Objective To summarize the changing prevalence of carbapenem resistance in Enterobacterales based on the data of CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021 for improving antimicrobial treatment in clinical practice.Methods Antimicrobial susceptibility testing was performed using a commercial automated susceptibility testing system according to the unified CHINET protocol.The results were interpreted according to the breakpoints of the Clinical & Laboratory Standards Institute(CLSI)M100 31st ed in 2021.Results Over the seven-year period(2015-2021),the overall prevalence of carbapenem-resistant Enterobacterales(CRE)was 9.43％(62 342/661 235).The prevalence of CRE strains in Klebsiella pneumoniae,Citrobacter freundii,and Enterobacter cloacae was 22.38％,9.73％,and 8.47％,respectively.The prevalence of CRE strains in Escherichia coli was 1.99％.A few CRE strains were also identified in Salmonella and Shigella.The CRE strains were mainly isolated from respiratory specimens(44.23±2.80)％,followed by blood(20.88±3.40)％and urine(18.40±3.45)％.Intensive care units(ICUs)were the major source of the CRE strains(27.43±5.20)％.CRE strains were resistant to all the β-lactam antibiotics tested and most non-β-lactam antimicrobial agents.The CRE strains were relatively susceptible to tigecycline and polymyxins with low resistance rates.Conclusions The prevalence of CRE strains was increasing from 2015 to 2021.CRE strains were highly resistant to most of the antibacterial drugs used in clinical practice.Clinicians should prescribe antimicrobial agents rationally.Hospitals should strengthen antibiotic stewardship in key clinical settings such as ICUs,and take effective infection control measures to curb CRE outbreak and epidemic in hospitals.

AIM To establish a UPLC method for the simultaneous content determination of liquiritin,ammonium glycyrrhizate,naringin,neohesperidin,hesperidin,rosmarinic acid,baicalin,wogonoside,baicalein,wogonin and praeruptorin A in Tongxuan Lifei Pills,and to make chemometric investigation.METHODS The analysis was performed on a 30 ℃ thermostatic SVEA C18 column(2.1 mm×150 mm,2.5 μm),with the mobile phase comprising of acetonitrile-0.1％phosphoric acid flowing at 0.5 mL/min in a gradient elution manner,and the detection wavelength was set at 250 nm.Subsequently,cluster analysis,principal component analysis and partial least square discriminant analysis were performed.RESULTS Eleven constituents showed good linear relationships within their own ranges(R2＞0.990 0),whose average recoveries were 90.00％-98.32％with the RSDs of 0.35％-1.89％.Forty batches of samples were clustered into 3 types.Baicalein,baicalin,liquiritin,wogonin,wogonoside and neohesperidin were taken as quality differential markers.CONCLUSION This simple and reproducible method can provide the basis for quality control and evaluation of Tongxuan Lifei Pills.

Objective To summarize the changing prevalence of carbapenem resistance in Enterobacterales based on the data of CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021 for improving antimicrobial treatment in clinical practice.Methods Antimicrobial susceptibility testing was performed using a commercial automated susceptibility testing system according to the unified CHINET protocol.The results were interpreted according to the breakpoints of the Clinical & Laboratory Standards Institute(CLSI)M100 31st ed in 2021.Results Over the seven-year period(2015-2021),the overall prevalence of carbapenem-resistant Enterobacterales(CRE)was 9.43％(62 342/661 235).The prevalence of CRE strains in Klebsiella pneumoniae,Citrobacter freundii,and Enterobacter cloacae was 22.38％,9.73％,and 8.47％,respectively.The prevalence of CRE strains in Escherichia coli was 1.99％.A few CRE strains were also identified in Salmonella and Shigella.The CRE strains were mainly isolated from respiratory specimens(44.23±2.80)％,followed by blood(20.88±3.40)％and urine(18.40±3.45)％.Intensive care units(ICUs)were the major source of the CRE strains(27.43±5.20)％.CRE strains were resistant to all the β-lactam antibiotics tested and most non-β-lactam antimicrobial agents.The CRE strains were relatively susceptible to tigecycline and polymyxins with low resistance rates.Conclusions The prevalence of CRE strains was increasing from 2015 to 2021.CRE strains were highly resistant to most of the antibacterial drugs used in clinical practice.Clinicians should prescribe antimicrobial agents rationally.Hospitals should strengthen antibiotic stewardship in key clinical settings such as ICUs,and take effective infection control measures to curb CRE outbreak and epidemic in hospitals.

Objective To summarize the clinical features and prognosis of children suffered from malignant solid tumors of head and neck.Methods The clinical data of children with primary malignant solid tumors located in the head and neck was retrospectively analyzed from January 2007 to December 2021 in the Department of Oncology,Beijing Children's Hospital,Capital Medical University,and the clinical features,prognostic factors were summarized.Results A total of 234 children with malignant solid tumors of head and neck were included,with a male to female ratio of 1∶0.7,aged from 3 months to 17 years and 6 months(median age 51 months).173 cases(73.9％)were treated with local painless masses.Other symptoms included snoring and facial paralysis.The proportion of rhabdomyosarcoma(RMS)was the highest(145 cases,62.0％),followed by neuroblastoma(NB)(25 cases,10.7％),Ewing sarcoma(19 cases,8.1％),etc.A total of 47 cases(20.1％)had distant metastasis.The patients received surgery,chemotherapy and radiotherapy under the mode of multidisciplinary treatment(MDT).The 3-year and 5-year overall survival(OS)were 80.8％and 75.8％,respectively,and the 3-year and 5-year progression free survival(PFS)were 64.0％and 58.9％,respectively.Tumor survivors had abnormal appearance or facial motor function(49 cases,41.2％),developmental problems or abnormal tooth loss(18 cases,15.1％),and other long-term complications that may be related to the tumor or treatment.Conclusion There are various pathologic types of pediatric head and neck malignant solid tumors,RMS and NB are the most common.Local painless mass was the most common complaint.Distant metastasis is an independent risk factor for the prognosis of head and neck malignant solid tumors.Under the MDT model,the prognosis of malignant solid tumors of the head and neck in our center was generally good.In the treatment of the tumors,the side effects and sequelae should be controlled as small as possible under the premise of long-term survival.

AIM To establish a UPLC method for the simultaneous content determination of liquiritin,ammonium glycyrrhizate,naringin,neohesperidin,hesperidin,rosmarinic acid,baicalin,wogonoside,baicalein,wogonin and praeruptorin A in Tongxuan Lifei Pills,and to make chemometric investigation.METHODS The analysis was performed on a 30 ℃ thermostatic SVEA C18 column(2.1 mm×150 mm,2.5 μm),with the mobile phase comprising of acetonitrile-0.1％phosphoric acid flowing at 0.5 mL/min in a gradient elution manner,and the detection wavelength was set at 250 nm.Subsequently,cluster analysis,principal component analysis and partial least square discriminant analysis were performed.RESULTS Eleven constituents showed good linear relationships within their own ranges(R2＞0.990 0),whose average recoveries were 90.00％-98.32％with the RSDs of 0.35％-1.89％.Forty batches of samples were clustered into 3 types.Baicalein,baicalin,liquiritin,wogonin,wogonoside and neohesperidin were taken as quality differential markers.CONCLUSION This simple and reproducible method can provide the basis for quality control and evaluation of Tongxuan Lifei Pills.

Objective To summarize the clinical features and prognosis of children suffered from malignant solid tumors of head and neck.Methods The clinical data of children with primary malignant solid tumors located in the head and neck was retrospectively analyzed from January 2007 to December 2021 in the Department of Oncology,Beijing Children's Hospital,Capital Medical University,and the clinical features,prognostic factors were summarized.Results A total of 234 children with malignant solid tumors of head and neck were included,with a male to female ratio of 1∶0.7,aged from 3 months to 17 years and 6 months(median age 51 months).173 cases(73.9％)were treated with local painless masses.Other symptoms included snoring and facial paralysis.The proportion of rhabdomyosarcoma(RMS)was the highest(145 cases,62.0％),followed by neuroblastoma(NB)(25 cases,10.7％),Ewing sarcoma(19 cases,8.1％),etc.A total of 47 cases(20.1％)had distant metastasis.The patients received surgery,chemotherapy and radiotherapy under the mode of multidisciplinary treatment(MDT).The 3-year and 5-year overall survival(OS)were 80.8％and 75.8％,respectively,and the 3-year and 5-year progression free survival(PFS)were 64.0％and 58.9％,respectively.Tumor survivors had abnormal appearance or facial motor function(49 cases,41.2％),developmental problems or abnormal tooth loss(18 cases,15.1％),and other long-term complications that may be related to the tumor or treatment.Conclusion There are various pathologic types of pediatric head and neck malignant solid tumors,RMS and NB are the most common.Local painless mass was the most common complaint.Distant metastasis is an independent risk factor for the prognosis of head and neck malignant solid tumors.Under the MDT model,the prognosis of malignant solid tumors of the head and neck in our center was generally good.In the treatment of the tumors,the side effects and sequelae should be controlled as small as possible under the premise of long-term survival.

In the multi-campus development and construction of public hospitals,hospital-associated infection man-agement has consistently faced escalating difficulties and challenges.Throughout the long-term exploration and practice,the Second Affiliated Hospital Zhejiang University School of Medicine has adhered to the principles of"integrated planning and deployment,homogeneous and homologous training,information and data sharing,and a focus on professional features".By continuously addressing emerging infection control risk points and weak points,overcoming barriers posed by dispersed human resources,and balancing homogeneity with individualization,the hospital has actively promoted integration and collaborative development across its campuses.This approach has significantly contributed to the sustained improvement of healthcare service capacity and quality across multiple campuses.From the novel perspective of symbiosis theory,this paper analyzes the symbiotic dilemmas in multi-campus hospital-associated infection management,summarizes practical experiences,and explores future direc-tions,aiming to provide references for other public hospitals in multi-campus hospital-associated infection manage-ment.

Objective To explore the changes in neural activity in patients with type 2 diabetes mellitus(T2DM)and their corre-lation with executive function,and to analyze the neural mechanisms underlying the decline in executive function in T2DM patients.Methods Thirty-one T2DM patients(T2DM group)and thirty-two healthy controls(HC)(HC group)matched for body mass index(BMI)underwent resting-state functional magnetic resonance imaging(rs-fMRI)scans and N-back task tests were included.Differ-ences in the amplitude of low-frequency fluctuation(ALFF),regional homogeneity(ReHo),and seed-based functional connectivity(FC)between the two groups were compared,and partial correlation analyses were performed between the difference results and N-back task performance.Results The T2DM group showed prolonged reaction time(RT)in the 1-back and 2-back tasks.T2DM patients exhibited increased ALFF in the bilateral caudate nucleus,left medial superior frontal gyrus,and right postcentral gyrus,as well as elevated ReHo in the right putamen.FC analysis revealed significant alterations in FC between the caudate nucleus,putamen,and multiple brain regions in T2DM patients,with some of these FC changes significantly correlated with RT and accuracy(ACC)in the N-back task.Conclusion The decline in executive function in T2DM patients may be associated with abnormal neural activity in brain regions such as the striatum,salience network,and frontoparietal control network.FC further decreases under increased cognitive load.These findings provide evidence for the study of the neural mechanisms of executive function impairment in T2DM patients.

Objective:To develop and validate the Pain nursing Competency Evaluation Questionnaire for Nursing Students to provide an effective tool for measuring the pain management competency of nursing students in China.Methods:The questionnaire was constructed through literature review, semi-structured interviews, focus group discussions, Delphi expert consultation, and a pre-survey. From September 2023 to January 2024, a convenience sampling method was used to select 250 nursing students from Hangzhou Normal University and Lishui University in Zhejiang Province for the survey. Reliability and validity of the developed questionnaire were tested. A random sample of 30 nursing students was selected for retesting after two weeks.Results:A total of 10 female experts were consulted through correspondence. The Pain Care Competency Evaluation Questionnaire for nursing students consists of 36 items. Through exploratory factor analysis, five common factors were extracted: pain health education, comprehensive pain assessment, pain screening and assessment, analgesic interventions, and analgesic side effects nursing, which together explained 61.695% of the variance. The content validity of the questionnaire was 0.96, and the item-level content validity index ranged from 0.900 to 1.000. The overall Cronbach′s α coefficient was 0.924, and the Cronbach′s α coefficients for the five dimensions ranged from 0.856 to 0.915. The test-retest reliability was 0.831. Conclusions:The Pain Care Competency Evaluation Questionnaire for nursing students developed in this study has good reliability and validity. It can be used as a tool to assess nursing students′ competency in pain care and provides a reference for the design and optimization of pain care courses and clinical practice programs for nursing students in undergraduate institutions.

Vitiligo is a chronic and refractory pigmentary loss skin disease with a complex pathogenesis. Traditional Chinese medicine（TCM） offers advantages in treating vitiligo， such as multi-component and multi-target effects， delivering definite clinical efficacy. This article summarizes the action mechanisms of TCM monomer components and compound formulations in the treatment of vitiligo. It is found that pinostrobin， tribuloside and Erzhi pills can activate the cyclic adenosine monophosphate/protein kinase A （cAMP/PKA） signaling pathway； cannabidiol and tanshinone Ⅱ A can activate the p38 mitogen-activated protein kinase（p38 MAPK）signaling pathway； Ginkgo biloba extract EGb761 and astragaloside Ⅳ can activate the aryl hydrocarbon receptor（AhR） signaling pathway； escin and psoralen derivative BSP-1 can activate the Wnt/β-catenin signaling pathway； apigenin and Baiban granules can activate the nuclear factor erythroid 2-related factor 2/heme oxygenase-1（Nrf2/HO-1） signaling pathway； hyperoside and kaempferol can activate the phosphatidylinositol 3-kinase/protein kinase B（PI3K/Akt） signaling pathway； Ruyi heibai powder can activate the programmed death-1/programmed death-ligand 1（PD-1/PD-L1） signaling pathway； Compound honghua buji granules and demethylzeylasteral can inhibit the Janus kinase/signal transducer and activator of transcription （JAK/STAT） signaling pathway. These mechanisms promote melanin production and deposition， reduce oxidative stress， inhibit the destruction of melanocytes by autoimmunity， and reduce melanocyte apoptosis， thereby exerting therapeutic effects on vitiligo.