Objective To explore the application efficacy of refined management on antimicrobial agents in a chest specialty hospital.Methods Multiple measures were implemented through perfecting management systems and processes,as well as conducting knowledge training,such as multi-dimensional specialized prescription reviewing,optimizing information systems,and implementing grid-based management of clinical pharmacist.A refined manage-ment mode for antimicrobial agents in a chest specialty hospital has been established.Antimicrobial management in-dicators for the whole hospital and each clinical specialty in 2023(before management)and 2024(after manage-ment)were analyzed.Results Compared with 2023,antimicrobial use rate among hospitalized patients in 2024 de-creased from 47.48％to 45.92％,and antimicrobial use density(AUD)decreased from 46.28 defined daily doses(DDDs)/(100 person·day)to 39.73 DDDs/(100 person·day).The ratio of antimicrobial cost to total drug cost decreased from 12.71％to 9.51％,and the per capita cost of antimicrobial use decreased from 1 344.18 Yuan to 975.52 Yuan.The use rate of prophylactic antimicrobial agents for class Ⅰ incision surgery increased from 84.48％to 89.52％,and the rationality rate increased from 69.25％to 94.53％.The management indicators of each clinical specialty improved significantly.Conclusion Through adopting a series of refined management measures,antimi-crobial management modes that are suitable for the actual situation of the hospital has been constructed,and obvious efficacy was achieved.Clinical application of antimicrobial agents is more standardized and rational.

Objective To explore the application efficacy of refined management on antimicrobial agents in a chest specialty hospital.Methods Multiple measures were implemented through perfecting management systems and processes,as well as conducting knowledge training,such as multi-dimensional specialized prescription reviewing,optimizing information systems,and implementing grid-based management of clinical pharmacist.A refined manage-ment mode for antimicrobial agents in a chest specialty hospital has been established.Antimicrobial management in-dicators for the whole hospital and each clinical specialty in 2023(before management)and 2024(after manage-ment)were analyzed.Results Compared with 2023,antimicrobial use rate among hospitalized patients in 2024 de-creased from 47.48％to 45.92％,and antimicrobial use density(AUD)decreased from 46.28 defined daily doses(DDDs)/(100 person·day)to 39.73 DDDs/(100 person·day).The ratio of antimicrobial cost to total drug cost decreased from 12.71％to 9.51％,and the per capita cost of antimicrobial use decreased from 1 344.18 Yuan to 975.52 Yuan.The use rate of prophylactic antimicrobial agents for class Ⅰ incision surgery increased from 84.48％to 89.52％,and the rationality rate increased from 69.25％to 94.53％.The management indicators of each clinical specialty improved significantly.Conclusion Through adopting a series of refined management measures,antimi-crobial management modes that are suitable for the actual situation of the hospital has been constructed,and obvious efficacy was achieved.Clinical application of antimicrobial agents is more standardized and rational.

ObjectiveTo investigate the efficacy and safety of cinobufagin tablets combined with thalidomide/dexamethasone （TD） regimen in the treatment of newly diagnosed multiple myeloma （NDMM） with phlegm and stasis obstruction. MethodsThe clinical data of 50 patients with NDMM of phlegm and stasis obstruction who were hospitalized at the Jiangsu Province Hospital of Chinese Medicine from June 1st， 2015 to July 31th， 2019 were retrospectively analyzed， and they were divided into a control group （bortezomib/dexamethasone-containing regimen， 27 cases） and an observation group （cinobufagin tablets combined with TD regimen， 23 cases）. The clinical efficacy and safety were compared between the two groups after two or three courses of treatment. The primary outcomes were clinical remission rate including overall response rate and deep remission rate， one-year and two-year overall survival rate， and adverse effects. The secondary outcomes were the proportion of plasma cells in bone marrow， hemoglobin， β2-microglobulin， lactate dehydrogenase， serum creatinine， blood urea nitrogen， bone pain score， and KPS functional status score （KPS score） before and after treatment. ResultsIn terms of clinical efficacy， there was no statistically significant difference （P＞0.05） in the overall response rate ［the observation group 69.57%（16/23） vs the control group 70.37% （19/27）］ and deep remission rate ［the observation group 56.52% （13/23） vs the control group 55.56% （15/27）］ between groups after the treatment. The one-year overall survival rates of the observation group and the control group were 90.9% and 92.4%， and the two-year overall survival rates were 81.8% and 80.9% respectively， with no statistically significant differences between groups （P＞0.05）. During the treatment， no renal function injury occurred in both groups. The incidence of peripheral nerve injury in the observation group was 8.70%， which was lower than 48.15% in the control group （P＜0.01）. After the treatment， the proportion of myeloma plasma cells， β2-microglobulin， serum creatinine level， and bone pain score decreased， while the hemoglobin level and KPS score increased in both groups （P＜0.05 or P＜0.01）. Compared between groups after treatment， the bone pain score of the observation group was lower than that of the control group， while the KPS score was higher than that of the control group （P＜0.05）. ConclusionThe clinical efficacy of cinobufagin tablets combined with TD in the treatment of NDMM is equivalent to bortezomib/dexamethasone-containing regimen， but the former is more helpful in relieving the pain and improving the quality of life， and has better safety.

Objective To explore the effect of scalp acupuncture combined with repetitive transcranial magnetic stimulation(rTMS)on global cognitive function in patients with post-stroke cognitive impairment(PSCI).To explore the resting-state neuroimaging mechanism of scalp acupuncture combined with rTMS in improving cognitive function in patients with PSCI using fraction amplitude of low frequency fluctuation(fALFF).Methods PSCI patients were randomly assigned to scalp acupuncture group and scalp acupuncture combined with rTMS group(the combined group).Both groups were given conventional rehabilitative training.The scalp acupuncture group selected the affected-side anterior oblique parietotemporal line(MS6).Low frequency(1Hz)rTMS over primary motor cortex(M1)of the unaffected-side in the combined group.The duration was once a day for 20 min,6 sessions one week,in total of 12 sessions for consecutive two weeks.Comparing the total and subtests of the Montreal Cognitive Assessment Scale(MoCA)before and after treatment.At the same time,the statistical method of Difference-in-Difference(DID)was used to analyze the trend of each observational index.The fALFF was used to detect the changes of spontaneous neurological activity in local brain areas and partial correlation analysis was performed with statistical differences cognitive behavioral indicators and significant fALFF values.Results A total of 47 subjects entered the final statistical analyses,including 25 subjects in the scalp acupuncture group and 22 subjects in the combined group.Compared with scalp acupuncture group,there were no significant differences in the global cognitive function in the combined group(P=0.914＞0.05).However,the MoCA subscore-delayed memory task score was significantly improved in the combined group(P=0.035＜0.05).At the same time,the trend analysis also showed that the improvement effect in the combined group was significantly better than those in the scalp acupuncture group(DID=0.80,t=2.20,P=0.033＜0.05).After two weeks of intervention,compared with the baseline fALFF value,the increase of left precuneus,right cerebelum,left fusiform gyrus,left superior parietal gyrus in the combined group were significantly decreased than those of scalp acupuncture group.(GRF corrected,voxel P＜0.01,cluster P＜0.05).The results of partial correlation analysis showed that the fALFF difference of left fusiform gyrus was positively correlated with the difference of subscore-delayed memory in combined group(r=0.719,P＜0.05).Other correlation analyses were not statistically significant(P＞0.05).Conclusion Scalp acupuncture combined with rTMS intervention have definite efficacy in delayed memory.The underpinning neuroimaging mechanism may be related to local neurological spontaneous activity in brain regions involving in cognitive processing such as left fusiform gyrus.

Objective To explore the effect of scalp acupuncture combined with repetitive transcranial magnetic stimulation(rTMS)on global cognitive function in patients with post-stroke cognitive impairment(PSCI).To explore the resting-state neuroimaging mechanism of scalp acupuncture combined with rTMS in improving cognitive function in patients with PSCI using fraction amplitude of low frequency fluctuation(fALFF).Methods PSCI patients were randomly assigned to scalp acupuncture group and scalp acupuncture combined with rTMS group(the combined group).Both groups were given conventional rehabilitative training.The scalp acupuncture group selected the affected-side anterior oblique parietotemporal line(MS6).Low frequency(1Hz)rTMS over primary motor cortex(M1)of the unaffected-side in the combined group.The duration was once a day for 20 min,6 sessions one week,in total of 12 sessions for consecutive two weeks.Comparing the total and subtests of the Montreal Cognitive Assessment Scale(MoCA)before and after treatment.At the same time,the statistical method of Difference-in-Difference(DID)was used to analyze the trend of each observational index.The fALFF was used to detect the changes of spontaneous neurological activity in local brain areas and partial correlation analysis was performed with statistical differences cognitive behavioral indicators and significant fALFF values.Results A total of 47 subjects entered the final statistical analyses,including 25 subjects in the scalp acupuncture group and 22 subjects in the combined group.Compared with scalp acupuncture group,there were no significant differences in the global cognitive function in the combined group(P=0.914＞0.05).However,the MoCA subscore-delayed memory task score was significantly improved in the combined group(P=0.035＜0.05).At the same time,the trend analysis also showed that the improvement effect in the combined group was significantly better than those in the scalp acupuncture group(DID=0.80,t=2.20,P=0.033＜0.05).After two weeks of intervention,compared with the baseline fALFF value,the increase of left precuneus,right cerebelum,left fusiform gyrus,left superior parietal gyrus in the combined group were significantly decreased than those of scalp acupuncture group.(GRF corrected,voxel P＜0.01,cluster P＜0.05).The results of partial correlation analysis showed that the fALFF difference of left fusiform gyrus was positively correlated with the difference of subscore-delayed memory in combined group(r=0.719,P＜0.05).Other correlation analyses were not statistically significant(P＞0.05).Conclusion Scalp acupuncture combined with rTMS intervention have definite efficacy in delayed memory.The underpinning neuroimaging mechanism may be related to local neurological spontaneous activity in brain regions involving in cognitive processing such as left fusiform gyrus.

Objective To investigate radiation resources in medical diagnosis and treatment and their use frequency in medical institutions in Hangzhou, China, and to provide a basis for relevant departments to rationally allocate and scientifically supervise the resources. Methods From April 1, 2019 to March 31, 2020, a survey was conducted on the basic information, radiation staff, equipment configuration, and frequency of radiation diagnosis and treatment of all medical institutions in Hangzhou using a questionnaire. Results There were 1001 institutions with radiation services in Hangzhou, with 6714 radiation staff members and 2742 pieces of radiation equipment. The frequency of conventional X-ray diagnosis was 788.43 per 1000 population. The frequency of computed tomography diagnosis was 531.93 per 1000 population. The frequency of mammography and dental photography diagnosis was 246.34 per 1000 population. The frequency of interventional diagnosis and treatment was 10.01 per 1000 population. The frequency of radiotherapy was 2.39 per 1000 population. The frequency of nuclear medicine diagnosis was 8.90 per 1000 population. The frequency of nuclear medicine treatment was 0.99 per 1000 population. Conclusion Medical institutions have developed rapidly in Hangzhou, but with an unbalanced situation. In order to better protect the health of examinees, we recommend relevant departments optimize resource allocation and strengthen supervision on radiation protection in medical institutions.

Enterotoxigenic Escherichia coli（ETEC）infection can induce watery diarrhea，leading to dehydration，electrolyte disturbance，and even death in severe cases. Recombinant B subunit/inactivated whole-cell cholera（rBS/WC）vaccine is effective in preventing ETEC infectious diarrhea. On the basis of the latest evidence on etiology and epidemiology of ETEC，as well as the effectiveness，safety，and health economics of rBS/WC vaccine，National Clinical Research Center for Child Health（The Children’s Hospital，Zhejiang University School of Medicine）and Zhejiang Provincial Center for Disease Control and Prevention invited experts to develop expert consensus on rBS/WC vaccine in prevention of ETEC infectious diarrhea. It aims to provide the clinicians and vaccination professionals with guidelines on using rBS/WC vaccine to reduce the incidence of ETEC infectious diarrhea.

Objective To explore the quality control results of Digital Diagnost digital radiography (DR), and also to analyze the differences in signal transfer characteristics (STP) of DR from different manufacturers, in order to provide a reference for quality control of testers and daily supervision of administrative staff. Methods According to WS 76—2020 “Specification for testing of quality control in medical X-ray diagnostic equipment”, the test items such as automatic exposure control (AEC) repeatability, AEC response, detector dose indication (DDI), STP, high-contrast resolution, and low-contrast resolution of Digital Diagnost DR were qualitatively controlled, and several common DRs on the market were selected to analyze their STP functional relationships. Results The baseline values of DDI, high-contrast resolution, and low-contrast resolution of Digital Diagnost DR were 19733, 2.8 Lp/mm, and H5 of image central pixel value, respectively; the quality control results of other test items met the requirements of WS 76—2020. The STP functional relationships of common DRs were mainly linear and logarithmic, but different models of DR from the same manufacturer might also have different STP functional relationships. Conclusion When testing some special test items of DR, attention should be paid to the influence of a variety of factors, while refining the test steps and condition settings for the test items. The simulation should be performed in accordance with the functional relationship provided by the manufacturer when analyzing the STP.

Objective To explore the absorbed dose to the common tissues of subjects in four clinical CT scanning modes and the spatial distribution of the radiation field in chest scanning, in order to provide a basis for the radiation protection of subjects and the space in the machine room. Methods A thermoluminescence detector (TLD) was used to measure the absorbed doses to the eye lens, thyroid gland, gonad, chest and abdominal skins of the anthropomorphic phantom in four CT scanning modes. The TLD was used to monitor the air kerma at different positions from the CT diagnostic table during chest spiral scanning. Results The absorbed doses to the eye lens, thyroid gland, gonad, chest and abdominal skins of the anthropomorphic phantom in four CT scanning modes were 0.040-64.818 mGy, 0.154-10.155 mGy, 0.028-0.154 mGy, 0.443-17.141 mGy, and 0.093-14.346 mGy, respectively. The maximum air kerma value of the space radiation field during chest scanning was 0.049 mGy, and the farther the distance from the CT tube, the smaller the value. Conclusion The absorbed doses to the common tissues of subjects examined by the four CT scanning modes generally do not exceed the threshold doses. The dose received by the companion of the subject during a single chest CT scan was small. In order to minimize radiation hazards, shielding measures can be taken in CT scanning to reduce the absorbed doses to the tissues of the subject, and the companion of the subject should appropriately increase the distance from the tube and the diagnostic table.

Objective:To understand the current situation of nurses in 52 hospitals in China on mastery of knowledge about skin injury in the elderly based on the background of mixed-mode homogenization training.Methods:Using the convenient sampling method, a total of 1 067 nurses from 52 hospitals in China were selected as the research objects in January 2021. A self-designed questionnaire on knowledge of skin injury in the elderly was used to investigate the nurses through the questionnaire star and univariate analysis was used to analyze the influencing factors. A total of 1 067 questionnaires were distributed and 1 067 valid questionnaires were recovered, and the effective recovery rate was 100%.Results:The knowledge scores of pressure injury, incontinence-associated dermatitis, skin tear and xerosis cutis among 1067 nurses were (95.66±7.37) , (95.65±9.15) , (91.37±15.45) and (87.67±15.91) , respectively. The results of univariate analysis showed that hospital grade was the influencing factor of nurses' knowledge score of pressure injury, skin tear and incontinence-associated dermatitis ( P<0.05) , educational background was the influencing factor of nurses' knowledge score of skin tear ( P<0.05) , professional title was the influencing factor of nurses' knowledge scores of pressure injury, incontinence-associated dermatitis and xerosis cutis ( P<0.05) . Conclusions:Hospitals at all levels need to strengthen the theoretical and practical knowledge training for nurses on skin xerosis and skin tear in the elderly, especially for nurses with primary titles and lower education in grassroots hospitals.