OBJECTIVE To explore the source resulting in nosocomial infection and main component elements managing and controlling nosocomial infection in order to enhance the administration of nosocomial infection and to raise proposition on standardized administration.METHODS Main component elements resulting in nosocomial infection were investigated by reviewing literature and clinical data,and analyzing hierarchy process of administration.RESULTS Emphasis on the administrative measures of main component elements resulting in nosocomial infection might achieve the aim of preventing and reducing nosocomial infection.CONCLUSIONS Reconstruction of administrative links on nosocomial infection can reduce medical risk and cost.

Objective To analyze the etiology of fever of unknown origin (FUO).Methods A total of 372 patients with FUO who hospitalized in Capital Medical University Affiliated Beijing Friendship Hospital were retrospectively analyzed from January 2003 to August 2013.All the patients were divided into two groups:group A (January 2003-December 2007) and group B (January 2008-August 2013).Diagnosis rate,duration of hospitalization (days) and time to diagnosis between the two groups were artificially compared.Results Of the 372 FUO cases,336 were positively diagnosed with a diagnosis rate of 90.3％.Infectious diseases were still the primary causes of FUO (60.2％),including 72 cases (32.1％) of tuberculosis.Connective tissue diseases accounted for 12.9％ of the FUO cases,malignancies were 8.3％,and miscellaneous diseases were 8.9％.Yet thirty six patients (9.7％) could not be confirmed until they were discharged from hospital.The duration of fever in patients with malignancies was longer than that with infectious diseases [60.0 (30.0,90.0) days vs 30.0 (20.0,60.0) days,P =0.003].Time to diagnosis of connective tissue disease and malignancies was longer than infectious diseases [(12.0 (7.3,18.8) days and 11.0 (7.0,18.0) vs 5.0 (3.0,8.0) days,both P values =0.000].The duration of hospitalization in group A was longer than that of group B [17.0(12.0,30.0) days vs 14.0(10.0,20.0) days,P =0.000].The diagnosis rate and time to diagnosis of group A were similar with those of group B.The proportion of connective tissue diseases in group A was higher than group B(18.1％ vs 9.2％,x2 =6.201,P =0.013).The proportion of infectious disease,malignancies and miscellaneous diseases was not significantly different between the two groups.Conclusions Infectious diseases are the major causes of FUO,and the most common cause is tuberculosis.Connective tissue diseases and malignancies are the second and third causes of FUO.The duration of fever and time to diagnosis are significantly different between the different origins.

Objective To investigate the expression of metastasis associated gene-1 (mag-1) and mammalian target of rapamycin (mTOR) in rectal cancer, and its correlation with clinical pathology. Methods The expressions of mag-1 and mTOR in 60 rectal cancer tissue, 30 adenoma tissues and 10 normal rectal tissues were detected by immunohistochemical method, and the correlation between the expression levels and rectal cancer clinical pathologic characteristics was discussed. Results The positive expression rates of mag-1 and mTOR in rectal cancer tissue were significantly higher than those in normal rectal tissue and adenoma tissue:55%(33/60) vs. 1/10 and 27%(8/30), 58%(35/60) vs. 2/10 and 30% (9/30), and there were statistical differences (P<0.05). The expression levels of mag-1 and mTOR in rectal cancer tissue were correlated with carcinoembryonic antigen on admission, degree of cell differentiation, TNM stage, lymph node metastasis and distant metastasis (P<0.01 or<0.05), but had no correlation with age, gender, neoplasm location and neoplasm appearance (P > 0.05). The correlation analysis result showed that the expressions of mag-1 and mTOR were positively correlated in rectal cancer tissue (r=0.730, P<0.01). Conclusions The mag-1 and mTOR may correlate with invasion and metastasis in rectal cancer, and monitoring mag-1 and mTOR expression has a certain value for determining biological behavior of rectal cancer.

Objective To evaluate the different expression of the serum proteome of patient with severe acute pancreatitis (SAP) before and after treatment,and search for the protein that can predict SAP improvement.Methods SELDI-TOF-MS was used to analyze the expression of serum protein spectrum of 20 SAP patients before treatment and 7 days after treatment,and make the APACHE Ⅱ score at the same time.Results The APACHE Ⅱ score was 10.70 ± 3.47 in patients with SAP 7 days after treatment,which were significantly lower than that before treatment ( 13.00 ± 2.21,P ＜0.05 ).One hundred thirty-two spectral peak clusters were detected before and after treatment,there were 27 proteins that had significantly different signal intensities had been detected from 2000 Da to 50000 Da (P ＜ 0.05 ).The peak cluster at 47 000 Dawas significantly down-regulated after SAP attenuation.While the peak clusters at 1l700 Da and 15900 Dawere significantly up-regulated after treatment.Conclusions Serum analysis with SELDI-TOF MS can detect the different expression of the SAP serum proteomics before and after treatment,the increased expression of the protein with molecular weight of 11500 Da and 15900 Da and the decreased expression of 4700 Da may be asignal of improvement of SAP.

Objective To investigate the high mobility group box chromosomal protein-1 (HMGB1) levels in patients with acute pancreatitis (AP); and to study the relationship between the serum level of HMGB1 and the severity of AP. Methods The patients' serum HMGB1 concentrations were determined right after admission, 24, 48 hour after admission. The levels of HMGB1 were measured by ELASA kit and its relationship with the severity of AP was analyzed. 20 healthy adults were treated as the control group. Results At the time of admission, and 24, 48 hours after admission, the serum HMGB1 levels in AP patients were (8.05 + 1.60 ), ( 8.04 ± 1.39 ), ( 8.25 ± 1.56) ng/ml, respectively, which were significantly higher than that in the healthy control [ ( 2.20 + 0.57 ) ng/ml, P ＜ 0. 01]. There were 35 patients with severe acute pancreatitis (SAP) and 27 patients with mild acute pancreatitis (MAP). The HMBG1 levels in patients with SAP were (7.99 + 1.69) ,(8.12 ± 1.40), (8.13 ± 1.34) ng/ml, and they were (8.12 + 1.52), (7.92 +1.40), (8.39 ± 1.81 )ng/ml in patients with MAP, and the difference between the two groups was not statistically significant. Conclusions The serum HMGB1 level in AP patients was significantly higher than that in healthy controls, but it was not related with the severity of AP.

Background The Qingcaosha Reservoir is facing issues of algal blooms and eutrophication, and the resulting increase in the level of chlorination disinfection by-products in the water has been a major concern. Objective To evaluate the impact of "Algae Monitoring and Control Program in Qingcaosha Reservoir" (hereinafter referred to as the program) on the control of trihalomethanes (THMs) in conventional finished water. Methods From 2011 to 2019, water samples were collected from the Lujiazui Water Plant once per season, one sample each time, and the concentrations of four THMs (trichloromethane, dichlorobromomethane, monochlorodibromomethane, and tribromomethane) were measured in the samples. Using 2014 when the program was implemented as a cut-off point, the entire study period was divided into two phases: pre-implementation (2011–2013) and post-implementation(2014–2019). Segmented linear regression with interrupted time series analysis was applied to assess the concentrations and trends of THMs in the finished water before and after the program launch. Results The concentration of total THMs in finished water increased by 1.561 µg·L⁻¹ (P=0.010) for each season of time extension before launching the program. The change in the concentration of total THMs in finished water was not statistically significant after the program launch, but the THMs concentration showed a decreasing trend as the slope was −0.626 (P=0.001). From 2017 until the end of 2019, the average concentration of THMs in finished water of Lujiazui Water Plant dropped to 10 μg·L⁻¹ or less. Conclusions The algae and eutrophication control measures in Qingcaosha Reservoir have achieved good results, controlling THMs in finished water at a low level, and the trend of THMs has changed from a yearly increase pattern before the program to a yearly decrease pattern after the program.

OBJECTIVETo explore the relationship between nonalcoholic fatty liver disease (NAFLD) and the incidence of type 2 diabetes mellitus (T2DM) in Chinese adults.

METHODSA total of 4847 Chinese adults were enrolled in this prospective study. All participants underwent physical examination at one of three hospitals in Nanjing during 2008. According to results from B ultrasound, the participants were grouped according to NAFLD diagnosis, with 1468 in the NAFLD group and 3379 in the control group.Participants were followed up until diagnosis of T2DM or for 4 years. The cumulative incidence rates of T2DM were calculated for and compared between the NAFLD group and the control group. The relationship between NAFLD and risk of T2DM was examined by Cox proportional hazards modeling.

RESULTSDuring the 4-year follow-up,387 (8.0%) of the patients were diagnosed with T2DM. The cumulative incidence rates of T2DM in the NAFLD group and the control group were 17.2% and 4.0%, respectively. After adjusting for age,sex,body mass index,blood pressure,triglyceride level and alanine aminotransferase level, NAFLD was found to be closely related to the incidence of T2DM (relative risk:3.465,95% confidence interval:2.755-4.358).

CONCLUSIONNAFLD is associated with elevated risk of T2DM in adult patients in Nanjing,China. The general population of this region may benefit from focused public health intervention and treatment strategies targeting to prevent development of T2DM in conjunction with NAFLD.

Adult ; Asian Continental Ancestry Group ; China ; epidemiology ; Diabetes Mellitus, Type 2 ; epidemiology ; Humans ; Incidence ; Non-alcoholic Fatty Liver Disease ; epidemiology ; Prospective Studies ; Risk Factors

The clinical application of immune checkpoint inhibitors (ICIs) has significantly improved the prognosis of hepatocellular carcinoma (HCC) patients. With the widespread applica-tion of ICIs in HCC, the management of immune-related adverse events (irAE) gained more and more attention. However, the complicated disease characteristics and various combination therapies in HCC throw out challenges to irAE management. Therefore, the editorial board of the 'Chinese expert consensus on the management of immune-related adverse events of hepatocellular carcinoma treated with immune checkpoint inhibitors (2021 edition)' organizes multidisciplinary experts to discuss and formulate this consensus. The consensus focuses on issues related to HCC irAE manage-ment, and puts forward suggestions, in order to improve standardized and safety clinical medication, so as to maximize the benefits of immunotherapy for patients.

OBJECTIVE: To observe the difference for vascular dementia among flipping moxibustion of medicine at acupoints in governor vessel combined with acupuncture, simple medicine and simple acupuncture. METHODS: A total of 120 patients with vascular dementia were randomly assigned into a combination group, a flipping moxibustion group and an acupuncture group, 40 cases in each one, with 2 patients dropping respectively. Flipping moxibustion was used at the acupoints of group A on Monday and at the acupoints of group B on Friday in the flipping moxibustion group. The acupoints of group A were Baihui (GV 20), Dazhui (GV 14), Shenzhu (GV 12), Zhiyang (GV 9), Jizhong (GV 6), Mingmen (GV 4), Yaoyangguan (GV 3), and the acupoints of group B were Fengfu (GV 16), Taodao (GV 13), Shendao (GV 11), Jinsuo (GV 8), Xuanshu (GV 5), Changqiang (GV 1). Acupuncture was used in the acupuncture group at the main acupoints of Baihui (GV 20), Sishencong (EX-HN 1), Neiguan (PC 6), Zusanli (ST 36), Taixi (KI 3) and Xuanzhong (GB 39), matched with the acupoints based on syndrome differentiation, 30 min a time, once a day, continuous 5 times a week. The above two methods were applied in the combination group. All the treaments were for 4 weeks. The indexes were observed before and after treatment, including syndrome differentiationof TCM scale for vascular dementia (SDSVD), simple mental state scale (MMSE), self-care ability of daily life scale (ADL). The clinical effects and safety were evaluated. RESULTS: After treatment, the total effective rate in the combination group was 89.5% (34/38); the rate in the flipping moxibustion group was 65.8% (25/38); the rate in the acupuncture group was 63.2% (24/38). The difference among groups was statistically significant (<0.05). The effect in the combination group was better than those in the flipping moxibustion group and in the acupuncture group (both <0.05). There was no statistically significant difference between the flipping moxibustion group and the acupuncture group (>0.05). The SDSVD scores after treatment were lower and the MMSE and ADL scores after treatment were higher than those before treatment in the three groups (all <0.01), with better results on the above three scores in the combination group than those in the other two groups (<0.05, <0.01), and the differences on the three scores between the flipping moxibustion group and the acupuncture group were not statiatically significant (all >0.05). The treatment in the three groups was safe, without stastical significance (>0.05). CONCLUSION The effect of flipping moxibustion combined with acupuncture for vascular dementia is better than those of simple flipping moxibustion and simple acupuncture. The combination treatment achieves better effect on TCM syndrome, cognitive function and daily activity ability than the other two simple treatment.
Activities of Daily Living ; Acupuncture Points ; Dementia, Vascular ; Humans ; Moxibustion

【Objective】 To investigate the establishment of multi-center haemovigilance (HV) and the monitoring of adverse reactions to blood donation (ARBD), in order to provide basis for the management of blood donors. 【Methods】 The operation of HV was investigated by questionnaire. The total number of blood donations (including plateletpheresis) and ARBD cases occurred in each blood center from 2014 to 2018 were analyzed. 【Results】 Among the 24 blood centers in this survey, only nine got HV operated. The incidence of ARBD of 19 blood centers that fulfilled the questionnaire was in the range of (0.003~1.151) %. The change trend of number and incidence of ARBD cases were indeterminate. 【Conclusion】 Most blood centers did not got HV established. The incidence of ARBD varied greatly and was indeterminate. The application of HV should be further improved to strengthen ARBD management.