1.Regulatory Effect of Danhe Granules on Oxidative Stress in Rats with Mixed Hyperlipidemia
Jingke MENG ; Susu LIU ; Pan GAO ; Mingjiao JIA ; Bochao JIA ; Qingzheng XING ; Yulong CHEN ; Wei WANG ; Xinlou CHAI
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(10):112-122
ObjectiveTo investigate the therapeutic mechanism of Danhe granules in treating mixed hyperlipidemia based on network pharmacology, as well as animal and cell experiments. MethodsThe active compounds and targets of Danhe granules were screened using the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) and the Encyclopedia of Traditional Chinese Medicine (ETCM). Related targets for mixed hyperlipidemia were obtained from the GeneCards database. The intersecting targets were subjected to Gene Ontology (GO) functional annotation and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses. A high-fat model was established in human hepatocellular carcinoma cells (HepG2) induced by palmitic acid (PA), followed by intervention with Danhe granules to assess intracellular lipid accumulation and oxidative stress levels. A mixed hyperlipidemia rat model was also established and divided into low-, medium-, and high-dose Danhe granules groups (1.134, 2.268, and 4.536 g·kg-1, respectively), as well as a positive control group treated with pravastatin sodium (4.020 mg·kg-1). After eight weeks of intervention, serum lipid levels, inflammatory factors, oxidative stress indices, and the expression of key hepatic lipid metabolism-related proteins were determined. ResultsNetwork pharmacology identified 93 intersecting targets between Danhe granules and mixed hyperlipidemia, with peroxisome proliferator-activated receptor gamma (PPARG), peroxisome proliferator-activated receptor alpha (PPARA), tumor necrosis factor (TNF), interleukin-6 (IL-6), and IL-1B among the key nodes. The PPAR signaling pathway, AGE/RAGE signaling pathway, lipid metabolism, atherosclerosis and non-alcoholic fatty liver disease (NAFLD) were among the most significantly enriched pathways. Cellular experiments demonstrated that Danhe granules significantly reduced reactive oxygen species (ROS) and malondialdehyde (MDA) levels while increasing catalase (CAT) activity (P<0.05), thereby alleviating intracellular lipid accumulation and triglyceride (TG) content in HepG2. In animal experiments, Danhe granules markedly decreased serum total cholesterol (TC), TG, and low-density lipoprotein cholesterol (LDL-C) levels (P<0.05), reduced hepatic MDA levels, and elevated superoxide dismutase (SOD) and CAT levels. Histological analysis showed alleviation of hepatic steatosis, upregulation of hepatic PPARA and lipoprotein lipase (LPL) expressions, and downregulation of sterol regulatory element-binding protein 1 (SREBP1) expression (P<0.05, P<0.01). ConclusionDanhe granules improve lipid metabolism disorders in mixed hyperlipidemia by reducing MDA levels, enhancing SOD and CAT activities, scavenging excessive ROS, inhibiting oxidative stress, and mitigating liver injury. The underlying mechanism may involve the upregulation of PPARA and LPL and the suppression of SREBP1 expression.
2.Regulatory Effect of Danhe Granules on Oxidative Stress in Rats with Mixed Hyperlipidemia
Jingke MENG ; Susu LIU ; Pan GAO ; Mingjiao JIA ; Bochao JIA ; Qingzheng XING ; Yulong CHEN ; Wei WANG ; Xinlou CHAI
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(10):112-122
ObjectiveTo investigate the therapeutic mechanism of Danhe granules in treating mixed hyperlipidemia based on network pharmacology, as well as animal and cell experiments. MethodsThe active compounds and targets of Danhe granules were screened using the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) and the Encyclopedia of Traditional Chinese Medicine (ETCM). Related targets for mixed hyperlipidemia were obtained from the GeneCards database. The intersecting targets were subjected to Gene Ontology (GO) functional annotation and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses. A high-fat model was established in human hepatocellular carcinoma cells (HepG2) induced by palmitic acid (PA), followed by intervention with Danhe granules to assess intracellular lipid accumulation and oxidative stress levels. A mixed hyperlipidemia rat model was also established and divided into low-, medium-, and high-dose Danhe granules groups (1.134, 2.268, and 4.536 g·kg-1, respectively), as well as a positive control group treated with pravastatin sodium (4.020 mg·kg-1). After eight weeks of intervention, serum lipid levels, inflammatory factors, oxidative stress indices, and the expression of key hepatic lipid metabolism-related proteins were determined. ResultsNetwork pharmacology identified 93 intersecting targets between Danhe granules and mixed hyperlipidemia, with peroxisome proliferator-activated receptor gamma (PPARG), peroxisome proliferator-activated receptor alpha (PPARA), tumor necrosis factor (TNF), interleukin-6 (IL-6), and IL-1B among the key nodes. The PPAR signaling pathway, AGE/RAGE signaling pathway, lipid metabolism, atherosclerosis and non-alcoholic fatty liver disease (NAFLD) were among the most significantly enriched pathways. Cellular experiments demonstrated that Danhe granules significantly reduced reactive oxygen species (ROS) and malondialdehyde (MDA) levels while increasing catalase (CAT) activity (P<0.05), thereby alleviating intracellular lipid accumulation and triglyceride (TG) content in HepG2. In animal experiments, Danhe granules markedly decreased serum total cholesterol (TC), TG, and low-density lipoprotein cholesterol (LDL-C) levels (P<0.05), reduced hepatic MDA levels, and elevated superoxide dismutase (SOD) and CAT levels. Histological analysis showed alleviation of hepatic steatosis, upregulation of hepatic PPARA and lipoprotein lipase (LPL) expressions, and downregulation of sterol regulatory element-binding protein 1 (SREBP1) expression (P<0.05, P<0.01). ConclusionDanhe granules improve lipid metabolism disorders in mixed hyperlipidemia by reducing MDA levels, enhancing SOD and CAT activities, scavenging excessive ROS, inhibiting oxidative stress, and mitigating liver injury. The underlying mechanism may involve the upregulation of PPARA and LPL and the suppression of SREBP1 expression.
3.Application Analysis of Alzheimer's Disease Animal Models Based on Data Mining
Zhichen WANG ; Senlin CHEN ; Yulong ZOU ; Gengzhao CHEN ; Qianhong ZHU ; Saie HUANG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(13):244-252
ObjectiveThis paper aims to systematically summarize the construction methods and characteristics of Alzheimer's disease (AD) animal models, providing a reference for improving AD animal models. MethodsLiterature related to AD animal models published between January 2022 and April 2025 was retrieved from China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), Wanfang Data, and VIP Database. Information such as experimental animal species, month of age, sex, modeling methods, and period, as well as evaluation indicators, was collated, extracted, and imported into Microsoft Excel 2024 to establish the database. In addition, various modeling methods and detection means were summarized and compared. ResultsA total of 400 articles were included. Among the AD animal models, amyloid precursor protein/presenilin-1 (APP/PS1) mice were used most frequently, with a predominance of male animals. Typically, 3-4-month-old rats or 5-6-month-old mice were selected. The main modeling methods included natural aging, accelerated aging, surgical intervention, drug induction, and transgenic technology. The modeling period was mainly concentrated in a single day or 6-8 weeks. Detection indicators of the models focused on physiological, behavioral, pathological-morphological, and biochemical phenotypes. ConclusionThe construction methods of AD animal models are relatively mature, with multifactorial interventions effectively simulating human pathology, though certain limitations remain. By systematically reviewing and analyzing recent experimental literature of AD animal models, this study aims to provide theoretical support and a reference for further improving the construction of the AD animal model.
4.Clinical effect and mechanism of Gongliuxiao capsule combined with dienogest in treating refractory/recurrent endometriosis
Hui YUAN ; Yalin MAO ; Xiangqian XU ; Yulong CHEN ; Shoufang KONG
China Pharmacy 2026;37(11):1468-1472
OBJECTIVE To investigate the clinical efficacy and mechanism of Gongliuxiao capsule combined with dienogest (DNG) in the treatment of refractory/recurrent endometriosis (EMT). METHODS A retrospective analysis was conducted on the clinical data of 94 patients with refractory/recurrent EMT admitted to Qingdao TCM Hospital from January 2022 to January 2025. According to different treatment methods, they were divided into a monotherapy group (47 cases, receiving DNG monotherapy) and a combination group (47 cases, receiving Gongliuxiao capsule combined with DNG). The cl inical efficacy, symptom and sign scores [Visual Analog Scale (VAS) and Pictorial Blood Loss Assessment Chart (PBAC) scores ] , vascular endothelial function indicators [serum transforming growth factor-β 1 (TGF-β 1 ), vascular endothelial growth factor (VEGF), matrix metalloproteinase-2 (MMP-2), MMP-9, basic fibroblast growth factor (bFGF) ] , serum pathological factors [carbohydrate antigen 125 (CA125), CA199, anti-endometrial antibody (EMAb) ] , and Th1/Th2 drift indicators [interferon-γ (IFN-γ), interleukin-4 (IL-4) ] were compared between the two groups before and after 6 months of treatment. RESULTS After treatment, the VAS and PBAC scores, serum levels of TGF-β 1 , VEGF, MMP-2, MMP-9, bFGF, CA125, CA199, EMAb, and IL-4 in both groups were significantly lower than those before treatment, while IFN-γ levels were significantly higher than those before treatment ( P <0.05). Moreover, the magnitude of increase or decrease in the combination group was significantly greater than that in the monotherapy group ( P <0.05). The total effective rate in the combination group was significantly higher than that in the monotherapy group (93.62% vs. 76.60%, P <0.05). CONCLUSIONS The combination of Gongliuxiao capsule and DNG is effective in treating refractory/recurrent EMT, and can effectively improve the degree of dysmenorrhea and abnormal menstrual volume in patients. The mechanism may be related to improving vascular endothelial function, inhibiting the expression of tumor pathological factors, and correcting Th1/Th2 drift.
5.Role of Autophagy Flux in Chemoresistance of Medullary Thyroid Carcinoma and Sensitizing Effect of Chloroquine Combined with Doxorubicin
Yating CHEN ; Xueyu WANG ; Yulong WANG
Cancer Research on Prevention and Treatment 2026;53(7):516-522
Objective To investigate the role of cellular autophagy in medullary thyroid carcinoma (MTC) under doxorubicin (DOX)-induced stress and chemoresistance and to evaluate the synergistic antitumor effect of combining the autophagy inhibitor chloroquine (CQ) with DOX. Methods The human MTC cell line TT was used as an in vitro model and assigned to four groups: control, DOX, CQ, and DOX+CQ combination. Autophagy flux was assessed by Western blot analysis of LC3-Ⅱ protein expression, whereas autophagic structures were observed through transmission electron microscopy (TEM). An MTC xenograft model was established in nude mice, and tumor-bearing mice were randomly allocated to corresponding treatment groups. Tumor growth volume and weight were monitored, and autophagy levels in tumor tissues were detected. Results In vitro experiments showed that DOX treatment considerablyincreased LC3-Ⅱ levels, indicating autophagy induction. The combination of DOX and CQ led to further LC3-Ⅱaccumulation, and TEM revealed numerous undegraded autophagosomes and abnormal autolysosomes, confirming the successful blockade of autophagic flux. In vivo, the DOX+CQ combination therapy inhibited tumor growth significantly more effectively than any single-agent treatment (tumor inhibition rate: 60.0%, P<0.01) without causing considerable systemic toxicity. Marked accumulation of LC3-Ⅱ in tumor tissues from the combination group indicated the effective inhibition of autophagic flux in vivo. Conclusion Functional autophagy flux is a key mechanism underlying DOX chemoresistance in MTC. CQ can effectively reverse this resistance by blocking autophagic flux, and its combination with DOX exhibits a considerable synergistic antitumor effect. These findings suggest a promising therapeutic strategy for the management of advanced MTC.
6.Mechanism of Huanglian Wendantang on Damp-heat Type Diabetes Enteropathy Rats Based on TGR5/GLP-1 Signaling Pathway and Intestinal Flora
Yujin WANG ; Yulong QIE ; Hua JIANG ; Chen YUAN ; Xirui DENG ; Xuelian MENG ; Wenli WANG ; Yanjin SU
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(15):10-18
ObjectiveTo explore the mechanism of Huanglian Wendantang on damp-heat type diabetes enteropathy rats based on the G protein coupled bile acid receptor 5/glucagon like peptide-1 (TGR5/GLP-1) signaling pathway and intestinal flora. MethodsA total of 72 male Sprague Dawley (SD) rats were adaptively fed for one week. Twelve SD rats were randomly selected as a blank group and fed with an ordinary diet. The rest of the SD rats were fasted for 12 hours without water. A rat model with damp-heat type diabetes enteropathy was made by left intraperitoneal injection of streptozotocin (55 mg·kg-1) and high sugar and high fat diet (20% sucrose solution + high fat diet) in a humid and hot environment (artificial climate box: temperature 30-34 ℃, relative humidity: 85%-95%). After successful modeling, the rats were randomly divided into a model group, a metformin group (200 mg·kg-1), low-dose, medium-dose, and high-dose Huanglian Wendantang groups (7.10, 14.20, 28.39 g·kg-1), with 12 rats in each group. The normal group and the model group were orally administered with physiological saline once a day for 6 consecutive weeks. During the observation period, the weight and blood glucose levels of rats were measured and recorded weekly. After the administration, fresh feces were collected from rats, and 16S rRNA sequencing technology was used to study the differences and changes in intestinal flora among different groups. The levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in the serum of rats were detected by enzyme-linked immunosorbent assay (ELISA), and the pathological morphological changes of colon tissue were examined. The expression of TGR5 and GLP-1 in colon tissue was detected by immunohistochemistry, and the expression of TGR5 and GLP-1 proteins in colon tissue was measured by Western blot. ResultsCompared with the blank group, the model group showed a decrease in body weight, an increase in blood glucose, and significant damp-heat symptoms. The levels of IL-6 and TNF-α in serum were significantly increased (P<0.01). The expression of TGR5 and GLP-1 was decreased (P<0.01), and the pathogenic bacteria were increased. Compared with the model group, the treatment groups exhibited improvements in body weight, blood glucose levels, and damp-heat syndrome in rats. Among them, the high-dose group of Huanglian Wendantang displayed the most significant improvement effect, with significantly reduced inflammation levels (P<0.01) and elevated expression of TGR5 and GLP-1 (P<0.01). Colonic pathological sections showed that Huanglian Wendantang could effectively ameliorate colonic pathological changes. The 16S rRNA sequencing result indicated a significant increase in beneficial bacteria in the treatment groups. ConclusionHuanglian Wendantang can effectively ameliorate the damp-heat symptoms and blood glucose levels in rats with damp-heat type diabetes enteropathy, and it may exert an effect by regulating the TGR5/GLP-1 signaling pathway and intestinal flora disorder.
7.Distribution of Traditional Chinese Medicine Syndromes in 2 027 Patients with Esophageal Squamous Cell Carcinoma
Jianing JIAN ; Yulong CHEN ; Ruohan LI ; Runze GUO ; Yaling ZHANG ; Yuling ZHENG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(15):173-181
ObjectiveTo investigate the characteristics and distribution of traditional Chinese medicine (TCM) syndromes in the patients with esophageal squamous cell carcinoma (ESCC). MethodsAn electronic questionnaire was developed to collect the general data and four examination information of ESCC patients treated in 10 areas with high incidence of esophageal cancer in China from June 2020 to March 2021. Multiple analyses including frequency analysis, factor analysis, and hierarchical cluster analysis were performed to analyze the potential syndrome elements, disease location, and common syndromes of ESCC. ResultsA total of 2 027 patients with ESCC were included. Statistical analysis was performed on 113 symptoms, physical signs, 33 tongue manifestation variables, and 23 pulse manifestation variables of the patients’ four examination information. Factor analysis was performed on 55 variables with frequency>10%, extracting 19 common factors. According to clinical experience and expert opinions, the main lesions of patients with ESCC were in the spleen and stomach, and the main syndrome elements were Qi stagnation, blood stasis, phlegm, dampness, and Qi deficiency, with the syndrome element combination of phlegm obstruction + Qi stagnation + blood stasis being the most common. The syndromes can be classified into four categories of liver-stomach disharmony + combined phlegm and Qi obstruction, kidney-spleen dysfunction + combined phlegm and stasis, spleen-kidney Yang deficiency + obstinate phlegm and blood stasis, and liver-kidney Yin deficiency + obstinate phlegm and blood stasis. The main syndrome of ESCC was liver-stomach disharmony + combined phlegm and Qi obstruction in the early stage, liver-spleen dysfunction + combined phlegm and stasis in the middle stage, and spleen-kidney Yang deficiency + obstinate phlegm and blood stasis in the late stage. ConclusionESCC mainly has main pathological features of internal deficiency and external excess and combined deficiency and excess, with the key syndrome elements being phlegm obstruction, Qi stagnation, and blood stasis. The main disease locations are in the spleen and stomach, involving the liver, kidney, chest and diaphragm, heart, and lung. The main syndrome is liver-stomach disharmony + combined phlegm and Qi obstruction. In clinical practice, it is necessary to grasp the pathogenesis dynamics of the disease and use prescriptions according to patients’ syndromes.
8.Correlation between Kayser-Fleischer ring grading and cognitive function in Wilson’s disease
Wei HE ; Yulong YANG ; Wenming YANG ; Yue YANG ; Chen HU ; Hui LI ; Peng HUANG
Journal of Clinical Hepatology 2025;41(6):1150-1155
ObjectiveTo investigate the correlation with cognitive function based on a new Kayser-Fleischer ring (K-F ring) grading method in Wilson’s disease (WD). MethodsA total of 136 WD patients who were hospitalized in Encephalopathy Center, The First Affiliated Hospital of Anhui University of Chinese Medicine, from April 2022 to October 2023 were enrolled. All subjects underwent slit lamp examination, and the grade of K-F ring was determined according to the shape and extent of copper deposition in the cornea, whether it formed a ring or not, and whether there was a sunflower-like cloudy change in the lens. The patients were instructed to complete UWDRS, MoCA, and MMSE scale assessments, and these indicators were compared between patients with different K-F ring grades. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t-test (homogeneity of variance) or the Dunnett’s T3 test (heterogeneity of variance) was used for further multiple comparisons; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups; the chi-square test was used for comparison of categorical data between groups. The Spearman correlation analysis was used to investigate the correlation of K-F ring grade with UWDRS, MoCA, and MMSE scores. ResultsAmong the 136 patients with WD, there were 40 patients with grade 4 K-F ring, accounting for the highest proportion of 29.4%, and 14 patients with grade 0 K-F ring, accounting for the lowest proportion of 10.3%, and there were 22 patients with grade 1 K-F ring (16.2%), 19 with grade 2 K-F ring (14%), 25 with grade 3 K-F ring (18.4%), and 16 with grade 5 K-F ring (11.7%). According to the different grades of K-F ring, there was a significant increase in UWDRS score (F=22.61, P<0.001) and significant reductions in MoCA and MMSE scores (F=16.40 and 13.80, both P<0.001). The Spearman correlation analysis showed that K-F ring grade was positively correlated with UWDRS score (r=0.67, P<0.01) and was negatively correlated with MoCA and MMSE scores in WD patients (r=-0.59 and -0.57, both P<0.01). ConclusionThe new K-F ring grading method can determine disease severity in WD patients to a certain degree and partially reflect cognitive function and activities of daily living in such patients.
9.Effect of tritiated water on the immune system of zebrafish and mechanism analysis
Xiaofang GENG ; Chang LIU ; Yinyin YANG ; Yang ZHANG ; Le ZHAO ; Bingqing ZENG ; Chen WANG ; Pengyu LIN ; Yulong LIU
Chinese Journal of Radiological Health 2025;34(3):354-362
Objective To investigate the effect of tritiated water on the immune system of zebrafish and its potential molecular mechanism. Methods Zebrafish embryos (2.5 to 3 hours post-fertilization [hpf]) were exposed to 3.7 × 104 Bq/mL tritiated water (tritiated water group), and those exposed to E3 culture medium were used as the control group. The mortality rate, hatching rate, deformity rate, heart rate, body length, yolk sac area, neutrophil count in the tail, immune-related gene expression, and immune-related protein expression of zebrafish in the two groups were determined. Then transcriptome technology was used to further analyze the possible mechanism of tritiated water affecting the immune system of zebrafish. Results Compared with the control group, zebrafish at 72 hpf in the tritiated water group had no significant changes in the mortality rate, hatching rate, deformity rate, body length, and yolk sac area((t = 0.9045, 0.5000, 1.0000, 0.7238, 0.0337, P = 0.4169, 0.6433, 0.3739, 0.4785, 0.9735), but had significantly increased heart rate(t = 4.575,P = 0.002). At 4 days post-fertilization (dpf), the neutrophil count in the tail of zebrafish in the tritiated water group was significantly increased(t = 2.563,P = 0.0196), the mRNA expression of TNF-α was significantly decreased(t = 2.891, P = 0.045), the protein expression of nuclear factor-kappa B (NF-κB) was significantly increased(t = 3.848, P = 0.018), and the protein expression of NLRP3 was significantly decreased(t = 14.98, P = 0.001). At 7 dpf, the neutrophil count in the tail and the protein expression levels of NF-κB, NLRP3, and interleukin-1β were significantly decreased(t = 3.772, 7.048, 15.620, 4.423, P = 0.014, 0.002, 0.0001, 0.012). Transcriptome sequencing revealed that differentially expressed genes were mainly enriched in the “neutrophil activation” and “platelet activation pathways” at 4 dpf and in the “neutrophil apoptosis”, “ferroptosis”, and “necroptosis” pathways at 7 dpf. Conclusion Tritiated water exposure induces a temporally dynamic immune response in zebrafish, potentially affecting immune homeostasis by regulating neutrophil activation and apoptosis, as well as the expression of NF-κB and NLRP3.
10.Exploration of epidemiological characteristics of multidrug-resistant organisms among burn wound patients and prevention and control strategies based on worldwide database for nosocomial outbreaks
Jiao SHAN ; Wei HUAI ; Shanshan MENG ; Meng JIN ; Xiaoyuan BAO ; Yulong CAO ; Hong LI ; Hui CHEN
Chinese Journal of Nosocomiology 2025;35(17):2592-2596
OBJECTIVE To investigate the epidemiological characteristics of hospital-associated infections caused by multidrug-resistant organisms(MDROs)among the burn wound patients so as to provide bases for taking tar-geted control measures.METHODS A systematic search was conducted in the worldwide database for nosocomial outbreaks,PubMed and CNKI databases so as to summarize and analyze the data regarding to outbreaks of MDROs hospital-associated infections among burn wound patients.RESULTS A total of 61 incidents of MDROs hospital-associated infections outbreaks among the burn wound patients were included,involving 2 293 patients from 21 countries and regions,50(81.97%)of which were reported for the infection sites or colonization sites in-volving burn wound,12(19.67%)involving the respiratory tract,10(16.39%)involving the bloodstream infec-tions.Methicillin-resistant Staphylococcus aureus(28 incidents,45.90%)was dominant among the pathogens causing the infections,followed by multidrug-resistant Acinetobacter baumannii(17 incidents,27.87%)and multidrug-resistant Pseudomonas aureus(9 incidents,14.75%).52 incidents(82.25%)of outbreaks were reported the contact as the major transmission mode.The suspected sources of the outbreaks included the patients(37 incidents,28.46%),health care workers(30 incidents,23.08%),ward environments(28 incidents,21.54%),medical equipments(19 incidents,30.56%),drainage systems(6 incidents,4.62%).The major pre-vention and control measures included environmental cleaning and disinfection,screening of colonization in patients and health care workers,isolation of patients with infections and hand hygiene;8 incidents were taken the measure of closing the ward.CONCLUSIONS The outbreaks of MDROs infections in the burn wound patients are mostly associated with the high frequently contact environments,medical equipments and hand hygiene of health care workers.In view of the peculiarities of the burn wound patients,it is feasible to take the targeted measures based on the summarized prevention and control combinations for MDROs so as to prevent the outbreak of hospital-asso-ciated infections.

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