Objective:To investigate the efficacy and safety of insulin glarsine combined with sitagliptin in elderly type 2 diabetic patients whose blood glucose levels were inadequately controlled by oral anti-diabetic drugs ( OAD) . Methods: In the open-labeled, randomized and parallel study, 98patients (≥60 years) were randomly divided into two groups: insulin glargine/sitagliptin combina-tion group (n=52, the observation group ) and insulin Aspart 30 injection group (n=46, the control group). The dose was adjusted according to the blood glucose. The fasting blood glucose (FBG), 2h postprandial blood glucose (2hPBG), glycosylated hemoglobin (HbA1c), the incidence of hypoglycemia and body mass index (BMI) after the 12-week treatment were compared between the two groups. Results:The fasting glucose and the incidence of hypoglycemia in the observation group were lower than those in the control group (P<0. 05). There were no significant differences in 2h postprandial blood glucose, HbA1c and BMI between the two groups (P>0. 05). Conclusion:The treatment of insulin glargine combined with sitagliptin is safe, effective and convenient in elderly type 2 diabetes patients with poor glycemic control. By diabetic education, the lower incidence of hypoglycemia treatment will be a better choice for elderly type 2 diabetic patients.

Objective To investigate the effect of root cause analysis (RCA) on fall management of psychiatric inpatients.Methods A total of 3 245 patients without RCA treated in our hospital from January 2014 to June 2015 were selected as control group,and 3 406 cases with RCA from July 2015 to December 2016 were selected as the observation group.Fall events in psychiatric ward were reported in nursing department by retrospective analysis,the main reasons were find out,and nursing measures were improved,and corresponding nursing measures were optimized.Results After intervention,the incidence rate of falls in observation group was lower than that in the control group(0.493％ vs.0.206％,P＜0.05).Conclusion RCA method can reduce the occurrence of fall events in psychiatry inpatients and ensure the safety of the patients.

Objective To investigate the effect of root cause analysis (RCA) on fall management of psychiatric inpatients.Methods A total of 3 245 patients without RCA treated in our hospital from January 2014 to June 2015 were selected as control group,and 3 406 cases with RCA from July 2015 to December 2016 were selected as the observation group.Fall events in psychiatric ward were reported in nursing department by retrospective analysis,the main reasons were find out,and nursing measures were improved,and corresponding nursing measures were optimized.Results After intervention,the incidence rate of falls in observation group was lower than that in the control group(0.493％ vs.0.206％,P＜0.05).Conclusion RCA method can reduce the occurrence of fall events in psychiatry inpatients and ensure the safety of the patients.

Objective To evaluate the feasibility and safety profile of pegylated-interferonα-2a (Peg IFNα-2a) combined with adefovir dipivoxil (ADV) in inactive hepatitis B surface antigen (HBsAg) carriers (IHC).Methods This was a single center, prospective and open-label study.IHC were divided into therapeutic group (T, 112 subjects) and control group (C, 72 subjects) according to personal willingness.Patients with hepatitis B virus (HBV) DNA<20 IU/mL were treated with Peg IFNα-2a monotherapy, and those with HBV DNA ≥20-<2 000 IU/mL were treated with Peg IFNα-2a combined with ADV.Total therapy duration was 96 weeks.For patients who achieved HBsAg seroconversion and continued consolidation treatment for 24 weeks, the treatment duration could be less than 96 weeks.t test was used for continuous variable comparison between the two groups, while chi-square test or Fisher′s exact probability method was used for counting data analysis.The related factors affecting HBsAg clearance was analyzed by univariate or multivariate logistic regression analysis.Results A total of 194 patients were enrolled with 112 in therapeutic group and 72 in control group.The HBsAg clearance rate and seroconversion rate at week 48 in therapeutic group were 30.8% (32/104) and 26.0% (27/104), respectively.The rates at week 96 increased to 45.2% (47/104) and 38.5% (40/104), respectively.The HBsAg clearance rates at weeks 48 and 96 in control group were both 1.5% (1/68).HBsAg seroconversion was not achieved in control group.The HBsAg clearance rate in treatment group was significantly higher than that in control group (χ2=39.066, P<0.01).The quantitative HBsAg levels at baseline (OR=2.313, 95%CI: 1.258-4.251, P=0.007), week 12 (OR=3.159, 95%CI: 1.826-5.466, P<0.01) and week 24 (OR=3.347, 95%CI: 2.050-5.465, P<0.01), the decline of HBsAg at week 12 (OR=5.343, 95%CI: 2.085-13.689, P<0.01), and week 24 (OR=4.855, 95%CI: 2.380-9.902, P<0.01), and alanine transaminase (ALT) elevation at week 12 (OR=3.520, 95%CI: 1.369-9.052, P=0.009) were independent predictors for HBsAg clearance.Conclusions Peg IFNα-2a-based treatment for IHC could achieve higher HBsAg clearance rate and seroconversion rate, and has a safety profile.Decline of HBsAg at week 12 and week 24 with ALT elevation at week 12 could predict a higher HBsAg clearance rate.

Recruitment advertising for clinical trials is a communication carrier of research information prior to participants' participation in the trial, and an important part of the form to recruit and inform subjects. Recruitment advertising should include the necessary information about the clinical trial, but cannot contain the inappropriate content such as those misleading and inducting information, and the content and the modality of advertising must be approved by ethics committee before being used. At present, there are laws and regulations, ethical review, re-searchers' understanding, non-standard operation and other issues in the advertising for recruitment. Therefore, it ' s need to continuously strengthen the ethical review and management of advertising to protect the rights and inter-ests of subjects from the angles of improving relevant laws and regulations, enhancing ethical review ability, raising researchers' awareness and strengthening fighting force on the illegal activities and so on.

Objective:To explore the clinical significance of patient for patient safety strategy in inpatients with traumatic fracture.Methods:Convenience sampling method was used to randomly select 120 patients with traumatic fracture from September to December 2019 in the Department of Orthopaedics and Traumatology of a third-class hospital of Zibo city. Sixty patients with traumatic fracture treated from September to October 2019 were the control group, and 60 patients with traumatic fracture treated from November to December 2019 were the intervention group. The control group implemented routine safety management, and the intervention group implemented patient for patient safety strategy on the basis of routine safety management. The general information questionnaire, Hamilton Anxiety Scale (HAMA), patient for patient safety attitude questionnaire, incidence of adverse events during hospitalization and inpatient satisfaction scale were used to evaluate the effect after application.Results:HAMA score was 17.6±3.4,11.5±2.7 3 days after operation and at discharge in the intervention group, whcih were significantly lower than 23.3±4.3, 14.3±3.2 in the control group ( t values were 7.919, 6.912, P<0.001). The score of patients for patient safety attitude questionnaire was significantly higher in the intervention group at discharge compared with one day after operation ( t values were 3.246-6.558, P<0.001), as well as compared with those in the control group ( t values were 2.251-6.445, P<0.05). The total incidence rate of adverse events during hospitalization and satisfaction degree was 6.7%(4/60) and 95.0% (57/60) in the intervention,better than 13.3%(8/60), 90.0% (54/60) in the control group ( χ2 values were 7.260,16.008, P<0.001). Conclusions:The patient for patient safety strategy can effectively alleviate patients' negative psychological emotions, enhance patients' attitude to participate in safety behaviors, increase their enthusiasm to participate in safety behaviors, reduce the occurrence of adverse events during hospitalization, and improve patients' satisfaction with hospitalization.

Objective:To analyze the correlation between the skin temperature changes in the radiation area and the occurrence of radiodermatitis during postoperative radiotherapy for female breast cancer and to explore the application value of skin temperature monitoring in the early warning of radiodermatitis risks.Methods:A total of 103 patients who received three-dimensional conformal radiotherapy after radical mastectomy in the Fourth Hospital of Hebei Medical University were continuously enrolled from May to November, 2022 in this study. Their skin temperature in the radiation area and radiodermatitis were recorded weekly. The relationships between relative skin temperature differences and different grades of radiodermatitis were determined. The optimal cut-off values for grade ≥ radiodermatitis were calculated, and the predictive effect was evaluated using the receiver operating characteristic (ROC) curve. Furthermore, the radiodermatitis risks under different skin temperatures were compared using binary logistic regression.Results:There was a positive correlation between the skin temperature in the radiation field and the grade of radiodermatitis. The optimal cut-off values for the average relative skin temperature difference of the chest wall (under 40 Gy/20 fractions), the maximum relative skin temperature difference of the chest wall (under 40 Gy/20 fractions), and the relative skin temperature difference of the supraclavicular block (under 30 Gy/15 fractions) were 0.45℃, 0.55℃, 0.15℃, respectively. The patients were divided into low- and high-risk groups based on the optimal cut-off values (0.45℃, 0.55℃, and 0.15℃). Binary logistic regression result showed that the risks of grade ≥ 2 radiodermatitis in the high-risk group were 5.71, 4.29, and 5.15 times those in the low-risk group, respectively ( OR = 5.71, 95% CI 1.81-17.99, P = 0.003; OR = 4.29, 95% CI 1.65-11.12, P = 0.003; OR = 5.15, 95% CI 2.16-12.31, P < 0.001). Conclusions:Skin temperature monitoring using medical infrared thermometers can be used to effectively predict the occurrence of grade ≥ 2 radiodermatitis. The skin temperature changes in the radiotherapy area should be closely observed. The risk of grade ≥ 2 radiodermatitis will increase when the mean and maximum relative temperature differences of the chest wall increase by 0.45℃ and 0.55℃, respectively under 40 Gy/20 fractions of radiotherapy or when the relative temperature differences of the supraclavicular block increases by 0.15℃ under 30 Gy/15 fractions of radiotherapy.

OBJECTIVE: To analyze the pathogenic variant of preaxial polydactyly in a Chinese Han pedigree and identify the cause of polydactyly. METHODS: The peripheral blood DNA of the proband and her parents was extracted. The polydactyly-related genes were detected by trio whole exome sequencing, and the suspected pathogenic gene was screened out. Sanger sequencing was applied to other members of the pedigree. RESULTS: The results of gene sequencing showed that the LMBR1 gene had a heterozygous variant of c.423+4909(IVS5)C>T in 6 patients of the pedigree. The same variant was not detected in family members with normal phenotype. Based on the ACMG guidelines, c.423+4909(IVS5)C>T of the LMBR1 gene was predicted to be pathogenic (PM1+PM2+PP1-S(PS)+PP4+PP5). CONCLUSION The heterozygous C>T variant at position 4909 of intron 5 of the LMBR1 gene probably underlies the disease in this pedigree.
China ; Female ; Humans ; Mutation ; Pedigree ; Polydactyly/genetics* ; Thumb ; Whole Exome Sequencing

Objective: To explore the therapeutic feasibility of uterus transplantation for uterine infertility. Methods: Retrospective analysis was performed for the diagnosis, treatment and pregnancy course of the first domestic case of uterus transplantation and the relevant literature reviewed. The recipient was a 22-year-old woman with a congenital absence of uterus and vagina. Previously she underwent vaginal reconstruction and the donor was her mother. The specific procedures included donor/recipient screening, ethical argumentation, assisted reproductive technology of obtaining frozen embryos, Vinci robot-assisted uterine procurement, orthotopic replacement & fixation of retrieved uterus, revascularization; immunoregulation & monitoring of transplanted uterine recipient, assisted reproductive technology after transplantation and gestational management. Results: The durations of donor and recipient surgeries were 360 and 530 min respectively. No complications of recipient or donor occurred during the perioperative period. First menstruation occurred at 40 days post-transplantation and regularly thereafter. Pregnancy occurred after embryo transfer at 31 months post-transplantation. No rejection episodes occurred after transplantation or during gestation. Caesarean delivery occurred near gestational week 34. The boy weighed 2000 grams at birth and the mother remained well. Conclusions In conjunctions with literature review, uterine infertility may be treated by modified uterus transplantation. And a new path is paved for healthy pregnancy of women with uterine infertility.

Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2022.Methods:The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of national bloodstream infection Bacterial Resistant Investigation Collaborative System（BRICS）were collected during January 2022 to December 2022. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 software were used to analyze the data.Results:During the study period，9 035 strains of Gram-negative bacteria were collected from 51 hospitals，of which 7 895（87.4%）were Enterobacteriaceae and 1 140（12.6%）were non-fermenting bacteria. The top 5 bacterial species were Escherichia coli（ n=4 510，49.9%）， Klebsiella pneumoniae（ n=2 340，25.9%）， Pseudomonas aeruginosa（ n=534，5.9%）， Acinetobacter baumannii complex（ n=405，4.5%）and Enterobacter cloacae（ n=327，3.6%）. The ESBLs-producing rates in Escherichia coli， Klebsiella pneumoniae and Proteus spp. were 47.1%（2 095/4 452），21.0%（427/2 033）and 41.1%（58/141），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（58/4 510）and 13.1%（307/2 340）；62.1%（36/58）and 9.8%（30/307）of CREC and CRKP were resistant to ceftazidime/avibactam combination，respectively. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 59.5%（241/405），while less than 5% of Acinetobacter baumannii complex was resistant to tigecycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 18.4%（98/534）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of main Gram-negative bacteria resistance among different regions，with statistically significant differences in the prevalence of CRKP and CRPA（ χ2=20.489 and 20.252， P<0.001）. The prevalence of CREC，CRKP，CRPA，CRAB，ESBLs-producing Escherichia coli and Klebsiella pneumoniae were higher in provinicial hospitals than those in municipal hospitals（ χ2=11.953，81.183，10.404，5.915，12.415 and 6.459， P<0.01 or <0.05），while the prevalence of CRPA was higher in economically developed regions（per capita GDP ≥ 92 059 Yuan）than that in economically less-developed regions（per capita GDP <92 059 Yuan）（ χ2=6.240， P=0.012）. Conclusions:The proportion of Gram-negative bacteria in bloodstream infections shows an increasing trend，and Escherichia coli is ranked in the top，while the trend of CRKP decreases continuously with time. Decreasing trends are noted in ESBLs-producing Escherichia coli and Klebsiella pneumoniae. Low prevalence of carbapenem resistance in Escherichia coli and high prevalence in CRAB complex have been observed. The composition ratio and antibacterial spectrum of bloodstream infections in different regions of China are slightly different，and the proportion of main drug resistant bacteria in provincial hospitals is higher than those in municipal hospitals.