Objective To explore the disinfection effect of periodic hypochlorous acid infusion on water supply pipelines.Methods Water specimens from 6 water outlets of central sterile supply department were collected at baseline for microbial culture.After introducing a slightly acidic hypochlorous acid water generator,water speci-mens were collected every 10 days.Continuous disinfection with hypochlorous acid was carried out on the 1st-3rd day,and discontinued on the 4th-10th day.Water specimens of 6 water outlets were collected on the 1st,4th,7th,and 10th day of each cycle,in total 3 cycles.Microbial culture and metagenomic next-generation sequencing(mNGS)analysis were conducted simultaneously on all water specimens from the outlets of the endoscope cleaning tank.Results Before disinfection of the pipeline,a total of 18 bottles of water specimens were collected.Bacterial count of water specimens from 10 bottles(55.56％)was between 102 and 104 CFU/mL,mainly Sphingomonas ad-hesins and Bacillus cereus.After disinfection,only 2 out of 72 water specimens(2.78％)exceeded the bacterial lim-it.The mNGS results showed that three most dominant bacterial genera in the pre-disinfection water specimens were Sphingomonas,Methylobacterium,and Ralstonia,with stringent mapped reads number(SMRN)ranging from 10 000 to 100 000;while the most dominant bacterial genera in post-disinfection water specimens were Lacto-baci-llus,Ralstonia,Acinetobacter,and Bradyrhizobium.PCoA analysis showed that there was a statistically sig-nificant difference in β-diversity of water specimens before and after disinfection(P＜0.05).Conclusion Periodic hypochlorous acid infusion disinfection can effectively remove bacterial biofilms in water pipelines,but there is a risk of bacterial biofilm recovery during disinfection suspension.In the future,monitoring and management of medical water should be strengthened.

Objective:To explore the enhancement factors for the China-PAR assessment model based on a university employee cohort and validate its predictive efficacy.Methods:In this retrospective cohort study, 423 employees from a university in Beijing who underwent health checks at Peking University Third Hospital from 2019 to 2022 were enrolled. General demographics, physical examination data, biochemical indicators, and carotid artery ultrasound results were collected. The China-PAR model was used to predict initial atherosclerosis risk in those subjects. Univariate and multivariate analyses of carotid atherosclerosis progression were used to identify enhancement factors for atherosclerosis. Using carotid atherosclerosis progression during follow-up as the endpoint, the ROC curve was employed to compare the predictive efficacy of the China-PAR model for the risk of atherosclerosis before and after the incorporation of the enhancement factors.Results:Among the 423 employees included in the analysis, there were 224 males and 199 females, with a baseline age of (56.2±11.8) years. The proportions of carotid atherosclerosis progression were significantly higher in populations with hyperuricemia, hyperhomocysteinemia, body mass index≥28 kg/m2, waist-to-height ratio>0.5, and low-density lipoprotein cholesterol (LDL-C)≥3.4 mmol/L than those in patients without these health issues (66.0% vs 55.3%, 68.0% vs 56.2%, 72.1% vs 56.6%, 64.5% vs 54.2%, 80.5% vs 56.8%, respectively) (all P<0.05). Hyperhomocysteinemia ( OR=1.833, 95% CI: 1.076-3.123) and LDL-C≥3.4 mmol/L ( OR=3.891, 95% CI: 1.600-9.116) were positively correlated with carotid atherosclerosis progression (all P<0.05) and could be considered as enhancement factors for atherosclerosis. Using carotid atherosclerosis progression during follow-up as the endpoint event, the AUC of the China-PAR model after the incorporation of the enhancement factors was higher than that before incorporation (0.743 vs 0.684) ( P<0.05). The C-statistics of the China-PAR model before and after the incorporation of the enhancement factors was 0.702 and 0.757, respectively, with a net reclassification index of 0.090. Conclusion:Using carotid atherosclerosis progression as the follow-up endpoint, the China-PAR model incorporating hyperhomocysteinemia and LDL-C≥3.4 mmol/L as enhancement factors can better predict the risk of atherosclerosis among university employees.

OBJECTIVE To investigate the use of common disposable and reusable supplies for prevention and con-trol of infections in Shanghai.METHODS A survey was conducted for the use and reuse of disposable high-value consumables,disposable bronchoscopes and environmental cleaning and disinfection tools in Shanghai by using structured questionnaire.RESULTS Totally 81 medical institutions were involved in the survey,44(54.32％)of which were tertiary hospitals,and the median number of beds was 500.The orthopedic implants(70.37％),ul-trasound knife(69.14％)and endoscopic puncture instrument(66.67％)were the high-value consumables rank-ing the top 3 utilization rates.There was reuse of 18 types of high-value consumables in total among the 12 medi-cal institutions.The major causes of reuse of high-value consumables included fee less tan cost of consumables(58.33％)or being unable to included in charge items(33.33％).27.78％of the recycle high-value consumables were not treated with a dedicated disinfection and sterilization system and procedures for the disposable high-value consumables,and 33.33％did not have the report systems for related adverse reactions.49.09％of the medi-cal institutions reported to use the disposable bronchoscopes,4 of which reused them.The majority of the medi-cal institutions could carry out centralized cleaning and disinfection for the recycled floor cloths(60.81％)and cloth towels(56.76％),and 32.43％of the medical institutions reused the cloth towels by manual cleaning.The utilization rate of antiseptic wipes was 75.41％in adult intensive care unit,62.50％in neonatal intensive care unit.CONCLUSION The study reveals that there are some problems in the use of disposal and reusable supplies for prevention and control of infections,which may provide baseline data for management of the related supplies and the surveillance of disinfection of the recycled supplies so as to enhance the quality of management of hospital-asso-ciated infections.

Objective To explore the trend of lung cancer prevalence and influencing factors in a Hospital of Zigong from 2019-2023. Methods Select 2 835 lung cancer patients in Zigong region admitted to the Zigong Fourth People's Hospital from January 2019 to December 2023, and analyze the changes in the clinical characteristics and age strata of patients in different time periods in this group. Three thousand non-cancer respiratory patients in the same time period were included to compare the differences in patient data and to analyze the influencing factors affecting the changes in the characteristics of lung cancer in this region. Results There was an upward trend in the number of patients with pneumonia included between 2019 and 2023, with the highest volume of patients included in 2021 (609 cases). Over the 5-year period, the percentage of patients aged 0-39 years did not change significantly and accounted for a relatively low percentage. The proportion of patients aged 40-49 years increased (APC=0.69%, t=2.990, P<0.05), and the proportion of patients over 60 years old decreased, but to a lesser extent (APC=-0.25%, t=2.210, P<0.05). There were no significant differences in male percentage, lesion site, distant metastasis, smoking history and tumor diameter among patients in different years (all P>0.05). There were significant differences in TNM stage and lymphatic metastasis among patients in different years (all P<0.05). Compared with 2019, the proportion of early stage and patients with lymph node metastasis showed an upward trend within five years (χ²_{early stage}=9.153, P_{early stage}=0.002; χ²_{lymph node metastasis}=5.848, P_{lymph node metastasis}=0.016). The factor associated with the change in age of lung cancer patients in different years was family history of lung cancer (P<0.01). Factors associated with histologic changes in lung cancer patients in different years were age, family history of lung cancer and smoking history (all P<0.05). Factors associated with changes in TNM distribution in lung cancer patients in different years were age, tumor diameter, family history of lung cancer and lymph node metastasis (all P<0.05). Factors associated with changes in lymph node metastasis in lung cancer patients in different years were tumor diameter and TNM stage (all P<0.05). Conclusion From 2019 to 2023, the age of patients with lung cancer in a Hospital in Zigong area showed a decreasing trend, which may be influenced by family history of lung cancer.Patients with TNM early stage and lymph node metastasis increased respectively, which influenced each other and were interfered by factors of age, tumor diameter, and family history of lung cancer.

BACKGROUND: Death burden of stroke is severe with over one-third rural residents in China, but there is still a lack of specific national and high-quality reports on the urban-rural differences in stroke burden, especially for subtypes. We aimed to update the understanding of urban-rural differences in stroke deaths. METHODS: This is a descriptive observational study. Data from the national mortality surveillance system, which covers 323.8 million with 605 disease surveillance points (DSPs) across all 31 provinces, municipalities, and autonomous regions in China. All deaths from stroke as the underlying cause from 2015 to 2020 according to DSPs. Crude mortality rate and age-standardized mortality rate (ASMR) were estimated through DSPs. Average annual percentage change was used to explain the change in mortality rate. RESULTS: From 2015 to 2020, the majority of deaths from all stroke subtypes occurred in rural areas. There were significant differences between the changes of urban and rural ASMRs. On the whole, the changes in urban areas were evidently better, and the ASMR differences were basically expanding. Stroke ASMR in urban China decreased by 15.5%. The rural ASMR of ischemic stroke increased by 12.9%. The rural and urban ASMRs of intracerebral hemorrhage decreased by 24.9% and 27.4%, and those of subarachnoid hemorrhage decreased by 29.5% and 40.4%, respectively. The highest ASMRs of all stroke subtypes and the increasing trend of ischemic stroke ASMR make rural males the focus of stroke management. CONCLUSIONS The death burden of stroke varies greatly between urban and rural China. Rural residents face unique challenges.
Humans ; China/epidemiology* ; Stroke/mortality* ; Rural Population/statistics & numerical data* ; Male ; Female ; Urban Population/statistics & numerical data* ; Middle Aged ; Aged ; Aged, 80 and over ; Adult

Objective To investigate the perioperative use of antimicrobial agents in class Ⅰ incisional ophthalmic surgeries in secondary first-class and above medical institutions in Shanghai City,and provide a basis for the rational use of antimicrobial agents in such surgeries.Methods Perioperative antimicrobial prophylaxis(PAP)in patients undergoing class Ⅰ incisional ophthalmic surgery reported by secondary first-class and above hospitals in Shanghai City from 2017 to 2022 was collected retrospectively.The prophylactic use rate,types,rationality of selection,and timing of use of antimicrobial agents were analyzed comprehensively.Results From 2017 to 2022,a total of 54 868 cases of class Ⅰ incisional ophthalmic surgeries were reported from secondary first-class and above hospitals in Shanghai City.The PAP rates in tertiary comprehensive hospitals,tertiary specialty hospitals,tertiary traditional Chinese medicine hospitals,and secondary comprehensive hospitals were 4.72％,1.79％,3.22％,and 6.63％,re-spectively.The overall PAP rate showed a yearly decreasing trend,from 6.39％in 2017 to 2.31％in 2021.Among different types of hospitals,the PAP rate in secondary comprehensive hospitals decreased most significantly,from 12.72％in 2017 to 0.53％in 2022.The main types of prophylactic antimicrobial use were first-,second-and third-generation cephalosporins,and quinolones.The rational selection rates of antimicrobial agents were highest in ter-tiary comprehensive hospitals(17.13％)and lowest in tertiary specialty hospitals(1.08％).The PAP rates in sys-temic veins 0.5-1 hour before surgery were highest in tertiary specialty hospitals(88.17％)and lowest in tertiary comprehensive hospitals(71.53％).The withdrawal rates of antimicrobial agents within 24 hours after surgery were highest in tertiary traditional Chinese medicine hospitals(80.87％)and lowest in tertiary specialty hospitals(13.26％).Conclusion The PAP for class Ⅰ incisional ophthalmic surgeries in secondary first-class and above medical institutions in Shanghai City still presents certain irrational phenomena in terms of antimicrobial types and administration routes.The administration rate 0.5-1 hour before surgery and withdrawal rate of antimicrobial agents within 24 hours after surgery need to be further improved.Enhanced management is necessary to promote more rational use of antimicrobial agents.

Objective To explore the disinfection effect of periodic hypochlorous acid infusion on water supply pipelines.Methods Water specimens from 6 water outlets of central sterile supply department were collected at baseline for microbial culture.After introducing a slightly acidic hypochlorous acid water generator,water speci-mens were collected every 10 days.Continuous disinfection with hypochlorous acid was carried out on the 1st-3rd day,and discontinued on the 4th-10th day.Water specimens of 6 water outlets were collected on the 1st,4th,7th,and 10th day of each cycle,in total 3 cycles.Microbial culture and metagenomic next-generation sequencing(mNGS)analysis were conducted simultaneously on all water specimens from the outlets of the endoscope cleaning tank.Results Before disinfection of the pipeline,a total of 18 bottles of water specimens were collected.Bacterial count of water specimens from 10 bottles(55.56％)was between 102 and 104 CFU/mL,mainly Sphingomonas ad-hesins and Bacillus cereus.After disinfection,only 2 out of 72 water specimens(2.78％)exceeded the bacterial lim-it.The mNGS results showed that three most dominant bacterial genera in the pre-disinfection water specimens were Sphingomonas,Methylobacterium,and Ralstonia,with stringent mapped reads number(SMRN)ranging from 10 000 to 100 000;while the most dominant bacterial genera in post-disinfection water specimens were Lacto-baci-llus,Ralstonia,Acinetobacter,and Bradyrhizobium.PCoA analysis showed that there was a statistically sig-nificant difference in β-diversity of water specimens before and after disinfection(P＜0.05).Conclusion Periodic hypochlorous acid infusion disinfection can effectively remove bacterial biofilms in water pipelines,but there is a risk of bacterial biofilm recovery during disinfection suspension.In the future,monitoring and management of medical water should be strengthened.

OBJECTIVE To investigate the use of common disposable and reusable supplies for prevention and con-trol of infections in Shanghai.METHODS A survey was conducted for the use and reuse of disposable high-value consumables,disposable bronchoscopes and environmental cleaning and disinfection tools in Shanghai by using structured questionnaire.RESULTS Totally 81 medical institutions were involved in the survey,44(54.32％)of which were tertiary hospitals,and the median number of beds was 500.The orthopedic implants(70.37％),ul-trasound knife(69.14％)and endoscopic puncture instrument(66.67％)were the high-value consumables rank-ing the top 3 utilization rates.There was reuse of 18 types of high-value consumables in total among the 12 medi-cal institutions.The major causes of reuse of high-value consumables included fee less tan cost of consumables(58.33％)or being unable to included in charge items(33.33％).27.78％of the recycle high-value consumables were not treated with a dedicated disinfection and sterilization system and procedures for the disposable high-value consumables,and 33.33％did not have the report systems for related adverse reactions.49.09％of the medi-cal institutions reported to use the disposable bronchoscopes,4 of which reused them.The majority of the medi-cal institutions could carry out centralized cleaning and disinfection for the recycled floor cloths(60.81％)and cloth towels(56.76％),and 32.43％of the medical institutions reused the cloth towels by manual cleaning.The utilization rate of antiseptic wipes was 75.41％in adult intensive care unit,62.50％in neonatal intensive care unit.CONCLUSION The study reveals that there are some problems in the use of disposal and reusable supplies for prevention and control of infections,which may provide baseline data for management of the related supplies and the surveillance of disinfection of the recycled supplies so as to enhance the quality of management of hospital-asso-ciated infections.

Objective To investigate the perioperative use of antimicrobial agents in class Ⅰ incisional ophthalmic surgeries in secondary first-class and above medical institutions in Shanghai City,and provide a basis for the rational use of antimicrobial agents in such surgeries.Methods Perioperative antimicrobial prophylaxis(PAP)in patients undergoing class Ⅰ incisional ophthalmic surgery reported by secondary first-class and above hospitals in Shanghai City from 2017 to 2022 was collected retrospectively.The prophylactic use rate,types,rationality of selection,and timing of use of antimicrobial agents were analyzed comprehensively.Results From 2017 to 2022,a total of 54 868 cases of class Ⅰ incisional ophthalmic surgeries were reported from secondary first-class and above hospitals in Shanghai City.The PAP rates in tertiary comprehensive hospitals,tertiary specialty hospitals,tertiary traditional Chinese medicine hospitals,and secondary comprehensive hospitals were 4.72％,1.79％,3.22％,and 6.63％,re-spectively.The overall PAP rate showed a yearly decreasing trend,from 6.39％in 2017 to 2.31％in 2021.Among different types of hospitals,the PAP rate in secondary comprehensive hospitals decreased most significantly,from 12.72％in 2017 to 0.53％in 2022.The main types of prophylactic antimicrobial use were first-,second-and third-generation cephalosporins,and quinolones.The rational selection rates of antimicrobial agents were highest in ter-tiary comprehensive hospitals(17.13％)and lowest in tertiary specialty hospitals(1.08％).The PAP rates in sys-temic veins 0.5-1 hour before surgery were highest in tertiary specialty hospitals(88.17％)and lowest in tertiary comprehensive hospitals(71.53％).The withdrawal rates of antimicrobial agents within 24 hours after surgery were highest in tertiary traditional Chinese medicine hospitals(80.87％)and lowest in tertiary specialty hospitals(13.26％).Conclusion The PAP for class Ⅰ incisional ophthalmic surgeries in secondary first-class and above medical institutions in Shanghai City still presents certain irrational phenomena in terms of antimicrobial types and administration routes.The administration rate 0.5-1 hour before surgery and withdrawal rate of antimicrobial agents within 24 hours after surgery need to be further improved.Enhanced management is necessary to promote more rational use of antimicrobial agents.

Objective:To explore the enhancement factors for the China-PAR assessment model based on a university employee cohort and validate its predictive efficacy.Methods:In this retrospective cohort study, 423 employees from a university in Beijing who underwent health checks at Peking University Third Hospital from 2019 to 2022 were enrolled. General demographics, physical examination data, biochemical indicators, and carotid artery ultrasound results were collected. The China-PAR model was used to predict initial atherosclerosis risk in those subjects. Univariate and multivariate analyses of carotid atherosclerosis progression were used to identify enhancement factors for atherosclerosis. Using carotid atherosclerosis progression during follow-up as the endpoint, the ROC curve was employed to compare the predictive efficacy of the China-PAR model for the risk of atherosclerosis before and after the incorporation of the enhancement factors.Results:Among the 423 employees included in the analysis, there were 224 males and 199 females, with a baseline age of (56.2±11.8) years. The proportions of carotid atherosclerosis progression were significantly higher in populations with hyperuricemia, hyperhomocysteinemia, body mass index≥28 kg/m2, waist-to-height ratio>0.5, and low-density lipoprotein cholesterol (LDL-C)≥3.4 mmol/L than those in patients without these health issues (66.0% vs 55.3%, 68.0% vs 56.2%, 72.1% vs 56.6%, 64.5% vs 54.2%, 80.5% vs 56.8%, respectively) (all P<0.05). Hyperhomocysteinemia ( OR=1.833, 95% CI: 1.076-3.123) and LDL-C≥3.4 mmol/L ( OR=3.891, 95% CI: 1.600-9.116) were positively correlated with carotid atherosclerosis progression (all P<0.05) and could be considered as enhancement factors for atherosclerosis. Using carotid atherosclerosis progression during follow-up as the endpoint event, the AUC of the China-PAR model after the incorporation of the enhancement factors was higher than that before incorporation (0.743 vs 0.684) ( P<0.05). The C-statistics of the China-PAR model before and after the incorporation of the enhancement factors was 0.702 and 0.757, respectively, with a net reclassification index of 0.090. Conclusion:Using carotid atherosclerosis progression as the follow-up endpoint, the China-PAR model incorporating hyperhomocysteinemia and LDL-C≥3.4 mmol/L as enhancement factors can better predict the risk of atherosclerosis among university employees.