Trueperella pyogenes(TP),an important livestock and poultry pathogen,can cause vari-ous diseases such as suppurative pneumonia,arthritis,and mastitis in animals.The newly brought calves of one cattle farm occurred respiratory diseases and accompanied death in Yunyang,Chongqing,based on post-mortem examination,suppuration nodules were found in the lungs,and microscopic observation of tissue smears with staining showed that a lot of short rod shape bacteri-a were in tissue.The bacteria were isolated and purified from the clinic lung tissue and analyzed by 16S rRNA sequence,the result showed the infectious bacteria was Rueperella pyogenes,and it was nominated as TpCQ-yy1.TpCQ-yy1 cultured on rabbit blood agar plates could form double-zone hemolysis,and can utilize glucose and lysine.Interestingly,the drug-resistance characteristics of TpCQ-yy1 partially changed along with the variation of the culture medium.Pathogenicity analysis showed that TpCQ-yy1 could make suppurative lesions in the lungs of mice infected via the thorac-ic and intraperitioneal route,and later led mice to death,while the subcutaneous and intramuscular routes of infection had only suppurative foci at the site of injection and were dose-dependent and non-lethal.The genome size of TpCQ-yy1 is 2.335 Mb,which encoding 2 107 proteins,and the phy-logenetic analysis showed TpCQ-yy1 is close to Trueperella pyogenes TP1 strain but away from other strains.TpCQ-yy1 infection could promote the secretion of inflammatory factors of macro-phage.TpCQ-yy1 inactivated bacterial vaccine and recombinant hemolysin(rPLO)subunit vaccine could induce high levels of antibodies production in mice immunized via subcutaneous and muscle route,but only provided 33.3％-66.7％protection to the immunized mice against TpCQ-yyl infec-tion via intraperitioneal route.This research provides a fundamental basis for the understanding of the biological characteristics,pathogenicity,and prevention and control of Trueperella pyogenes.

Objective:To construct a prediction model for peripherally inserted central catheter-related upper extremity deep vein thrombosis (PICC-UEDVT) in patients with traumatic brain injury (TBI) and validate its effectiveness.Methods:A case-control study was conducted on the clinical data of 222 TBI patients admitted to Xiangya Hospital of Central South University from January 2019 to December 2021, including 171 males and 51 females, aged 18-86 years [54.5(46.0, 65.0)years]. Glasgow coma scale (GCS) motor score was 4.0(3.0, 5.0)points on the day of catheterization. A total of 82 patients (36.9%) had PICC-UEDVT. The patients were randomly divided with a ratio of 7∶3 into training set ( n=156, including 58 with PICC-UEDVT) and validation set ( n=66, including 24 with PICC-UEDVT) using R programming language. The baseline data of general information, intravenous medication, catheterization, and laboratory indices were compared between the training set and the validation set. Lasso regression analysis was employed to identify those variables, with the diagnosis of PICC-UEDVT as the outcome variable. Variables with non-zero regression coefficients were included in a multifactorial Logistic regression model and independent variables were selected based on the Akaike Information Criterion (AIC) of R programming language. The regression equation was constructed, based on which, the predictive nomogram model was constructed for PICC-UEDVT in TBI patients. Receiver operating characteristic (ROC) curves for the training set and validation set were plotted and the discriminability of the model was assessed. The calibration of the model was evaluated using the Hosmer-Lemeshow (H-L) goodness-of-fit test and calibration curves and the clinical practicality of the model was assessed with decision curve analysis (DCA). Results:The baseline analysis of both the training set and the validation set demonstrated a well-balanced sample distribution. Through Lasso regression analysis, 5 prediction variables were identified: GCS motor score on the day of catheterization, Caprini score on the day of catheterization, use of glucocorticoids, tip position of the catheter, and D-dimer (D-D) level before catheterization. The multivariate Logistic regression analysis revealed that the Caprini score on the day of catheterization ( OR=1.20, 95% CI 1.08, 1.33), use of glucocorticoids ( OR=3.13, 95% CI 0.99, 10.46), and D-D level before catheterization ( OR=1.16, 95% CI 1.07, 1.33) were independent risk factors for PICC-UEDVT in TBI patients. The regression equation was developed as: Logit [ P/(1- P)]=-2.56+0.18×"Caprini score on the day of catheterization"+1.14×"use of glucocorticoids"+0.15×"D-D level before catheterization". In the prediction model which was constructed based on the equation, the AUC values for the training set and validation set were 0.73 (95% CI 0.65, 0.81) and 0.77 (95% CI 0.65, 0.87) respectively. The H-L goodness-of-fit test indicated χ2=3.28, P=0.950 for the training set and χ2=13.05, P=0.160 for the validation set. Calibration curves for both sets demonstrated alignment between the actual and predicted probabilities of PICC-UEDVT in TBI patients. DCA results showed that the net benefit rate of patients was optimal when the threshold probability ranged from 15% to 72% for the training set and from 10% to 81% for the validation set. Conclusion:The prediction model based on the Caprini score on the day of catheterization, use of glucocorticoids, and D-D level before catheterization demonstrates good predictive accuracy, calibration and clinical practicality in predicting PICC-UEDVT in TBI patients.

ObjectiveTo understand the current situation of tobacco use among rural adolescents in Sichuan Province and its influencing factors， to explore the relationship between smoking behavior and psychosocial influencing factors of rural adolescents in Sichuan Province， and to provide a scientific basis for the prevention and control of smoking among rural adolescents. MethodsAn "Adolescent Health Questionnaire" was used as the survey tool to investigate 2 671 students in the 8th and 11th grades of two township middle schools in Zizhong County， Sichuan Province. The structural equation model in Mplus 7.0 was used to analyze the relationship between adolescent tobacco use behavior， mental health， and life satisfaction. ResultsAmong the surveyed adolescents， 28.3% （756/2 671） had tried tobacco products， and 9.5% （255/2 671） had used tobacco products in the past 30 days. The prevalence of tobacco use was higher among boys （16.6%） than girls （3.5%）， and among 11th grade students （21.9%） compared to 8th grade students （7.3%）， with statistically significant differences （χ²=131.99 and 4.24， both P<0.05）. The current tobacco use rate increased with the increase in monthly allowance （χ²=46.96， P<0.05）. The structural equation model of smoking behavior showed that mental health had a positive and direct impact on smoking behavior， and an indirect impact on smoking behavior through living environment satisfaction. Living environment satisfaction had a negative and direct impact on smoking behavior with the mediating effect accounting for 19.2% of the total effect. The non-standardized mediating effect of mental health on smoking behavior through life environment satisfaction and its 95%CI were 0.007 （0.002‒0.012）. ConclusionAdolescent smoking behavior is a complex psychosocial behavior， and the situation of adolescent tobacco use in rural areas in Sichuan is severe. There is a correlation between adolescent tobacco use behavior and psychosocial influencing factors. Psychosocial influencing factors can predict adolescents’ tobacco use behavior. Attention should be paid to the important role of psychosocial influencing factors when intervening in rural adolescents’ smoking behavior.

Objective To investigate the prevalence of nosocomial infection among inpatients in a tertiary hospital， and provide scientific evidence for hospital infection control and targeted surveillance. Methods A cross-sectional survey was conducted to investigate a total of 543 hospitalized patients using the hospital information system. Results The prevalence of hospital-acquired infection （HAI） was 4.24%， and that of community-acquired infection （CAI） was 23.39%. HAI prevalence differed significantly among the departments （ χ ²=148.870， P <0.05）， and was highest in the department of intensive care medicine （72.73%）. Sites of infection were significantly different between HAI and CAI （ χ ²=22.942， P =0.011）； however， the most frequent site of infection was lower respiratory tract in both HAI and CAI. Major pathogens for nosocomial infection were Gram-negative bacteria （56.92%）， mainly Escherichia coli and Klebsiella pneumoniae . Antimicrobial usage was observed in 31.68% of the patients， principally for therapeutic use of antibacterial drugs （80.23%） and a combination of drugs （88.95%）. Examination rate of pathogens following the antimicrobial usage was 72.08%. Conclusion The investigation on the prevalence of nosocomial infection may facilitate fully understanding the nosocomial infection. It warrants strengthening the monitoring in the departments of intensive care medicine and on multi-resistant bacteria， and achieving antimicrobial stewardship， so as to improve the awareness of hospital infection control in medical staff' and effectively reduce the occurrence of nosocomial infection.

Objective:To explore the diagnostic value of C-TIRADS combined with artificial intelligence-assisted diagnosis S-Detect technology in the differential diagnosis of thyroid nodules.Methods:A total of 237 thyroid nodules patients (237 thyroid nodules)with ultrasound examination and definitive pathologic results in Henan Cancer Hospital from April to September 2020 were retrospectively analyzed. The nodules were diagnosed according to C-TIRADS guidelines, and then by S-Detect technology combined with C-TIRADS guidelines. The ROC curve was plotted with the pathological results as the gold standard, and the area under the ROC curve, sensitivity, specificity and accuracy of the diagnosis results between the two groups were compared.Results:Among the 237 thyroid nodules, 105 were benign and 132 were malignant.The area under the ROC curve of C-TIRADS diagnosis alone and C-TIRADS diagnosis combined with artificial intelligence were 0.869 and 0.942 respectively, the difference between the two groups was statistically significant (χ 2=36.11, P<0.001); When Category 4A was used as the cutoff value of benign and malignant differential diagnosis, the specificity and accuracy of C-TIRADS classification of artificial intelligence-assisted diagnosis was significantly higher than that of C-TIRADS alone, and the difference was statistically significant(83.81% vs 47.62%, 90.72% vs 75.53%, all P<0.05). Conclusions:C-TIRADS combined with artificial intelligence-assisted diagnosis S-Detect technology has a high efficiency in the diagnosis of thyroid nodules and can improve the specificity and accuracy of thyroid nodules diagnosis and reduce unnecessary biopsy.

Objective To investigate the preventive and inhibitory effects of tumor cell lysate(TCL) combined with IL-2 on melanoma and the potential immune mechanism. Methods The B16F10 melanoma TCL cell were prepared using an ultrasonic disruptor. Twenty-four C57BL/6 mice were randomly divided into four groups which were immunized with PBS, IL-2, TCL and TCL+IL-2 for three weeks, and contra lateral tumors were implanted in the fourth week. We observed onset time of tumor and tumor size, collected peripheral blood continuously and monitored the expression of CD4⁺T and CD8⁺T cell subsets dynamically by flow cytometry. Spleen and tumor tissues of mice were also tested for CD4⁺T and CD8⁺T cell subsets by flow cytometry and immunohistochemistry, respectively. Results The preventive immunization of the TCL+IL-2 group significantly delayed the onset time of tumor (P=0.034); moreover, the tumor volume (P=0.023) and tumor weight (P=0.0015) were also significantly smaller than those in the control group. The expression of CD8⁺T cell subsets in the TCL+IL-2 group and the TCL-only group were significantly higher than that in the control group (P=0.0016, P=0.012). However, the CD4⁺T cell subsets of the TCL+IL-2 group decreased after tumor implantation, compared with the control group (P=0.0089). The expression of CD4⁺T and CD8⁺T cell subsets in spleen and tumor tissues were as same as those in peripheral blood. Conclusion The tumor vaccine of TCL combined with IL-2 could prevent the occurrence of melanoma in mouse and effectively inhibit tumor growth by activating CD8⁺T cells.

Objective:To investigate the standardized construction of critical care departments in different cities and counties of Guizhou province to promote the homogenization development of critical care medicine in Guizhou Province.Methods:Using research methods such as field investigation and data collection, the public hospitals of 88 counties and urban areas in 9 prefectures and cities of Guizhou province were divided into five routes: southeast, northeast, northwest, southwest, and Guiyang. To design the survey form for the standardized construction of ICU, the e-form was sent to the director of ICU or his/her designated personnel by email or wechat 2-3 days in advance. Check the authenticity of data item by item on site, and leave the hospital after checking the receipt form.Results:From April to July 2021, the survey and research data collection was completed for 146 public hospitals (excluding provincial hospitals) with intensive care departments in 88 counties and cities of 9 dizhou cities in Guizhou Province, including 24 Grade-Ⅲ Level A hospitals. 122 Grade-Ⅱ and above hospitals (including 8 Grade-Ⅲ Level B hospitals, 11 Grade-Ⅲ comprehensive hospitals, 97 Level-Ⅱ A hospitals, 3 Level-Ⅱ B hospitals, and 3 Level-Ⅱ comprehensive hospitals). 146 public hospitals have a total of 80 983 beds and 104 017 open beds. The department of Critical Care has 2 035 beds. The ratio of actual beds in ICU to total beds in hospital was 2.51%. From 1999 to 2010, 18 (12.33%) established departments, and from 2011 to 2021, 128 (87.67%) established departments. The total area of the discipline is 113 355.48 m 2, with an average bed area of 55.70 m 2. There were 97 hospitals with 1.5-2.0 m bed spacing, accounting for 66.44%, and 49 hospitals with 2.1- > 2.5 m spacing, accounting for 33.56%. The number of negative pressure wards: 1 in each of 43 hospitals, accounting for 29.45%; 103 hospitals did not have, accounting for 70.55%. The number of single rooms: 288 in 140 hospitals, accounting for 95.89%; 6 hospitals did not have, accounting for 4.11%. Central oxygen supply: 138 hospitals have (94.52%); 8 hospitals did not have, accounting for 5.48%. Natural ventilation: in 129 hospitals with 88.36%; 17 hospitals did not have, accounting for 11.64%. Specialized ICU construction: 66 hospitals, accounting for 45.21%; none in 80 hospitals, accounting for 54.79%. There are 3 712 doctors and nurses in 146 public hospitals. The total number of doctors was 1 041, and the ratio of doctors to beds was 0.51∶1. The total number of nurses was 2 675, and the ratio of nurses to beds was 1.31∶1. Conclusions:All 88 counties and districts in 9 prefectures and cities of Guizhou province have established intensive care medicine departments. The standardization of the discipline construction has been significantly improved. Lack of talents is still an important factor restricting the rapid development of the discipline.

Objective:To investigate the related risk factors for biliary anastomotic stenosis after liver transplantation (LT) from donation after cardiac death(DCD) and therapeutic strategies.Methods:The data of 192 patients who received LT from DCD in First Hospital of Kunming from Jan 2010 to Jun 2018 were retrospectively analyzed. A total of 145 patients were enrolled, 85 males and 60 females, with average age 45 years. There was a biliary anastomotic stenosis in 8 cases and no stenosis in 137 cases. Their Chinese criterion for biliary anatomic stenosis, age, body mass index, liver fat, cold/warm ischemia time, unschedule cardiac arrest time, usage of vasopressors, high sodium in the donor were compared, and stenosis related factors were analysed by Spearman correlation analysis.Results:The stenosis was positively correlated with age ( r=0.229), body mass index ( r=0.204), lipoidosis ( r=0.239), duration of hot ischemia ( r=0.214), total duration of unplanned cardiac arrest ( r=0.401), use of booster drugs ( r=0.237), and preoperative donor hypernatremia ( r=0.557) (all P<0.05). Endoscopic biliary stent implantation is effective in the treatment of biliary anastomotic stenosis and has a high success rate. Conclusions:There are many factors related to biliary anastomotic stenosis after DCD liver transplantation, but the better donor maintenance, shorten cold/ warm ischemia time, improved anastomosis will be helpful to reduce biliary complications.As the same time, endoscopic biliary stent placement is the preferred way to treat biliary anastomotic stenosis.

Objective:To discuss the feasibility of offering specialized courses of critical care medicine in undergraduate clinical medicine education, so as to alleviate the shortage of critical care medicine staffs and lay a foundation for improving the success rate for the treatment of critical cases.Methods:The undergraduates majoring in clinical medicine from 2008 to 2011 in Guizhou Medical University (the former Guiyang Medical College) were enrolled. After they had been enrolled in the undergraduate education for 3 years and were ready for Grade four, which meant basic medicine teaching had been completed and clinical medicine teaching was about to start, they were introduced and preached to each discipline, including critical care medicine. The undergraduates were free to choose professional direction of clinical training in Grade four. Students majoring in clinical medicine from 2012 to 2014 were free to choose their major direction when they entered the school.Results:From September 2011 to July 2019, the university had cultivated 246 undergraduates majoring in clinical critical care medicine from 2008 to 2014, and the critical care medicine professional team of affiliated hospital had undertaken 540 teaching hours. By July 2019, all students had graduated on time, with an employment rate of 100%. Forty students took postgraduate programs in our school and other schools, accounting for 16.3%.Conclusions:Professional education of critical care medicine in the undergraduate course of clinical medicine can mobilize students' interest in learning and subjective initiative, which is conducive to career selection. During the clinical training, the students can identify and timely cure critical care cases in the early stage, and partly alleviate the current shortage of critical care medical staffs.

Carbon dioxide (CO 2) ejection syndrome is common after artificial pneumoperitoneum, and it often attracts the attention of anesthesiologists because of its rapid changes in vital signs. CO 2 ejection syndrome is not uncommon in critically ill patients, and may occur after mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). There are few relevant reports about CO 2 ejection syndrome, and a considerable number of clinicians have little understanding of the pathological changes. A case of AECOPD patient with CO 2 ejection syndrome after endotracheal intubation was admitted to the intensive care unit (ICU) of the Affiliated Hospital of Guizhou Medical University. After treatment, such as fluid expansion, vasoactive drugs and ventilator assistance, the patient's condition improved and was transferred out of the ICU. It is expected to provide some references by summarizing the diagnosis and treatment of this case and reviewing relevant literature reports.