In the global public health field,healthcare-associated infection(HAI)has become one of the important factors affecting patient safety,decreasing medical quality,and increasing medical expense.This paper comprehen-sively analyzes relevant research in recent years,deeply explores the relationship between the use of different types of drugs and HAI,including antimicrobial agents,immunosuppressants,and proton pump inhibitors,aiming to systematically review the risk factors and pathogenicity of drug-related HAI in hospitalized patients both domestica-lly and internationally,so as to provide theoretical basis for the prevention and control of HAI.

In the global public health field,healthcare-associated infection(HAI)has become one of the important factors affecting patient safety,decreasing medical quality,and increasing medical expense.This paper comprehen-sively analyzes relevant research in recent years,deeply explores the relationship between the use of different types of drugs and HAI,including antimicrobial agents,immunosuppressants,and proton pump inhibitors,aiming to systematically review the risk factors and pathogenicity of drug-related HAI in hospitalized patients both domestica-lly and internationally,so as to provide theoretical basis for the prevention and control of HAI.

Immune checkpoint inhibitors are effective tumor treatment agents with survival benefits.However,immune toxicity to various organs has become a new challenge in clinical practice.The cardiac involvement can be presented as heart failure,arrhythmia(atrial fibrillation,atrioventricular block,bundle branch block,ventricular tachycardia,etc.),myocardial-pericarditis,myocardiopathy,and sudden cardiac death,etc.This patient developed abnormally increased myocardial enzymes,impaired cardiac function,and atrioventricular block after 1-month treatment with tislelizumab.Endomyocardial biopsy examination confirmed the diagnosis of immune checkpoint inhibitor-associated myocarditis.Through the diagnosis,treatment,and review of relevant literatures of this case,we wish to improve the understanding of immune checkpoint inhibitor-associated myocarditis,and therefore improve the diagnosis and treatment of immune checkpoint inhibitor-associated myocarditis for clinicians.

Objective To investigate the predictive value of serum circular RNA(circRNA)CDYL and circRNA ACAP2 expression levels for major adverse cardiovascular events(MACE)in pa-tients with acute myocardial infarction(AMI).Methods A total of 98 AMI patients were enrolled into the observation group,and divided into MACE group(n=45)and no-MACE group(n=53)based on whether they experienced MACE.Another 98 healthy individuals who underwent physical ex-amination during the same period were selected as the control group.The expression levels of serum cir-cRNA CDYL and circRNA ACAP2 were compared among groups.Multivariate logistic regression analysis was used to identify factors influencing the occurrence of MACE in AMI patients.Receiver operating characteristic(ROC)curve analysis was conducted to evaluate the predictive value of serum circRNA CDYL and circRNA ACAP2 levels for MACE in AMI patients.Results The serum circRNA CDYL level in the observation group was significantly lower than that in the control group,while the circRNA ACAP2 level was significantly higher(P＜0.05).The circRNA CDYL level in the MACE group was significantly lower,and the circRNA ACAP2 level was significantly higher than that in the no-MACE group(P＜0.05).Heart rate and circRNA ACAP2 were identified as independent risk factors for MACE in AMI patients,whereas circRNA CDYL served as independent protective factor(P＜0.05).The area under the ROC curve(AUC)for predicting MACE in AMI patients using se-rum circRNA CDYL,circRNA ACAP2 and their combination were 0.814,0.821 and 0.921,re-spectively.The sensitivity and specificity of combined prediction using serum circRNA CDYL and circRNA ACAP2 were 91.11％and 79.25％,respectively.The combined prediction efficacy of serum circRNA CDYL and circRNA ACAP2 was superior to their individual prediction(Zcombined-circRNA CDYL=1.975,Zcombined-circRNAACAP2=2.064,P=0.048,0.039).Conclusion Serum circRNA CDYL lev-el is down-regulated and circRNA ACAP2 level is up-regulated in AMI patients,and circRNA ACAP2 is an independent risk factor for MACE,while circRNA CDYL is a independent protective factor.The combined value of circRNA CDYL and circRNA ACAP2 in predicting the occurrence of MACE is higher.

Immune checkpoint inhibitors are effective tumor treatment agents with survival benefits.However,immune toxicity to various organs has become a new challenge in clinical practice.The cardiac involvement can be presented as heart failure,arrhythmia(atrial fibrillation,atrioventricular block,bundle branch block,ventricular tachycardia,etc.),myocardial-pericarditis,myocardiopathy,and sudden cardiac death,etc.This patient developed abnormally increased myocardial enzymes,impaired cardiac function,and atrioventricular block after 1-month treatment with tislelizumab.Endomyocardial biopsy examination confirmed the diagnosis of immune checkpoint inhibitor-associated myocarditis.Through the diagnosis,treatment,and review of relevant literatures of this case,we wish to improve the understanding of immune checkpoint inhibitor-associated myocarditis,and therefore improve the diagnosis and treatment of immune checkpoint inhibitor-associated myocarditis for clinicians.

Objective:To analyze the application value of negative pressure closed drainage in tuberculous surgery infected wounds and its effect on wound healing and Th1/Th2 expression.Methods:A prospective study was conducted on 120 patients with tuberculous surgery infected wounds admitted to Hebei Provincial Chest Hospital from January 2019 to June 2021. The patients were divided into observation group and control group according to the random envelope method, with 60 cases in each group. The control group received conventional suture drainage tube intervention, while the observation group received negative pressure closed drainage intervention. The survival rate of skin grafting at 2 weeks after operation, the wound healing rate at 8 weeks after operation, and the pain situation during the first 3 dressing changes were observed. The levels of interferon γ (IFN-γ), interleukin 2 (IL-2), tumor necrosis factor α (TNF-α), IL-6, alkaline phosphatase (ALP), phosphorus (P), calcium (Ca), Th1 and Th2 in serum were detected before treatment and 14 days after treatment.Results:The survival rate of skin grafting at 2 weeks and the wound healing rate at 8 weeks in the observation group were significantly higher than those in the control group, with statistically significant differences (all P<0.05). The Visual Analog Scale (VAS) scores of the observation group were significantly lower than those of the control group during the second and third dressing changes (all P<0.05). At 14 days after treatment, the serum levels of Th1 and Th2 in the observation group were significantly higher than those in the control group, while the levels of IFN-γ, IL-2, TNF-α, IL-6, ALP, P, Ca, Th1/Th2 in serum were significantly lower than those in the control group (all P<0.05). Conclusions:Using negative pressure closed drainage technology can effectively promote wound healing in patients with tuberculous surgery infected wounds and improve the balance of Th1/Th2 in blood.

Objective:To investigate the correlation between the prolongation of the QTc interval and carotid atherosclerosis in elderly patients with type 2 diabetes mellitus(T2DM).Methods:CIinical data of 212 elderly patients with T2DM admitted to our hospital from February 2016 to February 2019 were retrospectively collected.Based on carotid intima-media thickness(CIMT), patients were divided into the CIMT≥1.0 mm group(n=110)and the CIMT<1.0 mm group (n=102). Meanwhile, patients were divided into the prolonged QTc interval group(QTc interval>440 ms, n=50)and the normal QTc interval group(QTc interval≤440 ms, n=162), base on the adjusted QTc interval.General clinical data were compared between the groups, and the logistic regression equation was used to analyze the related factors for carotid atherosclerosis.Results:Higher values of age, duration of disease, systolic blood pressure(SBP), fasting plasma glucose(FPG), triglycerides(TG), creatinine(Cr), uric acid and C-reactive protein(CRP)were found in the CIMT≥1.0 mm group than in the CIMT<1.0 mm group( P<0.05). The QTc interval was longer in the CIMT≥1.0 mm group than in the CIMT<1.0 mm group[(419.2 ± 42.6) ms vs. (396.5 ± 45.2) ms, t=3.849, P<0.01]. CIMT was greater in the prolonged QTc interval group than in the normal QTc interval group[(1.2± 0.3)mm vs.(0.9±0.3) mm, t=6.956, P<0.01]. The detection rates of carotid atherosclerosis, intimal thickening and atheromatous plaques were higher in the prolonged QTc interval group than in the normal QTc interval group( 76.0% or 38 vs. 44.4% or 72, 32.0% or 16 vs.18.5% or 30 and 44.0% or 22 vs.25.9% or 42, respectively, χ2=15.239, 4.087 and 5.922, P<0.05). Pearson’s correlation analysis showed that CIMI was positively correlated with age, duration of disease, SBP, FPG, TG, Cr, uric acid, CRP and QTc interval( P<0.05). Multivariate logistic regression showed that the risk of carotid atherosclerosis in patients with QTc interval>440 ms was 1.761 times higher than that in patients with QTc≤440 ms( OR=1.761, 95% CI: 1.460-3.126, P<0.01). Conclusions:QTc interval prolongation is correlated with carotid atherosclerosis in elderly patients with T2DM, and attention should be paid to the QTc interval on the electrocardiogram, which is helpful to assess the risk of carotid atherosclerosis in elderly T2DM patients.

Objective: To investigate the short-term outcome of patients with acute myocardial infarction complicating cardiogenic shock due to left main disease. Methods: A total of 24 patients with acute myocardial infarction complicating cardiogenic shock due to left main artery disease hospitalized in Fuwai hospital from June 2012 to May 2018 were included. The clinical data were analyzed,and the patients were divided into survivor group (11 cases) and death group (13 cases) according to survival status at 28 days post the diagnosis of shock. The patients were further divided into thrombolysis in myocardial infarction(TIMI) flow grade 0-2 group (11 cases) and TIMI flow grade 3 group (13 cases) according to TIMI flow grade after the procedure. The patients were then divided into non-three-vessel lesions group (14 cases) and three-vessel lesions group (10 cases) according to coronary angiography results. Results: Compared with survivor group, patients in death group presented with lower worst systolic blood pressure within 24 hours after admission (50(48, 70) mmHg (1 mmHg=0.133 kPa) vs. 73(70, 80) mmHg, P<0.01), lower worst diastolic blood pressure with in 24 hours after admission ((33.5±12.4) mmHg vs. (48.9±9.4) mmHg, P<0.01), higher respiratory rates ((27.3±2.5) times/min vs. (21.5±4.0) times/min, P<0.01), less 24 hours urine output ((422±266) ml vs. (1 680±863) ml, P<0.01), lower platelet counts ((161.9±81.9)×10⁹/L vs. (241.6±94.0)×10⁹/L, P=0.03), higher serum creatinine ((250.0±36.8) μmol/L vs. (132.7±34.2) μmol/L, P<0.01), higher alanine aminotransferase (288(76,846) IU/ml vs. 81(42, 109) IU/ml, P=0.04), lower artery pH (7.11±0.17 vs. 7.39±0.09, P<0.01), higher lactic acid ((10.29±3.62) mmol/L vs. (4.21±2.85) mmol/L, P<0.01), higher incidence of invasive ventilation (7/13 vs. 2/11, P=0.02), higher scores of acute physiology and chronic health evaluation (APACHE) Ⅱ (35.4±6.8 vs. 18.7±1.7, P<0.01) and simplified acute physiology score (SAPS) Ⅱ (73.5±17.4 vs. 47.0±4.3, P<0.01), and higher incidence of target vessel TIMI flow grade 0-2 (10/13 vs. 1/11, P<0.01). Kaplan-Meier survival curve analysis showed that survival rate at 28 days post the diagnosis of shock in TIMI flow grade 3 group was higher than that in TIMI flow grade 0-2 group (76.9% vs. 9.1%, log-rank test, P<0.01), and mortality rate was similar at 28 days post the diagnosis of shock between non-three-vessel lesions group and three-vessel lesions group (35.7% vs. 60.0%, log-rank test, P=0.14). Multivariate logistic regression analysis showed that compared with TIMI flow grade 0-2 group, the OR value of death at 28 days post the diagnosis of shock in TIMI flow grade 3 patients with acute myocardial infarction complicating cardiogenic shock due to left main disease was 0.030(95%CI 0.003-0.340, P<0.01). Conclusion Short-term outcomeof patients with acute myocardial infarction complicating cardiogenic shock due to left main disease remains poor, and final flow of TIMI grade 3 is confirmed as independent protective factor of death at 28 days post the diagnosis of shock in these patients.

Objective To evaluate the efficacy and safety of modified transurethral plasmakinetic enucleation of prostate (M-TPEP) combined with cystolithectomy in elderly patients with high risk of large volume benign prostatic hyperplasia (BPH) complicated with large urinary bladder calculi. Methods Seventy-one patients with high risk of large volume BPH complicated with large urinary bladder calculi were selected, and the patients were treated with M-TPEP combined with cystolithectomy. The operation time, intraoperative blood loss, hospitalization time, complications, and the maximum urinary flow rate (Qmax), post-void residual volume (PVR), serum potassium, international prostate symptom score (IPSS), quality of life (QOL) score preoperative and postoperative 3 months were recorded. Results Seventy-one patients successfully completed the operation, and no death occurred. The operation time was (75.48 ± 6.51) min, intraoperative blood loss was (82.63 ± 10.08) ml, and postoperative hospitalization time was 5-7 d. Incidence of intraoperative capsule perforation was 2.82% (2/71), incidence of postoperative temporary urinary incontinence was 7.04% (5/71), incidence of urethral and bladder irritation after operation was 8.45% (6/71), and incidence of postoperative wound infection was 2.82% (2/71). The PVR, IPSS and QOL score 3 months after operation were significantly lower than those before operation: (6.89 ± 0.74) ml vs. (205.13 ± 40.08) ml, (2.71 ± 0.45) scores vs. (28.62 ± 3.57) scores and (1.36 ± 0.24) scores vs. (4.93 ± 0.38) scores, the Qmaxwas significantly higher than that before operation: (22.46 ± 2.97) ml/s vs. (5.24 ± 0.43) ml/s, and there were statistical differences (P＜0.01);there was no statistical difference in serum potassium between before operation and 3 months after operation (P＞0.05). Conclusions M-TPEP combined with cystolithectomy has short operation time, quick recovery after operation and low complication rate. It is a proper operative method for the elderly patients with high risk of large volume BPH and large urinary bladder calculi.