Objective To evaluate the effect of bundle intervention on reducing catheter-associated urinary tract in-fection(CAUTI).Methods Hospitalized patients with urinary catheterization in a tertiary first-class hospital were subjected to targeted monitoring of a baseline survey from January to December 2022(pre-intervention).The main causes were found out,and bundle intervention measures were developed and implemented through plan-do-check-act(PDCA)tools from January to March 2023(intervention period).The data from April to December 2023(post-intervention)were collected,difference in catheter use rate and incidence of CAUTI before and after intervention were compared.Results The implementation rate of correctly hanging urine collection bags after intervention was 97.00％,the implementation rate of timely emptying urine collection bags was 91.72％,awareness rate of hand hy-giene among patient's family members was 79.13％,implementation rate of urinary catheter clamping during trans-portation was 74.79％,and daily evaluation implementation rate was 87.68％,which were higher than the pre-in-tervention rates of 85.63％,80.47％,62.75％,60.00％,and 79.93％,respectively.The incidence of CAUTI de-creased from 1.23‰ before intervention to 0.57‰ after intervention,the use rate of urinary catheter decreased from 5.53％before intervention to 5.37％after intervention.Differences of the above indicators were all statistically sig-nificant(all P＜0.05).Conclusion Through targeted monitoring on CAUTI and PDCA quality tools,the weak links in healthcare-associated infection control are identified,more targeted prevention and control measures are for-mulated,the implementation of bundle intervention measures can reduce the incidence of CAUTI.

Objective To evaluate the effect of bundle intervention on reducing catheter-associated urinary tract in-fection(CAUTI).Methods Hospitalized patients with urinary catheterization in a tertiary first-class hospital were subjected to targeted monitoring of a baseline survey from January to December 2022(pre-intervention).The main causes were found out,and bundle intervention measures were developed and implemented through plan-do-check-act(PDCA)tools from January to March 2023(intervention period).The data from April to December 2023(post-intervention)were collected,difference in catheter use rate and incidence of CAUTI before and after intervention were compared.Results The implementation rate of correctly hanging urine collection bags after intervention was 97.00％,the implementation rate of timely emptying urine collection bags was 91.72％,awareness rate of hand hy-giene among patient's family members was 79.13％,implementation rate of urinary catheter clamping during trans-portation was 74.79％,and daily evaluation implementation rate was 87.68％,which were higher than the pre-in-tervention rates of 85.63％,80.47％,62.75％,60.00％,and 79.93％,respectively.The incidence of CAUTI de-creased from 1.23‰ before intervention to 0.57‰ after intervention,the use rate of urinary catheter decreased from 5.53％before intervention to 5.37％after intervention.Differences of the above indicators were all statistically sig-nificant(all P＜0.05).Conclusion Through targeted monitoring on CAUTI and PDCA quality tools,the weak links in healthcare-associated infection control are identified,more targeted prevention and control measures are for-mulated,the implementation of bundle intervention measures can reduce the incidence of CAUTI.

Objective:To investigate the factors affecting phenotypes in the patients of methylmalonic acidemia combined with homocysteinemia cblC type with MMACHC c. 609G>A homologous variant. Methods:A retrospective study on the clinical manifestations, complications, treatment, and outcome in 164patients of cblC type with MMACHC c. 609G>A homologous variant was conducted.The patients were diagnosed by biochemical and genetic analysisfrom January 1998 to December 2020. Results:Among the 164 patients, 2 cases were prenatally diagnosed and began treatment after birth. They are 3 and 12 years old with normal physical and mental development. Twenty-one cases were diagnosed by newborn screening. Among them, 15 cases had with normal development. They were treated fromthe age of two weeks at the asymptomatic period. Six cases began treatment aged 1 to 3 months after onset. Their development was delayed. One hundred and forty-one cases were clinically diagnosed. Their onset age ranges from a few minutes after birth to 6 years old. 110 cases had early-onset (78.0%). 31 cases had late-onset (22.0%). Five of them died. 24 patients lost to follow-up. Of the 141 clinically diagnosed patients, 130 (92.2%) with psychomotor retardation, 69 (48.9%) with epilepsy, 39 (27.7%) with anemia, 30 (21.3%) had visual impairment, 27 (19.1%) had hydrocephalus, 26 (18.4%) had feeding difficulties, 7 (5.0%) with liver damage, and 5 (3.5%) with metabolic syndrome. The frequency of hydrocephalus and seizures was significantly higher in the early-onset group. The urinary methylmalonic acid increased significantly in the patients with epilepsy. During the long-term follow-up, the level of plasma total homocysteine in the seizure-uncontrolled group was significantly higher than that in the seizure-controlled group, the difference had a statistical significance ( P<0.05). Conclusion:Most of the patients with MMACHC c. 609G>A homozygous variant had early-onset disease, with a high mortality and disability rate. If not treated in time, it will lead to neurological damage, resulting in epilepsy, mental retardation, hydrocephalus, and multiple organ damage. Pre-symptomatic diagnosis and treatment are crucial to prevent irreversible neurological damage. Neonatal screening and prenatal diagnosis are important to improve the outcome of the patients.

Objective:To analyze the clinical features, genetic characteristics, treatment and follow-up results of patients with hydrocephalus caused by methylmalonic acidemia combined with homocysteinuria, and to discuss the optimal strategies for assessing and treating such patients.Methods:From January 1998 to December 2020, 76 patients with hydrocephalus due to methylmalonic acidemia combined with homocysteinuria in the Department of Pediatrics in 11 hospitals including Peking University First Hospital were diagnosed by biochemical, genetic analysis and brain imaging examination. The patients were divided into operation-group and non-operation-group according to whether they underwent ventriculoperitoneal shunt. The clinical features, laboratory examinations, genotype, and follow-up data were retrospectively analyzed. Data were compared between the two groups using rank sum test, and categorical data were compared using χ 2 test. Results:Among the 76 patients (51 male, 25 female), 5 were detected by newborn screening, while 71 were diagnosed after clinical onset, 68 cases (96%) had early-onset, 3 cases (4%) had late-onset. The most common clinical manifestations of 74 cases with complete data were psychomotor retardation in 74 cases (100%), visual impairment in 74 cases (100%), epilepsy in 44 cases (59%), anemia in 31 cases (42%), hypotonia or hypertonia in 21 cases (28%), feeding difficulties in 19 cases (26%) and disturbance of consciousness in 17 cases (23%). Genetic analysis was performed in 76 cases, all of whom had MMACHC gene variations, including 30 homozygous variations of MMACHC c.609G>A. The most common variations were c.609G>A (94, 62.7%), followed by c.658_660del (18, 12.0%), c.567dupT (9, 6.0%) and c.217C>T (8, 5.3%). Therapy including cobalamin intramuscular injection, L-carnitine and betaine were initiated immediately after diagnosis. A ventriculoperitoneal shunt operation was performed in 41 cases (operation group), and 31 patients improved after metabolic intervention (non-operation group). There was no significant difference in the age of onset, the age of diagnosis, the blood total homocysteine, methionine, and urinary methylmalonic acid concentration between the two groups (all P>0.05). The symptoms of psychomotor development, epilepsy, and visual impairments improved gradually after a long-term follow-up in the operation group. Conclusions:Hydrocephalus is a severe complication of methylmalonic acidemia combined with homocysteinuria. The most common clinical manifestations are psychomotor retardation, visual impairment, and epilepsy. It usually occurs in early-onset patients. Early diagnosis and etiological treatment are very important. Hydrocephalus may improve after metabolic intervention in some patients. For patients with severe ventricular dilatation, prompt surgical intervention can improve the prognosis.

Objective To explore the MRI features of Langerhans cell histiocytosis (LCH) in central nervous system (CNS) in children. Methods Clinical and MRI data of 25 cases with LCH in CNS from three children's hospitals between January 2009 and December 2014 were retrospectively studied. All cases were confirmed by surgery or biopsy. All cases underwent non?contrast and contrast pituitary and/or cranial MRI examinations. The location, morphology, MRI signal and enhanced patterns of LCH lesions were observed and analyzed. Result A total of 17 cases had hypothalamic-pituitary LCH, with 2 of them complicated with pineal cyst, 2 complicated with brain parenchymal lesions, and one complicated with both pineal cyst and brain parenchymal lesions. MR images showed that neurohypophysis lost its original hyper?intensity on T1WI, and nodular or homogeneous thickening was seen in the pituitary stalks. Dura matter was involved in 3 cases, 2 of them had single lesion, and the other one got multiple lesions. Neoplasm in choroid plexus was seen in trigone of left lateral ventricles in one case. Three cases with pineal gland involved demonstrated cystic change. Four cases had gray matter involved, with cerebellar dentate nuclei involvement in 2 cases, and both thalamus and basal ganglia involvement in the other two cases. Three cases showed white matter involvement without obvious Virchow-Robin space enlargement and brain atrophy. Conclusions MR imaging of LCH in CNS shows certain specific characteristics. The diagnosis can be made comprehensively based on both clinic features and other imaging findings.

Myocarditis refers to inflammatory disease of the myocardium caused by variety patho-gens,90%of patients are asymptomatic.A new and effective screening method is badly needed.Lake Louise standard cardiac MRI has become the non-invasive alternative diagnostic methods for myocarditis(instead of myocardial biopsy),as it can not only to show myocardial injury site,but can also reveal the extent of myo-cardial edema,fibrosis repair in late phase.

Objective To evaluate the clinical application of perforator flap in extended radical vulvectomy of vulvar carcinoma.Methods Retrospectively,twelve cases of vulva carcinoma were treated by radical extensive excision,and the defects were repaired with perforator flap.Results All the flaps were survived and healed with first intention except one infection.The wound infection patient was treated with change of the dressing and antibiotics.The reconstructed vulvae were plump and elastic.It appeared like the normal vulvae and there was no contraction of the vagina.Conclusions Vulvar reconstruction with the perforator flap after the radical vulvectomy could make the patients recover easily,which produces almost normal appearance and function of the vulvae,reduces the time of wound healing,the patient could get the next therapy more quickly and the quality of life improving.It has wide clinical application value.

The aim was to establish the chromatographic fingerprint of Rhizoma Panacis Japonici for its quality evaluation. Analysis was performed on a YMC-Pack ODS-AQ column (4.6 mm x 250 mm, 5 microm) eluted with the mobile phases of acetonitrile(A) and 5% acetic acid solution (B) at in gradient a flow rate of 1.0 mL x min(-1). The elution program was as follow: 0-5 min, changed from 20% A to 40% A, 5-20 min, kept 40% A. The temperature of column was 30 degrees C. The temperate of drift tube was 40 degrees C, and the nitrogen pressure was 33 Psi. Ten batches of Rhizoma Panacis japonici were determined. The HPLC-ELSD chromatographic fingerprint of chemical constituents was established from the 10 batches of Rhizoma Panacis japonici and it had 9 characteristic common peaks. The 10 batches of samples were classified into 2 cluster by cluster analysis. Furthermore, five known chemical constuituents were identified after isolation and purification by means of silica gel column chromatography, and semi-preparative high performance liquid chromatography. They were panaxsaponins Re, chikusetsusaponins IV, IVa, V and pjs-2, respectively. This study provided experimental data for comprehensive evaluation of the quality of Rhizoma Panacis japonici.
Chromatography, High Pressure Liquid ; Cluster Analysis ; Organic Chemicals ; analysis ; chemistry ; Panax ; chemistry ; Rhizome ; chemistry

Objective To investigate the change of the neutrophil apoptosis and neutrophil respiratory burst in the patients and the effect of ulinastatin on the apoptosis of neutrophil and respiratory burst of neutrophil during cardiopulmonary bypass (CPB). Methods Sixty-two patients undergoing valve replacement with CPB were randomly divided into two groups: ulinastatin group (U group, 31 cases) and control group (C group, 31 cases). In U group patients received ulinastatin after induction of anesthesia. In C group patients received equal volume of normal saline, instead of ulinastatin. Arterial blood was obtained before operation (T1), 30 min after the start of CPB (T2), 30 min after the termination of CPB (T3). The apoptosis of neutrophil and respiratory burst of neutrophil were measured by flow cytometer. The level of superoxide dismutase (SOD) and malondialdehyde (MDA) were measured by kit. Results In C group, compared with T1 [(66.57±5.93)%], the rate of the apoptosis of neutrophil was significantly decreased at T2[(55.37±3.51)%] and T3 [(48.92±4.21)%] (P<0.05). And in U group, compared with T1 [(73.57±7.94)%], the rate of the apoptosis of neutrophil was significantly decreased at T2 [(68.34±4.92)% ] and T3 [(62.13±4.76)%] (P<0.05), And it reached to the minimum at T3. The rate of the neutrephil apeptosis was significantly lower in C group than that in U group (P<0.05). The respiratory burst of neutrophil increased significantly after the start of CPB and reached to the peak at T3[C group (1422.50±89.75) MCF,U group (1156.52±93.20) MCF]. The respiratory burst of neutrophil in U group was significandy lower than that in C group at T2 and T3 (P<0.05). The vitality of SOD decreased significantly after the start of operation in the two groups (P<0.05). The level of MDA increased significantly after the start of operation in the two groups, and reached to the peak at T3. The vitality of SOD in C group was significantly lower than that in U group at T3 (P<0.05). The level of MDA in C group was significantly higher than that in U group at T3 (P<0.05). Conclusions The rate of neutrophil apoptosis decreased and the respiratory burst of neutrophil increased during CPB. By improving the apoptosis of neutrophil and reducing the respiratory burst of neutrophil, ulinastatin can inhibit inflammatory reaction during CPB. Meanwhile, ulinastatin can improve the vitality of SOD and reduce the level of MDA. In conclusion, ulinastatin has a significant protective effect during CPB.

Applying the specialized Master of Public Health (MPH) degree education is one of the most important parts of our nation's medical degree system innovation. It has a positive effect on the development of health care in our country. To ensure the quality of the MPH degree, we should be more careful with course studies, do better in field and social practice, be stricter with degree dissertation rejoining, and supervise and control the process of the training.