Objective: To analyze the physical and chemical properties of human gastric factor by bioinformatics method , and to express and purify the protein. Methods: Protein online analysis software was used to predict the physical and chemical properties of gastric intrinsic factor and analyze their hydrophilicity and hydrophobicity. The online tool was used to predict and analyze the human gastric factor signal peptide and its subcellular location . The eukaryotic expression recombinant plasmid pcDNA3 . 1 ( + ) _human GIF_His tag was constructed , and the gastric intrinsic factor was purified by nickel column after expression in HEK293F cells . The purity and activity of purified gastric intrinsic factor were verified by SDS_PAGE , Western blot and indirect ELISA . Results: Gastric factor contained 417 amino acids and was a hydrophilic acid stable protein . It was a secreted protein with Sec original signal peptide . pcDNA3 . 1 ( + ) _human GIF_His tag recombinant plasmid was successfully constructed and soluble expression was obtained in HEK293F cell expression system. Conclusion The eukaryotic source of human gastric intrinsic factor is successfully prepared , and the bioinformatics results show that the protein is a hydrophilic acid stable secreted protein , laying a foundation for the subsequent use of this protein as an immunogen and protein calibrator to construct an immunoassay for gastric factor.

OBJECTIVE To explore the implementation and standardized management of infection control core ele-ments in grass-roots medical institutions within county-level medical communities.METHODS From Mar.2024 to Apr.2024,the current status of implementation of infection control core elements in the grass-roots medical institu-tions within county-level medical communities was investigated by means of questionnaire survey and qualita-tive interview,and the implementation strategies were further explored.RESULTS The infection management or-ganizational system and functions of the two county-level medical institutions within the county medical communi-ties were completed,there is no independent hospital infection management department in the primary medical in-stitutions.The infection management personnel in the 16 grass-roots medical institutions were part-time person-nel,the personnel with the educational background below junior college accounted for 84.21％,the personnel with the professional background of nursing accounted for 100.00％,the personnel with less than 5 years of working experience accounted for 78.95％,none of them had an on-the-job training certificate.The monitoring programs of the county-level medical institutions within the county medical communities were completed,there was no infec-tion management monitoring information platform in the grass-roots medical institutions.The infection cases,hand hygiene,environmental health and occupational exposures were monitored by people.The grass-roots medi-cal institutions had the highest requirements for various professional trainings and increase of training contents of prevention and control of public health infectious diseases(100.00％).The county-level medical institutions had inadequate capabilities of professional examination of medical equipment replacement and construction of medi-cal architecture.CONCLUSION It is necessary for the country and local levels of governments to attach great importance to the implementation of the infection control core elements in the grass-roots medical institutions within the county-lev-el medical communities,establish the county-level regional information platform,formulate the corresponding surveil-lance indexes and homogenized management systems,complete the cultivation of talents,and offer financial support.

OBJECTIVE To explore the current status of surveillance data of nosocomial infections in a three-A hos-pital of Jiangsu Province and find out the problems in prevention and control of the nosocomial infection so as to provide scientific bases for formulating targeted prevention strategies.METHODS The related data of all infection cases from Changzhou First People's Hospital between 2014 and 2023 were exported from information real-time surveillance system and were analyzed by using Excel 2021 and R 4.3.2 software.RESULTS The average incidence rate of hospital-associated infection was 1.32％from 2014 to 2023,declining from 2.11％in 2014 to 0.97％in 2023,and it showed a downward trend(Z=-30.010,P＜0.001).The incidence rate of hospital-associated infec-tion was 19.86％in neurosurgery department(Z=-3.041,P=0.002),10.27％in hematology department(Z=5990,P＜0.001),8.85％in neurology department(Z=-1.437,P=0.151),7.00％in critical care medicine de-partment(Z=5.907,P＜0.001),6.28％in gastrointestinal surgery department(Z=-4.435,P＜0.001),thorac-ic surgery department(Z=1.696,P=0.090),4.52％in cardiothoracic surgery department(Z=13.218,P＜0.001),2.95％in oncology department(Z=9.064,P＜0.001).Among the patients with hospital-associated infec-tions,the patients with lower respiratory tract infection accounted for 46.71％(the highest),increasing from 34.94％to 51.67％(Z=12.532,P＜0.001),the patients with upper respiratory tract infection 10.37％(Z=-10.229,P＜0.001),the patients with urinary tract infection 6.92％(Z=1.489,P=0.137),the patients with urinary catheter-related infection 3.71％(Z=13.218,P=0.317).Totally 13,593 strains of pathogens were isola-ted,65.26％of which were gram-negative bacteria and did not show a significant changing trend,24.62％were gram-positive bacteria,and 10.12％were fungi;Klebsiella pneumoniae(15.76％)and Acinetobacter baumannii(15.34％)were the predominant species of the gram-negative bacteria;Staphylococcus aureus(8.37％)and Corynebacterium striatum(3.60％)were dominant among the gram-positive bacteria;Candida albicans(5.13％)and Candida tropicalis(0.96％)were the major species of the fungi.The percentage of central venous catheteriza-tion was the highest(27.04％)among the risk factors for the hospital-associated infection,increasing from 14.87％to 21.75％(Z=17.482,P＜0.001).CONCLUSIONS The control of hospital-associated infection has been made remarkable achievement.It is necessary to strengthen the construction of infection control team,push for-ward the whole process and delicacy management,normalize the use of antibiotics,reduce the unnecessary inva-sive procedures and shorten the duration of invasive operations so as to further improve the medical quality.

Objective To understand the economic losses due to healthcare-associated infection(HAI)in patients after Da Vinci robotic thoracic surgery,and provide basis for preventing and controlling HAI after robotic surgery.Methods Patients who underwent Da Vinci robotic surgery from April 2019 to April 2023 were retrospective stu-died.Patients were divided into HAI group and non-HAI group based on the occurrence of postoperative infection.Through 1∶1 propensity score matching(PSM),31 cases were included in each group,economic losses of two groups of patients were compared.Results A total of 921 patients who underwent Da Vinci robotic thoracic surgery were included in the study,51 cases with HAI(HAI group)and 870 without HAI(non-HAI group).After 1∶1 PSM,31 cases were included in each group.Four covariates were compared between two groups of patients before PSM,namely gender,age,comorbidities,and the American Society of Anesthesiologists(ASA)grading,all with statistically significant differences(all P＜0.05).After PSM,distribution of the above covariates reached equilib-rium between the two groups(both P＞0.05).The median total expense for HAI group before PSM during hospi-talization was 88 711.72 Yuan,while 78 509.46 Yuan for the non-HAI group.The direct economic losses caused by HAI after Da Vinci robot surgery was 10 202.26 Yuan,mainly increased by expense of medicine,nursing,laborato-ry diagnosis,etc.Difference in western medicine expense was the highest(8 839.12 Yuan),out of which expense of antimicrobial agents accounted for the highest proportion(73.55％).Difference in daily hospitalization expense between HAI-group and non-HAI group was 502.38 Yuan.Length of hospital stay of patients in HAI group and non-HAI group were(21.59±10.62)and(13.92±9.21)days,respectively,with statistical differences(all P＜0.05).Conclusion The occurrence of HAI in patients undergoing Da Vinci robotic thoracic surgery leads to direct economic losses,with obvious increases in expenses of nursing,laboratory diagnosis,western medicine(mainly an-timicrobial agents).Length of hospital stay of patients also prolongs.

OBJECTIVE To explore the implementation and standardized management of infection control core ele-ments in grass-roots medical institutions within county-level medical communities.METHODS From Mar.2024 to Apr.2024,the current status of implementation of infection control core elements in the grass-roots medical institu-tions within county-level medical communities was investigated by means of questionnaire survey and qualita-tive interview,and the implementation strategies were further explored.RESULTS The infection management or-ganizational system and functions of the two county-level medical institutions within the county medical communi-ties were completed,there is no independent hospital infection management department in the primary medical in-stitutions.The infection management personnel in the 16 grass-roots medical institutions were part-time person-nel,the personnel with the educational background below junior college accounted for 84.21％,the personnel with the professional background of nursing accounted for 100.00％,the personnel with less than 5 years of working experience accounted for 78.95％,none of them had an on-the-job training certificate.The monitoring programs of the county-level medical institutions within the county medical communities were completed,there was no infec-tion management monitoring information platform in the grass-roots medical institutions.The infection cases,hand hygiene,environmental health and occupational exposures were monitored by people.The grass-roots medi-cal institutions had the highest requirements for various professional trainings and increase of training contents of prevention and control of public health infectious diseases(100.00％).The county-level medical institutions had inadequate capabilities of professional examination of medical equipment replacement and construction of medi-cal architecture.CONCLUSION It is necessary for the country and local levels of governments to attach great importance to the implementation of the infection control core elements in the grass-roots medical institutions within the county-lev-el medical communities,establish the county-level regional information platform,formulate the corresponding surveil-lance indexes and homogenized management systems,complete the cultivation of talents,and offer financial support.

OBJECTIVE To observe the isolation rates and drug resistance rates of Acinetobacter baumannii strains isolated from intensive care unit(ICU)patients in 8 consecutive years so as to provide bases for reasonable clinical application of antibiotics and control of infections.METHODS The isolation rates and specimens from which the A.baumannii and carbapenem-resistant A.baumannii(CRAB)strains were isolated from ICU patients of the First People's Hospital of Changzhou between 2017 and 2024 were retrospectively analyzed.The trends of the drug resistance rates were observed.RESULTS Totally 2078(18.03％)strains of A.baumannii were isolated from the ICU patients from 2017 to 2024,and there was no significant difference in the changing trend among the years(x2=-1.573,P=0.116).Among the A.baumannii strains that were isolated from 2017 to 2024,58.08％were isolated from sputum,and 24.25％from lavage fluid specimens;the percentage of sputum specimens showed a downward trend in the 8 years(x2=-8.257,P＜0.001),while the percentage of lavage fluid speci-mens showed an upward trend(x2=12.964,P＜0.001).The isolation rate of the CRAB strains was 91.48％in 2017,92.61％in 2018,92.56％in 2019,82.53％in 2020,52.44％in 2021,showing a down-ward trend,and it began to rise in 2022-2024,there was significant difference(x2=-2.277,P=0.012).The isolation rates of the CRAB strains from both sputum and lavage fluid specimens showed downward trends and then upward trends(all P＜0.05).The drug resistance rates of the A.baumannii strains to piperacillin and minocycline showed slow upward trends,while the drug resistance rates to gentamicin and tigecycline showed downward trends,and there were significant differences(P＜0.05).The drug resistance rates of the A.bau-mannii strains to imipenem and meropenem remained more than 90％.CONCLUSIONS Acinetobacter spp is the major pathogen causing the hospital-acquired infection.The isolation rate of CRAB strains shows a downward trend then a upward trend in recent two years.It is necessary for the hospital to standardize the submission of spu-tum specimens and increase the aseptic submission.The A.baumannii strains show high drug resistance rates to the commonly used antibiotics.Polymyxin B,tigecycline and minocycline are the major antibiotics for treatment of CRAB infection.

OBJECTIVE To observe the isolation rates and drug resistance rates of Acinetobacter baumannii strains isolated from intensive care unit(ICU)patients in 8 consecutive years so as to provide bases for reasonable clinical application of antibiotics and control of infections.METHODS The isolation rates and specimens from which the A.baumannii and carbapenem-resistant A.baumannii(CRAB)strains were isolated from ICU patients of the First People's Hospital of Changzhou between 2017 and 2024 were retrospectively analyzed.The trends of the drug resistance rates were observed.RESULTS Totally 2078(18.03％)strains of A.baumannii were isolated from the ICU patients from 2017 to 2024,and there was no significant difference in the changing trend among the years(x2=-1.573,P=0.116).Among the A.baumannii strains that were isolated from 2017 to 2024,58.08％were isolated from sputum,and 24.25％from lavage fluid specimens;the percentage of sputum specimens showed a downward trend in the 8 years(x2=-8.257,P＜0.001),while the percentage of lavage fluid speci-mens showed an upward trend(x2=12.964,P＜0.001).The isolation rate of the CRAB strains was 91.48％in 2017,92.61％in 2018,92.56％in 2019,82.53％in 2020,52.44％in 2021,showing a down-ward trend,and it began to rise in 2022-2024,there was significant difference(x2=-2.277,P=0.012).The isolation rates of the CRAB strains from both sputum and lavage fluid specimens showed downward trends and then upward trends(all P＜0.05).The drug resistance rates of the A.baumannii strains to piperacillin and minocycline showed slow upward trends,while the drug resistance rates to gentamicin and tigecycline showed downward trends,and there were significant differences(P＜0.05).The drug resistance rates of the A.bau-mannii strains to imipenem and meropenem remained more than 90％.CONCLUSIONS Acinetobacter spp is the major pathogen causing the hospital-acquired infection.The isolation rate of CRAB strains shows a downward trend then a upward trend in recent two years.It is necessary for the hospital to standardize the submission of spu-tum specimens and increase the aseptic submission.The A.baumannii strains show high drug resistance rates to the commonly used antibiotics.Polymyxin B,tigecycline and minocycline are the major antibiotics for treatment of CRAB infection.

OBJECTIVE To explore the current status of surveillance data of nosocomial infections in a three-A hos-pital of Jiangsu Province and find out the problems in prevention and control of the nosocomial infection so as to provide scientific bases for formulating targeted prevention strategies.METHODS The related data of all infection cases from Changzhou First People's Hospital between 2014 and 2023 were exported from information real-time surveillance system and were analyzed by using Excel 2021 and R 4.3.2 software.RESULTS The average incidence rate of hospital-associated infection was 1.32％from 2014 to 2023,declining from 2.11％in 2014 to 0.97％in 2023,and it showed a downward trend(Z=-30.010,P＜0.001).The incidence rate of hospital-associated infec-tion was 19.86％in neurosurgery department(Z=-3.041,P=0.002),10.27％in hematology department(Z=5990,P＜0.001),8.85％in neurology department(Z=-1.437,P=0.151),7.00％in critical care medicine de-partment(Z=5.907,P＜0.001),6.28％in gastrointestinal surgery department(Z=-4.435,P＜0.001),thorac-ic surgery department(Z=1.696,P=0.090),4.52％in cardiothoracic surgery department(Z=13.218,P＜0.001),2.95％in oncology department(Z=9.064,P＜0.001).Among the patients with hospital-associated infec-tions,the patients with lower respiratory tract infection accounted for 46.71％(the highest),increasing from 34.94％to 51.67％(Z=12.532,P＜0.001),the patients with upper respiratory tract infection 10.37％(Z=-10.229,P＜0.001),the patients with urinary tract infection 6.92％(Z=1.489,P=0.137),the patients with urinary catheter-related infection 3.71％(Z=13.218,P=0.317).Totally 13,593 strains of pathogens were isola-ted,65.26％of which were gram-negative bacteria and did not show a significant changing trend,24.62％were gram-positive bacteria,and 10.12％were fungi;Klebsiella pneumoniae(15.76％)and Acinetobacter baumannii(15.34％)were the predominant species of the gram-negative bacteria;Staphylococcus aureus(8.37％)and Corynebacterium striatum(3.60％)were dominant among the gram-positive bacteria;Candida albicans(5.13％)and Candida tropicalis(0.96％)were the major species of the fungi.The percentage of central venous catheteriza-tion was the highest(27.04％)among the risk factors for the hospital-associated infection,increasing from 14.87％to 21.75％(Z=17.482,P＜0.001).CONCLUSIONS The control of hospital-associated infection has been made remarkable achievement.It is necessary to strengthen the construction of infection control team,push for-ward the whole process and delicacy management,normalize the use of antibiotics,reduce the unnecessary inva-sive procedures and shorten the duration of invasive operations so as to further improve the medical quality.

Objective To understand the economic losses due to healthcare-associated infection(HAI)in patients after Da Vinci robotic thoracic surgery,and provide basis for preventing and controlling HAI after robotic surgery.Methods Patients who underwent Da Vinci robotic surgery from April 2019 to April 2023 were retrospective stu-died.Patients were divided into HAI group and non-HAI group based on the occurrence of postoperative infection.Through 1∶1 propensity score matching(PSM),31 cases were included in each group,economic losses of two groups of patients were compared.Results A total of 921 patients who underwent Da Vinci robotic thoracic surgery were included in the study,51 cases with HAI(HAI group)and 870 without HAI(non-HAI group).After 1∶1 PSM,31 cases were included in each group.Four covariates were compared between two groups of patients before PSM,namely gender,age,comorbidities,and the American Society of Anesthesiologists(ASA)grading,all with statistically significant differences(all P＜0.05).After PSM,distribution of the above covariates reached equilib-rium between the two groups(both P＞0.05).The median total expense for HAI group before PSM during hospi-talization was 88 711.72 Yuan,while 78 509.46 Yuan for the non-HAI group.The direct economic losses caused by HAI after Da Vinci robot surgery was 10 202.26 Yuan,mainly increased by expense of medicine,nursing,laborato-ry diagnosis,etc.Difference in western medicine expense was the highest(8 839.12 Yuan),out of which expense of antimicrobial agents accounted for the highest proportion(73.55％).Difference in daily hospitalization expense between HAI-group and non-HAI group was 502.38 Yuan.Length of hospital stay of patients in HAI group and non-HAI group were(21.59±10.62)and(13.92±9.21)days,respectively,with statistical differences(all P＜0.05).Conclusion The occurrence of HAI in patients undergoing Da Vinci robotic thoracic surgery leads to direct economic losses,with obvious increases in expenses of nursing,laboratory diagnosis,western medicine(mainly an-timicrobial agents).Length of hospital stay of patients also prolongs.

Objective:To explore the application value of histogram and texture feature analysis based on CT images in distinguishing long bone osteosarcoma (OS) from Ewing sarcoma (ES).Methods:A retrospective collection of 25 patients with long bone osteosarcoma and 25 patients with Ewing sarcoma confirmed by surgery and pathology in National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Qilu Hospital of Shandong University and Nanjing Drum Tower Hospital, Nanjing University Medical School, from March 2018 to May 2023 was conducted. All patients were randomly divided into a training set (21 cases of OS and 19 cases of ES) and a validation set (4 cases of OS and 6 cases of ES) in an 8∶2 ratio. The region of interest (ROI) on CT images to extract texture feature parameters was manually sketched. Random forest and least absolute shrinkage and selection operator (LASSO) algorithm were used for feature screening. Logistic regression (LR), random forest (RF), support vector machine (SVM) and K-nearest neighbor (KNN) classifiers were used to establish models respectively. Receiver operating characteristic (ROC)curve was drawn and area under the curve (AUC) was calculated to evaluate the diagnostic efficiency of the four models.Results:A total of 100 texture parameters were extracted from CT images, and 8 feature parameters (maximum 3D diameter, 10th percentile, kurtosis, maximum pixel intensity value, inverse normalization, grayscale level variance, long range high grayscale emphasis, and low grayscale area emphasis) were obtained through screening. Four classifiers were used to establish models, and the AUC values of the four models (LR, RF, SVM, KNN) in the validation group were 0.92, 0.79, 0.83, and 0.73, respectively. LR and SVM classifier algorithm trains models had high diagnostic efficiency, with an accuracy of 90%, sensitivity of 83%, specificity of 100%, and AUC of 92% for the LR classifier validation set; the accuracy of SVM classifier validation set was 80%, sensitivity was 67%, specificity was 100%, and AUC was 83%.Conclusions:LR and SVM models have high value in distinguishing OS and ES.