Objective To analyze the monitoring of healthcare-associated infection(HAI)in the intensive care unit(ICU)over the past 12 years based on Joinpoint regression model,and evaluate the trend changes and relevant fac-tors of HAI incidence.Methods ICU patients in a tertiary first-class hospital from January 2012 to December 2023 were selected and performed prospective monitoring.Trend changes of HAI incidence and the correlation with con-sumption of hand hygiene products as well as HAI management measures were analyzed.Results From 2012 to 2023,6 929 ICU patients were included in the monitoring,543 patients had 655 episodes of HAI,with incidence and case incidence of HAI being 7.84％ and 9.45％,respectively.The average severity of the disease was 3.62,and the adjusted HAI incidence was 2.17％.The daily incidence of ventilator-associated pneumonia(VAP),cathe-ter-associated urinary tract infection(CAUTI),and central line-associated bloodstream infection(CLABSI)were 6.19‰,3.45‰,and 1.23‰,respectively.The consumption of hand hygiene products was 122.98 mL/bed-day.The compliance rate and correct rate of hand hygiene were 90.63％and 90.46％,respectively.From 2012 to 2023,incidence of HAI(51.29％vs 4.39％),case incidence of HAI(72.41％vs 4.94％),the adjusted incidence of HAI(15.98％vs 1.04％),daily incidence of VAP(22.50‰ vs 4.33‰),daily incidence of CAUTI(14.23‰ vs 1.64‰),and daily incidence of CLABSI(10.60‰ vs 0.20‰)all decreased significantly(all P＜0.05).Both con-sumption of hand hygiene products(75.16 mL/bed-day vs 147.35 mL/bed-day)and correct rate of hand hygiene(85.00％vs 90.28％)increased significantly(both P＜0.05).A total of 1 946 pathogens were detected,with an increase in the proportion of Staphylococcus aureus(1.30％ vs 9.57％)and a decrease in the proportion of fungi(11.04％vs 1.74％).The daily consumption of hand hygiene products negatively correlated with the incidence of HAI,the case incidence of HAI,as well as the daily incidence of CAUTI and CLABSI(all P＜0.05).Incorpora-ting HAI real-time monitoring system and HAI management into performance assessment could decrease HAI-rela-ted incidence(P＜0.05).Conclusion HAI-related incidence presents a downward trend.Scientific and comprehen-sive HAI prevention and control management measures such as healthcare workers'hand hygiene management,on-line HAI real-time monitoring system,and incorporating HAI management into performance assessment can de-crease HAI-related incidence and promote the improvement of medical quality.

Objective To analyze the monitoring of healthcare-associated infection(HAI)in the intensive care unit(ICU)over the past 12 years based on Joinpoint regression model,and evaluate the trend changes and relevant fac-tors of HAI incidence.Methods ICU patients in a tertiary first-class hospital from January 2012 to December 2023 were selected and performed prospective monitoring.Trend changes of HAI incidence and the correlation with con-sumption of hand hygiene products as well as HAI management measures were analyzed.Results From 2012 to 2023,6 929 ICU patients were included in the monitoring,543 patients had 655 episodes of HAI,with incidence and case incidence of HAI being 7.84％ and 9.45％,respectively.The average severity of the disease was 3.62,and the adjusted HAI incidence was 2.17％.The daily incidence of ventilator-associated pneumonia(VAP),cathe-ter-associated urinary tract infection(CAUTI),and central line-associated bloodstream infection(CLABSI)were 6.19‰,3.45‰,and 1.23‰,respectively.The consumption of hand hygiene products was 122.98 mL/bed-day.The compliance rate and correct rate of hand hygiene were 90.63％and 90.46％,respectively.From 2012 to 2023,incidence of HAI(51.29％vs 4.39％),case incidence of HAI(72.41％vs 4.94％),the adjusted incidence of HAI(15.98％vs 1.04％),daily incidence of VAP(22.50‰ vs 4.33‰),daily incidence of CAUTI(14.23‰ vs 1.64‰),and daily incidence of CLABSI(10.60‰ vs 0.20‰)all decreased significantly(all P＜0.05).Both con-sumption of hand hygiene products(75.16 mL/bed-day vs 147.35 mL/bed-day)and correct rate of hand hygiene(85.00％vs 90.28％)increased significantly(both P＜0.05).A total of 1 946 pathogens were detected,with an increase in the proportion of Staphylococcus aureus(1.30％ vs 9.57％)and a decrease in the proportion of fungi(11.04％vs 1.74％).The daily consumption of hand hygiene products negatively correlated with the incidence of HAI,the case incidence of HAI,as well as the daily incidence of CAUTI and CLABSI(all P＜0.05).Incorpora-ting HAI real-time monitoring system and HAI management into performance assessment could decrease HAI-rela-ted incidence(P＜0.05).Conclusion HAI-related incidence presents a downward trend.Scientific and comprehen-sive HAI prevention and control management measures such as healthcare workers'hand hygiene management,on-line HAI real-time monitoring system,and incorporating HAI management into performance assessment can de-crease HAI-related incidence and promote the improvement of medical quality.

【Objective】 To evaluate the efficacy and weight of sellar floor repair techniques such as different dura suture, bone reconstruction, and pedicled nasoseptal flap (PNSF) on the skull base reconstruction of medium and high flow cerebrospinal fluid leakage during endonasal endoscopic pituitary adenoma surgery. 【Methods】 We collected the data of Grade 2-3 cerebrospinal fluid leakage (Kelly grade) during endonasal endoscopic pituitary adenoma resection in our hospital from January 2015 to April 2021. Multiple reconstruction techniques such as dura suture, bone reconstruction and PNSF, and related factors such as age, sex, body mass index (BMI), diabetes, tumor size and diameter of diaphragmatic defect were recorded and introduced to multivariate regression to analyze the effects of the above factors on the duration of postoperative cerebrospinal fluid rhinorrhea and bed rest time, with a special focus on the weight priority of dura suture, bone reconstruction, and PNSF. 【Results】 A total of 281 patients were included, with the average age of (47±12.6) years, males accounting for 52.6%. There were 93 cases of PNSF, 268 cases of bone reconstruction, 109 cases of dura anchor suture, 50 cases of patch suture, and 122 cases without suture. The results of multivariate analysis indicated that the application of PNSF, bone reconstruction, and dura suture significantly reduced postoperative rhinorrhea time [reduced by 18.524, 35.876, and 16.983/19.791 (anchor suture/patch suture) hours, respectively; all P<0.001] and bed time [reduced by 16.797, 58.233, and 18.063/21.604 (anchor suture/patch suture) hours, respectively; all P<0.001], and there was no significant difference between anchor suture and patch suture. The weight of the standardized coefficient in reducing postoperative rhinorrhea time was dura suture>PNSF>bone reconstruction [Standard β=0.211/0.207 (anchor suture/patch suture)>0.200>0.165]. The weight of reducing bed time was bone reconstruction >dura suture > PNSF [Standard β=0.239>0.206/0.210 (anchor suture/patch suture) >0.164]. After stabilizing the learning curve in 25-30 cases, the average time for bone reconstruction was (3.9±0.4) minutes. After stabilizing learning curve in 30-40 cases, the dura suture technique took an average of (3.7±0.3) minutes per stitch, (3.7±1.0) stitches per case, and (13.6±2.7) minutes of total time consumption per case. 【Conclusion】 Dural anchoring and patching suture can both effectively shorten the duration of cerebrospinal fluid rhinorrhea and bed rest time. Bone reconstruction significantly improves the stability of reconstruction, especially in prompting patients’ early disengagement of bed rest. Moreover, the learning curves of the above two methods are economical and reasonable, and their weight is close to or even exceeds that of PNSF. Therefore, they can be an effective supplement or even substitute for PNSF.

【Objective】 To introduce the repair application in medium-flow cerebrospinal fluid leakage during transsphenoidal pituitary tumor resection by using autologous material from the surgical site in situ， combined with dural suture and bone-mucosa embedding technique， and evaluate its effect. 【Methods】 We conducted a retrospective case analysis of medium-flow cerebrospinal fluid leakage during endoscopic transsphenoidal approach pituitary tumor resection in our hospital from September 2016 to March 2020. All the collected cases were divided into two groups. In situ material harvest group： dural suture + in situ bone-mucosa embedding， avoiding additional trauma to the thigh and nasal cavity， referred to as in situ group. Traditional multi-layer reconstruction group： fat + fascia lata + pedicled nasoseptal flap （PNSF）， referred to as traditional group. The important indexes related to repair were compared and analyzed between the two groups. 【Results】 The in situ group and the traditional group consisted of 108 and 63 cases， respectively. The baseline data of the two groups were comparable. For the incidence of postoperative cerebrospinal fluid leakage ［（1/108， 0.9%） vs. （1/63， 1.6%）， P>0.05］ and intracranial infection rate ［（2/108， 1.9%） vs. （2/63， 3.2%）， P>0.05］， no statistical difference was shown between the groups. While compared with that in the traditional group， the mean postoperative bed stay time ［（3.7±1.6） vs. （4.4±1.5） days， P<0.001］ and the mean postoperative hospital stay ［（5.8±1.8） vs. （6.5±1.7） days， P<0.001］ of the in situ group were significantly shorter. The in situ group had significantly lower incidences of postoperative olfactory disturbance ［（0/108， 0%） vs. （3/63， 4.8%）， P<0.05］ and nasal discomfort ［（3/108， 2.8%） vs. （7/63， 11.1%）， P<0.05］. Follow-up imaging and endoscopic examination showed that the reconstructed structure of the in situ group was stable， and there was no delayed cerebrospinal fluid leakage. 【Conclusion】 This technique showed a reliable effect in repairing medium-flow leaks during transsphenoidal pituitary tumor resection by restoring the anatomical structure while avoiding the additional trauma. It is beneficial to shortening bed stay and hospitalization time and improving the subjective experience of patients， thus having a great value in clinical application.

Objective :To explore therapeutic effect of upper and lower extremity active and passive rehabilitation treadmill combined occupational therapy on patients with chronic obstructive pulmonary disease (COPD) during sta—ble period .Methods : A total of 92 COPD patients were randomly and equally divided into occupational therapy group and treadmill + occupational therapy group .Both groups received routine nursing care ,treatment and com—prehensive rehabilitation therapy ,occupational therapy group also received occupational therapy ,while treadmill +occupational therapy group received upper and lower extremity active and passive treadmill training based on occupa—tional therapy group .After eight—week treatment ,pulmonary function ,exercise function ,daily living capacity and quality of life were analyzed and compared between two groups .Results : Compared with before treatment ,after treatment ,there were significant improvements in pulmonary function ,exercise function ,score of activity of daily living scale (ADL) and quality of life (SGRQ) in two groups , P＜ 0. 05 or ＜ 0. 01. Compared with occupational therapy group after treatment ,there was significant reduction in modified Medical Research Council dyspnea scale (mMRC) [ (2. 7 ± 0. 4) grade vs.(2. 4 ± 0.6) grade] ,and significant rise in 6min walking distance [ (291. 4 ± 28. 9) m vs.(307. 8 ± 30. 4) m] and ADL score [(56.0 ± 11.4) scores vs .(62. 0 ± 10.9) scores] in treadmill + occupation—al therapy group ( P＜0.05 or ＜0. 01) ,but there were no significant differences in pulmonary function indexes and quality of life (SGRQ) between two groups , P＞0.05 all.Conclusion : Upper and lower extremity active and passive treadmill training combined occupational therapy can significantly improve pulmonary function and exercise function and daily living capacity in patients with chronic obstructive pulmonary disease .

Objective To investigate the value of three-dimensional CT volume rendering in predicting ARDS following pulmonary contusion and identifying high-risk patients.Methods Seventy-one cases of pulmonary contusion (AIS ＞ 2 points) confirmed by chest CT during an emergency admission between July 2010 and June 2011 were enrolled.Using computer-generated three-dimensional reconstruction,contusion volume was measured and expressed as a percentage of total lung volume.The admission data,such as blood gas analysis results,systolic arterial pressure,hematocrit,AIS,ISS,and injury distribution,were prospectively collected.Independent predictive factors of ARDS following pulmonary contusion was identified using logistic regression analysis and further estimation on accuracy and value of the predictors were performed.Influence of contusion volume percentage on clinical outcomes was detected.Results Of all,mean contusion volume percentage was (22.07 ± 14.50)％ (range,5.60％-61.00％),which was not strongly correlated to the admission PaO2/FiO2 ratio (R2 =0.059).ARDS and infection were diagnosed in 31 cases and 25 cases respectively.PaO2/FiO2 ratio and contusion volume percentage were independent predictive factors of ARDS after pulmonary contusion.The best cut-off of contusion percentage in predicting ARDS development was 21.5％ with a specificity of 80.0％,sensitivity of 71.0％,positive predictive value of 73.3％,and negative predictive value of 78.1％.Conclusion Three-dimensional CT volume rendering technique allows quantification of pulmonary contusion and identification of patients at high risk of ARDS,to whom further treatment may be directed.

Objective To do research on Multi-points EGFR gene mutation and heterogeneity in lung adenocarcinoma and its influence on the prognosis,to analyze EGFR gene mutation and its heterogeneity influence on patients'overall prognosis.Methods The clinical features of patients with lung adenocarcinoma at stage Ⅲa from January 2006 to January 2007 at our institution were retrospectively reviewed.The primary lung tumors and corresponding metastatic lymph nodes tissue specimens were obtained by surgery.The adenocarcinoma primary nodes and corresponding metastatic lymph nodes EGFR mutation were detected by amplification refractory mutation system (ARMS).Univariate analysis and multivariate analysis by Cox proportional-hazard model were used to analyze the impact of EGFR mutation and its heterogeneity as influential factor on patients 'prognosis.Results 76 patients with the adenocarcinoma primary nodes and corresponding metastatic lymph nodes were detected by epidermal growth factor receptor (EGFR) mutation.40 patients with EGFR mutation were detected (40/76,52.63％).There were 9 specimens out of 40 who had lung primary nodes and corresponding metastatic lymph nodes EGFR gene heterogeneity (9/40,22.5％).Log-Rank univariate analysis showed that there was no significant difference in overall survival period between EGFR mutation patients and wild-type patients(x2 =0.382,P =0.537),but there was significant difference in illnessfree progression period(x2 =4.147,P =0.042).Gene heterogeneity factor does not affect on the overall survival period and illness-free progression period of the patients with EGFR gene mutation (x2 =1.774,P =0.183 ;x2 =1.249,P =0.264).Multivariate analysis by Cox proportional-hazard model showed that EGFR gene mutation is not the independent risk factor that has 赵 impact on the prognosis of patients with lung adenocarcinoma.Conclusion Assessment of EGFR gene mutations in a single-point specimen can not reflect the whole EGFR gene mutation status,which may probably cause difference between targeted drugs'predicted effect and its actual usage effect.

BACKGROUNDXeroderma pigmentosum group D (XPD) is one of the important DNA repair genes. XPD polymorphism at Lys751Gln site has been shown to alter XPD protein function, modulate DNA repair capacity and therefore affect cancer risk. The aim of this study is to explore the relationship between XPD polymorphism and susceptibility to lung cancer in nonsmoking female via a population-based case-control study.

METHODSThere were 105 female patients who were diagnosed with lung cancer between January 2004 and December 2005 from Liaoning Tumor Hospital and 202 Hospital, and the control group included 105 healthy volunteers who were obtained from community centers at the same time. Information concerning demographic and risk factors was obtained for each case and control by a trained interviewer. XPD genotypes of cases and controls were determined by PCR-RFLP method. Two-sided Chi-Square test was used to compare the distribution of the genotypes and risk factors between cases and controls. Unconditional logistic regression analysis was performed to calculate the odds ratios (OR) with 95% confidence intervals (CI) for estimating the association between certain genotypes and lung cancer and exploring the interaction of environmental risk factors and genetic polymorphism.

RESULTSAll of the subjects in this study were nonsmoking females in Shenyang. There was no significant demographic difference (age, economic level and education) between cases and controls. There was a significant difference in the frequencies of XPD polymorphism between cancer cases and controls. The frequencies of XPD 751Gln allele were 6.2% in controls and 13.8% in cases (P < 0.05). The risk of lung cancer was higher in those with the Lys/Gln or Gln/Gln genotype than in those with the Lys/Lys genotype and adjusted OR was 2.80 (95% CI: 1.21-6.48). The result showed that cooking fumes exposure was a risk factor for lung cancer (OR was 2.44). Furthermore, an interaction between environmental risk factors and the variant XPD 751Gln allele on the risk of lung cancer was observed. Individuals with both risk gen-otype and exposure to cooking fumes had a higher elevated risk of cancer than those with only one of them (adjusted OR= 6.85 ; 95% CI: 1.69-27.67; P=0.007).

CONCLUSIONSThe above findings indicate that the Lys751Gln polymorphism in XPD gene is associated with the risk of lung cancer in nonsmoking females. Individuals with both XPD 751Gln allele genotype and exposure to cooking fumes have a higher elevated risk of cancer than those with only one of them in nonsmoking female population.

BACKGROUNDXRCC1 polymorphism at Arg399Gln site has been shown to modulate DNA repair capacity. The aim of this study is to assess the relationship between XRCC1 polymorphism and susceptibility to lung adenocarcinoma in nonsmoking female via a hospital-based case-control study.

METHODSCases were 126 female patients with lung adenocarcinoma from January 2002 to October 2004 in China Medical University Hospital and Liaoning Tumor Hospital. Controls were selected from patients with other pulmonary diseases in the hospitals at the same time. These controls were matched to cases on age (±5 years). Information concerning demographic and risk factors was obtained for each case and control by a trained interviewer. XRCC1 genotypes were determined by PCR-RFLP. The adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated using logistic regression.

RESULTSCases showed a higher prevalence of oil smoke compared with controls (P < 0.05). The frequencies of Arg/Arg, Arg/Gln and Gln/Gln in lung adenocarcinoma group (32.54%, 42.86%, 24.60%) were significantly different from those in controls (54.76%, 40.48%, 4.76%) (P < 0.05). The individual carrying Gln/Gln genotype was at a significantly increased risk of lung adenocarcinoma compared with those with Arg/Arg genotype (OR=8.695, 95%CI 3.343-22.614, adjusted for age and oil smoke exposure). Furthermore, the OR of lung adenocarcinoma for the variant XRCC1 399Gln allele combined with exposure to oil smoke was 5.21 (95%CI 1.85-14.70, P < 0.001).

CONCLUSIONSThe results indicate that the Arg399Gln polymorphism in XRCC1 is associated with the risk of lung adenocarcinoma in nonsmoking women.

0.05).There was significant difference in expression of CerbB2 in breast cancer with different histology class and lymphatic metastasisi numbe(rP