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.

Inguinal hernia is a common surgical disease, and most patients need surgical treatment. In recent years, minimally invasive surgery based on laparoscopy has been popularized in hernia surgery. With the release of clinical guidelines, the progress of instruments and materials, the update of treatment concepts and anatomical knowledge, laparoscopic inguinal hernia repair, especially laparoscopic total extraperitoneal hernia repair (TEP), is developing towards a more accurate and minimally invasive direction. Based on literatures in recent years and combined with clinical practice, the authors explore the advances in clinical application of laparoscopic TEP.

Objective: To explore the safety and feasibility of transumbilical single channel laparoscopic cryptorchidopexy with conventional instruments in treatment of cryptorchidism in children. Methods: Thirty-five children with cryptorchidism were treated by transumbilical single channel laparoscopic cryptorchidopexy with conventional instruments from November 2017 to March 2018 at Department of Pediatric Surgery, the First Affiliated Hospital of Guangxi Medical University.Clinical data were recorded including the general information, operation time, intraoperative blood loss, postoperative testicular position and postoperative complications, etc. Results: All 35 patients completed the cryptorchidopexy in one operation.Among those 35 patients, 28 patients had unilateral lesions and 7 patients had bilateral lesions, with a total of 42 sides.Twenty-six patients were of groin type(33 sides), 9 patients abdominal type(9 sides). The average operation time was (40.4±8.2) min for unilateral lesion, and (62.5±15.3) min for bilateral lesions; the average intraoperative blood loss was (3.0±1.8) mL; and the average postoperative hospital stay was (6.4±2.1) h. Testis of 32 patients (40 sides) were fixed in the middle and bottoms of the scrotum, and testis of 2 patients (2 sides) were fixed on the top of the scrotum.One case had poor healing of naval incision, which was recovered in 1 week after dressing change.There were no postoperative complications such as scrotum hematoma, infection of incision, testicular epididymitis, testicular necrosis, testicular retraction or testicular atrophy, etc.No obvious visible scar was found in the abdomen review 2 weeks postoperatively, with the incidence of complications was 2.9%(1/35 cases). Conclusions Transumbilical single channel laparoscopic cryptorchidopexy with conventional instruments in treatment of cryptorchidism is characterized by small trauma, quick recovery, low complication rate and visible scar free result, which is worthy of clinical promotion, but the operation is relatively complex and the correct procedures are required.

Objective To observe the effect of connect meridians inducing Yin from Yang on muscle-tension after cerebral infarction. Methods 82 patients with cerebral infarction in Second Hospital of Harbin from 2010 to 2014 were divided into observation group (n=41) and control group (n=41) according to hospitalization order. The observation group accepted acupuncture of connecting meridians inducing Yin from Yang, and the control group accepted the traditional acupuncture method for 2 weeks. The situation of spasticity, the motor limb function of limbs, and activities of daily living were evaluated with modified Ashworth Scale (MAS), Clinic Spasticity Index (CSI), Fugl-Meyer Assessment (FMA) and Barthel index (BI), respectively. Results Compared with the control group, the score of MAS decreased (t=2.212, P=0.030), the score of CSI decreased (t=2.514, P=0.014), the score of FMA increased (t=4.288, P<0.001), and the score of BI in-creased (t=2.970, P=0.004) in the observation group after treatment. Conclusion The acupuncture of connecting meridians inducing Yin from Yang can reduce the muscle-tension of limbs, improve the motor function and increase the activities of daily living.

Objective To observe the effect of Shenkang-Ⅱ on hypothalamus-pituitary-adrenal axis (HPA axis) in nephrotic syndrome rats during high-dose glucocorticoids withdrawal, and provide a theoretical basis for clinical application of Shenkang-Ⅱ during the withdrawing and maintaining stages of glucocorticoids in the treatment of nephrotic syndrome. Methods The models of nephrotic syndrome in rats were established with adriamycin, and treated with high-dose glucocorticoid which can cause HPA axis suppression. After the HPA axis was suppressed, the hormone was reduced gradually. At the same time, the rats were treated by intragastric administration with different doses of Shenkang-Ⅱ. The changes of serum ACTH, cortisol and adrenal morphological in large dose of Shenkang-Ⅱ group, small dose of Shenkang-Ⅱ group, hormone control group, nephrotic syndrome model group and normal group were observed after two weeks. Results In the stage of withdrawing glucocorticoids, there were some amelioration in the changes of serum ACTH, cortisol in every group. After 2 weeks, those changes didn’t return to normal level. However, compared with the level of hormone control group, there were obvious increases in the levels of serum ACTH and cortisol in the large and small dose of Shenkang-Ⅱ group (P

Objective To analyze the clinical characteristics and to evaluate prognosis of critically ill patients who developed acute renal failure(ARF).Methods A retrospective study was carried out in critically ill patients who developed ARF.APACHE Ⅱ,SAPSⅡ,SOFA and ATN-ISI were used to evaluate outcome of ARF.Results The incidence of ARF in critically ill patients was 19.1% with a high mortality(51.2%).The clinical characteristics of 41 patients with ARF were:mechanical ventilation 65.9%,vasopressor support 46.3%,oliguria 41.5%,number of insufficient organs 2.16,APACHEⅡscore 17.3,SAPSⅡ score 52.0,SOFA score 9.26 and ATN-ISI 0.54.By COX regression,number of insufficient organs(RR 2.54;95%CI 1.316 ~ 4.913)(P=0.006)and requirement of mechanical ventilation(RR 6.0;95%CI 1.102~32.6)(P=0.038)were independent risk factors for ICU mortality of ARF.APACHEⅡscore,SAPSⅡscore,SOFA score and ATN-ISI were demonstrated to predict mortality of ARF patients accurately as indicated by areas under the receiver operating characteristics(ROC)curves of 0.848(95% CI: 0.722~0.974;P

Objective To evaluate the pharmacokinetics and pharmacodynamics of bupivacaine polylactic acid microspheres in rabbits. Methods Sixteen New Zealand rabbits weighing (2.58?0.17) kg were randomly divided into two groups:in group A a bolus of bupivacaine solution 5 mg?kg-1 was injected subcutaneously, in group B a bolus of bupivacaine polylactic acid microspheres 5 mg ? kg-1 was implanted in subcutaneous tissue. Blood samples were obtained for determination of plasma bupivacaine concentration at 5,10,20,30,45 min and 1,2,3,4, 6,8,12,24h after subcutaneous injection in group A and at 0.5,1,2,3,4,5,6,8,12,24,36,48 and 60 h after subcutaneous implantation in group B. Pharmacodynamics study was conducted using a model evaluating the efficacy of regional anesthesia by skin incision and needle pricking. Results In group A plasma bupivacaine concentration peaked quickly at about 0. 34h after subcutaneous injection, then quickly declined and became indetectable in plasma within 12 h. In group B plasma bupivacaine concentration reached a peak much slowly at about 13h after subcutaneous implantation. Cmax was 0.7781 ? 0.3573 ?g?ml-1 significantly lower than that in group A [Cmax = (2.4664 ? 0.7822) ?g?ml-1 ] . The mean retention time (MRT) was 25.2667 ? 2.4857 h, significantly longer than that in group A [MRT= (5.5580 ? 1.3843)h] . Pharmacodynamic study showed that the duration of regional sensory block was significantly longer in group B than that in group A( P

0.05). CONCLUSION: Serum Cys C is significantly increased in ARF and correlated well with the severity of ARF. Serum Cys C can be one of the detectable markers of ARF, but it is independent of the mortality and does not predict the prognosis of these patients.