ObjectiveTo investigate a suspected outbreak of healthcare-associated infection with carbapenem-resistant Klebsiella pneumoniae (CRKP) in a geriatric emergency ward, and to provide references for the prevention and control of multidrug-resistant bacteria in a hospital in Shanghai. MethodsOn-site epidemiological investigation, combined with environmental hygiene monitoring and pulsed field gel electrophoresis (PFGE) molecular typing method, were adopted to investigate a suspected outbreak of CRKP infection in the geriatric emergency ward of a hospital from October to November 2022, aiming at finding out factors caused the outbreak before taking corresponding control measures. ResultsA total of 3 cases of healthcare-associated CRKP infection were identified, of which 2 cases were homologous to a previous case of community-associated CRKP infection. What’s more, the 2 cases lived in the same ward with the latter and with adjacent beds, but the third case was non-homologous to the community-associated infection case. A total of 46 samples were collected from the environmental surfaces and the hands of healthcare workers, of which 7 samples tested positive for CRKP and were identical to the strains from the 2 healthcare-associated infection cases and the 1 community-associated infection case, originating from the bedrails, bedside tables, surface of non-invasive ventilator, bed curtains and panels of monitoring equipment, with a detection rate of 15.22%. But none of the 11 samples from the hands of healthcare workers tested positive for CRKP. The outbreak was effectively controlled after taking specific prevention and control measures such as strengthening personnel management, intensifying environmental cleaning and disinfection and strictly enforcing hand hygiene among healthcare workers. Subsequently, no similar new cases were reported during the 14-day follow-up period. ConclusionIncomplete environmental cleaning and disinfection, as well as inadequate enforcement of hand hygiene among heatheare workers may have contributed to the suspected outbreak of CRKP in the geriatric emergency ward. Early warning and timely investigation of suspected outbreaks of multidrug-resistant bacteria are crucial for preventing and controlling such outbreaks in hospitals.

Objective To observe the impact of impaired mitral annular motor on atrial functional mitral regurgitation(AFMR)in patients with persistent atrial fibrillation(AF).Methods Forty-four persistent AF patients who would undergo radiofrequency ablation(RFA)were prospectively enrolled.Two-dimensional transthoracic echocardiography and real-time three-dimensional transesophageal echocardiography(RT-3D TEE)parameters obtained 1 day before RFA and 3 months after RFA were compared.AFMR was assessed according to effective regurgitant orifice area(EROA),and the change rates of overall annular area(AA)and presystolic AA were evaluated.The difference of EROA before and after RFA was used to describe the improvement degree of AFMR,which was used as the dependent variable,and the related ultrasonic factors 1 day before RFA that affected the improvement degree of AFMR 3 months after RFA were screened.Results Compared with those before RFA,the left atrium global longitudinal strain and left ventricular ejection fraction increased,while the left atrial diameter,left atrial volume,EROA,anteroposterior diameter of valve ring,annular circumference of valve ring,AA,valve leaflet area and non-planar angle decreased,and both the overall AA change rate and presystolic AA change rate increased(all P＜0.05).The change rate of presystolic AA before RFA was an independent impact factor of the improvement degree of AFMR in persistent AF patients 3 months after RFA(P＜0.05).Conclusion Impaired mitral annular motor in persistent AF patients mainly manifested as decreased mitral annular motor function in presystolic period,which impacted the degree of AFMR.

The effect of porcine SIRT5 on replication of foot and mouth disease virus type O(FMDV-O)and the underlying regulatory mechanism were investigated.Western blot and RT-qPCR analyses were employed to monitor expression of endoge-nous SIRT5 in PK-15 cells infected with FMDV-O.Three pairs of SIRT5-specific siRNAs were synthesized.Changes to SIRT5 and FMDV-O protein and transcript levels,in addition to virus copy numbers,were measured by western blot and RT-qPCR analyses.PK-15 cells were transfected with a eukaryotic SIRT5 expression plasmid.Western blot and RT-qPCR analyses were used to explore the impact of SIRT5 overexpression on FMDV-O replication.Meanwhile,RT-qPCR analysis was used to detect the effect of SIRT5 overexpression on the mRNA expression levels of type I interferon-stimulated genes induced by SeV and FMDV-O.The results showed that expression of SIRT5 was up-regulated in PK-15 cells infected with FMDV-O and siRNA interfered with SIRT5 to inhibit FMDV-O replication.SIRT5 overexpression promoted FMDV-O replication.SIRT5 over-expression decreased mRNA expression levels of interferon-stimulated genes induced by SeV and FMDV-O.These results suggest that FMDV-O infection stimulated expression of SIRT5 in PK-15 cells,while SIRT5 promoted FMDV-O rep-lication by inhibiting production of type I interferon-stimula-ted genes.These findings provide a reference to further ex-plore the mechanism underlying the ability of porcine SIRT5 to promote FMDV-O replication.

Objective:To investigate which indicator is more advantageous when using arterial oxygen saturation(SaO2)and fingertip pulse oxygen saturation(SpO2)for blood oxygen detection in patients with hyperleukocytic acute leukemia(HAL).Methods:In this prospective research,the difference between SaO2 and SpO2 of 18 HAL patients(observation group)and 14 patients(control group),as well as the relationship between the difference and white blood cell(WBC)counts were analyzed.Results:SaO2 was lower than SpO2 in the observation group(P＜0.05),and SpO2-SaO2 difference was positively correlated with WBC counts(r=0.47).However,there was no statistical difference between SaO2 and SpO2 in the control group.SaO2 and PO2 showed a downward trend with the prolongation of detection time after arterial blood was collected in the observation group,but there was no statistical difference.There was no downward trend of SaO2 and PO2 in the control group.Conclusion:HAL patients have a phenomenon where SaO2 is lower than SpO2,that is pseudohypoxemia,and this phenomenon may be caused by excessive consumption of oxygen by the leukemia cells in vitro.SpO2 can be monitored bedside in real time and is non-invasive,it is a better way to detect the blood oxygen status of HAL patients.

Objective Action research methodology was used in a constructed self-management program for diabetic foot amputees to continuously improve the program and ensure the smooth implementation of the program.Methods Using the action research method,from February to June,2023,the self-management program constructed by the author was continuously revised and improved through the cyclic process of"planning-action-observation-reflection"for patients with diabetic foot amputation.Results After 2 rounds of action research,the action research refined the delivery of the program and the timing of the intervention,and the level of patient self-management behaviors increased significantly(P＜0.05).Conclusion Using the action research method,the researchers conducted a comprehensive analysis of the problems that existed in the process of patients'behavioral health interventions,and adjusted the program through feedback from the patients'hospitalization period,transition period,and home period,to ensure that the corresponding indexes at each stage could basically satisfy the patients'self-management needs,and to improve the smooth implementation of the self-management program for patients with diabetic foot amputation.

Objective To explore the application of high-pitch late artery scanning by dual-source CT in evaluating the filling defect and morphological measurement of left atrial appendage(LAA).Methods A total of 80 patients requiring LAA CT angiography(CTA)scanning due to atrial fibrillation(AF)admitted in our hospital from July to October 2022 were enrolled,and their clinical data were collected.The second-generation dual-source CT high-pitch FLASH scanning was adopted to all the patients who were randomly divided into group A(arterial phase scanning,40 cases)and group(late arterial phase scanning B,40 cases).All patients underwent dual-phase scanning and the time interval was 30 s.According to the filling defects of LAA in the first phase,the patients were divided into LAA filling group(n=59)and non-filling group(n=21).The radi-ation dose the patients received was recorded.The CT values of LAA,ascending aorta(AA)at the same slice and left atrium(LA)at its largest slice were calculated,and the short diameter,long di-ameter,area of LAA opening and depth of LAA were also measured.Results The radiation dose received in patients in phase 1 was 2.2(2.0,3.9)mSv,and that in phase 1+delayed was 2.7(2.4,4.8)mSv,with significant difference between the first and the first+delayed scanning period(P＜0.01).The ratios of CT values(LAAHU/AAHU and LAAHU/LAHU)and of LAA filling defect in the first phase were significantly higher in the group B than the group A(P＜0.05,P＜0.01).The long diameter,short diameter,area of LAA opening and depth of LAA were obviously lower in the LAA filling group than the non-filling group(26.6±3.1 mm vs 30.1±2.8 mm,P＜0.01;20.8±2.9 mm vs 22.8±2.1 mm,P＜0.01;454.6±92.1 mm2 vs 561.9±85.9 mm2,P＜0.01;35.8±4.8 mm vs 40.7±5.4 mm,P＜0.01).Conclusion High-pitch Flash late arterial phase scanning by dual source CT can significantly elevate the LAA filling defects,shorten the examination time and reduce the radiation dose in patients.It is worthy of clinical application and promotion.

β-receptor blockers are used to treat cardiovascular disease(CVD),while β-receptor agonists are used to treat chronic obstructive pulmonary disease(COPD).The two drugs have opposite mechanisms of action.Howev-er,there is a close relationship between COPD and CVD,and CVD is related to the severity of pulmonary dysfunc-tion.The use of β-receptor blockers in COPD is still controversial,but studies have shown that cardiac selective β-receptor blockers can reduce mortality in mild and moderate COPD with CVD and reduce the risk of COPD exacerbation,while non-selective β-receptor blockers increase the risk of COPD exacerbation.However,the dosage of cardiac selective β-receptor blockers and its balance with β-receptor agonists in COPD patients with CVD still requires serious treatment.Research on new β-receptor blockers is a problem to be paid close attention to in the future.

Objective To investigate the association between auditory processing and problem behaviors in preschool children,as well as the mediating role of executive function.Methods A total of 2 342 preschool children were selected from 7 kindergartens in Nanjing,China from June to August 2021.They were evaluated using Preschool Auditory Processing Assessment Scale,Conners Parent Symptom Questionnaire,and Behavior Rating Inventory of Executive Functioning-Preschool version.Children with different demographic features were compared in the scores and the abnormality rates of auditory processing,problem behaviors,and executive function.The influencing factors of the total scores of auditory processing,problem behaviors,and executive function were evaluated using multiple linear regression analysis.Whether executive function was a mediating factor between auditory processing and executive function was examined.Results Sex and grade were the main influencing factors for the total score of auditory processing(P<0.05),and sex,grade,parental education level,and family economic status were the main influencing factors for the total scores of problem behaviors and executive function(P<0.05).The auditory processing score(rs= 0.458,P<0.05)and problem behavior score(rs=0.185,P<0.05)were significantly positively correlated with the executive function score,and the auditory processing score was significantly positively correlated with the problem behavior score(rs=0.423,P<0.05).Executive function played a partial mediating role between auditory processing and problem behaviors,and the mediating effect accounted for 33.44% of the total effect.Conclusions Auditory processing can directly affect the problem behaviors of preschool children and indirectly affect problem behaviors through executive function.[Chinese Journal of Contemporary Pediatrics,2024,26(2):174-180]

Objective To investigate the risk factors for bronchopulmonary dysplasia(BPD)in twin preterm infants with a gestational age of<34 weeks,and to provide a basis for early identification of BPD in twin preterm infants in clinical practice.Methods A retrospective analysis was performed for the twin preterm infants with a gestational age of<34 weeks who were admitted to 22 hospitals nationwide from January 2018 to December 2020.According to their conditions,they were divided into group A(both twins had BPD),group B(only one twin had BPD),and group C(neither twin had BPD).The risk factors for BPD in twin preterm infants were analyzed.Further analysis was conducted on group B to investigate the postnatal risk factors for BPD within twins.Results A total of 904 pairs of twins with a gestational age of<34 weeks were included in this study.The multivariate logistic regression analysis showed that compared with group C,birth weight discordance of>25%between the twins was an independent risk factor for BPD in one of the twins(OR=3.370,95%CI:1.500-7.568,P<0.05),and high gestational age at birth was a protective factor against BPD(P<0.05).The conditional logistic regression analysis of group B showed that small-for-gestational-age(SGA)birth was an independent risk factor for BPD in individual twins(OR=5.017,95%CI:1.040-24.190,P<0.05).Conclusions The development of BPD in twin preterm infants is associated with gestational age,birth weight discordance between the twins,and SGA birth.

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.