Wuhan's experience in fighting against COVID-19:How to prevent COVID-19 infection among health care workers / 中国感染控制杂志

In the context of the coronavirus disease 2019 (COVID-19)pandemic,thousands of health care wor- kers (HCWs)worldwide infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2),some even have lost their lives.At the early stage of the epidemic,some Chinese HCWs were infected.Owing to limited knowledge of characteristics of SARS-CoV-2,more than 3,000 HCWs in Hubei Province contracted SARS-CoV-2 at the early stage of the outbreak.Due to overloaded work of HCWs in local hospitals,more than 42,000 HCWs (including HCWs from the military)were dispatched to Hubei Province from all over the country.At the peak of epidemic,one in 10 intensive care HCWs in China were working in Wuhan.During fighting against COVID-19 in China,although a certain number of HCWs were infected with SARS-CoV-2 at the early stages of the epidemic, effective prevention was achieved through timely adoption of prevention measures,including fast diagnosis,timely isolation of patients,strengthening of HCWs'safety,intensified training on basic protective knowledge and unified management of HCWs,there was no report about infection among the 42,632 members of the national medical teams sent to Hubei,and the number of COVID-19 cases among HCWs in local hospitals also significantly de- creased,thereby indicating that healthcare-associated infection (HAI)of COVID-19 among HCWs are fully pre- ventable.This paper explores how to prevent HCWs from contracting SARS-CoV-2 through effective measures during the epidemic in Wuhan,China.

How to deal with severe challenge of healthcare-associated infection due to multidrug-resistant organisms / 中国感染控制杂志

In recent years, with the widespread use of broad-spectrum antimicrobial agents, multidrug-resistant organisms (MDROs) have emerged and become more and more common, such as methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteriaceae (CRE), which pose severe challenge to clinical anti-infective treatment and prevention and control of healthcare-associated infection. The new antimicrobial agents and bacterial resistance have developed at the same time, development of bacterial resistance seems to have a tendency to overwhelm the development of antimicrobial agents. Antimicrobial resistance (AMR) is now recognized as one of the major threat to human health worldwide. The Center for Disease Control and Prevention (CDC) of America has proposed four core plans to address the challenge of MDROs: surveillance, antimicrobial management, improvement of antimicrobial agents and diagnosis, as well as prevention and control of transmission. In response to the severe threat of MDRO infection, prevention of infection should be focused on, antimicrobial management and HAI management should be grasped at the same time and attached sufficient importance, effective measures should be taken based on the source, route, and susceptible people of infection, multiple details and constant innovation should be paid attention to, the final victory can be achieved.

Is cerebral cavernous malformation a pre-glioma lesion? / 中华医学杂志(英文版)

Glioma is the most malignant tumor in the brain, the origin of glioma is still unknown. Recently some papers indicated that glioma may be developed from cerebral cavernous malformation (CCM). We describe a man with a right temporal lobe CCM, after gamma-knife radiotherapy, the patient developed a low-grade astrocytoma in the area of the preexistent CCM. This case, together with other reports, may indicated an oncogenetic properties of CCM, and we proposed that CCM may be a pre-glioma lesion.

Increase of plasma IgE during treatment correlates with better outcome of patients with glioblastoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Previous studies have shown that glioma patients have lower blood IgE levels than controls. To evaluate its potential as a surrogate biomarker for glioma, we measured plasma IgE levels in glioma patients and healthy controls, and correlated them with clinicopathological factors and the patients' outcome.</p><p><b>METHODS</b>We used enzyme-linked immunosorbant assay (ELISA) to determine the plasma IgE levels of 25 normal subjects and 252 glioma patients (85 patients with grade II glioma, 46 patients with grade III glioma, and 121 patients with glioblastoma). We also collected longitudinal plasma samples from glioblastoma patients and compared the plasma IgE levels before operation, one week after operation, in the middle of radiotherapy, after two cycles of chemotherapy, and after recurrence. The correlations between plasma IgE levels and the outcomes of the patients were determined.</p><p><b>RESULTS</b>Plasma IgE levels were significantly lower in glioma patients (P = 0.004); patients with low-grade glioma have lower IgE levels than patients with high-grade glioma do (P = 0.029). In 24 patients with both preoperative plasma and two-cycle chemotherapy plasma samples, IgE levels increased after successful removal of the tumor (P = 0.021), and the increase correlated with the patients' survival (increase > 100 ng/ml vs. ≤ 100 ng/ml, 127.5 weeks vs. 62.3 weeks. P = 0.012, log-rank). Plasma IgE level increase of > 100 ng/ml has a specificity of 80% and a sensitivity of 78% to predict the patients' long survival (> 18 months).</p><p><b>CONCLUSIONS</b>Our results suggest that plasma IgE level correlates with clinical and pathological factors in glioma patients. It has the potential to be a biomarker for glioma patients.</p>

Analysis of surgical treatment strategies of petroclival region tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the surgical strategy of the tumors of petroclival region.</p><p><b>METHODS</b>The surgical data of 55 cases presented with meningioma and trigeminal nerve sheath tumors from January 2002 to February 2009 was retrospectively analyzed. All the cases were divided into full-cut group, sub-total resection group, part of resection group or divided into full-cut group and no-total resection group, in terms of various surgical strategy. The incidence of postoperative neurological disorder and quality of life status were focused and statistical analysis was carried out.</p><p><b>RESULTS</b>There were 21 patients with complete cut, 22 patients with sub-total resection and 12 patients with part of resection. There were 12 patients with neurological deterioration in full-cut group and 10 patients in no-total resection group. There was significant difference between total resection group and no-total resection group (χ(2) = 4.16, P < 0.05). All the patients were assessed based on the criterion of KPS, 12 patients of full-cut whose KPS ≥ 80, 29 patients were the same in no-total resection group. There was significant difference between the two groups (χ(2) = 5.42, P < 0.05). The mean follow-up time was 3 years. No recurrence was found in full-cut group and 5 recurrence of no-total resection group.</p><p><b>CONCLUSIONS</b>The pursuit of full-cut for the tumors of petroclival region may result in serious neurological dysfunction and poor life quality after the operation. Non-full-cut combination of postoperative radiotherapy may receive a relative better results.</p>

Microsurgical treatment of cerebrospinal fluid rhinorrhea in sphenoidal sinus / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To explore the clinical manifestation, diagnosis and surgical treatment of cerebrospinal fluid rhinorrhea in sphenoidal sinus.</p><p><b>METHODS</b>Nine cases of cerebrospinal fluid rhinorrhea in sphenoidal sinus from 2007 to 2009 were retrospectively analyzed consisting of their possible etiological factors, clinical manifestations, localization of the leakage site and treatment methods. Among them, there were 3 cases of traumatic rhinorrhea, 4 postoperative rhinorrhea and 2 spontaneous rhinorrhea. All 9 patients underwent 3-dimensional CT scan in sellar region including all para-nasal sinus. Leakage site was identified and repairing procedure was performed through trans-sphenoidal approach.</p><p><b>RESULTS</b>All cases were cured with the trans-sphenoidal microsurgical procedure. They were followed up for 9 months to 2 years. No recurrence, no infection and epilepsy complications were observed.</p><p><b>CONCLUSION</b>For the cerebrospinal fluid rhinorrhea at sphenoidal sinus, it is critical to identify the leakage site accurately and the trans-sphenoidal approach is a microinvasive and effective way to repair the leakage, which is worthy to be advocated.</p>

Burr-hole craniotomy treating chronic subdural hematoma: a report of 398 cases / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the treatment of chronic subdural hematoma (CSDH) with burr-hole craniotomy in our hospital.</p><p><b>METHODS</b>From January 2004 to December 2009, 398 patients with CSDH, 338 males and 60 females (male/female equal to 5.63/1), received burr-hole craniotomy in our hospital. The median age was 60 years with the mean age of (58.1 ± 18.1) years, (65.0 ± 14.5) years for females and (57.0 ± 18.2) years for males. Trauma history was determined in 275 patients (69.1%). Burr-hole craniotomy was performed under local anesthesia in 368 patients and general anesthesia in 30 patients. CSDH was classified into 3 groups according to the density on CT scan. Clinical data concerning etiologies, symptoms and signs, concomitant diseases, diagnosis, therapies and outcomes were investigated retrospectively. Patients'neurological status on admission and at discharge was also classified to judge the outcomes.</p><p><b>RESULTS</b>Generally, trauma history showed few differences between those over 60 years old and under 60 years old, but showed obvious differences when gender was taken into account. Totally 123 male patients (60.0% of 204 cases) suffering from head injuries were under 60 years, whereas 35 female patients (85.4% of 41 cases) with trauma histories were over 60 years. The duration from trauma to appearance of clinical symptoms was (84.0 ± 61.7) days (range, 0-1493 days). Traumatic accident was the leading etiology, other accompanying diseases such as cerebral vascular disease, hypertension, etc, were also predisposing factors. Commonly, the elderly presented with hemiplegia/hemidysesthesia/hemiataxia and the young with headache. Most CSDH patients (95.6%) treated with burr-hole craniotomy successfully recovered. However, postoperative complications occurred in 17 cases, including recurrence of CSDH in 15 cases, subdural abscess in 1 case and pneumonia in 3 cases.</p><p><b>CONCLUSION</b>Burr-hole craniotomy is an easy, efficient and reliable way to treat CSDH.</p>

Antimicrobial resistance of methicillin-resistant Staphylococcus aureus in hospital environment and inpatients / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the spread and antimicrobial susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) at hospital.</p><p><b>METHODS</b>Totally 110 strains of Staphylococcus aureus (SA) were isolated from the clinical samples of patients in 4 hospitals and 30 strains of SA were isolated from the hospital environment and personnel in Xiangya Hospital. MRSA was detected using oxacillin disk diffusion test, cefoxitin disk diffusion test and MecA, FemA gene PCR assay. Beta-lactamase was detected using nitrocephin sticks. The antimicrobial susceptibility of MRSA was tested by K-B disk diffusion test.</p><p><b>RESULTS</b>Among the 140 strains, 89 were MRSA, accounting for 63.57% of the total SA. The isolation rates of MRSA in clinical strains and environment strains were 64.55% and 60.00% (P > 0.05). All MRSA strains were sensitive to vancomycin and linezolid, 87 MRSA strains (97.75%) were sensitive to teicoplanin, most of which, however, were resistant to other antibiotics. Among the 89 strains, 85 MRSA strains (95.51% ) expressed beta-lactamase.</p><p><b>CONCLUSIONS</b>MRSA is highly prevalent in hospitals. Most MRSA strains are multi-drug resistant, but are still sensitive to vancomycin, linezolid, and teicoplanin.</p>

Study on the frequency of antibiotics use per day among inpatients in 151 hospitals in 2003 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To investigate the antibiotics use in inpatients with hospitals under different scales.</p><p><b>METHODS</b>On the day of August 7, 2003, antibiotics use among inpatients were investigated, medical order to each inpatient was checked and forms were filled.</p><p><b>RESULTS</b>Data showed that 54.86% of the 89,539 inpatients from 151 hospitals were using antibiotics, out of which 48.98% were used for therapeutic purposes while 35.44% for prophylaxis, and 15.58% for both therapy and prophylaxis. Among those who had received antibiotics, 61.43% received one, 33.65% received two and 4.92% received 3 or more agents. In patients who were on antibiotics for therapy, only 23.92% of the samples were sent for pathogens detection. The prevalence of antibiotics use was different among different hospitals, with teaching hospitals having the lowest and hospitals with less than 300 beds were higher than those with more than 300 beds. Departments of respiratory diseases, intensive care unit, and pediatrics had the higher use of antibiotics.</p><p><b>CONCLUSION</b>Inpatients in 151 hospitals had high prevalence of antibiotics use, especially for prophylaxis use but pathogen detection was seldomly done. It is necessary to strengthen the rational use and management of antibiotics use in the hospitals.</p>