Objective To analyze the distribution of multidrug resistance bacteria infections in clinical departments and put for‐ward the corresponding countermeasures of prevention and control ,for providing basis for clinical diagnosis and treatment .Methods By carrying out the monitor of the drug resistance of bacteria ,the infection site and drug resistance strain and pathogenic bacteria distribution ,with 156 cases of multiple drug‐resistant bacteria infection ,were analyzed .Results The multidrug resistance bacteria of our hospital was distributed in the ICU unit ,accounted for 34% .Nosocomial infection of multidrug resistance bacteria was mainly the gram‐negative bacillus ,followed by the gram‐positive cocci ,and the majority of multidrug‐resistant bacteria were Escherichia co‐li(46 .2% ) ,Acinetobacter Baumannii(19 .9% ) ,Pseudomonas Aeruginosa(17 .9% ) ,Klebsiella Pneumoniae(17 .9% ) ,Staphylococcus Aureus(4 .5% ) .The priority was given to respiratory system infection ,accounted for 48 .1% ,followed by urinary system infection , accounted for 39 .0% .Conclusion The increase of multidrug resistance bacteria was very important problem that the hospital faced .It can effectively prevent and control multiple drug‐resistant bacteria infection by strengthening the monitoring of multi‐re‐sistant bacteria ,strictly executing disinfection and isolation measures ,the implementation of hand hygiene and reasonable application of antibiotics .

Background Keratoconus is a progressive corneal thinning and protrusion disease that develop in the age of puberty,resulting in a certain extent impairment of visual function.Corneal collagen cross-linking (CXL) increases the stiffness of the cornea through the photooxidation of ultraviolet A (UVA) and riboflavin,with the aim to postpone and prevent the progression of keratoectasia.Objective This study was to evaluate the safety and efficacy of transepithelial CXL in the treatment of pediatric keratoconus.Methods Ten eyes of 9 pediatric patients with keratoconus undergoing transepithelial CXL were enrolled from February 2010 to March 2013 in Affiliated Eye Hospital of Wenzhou Medical University,with the mean age was (15± 1) years (range from 13 years to 17 years).After topical anesthesia (0.1％ tetracaine) for 15 minutes,0.5％ riboflavin was applied until it was saturated in the anterior chamber,then UVA with the intensity of 3 mW/cm2 was performed on the cornea for 30 minutes.The uncorrected distance visual acuity (UDVA),corrected distance visual acuity (CDVA),refractive error,topography,corneal thinnest thickness were measured 7 days,1 month,3 months,6 months and 1 year after operation.Endothelium cell density (ECD) was measured 7 days afier operative.Results The mean corneal reepithelization time was (1.4±0.8) days.The UDVA and CDVA were significantly improved from preoperative 1.02±0.16 and 0.34±0.20 to postoperative 0.77±0.18 and 0.25 ±0.15,respectively (t =4.251,3.750;both at P＜0.05).The refractive sphere and spherical equivalent significantly changed from preoperative (-7.15±3.00)D and (-9.26±3.23)D to postoperative (-5.28±2.05) D and (-7.05±2.08) D 1 year,respectively (t =-2.515,-2.597;both at P＜0.05).Maximum Kvalue (Kmax) was significantly decreased from preoperative (64.1 ± 11.9) D to postoperative (61.8 ± 10.4) D (t =2.304,P＜0.05).The refractive cylinder,corneal thinnest thickness and ECD showed no significant differences between preoperation and postoperation (t =-1.331,0.328,1.205;all at P＞0.05).Stromal opacity was observed in 2 eyes 3 months and 6 months after operation,respectively.Conclusions Transepithelial CXL is safe and effective in prolonging or halting progression in adolescent keratoconus.

Objective To evaluate the effectiveness of nurse-led discharge planning for hospital inpatients with chronic disease.Methods The Cochrane Library,PubMed,Medline,EMBASE,Chinese Biomedical Literature Database Database(CBM),China National Kmowledge Infrastructure (CNKI),VIP Chinese full text database (VIP) and Wanfang Data were searched for randomized controlled trials assessing nurse-directed discharge planning for hospital inpatients with chronic disease.Two reviewers independently extracted data and assessed risk of bias.Meta-analysis was conducted for the eligible studies by RevMan 5.3.4.Results Seventeen randomized controlled trials and 5 331 participants were included.Meta-analysis demonstrated that,compared to standard care,nurse-led discharge planning were effective in reducing hospital readmission [risk radio (RR)=0.73,95％ confidence interval (CI) 0.64-0.84,P＜0.01],duration of inpatient readmissions [mean difference (MD)=-2.48,95％CI-3.68--1.29,P＜0.01],and all-cause mortality (RR=0.78,95％CI 0.62-0.97,P＜ 0.05).However,no reduction in the length of stay of the index admission (MD=-0.18,95％CI-0.64-0.27,P ＞ 0.05) was demonstrated.Conclusions Nurse-led discharge planning has a positive impact on several aspects of care for hospital inpatients with chronic disease,including reducing readmission,readmission length of stay,and all-cause mortality.It is worth being popularized.

Objective To explore the correlation between polymorphism of interleukin-28B(IL-28B) rs12979860 T/ C and susceptibility of hepatocellular carcinoma( HCC). Methods All eligible case-control studies published up to 2014-09-30 were identified by searching PubMed,EMBase,CNKI,CBM,VIP and WanFang databases. Two reviews independently identified the literature according to inclusion and exclusion criteria. Meta-analysis was performed using Rev Man 5. 2 and Stata 12. 0 software. Results A total of 6 stud-ies comprising 1 138 cases and 955 controls were finally included. Meta-analysis showed that IL-28B rs12979860 T/ C polymorphism was associated with the susceptibility of HCC. Compared with the genotype CC and CT + CC,genotype TT increased the risk of suffering from HCC(TT vs CC:OR = 2. 26,95% CI:1. 40-3. 64,Z = 3. 33,P = 0. 000 9;TT vs CT + CC:OR = 1. 90,95% CI:1. 23-2. 93,Z = 2. 89,P = 0. 004). In stratification analysis by ethnicity,we observed that the polymorphism of IL-28B rs12979860 T/ C was associat-ed with the susceptibility of HCC among Caucasian populations(TT vs CC:OR = 2. 06,95% CI:1. 22-3. 47, Z = 2. 70,P = 0. 007;TT vs CT + CC:OR = 1. 71,95% CI:1. 07-2. 72,Z = 2. 23,P = 0. 03). Conclusion The polymorphism of IL-28B rs12979860 T/ C is associated with the susceptibility of HCC,genotype TT may increase the susceptibility to HCC.

Objective To analyze the characteristics of toxin, the PCR-ribotyping(RT) and the multilocus sequence typing(MLST) of Clostridium difficile strains isolated from China-Japan Friendship Hospital in order to provide a basis for monitoring the outbreak of nosocomial Clostridium difficile infection.Methods A total of 321 samples were collected from the patients with suspected Clostridium difficile infection(CDI) in China-Japan Friendship Hospital(CJFH) during 2012 to 2013.All Clostridium difficile strains were isolated and identified by the standard phenotypic culture method.Cytotoxicity test was performed to detect toxin B.Toxin genes (tcdA and tcdB) and binary toxin genes (cdtA and cdtB) harbored by those strains were analyzed.RT and MLST were used for homologous analysis.Clinical data of the patients were collected to analyze the isolation rate of Clostridium difficile in different populations.Results Forty-eight strains of Clostridium difficile were isolated from 46 patients with diarrhea and three of them were isolated from the same patient.The incidence of CDI among all patients, outpatients and inpatients were 14.3%(46/321), 12.8%(5/39) and 14.5%(41/282), respectively.Toxin B was detected in all of the strains as indicated by the cytotoxicity test.Strains of sequence type 1(ST1) showed the strongest cytotoxicity of all the isolated Clostridium difficile strains.Ten out of the 48 strains (20.8%) were tcdA(-)/tcdB(+) strains, which belonged to either ST37 or ST81.The results of RT and MLST were consistent in assigning the strains into nine types, in which the predominant type was ST1/RT027 accounting for 27.1% (13/48).All of the ST1/RT027 strains presented a toxin gene profile of tcdA(+)/tcdB(+) and cdtA(+)/cdtB(+).Most of the ST1/RT027 strains were isolated from the Traditional Chinese Medicine Department of Respiratory, where smallnosocomial outbreaks of ST1/RT027 strain infection might happen.Conclusion CDI diagnosed in CJFH mainly belongs to nosocomial infection.Most of the isolated strains harbor tcdA(+)/tcdB(+) genes.Surveillance for the outbreaks of CDI caused by ST1/RT027 strains over producing toxins A and B should be strengthened in hospitals.

Objective:To evaluate the effectiveness and safety of transepithelial photorefractive keratectomy (TransPRK) assisted by smart pluse technology (SPT) for the correction of high myopia.Methods:An observational case series study was conducted.Sixty high myopic patients (107 eyes) with spherical equivalent (SE)≥-6.0 D who received TransPRK assisted by SPT from January to December 2016 in Eye Hospital of Wenzhou Medical University were enrolled.Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) of the patients were examined and recorded in logarithm of the minimum angle of resolution (LogMAR) units, and refraction was examined with a subjective refractometer.The healing of corneal epithelium and corneal haze was observed with a slit lamp.Intraocular pressure (IOP) was measured with the non-contact tonometer.Safety index (SI) and efficacy index (EI) were analyzed.The follow-up time was 12 months.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Eye Hospital of Wenzhou Medical University (No.2019-197-k-177). Written informed consent was obtained from each patient prior to any medical examination.Results:The mean epithelial healing time was (3.77±1.02) days.There were statistically significant differences in UCVA and BCVA between before and after surgery ( Z=380.812, 267.313; both at P<0.001). And the 7-day, 6-month, and 12-month postoperative BCVA were better than preoperative BCVA, showing statistically significant differences (all at P<0.05). Mean SI was 1.10±0.12, and mean EI was 1.05±0.17 at 12 months after surgery.There was no significant difference between the attempted SE before surgery (-8.02±1.36)D and the achieved SE at 12 months after surgery (-8.04±1.51)D ( P=0.523). SE in the predictive range within ±0.50 D accounted for 79% (85/107) and that within ±1.0 D accounted for 92% (98/107). The IOP was slightly increased in 3 eyes at 7 days and 7 eyes at 1 month after surgery, respectively, which returned to normal after the use of ophthalmic solution for lowing IOP.The incidence of haze severer than grade 1 was less than 1% (1 eye), and haze gradually disappeared after application of drugs. Conclusions:TransPRK assisted by SPT for high myopia shows good safety, effectiveness and predictability.It is an ideal corneal surface surgery to correct high myopia.

Hedgehog (Hh) signaling pathway is present in many animals and plays an important role in regulating embryonic development and differentiation. Aberrant activation of Hh signaling contributes to the pathogenesis of many malignancies. Recent studies have shown that dysregulated Hh signaling pathway participates in the tumorigenesis, tumor invasion, and metastasis of hepatocellular carcinoma (HCC). Investigation of the relationship between Hh signaling pathway and HCC will help elucidate the molecular mechanism of pathogenesis of HCC and provide a new insight into the development of novel anticancer therapy and therapeutic target.

Objective:To investigate the effects of a perioperative whole course composite thermal insulation strategy on complications of cesarean section, maternal coagulation function and serum inflammatory indexes.Methods:A total of 250 pregnant women who were subjected to cesarean section in Zhoushan Hospital between June 2020 and August 2021 were included in this study. The 125 pregnant women who gave birth using a routine simple thermal insulation strategy from June to November 2020 were assigned to the routine simple thermal insulation group, and those who gave birth using a perioperative whole course composite thermal insulation strategy were assigned to whole course composite thermal insulation group. Two groups of pregnant women underwent cesarean section under subarachnoid block. Volume of intraoperative blood loss was recorded. The incidence of complications such as shivering and postoperative infection was calculated. Platelet count, prothrombin time, activated partial thromboplastin time, thrombin time measured before surgery and 48 hours after surgery were compared between the two groups. Peripheral blood white blood cell count, neutrophil count (N%), C-reactive protein, procalcitonin, interleukin-6 measured 48 hours after surgery were compared between the two groups.Results:Volume of intraoperative blood loss in the whole course composite thermal insulation group was significantly lower than that in the routine simple thermal insulation group [(393.84 ± 79.78) mL vs. (434.80 ± 123.49) mL, t = 3.11, P < 0.05). The incidence of shivering and postoperative infection in the whole course composite thermal insulation group was 10.4% (13/125) and 7.2% (9/125), respectively, which was significantly lower than that in the routine simple thermal insulation group [25.6% (32/125), 18.4% (23/125), χ 2 = 9.78, 7.02, both P < 0.05]. At 48 hours after surgery, prothrombin time, activated partial thromboplastin time, thrombin time in the whole course composite thermal insulation group were (10.28 ± 0.48) seconds, (26.97 ± 2.27) seconds, and (14.09 ± 1.36) seconds, respectively, which were significantly shorter than those in the routine simple thermal insulation group [(11.71 ± 0.27) seconds, (27.96 ± 2.25) seconds, (15.91 ± 1.09) seconds, t = 7.34, 3.43, 11.66, all P < 0.05]. At 48 hours after surgery, white blood cell count, neutrophil count, C-reactive protein, procalcitonin, and interleukin-6 in the whole course composite thermal insulation group were (10.38 ± 2.38) ×10 9/L,(0.79 ± 0.06), (52.79 ± 20.73) mg/L, (0.13±0.42) μg/L, and (55.73 ± 24.38) ng/L, respectively, which were significantly lower than those in the routine simple thermal insulation group [(12.24 ± 7.05) × 10 9/L, 0.81 ± 0.05, (65.38 ± 25.92) mg/L, (0.20 ± 0.97) μg/L, (76.22 ± 39.08) ng/L, t = 2.79, 2.92, 4.24, 8.12, 4.97, all P < 0.05]. Conclusion:Perioperative whole course composite thermal insulation strategy can improve the coagulation function of pregnant women who are subjected to cesarean section under subarachnoid block, reduce volume of intraoperative blood loss, and decrease incidence of shivering, inflammatory reaction, and postoperative infection.

Objective To evaluate the effect of self-management on blood pressure control of non-hospital hypertension patients by conducting a Meta-analysis.Methods Data were collected from WanFang , CBM, CNKI, PubMed and Medline from January 2005 to December 2015.RevMan 5.3 was used for the Meta-analysis.Results A total of 13 studies were included in Meta-analysis.The results showed that self-management program could decrease non-hospital hypertension patients′systolic pressure and diastolic pressure ( P<0.01) and improve self-assessment of health score , but had no significant differences on energy and fatigue which were tested by Chinese version of chronic disease self-management questionnaire ( P >0.05 ). Conclusions Self-management can improve non-hospital patients′blood pressure , but it has little effect on patients′energy and fatigue .The results should be checked by more high quality randomized controlled trials using Chinese version of chronic disease self-management questionnaire .