With the deepening of population aging and the rising prevalence of chronic diseases among the elderly in China， the traditional elderly care models are facing challenges. This paper proposed a community-integrated medical-nursing-rehabilitation-care service model， characterized by “integration， flexibility， community orientation， and demand orientation.” This model optimizes and combines various service resources such as healthcare， elderly care， rehabilitation， and nursing at the community level， providing more comprehensive and targeted services for the elderly with chronic diseases in the community. However， a series of challenges existed in dimensions such as the service integration， benefit distribution， resources and funds， as well as policies and systems， hindering the sustainable development of the community-integrated medical-nursing-rehabilitation-care service model. Future efforts should focus on constructing a more standardized collaborative system， clarifying standards for resource investment and benefit distribution， as well as strengthening policy guidance， financial support， and talent team development.

OBJECTIVE To carry out regular monitoring of carbapenem-resistant Klebsiella pneumoniae(CRKP)contamination status in the environment of intensive care unit(ICU)and take targeted prevention and control measures so as to reduce the incidence of hospital-associated infections with multidrug-resistant organisms(MDROs).METHODS The surfaces of surroundings of the patients who were colonized and infected with CRKP in the ICU of grade A tertiary hospital of Shanghai and the hands of relevant staff were sampled by stages from Jan 1,2021 to Jun 30,2024.The distribution of the CRKP strains in the surroundings were analyzed according to the locations positive for CRKP,and the disinfection measures were accordingly and continuously modified.The trend of isolation rate of CRKP strains from the ICU patients was analyzed during the time period when the measures were implemented.RESULTS Totally 266 environmental samples were collected during the baseline period(from Jan.1 2021 to Dec.31 2021),265 during intervention period(from Jan.1 2022 to Dec.31 2023),274 during con-solidation period(from Jan.1 to Jun.30 2024);the isolation rates of the CRKP strains were 4.51％,4.91％and 3.65％,respectively.The isolation rate of the strains was highest from the bed unit(10.40％),followed by the article for public use(6.74％),articles used by health care workers(2.98％)and diagnosis and treatment arti-cles(1.91％).The isolation rate of CRKP of the patients was 24.75％during the baseline period,15.48％during the intervention period,5.69％during the consolidation period,showing a continuously downward trend(x2=30.330,P＜0.001).CONCLUSION It is necessary to regularly carry out the environmental monitoring of CRKP strains,seek for the weak links of environmental disinfection and implement the intensified prevention and control measures so as to reduce the incidence of CRKP infection,which may provide theoretical bases for effective control of the CRKP strains.

OBJECTIVE To carry out regular monitoring of carbapenem-resistant Klebsiella pneumoniae(CRKP)contamination status in the environment of intensive care unit(ICU)and take targeted prevention and control measures so as to reduce the incidence of hospital-associated infections with multidrug-resistant organisms(MDROs).METHODS The surfaces of surroundings of the patients who were colonized and infected with CRKP in the ICU of grade A tertiary hospital of Shanghai and the hands of relevant staff were sampled by stages from Jan 1,2021 to Jun 30,2024.The distribution of the CRKP strains in the surroundings were analyzed according to the locations positive for CRKP,and the disinfection measures were accordingly and continuously modified.The trend of isolation rate of CRKP strains from the ICU patients was analyzed during the time period when the measures were implemented.RESULTS Totally 266 environmental samples were collected during the baseline period(from Jan.1 2021 to Dec.31 2021),265 during intervention period(from Jan.1 2022 to Dec.31 2023),274 during con-solidation period(from Jan.1 to Jun.30 2024);the isolation rates of the CRKP strains were 4.51％,4.91％and 3.65％,respectively.The isolation rate of the strains was highest from the bed unit(10.40％),followed by the article for public use(6.74％),articles used by health care workers(2.98％)and diagnosis and treatment arti-cles(1.91％).The isolation rate of CRKP of the patients was 24.75％during the baseline period,15.48％during the intervention period,5.69％during the consolidation period,showing a continuously downward trend(x2=30.330,P＜0.001).CONCLUSION It is necessary to regularly carry out the environmental monitoring of CRKP strains,seek for the weak links of environmental disinfection and implement the intensified prevention and control measures so as to reduce the incidence of CRKP infection,which may provide theoretical bases for effective control of the CRKP strains.

As the most efficient perception system in nature, the perception mechanism of the insect (such as honeybee) antennae is the key to imitating the high-performance sensor technology. An automated experimental device suitable for collecting electrical signals (including antenna reaction time information) of antennae was developed, in response to the problems of the non-standardized experimental process, interference of manual operation, and low efficiency in the study of antenna perception mechanism. Firstly, aiming at the automatic identification and location of insect heads in experiments, the image templates of insect head contour features were established. Insect heads were template-matched based on the Hausdorff method. Then, for the angle deviation of the insect heads relative to the standard detection position, a method that calculates the angle of the insect head mid-axis based on the minimum external rectangle of the long axis was proposed. Eventually, the electrical signals generated by the antennae in contact with the reagents were collected by the electrical signal acquisition device. Honeybees were used as the research object in this study. The experimental results showed that the accuracy of template matching could reach 95.3% to locate the bee head quickly, and the deviation angle of the bee head was less than 1°. The distance between antennae and experimental reagents could meet the requirements of antennae perception experiments. The parameters, such as the contact reaction time of honeybee antennae to sucrose solution, were consistent with the results of the manual experiment. The system collects effectively antenna contact signals in an undisturbed state and realizes the standardization of experiments on antenna perception mechanisms, which provides an experimental method and device for studying and analyzing the reaction time of the antenna involved in biological antenna perception mechanisms.
Animals ; Arthropod Antennae ; Bees

Objective To discuss the feasibility of single hole thoracoscopy of pleural fibreboard endarterectomy surgical treatment on chronic tuberculous empyema. Methods Retrospective analysis of minimally invasive treatment of 52 cases of chronic tuberculous empyema form January 2013 to May 2016, 50 cases applied single hole thoracoscopy surgery, video-assisted mini-thoracoscopy for another 2 cases. Results There was no death, operation time 60 ~ 240 min, average 160 min, bleeding 150 ~ 2000 ml, average 350 ml, postoperative chest tube drainage time 3 ~ 21 d, average 7 d, postoperative persistent leakage in 3 patients, 3 cases of atelectasis, incisional infection in 1 case, pleural effusion in 1 case, 3 cases of arrhythmia. All the cured patients are received the corresponding treatment, the follow-up of 3 ~ 36 m, the chest CT scan show no atelectasis. Conclusion Under the condition of strict selection of indication, single hole thoracoscopy of pleural fibreboard endarterectomy in treatment of chronic tuberculous empyema is safe and feasible, so it is worthy of making further clinical promotion and application.

Objective To explore the effect of ventilator circuit change frequency on the incidence of ventilator-associated pneumonia (VAP). Methods Patients receiving mechanical ventilation in the ICU,Department of Emergency, Respiratory Department and Department of Neurosurgery from March 2008 to September 2010 were randomized into two groups. For these two groups ,the ventilator circuit was changed once or twice a week. The recorded parameters included the clinical symptoms and signs of the ventilated patients. Samples at different parts of the circuit were collected for microbiological detection. The data were analyzed statistically. Results The incidence of VAP was 28. 30% ( 13/53 ) in twice-a-week group and 35.84%( 19/53 ) in once-a-week group. There was no significant difference between the two groups. The rates for positive microbiological detection in the circuit were 48. 16% and 44. 49% for once-a-week and twice-a-week group,respectively. No significant difference was observed ( P ＞ 0.05 ). Moreover, there was no significant difference in terms of the microbiology positivity between different parts of the circuit(P ＞ 0. 05 ). Gram-negative bacteria were the main pathogen of VAP with Acinetobacter baumannii ranking at the top. Conclusion Frequency of Ventilator circuit change does not influence the incidence of VAP. We suggest that the frequency for ventilator circuit change should be once a week. At the same time, the nurse staff should be trained for specific technology and the incidence of hospital infection should be controlled at multiple rings of the chain.

OBJECTIVE To promote the multidrug-resistant bacteria infection control. METHODS Questionnaire investigated has been used to understand what degree the healthcare workers have known about controlling multidrug-resistant bacteria infection,what difficulties they would be met when they had put prevention and control measures in practice. RESULTS Total 13 questions of prevention and control multidrug-resistant bacteria nosocomial infection,the rate of right answer was 26.9% and the rate of partial right answer was 38.4%.The healthcare workers had lacked of professional knowledge about the prevention and control of multidrug-resistant bacteria nosocomial infection. The major difficulties were crowded wards,short of beds,incomprehension of patients and their families,cost of articles for disinfection and isolation when the medical staff put isolation measures into practice. CONCLUSIONS All prevention and control measures againt multidrug-resistant bacteria infection should be put into practice. We should strengthen training of healthcare workers about professional knowledge,gain support of leaders,and enhance communication between medical staff with patients and supervision.

Objective To investigate the roles of transforming growth factor(TGF)-β1 gene polymorphisms in severe acute respiratory syndrome-coronavirus(SARS-CoV)infection and the interstitial lung fibrosis after recovered.Methods Sixty-five recovered SARS patients,37 health care workers and 66 healthy controls were enrolled in this case-case study.The association between genetic polymorphisms of TG F-β1 and suscept ibility to SARS or interstitial lung changes after SARS reco,vered was carried out.Polymerase chain reaction-sequencing based typing(PCR-SBT)method was used to determine the polymorphisms of TGF-β1 gene at locus+869 and+915.Data were analyzed using t test and chi square test.Results There was no significant association of TGF+β1 gene polymorphisms at locus+869 and+915 in recovered SARS patients,health care workers and heahhy controls.And gene linkage of this two loci was not related with SARS-CoV susceptibility.Furthermore,no association between interstitial lung changes in recovered SARS palients and TGF-β1 gene polymorphisms or genetic linkage of this two loci.Conclusions It may not be related between TGFβ1 gene polymorphisms at locus+869 and+915 and SARS-CoV susceptibility.And interstitial lung changes in recovered SARS patients may not be influenced by TGF-β1 gene polymorphisms.