Objective:To investigate the expression of high mobility group box‐1 (HMGB1) in rat model of ventilator‐induced lung injury (VILI) .Methods :Twenty‐four healthy adult SD rats were randomly divided into three groups ,with 8 rats in each group .The control group:autonomous respiration .The large tidal volume group :tidal volume(TV)= 30 mL/kg .The ethyl pyruvate(EP) intervention group :EP 100 mg/kg via the caudal vein and the same ventilation mode as the large tidal volume group .The levels of HMGB1 and inflammatory factors in serum and bronchoalveolar lavage fluid (BALF)and lung tissues ,as well as in the culture medium of alveolar macrophages before and after mechanical stretching ,were detected with Western blot‐ting ,RT‐PCR and ELISA .Results:The levels of HMGB1 in serum ,BALF and lung tissues of the large tidal volume group were higher than those of the control group .HMGB1 in the culture medium of alveolar macrophages was increased under me‐chanical stretching .The expression of HMGB1 decreased ,and the proteins related to signal pathway of apoptosis as Caspase3 , Caspase9 and PARP increased ,in lung tissues of rat with VILI after EP intervention .Conclusions :The expression of HMGB1 increases in rat model of VILI ,which may be related with the effect of mechanical stretching on alveolar macrophages .EP intervention had certain protective effect on lung tissues with VILI .

Objective:To analyze the bubble dynamic characteristics of shock wave enhanced emission photoacoustic streaming(SWEEPS)technique in free water region under different temporay delays.Methods:The Er∶YAG laser tip was activated in free water model with SWEEPS mode at 150-600 μs pulse delay.The bubble dynamic process during irrigation was recorded by a high-speed camera(200 000 Hz).Matlab was used to analyze the interaction between bubble made by the dual pulses frame by frame.The distance between bubble remnants and laser tip was measured before the bubble disappeared.The experimental data were statisti-cally analyzed by SPSS 19.0.Results:In free water region,different temporal delays caused different interaction between the bub-bles activated by the SWEEPS technique with a dual pulse modality.The interactions include bubble fusion,bubble collision and bubble separation.When the temporal delay between 360-440 μs,bubble collision was the most violent,and the farthest distance between bubble remnants and laser tip was reached.Conclusion:In free water region,the dual pulse of SWEEPS technique can lead to bubble interaction which may enhance the cavitation effect of Er∶YAG laser irrigation,and improve the debridement in clinic ap-plication.

Objective:To explore the distribution characteristics and antibiotic resistance of pathogen in children with hematological disorders and cancers complicated with sepsis in pediatric intensive care unit (PICU).Methods:The clinical data of children with hematological disorders and cancers complicated with sepsis hospitalized at Shenzhen Children′s Hospital affiliated to China Medical University from January 2016 to August 2023 were retrospectively analyzed. Patients were divided into survival group and death group based on the outcome of sepsis on 28 days after diagnosis.Results:A total of 202 sepsis episodes occurred in 176 children were enrolled in this study. Among all, 144 (71.3%) cases of bloodstream infection, 59 (29.2%) cases of pulmonary infection, 21 (10.4%) cases of abdominal infection, 9 (4.5%) cases of soft tissue infection, 9 (4.5%) cases of nervous system infection, and 3 (1.5%) cases of urinary tract infection. A total of 244 pathogenic strains were identified, in which 74 (30.3%) cases were gram-positive bacteria. The top 3 pathogens isolated were Coagulase negative Staphylococcus (21 strains), Staphylococcus aureus (19 strains) and Streptococcus pneumoniae (13 strains). Gram-negative bacteria accounted for 122 (50.0%) strains, in which top 3 were Klebsiella pneumonia (33 strains), Escherichia coli (25 strains), and Pseudomonas aeruginosa (23 strains). Fungi comprised 48 (19.7%) strains:the top 3 were Candida tropicalis (14 strains), Candida albicans (10 strains), Aspergillus and Pneumocystis jirovecii (7 strains each). The incidence of Acinetobacter baumannii, Stenotrophomonas maltophilia, and Pseudomonas aeruginosa were significantly higher in death group compared to survival group[9.0%（6/67）vs. 2.3%（4/177）, χ2＝3.971 ，P＝0.046; 9.0%（6/67）vs. 1.1%（2/177）, χ2＝7.080 ，P＝0.008;16.4%（11/67）vs. 6.8%（12/177）, χ2＝5.288 ，P＝0.021]. The samples of 57 cases were simultaneously detected by both culture and metagenomic next-generation sequencing (mNGS). Pathogens were detected in 25 cases by both culture and mNGS. In 30 cases, pathogen detection were mNGS positive but culture negative. Two cases showed positive results only with culture. A total of 79 (46.8%) strains were multi-drug resistant bacteria, including 27 (34.2%) strains of gram-positive bacteria and 52 (65.8%) strains of gram-negative bacteria. A total of 174 (86.1%) children with sepsis received empirical anti-infective drugs within 24 hours of fever onset. A total of 124 (61.4%) cases were appropriately covered by the initial empirical antibiotics, while 40 (19.8%) cases were not adequately covered and 10 (5.0%) cases had incomplete coverage. Despite the inclusion of pathogenic in the coverage, resistance to initial antibiotics was observed in 22 (10.9%) cases. Fifty-one patients died. Conclusion:The predominant pathogens responsible for sepsis in PICU with hematological disorders and cancers is gram-negative bacteria, followed by gram-positive bacteria and fungi. In comparison to healthy children with sepsis, there is a higher incidence of fungal infections among hematological disorders and cancers. The proportion of multi-drug resistant bacteria infection is high. Early identification and combination of local etiological distribution and drug resistance, along with the empirical selection of appropriate anti-infection treatment strategies, can greatly enhance survival rate.

Triple-negative breast cancer (TNBC) is a subtype of breast cancer characterized by the absence of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). It is highly aggressive, easy to relapse, and chemotherapy remains its mainstay treatment due to the lack of therapeutic targets. In recent years, many advances have been made in the development of immunotherapy for TNBC. This review summarizes the primary modalities of immunotherapy for TNBC, including immune checkpoint inhibitors, adoptive immune cell therapy, tumor vaccines and oncolytic virus. We present the latest research progress on each treatment from the perspective of clinical study and fundamental research, while introducing the potential predictive biomarkers and resistance mechanisms of immunotherapy for TNBC.

ObjectiveTo explore the establishment of performance assessment indicators for the classification and grading of public health staff in district-level Centers for Disease Control and Prevention (CDCs), and to provide a basis for such evaluations. MethodsThrough literature review and group interviews, performance evaluation indicators were developed based on competency evaluation. Experts were invited to evaluate the weight of performance evaluation indicators for public health staff from different categories, with the average value used to represent the weight of each indicator. ResultsTwenty-nine experts from universities in Shanghai, municipal CDCs, and district CDCs participated, yielding an expert authority coefficient of 0.86. The performance evaluation indicators for department managers were categorized into three levels, with 4 indicators at the primary level, 16 indicators at the secondary level, and 42 indicators at the tertiary level, while those for general staff included 4 primary indicators, 15 secondary indicators, and 36 tertiary indicators. Significant differences were observed in the weight coefficients of the primary indicators (internal operations, professional work, and learning and growth) between department managers and general staff. The top three secondary indicators for department managers were department management, monitoring and prevention, and level of expertise. For mid-level and senior staff, the top three secondary indicators were monitoring and prevention, level of expertise, and research work. The top three secondary indicators for junior staff were monitoring and prevention, professional expertise, and professional attitude. No significant statistical differences were found among tertiary indicators. ConclusionThe developed performance evaluation indicators are reliable. Staff at different levels and classifications should be evaluated using different performance evaluation standards to accurately reflect individual performance and contributions.

ObjectiveTo understand the stress level of people seeking psychological counseling under the coronavirus disease 2019 （COVID⁃19） pandemic and to explore its related factors. MethodsAn online survey was conducted on 1 194 people who sought psychological counseling in Shanghai through the “health cloud” psychological counseling service platform. The questionnaire included demographic information，lifestyle and stress during the COVID-19 pandemic. ResultsParticipants with low，medium，high and very high stress levels accounted for 33.1% （395/1 194），34.6% （413/1 194），25.4% （303/1 194） and 7.0% （83/1 194），respectively. Women and participants aged 18 to 30 years had higher stress levels（Z=-5.368，P<0.001； Z=35.822，P<0.001） compared with other groups. Factors contributing to the rise in stress included reading too much information about COVID-19 （OR=2.057，95%CI：1.012‒4.181），large changes in sleep state （OR=3.496，95%CI：1.669‒7.325），lack of hobbies and interests （OR=2.852，95%CI：1.252‒6.500），and prone to anxiety/irritability/sadness （OR=4.098，95%CI：1.772‒9.480）. Conclusionpeople who sought psychological counseling show high levels of psychological stress during the COVID-19 pandemic. We should pay more attention to the vulnerable groups with the following characteristics： women，18‒30 years old， residents who pay too much attention to the pandemic information，sleep less， and almost lose interest in hobbies， and easily become anxious/irritable/sad.

ObjectiveTo explore the relapse status based on the positive and negative syndrome scale （PANSS Scale） and related factors of schizophrenics in Shanghai communities， and to analyze the association between socio demographic characteristics， lifestyles， clinical characteristics and relapse. MethodsA dynamic cohort prospective study design was used in this study. From March 2018 to February 2019， a total of 189 schizophrenics in Xuhui， Hongkou， Changning， Jiading， Songjiang and Baoshan districts were enrolled successively. Baseline questionnaires were conducted through face-to-face interviews at baseline， which contained social demographic information， lifestyle information and clinical information. A follow-up was conducted every 2 weeks for a measurement of PANSS Scale for a total of 6 months. Relapse was assessed by a PANSS score increase of ≥25% from baseline （or an increase of 10 points or more if the baseline score was ≤40 points）. Univariate and multivariate Cox regression models were used to analyze the associations between relapse status （assessed by PANSS Scale） and socio demographic characteristics， lifestyles， and clinical characteristics， respectively. ResultsA total of 165 community schizophrenics completed baseline and follow-up surveys， with a loss to follow-up rate of about 12.7%. After exclusion of sociodemographic and clinical information deficits， 132 patients were included in the analysis totally， with an average age of 48.18±12.67 years， among whom 41.67% were male. Totally 33 patients relapsed during the 6-month follow-up period， with a relapse rate of 25.0%. After adjusting for gender， family history， age， employment， education， marital status， smoking， drinking， exercise frequency， medication compliance， insight， social function， violence history， stress recent events， adverse drug reactions and baseline scores of PANSS Scale， risk factors of relapse included the following four factors： age below 40 years （HR=4.47， 95%CI： 1.15-17.40）， primary school or below （HR=7.11， 95%CI： 1.54-32.83）， unemployed （HR=8.34， 95%CI： 1.78-38.98）， and adverse drug reactions （HR=5.02， 95%CI： 1.75-14.37）. ConclusionWe should pay attention to the risk factors such as age， education， employment and adverse drug reactions， in order to identify high-risk patients and to conduct timely interventions during the relapse management of schizophrenics in Shanghai community.

ObjectiveTo determine the factors associated with aggressive behaviors of patients with schizophrenia by gender in communities in Shanghai， and further develop and validate the prediction model. MethodsA total of 7 955 community patients with schizophrenia were investigated in Xuhui District， Hongkou District and Jiading District of Shanghai. Baseline information was collected from April 2018 and follow-up was conducted every 3 months for 6 months. Multivariate logistic regression was used to calculate the odd ratio （OR） and 95% CI， and determine the factors associated with aggressive behaviors of patients. The risk score for each patient was developed based on the β coefficient， and the best cut-off value was determined by the Youden index. For the models， predictive ability was determined using area under the curve （AUC） of receiver operator characteristic curve （ROC curve）， and internal validation ability was evaluated by the ten-fold cross validation method. ResultsThere were 3 563 males in this study with an average age of （54.83±13.72） years old， and the incidence of aggressive behaviors was 2.55%.There were 4 392 females with an average age of （57.20±14.98） years， and the incidence of aggressive behaviors was 2.64%. For male patients with schizophrenia， single/divorced status （OR=2.04， 95%CI： 1.15‒3.61）， low economic status （OR=2.79， 95%CI： 1.71‒4.54）， irregular medication （OR=4.35， 95%CI：2.23‒8.47）， no medication （OR=1.83， 95%CI：1.03‒3.26）， incomplete/no insight （OR=1.97， 95%CI：0.99‒3.94）， adverse drug reaction （OR=2.61， 95%CI：1.27‒5.37）， psychiatric symptoms involving violence （OR=2.06， 95%CI：1.01‒4.18）， history of aggression （OR=5.29， 95%CI：2.33‒11.98） and recent stress events （OR=8.36， 95%CI：4.13‒16.92） were associated with aggressive behaviors. In contrast， for female patients， age less than 60 years （50‒59 years， OR=2.09， 95%CI： 1.13‒3.87； 40‒49 years， OR=2.74， 95%CI： 1.46‒5.17； 30‒39 years，OR=2.88， 95%CI： 1.48‒5.60； 18‒29 years， OR=5.71， 95%CI： 2.44‒13.37）， educational level of high school and above （senior high school， OR=3.30， 95%CI： 1.46‒7.49； college and university， OR=2.88， 95%CI： 1.21‒6.82）， unemployed status （OR=1.81， 95%CI=1.17‒2.82）， irregular medication （OR=7.87， 95%CI：4.75‒13.05）， no medication （OR=2.11， 95%CI：1.24‒3.62）， adverse drug reaction （OR=2.75， 95%CI：1.50‒5.04）， psychiatric symptoms involving violence （OR=3.08， 95%CI：1.77‒5.37）， social function （OR=3.51， 95%CI：2.07‒5.94） and recent stress events （OR=5.92， 95%CI： 2.82‒12.44） were risk factors. In both male and female， the prediction models for aggressive behaviors of community patients with schizophrenia had strong predictive ability （AUC=0.779， 95%CI： 0.725‒0.834； AUC=0.822， 95%CI： 0.780‒0.863）. ConclusionThis study suggests that diverse risk factors should be considered for community patients with schizophrenia by gender to prevent the aggressive behaviors.