OBJECTIVE To analyze the risk factors for positive culture of carbapenem-resistant Enterobacteriaceae(CRE)in the intensive care unit(ICU)patients so as to provide scientific technical support for early identification of the patients at high-risk of CRE colonization/infection in clinical practice.METHODS The clinical data and bac-terial culture data were collected from the ICU patients who were hospitalized in Beijing Friendship Hospital from 2021 to 2023 so as to build up retrospective cohorts.The risk factors for positive culture of CRE in the ICU pa-tients were screened out with the use of multivariate logistic regression model,and the predictive effect of the model was evaluated by means of receiver operating characteristic(ROC)curves and Hosmer-Lemeshow test.RESULTS Gastric tube indwelling history(OR=3.992,95％CI:1.894 to 8.121),wards of patients detected with CRE within 7 days during the stay(OR=3.518,95％CI:1.492 to 8.294),renal disease history(OR=2.063,95％CI:1.128 to 3.775),history of isolation of multidrug-resistant organisms(OR=2.400,95％CI:1.240 to 4.647)and use of carbapenem antibiotics(OR=1.141,95％CI:1.088 to 1.196)were the independent risk fac-tors for the positive culture of CRE in the ICU patients.The prediction model that was established based on the risk factors showed favorable discrimination,and the area under the ROC curve(AUC)was 0.773.The actual probability was comparatively consistent with the ideal probability,with the Hosmer-Lemeshow test(x2=9.274,P=0.233).CONCLUSION The model shows remarkable effect on prediction of positive culture of CRE in the ICU patients,and it has high value in early identification of the patients at high risk of CRE colonization/infection in clinical practice.

Objective To conduct microbiological monitoring before the operation of the purified water treatment system in a newly-built endoscopy center,comprehensively analyze the causes for the standard-exceeding results of microbial detection of final rinse water,propose solutions,and provide reference for handling similar events in the future.Methods Microbial detection data of the final rinse water in the newly-built digestive endoscopy center of a tertiary first-class general hospital in Beijing from April to July 2024 were monitored.The potential causes for standard-exceeding results of microbial detection of final rinse water were analyzed from the perspectives of equip-ment maintenance and management of the purified water treatment system as well as the improvement of cleaning and disinfection methods for the purified water supply pipeline in the endoscopy center,targeted improvement mea-sures were proposed accordingly.Results The microbial monitoring result of final rinse water in the newly-built di-gestive endoscopy center built in April 2024 was 1 400 CFU/100 mL,with the main bacterial type being Cupriavi-duspauculus.After five rounds of improvement measures and rechecks,microbial monitoring result of the final rinse water in the newly-built endoscopy center was 0 CFU/100 mL,with a qualification rate of 100％.Analysis suggested that the main causes for the standard-exceeding results of microbial detection of final rinse water were due to the damage of the reverse osmosis membrane,lack of cleaning for the pure water storage tank before use,and non-standard cleaning and disinfection process for the pure water supply pipeline,after targeted improvement,the problem was solved.Conclusion Medical institutions should continuously conduct periodic monitoring on water used for endoscope,regularly perform cleaning and disinfection of the purified water treatment system,standardize cleaning and disinfection procedures,ensure medical quality and patient safety.

OBJECTIVE To analyze the risk factors for positive culture of carbapenem-resistant Enterobacteriaceae(CRE)in the intensive care unit(ICU)patients so as to provide scientific technical support for early identification of the patients at high-risk of CRE colonization/infection in clinical practice.METHODS The clinical data and bac-terial culture data were collected from the ICU patients who were hospitalized in Beijing Friendship Hospital from 2021 to 2023 so as to build up retrospective cohorts.The risk factors for positive culture of CRE in the ICU pa-tients were screened out with the use of multivariate logistic regression model,and the predictive effect of the model was evaluated by means of receiver operating characteristic(ROC)curves and Hosmer-Lemeshow test.RESULTS Gastric tube indwelling history(OR=3.992,95％CI:1.894 to 8.121),wards of patients detected with CRE within 7 days during the stay(OR=3.518,95％CI:1.492 to 8.294),renal disease history(OR=2.063,95％CI:1.128 to 3.775),history of isolation of multidrug-resistant organisms(OR=2.400,95％CI:1.240 to 4.647)and use of carbapenem antibiotics(OR=1.141,95％CI:1.088 to 1.196)were the independent risk fac-tors for the positive culture of CRE in the ICU patients.The prediction model that was established based on the risk factors showed favorable discrimination,and the area under the ROC curve(AUC)was 0.773.The actual probability was comparatively consistent with the ideal probability,with the Hosmer-Lemeshow test(x2=9.274,P=0.233).CONCLUSION The model shows remarkable effect on prediction of positive culture of CRE in the ICU patients,and it has high value in early identification of the patients at high risk of CRE colonization/infection in clinical practice.

Objective To conduct microbiological monitoring before the operation of the purified water treatment system in a newly-built endoscopy center,comprehensively analyze the causes for the standard-exceeding results of microbial detection of final rinse water,propose solutions,and provide reference for handling similar events in the future.Methods Microbial detection data of the final rinse water in the newly-built digestive endoscopy center of a tertiary first-class general hospital in Beijing from April to July 2024 were monitored.The potential causes for standard-exceeding results of microbial detection of final rinse water were analyzed from the perspectives of equip-ment maintenance and management of the purified water treatment system as well as the improvement of cleaning and disinfection methods for the purified water supply pipeline in the endoscopy center,targeted improvement mea-sures were proposed accordingly.Results The microbial monitoring result of final rinse water in the newly-built di-gestive endoscopy center built in April 2024 was 1 400 CFU/100 mL,with the main bacterial type being Cupriavi-duspauculus.After five rounds of improvement measures and rechecks,microbial monitoring result of the final rinse water in the newly-built endoscopy center was 0 CFU/100 mL,with a qualification rate of 100％.Analysis suggested that the main causes for the standard-exceeding results of microbial detection of final rinse water were due to the damage of the reverse osmosis membrane,lack of cleaning for the pure water storage tank before use,and non-standard cleaning and disinfection process for the pure water supply pipeline,after targeted improvement,the problem was solved.Conclusion Medical institutions should continuously conduct periodic monitoring on water used for endoscope,regularly perform cleaning and disinfection of the purified water treatment system,standardize cleaning and disinfection procedures,ensure medical quality and patient safety.

Objective:To retrieve, evaluate and summarize the relevant evidence of subcutaneous injection in patients to reduce pain at the injection site, so as to provide reference for clinical practice.Methods:According to the evidence pyramid "6S" model, all evidence on subcutaneous injection and injection site pain, including guidelines, expert consensus, summary of evidence, clinical decision, systematic review, etc were retrieved from domestic and international guideline networks and databases. The search period was from database establishment to October 2, 2022. The literature quality evaluation and evidence grading system of Joanna Briggs Institute (JBI) Evidence-based Health Care Center was used to evaluate the literature quality and classify the evidence level.Results:A total of 12 articles were included, including 2 expert consensus, 6 systematic reviews, 2 best evidence summaries and 2 clinical guidelines. A total of 21 pieces of best evidence were summarized from 8 aspects, including pre-subcutaneous injection assessment, injection site, injection needle, injection position, injection method, precautions, personnel training and health education.Conclusions:This study summarized a comprehensive and practical subcutaneous injection method. Clinical practitioners can use evidence to administer subcutaneous injection to patients, reduce pain and improve patients ′ comfort.

ObjectiveTo explore the correlation between dryness and energy metabolism of Atractylodis Rhizoma， and to analyze the difference of medicinal properties between Atractylodes lancea and A. chinensis. MethodA total of 110 healthy SD rats were randomly divided into 11 groups， including normal group， volatile oil of A. lancea 1-5 group （S1-S5 group， doses of 447， 473， 442， 489， 496 mg·kg^-1） and volatile oil of A. chinensis 1-5 group （N1-N5 group， doses of 197， 118， 281， 222， 185 mg·kg^-1）， the administration volume was 0.01 mL·g^-1 with intragastric administration for 21 days. Dryness effect of A. lancea and A. chinensis on rats was evaluated by comparing the body weight， drinking water volume， urine volume， whole blood viscosity and pathological sections of submandibular gland stained with hematoxylin-eosin （HE）. The expression of aquaporin 2 （AQP2） in rat kidney was measured by immunohistochemistry， the mRNA expressions of cytochrome C oxidase subunit 7A2 （COX7A2） and succinate dehydrogenase （SDH） complex subunit D （SDHD） in liver tissue were detected by real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. The contents of SDH， lactate dehydrogenase （LDH） and sodium ion-potassium ion-adenosine triphosphatase （Na⁺-K⁺-ATPase） in rat plasma were determined by colorimetry. The quality of A. lancea and A. chinensis was evaluated by coefficient of variation method， and Pearson correlation coefficient was used to analyze the correlation between dryness and energy metabolism. ResultCompared with the normal group， the amounts of drinking water and urine in volatile oil of A. lancea group and volatile oil of A. chinensis group increased， and the submandibular gland acini atrophied， the whole blood viscosity of rats in the volatile oil of A. lancea group increased significantly （P<0.01）， the expression levels of COX7A2 and SDHD mRNA， the activities of SDH， LDH and Na⁺-K⁺-ATPase increased significantly （P<0.01）， and the expression of AQP2 in kidney decreased significantly （P<0.01）. Compared with the normal group， the expression level of COX7A2 mRNA， SDH activity and whole blood viscosity in the volatile oil of A. chinensis group increased （P<0.05， P<0.01）， the AQP2 and SDH mRNA expression levels， LDH and Na⁺-K⁺-ATPase activities had no significant difference. The comprehensive score analysis of each index showed that the effect of volatile oil of A. lancea on dryness and energy metabolism was stronger than that of volatile oil of A. chinensis， and there was a positive correlation between dryness index and energy metabolism index. ConclusionThe two indexes show that medicinal properties of A. lancea is stronger than that of A. chinensis， and energy metabolism is closely related to the dryness of Atractylodis Rhizoma. It is suggested that it is reasonable to evaluate the dryness effect of Atractylodis Rhizoma from the perspective of energy metabolism， which can further enrich the evaluation indexes of medicinal properties.

【Objective】 To investigate the clinical efficacy and safety of low-dose rituximab combined with dexamethasone in the treatment of refractory ITP (RITP) in children. 【Methods】 A total of 31 RITP children, admitted to the Hematology Department of Kunming Children′s Hospital from January 2016 to December 2019 and agreed to receive low-dose rituximab (100 mg/ time, once a week, for 4 successive weeks) combined with dexamethasone (0.6 mg/kg, once a day, for 4 successive days) were enrolled and studied. Blood routine was monitored every other day during treatment, and adverse drug reactions were recorded. The influence of gender, disease course and age on prognosis was compared by χ² test. 【Results】 1) Among the 31 cases, 11 (35.5%) had platelets >100×10⁹/L after 4 weeks and had no recurrence in 6 months; 9 (29%) had platelets >30×10⁹/L but <100×10⁹/L and had no recurrence in 6 months; 11 (35.5%) showed no recovery of platelets, which were consistently lower than 30×10⁹/L. 2) Rituximab was used in 4 cases (12.9%), 1 case (3.2%) presented with severe drug-induced rashes; Headache, vomiting and elevated blood pressure occurred in 2 cases (6.4%). 1 case (3.2%) presented with laryngeal edema. 3) There was no difference in the total effective rate among different gender, age and disease course (P >0.05). 【Conclusion】 The total effective rate of low-dose rituximab combined with dexamethasone for children with refractory ITP in 6 months is 64.5%, and the adverse reactions are tolerable, so it can be used as a treatment option for children with refractory ITP.

Objective To study the clinical effect of psychological intervention combined with oral administration of aminoglucose hydrochloride capsules combined with intra-articular injection of sodium hyaluronate combined with functional exercise in the treatment of knee osteoarthritis.Methods Forty-eight patients with knee osteoarthritis were randomLy divided into control group and study group(n=39).The patients were randomLy divided into control group and study group.The control group was given intraperitoneal injection of sodium hyaluronate combined with functional exercise, the study group on the basis of the control group to give psychological intervention and oral administration of aminoglucose capsules combined therapy.Comparison of two groups of Lysholm knee function score and postoperative efficacy.Results The scores of Lysholm knee function were significantly improved after treatment, but the improvement rate of the study group was significantly better than that of the control group (P<0.05).The clinical effect of the study group was significantly better than that of the control group(94.87% vs 43.59%).The difference was statistically significant (P<0.05).Conclusion The combination of psychological intervention combined with oral administration of aminoglucose capsules with intraperitoneal injection of sodium hyaluronate combined with functional exercise in the treatment of knee osteoarthritis can significantly improve the clinical efficacy, improve the knee function and improve the prognosis, worthy of clinical application and promotion.

Objective To explore the clinical effect of calcium and calcium combined with psychological intervention on elderly patients with osteoporosis and pain.Methods The control group was given routine drug treatment (Miacalcic+Caltrate D), the study group of osteoporosis pain in patients with psychological intervention in the conventional miacacic+Caltrate D treatment on the basis of records of two groups of VAS, SDS, SAS, SF-36 scale score changes (before and after treatment).Results After treatment, two groups of SF-36 scale scores were significantly increased than before, while the VAS scale was significantly lower than before, the quality of life of the study group the degree of pain, improve the effect of better (P<0.05);the research group after treatment SDS, SAS score than before the decline than the control group (P<0.05).Conclusion The application of calcium dense combined with psychological intervention in the treatment of elderly patients with osteoporosis pain is beneficial to achieve more satisfactory pain relief effect, and significantly alleviate the corresponding negative emotions.

Objective To investigate the way that nasopharyngeal carcinoma (NPC) and NPC stem cells develops resistance to cisplatin through anti-reactive oxygen species mechanism. Methods Using CCK-8 cell counting kit, we measured the half inhibitory concentration of cisplatin against NPC cellsCNE-2and NPC stem cellsCNE-2S, and compared their resistant index. We examined the differences in the reactive oxygen species (ROS) levels, total glutathi?one (GSH) levels, and total superoxide dismutase (SOD) levels between CNE-2 and CNE-2S at different concentrations of cisplatin administration (0.1,0.5 and 1.0μmol·L-1). Using q-PCR, we determined the mRNA expression level of GSS, GCLC, GCLM, SOD1 and SOD2 after 48 hours administration of cisplatin at 1 μmol · L-1. Protein expression level of SOD2 was also tested using Western Blot after 48 hours administration of cisplatin at 1μmol · L-1. Upon silencing the SOD2 in NPC cell through siRNA, Trypan blue was used to analyze cell survival after cisplatin was administrated at 1μmol · L-1. Results The inhibition concentration of cisplatin against CNE-2 was higher than that against CNE-2S (μmol · L-1:9.8 ± 1.1 vs 2.4 ± 0.6,P<0.05). ROS levels in CNE-2 and CNE-2S both rise with cisplatin administration, but ROS levels of CNE-2 before and after cisplatin treatment were both higher than those in CNE-2S (P<0.05). The total gluta?thione levels in CNE-2 and CNE-2S were both increased after 1μmol·L-1 cisplatin treatment but there is no significant dif?ference in levels of glutathione between these two cell lines. After treated with cisplatin, SOD level were increased in both CNE-2S and CNE-2, but it is higher in CNE-2S than that in CNE-2 (P<0.05). The mRNA levels of GSS, GCLC, GCLM, and SOD1 were not different significantly between in CNE-2 and in CNE-2S with or without cisplatin treatment. However, SOD2 in CNE-2S were higher than that in CNE-2 on both mRNA and protein levels (P<0.05). Silenced SOD2 disrupted the resistance of cisplatin in CNE-2S. Conclusion These data suggest that NPC stem cells (CNE-2S) enhance its drug re?sistance to cisplatin through highly expression of SOD2 which posed anti-ROS capacity.