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 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 summarize and analyze the difficulties and key points in the measurement of gross α and gross β radioactivity in water based on the results of national measurement capability comparison assessment, and provide the basis and reference for the future work and the development of new local standards. Methods The research team participated in the comparison assessment for measurement of the gross radioactivity in water samples organized by National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention. According to the comparison assessment results and the content in the national standard GB/T 5750.13—2023 (published draft), the steps of spike recovery involved during the measurement were analyzed and discussed. Two different formulas used for spike recovery calculation were analyzed for their impact on the final measurement results. Results When the spike recovery F_(derived) derived from the formulas was used for result calculation, the spike recovery ranged as follows: gross α: 63.00%−84.60%, and gross β: 95.0%−99.1%; 3/6 of the comparison results were determined as excellent and 3/6 as pass as a whole (among them, 4 were excellent and 2 were pass for both single gross α assessment items and single gross β assessment items). When the spike recovery F from the GB/T 5750.13—2023 (published draft) was used for result calculation, the spike recovery ranged as follows: gross α: 39.69%−71.57%, and gross β: 90.25%−98.21%; 5/6 of the comparison results were determined as fail and 1/6 as pass (among them, 5 were fail and 1 was pass for single gross α assessment items; 5 were excellent and 1 was pass for single gross β assessment items). When two different formulas were used for spike recovery calculation, there was a significant difference in gross α radioactivity measurement (t = 4.27, P = 0.03 < 0.05), but there was no significant difference in gross β radioactivity measurement (t = 0.667, P = 0.524 > 0.05). Conclusion In the measurement of gross α and gross β radioactivity in water, appropriate reference to the spike recovery has a great influence on the measurement results. Therefore, quality control should be strengthened to further ensure the accuracy of measurement.

Objective To monitor the antifungal resistance of clinical isolates of Candida spp.in the East China region.Methods MALDI-TOF MS or molecular methods were used to re-identify the strains collected from January 2018 to December 2022.Antifungal susceptibility testing was performed using the broth microdilution method.The susceptibility test results were interpreted according to the breakpoints of 2022 Clinical and Laboratory Standards Institute(CLSI)documents M27 M44s-Ed3 and M57s-Ed4.Results A total of 3 026 strains of Candida were collected,65.33％of which were isolated from sterile body sites,mainly from blood(38.86％)and pleural effusion/ascites(10.21％).The predominant species of Candida were Candida albicans(44.51％),followed by Candida parapsilosis complex(19.46％),Candida tropicalis(13.98％),Candida glabrata(10.34％),and other Candida species(0.79％).Candida albicans showed overall high susceptibility rates to the 10 antifungal drugs tested(the lowest rate being 93.62％).Only 2.97％of the strains showed dose-dependent susceptibility(SDD)to fluconazole.Candida parapsilosis complex had a SDD rate of 2.61％and a resistance rate of 9.42％to fluconazole,and susceptibility rates above 90％to other drugs.Candida glabrata had a SDD rate of 92.01％and a resistance rate of 7.99％to fluconazole,resistance rates of 32.27％and 48.24％to posaconazole and voriconazole non-wild-type strains(NWT),respectively,and susceptibility rates above 90％to other drugs.Candida tropicalis had resistance rates of 29.55％and 26.24％to fluconazole and voriconazole,respectively,resistance rates of 76.60％and 21.99％to posaconazole and echinocandins non-wild-type strains(NWT),and a resistance rate of 2.36％to echinocandins.Conclusions The prevalence and species distribution of Candida spp.in the East China region are consistent with previous domestic and international reports.Candida glabrata exhibits certain degree of resistance to fluconazole,while Candida tropicalis demonstrates higher resistance to triazole drugs.Additionally,echinocandins resistance has emerged in Candida albicans,Candida glabrata,Candida tropicalis,and Candida parapsilosis.

Objective To understand the current situation and influencing factors of kindergarten teach-ers'participation in training for preschool sex education in Luzhou city,and provide a basis for improving the sex education literacy of kindergarten teachers in the future.Methods A multi-stage stratified cluster sampling meth-od was adopted,and a questionnaire survey was conducted from December 2021 to January 2022 on the knowl-edge,attitude,and practice of preschool sex education among all the teachers in 24 kindergartens in Luzhou city.Results Among the 461 teachers,43.0％had participated in lectures/courses/training activities related to pre-school sex education;99.1％hoped to participate in lectures/courses/training activities related to preschool sex education;82.6％learned about child sexual knowledge through school education;75.5％expressed the hope to learn about child sexual knowledge through expert training.The results of multivariate Logistic regression showed that except private kindergartens as an inhibiting factor(OR=0.57,95％CI=0.37-0.87,P=0.008),high monthly income(OR=3.52,95％CI=1.13-9.30,P=0.011),more ways to know about sex education knowledge(OR=2.87,95％CI=1.76-4.70,P＜0.001),and social support(OR=1.58,95％CI=1.04-2.38,P=0.030)were promoting factors for teachers to participate in the training for preschool sex educa-tion.Conclusions The kindergarten teachers presented a participation rate but a high demand for the training for preschool sex education.They mainly obtain the sex education knowledge from school education.The nature of kindergarten,monthly income of teachers,social support situation,and ways of understanding sex education knowledge are the key factors influencing the teachers'participation in the training for preschool sex education.

Objective:To accurately ascertain the whole genome sequencing and the composition of open reading frames (ORFs) of non-replicating Tiantan strain of vaccinia virus (NTV) using next-generation long-read sequencing technology.Methods:NTV, obtained from our laboratory stock, was amplified and purified on chicken embryo fibroblast cells(CEFs), and the full-length genomic nucleic acid of NTV was extracted. The PacBio HiFi sequencing platform was utilized for de novo assembly to obtain the complete genomic sequence of NTV. Using a homology annotation strategy, we identified its ORF composition and compared it with known non-replicating vaccinia virus strains. Results:The total length of NTV′s genome was 171 729 bp, with a GC content of 33%. Its unique inverted terminal repeat (ITR) region comprised hairpin structures, two tandem repeat regions, and three non-repeat regions. NTV contained 166 ORFs, with major differences observed in the ITR and its surrounding regions when compared to MVA-BN and NYVAC. These three strains shared a common set of 138 ORFs. NTV encoded six unique ORFs related to virus evasion of host antiviral response.Conclusions:This study accurately determines the whole genome sequencing and ORFs composition of NTV, and reveals its similarities and differences with other replication-deficient vaccinia virus strains, which pave a way for the development and application of the next generation of monkeypox vaccines and novel viral vectors.

Humans ; Female ; Breast Neoplasms/genetics* ; Prognosis ; Gene Expression Profiling ; Biomarkers, Tumor/genetics* ; Gene Expression Regulation, Neoplastic/genetics* ; Receptor, ErbB-2/metabolism* ; Gene Regulatory Networks/genetics*

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.

Objective:To evaluate the clinical efficacy of modified Liqi-Hewei Decoction combined with conventional western medicine therapy in the treatment of Hp-positive chronic superficial gastritis (CSG). Methods:A total of 96 patients with Hp-positive CSG in the First People’s Hospital of Lianyungang and Changshu No.1 People’s Hospital who met the inclusion criteria between January 2017 and January 2019 were divided into two groups according to the random number table method, with 48 in each group. The control group was treated with conventional western medicine, and study group was additionally given modified Liqi-Hewei Decoction on the basis of control group. Both groups were treated for 8 weeks and followed up for 12 weeks. The TCM symptom score, gastric mucosa and pathological grading were scored before and after treatment. Levels of motilin, gastrin and somatostatin were detected by immunoturbidimetry, and levels of CD3 +, CD4 + and CD8 + were detected by automatic flow cytometry and the ratio of CD4 +/CD8 + was calculated. The Hp negative conversion rate was observed, the adverse reactions were recorded, the clinical efficacy was evaluated and the recurrence rate was statistically analyzed. Results:The Hp negative conversion rate was 89.6% (43/48) in study group and was 72.9% (35/48) in control group, where the difference was statistically significant ( χ2=4.376, P=0.036). The total effective rate was 95.8% (46/48) in study group and was 83.3% (40/48) in control group ( χ2=5.031, P=0.025). After treatment, the scores of epigastric pain, upper abdominal fullness, acid reflux, belching and poor appetite in the study group were significantly lower than those in control group ( t=8.919, 3.971, 7.949, 8.171, 9.865, all Ps<0.01). The scores of gastric mucosa and pathological grading were significantly lower than those in control group ( t=13.705, 15.495, all Ps<0.001). After treatment, the levels of gastrin [(126.15 ± 14.36) ng/L vs. (152.38 ± 17.51) ng/L, t=8.025], motilin [(93.59 ± 11.87) ng/L vs. (102.48 ± 14.68) ng/L, t=3.263] and somatostatin [(36.76 ± 8.97) ng/L vs. (40.84 ± 10.68) ng/L, t=2.027] in the study group were significantly lower than those in the control group ( P<0.01 or P<0.05). The levels of CD3 +, CD4 + and CD4 +/CD8 + were significantly higher than those in the control group ( t=6.883, 6.720, 4.306, all Ps<0.001). The recurrence rate was 4.3% (2/46) in the study group and was 17.5% (7/40) in the control group ( χ2=3.950, P=0.046). During treatment, the incidence rate of adverse reactions was 8.3% (4/48) in the study group and was 12.5% (6/48) in the control group ( χ2=0.446, P=0.504). Conclusion:Modified Liqi-Hewei Decoction combined with conventional western medicine therapy can effectively improve the levels of gastrointestinal hormones and clinical symptoms, enhance the immunity and Hp negative conversion rate, and reduce the recurrence rate of patients with Hp-positive CSG.