This study aimed to explore key quality control factors that affected the prognosis of intensive care unit (ICU) patients in Chinese mainland over six years (2015-2020). The data for this study were from 31 provincial and municipal hospitals (3425 hospital ICUs) and included 2 110 685 ICU patients, for a total of 27 607 376 ICU hospitalization days. We found that 15 initially established quality control indicators were good predictors of patient prognosis, including percentage of ICU patients out of all inpatients (%), percentage of ICU bed occupancy of total inpatient bed occupancy (%), percentage of all ICU inpatients with an APACHE II score ⩾15 (%), three-hour (surviving sepsis campaign) SSC bundle compliance (%), six-hour SSC bundle compliance (%), rate of microbe detection before antibiotics (%), percentage of drug deep venous thrombosis (DVT) prophylaxis (%), percentage of unplanned endotracheal extubations (%), percentage of patients reintubated within 48 hours (%), unplanned transfers to the ICU (%), 48-h ICU readmission rate (%), ventilator associated pneumonia (VAP) (per 1000 ventilator days), catheter related blood stream infection (CRBSI) (per 1000 catheter days), catheter-associated urinary tract infections (CAUTI) (per 1000 catheter days), in-hospital mortality (%). When exploratory factor analysis was applied, the 15 indicators were divided into 6 core elements that varied in weight regarding quality evaluation: nosocomial infection management (21.35%), compliance with the Surviving Sepsis Campaign guidelines (17.97%), ICU resources (17.46%), airway management (15.53%), prevention of deep-vein thrombosis (14.07%), and severity of patient condition (13.61%). Based on the different weights of the core elements associated with the 15 indicators, we developed an integrated quality scoring system defined as F score=21.35%xnosocomial infection management + 17.97%xcompliance with SSC guidelines + 17.46%×ICU resources + 15.53%×airway management + 14.07%×DVT prevention + 13.61%×severity of patient condition. This evidence-based quality scoring system will help in assessing the key elements of quality management and establish a foundation for further optimization of the quality control indicator system.
Humans ; China/epidemiology* ; Cross Infection/epidemiology* ; Intensive Care Units/statistics & numerical data* ; Quality Control ; Quality Indicators, Health Care/statistics & numerical data* ; Sepsis/therapy* ; East Asian People/statistics & numerical data*

Objective:To compare the value of new gastric cancer screening scoring system and serum pepsinogen (PG) combined with gastrin-17 (G-17) (new ABC method) in screening gastric cancer and precancerous lesions.Methods:A total of 576 patients were enrolled after the examination of endoscopy at Endoscopy Center,Department of Gastroenterology,from December 2017 to December 2019. There were 275 males and 301 females with an age of 40-72 (52±10) years. According to the new ABC method and the new gastric cancer screening scoring system, the population was divided into three groups according to age,gender,serum helicobacter pylori antibody test, PG Ⅰ/PG Ⅱ(PGR) and G-17 before endoscopy. The detection rates of gastric cancer and atrophic gastritis by two different methods were analyzed and the value in screening gastric cancer and precancerous lesions were evaluated. Statistical analysis was accomplished by Chi-square test and Gamma coefficient analysis. Results:A total of 576 patients were enrolled. According to the new ABC method, 382 patients were classified into low-risk group, 170 patients into middle-risk group and 24 patients into high-risk group, respectively. In the new ABC method, 1 case of gastric cancer (0.3%) was detected in low-risk group, 8 cases (4.7%) in middle-risk group and 3 cases (12.5%) in high-risk group. As for atrophic gastritis, 89 cases (23.3%) was detected in low-risk group, 94 cases (55.3%) in middle-risk group and 18 cases (75.0%) in high-risk group. According to the new gastric cancer screening scoring system, 336 patients were classified into low-risk group, 205 patients into middle-risk group and 35 patients into high-risk group, respectively. One case of gastric cancer (0.3%) was detected in low-risk group, 6 cases (2.9%) in middle-risk group and 5 cases (14.3%) in high-risk group. As for atrophic gastritis, 41 cases (12.2%) were detected in low-risk group, 134 cases (65.4%) in middle-risk group and 26 cases (74.3%) in high-risk group. In this two methods, the prevalence of gastric cancer increased according to the disease stage ( χ2 =22.509, P<0.01; χ2=24.156, P<0.01); in terms of atrophic gastritis, the detection rate of the new screening scoring system in the low-risk group was significantly lower than that in the new ABC method ( χ2=14.844, P<0.01), but higher in the middle-risk group ( χ2=3.955, P=0.047). Gamma coefficient test showed that there were strong correlations between gastroscopy pathology and classification grade of both methods ( P<0.01). Conclusions:Both methods are suitable for screening gastric cancer and precancerous lesions, and the new scoring system may be more valuable in screening gastric cancer and precancerous lesions.

Objective:To evaluate the effectiveness of syncope unit in improving the diagnosis efficiency and treatment prognosis of patients with suspected syncope.Methods:The standardized syncope unit was established in the Affiliated Nanyang Second General Hospital of Xinxiang Medical College in 2018. Patients with suspected syncope attending from November 2018 to April 2019 (before the establishment of syncope unit) and from May to October 2019 (after the establishment of syncope unit) were enrolled in the study. There were 109 cases attending before the establishment of syncope unit (control group) and 126 cases attending after establishment (syncope unit group). The positive rate of examination, the treatment and its cost before and after the establishment of syncope unit were compared. After one year, the follow-up rate, recurrence rate, rehospitalization rate, treatment satisfaction and quality of life of patients were documented and compared between two periods.Results:The positive rates of tilt table test [61.90%), Holter monitoring [64.29%(81/126)], exercise stress test [7.14%(9/126)] invasive electrophysiology [40.48%(51/126)], cardiac imaging [9.52%(12/126)] and 24-h blood pressure monitoring [55.56%(70/126)] in syncope unit group were significantly higher than those in control group [44.95%(49/109), 36.70%(40/109), 5.50%(6/109), 10.09%(11/109), 2.75%(3/109) and 40.37%(44/109); χ2=19.28, 23.11, 6.93, 28.18, 15.85 and 11.61,respectively; all P<0.01]. The diagnostic rate of etiology in syncope unit group was significantly higher than that in control group [87.30%(110/126) vs. 77.06%(84/109), χ2=21.70, P<0.01].The time from onset to cardiac assessment and hospitalization time in syncope unit group were significantly shorter than those in control group[(3.68±1.93)h vs. (7.31±2.64)h;(6.17±1.52)d vs. (10.83±2.09)d]. The hospitalization rate [3.17%(4/126) vs. 8.26%(8/109)], hospital mortality [0.79%(1/126) vs. 2.75%(3/109)] and treatment cost [(4.91±1.14) thousands Yuan vs. (7.05±2.53) thousands Yuan] in syncope unit group were significantly lower than those in control group ( t=14.49, P<0.01; t=8.62, P=0.02;χ2=15.83, P<0.01;χ2=10.03, P=0.01; t=6.17, P=0.03).The outpatient follow-up rate [82.54%(104/126)] and treatment satisfaction rate [91.35%(95/104)] in syncope unit group were significantly higher than those in control group [61.47%(67/109) and 64.18%(43/67)]; and the recurrence rate [14.42%(15/104)] and rehospitalization rate [7.69%(8/104)] in syncope unit group were significantly lower than those in control group [40.30%(27/67) and 23.88%(16/67)](χ2=17.30, 20.37, 18.56, 15.08,all P<0.01). The scores of psychological status, physiological status, environmental status, social relations and overall quality of life in contral group were significantly lower than those in syncope unit group (43.62±12.84 vs. 59.13±13.95,43.10±11.31 vs. 5.86±12.09,52.35±12.76 vs. 63.58±13.05,54.87±12.08 vs. 67.91±14.23,58.42±11.87 vs. 69.28±13.51; t=7.74, P=0.03; t=7.50, P=0.03; t=8.66, P=0.02; t=9.77, P=0.01; t=8.46, P=0.02, respectively). Conclusion:The establishment of standardized syncope unit is helpful to improve the diagnosis efficiency and the prognosis of patients with suspected syncope, and also reduce the cost of diagnosis and treatment.

Objective:To evaluate the new scoring system for gastric cancer screening and risk assessment of gastric precancerous lesions.Methods:A total of 442 patients who underwent endoscopy due to stomach discomfort at the First Hospital of Jiaxing from March 2018 to September 2019 were enrolled. The patients were divided into three groups based on the new scoring system for gastric cancer screening before endoscopy: low-risk group (0-11 points), median-risk group (12-16 points) and high-risk group (17-23 points). The detection rates of gastric cancer and atrophic gastritis in three groups were analyzed. According to the range or degree of atrophy or intestinal metaplasia, patients were divided into five groups of stage 0 to Ⅳ based on the operative link for gastritis assessment (OLGA) or operative link for gastritis intestinal metaplasia (OLGIM). The correlation between the new gastric cancer screening scoring system and OLGA or OLGIM staging system were evaluated.Results:Among 442 patients, 211 were assigned to low-risk group, 207 median-risk group and 24 high-risk group according to the new scoring system. For OLGA staging system, there were 241 cases of stage-0, 105 of stage-Ⅰ, 58 stage-Ⅱ, 27 stage-Ⅲ and 11 stage-Ⅳ. For OLGIM staging system, there were 224 cases of stage-0, 113 stage-Ⅰ, 61 stage-Ⅱ, 31 stage-Ⅲ and 13 stage-Ⅳ. The pepsinogen (PG) Ⅰ and pepsinogen ratio (PGR) levels had differences among different OLGA stages ( F=2.844, P=0.027; F=5.435, P=0.001), and these two variables at Stage-Ⅲ and Ⅳ were significantly lower than three other OLGA stages (all P<0.001). The PGR level had differences among different OLGIM stages ( F=3.887, P=0.008), which was significantly lower at Stage-Ⅳ than at other OLGIM stages (all P<0.001). Gamma coefficient analysis and Kendall′s tau-b analysis showed significant correlations between OLGA/OLGIM staging system and new gastric cancer screening scoring system ( P<0.001). Conclusion:The new scoring system is reliable for gastric cancer screening, and is closely linked with OLGA/OLGIM staging system in the risk assessment of gastric precancerous lesions.

Objective To observe the clinical effects of preoperative intranasal dexmedetomidine in pediatric anesthesia.Methods From April 2014 to April 2017,40 pediatric patients who accepted elective circumcision,ASA Ⅰ,aged 2 to 10 years in Wenjiang Branch of Sichan Provincial People's Hospital were divided into two groups,with 20 cases in each group.The test group received intranasal dexmedetomidine 1 μg/kg,and the control group received intranasal equal volume of saline 30 min before surgery.HR,SpO2,BP were monitored and recorded before intranasal (T0),5min after intranasal (T1),10min after intranasal (T2),20min after intranasal (T3),30min after intranasal (T4).The sedation score was assessed after 30 min of administration.The restless score was observed after waking.Results ANOVA analysis showed that there were significant differences in SBP (F =14.54,P ＜ 0.05) and DBP (F =22.69,P ＜ 0.05) between the two groups,and the SBP (F =13.77,P ＜ 0.05),DBP (F =10.48,P ＜ 0.05),HR(F =5.13,P ＜ 0.05) had interaction effects.Compared with those of the control group,the heart rate and the diastolic pressure of the test group were decreased at T2 ～ T4 (all P ＜ 0.05).The sedation score of the test group was superior than that of the control group(t =-9.131,P ＜0.05),and the postoperative agitation score was lower than that of the control group (t =3.387,P ＜ 0.05).Conclusion Intranasal dexmedetomidine can provide satisfactory sedative effects without affecting the vital signs of children and significantly reducing the postoperative agitation.

OBJECTIVE:To optimize the extraction technology of polysaccharides from antlion and explore its effect on im-mune functions of mice. METHODS:Using content of polysaccharides as investigation index,the effects of extracting polysaccha-rides from antlion by water extraction method protease hydrolysis extraction(optimized by orthogonal test using extraction tempera-ture,enzyme dosage,extraction time as indexes),and diluted alkali extraction(optimized by orthogonal test using alkali concentra-tion,extraction temperature,extraction time as indexes)were compared. 128 KM mice were randomly divided into 4 groups,then randomly divided into control group(normal saline),polysaccharides low-dose,medium-dose,high-dose groups(20,40,80 mg/kg),8 in each group,iv in tail vein,0.2 mL/10 g,once a day,for 1 week,which were respectively used to determine the phago-cytosis percentage and phagocytic index of peritoneal macrophages,spleen and thymus index,lymphocyte transformation rate and serum hemolysin levels. RESULTS:The contents of polysaccharides by 3 methods were 14.48%,38.66%,30.62%,respectively. The content of polysaccharides by protease hydrolysis extraction was the highest,the optimal extraction technology were as follows as using 100 μg/g papain extracting 3 h under 40 ℃. Compared with control group,phagocytosis percentage,phagocytic index, spleen index in polysaccharides low-dose,medium-dose,high-dose groups were significantly increased (P<0.05),thymus index was significantly decreased(P<0.05),while lymphocyte transformation rate had no significant changes(P>0.05);serum hemoly-sin in polysaccharides medium-dose group was significantly increased (P<0.05). CONCLUSIONS:Protease hydrolysis extraction is suitable for the extraction of polysaccharides from antlion,the optimal technology is reliable. Polysaccharides from antlion show activity in enhancing mice non-specific immunity and humoral immunity.

Background:Serum pepsinogens (PGs),as a serologic marker for gastric mucosal lesions,can reflect the functional status of gastric mucosa. Helicobacter pylori (Hp)infection can cause pathological changes in gastric mucosa,and has been reported to influence the serum level of PGs. Aims:To explore the influence of Hp infection on diagnostic performance of serum PGs for gastric mucosal lesions. Methods:The endoscopic findings,biopsy pathology (including Giemsa staining) and serum PGs test in 1216 cases of patients from July 2014 to June 2015 at the First Affiliated Hospital of Jiaxing University were collected. Patients were categorized according to the pathological diagnosis and Hp status,and the results of serum PGs test were analyzed between different groups. Results:When patients were classified by gastric mucosal lesion,no significant differences were found in serum levels of PGⅠ,PGⅡ,ratio for PGⅠ/ Ⅱ (PGR)and proportion of PG-positive (PGⅠ≤70 μg/ L and PGR < 3. 0)patients of different mucosal lesion groups with Hp-positive status (P >0. 05),whereas significant differences were observed in serum levels of PGⅠ,PGⅡ,PGR and proportions of patients with PGⅠ≤70 μg/ L or PGR < 3. 0 of different mucosal lesion groups with Hp-negative status (P < 0. 05). When patients were classified by Hp status,PGⅠ level and PGR were lower and PGⅡ level and proportion of PG-positive patients were higher in Hp-positive patients than in Hp-negative patients in any of the gastric mucosal lesion groups (P < 0. 05 in part of the comparisons). Conclusions:Hp infection is strongly associated with the alterations in serum PGs test,which narrows the differences in PGs between groups with different gastric mucosal lesions and expands that within the same mucosal lesion, subsequently decreasing PGR and increasing the proportion of PG-positive patients. Patients negative for Hp infection may need new cut-off value of serum PGs test to improve the sensitivity for diagnosis of gastric mucosal lesion.

Background:Hydrotalcite has been used in the treatment of gastric ulcer,but its mechanism is not clear. Aims:To investigate the efficacy and mechanism of hydrotalcite on experimental gastric ulcer in rats. Methods:Experimental acetic acid-induced gastric ulcer model was established in rats. Model rats were randomly assigned into control group,low and high dose hydrotalcite groups,and 0. 9% NaCl solution,880 mg·kg - 1 ·d - 1 ,1 230 mg·kg - 1 ·d - 1 hydrotalcite were intragastrically administrated,respectively. After 14 days,macroscopic examination was performed;and HE staining, CD31 staining and VG staining were used to evaluate the histological maturity,AB-PAS staining,level of hexosamine, immunohistochemical staining,serum levels of epidermal growth factor( EGF),prostaglandin E2( PGE2 )were used to evaluate the functional maturity. Results:Compared with control group,ulcer index(UI)was significantly decreased in high dose hydrotalcite group(P < 0. 05). Thickness of restored mucosa was significantly increased(P < 0. 05),number of cystically dilated gland was significantly decreased(P < 0. 01),microvessel density(MVD),collagen fiber,secretion of mucus,level of hexosamine,expressions of EGF,EGR receptor(EGFR)and PGE2 ,serum levels of EGF and PGE2 were significantly increased in low and high hydrotalcite groups( P < 0. 05,P < 0. 01). Conclusions:Hydrotalcite could obviously improve the histological and functional maturity of regenerative mucosa,as well as the quality of ulcer healing. The mechanism might be related to the neutralization of gastric acid,enhancement of mucus-HCO3 - barrier and up-regulation of expressions of EGF and PGE2 .

Objective To identify small non-coding RNAs encoded by plasmid pPCP1 and investigate their roles in biofilm formation, stress tolerance and/or virulence in Yersinia pestis.Methods Seven plasmid pPCP1-encoded sRNAs were identified by RNA-seq results in Y.pestis in our previous studies.Northern blot was used to validate the presence of the seven sRNAs.The sRNA-deletion mutants were constructed via λ-Red homologous recombination system.The biofilm formation, high salt tolerance and virulence of the phenotypes were compared between Y.pestis WT strain and sRNA mutants.Results and Conclusion The expression of seven pPCP1-encoded sRNAs was validated and the transcript length detected by Northern blotting corresponded to the length observed by RNA-seq.On this basis, five sRNA-deletion mutants were obtained.The capacity of biofilm formation was weakened upon deletion of sR3446.The tolerance of sR3446, sR3457, sR4338 and sR4340 mutants was found weakened in vitro compared to that of wild-type strain,but the tolerance of sR6143 was found increased.Slight virulence attenuation was found in two sRNA mutants ( sR4338 and sR4340 ) .The results suggest that pPCP1-deriving sRNA might be implicated in stress response, biofilm and virulence in Y.pestis.

OBJECTIVE To investigate the prevalence of meticillin-resistant Staphylococcus haemolyticus(MRSH)and resistance in S.haemolyticus isolates. METHODS MRSH was detected by cefoxitin disc test and susceptibilities were tested by agar dilution method. RESULTS There were 86.4% of MRSH isolates.MRSH was highly resistant to penicillin,cefazolin,cefuroxime,ceftriaxone,tetracycline,ciprofloxacin,and clindamycin.The resistance rate to amikacin,rifampicine and chloramphenicol was 16.9%,11.2% and 28.1%,respectively.All isolates were susceptible to vancomycin and teicoplanin.Except for tetracycline,amikacin,rifampicin,and chloramphenicol,the resistant rate to other antimicrobial agents was significantly higher in MRSH than in MSSH. CONCLUSIONS MRSH is mostly occupied in S.haemolyticus isolates and resistant to most of antimicrobial agents.More attention should be paid to survey and detect these strains.