Evidence summary of surgical site infection prevention in adult inpatients based on guidelines and clini-cal decision making / 现代医院

Objective To provide evidence-based references for the prevention of surgical site infection(SSI)by sum-marizing the best evidence for the prevention of SSI in adult inpatients.Methods The'6S'evidence resource pyramid model was used to systematically search the related evidence in domestic and foreign databases,guideline websites,and academic socie-ty websites from the inception of the database to September 30,2023.Four researchers evaluated the quality of the included guidelines,and two researchers independently evaluated the quality of other types of literature and rated the level of evidence.Results A total of 12 articles were included,including 6 clinical decision making and 6 clinical guidelines.Thirty best items of the evidence were summarized from 7 aspects:diagnosis,clinical symptoms,influencing factors,patient prevention strategies,preventive strategies for medical staff,intraoperative and postoperative treatment,and consultation and education.Conclusion Clinical staff should develop a standardized management plan for infection prevention based on corresponding evidence to reduce the incidence of SSI instead of taking a single measurement.Moreover,they need to formulate a standardized work process for preventing SSI based on the clinical practice and patients'preference.

Summary of the best evidence for intracranial hypertension care in adults with severe brain injury / 中国实用护理杂志

Objective:To summarize the best evidence of intracranial hypertension nursing for adult patients with severe brain injury, and to provide reference for clinical nursing practice.Methods:According to the evidence-based methodology, a systematic search of Chinese and English literature on intracranial hypertension nursing of adult patients with severe brain injury was conducted in domestic and foreign databases such as CNKI, Wanfang, PubMed, Cochrane Library and Cinahl Plus and so on, as well as related guide websites and professional association websites from the establishment of database to August 2022. Two researchers independently evaluated literature quality and screened evidence, and then the project team summarized and concluded the evidence.Results:A total of 6 009 articles were obtained through preliminary search, and 33 articles were included after screening, including 13 guidelines, 1 systematic review, 17 expert consensus, 1 evidence summary, and 1 meta-analysis. In total, 33 pieces of best evidence were obtained from 8 dimensions, including intracranial pressure related threshold, assessment and monitoring, respiratory care, circulation care, analgesic and sedative care, temperature care, nutrition care and cerebrospinal fluid care.Conclusions:This study summarizes the evidence-based basis of intracranial hypertension nursing in adult patients with severe brain injury, which provides a basis for the standardized construction of clinical nursing strategies and empirical research.

Characteristics of skin damage among healthcare workers during COVID-19 pandemic: an epidemiological survey / 中华皮肤科杂志

Objective:To investigate epidemiological features of skin damage among front-line healthcare workers fighting against COVID-19 pandemic.Methods:A self-designed questionnaire was released on an online survey website "wenjuan.com", and sent to the front-line medical staff caring for patients with confirmed COVID-19 in 6 infectious disease wards of the General Hospital of Central Theater Command of PLA via WeChat from March 10th to 20th, 2020. Then, the questionnaires were collected, a database was established, and statistical analysis was performed on the incidence, types and epidemiological characteristics of skin damage among the medical staff.Results:A total of about 550 medical staff were surveyed, 404 questionnaires were collected, of which 391 were valid, and 303 cases had skin damage. The survey showed that females, hand cleaning frequency > 10 times per day, wearing three-level protective equipment for more than 6 hours per week were risk factors for skin damage, and frequent use of a hand cream could reduce skin problems. Among the respondents, the incidence of skin damage was significantly higher in the females (79.81%, 249/312) than in the males (38.35%, 54/79; χ2 = 4.741, P = 0.029), and higher in the groups with hand cleaning frequency of 10-20 times per day (79.73%, 118/148) and > 20 times per day (85.71%, 84/98) than in the group with hand cleaning frequency of 1-10 times per day (69.66%, 101/145; χ2 = 9.330, P = 0.009). The incidence of skin damage was significantly lower in the group wearing protective equipment for 1-5 hours per week (64.04%, 73/114) than in the groups wearing protective equipment for 6-10 hours per week (81.48%, 66/81), 11-15 hours per week (95.24%, 20/21), 16-20 hours per week (81.82%, 36/44), 21-25 hours per week (86.49%, 32/37), and > 25 hours per week (80.85%, 76/94; χ2 = 19.164, P = 0.002). Among the 391 respondents, the skin damage related to disinfection and protective equipment mainly manifested as dry skin (72.89%), desquamation (56.78%), skin pressure injury (54.48%), skin maceration (45.01%), and sensitive skin (33.50%) ; acne (27.11%) was the related skin disease with the highest incidence, followed by facial dermatitis (23.27%), eczematous dermatitis (21.48%), folliculitis (18.92%), dermatomycosis (11.00%), urticaria (9.21%), etc. Conclusion:There was a high incidence of skin damage related to protective equipment among the front-line healthcare workers fighting against COVID-19, and strengthening skin protection could markedly reduce the incidence of skin damage.

Clinical efficacy of fractionated ultrapulse carbon dioxide laser combined with microneedle for the treatment of acne scars / 中华医学美学美容杂志

Objective To investigate the clinical efficacy of fractionated ultrapulse carbon dioxide laser combined with microneedle for depressed acne scars.Methods Totally 86 patients with depressed acne scar were randomly divided into 2 groups:the treatment group received fractionated ultrapulse carbon dioxide laser combined with microneedle technology and the control group only received fractionated ultrapulse carbon dioxide laser.The treatment interval was 1 to 3 months,and the whole course was 2-8 times.The total effective rate and the adverse reaction were analyzed in the facial acne scar.Results The surface of depressed acne scars was significantly improved.ECCA score of all patients declined obviously after treatment,the score of the treatment group declined from 61± 11 to 45± 15,and the control group declined from 57± 14 to 40± 16.There were significantly statistical differences in the results of each group (P＜0.05).More treatment times resulted in better surface improvement.The total effective rate were 81.8％ (18/22) and 100％ (24/24) in the treatment group,and 80.0％ (16/20) and 100％ (20/22) in the control group.The course was 6.8± 1.6 months in the treatment group and 20.8±4.6 months in the control group (P＜0.05) to get a similar satisfied result.There were no obvious adverse reactions except two cases of erythema and pigmentation in the treatment group and 5 cases in the control group.The former was with less adverse reactions.Conclusions Ultrapulse carbon dioxide laser combined with microneedle technique is effective for facial acne scars,with less complications and shorten treatment course.

Efficacy of Q-switch 1064 nm laser combined with microneedle technology for treatment of melasma / 中华医学美学美容杂志

Objective To investigate the clinical efficacy of Q-switch 1064 nm wavelength laser combining with microneedle technology for the treatment of melasma.Methods 70 melasma patients were selected in the Out-patient Department of Wuhan General Hospital of Guangzhou Military Command from July 2012 to Sept.2013.The patients were randomly divided into 3 groups:the combining therapy group (patients in this group received Q-switch 1064 nm wavelength laser combining with microneedles technology,the treatment interval was 2 or 3 weeks,and the whole course was 2-6 months);the microneedle group and the Q-switch 1064 nm wavelength laser group.The effect and the adverse reaction were observed and recorded during the treatment,and the reduced area of the pigment patch was also measured to judge the total efficacy after the course.Results The total effective rate was 78.6％ (22/28) in the combining therapy group and 40.0％ (8/20) in the microneedle group,45.5％ (10/22) in the Q-switch 1064 nm wavelength laser group.There were statistically significant differences between the combining therapy group and the other groups (P1 ＜0.05,P2 ＜0.05),without obvious adverse reaction.Conclusions It is significantly better to use American Medlite C6 Q-switch 1064 nm wavelength laser combining with microneedles technology than that of the single use of Q-switch 1064 nm wavelength laser or microneedles in the treatment for the patients with melasma.The method is also simple to handle and suitable for clinical application.

Clinical efficacy of hair removal by using Lightsheer Duet diode laser / 中华医学美学美容杂志

Objective To evaluate the efficiency and safety of hair removal in different areas with Lightsheer Duet diode laser and to compare clinical effect and safety in axillae hair removal between the two models,high-speed and standard model.Methods Lightsheer Duet diode laser was used to remove hairs from different areas in 200 cases,for 4-8 weeks treatment 1 time,4 times for 1course.The curative effect and adverse reaction were observed after the treatment.Thirty axillae hair removal subjects were chosen randamly and received treatments using the different models,high-speed hand piece on one side and the standard hand piece on the other side.Hair removal efficiency and the immediate pain were compared and evulated on each subject.Results The hair was significantly reduced after 4 times treatments in 200 cases.The total effective rate was 95.54 ％ and positively related with the treatment times.Pigmentation was found in 3 cases,but it disappeared after 1-3 months.The total effective rate was 100 ％ after the 3 times treatments in axillae hair removal subjects both using the high-speed model or the standard model in 30 cases.There was no statistical difference between the two models except less pain in the high-speed model.Conclusions Lightsheer Duet diode laser is a safe and efficient method in hair removal.The high-speed model has more advantage on speed and causing pain.

Expression of complement receptor type 1 on erythrocytes and its correlation with immunoglobulin E,complement C3 and C4 expressions in patients with chronic urticaria / 中华皮肤科杂志

Objective To investigate the role of erythrocyte complement receptor type 1 (CR1) in the pathogenesis of chronic urticaria.Methods Venous blood samples were collected from 59 patients with chronic urticaria (including 14 cases of dermatographism and 45 chronic idiopathic urticaria) and 29 healthy human controls.Flow cytometry was carried out to quantify the expression level of CR1,and double-antibody sandwich enzyme-linked immunosorbent assay to determine the serum level of immunoglobulin E (IgE),complement C3,C4 and 50％ complement hemolytic activity (CH50).Differences in these parameters were analyzed by one-way ANOVA and independent samples t-test,and correlation between these paramenters by Pearson correlation analysis.Results The expression level (expressed as mean fluorescence intensity per 10 000 erythrocytes) of CR1 was significantly higher in patients with dermatographism and chronic idiopathic urticaria than in the healthy controls (35.06 ± 2.06 and 29.17 ± 1.53 vs.20.46 ± 2.57,t =4.20 and 3.33,both P ＜ 0.05),while no statistical difference was observed between the patients with dermatographism and chronic idiopathic urticaria (P ＞ 0.05).Increased total serum IgE levels were observed in patients with dermatographism and chronic idiopathic urticaria compared with the healthy controls ((769.89 ± 123.0) μg/L and (340.09 ± 29.74) μg/L vs.(107.63 ± 88.79) μg/L,t =5.58,5.85,both P ＜ 0.05),and in patients with dermatographism compared with those with chronic idiopathic urticaria (t =3.49,P ＜ 0.05).For patients with chronic urticaria,there was a statistical difference in the expression level of CR1 between individuals (n=22) with total serum IgE levels ranging from 0 to 240 μg/L and those (n =17) higher than 500 μg/L (24.45 ± 10.83 vs.33.09 ± 11.86,t =3.33,P＜ 0.05).The total serum IgE levels were positively correlated with the level of CR1 (r =0.27,P ＜ 0.05),but uncorrelated with that of complement C3 (r =0.16,P ＞ 0.05) or C4 (r =-0.08,P＞ 0.05).The level of complement C3 was positively correlated with that of C4 (r =0.54,P ＜ 0.01).One-way ANOVA revealed no significant difference in the serum levels of complement C3,C4,or CH50 between the patients with dermatographism,patients with chronic idiopathic urticaria and healthy controls (all P ＞ 0.05).Conclusion CR1 is abnormally expressed in patients with chronic urticaria.

Piebaldism: a clinical survey and mutation analysis in a pedigree / 中华皮肤科杂志

Objective To investigate the clinical features of and gene mutations in a Chinese Han pedigree with piebaldism. Methods Clinical data were collected with informed consent from a pedigree with piebaldism, processed and documented. A clinical genetic analysis was conducted and pedigree chart was drawn. Genomic DNA was extracted from the peripheral blood of 14 patients and 40 unaffected individuals in the family as well as 50 unrelated human controls, and subjected to the amplification of 21 exons and flanking sequences of the KIT gene by PCR. Sequence analysis was performed by Mutation SurveyorTM. Results There were 73 members in the family, and of them, 14 were diagnosed with piebaldism according to typical clinical features. Piebaldism was inherited in an autosomal dominant pattern in this family. A heterozygous 4-base insertion mutation 1900insATGA in exon 13 of KIT gene was identified in all the 14 affected family members, which resulted in a frame-shift mutation at codon 634 and produced a premature translation termination codon. This mutation was undetected in either the unaffected family members or unrelated controls. Up to the time of this writing, this mutation had not been previously reported. Conclusion The novel mutation 1900insATGA in the KIT gene may be the cause of clinical phenotype of piebaldism in the family.

Absorption mechanism of tanshinone II A, cryptotanshinone, tanshinone I and tanshinones extract in rat small intestine in vivo / 中国中药杂志

<p><b>OBJECTIVE</b>To study the absorption mechanism of tanshinones in the roots of Salvia miltiorrhiza as well as the interaction between the components in the effective fraction.</p><p><b>METHOD</b>The model of intestinal absorption in vivo was used and the concentrations of the tanshinones were determined by HPLC, the apparent absorption constant (K(a)) and half life of absorption (t1/2) were obtained, the other components in the extract on the absorption of the there components were also studied.</p><p><b>RESULT</b>With the increase of dosage of tanshinone II A or cryptotanshinone, K(a) decreased and absorption half life t1/2 increased, the drug absorption rate constant (K(a)) had little significant effect on duodenum, Jejunum and ileum. Tanshinone I has a good absorbing in the rat small intestine. The absorption of tanshinone II A and cryptotanshinone was promoted by the other components in tanshinones extract while tanshinone I' was decreased.</p><p><b>CONCLUSION</b>When the concentration increases to a certain level, the uptake of tanshinone II A and cryptotanshinone do not increase. The transport mechanism of tanshinone II A and cryptotanshinone in vivo is similar to active transport or facilitated diffusion. They could be well absorbed in general intestinal tract without specific absorption site, and the complex constituents in extract could significant effect the absorption of the pharmaceutical effective constituents.</p>