OBJECTIVE To explore comprehensive management and potential issues associated with long-term prescriptions medications of psychiatry， in order to provide a reference for the comprehensive management of long-term prescriptions of psychiatry in psychiatric hospitals and other medical institutions’ pharmacies. METHODS Starting from the applicable principles for long-term prescriptions of psychiatry， this study introduced the standardized assessment and precautions before issuing long-term prescriptions， the formulation and adjustment of the drug list， as well as the rational management of the long-term prescriptions. It also analyzed potential issues that may arise in the comprehensive management of long-term prescription medications and proposed corresponding countermeasures and suggestions. RESULTS & CONCLUSIONS Prior to initiating long-term prescriptions， a standardized assessment should be conducted on patients from the aspects of their psychiatric condition and long-term potential risk factors， pharmacological treatment plans and other non-pharmacological therapies， physical illnesses. Additionally， healthcare providers should fulfill their obligation to inform patients or their family members. The comprehensive management of long-term prescription medications should be jointly established and improved by multiple departments， and the formulation of drug catalogs should avoid including drugs with potential social harm or medication risks while complying with policy requirements. Furthermore， measures such as adding special identifiers to long-term prescriptions， providing patients with reminders about （No.YGLX202537） prescription expiration， or offering online consultations can also effectively enhance the rationality of medication use under long-term prescriptions. Currently， the implementation of long-term prescriptions in psychiatry remains challenged by inconsistencies in prescription duration， incomplete coverage of diagnostic categories， poor patient adherence， and the risk of deviation in clinical assessments. In this regard， measures such as collaborating with multiple departments to strengthen long-term prescription information management， providing matching pharmaceutical services， ensuring the quality and rationality of long-term prescription implementation， and using modern methods to screen high-risk patients can be taken to improve patient medication compliance and safety.

ObjectiveThis study observes the intervention effect of Longmu Piyan prescription on oxidative stress in BALB/c mice with atopic dermatitis （AD） induced by 2，4-dinitrochlorobenzene （DNCB） and explores its mechanism. MethodThe AD model was established using the method of DNCB sensitization on the back skin of BALB/c mice. Forty male BALB/c mice were randomly divided into a blank group， a model group， a vitamin C control group （0.5×10^-3 mg·kg^-1）， and a Longmu Piyan prescription group （26 g·kg^-1）. Except for the blank group， other groups were sensitized with different concentrations of DNCB on the back to induce AD， and the blank group was treated with matrix coating. The gastric administration was started on the seventh day after sensitization with 2% DNCB and on the 24th day after sensitization with 0.2% DNCB continuously for 21 days. The changes in skin lesions of each group were directly observed after the experiment. Enzyme-linked immunosorbent assay （ELISA） was used to detect the levels of interleukin （IL）-4， tumor necrosis factor （TNF）-α， immunoglobulin E （IgE）， and reactive oxygen species （ROS） in the serum of each group. The total antioxidant capacity determination kit-trace method (ABTS method) was used to measure the level of total antioxidant capacity （TAOC） in serum. The Hematoxylin eosin （HE） staining method was used to observe the pathological and morphological changes of the skin lesion site. The immunohistochemical method was used to detect the expression of thymic stromal lymphopoietin （TSLP） in the skin lesion site. Western blot was used to detect the expression of filaggrin （FLG） in the dorsal skin lesions. ResultThe results showed that compared with the blank group， the skin lesion score of the model group mice was significantly increased （P<0.01）， and HE staining showed characteristic pathological changes of AD in the skin lesion site. At the same time， the expression of TSLP in the skin lesion was significantly increased， and that of FLG was reduced （P<0.05）. The levels of TNF-α， IL-4， IgE， and ROS in serum increased， while the activity of TAOC decreased （P<0.01）. Compared with the model group， the Longmu Piyan prescription group showed a significant decrease in skin lesion scores and a significant improvement in skin lesion pathology. At the same time， the expression of TSLP decreased， and the expression of FLG increased in the skin lesions （P<0.05）. In addition， compared with the model group， the serum levels of TNF-α， IL-4， IgE， and ROS also decreased to varying degrees （P<0.05，P<0.01）， and TAOC activity increased in the Longmu Piyan prescription group （P<0.01）. ConclusionThere is a significant correlation among the degree of oxidative stress， the severity of skin lesions in AD， and the levels of inflammatory cytokines. Longmu Piyandu prescription can improve AD-like skin lesions in BALB/c mice by promoting ROS clearance， enhancing TAOC， and inhibiting oxidative stress， thus protecting the skin barrier and reducing inflammation.

Based on the theory of "mutual interference of clear and turbid Qi" in Huangdi Neijing（《黄帝内经》）， this study explored the pathogenesis of spleen and stomach diseases and the therapeutic effects of Banxia Xiexintang on them. It suggested that "mutual interference of clear and turbid Qi" represents a pathological state of Yin and Yang disturbance and imbalance in Qi circulation due to the mixture of clear and turbid Qi， which can elucidate the pathogenesis of spleen and stomach diseases. According to this theory， the pathogenesis of spleen and stomach diseases was summarized as Qi disorder in spleen and stomach， disharmony between Ying Qi and Wei Qi， and conflict between cold and heat. Banxia Xiexintang， as a crucial prescription for treating spleen and stomach diseases， achieves its therapeutic effects by dispersing stagnation with pungent flavor， descending adverse Qi with bitterness， regulating Ying Qi and Wei Qi， and harmonizing cold and heat. By regulating Qi circulation， balancing internal and external factors， and addressing deficiency and excess， it can rectify the pathological state of "mutual interference of clear and turbid Qi" of spleen and stomach diseases. Modern research reveals that Banxia Xiexintang can modulate gastrointestinal motility， restore mucosal immune barrier function of the digestive system， and exhibit optimal therapeutic effects when combined with both cold-cool and warm-hot medicines， aligning with its therapeutic role under the theory of "mutual interference of clear and turbid Qi". By delving into the essence of the "mutual interference of clear and turbid Qi" theory and exploring the pathogenesis of spleen and stomach diseases and the therapeutic effects of Banxia Xiexintang based on this theory， this study further elucidated the inherent connection between spleen and stomach diseases and the "mutual interference of clear and turbid Qi" theory， offering insights and theoretical references for the clinical diagnosis and treatment of spleen and stomach diseases.

Based on the concept definition and research status of the core competencies for home-based elderly caregivers,combined with the current development situation of China's elderly care industry and the relevant experience of Japan,Germany,and other countries in the construction of elderly care service systems,this paper sorted out that the core competencies for home-based elderly caregivers in China at this stage,such as elderly care skills,legal and ethical qualities,communication skills,and digital intelligence application capabilities,were relatively weak and cannot meet the comprehensive requirements of the current complex social environment,the individual needs and complex psychology of disabled elderly,and traditional concepts for caregivers.By closely integrating the active aging strategy proposed by the Party and our country,it was clear that home-based elderly caregivers should possess four core competencies,including comprehensive elderly care skills,basic legal and ethical qualities,good communication skills,and necessary informatization application capabilities.It was recommended that training institutions and universities enhance the core competencies for home-based elderly care caregivers by conducting training courses in elderly care,basic legal ethics,communication skills,and the use of smart devices,with a view to providing references for the sustainable development of elderly care.

Objective:To explore the application effects of the goal-oriented teaching method based on mind mapping in the teaching of stomatology practical courses.Methods:From September 2022 to September 2023, 52 fourth-year students of clinical stomatology at Harbin Medical University were divided into test group and control group for practical teaching, with 26 cases in each group. The test group received goal-oriented teaching based on mind mapping, while the control group received traditional teaching, for 20 class hours in both groups. The two groups were compared in terms of general data, theoretical and practical assessment scores, the score of the self-rating scale of self-directed learning (SRSSDL) and the score of critical thinking disposition inventory-Chinese version (CTDI-CV) before and after training, and student satisfaction with teaching activities. SPSS 25.0 software was used to perform the t-test or χ2 test. Results:After completing the practical training courses, the test group showed significantly higher scores than the control group in multiple-choice questions [(16.85±1.39) vs. (15.33±2.21)], fill-in-the-blank questions [(17.21±1.98) vs. (16.01±2.02)], short answer questions [(17.47±2.27) vs. (15.23±2.45)], case analysis [(34.36±2.79) vs. (32.57±3.02)], and practical assessment [(84.69±4.73) vs. (80.57±4.21)] (all P<0.05). The SRSSDL score and CTDI-CV score were improved in both groups, and were significantly higher in the test group [(215.29±10.42) and (357.49±17.80)] than in the control group [(200.23±11.42) and (342.23±17.26)] (both P<0.05). The students of the test group were significantly more satisfied with teaching activities than those of the control group ( P<0.05). Conclusions:Compared with the traditional teaching method, the goal-oriented teaching method based on mind mapping is more effective in stomatology practical teaching, which can improve students' self-directed learning ability and critical thinking ability, promote their mastery of theoretical knowledge, enhance their clinical practice ability, and increase their satisfaction with teaching activities.

Venous thromboembolism(VTE)is a common disease with high morbidity and mortality.The incidence and mortality of VTE are higher in elderly patients and increased level of D-dimer,a thrombosis marker is positively related with age.Therefore,the diagnostic threshold needs to be adjusted to screen VTE with D-dimer level.Elderly patients may still have VTE after implementation of anticoagulant prevention,and increasing age is a high risk factor for bleeding after anticoagulant prevention.Whether elderly patients need to be monitored for anticoagulant prevention of VTE,and the relationship between age and VTE recurrence remains to be determined.In-depth re-search on the prevention of VTE in elderly patients and exploration of innovative VTE prevention strategies may ori-ent future research.

The incidence and mortality of venous thromboembolism (VTE) are high in critically ill patients, and there is still a risk of VTE and bleeding after the use of fixed-dose low molecular weight heparin (LMWH) for prophylaxis. The level of anti-factor Ⅹa is not up to standard after LMWH prophylaxis in patients with surgery or trauma. The condition of critically ill patients is complicated, and the proportion of patients with low antithrombin Ⅲ is high, which can affect the prophylactic efficacy of LMWH and contribute to VTE occurrence. There is currently no consensus on whether adjusting LMWH dose according to anti-factor Ⅹa levels can reduce VTE occurrence in critically ill patients. High-quality multicenter randomized controlled studies are needed in the future to establish new approaches for precise prevention of VTE in critically ill patients.

L-asparaginase (L-ASN) is widely applied in the treatment of malignant tumor and low-acrylamide food production, however, the low expression level hampers its application. Heterologous expression is an effective strategy to increase the expression level of target enzymes, and Bacillus is generally used as the host for efficient production of enzymes. In this study, the expression level of L-asparaginase in Bacillus was enhanced through optimization of expression element and host. Firstly, five signal peptides (SP_SacC, SP_AmyL, SP_AprE, SP_YwbN and SP_WapA) were screened, among which SP_SacC showed the best performance, reaching an activity of 157.61 U/mL. Subsequently, four strong promoters (P43, P_ykzA-P43, P_Ubay and P_bacA) from Bacillus were screened, and tandem promoter P_ykzA-P43 showed the highest yield of L-asparaginase, which was 52.94% higher than that of control strain. Finally, three Bacillus expression hosts (B. licheniformis Δ0F3 and BL10, B. subtilis WB800) were investigated, and the maximum L-asparaginase activity, 438.3 U/mL, was reached by B. licheniformis BL10, which was an 81.83% increase compared with that of the control. This is also the highest level of L-asparaginase in shake flask reported to date. Taken together, this study constructed a B. licheniformis strain BL10/P_ykzA-P43-SP_SacC-ansZ capable of efficiently producing L-asparaginase, which laid the foundation for industrial production of L-asparaginase.
Bacillus licheniformis/metabolism* ; Asparaginase/genetics* ; Bacillus/genetics* ; Protein Sorting Signals ; Promoter Regions, Genetic/genetics* ; Bacillus subtilis/genetics* ; Bacterial Proteins

Objective:To analyze and compare the X-ray procedures and radiation dose composition of ophthalmic inpatients, and to explore the changes of the X-ray examination mode in recent years and the effect of optimization in imaging technology on the radiation dose level of the patients.Methods:The simple random sampling method was used to retrospectively select the imaging data of the ophthalmic inpatients in the Second Affiliated Hospital of Zhejiang University School of Medicine from July 1st to November 31st in 2019 and from July 1st to November 31st in 2020. A total of 516 cases were selected according to the imaging time, including 258 cases in 2019 and 258 cases in 2020. Based on our previous research and the related documents of low-dose CT screening, a series of optimizations on CT scanning parameters and process were carried out in 2020, including the frequency of DR and CT scanning, the number of examinations per capita, the composition ratio of CT and DR, and X-ray dose per capita.Results:In 2020, the average effective doses of chest CT and orbital CT for ophthalmic inpatients were (2.587±1.586) mSv and (0.877±0.733) mSv, significantly lower than those in 2019 ( F=0.52, 0.72, P<0.05), and decreased by 34.82% and 37.13%, respectively. There was no significant difference in the average effective dose of chest DR and head CT between 2020 and 2019 ( F=6.01, 1.81, P>0.05). The number of X-ray examination per capita increased by 0.15 times, and the effective dose increased by 1.44 times (1.589 mSv). Chest DR was the main type of X-ray examination, accounting for 68.79% of all examinations in 2019, while chest CT was the main type, accounting for 71.05% in 2020. The composition of chest CT in 2020 increased by 63.17% compared with 2019, and the compositions of chest DR, orbital CT and cranial CT were decreased by 53.88%, 5.79% and 2.89%, respectively. Conclusions:With dose optimization measures, the single CT dose of ophthalmic inpatients in 2020 was lower than that in 2019. Chest CT increased significantly in frequency, and became main X-ray examination instead of chest DR which made the effective dose of ophthalmic inpatients increasing significantly.

ObjectiveTo explore the effect of Qingre Huashi Tiaoshu prescription on mice with ulcerative colitis （UC） based on the change of the intestinal mucosal barrier function. MethodSix of thirty-six C57BL/6 mice were randomly selected as the normal group. The remaining mice were free to drink 2.5% dextran sulfate sodium （DSS） solution for 7 days to prepare UC model mice. After modeling， they were randomly divided into model group， mesalazine group， and Qingre Huashi Tiaoshu prescription high-， medium- and low-dose groups， 6 in each group. Mesalazine group was given 0.52 g·kg^-1·d^-1 suspension （ig）. Qingre Huashi Tiaoshu prescription high-， medium- and low-dose groups were given 3.38， 1.69， 0.845 g·kg^-1·d^-1 suspension， respectively （ig）. The normal group and the model group were treated with an equal volume of purified water for 10 days （ig）. After intervention， the general condition， body weight， disease activity index （DAI） score， and colon length of the 6 groups of mice were compared. The colon tissue was stained with hematoxylin and eosin （HE） for pathological analysis， and the expression of Ki67 in colon tissue was detected by immunohistochemistry. Western blot was used to determine the protein expression of matrix metalloproteinase-9 （MMP-9）， cleaved cysteine aspartate-specific protease-3 （Caspase-3） and Caspase-3 in colon tissue. ResultCompared with the model group， the mesalazine group and the Qingre Huashi Tiaoshu prescription high- and medium-dose groups alleviated the diarrhea， blood in the stool， weight loss， and other symptoms in UC mice， reduced the DAI score （P<0.05）， and restored the colon shape （P<0.05）. The colonic mucosal defect and inflammatory cell infiltration were improved in the mesalazine group and the Qingre Huashi Tiaoshu prescription high- and medium-dose groups，and there were more intact crypt stem cells. Western blot showed that the protein expression of MMP-9 and cleaved Caspase-3 in the mesalazine group and the Qingre Huashi Tiaoshu prescription high-dose group was lower than that in the model group （P<0.05）， and there was no significant difference between the groups. The expression of Caspase-3 in the Qingre Huashi Tiaoshu high-dose prescription group was decreased compared with the condition in the model group （P<0.05）. ConclusionQingre Huashi Tiaoshu prescription could effectively relieve DSS-induced UC， and its mechanism of action might be related to regulating the expression of MMP-9， cleaved Caspase-3， and Caspase-3， and promoting the repair of intestinal mucosal barrier.