Objective To explore the impact of antimicrobial volume-based procurement(VBP)and classification management policy on the clinical use of carbapenem antibiotics.Methods Changing trend in defined daily doses(DDDs),procurement cost(Cost),defined daily dose cost(DDDc),and DDDs per 1 000 inhabitants daily(DID)of carbapenem antibiotics in all levels of medical institutions were analyzed by Mann-Kendall trend test.May 1,2020 was taken as the intervention cut-off point of VBP policy,September 2021 was as intervention cut-off point of cla-ssification management list.The impact of VBP and classification management policy on the clinical use of carbape-nem antibiotics were studied by interrupted time series analysis.Results After implementing VBP policy,the DDDs and DID of carbapenem antibiotics increased obviously,but the long-term trend didn't change significantly.Compared with before the implementation of the policy,the cost and DDDc of carbapenem antibiotics decreased im-mediately,the long-term trend of DDDc changed significantly,but the long-term trend of cost didn't change signifi-cantly.The DDDs and Cost of carbapenem antibiotics decreased immediately after the update of classification ma-nagement list,but the long-term downward trend was not significant,and DDDc presented a long-term upward trend.Conclusion VBP policy reduces the DDDc and short-term cost of carbapenem antibiotics,but its long-term impact on DDDs,cost and DID is limited.Classification management has limited impact on the use of carbapenem antibiotics in medical institutions.

Objective To explore the impact of antimicrobial volume-based procurement(VBP)and classification management policy on the clinical use of carbapenem antibiotics.Methods Changing trend in defined daily doses(DDDs),procurement cost(Cost),defined daily dose cost(DDDc),and DDDs per 1 000 inhabitants daily(DID)of carbapenem antibiotics in all levels of medical institutions were analyzed by Mann-Kendall trend test.May 1,2020 was taken as the intervention cut-off point of VBP policy,September 2021 was as intervention cut-off point of cla-ssification management list.The impact of VBP and classification management policy on the clinical use of carbape-nem antibiotics were studied by interrupted time series analysis.Results After implementing VBP policy,the DDDs and DID of carbapenem antibiotics increased obviously,but the long-term trend didn't change significantly.Compared with before the implementation of the policy,the cost and DDDc of carbapenem antibiotics decreased im-mediately,the long-term trend of DDDc changed significantly,but the long-term trend of cost didn't change signifi-cantly.The DDDs and Cost of carbapenem antibiotics decreased immediately after the update of classification ma-nagement list,but the long-term downward trend was not significant,and DDDc presented a long-term upward trend.Conclusion VBP policy reduces the DDDc and short-term cost of carbapenem antibiotics,but its long-term impact on DDDs,cost and DID is limited.Classification management has limited impact on the use of carbapenem antibiotics in medical institutions.

BACKGROUND: Insufficient angiogenesis and the lack of skin appendages are critical challenges in cutaneous wound healing. Stem cell-fabricated cell sheets have become a promising strategy, but cell sheets constructed by a single cell type are inadequate to provide a comprehensive proregenerative microenvironment for wound tissue. METHODS: Based on the communication between cells, in this study, bone marrow mesenchymal stem cells (BMSCs) and hair follicle stem cells (HFSCs) were cocultured to fabricate a composite cell sheet (H/M–CS) for the treatment of fullthickness skin wounds in mice. RESULTS: Experiments confirmed that there is cell–cell communication between BMSCs and HFSCs, which enhances the cell proliferation and migration abilities of both cell types. Cell–cell talk also upregulates the gene expression of proangiogenic-related cytokines in BMSCs and pro-hair follicle-related cytokines in HFSCs, as well as causing changes in the properties of secreted extracellular matrix components. CONCLUSIONS Therefore, the composite cell sheet is more conducive for cutaneous wound healing and promoting the regeneration of blood vessels and hair follicles.

OBJECTIVES: Our previous study has verified that high level of SET and MYND domain-containing protein 2 (SMYD2) plays an important role in acquiring aggressive ability for liver cancer cells in hepatocellular carcinoma. MiR-200b as a tumor suppressor gene involves in a variety of cancers. This study aims to investigate the correlation between miR-200b and SMYD2 in hepatocellular carcinoma and the underlying mechanism. METHODS: Firstly, the levels of SMYD2 and miR-200b in hepatocellular carcinoma tissues and matched adjacent non-tumor liver tissues were tested with real-time reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting. Secondly, we evaluated the interaction between miR-200b and SMYD2 using dual-luciferase reporter assay. Thirdly, we elucidated the effect of miR-200b on SMYD2 and its downstream targets p53/CyclinE1. Finally, we silenced SMYD2 in hepatocellular carcinoma cell lines to investigate its effect on tumor proliferation and cell cycle progression, and further confirmed the correlation among SMYD2 and p53/CyclinE1. RESULTS: Compared with the matched adjacent non-tumor liver tissues, miR-200b was obviously decreased, and SMYD2 was significantly increased in hepatocellular carcinoma (both P<0.05). Spearman's rank correlation revealed that miR-200b expression was negatively correlated with SMYD2 (P<0.01). Computer algorithm and dual-luciferase reporter assay revealed that miR-200b directly targeted and suppressed SMYD2 in HEK 293T cells. The down-regulated miR-200b expression promoted hepatoma cell proliferation (P<0.05) and increased SMYD2 expression(P<0.01), while the up-regulated expression of miR-200b had an opposite effect. The knockdown of SMYD2 suppressed the proliferation of MHCC-97L cells (P<0.01), down-regulated CyclinE1, and up-regulated p53 expression (both P<0.05). CONCLUSIONS MiR-200b is involved in hepatocellular carcinoma progression via targeting SMYD2 and regulating SMYD2/p53/CyclinE1 signaling pathway and may be used as a potential target for hepatocellular carcinoma treatment.
Humans ; Carcinoma, Hepatocellular/pathology* ; Tumor Suppressor Protein p53/metabolism* ; MicroRNAs/metabolism* ; Cell Line, Tumor ; Signal Transduction ; Liver Neoplasms/pathology* ; Cell Proliferation/genetics* ; Histone-Lysine N-Methyltransferase/metabolism*

In order to improve the motion fluency and coordination of lower extremity exoskeleton robots and wearers, a pace recognition method of exoskeleton wearer is proposed base on inertial sensors. Firstly, the triaxial acceleration and triaxial angular velocity signals at the thigh and calf were collected by inertial sensors. Then the signal segment of 0.5 seconds before the current time was extracted by the time window method. And the Fourier transform coefficients in the frequency domain signal were used as eigenvalues. Then the support vector machine (SVM) and hidden Markov model (HMM) were combined as a classification model, which was trained and tested for pace recognition. Finally, the pace change rule and the human-machine interaction force were combined in this model and the current pace was predicted by the model. The experimental results showed that the pace intention of the lower extremity exoskeleton wearer could be effectively identified by the method proposed in this article. And the recognition rate of the seven pace patterns could reach 92.14%. It provides a new way for the smooth control of the exoskeleton.
Algorithms ; Exoskeleton Device ; Humans ; Lower Extremity ; Motion ; Support Vector Machine

Objective:To study the role of indocyanine green(ICG)fluorescence imaging in laparoscopic partial splenectomy (LPS).Methods:The data of 4 patients who underwent ICG fluorescence imaging technology for LPS at Beijing Luhe Hospital Affiliated to Capital Medical University from May 2017 to May 2020 were retrospectively analyzed. There were 3 females and 1 male, aged 46, 41, 27 and 12 years respectively. The extents of spleen preservation were compared between ICG fluorescence imaging with ordinary white light during operation. The residual splenic remnants were tested with fluorescence imaging after splenectomy, which showed fluorescence fading indicating good vascular perfusion.Results:ICG fluorescence imaging was performed on 4 patients. The operation time ranged from 180.0 to 250.0 min, and the intraoperative blood loss ranged from 40.0 to 200.0 ml. The postoperative hospital stay ranged from 4 to 14 days. There were no serious complications. Postoperative histopathology showed: splenic cyst ( n=1), splenic hemangioma ( n=2), and splenic laceration ( n=1). Conclusions:ICG fluorescence imaging technology had a significant role to play in partial splenectomy. This study showed this technique to improve safety of laparoscopic partial splenectomy.

A 42-year-old female patient who had a fever for 10 days and was suspected of cytomegalovirus infection received IV infusions of ganciclovir 150 mg dissolved in 0.9% sodium chloride injection 100 ml and cefoperazone sodium and tazobactam sodium 2.25 g dissolved in 0.9% sodium chloride injection 100 ml twice daily. Before medication, the patient′s white blood cell count (WBC) was 12.71×10 9/L, platelet count (PLT) was 262×10 9/L, ren blood cell count (RBC) was 2.99×10 12/L, and hemoglobin (Hb) was 84 g/L. Because the patient developed edema 2 days later, the drugs were adjusted to IV infusions of ganciclovir 150 mg dissolved in 0.9% sodium chloride injection 50 ml once daily and piperacillin sodium tazobactam sodium 2.25 g dissolved in 0.9% sodium chloride injection 50 ml twice daily. On day 11 of medication, laboratory tests showed WBC 3.01×10 9/L, 2.32×10 9/L, PLT 92×10 9/L, RBC 2.39×10 12/L and Hb 68 g/L; on day 13 of medication, her WBC was 1.98×10 9/L, PLT was 86×10 9/L, RBC was 2.44×10 12/L, and Hb was 69 g/L. After tracing the patient′s previous medical records, it was learned that the patient had previously experienced mild myelosuppression due to ganciclovir treatment. Then ganciclovir-induced pancytopenia was considered. Ganciclovir was stopped and subcutaneous injections of recombinant human granulocyte stimulating factor injection 200 μg once daily and recombinant human erythropoietin injection 10 000 U once a week were given. Five days later, laboratory tests showed WBC 3.82×10 9/L, PLT 197×10 9/L, RBC 3.12×10 12/L, and Hb 92 g/L. The patient had renal transplantion 3 years ago. According to the level of creatinine clearance rate, overdose of ganciclovir was used in the patient.

A 42-year-old female patient who had a fever for 10 days and was suspected of cytomegalovirus infection received IV infusions of ganciclovir 150 mg dissolved in 0.9% sodium chloride injection 100 ml and cefoperazone sodium and tazobactam sodium 2.25 g dissolved in 0.9% sodium chloride injection 100 ml twice daily. Before medication, the patient′s white blood cell count (WBC) was 12.71×10 9/L, platelet count (PLT) was 262×10 9/L, ren blood cell count (RBC) was 2.99×10 12/L, and hemoglobin (Hb) was 84 g/L. Because the patient developed edema 2 days later, the drugs were adjusted to IV infusions of ganciclovir 150 mg dissolved in 0.9% sodium chloride injection 50 ml once daily and piperacillin sodium tazobactam sodium 2.25 g dissolved in 0.9% sodium chloride injection 50 ml twice daily. On day 11 of medication, laboratory tests showed WBC 3.01×10 9/L, 2.32×10 9/L, PLT 92×10 9/L, RBC 2.39×10 12/L and Hb 68 g/L; on day 13 of medication, her WBC was 1.98×10 9/L, PLT was 86×10 9/L, RBC was 2.44×10 12/L, and Hb was 69 g/L. After tracing the patient′s previous medical records, it was learned that the patient had previously experienced mild myelosuppression due to ganciclovir treatment. Then ganciclovir-induced pancytopenia was considered. Ganciclovir was stopped and subcutaneous injections of recombinant human granulocyte stimulating factor injection 200 μg once daily and recombinant human erythropoietin injection 10 000 U once a week were given. Five days later, laboratory tests showed WBC 3.82×10 9/L, PLT 197×10 9/L, RBC 3.12×10 12/L, and Hb 92 g/L. The patient had renal transplantion 3 years ago. According to the level of creatinine clearance rate, overdose of ganciclovir was used in the patient.

Coronavirus disease 2019 (COVID-19) can cause great damage to the elderly patients and lead to high mortality. The clinical presentations and auxiliary examinations of the elderly patients with COVID-19 are atypical, due to the physiological ageing deterioration and basal pathological state. The treatment strategy for the elderly patients has its own characteristics and treatment protocol should be considered accordingly. To improve the diagnosis, treatment, and prevention of COVID-19 in the elderly, the Expert Committee of Geriatric Respiratory and Critical Care Medicine, China Society of Geriatrics established the "Expert consensus for the diagnosis, treatment, and prevention of coronavirus disease 2019 in the elderly" . We focused on the clinical characteristics and key points for better treatment and prevention of COVID-19 in the elderly. (1) For diagnosis, atypical clinical presentation of COVID-19 in the elderly should be emphasized, which may be complicated by underlying disease. (2) For treatment, strategy of multiple disciplinary team (mainly the respiratory and critical care medicine) should be adopted and multiple systemic functions should be considered. (3) For prevention, health care model about integrated management of acute and chronic diseases, in and out of hospital should be applied.

Objective: To investigate the computer-aided design(CAD) of enblock porous silicone prosthesis for forehead and temporal augmentation with endoscope technique. Methods: The 3-dimensional image of the enblock porous silicone prosthesis for forehead and temporal augmentation was designed with the aid of computer based on the 3-D images, the metal model and silicone prosthesis were made for surgery guided by endoscope technique. Results: 20 cases underwent frontal and temporal augmentation with enblock protheis with primary healing. No complication, like infection, effusion, nerve injury, prothesis displacement, happened. The patients were followed up for half a year with satisfactory result . Conclusions CAD for enblock porous silicone prosthesis for forehead and temporal augmentation has the advantages of individual design and good adaptation. Endoscope technique can be effective for reduction of the complication, like bleeding and protheis displacement.