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.

Lots of patients with obstructive sleep apnea(OSA)are first recognized in dental institutions.In consideration of dental characteristics,we summarize advances in the application of screening methods for adult OSA patients based on oral examination,craniofacial structure,imaging examination,medical history,clinical symptoms,manifestation,populations at risk and questionnaires.Dental practitioners can screen and identify potential OSA patients,play a better role in the multidisciplinary of OSA,and help the pre-vention of OSA.

Objective:To compare the clinical outcomes of single oral dydrogesterone with vaginal progesterone gel plus oral dydrogesterone in gonadotropin-releasing hormone (GnRH) antagonist cycles with fresh embryo transfer.Methods:This study retrospectively analyzed 658 treatment cycles of fresh embryo transfer cycle with GnRH antagonist protocol from December 2015 to December 2020 in the Center of Reproductive Medicine of the University of Hong Kong-Shenzhen Hospital. Each cycle was the first fresh stimulation cycle of the patients. The patients were divided into two groups according to different luteal support regimens. Group A included 368 cycles with a regimen of 30 mg dydrogesterone tablets orally daily, while group B included 290 cycles with a regimen of 90 mg vaginal progesterone gel vaginally daily combined with 20 mg dydrogesterone tablets orally daily. A 1∶1 propensity score matching (PSM) was carried out to adjust for numerical differences and to balance between the two groups, and further they were divided into cleavage stage embryo transfer cycles and the blastocyst transfer cycles according to the different type of embryo for layer analysis, and the laboratory results and assisted reproductive outcomes of the two groups were compared.Results:After matching, the baseline characteristics were comparable between the two groups, with 251 cycles remaining in each group for retrospective analysis. After PSM, statistically significant differences were observed between group A and group B in laboratory data including the number of fertilized oocytes [5 (2, 7) vs. 6 (3, 9), P=0.002], cleavage rate [100.0% (86.31%, 100.0%) vs. 87.28% (75.32%, 100.0%), P<0.001], and available embryo rate [80.18% (54.64%, 100.0%) vs. 67.48% (50.62%, 100.0%), P=0.019]. However, there were no significantly statistical differences in other laboratory data and clinical outcomes (all P>0.05). If we divided the data into two comparison according to the different type of embryo, there were no significantly statistical differences in clinical pregnancy rate, embryo implantation rate, live birth rate, miscarriage rate, multiple pregnancy rate, ovarian hyperstimulation syndrome incidence, and ectopic pregnancy rate neither in day 2 cleavage stage embryo transfer cycles nor in the blastocyst transfer cycles. Conclusion:In this study, the clinical outcomes are similar between taking 30 mg of dydrogesterone tablets orally alone and taking 20 mg of dydrogesterone tablets orally combined with vaginal progesterone gel in the fresh embryo transfer cycle of the GnRH antagonist protocol. Moreover, taking dydrogesterone tablets orally alone can be a new option for luteal support in the fresh cycle of the GnRH antagonist protocol.

Objective:To construct and verify a risk prediction model for pulmonary infection in patients with aneurysmal subarachnoid hemorrhage (aSAH) after craniotomy and clipping, providing theoretical basis and practical guidance for improving the quality of postoperative care.Methods:Using the convenience sampling method, a retrospective selection was made of 397 patients with aSAH after craniotomy and clipping who were hospitalized in the Department of Neurosurgery of Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences) from January 2019 to December 2023 as the modeling group. They were randomly divided into the training set and the test set at a ratio of 7:3, with 278 cases in the training set and 119 cases in the test set. Patients were divided into the infection group and the non-infection group based on whether they developed pulmonary infection. Univariate analysis was used to model the risk factors of pulmonary infection after aSAH craniotomy and clamping in the group, and Lasso regression was used to construct a predictive model. A total of 119 patients with aSAH admitted to the neurosurgery department of the same hospital from January to April 2024 were selected for the external validation of the model. The predictive effect of the model was evaluated through the receiver operating characteristic (ROC) curve.Results:In the modeling group, there were 216 male patients and 181 female patients. The incidence of pulmonary infection was 38.54% (153/397). Finally, five influencing factors, namely stroke, Hunt-Hess classification, mechanical ventilation, indwelling nasogastric tube and the timing of initiating enteral nutrition, were included to construct a predictive model. The areas under the ROC curves of the nomogram prediction models of this model in the training set, test set, and external validation group were 0.859(95% CI 0.791-0.928), 0.843(95% CI 0.796-0.890), and 0.800(95% CI 0.711-0.889), respectively. The calibration curve shows that the model's prediction fits well with the actual situation and has a high degree of calibration. Decision curve analysis indicates that this model has high clinical application value under different risk thresholds. Conclusions:The risk prediction model for pulmonary infection in patients after craniotomy and clipping with aSAH has good discrimination and calibration, which can provide reference for medical staff to identify high-risk patients at an early stage and take preventive intervention measures.

Objective:To compare the clinical outcomes of single oral dydrogesterone with vaginal progesterone gel plus oral dydrogesterone in gonadotropin-releasing hormone (GnRH) antagonist cycles with fresh embryo transfer.Methods:This study retrospectively analyzed 658 treatment cycles of fresh embryo transfer cycle with GnRH antagonist protocol from December 2015 to December 2020 in the Center of Reproductive Medicine of the University of Hong Kong-Shenzhen Hospital. Each cycle was the first fresh stimulation cycle of the patients. The patients were divided into two groups according to different luteal support regimens. Group A included 368 cycles with a regimen of 30 mg dydrogesterone tablets orally daily, while group B included 290 cycles with a regimen of 90 mg vaginal progesterone gel vaginally daily combined with 20 mg dydrogesterone tablets orally daily. A 1∶1 propensity score matching (PSM) was carried out to adjust for numerical differences and to balance between the two groups, and further they were divided into cleavage stage embryo transfer cycles and the blastocyst transfer cycles according to the different type of embryo for layer analysis, and the laboratory results and assisted reproductive outcomes of the two groups were compared.Results:After matching, the baseline characteristics were comparable between the two groups, with 251 cycles remaining in each group for retrospective analysis. After PSM, statistically significant differences were observed between group A and group B in laboratory data including the number of fertilized oocytes [5 (2, 7) vs. 6 (3, 9), P=0.002], cleavage rate [100.0% (86.31%, 100.0%) vs. 87.28% (75.32%, 100.0%), P<0.001], and available embryo rate [80.18% (54.64%, 100.0%) vs. 67.48% (50.62%, 100.0%), P=0.019]. However, there were no significantly statistical differences in other laboratory data and clinical outcomes (all P>0.05). If we divided the data into two comparison according to the different type of embryo, there were no significantly statistical differences in clinical pregnancy rate, embryo implantation rate, live birth rate, miscarriage rate, multiple pregnancy rate, ovarian hyperstimulation syndrome incidence, and ectopic pregnancy rate neither in day 2 cleavage stage embryo transfer cycles nor in the blastocyst transfer cycles. Conclusion:In this study, the clinical outcomes are similar between taking 30 mg of dydrogesterone tablets orally alone and taking 20 mg of dydrogesterone tablets orally combined with vaginal progesterone gel in the fresh embryo transfer cycle of the GnRH antagonist protocol. Moreover, taking dydrogesterone tablets orally alone can be a new option for luteal support in the fresh cycle of the GnRH antagonist protocol.

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.

Lots of patients with obstructive sleep apnea(OSA)are first recognized in dental institutions.In consideration of dental characteristics,we summarize advances in the application of screening methods for adult OSA patients based on oral examination,craniofacial structure,imaging examination,medical history,clinical symptoms,manifestation,populations at risk and questionnaires.Dental practitioners can screen and identify potential OSA patients,play a better role in the multidisciplinary of OSA,and help the pre-vention of OSA.

Objective:To construct and verify a risk prediction model for pulmonary infection in patients with aneurysmal subarachnoid hemorrhage (aSAH) after craniotomy and clipping, providing theoretical basis and practical guidance for improving the quality of postoperative care.Methods:Using the convenience sampling method, a retrospective selection was made of 397 patients with aSAH after craniotomy and clipping who were hospitalized in the Department of Neurosurgery of Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences) from January 2019 to December 2023 as the modeling group. They were randomly divided into the training set and the test set at a ratio of 7:3, with 278 cases in the training set and 119 cases in the test set. Patients were divided into the infection group and the non-infection group based on whether they developed pulmonary infection. Univariate analysis was used to model the risk factors of pulmonary infection after aSAH craniotomy and clamping in the group, and Lasso regression was used to construct a predictive model. A total of 119 patients with aSAH admitted to the neurosurgery department of the same hospital from January to April 2024 were selected for the external validation of the model. The predictive effect of the model was evaluated through the receiver operating characteristic (ROC) curve.Results:In the modeling group, there were 216 male patients and 181 female patients. The incidence of pulmonary infection was 38.54% (153/397). Finally, five influencing factors, namely stroke, Hunt-Hess classification, mechanical ventilation, indwelling nasogastric tube and the timing of initiating enteral nutrition, were included to construct a predictive model. The areas under the ROC curves of the nomogram prediction models of this model in the training set, test set, and external validation group were 0.859(95% CI 0.791-0.928), 0.843(95% CI 0.796-0.890), and 0.800(95% CI 0.711-0.889), respectively. The calibration curve shows that the model's prediction fits well with the actual situation and has a high degree of calibration. Decision curve analysis indicates that this model has high clinical application value under different risk thresholds. Conclusions:The risk prediction model for pulmonary infection in patients after craniotomy and clipping with aSAH has good discrimination and calibration, which can provide reference for medical staff to identify high-risk patients at an early stage and take preventive intervention measures.

Objective To compare the clinical efficacy of luteal phase support with oral dydrogesterone tablets and vaginal progester-one gel combined with oral dydrogesterone tablets during hormone replacement therapy-frozen embryo transfer(HRT-FET).Methods A retrospective analysis was conducted on a total of 489 cycles which underwent HRT-FET at the Center of Reproductive Medicine,the University of Hong Kong-Shenzhen Hospital from November 2018 to June 2022.There were 226 cycles underwent with oral dydrogester-one tablets as luteal support,and 263 cycles underwent with vaginal progesterone gel combined with oral dydrogesterone tablets as luteal support.The primary observation index was the delivery rate.The pregnancy outcomes of HRT-FET in the two groups were compared and analyzed,and the related factors were analyzed.Results There were no significant differences in the age,body mass index,number of antral follicles,total number of eggs,serum levels of estradiol and progesterone on the second day of the menstrual cycle and the day before endometrial transformation between the two pregnant women(P＞0.05).There were also no significant differences in the abortion rate,ectopic pregnancy rate,biochemical pregnancy rate,clinical pregnancy rate,delivery rate,and neonatal weight between the two groups(P＞0.05).In the second day of cleavage stage embryo transfer subgroup,there were no significant differences in the abortion rate,ectopic pregnancy rate,biochemical pregnancy rate,clinical pregnancy rate,delivery rate,and neonatal weight between the two groups(P＞0.05),and in the fifth day of blastocyst transfer subgroup,there were also no significant differences in abortion rate,ectopic pregnancy rate,biochemical pregnancy rate,clinical pregnancy rate,delivery rate between the two groups(P＞0.05),and in the oral dydrogesterone tablets group,the neonatal weight was significantly higher than that of the vaginal progesterone gel combined with oral dydrogesterone tablets,and the difference was statistically significant(P＜0.05).The multivariate Logistic regression analysis showed that different luteal support protocols had no significant impact on the delivery rate(OR=0.703,95％CI:0.461-1.062,P=0.09).Conclusion There were no significant differences between oral dydrogesterone tablets and vaginal progesterone gel combined with oral dydrogesterone tablets in clinical pregnancy rate and delivery rate during HRT-FET.Therefore,the use of oral dydrogesterone tablets a-lone can be a new option for luteal support in HRT-FET.

Amniotic fluid embolism (AFE) is a rare but extremely dangerous obstetric catastrophic disease, with coagulation dysfunction being a common clinical manifestation. This article reports a case of AFE with disseminated intravascular coagulation as the initial presentation, and conducts literature review. In order to increase the attention of clinical physicians to obstetric coagulation dysfunction and provide a basis for early identification and treatment of AFE.