Objective To explore the risk factors for healthcare-associated infection(HAI)in lung transplant re-cipients(LTRs),and construct a predictive nomogram model.Methods Clinical data of patients who underwent lung transplant in Wuxi People's Hospital from January 2019 to December 2023 were analyzed retrospectively.The patients were divided into a training set(n=506)and a validation set(n=218).Independent risk factors were screened through LASSO regression,and multivariate logistic regression was included to construct a nomogram pre-diction model.The discrimination,calibration,and clinical applicability of the model were evaluated using receiver operating characteristic(ROC)curves,Hosmer-Lemeshow goodness-of-fit,and decision curves.Results Among the 506 LTRs,201 developed HAIs,with an incidence of 39.72％.The major infection site was lower respiratory tract,and the major pathogen were Gram-negative bacilli(Acinetobacter baumannii).Older age,use of extracorpo-real membrane oxygenation(ECMO),double-lung transplant,surgery duration＞3 hours,long duration of contin-uous fever,frequent abnormal blood routine examination,and long duration of combined use of antimicrobial agents were identified as independent risk factors for HAI after lung transplant.The ROC curve analysis results showed that the areas under the curve(AUCs)of the training set and the validation set were 0.74(95％CI:0.70-0.78)and 0.71(95％CI:0.64-0.78),respectively.The Hosmer-Lemeshow test results showed that there was no sta-tistically significant difference between the predictive and actual probability of HAI(P＞0.05).The clinical decision curve results indicated that the model had clinical benefits at a threshold probability value of 7％-71％.Conclusion The nomogram prediction model constructed in this study can effectively evaluate the risk of postoperative infection in LTRs.The model is stable and has high clinical application value,providing scientific reference for postoperative infection prevention and control.

Objective To explore the risk factors for healthcare-associated infection(HAI)in lung transplant re-cipients(LTRs),and construct a predictive nomogram model.Methods Clinical data of patients who underwent lung transplant in Wuxi People's Hospital from January 2019 to December 2023 were analyzed retrospectively.The patients were divided into a training set(n=506)and a validation set(n=218).Independent risk factors were screened through LASSO regression,and multivariate logistic regression was included to construct a nomogram pre-diction model.The discrimination,calibration,and clinical applicability of the model were evaluated using receiver operating characteristic(ROC)curves,Hosmer-Lemeshow goodness-of-fit,and decision curves.Results Among the 506 LTRs,201 developed HAIs,with an incidence of 39.72％.The major infection site was lower respiratory tract,and the major pathogen were Gram-negative bacilli(Acinetobacter baumannii).Older age,use of extracorpo-real membrane oxygenation(ECMO),double-lung transplant,surgery duration＞3 hours,long duration of contin-uous fever,frequent abnormal blood routine examination,and long duration of combined use of antimicrobial agents were identified as independent risk factors for HAI after lung transplant.The ROC curve analysis results showed that the areas under the curve(AUCs)of the training set and the validation set were 0.74(95％CI:0.70-0.78)and 0.71(95％CI:0.64-0.78),respectively.The Hosmer-Lemeshow test results showed that there was no sta-tistically significant difference between the predictive and actual probability of HAI(P＞0.05).The clinical decision curve results indicated that the model had clinical benefits at a threshold probability value of 7％-71％.Conclusion The nomogram prediction model constructed in this study can effectively evaluate the risk of postoperative infection in LTRs.The model is stable and has high clinical application value,providing scientific reference for postoperative infection prevention and control.

Objective:To evaluate the 10-year protective effect and immunogenicity of quadrivalent human papillomavirus (HPV) vaccine in Chinese women aged 20 to 45 years.Methods:From October 2019 to April 2020, a long-term follow-up study was conducted on the subjects of the Phase III clinical trial of the quadrivalent HPV vaccine (NCT00834106). Participants underwent a questionnaire survey, venous blood sampling, gynecological examination, cervical exfoliated cell pathology examination, and serum neutralizing antibody titers for HPV-6, 11, 16, and 18 were measured using a pseudovirus neutralization assay. The results of the cytological examination and the positive rate and titers of serum antibodies of different cervical exfoliated cells were compared.Results:A total of 889 subjects were followed up, including 240 in the control group, 453 in the vaccination group and 196 in the post-trial vaccination group. The age of the control group was (40±7) years old, which was higher than that of the supplementary vaccination group and the vaccination group [(38±4) and (38±6) years old, respectively] ( P<0.05). There were no statistically significant differences in condom use and sexual frequency among all groups (all P values>0.05). The abnormal proportion of cervical exfoliation cytopathology in the vaccination group was 3.7% (17/453), which was significantly lower than that in the control group [9.6% (23/240)] and post-trial vaccination group [5.6% (11/196)] ( P<0.05). There were two cases of cervical intraepithelial neoplasia (CIN) grade 1 in the vaccination group, two cases of CIN grade 1 and three cases of CIN grade 2 and above in the control group, and no CIN grade 1 and above cases in the post-trial vaccination group. The positive rate of HPV-18 antibody was 35.5% (161/453) in the vaccination group and 76.0% (149/196) in the post-trial vaccination group, which was significantly lower than that of other types ( P<0.05). The neutralizing antibody GMT ratio between the vaccination group and the control group ranged from 2.62 to 25.33 (9.05 to 83.08). Conclusion:Protective neutralizing antibodies are sustained in Chinese women aged 20 to 45 years after ten years of vaccination with quadrivalent HPV vaccine.

Objective:To evaluate the 10-year protective effect and immunogenicity of quadrivalent human papillomavirus (HPV) vaccine in Chinese women aged 20 to 45 years.Methods:From October 2019 to April 2020, a long-term follow-up study was conducted on the subjects of the Phase III clinical trial of the quadrivalent HPV vaccine (NCT00834106). Participants underwent a questionnaire survey, venous blood sampling, gynecological examination, cervical exfoliated cell pathology examination, and serum neutralizing antibody titers for HPV-6, 11, 16, and 18 were measured using a pseudovirus neutralization assay. The results of the cytological examination and the positive rate and titers of serum antibodies of different cervical exfoliated cells were compared.Results:A total of 889 subjects were followed up, including 240 in the control group, 453 in the vaccination group and 196 in the post-trial vaccination group. The age of the control group was (40±7) years old, which was higher than that of the supplementary vaccination group and the vaccination group [(38±4) and (38±6) years old, respectively] ( P<0.05). There were no statistically significant differences in condom use and sexual frequency among all groups (all P values>0.05). The abnormal proportion of cervical exfoliation cytopathology in the vaccination group was 3.7% (17/453), which was significantly lower than that in the control group [9.6% (23/240)] and post-trial vaccination group [5.6% (11/196)] ( P<0.05). There were two cases of cervical intraepithelial neoplasia (CIN) grade 1 in the vaccination group, two cases of CIN grade 1 and three cases of CIN grade 2 and above in the control group, and no CIN grade 1 and above cases in the post-trial vaccination group. The positive rate of HPV-18 antibody was 35.5% (161/453) in the vaccination group and 76.0% (149/196) in the post-trial vaccination group, which was significantly lower than that of other types ( P<0.05). The neutralizing antibody GMT ratio between the vaccination group and the control group ranged from 2.62 to 25.33 (9.05 to 83.08). Conclusion:Protective neutralizing antibodies are sustained in Chinese women aged 20 to 45 years after ten years of vaccination with quadrivalent HPV vaccine.

Objective:To evaluate the effect of acupuncture with invigorating viscera and purging fu, replenishing qi and nourishing yin for the T2DM patients with qi and yin deficiency syndrome.Methods:A total of 59 patients who met the inclusion criteria from January 1, 2019 to December 31, 2020 in the Endocrinology Department of the Second Affiliated Hospital of Anhui University of Chinese Medicine were divided into the acupuncture group with 30 cases and a control group with 29 cases, according to the random number table method. The control group received conventional hypoglycemic treatment. And the acupuncture group was treated with acupuncture on the basis of the control group treatment. Both groups were treated for 4 weeks. TCM syndrome scores were performed before and after treatment, respectively. Serum IL-6 was measured by ELISA, serum CRP by immunoturbidimetry, and serum fasting blood glucose (FPG), 2 hPG, HbAlc, TC, TG, HDL-C, LDL-C levels by spectrophotometry. The BMI, clinical effect rates were calculated.Results:The total effective rate was 96.7% (29/30) in acupuncture group and 75.9% (22/29) in control group, and the difference was statistically significant ( χ2=5.96, P<0.01). After treatment, the scores of fatigue, dryness of mouth and pharynx, spontaneous sweating and night sweating, shortness of breath and lazy speech in acupuncture group were significantly lower than those in the control group ( t values were 6.02, 4.31, 4.34, 3.63, respectively, all Ps<0.01). The serum CRP level in acupuncture group was significantly lower than that of the control group at 21, 48 d after treatment ( t values were -4.36, -3.75, respectively, all Ps<0.01), and IL-6 level was significantly lower than that of the control group at 14, 21, 28 d after treatment ( t values were -2.92, -5.35, -8.71, respectively, all Ps<0.01). After treatment, the serum TC [(4.62±0.68) mmol/L vs. (5.56±0.72) mmol/L, t=5.16], TG [(1.48±0.42) mmol/L vs. (2.12±0.89) mmol/L, t=3.55], LDL-C [(2.48±0.84) mmol/L vs.(3.02±0.95) mmol/L, t=2.32] in the acupuncture group were significantly lower than those in the control group ( P<0.05), HDL-C [(1.39±0.27) mmol/L vs. (1.26±0.22) mmol/L, t=-2.02] in the acupuncture group was significantly higher than that of the control group ( P<0.05). The serum FPG level at 21 d [(6.12±0.67) mmol/L vs. (6.57±0.61) mmol/L, t=-4.96], 28 d [(5.78±0.52) mmol/L vs. (6.49±0.58) mmol/L, t=-2.70] in acupuncture group were significantly lower than those in the control group ( P<0.01). The 2h PG level at 14 d after treatment [(10.23±1.06) mmol/L vs. (11.76±1.34) mmol/L, t=-4.87], 21 d [(9.05±0.98) mmol/L vs. (10.53±1.24) mmol/L, t=-5.10], 28 d [(7.45±0.69) mmol/L vs. (9.31±0.78) mmol/L, t=-9.71] in the acupuncture group were significantly lower than those in the control group ( P<0.01), and HbA1c level were decreased 14 d [(7.93±0.86)% vs. (8.52±0.97)%, t=-2.47], 21 d [(7.63±0.85)% vs. (8.15±0.92)%, t=-2.26], 28 d [(6.47±0.51)% vs. (7.51±0.62)%, t=-7.05] significantly lower than those in the control group ( P<0.01), BMI [(22.13±1.57) kg/m 2vs. (24.16±1.82) kg/m 2, t=-4.59] 28 d after treatment was significantly lower than that of the control group ( P<0.01). Conclusion:Acupuncture therapy of nourishing viscera and purging fu, nourishing qi and nourishing yin can regulate the disorder of glucose and lipid metabolism in patients with T2DM and syndrome of qi and yin deficiency.

Objective:To construct a perioperative venous thrombosis prevention program for patients with spinal surgery based on evidence-based nursing, and to discuss its application effect.Methods:Using the convenient sampling method, a total of 90 patients with spinal surgery who were admitted to Jinhua People's Hospital from June 2019 to June 2020 were selected as the control group and received routine nursing management. A total of 90 patients with spinal surgery who were admitted to Jinhua People's Hospital from July 2020 to July 2021 were selected as the observation group, and they were given a venous thrombosis prevention scheme based on evidence-based nursing. The prothrombin time, thrombin time, activated partial thromboplastin time, fibrinogen and D-dimer levels, blood flow velocity of common femoral vein, popliteal vein, iliac vein and occurrence of thrombosis were compared between the two groups.Results:The prothrombin time, thrombin time, fibrinogen and D-dimer levels in the two groups had interaction, and the differences were statistically significant ( Finteraction=6.079, 8.735, 6.918, 8.657; all P<0.01) . Postoperative prothrombin time, thrombin time and activated partial thromboplastin time all showed a trend of decreasing first and then increasing and the levels of fibrinogen and D-dimer showed a trend of increasing first and then decreasing, and the differences were statistically significant ( P<0.05) . Regardless of the time factor, postoperative prothrombin time, thrombin time, and activated partial thromboplastin time in the observation group were longer than those in the control group, and the levels of fibrinogen and D-dimer were lower than those in the control group, and the differences were statistically significant ( P<0.05) . The blood flow velocity of common femoral vein, popliteal vein, and iliac vein in the two groups were interacted, and the difference was statistically significant ( Finteraction=6.257, 3.281, 7.697; all P<0.05) . After operation, the blood flow velocity of common femoral vein, popliteal vein and iliac vein all showed a trend of first decreasing and then increasing, and the differences were statistically significant ( P<0.05) . Regardless of the time factor, the postoperative blood flow rates of the common femoral vein, popliteal vein and iliac vein in the observation group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . The incidence of venous thromboembolism in the observation group was 1.11%, which was lower than 6.67% in the control group, and the difference was statistically significant ( P<0.05) . Conclusions:The perioperative venous thrombosis prevention and management plan based on evidence-based nursing can provide individualized nursing intervention for spinal surgery patients according to different thrombosis risks, which can improve patients' coagulation and lower extremity venous function and effectively reduce the risk of thrombosis.

Objective:To construct a perioperative venous thrombosis prevention program for patients with spinal surgery based on evidence-based nursing, and to discuss its application effect.Methods:Using the convenient sampling method, a total of 90 patients with spinal surgery who were admitted to Jinhua People's Hospital from June 2019 to June 2020 were selected as the control group and received routine nursing management. A total of 90 patients with spinal surgery who were admitted to Jinhua People's Hospital from July 2020 to July 2021 were selected as the observation group, and they were given a venous thrombosis prevention scheme based on evidence-based nursing. The prothrombin time, thrombin time, activated partial thromboplastin time, fibrinogen and D-dimer levels, blood flow velocity of common femoral vein, popliteal vein, iliac vein and occurrence of thrombosis were compared between the two groups.Results:The prothrombin time, thrombin time, fibrinogen and D-dimer levels in the two groups had interaction, and the differences were statistically significant ( Finteraction=6.079, 8.735, 6.918, 8.657; all P<0.01) . Postoperative prothrombin time, thrombin time and activated partial thromboplastin time all showed a trend of decreasing first and then increasing and the levels of fibrinogen and D-dimer showed a trend of increasing first and then decreasing, and the differences were statistically significant ( P<0.05) . Regardless of the time factor, postoperative prothrombin time, thrombin time, and activated partial thromboplastin time in the observation group were longer than those in the control group, and the levels of fibrinogen and D-dimer were lower than those in the control group, and the differences were statistically significant ( P<0.05) . The blood flow velocity of common femoral vein, popliteal vein, and iliac vein in the two groups were interacted, and the difference was statistically significant ( Finteraction=6.257, 3.281, 7.697; all P<0.05) . After operation, the blood flow velocity of common femoral vein, popliteal vein and iliac vein all showed a trend of first decreasing and then increasing, and the differences were statistically significant ( P<0.05) . Regardless of the time factor, the postoperative blood flow rates of the common femoral vein, popliteal vein and iliac vein in the observation group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . The incidence of venous thromboembolism in the observation group was 1.11%, which was lower than 6.67% in the control group, and the difference was statistically significant ( P<0.05) . Conclusions:The perioperative venous thrombosis prevention and management plan based on evidence-based nursing can provide individualized nursing intervention for spinal surgery patients according to different thrombosis risks, which can improve patients' coagulation and lower extremity venous function and effectively reduce the risk of thrombosis.

Objective:To investigate the effects of caspase-11 non-canonical inflammasome on the Leptospira interrogans ( L. interrogans)-induced secretion of inflammatory cytokines in J774A.1 cells. Methods:Murine mononuclear macrophage cells (J774A.1) were infected with L. interrogans strain 56601. Expression of caspase-11, IL-1β, IL-1α and IL-18 at mRNA level in J774A.1 cells were detected by real-time RT-PCR. The levels of caspase-11, IL-1β, IL-1α and IL-18 in the culture supernatants of J774A.1 cells were detected by ELISA. Results:Real-time RT-PCR showed that caspase-11 expression at mRNA level was 5.12, 14.21, 8.94, 14.06, 18.58 and 0.93 times of that in uninfected cells after 1, 2, 4, 8, 12 and 24 h of L. interrogans infection, and respectively decreased to 0.10, 0.07, 0.10, 0.09, 0.07 and 0.45 times after caspase-11 inhibitor intervention ( P<0.05). Expression of IL-1β, IL-1α and IL-18 at mRNA level was significantly increased after infection ( P<0.05). After the intervention with caspase-11 inhibitor, IL-1β mRNA decreased to 0.05, 0.03, 0.02, 0.05, 0.06 and 0.02 times ( P<0.05); IL-1α mRNA decreased to 0.14, 0.07, 0.15, 0.10, 0.03 and 0.06 times ( P<0.05); IL-18 mRNA decreased to 0.08, 0.10, 0.16, 0.18, 0.10 and 0.07 times ( P<0.05). ELISA results showed that the expression of caspase-11, IL-1β, IL-1α and IL-18 at protein level was significantly increased. After the intervention with caspase-11 inhibitor, caspase-11 level decreased to 43.07, 41.64, 51.96, 86.56, 105.36, and 129.95 pg/ml ( P<0.05); IL-1β level decreased to 15.01, 14.19, 68.02, 31.20, 173.13 and 104.98 pg/ml ( P<0.05); IL-1α level decreased to 12.14, 15.40, 38.01, 21.97, 24.48 and 27.09 pg/ml ( P<0.05); IL-18 level decreased to 96.27, 102.21, 85.34, 116.28, 155.36 and 114.03 pg/ml ( P<0.05). Conclusions:Caspase-11 non-canonical inflammasome was involved in the mediation of IL-1β, IL-1α and IL-18 secretion in mouse mononuclear macrophages after L. interrogans infection.

Objective To get well-informed of the current status of emergency training in primary hospitals in Sichuan Province and to find weaknesses in the system in order to provide scientific basis for emergency knowledge and skills training.Methods A stratified random cluster sampling method as adopted and an anonymous questionnaire survey method was conducted to investigate the basic circumstances of the current training and the training needs of 1 000 emergency medical staff in 9 regions throughout Sichuan Province.Results The scope of the survey covered emergency doctors,nurses and technicians in hospitals of Grade Ⅱ,Grade Ⅲ and below.A total of 1 000 surveys were sent out and 983 were recovered.The questionnaire completion rate was 98.3％.The respondents mainly worked for more than 10 years,most of which with Bachelor degree,junior and intermediate titles.Results of the survey showed,63.1％ Most respondents have only one or two training opportunities per year.The training methods are mainly continuing education (59.0％,580 trips),training organized within the unit (58.5％,575 trips),and training organized by health administrative units (39.3％,386 trips).The main contents of the training are:basic professional skills learning (66.7％,655 trips),basic professional theoretical study (59.2％,582 trips),and new emergency technology (42.5％,418 trips),only 32.0％ of the respondents believe that these methods meet the practical needs.The main factors that influence participation in the training were:not be arranged by employer (36.2％,356 trips);the training was different from actual work (31.6％,311 trips);no replacement for work so they couldn't join training (29.8％,293 trips).The survey showed that the most desirable way of training is:practical application (60.1％,591 trips) and the most desirable training content is:emergency first aid knowledge (73.7％,724 trips).There were significant differences in case discussion,technical observation,academic lectures,special study trainingand learning methods in hospitals of different levels (P＜0.05),but there was no significant difference in the choice of professional practice methods (P＞0.05),and the selection of training contents was in emergency first aid knowledge,general medical knowledge and prevention and treatment of chronic diseases.There was no statistical difference in the selection of training contents of knowledge,infectious disease knowledge and department management knowledge (P＞0.05).There were significant differences in the choice of nursing knowledge training (P＜0.05).Conclusion The current situation showed a lack of first-aid knowledge and skills training for emergency personnel in Sichuan Province.The present situation of skill training can't satisfy the need of their desire to participate in training.It is urgent to develop a standardized,systematic and scientific training mode to improve the emergency first aid ability of primary medical and emergency personnel.

Objective To evaluate the 15 years changing trends of prevalence of high risk HPV (HR?HPV) infection and the risks of cervical cancer and precancerous lesions (CIN2+) among a Chinese rural population. Methods The screening cohort with 1 997 women aged 35 to 45 years old was built in 1999 in Xiangyuan County, Shanxi province ( SPOCCS?I) and followed up by cytology and HR?HPV testing in the years of 2005, 2010, and 2014. The changes of HR?HPV prevalence and the risks of cervical precancerous lesions with CIN2+ as the endpoints were analyzed during the past 15 years. Results The detection rates of HPV infection and CIN2+ were 15.7%?22.3% and 1.1%?4.3% for the baseline visit and the other 3 follow?ups, respectively. The cumulative risk of CIN2+ in HR?HPV positive women at baseline was significantly higher than HR?HPV negative women ( P<0.01) during the 15?year follow?up. The risk of CIN2+ in the four?times HPV positive group was 40. 0%, while the group with four?times negative HPV results was 0.6% (Adjusted RR = 55.0, 95% CI: 11.3 to 268.4). Conclusions The prevalence of HR?HPV infection and CIN2+ lesions were high in Xiangyuan county during the 15 years. HR?HPV positivity elevated the risk of CIN2+ compared to women whose HR?HPV test was negative. The risks of CIN2+incidence in 6 years were low among women with negative HR?HPV test. The risk of CIN2+ increased with the numbers of HPV infection events. The screening interval could be extended to 5?6 years.