Objective To investigate the clinical application of ceftazidime/avibactam(CAZ/AVI)in lung trans-plant recipients with pulmonary infection caused by carbapenem-resistant Gram-negative bacilli(CRGNB),and ana-lyze the factors affecting the prognosis.Methods Lung transplant recipients who had CRGNB pulmonary infection and were treated with CAZ/AVI were included in the analysis.Based on 14-day clinical response,14-day microbial response,and 30-day survival status,the recipients were divided into a clinical response group and a clinical failure group,a microbial response group and a microbial failure group,as well as a survival group and a death group,re-spectively.Univariate analysis was conducted on various data from the two groups.Factors affecting therapeutic ef-ficacy and survival were included in a binary logistic regression model.Independent risk factors for CAZ/AVI anti-infective efficacy and all-cause mortality outcomes were analyzed.Results A total of 43 recipients were included.After 14-day anti-infective treatment,32 recipients(74.42％)achieved clinical response,and 30 recipients(69.77％)achieved microbial response.34 recipients(79.07％)survived 30 days after CAZ/AVI treatment.The Charlson comorbidity index(CCI),proportion of renal dysfunction,and incidence of shock in recipients in the clini-cal response group were all lower than those in the clinical failure group(P＜0.05),while the serum albumin(ALB)level was higher(P＜0.05).The incidence of shock in recipients in the microbial response group was lower than that in the microbial failure group(P＜0.05).CCI,proportion of renal dysfunction,and incidence of shock in recipients in the survival group were all lower than those in the death group(all P＜0.05),while ALB level was higher during treatment period(P＜0.05).Multivariate analysis of 14-day clinical response and 30-day survival showed that higher CCI was an independent risk factor affecting 14-day clinical response of recipients(OR=2.22,95％CI:1.07-4.63),while lower ALB levels(OR=0.72,95％CI:0.54-0.98)and higher CCI(OR=5.27,95％CI:1.18-23.58)were independent risk factors for 30-day all-cause mortality in recipients with pulmonary in-fection after lung transplant.Conclusion CAZ/AVI may be an effective drug for treating pulmonary infection caused by CRGNB in lung transplant recipients.Higher CCI is an independent risk factor for 14-day clinical failure in recipients after CAZ/AVI treatment.Lower ALB level and higher CCI are independent risk factors for increased 30-day mortality in recipients.

Objective To verify the accuracy of Youssef's formula and evaluate whether fetal biacromial diameter(BA)and other fetal biological diameters estimated by ultrasound can be used to predict macrosomia and shoulder dystocia,so as to provide the possibility for clinical prediction of shoulder dystocia.Methods A total of 200 pregnant women with a gestational period of 37-42 weeks were examined with ultrasound within 3 days before delivery for collecting biparietal diameter(BPD),head circumference(HC),abdominal circumference(AC),humerus length(HL),femur length(FL),thoracic transverse diameter and midpoint diameter of upper arm;and the fetal BA was estimated by Youssef's formula.Neonatal BA,body mass and body length were measured within 1 day after delivery.The above data were analyzed for correlation.Newborns were grouped according to their body mass(macrosomia vs non-macrosomia)and whether they had shoulder dystocia or not(shoulder dystocia vs non-shoulder dystocia).Results(1)The fetal BA estimated by Youssef's formula was consistent with neonatal BA(P>0.05),and the estimated BA was positively correlated with BPD,HC,AC and neonatal body mass(P<0.001).(2)The BA,BA/AC and BA/HC in macrosomia group were different from those in non-macrosomia group(P<0.05).ROC curve showed that the sensitivity and specificity were 92.3%and 88.2%for macrosomia prediction when the estimated BA threshold was 16.05 cm,and those were 61.5%and 77.0%when BA/AC threshold was 0.455,and 76.9%and 72.7%when BA/HC threshold was 0.465.(3)Shoulder dystocia group had neonatal weight close to non-shoulder dystocia group(P>0.05),but higher BA/BPD,BA/HC and BA-BPD(P<0.05).ROC curve showed that the sensitivity and specificity were 100.0%and 66.8%for shoulder dystocia when BA threshold was 15.45 cm,100.0%and 80.6%when BA/BPD threshold was 1.695,100.0%and 81.6%when BA/HC threshold was 0.475,and 100.0%and 76.0%when the threshold difference between BA and BPD was 6.35 cm.Conclusion Fetal BA,BA/BPD,BA/HC,BA/AC and BA-BPD may be effective predictors of shoulder dystocia and macrosomia.

Objective:To investigate the pathogen distribution, temporal trends in the rates of antimicrobial resistance, and susceptibility of bloodstream isolates and comparatively explore the epidemiological characteristics of bloodstream infections in hematology departments across 56 healthcare facilities in Guangdong Province from 2020 to 2024.Methods:A multicenter analysis was conducted to evaluate the constituent ratio of different pathogens isolated from clinical isolate data from bloodstream specimens in hematology, respiratory, and intensive care unit (ICU) departments across 56 healthcare facilities in Guangdong Province (2020-2024), and antimicrobial resistance trends in pathogens with high-detection rate over 5 years were assessed. Carbapenem-resistant Gram-negative organisms (CRO) were randomly sampled for carbapenemase gene detection and in vitro antimicrobial susceptibility tests with novel antimicrobial agents.Results:From 2020 to 2024, a total of 8 968, 6 440, and 25 511 bloodstream isolates were identified in the hematology, respiratory, and ICU departments, respectively, across 56 participating facilities in Guangdong Province, with significant differences in the pathogen constituent ratio among departments ( P<0.001). Notably, the hematology department demonstrated a predominance of Escherichia coli (24.1%), Klebsiella pneumoniae (17.5%), Pseudomonas aeruginosa (11.7%), coagulase-negative Staphylococci (15.2%), and Staphylococcus aureus (5.1%). In the resistance analysis, the rates of meropenem resistance of Escherichia coli and Klebsiella pneumonia increased from 6.7% and 5.8% (2020) to 14.0% and 15.8% (2024), respectively. Conversely, Pseudomonas aeruginosa exhibited a declining trend in the rate of meropenem resistance (6.2% to 1.9%) and imipenem (10.2% to 6.1%) during the same period. Acinetobacter baumannii demonstrated a biphasic resistance pattern to common antimicrobial agents, characterized by an initial decline, followed by a rebound. In this study, the susceptibility rates to conventional antimicrobial agents were significantly higher in Staphylococcus aureus versus coagulase-negative Staphylococci, with no glycopeptide- or linezolid-resistant strains detected. Notably, the prevalence of vancomycin-resistant Enterococcus faecium increased from 0 in 2020 to 23.1% in 2024. CRO carbapenemase phenotypes through active surveillance revealed that 80% Escherichia coli isolates were carrying blaNDM, 90% Klebsiella pneumoniae isolates were carrying blaKPC, 10% Pseudomonas aeruginosa isolates were carrying blaVIM, and 100% Acinetobacter baumannii were carrying blaOXA-23. The results of the antimicrobial susceptibility test in CRO revealed that carbapenem-resistant Escherichia coli (CRECO) demonstrated a 0 resistance rate to tigecycline, polymyxin B, and aztreonam/avibactam, whereas carbapenem-resistant Klebsiella pneumoniae exhibited a 0 resistance rate to aztreonam/avibactam, ceftazidime/avibactam, and imipenem/relebactam. Carbapenem-resistant Pseudomonas aeruginosa exhibited a 95.0% susceptibility rate to amikacin and polymyxin B, with a 45.0% resistance rate to ceftazidime/avibactam. In contrast, carbapenem-resistant Acinetobacter baumannii demonstrated complete susceptibility (100.0%) to sulbactam/durlobactam (MIC90=2 μg/ml), whereas eravacycline showed MIC50 and MIC90 values of 1 and 2 μg/ml, respectively. Conclusion:The pathogen constituent ratio of bloodstream isolates differed significantly among hematology, respiratory, and ICU departments. Notably, although CRO exhibited an escalating prevalence, it sustained high susceptibility to novel antimicrobial agents.

Objective:To explore the categories and characteristics of health behaviors of community residents in Dongfang City, Hainan Province, and to analyze the influencing factors of different categories.Methods:From March to May 2023, 795 community residents of Dongfang City were selected for the study using a simple random sampling method. General Information Questionnaire, Chinese version Short of Health Promotion Lifestyle Profile-Ⅱ, Health Conception Scale, and Self-rated Abilities for Health Practice Scale were used to conduct the survey. Cluster analysis was used to explore the health behavior categories of community residents, and a decision tree model was applied to analyze the influencing factors of different categories.Results:A total of 830 questionnaires were distributed, and 795 valid questionnaires were recovered, with a valid recovery rate of 95.78%. The health behaviors of 795 community residents in Dongfang City were divided into four categories of comprehensive behavior group (26.04%, 207/795), healthy behavior group (37.23%, 296/795), risky behavior group (18.99%, 151/795), and poor health behavior group (17.74%, 141/795). The decision tree model showed that exercise efficacy, gender, ethnicity, and clinical health concepts were the factors influencing different health behavior categories of community residents in Dongfang City ( P<0.05), with exercise efficacy being the core factor. Conclusions:There is heterogeneity in the health behavior of community residents in Dongfang City. Community healthcare workers can implement targeted health promotion measures according to the behavioral characteristics of the population.

Objective To investigate the clinical application of ceftazidime/avibactam(CAZ/AVI)in lung trans-plant recipients with pulmonary infection caused by carbapenem-resistant Gram-negative bacilli(CRGNB),and ana-lyze the factors affecting the prognosis.Methods Lung transplant recipients who had CRGNB pulmonary infection and were treated with CAZ/AVI were included in the analysis.Based on 14-day clinical response,14-day microbial response,and 30-day survival status,the recipients were divided into a clinical response group and a clinical failure group,a microbial response group and a microbial failure group,as well as a survival group and a death group,re-spectively.Univariate analysis was conducted on various data from the two groups.Factors affecting therapeutic ef-ficacy and survival were included in a binary logistic regression model.Independent risk factors for CAZ/AVI anti-infective efficacy and all-cause mortality outcomes were analyzed.Results A total of 43 recipients were included.After 14-day anti-infective treatment,32 recipients(74.42％)achieved clinical response,and 30 recipients(69.77％)achieved microbial response.34 recipients(79.07％)survived 30 days after CAZ/AVI treatment.The Charlson comorbidity index(CCI),proportion of renal dysfunction,and incidence of shock in recipients in the clini-cal response group were all lower than those in the clinical failure group(P＜0.05),while the serum albumin(ALB)level was higher(P＜0.05).The incidence of shock in recipients in the microbial response group was lower than that in the microbial failure group(P＜0.05).CCI,proportion of renal dysfunction,and incidence of shock in recipients in the survival group were all lower than those in the death group(all P＜0.05),while ALB level was higher during treatment period(P＜0.05).Multivariate analysis of 14-day clinical response and 30-day survival showed that higher CCI was an independent risk factor affecting 14-day clinical response of recipients(OR=2.22,95％CI:1.07-4.63),while lower ALB levels(OR=0.72,95％CI:0.54-0.98)and higher CCI(OR=5.27,95％CI:1.18-23.58)were independent risk factors for 30-day all-cause mortality in recipients with pulmonary in-fection after lung transplant.Conclusion CAZ/AVI may be an effective drug for treating pulmonary infection caused by CRGNB in lung transplant recipients.Higher CCI is an independent risk factor for 14-day clinical failure in recipients after CAZ/AVI treatment.Lower ALB level and higher CCI are independent risk factors for increased 30-day mortality in recipients.

Objective To verify the accuracy of Youssef's formula and evaluate whether fetal biacromial diameter(BA)and other fetal biological diameters estimated by ultrasound can be used to predict macrosomia and shoulder dystocia,so as to provide the possibility for clinical prediction of shoulder dystocia.Methods A total of 200 pregnant women with a gestational period of 37-42 weeks were examined with ultrasound within 3 days before delivery for collecting biparietal diameter(BPD),head circumference(HC),abdominal circumference(AC),humerus length(HL),femur length(FL),thoracic transverse diameter and midpoint diameter of upper arm;and the fetal BA was estimated by Youssef's formula.Neonatal BA,body mass and body length were measured within 1 day after delivery.The above data were analyzed for correlation.Newborns were grouped according to their body mass(macrosomia vs non-macrosomia)and whether they had shoulder dystocia or not(shoulder dystocia vs non-shoulder dystocia).Results(1)The fetal BA estimated by Youssef's formula was consistent with neonatal BA(P>0.05),and the estimated BA was positively correlated with BPD,HC,AC and neonatal body mass(P<0.001).(2)The BA,BA/AC and BA/HC in macrosomia group were different from those in non-macrosomia group(P<0.05).ROC curve showed that the sensitivity and specificity were 92.3%and 88.2%for macrosomia prediction when the estimated BA threshold was 16.05 cm,and those were 61.5%and 77.0%when BA/AC threshold was 0.455,and 76.9%and 72.7%when BA/HC threshold was 0.465.(3)Shoulder dystocia group had neonatal weight close to non-shoulder dystocia group(P>0.05),but higher BA/BPD,BA/HC and BA-BPD(P<0.05).ROC curve showed that the sensitivity and specificity were 100.0%and 66.8%for shoulder dystocia when BA threshold was 15.45 cm,100.0%and 80.6%when BA/BPD threshold was 1.695,100.0%and 81.6%when BA/HC threshold was 0.475,and 100.0%and 76.0%when the threshold difference between BA and BPD was 6.35 cm.Conclusion Fetal BA,BA/BPD,BA/HC,BA/AC and BA-BPD may be effective predictors of shoulder dystocia and macrosomia.

Objective:To investigate the pathogen distribution, temporal trends in the rates of antimicrobial resistance, and susceptibility of bloodstream isolates and comparatively explore the epidemiological characteristics of bloodstream infections in hematology departments across 56 healthcare facilities in Guangdong Province from 2020 to 2024.Methods:A multicenter analysis was conducted to evaluate the constituent ratio of different pathogens isolated from clinical isolate data from bloodstream specimens in hematology, respiratory, and intensive care unit (ICU) departments across 56 healthcare facilities in Guangdong Province (2020-2024), and antimicrobial resistance trends in pathogens with high-detection rate over 5 years were assessed. Carbapenem-resistant Gram-negative organisms (CRO) were randomly sampled for carbapenemase gene detection and in vitro antimicrobial susceptibility tests with novel antimicrobial agents.Results:From 2020 to 2024, a total of 8 968, 6 440, and 25 511 bloodstream isolates were identified in the hematology, respiratory, and ICU departments, respectively, across 56 participating facilities in Guangdong Province, with significant differences in the pathogen constituent ratio among departments ( P<0.001). Notably, the hematology department demonstrated a predominance of Escherichia coli (24.1%), Klebsiella pneumoniae (17.5%), Pseudomonas aeruginosa (11.7%), coagulase-negative Staphylococci (15.2%), and Staphylococcus aureus (5.1%). In the resistance analysis, the rates of meropenem resistance of Escherichia coli and Klebsiella pneumonia increased from 6.7% and 5.8% (2020) to 14.0% and 15.8% (2024), respectively. Conversely, Pseudomonas aeruginosa exhibited a declining trend in the rate of meropenem resistance (6.2% to 1.9%) and imipenem (10.2% to 6.1%) during the same period. Acinetobacter baumannii demonstrated a biphasic resistance pattern to common antimicrobial agents, characterized by an initial decline, followed by a rebound. In this study, the susceptibility rates to conventional antimicrobial agents were significantly higher in Staphylococcus aureus versus coagulase-negative Staphylococci, with no glycopeptide- or linezolid-resistant strains detected. Notably, the prevalence of vancomycin-resistant Enterococcus faecium increased from 0 in 2020 to 23.1% in 2024. CRO carbapenemase phenotypes through active surveillance revealed that 80% Escherichia coli isolates were carrying blaNDM, 90% Klebsiella pneumoniae isolates were carrying blaKPC, 10% Pseudomonas aeruginosa isolates were carrying blaVIM, and 100% Acinetobacter baumannii were carrying blaOXA-23. The results of the antimicrobial susceptibility test in CRO revealed that carbapenem-resistant Escherichia coli (CRECO) demonstrated a 0 resistance rate to tigecycline, polymyxin B, and aztreonam/avibactam, whereas carbapenem-resistant Klebsiella pneumoniae exhibited a 0 resistance rate to aztreonam/avibactam, ceftazidime/avibactam, and imipenem/relebactam. Carbapenem-resistant Pseudomonas aeruginosa exhibited a 95.0% susceptibility rate to amikacin and polymyxin B, with a 45.0% resistance rate to ceftazidime/avibactam. In contrast, carbapenem-resistant Acinetobacter baumannii demonstrated complete susceptibility (100.0%) to sulbactam/durlobactam (MIC90=2 μg/ml), whereas eravacycline showed MIC50 and MIC90 values of 1 and 2 μg/ml, respectively. Conclusion:The pathogen constituent ratio of bloodstream isolates differed significantly among hematology, respiratory, and ICU departments. Notably, although CRO exhibited an escalating prevalence, it sustained high susceptibility to novel antimicrobial agents.

Objective:To explore the categories and characteristics of health behaviors of community residents in Dongfang City, Hainan Province, and to analyze the influencing factors of different categories.Methods:From March to May 2023, 795 community residents of Dongfang City were selected for the study using a simple random sampling method. General Information Questionnaire, Chinese version Short of Health Promotion Lifestyle Profile-Ⅱ, Health Conception Scale, and Self-rated Abilities for Health Practice Scale were used to conduct the survey. Cluster analysis was used to explore the health behavior categories of community residents, and a decision tree model was applied to analyze the influencing factors of different categories.Results:A total of 830 questionnaires were distributed, and 795 valid questionnaires were recovered, with a valid recovery rate of 95.78%. The health behaviors of 795 community residents in Dongfang City were divided into four categories of comprehensive behavior group (26.04%, 207/795), healthy behavior group (37.23%, 296/795), risky behavior group (18.99%, 151/795), and poor health behavior group (17.74%, 141/795). The decision tree model showed that exercise efficacy, gender, ethnicity, and clinical health concepts were the factors influencing different health behavior categories of community residents in Dongfang City ( P<0.05), with exercise efficacy being the core factor. Conclusions:There is heterogeneity in the health behavior of community residents in Dongfang City. Community healthcare workers can implement targeted health promotion measures according to the behavioral characteristics of the population.

[Objective]To investigate the relationship between the non-fasting triglyceride and glucose(TyG)index and hyperglycemia in pregnancy during the third trimester in high altitudes.[Methods]This study selected clinical and laboratory data of 774 Tibetan singleton pregnant women who delivered at Chaya People's Hospital of Qamdo city in Xizang autonomous region,from January 2023 to April 2025.The non-fasting TyG index was calculated from non-fasting triglyceride(TG)and random plasma glucose(PG).Based on the tertiles of the non-fasting TyG index values,the individuals were split into three groups(corresponding to non-fasting TyG index of 8.89 and 9.21,respectively).The baseline clinical characteristics,lipid levels and the occurrence of developing hyperglycemia in pregnancy were compared among the three groups.Statistical analyses were performed using ANOVA,Kruskal-Wallis H test,Chi-square test,or Fisher exact test and the relationship between the non-fasting TyG index and hyperglycemia in pregnancy were examined using multivariate logistic regression models and curve fitting.[Results]A total of 774 Tibetan singleton pregnant women were included,with a average age of 27.3±6.1 years,a pre-delivery body mass index(Pre-BMI)of(25.2±2.3)kg/m2,a proportion of 26.7%(207/774)primigravid women,the mean non-fasting TyG index was 9.1±0.4.Thirty pregnant women were diagnosed with hyperglycemia in pregnancy,with a detection rate of 3.9%(30/774).Statistically significant differences in serum total cholesterol(TC),TG,low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C)levels were identified when comparing different non-fasting TyG groups(all P values<0.05).Subsequent trend test analysis indicated that the levels of TC,TG,LDL-C,and PG gradually increased with elevated the non-fasting TyG index(Ftrend TC=95.61,P<0.001;Ftrend TG=1 051.91,P<0.001;Ftrend LDL-C=97.20,P<0.001;Ftrend TG=195.20;P<0.001).After adjustment for maternal age,pre-delivery BMI,altitude,TC,LDL-C,and HDL-C,multivariate Logistic regression models revealed independent positive associations between non-fasting TyG index and hyperglycemia in pregnancy(Model 1:OR=2.72,95%CI:1.13-6.53,P=0.026;Model 2:OR=2.56,95%CI:1.01-6.50,P=0.048;Model 3:OR=2.72,95%CI:1.06-6.97,P=0.037;Model 4:OR=4.02,95%CI:1.42-11.40,P=0.009)and the incident of hyperglycemia in pregnancy showed an increasing tendency as increasing with the non-fasting TyG index,however,this association did not statistical significance(P trend>0.05).Curve fitting by restricted cubic splines(RCS)were used to assess linearity between non-fasting TyG and hyperglycemia in pregnancy,and there was a linear dose-response relationship between non-fasting TyG and hyperglycemia in pregnancy(P for non-linear=0.515).[Conclusion]Non-fasting TyG index in the third trimester is a risk factor for hyperglycemia in pregnancy among the Tibetan singleton pregnant women at high altitudes and there was a possible linear dose-response relationship between the non-fasting TyG index and hyperglycemia in pregnancy.

OBJECTIVE To explore the effects and mechanisms of cycloartenol on myocardial ischemia-reperfusion injury in mice.METHODS In vitro experiments,primary cardiomyocytes were extracted from 1-3 days SD mice.The hypoxia/reoxygenation model was established by incubating cells in a hypoxic culture box for 3 hours followed by reoxygenation in a normal culture box for 3 hours.The primary cardiomyocytes were divided into Control group,H/R group,low-dose(3 μmol·L-1)and high-dose(10 μmol·L-1)cycloartenol groups,and SB203580 group.CCK-8 was used to detect cell viability,the apoptosis rate was detected by flow cytometry,and Western blot was used to detect the expression levels of p38 MAPK and p-p38 MAPK in each group.In an in vi-vo experiment,7-week-old male C57BL/6J mice were randomly divided into a Control group,an I/R group,and three doses of cyclo-artenol(0.2,0.5,1.0 mg·kg-1)groups.The mice were continuously administered for seven days before the surgery.The model was prepared by ligation of the left anterior descending coronary artery(LAD)for 30 minutes,followed by reperfusion for 24 hours to in-duce myocardial ischemia-reperfusion injury.Left ventricular ejection fraction(LVEF),cardiac output(CO),left ventricular fractional shortening(LVFS)of each group of mice were detected by small animal ultrasound.TTC staining was used to detect the changes of is-chemic infarct size in each group.The changes of myocardial tissue in each group were observed by HE staining.The expression levels of p38 MAPK,p-p38 MAPK,IL-6 and TNF-α in myocardial tissue of mice were detected by Western blot.Serum levels of creatine ki-nase isoenzyme(CK-MB),lactate dehydrogenase(LDH),cardiac troponin I(cTnI),interleukin-6(IL-6),and tumor necrosis fac-tor-α(TNF-α)were measured using ELISA kits.RESULTS In vitro experiments demonstrated that compared with the H/R group,both the cycloartenol and SB203580 pretreatment groups showed a significant increase in myocardial cell viability and the apoptosis rate decrease,which can downregulate the protein expression level of p-p38 MAPK and decrease the ratio of p-p38 MAPK/p38 MAPK(P<0.05).In vivo experiments confirmed that compared with the I/R group,cycloartenol pretreatment significantly improved LVEF,LVFS,and CO values(P<0.05),reduce myocardial ischemic infarct size,thereby enhancing myocardial function.The protein ex-pression level of p-p38 MAPK in myocardial tissue was down-regulated,the ratio of p-p38 MAPK/p38 MAPK was decreased,and the expression levels of IL-6 and TNF-α were decreased.Additionally,cycloartenol pretreatment reduced the levels of CK-MB,LDH,cT-nI,IL-6,and TNF-α in mouse serum(P<0.05).CONCLUSION Pre-treatment with cycloartenol can protect mouse cardiac func-tion and alleviate myocardial ischemia-reperfusion injury.Its mechanism of action may be related to the inhibition of p38 MAPK phos-phorylation,reducing inflammatory reactions.