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.

Objective To evaluate the influence of the single and multiple intervertebral space radiofrequency ablation nucleoplasty on the sheep cervical spine stability.Methods Twenty healthy adult sheep were randomly divided into single intervertebral space operation group (A group )and multiple intervertebral space operation group ( B group ),each group was subdivided into postoperative 24 hours group ( A1,B1 group ) and post- operative 3 months group ( A2,B2 group),each group had five sheep.Radiofrequency ablation nucleoplasty on sheep C3/4 in the single intervertebral space operation group or C3/4,C4/5 in multiple intervertebral space operation group.Preoperative cervical vertebrae roentgenograms from all samples in neutral,lateral,hyperextension and hyperflexion positions were collected,and 5F pipe was used as the survey mark of ieonography.For the postoperative 24 hours group( A1,B1 group ),the roentgenograms were collected postoperatively 24 hours later,while for post- operative 3 months group (A2,B2 group),they were collected postoperatively 3 months later.The height of operative intervertebral space,horizontal and angular displacement of neighboring vertebral body were measured respectively.Results The roentgenograms showed no any obvious decrease in the height of intervertebral disc and no any increase in horizontal and angular displacement of neighboring vertebral body were observed in single intervertebral space operation group (A group) and multiple intervertebral space operation group (B group ).There was no significant difference between pre - operation and post - operation in them ( P ＞ 0.05 ).Conclusions The stability of the sheep cervical spine had not been affected by the single or multiple intervertebral space radiofrequency ablation nucleoplasty on the basis of X-ray results.The radiofrequency ablation nucleoplasty had no influences on the stability of sheep cervical vertebrae.

Objective To investigate the radioactivity levels of total α and total β in drinking water in nine districts of Chongqing City from 2019 to 2021, and to provide reference for the risk monitoring of drinking water in the metropolitan areas of Chongqing. Methods The total α and total β radioactivity levels in water samples were determined by the comparative measurement method and the thin source deposit method in GB/T5750.13-2006 ^“Standard Examination Methods for Drinking Water-Radiological Parameters^”. The monitoring results were assessed according to GB5749-2006 ^“Standards for Drinking Water Quality^” and the fourth edition of the WHO Guidelines for Drinking Water Quality. Results From 2019 to 2021, the total α activity concentration of the water samples measured in the nine districts of metropolitan Chongqing ranged from 0.002 to 0.039 Bq /L, and the total β activity concentration ranged from 0.015 to 0.190 Bq /L. There was no significant difference in the activity concentration (tα=0.545, Pα=0.591; tβ=-1.438, Pβ=0.163>0.05). From 2019 to 2021, the average value of total α radioactivity decreased year by year and its activity value was relatively low, indicating a low health risk. However, the average value of total β radioactivity increased year by year, which should be paid attention to. Conclusion The total α and total β radioactivity in water samples measured in the present study are lower than the standard recommended limits. The estimated annual average effective dose of radiation caused by drinking water is 0.005-0.010 mSv, which is lower than the limit of 0.1 mSv recommended by WHO, and this radioactivity level will not have an impact on the health of residents. However, the total β radioactivity level of the monitoring points in Banan and Shapingba is relatively high compared to other jurisdictions, and further tracking and monitoring should be carried out.

Objective To investigate the metabolite changes in systemic lupus erythematosus (SLE) patients with and without neuropsychiatric symptoms using magnetic resonance spectroscopy (MRS) and explore the associations between image findings and clinical variables. Methods Twenty-two SLE patients with neuropsychiatric symptoms (NPSLE), twenty-one SLE patients without neuropsychiatric symptoms (non-NPSLE) and twenty healthy controls (HCs) underwent routine MRI scan and multivoxel magnetic reson-ance spectroscopy (MVS). The absolute metabolite concentrations were measured bilaterally in the posterior cingulate gyrus (PCG), dorsal thalamus (DT), lentiform nucleus (LN) and posterior paratrigonal white matter (PWM) using LCModel and SAGE software. The relationships between metabolite con-centrations and cognitive function scores were analyzed by Spearman rank correlation. Single-factor Chi-square analysis and t-test were used for analysis. Results ① Compared to control subjects, NPSLE patients had significantly lower N-acetylaspartate (NAA) values in bilateral PCG and DT, with the mean differences of -1.504 [95% confidence interval ( CI) (-2.335, -0.672), P=0.001], -1.460 [95%CI (-2.349, -0.570), P=0.002], -1.259 [95%CI (-1.894, -0.625), P=0.000] and -1.022[95%CI (-1.688, -0.356), P=0.003] for RPCG, LPCG, RDT and LDT, respectively. The concentration of total creatinine were observed to decline in RPCG and RDT, with the mean differences of-1.094 [95%CI (-1.845, -0.342), P=0.003], -0.955 [95%CI (-1.630, -0.280), P=0.006], -1.259 [95%CI (-1.894,-0.625), P=0.006] respectively. Glutamine and glutamate-values decreased significantly in RDT [mean difference=-2.586, 95%CI (-4.139, -1.033), P=0.002]. ② Compared to non-NPSLE patients, NPSLE patients had a lower NAA level in LPCG [mean difference=-1.256, 95%CI (-2.146, -0.367), P=0.006]. Positive correlations between mini-mental state examination scores [RPCG: rs=0.312, P<0.05; LPCG: rs=0.355, P<0.01], Montreal cognitive assessment scores (RPCG: rs=0.362, P<0.01; LPCG: rs=0.285, P<0.05) and NAA values in bilateral PCG were detected. Conclusion Both NPSLE and non-NPSLE patients may have metabolite dysfun-ctions in different brain regions. The cognitive disorder in SLE patients may be interpreted by neuronic damage of PCG.

Objective To explore the regularity between the change of urine osmotic pressure to the syndrome of kidney Yin deficiency and kidney Yang deficiency in patients with chronic kidney disease,to provide an objective evident for the syndrome differentiation of TCM and the judgment of renal function.Methods Urine osmolality and renal function of one hundred and twenty-one patients with chronic kidney disease,belonging to the syndrome of kidney Yin deficiency of kidney Yang deficiency,were detected.The connection between urine osmolality,renal function and TCM syndromes of kidney Yin deficiency and kidney Yang deficiency and the relation of TCM symptom score between them were analyzed.Results The research suggested an obvious link between urine osmolality,renal function and the TCM Syndromes of kidney Yin deficiency and kidney Yang deficiency in Chronic kidney disease.It also suggested an obvious correlation between the urine osmolality and TCM symptom scores.Conclusion The determination of urine osmolality can provide an objective evident for differentiating syndromes of kidney Yin deficiency or kidney Yang deficiency in chronic renal disease.

Objective To study the pathogens associated with infectious keratitis for early diagnosis and treatment.Methods This study was conducted with the patients with confirmed diagnosis of infectious keratitis in our hospital during the period from January 2011 through December 2015.The specimens from corneal ulcer were subject to bacterial and fungal culture.The pathogens and associated risk factors of infectious keratitis were analyzed retrospectively.Results Of the 1 046 corneal specimens,369 (35.3％) were positive for microorganisms.The most frequently isolated microorganism was fungal species (53.1％),followed by grampositive cocci (31.2％),gram-negative bacilli (11.1％),and gram-positive bacilli (4.6％).Of the fungal strains,most were Fusarium (69.4％),followed by Aspergillus species (21.9％).Coagulase negative Staphylococcus accounted for more than half (50.4％) of the gram positive cocci.Conclusions Infectious keratitis is primarily associated with fungal infection,especially filamentous fungus such as Fusarium.

Objective To study the application value of laparoscopic curettage in the standardized training for residents.Methods In this study,we selected residents of the Wuhan First Hospital as the research subjects.Thirty of the subjects from the 2015 grade were the control group and another 29 from the 2016 grade were the experimental group.Both groups had three classes,including one theory class,and two practice classes.After the theoretical class,the experimental group practiced laparoscopic curettage,while the control group practiced curettage.After practice,the experimental group filled out the questionnaire on teaching quality,and both groups participated in the theory test.Results Laparoscopic curettage can significantly improve students' ability to learn and understand curettage,so that most students can adapt to curettage,eliminate the panic from uterine perforation and be more sensitive to the uterus textures,and satisfactory teaching results were achieved.The average score of the practice test for the experimental group (9.150 ± 2.461) was statistically higher than that for the control group (7.053 ± 1.347).The average score of the theory test (7.581 ± 1.632) for the experimental group was not statistically different from that for the control group (6.983 ± 1.726).The average scores of the two tests for the experimental group (9.037 ± 1.951) and the control group (6.891 ± 2.140) were statistically different.Conclusions Laparoscopic curettage can significantly improve the ability to learn,understand and feel curettage for residents who are under standardized training,and it has great application value in the three basic operation trainings.

Objective To observe the short-term curative effects and safety of conventional immunosuppressor (hydrox-ychloroquine sulphate) combined with tacrolimus in the treatment of oral lichen planus. Methods Eighty patients with oral lichen planus were assigned to two groups. The experiment group was sublingually given 0.0015%of tacrolimus so-lution twice a day, and was orally given 100 mg of hydroxychloroquine sulphate tablets once a day. The control group was orally given 100 mg of hydroxychloroquine sulphate tablets once a day. The treatment was observed for 4 weeks, and the effective rate and incidence of adverse effects at the end of the treatment were evaluated. Results The effective rate of experiment group was 95.0%, and the control group was 35.0%. The short-term curative effect of hydroxychloro-quine sulphate combined with tacrolimus in the treatment of oral lichen planus was significantly better than that of hydroxychloroquine sulphate alone (χ2=31.65, P=0.00), but the incidence of adverse had not significantly different be-tween two groups. Conclusion The short-term curative effect of hydroxychloroquine sulphate combined with tacrolimus in the treatment of oral lichen planus is significantly better than that of hydroxychloroquine sulphate alone, which is safe and effective, and is worthy of clinical promotion and application.

Objective:To construct the selection index system of clinical nursing teachers, and to provide theoretical basis for improving the comprehensive quality of clinical teachers and the comprehensive clinical practice ability of undergraduate nursing students.Methods:Using the methods of literature review, brainstorming and semi-structured interview, the selection index system of clinical nursing teachers was initially constructed. Delphi method was used to conduct two rounds of consultation on 25 experts. SPSS 20.0 was used to analyze the consulting data and calculate the experts' positive coefficient, authority coefficient, degree of concentration of opinions and degree of coordination, and the index contents were modified and improved according to the expert opinions. Finally, the selection index system of clinical nursing teachers was established.Results:Based on the two rounds of expert consultation, the positive coefficient of experts was 96%, the authoritative coefficient of experts was 0.857 and 0.848 respectively, and the coordination coefficient of experts was 0.277~0.442 ( P<0.001). Four first level indexes, 12 second level indexes and 45 third level indexes were determined. Conclusion:The selection index system of clinical nursing teachers is scientific and reliable, which can provide a theoretical basis for the selection of clinical nursing teachers.

Objective:To explore the application effect of TBL (team-based learning) + PAL (peer assisted leaning) + Flipped Class mixed teaching mode in the course of "nursing psychology" for nursing undergraduates.Methods:A total of 146 nursing undergraduates from four classes enrolled in 2018 were subjected to cluster sampling and assigned to classes 1-2 (experimental group, n=73) and classes 3-4 (control group, n=73). The experimental group adopted the TBL + PAL + Flipped Class mixed teaching mode, while the control group adopted the traditional teaching method. After the course, the two groups were evaluated by final exam score, case analysis score, and core competence self-assessed score with a t-test in SPSS 18.0. Results:The final examination score (82.30±7.77) and case analysis score (46.13±2.91) of the experimental group were significantly higher than those in the control group (74.97±7.05 and 40.36±4.25). The experimental group showed significantly higher scores in autonomous learning ability (8.03±0.91), problem analysis ability (7.99±0.99), teamwork ability (7.67±1.09) and critical thinking ability (7.03±1.33) as compared with the control group (6.21±1.17, 5.64±1.28, 5.79±1.27, 5.15±1.16).Conclusion:TBL + PAL + Flipped Class mixed teaching mode integrates the advantages of the three teaching forms, promotes students' understanding and application of knowledge points, improves students' ability of independent learning, teamwork, and problem analysis, strengthens students' ability of transfer and application of knowledge and skills, increases the teaching effect, and expands the teaching method of nursing psychology.