Objective To compare whether there is a difference in medical cost of intensive care unit(ICU)pa-tients with catheter-associated infection (CAI)between before and after targeted intervention.Methods CAI in ICU patients in 2010(pre-intervention group)and 2013 (post-intervention group)were investigated by retrospective survey,hospitalization cost of two groups of patients before and after intervention was compared.Results The morbidity and mortality in patients with CAI both decreased significantly after intervention,morbidity of healthcare-associated infection(HAI)decreased from 13.47% in 2010 to 4.41 % in 2013,mortality decreased from 10.36% in 2010 to 2.2% in 2103.Total hospitalization cost,blood transfusion cost,and cost of special material before and af-ter the implementation of targeted intervention all significantly different (all P <0.05),the difference of procalcito-nin and antimicrobial agents cost were also significant(all P <0.05).Conclusion Medical cost in ICU patients with CAI decreased after intervention.

Humans ; Accidents, Traffic ; Cause of Death ; Technology

OBJECTIVE: To investigate a family with congenital dysfibrinogenemia, and analyze the risk of hemorrhage and thrombosis and blood transfusion strategies. METHODS: Prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) of the proband and her family members were detected by automatic coagulometer, fibrinogen (Fg) activity and antigen were detected by Clauss method and PT algorithm respectively. Meanwhile, thromboelastometry was analyzed for proband and her family members. Then, peripheral blood samples of the proband and her family members were collected, and all exons of FGA, FGB and FGG and their flanks were amplified by PCR and sequenced to search for gene mutations. RESULTS: The proband had normal APTT and PT, slightly prolonged TT, reduced level of Fg activity (Clauss method). The Fg of the proband's aunt, son and daughter all decreased to varying degrees. The results of thromboelastogram indicated that Fg function of the proband and her family members (except her son) was basically normal. Gene analysis showed that there were 6233 G/A (p.AαArg35His) heterozygous mutations in exon 2 of FGA gene in the proband, her children and aunt. In addition, 2 polymorphic loci were found in the family, they were FGA gene g.9308A/G (p.AαThr331Ala) and FGB gene g.12628G/A (p.BβArg478Iys) polymorphism, respectively. The proband was injected with 10 units of cryoprecipitate 2 hours before delivery to prevent bleeding, and no obvious bleeding occurred during and after delivery. CONCLUSION Heterozygous mutation of 6233G/A (p.AαArg35His) of FGA gene is the biogenetic basis of the disease in this family with congenital dysfibrinogenemia.
Humans ; Child ; Female ; Fibrinogen/genetics* ; Pedigree ; Afibrinogenemia/genetics* ; Mutation ; Blood Transfusion

OBJECTIVETo investigate the changes of E-selectin, thrombin-antithrombin complex（TAT）, prothrombin fragment 1+2（F1+2）, tissue factor（TF）and tissue factor pathway inhibitor（TFPI）before and one year after splenectomy in thalassemia patients.

METHODSA total of 30 thalassemia patients undergoing electric laparoscopic splenectomy and 30 normal controls（NC） were enrolled in the study．Plasma levels of E-selectin, TAT, F1+2, TF and TFPI were detected by enzyme-linked immuno sorbent assay（ELISA）.

RESULTSOne year after splenectomy，the plasma concentrations of E-selectin, TAT, F1+2, TF, TFPI were significantly higher than those in both preoperative and NC groups．Levels of E-selectin, TAT, F1+2 before splenectomy were significantly higher than those in NC groups. In addition, there was a positive correlation between plasma TF and TFPI level before and after splenectomy, and the levels of TF and TFPI positively correlated with TAT and F1+2, respectively.

CONCLUSIONAfter splenectomy, the platelet count increases, the activity of endothelial cells is injured, the procoagulant factor increases, the blood is in procoagulant state, the TF/TFPI shows an importent role in the thrombosis of thalassemia patieints after splenectomy and may be used to evaluate the prothrombotic state of this diasease.

OBJECTIVE: To explore whether the high risk factors possibly leading to hypercoagulative status and thrombosis exist in Thalassemia patients of Guangxi region through detecting plasma tissne factor-bearing microparticles (TFMP), procoagulatima activity, coagulation and anticoagulation function, fibrinolytic function, endothelial function and platelet count. METHODS: The TFMP procoagulation activity was detected by chromogenic saubstract method, the levels of tissue factors (TF), tissue factor pathway inhibitor(TFPI), protein C (PC), protein S (PS), antithrombin Ⅲ(AT-Ⅲ), tissue plasminogen activator (tPA), thrombin-activated fibrinolysis inhibitor (TAFI), soluble E-selectin (sE-sel), intercellular adhesion molecule-1 (ICAM-1) and thrombomodulin (TM) were detected by ELISA in thalassemia group (n=71) and control group (n=20 heathy persons). RESULTS: Compared with control group, the AT-Ⅲ level decreased in β-thalastemia major group (TM) (P<0.05), the AT-Ⅲ level in TM group independeutly posstiody correlated with plt count (r=0.37, P<0.05); the levels of TF and sICAM in α-thalassenia intermediate group (TA) significantly decteased (P<0.05), the procoagulatim activity of TFMP in β-thalassemia intermediate group (TI) increased sngnificantly (P<0.05)， moreover positively corretated with AT-Ⅲ level (r=0.77, P<0.05). The TF and sICAM-1 levels in normal liver functim group of Thalassemia patients were lower tham those in control group (P<0.01 and P<0.05, respectively), the TFMP activity between normal and abnormal liver function was significantly different (P<0.05), while there were no significant difference in other correspoding indexes beween thalassemia group and control group as well as between each thalassemia groups. CONCLUSION The damage of liver function and reduction of anticoagylation substances exist in patients with β-thalassenia major in Guangxi region, the procoagulation activity of plasma TFMP in patients with β-thalassemia intermedia abnormally increases. All the above-mentioned factors may increase the risk of high coagulation status or thrombosis is thalassemia patients, the decrease of TF and SICAM-1 levels in patients with α-thalassemia intermedia may be factor against thrombosis.
Anticoagulants ; Antithrombin III ; China ; Humans ; Thalassemia ; Thromboplastin ; Tissue Plasminogen Activator

OBJECTIVETo investigate the molecular characteristics of noroviruses detected in Beijing.

METHODSFrom January to March 2007, cases from both outbreaks and sporadic episodes of acute nonbacterial gastroenteritis were investigated in Beijing, and the fecal specimens of the patients were collected. Noroviruses were detected by a reverse transcription polymerase chain reaction (RT-PCR), and then the PCR products were cloned and sequenced.

RESULTSA total of 27 positive cases were identified as caused by noroviruses among the 38 patients with acute viral gastroenteritis, and four PCR products were randomly selected for further studies on sequencing. When comparing to the nucleotide sequences of norovirus reference strains from GenBank, the highest homology was found between the four isolates and the norovirus GII/4 strains. The four strains isolated from Beijing were almost identical to the GII/4 variants that causing epidemics in the Netherlands and in Japan with the homology of 97.8%-98.5% and 95.2%-95.9%, respectively. Phylogenetic analysis revealed that the four isolates were located at the same branch as the norovirus GII/4 variants in Netherlands and Japan.

CONCLUSIONNew norovirus GII/4 variants were found in Beijing, and data from sequence analysis showed that the four isolates and the epidemic strains isolated from both the Netherlands and Japan in 2006 belonged to the same group of norovirus GII/4.

Amino Acid Sequence ; Caliciviridae Infections ; epidemiology ; virology ; China ; epidemiology ; Gastroenteritis ; virology ; Humans ; Molecular Sequence Data ; Norovirus ; enzymology ; Phylogeny ; RNA-Directed DNA Polymerase ; chemistry ; classification ; genetics ; Reverse Transcriptase Polymerase Chain Reaction ; Sequence Homology, Amino Acid ; Viral Proteins ; chemistry ; classification ; genetics

ObjectiveTo understand the protective effect of pentavalent rotavirus （RV） vaccine in preventing infectious diarrhea among infants and young children， and to provide a basis for formulating prevention and control strategies for this population. MethodsA retrospective cohort study was conducted to follow up resident children born in Pinghu City from January 2019 to June 2021 for two years. Data on morbidity and pentavalent RV vaccine inoculation were collected to analyze the incidence density of rotavirus infection among children inoculated with different doses of the pentavalent RV vaccine， and to calculate the vaccine protection rate. ResultsA total of 5 141 resident children were surveyed， with a RV vaccination rate of 31.63% and a full vaccination rate of 30.83%. There were 154 cases of RV infection， with an incidence density of 1 392.69/100 000 person-years. Among the 875 migrant children （17.02%）， the full vaccination rate was 20.46%， while among the 4 266 local children （82.98%）， the full vaccination rate was 32.96%. The difference in full vaccination rate between migrant children and local children was statistically significant （χ²=53.209， P<0.001）. The proportions of boys and girls were 51.94% and 48.06%， respectively， with a full vaccination rate of 29.74% and 32.01%， respectively； and the difference was not statistically significant （χ²=3.111， P=0.078）. The proportions of children with normal birth weight and abnormal birth weight were 91.56% and 8.44%， respectively， with a full vaccination rate of 31.82% and 20.05%， respectingly； and the difference was statistically significant （χ²=25.852， P<0.001）. Among the 3 515 children who were not vaccinated with the pentavalent RV vaccine， 118 of which were infected， with an incidence density of 1 503.32/100 000 person-years （with an incidence rate of 3.36%）. Among the 41 children who were partially vaccinated （received only 1-2 doses）， the incidence density was 1 058.54/100 000 person-years （with an incidence rate of 2.44%）. Among the 1 585 fully vaccinated children， 35 of which were infected， with an incidence density of 1 123.96/100 000 person-years （with an incidence rate of 2.21%）； and the difference in incidence rate was statistically significant （χ²=4.988， P=0.026）. The protection rate for partial vaccination was 28.00% （95%CI：22.00%‒33.50%）， while for full vaccination was 35.10% （95%CI： 29.80%‒40.00%）. ConclusionPentavalent RV vaccination can effectively prevent rotavirus infection in infants and young children， in which the full vaccination is more effective than partial vaccination. It is recommended to strengthen the monitoring of circulating RV strains in the city， develop more targeted vaccines， and increase the RV vaccine coverage rate and full vaccination rate among infants and young children through the expansion of the national immunization program and enhancement of public education， so as to effectively reduce the incidence of infectious diarrhea in infants and young children.

OBJECTIVETo screen breast cancer resistance protein BCRP-mediated resistance agents and to investigate the relations between BCRP expression and drug resistance.

METHODSMT assay was performed to screen BCRP-mediated resistant agents with established BCRP expression cell model. While, the high performance liquid chromatography (HPLC) assay was administrated to measure the related dosage of intracellular retention resistant agents. The BCRP expression was investigated by both real-time RT-PCR and immunohistochemistry (IHC) assay in 140 clinical breast cancer tissue specimens. Chemosensitivity to resistant agents for clinical breast cancer tissue specimens was analyzed by MT assay. The Nonparametric variance statistics method was used to analyze the correlations between clinical breast cancer tissue of BCRP expression and drug resistance.

RESULTSMT assay showed that increasing resistance of 5-fluorouracil (5-Fu) climbed with the increases of the BCRP expressions by 10.58 times (P < 0.05, n = 3) in cell model. HPLC assay also proved that a significant negative correlation between the intracellular retention dose of 5-Fu with different expression of BCRP (r = -0.897, P < 0.05, n = 3). Forty-seven tissue specimens of BCRP-positive expression were rapidly determined by using both real-time RT-PCR and IHC in 140 clinical breast cancer tissue specimens. Subsequently, the resistance index (RI) for 47 BCRP-positive clinical breast cancer tissues to 5-Fu was shown from 7 to 12 times compared with normal cancer-side tissues through MT assay. The statistical correlation between BCRP expression and 5-Fu resistance was observed in clinical breast cancer tissue specimens (R2 = 0.8124, P < 0.01).

CONCLUSIONThis study results showed that there is a significant relationship between BCRP expression and 5-Fu resistance. Moreover, the results suggest that the chemotherapy scheme could be optimized on BCRP-positive expression breast cancer patients.

ATP Binding Cassette Transporter, Sub-Family G, Member 2 ; ATP-Binding Cassette Transporters ; genetics ; metabolism ; Adult ; Antimetabolites, Antineoplastic ; pharmacology ; Breast Neoplasms ; drug therapy ; metabolism ; Drug Resistance, Multiple ; genetics ; Drug Resistance, Neoplasm ; genetics ; Female ; Fluorouracil ; pharmacology ; Humans ; Middle Aged ; Neoplasm Proteins ; genetics ; metabolism ; Tumor Cells, Cultured

Background:The Food and Drug Administration recently announced that the use of morcellation may cause fibroids or pelvic dissemination and metastasis of uterine sarcoma;therefore,the use of morcellation is limited in the USA.A large sample study is necessary to assess the proportion of uterine malignant tumors found in patients with laparoscopic myomectomy.Methods:A national multicenter study was performed in China.From 2002 to 2014,33,723 cases were retrospectively selected.We calculated the prevalence and recorded the clinical characteristics of the patients with malignancy after morcellation application.A total of 62 cases were finally pathologically confirmed as malignant postoperatively.Additionally,the medical records of the 62 patients were analyzed in details.Results:The proportion of postoperative malignancy after morcellation application was 0.18％ (62/33,723) for patients who underwent laparoscopic myomectomy.Nearly 62.9％ (39/62) of patients had demonstrated blood flow signals in the uterine fibroids before surgery.And,23 (37.1％) patients showed rapid growth at the final preoperative ultrasound.With respect to the pathological types,38 (61.3％) patients had detectable endometrial stromal sarcoma,13 (21.0％) had detectable uterine leiomyosarcoma,only 3 (3.2％) had detectable carcinosarcoma,and 5 (8.1％) patients with leiomyoma had an undetermined malignant potential.Conclusions:The proportion of malignancy is low after using morcellation in patients who undergo laparoscopic myomectomy.Patients with fast-growing uterine fibroids and abnormal ultrasonic tumor blood flow should be considered for malignant potential,and morcellation should be avoided.

Objectives:To investigate the clinical and genetic features of young Chinese patients with myeloproliferative neoplasms (MPN) .Methods:In this cross-sectional study, anonymous questionnaires were distributed to patients with MPN patients nationwide. The respondents were divided into 3 groups based on their age at diagnosis: young (≤40 years) , middle-aged (41-60 years) , and elderly (>60 years) . We compared the clinical and genetic characteristics of three groups of MPN patients.Results:1727 assessable questionnaires were collected. There were 453 (26.2%) young respondents with MPNs, including 274 with essential thrombocythemia (ET) , 80 with polycythemia vera (PV) , and 99 with myelofibrosis. Among the young group, 178 (39.3%) were male, and the median age was 31 (18-40) years. In comparison to middle-aged and elderly respondents, young respondents with MPN were more likely to present with a higher proportion of unmarried status (all P<0.001) , a higher education level (all P<0.001) , less comorbidity (ies) , fewer medications (all P<0.001) , and low-risk stratification (all P<0.001) . Younger respondents experienced headache (ET, P<0.001; PV, P=0.007; MF, P=0.001) at diagnosis, had splenomegaly at diagnosis (PV, P<0.001) , and survey (ET, P=0.052; PV, P=0.063) . Younger respondents had fewer thrombotic events at diagnosis (ET, P<0.001; PV, P=0.011) and during the survey (ET, P<0.001; PV, P=0.003) . JAK2 mutations were found in fewer young people (ET, P<0.001; PV, P<0.001; MF, P=0.013) ; however, CALR mutations were found in more young people (ET, P<0.001; MF, P=0.015) . Furthermore, mutations in non-driver genes (ET, P=0.042; PV, P=0.043; MF, P=0.004) and high-molecular risk mutations (ET, P=0.024; PV, P=0.023; MF, P=0.001) were found in fewer young respondents. Conclusion:Compared with middle-aged and elderly patients, young patients with MPN had unique clinical and genetic characteristics.