Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ 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) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had 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 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ 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) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had 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 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

Objective:To explore the effects of 3 osteotomy methods on the bone healing in Ilizarov tibial bone transport.Methods:The data of 93 patients were retrospectively reviewed who had been treated by Ilizarov single-segment tibial bone transport at Department of Hand Surgery, The Second Hospital of Tangshan from December 2003 to April 2019. Minimally invasive osteotomy was performed in 16 patients [group A: 16 males with an age of (37.1±8.3) years; 5 cases of type Ⅱ and 11 ones of type Ⅲ by Gustilo classification], subperiosteal saw osteotomy in 57 patients [group B: 47 males and 10 females with an age of (39.1±11.8) years; 17 cases of type Ⅱ and 40 ones of type Ⅲ by Gustilo classification] and extraperiosteal wire saw osteotomy in 20 patients [group C: 19 males and one female with an age of (37.7±11.2) years; 18 cases of type Ⅱ and 2 cases of type Ⅲ by Gustilo classification]. The 3 groups were compared in terms of the bone healing index and the Association for the Study and Application of the Method of Ilizarov (ASAMI) functional scores.Results:The 3 groups were comparable because there was no significant difference in the preoperative general data between them ( P>0.05). All the patients were followed up for 19 to 50 months (average, 27.4 months). All patients achieved bony healing, and their associated complications were cured after corresponding treatments. There were no significant differences in the bone healing index between the 3 groups [(53.09±21.88) d/cm for group A, (59.97±33.29) d/cm for group B and (46.20±14.11) d/cm for group C] ( P>0.05). There were no significant differences either in the good to excellent rate by the ASAMI functional scores between the 3 groups (87.5% for group A, 89.5% for group B and 90.0% for group C) ( P> 0.05). Conclusion:All the 3 osteotomy methods may achieve good bony union, leading to similar bone healing indexes and postoperative functional scores.

Objective:To investigate the clinical effect of saphenous artery perforating branch flap in repairing anterior knee soft tissue defects with patella exposure.Methods:From July 2010 to September 2017, 12 patients whose patella exposed due to anterior soft tissue defects of knee were treated. The 12 cases included 8 males and 4 females, aged from 24 to 60 years (42.6 years on average). The causes of injury included car accident in 5 cases, rolling injury in 3 cases, burn and scald in 2 cases, and postoperative patella fracture in 2 cases. The areas of the wounds ranged from 6 cm × 5 cm to 8 cm × 7 cm. The wounds were repaired by saphenous artery perforating flaps with the area ranged from 7 cm × 6 cm to 9 cm × 8 cm, and the donor sites were repaired with free skin grafting.Results:All the 12 cases ended up with the wounds healed primarily and no postoperative complications. The 12 cases were followed up for 6 months to 24 months, with an average of 12 months. The color, texture and appearance of the flaps were good, the thickness of the flap were moderate, and the function of knee joint was recovered well. Skin flap sensation was graded according to the criteria of the British Medical Research Society: 2 cases for Grade S 3+, 6 cases for Grade S 3 and 4 cases for Grade S 2. Conclusions:Saphenous artery perforating flap is an effective method to repair anterior knee soft tissue defect and patella exposure.

Objective:To investigate the clinical application of the free medial plantar artery perforator flap for soft tissue defect reconstruction of the weight-bearing surface of the heel.Methods:The clinical data of patients with soft tissue defects in the weight-bearing surface of the heel were analyzed retrospectively, which were reconstructed with the free medial plantar artery perforator flaps in the Second Hospital of Tangshan from April 2011 to November 2017. The medial plantar artery was anastomosed with the posterior tibial artery. The venae comitantes were anastomosed with the great saphenous vein. The cutaneous branch of the medial plantar nerve was also anastomosed with the saphenous nerve. The donor sites were covered with full-thickness skin grafting. The survival condition, sensory function, countour, stability, and donor site scars were observed during follow-up.Results:A total of 11 patients with soft tissue defects in the weight-bearing surface of the heel were enrolled. There were six males and five females aged 24-41 years (mean, 31.3 years). All flaps survived uneventfully. Patients were followed up 11-56 months (mean 18.5 months). The appearance and function recovery of the flaps were satisfactory with 6-13 mm two-point discrimination(2-PD). No ulcer occurred. All patients returned to a normal walk.Conclusions:It is a feasible way for one-staged reconstruction of the combined loss of Achilles tendon and soft tissue in the heel by using free anterolateral femoral artery perforator flap with fascia lata, which has the advantages of good functional recovery, less trauma, short curing course, the satisfactory contour, and protective sensation achievable.

Objective:To investigate the clinical effect of saphenous artery perforating branch flap in repairing anterior knee soft tissue defects with patella exposure.Methods:From July 2010 to September 2017, 12 patients whose patella exposed due to anterior soft tissue defects of knee were treated. The 12 cases included 8 males and 4 females, aged from 24 to 60 years (42.6 years on average). The causes of injury included car accident in 5 cases, rolling injury in 3 cases, burn and scald in 2 cases, and postoperative patella fracture in 2 cases. The areas of the wounds ranged from 6 cm × 5 cm to 8 cm × 7 cm. The wounds were repaired by saphenous artery perforating flaps with the area ranged from 7 cm × 6 cm to 9 cm × 8 cm, and the donor sites were repaired with free skin grafting.Results:All the 12 cases ended up with the wounds healed primarily and no postoperative complications. The 12 cases were followed up for 6 months to 24 months, with an average of 12 months. The color, texture and appearance of the flaps were good, the thickness of the flap were moderate, and the function of knee joint was recovered well. Skin flap sensation was graded according to the criteria of the British Medical Research Society: 2 cases for Grade S 3+, 6 cases for Grade S 3 and 4 cases for Grade S 2. Conclusions:Saphenous artery perforating flap is an effective method to repair anterior knee soft tissue defect and patella exposure.

Objective:To investigate the clinical application of the free medial plantar artery perforator flap for soft tissue defect reconstruction of the weight-bearing surface of the heel.Methods:The clinical data of patients with soft tissue defects in the weight-bearing surface of the heel were analyzed retrospectively, which were reconstructed with the free medial plantar artery perforator flaps in the Second Hospital of Tangshan from April 2011 to November 2017. The medial plantar artery was anastomosed with the posterior tibial artery. The venae comitantes were anastomosed with the great saphenous vein. The cutaneous branch of the medial plantar nerve was also anastomosed with the saphenous nerve. The donor sites were covered with full-thickness skin grafting. The survival condition, sensory function, countour, stability, and donor site scars were observed during follow-up.Results:A total of 11 patients with soft tissue defects in the weight-bearing surface of the heel were enrolled. There were six males and five females aged 24-41 years (mean, 31.3 years). All flaps survived uneventfully. Patients were followed up 11-56 months (mean 18.5 months). The appearance and function recovery of the flaps were satisfactory with 6-13 mm two-point discrimination(2-PD). No ulcer occurred. All patients returned to a normal walk.Conclusions:It is a feasible way for one-staged reconstruction of the combined loss of Achilles tendon and soft tissue in the heel by using free anterolateral femoral artery perforator flap with fascia lata, which has the advantages of good functional recovery, less trauma, short curing course, the satisfactory contour, and protective sensation achievable.

Objective: To investigate the effect of repairing the skin and soft tissue defects of foot with the anterior tibial artery perforator flap. Methods: Nine patients received the operation using the anterior tibial artery periosteal perforator flap to repair distal foot lesion with skin and soft tissue defects.There were six males and three females.All cases were the distal foot defects of skin and soft tissue with tendon and bone exposure, including traffic accident injury in 5 cases, crush injury in 3 cases, other causes of injury in 1 case. The defects ranged from 5 cm×3 cm to 9 cm×6 cm. The flaps ranged from 7 cm×5 cm—11 cm×8 cm. The donor sites were repaired with direct suture or full-thickness skin grafts. Results: All the flaps were survived, without vascular crisis, congestion and blisters. 1 case had partial necrosis of flap margin, which was cured after dressing. All cases were followed up for 6 months to 34 months(mean 18 months). The appearance and function recovery of flaps were satisfactory. Conclusions It is an ideal flap donor site for repairing soft tissue defects of the distal foot with the anterior tibial artery perforator flap, which has the advantages of simple operation, less trauma, high skin flap survival rate and good appearance.

Objective To contrast and compare two surgical treatments for mucous cysts of the distal interphalangeal joint.Methods Clinical data from April 2004 to January 2016 were retrospectively analyzed.Patients who underwent tumor excision,osteophyte excision,and local flap coverage were assigned into a flap group(n=16),while patients who received osteophyte excision,cyst pedicle resection,and cystic fluid drainage were assigned into a simple osteophyte resection group(n=17).Procedure time,pain,satisfaction score,and hand function were compared between the two groups.Results Patients in the flap group were followed up for 14 to 28 months(mean=19.5 months);the simple osteophyte resection group for 15 to 26 months(mean=20.5 months).There was no recurrence in either group.The rate of excellent efficacy was 81.25 ％ (13/16)for the skin flap group and 82.35 ％ (14/17) for the simple osteophyte resection group,and the difference was not statistically significant(x2=0.007,P ＞ 0.05).Pain relief was achieved in both groups after operation,and the postoperative satisfaction score was higher than the pre-operation score.There was no statistical difference in pre operation pain and satisfaction scores (t 0.14 and 0.35,both P ＞ 0.05),no statistical difference in postoperative pain scores(t =-0.09,P ＞ 0.05),but a statistically significant difference in postoperative satisfaction scores (t =-4.15,P ＜ 0.05) between the two groups.Conclusions Two surgical treatments of mucous cysts can achieve satisfactory aesthetic and clinical outcomes.The simple osteophyte resection method is characterized by a short procedure time and a high level of postoperative satisfaction,but it requires training in microsurgery.Local flap coverage is simple and suitable for lower level hospitals where staff surgeons may lack microsurgical skills,but it may result in certain minor injuries.

Objective To summarize the cutaneous branches of the superficial branch of radial artery distribution were dissected and to discuss the operational technique and clinical efficacy of repairing hand tissue defect by the flap based on the superficial branch of radial artery.Methods From May,2014 to February,2017,8 fresh hand specimens perfused with red latex to observe the distribution and characteristics.And 24 cases of fingers tissue defects (3 thumbs,6 index fingers,5 middle fingers,9 ring fingers,and 1 litter finger) which were repaired with the free wrist crease flap based on the cutaneous branches of superficial palmar branch of the radial artery.Combined fracture in 5 cases.Combined rupture or defect of the flexor tendon in 8 cases.Combined vascular nerve injury in 6 cases.The maximum area of the flap was 5.5 cm × 3.2 cm,and the minimum was 2.0 cm × 1.5 cm.Regular followedup was performed after operation.Results Superficial palmar branch of the radial artery came from the level of radial styloid process ulnar palmar then through ulnar of tubercle of scaphoideum and tended to the thenar muscle.It gave 1-3 branches of the direct skin perforators at distal wrist crease and the anatomical location was constant.The vascular pedicle length could achieve 2.0-3.2 cm.All flaps were survived uneventfully.Twenty-four cases were followed-up for 6-29 months (mean,18.6 months),and the appearance and functional recovered satisfactorily.Flap sensation recovered to S3+.The 2 point discrimination was 8-13 mm.There was no complication in donor area.According to the fingers total active motion (TAM) method to assess:excellent in 17 cases,good in 5 cases,fair in 2 cases.The excellent and good rate was 91.7％.Conclusion The wrist crease cutaneous branches of superficial palmar branch of the radial artery anatomical location is constant.And the flap based on the artery has a reliable blood supply.The vascular pedicle flap is long enough and the operational technique is easy and safe.The postoperative effect is satisfied.It is an ideal method for repairing finger tissue defect.