为实现培养实用型与创新性相结合人才的教育目标,我们对传统的预防医学实验教学模式进行了改革,包括实验内容、考核方式、学生参与实验准备等环节。通过改革,充分激发了学生的积极性和自主性,提高了学生的实际动手能力,增强了学生的团队合作精神和创新意识,有利于学生综合素质的提高。
Objective To discuss the effect of monitoring-training-planning (MTP) intervention model on the prevention and control of catheter–associated urinary tract infection (CAUTI) in Intensive Care Unit (ICU). Methods Patients with indwelling catheter from departments with ICU (ICU, ICU of the Department of Neurosurgery, ICU of the Department of Neurologic Medicine) between 2014 and 2015 were included in this study. Based on the inclusion criteria, target monitoring indicators were set in accordance with Hospital Infection Monitoring Norms. A total of 493 patients with indwelling catheters from January to December 2014 were subjected to target surveillance, and were used as baseline for the study. A total of 529 patients with indwelling catheters from January to December 2015 were treated with MTP intervention. The occurrence of indwelling catheter–associated urinary tract infections in the intensive care unit was compared before and after intervention. Results The incidence of indwelling catheter-associated urinary tract infections before and after MTP intervention were different, and the difference was statistically significant (P<0.05). Conclusion MTP intervention model can effectively prevent and reduce indwelling catheter-associated urinary tract infections in ICU.
Objective To investigate the detection of multidrug-resistant organisms (MDRO) by targeted monitoring in a tertiary hospital, and to understand the distribution of MDRO. Methods We retrospectively analyzed the detection and distribution of methicillin-resistantStaphylococcus aureus (MRSA), carbon black alkeneAcinetobacter baumannii (CRABA), carbapenem-resistantPseudomonas aeruginosa (CRPAE), vancomycin-resistantEnterococci (VRE) and carbapenem-resistantEnterobacter (CRE) in clinical samples collected from 2013 to 2015. Results A total of 990 multidrug-resistant bacteria strains were isolated from 2013 to 2015, of which 445 were MRSA (44.95%), 328 were CRABA (33.13%), 99 were CRPAE (10.00%), 12 were VRE (1.21%), and 106 were CRE (10.71%). They were mainly distributed in the Department of Burn, Comprehensive ICU, Department of Neurosurgery, Department of Respiratory Medicine and Department of Orthopedic Surgery. The detection rates of multidrug-resistant organisms of 2013-2015 were 10.85% (352/3 244), 9.20% (304/3 303), and 7.11% (334/4 699) respectively, which reduced year by year with significant difference (χ2= 34.42,P< 0.001). The detection rates of CRPAE, CRE and VRE all reduced with significant differences (P< 0.05). Conclusions The detection rate of multidrug-resistant organisms under targeted monitoring shows an obvious downward trend. MRSA and CRABA are still the major MDROs, which show no obvious change. The detection rates of CRPAE, VRE and CRE show obvious downward trend. Department of Burn, Comprehensive ICU, Department of Neurosurgery, Department of Respiratory Medicine and Department of Orthopedic Surgery have the highest risks of MDRO. In the future, we should strengthen the monitoring of high-risk departments, and focus on the reasonable choice of special antimicrobial agents to avoid special MDROs.
ObjectiveTo explore the practical effects of multi-disciplinary team (MDT) management model in the management of multidrug-resistant organisms (MDROs).MethodsIn 2015, the multi-drug resistant MDT was established, and MDT meetings were held regularly to focus on the problems in the management of MDROs and related measures to prevent and control nosocomial infections of MDROs.ResultsThe detection rate of MDROs from 2014 to 2017 was 9.20% (304/3 303), 7.11% (334/4 699), 8.01% (406/5 072), and 7.81% (354/4 533), respectively. The difference was statistically significant (χ2=11.803, P=0.008), in which the detection rates of carbapenem-resistant Acinetobacter baumannii (CRABA), carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Enterobacteriaceae (CRE) changed significantly (χ2=39.022, 17.052, 12.211; P<0.05). From 2014 to 2017, the proportion of multi-drug resistant infections decreased year by year, from 84.54% to 52.82%, and the proportion of multi-drug resistant hospital infections also declined, from 46.05% to 23.16%; the nosocomial infection case-time rate decreased from 0.24% to 0.13% year-on-year; the proportion of multi-drug resistant hospital infections in total hospital infections was 9.07%, 11.17%, 10.47%, and 6.16%, respectively; in the distribution of multi-drug resistant nosocomial infection bacteria, the proportion of methicillin-resistant Staphylococcus aureus, CRABA, CRE hospital infections accounted for the number of MDROs detected decreased year by year. The use rate of antibiotics decreased from 46.58% in 2014 to 42.93% in 2017, and the rate of pathogens increased from 64.83% in 2014 to 84.59% in 2017.ConclusionThe MDT management mode is effective for the management and control of MDROs, which can reduce the detection rate, infection rate, hospital infection rate, and antibacterial drug use rate, increase the pathogen detection rate, and make the prevention and control of MDROs more scientific and standardized.
ObjectiveTo understand the economic burden of disinfection supply to medical institutions in Yibin City, and explore the feasibility of establishing a regional centralized management model of disinfection supply center in Yibin City.MethodsFrom April to May 2018, 263 medical institutions in the eight counties and two districts of Yibin City were investigated by means of mobile phone application-designed questionnaire, to obtain the information of cost accounting and economic burden of disinfection supply.ResultsThere were 263 medical institutions involved in the survey, in which 61 (23.19%) had set up the central sterile supply department (CSSD), including 43 public hospitals and 18 private hospitals; 202 medical institutions were without CSSD, which were mainly secondary hospitals [195 (74.14%), including 120 public hospitals and 75 private hospitals]. The higher the hospital level was, the larger the average area of the CSSD was; the difference was statistically significant (χ2=40.009, P<0.001). The higher the hospital level was, the more full-time personnel were employed, and the difference was statistically significant (χ2=31.862, P<0.001), and the care staff were the majority (66.23%). The cost burden of CSSD was more than 1 million yuan in the tertiary hospitals, which was 100 000 yuan or above in 61.90% of the secondary hospitals, and was below 100 000 yuan in hospitals below secondary level. The higher the hospital level was, the higher the total cost burden became; the difference was statistically significant (χ2=37.995, P<0.001). ConclusionIn view of the heavy economic burden of CSSD in medical institutions and the unbalanced setting up of medical institutions below secondary level, the establishment of a regional CSSD centralized management model is a new direction, new trend, and new model for future development, which is conducive to improving the quality of disinfection and sterilization, reducing medical care costs, making rational use of health resources, effectively preventing hospital infections, and ensuring the medical safety.
ObjectiveTo systematically evaluate postpartum depression risk prediction models in order to provide references for the construction, application and optimization of related prediction models. MethodsThe CNKI, VIP, WanFang Data, PubMed, Web of Science and EMbase were electronically searched to collect studies on predictive model for the risk of postpartum from January 2013 to April 2023. Two reviewers independently screened the literature, extracted data, and assessed the quality of the included studies based on PROBAST tool. ResultsA total of 10 studies, each study with 1 optimal model were evaluated. Common predictors included prenatal depression, age, smoking history, thyroid hormones and other factors. The area under the curve of the model was greater than 0.7, and the overall applicability was general. Overall high risk of bias and average applicability, mainly due to insufficient number of events in the analysis domain for the response variable, improper handling of missing data, screening of predictors based on univariate analysis, lack of model performance assessment, and consideration of model overfitting. ConclusionThe model is still in the development stage. The included model has good predictive performance and can help early identify people with high incidence of postpartum depression. However, the overall applicability of the model needs to be strengthened, a large sample, multi-center prospective clinical study should be carried out to construct the optimal risk prediction model of PPD, in order to identify and prevent PPD as soon as possible.
Objective To explore the influence and mechanism of mechanistic target of rapamycin kinase (mTOR)/ receptor of advanced glycation end products (RAGE) pathway mediated-ferritinophagy on high glucose consumption promoting invasion and migration of colorectal cancer (CRC). Methods① Patients and tissue samples. Clinical data and tissues were collected from CRC patients underwent surgery and completed the dietary questionnaire in the Second Affiliated Hospital of Harbin Medical University between October 2022 and October 2023. Real-time quantitative reverse transcription PCR (qRT-PCR) was used to analyzed the expression of nuclear receptor coactivator 4 (NCOA4) and ferritin in CRC and para-carcinoma tissues.② Cell culture and treatment. The HT29 and HCT116 cells were treated by RPMI1640 medium containing 0, 35, 70, 105, 140 mmol/L glucose, and cell counting kit-8 (CCK-8) and lactate dehydrogenase (LDH) activity analysis were performed to confirm 105 mmol/L glucose was the optimal concentration in the current study. Then the HT29 and HCT116 cells were randomly divided into: control group, glucose group; control group, glucose group, si-RAGE group, and glucose+si-RAGE group; control group, glucose group, rapamycin group, and glucose+rapamycin group. Untreated HT29 and HCT116 cells were considered as control group. The cells in glucose group were treated with 105 mmol/L glucose for 48 h. The CRC cells in si-RAGE group were transfected with si-RAGE for 6 h. The CRC cells in rapamycin group were treated with 10 nmol/L rapamycin for 48 h. The CRC cells in glucose+si-RAGE group were treated with 105 mmol/L glucose for 48 h combination transfected with si-RAGE for 6 h. The CRC cells in glucose+rapamycin group were treated with 105 mmol/L glucose for 48 h combination treated with 10 nmol/L rapamycin for 48 h. Then electron microscopy and western blot, wound healing assay and transwell assay were exhibited, respectively.③ Azoxymethane (AOM)-induced CRC rat model. The effects of glucose consumption on malignant behavior and ferritinophagy mediated by mTOR/RAGE pathway were evaluated in AOM-induced CRC rat models. A total of 16 rats were randomly divided into control group and glucose group, the colorectal tumor number was record and HE staining of colorectal tumor tissues was further performed. The expression of RAGE, mTOR, NCOA4, and ferritin in colorectal tissues of rats from each group was detected by qRT-PCR. Results① More lymphatic node metastasis and TNM Ⅲ/Ⅳ stages was observed in CRC patients from high glucose consumption group (P=0.004, P=0.004). Moreover, we confirmed that NCOA4 expression was significantly decreased (P<0.001) while ferritin was significantly increased (P<0.001) in CRC tissues especially in the CRC tissues from patients with positive lymph nodes metastasis. Additionally, high glucose consumption of CRC patients was negatively correlated with ferritinophagy flux. ② High glucose treatment significantly decreased autophagosomes in HT29 and HCT116 cells while si-RAGE transfection increased autophagic vacuoles compared to the control group. When compared with the glucose group, autophagosomes were increased in the glucose+si-RAGE group. Moreover, compared to the control group, the expression of RAGE, p-mTOR, and ferritin was increased (P<0.001) while the expression of NCOA4 was decreased (P<0.001) in glucose group, but the expression of RAGE, p-mTOR and ferritin was decreased (P<0.001) while the expression of NCOA4 was increased (P<0.001) in si-RAGE group; when compared with the glucose group, the expression of RAGE, p-mTOR and ferritin was downregulated (P<0.001) while the expression of NCOA4 was upregulated (P<0.001) in HT29 and HCT116 cells from the glucose+siRAGE group. Compared to the control group, the HT29 and HCT116 cells in the glucose group performed enhanced wound scratch healing and migration, invasion viability (P<0.05); but the HT29 and HCT116 cells in the si-RAGE group performed impaired wound scratch healing and migration, invasion viability (P<0.05). When compared with the glucose group, the HT29 and HCT116 cells in the glucose+si-RAGE group performed impaired wound scratch healing and migration, invasion viability (P<0.05).③ Rapamycin treatment significantly inhibited the expression of RAGE, p-mTOR and ferritin (P<0.05) but induced the expression of NCOA4 (P<0.05) compared to the control group. When compared with the glucose group, the expression of RAGE, p-mTOR and ferritin was downregulated (P<0.05) while the expression of NCOA4 was upregulated (P<0.05) in HT29 and HCT116 cells from the glucose+rapamycin group. Additionally, compared to the control group, rapamycin treatment performed inhibited effect on wound scratch healing and migration, invasion viability in the HT29 and HCT116 cells (P<0.05); while the HT29 and HCT116 cells in the glucose+rapamycin group performed impaired wound scratch healing and migration, invasion viability (P<0.05) when compared with the glucose group.④ In the AOM induced CRC rat model, we found the more colorectal tumors, aggravated cellular pleomorphism and upregulate expression of RAGE, p-mTOR, ferritin (P<0.05) while downregulated expression of NCOA4 (P<0.05) in the control group than those of the glucose group. ConclusionHigh glucose consumption promote invasion and migration in CRC through suppressing ferritinophagy via activating the mTOR/RAGE pathway.