This article briefly introduces the new concept of burnout and the new burnout assessment tool BAT. In the past, the most famous burnout definition was proposed by Maslach and Leiter. The Maslach Burnout Inventory (MBI) developed by Maslach has also been the gold standard for evaluating burnout. With the development of burnout research, the concept of burnout has a certain defect. MBI has also been criticized in conceptual, practical and psychological measurement. It may hinder new research, and urgently needs to improve the concept and evaluation of burnout. Therefore, Schaufeli redefined the concept of burnout, and developed a new burnout assessment tool for groups and individuals based on the new concept of burnout-Burnout Assessment Tool (BAT) . This paper systematically reviews the proposal of the new concept of burnout, the development of the BAT scale and its application at home and abroad, and analyzes the advantages and application prospects of the BAT scale.

Objective:To verify the reliability and validity of the short version of the Chinese version of the new Burnout Assessment Tool (12 items version of Burnout Assessment Tool, BAT-12) .Methods:From October to December 2023, the cluster sampling method was adopted, and the Chinese version of the Maslach Burnout Inventory-General Survey (MBI-GS) and the BAT-12 scale were used simultaneously. A questionnaire survey was conducted among enterprise employees (4329 people) in Shanghai and Guangdong Province. Exploratory factor analysis and confirmatory factor analysis and other methods were employed to analyze its reliability (internal consistency reliability and combination reliability) and validity (structural validity, convergent validity, discriminative validity and criterion validity) .Results:A total of 4329 questionnaires were retrieved, among which 4086 were valid, with an effective recovery rate of 94.39%. The Cronbach's α coefficient of the Chinese version of the BAT-12 total scale was 0.956, and the combination reliability coefficients of each dimension ranged from 0.914 to 0.952. The scale contained 12 items, and 4 common factors were extracted from exploratory factor analysis, including exhaustion, mental distance, cognitive impairment, and emotional impairment. The cumulative variance contribution rate reached 86.63%. Confirmatory factor analysis showed that both the four-factor correlation model and the second-order model were ideally fitted overall, with the four-factor correlation model having the best data fit (comparative fit index 0.972, Tuker-Lewis fit index 0.962, root mean square error of approximation 0.064, and standardized root mean square residual 0.033). The average variance extracted (AVE) of each dimension of the scale ranged from 0.780 to 0.868, and the square roots of AVE (0.883 to 0.932) were all greater than their Pearson correlation coefficients (0.630 to 0.850). The Pearson correlation coefficient between BAT-12 and MBI-GS was 0.787 ( P<0.001) . Conclusion:The Chinese version of the BAT-12 scale demonstrates strong internal consistency and combination reliability, with excellent reliability. Its four-dimensional structure validity has been validated, with good convergent validity, discriminative validity, and ideal criterion validity, demonstrating excellent validity. The Chinese version of the BAT-12 scale can be used to measure the level of occupational burnout among Chinese employees.

This article briefly introduces the new concept of burnout and the new burnout assessment tool BAT. In the past, the most famous burnout definition was proposed by Maslach and Leiter. The Maslach Burnout Inventory (MBI) developed by Maslach has also been the gold standard for evaluating burnout. With the development of burnout research, the concept of burnout has a certain defect. MBI has also been criticized in conceptual, practical and psychological measurement. It may hinder new research, and urgently needs to improve the concept and evaluation of burnout. Therefore, Schaufeli redefined the concept of burnout, and developed a new burnout assessment tool for groups and individuals based on the new concept of burnout-Burnout Assessment Tool (BAT) . This paper systematically reviews the proposal of the new concept of burnout, the development of the BAT scale and its application at home and abroad, and analyzes the advantages and application prospects of the BAT scale.

Objective:To verify the reliability and validity of the short version of the Chinese version of the new Burnout Assessment Tool (12 items version of Burnout Assessment Tool, BAT-12) .Methods:From October to December 2023, the cluster sampling method was adopted, and the Chinese version of the Maslach Burnout Inventory-General Survey (MBI-GS) and the BAT-12 scale were used simultaneously. A questionnaire survey was conducted among enterprise employees (4329 people) in Shanghai and Guangdong Province. Exploratory factor analysis and confirmatory factor analysis and other methods were employed to analyze its reliability (internal consistency reliability and combination reliability) and validity (structural validity, convergent validity, discriminative validity and criterion validity) .Results:A total of 4329 questionnaires were retrieved, among which 4086 were valid, with an effective recovery rate of 94.39%. The Cronbach's α coefficient of the Chinese version of the BAT-12 total scale was 0.956, and the combination reliability coefficients of each dimension ranged from 0.914 to 0.952. The scale contained 12 items, and 4 common factors were extracted from exploratory factor analysis, including exhaustion, mental distance, cognitive impairment, and emotional impairment. The cumulative variance contribution rate reached 86.63%. Confirmatory factor analysis showed that both the four-factor correlation model and the second-order model were ideally fitted overall, with the four-factor correlation model having the best data fit (comparative fit index 0.972, Tuker-Lewis fit index 0.962, root mean square error of approximation 0.064, and standardized root mean square residual 0.033). The average variance extracted (AVE) of each dimension of the scale ranged from 0.780 to 0.868, and the square roots of AVE (0.883 to 0.932) were all greater than their Pearson correlation coefficients (0.630 to 0.850). The Pearson correlation coefficient between BAT-12 and MBI-GS was 0.787 ( P<0.001) . Conclusion:The Chinese version of the BAT-12 scale demonstrates strong internal consistency and combination reliability, with excellent reliability. Its four-dimensional structure validity has been validated, with good convergent validity, discriminative validity, and ideal criterion validity, demonstrating excellent validity. The Chinese version of the BAT-12 scale can be used to measure the level of occupational burnout among Chinese employees.

Objective:To explore the clinical effect of perforator pedicled propeller flap (PPPF) in reconstruction of soft tissue defect in ankle and foot, as well as the role of preoperative ultrasonography in assistance of the location of perforators in donor site.Methods:From January 2017 to June 2023, the Department of Microorthopedics of the Second Affiliated Hospital of Luohe Medical College of Higher Education applied PPPF to reconstruct small and medium-sized soft tissue defects in the ankle and foot for 26 patients. The patients were 17 males, 9 females, aged 18 to 68 years old with 46 years old in average. The defect sites were 3 in forefoot and 6 in midfoot and combined with different degrees of tendon and bone exposure, 17 in ankle and heel and combined with various degrees of bone exposure, 12 with ankle open injury and 5 with Achilles tendon exposure. The area of soft tissue defects ranged from 2.5 cm×1.5 cm to 16.0 cm × 6.5 cm. The width of injury was measured before surgery, and a HHD was used to detect the perforators proximal to the defect site, and then high-frequency CDU was used to locate and confirm the location of the perforator and its alignment, blood flow and diameter. The line drawn between the 2 perforators was set as the axis of flap. The donor site was assessed by a "pinching and lifting" method to determine a direct closure of donor site or to have it closed by a flap transfer. The sizes of flap were from 2.8 cm×1.5 cm to 24.0 cm×7.5 cm. Twenty-two donor sites were directly closed and 4 received flap transfers. Four flaps had sutures with the skin nerves in the recipient site. Masquelet technique was performed in 6 patients with bone defects in the surgery. Patients received outpatient reviews with 1-2 weeks of intervals in the first 2 months after surgery, and X-ray reviews per 1-2 months for those with bone implants until bone healing.Results:All flaps survived successfully without any special treatment after surgery, except 1 flap that had blood vessel congestion and showed swelling and poor blood supply to the distal flap at 24 hours after surgery. The blood vessel congestion was revised by removal of part of the suture at the tip of flap pedicle. One week later, the tip of the flap remained with a small area of necrosis, which was then healed after dressing changes. A total of 21 patients were included in postoperative follow-up with 4 months to 3 years. All of the flaps had satisfactory appearance, colour and texture, and without any ulceration. Three cases of nerve suture were also included in follow-up. According to the assessment criteria of British Medical Research Council (BMRC), the sensory recovery of the flaps was found of S 2 in 1 flap and S 3 in 2 flaps. According to the American Orthopaedic Foot and Ankle Society (AOFAS), the ankle-hindfoot function scores, there were excellent in 16 patient and good in 5 patients. Conclusion:With the assistance of ultrasound, the PPPF can be effectively used in reconstruction of soft tissue defects in ankle and foot.

Background Under the backdrop of the national innovation-driven development strategy, the increasing occupational stress and job burnout among employees are noteworthy for their impact on employees' subjective well-being. Objective To clarify the status, distribution characteristics, and the relationship between subjective well-being, occupational stress, and job burnout of employees in research and development (R&D) enterprises, in order to improve their subjective well-being. Methods A total of 3366 employees from R&D departments at 7 enterprises in Minhang District of Shanghai were selected. The well-being level of the research subjects was investigated by using the World Health Organization Well-Being Index (WHO-5) that yielded total scores from 0 to 25, and a higher total score indicated a higher well-being level; the levels of occupational stress and job burnout were investigated by using the Chinese version of the Job Content Questionnaire, and the Chinese version of the Maslach Burnout Inventory-General Survey (MBI-GS). The scores of WHO-5, JDC, and MBI-GS were incorporated into structural equation modeling (SEM) as numerical variables to analyze their relationship. Results The scores of subjective well-being, occupational stress, and job burnout of employees in the R&D enterprises were 13.30±6.09, 1.12±0.45, and 2.18±1.12, respectively. The positive rates of occupational stress and job burnout were 44.4% and 70.9% respectively, and the positive rate of severe job burnout was 11.7%. There were statistically significant differences in the score of subjective well-being among the participants by gender, age, educational level, marital status, registered residence, working seniority, and jobs (P<0.05); there were statistically significant differences in the positive rate of occupational stress by gender, educational level, marital status, working seniority, and jobs (P<0.05); there were statistically significant differences in the positive rate of job burnout by gender, age, educational level, marital status, registered residence, working seniority, and jobs (P<0.05). There was a negative correlation between subjective well-being and occupational stress (r=−0.1747, P < 0.01), a negative correlation between subjective well-being and job burnout (r=−0.2987, P < 0.01), and a positive correlation between occupational stress and job burnout (r=0.3342, P < 0.01). A structural equation containing partial mediating effect of job burnout on the relationship between occupational stress and subjective well-being was established, and the partial effect accounting for 52.5% of the total effect. Conclusion The job burnout among employees in R&D companies partially mediates the impact of occupational stress on subjective well-being. Reducing the level of job burnout will help alleviate occupational stress and thus improve employees' subjective well-being.

Group 3 innate lymphoid cells (ILC3) are an ILC subset that is characterized by the expression of retinoic acid-related orphan nuclear receptor γt (RORγt) and interleukin 22 (IL-22). This review summarizes the role of ILC3 in coordinating innate immunity and adaptive immunity based on current research and elaborate the significance of ILC3 from the perspective of immune system evolution. In addition, based on immune-related functions, we propose a possible time when ILC3 appears in the evolution of the immune system. And then, the research limitations and prospects are discussed.
Immunity, Innate ; Lymphocytes ; Tretinoin

Background Civil aviation pilots are actual operators of civil aircraft. Their job operations are directly associated with passenger safety and flight safety. Unsafe aviation operations are related to fatigue caused by poor sleep quality. Recently, with the promotion of China's air transportation business, irregular working hours of civil aviation pilots rise gradually. However, there is still a lack of relevant research on the influence of working conditions on sleep quality in this group. Objective To explore potential impact factors of sleep quality among civil aviation pilots, for the purposes of improving sleep quality and health level of this group and ensuring aviation flight safety by formulating health management suggestions in a targeted manner. Methods All pilots of an aviation company were approached when they visited the Shanghai Hospital of Civil Aviation Administration of China for their health examinations. After informed consent, an online questionnaire survey was conducted. Self-made questionnaires were used to collect information on general conditions, lifestyle, and subjective work stress levels. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. A total of 1204 valid questionnaires were recovered. Statistical analysis was conducted using SPSS 26.0 software. Results There were 410 pilots (16.8%) who reported sleep disorders, including insufficient sleep time, difficulty falling asleep, and poor sleep quality, and 894 pilots (74.3%) who reported moderate to severe work stress. Associations were identified between sleep quality of pilots and work stress or lifestyle indicators (P<0.05), while work stress showed the strongest association (r=0.28). Further multiple-factor analysis results showed that severe work stress (OR=4.25, 95%CI: 2.89, 6.30) and alcohol use (OR=1.72, 95%CI: 1.31, 2.27) associated with an increased risk of sleep disorders. Regular breakfast (OR=0.62, 95%CI: 0.42, 0.91) and physical exercise (OR=0.68, 95%CI: 0.45, 1.03) associated with a lower risk of sleep disorders. Conclusion A certain degree of sleep disturbance is reported in the civil aviation pilot group, which is closely related to work stress and lifestyle indicators. Targeted measures must be taken to effectively improve the quality of their sleep.

Background At present, domestic research on job burnout and health-related productivity is limited to medical workers, and the impact of job burnout on health-related productivity of enterprise staff deserves attention. Objective To explore the association between job burnout and health-related productivity loss among enterprise staff. Methods A cross-sectional online questionnaire survey was conducted among enterprise staff who were selected from seven enterprises in Minhang District of Shanghai. The Chinese version of Maslach Burnout Inventory-General Survey (MBI-GS) was used to assess job burnout, and a questionnaire based on and modified from the WHO Health and Work Performance Questionnaire was used to assess the loss of health-related productivity. Logistic regression was used to analyze the impact of job burnout on health-related productivity under the control of selected demographic characteristics, socio-economic factors, and occupational factors. Results A total of 3489 questionnaires were recovered, and 3156 valid questionnaires were included in the statistical analysis. Among the 3156 valid questionnaires, 2228 (70.8%) respondents were assessed as suffering from job burnout, in which 1858 (59.0%) were mild to moderate job burnout, and 370 (11.7%) were severe job burnout; the median score (interquartile range) of MBI-GS was 2.18（2.69）, the median rates (interquartile range) of absenteeism and presenteeism were 0.00% (0.00%) and 20.00% (50.00%), respectively. The prevalence of presenteeism significantly varied by gender, education, marital status, working years, job category, exhaustion, cynicism, professional efficacy, and job burnout (P<0.05). The prevalence of absenteeism significantly varied by education, marital status, working years, job category, exhaustion, cynicism, professional efficacy, and job burnout (P<0.05). Job burnout was positively correlated with absenteeism (r=0.157) and presenteeism (r=0.412) (P<0.01). After controlling for selected demographic characteristics, social economic factors, and occupational factors, the logistic regression showed that job burnout was associated with health-related productivity loss, the OR value remained relatively stable, and referring to negative job burnout, the OR (95%CI) of severe job burnout was 6.35 (4.52-8.92). Conclusion Job burnout of enterprise staff has a negative impact on health-related productivity. Severer job burnout associates with higher health-related productivity loss. Enterprises should pay attention to the prevention and control of job burnout to reduce health-related productivity loss.

Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.