Involuntary hospitalization system is a controversial issue in international mental health legislation. During the legislation and implementation process of Mental Health Law of the People’s Republic of China, the substantive and procedural elements of the involuntary hospitalization system have always been under dispute and discussion. These disputes have profound ethical implications, highlighting the phenomenon of the coexistence of "insufficient" and "excessive" regarding China’s involuntary hospitalization system in protecting individual autonomy. From the perspective of public health ethics, the values of respect, justice, and care can provide ethical guidance for improving the involuntary hospitalization system and promoting the construction of mental health law.

Objective To evaluate the safety of the da Vinci Si surgical system in thyroid surgery and to accumulate operation experience .Methods The da Vinci Si surgical system consists of a surgeon's console, a patient-side robotic cart, and high-definition 3D vision system.The robot arm tips were introduced via a single axillary incision or small chest wall ports and attached to the arms of the robot .The surgeon , sitting at the con-sole, manipulated the EndoWrist instruments and endoscope view that transfer the surgeon 's movements to the arm tips.The so called EndoWrist'technology offers seven degrees of movements ( up, down, left, right, twist, et al) , thus exceeding the capacity of a surgeon's hand in open surgery .The da Vinci Si surgical system was used to perform thyroidectomy in two small pigs .The animals were intubated and kept anesthetized with halothane .Re-sults Four surgical procedures were done using the da Vinci Si system from beginning to the end , including 2 thyroidectomies and 2 thymectomies .No conversions to open or laparoscopic procedure was used .The procedure length was 61 minutes and 50 minutes, respectively.Conclusions Robotic thyroidectomy can be performed safe-ly by the experienced surgeons after short-term da Vinci Si surgical system training .The learning curve for robotic thyroidectomy is shorter .

Objective: To explore the relationships between the characteristics of childhood sexual abuse and non-suicidal self-injury in nursing female college students. Methods: Two medical colleges and junior colleges were selected in Anhui province. A total of 2 549 female nursing students in grade 1 to 3 were asked to fill a questionnaire regarding sociodemographic information,childhood sexual abuse and non-suicidal self-injury. Results: The reported rate of non-suicidal self-injury among female nursing students in the past six months was 8.2%. Sexual abuse at any time during childhood (primary school or earlier,middle school and high school) increased the risk of non-suicidal self-injury among female nursing students (P<0.05). Exposure to sexual abuse in all three periods was associated with 5.04(95%CI=1.73-14.62) times odds ratio than that of those who not exposed to sexual abuse (P<0.01). Only contact sexual abuse and both contact and non-contact sexual abuse in childhood were correlated with nonsuicidal selfinjury among female nursing students [OR(95%CI)=2.21(1.48-3.29), 3.56(2.13-5.96)] (P<0.05). Two patterns of sexual abuse experiences were identified,including persistent sexual abuse (3.1%) and the other group is occasional sexual (96.9%). Persistent sexual abuse in childhood was correlated to higher risk of non-suicidal self-injury compared with occasional sexual abuse (OR=2.61,95%CI=1.35-5.05,P<0.01). Conclusion The occurrence periods,types and patterns of sexual abuse in childhood are closely related to non-suicidal self-injury in female nursing students.

Objective:To investigate the imaging findings of incomplete partition type Ⅲ (IP-Ⅲ) cochlea malformation using high-resolution CT (HRCT) and MRI, and to measure the key anatomical structures, providing the accurate qualitative and quantitative data for cochlear implantation (CI).Methods:Totally 14 patients (28 ears) with IP-Ⅲ cochlea malformation who underwent cochlear implantation at Beijing Tongren Hospital, Capital Medical University from February 2012 to March 2019 were retrospectively collected. All the patients were male, aged 7 months to 27 years old, with the median age as 3 years old. All the 14 patients underwent preoperative HRCT and 9 of them underwent preoperative MRI. The development of inner ear structure, including cochlea, vestibule, semicircular canals, vestibular aqueduct and internal auditory canal (IAC) was reviewed and analyzed. The travel route and position of labyrinthine, tympanic and mastoid segment of facial nerve canal were evaluated; the width of labyrinthine segment of facial nerve canal and superior vestibular nerve canal, as well as the angle between first and second parts of the facial nerve canal were measured on HRCT. The shape of stapes and the development of cochlear nerve were analyzed on MRI.Results:All the 14 cases (28 ears) showed nearly normal shape of the cochlea, with the bony interscalar septa presenting while the modiolus completely absent. The lateral portion of the IAC was dilated, and the septum was absent between the base of the cochlea and the IAC, appearing as a"gourd-like"shape. A small saclike protrusion was formed in the vestibule and protruded into the upper semicircular canal in 10 cases (20 ears) (71.4%, 20/28). The beginning of the vestibular aqueduct enlarged in 12 cases (24 ears) (85.7%, 24/28). All the 14 cases (28 ears) showed that labyrinthine segment of facial nerve canal was located almost above the cochlea and showing stiffly. The labyrinthine segment of facial nerve canal widened in 7 cases (14 ears) (50.0%, 14/28) and the superior vestibular canal widened in 13 cases (26 ears) (92.9%, 26/28). The width of labyrinthine segment of facial nerve canal and the superior vestibular canal were (1.14±0.37) mm and (1.66±0.35) mm, respectively. The angle between the first and second parts of the facial nerve canal was 96.83°±15.63°. Eleven cases (22 ears) (78.6%, 22/28) showed thickened footplate of stapes and poor oval window, but the round window was clear. Nine cases (18 ears) showed normal development of the cochlear nerve on MRI.Conclusion:IP-Ⅲ cochlea malformation has the characteristic imaging features. Preoperation accurate assessment of the shape and location of important anatomical structures such as cochlea, internal auditory canal and facial nerve can provide valuable information for CI.

Objective:To observe the effects of acupuncture and moxibustion on phosphatase and PTEN-induced putative kinase 1(PINK1)/Parkin signaling pathway in the midbrain substantia nigra of Thy1-α synuclein(αSyn)transgenic model mice with Parkinson disease(PD). Methods:Twenty-four Thy1-αSyn transgenic mice were randomly divided into a model group,an acupuncture group,an acupuncture + moxibustion group,and a Western medicine group.Six wild-type mice in the same litter were used as the wild-type group.In the acupuncture group,Baihui(GV20)and Yanglingquan(GB34)were selected for acupuncture.In the acupuncture + moxibustion group,Guanyuan(CV4)was added on the basis of the acupuncture group.The Western medicine group was given rapamycin intraperitoneal injection at a dose of 10 mg/(kg·bw).The wild-type group and the model group were fixed without intervention.The overall rod performance(ORP)score of mice was observed in each group.The immunohistochemical method was used to detect the tyrosine hydroxylase(TH)positive neurons in the substantia nigra of mice in each group.The αSyn was detected by the immunofluorescence chemical method.The expression levels of αSyn,microtubule-associated protein 1 light chain 3(LC3)-Ⅱ/LC3-Ⅰ,autophagy protein sequestosome-1/protein 62(SQSTM-1/p62),PINK1,Parkin,and ubiquitin-specific protease 30(USP30)proteins were detected by Western blotting assay.The expression levels of LC3B,p62,PINK1,Parkin,and USP30 mRNAs were detected by fluorescence quantitative polymerase chain reaction. Results:Compared with the wild-type group,the ORP score,the p62,PINK1,and Parkin protein expression levels decreased significantly(P<0.01),the PINK1 mRNA expression level decreased(P<0.05),while the protein and mRNA expression levels of USP30 increased(P<0.05)in the model group.Compared with the model group,the ORP score in the acupuncture group and the acupuncture + moxibustion group increased(P<0.05);the expression level of LC3-Ⅱ/LC3-Ⅰ protein in the acupuncture + moxibustion group and the Western medicine group increased(P<0.05);the protein expression levels of p62,PINK1,and Parkin increased(P<0.05),while the USP30 protein expression level decreased significantly(P<0.01)in the acupuncture group,the acupuncture + moxibustion group,and the Western medicine group;the Parkin mRNA expression level in the acupuncture group and the acupuncture + moxibustion group increased(P<0.05);the USP30 mRNA expression level in the acupuncture + moxibustion group decreased(P<0.05). Conclusion:Acupuncture and moxibustion regulate the related molecule expression levels of PINK1/Parkin signaling pathway in the Thy1-αSyn transgenic PD model mice and promote the autophagy degradation of αSyn to exert the protective effect of dopaminergic neurons.

Objective To explore the influence factors of recurrence after a first unprovoked seizure in adults within 1 year. Methods One hundred fifty-nine adult patients with first unprovoked seizure were recruited in the study. Patients were then divided into the relapse group (n=54) and the relapse group (n=105). Statistic analysis was performed on the clinical data including gender, age, history of traumatic brain injury, electroencephalogram (EEG) and brain imaging, the form of attack time, seizures, diabetes mellitus, hypertension, coronary heart disease, hyperlipidemia disease. Results Multiariable Logistic regression analysis found that history of brain injury (P=0.033, OR=5.547), period (P=0.001, OR=33.660) in the evening, cortical lesions (P=0.004, OR=14.865) were independent risk factors for recurrence. Conclusions Adult patients with first unprovoked seizure have a high risk of one-year recurrence if the patients have a history of traumatic brain injury, the radiographic abnormalities, cortical lesions and sleep attacks.

Coronary artery calcifications (CAC) is an independent risk factor for cardiovascular disease (CVD). It has been revealed that this condition can be automatically quantified through computerize tomographic (CT) scan contained in radiotherapy plan for patients with breast cancer, with which, physicians can identify the patients with increased risk of CVD after radiotherapy prematurely and take intervention measures in advance. In this article, the current literature and research progress on the correlation between CAC and cardiotoxicity in patients with breast cancer after radiotherapy were reviewed, expecting to provide a strategy to reduce the CVD risk in patients with breast cancer after radiotherapy.

AIM:To investigate the therapeutic effect of mitochondrial fission inhibitor-1(Mdivi-1)on experi-mental autoimmune encephalomyelitis(EAE)in mice,and to explore its mechanism.METHODS:The mice immunized with myelin oligodendrocyte glycoprotein peptide fragment 35-55(MOG35-55)were randomly divided into DMSO model group and Mdivi-1 intervention group.All mice were sacrificed on the 28th day after the first immunization.The demyelination was analyzed by Luxol fast blue staining.The protective mechanism of Mdivi-1 in the spinal cord tissue was investigated by immunofluorescence staining,TUNEL staining and the in vitro experiment with MO3.13 oligodendrocytes treated with staurosporine.The mitochondrial depolarization was detected by JC-1 staining,the cell injury was checked by LDH leakage,and the viability of MO3.13 oligodendrocytes was determined by MTT assay.RESULTS:Compared with DMSO model group,the demyelinating injury was alleviated and the proportion of apoptotic CC1+ oligodendrocytes in Mdivi-1 group was decreased.The cleaved caspase-3,caspase-9,cytochrome C and Bax protein expression levels in the spinal cord of Mdivi-1-treated mice was also attenuated.The in vitro MO3.13 cell experiments suggested that Mdivi-1 inhibited MO3.13 cell mitochondrial depolarization,attenuated the cell damage and increased the cell viability.CONCLUSION:Mdivi-1 pro-tects against the myelin injury in EAE mice,which may be related to the suppression of oligodendrocyte apoptosis.

Objective Explore the feasibility and accuracy of using deep learning techniques for gender inference in panoramic dental radiography images of Chinese Han population.Methods A total of 10,600 OPG images from Han individuals aged 18 to 70(5,300 males and 5,300 females)were collected and randomly divided into training set,validation set,and test set in an 8:1:1 ratio.MobileNetV2,Swin Transformer Small,and Swin Transformer Tiny models were trained,and the classification performance of the models was evaluated and visually displayed using accuracy,F1 score,and Grad-CAM algorithm.Results The accuracy of MobileNetV2,Swin Transformer Small,and Swin Transformer Tiny models was 97.57%,95.13%,and 96.28%respectively,with MobileNetV2 model showing the best overall performance.The Grad-CAM algorithm revealed that male OPG images mainly focused on the left and right mandibular branches and alveolar bone,while female OPG images mainly focused on the maxillary sinus,left mandibular branch,and posterior alveolar bone.Conclusion This study demonstrates that the gender inference model based on deep learning techniques for OPG images of Chinese Han population has high accuracy and generalization ability,providing a new approach for forensic gender determination in forensic medicine.

Objective: To explore the association between cardiometabolic diseases (CMD) and quality of life, the association between CMD and perceived stress, and the mediation effect of perceived stress on the association between CMD and quality of life, and to provide evidence for the prevention and treatment of CMD and the improvement of quality of life in these patients. Methods: This is a cross-sectional study. Data were collected by the employees' physical examination of a company in Xi'an in 2021. Multiple linear regression models were used to analyze the association between the status of CMD (divided into three categories: no CMD, presence of one kind of CMD, and with≥2 kinds of CMD (≥2 kinds of CMD were defined as cardiometabolic multimorbidity (CMM)), quality of life, and perceived stress. Mediation analysis with a multi-categorical independent variable was conducted to determine the mediation effect of perceived stress on the association between CMD and quality of life. Results: Among all 4 272 participants, 1 457 (34.1%) participants had one kind of CMD and 677 (15.8%) participants had CMM. The average scores for quality of life and perceived stress were (57.5±15.7) and (16.9±7.9), respectively. Compared with participants without CMD, after adjusting for demographic and lifestyle factors, no statistically significant associations were observed between one kind of CMD and perceived stress or quality of life (both P>0.05). Perceived stress did not mediate the association between one kind of CMD and quality of life. However, participants with CMM had lower quality of life and higher perceived stress than participants without CMD. The relative total effect coefficient c (95%CI) and the relative direct effect coefficient c' (95%CI) between CMM and quality of life were -3.71 (-5.04--2.37) and -2.52 (-3.81--1.24) (both P<0.05), respectively. The relative indirect effect coefficient a₂b (95%CI) of perceived stress on the association between CMM and quality of life was -1.18 (-1.62--0.77) (P<0.05). The mediation effect size was 31.8%. Conclusions: CMM is negatively associated with quality of life and positively associated with perceived stress. Perceived stress partially mediates the association between CMM and quality of life. Our results suggest that, in addition to preventing and treating CMM actively, efforts should be taken to relieve the perceived stress of people with CMM to improve their quality of life.
Humans ; Quality of Life ; Cross-Sectional Studies ; Cardiovascular Diseases/complications* ; Stress, Psychological