The management of clinical application of antimicrobial drugs is an important part of the pharmaceutical management and pharmacy services in medical institutions.Based on national policies and regulations,this standard focuses on the whole life cycle of antimicrobial drugs in medical institutions.It is developed based on the principles of scientific validity,universality,guidance and operability,formed by sorting out problems,collecting opinions,expert argumentation and deliberation.It is the first group standard to standardize the clinical application management of antimicrobial drugs.This paper introduces and analyzes the team composition,problem sorting and compilation process,and various elements of the standard in the process of formulating the standard,and provide a reference for the majority of peers who use it.

Objective:To explore the effect of clinical pharmacist-led safety management in clinical use of oral anticoagulants (OACs) on reducing medication errors (MEs) in hospitalized patients.Methods:On July 1st, 2018, the working group on the safe application of anticoagulants, composing clinical pharmacists majoring in cardiology, cardiac surgery, neurology, geriatrics, orthopedics, respiratory, and vascular surgery, was established at the Department of Pharmacy, Zhongshan Hospital Affiliated to Fudan University to comprehensively strengthen the intervention in the OACs prescription MEs for inpatients in relevant departments. Two percent of patients who were treated with OACs and aged ≥18 years during hospitalization in the above departments were screened using stratified sampling method and divided into pre-intervention group (patients were admitted in January 2017 to June 2018) and post-intervention group (patients were admitted in July 2018 to December 2019). The medical records of patients in the 2 groups were collected using the hospital information system, and the occurrence of MEs in the prescription link was analyzed retrospectively.Results:A total of 296 and 325 patients were included in the pre- and post-intervention groups respectively. There was no significant difference in terms of gender, age, inpatient department, anticoagulation indications, OACs class, comorbidities, and concomitant medications in patients between the 2 groups (all P>0.05). The most frequently used anticoagulants in the 2 groups both were warfarin, which was used in 75.3% (223/296) and 71.4% (232/325) of the patients respectively, and followed by rivaroxaban, which was used in 17.6% (52/296) and 23.7% (77/325) of the patients respectively. Among the 296 patients in the pre-intervention group, 75 times of MEs related to OACs were found in the prescription for 72 (24.3%) patients, of which 30, 39, 5, and 1 times of MEs graded C, D, E, and F in severity respectively, and the incidence of severe MEs (grade E and F) was 2.0% (6/296). Among the 325 patients in the post-intervention group, 49 times of MEs related to OACs were found in the prescription for 47 (14.5%) patients, of which 22 times of MEs were grade C and 27 were grade D, and no severe ME was found. The incidences of overall MEs and severe MEs in the post-intervention group were significantly lower than those in the pre-intervention group (all P<0.05). Four types of MEs were all found in the prescription of OACs in the 2 groups, including choosing inappropriate drugs (all presented as not selecting drugs based on drug interactions), wrong drug dose, drug omission, and wrong dosing frequency. The incidences of the above 4 types of MEs were 11.5% (34/296), 8.1% (24/296), 4.7% (14/296), and 0.7% (2/296) in the pre-intervention group, and 5.5% (18/325), 6.2% (20/325), 3.1% (10/325), and 0.3% (1/325) in the post-intervention group, respectively. The incidence of choosing inappropriate drugs in the post-intervention group was significantly lower than that in the pre-intervention group [5.5% (18/325) vs. 11.5% (34/296), χ2=7.143, P=0.008]. Conclusion:The safety management of OACs in clinical application led by clinical pharmacists can reduce the MEs in prescriptions of OACs for inpatients, especially the incidence of severe MEs and choosing inappropriate drugs, and improve the safety of OACs in application.

Objective:To explore the effect of clinical pharmacist-led safety management in clinical use of oral anticoagulants (OACs) on reducing medication errors (MEs) in hospitalized patients.Methods:On July 1st, 2018, the working group on the safe application of anticoagulants, composing clinical pharmacists majoring in cardiology, cardiac surgery, neurology, geriatrics, orthopedics, respiratory, and vascular surgery, was established at the Department of Pharmacy, Zhongshan Hospital Affiliated to Fudan University to comprehensively strengthen the intervention in the OACs prescription MEs for inpatients in relevant departments. Two percent of patients who were treated with OACs and aged ≥18 years during hospitalization in the above departments were screened using stratified sampling method and divided into pre-intervention group (patients were admitted in January 2017 to June 2018) and post-intervention group (patients were admitted in July 2018 to December 2019). The medical records of patients in the 2 groups were collected using the hospital information system, and the occurrence of MEs in the prescription link was analyzed retrospectively.Results:A total of 296 and 325 patients were included in the pre- and post-intervention groups respectively. There was no significant difference in terms of gender, age, inpatient department, anticoagulation indications, OACs class, comorbidities, and concomitant medications in patients between the 2 groups (all P>0.05). The most frequently used anticoagulants in the 2 groups both were warfarin, which was used in 75.3% (223/296) and 71.4% (232/325) of the patients respectively, and followed by rivaroxaban, which was used in 17.6% (52/296) and 23.7% (77/325) of the patients respectively. Among the 296 patients in the pre-intervention group, 75 times of MEs related to OACs were found in the prescription for 72 (24.3%) patients, of which 30, 39, 5, and 1 times of MEs graded C, D, E, and F in severity respectively, and the incidence of severe MEs (grade E and F) was 2.0% (6/296). Among the 325 patients in the post-intervention group, 49 times of MEs related to OACs were found in the prescription for 47 (14.5%) patients, of which 22 times of MEs were grade C and 27 were grade D, and no severe ME was found. The incidences of overall MEs and severe MEs in the post-intervention group were significantly lower than those in the pre-intervention group (all P<0.05). Four types of MEs were all found in the prescription of OACs in the 2 groups, including choosing inappropriate drugs (all presented as not selecting drugs based on drug interactions), wrong drug dose, drug omission, and wrong dosing frequency. The incidences of the above 4 types of MEs were 11.5% (34/296), 8.1% (24/296), 4.7% (14/296), and 0.7% (2/296) in the pre-intervention group, and 5.5% (18/325), 6.2% (20/325), 3.1% (10/325), and 0.3% (1/325) in the post-intervention group, respectively. The incidence of choosing inappropriate drugs in the post-intervention group was significantly lower than that in the pre-intervention group [5.5% (18/325) vs. 11.5% (34/296), χ2=7.143, P=0.008]. Conclusion:The safety management of OACs in clinical application led by clinical pharmacists can reduce the MEs in prescriptions of OACs for inpatients, especially the incidence of severe MEs and choosing inappropriate drugs, and improve the safety of OACs in application.

Protein kinase C (PKC) is a special kinase widely distributed in various tissues and cells of human body and involved in signal transduction of hormones and cytokines.It plays an important role in the pathogenesis of many diseases.Therefore,altering the activity of protein kinase C may be an effective treatment for many diseases.This article reviews the progress of protein kinase C in liver diseases.

Objective To investigate functional connectivity between the two hemispheres in patients with positive symptoms of schizophrenia using voxel-mirrored homotopic connectivity ( VMHC ) based on resting-state functional magnetic resonance imaging (rs-fMRI). Methods Eighteen patients with positive symptoms of schizophrenia and 22 healthy controls underwent the rs-fMRI. The whole brain VMHC was calculated in order to provide imaging basis for the study of the pathological mechanism of schizophrenia. Results Compared to the controls, VMHC values were decreased in the bilateral orbitofrontal cortex (t=-5.31, P<0.01), fusiform gyrus (t=-5.16, P<0.01), middle occipital gyrus (t=-5.31, P<0.01) in patients with positive symptoms of schizophrenia. Conclusion The functional coordination between homotopic brain regions is impaired in patients with positive symptoms of schizophrenia .

Objective To provide a basic profile of resting?state functional connectivity (FC) in unmedicated patients with major depressive disorder (MDD). Methods Fifty unmedicated patients with MDD and 51 healthy controls underwent the resting?state functional magnetic resonance imaging (rs?fMRI). After preprocessing of rs?fMRI, the seed?based resting?state FC of the insular subdivisions, including the anterior insula, middle insula, and posterior insula, was evaluated. Two?sample t?test and multiple comparison correction of Threshold?Free Cluster Enhancement (TFCE) were used to compare the FC values of each group to locate the regions with significant change, where its correlation to the Hamilton Depression Scale (HAMD24) scores was also explored. Results In comparison to the healthy controls, the MDD patients decreased FC between the left anterior insula and bilateral anterior cingulate cortices (t=-4.83, P<0.05, TFCE correction), and increased FC between the left anterior insula and the left middle frontal gyrus, as well as the bilateral posterior cingulate cortices/precuneus (t=4.08, 4.42;both P<0.05, TFCE correction). There were no significant correlations between the HAMD24 scores and the FC values from the left anterior insula to the bilateral anterior cingulate cortices (r=-0.125, P=0.387), the left middle frontal gyrus (r=0.149, P=0.302), and the bilateral posterior cingulate cortices/precuneus (r=-0.207, P=0.148). Conclusion Patients with depression have abnormal functional connectivity between the left anterior insula and the other two regions, such as the limbic system and the frontal cortex, which may present with an aweakened insula?anterior cingulate gyrus connectivity, and the enhanced insular?frontal, and insula-posterior cingulate/precuneus connectivity.

Objective To provide a basic profile of resting?state functional connectivity (FC) in unmedicated patients with major depressive disorder (MDD). Methods Fifty unmedicated patients with MDD and 51 healthy controls underwent the resting?state functional magnetic resonance imaging (rs?fMRI). After preprocessing of rs?fMRI, the seed?based resting?state FC of the insular subdivisions, including the anterior insula, middle insula, and posterior insula, was evaluated. Two?sample t?test and multiple comparison correction of Threshold?Free Cluster Enhancement (TFCE) were used to compare the FC values of each group to locate the regions with significant change, where its correlation to the Hamilton Depression Scale (HAMD24) scores was also explored. Results In comparison to the healthy controls, the MDD patients decreased FC between the left anterior insula and bilateral anterior cingulate cortices (t=-4.83, P<0.05, TFCE correction), and increased FC between the left anterior insula and the left middle frontal gyrus, as well as the bilateral posterior cingulate cortices/precuneus (t=4.08, 4.42;both P<0.05, TFCE correction). There were no significant correlations between the HAMD24 scores and the FC values from the left anterior insula to the bilateral anterior cingulate cortices (r=-0.125, P=0.387), the left middle frontal gyrus (r=0.149, P=0.302), and the bilateral posterior cingulate cortices/precuneus (r=-0.207, P=0.148). Conclusion Patients with depression have abnormal functional connectivity between the left anterior insula and the other two regions, such as the limbic system and the frontal cortex, which may present with an aweakened insula?anterior cingulate gyrus connectivity, and the enhanced insular?frontal, and insula-posterior cingulate/precuneus connectivity.

Objective To investigate the characteristics of striatum functional connectivity (FC) in patients with major depressive disorder (MDD).Methods Fifty unmedicated patients with MDD and 48 healthy controls underwent resting-state functional magnetic resonance imaging (rs-fMRI) scan.Routine preprocessing of rs-fMRI data was performed.The striatum was divided into bilateral inferior ventral striatum,bilateral superior ventral striatum,bilateral dorsal caudate,bilateral dorsal caudal putamen,bilateral dorsal rostral putamen,and bilateral ventral rostral putamen.Whole brain functional connectivity analysis was performed with the above 12 seed points.And significant differences of each seed FC among two groups were calculated with Two-sample t-test and multiple comparison correction of threshold-free cluster enhancement (TFCE).Finally,correlation analysis was performed between the FC of the brain regions and clinical features (i.e.Hamilton Depression Scale of 24 items (HAMD24) scores).Results In comparison to the control group,the MDD patients showed significantly decreased FC in the left dorsal caudal putamen and the right superior temporal gyrus (t=-5.46,P＜0.008,TFCE correction),the right dorsal rostral putamen and bilateral postcentral gyrus (right t=-4.85,left t=-4.81,P＜0.008,TFCE correction) and left precuneus (t=-4.58,P＜0.008,TFCE correction).There were no significant correlations between the FC values in these regions and HAMD24 scores (r=0.171,0.002,0.005,0.098;all P＜0.05).Conclusion The MDD patients possibly have abnormal FC in the striatum and the superior temporal gyrus,the postcentral gyrus and the precuneus,and it suggests these sensorimoter areas may play an important role in the pathological mechanisms of MDD.

Objective To investigate the characteristics of striatum functional connectivity (FC) in patients with major depressive disorder (MDD).Methods Fifty unmedicated patients with MDD and 48 healthy controls underwent resting-state functional magnetic resonance imaging (rs-fMRI) scan.Routine preprocessing of rs-fMRI data was performed.The striatum was divided into bilateral inferior ventral striatum,bilateral superior ventral striatum,bilateral dorsal caudate,bilateral dorsal caudal putamen,bilateral dorsal rostral putamen,and bilateral ventral rostral putamen.Whole brain functional connectivity analysis was performed with the above 12 seed points.And significant differences of each seed FC among two groups were calculated with Two-sample t-test and multiple comparison correction of threshold-free cluster enhancement (TFCE).Finally,correlation analysis was performed between the FC of the brain regions and clinical features (i.e.Hamilton Depression Scale of 24 items (HAMD24) scores).Results In comparison to the control group,the MDD patients showed significantly decreased FC in the left dorsal caudal putamen and the right superior temporal gyrus (t=-5.46,P＜0.008,TFCE correction),the right dorsal rostral putamen and bilateral postcentral gyrus (right t=-4.85,left t=-4.81,P＜0.008,TFCE correction) and left precuneus (t=-4.58,P＜0.008,TFCE correction).There were no significant correlations between the FC values in these regions and HAMD24 scores (r=0.171,0.002,0.005,0.098;all P＜0.05).Conclusion The MDD patients possibly have abnormal FC in the striatum and the superior temporal gyrus,the postcentral gyrus and the precuneus,and it suggests these sensorimoter areas may play an important role in the pathological mechanisms of MDD.

Objective To assess the clinical value of lung ultrasound (LUS) B-lines in diagnosis of rheumatoid arthritis (RA) associated interstitial lung diseases (RA-ILD).Methods Forty-five consecutive patients with RA who underwent a high resolution computed tomography (HRCT) scan of the chest,were also examined by LUS for detection of B-lines(within 1 month independently in all patients).The B-lines score was obtained by summing the number of total 50 inter-costal spaces (ICSs) of chest wall.Pulmonary fibrosis was quantified by HRCT as previously described by the 30-point Warrick score.Results B-lines score significantly correlated with the Warrick score [(r=0.778,95％CI(0.627,0.872),P＜0.05].Receiver operating characteristic (ROC) curve confirmed that B-lines cut-off point 77[sensitivity of 100％,specificity of 64.3％ respectively,area under curve [AUC] =0.86,95％CI(0.724,0.945)] and 108[sensitivity of 90％,specificity of 88.6％ respectively,AUC=0.879,95％CI(0.747,0.957)] had an optimal power to discriminate mild (Warrick score＜8) and severe fibrosis (Warrick score＞15):Conclusion The data confirm that LUS is a useful technique to identify ILD in RA.In RA-ILD,B-lines correlate significantly with HRCT and are able to identify mild and severe degree of fibrosis.LUS is a promising non-invasive and non-ionizing strategy for screening RA-ILD.