Objective:To validate the effectiveness of the "ventilator-associated pneumonia (VAP) cluster nursing package" in Tianjin.Methods:A self-test questionnaire was prepared based on the "Ventilator-associated pneumonitis bundled nursing package", and an electronic questionnaire was used to investigate the comprehensive ICU of 40 hospitals in Tianjin.Results:The average self-examination form of the comprehensive ICU "ventilator-associated pneumonia cluster nursing package" in Tianjin was 28.92 points (out of 30 points), of which the bedside elevation, sedation and wake up, timely extubation, strict hand hygiene, and maintenance Effective airbag pressure, timely dumping of condensate water, timely removal of stagnation, and prevention of the total score of VAP package execution were related to the occurrence of VAP in patients in Tianjin from August 2018 to August 2019 ( r value was 0.101, P <0.01); ICU unit layout, nurse level and prevention of VAP package implementation are the influencing factors of VAP in ICU patients. Conclusion:The "ventilator-associated pneumonitis cluster nursing package" has been well implemented in Tianjin ICU, and the implementation of this package can reduce the incidence of VAP.

Objective:To evaluate the effectiveness of multi-disciplinary treatment (MDT) for reducing carbapenem-resistant Enterobacteriaceae (CRE) infections in intensive care unit(ICU).Methods:Patients admitted in the emergency ICU (EICU) and neurosurgical ICU (NICU) of the First People’s Hospital of Lianyungang during January 2018 to December 2019 were enrolled in the study, which was analyzed by historical control study. For patients admitted in 2018, the conventional method was adopted for prevention and control of drug-resistant bacteria (control group, n=1, 076), and for patients admitted in 2019, the MDT was adopted for the prevention and control of CRE (intervention group, n=1, 237). Chi-square test was used to compare the incidence rate of CRE infection, CRE detection rate, rate of rational antibiotic use and compliance with implementation of prevention and control measures between two groups. Results:Compared to control group, the incidence rate of CRE infection in EICU and NICU decreased from 3.45% (14/406) and 3.58% (24/670) to 1.65% (9/547) and 2.32% (16/690) in intervention group, respectively; while the detection rate of CRE decreased from 66.21% (96/145) and 57.72% (86/149) to 41.11% (51/124) and 33.06% (40/121), the pathogens were mainly carbapenem-resistant Klebsiella pneumoniae (CRKP). The rational medication rate of carbapenem antibiotics was significantly increased from 65.00%(78/120) in 2018 to 92.73%(319/344) in 2019 ( χ2=55.382, P<0.05). In addition, the single room isolation rate, the rate of specialized nursing care, the cleaning and disinfection quality of bench surface and the special use rate of articles were also significantly improved( χ2=21.646, 18.116, 39.869 and 19.713, P<0.01). Conclusion:The establishment of multi-department collaborative management based on MDT can effectively improve the prevention and control effect of CRE in ICU and significantly reduce the prevalence of CRE infection.

Discipline structure, as the core of discipline construction, plays an important role in promoting the prosperity of medical humanities. By sorting out the Chinese scholars’ division of the structure of medical humanities in China, this paper preliminarily discussed the existence of the subordinate discipline of medical humanities in China, and preliminarily verified the rationality and feasibility the viewpoint of "building a first-class discipline of medical humanities under the medical category, and forming a subordinate discipline of medical humanities based on horizontal association". At the same time, this paper put forward the view that the structure of medical humanities in China should be determined according to the needs of the current social development in China, and the concepts and criteria contained in the division of the Chinese discipline catalogue, so as to pave the way for the follow-up research.

Objective:To investigate the correlation between non-traditional lipid parameters and in-hospital recurrence in patients with acute minor ischemic stroke (AMIS).Methods:Patients with AMIS admitted to three sub-central hospitals in Shanxi Province within 72 h of onset in March, June, September, and December of 2012, 2014, 2016, and 2018 were retrospectively included. The demographic information, clinical features, blood lipid parameters, and in-hospital stroke recurrence events were collected. Non-traditional lipid parameters included low density lipoprotein cholesterol (LDL-C)/high density lipoprotein cholesterol (HDL-C) ratio, total cholesterol (TC)/HDL-C ratio, triglycerides (TG)/HDL-C ratio, and non-HDL-C levels. Multivariate logistic regression analysis was used to determine the independent correlation between the non-traditional lipid parameters and the risk of in-hospitals stroke recurrence. Results:A total of 1 040 patients with AMIS were included, including 727 males (69.9%), aged 61.5±13.0 years old; 51 patients (4.904%) experienced in-hospital stroke recurrence, with an average time from admission to recurrence was 7.4±5.7 d. Four hundred and thirty-six (41.9%) AMIS patients complicated with ICAS, aged 61.0±12.5 years old, with 304 males (69.7%); 26 (6.0%) experienced recurrence of in-hospital stroke, and the time from admission to recurrence was 7.8±6.2 d. Multivariate logistic analysis showed that after adjusting for confounding variables, the higher TC/HDL-C ratio (odds ratio [ OR] 1.35, 95% confidence interval [ CI] 1.02-1.77; P=0.035) and non-HDL-C ( OR 1.37, 95% CI 1.02-1.77; P=0.045) were the independent risk factors for in-hospital stroke recurrence. In AMIS patients with intracranial atherosclerotic stenosis, only higher non-HDL-C was significantly and independently associated with the risk of in-hospital stroke recurrence ( OR 1.67, 95% CI 1.05-2.65; P=0.030). Conclusion:The higher non-traditional lipid parameters are associated with an increased risk of in-hospital stroke recurrence in patients with AMIS.

Depression is one of the common and serious complications after stroke. Post-stroke depression (PSD) is associated with poor outcomes and increased mortality. The American Heart Association/American Stroke Association guidelines for the early management of patients with acute ischemic stroke recommend that pharmacological therapy should be administered to patients with PSD. This article reviews the pharmacological therapy for PSD.

Objective:To investgate the effect of endovascular therapy (EVT) on the requirement for decompressive craniectomy (DC) and functional outcomes in patients with large anterior circulation ischemic stroke.Methods:Patients with large anterior circulation ischemic stroke within 24 hours of onset admitted to the Department of Neurology, West China Hospital, Sichuan University between September 2017 and December 2019 were included. Outcome indicators included DC demand and poor outcome at 3 months. The latter was defined as a modified Rankin Scale score >2. Multivariate logistic regression analysis was used to determine independent factors of DC requirement and functional outcomes at 3 months. Results:A total of 381 patients with large anterior circulation ischemic stroke were enrolled, including 203 males (53.3%), and the mean age was 70.7±14.3 years. The median time from onset to admission was 4.5 hours. The median baseline National Institutes of Health Stroke Scale score was 17 and median baseline Alberta Stroke Program Early Computed Tomography Score (ASPECTS) was 7. Totally 139 patients (36.5%) received EVT, and 64 (16.8%) required DC; 376 patients (98.7%) completed a 3-month follow-up (5 who did not complete follow-up did not require DC, of which 2 received EVT), 312 (83.0%) had poor outcome at 3 months, and 146 (38.8%) died. Multivariate logistic regression analysis showed that EVT was an independent predictor for the requiremet of DC (odds ratio [ OR] 4.42, 95% confidence interval [ CI] 1.81-10.81; P=0.001), higher baseline ASPECTS ( OR 0.80, 95% CI 0.71-0.89; P<0.001) and successful recanalization ( OR 0.37, 95% CI 0.15-0.90; P=0.028) were independent protective factors of reducing the requirement of DC. Successful recanalization ( OR 0.09, 95% CI 0.01-0.72; P=0.023) and antiplatelet therapy ( OR 0.29, 95% CI 0.11-0.76; P=0.012) were independent predictors for reduced risk of poor outcome. In 139 patients who received EVT, 27 (19.4%) received intravenous thrombolysis, 96 (69.1%) achieved successful recanalization, 88 (63.3%) had hemorrhagic transformation, 61 (43.9%) had symptomatic hemorrhagic transformation, and 34 (24.5%) required DC; 137 (98.6%) completed a 3-month follow-up, 116 (84.7%) had poor outcome at 3 months, and 67 (48.9%) died. For patients receiving EVT, a higher baseline ASPECTS ( OR 0.72, 95% CI 0.60-0.88; P=0.001) and successful recanalization ( OR 0.35, 95% CI 0.14-0.90; P=0.029) were independent predictors of reducing the requirement of DC, while successful recanalization ( OR 0.09, 95% CI 0.01-0.71; P=0.022) was an independent predictor for reduced risk of poor outcome. Among 64 patients who required DC, 22 (34.4%) received DC. Receiving DC significantly reduced the mortality within 3 months ( OR 0.25, 95% CI 0.07-0.86; P=0.028), but had no significant effect on functional outcome at 3 months ( OR 0.35, 95% CI 0.03-4.38; P=0.412). There was no significant interaction of either EVT or successful recanalization in the effect of DC on 3-month death ( P for interaction > 0.05). Conclusions:Successful recanalization after EVT reduces requirement for DC in patients with large anterior circulation ischemic stroke and improves functional outcome at 3 months. DC can reduce the mortality in patients required DC, and have no interactive effect with EVT or successful recanalization.

ObjectiveTo clarify the current situation and trend of the social application field of medical humanities in China， explore contributions and characteristics of interdisciplinary fields， and provide a reference for improving the disciplinary research system and forming disciplinary synergy. MethodsCiteSpace， a visual software， was used to cluster the keywords of the social application of medical humanities journals from 2010 to 2022， which were included in three major databases of CNKI， Wanfang Data， and VIP. The clusters were classified according to the functions of contemporary universities. This paper summarized the current social application fields of medical humanities in China and conducted a holistic analysis. ResultsThe current social application field of medical humanities in China included eight fields： education and teaching of medical humanities， construction of discipline professional， academic research on discipline ideology， application of medical scientific research work， medical health service and safety management， resolution of doctor-patient relationship and dispute， traditional Chinese medicine culture and humanistic spirit， and adaptation to the national strategic development concept respectively. ConclusionThere was an uneven tendency in the development of the social application field of medical humanities in China. The overall distribution of its social application fields showed a trend of “strong humanities education， strong academic research， strong medical safety， and weak cultural concepts”. Medical humanities education was the common focus of the social application of medical humanities in China.

Rejection and adverse reactions caused by long-term use of immunosuppressants severely affect the survival rate and quality of life of organ transplant recipients. Immune tolerance induction plays a key role in improving the survival rate and quality of life of organ transplant recipients. In recent years, tremendous progress has been achieved in adoptive re-transfusion of regulatory cells. In this article, research progress in regulatory T cell (Treg), myeloid-derived suppressor cell (MDSC) and regulatory B cell (Breg) in animal experiment and clinical application was reviewed, and the main clinical problems of adoptive re-transfusion of regulatory cells, the application of chimeric antigen receptor Treg and the concept of cell therapy in immune evaluation were summarized, aiming to deepen the understanding of regulatory cell therapy, promote the application of regulatory cells in immune tolerance of organ transplantation, and improve clinical efficacy of organ transplantation and the quality of life of recipients.