To analyze the factors associated with infection and death of carbapenem-resistant Klebsiella pneumoniae (CRKP) in patients. Using a case-control study method, patients with CRKP infection from January 2019 to December 2021 in the 3201 Hospital were selected as the case group, and patients with carbapenem-susceptible Klebsiella pneumoniae (CSKP) infection in the same period were selected as the control group in a ratio of 1∶1. The study subjects were followed up for 30 days. The two groups of patients were categorized into survival and death groups based on whether they died or not, respectively, and the 30-day morbidity and mortality rates of the CRKP case group and the CSKP control group were compared. The logistic regression model was used to analyze the factors associated with CRKP infection and death after CRKP infection. This study included 59 cases in the CRKP case group and 59 in the CSKP control group. The 30-day mortality rate of CRKP-infected patients and CSKP-infected patients were 30.5% (18/59) and 5.1% (3/59), with statistically significant differences ( P<0.001). Surgery within three months prior to KP infection ( OR=17.285, P=0.001), use of carbapenems within three months prior to KP infection ( OR=11.235, P=0.002), use of more than three types of antibiotics ( OR=7.993, P=0.016), albumin<30 g/L in patients prior to KP infection ( OR=10.463, P=0.002), sex ( OR=0.078, P<0.001), and diabetes ( OR=0.076, P=0.011) were associated factors of CRKP infection. Higher age-corrected Charlson Comorbidity Index scores of patients ( OR=1.522, P=0.024) and use of carbapenems by the patients with in the first three months prior to the KP infection ( OR=4.902, P=0.029) were associated factors for the deaths of patients with CRKP. In conclusion, medical personnel should be cautious in performing invasive procedures, strictly control the use of antibiotics, and provide targeted protection and treatment for high-risk patients as soon as possible.

Objective To identify symptom clusters in breast cancer patients undergoing chemotherapy and investigate the bridge symptoms that connect the symptom clusters,therefore to provide a guidance for precise intervention in the symptoms.Methods From October 2022 to October 2023,convenience sampling method was employed to selelct 340 breast cancer patients,who underwent postoperative chemotherapy,for investigation in the related symptom clusters and quality of life by using Anderson symptom assessment scale and breast cancer quality of life scale.Cluster analysis was performed to extract the symptom clusters by R software and the impacts of each symptom cluster on quality of life were analysed by stratified regression.A contemporaneous symptom network was constructed to identify the bridge symptoms.Results All 327 patients had completed the study.Three distinct symptom clusters were extracted:-gastrointestinal,psychological and neurological symptom clusters.The gastrointestinal cluster alone accounted for 10.2%of the variation in quality of life.Network analysis highlighted that distress(rbe=3.927,rbs=3.927,rbc=0.436),fatigue(rbe=3.907,rbs=3.907,rbc=0.434)and lack of appetite(rbe=3.842,rbs=3.842,rbc=0.427)were the bridging symptoms which had high expected influence coefficient,strength and closeness centrality index.Conclusion The gastrointestinal symptom cluster makes notably impact on the quality of life in breast cancer patients undergoing chemotherapy.Fatigue,lack of appetite and distress are the bridge symptoms in symptom management strategies in potentially improving the efficiency of intervention and reducing the costs to patient.

To analyze the factors associated with infection and death of carbapenem-resistant Klebsiella pneumoniae (CRKP) in patients. Using a case-control study method, patients with CRKP infection from January 2019 to December 2021 in the 3201 Hospital were selected as the case group, and patients with carbapenem-susceptible Klebsiella pneumoniae (CSKP) infection in the same period were selected as the control group in a ratio of 1∶1. The study subjects were followed up for 30 days. The two groups of patients were categorized into survival and death groups based on whether they died or not, respectively, and the 30-day morbidity and mortality rates of the CRKP case group and the CSKP control group were compared. The logistic regression model was used to analyze the factors associated with CRKP infection and death after CRKP infection. This study included 59 cases in the CRKP case group and 59 in the CSKP control group. The 30-day mortality rate of CRKP-infected patients and CSKP-infected patients were 30.5% (18/59) and 5.1% (3/59), with statistically significant differences ( P<0.001). Surgery within three months prior to KP infection ( OR=17.285, P=0.001), use of carbapenems within three months prior to KP infection ( OR=11.235, P=0.002), use of more than three types of antibiotics ( OR=7.993, P=0.016), albumin<30 g/L in patients prior to KP infection ( OR=10.463, P=0.002), sex ( OR=0.078, P<0.001), and diabetes ( OR=0.076, P=0.011) were associated factors of CRKP infection. Higher age-corrected Charlson Comorbidity Index scores of patients ( OR=1.522, P=0.024) and use of carbapenems by the patients with in the first three months prior to the KP infection ( OR=4.902, P=0.029) were associated factors for the deaths of patients with CRKP. In conclusion, medical personnel should be cautious in performing invasive procedures, strictly control the use of antibiotics, and provide targeted protection and treatment for high-risk patients as soon as possible.

ObjectiveTo investigate the abnormal changes of gray matter structure covariant network in post-stroke aphasia (PSA) patients. MethodsFrom June, 2019 to March, 2022, 15 PSA patients (patient group) from Dongzhimen Hospital, Beijing University of Chinese Medicine and Beijing Bo'ai Hospital were recruited, as well as 15 healthy subjects (control group). Their brain structure magnetic resonance imaging data were collected. The brain covariant network was constructed based on gray matter volume correlation, and graph theory analysis method was used to evaluate the global and node network level topology properties of structural covariant network. The differences of gray matter covariant network properties between patients and controls were compared. ResultsThere was no significant difference in the global network level topology properties between two groups (P > 0.05). At the nodal level, compared with the control group, the betweenness decreased in the right middle frontal gyrus, right posterior cingulate gyrus, right amygdala, left middle occipital gyrus, and increased in the right inferior frontal gyrus and the right suboccipital gyrus of the insula operculum (P < 0.05); the node degree decreased in the left superior frontal gyrus, left anterior cingulate and paracingulate gyrus, left hippocampus and left amygdala, while it increased in the right inferior frontal gyrus, left supplementary motor area, right superior occipital gyrus, right inferior occipital gyrus, and right lentiform pallidus (P < 0.05); the node efficiency decreased in the left anterior cingulate and paracingulate gyrus, left hippocampus, left amygdala, left temporal pole: superior temporal gyrus, and increased in the inferior frontal gyrus of right insula, left supplementary motor area and right suboccipital gyrus (P < 0.05). ConclusionThe abnormal reduction of node network properties in some brain regions in the left hemisphere of PSA patients may be a characteristic structural covariation pattern, and there may be some compensation in the right hemisphere of the structural network in some brain regions.

OBJECTIVE：To provide reference for clinical empirical treatme nt of non-fermentative Gram-negative bacilli （NFGNB）infection. METHODS ：All kinds of clinical specimens were collected from Jan. 2010 to Dec. 2019 in a tertiary hospital from Hanzhong city of Shaanxi province ；the distribution and drug resistance of NFGNB were analyzed retrospectively. RESULTS ： A total of 26 386 strains of pathogenic bacteria were detected in the hospital during 2010-2019，including 4 077 strains of NFGNB （15.45％），mainly from patients ≥60 years old （1 836 strains，45.05％）. During the 10 years，the detection rate of NFGNB decreased from 20.14％ in 2010 to 15.36％ in 2019 （P＜0.001）. Acinetobacter baumannii （1 359 strains），Pseudomonas aeruginosa （1 269 strains），Stenotrophomonas maltophilia （447 strains） and Burkholderia cepacia （351 strains） were main pathogens. The detected NFGNB mainly came from hospitalized patients （4 001 strains），and most of them were found in ICU （17.05％），neurosurgery department （14.52％），respiratory department （12.41％），and respiratory tract （66.69％），secretion （7.80％）specimens. The detection rates of A. baumannii and P. aeruginosa in oncology department ，blood specimens and urine specimens showed an overall upward trend ，while the detection rates in ICU of the hospital showed a downward trend （P＜0.05）； the detection rate of P. aeruginosa in neurosurgery department showed an upward trend （P＜0.05），and that of A. baumannii in respiratory department showed an upward trend （P＜0.05）. The resistance rate of A. baumannii to carbapenems increased from about 10％ in 2010 to about 75％ in 2019，and the guyh3201@163.com resistance rate to cephalosporins exceeded 78％. The resistance rates of P. aeruginosa to imipenem and me ropenem were lower than 35％ and 30％ respectively，and the trend of drug resistance did not change significantly （P＞0.05）；the resistance rates to 12 kinds of clinically commonly used antibiotics as piperacillin and aztreonam were lower than 40％. The resistance rate of S. maltophilia to compound sulfamethoxazole showed a decreasing trend （P＜0.001），and the resistance rate to ceftazidime was high （54.70％-74.10％）. The resistance rates of B. cepacia to compound sulfamethoxazole，meropenem and ceftazidime showed a downward trend （P＜0.01），and were lower than 15％ after 2014. CONCLUSIONS：Although the detection rate of NFGNB in our hospital showed a downward trend ，the multi-drug resistance and pan-drug resistance of A. baumannii are serious ，and the resistance rate to carbapenems is increased. Sensitive drugs such as cefoperazone/sulbactam，amikacin，levofloxacin and ceftazidime should be selected for NFGNB infection according to the results of drug sensitivity tests.

Objective To explore the effects of multidisciplinary cooperative continuous nursing on psychological state and life quality of patients with breast cancer. Methods A total of 105 patients with breast cancer who were to be discharged within February to June 2016 were selected and divided into observation group (n=54) and control group (n=51) randomly. The control group received only routine discharge health education, while the observation group received the multidisciplinary cooperation continuous nursing performed by nurses, doctors, psychologists and nutritionist through wechat, QQ software, telephone interview and patients' clubs. After follow-up for 12 weeks, patients of the two groups were evaluated by self-rating anxiety scale (SAS), self-rating depression scale (SDS) and function assessment of cancer therapy-breast cancer (FACT-B). Results The scores of SAS and SDS in the observation group were (34.18±5.34), (35.73±4.26), and (56.35±7.12), (49.36±6.32) in the control group respectively. The differences were statistically significant (t=21.890,18.340; P<0.01). The total score of life quality of the observation group and the control group was (87.21±6.53) and (82.65±5.34) respectively, with statistical significance (t=3.330, P< 0.01). Conclusions Implementing of multidisciplinary cooperative continuous nursing in patients with breast cancer can reduce anxiety and depression, improve patients' psychological state and quality of life.

Objective To observe the expressions of endoplasmic reticulum chaperone (ERP57) and endoplasmic reticulum aminopep-tidase (ERAP1) in female breast cancer, and to explore their relationship with clinical pathological parameters of breast cancer. Methods A total of 124 samples of breast cancer and 24 samples of breast fibroadenoma were collected in the Affiliated Tumor Hospital of Xinjiang Medical University from January 2011 to December 2015. The expressions of ERP57 and ERAP1 were detected by immunohistochemistry SP method. The patients were divided into two groups according to the clinicopathological parameters. The differences of ERP57 and ERAP1 expression were analyzed between the groups. Results The positive expression rates of ERP57 were 58.8% (73/124) and 100% (24/24) in breast cancer and breast fibroadenoma samples, respectively. The difference was statistically significant (χ2=15.061, P<0.05). The positive expression rates of ERAP1 were 47.5%(59/124) and 83.3%(20/24), and there was a difference between them (χ2=10.328, P<0.05). The positive expression rates of ERP57 and ERAP1 in breast cancer samples were higher in patients without axillary lymph node metastasis than those in patients with axillary lymph node metastasis; which were higher in patients with histological gradeⅠcompared with those in patients with histological grade ⅡandⅢ;which were higher in patients with TNM stage Ⅰ-Ⅱ than those in patients with TNM stage Ⅲ-Ⅳ. There were significant differences between these groups (P<0.05). In addition, the positive expression rate of ERAP1 in breast cancer was higher in patients more than 35 years old than those in patients under 35 years old. The positive rate of Ki67 was higher in patients≤14%than that in patients >14%, and which was significantly higher in patient with non-triple negative than that in patients with the triple negative (P<0.05). Conclusion The low expression levels of ERP57 and ERAP1 may play an important role in the carcinogenesis of breast cancer, and which may be valuable in judging the malignant degree and prognosis of breast cancer.

Objective To study the CBCT image registration of PTV enlarging distance and IMRT planning(CT-1) for patients with lung cancer,and evaluate their characters.Methods Ten patients with lung cancer were included in the study.Two sets image,before and after radiotherapy,were acquired every week.Then delineated the targeted volume and made the planning (CT-2) according the enlarging distance data.To comparize the parameters of DVH for lung and spinal cord,volumes and dose of PTV and NTCP with CT-1 and CT-2.The difference of two plan was analyzed by covariance analysis or Wilcoxson's z-test.Results The max,min and mean dose of PTV,the lung V5,V10,V20,V30,V50 were similar in both plans (P =0.242-0.663).There was superiority in CT-2 of PTV and lung's mean dose(P =0.049,0,035).The NTCP had the decent tendency followed by the increasing of lung Vs,V10,V20(P =0.146,0.053,0.000).Conclusions CBCT based image registration can reduce PTV,the mean dose of lung,NTCP,and increase PTV dose.This provides a tool for exploring acurate radiotherapy strategies.

Objective To explore the preliminary study of the four-dimensional CT-based respiratory gating applications in the IGRT treatment of lung cancer .Methods 38 patients′ were scanned with 4D-CT ,and could got 10 images:0-90% each one ,and then two kinds of radiation treatment plans :Plan-3D and Plan-4D were used ,respectively .Treatment of the patients in the IGRT mode with Plan-4D and following up were done in two months after treatment to evaluate the efficacy and complication probability . Meanwhile evaluation of the two plans by the volume histogram was done .Results The displacement of lung tumor respiratory mo-tion was different in three dimensions ,especially in the Vertical direction ,about(9 .1 ± 2 .2)mm .Accuracy of the distance was 2 .6 mm .The Plan-4D′s CTV was bigger than Plan-3D ,but its PTV was less than the Plan-3D significantly ,at the same time its lung V20 ,MLD were both less than the Plan-3D ,and the difference was statistically significant(P< 0 .05) .The total efficiency(CR+PR)was 77 .78% (28 case);the incidence of 1 ,2 ,3 acute radiation-induced lung injury were 86 .11% ,11 .11% ,2 .78% ,respectively ;the incidence of 1 ,2 acute radiation esophagitis injury were 80 .56% ,8 .33% .Conclusion The respiratory gating techniques based on 4D CT applied in image guided radiotherapy of lung cancer in clinical is feasible ,and it can reduce the volume of the planning tar-get volume ,and help to improve the accuracy of radiotherapy .The degree of respiratory motion is significantly different in individu-als ,and expanding outside the target ranges should be individualized .

Objective To compare image-guided radiotherapy(IGRT) and intensity-modulated radiotherapy(IMRT) treatment in patients with recent efficacy and toxicity of radioactive reaction ,discuss factors affecting prognosis .Methods Collection of 52 cases of IGRT and 55 cases of IMRT patients with non-small-cell lung cancer(NSCLC) ,satisfy the requirement of target prescription dose in the case ,the recent efficacy of tumor ,comparing two treatments in patients with radioactive toxic effects and factors affect-ing the prognosis .Results The incidence of radioactive pneumonia in IGRT group was lower than the IMRT group (P<0 .05) ,the incidence of radiation esophagitis had no statistical differences in the two groups (P>0 .05) .The survival rates of IGRT group 1 , 1 .5 ,2 years after radiotherapy were 57 .7% ,35 .0% ,27 .3% ,IMRT group were 50 .9% ,34 .1% ,21 .8% .The median survival time of IGRT group and IMRT group was 17 months and 13 months respectively ,there was no statistically significant difference(P>0 .05) .Conclusion In NSCLC treatment ,compared with IMRT ,TGRT could reduce the toxic reaction of radiotherapy ,but the effect of two kinds of treatment for the recent difference is not obvious .