Objectives:To investigate the effect of body mass index(BMI)on perioperative and long-term prognosis of patients with severe aortic stenosis(AS)after transcatheter aortic valve replacement(TAVR). Methods:This retrospective study imcluded 180 patients with severe AS who received TAVR in Fujian Provincial Hospital from January 2019 to January 2022.According to the BMI,patients were divided into four groups:low weight group(BMI<18.5 kg/m2,n=23),normal weight group(18.5 kg/m2≤BMI<24.0 kg/m2,n=65),overweight group(24.0 kg/m2≤BMI<28.0 kg/m2,n=57),obesity group(BMI≥28.0 kg/m2,n=35).The general clinical characteristics,imaging parameters,perioperative indexes,all-cause death and the incidence of other adverse cardiac events during(18.0±6.8)months follow-up were compared among different groups.Risk factors for the perioperative complications and long-term outcomes of TAVR were evaluated. Results:The prevalence of hypertension and diabetes,left ventricular end-diastolic diameter,ventricular septal thickness and left ventricular posterior wall thickness were significantly higher in the obese group than in normal weight group(all P<0.05).The level of prealbumin in low weight group was lower than in normal weight group(P<0.05).The total perioperative complications in low weight group were higher than in normal weight group(60.9%vs.12.3%,P=0.042).During(18.0±6.8)months follow-up,the incidence of all-cause death in the low weight group was significantly higher than that in normal weight group,overweight group and obese group(17.4%vs.4.6%vs.3.5%vs.5.7%,P=0.003).Kaplan-Meier survival analysis evidenced higher mortality rate in low weight group at 18 months after TAVR(log-rank P<0.01).Multivariate Cox regression analysis showed that the risk of long-term adverse cardiovascular events was significantly higher in low weight group than in normal weight group(HR=7.633,95%CI:1.012-57.564,P=0.049). Conclusions:Low weight patients with severe AS have a higher incidence of perioperative complications and a poor long-term prognosis.Such patients should appropriately strengthen their nutritional intake and adjust their body weight to normal levels before performing TAVR.

Objective:To analyze the correlation between serum antibody titers of anti-contactin associated protein-like 2 (CASPR2) antibody and clinical features and prognosis in encephalitis.Methods:A retrospective analysis was conducted on the clinical data of 31 patients diagnosed with anti-CASPR2 antibody encephalitis at the First Affiliated Hospital of Zhengzhou University from January 2018 to April 2024. Patients were divided into low titer group (≤1∶32) and high titer group (>1∶32) based on serum anti-CASPR2 antibody titers, and their clinical characteristics, auxiliary examination results, and prognosis were compared between the two groups.Results:Among the 31 patients with anti CASPR2 antibody encephalitis (male∶female=1∶1.4), there were 16 cases in the low titer group and 15 cases in the high titer group; The age of patients in the high titer group was (33.9±17.9)years, which was lower than that of patients in the low titer group [(52.9±17.9)years], and the difference was statistically significant ( P=0.006). The proportion of patients with prodromal infection in the high titer group (6/15) was higher than that in the low titer group (1/16, P=0.037). There was no statistically significant difference in the cerebrospinal fluid related test results, imaging examination of intracranial abnormal lesions, abnormal electroencephalogram, serum abnormal tumor markers, and serum abnormal rheumatic immune indicators between the two groups of patients (all P>0.05). During hospitalization, one patient in the high titer group died; During the follow-up period, one patient died and three patients relapsed, all of whom were in the high titer group. During follow-up, the mRS scores of 6 patients ranged from 3 to 5 points (indicating functional impairment), with 4 cases in the high titer group and 2 cases in the low titer group. The proportion of patients with poor prognosis in the high titer group (9/15) was higher than that in the low titer group (2/16), and the difference was statistically significant ( P=0.021). Conclusions:Patients with high serum anti-CASPR2 antibody titers and encephalitis have a lower age of onset and are prone to pre infection triggers. High antibody titers may be associated with a higher risk of disease recurrence and poor prognosis for patients.

Objective: To explore the relationship between different serum albumin and lymphocyte levels in patients with 2019-novel coronavirus (2019-nCoV) pneumonia (COVID-19). Methods: A retrospective study was performed to identify the characteristics of the clinical data of 205 COVID-19 patients who were hospitalized in the Happy Street of Hanchuan People's Hospital, Xiaogan, Hubei Province from January 24 to February 12, 2020, including their general information, serum albumin (ALB) levels, lymphocyte counts (LYM), percentage of lymphocytes (LYM%) and other laboratory parameter levels. Low ALB group and normal ALB group were demarcated by the concentration of 35g/L, further to identify the differences of LYM and LYM% levels and the incidence of LYM and LYM% decline at different ALB levels between groups,as well as the correlation between ALB and LYM, LYM% levels in hypoalbuminemia conditions . Results: 17.5% of COVID-19 patients were associated with hypoalbuminemia. The levels of LYM and LYM% in the low ALB group were significantly lower than those in the normal ALB group (P <0.001). The incidence of LYM and LYM% decline in the low ALB group was significantly higher than those in the normal ALB group (P <0.001). The levels of LYM and LYM% in the low ALB group were significantly positively correlated with serum ALB concentrations (P <0.05). Conclusions The decrease of lymphocyte levels in COVID-19 patients may be correlated to hypoalbuminemia. COVID-19 patients complicated by hypoalbuminemia should be actively intervened to maintain serum albumin in the normal range.

Objective To investigate the causes of a healthcare-associated lower respiratory tract infection(HA-LRTI) outbreak due to Enterobacter cloacae(E.cloacae), and provide basis for clinical prevention and control of HAI.Methods Epidemiological data of patients with E.cloacae HA-LRTI following bronchoalveolar lavage(BAL) in the departments of respiratory disease and thoracic surgery of a hospital were collected, antimicrobial resistance analysis on isolated pathogens from patients and environment was performed, pulsed-field gel electrophoresis (PFGE) was used for genotyping.Results On March 8-16, 2013, a total of 15 patients underwent BAL in the fiberobronchoscopy room in the departments of respiratory disease and thoracic surgery of a hospital, 13 of whom developed E.cloacae LRTI, 4 cases were community-associated infection (the initial case was included), the other 9 cases were HAI;8 environmental specimens were detected 2 strains of E.cloacae, the strains were from vacuum suction joint of fiberbronchoscope and scissors used for trimming disposable controllable sputum suction pipeline.15 strains of E.cloacae from environment and patients were screened by antimicrobial susceptibility testing, 11 strains were with similar antimicrobial susceptibility testing result, 2 of which were environmental strains, 6 were from inpatients, and 3 were from patients in community.PFGE typing of 11 strains revealed that there were 8 strains with the same genotype, 6 of which were from patients in department of thoracic surgery, 2 were from vacuum suction joint of fiberbronchoscope and scissors used for disposable controllable sputum suction pipeline;the other 3 strains were of the same genotype, and from departments of respiratory disease and thoracic surgery.Conclusion This outbreak is due to contamination of bronchofibroscope by the same E.cloacae strain, the strain is susceptible to the clinic commonly used antimicrobial agents, such events should be paid attention in clinic, the key to control infection is to take necessary measures for cutting off the spread of the epidemic.

Objective To understand the risk factors of hospital-acquired pneumonia(HAP) due to Carbapenem-resistant Kleb-siella pneumonia (CRKP) ,and propose prevention and control measures to reduce the incidence of hospital infection rate .Methods A total of Klebsiella pneumonia infection 73 patients with HAP ,who were treated in the ICU of a tertiary hospital in Chongqing from January 2014 to March 2016 were included .The 27 cases with CRKP were assigned as case group ,46 cases with Carbapenem-susceptible Klebsiella pneumonia(CSKP) were included as control group .Univariate and the multivariate Logistic regression analy-sis was performed for the risk factors .Results Univariate analysis showed that ,before infection ,the use of antimicrobial agents≥7 days ,Carbopenems ,mechanical ventilation ≥7 days ,APACHE Ⅱ score ,and at least 11 factors were the risk factors for CRKP HAP .Multivariate Logistic regression analysis showed that ,Carbapenems ,and mechanical ventilation≥7 days before infection and APACHE Ⅱ score was an independent risk factor of CRKP HAP .Conclusion Carbapenems ,and mechanical ventilation≥7 days before infection and APACHE Ⅱ score are the independent risk factors for CRKP HAP .Rational use of antibiotics ,reducing me-chanical ventilation and doing good hand hygiene are effective measures to reduce the incidence of CRKP HAP .

Objective To understand colonization of pathogens in nasal vestibular of health care workers (HCWs) in intensive care unit (ICU),and provide evidence for strengthening the prevention and control of healthcare-associated infection (HAI)in ICU.Methods On may 2015,colonization status of pathogens in nasal vestibular of uninfected HCWs in ICU were actively screened,bacterial culture,isolation and identification were performed.The surveyed results were analyzed and compared with antimicrobial resistance of pathogens from patients at the same stage.Results A total of 96 HCWs were surveyed,43 pathogenic strains were isolated from different HCWs’na-sal vestibular,isolation rate and carriage rate were both 44.79%.The main pathogenic bacteria was Staphylococcus aureus(n=15,34.88%),followed by Enterobacter aerogenes (n =9,20.93%)and Klebsiella pneumoniae (K . pneumoniae ,n=7,16.28%).There was a high detection rate of pathogens from nasal vestibular of doctors,HCWs who smoked frequently and those who never exercised (all P <0.05).There were 1 strain of imipenem-resistant K . pneumoniae among 43 pathogenic strains.Resistance rate of 7 K .pneumoniae from HCWs to ampicillin/sulbactam, cefazolin,and furantoin were all >50.00%,resistance rates to cefotaxime and imipenem were 28.57% and 14.29%respectively;resistance rates of 11 strains of K .pneumoniae from patients to furantoin was 100.00% during the same stage,but were sensitive to other commonly used antimicrobial agents.Resistance rate of 4 strains of Esche-richia coli (E.coli)to ampicillin was 75.00%,to gentamicin,tobramycin,levofloxacin,ciprofloxacin,and com-pound sulfamethoxazole were all 50.00%,6 strains of E.coli isolated from patients during the same period were found to be resistant to most commonly used antimicrobial agents.Conclusion Colonization rate of pathogens is high in nasal vestibular of HCWs in ICU,active screening and monitoring on colonization of pathogens in HCWs’ nasal vestibular is significant for preventing the occurrence and cross transmission of HAI among HCWs and pa-tients.

Objective To investigate the basic data and quality control indicators of infection monitoring in 67 hospitals in Chongqing area ,and provide basic data for the exploration of hospital infection monitoring norms .Methods According to the sur‐vey of the basic data and quality control index of hospital infection monitoring by the national health planning commission ,a ques‐tionnaire survey was conducted in some medical institutions in Chongqing area ,and the data were collected and analyzed .Results A total of 67 valid questionnaires were collected ,21 for tertiary hospitals ,46 for secondary hospitals ,of which there were 5 teaching hospitals ,47 general hospital ,11 hospital of traditional Chinese medicine ,3 factories hospitals ,1 private hospital .Electronic medical records management system in 67 hospitals accounted for 71 .64% ,the hospital infection information system accounted for 83 .33% ,surgical anesthesia system accounting for 31 .34% ,antimicrobial drug management and monitoring system accounted for 68 .65% .Hospital infection monitoring was mainly based on routine monitoring and target monitoring ,the correct rate of monito‐ring objects was 74 .62% ,and the usage of antibiotics was 44 .78% in the operation room .Monitoring statistics took month as a u‐nit ,accounting for 73 .13% ,the correct rate of P75 value was not high when calculating the risk factors of NNIS operation ,opera‐tion and diagnosis and treatment operation confusion accounted for 97 .01% ,the knowledge and technology of microbiological exam‐ination was relatively low .Conclusion Basic data of hospital infection monitoring and quality control survey can understand the sit‐uation of hospital infection management ,it can help to improve the monitoring level of nosocomial infection by investigating the weak links and strengthening the intervention .

Objective To understand the specimen sources,clinical characteristics,and antimicrobial resistance of Burkholderia cepacia (B .cepacia )isolated from infected patients in intensive care unit(ICU),so as to provide reference for guiding rational use of antimicrobial agents.Methods Clinical data of patients with B .cepacia infec-tion in an ICU between 2011 and 2014 were analyzed retrospectively,antimicrobial resistance of strains was ana-lyzed.Results A total of 267 B .cepacia strains were isolated,the major specimen sources were sputum (80.15%, n=214),blood(14.23%,n =38),and urine(3.37%,n =9).Antimicrobial susceptibility testing results revealed that B .cepacia had multiple resistance,and was naturally resistant to multiple clinically used antimicrobial agents, such as ampicillin,cefazolin,ampicillin/sulbactam,nitrofurantoin,and cefuroxime,resistant rates were all 100%;resistant rates to ceftazidime and levofloxacin were 4.12% and 3.00% respectively;resistant rate to compound sulfa-methoxazole had increased tendency(χ2 =5.885,P =0.015).Conclusion Isolation of B .cepacia in ICU increased year by year,antimicrobial resistance is serious,management and targeted monitoring of prevention and control of healthcare-associated infection should be strengthened,antimicrobial agents should be chosen according to antimi-crobial susceptibility testing results.

OBJECTIVE: To explore the laws of traditional Chinese medicine (TCM) syndromes in unstable angina, and to establish the preliminary diagnostic criteria for TCM syndromes. METHODS: Multi-center prospective research on TCM syndromes in 815 cases of unstable angina was done with the nonlinear dimension reduction by factor analysis. RESULTS: There were five extracted factors in factor analysis: F1, F2, F3, F4 and F5. F1 was yin deficiency of heart and kidney, F2 was deficiency of both heart and spleen, F3 was intermingled phlegm and blood stasis, F4 was qi deficiency and blood stasis, and F5 was yang deficiency and coagulated cold. Qi deficiency and blood stasis (F4) syndrome accounted for the maximum proportion. The diagnostic criteria for TCM syndromes were preliminarily and respectively established. CONCLUSION: Qi deficiency and blood stasis is the key factor of pathogenesis. The factor analysis can help us classify traditional Chinese medicine syndromes and establish the preliminary diagnostic criteria.

OBJECTIVE: To discuss the distribution laws of traditional Chinese medicine (TCM) syndrome factor and their combination in coronary heart disease (CHD), and to study the correlation between the TCM syndrome factor combination and cardiac function as well as blood-lipid. METHODS: The parameters of the cardiac function of 300 patients with a final diagnosis of CHD by coronary angiography were measured by echocardiography, and the levels of blood lipids in the CHD patients were detected. An analysis of the correlation was done between the TCM syndrome factor combination and cardiac function as well as blood-lipid in CHD. RESULTS: The TCM syndrome factor combinations of CHD were blood stasis due to qi deficiency, qi and yin deficiency, intermingled phlegm and blood stasis, and yang deficiency and blood stasis. The ejection fraction of CHD patients with yang deficiency and blood stasis was markedly decreased. The levels of triglyceride and low-density lipoprotein cholesterol in CHD patients with intermingled phlegm and blood stasis were markedly increased, and the level of triglyceride in CHD patients with qi and yin deficiency was markedly increased too. CONCLUSION: The treatment of CHD should aim directly at the symptoms and causes. It is also proved that some compound traditional Chinese herbal medicines for supplementing qi and activating blood circulation, nourishing yin and resolving phlegm, and activating yang should be used in treatment of CHD. In cases of CHD with low cardiac function, particular emphasis should be laid on activating yang and blood circulation, while in cases of CHD with blood-lipid disturbance, particular emphasis should be laid on resolving phlegm and activating blood circulation, replenishing qi and nourishing yin.