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.

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.

Objective To investigate the value of the hepatocellular carcinoma (HCC) risk model REAL-B score in predicting the risk of HCC in chronic hepatitis B (CHB) patients receiving antiviral therapy in comparison with mPAGE-B, aMAP and PAGE-B scores. Methods A retrospective analysis was performed for the clinical data of 1160 CHB patients who received entecavir or tenofovir treatment for more than 1 year from January 2013 to December 2015 in Tianjin Second Peolple's Hospital, and the events of HCC were recorded. The area under the ROC curve (AUC) was used to evaluate the value of REAL-B, mPAGE-B, aMAP, and PAGE-B scores in predicting HCC. The Kaplan-Meier method was used to evaluate the cumulative incidence rate of HCC at different time points, and the log-rank test was used to compare the incidence rate of HCC between the groups with different scores. The independent samples t -test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. Results Among the 1160 CHB patients, 108 (9.8%) progressed to HCC within a median follow-up time of 5.3 (5.0-6.3) years. REAL-B score had an AUC of 0.848 (95% confidence interval [ CI ]: 0.816-0.880) in predicting the onset of HCC within 5 years, followed by aMAP score (AUC=0.823, 95% CI : 0.786-0.860), mPAGE-B score (AUC=0.822, 95% CI : 0.788-0.857), and PAGE-B scores (AUC=0.780, 95% CI : 0.736-0.824). The 5-year cumulative incidence rate of HCC was 0.8% in the low-risk group (with a REAL-B score of 0-3 points), which was significantly lower than the incidence rate of 11.8% in the medium-risk group (with a REAL-B score of 4-7 points) and 35.6% with the high-risk group (with a REAL-B score of 8-13 points) ( P < 0.05). In the low-risk group, REAL-B score had a negative predictive value of 100% and 99.67%, respectively, in predicting HCC within 3 and 5 years. Conclusion REAL-B score accurately predicts the risk of HCC in CHB patients receiving antiviral therapy, with a better predictive value than the other risk models within 3 years of antiviral therapy.

OBJECTIVE To pr ovide theoretic support for Guiyang to scientifically guide the development of drug retail industry and implement national health policies . METHODS The data were collected through statistical yearbook ，data cloud ， coordinate acquisition device of Application Programming Interface of Baidu map and so on. The spatial distribution characteristics and accessibility of medical insurance designated retail pharmacies （shorted for “designated pharmacies ”）in Guiyang were analyzed by spatial analysis based on Geographic Information System. The related factors for the distribution of designated pharmacies in Guiyang were analyzed by statistical method. RESULTS The number of designated pharmacies ，designated pharmacies per thousand people and designated pharmacies per 10 km2 in Guiyang increased from 2 018，0.41 and 2.51 in 2020 to 2 500，0.42 and 3.11 in 2021，with growth rates of 23.89％，2.44％ and 23.90％ respectively. The service area of the designated pharmacies that residents of Guiyang reached within 15 minutes on foot was 10.27％ of the total service area of designated pharmacies in Guiyang. The results of correlation analysis showed that the correlation coefficients between the regional gross regional production ，total retail sales of consumer goods ，population，urban per capita disposable income and the number of designated pharmacies in Guiyang were 0.999，0.999，0.977 and 0.992，respectively （all P＜0.05）. CONCLUSIONS The distribution of designated pharmacies is insufficient in Guiyang ，the development of designated pharmacies in various administrative regions is uneven ，and the layout of pharmacies is significantly affected by economic and demographic factors. It is suggested that the local government should explore the strategy of scientifically and reasonably expanding the coverage of designated pharmacies in urban and rural areas，promote the rational layout of pharmacies with appropriate economic and demographic policies ，and pay attention to improving the service capacity of designated pharmacies ，so as to improve the quality of life of the people and guide the healthy and high-quality development of drug retail industry.

Objective To investigate the value of neutrophil-to-lymphocyte ratio (NLR), red blood cell distribution width-to-lymphocyte ratio (RLR), and lymphocyte-to-monocyte ratio (LMR) in predicting the prognosis of early small hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA). Methods A retrospective analysis was performed for 132 patients newly diagnosed with early HCC who underwent RFA in Tianjin Second People's Hospital from September 2011 to December 2020. Preoperative data were collected and the patients were followed up to observe recurrence and overall survival (OS). The X-tile tool was used to determine the optimal cut-off values of NLR, RLR, and LMR based on 5-year survival rate and recurrence-free survival (RFS) rate, and then the patients were divided into N-R-L 0 group with 92 patients, N-R-L 1 group with 29 patients, and N-R-L 2 group with 11 patients. The chi-square test was used for comparison of categorical data between the three groups. The Kaplan-Meier method was used to plot the survival curve, and the log-rank test was used to compare RFS and OS rates between groups. The factors with statistical significance in the log-rank test were included in the multivariate Cox regression analysis to determine the risk factors for RFS and OS rates. Results There were significant differences in Child-Pugh class and albumin between the N-R-L 0, N-R-L 1, and N-R-L 2 groups ( χ 2 2=10.992 and 5.699, both P < 0.05). The 1-, 3-, and 5-year OS rates of the three groups were 100%/96.3%/90.7%, 96.6%/60.4%/41.3%, and 81.8%/46.8%/15.6%, respectively ( χ 2 =38.46, P < 0.000 1), and the 1-, 3-, and 5-year RFS rates of the three groups were 76.9%/52.5%/33.3%, 42.9%/13.1%/0, and 11.1%/0/0, respectively ( χ 2 =35.345, P < 0.000 1). The multivariate Cox regression analysis showed that tumor diameter ≥ 2 cm (hazard ratio[ HR ]=2.10, 95% confidence interval[ CI ]: 1.28-3.43, P =0.003; HR =3.67, 95% CI : 1.58-8.52, P =0.002), N-R-L score of 1 point ( HR =3.14, 95% CI : 1.81-5.46, P < 0.000 1; HR =8.27, 95% CI : 3.15-21.71, P < 0.000 1), and N-R-L score of 2 points ( HR =2.61, 95% CI : 1.06-6.42, P =0.037; HR =14.59, 95% CI : 3.96-53.78, P < 0.000 1) were independent predictive factors for RFS and OS. Conclusion N-R-L, a systemic inflammatory response marker composed of NLR, RLR, and LMR, is an independent risk factor for recurrence and survival of early small HCC after RFA, and it can be used as a useful noninvasive biomarker in combination with tumor features to predict the recurrence and survival of early HCC after RFA.

Objective:To explore the clinical features of decompensated liver cirrhosis patients with acute kidney injury (AKI) progressing to chronic kidney disease (CKD) and its impact on prognosis.Methods:From January 2015 to July 2019, at Tianjin Second People′s Hospital, the general data and laboratory test results of 346 hospitalized patients with decompensated liver cirrhosis were retrospectively analyzed. The patients were followed up for 12 months. Univariate analysis and multivariate logistic regression analysis were used to analyze the risk factors of AKI and CKD. Kaplan-Meier method was used for survival analysis. The independent sample t test, Mann-Whitney U test and chi-square test were used for statistical analysis. Results:A total of 128 patients with decompensated liver cirrhosis developed AKI, and 25 of them developed into CKD. Univariate analysis showed that age, hypertension, complications of liver cirrhosis infection, ascites and hepatic encephalopathy, acute-on-chronic liver failure, Child-Turcotte-Pugh score of liver function, baseline serum creatinine, post-admission serum creatinine, serum sodium, white blood cell count, total cholesterol, triglyceride, high-density lipoprotein, total bilirubin, albumin, international normalized ratio (INR) and prothrombin time activity were risk factors of AKI in patients with decompensated liver cirrhosis ( t=3.822, χ2=12.534, 26.761, 5.035, 3.894 and 26.101, U=7 004.500, 9 132.500, 5 925.000, 10 144.000, 10 717.500, 10 827.000, 10 912.000, 5 741.500, 10 017.000, 10 187.500, 11 680.500 and 11 321.500, all P<0.05). The risk factors of AKI progressing to CKD in decompensated liver cirrhosis included the etiology of liver cirrhosis, hypertension, baseline serum creatinine, serum creatinine at the time of diagnosis of AKI, total cholesterol, INR, AKI etiology and AKI classification ( χ2=13.153 and 9.144, U=353.000, 337.000, 576.500 and 481.000, χ2=9.501 and 17.801, all P<0.05). The results of multivariate logistic regression analysis showed that the independent risk factors of AKI progressing to CKD in decompensated liver cirrhosis included baseline serum creatinine (odds ratio ( OR)=1.066, 95% confidence interval ( CI) 1.020 to 1.114, P=0.005) and AKI classification ( OR=6.086, 95% CI 1.828 to 20.260, P=0.003). The Kaplan-Meier survival curve showing that after following up for 12 months, the survival rate of patients with decompensated liver cirrhosis patients who progressed to CKD from AKI was lower than that of patients who did not developed into CKD (52.0%, 13/25 vs. 86.4%, 51/59), and the difference was statistically significant ( χ2=11.482, P=0.001). Conclusion:The transition from AKI into CKD is common in patients with liver cirrhosis, which affects the clinical prognosis and reduces the survival rate.

Objective:To investigate the factors affecting the application of systemic glucocorticoids in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with carbon dioxide (CO 2) retention, and to guide the formulation of a strategy to reduce systemic glucocorticoid exposure. Methods:The AECOPD patients with CO 2 retention admitted to the Ningde Municipal Hospital of Fujian Medical University from January 2017 to December 2019 were enrolled. The general information, past history, times of acute exacerbations within 1 year, pneumonia on admission, causes of COPD, heart failure, blood gas analysis, eosinophil count (EOS), albumin (Alb) and apolipoprotein E (ApoE) levels, exhaled nitric oxide (FeNO) level, inhaled glucocorticoid and non-invasive mechanical ventilation treatment at acute exacerbation were collected. The patients were divided into recommended dosage group (exposure levels in the recommended dosage range, cumulative prednisone dosage ≤ 200 mg) and exceeded group (exposure levels exceeded the recommended dose, cumulative prednisone dosage > 200 mg) according to cumulative systemic glucocorticoid exposure dosage of the patients during hospitalization. The clinical data of patients between the two groups were compared, and possible factors with P < 0.1 in univariate analysis were included in multivariate Logistic regression analysis to screen the related factors of systemic glucocorticoid exposure level in AECOPD patients with CO 2 retention. Results:According to the order of hospitalization, 151 AECOPD patients with CO 2 retention were enrolled, 8 patients were excluded, and 143 patients were enrolled in the analysis. Of the 143 patients, 68 received the recommended dose of systemic glucocorticoid, and 75 received excessive systemic glucocorticoid. Age, percentage of forced expiratory volume in 1 second (FEV1%) at stable phase, frequency of acute exacerbation within 1 year, heart failure ratio, oxygen index (PaO 2/FiO 2), arterial partial pressure of carbon dioxide (PaCO 2), serum EOS and ApoE levels at admission, the ratio of aerosolized inhaled glucocorticoids and non-invasive mechanical ventilation showed statistical differences between the two groups. Multivariate Logistic regression analysis showed that related factors affecting systemic glucocorticoid exposure levels of AECOPD patients with CO 2 retention were FEV1% at stable phase [odds ratio ( OR) = 0.957, 95% confidence interval (95% CI) was 0.921-0.994, P = 0.023], acute exacerbation frequency within 1 year ( OR = 1.530, 95% CI was 1.121-2.088, P = 0.007), heart failure ( OR = 3.022, 95% CI was 1.263-7.231, P = 0.013), PaCO 2 ( OR = 1.062, 95% CI was 1.010-1.115, P = 0.018) and EOS at admission ( OR = 0.103, 95% CI was 0.016-0.684, P = 0.019), aerosolized inhaled glucocorticoids ( OR = 0.337, 95% CI was 0.145-0.783, P = 0.011) and non-invasive mechanical ventilation at acute exacerbation ( OR = 0.422, 95% CI was 0.188-0.948, P = 0.037), of which high FEV1% at stable phase, high EOS at admission, aerosolized inhaled glucocorticoid and non-invasive mechanical ventilation at acute exacerbation were protective factors, while high frequency of acute exacerbation within 1 year, heart failure and high PaCO 2 were risk factors. Conclusions:For AECOPD patients with CO 2 retention, high FEV1% at stable phase, high EOS level at admission, aerosolized inhaled glucocorticoid and non-invasive mechanical ventilation at acute exacerbation can reduce systemic glucocorticoid exposure. In addition, high frequency of acute exacerbation within 1 year, heart failure, and high PaCO 2 can increase systemic glucocorticoid exposure.

Objective:This study compares the magnetic resonance imaging (MRI) appearance of two types of breast tissue markers to investigate the appropriate clinical application of the markers.Methods:Breast MRI of 69 patients (78 masses) with breast tissue markers had been placed were analyzed retrospectively from November 2015 to August 2018 in our hospital. The sizes and shapes of breast tissue markers were assessed in axial fat-suppressed T2-weighted images, T1-weighted images and contrast-enhanced T1-weighed images.Results:The length of the coil nickel-free stainless steel markers were greater than ribbon titanium markers, with statistical difference in fat-suppressed T2-weighted images ( P=0.039). In contrast-enhanced T1-weighted images, all coil nickel-free stainless steel markers showed >6 mm diameter and round shape, and ribbon titanium markers showed >6 mm diameter ( n=20) or ≤6 mm diameter ( n=8), and round ( n=20), dot ( n=7) or band ( n=1) shapes. The categories of sizes and shapes in two types of breast tissue markers both had statistical significance ( P<0.001, P<0.001). Conclusions:Small breast lesions with breast tissue markers are not suitable for MRI evaluation. The artifact of ribbon titanium markers is smaller than coil nickel-free stainless steel markers, so they have less impact for lesions. The choice of the breast tissue markers and image evaluation methods should depend on the different clinical conditions.

Objective To better understand the relationship between the maximum tumor diameter and the most distant micrometastases in different types of non-small cell lung cancer (NSCLC) and to provide histological evidence for the delineation of clinical target volume (CTV) from gross tumor volume.Methods We retrospectively studied the pathological specimens from 113 surgically treated NSCLC patients (44 squamous cell carcinoma patients and 69 adenocarcinoma patients) who were admitted to our hospital from 2014 to 2015.The maximum tumor diameter was determined by a combination of gross and microscopic measurements.Micrometastases were microscopically determined.The distances between the tumor edges and micrometastases outside the tumor boundaries were measured by an ocular micrometer followed by a calculation.Quantitative data were analyzed by t test, and qualitative data were analyzed by logistic regression.Results The regression relationship between the maximum tumor diameter and micrometastases was significant in the adenocarcinoma group, but not significant in the squamous cell carcinoma group (P=0.151).The association between the presence or absence of lymph node metastasis and the most distant micrometastasis was significant in the adenocarcinoma group, but not significant in the squamous cell carcinoma group (P=0.597).No association between the degree of tumor differentiation and the most distant micrometastasis was observed in either group (P=0.113).The average measurement of the most distant micrometastases was 2.94 mm in the adenocarcinoma group, with 7.5 mm as the distance to cover 95% of the most distant micrometastases.To reach the same coverage, 4 mm was needed for tumor size smaller than 3 cm, 6 mm for those between 3 cm and 5 cm, and 7.5 mm for those larger than 5 cm.The average measurement of the most distant micrometastases was 2.69 mm in the squamous cell carcinoma group, with 6 mm as the distance to cover 95% of the most distant micrometastases.Conclusions For NSCLC, the most distant micrometastasis of adenocarcinoma is associated with the maximum tumor diameter and presence or absence of lymph node metastasis, and the CTV should thus be adjusted accordingly;no relevance between the most distant micrometastasis and maximum tumor diameter is observed in squamous cell carcinoma;there is no relationship between the most distant micrometastasis and the degree of tumor differentiation in adenocarcinoma and squamous cell carcinoma.

Objective To establish an evaluation index system of electricity saving at general hospitals.Methods Based on civil building energy saving studies and in accordance with national regulations on hospital energy saving, the authors build an electricity saving index system for general hospitals.The indexes were reduced by the rough set theory, and their weight was determined by analytical hierarchy process and expert analysis.Results An electricity saving evaluation index system for general hospitals is so developed, consisting of six level-2 indexes and 27 level-3 indexes.Conclusions Such an evaluation index system can guide hospital electricity consumption and saving.