Objective To understand hand hygiene(HH) among health care workers(HCWs) in primary medical institutions in Shijiazhuang,and evaluate HH compliance,so as to formulate the strategy for HH management.Methods In 2015,one county-level comprehensive medical institution and two township medical institutions from each of seven counties of Shijiazhuang city were randomly selected,HH qualified rates of HCWs in all divisions of internal medicine before clinical procedures and after HH were analyzed statistically.Results 118 HCWs before clinical procedures and 130 HCWs after HH were monitored.The qualified rate of HH of physicians and nurses before clinical procedures were 44.26％ (27/61) and 40.35％ (23/57) respectively;HH qualified rate of nurses in township hospitals before clinical procedures were higher than county-level hospitals(x2 =6.447,P =0.011);the qualified rate of HH of physicians and nurses after HH were 98.41 ％ (62/63) and 98.51 ％ (66/67) respectively;there were significant differences in the qualified rates before clinical procedures as well as after HH in HCWs at different levels and types of medical institutions(all P＜0.05).Conclusion The qualified rate of HH among HCWs in primary medical institutions in Shijiazhuang before clinical procedures is low,medical institutions should improve the HH compliance among HCWs from various aspects.

Objective To evaluate the efficacy and safety of modified sequential therapy versus different quadruple therapy for the helicobacter pylori (H .pylori) eradication .Methods A total of 240 H .pylori infected patients with non atrophic gastritis accompanies erosion and peptic ulcer diagnosed by gastroscopy ,were evenly divided into sequential therapy group (A group) ,con-comitant therapy group(B group) ,7 days bismuth-containing quadruple therapy group(C group) and 10 days bismuth-containing quadruple therapy group(D group) .A group :rabeprazole 10 mg ,amoxicillin 1 000 mg were taken twice daily for 5 days firstly ,then rabeprazole 10 mg ,clarithromycin 500 mg ,furazolidone 100 mg were taken twice daily for 5 days .B group :rabeprazole 10 mg , amoxicillin 1 000 mg ,clarithromycin 500 mg ,furazolidone 100 mg were taken twice daily for 7 days .C group and D group :rabe-prazole 10 mg ,bismuth 220 mg ,amoxicillin 1 000 mg ,clarithromycin 500mg were taken twice daily for 7 and 10 days respectively . H .pylori status was re-assessed with 14C-urea breath test after 4-weeks therapy .Results Among them ,224 cases completed the study .According to the analysis of intention-to-treat (ITT ) ,the H .pylori eradication rates of A ,B ,C ,D group were 88 .33% , 83 .33% ,73 .33% ,81 .67% respectively ,and according to per-protocol (PP )analysis which were 92 .98% ,90 .90% ,78 .57% , 87 .50% .The difference between A and C group was statistically significant (χ2 = 4 .36 ,4 .83 ,P= 0 .037 ,0 .028) .Conclusion Fura-zolidone-containing sequential therapy provide provide high H .pylori eradication rates ,which could be the first-line treatment option .

Objective To measure the expression of indoleamine 2, 3-dioxygenase(IDO)in condy-loma acuminatum (CA) lesions, and to evaluate its ability to locally metabolize tryptophan. Methods Immunohistochemical study was performed to observe the protein expression of IDO in skin lesions of patients with CA, and count the number of IDO-positive cells. Immunofluorescence assay was conducted to estimate the relationship between IDO-positive cells and dendritic cells. Epidermal cells and keratinocytes were isolated from warts of 30 patients with CA and prepuces of 11 healthy controls respectively, and both in vitro incubated with tryptophan solution for 4 hours. Then, high-performance liquid chromatography (HPLC)was performed to detect the level of tryptophan metabolite, kynurenine, in the culture supernatant of the above cells, which could reflect the ability of epidermal cells to metabolize tryptophan. Results Rare IDO-positive cells were found in the normal skin, but a lot of IDO-positive cells gathered in the epidermis of the wart tissues. The IDO-positive cell/total cell ratio was significantly higher in the wart tissues than in the normal skin(48.3%± 15.4%vs. 5.2%± 2.4%, P<0.05). The fluorescence signals of IDO-positive cells and CD1a-positive Langerhans cells were not overlapped with each other, suggesting that IDO-positive cells were derived from epidermal cells of the wart tissues. Compared with the keratinocytes from the healthy skin, the epidermal cells from warts had a stronger ability to metabolize tryptophan in vitro. Conclusion A large number of IDO-positive cells exist in CA warts, and may be involved in occurrence of CA.

To report a case of cutaneous and subcutaneous coinfection caused by Lichtheimia corymbifera and Candida parapsilosis.A 67-year-old female peasant consulted about proliferative granuloma developing on her left forearm after topical application of a Chinese herbal drug and splint fixation for the treatment of suspected fracture of the wrist.Direct microscopic examination showed gram positive budding yeast cells in lesion secretions.Pathological study with periodic acid-Schiff (PAS) and gormori methenamine silver (GMS) staining revealed broad non-separate hyphae in the corneum and dermis.Fungal culture of lesional tissue at 35℃ grew both mould and yeast.The mould was identified as Lichtheimia corymbifera based on morphological findings and sequences of the internal transcribed space (ITS) 1-4 regions.Thermal tolerance study revealed that the isolate grew fast at 37℃ but slowly at 40℃.Under a scanning electron microscope,the acrogenous sporangia were pear-shaped with conical sporangiophores originating from the top of stolon,which were among but not opposite to the rhizoids.The yeast was identified as Candida parapsilosis by Chromagar test and D1/D2 region sequencing.As antimicrobial susceptibility test indicated,the Lichtheimia corymbifera isolate was most sensitive to terbinafine and itraconazole.The proteolytic activity of Lichtheimia corymbifera was higher than that of Candida parapsilosis.The granuloma completely subsided after surgical resection and 6-week treatment with oral itraconazole 200 mg twice a day.No recurrence was observed during a 4-year follow-up.

Objective:To analyze the risk factors,clinical characteristics and prognosis of the pneumocystis pneumonia(PCP) that is one of the severe pulmonary complications after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods:The clinical features,laboratory data,treatment and outcomes of patients with PCP after allo-HSCT in our hospital from January,2016 to January,2021 were retrospectively collected and analyzed.Results:Twenty three cases who met the clinical diagnostic criteria of PCP were enrolled. The median time of diagnosed as PCP after transplantation was 221 days. The computed tomography (CT) of chest indicated diffuse ground glass opacity.The median of β-1,3-D glucan consentration was 894.25 ng/L, and 91.3% of the cases were over 60 ng/L.The lymphocyte count in 60.9% cases was lower than 1×10 9/L;CD4 +T lymphocyte count in 65.2% of patients was less than 200/μL. Pneumocytis sequences of mNGS were positive in all 21 cases.15 patients were complicated with mixed infection.All patients were treated with TMP-SMX,18 patients were cured and 5 patients died. Conclusions:Patients with PCP after allo-HSCT progresses rapidly, and which is usually with multiple infections. Serum β-1,3-D glucan concentration increase contributes to the diagnosis of PCP.And mNGS in alveolar lavage fluid is highly sensitive to Pneumocystis, which helps patients get treatment in time, so as to reduce mortality.Patients with respiratory failure progressing to a need for mechanical ventilation and high flow oxygen inhalation suggest a poor prognosis.

Objective To analyze characteristics of motoneurons controlling the extension of a single finger in different individuals, and obtain the similarity and difference of micro-motoneurons characteristics in different individuals. Methods The motoneurons were decomposed by blind source separation algorithm. The two dimensional (2D) features of the neurons were quantified, and the fingers were classified by the features of the neurons decomposed by different individuals. In addition, the proportion of shared motor neurons was used to study characteristics of motoneurons innervating the coordinated movement of different fingers between individuals. Results There were significant differences in spatial distribution of motoneurons between the index finger and the middle finger for different individuals, but the activation area was similar. Using data from different people as training sets and testing sets, the average accuracy of finger classification was 86. 99% , and it was significantly improved to 90. 07% after using transfer component analysis (TCA) calibration. Through analysis on the proportion of shared neurons in different individuals, it was found that the proportion of shared neurons between index finger and other three fingers (middle finger, ring finger and little finger) was relatively low, while that between ring finger and little finger was high. Conclusions The spatial discharge characteristics of motoneurons controlling different fingers in different individuals are similar and have small individual differences. This study reveals the internal neural mechanism of different individuals during finger movement, and provides references for clinical neural mechanism analysis of patients with finger movement disorders and the related engineering applications

Helicobacter pylori （Hp）， a spiral-shaped microaerophilic Gram-negative bacterium that has been classified as a class Ⅰ carcinogen by the World Health Organization， is associated with a variety of digestive system diseases. With the popularization of antibiotic therapy， Hp resistance has become the main reason for the failure of the eradication treatment of Hp. A variety of Chinese medicines have been proved to have anti-Hp effects， which are expected to serve as new options for the eradication of Hp. By reviewing the recent literature in China and abroad， we summarized the understanding of Chinese medicines in the treatment of Hp infection and elaborated on the mechanisms from two aspects： direct killing and indirect inhibition. On the one hand， Chinese medicines can directly kill Hp by inhibiting the growth， respiration， and metabolism of Hp， destroying the morphological structure of Hp， and inhibiting the formation of Hp biofilm. On the other hand， Chinese medicines can inhibit Hp by reducing Hp adhesion and colonization， regulating Hp-caused immune response， inhibiting Hp-caused inflammation， and alleviating the Hp-caused oxidative stress and gastric mucosal injury. Specifically， the indirect inhibition of Hp can be achieved via the following ways. Chinese medicines can reduce Hp adhesion and colonization by reducing Hp motility， inhibiting urease activity and the expression of related genes， and decreasing the production of adhesion proteins. They can regulate the Hp-caused immune responses by enhancing the immune protective response， modulating lysosomal function and immune cytokines， avoiding the immune evasion of Hp， and maintaining the balance between immunity and inflammation. Chinese medicines can inhibit Hp-caused inflammatory responses by inhibiting the release of inflammatory cytokines， down-regulating the expression of virulence factors， and regulating the targets and signaling pathways in the treatment of inflammation. In addition， Chinese medicines can alleviate the Hp-caused oxidative stress and gastric mucosal injury by improving the activities of antioxidant enzymes and oxidases， regulating the generation of reactive oxygen species and reactive nitrogen， and inhibiting inflammatory mediators. This article systematically introduces the mechanisms of Chinese medicines against Hp， aiming to provide a theoretical and scientific basis for the research and clinical application of Chinese medicines against Hp.

OBJECTIVE To systematically evaluate the safety of paroxetine in the treatment of pregnant patients with depression in the second and third trimesters of pregnancy， and provide reference for rational clinical use of it. METHODS Retrieved from Cochrane Library， PubMed， Embase， VIP， CNKI， Wanfang database and SinoMed database， by manual search， randomized controlled studies or observational studies were collected on depression patients who were given paroxetine vs. selective serotonin reuptake inhibitor （SSRI） in the second and third trimesters of pregnancy during the inception to Aug. 2022. Methodological qualities of the included studies were assessed by Cochrane Handbook 5.1.0 or Newcastle-Ottawa Scale （NOS）. Meta-analysis was performed with RevMan 5.4.1 software. RESULTS Finally， 9 observational studies were included， and all included studies were of high quality in NOS scale. Meta-analysis was performed on 8 cohort studies. Meta-analysis showed that the total incidence of adverse pregnancy outcomes of mothers and infants [RR＝0.99， 95%CI（0.89，1.10），P＝0.87]， total incidence of maternal adverse pregnancy outcomes [RR＝0.98， 95%CI （0.87，1.10）， P＝0.69] and premature birth [RR＝0.89， 95%CI （0.43， 1.83）， P＝0.75] in the second and third trimesters of pregnancy were lower than that with other SSRI， without statistical significance. The incidence of neonatal complications with paroxetine in the second and third trimesters of pregnancy was higher than that with other SSRI， but the difference was not statistically significant [RR＝1.02， 95%CI （0.82，1.29）， P＝0.84]. One study reported that the incidence of neonatal pulmonary hypertension in paroxetine group was higher than that in other SSRI group （0.4% vs. 0.3%）. CONCLUSIONS The safety of peroxetine in the second and third trimesters of pregnancy is comparable with that of other SSRI， but it is necessary to be alert to the occurrence of neonatal pulmonary hypertension.