ObjectiveTo investigate the contamination status, transmission risk and drug resistance of Klebsiella pneumoniae (KP) on the object surfaces in the surrounding environment of hospitalized patients infected with carbapenem-resistant Klebsiella pneumoniae (CRKP) , so as to provide a scientific guidance for the prevention and control of healthcare-associated infection. MethodsSamples from the surfaces of objects in the surrounding environment of CRKP infected patients living in the intensive care unit (ICU) and hand specimens from healthcare workers were collected for KP isolation and identification, as well as drug susceptible test in a medical institution located in Minhang District, Shanghai from 2021 to 2023. Additionally, both univariate and multivariate logistic regression analyses were used to identify the influencing factors associated with KP contamination in the hospital environment. ResultsA total of 546 surface samples were collected from the surrounding environment objects of 15 patients infected with CRKP, with a KP detection rate of 6.59% (36/546).The KP detection rate in the ICU of general ward (10.22%) was higher than that in the ICU of emergency department (2.94%) (χ²=12.142, P<0.001). Moreover, the KP detection rate on the surfaces of patient-contacted items (15.66%) was higher than that on shared-use items (6.25%), cleaning items (10.00%), and medical supplies (3.30%) (χ²=17.943, P<0.001). Besides, the detection rate of KP in items sent out of hospital for disinfection (15.38%) was higher than that in those self-disinfected (4.20%) (χ²=19.996, P<0.001).The highest detection rate of KP was observed in high-temperature washing (15.13%, 18/119) (χ²=21.219, P<0.001), while the lowest detection rate was observed in antibacterial hand sanitizer with trichlorohydroxydiphenyl ether sanitizing factor (0, 0/60) ( χ²=21.219, P<0.001).The detection rate of KP in samples taken more than 24 hours after the last disinfection (23.08%) was higher than that in those taken at 4 to24 hours (12.90%) and less than 4 hours (4.22%) (χ²=23.398,P<0.001).ICU of general ward (OR=4.045, 95%CI: 2.206‒7.416), patient-contacted items (OR=3.113, 95%CI: 1.191‒8.141), and self-disinfection ( OR=0.241, 95%CI:0.144‒0.402) were influencing factors for KP contamination in environmental surface. From 2021 to 2023, the drug resistance rates of hospital environmental KP isolates showed an upward trend (P<0.001) to antibiotics such as ceftazidime and gentamicin. Furthermore, high drug resistance rates of KP (>90%) were observed to ciprofloxacin, levofloxacin, cefotaxime, ceftriaxone, and cefepime. ConclusionCRKP can be transmitted outward through the surfaces of objects in the patients’ surroundings, and the drug resistance situation is severe. In clinical settings, it is necessary to implement isolation measures for CRKP infection patients, to increase the frequency of disinfection for objects in their surroundings, to strengthen hand hygiene practices, and to use antibiotics appropriately.

Objective:To investigate the clinical value of dynamic AI ultrasonic intelligent assisted diagnosis system for preoperative evaluation of thyroid nodules with diameter ≤1.0 cm.Methods:From Apr. 1, 2023, to Dec. 30, 2023, 742 thyroid nodules with diameter ≤1.0 cm were removed from 532 patients with thyroid nodule disease who received surgical treatment in the Department of Thyroid (hernia) of the First Medical Center of the Chinese People’s Liberation Army General Hospital. Among them, 423 were d≤0.5 cm. 319 cases (235 males and 507 females) with 0.5

Objective:To analyze the perioperative risks and prognosis in patients with differentiated thyroid cancer (DTC) complicated by Graves' disease (GD) .Methods:Clinical data of 880 DTC patients who underwent radical thyroidectomy at the Department of General Surgery, the First Medical Center of Chinese PLA General Hospital between Jan. 2016 and Dec. 2022 was retrospectively collected. The cohort included 119 DTC patients with GD (hyperthyroid group) and 761 DTC patients with normal thyroid function without GD (normal group) . Use propensity score matching (PSM) was used to obtain cohorts with balanced baseline characteristics between the hyperthyroid and normal groups. Perioperative risks and prognos were compared between the two groups.Results:For perioperative risk comparison, after 1∶2 matching, 116 patients were included in the hyperthyroid group and 232 patients in the normal group. The operation time was longer in the hyperthyroid group compared to normal group ([107.26±30.27]min vs. [96.45±32.51]min, P=0.003) . There were no statistical differences between the two groups in intraoperative blood loss, postoperative drainage volume or postoperative hospital stay ( P>0.05) . There were no statistical difference in the incidence of complications such as temporary or permanent hypoparathyroidism, temporary or permanent recurrent laryngeal nerve injury, and lymphatic leakage between the two groups. For prognostic comparison, after 1∶2 matching, 117 cases were included in the hyperthyroid group and 234 cases in the normal group. During follow-up period, 16 patients experienced DTC recurrence, including 5 cases in the hyperthyroid group and 11 cases in the normal group. There was no statistical difference in reccurence-free survival rates between the two groups (5-year RFS: 95.7% vs. 95.3%, P=0.907) . Multivariate Cox regression analysis revealed GD was not the risk factor for DTC recurrence. Conclusions:With standardized and adequate preoperative preparation, the perioperative risks of DTC patients complicated by GD were not increased compared to patients without GD. Additionally, GD does not increase the risk of postoperative tumor recurrence in DTC patients.

Objective Investigate the clinical efficacy and application value of gasless trans-subclavian approach endoscopic surgery(GTAES)for the treatment of primary hyperparathyroidism(PHPT).Methods 55 PHPT patients who underwent unilateral parathyroid adenoma resection from January 2023 to October 2024 were absorbed.Based on surgical approaches,31 patients were divided into the traditional low-collar arc incision open surgery group(open group)and 24 patients were divided into gasless trans-subclavian approach endoscopic surgery group(endoscopic group).The perioperative data,anterior neck function recovery,and incision healing were compared between two groups.Results There were no significant differences in operation time,intraoperative blood loss,postoperative drainage volume and postoperative hospital stay between the two groups(P＞0.05).The preoperative blood calcium levels of the endoscopic group and the open group were(2.68±0.10)mmol/L and(2.63±0.16)mmol/L,respectively.The blood calcium levels on the first day after surgery were(2.39±0.12)mmol/L and(2.36±0.16)mmol/L,respectively.Preoperative parathyroid hormone(PTH)was 27.55(110.05,155.75)pg/ml in endoscopic group and 137.00(107.00,210.30)pg/ml in open group,respectively.PTH on the first day after surgery was 18.98(12.64,23.53)pg/ml and 13.85(7.36,23.23)pg/ml,respectively.Blood calcium and PTH in each group 1 day after surgery decreased compared with that before surgery,and the difference was statistically significant(P＜0.05).There were no postoperative complications such as hoarseness,bleeding and incision infection in both groups.Postoperative hand and foot numbness:5 cases(20.8％)in endoscopic group and 8 patients(25.8％)in the open group,there was no significant difference between the two groups(P=0.667).There was no significant difference in the score of neck pain 3 days after surgery between the two groups(P＞0.05).The score of swallowing tension[(1.92±1.06)points compared with(2.77±1.38)points,P=0.015]and the score of anterior neck discomfort[(1.63±0.88)points compared with(2.35±1.33)points,P=0.018]in the endoscopic group one month after surgery were better than those in the open group.There was no significant difference in the score of neck scar scale between the two groups 3 months after surgery(P＞0.05).VAS score of incision satisfaction was(9.08±0.88)in endoscopic group and(8.19±1.30)in open group,and the endoscopic group was better than the open group,the difference was statistically significant(P=0.004).Conclusion For PHPT patients caused by unilateral parathyroid adenoma confirmed through preoperative localization examination,GTAES is a safe and effective surgical approach,which offers unique advantages in intraoperative lesion identification,cosmetic outcomes of the incision,and preservation of anterior neck function,providing a new surgical option for PHPT patients.

AIM To explore the differential metabolites of different aged Citrus reticulate'Chachi'and their processed cakes.METHODS Non-targeted metabolomics technology of GC-TOF-MS was used to analyze the chemical constituents.The data was processed by principal component analysis and orthogonal partial least squares discriminant analysis,and the differential metabolites were identified.RESULTS A total of 74 differential metabolites were identified,including 16 glycosides,14 organic acids and their derivatives,11 amino acids and their derivatives,and 4 flavonoids.Comparative analysis revealed 40 and 30 differential metabolites between fresh C.reticulate'℃hachi'and 3-year or 5-year aged samples,respectively.Furthermore,27 and 34 differential metabolites were identified between the 3-year or 5-year aged samples and their corresponding processed cakes,respectively.Differential metabolites among fresh,aged C.reticulate'Chachi',and processed cakes were predominantly enriched in 6 metabolic pathways,including the biosynthesis of secondary metabolites.Specifically,differential metabolites between 3-year aged C.reticulate'Chachi'and its processed cake were significantly enriched in 4 pathways,such as ABC transporters.Differential metabolites between 5-year aged C.reticulate'Chachi'and its processed cake were mainly enriched in 5 pathways,including carbon metabolism.CONCLUSION Non-targeted metabolomics technology can elucidate the chemical compositional differences among fresh/aged and processed cakes of C.reticulate'Chachi',laying a foundation for the research into C.reticulate'Chachi'aging processing techniques and the development of processed products.

Objective:To explore the clinical effect of endoscopic radical thyroidectomy via three-port gasless intermuscular approach.Methods:This is a retrospective cohort study. The data of 148 patients who underwent radical thyroidectomy at the Fourth General Surgery Department of the Second Affiliated Hospital of Harbin Medical University from January to June 2024 were retrospectively analyzed. There were 31 males and 117 females,aging (43.5±9.6) years (range: 21 to 64 years). The surgical method was selected according to the needs and wishes of patients. Among them, 77 cases underwent endoscopic radical thyroidectomy via unilateral three-port gasless intermuscular approach (three-port gasless group),and 71 cases underwent unilateral conventional open radical thyroidectomy(open group). The surgical technique exploration curve of the three-port gasless group was drawn based on the operation time and the number of lymph node dissections,and the technical exploration period and the technical maturity period were divided. The clinical data of the cases in the three-port gasless group and the open group were compared during the technical maturity period. The independent sample t test was used to compare the quantitative data between the two groups, and the χ2 test or Fisher exact probability method was used to compare the categorical data, respectively. Results:According to the technical exploration curve,there were 11 cases in the technical exploration period of the three-port gasless group,and 66 cases in the technical maturity period. In the technical mature period,the injury rate of temporary recurrent laryngeal nerve in the three-port gasless group was 1.5% (1/65),and the number of lymph node dissections was 5.9±3.5(range:0 to 14),which was not statistically significant compared with 4.4% (3/68) and 5.8±3.7(range:0 to 16) in the open group (all P>0.05). In the technical mature period,the operation time of the three-port gasless group was (39.2±6.2)minutes(range:30 to 55 minutes) and the postoperative drainage volume was (57.6±11.8) ml(range:30 to 90 ml),which were lower than those of the open group((67.8±13.9) minutes (range: 30 to 105 minutes) and (82.9±22.4)ml(range:50 to 175 ml)),and the differences were statistically significant ( t=15.303, 8.177, both P>0.05). During the technical maturity period,the postoperative hospital stay in the three-port gasless group was (3.2±0.4)days(range:3 to 4 days), which was not statistically different from that of the open group((3.2±0.4)days(range:3 to 5 days))( P>0.05). The incision satisfaction of patients in the three-port gasless group one month after the operation was higher than that of the control group (100% vs. 62.0%) ( P<0.01). Conclusion:Compared with open surgery,endoscopic radical thyroidectomy via three-port gasless intermuscular approach has certain advantages in terms of operation time, postoperative drainage volume and patient cosmetic satisfaction.

Objective:To compare surgical-related indicators between non-inflated subclavian endoscopic surgery and axillary and traditional open surgery for the treatment of right lobe thyroid cancer,as well as their effects on postoperative anterior cervical function and cosmetic outcomes.Methods:This retrospective cohort study analyzed 151 cases of thyroid cancer patients who underwent surgical treatment at the Department of Thyroid Surgery,Zhengzhou Central Hospital Affiliated to Zhengzhou University from June 2024 to October 2024. Based on the surgical approach,patients were divided into three groups:56 cases of traditional open surgery group, 44 cases of non-inflated axillary approach group,and 51 cases of non-inflated subclavian approach group. Comparative indicators included surgical time, parathyroid autotransplantation rate,complete exposure rate of central area, number of lymph node dissections, number of positive lymph nodes, anterior cervical function, and satisfaction with incision beauty. One-way analysis of variance,non-parametric test,Kruskal-Wallis test,Pearson χ2 test and Fisher′s exact probability method were used to compare the results of the three groups and subsequent pairwise comparisons,respectively. Results:All laparoscopic surgeries were successfully completed without conversion to open surgery. (1) Surgical time:the traditional open surgery group had the shortest operative time ( M(IQR))(71.5(16.0)minutes), significantly shorter than both endoscopic groups (both P<0.01); among the endoscopic approaches, the non-inflated subclavian approach group (97.0(10.0)minutes) had a significantly shorter operative time than the non-inflated axillary approach group (115.0(11.0)minutes)( P<0.01). (2) Parathyroid autotransplantation rate:the rates were 53.6%(30/56) in the traditional group, 70.5%(31/44) in the non-inflated axillary approach group, and 66.7%(34/51) in the non-inflated subclavian approach group, with no statistically significant differences ( P>0.05). (3) Complete exposure rate of the central area:the exposure rate was 100%(56/56) in the traditional open surgery group, 86.4%(38/44) in the non-inflated axillary approach group, and 96.1%(49/51) in the non-inflated subclavian approach group. A significant difference was observed between the traditional open surgery group and the non-inflated axillary approach group ( χ2=8.124, P<0.01), but not observed between other groups. (4) Number of lymph node dissection:no significant difference was found among the three groups (8(6)(range:2 to 17) in the traditional open surgery group,7(3)(range:2 to 16) in the non-inflated axillary approach group,7(4)(range:2 to 16) in the non-inflated subclavian approach group)( P=0.078).(5) Number of positive lymph nodes:no significant differences were observed among the three groups( P=0.923). (6) Postoperative anterior cervical function:① Visual analogue scale: there was no significant difference between the non-insufflation transaxillary approach group and the non-insufflation subclavian approach group at 3 days and 1 month postoperatively ( P>0.017). However, the two groups had significantly lower scores than the traditional open group (both P<0.01). ② Neck disability index:at 3 days post-surgery, there were significantly lower in the axillary and subclavian groups compared to the traditional open group ( P<0.01), with no significant difference between the two endoscopic groups( P>0.017); at 1 month postoperatively, the traditional open surgery group, gasless axillary approach group, and gasless subclavian approach group, with statistically significant differences between each group (both P<0.01). ③ Swallowing disorder index: no significant differences were observed at 3 days post-surgery( P>0.05); however, at 1 month post-surgery, the endoscopic groups showed significantly lower scores compared to the traditional open group(both P<0.01).(7) Satisfaction with incision beauty:significant differences were found among the three groups in terms of vancouver scar scores, patient scar assessment scores, and observer scar assessment scores(all P<0.01). Conclusions:Compared to the non-inflated axillary endoscopic thyroidectomy, the non-inflated subclavian approach offers a technically simpler procedure, better exposure of the central lymph node dissection area, and superior protection of anterior cervical function, although it results in less favorable cosmetic outcomes. Under strict preoperative evaluation and appropriate indications,both non-inflated subclavian and axillary approaches can achieve outcomes comparable to traditional open surgery for cN0 thyroid cancer,demonstrating good clinical application value.

Objective To investigate the outcome of endovascular aortic repair under digital subtraction angiography (DSA) in the treatment of Stanford type B aortic dissection (TBAD). Methods A total of 104 TBAD patients admitted to our hospital from October 2019 to October 2022 were selected,of which 52 patients treated with best medication treat (BMT) were included into the BMT group,and 52 patients who underwent endovascular aortic repair under DSA on the basis of BMT were included into the combination group. The acute physiological and chronic health evaluation Ⅱ (APACHE Ⅱ) score,serum inflammatory indicators,liver and kidney function indicators,and coagulation function indicators before and after treatment,and hospital stay were compared between the two groups. Results The APACHE Ⅱ score,liver and kidney function indicators and inflammatory factors after treatment in the combination group were lower than those before treatment and in the BMT group (P<0.05). The combination group had more significant changes of coagulation function indicators after treatment than those before treatment and in the BMT group (P<0.05). The hospital stay of the combination group was shorter than that of the BMT group (P<0.05). Conclusion Endovascular aortic repair under DSA for TBAD can reduce inflammatory response,improve liver and kidney functions and coagulation function,and shorten the hospital stay,which has a better therapeutic effect than conservative drug treatment.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Objective: To explore the bidirectional associations among body mass index Z scores (BMI Z scores) and weight stigma with depressive symptoms in adolescents, thereby providing evidence for targeted intervention strategies. Methods: A stratified cluster random sampling method was employed to select 18 301 adolescents aged 12-18 years from all 12 prefectures (103 counties) in the Inner Mongolia Autonomous Region, and two waves of longitudinal surveys were conducted in September 2023 (T1) and September 2024 (T2) among the adolescents. Weight stigma was assessed by using a self developed questionnaire, depressive symptom was measured with the Center for Epidemiologic Studies Depression Scale (CES-D), and BMI Z scores were calculated according to the World Health Organization standards. Pearson correlation analysis was used to examine associations among variables, and cross lagged panel models were constructed to investigate the dynamic bidirectional relationships among the three variables. Results: Adolescents BMI Z scores and weight stigma with depressive symptoms all exhibited autoregressive stability across the two time points (autoregressive paths, all P <0.01). Cross lagged model comparisons indicated that the bidirectional path model achieved the best fit ( χ 2=12.65, RMSEA =0.017, CFI =1.000; △ χ 2=193.39, P <0.01), supporting dynamic bidirectional associations among the three variables. After adjusting for gender, age, subjective social status and only child status, T1 BMI Z scores among adolescents positively predicted T2 weight stigma ( β =0.061), and T1 weight stigma positively predicted T2 depressive symptoms ( β =0.608); in the reverse direction, T1 depressive symptoms predicted T2 weight stigma ( β =0.003), and T1 weight stigma predicted T2 BMI Z scores ( β =0.081) (all P <0.01). Conclusions There is a bidirectional cross lagged relationship among adolescents BMI Z scores and weight stigma with depressive symptoms, suggesting that weight stigma may serve as a key psychological variable linking obesity and depressive symptoms. Greater attention should be paid to the potential threat of weight stigma to adolescents mental health, with intervention strategies expanded from a solely physiological focus to encompass psychosocial dimensions.