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.

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.

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 examine the mid- and long-term outcomes of endovascular aneurysm repair (EVAR).Methods:This was a retrospective cohort study of 540 patients with abdominal aortic aneurysm who received EVAR at Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University from January 2009 to December 2018. There were 503 males and 37 females, aged of (69±8) years (range: 44 to 87 years). Clinical data including concomitant disease, aneurysm size and surgical data were collected and patients were followed up after operation. The cumulative survival rate was assessed using the Kaplan-Meier estimator and multivariate Cox regression was used to analyze the independent prognosis factors.Results:The technical success rate was 91.1% (492/540). The perioperative mortality rate was 1.3% (7/540) and the follow-up rate was 91.7% (489/533). The median follow-up time was 45(63) months (range: 1 to 133 months). The all-cause mortality rate was 21.3% (104/489) and the aneurysm-related mortality rate was 6.3% (31/489) during follow-up period. The overall cumulative survival rate of 1-, 3-, 5- and 10-year were 95.1%, 84.0%, 69.5% and 38.6%, respectively, while freedom from aneurysm-related death were 98.4%, 93.3%, 88.4% and 84.4%. During the follow-up period, the complications rate was 9.0% (44/489), and the re-intervention rate was 4.9% (24/489). Cox regression analysis showed that elder age ( HR=2.15, 95 %CI: 1.41 to 3.26, P<0.01), preoperative aneurysm rupture ( HR=2.72, 95 %CI: 1.78 to 4.15, P<0.01) and short neck aneurysm ( HR=1.97, 95 %CI: 1.07 to 3.61, P=0.029) were independent prognosis factors for long-term survival after EVAR. Connclusion:EVAR has low perioperative mortality, high technical success rate, and satisfactory mid-and long-term outcomes.

Objective:To examine the mid- and long-term outcomes of endovascular aneurysm repair (EVAR).Methods:This was a retrospective cohort study of 540 patients with abdominal aortic aneurysm who received EVAR at Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University from January 2009 to December 2018. There were 503 males and 37 females, aged of (69±8) years (range: 44 to 87 years). Clinical data including concomitant disease, aneurysm size and surgical data were collected and patients were followed up after operation. The cumulative survival rate was assessed using the Kaplan-Meier estimator and multivariate Cox regression was used to analyze the independent prognosis factors.Results:The technical success rate was 91.1% (492/540). The perioperative mortality rate was 1.3% (7/540) and the follow-up rate was 91.7% (489/533). The median follow-up time was 45(63) months (range: 1 to 133 months). The all-cause mortality rate was 21.3% (104/489) and the aneurysm-related mortality rate was 6.3% (31/489) during follow-up period. The overall cumulative survival rate of 1-, 3-, 5- and 10-year were 95.1%, 84.0%, 69.5% and 38.6%, respectively, while freedom from aneurysm-related death were 98.4%, 93.3%, 88.4% and 84.4%. During the follow-up period, the complications rate was 9.0% (44/489), and the re-intervention rate was 4.9% (24/489). Cox regression analysis showed that elder age ( HR=2.15, 95 %CI: 1.41 to 3.26, P<0.01), preoperative aneurysm rupture ( HR=2.72, 95 %CI: 1.78 to 4.15, P<0.01) and short neck aneurysm ( HR=1.97, 95 %CI: 1.07 to 3.61, P=0.029) were independent prognosis factors for long-term survival after EVAR. Connclusion:EVAR has low perioperative mortality, high technical success rate, and satisfactory mid-and long-term outcomes.

Objective To evaluate the iodine nutritional status and thyroid function of pregnant women in different periods of pregnancy,analyze the relationship between iodine nutritional status and thyroid function and provide a basis for scientific supplementation of iodine to pregnant women.Methods In 2013 and 2014,using stratified random sampling method,six counties were selected in the city;around 30 early,middle and late pregnant women each in every county were selected;a total of 545 (173 early,203 middle and 169 late) pregnant women were investigated in the 6 counties;instant random urine samples of 25 ml were collected and urinary iodine was tested.A total of 151 (52 early,55 middle and 44 late) pregnant women were selected to collect 3 ml venous blood samples for determination of thyroid hormone and thyroid autoantibodies.Results Median urinary iodine levels of early,middle and late pregnant women were 132.2,128.9 and 113.5 μg/L,respectively,under the condition of iodine deficiency.Prevalence rates of low frce thyroxine FT4,subclinical hypothyroidism,hypothyroidism and hyperthyroidism in pregnant women were 0.66％ (1/151),15.23％ (23/151),0.66％ (1/151) and 0.66％ (1/151),respectively.The positive rate of TgAb and TPOAb was 15.23％ (23/151) and 11.92％ (18/151),respectively.There were significant differences in the levels of free three iodine thyroid (FT3) in different periods of pregnancy (F =7.723,P ＜ 0.05);FT3 in late pregnancy was lower than that in early and middle pregnancy (P ＜ 0.05).There were significant differences in the levels of FT4 in different periods of pregnancy (F =3.762,P ＜ 0.05);FT4 in late pregnancy was lower than that in early and middle pregnancy (P ＜ 0.05).There were significant differences in the levels of thyroid stimulating hormone (TSH) in different periods of pregnancy (F =13.199,P ＜ 0.05);TSH in early pregnancy was higher than that in middle and late pregnancy (P ＜ 0.05).Subclinical hypothyroidism prevalence rate in late pregnancy was higher than that in middle pregnancy (x2 =3.912,P ＜ 0.05).The positive rate of TgAb in early and middle pregnancy was higher than that in late pregnancy (x2 =9.883,3.906,all P ＜ 0.05).Urinary iodine ≥250 μg/L was a risk factor for subclinical hypothyroidism in pregnant woman [odds ratio (OR) =5.076,P ＜ 0.05].Conclusions The iodine nutrition of pregnant women in Tianjin is insufficient.Excessive urinary iodine is an increased risk of subclinical hypothyroidism.We should monitor the urinary iodine and thyroid function in pregnant women.

Objective To explore the application value of hemi-hepatic blood flow occlusion through descending hilar plate in laparoscopic anatomic hepatectomy.Methods The clinical data of 15 patients who underwent laparoscopic anatomic hepatectomy by hemi-hepatic blood flow occlusion using descending hilar plate technique at the First People's hospital of Foshan between August 2012 and May 2014 were retrospectively analyzed.The hilar plate was bluntly dissected to expose the left and right Glissonean pedicles.Either side of Glissonean pedicle was tied up with a turnable aspirator with a cotton rope or shoelace and then bypassed the back of hilar plate.Anatomic hepatectomy was performed when hemi-hepatic blood flow was occluded.The follow-up by telephone interview and outpatient examination was done till October 2014.Results Among the 15 patients,the conversion to open surgery was done in 1 patient,Pringle maneuver in 1 patient,and hemi-hepatic blood flow occlusion by descending the hilar plate in 14 patients.Thirteen patients received succesfully laparoscopic anatomic hepatectomy by hemi-hepatic blood flow occlusion using descending hilar plate technique,including 4 of left hemihepatectomy,4 of left lateral lobectomy,2 of right hemihepatectomy,1 of right posterior lobectomy,1 of segment Ⅳ hepatectomy and 1 of segment Ⅵ hepatectomy.Bile duct exploration was applied to 4 patients with left hepatic duct stones and T-tube was placed in 2 patients.Nine and 4 patients received left and right hemi-hepatic blood flow occlusion,respectively.The operation time,mean volume of intraoperative blood loss and time of hemi-hepatic blood flow occlusion in 13 patients were (196 ±63)minutes,320 mL (range,50-1 200 mL) and (51 ± 20)minutes,respectively.The time of descending the hilar plate in 14 patients was (10 ±4)minutes.Among the 13 patients,bile leakage was detected in 1 patient with a maximum volume of drainage of 120 mL/day,liver wound bleeding in 1 patient with a volume of abdominal bloodstained drainage of 400 mL at postoperative day 2.Two patients were cured by conservative treatment,and no liver failure and perioperative death were occurred.The duration of hospital stay was (6.9 ± 2.4)days.Among the 15 patients,2 patients were loss to follow-up and other patients were followed up for 5-26 months with good survival,1 patient died.Conclusion Hemi-hepatic blood flow occlusion through descending hilar plate in laparoscopic anatomic hepatectomy is safe and feasible.