Effects of intrauterine infection in different periods on the placenta and endometrial blood vessel formation of pregnant mice and the growth and development of fetal rats

Objective:To investigate the effects of intrauterine infection in different periods on the placenta and endometrial blood vessel formation of pregnant rats and the growth and development of fetal rats.Methods:According to the random number table method,32 pregnant rats were divided into the early infection group,the mid-term infection group,the late infection group and the control group,with 8 rats in each group.On the 3rd,9th and 15th day of pregnancy,lipopolysaccharide was injected intraperitoneally to construct intrauterine infection models.The pregnant rats in the control group were intraperitoneally injected with the same dose of 0.9%sodium chloride solution.On the 18th day of pregnancy,the inflammatory factors[interleukin-6(IL-6),tumor necrosis factor-(TNF-)],the blood vessel density of placenta and endometrium in the placental tissues of pregnant rats,dead fetus+absorbed fetus,the inflammatory factors IL-6,TNF-and oxidation reaction indicators[malondialdehyde(MDA)and myeloperoxidase(MPO)]in the fetal rat lung and brain tissues were detected.Results:The changing trend of IL-6 and TNF-levels in the placental tissues of pregnant rats with intrauterine infection in different periods was:the control group<the late infection group<the mid-term infection group<the early infection group,the differences were statistically significant(p<.05).The changing trend of fetal rat weight,placental weight and placental coefficient in the intrauterine infection groups in different periods was:the control group>the late infection group>the mid-term infection group>the early infection group,the differences were statistically significant(p<.05).The blood vessel density of placenta and endometrium,the mean number of fetuses,brain coefficient and lung coefficient in the late infection group were significantly increased in comparison with the early infection group and the mid-term infection group.The total number and the ratio of dead fetus+absorbed fetus,the levels of IL-6,TNF-,MDA and MPO in brain and lung tissues were significantly reduced,and the differences were statistically significant(p<.05).The blood vessel density of placenta and endometrium,brain coefficient and lung coefficient of pregnant rats in the mid-term infection group were significantly increased in comparison with the early infection group,and the differences were statistically significant(p<.05).There was no statistically significant difference in the other indicators between the two groups(p>.05).Conclusions:Intrauterine infection in different periods can inhibit placental and endometrial angiogenesis,and affect the survival rate of fetal rats and the growth and development of brain and lung.The reason may be related to the aggravation of fetal inflammatory responses and oxidative stress.The earlier the intrauterine infection occurs,the severer the adverse effects on the fetal rats will be.

Device-associated infection rates, mortality, length of stay and bacterial resistance in intensive care units in Ecuador: International Nosocomial Infection Control Consortium's findings

AIM To report the results of the International Nosocomial Infection Control Consortium(INICC) study conducted in Quito, Ecuador.METHODS A device-associated healthcare-acquired infection(DAHAI) prospective surveillance study conducted from October 2013 to January 2015 in 2 adult intensive care units(ICUs) from 2 hospitals using the United States Centers for Disease Control/National Healthcare Safety Network(CDC/NHSN) definitions and INICC methods. RESULTS We followed 776 ICU patients for 4818 bed-days. The central line-associated bloodstream infection(CLABSI) rate was 6.5 per 1000 central line(CL)-days, the ventilator-associated pneumonia(VAP) rate was 44.3 per 1000 mechanical ventilator(MV)-days, and the catheterassociated urinary tract infection(CAUTI) rate was 5.7 per 1000 urinary catheter(UC)-days. CLABSI and CAUTI rates in our ICUs were similar to INICC rates [4.9(CLABSI) and 5.3(CAUTI)] and higher than NHSN rates [0.8(CLABSI) and 1.3(CAUTI)]- although device use ratios for CL and UC were higher than INICC and CDC/NSHN's ratios. By contrast, despite the VAP rate was higher than INICC(16.5) and NHSN's rates(1.1), MV DUR was lower in our ICUs. Resistance of A. baumannii to imipenem and meropenem was 75.0%, and of Pseudomonas aeruginosa to ciprofloxacin and piperacillin-tazobactam was higher than 72.7%, all them higher than CDC/NHSN rates. Excess length of stay was 7.4 d for patients with CLABSI, 4.8 for patients with VAP and 9.2 for patients CAUTI. Excess crude mortality in ICUs was 30.9% for CLABSI, 14.5% for VAP and 17.6% for CAUTI. CONCLUSION DA-HAI rates in our ICUs from Ecuador are higher than United States CDC/NSHN rates and similar to INICC international rates.

Application of Nursing Quality Index Management in Reducing the Infection of Tunnel-Cuffed Hemodialysis Catheter

Objective: To explore how the nursing quality management reduces the infection of tunneled-cuffed hemodialysis catheter (TCC). Methods: The TCC infection rate from January 1st to December 31th was used as the baseline data, and the TCC infection rate from January 2014 to December 2017 was used for annual comparison. Through the nursing quality index management mode, the TCC infection rate was compared quarterly, annually and year by year by taking the measures of joint ward checking, optimizing nursing process, analyzing the root cause of infection cases and formulating countermeasures. Results: The Centre has been implementing the management of nursing quality indicators since 2014. TCC infection rate is an important part of Quality of Nursing Index Management. The comparison between 2013 and 2014 (X2 = 4.20, P = 0.04) was P Conclusion: The nursing quality index management can effectively reduce the incidence of TCC infection.

ICU护士血管导管相关感染预防与控制知识的现状调查

目的调查重症医学科(intensive care unit,ICU)护士血管导管相关感染(vessel catheter associated infection,VCAI)预防与控制知识的现状,为提高ICU护理质量提供改进依据。方法采用便利抽样方法,选取2022年11—12月厦门大学附属第一医院ICU 60名在职护士作为调查对象。采用一般资料调查表、VCAI预防与控制知识现状调查表和学习情况调查表对其进行调查,并调查2020—2022年ICU的VCAI发生率。结果60名护士VCAI预防与控制知识总得分为10~27分,平均(20.57±3.50)分,平均得分率为76.18%,处于中等水平,各维度知识掌握水平不等。2020年发生1例VCAI,发生率为3.19‰;2021年发生2例VCAI,发生率分别为2.52‰、2.91‰;2022年未发生VCAI。结论ICU护士对VCAI知识掌握程度处于中等水平,应进一步加强对护士相关知识的培训和考核,规范操作流程,提高ICU护理质量。

基于循证理论构建MDT网格化血管导管感染管控体系

目的构建多学科诊疗(multi-disciplinary treatment,MDT)网格化血管导管相关感染(vessel catheter-associated infection,VCAI)管控体系。方法在循证理论的基础上,使用德尔菲专家函询法构建MDT网格化VCAI管控体系,比较应用此体系前后临床医护人员对VCAI相关知识的掌握情况。结果经过两轮专家函询构建和完善预防VCAI的理论知识、实践能力、专业发展能力三级管理构架的管控体系;使用该管控体系对医护人员进行培训显著提高医护人员对VCAI相关知识的掌握情况(P<0.05)。结论基于循证理论构建的MDT网格化VCAI管控体系可有效保障患者安全。

Prevention of urinary tract infection using a silver alloy hydrogel-coated catheter in critically ill patients: A single-center prospective randomized controlled study

Background:A new type of silver alloy hydrogel-coated(SAH)catheter has been shown to prevent bacterial adhesion and colonization by generating a microcurrent,and to block the retrograde infection pathway.However,these have only been confirmed in ordinary patients.This study aims to evaluate the effectiveness of a SAH catheter for preventing urinary tract infections in critically ill patients.Methods:This was a prospective single-center,single-blind,randomized,controlled study.A total of 132 patients requiring indwelling catheterization in the intensive care unit(ICU)of the First Affiliated Hospital of the University of Science and Technology of China between October 2022 and February 2023 and who met the study inclusion/exclusion criteria were randomly divided into two groups.Patients in the SAH catheter group received a SAH catheter,while patients in the conventional catheter group received a conventional siliconized latex Foley catheter.The main outcome measure was the incidence of catheter-associated urinary tract infections(CAUTIs).Secondary outcome indicators included urine positivity for white blood cells and positive urine cultures on 3 days,7 days,10 days,and 14 days after catheterization,number of viable bacteria in the catheter biofilm on day 14,pathogenic characteristics of positive urine cultures,length of ICU stay,overall hospital stay,ICU mortality,and 28-day mortality.All the data were compared between the two groups.Results:A total of 68 patients in the conventional catheter group and 64 patients in the SAH catheter group were included in the study.On day 7 after catheter placement,the positivity rate for urinary white blood cells was significantly higher in the conventional catheter group than in the SAH catheter group(33.8%vs.15.6%,P=0.016).On day 10,the rates of positive urine cultures(27.9%vs.10.9%,P=0.014)and CAUTIs(22.1%vs.7.8%,P=0.023)were significantly higher in the conventional catheter group than in the SAH catheter group.On day 14,the numbers of viable bacteria isolated from the catheter tip([3.21±1.91]×10^(6) colony-forming units[cfu]/mL vs.[7.44±2.22]×10^(4) cfu/mL,P<0.001),balloon segment([7.30±1.99]×10^(7) cfu/mL vs.[3.48±2.38]×10^(5) cfu/mL,P<0.001),and tail section([6.41±2.07]×10^(5) cfu/mL vs.[8.50±1.46]×10^(3) cfu/mL,P<0.001)were significantly higher in the conventional catheter group than in the SAH catheter group.The most common bacteria in the urine of patients in both groups were Escherichia coli(n=13)and Pseudomonas aeruginosa(n=6),with only one case of Candida in each group.There were no significant differences between the two groups in terms of ICU hospitalization time,total hospitalization time,ICU mortality,and 28-day mortality.Conclusion:SAH catheters can effectively inhibit the formation of catheter-related bacterial biofilms in critically ill patients and reduce the incidence of CAUTIs,compared with conventional siliconized latex Foley catheters;however,regular replacement of the catheter is still necessary.

目标管理理论指导下血管导管相关感染预防干预在连续性肾脏替代疗法患者中的应用效果

目的探讨对连续性肾脏替代疗法(CRRT)患者实施以目标管理理论为导向的血管导管相关感染(VCAI)预防干预的效果。方法选取2022年1月至12月南通大学附属南通第三医院收治的102例CRRT患者,采用随机数字表法将其分为目标组和对照组,各51例。两组患者均实施常规护理,目标组同时实施以目标管理理论为导向的VCAI预防性护理。比较两组VCAI发生情况,并比较两组干预前后急性生理和慢性健康评分系统Ⅱ(APACHE-Ⅱ)评分。结果目标组VCAI发生率低于对照组,VCAI出现时间晚于对照组、VCAI持续时间短于对照组、导管留置时间长于对照组(P<0.05)。干预后,两组APACHE-Ⅱ评分低于干预前,且目标组低于对照组(P<0.05)。结论为CRRT患者实施以目标管理理论为导向的VCAI预防性护理,可降低VCAI发生率,延缓VCAI的发生并缩短持续时间,在治疗过程中促进患者机体恢复并提升机体健康状况。

基于“肺朝百脉”理论探讨新冠病毒感染转阴后下肢深静脉血栓形成的治疗思路

下肢深静脉血栓形成是周围血管科常见病,可引起血栓形成后综合征,严重影响患者生活质量,亦可导致肺栓塞,甚者危及生命。有关数据显示,新冠病者感染后患者深静脉血栓形成的发病率较前有明显升高,可见肺部受损在下肢深静脉血栓形成的发病机制中具有一定影响。中医药防治下肢深静脉血栓形成具有长期的实践性及有效性,本文基于“肺朝百脉”理论论述新冠病毒感染转阴后下肢深静脉血栓形成的发病机制,归纳其从肺论治的中医治疗原则,探讨新的辨证思路,为进一步提高临床疗效提供理论依据。

铋剂四联疗法联合针刺督脉背段压痛穴位治疗脾胃虚寒型Hp感染性胃溃疡疗效分析

目的分析铋剂四联疗法联合针刺督脉背段压痛穴位治疗脾胃虚寒型幽门螺杆菌(Hp)感染性胃溃疡的临床疗效。方法选取2020年1月至2021年12月河南科技大学第一附属医院收治的80例脾胃虚寒型Hp感染性胃溃疡患者作为研究对象,按照不同治疗方法将其分为联合组(40例)与对照组(40例),联合组患者采用铋剂四联疗法联合针刺督脉背段压痛穴位治疗,对照组患者单纯采用铋剂四联疗法治疗,对比观察两组患者中医症候评分、溃疡长径、血清胃泌素(GAS)水平、Hp转阴率及临床疗效。结果治疗14 d后,联合组患者胃脘疼痛、食后腹胀、嗳气泛酸、恶心反胃评分以及血清GAS水平均明显低于对照组(t=6.910、6.318、7.140、9.345、8.819,P均<0.001),溃疡长径明显短于对照组(t=18.860,P<0.001);联合组患者Hp转阴率为87.5%,明显高于对照组患者的Hp转阴率67.5%(χ^(2)=4.588,P=0.032);联合组患者中显效26例、有效11例、无效3例,明显优于对照组患者的显效19例、有效10例、无效11例(Z=-1.997,P=0.046)。结论铋剂四联疗法联合针刺督脉背段压痛穴位治疗脾胃虚寒型Hp感染性胃溃疡,可明显降低GAS水平,提高Hp转阴率,改善患者脾胃虚寒症状,促进溃疡愈合。

急诊人工血管移植治疗吸毒者假性股动脉瘤疗效观察

目的探讨急诊条件下人工血管移植治疗吸毒所致感染性假性股动脉瘤的可行性及临床效果。方法在急诊条件下,对5例感染并大出血的假性股动脉瘤吸毒患者,采用切除瘤体及周围炎性组织彻底清创后行人工血管移植治疗,观察移植效果及并发症发生情况。结果手术顺利,5例患者均保肢成功,经3～24个月随访,移植血管通畅,未发生并发症。结论吸毒所致感染性假性股动脉瘤并发大出血时,可在急诊条件下,彻底清创后,采用人工血管移植治疗。

丁学屏从奇经论治糖尿病合并尿路感染的临床经验

尿路感染是糖尿病患者的常见合并症,病情复杂,临床治疗难度较大。丁学屏教授对糖尿病合并尿路感染的治疗颇有心得,尤其对反复发作的难治性尿路感染强调从奇经论治,疗效显著。

感染性颈动脉破裂的治疗

目的探讨感染性颈动脉破裂的治疗方法。方法回顾性分析我科自2000~2011年所有感染性颈动脉破裂病例及同期内所有英语文献记载的病例。结果 31例患者共发生46次感染性颈动脉破裂,最常见的破裂部位为颈总动脉（33/46,71.7%）。经血管结扎治疗17次（37.8%）,血管内支架置入20次（44.4%）,栓塞治疗7次（15.6%）。血管结扎在治疗感染性颈动脉破裂时再次出血发生率11.8%（2/17）明显低于血管内支架置入60.0%（12/20）差异有统计学意义（χ2=4.355,P=0.037）。结论血管结扎是感染性颈动脉破裂较好的治疗方法,它可能是防止再次出血的最好方法。但是如果结扎颈内动脉或颈总动脉,其并发症发生率可能相对较高。

NETs刺激下慢性支气管炎大鼠血清ANCA产生机制探讨

目的:探讨长期慢性感染刺激诱导机体产生抗中性粒细胞胞浆抗体(ANCA)的机制。方法:烟熏法联合脂多糖气管内注入,建立慢性支气管炎大鼠模型,用佛波脂(PMA)体外刺激大鼠中性粒细胞产生中性粒细胞胞外网络(NETs),以NETs免疫慢性支气管炎大鼠,比较慢性支气管炎NETs刺激组(CB/NETs)、慢性支气管炎组(CB)和正常组三组大鼠血清髓过氧化物酶-抗中性粒细胞胞浆抗体(MPO-ANCA)、血清瓜氨酸化的组蛋白H3(Cit H3)、血清IFN-α水平及血清肌酐、血清尿素氮、尿红细胞计数、24 h尿蛋白定量水平。结果:(1)CB/NETs组的血清MPO-ANCA水平明显高于CB组及正常组,(62.4975±19.637 64)ng/ml vs(17.380 6±4.886 49)ng/ml,(20.888 4±4.396 07)ng/ml(P<0.01)。(2)CB/NETs组的血清Cit H3水平明显高于CB组及正常组,(32.597 4±20.291 5)ng/ml vs(8.856 8±2.366 92)ng/ml,(5.622 5±0.837 38)ng/ml,(P<0.05,P<0.01)。(3)CB/NETs组中有两只大鼠的血清IFN-α水平异常升高(3 735.7、3 428.4 pg/ml)。(4)三组大鼠的肾脏相关指标差异暂未呈现出统计学意义。(5)大鼠血清Cit H3水平与血清MPO-ANCA水平呈正相关(r=0.61,P<0.05)。结论:慢性支气管炎长期、反复感染可导致ANCA水平升高,从形成高水平的ANCA到最终形成ANCA相关性小血管炎尚需要时间。

腓动脉穿支皮瓣的临床研究进展

腓动脉穿支皮瓣是以腓动脉发出的肌间隔穿支动脉及肌皮穿支动脉为轴型血管的皮瓣。腓动脉穿支皮瓣具有对供区损伤小、不破坏供区外形、受区修复重建功能和外形好、设计灵活以及患者术后康复快等诸多优点,已广泛应用于临床。如何提高腓动脉穿支的定位,加强基础研究成果与临床应用的结合,掌握好利用腓动脉穿支皮瓣的手术指征,最大程度地减少对供区的损害,切取大小最合适的皮瓣,并达到创面修复的最佳效果,将是今后研究方向的热点。该文对近年来国内外有关腓动脉穿支皮瓣基础研究和临床应用的相关文献进行综述,以了解腓动脉穿支皮瓣的研究进展。

注射毒品所致假性股动脉瘤治疗体会(附34例)

目的探讨注射毒品所致假性股动脉瘤的外科疗法。方法对34例注射毒品所致假性股动脉瘤病人的临床资料进行回顾分析。结果13例直接采用ePTFE人造血管行旁路髂外动脉和股浅动脉端侧吻合术,3例采用自体大隐静脉原位移植术,其中1例术后吻合口破裂出血改行ePTFE人造血管行旁路髂外动脉动脉和股浅端侧吻合术,18例股动脉结扎术。全部病例保肢成功。血管移植者术后复查彩色多普勒显示移植血管通畅。结论在患者不能采用合适的自体大隐静脉移植及人造血管移植时,运用结扎股动脉术是治疗注射毒品所致假性股动脉瘤的有效方法。

督脉电针对外伤性截瘫患者尿路功能的改善

督脉电针疗能有效地对抗输尿管返流，降低膀胱内压，扩大膀胱容量，从而改善膀胱贮尿排尿功能，预防和控制泌尿系感染急性发作。

综合护理干预对维持性血液透析患者的影响

目的：探讨综合护理干预对维持性血液透析患者的影响。方法：选择2013年12月～2015年9月我院收治的维持性血液透析患者120例，将其随机等分为对照组和观察组，对照组患者采用常规护理；观察组采用综合护理干预。比较两组患者血管通路感染等并发症发生率、生存质量、护理满意度。结果：观察组患者并发症发生率低于对照组（P〈0．05），生存质量各项指数评分高于对照组（P〈0．05），护理满意度高于对照组（P〈O．05）。结论：在维持性血液透析患者治疗的过程中，对其实施综合护理干预，可以降低并发症的产生，减少血管通路感染，提高患者的生存质量和护理满意度。

人工血管感染处理策略

目的:总结人工血管感染的处理策略及治疗经验。方法:8例均行人工血管切除及清创术,2例另行解剖外旁路自体大隐静脉移植术,1例行异位人工血管移植。结果:3例人工血管切除后行膝上截肢术,1例3个月后改行经胸Budd-Chiari综合征下腔静脉病变根治术,其余病例感染消失,创口愈合。本组无死亡病例。结论:人工血管感染采取不同的治疗措施,可以取得较为满意的临床效果。

发酵装备引起发酵染菌的原因和预防

从发酵工业的配套装备入手,分析了由于设备原因导致的发酵染菌,并提出了预防和改进的方法。从设备方面杜绝发酵染菌的隐患。

负压封闭引流术对Ⅲ、Ⅳ期压疮感染创面血管神经生成的影响

目的:探讨负压封闭引流术对压疮感染创面血管和神经生成的影响。方法:选择我院2018年1月至2019年12月治疗的86例Ⅲ、Ⅳ期压疮感染创面患者作为研究对象,根据住院号顺序编号,采用随机数字表法分为观察组和对照组,各43例;观察组予负压封闭引流术治疗,对照组采取换药治疗;以创面感染控制时间、创面愈合时间、McGill疼痛评分、创面面积、压疮愈合计分表(PUSH)评分、微血管数量、神经生长因子(NGF)为观察指标。结果:观察组感染控制时间、创面愈合时间均短于对照组,McGill疼痛评分低于对照组,差异有统计学意义(P<0.05);观察组治疗21 d时创面面积较治疗前明显缩小,PUSH评分较治疗前明显降低,与对照组比较,差异均有统计学意义(P<0.05);观察组与对照组相比在治疗7 d、14 d微血管数量及NGF阳性细胞数均比较多;观察组与对照组微血管数量及NGF阳性细胞数变化趋势有差别(P<0.05)。结论:负压封闭引流术较传统换药能更好的控制压疮创面感染,明显促进压疮创面血管和神经生成,提高创面愈合速度,是一种疗效较好的治疗方法。