ObjectiveTo investigate the therapeutic effect of proanthocyanidins （PC） on rats with type 2 diabetes mellitus （T2DM） complicated with cognitive impairment （CI） and to explore its potential mechanism by inhibiting the NOD-like receptor family pyrin domain-containing protein 3 （NLRP3）/cysteine-aspartic acid protease-1 （Caspase-1） pathway. MethodsA T2DM rat model was established by high-fat diet combined with intraperitoneal streptozotocin （STZ） injection. Thirty-six diabetic rats complicated with CI were screened by Morris water maze test and randomly divided into model group， PC low-dose （50 mg/kg） group， PC medium-dose （100 mg/kg） group， and PC high-dose （200 mg/kg） group. Another 9 normal rats served as the normal control group. Each group was administered with the corresponding doses of PC or an equal volume of distilled water by gavage for 8 weeks. After the intervention， spatial learning and memory abilities were evaluated using the Morris water maze test. Fasting blood glucose， body weight， and organ coefficients were measured. Pathological changes in the hippocampus were observed by hematoxylin-eosin （HE） staining. Reactive oxygen species （ROS） levels， as well as levels of inflammatory cytokines tumor necrosis factor-α （TNF-α） and interleukin-1β （IL-1β） in hippocampal tissue， were detected by enzyme-linked immunosorbent assay （ELISA）. The protein expression levels of NLRP3， Caspase-1， IL-1β， and IL-18 in the hippocampus were determined by Western blot. ResultsCompared with the normal control group， the model group exhibited significantly increased blood glucose and decreased body weight （P<0.05）. In the Morris water maze test， the model group showed prolonged escape latency， fewer platform crossings， and lower percentages of time and path length in the target quadrant （P<0.05）. Disordered arrangement and pyknotic nuclei were observed in hippocampal neurons. ROS and the levels of TNF-α and IL-1β were elevated， and the protein expression levels of NLRP3， Caspase-1， IL-1β and IL-18 were upregulated （P<0.05）. Compared with the model group， all PC-treated groups， especially the high-dose group， presented dose-dependent improvements in the above indicators， including reduced blood glucose （P<0.05）， improved spatial memory performance in the Morris water maze （P<0.01）， alleviated hippocampal pathological damage， decreased ROS and inflammatory cytokine levels （P<0.05）， and significantly downregulated expression of NLRP3/Caspase-1 pathway-related proteins （P<0.05）. ConclusionProanthocyanidins can ameliorate glycolipid metabolic disorder， visceral organ injury as well as cognitive dysfunction in T2DM rats. The underlying mechanism may be associated with reduced hippocampal ROS levels， inhibition of the NLRP3/Caspase-1 signaling pathway， and attenuated neuroinflammation in the hippocampus， with the optimal effect observed at a dose of 200 mg/kg.

OBJECTIVE To evaluate the application effect of implementation strategies in the prevention and control of sur-gical site infection(SSI),and to review its research progress.METHODS A scoping review method was employed,invol-ving systematic searches across databases such as Web of Science,PubMed,Cochrane,CNKI and Wanfang.After screening based on the inclusion and exclusion criteria,the included literature was analyzed and reported in a standard-ized manner.RESULTS A total of 47 articles were included.Most studies adopted comprehensive evidence-based practices(EBP)(≥2 types)and employed multimodal implementation strategies(≥3 items)to facilitate the implementation of SSI prevention and control EBP.Within the framework of the WHO multimodal strategy,42,39,39 and 24 studies re-spectively applied the four implementation strategies of system change,education and training,monitoring and feedback and reminder and communication,while only 9 studies applied the strategy of creating a safety culture.The highest pro-portion of studies(31.91％,15/47)employed a combination of four implementation strategies,with the common combi-nation being"system change+education and training+monitoring and feedback+reminder and communication"(29.79％,14/47),and this combination of four implementation strategies demonstrated outstanding performance in en-hancing EBP compliance.Totally 26(55.32％)showed decrease in the incidence of SSI after intervention(P＜0.05).CONCLUSIONS Implementation strategies are crucial for the successful implementation of SSI prevention and con-trol EBP.Multimodal implementation strategies are common approaches to facilitate the implementation of EBP.In the future,it is necessary to further standardize the application of scientific methods and improve the effect evaluation of im-plementation strategies,providing a reference for the sustained and widespread application of EBP in clinical practice.

Objective:To investigate the correlation between rectal colonization of carbapenem resistant Klebsiella pneumoniae（CRKP）and bloodstream infections（BSI）using molecular epidemiological analysis. Methods:Patients admitted to the Intensive Care Unit（ICU），Hematology Department，and Neurosurgery Department of the First Hospital of Jiaxing from January 2022 to December 2024，were enrolled. Rectal CRKP colonization screening was performed for all participants，with concurrent monitoring for BSI.Whole genome sequencing of CRKP strains in the intestine and blood flow of patients with CRKP rectal colonization and CRKP-BSI was performed using the Illumina NovaSeq PE150 sequencing platform，and samples were genotyped based on the PubMLST database. MLST 2.0 was applied for multi site sequence typing，VFDB online database was used to analyze virulence genes，ResFinder was used to analyze resistance genes，and whole genome sequences were imported into BioNumerics software for core genome multi site sequence typing and clustering analysis. Using the BacWGSTdb database to construct a phylogenetic tree based on genomic SNPs，and the homology between CRKP rectal fixed plants and corresponding BSI-CRKP infected plants were analyzed.Results:A total of 772 patients were included，including 78 cases with positive results in rectal CRKP colonization screening（10.1%）and 694 cases without rectal CRKP colonization（89.9%）. The CRKP-BSI rate in rectal CRKP colonization patients was significantly higher than that in non-CRKP colonization patients［19.2%（15/78） vs. 5.5%（38/694）， χ2=20.749， P<0.001］. Analysis of CRKP rectal colonization strains and bloodstream infection strains in 15 patients with CRKP rectal implantation and CRKP-BSI revealed that ST11 type was the main strain（ n=10），followed by ST37 type（ n=3），with all carrying multiple β-lactam and carbapenem producing enzyme resistance genes.The distribution of virulence genes showed that CRKP strains carried multiple virulence genes，with iroE being ubiquitous，followed by iucA/ B/ C/ D， rmpA2，rmpA，and iroN. All ST11-type CRKP strains exhibited hypervirulent characteristics. Capsular serotyping analysis showed that the predominant type of CRKP colonization and infection strains was KL64. The results of cgMLST and SNP clustering analysis showed that CRKP rectal fixed plants exhibited homology with blood flow infected plants. Moreover，two clusters of CRKP rectal colonization strains with significant homology were found to cluster together among 15 patients. Conclusions:Rectal colonization of CRKP is an important risk factor for the occurrence of BSI-CRKP in hospitals，and ST11 hypervirulent CRKP is the main type. It is recommended to screen high-risk patients for CRKP to reduce the risk of BSI-CRKP.

With the development of the economy in our country,trauma has already become a major medical burden in society,traffic injury has already become a major type of trauma,and the trauma of lower limbs is relatively much more.Since patients with lower extremity trauma have limited mobility,postoperative dressing changes need to be done at the bedside.At present,in the process of lower limb dressing change,it is necessary for family members or medical staff to help elevate the affected limb,which is unstable and difficult to adhere to.The dressing change process not only increases the pain of patients,but also affects the sight line and comfort of medical staff during operation,resulting in incomplete wound exposure and affecting the effect of dressing change.The washing solution and disinfectant in the dressing change process are easy to contaminate the sheets,which increases the difficulty of ward management.This dressing change method is unscientific,irregular and inconvenient to operate.Therefore,the medical staff of department of emergency of the First Hospital of Jiaxing City developed a mobile treatment vehicle for leg care for debridement and dressing change of patients with lower limb trauma,this device has been granted the National Utility Model Patent of China(patent numbeer:ZL 2021 2 0647636.0),which makes bedside debridement and dressing change more scientific,convenient and normative.The utility model relates to a mobile treatment vehicle for leg care,which is composed of a base,a support seat,a leg support plate,a support rod,a fixed plate and a smart trash can.The angle of the leg support plate can be adjusted 360 °by loosening the bolt,and the height can be adjusted by sliding up and down.Adequate rotation flexibility and high adjustment space can effectively solve problems of bedside debridement and dressing change for patients with lower limb trauma,provide scientific,simple and operable auxiliary tools for trauma medical staff,improve the comfort of patients and operators,and improve the quality of ward management in emergency trauma ward.

OBJECTIVE To evaluate the application effect of implementation strategies in the prevention and control of sur-gical site infection(SSI),and to review its research progress.METHODS A scoping review method was employed,invol-ving systematic searches across databases such as Web of Science,PubMed,Cochrane,CNKI and Wanfang.After screening based on the inclusion and exclusion criteria,the included literature was analyzed and reported in a standard-ized manner.RESULTS A total of 47 articles were included.Most studies adopted comprehensive evidence-based practices(EBP)(≥2 types)and employed multimodal implementation strategies(≥3 items)to facilitate the implementation of SSI prevention and control EBP.Within the framework of the WHO multimodal strategy,42,39,39 and 24 studies re-spectively applied the four implementation strategies of system change,education and training,monitoring and feedback and reminder and communication,while only 9 studies applied the strategy of creating a safety culture.The highest pro-portion of studies(31.91％,15/47)employed a combination of four implementation strategies,with the common combi-nation being"system change+education and training+monitoring and feedback+reminder and communication"(29.79％,14/47),and this combination of four implementation strategies demonstrated outstanding performance in en-hancing EBP compliance.Totally 26(55.32％)showed decrease in the incidence of SSI after intervention(P＜0.05).CONCLUSIONS Implementation strategies are crucial for the successful implementation of SSI prevention and con-trol EBP.Multimodal implementation strategies are common approaches to facilitate the implementation of EBP.In the future,it is necessary to further standardize the application of scientific methods and improve the effect evaluation of im-plementation strategies,providing a reference for the sustained and widespread application of EBP in clinical practice.

Objective To evaluate the efficacy and safety of polyethylene glycol electrolyte powder(PEG)combined with linaclotide(Lin)for bowel preparation in elderly constipated patients before colonoscopy.Methods In this prospective,randomized controlled trial,90 elderly patients with constipation undergoing colonoscopy were recruited at our hospital from June 2022 to December 2023.Participants were randomly assigned to three groups(n=30 each):PEG-3L alone,PEG-3L+Lin,and PEG-2L+Lin.Primary outcome was Boston Bowel Preparation Scale(BBPS)score and secondary outcomes included adverse event rates,colonoscopy completion rate,withdrawal time,and polyp detection rate.Statistical analysis was performed using independent t-tests and chi-square tests.Results The PEG-3L+Lin group achieved significantly higher BBPS scores than both PEG-3L alone and PEG-2L+Lin groups did(both P<0.001).The PEG-2L+Lin group also outperformed the PEG-3L alone group in cleansing efficacy(90.0%vs.76.7%,P=0.008).The PEG-2L+Lin group demonstrated the best tolerability and lowest adverse event rate,the PEG-3L group had the longest withdrawal time(P<0.05),but the three groups showed no significant difference in polyp detection rates.Conclusion PEG combined with linaclotide significantly improves bowel cleansing in elderly constipated patients.PEG-2L+Lin regimen provides optimal balance between efficacy,safety,and tolerability,making it a preferable choice for this population.

With the development of the economy in our country,trauma has already become a major medical burden in society,traffic injury has already become a major type of trauma,and the trauma of lower limbs is relatively much more.Since patients with lower extremity trauma have limited mobility,postoperative dressing changes need to be done at the bedside.At present,in the process of lower limb dressing change,it is necessary for family members or medical staff to help elevate the affected limb,which is unstable and difficult to adhere to.The dressing change process not only increases the pain of patients,but also affects the sight line and comfort of medical staff during operation,resulting in incomplete wound exposure and affecting the effect of dressing change.The washing solution and disinfectant in the dressing change process are easy to contaminate the sheets,which increases the difficulty of ward management.This dressing change method is unscientific,irregular and inconvenient to operate.Therefore,the medical staff of department of emergency of the First Hospital of Jiaxing City developed a mobile treatment vehicle for leg care for debridement and dressing change of patients with lower limb trauma,this device has been granted the National Utility Model Patent of China(patent numbeer:ZL 2021 2 0647636.0),which makes bedside debridement and dressing change more scientific,convenient and normative.The utility model relates to a mobile treatment vehicle for leg care,which is composed of a base,a support seat,a leg support plate,a support rod,a fixed plate and a smart trash can.The angle of the leg support plate can be adjusted 360 °by loosening the bolt,and the height can be adjusted by sliding up and down.Adequate rotation flexibility and high adjustment space can effectively solve problems of bedside debridement and dressing change for patients with lower limb trauma,provide scientific,simple and operable auxiliary tools for trauma medical staff,improve the comfort of patients and operators,and improve the quality of ward management in emergency trauma ward.

Objective To evaluate the efficacy and safety of polyethylene glycol electrolyte powder(PEG)combined with linaclotide(Lin)for bowel preparation in elderly constipated patients before colonoscopy.Methods In this prospective,randomized controlled trial,90 elderly patients with constipation undergoing colonoscopy were recruited at our hospital from June 2022 to December 2023.Participants were randomly assigned to three groups(n=30 each):PEG-3L alone,PEG-3L+Lin,and PEG-2L+Lin.Primary outcome was Boston Bowel Preparation Scale(BBPS)score and secondary outcomes included adverse event rates,colonoscopy completion rate,withdrawal time,and polyp detection rate.Statistical analysis was performed using independent t-tests and chi-square tests.Results The PEG-3L+Lin group achieved significantly higher BBPS scores than both PEG-3L alone and PEG-2L+Lin groups did(both P<0.001).The PEG-2L+Lin group also outperformed the PEG-3L alone group in cleansing efficacy(90.0%vs.76.7%,P=0.008).The PEG-2L+Lin group demonstrated the best tolerability and lowest adverse event rate,the PEG-3L group had the longest withdrawal time(P<0.05),but the three groups showed no significant difference in polyp detection rates.Conclusion PEG combined with linaclotide significantly improves bowel cleansing in elderly constipated patients.PEG-2L+Lin regimen provides optimal balance between efficacy,safety,and tolerability,making it a preferable choice for this population.

Objective:To investigate the correlation between rectal colonization of carbapenem resistant Klebsiella pneumoniae（CRKP）and bloodstream infections（BSI）using molecular epidemiological analysis. Methods:Patients admitted to the Intensive Care Unit（ICU），Hematology Department，and Neurosurgery Department of the First Hospital of Jiaxing from January 2022 to December 2024，were enrolled. Rectal CRKP colonization screening was performed for all participants，with concurrent monitoring for BSI.Whole genome sequencing of CRKP strains in the intestine and blood flow of patients with CRKP rectal colonization and CRKP-BSI was performed using the Illumina NovaSeq PE150 sequencing platform，and samples were genotyped based on the PubMLST database. MLST 2.0 was applied for multi site sequence typing，VFDB online database was used to analyze virulence genes，ResFinder was used to analyze resistance genes，and whole genome sequences were imported into BioNumerics software for core genome multi site sequence typing and clustering analysis. Using the BacWGSTdb database to construct a phylogenetic tree based on genomic SNPs，and the homology between CRKP rectal fixed plants and corresponding BSI-CRKP infected plants were analyzed.Results:A total of 772 patients were included，including 78 cases with positive results in rectal CRKP colonization screening（10.1%）and 694 cases without rectal CRKP colonization（89.9%）. The CRKP-BSI rate in rectal CRKP colonization patients was significantly higher than that in non-CRKP colonization patients［19.2%（15/78） vs. 5.5%（38/694）， χ2=20.749， P<0.001］. Analysis of CRKP rectal colonization strains and bloodstream infection strains in 15 patients with CRKP rectal implantation and CRKP-BSI revealed that ST11 type was the main strain（ n=10），followed by ST37 type（ n=3），with all carrying multiple β-lactam and carbapenem producing enzyme resistance genes.The distribution of virulence genes showed that CRKP strains carried multiple virulence genes，with iroE being ubiquitous，followed by iucA/ B/ C/ D， rmpA2，rmpA，and iroN. All ST11-type CRKP strains exhibited hypervirulent characteristics. Capsular serotyping analysis showed that the predominant type of CRKP colonization and infection strains was KL64. The results of cgMLST and SNP clustering analysis showed that CRKP rectal fixed plants exhibited homology with blood flow infected plants. Moreover，two clusters of CRKP rectal colonization strains with significant homology were found to cluster together among 15 patients. Conclusions:Rectal colonization of CRKP is an important risk factor for the occurrence of BSI-CRKP in hospitals，and ST11 hypervirulent CRKP is the main type. It is recommended to screen high-risk patients for CRKP to reduce the risk of BSI-CRKP.

Non-invasive mechanical ventilation(NIV)is increasingly being used as a respiratory support technique in clinical practice.However,the pressure-related injuries should not be overlooked.In order to prevent local pressure injuries caused by NIV technology,a series of preventive measures have been adopted in clinical work.These measures include the use of dressings to provide pressure relief to the local skin.Currently,in clinical practice,when using preventive dressings,nurses need to cut them themselves based on the physiological structure of the patient's nose,forehead,or face.However,precise cutting can be challenging.If the dressing is cut too small,it may not provide adequate prevention,and if it's cut too large,it can cover too much skin,affecting the nurse's observation and the patient's comfort.Additionally,during NIV treatment,the preventive dressings used may become curled or displaced,requiring nurses to re-cut and replace them.This process inevitably leads to material wastage,increasing the cost of dressing use for patients.Moreover,the cutting tools used must meet infection control requirements,adding to the nursing workload and reducing the compliance of nurses in changing dressings.Our research team has designed a ready-made pressure injury prevention dressing component for use with NIV masks to prevent pressure injuries to the nasal and facial areas.It is precisely designed,flexible in composition,easy to use,and can provide multiple usage modes.It effectively combines emergency care with pressure relief measures,reducing the occurrence of pressure injuries to the patient's nasal and facial areas.This improves patient comfort and treatment compliance,facilitates technology-based nursing,and enhances clinical efficiency.It has significant clinical application value and has been granted a National Utility Model Patent(ZL 202020529121.6).