AIM:To investigate the relationship of clinical efficacy,blood trough concentration and adverse reavtion,which in the treatment of methicillin-resistant Staphylococcus aureus infection with Vancomycin.METHODS:The clinical data of 82 hospital patients who were infected by methicillin-resistant Staphylococcus aureus and treated with Vancomycin from January 2008 to October 2009 were retrospectively analyzed the clinic efficacy,bacteriological treatment,adverse reaction were observed,and the blook trough concentration was detected.RESULTS:The treatment effective rate of Vancomycin-blood trough concentration which was less than 5 ?g/mL,in the range of 5-10 ?g/mL,and greater than 10 ?g/mL were 68.75%,72.73% and 81.82%.The bacterial clearance rates were 62.50%,68.18% and 72.73%.One case of blood trough concentration of 14.6 ?g/mL in patients with renal toxicity.CONCLUSION:Increasing the blood trough concentration of Vancomycin can improve the treatment of methicillin-resistant Staphylococcus aureus infection in the efficacy and bacterial eradication rates,but the probability of renal toxicity adverse reactions will also increase accordingly.

Objective To observe the changes of cardiovascular function after acupuncture at Neiguan (PC 6) respectively with slowly twirling needling and tube needling in healthy subjects, and to objectively evaluate the pain intensity of the two needling methods.Method A hundred healthy young subjects were randomized into group A and group B, 50 cases in each group. Neiguan (PC 6) point was selected for acupuncture in both groups. In the first stage, group A received acupuncture by slowly twirling needling, while group B received acupuncture with tube needling; in the second stage (a week later), group A received acupuncture with tube needling, while group B by slowly twirling needling. The Short-form McGill Pain Questionnaire (SF-MPQ) was observed after acupuncture for each subject, and ZXG-E automatic cardiovascular function detector was adopted to evaluate the cardiovascular function before puncturing, 5 min after puncturing, and 30 min after puncturing.Result The Sensory Pain Rating Index (S-PRI) and total SF-MPQ scores of slowly twirling needling were significantly different from that of tube needling (P<0.01). The Affective Pain Rating Index (A-PRI), Visual Analogue Scale (VAS), and Present Pain Intensity (PPI) of slowly twirling needling method were significantly different from that of tube needling (P<0.01). At 5 min after needle insertion, the FEK and VER values of twirling needling were significantly different from that of tube needling (P<0.01).Conclusion The pain produced by slowly twirling needling is more variant and stronger than that by tube needling, and this pain variation can produce a positive effect on cardiovascular function.

OBJECTIVETo make an animal periodontitis and atherosclerosis compound model, and to study the effects of periodontitis on atherosclerosis.

METHODS36 Japan rabbits were randomly divided into four groups: Including periodontitis model group, periodontitis and atherosclerosis compound model group, atherosclerosis model group and control group. Periodontitis model was initiated by ligating floss around teeth cervical and oral inoculating with Porphyromonas gingivalis (P. gingivalis). Atherosclerosis was established by single iliac artery of balloon-injured rabbit. Histopathological change of injured iliac artery was observed under optical microscope after hematoxylin-eosion stain. Elastica van Gieson-stained sections were used for the morphometric analysis. We measured intimal and medial lesion areas in iliac artery cross-sections as well as the intimal/medial ratio (I/M). We also analyzed P. gingivalis 16S rDNA amplification with nested-polymerase chain reaction (nested-PCR), and detect systemic proinflammatory mediators with enzyme linked immunosorbent assay (ELISA), including C-reactive protein (CRP), interleukin-6 (IL-6) and interleukin-1beta (IL-1beta).

RESULTSThe serum levels of CRP, IL-6 and IL-1beta increased obviously among the compound model group than other groups (P<0.01). Histopathological observation revealed the compound model group in I/M was bigger than other groups (P<0.01). P. gingivalis 16S rDNA was detected among the periodontitis model group and the compound model group by nested-PCR.

CONCLUSIONPeriodontitis may accelerate intimal hyperplasia in balloon-injured iliac arteries by upgrade of systemic inflammation factors and local bacterial infection.

Animal Experimentation ; Animals ; Atherosclerosis ; C-Reactive Protein ; Disease Models, Animal ; Enzyme-Linked Immunosorbent Assay ; Interleukin-6 ; Periodontitis ; Porphyromonas gingivalis ; Rabbits

Objective To investigate the diagnostic value of the medial plantar nerve in diabetic peripheral neuropathy(DPN).Methods A retrospective analysis was conducted in 114 patients with type 2 diabetes mellitus in our hospital.All the participants were divided into DPN group(n=73)and type 2 diabetes mellitus(T2DM)group(n=41)based on the presence of peripheral nerve damage.Simultaneously,35 healthy volunteers were chosen as the normal control(NC)group.General data,biochemical indexes,medial plantar nerve amplitude,conduction velocity,and abnormal rates were compared among the three groups.DPN patients were further divided into symptomatic and asymptomatic groups based on the presence of plantar paresthesia symptoms.The abnormal rate of the medial plantar nerve was compared with that of the superficial peroneal nerve and sural nerve in each group.Receiver operating characteristic(ROC)curve analysis was employed to assess the diagnostic value of the medial plantar nerve in DPN.Results The amplitude of the medial plantar nerve was significantly lower[(3.00±1.42)vs(6.64±3.76)vs(6.51±3.58)μV],the conduction velocity was markedly reduced[(46.57±7.42)vs(49.42±6.96)vs(51.22±5.34)m/s],and the abnormality rate was elevated(87.67%vs 12.20%)in T2DM group,than in NC groups(P<0.05).Spearman correlation analysis indicated a negative correlation between the medial plantar nerve amplitude and HbA1c(r=-0.267,P<0.05),while the conduction velocity showed a negative correlation with age(r=-0.157,P<0.05).In both symptomatic and asymptomatic DPN patients,the abnormal rate of the medial plantar nerve was higher than that of the superficial peroneal nerve and sural nerve(P<0.05).The area under the ROC curve was 0.942,signifying a reliable diagnostic value for DPN using the medial plantar nerve(P<0.05).Conclusions The medial plantar nerve proves valuable in the diagnosis of DPN,exhibiting higher sensitivity than the superficial peroneal nerve and sural nerve.

Objective:To analyze the impact of implementing regular supervision and communication based on employee needs in the management of head nurses on improving the nursing practice environment, for reference for improving the nursing proctice environment.Methods:In December 2020 and January 2022, convenience sampling method was used to select 5 nursing unit nurses from a hospital which implemented regular supervision and communication based on employee needs(January to December 2021) as the research subjects. The survey was conducted using the Gallup Q12 questionnaire(Q12 questionnaire), which included 12 items from 4 dimensions: basic needs, head nurse support, team cooperation, and self growth. At the same time, a focus group interview method was made to interviews 10 survey subjects regarding their regular supervision and communication experiences.Results:A total of 165 survey subjects were included in this study, including 77 before and 88 after the implementation.The average total score of the Q12 questionnaire increased from 53.75 points before implementation of supervision communication to 56.96 points after implementation, with a statistically significant difference( P<0.05). The scores of the four dimensions of basic needs, head nurse support, team collaboration, and self growth increased from 4.59 points, 4.41 points, 4.50 points, and 4.45 points before implementation to 4.84 points, 4.69 points, 4.75 points, and 4.75 points after implementation, with statistical significances( P<0.05). The interview results showed that supervisory communication can create a humanistic care atmosphere, enhance team cohesion, enhance self-efficacy, improve work efficiency, solve problems in a timely manner, and improve nursing quality. Conclusions:Implementing regular supervision and communication based on employee needs can strengthen the connection between the head nurse and nurses, and enhance nurses′ recognition of basic needs, head nurse support, teamwork, and self growth. It was conducive to creating a good nursing practice environment, meeting the emotional and growth needs of nurses, and improving their job satisfaction.

Objective: To study Duraphat fluoride varnish on the remineralization of demineralized permanent enamel by carbonated beverages. Methods: 30 permanent premolar teeth from 12 to 25 years old young people were collected from orthodontic extraction. Enamel blocks were prepared from each tooth and randomly divided into group A (Coco cola), B(deionized water), C(Coco cola + Duraphat), D(Coco cola + 2％ NaF) and E(Coco cola + artificial saliva) (n = 15), the specinens were respectively treated for 7 d. The enamel surface were observed by scanning electron microscope(SEM). The Ca2 + and P3 + content(weight percentage) were detected by energy spectrum analyzer. Results: The surface of permanent enamel of group A showed a characteristic honeycomb-like appearance, that of group B were smooth. Group C showed irregular large globule deposits on the surface, group D showed some globule structures on the surface, group E showed a little deposits on the surface. Ca2 + and P3 + content of group A was lower than that of group B, in group C was higher than in group E(P＜ 0. 05). Ca2 + content in group D was higher than that in group E(P＜ 0. 05). Conclusion: Duraphat fluoride varnish can promote the remineralization of demineralized permanent enamel by carbonated beverage.

Chemical cleaning and disinfection are crucial steps for eliminating infection in root canal treatment.However,irrigant selection or irrigation procedures are far from clear.The vapor lock effect in the apical region has yet to be solved,impeding irrigation efficacy and resulting in residual infections and compromised treatment outcomes.Additionally,ambiguous clinical indications for root canal medication and non-standardized dressing protocols must be clarified.Inappropriate intracanal medication may present side effects and jeopardize the therapeutic outcomes.Indeed,clinicians have been aware of these concerns for years.Based on the current evidence of studies,this article reviews the properties of various irrigants and intracanal medicaments and elucidates their effectiveness and interactions.The evolution of different kinetic irrigation methods,their effects,limitations,the paradigm shift,current indications,and effective operational procedures regarding intracanal medication are also discussed.This expert consensus aims to establish the clinical operation guidelines for root canal irrigation and a position statement on intracanal medication,thus facilitating a better understanding of infection control,standardizing clinical practice,and ultimately improving the success of endodontic therapy.

Objective:To analyze the absence of congenital arterial duct in fetus and to improve the diagnostic accuracy.Methods:Four hundred cases of congenital heart disease diagnosed by echocardiography during pregnancy were examined the fetal cardiovascular malformation and visceral malformation, and the absence of arterial duct was analyzed.Results:There were 24(6%)cases of absence of arterial duct, including 19 cases of left aortic arch and five cases of right aortic arch. There were 21 cases with main pulmonary arteries and 3 cases without main pulmonary arteries and branches. There were 15 cases of pulmonary artery stenosis with absence of arterial duct and the major cardiovascular malformations included six cases of single ventricle, six cases of atrial septal defect, four cases of single atrium, four cases of right atrium isomerism, four cases of double outlet right ventricle, four cases of anomalous pulmonary venous drainage, three cases of tetralogy of Fallot, and three cases of persistent left superior vena cava. There were seven cases of pulmonary atresia with absence of arterial duct and with systemic-pulmonary collateral circulation. There was one case of tetralogy of Fallot with absent pulmonary valve and absent arterial duct and the pulmonary artery was dilated. There was one case of aortopulmonary septal defect with absent arterial duct, with normal pulmonary artery. There were also seven cases of asplenia, seven cases of pulmonary abnormality and seven cases of visceral inversion.Conclusions:The absence of arterial duct is often associated with congenital heart disease. Pulmonary atresia is often associated with systemic-pulmonary collateral circulation. The visceral malformations are related to the accompanying congenital cardiovascular malformations.

Objective : To investigate the mechanism of sertoli/spermatogenic injury induced by cigarette smoke extract(CSE) based on ROS/NLRP3 signaling pathway. Methods : The sertoli/spermatogenic of rat were cultured in vitro , and they were divided into control group , cigarette Smoke extract (CSE) group and CSE + NLRP3 inflammosome inhibitor MCC950 group. Cell viability was detected by CCK⁃8 assay; Lactate dehydrogenase ( LDH) was used to detect cell membrane damage ; reactive oxygen species ( ROS) production was used to detect oxidative stress level ; Hoechst/PI fluorescent staining was used to detect cell pyroptosis. Real⁃time quantitative PCR ( RT⁃qPCR) was used to determine the mRNA level of NLRP3 , ASC , Caspase⁃1 , GSDMD , IL⁃1β and IL⁃18. Western blot was used to determine the protein level of NLRP3 , ASC , Caspase⁃1 , GSDMD , IL⁃1β and IL⁃18. Results: CCK⁃8 assay showed that cell viability decreased in CSE group (P < 0. 001) , LDH leakage rate (P < 0. 001) and ROS (P < 0. 001) production increased. Compared to the CSE group , cell viability increased (P < 0. 001) , LDH leakage rate (P < 0. 01) and ROS (P < 0. 001) production decreased in CSE + MCC950 group. The number of PI staining cells in CSE group was more than that in control group and CSE + MCC950 group , but staining cells in CSE + MCC950 group was less than that in CSE group. RT⁃qPCR and Western blot results showed that the expression levels of NLRP3 , ASC , Caspase⁃1 , GSDMD , IL⁃1β and IL⁃18 increased in CSE group but decreased in CSE+ MCC950 group. Conclusion The oxidative stress and inflammation of sertoli/spermatogenic induced by ciga⁃ rette smoke may be related to the activation of ROS/NLRP3 signaling pathway.

ObjectiveTo investigate a suspected outbreak of healthcare-associated infection with carbapenem-resistant Klebsiella pneumoniae (CRKP) in a geriatric emergency ward, and to provide references for the prevention and control of multidrug-resistant bacteria in a hospital in Shanghai. MethodsOn-site epidemiological investigation, combined with environmental hygiene monitoring and pulsed field gel electrophoresis (PFGE) molecular typing method, were adopted to investigate a suspected outbreak of CRKP infection in the geriatric emergency ward of a hospital from October to November 2022, aiming at finding out factors caused the outbreak before taking corresponding control measures. ResultsA total of 3 cases of healthcare-associated CRKP infection were identified, of which 2 cases were homologous to a previous case of community-associated CRKP infection. What’s more, the 2 cases lived in the same ward with the latter and with adjacent beds, but the third case was non-homologous to the community-associated infection case. A total of 46 samples were collected from the environmental surfaces and the hands of healthcare workers, of which 7 samples tested positive for CRKP and were identical to the strains from the 2 healthcare-associated infection cases and the 1 community-associated infection case, originating from the bedrails, bedside tables, surface of non-invasive ventilator, bed curtains and panels of monitoring equipment, with a detection rate of 15.22%. But none of the 11 samples from the hands of healthcare workers tested positive for CRKP. The outbreak was effectively controlled after taking specific prevention and control measures such as strengthening personnel management, intensifying environmental cleaning and disinfection and strictly enforcing hand hygiene among healthcare workers. Subsequently, no similar new cases were reported during the 14-day follow-up period. ConclusionIncomplete environmental cleaning and disinfection, as well as inadequate enforcement of hand hygiene among heatheare workers may have contributed to the suspected outbreak of CRKP in the geriatric emergency ward. Early warning and timely investigation of suspected outbreaks of multidrug-resistant bacteria are crucial for preventing and controlling such outbreaks in hospitals.