Objective:To explore the safety and efficacy of intraosseous regional administration (IORA) of vancomycin for preventing infection in primary total knee arthroplasty (TKA).Methods:A total of 124 patients with knee osteoarthritis undergoing TKA between February 2024 and May 2024 at nine hospitals were enrolled. Preoperative infection prophylaxis involved either IORA (0.5 g vancomycin administered via intraosseous regional infusion before incision) or intravenous infusion (1 g vancomycin via peripheral vein). The IORA group included 15 males and 47 females with a median age of 66.5 years (range, 60.0-70.0 years), while the intravenous group included 14 males and 48 females with a median age of 66.0 years (range, 61.8-70.3 years) years. Intraoperative samples were collected including fat and synovium tissues after incision, before prosthesis placement, and after tourniquet release; distal femoral cancellous bone during femoral osteotomy; proximal tibial cancellous bone during tibial osteotomy; proximal intercondylar cancellous bone before prosthesis placement; and peripheral blood from non-infused arms at surgery initiation and after tourniquet release. Vancomycin concentrations were measured using liquid chromatography-tandem mass spectrometry. Vital sign changes were recorded from admission to 5~10 minutes post-IORA (IORA group) or post-incision (intravenous group). Follow-ups were conducted on postoperative day 1 and 3, and at 1 and 3 months, to document complications including IORA-related adverse events, periprosthetic joint infections, surgical site infections, red man syndrome, acute kidney injury, deep vein thrombosis and so on.Results:Vancomycin concentrations in bone, fat, and synovial tissue samples were significantly higher in the IORA group than in the intravenous group ( P<0.05), while vancomycin concentrations in blood samples were significantly lower in the IORA group than in the intravenous group ( P<0.05). Only 7.3%(41/558) of tissue samples in the IORA group had vancomycin concentrations below 2.0 μg/g (the minimum inhibitory concentration of vancomycin against coagulase-negative staphylococcus), compared to 59.3%(331/558) in the intravenous group (χ 2=11.285, P<0.001). In the intravenous group, 16.9%(21/124) of blood samples had vancomycin concentrations exceeding 15.0 mg/L (the threshold associated with a significantly increased risk of nephrotoxicity), while all concentrations in the IORA group were below this threshold, the difference was statistically significant (χ 2=22.943, P<0.001). There were no statistically significant difference ( P>0.05) in vital signs changes before and after vancomycin administration between the two groups. Two patients in the intravenous group experienced incision exudate, while no other related complications occurred in either group. Conclusions:Compared to the traditional intravenous infusion of 1 g vancomycin, intraosseous injection of a low dose (0.5 g) of vancomycin achieves higher local tissue concentrations in the knee joint with a lower incidence of adverse reactions and is safe for infection prophylaxis. Despite guidelines not recommending the routine use of vancomycin for preventing infection after primary TKA, intraosseous injection of 0.5 g vancomycin may be considered intraoperatively for primary TKA in the following scenarios: patients in medical institutions with a high prevalence of methicillin-resistant staphylococcus aureus (MRSA) infections, patients with potential preoperative MRSA colonization, or patients with cephalosporin allergy.

Objective:To explore the safety and efficacy of intraosseous regional administration (IORA) of vancomycin for preventing infection in primary total knee arthroplasty (TKA).Methods:A total of 124 patients with knee osteoarthritis undergoing TKA between February 2024 and May 2024 at nine hospitals were enrolled. Preoperative infection prophylaxis involved either IORA (0.5 g vancomycin administered via intraosseous regional infusion before incision) or intravenous infusion (1 g vancomycin via peripheral vein). The IORA group included 15 males and 47 females with a median age of 66.5 years (range, 60.0-70.0 years), while the intravenous group included 14 males and 48 females with a median age of 66.0 years (range, 61.8-70.3 years) years. Intraoperative samples were collected including fat and synovium tissues after incision, before prosthesis placement, and after tourniquet release; distal femoral cancellous bone during femoral osteotomy; proximal tibial cancellous bone during tibial osteotomy; proximal intercondylar cancellous bone before prosthesis placement; and peripheral blood from non-infused arms at surgery initiation and after tourniquet release. Vancomycin concentrations were measured using liquid chromatography-tandem mass spectrometry. Vital sign changes were recorded from admission to 5~10 minutes post-IORA (IORA group) or post-incision (intravenous group). Follow-ups were conducted on postoperative day 1 and 3, and at 1 and 3 months, to document complications including IORA-related adverse events, periprosthetic joint infections, surgical site infections, red man syndrome, acute kidney injury, deep vein thrombosis and so on.Results:Vancomycin concentrations in bone, fat, and synovial tissue samples were significantly higher in the IORA group than in the intravenous group ( P<0.05), while vancomycin concentrations in blood samples were significantly lower in the IORA group than in the intravenous group ( P<0.05). Only 7.3%(41/558) of tissue samples in the IORA group had vancomycin concentrations below 2.0 μg/g (the minimum inhibitory concentration of vancomycin against coagulase-negative staphylococcus), compared to 59.3%(331/558) in the intravenous group (χ 2=11.285, P<0.001). In the intravenous group, 16.9%(21/124) of blood samples had vancomycin concentrations exceeding 15.0 mg/L (the threshold associated with a significantly increased risk of nephrotoxicity), while all concentrations in the IORA group were below this threshold, the difference was statistically significant (χ 2=22.943, P<0.001). There were no statistically significant difference ( P>0.05) in vital signs changes before and after vancomycin administration between the two groups. Two patients in the intravenous group experienced incision exudate, while no other related complications occurred in either group. Conclusions:Compared to the traditional intravenous infusion of 1 g vancomycin, intraosseous injection of a low dose (0.5 g) of vancomycin achieves higher local tissue concentrations in the knee joint with a lower incidence of adverse reactions and is safe for infection prophylaxis. Despite guidelines not recommending the routine use of vancomycin for preventing infection after primary TKA, intraosseous injection of 0.5 g vancomycin may be considered intraoperatively for primary TKA in the following scenarios: patients in medical institutions with a high prevalence of methicillin-resistant staphylococcus aureus (MRSA) infections, patients with potential preoperative MRSA colonization, or patients with cephalosporin allergy.

On the basis of synergetic theory and complex adaptive system theory, the dialectical relationship of "industry-university-research-competition" four-in-one practical teaching was analyzed. The path of practicing "industry-university-research-competition" four-in-one practical teaching in medical universities was explored. In terms of industry, the development adheres to the principles of broad vision and selective implementation, as well as accumulating resources gradually for substantial progress. Currently, the company operates in compliance with standards, seeking steady and proactive advancement. In terms of university, we explored the combination of professional courses and entrepreneurship and innovation teaching, the combination of experimental platform and entrepreneurship and innovation incubation, and the combination of holiday practice learning and entrepreneurship and innovation practice, so as to achieve full coverage of entrepreneurship and innovation practice teaching in class and outside class. In terms of research, students participated in the faculty research projects and teams or independently applied for college student innovation and entrepreneurship projects. Scientific research has become the primary carrier of training the innovation awareness of college students. At present, we have been granted with four national college student innovation and entrepreneurship projects. In terms of competition, we have normatively participated in discipline competitions and innovation and entrepreneurship competitions, and established a complete competition system. We have won more than 200 awards in competitions at various levels. Several years of unremitting efforts to practice teaching reform have led to promising results and moderate scale of teaching practice.

Objective:To explore the effects of internet-based group cognitive-behavioral therapy(IGCBT)on the depressive and anxiety symptoms in patients with major depressive disorder(MDD).Methods:Eighty pa-tients with MDD were recruited and randomly divided into IGCBT combined drug therapy group and control group with drug therapy.Blind assessments were performed using the Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA)three times at baseline,4 weeks after treatment and 8 weeks after treatment,respectively.Results:The effective rates of HAMD and HAMA at the end of the 4th and 8th week,and the effective rates of HAMA at the end of the 8th week were higher in the combined treatment group than those in the control group(Ps＜0.05).The total scores of HAMD and HAMA in the combined treatment group and the control group were lower at the end of the 4th and 8th week than those at baseline(Ps＜0.001).The total scores of HAMD and HAMA were lower in the combined treatment group than those in the control group at the baseline,4 weeks and 8 weeks after treatment(Ps＜0.01).Conclusion:It suggests that intemet-based group cognitive-behavioral therapy combined with antidepressant medication has a better effect on relieving depressive and anxiety symptoms in patients with ma-jor depressive disorder than drug therapy alone,and especially has a better effect on improving anxiety symptom.

This paper presents a systematic review of extant research investigating the effectiveness of Internet-based group cognitive behavioral therapy （IGCBT） for depression and anxiety symptoms with an emphasis on the treatment modalities， treatment protocols， efficacy and mechanism， together with a summary of research limitations and suggestions for future research. Cognitive behavioral therapy （CBT） is a structured， short-term and present-oriented psychotherapeutic treatment， its Internet- and group-delivered modalities have led to its wider application， and has proven to be clinically effective in alleviating depression and anxiety symptoms caused by different diseases， whereas some drawbacks have been reported. Thus this paper elaborates the clinical application， therapeutic effect and underlying mechanisms of IGCBT intervention for depression and anxiety symptoms， so as to provide references for its future application. ［Funded by the Natural Science Foundation of the Inner Mongolia Autonomous Region （number， 2019MS03038）

ObjectiveTo study the epidemiological characteristics of deaths due to pneumoconiosis and its complications in order to improve the prevention and management of pneumoconiosis. MethodsThe pneumoconiosis deaths who died during 1959‒2019 in Chongming District of Shanghai were investigated and analyzed retrospectively by the descriptive epidemiological methods. The correlation of the age of onset and the course of disease was analyzed by Spearman rank correlation，as well as the duration of dust exposure and the course of disease in pneumoconiosis patients. ResultsFrom 1959 to 2019， there were 226 pneumoconiosis deaths， 223 males （98.67%）. The mortality of silicosis was the highest （82.07%）. The age of onset of pneumoconiosis was negatively correlated with the course of disease （r_s=-0.596，P<0.001）.There was no correlation between the duration of dust exposure and the course of disease in pneumoconiosis patients （r_s=-0.107，P=0.109）.There were statistically significant differences in mortality among groups in different types and stages of pneumoconiosis（χ²=59.250，27.666，both P<0.05）. The mortality increased with the increase of stage of pneumoconiosis. The mortality of pneumoconiosis was significantly different in 1959‒1979， 1980‒1989， 1990‒1999， 2000‒2009 and 2010‒2019 （χ²=29.750， P<0.05）. The top three causes of death in pneumoconiosis cases were respiratory diseases， malignant tumor and cardiovascular and cerebrovascular diseases.ConclusionIt is suggested to further strengthen the health monitoring and management of pneumoconiosis patients，control lung and chronic respiratory diseases to delay the life expectancy and improve quality of life of pneumoconiosis patients.

Objective To analyze the medical examinations of radiation worker in medical institutions and provide some basic data for radiation protection management. Methods The occupational health examination of 3568 radiation workers from 681 medical institutions who came to our hospital for occupational health examination from January 1 to December 31 in 2020 were summarized and analyzed. Results There was no case of suspected occupational radiation sickness. The abnormal rate was in the range of 2.17%～2.99%, the rate of occupational contraindicated was about 1.44%～2.17%. The total review rate was about 13.00%, more than 79.48% of the radiation workers were checked out other diseases or abnormal. The abnormal examination items are mainly ophthalmology, B ultrasound of liver, gallbladder, spleen and pancreas, liver function, electrocardiogram, blood routine, urine routine, blood pressure, B ultrasound of both kidneys and kidney function. The abnormal rate of ophthalmology in each level of institutions was decreased with the increase of the length of service, while the abnormal results of B-ultrasound of liver, gallbladder, spleen and pancreas, blood pressure, B-ultrasound of both kidneys and renal function were increased with the increase of service. Conclusion Maybe the radiation protection of radiation workers in medical institutions was well in Shenzhen, but there were different effects of the health status of the staff. Therefore, it is important to further strengthen the occupational health monitoring management.

Objective: To explore the effects of high-fat diet exposure on glucolipid metabolism and ovarian function in offspring of female Sprague Dawley rats. Methods: Female and male rats were mated in cages at a ratio of 2∶1. Pregnant mice were collected and randomly divided into normal feed group (control group) and high-fat and high-glucose feed group (observation group). Female offspring were selected as the research object. After the offspring entering the stage of sexual maturity, the blood was taken from abdominal aorta artery. The contents of serum related factors were determined by automatic biochemical analyzer and enzyme linked immunosorbent assay (ELISA) kit. Hematoxylin-eosin staining (HE) was used to directly observe the distribution and quantity of liver tissue and the quantity and structure of ovarian follicles. Results: Compared with the normal control group, the body weight, blood glucose, blood lipids and fat coefficient in high-fat diet rats were significantly increased (P<0.05). The secretions of estradiol (E₂), follicle stimulating hormone (FSH) and luteinizing hormone (LH) in the ovary were significantly reduced (P<0.05). HE slices showed that compared with the normal control group, there were fat vacuoles in the cytoplasm of hepatocytes, the increase of hepatocyte arrangement gap, the number of adipocytes and the diameter of fat droplets in the observation group. The quantities of primordial follicles and primary follicles in the ovary showed increasing trend in high-fat diet group, and the diameter of follicles was decreased. Conclusions High-fat and high glucose diet may cause abnormal glucolipid metabolism. It is speculated that high fat diet may cause ovary to be surrounded by fat through fat accumulation in the abdomen and buttocks of female offspring, which directly leads to dysfunction.

Objective To measure the body surface dose under different confinations of additional filters,tube voltage and tube current and discuss the lowest amount of different additional filters,tube voltage and tube current combination for crib side X-ray radiation dose while the quality of the image is guaranteed.Methods Japan Shimadzu wireless tablet mobile DR machine and Dutch Artinis CDRAD 2.0 phantom were used.The tube voltage and tube current for children's crib side X-ray normal work were 50 kV and 1.40 mAs to get the image quality figure inverse (IQFInv),respectively.Totally four filter combinations of 1 mm A1,2 mm A1,1+2 mm A1 and 0.3 mm Cu were added to the opening of collimator system by mobile DR machine.Phantom was shot by respectively combination of 50,66,83 and 100 kV tube voltages and different tube currents.All images to get the IQFInv value,Pearson correlation and regression analysis of the influence of tube voltage and current on IQFInv value were analyzed.The IQFInv value of the additional filter corresponds to the image quality of normal work.The combination of the additional filter with the tube voltage and the tube current was also found.Swedish RTI Barracuda diagnostic level dosimeter was used to measure the entrance surface dose of these combinations after filtration,20 times for each group.Results Comparisons among different filters,tube voltage and tube current combination with quality of daily work images:the tube voltage was positively correlated with IQFInv value in the test range(r=0.49,P＜0.05),and tube current was positively correlated with IQFInv value (r=0.36,P＜0.05).As the additional filters increase,it required greater tube current to acquire the desired value of images.Meanwhile,greater additional filters would increase the difference of IQFInv of tube voltage at each level.Comparisons among different filters,tube voltage and tube current combination with daily shooting dose,and after using additional filters,entrance surface dose changed from (30.58±0.21)to (10.49±0.09) μGy.There is a significant difference between each group (t=-15.306-514.585,P＜0.05).All additional filters effectively reduced entrance surface dose.Meanwhile,as the filter and tube voltage increased,entrance surface dose showed a more significant reduction.However,when the tube voltage exceeded 83 kV,all entrance surface dose of additional filters showed an increasing trend.Conclusions Additional filter is an effective method to reduce the crib side X-ray entrance surface dose.Under the premise of ensuring image quality,additional filter with high atomic number and second high kilovolt tube voltage with paired tube current is the best condition for crib side X-ray.

OBJECTIVE:To provide reference for pharmacy staff to choose different drug label databases according to different needs.METHODS:The information organization mode of the three open access drug label databases that included Drugs@FDA,FDA Online Label Repository and DailyMed had been collected and analyzed comparatively from three aspects:retrieval function settings,search results display,data resources and service targets.RESULTS & CONCLUSIONS:In respect of retrieval function,DailyMed provided the most abundant retrieval functions than others.In respects of search results display,DailyMed provided the highest degree of formatted data,followed by FDA Online Label Repository,while Drugs@FDA provided semi-formatted data.Three databases provided the functions of page replication and printing,among which the interface of DailyMed was friendlier and the content of DailyMed was more open;it provided all the download functions.In respects of data resources and service targets,developers of Drugs@FDA and FDA Online Label Repository were FDA,and that of DailyMed was National Library of Medicine (NLM).The data sources used by Drugs@FDA were the drug labels after strict approval by FDA,and the description of drug information by Drugs@FDA was the most comprehensive.FDA Online Label Repository was the original drug labels submitted by the manufacturer to FDA,which was the latest content,and even included unlisted drugs.The data sources of DailyMed were from the information listed on the drug package,and included the information of drug label which was listed but not approved strictly;it covered most comprehensive drugs.