Objective To investigate the environmental contamination related to first patient with carbapenem-re-sistant Acinetobacter baumannii(CRAB)infection and the infection status of relevant patients in a newly established intensive care unit(ICU)of a hospital in Tibetan area,and analyze the transmission risk.Methods From the ad-mission in ICU of a patients who was first detected CRAB on November 15,2021 to the 60th day of hospitalization,all patients who stayed in ICU for＞48 hours were performed active screening on CRAB.On the 30th day and 60th day of the admission to the ICU of the first CRAB-infected patient,environment specimens were taken respectively 2 hours after high-frequency diagnostic and therapeutic activities but before disinfection,and after disinfection but before medical activities.CRAB was cultured with chromogenic culture medium.Results Among the 13 patients who were actively screened,1 case was CRAB positive,he was transferred from the ICU of a tertiary hospital to the ICU of this hospital on November 19th.On the 40th day of admission to the ICU,he had fever,increased frequency for sputum suction,and CRAB was detected.The drug sensitivity spectrum was similar to that of the first case,and he also stayed in the adjacent bed of the first case.64 environmental specimens were taken,and 9 were positive for CRAB,with a positive rate of 14.06％,8 sampling points such as the washbasin,door handle and bed rail were positive for CRAB after high-frequency diagnostic and therapeutic activities.After routine disinfection,CRAB was detected from the sink of the washbasin.Conclusion For the prevention and control of CRAB in the basic-level ICU in ethnic areas,it is feasible to conduct risk assessment on admitted patients and adopt bundled prevention and con-trol measures for high-risk patients upon admission.Attention should be paid to the contaminated areas(such as washbasin,door handle,and bed rail)as well as the effectiveness of disinfection of sink of washbasin.

Objective To explore the efficacy and safety of recombinant human anti-severe acute respiratory syn-drome coronavirus 2(anti-SARS-CoV-2)monoclonal antibody injection(F61 injection)in the treatment of patients with coronavirus disease 2019(COVID-19)combined with renal damage.Methods Patients with COVID-19 and renal damage who visited the PLA General Hospital from January to February 2023 were selected.Subjects were randomly divided into two groups.Control group was treated with conventional anti-COVID-19 therapy,while trial group was treated with conventional anti-COVID-19 therapy combined with F61 injection.A 15-day follow-up was conducted after drug administration.Clinical symptoms,laboratory tests,electrocardiogram,and chest CT of pa-tients were performed to analyze the efficacy and safety of F61 injection.Results Twelve subjects(7 in trial group and 5 in control group)were included in study.Neither group had any clinical progression or death cases.The ave-rage time for negative conversion of nucleic acid of SARS-CoV-2 in control group and trial group were 3.2 days and 1.57 days(P=0.046),respectively.The scores of COVID-19 related target symptom in the trial group on the 3rd and 5th day after medication were both lower than those of the control group(both P＜0.05).According to the clinical staging and World Health Organization 10-point graded disease progression scale,both groups of subjects improved but didn't show statistical differences(P＞0.05).For safety,trial group didn't present any infusion-re-lated adverse event.Subjects in both groups demonstrated varying degrees of elevated blood glucose,elevated urine glucose,elevated urobilinogen,positive urine casts,and cardiac arrhythmia,but the differences were not statistica-lly significant(all P＞0.05).Conclusion F61 injection has initially demonstrated safety and clinical benefit in trea-ting patients with COVID-19 combined with renal damage.As the domestically produced drug,it has good clinical accessibility and may provide more options for clinical practice.

Objective:To investigate the status quo of training and domestic use of 707 clinical nutrition support specialty nurses from 21 provinces,cities,and autonomous regions in China. And to analyze their influencing factors and provide reference for improving the training system of clinical nutrition support specialty nurses,selection and development of specialist nurses in clinical nutrition support. Methods:From October to November 2023,a cross-sectional survey was conducted on 707 clinical nutrition support specialty nurses from 21 provinces,cities,and autonomous regions across China was conducted using a convenience sampling method based on a questionnaire about the training and home use of clinical nutrition support nurses. Univariate and multiple linear regression analysis was used to examine the use status and application of clinical nutrition support specialty nurses in five aspects:clinical nursing practice,nursing education,nursing management,coordination,nursing research and consultation. Results:The use of specialist clinical nutrition support nurses is not ideal,with 75.67％ of specialist nurses scoring less than 208 points (i.e. less than 80％ of the total score). Among the use of different dimensions,the clinical nursing practice dimension received the highest score (54.17±10.26),followed by the nursing education dimension (36.98±8.00). The results of multiple linear regression analysis show that hospital level and professional title are independent influencing factors influencing the use and development of specialist nurses. Conclusion:There is a need to further improve the utilisation of clinical nutrition support nurses. It is recommended that links and cooperation between hospitals at all levels,communities,and families be strengthened. For specialist nurses with higher professional titles,encourage them to fully play their roles,strengthen training in weak areas,continuously optimize the professional ability of clinical nutrition support nursing teams,comprehensively improve the quality of clinical nutrition support specialist nursing,and promote their high-level development.

Objective:To investigate the relationship between phase angle (PA) and nutritional status,duration of mechanical ventilation,length of intensive care unit (ICU) stay,and clinical outcomes in patients with severe acute pancreatitis (SAP) complicated with ARDS. Methods:The clinical data of patients with SAP complicated with ARDS admitted to the surgical ICU,Jinling hospital,medical school of Nanjing University,from July 2023 to March 2024 were retrospectively collected. Patients are divided into low-PA group and normal-PA group based on phase angle. The correlation analysis between phase angle,nutritional status,and clinical outcomes,and evaluation of risk factors for mortality in patients with SAP combined with ARDS were performed. Result:A total of 83 patients with SAP complicated with ARDS were included in this study. PA was negatively correlated with nutritional risk scores (rs=-0.352,P=0.001),duration of mechanical ventilation (rp=-0.475,P<0.001),length of ICU stay (rp=-0.313,P=0.004),and mortality (rs=-0.371,P=0.001). Univariate analysis showed statistically significant differences in age,PA value,and duration of mechanical ventilation for predicting mortality (P<0.05);Multivariate analysis showed that the PA value was an independent risk factor for mortality (P<0.05). Conclusion:PA is significantly correlated with clinical outcomes,such as nutritional risk,duration of mechanical ventilation,length of ICU stay and mortality,and may be a promising biomarker in future.

OBJECTIVE: To assess the effect and safety of Reyanning Mixture (RYN) in treating asymptomatic or mild severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents. METHODS: This is a prospective, open-label, randomized controlled trial. Patients aged 1-17 years and diagnosed with asymptomatic or mild coronavirus disease-2019 (COVID-19) were assigned to an intervention group (RYN plus standard care) and a control group (standard care) according to a randomization list. The primary outcomes were SARS-CoV-2 negative conversion time. Secondary outcomes included negative conversion rate on days 3 and 7, hospital length of stay, symptom relief rate, new-onset symptoms of asymptomatic infected patients, and progressive disease rate. The cycle threshold (Ct) values of ORF1ab or N genes were also tested. RESULTS: A total of 214 patients in the intervention group and 217 in the control group were analyzed. The SARS-CoV-2 negative conversion time was significantly shortened in the intervention group [5 days (interquartile range (IQR): 5-6) vs. 7 days (IQR: 6-7), P<0.01]. By days 3 and 7, the negative conversion rates were significantly higher in the intervention group (day 3: 32.7% vs. 21.2%, P=0.007; day 7: 75.2% vs. 60.8%, P=0.001). Ct values significantly increase on day 2 [ORF1ab gene: 35.62 (IQR: 29.17-45.00) vs. 34.22 (IQR: 28.41-39.41), P=0.03; N gene: 34.97 (IQR: 28.50-45.00) vs. 33.51 (IQR: 27.70-38.25), P=0.024] and day 3 [ORF1ab gene: 38.00 (IQR: 32.72-45.00) vs. 35.81 (IQR: 29.96-45.00), P=0.003; N gene: 37.16 (IQR: 32.01-45.00) vs. 35.26 (IQR: 29.09-45.00), P=0.01]. No significant difference was found in hospital length of stay between the two groups (P>0.05). Symptoms of cough were significantly improved (82.2% vs. 70.0%, P=0.02) and wheezing was significantly reduced (0.7% vs. 12.9%, P<0.01) in the intervention group compared with the control group. During the trial, no disease progression or serious adverse events were reported. CONCLUSION Adding RYN to standard care may be a safe and effective treatment for children with asymptomatic and mild SARS-CoV-2 infection. (Registration No. ChiCTR2200060292).

COVID-19 has been prevalent for three years. The virulence of SARS-CoV-2 is weaken as it mutates continuously. However, elderly patients, especially those with underlying diseases, are still at high risk of developing severe infections. With the continuous study of the molecular structure and pathogenic mechanism of SARS-CoV-2, antiviral drugs for COVID-19 have been successively marketed, and these anti-SARS-CoV-2 drugs can effectively reduce the severe rate and mortality of elderly patients. This article reviews the mechanism, clinical medication regimens, drug interactions and adverse reactions of five small molecule antiviral drugs currently approved for marketing in China, so as to provide advice for the clinical rational use of anti-SARS-CoV-2 in the elderly.

Objective To investigate the factors affecting the dose distribution to the tumor target volume(GTV)and normal tissues in cerebral arteriovenous malformation(AVM)treated with CyberKnife,and to analyze the effect of collimators of different diameters on the dose distribution of cerebral AVM,so as to provide references for cerebral AVM CyberKnife treatment plans.Methods Totally 12 cerebral AVM patients receiving CyberKnife treatment after embolization in some hospital between 2015 and 2020 were selected.Collimators were determined according to 30％,40％,50％,30％+40％+50％of the GTV cross-sectional long diameters,and four different treatment plans were developed for each patient and then enrolled into Group A,Group B,Group C,and Group D,respectively.The effects of the shape and volume of GTV and the size of collimator on the dose distribution in the target area were analyzed,and the dose fall-off outside the target area was investigated.SPSS 20.0 software was used for statistical analysis.Results The effects of width,height,volume and regularity of GTV on the conformity index(CI),new conformity index(nCI),geometric conformity index(gCI)and number of beams were statistically significant(P＜0.05).When compared with group A,B and D,group C had the minimum dose,median absorbed dose,target area coverage,target gradient index and prescription dose line of GTV increased while the CI,nCI,gCI of GTV and the number of monitor units,treatment nodes and beams decreased significantly(P＜0.05).In group C median absorbed dose of normal tissue more than 20 mm apart from the target area decreased,while median absorbed dose of normal tissue not longer than 15 mm apart from the target area increased.Conclusion During CyberKnife treatment of cerebral AVMs,collimator selection based on 50％of the GTV cross-sectional long diameter can achieve an optimal dose distribution while improving the efficiency of the execution of the CyberKnife treatment plan.[Chinese Medical Equipment Journal,2023,44(11):56-60]

The purpose of this study was to evaluate the diagnostic performance of multiparametric ultrasound (mpUS; grayscale US, color Doppler US, strain elastography, and contrast-enhanced US) in the assessment of testicular lesions with negative tumoral markers. MpUS imaging data, patient age, serum tumor markers, scrotal pain, cryptorchidism, and related clinical information were retrospectively collected for patients who underwent mpUS examination between January 2013 and December 2019. Histologic results or follow-up examinations were used as the reference standard. In total, 83 lesions from 79 patients were included in the analysis. Fifty-six patients were finally diagnosed with benign tumors, and 23 patients were ultimately diagnosed with malignant tumors. Chi-square tests or Fisher's exact tests were used to assess the difference between the two groups. Stepwise multivariate logistic regression analysis showed that lesion diameter (odds ratio [OR] = 1.072, P = 0.005), vascularization on color Doppler US (OR = 4.066, P = 0.001), and hyperenhancement during the early phase (OR = 6.465, P = 0.047) were significant independent risk factors for malignancy; however, when compared with neoplastic lesions, pain (OR = 0.136, P < 0.001), absence of vascularization on color Doppler US (OR = 1.680, P = 0.042), and nonenhancement during the late phase (OR = 3.461, P = 0.031) were strongly associated with nonneoplastic lesions. MpUS features are useful for differentiating testicular lesions with negative tumoral markers and improving the preoperative diagnosis, which may avoid inappropriate radical orchiectomy.
Male ; Humans ; Testicular Neoplasms/pathology* ; Biomarkers, Tumor ; Retrospective Studies ; Contrast Media ; Ultrasonography/methods*

To explore the quality consistency evaluation method for multi-component traditional Chinese medicine and establish a dissolution evaluation method suitable for the characteristics of multi-component Chinese patent medicine, this study discussed the characteristics and advantages of the flow-through cell method in the dissolution evaluation of Chinese patent medicine by comparing the impact of the small cup method and the flow-through cell method on the dissolution behavior of water-soluble and lipid-soluble major active components of Danshen Tablets. Dissolution tests were performed using the small cup method as described in the 2020 edition of the Chinese Pharmacopoeia and the newly introduced flow-through cell method(closed-loop method) with water solution containing 0.5% SDS as dissolution medium. Cumulative dissolution curves of the water-soluble component salvianolic acid B and the lipid-soluble component tanshinone Ⅱ_A in Danshen Tablets were plotted, and fitting and similarity analysis of the dissolution models was conducted to identify the characteristics and advantages of the flow-through cell method. For the small cup method, 150 mL of water containing 0.5% SDS was used as the dissolution medium, with a rotation speed of 75 r·min~(-1) and a temperature of(37±0.5) ℃, and 3 mL of samples were taken at 15, 30 min, 1, 2, and 4 h, with fresh dissolution medium added at the same temperature and volume. For the flow-through cell method, a closed-loop system was used. Danshen Tablets were placed in the flow-through cell with approximately 6.7 g of glass beads, and 150 mL of water containing 0.5% SDS was used as the dissolution medium. The flow rate was set at 20 mL·min~(-1), and the temperature and sampling were the same as the small cup method. The results showed that compared with the small cup method, the flow-through cell method had stronger discriminative power and higher sensitivity in distinguishing the dissolution behavior of the two components, and could better reflect the differences in formulation quality, especially for water-insoluble lipid-soluble components. Given that there were no essential differences in the in vitro release kinetics between the two methods, the flow-through cell method could not only replace the traditional small cup method but also better guide the formulation development and identify quality issues of formulations.
Salvia miltiorrhiza ; Medicine, Chinese Traditional ; Tablets ; Water ; Lipids ; Solubility

Objective:To investigate the application value of fluorescence imaging in single-port thoracoscopic anatomic segmentectomy.Methods:The clinical data of 280 patients (145 patients with fluorescence method and 135 patients with modified inflation-deflation method) who underwent thoracoscopic anatomic segmentectomy were retrospectively studied in the Anhui Chest Hospital from June 2020 to June 2021. There were 113 patients in the simple segmentectomy group and 167 patients in the complex segmentectomy group. The baseline data of the fluorescence method and the modified inflation-deflation method in the complex segmentectomy group were corrected by propensity score matching, and the perioperative results were compared between the groups.Results:There were no significant differences in segmental resection time, intraoperative blood loss, postoperative drainage, postoperative pain, postoperative extubation time, length of hospital stay, incidence of complications and cost of hand-holding between the fluorescence method and the modified method of the simple segmentectomy group.In the complex segmentectomy group, the time of segmental resection with the fluorescence method was significantly shorter than that with the modified inflation-deflation method( P<0.05), and other indexes had no significant difference. Conclusion:Fluorescence method single-port thoracoscopic anatomic segmentectomy has the same perioperative safety and short-term efficacy as modified inflation-deflation method, which can significantly shorten the operative time and improve the operative efficiency in complex anatomic segmentectomy.