Objective To explore the clinical characteristics and treatment strategies of patients with Carbapenem-resistant Enterobacteriaceae(CRE)bloodstream infection.Methods A retrospective analysis was conducted on demographic information,microbiological data,and clinical characteristics of patients with CRE bloodstream infections in Sichuan Provincial People's Hospital from September 2018 to December 2021.Results A total of 53 cases of CRE bloodstream infections were identified,with a treatment failure rate of 47.2% .Patients with bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae(CRKP)had a worse prognosis(P<0.05).Patients with treatment failure showed higher levels of procalcitonin,C-reactive protein,lactate dehydrogenase,and prolonged prothrombin time,along with lower levels of globulin(P<0.05).Among the 53 patients included in the outcome analysis following drugs,there was no statistically significant difference between monotherapy(n=15)and combination therapy(n=38)(P>0.05).Treatment regimens containing tigecycline were not superior to other strategies without tigecycline(P>0.05).Univariate analysis results indicated that the prognosis of CRE bloodstream infection was associated with endotracheal intubation,central venous catheterization,bacterial species which lead infection,comorbidities of the hepatobiliary system,and infection occurring after ICU admission(P<0.05).Health issues involving the hepatobiliary system and ICU-onset admission were independent risk factors for the prognosis of CRE bloodstream infection(P<0.05).Conclusion Patients with CRE bloodstream infections have a high mortality rate,and those with elevated procalcitonin and C-reactive protein levels indicate a poor prognosis.The use of tigecycline in combination or alone may not be the optimal treatment choice for CRE-related BSI.

Objective To explore the clinical features,diagnoses,differential diagnoses and treatments of superior cerebellar artery aneurysms.Methods The clinical data of 16 patients with superior cerebellar artery aneurysms,admitted to our hospital from January 2013 to March 2018,were retrospectively collected.Their clinical manifestations,imaging features,surgical effects and related problems in the process of diagnoses and treatments were analyzed.Results Among the 16 patients,11 were caused by aneurysm rupture;8 had subarachnoid hemorrhage alone,and three had subarachnoid hemorrhage accompanied by ventricular hemorrhage;CT and CTA confirmed that 8 were superior cerebellar artery aneurysms,two were posterior cerebral artery aneurysms,and one was with unclear diagnosis.In the other 5 patients,three had eyelid ptosis and two had abducent nerve palsy;CT,CTA or MR imaging showed that two were considered as ventral brainstem occupying lesions,and three did not have clear diagnosis.Finally,all patients were diagnosed as having superior cerebellar artery aneurysms by three-dimensional DSA.Five patients were treated with interventional embolization first,and one was treated with surgical clipping because of vertebral artery stenosis and difficulty of catheter access;two patients were transferred to our department for surgical clipping due to aneurysm rupture after embolization treatment in other hospitals;and 9 patients were treated by surgical clipping directly.After treatments,one patient was in bed for a long time due to cerebellar infarction and systemic complications,and the other 15 patients recovered well;two of them underwent ventricular peritoneal shunt due to hydrocephalus.Conclusions Superior cerebellar artery aneurysm has onset of subarachnoid hemorrhage mostly,and oculomotor and abductor nerve paralysis,and space occupying manifestation around the brainstem sometimes.For patients with suspicious posterior circulation aneurysms whose diagnosis or location are unclear,three-dimensional DSA examination should be performed early to confirm the diagnosis.Treatment should be taken as soon as possible once the superior cerebellar artery aneurysm is defined.Interventional embolization may be the first choice,but it is necessary to master the methods of surgical clipping in order to treat the disease timely.

Objective To compare the image quality and patient radiation dose of coronary computed tomography angiography (CCTA) received by prospectively-gated step-and-shoot (SAS) technique with those obtained by retrospectively-gated spiral (RGS) technique on a 256-slice CT scanner. Methods A total of 200 patients were enrolled in this study. One hundred patients underwent CCTA with SAS mode were subdivided into two groups: ( 1 ) 50 patients with an average heart rate (HR) ≤70 bpm were scanned with a data acquisition time window centered at the 75％ of the R-R cycle ( group A) and (2) 50 patients with HR ＞ 70 bpm were scanned with the data acquisition time window centered at the 45％ of the R-R cycle, including a phase tolerance of ±％ (group B). Other 100 patients underwent CCTA with RGS mode and ECG-based tube current modulation were also subdivided into two groups: (3) 50 patients with HR ≤70 bpm were scanned with cardiac dose right set to phase of 75％ (group C) and (4) 50 patients with HR ＞ 70 bpm were scanned with cardiac ose Rdight set to phases of 45％ and 75％ (group D). All patients were grouped in randomized order. The image quality of CCTA were evaluated using a rank scale from 1 to 4 ( 1 : excellent ; 4 : non-assessable ) .Radiation dose of the four groups received was also estimated. The image quality between groups was compared by Mann-Whitney U test.The radiation dose between groups was compared by t test. For the 100 patients received by prospective ECG-gated CCTA, the receiver operating characteristic curve (ROC) was used to analyze the CCTA image quality and average heart rate to determine the uppercutoff of HR for obtaining diagnostic coronary images with SAS mode. A spearman correlation analysis was also performed to analyze the correlation of HR and image quality in patients underwent CCTA with SAS mode.Results Of 2338 coronary artery segments, excellent or good image quality( score of 1 or 2) was achieved in 96. 5％ (585 of 606) in group A, 77.7％ (445 of 573 ) in B,96. 1％ (548 of 570) in C, and 85. 7％ (505/589) in D, with no significant difference for A vs C(Z ＝- 1. 351 ,P ＞0. 05) and with significant differenceS for B vs D (Z＝ -2. 236,P ＜0. 05). Linear correlation analysis indicated a significant degradation of image quality with the increase of heart rate using SAS mode (Spearman correlation, r ＝ 0. 577, P ＜0. 01 ). ROC analysis established an upper HR threshold of 78 bpm for obtaining diagnostic image quality using SAS mode( AUC ＝ 0. 827, P ＜ 0. 05 ). The average radiation dose in group A [ ( 2. 6 ± 0. 5 ) mSv]reduced 75 ％ comparing with that in group C [ ( 10. 6 ± 2. 3 ) mSy], and the average radiation dose in group B [ ( 4.0 ± 0. 7 ) mSy]reduced 69％ comparing with that in group D [ ( 13.0 ± 1. 4) mSv]. ConclusionUsing SAS mode to perform low-dose CCTA with 256-slice helical CT could keep the image quality and reduce radiation dose significantly. Our preliminary experience suggests a good promise of this technique which could be applied to a wider group of patients such as with higher heart rates.