【Objective】 To study the safety, effectiveness and nursing of blood/fluid warmer during the process of plateletpheresis in winter. 【Methods】 The blood re-transfusion speed during plateletpheresis in winter and the time of blood passing through the blood return pipeline was counted. The vitro blood was heated with a blood/fluid warmer under different temperature settings, and the rising speed of blood temperature was recorded. The blood samples were tested for blood routine examination, free Hb and erythrocyte morphology at 0, 15 and 30 minutes. In the process of plateletpheresis in winter, the blood donors′ ear temperature and the skin temperature near the reinfusion needle in the observation group and the controls were measured, and the blood donors were observed for shivering, arm chills, pain or other discomfort. After the blood donation, the thermal comfort was evaluated. 【Results】 There was no difference in the results of routine blood test and plasma free Hb test of vitro blood after warming at 41℃, 42℃ and 43℃ for 0, 15 and 30 minutes (P>0.05), and no change in erythrocyte morphology was found. The skin temperature near the reinfusion needle (before vs. after the start of phlebotomy) was statistically different by applying blood/fluid warmer or not(P<0.05), and no difference in the temperature between the start and end of phlebotomy was observed in the observation group(P>0.05). The vitro blood heating experiment showed that when the room temperature was within 22~24℃, the blood retransfusion speed was (100-120) mL/min; after the application of blood/fluid warmer, the temperature of reinfusion blood could be raised from 27℃ to 33~37℃. The proportion of feeling comfortable and very comfortable and the score of thermal comfort in the blood donors who used the warmer were higher than those in the controls (P<0.05). When the temperature of the warmer was set above 38℃, the average score of thermal comfort of blood donors was above 8. 【Conclusion】 It is safe to apply the blood/fluid warmer during the plateletsapheresis in winter, which can significantly improve the comfort of blood donors and reflect the humanized service of blood stations, and is worth popularizing.

Objective:To investigate the differential expression of four-jointed box kinase 1 (FJX1) gene in colorectal cancer and its relationship with prognosis and the related mechanisms.Methods:On July 16, 2021, the transcriptome data and clinical data of colorectal cancer were downloaded from The Cancer Genome Atlas (TCGA) database to analyze the expressions of FJX1 mRNA in colorectal cancer tissues and paracancerous tissues, and the relationship between FJX1 mRNA and clinicopathological characteristics and prognosis of patients. Receiver operating characteristic (ROC) curve was drawn to evaluate the value of FJX1 mRNA in predicting the survival of patients with colorectal cancer. Cox proportional hazards model was used to evaluate whether FJX1 mRNA was an independent influencing factor for prognosis of colorectal cancer. The overall survival (OS) time and survival status of colorectal cancer patients were downloaded from the Gene Expression Omnibus (GEO) database, and the relationship between FJX1 mRNA and prognosis of patients was analyzed. The methylation data of colorectal cancer was downloaded from the University of California, Santa Cruz (UCSC xena) database to determine the degree of methylation at each site of FJX1 mRNA and the correlation between the expression of FJX1 mRNA and the degree of methylation at each site. Signaling pathways associated with FJX1 mRNA in colorectal cancer were analyzed by using the Gene Set Enrichment Analysis (GSEA) (4.1.0). The correlation between FJX1 mRNA and tumor-infiltrating immune cells was investigated by using the Tumor Immunity Evaluation Resource (TIMER) database. Spearman analysis and small molecule/drug sensitivity analysis were used to explore the correlation between FJX1 mRNA expression and drug sensitivity.Results:In the transcriptome data of 612 colorectal cancer cases in TCGA database, the expression of FJX1 mRNA in colorectal cancer tissues was higher than that in the paracancerous tissues ( P < 0.001). In 549 colorectal cancer patients with complete data, FJX1 mRNA expression was correlated with M stage ( P = 0.007), pathological stage (stage Ⅳ vs. stage Ⅰ, P = 0.016; stage Ⅳ vs. stage Ⅱ, P = 0.03; stage Ⅳ vs. stage Ⅲ, P = 0.012), but it was not correlated with age, gender, T stage and N stage (all P > 0.05). In TCGA database and GEO database, the patients were divided into high expression group and low expression group according to the median expression of FJX1 mRNA. The OS in FJX1 mRNA high expression group was worse than that in low expression group (all P<0.05). The ROC curve of FJX1 mRNA expression on the 1-, 3-, and 5-year OS rates of colorectal cancer patients was drawn by using the data in TCGA database, and the areas under the curve (AUC) were 0.595, 0.625 and 0.764, respectively. Multivariate Cox regression analysis showed that age ( HR = 1.050, 95% CI 1.028-1.073, P < 0.001), T stage ( HR = 1.787, 95% CI 1.090-2.927, P = 0.021) and high FJX1 mRNA expression ( HR = 1.160, 95% CI 1.049-1.282, P = 0.004) were independent influencing factors for poor OS in colorectal cancer. The gene set enrichment analysis found that FJX1 mRNA was related to colorectal cancer, TGF-β signaling pathway, VEGF signaling pathway, Wnt signaling pathway, etc. The expression of FJX1 mRNA in colon cancer was negatively correlated with the degree of methylation of FJX1 mRNA ( r = -0.16, P < 0.001), and the expression of FJX1 mRNA in rectal cancer was positively correlated with the degree of methylation of FJX1 mRNA ( r = 0.33, P < 0.001). The expression of FJX1 mRNA was related to the infiltration of resting memory CD4 + T cells, M0 macrophages and resting dendritic cells. FJX1 mRNA was significantly associated with the resistance of various chemotherapeutic drugs and tumor-targeted drugs such as methotrexate, 5-fluorouracil, gefitinib, etc. Conclusions:FJX1 mRNA may be a potential biomarker of colorectal cancer and is associated with the infiltration of immune cells.

Objective To understand the current status of healthcare-associated infections (HAI) among inpatients in medical institutions of Wuhan, and to provide a scientific basis for improving the management of healthcare-associated infections. Methods A combined method of bedside investigation and case review of the patients’ medical records were used to investigate all hospitalized patients in 31 hospitals. Results A total of 42 429 inpatients were investigated, of whom 938 had HAI (2.21%), and 7 561 had community-associated infection (CAI, 17.82%). The top three departments with the highest prevalence rate of HAI were ICU (17.95%), hematology (8.49%), and neurosurgery (6.57%), while the top three departments with the highest prevalence rate of CAI were burns (75.00%), pediatric non-neonatal group (70.26%) and respiratory department (67.53%). Both healthcare-associated infections and community infections were mainly in the lower respiratory tract, which accounted for 47.33% and 53.00%, respectively. The main pathogens of both HAI and CAI were Gram-negative bacteria, which accounted for 65.03% and 57.73%, respectively. The use rate of antimicrobial drugs was 31.74%, and the detection rate of pathogenic bacteria before antimicrobial treatment was 55.77%. The three departments with the highest rates of the use of antibacterial drugs were the pediatric non-neonatal group (78.20%), the department of burns (75.00%) and the department of urology (73.24%). Conclusion ICU, hematology department, and neurosurgery department were high-risk departments for healthcare-associated infections. Pediatrics, burns, and urology departments were the departments with high use of antibacterial drugs. The pathogenic bacterial detection rate has declined, which needs to be strengthened.

Objective:To observe the effect of autologous platelet-rich plasma (PRP) combined with Meek microskin grafts in repairing the wounds of limbs in severely burned patients, and to explore the mechanism.Methods:The prospective controlled research method was used. From September 2016 to January 2020, 16 patients aged 18-69 years, with extensive deep burns, including 9 males and 7 females, who met the selection criteria were admitted to the Department of Burns and Plastic Surgery of the 909th Hospital of the Joint Logistic Support Force of PLA. The bilateral limbs with similar injury in 8 patients were divided into Meek skin grafting+PRP group and Meek skin grafting alone group according to the random number table; in the other 8 patients, the limbs with severer injury were included in Meek skin grafting+PRP group, and the limbs on the other side were included in Meek skin grafting alone group. The wounds of affected limbs in the two groups were treated correspondingly. On post surgery day (PSD) 10, the survival and fusion of Meek microskin grafts were observed and the survival rate and fusion rate were calculated; the histological morphology and the angiogenesis of the basal tissue of Meek microskin graft were observed by hematoxylin-eosin staining and immunohistochemical staining, respectively, with the microvessels being counted. Data were statistically analyzed with paired sample t test. Results:On PSD 10, the wounds of affected limbs in Meek skin grafting+PRP group were dry, and most of the transplanted skin grafts were closely adhered to the basal tissue; while a small amount of exudate could be found in the wounds of affected limbs in Meek skin grafting alone group, and a small part of the transplanted microskin grafts fell off or poorly attached to the basal tissue. On PSD 10, the survival rate and the fusion rate of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group were (94±3)% and (86±4)%, which were significantly higher than (89±4)% and (79±4)% of Meek skin grafting alone group, respectively ( t=3.633, 4.229, P<0.01). On PSD 10, the basal epidermis was closely connected with dermis of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group, with more inflammatory cell infiltration and active microvascular hyperplasia, while the basal epidermis was less closely connected with dermis of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting alone group, with obvious degeneration of collagen fibers under the dermis, less inflammatory cell infiltration, and slightly poor microvascular hyperplasia. On PSD 10, the distribution of microvessels in basal tissue of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group were densely clustered, while the distribution of microvessels in Meek skin grafting alone group were scattered, sparse, and dotted. On PSD 10, the number of microvessels in basal tissue of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group was 36±6 in each 400-fold visual field, which was significantly more than 29±7 of Meek skin grafting alone group ( t=2.671, P<0.05). Conclusions:Autologous PRP can effectively promote the survival rate and fusion rate of Meek microskin grafts in the wounds of limbs after escharectomy in severely burned patients by promoting angiogenesis at the base of Meek microskin grafts.

Objective:To observe the effectiveness of bone cement-enhanced proximal femoral nail antirotation (PFNA) in the treatment of severe osteoporotic intertrochanteric fracture.Methods:Between January 2016 and June 2017, 23 patients with severe osteoporotic intertrochanteric fracture were treated with bone cement-enhanced PFNA at Department of Orthopaedics, The Second Affiliated Hospital to Luohe Medical College. They were 9 men and 14 women with an average age of 85.3 years (range, from 80 to 91 years). According to AO/OTA-2018 classification, there were 2 cases of type 31-A1.3, 5 cases of type 31-A2.2, 13 cases of type 31-A2.3 and 3 cases of type 31-A3.3. According to Singh standard grading, 4 cases were rated as level 1, 16 cases as level 2 and 3 cases as level 3. The PFNA fixation was enhanced by bone cement in all. The operation time, amount of intraoperative bleeding, postoperative complications, fracture healing time and hip Harris scores at the last follow-up were recorded.Results:The operation time averaged 56.3 minutes (range, from 47 to 91 minutes) and the amount of intraoperative bleeding 197 mL (range, from 110 to 450 mL). All patients were followed up for 5 to 27 months (mean, 14.7 months). One patient who had been rated as good by the Harris hip score died 5 months after surgery because of acute suppurative obstructive cholangitis. All the 23 fractures achieved bony union. The healing time averaged 11.3 weeks (range, from 8 to 18 weeks). By the Harris scores at the last follow-up, 11 cases were excellent, 10 cases good and 2 cases fair, giving an excellent and good rate of 91.3%.Conclusion:Bone cement-enhanced PFNA can bring about good short-term outcomes for severe osteoporotic intertrochanteric fractures because it can improve the screw control and reduce the risk of internal fixation failure.

Objective To summarize and analyze the clinical features,diagnostic methods and treatment measures of patients with advanced spontaneous esophageal rupture. Methods Retrospective analysis of clinical characteristics of 10 patients with advanced spontaneous esophageal rupture was conducted. Results The average age of the patients was 49. 3 years old. The average time of diagnosis was 82. 6 hours. The cause of onset was drastic vomiting except for one case falling down. The main clinical manifestations were chest pain,abdominal pain,and shortness of breath,fever and elevation of hemogram,pleural effusion appeared in all patients,1 case was not treated in time,and 9 cases of the first checks were delayed for diagnosis and treatment in other specialties. Conservative treatment(closed thoracic drainage,gastrointestinal decompression,enteral nutrition support and antimicrobial therapy) was given to all patients. All 10 cases were cured by conservative treatment,the average time of hospitalization was 49. 4 days,followed up for 2 years, no chronic empyema, stricture of the esophagus and reflux esophagitis were observed. Conclusion Late spontaneous rupture of the esophagus is caused by delays in the diagnosis and treatment of the esophagus,the effect of comprehensive conservative treatment is satisfactory.

OBJECTIVE： To systematically evaluate the efficacy and safety of octreotide combined with conventional therapy in alleviating malignant bowel obstruction （MBO）， and provide evidence-based reference for clinical medication. METHODS： Retrieved from Cochrane Library， PubMed， Embase， CNKI， Wanfang database and Google academic， RCTs about octreotide combined with conventional therapy （trial group） vs. conventional therapy （control group） for relieving MBO were collected. After literature screening， data extraction and quality evaluation with Cochrane system evaluator manual 5.0 risk evaluation tool， Meta-analysis was conducted by using Rev Man 5.3 statistical software. RESULTS： A total of 13 items of RCT were included， with a total of 850 patients. Meta-analysis results showed that total response rate of trial group was significantly higher than control group [OR＝5.30，95％CI（3.47，8.10），P＜0.000 01]. Results of subgroup analysis showed that total response rate of single administration patients [OR＝6.88，95％CI（3.22，4.68），P＜0.000 01] and continuous administration patients [OR＝4.60， 95％CI（2.76，7.68）， P＜0.000 01] in trial group were significantly higher than control group. The abdominal distension relief time [MD＝－3.92， 95％CI（－4.15， －3.70）， P＜0.000 01]， abdominal pain relief time [MD＝－3.37， 95％CI（－3.61，－3.14）， P＜0.000 01]， nausea and vomiting relief time [MD＝－2.46， 95％CI（－2.81，－2.21）， P＜0.000 01] and exhaust relief time [MD＝－2.88， 95％CI（－3.31， －2.46）， P＜0.000 01] in trial group were significantly shorter than control group. Subgroup analysis of exhaust relief time showed that exhaust relief time of single administration patients [MD＝－2.90，95％CI（－3.48，－2.32），P＜0.000 01] and continuous administration patients [MD＝－2.71， 95％CI（－3.14，－2.29）， P＜0.000 01] in trial group were significantly shorter than control group. After treatment， the gastrointestinal decompression volume （P＜0.05） and the incidence of ADR [OR＝0.28，95％CI（0.13，0.62），P＝0.001] in trial group were significantly lower than in control group. CONCLUSIONS： Octreotide combined with conventional treatment is safe and effective in alleviating MBO.

Objective Triple negative breast cancer(TNBC), a special breast cancer subtype, is lack of effective target therapy.The article aimed to investigate the role of lysophosphatidic acid (LPA) and Hippo Yes-associated protein (Hippo-YAP) signaling pathway in TNBC invasion and metastasis and the mechanisms.Methods The specific small interfering RNA (siRNA) of YAP was synthetized in vitro, and was transfected into MDA-MB-231 cells using liposome transfection.The experiment was divided into YAP-siRNA group, positive control group and blank control group.Each group is provided with 2 parallel holes.Evaluation was made on the effects of each group on Hippo-YAP, the mechanisms and regulation on upstream and downstream molecules of Hippo-YAP pathway.Results In experiment group, YAP content, the capacity of invasion and metastasis after transfection ([0.035±0.005], [2.200±1.000], [3.500±0.800]) significantly decreased compared with positive control group([0.343±0.012], [27.600±5.100], [22.300±5.000]) and blank control group([0.384±0.017], [26.500±4.800], [22.350±6.000]) (P<0.05).YAP expression levels at 60 min, 120 min, and 240 min in experiment group significantly decreased compared with positive control group and blank control group (P<0.05).YAP relative expression levels of 10, 20, 50 μmol/Lwere significantly lower than those of positive control group and blank control group (P<0.05).After respective interference of C3 transferase and Y27623, significant difference was found in the pYAP mRNA contents of experiment group([0.255±0.052], [0.326±0.017]), blank control group([0.048±0.032], [0.534±0.017]) and positive control group([0.052±0.021], [0.528±0.024])(P<0.05).The expression levels of YAP mNA and AREG mNA significantly increased in experiment group([0.176±0.032], [0.263±0.008]) compared with blank control group([0.043±0.013], [0.263±0.008]) and positive control group([0.049±0.025], [0.057±0.043])(P<0.05).Conclusion LPA induces breast cancer invasion and metastasis, which is YAP-dependent, time-dependent and concentration-dependent.LPA-Hippo-YAP singaling pathway may be one of the mechanisms promoting delayed metastasis of TNBC.

Objective To understand the basic situation of healthcare-associated infection(HAI)management and prevention and control of multidrug-resistant organism(MDRO)infection in medical institutions in Hubei Province.Methods Questionnaires were used to investigate the basic situation of HAI management and MDRO infection in 47 tertiary and secondary hospitals in Hubei Province.Results 47 hospital were enrolled in this study,HAI management full-time staff was allocated with a median of 0.90/250 beds;in 2015,the isolation rates of methicillin-resistant Staphylococcus aureus,carbapenem-resistant Enterobacteriaceae,carbapenem-resistant Pseudomonas aeruginosa,carbapenem-resistant Acinetobacter baumannii,and vancomycin-resistant Enterococcus were 39.13%,4.13%,19.44%,63.60%,and 2.77%respectively.47 hospitals all carried out surveillance on MDROs,28(59.57%)hospitals were installed HAI monitoring system software,could directly obtain data through collecting with the laboratory system.The diagnosis of MDRO infection was mainly based on the combined diagnosis by HAI full-time personnel and clinicians(26 hospitals,55.32%).44(93.62%)hospitals regularly convened coordination meeting on prevention and control of MDROs,in 2015,hand hygiene compliance rate were 10.0%-89.2%by self-inspection;42(89.36%)hospitals routinely prescribed isolation orders for patients with MDRO infection,33(70.21%)hospitals conducted environmental clean and disinfection twice a day,24(51.06%)hospitals performed personal protection by using complete set of protective equipment.Conclusion This investigation is helpful for understanding the general situation of HAI management in medical institutions,as well as the detection and control of MDROs in this area,and make continual improvement on the problems and weakness found in the investigated project,so as to promote the development of HAI management in this area.

Objective To investigate the prevalence rates of healthcare-associated infection(HAI) and community-associated infection(CAI) in hospitalized patients in Wuhan City, and provide a scientific basis for the prevention and control of HAI.Methods Convenience sampling method was used to select 33 hospitals in Wuhan City, all hospitalized patients were surveyed by bedside investigation and medical record reviewing, SPSS 16.0 software was used for data analysis.Results A total of 36 222 hospitalized patients were investigated, of whom 1 116 (3.08%) had HAI, 6 968 (19.24%) had CAI.The prevalence rate of HAI was highest in hospitals with ≥900 beds(3.40%), and the prevalence rate of CAI was highest in hospitals with<300 beds (43.70%).Of departments, general intensive care unit had the highest prevalence rate of HAI(32.88%), department of respiratory diseases had the highest prevalence rate of CAI (78.34%).A total of 699 pathogens were isolated from patients with HAI, the top three were Pseudomonas aeruginosa (18.03%), Acinetobacter baumannii (16.31%) and Staphylococcus aureus (12.88%), a total of 1 149 pathogens were isolated from patients with CAI, the top three were Escherichia coli (14.45%), Pseudomonas aeruginosa (11.23%), and Mycoplasma (10.01%).The main infected sites of both HAI and CAI were the lower respiratory tract, accounting for 48.24% and 45.15% respectively.Conclusion HAI and CAI have different characteristics, it is necessary to take targeted measures according to key departments and key sites, so as to reduce the occurrence of HAI effectively.