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 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 aid in the detection of thyroid cancer by using deep learning to differentiate the unique bioimpedance parameter patterns of different thyroid tissues.Methods:An electrical impedance system was designed to measure 331 ex-vivo thyroid specimens from 321 patients during surgery. The impedance data was then analyzed with one dimensional convolution neural (1D-CNN) combining with long short-term memory (LSTM) network models of deep learning. In the process of analysis, we assigned 80% of the data to training set (1072/1340) and the remaining 20% data to the test set (268/1340). The performance of final model was assessed using receiver operating characteristic (ROC) curves. In addition, sensitivity, specificity, positive predictive value, negative predictive value, Youden index were applied to compare impedance model with ultrasound results.Results:The ROC curve of the two-classification (malignant /non-malignant tissue) model showed a good performance (area-under-the-curve AUC=0.94), with an overall accuracy of 91.4%. To better fit clinical practice, we further performed a three-classification (malignant/ benign/ normal tissue) model, of which the areas under ROC curve were 0.91, 0.85, 0.92 for normal, benign, and malignant group, respectively. The results indicated that the area under micro-average ROC curve and the macro-average ROC curve were 0.91 and 0.90, respectively. Moreover, compared with ultrasound, the impedance model exhibited higher specificity.Conclusions:A deep learning model (CNN-LSTM) trained by thyroid electrical impedance spectroscopy (EIS) parameters shows an excellent performance in distinguishing among different in-vitro thyroid tissues, which is promising for applications. In future clinical utility, our study does not replace existing tests, but rather complements others, thus contributing to therapeutic decision-making and management of thyroid disease.

Objective:To investigate the feasibility of individualized primary clinical target volume (CTV) delineation in intensity-modulated radiotherapy for nasopharyngeal carcinoma (NPC).Methods:Clinical data of 87 consecutive patients newly diagnosed with lateralized NPC in Jiangsu Cancer Hospital between October 2016 and February 2018 were retrospectively analyzed. Lateralized NPC is defined as tumor invasion not exceeding the contralateral wall. According to the tumor spread, the primary CTV was optimized as follows: CTV2 only covered the medial part of the contralateral pterygopalatine fossa, whereas the contralateral foramen oval was not included; on the level of parapharyngeal space, the contralateral side of CTV only covered the posterior lateral lymph nodes, whereas the contralateral internal jugular vein was not regularly covered. Failure patterns and 5-year survival [local control rate (LCR), progression-free survival (PFS) and overall survival (OS)] were evaluated by Kaplan-Meier method. Paired t-test and rank-sum test were used to analyze the dose variation in the optimized region and adverse reactions. Results:The median follow-up time was 59.5 months. The 5-year LCR, PFS, and OS were 98.9%, 86.5% and 92.1%, respectively. There was no local recurrence in the optimized area of CTV. Dosimetric comparison results showed that the doses of parotid gland, temporal lobe, cochlea and middle ear on the contralateral side were reduced by 13.45%, 9.14%, 38.83%, and 29.36%, respectively. Four cases (4.6%) developed grade 3 hearing loss, all on the ipsilateral side. The optimized scheme significantly alleviated the hearing loss on the contralateral side compared to that on the ipsilateral side ( P<0.001). Other grade 3 late adverse reactions included cranial nerve injury, subcutaneous fibrosis in the neck and visual impairment, with 1 case each. Conclusion:Individualized primary CTV for lateralized NPC is feasible and safe, with obvious dosimetric advantages and reduced adverse reaction rate, which is worthy of clinical promotion.

Objective:To develop a national secondary reference material of Urea and Creatinine in frozen human serum as a standard for metrological traceability.Methods:According to JJF1343-2012 "General and Statistical Principles for Characterization of Reference Materials" and JJF 1006-1994 " Technical Norm of Primary Reference Material ", the homogeneity, stability, and commutability were evaluated;Using the JCTLM recommended methods, the value of the reference materials was assigned through collaboration with 6 accredited reference laboratories from Guangdong Provincial Hospital of Chinese Medicine, Beijing Aerospace General Hospital, Shenzhen Mindray Bio-Medical Electronics, Maccura Biotechnology, Beijing Leadman Biochemistry, and Zhejiang MedicalSystem Biotechnology. Uncertainty components including inhomogeneity, stability and value assignment were evaluated.Results:The results of one-way analysis of variance of homogeneity for the reference materials showed P>0.05, and the stability evaluation was less than the critical value of the t-test. The measured values were in the 95% confidence interval in the four conventional detection systems for commutability, and the certified values and expanded uncertainties were urea:(14.7±0.3) mmol/L ( k=2),Cr:(313.9±14.5) μmol/L ( k=2). Conclusion:The prepared secondary reference materials of urea and creatinine had promising homogeneity, stability, and commutable, the values of urea and creatinine concentration in reference materials were accurate and reliable.

Objective: To investigate thoracic endovascular aortic repair (TEVAR) and “Chimney” technique for treating the involved left common carotid artery (LCCA) or left subclavian artery (LSA) in Standford B patients with aortic lesion and in-sufficient proximal anchoring area. Meanwhile, to explore the relationship between endoleaking condition and the location of lesion with the prognosis. Methods: A total of 32 relevant patients treated by TEVAR + “Chimney” technique in our hospital from 2011-09 to 2015-07 were retrospectively analyzed. Immediate post-operative image development of LCCA or LSA was observed; cerebral complications, severe upper limb ischemic symptoms and endoleaking conditions were recorded. The patients were followed-up for (3-46) months. Results: Thoracic aortic stent-graft placement was successfully carried out in all 32 patients. Immediate post-operative image development of LCCAor LSAwas favorable, no cerebral complications and no severe upper limb ischemic symptoms were observed. There were 7 patients suffered from endoleak at aortic arch including 6 with the lesion located at the greater curvature side and 1 at the small curvature side. During follow-up period, aortic stent-graft remained in a stable condition and the blood flow in “Chimney” stent was unobstructed. Endoleking condition was gradually reduced and disappeared in 5 patients, it was persisted in 2 patients. Conclusion: “Chimney” technique may prolong anchoring area and keep LCCA or LSA unobstructed, therefore expand the indication of TEVAR in a mini-invasive, safe and effective way. When aortic lesion located at the greater curvature side, the endoleaking probability could be increased.

Objective: To explore the effect and safety of pre-operative loading ticagrelor on myocardium reperfusion in patients with acute ST-elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI). Methods: A total of 105 acute STEMI patients received PCI within 12-hour of onset were studied and they were divided into 2 groups: Ticagrelor group, the patients received pre-operative oral chewing ticagrelor 180 mg,n=58 and Clopidogrel group, the patients received pre-operative oral chewing clopidogrel 600 mg,n=47. The baseline feathers, operative TIMI and corrected TIMI frame count (CTFC), TIMI myocardial perfusion grade (TMPG), no-relfow/slow lfow conditions were compared between 2 groups. Results: The baseline feathers and pre-operative TIMI were similar between 2 groups, bothP>0.05. Compared with Clopidogrel group, Ticagrelor group showed increased ratios of TIMI 3 lfow (94.8% vs 80.9%) and TMPG (89.7% vs 72.3%), bothP<0.05, improved CTFC (20.0 ± 4.9) vs (31.8 ± 3.9),P<0.001; decreased rates of no-relfow/slow lfow,P=0.016 and less MACE occurrence,P<0.05; while the post-operative bleeding events were similar between 2 groups,P>0.05. Conclusion: Prior PCI loading ticagrelor may reduce no-relfow/slow lfow incidence, improve myocardium reperfusion safely and therefore, decrease MACE occurrence in acute STEMI patients.

Objective To explore the correlation of general self-efficacy, self-esteem and quality of life of adolescents through the current situation of adolescents′ self-effiency, self-esteem and quality of life. Methods Totally 338 adolescents from elementary school and junior middle school in Beijing were investigated by general self-efficacy scale ( GSES) , Rosenberg self-esteem scale, and the Chinese version pediatric quality of life inventory 4.0 (PedsQLTM4.0).Results The mean score of PedsQL of 338 adolescents was (87.07±10.20);the mean score of GSES of 338 adolescents was (3.07±0.63); the score of Rosenberg self-esteem scale was (33. 86±5.29). Except that the score of quality of life in elementary students was lower than the middle school students, the scores of self-efficacy, self-esteem and quality of life in students with different gender, grade, education level of parents, monthly income of family and living condition were similar. The correlation coefficient of the scores of self-efficacy and quality of life was 0.252, and of the score of the self-esteem and quality of life was 0.339, and they were all positively correlated ( P<0.01) . The scores of self-efficacy, self-esteem and quality of life were positively correlated (P<0.01).Conclusions The level of self-efficacy, self-esteem and quality of life in adolescents were high. It shows that we can improve the quality of life through improving the level of self-efficacy and self-esteem in adolescents, to promote their health growth.

BACKGROUND:Restenosis after angioplasty severely limited the application and long-period therapeutic effects of percutaneous coronary intervention. Changes in smooth muscle cel phenotype and their proliferation are important mechanisms of restenosis after angioplasty.
OBJECTIVE:To use bal oon in vivo transduction of osteopontin short hairpin RNA (OPN-shRNA), to inhibit osteopontin expression at the injured blood vessels of a rabbit model of experimental atherosclerosis, and to prevent restenosis after angioplasty.
METHODS:A total of 20 rabbit models of atherosclerosis were established and randomly equal y assigned to empty plasmid group and OPN-shRNA plasmid group. The plasmid recombinant OPN-shRNA and empty plasmid were transferred to the ventral aorta by bal oon.
RESULTS AND CONCLUSION:After bal oon dilatation, specific green fluorescence was detected in the layer of vascular smooth muscle in the two groups. Moreover, with prolonged time of transfection, fluorescence intensity gradual y decreased. Compared with the empty plasmid group, the expanded artery lumen area obviously increased in the OPN-shRNA plasmid group, and plaque burden evidently reduced. Results indicated that bal oon catheter used in regional blood vessels in rabbit models of atherosclerosis could successful y transduce OPN-shRNA plasmid. The restenosis of the expanded blood vessels lessened, and thrombus burden relieved. It is of great importance to prevent the occurrence of restenosis after angioplasty in rabbit models.