Objective:To establish an environmental management strategy for the prevention of ventilator-associated pneumonia from the perspective of etiological characteristics and to verify its application effect.Methods:Based on a sampling survey, this study constructed preventive management strategies for ventilator-associated pneumonia by blocking pathogen characteristics from the perspective of both colonization and infection management in patients. From July 2021 to June 2023, a non-synchronous randomized controlled study was conducted, including a control group of 59 cases and an experimental group of 57 cases from ICU of Tianjin Teda Hospital, all of them were mechanically ventilated patients. The effectiveness of the strategy was confirmed.Results:In the control group, there were 35 males and 24 females, with an average age of (46.97 ± 18.84) years. In the experimental group, there were 39 males and 18 females, with an average age of (47.49 ± 13.85) years. During the study period, there were 9 cases of ventilator-associated pneumonia (VAP) in the control group and 2 cases in the experimental group, the difference between the two groups was statistically significant (exact odds ratio=0.031). The duration of mechanical ventilation in the experimental group (122.41 ± 18.36) h, which was shorter than that in the control group (187.62 ± 18.05) h, and the difference was statistically significant ( t=19.28, P<0.05). The length of ICU stay in the experimental group was (8.38 ± 0.79) d, in the control group was (10.99 ± 1.10) d, the difference between them was statistically significant ( t=14.66, P<0.05). On the 7th day, there were 7 cases of positive pathogenic bacteria in sputum culture in the experimental group, which was significantly different from the 29 cases in the control group ( χ2=16.73, P<0.05). Conclusions:The vector management strategy for preventing ventilator-associated pneumonia by blocking etiological characteristics can reduce the incidence of VAP, shorten the duration of mechanical ventilation and ICU stay, and reduce the pathogen load in the sputum of mechanically ventilated patients on the 7th day.

【Objective】 To explore the role and mechanism of TRPC in promoting extracellular matrix (ECM) deposition in rat glomerular mesangial cells (HBZY-1). Methods Immunofluorescence staining was performed to observe the distribution and expression of TRPC1 and TRPC6 in HBZY-1 cells. After AngⅡ stimulation, qRT-PCR and Western blotting were used to detect the mRNA and protein expressions of Gαq/PLCβ4/TRPC signaling pathway main proteins and ECM deposition indicators (α-SMA, collagenⅢ and fibronectin). By silencing the expressions of TRPC1 and TRPC6 by RNA interference, the expressions of ECM deposition indicators were detected. Changes in [Ca²⁺]i influx were determined through Fluo-4AM Ca²⁺ imaging. 【Results】 Both TRPC1 and TRPC6 were expressed in HBZY-1, and were mainly located in cell membrane and cytoplasm. After AngⅡ stimulation, Gαq/PLCβ4/TRPC signaling pathway was activated, and the mRNA and protein expressions of Gαq, PLCβ4, TRPC1 and TRPC6 were all increased (P<0.05). [Ca²⁺]i influx also increased (P<0.01), and the mRNA and protein expressions of ECM deposition indicators (α-SMA, ColⅢ and Fn) were upregulated (P<0.05). Silencing the expressions of TRPC1 and TRPC6 by RNA interference led to decreased [Ca²⁺]i influx (P<0.05), and downregulated mRNA and protein expressions of ECM deposition indicators in HBZY-1 cells (P<0.05). The results suggested that inhibition of TRPC expressions could inhibit AngⅡ induced ECM deposition in HBZY-1 cells, which might be associated with decreased [Ca²⁺]i influx. 【Conclusion】 TRPC may be a novel therapeutic target of renal fibrosis.

Objective:To anaylyze the influencing factors of peripheral arterial catheter-related bloodstream infection (CRBSI), and provide theoretical basis for clinical medical staff to control CRBSI.Methods:Adopting cross-sectional survey method. Convenient sampling method was used to select 331 patients with arterial catheterization in Tianjin Beichen Hospital from January 2021 to January 2022. The general status, catheter related infections,local skin abnormalities and catheterization status of the subjects were collected. The positive microbial culture at the tip of the catheter after extubation was taken as the outcome index, the influencing factors of peripheral arterial CRBSI were analyzed.Results:The incidence of CRBSI was 8.15% (27/331). Adjusted Logistic regression showed that age ( OR=3.013, 95% CI 1.158-14.365), local abnormality ( OR=3.357, 95% CI 1.670-9.269), number of days of catheterization ( OR=2.338, 95% CI 1.127-4.183) and location of catheterization (lower limb) ( OR=3.325, 95% CI 1.007-3.954) were the risk factors of peripheral artery CRBSI (all P<0.05). Conclusions:Peripheral artery CRBSI is more likely to occur in ICU patients aged ≥65 years, with local skin abnormalities, catheterization days ≥14 d and catheterization site in lower extremity. Paying attention to the elderly, paying attention to the integrity of the sterile barrier at the puncture site, shortening the catheterization days and avoiding lower extremity puncture can reduce the occurrence of peripheral artery CRBSI.

The National Medical Insurance Administration launched a national pilot project based on diagnosis-related group (DRG) payment across the country in 2019. It optimizes and reuses limited resources from a clinical perspective, controls hospitalization expenses and medical costs, and reduces average hospital stays based on DRG payment. This article expounds the concept and application of DRG payment, from the perspective of clinical nursing, expounds the research progress of DRG payment at home and abroad, attempts to analyze the relationship between DRG payment and nursing, and further proposes the impact on the development of clinical nursing.

Objective:To analyze the data of critical care related literatures published in Web of Science core set by knowledge map visualizing technology, and summarize the research status and hotspots of critical care.Methods:The core set database of Web of Science from January 2011 to December 2020 was searched, the extracted information was standardized and analyzed by knowledge map visualizing technology.Results:A total of 783 articles in the field of critical care were included, and the number of literatures increased year by year, among which the number of articles published in the American Journal of Critical Care(305) was the most. The United States (437) was the country with the most published literatures, and Australia was the country with the highest centrality (centrality=0.67). The number and centrality of articles published from China were at the lower middle level. There was cooperation among countries, but not close cooperation. The cooperation among authors was in the state of small aggregation and large dispersion. Cluster analysis and keyword emergence analysis showed that many aspects in the field of intensive care had been the research hotspots, among which "post intensive care syndrome" and "children′s intensive care" were the research hotspots in recent years.Conclusions:The research field of intensive care is still in the rising stage of development, and post intensive care syndrome and children's intensive care are the latest hotspots in intensive care research.

Objective:To establish early warning indicators for Chinese nurses to recognize in-hospital cardiac arrest (IHCA) of adult inpatients.Methods:Computer retrieval of Chinese and English databases such as CNKI, Wanfang Database, VIP, National Medical Library of the United States PubMed Database, Web of Science, Embase Database of the Netherlands Medical Abstracts, Cochrane Library Database and other international guidelines collaboration network (GIN), National Institute for Health and Clinical Optimization (NICE), Scottish Intercollegiate Guidelines Network (SIGN), BMJ best clinical practice and other guidelines was performed. The retrieval time limit for respiratory and cardiac arrest early warning indicators or risk identification related content of the adult inpatient in the professional website was until June 30, 2020. After literature research and expert group analysis, the research group drew up an expert correspondence questionnaire, and selected 32 medical and nursing experts from Beijing, Tianjin, Jilin, Shandong, Shaanxi, Sichuan, Zhejiang and other grade three first-class general hospitals from July to September 2022. The Delphi method was used to conduct two rounds of expert correspondence, forming the final version of the early warning index of cardiac arrest in adult inpatients.Results:Five first-level indicators, 23 second-level indicators and 41 third-level indicators including vital signs, consciousness and pupils, postoperative blood drainage volume, lab results and other five aspects were initially formed. The effective response rates of the two rounds of expert correspondence were 100% (32/32) and 93.75% (30/32), respectively, the Kendall coordination coefficients W of the first round and the second round were 0.340 and 0.462, respectively, the expert authority coefficients Cr were 0.88 and 0.89, respectively, the mean value of importance assignment was 3.94-5.00, 4.07-5.00, and the coefficient of variation was 0-0.16, 0-0.14, with statistically significant differences (all P < 0.05). Finally, 5 primary indicators, 23 secondary indicators and 43 tertiary indicators were formed, including five aspects of vital signs, consciousness and pupils, postoperative blood drainage, lab results, symptoms and chief complaints. Conclusion:The expert consultation on the early warning indicators of IHCA for adult patients tends to be consistent and scientific, which is applicable to help nurses detect the changes of patients' condition as early as possible.

In view of the shortage of research on the seismic performance of medical imaging equipment, this paper investigates and summarizes the seismic regulatory requirements and seismic tests of medical imaging equipment, and focuses on the parameter selection, detection steps, result evaluation and detection equipment requirements of seismic detection of medical imaging equipment. The seismic test data of medical imaging equipment with various installation modes are analyzed, and the seismic performance of medical imaging equipment is analyzed and summarized.
Diagnostic Imaging

Objective:To understand the sleep quality and mental health status of nurses in public health emergencies, and analyze the correlation between them.Methods:A total of 128 first-line nursing staff participating in public health emergencies on February 22-23, 2020 in Tianjin Beichen Hospital, Tianjin First Central Hospital, Tianjin Fourth Central Hospital were investigated by the general data questionnaire, Pittsburgh Sleep Quality Index (PSQI), and Symptom Checklist 90 (SCL-90).Results:70.3%(90/128) of nursing staff had poor sleep quality, and the total score of PSQI was (9.71±4.01) points, which was statistically significant compared with the domestic norm ( t value was 16.479, P<0.01). The total score of SCL-90 was 1.59±0.52, which was statistically significant compared with the domestic norm ratio ( t value was 4.505, P<0.01). One-way ANOVA showed that the nursing staff's age had a significant impact on sleep quality, and the difference was statistically significant ( F value was 4.092, P<0.05). Pearson correlation analysis showed that the Pittsburgh sleep quality scale index scores and symptom self-assessment scale and somatization, force, sensitive interpersonal relationship, depression, anxiety, hostile, terrorist, paranoia, and psychosis were positively correlated( r values were 0.292-0.444, P< 0.01). Conclusions:The sleep quality and mental health status of nurses in public health emergencies are poor, and the sleep quality is correlated with mental health status.

Objective:To clarify the infection and epidemic characteristics of the human metapneumovirus (HMPV) in Chinese patients with febrile respiratory syndrome (FRS), and to provide important baseline data for clinical diagnosis, treatment, prevention and control of HMPV-induced respiratory tract diseases in China.Methods:FRS cases from January 2009 to June 2021 in 9 provinces in China, including Beijing, Hebei, Jilin, Shandong, Shaanxi, Xinjiang, Anhui, Guangdong, Hunan were retrospectively analyzed for their respiratory samples, clinical and epidemic data.The respiratory samples were detected for HMPV by quantitative real-time PCR.Results:A total of 11 660 cases were tested for HMPV, involving 296 (2.54%) HMPV-positive cases.Among 296 HMPV-positive cases, 218 were single HMPV infection, and 78/296 (26.35%) were co-infected with one or more respiratory viruses.HMPV mainly affected children under 5 years of age (3.10%), and in this population, the proportion of pneumonia in HMPV co-infection cases was significantly higher than that of single HMPV infection.HMPV could be detected all year round, which was more popular in winter and spring, with the peak of HMPV epidemic in March.Conclusions:HMPV is one of the important pathogens causing acute respiratory infection in children, showing a clear seasonal epidemic.HMPV can be infected alone or in combination with other respiratory viruses, which may increase the risk of pneumonia in children.

Objective:To explore the effect of mindfulness therapy on self burden, hope and sleep of middle-aged bladder cancer patients undergoing bladder sparing chemotherapy.Methods:Sixty patients with bladder cancer treated by intravesical instillation chemotherapy with bladder preservation from January 2018 to December 2019 were selected as the study subjects. They were divided into control group and intervention group according to the sequence of chemotherapy time, with 30 cases in each group. Both groups received routine nursing and rehabilitation training in urology, and mindfulness therapy was added to the intervention group for 6 weeks. Before and 6 weeks after the intervention, the sleeping and mental status of the two groups were compared by the Self-Burden Feeling Scale (SPBS), Herth Hope Scale (HHI) and Insomnia Severity Index Scale (lSI).Results:There was no significant difference in SPBS, HHI and ISI scores between the two groups before intervention ( P > 0.05). After 6 weeks of intervention, SPBS score of patients in the intervention group was 47.00±1.41, and that of the control group was 49.50±0.62.After 6 weeks of intervention, the total score of HHI was 32.61±1.94 in the intervention group and 27.22±2.67 in the control group.After 6 weeks of intervention, ISI score of patients in the intervention group was 19.17± 1.72, and that of the control group was 20.67±2.24. The difference between the two groups was statistically significant ( t values were 6.454, -7.042, 2.097, P < 0.01 or 0.05). Conclusions:Mindfulness therapy can effectively improve insomnia and cancer emotional problems in patients with bladder cancer who underwent bladder preservation and perfusion.