OBJECTIVE To explore the correlation and biological significance of the expression levels of microribo-nucleic acid-362(miR-362)and long-chain non coding ribonucleic acid(RNA)small nucleolar RNA host gene 12(LncRNA SNHG12),and the positive rate of interleukin-17(IL-17)methylation with high-risk human papilloma-virus(hr-HPV)infection in patients with cervical cancer.METHODS A total of 168 patients with cervical cancer admitted to the Fifth Central Hospital in Tianjin from Jan 2019 to Aug 2023 were enrolled and divided into the group A;170 patients with cervical intraepithelial neoplasia in the hospital were included in the group B,and 180 female volunteers under health examinations during the same period were in the group C.The clinical data and the occurrence rate of hr-HPV infection were compared among the three groups;the expression levels of cervical tis-sue miR-362 and LncRNA SNHG12 and positivity rate of IL-17 methylation among the three groups and between the hr-HPV-positive and negative cervical tissues were also compared.RESULTS The expression level of miR-362 in cervical tissue of the group A was lower than that of the group B and the group C,and the group B was lower than the group C.The expression level of LncRNA SNHG12 in cervical tissue of the group A was higher than that of the group B and the group C,and the group B was higher than the group C.The positive rates of IL-17 methyl-ation in the three groups were 68.45％,52.35％,and 37.78％,respectively,and the differences among them were statistically significant(P＜0.05).The expression level of miR-362 in hr-HPV-positive CC patients was lower than that of HR-HPV-negative CC patients.The LncRNA expression level of SNHG12 in cervical tissues was higher than that of HR-HPV-negative CC patients.The positive rate of IL-17 methylation was 72.54％,which was higher than 46.15％in the hr-HPV-negative CC patients(P＜0.05).The expression level of miR-362 in cervical tissue of cervical cancer patients was negatively correlated with hr-HPV-positive infection(r=-0.565,P＜0.05),while the expression level of LncRNA SNHG12 and positivity rate of IL-17 methylation in cervical tis-sue were positively correlated with hr-HPV infection(r=0.498,0.512,P＜0.05).The proportion of highly dif-ferentiated tumors in IL-17 methylation positive patients was 60.87％,higher than 39.62％in the IL-17 methyla-tion negative patients(P＜0.05).CONCLUSION The expression levels of miR-362 and LncRNA SNHG12 in cer-vical tissue,as well as the positive rate of IL-17 methylation were closely related to the occurrence of cervical canc-er and hr-HPV infection,which has certain correlation with pathological characteristics of patients in clinic.
Objectives: The goal of this project was to evaluate the degree of contamination of the air and lab surfaces during the extraction of RNA from COVID-19 under laboratory ventilation systems, identify operational risk areas, and provide a reference for reducing medical contamination in COVID-19 detection.Methods: Our COVID-19 testing contains the real-world test and a splash test, detected the RNA residue of COVID-19 pseudovirus on the surface of air and object with PCR.Results: Our results show that RNA extraction contamination occurs more frequently under non-negative pressure than under negative pressure. The biological safety cabinet features a system to stop contamination that may successfully halt the transmission of aerosols as well as the contamination of the experimenter's glove, which is a major source of transmission. Furthermore, UV disinfection cannot completely sterilize an area and regular and effective cleaning is also necessary.Conclusions: In summary,our study lays the foundation for efficacy evaluation of laboratory construction of positive and negative pressure systems and also elucidates the focus of laboratory contamination prevention, providing a strong anti-contamination basis for the extraction of RNA testing for the prevention and control of COVID-19 and even other respiratory transmitted diseases.
目的 探究结直肠癌术后切口感染患者分离产β-内酰胺酶(ESBLs)大肠埃希菌的耐药性及分子分型.方法 收集 2018 年 5 月-2021 年 5 月于中国医科大学附属盛京医院进行手术治疗的结直肠癌患者术后切口感染分泌物分离出的大肠埃希菌 105 株,筛选产 ESBLs大肠埃希菌菌株 48 株,采用纸片扩散(K-B)法进行药敏试验,采用聚合酶链式反应(PCR)扩增鉴定产 ESBLs大肠埃希菌β-内酰胺酶基因型,采用多位点序列分型(MLST)分析产ESBLs大肠埃希菌ST分型.结果 48 株产ESBLs大肠埃希菌对碳青霉烯类抗菌药物完全敏感,对阿米卡星、妥布霉素耐药率分别为 18.75%和 25.00%,但对其他抗菌药物耐药率均较高,表现为多重耐药;产 ESBLs大肠埃希菌对常用抗菌药物(阿米卡星、妥布霉素、亚胺培南和美罗培南除外)的耐药率高于非产 ESBLs 大肠埃希菌(P<0.05);48 株产 ESBLs大肠埃希菌均检出β-内酰胺酶基因,其中 31 株(64.58%)检出携带TEM-1 基因,19 株(39.58%)检出携带CTX-M-14 基因;48 株产 ESBLs大肠埃希菌共有 10 种 ST分型,以 ST131(31.25%)为主.结论 结直肠癌术后切口感染患者分离产 ESBLs大肠埃希菌表现为多重耐药,对多种抗菌药物存在不同程度耐药,产 ESBLs大肠埃希菌以TEM-1、CTX-M-14 为主要基因型,主要 ST分型为 ST131 型.
目的 探究树突状细胞相关C型凝集素受体 2(Dectin-2)基因多态性与乳腺癌根治术后继发侵袭性真菌感染(IFI)的关联.方法 选取 2019 年 1 月-2021 年 6 月于中国医科大学附属盛京医院接受根治术的乳腺癌患者124 例,根据患者术后是否发生 IFI分为 IFI组 39 例和非 IFI组 85 例.调查患者病历档案收集临床资料,分析患者术后发生 IFI的危险因素.采用酶联免疫吸附法检测两组患者血清Dectin-2、白细胞介素-1β(IL-1β)和干扰素-γ(IFN-γ)水平,聚合酶链式反应-限制性片段长度多态性(PCR-EFLP)技术检测 Dectin-2 基因 rs11045418 位点单核苷酸多态性.结果 IFI组合并糖尿病、住院时间≥10 d及进行辅助化疗占比高于非 IFI组(P＜0.05),但两组年龄、体质量指数(BMI)及高血压分布占比的比较,无统计学差异;Logistic回归模型分析显示,合并糖尿病、住院时间是乳腺癌患者根治术后继发 IFI的危险因素(P＜0.05);IFI组患者 Dectin-2、IL-1β和 IFN-γ水平高于非 IFI组(P＜0.05);rs11045418 位点 CC 基因型是乳腺癌患者根治术后继发 IFI 的保护因素(P＜0.05),但两组rs11045418 位点基因型和等位基因分布频数的比较,无统计学差异.结论 Dectin-2 基因 rs11045418 位点 CC基因型可能降低乳腺癌患者根治术后继发 IFI风险,血清Dectin-2 水平在 IFI患者中也异常升高.
目的 探究风险控制模式护理对无菌层流床入住的白血病患儿化疗感染预防的应用效果.方法 选择2019年6月-2022年6月于中国医科大学附属盛京医院接受化疗治疗的急性白血病患儿126例作为研究对象,随机分为研究组和对照组,各63例,对照组采用常规护理,研究组在对照组的基础上采用风险控制模式护理.比较两组患者治疗期间的感染情况、住院时间、抗菌药物使用时间及患儿家属满意度.结果 研究组患儿的感染率为22.22％(14/63)低于对照组(P=0.001);研究组住院时间、抗菌药物使用时间均短于对照组(P＜0.05);研究组满意度优于对照组(P=0.020).结论 风险控制模式护理应用于急性白血病患儿化疗治疗入住无菌层流床,可有效降低患儿的感染率,提高患儿家属的满意度.
目的 分析学龄前期儿童急性下呼吸道感染合并呼吸道合胞病毒(RSV)感染的临床特征及其影响因素.方法 回顾性分析2020年1月-2021年12月中国医科大学附属盛京医院收治的776例学龄前期急性下呼吸道感染患儿的临床资料,根据患儿是否发生RSV感染将其分为RSV感染组(n=102)、非RSV感染组(n=674).统计学龄前期急性下呼吸道感染合并RSV感染患儿的临床特征,采用多因素Logistic回归分析学龄前期儿童急性下呼吸道感染合并RSV感染的危险因素,构建预测模型,采用受试者工作特征(ROC)曲线分析预测模型对学龄前期儿童急性下呼吸道感染合并RSV感染的预测价值.结果 低出生体质量、发病季节为秋冬、血清免疫球蛋白G(IgG)、IgM、外周血CD4+、CD19+水平较低,血清白细胞介素-6(IL-6)、C-反应蛋白(CRP)、外周血CD8+、中性粒细胞较高均为学龄前期急性下呼吸道感染患儿合并RSV感染的影响因素(P＜0.05);根据Logistic回归分析结果构建预测模型:logit(P)=-11.025+低出生体质量×1.241+发病季节为秋冬× 1.027+IgG×＜0.836+IgM× 1.293+CD4+× 1.056+CD19+×1.172+IL-6×0.996+CRP×0.793+CD8+× 1.137+中性粒细胞 × 1.196;ROC曲线分析结果显示,当logit(P)＞12.58时,曲线下面积(AUC)值为0.899,95％CI为0.876～0.919,敏感度为80.39％,特异度为82.05％.结论 学龄前期急性下呼吸道感染患儿合并RSV感染的影响因素包括低出生体质量、发病季节为秋冬、血清IgG、IgM、外周血CD4+、CD19+,血清IL-6、CRP、外周血CD8+、中性粒细胞水平,据此构建预测模型对学龄前期急性下呼吸道感染患儿合并RSV感染具有较好的预测价值,临床可根据此预测模型对有以上特征的患儿进行针对性干预或治疗,降低患儿RSV感染发生的风险.
OBJECTIVE To investigate the distribution of drug-resistant bacteria on surfaces of highly frequent contact objects in ICUs so as to provide scientific basis for prevention and control of nosocomial infection and provide guidance for disinfection in hospitals. METHODS The surfaces of highly frequent contact objects were sampled from respiratory medicine department from Jul 2021 to Dec 2021. The drug-resistant strains were screened and cultured by 5 types of antibiotic media, and the species of the strains were identified by means of PCR amplification of full-length 16S rRNA gene and first generation sequencing technology. RESULTS A total of 48 environmental swabs of 6 batches were collected from 8 highly frequent contact sites in the ICUs, 35 of which were cultured positive, with the total positive rate 72.92%. Totally 115 strains of bacteria were screened, isolated and identified. The top 3 species of bacteria were as follows: Acinetobacter baumannii（14 strains, 12.17%）, Pseudomonas aeruginosa（13 strains, 11.30%）, Klebsiella pneumoniae（11 strains, 9.57%）. The sampled sites with heavy loads of drug-resistant bacteria were as the following: sink traps（30 strains）, faucets（25 strains）, bedside tables（20 strains） and bed railings（18 strains）; 4（13.33%） strains of P. aeruginosa and 4（13.33%） strains of K. pneumoniae were isolated from sink traps; 4（16%） strains of Acinetobacter berghei and 4（16%） strains of P. aeruginosa were isolated from faucets; 2（10%） strains of P. aeruginosa were isolated from bedside tables; totally 18 strains of drug-resistant bacteria were isolated from bed railings, A. baumannii（6 strains, 33.33%） was dominant. CONCLUSION There is difference in the distribution of drug-resistant bacteria isolated from the surfaces of objects in the ICUs. There are more drug-resistant strains on the sampled sites close to water sources and patients. It is suggested that the hospital should strengthen the disinfection of surfaces of objects in ICUs so as to effectively control the nosocomial drug-resistant bacteria infections.
OBJECTIVE To explore the epidemiological characteristics of the Chinese population carried with mcr genes so as to provide guidance for clinical research. METHODS mcr-related literatures were searched from PubMed and CNKI by setting ′mcr,China′ and ′mcr′ as key words, and the distribution of mcr-positive strains was observed. RESULTS Totally 3 745 mcr-positive strains were reported in 31 provinces and municipalities, the strains carrying with mcr-1（3 684） and mcr-3（34） were dominant. mcr-6 and mcr-7 have not been discovered among the Chinese population, and the strains carrying with other mcr genes were less than 10 strains. The prevalence of the strains was higher in the south than in the north and was higher in the coast than in the inland. Guangdong Province had the largest number of reported strains（1 654）, followed by Zhejiang（579）. Among the Escherichia strains, mcr-positive strains（1 872） were dominant, there were 1869 strains of Escherichia coli carrying with mcr-1 gene, there were 10 strains of Salmonella and 9 strains of Aeromonas that carried with mcr-3 gene, there were 7 strains of Klebsiella pneumoniae positive for mcr-8 gene, and there were 3 strains of Enterobacteriaceae positive for mcr-9 gene. The prevalence started to rise then declined and then rose again from 2008. Among the specimens sources, 1 615 strains were from hospitalized patients, and 1529 strains were from people receiving physical examination; the strains were mainly from enteric diseases clinics and patients with gastrointestinal diseases. There were 2882 specimens sources that were collected from stool and rectal swabs. CONCLUSION mcr gene is highly prevalent among Chinese population, the positive strains show an increasing trend, and it suggests that the medical disease control institutions should carry out the reasonable monitoring of mcr-positive strains and take prevention measures.
OBJECTIVE To explore the influencing factors for postoperative infection in gastric cancer patients undergoing radical resection and analyze the association of expressions of serum nuclear factor κB（NF-κB）, monocyte chemoattractant protein-1（MCP-1）, intestinal microecology with intestinal barrier function. METHODS Totally 108 gastric cancer patients who underwent radical resection in Shengjing Hospital Affiliated to China Medical University from Jun 2018 to Jun 2021 were enrolled in the study and divided into the infection group with 21 cases and the 87 cases according to the status of postoperative infection. The sputum, midstream urine, stool and skin wound secretion specimens were collected from the patients by aseptic means, the pathogens were isolated and identified, the fresh stool specimens were collected from the patients when they defecated for the first time after surgery so as to detect the intestinal flora. The levels of serum D-lactate, diamine oxidase（DAO）, NF-κB and MCP-1 were detected by enzyme-linked immunosorbent assay. Multivariate logistic regression analysis was carried out for the influencing factors for the postoperative infection, and Pearson correlation analysis was performed for the relationship between the gastrointestinal flora and the intestinal barrier function indexes. RESULTS Klebsiella pneumoniae was dominant among the pathogens that were isolated from the patients with postoperative infection. The no less than 60 years of age, complication with diabetes mellitus and length of hospital stay no less than 14 days were independent influencing factors for the postoperative infection in the gastric cancer patients undergoing radical resection（P＜0.05）. The gastrointestinal tract colony counts of Escherichia coli of the infection group were higher than those of the no infection group, while the colony counts of Bifidobacteria of the infection group were lower than those of the no infection group（P＜0.05）. The levels of serum D-lactate and DAO of the infection group were lower than those of the no infection group, while the levels of serum NF-κB and MCP-1 of the infection group were higher than those of the no infection group（P＜0.05）. Pearson correlation analysis showed that the colony counts of E. coli of the infection group were positively correlation with the levels of D-lactate and DAO, the colony counts of Bifidobacteria were negatively correlated with the levels of D-lactate and DAO（P＜0.05）. CONCLUSION The gastric cancer patients with postoperative infection show remarkable rise of levels of serum NF-κB and MCP-1, and the gastrointestinal tract flora are closely associated with the intestinal barrier function.
OBJECTIVE To investigate the current status of nosocomial infection in secondary or above medical institutions of Suzhou so as to provide data support for management, prevention and control of nosocomial infection in hospitals at all levels. METHODS The related monitoring indexes for nosocomial infection management quality control that the hospitals participated from Jan 2020 to Dec 2020 were extracted by regional nosocomial infection monitoring platform. The related data from the secondary and tertiary hospitals were statistically analyzed. RESULTS Among 1 324 890 hospitalized patients from the 41 hospitals in 2020, 18 353 were new onset cases of nosocomial infection, with the incidence of nosocomial infection 1.39%; the missing report rate of nosocomial infection cases was 6.95%; the incidence rate of type I incision site infection was 0.30%, the rate of antibiotics prophylaxis was 17.58% for the type I incision surgery; the incidence of endovascular catheter-related bloodstream infection was 0.343‰, the incidence of ventilator-associated pneumonia was 6.528 ‰, and the incidence of urinary catheter-related urinary tract infection was 1.176 ‰. There was no significant difference in the rate of antibiotics prophylaxis for the type I incision surgery among the medical institutions at different levels, the rest of the related indexes for nosocomial infection management quality control were higher in the tertiary hospitals than in the secondary hospitals（P＜0.05）. CONCLUSION There are significant differences in the monitoring indexes for nosocomial infection management quality control among the different levels of medical institutions in the city. It is necessary for the hospitals to formulate effective monitoring strategies and prevention programs based on the monitoring results so as to reduce the risk of infection.
目的 探讨非小细胞肺癌患者甲基转移酶DNMT3B基因多态性及其与化疗期间肺部感染易感性的关系.方法 选择中国医科大学附属盛京医院2018年10月-2021年10月因非小细胞肺癌住院并接受化疗治疗患者为研究对象,选择在化疗期间出现肺部感染性疾病和未出现肺部感染性疾病患者各60例,分别纳入感染组和非感染组.检测并分析感染组病原菌分布情况,通过电子病历系统收集所有非小细胞肺癌患者性别、年龄、肿瘤分期、肿瘤分化程度和治疗方案情况,参照文献统计感染组患者临床肺炎感染评分(CPIS)、病原检出和感染确诊当天实验室检查指标C-反应蛋白(CRP)、降钙素原(PCT)水平.采用聚合酶链式反应-限制性片段长度多态法检测DNMT3B基因-579位点多态性分布情况.结果 哈迪-温伯格检验结果显示,感染组、非感染组DNMT3B基因-579位点均由GG、GT和TT 3种基因型组成,且实际频数和理论频数分布比较差异均无统计学意义,表明所选对象具有较好的群体代表性;感染组非小细胞肺癌患者DNMT3B基因-579位点携带GG基因型和G等位基因频率高于非感染组患者,TT基因型频率低于非感染组患者(P＜0.05);感染组携带GG基因型患者CPIS评分、外周血CRP和PCT水平高于携带GT/TT组患者(P＜0.05).结论 非小细胞肺癌患者化疗期间肺部感染病原菌主要为革兰阴性菌,DNMT3B基因-579位点携带GG基因型增加非小细胞肺癌患者化疗期间肺部感染易感性,且与严重程度有关,但与感染病原无关.
目的 分析感染性休克患者病原学特点及脉波指示持续心排血量(PiCCO)血流动力学、动脉血乳酸在血液灌流治疗中的监测价值.方法 选取2019年7月一 2021年7月医院收治的91例感染性休克患者为研究对象,收集所有研究对象的临床资料,随访患者入住急诊重症监护室(EICU)后28 d预后情况,并根据患者预后情况将其分为存活组(52例)和死亡组(39例).监测入住EICU后0、6、24 h时的PiCCO血流动力学及动脉血乳酸指标水平.采用受试者工作特征(ROC)曲线分析PiCCO血流动力学指标及血乳酸水平对感染性休克患者预后的预测价值,曲线下面积(AUC)表示预测的准确度;采用多因素Logistic回归分析法分析预后影响因素.结果 对患者进行病原学检测,共检出病原菌91株,其中革兰阴性菌67株(73.63％)、革兰阳性菌22株(24.18％)、真菌2株(2.20％).存活组在24 h时的CO指标高于死亡组,而SVRI、EVLWI及PVPI指标低于死亡组(P＜0.05).存活组在6、24 h时的血乳酸指标水平低于死亡组(P＜0.05).24 h CO、24 h SVRI、24 h EV-LWI、6 h血乳酸及24 h血乳酸指标用于感染性休克患者预后预测的AUC值分别为0.876、0.846、0.877、0.797、0.836,各指标间AUC值比较差异无统计学意义.Logistic回归分析结果显示,24 h CO≤4.21 L/min、24 h SVRI＞2 179.2 mmHg·min/L·m2、24 h EVLWI＞8.05 ml/kg、6 h 血乳酸＞4.36 mmol/L、24 h 血乳酸＞2.43mmol/L是感染性休克患者血液灌流治疗预后不良的独立影响因素(P＜0.05).结论 监测感染性休克患者血液灌流治疗期间的PiCCO血流动力学和乳酸指标水平对于预测患者预后可能具有积极意义.
目的 监测2021年全国各重症监护室(ICU)、急症监护室(EICU)、呼吸监护室(RICU)及心脏监护室(CCU)患者临床分离菌株分布及耐药情况.方法 按照全国细菌耐药监测网(CARSS)方案(2020版),应用WHONET 5.6软件对2020年10月-2021年9月CARSS成员单位上报的ICU、EICU、RICU及CCU患者临床分离细菌及药敏结果数据进行分析.结果 2021年ICU、EICU、RICU及CCU患者分离的总菌株数为449 279、33 909、18 518、10 241株,其中耐甲氧西林金黄色葡萄球菌(MRSA)的检出率为36.2％、34.1％、46.7％和35.5％,未发现对万古霉素、替考拉宁及利奈唑胺耐药的菌株.除利奈唑胺外,粪肠球菌对多数测试抗菌药物的耐药率均低于屎肠球菌,其中万古霉素耐药粪肠球菌(VREFA)为0.5％、0.2％、0、0;万古霉素耐药屎肠球菌(VREFM)为1.5％、1.2％、1.1％、1.4％.铜绿假单胞菌、鲍氏不动杆菌对碳青霉烯类抗菌药物耐药率分别为28.7％、26.9％、36.0％和17.7％;78.2％、78.3％、86.1％和56.2％.大肠埃希菌对碳青霉烯类抗菌药物耐药率为3.5％、3.5％、4.2％和1.5％;肺炎克雷伯菌对碳青霉烯类抗菌药物耐药率为20.6％、20.2％、40.1％和9.9％.结论 ICU患者中MRSA、碳青霉烯类耐药鲍氏不动杆菌(CRAB)、碳青霉烯类耐药铜绿假单胞菌(CRPA)、碳青霉烯类耐药大肠埃希菌、碳青霉烯类耐药肺炎克雷伯菌(CRKP)等表型的发生率明显更高,其中RICU耐药率高于其他三个监护室.
目的 探讨肺炎支原体感染患者临床特征与TGF-β1/Smads信号通路在免疫反应中的作用.方法 选取2021年6月-2022年5月在内蒙古医科大学附属医院就诊的120例肺炎支原体感染患者为研究对象,其中规范性地应用大环内酯类抗菌药物治疗≥7 d的60例患者为难治性肺炎支原体肺炎(RMPP)组,其余60例患者为支原体肺炎(MPP)组;按照随机数字表法从2022年在医院进行查体的健康人群中选择60名为对照组.对两组患者临床症状与生命质量进行评估,测定三组TGF-β1/Smads信号通路相关蛋白与mRNA水平、炎症因子水平以及T淋巴细胞亚群水平.结果 RMPP组临床症状发生率大多高于MPP组(P＜0.05);对照组生命质量评分高于MPP组,MPP组高于RMPP组(P＜0.05);MPP组和RMPP组血清C-反应蛋白(CRP)、干扰素γ(IFN-γ)、肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-4、IL-6、IL-10水平均要高于对照组,IL-1β低于对照组(P＜0.05);RM-PP组CD3+、CD4+、CD8+水平最低,低于对照组与MPP组,CD4+/CD8+对照组最低,RMPP组最高(P＜0.05);MPP组和RMPP组TGF-β1、Smad3蛋白与mRNA表达水平高于对照组,Smad7蛋白与mRNA表达水平低于对照组(P＜0.05).结论 MP感染与患者体内TGF-β1/Smads信号通路有关,TGF-β1/Smads信号通路可介导支原体肺炎患者的免疫反应.
目的 了解医院连续8年老年住院患者医院感染流行特征并对整体防控成效进行分析,为开展针对性防控及动态调整防控策略提供依据.方法 以江苏省连云港市第一人民医院2014年1月1日-2021年12月31日年龄≥60周岁的老年住院患者为研究对象,采用医院感染实时监控系统对老年住院患者医院感染情况开展前瞻性监测,收集数据并对其流行病学特征进行分析,在全院范围推行综合性感控措施,对比监测数据,评价成效.结果 连续8年共监测老年住院患者288 001例,发生医院感染6 351例次,例次发生率为2.21％.其中,男性医院感染发生率是女性的1.45倍,住院时长≥14 d的感染率为＜14 d的14.00倍(P＜0.05);除老年医学科外,老年患者医院感染科室集中于神经外科、神经内科、呼吸与危重症医学科;感染部位以下呼吸道、泌尿道和上呼吸道为主.老年患者耐药菌总体检出率为1.14％,以耐碳青霉烯鲍氏不动杆菌(CRAB)、耐碳青霉烯铜绿假单胞菌(CRPA)和耐碳青霉烯肺炎克雷伯菌(CRKP)为主.通过推行综合防控措施,老年患者总体医院感染发生率由3.87％降至1.45％.耐药菌感染发现率由0.541％降至0.251％,呼吸机相关性肺炎(VAP)、导管相关血流感染(CRBSI)以及导尿管相关尿路感染(CAUTI)分别由9.72‰、1.37‰、2.00‰降至1.46‰、0.46‰和0.92‰,差异均有统计学意义(P＜0.05).结论 综合性医院应加大对老年患者院感防控力度,尤其关注呼吸系统以及细菌耐药问题,多措并举,有效降低医院感染发生风险.
目的 探讨结直肠癌根治术后合并切口感染病原学及构建预测决策树模型.方法 选取海南省第三人民医院普外科于2018年1月-2021年10月收治的242例行结直肠癌根治术患者,根据术后合并手术切口感染情况分为感染组45例和非感染组197例.分析感染病原菌分布特点,采用单因素和多因素Logistic回归分析感染的危险因素.基于感染危险因素建立决策树模型,采用受试者工作特征(ROC)曲线分析决策树模型的预测效果.结果 45例感染患者共检出62株病原菌,革兰阳性菌22株(35.48％)、革兰阴性菌36株(58.06％)、真菌4株(6.45％).Logistic回归分析显示,糖尿病、TNM分级、出血量、手术时间、血清白蛋白是结直肠癌根治术后合并手术切口感染的危险因素(P＜0.05).筛选出3类高危人群:①合并糖尿病,血清白蛋白≤35 g/L,占该节点构成的31.25％;②合并糖尿病,血清白蛋白＞35 g/L,占该节点构成的14.29％;③无合并糖尿病,TNM分期≥Ⅲ期,手术时长＞150 min,占该节点构成的30.77％.ROC曲线分析显示决策树模型预测感染的曲线下面积为0.806(95％CI:0.729～0.869).结论 结直肠癌患者根治术后合并感染病原菌以革兰阴性菌为主,其中糖尿病、TNM分级、出血量、手术时间、血清白蛋白均是手术切口感染的危险因素.决策树模型具有良好的手术切口感染预测价值.
目的 探讨乳腺癌人乳头瘤病毒(HPV)感染状况及与低氧诱导因子-1α(HIF-1α)、葡萄糖转运蛋白-1(Glut-1)、血管内皮生长因子(VEGF)表达的相关性.方法 随机选取2020年1月-2023年3月在内蒙古医科大学附属医院接受乳腺癌手术治疗的120例原发性乳腺癌患者为研究对象,上述研究对象中共收集乳腺癌组织110例、癌旁组织80例、正常乳腺组织80例,采用免疫组化染色SP法检测三种组织中HIF-1α,Glut-1及VEGF表达情况;分子原位杂交技术检测三种组织中HPV感染状况.对比HPV感染及未感染乳腺癌、癌旁组织及正常乳腺组织中HIF-1α、Glut-1、VEGF蛋白阳性表达情况.结果 乳腺癌组织中HPV感染率为56.36％,癌旁组织中HPV感染率为17.50％,正常乳腺组织中HPV感染率为1.25％;乳腺癌组织中HIF-1α、Glut-1、VEGF蛋白阳性表达率均高于癌旁组织、正常乳腺组织(P＜0.05),癌旁组织中HIF-1α、Glut-1、VEGF蛋白阳性表达率均高于正常乳腺组织(P＜0.05);感染HPV的乳腺癌组织、癌旁组织、正常乳腺组织中的HIF-1α、Glut-1、VEGF蛋白阳性表达率均高于未感染HPV组织(P＜0.05).结论 根据HIF-1α、Glut-1、VEGF在乳腺癌组织的表达高于癌旁组织和正常乳腺组织,推测可能是由于HPV在乳腺癌组织中感染,从而使抑制相关炎症通路的信号因子如HIF-1α、Glut-1、VEGF的产生及释放,推测HIF-1α、Glut-1、VEGF可能参与了乳腺癌的发生和发展.
目的 了解2021年度全国神经外科细菌的分离及耐药性现状.方法 应用WHONET 5.6软件对2020年10月-2021年9月全国细菌耐药监测网1 371所医院神经外科分离的细菌进行分析,分析内容包括各菌株的标本分布、菌种分布及对常用抗菌药物的敏感率和耐药率.结果 2020年10月-2021年9月全国细菌耐药监测网1 371所医院神经外科共分离细菌180 909株,其中痰为主要标本来源,痰分离的菌株占所有菌株的72.04％;革兰阴性菌占78.97％,革兰阳性菌占21.03％.分离前五的细菌分别为:肺炎克雷伯菌39 812株,占22.01％,其次为鲍氏不动杆菌,24 177株,占13.36％,铜绿假单胞菌22 591株,占12.49％,大肠埃希菌17 293株,占9.56％,金黄色葡萄球菌16 158株,占8.93％.神经外科耐甲氧西林金黄色葡萄球菌(MRSA)的分离率为36.7％,屎肠球菌和粪肠球菌对万古霉素、替考拉宁和利奈唑胺的耐药率分别为1.7％和0.2％、2.1％和0.7％、0.4％和2.5％;大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和鲍氏不动杆菌对亚胺培南和美罗培南的的耐药率分别为2.9％和3.0％、16.6％和17.2％、24.4％和20.7％、65.8和67.2％,均高于2020年所有科室来源菌株.结论 应加强神经外科抗菌药物的监管,提高医院感染防控能力.
目的 探讨儿童急性淋巴细胞白血病(ALL)化疗继发肺炎支原体(MP)感染(ALL-MP)临床特征及其影响因素.方法 选取苏州大学附属儿童医院血液科2015年1月-2019年12月住院接受系统化疗的675例儿童ALL为研究对象,收集患儿临床资料、检测MP血清抗体、C-反应蛋白(CRP)等,分析化疗方案及临床结局,单因素及多因素分析ALL-MP患儿累及肺部的影响因素.结果 675例儿童ALL化疗期间继发感染594例,其中ALL-MP占12.46％(74/594例),24.32％(18/74例)ALL-MP感染部位不明;初诊ALL年龄≥2岁者MP感染发生率高于＜2岁者(P＜0.05);T系ALL的MP感染发生率高于B系ALL(P＜0.05);大剂量甲氨蝶呤(HD-MTX)化疗组MP感染发生率高于非HD-MTX组(P＜0.05);ALL-MP儿童中,＜5岁下呼吸道感染发生率高于≥5岁(P＜0.05),累及肺部组较未累及肺部组年龄偏小、女性偏多、非粒缺发生率更高(P＜0.05),其中女性、年龄小是ALL-MP感染后累及肺部的危险因素(P＜0.05);阿奇霉素抗ALL-MP疗效显著;随访中MP感染组仅1例ALL复发.结论 儿童ALL-MP存在下列特征:T系ALL、HD-MTX化疗组的MP感染发生率高,＜5岁下呼吸道感染发生率较高,女性、年龄小可能为ALL-MP感染后累及肺部的危险因素.
目的 探讨基于达标理论的支持性照护方案在Miles术后结肠造口并发感染患者护理中的应用效果.方法 选取郑州大学第二附属医院2019年1月-2022年2月收治的Miles术后结肠造口并发感染患者63例进行回顾性研究,2019年1月-2020年1月收治的Miles术后结肠造口并发感染患者31例为对照组,2020年2月-2022年2月收治的Miles术后结肠造口并发感染患者32例为研究组;对照组常规护理,研究组实施基于达标理论的支持性照护方案.两组护理前后的生活质量用造口患者生活质量问卷评估,社会心理适应用造口患者社会心理适应量表(OAI-20)评估,自我管理用肠造口患者自我管理问卷(EPSQ),造口周围皮肤状况用造口周围皮肤评估工具(DET评估表)评估,观察造口并发症.结果 研究组护理后COH-QOL-OQ评分均高于对照组(P＜0.05);研究组护理后OAI-20评分高于对照组(P＜0.05);研究组护理后DET评分低于对照组(P＜0.05);研究组出院后3个月时肠造口总发生率低于对照组(P=0.017).结论 基于达标理论的支持性照护方案可显著提升Miles术后结肠造口并发感染患者生活质量和社会心理适应能力,降低造口周围皮肤变色、侵蚀、组织增生和肠造口并发症发生率.
