OBJECTIVE To investigate the relationship between nurse-to-patient ratios and hospital-acquired infec-tions(HAIs)in the intensive care units,and to assess the impact of both average and maximum nurse-to-patient ratios on the risk of HAIs.METHODS Data were obtained from the hospital information system(including Hospi-tal Information System,nursing sensitive quality indicator monitoring system and hospital infection management system).Inpatients aged 18 years and older in ten intensive care units from 1 Jan.2022 to 31 Dec.2023 were in-cluded;data on the nurse-to-patient ratios during day shifts,night shifts and the overall period and HAIs cases were collected.Univariate test was conducted to compare differences between the infection group and the non-infection group.Logistic regression models were utilized to evaluate the association between various nurse-to-patient ratio indicators and the risk of HAIs while controlling the covariates.RESULTS A total of 2 742 patients were included,with an HAIs incidence rate of 18.23％.The average patient-to-nurse ratio was significantly low-er in the infection group than in the non-infection group(2.76±0.82 vs.3.27±1.16,P＜0.001),whereas the maximum nurse-to-patient ratios for the overall period,day and night shifts were 3.57±1.09(infected)vs.3.91±1.31(uninfected),3.30±1.12 vs.3.48±1.16,and 4.62±1.85 vs.5.10±2.08,respectively(all P＜0.001).Regression analysis showed that no significant association between the average nurse-to-patient ratios for the overall period,day and night shifts and the risk of HAIs;whereas the odds ratios(ORs)for the maximum patient-to-nurse ratio greater than 4 were 2.122(1.355-3.324)for the overall period,2.061(1.333-3.186)for the day shift and 1.495(1.055-2.118)for the night shifts(all nurse-to-patient ratios≤3 in the reference group).CONCLUSIONS The maximum nurse-to-patient ratios are important risk factors for HAIs in the intensive care u-nits,whereas the average nurse-to-patient ratios are not significantly associated with HAIs.It is suggested that in-sufficient nursing resources during peak hours may increase the risk of infection,and optimizing the allocation of nursing care during peak hours will help to reduce the incidence of HAIs.

Objective:To analyze the occurrence of metabolic dysfunction-associated fatty liver disease (MAFLD) and related inflammatory indicators in obstructive sleep apnea hypopnea syndrome (OSAHS) and explore the risk factors of MAFLD.Methods:A cross-sectional study. From January 2022 to October 2024,172 patients with sleep disorders were enrolled in the First Affiliated Hospital of Soochow University,including 38 patients with non-OSAHS,53 patients with mild OSAHS,37 patients with moderate OSAHS,and 44 patients with severe OSAHS. The occurrence of MAFLD was comprehensively judged from three aspects: metabolic dysfunction-associated fatty liver (MAFL),elevated liver enzymes,and liver fibrosis. The situation of MAFLD and the level of related inflammatory markers were compared among the four groups. Binary logistic regression was used to analyze the risk factors for MAFLD in OSAHS.Results:There were significant differences in the prevalence of MAFL,the percentage of elevated liver enzymes,and interleukin-6 and tumor necrosis factor-alpha levels among the four groups ( P<0.05). The differences of fibrosis-4 index and C-reactive protein among the four groups were not statistically significant ( P>0.05). Binary logistic regression showed that BMI,triglycerides,longest time of sleep apnea and tumor necrosis factor-alpha were the risk factors for MAFL ( P<0.05). BMI,glucose,and apnea-hypopnea index were the risk factors for elevated liver enzymes ( P<0.05). Conclusions:OSAHS is strongly associated with MAFLD,and the involvement of OSAHS in the occurrence and development of MAFLD may be related to obesity,lipid metabolism disorders,insulin resistance,inflammatory responses,and intermittent hypoxia.

Objective To develop a graded early mobility implementation pathway for critically ill adult patients in tertiary hospitals in Beijing and to preliminarily validate its feasibility and effectiveness.Methods Based on the"goal-directed"early mobility concept,a graded early mobility implementation pathway for critically ill patients was developed through evidence synthesis and the Delphi method,consisting of 3 components:patient inclusion,mobility implementation,and mobility evaluation.Using convenience sampling,patients meeting inclusion criteria in the general ICU of a tertiary hospital in Beijing from October 2024 to January 2025 were selected as participants.Among them,25 patients admitted from December 2024 to January 2025 were assigned to an experimental group and received early mobility interventions following the developed pathway.25 patients admitted from October to November 2024 served as a control group and received routine ICU mobility care.Outcomes including diaphragm excursion,muscle strength,ICU length of stay,and adverse events were compared between the 2 groups.Results The graded early mobility pathway achieved an implementation rate of 70.05％in the experimental group,significantly higher than it in the control group(P＜0.001),without increasing adverse events.Post-intervention diaphragm excursion in the experimental group was significantly greater than that in the control group(P=0.018).Conclusion The developed graded early mobility implementation pathway for ICU patients demonstrates scientific rigor and clinical practicality.It provides a reference for the widespread and effective implementation of early mobility in ICUs,standardizing its clinical application.

Humanistic caring for patients in the operating room refers to providing the whole process of caring medical services for patients in the operating room. In order to standardize humanistic caring services for patients in the operating room of medical institutions, improve the comprehensive service level of the operating room, and enhance the surgical experience of patients, the Chinese Association for Life Care released the group standard " Humanistic Caring Management Standards for Patients in the Operating Room" in December 2023. This article interpreted the basic requirements for humanistic caring of patients in the operating room, the environment and facilities for humanistic caring, the procedures and measures for humanistic caring, and the quality management framework, aiming to assist administrators and clinical practitioners across various levels of medical institutions in accurately understanding and effectively implementing the standard, and to provide essential textual reference and practical guidance for promoting the application of the standard.

Objective To explore the characteristics of gastric emptying in the whole process of drinking water for colonoscopy in the elderly,and to develop an elderly-friendly drinking water program,thereby improving the comfort and the quality of bowel preparation.Methods From April to September 2024,gastric ultrasound was used to monitor gastric emptying indicators in the whole process of drinking water for colonoscopy in the elderly,summa-rizing its physiological features.On this basis,in October 2024,through literature review and expert argumentation,a bowel preparation drinking water program that meets the characteristics of gastric emptying in the elderly was de-veloped.A convenience sample of 90 elderly patients scheduled for colonoscopy at 2 tertiary hospitals in Beijing was enrolled from November 2024 to January 2025.A non-concurrent controlled trial was conducted:an experimen-tal group from December 2024 to January 2025 received the new elderly-friendly drinking water program,while a control group in November 2024 followed the conventional program.Outcomes included drinking comfort assessed via Visual Analogue Scale(VAS),adverse events,total fluid intake volume and bowel preparation quality via Boston Bowel Preparation Scale(BBPS).Results The experimental group demonstrated superior VAS score(P＜0.05),bowel preparation quality(P＜0.05),total fluid intake(P＜0.05),and higher compliance with optimal stool consistency(P＜0.05),compared to the control group.The experimental group also exhibited a lower incidence of adverse events(P＜0.05).No significant difference was observed in total bowel preparation duration between 2 groups(P＞0.05).Conclusion The bowel preparation drinking water program based on the characteristics of gastric emptying in the elderly improved solution intake tolerance and bowel preparation quality,with practical implications for clinical implementation.

The early symptoms of chronic obstructive pulmonary disease(COPD)are insidious,and its occurrence and development are a gradual accumulation of pathogenic factors.Clinically,it exhibits symptoms of yang deficiency and yin injury,and its pathogenic characteristics are consistent with the insidious,accumulative and injury positive characteristics of the latent cold."Latent cold"runs through the entire course of COPD.Qi-yang deficiency is the basis for the production of latent cold,external cold triggers the onset of latent cold and the cohesion of latent cold is the key to its onset.The clinical practice advocates for staged treatment based on clinical manifestations and the characteristics of changes in latent cold.During the acute phase of the attack,external cold invasion occurs and there is excessive movement due to the presence of cold.Treatment is based on warming and promoting the spread of pathogenic factors;during chronic stable period,warming and supplementing qi yang should be adopted;during the gradual aggravation period,the patients are prone to prolong chilliness and stagnation with phlegm and blood stasis forming.The treatment is based on a combination of warming and cooling.

Objective To investigate the level of self-efficacy in peritoneal dialysis patients,and to ana-lyze its influencing factors.Methods The convenience sampling method was adopted.A total of 232 patients with peritoneal dialysis in the First Medical Center of PLA General Hospital from March 2022 to March 2023 were selected as the study subjects to conduct the status quo survey of chronic disease self-efficacy scale,social support scale,medical coping style questionnaire and patient positivity scale,and the results were analyzed.Re-sults The self-efficacy score of the patients with peritoneal dialysis(6.67±2.14)points,education level,fam-ily monthly income,working status,submission,social support,objective support,subjective support and pa-tient positivity were the main factors affecting the level of self-efficacy(P<0.05),explaining 64.4%of the variation amount.Self-efficacy was positively correlated with social support,facing and patient positivity(P<0.05),and negatively correlated with avoidance and submission(P<0.05).Conclusion The self-efficacy of peritoneal dialysis patients is generally at a low to medium level.Medical staff should pay more attention to it and improve it.

Objective To explore the genes related to the pathogenesis of polycystic ovary syndrome(PCOS)through bioinformatics methods and verify them in ovarian granulosa cells,providing a reference for screening potential molecular markers of PCOS.Methods The GSE34526 and GSE137684 datasets were re-spectively used as the training set and validation set.The inflammation-related genes potentially associated with the onset of PCOS were explored through differential expression analysis and weighted gene co-expres-sion network analysis.Subsequently,their predictive value was verified through the receiver operating charac-teristic(ROC)curve.Thirty patients with PCOS(the PCOS group)and 27 patients without PCOS(the con-trol group)who were treated in Affiliated Hospital of Youjiang Medical University for Nationalities were se-lected as the research objects.RT-qPCR was applied to verify the expression level of core genes in granular cells.Spearman correlation and multiple linear regression were used to analyze the correlation between the ex-pression level of core genes and various clinical parameters,and the ROC curve was used to analyze the diag-nostic efficacy of the expression level of core genes for PCOS.Finally,the protein expression level of core genes was verified on animal models.Results A total of 1 888 differentially expressed genes,89 module-relat-ed genes and 366 inflammatory response-related genes were identified.The core gene phosphatidylinositol-4,5-diphosphate 3-kinase catalytic subunit γ(PIK3CG)was ultimately obtained by taking co-expressed genes and verifying with the ROC curve.RT-qPCR results showed that the expression level of PIK3CG in granulosa cells of the PCOS group was higher than that of the control group(P<0.05).Spearman correlation analysis showed that the expression level of PIK3CG was positively correlated with BMI,testosterone(T),fasting in-sulin(FINS),and insulin resistance index(HOMA-IR,P<0.05).Multivariate linear regression analysis showed that FINS,HOMA-IR and BMI were increased with the increasing of PIK3CG expression level(P<0.05).ROC curve analysis showed that the area under the curve for diagnosing PCOS patients with PIK3CG mRNA expression levels in granulosa cells was 0.659 3.The immunohistochemical results showed that the ex-pression of PIK3CG protein in the ovarian tissues of mice in the PCOS group was significantly increased.Con-clusion PIK3CG may be potentially associated with the pathogenesis of PCOS.

Objective To observe the clinical efficacy of Penyan pill combined with thunder fire moxibustion(TFM)in patients with sequelae of pelvic inflammatory disease(SPID).Methods This study was conducted at the department of gynecology,the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from May 2023 to May 2024.Patients with SPID were recruited and randomly and equally divided into group A(treated with ornidazole),group B(treated with ornidazole combined with Penyan pill),and group C(treated with ornidazole combined with Penyan pill and TFM).The primary outcome was the treatment effective rate,the secondary indicators were the Traditional Chinese Medicine Syndrome Integral(TCMSI),Visual Analogue Scale(VAS)score,short-form 36 health survey(SF-36)score,Self-rating Anxiety Scale(SAS)score,inflammatory factors[interleukin-6(IL-6),tumor necrosis factor(TNF-α),and C-reactive protein(CRP)],and the incidence of adverse drug reactions.All observation indicators were evaluated before treatment and 12 weeks after treatment.Results A total of 195 patients with SPID were included,and 16 patients failed to complete the study due to poor compliance.Therefore,the final number of cases was 59 in group A,60 in group B,and 60 in group C.The treatment effective rate in group C was 95.00％,which was significantly higher than that in group B(80.00％)and group A(71.19％)(P＜0.017).However,there was no significant difference in the effective rates between group A and group B(P＞0.017).After treatment,the TCMSI total score,VAS score,SF-36 score,SAS score,and the levels of serum IL-6,TNF-α,and CRP in the three groups were significantly improved compared with those at enrollment(P＜0.05).In addition,all the indicators in group C were significantly better than those in group B and group A(P＜0.05).No adverse reactions were observed in the three groups.Conclusion Penyan pill combined with TFM can improve the pain degree,quality of life and anxiety state in SPID patients,which may be related to the regulation of inflammatory factor expression.

Pasteurella multocida(Pm)type A is an important pathogen responsible for respiratory diseases,such as bovine pneumonia,which seriously restricts the development of cattle industry in China.Currently,the prevention of Pm infection-related diseases primarily relies on vaccination in production.However,the diverse Pm serotypes result in inadequate cross-immunological protection from vaccines.Therefore,it is of great significance to develop vaccines with cross-protection for the prevention and control of Pm infectious diseases.The previous studies conducted by our team have demonstrated that PmCQ2△cra exhibits a strong immune protective effect against Pm type A(PmA),Pm type B(PmB),and Pm type F(PmF).Transcriptomic sequencing results suggest that the cross-immunoprotective effect of PmCQ2△cra may be attributed to high expression levels of bacterial surface protective antigens.Consequently,four putative immune protective antigens,namely PmCQ2-5175,PmCQ2-6290,PmCQ2-0275 and PmCQ2-2640,were screened through bioin-formatics analysis in this study.Subunit vaccines formulated with these potential antigenic proteins exhibited protective efficacy of 62.5％,25％,12.5％and 10％against PmA-infected mice,respectively.Importantly,PmCQ2-5175,one of the most protective single-component antigen vac-cines,demonstrating a 75％cross-protection against PmB infection in mice.Furthermore,the pro-tective efficacy of the PmCQ2-5175 protein screened in this study was superior to that of the previ-ously reported Pm antigen protein plpE.Moreover,the fusion expression protein PmCQ2-5175-PLPE exhibited better protective effects against PmA compared to a single protein.The findings of this study will establish a theoretical foundation for the advancement of Pm subunit vaccines with broad-spectrum immune protection.