Objective To analyze the timeliness of the start time of the first elective operation in a hospital and observe its impact on the operating room cost.Methods Make statistics and analysis on the opening of the first operation in a hospital,record the on-time opening rate of the first operation,analyze the reasons for the delay in the opening time of the first operation,formulate corresponding intervention measures and set up a"management team to improve the efficiency of operating room use".The on-time rate of the first operation,operation,cost control and the satisfaction of surgeons and patients were compared before and after the operation.Results The overall punctuality rate of the first operation was 53.74％,among which the colorectal sur-gery department had the highest punctuality rate of 63.16％,while the minimally invasive surgery department had the lowest punctuality rate of 45.45％.The main reasons for the delay of first operation(35.29％),failed anesthesia(30.88％),and the termination of the operation(17.65％);compared with before implementation,higher overtime time of nurses,shorter opening time and expected time,decreased interval between operation(P＜0.05),lower frequency of centralized delivery and unnecessa-ry consumables cost within 1 month after implementation(P＜0.05),and higher satisfaction of patients and physicians after im-plementation(P＜0.05).Conclusion By improving the first elective operation on time,can effectively reduce the cost of the operating room,shorten the nurse overtime time,at the same time improve the satisfaction of doctors and patients,and improve the management efficiency of the operating room,the first operation on time improved,interval time and unnecessary consumables costs are significantly reduced,optimize the use efficiency of the operating room resources.

Objective To analyze the short-term survival and prognostic quality of life of patients with liver cirrhosis complicated by bacterial infection. Methods This study collected and analyzed 300 patients with liver cirrhosis complicated with infection who were hospitalized in the First Affiliated Hospital of Hebei North University, and followed up to discuss their survival and quality of life. Results In this study, the top two causes of infection were spontaneous bacterial peritonitis (60.67% of patients) and pneumonia (50.67% of patients). The second causes were urinary tract infections (15.33%), gastrointestinal infections (12.33%), and other causes. There was no statistically significant difference between male and female patients (P>0.05). In addition, the proportion of hospital infections was 71.00%, and there was no statistically significant difference between male and female patients (P>0.05). A total of 353 strains of pathogenic bacteria were isolated in this study (73.37% of patients with hospital infections). The distribution analysis of pathogenic bacteria showed that the highest proportion of ECO was 35.98%, followed by Klebsiella pneumoniae (18.98%). The distribution trend of 259 strains of pathogenic bacteria among hospital patients was consistent with that of all strains, and the difference was not statistically significant (P>0.05). Gram negative bacteria accounted for 79.60% (281/353) of all detected strains, of which Escherichia coli was mostly detected in patients with spontaneous bacterial peritonitis, Klebsiella Pneumoniae (KPN) and Pseudomonas aeruginosa (PAE) were mostly detected in patients with pneumonia, and Enterococcus (ENF) was mostly detected in patients with urinary tract infection; Among gram-negative bacteria, Staphylococcus epidermidis (SEP) and Staphylococcus aureus (SAU) are mostly found in patients with other infectious causes (blood flow infection, etc.) , and Streptococcus (STR) accounts for a high proportion in patients with Spontaneous bacterial peritonitis. In this study, 9 cases of death prognosis were detected during follow-up, and there was no statistically significant difference in the detection of death prognosis between different bacterial strains in both genders, as well as the difference in detection of death prognosis between hospital infections and out of hospital infections in both genders (P>0.05). There was no statistically significant difference in the detection of death prognosis between males and females due to different causes of infection, P>0.05. The quality of life scores of 291 surviving patients were compared between baseline and follow-up, indicating an increase in follow-up scores, especially in the dimensions of physiological function and physical pain. There was no statistically significant difference between different bacterial strains, infection causes, and hospital/non hospital infections (P>0.05) . Conclusion Spontaneous bacterial peritonitis and pneumonia are the main causes of infection that deserve special attention, and the main pathogens of infection are Gram negative bacteria. Targeted treatment and rehabilitation should be provided for patients with liver cirrhosis complicated by infection. At the same time, the proportion of hospital infections is relatively high, and attention should be paid to, prevention and control measures should be implemented as well.

Objective:To investigate the factors predictive of heart failure developing during hospital stay after undergoing percutaneous coronary intervention (PCI).Methods:A retrospective analysis was performed on 534 patients with coronary heart disease who underwent PCI treatment at Hangzhou Ninth People′s Hospital from January 2017 to September 2022. The patients were divided into two groups according to whether heart failure occurred after the operation: a heart failure group consisting of 51 patients and a control group consisting of 483 patients. Univariate comparison and multivariate analysis were performed on factors that could lead to heart failure between the two groups, and a prediction model was established.Results:Univariate analysis showed that there were significant differences in age at admission, presence of cerebral infarction, presence of hypertension, New York Heart Association (NYHA) heart function classification, left ventricular ejection fraction (LVEF), serum albumin, neutrophil-to-lymphocyte ratio (dNLR), D-dimer, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels between the PCI postoperative heart failure group and the control group (all P<0.05). Multivariate analysis showed that age ≥60 years, LVEF<40%, presence of cerebral infarction, NYHA heart function classification Ⅱ/Ⅲ, serum albumin<40.15 g/L, and dNLR≥2.30 were independent risk factors for the development of heart failure during hospitalization after PCI (all P<0.05). Conclusions:Age, LVEF, presence of cerebral infarction, NYHA heart function classification, serum albumin, and dNLR can all affect the occurrence of heart failure during hospitalization after PCI for coronary heart disease. Establishing a prediction model based on these indicators can provide guidance for clinical practice.

Background: The poor intracellular concentration of enrofloxacin might lead to treatment failure of cow mastitis caused by Staphylococcus aureus small colony variants (SASCVs). Objectives: In this study, enrofloxacin composite nanogels were developed to increase the intracellular therapeutic drug concentrations and enhance the efficacy of enrofloxacin against cow mastitis caused by intracellular SASCVs. Methods: Enrofloxacin composite nanogels were formulated by an electrostatic interaction between gelatin (positive charge) and sodium alginate (SA; negative charge) with the help of CaCl 2 (ionic crosslinkers) and optimized by a single factor test using the particle diameter, zeta potential (ZP), polydispersity index (PDI), loading capacity (LC), and encapsulation efficiency (EE) as indexes. The formation mechanism, structural characteristics, bioadhesion ability, cellular uptake, and the antibacterial activity of the enrofloxacin composite nanogels against intracellular SASCVs strain were studied systematically. Results: The optimized formulation was comprised of 10 mg/mL (gelatin), 5 mg/mL (SA), and 0.25 mg/mL (CaCl2). The size, LC, EE, PDI, and ZP of the optimized enrofloxacin composite nanogels were 323.2 ± 4.3 nm, 15.4% ± 0.2%, 69.6% ± 1.3%, 0.11 ± 0.02, and −34.4 ± 0.8 mV, respectively. Transmission electron microscopy showed that the enrofloxacin composite nanogels were spherical with a smooth surface and good particle size distributions. In addition, the enrofloxacin composite nanogels could enhance the bioadhesion capacity of enrofloxacin for the SASCVs strain by adhesive studies. The minimum inhibitory concentration, minimum bactericidal concentration, minimum biofilm inhibitory concentration, and minimum biofilm eradication concentration were 2, 4, 4, and 8 μg/mL, respectively. The killing rate curve had a concentration-dependent bactericidal effect as increasing drug concentrations induced swifter and more radical killing effects. Conclusions This study provides a good tendency for developing enrofloxacin composite nanogels for treating cow mastitis caused by intracellular SASCVs and other intracellular bacterial infections.

Background: The poor bioadhesion capacity of tilmicosin resulting in treatment failure for Staphylococcus aureus small colony variants (SASCVs) mastitis. Objectives: This study aimed to increase the bioadhesion capacity of tilmicosin for the SASCVs strain and improve the antibacterial effect of tilmicosin against cow mastitis caused by the SASCVs strain. Methods: Tilmicosin-loaded chitosan oligosaccharide (COS)-sodium carboxymethyl cellulose (CMC) composite nanogels were formulated by an electrostatic interaction between COS (positive charge) and CMC (negative charge) using sodium tripolyphosphate (TPP) (ionic crosslinkers). The formation mechanism, structural characteristics, bioadhesion, and antibacterial activity of tilmicosin composite nanogels were studied systematically. Results: The optimized formulation was comprised of 50 mg/mL (COS), 32 mg/mL (CMC), and 0.25 mg/mL (TPP). The size, encapsulation efficiency, loading capacity, polydispersity index, and zeta potential of the optimized tilmicosin composite nanogels were 357.4 ± 2.6 nm, 65.4 ± 0.4%, 21.9 ± 0.4%, 0.11 ± 0.01, and -37.1 ± 0.4 mV, respectively; the sedimentation rate was one. Scanning electron microscopy showed that tilmicosin might be incorporated in nano-sized crosslinked polymeric networks. Moreover, adhesive studies suggested that tilmicosin composite nanogels could enhance the bioadhesion capacity of tilmicosin for the SASCVs strain. The inhibition zone of native tilmicosin, tilmicosin standard, and tilmicosin composite nanogels were 2.13 ± 0.07, 3.35 ± 0.11, and 1.46 ± 0.04 cm, respectively. The minimum inhibitory concentration of native tilmicosin, tilmicosin standard, and tilmicosin composite nanogels against the SASCVs strain were 2, 1, and 1 µg/mL, respectively. The in vitro time-killing curves showed that the tilmicosin composite nanogels increased the antibacterial activity against the SASCVs strain. Conclusions This study provides a potential strategy for developing tilmicosin composite nanogels to treat cow mastitis caused by the SASCVs strain.

Objective: The use and effect of nitrous oxide sedation techniques in oral clinics were analyzed retrospectively. Methods: Patients who were treated with nitrous oxide inhalation sedation in the clinic of the Affiliated Stomatological Hospital of Guangzhou Medical University from January 1, 2016, to December 30, 2018, were examined. Age and gender of the patients, dental treatments involved, reasons for nitrous oxide inhalation, sedative effects and adverse reactions were compiled. Results : A total of 1 429 cases were examined, comprising 587 males and 842 females, and the average age was 32.64±16.34 years old. Among the patients who underwent nitrous oxide inhalation sedation in the oral clinic, 79.98% needed tooth extraction, and 79.50% had a dental fear of procedures. The patients were divided into following 7 age groups: 5-15 years old, 16-25 years old, 26-35 years old, 36-45 years old, 46-55 years old, 56-65 years old and > 65 years old. The sedation satisfaction rate of the 5-15-year-old group was 45.71%, and the sedation satisfaction rate of the other 6 age groups was 90.83%- 96.20% (P < 0.001). The incidence of total adverse reactions was 5.39%; the incidence was higher in females than in males, and the incidence was higher in the 16-25 age group than in the other age groups (P < 0.05). The most frequent adverse reaction was vertigo (81.82%). Conclusion Among the four common oral outpatient treatment programs including the extraction of teeth, dental implants, pulp treatment and periodontal treatment, patients undergoing inhalation sedation of nitrous oxide in the dental extraction most. The most common reason for requiring sedation is dental fear, and the sedative effect of the 5-15-year-old group was significantly worse than that of the other age groups. The incidence of adverse reactions of nitrous oxide sedation was low and manageable.

Background: and Purpose Previous studies suggested increased visit-to-visit variability of total cholesterol (TC) is associated with stroke. This study aimed to investigate the associations of various lipids measurements variability and the risk of stroke and stroke type (ischemic and hemorrhagic stroke). Methods: Fifty-one thousand six hundred twenty participants in the Kailuan Study without history of myocardial infarction, stroke, and cancer who underwent three health examinations during 2006 to 2010 were followed for incident stroke. Variability in TC, triglycerides, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) measurements were measured using the coefficient of variation (CV), standard deviation (SD), variability independent of the mean (VIM), and average real variability (ARV). Results: During a median of 6.04 years of follow-up, 1,189 incident stroke (1,036 ischemic and 160 hemorrhagic stroke) occurred. In the multivariable-adjusted model, the hazard ratio (HR) comparing participants in the highest versus lowest quartile of CV of HDL-C were 1.21 (95% confidence interval [CI], 1.02 to 1.45; P for trend=0.013) for ischemic stroke. The highest quartile of CV of LDL-C was associated with 2.17-fold risk of hemorrhagic stroke (HR, 2.17; 95% CI, 1.25 to 3.75; P for trend=0.002) compared with the lowest quartile. We did not observe any significant association between TC and triglycerides variability with any of stroke. Consistent results were obtained when calculating variability index using SD, VIM, or ARV. Conclusions These findings suggest the high visit-to-visit HDL-C and LDL-C variability were associated with an increased incidence of ischemic and hemorrhagic stroke, respectively.

Objective:To investigate the relationship between plasma N-terminal B-type natriuretic peptide precursor (NT-proBNP), hypersensitive C-reactive protein (hs-CRP), troponin Ⅰ (cTnⅠ) and carbohydrate antigen 125 (CA125) and cardiac function in patients with acute heart failure.Methods:From May 2017 to May 2019, 97 patients with acute heart failure admitted to Hangzhou Dajiangdong Hospital were selected as the observation group.According to the cardiac function classification of New York Heart Association (NYHA), 29 patients were classified as grade Ⅱ group, 51 patients as grade Ⅲ group and 17 patients as grade Ⅳ group.Fifty healthy people were selected as control group.The changes of plasma NT-proBNP, hs-CRP, cTnⅠ and CA125 levels, left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) were compared between the two groups.The changes of plasma NT-proBNP, hs-CRP, cTnⅠ and CA125 levels, as well as the changes of LVED and LVEF in the different heart function grading group were compared.The correlation between plasma NT-proBNP, hs-CRP, cTnⅠ, CA125 and LVEDD, LVEF was analyzed.Results:The plasma NT-proBNP[(5 684.21±174.39)ng/L], hs-CRP[(16.54±3.27)mg/L], cTnⅠ[(0.43±0.13)g/L] and CA125[(83.24±15.46)U/mL] in the observation group were higher than those in the control group( t=216.813, 25.684, 19.432, 34.138, all P<0.05). The LVEDD in the observation group[(63.21±4.87)mm] was higher than that in the control group[(48.97±2.41)mm], and the LVEFin the observation group[(39.27±3.25)%] was lower than that in the control group[(62.87±4.36)%], the differences were statistically significant ( t=19.461, 37.008, all P<0.05). The levels of NT-proBNP[(7 368.18±201.05)ng/L], hs-CRP[(24.19±4.18)mg/L], cTnⅠ[(0.63±0.14)μg/L] and CA125[(164.52±27.48)U/mL] in the grade Ⅳ group were higher than those in the grade Ⅱ group and grade Ⅲ group(grade Ⅲ group: t=31.109, 6.557, 5.321, 13.017; grade Ⅱ group: t=75.873, 16.582, 11.755, 23.178, all P<0.05). The plasma NT-proBNP[(5 751.42±180.34)ng/L], hs-CRP[(15.98±4.56)mg/L], cTnⅠ[(0.41±0.15)g/L] and CA125[(87.97±18.45)U/mL] in the grade Ⅲ group were higher than those in the grade Ⅱ group[(3 481.34±145.26)ng/L, (8.23±2.37)mg/L, (0.25±0.08)μg/L and (28.43±12.21)U/mL]( t=57.893, 8.507, 5.320, 15.530, all P<0.05). The LVEDD[(67.95±5.15)mm] in the grade Ⅳ group was higher than that in the grade Ⅱ group and grade Ⅲ group(grade Ⅲ group: t=3.553, grade Ⅱ group: t=8.157, P<0.05), while the LVEF[(34.28±2.36)%] in the grade Ⅳ group was lower than that in the grade Ⅱ group and grade Ⅲ group(grade Ⅲ group: t=6.673, grade Ⅱ group: t=10.417, all P<0.05). The LVEDD[(62.78±5.21)mm] in the grade Ⅲ group was higher than that in the grade Ⅱ group[(57.87±3.25)mm]( t=4.586, P<0.05), while the LVEF in the grade Ⅲ group[(39.98±3.24)%] was lower than that in the grade Ⅱ group[(45.98±4.25)%]( t=7.097, P<0.05). LVEDD was positively correlated with NT-proBNP, hs-CRP, cTnⅠ and CA125, while LVEF was negatively correlated with NT-proBNP, hs-CRP, cTnⅠ and CA125. Conclusion:The levels of NT-proBNP, hs-CRP, cTnⅠ and CA125 in plasma of patients with acute heart failure are elevated, and they are significantly correlated with cardiac function grading and cardiac function indicators.

Objective To investigate the clinical manifestations,imaging and pathological features and treatment prognosis of primary renal sarcoma in adults.Methods A retrospective analysis was performed on the clinical data of 48 patients with primary renal sarcoma from January 2009 to December 2018 in the first affiliated hospital and cancer center of Sun Yat-Sen university.There were 30 males and 18 females.Their aged ranged from 27 to 76 yrs with an average age of 50 yrs.A total of 24 patients presented with lumbar and abdominal pain.Abdominal mass was found in 2 cases.Gross hematuria was noticed in 4 cases.Febrile was recorded in 2 cases and 21 cases were diagnosed by physical examination.31 tumors located in the left kidney and 17 tumors located in the right kidney.The tumor diameter ranged from 3 to 16 cm with an average diameter of 8 cm.All patients underwent ultrasound or CT/MRI examination of the urinary system before surgery.The ultrasound showed the undistributed echo inside the tumor with the undistinguished border.The image of necrosis and liquefaction could be seen in some cases.The CT/MRI examination showed the lesion site with the necrosis,liquefaction or cystic changing.The mass exhibited the unregular enhancement with undistinguished border line.The mean diameter of liposcarcoma was 10.2 cm.CT scan demonstrated the relative low density of tumor,which was hard to be identified with AML.The average diameter of leiomyosarcoma was 6.5 cm.The enhanced CT scan showed the low density of tumor,compared with renal parenchyma.46 patients underwent radical nephrectomy,2 patients underwent renal tumor biopsy.And postoperative follow-up was performed.Results Pathological diagnosis revealed that 19 cases with liposarcoma,9 cases with leiomyosarcoma and 4 cases with synovial sarcoma,especially 4 cases with Ewing' s sarcoma and 12 cases with other sarcoma.36 cases were followed up and survived for 4 to 64 months.The average survival time was 28 months.The longest mean survival time was seen in patients with liposarcoma,which was 32 months (ranging 11 to 64 months).The mean survival time of synovial sarcoma group was 25 months (ranging 5-58 months).The mean survival time of Ewing's sarcoma group was 22 months(ranging 12-46 months).and the survival time of leiomyosarcoma group was the shortest 20 months (ranging 4-36 months).Conclusion Renal sarcoma is rare and highly malignant.It needs to be diagnosed with clinical manifestations,imaging and pathological data together.

Objective To explore the short－term and long－term clinical efficacy of aspirin combined with ticagrelor in the treatment of acute coronary syndrome ( ACS) patients with non －revascularization, to assess the improvement of cardiac function.Methods A total of 114 ACS patients with non －revascularization in Dajiang Hospital of Hangzhou were selected .They were randomly divided into control group and study group by random number table method,with 57 patients in each group.The control group was given aspirin and clopidogrel conventional therapy.The study group was treated with aspirin and ticagrelor .The clinical efficacy was evaluated .The Grace scores of ACS before and after treatment were evaluated ,and the serum levels of lactate dehydrogenase (LDH) and creatine phosphokinase(CPK) were measured.The patients were followed up for 12 months,the incidence of primary and secondary end points and the occurrence of dyspnea were observed .Results The total effective rate of the study group was 87.72%(50/57),which was higher than 71.93%(41/57) of the control group,the difference was statis－tically significant(χ2＝10.65,P＜0.05).The incidence rates of primary end point and secondary end point of the study group were 12.28%(7/57) and 17.54%(10/57),respectively,which were lower than 21.05%(12/57) and 35.09%(20/57) of the control group,the differences were statistically significant(χ2＝9.82,10.13,all P＜0.05). The incidence rate of dyspnea of the study group was 24.56%(14/157),which was higher than 3.51%(2/57) of the control group,the difference was statistically significant (χ2＝10.96,P＜0.05).The Grace score of the study group was (80.23 ±7.89)points,which was lower than (85.58 ±8.14) points of the control group,the difference was statistically significant(t＝9.38,P＜0.05).The levels of LDH and CPK of the study group were (217.06 ±44.34)U/L and (167.52 ±37.41)U/L,respectively,which were lower than (261.58 ±43.10)U/L and (225.48 ±38.26)U/L of the control group,the differences were statistically significant (t＝10.06,10.29,all P＜0.05).Conclusion Aspi－rin combined with ticagrelor for ACS patients with non －revascularization can effectively inhibit platelet aggregation , the clinical efficacy is significant ,the incidence of primary and secondary end points of patients with ACS was signifi －cantly reduced,the prognosis is good .While dyspnea rate increased ,but does not affect the treatment of patients .