Cancer is one of the most lethal and burdensome diseases worldwide. Its progression not only causes irreversible damage to the body, but also imposes a substantial psychological burden on patients due to its complex prognosis. Immune imbalance, a hallmark of the tumor microenvironment (TME), accelerates tumor invasion and metastasis by impairing the function of effector immune cells, promoting the abnormal infiltration of immunosuppressive cells, and disrupting cytokine homeostasis, thereby constituting a major barrier to the efficacy of cancer immunotherapy. Compared with conventional chemotherapy and radiotherapy, aerobic exercise has shown considerable potential in antagonizing tumor progression through relatively mild but effective immunomodulatory mechanisms. On the one hand, regular aerobic exercise enhances the number and activity of key effector immune cells, such as CD8⁺ T cells, thereby strengthening their ability to recognize and eliminate tumor cells and alleviate immune imbalance. On the other hand, aerobic exercise promotes tumor vascular normalization, improves vascular maturity, and stimulates the secretion of irisin and other anti-inflammatory myokines, thereby remodeling the TME and relieving its immunosuppressive state to delay tumor progression. However, psychological stress following a cancer diagnosis can not only act as an independent disruptive factor that exacerbates immune imbalance within the TME, but also amplify the effects of other detrimental factors, such as reduced treatment adherence, thereby further weakening the antagonistic effect of aerobic exercise on tumor growth. Psychological stress, as a chronic stressor, promotes the excessive secretion of emotion-related hormones, including glucocorticoids (GCs) and norepinephrine (NE), which further suppress the activation and effector functions of antitumor immune cells such as CD8⁺ T cells and natural killer (NK) cells, while facilitating the recruitment of protumor immune cells such as regulatory T cells (Tregs). These changes ultimately disrupt immune homeostasis in the TME, promote tumor immune evasion, accelerate tumor invasion and metastasis, and offset the beneficial effects of aerobic exercise on tumor control. In addition, psychological stress induces hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis and abnormal excitation of the sympathetic nervous system (SNS), thereby maintaining elevated levels of GCs, NE, and related stress hormones, suppressing inflammatory chemokine expression and immune cell recruitment, and further disturbing immune homeostasis in the TME, which accelerates tumor progression. More importantly, prolonged psychological stress can also disrupt the homeostasis of central neurotransmitters, such as 5-hydroxytryptamine (5-HT) and glutamate (Glu). This not only directly inhibits the activation and effector functions of antitumor immune cells and promotes the establishment of an immunosuppressive microenvironment, but also impairs cellular energy metabolism and continuously provides energy for tumor cells through metabolic reprogramming, thereby sustaining rapid tumor growth and adaptation to a hostile TME. Ultimately, these alterations contribute to the dysregulation of “neuro-endocrine-immune” axis and weaken the protective effect of aerobic exercise against tumor progression. Therefore, this review focuses on the interaction between psychological stress and the “neuro-endocrine-immune” axis, with particular emphasis on the mechanisms by which psychological stress induces immune imbalance and weakens the antagonistic effect of aerobic exercise on tumor progression. We further highlight the important role of psychological stress in tumor progression and propose that combining psychotropic interventions, aerobic exercise, and clinical antitumor immunotherapy may help restore the tumor-killing capacity of the immune system. Such a multimodal strategy may exert synergistic effects at multiple levels, including psychological stress relief, neuroendocrine regulation, and reconstruction of immune homeostasis, thereby providing new perspectives for identifying therapeutic targets in solid tumors, enhancing the efficacy of cancer immunotherapy, and improving patient prognosis.

Objective Based on the SWOT analysis method,the temporary medical order dispensing service model of pharmacy intravenous admixture service(PIVAS)of M Hospital was constructed and its implementation effect was evaluated,so as to provide reference for other medical institutions to carry out PIVAS temporary dispensing services.Methods SWOT analysis was used to analyze the advantages,disadvantages,opportunities and threats of PIVAS in M Hospital,and targeted operation strategies and practices were proposed.The safety of intravenous medication,the level of pharmacy service and the cost-effectiveness of the department were used to evaluate the implementation effect of PIVAS temporary medical order dispensing service.Results After the operation strategy of PIVAS temporary medical order dispensing service was constructed and implemented based on SWOT analysis,the time of a single medical order for PIVAS labeling in M Hospital was significantly decreased from(7.19±0.06)s/bag to(6.06±0.09)s/bag(P＜0.05);and the number of errors was significantly reduced from(32.50±2.54)pieces/quarter to(19.75±0.59)pieces/quarter(P＜0.05);The qualified rate of temporary prescription increased from(60.52±1.17)％to(90.63±1.72)％(P＜0.05);The qualified rate of finished infusion delivery time increased from(80.63±1.66)％to(90.80±2.98)％(P＜0.05);The satisfaction rate of PIVAS service in the ward increased from 50％to 90％(P＜0.05);the cost of blending decreased from(3.50±0.05)yuan/bag to(3.00±0.12)yuan/bag(P＜0.05).Conclusion The operation strategy of PIVAS temporary medical order dispensing service of M Hospital based on SWOT analysis gives full play to its own advantages,provides more comprehensive and high-quality services for clinicians and patients,ensures the safety and timeliness of patients' medication,and improves the economic efficiency of the department,which is worthy of reference and promotion.

Objective To investigate the antimicrobial resistance of clinical isolates from elderly patients(≥65 years)in major medical institutions across China.Methods Bacterial strains were isolated from elderly patients in 52 hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program during the period from 2015 to 2021.Antimicrobial susceptibility test was carried out by disk diffusion method and automated systems according to the same CHINET protocol.The data were interpreted in accordance with the breakpoints recommended by the Clinical and Laboratory Standards Institute(CLSI)in 2021.Results A total of 514 715 nonduplicate clinical isolates were collected from elderly patients in 52 hospitals from January 1,2015 to December 31,2021.The number of isolates accounted for 34.3％of the total number of clinical isolates from all patients.Overall,21.8％of the 514 715 strains were gram-positive bacteria,and 78.2％were gram-negative bacteria.Majority(90.9％)of the strains were isolated from inpatients.About 42.9％of the strains were isolated from respiratory specimens,and 22.9％were isolated from urine.More than half(60.7％)of the strains were isolated from male patients,and 39.3％isolated from females.About 51.1％of the strains were isolated from patients aged 65-＜75 years.The prevalence of methicillin-resistant strains(MRSA)was 38.8％in 32 190 strains of Staphylococcus aureus.No vancomycin-or linezolid-resistant strains were found.The resistance rate of E.faecalis to most antibiotics was significantly lower than that of Enterococcus faecium,but a few vancomycin-resistant strains(0.2％,1.5％)and linezolid-resistant strains(3.4％,0.3％)were found in E.faecalis and E.faecium.The prevalence of penicillin-susceptible S.pneumoniae(PSSP),penicillin-intermediate S.pneumoniae(PISP),and penicillin-resistant S.pneumoniae(PRSP)was 94.3％,4.0％,and 1.7％in nonmeningitis S.pneumoniae isolates.The resistance rates of Klebsiella spp.(Klebsiella pneumoniae 93.2％)to imipenem and meropenem were 20.9％and 22.3％,respectively.Other Enterobacterales species were highly sensitive to carbapenem antibiotics.Only 1.7％-7.8％of other Enterobacterales strains were resistant to carbapenems.The resistance rates of Acinetobacter spp.(Acinetobacter baumannii 90.6％)to imipenem and meropenem were 68.4％and 70.6％respectively,while 28.5％and 24.3％of P.aeruginosa strains were resistant to imipenem and meropenem,respectively.Conclusions The number of clinical isolates from elderly patients is increasing year by year,especially in the 65-＜75 age group.Respiratory tract isolates were more prevalent in male elderly patients,and urinary tract isolates were more prevalent in female elderly patients.Klebsiella isolates were increasingly resistant to multiple antimicrobial agents,especially carbapenems.Antimicrobial resistance surveillance is helpful for accurate empirical antimicrobial therapy in elderly patients.

Objective To investigate the antimicrobial resistance of clinical isolates from elderly patients(≥65 years)in major medical institutions across China.Methods Bacterial strains were isolated from elderly patients in 52 hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program during the period from 2015 to 2021.Antimicrobial susceptibility test was carried out by disk diffusion method and automated systems according to the same CHINET protocol.The data were interpreted in accordance with the breakpoints recommended by the Clinical and Laboratory Standards Institute(CLSI)in 2021.Results A total of 514 715 nonduplicate clinical isolates were collected from elderly patients in 52 hospitals from January 1,2015 to December 31,2021.The number of isolates accounted for 34.3％of the total number of clinical isolates from all patients.Overall,21.8％of the 514 715 strains were gram-positive bacteria,and 78.2％were gram-negative bacteria.Majority(90.9％)of the strains were isolated from inpatients.About 42.9％of the strains were isolated from respiratory specimens,and 22.9％were isolated from urine.More than half(60.7％)of the strains were isolated from male patients,and 39.3％isolated from females.About 51.1％of the strains were isolated from patients aged 65-＜75 years.The prevalence of methicillin-resistant strains(MRSA)was 38.8％in 32 190 strains of Staphylococcus aureus.No vancomycin-or linezolid-resistant strains were found.The resistance rate of E.faecalis to most antibiotics was significantly lower than that of Enterococcus faecium,but a few vancomycin-resistant strains(0.2％,1.5％)and linezolid-resistant strains(3.4％,0.3％)were found in E.faecalis and E.faecium.The prevalence of penicillin-susceptible S.pneumoniae(PSSP),penicillin-intermediate S.pneumoniae(PISP),and penicillin-resistant S.pneumoniae(PRSP)was 94.3％,4.0％,and 1.7％in nonmeningitis S.pneumoniae isolates.The resistance rates of Klebsiella spp.(Klebsiella pneumoniae 93.2％)to imipenem and meropenem were 20.9％and 22.3％,respectively.Other Enterobacterales species were highly sensitive to carbapenem antibiotics.Only 1.7％-7.8％of other Enterobacterales strains were resistant to carbapenems.The resistance rates of Acinetobacter spp.(Acinetobacter baumannii 90.6％)to imipenem and meropenem were 68.4％and 70.6％respectively,while 28.5％and 24.3％of P.aeruginosa strains were resistant to imipenem and meropenem,respectively.Conclusions The number of clinical isolates from elderly patients is increasing year by year,especially in the 65-＜75 age group.Respiratory tract isolates were more prevalent in male elderly patients,and urinary tract isolates were more prevalent in female elderly patients.Klebsiella isolates were increasingly resistant to multiple antimicrobial agents,especially carbapenems.Antimicrobial resistance surveillance is helpful for accurate empirical antimicrobial therapy in elderly patients.

The incidence of pediatric inflammatory bowel disease(IBD)is rising,with an especially high proportion of early-onset cases in Asia.Conventional treatments such as glucocorticoids and immunosuppressants have limited efficacy and notable adverse effects,whereas biologic therapies substantially improve remission rates and quality of life.Therapeutic drug monitoring(TDM),by assessing trough concentrations and anti-drug antibodies,enables individualized dose optimization,reduces immunogenicity,and prolongs treatment persistence.However,challenges remain,including insufficient standardization and the lack of pediatric-specific concentration thresholds.This review summarizes recent advances in biologics and TDM in pediatric IBD to inform precision treatment.

The incidence of pediatric inflammatory bowel disease(IBD)is rising,with an especially high proportion of early-onset cases in Asia.Conventional treatments such as glucocorticoids and immunosuppressants have limited efficacy and notable adverse effects,whereas biologic therapies substantially improve remission rates and quality of life.Therapeutic drug monitoring(TDM),by assessing trough concentrations and anti-drug antibodies,enables individualized dose optimization,reduces immunogenicity,and prolongs treatment persistence.However,challenges remain,including insufficient standardization and the lack of pediatric-specific concentration thresholds.This review summarizes recent advances in biologics and TDM in pediatric IBD to inform precision treatment.

Objective This study focuses on the analysis of disaster vulnerability among multiple hospital districts to ex-plore the core of integrated emergency management among these districts.Methods Taking the First Affiliated Hospital of Guan-gzhou Medical University as an example,the Kaiser model analysis tool was used to identify risk events in the three hospital dis-tricts.A 42-item questionnaire was developed based on four dimensions,and surveys were conducted among administrative de-partment heads and some frontline staff in the three districts.After selecting valid data,the arithmetic mean of single-item scores from multidimensional scorers was calculated as the final single-item score for risk evaluation.Results The analysis revealed significant differences in the ranking of the top 10 risk events among the three hospital districts.The top risk event in the riverside district was typhoon,with a risk coefficient of 60.2％,which was higher than the top risk events in the Tan Sha district(55.2％)and Hai Yin district(52.8％).This indicates that the overall risk coefficient in the riverside district is higher,with a higher probability of different types of risk events occurring.Conclusion The study found differences in risk events among multiple hospital districts and identified conflicts in the implementation of integrated collaborative emergency management.To ad-dress these differences and conflicts,it is necessary to establish a unified command system,enhance information sharing,in-tegrate resources,strengthen risk assessment,and optimize management culture,thereby achieving efficient operation of compre-hensive emergency management in multiple hospital districts.

Objective Based on the SWOT analysis method,the temporary medical order dispensing service model of pharmacy intravenous admixture service(PIVAS)of M Hospital was constructed and its implementation effect was evaluated,so as to provide reference for other medical institutions to carry out PIVAS temporary dispensing services.Methods SWOT analysis was used to analyze the advantages,disadvantages,opportunities and threats of PIVAS in M Hospital,and targeted operation strategies and practices were proposed.The safety of intravenous medication,the level of pharmacy service and the cost-effectiveness of the department were used to evaluate the implementation effect of PIVAS temporary medical order dispensing service.Results After the operation strategy of PIVAS temporary medical order dispensing service was constructed and implemented based on SWOT analysis,the time of a single medical order for PIVAS labeling in M Hospital was significantly decreased from(7.19±0.06)s/bag to(6.06±0.09)s/bag(P＜0.05);and the number of errors was significantly reduced from(32.50±2.54)pieces/quarter to(19.75±0.59)pieces/quarter(P＜0.05);The qualified rate of temporary prescription increased from(60.52±1.17)％to(90.63±1.72)％(P＜0.05);The qualified rate of finished infusion delivery time increased from(80.63±1.66)％to(90.80±2.98)％(P＜0.05);The satisfaction rate of PIVAS service in the ward increased from 50％to 90％(P＜0.05);the cost of blending decreased from(3.50±0.05)yuan/bag to(3.00±0.12)yuan/bag(P＜0.05).Conclusion The operation strategy of PIVAS temporary medical order dispensing service of M Hospital based on SWOT analysis gives full play to its own advantages,provides more comprehensive and high-quality services for clinicians and patients,ensures the safety and timeliness of patients' medication,and improves the economic efficiency of the department,which is worthy of reference and promotion.

Objective To examine the changing prevalence and antimicrobial resistance profiles of Burkholderia cepacia in 52 hospitals across China from 2015 to 2021.Methods A total of 9 261 strains of B.cepacia were collected from 52 hospitals between January 1,2015 and December 31,2021.Antimicrobial susceptibility of the strains was tested using Kirby-Bauer method or automated antimicrobial susceptibility testing systems according to a unified protocol.The results were interpreted according to the breakpoints released in the Clinical & Laboratory Standards Institute(CLSI)guidelines(2023 edition).Results A total of 9 261 strains of B.cepacia were isolated from all age groups,especially elderly patients.The proportion was 11.1％(1 032 strains)in children,significantly lower than the proportion in adults.About half(46.5％,4 310/9 261)of the strains were isolated from patients at least 60 years old and 42.3％(3 919/9 261)of the strains were isolated from young adults.Most isolates(71.1％)were isolated from sputum and respiratory secretions,followed by urine(10.7％)and blood samples(8.1％).B.cepacia isolates were highly susceptible to the five antimicrobial agents recommended in the CLSI M100 document(33rd edition,2023).B.cepacia isolates showed relatively higher resistance rates to meropenem and levofloxacin.However,the resistance rates to ceftazidime,trimethoprim-sulfamethoxazole,and minocycline remained below 8.1％.The percentage of B.cepacia strains resistant to levofloxacin was the highest compared to other antibiotics in any of the three age groups(from 12.4％in the patients＜18 years old to 20.6％in the patients aged 60 years or older).Conclusions B.cepacia is one of the clinically important non-fermenting gram-negative bacteria.Accurate and timely reporting of antimicrobial susceptibility test results and ongoing antimicrobial resistance surveillance are helpful for rational prescription of antimicrobial agents and proper prevention and control of nosocomial infections.

Objective To investigate the distribution and antimicrobial resistance profiles of clinically isolated Haemophilus influenzae and Moraxella catarrhalis in hospitals across China from 2015 to 2021,and provide evidence for rational use of antimicrobial agents.Methods Data of H.influenzae and M.catarrhalis strains isolated from 2015 to 2021 in CHINET program were collected for analysis,and antimicrobial susceptibility testing was performed by disc diffusion method or automated systems according to the uniform protocol of CHINET.The results were interpreted according to the CLSI breakpoints in 2022.Beta-lactamases was detected by using nitrocefin disk.Results From 2015 to 2021,a total of 43 642 strains of Haemophilus species were isolated,accounting for 2.91％of the total clinical isolates and 4.07％of Gram-negative bacteria in CHINET program.Among the 40 437 strains of H.influenzae,66.89％were isolated from children and 33.11％were isolated from adults.More than 90％of the H.influenzae strains were isolated from respiratory tract specimens.The prevalence of β-lactamase was 53.79％in H.influenzae strains.The H.influenzae strains isolated from children showed higher resistance rate than the strains isolated from adults.Overall,779 strains of H.influenzae did not produce β-lactamase but were resistant to ampicillin(BLNAR).Beta-lactamase-producing strains showed significantly higher resistance rates to these antimicrobial agents than the β-lactamase-nonproducing strains.Of the 16 191 M.catarrhalis strains,80.06％were isolated from children and 19.94％isolated from adults.M.catarrhalis strains were mostly susceptible to both amoxicillin-clavulanic acid and cefuroxime,evidenced by resistance rate lower than 2.0％.Conclusions The emergence of antibiotic-resistant H.influenzae due to β-lactamase production poses a challenge for clinical anti-infective treatment.Therefore,it is very important to implement antibiotic resistance surveillance for H.influenzae and guide rational antibiotic use.All local clinical microbiology laboratories should actively improve antibiotic susceptibility testing and strengthen antibiotic resistance surveillance for H.influenzae.