Objective:To conduct a qualitative analysis of the operating room service demands of patients undergoing foraminal endoscopic surgery based on the Kano model, and the influence of satisfaction on each demand was calculated to provide a basis for the development of targeted improvement strategies.Methods:A cross-sectional study method was adopted to select 510 patients from the Affiliated Hospital of Qingdao University with foraminal endoscopic surgery from January 2022 to June 2023 by convenient sampling method. Kano two-factor questionnaire was compiled from five dimensions of surgical environment needs, information and knowledge needs, surgical safety needs, surgical nursing quality needs, emotional support needs and psychological needs for investigation, and the attribute classification of needs was determined. The service demand importance-satisfaction matrix of patients undergoing foraminoscopic surgery was drawn.Results:Finally, 472 patients were enrolled. with 217 males and 255 females, aged (57.78 ± 12.61) years old. Among the 42 operating room service needs of patients undergoing foraminal endoscopic surgery, 12 were attractive attributes (28.57%), 7 were expected attributes (16.67%), 17 were necessary attributes (40.48%), and 6 were indifferent attributes (14.29%). The importance-satisfaction matrix shows that there were 2 improvement needs for the first best, 2 improvement needs for the middle best and 15 improvement needs for the second best.Conclusions:Kano model can clearly define the demand attributes of patients undergoing local anesthesia foraminal endoscopic surgery and the influence on their satisfaction, effectively guide the priority improvement sequence of demands, and facilitate managers to scientifically and accurately improve surgical patient satisfaction.

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 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 provide ideas for pharmaceutical care of Mycobacterium abscess infection. METHODS The diagnosis and treatment plan ，about a patient with M. abscess infection after resection of intervertebral neurilemmoma participated by clinical pharmacists ，was analyzed . According to the results of bacterial culture and drug sensitivity test of wound secretion ，the clinical pharmacist timely dealed with the adverse drug reactions during the treatment . For the tinnitus caused by the patient taking amikacin（0.4 g，intravenous drip ，q12 h），it was suggested to stop amikacin and replace it with linezolid ；however，the patient suffered from knee pain after taking linezolid . The clinical pharmacist once again suggested stopping linezolid ，continuing to use amikacin，and adjusting the dose to 0.8 g，intravenous drip ，q24 h；at the same time ，the patients were given medication guidance and ordered to have regular follow -up after discharge . RESULTS The physicians adopted the suggestions of clinical pharmacists ， and the patient did not suffer from tinnitus ，knee pain and other discomfort ，and the liver and kidney functions were normal . CONCLUSIONS Clinical pharmacists timely assist clinicians to adjust the medication plan ，which improves the effectiveness and safety of patients ’medication.

OBJECTIVE: To report on the diagnosis and treatment process and clinical characteristics of a child with disorder of sex development (DSD) and to conduct pathological, imaging and genetic analysis for the patient. METHODS: Clinical data of the patient were collected. Genetic testing including chromosomal karyotyping, fluorescence in situ hybridization (FISH), copy number variations (CNVs) analysis, SRY gene detection and multiple ligation-dependent probe amplification (MLPA) were carried out. RESULTS: The patient had a social gender of male, with a history of hypospadia and breast development. Sex hormone tests showed slightly raised prolactin. Imaging results showed bilateral breast hyperplasia, abnormal seminal vesicle glands, rudimentary uterus, and underdeveloped right testis. Intraoperative examination revealed that the child had an ovary on the left and a testis on the right. The pathological results showed fibroadenomatoid changes in the breast. The patient had a karyotype of 46,XX. FISH results showed 46,XX.ish(DXZ1x2, SRYx0). Molecular testing showed that NR0B1, PHEX, CXORF21, GJB1, PQBP1, and COL4A5 genes are duplicated. There was a presence of SRY gene and absence of UYT gene. CONCLUSION DSD should be considered in patients with genital abnormality and male breast development. Ultrasound, sex hormone test and genetic testing should be performed to confirm the diagnosis of DSD, and molecular testing should be performed if necessary. Individualized treatment of DSD patient requires cooperation of multiple clinical disciplines.
Child, Preschool ; DNA Copy Number Variations ; DNA-Binding Proteins/genetics* ; Disorders of Sex Development/genetics* ; Female ; Genetic Testing ; Gonadal Steroid Hormones ; Humans ; In Situ Hybridization, Fluorescence ; Male ; Sexual Development/genetics*

Objective:To study the clinical value of color Doppler ultrasonography in the diagnosis of persistent sciatic vein(PSV).Methods:A retrospective study was performed on 17 patients who were diagnosed with PSV by color Doppler ultrasound in the Second Hospital of Shandong University and the Shandong Provincial Hospital Affiliated to Shandong First Medical University from May 2010 to December 2021. Their sonographic features were analyzed, summarized and classified.Results:In all the 17 cases, the sciatic vein showed a vein adjacent to the sciatic nerve in the pelvis or back of the thigh. According to anatomy, persistent sciatic vein could be divided into three types: complete PSV, upper PSV and lower PSV. There were 7 cases of complete PSV, 2 cases of upper PSV and 8 cases of lower PSV. Femoral vein dysplasia was found in 11 of 17 patients with PSV. In addition to 1 case of bilateral PSV, the diameter of the femoral vein on the affected side was (0.36±0.19)cm in 16 cases, and the diameter of femoral vein at the corresponding position on the healthy side was (0.61±0.11)cm, there was significant difference between the two groups ( P<0.001). Conclusions:Color Doppler ultrasonography is the effective imaging method for diagnosis of the PSV.

Objective:To identify 49 Aeromonas caviae strains isolated form foodborne and environmental samples and analyze their virulence and antibiotic resistance. Methods:All strains were identified by VITEK and API 20NE. Two housekeeping genes, gryB and rpoD, were amplified by PCR for phylogenetic analysis. Virulence genes including act, alt, ast, lip, ahp, aerA, hlyA, ompA1 and fla were detected by PCR. In vitro antimicrobial susceptibility of these strains was tested with AST-GN16 kit. Results:Fifty-four Aeromonas caviae/ Aeromonas hydrophila strains were identified by biochemical tests. Phylogenetic analysis revealed that there were 49 Aeromonas caviae strains, four Aeromonas hydrophila strains and one Aeromonas taiwanensis strain. The positive rates of alt, lip, ompA1, fla, act, aerA and hlyA genes were 100.00%, 100.00%, 79.59%, 14.29%, 2.04%, 2.04% and 2.04%, respectively. None of the isolates carried ast or ahp gene. A total of four virulence gene combination patterns were detected, and the predominant pattern was alt/ lip/ ompA1 (32/49). Antibiotic resistance rates of the Aeromonas caviae strains to ampicillin, cefazolin, cefoxitin, amoxicillin/clavulanic acid, ceftriaxone, trimethoprim/sulfamet hoxoazole and aztreonam were 79.59%, 14.29%, 10.20%, 6.12%, 4.08%, 4.08% and 2.04%, respectively. All strains were susceptible to piparacillin/tazobactam, imipenem, amikacin, gentamicin, levofloxacin, tigacycline and nitrofurantoin. Two multidrug-resistant strains were detected. Conclusions:Aeromonas caviae/ Aeromonas hydrophila can be effectively identified by the housekeeping genes gyrB and rpoD, and the closely related Aeromonas caviae and Aeromonas taiwanensis strains can be identified by rpoD. All Aeromonas caviae strains carried two or more virulence genes and one strain isolated from environment was positive for seven virulence genes. Aeromonas caviae strains were generally resistant to penicillin, which was mainly relate to the production of β-lactamase. No strain was resistant to carbapenems, aminoglycosides, fluoroquinolones, tetracyclines or furans. Multidrug-resistant strains were observed in food and drinking water.

Objective: The objective of this study was to verify the lipid-lowering effect of Juhe Fang extract (JHFE) and to determine its characteristic chemical profile in vitro and in vivo. Methods: A hyperlipidemia model was established by feeding mice a high-fat diet (HFD). After treatment for 30 days, serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels were measured with an automatic biochemistry analyzer. The components from JHFE obtained from in vivo and in vitro experiments were investigated using an UPLC-Q Exactive-Orbitrap MS/MS. Results: The TC, TG, and LDL-C in the serum significantly decreased and the HDL-C significantly increased after JHFE treatment. A total of 95 compounds from JHEF including 15 phenolic acids (PA), 4 phenyl-ethanoid glycosides (PG), 24 flavonoids (F), 14 triterpenoids (T), 10 diterpenoid glycosides (D), 18 alka-loids (A) and 10 others (O) were identified. Trigonelline was discovered for the first time in a herbal medicine of Juhe Fang. Furthermore, 68 compounds were identified in vivo including 28 prototype compounds and 40 metabolites. The metabolic characteristics of these components were revealed including identification of new metabolites of 4-hydroxyphenyl ethyl-8-O-[α-L- arabinopyranosyl-(1→6)]-β-D-glucopyranoside (PEG) and lirinidine. A total of 43 components from JHFE were absorbed and/or metabolized. The contribution rate of each type of chemical component from JHFE to its lipid-lowering effect from high to low were A, F, PG, PA, D and T. Conclusion: The results of this study showed that JHFE demonstrated a significant lipid-lowering effect in a high-fat diet (HFD)-induced hyperlipidemia mouse model. Specific types of PA, PG, F, D, T and A formed the pharmaceutical architecture of the lipid-lowering effect of JHFE. This study should prove useful for clarifying the components responsible for the lipid-lowering effect of JHFE and provide a basis for precision quality control research.

OBJECTIVETo diagnose chromosomal abnormalities in amniotic fluid cells by combining karyotyping and single nucleotide polymorphism array (SNP-array) analysis, and to explore the application of SNP-array in routine clinical practice.

METHODSConventional G banding was used to karyotype a fetal amniotic fluid sample and the corresponding peripheral blood samples from the parents, followed by SNP-array analysis of the fetal genomic DNA from the amniotic fluid.

RESULTSThe karyotype of the amniocytes was 47, XX, +mar. The marker chromosome was further identified as psu idic (22) (q11.2) by SNP-array analysis, revealing tetraploidy of a 1.7 Mb fragment in 22q11.1-q11.2 interval that involves the critical region for Cat eye syndrome.

CONCLUSIONA rare chromosomal abnormality was identified by combining conventional G banding and SNP-array. The high resolution SNP-array could provide more detailed information for determining the origin of chromosomal abnormalities.

Adult ; Amniotic Fluid ; cytology ; Aneuploidy ; Chromosome Disorders ; genetics ; Chromosomes, Human, Pair 22 ; genetics ; Eye Abnormalities ; genetics ; Female ; Humans ; Isochromosomes ; Karyotyping ; Polymorphism, Single Nucleotide ; Pregnancy ; Tetraploidy