ObjectiveTo understand the use of antibiotics in inpatients and the incidence and trend of hospital infections， to explore the implementation effect of comprehensive management measures， and to provide reference for hospitals to use antibiotics reasonably. MethodsBased on the hospital infection monitoring and management system， a retrospective analysis and comparison were conducted on the use of antibiotics， submission of microbial test samples， and incidence of hospital infections among inpatients in a tertiary hospital from 2012 to 2021. ResultsFrom 2012 to 2021， the use of antibiotics showed a downward trend， from 50.82% in 2012 to 41.29% in 2021. At the same time， the use rate of restricted and special antibiotics had also decreased， and the use rate of restricted and special antibiotics in patients without hospital infection was significantly lower than that in patients with hospital infection， and the microbial testing rate was also on the rise. The annual incidence rate of hospital infection was 0.69%‒1.92%， and the annual case-time prevalence rate was 0.79%‒2.17%. The annual average rate of the above two in 10 years was 1.18% and 1.34%， respectively. The results of the exponential smoothing model also showed that the utilization rate of antibiotics was decreasing and the incidence of nosocomial infection was stable. ConclusionLarge general hospitals took comprehensive management measures to strengthen the management of rational use of antibiotics， which led to a decline in the use rate of antibacterial drugs for inpatients and an increase in the rate of microbial examination. At the same time， the overall incidence of hospital infection was relatively stable， suggesting that the comprehensive management measures of antibacterial drugs in hospitals had achieved certain results. The current measures need to be optimized in the future to continuously improve the management level of rational use of antibacterial drugs.

Objective To investigate the image quality,radiation dose and contrast medium(CM)intake in coronary computed tomography angiography(CCTA)of overweight patients based on wide-detector using different tube voltages and CM of different concentrations.Methods A total of 150 overweight patients[body mass index(BMI)≥ 25 kg/m2]who underwent CCTA were divided into three groups according to scan protocols:group A(120 kVp,370 mg I/mL CM),group B(100 kVp,350 mg I/mL CM),and group C(80 kVp,320 mg I/mL CM),with each group had 50 patients.The mean CT value,mean signal-to-noise ratio(SNR),mean contrast-to-noise ratio(CNR),figure of merit(FOM)of all images were measured and calculated.Images were assessed using a 5-point scale by two radiologists.The volume CT dose index(CTDIvol)and dose length product(DLP)of each patient were recorded and the effective dose(ED)was calculated.The total iodine intake values of patients in three groups were calculated.The above data were statistically analyzed by one-way ANOVA.Results The mean CT value,mean SNR,mean CNR,and mean subjective score of groups B and C were significantly higher than those of group A(P＜0.001),but there was no significant difference between groups B and C(P＞0.05).The FOM value of groups B and C was significantly higher than that of group A(P＜0.001),and the FOM value of group B was significantly lower than that of group C(P＜0.001).The total iodine intake values of groups B and C was significantly lower than that of group A(P＜0.001).The ED and total iodine intake values in groups B and C were 30.34％,68.53％and 10.22％,16.85％lower than those in group A,respectively(P＜0.001).Conclusion Under the premise of ensuring image quality,the lower tube voltage and lower concentration of CM based on wide-detector allows for significant reduction in radiation dose and total iodine intake in CCTA for overweight patients compared to routine scan protocols.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Currently, in precision cardiac surgery, there are still some pressing issues that need to be addressed. For example, cardiopulmonary bypass remains a critical factor in precise surgical treatment, and many core aspects still rely on the experience and subjective judgment of cardiopulmonary bypass specialists and surgeons, lacking precise data feedback. With the increasing elderly population and rising surgical complexity, precise feedback during cardiopulmonary bypass becomes crucial for improving surgical success rates and facilitating high-complexity procedures. Overcoming these key challenges requires not only a solid medical background but also close collaboration among multiple interdisciplinary fields. Establishing a multidisciplinary team encompassing professionals from the medical, information, software, and related industries can provide high-quality solutions to these challenges. This article shows several patents from a collaborative medical and electronic information team, illustrating how to identify unresolved technical issues and find corresponding solutions in the field of precision cardiac surgery while sharing experiences in applying for invention patents.

Objective:To construct a training program to improve the psychological nursing ability of clinical nurses, so as to provide a strong guarantee for the clinical development of psychological nursing.Methods:By consulting the literature, related books and investigating the curriculum of nursing colleges, the first draft of the training program was drawn up. Four departments of Cardiovascular Medicine of the Second Xiangya Hospital of Central South University from May to August 2019 were recruited and 64 nurses were trained. After the training, the training program was revised again. After two rounds of training and modification, the second draft of the training program was formed, and then Delphi method was used to conduct two rounds of expert consultation on the second draft of the training program.Results:The positive coefficients of experts in the two rounds of consultation were 94.1% and 96.7% respectively, and the average authority coefficient of experts was 0.81. The final training contents included 5 first-class indexes, 18 second-class indexes and 45 third-class indexes. The coefficient of variation of each item of training contents was 0.06-0.23, and the coefficient of variation of training methods and training duration of each part was 0.06-0.17.Conclusions:The training program is scientific, reasonable, detailed and practical, which can provide guarantee for improving the psychological nursing ability of clinical nurses.

Objective:To investigate the clinical and molecular genetic characteristics of 6q24-related transient neonatal diabetes mellitus (6q24-TNDM).Methods:The clinical data of two neonates with 6q24-TNDM admitted to Shanghai Children's Hospital, Shanghai Jiao Tong University in 2017, were retrospectively collected. The methylation levels of 16 cytidine-phosphate-guanosine (CpG) sites from the methylated differentially modified region (DMR) in 6q24 were quantitatively analyzed by pyrosequencing.Results:Case 1, aged 5 d, was born at 37 +4 gestational weeks due to fetal growth restriction, and case 2 was 11-days old and born at 38 +2 gestational weeks. Both infants were male and small for age. They were born through a cesarean section. The birth weight of case 1 and case 2 were 2 340 g and 2 600 g, respectively. They were admitted due to hyperglycemia with blood glucose of 12.95 and 8.00 mmol/L on admission, respectively. Physical examination showed slightly poor skin elasticity and thin subcutaneous fat. Laboratory examination revealed lower serum insulin (<1.39 and 3.94 pmol/L) and peptide C (0.05 and 0.14 nmol/L) levels, positive results of urine glucose, negative tests for urine ketone, serum anti-glutamic acid decarboxylase antibody, anti-insulin antibody, and islet cell antibody in both cases. Normal size of the pancreas was observed by ultrasonography. The infants were improved and were discharged after subcutaneous insulin infusion for more than two weeks. The treatment was discontinued at 69 d and 42 d postnatally for case 1 and case 2. Prenatal diagnosis of the two infants showed normal karyotypes and uniparental disomy of chromosome 6 indicated by single nucleotide polymorphism chip. No pathogenic mutations were detected by next-generation sequencing after admission. The methylation levels of 16 CpG sites in DMR of 6q24 in the two cases, which were quantitatively analyzed by pyrosequencing, were lower than 10% (normal value in healthy matched controls: 40%), indicating an obvious hypomethylation. Conclusions:For children with TNDM who are small for gestational age at birth, presenting hyperglycemia with decreased serum insulin and C-peptide levels, pyrosequencing can be used to quantitatively analyze the methylation levels of CpG sites in 6q24 DMR, which can quickly and directly assist in the diagnosis of 6q24-TNDM, thereby contributing to the treatment and prognosis assessment.

This paper introduced the incidence of postpartum fatigue, and analyzed the effects of various interventions on postpartum fatigue in women, such as in self-management, exercise, psychological education, theoretical guidance as well as lavender, in the hope of providing a theoretical basis for carrying out postpartum fatigue intervention for women in China so as to help postpartum women actively cope with postpartum fatigue, meet the health demand and improve the quality of life.

Sleep disorders commonly found in pregnant women can lead to adverse pregnancy outcomes and affect postpartum physical and mental health. Proper exercise during and after pregnancy is beneficial to the overall health of a woman. Relaxation training, gymnastics, water sports, Pilates yoga and other sports interventions, as a low-cost and safe exercise, can effectively improve the sleeping status of pregnant and postpartum women and benefit their physical and mental health.

Small interfering RNA-based RNA interference(RNAi)is an emerging treatment which has attracted more and more attention from both academia and industry. Studies on clinical translation of siRNA are popular in biomedical field, where safe and efficient carriers are necessary. As novel drug/gene vectors, dendrimers are widely used in siRNA delivery due to their unique and precise structure, multiple terminal groups and nano-sized chemophysical properties. Here, we present an overall view of current studies on dendrimer-based siRNA delivery systems, with the aim to provide an understanding of future siRNA therapeutics which could be used in clinic.

Objective To investigate the change of cardiac troponin Ⅰ (cTn Ⅰ),interleukin (IL)-6 in patients undergoing cardiac valve replacement and compare the degrees of fentanil,sufentanil,and remifentanil on myocardial protection and inhibiting effect of inflammatory.Methods Forty-eight patients,undergoing cardiac valve replacement,were randomly divided into three groups (n =16):remifentanil (group R),sufentanil (group S),and fentanil (group F).All the patients were total intravenous anesthesia of midazolam,opioid,vecuronim,and propofol.Different opioids were used in each group.Group R was induced with remifentanyl 1 ～2 μg/kg and maintained at a rate of 1 ～4 μg/(kg · min).Group S was induced with sufentanyl 1 ～2 μg/kg and maintained at a rate of 1 ～4 μg/(kg · h).Group F was induced with fentanyl 5 ～ 10 μg/kg and maintained at a rate of 10 ～30 μg/(kg · h).Blood samples were taken before anesthesia (T0),twenty minutes after aortic declamping (T1),the end of operation (T2),6 h (T3),and 24 h (T4) after cardiopulmonary bypass (CPB) for determination of plasma concentration of troponinⅠ and IL-6.Results Compared to T0,cTn Ⅰ and IL-6 in three group at T1,T2,T3 were significantly higher (P ＜ 0.05),cTn Ⅰ reached the peak level at T4 (P ＜ 0.05),IL-6 reached the peak level at T3 (P ＜ 0.05).Compared to group F,cTn Ⅰ and IL-6 in groups S and R at T1,T2,T3,and T4 decreased significantly (P ＜0.05).Conclusion Compared to fentanil,sufentanil and remifentanil had comparative advantages on lessening myocardial injury and inhibiting effect of inflammatory for patients who are undergoing cardiac valve replacement.