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.

Purpose/Significance To conduct a cross-metric analysis of citations and cited references of highly cited medical infor-matics articles in the first quartile of the journal citation reports(JCR)over the past 10 years,and to analyze the sources of citing disci-plines and the origins of cited disciplines.Method/Process The screened data is divided into citation literature data and citing literature data.Statistics are performed from the perspective of secondary disciplines,and the general analysis is carried out from the perspective of first-level disciplines.The measurement indicators are set as discipline diversity,discipline balance,discipline continuity and disci-pline interdisciplinarity,which are analyzed respectively from the perspectives of citations and citing.Result/Conclusion The interdisci-plinary characteristics of medical informatics include a wide range of disciplines involved,consistent and stable external influence,and a tendency towards certain cross-disciplinary objects,and on this basis,the suggestions for disciplinary development are proposed.

In the context of the digital economy， the operational relationship between traditional Chinese medicine （TCM） and Internet healthcare organizations as well as related governance institutions has attracted much attention. As the market scale of the Internet healthcare has continued to grow in recent years， the quality of Internet TCM healthcare has also been improved. By analyzing the development status of Internet TCM healthcare， it is proposed that Internet TCM health service should seize the opportunities and challenges in future， promote the growth of market scale from varied aspects， enhance patient-centered care awareness， and strengthen the promotion and popularization of digital services， thereby promoting the high-quality development of Internet TCM health service in the context of the digital economy.

To analyze the epidemic characteristics and to explore the spatial-temporal clusters of pulmonary tuberculosis (PTB) in Changsha from 2013 to 2016.
 Methods: Descriptive analysis and space-time permutation scan statistic were used to analyze the reported PTB cases in Changsha from 2013 to 2016.
 Results: Between 2013 and 2016, a total of 17 721 PTB cases were reported in Changsha, with annual reported incidence rate at 60.87 per 100 000 population. Males and individuals aged 15 to <60 years accounted for higher proportion of PTB cases compared to females and other age groups. The number of reported PTB cases reached peak from March to May in each year. The space-time permutation scan statistic identified one most likely cluster and two secondary clusters of PTB cases. The most likely cluster covered most areas of Liuyang City and the North-east part of Changsha County from October 1, 2013 to February 28, 2014. The first cluster occupied 12 towns (streets) in Kaifu District and Changsha County in December 2016. The second cluster included four towns (streets) in Yuhua District and Tianxin District from March 1 to September 30, in 2013.
 Conclusion: Between 2013 and 2016, significant space-time clusters of PTB cases were identified in Changsha. These findings could provide a guide for development of regional intervention strategies for PTB control.
Adolescent ; Adult ; Age Distribution ; Aged ; China ; epidemiology ; Cluster Analysis ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Sex Distribution ; Spatio-Temporal Analysis ; Tuberculosis, Pulmonary ; epidemiology

Objective To investigate the strategy of cardiopulmonary resuscitation (CPR) after lung protective mechanical ventilation in critical children and follow-up study of the survivals 90 d after discharge.Methods Four hundred and eighty-nine cases of respiratory cardiac arrest which occurred for various reasons from January 2011 to June 2016 were analyzed in Pediatric Intensive Care Unit (PICU) in Guiyang Children's Hospital,in which mechanical ventilation was performed after CPR in 251 cases,death,or giving up treatment within 24 h in 83 cases,children surviving ＞ 24 h in 168 cases,118 cases were assigned into small tidal volume ventilation group,and 50 cases into conventional tidal volume ventilation group,and according to the tidal volume to adjust positive end expiratory pressure ventilation (PEEP),and the oxygen partial pressure [pa (O2)] and the oxygen index (OI),the change of the indexes of blood gas analysis,lactic acid clearance,and oxygenation were also observed.To observe the complications of mechanical ventilation,the situation of withdrawing machine as well as the outcome of the children.Follow-up was conducted for 90 d,including continuous respiratory symptoms,lung imaging examination after discharge and lung function,nervous system examination.Results (1) After mechanical ventilation treatment of 48 hours,compared with the levels of fractional inspired oxygen (FiO2) (0.42 ± 0.15 vs.0.43 ± 0.22),pa (O2) (8.25 ± 0.22 vs.8.27 ± 0.68),OI (5.33 ± 2.01 vs.6.59 ± 1.99) and lactic acid clearance(61.05 ± 1.87 vs.60.93 ± 2.71) between the routine tidal volume ventilation group and the lower tidal volume ventilation group,showing that the difference had no statistical significance (t =1.645,1.165,2.302,2.037,all P ＞ 0.05).(2) In small tidal volume group,the incidence of ventilator associated lung injury was significantly lower than that in the conventional tidal volume group,and the difference was statistically significant (x2 =5.873,P ＜ 0.05).(3) Comparing 2 groups of different tidal volume ventilation,the mortality of critical ill children had no statistically significant difference (x2 =1.063,P ＞ 0.05).(4) One hundred and twenty-seven cases of children survived and were discharged,and compared with their discharge,the follow-up of 62 cases after discharge for 30 d,90 d showed that all the children's lung function improved,tidal volume,inspiratory and expiratory time ratio(I/E),volume ratio of peak(VP/VE),time ratio of peak(TP/TE) and breathing rate(RR) were also improved,and there was significant difference (F =43.225,6.108,68.821,78.237,20.361,all P ＜ 0.05).(5) Neurological examination and children's brain function classification rating scale showed that some children had nerve dysfunction.Conclusions Small tidal volume ventilation in reducing the occurrence of ventilator associated lung injury is superior to the conventional tidal volume ventilation.To improve case fatality rate of the children with cardiac arrest resuscitation and oxygenation is not better than the conventional tidal volume group.Dynamic monitoring is helpful to adjust breathing mechanics indexes and parameters and ventilator.Through the follow-up most of the discharged children recovered well,but a few had recurrent respiratory infection and neurological sequelae.

Objective The objective of this study was to investigate the expression of P28 and P43 in papillary thyroid carcinoma(PTC)and its relationship with clinicopathological features after TRa1 gene transcription.Methods Real-time fluorescence quantitative PCR(RT-PCR)and gel electrophoresis were used to determine the target fragments and to isolate the bands of different fragments.The optical density of each band was scanned by UV transmittance analyzer to detect 31 cases of PTC tissue and expression levels of P28 and P43 in para-cancerous tissues.Results The average gray value of P28 in thyroid carcinoma group was 0.77±0.34,which was significantly higher than that in para-cancer group(0.31±0.18).The average gray value of P43(0.85+0.21)in thyroid carcinoma group was significantly higher than that in para-cancer group(0.34±0.15)(P<0.05).The expression levels of P28 were not correlated with gender,age,tumor size,lymph node metastasis and clinical pathologic stage(P>0.05),The expression levels of P43 were not correlated with gender,age,tumor size and lymph node metastasis.(P>0.05)but they were related to clinical pathologic stage(P<0.05).There was no correlation between expression levels of P28 and P43(r=0.266,P=0.071).Conclusion The increased expression of P28 and P43 may have a high degree of malignancy and a certain clinical value in predicting the adverse prognosis of PTC.Both factors are helpful for the prevention and treatment of PTC.

OBJECTIVE: To examine the relationship between COMT polymorphisms and the response to antipsychotic drugs, and then provide a basis for personalized medicine of antipsychotic drugs.
 METHODS: We performed a systematic search from PubMed, Embase, Cochrane Library, CBM, CNKI, VIP and Wanfang database for eligible studies. Stata 12.0 was used for Meta-analysis after evaluating the quality of studies and collecting the data.
 RESULTS: Nine studies included 868 participants met inclusion criteria. Significant association was found between the COMT Val108/158Met gene polymorphism and antipsychotic drug efficacy. Evaluating the therapeutic efficacy through general symptoms: Met vs Val, RR=1.18, 95% CI: 1.04-1.35, P=0.013; Met/Met vs Val/Val, RR=1.40, 95% CI: 1.08-1.82, P=0.010. Evaluating the therapeutic efficacy through negative symptoms: Met vs Val, RR=1.24, 95% CI: 1.05-1.46, P=0.013; Met/Met vs Val/Val, RR=1.60, 95% CI: 1.04-2.46, P=0.031.
 CONCLUSION COMT Val108/158Met gene polymorphism is significantly associated with antipsychotic drug efficacy, and Met gene is a dominant gene which displays a better response to antipsychotic drugs.
Antipsychotic Agents ; therapeutic use ; Catechol O-Methyltransferase ; genetics ; Humans ; Polymorphism, Genetic

OBJECTIVE: To establish a more reliable and accurate scale of perinatal maternal health literacy during perinatal period by selecting items form existing scale. METHODS: Two rounds of inquiry were performed by 14 experts on mother and children to evaluate the necessary and importance of 56 items by Delphi method, in which 50 items were retained. Th en we proceeded a cross-sectional survey in 350 woman who just gave birth 1-3 days before. 10% of them were selected to retest aft er 1 week. Based on these data, we used 6 different methods to select items and kept those that could pass by at least 3 different methods. The methods used in data analysis were Chi-square test, correlation coefficient method (2 kinds), factor analysis, Cronbach α coefficient method and the retest reliability method. RESULTS: The Person correlation coefficient was 0.507 (P=0.004). By using the 6 statistical methods, we deleted 9 items through Chi-square test, 25 items through correlation coefficient method 1, 1 item through correlation coefficient method 2, 19 items through Cronbach α coefficient method, 8 items through factor analysis and 37 items through retest reliability method. In the end, 33 items were retained for the novel scale of maternal health literacy during perinatal period. CONCLUSION Simplified novel scale is acquired, which need to do large efforts before extensive use, such as large sample survey, reliability and validity test.
Cross-Sectional Studies ; Delphi Technique ; Factor Analysis, Statistical ; Female ; Health Literacy ; Humans ; Mothers ; Postnatal Care ; Reproducibility of Results ; Surveys and Questionnaires

Objective To explore the methods of the nutritional support of children with severe sepsis.Methods The biochemical index,nutrition index,blood gas,blood routine and 24 hours urinary urea nitrogen of 198 children with severe sepsis were detected after hospitalization.Enteral nutrition,parenteral nutrition,or enteral and parenteral nutrition at the same time were selected for every children according to patients status.Children with parenteral nutrition were divided into glutamine (Gln) group and non-Gln group.Nutrition and metabolism indexes of survival and dead children were detected,including blood glucose,C-reactive protein,hemoglobin (Hb),pH,blood sodium,blood potassium,alanine transaminase,blood urea nitrogen,creatinine,blood lacticacid,lactate clearance rate,blood triglycerides,blood total cholesterol,serum pre-albumin (PA),retinal-binding protein (RBP),serum albumin (ALB) and 24 hours urinary urea nitrogen.The intake of calories were compared between survival and dead children before nutrition support (0 d),3 d and 7 d after nutrition support.Immunoglobulins of Gln group and non-Gln group were compared.Results The nutrition indexes of the survival group were higher than those of dead group [PA (130.0 ± 30.0) mg/L vs (50.8 ±20.5) mg/L,RBP(22.3 ±10.3) mg/L vs (15.7 ±6.7) mg/L,ALB(35.3 ±8.1) g/L vs (28.7 ±6.2) g/L,Hb(113.2 ±27.7) g/L vs (95.3 ±10.6) g/L,IgA(0.40 ±0.03) g/L vs (0.40 ±0.03) g/L,IgM(0.52 ±0.18) g/L vs (0.49 ±0.03) g/L] (P ＜0.05).The intake calories of survival group in 3 d and 7 d after nutrition support were (50.32 ±2.76) kcal/(kg·d) and (65.70 ±3.25) kcal/(kg·d),which were significantly higher than those of dead group [(32.54 ± 1.72) kcal/(kg·d) and (46.12 ± 1.08) kcal/(kg·d)).Among the survival children with parenteral nutrition,the levels of immunoglobulin in Gln group were higher than non-Gln group [IgG(4.93 ± 2.1) g/L vs (4.01 ± 1.03) g/L,IgA (0.31 ± 0.07) g/L vs (0.19 ±0.03) g/L,IgM(0.52 ±0.08) g/L vs (0.32 ±0.10) g/L] (P ＜0.05).Negative nitrogen balance was better in Gln group as(-2.5 ± 1.4) g/d than non-Gln group as (-5.3 ± 1.3) g/d(P ＜0.05).Conclusion Children with severe sepsis manifeste significantly increased metabolic rate and energy consumption,the protein decomposition utilization is greater than the synthetic with negative nitrogen balance.Children with more severe sepsis have lower metabolic indexes,nutrition indexes,and immunoglobulin.It is necessary for children with severe sepsis to use glutamine while having parenteral nutrition.