Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％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)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed 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 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective To investigate the mechanical properties of both artificial cartilage and host cartilage by establishing the in vitro model of tissue engineered cartilage for repairing defects. Methods The agarose gel as an artificial cartilage was implanted in a deep cartilage defect connected with biological adhesive to set up the in vitro model of tissue engineered articular cartilage defects. Under the compression load, the instant mechanical behavior of the repair area was studied using the digital image correlation technology. Results There was no cracking phenomenon occurred at the interface during the compression process. The Strain distributions at middle layer of the repair area were obtained when the cartilage thickness appeared changes with 3.5%, 5.6%, 7.04% and 9.0% by the compression, respectively. When the compressing change increased from 3.5% to 9%, the maximum compressive strain of host cartilage was increased by 75.9%, and the maximum tensile strain of artificial cartilage was increased by 226.99% in the vertical direction of cartilage surface. In the direction parallel with cartilage surface, the maximum tensile strain at the interface was increased by 116.9%, and the increment was far more than that at the host cartilage area and artificial cartilage area. For shear strain at the repair area, the direction of shear strain at the interface changed oppositely with the compression increasing. Conclusions The repair effect of tissue engineered cartilage was uncertain due to the mechanical environment of the repair area. After the tissue engineered cartilage was implanted in the defect, the repair area was under the influence of complex strain states. The strains changed greatly at the interface both with the host cartilage and artificial cartilage as the compression increasing. The strain in the vertical direction of cartilage surface at the interface might change from compressive stain to tensile strain, which was significantly increased in the direction parallel with cartilage surface. The strain direction at the interface could even be changed oppositely, and the shear strain appeared rapidly increase. The complex strain states lead to such great changes in mechanical environment of the defect area, and may cause cracking at the interface, and even further affect the repair process. Therefore, attention should be given to this complex mechanical environment during cartilage defect repair process in clinical treatment.

Objective To compare the proteomic spectrum of cerebrospinal fluid between patients with hypertensive cerebral hemorrhage before surgery and patients with hypertension,between patients with hypertensive cerebral hemorrhage before surgery and after surgery,between healthy controls and patients with hypertension,and find out disease-specific proteins (DSPs) closely correlated with hypertensive cerebral hemorrhage to explore their roles in hypertensive cerebral hemorrhage. Methods Sixty-nine cerebrospinal fluid samples from patients with hypertensive cerebral hemorrhage (before operation,n=24; after operation,n=20),from patients with hypertension (n=10),and from healthy controls (n=15) were detected by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS).Data were analyzed by Biomark Wizard software(Ciphergen Inc.),and DSPs closely correlated with hypertensive cerebral hemorrhage were searched by protein databases.Results By comparing and analyzing the proteomic spectrum of patients from group of hypertensive cerebral hemorrhage before surgery and group of hypertension, from groups of hypertensive cerebral hemorrhage before surgery and after surgery,from group of healthy controls and group of hypertension,the candidate protein peaks were screened,and the number of them was 23,16,and 0,respectively.The 23 different protein peaks between patients with hypertensive cerebral hemorrhage before surgery and patients with hypertension were analyzed by Biomarker pattern software, showing 6 different protein peaks were important; through searching the database according to molecular weight,we noted that these protein might be brain natriuretic peptide (BNP),human neutrophil peptide alpha-defensin (HNP-2),reactive oxygen species (ROS), PCYOX, secretory carrier membrane protein 4 (SCAMP4) and interleukin-31. Conclusion Differentially expressed proteins from patients with hypertensive cerebral hemorrhage could be screened after analyzing the map of cerebrospinal fluid protein mass spectrum,and these differentially expressed proteins are expected to be the molecular markers to forecast hypertensive cerebral hemorrhage.

Objective To study the relationship between the width and the content of fiber in peridontal ligament (PDL) and the strength of peridontal membrane. Methods Fresh mandible of bull was obtained to prepare for a 5 mm×2 mm×10 mm cuboid including teeth, peridontal membrane, and alveolar bone. The width of the PDL was measured under a stereomicroscope. Pull stress was loaded on the test piece until it broke. The stress-strain curve was recorded. The broken ends of the PDL was dyed with siriue to analyze the content of fiber. Results The relationship between the width of the PDL and the maximum stress was expressed as Y＝9.786e~(-3.6693x). The relationship between the width of the PDL and the physiological ultimate stress was expressed as Y=e~(2.188(-3.953)x). The relationship between the percentage of fiber and maximum stress was expressed as Y=20.788-0.755x+0.007x~2. The relationship between the percentage of fiber and the physiological ultimate stress was expressed as Y=1.39e~(-14)·x~(7.666). The initial physiological stress was 0.28 N/mm~2. Conclusion The strength of PDL increases with the decrease of PDL width and increase of fiber content.

Objective To evaluate the stress distribution and offset of dental and periodontal tissues imposed by changes in inner diameter of pulp cavity.Methods Six models of maxillary second bicuspid tooth with different inner diameter of pulp cavity were established, including: ① calcificated pulp without pulp chamber; ② mostly calcificated pulp chamber with inward reduction of 0.5 mm in normal pulp cavity; ③ initially calcificated pulp chamber with inward reduction of 0.25 mm in normal pulp cavity;④ normal pulp cavity; ⑤ initially absorbed pulp chamber with outward expansion of 0.25 mm in normal pulp cavity; ⑥ mostly absorbed pulp chamber with outward expansion of 0.5mm in normal pulp cavity.Vertical and oblique forces with 160 N were loaded on the central fossa, respectively, in order to calculate the stress distribution of dental and periodontal tissues and the maximum incipient offset of the teeth.Results With loaded vertical and oblique forces on central fossa, increased stress distribution of periodontal tissues and maximum incipient offset of teeth were found in all of the models, which increased with the increase of pulp cavity.Conclusion The change in inner diameter of pulp cavity has an impact on the stress distribution of periodontal tissues and maximum incipient offset of the second upper bicuspid teeth.

OBJECTIVETo report initial experience with laparoscopic radical cystectomy in 43 patients with invasive bladder carcinoma.

METHODSFrom December 2003 to October 2006, 29 men and 14 women underwent laparoscopic radical cystectomy with extracorporeal-assisted urinary diversion for transitional cell carcinoma of the bladder (n=40), adenocarcinoma (n=2) and squamous cell arcinoma (n=1). We report the specific technical details and present initial results of our series.

RESULTSThe mean operative time of laparoscopic radical cystectomy with pelvic lymph node dissection was 195.4 min, the mean blood loss 273.7 ml, and the transfusion rate 6.9%. Two procedures converted to open techniques. Lymphadenectomy detected lymph node metastasis in three patients.

CONCLUSIONSWe demonstrate that the combination of laparoscopic radical cystectomy and extracorporeal urinary diversion is possible and remains a safe, feasible, and repeatable surgical technique. The laparoscopic surgery with extracorporeal urinary reconstruction is emerging as a viable alternative to open radical cystectomy while characterized by less trauma, short recovery time and low complications. Intermediate oncologic outcomes are encouraging and comparable to those of open series. To determine the oncologic outcome long-time follow-up will be necessary.

Aged ; Cystectomy ; methods ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; Male ; Middle Aged ; Treatment Outcome ; Urinary Bladder Neoplasms ; surgery ; Urinary Diversion ; methods

BACKGROUNDLaparoscopic dismembered pyeloplasty with less trauma than open surgery is commonly performed for ureteropelvic junction obstruction despite a longer operating time and a long learning curve. We describe in this paper a new technique, which combines laparoscopic and open procedure in dismembered pyeloplasty, that we have developed in 51 patients and achieved excellent results.

METHODSThe surgical procedure can be divided into two steps: laparoscopic dissection of the renal pelvis and proximal ureter transperitoneally; then accomplishing the pyeloplasty through the extended port incision above the ureteropelvic junction as in open surgery.

RESULTSAll 51 operations were successful without conversion to open surgery. No intraoperative complications were observed. The operating time was 40 minutes to 90 minutes with an average of 57.5 minutes. The estimated blood loss was 15 ml to 30 ml with an average of 21.2 ml. Aberrant artery vessel and primary stricture as the cause of ureteropelvic junction obstruction was noted in 2 and 49 patients, respectively. Thirty-nine patients had fever to differing extents in the 4 days postoperation and no severe infection was observed. Four patients had urinary leakage with their drains being retained for 6 days, 6 days, 5 days or 8 days after the operation. The mean followup was 10.8 months (range 3 months to 36 months). The followup showed good results with symptom resolution in all the patients. Renal ultrasonography demonstrated that the average separation of the collecting systems decreased from preoperative 2.7 cm (range 2.0 cm to 4.7 cm) to postoperative 1.5 cm (range 1.0 cm to 2.3 cm). Excretory urography at 3 months postoperatively showed improved drainage. Of the 51 patients, 35 underwent two or more excretory urograms, demonstrating stable renal function, improved drainage and no evidence of recurrent obstruction. At the last followup visit, each patient was doing well.

CONCLUSIONSCombination of laparoscopic and open procedure in dismembered pyeloplasty offers a simpler, timesaving method in a minimally invasive fashion with low morbidity for patients with ureteropelvic junction obstruction. Ensuring quality of repair, the method provides a minimally invasive alternative with good results. It is worth future clinical application.

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Humans ; Kidney Pelvis ; surgery ; Laparoscopy ; methods ; Male ; Middle Aged ; Ureteral Obstruction ; surgery ; Urologic Surgical Procedures ; methods

Objective To assess the laparoscopic technique combined with open surgical technique in pyeloplasty.Methods Overall,45 patients with ureteropelvic junction obstruction underwent laparo- scopic dissection of the renal pelvis and upper ureter transperitoneally,and pyeloplasty was performed through a expanded trocar-incision(extension of 1-2 cm)as open surgery was performed.Results The opera- tion was successful in all 45 patients.The mean operative time was 58 min(range,40-85 min),and the mean blood loss was 22 ml(range,15-30 ml).No complication was observed during and after operation. Follow-up for 3-36 months was available in 34 patients.Intravenous urography(IVU)showed no obstruc- tion of the anastomotic stoma,and B-ultrasound indicated relief of hydronephrosis.Conclusions Laparo- scopic approach combined with open surgery in pyeloplasty is an effective way to treat ureteropelvic junction obstruction.This technique can simplify the operative manipulation and shorten the operative time without more trauma to the patients.It is worth general application in clinical practice.

Objective To investigate the characteristics of attention networks impairment in Parkinson' s disease patients.Methods Attention network test was performed in 28 PD patients and 28 normal controls on the efficiency of three anatomically defined attentional networks:alerting,orienting,and executive control.Results The correct rate of attention network test was significantly lower(P0.05).The relative analysis showed that the Hoehn Yahr stage was positively correlated with the value of executive netwok(r=0.794,P