Objective To investigate the association of nonalcoholic fatty liver disease with hypertriglyceridaemic wasit phenotype complicated with type 2 diabetes mellitus. Methods Base on whether plasma triglycerides concentra? tion≥1.7 mmol/L or not, waist circumference≥90 cm or not in men or≥85 cm or not in women, patients with type 2 diabe?tes mellitus (n=804) were divided into four groups:normal waist circumference with normal triglycerides, normal waist cir?cumference with hypertriglyceridemia, abdominal obesity with normal triglycerides and hypertriglyceridemic-waist pheno?type (HTWC). The four groups’clinical data were recorded. Body mass index (BMI), homeostasis model assessment insulin resistance (HOMA-IR) and nonalcoholic fatty liver disease fibrosis score (NAFLDFS) were calculated and the results were compared among four groups. Results BMI, waist circumference, systolic blood pressure, diastolic blood pressure, HOMA-IR, alanine aminotransferase, aspartate aminotransferase , γ-glutamyltransferase, serum uric acid,NAFLDFS and the inci?dence of NAFLD were all higher in the HTWC group compared to non-HTWC group (P<0.01). Logistic regression analysis revealed that besides BMI,γ-glutamyltransferase and serum uric acid,HTWC was also a risk factor for NAFLD in patients with type 2 diabetes mellitus(OR=1.986,95%CI:1.006-3.921). Conclusion HTWC is a risk factor for NAFLD in patients with type 2 diabetes mellitus. Screening and diagnosis of HTWC is helpful for reducing the occurrence of NAFLD and can slow its progress through controlling and interfering metabolic disturbance.

Objective To investigate the changes of waist muscle density and area in the subjects with spiral CT scan examination,and through the quantitative analysis of different age and gender to get the degree of lumbar muscle degeneration.Methods 240 cases of lumbar CT scan reconstruction images (including the patients suffering from low back pain)were collected.According to the age,20 - 29 years old group,30 - 39 years old group,40 -49 years old group,50-59 years old group,60-69 years old group,and 70-79 years old group were set up.The lumbar transverse psoas muscle,lumbar side muscle,erector spinae cross-sectional areas (CSA)and mean CT values were measured at different levels.Scanning equipment:Toshiba Activion 16-slice spiral CT scanners, acquisition range from the waist 1 to S1.Results ①Compared between the measurement results of the same age groups (except 70-79 years old group),the average CSA of the male at the same level waist was higher than the female (P <0.05).②Compared between the same level groups of 20-29 years,30-39 years and 40-49 years, there were no significant differences (P >0.05).Compared between the same level groups of 50-59 years,60-69 years and 70-79 years,there was no significant difference (P >0.05).③Compared the CSA of man’s erector spinae muscle between 40-49 years group and 50-59 years group,there were significant differences (P <0.05).④Compared the same level CSA of female between 20-29 years,30-39 years,40-49 years,50-59 years,60-69 years,70-79 years groups,and the adjacent groups,there were no significant differences (P >0.05).⑤The same level average density of erector spinae muscle was lowest compared with the psoas major muscle and quadratus lumborum muscle,and falling faster,the psoas major muscle was relatively higher.The same level average density of female’s erector spinae muscle was lower than man’s,specially in 70-79 years group.Conclusion Multi-slice spiral CT can be used to diagnose the lumbar degenerative conditions.

Objective To explore the behaviors caused by fear of hypoglycemia in type 2 diabetic patients, and deeply analyze the causes of these behaviors, providing help for medical staff to fully understand the inner demands of diabetic patients with hypoglycemia, so as to manage the blood glucose effectively, laying the foundation of Hypoglycemia Fear Survey-behavior scale suitable for domestic type 2 diabetic patients. Methods The interpretative phenomenological analysis method was used guided by the knowledge-attitude-belief-practice and social cognitive theory, 33 patients with hypoglycemia from 5 hospitals with different levels were interviewed by semi-structured interview. Results Four themes were extracted, including excess sensitivity, caution, avoidance and compromise. The theme excess sensitivity contained three kinds of behaviors, that were meal with sensitive alertness, drug sensitivity and excessive response to the hypoglycemia, while the theme caution contained two kinds of behaviors, that were strive to blood sugar stable and must prepare food. Conclusions The results show that the fear of hypoglycemia is serious in type 2 diabetic patients, and they make many behavior change to avoid it, affecting their quality of life and glycemic management. Medical staff should attach importance to the inner feelings and behaviors of diabetic patients with hypoglycemia, and provide guidance and support after comprehensive assessment, working together with the patient to realize the effective management of blood glucose.

BACKGROUND:More recently, the focus has been on searching for a compound Chinese medicine for reinforcing kidney, which cannot only inhibit bone absorption, but also promote osteogenesis to protect against osteoporosis. OBJECTIVE:To explore effects of drug serum of Jianbuhuqian pil s on proliferation and function of osteoblast-like cel s in vitro. METHODS:Twenty-four adult female Sprague-Dawley rats were randomly divided into low-dose, medium-dose, high-dose and normal saline groups, and given intragastric administration of 1.5, 3.0, and 6 g/kg Jianbuhuqian pills and equal volume of normal saline, respectively twice daily for 1 week. At 1 hour after final gavage, rats were decapitated to prepare drug sera used for culturing osteoblast-like cells. At 24, 48 and 72 hours of culture, the cellular morphology was observed, as well as the cell proliferation and alkaline phosphatase activity was detected by MTT assay and alkaline phosphatase staining, respectively. RESULTS AND CONCLUSION:Compared with the normal saline group, the cel density began to increase significantly in three Jianbuhuqian groups at 24 hours after culture, mitotic figures were easy to be observed, cel s were in overlapping growth, much secretions and matrix accumulation appeared, especial y in the high-dose group. The obsorbance values in Jianbuhuqian groups were significantly higher than that in the normal saline group. After 24 hours of culture, the obsorbance values in the medium-dose and high-dose groups were significantly increased compared with the low-dose group, and the values showed significant differences among three Jianbuhuqian groups after 48 and 72-hour culture. In addition, the alkaline phosphatase activity presented overt increase in the Jianbuhuqian groups compared with the normal saline group, and significant differences could be found among Jianbuhuqian groups. To conclude, the drug serum of Jianbuhuqian pil s can promote the activity of osteoblast-like cel s in a time-and concentration-dependent manner.

【Objective】 To establish and evaluate a nephelometric assay for the determination of immunoglobulin A (IgA) residues in human intravenous immunoglobulin(IVIG). 【Methods】 BN ProSpec^© automatic protein analyzer and its supporting immunoglobulin A determination kit (nephelometry) produced by German Siemens and the national standard of human IgA were used to establish the nephelometric assay to determine IgA residue in test products and verify the methodology. The test products include IVIG (pH4) prepared by low-temperature ethanol protein separation process and a novel IVIG prepared by chromatography. 【Results】 The average deviation of three calibration curves for IgA residues determination by the nephelometric assay were 1.08%, 0.95% and 1.54%,, and the three deviations of the quality control were 4.00%, -2.30% and -0.20%, respectively, which indicated good calibration and quality control. In the specificity test, the average recovery rates of IgA for reference substance 1 containing 100g/L maltose and reference substance 2 containing 20g/L glycine were 102.7% and 105.8%, respectively. The relative standard deviation (RSD) values of the repeatability tests of the two test products were 3.9% and 1.9%, and the RSD values of the intermediate precision test were 3.6% and 2.3%, respectively.The difference values at each time point in the durability test of test products′ storage time were all less than 10%, and the RSD values of the two test products in the durability test of kits of different batches were 2.8% and 2.2%, respectively. In the accuracy test, the average recovery rates of IVIG (pH4) added to the standard were 94.2%, 101.7% and 96.2%, respectively, and the average recovery rates of the novel IVIG added to the standard were 102.8%, 106.3% and 99.7%, respectively. The average recovery rate of the limit quantification test was 101.0%, and the RSD was 4.0%. 【Conclusion】 Nephelometric assay has the advantages of strong specificity, high precision and accuracy, good repeatability, simple and rapid operation, and automation, and can be used for the determination of IgA residue in IVIG (pH4) and novel IVIG products.

Objective To establish a risk warning model for surgical site infection(SSI), provide support for screening high risk population and finding suspected cases.Methods Clinical data of 5 067 patients who underwent abdominal surgery in 6 domestic hospitals from January 2013 to December 2015 were collected retrospectively, all cases were randomly divided into modeling group and validation group according to a 6:4 ratio, warning model was established by employing logistic regression, the area under the receiver operating characteristic curve (AUC) was used to evaluate discriminant ability of evaluation model, the maximum Youden index was as the optimum cut-off point.Results For the warning model of high-risk patients, AUC was 0.823, sensitivity and specificity were 78.81% and 74.33% respectively, positive predictive value and negative predictive value were 19.67% and 97.78% respectively.For the discriminant model of suspected infection cases, AUC was 0.978, sensitivity and specificity were 93.38% and 95.62% respectively, positive predictive value and negative predictive value were 62.95% and 99.45% respectively.Conclusion The early-warning model established in this study has better discrimination ability, which can provide a reference for the development of early warning and discrimination of healthcare-associated infection information system.

Objective To realize the current situation of prevention and control of catheter-associated urinary tract infection (CAUTI)since the development of healthcare-associated infection(HAI)management in China in the re-cent 30 years.Methods Random cluster sampling was used to select 165 secondary and tertiary hospitals in 13 provinces and cities in China,questionnaires were filled in,the content included time,scope,method,data feed-back,and incidence of CAUTI monitoring.Results Of 165 hospitals,92.12% (152/165)have implemented targe-ted monitoring,the implementation rate in tertiary hospitals was higher than secondary hospitals (98.08% [102/104]vs 81.97%[50/61],χ2 =13.748,P <0.001).Most hospitals (82.24%[125/152])only implemented monito-ring in intensive care units(ICUs)or partial ICUs.HAI management professionals,HAI control doctors and nurses in 69.08%(105/152)of hospitals jointly took responsibility for CAUTI monitoring.95.39% (145/152)of hospitals diagnosed CAUTI by combination of clinical manifestations and laboratory examination results.98.68%(150/152) of hospitals have gradually implemented intervention measures,such as strictly mastering the indications of urinary indwelling catheters,hand hygiene of health care workers,non-frequent change of urinary indwelling catheters,and necessity for daily assessment of catheterization.75.66% (115/152)of hospitals conducted feedback of monitored results to the whole hospital.Incidences of CAUTI in pre-2010,2010,and 2015 were 3.10‰,4.72‰,and 1.89‰respectively.Conclusion In the recent 30 years,monitoring on CAUTI in China has obtained achievement,CAUTI monitoring is gradually standardized and scientific,but the development at all levels of medical institutions is still imbalance,which needs to be improved further.

Objective To develop a method for the determination of ketamine analogues in hair samples by liquid chromatography quadrupole linear ion trap mass spectrometry(QTRAP LC-MS/MS).Methods 20 mg of washed and dried hair was added to 1 mL extracting solution and then prepared using an ultrasonic extraction with frozen pulverization method.After centrifugation and purification with membrane,the supernatant was separated in a ACQUITY UPLC? HSS T3 column with gradient elution,finally tested with multiple reaction monitoring for the detection of 10 ketamine analogues.The above method was applied for quantitative analysis of ethylfluamine,F-norketamine and tiletamine in 20 positive samples.Results When the concentration ranged from 0.01 to 2.00 ng/mg,there was good linearity for 10 ketamine analogues with the correlation coefficients over 0.99.The recoveries ranged from 89.1％to 106.1％,and the matrix effects were between 88.3％and 106.0％.Among the 20 positive samples,the contents of ethylfluamine,F-norketamine and tiletamine in hair ranged between 0.02～8.35 ng/mg,0.01～0.94 ng/mg and 0.02～10.93 ng/mg,respectively.Their mean values were 1.59 ng/mg,0.28 ng/mg and 2.69 ng/mg.Their medians were 0.40 ng/mg,0.19 ng/mg and 2.11 ng/mg.Conclusion The established method was simple,efficient,reliable and suitable for the determination of ketamine analogues in hair.The data provided reference for the drug control and forensic science practice.

Objective To understand the status of awareness of hand hygiene(HH)knowledge and compliance among health care workers (HCWs)in China,and provide scientific basis for further improvement of HH practice. Methods A multi-centre retrospective survey on awareness of HH knowledge and compliance was conducted in 200 nationwide hospitals in 2015.Results The awareness rates of HH methods and HH indications among HCWs were 86.5% and 82.5% respectively;cleaning staff had the lowest awareness rate of HH indications(69.9%),followed by the other interns and advanced-study students (70.2%),as well as medical technicians (79.8%);attendants had the lowest awareness rate of HH methods(76.9%),followed by advanced-study students and interns(81.0%),and cleaning staff (82.4%);HH knowledge awareness rate among HCWs in secondary hospitals was lower than tertia-ry hospitals,and the district-level hospitals had the lowest awareness rate of HH.HH compliance rate and correct rate were 70.1% and 74.9% respectively;the interns and advanced-study students were at a low level of compliance and correct rates (61.4% and 60.9% respectively);the municipal hospitals had the lowest compliance and correct rates,non-teaching hospitals were lower than teaching hospitals.Conclusion HH in primary hospitals is weak,HH of interns,advanced-study students,as well as attendants and cleaning staffs are not enough,HH management should be strengthened,awareness and compliance of HH should be improved.

Objective To understand the development of healthcare-associated infection(HAI)management organ-izations in China in the past 30 years.Methods Development of HAI management organizations in 12 provinces (municipalities,autonomous regions)in China was surveyed.Results A total of 166 hospitals were surveyed,96 (57.83%)were tertiary hospitals.Among 164 hospitals which had a history of development of HAI management department,46(28.05%)before 1995,63(38.14%)in 1995-2005,and 55(33.54%)in 2005-2015 set up HAI management departments.HAI management professionals per 1 000 beds in 165 hospitals decreased from 4.80 in 1995 to 4.09 in 2015,occupational categories in HAI management departments in 1995 -2015 were significantly different (χ2 =26.22,P <0.01).The constituent ratios of education background and profession of HAI manage-ment professionals in each province in 1995-2015 were significantly different(χ2 =242.91,47.10,respectively,all P <0.01).In 1995 and 2005,70.81%,53.30% of professionals were with college degree or below;in 2015,the percentage of professionals with bachelor’s degree,doctoral degree,and master’s degree were 53.79%,2.45%, and 22.86% respectively.Most professionals were nursing staff,but the percentage decreased from 58.38% in 1995 to 45.96% in 2015.Conclusion Although HAI management organizations have developed for 30 years and made some achievements,there still remain some problems,the proportion of professionals needs to be enhanced,and personnel structure should be optimized.