The accumulation of fatigue during military operations may lead to decreased operational efficiency and non-combat attrition,which can impact combat effectiveness.On-site monitoring and evaluation of fatigue during military operations,as an important means to keep track of military operations and bring about quick changes in training,underlie the combat effectiveness of military personnel.Focusing on the on-site monitoring and evaluation methods of fatigue during military operations,this paper reviews the determinants of such fatigue as well as on-site monitoring and comprehensive evaluation methods so as to provide reference for accurate and efficient evaluation of fatigue during military operations and for early warning of such fatigue.

Objective:Distribution and antibiotic resistance of pathogen isolated from children with intra-abdominal infection (IAI) associated sepsis in the intensive care unit (ICU) were analyzed to provide a reference for the empirical anti-infective treatment of IAI in children.Methods:We retrospectively analyzed the data of 116 children with culture-positive IAI-associated sepsis admitted to Children's Hospital of Zhejiang University School of Medicine from January 2019 to December 2021. Clinical isolation and drug resistance analysis were conducted based on different years of onset, locations of onset, and primary diseases.Results:A total of 186 strains of pathogens causing children with IAI-associated sepsis in ICU were collected. The distribution and antibiotic resistance of pathogen were as follows: the percentages of gram-positive bacteria, gram-negative bacteria, and fungi were 53.2%, 40.9%, and 5.9%, respectively; the top four strains were Enterococcus faecium, Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis, accounting for 57.0% of all isolates; Enterococcus faecium(19.9%) and Enterococcus faecalis (10.2%) were the dominating gram-positive bacteria; Escherichia coli (13.4%) and Klebsiella pneumoniae (13.4%) were more common gram-negative bacteria; Fungi were dominated by Candida albicans (3.8%).Fifty-seven strains of gram-positive bacteria were detected in 61 children with infectious diseases, mainly Enterococcus faecium (28 strains). There were 53 gram-negative strains, mainly Klebsiella pneumoniae (21 strains). Thirty-two strains of gram-positive bacteria were detected in 40 children with digestive tract malformation, and Enterococcus faecalis (six strains) were the most common. There were 14 gram-negative strains, mainly Escherichia coli (six strains). In 13 children with malignant tumors of digestive system, nine strains of gram-positive bacteria were cultured, and Enterococcus faecium (four strains) was the most common. There were eight gram-negative strains, mainly Escherichia coli (four strains).In the 46 community-acquired IAI patients,30 gram-positive isolates were cultured,mainly including Enterococcus faecium (12 strains), Staphylococcus epidermidis (seven strains), and Viridans streptococci (six strains); Forty gram-negative isolates mainly contained Escherichia coli (16 strains), Klebsiella pneumoniae (14 strains), and Enterobacter cloacae (five strains). In the 70 hospital-associated IAI patients, 69 gram-positive isolates such as Enterococcus faecium (25 strains), Enterococcus faecalis (17 strains), Enterococcus gallinarum (eight strains), and Staphylococcus aureus (seven strains) were cultured;Tirty-six gram-negative isolates were dominated by Klebsiella pneumoniae (11 strains), Escherichia coli (nine strains), Pseudomonas aeruginosa (four strains), and Acinetobacter baumannii (four strains). The mixed infection rate of clinical pathogens was up to 46.6%, and the overall resistance rate was 43.4%, in which gram-negative bacteria had high sensitivity to piperacillin/tazobactam, cefoperazone/sulbactam, imipenem, and tigecycline.The detection rates of Klebsiella pneumoniae and Escherichia coli producing extended-spectrum β-lactamases were 36.0% and 24.6%, respectively, with 100% sensitivity to tigecycline. Gram-positive bacteria showed 100% sensitivity to vancomycin, linezolid, and tigecycline. Conclusion:Pathogen isolated from children with IAI-associated sepsis in ICU were dominated by Enterococcus faecium, Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis,respectively. Before confirmation of pathogenic bacteria, antibacterial agents can be selected according to the infection type. It is important to note that a single broad-spectrum antibacterial agent or combination medication can be considered the initial empirical choice due to the large variety of pathogens, high rates of mixed infections, and high overall resistance.

Objective To investigate the application value of transumbilical single-port total laparoscopic hysterectomy by conventional instrument without uterine-lifting in the treatment of cervical lesions.Methods We selected 60 cases of total laparoscopic hysterectomy due to cervical high-grade squamous intraepithelial lesion(HSIL)or cervical cancer stage ⅠA1 from December 2021 to June 2023.According to the patients'preference,30 cases of single-port laparoscopy through the umbilicus and 30 cases of multi-port laparoscopy were performed,both using conventional instruments without uterine-lifting.The surgical indicators of the two groups were compared.Results No conversion to open surgery occurred in both groups,and no intraoperative injuries to the urinary system,bowel,or major blood vessels occurred.As compared with the multi-port group,the single-port group had significantly reduced amount of bleeding during surgery[(54.6±20.5)ml vs.(67.5±27.0)ml,P = 0.041],earlier anal exhaust time[(27.6±8.0)h vs.(32.2±9.0)h,P =0.040],and shorter total hospitalization time[(4.4±1.5)d vs.(5.1±1.2)d,P = 0.044].There were no significant differences in uterine weight,surgical time,and postoperative complications between the two group(P>0.05).The healing of the abdominal wall puncture wounds in both groups of patients were satisfied.There were no short-term complications related to the puncture device(such as puncture wound infection and bleeding)or long-term complications(such as umbilical hernia and incisional hernia).Conclusion Transumbilical single-port total laparoscopic hysterectomy without uterine-lifting presents advantages of less intraoperative bleeding,faster postoperative recovery,and almost no scarring,with complications similar to traditional laparoscopic surgery.

Objective To explore the conditions for compulsory licensing of pharmaceutical patents and the steps for implementing compulsory licensing of pharmaceutical patents.Methods The current situation and problem of compulsory licensing of pharmaceutical patents in China were analyzed by collecting the relevant laws and regulations in China,United States,India,and the World Trade Organization.The feasible practices of compulsory licensing of pharmaceutical patents among the other countries and organizations were compared.Results China needs to improve the system of compulsory licensing of pharmaceutical patents,clarify the implementation details,strengthen policy guidance,and encourage cooperation between government and enterprises to ensure the smooth implementation in emergency situations.Conclusion Compulsory licensing system and implementation rules in China for pharmaceutical patents should be supplemented and improved by absorbing the useful provisions of international organizations and relevant countries,so as to achieve the pharmaceutical supply in emergency situations and meet the needs of public health.

Objective To explore the ideas and measures to further optimize China's drug emergency approval system by comparing the drug emergency approval systems in China and other countries.Methods The current situation of China's drug emergency approval system was analyzed and compared with the relevant systems of the United States,the European Union and Japan.Results The goal of drug emergency approval in other countries is clearly positioned to accelerate the review and listing of urgently needed clinical drugs for the purpose of clinical needs,forming a multi-channel,multi-mode and multi-mechanism priority review system covering the whole process,and the regulatory system is clear,complete,and operable.The corresponding approval system in China started late and is in the stage of continuous improvement,which needs to be improved in terms of system construction,government functions,personnel optimization,and post-market supervision.Conclusion Drug regulatory authorities in China should summarize their past work experience and draw on some feasible approval models and regulatory approaches in foreign countries,further improve the system and process of the drug emergency approval system and enhance the efficiency of drug approval and the ability to protect drugs in response to emergencies.

177Lu-prostate specific membrane antigen(PSMA)radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China.Based on domestic clinical practice and experimental data and referred to international experience and viewpoints,the expert group forms a consensus on the clinical application of 177Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.

Background Major depressive disorder and insomnia often coexist,and the two may share a mechanism of pathogenesis and be affected by common underlying genes with strong pleiotropic effects.Previous genome-wide association studies(GWAS)mainly focused on single-gene morphological characters analysis,which impose limitations on showing possible pleiotropic effects.Objective To identify genetic loci related to insomnia and major depressive disorder,and to examine whether there are common genetic factors underlying both insomnia and depression.Methods The GWAS data for major depressive disorder originates from the Psychiatric Genomics Consortium(PGC),which comprises a total of 246363 depressive cases and 561190 controls.The insomnia GWAS data was downloaded from Sleep Disorder Knowledge Portal,involving 1331010 participants.Then the conditional false discovery rate(cFDR)and conjunction cFDR(ccFDR)were utilized to identify the genetic loci associated with major depressive disorder and insomnia,and pathway enrichment analysis was performed to examine the biological functions of these loci.Results A significant pleiotropic effect was detected between major depressive disorder and insomnia.By leveraging pleiotropic enrichment,21 susceptibility loci(17 novel loci)for major depressive disorder and 38 susceptibility loci(28 novel loci)for insomnia were identified with the threshold of cFDR<0.01.A total of 16 pleiotropic loci(15 novel loci)related to both major depressive disorder and insomnia were identified with the threshold of ccFDR<0.05.pathway enrichment analysis indicated that the susceptibility loci were mainly enriched in synaptic transmission pathway,such as postsynaptic density(GO:0014069,P=4.91E-04,FDR=4.84E-03),asymmetric synapse(GO:0032279,P=5.09E-04,FDR=4.84E-03),and regulation of postsynaptic membrane neurotransmitter receptor levels(GO:0099072,P=5.11E-04,FDR=1.69E-02).Conclusion A significant pleiotropic enrichment is found between major depressive disorder and insomnia,and the comorbidity mechanism is related to synaptic transmission.

Objective To invesigate the feasibility of low radiation dose and low contrast dosage in triple-rule-out computed tomo-graphy angiography(TRO-CTA)on the 320-row detector CT.Methods A total of 120 patients who underwent CTA were prospec-tively selected.All patients were divided into control group(n=90)and experimental group(n=30).The control group employed standard-doses protocol of pulmonary CTA(120 kV tube voltage,45 mL contrast dosage),coronary CTA(120 kV,50-60 mL),and aortic CTA(120 kV,75 mL),while the experimental group received TRO-CTA with 100 kV and 70-80 mL.The peak time of contrast dosage at the pulmonary artery and aorta was measured by low-dose detection method in the experimental group,and the contrast examination was performed sequentially in the control group.Subjective scores and objective image quality of the pulmonary artery,coronary artery,and aorta in the experimental group and the control group were measured and compared,respectively.The effective dose(ED)between the two groups were recorded and compared.Independent samples t-test and Fisher exact probability were used to analyze the statistical differences between the above measures.Results There were no significant differences in CT values,con-trast-to-noise ratio(CNR),signal-to-noise ratio(SNR)of pulmonary artery,coronary artery and aorta between the two groups(P＞0.05).The mean subjective scores of pulmonary artery,coronary artery and aorta segments in the two groups were not less than 3 points,meeting the requirement of clinical diagnosis.There was no statistical difference in subjective scores between the two groups(P＞0.05).There was statistically significant difference in ED between the two groups(P＜0.05).The ED of pulmonary artery,coronary artery,and aorta in the experimental group were 11.49％,13.33％,and 11.46％significantly lower than those in the control group,respec-tively.Conclusion It is feasible to obtain TRO-CTA images used by the low radiation dose and low contrast dosage on the 320-row detector CT,and radiation dose and contrast dosage can be reduced reasonably without alterations of TRO-CTA images quality in clinical practice.

Aim To investigate the levels of krüppel-like factor 2(KLF2)and endothelial nitric oxide synthase 3(NOS3)in the serum of patients with acute cerebral infarction(ACI)of large-artery atherosclerosis(LAA)type,and to analyze their value in the diagnosis and disease assessment of LAA type ACI.Methods A total of 150 patients with LAA type ACI were divided into mild group(n=36),moderate group(n=48),and severe group(n=66)based on their condition.Additionally,a control group(n=150)was selected from health exminers during the same period.The levels of serum KLF2 and NOS3 in each group were compared;receiver operator characteristic(ROC)curve was applied to analyze the diagnostic value of serum KLF2 and NOS3 levels for LAA type ACI and the predictive value for the occurrence of severe LAA type ACI,respectively.Results The serum KLF2 and NOS3 levels were significantly lower in LAA type ACI group than those in control group(P＜0.05).The serum KLF2 and NOS3 levels in the mild,moderate and se-vere groups were significantly decreased in turn(P＜0.05).The area under the curve(AUC)of the combined diagnosis of serum KLF2 and NOS3 for LAA type ACI was 0.858,with a sensitivity of 73.33％and a specificity of 86.00％,which was superior to the individual diagnosis of KLF2 and NOS3(Zcombined detection-KLF2=3.796,Zcombined detection-NOS3=4.689,all P＜0.001).The AUC of combined prediction of serum KLF2 and NOS3 for the occurrence of severe LAA type ACI was 0.878,with a sensitivity of 77.27％and a specificity of 90.48％,which was superior to the independent prediction of KLF2 and NOS3(Zcombineddetection-KLF2=2.401,P=0.016;Zcombined detection-NOS3=3.070,P=0.002).Conclusions The serum levels of KLF2 and NOS3 in patients with LAA type ACI were significantly reduced and negatively correlated with the severity of the disease.The combination of the two has high evaluation efficacy in the diagnosis and disease prediction of LAA type ACI.

Objective To investigate the efficacy and safety of preemptive one lung ventilation(OLV)combined with disconnection technique for lung collapse during OLV with bronchial blocker(BB)in thoracoscopic surgery.Methods 75 patients who were scheduled for elective left lung segment or lobectomy under thoracoscopy were randomly divided into preemptive OLV group(group A),disconnection technique group(group B)and preemptive OLV combined with disconnection technique(group C),25 cases in each group.The time of complete lung collapse,surgeon satisfaction,pre-thoracic preparation time,OLV time,operation time,and occurrence of hypoxemia[percutaneous arterial oxygen saturation(SpO2)<90%]within 20 minutes after the onset of OLV were recorded;The lung collapse score(LCS)at the moment of pleural cavity opening(T0),1 min(T1),5 min(T2),10 min(T3)and 20 min(T4)after pleural cavity opening were recorded.Results Compared with group A and B,the complete lung collapse time in Group C was significantly shortened,and the surgeon satisfaction was significantly improved,the differences were statistically significant(P<0.05).There was no statistical significance in the complete lung collapse time and surgeon satisfaction between group A and B,the differences were not statistically significant(P>0.05).Compared with group A,the LCS at T0 in group B was lower than that in group A,but significantly higher at T1,the differences were statistically significant(P<0.05).The LCS at T1,T2,T3 and T4 in group C were significantly higher than those in group A and group B,the differences were statistically significant(P<0.05).The value of SpO2 at T2 in group C was obviously lower than that in group A and group B,the difference was statistically significant(P<0.05).Conclusion Preemptive OLV combined with disconnection technique can improve the lung collapse of the non-ventilated lung during OLV with BB in thoracoscopic surgery,shorten complete lung collapse time,with higher surgeon satisfaction,and higher LCS score during OLV.However,SpO2 during OLV still needs to be monitored.