Objective:Prolonged length of stay (LOS) following orthopedic surgery places a significant strain on healthcare systems. However, effective tools for predicting LOS in patients undergoing clean (Class I) orthopedic surgery are lacking. This study aims to identify factors influencing length of stay in orthopedic Class I incision surgery and construct a predictive nomogram based on these factors. Methods:Retrospective analysis of patients undergoing orthopedic Class I incision surgery in Taihe Hospital from January 1, 2018 to October 31, 2023. Patients meeting the inclusion criteria were enrolled. Using prolonged length of stay (LOS > 7 days) as the primary outcome, we performed univariate analysis followed by binary logistic regression to identify risk factors. An individual nomogram was developed using R 4.3.3. Results:31,248 patients were ultimately included, with 20,419 (65.34%) patients demonstrating prolonged length of stay (LOS > 7 days). The results of binary logistic regression show that the independent risk factors for prolonged LOS (LOS > 7 days) in patients undergoing orthopedic Class I incision surgery were: age, surgical duration, surgical grade, American Society of Anesthesiologists' Physical Status Classification System (ASA PS), antibiotic use, combined antibiotic, and blood potassium(K), sodium (Na), magnesium(Mg) and calcium(Ca) concentrations. Validation using the receiver operating characteristic (ROC) curve showed that the nomogram had an area under the curve (AUC) of 0.846 (95% CI: 0.841-0.850), demonstrating good accuracy. The bootstrap method was used to repeatedly sample 1,000 times to verify the nomogram. The mean absolute error of the calibration curve was 0.003, indicating that the calibration curve fits well with the ideal curve. Decision curve analysis showed a significantly greater net benefit of the nomogram. Conclusion:The developed nomogram accurately predicts prolonged hospitalization risk in orthopedic patients with Class I incisions, integrating key determinants including age, surgical complexity, physiological status, and electrolyte levels. This tool demonstrates robust performance and offers tangible clinical utility for optimizing resource allocation and guiding personalized perioperative management.

Infections rank as the third leading cause of death among patients with type 2 diabetes (T2D), representing a critical clinical burden that cannot be ignored. The gut, as a major microbial reservoir, is strongly implicated in this heightened susceptibility. However, the specific enteric pathogens responsible remain poorly defined. This study, therefore, aims to identify specific enteric pathogens associated with T2D and translate these findings into an effective detection strategy by developing a robust molecular tool for clinical prevention. We first conducted a systematic meta-analysis to identify T2D-associated gut pathogens. Then, targeted next-generation sequencing (tNGS) was performed on carefully matched stool samples to further characterize pathogen enrichment. Subsequently, findings from meta-analysis and tNGS were validated in independent clinical cohorts using qPCR analysis. Finally, we developed a dual-probe fluorescence-based PCR assay and conducted comparative evaluation between droplet digital PCR (ddPCR) and quantitative PCR (qPCR) platforms using clinical fecal samples. The meta-analysis revealed significantly increased abundance of Klebsiella and Escherichia/Shigella in T2D individuals, findings that were consistently replicated in independent validation cohorts. Subsequent tNGS analysis confirmed elevated abundance and detection rates of enteropathogenic Escherichia coli (EPEC) in the T2D group. Based on these findings, we developed a highly sensitive and specific dual-probe fluorescence-based PCR assay. Methodological comparisons demonstrated that ddPCR substantially outperformed qPCR in direct detection of target bacteria from fecal samples, exhibiting enhanced analytical sensitivity and superior resistance to fecal matrix inhibitors. This study establishes a significant association between specific enteric pathogens and T2D, underscoring their putative role in diabetes-related complications. The demonstrated superiority of ddPCR enables sensitive, matrix-resistant enteric pathogen detection in T2D patients, providing a robust diagnostic tool that supports targeted diagnosis, risk stratification, and optimized clinical management of at-risk individuals. National Medical Research Registration and Filing Information System MR4225044248, 13-Jun-2025.

Accumulating studies have shown that E3 ligases play crucial roles in regulating cellular biological processes and signaling pathways during carcinogenesis via ubiquitination. Tripartite-motif (TRIM) ubiquitin E3 ligases consist of over 70 members. However, the clinical significance and their contributions to tumorigenesis remain largely unknown. In this study, we analyzed the RNA-sequencing expression of TRIM E3 ligases in colorectal cancer (CRC) and identified 10 differentially expressed genes, among which TRIM1 expression predicted poor prognosis of CRC patients. We demonstrated that TRIM1 expression is positively associated with CRC pathological stages, and higher expression is positively correlated with infiltrating levels of immune cells and immunotherapy biomarkers. TRIM1 expression promotes the proliferation and migration of colorectal cancer cells in vitro and in vivo. Transcriptional analysis showed that TRIM1 is responsible for metabolism promotion and immune suppression. Mechanistically, we found that TRIM1 binds HIF1α and mediates its K63-linked ubiquitination, which is required for HIF1α nuclear translocation and subsequent activation. Ubiquitination occurs at Lys214 in the loop between the two PAS domains of HIF1α, and mutation of Lys214 severely disturbs the function of HIF1α. Besides, HIF1α ubiquitination enhances its binding with proteins involved in cellular trafficking and nucleocytoplasmic transport pathway. Collectively, our results indicate TRIM1’s role in predicting prognosis and reveal how TRIM1 functions to upregulate HIF1α expression and promote tumor cell proliferation.

由于宫内生长受限的解除以及出生后的营养环境改变,大部分小于胎龄(SGA)儿都会出现追赶生长.追赶生长可以促进SGA儿的体格发育,提高生存质量.近年来许多研究表明SGA儿过快追赶生长与儿童期肥胖密切相关,母乳喂养可降低肥胖的发生率.本文就SGA儿过快追赶生长与儿童期肥胖关系、可能机制的研究进展做一综述.

达芬奇机器人手术系统已被广泛应用,国内外目前相关研究多为达芬奇机器人手术系统在相关科室或术种的发展现状及术后并发症对比,对达芬奇机器人手术系统相关医院感染与防控研究较少.本文综合达芬奇机器人手术系统特点和相关医院感染研究现状,探讨达芬奇机器人手术系统相关医院感染的危险因素,提出从加强围手术期管理、加强手术间环境管理、加强团队培训和强化手术器械清洗灭菌四个方面降低相关感染风险,以期为临床医务人员及医院感染管理专职人员开展医院感染防控工作提供参考.

目的 分析体外膜肺氧合(ECMO)支持治疗患者医院感染流行病学特点及医院感染危险因素.方法 选取2017年2月-2022年4月湖北医药学院附属太和医院收治的ECMO支持治疗患者为研究对象,根据是否发生医院感染分为感染组和非感染组,统计感染部位及病原菌分布,单因素和多因素Logistic回归分析ECMO支持治疗患者发生医院感染的危险因素.结果 共68例ECMO支持治疗患者纳入研究,平均年龄为(45.78± 15.83)岁,男性55例(80.9％),60例患者行V-A模式;17例(25.00％)患者发生28例次医院感染,感染部位以呼吸系统(12例次,42.86％)为主,其次为血液系统(7例次,25.00％);中心ICU感染例次率最高(17例次,58.62％);共检出病原菌45株,以革兰阴性菌为主(30株,66.67％),检出菌中多药耐药菌29株占64.44％;多因素Logistic回归分析显示,ECMO支持治疗时长是ECMO支持治疗患者发生医院感染的独立危险因素(OR=1.945,95％CI=1.067～3.546,P=0.030).结论 ECMO支持治疗患者医院感染发病率高,ECMO支持治疗时长为其危险因素;应开展综合防治措施,降低ECMO支持治疗患者医院感染率.

Objectives This study aimed to explore the association between multiple metals' exposure and children's height. Methods We collected urine samples and physical measurement data of 1477 preschoolers in China. Children's actual height was measured, and whether reached target height was also assessed. Logistic regression analysis was performed to explore the association between heavy metals and height. The least absolute shrinkage and selection operator regression was used to select the urinary metals, which were highly correlated. Results In the single-metal model after adjusting for potential confounders, urinary iron, aluminum, nickel, chrome, titanium, vanadium, selenium, rubidium, and thallium levels were negatively associated with actual height. Urinary iron, aluminum, nickel, and chrome concentrations were also negatively associated with target height. Conclusions The findings suggested that some urinary metal exposure might be associated with height in preschoolers.

目的 探索基于DRG时间消耗指数的平均住院日目标管理,实现医院精细化管理.方法根据某三级甲等综合医院康复院区2018年1月1日-12月31日12591例出院患者信息,结合DRG时间消耗指数计算出各科室缩短平均住院日计划指标;将该院区2019年上半年平均住院日做为干预组,上年同期数据为干预前对照组,采用匹配样本t检验比较差异.结果该院康复院区2019年上半年平均住院日(17.77天)同比减少2.68天,顺利完成平均住院日目标;各科室2019年上半年平均住院日与上年同期对比数据差异具有统计学意义,P<0.001.结论将DRG时间消耗指数应用于科室平均住院日目标管理,有利于合理控制平均住院日,提高医院整体运行效率.

目的 基于DRGs综合评价某三级综合医院各科室2016年绩效情况,为医院管理、专科评价、制定政策提供科学依据.方法 根据2016年各科室总权重、DRGs组数、CMI指数、费用消耗指数、时间消耗指数,联用TOPSIS与RSR方法进行科室绩效综合评价.结果 对医院各科室(病区)的绩效评价结果进行了排序,儿科Ⅰ病区(0.61)、心内科Ⅲ病区(0.52)、心内科Ⅱ病区(0.51)、普外Ⅱ病区(0.51)、急诊ICU (0.51)等科室排名靠前,神经康复Ⅰ病区(0.19)、骨科康复Ⅰ病区(0.19)、骨科康复Ⅱ病区(0.19)、睡眠科(0.19)、PICU(0.16)等科室排名靠后.各科室的绩效表现分为优、良、一般、较差四档,儿科Ⅰ病区等5个科室为优,心内科Ⅰ病区等42个科室为良,骨科V病区等24个科室为一般,神经康复Ⅰ病区等5个科室表现较差.结论 联用TOPSIS与RSR方法综合评价临床科室DRGs指标可对科室绩效情况排序和分档,改善医疗服务质量,优化资源配置,有实际意义.

目的 利用DRGs对疾病进行分组,探讨消除传统绩效评价下因临床专业及疾病谱不同导致的评价误差,为医院绩效管理探索新方法.方法 应用熵权法和TOPSIS法,结合DRGs指标,对医院临床专科住院医疗服务绩效进行综合评价.结果 熵权法得到的DRGs各评价指标权重分别为0.2791、0.3778、0.0364、0.1548、0.1513、0.0001、0.0006,总权重熵权最大,低风险死亡率权重最小.综合评价数据测算结果,顺位排序前5位分别是儿科、康复医学科、皮肤科、骨科和妇科,后5位分别为精神科、介入放射学、儿童康复、产科和肾病学.结论 基于DRGs的熵权TOPSIS评价法能客观、准确地反映医院内部不同科室的医疗服务情况,为医院的绩效管理、学科发展提供了参考.

目的 蛋白质磷酸化是通过激酶催化特定位点把磷酸基转移到底物蛋白质氨基酸残基的过程,是研究蛋白质活力及功能的重要机制.目前已鉴定的数千个磷酸化位点大多缺失激酶信息,为此本研究提出基于PU?learning的磷酸激酶预测算法,通过迭代标记磷酸位点,可以准确预测催化磷酸肽的磷酸激酶.方法 首先该算法以PU?learning为框架,利用最大熵方差对不同种类的磷酸激酶自动筛选最佳阈值,从而提取每条磷酸肽上潜在的磷酸化位点,然后根据统计分析确定磷酸化位点对应的激酶,最后通过五折交叉验证该算法在Phospho.ELM数据库上的预测性能,并与现有算法对比.结果 该算法的交叉验证特异性和灵敏度比现有最好算法在单个数据集上最高提高4％及10％,其预测Phospho.ELM中数据准确度达到79.52％.结论 基于PU?learning的磷酸激酶预测算法显著优于现有算法,且可以准确预测Phospho.ELM数据库中未知激酶信息的磷酸肽,在磷酸化实验中具有较强的指导意义.

目的 探讨Ⅰ类切口手术部位感染(surgical site infections,SSI)发生的危险因素,为制定Ⅰ类切口SSI防控措施提供理论依据.方法 采用病例对照研究,收集某三甲教学医院手术日期为2015年1月～2016年12月的Ⅰ类切口手术病人病例资料,分析SSI情况及其危险因素.结果 Ⅰ类切口手术14 023例病人共发生SSI 63例,发生率为0.45％.骨外科Ⅰ类切口手术SSI发生率较高,为0.55％.单因素分析结果表明,不同手术时间(x2=9.62)、术中出血量(x2=30.93)、ASA分级(x2=9.17)、NNIS分级(x2=10.60)、术前住院天数(x2=7.07)、术后抗菌药物使用天数(x2=109.25)的病人SSI发生率不同,差异均有统计学意义(P＜0.05).多因素分析结果显示,手术时间过长和术后抗菌药物使用天数过长是发生Ⅰ类切口SSI的危险因素(OR=2.84和11.87).结论 Ⅰ类切口手术病人SSI发生率与手术时间和术后抗菌药物使用天数等因素有关,应采取相应的预防措施,降低SSI发生率.

目的分析了解综合医院骨外科住院医疗服务现状,为医院加强精细化管理和学科建设提供数据支持.方法收集某三甲医院骨外科5个病区2017年1月1日-2017年12月31日9125例住院病案首页数据以及某平台DRG分组数据,采用综合评价法中综合指数法进行数据处理并评价.结果DRGs指标与传统指标的综合评价结果存在一定差异,各专科收治病种各有侧重;费用消耗指数为0.85,时间消耗指数为1.25,说明骨外科治疗同类疾病所花费的费用较低,时间较长.结论DRGs指标能从多维的角度呈现科室医疗服务情况,对于医院管理和学科建设均具有重要意义.

To ensure the occupational safety and health of the medical staff in China and to solve this problem systematically,the paper summarizes the occupational injury related factors at present based on literature review.The results show that the occupational injury is related with hospital environment,occupational characteristics and factors of the medical staff.So we come up with the framework and details of occupational safety and the disposalof health management system,mainly including coordination,routine guarantee,occupational exposure assessment and the disposal of follow-up.This rudiment can give medical institutions advice on establishment of occupational safety and health management system.

Objective To study the changing trend of prevalence rates of healthcare-associated infection (HAI) and antimicrobial use in hospitalized patients in medical institutions of Hubei Province,and provide a scientific basis for improving HAI management.Methods The cross-sectional survey results of HAI in Hubei Province in 2010, 2012,and 2014 were analyzed.Results The prevalence rates of HAI in 2010,2012,and 2014 were 3.48%(1526/43909),3.03%(1919/63320),and 2.86%(2174/76145)respectively,which showed a downward trend,differ-ence was statistically significant(χ2 =36.44,P <0.01).Antimicrobial usage rate decreased from 54.29% (23838/43909)in 2010 to 41.02% (31238/76145)in 2014,difference was statistically significant(χ2 =2194.09,P <0.01).Among patients receiving therapeutic use of antimicrobial agents,the specimen detection rate increased from 30.49% (4297/14091)in 2010 to 52.13% (10556/20248)in 2014 (χ2 =1593.98,P <0.01).Conclusion The prevalence rate of HAI showed a downward trend in Hubei Province,cross-sectional survey on antimicrobial use showed a gradual decrease.

Objective To understand the basic situation of healthcare-associated infection(HAI)management and prevention and control of multidrug-resistant organism(MDRO)infection in medical institutions in Hubei Province.Methods Questionnaires were used to investigate the basic situation of HAI management and MDRO infection in 47 tertiary and secondary hospitals in Hubei Province.Results 47 hospital were enrolled in this study,HAI management full-time staff was allocated with a median of 0.90/250 beds;in 2015,the isolation rates of methicillin-resistant Staphylococcus aureus,carbapenem-resistant Enterobacteriaceae,carbapenem-resistant Pseudomonas aeruginosa,carbapenem-resistant Acinetobacter baumannii,and vancomycin-resistant Enterococcus were 39.13%,4.13%,19.44%,63.60%,and 2.77%respectively.47 hospitals all carried out surveillance on MDROs,28(59.57%)hospitals were installed HAI monitoring system software,could directly obtain data through collecting with the laboratory system.The diagnosis of MDRO infection was mainly based on the combined diagnosis by HAI full-time personnel and clinicians(26 hospitals,55.32%).44(93.62%)hospitals regularly convened coordination meeting on prevention and control of MDROs,in 2015,hand hygiene compliance rate were 10.0%-89.2%by self-inspection;42(89.36%)hospitals routinely prescribed isolation orders for patients with MDRO infection,33(70.21%)hospitals conducted environmental clean and disinfection twice a day,24(51.06%)hospitals performed personal protection by using complete set of protective equipment.Conclusion This investigation is helpful for understanding the general situation of HAI management in medical institutions,as well as the detection and control of MDROs in this area,and make continual improvement on the problems and weakness found in the investigated project,so as to promote the development of HAI management in this area.

Objective To evaluate the effects of fluorescent labeling combined with comprehensive manage-ment on the environmental cleanliness in hospital. Methods Five wards were randomly selected from five depart-ments of Neurology, Respiratory medicine, Neurosurgery, Cardiothoracic Surgery and Intensive Care Unit each in Shi-yan Taihe Hospital from January 2016 to June 2016. In these wards, we adopted fluorescence labeling and ATP fluores-cence detection to monitor the cleaning quality of articles surface which were frequently touched, then we developed and applied comprehensive management measures for existing problems. Finally, the cleaning quality were compared before and after the intervention. Results After taking the comprehensive management measures, the clearance rate of fluores-cence labeling and the compliance rate of ATP bioluminescence in this hospital respectively enhanced from 41.11%and 38.89%to 90.42%and 83.33%before and after the intervention. After 6 months of continuous intervention, the clear-ance rate of fluorescence labeling increased from 26.04%to 87.50%in the medical ward, from 22.23%to 86.25%in the surgical ward, and from 63.46%to 97.50%the intensive care unit, respectively. The differences were all statistically sig-nificant (P<0.01). Conclusion Fluorescent labeling combined with comprehensive management can improve the clean-ing effect of articles surface and environment of hospital, and reduce the risk of hospital infection.

OBJECTIVE Circulating tumor cells are considered to be the main factor of recurrence of tumor.There were reports showed that the CTCs positive percentage of esophageal cancer were decreased after the radiation, which was closely related to the prognosis of esophageal cancer.This study was designed to evaluate the changes of circulating tumor cells in locally advanced esophageal squamous cell carcinoma patients treated with neoadjuvant therapy.The dynamic changes of circulating tumor cells during neoadjuvant were also analyzed.METHODS Between Jan 2013 and Mar 2014, 96 cases with histologically diagnosed esophageal squamous carcinoma were enrolled.Circulating tumor cells were detected by immunomagnatec enrichment and fluorescence in these patients.The dynamic changes of CTCs were compared between pre-and post-neoadjuvant therapy.the association of these changes with the clinical characteristics and two-year survival rate were analyzed.The different CTCs status among esophageal cancer patients were compared with χ2 test and survival analysis was performed by Kaplan-Meier methods and Cox model.RESULTS To March 27th in 2014, the follow-up rate was 100%.The positive rate of CTCs was closely related with the length of lesion, T stage, N stage and clinical stage (P<0.05), and it was not likely to be associated with age, sex and lesion location (P>0.05).The median survival of CTCs positive group was 19.2 months, and it was 26.8 months in CTCs negative group.Multivariate analysis revealed that the clinical stage was the prognostic influencing factor.The median survival time of stage Ⅲ patients were 19.9 months and 24.6 months respectively.The difference had statistical significance (P=0.044).The median survival time of stage Ⅳ patients were 11.2 months and 21.2 months respectively, and it also showed statistical significance (P=0.045).There was no significant difference in clinical stage Ⅱ between two groups (P=0.189).After neoadjuvant therapy, there were 21 cases showed CTCs negative and they were switched from CTCs positive status, and this change was statistically significant (P<0.05).After neoadjuvant therapy, the CTCs status remain positive showed quite poor survival (16.5 months), which was significant inferior to CTCs change group and CTCs negative group (23.4 mon and 26.8 mon, respectively).There was no statistically difference between CTCs change group and CTCs negative group.CONCLUSIONS Circulating tumor cells could reflect the disease progression in patients with locally advanced esophageal squamous cell carcinoma, and it may be a quite good prognostic factor.In addition, it seems that the neoadjuvant therapy was beneficial to the median survival of CTCs positive esophageal patients.

目的 分析十堰市城区2013-2015年间0-2岁儿童营养与健康状况,为进一步做好儿童保健工作提供科学依据.方法 选择2013年4月-2015年1 1月期间在十堰市某综合性三甲医院预防保健门诊就诊的城区0～24月龄婴幼儿体检资料,按照2006年WHO推荐的Z评分法进行营养与健康状况评价.结果 十堰市城区儿童整体营养状况优于WHO推荐标准.6个月内纯母乳喂养率为53.39％,母乳喂养的儿童营养状况优于混合喂养和人工喂养.结论 十堰市城区儿童营养状况虽然整体优于WHO推荐标准,但是仍然存在6个月内纯母乳喂养率较低,婴幼儿食物转换过早等问题,因此政府及社会应进一步关注及改善儿童的营养状况,强化科学喂养的观念和能力,提高纯母乳喂养的比率.