Objective To explore the application effect of"Internet + Medical treatment"model in patients with pulmonary rehabilitation after lung cancer surgery.Methods A total of 87 patients with lung cancer who received elective surgery in our hospital from June 2022 to January 2023 were selected and divided into control group(44 cases)and observation group(43 cases)according to random number table method.The control group received routine intervention,and the observation group received intervention based on"Internet + medical treatment"mode.The pulmonary function indexes[forced vital capacity(FVC),first second forced vital capacity(FEV1),respiratory flow(PEF)],cardiorespiratory endurance level[6min walking test(6MWT)],respiratory fatigue and quality of life(WHOQOL-BREF)of the two groups were compared.Results After 6 months of intervention,the scores of FVC,FEV1,PEF,6MWT distance and WHOQOL-BREE in the study group were higher than those in the control group,and the scores of respiratory fatigue were lower than those in the control group,with statistical significance(P<0.05).Conclusion"Internet + Medical treatment"intervention can improve lung function,increase cardiopulmonary endurance,reduce respiratory fatigue and improve quality of life in patients recovering from lung cancer surgery.

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.

The development of longitudinal cohorts has made the identification and surveillance of multiple biological markers and behavioral factors which influence disease course or health status become possible. However, traditional statistical methods typically use univariate longitudinal data for research, failing to fully exploit the information from multivariate longitudinal data. The group-based multi-trajectory model (GBMTM) emerged as a method to study the developmental trajectory of multivariate data in recent years. GBMTM has distinct advantages in analyzing multivariate longitudinal data by identifying potential subgroups of populations following similar trajectories by multiple indicators that influence the outcome of interest. In this study, we introduced the application of GBMTM by explaining the fundamental principles and using the data from a health management study in the elderly by using smart wearing equipment to investigate the relationship between multiple life-related variables and hypertension to promote the wider use of GBMTM in longitudinal cohort studies.

Objective:To explore the effectiveness of SECI (socialization, externalization, combination, and internalization) model in clinical practice training of hematology nurses.Methods:A total of 86 students from the clinical practice training course for hematology nurses from October 2022 to September 2023 were selected as the research subjects. The 43 trainees who received practical training from October 1, 2022 to March 31, 2023 were included in the traditional group, and the 43 trainees who received practical training from April 1, 2023 to September 30, 2023 were included in the observation group. The traditional group received traditional teaching, while the observation group received SECI teaching. After the training, basic assessment and satisfaction evaluation were conducted, and a long-term evaluation was conducted at 6 months after the training. The t test and chi-square test were performed using SPSS 25.0. Results:The observation group had higher scores in case reports [(92.03±2.21) vs. (88.14±2.36)], theoretical assessments [(95.61±3.79) vs. (86.58±3.75)], and operational assessments [(96.24±1.45) vs. (90.13±1.41)] compared with the traditional group (all P<0.05). The observation group had higher scores for teaching plans, teaching methods, teaching effectiveness, teaching atmosphere, internship content, and overall satisfaction with practical training than the traditional group ( P<0.05). The long-term evaluation showed that the theoretical and operational assessment scores of the observation group were higher than those of the traditional group at 6 months after training (both P<0.05). Conclusions:The application of SECI teaching in the clinical practice training of hematology nurses has shown good results, which can help nurses better grasp clinical theoretical knowledge and significantly improve their practical operation ability and training satisfaction.

Objective:To establish a pediatric visualized teaching network containing disease images and videos, and to investigate its application effect in assisting the integrated online-offline teaching of pediatric students.Methods:The medical students of classes 2014 and 2015 in the eight-year program who studied as an intern in Department of Pediatrics, Peking Union Medical College Hospital, were enrolled as subjects. The medical students of class 2014 before the application of the pediatric visualized teaching network in the integrated online-offline teaching of pediatrics were enrolled as control group ( n=75), and the medical students of class 2015 after the application of the network were enrolled as experimental group ( n=64). The two groups were compared in terms of the results of group interview and the scores of clinical competency self-assessment scale before and after teaching assisted by the pediatric visualized teaching network. SPSS 26.0 software was used to perform a statistical analysis, with a significance level of α=0.05. Results:During the interview, most students thought that the visualized teaching network improved their learning interest in pediatrics and reduced the emotion of fear of difficulties when they just entered the pediatric internship. They were more confident in operation, and there were also increases in the degree of participation and success rate of operation. There were significant differences between the control group and the experimental group in the scores of six dimensions of the clinical competency self-assessment scale, professional competence [(3.1±0.4) vs. (4.2±0.6), P<0.001], knowledge and skills [(3.7±0.9) vs. (4.2±0.8), P<0.001], patient care [(3.7±0.8) vs. (4.3±0.6), P<0.001], communication and cooperation [(3.7±0.4) vs. (4.2±0.7), P<0.001], teaching ability [(3.8±0.5) vs. (4.3±0.8), P<0.001], lifelong learning [(3.9±0.6) vs. (4.4±0.6), P<0.001]. Conclusions:The visualized teaching network promotes the transformation of offline teaching to integrated online-offline teaching and the optimization of clinical competency-oriented teaching system.

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 study the effects of Danggui-Chuanxiong herb pair medicine on vasoactive substances,adhesion factors,inflammatory factors,and VEGF-PI3K-AKT/NF-κB signaling pathways,in order to elucidate the mechanism of Danggui-Chuanxiong herb pair on the treatment of ischemic stroke(IS).Methods The oxygen glucose deprivation/reoxygenation(OGD/R)model of human umbilical vein endothelial cells(HUVEC)was constructed,and the cell viability was detected by cell proliferation kit(CCK-8 method)to explore the optimal modeling time of seven components;The release of lactate dehydrogenase(LDH)was detected by cytotoxicity kit;The expression of related cytokines was detected by enzyme-linked immunosorbent assay(ELISA);The mRNA expression of key proteins in the signaling pathway was detected by reverse transcription-polymerase chain reaction(RT-PCR).Results Reoxygenation after 6 h of oxygen-glucose deprivation of HUVEC is the best modeling time.High-dose chlorogenic acid group,ferulic acid group,senkyunolide H,low-dose and medium-dose butylidenephthalide group,medium-dose and high-dose senkyunolide A and ligustilide groups significantly decreased LDH leakage rate(P<0.05,P<0.01);The expression of IL-6 in the cells of the partial dose group of chlorogenic acid,caffeic acid,butenylphthalide,senkyunolide H and senkyunolide A was significantly increased,the expression of IL-1 in the cells of the partial dose group of chlorogenic acid,ferulic acid and senkyunolide A was significantly decreased,the expression of VEGF,ICAM-1 and VCAM-1 in the cells of the partial dose group of chlorogenic acid,ferulic acid and senkyunolide H was significantly decreased,the expression of NF-κB in the cells of the partial dose group of chlorogenic acid,ferulic acid,senkyunolide H and ligustilide was significantly decreased,the expression of PAI-1 in the cells of ferulic acid and senkyunolide H partial dose group decreased significantly(P<0.05,P<0.01);The mRNA relative expression levels of ERK,VEGF,NF-κB,VEGFR2 and MMP9 were significantly down-regulated in the cells of chlorogenic acid,ferulic acid,caffeic acid,butylidenephthalide and senkyunolide A partial dose group,while the mRNA relative expression levels of AKT were significantly up-regulated in the cells of senkyunolide H and senkyunolide A partial dose groups(P<0.05,P<0.01).Conclusion The medicinal components of Danggui-Chuanxiong herb pair may play a role in IS by inhibiting the mRNA expression of adhesion factor,inflammatory factor and key protein of VEGF-PI3K-AKT/NF-κB signaling pathway in HUVEC.

Objective:To evaluate the efficacy and safety of Qingxuan Zhike granules in improving cough symptoms and shortening the course of influenza (wind-heat invading lung) in children.Methods:In this multicenter, randomized, controlled clinical trial, a total of 240 outpatient influenza patients from 7 hospitals, including the First Affiliated Hospital of Yunnan University of Traditional Chinese Medicine, from April 2023 to December 2023 were collected.The subjects were randomly divided into the control group and the experimental group via SAS software using the block randomization method.The differences between two groups were compared with t test, corrected t test and χ2 test.Subjects in the control group were given Oseltamivir phosphate granules, orally, twice a day (weight ≤15 kg, 30 mg/time; weight >15-23 kg, 45 mg/time; weight >23-40 kg, 60 mg/time; weight >40 kg, 75 mg/time; age≥13 years, 75 mg/time).In addition to Oseltamivir phosphate granules, subjects in the experimental group were also given Qingxuan Zhike granules, orally, 3 times a day (1-3 years old, 1/2 bag each time; >3-6 years old, 3/4 bag each time; >6-14 years old, 1 bag each time).After 5 days of treatment, the medication was suspended for 2 days.The effect of cough, antipyretic effect, clinical recovery rate, clinical recovery time, Canadian Acute Respiratory Illness and Flu Scale (CARIFS) score, traditional Chinese medicine (TCM) syndrome effect, complication rate, and adverse reactions were evaluated between the two groups. Results:Finally, 232 cases were included in the study, including 115 cases in the experimental group and 117 cases in the control group.Before and after treatment, there were no significant difference in CARIFS cough score between the experimental group and the control group (all P>0.05).After treatment, the change in CARIFS cough score in the experimental group [(-1.00±0.91) scores]was significantly higher than that in the control group [(-0.75±0.98) scores] ( t=-1.995, P=0.047).After treatment, the change in TCM syndrome cough score in the experimental group [(-1.69±1.51) scores] was significantly higher than that in the control group [(-0.97±1.63) scores] ( t′=-0.035, P=0.001).The time of complete regression of fever in the experimental group [(44.82±22.72) h] was shorter than that in the control group [(51.35±27.07) h], and the difference between the two groups was statistically significant ( t=-1.966, P=0.050).The fever score showed that the area under the curve between the CARIFS symptom fever score and time in the experimental group was 4.40±2.42, while that in the control group was 5.12±2.44, and the difference between the two groups was statistically significant ( t=-2.252, P=0.025).The clinical recovery rate was 93.91%(108/115) in the experimental group and 92.31%(108/117) in the control group, and there was no significant difference between the two groups ( χ2=0.233, P>0.05).The clinical recovery time in the experimental group [(2.93±1.21) d] was shorter than that in the control group [(3.29±1.15) d], and the difference between the two groups was statistically significant ( t=-2.279, P=0.024).After treatment, there was a significant difference in TCM syndrome score variation between the experimental group [(-12.00±4.13) scores] and the control group [(-10.85±4.31) scores] ( t′=-2.067, P=0.040).No complication occurred in both groups, and there was no significant difference in the incidence of adverse events between the two groups ( χ2=1.299, P>0.05). Conclusions:Qingxuan Zhike granules combined with Oseltamivir phosphate can effectively improve the cough symptoms associated with influenza in children, shorten the time and course of fever, and improve the TCM syndrome score; thus, they are safe in clinical application.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective To investigate the correlations of serum levels of NOD-like receptor family CARD domain containing 3 (NLRC3) and extracellular matrix protein 1 (ECM1) with the development of acute respiratory distress syndrome (ARDS) in patients with sepsis. Methods A total of 133 patients with sepsis were enrolled in sepsis group, and 80 healthy individuals during the same period were included in control group. The sepsis group was further divided into ARDS group (52 cases) and non-ARDS group (81 cases) based on the presence or absence of ARDS. Serum levels of NLRC3 and ECM1 expression were measured using enzyme-linked immunosorbent assays (ELISA). Multivariate Logistic regression analysis was used to identify factors associated with the development of ARDS in sepsis patients. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of serum NLRC3 and ECM1 levels for ARDS in sepsis patients. Results Compared with the control group, the sepsis group had significantly lower serum NLRC3 level and higher ECM1 level (P < 0.05). The incidence of ARDS in the 133 sepsis patients was 39.10% (52/133). Compared with the non-ARDS group, the ARDS group had significantly lower serum NLRC3 level and higher ECM1 level (P < 0.05). Independent risk factors for the development of ARDS in sepsis patients were increased Sequential Organ Failure Assessment (SOFA) score, elevated blood lactate level and increased ECM1 level, while increased NLRC3 level was an independent protective factor (P < 0.05). The area under the curve for the combined prediction of serum NLRC3 and ECM1 expression in sepsis patients with ARDS was 0.887, which was greater than 0.811 and 0.792 predicted by serum NLRC3 and ECM1 expression alone (P < 0.05). Conclusion Decreased serum NLRC3 level and increased ECM1 level are closely associated with the development of ARDS in sepsis patients. The combined assessment of serum NLRC3 and ECM1 level has a high predictive value for ARDS in sepsis patients.