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.

Objectives:To evaluate the safety and mid-term clinical efficacy of cement augmentation of pedicle screws in the treatment of thoracolumbar osteoporotic vertebral compression fractures complicated with spinal kyphosis deformity.Methods:A retrospective study was conducted to analyze the clinical data of el-derly patients with osteoporotic vertebral compression fractures complicated with spinal kyphosis deformity ad-mitted and treated from January of 2017 to October of 2020.According to whether pedicle augmentation us-ing bone cement was used,the patients were divided into a cement-augmented group(22 cases,cement-augmented pedicle screws)and a control group(23 cases,pedicle screws without cement augmentation).In the reinforced group,there were 9 males and 13 females;age ranged from 70 to 91 years,with a mean of 78.68±7.12 years;disease duration ranged from 1.1 to 3.8 years,with a mean of 2.39±0.71 years.In the control group,there were 10 males and 13 females;age ranged from 70 to 89 years,with a mean of 77.73±5.83 years,and disease duration ranged from 0.8 to 3.3 years,with a mean of 2.38±0.67 years.The follow-up period was 36-69 months.The incidence of pedicle screw loosening,correction rate of kyphosis,and improvement rate of visual analogue scale(VAS)and Oswestry disability index(ODI)at final follow-up were compared between the two groups.Results:In the cement-augmented group,1-2 segments of surgical decompression were performed,6-9 segments were fixed and fused,and 14 cases underwent SPO and 8 cases underwent PSO.The operational time was 221±32mins,and the volume of blood loss was 939±113mL.In the control group,1-3 segments of surgical decompression were performed,6-8 segments were fixed and fused,and 16 cases underwent SPO and 7 cases underwent PSO.The operative time was 209±36mins,and the vol-ume of blood loss was 979±111mL.One case in the cement-augmented group and two cases in the control group complicated with cerebrospinal fluid leakage,which were treated with intraoperative repair of the dura mater,tight suturing of the incision,and postoperative Trendelenburg's position.There was no statistical differ-ence in the comparison of decompression segments(t=1.785,P=0.081),fusion segments(t=0.922,P=0.362),oper-ative time(t=1.162,P=0.252),bleeding(t=1.193,P=0.239),and CSF leak complications(x2=0.311,P=0.577)be-tween the two groups.There were no complications of incision infection or leakage of bone cement into the spinal canal causing neurological symptoms.At final follow-up,the screw loosening rate was 0％in the ce-ment-augmented group(0/268)and 18.6％in the control group(45/242).The difference in screw loosening rate between the two groups was statistically significant(x2=54.657,P=0.000).The correction rate of kyphosis defor-mity was(73.27±9.78)％in the cement-augmented group and(55.96±11.31)％in the control group.There was a significant difference in the correction rate of kyphosis between the two groups(t=5.480,P=0.000).The im-provement rate of VAS in the cement-augmented group was(67.94±14.72)％,while in the control group was(74.29±13.18)％.There was no significant difference in the improvement rate of VAS between the two groups(t=1.526,P=0.134).The improvement rate of ODI in the cement-augmented group was(82.01±3.11)％,while in the control group it was(81.96±3.58)％,there was no significant difference in the improvement rate of ODI between the two groups(t=0.41,P=0.968).Conclusions:The application of cement augmentation of pedicle screws in decompression,osteotomy,and long segment fixation fusion for the treatment of thoracolumbar osteo-porotic vertebral compression fractures with spinal kyphosis deformity can effectively reduce the loosening rate of pedicle screws and improve the correction rate,resulting in satisfactory clinical outcomes.

Objective:To investigate the establishment method, coordination points and safe transport management strategy of vena-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with downtime difficulties during cardiopulmonary bypass (CPB).Methods:A observation study was conducted. The patients admitted to the department of critical care medicine of the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital) from January 2020 to October 2022 were enrolled. These patients could not be separated from CPB and received VA-ECMO-assisted CPB surgery. The clinical data of the patients were recorded, including the basic information of the patients, the data of VA-ECMO establishment and transport process, the clinical indicators before and after VA-ECMO installation, the operation data of VA-ECMO and clinical outcomes. The experience was summarized from the aspects of extracorporeal membrane oxygenation (ECMO) establishment, transport process, team cooperation, and adverse events during transport. The clinical indicators before and after ECMO operation were compared. According to whether ECMO was successfully weaned, the patients were divided into a successful weaning group and a failure weaning group, and the clinical data between the two groups were compared.Results:Eighteen patients who underwent VA-ECMO-assisted CPB were enrolled, including 10 males and 8 females. The average age was (56.7±12.3) years old. Preoperative left ventricular ejection fraction (LVEF) was 0.46±0.10, and the main reasons for switching to VA-ECMO assistance included right ventricular systolic weakness in 6 cases, total cardiac systolic weakness in 5 cases, left ventricular systolic weakness in 4 cases, high pulmonary arterial pressure in 2 cases, and intractable ventricular fibrillation in 1 case. Among the 18 patients transferred from CPB to VA-ECMO, 10 cases were successfully weaned and 8 cases failed. In ICU, 8 cases survived, 5 cases died, and 5 cases gave up treatment and discharged. The average time for successful CPB to VA-ECMO establishment was (24.6±7.4) minutes, initial blood flow was (3.3±0.4) L/min, and transit time was (8.4±1.5) minutes. ECMO-assisted duration averaged (82.0±69.3) hours. Adverse events occurred in 9 patients during ECMO establishment and transfer. Post-ECMO onboarding for 4 hours, significant improvements were noted in blood lactic acid (Lac), pH value, mean arterial pressure (MAP), central venous oxygen saturation (ScvO 2) as compared with pre-ECMO onboarding [Lac (mmol/L): 10.5±7.0 vs. 15.2±6.8, pH value: 7.38±0.92 vs. 7.26±0.87, MAP (mmHg, 1 mmHg≈0.133 kPa): 74.9±13.7 vs. 58.4±17.0, ScvO 2: 0.678±0.065 vs. 0.611±0.061, all P < 0.01], and vasoactive-inotropic score (VIS) was also decreased (39.8±29.8 vs. 68.9±64.4, P < 0.01). Compared with successful weaning group, the patients in the failed weaning group exhibited higher pre-machine Lac (mmol/L: 18.8±7.8 vs. 12.3±4.3, P < 0.05), longer CPB time [minutes: 238.0 (208.8, 351.2) vs. 200.0 (185.8, 217.0), P < 0.05], and shorter ECMO-assisted time [hours: 19.5 (11.0, 58.8) vs. 94.5 (65.8, 179.8), P < 0.01]. However, there was no statistically significant difference in pre-machine pH value, ScvO 2, MAP, VIS score, and initial blood flow and establishment time of ECMO between the two groups. Conclusions:VA-ECMO is an effective circulatory aid for CPB surgery that cannot be weaned after CPB. The establishment and transfer of CPB "bridge" to ECMO aid depends on multi-disciplinary treatment (MDT) cooperation. The success rate of ECMO weaning is related to the Lac and CPB duration. If it is not possible to detach from the CPB successfully, VA-ECMO should be initiated as early as possible.

Objective:To integrate the best evidence for early rehabilitation of mechanically ventilated ICU-acquired weakness (ICU-AW) patients using evidence-based methods, providing evidence-based basis for standardized evaluation and intervention of early exercise therapy for mechanically ventilated ICU-AW patients.Methods:A systematic search was conducted on the American Thoracic Society (ATS) Clinical Practice Guidelines, Registered Nurses' Association of Ontario (RNAO), Guidelines International Network (GIN), Canadian Medical Association Clinical Practice Guideline Library (CMACPGL), BMJ Clinical Evidence, UpToDate, Scottish Intercollegiate Guidelines Network (SIGN), PubMed, Cochrane Library, National Guideline Clearinghouse (NGC), Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), UM-library, Physiotherapy Evidence Database (PEDro), National Institute for Health and Care Excellence (NICE), New Zealand Guidelines Group (NZGG), Chinese Medical Pulse Guidelines Website, CNKI and Wanfang data and other Chinese and English databases, professional team websites, and guideline websites for expert consensus, guidelines, randomized collected trial (RCT), systematic reviews and other evidence on early exercise rehabilitation for mechanically ventilated ICU-AW patients. The search time limit was from the establishment of the database to December 31, 2023. Literature search, screening, evaluation, information extraction was independently conducted by two evaluators with cross checking, and quality evaluation of the included literature was conducted.Results:A total of 21 literatures were enrolled, including 5 guidelines, 5 systematic reviews, 4 expert consensuses, and 7 RCT, all of which with high evidence level and all were enrolled. They were summarized into seven aspects with assessment screening, exercise safety standards, precautions, setting of exercise time, exercise intensity, exercise sequence, and recommended exercise content as the core, and 32 best evidences.Conclusions:The evidence summarized can provide evidence-based basis for standardized assessment and intervention of early exercise rehabilitation in mechanically ventilated ICU-AW patients. ICU medical practitioners need to combine the actual clinical environment, individual differences and rehabilitation goals of patients, to provide targeted health guidance and intervention for the prevention of ICU-AW in mechanically ventilated patients.

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

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.

The prevalence of diabetes in China is increasing year by year， and has become a health issue of close concern to the whole society. Glucagon-like peptide-1 （GLP-1） receptor agonist （GLP-1RA）， as a new class of glucose-lowering drugs， is now widely used in the treatment of type 2 diabetes mellitus （T2DM） because of its significant glucose-lowering efficacy and low risk of hypoglycemia. As the level of evidence for its effects on improving cardiovascular system and renal protection and reducing body mass continues to improve， its status in the treatment guidelines for T2DM is gradually increasing. Currently， nine GLP-1RA drugs have been approved for the clinical treatment of T2DM in China. Although all of these drugs exert hypoglycemic effects based on the activation of GLP-1 receptors in the body， the differences in their own structures and natural GLP-1 amino acid homology lead to large differences in pharmacokinetic parameters and clinical efficacy among different analogs. In order to enable clinicians and pharmacists to have a full understanding of the characteristics and clinical evidence of these analogs and to better perform their therapeutic effects， Liaoning Provincial Pharmaceutical Society organized clinical medicine and pharmacy experts to develop a medication guide for nine GLP-1RA drugs to provide a reference for clinical medication needs and promote rational and standardized use by compiling and summarizing the pharmacological characteristics， clinical applications， adverse reactions， interactions， the medications in special populations and medication management.

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 compare the curative effects of posterior atlantoaxial non-fusion fixation and anterior cervical odontoid screw fixation in the treatment of odontoid fracture of Anderson-D'Alonzo type Ⅱ.Methods:A retrospective study was conducted to analyze the clinical data of 21 patients with odontoid type II fracture who had been treated at Department of Spine Surgery, The Central Hospital of Luohe from January, 2015 to January, 2020. The patients were divided into a posterior group subjected to posterior atlantoaxial non-fusion fixation and an anterior group subjected to anterior cervical odontoid screw fixation. In the posterior group of 12 patients, there were 7 males and 5 females with an age of (42.2±11.8) years. In the anterior group of 9 patients, there were 5 males and 4 females with an age of (40.0±9.1) years. The 2 groups were compared in terms of operation time, bleeding volume, intraoperative fluoroscopy, fusion time, cervical rotation and neck dysfunction index (NDI).Results:The differences in the preoperative general information were not statistically significant between the 2 groups, indicating comparability ( P>0.05). The implants were successfully inserted in all patients. Intraoperative fracture reduction was satisfactory and no arteriovenous or spinal cord injuries occurred. The mean follow-up time was (24.5±11.3) months. The operation time [(108.5±15.9) min] and bleeding volume [(48.3±12.2) mL] in the anterior group were significantly less than those in the posterior group [(153.9±34.2) min and (275.8±56.0) mL], and the intraoperative fluoroscopy [(13.0±2.1) times] in the anterior group was significantly higher than that in the posterior group [(7.2±1.4) times] ( P<0.05). There was no statistically significant difference in fracture healing time between the 2 groups ( P>0.05). There was no statistically significant difference either in total cervical rotation or NDI between the 2 groups at the last follow-up ( P>0.05). Conclusions:Posterior atlantoaxial non-fusion fixation can preserve the range of rotation of the cervical spine and reduce the dysfunction of the cervical spine. The anterior screw fixation may result in shorter operation time and less intraoperative bleeding, but more intraoperative X-ray fluoroscopy. Therefore, the 2 internal fixation methods should be adopted on the basis of each individual in the treatment of odontoid type Ⅱ fracture to achieve good curative results.

Different kinds of poisonous mushrooms contain different toxic components. Acute liver injury caused by amanita mushroom is the main cause of death from poisonous mushroom poisoning in China. Consumption of poisonous mushrooms has an incubation period, there is a false recovery period in the clinical process, and the early performance is slight and does not attract enough attention from doctors, and it is easy to miss the treatment opportunity. The clinical characteristics, treatment and identification of mushrooms containing amanita in 4 patients were analyzed in order to improve clinicians' understanding of the diagnosis and treatment of mushroom poisoning and early species identification.