Objective: To investigate the hygienic status of the central air conditioner ventilation system in public places in urban areas of Ma'anshan City, Anhui Province, so as to provide insights into formulation of supervision and management interventions. Methods: A total of 15 public places with the central air conditioner ventilation system were randomly sampled from main urban areas in Ma'anshan City in 2022. Sampling and detection were performed following the standard GB/T 18204.5—2013 Examination methods for public places Part 5: Central air conditioning ventilation system, including total number of bacteria and total number of fungus on the inner surface of wind pipes, total number of bacteria and fungus, particulate matter (PM10) and β-hemolytic streptococci in the air supply system, and Legionella pneumophila in the cooling water, and the detection indicators were assessed following the WS 394—2012 Guideline for hygiene of the central air conditioner ventilation system in public places. The eligible rate of samples, the detection rate of L. pneumophila were analyzed. Results: A total of 368 samples were collected from 15 public places, and the qualified rate was 50.54%, no places had all eligible measurement indicators. The qualified rates of total bacteria and fungus numbers on the inner surface of wind pipes were 52.67% and 59.33%. The qualified rates of total bacterium number, total fungus number, PM10 and β-hemolytic streptococci were 12.00%, 28.00%, 90.00% and 96.00% in the air supply system. The qualified rates of samples in administrative workplaces, hotels, bathing places and malls (supermarkets) were 32.50%, 59.24%, 61.09% and 68.92%, the qualified rates of total bacteria on the inner surface of air ducts were 8.33%, 72.46%, 66.67% and 61.90%, and the qualified rates of total fungus numbers in air supply were 0, 21.70%, 33.30% and 71.40%, respectively, with statistical significance (P<0.05). A total of 18 cooling water samples were collected, and L. pneumophila was detected in three samples (16.67%). Conclusions Poor hygiene is seen in the central air conditioning ventilation systems in public places in main urban areas of Ma'anshan City. High attention needs to be paid to contamination of bacterium, fungus and L. pneumophila, and expansion of supervision coverage and improved supervision intensity are recommended.

Objective To investigate the distribution of common carbapenem resistance genes and virulence genes in and understand the molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae (CRKP) strains.Methods A total of 84 non-duplicate CRKP isolates were collected from Renji Hospital,Shanghai Jiao Tong University School of Medicine and Changzheng Hospital,the Second Military Medical University,in 2015.Kirby-Bauer disk diffusion method was used to test their susceptibility to 15 antimicrobial agents.The HM phenotype of K.pneumoniae was determined by string test.Carbapenem-resistant genes and virulence genes were detected by polymerase chain reaction (PCR).The molecular epidemiology of the 84 isolates were further analyzed by multi locus sequence typing (MLST).The population structure of CRKPs was evaluated by eBURST with the results of MLST.Results Antimicrobial susceptibility test showed that 84 isolates were highly resistant to most antimicrobial agents such as carbapenems,penicillins,cephalosporins and aztreonam.More than 90％ of the strains were resistant to most of the antibiotics tested except ciprofloxacin (77.4％,65/84) and amikacin (82.1％,69/84).Two strains showed HM phenotype.PCR results showed that 90.5％ (76/84) of the strains were positive for blaKPC-2,1.2％ (1/84) positive for blaNDM and blaIMP each,but either blaOXA or blaVIM was not identified.The overall prevalence of virulence genes was low except for mrkD (97.6％,82/84),ybtS (92.9％,78/84) and entB (100％,84/84).Eight sequence types (STs) were obtained.The dominant clone was ST11 (84.5％,71/84),and the two strains of HM phenotype were ST11.eBURST analysis identified 2 ST groups among the 84 CRKPs.Each ST group includes 2 ST types (ST11 and ST1869,ST15 and ST709),respectively.The other four ST types were single ST type.In this study,71 strains of ST11,4 ST15 and 4 ST323 belonged to CC258,CC15 and CC163 clones,respectively.Conclusions CRKP is highly resistant to the commonly used antibiotics.The multidrug resistance or pandrug-resistance of K.pneumoniae is mainly associated with the expression of blaKPC-2 gene.Three virulence genes mrkD,ybtS and entB are highly prevalent in the CRKP isolates.The dominant clone of KPC-producing K.pneumoniae is ST11 in both hospitals.

Objective To analyze the etiology and risk factors of central venous catheter (CVCs) infections, and to explore the prophylaxis and treatment for catheter-related infections. Methods A retrospective study was conducted. The patients with CVCs admitted to intensive care unit (ICU) of Qianfoshan Hospital Affiliated to Shandong University from January 2000 to December 2016 were enrolled. The gender, age, catheter data and microorganism culture results of all patients were collected. The infection rate and the incidences of CVCs infection per 1 000 catheter days were calculated. The risk factors of CVCs infection were analyzed by Logistic regression. Results 1 160 patients were enrolled in 17 years [male 915, female 245, age 7-98 years, mean (71.8±17.5) years]. The incidences of CVCs infection per 1 000 catheter days were descended every 3 years (cases/1 000 days: 21.87, 24.50, 19.95, 12.64, 16.34, 12.40, χ2=38.851, P = 0.000). Of the 1 160 patients, 375 were positive for catheter culture, and 397 strains were cultured, among which 173 strains (43.58%) were Gram negative (G-), 130 strains (32.74%) of Gram positive (G+), and 94 strains of fungi (23.68%). Non-fermenting bacteria (Pseudomonas aeruginosa 11.59%, Acinetobacter baumannii 8.82%) was predominant in the G- bacteria, followed by Enterobacteria (Klebsiella pneumoniae 8.06%, Escherichia coli 2.02%); Staphylococcus spp. (Staphylococcus epidermidis 11.84%, Staphylococcus aureus 5.29%) was the main species of G+bacteria; the main fungi were Candida tropicalis (9.07%) and Candida albicans (5.79%). The catheter infection rate of internal jugular vein, femoral vein and subclavian vein were 36.07% (22/61), 35.52% (119/335), 30.63% (234/764) respectively (χ2=2.275, P = 0.099), the incidence of catheter infection of three vein insertion sites per 1 000 catheter days were 18.00, 17.71, 17.08 cases/1 000 days respectively (χ2= 0.034, P = 0.714). The mean placement time of infected CVCs in situ was longer than that of non-infected CVCs (days: 20.80±11.68 vs. 17.64±10.77, t = 4.417, P = 0.000).The positive rate was lowest during 1-7 days of indwelling time (19.87%, 30/151). The infection rate was increased with long indwelling time. The positive rate was 44.44% (68/153) as indwelling time was over 30 days. The infection rate was significantly positively related to indwelling time (χ2= 22.849, P = 0.000). Multiple Logistic regression analysis showed that the infection risk of femoral vein catheter was increased [odds ratio (OR) = 1.362, 95% confidence interval (95%CI) = 1.030-1.801, P = 0.030] as compared with that of subclavian vein catheter; the infection risk was increased with long indwelling time (OR = 1.306, 95%CI = 1.177-1.480, P = 0.000). Conclusions G- are the major pathogens of CVCs infection. Femoral vein catheter and long indwelling time are the risk factors of CVCs infection.

Objective To investigate the feasibility of subtraction coronary computed tomography angiography (Sub-CCTA) for the diagnosis of coronary heart disease in the segment with severe calcification.Methods A retrospective analysis was performed on 27 patients who underwent clinically indicated digital subtraction angiography (DSA) and CCTA using a 320-detector row CT.Compared with the results of DSA,sensitivity,specificity,positive predictive value,negative predictive value and accuracy of Con-CCTA and Sub-CCTA were calculated.The clinical diagnostic accuracy of the two imaging methods was evaluated using the receiver operating characteristic (ROC) curve.The stenosis of coronary segments was divided into four grades (Ⅰ,Ⅱ,Ⅲ,Ⅳ).Kappa coefficient was used to measure agreement between two imaging methods.Image quality of 4-scale grade scoring method was used and t test was conducted.Results A total of 52 segments with severe calcification were evaluated.The scores of image quality in Con-CCTA and Sub-CCTA were 2.8 ± 0.5 and 3.4 ± 0.7,respectively.There was significant difference between them (t =5.9,P ＜ 0.05).Compared with the result of DSA as the golden standard,the Kappa coefficients were 0.55 and 0.81 respectively in Con-CCTA and Sub-CCTA for the quantitative evaluation of the severe calcified segments.The sensitivity,specificity,positive predictive value and negative predictive value and accuracy of Con-CCTA were 81.0％,63.1％,63.1％,81.1％ and 70.8 ％;and for Sub-CCTA they were 90.5 ％,85.2％,82.1 ％,92.0％ and 87.5 ％ respectively.Compared with Con-CCTA,the area under the ROC curve of Con-CCTA and Sub-CCTA were 0.84 (95％CI:0.70-0.93) and 0.96 (95％ CI:0.86-1.00),respectively,and the difference was statistically significant (P =0.03).Conclusions Sub-CCTA can improve the diagnostic accuracy of coronary artery stenosis in severe calcified segment.Application of subtraction technique in CCTA can reduce or even eliminate the artifacts caused by severe calcified plaque,and has a good clinical application prospect.

Objective To explore the effects of the motivational interview on medication adherence and control level of asthma in adult patients with asthma. Methods A total of 100 asthma patients who were hospitalized in the Respiration Department of Putuo People's Hospital in 2016 were selected in the study using convenience sampling. According to the random number table, the participants were divided into the observation group (n=50) and the control group (n=50). Two cases from the observation group withdrew from the study due to personal reasons, leaving 48 patients in the observation group. Three cases from the control group withdrew from the study (i.e. two for disease changes and one for personal reasons), leaving 47 cases in the control group. The control group received conventional health education while the observation group received education based on motivational interview. The asthma medication compliance scale (Chinese version) (MARS-A) and asthma control test (ACT) questionnaire were used to evaluate the medication compliance and asthma control level before the intervention and 1, 2 and 3 months after the intervention. Results None of the patients had good medication compliance before the intervention. However, patients in the observation group had significantly better adherence at 1, 2, and 3 months after the intervention compared with the control group (P<0.05). There were no significant differences in asthma control level between two groups before intervention (P>0.05). But after the intervention, the repeated variance analysis showed that there were significant differences in both intervention effect and time effect for asthma control score, and the interaction effects existed between intervention and time (P< 0.05). Conclusions The health education based on motivational interview can effectively improve the medication adherence and the control level of asthma in adult patients with asthma.

BACKGROUND:Femoral offset reconstruction is significant for recovering strength of abductor and the balance of soft tissue tension surrounding hip joint, maintaining joint stabilization, restoring joint function, reducing limping after replacement, decreasing prosthetic abrasion, and the incidence of joint prosthesis dislocation.
OBJECTIVE:To discuss effect of femoral offset reconstruction on hip joint function in total hip arthroplasty.
METHODS:We comparatively analyzed 20 patients (20 hips) undergoing the modular prosthesis (S-ROM) total hip arthroplasty and 19 patients (20 hips) undergoing the one modular prosthesis (Corail) total hip arthroplasty at the same time. According to Harris hip score and radiography results, hip joint function and femoral offset reconstruction rate were comparatively studied in both groups.
RESULTS AND CONCLUSION:No infection, fracture, dislocation, deep venous thrombosis or neurovascular injury occurred in either group. Clinical fol ow-up results:In the modular prosthesis and one modular prosthesis groups, there was no significant difference in preoperative Harris hip score between the femoral offset reconstruction and non-reconstruction groups (P>0.05). At 12 months and the latest fol ow-up, the Harris hip score was higher in the patients with femoral offset reconstruction than those with femoral offset non-reconstruction (P<0.05). The range of abduction of hip joint was larger in patients with femoral offset reconstruction than those with femoral offset non-reconstruction (P<0.05). Radiographic fol ow-up results:significant differences in the rate of femoral offset reconstruction were detected between the modular prosthesis and one modular prosthesis groups (χ2=3.956, P<0.05). 39 (98%) femoral stems were in neutral position and one (2.5%) was in mild valgus. There was no significant difference in the abduction angle and the anteversion angle between patients with and without femoral offset reconstruction (P>0.05). These results indicated that functional recovery and the range of abduction were better in patients with femoral offset reconstruction than those without femoral offset reconstruction. Modular prosthesis has a high rate of femoral offset reconstruction.

Objective To explore the related imaging factors about the change of systemic circulation time for aortic dissection (AD)patients.Methods Image data of 36 patients with AD and 30 patients in control group were analyzed retrospectively,the cor-relation analysis was made between the results of imaging measurement by using CT angiography (CTA)and the threshold time of the contrast agent in the left ventricular.3 6 patients with AD were divided into 2 groups (type A 1 7 cases and type B 1 9 cases)by using Stanford type.First,the threshold time in the left ventricular of the 3 groups were analyzed comparatively;next,the correla-tions between each CTA measured parameter and the threshold time in the left ventricle were analyzed.Results Threshold time in left ventricular of group Stanford A and group Stanford B were compared with the control group respectively,the overall mean difference was statistically significant (P <0.05).Between Stanford A and B,there was no significant difference (P>0.05).There was a significant correlation between threshold time in left ventricular and the ratio of false/true lumen (r=0.676,P<0.001).And the correlation was also found between threshold time and the maximum diameter of aorta or the diameter of intimal tear (r = 0.371 and 0.355,P> 0.05).Conclusion The threshold time of left ventricular for aortic dissection patients is significantly longer than the normal control group,and is significantly related with the ratio of false/true lumen.

Objective Toevaluatea modified Ziehl-Neelsen(Z-N) stain in the diagnosis of tuberculous meningitis. Methods Cerebrospinal fluid specimens from 35 patients were stained by using the modified Ziehl-Neelsen staining. Re-sults The positive rate was 94.29% in 35 patients with tuberculous meningitisand the intracellular acid-fast bacilli was detected in 53.40%of all specimens. One case was stained positive in 15 patients with non-tuberculous meningitis. Con-clusion The modified Ziehl-Neelsen stain not only significantly improves the detection rates of tuberculous meningitisbut alsois able to identify intracellular M.tuberculosisin cerebrospinal fluidspecimen.Thus, the modified Z-N stain can be a convenient tool for diagnosing tuberculous meningitis.

BACKGROUND:Anatomic medul ary locking (AML) femoral prosthesis is circular cylinder and has satisfactory efficacy. However, some scholars found the complications such as thigh pain, loss of bone at the proximal end of the femur, and wearing-related osteolysis. F2L femoral prosthesis is cone-shaped and also has satisfactory efficacy, but the thigh pain incidence is relatively low. ＜br> OBJECTIVE:To compare the intermediate-long term results of AML versus F2L in total hip arthroplasty. ＜br> METHODS:Between November 1997 and January 2005, we retrospectively reviewed 60 patients (66 hips) undergoing total hip arthroplasty using biological femoral prosthesis. At fol ow-up examination, 58 hips in 52 patients were available for clinical and roentgenographic review. 26 AML devices were placed in 24 patients, and 32 F2L devices were placed in 28 patients. The AML group were reviewed with an average of 12.7 years fol ow-up (range 10 years and 3 months to 15 years and 5 months), while the F2L group were reviewed with an average of 9.5 years fol ow-up (range 8 years and 3 months to 11 years and 1 month). The clinical results were evaluated with Harris methods and X-ray examination. Kaplan-Meier analysis was performed to evaluate the survival of femoral component. End point was radiographical loosening or revision of the femoral component for any reason. ＜br> RESULTS AND CONCLUSION:There were no significant difference between AML and F2L about Harris score in the latest fol ow-up (P>0.05). After surgery, the incidence of thigh pain was significantly lower in F2L group than that in AML group (P＜0.05). In AMKL group, the stress-shielding 1 level was observed in 21 hips (81%), and 2 level in five hips (19%);in F2L group, the stress shielding 0 level was observed in 20 hips (62%) and 1 level in 12 hips (38%). There were significant differences between the two groups (P＜0.05). The stress shielding showed significant differences between the two groups (P＜0.05). The incidence of osteolysis in F2L group was significantly lower than that in AML group (P＜0.05). Kaplan-Meier analysis showed that, the survival rate of both AML and F2L components were 1.0 (95%confidence interval:0.98-1.00). Experimental findings indicate that, both AML and F2L femoral prosthesis have a satisfactory long-term efficacy after total hip arthroplasty, and the incidence of thigh pain and osteolysis is significantly lower in F2L group.

Drug delivery system in tumor targeting research has always been a difficult problem.Apoptosis in vitro experiments and body pharmacokinetic experiments can not reflect the targeting of drug delivery system indirectly.Imaging techniques both in vivo and in vitro solve the problem,researchers can not only observe the drug delivery system in the target organ,the target tissue and target cell directly,but also analyze quantitatively and qualitatively.