Objective To analyze drug resistance and clustering of environmental and clinical isolates of Acinetobacter baumannii (A. baumannii) in ICU of a medical institution in Shanghai. Methods The isolates of A. baumannii from ICU environments and clinic were used to analyze the contamination and distribution in 2021-2024. Antimicrobial susceptibility testing was carried out with microbroth dilution method. Whole genome sequencing was performed out of strains for MLST typing and SNP clustering. Results The detection rate of contamination in ICU environment was 7.67%, and the most serious contamination was found in pillows, bedding, hospital gowns and other items that patients directly contacted. Clinical isolates were predominantly from sputum specimens. The environmental and clinical isolates had a high level of resistance to third generation cephalosporins, third generation quinolones and carbapenems (more than 85%). Environmental isolates had a low level of resistance to polymyxin B, but none of the clinical isolates were resistant. MLST typing showed that ST2 was the dominant clone (66.67%), and SNP clustering found that isolates from different sources but with the same ST type were clustered together. Conclusion ST2 is the dominant clone of A. baumannii isolates in this medical institution, and there is cross-contamination between different samples. Monitoring of drug resistance and disinfection should be further strengthened to prevent the emergence and spread of pan-resistant or even fully resistant strains.

Objective To assess the efficacy of endoscopic transethmoidal orbital wall decompression(ETMOWD)in conjunction with fat removal orbital decompression(FROD)on restrictive strabismus in patients with thyroid-associated ophthalmopathy(TAO).Methods A retrospective case series study was conducted involving patients diagnosed with TAO at our hospital from December 2021 to August 2024.Patients were divided into two groups:the orbital decompression group(OD group)and the non-orbital decompression group(NOD group),based on whether they underwent orbital decompression surgery.The study compared perioperative data,types of strabis-mus,degree of ocular motility limitation,extent of posterior migration of ocular muscles,and postoperative outcomes between the two groups.Additionally,the effects of ETMOWD combined with FROD on strabismus were evaluated by analyzing changes in relevant indices before and after surgery in the OD group.Results A total of 65 participants were included in the analysis,with 40 in the OD group group and 25 in the NOD group.There was no statistically significant difference in baseline characteristics between the two groups.Preoperative strabismus types,including horizontal and vertical strabismus,did not differ significantly between the OD and NOD groups(P>0.05).However,the mean preoperative restriction grade of eye movement was significantly higher in the OD group compared to the NOD group.Additionally,the number of surgeries,mean total operated muscles,and number of horizontal muscles were all significantly higher in the OD group than in the NOD group(all P<0.05),with a notably different effect on horizontal muscle migration between the two groups.The degree of restriction of eye movement and diplopia improved significantly in all patients,with cure rates of 70%in the OD group and 72%in the NOD group.Furthermore,the OD group underwent ETMOWD combined with FROD orbital decompression surgery,which resulted in a decrease in intraocular pressure(IOP)from(19.43±3.9)mmHg preoperatively to(15.05±2.2 mmHg postoperatively(P<0.001).Both horizontal and vertical strabismus increased after surgery.Conclusions Our results demonstrated that,compared with the NOD group,the OD group exhibited increased complexity in strabismus surgery,as evidenced by a higher number of operations,total muscle strips,horizontal muscle strips,and greater migratory effect size of the horizontal muscles.The combination of ETMOWD and FROD effectively reduced exophthalmos,with a more pronounced effect on the medial rectus muscle compared to the vertical muscles.However,the long-term outcomes between the two groups were similar.

Objective To assess the efficacy of endoscopic transethmoidal orbital wall decompression(ETMOWD)in conjunction with fat removal orbital decompression(FROD)on restrictive strabismus in patients with thyroid-associated ophthalmopathy(TAO).Methods A retrospective case series study was conducted involving patients diagnosed with TAO at our hospital from December 2021 to August 2024.Patients were divided into two groups:the orbital decompression group(OD group)and the non-orbital decompression group(NOD group),based on whether they underwent orbital decompression surgery.The study compared perioperative data,types of strabis-mus,degree of ocular motility limitation,extent of posterior migration of ocular muscles,and postoperative outcomes between the two groups.Additionally,the effects of ETMOWD combined with FROD on strabismus were evaluated by analyzing changes in relevant indices before and after surgery in the OD group.Results A total of 65 participants were included in the analysis,with 40 in the OD group group and 25 in the NOD group.There was no statistically significant difference in baseline characteristics between the two groups.Preoperative strabismus types,including horizontal and vertical strabismus,did not differ significantly between the OD and NOD groups(P>0.05).However,the mean preoperative restriction grade of eye movement was significantly higher in the OD group compared to the NOD group.Additionally,the number of surgeries,mean total operated muscles,and number of horizontal muscles were all significantly higher in the OD group than in the NOD group(all P<0.05),with a notably different effect on horizontal muscle migration between the two groups.The degree of restriction of eye movement and diplopia improved significantly in all patients,with cure rates of 70%in the OD group and 72%in the NOD group.Furthermore,the OD group underwent ETMOWD combined with FROD orbital decompression surgery,which resulted in a decrease in intraocular pressure(IOP)from(19.43±3.9)mmHg preoperatively to(15.05±2.2 mmHg postoperatively(P<0.001).Both horizontal and vertical strabismus increased after surgery.Conclusions Our results demonstrated that,compared with the NOD group,the OD group exhibited increased complexity in strabismus surgery,as evidenced by a higher number of operations,total muscle strips,horizontal muscle strips,and greater migratory effect size of the horizontal muscles.The combination of ETMOWD and FROD effectively reduced exophthalmos,with a more pronounced effect on the medial rectus muscle compared to the vertical muscles.However,the long-term outcomes between the two groups were similar.

Objective:To analyze the short-term clinical efficacy and safety of arsenic trioxide (ATO) combined with a modified N7 induction regimen in the treatment of children with high-risk neuroblastoma (NB).Methods:This study was a prospective, single-arm, multicenter phase Ⅱ clinical study. Sixty-seven high-risk NB children from eight units of Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Wuhan Children′s Hospital of Tongji Medical College of Huazhong University of Science and Technology, First Affiliated Hospital of Guangxi Medical University, Hainan General Hospital, Affiliated Hospital of Guangdong Medical University, Kunming Children′s Hospital, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, and Guangdong Provincial Agricultural Reclamation Center Hospital were enrolled from January 2019 to August 2023 and were treated with ATO combined with a modified N7 induction regimen. The efficacy and adverse effects at the end of induction chemotherapy were assessed and analyzed, and the differences in the clinical characteristics were further compared between the treatment-responsive and treatment-unresponsive groups by using the Fisher′s exact test.Results:Among 67 high-risk NB children, there were 40 males (60%) and 27 females (40%), with the age of disease onset of 3.5 (2.6, 4.8) years. Primary NB sites were mostly in retroperitoneum (including adrenal gland) (56/67, 84%) and the common metastases sites at initial diagnosis were distant lymph node in 25 cases (37%),bone in 48 cases (72%),bone marrow in 56 cases (84%) and intracalvarium in 3 cases (4%). MYCN gene amplification were detected in 28 cases (42%). At the end of induction, 33 cases (49%) achieved complete remission, 29 cases (43%) achieved partial remission, 1 case (1%) with stable disease, and 4 cases (6%) were assessed as progressive disease (PD). The objective remission rate was 93% (62/67) and the disease control rate was 94% (63/67). The percentage of central system metastases at the initial diagnosis was higher in the treatment-unresponsive group than in the treatment-responsive group (2/5 vs. 2% (1/62), P=0.013), whereas the difference in MYCN gene amplification was not statistically significant between two groups (3/5 vs.40% (25/62), P=0.786). Grade Ⅲ or higher adverse reactions during the induction chemotherapy period were myelosuppression occurred in 60 cases (90%), gastrointestinal symptoms occurred in 33 cases (49%), infections occurred in 20 cases (30%), hepatotoxicity occurred in 4 cases (6%), and cardiovascular toxicity occurred in 1 case (2%). There were no chemotherapy-related deaths. Conclusion:ATO combined with N7-modified induction regimen had a superiority in efficacy and safety, which deserved further promotion in clinical practice.

Objective To investigate hepatic expressions and significances of cannabinoid receptor 1 (CB1) and cannabinoid receptor 2(CB2) in C57 mice with experimental cirrhosis.Methods Thirty C57 mice were randomly divided into three groups,i.e.normal control group,model control group and model colchicine group.Hepatic fibrosis model was prepared by intraperitoneal injection of carbon tetrachloride.The expressions of CB1 and CB2 in liver tissue of mice were observed by immunohistochemistry.The scores of inflammation grade (G) and fibrosis stage (S) were simultaneously performed.Results The scores of G and S in model control group and model colchicine group were significantly higher than those in normal control group( F =125.41,P =0.00; F =99.18,P =0.00).The scores of G and S in model control group were significantly higher than those in model colchicine group(P ＜0.01 ).The scores of CB1 and CB2 expressions in model control group and model colchicine group were significantly higher than those in normal control group ( F =29.27,P =0.00; F =36.99,P =0.00).The scores of CB1 and CB2 in model control group were significantly higher than those in model colchicine group( P ＜ 0.05 or P ＜ 0.01 ).There were significant relationships among scores of CB1,CB2,G and S in model control group and model colchicine group(Ps ＜0.05).As the scores of G and S became higher,the expressions of CB1 and CB2 gradually became more intensive.Conclusion The hepatic expressions of CB1 and CB2 in C57 mice with experimental cirrhosis increased significantly and have significant relationship with the grades of liver tissue inflammation and fibrosis.

OBJECTIVE To discuss the management experience of protective measures for emergently admitted influenza H1N1 patients in our hospital who were converted from general ward into isolated ward in no more than three hours.METHODS Laying out the guideline of the work,personal training and personal protective measures were taken to manage the staff who working in the isolated ward.RESULTS There was statistically significant difference in hand washing,wearing mask and head wear,taken off gloves,mask and clothes among medical staff who worked in the isolated ward,in comparison with staff from other ward and non-medical staff From 14 points of suruey.there were 8 points were over 80% pass rate.The use of protective equipment was correct.without any cross infection.CONCLUSIONS Management of protective measures plays an important role in control of cross infection in treatment of H1N1 patients.