OBJECTIVE To observe the clinical efficacy of donafenib combined with programmed death-1 （PD-1） inhibitors and vascular intervention therapy in the treatment of unresectable hepatocellular carcinoma （HCC）. METHODS This retrospective study included 165 patients with unresectable HCC who were treated at the Fourth and First Affiliated Hospitals of Soochow University between June 2022 and March 2023. Among them， 89 patients received PD-1 inhibitors （tislelizumab or sintilimab， similarly hereinafter） plus vascular intervention （control group） and 76 patients received donafenib in combination with PD-1 inhibitors and vascular intervention （observation group）. Short-term efficacy （3 months after treatment）， long-term efficacy （2 years after treatment）， the levels of liver function indexes [serum alanine amino-transferase （ALT）， aspartate transferase （AST）， and total bilirubin （TBil）] and tumor biomarkers [alpha fetoprotein （AFP）， carcinoembryonic antigen （CEA）， carbohydrate antigen 19-9 （CA19-9）， and des-gamma-carboxy prothrombin （DCP）] before treatment and after 3 months of treatment， as well as the occurrence of adverse drug reaction （ADR） during treatment， were compared between the two groups. In addition， overall response rate （ORR） stratified by PD-1 inhibitor type was analyzed. RESULTS After treatment， the ORR was significantly higher in the observation group than in the control group （P＜0.05）； although the disease control rate was higher in the observation group compared to the control group， the difference was not statistically significant （P＞0.05）. The median overall survival of patients in the observation group was 16.9 months [95% confidence interval （CI）： 14.2 to 19.1 months]， which was significantly longer than that in the control group （12.4 months， 95%CI： 10.1 to 15.3 months） （P＜0.05）. Subgroup analysis result indicated that therapeutic advantage was consistent across both sintilimab and tislelizumab subgroups， with no significant heterogeneity （P＞0.1， I 2＜0.001%）. Before treatment， there were no significant differences in liver function indexes or tumor marker levels between 2 groups （P＞0.05）. After treatment， both groups showed significant declines in these indicators compared with baseline （P＜0.05）， with greater reductions observed in the observation group （P＜0.05）. There were no statistically significant differences in overall incidence of ADR and grade ≥3 ADRs between the two groups （P＞0.05）. CONCLUSIONS For patients with unresectable HCC， the combination of donafenib， PD-1 inhibitors and vascular intervention therapy may achieve superior clinical outcomes without increasing the risk of treatment-related ADR.

Objective:To investigate the effects of lactulose and oral rehydration salt powder (Ⅲ) on bowel preparation for colonoscopy and their impact on the detection rate of lesions.Methods:A retrospective study was conducted with 120 patients who underwent colonoscopy at The Second Affiliated Hospital of Wenzhou Medical University from January 2023 to April 2024. The patients were randomly divided into a control group and an experimental group, with 60 patients in each group. The control group received Hengkang Zhengqing and simethicone for bowel preparation, while the experimental group received lactulose, oral rehydration salt powder (Ⅲ), and simethicone for bowel preparation. The Boston Bowel Preparation Scale (referred to as the Boston scale) was used to assess bowel cleanliness, the Bubble scale was used to assess the presence of gas in the bowel, and a self-designed questionnaire was used to evaluate patient satisfaction after colonoscopy. The Boston scale scores, Bubble scale scores, patient satisfaction, lesion detection rates, and the incidence of adverse reactions were compared between the two groups. Results:The total score on the Boston scale in the experimental group was significantly higher than that of the control group [(7.23 ± 1.30) vs. (5.44 ± 1.17), t = 7.92, P < 0.001]. The Bubble scale score in the experimental group was significantly higher than that of the control group [(2.60 ± 0.15) vs. (2.21 ± 0.10), t = 16.75, P < 0.001]. The rates of acceptable taste and tolerance in the experimental group were 96.6% (58/60) and 95.0% (57/60), respectively, both of which were higher than those in the control group at 86.6% (52/60) and 81.6% (49/60) ( χ2 = 3.92, 5.17, P = 0.048, 0.023). The detection rate of colonic polyps in the experimental group was significantly higher than that in the control group [31.67% (19/60) vs. 15.00% (9/60), χ2 = 4.65, P = 0.031]. The incidence of adverse reactions in the experimental group was significantly lower than that in the control group [3.33% (2/60) vs. 13.33% (8/60), χ2 = 3.92, P = 0.048]. The patient satisfaction rate after examination in the experimental group was significantly higher than that in the control group [96.67% (58/60) vs. 85.00% (52/60), χ2 = 4.90, P = 0.027]. Conclusions:The intestinal preparation for colonoscopy using the lactulose and oral rehydration salt powder (Ⅲ) regimen can significantly improve the quality of bowel preparation and the detection rate of lesions. Additionally, it offers better taste, higher patient tolerance, and greater satisfaction, along with fewer adverse reactions compared with the Hengkang Zhengqing and simethicone regimen.

Objective:To investigate the effects of lactulose and oral rehydration salt powder (Ⅲ) on bowel preparation for colonoscopy and their impact on the detection rate of lesions.Methods:A retrospective study was conducted with 120 patients who underwent colonoscopy at The Second Affiliated Hospital of Wenzhou Medical University from January 2023 to April 2024. The patients were randomly divided into a control group and an experimental group, with 60 patients in each group. The control group received Hengkang Zhengqing and simethicone for bowel preparation, while the experimental group received lactulose, oral rehydration salt powder (Ⅲ), and simethicone for bowel preparation. The Boston Bowel Preparation Scale (referred to as the Boston scale) was used to assess bowel cleanliness, the Bubble scale was used to assess the presence of gas in the bowel, and a self-designed questionnaire was used to evaluate patient satisfaction after colonoscopy. The Boston scale scores, Bubble scale scores, patient satisfaction, lesion detection rates, and the incidence of adverse reactions were compared between the two groups. Results:The total score on the Boston scale in the experimental group was significantly higher than that of the control group [(7.23 ± 1.30) vs. (5.44 ± 1.17), t = 7.92, P < 0.001]. The Bubble scale score in the experimental group was significantly higher than that of the control group [(2.60 ± 0.15) vs. (2.21 ± 0.10), t = 16.75, P < 0.001]. The rates of acceptable taste and tolerance in the experimental group were 96.6% (58/60) and 95.0% (57/60), respectively, both of which were higher than those in the control group at 86.6% (52/60) and 81.6% (49/60) ( χ2 = 3.92, 5.17, P = 0.048, 0.023). The detection rate of colonic polyps in the experimental group was significantly higher than that in the control group [31.67% (19/60) vs. 15.00% (9/60), χ2 = 4.65, P = 0.031]. The incidence of adverse reactions in the experimental group was significantly lower than that in the control group [3.33% (2/60) vs. 13.33% (8/60), χ2 = 3.92, P = 0.048]. The patient satisfaction rate after examination in the experimental group was significantly higher than that in the control group [96.67% (58/60) vs. 85.00% (52/60), χ2 = 4.90, P = 0.027]. Conclusions:The intestinal preparation for colonoscopy using the lactulose and oral rehydration salt powder (Ⅲ) regimen can significantly improve the quality of bowel preparation and the detection rate of lesions. Additionally, it offers better taste, higher patient tolerance, and greater satisfaction, along with fewer adverse reactions compared with the Hengkang Zhengqing and simethicone regimen.

Objective:To evaluate the effect of preemptive analgesia with ibuprofen on postoperative pain following single posterior tooth implantation, aiming to provide a clinical reference for its application.Methods:A multicenter, randomized, double-blind, placebo-controlled parallel-group trial was conducted. A total of 82 participants were included in the trial, meeting the eligibility criteria from April 2022 to April 2024 at the Capital Medical University School of Stomatology (40 cases), Beijing TianTan Hospital, Capital Medical University (22 cases), Beijing Chao-Yang Hospital, Capital Medical University (20 cases). Participants were randomly assigned in a 1∶1 ratio to either the ibuprofen group or the control group, with each group comprising 41 individuals. Participants in the ibuprofen group received 300 mg of sustained-release ibuprofen capsules orally 15 min before surgery, while the control group received a placebo. Both groups received the same postoperative analgesic regimen for 3 days. Pain scores were assessed using the numerical rating scale at 30 min, 4 h, 6 h, 8 h, 24 h, 48 h, and 72 h postoperatively, and the additional use of analgesic medication was recorded from days 4 to 6 postoperatively.Results:A total of 82 participants were initially enrolled in the study, with 7 dropouts (4 from the control group and 3 from the ibuprofen group), resulting in 75 participants (37 in the control group and 38 in the ibuprofen group) completing the trial. There were no reports of adverse events such as nausea or vomiting among the participants. The ibuprofen group exhibited significantly lower pain scores at 4 h, 6 h and 8 h [1.0 (0.0, 2.0), 1.0 (0.0, 2.0), 1.5 (0.0, 3.0) ] postoperatively compared to the control group 4 h, 6 h and 8 h [2.0 (1.0, 3.0), 3.0 (1.5, 4.0), 2.0 (1.0, 4.0)] ( Z=-1.99, P=0.047; Z=-3.01, P=0.003; Z=-2.10, P=0.036). The proportions of patients requiring additional analgesic medication between days 4 and 6 post-surgery were 18.4% (7/38) in the ibuprofen group and 27.0% (10/37) in the control group, with no significant difference (χ 2=0.79, P=0.373). The median additional medication usage postoperatively was [0.0 (0.0, 0.0) pills] in the ibuprofen group and [0.0 (0.0, 1.0) pills] in the control group, with no significant difference ( Z=-0.78, P=0.439). Conclusions:Preemptive analgesia with ibuprofen effectively reduces postoperative pain following tooth implantation, representing a safe and effective perioperative pain management strategy.

Objective To investigate the mechanism of Ganmao Qingre Pills(GQP)against lung injury based on network pharmacology,molecular docking and in vivo experiments.Methods The potential targets of GQP in the treatment of lung injury were screened through traditional Chinese medicine systems pharmacology database and analysis platform(TCM-SP)and Genecards.A"Chinese medicine-active ingredients-targets"network was constructed using Cytoscape 3.9.0 software,then gene ontology(GO)function and Kyoto encyclopaedia of genes and genomes(KEGG)pathway enrichment analysis for potential targets were conducted using a bioinformatics cloud platform.We established a protein-protein interaction(PPI)network,which was intersected with"Chinese medicine-active ingredients-targets"network to obtain core targets.The molecular docking between key target proteins and active ingredients was performed.The effect of GQP on these key target proteins was verified by using a mouse model of lung injury.Results A total of 707 targets for the treatment of lung injury by GQP were identified,corresponding to 107 active ingredients in 11 Chinese medicines.It was found that GQP might regulate targets such as PTGS1,AR,and ACHE through active ingredients including stigmasterol,luteolin,and acacetin using the"Chinese medicine-active ingredients-targets"network analysis.Core targets such as SRC,EGFR,and STAT3 were discovered by using the PPI network.Key target proteins,including CDK1,CDK2,EGFR,ESR1 and SRC,were screened through the intersection analysis of the PPI network and"Chinese medicine-active ingredients-targets"network.Molecular docking study showed that stigmasterol,luteolin and acacetin had good binding effects with CDK1,CDK2,EGFR,ESR1,and SRC,respectively.In vivo experiments revealed that GQP dose-dependently attenuated lung injury and inflammatory infiltration,reduced the release of pro-inflammatory factors TNF-α,IL-1β and IL-6,increased the expression of CDK1 and CDK2,and decreased the expression of EGFR,ESR1 and SRC in lung injury mice.Conclusion The therapeutic effect of GQP against lung injury may be achieved through interaction of key active ingredients(stigmasterol,luteolin,and acacetin)and key target proteins(CDK1,CDK2,EGFR,ESR1,SRC),and regulation of key signaling pathways such as neuroactive ligand-receptor interactions,cancer pathways,and calcium signaling pathways.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

The management of drug withdrawl in the ward is an important part of hospital pharmaceutical management. In October 2023, a tertiary hospital constructed a drug withdrawl mode of multiple wards. Through building a drug withdrawl information system(including nurse side drug withdrawl module, pharmacist side real-time drug withdrawl operation module, drug query module, and ward virtual secondary cache), standardized drug withdrawl processes and quality supervision measures were implemented. This mode clarified the responsibility of the ward to submit drug return orders, ensured the continuity of drug orders for patients during cross ward diagnosis and treatment, and realized automatic review of drug return orders, " one click refund", and priority offsetting for drug withdrawl. Taking the cardiac and vascular surgery department of the hospital as an example, the implementation effect of the mode was evaluated. The overall physical drug return rate of the department decreased from 9.58% in May 2023 to 0.89% in November 2023; The average weekly drug return time of pharmacy pharmacists decreased from 610.53 minutes to 122.07 minutes; The average waiting time for patients to be discharged was shortened from 64.43 minutes to 44.38 minutes. The drug withdrawl mode of multiple wards in a certain hospital had reduced the physical drug return rate in the ward, saved the time spent on drug withdrawl work and patient waiting time, improved the efficiency of drug return in the ward, so as to provide references for other hospitals to carry out drug withdrawl management of multiple wards.

The management of drug withdrawl in the ward is an important part of hospital pharmaceutical management. In October 2023, a tertiary hospital constructed a drug withdrawl mode of multiple wards. Through building a drug withdrawl information system(including nurse side drug withdrawl module, pharmacist side real-time drug withdrawl operation module, drug query module, and ward virtual secondary cache), standardized drug withdrawl processes and quality supervision measures were implemented. This mode clarified the responsibility of the ward to submit drug return orders, ensured the continuity of drug orders for patients during cross ward diagnosis and treatment, and realized automatic review of drug return orders, " one click refund", and priority offsetting for drug withdrawl. Taking the cardiac and vascular surgery department of the hospital as an example, the implementation effect of the mode was evaluated. The overall physical drug return rate of the department decreased from 9.58% in May 2023 to 0.89% in November 2023; The average weekly drug return time of pharmacy pharmacists decreased from 610.53 minutes to 122.07 minutes; The average waiting time for patients to be discharged was shortened from 64.43 minutes to 44.38 minutes. The drug withdrawl mode of multiple wards in a certain hospital had reduced the physical drug return rate in the ward, saved the time spent on drug withdrawl work and patient waiting time, improved the efficiency of drug return in the ward, so as to provide references for other hospitals to carry out drug withdrawl management of multiple wards.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.