OBJECTIVE To investigate the changes of air aerosols in the digestive endoscope cleaning and disinfec-tion room under real working conditions and observe the purification effects of aerosols under different ventilation and disinfection modes.METHODS Under the real working conditions(with both the air conditioner and recircu-lating air disinfection machine under the working mode),the air samples were collected every 1 hour from 8:00 to 16:00 from the digestive endoscope cleaning and disinfection room of Ren Ji Hospital,Shanghai Jiao Tong U-niversity School of Medicine from May 2023 to Oct.2023;the contents of particulate matters(PM)and microor-ganisms in the air were detected.At the busiest moment of the cleaning and disinfection room,the air was respec-tively sampled from the cleaning and disinfection room with the working condition modes of air condition systems,recirculating air disinfection machine or natural ventilation before the starting of systems and after the work for 0.5 hour,1 hour and 2 hours.The contents of PMs and microorganisms were detected.RESULTS The PM0.5 con-centrations during various time periods met the Grade 9 ISO clean room standard(≤35,200 particles/L)under the real working conditions,and the content of airborne viable particles also conformed to the Class Ⅲ environmental requirements(≤500 CFU/m3).All of the three ventilation and disinfection methods showed certain effects on purification of the con-tents of PM0.5 and microorganisms after the ventilation for 2 hours,the contents of PMs and microorganisms of the air disinfection machine group decreased most remarkably,followed by the air conditioner group,the natural ventilation group the least.There were no significant differences in the PM concentration and the content of microorganisms among the three groups at the time points;there were only significant differences in the PM concentration and the content of mi-croorganisms of the air disinfection machine group after the ventilation for 2 hours,0.5 hour and 1 hour(P＜0.05).CONCLUSIONS Both the air conditioning systems and recirculating air disinfection machine under the working con-dition mode have certain effect on purification of the contents of PM and microorganisms,and the specific effect need to be further studied.The implementation of multicenter dynamic surveillance with the help of intelli-gent techniques may provide reference for the optimization of ventilation and disinfection strategies.

OBJECTIVE To investigate the changes of air aerosols in the digestive endoscope cleaning and disinfec-tion room under real working conditions and observe the purification effects of aerosols under different ventilation and disinfection modes.METHODS Under the real working conditions(with both the air conditioner and recircu-lating air disinfection machine under the working mode),the air samples were collected every 1 hour from 8:00 to 16:00 from the digestive endoscope cleaning and disinfection room of Ren Ji Hospital,Shanghai Jiao Tong U-niversity School of Medicine from May 2023 to Oct.2023;the contents of particulate matters(PM)and microor-ganisms in the air were detected.At the busiest moment of the cleaning and disinfection room,the air was respec-tively sampled from the cleaning and disinfection room with the working condition modes of air condition systems,recirculating air disinfection machine or natural ventilation before the starting of systems and after the work for 0.5 hour,1 hour and 2 hours.The contents of PMs and microorganisms were detected.RESULTS The PM0.5 con-centrations during various time periods met the Grade 9 ISO clean room standard(≤35,200 particles/L)under the real working conditions,and the content of airborne viable particles also conformed to the Class Ⅲ environmental requirements(≤500 CFU/m3).All of the three ventilation and disinfection methods showed certain effects on purification of the con-tents of PM0.5 and microorganisms after the ventilation for 2 hours,the contents of PMs and microorganisms of the air disinfection machine group decreased most remarkably,followed by the air conditioner group,the natural ventilation group the least.There were no significant differences in the PM concentration and the content of microorganisms among the three groups at the time points;there were only significant differences in the PM concentration and the content of mi-croorganisms of the air disinfection machine group after the ventilation for 2 hours,0.5 hour and 1 hour(P＜0.05).CONCLUSIONS Both the air conditioning systems and recirculating air disinfection machine under the working con-dition mode have certain effect on purification of the contents of PM and microorganisms,and the specific effect need to be further studied.The implementation of multicenter dynamic surveillance with the help of intelli-gent techniques may provide reference for the optimization of ventilation and disinfection strategies.

Objective To investigate the impact of ampelopsin(AMP)on oxygen glucose deprivation/reperfusion(OGD/R)induced neuronal damage and its mechanism,and to lay a foundation for the study of neonatal hypoxic-ischemic brain damage.Methods Neurons of newborn SD rats were isolated and cultured in vitro,and they were divided into 5 groups:control group(AMP 0 μmol/L),OGD/R group,low dose AMP group(OGD/R+AMP 20 μmol/L),high dose AMP group(OGD/R+AMP 30 μmol/L)and JAK2/STAT3 activator group(OGD/R+AMP 30 μmol/L+Coumermycin A1 10 μmol/L).CCK-8 method was used to de-tect the cell viability of different treatment groups,the lactate dehydrogenase(LDH)kit was used to detect the cell activity of LDH in the medium,flow cytometry was used to detect the apoptosis rate,enzyme-linked immunosorbent assay was used to detect the levels of interleukin-6(IL-6),interleukin-10(IL-10)and tumor necrosis factor α(TNF-α),the kit was used to detect the levels of reactive oxygen species(ROS),malondial-dehyde(MDA)and superoxide dismutase(SOD),and Western blotting was used to detect the expression of apoptosis related proteins B-cell lymphoma-2(Bcl-2),Bcl-2 associated X protein(Bax),enzymatic cleavage of cysteine containing aspartate protein hydrolase-3(C-caspase-3),tyrosine kinase 2(J AK2),phosphorylated JAK2(p-JAK2),signal transduction and transcription activating factor 3(STAT3)and phosphorylated STAT3(p-STAT3).Results Compared with the concentration of AMP of 0 μmol/L,the cell viability in con-centration of AMP of 5-30 μmol/L was not obvious different(P＞0.05),when the concentration of AMP was 40 μmol/L,the cell viability decreased obviously(P＜0.05).Compared with the control group,the cell viability,the levels of SOD fluorescence intensity,IL-10 and Bcl-2 in OGD/R group decreased obviously,the LDH activity,cell apoptosis rate,the levels of ROS,MDA,IL-6,TNF-α,Bax,C-caspase-3,p-JAK2/JAK2,and p-STAT3/STAT3 increased obviously(P＜0.05).Compared with OGD/R group,the cell viability,the levels of SOD fluorescence intensity,IL-10 and Bcl-2 in low and high dose AMP groups increased,the LDH activity,cell apoptosis rate,the levels of ROS,MDA,IL-6,TNF-α,Bax,C-caspase-3,p-JAK2/JAK2,and p-STAT3/STAT3 decreased(P＜0.05),and JAK2/STAT3 activator was able to reverse the protective effect of AMP on OGD/R induced neuronal.Conclusion AMP attenuates OGD/R induced neuronal by reducing oxidative stress and inflammatory response,and its mechanism may be related to inhibition of JAK2/STAT3 signal pathway phosphorylation.

ObjectiveTo investigate a suspected outbreak of carbapenem-resistant Acinetobacter baumannii （CRAB） nosocomial infection in an intensive care unit （ICU） and provide scientific evidence for prevention and control of multi-drug resistant nosocomial infection. MethodsClinical and epidemiological data of 4 patients with CRAB infection were retrospectively investigated in the ICU of Renji Hospital in November 2021. Environmental hygiene monitoring and multilocus sequence typing （MLST） were conducted and intervention measures were taken. ResultsA total of 4 cases with CRAB infection were identified， among which 1 case was determined to be community-acquired and3 cases were hospital-acquired. The isolated strains shared the same drug resistance， and were all classified into ST368 type. In the surface and hand samples （n=40）， 2 CRAB strains were detected in the air filter beside the bed of the first case， with a detection rate of 5%. After adopting comprehensive prevention and control strategies， including environmental cleaning and disinfection， hand hygiene， staff management and training， and supervision， no similar case with CRAB infection was found. ConclusionThis suspected outbreak of CRAB nosocomial infection may be induced by inadequate environmental cleaning and disinfection， and inadequate implementation of hand hygiene. Timely identification， investigation， and targeted measures remain crucial to effective control of possible nosocomial infection.

Objective:To investigate the segmentation methods of pancreatic ductal adenocarcinoma (PDAC) tumor regions in 18F-fluorodeoxyglucose (FDG) PET/CT images, as well as their impact on radiomic features-based pathological grade prediction. Methods:A total of 72 patients (46 males, 26 females, age range: 25-87 years) with pathologically confirmed PDAC and a preoperative 18F-FDG PET/CT scan in Peking Union Medical College Hospital between September 2010 and January 2016 were enrolled retrospectively. The cohort of patients was classified as well differentiated group and non-well differentiated group based on the pathological grade of PDAC, and patients were divided into training set and validation set in the ratio of 3∶1 randomly. Two physicians performed manual contours in the tumor region (referred as region of interest (ROI)_M1 and ROI_M2) and semi-automatic ROIs based on standardized uptake value (SUV) gradient edge search (referred as ROI_G) and 40% threshold applied to the maximum SUV (SUV max; referred as ROI_S) were drawn. The four types of segmentation results were compared in terms of volume and Dice similarity coefficient (DSC). Shape, first-order, and texture features were extracted from PET/CT original and preprocessed images, and the interclass correlation coefficient (ICC) was used to assess each feature′s consistency across all segmentations. Kruskal-Wallis rank sum test, independent-sample t test or z test were used to analyze the data. The area under the receiver operating characteristic curve was used to assess model accuracy, and cross validation was used to assess generalization ability. Results:There were 55 patients in the training set (14 well differentiated cases and 41 non-well differentiated cases) and 17 patients in the validation set (4 well differentiated cases and 13 non-well differentiated cases). A total of 44 selected features were predictive of the pathological grade of PDAC among 20 feature groups. There was significant difference among the volumes of ROI_M1, ROI_M2, ROI_G and ROI_S (10.29(4.01, 19.43), 9.34(4.26, 17.27), 11.86(5.52, 19.74) and 15.08(9.62, 27.44) cm 3; H=18.641, P<0.05). The degree of contour coincidence and feature consistency between ROI_M1 and ROI_M2 were both higher (DSC=0.86 (0.76, 0.90), ICC=0.86 (0.74, 0.94)). Compared to manual contours, the degree of contour coincidence and feature consistency of ROI_G (DSC: 0.86(0.75, 0.91), 0.91(0.85, 0.96); ICC: 0.87(0.72, 0.94), 0.94(0.88, 0.98)) were better. There was no statistically significant difference in model accuracy or generalization ability between ROI_M1 and ROI_G ( z=1.052, t=0.712, both P>0.05). The accuracy of ROI_M2 was better than ROI_G ( z=3.031, P=0.002), but the generalization ability of ROI_M2 was insufficient ( t=3.086, P=0.012). Conclusions:Although the manual contour prediction models are highly accurate, their performance are unstable. Semi-automatic contouring based on gradient can achieve comparable accuracy to manual contouring, and the model′s generalization ability is stronger.

Objective To study the effect of age-related white matter changes (ARWMC) on first symptomatic ischemic stroke events in the oldsters. Methods For the prospective study, a total of 368 eligible oldsters were enrolled in the study from January 2010 to August 2012. The degrees of ARWMC were assessed by ARWMC scale;according to the scores, they were divided into non ARWMC group, mild-moderate ARWMC group and severe ARWMC group. The patients were followed up once every 3 months. The clinical endpoint events and time (first symptomatic ischemic stroke, myocardial infarction and all-cause death) were recorded. Analyses of variance and Chi-square test were used to compare the differences of clinical data among the 3 groups. COX regression was used to assess the risk differences of first symptomatic ischemic stroke in the oldsters of three groups. Results After an average of follow-up for 48.7 months, 50 participants (13.6％) had first symptomatic ischemic stroke;25 (25.8％) were categorized as the severe ARWMC group, 22 (10.9％) were as the mild-medium group, and 3 (4.4％) were as the non ARWMC group. Among the three groups, the differences in age, history of hypertension, systolic blood pressure, incidence of clinical endpoint events and first symptomatic ischemic stroke, and follow-up time of endpoint events were statistically significant (P<0.05); patients from the severe ARWMC group were the oldest, and had the longest history of hypertension, the highest systolic blood pressure, the highest incidence of clinical end events and first symptomatic ischemic stroke, and the shortest follow-up period for clinical end events. COX regression analysis showed that the risk of first symptomatic ischemic stroke in the severe ARWMC group was about 8 times higher than that in the non ARWMC group (hazard ratio=9.012, 95％CI: 2.310-35.154, P=0.002). Conclusion In oldsters, severe ARWMC often accompany hypertension history and poor blood pressure controll, and it is an independent and serious risk factor for long-term first symptomatic ischemic stroke.

Objective? To explore the effects of the problem-oriented intervention model on major nursing issues, self-care behavior and illness perception in elderly patients with type 2 diabetes. Methods? Totally 112 elderly patients with type 2 diabetes admitted in the First Hospital of Jiaxing from September 2016 to September 2017 were selected by convenient sampling and divided into the control group (n=56) and the observation group (n=56) based on the time of admission. Patients in the control group received conventional nursing care, while patients in the observation group received conventional nursing care in addition to problem-oriented nursing interventions. The Omaha Problem Classification Scheme was used to evaluate the nursing issues in the two groups, and the Chinese version of Summary of Diabetes Self-Care Activities (SDSCA) and the Brief Illness Perception Questionnaire (BIPQ) were used to evaluate the intervention effects between the two groups. Results? After 6 months, the resolution rate of major nursing issues in the observation group was 82.93% (68/82), while that in the control group was 63.16% (48/76); (χ2=7.898, P＜ 0.05). The self-care behavior and illness perception in the observation group totaled (27.33±7.36) and (38.49±5.76), respectively, both higher than that in the control group (t=5.180, 7.201; P＜ 0.01). Conclusions? The problem-oriented nursing intervention model can effectively enhance the self-care ability and illness perception in elderly patients with type 2 diabetes.

?? [Abstract]? Objective? To explore the current status of dyadic coping among pelvic floor dysfunction (PFD) patients and their spouses so as to provide a new perspective for clinical medical staff to carry out PFD family prevention intervention contrapuntally. Methods? From March to December 2017, we selected totals of 150 pelvic floor dysfunction patients and their spouses in the Second Affiliated Hospital of Wenzhou Medical University by convenience sampling. All of the patients were investigated with the general information questionnaire and Dyadic Coping Inventory (DCI). Totals of 150 questionnaires were sent out to patients and their spouses, and 138 valid of them from patients and their spouses were collected with 92.0% for the valid recovery rate. Results? The score of pressure communication of PFD patients was lower than that of their spouses, and the score of negative coping of PFD patients was higher than that of their spouses with statistical differences (P＜ 0.05). Pearson correlation analysis showed that the scores of dyadic coping of PFD patients had positive correlations with those of their spouses (P＜ 0.05), and the scores of negative coping of PFD patients and their spouses had negative correlations with the scores of pressure communication, support, authorized coping and cooperation (P＜ 0.05). Conclusions? PFD patients and their spouses are with obvious negative coping and inadequate dyadic coping. Besides, dyadic coping of patients is closely related to dyadic support. Clinical medical staff should stress the importance of dyadic coping, and encourage PFD patients and their spouses to actively participate in and face disease together and to relieve stress.

Objective To investigate the characteristics of NEN metastasis with SSTR PET/CT and to correlate the results with FDG-PET and pathology.Methods From November 2011 to August 2016,a total of 43 patients with NEN (18 males,25 females;age range:26-74 years) were recruited into this retrospective study;they underwent 68Ga-DOTA-TATE PET/CT (TATE-PET) imaging 40-60 min after 44.4-229.4 MBq 68Ga-DOTA-TATE administration.Metastases in 31 patients were confirmed by histopathology and in 12 patients by follow-up and other imaging modalities.Twenty-eight of 43 patients finished routine FDG-PET in a week after TATE-PET.PET/CT results were considered positive when the metastatic lesions were tracer-avid.ROI was drawn over each lesion for size and SUV measurement.x2 test and Pearson correlation analysis were used for statistical analysis.Results (1) Of 43 patients,TATE-PET detection rates of metastasis in the liver,lymph nodes,bones.and lungs were 85.7％(30/35),12/13,7/7,2/3,respectively,with their corresponding SUVmax of 18.1(11.3-23.3),10.8(5.4-15.6),7.7(4.2-9.9) and 1.8(1.3-2.3),respectively.Statistical correlation between size and SUVmax was found in metastatic bone lesions(r=0.233,P＜0.05).(2) In 31 patients with histopathologically proven metastasis,TATE-PET detected 23/24 (95.8％) G2,1/2 G1 and 5/5 G3 metastases.G1 metastases were only found in the liver.(3)Among 28 patients underwent both TATE-PET and FDG-PET,there was no significant difference between the detecting rate of metastasis:89.2％ (25/28) vs 71.4％ (20/28);x2 =2.389,P＞0.05.Compared with FDG-PET,TATE-PET was superior in demonstrating metastasis in the liver and bones (70.0％ (14/20) vs 65.0％ (13/20),3/3 vs 2/3),equal in detecting lung metastasis (both 2/3) but inferior in demonstrating metastasis in lymph nodes (9/10vs 10/10).Conclusions The capability of TATE-PET in revealing NEN metastasis varies depending on lesion localization and histologic grade.TATE-PET and FDG-PET are complementary to each other in detection of NEN metastasis,but without obvious relationship to histologic grade.

Objective To retrospectively study the biodistribution of 68Ga-DOTA-TATE as a SSTR imaging agent in human subjects.Methods A total of 106 patients with suspected disease were enrolled in this study.All patients were histologically proven for having either a single tumor ＜2 cm or without evidence of tumor during follow-up.Patients underwent PET/CT whole-body scan 17-100 min after intravenous injection of 55.2-220.0 MBq 68Ga-DOTA-TATE.ROI was drawn for measuring SUV of tracer-avid pathologies.One-way analysis of variance and two-sample t test were used for statistical analysis.Results High 68Ga-DOTA-TATE avidity was found in pituitary,with SUVmax of 4.00± 1.21.Tracer was excreted mainly through urinary system resulting in highest uptake in the urinary tracts.The SUVmax of kidney cortex was 19.01 ± 5.45.Mediastinal blood pool and liver SUVmax were 0.93±0.33 and 7.69±2.26,respectively.Mild uptake of 68Ga-DOTA-TATE was found in the brain,cerebellum,lung and muscle,all lower than that of mediastinal blood pool.Moderate accumulation of 68 Ga-DOTA-TATE (close to or slightly higher than liver) was found in adrenal gland and spleen,with SUVmax 7.61 ± 3.42 and 8.63± 2.31,respectively.Other organs (pituitary,salivary gland,thyroid,pancreas,small intestine,colon,uterus,prostate and bone) showed tracer uptake in the range between those of mediastinal blood pool and liver.68Ga-DOTA-TATE distribution in pancreas was not uniform.Nine patients had focal accumulation in the uncinate process of pancreas with highest SUVm~ up to 8.48.However,the SUVmax and SUV in the rest of pancreas (head,neck,body and tail) showed insignificant difference (F values:0.703,0.563,both P＞0.05).68Ga-DOTA-TATE uptake in each organ reached equilibrium quickly after injection but with slight increase over time.The changes in SUV,however,showed insignificant difference among organs,including different parts of pancreas (t values:from -0.09 to 1.75,from-1.70 to-0.42,respectively,all P＞0.05).Conclusions The biodistribution of 68Ga-DOTA-TATE reaches equilibrium shortly after intravenous administration and is stably maintained.The biodistribution activities are organ-specific,and characteristic to that of SSTR concentration.