Objective:To investigate the characteristics of short-term prognostic factors in very elderly patients with acute coronary syndrome (ACS).Methods:A total of 2 912 ACS patients admitted to Shengjing Hospital of China Medical University from January 1, 2010 to October 31, 2014 and treated with percutaneous coronary intervention (PCI) were enrolled and divided into two groups according to age: very elderly group (≥75 years, 480 cases) and control group (< 75 years, 2 432 cases). The clinical data and coronary artery lesions of the included patients were detected. Major cardiovascular adverse events (MACE) occurred within 30 d after discharge were followed up and recorded. The short-term prognostic factors in very elderly patients with ACS were analyzed by Logistic regression.Results:Compared with control group, the percentage of hypertension, global registry of acute coronary events (GRACE) score, high density lipoprotein cholesterol, N-terminal pro-brain natriuretic peptide, the left main lesion ratio and Gensini score in very elderly group were higher, while the percentage of men, number of smoking, hyperlipidemia proportion, red blood cell count, white blood cell count, blood platelet count, albumin, and long term oral administration of aspirin, clopidogrel, statins, angiotensin receptor inhibitor after discharge were lower, and the differences were statistically significant ( P<0.01 or<0.05). During the follow-up period, the all-cause mortality in very elderly group was higher than that in control group: 2.5%(12/480) vs. 0.9% (21/2 432), and the difference was statistically significant ( P<0.01). Multivariate analysis showed that oral angiotensin converting enzyme inhibitor was a protective factor for elderly ACS patients after discharge ( OR = 0.046, 95% CI 0.006 to 0.383, P = 0.004). The receiver operating characteristic curve analysis showed that Gensini score ≥ 87.75 scores was a threshold value for all-cause mortality. The all-cause mortality ratio in high Gensini score (≥ 87.75 scores) group was higher than that in low Gensini score (<87.75 scores) group: 6.6% (9/137) vs. 0.9% (3/343), and the difference was statistically significant ( P<0.01). Conclusions:Very elderly patients with ACS have their own characteristics from both clinical history and prognostic factors. Patients with Gensini score of ≥ 87.75 scores should be closely observed, and drug treatment during hospitalization should be intensified if necessary. Follow-up should be strengthened for such patients, and oral drug treatment should be continued after discharge.

pancreatic cancer is a common malignant tumor of digestive system, with poor prognosis. About 80% of patients have lost the opportunity of surgical resection when diagnosed. In different treatment schemes, radioactive seed 125I implantation can improve the quality of life of patients with unresectable pancreatic cancer and is expected to improve their survival rate. This article reviews the clinical applications of 125I particle implantation therapy combined with chemotherapy, cryotherapy, intracavitary irradiation, stent placement, radiofrequency ablation, nanoknife, and bypass surgery, in order to better promote its clinical application. However, it is necessary to establish unified dosage standards and regulatory guidelines to make them safer and more widely serve clinical practice.

Objective To investigate the species, antimicrobial resistance, and fluoroquinolone resistance gene profiles of Nocardia in the General Hospital of Ningxia Medical University. Methods Nocardia isolates were collected in the General Hospital of Ningxia Medical University during the period from January 2013 to June 2017. Broth dilution method was used to determine the susceptibility of the Nocardia strains to 15 antibiotics. Fluoroquinolone resistance genes gyrA, parC, qnrA, qnrB and qnrS were detected by polymerase chain reaction. Results A total of 16 isolates of Nocardia were collected, including Nocardia cyriacigeorgica (62.6％, 10/16), Nocardia farcinica (18.7％, 3/16), and Nocardia otitidiscaviarum (18.7％, 3/16). Most Nocardia isolates (81.2％, 13/16) were resistant to ciprofloxacin. About 12.5％, 12.5％, 25.0％ and 18.7％ of the strains were resistant to ceftriaxone, tobramycin, gentamicin and cefepime. Overall, gyrA, parC, qnrA and qnrB were identified in 18.8％, 37.5％, 25.0％ and 18.7％ of the Nocardia strains. The qnrS gene was not found in any strain. Conclusions The most frequently Nocardia species in the hospital was Nocardia cyriacigeorgica. Fluoroquinolone resistance is serious in the Nocardia isolates.Fluoroquinolone resistance of Nocardia is likely associated with gyrA, parC, qnrA, and qnrB genes. We should pay close attention to the emergence and antimicrobial susceptibility of Nocardia infection.

Objective:To analyze the epidemiological and clinical characteristics of human brucellosis in Sichuan Province, and to provide a scientific basis for prevention and control of brucellosis.Methods:Retrospective analysis methods were used to collect the data of reported cases of brucellosis in Sichuan Province from 2018 to 2020 from the "Infectious Disease Reporting Information Management System" in the "China Disease Prevention and Control Information System". The distribution (population, time and region) and case investigation data (epidemiological contact history and clinical manifestations) were analyzed by descriptive epidemiological.Results:A total of 309 cases of brucellosis were reported in Sichuan Province in 2018 - 2020, and no deaths occurred. The annual incidence rate was 0.123/100 000. Among the 309 reported cases of brucellosis, the sex ratio of men to women was 2.4 ∶ 1.0 (218 ∶ 91); the age of onset was mainly 20 - 60 years old, accounting for 79.9% (247/309); the occupation was mainly farmers, accounting for 51.8% (160/309). Brucellosis cases were reported in every month of the year, mainly from March to August, accounting for 72.5% (224/309) of the total number of cases. Cases were reported in 21 cities (autonomous prefectures) in Sichuan Province from 2018 to 2020. The top 5 cities (autonomous prefectures) in terms of cumulative number of cases were Chengdu, Liangshan, Zigong, Neijiang and Luzhou in order, accounting for 60.5% (187/309) of the total number of cases. Among the 309 reported cases of brucellosis, 279 case investigations were completed. Among them, 258 cases had a history of contact with livestock and their products, accounting for 92.5%; all contacted livestock were sheep; the main mode of transmission was direct contact, accounting for 88.5% (247/279); the main routes of transmission were sheep farming (50.2%, 140/279), sheep slaughtering (18.6%, 52/279), selling mutton or cutting sheep products in mutton restaurants (11.1%, 31/279); the main clinical manifestations were fever, fatigue, hyperhidrosis, and muscle and joint pain, accounting for 91.4% (255/279), 89.2% (249/279), 80.3% (224/279) and 65.2% (182/279), respectively.Conclusions:The spread of brucellosis in Sichuan Province is increasing, and spring and summer are the epidemic seasons. Brucellosis cases are most common in sheep farms, and the infection method is mainly direct contact infection; the clinical manifestations are diverse and non-specific. Relevant departments should strengthen the prevention and control of the disease in key populations and regions to control the outbreak of brucellosis.

Objective To explore the application effect of healthcare failure mode and effect a-nalysis(HFMEA)in nursing risk management of emergency surgery for patients with traumatic brain injury(TBI).Methods Taking the HFMEA model as the theoretical framework,the emergency sur-gical process of TBI was analyzed,a flow chart was drawn,and the potential risk factors were ana-lyzed.Corresponding intervention programs were adopted for high-risk failure modes,and 80 patients from November 2022 to April 2023 were conducted with routine management before implementation of HFMEA(control group),the other 80 patients from May to October 2023 were conducted with man-agement after implementation of HFMEA(observation group).The surgical efficiency(preoperative waiting time,surgical preparation time,anesthesia induction time,postoperative handover time),the incidence rates of adverse events in the operation room(incomplete preparation of supplies,contami-nation of surgical drapes,insufficient or defective intraoperative instruments,errors in writing nursing records,incorrect or missing items in handover information),the incidence rates of perioperative com-plications(low intraoperative body temperature,pressure injury,abnormal fluctuations in vital signs during surgery,wound infection,lung infection)and satisfaction degree of surgical doctors to nurses for current operations(itinerant nurses,instrument nurses)were compared between two groups.Re-sults The observation group had significantly shorter preoperative waiting time,surgical preparation time,anesthesia induction time,and postoperative handover time compared to the control group(P＜0.01).The incidence rate of adverse events in the operation room for the observation group was 16.25％,which was significantly lower than 46.25％of the control group(P＜0.01).The inci-dence rate of complications was 8.75％in the observation group,which was significantly lower than 26.25％in the control group(P＜0.01).Satisfaction degree of the doctors to nurses for the current operation in the observation group was significantly higher than that in the control group(P＜0.05).Conclusion Application of the HFMEA model in the perioperative nursing management of patients with emergency surgery for TBI can effectively improve surgical efficiency,reduce the inci-dence rates of nursing-related adverse events and complications,and enhance satisfaction degree of doctors to nurses in operation room.

Objective:To evaluate the safety and effectiveness of transjugular intrahepatic portosystemic shunt (TIPS) in hepatocellular carcinoma (HCC) patients with Vp4 portal vein tumor thrombus (PVTT).Methods:Data of 15 patients undergoing TIPS for HCC with Vp4 PVTT and portal hypertension (PTN) in Peking University First Hospital from July 2018 to February 2023 were retrospectively analyzed, including 14 males and 1 female, aged (61.5±11.1) years old, ranging from 40 to 78 years old. The success rate of TIPS, portal pressure gradient (PPG) before and after procedure, perioperative adverse effects and complications were recorded. The survival status of patients was followed up by telephone review after surgery. Kaplan-Meier method was used for survival analysis.Results:The procedure of TIPS was performed uneventfully in all patients, with a technical success rate of 100% (15/15). PPG before and after TIPS were (31.73±5.48) mmHg (1 mmHg=0.133 kPa) and (17.60±3.66) mmHg, respectively, and the difference was statistically significant ( P<0.001). No perioperative death, hepatic artery or bile duct injury, acute liver failure or other major complications occurred. Compared with the preoperative status, the performance status scores [0(0, 0) vs. 3(3, 3)] and Child-Pugh scores [6(5, 8) vs. 9(8, 10)] were lower in patients one month after TIPS (all P<0.05). The median survival time was 228 d. Kaplan-Meier curves showed that the cumulative survival rates at 3, 6, 12 and 24 months after TIPS were 100%, 64.3%, 32.7% and 8.2%, respectively. Conclusion:TIPS could be safe and effective for HCC with Vp4 PVTT and severe PTN.

Objective To explore the application effect of healthcare failure mode and effect a-nalysis(HFMEA)in nursing risk management of emergency surgery for patients with traumatic brain injury(TBI).Methods Taking the HFMEA model as the theoretical framework,the emergency sur-gical process of TBI was analyzed,a flow chart was drawn,and the potential risk factors were ana-lyzed.Corresponding intervention programs were adopted for high-risk failure modes,and 80 patients from November 2022 to April 2023 were conducted with routine management before implementation of HFMEA(control group),the other 80 patients from May to October 2023 were conducted with man-agement after implementation of HFMEA(observation group).The surgical efficiency(preoperative waiting time,surgical preparation time,anesthesia induction time,postoperative handover time),the incidence rates of adverse events in the operation room(incomplete preparation of supplies,contami-nation of surgical drapes,insufficient or defective intraoperative instruments,errors in writing nursing records,incorrect or missing items in handover information),the incidence rates of perioperative com-plications(low intraoperative body temperature,pressure injury,abnormal fluctuations in vital signs during surgery,wound infection,lung infection)and satisfaction degree of surgical doctors to nurses for current operations(itinerant nurses,instrument nurses)were compared between two groups.Re-sults The observation group had significantly shorter preoperative waiting time,surgical preparation time,anesthesia induction time,and postoperative handover time compared to the control group(P＜0.01).The incidence rate of adverse events in the operation room for the observation group was 16.25％,which was significantly lower than 46.25％of the control group(P＜0.01).The inci-dence rate of complications was 8.75％in the observation group,which was significantly lower than 26.25％in the control group(P＜0.01).Satisfaction degree of the doctors to nurses for the current operation in the observation group was significantly higher than that in the control group(P＜0.05).Conclusion Application of the HFMEA model in the perioperative nursing management of patients with emergency surgery for TBI can effectively improve surgical efficiency,reduce the inci-dence rates of nursing-related adverse events and complications,and enhance satisfaction degree of doctors to nurses in operation room.

Objective Through factor analysis of the quantified syndrome information of 558 cases of kidney yang deficiency syndrome,the constructing feature of kidney yang deficiency syndrome was revealed,which provides clinical data support for the objectification,standardization and normalization of kidney Yang deficiency syndrome.Methods Firstly,the frequency analysis of symptoms,tongue and pulse signs of 558 patients with kidney Yang deficiency syndrome was carried out,and then the main syndrome information of the patients with kidney Yang deficiency syndrome was quantified.Finally,the common factors and their representative variables of kidney Yang deficiency syndrome were screened out through factor analysis,and the constructing feature of kidney Yang deficiency syndrome was analyzed combined with TCM syndrome knowledge.Results Eight common factors with eigenvalues greater than 1 were extracted by principal component analysis,and the cumulative contribution rate was 60.483%.After the factor rotation,the representative variables with the absolute value of load coefficient greater than 0.45 in each common factor were selected.The representative variables of F1 are afraid of cold and fond of warmth(0.947)and intolerance to cold(0.932).The representative variables of F2 are waist pain(0.754),waist and knee weakness(0.720)and cold in waist and knees(0.466).The representative variables of F3 are depression(0.749),insomnia(0.711)and diarrhoea(0.470).The representative variables of F4 are thin fur(0.819)and white fur(0.768).The representative variable of F5 are tinnitus and deafness(0.687),frequent nocturnal urination(0.591)and decreased libido(0.587).The representative variables of F6 are pulse sinking(0.766)and pulse weakness(0.736).The representative variables of F7 is thready pulse(0.942).The representative variable of F8 is pale tongue(0.961).External syndrome of disease location involved in these common factors are waist,bone,brain,ear,anterior Yin,posterior Yin and reproductive function.The disease nature involved in these common factors is deficiency and cold.Conclusion The basic constituent units of kidney Yang deficiency syndrome include disease location syndrome elements and disease nature syndrome elements.The disease location is kidney,and the abnormal changes of kidney location are mainly external symptoms of waist,bone,brain,ear,anterior Yin,posterior Yin and reproductive function.Its disease nature is deficiency and cold.Yang deficiency leads to external cold.Yang Qi deficiency can not warm the body surface resulting in the appearance of external cold syndrome.

Objective:To compare the phylotypes of Staphylococcus epidermidis (SE) in skin lesions of acne vulgaris patients versus hair follicles of healthy people, and to analyze their roles in the pathogenesis of acne vulgaris. Methods:A cross-sectional study was conducted from August 2022 to August 2023. Patients with moderate acne vulgaris, as well as healthy volunteers, were enrolled from the Department of Dermatology, Renji Hospital, School of Medicine, Shanghai Jiaotong University. SE strains were isolated from the pustules of acne vulgaris patients and hair follicles of healthy volunteers. Housekeeping genes were amplified by PCR. Sequencing and multilocus sequence typing were performed to compare the phylotypes and genetic relationships of strains from different sources.Results:The acne group consisted of 28 patients (10 males and 18 females) with the age being 22.6 ± 2.6 years, while the healthy group consisted of 19 volunteers (7 males and 12 females) with the age being 22.4 ± 0.96 years. There were no significant differences in age or gender ratio between the two groups (both P > 0.05). The positive rates of SE in the samples of the acne group and the healthy group were 60.71% (17/28) and 73.68% (14/19), respectively, with no significant difference between the two groups ( P = 0.53). The 144 SE strains from the healthy group could be divided into 10 sequence types (STs), and the most common ST was ST35 (8 cases), followed by ST73 (4 cases), ST193 (2 cases), ST59 (2 cases) and ST540 (2 cases) ; 190 SE strains from the acne group could be divided into 16 STs, and the most common STs were ST59 (6 cases) and ST73 (6 cases), followed by ST802 (3 cases), ST130 (3 cases) and ST35 (2 cases). The positive rate of ST35 was significantly lower in the acne group than in the healthy group ( P = 0.018), while there were no significant differences in the positive rates of other STs between the two groups (all P > 0.05). The evolutionary tree analysis showed that the SE strains were mainly distributed in 3 branches. Most of the SE strains from the healthy group belonged to clade A. The proportion of SE strains in clade A ( M[ Q]) was significantly lower in the acne group (25% [85%]) than in the healthy group (100% [33.33%], P = 0.025), while the proportion of SE strains in clade B was significantly higher in the acne group (14.29% [89.17%]) than in the healthy group (0[0], U = 62, P = 0.010), and there was no significant difference in the proportion of SE strains in clade D between the acne group (0 [57.14%]) and healthy group (0[4.17%], P = 0.420) . Conclusion:The phylotypes of SE strains differed between acne vulgaris patients and healthy controls, possibly associated with the occurrence and development of acne vulgaris.

Objective To assess the change of sexual behaviors before and after HIV was recently identified among men who have sex with men(MSM). Methods A retrospective study was conducted on recently identified HIV-infected MSM in Chengdu and Tianjin. A face-to-face questionnaire interview was administrated to collect sexual behaviors within six months,before and after HIV was diagnosed. Differences in sexual behavior before and after the diagnosis were assessed, using the McNemar χ 2 test. Logistic regression analysis was conducted to identify predictors for sexually risk behaviors. Results Of 129 HIV-infected MSM under survey,the average age was 31.8 years and the main venue in seeking male sex partners was through Internet. The proportions of MSM with unprotected anal intercourse (UAI) decreased from 70.5% before diagnosis to 16.3% after diagnosis and the percentage of having more than 1 partner decreased from 66.7%before diagnosis to 33.3%after diagnosis. After the diagnosis was made,there appeared a significant decrease in the percentage of persons who had one main partner from 72.9% to 55.0% and having casual partners declined from 62.8% to 31.0%. Data from multiple logistic regression analysis revealed that risk factors as UAI before diagnosis,more than 1 partner after diagnosis and having one main partner,were all significantly associated with UAI after diagnosis. After the diagnosis was made for UAI,risk factors for‘having more than 1 partner’after diagnosis,would include:using Internet to seek for sexual partners,after diagnosis,having one main partner but not disclosing to him. Conclusion After the diagnosis was made,most HIV-infected MSM would reduce their high risk sexual behaviors but some continued to practice UAI.