Objective To understand the current status of healthcare-associated infection(HAI)management for transesophageal echocardiography(TEE)examination in China,and provide a scientific basis for formulating guide-lines and standards for infection prevention and control in ultrasound diagnosis and treatment.Methods A stratified sampling survey was conducted in 162 medical institutions(MIs)in 14 provinces(autonomous regions,municipali-ties)in China.A unified questionnaire was designed,and on-site surveys were conducted in the TEE examination room of each MI,with questionnaires filled out based on the results of the on-site survey.Results 162 MIs were surveyed,out of which 114(70.4％)carried out TEE examination.TEE examination was undertaken by ultrasound medicine department(66.7％)and cardiology department(36.0％)in most MIs,and 91.0％of HAI departments had specially-assigned infection prevention and control professional to responsible for the management of HAI rela-ted to examination.32.4％(n=36)of TEE examinations used ultrasound probe isolation sleeves,mainly sterilized isolation membranes.The overall high-level disinfection or sterilization rate of TEE probes was 79.3％,19.8％of MIs chose medium-level disinfection.However,based on the number of equipped probes,the interval between pa-tient examination,and the disinfection method of probes,it was inferred that the proportion of effective high-level disinfection was only 67.6％.The most commonly adopted sterilization,high-level disinfection and medium-low le-vel disinfection methods for probes were low-temperature hydrogen peroxide sterilization,o-phthalaldehyde disinfec-tion and quaternary ammonium wiping disinfection,respectively.92.8％of examination rooms stored the probes in special storages cabinets(boxes)after disinfection.32.4％of examination rooms cleaned and disinfected ultrasound devices other than TEE probe between each patient examination,all were with medium-level disinfection.Most exa-mination rooms equipped complete hand hygiene(HH)facilities and ventilation,59.5％of the operators had the HH compliance rate of more than 90％.The wearing of disposable medical rubber examination gloves and glove changing for each patient was ideal.However,the change of bedding and the change of medical operators'overalls for each patient were not ideal.Conclusion TEE examination is generally carried out in large MIs across the coun-try,but the high-level disinfection rate of TEE probes still needs to be improved,and the appropriate disinfection methods still need further discussion and research.The disinfection awareness of ultrasound devices other than TEE probes still needs to be enhanced,and the compliance of hand hygiene of operators,the awareness of timely chan-ging of bedding of patients'examination beds,and the awareness of changing of overalls of diagnosis and treatment operators need to be enhanced.

Objective To understand the current status of healthcare-associated infection(HAI)management for transesophageal echocardiography(TEE)examination in China,and provide a scientific basis for formulating guide-lines and standards for infection prevention and control in ultrasound diagnosis and treatment.Methods A stratified sampling survey was conducted in 162 medical institutions(MIs)in 14 provinces(autonomous regions,municipali-ties)in China.A unified questionnaire was designed,and on-site surveys were conducted in the TEE examination room of each MI,with questionnaires filled out based on the results of the on-site survey.Results 162 MIs were surveyed,out of which 114(70.4％)carried out TEE examination.TEE examination was undertaken by ultrasound medicine department(66.7％)and cardiology department(36.0％)in most MIs,and 91.0％of HAI departments had specially-assigned infection prevention and control professional to responsible for the management of HAI rela-ted to examination.32.4％(n=36)of TEE examinations used ultrasound probe isolation sleeves,mainly sterilized isolation membranes.The overall high-level disinfection or sterilization rate of TEE probes was 79.3％,19.8％of MIs chose medium-level disinfection.However,based on the number of equipped probes,the interval between pa-tient examination,and the disinfection method of probes,it was inferred that the proportion of effective high-level disinfection was only 67.6％.The most commonly adopted sterilization,high-level disinfection and medium-low le-vel disinfection methods for probes were low-temperature hydrogen peroxide sterilization,o-phthalaldehyde disinfec-tion and quaternary ammonium wiping disinfection,respectively.92.8％of examination rooms stored the probes in special storages cabinets(boxes)after disinfection.32.4％of examination rooms cleaned and disinfected ultrasound devices other than TEE probe between each patient examination,all were with medium-level disinfection.Most exa-mination rooms equipped complete hand hygiene(HH)facilities and ventilation,59.5％of the operators had the HH compliance rate of more than 90％.The wearing of disposable medical rubber examination gloves and glove changing for each patient was ideal.However,the change of bedding and the change of medical operators'overalls for each patient were not ideal.Conclusion TEE examination is generally carried out in large MIs across the coun-try,but the high-level disinfection rate of TEE probes still needs to be improved,and the appropriate disinfection methods still need further discussion and research.The disinfection awareness of ultrasound devices other than TEE probes still needs to be enhanced,and the compliance of hand hygiene of operators,the awareness of timely chan-ging of bedding of patients'examination beds,and the awareness of changing of overalls of diagnosis and treatment operators need to be enhanced.

Objective:To investigate the possible role of long non-coding RNA (LncRNA) 00602 in promoting browning in adipocytes induced by adenovirus type 36 (Ad36).Methods:According to Ad36 infection, adipose tissue samples of obese patients were divided into Ad36-negative group and Ad36-infected group. Realtime fluorescent quantitative PCR (qRT-PCR) was used to detect the changes in the expression of LncRNA00602 mRNA in omental adipose tissue of the two groups, and analyze the differences between the two groups. The correlation between waist-to-hip ratio, systolic blood pressure, diastolic blood pressure, fasting blood glucose, triacylglyceride and other indicators of the patients in the group with LncRNA00602 mRNA expression were analyzed. HE staining was used to detect the size of adipocytes in the omental adipose tissue of the Ad36 negative group and the Ad36 infection group. qRT-PCR and Western blotting were used to detect the mRNA and protein expression levels of uncoupling protein 1 (UCP1) and PR domain containing 16 (PRDM16) in omental adipose tissue of two groups of patients. Human adipose-derived stem cells (hADSC) were isolated and cultured, using Ad36 to induce differentiation, and divided into control group and LncRNA00602 knockdown group. On 0, 2, and 4 days after LncRNA00602 knockdown, fluoroboron dipyrrole (BODIPY) and mitochondrial red fluorescence (Mito-Tracker Red) were used to stain intracellular lipid droplets and mitochondria. At the same time, qRT-PCR and Western blotting were used to detect changes in the expression of UCP1 and PRDM16.Results:The expression of LncRNA00602 gene in the Ad36 infection group was higher than that in the Ad36 negative group (all P<0.05). The expression of LncRNA00602 in the Ad36 negative group was not significantly different from the above clinical indicators, while the expression of LncRNA00602 was negatively correlated with serum fasting blood glucose and triacylglyceride ( r=-0.522, -0.486, P<0.05) in the Ad36 infection group; HE staining showed that the average adipocyte area of the Ad36 infection group was smaller than that of the Ad36 negative group. At the same time, UCP1 and PRDM16 gene expression were higher than the negative group (all P<0.05). At the cellular level, on the 2nd and 4th days after knockdown of LncRNA00602, the lipid droplet area of adipocytes in the LncRNA00602 knockdown group was larger than that of the control group, the number of mitochondria decreased compared with the control group, and difference was statistically significant ( P<0.05 or P<0.01); Compared with the control group, there was significantly lower expression of the browning marker genes UCP1, PRDM16, and protein in the adipocytes in the LncRNA00602 knockdown group (all P<0.05). Conclusion:In Ad36-induced adipocyte differentiation, LncRNA00602 may positively regulate the expression of UCP1, PRDM16 and lipid droplet metabolism, and promote the browning of adipocytes.

Objective The aim of this study is to explore the hypoglycemic effect of active components of Anoectochilus roxburghii on zebrafish models. Methods Anoectochilus roxburghii components were extracted and separated into three groups: the alcohol extraction group, macromolecular polysaccharide group (≥ 5 ×103) and small molecular polysaccharide group (＜5×103). Zebrafish embryos were exposed to 2% glucose solution (2% Glu) at 24 h to imitate acute hyperglycemia phenotype, and then treated with the three Anoectochilus roxburghii components. Based on this high-glucose model, the zebrafish embryos at 72 h were collected to detect the whole tissue glucose value. Furthermore, semi-quantitative PCR and whole mount in situ hybridization were performed to detect the expression of mRNA levels of glycometabolism-related genes. Results An acute diabetic zebrafish model was induced by high glucose stress. In this model, some key factors during glycometabolism such as insulin, pck-1 and pdx-1 were significantly affected, while the alcohol extracts of Anoectochilus roxburghii obviously reversed these abnormalities induced by high glucose stress, even to normal levels. Conclusions The alcohol extracts of Anoectochilus roxburghii has obvious hypoglycemic effect on diabetic zebrafish model. Our result suggest that Anoectochilus roxburghii has a potential application in the hypoglycemic drug screening.

Objective To investigate the influencing factors of the controlled virtual touch tissue quantification (VTQ) in liver of patients with type 2 diabetes mellitus (T2DM) complicated withnon-alcoholic fatty liver disease (NAFLD). Methods Two hundred and twenty-seven patients with T2DM complicated with NAFLD were enrolled in this study,and the shear wave speed of the liver was measured by VTQ. Levels of the fasting plasma glucose, glycated hemoglobin,total cholesterol three acids glyceride, low density lipoprotein, high density lipoprotein , aspertate aminotransferase , alanine aminotransferase , gamma glutamyl transpeptidase and uric acid were measured. The relationships among VTQ and the severity of NAFLD , and those quantitative indexes were analyzed. Results Univariate analysis showed that the value of shear wave speed was negatively correlated with age,duration of diabetes,INS and HDL-C,while was positively correlated with HbA1c and AST. Conclusion Age, sex and levels of serum HbA1c,INS,AST and HLD-C might affect the values of shear wave speed in patients with T2DM complicated with NAFLD.

Objective To evaluate the association between vitamin D deficiency and diabetic nephropathy in type 2 diabetic patients.Methods A total of 594 patients with type 2 diabetes were enrolled from the inpatients of the Nanjing Medical University Affiliated Nanjing Hospital.Fasting serum lipid profile,25-hydroxycalciferol vitamin D and urinary albumin excretion rate were investigated.The relationship between nephropathy and vitamin D deficiency (＜ 20 μg/L) or insufficiency (20-＜ 30 μg/L) was analyzed.Results Nephropathy was found in 177 subjects (29.8％) with albuminuria in 141 and proteinuria in 36 subjects.Vitamin D deficiency was found in 180 subjects and insufficiency in 157 subjects.The proportion of vitamin D deficiency was higher in the individuals with nephropathy than those without nephropathy (36.2％ vs 27.8％,P ＜0.05).The urinary albumin excretion rate was significantly higher in the patients with vitamin D deficiency than those with normal vitamin D concentration [(123.0 ± 299.2)mg/24h vs (47.6 ±97.1) mg/24h,P ＜0.01].The prevalence of nephropathy was higher in the patientswith vitamin D deficiency than those with normal vitamin D concentration (35.6％ vs 26.1％,P ＜ 0.05),while the prevalence of proteinuria was higher in patients with vitamin D deficency (12.2％ vs 3.1％,P ＜0.01).Logistic regression analysis demonstrated that vitamin D deficiency was associated with nephropathy (OR 1.57,95％ CI 1.04-2.37),even after the adjustment for age,gender,hypertension,dyslipidemia,smoking status,use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (OR 1.78,95％ CI 1.12-2.81).The Vitamin D concentration was significantly negatively correlated with urinaryalbumin excretion rate (r =-1.783,P ＜ 0.001).Conclusions Type 2 diabetic patients have a high prevalence of vitamin D deficiency.Vitamin D deficiency is independently associated with diabetic nephropathy.

Objective To investigate the association between the six single nucleotide polymorphisms ( SNP),named as rs179247,rsl2101261,rs2284722,rs4903964,rs2300525,rsl7111394 in the intron 1 of thyroid stimulating hormone receptor gene (TSHR) and Graves' disease (GD).MethodsThe genotypes of the six SNPs were genotyped by Taqman probe technique on Fluidigm EP1 platform in 618 GD patients and 646 control subjects.Meanwhile,TSH receptor antibodies (TRAb) of the patients were determined.ResultsAmong the six SNPs,five S NPs were strongly associated with GD,with the most signals at rs179247_G,rs12101261_C,rs4903964 _G (P=2.85×10-10,OR=1.73,95％CI1.46-2.05;P=1.74×10-10,OR=1.73,95％CI 1.46-2.05;P=2.24×10-10,OR=1.69,95％ CI 1.44-1.99 ).The results of logistic regression analysis indicated that rs12101261 and rs4903964 were main susceptibility loci of GD in the intron 1 of TSHR.rs179247_G,rs1210126 1_C,and rs4903964_G were associated with subset of the GD patients with positive TRAb (P=4.24× 10-13,p=5.48× 10-13,P =3.89×10-12 ).Conclusionrs179247,rs12101261,and rs4903964 in TSHR intron 1 were significantly associated with GD in the Chinese Han population from Bengbu city.rs12101261 and rs4903964 were the major susceptibility SNPs associated with GD.TSHR gene may play a main role of susceptibility gene in the subset of GD patients with persistent positive TRAb.

Objective To explore more reasonable way of early post-operative effect of enteral nutrition fluids support for colon cancer.Methods A total of 86 case of colon cancer were selected and assigned to enteral nutrition group(EN n=45)and parenteral nutrition group(PN n=41)randomly.Parameters inclu ding the body wetght,IsA,IgM,lymphocyte,human serum prealbumin and albumen were monitored on three days before operation,the fifth,and eighth days after operation.Results The IgA,IgM,lympho cyte,human serum prealbumin and albumen levels of patients in EN group were much higher than that in PN group on the fifth and eighth days after operation(P＜0.05).Also IgA,lgM levels of EN group patients were almost higher than that in PN group on eighth day after operation(P＜0.01).Concusions It showed that to perform enteral nutrient supports for patients of colon cancer during early post-operative could increase their gut immunity after operation and reduce the complications and raise human serum prealbumin and albu men of them for their body recovery.

The therapy based upon individuality is becoming a trend Oil general surgery field which has been highlighted by lots of specialists,scholars and clinic doctors,and so as the therapy of inguinal hernia.Along with the rushing appearoace of new idea and technique,the problem up to the minite which is confusing clinic doctors is how to select proper method of inguinal hernia therapy.This article is focused on the therapy of inguinal hernia based upon individuality.

Previous studies suggest that NGAL (neutro phil gelatinase-associated lipocalin) is involved in the transformation and development of esophageal carcinoma. Alteration of NGAL expression can trigger the change of cellular morphology in esophageal carcinoma cells. However, the mechanisms remain unclear. To get a better understanding of NGAL function in esophageal carcinoma, NGAL protein was expressed in methylotrophic yeast, Pichia pastoris, and purified by chromatography. EC1.71 cells expressed high levels of NGALR (NGAL receptor) and EC109 cells expressed low levels of NGALR were used as cells model. The trafficking and the possible function of NGAL protein were then analyzed in the esophageal carcinoma cells. The results showed that 5-FAM-labeled recombinant NGAL protein could internalize into the EC1.71 and EC109 cells. Furthermore, the internalized NGAL protein could induce the alteration of cellular morphology, resulting in generation of autophagosome, transcriptional up-regulation of genes associated with autophagy and increase of phospho-ERK1/2 (p-ERK1/2). Interestingly, the treatment with the NGAL protein did not affect the intracellular iron level. These data indicate that induced autophagy by exogenous NGAL protein is a mechanism that internalized NGAL plays important roles in esophageal carcinoma cells, independent with NGAL-mediated iron transport process, while ERK1/2 signal pathway is involved in activation of autophagy by exogenous NGAL protein.