OBJECTIVE To provide reference for improving the rational use of antimicrobial drugs in primary township medical institutions. METHODS Based on the county prescription pre-review center， a team led by anti-infective clinical pharmacists constructed the management mode for the use of antimicrobial drugs in county-level medical communities with clinical pharmacists as the main team by finding out the main problems in the use of antimicrobial drugs in primary township medical institutions， providing feedback on the problems， organizing relevant training for the problems， improving the customization rules of the prescription pre-review software， implementing the automatic interception and pharmacist online prescription review and other measures. Data on the use of antimicrobial drugs were collected and compared in the 15 primary township medical institutions between January-June in 2022 （before the implementation of the mode） and January-June in 2023 （after the implementation of the mode）. RESULTS Compared with before the implementation of the mode， the utilization rate of antimicrobial drugs in outpatients of primary township medical institutions decreased from 24.97% before the implementation of the mode to 19.39% after the implementation of the mode； the utilization rate of antimicrobial injection in outpatients decreased from 66.10% to 46.80%； the utilization rate of intravenous drip of antimicrobial drugs in outpatients decreased from 52.33% to 40.35%； the rates of combined use of antimicrobial drugs in outpatients decreased from 12.70% to 8.19%； the reasonable rate of antimicrobial prescribing in outpatients increased from 55.28% to 73.93%. After the implementation of the mode， the proportion of antimicrobial prescriptions for each diagnosis was basically the same as before； the defined daily dose system （DDDs） and proportion of a few antimicrobial drugs changed compared with before according to the anatomical therapeutic chemical classification of drugs， among which DDDs of lincomycin， gentamicin and other drugs declined significantly； DDDs of antimicrobial drugs for each classification was basically the same as before according to AWaRe classification. CONCLUSIONS The management mode of the use of antimicrobial drugs led by anti-infective clinical pharmacists is constructed in the prescription pre-reviewing center of county-level medical communities， which can effectively improve the rational use of antimicrobial drugs in the primary township medical institutions.

Objectives:To study the clinical significance of time to positive (TTP) of blood culture for neonatal sepsis.Methods:From August 2016 to June 2019, a retrospective study was conducted in patients with positive blood cultures admitted to the Neonatology Department of our hospital. The patients were assigned into different groups according to the species of pathogen, types of neonatal sepsis and the samples contaminated or not. TTP of different groups were analyzed.Results:A total of 307 cases with positive blood cultures were identified from 10 035 cases with blood culture specimens. Among the 307 cases, 162 were contaminated (the contaminated group) and 145 (1.4%) were diagnosed of neonatal sepsis (the pathogenic group). The proportion of TTP <24 h, 24~<48 h, 48~<72 h and ≥72 h in the 145 sepsis cases were 90.3% (131/145), 7.6% (11/145), 1.4% (2/145) and 0.7% (1/145), respectively. The median TTP was 9.0 h in early-onset sepsis (EOS) group and 11.5 h in late-onset sepsis (LOS) group. The median TTP of the contaminated group was 24.5 (19.9, 30.5)h, which was longer than 11.1 (8.1,16.2)h of the pathogenic group ( P<0.05). The median TTP of Gram (+) group was 14.0 (9.4,18.8)h, which was longer than 9.6 (7.5,11.3)h of Gram (-) group ( P<0.05). The median TTP of fungi group was 32.5 (25.5, 39.0) h, which was longer than 10.6 (8.1, 15.5)h of bacteria group ( P<0.05). Conclusions:Different pathogens has different TTP for neonatal sepsis. If blood culture maintains negative for more than 72 h, empiric use of antibiotics may be discontinued for patients of suspected sepsis without specific clinical manifestations or other lab results.

The implementation of artificial intelligence courses in medical colleges is of great significance to the cross-integration of artificial intelligence and medical fields. However, there are problems such as the lack of basic knowledge of artificial intelligence, the lack of closely related teaching materials, and the difficulty in copying the teaching mode of medical courses. Based on the above problems, through the establishment of artificial intelligence course in our school, the teaching implementation process and teaching effects have been summarized and analyzed, aiming at exploring the artificial intelligence curriculum system which is suitable for medical undergraduate students, so as to improve the students' ability of using artificial intelligence technology for medical project practice, promote the combination of medical and engineering, and provide reference for the teaching reform of undergraduate artificial intelligence courses in medical colleges at home and abroad.

Objective:To explore the clinical application of peroneal artery pedicled with lateral calf muscle wear skin flap in repair of foot and ankle soft tissue defect.Methods:From February 2017 to May 2019, the peroneal artery pedicled with lateral calf muscle wear foot and ankle soft tissue defect was used with skin flap in 20 cases, which included car accident injuries in 11 cases, 3 cases of heavy injuries, skin ulcer in 4 cases, and 2 cases of bone scars. All of the affected limb wounds presented with the exposure of deep tissue such as bone or tendons. The flap cut ranged from 5.0 cm×4.0 cm~7.0 cm×5.0 cm. The donor area was closely sutured in 5 cases, and inguinal full thickness skin pack was used with skin grafting in 15 cases.Results:20 cases of postoperative skin flap survived of all, healing of wounds and cuts for phase I. After follow-up of 5~18 months, the flap had good shape and wear-resistant quality, without feeling bloated. The two points of flap were different within 3~5 mm; the functional activity of the ankle joint was good in the affected limb, with satisfactory results.Conclusions:It is a convenient and reliable procedure, with smaller surgical trauma, which is an ideal skin flap for repair of soft tissue defect in foot and ankle.

Objective: To study the correlation between the level of T-bet expression and liver damage in peripheral plasma cells of patients with autoimmune hepatitis (AIH) in order to provide reference for the study of pathogenesis and development of diseases. Methods: The peripheral venous blood and clinical examination data of 29 cases with AIH and 6 healthy volunteers were collected. The percentage of subpopulations of peripheral blood B cells and the proportion of T-bet⁺ cells in each subgroup were detected by flow cytometry. Plasma cells (CD19⁺CD10^-CD27^hiCD38^hi), primary B cells (CD19⁺CD10^-CD27^-IgD⁺), transitional B cells (CD19⁺CD10⁺), and memory B cells (CD19⁺CD10^-CD27⁺IgD^-) were the included subsets of B cells. Serum immunoglobulin G (IgG) and alanine aminotransferase (ALT) levels, the proportion of B cells in peripheral blood subsets and IgG level, the proportion of T-bet⁺ cells in each subset and the proportion of T-bet⁺ plasma cells in each subset in B cells, the proportion of T-bet⁺ plasma cells and the level of serum ALT were analyzed for correlation analysis. Statistical analysis was performed using two independent sample t-tests and linear regression. Results: The serum IgG level of AIH patients with abnormal ALT (19.47 ± 1.039)g/L was significantly higher than that of normal ALT patients (15.5 ± 1.069)g/L, and the difference was statistically significant (t = 2.65, P < 0.05). The percentage of peripheral plasma cells in B cells of AIH patients (2.80 ± 0.14) % was higher than that of healthy volunteers (0.73 ± 0.09) %, and the difference was statistically significant (P < 0.01). The percentage of T-bet⁺ cells in peripheral plasma cells of AIH patients (23.54 ± 1.61) % was higher than that of healthy volunteers (6.59±0.59) % , and the difference was statistically significant (P < 0.01). The correlation analysis showed that the proportion of T-bet⁺ cells in peripheral plasma cells of AIH patients was positively correlated with the proportion of plasma cells to B cells (r = 0.224 7, P < 0.01), and the percentage of peripheral plasma cells to B cells was positively correlated with the level of serum IgG (r = 0.299 1, P < 0.01). Serum IgG level was correlated with the level of ALT, reflecting an indicator of liver damage (t = 2.65, P < 0.05). Conclusion The increase of T-bet expression in the peripheral plasma cells of AIH patients is associated with liver damage, which is a new mechanism of AIH pathogenesis and disease progression.

Lipedema is secondary to local fat deposition, a disease characterized by the symmetric thickening of lower limbs, mostly occurs in women, especially in adolescence and pregnancy. In its early stage, it could be easily confused with lymphedema. Extensive literature review on primary fat edema in recent years, as well as a summary of the clinical symptoms and signs and diagnosis and treatment of lipedema were conducted, so as to provide a useful reference for clinicians.

Objective: To evaluate the influence of happiness therapy intervention on the medication compliance and quality of life of acquired immune deficiency syndrome (AIDS) patients after discharge. Methods: A total of 106 adult AIDS patients discharged from hospital from July 2016 to July 2017 were randomly divided into control group (52 cases), observation group (54 cases). The control group was given routine health education and instruction, and three times of happiness therapy intervention were performed during the hospitalization. The observation group increased the number of happiness therapy intervention after discharge according to the patient′s medication compliance. The medication compliance scale and quality of life scale were used to evaluate the compliance rate and quality of life of patients in 2 groups at discharge, 3 months after discharge, 6 months after discharge, and 12 months after discharge. Results: There was no significant difference in medication compliance and quality of life at discharge and 3 months after discharge between the two groups (P>0.05). At 6 months and 12 months after discharge, the compliance rate and quality of life scores in the observation group was 90.74%(49/54), 88.89%(46/54) and (69.62 ± 5.82) points, (68.76 ± 5.63) points, respectively, 61.54% (32/52), 59.62% (31/52) and (52.12 ± 4.30) points, (52.05 ± 4.25) points in the control group, the difference was statistically significant (χ²=9.684, 9.035, t=8.638, 8.963, P<0.01). Conclusions The happiness therapy intervention during hospitalization can effectively improve the medication compliance and quality of life of AIDS patients. After the discharge, the happiness therapy intervention can provide the patients with long-term nursing programs, which can improve the adherence and quality of life of AIDS patients compared with the control group Have a better long-term effect.

Objective To establish the HPLC fingerprints of petroleum ether parts from five traditional medicine (Alpinia officinarum Hance, Alpinia galangal ( L.) Wild, Alpinia galanga Will., Alpinia katsumadai Hayata, and Alpinia oxyphylla Miq), and to explore the similarities and differences of chemical composition,as well as the correlation between the genetic relationship and the chemical composition. Methods HPLC method was used to analysis the five traditional medicines. The data were evaluated by using the"similarity evaluation system for chromatographic fingerprint of TCM" software. Results The similarity chemical composition from Alpinia officinarum Hance,Alpinia galangal(L.) Wild,Alpinia galanga Will.,Alpinia katsumadai Hayata,and Alpinia oxyphylla Miq in ethyl acetate were 0.741,0.855,0.610,0.510, 0.680,respectively. Conclusion Though there were differences of fingerprint peak of petroleum ether parts between five the traditional Chinese medicines, similarities were also observed among them.

Objective To evaluate the correlation between the expression of C5b-9 and the gastric carcinoma.Methods In this study, the human gastric adenocarcinoma (HGAC)tissues (n =32 cases)from 32 patients were evaluated by immunohistochemistry and tissue chip.The result was analyzed and evaluated by Multinomial logistic regression and likelihood ratio.Results Multinomial logistic regression and likelihood ratio testing showed that over-expression of C5b-9 in HGAC tissue was significantly correlated with clinical stage (P =0.007) and tumor stage (P =0.005),but not with tumor metastasis,lymphoid nodal status,sex or age.Conclusion C5b-9 can be the criteria of di-agnosis and clinical staging for gastric adenocarcinoma,which may help in diagnosis and assessment disease severity of human gastric carcinoma.

Objective To study the quality control of urinary arsenic detection .Methods Quality control before ,during and after analysis were performed to avoid the random error and control the system errors .Results The low detection value of self-made quality control material of urinary arsenic and coefficient of variation (CV) were (0 .644 ± 0 .024) mg/L and 3 .72% ,respectively , while the high detection value and CV were (1 .353 ± 0 .042) mg/L and 3 .14% ,respectively .Conclusion Quality control before , during and after analysis may effectively reduce the incidence of random error and control the system error of urinary arsenic detec-tion and ensure the accuracy of test results .