Objective To establish an effective management mode, play the full role of DRGs in rational drug use, formulate the pharmaceutical clinical path, and intervene the prescription behavior of doctors, which could improve the level of rational drug use in the hospital through the management practice of rational drug use under the payment method of DRGs in a third-grade hospital. Methods A drug entering mechanism, a rational drug use supervision mechanism and an active and rational drug use data exposure mechanism based on DRGs were established, and the rational drug use indicators such as drug consumption index, average drug cost, and auxiliary drug use were accurately positioned based on the information platform, and the accurate and refined management of rational drug use was realized through the daily supervision of the office of the Pharmaceutical Affairs Committee. Results and Conclusion Under the multi-dimensional and multi-level rational drug use management based on DRGs, the effect of rational drug use was evaluated after the reform of DRGs payment method, and all the index of rational drug use in our hospital were continuously improved.

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.

ObjectiveTo analyze and construct a curriculum framework and content system of the vocational college rehabilitation therapy technology exercise therapy technology course, based on World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) and rehabilitation competency framework (RCF). MethodsUsing educational psychology and curriculum theory, and applying the ICF and RCF, the curriculum system for rehabilitation therapy technology curriculum system was constructed. A systematic analysis of the existing exercise therapy technology course content was conducted to identify the core elements related to ICF and RCF. Through the design of course modules, these core elements were integrated into theoretical courses, skills training and practical courses to form a comprehensive curriculum structure. ResultsCombining the ICF and RCF, a curriculum system for rehabilitation therapy technology curriculum system was constructed, covering theoretical courses, skills training and practical courses. This system enabled students to systematically master rehabilitation assessment and treatment techniques and develop clinical decision-making abilities and interdisciplinary collaboration skills. The introduction of the ICF framework allowed students to acquire knowledge, skills and abilities in the field of exercise therapy technology through the course. Developing competency-oriented courses based on RCF framework helped students develop comprehensive professional competencies through learning. ConclusionBy integrating the ICF and RCF, a curriculum for exercise therapy technology course in vocational colleges has been constructed. Based on the ICF framework, the content of the course has been aligned with the bio-psycho-social theory of functioning and health, covering three levels: body function, activity and participation, and environmental factors. The curriculum content should include the analysis, assessment and intervention of these functioning. RCF provides a theoretical structure and methodology for developing competency-oriented courses. When designing the course modules, teaching objectives have been established based on the core competency framework, aiming to develop students' comprehensive professional competence and professionalism through theoretical courses, practical training and clinical internships.

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.

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 understand the clinical characteristics of risperidone-induced rhabdomyolysis (RM).Methods:Risperidone-related RM case reports were collected by searching relevant databases at home and abroad as of February 2021, and the patients′ general conditions, disease conditions, medication use, RM occurrence [time of occurrence, clinical symptoms, and serum creatine kinase (CK) level, etc.], and treatment and outcome were recorded and descriptively analyzed.Results:A total of 16 patients were collected, including 14 males and 2 females, with age of 13-76 years. The primary diseases were schizophrenia in 11 patients, psychomotor agitation, obsessive-compulsive disorder, depressive syndrome with psychotic symptoms, depressive symptom cluster, and suspected psychotic symptoms in 1 case each. Among the 16 patients, 2 were treated with risperidone alone, and 14 were treated with risperidone combined with other drugs (6, 6, 5, 4, 3, and 1 with other antipsychotics, sedatives, antidepressants, statins, anticholinergics, and cyclosporine, respectively, and 3, 7, 1, and 3 cases with 1, 2, 3, and 4 combination drugs, respectively). Except that the medication method was not described in 2 cases, risperidone was orally administered in 13 cases and injected in 1 case. Thirteen patients with oral risperidone had dosage descriptions, of which 12 cases′ dose met the requirements of the drug labels, and 1 case took risperidone 96 mg due to severe hallucinations induced by drug withdrawal after taking the drug with routine dose for 5 years. In addition to the patient with overdose of risperidone, the occurrence time of RM was described in 14 cases, which was 4 days to 2 years after risperidone, and 10 cases occurred within 4 to 15 days after risperidone use. The main clinical symptoms were muscle pain (10 cases), acute liver injury (8 cases), acute kidney injury (5 cases), muscle weakness (4 cases), fever (3 cases), tachycardia (3 cases), and acute tendon intermembrane space syndrome (3 cases). The CK level was 4 587 to 928 961 U/L with a median level of 27 355 U/L in the 16 patients with RM, and it was>15 000 U/L in 10 cases (62.5%). After RM occurred, risperidone was discontinued in 13 patients, continued in 2 patients, and used at reduced dose in 1 patient; 8 patients received hydration therapy, 3 received hemodialysis, 1 received organ support therapy, and 3 with acute compartment syndrome (ACS) were treated with fasciotomy. All 16 patients′ symptoms disappeared and CK levels returned to normal. Among them, the specific time of recovery were described in 12 patients. The time of symptom disappearance was 2-12 months and the time of CK level recovery was 7-56 days.Conclusions:Risperidone-related RM mostly occurs within 4-15 days after exposure to risperidone, which is mostly related to the combination with other drugs. The elevation of CK level is usually severe, which can be complicated by ACS. Symptoms could return to normal after risperidone was discontinued and/or symptomatic treatments are given.

Objective:To understand the clinical characteristics of risperidone-induced rhabdomyolysis (RM).Methods:Risperidone-related RM case reports were collected by searching relevant databases at home and abroad as of February 2021, and the patients′ general conditions, disease conditions, medication use, RM occurrence [time of occurrence, clinical symptoms, and serum creatine kinase (CK) level, etc.], and treatment and outcome were recorded and descriptively analyzed.Results:A total of 16 patients were collected, including 14 males and 2 females, with age of 13-76 years. The primary diseases were schizophrenia in 11 patients, psychomotor agitation, obsessive-compulsive disorder, depressive syndrome with psychotic symptoms, depressive symptom cluster, and suspected psychotic symptoms in 1 case each. Among the 16 patients, 2 were treated with risperidone alone, and 14 were treated with risperidone combined with other drugs (6, 6, 5, 4, 3, and 1 with other antipsychotics, sedatives, antidepressants, statins, anticholinergics, and cyclosporine, respectively, and 3, 7, 1, and 3 cases with 1, 2, 3, and 4 combination drugs, respectively). Except that the medication method was not described in 2 cases, risperidone was orally administered in 13 cases and injected in 1 case. Thirteen patients with oral risperidone had dosage descriptions, of which 12 cases′ dose met the requirements of the drug labels, and 1 case took risperidone 96 mg due to severe hallucinations induced by drug withdrawal after taking the drug with routine dose for 5 years. In addition to the patient with overdose of risperidone, the occurrence time of RM was described in 14 cases, which was 4 days to 2 years after risperidone, and 10 cases occurred within 4 to 15 days after risperidone use. The main clinical symptoms were muscle pain (10 cases), acute liver injury (8 cases), acute kidney injury (5 cases), muscle weakness (4 cases), fever (3 cases), tachycardia (3 cases), and acute tendon intermembrane space syndrome (3 cases). The CK level was 4 587 to 928 961 U/L with a median level of 27 355 U/L in the 16 patients with RM, and it was>15 000 U/L in 10 cases (62.5%). After RM occurred, risperidone was discontinued in 13 patients, continued in 2 patients, and used at reduced dose in 1 patient; 8 patients received hydration therapy, 3 received hemodialysis, 1 received organ support therapy, and 3 with acute compartment syndrome (ACS) were treated with fasciotomy. All 16 patients′ symptoms disappeared and CK levels returned to normal. Among them, the specific time of recovery were described in 12 patients. The time of symptom disappearance was 2-12 months and the time of CK level recovery was 7-56 days.Conclusions:Risperidone-related RM mostly occurs within 4-15 days after exposure to risperidone, which is mostly related to the combination with other drugs. The elevation of CK level is usually severe, which can be complicated by ACS. Symptoms could return to normal after risperidone was discontinued and/or symptomatic treatments are given.

Objective:To explore the effect of online appointment system of standardized patients (SP) in cardiology practice teaching.Methods:The undergraduate students who entered the cardiology department of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine for clinical practice in 2018 and 2019 were selected as teaching objects, and they were divided into traditional teaching group ( n=30) and appointed SP teaching group ( n=30). After the teaching, SPSS 19.0 software was used for data analysis to compare the teaching effect of the two groups. Results:The scores of SP teaching group were higher than those of traditional teaching control group, with statistical significance ( P<0.05). Conclusion:Through constructing SP database and typical case database, online appointment system of SP for medical history inquiry and doctor-patient communication skills training can effectively solve the problems such as lack of clinical practice cases and doctor-patient contradiction, and greatly improve the teaching efficiency.

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.