Investigation of a suspected outbreak of carbapenem-resistant Klebsiella pneumonia infection / 上海预防医学

ObjectiveTo investigate a suspected outbreak of healthcare-associated infection （HAI） caused by carbapenem-resistant Klebsiella pneumonia （CRKP） in a secondary grade-A hospital， analyze the infection source and transmission route， and put forward corresponding preventive and control measures. MethodsEpidemiological investigation was conducted on 5 patients with CRKP infection in department of neurosurgery during December 23‒30， 2021. Specimens were collected with the environmental microbiology monitoring procedure. CRKP isolated from the environmental samples were analyzed by multilocus sequence typing （MLST） method. Comprehensive measures were taken to control the CRKP infection. ResultsThe 5 infected patients were located in 3 rooms， and all were diagnosed as HAI. The antimicrobial susceptibility testing results from the specimens of 3 CRKP infected patients were the same. Through environmental microbiology monitoring， CRKP strains were detected from the faucet handle and sink specimens in 3 rooms. The results of MLST analysis showed that the faucet handle and sink specimens in room 2 and 3 were ST11 type. The environmental specimen in room 1 was ST23 type. The suspected outbreak was effectively controlled after comprehensive interventions. ConclusionHAI suspected outbreak might be caused by the environmental contamination from the pathogens of CRKP-infected patients as well as the contaminated hands of medical staff and accompanying family members. Strengthening the publicity， education and management of medical staff and accompanying staff， early identification of infection outbreaks， and timely comprehensive control measures are the keys to controlling multidrug-resistant nosocomial infection outbreaks.

Quantifying calcium carbonate and organic carbon content in marine sediments from XRF-scanning spectra with a machine learning approach.

Geochemical variations of sedimentary records contain vital information for understanding paleoenvironment and paleoclimate. However, to obtain quantitative data in the laboratory is laborious, which ultimately restricts the temporal and spatial resolution. Quantification based on fast-acquisition and high-resolution provides a potential solution but is restricted to qualitative X-ray fluorescence (XRF) core scanning data. Here, we apply machine learning (ML) to advance the quantification progress and target calcium carbonate (CaCO3) and total organic carbon (TOC) for quantification to test the potential of such an XRF-ML approach. Raw XRF spectra are used as input data instead of software-based extraction of elemental intensities to avoid bias and increase information. Our dataset comprises Pacific and Southern Ocean marine sediment cores from high- to mid-latitudes to extend the applicability of quantification models from a site-specific to a multi-regional scale. ML-built models are carefully evaluated with a training set, a test set and a case study. The acquired ML-models provide better results with R2 of 0.96 for CaCO3 and 0.78 for TOC than conventional methods. In our case study, the ML-performance for TOC is comparably lower but still provides potential for future optimization. Altogether, this study allows to conveniently generate high-resolution bulk chemistry records without losing accuracy.

Clinical characteristics of 151 COVID-19 cases in a designated hospital in a district of Shanghai， 2022 / 上海预防医学

ObjectiveTo analyze the clinical characteristics of 151 local COVID-19 patients in Shanghai， 2022. MethodsThe clinical data of 151 COVID-19 patients admitted to a district-level designated hospital in Shanghai from April 13 to May 10， 2022 were reviewed， and their clinical manifestations， laboratory tests， lung imaging， treatment and outcomes were analyzed. ResultsThe 151 patients ranged from 3 to 97 years old， with a median age of 72 years. Most of them were clustered cases in the communities and families. The main clinical types were mild （95 cases， 62.9%） and general （47 cases， 31.1%）. Most of the 9 severe/critical patients （6.0%） were elderly and complicated with multiple comorbidities. The proportion of people who had not been vaccinated was as high as 66.9%， and the proportion of those among severe/critically ill patients who had not been vaccinated was even higher. The most common first symptoms were expectoration in 71 cases （47.0%）， fever in 51 cases （33.8%） and dry cough in 30 cases （19.9%）. The counts of white blood cells and neutrophils in mild or general group were mostly normal or decreased， and in the severe/critical group increased significantly （P<0.001）. Increase of troponin， D-dimer， creatinine， and myoglobin； and decrease of lymphocytes in severe/critical group were more common than the other clinical types （P<0.05）. The proportions of use of antibiotics， antiviral drugs， thymalfasin and heparin in severe/critical and general patients were significantly higher than those in mild patients （P<0.05）. Among the cured and discharged patients （138 cases， 91.4%）， the median number of days for COVID-19 viral nucleic acid to turn negative after treatment was 12 days. The negative conversion days of mild patients were significantly shorter than those of general patients and severe/critical patients （P<0.01）. Four （2.6%） death patients were all over 80 years old， unvaccinated， combined with multiple comorbidities， and eventually died of those serious comorbidities. ConclusionCOVID-19 patients at the district-level designated hospital are mainly clustered cases， and the proportion of patients who do not receive COVID-19 vaccine is high. Most of the hospitalized patients are mild， but advanced age， multiple underlying diseases， and lack of vaccination are high-risk factors for developing severe disease. Early assessment and comprehensive treatment are the key to improve prognosis.

Cross-country analysis of correlation between protection of women's economic and social rights, health improvement and sustainabledevelopment.

OBJECTIVE: The goal of this study is to assess the correlation between protection of women's economic and social rights (WESR), health improvement and sustainable development. METHODS: A cross-country analysis of 162 countries was employed to assess development, health and human rights of the countries by measuring associated variables. Data sets for the health, human rights and economic and social rights of these countries were from 2004 to 2010. The dependent variables are health and human development and the independent variables are the human rights variables. Regression analysis and principle axis factoring were used for extraction and varimax method for rotation. Country grouping was made using cluster analysis. Potential biases, resulting from measurement differences in human rights values, were eliminated by using z-transformation to standardise variables. RESULTS: Regression results reveal that WESR variable is correlated with the health outcomes. Cluster analysis separated the countries into three clusters, based on the WESR variable. Countries where WESR were 'highly respected' (44 countries) are categorised into cluster 1; countries where WESR were 'moderately respected' (51 countries) are categorised into cluster 2 and countries where WESR were 'poorly respected' (63 countries) are categorised into cluster 3. Countries were then compared in their respective clusters based on health and human development variables. It was found that the countries which 'highly respected' WESR had better average health values compared with the second and third clusters. Our findings demonstrate that countries with a strong women's rights status ultimately had better health outcomes. CONCLUSION: WESR status has correlation with the health and human development. When women's rights are highly respected, the nation is more likely to have higher health averages and accelerated development.

Single-incision laparoscopic splenectomy with conventional instruments: preliminary experience in consecutive patients and comparison to standard multiple-incision laparoscopic splenectomy.

AIM: To study the feasibility and efficiency of transumbilical single-incision laparoscopic surgery splenectomy (SILS-Sp) using conventional instruments in consecutive patients and to compare outcomes of the procedure with those of standard multiple-incision laparoscopic splenectomy (MLS). PATIENTS AND METHODS: A retrospective review was conducted to evaluate all SILS-Sp procedures performed by a single surgeon between March 2010 and January 2013. Additionally, patients who underwent MLS by other surgeons in the same surgical group during the same period were evaluated to serve as a control group. Demographic data, operative parameters, and postoperative outcomes were assessed. RESULTS: Thirteen patients underwent successful SILS-Sp during the study period without conversion to an open procedure or requiring additional ports. The median operative time was 165 minutes. There was 7.7% morbidity and no mortality in the study group. Median length of stay was 8.8 days. Additionally, 12 patients who underwent MLS were evaluated for comparison. No significant differences were identified in the preoperative patient characteristics between the two groups. For MLS, the median operative time was 158 minutes. There was 8.3% morbidity and no mortality in the group. Median length of stay was 8.3 days. SILS-Sp using conventional instruments was associated with reduced postoperative pain scores, but this did not reach statistical significance. The operative time, conversion rate, and length of stay were equivalent. The mortality, morbidity, and cost were also similar in the two groups. The umbilical incision of the single-incision group can be easily hidden in the umbilical fold with ideal cosmetic result. CONCLUSIONS: SILS-Sp is feasible and efficient in an unselected patient population in the hands of an experienced laparoscopic surgeon. The single-incision technique is comparable to standard laparoscopic splenectomy in terms of operative time and perioperative outcomes. Ideal cosmetic effect may be its potential advantage.

Benefits and challenges of electronic health record system on stakeholders: a qualitative study of outpatient physicians.

Electronic health record system (EHRS) is an important healthcare innovation associated with many controversies about the benefits and challenges to different stakeholders. The aim of this study was to investigate the utility of EHRS by outpatient physicians in Macao and to identify, in their opinions, the significance of EHRS on health institutes, patients, and physicians. Semi-structured interviews were conducted with 32 physicians who worked in the outpatient department. The interview data showed that 78% physicians interviewed used EHRS frequently during their daily practice despite individual preferences of documentation methods. They agreed that systemic health record offered by EHRS allowing smooth communication was beneficial to the health institutes, patients and physicians. However, privacy and confidentiality concerned both the health institutes and patients. Inefficiency of the EHRS that only allowed retrieval of limited medical information of the patients hindered physicians' acceptability of EHRS. It was also suggested that the health institutes should take into consideration interests of different stakeholders when designing and implementing EHRS.

Clinical implication of peri-operative urine bacterial examination in upper urinary tract stone / 中华泌尿外科杂志

Objective To analyze the bacterial distribution and resistance in upper urinary tract stone patients, then choose suitable antibiotics and reduce infectious complications accordingly.Methods Middle flow urine, infectious stone and the end of kidney drainage tube were taken for culture in 148 patients who underwent percutaneous nephrolithotomy between January 2009 to September 2010. Antibiotics were used according to the culture results and the complications secondary to infection were analyzed. Results Urinary pathogens presented in 38 (25.7%) patients before operation.There were 112 strains of bacteria. The predominant strains included: Escherichia coli (17 cases,11.5%), Staphylococcus epidermidis (4 cases) and Proteus mirabillis (4 cases). Escherichia coli and Proteus mirabillis were common in stone culture. Staphylococcus epidermidis (5 cases),Pseudomonas aeruginosa (5 cases) and Staphylococcus haemolytcus (5 cases) were found in renal drainage tube culture which were positive in 25 patients. Imipenem, cefepime, vacomycin, nitrofurinton were sensitive and commonly used antibiotics. Forty-one patients (27.7 %) had fever postoperatively, including 10 positive for middle urine culture and 9 positive for drainage tube culture. One infective shock was diagnosed postoperatively. Conclusions Gram-negative bacilli are predominant in the upper urinary tract stone patients preoperatively. Gram-positive ones are common postoperatively.Suitable antibiotics, based on middle flow urine culture, could reduce urinary infective complications.

Aortic elastic properties and its clinical significance in intracranial aneurysms / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the aortic elastic properties and its clinical significance in intracranial aneurysms (IAs).</p><p><b>METHODS</b>One hundred and seven IAs patients (57 with hypertension) and 108 healthy subjects were recruited. The internal aortic diameters in systole and diastole were measured by the M-mode echocardiography, the aortic elasticity indexes were calculated and compared.</p><p><b>RESULTS</b>The aortic distensibility (DIS) was lower and the aortic stiffness index (SI) was higher in IAs patients than those in controls (both P <0.001). DIS was lower and SI was higher in IAs patients with hypertension (IAs-HP) than those in IAs with no hypertension (P <0.001). Similar results were obtained when the aortic elasticity index were adjusted for body surface area and body mass index.</p><p><b>CONCLUSION</b>Abnormal aortic elasticity is a common finding in IAs patients and hypertension is closely related to the severity of aortic elasticity.</p>