Objective To analyze the clinical characteristics and risk factors of vancomycin-resistant En-terococcus faecium(VRE-fm)isolated from urine,and to provide a scientific basis for the prevention and treatment of VRE-fm in clinic.Methods The clinical data and drug sensitivity results of 60 patients with VRE-fm strains isolated from urine in this hospital from January 2017 to June 2023 were retrospectively ana-lyzed.The patients were divided into the infection group(n=46)and the non-infection group(n=16)accord-ing to the status of urinary tract infection.Univariate and multivariate logistic regression were used to analyze the risk factors of urinary tract infection caused by VRE-fm.Results Among the 60 patients with VVRE fm strain isolated from urine,43 cases(71.7%)were female,36 cases(60.0%)were≥65 years old,42 cases(70.0%)had a history of indignant catheter,and the median length of hospitalization was 26.5 days.The re-sults of in vitro VRE-fm drug sensitivity test showed that the resistance rate of Teicolanin was 95%,and the resistance rate of linezolid and tigacycline were 1.7%.Multivariate logistic regression analysis showed that u-rinary sludge white blood cell count＞5/HP was an independent risk factor for VRE-fm urinary tract infec-tion(P＜0.05).Conclusion Urine-isolated VRE-fm infections were more common in female,older patients and were significantly associated with a history of indwelling catheters.

Objective To investigate the risk factors for carbapenem-resistant Acinetobacter baumannii(CRAB)bloodstream infection in intensive care units(ICU)and construct a nomogram prediction model.Methods A retrospective analysis was conducted on the medical records of patients with CRAB bloodstream(BSI)infection in the ICU ward of the First Afliated Hospital,Sun Yat-sen University from January 1,2018 to December 31,2023.Cox regression analysis was usedo determine the risk factors for death in patients with CRAB bloodstream infection and to construct a nomogram.prediction model.The predictive ability of the no-mogramprediction model was evaluated by drawing calibration curves,receiver operating characteristic(ROC)curves,and consistency index(C-index).Results Septic shock(HR=7.770,95％CI:1.852-32.593)was an independent risk factor for mortality in patients with CRAB bloodstream infections,and hospitalisation day＞14 d(HR=0.331,95％CI:0.165-0.665)was an independent protective factor for mortality in patients with CRAB bloodstream infections.A nomogram was constructed based on the above factors,with a C-index of 0.725(95％CI:0.652-0.798).The predictive efficacy of patient survival rates at 20 d and 30 d was 0.831(95％CI:0.752-0.910)and 0.826(95％CI:0.715-0.937),respectively.The calibration curve was well fit-ted.Conclusion Septic shock was an independent risk factor for mortality in patients with CRAB bloodstream infections,and hospitalisation days＞14 d was an independent protective factor for mortality in patients CRAB BSI infections.The nomogram prediction model constructed accordingly has good predictive value for the sur-vival rate of patients in the intensive care unit who undergo CRAB bloodstream infections.

OBJECTIVE To investigate the effects and mechanism of Yiqi huoxue decoction （YQHX） on lumbar disc herniation in rats. METHODS Rats were randomly divided into sham operation group， model group， NF-κB inhibitor group （QNZ group， 1 mg/kg）， YQHX group （9.1 g/kg） and combination group （YQHX+QNZ group， the same dose as each single drug group）， with 10 rats in each group. Except for sham operation group， lumbar disc herniation model of rats was induced in other groups； administration groups were given QNZ intraperitoneally or/and YQHX intragastrically， once a day， for 8 consecutive weeks. The severity of intervertebral disc herniation was evaluated in each group； the pathological changes of intervertebral discs and the changes of autophagy of nucleus pulposus cells were all observed； the level of tumor necrosis factor-α （TNF-α） in serum， and the ratios of Bcl-2/adenovirus E1B interacting protein 3 （BNIP3） and Beclin-1 positive cells in intervertebral disctissues were detected； the phosphorylation of nuclear factor-κB （NF-κB） p65， the expressions of tumor necrosis factor receptor- associated factor-2 （TRAF-2）， TRAF-3， BNIP3 and LC3B protein， and mRNA expressions of NF-κB p65， LC3B， p62，BNIP3 and Beclin-1 were determined. RESULTS Compared with model group， Pfirrmann grading score decreased significantly，the pathological injury of intervertebral disc tissue was relieved in YQHX group； the number of autophagosomes in nucleus pulposus cells increased； serum level of TNF-α and mRNA expression of p62 in intervertebral disc tissue decreased significantly； the ratios of BNIP3 and Beclin-1 positive cells， the phosphorylation of NF-κB p65， the expressions of TRAF-2， TRAF-3， BNIP3 and LC3B protein as well as the mRNA expressions of NF- κB p65， LC3B， BNIP3 and Beclin-1 decreased significantly in intervertebral disc tissues （P＜0.05）. The changes of above indexes in YQHX group were reversed partly in YQHX+QNZ group. CONCLUSIONS YQHX promotes the elevation of autophagy level of intervertebral discs， slows down the inflammatory response and the progression of lumbar disc herniation by activating the NF-κB signaling pathway.

Objective To explore the bloodstream infection of refractory drug-resistant Pseudomonas aeruginosa(DTR-PA)patients with clinical characteristics and risk factors.Methods Clinical data of patients with Pseudomonas aeruginosa bloodstream infection in the First Affiliated Hospital of Sun Yat-sen University from January 2017 to December 2022 were retrospectively analyzed.Multivariate Logistic regression analysis was used to explore the independent risk factors for DTR-PA bloodstream infection.Cox proportional hazards regression was used to explore the risk factors related to the death of Pseudomonas aeruginosa bloodstream in-fection.Results A total of 114 patients with Pseudomonas aeruginosa bloodstream infection were enrolled,with an average age of(51.05±17.55)years.The 28 d mortality was 14.0％(16/114),and 24 patients(21.1％,24/114)had DTR-PA.Age,ICU admission,diabetes,hypoproteinemia and septic shock were associ-ated with DTR-PA bloodstream infection(P＜0.05).Multivariate Logistic regression analysis showed that septic shock was an independent risk factor for DTR-PA bloodstream infection(P＜0.05).ICU admission was an independent risk factor for the death of patients with DTR-PA and Pseudomonas aeruginosa blood-stream infection(P＜0.05).Conclusion There are many risk factors for DTR-PA bloodstream infection.Septic shock and ICU admission are independent risk factors for DTR-PA bloodstream infection and death,respectively.