Objective To improve microbial specimen detection rate before therapeutic antimicrobial use.Methods A system of selective targeted management by clinical department was established,before management was as control group (July-September 2013),after management was as intervention group(October-December 2013),microbial specimen detec-tion in patients before antimicrobial use was compared between before and after management.Results Of all hospitalized pa-tients,11 254 received therapeutic antimicrobial agents,3 426 were sent specimens for microbial detection,the specimen detection rate was 30.44%;specimen detection rate in control and intervention group was 28.80% and 31.89% respective-ly ,the difference was significant(χ2 =12.71,P <0.05).3 716 patients(46.61%)received restrained antimicrobial therapy, and 1 418 (79.20%)received special antimicrobial therapy,compared with control group,the difference were both signifi-cant(χ2 =32.86,19.31,respectively,both P <0.05).Conclusion Applying selective targeted management can improve microbial specimen detection rate before therapeutic use of antimicrobial agents.

OBJECTIVE To survey the drug resistance variation of pathogens.METHODS We analyzed all of the pathogens isolated from Jan 1998 to Dec 2005 and the drug resistance results.WHONET5 software was used to analyze the data.RESULTS A total of 19 832 strains of pathogens were detected for eight years.There was ascending tendency in ESBLs and MRS.The ratio of strains and resistance also varied.The general trend was that the order of Staphylococcus was going up and the order of non-fermented and fermented bacteria was ascending alternately.CONCLUSIONS The resistance variation of pathogens in our hospital consists with the global tendency of bacteria resistance.Of course it has its own characteristics.The resistance surveillance should be continued especially for ESBLs,MRS,VISA and VRSA.

Strengthening the management of key positions in medical and health institutions, implementing rotation management of personnels in key positions, is of great significance for regulating the operation of power and preventing corruption risks. A tertiary grade A hospital in Qingdao has implemented a rotation system for personnels in key positions among functional department from an internal control perspective since 2022. On the basis of conducting job risk assessment, the hospital has developed a key position rotation system, determining the scope, rotation cycle, and rotation method for key position personnels, and formulated key position rotation plan. The Party Committee Office and the Human Resources Department were responsible for organizing and implementing it, and evaluating the implementation effect. From 2022 to 2023, 61 key positions were rotated between departments and within departments, accounting for 37.7% of the total number of key positions. Compared with 2021, the number of petitions and reports received by the Discipline Inspection and Supervision Office for key positions in 2022 has decreased by 12.5%, which can provide reference for other medical and health institutions to carry out anti-corruption risk management.

Objective To explore the characteristics of distribution of TCMsyndrome elements of disease nature between active stage and stationary stage of patients with hepatitis cirrhosis,and to study the corre-lation between the TCMsyndrome elements and serum level of homocysteine (Hcy).Methods By using Information Collection Form ofHepatitis Cirrhosis drafted by our research team,a national multicenter and cross-sectional epidemiological survey was conducted to collect the general condition,symptoms,and blood samples from which the serum Hcy levels were obtained.In accordance with Standard ofHepatitis Cirrhosis Syndrome Elements Differentiation,the TCM syndrome elements of nature of the patients were determined.Then the correlation of the TCMsyndrome elements and the serum levels of Hcy was investi-gated at active stage and stationary stage.Results Altogether 715 patients were included.The frequen-cy of all syndrome elements in patients of active stage were higher than those in patients of stationary phase,in which the element of blood stasis,yin deficiency,qi deficiency,yang deficiency and water re-tention showed statistical differences (P <0.05).The serum level of Hcy in patients of active stage was higher significantly than that of stationary stage (P <0.05).The Hcy level of patients with yin deficiency pattern was lower than that of patients without yin deficiency pattern,the same as element of damp heat, qi stagnation and yang deficiency;however,the situations of element of blood stasis,qi deficiency and water retention were quite the reverse.In the patients of stationary stage,the serum levels of Hcy showed significant difference between qi stagnation group and non qi stagnation group (P <0.05).In the pa-tients of active stage,the levels of Hcy showed difference between yin deficiency group and non yin defi-ciency group,as well as the element of qi deficiency (P <0.05).Conclusion The frequency of TCM syndrome elements and the serum Hcy level in patients of active stage higher than those of patients of sta-tionary stage,reflected the degree of hepatic inflammation and severity of disease.That the correlation between the Hcy level and the TCMsyndrome elements of nature could provide the evidence for pathologi-cal basis and standardization study of TCMsyndrome elements in patients with hepatitis cirrhosis.

Objective To analyze the distribution of diseases with TCMpattern of spleen-stomach damp-ness-heat (SSDHP)and the prescriptions and Chinese herbal medicines involved,so as to guide TCM clinical practice and further research on SSDHP.Methods Taking “SSDHP”(Chinese:脾胃湿热证) as subject term or title /keyword,the databases of China National Knowledge Infrastructure(CNKI),Wan-fang Data Knowledge Service Platform and VIP Information were systematically retrieved,from the begin-ning of the databases to 31 December,2015.The articles related to treatment on SSDHP were collected, and the database was established by using Microsoft Excel 2010,on which data were descriptively statisti-cal analyzed.Results 109 articles were eligible from total 1 681 retrieved ones.The top two diseases with SSDHP were digestive system disorders (86.41%)and dermatoses (5.83%).The common formu-la directed at clearing heat and dampness including Pingwei Powder,Huopu Xialing Decoction,and Sanren Decoction,combined with specific medications for exact symptoms.The common Chinese herbal medications with frequency more than 1 percent were listed as the following:Golden Thread (Huangli-an),Pinellia Tuber(Banxia),Official Magnolia Bark(Houpu),Liquorice Root (Gancao),Dried De-coctionerine Peel (Chenpi),Baical Skullcap Root (Huangqin),Indian Bread (Fuling),Dandelion (Pugongying),Agastache Rugosus (Huoxiang),Atractylodes Rhizome (Cangzhu),Coix Seed (Yiy-iren),Round Cardamon Fruit (Baidoukou),Largehead Atractylodes Rhizome (Baizhu),Orange Fruit (Zhiqiao),Immature Orange Fruit (Zhizi ),Corydalis Rhizoma (Yanhusuo ),White Peony Root (Baishao),Medicinal Evodia Fruit (Wuzhuyu),Dried Ginger (Ganjiang),Bamboo Shavings (Zhu-ru),Virgate Wormwood Herb (Yinchen),Grassleaf Sweetflag Rhizome (Shichangpu),Turmeric Root Tuber (Yujin),Immature Orange Fruit (Zhishi),Chinese Thorowax Root(Chaihu),Common Bletilla Tuber (Baiji),Danshan Root (Danshen),Bitter Apricot Seed (Kuxingren),Villous Amomum Fruit (Sharen),Common Aucklandia Root (Muxiang),Finger Citron (Foshou),Talc (Huashi).Conclu-sion Now,the diseases with SSDHP were most common in digestive system,but also in other systems. And the prescription and Chinese herbal medicines should be applied by holistic conception,combination of disease and pattern and pattern differentiation and treatment.Classic herbal formulas in TCM ancient books are still playing the strictly key roles in clinical practice,but proved formulas of modern outstand-ing senior traditional Chinese practitioners and Hospital Preparations also are paid more attention by re-searchers.

Objective:To investigate the relationship between lifestyle factors and stroke in the elderly.Methods:Data were obtained from a natural cohort of the Multimodal Intervention to Delay Dementia and Disability in Rural China(MIND-China)study.A total of 5 009 participants aged 60 years and above were enrolled, of whom 954(19.05%)had experienced a stroke.Logistic regression analyses were conducted to assess the association between five lifestyle factors(smoking, drinking, physical exercise, social activity and sleep quality)and the incidence of stroke.Results:In model 1, after adjusting for age, sex and education, only social activity( OR=0.783, 95% CI: 0.668-0.917)and good sleep quality( OR=0.731, 95% CI: 0.621-0.860)emerged as protective factors against stroke(both P<0.05).No statistically significant associations were found between other lifestyle factors and stroke.Analysis of a variety of healthy lifestyle practice combinations showed that having 3( OR=0.639, 95% CI: 0.433-0.944), 4( OR=0.620, 95% CI: 0.409-0.941)and 5( OR=0.397, 95% CI: 0.197-0.799)healthy lifestyle practices were protective factors against stroke(all P<0.05).In model 2, after adjusting for age, sex, education, body mass index, diabetes, hyperlipidemia, hypertension, and the APOE genotype, the results were consistent with those of Model 1. Conclusions:Lifestyle factors are significantly associated with the risk of stroke in the elderly population.The healthier lifestyle practices are adopted, the lower the risk of stroke will be.

Objective:To study the life characteristics and related risk factors of patients with depression in Shandong Province.Methods:Based on the 2015 mental epidemiological survey database in Shandong Province,a total of 832 patients with depression,807 high-risk individuals with depression,and 819 low-risk individuals were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition(DSM-Ⅳ)and the Structured Clinical Interview for DSM-Ⅳ-TR Axis I Disorders,Research Version(SCID-I/P).In 2020,SCID-I/P was used for re diagnosis,and the General Health Questionnaire(GHQ-12),Simple Quality of Life question-naire,Pittsburgh sleep quality index(PSQI),Childhood Trauma Questionnaire(CTQ),Social Support Rating Scale(SSRS),Global Pain Scale(GPS),Montreal Cognitive Assessment(MoCA),Simplified Coping Style Question-naire(SCSQ)were used for evaluation.Compare changes in the quality of life of depression patients and construct a risk factor model.Results:Patients with depression had lower scores on the simple quality of life questionnaire at baseline and at retest after 5 years than those in the high-and low-risk groups,those in remission of depression had higher scores on the simple quality of life questionnaire at baseline and at retest after 5 years than those in non-re-mission,and those with new-onset disorder in the high-and low-risk groups had lower scores on the simple quality of life questionnaire at baseline and at retest after 5 years than those with no-onset disorder(Ps＜0.001).Depres-sion diagnosis and PSQI scale scores at baseline negatively predicted at retest after 5 years(β=-0.06,-0.15),while coping style tendencies at baseline positively predicted(β=0.06).The simple quality of life questionnaire at baseline negatively predicted depression diagnosis at retest after 5 years,GHQ-12 scores at retest after 5 years,and PSQI scale scores at retest after 5 years(β=-0.11,-0.17,-0.09),while the simple quality of life question-naire at baseline positively predicted coping style tendencies at retest after 5 years(β=0.13).Depression diagnosis at retest after 5 years,GHQ-12 scores at retest after 5 years,PSQI scale scores at retest after 5 years,coping style tendencies at retest after 5 years,SSRS scale scores,CTQ scale scores,GPS scale scores,and the simple quality of life questionnaire at baseline all influenced the simple quality of life questionnaire at retest after 5 years through ei-ther direct or indirect pathways.Conclusion:It suggest that the quality of life is lower in patients with depression than in the general population.Depression diagnosis,sleep,mental health,pain,social support,childhood trauma and coping are direct and indirect risk factors affecting life.

OBJECTIVETo investigate the risk factor of cholecystitis after radical gastrectomy for gastric cancer.

METHODSClinicpathological data of 553 gastric cancer patients with normal gallbladders undergoing radical gastrectomy in Tianjin Medical University Cancer Institute and Hospital between March 2013 and March 2015 were analyzed retrospectively. Univariate and multivariate analysis were applied to evaluate factors influencing the cholecystitis after radical gastrectomy using log-rank and logistic regression model.

RESULTSThere were 360 males and 193 females with a median age of 60 years. All patients were followed up from 6 months to 2 years. The incidence of cholecystitis after radical gastrectomy for gastric cancer was 33.1%(183/553), while incidence of cholecystolithiasis was 4.9%(27/553). In addition, the cholecystitis incidence of patients with No.12 lymph node cleaning was 39.6%(89/225), while with No.8a lymph node cleaning was 38.0%(151/397), with No.5 lymph node cleaning was 38.0%(68/179), with No.7 lymph node cleaning was 34.4%(138/402), with No.9 lymph node cleaning was 34.7%(136/392). Univariate log-rank test indicated that the lymphadenectomy of No.8a(χ(2)=15.530, P=0.000), No.12 group(χ(2)=7.157, P=0.007) and surgical methods (χ(2)=7.427, P=0.024) were significantly associated with cholecystitis after radical gastrectomy. Multivariate analysis showed that the lymphadenectomy of No.8a was independent factor of cholecystitis after radical gastrectomy (OR=2.016, 95% CI:1.244 to 3.267, P=0.004).

CONCLUSIONSVagal nerve trunk and sympathetic ganglion should be protected carefully during No.8a lymphadenectomy in radical gastrectomy for gastric cancer, in order to reduce the incidence of postoperative cholecystitis.

Cholecystitis ; epidemiology ; Female ; Gastrectomy ; adverse effects ; Humans ; Logistic Models ; Lymph Node Excision ; Lymph Nodes ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Period ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; surgery

OBJECTIVETo explore the association of perioperative blood transfusion (PBT) with survival of gastric cancer after surgery.

METHODSWe retrospectively reviewed the medical records of 1 000 gastric cancer patients, including 738 non-transfused (73.8%) and 262 transfused (26.2%) cases. A one to one match was created using propensity score analysis, except preoperative hemoglobin level and operative blood loss. The survival was analyzed by Kaplan-Meier survival model.

RESULTSThe 5-year survival rate of the 1 000 cases of gastric cancer patients was 39.9%. Before matching, there was a significant difference between transfused group (33.6%) and non-transfused group (49.1%, P<0.005). Univariate analysis showed that age, tumor size, hemoglobin level, albumin level, depth of invasion, lymph node metastasis, lymph node dissection, surgery mode, adjuvant chemotherapy, blood loss and blood transfusion during perioperative period were associated with prognosis in the gastric cancer patients (all P<0.05). Multivariate analysis showed that tumor invasion, lymph node metastasis, lymph node dissection, chemotherapy and perioperative blood transfusion were independent prognostic factors in gastric cancer (all P<0.05). After matching, the 5-year survival rate of the 262 non-transfused patients was 37.7%, while that of the 262 transfused patients was 33.6% (P>0.05).

CONCLUSIONSPerioperative blood transfusion has no significant effect on the prognosis of gastric cancer patients.

Analysis of Variance ; Blood Transfusion ; mortality ; Humans ; Kaplan-Meier Estimate ; Lymph Node Excision ; Lymphatic Metastasis ; Perioperative Period ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; mortality ; pathology ; surgery ; Survival Rate

Objective: To understand the consistency of ALK Ventana-D5F3 immunohistochemistry (IHC) interpretation in Chinese lung adenocarcinoma among histopathologists from different hospitals, and to recommend solution for the problems found during the interpretation of ALK IHC in real world, with the aim of the precise selection of patients who can benefit from ALK targeted therapy. Methods: This was a multicenter and retrospective study. A total of 109 lung adenocarcinoma cases with ALK Ventana-D5F3 IHC staining were collected from 31 lung cancer centers in RATICAL research group from January to June in 2018. All cases were scanned into digital imaging with Ventana iSCANcoreo Digital Slide Scanning System and scored by 31 histopathologists from different centers according to ALK binary (positive or negative) interpretation based on its manufacturer′s protocol. The cases with high inconsistency rate were further analyzed using FISH/RT-PCR/NGS. Results: There were 49 ALK positive cases and 60 ALK negative cases, confirmed by re-evaluation by the specialist panel. Two cases (No. 2302 and No.2701) scored as positive by local hospitals were rescored as negative, and were confirmed to be negative by RT-PCR/FISH/NGS. The false interpretation rate of these two cases was 58.1% (18/31) and 48.4% (15/31), respectively. Six out of 31 (19.4%) pathologists got 100% accuracy. The minimum consistency between every two pathologists was 75.8%.At least one pathologist gave negative judgement (false negative) or positive judgement (false positive) in the 49 positive or 60 negative cases, accounted for 26.5% (13/49), 41.7% (25/60), respectively, with at least one uncertainty interpretation accounted for 31.2% (34/109). Conclusion There are certain heterogeneities and misclassifications in the real world interpretation of ALK-D5F3 IHC test, which need to be guided by the oncoming expert consensus based on the real world data.