Hepatocellular carcinoma （HCC）， as the sixth most common malignant tumor worldwide， poses a serious threat to human health due to its insidious onset and high mortality rate. This article reviews the molecular mechanisms and intervention strategies of gut microbiota （GM） homeostasis in the development and progression of HCC， in order to provide new ideas for the intervention and treatment of HCC. Studies have shown that GM dysbiosis， intestinal leakage， microbial-associated molecular pattern， bacterial translocation， and metabolic products play key roles in the progression of HCC. GM imbalance may lead to immune escape， thereby promoting tumor cell proliferation and metastasis. This article elaborates on the association between GM and HCC， deeply analyzes the mechanism of action of GM in the development and progression of HCC， investigates the role of bile acid-related metabolites， short-chain fatty acid-related metabolites， and other metabolites in HCC， and explores the strategies for targeting GM in the treatment of HCC， including probiotics， prebiotics， antibiotics， Toll-like receptor 4 antagonists， and fecal microbiota transplantation. This article emphasizes that maintaining the integrity of the intestinal barrier and GM homeostasis is of great significance in the prevention and treatment of HCC， which provides a direction for developing new diagnosis and treatment strategies.

Objective:To analyze the clinical data and to screen the mortality risk factors of necrotizing fasciitis (NF) secondary to intestinal fistulas (NFsIF).Methods:This study was a retrospective observational study. The data of all NFsIF cases who met the inclusion criteria and were admitted into Shandong Provincial Hospital Affiliated to Shandong First Medical University (hereinafter referred to as our unit) from January 2000 to October 2023, and in PubMed, Web of Science, Scopus, China National Knowledge Infrastructure, and Chinese Medical Journal Network databases from its establishment to October 2023 were retrieved and screened. Based on clinical outcomes, the cases were divided into survival group (47 males and 24 females) and death group (16 males and 7 females), and the mortality rate was calculated. Clinical data of patients in the two groups including age, underlying diseases (most related to NF), symptom duration before presentation, white blood cell count, causes of NF, signs of peritonitis, scope of NF involvement, and intestinal management and wound management measures were compared and analyzed to screen the risk factors of death in 94 patients with NFsIF.Results:A total of 94 valid cases were collected, including 90 patients reported in the literature and 4 patients admitted to our unit, with the mortality rate of patients being 24.5% (23/94). Univariate analysis showed that there were no statistically significant differences in age, underlying diseases, symptom duration before presentation, white blood cell count, causes of NF, signs of peritonitis, scope of NF involvement between patients in the two groups ( P>0.05); there were statistically significant differences in intestinal treatment and wound treatment between the two groups (with χ2 values of 17.97 and 8.33, respectively, P<0.05). Multivariate logistic regression analysis showed that both intestinal treatment measures and wound treatments measures were independent risk factors for death in 94 NFsIF patients, among which first-stage colostomy+late-stage reconstruction and negative presssure therapy had higher protective effects (with odds ratios of 0.05 and 0.27, respectively, 95% confidence intervals of 0.01-0.33 and 0.08-0.88, respectively, P<0.05). Conclusions:The mortality risk of patients with NFsIF is high. Based on comprehensive treatments, active intestinal and wound treatment may be the key to avoid death, with first-stage colostomy+late-stage reconstruction and negative pressure therapy having higher protective effects.

Epidural labor analgesia aims to provide effective medical services to alleviate labor pain in parturients, while adhering to the principles of voluntary participation and clinical safety. In 2018, Peking Union Medical College Hospital(PUMCH)became one of the first pilot units for labor analgesia in China, and has achieved satisfactory results in high-quality development of labor analgesia. This article mainly introduces the achievements and experience of labor analgesia at PUMCH, including: (1) prioritizing maternal and infant safety, arranging personnel rationally, and developing standardized treatment processes through multidisciplinary collaboration to ensure safe and comfortable childbirth; (2) leveraging the hospital's comprehensive capabilities in emergency treatment, and improving collaborative rescue plans for critically ill parturients and newborns; (3) implementing advanced teaching methods to effectively train and conduct simulated drills for labor analgesia and rescue of critically ill parturients; (4) conducting patient education and informative lectures to help parturients acquire a scientific understanding of labor analgesia. We hope that this experience can provide reference and inspiration for other hospitals.

Objective To study the infection of multidrug-resistant organism(MDRO)in elderly pa-tients with catheter-associated urinary tract infection(CAUTI)and analyze the infection factors.Methods The medi-cal records of 175 elderly patients with CAUTI admitted to Jiangsu Province Hospital from January 2021 to July 2022 were selected,the distribution of MDRO infection in elderly patients with CAUTI was analyzed,and the influencing factors of MDRO infection were analyzed.The predictive value of independent risk factors for rele-vant nosocomial infections was analyzed by receiver operating characteristics(ROC)curves.Results Among the 175 elderly patients with CAUTI,87 cases(49.71％)developed MDRO infection and were included in the MDRO infection group),and 88 cases(50.29％)had no MDRO infection and were included in the non-MDRO infection group.A total of 432 MDRO pathogens were detected in the MDRO infection group,inclu-ding 415 strains of Gram-negative bacteria,accounting for 96.06％,186 strains of carbapenem-resistant Acine-tobacter baumannii(43.06％),147 strains of carbapenem-resistant Klebsiella pneumoniae(34.03％),79 strains of carbapenem-resistant Pseudomonas aeruginosa(18.29％)and 3 strains of carbapenem-resistant Escherichia coli(0.69％).There were 17 strains of Gram-positive bacteria(3.94％),all of which were methi-cillin-resistant Staphylococcus aureus.Multivariate analysis showed that the use of carbapenems,tigecycline,polymyxin,and days of central venous intubation were considered as independent risk factors.The area under the curve of MDRO infection was 0.883.Conclusion For elderly patients with CAUTI,it is necessary to take strict antimicrobial management measures,master the indications of antimicrobial application,shorten the hos-pitalization time of patients and reduce the incidence of MDRO infection.

Objective:To explore the effects of applying a four-step training method based on an attitude-skill-knowledge (ASK) model combined with workshops in training on the prevention and control of nosocomial infection among medical students, and to provide a reference for reforming nosocomial infection prevention and control training for medical students and establishing a nosocomial infection prevention and control training system.Methods:Medical students from five medical schools entering clerkships during 2018 to 2020 were selected. They were divided into control group (218 medical students in 2018-2019 receiving conventional nosocomial infection control training) and experimental group (216 medical students in 2019-2020 receiving nosocomial infection control training based on the ASK model-based four-step method combined with workshops). The two groups were compared in terms of the compliance rate of hand hygiene, the pass rates of nosocomial infection control theory and skill examinations, the correct rate of medical waste disposal, the incidence of occupational exposure, and the degree of satisfaction with teaching.Results:All the indices of the experimental group were significantly better than those of the control group: the compliance rate of hand hygiene ( χ2=4.92, P=0.027), the correct rate of medical waste disposal ( χ2=5.13, P=0.023), the pass rate of nosocomial infection control theory examination ( χ2=4.03, P=0.038), the pass rate of nosocomial infection control skill examination ( χ2=6.71, P=0.010), and the degree of satisfaction with teaching [(98.03±2.16) vs. (92.53±2.01), P<0.001]. No one had occupational exposure in the experimental group, while there were three cases in the control group. Conclusion:The ASK model-based four-step method combined with workshops is effective in nosocomial infection prevention and control training for medical students. This innovative training method improves students' satisfaction with clinical teaching, providing a basis for the establishment of a training system for the prevention and control of nosocomial infection.

Hepatocellular carcinoma (HCC) is the most common pathological type of primary liver cancer, with high fatality rate. The pathogenesis of HCC is complex, and the specific occurrence and development mechanism is still in the exploratory stage. CircRNA is a special endogenous noncoding RNA and mainly participates in the regulation of gene expression at the transcriptional and posttranscriptional levels. By regulating gene transcription, it acts as a molecular sponge of miRNA, participates in protein translation, and interacts with RNA binding protein (RBP). CircRNA is involved in the occurrence and development of HCC. Its abnormal expression in HCC cells is related to the pathological characteristics of HCC tissue, regulates the expression of downstream target genes, miRNA and proteins, participates in the proliferation, migration, invasion and apoptosis of HCC cells, and regulates tumor microenvironment and signal pathways, suggesting that circRNA may be a potential novel biomarker and therapeutic target for the diagnosis and prognosis of HCC. This paper reviews the biological mechanism of circRNA, its role in HCC, and research progress in diagnosis and treatment.

Peking Union Medical College Hospital, as one of the most stressful medical institutions in China, is facing the problem of emergency department overcrowding. In order to effectively alleviate the emergency overcrowding, improve the medical quality and patients′ medical experience, the hospital firmly grasped the two incremental links of " throughput" and " output" factors, established a multidisciplinary and multi-department cooperation team, constructed a close medical alliance cooperation mode, and innovated and explored a harmonious emergency overcrowding relief mode with the goal of unblocking the " exit" of patients. The practice showed that the comprehensive measures could effectively alleviate the problem of emergency overcrowding, and improve the medical environment and medical quality.

The medical management department of individual hospitals varies with their organizational structure and operational mechanism, instead of following a general pattern. Inspired by the"super-ministry" system of government,the hospital has integrated successively the Medical Affairs Office, Patient Safety Office,Medical Quality Control Office,Hospital-acquired Infection Control Office and Medical insurance office. Through integration and innovation of duties, regulations, culture, decision-making progress,coordination and talent training mechanism, the " Five-in-One" super-ministry model of medical management came into being,achieving collaborative and efficient medical management as a result.

Objective To retrospectively analyze the implementation of the antimicrobial agents prescription monthly review at the emergency and outpatient departments for the past five years, for evaluation of its action in promoting rational application of antimicrobial drugs. Methods At the baseline investigation stage, 1780 prescriptions on antibiotics in emergency and outpatient department from June 2012 to November 2012 were randomly selected for centralized evaluation. The period of correction and observation falls into two stages. The first stage ranged from December 2012 to February 2015, when the prescription of antibiotics was sampled manually for monthly review. The second stage ranged from March 2015 to June 2017, when a prescription review software for prescription comment was introduced for the sample purpose. The data so acquired were subject to chi-square test and linear regression analysis using Excel 2010 and SPSS 16. 0. Results The rational rate of prescription for antibiotics at the emergency department increased from 80. 56％ of the baseline stage to 99. 47％ of the second stage (166506/167400), scoring a difference of statistical significance (P<0. 001). With intervention of the prescription review software, the percentage of irrational use of antimicrobial agents dropped by 5. 18％ compared to the baseline stage. Conclusions Monthly prescription review on antimicrobial agents at the outpatient and emergency departments could promote the rational use of antimicrobial agents and play an important role in clinical drug safety. Information system and performance assessment contributed to the effect of prescription review.

Objective To better understand the infection status of HIV in the patients seeking medical care in Peking Union Medical College Hospital.Methods The HIV detection data of the patients in the hospital from 2003-2014 were collected for a statistical analysis with software SPSS 19.0.Results A total of 715 421 patients were screened,and 1 012 (0.14％) patients were HIV positive,and HIV infection were confirmed in 776 (0.11％) patients by Western Blot testing.The detection rate of HIV infection increased from 0.05％ in 2003 to 0.17％ in 2014 (trend x2=66.83,P=0.000),and the increase during 2012-2014 was obvious.Of the 776 newly diagnosed HIV-infected individuals,631 (81.31％) were men and 145 (18.69％) were women.The percentage of the males infected with HIV increased from 50.00％ to 90.26％ (trend x2=58.41,P=0.000).The median age was 36 years (interquartile range:27-43),and the age group 18-50 years were mostly affected.In the 776 patients infected with HIV,634 (81.70％) were infected through sexual contacts,and the proportion of sexual transmissions increased with year (trend x2=126.38,P=0.000).The proportion of infected men who have sex with men (MSM) increased from 0％ in 2003 to 53.90％ in 2014 (trend X2=11.96,P=0.001),similar to the trend in western countries.The proportion of infected patients who were not married increased from 18.75％ to 42.21％ (trend x2=43.74,P=0.000).The top three source departments of HIV/AIDS cases were internal medicine (51.03％),emergency room (18.30％) and dermatology (13.53％).The proportion of the HIV/AIDS patients from department of gynecology and obstetrics declined from 18.75％ in 2003 to 2.60％ in 2014.No HIV/AIDS patients were detected in department of surgery,department of otorhinolaryngology,department of ophthalmology,department of stomatology and health examination center in 2003,but 14 cases (9.10％),11 cases (7.14％) and 4 cases (2.60％) were detected in these departments respectively in 2014.Conclusion The HIV detection rate increased with year in Peking Union Medical College Hospital,suggesting the necessity of strengthened HIV test in general hospitals.MSM are the population at high risk,to whom more attention should be paid.