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OBJECTIVE To syste matically evaluate the prevention effects of nicorandil on contrast-induced nephropathy in patients underwent coronary angiography （CAG）or stent implantation （CSI），and to provide evidence-based reference for clinical drug use. METHODS Retrieved from PubMed ，Embase，Cochrane library ，Wanfang database ，CBM and CNKI ，randomized controlled trial （RCT）about nicorandil （trial group ）versus normal saline or placebo （control group ）prevented contrast-induced nephropathy in patients underwent CAG or CSI were collected during the inception to Nov. 2021. After extracting literature that met the inclusion criteria ，the bias risk assessment tool of RCT in Cochrane manual was used for quality evaluation ，and meta-analysis was performed by using RevMan 5.3 software. RESULTS A total of 17 RCTs were included ，involving 3 279 patients. Among them，there were 1 587 patients in trial group ，and 1 692 patients in control group. Results of meta-analysis showed that the incidence of contrast-induced nephropathy in trial group was significantly lo wer than control group [RR ＝0.40，95％CI（0.31，0.51）， P＜0.000 1] . Results of subgroup analysis showed that the incidence of contrast-induced nephropathy in trial group was significantly lower than control group ，whether intravenous administration [RR ＝0.47，95％CI（0.29，0.74），P＝0.001] or oral administration [RR ＝0.37，95％CI（0.28，0.50），P＜0.000 01]，whether patients with normal renal function [RR ＝0.42，95％CI（0.30， 0.59），P＜0.000 01] or with renal insufficiency [RR ＝0.38， 95％ CI（0.26，0.54），P＜0.000 01]. Scr of 24 h[SMD＝ －1.38，95％CI（－2.32，－0.44），P＝0.004]，48 h[SMD＝ －0.81，95％CI（－1.19，－0.43），P＜0.000 1] and 72 h[SMD＝ －0.24，95％CI（－0.43，－0.05），P＝0.01] after surgery in trialgroup were significantly lower than control group ；the 163.com decrease of creatinine clearance rate of 48 h[SMD＝1.27， 95％CI（0.48，2.07），P＝0.001] and 72 h[SMD＝0.37，95％CI（0.07，0.67），P＝0.02] after surgery in trial group were significantly lower than control group ；cystatin C of 24 h[SMD＝－0.93，95％CI（－1.72，－0.14），P＝0.02]，48 h[SMD＝－1.72，95％CI （－2.33，－1.10），P＜0.000 01] and 72 h[SMD＝－0.36，95％CI（－0.62，－0.10），P＝0.006] after surgery in trial group were significantly lower than control group. CONCLUSIONS Pretreatment of nicorandil can reduce the incidence of contrast-induced nephropathy in patients underwent CAG or CSI ，and reduce the damage of renal function after application of contrast.
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Objective:To systematically analyze and compare the focuses and frontiers of research on microbial resistance to disinfectants in China and abroad, and to provide suggestions for strengthening academic research on microbial resistance to disinfectants as well as the prevention and control of antimicrobial resistance in China.Methods:Relevant literature focusing on the resistance of microorganisms to disinfectants was retrieved from the China National Knowledge Infrastructure (CNKI) and Web of Science? Core Collection database from January 1, 1994 to December 31, 2018. After analyzing the basic information of the literature, co-occurrence and cluster analyses by the CiteSpace visualization software were introduced to identify and compare the similarities and differences of topics and frontiers between domestic and foreign research on microbial resistance to disinfectants.Results:A total of 234 literatures published in Chinese and 1 563 literatures in English were included. Among the 1 563 literatures in English, 97 literatures were published by domestic scholars as the first author or corresponding author, and 1 466 literatures by foreign scholars. The quality of the journals publishing these studies was relatively high. Compared with the general trend of foreign research in this field, the number of relevant articles published by domestic scholars started to decline in recent years, and the journals were relatively concentrated. According to the co-occurrence analysis on keywords, " Acinetobacter baumannii" had the highest centrality value of 0.36 among the literatures published in Chinese by domestic scholars, while " Escherichia coli" was presented with the highest centrality value of 0.63 and 0.21 in English literatures published by domestic and foreign scholars, respectively. According to the analysis of the research trends of the literatures, much more burst terms were detected in the papers published in English by foreign scholars. Among those literatures published from 1994 to 2018, the focuses on the types of pathogens had gradually shifted from Escherichia coli and Staphylococcus aureus to Klebsiella pneumoniae and Salmonella enterica, and the attention to the types of disinfectants had gradually switched from chlorhexidine and quaternary ammonium compound to sodium hypochlorite and peracetic acid. However, only a few burst terms, mainly including "bacteria" and " Pseudomonas aeruginosa" , were detected in the papers published in Chinese by domestic scholars, which emerged in an earlier period and ended in 2008 and 2010. Conclusion:Although domestic research on microbial resistance to disinfectants has made some progresses and gradually achieved international standard, comprehensive and in-depth research should be consistently strengthened to form a stable and sustainable development pattern.
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ObjectiveTo investigate the interventional effect of mangiferin on carbon tetrachloride (CCl4)-induced hepatic fibrosis in mice and the potential mechanism. MethodsA total of 45 male C57BL/6 mice were randomly divided into three groups: normal control group (NC group), liver fibrosis model group (CCl4 group), and mangiferin pretreatment group (CCl4+M group), with 15 mice in each group. An automatic biochemical analyzer was used to measure the serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST); HE staining and Masson staining were performed to observe liver pathological changes; ELISA was used to measure the serum levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNFα); Western Blot was used to measure the protein expression of α-smooth muscle actin (α-SMA), nuclear factor-kappa B (NF-κB), IL-1β, p62, and microtubule-associated protein 1 light chain 3 (LC3) in the liver; quantitative real-time PCR was used to measure the mRNA expression of type I collagen (Col-I) and α-SMA in the liver. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups. ResultsHE staining and Masson staining showed a low proportion of mice with hepatocyte degeneration and necrosis and a significant reduction in collagen fibers in the CCl4+M group. Compared with the CCl4 group, the CCl4+M group had significant reductions in the serum levels of ALT and AST (both P＜001). ELISA showed that compared with the CCl4 group, the CCl4+M group had significant reductions in the serum levels of IL-1β, IL-6, and TNF-α (all P＜0.01). Western Blot showed that compared with the CCl4 group, the CCl4+M group had significant reductions in the protein expression of α-SMA, NF-κB, IL-1β, and LC3-II/I in the liver (P＜0.01, P＜0.05, P＜0.01, and P＜0.05) and a significant increase in the protein expression of p62 (P＜0.05). Quantitative real-time PCR showed that compared with the CCl4 group, the CCl4+M group had significant reductions in the mRNA expression of Col-I and α-SMA (P＜0.05 and P＜0.01). ConclusionMangiferin can alleviate CCl4-induced hepatic fibrosis in mice, possibly by reducing inflammation to protect liver function and inhibiting autophagy to reduce the activation of hepatic stellate cells.
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A comprehensive physician authorization management system has been established at Renmin Hospital of Wuhan University in its effort of promoting the clinical standardization.This system covers authorization of prescription,disposition,surgery,and medical report among others,adhering to the principle of clear,complete quantitative competence-based,authorization.The training and assessment of physicians in parallel canimprove physicians' competence and quality of care.
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Objective To evaluate the effect of plan-do-check-act (PDCA)cycle method in improving disinfection efficacy of object surface in intensive care unit (ICU).Methods On the basis of management of healthcare-associat-ed infection (HAI)and prevention of multidrug-resistant organisms,disinfection efficacy of object surface in an ICU was intervened,data about surface object specimens taken before,during,and after intervention,HAI in patients, as well as detection of MDROs were collected.Results The total qualified rate of specimens taken before,during, and after intervention was 58.24%,76.74%,and 88.71 %,respectively,there was an increased tendency,the difference was significant (χ2 =17.41 ,P =0.009);the incidence of HAI was 3.72%,2.42%,and 1 .78%,respec-tively,there was a decreased tendency(χ2 =6.03,P =0.039),case infection rate was 4.36%,2.75%,and 2.37%respectively,there was a decreased tendency (χ2 = 7.24,P = 0.046 );detection rate of MDROs was 34.03%, 27.45%,and 14.05%,respectively,there was a decreased tendency (χ2 =33.84,P =0.007),the percentage of pa-tients who were detected MDROs and HAI caused by MDROs showed a decreased tendency(χ2 =6.14,6.02,both P<0.05).Conclusion The implementation of PDCA cycle can effectively improve disinfectant efficacy of ICU object surface,and reduce the incidence of MDRO HAI.
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Objective To analyze risk factors and antimicrobial use for hospital-acquired pneumonia (HAP)due to multidrug-resistant organisms (MDROs)in an intensive care unit(ICU),so as to perform risk assessment and guide antimicrobial use.Methods From January 2012 to December 2013,HAP patients were conducted retrospective co-hort study,risk factors for MDRO-HAP and rationality of antimicrobial use were analyzed.Results A total of 110 cases of HAP occurred in ICU,63 cases (57.27%)were MDR-HAP.Logistic regression analysis revealed that re-cent hospital stay ≥5 days (OR=19.94),transference from other hospitals (OR =19.33),infection type of late-onset HAP (OR=7.98),and antimicrobial use in recent 90 days (OR =3.42)were independent risk factors for MDR-HAP.Initial empirical anti-infective treatment revealed that there were no significant difference in timing of antimicrobial administration within 24 hours after clinical diagnosis was confirmed,and rationality of antimicrobial selection between MDR-HAP group and non-MDR-HAP group (both P >0.05);The isolation rate of pathogens in MDR-HAP group was lower than non-MDR-HAP group (73.02% vs 91 .49% P 0.05 );the rationality rate of therapy course in MDR-HAP group was higher than no-MDR-HAP group,but rationality rate of combination use of antimicrobial agents was slightly lower than the latter (both P < 0.05 ).Conclusion Patients in ICU should be conducted risk factor assessment,and according prevention and control measures should be formulated,so as to reduce the occurrence of MDR-HAP,health care workers should standardized the initial empirical anti-infective treatment.