Objective To provide evidence-based references for the prevention of surgical site infection(SSI)by sum-marizing the best evidence for the prevention of SSI in adult inpatients.Methods The'6S'evidence resource pyramid model was used to systematically search the related evidence in domestic and foreign databases,guideline websites,and academic socie-ty websites from the inception of the database to September 30,2023.Four researchers evaluated the quality of the included guidelines,and two researchers independently evaluated the quality of other types of literature and rated the level of evidence.Results A total of 12 articles were included,including 6 clinical decision making and 6 clinical guidelines.Thirty best items of the evidence were summarized from 7 aspects:diagnosis,clinical symptoms,influencing factors,patient prevention strategies,preventive strategies for medical staff,intraoperative and postoperative treatment,and consultation and education.Conclusion Clinical staff should develop a standardized management plan for infection prevention based on corresponding evidence to reduce the incidence of SSI instead of taking a single measurement.Moreover,they need to formulate a standardized work process for preventing SSI based on the clinical practice and patients'preference.

Digital subtraction angiography examination is a common reexamination method after intracranial aneurysm embolization,but it is poorly tolerated by patients.With the development of medical imaging technology,MRI examination is less affected by metal artifacts and has the advantages of non-radiation,non-invasive and high resolution.Zero echo magnetic resonance angiography and high resolution vessel wall imaging technology will have better clinical application value:it can not only better show the degree of vascular stenosis and the size of residual aneurysm,but also show the degree of vascular wall enhancement and prognosis.With the development of spectral CT,the application value of computed tomography angiography in the postoperative review of aneurysm has been further improved.This article mainly describes the application of different imaging techniques in postoperative reexamination of intracranial aneurysms.

OBJECTIVE To investigate the improvement effect and mechanism of calycosin （CA） on acute inflammatory injury secondary to intracerebral hemorrhage. METHODS Male C57BL/6 mice were injected with type Ⅶ collagenase into the basal ganglia to establish an intracerebral hemorrhage model， which were divided into sham-operation group（phosphate buffered saline instead of collagenase）， model group， and different CA dose groups（15，30，60，120 mg/kg）. Based on the modified neurological severity score （mNSS） to screen the intervention doses， the volume of intracerebral hemorrhage， brain water content， the expressions of ionized calcium-binding adaptor molecule 1 （Iba1） in brain tissue， Toll-like receptor 4 （TLR4） and its downstream inflammatory factors [tumor necrosis factor-α （TNF-α）， inducible nitric-oxide synthase （iNOS）， interleukin-1β （IL- 1β）] in brain tissue， and the apoptosis of cells in brain tissue were detected. Primary microglia were cultured in vitro， and the expressions of TLR4 and its downstream inflammatory factors were detected. Primary neurons and primary microglia were co- cultured in vitro， and the apoptosis of neurons was detected. RESULTS The doses of 30 mg/kg and 60 mg/kg were selected as intervention doses of CA for subsequent experiments. Compared with the sham-operation group， the mice in the model group had cerebral hemorrhage， the volume of cerebral hemorrhage and brain water content were significantly increased （P＜0.05）； the positive expression rate of Iba1 protein in brain tissue was significantly increased， and the relative expression levels of TLR4， TNF-α， IL-1β and iNOS protein in brain tissue were up-regulated significantly. The apoptosis rate also increased significantly （P＜0.05）. Compared with model group， the above indexes of the mice in the 30 and 60 mg/kg CA groups were significantly improved （P＜0.05）. CA significantlyreduced the relative expression levels of TLR4 and its downstream inflammatory factors in microglia， and reduced the apoptosis of neurons in the co-culture system of primary neurons and primary microglia （P＜0.05）. CONCLUSIONS CA can exert a protective effect on the brain， which may be related to relieving the secondary acute inflammatory injury after intracerebral hemorrhage by inhibiting TLR4-mediated inflammatory response.

Objective:To explore the clinical application of time of flight-magnetic resonance angiography (TOF-MRA), silent magnetic resonance angiography (SilenZ-MRA) and high-resolution vessel wall imaging (HR-VWI) in non-invasive evaluation of intracranial aneurysm after embolization.Methods:From February 2021 to February 2022, 39 patients, including 8 males and 31 females, who were 29-86 (54.50±11.80) years old and had received intracranial aneurysm embolization were collected in the Second Affiliated Hospital of Nanchang University. Kruskal-Wallis test was used to compare the image quality score and the evaluation results of lumen stenosis rate in the stent segments by TOF-MRA, SilenZ-MRA and HR-VWI. The diagnostic value of TOF-MRA, SilenZ-MRA and HR-VWI was analyzed by receiver operating characteristic (ROC) curve with DSA as the reference standard.Results:The image quality scores of TOF-MRA, SilenZ-MRA and HR-VWI were 2(1, 3), 4(3, 4) and 4(4, 4), respectively, with statistically significant difference ( H=80.78, P<0.05). The pairwise comparison results were as follows: TOF-MRA vs SilenZ-MRA, P<0.017; TOF-MRA vs HR-VWI, P<0.017; SilenZ-MRA vs HR-VWI, P>0.017. The lumen stenosis rates of stent segments measured by TOF-MRA, SilenZ-MRA, HR-VWI and DSA were 45.00% (29.60%, 61.05%), 17.60% (10.80%, 26.80%), 13.35% (8.90%, 15.95%) and 7.95% (4.80%, 11.25%), respectively, with statistically significant difference ( H=67.96, P<0.05). The results of comparison between TOF-MRA, SilenZ-MRA, HR-VWI and DSA were respectively as follows: TOF-MRA vs DSA, P<0.017; SilenZ-MRA vs DSA, P<0.017; HR-VWI vs DSA, P>0.017. DSA review showed that 12 (27.91%,12/43) aneurysms were not completely embolized, and 31 (72.09%, 31/43) aneurysms were completely embolized. The area under the curve of TOF-MRA, SilenZ-MRA and HR-VWI for evaluating the postoperative complete embolization of aneurysm was 0.75, 1.00 and 0.94, respectively, with statistically significant differences between TOF-MRA and HR-VWI ( Z=2.53, P<0.05) as well as between TOF-MRA and SilenZ-MRA ( Z=3.32, P<0.05). Conclusions:HR-VWI can clearly display the stent-segment lumen of the parent artery, and evaluate the stent-segment arterial wall and whether the stent-segment lumen is unobstructed or not. SilenZ-MRA is significantly superior to TOF-MRA in the evaluation of postoperative embolization status of aneurysms, and slightly superior to HR-VWI in tumor neck display. Combined application of HR-VWI and SilenZ-MRA has certain clinical significance for non-invasive evaluation of intracranial aneurysm after embolization.

OBJECTIVE：To provide reference for the participation of clinical pharm acists in outpatient antibiotics management so as to promote the rational use of antibiotics in outpatient department. METHODS ：The pharmacist reset medication rules ， classified irrational medication levels ，formulated warning contents ，and established a diagnosis database of mild to moderate non- complex infections ，according to the problems found in the post review of outpatient antibiotics prescription through sorting out the previous rules of antibiotics use in the Yiyao Rational Drug Use Management Software （called“review software ”for short ）in our hospital. The special pre-review was performed by using combination of system review and manual review. Pharmacists used the review saftware to count the data of outpatient antibiotics prescriptions before （the first quarter of 2020）and after （the second ， third and fourth quarters of 2020）the implementation of special pre-review. The post review for antibiotics prescriptions in Dec. 2019（before the implementation of special pre-review ）and Dec. 2020（after implementation of special pre-review ）were performed by pharmacists to evaluate the impact of the implementation of special pre-review on promoting rational use of outpatient antibitics. RESULTS：Comared with before the implementation of special pre-review in the first quarter of 2020，the prompt rate of the review software for antibiotics prescriptions was decreased ，and the interception rate was increased after the implementation of special pre-review in the second quarter of 2020（P＜0.05）. Compared with before the implementation of special pre-review in Dec. 2019，the proportion of outpatient antibiotics prescriptions in all outpatient prescriptions ，the ratio of bi-antibiotics prescriptions in all antibiotics prescriptions in the same month ，the ratio of prescriptions with unsuitable indications in all antibiotics prescriptions in the same month were all decreased E-mail：phdloveyou@163.com significantly （P＜0.01）， while the ratio of prescriptions with rational antibiotics use in all antibiotics prescriptions in the same month was increased significantly （P＜0.01）. CONCLUSIONS：Pharmacists establishing a rule for rational use of antibiotics in outpatient department b ased o n the hospital ’s situation，implementing a special pre-review for antibiotics prescriptions with the help of review software ，can promote the rational use of antibiotics in outpatient department.

Objective To establish the reference intervals(RIs) for plasma presepsin in healthy population.Methods The document C28-A3 issued by CLSI was a guideline about how to define,establish,and verify reference intervals in the clinical laboratory.Plasma values were determined with CLEIA for 1 250 healthy adults(aged 20-90 years old),including 624 males and 626 females.The central 95 percentile of RIs were determined using nonparametric statistical methods.Results The presepsin values in elderly population showed a Gaussian distribution and age/sex related changes.The RIs for plasma presepsin in the reference population respective of age(ranged from 20-＜30,30-＜ 60,60-＜ 90 years) were 50-195,47-170,41-142 pg/mL for males and 43-173,44-162,38-137 pg/mL for females respectively.Conclusion The RIs for plasma presepsin were established according to the gender and age groups in the healthy adults,and could provide a reference for the clinical and laboratory.

Objective To explore the clinical value of heart-type fatty acid binding protein testing (H-FABP) in the diagnosis of early myocardial ischemia injury.Methods One hundred and eighty cases diagnosed with myocardial ischemia from January 2016 to December 2016 were selected as the experimental group,then according to the disease time,the subjects were divided into the earlier group(≤3 h),middle group(3~6 h)and later group(≥6 h),each group 60 cases.180 cases with healthy physical examination results were enrolled in the control group.The concentration of serum H-FABP and IMA were detected in order to analyze the clinical value comprehensively.Results Compared with the control group,the concentration of serum H-FABP ((11.54±4.31) μg/L) and IMA ((92.72±5.31)U/ml) in the experimental group increased greatly,the differences were statistically significant(t=2.305,3.001,P<0.05).Among the subgroups in the experimental group,the concentration of IMA was the highest in the early stage and decreased in the middle and later stages,and there were significant difference between the earlier group and later group(t=2.326,P<0.05).The concentration of serum H-FABP and IMA in the experimental group and control group were positively correlated (r=0.9237,P<0.05).Positive detection rate analysis showed that the positive rates of H-FABP and IMA among the subgroups were above 80.00%,and the positive rate of combined detection was obviously improved (P<0.05).The clinical diagnosis was used as the gold standard,the Kappa of the results of H-FABP detection and clinical diagnosis was 0.85 (P<0.05).Conclusion H-FABP has a positive clinical significance in the diagnosis of early myocardial ischemia,as IMA has high positive detection rate,and has high consistency with clinical diagnosis results,it can effectively reduce the misdiagnosis rate and combined detection can reduce the rate of missed diagnosis.

Objective To investigate the molecular mechanism of P75NTR gene-induced apoptosis in tongue squamous cell carcinoma Tca8113 cell lineage.Methods P75NTR specific siRNA was transferred into P75NTR positive tongue squamous cell carcinoma Tca8113 cells.P75NTR positive Tca8113 cells were divided into 4 groups:blank group (without transfection),negative control group (transfected with negative control siRNA ), experiment group-776 (transfected with siRNA-P75NTR-776 ) and experiment group-1234 (transfected with siRNA-P75NTR-1234).Transfection efficiency and cell apoptosis were detected by flow cytometry.The interference effect of P75NTR mRNA expression was detected by fluorescence quantitative PCR. 3-(4,5-dimethyl-2-thiazoly)-2,5-diphenyl-2H-tetrazolium bromide assay was applied in measuring cell prolife-ration.The protein changes of P75NTR were detected by Western blotting.The distributions of nuclear factor-κB(NF-κB)of cells were observed by cell immunofluorescence labeling method.Results The transfection efficiency was 30%.The apoptosis rate of experiment group-776,experiment group-1234 and negative control group was (20.35 ±0.18)%,(12.32 ±1.51)% and (2.63 ±0.10)% respectively.Compared with the negative control group,the differences of the former two group had statistical significance (t =177.20,P <0.005;t =37.12,P <0.005).The P75NTR gene interference was successful.The inhibition rate of P75NTR protein reached 31% in experiment group-776.The cell viability of Tca8113 cells after P75NTR-siRNA inter-
ference was 70.02%,78.01% and 95.81% in experiment group-776,experiment group-1234 and negative control group.And there were significant differences between experiment group-776 and negative control group (χ2 =235.3,P <0.010),and between experiment group-1234 and negative control group (χ2 =117.5,P <0.005 ).NF-κB distribution was increased in cell cytoplasm in the interference group than that in control group.Conclusion P75NTR may promote the proliferation or inhibit the apoptosis of tongue squamous cell carcino-ma,and the molecular mechanism may be correlated with hindering the transportion of NF-κB into cell nuclear.

Background:With the development of capsule endoscopy,small intestinal injury induced by non-steroidal anti-inflammatory drugs( NSAIDs)has become an issue of growing concern. Although there are a variety of drugs used for NSAIDs-induced gastric mucosal injury,small intestinal injury caused by NSAIDs is lack of effective prevention and treatment modalities. Aims:To investigate the protective effect and possible mechanism of rebamipide on human colon cancer cell line Caco-2 injury induced by aspirin. Methods:In aspirin group,Caco-2 cells were treated with aspirin 10 mmol/L;in rebamipide group,Caco-2 cells were treated with aspirin and different concentrations of rebamipide(0. 1, 0. 5,1. 0 mmol/L),and a negative control group was established. Cell proliferation inhibition was measured by MTT assay. Cell apoptosis was determined by flow cytometry. Morphological changes of cells were observed under inverted phase contrast microscope. Permeability of cells was assessed by Transwell assay. Expressions of tight junction proteins occludin and zonula occluden-1(ZO-1),as well as mitogen activated protein kinase(MAPK)signaling pathway-associated proteins including extracellular signal-regulated kinase(ERK)1/2,phosphorylated ERK1/2(p-ERK1/2),p38,p-p38,c-Jun N-terminal kinase( JNK),and p-JNK,were determined by Western blotting. Results:Proliferation inhibition rate,apoptosis rate and permeability of Caco-2 cells in rebamipide 0. 1,0. 5,1. 0 mmol/L groups were significantly lower than those in aspirin group in a dose-dependent manner(P<0. 05). Injuries of Caco-2 cells were seen in aspirin group by inverted phase contrast microscope and rebamipide could reduce these injuries. Expressions of occludin,ZO-1 and p-JNK were significantly higher and expressions of p-p38 and p-ERK1/2 were significantly lower in rebamipide 0. 1,0. 5,1. 0 mmol/L groups than those in aspirin group in a dose-dependent manner(P<0. 05). Conclusions:Rebamipide have a protective effect against aspirin-induced Caco-2 cell injury,probably through regulating MAPK signaling pathway( inhibiting p38 and ERK1/2 phosphorylation,stimulating JNK phosphorylation),and subsequently up-regulating the expressions of tight junction proteins and decreasing the permeability of cells.

Objective:To study the effect of p75NTR gene on the apoptosis of tongue squamous cell carcinoma Tca8113 cells. Methods:p75NTR +Tca8113 cells were isolated from Tca 8113 cell line and transfected by p75NTR siRNA using lipofectamine. p75NTR mRNA and protein expression was examined by real time RT-PCR and western blot respectively.Cell proliferation was stud-ied by MTT assay,cell apoptosis was examined by flow cytometry.Results:Proliferation of p75NTR + cells was faster than that of p75NTR - cells.Transfection of p75NTR siRNA inhibited p75NTR mRNA and protein expression in p75NTR + Tca8113 cells,inhibi-ted the proliferation and increased the apoptosis of the cells.Conclusion:p75NTR gene plays a role in the apoptosis of Tca8113 cells.