OBJECTIVE To estimate the cost-utility of sacituzumab govitecan （SG） versus single-agent chemotherapy in the treatment of hormone receptor-positive （HR+）/human epidermal growth factor receptor 2-negative （HER2－） advanced metastatic breast cancer. METHODS From the perspective of the Chinese medical system， a three-state partitioned survival model was constructed to examine the cost-utility of SG versus single-agent chemotherapy based on TROPiCS-02 trial. The cycle length was set to 1 month， and the time horizon was 10 years. The annual discount was 5%. The model output included total costs and quality adjusted life month （QALM）， and incremental cost-effectiveness ratio （ICER） was calculated for cost-utility analysis， by setting willingness-to-pay （WTP） threshold at 3 times gross domestic product （GDP） per capita of China in 2023 （22 340 yuan/QALM）. Univariate sensitivity analyses， probability sensitivity analyses， and scenario analyses were performed to evaluate the robustness of the results and calculate the price threshold when SG had economic advantages. RESULTS SG group gained incremental 4.25 QALM and 561 570 yuan compared with single-agent chemotherapy， which resulted in an ICER of 132 102/QALM that was higher than WTP. The results of the univariate sensitivity analysis showed that the monthly average cost of SG had the greatest impact on the results； the results of probability sensitivity analysis showed that the probability of SG scheme being cost-effective at the WTP threshold was 0. The results of scenario analysis showed that the conclusions of this study were robust under different time horizons （5， 10， 15 years）. The price threshold for SG being cost-effective was 1 344 yuan per 180 mg. CONCLUSIONS Based on the perspective of Chinese medical system， SG appears to be not cost-effective compared with single-agent chemotherapy for HR+/ HER2－ advanced metastatic breast cancer at the price of 8 400 yuan per 180 mg. A substantial price cut should be taken to be cost- effective.

Grid management plays an important role in improving the efficiency of social service management. The authors explored the establishment of a nosocomial infection grid management model and implemented it at a tertiary general hospital in Shanghai. χ2 test results showed that since the hospital fully implemented the grid management model in early 2016, the number of hospital infections, surgical site infections, type I surgical incision infections, and ventilator-related pneumonia had shown a downward trend year by year. The number of inspections before the use of antibacterial drugs, the number of blood cultures submitted for fever patients, and the timing of hand hygiene compliance showed an increasing trend year by year( P<0.05), and the management of nosocomial infection was more effective than the previous period. The application of grid management model required establishment of grid organization structure, control of key links, implementation of the special personnel responsibility, formulation of a performance evaluation system, and implementation of incentive measures. The grid management model can significantly reduce the risk of hospital infection, improve the efficiency of hospital infection management, and was valuable to be applicated and promoted in medical institutions.

Objective:This paper aimed to explore the problems and solutions in the management of Investigator-Initiated Trail (IIT) in medical institutions, to provide suggestions particularly in the absence of relevant high-level policy support.Methods:By combining literature review with working practice experiences, this paper analyzed the current situation of IIT’s management and the rationale, put forward suggestions.Results:IIT related problems identified including as the responsible entities of the management, research topics selection, protocol design, continuity, research team construction, ethical review and the cultivation of research management personnel. The centralized management will help the standardized management of such projects, the training of investigators and team building, the review awareness strengthening of the ethics committee, improvement of management ability.Conclusions:IIT plays an important role in promoting the development of medical scientific research. Medical institutions should integrate resources, provide platforms, train investigators assure the quality of IITs.

Objective To understand the occurrence and risk factors of healthcare-associated infection(HAI) in a neonatal intensive care unit(NICU).Methods Neonates who were admitted to the NICU of a hospital from January 2012 to December 2014 were investigated retrospectively,risk factors for HAI were performed univariate analysis.Results A total of 760 neonates were included in the investigation,198 neonates developed 259 times of HAI,incidence of HAI was 26.05％,case incidence of HAI was 34.08％,incidence of HAI per 1 000 patient days was 9.50‰;the main infection site was lower respiratory tract (n =92,35.52％);among 259 cases of HAI,172 strains of pathogenic bacteria were isolated,the major pathogen was Acinetobacter spp.(n =40,23.26％);incidence of HAI was high in neonates with gestational age ≤32 weeks,birth weight≤1 500 g,length of hospital stay ≥10 days,duration of antimicrobial use≥10 days,mechanical ventilation,deep venous catheterization,and feeding intolerance,difference was statistically significant (all P＜0.001).Conclusion Incidence of HAI in NICU is high,effective prevention and control measures should be formulated according to its risk factors,so as to reduce the occurrence of HAI in neonates.

Aim To evaluate the antitumor activity of dianhydrogalactitol ( DAG) in vitro, and further clarify its underlying mechanisms. Methods The inhibitory effect of DAG in NCI-H460 cells was detected by CCK-8 assay and colony formation assay. The morphology of cells treated with DAG was observed under optical mi-croscope. Nuclear morphology was captured by fluores-cence microscopy after Hoechst 33342 staining. Real-time PCR was used to analyze the expression level of topoisomerase Ⅱ ( Topo Ⅱ) mRNA. The protein ex-pression level of Topo Ⅱ was detected by Western blot. Additionally, molecular docking approaches were used to predict the interaction between DAG and TopoⅡ. Results DAG exhibited potent antitumor activity in NCI-H460 cells, and inhibited cell proliferation per-sistently. DAG obviously induced nuclear morphologi-cal changes of NCI-H460 cells. Furthermore, DAG could down-regulate the mRNA and protein expression level of Topo Ⅱ detected by Real-time PCR analysis and Western blot, respectively. Molecular docking predicted that DAG could bind to Topo Ⅱ. Conclu-sion DAG can significantly inhibit the proliferation of NCI-H460 cells, and its underlying mechanisms may involve the down-regulation of Topo Ⅱ mRNA and di-rect binding to Topo Ⅱ, leading to cancer cell death.

Objective To investigate the effect of group cognitive behavioral therapy on anxiety and depression in patients with chronic heart failure ( CHF ) .Methods One hundred patients with CHF were recruited from January 2012 to December 2013 in cardiovascular department , and were divided into the intervention group and the control group , with 50 patients each .Comprehensive intervention including routine heart failure care and group cognitive behavioral therapy combined with other therapies was adopted on the patients in the intervention group .The Self-rating Anxiety Scale ( SAS ) and the Self-rating Depression Scale ( SDS) were used to compare the difference of anxiety and depression between groups .Results At the baseline, the incidence of anxiety was 25%, within which 11 patients had mild anxiety , and 10 patients had moderate anxiety, and 4 patients had severe anxiety.The incidence of depression was 39%, within which 19 patients had mild depression , and 14 patients had moderate depression , and 6 patients had severe depression .The score of SAS and SDS in the intervention group after intervention were (36.90 ±8.465) and (27.53 ±7.162), respectively, which were significantly lower than (40.91 ±8.019) and (36.78 ±10.562) in the control group (t=9.244,10.335, respectively;P<0.01).Conclusions Group cognitive behavioral therapy can effectively relieve the anxiety and depression in patients with chronic heart failure .

Objective To investigate the influence of health care workers’(HCWs)hand hygiene intervention in healthcare-associated infection(HAI)in an intensive care unit(ICU).Methods Intervention measures of hand hygiene were adopted,effective supervision and management systems were established,hand hygiene compliance and HAI rate be-fore intervention(January-December 2012)and after intervention (the first stage:January-June 2013;the second stage:Ju-ly-December 2013)were compared.Results A total of 4 066 patients were surveyed,HCWs’hand hygiene compliance rate before intervention was 50.03%,the first and second stage after intervention was 61.80% and 64.57% respectively,there was increasing trend (rs=1.00,P<0.001).HAI before intervention was 5.48%,the first and second stage after inter-vention was 3.86% and 3.30% respectively,there was decreasing trend (rs=-1.00,P<0.001).Significant decreasing trends were found in rates of catheter-related bloodstream infection(CRBSI),catheter-associated urinary tract infection (CAUTI)and ventilator-associated pneumonia(VAP)(rs=-1.00,P<0.001).There were negative correlations between hand hygiene compliance rate and the infection rate of ICU,infection rate of CRBSI,CAUTI and VAP (P<0.05 ). Conclusion The improvement of hand hygiene compliance can effectively reduce the incidence of HAI in ICU ward.

We developed a microfluidic device to integrate sample introduction, bacteria culturing and results reading. The identification of multiple bacteria was achieved by combining the spatial resolution of the arrayed bacteria culture chambers and the color resolution benefited from the bacteria specific chromogenic media. A set of 4 common pathogenic bacteria responsible for urinary tract infection were used as a model to test the microfluidic assay. Our results showed that the bacteria identification assay can be completed in 15 h, with a limit of detection (LOD) of bacteria density down to 10 cfu / mL. Clinical sample testing using the microchip approach showed a coincidence rate of 96. 3% as compared with the conventional method. The developed microfluidic approach is simple and rapid, thus hold the potential to serve as a powerful tool for detection of multiple bacteria.

Objective To study the risk factors for catheter-related bloodstream infection (CRBSI)in an intensive care unit (ICU),and provide scientific evidence for CRBSI prevention and control.Methods 1 677 ICU patients with central venous catheterization (CVC)for>48 hours between January 2008 and December 2012 were divided in-to CRBSI group and non-CRBSI group,risk factors for CRBSI were analyzed.Results The utilization rate of CVC was 92.88% (21 041 d);86 (5.13%)patients developed CRBSI,the incidence of CRBSI per 1 000 catheterization-day was 4.02,the mortality of CRBSI group was significantly higher than non-CRBSI group (58.14% [50/86]vs 36.83%[586/1 591])(χ2 =15.74,P <0.01 ).Multivariate logistic regression analysis showed that the risk factors for CRBSI in-cluded length of stay in ICU>5 days,CVC>5 days,the episode of CVC>1 (P <0.01).Conclusion Realizing the occur-rence status and risk factors of CRBSI in ICU patients can provide reference for further targeted monitor and implementation of zero tolerance goal of the CRBSI.

Objective To determine the distribution and antibiotic resistance of hospital - associated pneu-monia(HAP) in senile patient,and the high risk factors of HAP,pathogenic bacterium and prognosis,so as to instruct the clinic prevention and treatment. Methods Patients with age over 60 years old,who were diagnosed of HAP with confirmed pathogens. Pathogens were identified, then the antibiotic resistance was determined by Kirty-Baucer disk dif-fusion assay. High risk factors of HAP, pathogenic bacterium and prognosis were analyzed by Logistic regression analy-sis. Results The first 10th pathogens of HAP patients were pseudomonas aeruginosa( 16.1% ),staphylococcus au-reus( 14.6% ) ,klebsiella pneumonia( 10.2% ), escherichia coil (8.8%) ,staphylococcus hemolyticus (7.3%). MR-SA accounted for 90% in staphylococcus aureus. The drug resistance of pseudomonas aeruginosa to imipenem was 29.5%. The high risk factors of HAP were acute brain accident, hypoalbuminemia, tracheal intubation or mechanical ventilation, rennal failure,COPD, gastric tube, anaemia,liver disfunction,long length of stay ( all P < 0.05 ). The mor-tality of senile HAP was 29.2%. Conclusion There are high antibiotic resistance and high mortality of HAP in se-nile patients. Measures should be taken to modify the risk factors.