1.Hospital Infection Control in Community Health Service Center Improving by Introducing PDCA Circle Method
Huizhen ZHANG ; Hualan NING ; Jiaying FANG ; Quanzhen WEI ; Lihua LIU
Chinese Journal of Nosocomiology 1994;0(01):-
OBJECTIVE To enhance the hospital infection control quality level,decreasing hospital infection incidence and safeguarding the medical treatment in community health servnice canter(CHSC).METHODS Through plan,do,check and action(PDCA) circle method,combined with the management analysis the risk factors were found,and the method was useful for improving hospital infection control quality.RESULTS After one and a half years all-process progressive improvement of our work,the risk factors were diminished,the quality evaluation was improved and the management was more effective.CONCLUSIONS Practicing scientific management to improve control quality,can effectiely enhance the hospital infection control quality.
2.Analysis of microbiological trends and antibiotic susceptibility in 711 episodes of peritoneal dialysis-related peritonitis
Yijing TONG ; Hao YAN ; Zhenyuan LI ; Jiaying HUANG ; Aiping GU ; Zhaohui NI ; Wei FANG
Chinese Journal of Nephrology 2017;33(8):601-608
Objective To investigate the microbiological trends and antibiotic susceptibility of peritoneal dialysis(PD)-related peritonitis (PDAP).Methods All patients who developed PDAP between 2004 and 2015 in Renji Hospital,Shanghai Jiao Tong University School of Medicine were enrolled.Demographic data,results of dialysate pathogen culture and drug susceptibility test were recorded.The trend of peritonitis incidence was measured by Poisson regression and the chi-square test or Fisher exact test method was used to compare the composition of causative organisms and their antimicrobial susceptibilities over time.Results During the study period,a total of 711 episodes of PDAP were occurred in 386 patients.The culture positive rate of pathogens rose from 52.0% in 2004 to 77.0% in 2015 (P < 0.001).The distribution of causative organisms of the culture positive peritonitis was gram-positive bacteria (270,59.5%),followed by gram-negative bacteria (129,28.4%),polymicrobial(39,8.6%),fungi (15,3.3%) and mycobacteria (1,0.2%).From 2004 to 2015,the incidence of peritonitis decreased from 0.214 to 0.160 episodes/patient·year (P=0.034).The incidence of coagulase-negative staphylococcus peritonitis decreased from 0.049 to 0.027 episodes/patient · year (P=0.025),while others had no significant change;A significant decline was observed in the sensitivity of Gram-positive strains to the first generation cephalosporin and ampicillin/sulbactam in 2010-2015 group compared with those in 2001-2009 group (61.3% vs 88.2%,P < 0.001;61.7% vs 85.5%,P=0,001),whereas the sensitivity to vancomycin remained the same.The sensitivity of Gram-negative strains to ceftazidime and amikacin showed no significant change.As for the gram-positive peritonitis treated with cefradine as empirical treatment,compared with those in 2004-2009 group,in 2010-2015group the proportion of patients requiring to change their treatment regime was significantly higher,and the treatment course was longer.Conclusions A gradual decline is observed in the incidence of PDAP and the culture positive rate of pathogens improves.Peritonitis caused by coagulase-negative staphylococcus decreases overtime.The present empirical treatment protocols may need re-evaluation considering the decreased rate of the first generation cephalosporin sensitivity in recent years.
3.Role of astograph methacholine provocation test in diagnosis of bronchial asthma
Hongkuan YANG ; Jiaying ZHANG ; Fang WANG ; Fang CHEN
The Journal of Practical Medicine 2017;33(22):3807-3809
Objective To evaluate the diagnostic value of astograph methacholine provocation test for bronchial asthma.Methods A total of 238 asthma patients and 499 non-asthma patients participated in the detection by astograph methacholine provocation test.Statistical methods were used to analyze the differences of astograph parameters and find the indicators of asthma diagnosis and the critical value.Results Dmin,Cmin and PD15 were much lower in the asthma group (P < 0.01),compared with the the non-asthma group,when SGrs,SGrs/Grs cont were much higher (P < 0.01).SGrs was relevant with Dmin,Cmin,PD15 in the asthma group (P =0.000;r =0.685,r =0.657,r =0.639) as well as the SGrs/Grs cont did (P =0.000,r =0.775;r =0.740,r =0.708).In ROC analysis,Dmin presented an AUC of 0.661,the cutoff value was 2.71 unit,with a sensitivity of 0.739 and specificity of 0.551.PD15 presented an AUC of 0.746,the cutoff value was 4.856 5 unit,with a sensitivity of 0.693 and specificity of 0.684.Conclusion Astograph methacholine provocation test shows good sensitivity and specificity in the diagnosis of asthma,particularly when Dmin ≤ 2.71 Unit or PD15 ≤ 4.8565 Unit as the cutoff value.
4.An analysis on the combination of chrono-chemotherapy with different speed rate and concomitant intensity-modulated radiotherapy in the treatment of locally advanced nasopharyngeal carcinoma
Shan WAN ; Feng JIN ; Weili WU ; Yuanyuan LI ; Jinhua LONG ; Guoyan CHEN ; Jiaying GAN ; Zhixu HE ; Jianjiang ZHOU ; Fang YU
Chinese Journal of Radiological Medicine and Protection 2018;38(4):278-284
Objective To evaluate the differences of toxicities,therapeutic efficacy and immune function between induction chemotherapy followed by sinusoidal chrono-modulated infusion and flat intermittent infusion of cisplatin (DDP)with intensity-modulated radiotherapy (IMRT) in patients with locoregionally advanced nasopharyngeal carcinoma (NPC).Methods Seventy patients with biopsydiagnosed stages Ⅲ and Ⅳ B NPC (according to the 2010 UICC staging system) were treated with two-cycle induction chemotherapy before chemoradiotherapy in Guizhou Cancer Hospital.The TPF chemotherapy regimen was administered as follows:The TXT and DDP with the dose of 75 mg/m2 was carried out by bolus infusing for the first day,the 5-FU with 750 mg · m-2 · d-1 was carried out by continuous intravenous pumping for the first day to fifth day(120 h).The induction chemotherapy was 21 days per cycle,for two cycles.After that all patients were randomly treated with 2-3 cycles of sinusoidal chronomodulated infusion or flat intermittent constant rate infusion of DDP with IMRT.Using a multi-channel programmed pump,the patients were given 12 h continuous infusions of DDP (100 mg/m2) for day one,repeated every 3 weeks for 2-3 cycles.DDP was administered from 10:00 am to 10:00 pm.Concurrent radiotherapy regimen was administered as follows:GTVnx 69.96-73.92 Gy/33 f,PTVnx 69.96 Gy/33 f,PTVnd 69.96 Gy/33 f,PTV1 60.06 Gy/33 f,PTV2 50.96 Gy/28 f.Results The main toxicities of chemoradiotherapy in the group of sinusoidal chrono-modulated infusion were bone marrow suppression:leukocytes,and then nausea,oral mucositis and hemoglobin.The main toxicities of chemoradiotherapy in the group of flat intermittent constant rate infusion were bone marrow suppression:hemoglobin,leukocytes,and then nausea,oral mucositis.No significant differences were observed for toxicities(P > 0.05).After concurrent chemoradiotherapy,the complete response rate (CR),partial response rate (PR),stable disease rate(SD),progressive disease rate (PD) and overall response rate (ORR) were 11.4%,85.7%,2.9%,0 and 97.1% in the group of sinusoidal chrono-modulated infusion.The CR,PR,SD,PD,ORR in the group of flat intermittent constant rate infusion were 22.9%,74.2%,2.9%,0,97.1%,respectively.However,there was no significant differences of effect in the two Arms (P > 0.05).For sinusoidal ehrono-modulated infusion and flat intermittent infusion group,the 2-year overall survival(OS) were 82.9% and 94.3% respectively,the 2-year progression-free survival(PFS) were 77.1%,91.4% respectively,and the 2-year distant metastasis free survival (DMFS) were 82.9%,91.4% respectively.The value of CD3 + in the group of sinusoidal chrono-modulated infusion was higher than the group of flat intermittent constant rate infusion after therapy (Z =3.254,P < 0.05).The value of CD4 +,CD8 +,CD16 + CD56 +,CD19 +,and CD4 +/CD8 + had no differences in two Arms (P > 0.05).Conclusions No significance differences on the toxicities,therapeutic efficacy and survival were observed between the two groups,but immune function might be improved in the sinusoidal chrono-modulated infusion group.
5. Effects of airway management team in the treatment of severely mass burn patients combined with inhalation injury
Dan SUN ; Peng ZHAO ; Jiaying NI ; Jingjing SUN ; Yingwei REN ; Fang WANG ; Lihong ZHU
Chinese Journal of Burns 2018;34(6):354-359
Objective:
To explore and analyze the effects of airway management team (AMT) in the treatment of severely mass burn patients combined with inhalation injury.
Methods:
The clinical data of 58 severely burned patients combined with inhalation injury hospitalized in our unit from January 2012 to August 2014, conforming to the inclusion criteria, were retrospectively analyzed. According to whether airway management was implemented by AMT or not, patients hospitalized from January 2012 to July 2014 were divided into control group (
6.Comparison of the predictive value of the modified CADILLAC, GRACE and TIMI risk scores for the risk of short-term death in patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention
Chunling JI ; Fang SONG ; Xiaomo HUANG ; Xiang QU ; Nan QIU ; Jiaying ZHU
Chinese Critical Care Medicine 2023;35(3):299-304
Objective:To establish a modified controlled abciximab and device investigation to lower late angioplasty complication (CADILLAC) score, and to compare the predictive value of modified CADILLAC score, the global registry of acute coronary event (GRACE) score and the thrombolysis in myocardial infarction (TIMI) score in predicting the risk of short-term death after percutaneous coronary intervention (PCI) in patients with acute ST segment elevation myocardial infarction (STEMI).Methods:A retrospective study was conducted. The clinical data of 169 STEMI patients under going PCI admitted to the department of cardiology of Guizhou Provincial People's Hospital from September 2019 to December 2020 through emergency chest pain fast track were enrolled. A multivariate Logistic regression analysis was used to screen the factors closely related to the mortality risk within 30 days of STEMI, and a modified CADILLAC scoring system was established by referring to CADILLAC scoring settings. The score of modified CADILLAC, GRACE and TIMI scores of patients were calculated after admission, and the number of deaths due to cardiovascular disease (CVD) within 30 days after onset was recorded. The receiver operating characteristic curve (ROC curve) was used to evaluate the predictive value of three scoring systems on the risk of death within 30 days after PCI in patients with STEMI.Results:In 169 STEMI patients, 16 patients died of CVD within 30 days after PCI, and the actual case mortality was 9.47%. Multivariate Logistic regression analysis showed that age > 75 years old, cardiac function Killip ≥ Grade Ⅲ, ventricular arrhythmia, ST segment elevation ≥ 0.2 mV, cardiac troponin I (cTnI) increase, systolic blood pressure (SBP) < 90 mmHg (1 mmHg ≈ 0.133 kPa) were all independent predictors of death after PCI in STEMI patients. The improved CADILLAC scoring system was constructed based on the above predictive factors combined with left ventricular ejection fraction (LVEF) less than 0.40. The GRACE, TIMI and modified CADILLAC scores of dead patients were significantly higher than those of survival patients (GRACE score: 197.60±31.83 vs. 149.81±36.72, TIMI score: 11.21±2.13 vs. 7.27±1.97, modified CADILLAC score: 12.60±2.52 vs. 6.96±2.17, all P < 0.05). The higher the risk stratification of the three scores, the higher the mortality of patients with CVD within 30 days after PCI [the mortality of patients with low, medium and high risk in GRACE score were 2.41% (2/83), 9.61% (5/52) and 26.47% (9/34); the mortality of patients with low, medium and high risk in TIMI score were 3.12% (3/96), 12.82% (5/39) and 23.53% (8/34); and the mortality of patients with low, medium and high risk in modified CADILLAC score were 3.19% (3/94), 7.69% (4/52) and 39.13% (9/23), respectively, all P < 0.01]. The area under the ROC curve (AUC) of the GRACE, TIMI and the modified CADILLAC scores predicting the risk of death 30 days after PCI in STEMI patients were 0.855 [95% confidence interval (95% CI) was 0.702-0.923], 0.725 (95% CI was 0.666-0.812) and 0.882 (95% CI was 0.732-0.936), respectively, all P = 0.000; the sensitivity of its prediction accuracy were 81.59%, 78.65% and 89.26%, and the specificity were 78.62%, 57.12% and 75.54%, respectively. Conclusions:The GRACE and the modified CADILLAC scores have predictive value for the short-term mortality risk of STEMI patients after PCI, and the modified CADILLAC score is more accurate. But the TIMI score has a poor predictive effect on the short-term mortality risk of STEMI patients after PCI.
7.Complications and prognosis of urgent-start peritoneal dialysis and urgent-start hemodialysis in end-stage renal disease patients
Haijiao JIN ; Wei FANG ; Mingli ZHU ; Zanzhe YU ; Yan FANG ; Hao YAN ; Minfang ZHANG ; Qin WANG ; Xiajing CHE ; Yuanyuan XIE ; Jiaying HUANG ; Chunhua HU ; Haifen ZHANG ; Shan MOU ; Zhaohui NI
Chinese Journal of Nephrology 2016;32(10):739-744
Objective To compare the complications and outcomes of urgent?start peritoneal dialysis (PD) and hemodialysis (HD) in end?stage renal disease (ESRD) patients, and explore the safety and effectiveness of PD which was as an urgent?start dialysis modality in ESRD patients. Methods All patients for urgent?start dialysis, who initiated dialysis without a long?term dialysis access or had the long?term dialysis access under 30 days in Renji Hospital from January 1st 2013 to December 31st 2014, were enrolled. According to the dialysis modalities, patients were divided into PD group and HD group. Participants were followed up until death, transferred to other centers, lost of follow up or January 1st 2016. Dialysis?related complications within 30 days of implantation, complications of reimplantation and the occurrence of bacteremia between two groups were compared, and their survival rates were tested by Kaplan?Meier curves. Results Among 178 patients in this study, there were 96 (53.9%) patients in PD group and 82 (46.1%) patients in HD group. Compared with those of HD group, patients of PD group presented more cardiovascular disease [21(21.9%) vs 8(9.8%), P=0.029], higher serum potassium [(4.5±0.8) mmol/L vs (4.3±0.8) mmol/L, P=0.038], but less heart failure (NYHA Ⅲ?Ⅳ) [26(30.2%) vs 40 (48.8%), P=0.014], lower brain natriuretic peptide (BNP) [328.5 (129.5, 776.8) ng/L vs 503.5(206.0, 1430.0) ng/L, P=0.008], higher hemoglobin [(81.5 ± 17.7) g/L vs (75.3 ± 22.5) g/L, P=0.039], higher serum albumin (33.5±5.7) g/L vs (31.3±6.7) g/L, P=0.022] and higher serum pre?albumin (304.5±78.0) mg/L vs (257.0 ± 86.1) mg/L, P<0.001]. PD group presented less dialysis?related complications [5 (5.2%) vs 20(24.4%), P<0.001], less dialysis?related complications requiring reimplantation [1(1.0%) vs 20(24.4%), P<0.001] and less bacteraemia [3(3.1%) vs 11(13.4%), P=0.011]. The 3?, 6?and 12?month patient survival rates of PD and HD group were 97.9% vs 98.4%, 97.9% vs 98.4%, and 92.1%vs 93.0% respectively, and no significant difference was found (Log ? rank=0.004, P=0.947). Conclusions Patients with urgent?start PD have less complications within 30 days of implantation and occurrence of bacteremia than patients with urgent?start HD, and the same survival rates. PD may be a feasible and safe urgent?start dialysis modality for ESRD patients.
8.Role of uropathogenic Escherichia coli virulence factor TcpC in immune evasion and its pathogenic mechanism
Weiyu JIANG ; Jiaying FAN ; Liming FAN ; Jiadong WANG ; Ziyan JIANG ; Ziyu GUAN ; Qian OU ; Jiaqi FANG
Chinese Journal of Microbiology and Immunology 2024;44(3):198-204
Objective:To investigate the role of TcpC, a virulence factor of uropathogenic Escherichia coli (UPEC), in immune evasion, and analyze its related pathogenic mechanism. Methods:C57BL/6 mice were injected with 10 9 colony-forming unit of wild-type (CFT073 wt) or tcpc gene-knockout (CFT073 Δ tcpc) UPEC CFT073 strains from urethra into bladder to construct a mouse model of pyelonephritis. These mice were sacrificed 5 d after infection and their kidneys were taken to observe the gross pathological changes. Hematoxylin-eosin staining was used to observe histopathological changes in kidney tissues and immunohistochemistry was performed to locate TcpC in kidney tissues. The bacterial loads in urine samples of UPEC infected-mice were counted by ten-fold dilution method, and the presence of tcpc gene in the genomic DNA of bacteria from CFT073-infected mouse kidney or urine samples was measured by PCR. The expression of TcpC at mRNA level was detected by qRT-PCR after infecting dendritic cells with CFT073 wt strains. The influences of UPEC infection on the activation of NF-κB signaling pathway and the secretion of proinflammatory factors by dendritic cells were analyzed by Western blot and ELISA, respectively. The viability of UPEC strains in dendritic cells were observed by laser confocal microscope. Results:Compared with the CFT073 Δ tcpc group, the mice in the CFT073 wt group had obvious abscess in the kidneys as well as massive neutrophil infiltration and abundant TcpC in kidney tissues. The bacterial loads in the urine of CFT073 wt-infected mice were significantly higher than those in the urine of CFT073 Δ tcpc mice. PCR results showed that tcpc gene was successfully amplified from mouse kidney and urine samples. Increased expression of TcpC at both mRNA and protein levels was detected in CFT073 wt-infected dendritic cells. CFT073 wt infection inhibited the phosphorylation of NF-κB p50 and the production of proinflammatory factors in dendritic cells. TcpC promoted the survival of CFT073 wt in dendritic cells. Conclusions:TcpC expression increases significantly during CFT073 wt infection or in mice with CFT073 wt-induced pyelonephritis. It promotes the survival of CFT073 wt in dendritic cells by inhibiting the activation of NF-κB signaling pathway and reducing the secretion of pro-inflammatory cytokines. TcpC is involved in the pathogenesis of UPEC and immune evasion.
9.Correlation between expressions of myeloperoxidase and eosinophil cationic protein in sputum and clinical features of asthma-chronic obstructive pulmonary disease overlap.
Hongkuan YANG ; Yan ZHANG ; Jiaying ZHANG ; Junjie PAN ; Fang WANG ; Xuping LUO ; Fang CHEN
Journal of Southern Medical University 2018;38(10):1215-1221
OBJECTIVETo observe the role of myeloperoxidase(MPO)and eosinophilic cationic protein(ECP)in the airway inflammation and their correlation with clinical feature in asthma-COPD overlap (ACO) patients.
METHODSTwenty patients with COPD, 20 with asthma, 20 with ACO and 20 control subjects underwent pulmonary function test for measurement of forced expiratory volume in 1 second (FEV), forced vital capacity (FVC), peak expiratory flow (PEF), and maximum midexpiratory flow (MMF). COPD assessment test (CAT) was used to evaluate the clinical symptoms of the patients with COPD and ACO. The asthma control test (ACT) was used to evaluate the asthma control in the patients with asthma and ACO. Induced sputum samples were collected from the subjects for analysis of neutrophil and eosinophil ratios, and enzyme-linked immunosorbent assay was used to determine the expression levels of MPO and ECP in the sputum.
RESULTSNo significant difference was observed in the CAT scores between ACO group and COPD group (> 0.05). Compared with the asthma group, the patients with ACO had significantly lower ACT scores and lower FEV, PEF and MMF ( < 0.05). The patients with ACO had significantly higher FVC and sputum eosinophil ratio than those with COPD ( < 0.05), and a higher sputum neutrophil ratio than those with asthma ( < 0.01). In ACO group, the MPO level in sputum was significantly higher than that in the asthma group ( < 0.05), while sputum ECP level was significantly higher than that in both the asthma group and COPD group ( < 0.05 or 0.01). In ACO group, sputum MPO level was positively correlated with sputum neutrophil ratio (=0.8358, < 0.01) but was not correlated with CAT score or FEV (> 0.05); sputum ECP level was positively correlated with sputum eosinophil ratio (=0.4666, < 0.05) and was inversely correlated with ACT score (=-0.4966, < 0.05) and FEV (=-0.4610, < 0.05).
CONCLUSIONSBoth neutrophilic and eosinophilic inflammations occur in the airway of patients with ACO, and their sputum ECP level is negatively correlated with asthma control and obstructive airflow limitation.
10.Trend and gender difference of mortality rate of senile dementia: based on the method of annual percent change
Naisi QIAN ; Lei CHEN ; Bo FANG ; Huiting YU ; Jiaying QIAO ; Shan JIN ; Qi LI ; Chunfang WANG
Shanghai Journal of Preventive Medicine 2023;35(2):132-136
ObjectiveTo investigate the characteristics of gender difference and the trend of the mortality rate of senile dementia in registered population in Shanghai from year 2002 to 2018, and to provide the basis for formulating relative intervention measures before and after senile dementia from an public-health view. MethodsBased on the collected data of death registration, focused on the senile dementia disease codes F03,G30.0,G30.1,G30.8,G30.9 according to The International Classification of Diseases 10th revision (ICD-10). We analyzed the characteristics of gender difference in the mortality rate of senile dementia in registered population in Shanghai from year 2002 to 2018. According to ASR, we calculated the standardized mortality rate of senile dementia, and used the chi-square test to compare the difference between the gender mortality rates. The trend and the turning point of the mortality rate of senile dementia were determined by linear regression analysis by Join-point. ResultsThe crude mortality rate of senile dementia in the registered population in Shanghai from year 2002 to 2018 was 5.46/105, 3.50/105 in males and 7.43/105 in females. The standardized mortality rate of senile dementia was 2.61/105, 1.67/105 in males and 3.56/105 in females. The trend of the standardized mortality rate of senile dementia in 17 years decreased [APC=-5.5(-6.5,-4.5)%,P<0.01]. The trend of the standardized mortality rate of senile dementia decreased in both males [APC=-4.9(-6.2,-3.6)%,P<0.01] and females [APC=-5.9(-6.9,-4.9)%,P<0.01]. The trend of the gender difference decreased [APC=-6.8(-8.2,-5.3)%,P<0.01]. The mortality rate of senile dementia was higher in females than in males [(χ2=33.63,P<0.01)]. ConclusionThe mortality rate of senile dementia in females is higher than in males in Shanghai, though the trend of the gender difference decreased. This gender difference is worth of attention.