Objective Through adverse event reporting module in hospital nursing manage-ment system, research group screened out the fall incidence higher departments to explore the effect of workshop mode in tralning nurses' prevention of falls of hospitalized patients. Methods A tralning team was set up under the guidance of hospital nursing department, to determine the content of the project and implementation process. 176 registered nurses were received tralning of fall-prevention by workshop mode, compared the differences in fall prevention knowledge level of nurses before and after tralning. Likert's 5-points were used in the investigation for satisfaction of participants. Results Aver-age score of after tralning was (18.66 ±1.32). The previous increase was (2.42 ±2.06). The differences was statistically significant (P=0.000). The comprehensive evaluation of the tralning mode from the participants was over 92.00%, except for the tralner was 89.77%. Participants were satisfied with the workshop mode . Conclusion Application of workshop in tralning program can improve nurses' knowledge of fall-prevention and guarantee patient safety.

Objective To investigate the antibiotic resistance of extended-spectrum-β-1actamases (ESBLs)-producing Escherichia coli (E.coli) and Klebsiella pneumoniae (K.pneumoniae) isolates and the risk factors of bloodstream infections caused by these strains.Methods Clinical data of 131 patients with E.coli or K.pneumoniae-induced bloodstream infections admitted in the Second Affiliated Hospital of Zhejiang Chinese Medical University during September 2009 and June 2014 were retrospectively analyzed.Species identification and antimicrobial susceptibility test were performed by Vitek 2 system,and ESBLs production was tested by standard disk diffusion method.Logistic regression analysis was performed to identify the risk factors of bloodstream infections induced by ESBLs-producing strains.Results Among 131 patients,65 were infected with ESBLs-producing strains,and 66 were infected with non-ESBLs-producing strains.The resistance rates of ESBLs-producing strains were above 50％ for penicillin,aztreonam and third/fourth generation cephalosporins,which were significantly higher than those of non-ESBLs producing strains.The resistance rates of ESBLs-producing E.coli and K.pneumoniae to carbapenems and piperacillin/tazobactam were 0-2.0％,2.3％ and 0-14.3％,26.7％,respectively.The univariate analysis revealed that patients with exposure to cephalosporins in recent 3 months (x2 =18.322,P ＜ 0.01),prior infection with ESBLs-producing strains (x2=14.610,P＜0.01),indwelling catheter in recent 3 months (x2 =13.016,P ＜ 0.01),history of hospitalization in recent 3 months (x2 =11.269,P ＜ 0.01),exposure to quinolones in recent 3 months (x2 =10.638,P ＜ 0.01),nosocomial infection (x2 =8.205,P ＜ 0.01),history of indwelling deep venous catheter or percutaneous central catheter in recent 3 months (x2 =4.817,P ＜ 0.05) and exposure to glucocorticoid hormone in recent 3 months (x2 =4.265,P ＜ 0.05) were associated with infection of ESBLs-producing strains.Multivariate Logistic regression analysis revealed that exposure to quinolones in recent 3 months (OR =6.851,P ＜ 0.01),prior infection with ESBLs-producing strains (OR =6.344,P ＜ 0.01),exposure to cephalosporins in recent 3 months (OR =3.719,P ＜ 0.01),and indwelling catheter in recent 3 months (OR =3.180,P ＜ 0.05) were independent risk factors for ESBLs-producing E.coli or K.pneumoniae infection.Conclusions ESBLs-producing E.coli or K.pneumoniae isolates are highly resistant to most antibiotics,and multidrug-resistance is common.Carbapenems were still the most effective antibiotics against ESBLs-producing E.coli or K.pneumoniae infection.Rational use of cephalosporins and quinolones,strictly following aseptic technique in operation,strict use of indications for indwelling catheterization,and completely eradicating ESBLs-producing strains in previous infections may be helpful in reducing bloodstream infections by ESBLs-producing E.coli or K.pneumoniae.

Objective To explore the theory of curriculum contents for gerontological nurse practitioner training which is suitable for the situation of our country. Method Delphi technique was used in this research to build content indicators of gerontological nurse practitioner training curricu-lum, and calculate the variation coefficient. Results The theory training curriculum includes founda-tions of gerontological nursing, geriatric syndrome, facilitating physiological balance and general gero-tological care modules and 41 core indexs. Every coefficient of variation is less than 20 percent [(4.35±0.71), (4.63±0.57), (4.55±0.57), (4.67±0.55)]. The mean values of the importance (4.54± 0.622) and general characteristics are more than four. Conclusion The content setting of the geron-tological nurse practitioner training theory course not only highlights the training characteristics of the geriatric care, but also has comprehensive and systematic content, reflects humanistic care spirit and pays attention to developing nurses’clinical practice ability. Therefore, it is worthy of reference and promotion.

Objective:To investigate the clinicopathological characteristics and prognosis of invasive micropapillary carcinoma (IMPC) of the breast. Methods:Data of 65 IMPC cases obtained from the Fourth Hospital of Hebei Medical University between Janu-ary 2009 and December 2011 were retrospectively analyzed. The expression of epithelial membrane antigen (EMA) was evaluated us-ing immunohistochemistry (IHC) to detect the micropapillary component in the tumor. The patients were divided into 4 groups based on the percentage of micropapillary component:≤10%, 11%-30%, 31%-50%, and>50%. Expressions of estrogen receptor (ER), pro-gesterone receptor (PR), and HER-2 were analyzed by IHC. Kaplan-Meier method, Log rank test, and multivariate Cox proportional hazard model were used to determine the factors affecting post-treatment survival. Results:Of the 65 cases, 12 were simple IMPC, 46 were IMPC with invasive ductal carcinoma, and 7 were other invasive carcinoma cases. The≤10%, 11%-30%, 31%-50%, and>50%micropapillary component groups comprised 7.69%(5/65), 44.62%(29/65), 26.15%(17/65), and 21.54%(14/65) of the total cases, re-spectively. Statistically significant differences were found in the four groups (P<0.01). IHC results showed that the positive rates of ER, PR, and HER-2 in the IMPC tissues were 76.92%(50/65), 67.69%(44/65), and 24.62%(16/65), respectively. Statistical differences ex-isted among the groups (P<0.05). Kaplan-Meier method indicated that positive rate of lymph node metastasis, the proportion of IMPC, vascular invasion, and the expression of ER, PR, and HER-2 significantly affect survival time of IMPC cases (P<0.05). Conclusion:Positive rate of nodal metastasis, the proportion of IMPC, vascular invasion, and the expression of ER, PR, and HER-2 are correlated with the prognosis of IMPC.

ObjectiveTo assess gene chip application value in detecting pathogenic bacteria in intracranial infection cases.MethodsPrimers and probes aiming at the specific DNA sequences of 4 kinds of common pathogenic bacteria and 6 kinds of common drug resistance genes (DRGs) were designed and used to identify the bacteria and DRGs among 30 cerebrospinal fluid (CSF) specimens (12 positive,18negative in CSF culture) from patients with intracranial infection using multiplex polymerase chain reaction (mPCR) and gene chip.The results of gene detection were compared with those of CSF culture and drug sensitivity testing.ResultsBacteria were identified and DRGs were detected in 15 specimens; DRGs and 16S gene were detected in 8 specimens; neither bacterium nor DRG was detected in 7 specimens.ConclusionGene chip technique is characterized by its relative sensitivity and rapidity of detecting the pathogenic bacteria in CSF of intraeranial infection cases.

ObjectiveTo investigate the prognostic value of fluid responsiveness in patients with acute respiratory stress syndrome (ARDS).Methods Fifty-nine mechanically ventilated patients with ARDS were enrolled.Their stroke volume variations (SVV) were detected by pulse contour continuous cardiac output (PiCCO) analysis device,and then the patients were subsequently divided into fluid responsive group (SVV≥15％) and fluid non-responsive group (SVV ＜ 15％ ).The differences in 28-day survival,length of ICU stay and duration of mechanical ventilation between the 2 groups were compared.Thereafter,the 28-day survival of patients was analyzed by Kaplain-Meier survival model and the relationship between SVV and mortality within 28 days was analyzed by logistic regression model.Results In comparison with fluid non-responsive group,the 28-day survival of fluid responsive group was significantly increased (85.3％ vs.56.0％,P =0.012),the length of ICU stay was significantly shortened [( 13.1 ±5.2 ) d vs. (21.6±9.0) d,P=0.008],and the duration of mechanical ventilation was significantly shortened as well [( 11.4 ± 5.3 ) d vs.( 18.3 ± 4.9) d,P =0.022] ; Logistic analysis revealed that SVV ＜ 15％ increased the risk of 28-day mortality ( OR =4.82 ; 95％ CI:2.67 ～ 11.71,P =0.009 ).ConclusionsSVV-based fluid responsiveness can be served as a prognostic predictor for ventilated patients with ARDS.

Objective To detect serum biomarkers for pancreatic cancer associated diabetes and establish a model for diagnosis.Methods SELDI-TOF-MS was used to detect the differentially expressed serum proteins from 17 pancreatic cancer associated diabetes patients,17 new-onset type Ⅱ diabetes patients and 17 healthy controls,then a model of biomarkers was constructed and validated by Biomarker Patterns Software 5.0.Results Twelve discriminating m/z peaks were identified in the protein fingerprints in 10 pancreatic cancer associated diabetes patients,10 new-onset type Ⅱ diabetes patients and 10 healthy controls.Among them,the three biomarkers of mass/charge ratio 6116,6695 and 8936 were used to construct the model,which could diagnose 90％ pancreatic cancer associated diabetes form control groups.Blind test of other7 samples of three groups showed that 100％ pancreatic cancer associated diabetes,71％ new-onset diabetes and 86％ healthy controls were correctly classified.After searching protein database,there were metallothionein,pancreatic progenitor cell differentiation and proliferation factor-like protein,and fibroblastic growth factor 1,which were close to the weights of the above mentioned 3 differentially expressed proteins.Conclusions SELDI can identify 3 biomarkers for pancreatic cancer associated diabetes and a reliable model for diagnosis of pancreatic cancer associated diabetes is established.

Objective To researching the effect of gestational diabetes mellitus (GDM) prevention and control management by WeChat consultation on the Internet platform. Methods There were 586 pregnant women who performed prenatal care regularly and accepted glucose tolerance test for GDM at 24 to 28 weeks in our hospital during 2015 and 2016 as research objects. Determination of the observation group:in 2016, the 308 people who match the condition of the study during annual prenatal examination in line, in addition to routine guidance outside the clinic and joined the division to establish a dedicated WeChat group for a comprehensive health management consulting. Determination of the control group:in 2015, the 278 people who match the condition of the study during annual prenatal examination in line were treated as control groups. The two groups of observation indexes included the fasting blood glucose and two-hour postprandial blood glucose control in GDM pregnant women, the weight growth rate of the whole pregnancy, cesarean section rate, birth rate of newborns, neonatal referral rate and so on. Results The rate of fasting blood glucose and two-hour postprandial blood glucose control in the observation group was significantly better than that in the control group (t=2.01-3.11, all P<0.05). According to the pre-pregnancy physical index, the weight growth of the observation group was significantly better than the control group (t=2.12-3.76, all P<0.05).The cesarean section rate, birth rate and neonatal referral rate were 21.10％(65/308), 4.87％(15/308), 7.14％(22/308)in the observation group , and 28.78％(80/278), 10.07％(28/278), 12.23％(34/278)in the control group, there were significant differences (U = 2.10-2.42, all P<0.05). Conclusions Gestational diabetes prevention and control management in the Internet platform for WeChat consultation application effect is remarkable, which can effectively improve the maternal and child outcomes. In the protection of maternal and child health is of great significance.

The clinical data of two children with refractory/relapsed acute B-lymphoblastic leukemia (ALL-B)treated with Blinatumomab in Department of Pediatrics, Peking University People′s Hospital from September 2019 to May 2021 were retrospectively analyzed.After 1 course of Blinatumomab infusion, both children achieved complete hematologic remission.During the infusion process, grade 2 cytokine release syndrome (CRS) was observed, and there were no fatal adverse reactions.One case underwent bridging hematopoietic stem cell transplantation after remission and achieves disease-free survival currently.The other case is still alive after subsequent consolidation chemotherapy.As a novel bispecific antibody, Blinatumomab has a good response rate to refractory/relapsed ALL-B and induces fewer adverse events, so it can be used as a candidate immunotherapy for patients with high tumor burden.

Objective To study the effects of mirabilite stuck on umbilical region combined with early enteral nutrition (EEN) on gastrointestinal function and serum inflammatory mediators in patients with mechanical ventilation. Methods Sixty-four patients with mechanical ventilation admitted to the Department of Intensive Care Unit of the Second Affiliated Hospital of Zhejiang Traditional Chinese Medical University from January to December 2016 were enrolled, and they were divided into an observation group and a control group by random number table, 32 cases in each group. The control group was treated with routine western medicine+ EEN, and the observation group was treated additionally with mirabilite stuck onto umbilical region on the basis of the treatment of the control group. The clinical effect was observed after 7 days of treatment. The differences in gastrointestinal function scores and the levels of serum inflammatory mediators were compared between the two groups before and after treatment.Results After treatment, gastrointestinal function scores of the diarrhea, bowel sound, abdominal distension and the levels of white blood cell count (WBC), serum procalcitonin (PCT), serum C-reactive protein (CRP) were decreased significantly in both groups compared with those before treatment, and the degrees of decreasing in above index levels after treatment in the observation group were more obvious than those in the control group [diarrhea: 0.72±0.03 vs. 1.59±0.21, bowel sounds: 0.87±0.05 vs. 1.54±0.18, abdominal distension: 0.77±0.04 vs. 1.63±0.09, WBC (×109/L): 9.87±1.25 vs. 12.46±2.04, PCT (μg/L): 5.43±1.02 vs. 9.65±1.63, CRP (mg/L): 56.87±4.52 vs. 89.43±8.24, allP < 0.05].Conclusion Applying mirabilite stuck on umbilical region combined with EEN can effectively promote the recovery of gastrointestinal function and significantly decrease the levels of serum inflammatory mediators in patients with mechanical ventilation.