Climate change has emerged as a focal point of global concern in the 21st century.This paper systema-tically summarizes the direct and indirect impacts of climate change on human health,including directly causing hu-man death and disability in the form of disasters,and increasing the risk of climate-sensitive diseases,including chronic non-infectious diseases,infectious diseases,mental and psychological problems,as well as allergic diseases and malnutrition through changes in temperature and humidity,air pollution,as well as changes in the geographical distribution of disease vectors.Based on these,within the global governance framework,this paper focuses on the challenges faced by medical institutions in the field of infection prevention and control,and explores in depth infec-tion control response strategies from five aspects,so as to provide reference for further enhancing the climate resi-lience capacity of the medical system and safeguarding public health.

Climate change has emerged as a focal point of global concern in the 21st century.This paper systema-tically summarizes the direct and indirect impacts of climate change on human health,including directly causing hu-man death and disability in the form of disasters,and increasing the risk of climate-sensitive diseases,including chronic non-infectious diseases,infectious diseases,mental and psychological problems,as well as allergic diseases and malnutrition through changes in temperature and humidity,air pollution,as well as changes in the geographical distribution of disease vectors.Based on these,within the global governance framework,this paper focuses on the challenges faced by medical institutions in the field of infection prevention and control,and explores in depth infec-tion control response strategies from five aspects,so as to provide reference for further enhancing the climate resi-lience capacity of the medical system and safeguarding public health.

Abstract: Objective　To understand the behavioral characteristics of men who have sex with men (MSM) in different sexual roles and the current status of syphilis-HIV co-infection and mono-infection in Shenzhen, and to analyze the relationship between sexual roles and syphilis-HIV status. Methods　The snowball and respondent-driven sampling (RDS) were used to recruit MSM in Shenzhen for questionnaire surveys and serological testing of syphilis and HIV. Chi-square test, Wilcoxon two-sample test, Kruskal-Wallis test, and multivariate logistic regression model were used to analyze the factors associated with the sexual roles and syphilis-HIV co-infection and mono-infection. Results　A total of 839 MSM were recruited from 2019 to 2021. Of all, 289(34.45%) were receptive group, 270(32.18%) were insertive group, and 280(33.37%) were versatile group. Statistically significant differences were found among the three groups in age, household registration, educational background, first sexual partner, age of having anal sex for the first time, number of sexual partners in the last 6 months, having heterosexual sex in the last 6 months, and drug abuse (rush) in the last 6 months (χ2=34.980, 9.570, 7.621, 7.924, 23.229, 11.991, 37.717, 10.678, P<0.05). Among 839 MSM, the prevalence of syphilis-HIV co-infection, mono-HIV infection, and mono-syphilis infection were 4.17%, 5.13%, and 9.54%, respectively; the infection rates of the receptive group were 5.54%, 6.92%, and 10.03%, respectively; the infection rates of the versatile group were 4.29%, 6.43%, and 9.64%, respectively; the infection rates of insertive group were 2.59%, 1.85%, and 8.89%, respectively; there were statistical differences in infection rates of syphilis-HIV co-infection and mono-infection among different sexual roles (χ2=14.520, P=0.024 3). Ordinal logistic regression indicated that playing exclusively receptive and versatile roles in anal sexual intercourse in the last 6 months, the older MSM (≥30), senior high school and below, the younger age at the first anal, having 6 or more anal sexual partners, and not insist on using condoms in anal sexual intercourse were associated risk factors for syphilis-HIV co-infection and mono-infection. Compared with MSM in the insertive group, receptive MSM had 2.21 times the risk of syphilis-HIV co-infection and mono-infection (aOR=2.21, 95%CI:1.39-3.51), and versatile MSM had 1.26 times the risk (aOR=1.26, 95%CI:1.07-2.18). Conclusion　MSM with different sexual roles exhibit distinct demographic and sexual behavior characteristics, as well as varying risks for syphilis and HIV infections. Individualized and different corresponding preventive measures should be taken for MSM towards different sex roles and sexual behaviors.

OBJECTIVE To investigate the improvement effects of Arisaema Cum Bile on Parkinson’s disease （PD） model mice and its potential mechanism. METHODS Sixty male C57BL/6J mice were randomly divided into normal group， model group， Arisaema Cum Bile low-dose group [0.39 g/（kg·d）]， Arisaema Cum Bile high-dose group [1.56 g/（kg·d）] and positive control drug Levodopa tablet group [80 mg/（kg·d）]， with 12 mice in each group. Except that normal group was given constant volume of normal saline， other groups were given 1-methyl-4-phenyl-1，2，3，6-tetrahydropyridine [MPTP，35 mg/（kg·d）] intraperitoneally for 5 consecutive days to induce subacute PD model； after modeling， they were given relevant medicine continuously for 7 d； rod climbing test and line suspension test were performed 1 d before modeling， on the 5th day of modeling and after the last medication. The number of tyrosine hydroxylase （TH）-positive neurons in the substantia nigra of mice were measured by immunofluorescence； the levels of interleukin 1β （IL-1β） and tumor necrosis factor α（ TNF-α） in serum and the levels of IL- E-mail：qhwang668@sina.com 1β， TNF-α， cyclooxygenase-2 （COX-2） and inducible nitric oxide synthase （iNOS） in the substantia nigra of mice were measured by enzyme-linked immunosorbent assay. The expression levels of cAMP-dependent protein kinase catalytic subunit α （PKA C-α）， glutathione peroxidase 4 （GPX4） and ferritin heavy chain polypeptide 1 （FTH1） proteins in the substantia nigra of mice was measured by Western blot. RESULTS After last medicine， compared with the normal group， mice in the model group had significantly longer pole-climbing time （P＜0.01）， significantly lower line suspension scores （P＜0.01）， significantly fewer TH-positive neurons in the substantia nigra （P＜0.01）， significantly higher serum concentrations of IL-1β and TNF-α and nigrostriatal concentrations of IL-1β， TNF-α， COX-2 and iNOS （P＜0.01）， while lower protein expression levels of GPX4， PKA C-α and FTH1 in the substantia nigra （P＜0.05 or P＜0.01）. Compared with the model group， the above indexes of mice were significantly returned in Arisaema Cum Bile high-dose group （P＜0.05 or P＜ 0.01）. CONCLUSIONS Arisaema Cum Bile can improve motor impairment and reduce apoptosis of nigrostriatal TH neurons in MPTP-induced PD mice， and has neuroprotective effects on model mice； this may be related to its inhibition of neuroinflammation and the inhibition of ferroptosis by up-regulating PKA signaling pathway.

By searching the literature on the application of entrustable professional activities in college education in China and globally, this article comprehensively analyzes the concept of entrustable professional activities, the development of evaluation items, the effectiveness of clinical application, the problems to be improved, and research prospects, so as to provide a useful reference for the reform and evaluation of competency-oriented medical education in China and the application of entrustable professional activities that can be repeated and promoted in clinical teaching.

Abstract OBJECTIVE Linezolid(LZD) is a synthetic oxazolidone antibacterial drug that has activity against most Gram positive bacteria. LZD is widely used in pediatric patients, and its common adverse reactions include gastrointestinal reactions and bone marrow suppression, etc. In recent years, LZD-induced hyperlactatemia has gradually attracted attention. LZD-induced hyperlactatemia can exacerbate the condition of pediatric patients and is associated with high mortality rates in children. However, there is currently a lack of data on the risk factors for LZD-induced hyperlactatemia in pediatric patients. METHODS Therefore, this paper collected and retrospectively analyzed the information of hospitalized pediatric patients who received LZD treatment at the Children's Hospital of Chongqing Medical University from October 2012 to February 2023, including demographic characteristics of pediatric patients and clinical treatment related records, etc. According to the inclusion and exclusion criteria, this paper identified whether the included pediatric patients had developed hyperlactatemia and evaluated the causal relationship between LZD and hyperlactatemia using the Naranjo's Scale. The risk factors were analyzed using univariate and multivariate logistic regression, and the dose-response relationship between risk factors and LZD-induced hyperlactatemia was further analyzed using a restricted cubic spline(RCS) model. RESULTS A total of 331 pediatric patients were included, of which 145 pediatric patients(43.8%) developed LZD-induced hyperlactatemia, including 122 cases of mild hyperlactatemia and 23 cases of severe hyperlactatemia; the causal relationship score of LZD-induced hyperlactatemia was “possibly related” in 87 cases(60.0%) and “highly likely related” in 58 cases(40.0%). The median age of pediatric patients was 3(0.92, 9) years old, with 55.29% males, 25.38% patients with liver disease, 8.76% pediatric patients with kidney disease, and 36.56% pediatric patients with cardiovascular disease; the median number of treatment days for pediatric patients receiving LZD was 13(8, 22) d, with pediatric patients with hyperlactatemia having a longer median number of LZD treatment days than those without hyperlactatemia[16(10, 28) vs 11(7, 18)]; 41.09% of pediatric patients used P-glycoprotein inducers in combination, with more pediatric patients(57.4%) experiencing hyperlactatemia; 53.47% of pediatric patients used P-glycoprotein inhibitors in combination; the median values of lactic acid baseline, creatinine baseline, and baseline estimated glomerular filtration rate(eGFR) were 0.92(0.80, 0.92)mmol·L-1, 26(18.25, 34.90) μmol·L-1, 179.97(137.23, 222.70)mL·min-1·(1.73 m)-2, respectively. Multivariate logistic regression analysis showed that pediatric patients received longer LZD treatment duration(OR=1.026, P=0.004), and the combination of P-glycoprotein inducers(OR=2.023, P=0.004), higher lactic acid baseline levels(OR=2.408, P=0.022), and lower eGFR(OR=0.997, P=0.047) were independent risk factors for LZD-induced hyperlactatemia. The RCS model showed that as the number of days of LZD treatment increases, the risk of LZD-induced hyperlactatemia increased nonlinearly(P-non-linear=0.041); when the lactic acid baseline value was -1, the risk of LZD-induced hyperlactatemia dramatically increased as the lactic acid baseline value increased, when it was >0.92 mmol·L-1, the risk of LZD-induced hyperlactatemia slowly increased as the lactic acid baseline value increased(P-non-linear=0.013). CONCLUSION This study explores for the first time the risk factors of LZD-induced hyperlactatemia in pediatric patients, including the impact of the interaction between LZD and drugs that affect mitochondrial function, P-glycoprotein inducers, and P-glycoprotein inhibitors on hyperlactatemia. RCS models are used to analyze the dose-response relationships between LZD treatment days, lactic acid baseline values, and the occurrence of LZD-induced hyperlactatemia. When LZD is combined with P-glycoprotein inducers(mainly isoniazid, rifampicin, and ethambutol), the risk of LZD-induced hyperlactatemia increases, and its related mechanisms still need further research. In addition, pediatric patients with renal insufficiency may need to adjust the LZD dosage appropriately to avoid the occurrence of hyperlactatemia. In conclusion, when pediatric patients receive LZD treatment, attention should be paid to risk factors such as lactic acid baseline value, duration of LZD use, combined use of P-glycoprotein inducers, and renal dysfunction, in order to prevent the occurrence of LZD-induced hyperlactatemia based on the pediatric patient's treatment needs.

Objective:To investigate the effects of mixed probiotics on food allergy and the underlying mechanism.Methods:BALB/c mice on the 15 th day of pregnancy were randomly (random number table method) classified into the control group, food allergy model group and mixed probiotics group.Mice in the food allergy model and mixed pro-biotics group were subjected to ovalbumin (OVA) sensitization after birth, and those in the mixed probiotics group were then given probiotic solution by gavage from day 21 to day 35.Mice in control group were similarly given 9 g/L saline.Twenty-four hours after the last OVA sensitization, intestinal histopathological sections were prepared to observe intestinal pathological changes.Blood smears were prepared to detect eosinophil count.In addition, serum samples were collected to measure cytokine levels and OVA specific antibodies.The number of dendritic cells (DCs) and regulatory T cells (Tregs) in mouse mesenteric lymph nodes was calculated.Differences among 3 groups were compared by the One- Way ANOVA or Kruskal- Wallis H test. Results:Compared with those of food allergy model group, diarrhea score, the ratio of eosinophils and serum levels of interleukin(IL)-4, IL-5, IL-13, mast cell protease 1 (MCPT-1), and OVA specific antibodies IgE and IgG were significantly lower in mixed probiotics group[(2.00±0.71) points vs.(3.22±0.97) points, (2.28±1.61)% vs.(10.99±2.26)%, (413.68±22.81) ng/L vs.(708.78±27.66) ng/L, (36.64±3.74) ng/L vs.(46.05±4.95) ng/L, (201.37±65.61) ng/L vs.(495.22±96.66) ng/L, (31 924.15±1 177.77) ng/L vs.(36 175.77±618.29) ng/L, (9.10±8.08) ng/L vs.(19.69±0.84) ng/L, (30.50±8.81) ng/L vs.(190.32±6.40) ng/L], while IL-10 level was significantly higher[(164.12±3.88) ng/L vs.(123.90±7.31) ng/L] ( t=3.37, 8.72, 16.07, 3.90, 7.40, 7.95, 3.91, 44.00 and 7.76, respectively, all P<0.01). Compared with those of food allergy model group, programmed cell death ligand 1 (PD-L1) level on the surface of CD 103+ DCs and CD 103+ CD 80-CD 40-DCs, the proportion of Tregs in CD4 + T cells, and the level of programmed cell death 1 (PD-1) on the surface of Tregs were significantly higher in mixed probiotics group[(75.59±0.45)% vs.(45.60±4.73)%, (67.56±1.87)% vs.(37.12±6.07)%, (8.24±0.69)% vs.(6.20±0.66)%, (11.25±3.12)% vs.(4.08±2.33)%]( t=7.88, 4.48, 3.63 and 3.71, all P<0.01). Conclusions:Mixed probiotics can alleviate the symptoms of food allergy and inflammatory response of young rats through mediating Tregs via the PD-1/PD-L1 pathway.

Objective:To study minimally invasive treatment using percutaneous transhepatic choledochoscopic lithotripsy (PTCSL) to treat complicated hepatolithiasis.Methods:Patients with complicated hepatolithiasis who were treated at the Second Affiliated Hospital of Kunming Medical University from July 2017 to September 2021, were included into this study. There were 48 patients treated with PTCSL (the PTCSL group) and 150 patients treated with conventional open hepatectomy (the OH group). Propensity score matching (PSM) was used to match 40 patients in the PTCSL group with 40 patients in the OH group. There were 11 males and 29 females, aged 32 to 85 (59.3±12.7) years in the PTCSL group and 15 males and 25 females, aged 20 to 74 (55.4±10.9) years in the OH group. Theoperation time, intraoperative blood loss, hospitalization time, hospitalization cost, incidences of major complications (including pleural effusion, biliary bleeding), residual stone rates and recurrence rates were analyzed.Results:Baseline data were comparable between groups after PSM. For the PTCSL group, the operation time was (135.8±42.6) minutes, intraoperative bleeding volume 32.5(20.0, 50.0) ml, hospitalization time 13.5(11.0, 18.0) days, and hospitalization expense 3.4(2.9, 5.0) wanyuan compared with the corresponding figures in the OH group with operation time (350.7±113.8) minutes, intraoperative bleeding volume 475.0(200.0, 900.0) ml, hospitalization time 24.0(17.3, 28.8) days, and hospitalization expense 6.6(5.0, 8.9) wanyuan. The differences between the two groups were statistically significant (all P<0.05). The overall complication rate was 2.5%(1/40) in the PTCSL group and 22.5%(9/40) in the OH group (χ 2=7.31, P=0.007). The residual stone rate of 20.0%(8/40), stone recurrence rate of 17.5%(7/40), compared with the OH group with the stone residual rate of 27.5%(11/40), stone recurrence rate of 12.5%(5/40). There was no significant difference between the two groups in both the stone residual rates and stone recurrence rates (both P>0.05). Conclusion:In treatment of complex hepatolithiasis, the stone residual rate after repeated PTCSL was comparable to traditional open hepatectomy. PTCSL had the advantages of shorter operation time, less bleeding, lower hospitalization time, lower complication rate and lower hospitalization cost. PTCSL is worthy of wider application and popularization.

OBJECTIV E To establish the method for evaluating the quality o f Plantago asi atica and fried P. asiatica . METHODS The fingerprints of 15 batches of P. asiatica and 15 batches of fried P. asiatica were established by HPLC. The common peaks were identified with the Similarity Evaluation System for Chromatographic Fingerprinting of TCM （2012 edition）， and similarity evaluation was performed. Analysis of chemical pattern recognition was performed by using SPSS 25.0 and SIMCA-P 14.1 software（cluster analysis ，principal component analysis and orthogonal partial least squares regression analysis ）. The markers which affected the difference in the quality between P. asiatica and fried P. asiatica were screened with variable importance projection（VIP）value greater than 1. RESULTS There were 18 common peaks in the fingerprints of 15 batches of P. asiatica and 13 common peaks in the fingerprints of 15 batches of fried P. asiatica . A total of 8 common peaks were found in both of them. Their similarities were greater than 0.920. Two common peaks were identified as geniposidic acid ，acteoside. The results of cluster analysis showed that when the spacing was 10，the 30 batches of samples could be clustered into three categories ，with S 1-S5 as one，S16-S20 as one ，S6-S15 and S 21-S30 as one . The results of the pri ncipal component analysis showed that the cumulative variance contribution rate of the first two principal components was 82.575％ . The results of the orthogonal partial least squares regression analysis showed that the VIP values of the three common peaks were greater than 1，namely peak E（acteoside）， peak D （geniposidic acid ） and peak G. CONCLUSIONS Established fingerprints are stable ，simple sina.com and rapid. It can be used for the quality evaluation of P. asiatica and fried P. asiatica ，by combining with analysis of chemical pattern recognition. Acteoside ，geniposidic acid and the component represented by peak G may be the markers affecting the difference in quality of P. asiatica and fried P. asiatica .

Objective:To develop an program for training diabetes educators amid normalization stage of novel coronavirus pandemic prevention and control, and provide reference for clinical teaching under special circumstances.Methods:From January 2020 to June 2021, The head member of Diabetes Education and Management Committee of Hunan Health Management Association Xiangya Hospital of Central South University, developed and implemented a program based on core competencies of diabetes educators. It included 26 online courses, one to one education demonstration video with 7 themes, one diabetes conversation map and simulation, and three-week clinical practice. From April 2021 to June 2021, 55 health workers participated in the program. Theoretical tests, video feedback and questionnaires were used to evaluate the trainees′ diabetes knowledge, educational skills and satisfaction with the training program.Results:A total of 55 health workers participated in the program. All the participants completed the online courses and passed the quizzes, the theoretical examination score was (92.93 ± 5.28). Fifty-four participants finished the tasks of clinical practice and obtained the certificate of diabetes educator. Their communication skills and strategies of behavior change were significantly improved ( χ2 values were 4.17 -26.34, all P<0.05), and all of them were satisfied with the program. Conclusions:The training mode based on online training is flexible, convenient and effective,which is suitable for stage of novel coronavirus pandemic prevention and control.