OBJECTIVE: To explore the clinical features of patients with necrotizing soft tissue infection (NSTI) and the related factors for sepsis, so as to provide a basis for early intervention and improvement of patients' prognosis. METHODS: A retrospective case series study was conducted to analyze the clinical data of NSTI patients admitted to the department of burns and wound repair surgery of Guangdong Provincial People's Hospital from October 2021 to December 2024. Demographic information, underlying diseases, infection characteristics, laboratory test results and etiological findings at admission, treatment status, occurrence of complications (including sepsis) and prognosis were collected. Univariate and multivariate Logistic regression analyses were used to identify the associated factors for sepsis in NSTI patients. Receiver operator characteristic curves (ROC curves) were plotted to evaluate the predictive value of individual and combined factors for sepsis. RESULTS: A total of 159 NSTI patients were enrolled, mainly middle-aged and elderly males. Most patients had comorbidities, including diabetes mellitus (110 cases, 69.2%) and hypertension (67 cases, 42.1%). The main infection site was the lower extremities (104 cases, 65.4%). Common symptoms included redness (96 cases, 60.4%), swelling (129 cases, 81.1%), local heat (60 cases, 37.7%), pain (100 cases, 62.9%), and skin ulceration or necrosis (9 cases, 5.7%). Imaging findings included soft tissue swelling (66 cases, 57.9%), gas accumulation (41 cases, 36.0%), and abnormal signal/density shadows (50 cases, 43.9%). Staphylococcus aureus was the main pathogenic bacterium [12.0% (31/259)], and drug-resistant Escherichia coli had the highest detection rate among drug-resistant bacteria [35.1% (13/37)]. Regarding debridement and repair, most patients (80 cases, 50.3%) underwent debridement ≥ 72 hours after admission, while only 10.1% (16 cases) received debridement within 6 hours. Most patients underwent multiple debridements, with 2 times of debridements being the most common (68 cases, 42.8%), and the maximum times of debridements reached 6. The largest number of patients received secondary suture (44 cases, 27.7%). In terms of complications, sepsis was the most common (66 cases, 41.51%), followed by acute kidney injury, respiratory failure requiring mechanical ventilation, and multiple organ dysfunction syndrome (MODS), while disseminated intravascular coagulation (DIC) was the least common. During the follow-up period, 9 patients (5.66%) were readmitted within 90 days, and 11 patients died, with a mortality rate of 6.92%. Univariate analysis showed that diabetes, coronary heart disease, gout, body temperature, heart rate, C-reactive protein, platelet count, total bilirubin, albumin, creatinine, out-of-hospital treatment, and out-of-hospital use of antimicrobial agents were significantly associated with sepsis in NSTI patients (all P < 0.05). Multivariate Logistic regression analysis showed that coronary heart disease [odds ratio (OR) = 30.085, 95% confidence interval (95%CI) was 2.105-956.935], C-reactive protein (OR = 1.026, 95%CI was 1.009-1.054), and total bilirubin (OR = 1.436, 95%CI was 1.188-1.948) were independent associated factors for sepsis in NSTI patients (all P < 0.05). ROC curve analysis revealed that the combination of the three predictors yielded the highest AUC for predicting sepsis in NSTI patients compared to any individual predictor [area under the curve (AUC) = 0.799 (95%CI was 0.721-0.878)]. CONCLUSIONS The clinical features of NSTI patients show certain regularity. Coronary heart disease, C-reactive protein, and total bilirubin are independent associated factors for sepsis in NSTI patients.
Humans ; Retrospective Studies ; Male ; Sepsis ; Soft Tissue Infections/microbiology* ; Female ; Middle Aged ; Aged ; Adult ; Prognosis ; Risk Factors ; Necrosis ; Logistic Models ; Fasciitis, Necrotizing

ObjectiveTo establish a vaginal self-sampling HPV cervical cancer screening model in Hainan Province, to analyze the application of p16 protein detection in HPV positive and non-HPV16 /18 shunt screening. MethodsFrom January 2019 to September 2022, a total of 200 women from the targeted population was randomly selected for vaginal self-sampling HPV typing test to screen cervical cancer using randomized numeric table method, followed by cervical cytology sampling for cytology p16 protein detection. Postoperative pathological examination was used as the gold standard. Multivariate logistic regression analysis was used to analyze the influencing factors of HPV positive detection rate in cervical lesions, and the nomogram model was constructed simultaneously. The receiver operating characteristic(ROC) curve and calibration curve were used for evaluating the accuracy of the nomogram model. Differences in the distribution of self-sampled HPV-positive and HPV infected genotypes were recorded, and the application of p16 protein detection in HPV-positive and non-HPV16/18 shunt screening was analyzed. ResultsAged ≥40 years, BMI ≥28.00 kg·m^-2, number of sexual partners ≥2, frequency of sexual life ≥10 times·month^-1, bleeding from sexual intercourse, and age of first sexual intercourse <22 years were the risk factors for HPV positive of cervical lesions (all P<0.001). The results of ROC curve and calibration curve showed that the area under ROC curve (AUC) was 0.874 (95%CI: 0.823‒0.907, P<0.05), the sensitivity was 0.835, the specificity was 0.847, and the Youden index was 0.672, indicating a good fit of the model. Results of vaginal self-sampling HPV test showed that the positive rate of HPV was 86.50% (173/200). HPV high-risk infection types mainly included HPV16, 18, 31, 33, 35, 39, 45, 52, 56, 58, 59, 68, 73, and 82. Single HPV infection accounted for 95.95% (166/173), 2.89% (5/173) were infected with two types of HPV, and 1.16% (2/173) were infected with three or more types of HPV. Colposcopic pathologic diagnosis was used as the gold standard, and the results showed that the accuracy of p16 protein detection in the diagnosis of cervical cancer was 93.50% (187/200), with a sensitivity of 96.53% (167/173), and a specificity of 74.07% (20/27). The negative and positive predictive value were 76.92% (20/26) and 95.98% (167/174), respectively. The results of shunt screening showed that there were 80 cases infected with HPV16, 79 cases infected with HPV18 and 41 cases of non-HPV16/18, with a sensitivity of 90.91%, 90.32% and 86.67%, a specificity of 71.43%, 64.71% and 72.73%, a negative predictive value of 62.50%, 64.71% and 66.67%, a positive predictive value of 93.75%, 90.32% and 89.66%, and an accuracy of 87.50%, 84.81% and 82.93%, respectively. The specificity and accuracy of p16 positive screening for cervical cancer were significantly higher than that of HPV positive detection, but the false positive rate was significantly lower than that of HPV positive detection. The AUCs of HPV positive, p16 positive and combination of the two detection methods for cervical cancer were 0.603, 0.822 and 0.907, respectively. ConclusionVaginal self-sampling HPV testing is a widely accepted mode for cervical cancer screening. Cervical cytology p16 protein detection is important for self-sampled HPV positive and shunt screening of non-HPV16/18.

Objective To investigate and analyze the epidemiological characteristics of nosocomial infection in the neurosurgery department of Jinan Fourth People's Hospital,and to provide reference for nosocomial infection prevention and control and rational use of antibiotics.Methods The infection related information of 5 200 inpatients in neurosurgery from January 2019 to December 2022 was retrospectively collected through the hospital infection monitoring system and hospital information system,and the distribution of infection sites,the incidence of hospital infection,distribution of pathogens and drug resistance were statistically and descriptively analyzed.Results From 2019 to 2022,the average infection rate of inpatients in the neurosurgery department was 3.3%,which was decreased year by year(χ2=39.000,P<0.001).Nococomial infections mostly occurred in elderly male patients,the infection sites were mainly lower respiratory tract,urinary system,bacteremia,and intracranial infection.From 2019 to 2022,296 strains of pathogenic bacterium were detected in neurosurgery,including 207 strains of Gram-negative bacteria,accounting for 69.9%;53 Gram-positive bacterium,accounting for 17.9%;36 Fungi,accounting for 12.2%.The top four pathogens were Klebsiella pneumoniae(21.6%),Pseudomonas aeruginosa(12.5%),Escherichia coli(9.8%),and Acinetobacter baumannii(8.8%).The drug sensitivity results showed that the resistance of Acinetobacter baumannii to carbapenems was significant.Conclusion In the past four years,the incidence of nosocomial infections of the Neurosurgery department has improved year by year.The pathogenic bacteria detected were mainly gram-negative bacteria,and the problem of drug resistance is more prominent.The drug resistance management should be strengthened.

Based on the practice of intelligent construction of medical education in Fuwai Hospital of CAMS&PUMC in recent years,this article deeply discusses the important role of R & D management thinking of integrated product development(Integrated Product Development,IPD)in the intelligent construction of hospital education.By building an intelligent platform for medical education,we can help hospitals improve their teaching strength in an all-round way,provide strong technical support for the performance evaluation of third-tier public hospitals,greatly improve the operational efficiency of hospitals,and firmly grasp the pulse of the times.to provide new solutions for the construction of hospital education intelligence system.

Objective:To analyze the effects of noise exposure on the hearing at different frequencies in workers from the automobile manufacturing industry.Methods:A total of 4723 noise workers in a large automobile manufacturing company in Guangzhou were chosen as the research object by using judgment sampling method between April and July, 2018, and carried out 0.5, 1.0, 2.0, 3.0, 4.0 and 6.0 kHz pure tone audiometry threshold to analyze the characteristics of the status of hearing loss at different frequencies and its relationship with the noise exposure time.Results:The detection rate of hearing loss in noise-exposed workers was 29.8% (1406/4723) . Among them, the binaural hearing loss was 21.2% (999/4723) , and single unilateral hearing loss accounted for 8.6% (407/4723) . The hearing loss detection rate of right ear was higher than that of the left ear ( P<0.05) , especially in the 6.0 kHz ( P<0.001) . The detection rate of increased speech frequency hearing threshold was 1.9% (90/4723) , and the detection rate of increased high-frequency hearing threshold was 28.9% (1366/4723) . The detection rate of increased threshold in both the left and the right ear increased with the increase of frequency ( P<0.001) , the increased hearing threshold was the highest at the frequency of 6.0 kHz. The auditory threshold of left ear in 0.5 kHz were higher than that of right ear at the same frequency ( P<0.05) . The detection rate of hearing loss increased with the increase of noise exposure time ( P<0.001) , and the increased threshold of 3.0, 4.0 and 6.0 kHz from workers increased with the increase of noise exposure time ( P<0.001) . Conclusion:There is a significant increased threshold in workers exposed to noise frequency of 6.0 kHz, right ear is more easily damaged than left ear, there is a dose-response relationship for the noise exposure time and high-frequency hearing loss.

Objective:To explore the annexin A2 (ANXA2) expression and distribution in dorsal root ganglion (DRG) after chronic compression of DRG (CCD) in rat models.Methods:One hundred and two adult male Wistar rats were randomly divided into control group ( n=24), CCD model group A (7 d after modeling, n=30), CCD model group B (14 d after modeling, n=24), and CCD model group D (28 d after modeling, n=24). Rats in the later 3 groups were established CCD models with the help of "U" rod screw. Mechanical withdrawal threshold (MWT) and thermal radiation paw withdrawal latency (TWL) were measured by mechanical pain stimulator and thermal pain stimulator. The ANXA2 protein expression in the DRG was detected by Western blotting and immunofluorescent staining. The distributions of ANXA2 and class III β-tubulin (TUBB3) positive cells in DRG were detected by immunofluorescence double staining. Results:As compared with those in the control group, MWT and TWL in the CCD model group A and CCD model group B were significantly decreased ( P<0.05). Western blotting showed that ANXA2 protein expression in the DRG of CCD model group A was statistically increased as compared with that in the control group ( P<0.05). Immunofluorescent staining showed that the immunoreactivity of ANXA2 in DRG of CCD model group A was enhanced as compared with that in control group. Immunofluorescence double staining showed that ANXA2 was mainly expressed in the cell membrane of neurons in the DRG of CCD model group A. Conclusion:The mechanical and thermal pain thresholds are decreased, while the ANXA2 protein expression at the pressure side of DRG is up-regulated and the immunoreactivity is increased in CCD models; ANXA2 may be involved in the occurrence and development of pathological neuralgia after CCD.

Objective:To analyze the effects of noise exposure on the hearing at different frequencies in workers from the automobile manufacturing industry.Methods:A total of 4723 noise workers in a large automobile manufacturing company in Guangzhou were chosen as the research object by using judgment sampling method between April and July, 2018, and carried out 0.5, 1.0, 2.0, 3.0, 4.0 and 6.0 kHz pure tone audiometry threshold to analyze the characteristics of the status of hearing loss at different frequencies and its relationship with the noise exposure time.Results:The detection rate of hearing loss in noise-exposed workers was 29.8% (1406/4723) . Among them, the binaural hearing loss was 21.2% (999/4723) , and single unilateral hearing loss accounted for 8.6% (407/4723) . The hearing loss detection rate of right ear was higher than that of the left ear ( P<0.05) , especially in the 6.0 kHz ( P<0.001) . The detection rate of increased speech frequency hearing threshold was 1.9% (90/4723) , and the detection rate of increased high-frequency hearing threshold was 28.9% (1366/4723) . The detection rate of increased threshold in both the left and the right ear increased with the increase of frequency ( P<0.001) , the increased hearing threshold was the highest at the frequency of 6.0 kHz. The auditory threshold of left ear in 0.5 kHz were higher than that of right ear at the same frequency ( P<0.05) . The detection rate of hearing loss increased with the increase of noise exposure time ( P<0.001) , and the increased threshold of 3.0, 4.0 and 6.0 kHz from workers increased with the increase of noise exposure time ( P<0.001) . Conclusion:There is a significant increased threshold in workers exposed to noise frequency of 6.0 kHz, right ear is more easily damaged than left ear, there is a dose-response relationship for the noise exposure time and high-frequency hearing loss.

Objective To learn about the current situation and trends of novel coronavirus diseases 2019 (COVID-2019) in foreign countries. Methods The data on confirmed COVID-2019 cases were collected between January 20, 2020 and February 18, 2020 and by age, sex, nationality, contact history, region, and country were performed stratified analysis and onset time analysis. Results From January 20th to February 18th, the cumulative number of confirmed cases of COVI D-2019 abroad was 804. Excluding the 454 cases on the 'Diamond Princess' cruise ship in Japan, the daily number of new cases fluctuated, showed a trend of rising first and then maintaining a steady trend. The peak date for new cases was on February 1, with the number of cases reaching 26. The confirmed cases were mainly concentrated in Asian countries, but also distributed in Europe, North America, Oceania and Africa. As of February 15, there was no more increase reported in the number of countries where confirmed cases occurred after reaching 25. Among these countries, Singapore, Japan, and Thailand were with the highest number of cases, with 77, 65, and 35 cases, respectively. In accordamce to available information on confirmed cases, the cases with history of exposure to confirmed cases were more than those with history of living or traveling in Hubei. And more cases were non-Chinese nationalities, 40 years old and above, and males . Conclusion The novel coronavirus has transmitted abroad, and produced second-generation cases. Although the incidence is low abroad , its trend fluctuates greatly, so sufficient attention must be paid to the possibility of further transmission.

Objective: To analyze the relationships between the exposure of occupational noise and the occurrence of noise-induced high frequency hearing loss in automobile manufacturing industry. Methods: From June to November 2017, 1579 male workers were selected for exposure to noise hazards in the automobile manufacturing industry in Guangzhou for more than one year (including one year) using the convenient sampling method. According to the hearing test results, 276 people in the high frequency hearing loss group and 1303 in the normal hearing group were surveyed, occupational health tests were conducted, and the noise intensity in the workplace was measured. The cumulative noise exposure (CNE) was calculated. The relationship between shift work and high frequency hearing loss of noise work is analyzed. Results: Compared with the normal hearing group, the noise exposure intensity, age, length of service, marital status, working system, and physical exercise of the high frequency hearing loss group were statistically significant (P<0.05). Through logistic regression analysis, after correcting the effects of organic solvent contact, marital status, and physical exercise, CNE, age, and shift operations (double-shift operations, three-shift operations) are the risk factors for high frequency hearing loss to occur. Conclusion The risk of hearing loss of workers exposed to noise in the whole vehicle manufacturing industry may be related to CNE, age, and shift work. Two-shift and three-shift work are possible risk factors for noise-induced high frequency hearing loss.

Objective: To evaluate the effects of extended nursing mode on the asthmatic children with allergic rhinitis (AR). Methods: Totally116 children aged 6-14 years old with asthma and AR were enrolled to this study from November 2015 to October 2016 in our hospital. They were divided into the regular nursing group and the extended nursing group according to the voluntary principle. The patients in regular nursing group were received routine nursing care in or out of hospital, while the patients in extended nursing group received extended care besides routine nursing. The children were required to record diary about asthma and AR And participate in asthma action projects. Before and after intervention we observed the quantitative score of symptoms and signs, the times of acute attack, the times of oblivion medication, the average days of stay in hospital, the days of fail to School or kindergarten, the lung function and the fractional exhaled nitric oxide (FeNO) in children with asthma and AR within 1 year. These above marks were assessed five times respectively at starting (baseline) , 3 months, 6 months, 9 months and 12 months (1 year) The differences between two groups were compared with appropriate statistical methods. Results: 1 year later, out of 58 cases in extended nursing group, 40 patients (68.97%)were in good control and 18 cases (31.03%) in partial control. Out of 58 cases in regular nursing group, 22 cases (37.93%) were in good control and 36 patients (62.07%) in partial control. There were significant differences between two groups in the effect of disease (χ²=11.23, all P<0.01), the experimental group was significantly better than the control group. The symptoms and signs of allergic rhinitis average scores in regular nursing group were 1.88 ± 0.72, extended nursing group were 0.79 ± 0.71, the difference was statistically significant (t=8.080, P<0.01) with the extended nursing group much better that the regular nursing group. The symptoms and signs of asthma average scores in regular nursing group were1.83 ± 0.75, extended nursing group were 0.88 ± 0.67, the difference was also statistically significant (t=7.133, P<0.01) with the extended nursing group much better that the regular nursing group. In extended nursing groups within 1 year the numbers of acute attack (0.60±0.59), the times of oblivion medication (11.05±7.40), the average days of stay in hospital (8.83±2.79) days,the average days of failing to school or kindergarten (8.69±5.46) days, while in regular nursing group within 1 year the numbers of acute attack(2.94±1.52), the times of oblivion medication (35.28±8.84), the average days of stay in hospital(20.95±5.46 days), the average days of fail to school or kindergarten(24.72±5.92) days, the differences were also statistically significant (t=10.50-15.87, P<0.01). The lung function in extended nursing group (PEF: 82.02±6.04, FEVI: 88.19±5.10, FEV25: 80.67±4.88, FEV50: 80.07±3.73, FEV75: 81.52±3.85) and in regular nursing group (PEF: 79.02±6.12,, FEV1: 80.52±4.72, FEV25: 75.05±7.79, FEV50: 77.59±4.60, FEV75: 78.41±4.19) . The differences were also statistically significant (t=2.90-6.15, P<0.01).The FeNO(13.66±2.87) ppb in extended nursing group and (14.95±3.12) ppb in regular nursing group. There were statistical significant differences between the two groups (t=2.30, P<0.05) with extended nursing group much better than regular nursing group. Conclusion The effect of extended care group is better than that of regular nursing group, and extended care is much more benefit to control asthma and allergic rhinitis in children.