Objective To learn about the current situation of nosocomial infections and disinfection and sterilization in some basic medical institutions,then to investigate strategy in regulating the management of nosocomial infections,and to propose the improving measure.Methods With unified questionnaire,the following were investigated:(1)the management,organization and rules and regulations of nosocomial infections and disinfection and sterilization,(2)installation and usage of disinfection armamentaria,and(3)usage and disposal after using of disposable medical products in some basic medical institutions.The data were analyzed statistically by SPSS 13.0 statistics software.Results Some basic medical institutions were deficient in organization,rules and regulations about the management of nosocomial infections,lacked disinfection armamentaria,with disinfectants often used incorrectly.The qualified ratio of the effect of disinfection monitored was low(66.9%).Medical wastes and disposable medical products were disposed of inappropriately.Conclusions To normalize the management of nosocomial infections,training should be reinforced,investment increased and awareness and health supervision enhanced.Meanwhile,air disinfection must be fulfilled more intensively.

BACKGROUND: Therapist-assisted treadmill training is good gait training, but it consumes great physical strength of therapists, and requires many persons. Clinical application was limited. Robot-assisted treadmill training has been paid great attention. OBJECTIVE: To summarize the role of robot in recovery of walking after spinal cord injury (SCI) and its influence on muscle activation patterns and kinematic patterns.RESULTS AND CONCLUSION: Although there is currently no evidence that robot-assisted gait training improves walking function more than other locomotor training strategies. Several advantages of robotic devices are obvious for applications targeting gait rehabilitation. Robotic devices are passive in nature and focus primarily on repeated movements of the limbs via fixed kinematic trajectories. These types of training abolish the cycle-to-cycle variation in the kinematics and the sensorimotor pathways. They also cannot sensitively monitor important characteristics of the training as therapists do. Therapists need to know the robot devices, understand how to change parameters to continuously challenge the subjects, and are able to assess when the workload is inappropriate for the subject's abilities so that they can maximize voluntary locomotor performance during assisted stepping to augment the recovery of functional walking.

Objective To investigate the effect of robot-assisted walking therapy on gait of patients with incomplete spinal cord injury.Methods 10 patients with incomplete spinal cord injury accepted robot-assisted walking therapy with Lokomat for 12 weeks. The Lower Extremity Motor Scores (LEMS), step lenth (left and right), double support (left and right), single support (left and right), Symmetry Index (SI), overground gait speed, treadmill training speed, treadmill training distance and the amount of body-weight unload were recorded before,6 weeks and 12 weeks after training. Results All the patients finished the training. There was significant difference in all the indices among those were before, 6 weeks and 12 weeks after training (P<0.001). Conclusion Robot-assisted walking therapy with Lokomat facilitates to improve gait in patients with incomplete spinal cord injury.

The neonatal resuscitation program consisted of three stages:pilot promotion, provinces promotion and grass-roots promotion in China. Neonatal resuscitation was easy to learn, training forms were various, the duration was different. There were regional differences in the pass rate of examination and standard recovery rate. The neonatal resuscitation training rate, the system execution rate and the equipment rate in primary hospitals was lower than secondary hospitals and tertiary hospitals. The primary hospitals would be the key link of the neonatal resuscitation program. We suggested to build neonatal resuscitation training and treatment system.

Objective To explore the efficacy of glucose excursion by the continuous glucose monitors system (CGMS) in the patients of type 2 diabetes. Methods A total of 86 T2DM cases were enrolled. All patients were observed with CGMS for 72 hours. All the indexes were compared between the first day and the third day. Results The 24 h average blood glucose(24 h MBG) levels by insulin dose tendency reduced from (10.7±2.7) mmol/L to (7.9±1.6) mmol/L before the adjustment tendency (P < 0.05); Adjusted days average blood glucose fluctuation (MAGE) tendency reduced from (5.5±1.6)mmol/L to (2.3±1.0) mmol/L tendency (P <0.05);Insulin dose before and after the adjustment blood glucose were significantly decreased as a percentage of the time of PT1(≤3.9 mmol/L tendency)reduced from 0.8%to 0.3%, the PT3 (≥7.8 mmol/L tendency) reduced from (32.7±7.5)%to (14.7±3.1)%(P<0.05);Blood sugar lower than 5 mmol/L tendency for the average frequency reduced from 1.6 times to 0.7 times (P < 0.05). Conclusion Dynamic blood sugar monitoring system can display the extent of T2DM patients blood sugar drift in detail and the trend of more targeted hypoglycemic auxiliary clinician, effective control of blood glucose fluctuation and the occurrence of hypoglycemia, shorten hospitalization time.

Objective To study the effect of sitagliptin on insulin resistance and glucose variability in elderly patients with type 2 diabetes mellitus(T2DM) requiring high-dose insulin therapy.Methods A total of 100 elderly patients with T2DM failing to reach the standard application of large-dose insulin(＞60 U/d) treatment for three months or more [glycosylated hemoglobin (HbA1c) ＞8.0％] was randomly divided into sitagliptin group and pioglitazone group.Patients in sitagliptin group(50 cases) were treated with sitagliptin for oral use,100 mg each time,once a day,and patients in pioglitazone group(50 cases) were treated with pioglitazone for oral use,15 mg each time,once a day.The insulin dose was adjusted according to the blood glucose level in the two groups.Two groups were treated for 12 weeks.The indicators in both groups were compared,including fasting blood glucose (FBG),2 hours postprandial glucose (2hPG),glycosylated hemoglobin (HbA1c),24 hours glucose area under the curve (AUC),blood glucose coefficient of variation (CV),fasting C-peptide (FCP),2 hours postprandial C-peptide (2hPCP),fasting glucagon (FGG),2 hours postprandial glucagon(2 hFGG),cholesterol (TC),triglyceride (TG),systolic blood pressure (SBP),diastolic blood pressure(DBP),blood uric acid(BUA),daily insulin dosage(DID),body mass index(BMI),incidence of hypoglycemia and drug adverse reactions.Results After 12 weeks of treatment,the levels of FPG,2hPG,HbA1c,AUC,CV,FGG,2hFGG,TC,TG,SBP,DBP,DID and BMI in the sitagliptin group were significantly decreased than those before treatment(P＜0.05 or P＜0.01);The levels of FPG,2hPG,H bA1c,AUC,CV and BUA in the pioglitazone group were significantly decreased than those before treatment (P＜ 0.0 5 or P＜ 0.01);Compared with the pioglitazone group,the levels of 2 hPG,HbA1c,AUC,CV,FGG,2 hFGG,TC,TG,SBP,DBP,DID and BMI were significantly decreased in the sitagliptin group(all P＜0.05),and the levels of FCP and 2hPCP in the sitagliptin group were higher than those in the pioglitazone group(all P＜0.01).The incidence of hypoglycemia in the sitagliptin group was lower than that in the pioglitazone group(x2 =4.039,P =0.045).The incidence of adverse reactions in the sitagliptin group was lower than that in the pioglitazone grouP(x2 =3.979,P=0.043).Conclusion Sitagliptin combined with insulin is better than insulin combined with pioglitazone in elderly patients with T2DM requiring the application of high-dose insulin therapy,and the combining treatment could decrease insulin resistance,insulin dosage and the incidence of hypoglycemia.

OBJECTIVETo explore the changes in HBsAg titer and HBV DNA load and their correlation in patients with chronic hepatitis B (CHB) and HBV-related liver cirrhosis (HBV-LC).

METHODSForty-six patients with mild to moderate CHB (CHB-LM), 24 patients with severe CHB (CHB-S), and 28 patients with HBV-LC at admission, and 51 patients with HBV-LC at 4.08 ± 3.06 months during antiviral treatment were tested for serum HBsAg titer and HBV DNA load using Abbott chemiluminescence and fluorescence quantitative PCR, respectively.

RESULTSThe serum HBsAg titer and HBV DNA load gradually decreased with increased disease severity (from CHB-LM, CHB-S to HBV-LC; χ(2)=12.537 and 8.381, respectively, P<0.05). HBsAg titer and HBV DNA load were significantly higher in CHB-LM and CHB-S groups than in HBV-LC group (P<0.05), but comparable between CHB-LM and CHB-S groups (Z=-0.649 and 0.032, respectively, P>0.05). Among HBeAg-positive patients, HBsAg titer and HBV DNA load tended to decrease with increased disease severity (from CHB-LM, CHB-S to HBV-LC; χ(2)=6.146, P=0.046 and χ(2)=1.017, P>0.05; respectively), and CHB-LM group had significantly higher HBsAg titer than HBV-LC group (Z=-2.247, P=0.025). Among the HBeAg-negative patients, serum HBsAg and HBV DNA load gradually declined with the disease severity (χ(2)=8.660 and 13.581, respectively, P<0.05), and were obviously higher in CHB-LM and CHB-S groups than in HBV-LC group (P<0.05). Positive correlations were found between serum HBsAg and HBV DNA levels in CHB-LM (r=0.389, P=0.009) and HBV-LC groups (r=0.431, P=0.022), but not in CHB-S group (r=0.348, P=0.104). After antiviral therapy, the serum HBsAg titer was slightly decreased (Z=-1.050, P=0.294) while HBV DNA load markedly reduced (Z=-5.415, P<0.001), showing no correlation between them (r=0.241, P=0.111) or between the measurements before and after treatment (r=0.257, P=0.085).

CONCLUSIONSerum HBsAg titer and HBV DNA load decreases progressively from CHB-LM to CHB-S and HBV-LC in both HBeAg- positive and -negative patients. The serum HBsAg titer is positively correlated with HBV DNA load, but their levels are not consistently parallel.

Antiviral Agents ; therapeutic use ; DNA, Viral ; blood ; Hepatitis B Surface Antigens ; blood ; Hepatitis B, Chronic ; blood ; Humans ; Liver Cirrhosis ; blood ; virology ; Viral Load

OBJECTIVE：  To improve the method for the content determination of astragaloside Ⅳ in Xiangju granules， and to evaluate the consistency of relevant preparations with the components of original formulation， so as to provide evidence for the modern preparation of TCM compound. METHODS： HPLC-ELSD method was established for the content determination of astragaloside Ⅳ in Xiangju granules， and compared with original standard TLC scanning. Using critrinin， ferulic acid， calycosin glucoside， liquiritin， glycyrrhizic acid， rosmarinic acid， buddleoside and magnoline as control， HPLC method was used to determine the release components of self-made Xiangju granules， Xiangju capsules， Xiangju tablets in water. Fingerprint characteristics chromatogram of different Xiangju preparations and original formulation extract were compared by using Similarity Evaluation System for Chromatographic Fingerprint of TCM （2012 version）. At the same time， HPLC-ELSD method was used to determine and compare the release rate of astragaloside Ⅳ from different Xiangju preparations and original formulation extract in water. RESULTS： Established HPLC-ELSD method was specific. The linear range of astragaloside Ⅳ was 0.13-2.10 mg/mL. RSDs of precision， repeatability and stability tests were all lower than 3％ （n＝6）， and average recovery was 97.66％ （RSD＝1.01％，n＝6）. Average content of astragaloside Ⅳ by this method was 0.398 mg/g （RSD＝1.01％， n＝3）， which had better reproducibility than TLC scanning. The comparative results of characteristic fingerprints showed that the similarity among Xiangju granules， Xiangju capsules， Xiangju tablets and the original formulation dry extract powder was more than 0.850. Average release rates of astragaloside Ⅳ in Xiangju granules， Xiangju capsules， Xiangju tablets and the original formulation extract were 0.392， 0.358， 0.349， 0.389 mg， respectively. Compared with original formulation extract， there was no statistical significance in release rate of astragaloside Ⅳ in Xiangju granules （P＞0.05）， while there was statistical significance in Xiangju capsules and Xiangju tablets （P＜0.01）. CONCLU- SIONS： Established HPLC-ELSD method is accurate and feasible， and is suitable for the content determination of astragaloside Ⅳ in Xiangju granules. The main components of Xiangju granules are consistent with original formulation.

Objective:To investigate the application effect of Press-Z-track-Turn (PZT) intramuscular injection on the extravasation, local reaction, local pain after injection and patient satisfaction after Fulvestrant injection.Methods:Used a self-controlled study, 63 patients who underwent bilateral intramuscular injection of Fluvastatin in the outpatient injection room of Tianjin Medical University Cancer Hospital from August to October 2022 were conveniently selected. The observation time was two treatment cycles after inclusion in this study. Before the injection of the first treatment cycle, a coin toss was used to randomly decide to use traditional intramuscular injection and PZT intramuscular injection method for injection and record. After 28 days, another injection method was used, with a total of 126 injections per injection method. Observed the extravasation of drug solution and local reactions at the injection site within 7 days after injection using two injection methods, as well as the pain and satisfaction of patients within 7 days after injection.Results:The extravasation rate of drug solution for the PZT intramuscular injection was 1.59% (2/126), which was lower than 7.14% (9/126) for the traditional intramuscular injection, and the difference was statistically significant ( χ2=4.66, P<0.05); the incidence of mild and moderate local reactions for the PZT intramuscular injection was 3.97% (5/126) and 1.59% (2/126), respectively, lower than that for the traditional intramuscular injection 11.11% (14/126) and 5.56% (7/126), and the difference was statistically significant ( χ2=8.26, P<0.05); the pain score of the PZT intramuscular injection was (2.08 ± 0.85) points, lower than that of the traditional intramuscular injection (5.03 ± 1.06) points, and the satisfaction score of the PZT intramuscular injection was (23.68 ± 1.64) points, higher than that of the traditional intramuscular injection (20.10 ± 2.58) points. The difference was statistically significant ( t=-17.24, 9.16, both P<0.01). Conclusions:PZT intramuscular injection can effectively reduce the overflow rate, the incidence of grade 1 and 2 local reactions and the degree of pain of patients, and improve patient satisfaction, which is worthy of clinical application.