ObjectiveTo analyze the characteristics and influencing factors of elderly hospitalized patients with carbapenem-resistant gram-negative bacillus (CRO) infection in the intensive care unit (ICU) of a gradeⅡ level A general hospital in Yangpu District of Shanghai, and to provide scientific basis for the prevention and control of hospital-acquired CRO infection in such hospitals. MethodsThe clinical data of elderly ICU patients (age ≥60 years) from January 2019 to December 2023 were retrospectively collected. A total of 122 cases with hospital-acquired CRO infection were used as the case group, and a total of 68 cases with carbapenem-sensitive gram-negative (CSO) infection were used as the control group. The clinical characteristics of the two groups were analyzed, and univariate analysis and logistic regression analysis were performed for screening for possible influencing factors on hospital-acquired CRO infection. ResultsThe main pathogens of CRO infection were carbapenem-resistant Acinetobacter baumannii (CRAB) (53 cases, 43.44%) and carbapenem-resistant Klebsiella pneumoniae (CRKP) (46 cases, 37.70%), and 17 patients (13.93%) had more than two types of CRO infection. Among the CRO infection, the main sites were lower respiratory tract infection (58 cases, 47.54%), ventilator-associated pneumonia (21 cases, 17.21%), and catheter-associated urinary tract infections (16 cases, 13.11%). The incidence rate of poor prognosis was higher in the CRO infection group (54.10%) than that in the CSO infection group (36.76%) (P=0.021). The results of univariate analysis showed that male, history of hospitalization within three months, chronic respiratory disease, hypoproteinemia, anemia, and history of invasive procedures prior to infection, including indwelling central venous catheter, invasive mechanical ventilation, urinary catheter, gastric tube placement and parenteral nutrition, in addition, heparin anticoagulation, the use of broad-spectrum penicillin, third-generation cephalosporins, fluoroquinolones, carbapenems, carbapenems combined with fluoroquinolones, carbapenems combined with glycopeptides, use of ≥3 antibiotics and long time of antibiotic use prior to infection were all associated with the CRO infection (P<0.05). The results of logistic regression analysis showed that use of carbapenems (OR=7.739, 95%CI: 2.226‒26.911), ≥3 types of antibiotics (OR=6.307, 95%CI: 1.674‒23.754), invasive mechanical ventilation (OR=4.082, 95%CI: 1.795‒9.281), urinary catheter (OR=3.554, 95%CI: 1.074‒11.758), and comorbid hypoproteinemia (OR=4.741, 95%CI: 2.039‒11.022) and diabetes (OR=3.245, 95%CI: 1.344‒7.839) were positively correlated with the risk of CRO infection. ConclusionConcurrent use of carbapenems with multiple other antibiotics, as well as the use of invasive mechanical ventilation, urinary catheter, and comorbid hypoproteinemia and diabetes, may be associated with an increased influencing of CRO infection. More attention should be paid to the prevention and control of infection in elderly patients with the above-mentioned risk factors, and active screening of drug-resistant bacteria should be strengthened. Besides, the rational use of broad-spectrum antibiotics such as carbapenems, avoiding unnecessary invasive operations, and paying attention to patient nutrition and blood glucose control all can reduce the incidence of CRO infection and help to improve clinical outcomes.

OBJECTIVE: To assess the feasibility of first polar body transfer (PB1T) combined with preimplantation mitochondrial genetic testing for blocking the transmission of a pathogenic mitochondrial DNA 8993T>G mutation. METHODS: A Chinese family affected with Leigh syndrome which had attended the Reproductive Medicine Centre of the First Affiliated Hospital of Anhui Medical University in September 2021 was selected as the study subject. Controlled ovarian hyperstimulation was carried out for the proband after completing the detection of the mitochondrial DNA 8993T>G mutation load among the pedigree members. Mature MII oocytes were inseminated by intracytoplasmic sperm injection (ICSI), cultured in vitro for 5 to 6 days to the blastocyst stage, and trophoblastocytes were obtained by microbiopsy. Mitochondrial DNA testing (PGT-MT) and chromosomal aneuploidy (PGT-A) analyses were carried out after whole-genome amplification, and the embryos with zero mutation load were selected for transfer. Amniotic fluid and umbilical cord blood samples were collected during middle pregnancy and after birth respectively for mitochondrial DNA testing to verify the reliability of embryo screening. As an attempt, PB1 with good morphology of MII oocytes was selected for transfer into the enucleated oocytoplasm from healthy donors, followed by ICSI fertilization, blastocyst culture and PGT of embryos using the same procedure. This study has been approved by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University (No. 2021zhyx-B12). RESULTS: An antagonist protocol was used for ovarian stimulation, and a total of 19 oocytes were obtained, of which 14 MII were fertilized by ICSI, and 2 had developed into blastocysts. PGT-MT was carried out on biopsied trophoblastocytes, in which the mitochondrial DNA 8993T>G mutation load was not detected in one embryo, the other was 100% mutated, and the mutation loads of the remaining unfertilized eggs and developmentally arrested embryos ranged from 0% ~ 100%, presenting a clear biased distribution. With fully informed consent, one PGT-MT zero mutation load blastocyst was transferred and clinical pregnancy was achieved. Mitochondrial DNA and chromosomal testing of amniotic fluid cells during middle pregnancy had revealed no abnormalities. The proband had delivered a healthy boy through Caesarean section at 39⁺⁵ weeks of gestation, and no mutation was detected in the cord blood sample. Five well-formed PBs from 14 eggs were selected for PB1 transfer, followed by ICSI and culture, and two of the reconstituted embryos had formed blastocysts, with none of the above mutations detected in the biopsied samples. CONCLUSION The PGT-MT technology can help families affected with mitochondrial diseases to have healthy offspring. PB1 transfer in combination with ICSI and PGT-MT holds the promise of turning waste into treasure and providing an alternative means of fertility for such families.
Humans ; Preimplantation Diagnosis/methods* ; Female ; DNA, Mitochondrial/genetics* ; Genetic Testing/methods* ; Pregnancy ; Mitochondrial Diseases/genetics* ; Polar Bodies ; Adult ; Feasibility Studies ; Sperm Injections, Intracytoplasmic/methods* ; Embryo Transfer/methods* ; Mutation ; Male ; Blastocyst/metabolism* ; Pedigree

Objectives:To explore the risk factors for death from ruptured acute aortic dissection during emergency treatment,construct and validate a risk prediction model for death from ruptured acute aortic dissection during emergency treatment. Methods:A total of 301 cases of acute aortic dissection patients who were admitted to Chinese Academy of Medical Sciences Fuwai Hospital from January 2018 to August 2021 were included in this study.Patients were divided into survival subgroup(n=239)and death subgroup(n=62)according to whether dissection rupture occurred in the acute stage of the disease.Univariate and multivariate analyses were performed.Logistic regression analysis was used to establish the risk prediction model.The Hosmer-Lemeshow test was conducted to assess the model's goodness of fit,and the receiver operating characteristic curve(ROC curve)was used to evaluate the model's predictive performance.A prospective validation was performed on 129 cases of acute aortic dissection patients admitted to our hospital's emergency department from September 2021 to September 2022. Results:Among the 301 cases of acute aortic dissection patients,there were 62 cases of rupture and death,with an incidence rate of 20.6%.The results of multivariate analysis showed that age(OR=1.066,95%CI:1.034-1.099),type A dissection(OR=0.045,95%CI:0.006-0.364),history of hypertension(OR=0.377,95%CI:0.167-0.850),and concomitant hypotension(OR=4.424,95%CI:1.467-13.340)were determinants of deaths.The model formula was Z=-5.624+0.064×age-0.976×history of hypertension(yes=1,no=0)-3.104×type(Type A=0,Type B=1)+1.487×concomitant hypotension(yes=1,no=0).The Hosmer-Lemeshow test result showed χ2=9.328,df=8,P=0.315,the area under the ROC curve was 0.874,sensitivity was 79.0%,specificity was 81.6%,and the maximum Youden index was 0.606.The model validation result showed that the area under the ROC curve was 0.722,sensitivity was 73.7%,specificity was 69.1%,and accuracy was 89.9%. Conclusions:Age,history of hypertension,dissection type,and combined hypotension are predictors of the risk prediction model for death from dissection rupture in patients with acute aortic dissection during emergency treatment.The model constructed in this study has good predictive performance,which can provide reference for medical staffto quickly identify high-risk patients for death from ruptured acute aortic dissection and timely predictive measures could be highlighted in indicated cases.

Objective To review the status of pesticide residues in vegetables and fruits and the progress of risk assessment, and to provide data support for pesticide residue research, residents' dietary exposure risks and safety risk management. Methods Domestic and international literature and research data available are reviewed and analyzed. Results This article mainly reviews the literature on the investigation of current status of pesticide residues in vegetables and fruits. It also discusses several methods and models that have been widely employed in the dietary exposure risk assessment of pesticide residues worldwide. Conclusion Pesticide residues have been frequently reported in vegetables and fruits, mainly including organophosphorus, organochlorine, carbamate and pyrethroid pesticide residues. The relevant risk assessment results indicate that different groups of people, especially those with high exposure, have cumulative dietary exposure risks to pesticides in vegetables and fruits. Although most pesticide residues have been detected at low concentrations in vegetables and fruits, they have potential toxicity risks and require continuous attention.

Objective:To compare the clinical results of different endovascular thrombus reduction techniques in the treatment of acute lower extremity arterial thrombosis.Methods:The clinical data of 96 consecutive patients with acute femoral popliteal arterial thrombosis who were treated with catheter directed thrombolysis (CDT) and mechanical thrombus aspiration system (PMT) between Jan 2016 and Dec 2018 at Cangzhou People's Hospital and Peking University People's Hospital were retrospectively analyzed.Results:Ninty-six patients underwent thrombolytic surgery,including 36 with CDT thrombolysis, 28 with AngioJet aspiration alone and 32 with Rotarex aspiration alone. Angiojet thrombus aspiration reduced thrombus rate by 89.3% (25/28) and clinical success rate by 92.8% (26/28).The thrombus reduction rate of Rotarex group was 87.5% (28/32), and the clinical success rate was 96.8% (31/32). In the CDT thrombolytic group, the thrombolytic reduction rate was 61.1% (22/36), including 8 patients who underwent thrombectomy and 6 patients with PMT, with a clinical success rate of 86.1% (31/36). The rate of distal arterial embolization, puncture point and local subcutaneous hematoma and vascular rupture was 21.4%, 10.7% and 2.1%, respectively. There were no amputation cases reported during a mean 13 months follow-up.The survival rate was 97.9%. The first-stage patency rate of 67.8%, while the second-stage artery patency rate of 85.7% during the follow-up.Conclusion:Compared with CDT, PMT has higher efficiency and lower complication rate in the treatment of acute lower extremity arterial thrombosis.

Objective:To investigate the effect of IA10 regimen induction therapy on newly diagnosed adult acute myeloid leukemia (AML) patients without allogeneic hematopoietic stem cell transplantation (allo-HSCT) and the influencing factors of prognosis.Methods:The clinical data of 99 adult patients with newly diagnosed AML treated with IA10 regimen and without allo-HSCT in the Third Hospital of Yuncheng City in Shanxi Province from January 2007 to April 2017 were retrospectively analyzed. The baseline disease characteristics, relapse and survival status and minimal residual disease (MRD) levels were obtained. The influencing factors of prognosis were evaluated by Cox regression model.Results:All the 99 patients did not undergo allo-HSCT after achieved morphologic leukemia-free state (MLFS), the blood cells of 84 cases (84.8%) recovered to complete remission (CR) when reaching MLFS, 8 cases (8.1%) had CR with incomplete recovery of platelet count (CRp), 7 cases (7.1%) had CR with incomplete recovery of blood cell count (CRi). The median relapse time, median disease-free survival time, and median overall survival time were 35 months (6-54 months), 22 months (4-49 months) and 39 months (9-73 months). Multivariate analysis showed that FLT3-ITD was an independent risk factor for relapse, disease-free survival and overall survival in all patients and patients with consolidation therapy ≥1 course (all patients: HR=3.46, 95% CI 2.03-5.97, HR=2.49, 95% CI 1.40-5.47, HR=2.70, 95% CI 1.86-5.90; patients with consolidation therapy ≥1 course: HR=2.14, 95 CI 1.67-5.64, HR=2.63, 95 CI 1.54-5.03, HR=2.06, 95 CI 1.12-4.34; all P < 0.05); the high risk group of South West Oncology Group (SWOG) was an independent risk factor for relapse and disease-free survival in all patients ( HR=2.54, 95% CI 1.16-5.30; HR=2.57, 95% CI 1.38-5.10; both P < 0.05); CRi when achieving MLFS was an independent risk factor for disease-free survival and overall survival in all patients and patients with consolidation therapy ≥ 1 course (all patients: HR=5.71, 95% CI 2.66-11.03, HR=4.46, 95% CI 2.51-9.14; patients with consolidation therapy ≥ 1 course: HR=3.87, 95% CI 1.56-9.83, HR=4.67, 95% CI 2.33-11.59; all P < 0.05), and it was an independent risk factor for relapse in all patients ( HR=3.37, 95 CI 1.26-8.91, P < 0.01); the proportion of peripheral blood primitive cells ≥ 0.50 and the positive MRD after 1 course of consolidation therapy were the independent risk factors for relapse and disease-free survival in patients with consolidation therapy ≥ 1 course (proportion of peripheral blood primitive cells ≥ 0.50: HR=1.96, 95% CI 1.25-3.41, HR=1.56, 95% CI 1.02-2.94; positive MRD after 1 course of consolidation therapy: HR=2.21, 95% CI 1.37-4.05, HR=2.46, 95% CI 1.51-4.23; all P < 0.05). There were significant differences in cumulative relapse, disease-free survival and overall survival of patients without and with 1, 2 and 3 prognostic risk factors (all P < 0.05). Conclusions:IA10 regimen is effective in the induction therapy of newly diagnosed adult AML patients without allo-HSCT. The poor molecular genetic characteristics and CRi when achieving MLFS at the first diagnosis are risk factors for the prognosis of patients, and the high proportion of peripheral blood primitive cells, the combination of monokaryotype and positive MRD after 1 course of consolidation therapy are also closely related to the poor prognosis of patients.

Objective:To investigate the safety of inter-hospital referral and the prognosis of neonatal with critical congenital heart disease.Methods:The criticality score, transit distance and time, and the prognosis of 237 newborns with critical congenital heart disease in Guangdong Provincial People′s Hospital from July 2016 to July 2018 were retrospectively analyzed.Results:A total of 237 children were included (162 male and 75 female) with the median age of 6 days and the median body weight of 2.98 kg.The median transit distance was 90 km.The average value of neonatal critical illness score (NCIS) was (86.54±9.05) scores before transport; 136 cases were greater than 90 scores, 84 cases between 70 and 90 scores, 17 cases less than 70 scores; while the average NCIS was (87.05±8.19) scores when arrived at neonatal intensive care unit (NICU), 138 cases were greater than 90 scores, 82 cases between 70 and 90 scores, 17 cases less than 70 scores.There were no significant differences in the scores of critical cases before and after transfer according to the transfer time and distance ( t=0.346, P>0.05). There was no one death occurred during the transfer process.All over, 222 cases were cured and discharged from the hospital after surgery and or medical interventional treatments, 15 cases died after giving up treatment or losing the opportunity for surgery. Conclusions:It is safe and effective of the inter-hospital transport for the rescue of infants with critical congenital heart disease when followed the principles and transport rules and regulations, with trained workers and special equipments.

Objective:To explore effects of four postures nursing on oxygen partial pressure, pain and comfort degree of affected limbs in patients with lower extremity atherosclerotic occlusive disease (LEAOD) .Methods:A total of 357 patients with LEAOD who were admitted in Henan Provincial People's Hospital of Henan University from March 2018 to February 2019 were selected as the research objects by convenient sampling. All patients were respectively treated with four postural nursing methods, including supine position, sitting position, lower limb ptosis position and lower limb elevation position. The differences in oxygen partial pressure, pain value and comfort level of patients in different posture nursing states were compared.Results:Among 357 patients, 106 patients had no pain. Compared with the other three positions, the oxygen partial pressure level of the lower limb elevated position was the lowest, and the pain score and comfort score were the highest. The differences among the groups were statistically significant ( P<0.01) . The oxygen partial pressure level of lower limb ptosis position was the highest, and the pain score and comfort score were significantly lower than the other three positions. The differences were all statistically significant ( P<0.01) . Among the four postures, the changes of oxygen partial pressure in sitting position and lower limb ptosis position were the most significant, and the differences were statistically significant ( Z=145.433, P<0.01) . Conclusions:In the nursing of supine position, sitting position, lower limb ptosis position and lower extremity elevation position, lower extremity ptosis position has a more obvious improvement effect on oxygen partial pressure, comfort degree and pain value of patients with LEAOD compared with the other three positions. However, long-term prolapse of the affected limbs can easily cause blood stasis and discomfort symptoms. Therefore, it is necessary to set a reasonable nursing method and time for the affected limbs according to the condition of patients.

Objective: To analyze the neurodevelopmental outcome and its risk factors in infants with CHD at 18 months of age. Methods: Eighteen-month-old infants with CHD at the follow-up clinic of our hospital were selected. The Bayley scales of infant development(BSID) were used to evaluate the levels of mental development(MDI) and psychomotor development(PDI). The clinical features during hospitalization were reviewed, and the risk factors of MDI and PDI were analyzed. Results: A total of 116 children with CHD underwent BSID evaluation at 18 months of age. Both the MDI(95.38±22.98) and PDI(87.84±22.57) of the cohort were significantly lower than the average value of the normal population(P<0.05). In infants with cyanotic CHD, the MDI was higher(β=17.218). The longer the length was of the hospital stay, the lower the PDI(β=-0.577). In patients undergoing cardiopulmonary bypass surgery, the PDI was higher(β=11.956). Compared to infants with relatively normal behavior, the PDI of infants with mild behavioral problems was lower(β=-10.605). Conclusion Children with CHD who underwent cardiac surgery have delayed neurodevelopmental outcomes compared with those of healthy children. The outcomes of infants with cyanotic CHD or undergoing cardiopulmonary bypass surgery was better than others. Long hospital stays and mild behavioral problems were risk factors for poor neurodevelopmental outcomes.

Objectlve To explore the correlation between amplitude-integrated electroencephalographic(aEEG) findings and clinical features and to investigate the status of perioperative brain function in infants with critical congenital heart disease (CCHD) and its influencing factors.Methods Newborns and infants with critical CHD who were admitted to the NICU at our hospital were included.Postoperative aEEG was continuously monitored and analyzed,and its correlation with clinical conditions was compared.Results A total of 226 patients were enrolled.Of the 226 patients who underwent postoperative aEEG monitoring,approximately 5.8％ showed mild abnormal background patterns,0.9％ showed severe abnormalities,27.4％ demonstrated an immature SWC,and 3.5％ lacked SWC.The patients who had a history of hypoxia at birth exhibited delayed sternal closure or showed severe postoperative neurological symptoms and had higher probabilities of postoperative SWC abnormalities.Several infants,all with complex CHD,had postoperative seizures.Conclusion Gestational age and oxygen deficiency at birth were the risk factors of brain injury.Delayed sternal closure,severe postoperative infection,and postoperative neurological symptoms were risk factors for postoperative brain injury.Postoperative nervous system monitoring and prevention postoperative severe infection may obviously improve the brain function of neonates and small infants with critical congenital heart disease.