OBJECTIVE:To provide reference for promoting the management of antibiotics in the hospitals. METHODS:Each 3 hospitals from county second grade class A general hospitals,municipal third grade class A general hospitals and provincial third grade hospitals(including 2 third grade class A general hospitals and one third grade special hospital)in Anhui province were select-ed and respectively included into group A,B,and C. By on-site survey mode,questionnaires were used to investigate and score the situation of antibiotics management in hospitals of 3 groups,and then analyzed statistically. RESULTS:Scoring rate (SR) of overall situation on antibiotics management were 65.33%,89.34% and 86.67% in group A,B and C respectively;group A was statistically significantly lower than group B and C (P<0.001). SR of basic situation indicator on antibiotics management were 90.46%,95.25% and 95.25% in group A,B and C,respectively and there was no statistically significant difference among 3 groups (P>0.05). SR of development indicator of antibiotics management were 58.33%,88.90% and 86.10%,respectively in group A,B and C;group A was significantly lower than group B and C (P<0.001). SR of information construction indicator of antibiotics management were 50.00%,83.33% and 77.79% respectively in group A,B and C;group A was significantly lower than group B and C (P≤0.001). SR of information construction indicator of antibiotics management in 3 groups were all signifi-cantly lower than SR of basic situation indicator(P<0.05). SR of development indicator of antibiotics management in group A and C were all significantly lower than SR of basic situation indicator(P<0.05). CONCLUSIONS:The antibiotics management of mu-nicipal third grade class A general hospital is equal to that of provincial third grade hospital,and that of county second grade class A general hospital is in relatively low level. Different levels of hospitals should further strengthen the related antibiotics manage-ment work and information construction,especially for county second grade class A general hospitals.

Objective To analyze the effect of edaravone combined with ginkgo diterpene lactone in treatment of acute cerebral infarction (ACI) and discuss the better clinical treatment to ACI .Methods 100 cases of ACI and who accepted treat-ments in our hospital were selected as the research objects in January 2014 to January 2015 .50 patients as observation group were given the treatment of edaravone and ginkgo diterpene lactone at the same time ,while other 50 patients as control group were merely given the treatment of ginkgo diterpene lactone .At the same time ,both groups were given treatment of conven-tional therapy .The total neurological function ,effective rate ,adverse reactions ,and the treatment satisfaction of both groups before and after the treatment were observed .Results There were no significant different of NIHSS score of two groups before treatment (P>0 .05) .After treatment ,NIHSS score of the observation group was significantly lower than the control group (P<0 .05) .The total effective rate of observation group was 90％ ,which was significantly higher than the control group (66％ ,P<0 .05) .The main adverse reactions were rash ,nausea ,dizziness of two groups ,and there were no significant differ-ent of adverse reactions rate of two groups through the treatment (P>0 .05) .The treatment of patients with satisfaction rate of observation group was 94％ ,which was significantly higher than control group (84％ , P< 0.05) .Conclusion Edaravone combined with ginkgo diterpene lactone had a good effect on improving nerve function of ACI patients ,which could improve the treatment of patients with satisfaction ,high security ,and could be recommended in clinical .

Objective To evaluate the reliability of the inhibitor enhanced carbapenem inactivation method (ieCIM) in the detection and preliminary classification of carbapenemase in gram-negative rods.Methods The carbapenem inactivation method (CIM) was modified by adding tazobactam or ethylene diamine tetraacetic acid disodium salt as carbapenemase inhibitors into the reaction system.A total of 198 isolates of Enterobacteriaceae and 35 strains of nonfermenters were collected,and their preliminary classification of carbapenemase was performed by the ieCIM.Meanwhile,their carbapenemase genes were detected by polymerase chain reaction (PCR),and the results were compared with that of the ieCIM.Results Among 198 strains of Enterobacteriaceae,101 were positive for carbapenemase genes,while 99 were detected by the CIM.Among the other 97 strains with negative carbapenemase gene,the results of the ieCIM were also negative.Among 35 strains of nonfermenters,25 were positive for carbapenemase genes,while 24 were detected by the CIM.Among the other 10 strains with negative carbapenemase gene,the results of the CIM were also negative.Using the ieCIM,97.7％ (85/87) of strains producing class A carbapenemase and 88.0％ (22/25) of strains producing class B carbapenemase were detected.Twelve strains producing class D carbapenemase and 2 strains producing both class A and class B carbapenemase were detected by the ieCIM.The total detection sensitivity and specificity of the ieCIM were 96％ and 100％,respectively.Conclusion The ieCIM has the consistent results with the detection method of carbapenemase genes,which may be used to detect and classify carbapenemase in clinical microbiology laboratories.

Objective: To evaluate the effectiveness of surgery combined with multiple interventions in treating patients with ear keloid by network meta-analysis. Methods: Databases including " PubMed" , " Cochrane Library" were searched using key words " (((((((((((Ear, External[MeSH Terms]]] OR (Ears, Exernal]] OR (Outer Ear]] OR (Ear, Outer]] OR (Ears, Outer]] OR (External Ear]]] AND (((keloid[Mesh Terms]]] OR (keloids]]] AND ((((((surgery[MeSH Terms]]] OR (operative therapy]] OR (operative procedures]] OR (invasive procedures]] OR (operations]]]] AND (randomized controlled trial[pt]]" , database " Embase" was searched using key words ((′external ear′/exp] OR(′auricle′/exp] OR (′ear lobe′/exp]] AND ((′surgery′/exp] OR (′ear surgery′/exp]] AND (′keloid′/exp] AND (′randomized controlled trial′/exp] and Chineses journals full-text database, China biology medicine disc, VIP database, and Wanfang database were searched using key words in chinese version "耳瘢痕疙瘩,手术" to obtain the randomized controlled trails about surgery combined with multiple interventions in the treatment of ear keloid from the establishment of each database to June 2018. EndNote X7, Revman 5.3, STATA 14.0, GeMTC 14.3 statistical software were used to extract data from studies, study quality assessment, drawing network figure, publication bias analysis, traditional meta-analysis, heterogeneity test, consistency test, similarity test, network meta-analysis. Results: A total of 18 trails involving 8 therapeutic measures were included, and 1 425 patients with ear keloid were included. All of the 18 trails had high risk of bias. The network figure shows that there are 28 different pairwise comparisons among the eight treatments. Of the 18 studies included, 10 were directly compared, and the remaining 18 were not directly evidenced, those comparisons will be made indirectly by the network meta-analysis. The basic symmetry of each point in the funnel plot and the P values of Beggs test and Eggers test were all greater than 0.05, shows that the existence of publication bias is less likely. Traditional meta-analysis showed that the efficiency of surgery + hormone, surgery + pressure, surgery + radiotherapy and surgery + hormone + radiotherapy were better than that of simple surgery, and the difference was statistically significant(P<0.05); the efficiency of surgery + hormone + radiotherapy was better than that of surgery + hormone, the difference was statistically significant(P=0.001); surgery + hormone + fluorouracil and surgery + hormone + radiotherapy had statistical significance(P<0.05). Efficiency is higher than surgery + radiotherapy, the difference is statistically significant. The rest of the direct comparisons are not statistically significant. All P values in the heterogeneity test were greater than 0.1 and I² was less than 50%, so there was no significant heterogeneity in the study. 8 treatments formed 4 closed loops, the inconsistency factor IF ranged from 0.06 to 0.23, and the lower limit of 95% CI was 0, it means than the consistency of those loops were good. The similarity test of the 18 studies was good. Based on Bayesian theory, the random effect model of MCMC method was analyzed by network meta analysis. The results of 7 combined therapies were statistically significant compared with those of simple operation, and were superior to those of simple operation. The results of the seven combined therapies were statistically significant as follows: surgery + hormone + fluorouracil VS surgery + radiotherapy (OR = 0.28, 95% CI 0.08-0.93], surgery + hormone + fluorouracil was better than surgery + hormone; surgery + hormone + radiotherapy + VS surgery + hormone (OR = 0.06, 95% CI 0.01-0.23], surgery + hormone + radiotherapy Surgery + hormone + radiotherapy VS surgery + pressure (OR = 0.07, 95% CI 0.01-0.37], surgery + hormone + radiotherapy is better than surgery + pressure; surgery + hormone + radiotherapy VS surgery + radiotherapy (OR = 0.06, 95% CI 0.01-0.30], surgery + hormone + radiotherapy is better than surgery + radiotherapy. There was no significant difference in the curative effect between the other combined treatments. The SUCRA curves were drawn according to the randomized effect model of MCMC. The SUCRA values of each treatment measure were as follows: surgery, 0.4%; surgery + hormone, 33.0%; surgery + pressure, 52.2%; surgery + radiotherapy, 34.6%; surgery + imiquimod 53.3%; surgery + fluorouracil 51.6%; surgery + hormone + fluorouracil, 76.4%; surgery + hormone + radiotherapy, 34.6%; surgery + hormone + fluorouracil, 53.3%; surgery + hormone Radiotherapy, 98.4%. According to the results of SUCRA chart, the effectiveness of each treatment measure was sorted as follows: operation + hormone + radiotherapy > operation + hormone + fluorouracil > operation + imiquimod > operation + pressure > operation + fluorouracil > operation + radiotherapy > operation + hormone > operation. Conclusions Surgery combined with a variety of treatments for ear keloid were superior to simple surgical treatment, of which surgery + hormone + radiotherapy is the best.

Objective To explore the impact of sluggish cognitive tempo(SCT)on the efficacy of atomoxetine in the treatment of attention-deficit/hyperactivity disorder(ADHD).Methods A prospective study was conducted.Pediatric patients aged 6-12 years with a diagnosis of ADHD were selected from the Department of Psychiatry,Xijing Hospital,Air Force Military Medical University from May 2020 to May 2023.All the patients were treated with atomoxetine for 8 weeks.ADHD symptoms and SCT symptoms were assessed by Swanson,Nolan,and Pelham-Ⅳrating scale(SNAP-Ⅳ)and SCT rating scale at baseline(before treatment),4 weeks and 8 weeks after treatment.Pearson correlation analysis was used to analyze the correlation between SCT and SNAP-Ⅳscores.Results A total of 61 pediatric patients were enrolled,including 10 cases of inattentive type and 51 cases of mixed type.Baseline SCT score was positively correlated with baseline SNAP-Ⅳscore(r=0.490,P＜0.001)and reduction rate of SNAP-Ⅳscore at week 8(r=0.670,P＜0.001).The total SCT score at week 8 was positively correlated with total SNAP-Ⅳscore at baseline(r=0.320,P=0.012).The baseline SCT score of patients with mixed type was positively correlated with reduction rate of SNAP-Ⅳscore at week 8(r=0.578,P＜0.001).Conclusions The severity of SCT symptoms is positively correlated with the SNAP-Ⅳreduction rate 8 weeks after atomoxetine treatment,which could be a predictor of the efficacy of atomoxetine.

Objective:To systematically evaluate the clinical effects of microskin grafting and Meek microskin grafting in repairing extensively deep burn wounds using meta-analysis.Methods:Foreign language databases including PubMed and Cochrane Library were searched with the terms of " Meek micrografting, burn" , and Chinese databases including Chinese Journal Full- Text Database, Chinese Biomedical Database, VIP database, and Wanfang Data were searched with the terms in Chinese version of "微粒皮, Meek植皮,烧伤" to retrieve the publicly published randomized controlled trials on the microskin grafting and Meek microskin grafting in repairing extensively deep burn wounds from the establishment of each database to March 20, 2019. The outcome indexes included the survival rate of skin graft, primary healing rate, operation time, and surgical treatment cost after the first operation, as well as the wound healing time and length of hospital stay. RevMan 5.3 and Stata 14.0 statistical software were used to conduct a meta-analysis of eligible studies. Results:A total of 821 patients with extensively deep burns were included in 15 studies, including 410 patients in microskin group who received microskin grafting and 411 patients in Meek microskin group who received Meek microskin grafting. The bias risks of the 15 studies included were uncertain. Compared with those of microskin group, the survival rate of skin graft and primary healing rate of patients in Meek microskin group were significantly increased, with relative risks of 0.76 and 0.66 (95% confidence interval=0.66-0.88, 0.50-0.88, P<0.01), the surgical treatment cost was significantly reduced, with a standardized mean difference of 3.19 (95% confidence interval=1.36-5.01, P<0.01), and the operation time, wound healing time, and length of hospital stay were significantly shortened, with standardized mean differences of 6.05, 2.39, and 2.35 (95% confidence interval=3.66-8.44, 1.43-3.35, 2.03-2.68, P<0.01). Subgroup analysis showed that microskin grafting combined with allogenic skin graft might be a heterogeneous source of operation time. Sensitivity analysis showed that the combined effect size was stable in the operation time, surgical treatment cost, and wound healing time. There was no publication bias in the survival rate of skin graft, operation time, wound healing time, and length of hospital stay ( P>0.05), while the primary healing rate and surgical treatment cost had publication bias ( P<0.01). Conclusions:Compared with microskin grafting, Meek microskin grafting improves the rates of skin graft survival and primary healing, shortens operation time, wound healing time, and length of hospital stay, and reduces the treatment cost in treating extensively deep burn wounds.

Objective To investigate the role of interleukin-22 (IL-22)-regulated autophagy in hydrogen peroxide (H2 O2 )-induced hepatocarcinoma cell damage. Methods HepG2 cells were transfected with pEGFP-LC3 and then cultured in RPMI 1640 medium free of fetal bovine serum (FBS) or containing 1％ or 10％ FBS. These cells were pretreated with rapamycin or an autophagy inhibitor (3-MA) and then stimulated with recombinat human IL-22 (rhIL-22). GFP-LC3 puncta formation and autophagy signaling ac-tivation were measured. MTT assay was performed to detect cell viability. Results rhIL-22 significantly promoted GFP-LC3 puncta formation and LC3-Ⅱ expression in HepG2 cells treated with different stimulation protocols. The autophagy pathway inhibitor, 3-MA, dramatically suppressed the rhIL-22-activated autophagy signals. rhIL-22 attenuated H2 O2-mediated HepG2 cell death and that could be inhibited by 3-MA. Conclu-sion IL-22 promoted the activation of autophagy signaling pathways and alleviated H2 O2-mediated HepG2 cell damage.

Objective:To explore the efficacy and safety of low-dose rabbit anti-human thymocyte globulin (rATG) for induction therapy of kidney transplantation (KT) in children.Methods:From October 2018 to May 2021, clinical data were reviewed retrospectively for 77 pediatric KT recipients on a low-dose rATG induction protocol.Recipient/graft survival rate, renal function recovery, acute rejection (AR) and adverse reactions were observed at 1 year post-operation.The postoperative changes of renal function were examined by Friedman’s test; According to the preoperative baseline data, Pearson’s Chi-square or Fisher's exact test was utilized for examining the influencing factors of postoperative AR.Results:A total of 16(20.78%) recipients had AR within the first 6 months post-operation.The incidence of delayed graft function (DGF) was 14.29%(11/77); The incidence of severe infection post-transplantation 18.18%(14/77), the infection rate of BK virus 25.97%(20/77) and the incidence of neutropenia 32.47%(25/77).The recipient/graft survival rate at 1 year post-operation was 97.40%(75/77) and 94.81%(73/77) respectively.Chi-square test indicated that the incidence of postoperative infection in children with body weight ≤30 kg and height ≤138 cm was 28.95%(11/38) and 27.50%(11/40) respectively, Both were higher than 7.69%(3/39) and 8.11%(3/37) of children with body weight >30 kg and height>138 cm.The difference between groups was statistically significant ( P=0.016 and 0.028). Conclusions:Low-dose rATG is generally excellent in preventing AR in pediatric KT recipients.And the risk of related AR may be lower.The infection rate of recipients with decent preoperative development is low.

There is no doubt that double-eyelid blepharoplasty is one of the most common cosmetic surgery in Asia. Its purpose is to form a natural and beautiful double eyelid appearance on patients’ upper eyelids through this operation. The current surgical method of double blepharoplasty are mainly divided into incision and non-incision techniques. However, the full-incision choice in the traditional full-incision method brings complications that patients are unwilling to accept, such as postoperative scars and a long recovery period. In order to reduce the rate of complications, many plastic surgeons choose to modify the incision. The development and progress of diverse modified techniques are reviewed.

There is no doubt that double-eyelid blepharoplasty is one of the most common cosmetic surgery in Asia. Its purpose is to form a natural and beautiful double eyelid appearance on patients’ upper eyelids through this operation. The current surgical method of double blepharoplasty are mainly divided into incision and non-incision techniques. However, the full-incision choice in the traditional full-incision method brings complications that patients are unwilling to accept, such as postoperative scars and a long recovery period. In order to reduce the rate of complications, many plastic surgeons choose to modify the incision. The development and progress of diverse modified techniques are reviewed.