As the state vigorously promotes the high-quality development of hospitals and improves people's medical ex-perience,the patient-centered hospital should make full use of technological resources such as the Internet,5 G and artificial in-telligence,vigorously develop mobile medical services and artificial intelligence services,transform and optimize the diagnosis and treatment process,and streamline all links before,during and after diagnosis so as to provide better data services to the pa-tient to ensure that they can get things done with greater ease.The patients'medical experience and hospital management effi-ciency can be greatly improved.In this study,specific measures to create a new diagnosis and treatment model through the con-struction of smart hospital platform were expounded in order to provide references for related research and policy formulation of other Chinese medical institutions.

Objective:To review and summarize the best evidence of prevention and control measures of carbapenem-resistant Enterobacteriaceae (CRE) hospital infection, and provide evidence-based reference for health care workers to prevent and control CRE infection. Methods:A literature search strategy was developed to systematically search BMJ Best Clinical Practice, UpToDate, the World Health Organization, the Centers for Disease Control and Prevention website, the European Centers for Disease Control and Prevention website, the International Guidelines Collaboration website, the National Practice Technical Guidelines Library of the United States, the National Institute of Health and Clinical Optimization in the United Kingdom, the Ontario Medical Association of Canada, Maimai Tong, Cochrane Library, Australian Joanna Briggs Institute Evidence-Based Health Care Center database, PubMed, Web of Science, China National Knowledge Network, Wanfang database, VIP database, Chinese Biomedical Literature database of evidence related to the prevention and control of CRE hospital infection. The search period was from January 1, 2018 to October 1, 2023. The literature quality was evaluated independently by two research members, and evidence extraction and synthesis were carried out for the included literature.Results:A total of 10 articles were included, including 6 guidelines, 3 expert consensus articles, and 1 systematic review. 29 best evidences were formed from 6 aspects: preventive monitoring, active screening, contact isolation, environmental cleaning and disinfection, bacterial colonization, and hand hygiene measures.Conclusions:This study summarized the best evidence on the prevention and control measures of CRE infection in hospitals. Clinical staff and management departments should take active and effective prevention and control measures based on the local CRE epidemiological situation and resource requirements to reduce the risk of CRE infection.

Background/Aims: Ubiquitination is widely involved in the progression of hepatocellular carcinoma (HCC) by regulating various cellular processes. However, systematic strategies for screening core ubiquitin-related genes, clarifying their functions and mechanisms, and ultimately developing potential therapeutics for patients with HCC are still lacking. Methods: Cox and LASSO regression analyses were performed to construct a ubiquitin-related gene prediction model for HCC. Loss- and gain-of-function studies, transcriptomic and metabolomics analysis were used to explore the function and mechanism of UBE2S on HCC cell glycolysis and growth. Results: Based on 1,423 ubiquitin-related genes, a four-gene signature was successfully constructed to evaluate the prognosis of patients with HCC. UBE2S was identified in this signature with the potential to predict the survival of patients with HCC. E2F2 transcriptionally upregulated UBE2S expression by directly binding to its promoter. UBE2S positively regulated glycolysis in a HIF-1α-dependent manner, thus promoting the proliferation of HCC cells. Mechanistically, UBE2S enhanced K11-linkage polyubiquitination at lysine residues 171 and 196 of VHL independent of E3 ligase, thereby indirectly stabilizing HIF-1α protein levels by mediating the degradation of VHL by the proteasome. In particular, the combination of cephalomannine, a small molecule compound that inhibits the expression of UBE2S, and PX-478, an inhibitor of HIF-1α, significantly improved the anti-tumor efficacy. Conclusions UBE2S is identified as a key biomarker in HCC among the thousands of ubiquitin-related genes and promotes glycolysis by E3 enzyme-independent ubiquitination, thus serving as a therapeutic target for the treatment of HCC.

The new business forms are the new patterns of the job market extended by the use of mobile internet, big data, cloud computing, and other information technologies in the context of a new round of information technology development. In recent years, under the catalysis of the new employment model, a large number of new business employees have emerged such as food delivery riders, couriers, and online car-hailing drivers, whose employment forms are flexible and don’t fully conform to the establishment of labor relations with the employers, and whose problem of overtime work is common. The employment characteristics of new business forms of "focusing on performance and ignoring responsibility" make workers at great risks of occupational injuries and occupational health problems such as work-related musculoskeletal disorders, mental disorders, and overwork. However, the current research on occupational safety and health of workers in new business forms is insufficient, and the experience of institutional practice and supervision is also limited. Therefore, based on relevant research progress at home and abroad, this paper discussed the health injuries of workers in new business forms, summarized associated influencing factors from four aspects: employment form, employment affiliation, long working hours exposure, and institutional guarantee, and then proposed countermeasures to strengthen occupational safety and health protection of workers. For the current problems in the employment of new business forms, the government, enterprises, and workers need to work together to improve the legal and regulatory system for employment of new business forms, and standardize occupational safety and health management, thus effectively protect the occupational safety and health rights and interests of workers in new business forms.

Objective:To investigate the effect of dexmedetomidine-based anesthesia on gastrointestinal function in the patients undergoing laparoscopic radical resection for colorectal cancer.Methods:One hundred patients, aged 40-70 yr, with body mass index of 18-29 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ to Ⅲ, scheduled for elective laparoscopic radical resection for colorectal cancer, were divided into 2 groups ( n=50 each) using a random number table method: dexmedetomidine group (group D) and control group (group C). In group D, dexmedetomidine was intravenously infused as a bolus of 0.5 μg/kg at 10 min before anesthesia induction, followed by a continuous infusion of 0.5 μg·kg - 1·h - 1 until the end of surgery. In group C, the equal volume of normal saline was administered at the same time points. Patient-controlled intravenous analgesia was performed with hydromorphone, flurbiprofen, and metoclopramide after operation. Oxycodone was taken orally for rescue analgesia when visual analog scale score> 3. Serum intestinal fatty acid-binding protein concentrations were determined using an enzyme-linked immunosorbent assay at 10 min before anesthesia induction (T 1), 10 min after establishing pneumoperitoneum (T 2), immediately after tumor resection (T 3), 30 min before the end of surgery (T 4), and 1 h after the end of surgery (T 5). Gastrointestinal function was assessed using the I-FEED scoring system at 1-6 days after surgery.The intraoperative consumption of propofol and remifentanil, time to first flatus, first defecation and first oral intake and duration of hospital stay after surgery, and requirement for rescue analgesia within 3 days after surgery were recorded. Results:Compared with group C, the serum intestinal fatty acid-binding protein concentrations were significantly decreased at T 3-T 5, the I-FEED scores were decreased on postoperative days 3-5, the intraoperative consumption of propofol and remifentanil was decreased, and the time to first flatus, first defecation and first oral intake and duration of hospital stay were shortened ( P<0.05), and no significant difference was found in the rate of rescue analgesia in group D ( P>0.05). Conclusions:Dexmedetomidine-based anesthesia can promote the recovery of postoperative gastrointestinal function in the patients undergoing laparoscopic radical resection for colorectal cancer.

Objective:To observe the effects of different moxibustion time on cartilage morphology,tumor necrosis factor(TNF)-α and interleukin(IL)-10 of the knee joint in rats with knee osteoarthritis(KOA),and to explore the best treatment time of moxibustion for KOA.Methods:Healthy male Wistar rats were randomly divided into a blank group,a model group,a 15-minute-moxibustion group,a 30-minute-moxibustion group,and a 60-minute-moxibustion group,with 10 rats in each group.Except for the blank group,the KOA model was established in all groups by injecting sodium iodoacetate solution into the knee joint cavity of rats.Rats in the 15-minute-moxibustion group,the 30-minute-moxibustion group,and the 60-minute-moxibustion group were all treated with mild moxibustion intervention for 15 min,30 min,and 60 min,respectively at Neixiyan(EX-LE4)and Dubi(ST35)points near the patella,3 times a week for 4 weeks,12 times in total.Rats in the blank group and the model group were fixed for 30 min without moxibustion intervention.Macroscopic observation for the smoothness of knee cartilage surface was performed after the intervention.Hematoxylin-eosin staining,toluidine blue staining,and Mankin score were used to evaluate the pathological changes in the cartilage.The expression levels of TNF-α and IL-10 in the serum were detected by enzyme-linked immunosorbent assay.Results:Compared with the blank group,the articular cartilage surface in the model group was rough,the chondrocyte arrangement was irregular,the Mankin score and the serum TNF-α expression were significantly increased(P＜0.05),while the expression of serum IL-10 was significantly decreased(P＜0.05).Compared with the model group,the articular cartilage surface was smoother,the chondrocytes were arranged neatly,the Mankin score and serum TNF-α expression level were significantly lower in the three moxibustion intervention groups(P＜0.05);the serum IL-10 level in the 30-minute-moxibustion group and the 60-minute-moxibustion group was increased significantly(P＜0.05).Compared with the 15-minute-moxibustion group,the articular cartilage surface in the 30-minute-moxibustion group and the 60-minute-moxibustion group was smoother,the chondrocyte arrangement was more regular,the Mankin score and the serum TNF-α level were decreased significantly(P＜0.05),and the serum IL-10 level was increased(P＜0.05).There was no significant difference in the serum TNF-α or IL-10 level between the 30-minute-moxibustion group and the 60-minute-moxibustion group(P＞0.05).Conclusion:Moxibustion can obviously improve the morphology and structure of KOA articular cartilage,protect articular cartilage,inhibit cartilage inflammation,and delay KOA cartilage degeneration.Moxibustion's effect is closely related to moxibustion time;the therapeutic effect of the 30-minute-moxibustion and the 60-minute-moxibustion is better than that of the 15-minute-moxibustion.

OBJECTIVE: To investigate the incidence and risk factors of hypothermia in patients with acute renal injury (AKI) receiving continuous renal replacement therapy (CRRT), and to compare the effects of different heating methods on the incidence of hypothermia in patients with CRRT. METHODS: A prospective study was conducted. AKI patients with CRRT who were admitted to the department of critical care medicine of the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital) from January 2020 to December 2022 were enrolled as the study subjects. Patients were divided into dialysate heating group and reverse-piped heating group according to randomized numerical table method. Both groups were provided with reasonable treatment mode and parameter setting by the bedside physician according to the patient's specific condition. The dialysis heating group used the AsahiKASEI dialysis machine heating panel to heat the dialysis solution at 37 centigrade. The reverse-piped heating group used the Barkey blood heater from the Prismaflex CRRT system to heat the dialysis solution, and the heating line temperature was set at 41 centigrade. The patient's temperature was then continuously monitored. Hypothermia was defined as a temperature lower than 36 centigrade or a drop of more than 1 centigrade from the basal body temperature. The incidence and duration of hypothermia were compared between the two groups. Binary multivariate Logistic regression analysis was used to explore the influencing factors of hypothermia during CRRT in AKI patients. RESULTS: A total of 73 patients with AKI treated with CRRT were eventually enrolled, including 37 in the dialysate heating group and 36 in the reverse-piped heating group. The incidence of hypothermia in the dialysis heating group was significantly lower than that in the reverse-piped heating group [40.5% (15/37) vs. 69.4% (25/36), P < 0.05], and the hypothermia occurred later than that in the reverse-piped heating group (hours: 5.40±0.92 vs. 3.35±0.92, P < 0.01). Patients were divided into hypothermic and non-hypothermic groups based on the presence or absence of hypothermia, and a univariate analysis of all indicators showed a significant decrease in mean arterial pressure (MAP) in hypothermic patients (n = 40) compared with the non-hypothermic patients [n = 33; mmHg (1 mmHg ≈ 0.133 kPa): 77.45±12.47 vs. 94.42±14.51, P < 0.01], shock, administration of medium and high doses of vasoactive drug (medium dose: 0.2-0.5 μg×kg^-1×min^-1, high dose: > 0.5 μg×kg^-1×min^-1) and CRRT treatment were significantly increased [shock: 45.0% (18/40) vs. 6.1% (2/33), administration of medium and high doses of vasoactive drugs: 82.5% (33/40) vs. 18.2% (6/33), administration of CRRT (mL×kg^-1×h^-1): 51.50±9.38 vs. 38.42±10.97, all P < 0.05], there were also significant differences in CRRT heating types between the two groups [in the hypothermia group, the main heating method was the infusion line heating, which was 62.5% (25/40), while in the non-hypothermia group, the main heating method was the dialysate heating, which was 66.7% (22/33), P < 0.05]. Including the above indicators in a binary multivariate Logistic regression analysis, it was found that shock [odds ratio (OR) = 17.633, 95% confidence interval (95%CI) was 1.487-209.064], mid-to-high-dose vasoactive drug (OR = 24.320, 95%CI was 3.076-192.294), CRRT heating type (reverse-piped heating; OR = 13.316, 95%CI was 1.485-119.377), and CRRT treatment dose (OR = 1.130, 95%CI was 1.020-1.251) were risk factors for hypothermia during CRRT in AKI patients (all P < 0.05), while MAP was protective factor (OR = 0.922, 95%CI was 0.861-0.987, P < 0.05). CONCLUSIONS AKI patients have a high incidence of hypothermia during CRRT treatment, and the incidence of hypothermia can be effectively reduced by heating CRRT treatment fluids. Shock, use of medium and high doses of vasoactive drug, CRRT heating type, and CRRT treatment dose are risk factors for hypothermia during CRRT in AKI patients, with MAP is a protective factor.
Humans ; Continuous Renal Replacement Therapy ; Incidence ; Prospective Studies ; Acute Kidney Injury ; Dialysis Solutions

Objective:To construct a training program for the life care and caring abilities of home caregivers for the aged with cognitive impairment, so as to provide a basis for conducting training.Methods:From April to May 2021, a preliminary training program was developed through literature review and group discussion. From June to July 2021, purposive sampling was used to select 12 experts from Beijing city, Hebei and Hunan provinces to conduct two rounds of Delphi expert consultation, and finally a training program for life care and caring abilities of home caregivers for the aged with cognitive impairment was constructed.Results:The effective recovery rate of the questionnaire from two rounds of expert consultation was 100.00% (12/12). The authority coefficient of 12 experts was 0.891. The Kendall's W of the first, second, and third level indicators in the second round of consultation were 0.417, 0.205 and 0.200 respectively ( P<0.05). After the second round of consultation, the average value of each item's importance assignment was > 3.500, and the coefficient of variation was < 0.250. The final training program for the life care and caring abilities of home caregivers for the aged with cognitive impairment included 4 training modules, 11 training items, and 35 training content. Training forms included PPT teaching, video learning, case analysis, role playing, operational demonstrations, practical exercises, caregiver self-sharing, and other forms. Conclusions:The training program for life care and caring abilities of home caregivers for the aged with cognitive impairment has good scientific and practical significance, and can provide a basis for the training of home caregivers for the aged with cognitive impairment.

Objective:To investigate the effects of different connection schemes of continuous renal replacement therapy (CRRT) and extracorporeal membrane oxygenation (ECMO) on arterial pressure (PA), venous pressure (PV), and transmembrane pressure (TMP), and to provide a theoretical basis for choosing a suitable connection scheme.Methods:① In vitro study: the different connection schemes of CRRT and ECMO were simulated and divided into 6 schemes according to the connection between CRRT and ECMO circuits at different positions. Scheme A: connected to the front and back points of the oxygenator; scheme B: connected to the points behind and in front of the oxygenator; scheme C: connected to the points in front of the oxygenator and in front of the centrifugal pump; scheme D: connected to the points behind the oxygenator and in front of the centrifugal pump; scheme E: connected to the points in front of the oxygenator and the return catheter; scheme F: connected to the points after the oxygenator and the return catheter. Each set of ECMO circuits was measured 5 times under each connection scheme and different flow rates (2, 3, 4, 5, 5.5 L/min). Six ECMO circuits for a total of 30 measurements, and the PA, PV, and TMP of the 6 schemes were compared. ② In vivo study: the patients who were treated with ECMO combined with CRRT in the department of critical care medicine of the First Affiliated Hospital of Wannan Medical College from August 2017 to August 2021 changed the connection scheme due to high PA or PV (from scheme A or B to scheme E or F) were retrospectively analyzed. The changes of PA and PV before and after changing the scheme were compared. Results:① In vitro study results: there was no significant difference in PA between schemes A and B, C and D, E and F under different ECMO blood flow (2-5.5 L/min). The PA of schemes C and D was the lowest, followed by schemes E and F. PV of scheme B was higher than that of scheme A under different ECMO blood flow (2-5.5 L/min). There was no significant difference in PV between schemes C and D, E and F under high ECMO blood flow (3-5.5 L/min), and the absolute value of PV was lowest in schemes E and F. Compared with schemes A and B [partial PA > 300 mmHg (1 mmHg≈0.133 kPa) at high flow rate], C and D (partial PV > 350 mmHg at high flow rate), schemes E and F were more reasonable connection schemes. TMP was negative in schemes C and D at ECMO blood flow of 5 L/min and 5.5 L/min (mmHg; 5 L/min: scheme C was -29.14±11.42, scheme D was -42.45±15.70; 5.5 L/min: scheme C was -35.75±13.21, scheme D was -41.58±15.42), which indicated the presence of dialysate reverse filtration. Most of the differences in TMP among schemes A, B, E, and F under different ECMO blood flow (2-5.5 L/min) were statistically significant, and the absolute value of mean fluctuation was 9.89-49.55 mmHg, all within the normal range. ② In vivo study results: a total of 10 patients who changed the connection scheme (from scheme A or B to E or F) due to high PA or PV were enrolled, including 8 males and 2 females; 7 cases of venous-arterial ECMO (VA-ECMO) and 3 cases of venous-venous ECMO (VV-ECMO), all used continuous veno-venous hemodiafiltration (CVVHDF) mode. After changing the scheme, both PA and PV decreased significantly as compared with those before changing [PA (mmHg): 244.00±22.58 vs. 257.20±21.92, PV (mmHg): 257.20±18.43 vs. 326.40±15.41, both P < 0.01], and PV decreased more significantly than PA [difference (mmHg): 69.20±6.55 vs. 13.20±5.45, P < 0.01]. Conclusion:For patients treated with ECMO in combination with CRRT, the scheme of connecting the access line of CRRT to the pre-oxygenator or post-oxygenator and connecting the return line to the point of the return catheter can significantly reduce PA and PV and maintains normal CRRT operation even running high-flow ECMO.

Objective:To summarize the treatment process of rapid decrease in blood flow due to centrifugal pump dysfunction during extracorporeal membrane oxygenation (ECMO) and its related thinking.Methods:On September 25, 2021, the ECMO treatment of a 14-year-old boy with severe mycoplasma pneumonia, severe viral pneumonia and acute respiratory distress syndrome (ARDS) admitted to the department of critical care medicine of the First Affiliated Hospital of Wannan Medical College was analyzed.Results:Oxygenation of the child was difficult to maintain under invasive mechanical ventilation, and lung consolidation progressed seriously. After evaluation, venous-venous ECMO (VV-ECMO) was implemented, then oxygenation was improved. In the 120th hour after VV-ECMO establishment, the blood flow sudden decreased, the speed was 3 822 r/min, while the flow was only 0.2 L/min, more over there was no change in the flow when the speed was increased. Before that, the ECMO speed was 3 530 r/min, and the flow was up to 3.4 L/min and stable. After rapid screening, it was determined that the centrifugal pump was dysfunction. ECMO was successfully replaced and the flow was satisfactory.Conclusions:At present, most ECMO centers do not routinely monitor the pressure before and after the pump. There is a lack of visual and quantitative techniques or indicators to judge the pump's function, and there is also a lack of corresponding clinical experience in treatment. This paper summarizes the investigation and treatment process of ECMO pump dysfunction of this case to provide reference.