ObjectiveTo investigate the current status of emergency management for severe mental disorders in Shanghai, and to provide countermeasures and suggestions for the establishment of a sound emergency management system for severe mental disorders and the enhancement of emergency management capability. MethodsA questionnaire survey and qualitative interviews were used to conduct an investigation into the emergency management in 17 district-level mental illness prevention and control institutions in Shanghai, which includes the basic situation of emergency management for severe mental disorders, the construction of emergency response teams and personnel, emergency preparedness drills and training, emergency management plans and rules and regulations, and problems encountered in emergency management. ResultsIn terms of emergency management mechanism and basic situation, resources such as personnel allocation, security funds and green channel were well equipped in each district-level mental illness prevention and control institution in Shanghai. However, the equipment of some hardware facilities was still insufficient to some extent. Therefore, further improvement on the emergency management mechanism for severe mental disorders was needed. With regard to the construction of emergency team and personnel allocation, the majority were those aged between 35‒<45 years old, with a bachelor’s degree, and more than 10 years of working experience. For example, 90.27% staff in district-level mental illness prevention and control institution had a bachelor’s degree or above, which was higher than that among the staff in community-level (73.60%); staff majored in clinical medicine in district-level institution accounted for the proportion at 52.71%, higher than that among the staff in community-level (28.86%); 57.24% staff in district-level institution had an intermediate professional title, higher than that among the staff in community-level (42.28%); and 69.90% staff in district-level institution had more than 10 years of working experience, higher than that among the staff in community-level (43.62%). In the aspect of emergency drills and training, all district-level mental illness prevention and control institutions in Shanghai had a high demand for emergency training, and the weak aspects mainly focused on lack of emergency service protocols, skills of addressing technical challenges, and construction of effectiveness evaluation system. Moreover, the teaching methods were primarily centered on case analysis, simulation drills, interactive discussions, and so forth. Concerning emergency management plans and rules and regulations, all districts in Shanghai had relatively established well-developed systems for emergency response plans, emergency response leadership groups, and emergency response operational task forces for severe mental disorders. About half of the institutions had established other rules and regulations related to emergency management of severe mental disorders in addition to emergency plans. ConclusionShanghai has initially established an emergency management system for severe mental disorders, but it is still fragile in specialized training for emergency management of severe mental disorders, construction of emergency management mechanisms, and the building-up of grassroots emergency teams. Further priorities should include strengthening emergency management training, enhancing the construction of emergency management personnel teams, and gradually establishing a more comprehensive and integrated emergency management mechanism for severe mental disorders.

Background::Breast cancer (BC) risk-stratification tools for Asian women that are highly accurate and can provide improved interpretation ability are lacking. We aimed to develop risk-stratification models to predict long- and short-term BC risk among Chinese women and to simultaneously rank potential non-experimental risk factors.Methods::The Breast Cancer Cohort Study in Chinese Women, a large ongoing prospective dynamic cohort study, includes 122,058 women aged 25-70 years old from the eastern part of China. We developed multiple machine-learning risk prediction models using parametric models (penalized logistic regression, bootstrap, and ensemble learning), which were the short-term ensemble penalized logistic regression (EPLR) risk prediction model and the ensemble penalized long-term (EPLT) risk prediction model to estimate BC risk. The models were assessed based on calibration and discrimination, and following this assessment, they were externally validated in new study participants from 2017 to 2020.Results::The AUC values of the short-term EPLR risk prediction model were 0.800 for the internal validation and 0.751 for the external validation set. For the long-term EPLT risk prediction model, the area under the receiver operating characteristic curve was 0.692 and 0.760 in internal and external validations, respectively. The net reclassification improvement index of the EPLT relative to the Gail and the Han Chinese Breast Cancer Prediction Model (HCBCP) models for external validation was 0.193 and 0.233, respectively, indicating that the EPLT model has higher classification accuracy.Conclusions::We developed the EPLR and EPLT models to screen populations with a high risk of developing BC. These can serve as useful tools to aid in risk-stratified screening and BC prevention.

Objective To evaluate the effect of manual massage on complications after endoscopic foam sclerotherapy injection for the treatment of internal hemorrhoids.Methods Consecutive 113 patients with grade Ⅰinternal hemorrhoids were prospectively enrolled and completed endoscopic foam sclerotherapy.The patients were randomly divided into a massage group(n=65)and a control group(n=68).Massage group performed manual perianal massage,Visual analogue scale(VAS)was used to evaluate perianal pain.The postoperative bleeding,short-term and long-term efficacy were also compared.Results The median VAS of 24 h postoperation was 1.0(0.0,3.0)in massage group,which was significantly lower than 2.0(1.0,4.0)in control group,the difference was statistically significant(P=0.014).The no bleeding rate of one week postoperation was 84.6％in massage group,which was significantly higher than 64.7％in control group,the difference was statistically significant(P=0.009).After 12 weeks,6 months and 12 months of follow-up,there were no significant differences in cure rate and remission rate between the two groups(P＞0.05).Conclusion Manual massage after endoscopic sclerosing agent injection is beneficial to relieve postoperative pain of grade Ⅰ internal hemorrhoids and reduce bleeding.

This study was aimed at understanding the molecular characteristics of Plasmodium ovale curtisi and Plasmodi-um ovale wallikeri imported cases in Chongqing,to provide data to support monitoring and control efforts.In a retrospective analysis,26 Plasmodium ovale archival blood samples were characterized with respect to five molecular markers(Cox1,Cytb,Tra,Dhfr,and K13)from 2013 to 2023.PCR amplification of partial fragments of the Cox1,Cytb,and Tra genes of Plas-modium ovale was performed to distinguish the two subspecies.The drug-resistance Dhfr and K13 genes of Plasmodium ovale were amplified with PCR assays followed by DNA sequencing,and the sequences were aligned.The differentiation of 26 cases of Plasmodium ovale(14 cases of curtisi subspecies and 12 cases of wallikeri subspecies)according to ssrRNA was consistent with the classification results of Cox1,Cytb,and TRA genes.Thirteen single nucleotide dimorphism sites were identified in Cox 1,including the 145 and 153 loci,with only variations in amino acids M176I and I288V at loci 528 and 862,and N337H mutation in one sample.Twelve base substitutions were found among Cytb gene subspecies,with only the M248I mutation in amino acid 248.A total of 49 nucleotide dimorphism sites in Tra gene,resulting in 18 amino acid mutations,were identified be-tween the two subspecies.In the curtisi type sample,the poc1 type had more PINTINPINTIN and TITPIS amino acid units than the poc2 type.The mutation rate of the Dhfr gene was rel-atively high:25％of the samples showed S58R mutations.The K13 gene subspecies was not homozygous,and one sample was heterozygous.This study confirmed the dimorphism and mutation sites between Plasmodium ovale curtisi and wallikeri sub-species in Cox1,Cytb,Tra,Dhfr,and K13 gene fragments of imported Plasmodium ovale in Chongqing,thus enriching knowledge regarding gene polymorphisms in Plasmodium ovale curtisi and wallikeri imported cases.

In industrial production,the expression level of drug proteins in Chinese hamster ovary cells(CHO)is influenced by many factors:the regulatory elements on transcription and translation,the ge-nomic integration sites,and the expression system.Transcription,as the first step of gene expression,largely affects protein expression,and the promoter plays a crucial role in the initiation of transcription.Most of the promoters were screened through transient transfection or random integration,but the presence of unclear copy number or random integration sites makes it difficult to accurately evaluate the promoter activity.To some extent,site-specific integration can reduce the impact of positional effects on exogenous genes and may potentially increase the expression level of exogenous genes.In the early stage of our re-search,multiple sites that can stably express exogenous proteins were identified and verified in the CHO cell genome.In this study,one of these sites(2c6)was selected for the evaluation of promoter activity.The CRISPR/Cas9 gene editing technique was used to site-specifically integrate the reporter gene(EG-FP)regulated by the simian virus early promoter(SV40),mouse elongation factor-1α(mEF-1α),chicken β-actin(cACTB)promoter,and human phosphoglycerate kinase promoter(hPGK)into the 2c6 site,respectively.The mean fluorescence intensity of the cells was analyzed by flow cytometry,and the mRNA level of EGFP was detected by qPCR to comprehensively evaluate the activity of the promoter.The results showed that the activities of the mEF-1α and mACTB promoters were better than those of SV40 and hPGK.The results of the secondary flow cytometry sorting showed that site-specific integration can more accurately evaluate the activity of the promoter in the CHO cell expression system.

Objective To identify the factors associated with frailty in lung transplant patients by a meta-analysis.Methods Computerized search was performed for studies on the influencing factors of frailty in lung transplant patients in the CNKI,WanFangData,VIP,CBM,PubMed,Web of Science,Embase,Elsevier ScienceDirect and CINAHL databases.The search was conducted from the time of database construction to November 2023.Literature screening,quality assessment,and data extraction were performed independently by 2 investigators,and Meta-analysis was performed using Stata 17.0 software.Results 10 cohort studies,including 1 999 patients,were finally included,and 13 influencing factors were extracted,including advanced age(OR=1.05),female(OR=2.50),BMI(OR=0.38),diagnosis of primary pulmonary disease(OR=2.90),6MWD(OR=0.34),and lung allocation score(OR=0.69),FVC(OR=0.60),pre-transplant frailty(OR=0.81),hypoproteinemia(OR=4.12),hemoglobin(OR=0.50),anemia(OR=4.37),length of ICU stay(OR=1.24),and total length of stay(OR=1.05).Short Physical Performance Battery is an assessment tool for frailty in lung transplant patients,with an incidence of frailty in 24％before transplantation and 50％in post-transplantation.Fried Frailty Phenotype is an assessment tool for frailty in lung transplant patients,with a pre-transplant frailty incidence of 30％.Conclusion There are many factors involved in the incidence of frailty in lung transplant patients,and nursing staff should dynamically evaluate the frailty of lung transplant patients,and give individualized and precise interventions in combination with a multidisciplinary model to improve or delay the progression of frailty.

Objective To evaluate the effect of remote interventions with digital health technologies in lung transplant patients.Methods Databases,including CKNI,Wangfang,VIP,CMB,Cochrane Library,PubMed,Embase,Web of Science,Scopus and BMJ Best Practice were searched from their inception to July 2023.There were 2 researchers who independently screened and extracted the literature,and then evaluated quality of the included studies.Meta-analysis was performed using RevMan 5.2.Results 10 studies with 1 262 patients were included.The results of meta-analysis showed that compared with conventional intervention,remote intervention based on digital health technology could improve self-monitoring compliance of lung transplant patients[0R=0.64,95％CI(0.46,0.88),P=0.006],improve quality of life including mental health status[OR=3.08,95％CI(0.41,5.74),P=0.020]and physical health status[OR=3.81,95％CI(1.19,6.43),P=0.004].In terms of the intervention forms,the application-based remote intervention had better self-monitoring compliance,and the difference was statistically significant(P=0.007).However,in terms of the comparison of readmission rate[OR=1.73,95％CI(0.98,3.04),P=0.060],anxiety[OR=-0.12,95％CI(-1.36,1.11),P=0.850],and depression[OR=0.62,95％CI(-0.80,2.03),P=0.390],the effect of intervention was unclear.Conclusion Remote intervention based on digital health technology can improve self-monitoring compliance and quality of life in lung transplant patients;applications are the optimal form of intervention.Limited by the quality and quantity of included studies and the heterogeneity of study results,more high-quality studies are needed to further verify the effects of digital health technology on readmission rates,anxiety and depression of lung transplant patients.

Objective To investigate the incidence and risk factors of post-transplant diabetes mellitus(PTDM)in adult lung transplant recipients.Methods Conducting a convenience sampling method,we retrospectively analyzed the clinical data of lung transplant recipients from January 2020 to December 2022 at a tertiary A hospital in Hangzhou,Zhejiang Province.According to the PTDM diagnostic criteria,lung transplant recipients are divided into a PTDM group and a non-PTDM group.The incidence rate of PTDM is calculated,and the influencing factors for PTDM occurrence are analyzed using both univariate and multivariate logistic regression methods.Results A total of 140 patients were included in this study,and 54 lung transplant recipients developed PTDM within 6 months,with an incidence of 38.57％.Univariate analysis showed that there were significant differences in age,gender,BMI,smoking history,pre-operative glycated albumin,pre-operative fasting blood glucose,early post-operative blood glucose and pre-operative creatinine between the 2 groups(P＜0.05).Multivariate Logistic analysis showed that gender(OR=5.283),BMI(OR=6.122),pre-operative glycated albumin(OR=1.330),and early post-operative blood glucose(0R=1.444)were the influencing factors.Conclusion Lung transplant recipients who were male,BMI ≥24.0,with high levels of glycated albumin before surgery,and high blood sugar early after surgery had a higher risk of developing PTDM.Clinical nurses can formulate relevant nursing measures according to the influencing factors to prevent the occurrence of PTDM.

AIM To optimize the extraction process for uracil,hypoxanthine,xanthine,uridine,thymine,inosine,guanosine and 2'-deoxyguanosine from Pheretima guillelmi(Michaelsen),and to determine their contents.METHODS With solid-liquid ratio,ultrasonic time and ultrasonic temperature as influencing factors,contents of hypoxanthine and total nucleosides as evaluation indices,the extraction process was optimized by orthogonal test.HPLC was adopted in the content determination of varioud nucleosides,the analysis was performed on a 30℃thermostatic Agilent C18 column(4.6 mm×250 mm,5 μm),with the mobile phase comprising of methanol-water flowing at 1 mL/min in a gradient elution manner,and the detection wavelength was set at 260 nm.RESULTS The optimal conditions were determined to be 1∶250 for solid-liquid ratio,60 min for ultrasonic time,and 60℃for ultrasonic temperature.Eight nucleosides showed good linear relationships within their own ranges(R2＞0.999 0),whose average recoveries were 99.11%-103.27%with the RSDs of 0.85%-2.89%.CONCLUSION This stable and reliable method can be used for the extraction and content determination of nucleosides from P.guillelmi.

Objective:To summary the clinical and electrophysiological characteristics of temporal lobe epilepsy (TLE) originating from the temporal pole (TP), and to conduct brain network analysis based on stereo-electroencephalogram (SEEG) and head positron emission tomography- computed tomography (PET-CT).Methods:A retrospective analysis was conducted on patients with TLE who underwent SEEG implantation from January 1, 2019 to September 1, 2023 in Guangdong Sanjiu Brain Hospital. Based on anatomical-electrical-clinical analysis and SEEG findings, patients with seizures originating from the TP were selected. The clinical data, head magnetic resonance imaging (MRI), PET-CT, scalp electroencephalogram were reviewed, and the seizure-induced network was analyzed based on SEEG and head PET-CT.Results:A total of 108 cases of TLE were analyzed, of whom 13 cases had an epileptogenic zone located at the TP, accounting for 12% (13/108) of all TLE patients. Among them, 8 were males and 5 were females, and age of onset was (11.6±7.8) years. All of them were drug-resistant epilepsy patients, of whom 6 cases had normal cognitive function, 4 had mild cognitive abnormalities, and 3 had severe cognitive decline. A total of 59 seizures were recorded, and the occurrence rate of generalized tonic-clonic seizures (GTCS) was 42% (25/59). Seizure symptoms were classified into 3 types: the first type was hypermotor, seen in 9 patients; the second type was complex motor, seen in 2 patients; and the third type was automotor, seen in 2 patients. Head MRI showed that 9 cases had a blurring of the TP on one side, with or without hippocampal sclerosis; 2 cases had a mass at the TP without hippocampal sclerosis; 2 cases were negative on head MRI. Head PET-CT showed that 13 cases had TP hypometabolism on the lesion side, of whom 11 cases had hypometabolism involving the medial temporal lobe (mTL), posterior orbital gyrus (POG), anterior cingulate gyrus (ACG) and insular lobe at the same time, the other 2 cases combined with ipsilateral hypometabolism of the medial temporal lobe. Pathology showed that 7 cases had microcortical dysplasia of the TP; 3 had focal cortical dysplasia Ⅰ or focal cortical dysplasia Ⅱ; 2 had benign tumors. Scalp electroencephalogram showed that interictal phase was divided into 3 discharge patterns: bilateral temporal regions with prominent lesion side; bilateral anterior regions with prominent lesion side; lesion-side hemisphere with prominent temporal region. Ictal period showed 4 initial patterns: lesion-side hemispheric rhythmic spikes-slow waves or polyspikes-slow waves; lesion-side anterior region rhythmic slow waves; lesion-side anterior region low voltage fast (LVF) activities, and diffuse LVF with prominent lesion-side hemisphere. SEEG showed that 13 patients received electrode implantation with (9±2) electrodes per patient, divided into 3 seizure patterns: type 1: TP?adjacent temporal neocortex?POG, ACG and insula?mTL; type 2: TP?para hippocampal gyrus and the base of temporal lobe?ACG ,POG and insula?mTL; type 3: TP?mTL?insular lobe?POG.Conclusions:TLE originating from the TP is relatively rare, with hypermotor or complex motor as the main manifestations, and automotor being relatively less common, which is more likely to be followed by GTCS. The epileptogenic network analysis displays a tendency to spread from the TP to the frontal and insular lobes, as well as to the mTL, with the former pattern being more common. Common etiologies are cortical dysplasia and benign tumors of the TP without hippocampal sclerosis.