Elderly patients with COVID-19 are at high risk of nosocomial infection due to the factors such as advanced age, frequent invasive operations, extensive use of antimicrobial agents, and lower compliance of medical staff to implement hospital infection control measures during epidemic prevention and control. During the COVID-19 epidemic, on the basis of actively treating patients, we should pay attention to the prevention and control of nosocomial infection in elderly patients, and strictly prevent and control the aggregation and outbreak of nosocomial infection.

Objective:To evaluate the accuracy of point-of-care ultrasound in diagnosis of guidewire tip misplacement during central venous catheterization.Methods:Ninety patients of both sexes, aged 18-90 yr, with body mass index of 15.5-44.8 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅳ, scheduled for elective surgery with general anesthesia requiring central venous catheter (CVC) insertion through bilateral internal jugular veins or subclavian veins, were enrolled.The ultrasound probe was used, and the target vessel was selected.Anesthesia was induced with propofol, sufentanil and cisatracurium, and positive pressure ventilation was applied after endotracheal intubation.After central venous puncture was successfully performed under ultrasound guidance, the guidewire was inserted to a predetermined length, and the tips of the guidewire were confirmed with X-ray film and with point-of-care ultrasound including a phased array probe and linear array probe, and the results were recorded.The CVC was inserted after confirming the guidewire tip position.Agreement between the guidewire tip misplacement confirmed with point-of-care ultrasound and with bedside X-ray film was analyzed using Kappa statistics.The sensitivity, specificity, and total coincidence rate, rate of misdiagnosis, rate of missed diagnosis, Youden index, odds product, positive predictive value and negative predictive value of the guidewire tip misplacement were calculated during central venous catheterization confirmed using point-of-care ultrasound. Results:Among the 90 patients, 17 cases had guidewire tip misplacement, and the incidence of guidewire tip misplacement was 19%.Point-of-care ultrasound and bedside X-ray film were consistent in the diagnosis of guidewire tip misplacement during CVC insertion (Kappa value 0.945, P<0.05). The sensitivity of point-of-care ultrasound in diagnosing guidewire tip misplacement during CVC insertion was 97.44 %, specificity 97.78%, total coincidence rate 97.67%, rate of misdiagnosis 2.22%, rate of missed diagnosis 2.56%, Youden index 95.22%, odds product 1 672, positive predictive value 95.00%, and negative predictive value 98.88%. Conclusion:Point-of-care ultrasound can be used to diagnose guidewire tip malposition during central venous catheterization.

Objective:To explore the current status of nursing practice in the prevention and control of ICU catheter-associated bloodstream infection (CLABSI) in domestic ClassⅢ Grade A hospitals, evaluate the weaknesses in nursing practice, and discuss the common problems.Methods:On March 1, 2017, the ICUs of totally 55 hospitals from 16 Provinces /Municipalities /Autonomous Regions nationwide where the members of the Hospital Infection Committee under the Chinese Nursing Association worked were selected by convenient sampling and investigated with a self-designedquestionnaire on implementation of best practices for catheter-related bloodstream infections. Before the survey, the investigators participating in the survey were trained. Totally 134 questionnaires were recovered, accounting for a recovery rate of 100%. Totally 117 of them were valid, with a valid recovery rate of 87%.Results:In the 117 ICU, totally 71 (60.68%) ICUs filled in the incidence of CLABSI, and 18 (15.38%) data came from their departments. In the central venous catheterization (CVC) process, 65 (55.56%) ICUs were supervised; 109 (93.16%) ICUs used special puncture bags; 74 (63.25%) ICUs used sterile surgical gowns; 26 (22.22 %) ICUs used sterile towels to cover the whole body; and 13 (11.11%) ICUs used Statlock to fix the catheter. In the CVC maintenance process, the frequency of transparent dressing replacement was within 7 days in 106 (90.60%) ICUs; the frequency of gauze replacement was 1 to 2 days in 44 (37.61%) ICUs; 22 (18.80%) ICUs used disposable prefilled liquid flushing tube; 103 (88.03%) ICUs replaced infusion sets every 24 h during continuous transfusion; and 13 (11.11%) ICUs adopted chlorhexidine for sponge bath. 97 (82.91%) ICUs did not have procedures for using infusion connectors, and the nurses of 28 (23.93%) ICUs did not know the type of connectors used.Conclusions:At present, the clinical nursing measures to prevent and control CLABSI are quite different. It is recommended to standardize guidelines, conduct high-quality research, and strengthen personnel training.

Objective To observe the short-term clinical outcomes of arthroscopic single-tibial tunnel Pushlock fixation in the treatment of tibial avulsion fracture of the posterior cruciate ligament (PCL).Methods From December 2015 to January 2018,15 patients with tibial avulsion fracture of PCL were treated at Department of Articular Surgery,The Third Affiliated Hospital to Hebei Medical University.They were treated with arthroscopic single-tibial tunnel Pushlock fixation.All the fractures were fresh.They were 9 males and 6 females,aged from 14 to 64 years (average,33.6 years).The short-term outcomes were evaluated by comparing their preoperative and postoperative flexion of the knee,International Knee Documentation Committee (IKDC) and Lysholm scores.Results The operation lasted from 40 to 70 minutes (average,53 minutes).The 15 patients were successfully followed up for 10 to 18 months (average,12.2 months).All the fractures united well within 3 months after operation.All the posterior drawer tests were negative,showing no displacements or no complications like lesions of popliteal fossa,nerves and vessels,or impaired knee extension.At 6 months after surgery,the knee flexion (123.4°± 6.5°),the Lysholm scores (91.8 ± 3.5) and the IKDC scores (95.5 ± 1.6) were all significantly improved compared with the preoperative values (77.5°±13.1°,46.8 ±8.9 and 37.0±8.9) (P ＜0.05).Conclusion The tibial avulsion fracture of PCL can be treated by arthroscopic single-tibial tunnel Pushlock fixation with satisfactory early outcomes.

[Objective] To explore whether diabetes mellitus (DM) can influence the early bacterial translocation (BT) and progression of acute necrotizing pancreatitis (ANP) for guiding the early clinical treatment.[Methods] 35 Wistar male rats were randomly allocated to 4 groups,Group ANP associatcd with DM (DM+ANP,n =10):DM underwent induction of ANP;Group DM (n =10):DM underwent laparotomy with only manipulation of the pancreas and duodenum;Group ANP (n =10):non-DM underwent induction of ANP;Group sham operation (SO,n =5):non-DM underwent SO.After 12 h of the induction of ANP or laparotomy,the following parameters were analyzed:bacterial culture and identification of portal vein blood,mesenteric lymph nodes (MLNs),pancreas and liver,and calculate the total incidence of BT;serum amylase and endotoxin levels of portal vein blood;histological assessment of pancreas and ileum lesions.[Results] All animals except 3 in group DM+ANP (mortality rates:30％) and 1 in group ANP (mortality rates:10％) survived the experiment.The total incidence of BT was 23/28 (82.1％) in group DM+ANP whereas 16/36 (44.4％) in group ANP (P =0.002).Gram-positive bacteria were 17/23 (73.9％),3/16 (18.8％) in group DM+ANP and group ANP,respectively (P =0.001).Amylase activity (2302 ± 346) U/L in group ANP increased significantly (P =0.000) compared with other groups.However,group DM+ANP (501 ± 142) U/L decreased significantly (P =0.001) in comparison to group SO.Regarding to endotoxin concentrations and the severity of pancreas and ileum lesions,group DM + ANP increased significantly compared with group ANP,group DM and group SO (P ＜ 0.05).[Conclusion] Gram-positive bacteria translocates more frequently than Gram-negative bacteria in the early period of DM+ANP rats.DM aggravates the progression of ANP and increases early bacterial translocation,endotoxemia and severity of pancreas and ileum lesions.

This study was aimed to quickly identify Chinese medicine Olibanum.Thermal analysis method was used on the quality analysis of Chinese materia medica (CMM).A total of 25 batches of Olibanum on the market were collected.This study examined three important factors of temperature range,heating rate,powder mesh on the TGA and DTA thermal analysis experiments.And a method of rapid authentication of medicinal materials using TGA and DTA feature maps was built.Methods of the first-order points,connection on thermogravimetric analysis and heat enthalpy calculation were adopted in the quantitative analysis of Olibanum.The results showed that the best condition of TGA and DTA experiment on Olibanum was confirmed.The temperature range is 50-750℃.The heating rate is 20℃· min-1.The powder mesh is 100 mesh.Under these conditions,good quality goods of Olibanum,counterfeit Olibanum and adulterants of Olibanum could be distinguished through the characteristic peak (T1=447 ± 5℃,T2=549 ± 5℃,T3=350 ± 5℃),thermogravimetric analysis (TV-max,△W2+△W3) and thermal enthalpy analysis (△H).It was concluded that the TGA-DTA technology was simple.It was thought to be a rapid,accurate and simple new method for Olibanum identification and quality analysis.

Objective To study the relationships of health risk factors and health-related presenteeism in medical personnel of a tertiary grade A hospital. Methods A literature review and expert consultation were used to identify 14 health risk factors included in the survey, and the Michigan's Health Risk Appraisal Questionnaire was modified. Medical personnel of a tertiary grade A hospital in Beijing were selected for this cross-sectional study, including doctors, nurses, medical technicians, pharmacists, as well as scientific researchers, and staff members responsible for education, medical affairs, journal editors and other work. Physical measurement and questionnaire survey were conducted to collect demographic data, distribution of health risk factors of medical staff, and productivity information. Results Among 14 health risk factors, pressure or stress had the highest proportion (80.2%), followed by poor quality of sleep (63.7%), high blood lipid (33.8%), low physical activity (30.9%), and unreasonable diet (29.6%). Medical staff of different ages( c 2=16.141, P=0.001) and different occupations( c 2=15.982, P=0.003) had different probability of presenteeism. Medical staff under 30 years of age were most likely to be presenteeism (38.3%). The probability of presenteeism in nurse was the highest(56.2%). Under a high pressure and taking relax medicine seemed more likely to be presenteeism. Conclusion In the 14 kinds of health risk factors, pressure and taking relax medicine in medical staff may be associated with health-related presenteeism.

Objective:To compare and analyze clinical features between patients with early and non‐early acute coro‐nary syndrome (ACS) .Methods :A total of 120 ACS patients were selected ,including 71 patients with early ACS (early ACS group ,onset time≤12h) and 49 patients with non‐early ACS (non‐early ACS group ,onset time >12h) . Risk factors ,clinical features ,mortality ,incidence rates of myocardial infarction ,rehospitalization and major ad‐verse cardiovascular events (MACE) were compared and analyzed between two groups .Results:There were no sig‐nificant difference in percentage of each ACS risk factor between two groups , P>0.05. Compared with non‐early ACS group ,there was significant reduction in incidence rate of heart failure (73.5% vs .54.9% ) ,significant rise in incidence rates of obvious chest pain (32.7% vs .73.2% ) and shock (46.9% vs .62.0% ) in early ACS group (P<0.05 all) ,but there was no significant difference in incidence rate of arrhythmia between two groups (P>0.05) . After one‐year follow‐up , compared with non‐early ACS group , there were significant reduction in mortality (18.4% vs .4.2% ) ,incidence rates of myocardial infarction (18.4% vs .4.2% ) ,rehospitalization (30.6% vs . 14. 1% ) and MACE (38. 8% vs .16. 9% ) in early ACS group , P<0. 05 all .Conclusion:Initial symptom is more ob‐vious ,but related complications are fewer and the prognosis is better in patients with early acute coronary syndrome .

Between January 2011 and December 2011,86 patients undergoing operation for anorectal disease were randomized in a double-blind manner to receive a mixed injection of methylene blue,ropivacaine and sodium chloride (observation group,n =43) or traditional analgesic methods (control group,n =43).Patients in observation group had less visual analog scale (VAS) scores of pain at 6-48 h postoperation than control group (P ＜0.05).The scores had no significant difference at 72 h postoperation between two groups (P ＞ 0.05).The total postoperative complications (8,19％) and hospitalization duration [(5.3 ± 2.2) days] in observation group were significantly less than those [15,35 ％ and (6.4 ±1.7) days] in control group (P ＜ 0.05).A mixed injection of methylene blue and ropivacaine intraoperatively can relieve the postoperative pain of patients with anorectal disease and reduce the incidence of postoperative complications and the duration of hospitalization.