ObjectiveTo explore the feasibility and mechanism of inhibiting miR-429 to improve the permeability of the blood spinal cord barrier (BSCB) in vitro, and provide a new gene therapy target for enhancing the spinal cord microenvironment.MethodsFirst, the immortalized human brain microvascular endothelial cell line (hCMEC/D3) was transfected with the anti-miR-429 antagonist (antagomiR-429) and its negative control (antagomiR-429-NC), respectively. The miR-429 expression of hCMEC/D3 cells was observed by fluorescence microscopy and real-time fluorescence quantitative PCR to verify the transfection efficiency of antagomiR-429. Then the effect of miR-429 on BSCB permeability was observed in vitro. The experiment was divided into 4 groups. The blank control group (group A) was constructed of normal hCMEC/D3 cells and Ha-sc cells to prepare the BSCB model, the hypoxia-induced group (group B), the hypoxia-induced+antagomiR-429-NC group (group C), and the hypoxia-induced+antagomiR-429 group (group D) were constructed of normal, antagomiR-429-NC transfected, and antagomiR-429 transfected hCMEC/D3 cells and Ha-sc cells to prepare the BSCB models and hypoxia treatment for 12 hours. The permeability of BSCB in vitro was measured by horseradish peroxidase (HRP) permeability. Real-time fluorescence quantitative PCR, Western blot, and immunofluorescence staining were used to observe the expressions of ZO-1, Occludin, and Claudin-5.ResultsThe antagomiR-429 and antagomiR-429-NC were successfully transfected into hCMEC/D3 cells under a fluorescence microscope, and the transfection efficiency was about 90%. Real-time fluorescence quantitative PCR results showed that the relative expression of miR-429 in antagomiR-429 group was 0.109±0.013, which was significantly lower than that of antagomiR-429-NC group (0.956±0.004, P<0.05). HRP permeability measurement, real-time fluorescence quantitative PCR, and Western blot results showed that the HRP permeability of groups B and C were significantly higher than those of groups A and D (P<0.05), and the relative expressions of ZO-1, Occludin, and Claudin-5 proteins and mRNAs were significantly lower in groups B and C than in groups A and D (P<0.05) and in group D than in group A (P<0.05); there was no significant difference between groups B and C (P>0.05). Immunofluorescence staining showed that the immunofluorescence of ZO-1, Occudin, and Claudin-5 at the cell membrane boundary in group D were stronger than those in groups B and C, but not as strong as that in group A.ConclusionInhibition of miR-429 expression can promote the expressions of ZO-1, Occludin, and Claudin-5 proteins in microvascular endothelial cells, thereby improving the increased permeability of BSCB due to hypoxia.
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.
ObjectiveTo compare the strength difference between the interfacial screw and the interfacial screw combined with bone tunnel crossing technology to fix the tibial end of ligament during anterior cruciate ligament (ACL) reconstruction through the biomechanical test.MethodsTwenty fresh frozen pig tibia were randomly divided into two groups (n=10) to prepare ACL reconstruction models. The graft tendons in the experimental group were fixed with interfacial screw combined with bone tunnel crossing technology, and the graft tendons in the control group were fixed with interfacial screw. The two groups of specimens were fixed in the high-frequency dynamic mechanics test system M-3000, and the length change (displacement), ultimate load, and stiffness of graft tendons were measured through the reciprocating test and load-failure test.ResultsThe results of reciprocating test showed that the displacement of the experimental group was (3.06±0.58) mm, and that of the control group was (2.82±0.46) mm, and there was no significant difference between the two groups (t=0.641, P=0.529). The load-failure test results showed that the stiffness of the experimental group and the control group were (95.39±13.63) and (91.38±14.28) N/mm, respectively, with no significant difference (t=1.021, P=0.321). The ultimate load of the experimental group was (743.15±173.96) N, which was significantly higher than that of the control group (574.70±74.43) N (t=2.648, P=0.016).ConclusionIn ACL reconstruction, the fixation strength of tibial end with interface screw combined with bone tunnel crossing technology is obviously better than that of interface screw alone.
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.
Objective To investigate the effectiveness of transosseous suture in medial patellofemoral ligament (MPFL) double bundle reconstruction. Methods The clinical data of 75 patients with recurrent patella dislocation who met the selection criteria between January 2014 and December 2017 were retrospectively analyzed. All of them were treated with MPFL double bundle reconstruction, and divided into study group (39 cases, using new transosseous suture technique) and control group (36 cases, using traditional suture anchor fixation) depending on the intraoperative fixation technique. There was no significant difference in gender, age, body mass index, affected knee side, preoperative tibial tuberosity-trochlear groove distance, Insall-Salvati ratio, knee range of motion, Kujala score, International Knee Documentation Committee (IKDC) score, congruence angle, and tilt angle between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stay, and postoperative complications were recorded and compared between the two groups. Kujala score, IKDC score, and knee range of motion were used to evaluate the functional improvement of patients before and after operation. The congruence angle and tilt angle were measured on X-ray films. Results There was no significant difference in operation time, intraoperative blood loss, and hospital stay between the two groups (P>0.05). Patients in both groups were followed up 24-36 months, with an average of 29.4 months. There was no complication such as incision infection, fat liquefaction, patellar redislocation, and prepatellar pain during follow-up. At last follow-up, the Kujala score, IKDC score, knee range of motion, congruence angle, and tilt angle of two groups significantly improved when compared with those before operation (P<0.05), while there was no significant difference between the two groups (P>0.05). ConclusionThe application of suture anchor or transosseous suture to complete MPFL double bundle reconstruction can restore patellar stability, and there is no significant difference in the short-term effectiveness between them.
ObjectiveTo analyse the quality of implementation in clinical application guidelines of the Chinese patent medicines for the treatment of common diseases. MethodsWe retrieved clinical application guidelines of the Chinese patent medicines for the treatment of common diseases published from February, 2019 to August, 2022 in databases. The clinical practice guideline (CPG) implementation evaluation tool was used to evaluate the implementation of the included guidelines. ResultsA total of 29 guidelines were included. The implementation quality of included guidelines was moderate. Thirteen (44.8%) were high quality and 16 (55.2%) were moderate quality. ConclusionThe quality of implementation of clinical application guidelines of the Chinese patent medicines for the treatment of common diseases is higher than that of other traditional Chinese medicine CPG. The CPG implementation evaluation tool can be used in traditional Chinese medicine CPGs and particularity of TCM should also be considered.