Objective To investigate the effects of perineal massage combined with hip joint exercise on the outcome of delivery and mental resilience of primipara.Methods 90 pregnant women in the third trimester(after 36 weeks)who obtained the knowledge about perineal massage from midwife clinic were randomly divided into two groups with 45 cases each.The control group received regular antenatal examination and family self-exercise;the experimental group received perineal massage and hip joint training combined treatment.The delivery outcome,birth experience and maternal mental resilience of the two groups were compared.Results the number of vaginal delivery in the experimental group were higher than that in the control group(P<0.05);the second stage of labor was significantly shorter than that of the control group(P<0.05);the perineal integrity rate was higher than that of the control group(P<0.05);the scores of all dimensions in delivery experience questionnaire were higher than that of the control group(P<0.05);the scores of all dimensions in maternal mental resilience were higher than those of the control group(P<0.05)after intervention.Conclusion The perineal massage which conducted by midwives combined with hip movement can effectively improve the quality of delivery,relieve the negative emotions of pregnant women,improve the psychological elasticity level of pregnant women,and improve the delivery outcomes.

Objective:To investigate the prevalence of cataracts, the surgical coverage, and postoperative visual acuity of adults in Ningxia.Methods:A cross-sectional study using multistage cluster random sampling was conducted.Ten survey sites in Ningxia were selected and the population aged 18 years and over was surveyed with questionnaire, height and weight measurements, visual acuity, intraocular pressure, fundus photography and slit-lamp examinations.Cataract prevalence and its influencing factors were analyzed.Cataract prevalence, surgical coverage and presenting visual acuity (PVA) and best corrected visual acuity (BCVA) after surgery were investigated in different age groups of the examined population.The study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of the People's Hospital of Ningxia Hui Autonomous Region (No.[2023]-LL-010).Participants signed informed consent prior to the examination.Results:A total of 6 145 people should be examined, and 5 721 people were actually examined, with an examination rate of 93.10%.The study population consisted of 2 558 males, accounting for 44.71%, and 3 163 females, accounting for 55.28%, with ages ranging from 18 to 93 years old and an average age of (64.27±13.48) years.Among them, 1 180 patients diagnosed with cataract, with a cataract prevalence of 20.62%.The prevalence of cataract increased with age and decreased with education level, showing statistically significant differences ( χ2=1 091.32, 581.92; both at P<0.01).The prevalence of cataract was significantly higher among people with hypertension, diabetes mellitus, hyperlipidemia, and coronary heart disease than those without these diseases ( χ2=274.65, 118.15, 78.05, 182.71; all at P<0.01).Cataract surgery was performed in 245 cases in the cataract patient population, with a surgical coverage rate of 20.76%.Of the 245 cases, 229 cases were implanted with IOLs, with an implantation rate of 93.40%.The social burden rate of cataract blindness was 2.29%, and increased with age.Of the 339 eyes that underwent cataract surgery, 241 had a PVA≥0.3, accounting for 71.09%, and 272 had a BCVA≥0.3, accounting for 80.24%. Conclusions:In Ningxia, cataracts are still the main cause of vision impairment and blindness in the elderly, and the social burden rate of cataract blindness is high.Moreover, the coverage rate of cataract surgery is low, so both the coverage and quality of surgery need improvement.

OBJECTIVE To analyze the use status and development trend of proton pump inhibitors(PPIs) in 33 hospitals in Wuhan, Hubei Province after the implementation of the national centralized drug procurement(NCDP) policy, and to provide reference for promoting the subsequent rational use of NCDP drugs and improving related policies. METHODS To make statistics and analysis of purchasing amount of PPIs, defined daily dose system(DDDs), defined daily dose consumption(DDDc) and utilization rate of 33 hospitals in Wuhan in 2019 and 2022. RESULTS After the implementation of the NCDP policy, the total purchasing amount of PPIs decreased by 53.6%, DDDs decreased by 15.4%, DDDc decreased by 45.2%, and the utilization rate of PPIs injectable dosage forms decreased by 12.6%. After NCDP, the highest growth rate of oral dosage forms was omeprazole(5.7%), followed by rabeprazole(5.0%), while injectable dosage forms showed a significant difference in utilization rate, with a significant decline in NCDP varieties and a significant increase in non-NCDP varieties. The overall NCDP utilization rate of PPIs in Wuhan was 64.9%, with little difference among hospitals of different grades. CONCLUSION The NCDP policy achieves the purpose of reducing the drug cost of patients and improving the accessibility of drugs, and is more optimized in the selection of dosage forms, which is in line with the policy expectations overall; but the quantity and price of PPIs in Wuhan decreased after NCDP, and highlighted a certain tendency in the selection of varieties. In the future, we still need to optimize measures to guide clinical priority in the selection of NCDP drugs, to ensure and improve the implementation of NCDP policy.

Objective:Bone morphogenetic protein-4(BMP4)has been proved to be an important regulatory factor for the pathological process of atherosclerosis(AS).However,there are few related clinical studies.This study aims to investigate the levels of plasma BMP4 in patients suffering from the arterial occlusive diseases(ACD)characterized by AS,and further to test the relationship between BMP4 and inflammation and vascular injury. Methods:A total of 38 ACD patients(the ACD group)and 38 healthy people for the physical examination(the control group)were enrolled.The plasma in each subject from both groups was obtained to test the levels of BMP4,tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),IL-10,and vascular endothelial cadherin(VE-cadherin),and the relationship between BMP4 and the detected indicators above were further analyzed. Results:Compared with the control group,the patients in the ACD group displayed significant elevations in the neutrophil to lymphocyte ratio[NLR,1.63(1.26,1.91)vs 3.43(2.16,6.61)]and platelet to lymphocyte ratio[PLR,6.37(5.26,7.74)vs 15.79(7.97,20.53)],while decrease in the lymphocyte to monocyte ratio[LMR,5.67(4.41,7.14)vs 3.43(2.07,3.74)](all P<0.05).Besides,the ACD patients displayed significant elevations in plasma BMP4[581.26(389.85,735.64)pg/mL vs 653.97(510.95,890.43)pg/mL],TNF-α[254.16(182.96,340.70)pg/mL vs 293.29(238.90,383.44)pg/mL],and VE-cadherin[1.54(1.08,2.13)ng/mL vs 1.85(1.30,2.54)ng/mL],and decrease in IL-10[175.89(118.39,219.25)pg/mL vs 135.92(95.80,178.04)pg/mL](all P<0.05).While the levels of IL-1β remained statistically comparable between the 2 groups(P=0.09).Furthermore,the plasma BMP4 levels were further revealed to be positively correlated with the levels of IL-1β(r=0.35),TNF-α(r=0.31)and VE-cadherin(r=0.47),while they were negatively correlated with the levels of IL-10(r=-0.37;all P<0.01). Conclusion:After ACD occurrence,the patients'plasma concentrations of BMP4 would be upregulated,which may serve as a candidate to indicate the levels of inflammation and vascular injury.

Hip fracture in the elderly is characterized by high incidence, high disability rate, and high mortality and has been recognized as a public health issue threatening their health. Surgery is the preferred choice for the treatment of elderly patients with hip fracture. However, lower extremity deep venous thrombosis (DVT) has an extremely high incidence rate during the perioperative period, and may significantly increase the risk of patients′ death once it progresses to pulmonary embolism. In response to this issue, the clinical guidelines and expert consensuses all emphasize active application of comprehensive preventive measures, including basic prevention, physical prevention, and pharmacological prevention. In this prevention system, basic prevention is the basis of physical and pharmacological prevention. However,there is a lack of unified and definite recommendations for basic preventive measures in clinical practice. To this end, the Orthopedic Nursing Professional Committee of the Chinese Nursing Association and Nursing Department of the Orthopedic Branch of the China International Exchange and Promotive Association for Medical and Health Care organized relevant nursing experts to formulate Expert consensus on perioperative basic prevention for lower extremity deep venous thrombosis in elderly patients with hip fracture ( version 2024) . A total of 10 recommendations were proposed, aiming to standardize the basic preventive measures for lower extremity DVT in elderly patients with hip fractures during the perioperative period and promote their subsequent rehabilitation.

Objective To monitor the antifungal resistance of clinical isolates of Candida spp.in the East China region.Methods MALDI-TOF MS or molecular methods were used to re-identify the strains collected from January 2018 to December 2022.Antifungal susceptibility testing was performed using the broth microdilution method.The susceptibility test results were interpreted according to the breakpoints of 2022 Clinical and Laboratory Standards Institute(CLSI)documents M27 M44s-Ed3 and M57s-Ed4.Results A total of 3 026 strains of Candida were collected,65.33％of which were isolated from sterile body sites,mainly from blood(38.86％)and pleural effusion/ascites(10.21％).The predominant species of Candida were Candida albicans(44.51％),followed by Candida parapsilosis complex(19.46％),Candida tropicalis(13.98％),Candida glabrata(10.34％),and other Candida species(0.79％).Candida albicans showed overall high susceptibility rates to the 10 antifungal drugs tested(the lowest rate being 93.62％).Only 2.97％of the strains showed dose-dependent susceptibility(SDD)to fluconazole.Candida parapsilosis complex had a SDD rate of 2.61％and a resistance rate of 9.42％to fluconazole,and susceptibility rates above 90％to other drugs.Candida glabrata had a SDD rate of 92.01％and a resistance rate of 7.99％to fluconazole,resistance rates of 32.27％and 48.24％to posaconazole and voriconazole non-wild-type strains(NWT),respectively,and susceptibility rates above 90％to other drugs.Candida tropicalis had resistance rates of 29.55％and 26.24％to fluconazole and voriconazole,respectively,resistance rates of 76.60％and 21.99％to posaconazole and echinocandins non-wild-type strains(NWT),and a resistance rate of 2.36％to echinocandins.Conclusions The prevalence and species distribution of Candida spp.in the East China region are consistent with previous domestic and international reports.Candida glabrata exhibits certain degree of resistance to fluconazole,while Candida tropicalis demonstrates higher resistance to triazole drugs.Additionally,echinocandins resistance has emerged in Candida albicans,Candida glabrata,Candida tropicalis,and Candida parapsilosis.

Objective To analyze the research status of job competence in domestic public hospitals,provide directions for the construction of the talent pool in public hospitals,and promote their high-quality development.Methods Relevant litera-ture on job competence in domestic public hospitals from 2009 to 2023 was retrieved from the China National Knowledge Infra-structure(CNKI)database.Citespace software was used to analyze the selected literature in terms of publication timeline,author co-occurrence,institution co-occurrence,keyword co-occurrence,keyword clustering,and keyword burst analysis.A visualized knowledge map was constructed.Results A total of 501 valid articles were included.Research on job competence in domestic public hospitals showed an upward trend from 2009 to 2023.The research hotspots were mainly in the areas of resident physicians and nursing.The burst analysis of keywords indicated that targeted research on job competence in specific professional fields will be a future trend.Conclusion Research on job competence in domestic public hospitals is developing,but it still faces issues such as a loose network structure of author and institution co-occurrence and a lack of cooperation,as well as insufficient subdivi-sion of job competence research in specific professional fields.Therefore,it is necessary to further subdivide professional fields,expand research on job responsibilities,talent cultivation,and performance evaluation in different fields,and encourage collabo-ration among scholars and institutions.Continuous innovation and strategic responses are needed to promote the high-quality de-velopment of public hospitals.

Digital intraoral scanning is a hot topic in the field of oral digital technology.In recent years,digital intra-oral scanning has gradually become the mainstream technology in orthodontics,prosthodontics,and implant dentistry.The precision of digital intraoral scanning and the accuracy and stitching of data collection are the keys to the success of the impression.However,the operators are less familiar with the intraoral scanning characteristics,imaging process-ing,operator scanning method,oral tissue specificity of the scanned object,and restoration design.Thus far,no unified standard and consensus on digital intraoral scanning technology has been achieved at home or abroad.To deal with the problems encountered in oral scanning and improve the quality of digital scanning,we collected common expert opin-ions and sought to expound the causes of scanning errors and countermeasures by summarizing the existing evidence.We also describe the scanning strategies under different oral impression requirements.The expert consensus is that due to various factors affecting the accuracy of digital intraoral scanning and the reproducibility of scanned images,adopting the correct scanning trajectory can shorten clinical operation time and improve scanning accuracy.The scanning trajec-tories mainly include the E-shaped,segmented,and S-shaped methods.When performing fixed denture restoration,it is recommended to first scan the abutment and adjacent teeth.When performing fixed denture restoration,it is recommend-ed to scan the abutment and adjacent teeth first.Then the cavity in the abutment area is excavated.Lastly,the cavity gap was scanned after completing the abutment preparation.This method not only meets clinical needs but also achieves the most reliable accuracy.When performing full denture restoration in edentulous jaws,setting markers on the mucosal tissue at the bottom of the alveolar ridge,simultaneously capturing images of the vestibular area,using different types of scanning paths such as Z-shaped,S-shaped,buccal-palatal and palatal-buccal pathways,segmented scanning of dental arches,and other strategies can reduce scanning errors and improve image stitching and overlap.For implant restora-tion,when a single crown restoration is supported by implants and a small span upper structure restoration,it is recom-mended to first pre-scan the required dental arch.Then the cavity in the abutment area is excavated.Lastly,scanning the cavity gap after installing the implant scanning rod.When repairing a bone level implant crown,an improved indi-rect scanning method can be used.The scanning process includes three steps:First,the temporary restoration,adjacent teeth,and gingival tissue in the mouth are scanned;second,the entire dental arch is scanned after installing a standard scanning rod on the implant;and third,the temporary restoration outside the mouth is scanned to obtain the three-di-mensional shape of the gingival contour of the implant neck,thereby increasing the stability of soft tissue scanning around the implant and improving scanning restoration.For dental implant fixed bridge repair with missing teeth,the mobility of the mucosa increases the difficulty of scanning,making it difficult for scanners to distinguish scanning rods of the same shape and size,which can easily cause image stacking errors.Higher accuracy of digital implant impres-sions can be achieved by changing the geometric shape of the scanning rods to change the optical curvature radius.The consensus confirms that as the range of scanned dental arches and the number of data concatenations increases,the scanning accuracy decreases accordingly,especially when performing full mouth implant restoration impressions.The difficulty of image stitching processing can easily be increased by the presence of unstable and uneven mucosal mor-phology inside the mouth and the lack of relatively obvious and fixed reference objects,which results in insufficient ac-curacy.When designing restorations of this type,it is advisable to carefully choose digital intraoral scanning methods to obtain model data.It is not recommended to use digital impressions when there are more than five missing teeth.

Procurement management is an important part of the operation and management of public hospitals. Compliance and high-quality procurement management is of great significance to the development of high-quality hospitals. Based on the practical experience of Renmin Hospital of Wuhan University, this paper introduced in detail how to build a procurement management system with rule system as the cornerstone, quality and risk management as the core, learning training and assessment as the starting point, information as the support, and continuously improving. This system empowered procurement management to improve quality, increase efficiency, and reduce costs. The hospital has successfully completed its procurement tasks from 2021 to 2023, with an average cost saving rate of 11.65% for procurement projects, an effective questioning rate of 0.55%, and a zero litigation rate. The rate of bid rejection for procurement projects has been decreasing year by year. The ability level of procurement management personnel has significantly improved, and their industry influence continues to increase. This approach has certain reference significance for solving the common management problems in the hospital procurement management.

In vitro cell experiment based on serum pharmacology is a common way to study the pharmacodynamic mechanism of Chinese medicine， and screening the optimal intervention concentration of serum containing Chinese medicine is a key step in the whole experiment. Over-diluted serum containing Chinese medicine or over-high concentration leads to false negative or positive results， while the optimal concentration of medicated serum reduces the number of groups in subsequent experiments as well as the operation error. Thus it is of great significance to screen the optimal serum concentration in studying the pharmacodynamic mechanism of Chinese medicine in in vitro cell experiments. However， there has been no unified standards for the screening methods at present. After reviewing the literature in China and abroad in the past 20 years， this paper conducted an analysis from three aspects of intragastric dose of Chinese medicine， blood collection time and serum dilution degree， and then summarized the screening methods for optimal concentration of serum containing drugs， providing guidance for the study of pharmacodynamic mechanism of Chinese medicine. The screening methods mainly included "same intragastric dose， same blood collection time， and different concentrations" "different intragastric doses， same blood collection time， and same concentration" "same intragastric dose， different blood collection time， and same concentration" "different intragastric doses， different blood collection time， and different concentrations" "serum lyophilized powder" "simulation of gradient concentration of serum containing western medicine" and "pure serum intervention". Among them， the former two were the dominant ways in current related research. The above screening methods had their own advantages and disadvantages， and researchers should make a reasonable choice according to the specific requirements and actual situation of the experiments.