Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2022.Methods:The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of national bloodstream infection Bacterial Resistant Investigation Collaborative System（BRICS）were collected during January 2022 to December 2022. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 software were used to analyze the data.Results:During the study period，9 035 strains of Gram-negative bacteria were collected from 51 hospitals，of which 7 895（87.4%）were Enterobacteriaceae and 1 140（12.6%）were non-fermenting bacteria. The top 5 bacterial species were Escherichia coli（ n=4 510，49.9%）， Klebsiella pneumoniae（ n=2 340，25.9%）， Pseudomonas aeruginosa（ n=534，5.9%）， Acinetobacter baumannii complex（ n=405，4.5%）and Enterobacter cloacae（ n=327，3.6%）. The ESBLs-producing rates in Escherichia coli， Klebsiella pneumoniae and Proteus spp. were 47.1%（2 095/4 452），21.0%（427/2 033）and 41.1%（58/141），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（58/4 510）and 13.1%（307/2 340）；62.1%（36/58）and 9.8%（30/307）of CREC and CRKP were resistant to ceftazidime/avibactam combination，respectively. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 59.5%（241/405），while less than 5% of Acinetobacter baumannii complex was resistant to tigecycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 18.4%（98/534）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of main Gram-negative bacteria resistance among different regions，with statistically significant differences in the prevalence of CRKP and CRPA（ χ2=20.489 and 20.252， P<0.001）. The prevalence of CREC，CRKP，CRPA，CRAB，ESBLs-producing Escherichia coli and Klebsiella pneumoniae were higher in provinicial hospitals than those in municipal hospitals（ χ2=11.953，81.183，10.404，5.915，12.415 and 6.459， P<0.01 or <0.05），while the prevalence of CRPA was higher in economically developed regions（per capita GDP ≥ 92 059 Yuan）than that in economically less-developed regions（per capita GDP <92 059 Yuan）（ χ2=6.240， P=0.012）. Conclusions:The proportion of Gram-negative bacteria in bloodstream infections shows an increasing trend，and Escherichia coli is ranked in the top，while the trend of CRKP decreases continuously with time. Decreasing trends are noted in ESBLs-producing Escherichia coli and Klebsiella pneumoniae. Low prevalence of carbapenem resistance in Escherichia coli and high prevalence in CRAB complex have been observed. The composition ratio and antibacterial spectrum of bloodstream infections in different regions of China are slightly different，and the proportion of main drug resistant bacteria in provincial hospitals is higher than those in municipal hospitals.

Objective To evaluate the efficacy of Broncho-Vaxom combined with physiological sea water nasal wash in the treatment of chronic rhinitis-rhinosinusitis in children. Methods A total of 179 children with chronic rhinitis-rhinosinusitis were randomly divided into observation group of 90 cases and control group of 89 cases. The observation group received treatment of oral administration of Broncho-Vaxom capsules at a dose of 3.5 mg once daily on an empty stomach in the morning for 10 consecutive days, with a 20-day drug-free period as one course of treatment, for a total of 3 courses. Additionally, they underwent nasal irrigation with physiological sea water twice daily in the morning and evening, for 10 consecutive days, with a 20-day break as one course of treatment, for a total of 3 courses. The control group underwent nasal irrigation with physiological sea water using the same method of the observation group. Both groups received symptomatic treatment such as anti-allergy therapy, and antibiotics were added when there presented obvious inflammatory changes. After treatment, the clinical total effective rate was compared between the two groups. Changes in the scores of Visual Analogue Scale (VAS) and Lund-Kenndy scale for nasal endoscopy, as well as changes in serum IgG, IgE, and T lymphocyte subsets were also compared. A six-month follow-up was conducted to assess the recurrence rate and average number of episodes of rhinosinusitis (times per person). Results The clinical total effective rate in the observation group was significantly higher compared to that in the control group(95.56% versus 86.52%). The scores of VAS and Lund-Kenndy scale in the observation group were significantly better than those in the control group. Serum IgG levels in the observation group were increased and higher than those in the control group, while serum IgE level in the observation group was decreased and lower than that in the control group. After 3 courses of treatment, the levels of CD3⁺, CD4⁺, and CD4⁺/CD8⁺ in the blood of the observation group were increased, while the level of CD8⁺ was decreased. The six-month follow-up after treatment showed that the recurrence rate of rhinitis-rhinosinusitis in the observation group was 17.05%, with an average of 0.28 episodes per person, which was lower than that in the control group (P < 0.05). Conclusion The combination of Broncho-Vaxom and physiological sea water nasal wash is effective in treating chronic rhinitis-rhinosinusitis in children, and can increase serum IgG level, decrease serum IgE level, optimize the structure of T lymphocyte subsets, enhance immune resistance, and improve allergic constitution. The six-month follow-up of the treatment reduces recurrence rate and average number of episodes of rhinitis-rhinosinusitis.

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.

Objective To prepare the erythrocyte membrane camouflaged gefitinib(GEF)nanomedi-cine,and to observe its in vivo half-life and blood drug concentration by using the lung cancer bearing nude mouse model and explore its tumor suppression effect and tumor suppression mechanism.Methods The GEF standard curve was established by HPLC.A549 tumor bearing nude mice were constructed and divided into the GEF group,GEF nanoparticles group(GEF-NPs group),erythrocyte camouflaged GEF nanoparticles group(RBC@GEF-NPs group).The plasma drug concentration at different time points was detected by HPLC,the cell cycle was detected by flow cytometry and the tumor cellular apoptosis was detected by TUNEL.Results The tumor volume in the RBC@GEF-NPs group was significantly smaller than that in the GEF group and GEF-NPs group(P＜0.05);the in vivo half-life period in the RBC@GEF-NPs group was sig-nificantly longer than the GEF group and GEF-NPS group(18.90 h vs.2.44 h vs.10.50 h,P＜0.05),and the difference was statistically significant(P＜0.05);the GEF drug concentration in the tumor tissues of the RBC@GEF-NPs group was 48.5 ng/mg,which was 5 times and 2 times of that in the GEF group(10.8 ng/mg)and GEF-NPs group(24.7 ng/mg)respectively(P＜0.05).Compared with the GEF group,the proportion of G0/G1 phase cells in the RBC@GEF-NPs group was increased from 55.5％to 71.35％(P＜0.05)and which in the G2/M stage was decreased from 10.05％to 4.22％(P＜0.05),which in the S stage was decreased from 34.62％to 24.43％(P＜0.05);the cellular apoptosis index in the RBC@GEF-NPs group was significantly higher than that in the GEF group and GEF-NPs group[(23.42±2.47)％vs.(8.34±1.32)％vs.(14.32±2.59)％,P＜0.05],and the differences were statistically significant.Conclusion RBC@GEF-NPs could in-crease the half-life and blood concentration of A549 lung cancer bearing nude mice,block and inhibit the lung cancer growth by promoting tumor cell apoptosis and G1 phase arrest.

Objective:To explore whether transjugular intrahepatic portosystemic shunt (TIPS) can improve the prognosis of esophagogastric variceal bleeding (EGVB) combined with sarcopenia in cirrhotic patients.Methods:A retrospective cohort study was performed. A total of 464 cases with cirrhotic EGVB who received standard or TIPS treatment between January 2017 and December 2019 were selected. Regular follow-up was performed for the long-term after treatment. The primary outcome was transplantation-free survival. The secondary endpoints were rebleeding and overt hepatic encephalopathy (OHE). The obtained data were statistically analyzed. The t-test and Wilcoxon rank-sum test were used to compare continuous variables between groups. The χ2 test, or Fisher's exact probability test, was used to compare categorical variables between groups. Results:The age of the included patients was 55.27±13.86 years, and 286 cases were male. There were 203 cases of combined sarcopenia and 261 cases of non-combined sarcopenia. The median follow-up period was 43 months. The two groups had no statistically significant difference in follow-up time. There was no statistically significant difference in transplant-free survival between the TIPS group and the standard treatment group in the overall cohort ( HR=1.31, 95% CI: 0.97-1.78, P=0.08). The TIPS patient group with cirrhosis combined with sarcopenia had longer transplant-free survival (median survival: 47.76 vs. 52.45, χ2=4.09; HR=1.55, 95 CI: 1.01~2.38, P=0.04). There was no statistically significant difference in transplant-free survival between the two kinds of treatments for patients without sarcopenia ( HR=1.22, 95% CI: 0.78~1.88, P=0.39). Rebleeding time was prolonged in TIPS patients with or without sarcopenia combination (patients without combined sarcopenia: median rebleeding time: 39.48 vs. 53.61, χ2=18.68; R=2.47, 95 CI: 1.67~3.65, P<0.01; patients with sarcopenia: median rebleeding time: 39.91 vs. 50.68, χ2=12.36; HR=2.20, 95 CI: 1.42~3.40, P<0.01). TIPS patients had an increased 1-year OHE incidence rate compared to the standard treatment group (sarcopenia patients: 6.93% vs. 16.67%, χ2=3.87, P=0.049; patients without sarcopenia combination: 2.19% vs. 9.68%, χ2=8.85, P=0.01). There was no statistically significant difference in the long-term OHE incidence rate between the two kinds of treatment groups ( P>0.05). Conclusion:TIPS can significantly prolong transplant-free survival compared to standard treatment as a secondary prevention of EGVB concomitant with sarcopenia in patients with cirrhosis. However, its advantage is not prominent for patients with cirrhosis in EGVB without sarcopenia.

Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical Gram-positive bacteria isolates from bloodstream infections in China in 2022.Methods:The clinical isolates of Gram-positive bacteria from blood cultures in member hospitals of National Bloodstream Infection Bacterial Resistant Investigation Collaborative System（BRICS）were collected during January 2022 to December 2022. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 software were used to analyze the data.Results:A total of 3 163 strains of Gram-positive pathogens were collected from 51 member units，and the top five bacteria were Staphylococcus aureus（ n=1 147，36.3%），coagulase-negative Staphylococci（ n=928，29.3%）， Enterococcus faecalis（ n=369，11.7%）， Enterococcus faecium（ n=296，9.4%）and alpha-hemolyticus Streptococci（ n=192，6.1%）. The detection rates of methicillin-resistant Staphylococcus aureus（MRSA）and methicillin-resistant coagulase-negative Staphylococci（MRCNS）were 26.4%（303/1 147）and 66.7%（619/928），respectively. No glycopeptide and daptomycin-resistant Staphylococci were detected. The sensitivity rates of Staphylococcus aureus to cefpirome，rifampin，compound sulfamethoxazole，linezolid，minocycline and tigecycline were all >95.0%. Enterococcus faecium was more prevalent than Enterococcus faecalis. The resistance rates of Enterococcus faecium to vancomycin and teicoplanin were both 0.5%（2/369），and no vancomycin-resistant Enterococcus faecium was detected. The detection rate of MRSA in southern China was significantly lower than that in other regions（ χ2=14.578， P=0.002），while the detection rate of MRCNS in northern China was significantly higher than that in other regions（ χ2=15.195， P=0.002）. The detection rates of MRSA and MRCNS in provincial hospitals were higher than those in municipal hospitals（ χ2=13.519 and 12.136， P<0.001）. The detection rates of MRSA and MRCNS in economically more advanced regions（per capita GDP≥92 059 Yuan in 2022）were higher than those in economically less advanced regions（per capita GDP<92 059 Yuan）（ χ2=9.969 and 7.606， P=0.002和0.006）. Conclusions:Among the Gram-positive pathogens causing bloodstream infections in China， Staphylococci is the most common while the MRSA incidence decreases continuously with time；the detection rate of Enterococcus faecium exceeds that of Enterococcus faecalis. The overall prevalence of vancomycin-resistant Enterococci is still at a low level. The composition ratio of Gram-positive pathogens and resistant profiles varies slightly across regions of China，with the prevalence of MRSA and MRCNS being more pronounced in provincial hospitals and areas with a per capita GDP≥92 059 yuan.

Objective:To explore the current status of surgery for portal hypertension to grasp current status and future development of surgery in China.Methods:This study is jointly sponsored by China Hepatobiliary & Pancreatic Specialist Alliance & Portal Hypertension Alliance in China (CHESS).Comprehensive surveying is conducted for basic domestic situations of surgery for portal hypertension, including case load, surgical approaches, management of postoperative complications, primary effects, existing confusion and obstacles, liver transplantation(LT), laparoscopic procedures and transjugular intrahepatic portosystemic shunt(TIPS), etc.Results:A total of 8 512 cases of portal hypertension surgery are performed at 378 hospitals nationwide in 2021.Splenectomy plus devascularization predominated(53.0%)and laparoscopy accounted for 76.1%.Primary goal is preventing rebleeding(67.0%) and 72.8% of hospitals used preventive anticoagulants after conventional surgery.And 80.7% of teams believe that the formation of postoperative portal vein thrombosis is a surgical dilemma and 65.3% of hospitals practiced both laparoscopy and TIPS.The major reasons for patients with portal hypertension not receiving LT are due to a lack of qualifications for LT(69.3%)and economic factors(69.0%).Conclusions:Surgery is an integral part of management of portal hypertension in China.However, it is imperative to further standardize the grasp of surgical indications, the handling of surgical operation and the management of postoperative complications.Moreover, prospective, multi-center randomized controlled clinical studies should be performed.

Objective To explore the protective effect and mechanism of endoplasmic reticulum stress(ERS)signaling pathway PERK/eIF2α/ATF4/CHOP on BRL-3A cell injury by serum containing Zhige oral solution.Methods ①Preparation of drug-containing serum:SD male rats were randomly divided into 3 groups:Zhige oral solution group,Metadoxine group and normal group,and were gavaged with Zhige oral solution,Metadoxine and saline respectively,and the drug-containing serum was prepared by blood sampling from the abdominal aorta for 5 consecutive days of intervention.②Normal BRL-3A cells were cultured,and the cell survival rate of each group was determined by CCK-8 after 24h of cell intervention with different concentrations of ethanol(1.0%,1.5%,2.0%,2.5%,3.0%,5.0%,7.0%,10.0%).③Cultured normal BRL-3A cells were divided into normal group,model group,metadoxine group,and Zhige oral solution low,medium and high dose group(later referred to as low dose group,medium dose group and high dose group),After 24 h,the levels of γ-glutamyl transpeptidase(GGT)and lactate dehydrogenase(LDH)in the supernatant of each group were measured,and the survival rate of BRL-3A cells was measured by CCK-8.The expression levels of PERK/eIF2α/ATF4/CHOP pathway-related mRNA and protein in each group were measured by Real-time PCR and Western blot.Results ①After 24 h of cell intervention with the same concentration of ethanol(1.0%,1.5%,2.0%,2.5%,3.0%,5.0%,7.0%,10.0%),the cell survival rate gradually decreased with the increase of ethanol concentration,and when the ethanol concentration was 5%,the cell survival rate decreased significantly(P<0.05),so the ethanol concentrations of 1.0%,1.5%,2.0%,2.5%,3.0%,5.0%were chosen for the subsequent experiments.②Compared with the normal group,the GGT and LDH contents in the supernatant of the model group were significantly higher(P<0.05),and the expression of PERK/eIF2α/ATF4/CHOP pathway-related factors mRNA and protein were significantly higher(P<0.05),showing a significant state of liver injury.③Compared with the model group,the Zhige oral solution group and the metadoxine group showed different degrees of reduction in the above indexes,with the most significant effect in the Zhige oral solution high-dose group(P<0.05).Conclusion Serum containing Zhige oral solution ameliorated ethanol-induced hepatocyte injury in BRL-3A rats,and the mechanism may be related to the inhibition of endoplasmic reticulum stress PERK/eIF2α/ATF4/CHOP signaling pathway.

Brain edema belongs to the category of "stroke" and "true headache", while Traditional Chinese Medicine mostly understands its core disease mechanisms from the perspectives of stasis, deficiency, and heat, and mostly treats the disease by using warming yang to induce diuresis and eliminating stasis to remove water. Wuling Powder has been lauded as the "first party to typhoid and relieving diuresis", which is used to cure clearing damp and promoting diuresis and warming yang and transforming qi, and has been clinically used in the treatment of brain edema caused by various causes such as head trauma, intracerebral hemorrhage, cerebral infarction, and intracranial space occupying, all with remarkable efficacy. Wuling Powder improves cellular energy supply, scavenges excess oxygen radicals and calcium ions in brain tissue, and reduces the damage to brain tissue caused by vascular inflammatory factors and regulates aquaporins and vascular endothelial growth factor, thereby achieving therapeutic effects.

Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical bacterial isolates from bloodstream infections in China in 2021.Methods:The clinical bacterial strains isolated from blood culture from member hospitals of Blood Bacterial Resistant Investigation Collaborative System (BRICS) were collected during January 2021 to December 2021. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical Laboratory Standards Institute (CLSI). WHONET 5.6 was used to analyze data.Results:During the study period, 11 013 bacterial strains were collected from 51 hospitals, of which 2 782 (25.3%) were Gram-positive bacteria and 8 231 (74.7%) were Gram-negative bacteria. The top 10 bacterial species were Escherichia coli (37.6%), Klebsiella pneumoniae (18.9%), Staphylococcus aureus (9.8%), coagulase-negative Staphylococci (6.3%), Pseudomonas aeruginosa (3.6%), Enterococcus faecium (3.6%), Acinetobacter baumannii (2.8%), Enterococcus faecalis (2.7%), Enterobacter cloacae (2.5%) and Klebsiella spp (2.1%). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus aureus were 25.3% and 76.8%, respectively. No glycopeptide- and daptomycin-resistant Staphylococci was detected; more than 95.0% of Staphylococcus aureus were sensitive to ceftobiprole. No vancomycin-resistant Enterococci strains were detected. The rates of extended spectrum B-lactamase (ESBL)-producing isolated in Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis were 49.6%, 25.5% and 39.0%, respectively. The prevalence rates of carbapenem-resistance in Escherichia coli and Klebsiella pneumoniae were 2.2% and 15.8%, respectively; 7.9% of carbapenem-resistant Klebsiella pneumoniae was resistant to ceftazidime/avibactam combination. Ceftobiprole demonstrated excellent activity against non-ESBL-producing Escherichia coli and Klebsiella pneumoniae. Aztreonam/avibactam was highly active against carbapenem-resistant Escherichia coli and Klebsiella pneumoniae. The prevalence rate of carbapenem-resistance in Acinetobacter baumannii was 60.0%, while polymyxin and tigecycline showed good activity against Acinetobacter baumannii (5.5% and 4.5%). The prevalence of carbapenem-resistance in Pseudomonas aeruginosa was 18.9%. Conclusions:The BRICS surveillance results in 2021 shows that the main pathogens of blood stream infection in China are gram-negative bacteria, in which Escherichia coli is the most common. The MRSA incidence shows a further decreasing trend in China and the overall prevalence of vancomycin-resistant Enterococci is low. The prevalence of Carbapenem-resistant Klebsiella pneumoniae is still on a high level, but the trend is downwards.