ObjectiveTo understand the infection characteristics of multidrug-resistant organisms (MDROs) in hospitalized patients in a tertiary sentinel hospital in Shanghai, so as to provide an evidence for the development of targeted prevention and control measures. MethodsData of MDROs strains and corresponding medical records of some hospitalized patients in a hospital in Shanghai from 2021 to 2023 were collected, together with an analysis of the basic information, clinical treatment, underlying diseases and sources of sample collection. ResultsA total of 134 strains of MDROs isolated from hospitalized patients in this hospital were collected from 2021 to 2023 , including 63 strains of methicillin-resistant Staphylococcus aureus (MRSA), 57 strains of carbapenem-resistant Acinetobacter baumannii (CRAB), and 14 strains of carbapenem-resistant Klebsiella pneumoniae (CRKP). Of the 134 strains, 30 strains were found in 2021, 47 strains in 2022 and 57 strains in 2023. The male-to-female ratio of patients was 2.05∶1, with the highest percentage (70.90%) in the age group of 60‒<90 years. The primary diagnosis was mainly respiratory disease, with lung and respiratory tract as the cheif infection sites. There was no statistically significant difference in the distribution of strains between different genders and infection sites (P>0.05). However, the differences in the distribution of strains between different ages and primary diagnosis were statistically significant (P<0.05). Patients who were admitted to the intensive care unit (ICU), had urinary tract intubation, were not artery or vein intubated, were not on a ventilator, were not using immunosuppresants or hormones, and were not applying radiotherapy or chemotherapy were in the majority. There was no statistically significant difference in the distribution of strains for whether received radiotherapy or chemotherapy or not (P>0.05), while the differences in the distribution of strains with ICU admission history, urinary tract intubation, artery or vein intubation, ventilator use, and immunosuppresants or hormones use or not were statistically significant (all P<0.05). The type of specimen was mainly sputum, the hospitalized ward was mainly comprehensive ICU, the sampling time was mainly in the first quarter throughout the year, the number of underlying diseases was mainly between 1 to 2 kinds, the application of antibiotics ≥4 kinds, and those who didn’t receive any surgery recently accounted for the most. There were statistically significant differences in the distribution of strains between different specimen types, wards occupied and history of ICU stay (P<0.05), but no statistically significant difference in the distribution of strains between different sampling times, number of underlying diseases and types of antibiotics applied (P>0.05). ConclusionThe situation of prevention and control on MDROs in this hospital is still serious. Focus should be placed on high-risk factors’ and infection monitoring and preventive measures should be strengthened to reduce the incidence rate of MDROs infection.

Objective:To evaluate the quality and item characteristics of the Brief Job Stress Questionnaire (BJSQ) among employees in manufacturing and service industries.Methods:From December 2021 to December 2022, a total of 2077 employees from 4 manufacturing and service enterprises in Beijing were selected by the method of combining purpose sampling and convenience sampling. The Chinese version of BJSQ was used to carry out a survey on occupational stress from 57 items in 4 dimensions including job stress factors, stress response, social support factors and satisfaction. Classical test theory (CTT) was used to analyze the validity and reliability of the questionnaire. The Semejima hierarchical response model in item response theory (IRT) was used to analyze the differentiation a, difficulty coefficient b and information content of each item.Results:Among the 2077 subjects, the age M ( Q1, Q3) was 33 (28, 37) years old, and the working age M ( Q1, Q3) was 4 (2, 8) years. There were 723 (34.8%) people in manufacturing industry and 1354 (65.2%) people in service industry. Eleven common factors were extracted by exploratory factor analysis, with a cumulative variance contribution rate of 62.823%, the variance of the common factors of each entry ranging from 0.451 to 0.865, and the range of factor loading values from 0.413 to 0.825, with 5 items having cross-loadings. The results of the validation factor analysis showed that the model fit indexes of root means square error of approximation was 0.055, comparative fit index was 0.950, Tucker Lewis index was 0.948, and standardized root mean square was 0.066. Content validity results showed that the total scores of the Chinese version of the BJSQ were positively correlated with the scores of the 4 dimensions ( rs=0.487-0.936, P<0.05) . The results of the reliability analysis showed that the Cronbach's alpha coefficient for the total questionnaire was 0.945, and the Cronbach's alpha coefficients of job stress factors, stress response and social support factors were 0.775, 0.957, and 0.830, respectively. The Spearman-Brown coefficient for the total questionnaire was 0.866, and for the 3 dimensions, it was 0.572, 0.882 and 0.772. The results of IRT analysis showed that only 1 of the 57 items had a differentiation a-value<0.30, the difficulty coefficient b-value of each item ranged from -12.02 to 11.09, of which 8 items had a difficulty coefficient that was too high, 3 items had a difficulty coefficient that was too low, and 3 items did not meet the requirements, and the average amount of information in each item ranged from 0.022 to 2.566, and there were 47 items with average amount of information>0.088 (5/57) . Conclusion:The Chinese version of BJSQ has good reliability and validity in the typical occupational groups of manufacturing and service industries in China, and most of the items have good performance, but some items still need to be further improved and optimized or deleted.

Objective:To evaluate the quality and item characteristics of the Brief Job Stress Questionnaire (BJSQ) among employees in manufacturing and service industries.Methods:From December 2021 to December 2022, a total of 2077 employees from 4 manufacturing and service enterprises in Beijing were selected by the method of combining purpose sampling and convenience sampling. The Chinese version of BJSQ was used to carry out a survey on occupational stress from 57 items in 4 dimensions including job stress factors, stress response, social support factors and satisfaction. Classical test theory (CTT) was used to analyze the validity and reliability of the questionnaire. The Semejima hierarchical response model in item response theory (IRT) was used to analyze the differentiation a, difficulty coefficient b and information content of each item.Results:Among the 2077 subjects, the age M ( Q1, Q3) was 33 (28, 37) years old, and the working age M ( Q1, Q3) was 4 (2, 8) years. There were 723 (34.8%) people in manufacturing industry and 1354 (65.2%) people in service industry. Eleven common factors were extracted by exploratory factor analysis, with a cumulative variance contribution rate of 62.823%, the variance of the common factors of each entry ranging from 0.451 to 0.865, and the range of factor loading values from 0.413 to 0.825, with 5 items having cross-loadings. The results of the validation factor analysis showed that the model fit indexes of root means square error of approximation was 0.055, comparative fit index was 0.950, Tucker Lewis index was 0.948, and standardized root mean square was 0.066. Content validity results showed that the total scores of the Chinese version of the BJSQ were positively correlated with the scores of the 4 dimensions ( rs=0.487-0.936, P<0.05) . The results of the reliability analysis showed that the Cronbach's alpha coefficient for the total questionnaire was 0.945, and the Cronbach's alpha coefficients of job stress factors, stress response and social support factors were 0.775, 0.957, and 0.830, respectively. The Spearman-Brown coefficient for the total questionnaire was 0.866, and for the 3 dimensions, it was 0.572, 0.882 and 0.772. The results of IRT analysis showed that only 1 of the 57 items had a differentiation a-value<0.30, the difficulty coefficient b-value of each item ranged from -12.02 to 11.09, of which 8 items had a difficulty coefficient that was too high, 3 items had a difficulty coefficient that was too low, and 3 items did not meet the requirements, and the average amount of information in each item ranged from 0.022 to 2.566, and there were 47 items with average amount of information>0.088 (5/57) . Conclusion:The Chinese version of BJSQ has good reliability and validity in the typical occupational groups of manufacturing and service industries in China, and most of the items have good performance, but some items still need to be further improved and optimized or deleted.

{L-End}Objective To explore the suitable methods for individual occupational stress examination and evaluation for workers in China based on the electronics industry. {L-End}Methods A total of 1 164 workers from four electronics enterprises in Beijing City were selected as the research subjects using a convenient sampling method. The Occupational Stress Measurement Scale, which was developed based on the Japanese Brief Job Stress Questionnaire, was used to assess the occupational stress of the research subjects, and test the reliability and validity of the scale. Percentile norms and T-score norms were established, and the T-scores of the three dimensions of stress reaction (psychological reaction and physical symptoms), stress factors, and social support were divided into five stages using the normal distribution method with x¯±0.5 s and x¯±1.5 s, which was used to explore a proposed standard for assessing individual stress levels. {L-End}Results The revised scale consisted of 57 items, which could explain 64.0% of the total variation of occupational stress based on the result of item analysis and exploratory factor analysis. The results of confirmatory factor analysis showed that the model fitted well, with root mean square error of approximation of 0.052, standardized root mean square residual of 0.070, comparative fit index of 0.960, and Tucker-Lewis index of 0.958. The Cronbach's α coefficient of the scale was 0.951, and the Spearman-Brown coefficient was 0.837. Cronbach's α coefficients of the three dimensions ranged from 0.794 to 0.952, and the Spearman-Brown coefficients ranged from 0.737 to 0.850. The scores of the three dimensions of stress reaction, stress factors, and social support were (49.1±13.0), (44.9±7.7), and (18.1±3.6), respectively. Workers in the electronics industry met one of the following items were identified as the high level of occupational stress individuals: i) a score of stress reaction dimension ≥72.0 points; ii) a sum of stress factor and social support dimension scores ≥81.0 points, and a stress reaction dimension score ≥58.0 points. {L-End}Conclusion The Occupational Stress Measurement Scale and the criteria for determining high level of occupational stress can be used to assess the individual occupational stress levels of workers in the electronics industry in China. This method can provide a theoretical basis for the formulation of occupational stress examination and assessment for Chinese workers.

ObjectiveTo investigate the association between spontaneous portosystemic shunt （SPSS） and hepatorenal syndrome （HRS） in patients with liver cirrhosis. MethodsA retrospective analysis was performed for 93 patients with SPSS from Dezhou Hospital， Qilu Hospital of Shandong University， from January 2015 to January 2022， and the patients were followed up for 12 months with the onset of HRS as the observation endpoint. According to the presence or absence of HRS， the 93 patients with SPSS were divided into HRS group with 38 patients （40.86%） and non-HRS group with 55 patients （59.14%）， and the two groups were compared in terms of clinical data， laboratory data， complication， and shunt diameter. Based on the maximum shunt vein diameter of 1.5 cm， the 93 patients with SPSS were divided into high shunt group with 52 patients （55.91%） and low shunt group with 41 patients （44.09%）， and with the onset of HRS as the observation endpoint， the two groups were compared in terms of the incidence rate of HRS and survival time curve. The independent-samples t test was used for comparison of normally distributed continuous data with homogeneity of variance between two groups， and the chi-square test was used for comparison of categorical data between two groups. The receiver operating characteristic （ROC） curve was used to predict cut-off values， the Kaplan-Meier curve was used for comparison of survival time， and the Log-rank test was used to compare the differences in survival curves. The multivariate Cox regression analysis was used to investigate risk factors. ResultsCompared with the non-HRS group， the HRS group had significant increases in Child-Pugh score， Child-Pugh class， MELD score， serum creatinine， blood urea nitrogen， alanine aminotransferase， aspartate aminotransferase， maximum shunt vein diameter， the incidence rates of hepatic encephalopathy and spontaneous bacterial peritonitis， and the degree of ascites， as well as significant reductions in main portal vein diameter， serum sodium and albumin （all P<0.05）. Compared with the low shunt group， the high shunt group had a significant increase in the incidence rate of HRS （51.92% vs 26.83%， χ²=5.974， P=0.015） and a significant reduction in the time to the onset of HRS （Log-rank P=0.033）. A maximum shunt vein diameter of >1.5 cm （hazard ratio ［HR］=1.123， 95% confidence interval ［CI］： 1.041‍ ‍—‍ ‍1.211， P=0.003）， an increase in MELD score （HR=1.205， 95%CI： 1.076‍ ‍—‍ ‍1.437， P=0.039）， a reduction in serum albumin （HR=0.890， 95%CI： 0.814‍ ‍—‍ ‍0.974， P=0.011）， an increase in the degree of ascites （HR=2.099， 95%CI： 1.066‍ ‍—‍ ‍4.130， P=0.032）， and spontaneous bacterial peritonitis （HR=2.259， 95%CI： 1.020‍ ‍—‍ ‍5.003， P=0.045） were independent risk factors for the onset of HRS in SPSS patients. ConclusionThere is an association between SPSS and HRS， and shunt diameter >1.5 cm was an independent risk factor for HRS in SPSS patients， which should be taken seriously and require early intervention in clinical practice.

Objective:To investigate the value of 3D printing combined with intraoperative electrophysiological monitoring in excision of cerebellopontine angle (CPA) tumor.Methods:The clinical data of 43 patients with CPA tumor, admitted to our hospital from October 2016 to October 2019, were collected and analyzed. These patients were voluntarily divided into ordinary group ( n=27) and optimized group ( n=16). Patients in the ordinary group were operated microscopically, and those in the optimized group were operated microscopically with 3D printing combined with intraoperative electrophysiological monitoring. The degrees of tumor resection and neurological functions (facial and auditory nerve function, swallowing function, limb activity) improvements were compared between the two groups. Results:The degrees of tumor resection of the optimized group were significantly higher than those of the ordinary group ( P<0.05), and the improvement of facial and auditory nerve function in the optimized group was significantly better than that in the ordinary group ( P<0.05). There was no significant difference in improvements of swallowing function and limb activity between the two groups ( P>0.05). Conclusion:The 3D printing combined with intraoperative electrophysiological monitoring can improve the resection rate of CPA tumor, protect the facial auditory nerve, and improve the quality of life of patients after surgery.

Objective: To investigate the feasibility and effectiveness of unexposed ulnar nerve medial elbow incision, open reduction and internal fixation of anatomical locking compression plate (LCP) for distal humerus fractures. Methods: Fourteen patients with distal humerus fracture were treated between January 2014 and June 2017. There were 5 males and 9 females, aged 18-85 years (mean, 65.5 years). The causes of injury included falling from height in 12 cases and traffic accident in 2 cases, all were closed fractures. Fractures were classified according to the AO/Association for the Study of Internal Fixation (AO/ASIF): 3 cases of type A2, 2 cases of type A3, 4 cases of type B2, 2 cases of type C1, 2 cases of type C2, and 1 case of type C3; without ulnar nerve damage. The time from injury to operation was 4-15 days, with an average of 7 days. The type B2 fractures were treated with unexposed ulnar nerve elbow medial incision and anatomic LCP internal fixation, the rest patients were all treated with unexposed ulnar nerve medial plus conventional lateral approach and bilateral LCP internal fixation. Results: The operation time was 50-140 minutes (mean, 80 minutes), and the intraoperative blood loss was 20-200 mL (mean, 70 mL). There was no blood vessels or nerve damage during operation. All incisions healed by first intension, and no incision infection occurred. All the 14 cases were followed up 9-24 months (mean, 13 months). X-ray films showed that all fractures healed within 4 months without complications such as nonunion and osteomyelitis. No ulnar nerve injury, cubitus varus deformity, and ossifying myositis occurred during follow-up. At last follow-up, the elbow function was assessed by Mayo Elbow Performance score (MEPS), the results were excellent in 8 cases, good in 4 cases, fair in 1 case, and poor in 1 case (type C3 fracture), with the excellent and good rate of 85.7%. Conclusion: The unexposed ulnar nerve medial elbow incision can be used effectively to reduct the fracture, and it is not prone to ulnar nerve injury. Combined with the lateral approach to treat the distal humerus fracture, which has the advantages of short operation time, few trauma, little bleeding, and reliable effectiveness.

Objective To observe and identify the osteogenic activity,biocompatibility and mechanical property of a type of macro-pore bone block bioactive glass in rabbits.Methods Establish the femoral condyle defect model with New Zealand white rabbit.Implant in the defect with macro-pore bone block bioglass,β-TCP and NOVABONE(R) respectively.According to the different materials implanted in the defect,three groups were divided as macro-pore bone block bioglass group,β-TCP group and NOVABONE group.After the surgery,X-ray examination was performed to confirm the location and fixation of the materials and to observe the femoral condyle fracture.The specimens were harvested at 4,12 and 24 weeks after the surgery respectively.MicroCT was performed to assess the new bone formation and degradation of the materials.Tetracycline-calcein double labeling was used to detect the mineral apposition rate of new bone.Van Gieson staining was used to assess the new bone formation percentage.Biomechanical markers including the compress strength and elasticity modulus were also measured.Results X-ray examination showed that each femoral defect was filled fully with materials and the materials were all in proper position.As indicated by MicroCT results,at 24 weeks,the bone regeneration volume fraction of each group was 37.48％ ±0.70％,25.29％± 1.45％,27.03％±1.25％ respectively and the difference between macro-pore bone block group and β-TCP group or NOVABONE group was statistically significant.The residual material volume fraction of each group was 34.67％±3.52％,55.66％±2.05％,7.52％± 1.15％ respectively and the difference between macro-pore bone block group and β-TCP group or NOVABONE group was statistically significant.The results of tetracycline-calcein double labeling showed that the mineral apposition rate in macro-pore bone block bioglass group,β-TCP group and NOVABONE group at 4 weeks was (1.577±0.045) um/d,(2.064±0.068)um/d,(1.19±0.09)um/d respectively and the difference between macro-pore bone block bioglass group and β-TCP group was statistically significant.As shown by the results of Van Gieson staining,the new bone area percentage of macro-pore bone block bioglass group,β-TCP group and NOVABONE group was 5.43％± 1.25％,2.77％±0.85％,6.51％± 1.21％ at 4 weeks,8.48％±0.84％,2.94％±0.65％,11.42％±2.66％ at 12 weeks,23.55％± 1.13％,12.92％±0.45％,19.53％±0.91％ at 24 weeks.The difference between macro-pore bone block bioglass group and β-TCP group or NOVABONE group at 24 weeks was statistically significant.By biomechanical test,the compress strength of specimens in macro-pore bone block bioglass group and β-TCP group increased as time prolonged,with no statistically significant between the two groups.The elasticity modulus of specimens in macro-pore bone block bioglass group and NOVABONE group was stable after surgery,closer to the rabbit bone,while elasticity modulus of the β-TCP group increased a lot,unsuit to the rabbit bone.Conclusion Macro-pore bone block bioglass presented good biological activity,biocompatibility and suitable biomechanical properties.This research loaded foundation for the application in weight-bearing sites of this new material.

Objective To explore the effect of therapeutic hypothermia on the activation of inflammasome in the lung tissue of rats with hemorrhagic shock (HS).Methods Twenty-four male Sprague-Dawley rats were randomly (random number) divided into three groups:sham group,normothermia resuscitation (NR) group and hypothermia resuscitation (HR) group.Rats of each group were subjected to pressure-controlled (MAP 40 mmHg) HS for 1 h,then the NR group and the HR group were resuscitated with lactated Ringer and MAP was maintained at 90 mmHg for 1 h.Four hours later,the rats in each group were sacrificed by exsanguination.Hematoxylin eosin staining was used to observe the injury of lung tissue.The desiccation method was used to detect the edema of lung tissue.RT-PCR and western blot were employed to evaluate the mRNA and protein expression of NLRP-3,IL-1β,caspase-1.Analysis of variance was used for comparison among groups,and SNK-q test was used for comparison between two groups.Results (1) The injury of lung tissue in HR group was significantly milder than that in NR group;(2) Wet/dry (W/D) weight ratio of lung in HR group decrease compared with NR group [HR group 5.85 ± 0.102;NR group 6.471 ± 0.165 8 (t =3.14,P ＜ 0.05)];(3) NLRP-3 and of Caspase-1 protein expression in the HR group were lower than those in NR group.(4) The NLRP-3 mRNA expression in HR group was lower compared with NR group [(HR group 1.027 ± 0.143;NR group 1.3487 ± 0.163 (t =4.36,P ＜ 0.05)] and IL-1 mRNA expression in HR group was lower compared with NR group [HR group 162.3 ± 0.125;NR group 2.388 ± 0.229 (t =7.72,P ＜ 0.05)].Conclusions Therapeutic hypothermia attenuated ALI induced by HS in rats by modulation of signal way of inflammasome.

Objective To observe and identify the impact of a type of macro?pore bone block bioactive glass on osteo?blast in vitro. Methods Extract fluid of new bioactive glass was prepared withα?MEM culture medium as the bioactive medium group. And the concentrations of different ions were detected with Inductively Coupled Plasma?Atomic Emission Spectrometry in bioactive medium group andα?MEM medium group. MC3T3?E1 cells cultured in bioactive medium group were considered as ex?perimental group and cells cultured inα?MEM medium as control group. Giemsa and immunofluorescence staining was performed to detect the cell numbers, the karyoplasmic ratio and the average fluorescence intensity per cell. Cell proliferation and viability in different groups were detected by cell cycle analysis, MTT assay and BrdU assay, respectively. Total RNAs of cells in different groups were extracted and the expressions of ALP, OCN and collagenⅠwere measured by quantitative real time PCR. ALP stain?ing and alizarin red staining were performed to assess the differentiation and mineralization of MC3TC?E1 cells in different groups. Results The concentrations of Si and F were 40.02 ± 0.67 mg/L and 0.02 ± 0.001 mg/L in bioactive medium group, higher than 2.02±0.01 mg/L and 0.00 mg/L inα?MEM solution, and the concentration of Ca was lower than that inα?MEM solution. The con?centration of P and Na had no difference. In Giemsa staining, the cell number in 400 times field under a microscope was 106.0 ± 6.025 in bioactive medium group and 40.20 ± 3.639 inα?MEM medium group. In the immunofluorescence of vinculin, the karyo?plasmic ratio and the expression of vinculin were higher in bioactive medium group (40.85±5.720, 0.050 88±0.021 78) than inα? MEM medium group (21.93 ± 4.137, 0.023 60 ± 0.003 18). In cell cycle analysis, the proportion of cells retained in S and G2/M phase in the bioactive medium group was more than that in theα?MEM medium group after 72 hours of cell culture. In the BrdU and MTT assay, MC3T3?E1 cells in bioactive medium group both showed a higher proliferation rate with statistical significance. In MC3T3?E1 cells cultured with the bioactive medium, the expressions of osteogenesis?related genes were higher than those cultured with ordinaryα?MEM solution;in the ALP staining and alizarin red staining, the expression of ALP and the mineralization rate were higher in bioactive medium group (1.328%±0.015 36%, 2.953%±0.536 3%) than inα?MEM medium group (0.979%±0.030 59%, 1.000%±0.208 1%). Conclusion The bioactive medium promotes cell proliferation and osteoblastic differentiation of MC3T3?E1 cells, and has much more Si ions, which indicates that macro?pore bone block bioactive glass can promote cell proliferation and dif?ferentiation and has promising bioactivity.