OBJECTIVE To understand the changing trends of use of antibiotics and etiological submission rates in medical institutions of Wuhan and find out the key points of management.METHODS The survey data of Wuhan were collected from the cross-sectional survey databases for nosocomial infections in China of 2016,2018,2020 and 2022,and the data were retrospectively analyzed.RESULTS From 2016 to 2022,a total of 141 284 hospital-ized patients from 117 medical institutions were enrolled in the survey,and the utilization rate of antibiotics was 32.36％;the utilization rate of antibiotics was 32.87％in 2016,31.74％in 2018,28.75％in 2020,34.56％in 2022,showing an upward trend(x2=13.941,P＜0.001).The utilization rates of antibiotics were relatively high in respiratory medicine department and comprehensive ICU,which showed upward trends(x2=16.377,P＜0.001;x2=5.581,P=0.018);the utilization rate of antibiotics showed a downward trend in non-neonates pediatrics de-partment(x2=11.886,P＜0.001).The rates of prophylactic use of antibiotics for type Ⅰ incision surgery were 31.54％,23.53％,28.44％and 13.24％,respectively,showing downward trends(x2=230.333,P＜0.001).The etiological submission rates were 59.98％,55.77％,65.69％and 59.16％,respectively,which were basically same(P=0.072);the etiological submission rates of the medical institutions with less than 300 beds and 300 to 599 beds showed upward trends,while the etiological submission rates of the medical institutions with 600 to 899 beds and no less than 900 beds showed downward trends(x2=42.019,P＜0.001;x2=4.599,P=0.032).The etiological submission rate was 44.87％in 2018 before the treatment with antibiotics,47.80％in 2020,44.45％in 2022,which were basically same(P=0.431);the etiological submission rate of the medical institutions with no less than 900 beds showed a downward trend(x2=14.464,P＜0.001).CONCLUSIONS The use of antibiotics of the hospi-talized patients is generally normalized in the medical institutions of Wuhan,the utilization rate shows an upward trend,the etiological submission rate is basically same,and the rate of prophylactic use of antibiotics for type Ⅰincision surgery shows a downward trend.It is necessary to attach great importance to the etiological submission of large scale metical institutions before the treatment with antibiotics and the use of antibiotic of some key departments.

OBJECTIVE To understand the changing trends of use of antibiotics and etiological submission rates in medical institutions of Wuhan and find out the key points of management.METHODS The survey data of Wuhan were collected from the cross-sectional survey databases for nosocomial infections in China of 2016,2018,2020 and 2022,and the data were retrospectively analyzed.RESULTS From 2016 to 2022,a total of 141 284 hospital-ized patients from 117 medical institutions were enrolled in the survey,and the utilization rate of antibiotics was 32.36％;the utilization rate of antibiotics was 32.87％in 2016,31.74％in 2018,28.75％in 2020,34.56％in 2022,showing an upward trend(x2=13.941,P＜0.001).The utilization rates of antibiotics were relatively high in respiratory medicine department and comprehensive ICU,which showed upward trends(x2=16.377,P＜0.001;x2=5.581,P=0.018);the utilization rate of antibiotics showed a downward trend in non-neonates pediatrics de-partment(x2=11.886,P＜0.001).The rates of prophylactic use of antibiotics for type Ⅰ incision surgery were 31.54％,23.53％,28.44％and 13.24％,respectively,showing downward trends(x2=230.333,P＜0.001).The etiological submission rates were 59.98％,55.77％,65.69％and 59.16％,respectively,which were basically same(P=0.072);the etiological submission rates of the medical institutions with less than 300 beds and 300 to 599 beds showed upward trends,while the etiological submission rates of the medical institutions with 600 to 899 beds and no less than 900 beds showed downward trends(x2=42.019,P＜0.001;x2=4.599,P=0.032).The etiological submission rate was 44.87％in 2018 before the treatment with antibiotics,47.80％in 2020,44.45％in 2022,which were basically same(P=0.431);the etiological submission rate of the medical institutions with no less than 900 beds showed a downward trend(x2=14.464,P＜0.001).CONCLUSIONS The use of antibiotics of the hospi-talized patients is generally normalized in the medical institutions of Wuhan,the utilization rate shows an upward trend,the etiological submission rate is basically same,and the rate of prophylactic use of antibiotics for type Ⅰincision surgery shows a downward trend.It is necessary to attach great importance to the etiological submission of large scale metical institutions before the treatment with antibiotics and the use of antibiotic of some key departments.

ObjectiveTo systematically review the efficacy and safety of laparoscopic choledochoscopy combined with holmium laser lithotripsy through a meta－analysis. MethodsThis study was conducted based on PRISMA guidelines， with a PROSPERO registration number of CRD42023406221. Chinese databases including CNKI， Wanfang Data， and VIP and foreign language databases such as PubMed， Embase， the Cochrane Library， and Web of Science were searched for original articles on traditional laparotomy versus laparoscopic choledochoscopy combined with holmium laser lithotripsy in the treatment of bile duct stones. Dichotomous variables were assessed by odds ratio （OR） and 95% confidence interval （CI）， while continuous variables were assessed by weighted mean difference （WMD） and 95%CI， and a sensitivity analysis was performed for outcome measures with relatively high heterogeneity. The Begg test and Egger test were used to evaluate publication bias. Stata 15.0 and Review Manager 5.3 were used to perform the statistical analysis. ResultsA total of 26 retrospective studies from China were included in this study， with 2 238 patients in total. The meta－analysis showed that compared with traditional laparotomy for the treatment of bile duct stones， laparoscopic choledochoscopy combined with holmium laser lithotripsy had significantly shorter time of operation （WMD＝－1.26， 95%CI： －1.36 to －1.16， P<0.001）， length of hospital stay （WMD＝－1.93， 95%CI： －2.64 to －1.12， P <0.001）， and time to bowel function recovery （WMD＝－1.52， 95%CI： －1.68 to －1.35， P<0.001）， significantly less intraoperative blood loss （WMD＝－1.79， 95%CI： －1.93 to －1.66， P<0.001）， a significantly lower rate of intraoperative residual stone （OR＝0.15， 95%CI： 0.11－0.20， P<0.001）， and significantly fewer complications （OR＝0.17， 95%CI： 0.13－0.23， P<0.001）. ConclusionCompared with traditional laparotomy， laparoscopic choledochoscopy combined with holmium laser lithotripsy shows better efficacy in the treatment of bile duct stones.

【Objective】 To establish the multiple regression equation based on R language in order to guide scientific and reasonable blood preparation for clinicians before liver transplantation. 【Methods】 Basic clinical information, including gender, age and disease types, of 183 liver transplant patients were collected, and results of preoperative blood routine(MCV, MCHC, Hct, RBC, Hb and Plt), prothrombin time(PT), activated partial thromboplastin time(APTT), thrombin time(TT), fibrinogen(FIB), international normalized ratio(INR) and D dimer and antithrombin Ⅲ(AT Ⅲ), operation time, as well as intraoperative transfusion volume of red blood cells, plasma, cryoprecipitates and platelets were analyzed using R language analysis.The correlation between blood component transfusion volume and analysis factors was calculated by generalized linear function, and the regression equation for predicting blood preparation was obtained by Poisson regression analysis. 【Results】 Intraoperative transfusion rates of RBC, plasma, platelets and cryoprecipitates in liver transplantation patients were 85.79%(8.35±8.78 U), 100%(1 083±742.80 mL), 18.58%(0.26±0.60 treatment dose), and 12.02%(2.49±7.51 U), respectively. According to the analysis factors with good correlation, the prediction equations for the volume of each blood component were as follows: RBC: 3.348+ 1.276×Time-0.02×Hct-0.16×RBC-0.006×Hb, plasma: 6.901+ 0.826 ×Time-0.003×Hb, platelets: -1.275+ 1.866×Time-0.013 Hb+ 0.025×TT, and cryoprecipitates: -7.183+ 2.888×Time + 0.067×MCV+ 0.029×TT. 【Conclusion】 It is of great clinical significance to use R language to carry out multivariate regression analysis and establish the prediction regression equation of blood preparation before liver transplantation, which can provide scientific, reasonable and sufficient blood supply in operation.

Objective To observe the expression changes of 12 ischemia-related microRNAs (miRNA) in cerebral ischemia-reperfusion injury after deep hypothermic low flow (DHLF) in mice.Methods A total of 80 3-w eek-old healthy and clean grade C57BL/6 male mice w ere randomly divided into either a DHLF model group or a sham operation group. Each group w as redivided into 4 subgroups according to the time points of 2, 6, 12, and 24 h (10 in each group). The bilateral carotid arteries of the DHLF model group w ere clipped and a DHLF model w as established, w hile the carotid arteries of the sham operation group w ere not clipped. The mice w ere sacrified at each time point and the brain tissue w as removed. The total RNA w as extracted. Quantitative reverse transcriptase polymerase chain reaction w as used to detect miRNA expression. Results Compared w ith the sham operation group, the expression levels of 9 miRNAs w ere upregulated, 2 w ere dow n-regulated, and 1 did not have any significant change in the DHLF model group. Conclusions The expression levels of 11 miRNAs changed significantly after DHLF. It might have a regulatory role in cerebral ischemia-reperfusion injury after DHLF.

MicroRNAs (miRNAs) are a class of highly conserved small noncoding single stranded RNAs.They participate in the regulation of target genes through the degradation of mRNA and/or inhibition of translation.As the most abundant miRNAs in the central nervous system,miRNA-124 (miR-124) has been widely given attention in recent years.The recent research suggests that miR-124 is closely associated with ischemic cerebral injury,but its specific regulation mechanism remains unclear.This article reviews the roles of miR-124 in ischemic cerebral injury.

Objective To investigate the effects of down-regulation of polo-like kinase-1 (PLK1) gene by RNA interference (RNAi) on the invasion of a human malignant melanoma cell line A375 and their possible mechanisms.Methods Cultured A375 cells were classified into several groups:blank control group receiving no treatment,liposome group transfected with lipofectamine only,and three siRNA groups transfected with three concentrations of a small interference RNA (siRNA) targeting PLK1 respectively.After additional culture,real time quantitative PCR and Western blot analysis were performed to quantify the expressions of PLK1 mRNA and protein in A375 cells respectively,Transwell invasion assay to evaluate the invasive capacity of A375 cells,agarose gel electrophoresis and terminal deoxynucleotidyl-transferase-mediated dUTP-biotin nick end labelling (TUNEL) to detect anoikis in A375 cells.The colony-forming capacity was also evaluated for A375 cells.Statistical analysis was carried out by one-factor analysis of variance.Results There was a significant decrease in PLK1 mRNA and protein expressions as well as in colony-forming units in the siRNA groups compared with the blank control group (all P ＜ 0.05).The invasive capacity of A375 cells was significantly inhibited in the siRNA groups with the number of migrating cells in Transwell assay being 39 ± 5,19 ± 5 and 9 ± 3 in A375 cells transfected with 3.125,6.250 and 12.500 nmol/L siRNAs respectively,compared to 56 ± 5 in the blank control group (all P ＜ 0.05).A characteristic DNA ladder was observed on agarose gel electrophoresis in the siRNA (6.250 nmol/L) group.Compared with the blank control group and liposome group,the three siRNA groups showed increased apoptotic index (3.86％ ± 0.35％ (3.125 nmol/L siRNA),7.35％ ± 0.36％ (6.250 nmol/L siRNA) and 17.56％ ± 0.38％ (12.500 nmol/L siRNA) vs.1.15％ ± 0.25％ (blank control group) and 1.18％ ± 0.22％ (liposome group),all P ＜ 0.05).Conclusions PLK1 siRNA can inhibit the invasion of malignant melanoma cells,likely by inducing anoikis in these cells.

Objective To investigate the relationship among HbA1c、urine microalbuminuria (UmAlb)and blood lipids in pa-tients type 2 diabetes mellitus.Methods 120 patients with type 2 diabetes in the hospital were enrolled in the study in 2012.Ac-cording to the test results of HbA1c,the people enrolled in the study were divided into two groups,group A:HbA1c <6.5%,60 cases totally;group B:HbA1c≥6.5%,60 cases totally.UmAlb and blood lipids were measured.Results Compared with group A, UmAlb、TC、TG and LDL-C concentrations increased significantly in group B(P <0.05),while HDL-C decreased significantly(P <0.05).Conclusion In type 2 diabetic patients whose HbA1c≥6.5%,UmAlb,TC,TG and LDL-C concentrations increased obvi-ously and the risk of diabetic complications increase.

Objective To investigate the effects of miR-10a expression on migration and invasion of human pancreatic cancer cells AsPC-1.Methods Small interfering RNA targeting at miR-10a (miR-10a-siRNA) was constructed,then it was transfected into pancreatic cancer AsPC-1 cells,and nonsense siRNA (Nc-siRNA) group and blank control group was established.Real time PCR assay was used to detect the expression of miR-10a in the 3 groups,and wound healing assay and Transwell assay were used to determine the migration and invasion abilities of cancer cells.The amount of matrix metalloproteinase-13 (MMP-13) in supernatant of cancer cell culture of each group was examined by ELISA assay.Results The miR-10a levels in control group,NC-siRNA group and miR-10a-siRNA group were 1.05 ±0.08,1.03 ±0.06,0.02 ±0.01 ; and the number of transmembrane cell were (150 ± 2.6),(145 ± 2.2),(62 ± 1.8),the levels of MMP-13 in the supernatant were (108.5 ± 2.8),(107.8 ± 2.5),(35.8 ± 1.5) pg/ml.The values were significantly lower in miR-10a-siRNA group than those in control group and NC-siRNA group (P ＜ 0.01).The distance of cultured clone in miR-10a treated cancer cells (736± 18 μm) was significantly longer than those in the controls (385 ±5 μm) and NC-siRNA group (395± 13 μm,P＜0.01).Conclusions Down-regulation of miR-10a by siRNA may inhibit migration and invasion of pancreatic cancer AsPC-1 cells,and the downregulated expression of MMP-13 may be one of the important mechanisms.

Objective To study the effects of Forkhead box protein M1 (FoxM1) down regulation by small interfering RNA(siRNA) on chemosensitivity and mechanism of human pancreatic cancer cell and its mechanism.Methods Three FoxM1 siRNAs were designed and constructed.All cancer cells were divided into different groups,after transfected with FoxM1 siRNA for different time,the cultured cells were harvested to carry on the next tests.Expression of FoxM1 were determined by red-time PCR and Western blot,and prolifearion and chemosensitivity were evaluated by MTT assay,and the phosphorylation of Akt protein was examined by Western blot.Results FoxM1 siRNA could down-regulate the FoxM1 expression in a dose-and time-dependent manner.The MTF results showed that the inhibit rates was 17.78％,17.56％,35.39％,52.81％,70.98％ indifferentgroups [Con-A + Gemcitabine,Con-B + Gemcitabine,siRNA (3.125nM) + Gemcitabine,siRNA (6.25nM) + Gemcitabine and siRNA(12.5nM) + Gemcitabine,respectively.The phosphorylation of Akt protein was inhibited in a dose-dependent manner.Conclusions FoxM1 siRNA could sensitize human pancreaticr cancer cells chemotherapy sensitivity,it is the one of the important mechanisms through down-regulate Akt phosphorylated levels,but the molecular mechanism need to be explored further.