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Objective To explore the application of metagenomic next-generation sequencing(mNGS)technology in the investigation of healthcare-associated infection(HAI)outbreaks of carbapenem-resistant Acinetobacter bau-mannii(CRAB).Methods Pathogenic detection by mNGS and conventional pathogen culture were performed on 5 patients in the intensive care unit(ICU)of a hospital from June 8 to 22,2023 from whom CRAB were detected.Microbial sampling was carried out in potentially contaminated environment.Bacterial culture,identification,and antimicrobial susceptibility testing were conducted.Comprehensive control measures were taken,and the effect was evaluated.Results The time required for reporting results by mNGS was shorter than the culture time([3.92± 1.05]days vs[6.24±0.25]days,P＜0.001).CRAB was isolated from the specimens of 5 patients.mNGS de-tected OXA-23 resistance genes from all patients.After comprehensive assessment by experts,4 patients were HAI and 1 patient was due to specimen contamination.According to the definition from Guidelines for HAI outbreak control,this event was considered an outbreak of HAI.The monitoring results of environmental hygiene showed that the detection rate of CRAB in the environment during the outbreak was 51.30％(59/115),mainly from the hands of health care workers and the surface of ventilators.After implementing multidisciplinary infection control measures,clinicians'hand hygiene compliance rate and implementation rate of ventilator disinfection increased from 40.83％(49/120)and 33.33％(16/48)to 82.61％(95/115)and 83.33％(30/36),respectively.The prognosis of patients was good,and no new case emerged during subsequent monitoring.The outbreak of HAI in this hospital has been effectively controlled.Conclusion mNGS is characterized by high precision,less time consumption,and high accuracy,and can be applied to the prevention and control of HAI outbreak and the study of antimicrobial-re-sistant genomes.It is of great significance for the anti-infection treatment of patients with multidrug-resistant orga-nism infection as well as the formulation of HAI prevention and control measures.Continuous improving disinfec-tion effectiveness and hand hygiene compliance is important for preventing and controlling CRAB infection.
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Objective: To explore the evaluation of joint injury by HEAD-US-C (Hemophilic Early Arthropathy Detection with UltraSound in China, HEAD-US-C) in patients with moderate or severe hemophilia A treated with prophylaxis vs on-demand. Methods: The patients from June 2015 to July 2017 with moderate or severe hemophilia A were examined by ultrasound imaging of the elbows, knees and ankles; Meanwhile the HEAD-US-C ultrasound assessment scale and hemophilia joint health score scale 2.1 (HJHS2.1) were used to score the joint status. The correlation between the HEAD-US-C and HJHS score was performed in prophylaxis group and on-demand group patients, respectively. Results: A total of 925 cases of joint ultrasonography were conducted in 70 patients with moderate or severe hemophilia A. Among patients with moderate hemophilia, the median (IQR) of HEAD-US-C score and HJHS score in on-demand group were significantly higher than those in the prophylaxis group[1 (0, 6) vs 0.5 (0, 3) , z=0.177, P=0.046],[2 (0, 4) vs 2 (0, 3) z=0.375, P=0.007], even though there was no significant difference of the median (IQR) number of annualized target joints bleeding episodes between on-demand and prophylaxis groups[1 (0, 7) vs 1 (0, 5) , z=1.271, P=0.137]. Unlike in moderate cases, on-demand treatment group had more annualized target joints bleeding episodes than prophylaxis group among patients with severe hemophilia[3 (0, 8) vs 2 (0, 8) , z=0.780 P=0.037]. The prophylaxis group compared favorably with on-demand therapy group in terms of HEAD-US-C score[1 (0, 6) vs 4 (0, 7) , z=2.189, P=0.008], and HJHS score[2 (0, 5) , 4 (1, 6) , z=3646, P<0.001]for the severe hemophilia patients. The positive correlation between HEAD-US-C score and HJHS score was identified (P<0.05) , whether on-demand treatment or prophylaxis groups. The correlation coefficient between HEAD-US-C score and HJHS score in on-demand treatment and prophylaxis groups were 0.739 (95% CI 0.708-0.708) , 0.865 (95% CI 0.848-0.848) respectively, and 95% CI didn't overlap (P<0.05) , indicating that the correlation coefficient in prophylaxis group had stronger correlation than that in on-demand group. Conclusions: Clinical effects of prophylaxis were significantly better than those of on-demand treatment in patients with moderate or se-vere haemophilia A. HEAD-US-C scoring system could effectively evaluate joints damage in hemophilia A patients treated with on-demand or prophylaxis, companied by significantly positive correlation with HJHS clinical evaluation system, and provided objective index for clinical effect assessment.
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Humans , China , Hemophilia A , Hemorrhage , Joint Diseases , UltrasonographyABSTRACT
Objective To explore the correlation between quantitative parameters of blood perfusion with contrast-enhanced ultrasound (CEUS) and microvessel density (MVD),microvessel area (MVA) in papillary thyroid carcinoma (PTC).And to investigate the value of CEUS in evaluating the angiogenesis in PTC before operation.Methods Totally 69 cases of patients with papillary thyroid carcinoma were selected from April 2014 to October 2016 in the Affiliated Hospital of Qingdao University.The CEUS characteristics of 69 patients with papillary thyroid carcinoma confirmed by pathology were retrospectively analyzed.The patients were divided into three groups according to maximum diameter of lesions (＜ 1 cm group,1-2 cm group and ＞ 2.0 cm group),and two groups according to pathologic reports (neck lymph node metastatic and nonmetastatic groups).The blood perfusion parameters between or among different groups were evaluated by ttest or one-way ANOVA.Immunohistochemical staining were performed to evaluate the MVD,MVA in the surgical specimens,and the correlation of quantitative parameters with MVD,MVA were assessed by Spearman.Results (1) Peak Intensity (Peak),area under the curve (AUC),MVD and MVA of thyroid carcinoma were lower than the surrounding normal thyroid tissue (14.95 ± 4.96 vs 22.67±6.11,970.01±263.20 vs 1798.35±563.67,118.91±31.32 vs 206.27±39.58,8.58±-2.68 vs 18.47±3.13),and the differences were statistically significant (t=-8.700,-11.061,-14.377 and-20.532,all P ＜ 0.05).(2)With the increase of the lesion's maximum diameter,Peak,AUC,MVD and MVA increased,and the differences were statistically significant (t=0.000,0.000,0.000,0.000;t=0.027,0.044,0.033,0.000;t=0.027,0.044,0.033,0.000,all P ＜ 0.05).(3) Papillary thyroid carcinoma with lymphatic involvement had significantly higher values of Peak,AUC,MVD and MVA than those without lymphatic involvement (16.86±4.36 vs 13.80±3.55,1128.16±290.85 vs 874.39±192.27,114.12±30.69 vs 103.67±22.19,10.30 ± 2.44 vs 7.54 ± 2.29),and the differences were statistically significant (t=3.177,4.366,6.336 and 4.742,all P ＜ 0.05).(4) A positive correlation existed between the Peak,AUC and MVD,and the differences were statistically significant (r=0.506,0.478,all P ＜0.05).Peak,AUC and MVA showed positive correlation,and the differences were statistically significant (r=0.648,0.653,all P ＜ 0.05).TP,MTT and MVD,MVA showed no correlations (all P ＞ 0.05).Conclusions The values of Peak and AUC calculated from CEUS were correlated to MVD and MVA.CEUS may be used to evaluated the angiogenesis of PTC before operation.And CEUS is helpful for prediction of prognosis of PTC.
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Objective To explore the method for controlling the proportion of medical consumables.Methods The objective and significance of controlling the proportion of medical consumables were introduced,and the method was analyzed from the aspects of bidding procurement,total control mechanism,administrative approval and involvement in department management by objectives.Results The effective management of medical consumables decreased irrationality and procurement price of medical consumables.Conclusion Controlling the proportion of medical consumables promotes public hospital reform and the economic burden of the patient.
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Objective To explore the method for controlling the proportion of medical consumables.Methods The objective and significance of controlling the proportion of medical consumables were introduced,and the method was analyzed from the aspects of bidding procurement,total control mechanism,administrative approval and involvement in department management by objectives.Results The effective management of medical consumables decreased irrationality and procurement price of medical consumables.Conclusion Controlling the proportion of medical consumables promotes public hospital reform and the economic burden of the patient.
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Purpose To evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in papillary thyroid carcinomas (PTC) by exploring the relationship between quantitative parameters of time-intensity curve (TIC) of CEUS for PTC and tumor size and metastasis of cervical lymph nodes.Materials and Methods 124 patients with PTC confirmed by surgery and pathology in the Affiliated Hospital of Qingdao University were retrospectively analyzed.According to maximum diameter of lesions (D),the lesions were divided into three groups with D＜1.0 cm,1.0 cm ≤ D ≤ 2.0 cm and D＞2.0 cm.The lesions were also divided into LN(+) group with lymph node metastasis and LN(-) group without lymph node metastasis based on pathology of cervical lymph nodes.The features of CEUS and quantitative parameters of TIC of the above groups were analyzed.Results ① The CEUS showed that the PTC nodules were mainly concentric and heterogeneous enhancement.Thyroid carcinoma with D＜1.0 cm and 1.0 cm≤D≤2.0 cm showed low enhancement (45/57,31/42),while thyroid carcinomas with D＞2.0 cm exhibited high enhancement (14/25),and the difference was significant (P＜0.05).① With the increase of the diameter of PTC,the peak intensity [(12.75 ± 3.77)％,(15.53 ± 3.62)％,(18.11 ± 4.28)％],the area under the curve [(820.52±289.19)％.s,(873.84± 156.19)％· s,(1118.8± 152.48)％ ·s] and the ratio of the perfusion defects (24.56％,52.38％,72.00％) were increased,and the differences were statistically significant (P＜0.05).③ The cervical lymph node metastasis rate of PTCs with isoenhancement or hyperenhancement patterns showed by CEUS was significantly higher than that with hypoenhancement (P＜0.05).The peak intensity and the area under the curve of LN (+) group were higher than that of LN (-) group,and the differences were statistically significant (P＜0.05).Conclusion There were significant differences in imaging features of CEUS between the PTC nodules with different size and lymph node metastasis,which can provide valuable information for clinical diagnosis.
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@#ObjectiveTo study effects of oral administering alfa calcidol and diphosphonates on the bone mineral density (BMD) of patients with spinal cord injury (SCI).MethodsChanges of BMD of the 4th lumbar spine (L4), the proximal femur (total) and all of its subareas were studied between SCI cases of taking (n=31) and not taking (n=42) alfa calcidol. Changes of BMD between cases of taking diphosphonates (n=22) and not taking (n=24) were also compared.ResultsThere were no significant differences in BMD of L4, the proximal femur and all of its subareas between SCI cases of taking and not taking alfa calcidol. While there was a significant difference in BMD of the proximal femur (total) between cases of taking and not taking diphosphonates (P<0.05), and the reducing degree of BMD in the former is less than that in the latter.Conclusion Oral administering diphosphonates has a protective effect on SCI patients' BMD of the proximal femur.