Objective To improve the compliance of nurses in ICU standard specimen collection of blood culture by six sigma quality management method, so as to improve the quality of blood culture sample submission, to ensure the accuracy of inspection results. Methods A total of 158 nurses in ICU from February 2016 to January 2017 were selected as the research objects. The six sigma quality management method was used to analyze the operation of blood culture samples collected by ICU nurses,and the improvement plan was worked out and implemented. The compliance rate of blood culture samples collected by nurses before and after implementation and the feedback information of laboratory about blood culture specimen quality were compared. Results Before the application of six sigma quality management method, the compliance rate of blood culture specimens collected by ICU nurses was 54.1％(152/281), and the compliance rate after improvement was 88.6％(271/306), and the difference was statistically significant (χ2=86.45, P<0.01). Among the factors influencing nurses' blood culture,the importance of blood culture was not enough, the operation process was not mastered, the relevant knowledge of blood culture was not mastered, and the allocation of related consumables was unreasonable. After implementation,the composition ratio was reduced from 50.4％(65/129), 24.0％(31/129), 45.7％(59/129), 21.7％(28/129) to 17.1％(6/35), 8.6％(3/35), 25.7％(9/35), 2.9％(1/35), and the difference was statistically significant (χ2=4.00- 12.39, P<0.01 or 0.05). The contamination rate of blood culture specimens after six sigma management was 6.2％(19/306) and significantly lower than that of 16. 4％(46/281) before implementation,and the difference was statistically significant (χ2=15.36, P<0.01). Conclusions The six sigma quality management method can improve the nurses' attention to the correct collection of blood culture samples, reveal the defects in the operation, and reduce the irregular behavior of blood culture process. Therefore, the compliance of ICU nurses with standardized blood culture samples is improved, and the contamination rate of blood culture specimens is effectively reduced.

Human epidermal growth factor receptor 2 (HER2)-targeted therapy has greatly improved the prognosis of HER2-positive breast cancer. HER2-targeted therapy combined with chemotherapy dominated by trastuzumab+ pertuzumab is important in the neoadjuvant therapy, postoperative adjuvant therapy and late-stage standard treatment for HER2-positive breast cancer. Antibody-drug conjugates (ADCs) and tyrosine kinase inhibitors (TKIs) have further improved the efficacy of therapy. However, advanced breast cancer will eventually get a recurrence or drug resistance. HER2-positive breast cancer is characterized by moderate immunogenicity with the presence of large tumor-infiltrating lymphocytes (TILs), which provides a theoretical basis for immunotherapy. The application of HER2-targeted cancer vaccines and immune checkpoint inhibitors is promising and would offer more treatment options for the patients.

Objective To analyze the risk factors of enteral nutrition intolerance in elderly patients with severe pneumonia(SP)in intensive care unit(ICU)and construct its prediction model.Methods A total of 140 elderly patients with severe pneumonia in ICU ward of the First Affiliated Hospital of Ningbo University from January 2021 to December 2022 were selected.According to the tolerance of enteral nutrition,they were divided into tolerance group(n=82)and intolerance group(n=58).Univariate and multivariate Logistic regression analysis was used to analyze the risk factors of enteral nutrition intolerance in elderly patients with severe pneumonia in ICU.The risk prediction model was constructed,and the receiver operating characteristic(ROC)curve was drawn to evaluate the prediction effect of the model.Results Multivariate Logistic regression analysis showed that acute gastrointestinal injury(AGI),intra-abdominal pressure(IAP),and the use of antibiotics≥2 were independent influencing factors of enteral nutrition intolerance in elderly patients with severe pneumonia in ICU(P<0.05).The Hosmer-Lemeshow goodness-of-fit test was used to evaluate the fitting effect of the equation.The area under the curve was 0.867(95%CI:0.750-0.984),the sensitivity was 87.8%,and the specificity was 85.1%.Conclusion The risk prediction model constructed in this study can effectively predict the risk of enteral nutrition intolerance in elderly patients with severe pneumonia in ICU.

Objective: To evaluate the relationship between-590C/T polymorphisms of interleukin-4 gene and periodontitis by meta-analysis. Methods: Databases including PubMed, EMbase, Web of Science, CBM, CNKI, Wanfang and VIP, were searched from their establishment to December 31, 2016. Only case-control studies on the association between -590C/ T polymorphisms of interleukin-4 gene and periodontitis were selected, and the references of those selected studies were searched by hand. Assessment and data extraction were conducted by 2 reviewers independently, and the meta-analysis was performed with the R 3.3.1 software. Results : The meta-analysis showed that there was no association between the IL-4-590C/T polymorphism and periodontitis susceptibility (T vs C: OR=1.19, 95%CI=0.81~1.76, P =0.37). Subgroup analysis showed that the IL-4 -590 TT was associated with periodontitis in Caucasians (TT vs CT: OR=1.75, 95%CI=1.10 ~ 2.78, P = 0.02), but no significant association in Asians (P =0.63). Meanwhile, IL-4 gene polymorphisms were not significantly associated with the susceptibility of chronic periodontitis (CP) or aggressive periodontitis (AgP) ( e. g. T vs C, CP: P=0.45; AgP: P =0.45). Conclusion Based on current evidence, the polymorphisms of IL-4-590C/T are associated with the increased risk of periodontitis in Caucasians.