ObjectiveTo understand the use of antibiotics in inpatients and the incidence and trend of hospital infections， to explore the implementation effect of comprehensive management measures， and to provide reference for hospitals to use antibiotics reasonably. MethodsBased on the hospital infection monitoring and management system， a retrospective analysis and comparison were conducted on the use of antibiotics， submission of microbial test samples， and incidence of hospital infections among inpatients in a tertiary hospital from 2012 to 2021. ResultsFrom 2012 to 2021， the use of antibiotics showed a downward trend， from 50.82% in 2012 to 41.29% in 2021. At the same time， the use rate of restricted and special antibiotics had also decreased， and the use rate of restricted and special antibiotics in patients without hospital infection was significantly lower than that in patients with hospital infection， and the microbial testing rate was also on the rise. The annual incidence rate of hospital infection was 0.69%‒1.92%， and the annual case-time prevalence rate was 0.79%‒2.17%. The annual average rate of the above two in 10 years was 1.18% and 1.34%， respectively. The results of the exponential smoothing model also showed that the utilization rate of antibiotics was decreasing and the incidence of nosocomial infection was stable. ConclusionLarge general hospitals took comprehensive management measures to strengthen the management of rational use of antibiotics， which led to a decline in the use rate of antibacterial drugs for inpatients and an increase in the rate of microbial examination. At the same time， the overall incidence of hospital infection was relatively stable， suggesting that the comprehensive management measures of antibacterial drugs in hospitals had achieved certain results. The current measures need to be optimized in the future to continuously improve the management level of rational use of antibacterial drugs.

Objectives:Analyze the clinical characteristics of patients with primary antiphospholipid syndrome (PAPS) progressing to systemic lupus erythematosus (SLE).Explore the risk factors for the progression from PAPS to SLE.Methods:The clinical data of 262 patients with PAPS enrolled in Peking Union Medical College Hospital from February 2005 to September 2021 were evaluated. Assessments included demographic data, clinical manifestations, laboratory tests (serum levels of complement, anti-nuclear antibodies, anti-double-stranded DNA antibodies), treatment, and outcomes. Kaplan-Meier analysis was used to calculate the prevalence of SLE in patients with PAPS. Univariate Cox regression analysis was employed to identify the risk factors for PAPS progressing to SLE.Results:Among 262 patients with PAPS, 249 had PAPS (PAPS group) and 13 progressed to SLE (5.0%) (PAPS-SLE group). Univariate Cox regression analysis indicated that cardiac valve disease ( HR=6.360), positive anti-double-stranded DNA antibodies ( HR=7.203), low level of complement C3 ( HR=25.715), and low level of complement C4 ( HR=10.466) were risk factors for the progression of PAPS to SLE, whereas arterial thrombotic events ( HR=0.109) were protective factors ( P<0.05 for all). Kaplan-Meier analysis showed that the prevalence of SLE in patients suffering from PAPS with a disease course>10 years was 9%-15%. Hydroxychloroquine treatment had no effect on the occurrence of SLE in patients with PAPS ( HR=0.753, 95% CI 0.231-2.450, P=0.638). Patients with≥2 risk factors had a significantly higher prevalence of SLE compared with those with no or one risk factor (13-year cumulative prevalence of SLE 48.7% vs. 0 vs. 6.2%, P<0.001 for both). Conclusions:PAPS may progress to SLE in some patients. Early onset, cardiac-valve disease, positive anti-dsDNA antibody, and low levels of complement are risk factors for the progression of PAPS to SLE (especially in patients with≥2 risk factors). Whether application of hydroxychloroquine can delay this transition has yet to be demonstrated.

Objective We aimed to investigate the relationship between microscopic pattern of blood stasis and renal pathological grade and related physical and chemical indexes in children with Henoch-Sch?nlein purpura nephritis(HSPN).Methods We conducted a retrospective analysis of 800 HSPN children from the medical records of the First Affiliated Hospital of Henan University of Chinese Medicine.Laboratory indicators(blood routine test,urine routine test,coagulation test,liver function)and renal pathological indicators of them were collected.According to the severity of renal pathological microscopic lesions,the microscopic pattern of blood stasis was divided into three types,including choroidal discord,dead blood coagulation and intracarenal disease accumulation.The classification of renal microscopic pattern of blood stasis and the correlation between laboratory indexes and renal pathological index were analyzed by Spearman grade correlation and binary Logistic regression analysis.Results(ⅰ)There was no statistical difference of the distribution of the renal microscopic pattern of blood stasis in the different traditional Chinese medicine patterns.(ⅱ)There were significant differences in the contents or the grade of albumin and fibrinogen in the HSPN children with different microscopic pattern of blood stasis(all P＜0.05).(ⅲ)The maximum area under the receiver operating characteristic(ROC)curve between fibrinogen and intracarenal disease accumulation was 0.594(95％CI from 0.540 to 0.633,P＜0.001);sensitivity was 0.447,specificity was 0.725;the best threshold on the ROC curve of 0.172 was 3.755 g/L.(ⅳ)There were positive correlations between the content of fibrinogen,ISKDC grade and Bohle A grade respectively with the scores of intracarenal disease accumulation type(r=0.176,r=0.315,r=0.656;all P＜0.001).(ⅴ)There were positive correlations between the content of fibrinogen,ISKDC grade and Bohle A grade respectively with the renal microscopic pattern of blood stasis(r=0.157,r=0.377,r=0.429;all P＜0.001).Conclusion The microscopic renal pattern of blood stasis can not only reflect the severity of renal blood stasis,but also reflect the severity and long-term prognosis of renal diseases.Albumin and urinary protein grade can reflect the early stage of the microscopic renal pattern of the blood stasis(choroidal discord).The content of fibrinogen increases with the aggravation of renal microscopic pattern of blood stasis,reflecting the end-stage of HSPN,which has the correlation with the formation and severity of related indexes.Fibrinogen can be used as a laboratory indicator to assist in the diagnosis of irreversible lesionsin the renal pathology of HSPN children.

Objective:To study the efficacy and safety of anlotinib in the treatment of advanced radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC) and the effect of anlotinib on iodine uptake of lesions.Methods:A retrospective analysis was performed on 23 patients (10 males and 13 females, age (59.1±8.7) years) with advanced RAIR-DTC who were treated with anlotinib in Liaocheng Hospital Affiliated to Shandong First Medical University between January 2019 and February 2023 and met the enrollment criteria. Thyroid function, serum thyroglobulin (Tg) and Tg antibody (TgAb) were determined every 6 weeks during the treatment with anlotinib, and maximum diameter of target lesion (TL) was monitored by CT every 12 weeks, in order to evaluate the therapeutic efficacy, and treatment-related adverse reactions were observed. Diagnostic 131I whole body scan (Dx-WBS) was performed in some patients to evaluate the changes in iodine uptake of lesions after anlotinib treatment. In this study, the posttreatment changes of patients within 24 weeks during the treatment were analyzed. The maximum diameter of TL and Tg at different time points were compared by Friedman test, and were further compared in pairs with P values corrected by Bonferroni method. Results:After 24 weeks of treatment with anlotinib, 8 of 23 patients achieved partial response, 15 had stable disease, and no patients achieved complete response. Serum Tg levels at 6, 12, 18, 24 weeks after anlotinib treatment were 189.5(85.0, 483.3), 127.7(52.4, 319.8), 82.0(40.2, 213.5) and 80.1(39.9, 205.0) μg/L, all of which were lower than the baseline level of Tg (384.5(210.9, 1 605.0) μg/L; χ2 values: 4.23-7.86, all P<0.001). Tg level at 18 weeks after treatment was statistically different from that at 12 weeks after treatment ( χ2 =3.06, P<0.001), but was not statistically different from that at 24 weeks after treatment ( χ2 =12.57, P=0.059). The maximum TL diameters of lung and cervical lymph nodes were significantly reduced at week 12 and 24 of anlotinib treatment compared with baseline ( χ2 values: 14.76-31.12, all P<0.001), while there was no significant difference in TL maximum diameter at 12 and 24 weeks of treatment ( χ2 values: 5.65, 9.02, P values: 0.314, 0.070). Common adverse reactions included hypertension, hand-foot syndrome, hyperacylglyceremia and proteinuria. No adverse reactions above grade 4 or death related to adverse reactions occurred. Dx-WBS evaluation was performed in 7 patients after anlotinib treatment, and no change in iodine uptake was found. Conclusions:Anlotinib has a clear effect on advanced RAIR-DTC with less adverse reactions. The efficacy of anlotinib reaches the strongest at around 12-18 weeks and becomes stable at 24 weeks. No effect of anlotinib on inducing redifferentiation of RAIR-DTC cells and enhancing iodine uptake is found.

Objective:To analyze a Risk Scale for Emergence Agitation After General Anesthesia in Children (the EA risk scale) into simplified Chinese and evaluate the reliability and validity in children with strabismus correction surgery.Methods:After obtaining the authorization of the original author, the English version of the EA risk scale was translated, translated back and culturally debugged to form the Chinese version of the EA risk scale. Then 279 children with strabismus correction surgery were selected from a tertiary hospital of ophthalmology in Tianjin and were investigated to validate the scale.Results:The correlation coefficients of each item and the total score of the scale were respectively 0.768 (item 1) ,0.717(item 2), 0.676(item 3), 0.634(item 4) (all P < 0.01). Content validity index of the scale was 0.920, and each item was 0.80-1.00. One factors including 4 items were identified using exploratory factor analysis, accounting for 62.052% of the total variance. The optimal cut-off value for the EA risk in children was 10, with the AUG was 0.816, specificity of 0.704, and sensitivity of 0.839. The Cronbach α coefficient for the total scale was 0.819, and the intraclass correlation coefficient value between the scorers was 0.835. Conclusion:The Chinese version of the EA risk scale has good reliability and validity. The items are concise, clear, and easy to understand. It is suitable for clinical departments as a preliminary screening tool to identify emergence agitation after general anesthesia on children with strabismus correction surgery and to assess the risk of its occurrence.

Objective:To investigate the prevalence of Escherchia albertii in Shanxi province. Methods:The chicken intestines were enriched in EC broth. The eae gene was detected by PCR, and the eae-positive EC enrichments were inoculated in MacConkey agar plate. The eae-positive lactose non-fermenting isolates were presumed as Escherchia albertii, and then analyzed by triplex-PCR, 16S rDNA sequencing and MLST. Results:Two suspected Escherchia albertiiwere isolated from 250 samples of chicken intestines. It was identified as Escherchia albertii by phenotypic, specific genes,16S rDNA sequencing, and MLST analyses . The cytolethal distending toxin B ( cdtB) showed positive by PCR,and they were clusted to Ⅱ/Ⅲ/Ⅴ group by sequencing. Conclusion:This study showed that the Escherchia albertii was existed in Shanxi province, China.

Objective:To investigate the prevalence of Escherchia albertii in Shanxi province. Methods:The chicken intestines were enriched in EC broth. The eae gene was detected by PCR, and the eae-positive EC enrichments were inoculated in MacConkey agar plate. The eae-positive lactose non-fermenting isolates were presumed as Escherchia albertii, and then analyzed by triplex-PCR, 16S rDNA sequencing and MLST. Results:Two suspected Escherchia albertiiwere isolated from 250 samples of chicken intestines. It was identified as Escherchia albertii by phenotypic, specific genes,16S rDNA sequencing, and MLST analyses . The cytolethal distending toxin B ( cdtB) showed positive by PCR,and they were clusted to Ⅱ/Ⅲ/Ⅴ group by sequencing. Conclusion:This study showed that the Escherchia albertii was existed in Shanxi province, China.

Objective:To investigate the damage and mechanism of artemisia annua pollen on tight junction of human nasal mucosa epithelial cells (HNEpC).Methods:HNEpC were cultured in vitro. Different concentrations of artemisia annua pollen (0, 20, 40, 80, 100, 160, 200 μg/ml) were used to intervene the cells for 24 h, and the cell proliferation activity was detected by the CCK-8 method. The expression and phosphorylation of p38MAPK signaling pathway were detected by Western Blot before and after the intervention of SB203580, a p38MAPK inhibitor in HNEpC. Immunofluorescence chemical staining, Western Blot and quantitative real-time PCR (qPCR) were used to observe the expression and distribution of tight junctions Occludin and Claudin-1. SPSS 21.1 software was used for statistical analysis.Results:CCK-8 results showed that, compared with the control group, the proliferation activity of HNEpC increased after 6 h intervention with different concentrations of artemisia annua pollen (all P<0.05). After 12 h of intervention, the proliferation activity of HNEpC in the 20, 40, 80, 100 and 160 μg/ml groups was not significantly changed (all P>0.05), while that in the 200 μg/ml group was decreased ( P<0.05). After the intervention for 24 h, the proliferation activity of cells in the 20 and 40 μg/ml groups was not significantly changed (all P>0.05), while that in the 80, 100, 160 and 200 μg/ml groups was decreased (all P<0.05). Immunofluorescence staining showed that the Occludin and Claudin-1 proteins in the normal control group were localized on the cell membrane and expressed more and formed a ring structure around the cell membrane. However, under the intervention of high concentration artemisia annua pollen, its expression level decreased, appeared broken, fuzzy, and nonuniform distribution. Western Blot and qPCR results showed that after 24 h of intervention, the expression levels of HNEpC Claudin-1 protein and its mRNA in the pollen groups (40, 80, 100, 160, 200 μg/ml) of artemisia annua decreased compared with those of those of the control group (mRNA expression levels were 0.567±0.214, 0.443±0.109, 0.462±0.160, 0.497±0.134, 0.388±0.076 compared with 1.001±0.067, respectively, all P<0.05). However, the mRNA of Occludin protein and its mRNA only decreased in the 200 μg/ml treatment group (mRNA expression level was 0.631±0.109 compared with 1.016±0.026, P<0.05), while all the other treatment groups increased (mRNA expression levels were 1.258±0.134, 1.827±0.103, 2.429±0.077, 1.707±0.085, 1.477±0.066 compared with 1.016±0.026, respectively, all P<0.05). Western Blot showed that p-p38MAPK expression increased after intervention with 100, 160, 200 μg/ml artemisia annua pollen for 24 h. SB203580 could inhibit the decreasing expression of Occludin caused by artemisinin pollen (mRNA expression was 1.255±0.179 compared with 0.631±0.109, P<0.05), but had no effect on Claudin-1 protein expression. Conclusion:Pollen from artemisia annua may activate p38MAPK signaling pathway and destroy the close connection of HNEpC.

Objective: To investigate the relationship between V-raf murine sarcoma viral oncogene homologue B1 (BRAF)^V600E mutation and metastasis after thyroidectomy in papillary thyroid carcinoma (PTC) with different recurrence risk stratification. Methods: From March 2014 to September 2017, 134 PTC patients (45 males, 89 females; age: 16-72 years) who underwent ¹³¹I treatment in the Department of Nuclear Medicine of Liaocheng People′s Hospital and had undergone BRAF^V600E mutation detection were retrospectively analyzed. The recurrence risk during surgery was divided into 3 levels: low-, medium- and high-risk. Each recurrence risk group was divided into 3 subgroups according to the postoperative follow-up results: non-metastasis group, cervical lymph node metastasis group and pulmonary metastasis group. BRAF^V600E mutation rates in different groups were compared (χ² test). Results: The BRAF^V600E mutation rate was 55.22%(74/134) in 134 PTC patients. The mutation rates were not significantly different in the 3 metastasis subgroups for low-risk patients (n=46; χ²=2.39, P>0.05). In medium-risk patients (n=47), the mutation rate in neck lymph node metastasis group (16/19) was higher than that in pulmonary metastasis group (3/8) and non-metastasis group (25.00%, 5/20; χ² values: 5.89 and 13.75, both P<0.05), while there was no difference between pulmonary metastasis group and non-metastasis group (χ²=0.44, P>0.05). In high risk patients (n=41), the mutation rate in neck lymph node metastasis group (85.00%, 17/20) was higher than that in the pulmonary metastasis group (5/13) and non-metastasis group (1/8; χ² values: 7.68 and 13.08, both P<0.01), while there was no difference between pulmonary metastasis group and non-metastasis group (χ²=1.64, P>0.05). Conclusion The BRAF^V600E mutation is closely related to neck lymph node metastasis after operation in middle- and high-risk patients with PTC, but it does not significantly increase the probabilities of neck lymph node metastasis in low-risk patients and pulmonary metastasis in low-, medium- and high-risk patients.

Objective To observe the inhibitory effect of lentiviral vector miR-191 (LV-191) on retinal neovascularization (RNV) in mice model of oxygen-induced retinopathy (OIR).Methods Eighty healthy 7-day-old C57BL/6J mice were randomly divided into 5 groups including normal group, non-intervention group, normal saline (NS) group, LV-191 group and LV-green fluorescent protein (GFP) group, 16 mice in each group. The OIR model was established in the non-intervention group, NS group, LV-191 group and LV-GFP group. NS group, LV-191 group and LV-GFP group were given an intravitreal injection of 1 μl of NS, LV-191 and LV-GFP at the age of 12 days. No injection was performed in the non-intervention group. In normal group,newborn mouse were maintained in room air form P0 to P17, and no treatment was performed. Mice in all five groups were euthanized at P17. Retinal neovasculation (RNV) was evaluated by counting the number of pre-retinal neovascular cells and analysis of non-perfusion area area by immunofluorescent staining of the mouse retina. Real-time quantitative PCR (RT-PCR) to detect miR -191 and P21 expression of retinal tissue.Results In the LV-191 group, the non-perfusion area were both significantly smaller than those in non-intervention group, NS group and LV-GFP group (F=127.20,P<0.001). The number of pre-retinal neovascular cell nuclei in retinas from LV-191 group were obviously lower than those in the retinas from non-intervention group, NS group and LV-GFP group (F=31.71,P<0.05). RT-PCR showed that the LV-191 and P21 level of LV-191 group increased significantly than other groups (F=10.95, 15.60;P<0.05).Conclusion Intravitreal injection of LV-191 inhibits RNV in mice model of OIR possibly through up-regulating p21.