Objective:Analyze the influencing factors of postoperative recurrence in patients with high-grade squamous intraepithelial lesions of the cervix undergoing loop electrosurgical excision procedure,establish a no-mogram prediction model,and conduct internal and external validation.Methods:A total of 200 patients with high-grade squamous intraepithelial lesions of the cervix collected from the 981st Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from February 2018 to May 2021 were selected as the study subjects,serving as the modeling set.Based on whether patients relapsed within 2 years after treatment,they were divided into the relapse group(n=36)and the non-relapse group(n=164).A logistic regression risk model was used to analyze the influencing factors of postoperative recurrence in patients with high-grade squa-mous intraepithelial lesions of the cervix;internal data were employed to validate the clinical efficacy of the nomo-gram model.Following the principle that the validation set sample size should account for 30％of the total sample size,86 patients with high-grade squamous intraepithelial lesions of the cervix treated at our hospital from June 2021 to June 2022 were collected as the validation set for external validation of the model.Results:Compared with the non-relapse group,the relapse group had a higher proportion of patients with persistent high-risk human papil-lomavirus(HR-HPV)infection,glandular involvement,multi-quadrant involvement,and positive margin status,showing statistically significant differences(P＜0.05).Logistic regression analysis revealed that persistent postop-erative HR-HPV infection,glandular involvement,multi-quadrant involvement,and margin status were independent influencing factors for postoperative recurrence in patients with high-grade squamous intraepithelial lesions of the cervix(P＜0.05).Using these four factors as indicators,a nomogram model was constructed.The calibration curve analysis of the modeling set showed that the C-index of the predictive model for postoperative recurrence was 0.740(95％CI 0.655-0.825).Decision curve analysis demonstrated that when the risk threshold exceeded 0.08,the nomogram-based intervention provided greater clinical net benefit.The calibration curve analysis of the validation set showed that the C-index of the predictive model for postoperative recurrence was 0.788(95％CI 0.674-0.812).Decision curve analysis indicated that when the risk threshold exceeded 0.06,it could offer grea-ter clinical net benefit.ROC curve analysis revealed an AUC of 0.904(95％CI 0.795-1.000).The Hosmer-Leme-show goodness-of-fit test yielded x2=9.342,P=0.155(P＞0.05).Conclusions:The nomogram prediction model constructed based on postoperative HR-HPV persistent infection,glandular involvement,multi-quadrant involve-ment,and margin status of Broussonetia papyrifera demonstrates good predictive value for postoperative recur-rence in patients.

OBJECTIVE To evaluate the effect of antimicrobial stewardship scientific(AMS)of antimicrobial agents on special antibiotics so as to provide evidence-based bases for reasonable use of antibiotics.METHODS A retro-spective survey was conducted for the status of use of special antibiotics in Zhongnan Hospital,Wuhan University.The utilization rate of intravenous infusion of antibiotics,antimicrobials use density(AUD)of special grade antibi-otics,defined daily doses(DDDs),etiological submission rate of microorganisms before use of antibiotics and drug resistance rates of major gram-negative bacteria to special grade antibiotics were observed and compared be-fore and after the AMS was carried out.RESULTS There were no significant differences in gender,severity of dis-ease and spectrum of infectious diseases before and after the AMS was carried out.The utilization rate of intrave-nous infusion of antibiotics was(55.64±1.63)％among the hospitalized patients after the AMS was carried out,the AUD of special grade antibiotics was 2.08±0.57,and the DDDs was 2406.53±292.16,showing generally downward trends(P＜0.05).The drug resistance rates of Acinetobacter baumannii strains to cefepime and imi-penem were 89.15％and 90.21％,respectively,showing upward trends(P＜0.05).CONCLUSION The AUD and DDDs of the special grade antibiotics can be remarkably reduced through powerful means such as carrying out AMS,setting up AMS task group for special grade antibiotics,developing guidance documents for scientific use of special antibiotics,taking full advantage of reasonable drug administration surveillance system,implementing closed-loop management of the special antibiotics,and completing early warning mechanisms for bacterial drug re-sistance as well as information construction to boost management.

OBJECTIVE To evaluate the effect of antimicrobial stewardship scientific(AMS)of antimicrobial agents on special antibiotics so as to provide evidence-based bases for reasonable use of antibiotics.METHODS A retro-spective survey was conducted for the status of use of special antibiotics in Zhongnan Hospital,Wuhan University.The utilization rate of intravenous infusion of antibiotics,antimicrobials use density(AUD)of special grade antibi-otics,defined daily doses(DDDs),etiological submission rate of microorganisms before use of antibiotics and drug resistance rates of major gram-negative bacteria to special grade antibiotics were observed and compared be-fore and after the AMS was carried out.RESULTS There were no significant differences in gender,severity of dis-ease and spectrum of infectious diseases before and after the AMS was carried out.The utilization rate of intrave-nous infusion of antibiotics was(55.64±1.63)％among the hospitalized patients after the AMS was carried out,the AUD of special grade antibiotics was 2.08±0.57,and the DDDs was 2406.53±292.16,showing generally downward trends(P＜0.05).The drug resistance rates of Acinetobacter baumannii strains to cefepime and imi-penem were 89.15％and 90.21％,respectively,showing upward trends(P＜0.05).CONCLUSION The AUD and DDDs of the special grade antibiotics can be remarkably reduced through powerful means such as carrying out AMS,setting up AMS task group for special grade antibiotics,developing guidance documents for scientific use of special antibiotics,taking full advantage of reasonable drug administration surveillance system,implementing closed-loop management of the special antibiotics,and completing early warning mechanisms for bacterial drug re-sistance as well as information construction to boost management.

Objective:Analyze the influencing factors of postoperative recurrence in patients with high-grade squamous intraepithelial lesions of the cervix undergoing loop electrosurgical excision procedure,establish a no-mogram prediction model,and conduct internal and external validation.Methods:A total of 200 patients with high-grade squamous intraepithelial lesions of the cervix collected from the 981st Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from February 2018 to May 2021 were selected as the study subjects,serving as the modeling set.Based on whether patients relapsed within 2 years after treatment,they were divided into the relapse group(n=36)and the non-relapse group(n=164).A logistic regression risk model was used to analyze the influencing factors of postoperative recurrence in patients with high-grade squa-mous intraepithelial lesions of the cervix;internal data were employed to validate the clinical efficacy of the nomo-gram model.Following the principle that the validation set sample size should account for 30％of the total sample size,86 patients with high-grade squamous intraepithelial lesions of the cervix treated at our hospital from June 2021 to June 2022 were collected as the validation set for external validation of the model.Results:Compared with the non-relapse group,the relapse group had a higher proportion of patients with persistent high-risk human papil-lomavirus(HR-HPV)infection,glandular involvement,multi-quadrant involvement,and positive margin status,showing statistically significant differences(P＜0.05).Logistic regression analysis revealed that persistent postop-erative HR-HPV infection,glandular involvement,multi-quadrant involvement,and margin status were independent influencing factors for postoperative recurrence in patients with high-grade squamous intraepithelial lesions of the cervix(P＜0.05).Using these four factors as indicators,a nomogram model was constructed.The calibration curve analysis of the modeling set showed that the C-index of the predictive model for postoperative recurrence was 0.740(95％CI 0.655-0.825).Decision curve analysis demonstrated that when the risk threshold exceeded 0.08,the nomogram-based intervention provided greater clinical net benefit.The calibration curve analysis of the validation set showed that the C-index of the predictive model for postoperative recurrence was 0.788(95％CI 0.674-0.812).Decision curve analysis indicated that when the risk threshold exceeded 0.06,it could offer grea-ter clinical net benefit.ROC curve analysis revealed an AUC of 0.904(95％CI 0.795-1.000).The Hosmer-Leme-show goodness-of-fit test yielded x2=9.342,P=0.155(P＞0.05).Conclusions:The nomogram prediction model constructed based on postoperative HR-HPV persistent infection,glandular involvement,multi-quadrant involve-ment,and margin status of Broussonetia papyrifera demonstrates good predictive value for postoperative recur-rence in patients.

Objective: To analyze the clinical characteristics of patients with ankylosing spondylitis (AS) with inflammation bowel disease (IBD). Methods: AS patients fulfilling the 1984 modified New York diagnostic criteria were recruited in Chinese AS Prospective Imaging Cohort (CASPIC) consecutively from April 2016 to June 2017 in Chinese People′s Liberation Army General Hospital by using smart management system for spondyloarthritis (SpAMS). The diagnosis of IBD was confirmed by tissue pathology via ileocolonoscopy. Demographic, clinical and biochemical data were collected. Results: In total, 893 patients with AS were recruited with the mean age 30.8 years. The majority were men (739, 82.8%). There were 64 (7.2%) patients concomitant with IBD. The mean age [(34.5±7.5) years vs. (30.5±8.8) years, P<0.001] was older and the disease duration [(10.8±6.9) years vs. (8.1±5.9) years, P=0.001] was longer in patients with IBD than patients without. Compared with patients without IBD, patients with IBD had more frequent involvement of the cervical spine [(21.9% (14/64) vs. 10.5% (87/829), P=0.006) and thoracic spine [29.7% (19/64) vs. 12.3% (102/829), P<0.001]. Uveitis [28.1% (18/64) vs. 16.4% (136/829), P=0.017] and psoriasis [7.8% (5/64) vs. 2.3% (19/829), P=0.009] were also more common in patients concomitant with IBD. In addition, patients with IBD had significantly higher scores in BASDAI (3.3±2.1 vs. 2.4±1.8, P<0.001), BASFI [2.2 (1.0,3.3) vs. 1.1(0.2,2.4), P<0.001)] and ASAS HI (7.1±4.3 vs. 5.3±3.7, P= 0.001) than patients without IBD. Conclusions Compared with patients without IBD, AS patients concomitant with IBD have more severe disease activity and organ dysfunction. Furthermore, the uveitis and psoriasis are more frequently accompanied in AS patients with IBD.

Objective In order to assess the structure damage of hip joint in ankylosing spondylitis (AS), a new radiograph-based scoring method was developed according to the radiological characteristics of hip involvement in AS, as well referring to prior existing scoring indexes. Methods A new scoring method consti-tuted of erosion, sclerosis and joint space narrowing was developed, pelvis anterior-posterior plain films acquired from patients with AS at baseline and follow-up were collected and assessed by two physicians who were trained in image reading by radiologists. All films were scored independently and blindly. Intra- and inter-reader reliability were assessed by intra-class correlation coefficient (ICC), the feasibility of this new scoring method was assessed by the mean time acquired to score a plain (two hips), its ability to detect the change of structure damage was assessed by the comparison of score differences between baseline and different follow-ups. The date were analyzed by paired-t test or nonparametric tests. Analysis of Variance (ANOVA) or nonparametric tests were utilized for the comparison of means of quantitative variables among the three groups, while Chi-square test for rates of categorical variables. Results No statistically significant differences existed in demographic data and suspected risk factors among the three groups at baseline (P>0.05). Intra-observer reliability was good (0.84 and 0.89), as well as the inter-observer reliability (0.72), the mean time needed to score was (33 ±10) seconds. Score changes were not statistically significant in the groups with follow-up duration of 1-2 and 3-4 years, but in the group of over 5 years, baseline/final scores assessed by the two observers were (6.0±2.7/7.5±3.7) and (5.6±2.1/7.1±3.6), respectively, both changes were statistically significant (t=2.86, Z=-2.99; P<0.01). Conclusion This new method is not only reproducible and easy to operate in clinic practice, but also can tell the changes of hip joint structure damage in the interval of over 5 years, further validation is requeired to demonstrate its discriminability in large populations.

OBJECTIVE:To explore the role of clinical pharmacist in the therapy for patient with community-acquired Pseudo-monas aeruginosa lung abscess. METHODS:Clinical pharmacist participated in the therapy for a patient with community-acquired P. aeruginosa lung abscess,analyzed anti-infective therapy plan,and adjusted drug use timely to correct agranulocytosis induced by anti-infective drugs. RESULTS:The physicians adopted the suggestions of clinical pharmacists,controlled the infection successful-ly and corrected agranulocytosis. CONCLUSIONS:Community-acquired P. aeruginosa lung abscess is rare but has high mortality. Clinical pharmacists participate in drug therapy,assist physician to improve and optimize therapy plan and formulate individual medication plan so as to promote promote care rate of patients.