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 evaluate the analgesic effect of tetrodotoxin (TTX) in four types of acute pain models and provide experimental support for its rational application. Methods Mice or rats were intramuscularly pretreated with morphine (1 mg/kg) or TTX (0, 0.5, 1, 2, 4 and 8 μg/kg) 40 min before acetic acid writhing test, formalin stimulation test, hot plate test or tail flick test. Pain response or pain threshold were recorded, and inhibition rate was calculated during the tests. The arachidonic acid of serum was determined by Elisa. Results Significant analgesic effects were observed with morphine in all four acute pain models. TTX dose-dependently reduced the number of writhing induced by acetic acid and inhibited the pain response induced by formalin during phase I and phase II, with the highest inhibition rate of more than 80.00% in two pain models. TTX showed analgesic effect in tail flick test and hot plate test, with the highest inhibition rate of 25.00% and 19.79%, respectively. Both acetic acid and formalin increased arachidonic acid in animal serum, but TTX had no significant inhibitory effect on the releasing of arachidonic acid. Conclusion TTX showed significant analgesic effect in the chemical stimulation pain models induced by acetic acid and formalin, but limited analgesic effect was observed on the physical stimulation pain model induced by heat (hot plate and hot water). TTX may produce analgesic effect by blocking the inflammatory mediators mediating pain response.

Objective To investigate the expression of PRR11 in bladder cancer tissues and its effect on proliferation and apoptosis of bladder cancer cell line T24. Methods The expression of PRR11 was detected using immunohistochemistry method in 57 specimens of bladder urothelial carcinoma and adjacent tissues. The correlations of PRR11 expression with the clinicopathological characteristics of patients with bladder urothelial carcinoma were analyzed. The mRNA and protein expression levels of PRR11 in human immortalized bladder epithelial cell lines SV-HUC-1 and human bladder cancer cell lines HTB-9, T24, J82 and UM-UC-3 were measured by qRT-PCR and Western blot. The gene expression of PRR11 in T24 cells was silenced by lentivirus shRNA. The mRNA expression level of PRR11 was detected by qRT-PCR. CCK-8 was used to detect cell proliferative activity. Cell clonality was detected by plate cloning assays. The rate of apoptosis was evaluated using flow cytometry. The protein expression levels of PRR11, Caspase-3, Bcl-2 and Bax were assessed by Western blot. Results PRR11 was highly expressed in bladder urothelial carcinoma, and its expression level was correlated with the pathological grade and T stage of the tumor. The mRNA and protein expression levels of PRR11 in HTB-9, T24, J82 and UM-UC-3 cells were higher than those in SV-HUC-1 cells (P < 0.05), especially in T24 cells. PRR11 gene silence reduced the expression levels of PRR11 mRNA and protein, as well as the cell proliferation activity and cell clonality, elevated the apoptosis rate, up-regulated the protein expression levels of Cleaved caspase-3 and Bax, and down-regulated the protein expression level of Bcl-2. Conclusion The expression of PRR11 is upregulated in bladder urothelial carcinoma tissues and bladder cancer cell lines. Interfering with PRR11 expression can inhibit the proliferation and promote the apoptosis of bladder cancer T24 cells.

Objective:To evaluate the feasibility, safety and efficacy of robotic-assisted lateral lymph node dissection for mid-low advanced rectal cancer.Methods:A retrospective cohort study was performed. Inclusion criteria: (1) age between 18 and 80 years old; (2) rectal adenocarcinoma diagnosed by pathology; (3) without distant metastasis by preoperative CT or MRI; (4) patients underwent robotic-assisted total mesorectal resection (TME). Exclusion criteria: (1) conversion to open surgery; (2) multiple primary tumors; (3) patients underwent combined multiple organ resection. According to the above criteria, 137 patients undergoing robotic-assisted mid-low rectal cancer resection in the First Affiliated Hospital of Xi′an Jiaotong University from December 2016 to April 2019 were enrolled. Ninety-seven cases underwent robotic-assisted total mesorectal excision (TME group) and 40 underwent robotic-assisted total mesorectal resection with lateral lymph node dissection (LLND) (TME+LLND group, pelvic LLND was performed with neurovascular guidance to retain pelvic autonomic nerves in the order of the left side the first and then the right side). The propensity score matching of 1:1 was performed with R software, based on age, sex, BMI, ASA classification, distance from tumor to the anal verge, preoperative chemoradiotherapy history, preoperative abdominal surgery history, the size of tumors and TNM stage. The operative indicators, postoperative recovery, pathology and postoperative complications within 30 days were compared between the two groups.Results:A total of 72 cases were successfully matched (36 in each group), and there were no statistically significant differences in baseline data between the two groups (all P>0.05). The operation time of TME+LLND group was significantly longer than that of TME group [275.0 (180-405) minutes vs. 220.0 (140-320) minutes, Z=-3.680, P<0.001], while there were no statistically significant differences in blood loss during operation, time to postoperative first flatus, postoperative hospital stay, total hospital cost, tumor differentiation, and distal resection length of margin (all P>0.05). Circumferential resection margin was all negative in both groups. The number of harvested lymph modes in the TME+LLND groups was higher than that in the TME group [26 (18-37) vs. 14 (9-36), Z=-6.407, P<0.001]. In addition, there were no statistically significant differences in postoperative morbidity and Clavien-Dindo classification of complication within 30 days between the two groups (both P>0.05). Conclusions:Although robotic lateral lymph node dissection requires longer operation time, it is a feasible, safe and effective procedure.

Objective:To evaluate the feasibility, safety and efficacy of robotic-assisted lateral lymph node dissection for mid-low advanced rectal cancer.Methods:A retrospective cohort study was performed. Inclusion criteria: (1) age between 18 and 80 years old; (2) rectal adenocarcinoma diagnosed by pathology; (3) without distant metastasis by preoperative CT or MRI; (4) patients underwent robotic-assisted total mesorectal resection (TME). Exclusion criteria: (1) conversion to open surgery; (2) multiple primary tumors; (3) patients underwent combined multiple organ resection. According to the above criteria, 137 patients undergoing robotic-assisted mid-low rectal cancer resection in the First Affiliated Hospital of Xi′an Jiaotong University from December 2016 to April 2019 were enrolled. Ninety-seven cases underwent robotic-assisted total mesorectal excision (TME group) and 40 underwent robotic-assisted total mesorectal resection with lateral lymph node dissection (LLND) (TME+LLND group, pelvic LLND was performed with neurovascular guidance to retain pelvic autonomic nerves in the order of the left side the first and then the right side). The propensity score matching of 1:1 was performed with R software, based on age, sex, BMI, ASA classification, distance from tumor to the anal verge, preoperative chemoradiotherapy history, preoperative abdominal surgery history, the size of tumors and TNM stage. The operative indicators, postoperative recovery, pathology and postoperative complications within 30 days were compared between the two groups.Results:A total of 72 cases were successfully matched (36 in each group), and there were no statistically significant differences in baseline data between the two groups (all P>0.05). The operation time of TME+LLND group was significantly longer than that of TME group [275.0 (180-405) minutes vs. 220.0 (140-320) minutes, Z=-3.680, P<0.001], while there were no statistically significant differences in blood loss during operation, time to postoperative first flatus, postoperative hospital stay, total hospital cost, tumor differentiation, and distal resection length of margin (all P>0.05). Circumferential resection margin was all negative in both groups. The number of harvested lymph modes in the TME+LLND groups was higher than that in the TME group [26 (18-37) vs. 14 (9-36), Z=-6.407, P<0.001]. In addition, there were no statistically significant differences in postoperative morbidity and Clavien-Dindo classification of complication within 30 days between the two groups (both P>0.05). Conclusions:Although robotic lateral lymph node dissection requires longer operation time, it is a feasible, safe and effective procedure.

Objective To explore the value of quantitative parameters of gemstone spectral CT in the diagnosis of pulmonary embolism (PE). Methods 29 patients with PE were examined by gemstone spectral CT under GSI scanning mode.The pulmonary embolus on CTPA image were detected and the location and number of embolus were recorded.A variety of quantitative parameters of the embolic and normal areas were measured by the GSI Viewer.Paired t test was used to compare and analyze the quantitative parameters,and ROC curve was used to evaluate the diagnostic efficacy of quantitative parameters.Results 76 clots were diagnosed by CTPA in 29 patients.The iodine content,slope of energy spectrum curve and corresponding CT of 40 keV in the embolic area were significantly lower than those in the normal area (P＜0.001),there were no significant differences in water content and effective atomic number between the embolic and normal area;The ROC curve analysis showed that iodine content had the largest area under the diagnosis curve of pulmonary embolism (0.84)with the specificity of 88% and the sensitivity of 65%.The AUC could be up to 0.89 when three quantitative parameters were combined to get the ROC curve,with the sensitivity of 82% and the specificity of 90%.Conclusion Some quantitative parameters of the pulmonary embolic area are lower than those in the normal area,which indirectly reflect the abnormal blood perfusion of the embolism and provide more basis for the early diagnosis,condition assessment and evaluation of therapeutic effect of PE.

Objective To investigate the effect of Shenxiong glucose injection on platelet reactivity during aspirin treatment in patients with acute ischemic stroke.Methods A total of 263 patients with acute ischemic stroke admitted to 12 hospitals from January 2014 to December 2016 were enrolled prospectively.They were randomly divided into aspirin group and aspirin + Shenxiong glucose injection group.The changes of platelet maximum aggregation rate induced by 4 platelet aggregating agents (arachidonic acid,adenosine diphosphate,collagen and platelet activating factor) were detected before and after the treatment.Results There were no significant differences in the demographic data and baseline clinical characteristics between the aspirin group (n =132) and the Shenxiong glucose injection + aspirin group (n =131).At baseline,the maximum aggregation rate of platelet induced by arachidonic acid and platelet activating factor in Shenxiong glucose injection + aspirin group was significantly higher than that in the aspirin group (all P ＜0.05).On the 6th day after treatment,the maximum aggregation rate of platelets induced by the 4 aggregating agents in the Shenxiong glucose injection + aspirin group was significantly lower than that in the aspirin group (all P ＜ 0.001).Conclusion Shenxiong glucose injection had a significant inhibitory effect on platelet reactivity during aspkin treatment in patients with acute ischemic stroke.

OBJECTIVE:To systematically evaluate therapeutic efficacy and safety of recombinant mutant human tumor necrosis factor(rmhTNF)versus pleural perfusion of cisplatin in the treatment of malignant pleural effusions,and to provide evidence-based reference in clinic. METHODS:Retrieved from PubMed,Cochrane Library,Web of Science,CJFD,Wanfang database,VIP and CBM,RCTs about rmhTNF(trial group)vs. cisplatin(control group)in the treatment of malignant pleural effusions were included. Meta-analysis was conducted by using Rev Man 5.3 statistical software after quality evaluation and data extraction with Cochrane system evaluator manual 5.3.0. RESULTS:A total of 7 RCTs were included,involving 478 patients. Meta-analysis showed that clinical total response rate of trial group [RR=1.43,95%CI(1.27,1.62),P<0.001] was significantly higher than that of control group,with statistical significance. There was no statistical significance in the incidence of gastrointestinal reaction[RR=1.15,95%CI(0.73,1.80),P=0.55],chest pain[RR=1.12,95%CI(0.73,1.73),P=0.60],fever[RR=0.62,95%CI(0.35,1.08),P=0.09] and myelosuppression[OR=0.94,95%CI(0.57,1.54),P=0.79] between trial group and control group. CONCLUSIONS:Pleural perfusion of rmhTNF is significantly better than cisplatin in the treatment of malignant pleural effusions. The incidences of gastrointestinal reaction,chest pain,fever and myelosuppression induced by rmhTNF were similar to those induced by cisplatin.

Objective To investigate the independent association of serum Fetuin-B with metabolic syndrome in obese Chinese adults.Methods Cross-sectional data on socio-demographic,lifestyle,clinical characteristics, and serum Fetuin-B were collected for 1 318 Chinese adults with central obesity.Associations of serum Fetuin-B with metabolic syndrome and insulin resistance were analyzed using multivariable Logistic regression analysis.Results A total of 820(62.2%)individuals were identified as metabolic syndrome.Subjects with metabolic syndrome showed significantly increased levels of serum Fetuin-B than those with non-metabolic syndrome[(4.18 ±1.39 vs 4.02 ± 1.35)μg/ml,P=0.043].Increased serum Fetuin-B were significantly associated with increased fasting plasma glucose and insulin levels, as well as prevalences of non-alcoholic fatty liver disease(NAFLD)and insulin resistance.After adjustment for potential confounders, serum Fetuin-B was significantly associated with increased risks of metabolic syndrome and insulin resistance(OR=1.19,95%CI 1.06-1.34,P=0.004;OR=1.15,95%CI 1.01-1.30,P=0.031 respectively).Conclusion Serum Fetuin-B level was significantly associated with NAFLD;and elevated serum Fetuin-B was significantly associated with increased risk of metabolic syndrome.

Objective To investigate the prevalence of feeding intolerance (FI),and to explore the FI within 7 days of ICU admission in association with clinical outcome in critically ill patients.Methods The adult patients from 14 general ICUs in Zhejiang Province with an expected admission to ICU for at least 24h were recruited from March 2014 to August 2014,and all clinical,laboratory,and survival data were prospectively collected.The AGI (acute gastrointestinal injury) grade was daily assessed based on gastrointestinal (GI) symptoms,feeding details and organ dysfunction within the first week of ICU stay.The intra-abdominal pressures (IAP) was measured using AbViser device.Results Of 550 patients enrolled,418 were assessed in GI symptoms and feeding details within 7 days of ICU stay.The mean age and SOFA score were (65.1 ± 18.3) years and (8.96 ±4.10),respectively.Of them,355 patients (84.9％) were under mechanical ventilation support,and 37 (8.85％) received renal replacement therapy.The mean length of time for enteral feeding was (30.8 ±26.2) h,and the prevalence of FI on the 3rd and 7th day of ICU stay accounted for 39.2％ and 25.4％,respectively.Compared to those with FI within 7 days of ICU stay,the patients without FI had higher rate of successively weaning from mechanical ventilation (21.3％ vs.5.7％,P =0.003) and higher rate of withdrawal of vasoactive medication (45.5％ vs.20.0％,P =0.037),as well as lower mortality rate of 28-day (24.4％ vs.38.7％,P =0.004) and 60-day (29.6％ vs.44.3％,P =0.005).In multivariate Cox regression model with adjustment for age,sex,participant center,serum creatinine and lactate,AGI grade on the first day of ICU stay,and comorbidities,the FI within 7 days of ICU stay (x2 ≥ 7.24,P ＜ 0.01) remained to be independent predictors for 60-day mortality.After further adjusted for SOFA score,the FI within 7 days of ICU stay (HR =1.71,95％ CI:1.18-2.49;P =0.006) and AGI grade on the first day of ICU stay (HR =1.33,95 ％ CI:1.07-1.65;P =0.009) could provide independent prognostic values of 60-day mortality.Conclusions There is high rate of FI occurred within 7 days of ICU stay,and is significantly associated with worse outcome.In addition,this study also provides evidence to further support that measurement of gastrointestinal dysfunction could increase value of SOFA score in outcome prediction for the risk of 60-day mortality.