OBJECTIVE To explore the risk factors for central line-associated bloodstream infection(CLABSI)in the maintenance hemodialysis(MHD)patients based on the informatization surveillance system and establish and verify the risk prediction model so as to provide bases for early identification and prevention of CLABSI.METHODS A total of 300 MHD patients who were treated in hemodialysis center of the Affiliated Hospital of Xuzhou Medical University from Jan.2020 to Dec.2023 were recruited as the research subjects and were randomly divided into the training set group with 210 cases and the validation set group with 90 cases in a 7∶3 ratio.The risk factors for the CLABSI were analyzed,the prediction model was established and verified.The performance of the model was evaluated by the area under the curve(AUC)of receiver operating characteristic(ROC)curves and Hosmer-Lemeshow goodness of fit test.RESULTS Among the 300 MHD patients who were treated with central venous catheters,32 were diagnosed with CLABSI,and the incidence was 0.65 per 1,000 catheter days.Multivari-ate analysis showed that catheter indwelling time,repeated catheterization,previous history of catheter-related in-fection and diabetes mellitus were the risk factors for the CLABSI in the MHD patients(P＜0.05).The model based on the logistic regression equation was established as follows:logit(P)=-5.661+0.024 × catheter in-dwelling duration(week)+2.037 × repeated catheterization+1.546 × previous history of catheter-related infec-tion+3.391× diabetes mellitus.ROC curve analysis showed that the AUC of the training set was 0.916(95％CI:0.837 to 0.994),with the sensitivity 87.00％,the specificity 86.63％,Youden index 0.736;the AUC of the vali-dation set was 0.797(95％CI:0.632 to 0.962),with the sensitivity 77.78％,the specificity 82.72％,the Youden index 0.605.The model showed excellent discrimination and calibration degree.CONCLUSION The logistic regres-sion equation that is established based on the 4 risk factors,catheter indwelling duration,repeated catheterization,previous history of catheter-related infection and diabetes mellitus,shows remarkable predictive efficiency,and it can provide evidence for clinical screening and prevention of CLABSI.

Objective:To compare the efficacy of body posture combined with pharmacotherapy and pharmacotherapy alone in the treatment of chronic subdural hematoma(CSDH).Methods:Firstly, retrospective case series study was conducted. Thirty cases of CSDH that had received body posture combined with pharmacotherapy at Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University from December 2016 to October 2020 were studied retrospectively. Twenty-seven patients were male, and 3 patients were female. The age of patients ( M(IQR)) was 66(16) years (range:28 to 84). Nineteen patients had unilateral hematoma, and 11 patients had bilateral hematoma. All patients received pharmacotherapy and body posture therapy that was to raise their lower limbs 20 to 30 cm with leg lift pad and get abdominal compressed with customized abdominal belt in supine position. Patients were required to maintain the body posture as much as possible, with the maximum to 16 to 18 hours per day. Patients with unilateral hematoma should tilt the head to the affected side and avoid tilting it to the opposite side. For patients with bilateral hematoma, there was no need for head lateralization. Patient were treated with oral dexamethasone and atorvastatin simultaneously. The preliminary efficacy of body posture combined with pharmacotherapy was determined by hematoma improvement rate which was analyzed by Clopper-Pearson method. Then, the multi-center, prospective, randomized controlled trial had carried out in 9 medical centers from August 2020 to November 2021. The stratified block randomization method was adopted. Patients were randomized in a ratio of 1∶1 to either receive pharmacotherapy alone(the control group) or body posture combined with pharmacotherapy(the experiment group) for 3 months and followed up for 6 months. Effective treatment was defined as complete absorption of hematoma, or the hematoma volume decreased by more than 10 ml and Markwalder grading scale score had improved by more than 1 point compared to the baseline. The efficacy rate and surgery conversion rate at 3 months and recurrence at 6 months were observed. Comparison between groups was performed with paired sample t test, Mann-Whitney U test, χ2 test, corrected χ2 test, or Fisher exact probability method. Logistic regression was used to compare the effective rate and operation rate between the two groups. Results:In the respective study, 30 patients completed follow-up 13 to 353 days after treatment. At the last follow-up, the incidence of almost complete absorption or significantly absorption of hematoma (hematoma volume was significantly reduced accompanied by symptom improvement) was 93.3%. The 95% CI for the incidence that analyzed by the Clopper-Pearson method was 77.9% to 99.2%. One hundred and six patients were enrolled in the multicenter study. Fifty-five patients underwent body posture combined with pharmacotherapy. The age was 74(17) years (range:26 to 92). Thirty-nine patients were males and 16 were females. Fifty-one patients underwent pharmacotherapy alone. The age was 69(12) years (range:48 to 84). Thirty-seven patients were males and 14 were females. The length of body posture recorded in diary card was (15.7±2.3) hours(range:7.6 to 19.3 hours). The efficacy rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 83.6% (46/55) and 56.9% (29/51), respectively at 3 months. The result of the logistic regression analysis showed that the efficacy of body posture combined with pharmacotherapy group was better than that of pharmacotherapy alone group ( OR=3.88,95% CI:1.57 to 9.58, P=0.003). Surgery rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 5.5% (3/55) and 21.6% (11/51) respectively. The result of Logistic regression showed that the pharmacotherapy alone group was more likely to be converted to surgery ( OR=0.21,95% CI:0.05 to 0.80, P=0.023). At the 6 months, no recurrence of cases was found in the body posture combined with pharmacotherapy group. However, the recurrence rate of pharmacotherapy alone group was 6.3% (3/48), there was no significant difference between the two groups ( P>0.05). Conclusion:The effect of body posture combined with pharmacotherapy for chronic subdural hematoma is better than that of pharmacotherapy alone.

Objective:To investigate whether escin(ESC)and dextromethorphan(DEX)have the protective effects on the progression and symptoms of Alzheimer disease(AD).Methods:The AD model of Caenorhabditis elegans(C.elegans)was established by transgenic amyloid β-protein(Aβ protein).Different concentrations of ESC or DEX or 50 μmol/L memantine(MEM)were used to treat the AD model worms,and their lifespan was detected.The movement ability of AD model C.elegans was evalua-ted by body bending frequency and head swinging frequency.The changes in cognitive functions of AD model C.elegans before and after treatment were detected by chemotaxis experiments.The changes in A βprotein and reactive oxygen species(ROS)content in C.elegans were detected.The changes in gene pathways related to oxidative stress were detected by Real-time quantitative polymerase chain reaction(RT-qPCR).Results:At high dose 1 000 μmol/L,ESC or DEX treatment showed no significant effects on the activity of C.elegans.Compared with untreated worms,the survival time of AD model C.elegans in the 20 μmol/L ESC and 60 μmol/L DEX intervention groups was significantly extended.In the middle stage of AD progression,the body bending frequency and head swinging frequency of AD model worms after ESC or DEX treatment was significantly increased compared with the untreated control group with DEX being more effective in the recovery of head swinging frequency.For the early cognitive function tests,the chemotaxis index of ESC or DEX treated worms was significantly higher than that of the untreated worms,which correlated with marked reductions in the Aβ protein levels.The reactive oxygen species content in the drug intervention group was also lower than that in the control group.RT-qPCR results showed that ESC could inhibit oxidative stress in the AD model C.elegans by a 2-fold upregulation of skn1 expression.Conclusion:ESC and DEX could improve the reductions of movement ability and cognitive function in the AD model worms and delay the aggravation of AD-related symptoms.ESC delays the progression of AD pos-sibly by activating the SKN-1/Nrf2 pathway to protect against oxidative injury in the AD model.

Objective To construct a knowledge graph of healthcare-associated infection(HAI)prevention and control course,and evaluate its usability.Methods Based on the constructivist learning theory and the analyze-de-sign-develop-implement-evaluate(ADDIE)model,knowledge from various sources such as books,guidelines,and literature related to HAI prevention and control were integrated.The knowledge graph of HAI prevention and con-trol course were designed and constructed with the support of knowledge graph technology in Chaoxing Fanya plat-form.Thirty medical students were selected by convenience sampling method to try out the course knowledge graph.System usability scale and usage effect questionnaire were filled out to evaluate the usability of the knowledge graph.Results The knowledge graph of HAI prevention and control course contained 379 knowledge points asso-ciated with 520 test questions and 56 learning resources.After testing,the total score([70.50±12.20]points)was obtained for the usability of the knowledge graph.Among the four dimensions of the usage effect agreement ques-tionnaire,satisfaction,learning attitude,learning ability,and learning resource support accounted for 93.33％-96.67％,90.00％,93.33％-96.67％,and 83.33％-90.00％,respectively,with a high overall satisfaction rate.Conclusion The knowledge graph of HAI prevention and control course has good usability,which can realize students'personalized independent learning and improve their learning efficiency.

The clinical data of a child with refractory systemic juvenile idiopathic arthritis (sJIA) who was admitted to the Children′s Hospital, Zhejiang University School of Medicine in October 2023 were analyzed, and literature review was conducted.The patient was a 9-year-old boy, who was admitted due to recurrent fever, accompanied by rash and joint pain for more than 4 years.Four years ago, he was diagnosed with macrophage activation syndrome and sJIA.In the past 4 years, the condition recurred 3 times under treatment with glucocorticoids, Cyclosporine, and Methotrexate.He previously experienced allergic shock after 5 minutes of infusion of Tocilizumab.Due to Tocilizumab allergy, he was treated with Janus kinase inhibitors, but the disease still recurred.After informed consent was obtained from the guardian, 240 mg of Tocilizumab was administrated for desensitization once every 2 weeks and the process went smoothly.The patient has been followed up for more than 6 months and no allergic reactions had occurred.The condition was well controlled, and the Prednisone acetate tablet had been reduced to 2.5 mg orally once a day.At present, there are 10 patients undergoing desensitization treatment both domestically and internationally, including 2 males and 8 females, aged between 2.5 and 54.0 years.All of them have achieved a success in desensitization.Therefore, Tocilizumab desensitization therapy is of great significance for patients who are allergic to biologics in clinical practice.

Objective To explore the current situation of healthcare-associated infection(HAI)in patients in emergency rescue room and observation room,and analyze the causes.Methods Targeted surveillance was per-formed on patients in emergency rescue room and observation room of a tertiary first-class hospital in Xuzhou City from January 1 to December 31,2023 using prospective survey method.HAI,antimicrobial use,as well as invasive procedures and related infection rates were analyzed.Results The incidence of HAI in 540 patients was 0.19％(n=1),and the daily incidence of HAI was 0.54‰(1/1 841).The utilization rates of invasive ventilators,central ve-nous catheters,and indwelling urinary catheters were 6.79％(125/1 841),1.09％(20/1 841),and 2.93％(54/1 841),respectively.The incidences of ventilator-associated pneumonia,central line-associated bloodstream infec-tion,and catheter-associated urinary tract infection were 8.00‰(1/125),0(0/20),and 0(0/54),respectively.Pathogen detection rate before antimicrobial treatment was 99.22％(382/385).Conclusion The incidence of HAI in patients in emergency rescue room and observation room is low,the retention time of patients in rescue room is short,and pathogen detection of specimens before antimicrobial treatment is high.Patients in emergency rescue room and observation room are at high risk of HAI.It is necessary to carry out targeted surveillance on HAI to re-duce its incidence.

Objective To understand the application of healthcare-associated infection(HAI)quality control indi-cators and current status of HAI management in primary medical institutions in Jiangsu Province,and provide refe-rence and basis for primary medical institutions to improve HAI management quality and for health administrative departments to formulate HAI management relevant policies.Methods Data on HAI quality control indicators co-llected by Jiangsu Provincial Primary Healthcare Professional Quality Control Center from the first batch of 62 pri-mary sentinel medical institutions in the province were analyzed.Results of on-site inspections and assessments of 20 institutions were summarized and analyzed.Results From July 2023 to May 2024,a total of 145 814 inpatients were monitored,219 patients had 220 episodes of HAI.The incidence and case incidence of HAI were both 0.15％,and the main HAI site was upper respiratory tract(40.45％).The compliance rate and correct rate of hand hygiene were 81.34％(14.29％-100％)and 87.90％(18.46％-100％),respectively.The removal rate of surface pollu-tant from environmental objects was 77.24％(20.00％-100％),and the qualified rate of cleaning of device,appli-ances,and articles was 98.76％(10.00％-100％).The monitoring data records of quality control indicators in most primary healthcare institutions during on-site inspections didn't match the monthly data reported to the Jiangsu Provincial Primary Healthcare Professional Quality Control Center.Most healthcare workers in primary healthcare institutions lacked sufficient awareness and knowledge in infection prevention and control.Multiple HAI-related safety hazards existed in key departments of most primary medical institutions.Conclusion After nearly a year of continuous monitoring on HAI,the primary sentinel medical institutions have established their own data on the inci-dence of HAI.The compliance rate and correct rate of hand hygiene,as well as the removal rate of surface pollu-tants from environmental objects are still relatively low in some medical medical institutions,and there is much room for improvement.There is still a significant gap in terms of HAI prevention and control in some primary medical in-stitutions when referring to the standards.

Objective:To investigate whether escin(ESC)and dextromethorphan(DEX)have the protective effects on the progression and symptoms of Alzheimer disease(AD).Methods:The AD model of Caenorhabditis elegans(C.elegans)was established by transgenic amyloid β-protein(Aβ protein).Different concentrations of ESC or DEX or 50 μmol/L memantine(MEM)were used to treat the AD model worms,and their lifespan was detected.The movement ability of AD model C.elegans was evalua-ted by body bending frequency and head swinging frequency.The changes in cognitive functions of AD model C.elegans before and after treatment were detected by chemotaxis experiments.The changes in A βprotein and reactive oxygen species(ROS)content in C.elegans were detected.The changes in gene pathways related to oxidative stress were detected by Real-time quantitative polymerase chain reaction(RT-qPCR).Results:At high dose 1 000 μmol/L,ESC or DEX treatment showed no significant effects on the activity of C.elegans.Compared with untreated worms,the survival time of AD model C.elegans in the 20 μmol/L ESC and 60 μmol/L DEX intervention groups was significantly extended.In the middle stage of AD progression,the body bending frequency and head swinging frequency of AD model worms after ESC or DEX treatment was significantly increased compared with the untreated control group with DEX being more effective in the recovery of head swinging frequency.For the early cognitive function tests,the chemotaxis index of ESC or DEX treated worms was significantly higher than that of the untreated worms,which correlated with marked reductions in the Aβ protein levels.The reactive oxygen species content in the drug intervention group was also lower than that in the control group.RT-qPCR results showed that ESC could inhibit oxidative stress in the AD model C.elegans by a 2-fold upregulation of skn1 expression.Conclusion:ESC and DEX could improve the reductions of movement ability and cognitive function in the AD model worms and delay the aggravation of AD-related symptoms.ESC delays the progression of AD pos-sibly by activating the SKN-1/Nrf2 pathway to protect against oxidative injury in the AD model.

Objective To construct a knowledge graph of healthcare-associated infection(HAI)prevention and control course,and evaluate its usability.Methods Based on the constructivist learning theory and the analyze-de-sign-develop-implement-evaluate(ADDIE)model,knowledge from various sources such as books,guidelines,and literature related to HAI prevention and control were integrated.The knowledge graph of HAI prevention and con-trol course were designed and constructed with the support of knowledge graph technology in Chaoxing Fanya plat-form.Thirty medical students were selected by convenience sampling method to try out the course knowledge graph.System usability scale and usage effect questionnaire were filled out to evaluate the usability of the knowledge graph.Results The knowledge graph of HAI prevention and control course contained 379 knowledge points asso-ciated with 520 test questions and 56 learning resources.After testing,the total score([70.50±12.20]points)was obtained for the usability of the knowledge graph.Among the four dimensions of the usage effect agreement ques-tionnaire,satisfaction,learning attitude,learning ability,and learning resource support accounted for 93.33％-96.67％,90.00％,93.33％-96.67％,and 83.33％-90.00％,respectively,with a high overall satisfaction rate.Conclusion The knowledge graph of HAI prevention and control course has good usability,which can realize students'personalized independent learning and improve their learning efficiency.