ObjectiveTo investigate the clinical features of patients with acute-on-chronic liver failure （ACLF） and bacterial infection and early warning indicators associated with multidrug-resistant infections. MethodsA retrospective analysis was performed for 130 patients with ACLF and bacterial infection who attended The Second Affiliated Hospital of Air Force Medical University from January 1， 2010 to December 31， 2021， and according to the drug susceptibility results， the patients were divided into multidrug-resistant （MDR） bacterial infection group with 80 patients and non-MDR bacterial infection group with 50 patients. General information and laboratory examination results were compared between the two groups to screen for the early warning indicators associated with MDR bacterial infection. The Student’s t-test was used for comparison of normally distributed continuous data with homogeneity of variance between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data or continuous data with heterogeneity of variance between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The binary logistic regression analysis and the receiver operating characteristic （ROC） curve were used to assess the predictive value of early warning indicators. ResultsAmong the 130 patients with ACLF and bacterial infection， sputum （27.7%） was the most common specimen for detection， followed by blood （24.6%）， urine （18.5%）， and ascites （17.7%）. Bacterial infections were dominated by Gram-negative bacteria （58.5%）. Of all bacteria， Escherichia coli （18.5%）， Klebsiella pneumoniae （14.6%）， and Enterococcus faecium （13.8%） were the most common pathogens. Gram-positive bacteria had a high resistance rate to the antibacterial drugs such as erythromycin （72.2%）， penicillin （57.4%）， ampicillin （55.6%）， and ciprofloxacin （53.7%）， while Gram-negative bacteria had a high resistance rate to the antibacterial drugs such as ampicillin （73.3%）， cefazolin （50.0%）， and cefepime （47.4%）. The patients with ACLF and bacterial infection had a relatively high rate of MDR bacterial infection （61.5%）. Comparison of clinical data between the two groups showed that compared with the patients with non-MDR bacterial infection， the patients with MDR bacterial infection had significantly higher levels of alanine aminotransferase （Z=2.089， P=0.037）， aspartate aminotransferase （Z=2.063， P=0.039）， white blood cell count （Z=2.207， P=0.027）， and monocyte count （Z=4.413， P<0.001）. The binary logistic regression analysis showed that monocyte count was an independent risk factor for MDR bacterial infection （odds ratio=7.120， 95% confidence interval ［CI］： 2.478‍ ‍—‍ ‍20.456，P<0.001） and had an area under the ROC curve of 0.686 （95%CI： 0.597‍ ‍—‍ ‍0.776） in predicting ACLF with MDR bacterial infection（P<0.001）， with the optimal cut-off value of 0.50×10⁹/L， a sensitivity of 0.725， and a specificity of 0.400. ConclusionACLF combined with bacterial infections is mainly caused by Gram-negative bacteria， with the common pathogens of Escherichia coli and Klebsiella pneumoniae and a relatively high MDR rate in clinical practice. An increase in monocyte count can be used as an early warning indicator to distinguish MDR bacterial infection from non-MDR bacterial infection.

Objective:To analyze the clinical epidemiological characteristics and the prognostic risk factors of patients with hemorrhagic fever with renal syndrome (HFRS).Methods:A total of 2 245 HFRS patients who were admitted to the Second Affiliated Hospital of Air Force Medical University from September 2008 to December 2021 were enrolled. Clinical epidemiological data (including gender, age, onset season, onset region, case fatality rate, et al) of HFRS patients were analyzed. The clinical epidemiological characteristics of patients with HFRS in the 2008 to 2012, 2013 to 2017, and 2018 to 2021 groups were compared. Statistical comparisons were performed using chi-square test. The Bonferroni adjusted P-value method was used for pairwise comparisons between groups, and logistic regression analysis was used to screen and evaluate the risk factors associated with the prognosis of HFRS patients. Results:The age of 2 245 HFRS patients was (42.3±15.9) years old. Most of them were male (79.24%(1 779/2 245)), and the main incidence area was Xi′an City (69.53%(1 561/2 245)). There were 132 deaths with an overall case fatality rate of 5.88%. There were 1 088 patients (48.46%) from 2008 to 2012, 647 patients (28.82%) from 2013 to 2017, and 510 patients (22.72%) from 2018 to 2021, with a mortality rate of 7.17%(78/1 088), 5.10%(33/647) and 4.12%(21/510), respectively. From 2008 to 2021, both the number of HFRS cases and the case fatality rate had shown a fluctuating downward trend. There were significant differences in case fatality rate, age distribution, onset season, and onset region among patients in the different year groups ( χ2=6.84, 49.22, 83.47 and 19.29, respectively, all P<0.05). The results of pairwise comparisons showed that the proportion of patients aged >60 years in the 2018 to 2021 group (23.33%(119/510)) was higher than those in the 2008 to 2012 group (12.13%(132/1 088)) and the 2013 to 2017 group (12.36%(80/647)), and the differences were statistically significant (both P<0.05). The proportions of patients at large peak (October to December) were 62.35%(318/510) in the 2018 to 2021 group and 56.26%(364/647) in the 2013 to 2017 group, which were both lower than that in the 2008 to 2012 group (75.18%(818/1 088)), and the differences were both statistically significant (both P<0.05). The case fatality rate of patients aged >60 years was 9.67%(32/331), which was higher than those of patients aged <30 years (2.86%(16/559)) and patients aged 30 to 60 years (6.20%(84/1 355)), with statistically significant differences (both P<0.05). Univariate analysis showed that age 30 to 60 years, age >60 years, smoking, complicated with hypertension, hypotensive shock and hypoxemia were significantly correlated with the prognosis of HFRS patients (odds ratio ( OR)=2.243, 3.632, 1.484, 3.532, 79.422 and 143.955, respectively, all P<0.05). The results of multivariate logistic regression analysis indicated that complicated with hypertension ( OR=2.467, P=0.004), hypotensive shock ( OR=11.658, P=0.001), and hypoxemia ( OR=67.767, P<0.001) were the independent risk factors affecting the prognosis of HFRS patients. Conclusions:The prevalence of HFRS has shown new changing characteristics from 2008 to 2021. The numbers of HFRS patients and the case fatality rates show a downward trend, and the proportion of HFRS patients aged >60 years increases. Complicated with hypertension, hypotensive shock and development with hypoxemia are the independent risk factors for the prognosis of HFRS.

Objective:To investigate the high resolution computed tomography (HRCT) findings, laboratory test results and clinical manifestations of anti-melanoma differentiation-associated gene 5 (MDA5) antibody positive dermatomyositis complicated with lung interstitial lesions, and to analyze the correlation between the HRCT findings and clinical course of disease.Methods:Twenty-seven patients with anti-MDA5 antibody positive associated dermatomyositis (DM) were included and divided into two groups: acute/subacute group ( n=15) and chronic group ( n=12). HRCT images of lung were analyzed. Clinical data including gender, age, clinical manifestations and course of disease, anti-Ro52 antibody, creatine kinase (CK), antinuclear antibody (ANA), anti-Jo-1 antibody and erythrocyte sedimentation rate (ESR) were also collected. χ2 test was adopted for statistical analysis. Results:① Interstitial changes were 100%(27/27). The proportion of unilateral localized distribution was the most [48%(13/27)], followed by bilateral localized distribution [30%(8/27)], and bilateral diffuse distribution [22%(6/27)). ② Among the HRCT findings of lung interstitial changes, ground glass shadow was the most common presentations [59%(16/27)], followed by subpleural curve sign [63%(17/27)] and interlobular septal thickening [56%(15/27)], while honeycomb sign [0(0/27)] had the lowest rate of presentation. ③ Compared with the chronic progressive group, the acute/subacute progressive group presented as chest tightness (80% vs 8%, χ2=13.715, P<0.05) and dyspnea (47% vs 0, χ2=7.560, P<0.05). Acute/subacute HRCT showed ground glass opacity (87% vs 25%, χ2=10.501, P<0.05). The prominent HRCT showed interlobular septal thickening in the chronic course group (83% vs 33%, χ2=6.750, P<0.05). ④ The anti-MDA5 antibody (+++) index was significantly different (88% vs 25%, χ2=8.168, P<0.05). There was no significant difference in anti-Ro52 antibody (+), ANA(+), anti-Jo-1 antibody(+), CK elevation and ESR elevation between the two groups ( P>0.05). Conclusion:Most dermatomyositis patients with positive anti-MDA5 antibody are complicated with interstitial lung lesions, the HRCT manifestations of lung are diverse. In order to confirm the diagnosis of this disease, clinical manifestations, laboratory and pathological examinations are required.

Objective To investigate the correlation between serum vitamin D level in human body and Chlamydia trachomatis (Ct) genitourinary tract infection. Methods This study enrolled 174 outpa-tients (male: 95, female: 79, 20-49 years) infected with Ct and 380 healthy subjects (male: 211, female:169, 20-49 years) in Tianjin from November 1, 2016 to March 15, 2017. Blood samples were collected from all subjects after fasting overnight and the time points for sample collection in the Ct infection group were before and after a course of antibiotic treatment. Serum 25-hydroxyvitamin D [25-(OH)D] levels were measured with enzyme-linked immunosorbent assay (ELISA). PCR assay was used to assess the recovery in those patients one month after a course of treatment. Two case-control studies were respectively conducted, in which 161 patients and 161 healthy subjects as well as 41 uncured patients and 41 cured patients were randomly selected and matched for gender and age. Statistical analysis was performed using SPSS19. 0. Re-sults The two case-control studies showed that vitamin D deficiency was a risk factor for both Ct genital tract infection and poor efficacy, of which the adjusted ORs were 2. 281 (95％ CI: 1. 438, 3. 619) and 7. 266 (95％ CI: 2. 551, 21. 036). Among all subjects aged 20-39, male patients had lower 25-(OH)D level in serum than healthy men [(40. 10±17. 93) nmol/ L vs (53. 72±18. 00) nmol/ L, P< 0. 01] and fe-male patients also had lower 25-(OH)D level in serum than healthy women [(35. 71±19. 99) nmol/ L vs (45. 42±16. 08) nmol/ L, P<0. 01]. The levels of 25-(OH)D in uncured male and female patients were re-spectively lower than those in cured male and female patients [(30. 50±14. 53) nmol/ L vs (41. 32±17. 24) nmol/ L; (29. 47±16. 66) nmol/ L vs (41. 37±21. 03) nmol/ L; both P<0. 05]. Conclusion Vitamin D deficiency related to Ct infection in human genitourinary tract and poor prognosis. Lower serum vitamin D levels might increase the risk of Ct genitourinary tract infection and reduce the efficacy of treatment.

Objective To investigate the reasons and nursing countermeasures of the discomfort of peripher-ally inserted central catheter(PICC)intubation patients in the process of placing tube.Methods 290 patients with PICC who were treated with PICC for the first time were summarized.Results 290 patients with PICC in catheter had not comfortable experience.The main reason of causing discomfort was psychological factors,accounted for 90.0%, catheter when the cold experience leads to the discomfort of 82.8%,catheter environmental factors accounted for 6 3 .8 % ,pain caused by discomfort accounted for 15.5% ,puncture posture factors leading to 13.1% .Conclusion The causes of discomfort in the process of PICC is more,strengthen preoperative health education and the operation of effective communication,to create a relaxed comfortable environment to help patients take comfortable posture,improve a catheter success rate,preventing catheter during cold and other measures can improve the patients'comfort.

Objective To investigate the efficacy of widely used antibiotics for urogenital Chlamydia trachomatis infection in recent 5 years.Methods A total of 2 809 cases of Chlamydia trachomatis urogenital infected patients who visited STD clinics of Tianjin Medical University General Hospital from 2006 to 2010 were collected.All the patients had accomplished a course of treatment of azithromycin, minocycline, moxifloxacin or clarithromycin and followed up for 3 months (once every month).Cochran-Armitage trend test was used to analyzed the antibiotics effect changing trends overtime.Results From 2006 to 2010, the etiology clearance rates of azithromycin were 76.70% (79/103), 74.19% (92/124), 74.13% (106/143), 71.43% (100/140) and 70.77% (92/130), respectively;those of minocycline were 75.31% (61/81), 64.67% (97/150), 66.53% (159/239), 65.05% (188/289) and 63.03% (104/165), respectively;those of moxifloxacin were 88.82% (167/188), 86.23% (119/138), 82.96% (185/223), 81.19% (233/287) and 81.03% (158/37), respectively;those of clarithromycin were 82.93% (34/41), 80.49% (33/41), 79.25% (42/53), 78.18% (43/55) and 75.00% (18/24), respectively.Ochran-Armitage trend test showed that antimicrobial efficacy of moxifloxacin for urogenital Chlamydia trachomatis infection rates declined year by year (P<0.05), while those of azithromycin, clarithromycin and minocycline did not decline significantly (all P>0.05).Conclusions The etiology clearance rate of moxifloxacin is the highest but gradually declines by years, and that of azithromycin takes the second place, while the treatment efficacy of minocycline is lower but quite stable.The number of cases treated with clarithromycin is too small to draw a conclusion.

Objective To investigate the therapeutic effect of injection of dexamethasone solution on the mechanical phlebitis induced by PICC through a syringe pump on intravenous branch of the PICC puncture point.Methods A total of 90 patients who met the criteria were divided randomly into experimental group (n=45) and control group (n=45). Patients in the experimental group were injected on the forearm below the PICC puncture point,where was with good elasticity and obvious exposure,without damage or inflammation,easily fixed,and away from joints or end of tendons. 40 ml of dexamethasone solution,with concentration of 0.125 mg/ml,was injected by a syringe pump with scalp needle 5.5#,with an infusion speed of 10 ml/h,1 time/day. For 3 days of continuous use,the needle was withdrawn once the infusion was done,and the injection location was different for each day. If the mechanical phlebitis was cured after 1 day or 2 days of medication,the injection stopped instantly. For patients in the control group,a wet hot towel was compressed above the PICC point, 3 times/day,20 mins/time. After the application,Hirudoid ointment was rubbed on the side of the upper arm where the catheter was injected,3 days of continuous use was conducted. Observation was conducted to both groups until the 7th day after intervention measures were taken.Results There were significant differences in terms of cure rate and cure time between the two groups (P<0.05) in the treatment of mechanical phlebitis. Conclusions It is highly effective to treat mechanical phlebitis induced by PICC by injection of dexamethasone solution through a syringe pump on intravenous branch of the PICC puncture point,which can relieve symptoms of patients,reduce their pain within a shorter time.

Objective To observe the effect of hot compress with medicinal salt pack in preventing PICC-associated mechanical phlebitis.Method Totally 200 inpatients undergone PICC intubation were randomized into a treatment group and a control group, 100 cases in each group. After PICC intubation, the treatment group was intervened by hot compress with medicinal salt pack, while the control group was by hot compress with warm wet towel. The occurrence of mechanical phlebitis was observed at different time points and compared between the two groups. Result The occurrence rate of mechanical phlebitis was 9.0% in the treatment group versus 26.0% in the control group, and the difference was statistically significant (P<0.05). In the treatment group, the occurrence rate of mechanical phlebitis was respectively 6.0% and 3.0% when treatment≤72 h and>72 h, versus 16.0% and 10.0% in the control group, and the differences were statistically significant (P<0.05). Conclusion Hot compress with medicinal salt pack can effectively reduce the occurrence of PICC-associated mechanical phlebitis.

ObjectiveTo compare the recovery rates calculated according to different criteriain patients with urogenital Chlamydia trachomatis (Ct) infection after treatment with azithromycin. Methods Clinical data on outpatients who were diagnosed with urogenital Ct infection and treated with azithromycin in the sexually transmitted disease(STD) outpatient clinic of Tianjin Medical University General Hospital were retrospectively reviewed. Recovery rates were calculated according to the improvement of symptom and (or) reexamination results of Ct at 1,5 and 9 weeks after the end of treatment.ResultsSignificant differences were observed between the recovery rates calculated according to symptom improvement and those according to laboratory reexamination results.No obvious correlation existed between the presence of symptom and positive reexamination results.The recovery rates calculated according to the second reexamination result differed significantly from those according to the first reexamination result,but were similar to those according to the third reexamination result. ConclusionsThe cure of Ct infection should be determined according to laboratory test results,and two times of reexamination at 1 and 5 weeks after the final treatment are recommended.

[Objective] To observe the specific immune responses induced by the recombinant major outer membrane protein (rMOMP) vaccine against Chlamydia trachomatis E serotype in rhesus monkeys.[Methods] Six rhesus monkeys were equally divided into three groups:adjuvant and protein group vaccinated with purified rMOMP and Freund's adjuvants,adjuvant group immunized with Freund's adjuvants only,and control group immunized with phosphate buffer.All the rhesus monkeys were intramuscularly immunized in the triceps brachii for 3 times at a 2-week interval.Two weeks after the last vaccination,serum,vaginal wash and venous blood samples were collected from the rhesus monkeys,and lymphocytes were isolated from the blood samples.Enzyme linked immunosorbent assay (ELISA) was performed to determine the specific IgG antibody and interferon level in sera and secretory IgA (sIgA) level in wash samples,and methyl thiazolyl tetrazolium (MTT) assay to evaluate the proliferation of lymphocytes after stimulation with Chlaraydia trachomatis serotype E elementary bodies.Delayed hypersensitivity was observed in rhesus monkeys challenged by inactivated Chlamydia trachomatis serotype E elementary bodies.In vitro antibody neutralization assay was conducted with the serum from rhesus monkeys.Indirect immunofluorescenee was used to detect Chlamydia trachomatis in exfoliative vaginal cells from rhesus monkeys from week 1 to 10 after challenge with Chlamydia trachomatis.Data were statistically analyzed by using one-way analysis of variance and least significant difference (LSD) test with the SPSS 14.0 software.[Results] The adjuvant and protein group differed statistically from the adjuvant group and control group in the serum level of specific IgG antibody (1.718 ± 0.213 vs.0.841 ± 0.315 and 0.791 ±0.437,both P＜ 0.05),interferon ((1086 ± 121.730) ng/L vs.(409 + 53.440) ng/L and (162 ± 48.046) ng/L,both P＜ 0.05),lymphocyte proliferation index (7.012 ± 1.026 vs.4.473 ± 1.850 and 1A26 ± 1.104,both P＜0.01 ) and the diameter of nodus in delayed hypersensitivity assay ( ( 1 1 ± 2.134) mm vs.(3 ± 0.914) mm and 0,both P ＜ 0.01 ).After attack,the exfoliative cells kept positive for Chlamydia trachomatis in the adjuvant and protein group from week 1 to 5,and in the other 2 groups from week 1 to 10,but were negative in the adjuvant and protein group from week 6 to 10.[Conclusion] The rMOMP vaccine can induce a specific,protective,humoral and cellular immune response against Chlamydia tracbomatis in rhesus monkeys.