Objective To investigate the implementation of surveillance,prevention and control measures for healthcare-associated infection(HAI)in maternal and child healthcare(MCH)institutions,and provide policy evi-dence for optimizing HAI prevention and control in MCH institutions.Methods Stratified sampling was conducted among the MCH institutions at provincial,municipal and county levels in 8 provinces/autonomous regions.A uni-fied questionnaire was designed and the online survey was conducted through"Questionnaire Star".Results The data from 123 MCH institutions were included in the analysis.90.24％of the MCH institutions carried out compre-hensive surveillance on HAI.The ratios of MCH institutions which implemented targeted surveillance on HAI in neonatal intensive care unit(NICU),surgical site infection,multidrug-resistant organisms(MDROs)and HAI in intensive care units(non-NICU excluded)were 89.66％,85.96％,80.77％,and 74.19％,respectively.51.22％MCH institutions adopted information surveillance system on HAI cases.94.31％MCH institutions carried out surveillance on hand hygiene compliance.Over 90％MCH institutions carried out surveillance on environment hy-giene in high-risk departments.71.54％MCH institutions conducted centralized cleaning,disinfection,sterilization and supply for reusable medical instruments in the central sterile supply department(CSSD).Over 90％MCH insti-tutions established three-level pre-examination triage systems.86.18％set up transitional wards.MCH institutions generally adopted a management model with established effective communication,full appointment visits,and sepa-rate visits for special medical groups,such as registered pregnant women,high-risk newborns,healthcare groups,and long-term rehabilitation patients.However,the ratio of institutions conducting on-line follow-up visits was less than 50％.Conclusion MCH institutions have generally carried out comprehensive and targeted surveillance on HAI.Information surveillance need to be facilitated.Hand hygiene and environmental hygiene surveillance has been popularized to a certain extent at all levels of MCH institutions.The cleaning,disinfection,sterilization,and supply processes of reusable medical devices in a few MCH institutions are not standardized.Special medical populations get effective management.On-line healthcare is to be further promoted.

OBJECTIVE: To compare clinical effects of different postoperative rehabilitation modes on lumbar degenerative diseases, and explore influence of rehabilitation mode and other factors on postoperative effect. METHODS: From June 2013 to July 2016, totally 900 patients were admitted from nine tertiary hospitals in Beijing to perform single segment bone grafting and internal fixation due to lumbar degenerative diseases were prospectively analyzed. There were 428 males and 472 females, the age of patient over 18 years old, with an average of (51.42±12.41) years old;according to patients' subjective wishes and actual residence conditions, all patients were divided into three groups, named as observation group 1 (performed integrated rehabilitation approach and orthopedic treatment model intervention), observation group 2 (performed integrated rehabilitation approach and orthopedic treatment, classified rehabilitation model intervention), and control group(performed routine rehabilitation model intervention). Visual analogue scale(VAS), Oswestry Disability Index(ODI) and Japanese Orthopaedic Association (JOA) were used to evaluate postoperative efficacy among three groups at 24 weeks. Possible factors affecting the postoperative efficacy including age, age grouping, gender, body mass index (BMI), BMI grouping, education level, visiting hospital, payment method of medical expenses, preoperative complications, preoperative JOA score, clinical diagnosis, surgery section, operative method, intraoperative bleeding volume, postoperative complications and rehabilitation mode were listed as independent variables, and postoperative ODI score at 24 weeks as dependent variables. Univariate analysis was used to analyze relationship between influencing factors and postoperative efficacy. Multiple linear regression was used to analyze relationship between influencing factors, rehabilitation mode and postoperative ODI score at 24 weeks, in further to find out the main reasons which affect postoperative efficacy, and to analyze impact of rehabilitation mode on postoperative efficacy. RESULTS: All patients were followed up for 24 weeks after operation. All incisions healed at stage I with stable internal fixation. (1)Evaluation of postoperative efficacy:① There were no statistical differences in preoperative VAS and ODI among three groups( CONCLUSION Preoperative JOA score, gender, age could predict postoperative clinical effects of lumbar degenerative diseases in varying degrees treated with single level bone graft fusion and internal fixation. Different rehabilitation modes could improve clinical effects. Intergrated rehabilitation orthopedic treatment model and integrated rehabilitation approach and orthopedic treatment with classifiedrehabilitation model are superior to conventional rehabilitation model in improving patients' postoperative function and relieving pain, which is worthy of promoting in clinical.
Adolescent ; Adult ; Aged ; Female ; Humans ; Infant ; Lumbar Vertebrae/surgery* ; Lumbosacral Region ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fusion ; Treatment Outcome

Objective:To evaluate the efficacy of modified Xiaoji Baozhong granules combined with scraping in the treatment of abdominal obesity with gastric heat and dampness syndrome and its effect on adipocytokines. Method:One hundred and forty-four patients were randomly divided into the control group and the observation group， 72 cases in each group. The lifestyle adjustments were conducted in both groups. The observation group was given a comprehensive traditional Chinese medicine regimen of modified Xiaoji Baozhong granules combined with scraping. The control group was given modified Xiaoji Baozhong granules combined with scraping. The course of treatment was three months. The body mass index （BMI）， body fat percentage （FP）， waist circumference （WC）， waist to hip ratio （WHR）， obesity and abdominal fat thickness of the two groups were compared before and after treatment. The levels of fasting blood glucose （FBG）， insulin resistance index （HOMA-IR）， high density lipoprotein （HDL）， low density lipoprotein （LDL）， triglyceride （TG）， total cholesterol （TC）， adiponectin， leptin， resistin， endolipid and tumor necrosis factor-α （TNF-α） were compared between the two groups before and after treatment. The clinical efficacy and safety were evaluated. Result:After treatment， the BMI， FP， obesity， WC and WHR of the observation group were lower than those of the control group （P<0.01）. After treatment， the abdominal wall fat thickness and intra-abdominal fat thickness of patients in the observation group were lower than those in the control group （P<0.01）. The FBG， HOMA-IR， TG， TC and LDL of the observation group were lower than those of the control group （P<0.01）， while the HDL level was higher than the control group （P<0.01）. Adiponectin in the observation group was higher than the control group after treatment （P<0.01）. The leptin， resistin， visfatin and TNF-α were lower than those in the control group （P<0.01）. The total clinical efficacy rate of patients in the observation group was 88.24% （60/68）， which was better than 73.53% （50/68） in the control group （χ²=4.755， P<0.05）. Conclusion:In addition to lifestyle adjustments， modified Xiaoji Baozhong granules combined with scraping treatment can reduce the degree of obesity and fat thickness in patients with abdominal obesity， and regulate lipid， carbohydrate metabolism and adipocytokines， with a better clinical efficacy than simple scraping therapy and the safety in practice.

Objective The activation of NF-kappa B (NF-κB) signaling pathway plays an important role in the development of helicobacter pylori associated gastritis (HAG). The article aimed to investigate the effects of polygonum capitatum on the treatment of HAG in NF-κB signaling pathway and observe whether the regulation of NF-κB acetylation by silent information regulator 1 (SIRT1) affects the therapeutic effects of HAG. Methods The immortalized human gastric epithelial cells (GES-1) were cultured and the H.pylori stand- ard strain ATCC700392 was used for the replication of HAG cell model by 100∶1. The cells were divided into model group,drug group and normal control group. Cells were treated with 80 μg/mL in drug group,H.pylori and GES-1 were cultured together in model group and untreated GES-1 cells were taken as control group. Real time PCR was used to detect the mRNA levels of SIRT1,NF-κB/p65 and TNF-α. Western blotting was used to detect the expression levels of SIRT1,NF-κB/p65 and its acetylated protein in the total protein,as well as the expression levels of SIRT1 and NF-κB/p65 in cytoplasm and nuclear protein. Results At 12 h after the infection of H. pylori,the level of TNF-α in the supernatant was higher than that in the normal control group(P<0.05). The expression of SIRT1 de-creased in the cytoplasm of model group,while the expression levels of NF-κB/p65,acetyl-NF-κB p65(Lys310) and TNF-α in the nu-cleus increased (P<0.05). But after the treatment of polygonum capitatum,the expression of SIRT1 in the nucleus increased(P<0.05) while the expression of NF-κB/p65,acetyl-NF-κB p65(Lys310) and TNF-α decreased (P<0.05). Conclusion Polygonum capita-tum can activate the SIRT1 in the nucleus,which makes activated NF-κB/p65 in the nucleus carry out deacetylation modification in or-der to antagonize the cell damage induced by H.pylori.

OBJECTIVETo study clinical effects of one-hole microplate internal fixation for the treatment of collateral ligament injuries of the metacarpophalangeal joint of the thumb combined with fracture.

METHODSTwenty-two patients (16 males, 6 females) with collateral ligament injuries of the metacarpophalangeal joint of the thumb combined fracture were treated with one-hole microplate internal fixation. The age of the patients ranged from 18 to 53 years old with a mean age of 28.5 years old. The duration from injury to surgery ranged from 2 hours to 2 months, and the mean time was 6 days. All the patients had collateral ligament injuries combined with fracture of the metacarpophalangeal joint of the thumb. Thirteen patients had injuries in the right hand and 9 patients had injuries in the left hand. There were 18 cases of closed wound and 4 cases of open wound. Eighteen patients had fresh injuries (< 2 weeks) and 4 had old injuries (> 2 weeks). Sixteen patients had injuries in the ulnar collateral ligament of the thumb combined with fracture, 6 patients had radial collateral ligament injuries of the thumb combined with fracture, 4 cases of which were complicated with injuries of abductor pollicis brevis and the end of the flexor pollicis brevis tender. The size of the avulsed fragment was about 3.0 mm x 4.0 mm to 6.0 mm x 7.0 mm.

RESULTSThe incisions of 22 patients healed by first intention. The follow-up periods ranged from 6 months to 5 years old,with an average of 2.5 years old. The thumb function was evaluated by Saetta and other evaluation criteria, and 20 patients got an excellent result and 2 good.

CONCLUSIONThe application of one-hole microplate internal fixation in treating collateral ligament injuries with fracture of the metacarpophalangeal joint of the thumb is an effective method.

Adolescent ; Adult ; Bone Plates ; Collateral Ligaments ; injuries ; surgery ; Female ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Metacarpophalangeal Joint ; injuries ; surgery ; Middle Aged ; Thumb ; injuries ; surgery ; Young Adult

The management of postoperative leaks into the mediastinum after esophagectomy remains a challenge. We describe our clinical management of this complication through endoscopic transluminal drainage. Between 2008 and 2011, 4 patients with esophageal squamous cell carcinoma (ESCC) who underwent McKeown-type esophagectomy with two-field lymphadenectomy experienced complicated anastomotic fistulae in the presence of superior mediastinal sepsis. All 4 patients underwent endoscopic transluminal drainage, and all survived. The mean healing period was 50 days (range, 31 to 58 days), the mean stay in the intensive care unit was 7.3 days (range, 1 to 18 days), and the mean hospital stay was 64.5 days (range, 49 to 70 days). Endoscopically guided transluminal drainage should be considered for ESCC patients with superior mediastinal fistulae after esophagectomy.
Aged ; Carcinoma, Squamous Cell ; surgery ; Drainage ; Endoscopy ; Esophageal Fistula ; etiology ; therapy ; Esophageal Neoplasms ; surgery ; Esophagectomy ; adverse effects ; Humans ; Lymph Node Excision ; Male ; Mediastinum ; Middle Aged ; Sepsis ; etiology ; therapy

Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Surgical Flaps ; Thumb ; surgery ; Toes

OBJECTIVETo study the effect of culture supernatant of alveolar macrophage alveolar macrophages (AM) stimulated by SiO2 on the expression of matrix metalloproteinases (MMP-1), tissue inhibitor of metalloproteinase-1 (TIMP-1) and collagen of fibroblast human embryonic lung fibroblasts (HELF) in the development of silicosis fibrosis.

METHODSAMs were collected from a silicotic patient by bronchoalveolar lavage and exposed to SiO2, cultured human embryo lung fibroblast were allocated into a treated group, a control group, a positive group, and a blank group. HELF was incubated with the cultured supernatant of AMs for 6, 12, 18, 24, 36, 48 h. Immunocytochemical and Western blot technology were used to detect MMP-1 and TIMP-1 expressions in HELF and collagen expression in supernatant of HELF respectively.

RESULTSThe supernatant of AM exposed to SiO2 significantly decreased the expressions of MMP-1 (0.0605 +/- 0.0201, 0.0519 +/- 0.0117, 0.0412 +/- 0.0105 and 0.0213 +/- 0.0106 in the treated group at 18, 24, 36 and 48 h) compared with the control group and the blank group (P < 0.05, P < 0.01) but stimulated expressions of TIMP-1 and collagen (P < 0.05, P < 0.01). The ratio of TIMP-1 to MMP-1 increased. The ratio of TIMP-1 to MMP-1 was positively correlated with the expression of collagen III (r = 0.88, P < 0.01).

CONCLUSIONThrough AM mediation SiO2 can accelerate the expression of TIMP-1 and collagen, and inhibit the expression of MMP-1. The imbalance between the expression of TIMP-1 and that of MMP-1 is related with the abnormal increase in collagen III.

Cells, Cultured ; Collagen Type III ; metabolism ; Fibroblasts ; drug effects ; metabolism ; Humans ; Macrophages, Alveolar ; drug effects ; Male ; Matrix Metalloproteinase 1 ; metabolism ; Middle Aged ; Silicon Dioxide ; toxicity ; Silicosis ; pathology ; Tissue Inhibitor of Metalloproteinase-1 ; metabolism

OBJECTIVETo study the effect of silicosis alveolar macrophages (AM) restimulated by SiO(2) on expression of c-myc oncogene in human embryo lung fibroblasts.

METHODSThe bronchoalveolar lavage of silicosis patients was collected. AMs were divided into 2 groups: (1) SiO(2): AMs were stimulated with SiO(2) (30 microg/ml) for 1, 2, 6, 12, 24 and 36 h; (2) control: treated for the same time without SiO(2). Fibroblasts were cultured with different AMs supernatants for 2 h or 7 h respectively. The expression of c-myc mRNA was determined by RT-PCR and protein by Western Blot.

RESULTSThere was no c-myc expression when fibroblasts were static. The supernatants in the S6 group stimulated expression of c-myc mRNA and protein, with the peak expression at 2 h and 7 h respectively. In the control group, AMs supernatants cultured in different time stimulated expression of c-myc mRNA and protein with the most evident expression at 12 h. The ratios were 0.749 +/- 0.088 and 0.759 +/- 0.101 respectively. Compared with control in the same period, c-myc mRNA and protein expression were significantly stronger treated with the supernatants in which AMs were stimulated for 1 h, 2 h and 6 h by SiO(2) (P < 0.05 or P < 0.01).

CONCLUSIONAMs stimulated with SiO(2) has the ability to induce c-myc oncogene expression in human embryo lung fibroblasts.

Cells, Cultured ; Fibroblasts ; drug effects ; metabolism ; Humans ; Lung ; drug effects ; metabolism ; pathology ; Macrophages, Alveolar ; drug effects ; metabolism ; Proto-Oncogene Proteins c-myc ; genetics ; metabolism ; RNA, Messenger ; genetics ; Silicon Dioxide ; toxicity ; Silicosis ; metabolism ; pathology

Objective To report the outcome of emergency repair of severe complex defect in forearm by transplantation of free flap and simultaneous functional reconstruction.Methods From Mar.1994 to Aug.2003,4 cases with severe complex defect in forearm was repaired by transplantation of free skin flap, free skin flap combined with fibula flap,or fibula osteocutaneous flap in emergency.Simultaneously the flexion and extension function were repaired by muscle transfer and/or tendon grafting,tenonectomy.Results All the cases were successful.Follow-up period ranged from 1 to 3 years postoperatively.The blood-supply,tex- ture and elasticity of transferred flaps were excellent with good bone healing.Opposition of thumb with four fin- gers was good.Sensory recovery of the hand was satisfactory.Conclusion Transplantation of free flap com- bined with simultaneous functional reconstruction is an ideal method in emergency repair of severe complex de- fect in forearm.