ObjectiveTo explore the incremental cost of central line-associated bloodstream infections （CLABSI） after central venous catheterization （CVC） in critically ill patients in the intensive care unit （ICU）， as well as the main cost of nosocomial infection prevention and control. By comparing these two costs， the medical personnel to pay more attention should CLABSI prevention and control from the perspectives of medical quality and economic benefits， and promote the implementation of prevention and control measures. MethodsCluster sampling was used to select 126 critically ill patients who underwent CVC in the ICU of a tertiary traditional Chinese medicine hospital from January 2021 to December 2023， including 65 cases in the CLABSI group and 61 in the non-CLABSI group. Patients’ data were retrospectively collected from the hospital medical records， including the disease type， gender， age， length of hospital stay， outcome， and hospitalization expenses. The costs of different hand hygiene methods and differing approaches to environmental cleaning and disinfection were analyzed and compared. ResultsThere were significant differences in the length of hospital stay （Z=-5.35， P<0.05） and total hospitalization expenses （Z=-6.79， P<0.05） between the CLABSI and non-CLABSI group. Total hospitalization expenses showed significant differences among patients with different lengths of hospital stay （H=43.01， P<0.05）， with much higher median one in those with 60 or more days of hospital stay than other patients. Greater differences of median total hospitalization expenses were found in males than in females （Z=-3.98， P<0.05）， as well as in patients aged 60-80 years than in patients of other ages （Z=-5.79， P<0.05）. ConclusionsThe occurrence of CLABSI significantly increases the ICU patients’ length of hospital stay and hospitalization expenses. There are differences in the costs of different hand hygiene methods and differing approaches to environmental cleaning and disinfection， but these costs are acceptable compared to the incremental costs directly attributable to CLABSI. Therefore， medical institutions should attach importance to the investment in prevention and control of nosocomial infections such as hand hygiene and environmental cleaning and disinfection， formulate practical， reasonable and feasible plans， and ensure their implementation， in order to avoid nosocomial infections， improve the medical quality， effectively control patients’ length of hospital stay and hospitalization costs， and strive to maintain patient safety.

Cancer cells refer to a group of malignant cells with strong division and proliferation abilities.Cancer cells rely on the unstable plunder of human nutrition to sustain the large amount of energy that they need for their own division and proliferation.The division and proliferation of cancer cells are linked to the synthesis and replication of genetic material in the nucleus.Blockage or destruction of the synthesis of genetic material in cancer cells is one of the mechanisms underlying the action of most antitumor drugs.As the key material that dominates cell division,proliferation,and death,nuclear genetic material which mainly refers to the deoxyribonucleic acid located on the chromatin in the nucleus,plays a decisive role in the final fate of cells.The final fate of cancer cells after the damage of the genetic material is worthy of investigation and analysis.In this paper,we discuss and analyze the fate of cancer cells after genetic material damage from the aspect of cellular cycle arrest,apoptosis,autophagy,and senescence to provide ideas for the mechanism research on antitumor drugs.

OBJECTIVE To study the improvement effects of Cannabis sativa oil on the symptoms in dextran sodium sulfate （DSS）-induced ulcerative colitis （UC） model rats， and to investigate its effects on intestinal flora of rats. METHODS Forty SD rats were randomly divided into control group， model group， C. sativa oil group （1 g/kg） and sulfasalazine group （positive control， 300 mg/kg）， with 10 rats in each group. The rats in control group and model group were given 0.5% polysorbate 80 by gavage， and the rats in C. sativa oil group and sulfasalazine group were given corresponding drug solution by gavage once a day for 10 days. From the 4th day， rats in model group， C. sativa oil group and sulfasalazine group were given 4% DSS solution for 7 consecutive days to establish UC model. The body weight， disease activity index （DAI） score， colon length， colon weight， weight per unit length of colon， the pathological changes of colon tissue， and the contents of tumour necrosis factor-α （TNF-α）， interleukin-6 （IL-6） and IL-10 in serum of rats were determined. The changes of intestinal flora in rats were detected by high- throughput sequencing. RESULTS Compared with control group， the body weight and the length of colon were decreased significantly in model group， while DAI score， the weight of colon， weight per unit length of colon， serum contents of TNF-α and IL-6 were increased significantly， and the content of IL-10 was decreased significantly （P＜0.05）； epithelial layer of colon tissue fell off， inflammatory cells infiltrated and invaded the submucosa， and intestinal glands were disordered. Compared with model group， above indexes of C. sativa oil group and sulfasalazine group were reversed significantly （P＜0.05）， and related symptoms were improved significantly. The result of flora sequencing showed that ACE index and Chao1 index of model group were decreased significantly， compared with control group （P＜0.05）； while Chao1 index of C. sativa oil group was increased significantly， compared with model group （P＜0.05）. Compared with control group， 41 genera of bacteria in the model group changed； compared with model group， C. sativa oil could return 3 of the 41 genera to normal state， including Dubosilla， Porphyrobacter and Allobaculum. CONCLUSIONS C. sativa oil can improve the symptoms of UC model rats by regulating the diversity of intestinal flora， increasing beneficial bacteria and decreasing pathogenic bacteria.

Objective:To construct a competency-oriented clinical practice teaching system for undergraduate anesthesia nursing students.Methods:From December 2022 to April 2023, based on the theory of job competency, a preliminary expert consultation questionnaire was drafted on the basis of literature analysis and semi-structured interviews. The Delphi method was used for two rounds of consultation with 21 experts in the field of anesthesia to establish the clinical practice teaching system for undergraduate anesthesia nursing students.Results:The effective recovery rates of the two rounds of consultation questionnaires were both 100.00% (21/21), and the authority coefficients of the experts were 0.877 and 0.895, respectively. The Kendall's harmony coefficients were between 0.138 to 0.227 and 0.165 to 0.283, respectively (both P<0.01). The final clinical practice teaching system for undergraduate anesthesia nursing students included four primary indicators, 11 secondary indicators, and 68 tertiary indicators. Conclusions:The clinical practice teaching system for undergraduate anesthesia nursing students, constructed based on job competency, is scientific and reliable. It has certain reference and guidance significance for the training of undergraduate anesthesia nursing students.

Objectives:To explore obesity prevalence and its association with dietary patterns among Tibetan pastoralists during the urbanization transition in Qinghai Province.Methods:Using an open cohort study design, 1 003 subjects were enrolled at baseline in 2018, 599 were followed up, and 1 012 were newly recruited in 2022. A total of 1 913 adults over 18 years were included in the study, and a questionnaire survey and health examination were conducted. Factor analysis was used to identify dietary patterns, and a mixed-effects model was used to analyze the association between dietary patterns and obesity.Results:From 2018 to 2022, the prevalence rates of overweight, obesity, and central obesity were 27.6%, 33.8%, and 54.6%, respectively. Age-sex-standardized prevalence of obesity and central obesity increased. Three dietary patterns were identified: the modern pattern was characterized by frequent consumption of pork, poultry, processed meat, fresh fruits, sugary drinks, salty snacks, etcetera; the urban pattern was characterized by frequent consumption of refined carbohydrates, beef and mutton, vegetables and eggs, etcetera; and pastoral pattern featured frequent consumption of tsamba, Tibetan cheese, buttered/milk tea, and whole-fat dairy products. After adjusting for demographic characteristics, socioeconomic status, and lifestyle factors, compared with the T1, subjects in the T3 of urban pattern scores were more likely to be overweight ( OR=2.09, 95% CI: 1.10-3.95) and overweight/obese ( OR=1.23, 95% CI: 1.00-1.51), whereas those in the T3 of pastoral pattern scores had a lower risk of overweight ( OR=0.45, 95% CI: 0.24-0.84), obesity ( OR=0.81, 95% CI: 0.69-0.95), overweight/obesity ( OR=0.75, 95% CI: 0.61-0.91) and central obesity ( OR=0.58, 95% CI: 0.38-0.89). Conclusions:Prevalence of obesity and central obesity was high among Tibetan pastoralists during the urbanization transition. Urban dietary pattern was a risk factor for overweight and overweight/obesity, whereas pastoral dietary pattern was a protective factor for overweight, obesity, overweight/obesity, and central obesity. Tailored interventions are needed to improve local people's health.

The vagina contains at least a billion microbial cells,dominated by lactobacilli.Here we perform metagenomic shotgun sequencing on cervical and fecal samples from a cohort of 516 Chinese women of reproductive age,as well as cervical,fecal,and salivary samples from a second cohort of 632 women.Factors such as pregnancy history,delivery history,cesarean section,and breastfeeding were all more important than menstrual cycle in shaping the microbiome,and such information would be necessary before trying to interpret differences between vagino-cervical micro-biome data.Greater proportion of Bifidobacterium breve was seen with older age at sexual debut.The relative abundance of lactobacilli especially Lactobacillus crispatus was negatively associated with pregnancy history.Potential markers for lack of menstrual regularity,heavy flow,dysmenor-rhea,and contraceptives were also identified.Lactobacilli were rare during breastfeeding or post-menopause.Other features such as mood fluctuations and facial speckles could potentially be predicted from the vagino-cervical microbiome.Gut and salivary microbiomes,plasma vitamins,metals,amino acids,and hormones showed associations with the vagino-cervical microbiome.Our results offer an unprecedented glimpse into the microbiota of the female reproductive tract and call for international collaborations to better understand its long-term health impact other than in the settings of infection or pre-term birth.

Objective:To construct an inservice training curriculum system for nurses in the Department of Anesthesiology based on core competence, so as to provide a reference for improving the core competence and standard training of anesthesia nurses.Methods:A research group was established in July 2020. Preliminary drafting of training curriculum system indicators and consultation questionnaires were made through the literature search and based on the content of the core competence evaluation index system of nurses in the Department of Anesthesiology. Convenience sampling was used to select 15 experts from August to October 2020, and the Delphi method was used to conduct two rounds of expert consultation. The content of the consultation included course content, training hours and training methods, which were used to construct an inservice training course system for nurses in the Department of Anesthesiology based on core competence.Results:The effective recovery rate of the two rounds of expert consultation was 100.00% (15/15), the expert authority coefficient was 0.864, and the Kendall coordination coefficient in the second round of consultation was 0.245. The inservice training course system for nurses in the Department of Anesthesiology was formed including 5 first-level indicators, namely, clinical nursing ability, critical thinking ability, communication and coordination ability, professional development ability, scientific literacy, 18 second-level indicators and 79 third-level indicators.Conclusions:The core competency-based inservice training course system for anesthesia nurses is scientific and practical, and can provide a reference for improving the core competence and standard training of anesthesia nurses.

Objective To investigate the current situation in Chinese rheumatologic physicians' clinical diagnosis and evaluation of Takayasu's arteritis (TA).Methods Nineteen rheumatology experts and three vascular surgery specialists in China were invited to make the nationwide investigation for the first time about the diagnosis and disease activity evaluation of TA in China,through the questionnaire survey on the internet.Weighted average was used to calculate the average scores of corresponding problems.Results Chinese experts mainly adopted 1990 American College of Rheumatology (ACR) classification criteria for clinical diagnosis of TA.In details,symptoms of age,limb claudication and amaurosis,signs including pulselessness or pulse weakening,vascular bruits,increasing bilateral pulse pressure and hypertension and acute phase reactants (APR) were critical to the clinical diagnosis of TA.Besides,noninvasive imaging examinations,such as computed tomography angiography (CTA),magnetic resonance angiography (MRA),vascular ultrasonography,and positron emission tomography (PET) were also of great importance.In the aspect of disease activity assessment,Chinese experts mainly used Kerr scoring tool.APR and noninvasive radiological examinations were considered with vital value.Some TA patients with carotid artery involvement were recommended using vascular ultrasonography,while others with pulmonary artery and thoracic/abdominal aorta trunk involvement were preferred CTA other than MRA.Conclusions APR and noninvasive imaging examinations were thought with great help to make clinical diagnosis and evaluation of TA for Chinese physicians.

BACKGROUND:Donor selection for high-risk acute leukemia is still controversial.OBJECTIVE:To compare the therapeutic efficacy of the unrelated donor peripheral blood and matched sibling allogeneic hematopoietic stem cell transplantation for high-risk acute leukemia.METHODS:Total 65 patients with high-risk acute leukemia treated during January 2008 to January 2016 were included,in which 30 patients chose the unrelated donor peripheral blood stem cell transplantation (UD), and other 35 chose the matched sibling allogeneic hematopoietic stem cell transplantation (MS) according to the wishes of patients and their own situation. After treatment, the chi-square test, Kaplan-Meier survival analysis method, and other methods were used to compare the implanted and hematopoietic reconstitution, the occurrence of graft-versus-host disease, relapse mortality and long-term survival between the two groups.RESULTS AND CONCLUSION:The implantation rate, platelet hematopoietic reconstitution time, the incidence of acute and chronic graft-versus-host disease, and its type exhibited no significant differences between the two groups (P > 0.05).The relapse rate, total death rate, and transplant-related mortality rates were 10.0%, 50.0%, and 40.0% in the UD group and 20.0%, 48.6%, and 25.7% in the MS groups, respectively, and the intergroup difference was insignificant (P > 0.05).The expected 2-year cumulative disease-free free survival and overall survival rates were (49.4±9.2)% and (52.6±9.2)% in the UD group and (53.9±8.5)% and (53.9±8.5)% in the MS group, respectively, and the intergroup difference was also insignificant (P > 0.05). Our experimental findings show that unrelated donor peripheral blood stem cell transplantation can be used as an effective alternative in the absence of sibling donors.

To clarify the effect of the sympathetic nerves on the body's physiopathological changes and acupuncture effect by the alphal-AR mediation in the past 30 years.The paper has referred to the database of CNKI and Pubmed,and systematically reviewed the publications in the past 30 years about the research of the alphal-AR mediation of the sympathetic nerves to the body's physiological andpathological changes and acupuncture effect.Alphal-AR not only mediated the sympathetic nerves on the inotropic change of the heart,and the contraction of the vascular smooth muscles,bladder sphincter,and uterine smooth muscles and other physiological effect,but also mediated cardiac arrhythmia,myocardial hypertrophy and other pathological process.In addition,Alphal-AR also mediated the acupuncture signal transmission,and acupuncture was able to adjust the sympathetic nervous tension.The body's physiopathological changes are closely related to alpha1-AR and subtype alteration.The in-depth study of alphal-AR helps to explain physiopathological mechanism of the body,as well as provide theoretical basis and the corresponding pharmacological models for better selective drugs.Studying Alpha1-AR on meridians contributes to the discovery of meridian essence and the substantial basis of acupuncture effects.