OBJECTIVE To investigate the independent risk factors for carbapenem-resistant Klebsiella pneumoniae （CRKP） infection， develop a nomogram prediction model and validate it. METHODS Clinical data of hospitalized patients infected with CRKP between April 2020 and May 2023 at Kunming First People’s Hospital were retrospectively collected and matched 1∶1 with patients infected with carbapenem-susceptible Klebsiella pneumoniae （CSKP） during the same period as the modeling group. Using the same criteria， data from patients hospitalized and infected with CRKP and matched CSKP between June 2023 and June 2024 were collected as the validation group. Univariate analysis， LASSO regression and multivariate Logistic regression were conducted to identify independent risk factors for CRKP infection and to develop a nomogram prediction model. Internal validation of the model was performed using Bootstrap resampling， and external validation was carried out using the data of validation group. The predictive performance of the model was evaluated using receiver operating characteristic （ROC） curves and calibration plots. RESULTS A total of 530 patients were enrolled， with 372 in the modeling group and 158 in the validation group. Cerebrovascular disease， indwelling gastric tube， mechanical ventilation， exposure to carbapenem antibiotics， and exposure to β-lactamase inhibitor compound agents were identified as independent risk factors for CRKP infection （P＜0.05）. The nomogram predicting CRKP infection risk achieved an area under ROC of 0.729 and 0.803 in internal and external validations， respectively. Calibration curves indicated a high degree of consistency between predicted and observed probabilities. CONCLUSIONS Cerebrovascular disease， indwelling gastric tube， mechanical ventilation， exposure to carbapenem antibiotics， and exposure to β-lactamase inhibitor compound agent are independent risk factors for CRKP infection. The developed nomogram model for predicting CRKP infection risk demonstrates good predictive performance and can aid in the early identification of patients at high risk for CRKP infection.

Objective To explore the impact of diagnosis related groups (DRGs) payment and drug zero plus on the management of intensive care medicine department. Methods The clinical data of patients in one year from 2016 to 2017 admitted into the Department of ICU in Liuzhou Worker's Hospital concerning their numbers of discharged patients, transferred patients, bed utilization rate, number of bed turnover, average length of stay of discharged patients, cure and improvement rates, admission and discharge diagnostic coincidence rate, 3-day definite diagnosis rate, clinicopathological diagnosis coincidence rate, rescue success rate, total income, drug proportion, consumable proportion, DRGs payment and settlement data, etc were retrospectively analyzed to explore the dual challenges, DRGs payment and drug zero plus, facing the department and how to respond and deal with them. Results In 2016 and 2017, the total incomes of the department of critical care medicine in our hospital were 42.107 0 million yuan and 41.371 3 million yuan respectively, and the medical insurance incomes were 15.03 million yuan and 16.69 million yuan respectively;in 2016 and 2017, 2 693 patients and 2 922 patients were admitted and treated respectively; 595 patients and 577 patients were discharged respectively, with 2 071 patients and 2 334 patients transferred respectively; the balances of the department were 15.48 million yuan and 29.11 million yuan, respectively. From July to December 2017, the medical insurance DRGs payment data suggested that the proportion of loss of the department be 7.02%. Accelerating the Grade 6 electronic medical records and informationization construction, adopting the severe disease information solution program and fine quality control management in the department of critical care medicine can reduce the cost of manpower. Conclusion Our future development direction in the Department of Intensive Care Medicine includes the following aspects: Open source and reduce expenditure, strictly control the proportions of drugs and consumables, improve the balance of the department, and actively respond and deal with the medical insurance DRGs payment.

Objective To explore the prognostic factors for inability to walk independently in patients with multiple system atrophy (MSA).Methods A total of 123 patients with clinically confirmed MSA admitted to Navy General Hospital and Dongfang Hospital affiliated to the Second Clinical Medical College of Beijing University of Chinese Medicine , from February 2013 to February 2016, were retrospectively reviewed .Clinical data and all records were collected and all subjects were followed up by a telephone call in February 2016.The second milestone of activities of daily living scale (ADL), defined as inability to walk independently , was taken as the primary outcome .Eight possible prognostic factors were investigated and the survival analysis was performed with Cox proportional hazards model regression .Results Of all the MSA patients, 74 subjects were men and 49 were women with a sex radio of 1.51∶1(M∶F).Seventy cases were diagnosed with MSA-cerebellar type ( MSA-C ) and 53 with MSA-Parkinson type ( MSA-P ) (C∶P=1.32∶1).Mean age at the onset of first symptom was (53 ±8) years old.All patients had severe autonomic nervous dysfunction . At the last follow-up, 56 cases ( 45.5%) were unable to walk independently .The median survival time from the onset of MSA to inability to walk independently was 73 months.The age of onset ≥55 years (HR=1.969, 95%CI 1.095-3.542, P=0.024) and the interval time from disease onset to combined motor and autonomic involvement ≤3 years ( HR =2.308, 95%CI 1.158-4.600, P=0.017) were independent prognostic factors for inability to walk independently ,while gender, MSA clinical subtypes, initial symptoms, alcohol intake, smoking and toxic exposure were not indicators for independent walking (P>0.05).Conclusions The prognostic factors for inability to walk independently in patients with MSA are the age of onset ≥55 years and the interval time from disease onset to combined motor and autonomic involvement≤3 years.Although factors including gender , MSA clinical subtypes , initial symptoms , alcohol intake , smoking and toxic exposure are not the predictive factors for inability to walk independently in our MSA patients , their roles in the prognosis of MSA still need further investigation .

Objective:To investigate the efficacy and toxicity of oxaliplatin reintroduction combined with raltitrexed as second-line che-motherapy after the first-line oxaliplatin-based chemotherapy in advanced colorectal cancer patients. Methods:The 48 evaluable pa-tients with advanced colorectal cancer following disease progression prior to the first-line chemotherapy were treated with oxaliplatin and raltitrexed (raltitrexed 3 mg/m2 ivgtt d1, oxaliplatin 100-130 mg/m2 ivgtt d1, q21d). All 48 patients were divided into two groups:Group A, non-oxaliplatin-based regimens as the first-line chemotherapy, 20 cases;Group B, oxaliplatin-based regimens as the first-line chemotherapy, 28 cases. Each group was evaluated every two cycles. Results:The response rates (RR) of Groups A and B were 30.0%(6/20) and 32.1%(9/28), the disease control rates (DCR) were 80.0%(16/20) and 75.0%(21/28), the median progression free survival time (mPFS) was 6.5 and 7.0 months, and the median overall survival time (mOS) was 10 and 13 months, respectively. No statistical sig-nificance was observed between the two groups in their RR, CR, mPFS, and mOS (P=0.264, 0.514, 0.713, 0.788), respectively. The most common adverse effects observed wereⅠ-Ⅱgrades of bone marrow suppression, aminotransferase abnormality, and digestive toxici-ties. The incidence of neurotoxicity (Ⅰ-Ⅱgrades) between the two groups was similar. Conclusion:Instead of irinotecan combined with raltitrexed, oxaliplatin reintroduction combined with raltitrexed for second-line chemotherapy after the first-line oxaliplatin-based chemotherapy in advanced colorectal cancer patients is feasible.

Objective To study the significance of human rhinovirus C as a pathogen and the clini-cal features of human rhinovirus C infection in pediatric intensive care unit. Methods From November 2010 to April 2012,570 nasopharyngeal aspirates specimens were collected from children who were admitted to the pediatric intensive care unit with respiratory infections. Nest reverse transcription-polymerase chain reactions were applied to detect the human rhinovirus C. The other common respiratory viruses were detected by multi-plex polymerase chain reaction. The clinical data were collected. Results One hundred and seventy human rhinovirus positive samples ( 29. 8%) were detected in 570 nasopharyngeal aspirates specimens. The VP2/VP4 and 5′UTR region of the human rhinovirus genome was amplified from 170 human rhinovirus positive samples with 80. 6%(136/170) success. While 20. 0%(34/170) samples in total were unclassified to spe-cies. There were 85 single infected samples including 52 of type A,7 of type B,26 of type C. The nucleotide homology was 74. 0% to 99. 2% and the nucleotide variations was 3. 4% to 32. 3% in stains of human rhino-virus C. The late fall and early winter were the epidemic seasons of human rhinovirus C infection. Cough,fe-ver, polypnea and wheezing were the common symptoms. Conclusion Human rhinovirus C is the major cause of infectious disease in pediatric critical illnesses. Human rhinovirus C infections often cause cough, fever,polypnea and wheezing.

Objective To evaluate the concordance on cardiac index (CI) measured with arterial pressure based cardiac output (APCO) and pulmonary artery catheter (PAC) during cesarean section in parturients with congenital heart disease combined with severe pulmonary hypertension.Methods Forty-five congenital heart disease combined with severe pulmonary hypertension parturient who scheduled for cesarean section were selected,APCO and PAC were used for cardiac output and other parameters of hemodynamics monitoring during operation in all patients.Continuous epidural anesthesia was performed.CI was recorded immediately before epidural administration (T1),at 5 and 10 min after epidural administration (T2,T3),immediately before delivery (T4),and at 2 and 5 min after delivery (T5,T6).The correlation of CI between APCO and PAC (A-CI and P-CI,respectively) was tested by Pearson correlation analysis and agreement test.Results The P-CI was significantly higher than A-CI,there was statistical difference (P ＜ 0.05).Compared with T1,no significant differences between A-CI and P-CI were found at T2-T4 and T6 (P ＞ 0.05),The A-CI at T5 [(4.5 ± 1.1) L/(min·m2) vs.(4.2 ± 0.8) L/(min ·m2)] and P-CI [(6.2 ± 1.5) L/(min·m2) vs.(5.4 ± 1.2) L/ (min· m2)] were significantly higher,there were statistical differences (P ＜ 0.05).The correlation analysis showed that there was positive correlation between A-CI and P-CI at T1-6 (r =0.931,0.955,0.945,0.892,0.960,0.913 ; P ＜ 0.05).Bland-Altman analysis showed poor agreement between CI measured with the two methods.Conclusion CI value obtained with APCO agrees poorly with that obtained with PAC during cesarean section in parents with congenital heart disease combined with severe pulmonary hypertension,but agrees well in monitoring the changing trend of CI.

Objective To study of improved laryngeal mask airway of painless fiber endoscopy in elderly patients with painless bronchoscopy.Methods To choose 108 cases of elderly patients who were treated with painless fiber endoscopy in our hospital from January 2012 to May 2013 as the research objects, and were randomly divided into the local anesthesia group and the improved laryngeal mask group, each group was 54 cases.Observed and compared the laryngeal mask insertion, patients′basic situation and adverse reactions of patients in two groups .Results The blood pressure and heart rate in surgery and postoperative of patients in the local anesthesia group were significantly higher, and the intraoperative blood oxygen satu-ration was significantly lower, but the blood pressure and heart rate in surgery and postoperative of patients in the improved la-ryngeal mask group were significantly lower than that of preoperative, and it showed no significant change in the aspect of blood oxygen saturation.The indicators of patients in two groups in surgery and after surgery, had significant difference (p<0.05), none of the patients in the improved laryngeal mask group had adverse reactions, and its incidence was significantly reduced comparing with the local anesthesia group, and the patient satisfaction scores of the improved laryngeal mask group were obviously better than that of the local anesthesia group (p<0.05), the difference was statistically significant.And the completion time of inserting improved laryngeal mask was 3 min or less, a one-time placement success rate was 98.15%. Conclusion The improved laryngeal mask airway of painless fiber endoscopy can effective stabilize the blood pressure , heart rate and blood oxygen saturation of elderly patients, at the same time also can avoid choking cough, laryngospasm and pulling hypoxemia and other adverse reactions after laryngeal mask, shorten the operation time of laryngeal mask insertion and in-crease the one-time success rate, so it is worthy of clinical use.

Objective To explore the feasibility and clinical value of the trans-umbilical single-port laparoscopic operation with routine apparatus in treatment of hepatobiliary diseases. Methods From Mar 2010 to Sep 2012, 415 patients with hepatobiliary disease, splenic disease, abdominal cavity disease or combine hysteromyoma were performed by trans-umbilical single-port laparoscopic operation with routine apparatus. The clinical data of 415 cases were analyzed respectively.Result All patients except one patients who was added one port for hysterectomy, were performed successfully trans-umbilical single-port laparoscopic operation with routine apparatus without conversion to laparotomy or conventional laparoscopic surgery. Conclusions The trans-umbilical single-port laparoscopic operation with routine apparatus is safe and effective in treatment of hepatobiliary diseases. Limited by the anatomy position, the trans-umbilical single-port laparoscopic operation with routine apparatus can cure most hepatobiliary diseases. So the operator must have the experience both in single-port laparoscopic operation and traditional laparoscopic operation. With the improvement of rotatable equipment, the practical procedure is expected to be generalized in the future.

Objective To investigate the differences in the safety of the operation of different hepatic vascular exclusion for liver surgery. Methods Sixty patients with liver resection were grouped by different hepatic blood flow blocking methods, and given pre-operative assessment prior to surgery. Results On the first day after surgery, the average levels of ALT and AST were (395.0 ± 220.2) U/L and (415.3±311.0) U/L in patients who received Pringle’s method (110.2±53.0) U/L and (125.6±78.5) U/L in patients who received regional hepatic vascular exclusion, (98.9±32.2) U/L and (96.2 ±66.5) U/L in patients who didn't receive hepatic vascular exclusion, respectively. Postoperative liver function damage was more serious in patients who received Pringle's method than patients who received regional hepatic vascular exclusion or patients who didn't receive hepatic vascular exclusion, the difference was statistically significant (P<0.05) .Conclusion Regional hepatic vascular exclusion or not can not only reduce the incidence of postoperative complications, but also expand the indications for liver resection.

Objective To research the effect of perioperative thermal preservation on hemostatic function in elderly patients with laparoscopic rectal cancer resection.Methods Eighty-six elderly patients with laparoscopic rectal cancer resection with ASA Ⅰ-Ⅱ were randomly divided into control group (43 patients) and test group(43 patients).Control group was given routine operation,test group was given routine operation and thermal preservation.The nose pharynx temperature was monitored and recorded respectively on preanesthesia,30,60,90 min post-anesthesia and after operation.The level of prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT),platelets (PLT),D-dimer(DD),fibrinogen (FBG),yon Willebrand factor (vWF) were detected on preanesthesia,30,60,90 min post-anesthesia and 24,48 h post-operation.Results The temperature in control group on 30,60,90 min pest-anesthesia and after operation [(36.1 ± 0.2),(36.0 + 0.1),(35.7 + 0.1),(35.6 ± 0.2) ℃] was significantly lower than that on preanesthesia [(36.8 ± 0.2) ℃] and the same time in test group [(36.8 ± 0.0),(36.7 ± 0.1),(36.7 +0.2),(36.8 ±0.2) ℃] (P ＜0.05).The level of PT,APTT and TT in control group on 30,60,90 min post-anesthesia and after operation were significantly longer than those on preanesthesia and the same time in test group (P ＜0.05).The level of PLT in control group after operation and on 24,48 h post-operation were significantly lower than preanesthesia and the same time in test group(P ＜ 0.05).The level of DD and vWF in control group on 24,48 h post-operation were significantly higher than preanesthesia and the same time in test group (P ＜ 0.05).The level of FBG in control group on 24,48 h post-operation were significantly lower than preanesthesia and the same time in test group (P ＜ 0.05).The hemostatic function had no significant change in test group (P ＞0.05).Conclusion The perioperative thermal preservation in elderly patients with laparoscopic rectal cancer resection can alleviate hemostatic function suppression and promote recovery.