OBJECTIVE:To provide reference for rational use and standard management of antibiotics. METHODS:The relevant information for antibiotics used in the inpatients of our hospital involved in antibiotics special rectification during 2011 to 2014 were extracted from hospital information system,and the relevant data of antibiotics use were analyzed statistically. The changes of several indicators in the inpatients of our hospital were investigated,including the utilization rate and amount of antibiotics,DDDs and the uti-lization rate of typeⅠincision antibiotics for prophylactic use. RESULTS:The ratio of consumption sum of antibiotics in total con-sumption sum were decreasing from 2011 to 2014. The utilization rate of antibiotics and of typeⅠincision antibiotics for prophylactic use were decreased significantly,decreasing from 77.30% and 47.57% in 2011 to 57.24% and 5.89% in 2014. The consumption sum of cefepime occupied the first 3 places in 3 years. DDDs of cefotaxime and cefoperazone/sulbactam occupied the first 2 places in 4 years. CONCLUSIONS:The development of“antibiotics special rectification activities”have achieved remarkable results in our hospi-tal,the various index of antibiotics in the inpatients have been obviously improved,and clinical application of antibiotics become more reasonable,which lay a good foundation for continuous improvement of clinical application and management of antibiotics.

Objective:Evaluation of the effectiveness of domestic ultrapulsed thulium laser ablation of isolated porcine kidneys.Methods:Forty-two fresh porcine kidneys were taken. One porcine kidney was dissected along the sagittal plane at the renal hilum, and then dissected along the coronal plane and divided into four pieces.A total of 168 pieces of renal tissues were obtained, of which 162 pieces were selected for the domestic hyperpulsed thulium laser ablation of isolated porcine kidneys using the single-needle method and the double-needle method, respectively. The ablation was carried out with different ablation modes (single-needle and double-needle methods), ablation power (4, 5, and 6 W), ablation modes (continuous, low-energy and high-frequency mode, and high-energy and low-frequency mode), and ablation time (10, 15, and 20 s). The size of the ablation area in terms of the long diameter, the short diameter, and the thick diameter were measured and recorded. The embedded tissues were sectioned and stained with HE to study the microscopic pathological characteristics of the ablation foci. The ablation foci volume and sphericity coefficient (Φ) were calculated, and the ablation foci volume and sphericity coefficient were statistically analyzed by analytic factorial design and one-way ANOVA.Results:The gross specimen showed that the single-needle ablation foci were elliptical in shape, containing black carbonized areas and gray-white necrotic areas with clear boundaries, and the peripheral renal tissues were pink, and the ablation focus was clearly demarcated from the normal tissues. The double-needle ablation foci were a large ellipse containing two small ellipse ablation foci, and the structure was similar to that of the single-needle method. Under the light microscope, the center of the ablation focus was a "cavity-like" carbonized area, outside of which was an area of coagulation necrosis, with deepened cell staining, reduced cell volume, disorganized arrangement, loose nuclei, nuclear consolidation, and some cell nuclei were cleaved and ablated. Ablation mode ( P<0.001), ablation pattern ( P <0.001), ablation time ( P <0.001), and ablation power ( P <0.001) all significantly affected ablation focus volume. The volume of the ablation foci increased with increasing number of needle feeds, longer ablation time, higher ablation power, and with the ablation mode being continuous mode. Single-needle ablation produced the largest volume of ablation foci (259.56 mm 3) in continuous mode, ablation time of 20 s, and ablation power of 6 W. Double-needle ablation produced the largest volume of ablation foci (452.00 mm 3) in continuous mode, ablation time of 20 s, and ablation power of 6 W. The analysis of the sphericity coefficient showed that in single-needle ablation, the sphericity coefficient was the largest (Φ=0.76) under the conditions of continuous mode, ablation power of 4 W, and ablation time of 15 s. The sphericity coefficient was the smallest (Φ=0.56) under the conditions of high-energy, low-frequency mode, ablation time of 10 s, and ablation power of 6 W, and the morphology of the ablation foci were more close to ellipsoid shape. When ablated by the double-needle method, the ablation foci morphology was closer to spherical shape (Φ=0.91) under the conditions of continuous mode, ablation time of 10 s, and ablation power of 5 W. The combined main effect and interaction results showed that ablation mode ( P<0.001), ablation pattern ( P<0.001), and ablation power ( P<0.001) significantly affected the sphericity coefficient of the ablation foci, and ablation time did not affect the ablation foci morphology. Conclusions:Domestic ultrapulsed thulium laser ablates isolated porcine kidney tissues with precise effect, the tissue morphology of the unablated area is normal, the thulium laser ablated foci have a definite safe boundary. Choosing double needle method, continuous mode, ablation power 6 W for 20 s, can ablate spherical cancer foci within 1 cm in diameter, which can be used for spherical small kidney cancer ablation. Selecting the single-needle method, high-frequency, low-energy mode and ablation power of 6 W, the ablation foci were similar to the oval volume, and could be used for the ablation of oval small renal cancer. However, this study is only limited to the animal ex vivo model, which needs to be confirmed by further study.

It is believed that the occurrence and development of squamous cell carcinoma （SCC） is closely associated with inflammatory responses. The theory of fire and heat， advocated by LIU Wansu， provides significant clinical guidance for understanding the pathogenesis and treatment of SCC. Based on this theory， the pathological mechanisms and clinical characteristics of SCC at different stages were analyzed. In the precancerous and early stages， the primary pathogenesis is qi stagnation leading to internal generation of constrained heat； in post-surgery， the condition shifts to qi deficiency with latent yin fire； during the treatment phase， the pathogenesis involves accumulation of pathogenic factors， excess toxins， and severe heat toxicity； in the late stage， the main pathology is yin deficiency with toxic heat， and phlegm-stasis obstruction of the internal organs. Corresponding stage-based treatment strategies are proposed. In the early stage， regulating qi movement to dissipate constrained heat； for post-surgery， tonifying qi and raising yang to dispel latent fire； during treatment stage， clearing heat and detoxifying to eliminate cancerous toxins； and in the late stage， nourishing yin and unblocking the bowels to clear deficiency heat.

Gegen Qinlian Decoction (GQD), a traditional Chinese medicine (TCM) formula, has long been used for the treatment of common metabolic diseases, including type 2 diabetes mellitus. However, the main limitation of its wider application is ingredient complexity of this formula. Thus, it is critically important to identify the major active ingredients of GQD and to illustrate mecha-nisms underlying its action. Here, we compared the effects of GQD and berberine, a hypothetical key active pharmaceutical ingredient of GQD, on a diabetic rat model by comprehensive analyses of gut microbiota, short-chain fatty acids, proinflammatory cytokines, and ileum transcriptomics. Our results show that berberine and GQD had similar effects on lowering blood glucose levels, modulating gut microbiota, inducing ileal gene expression, as well as relieving systemic and local inflammation. As expected, both berberine and GQD treatment significantly altered the overall gut microbiota structure and enriched many butyrate-producing bacteria, including Faecalibacterium and Roseburia, thereby attenuating intestinal inflammation and lowering glucose. Levels of short-chain fatty acids in rat feces were also significantly elevated after treatment with ber-berine or GQD. Moreover, concentration of serum proinflammatory cytokines and expression of immune-related genes, including Nfkb1, Stat1, and Ifnrg1, in pancreatic islets were significantly reduced after treatment. Our study demonstrates that the main effects of GQD can be attributed to berberine via modulating gut microbiota. The strategy employed would facilitate further stan-dardization and widespread application of TCM in many diseases.

Objective:To discuss the effect of long-term use of chlorhexidine on the resistance of Enterococcus faecalis(E.faecalis),and to clarify its mechanism.Methods:The standard strain of E.faecalis was repeatedly exposed to chlorhexidine for 10 generations,and the minimum inhibitory concentration(MIC)was recorded at each passage.The bacteria collected from the 10th generation with increased MIC values were designated as the E.faecalis chlorhexidine-resistant strains(E.faecalis-Cs).The growth curves of two strains were drawn;the morphology of two strains were observed by transmission electron microscope;the number of biofilm formation of two strains was detected by crystal violet staining;the bacterial hydrophobicities of two strains were detected by microbial adhesion to hydrocarbons(MATH)method;the expression levels of S-ribosylhomocysteine lyase(LuxS)mRNA in the bacterial biofilms of two strains were detected by real-time fluorescence quantitative PCR(RT-qPCR)method.Results:From the 0th to the 10th generation,the MIC values of E.faecalis were gradually increased.The growth curves of E.faecalis and E.faecalis-Cs showed no significant differences.The transmission electron microscope observation results showed that both E.faecalis and E.faecalis-Cs appeared oval or diplococcal,with intact cell wall structures,smooth edges,and evenly distributed cytoplasm.There were no significant differences in the morphology,size,cell wall thickness,or integrity between two types of bacteria.The crystal violet staining results showed that compared with E.faecalis,the number of biofilm formation of E.faecalis-Cs was significantly increased(P<0.05).The MATH results showed tha the hydrophobicity of E.faecalis-Cs was significantly higher than that of E.faecalis(P<0.05).The RT-qPCR results showed that the expression level of LuxS mRNA in the biofilms of E.faecalis-Cs was significantly higher than that of E.faecalis(P<0.05).Conclusion:E.faecalis develops the resistance after repeated exposure to the chlorhexidine,and the pathogenicity of the resistant strain is enhanced.The high expressin of quorum sensing(QS)system LuxS gene and stronger biofilm forming ability of bacteria may be the potential mechanism for E.faecalis to tolerate the chlorhexidine.

Objective To investigate the current situation and health effects of indoor microbial pollution in Xi'an, to analyze the purification effect of air purifiers on indoor microbial pollution, and to provide reference for improving the indoor environment. Methods Through stratified random sampling, 20 families from rural areas and 20 families from upwind and downwind urban areas respectively were selected from Xi'an. Data was collected by questionnaire surveys and on-site environmental sampling. Non-parametric analysis and correlation analysis were used for statistical analysis. Results Overall, the standard-exceeding rate of total count of bacteria was 5.00%. The medians of the total count of bacteria and fungi were 312.50 cfu/m3 and 260.00 cfu/m³, respectively. In terms of health effects, the correlation between rhinitis and cold with total bacterial count was statistically significant (P<0.05), with the correlation coefficients of 0.182 and 0.223, respectively. Purification effect of air purifiers on microbial pollution was statistically significant (P<0.05). After opening for 2 hours, the total numbers of bacteria and fungi decreased significantly. Conclusion The occurrence risk of colds and rhinitis is increased by indoor microbial pollution. Air purifiers have a certain effect on decreasing the total number of bacteria and fungi. It is recommended to use air purifiers with high CADR of particulate matter, double-layer filter and sterilization and dehumidification function, and replace the filters regularly to reduce indoor microbiological contamination.