ObjectiveTo analyze the characteristics and influencing factors of elderly hospitalized patients with carbapenem-resistant gram-negative bacillus (CRO) infection in the intensive care unit (ICU) of a gradeⅡ level A general hospital in Yangpu District of Shanghai, and to provide scientific basis for the prevention and control of hospital-acquired CRO infection in such hospitals. MethodsThe clinical data of elderly ICU patients (age ≥60 years) from January 2019 to December 2023 were retrospectively collected. A total of 122 cases with hospital-acquired CRO infection were used as the case group, and a total of 68 cases with carbapenem-sensitive gram-negative (CSO) infection were used as the control group. The clinical characteristics of the two groups were analyzed, and univariate analysis and logistic regression analysis were performed for screening for possible influencing factors on hospital-acquired CRO infection. ResultsThe main pathogens of CRO infection were carbapenem-resistant Acinetobacter baumannii (CRAB) (53 cases, 43.44%) and carbapenem-resistant Klebsiella pneumoniae (CRKP) (46 cases, 37.70%), and 17 patients (13.93%) had more than two types of CRO infection. Among the CRO infection, the main sites were lower respiratory tract infection (58 cases, 47.54%), ventilator-associated pneumonia (21 cases, 17.21%), and catheter-associated urinary tract infections (16 cases, 13.11%). The incidence rate of poor prognosis was higher in the CRO infection group (54.10%) than that in the CSO infection group (36.76%) (P=0.021). The results of univariate analysis showed that male, history of hospitalization within three months, chronic respiratory disease, hypoproteinemia, anemia, and history of invasive procedures prior to infection, including indwelling central venous catheter, invasive mechanical ventilation, urinary catheter, gastric tube placement and parenteral nutrition, in addition, heparin anticoagulation, the use of broad-spectrum penicillin, third-generation cephalosporins, fluoroquinolones, carbapenems, carbapenems combined with fluoroquinolones, carbapenems combined with glycopeptides, use of ≥3 antibiotics and long time of antibiotic use prior to infection were all associated with the CRO infection (P<0.05). The results of logistic regression analysis showed that use of carbapenems (OR=7.739, 95%CI: 2.226‒26.911), ≥3 types of antibiotics (OR=6.307, 95%CI: 1.674‒23.754), invasive mechanical ventilation (OR=4.082, 95%CI: 1.795‒9.281), urinary catheter (OR=3.554, 95%CI: 1.074‒11.758), and comorbid hypoproteinemia (OR=4.741, 95%CI: 2.039‒11.022) and diabetes (OR=3.245, 95%CI: 1.344‒7.839) were positively correlated with the risk of CRO infection. ConclusionConcurrent use of carbapenems with multiple other antibiotics, as well as the use of invasive mechanical ventilation, urinary catheter, and comorbid hypoproteinemia and diabetes, may be associated with an increased influencing of CRO infection. More attention should be paid to the prevention and control of infection in elderly patients with the above-mentioned risk factors, and active screening of drug-resistant bacteria should be strengthened. Besides, the rational use of broad-spectrum antibiotics such as carbapenems, avoiding unnecessary invasive operations, and paying attention to patient nutrition and blood glucose control all can reduce the incidence of CRO infection and help to improve clinical outcomes.

Objective To analyze the prevalence and genetic characteristics of influenza A(H3N2) viruses in the city of Xiangyang in 2022-2023, and to provide a scientific basis for predicting the epidemic and mutation of influenza virus. Methods Throat swab specimens of the influenza like cases were collected from national influenza monitoring sentinel hospitals in Xiangyang every week. RNA was extracted from the specimens for influenza diagnosing using real-time RT-PCR．Viruses were isolated from H3N2 positive specimens, and HA and NA genes were amplified and sequenced．3D modeling analyses were conducted. Results The gene phylogenetic tree showed that the H3N2 isolates in 2022-2023 belonged to 3C.2a1b.2a1 and 3C.2a1b.2a2 branches, respectively. The A(H3N2) influenza virus strains all had amino acid point mutation sites on important antigenic determinants of HA protein. The epitope mutations of the 2022 A(H3N2) strain mainly occurred in regions B, C, and D. The epitope mutations of the A(H3N2) strain in 2023 mainly occurred in regions C and D. Different glycosylation sites of HA gene were found in 2022-2023 strains. No variation was found in key amino acid sites associated with neuraminidase inhibitor resistance. The difference of overall structure was not obvious in the three-dimensional simulation structure diagram. Conclusion The A(H3N2) influenza strains isolated in this study have shown antigenic drift, especially the mutation of HA, which may affect the protective effect of the vaccine on the local population and lead to influenza epidemic. The variations of HA and NA suggest that close attention should be paid to the epidemic and genetic variation of H3N2 subtype influenza virus, to provide a scientific basis for the selection of influenza virus vaccine strains and the prevention and control of influenza.

Based on the theory of “manifestation-body and spirit-qi”， it is considered that the pathogenesis of tic disorders （TD） involves three manifestations of “wind， phlegm and fire”， with wind as the leading factor and phlegm and fire as the accompanying factors. It is advocated to identify the abnormality of body and spirit， summarize the evolution of manifestation， and prescribe flexibly based on qi movement of zang-fu organs. Among them， the common symptoms related to tics are mostly belong to wind symptoms， which originated from lung qi failing to purify and liver qi over-ascent. The method of soothing liver wood and purifying lung gold is adopted， and modified Xiaochaihu Decoction （小柴胡汤） and Cangerzi Powder （苍耳子散） are recommended； Patients with prolonged illness and strange symptoms are often mixed with phlegm， which stemmed from the fact that spleen failing to rise clear and stomach failing to downward turbid. The method of raising spleen-earth and lowering stomach-earth is adopted， and modified Yigong Powder （异功散） and Erchen Decoction （二陈汤） are recommended； Patients with severe symptoms are often mixed with fire symptoms， which originated from discordance of water and fire and hyperactivity of heart fire. The method of interacting heart and kidney and coordinating water and fire is adopted， and modified Xiegan Pill （泻肝丸） and Liuwei Dihuang Pill （六味地黄丸） are recommended， in order to regulate qi movement， harmonize body and spirit， and improve the symptoms.

Objective:To analyze the clinical efficacy of treatment of cement dislodgement after vertebral augmentation for osteoporotic vertebral fractures.Methods:A retrospective study was conducted to analyze the data of 13 patients who had been treated at Department of Orthopaedics, The First Affiliated Hospital of Soochow University for cement dislodgement after vertebral augmentation for osteoporotic vertebral fractures from July 2013 to July 2022. There were 4 males and 9 females, with an average age of (76.5±8.6) years and a T value of bone mineral density of -3.3±0.6. By the CT and MRI features of cement dislodgement, their conditions fell in 4 types: cement loosening in situ (4 cases), anterior cement moving (6 cases), anterior cement moving with posterior bone mass moving (2 cases), and posterior cement moving (1 case). They were treated by percutaneous vertebroplasty (3 cases), pedicle screw fixation combined with bone graft fusion and decompression (7 cases), and conservative therapy (3 cases). The curative effects for surgical patients were evaluated by comparing their visual analogue scale (VAS), Oswestry dysfunction index (ODI) and cobb angle of kyphosis at preoperation, 1 week and 1 month postoperation, and the last follow-up, and Frankel grading for nerve injury as well. The curative effects for patients undergoing conservative treatment were evaluated by observing their symptoms.Results:This cohort was followed up for 7 (5, 12) months after treatment. The VAS scores [5.0 (4.0, 5.0) points, 3.0 (2.0, 3.0) points, and 3.0 (2.0, 3.0) points] in the 10 surgical patients at 1 week and 1 month postoperation and the last follow-up were significantly improved compared with the preoperative value [8.5 (8.0, 9.0) points] ( P<0.05); the VAS scores at 1 month postoperation and the last follow-up were also significantly improved compared with that at 1 week postoperation ( P < 0.05), but there was no significant difference between the last follow-up and 1 month postoperation ( P > 0.05). The ODIs (50.6%±4.2%, 37.8%±4.5%, and 29.3%±5.6%) in the 10 surgical patients at 1 week and 1 month postoperation and the last follow-up were significantly improved compared with the preoperative value (93.2%±3.6%), showing significant differences in pairwise comparisons ( P<0.05). The cobb angles [10.0 (9.0, 11.0)°, 9.0 (9.0, 11.0)°, and 10.0 (9.0, 12.0)°] in the 10 surgical patients at 1 week and 1 month postoperation and the last follow-up were significantly improved compared with the preoperative value [12.5 (11.0, 14.0)°] ( P<0.05) , but there was no statistically significant difference between the time points after operation ( P>0.05). The Frankel grading was significantly improved in the 6 patients with nerve injury after operation. Of the 3 patients undergoing conservative treatment, the symptoms were cured in one, showed no change during follow-up in one, and aggravated in one. Conclusion:Surgical treatment can significantly relieve pain, improve spinal dysfunction and repair nerve injury in patients with bone cement dislodgement after vertebral augmentation.

Objective:To explore the risk factors of venous leg ulcers (VLU) in patients with deep venous thrombosis (DVT) of central type.Methods:Using the convenient sampling, 268 patients with lower limb DVT of central type who were treated in the Vascular Surgery of Henan Provincial People's Hospital from January 2020 to January 2021 were selected for analysis. Patients were divided into a case group ( n=56) and a control group ( n=212) based on whether VLU occurred. Clinical factors were compared between the two groups. The risk factors for VLU in patients with lower limb DVT of central type were determined using univariate analysis and multivariate Logistic regression. A prediction model was constructed. The performance of the prediction model was evaluated using the Hosmer-Lemeshow test of goodness of fit and the area under the receiver operating characteristic (ROC) curve. Results:Univariate analysis showed that there were statistical differences between the two groups in terms of age, body mass index, smoking, alcohol consumption, work style, hypertension, deep venous reflux of the lower limbs, history of lower limb DVT, fracture history, Morisky Medication Adherence Scale scores, post-thrombotic syndrome, family history of lower limb varicose veins and family history of lower limb DVT ( P<0.05) . Multivariate Logistic regression analysis showed that age>60 years old, smoking cigarettes every day, post-thrombotic syndrome, hypertension and deep venous reflux were independent risk factors for VLU in patients with lower limb DVT ( P<0.05) . The area under the ROC curve of the risk prediction model for VLU in patients with lower limb DVT of central type was 0.972 (95% confidence interval was 0.945 to 0.988) . Conclusions:Age>60 years old, smoking cigarettes every day, post-thrombotic syndrome, hypertension, and deep venous reflux are independent risk factors for VLU in patients with lower limb DVT of central type. Nurses should provide prevention and treatment measures for the risk factors of VLU in patients with lower limb DVT of central type so as to reduce the incidence of VLU.

Objective:To understand the current situation of nurses in 52 hospitals in China on mastery of knowledge about skin injury in the elderly based on the background of mixed-mode homogenization training.Methods:Using the convenient sampling method, a total of 1 067 nurses from 52 hospitals in China were selected as the research objects in January 2021. A self-designed questionnaire on knowledge of skin injury in the elderly was used to investigate the nurses through the questionnaire star and univariate analysis was used to analyze the influencing factors. A total of 1 067 questionnaires were distributed and 1 067 valid questionnaires were recovered, and the effective recovery rate was 100%.Results:The knowledge scores of pressure injury, incontinence-associated dermatitis, skin tear and xerosis cutis among 1067 nurses were (95.66±7.37) , (95.65±9.15) , (91.37±15.45) and (87.67±15.91) , respectively. The results of univariate analysis showed that hospital grade was the influencing factor of nurses' knowledge score of pressure injury, skin tear and incontinence-associated dermatitis ( P<0.05) , educational background was the influencing factor of nurses' knowledge score of skin tear ( P<0.05) , professional title was the influencing factor of nurses' knowledge scores of pressure injury, incontinence-associated dermatitis and xerosis cutis ( P<0.05) . Conclusions:Hospitals at all levels need to strengthen the theoretical and practical knowledge training for nurses on skin xerosis and skin tear in the elderly, especially for nurses with primary titles and lower education in grassroots hospitals.

Objective:To explore the status and influencing factors of incontinence-associated dermatitis among elderly inpatients in 52 hospitals nationwide, and to analyze the nursing of elderly inpatients with incontinence, so as to provide a reference for clinical intervention.Methods:On March 31, 2021, convenience sampling was used to select 14 675 elderly inpatients from 52 hospitals across the country as the research object. The self-designed Incontinence-associated Dermatitis Questionnaire for Elderly Inpatients was used to collect general demographic data, health status, incontinence, and skin nursing. Binomial Logistic regression was used to investigate the influencing factors of incontinence-associated dermatitis in elderly inpatients.Results:Among 14 675 elderly inpatients, the prevalence rates of xerosis cutis, incontinence and incontinence-associated dermatitis were 38.78% (5 691/14 675) , 11.06% (1 623/14 675) and 1.91% (280/14 675) , respectively. The prevalence of mild, moderate and severe incontinence-associated dermatitis were 1.27% (186/14 675) , 0.55% (81/14 675) , and 0.09% (13/14 675) , respectively. Among the nursing of 1 623 elderly inpatients with incontinence, the items with low implementation rate were the use neutral lotion to clean skin (14.17%, 230/1 623) , use of skin protectant after moisturizing (17.68%, 287/1 623) , moisturizing after cleansing the skin (28.90%, 469/1 623) . The results of binomial Logistic regression analysis showed that xeroderma, fecal incontinence, urinary and fecal incontinence, ≥2 kinds of combined medication, and hospital stay >30 days were risk factors for incontinence-associated dermatitis in elderly inpatients.Conclusions:The risk factors of incontinence-associated dermatitis in elderly inpatients mainly include xerosis cutis, type of incontinence, ≥2 kinds of combined medication, and hospital stay >30 days.

Objective:To explore the changes of neuron-specific enolase (NSE) and S-100β protein (S-100β) during perioperative period in infants undergoing living liver transplantation and examine the effect of brain injury.Methods:From January 2015 to January 2016 in Department of Anesthesiology First Central Clinical College Tianjin Medical University, study group was composed of forty infants of congenital biliary atresia with an age range of (4-12) months, a body weight of (4-10) kg and American Society of Anesthesiologists (ASA) class Ⅲ/Ⅳ. Another 40 infants undergoing general surgery were selected as control group. In study group, blood samples were harvested from central vein pre-operation (T0), before skin incision (T1), 30 min after anhepatic phase (T2), 1 h of neohepatic phase (T3) and 24h after hepato-reperfusion (T4). In control group, blood samples were collected at pre-operation (T0) and 24 h post-operation (T4). Serum levels of S-100β, NSE, heart rate (HR), mean arterial blood pressure (MAP), central venous pressure (CVP) and bispectral index (BIS) were monitored at T1-4 and end of surgery. All children were assessed by Bayley Scale of Infant Development (BSID) at Day 1 pre-operation and 2/4 weeks post-operation for observing mental and motor development status. The results were described with mental development index (MDI) and psychomotor development index (PDI). Pediatric anesthesia emergence delirium (PAED) was employed for evaluating the severity of delirium during the recovery stage at 30 min and 2/4h post-extubation.Results:In study group, serum levels of S-100β and NSE changed significantly during non-hepatic and neohepatic reperfusion phases. After inferior vena cava occlusion, serum concentrations of S-100β and NSE spiked ( P<0.05) and gradually recovered during neohepatic reperfusion period ( P<0.05). No significant inter-group difference existed in serum S-100β or NSE at T4 ( P>0.05). In study group, as compared with Day 1 pre-operation, MDI/PDI decreased at Week 2 post-operation ( P<0.05) and increased from Month 1 post-operation ( P<0.05). Both MDI and PDI were lower than control group before and at Week 2 post-operation ( P<0.05). MDI/PDI of study group basically reached the preoperative level at Month 1 post-operation ( P<0.05). In control group, no significant difference existed in MDI/PDI at Day 1 pre-operation and Week 2/4 post-operation ( P>0.05). In study group, the delirium rate was up to 30% post-extubation and decreased at 2/4h post-extubation. In control group, the incidence of delirium was low at 30 min and 2/4h post-extubation ( P<0.05). Conclusions:Perioperative evaluations of serum levels of NSE and S-100β are significant for predicting the postoperative onsets of delirium and cognitive impairment in children with living donor liver transplantation.

Hodgkin lymphoma (HL) is a type of curable tumor. The treatment strategy of HL is based on staging and risk of recurrence. With the continuous optimization of combined treatment mode, the prognosis of HL has been greatly improved. The predictive value of the prognostic models widely used in HL is lower than before. Therefore, exploring new prognostic factors and enriching existing prognostic models to provide patients with precise and individualized treatment is an important research direction for HL. This article reviews the progress of prognostic factors for HL in recent years.

Hodgkin′s lymphoma (HL) is a unique malignancy in which rare malignant Hodgkin and Reed-Sternberg (HRS) cells are scattered in the inflammatory cell rich microenvironment. This extensive but ineffective inflammatory cell infiltrate indicates that HRS cells have developed mechanisms to evade immune surveillance. The immune escape mechanisms of HL provide prognostic biomarkers and opportunities to develop new drugs. The immune evasion mechanisms in Hodgkin lymphoma include a reduction of human leukocyte antigen (HLA) to affect first signal which is essential for T cell activation; an upregulation of negative co-stimulatory molecules to inhibit T cell activation; resistance to apoptosis or killing by expressing some molecules on HRS cells membrane; an immunosuppressive network formed by HRS cells regulating the microenvironment immune cells. Immune escape mechanisms of HRS cells provide new targets for the development of new drug and the new drug development strategies include drugs on HRS cells and drugs on microenvironment.