OBJECTIVE To provide reference for improving the rational use of antimicrobial drugs in primary township medical institutions. METHODS Based on the county prescription pre-review center， a team led by anti-infective clinical pharmacists constructed the management mode for the use of antimicrobial drugs in county-level medical communities with clinical pharmacists as the main team by finding out the main problems in the use of antimicrobial drugs in primary township medical institutions， providing feedback on the problems， organizing relevant training for the problems， improving the customization rules of the prescription pre-review software， implementing the automatic interception and pharmacist online prescription review and other measures. Data on the use of antimicrobial drugs were collected and compared in the 15 primary township medical institutions between January-June in 2022 （before the implementation of the mode） and January-June in 2023 （after the implementation of the mode）. RESULTS Compared with before the implementation of the mode， the utilization rate of antimicrobial drugs in outpatients of primary township medical institutions decreased from 24.97% before the implementation of the mode to 19.39% after the implementation of the mode； the utilization rate of antimicrobial injection in outpatients decreased from 66.10% to 46.80%； the utilization rate of intravenous drip of antimicrobial drugs in outpatients decreased from 52.33% to 40.35%； the rates of combined use of antimicrobial drugs in outpatients decreased from 12.70% to 8.19%； the reasonable rate of antimicrobial prescribing in outpatients increased from 55.28% to 73.93%. After the implementation of the mode， the proportion of antimicrobial prescriptions for each diagnosis was basically the same as before； the defined daily dose system （DDDs） and proportion of a few antimicrobial drugs changed compared with before according to the anatomical therapeutic chemical classification of drugs， among which DDDs of lincomycin， gentamicin and other drugs declined significantly； DDDs of antimicrobial drugs for each classification was basically the same as before according to AWaRe classification. CONCLUSIONS The management mode of the use of antimicrobial drugs led by anti-infective clinical pharmacists is constructed in the prescription pre-reviewing center of county-level medical communities， which can effectively improve the rational use of antimicrobial drugs in the primary township medical institutions.

Emerging SARS-CoV-2 variants have made COVID-19 convalescents susceptible to re-infection and have raised concern about the efficacy of inactivated vaccination in neutralization against emerging variants and antigen-specific B cell response. To this end, a study on a long-term cohort of 208 participants who have recovered from COVID-19 was conducted, and the participants were followed up at 3.3 (Visit 1), 9.2 (Visit 2), and 18.5 (Visit 3) months after SARS-CoV-2 infection. They were classified into three groups (no-vaccination (n = 54), one-dose (n = 62), and two-dose (n = 92) groups) on the basis of the administration of inactivated vaccination. The neutralizing antibody (NAb) titers against the wild-type virus continued to decrease in the no-vaccination group, but they rose significantly in the one-dose and two-dose groups, with the highest NAb titers being observed in the two-dose group at Visit 3. The NAb titers against the Delta variant for the no-vaccination, one-dose, and two-dose groups decreased by 3.3, 1.9, and 2.3 folds relative to the wild-type virus, respectively, and those against the Omicron variant decreased by 7.0, 4.0, and 3.8 folds, respectively. Similarly, the responses of SARS-CoV-2 RBD-specific B cells and memory B cells were boosted by the second vaccine dose. Results showed that the convalescents benefited from the administration of the inactivated vaccine (one or two doses), which enhanced neutralization against highly mutated SARS-CoV-2 variants and memory B cell responses. Two doses of inactivated vaccine among COVID-19 convalescents are therefore recommended for the prevention of the COVID-19 pandemic, and vaccination guidelines and policies need to be updated.

This paper reported a case of severe COVID-19 in the recovery stage with acute lymphoblastic leukemia treated by integrated traditional Chinese and western medicine， with the intention of shedding light on the clinical diagnosis and treatment of similar conditions. The patient， who had acute lymphoblastic leukemia， developed COVID-19 infection during the bone marrow suppression period after chemotherapy. Treatment with western medicine was mainly anti-infection， symptomatic management， and supportive care. During the recovery stage， considering the patient's chemotherapy history and disease progression， the overall syndrome was identified as deficiency of both qi and yin and binding of phlegm and blood. Based on the “state-target” combined treatment strategy， herbal prescriptions were selected and modified to address the “deficiency state”， “disease target”， and “symptom target”. In addition to western medicine， the patient was administered with Shengmai Powder （生脉散） and Compound Zhebei Granules （复方浙贝颗粒） in its modifications to boost qi， nourish yin， and reinforce healthy qi， nourish and cool the blood， ultimately achieving satisfactory therapeutic effects.

Objective:To investigate the impact of diabetes mellitus (DM) and stroke on long-term outcomes in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).Methods:Total 411 consecutive ACS patients undergoing PCI at the Ninth People′s Hospital of Zhengzhou between December 2014 and June 2018 were recruited, including 319 males and 92 females with a mean age of (64.7±10.1) years. These patients were divided into 4 groups according to the presence or absence of history of diabetes or stroke: non-DM non-stroke group ( n=192) , DM group ( n=140), stroke group ( n=41), and DM+stroke group ( n=38). The data of baseline demographic characteristics, clinical feature, coronary angiographic findings, and cardiovascular adverse events during long-term follow-up were obtained. Kaplan-Meier curves were used to investigate the long-term clinical outcomes among groups. Results:The mean interval of follow-up was (24.1±13.8) months. Patients with DM+stroke had the highest rates of non-fetal myocardial infarction (χ 2=24.932) , non-fetal stroke (χ 2=9.434) , hospitalization due to heart failure/angina (χ 2=69.290) , revascularization (χ 2=22.918) , cardiovascular death(χ 2=13.473)and all-cause death(χ 2=17.724)as well as hard endpoint events (the sum of non-fetal myocardial infarction, non-fetal stroke, and all-cause death) (χ 2=30.268)and combined major adverse cardiovascular events (MACE) (the sum of hard endpoint events, hospitalization due to heart failure/angina, and revascularization) (χ 2=119.556)among 4 groups(all P<0.01). In Kaplan-Meier survival analysis, the cumulative ratio of freedom from all-cause death decreased significantly in DM+stroke group compared with no DM no stroke group ( HR=17.121, 95 %CI: 2.527-115.934, P<0.01), but no statistical difference was observed in the cumulative ratio of freedom from all-cause death between DM+stroke group and DM group or stroke group respectively ( HR=3.178, 95 %CI: 0.744-13.582; HR=1.383, 95 %CI: 0.374-5.118; all P>0.05) . Meanwhile, patients with DM+stroke presented significantly lower cumulated ratio free from combined MACE than patients with non-DM non-stroke ( HR=5.423, 95 %CI:2.941-10.036, P<0.01), and the cumulated ratio free from combined MACE also decreased significantly in DM+stroke group as compared to DM group or stroke group respectively ( HR=1.859,95 %CI: 1.167-2.962; HR=1.991,95 %CI: 1.178-3.364; all P<0.01) . Conclusions:ACS patients with combined history of DM and stroke have a worse long-term outcomes after PCI than those with DM alone or stroke alone or without DM or stroke. DM and stroke seemed to have an additive effect on decrease in the cumulative ratio free from combined MACE in ACS patients following PCI.

OBJECTIVE: To observe the improvement effects of angiotensin converting enzyme inhibitor (ACEI) fosinopril, perindopril and benazepril on ventricular remodeling in patients with acute myocardial infarction (AMI), and to evaluate its safety. METHODS: A total of 96 AMI patients selected from our hospital during Jan. 2014-Oct. 2016 were divided into group A, B, C according to random number table, with 32 cases in each group. All patients received symptomatic treatment, underwent percutaneous coronary intervention, and then given ACEI after blood vessels recanalization and keeping blood pressure stable. Group A was given Fosinopril sodium tablets 10 mg, qd; group B was given Perindopril tert-butylamine tablets 4 mg, qd; group C was given Benazepril hydrochloride tablets 10 mg, qd. All groups were treated for consecutive 6 months. Cardiac structure and function indexes (LVESD, LVEDD, IVSD, LVPWD, LVEF, CO), hemodynamic indexes (SBP, DBP, HR) and related lab indexes (FPG, TG, TC, HDL-C, LDL-C, AST, ALT, Scr, BUN) of 3 groups were observed before and after treatment. The occurrence of ADR was recorded. RESULTS: Before treatment, there was no statistical significance in cardiac structure and function indexes, hemodynamic indexes or related lab indexes among 3 groups (P＞0. 05). After treatment, the levels of LVESD, LVEDD, LVPWD, CO, HR, FPG, TG, TC and LDL-C in 3 groups were decreased significantly, while the levels of LVEF and SBP were increased significantly, with statistical significance (尸＜0. 05). There was no statistical significance in above indexes among 3 groups after treatment (P＞0. 05). After treatment, the level of Scr in group B was significantly increased and higher than group A and C, with statistical significance (P＜0. 05). There was no statistical significance in the levels of IVSD, DBP, HDL-C, AST, ALT or BUN among 3 groups before and after treatment as well as the level of Scr between group A and C (P＞ 0. 05). There was no statistical significance in the incidence of ADR among 3 groups(P＞0. 05). CONCLUSIONS: Fosinopril, perindopril and benazepril can significantly improve ventricular remodeling in AMI patients, narrowing the heart cavity, increasing systolic pressure, lowering heart rate, reducing the oxygen consumption of the ventricle, with similar effects. Perindopril may increase the level of Scr, so fosinopril and benazepril are safe and suitable for AMI patients with renal function disorder.

ABSTRACT:Objective To compare the prognostic value of cystatin-C (Cys-C)and creatinine (Cr)in chronic heart failure (CHF)in old people.Methods We recruited 183 old patients (>75 years)diagnosed with CHF hospitalized at the Department of Cardiology and the Department of Geriatrics of our hospital from 2010 to 2012. Venous blood was withdrawn to detect the expressions of Cys-C and Cr.After three-year follow-up,the patients’ three-year survival was recorded.Logistic regression model was used to examine the relationship of Cys-C,Cr and other risk factors with the CHF patients’mortality.ROC curve was used to compare the prognostic value of Cys-C and Cr in CHF in old people and statistical method was adopted to analyze the combined use of Cys-C and Cr for determining their value in evaluating CHF prognosis.Results At the end of the follow-up,74 (40.44%)patients died.Serum cys-C and Cr levels of the patients in death group increased compared with those in survival group (P<0.05).Multivariate logistic regression showed that age (OR=1.11,95% CI=1.04-1.19),SBP (OR=1.06,95%CI=1.01-1.10),LVEF (OR=0.89,95% CI=0.82-0.95),BNP (OR=4.74,95% CI=1.77-12.69), creatinine (OR=2.04,95% CI=1.03-4.08),and Cys-C (OR=2.97,95% CI=1.44-6.12)were the independent risk factors for the prognosis of CHF.ROC analysis showed that Cys-C was superior to creatinine in AUC value (0.71 vs.0.65;95% CI,0.64-0.78;95% CI,0.58-0.72)(P<0.001).The AUC value of Cys-C and Cr in combination was 0.73 (95% CI,0.66-0.79).Conclusion Cys-C is a stronger predictor of the prognosis of CHF patients than creatinine and the combination of the two can increase the sensitivity and specificity in evaluating the prognosis of patients with CHF.

Objective To sum up the techniques of radiofrequency ablation assisted laparoscopic liver resection .Methods A ret-rospective analysis was done based on the clinical data of 16 patients undergone radiofrequency ablation assisted laparoscopic liver resection from July 1 ,2011 to July 30 ,2012 .Results Sixteen patients were all received successful total laparoscopic liver resection . Anatomical liver resection was carried out on 5 patients including 2 left hemihepatectomy ,2 left lateral segmentectomy ,1 right pos-terior lobectomy ,and 11 patients underwent nonanatomical hepatectomy .None was transected under regional hepatic blood inflow occlusion .The mean operation time was 125 minutes(range 35-335 minutes) ,mean blood loss 310 mL(range 20~1 100 mL) ,and mean hospital stay 9 days(range 5 to 16 days) .No operation death and postoperative complications occurred .The patients were fol-lowed up for 2 to 12 months ,1 recurrence was found in patients with Ⅶ segment hepatocellular carcinoma 60 day after operation . Conclusion The application of radiofrequency ablation assisted laparoscopic liver resection can effectively control the resection mar-gin hepatic blood inflow to ensure the success of operation and reduction of complications .

Objective To study the early therapeutic principle of severe acute pancreatitis(SAP)complicated with intra-abdominal hypertension(IAH).Methods We reviewed 32 cases SAP complicated with IAH from January 2003 to January 2008 in our department.All cases' clinical features and early management were summarized.Results The intra-abdominal pressure of all the cases was above 15cmH2O.5 deaths occured in non-operation treated cases,6 deaths in the 11 operated cases,and all the dead cases reached the standard of ACS.Conclusions The uses of early individualized treatment can decrease the opportunity of decompressive operation,we can effectively improve the therapeutic effect of SAP complicated with IAH and reduce the probability of complicating with ACS.

OBJECTIVE To determine the distribution and antibiotic resistance of bacteria isolated from cerebral spinal fluid in neurosurgical patients. METHODS Bacterial isolates from cerebral spinal fluid specimens in Department of Neurosurgery,Beijing Tiantan Hospital were collected from Jan 2000 to Dec 2004.Distribution and antibiotic resistance of pathogens were analyzed retrospectively. RESULTS Of 438 isolates,Gram positive cocci and Gram negative bacilli accounted for 72.1%(316 isolates) and 27.9%(122 isolates),respectively.The most frequently isolated pathogen was coagulasenegative staphylococci(53.7%) followed by Staphylococcus aureus(10.5%),Enterobacter spp(6.2%),Acinetobacter spp(6.2%),and Pseudomonas aeruginosa(3.7%).The most active compounds against Gram-negative bacilli were imipenem(87% susceptibility),piperacillin/tazobactam(77%),amikacin(68%),cefepime(64%) and ceftazidime(63% susceptibility).Imipenem,cefepime,ceftazidime,and piperacillin/tazobactam demonstrated excellent activity against most of Gram negative bacilli.In S.aureus and coagulase-negative staphylococci,oxacillin resistance strains accounted for 76% and 100%,respectively. CONCLUSIONS Prevailing pathogens are Gram positive cocci in intracranial infection after neurosurgical operation,especially coagulase-negative staphylococci and S.aureus.Data collected in present study will provide valuable information for prophylactic and empirical antibiotic use in post-operative intracranial infection.

OBJECTIVE: To observe the effects of recipes for replenishing qi and activating blood on p16, p21, proliferating cell nuclear antigen (PCNA), cyclin D1 and cyclin E gene expressions in the liver of aging rats. METHODS: A recipe for replenishing qi and a recipe for activating blood were administered to aging rats respectively, and the effects of the above recipes on the expressions of senescence related genes (p16, p21, PCNA, cyclin D1 and cyclin E) were examined by RT-PCR and Western blotting methods. RESULTS: The expressions of p16, p21 and cyclin D1 mRNAs and proteins in the liver of the untreated aging rats were up-regulated, while the expressions of PCNA and cyclin E mRNAs and proteins decreased. As compared with the untreated aging rats, both recipes could down-regulate the expressions of cyclin D1 mRNA and protein and up-regulate the expressions of cyclin E mRNA and protein, but had no obvious effects on the expressions of mRNAs and proteins of p16, p21 and PCNA. CONCLUSION: Recipes for replenishing qi and activating blood can improve the liver cell proliferation of aging rats via down-regulating the expressions of cyclin D1 mRNA and protein and up-regulating the expressions of cyclin E mRNA and protein.