Abstract:

Abstract:

Abstract:Objective To construct the algorithm of a nosocomial infection early warning system (NIEWS) with application of Large Data Screening based on the real-time nosocomial infection surveillance system (RT-NISS). Methods Large Data Screening and Mathematical Model were adopted to design a series of algorithms. Through process data acquisition and analysis, the influences of various influencing factors were compared, and then given different weights. The influencing factors for individual patient were also given weights. Then the warning interval was set to implement the early warning of nosocomial infection. Results Through the data mining of the Infection Information Database from the RT-NISS, a series of algorithms were successfully designed, and the risk factors of nosocomial infection were screened out. Then the weights of these risk factors were verified and adjusted in combination with the cases of nosocomial infection from hospitals. The early warning interval was set and implemented for nosocomial infection. ConclusionThe preliminary framework of the NIEWS based on RT-NISS system is designed and established. In the further study, we will verify and compare in combination with nosocomial infection data in order to improve the accuracy and precision of prediction, and implement the early warning before the infection, induce clinical concern and take preventive measures to reduce nosocomial infection rate.

Abstract:Objective To timely detect the patients with active tuberculosis and decrease the false negative rate in order to reduce the possibility of spread and outbreaks of infectious diseases. Methods The suspected cases which were screened out by the real-time surveillance system for infectious diseases were diagnosed by clinicians as active tuberculosis or not. Results From June 2014 to May 2015, there were 48 cases reported as active tuberculosis by the traditional manual passive monitoring mode, and 67 cases by the real-time surveillance system. The traditional mode had 19 patients reported as false negative, with a false negative rate of 28.36%. What’s more, compared to the 41 cases reported by the traditional mode from June 2013 to May 2014, the real-time system reported 26 cases more during the period from June 2014 to May 2015. Conclusion The real-time surveillance system for infectious diseases improves the sensitivity, accuracy and timeliness for report of active tuberculosis, and is of very important significance in prevention from the spread of infectious disease.

Abstract:Objective To evaluate the direct economic losses in the burn patients with wound infection. Methods A retrospective case-control study was carried out on 44 burn patients with wound infection and 44 matched burn patients but without wound infection admitted in our hospital during the period of January 2012 and December 2015. Hospital expense and length of hospital stay were recorded and compared between the 2 groups. Results The median expense was 81 079.85 (39 093.33, 198 185.38)RMB Yuan in the patients with wound infection during hospitalization. The median expense was 61 735.40 (32 167.43, 131 382.55)RMB Yuan in the patients without wound infection during hospitalization. There were significant differences in the total expense and the costs in medication, treatment, laboratory, examination, surgery, board expense and care services between the 2 groups of patients (P<0.05). The burn patients with wound infection had significantly longer length of hospital stay than those without infection［45(23,56) vs 32(21,45)d, P<0.05］. Conclusion Burn patients are the key target for nosocomial infection control and management. Wound infection will cause economic losses at different extents for the patients and the hospital. Reducing the incidence of wound infection in the burn patients can decrease their economic losses.

Abstract:Objective To determine the effect of an intelligent alert and management system introduced into intensive care units (ICU) on the management efficiency of hand hygiene compliance (HHC) for health care workers (HCWs) and on the indicators of nosocomial infection. Methods Surgical general ICUs from an upper first-class hospital was chosen and the study was implemented in two stages. Baseline stage: the HHC rates of ICU HCWs were investigated in secret by trained observers and the nosocomial infection indicators were also collected and analyzed. Intervention stage: the intelligent hand hygiene alert and management systems, which based on radiofrequency identification technology, have been deployed to collect ICU HCWs’ hand hygiene behaviors before or after patient contact and analyze the HHC rates automatically. The nosocomial infection indicators were also collected and analyzed. The HHC rates of ICU HCWs, nosocomial infection rate, the detection rate of multi-drug resistant bacteria and the consumption of alcohol-based hand rub were compared before and after the intervention. Results Compared with before intervention, total HCC rate increased significantly after intervention (69.52% vs 38.27%,P<0.05), and the HHC rates of HCWs in different positions were all significantly higher than before intervention (P<0.05). The HHC rates have been rising month by month and remained at high levels since intervention. The nosocomial infection rate (7.81% vs 35.56%, P<0.05) and the detection rate of multi-drug resistant bacteria (20.0% vs 40.63%) decreased, and the consumption of alcohol-based hand rub increased significantly［189.33 vs 36.69% ml/(bed·day)］. Conclusion The hand hygiene intelligent alert and management system not only realizes the intelligent reminds and effective management of HCWs’ hand hygiene behaviors, but also improves the hospital infection indicators.

Abstract:Objective To investigate the prevalence of hospital-acquired infections (HAI) in the hospitals of Sichuan Province in 2011, and to provide scientific basis for formulating and implementing infection control measures in accordance with the actual situation. Methods Bedside investigation and investigation of medical records were carried out to obtain the point prevalence of HAI on the day of June 25, 2011 among the inpatients in the 23 hospitals from Sichuan Province. Results The 1-day prevalence of HAI was 2.5% among the 27 144 inpatients. The prevalence was higher in the upper first-class general hospitals (2.7%) than the middle first-class hospitals (1.8%) and upper first-class specialized hospitals (1.0%, P<0.05). The main infection site was lower respiratory tract, accounting for 50.2% of all the HAI. Gram-negative bacilli were the main isolated pathogens. Factors such as gender, age, underlying diseases (diabetes, hypertension, respiratory failure, renal insufficiency, cardiac insufficiency, tumor and hematologic diseases), use of hormones, coma and invasive operation were related to HAI. Conclusion Special attentions should be paid to the HAI types, such as lower respiratory tract infection, surgical site infection and urinary tract infection, and targeted surveillance should be carried out. This investigation is helpful to grasp the basic situation of HAI in hospitals from Sichuan Province and of great significance for improving the work of infection control in the region.

Abstract:Objective To investigate the direct economic losses caused by hospital-acquired infections (HAI) in the hospitalized patients of an integrated intensive care unit (ICU). Methods A retrospective analysis was carried out on 32 patients with HAI from intensive medicine department of an upper first-class hospital during Jan. 2013 and Dec. 2014. They were assigned into the HAI group, and according to the ratio of 1∶1, another 32 matched patients served as the control group. The length of hospital stay, hospitalization expenses and the effect of infection sites on hospital stay were analyzed and compared between the 2 groups of patients. Results The length of hospital stay was 48.91 (14.25, 74.25) d and 13.47 (8.00, 12.75) d, respectively, in the infection group and control group, with significant difference between them (z=4.165, P<0.05). The total hospitalization expenses was 160 788.45(49 123.11, 223 523.13) RMB Yuan and 41 855.62 (24 684.55, 46 026.74) RMB Yuan, respectively. The expenses on Western medicine were the highest, followed by treatment fee, and the expenses were significantly higher in the infection group than in the control group (P<0.05). The length of hospital stay was significantly longer in the patients with multilocation infections than those with single site of infection ［(75.00±60.93) vs (16.64±9.91)d, t=2.82, P<0.05］. Conclusion Carrying out the economic loss assessment of HAI in ICU can more scientifically and effectively evaluate the economic losses caused by HAI, help the administers of medical institutions to increase financial support on the prevention and control of the infection, and save the limited medical resources, so as to reduce the economic burden of the patients.

Abstract:Objective To investigate the current status of the central sterile supply department (CSSD) from different level hospitals in the Inner Mongolia Autonomous Region and provide references for development of control measures. Methods Based on the different level of hospitals, stratified sampling and questionnaire were used to survey the CSSD of 156 hospitals. Results The major staffs working in the CSSD of Inner Mongolia Autonomous Region were nurses, accounting for 69.17% in the first-class hospitals, and for 69.20% in the second-class hospitals. Centralized management covered 53.85% in all management modes for the the first-class hospitals, but the ratio was decreased to 29.91% in the second-class hospitals. Significant differences were found in the equipments of cleaning and disinfecting, the devices of checking and packaging, and the chemical monitoring between the first-class and the second-class hospitals (P<0.05). Conclusion There are many problems in the CSSD of Inner Mongolia Autonomous Region, such as lagging management, insufficient facilities, and ineffective monitoring. The construction and management of the CSSD should be strengthened in order to ensure its standardization and scientization.

Abstract:Objective To investigate the prevalence, antibiotic resistance, virulence and pathogenicity of community-acquired Staphylococcus aureus (CA-SA) in the patients with skin soft-tissue infections. Methods Clinical specimen of the 55 patients with skin soft-tissue infections admitted in Department of Dermatology, Outpatient Department and Emergency Department in our hospital between January 2009 and August 2010 were collected. The isolates of SA strains were collected from the patients for bacterial identification and antibiotic susceptibility. Multilocus-sequence typing (MLST), staphylococcal protein A (SPA) typing and toxin gene screening were also performed. ResultsOf the 55 isolates, 12 strains of community-acquired methicillin-sensitive SA (CA-MSSA) were isolated. The CA-MSSA strains had comparatively high resistance rates (8.3%-50.0%) to erythromycin, tetracycline, clindamycin, gentamicin and levofloxacin, but were sensitive to other antibiotics. Their toxin positive rates were 33.3%, 25.0% and 8.3%, respectively to Panton-Valentine leukocidin (pvl), staphylococcal entotoxin C (sec) and toxic shock syndrome toxin-1 (tsst-1), but were none to staphylococcal entotoxin H (seh) and staphylococcal exfoliative toxin (et). The MLST and SPA typing results showed that there were 2 isolates of ST5-t002, 2 isolates of ST22-t309, and 1 isolate respectively of ST398-t034, ST15-t5864, ST7-t091, ST25-t078, ST30-t318, ST121-t1425, ST800-t1425 and ST630-t377. Conclusion The CA-MSSA isolates derived from the patients with skin soft-tissue infections of our hospital have high antibiotic sensitive rates, diversity of molecular types and multiple toxins.

Abstract:Objective To investigate the clinical features, diagnosis, treatment and prognosis of the elderly acute myocardial infarction (AMI) patients complicated with gastrointestinal bleeding (GIB). Methods All 90 patients diagnosed with AMI in our department from January 2012 to April 2014 were recruited in this study. They were divided into AMI group (n=30, without GIB), AMI-GIB group (n=30, GIB occurred after AMI) and GIB-AMI group (n=30, GIB followed by AMI). The clinical features and mortality after 6 months’ follow-up were analyzed. Results The ratio of the patients with a history of gastrointestinal diseases were significantly higher in the AMI-GIB and GIB-AMI groups than in the AMI group (P<0.05), and there were more patients undergoing percutaneous coronary intervention (PCI) in the AMI-GIB group than in the other 2 groups (P<0.05). Activated partial thromboplastin time (APTT) was obviously longer, and the more patients received blood transfusion and proton pump inhibitors (PPIs) treatment, while that of those receiving aspirin was less in the AMI-GIB and GIB-AMI groups than in the AMI group (P<0.05). The level of D-dimer and the ratio of blood urea nitrogen (BUN)/serum creatinine (SCr) were much higher in AMI-GIB group than in the other 2 groups (P<0.05). The level of hemoglobin (Hb) and the efficacy of anti-platelet therapy were significantly lower in the GIB-AMI group than in the other 2 groups (P<0.05). The mortality was significantly higher in the AMI-GIB group than in the other 2 groups (P<0.05). Conclusion The occurrence of AMI complicated with GIB is closely associated with the histories of gastrointestinal ulcers and PCI procedure. The ratio of BUN/SCr and level of D-dimer might be the predictive indicators for prognosis of GIB after AMI.

Abstract:Objective To investigate the prevalence of multiple geriatric syndromes in the elderly inpatients with type 2 diabetes mellitus, and determine the accumulated effects of multiple geriatric syndromes on their quality of life. Methods A cross-sectional study was carried out in 397 elderly patients with type 2 diabetes mellitus from geriatric and endocrinology departments of the affiliated hospital subjected by convenience sampling method in September 2015 to March 2016. Each subject was surveyed for general condition, quality of life as well as chronic pain, chronic constipation, urinary incontinence, risk of falling, malnutrition, sleep disorder, and polypharmacy. Results The average score of physical component summary was 277.1±64.30, and that of mental component summary was 307.00±60.45 in the patients. They averagely had 3.23±1.51 geriatric syndromes, and 44.3% of them had 4 or more. Having the syndromes or not and the number of these syndromes had effects on the physical and mental health in the elderly (P<0.05). Significant differences were seen in the scores of physical and mental component summary between the subjects with only 1 or those with 2 or more geriatric syndromes (P<0.05). Conclusion The incidence of geriatric syndromes is quite high in the hospitalized elderly patients with type 2 diabetes mellitus. Many patients have a number of syndromes at the same time, and have significant poor quality life.

Abstract:Objective To investigate the values of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) in severity assessment and prognostic prediction in the elderly patients with chronic heart failure. Methods A total of 122 elderly patients with chronic heart failure admitted in our hospital from January 2013 to June 2015 were enrolled into the study. According to New York Heart Association (NYHA) classification, the patients were divided into 3 group, that is, NYHAⅡ group (n=30), NYHAⅢ group (n=36), and NYHAⅣ group (n=56). Another 50 healthy individuals served as normal controls. The patients of NYHAⅣ group were further assigned into death subgroup (n=14) and non-death subgroup (n=42). The relationship of serum NT-proBNP level with left ventricular ejection fraction (LVEF) and left ventricular end diastolic diameter (LVEDd) was analyzed. The change of NT-proBNP level was compared among the 3 groups before and in 7 and 14 d after treatment. The serum level of NT-proBNP was monitored during the follow-up of 6 to 12 months. Results With the increase of NYHA classification, the age, LVEDd and NT-proBNP level were increased, while LVEF was decreased in the subjects. Serum NT-proBNP level was positively correlated with LVEDd (r=0.96, P<0.05) and negatively correlated with LVEF (r=-0.79, P<0.05). The level of NT-proBNP was significantly decreased in the patients from the 3 groups in 7 d after treatment (P<0.05), and further reduced after 14 days’ treatment, but significant difference was only found in NYHAⅢ group and NYHAⅣ non-death subgroup between the levels of 2 time points (P<0.05). Compared with the non-death subgroup, the level was remarkably higher in the death subgroup before, in 7 d after treatment and at the last time of detection (P<0.05). In the non-death subgroup, the level was in a trend of reducing (P<0.05). But in the death subgroup, there was no statistical difference in the level before and in 7 d after treatment (P>0.05), and the level was also higher at the last time of detection (P<0.05). Conclusion NT-proBNP is closely associated with heart function, and can be regarded as an important indicator in the diagnosis, efficacy evaluation and prognostic prediction for heart failure.

Abstract:Objective To observe the therapeutic effects of probucol combined with epalrestat in the treatment of early diabetic nephropathy (DN). Methods A total of 55 cases of early DN admitted in Zhongguancun Hospital from January 2014 to January 2016 were recruited in this study. They were divided randomly into 2 groups, the treatment group (50 mg epalrestat, tid and 0.5 g probucol, bid) and the control group (only 0.5 g probucol, bid). The 2 groups of patients were given diabetic diet with low protein, and kept well control of blood glucose and blood pressure. The 2 groups were treated for 24 weeks and some indicators were measured to evaluate the therapeutic results. Results The serum levels of creatinine (SCr), hyper-sensitivity C-reactive protein (hs-CRP) and urinary albumin excretion rate (UAER) were all reduced in the both groups after the treatment (P<0.05). The above indicators were decreased more significantly in the treatment group than in the control group (P<0.05). Conclusion Probucol combined with epalrestat is superior to single use of probucol in decrease of proteinuria in the patients with early DN.

Abstract:Objective To evaluate the efficacy and safety of decitabine in the treatment of acute myeloid leukemia (AML) in the elderly. Methods Retrospective analysis was conducted on 29 elderly AML patients admitted in our hospital from Jan. 2013 to Feb. 2016. They were divided into decitabine treatment group and conventional treatment group. Clinical outcomes and adverse reactions were observed and compared between the 2 groups. Results The complete remission (CR) rate was 60.0%(6/10) in the decitabine group, and 35.7%(5/14) for the conventional group, with significant difference between the 2 groups (P<0.05). Significant difference was also seen in the overall survival between them (44.9 vs 13.6 months, P<0.05). Various adverse events (AE) were identified in 80.0% patients from the decitabine group. Only 30.0% (3 patients) were Ⅲ-Ⅳ grade of AE, mainly manifested as neutropenia and thrombocytopenia. Conclusion Decitabine-based chemotherapy regimen is of higher response rate and prolongs survival in the treatment of AML in the elderly.

Abstract:

Abstract:

Abstract:In this article, we reported the successful treatment for an 87-year old male suffering from discordant lymphoma. He initially presented with enlargement of left parotid lymph node in 1987. Then in 1988, he was diagnosed with small B-cell non-Hodgkin’s lymphoma through lymph node biopsy, and treated with 50 courses of cyclophosphamide, vincristine, prednisone (COP or OP), and short-term local radiotherapy. However, he relapsed in 2014 with a sore throat, and an epiglottis biopsy revealed anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma. The final diagnosis of the patient was sequential discordant lymphoma consisting of small B-cell non-Hodgkin’s lymphoma and ALK-negative anaplastic large cell lymphoma. Discordant lymphoma is rare, especially those involving both B cell and T cell. Biopsy for the tissue specimen of every lesion can help avoiding missed diagnosis, and thus choose a more appropriate treatment regimen.

Abstract:Sepsis is a life-threatening condition caused by dysregulated host response to infection. The early organ dysfunction may be not easy to find. Though biotechnology and medical surveillance means have developed rapidly, early diagnosis of sepsis is still very difficult, and its mortality is very high. So, early diagnosis is of great significance for sepsis. In this article, we reviewed and summarized the current advances in the early diagnostic markers for sepsis, and hoped to have some implications for its clinical and scientific researches.

Abstract:Warfarin is widely used in the prevention and treatment of thromboembolic diseases. But, there still remain challenges for its safe and effective application and for how to obtain its best anticoagulation in clinical practice. In recent years, warfarin pharmacogenetics studies showed that the genetic variants of the genes (CYP2C9, VKORC1 and CYP4F2) related to the pathway of warfarin metabolism and function could affect the therapeutic dose of warfarin dramatically, as well as the risks for bleeding complications. In this review, we focused on the studies concerning on the correlation of above genetic variants with warfarin related over-anticoagulation and bleeding complications, so as to provide clinical reference for individualized anticoagulation therapy.

Abstract:Alzheimer’s disease (AD) has been regarded as one of the most common neurodegenerative diseases, and is mainly manifested as progressive cognitive dysfunction, memory and learning decline, abnormal daily behavior, personality changes and decline in activities of daily living though its cause remains unclear. The main pathological features of AD have been revealed as deposition of amyloid β-protein（Aβ）, neurofibrillary tangles (NFTs), synaptic and neuronal loss etc., and these changes contribute to neurological inflammatory responses. The etiology and pathogenesis of AD are quite complex and diverse, and current most prevailing hypotheses include Aβ cascade hypothesis, abnormal phosphorylation of tau protein, nerve inflammation and so on. Much evidence showed that the inflammation response played important roles in the development and progression of AD. In this paper, we reviewed the relationship of some inflammatory cytokines［IL-1β, IL-6, IL-4, IL-10, transforming growth factor-β1 (TGF-β1), tumor necrosis factor-α (TNF-α) and others］with AD.

Abstract:Statins, a group of selective 3-hydroxy-3-methylglutaryl-coenzmye A (HMG-CoA) reductase inhibitors, are widely used in clinical practice as lipid lowering drugs to reduce cardiovascular events. However, after taking statins for some time, some patients may have elevated aminotransferases, hepatosplenomegaly, jaundice, and other clinical liver damaged manifestations, while others may be accompanied with asymptomatic elevated transaminases, increased direct bilirubin level, and prolonged prothrombin time. To a large extent, diagnosis of statin-induced liver injury (SILI) depends on the experience of clinicians, so missed diagnosis and misdiagnosis are common. In this article, we summarized the studies concerning SILI diagnosis to provide references for clinicians to improve diagnostic level.