Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.

Objective:To introduce the cultivation model of the scientific research talent echelon in the university-affiliated specialized hospital, and talent cultivation system of Research-Life-Cycle based on this model, summarize its role in promoting discipline development, and propose future measures, providing references for the talent team building and discipline development of specialized hospitals and departments of general hospitals.Methods:This study examined and assessed the effectiveness of the cultivation and the contribution of talents to the advancement of academic disciplines by quantitatively analyzing and comparing the scientific research output and discipline development of personnel trained through the talent echelon policy before and after its implementation for over a decade, and integrating theories related to talent development.Results:Since the implementation of the cultivation model, 116 research talents had completed the cultivation process, accounting for 18% of the hospital′s overall research personnel, and the academic papers echelon talents published as main authors also accounted 60%, which indicated the majority of echelon talents have become the key talents to discipline development and national strategies. The growth rate of the hospital′s papers had significantly increased before and after the policy implementation, with the data rising from 0.16% to the current 1.01% globally.Conclusions:The scientific research talent echelon system has effectively strengthened the cultivation of medical science and technology innovation talents, promoted the formation of the group effect in the hospital, and provided strong support for the development of disciplines. According to the limitations we analyze to the scientific research talent echelon cultivation model, suggestions, for achieving better results in the cultivation of talent echelons, are proposed that we should continuously follow up on national policies to optimize systems, firmly serve for the central task of discipline development, promote the implementation of the comprehensive evaluation to scientific talents, systematically provide young talents with ″real combat″ opportunities, and continuously pursuit the transition from extensive management to refined and personalized management.

Objective:To analyze the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with main splenic artery embolization in the treatment of patients with portal hypertension upper gastrointestinal bleeding complicated with extensive portal vein thrombosis (PVT).Methods:This study was a prospective, single-center, open-label, single-arm clinical trial. In the first phase, 81 patients with portal hypertension upper gastrointestinal bleeding who were admitted to Beijing Shijitan Hospital, Capital Medical University from January 2018 to December 2018 were consecutively enrolled, including 57 males and 24 females, with the age of (51.3±10.4) years. During TIPS surgery, the pressure of the portal vein before and after the balloon blocking the splenic artery was measured to clarify the contribution of the splenic artery to portal hypertension. In the second stage, from January 2019 to December 2022, 104 patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT were re-enrolled, including 71 males and 33 females, with the age of (50.9±12.5) years. TIPS combined with main splenic artery embolization was performed, and portal vein pressure was measured before and after embolization. Follow up on the postoperative esophageal and gastric varices of the patients in the second stage.Results:The portal vein pressures before and after the first stage of balloon occlusion of the splenic artery were (35.2±8.4) mmHg (1 mmHg=0.133 kPa) and (24.2±6.3) mmHg, respectively. The pressure after occlusion was lower than that before occlusion, and the difference was statistically significant ( t=10.54, P<0.001). The portal vein pressures before and after the second stage embolization were (36.1±9.5) mmHg and (21.1±4.7) mmHg respectively. The pressure after embolization was lower than that before embolization, and the difference was statistically significant ( t=13.47, P<0.001). In the second stage, among the 104 patients, the proportion of those whose varicose veins disappeared or improved 6 months after the operation was 43.3%(45/104) and 51.0%(53/104), respectively. There were no patients with aggravation or rebleeding due to rupture. One year later, 8 patients (7.7%) had aggravated or ruptured esophageal and gastric varices with bleeding. Two years later, 12 patients (11.5%) had aggravated or bleeding. Conclusion:TIPS combined with main splenic artery embolization can effectively reduce the portal vein pressure in patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT, improve the degree of esophageal and gastric varices, and reduce the risk of gastrointestinal bleeding.

Objective Develop a prediction model for full-term neonatal mortality and conduct internal validation.Methods 86 full-term newborns who died in the pediatric department of Xuzhou Central Hospital from January 1,2015 to December 31,2023 were selected.According to the sample estimation method,135 full-term infants who were hospitalized during the same period were randomly selected as the control group.Clinical data such as maternal and child birth history,blood routine within 24hours after birth,coagulation function,arterial carbon dioxide pressure(PaCO2),and serum total bilirubin were collected.Using single factor analysis,stepwise regres-sion,and multiple Logistic regression analysis to screen possible predictive factors and establish a predictive model.The receiver operating characteristic(ROC)curve was used to evaluate the discriminative power of the model,and Hosmer Lemeshow was used to test the calibra-tion of the evaluation model.Bootstrap method was used for internal validation.Results Amniotic fluid contamination(OR=3.818,95％CI:1.009-14.447,P=0.048),coagulation dysfunction(OR=12.981,95％CI 3.732-45.152,P＜0.001),gynecological inflamma-tory diseases(OR=7.203,95％CI:1.216-42.659,P=0.03),mechanical ventilation(OR=54.451,95％CI:12.913-229.619,P＜0.001),PCO2(OR=1.131,95％CI:1.055-1.212,P=0.001),and serum lactate(OR=4.540,95％CI:2.561-8.046,P＜0.001)are independent influencing factors of full-term infant mortality,which can predict the occurrence of neonatal mortality in full-term infants(sensitivity 75.8％,specificity 87.0％,AUC=0.814).The Hosmer Lemeshow test showed that the model had good consis-tency with the actual occurrence probability of full-term neonatal mortality in clinical practice(x2=3.787,P=0.876).After internal validation by Bootstrap,the model had good discrimination(AUC=0.849).Conclusion A predictive model for mortality risk factors can be established based on maternal pregnancy history and clinical data within 24hours after full-term birth,which helps to make clinical decisions in advance.

Objective:To analyze the effect of alprostadil on renal hemodynamic parameters in patients with severe lupus nephritis (LN) complicated with acute kidney injury (AKI).Methods:The clinical data of 130 patients with severe LN complicated with AKI from August 2020 to August 2023 in Affiliated Hospital of Jining Medical University were retrospectively analyzed. Among them, 66 patients were treated with continuous renal replacement therapy (CRRT) (CRRT group), and 64 patients were treated with CRRT combined with alprostadil (combination group). All patients of both groups were treated 10 d. The efficacy, renal function (serum creatinine, blood urea nitrogen and 24 h urinary protein quantitation), renal hemodynamic parameters and serum inflammatory factors were compared between two groups. The renal hemodynamic parameters included peak systolic velocity (PSV), resistance index (RI) and end diastolic velocity (EDV)), serum inflammatory factors (procalcitonin (PCT); and the inflammatory factor included procalcitonin (PCT), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6).Results:The total effective rate in combination group was significantly higher than that in CRRT group: 96.88% (62/64) vs. 81.82% (54/66), and there was statistical difference ( χ2 = 7.67, P<0.01). There were no statistical difference in the indexes before treatment between two groups ( P>0.05). The serum creatinine, blood urea nitrogen, 24 h urinary protein quantitation, RI, PCT, TNF-α and IL-6 after treatment in combination group were significantly lower than those in CRRT group: (82.16 ± 16.66) μmol/L vs. (128.55 ± 21.06) μmol/L, (6.15 ± 1.66) nmol/L vs. (10.28 ± 2.45) nmol/L, (1.21 ± 0.42) g vs. (2.06 ± 0.52) g, (0.51 ± 0.12) cm/s vs. (0.61 ± 0.24) cm/s, (0.65 ± 0.12) μg/L vs. (0.89 ± 0.18) μg/L, (3.26 ± 0.34) μg/L vs. (6.82 ± 1.14) μg/L and (26.62 ± 3.62) μg/L vs. (40.55 ± 8.14) μg/L, the PSV and EDV were significantly higher than those in CRRT group: (25.66 ± 3.62) cm/s vs. (22.05 ± 1.84) cm/s and (10.92 ± 1.85) cm/s vs. (8.34 ± 1.26) cm/s, and there were statistical differences ( P<0.01). Conclusions:Alprostadil combined with CRRT can effectively improve renal function and renal hemodynamic in patients with severe LN complicated with AKI, enhance therapeutic efficacy, and inhibit the release of proinflammatory cytokines such as PCT.

Objective Develop a prediction model for full-term neonatal mortality and conduct internal validation.Methods 86 full-term newborns who died in the pediatric department of Xuzhou Central Hospital from January 1,2015 to December 31,2023 were selected.According to the sample estimation method,135 full-term infants who were hospitalized during the same period were randomly selected as the control group.Clinical data such as maternal and child birth history,blood routine within 24hours after birth,coagulation function,arterial carbon dioxide pressure(PaCO2),and serum total bilirubin were collected.Using single factor analysis,stepwise regres-sion,and multiple Logistic regression analysis to screen possible predictive factors and establish a predictive model.The receiver operating characteristic(ROC)curve was used to evaluate the discriminative power of the model,and Hosmer Lemeshow was used to test the calibra-tion of the evaluation model.Bootstrap method was used for internal validation.Results Amniotic fluid contamination(OR=3.818,95％CI:1.009-14.447,P=0.048),coagulation dysfunction(OR=12.981,95％CI 3.732-45.152,P＜0.001),gynecological inflamma-tory diseases(OR=7.203,95％CI:1.216-42.659,P=0.03),mechanical ventilation(OR=54.451,95％CI:12.913-229.619,P＜0.001),PCO2(OR=1.131,95％CI:1.055-1.212,P=0.001),and serum lactate(OR=4.540,95％CI:2.561-8.046,P＜0.001)are independent influencing factors of full-term infant mortality,which can predict the occurrence of neonatal mortality in full-term infants(sensitivity 75.8％,specificity 87.0％,AUC=0.814).The Hosmer Lemeshow test showed that the model had good consis-tency with the actual occurrence probability of full-term neonatal mortality in clinical practice(x2=3.787,P=0.876).After internal validation by Bootstrap,the model had good discrimination(AUC=0.849).Conclusion A predictive model for mortality risk factors can be established based on maternal pregnancy history and clinical data within 24hours after full-term birth,which helps to make clinical decisions in advance.

Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.

Objective:To analyze the effect of alprostadil on renal hemodynamic parameters in patients with severe lupus nephritis (LN) complicated with acute kidney injury (AKI).Methods:The clinical data of 130 patients with severe LN complicated with AKI from August 2020 to August 2023 in Affiliated Hospital of Jining Medical University were retrospectively analyzed. Among them, 66 patients were treated with continuous renal replacement therapy (CRRT) (CRRT group), and 64 patients were treated with CRRT combined with alprostadil (combination group). All patients of both groups were treated 10 d. The efficacy, renal function (serum creatinine, blood urea nitrogen and 24 h urinary protein quantitation), renal hemodynamic parameters and serum inflammatory factors were compared between two groups. The renal hemodynamic parameters included peak systolic velocity (PSV), resistance index (RI) and end diastolic velocity (EDV)), serum inflammatory factors (procalcitonin (PCT); and the inflammatory factor included procalcitonin (PCT), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6).Results:The total effective rate in combination group was significantly higher than that in CRRT group: 96.88% (62/64) vs. 81.82% (54/66), and there was statistical difference ( χ2 = 7.67, P<0.01). There were no statistical difference in the indexes before treatment between two groups ( P>0.05). The serum creatinine, blood urea nitrogen, 24 h urinary protein quantitation, RI, PCT, TNF-α and IL-6 after treatment in combination group were significantly lower than those in CRRT group: (82.16 ± 16.66) μmol/L vs. (128.55 ± 21.06) μmol/L, (6.15 ± 1.66) nmol/L vs. (10.28 ± 2.45) nmol/L, (1.21 ± 0.42) g vs. (2.06 ± 0.52) g, (0.51 ± 0.12) cm/s vs. (0.61 ± 0.24) cm/s, (0.65 ± 0.12) μg/L vs. (0.89 ± 0.18) μg/L, (3.26 ± 0.34) μg/L vs. (6.82 ± 1.14) μg/L and (26.62 ± 3.62) μg/L vs. (40.55 ± 8.14) μg/L, the PSV and EDV were significantly higher than those in CRRT group: (25.66 ± 3.62) cm/s vs. (22.05 ± 1.84) cm/s and (10.92 ± 1.85) cm/s vs. (8.34 ± 1.26) cm/s, and there were statistical differences ( P<0.01). Conclusions:Alprostadil combined with CRRT can effectively improve renal function and renal hemodynamic in patients with severe LN complicated with AKI, enhance therapeutic efficacy, and inhibit the release of proinflammatory cytokines such as PCT.

Objective:To analyze the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with main splenic artery embolization in the treatment of patients with portal hypertension upper gastrointestinal bleeding complicated with extensive portal vein thrombosis (PVT).Methods:This study was a prospective, single-center, open-label, single-arm clinical trial. In the first phase, 81 patients with portal hypertension upper gastrointestinal bleeding who were admitted to Beijing Shijitan Hospital, Capital Medical University from January 2018 to December 2018 were consecutively enrolled, including 57 males and 24 females, with the age of (51.3±10.4) years. During TIPS surgery, the pressure of the portal vein before and after the balloon blocking the splenic artery was measured to clarify the contribution of the splenic artery to portal hypertension. In the second stage, from January 2019 to December 2022, 104 patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT were re-enrolled, including 71 males and 33 females, with the age of (50.9±12.5) years. TIPS combined with main splenic artery embolization was performed, and portal vein pressure was measured before and after embolization. Follow up on the postoperative esophageal and gastric varices of the patients in the second stage.Results:The portal vein pressures before and after the first stage of balloon occlusion of the splenic artery were (35.2±8.4) mmHg (1 mmHg=0.133 kPa) and (24.2±6.3) mmHg, respectively. The pressure after occlusion was lower than that before occlusion, and the difference was statistically significant ( t=10.54, P<0.001). The portal vein pressures before and after the second stage embolization were (36.1±9.5) mmHg and (21.1±4.7) mmHg respectively. The pressure after embolization was lower than that before embolization, and the difference was statistically significant ( t=13.47, P<0.001). In the second stage, among the 104 patients, the proportion of those whose varicose veins disappeared or improved 6 months after the operation was 43.3%(45/104) and 51.0%(53/104), respectively. There were no patients with aggravation or rebleeding due to rupture. One year later, 8 patients (7.7%) had aggravated or ruptured esophageal and gastric varices with bleeding. Two years later, 12 patients (11.5%) had aggravated or bleeding. Conclusion:TIPS combined with main splenic artery embolization can effectively reduce the portal vein pressure in patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT, improve the degree of esophageal and gastric varices, and reduce the risk of gastrointestinal bleeding.

Objective:To introduce the cultivation model of the scientific research talent echelon in the university-affiliated specialized hospital, and talent cultivation system of Research-Life-Cycle based on this model, summarize its role in promoting discipline development, and propose future measures, providing references for the talent team building and discipline development of specialized hospitals and departments of general hospitals.Methods:This study examined and assessed the effectiveness of the cultivation and the contribution of talents to the advancement of academic disciplines by quantitatively analyzing and comparing the scientific research output and discipline development of personnel trained through the talent echelon policy before and after its implementation for over a decade, and integrating theories related to talent development.Results:Since the implementation of the cultivation model, 116 research talents had completed the cultivation process, accounting for 18% of the hospital′s overall research personnel, and the academic papers echelon talents published as main authors also accounted 60%, which indicated the majority of echelon talents have become the key talents to discipline development and national strategies. The growth rate of the hospital′s papers had significantly increased before and after the policy implementation, with the data rising from 0.16% to the current 1.01% globally.Conclusions:The scientific research talent echelon system has effectively strengthened the cultivation of medical science and technology innovation talents, promoted the formation of the group effect in the hospital, and provided strong support for the development of disciplines. According to the limitations we analyze to the scientific research talent echelon cultivation model, suggestions, for achieving better results in the cultivation of talent echelons, are proposed that we should continuously follow up on national policies to optimize systems, firmly serve for the central task of discipline development, promote the implementation of the comprehensive evaluation to scientific talents, systematically provide young talents with ″real combat″ opportunities, and continuously pursuit the transition from extensive management to refined and personalized management.