Objective To understand the development history and current situation of healthcare-associated infection(HAI)management in children’s hospitals in China during the past 30 years.Methods A retrospective survey was conducted in 20 children’s hospitals,the investigated contents included:basic situation of hospitals, HAI management organizations and professionals,the support of hospital leaders for the management of HAI, training on HAI knowledge,monitoring on HAI,and so on.Results Up to 2015,20 hospitals all set up independent HAI management departments and HAI management committees,46.15%(6/13)of hospitals with more than 1 000 beds were understaffed in HAI management.There were a total of 88 professionals in HAI management in 20 children’s hospitals in 2015,53.41% (n=47)of professionals had bachelor degree,34.09% (n=30)were with intermediate professional title,46.59%(n=41)were nursing staff.Up to 2015,incidences and missing report rates of HAI,antimicrobial usage rates,incidences of HAI in neonates all decreased compared with 2006.In 2015,20 (100.00%)hospitals all carried out monitoring on antimicrobial application,multidrug-resistant organisms,disin-fection and sterilization,and provided personnel protective equipment.In 2015,9(45.00%)hospitals used non-tou-ch faucets in all wards,19(95.00%)hospitals supplied hand-drying paper towel and alcohol-based hand rub in all wards.None of professionals in these hospitals participated in national-level training on HAI for ≥3 times in 1996, professionals in 11 hospitals (55.00%)participated in national-level training for ≥3 times in 2015.Conclusion In the past 30 years,the management of HAI in children’s hospitals in China has basically met the requirement,moni-toring on HAI gradually improved,but allocation of HAI professionals and personnel quality ability still need to be strengthened.

Objective To investigate the status and influencing factors of infusion-related adverse events in third-party cord blood stem cell infusion. Methods A total of 305 patients successfully underwent haploidentical stem cell transplantation combined with the third-party cord blood(CB) infusion,were recruited by convenience sampling from January 2013 to December 2015,in hematological department of a tertiary hospital in Suzhou. A self-developed questionnaire and adverse event assessment scale were used to investigate the influencing factors. Results The rate of infusion-related adverse events was 49.51%,81.82% were related to cardiovascular adverse events with the high-est rate of hypertension(76.14%). Logistic regression analysis showed that age(OR=1.030,95CI%:1.010-1.051),HLA matching between CB and receptor (OR=0.589,95%CI:0.413-0.838),thawed CB cell activity (OR=1.064,95%CI:1.015-1.115)were major influencing factors. Conclusion Nurses should pay attention to patients who are elderly,with low matching HLA and receive thawed CB product with high cell activities,and provide timely nursing care in advance.

ObjectiveTo study the effect of negative pressure suction during laser in situ keratomileusis (LASIK) on rabbit retinal structure.Methods32 New Zealand white rabbits were randomly divided into normal control, experimental control, negative suction 45 seconds and negative suction 3 minutes groups. Experimental control groups were treated only using eximer laser. In negative suction groups, rabbit eyes were suction for 45 seconds or 3 minutes by negative pressure generator. The tissues of optic nerve and retina both after negative pressure suction and of normal rabbit eyes were examined with electron and light microscope 0, 7, 14, 28 days after operation. ResultsThere was no change in the tissues of optic nerve and retina between normal control and experimental control. After the negative pressure suction for 45 s, the optic nerve and retinal cells changed lightly at different time point. After the negative pressure suction for 3 min, the optic nerve fibers and retinal cells changed sharply during postoperative instant to 14th days, which can be recovered until 28 days after operation.ConclusionUltrastructural changes of retina and optic nerve may be induced by acute intraocular pressure elevation caused by negative pressure suction during LASIK.

Objective Adhesion or too highly located folds upper eyelid and even hlepharoptosis are common complications after double eyelid operation. The method was designed to correct these de-formities. Methods The incision of upper eyelid was designed under the scar. Skin was resected between the former and the new double line, if there was excessive skin. Completely relieve the adhesion until nor-mal tissue was exposed. Expose lateral extension of retro-orbicularis oculi fat pad. An upper pedicle fat flap was formed after cutting tissues off along bilateral borders. Appropriately and transversely cutting lateral portion of the pedicle made it rotate inside downward with enough blood supply. The fat flap was fixed with released orbital fat and the lower edge of fat flat fixed with upper border of supratarsal to restorate the volume. For severe condition, fat granule injection could be used after the skin was sutured. Results 42 cases (80 eyes) were treated in the past two years. The deformities of 32 cases were corrected by the application of retro-orbicularis oculi fat pad. Fat granule injection was applied for the other 10 pa-tients meanwhile. 30 cases (60 eyes) were followed up for 6 to 24 months. The results were satisfactory. Conclusion The methods are performed easily and the results are satisfied. It is worth of recommenda-tion.

Objective To search for independent predictive factors of diabetic kidney disease(DKD)in patients with type 2 diabetes mellitus(T2DM),construct and validate an optional machine learning(ML)model for the risk of DKD.Methods A total of 528 patients with T2DM,hospitalized in the Endocrinology Department of Chengde Central Hospital from October 2019 to September 2020,were selected as the study objects,and patients were randomly divided into a training set(370 cases),and a validation set(158 cases).The training set was divided into the DKD group(89 cases)and the non-DKD group(281 cases)according to whether DKD existed.The general data and diagnostic examination of patients were performed by univariate analysis,in which variables with statistical differences were used to screen the best predictors by least absolute shrinkage and selection operator(LASSO)regression analysis.The best predictors were used to establish eight ML algorithms by three cross-validation methods,including Logistic regression(LR),K-nearest neighbor(KNN),support vector machine(SVM),decision tree(DT),random forest(RF),naive Bayes(NB),artificial neural network(ANN),and extreme gradient lift(XGBoost).The optimal prediction model was selected by receiver operating characteristic(ROC)curve,Delong test and GiViTI calibration curve.Decision curve analysis(DCA)was used to evaluate the clinical practicability of the model.Results Age,alanine aminotransferase,creatinine,triglyceride,cystatin C,25-hydroxy vitamin D and monocyte count were independent predictive factors of DKD.Eight ML models were established based on the above 7 predictors,and the ANN model performed best in the 8 ML models.The GiViTiI calibration curve indicated that the model had good accuracy(P＞0.05),and the DCA showed that the prediction model curve had clinical practical value in the threshold probability range of 0.027-0.612.Conclusion In this study,the ANN model constructed in this study to predict the risk of DKD is helpful for early discrimination of high-risk T2DM patients with DKD.

Objective Using Wisconsin Stone Quality of Life questionnaire (WISQOL) to compare standard percutaneous nephrolithotomy(PCNL) and tubeless PCNL.Methods From January 2017 to June 2017,patients who met the criteria (no urinary tract infection,stones between 1-3 cm,hydronephrosis larger than 3cm,renal cortex thickness ＞ 2 cm and without serious heart,lung,liver and kidney dysfunction and coagulation dysfunction) and underwent PCNL were prospectively enrolled and randomized into 2 groups,standard PCNL group and tubeless PCNL group.Diclofenac sodium suppositories were used to relieve pain in all patients with obvious pain.The quality of life of these patients were estimated and compared by using WISQOL.Safety and efficacy were also estimated.Result At the end of the study,a total of 50 patients were included in the analysis.There were 24 patients in the standard PCNL group and 26 patients in the tubeless PCNL group.There were 9 male patients in the standard PCNL group and 17 male patients in the tubeless PCNL group.There was no significant difference in gender between the two groups.The differences between the standard PCNL group and tubeless PCNL group in mean age (yrs.) [(53.21 ±13.35) vs.(51.1 ± 11.5),P =0.55],stone diameter (mm) [(18.46 ± 5.58) vs.(18.75 ± 5.39),P =0.85],stone-free rate (23/24 vs.24/26,P =0.60),mean hemoglobin decline (g/L) [(11.87 ± 9.20)vs.(10.43 ± 8.49),P =0.56] were not significant.Mean dosage of acesodyne(pcs) in tubeless PCNL group (4.07 ± 1.49) was significantly less than that in standard PCNL group (7.54 ± 2.23).There were no patient need transfusion or postoperative fever management.The influence of perioperative quality of life of patients treated with tubeless PCNL is significantly better than those treated with standard PCNL in 16 items which includ energy,sleep,work and family,physical symptoms,concerns related to intimacy and travel,and general emotional well-being.Conclusion Tubeless PCNL can improve patients' quality of life compared with standard PCNL.

Objective? To explore the effects of the problem-oriented intervention model on major nursing issues, self-care behavior and illness perception in elderly patients with type 2 diabetes. Methods? Totally 112 elderly patients with type 2 diabetes admitted in the First Hospital of Jiaxing from September 2016 to September 2017 were selected by convenient sampling and divided into the control group (n=56) and the observation group (n=56) based on the time of admission. Patients in the control group received conventional nursing care, while patients in the observation group received conventional nursing care in addition to problem-oriented nursing interventions. The Omaha Problem Classification Scheme was used to evaluate the nursing issues in the two groups, and the Chinese version of Summary of Diabetes Self-Care Activities (SDSCA) and the Brief Illness Perception Questionnaire (BIPQ) were used to evaluate the intervention effects between the two groups. Results? After 6 months, the resolution rate of major nursing issues in the observation group was 82.93% (68/82), while that in the control group was 63.16% (48/76); (χ2=7.898, P＜ 0.05). The self-care behavior and illness perception in the observation group totaled (27.33±7.36) and (38.49±5.76), respectively, both higher than that in the control group (t=5.180, 7.201; P＜ 0.01). Conclusions? The problem-oriented nursing intervention model can effectively enhance the self-care ability and illness perception in elderly patients with type 2 diabetes.

Objective To explore the efficacy of hematopoietic stem cell transplantation (HSCT) for 5 patients with Ph-like acute lymphoblastic leukemia (ALL).Methods Fluorescent in situ hybridization (FISH) was performed for detecting the rearrangement of susceptibility genes.Combined therapy of chemotherapy and ruxolitinib were applied,followed by HSCT.Those failing to achieve complete remission (CR) received an infusion of chimeric antigen T-cells (CAR-T),followed by HSCT once CR was achieved.Four patients accept allogenic HSCT while another auto HSCT.Results Three of them achieved CR after chemotherapy and ruxolitinib.The remaining 2 patients got CR after CAR-T.Four patients remained in CR after HSCT.Early relapse occurred in 1 patient after HSCT.Conclusions Combined therapy of chemotherapy,ruxolitinib and CAR-T are necessary for Phlike ALL patients.HSCT after an initial CR improve patient prognosis.

Urodynamics is a critical field that studies the physiological and biomechanical parameters involved in urine production, storage, and voiding.This paper first reviews the development process of urodynamics, expounds the development and progress of urodynamic testing instruments from early basic research to modern advanced equipment and the history of their introduction into China, and then introduces in detail the principle of action, system composition and clinical application status of major urodynamic instruments, and further points out the technical shortcomings of current instruments, and then proposes improvement directions, including the core load sensor technology, comfort and privacy of urodynamic testing instruments, work data transfer and close integration with artificial intelligence, in order to provide a valuable reference for clinical understanding of the development of this field.

Objective: Early T-cell precursor acute lymphoblastic leukemia (ETP-ALL) is a recently recognized high-risk T lymphoblastic leukemia subgroup. The optimal therapeutic approaches to adult patients with ETP-ALL are poorly characterized. In this study, we explore the efficacy and outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for ETP-ALL. Methods: The clinical data of 23 patients with ETP-ALL receiving allo-HSCT from 2010 to 2018 were retrospectively analyzed. Patients with ETP-ALL were diagnosed based on the characteristic immunophenotypes. Second-generation sequencing was done in all patients. As to the donors, 12 patients had haploidentical donors (Haplo-HSCT) , 7 HLA-matched sibling donors (Sib-HSCT) and 4 HLA-matched unrelated donors (URD-HSCT) . Before transplantation, 19 patients achieved complete remission (CR) and 4 patients without. Results: The main clinical features of ETP-ALL included high white blood cell counts in 5 patients, splenomegaly in 14, lymphadenopathy in 19, and thymus masses in 5. According to cytogenetic and molecular characteristics, 11 patients had gene mutations related to myeloid tumors, and 7 with high risk Karyotype. After first induction regimen, 14/23 patients achieved CR. 5 patients reached CR after more than 2 cycles of chemotherapy, while another 4 patients did not reach CR. After allo-HSCT, 22 patients were successfully implanted. The median time of granulocyte and platelet reconstitution was +12 and +19 days. One patient died of transplant-related infection at +14 days. The estimated 18-month overall survival (OS) and relapse-free survival (RFS) rates were (55.0±14.4) % and (48.1±14.7) % respectively. Transplant-related mortality was 4.3%. The median OS in patients achieving CR before transplantation was 20 months, however, that in patients without CR was only 13 months. OS and RFS between haplo-HSCT and sib-HSCT were comparable (P=0.460 and 0.420 respectively) . Conclusions Allo-HSCT is an effective therapy in some patients with ETP-ALL. Salvage HSCT cannot overcome the poor outcome. Haplo-HSCT and sib-HSCT in ETP-ALL patients have the similar clinical outcome.