Objective: To explore the independent and interactive effects of school green space exposure and outdoor activity duration on screening myopia among primary and secondary school students, so as to provide theoretical support for the prevention and control of screening myopia in children and adolescents. Methods: From September to November 2023, 117 487 primary and secondary school students from 497 schools were selected using a cluster random sampling method, covering 98 counties (cities, districts) in Jiangsu Province. Data on the students screening myopia status and associated health influencing factors were collected and analyzed. School green space exposure was quantified using the normalized difference vegetation index (NDVI), which was extracted with ArcGIS Pro software; meanwhile, information on students outdoor activity duration was gathered through self reported questionnaires. Multivariate Logistic regression was applied to assess the independent and interactive effects of green space exposure and outdoor activity duration on screening myopia among primary and secondary school students. Results: Univariate analysis showed that there were statistically significant differences in screening myopia detection rates among primary and secondary school students of different genders, NDVI groups, every outdoor activity duration, monitoring points, school stages, parents educational level, and whether they lived on campus or had parents with screening myopia ( χ 2=88.91-1 950.08, all P <0.05); as the school age and sedentary time increased, the detection rate of screening myopia in primary and secondary school students also increased ( χ 2 trend =8 410.15, 2 028.91, both P <0.05). Independent effects showed that compared to the low NDVI group, the medium and high NDVI groups had lower risks of screening myopia ( OR =0.93, 0.95, both P <0.05). Compared to those with outdoor activity duration<2 h/d, students with outdoor activity duration≥2 h/d had a lower risk of screening myopia ( OR =0.96, P <0.05). When stratified by school level, compared to the low NDVI group, the medium NDVI group had lower risks of screening myopia in primary and junior high schools (primary school: OR =0.91; junior high school: OR =0.88, both P <0.05). Compared to those with outdoor activity duration<2 h/d, junior high school students with outdoor activity duration≥2 h/d had a lower risk of screening myopia ( OR = 0.90, P <0.05). When stratified by monitoring site, urban primary and secondary school students in the medium and high NDVI groups and those with outdoor activity duration≥2 h/d had lower risks of screening myopia ( OR =0.92, 0.92, 0.93, all P <0.05). Interactive effects showed that when medium or high NDVI was combined with outdoor activity duration≥2 h/d, the risks of screening myopia among primary and secondary school students were lower (medium NDVI×≥2 h/d: OR =0.89; high NDVI×≥ 2 h/d : OR =0.89, both P <0.05), and the combined effect was superior to that of a single factor. Conclusion Green space exposure and outdoor activity duration have negative correlations with screening myopia among primary and secondary students, and the combined effect is better than that of a single factor.

Background::Few evidence is available in the early prediction models of behavioral and psychological symptoms of dementia (BPSD) in Alzheimer’s disease (AD). This study aimed to develop and validate a novel genetic-clinical-radiological nomogram for evaluating BPSD in patients with AD and explore its underlying nutritional mechanism.Methods::This retrospective study included 165 patients with AD from the Chinese Imaging, Biomarkers, and Lifestyle (CIBL) cohort between June 1, 2021, and March 31, 2022. Data on demographics, neuropsychological assessments, single-nucleotide polymorphisms of AD risk genes, and regional brain volumes were collected. A multivariate logistic regression model identified BPSD-associated factors, for subsequently constructing a diagnostic nomogram. This nomogram was internally validated through 1000-bootstrap resampling and externally validated using a time-series split based on the CIBL cohort data between June 1, 2022, and February 1, 2023. Area under receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were used to assess the discrimination, calibration, and clinical applicability of the nomogram.Results::Factors independently associated with BPSD were: CETP rs1800775 (odds ratio [OR] = 4.137, 95% confidence interval [CI]: 1.276-13.415, P = 0.018), decreased Mini Nutritional Assessment score (OR = 0.187, 95% CI: 0.086-0.405, P <0.001), increased caregiver burden inventory score (OR = 8.993, 95% CI: 3.830-21.119, P <0.001), and decreased brain stem volume (OR = 0.006, 95% CI: 0.001-0.191, P = 0.004). These variables were incorporated into the nomogram. The area under the ROC curve was 0.925 (95% CI: 0.884-0.967, P <0.001) in the internal validation and 0.791 (95% CI: 0.686-0.895, P <0.001) in the external validation. The calibration plots showed favorable consistency between the prediction of nomogram and actual observations, and the DCA showed that the model was clinically useful in both validations. Conclusion::A novel nomogram was established and validated based on lipid metabolism-related genes, nutritional status, and brain stem volumes, which may allow patients with AD to benefit from early triage and more intensive monitoring of BPSD.Registration::Chictr.org.cn, ChiCTR2100049131.

OBJECTIVE To investigate the damage effect and potential toxic mechanism of SARS-CoV-2 spike protein(S protein)on human neuroblastomacells(SH-SY5Y).METHODS SH-SY5Y were treated with S protein at concentrations of 25,50,75,and 100 mg·L-1 for 24 h.Cell viability of SH-SY5Y was detected using the CCK-8 assay.The cytotoxic lactate dehydrogenase(LDH)detection kit was used to measure the release rate of LDH,and the 5-ethynyl-2′-deoxyuridine(EdU)-488 cell prolifera-tion kit was used to assess cell proliferation.The ATP detection kit was used to measure intracellular ATP content.The JC-1 fluorescent probe method was employed to detect the mitochondrial membrane potential(MMP)of cells.Seahorse XF was used to measure mitochondrial respiratory and glycolytic capacity.RESULTS Compared with the cell control group,cell viability was significantly reduced in S protein 25,50,75 and 100 mg·L-1 groups(P<0.01),and the half-inhibition concentration(IC50)was 65.05 mg·L-1.The LDH release rate wassignificantly increased(P<0.01)and the proportion of EdU positive cellswas significantly reduced(P<0.01)in S protein 25,50,75 and 100 mg·L-1 groups.S protein signifi-cantly reduced intracellular ATP content(P<0.01)at the concentrations of 75 and 100 mg·L-1,while significantly reduced intracellular MMP(P<0.05,P<0.01)at the concentrations of 50 and 75 mg·L-1.S protein 50 mg·L-1 increased the maximum value of basal glycolysis levels and glycolytic capacity(P<0.05,P<0.01),and S protein 25 and 50 mg·L-1 increased the maximum value of respiration capacity(P<0.05,P<0.01).SH-SY5Y cell viability was positively correlated with the intracellular ATP content and the MMP level(r2=0.9209,P=0.001;r2=0.6170,P=0.0025),and negatively correlated with the maximum level of basal glycolysis and glycolytic capacity(r2=0.5194,P=0.0285;r2=0.6664,P=0.0073),and nega-tively correlated with ATP production capacity(r2=0.8204,P=0.0008).CONCLUSIONS protein decreases the viability of SH-SY5Y cells and inhibited cell proliferation.The mechanism may be closely related to the disorder of energy metabolism.

OBJECTIVE To investigate the damage effect and mechanisms of cyclophosphamide(CTX)and its active metabolite derivative 4-hydroperoxycyclophosphamide(4-HC)to human neuroblas-toma SH-SY5Y cells.METHODS SH-SY5Y cells were treated with CTX[0(cell control),0.01,0.1,1,5,10,20,40 and 80 mmol·L-1]and 4-HC[0(cell control),0.01,0.1,1,5,10,20,40 and 80 μmol·L-1]for 48 h.Cell confluence and morphology were observed by the IncuCyte ZOOM system.Cell viability was assessed by CCK-8 assay.Lactate dehydrogenase(LDH)release was measured by LDH assay kit.SH-SY5Y cells were treated with CTX(0,1,5,10 and 20 mmol·L-1)and 4-HC(0,1,5,10 and 20 μmol·L-1)for 48 h before cell proliferation was analyzed by 5-ethynyl-2′-deoxyuridine(EdU)staining assay.Immunofluorescence was employed to assess the levels of the DNA double-strand break marker γ-H2AX and to evaluate changes in mitochondrial membrane potential.SH-SY5Y cells were treated with CTX(0,1,5 and 10 mmol·L-1)and 4-HC(0,1,5 and 10 μmol·L-1)for 48 h,and the alterations in glycolysis and oxidative phosphorylation levels were analyzed using the Seahorse XFe96 Analyzer.RESULTS Compared with the cell control group,cell confluence and cell viability were significantly reduced in the CTX and 4-HC groups(P<0.01),and the half-maximal inhibitory concentrations(IC50)for CTX and 4-HC were 4.44 mmol·L-1 and 4.78 μmol·L-1,respectively.The release rate of LDH was signif-icantly increased while the percentage of EdU+cells was significantly reduced in the CTX and 4-HC groups(P<0.01).The percentage of γ-H2AX+cells was significantly increased and mitochondrial membrane potential significantly decreased in the CTX and 4-HC group(P<0.05).Treatment with CTX and 4-HC resulted in reduced levels of maximum glycolytic capacity,glycolytic reserve,maximal respi-ration,and ATP production(P<0.05).CONCLUSION CTX and 4-HC exert significant cytotoxic effects on SH-SY5Y cells by disrupting cell membrane structure,impeding cell proliferation,and reducing cell viability.The mechanisms underlying these effects may involve intracellular DNA damage,disturbance of energy metabolism and mitochondrial dysfunction.

The effect of Radix isatidis polysaccharide(IRPS)on TLR3/TRIF innate immune path-way and type Ⅰ interferon secretion in 3D4/21/CD163 cells infected by porcine reproductive and re-spiratory syndrome virus(PRRSV)was tested by Western blot and ELISA;moreover,the effect of IRPS on the immunosuppression infected by PRRSV was further verified with the TLR3 agonist poly(I∶C).The results showed that the protein levels of TLR3,TRIF,IRF3,IRF7 and type Ⅰ in-terferon secretion were significantly decreased at 18,24 h of PRRSV infection,while IRPS signifi-cantly inhibited this process;poly(I∶C)alleviated the protein levels of TRIF,IRF3 and IRF7 as well as the phosphorylation levels of IRF3 and IRF7 infected by PRRSV;at the same time,IRPS is synergistic with poly(I∶C).The results indicate that IRPS is able to alleviate immunosuppression caused by PRRSV infection via the TLR3/TRIF pathway.

Background: In the Chinese coal industry, widespread blame avoidance behavior (BAB) greatly impacts coal mine accidents. Therefore, it is necessary to stop the BAB of coal mine managers and raise the management level of coal mine enterprises for the safe development of Chinese coal industry. Methods: Based on the semi-structured interviews and questionnaire surveys (20 middle-level managers in coal mines), this paper used the Grounded Theory and Nvivo Software qualitative research methodology to open, spindle, and selectively encode the interview data. Then, an index system of factors influencing BAB of coal mine managers was constructed. The influence degree, affected degree, centrality degree, cause degree of each influencing factor were calculated and the hierarchical model of influencing factors of BAB of coal mine managers was established by the DEMATEL-ISM method which is a decision support tool used to evaluate and analyze the interdependencies between influencing factors. Results: Index system of factors influencing BAB of coal mine managers included four levels and 12 influencing factors: individual, organizational, institutional environmental, and situational factors. The hierarchical model identified eight causal factors and four consequential factors, of which safety management (15.355), work attitude (14.380), and work group performance (14.281) in the top three of the centrality rankings are the key factors affecting the avoidance behavior of coal mine managers; A 3-level multilevel structure was constructed to reflect the interactions among the factors influencing the BAB of coal mine managers in terms of direct, indirect, and root causes, and corresponding improvement measures were proposed. Conclusion This study offers a theoretical complement and practical guidance for stopping BAB of coal mine managers.

Objective:To analyze the gender difference in behavioral and psychological symptoms of dementia (BPSD) of amnestic mild cognitive impairment (aMCI) and Alzheimer′s disease (AD).Methods:It was a cross-sectional study. The clinical data of 201 patients with aMCI and 146 patients with AD were continuously collected from the Chinese Imaging, Biomarkers and Lifestyle Study of Alzheimer′s Disease (CIBL) cohort between June 1, 2021 to February 1, 2023 in Beijing Tiantan Hospital, Capital Medical University. The BPSD subtypes were compared between different gender. The gender-different BPSD subtypes were divided into depression group (126 cases) and non-depression group (221 cases), anxiety group (140 cases) and non-anxiety group (207 cases), indifference group (131 cases) and non-indifference group (216 cases). The sociodemographic data (age, sex, education level, marital status), hypertension, diabetes, stroke, heart disease, hyperlipidemia, smoking history, drinking history, carrier status of apolipoprotein E epsilon4 allele (APOE ε4), and the scores of the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Neuropsychiatric Inventory (NPI), Activity of Daily Living (ADL) were compared by using hypothesis testing. Multivariate logistic regression was used to analyze the gender differences of BPSD in aMCI and AD patients.Results:The incidence rates of depression and anxiety in female were both significantly higher than those in male (44.93% vs 23.57%, 44.93% vs 33.57%), and the incidence rate of apathy was significantly lower than that in male (32.37% vs 45.71%) (all P<0.05). The proportion of female and ADL scores in depression group were both significantly higher than those in non-depression group [73.81% vs 51.58%, 22.00 (20.00, 30.00) vs 20.00 (20.00, 26.00) points], and the proportion of smoking and drinking history and MoCA scores in depression group were all significantly lower than those in non-depression group [13.49% vs 25.79%, 19.84% vs 35.75%, 16.00 (10.00, 22.00) vs 19.00 (13.00, 24.00) points] (all P<0.05). The proportion of female and ADL scores in anxiety group were both significantly higher than those in non-anxiety group [66.43% vs 55.07%, 23.00 (20.00, 30.75) vs 20.00 (20.00, 25.00) points], and the MMSE and MoCA scores in anxiety group were both significantly lower than those in non-anxiety group [23.00 (16.00, 27.00) vs 24.00 (19.00, 28.00) points, 16.00 (10.00, 21.00) vs 20.00 (13.00, 13.00) points] (all P<0.05). The proportion of female and the MMSE and MoCA scores in apathy group were all significantly lower than those in non-apathy group [51.15% vs 64.81%, 19.00 (11.00, 25.00) vs 26.00 (22.00, 28.00) points, 14.00 (7.00, 19.00) vs 21.00 (15.25, 24.00) points], and the age, proportion of APOE ε4 carriers and ADL scores in apathy group were all significantly higher [67.0 (61.0, 76.0) vs 66.0 (60.0, 71.0) years, 42.74% vs 31.31%, 27.00 (22.00, 38.00) vs 20.00 (20.00, 22.00) points] (all P<0.05). Female ( OR=2.384, 95% CI: 1.274-4.459) and decrease in MoCA score ( OR=0.955, 95% CI: 0.914-0.998) were positively correlated with risk of depression. Female ( OR=1.704, 95% CI: 1.077-2.695) was positively correlated with risk of anxiety. Male ( OR=0.558, 95% CI: 0.333-0.936), decrease in MoCA scores ( OR=0.937, 95% CI: 0.894-0.983) and increase in ADL scores ( OR=1.070, 95% CI: 1.027-1.116) were positively correlated with risk of apathy (all P<0.05). Conclusions:There are significant gender differences in BPSD in aMCI and AD patients. Female is positively correlated with risk of depression and anxiety, while male is positively correlated with the occurrence of apathy. Clinical attention should be paid to hierarchical management of BPSD patients of different gender.

Objective:Using real-world data to analyze whether the administration of carbapenems within 7 days before the treatment or during the treatment will reduce the effectiveness of sodium valproate in patients with status epilepticus (SE) and seizure clusters (SC).Methods:The clinical data of SE and SC patients who received intravenous administration of sodium valproate in the Department of Emergency of Zhongshan Hospital, Fudan University from 2017 to 2021 were collected. The main endpoint was the failure to terminate epileptic seizures after sodium valproate injection. Univariate analysis and multivariate Logistic regression model were used to analyze whether the carbapenems was an independent risk factor for the failure of sodium valproate treatment.Results:Finally, 142 SE patients and 181 SC patients were included. Univariate analysis revealed that the use of carbapenems within 7 days before or during the treatment was a risk factor for the failure of sodium valproate treatment in SC patients (χ 2=5.498, P=0.019), but was not a risk factor for the failure of sodium valproate treatment in SE patients (χ 2=3.015, P=0.082). Through multiple factor analysis, it was found that the use of carbapenems was an independent risk factor for the seizures not terminatd by sodium valproate in SC patients ( OR=3.462, 95% CI 1.180-10.157); the interval between onset and medication≥4 hours increased the risk of sodium valproate treatment failure in SE patients ( OR=4.591, 95% CI 1.443-14.607); simultaneously using benzodiazepines could reduce the risk of sodium valproate treatment failure in SE patients ( OR=0.300, 95% CI 0.128-0.703). Conclusions:The use of carbapenems by SC patients within 7 days before or during treatment may lead to the failure of sodium valproate treatment. In clinical practice, the use of sodium valproate as a medication to terminate seizures in SC patients can be determined based on their medication records.

Research integrity is the foundation for ensuring the sound and orderly development of scientific and technological innovation. As the main battlefield of clinical medical research, hospitals should effectively fulfill their main responsibilities and do a good job in research integrity management. The China Hospital Research Integrity Alliance, consisting of the first batch of 43 hospitals, was established in November 2021. With the aim of " complementary advantages, resource sharing, and collaborative development", the alliance has carried out construction practices from seven aspects: construction mode, cultural system construction, organizational management, institutional construction, publicity and education, early warning and supervision, and technological empowerment. It has achieved the overall improvement of the research integrity construction ability of member units of the alliance, organic linkage between government and medical institutions, and efficient combination of internal and external resources, which can provide reference for the research integrity construction of medical institutions in China.

To explore reform paths and information technology construction models for procurement management in public hospitals,and to design effective business processes and system architectures,the Sixth Affiliated Hospital of Sun Yat-sen Univer-sity(hereinafter referred to as"Z Hospital")has taken the lead in procurement management reform.By building a digital man-agement system based on workflow,Z Hospital's procurement management system breaks down information silos,controls internal and external risks,and establishes informational supervision methods,thereby improving the efficiency of procurement activities and the quality of data.This paper uses the construction practice of Z Hospital's procurement management system as a case study to review the current status and issues of procurement management reform in public hospitals from the perspective of internal con-trol development.It analyzes the potential risks of information technology construction,target functions,system architecture,and application effects,providing practical experience for the informatization of procurement operations in public hospitals from both technical and theoretical perspectives.