the N9 and N20 amplitudes of SEP, shorten their latency, and enhance the excitement of the upper limb movement related brain area in the mirror neuron system.

Objective To investigate the correlation between interleukin-6 (IL-6) and future liver remnant (FLR) growth after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 15 patients who underwent ALPPS at the First Affiliated Hospital of Guangxi Medical University between March 2017 and May 2018 were collected.Observation indicators:(1) intraoperative situations in the first staged ALPPS and the second staged ALPPS;(2) postoperative situations:① postoperative complications and duration of hospital stay,② results of pathological examination;(3) IL-6 concentration in the peripheral blood before and after operation;(4)follow-up situations.Follow-up using outpatient examination,telephone interview and internet was performed to detect life quality and survival of patients.Imaging examination was done to detect tumor recurrence and metastasis.Follow-up was done up to May 2018.Measurement data with normal distribution or similar normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).Repeated measures data were analyzed by the repeated measures ANOVA.Correlation comparison was done using Pearson bivariate correlation test.Results (1) Intraoperative situations.① The first staged ALPPS:15 patients had liver parenchymal transection via anterior approach combined with selective hepatic vascular exclusion,without allogenic blood transfusion.The operation time,volume of intraoperative blood loss,FLR at postoperative 16 days,interval time to the second staged ALPPS,growth rate of liver volume,ratio of FLR and standard liver volume (SLV) were respectively 324 minutes (range,240-387 minutes),356 mL (range,200-600 mL),(582± 134) cm3,24 days (range,9-34 days),35％±20％ and 53％±7％.② The second staged ALPPS:of 15 patients,13 underwent the second staged ALPPS successfully including 11 undergoing middle hepatic vein preserved right hepatectomy and 2 undergoing expanded right hemihepatectomy or right trisegmentectomy,1 underwent transcatheter arterial chemoembolization (TACE) due to FLR/SLV =31％,1 was detected yellow-white nodules at left lobe and confirmed as hepatocellular carcinoma by frozen section pathological examination,and then improved and discharged after 5-FU abdominal local chemotherapy combined with postoperative TACE.The operation time,volume of intraoperative blood loss of 13 patients undergoing the second staged ALPPS were 324 minutes (range,140-515 minutes) and 639 mL(range,100-1 400 mL).Two patients had blood transfusion including 1 with 800 mL of fresh frozen plasma and 4.0 U of red cells and 1 with 600 mL of plasma and 9.5 U of de-leucocytes and red cells.(2) Postoperative situations.① Postoperative complications and duration of hospital stay:15 patients had no perioperative death,9 and 6 were detected grade A and grade B liver failure respectively,15 had grade Ⅰ complications of Clavien-Dindo classification and no patient had grade Ⅱ and above complications,10 had pleural effusion including 1 with volume of effusion ＞500 mL.Of 13 patients undergoing the second staged ALPPS,4 and 9 were detected grade A and grade B liver failure respectively,8 and 5 had grade Ⅰ and Ⅱ complications of Clavien-Dindo classification and no patient had grade Ⅲ and above complications,11 had few pleural effusion with volume of effusion ＜500 mL.Patients with grade B liver failure and grade Ⅱ complications were recovered and discharged after treatments of liver protection,gastric protection,reinforced dressing change,continuous use of Alb,fresh frozen plasma transfusion.The patient with volume of pleural effusion ＞ 500 mL was improved after closed thoracic drainage and other patients with pleural effusion were improved after symptomatic and supportive treatment.Duration of total hospital stay was 31 days (range,22-49 days) in 15 patients.② Results of pathological examination:13 patients undergoing complete ALPPS were diagnosed as hepaticocellular carcinoma with R0 resection and without cancer cells involving surgical margin,including 7 with grade Ⅱ portal vein tumor thrombus.Ishak score for postoperative pathological fibrosis and liver cirrhosis was 7.7±1.4 in 15 patients,including 1 case of 5,1 case of 6,2 case of 7,6 case of 8,5 case of 9.(3) IL-6 concentration in the peripheral blood before and after operation:IL-6 concentration in the peripheral blood before surgery was (8±3)ng/L in 15 patients,and (207±150)ng/L,(104±65)ng/L,(45±38)ng/L,(26±9)ng/L,(18±10)ng/L at 1,3,5,7,10 days after the first staged ALPPS,showing a statistically significant difference in changing trend before and after surgery (F=25.877,P＜0.05) and statistically significant differences in paired comparison between 1,3,5,7,10 days after the first staged ALPPS and before surgery respectively (P＜0.05).There was correlation between IL-6 concentration in the peripheral blood at 1,3 days after the first staged ALPPS and growth of FLR (r=0.766,0.881,P＜0.05),and also between IL-6 concentration in the peripheral blood at 1,3 days after the first staged ALPPS and growth rate of FLR (r =0.810,0.879,P＜ 0.05).(4) Follow-up:15 patients were followed up for 1-14 months with a median time of 7 months.Of the 15 patients,1 without the second staged ALPPS died of multiple organ dysfunction syndrome at 7 months after the first staged ALPPS,14 survived and took care of theirselves in daily life during follow-up with improved life quality,including 1 detected multiple lung metastases at 12 months after complete ALPPS with mild increased AFP and 13 undetected new lesions in the remnant liver on contrast-enhanced CT and liver contrast-enhanced ultrasonography with normal AFP.Conclusion The peak of IL-6 concentration in peripheral blood at 1,3 days after the first staged ALPPS is significantly correlated with the hyperplasia of FLR,which may be used to predict the hyperplasia of FLR.

Objective To explore any effect of combining urodynamic analysis with individualized bladder training in rehabilitating neurogenic bladder dysfunction after spinal cord injury.Methods Urology patients who had suffered a spinal cord injury were randomly divided into an experimental group and a control group.Both groups were given routine drugs and intermittent catheterization based on a urodynamics analysis using the Laborie urodynamic analyzer.The experimental group also received individualized bladder training for eight weeks.The bladder balance time and urinary infection rate of both groups were recorded 2,4,6 and 8 weeks after the intervention.Results After treatment,all of the patients wcrc able to achieve bladder balance,but the average bladder balance time of the experimental group was significantly shorter than that of the patients in the control group with similar injuries.After 2,4,6 and 8 weeks the incidence of urinary infection in the experimental group was significantly lower than in the control group.Moreover,after the treatment the average bladder storage volume (VH2O),bladder compliance (BC),bladder pressure (Pves) and detrusor pressure (Pdet) of both groups were significantly better than before the treatment,but the results of the experimental group were,on average,significantly better than those in the control group.Conclusion Individualized bladder training can effectively promote bladder balance and reduce the risk of urinary infection after spinal cord injury.

OBJECTIVETo assess the impact of metabolic syndrome(MS) on Framingham risk score(FRS) in patients with type 2 diabetes mellitus (T2DM).

METHODSThe anthropometric and biochemical data of 1708 patients with T2DM admitted in hospital from May 2008 to April 2013 were retrospectively analyzed, including 902 males and 806 females with a mean age of 57.1±11.8 years (20-79 years). Diagnosis of MS was made according to the criteria of the Adult Treatment Panel Ⅲ Criteria modified for Asians.

RESULTSCompared to non-MS/T2DM patients, MS/T2DM patients had higher waist circumference, body weight, body mass index, systolic and diastolic blood pressure, fasting C peptide, total cholesterol, triglyceride, and LDL-C (P<0.05), while lower HDL-C (P<0.01). Both FRS [13.0(10.0, 15.0) vs 11.0(9.0, 13.0) in male,15.0(12.0, 18.0) vs 12.0(6.0, 14.8) in female,P<0.01)] and 10-year cardiovascular risk [12.0%(6.0%, 20.0%) vs 8.0%(5.0%,12.0%) in male,3.0%(1.0%, 6.0%) vs 1.0%(0.0%, 2.8%) in female,P<0.01] were higher in MS/T2DM patients than those in non-MS/T2DM patients.Both FRS and 10-year cardiovascular risk were increased with the components of MS.

CONCLUSIONT2DM patients with MS have more cardiovascular risk factors, higher FRS and 10-year cardiovascular risk.