BackgroundPatients with schizophrenia experience low quality of life， and internalized stigma is considered an important indicator for quality of life， while the mediating role of self-esteem and severity of negative symptoms in the relationship between internalized stigma and quality of life remains underexplored. ObjectiveTo examine the mediating role of self-esteem and severity of negative symptoms in the relationship between internalized stigma and quality of life， so as to provide references for improving their quality of life. MethodsA total of 342 patients with schizophrenia who were hospitalized in 6 hospitals in Xiangyang City， Siping City and Changchun City from April to September 2023 were included， and all of whom met the diagnostic criteria for schizophrenia according to the International Classification of Diseases， tenth edition （ICD-10）. Internalized Stigma of Mental Illness Scale （ISMI）， Schizophrenia Quality of Life Scale （SQLS）， Self-Esteem Scale （SES） and negative symptom subscale of Positive and Negative Symptom Scale （PANSS） were administered to all patients. Spearman correlation analysis was adopted to determine correlations between the different scales. A structural equation modeling was constructed using Amos 28.0， and Bootstrap method was employed to verify the mediating effect of self-esteem and negative symptom severity in the association between internalized stigma and quality of life. ResultsA total of 309 patients （90.35%） completed questionnaires in this study. The ISMI score of schizophrenia patients was positively correlated with both SQLS score and the PANSS negative symptom subscale score （r=0.612， 0.492， P<0.01）， while was negatively correlated with SES score （r=-0.513， P<0.01）. The SQLS score was negatively associated with the SES score （r=-0.555， P<0.01） and positively associated with PANSS negative symptom subscale score （r=0.672， P<0.01）. The SES score was negatively correlated with PANSS negative symptom subscale score （r=-0.433， P<0.01）.The total effect value of internalized stigma on quality of life was 0.746 （95% CI： 0.680~0.806）. Self-esteem and severity of negative symptoms independently mediated the relationship between internalized stigma and quality of life， and the indirect effect values were 0.151 （95% CI： 0.062~0.254） and 0.126 （95% CI： 0.047~0.205）， accounting for 20.24% and 16.89% of the total effect， respectively. In addition， a chained mediation effect of self-esteem and quality of life was also demonstrated， the indirect effect value was 0.102 （95% CI： 0.049~0.165）， accounting for 13.67% of the total effect）. ConclusionInternalized stigma in patients with schizophrenia patients can not only directly affect the quality of life， but also indirectly affect the quality of life of patients through either separate or chained mediation of self-esteem and the severity of negative symptoms. ［Funded by Hubei Provincial Undergraduate Innovation and Entrepreneurship Project （number， S202410519027）］

In recent years,functional intraocular lenses(IOLs)have provided an effective choice for improving the visual quality of cataract patients,with high postoperative satisfaction and spectacle independence,but there are also ad-verse reactions such as glare and stereoscopic damage.More ophthalmologists have proposed the implantation of two dif-ferent IOLs to give full play to their respective advantages,thereby improving postoperative effects.It is an important topic to explore an optimized IOL implantation program for the treatment of cataracts and the correction of presbyopia.This arti-cle reviews the research progress on blended implantation of IOLs in treating cataracts and correcting presbyopia.

Abstract: Objective To investigate the occurrence of multidrug-resistance among tuberculosis patients in Hainan Province from 2014 to 2020 and to analyze the influencing factors, aiming to provide reference for formulating drug-resistant tuberculosis control strategies in this region. Methods This study collected sputum samples from the patients with pulmonary tuberculosis admitted to the Second Affiliated Hospital of Hainan Medical University from 2014 to 2020, and performed isolation and identification of Mycobacterium tuberculosis and drug susceptibility testing. After the strains were identified as positive, drug sensitivity tests were conducted, and multi-drug resistant patients were found. Clinical data was retrospectively collected, and chi-square test and unconditioned logistic regression were used to analyze the influencing factors of multidrug resistance. Results A total of 2 672 patients underwent sputum culture, strain identification, and drug susceptibility testing in TB designated hospitals in Hainan Province from January 1, 2014 to December 31, 2020. Among them, 1 942 patients with available drug susceptibility test results and complete clinical data were enrolled, among which 398 cases with drug-resistant TB were included in the case group, and 1 544 cases without drug resistance were included in the control group. Multivariate logistic regression analysis showed that farmers, rural residence, treatment history of retreatment, irregular medication history, number of pulmonary cavities ≥3, and BMI<18.5 were independent risk factors for MDR-TB. The risk of MDR-TB in farmers was higher than that in non-farmers (OR=1.542, 95%CI: 1.150-2.020); patients living in rural areas had a higher risk of multidrug resistance than those living in urban areas (OR=1.445, 95%CI: 1.095-1.907); the risk of MDR in the retreatment patients was higher than that in the initial treatment patients (OR=5.616, 95%CI: 4.250-7.421); the risk of multi-drug resistance in patients with irregular medication was higher than that in patients with regular medication (OR=2.665, 95%CI: 2.012-3.531); the risk of multidrug resistance in patients with pulmonary cavity number ≥3 was higher than that in patients with pulmonary cavity number <3 (OR=5.040, 95%CI: 3.768-6.740); compared with patients with BMI<18.5, patients with BMI=18.5-24.0 and BMI≥24.0 had a lower risk of multidrug resistance (OR=0.735, 95%CI: 0.555-0.975 and OR=0.447，95%CI:0.225-0.888, respectively). Conclusions Retreatment, farmer occupation, rural residence, irregular medication and low BMI may be the risk factors for multidrug resistance in Hainan Province.

Objective:To construct a prognostic model for lung squamous cell carcinoma (SqCLC) based on autophagy-related genes analyzed by bioinformatics and validate it.Methods:Expression profile data and clinical information of 268 SqCLC patients were downloaded from The Cancer Genome Atlas (TCGA) database and a dataset of normal lung tissues of 336 healthy people was downloaded from the Genotype Tissue Expression (GTEx) database; the autophagy-related genome was obtained from the GO_AUTOPHAGY genome of the Human Autophagy Database (HADb) and the Molecular Signature Database (MSigDB) 6.2. R 4.0.3 software was applied to analyze the differentially expressed genes between SqCLC tissues in TCGA database and normal lung tissues in GTEx database. Screening of autophagy-related genes differentially expressed between SqCLC tissues and normal lung tissues in the TCGA database (referred to as differentially expressed autophagy genes) was performed using R 4.0.3 software. The Cox proportional risk model was applied to analyze the relationship between the differentially expressed autophagy genes and prognosis of SqCLC patients in TCGA database, and a prognostic model was constructed. The SqCLC patients in TCGA database were divided into high-risk group and low-risk group based on the median risk score of the prognostic model, and the Kaplan-Meier method was used to compare the overall survival of the two groups; the time-dependent receiver operating characteristic (ROC) curve of the 3-, 5- and 10-year overall survival rates of 268 patients in TCGA database predicted by the prognostic model was plotted. Cox regression was used to analyze the independent influencing factors of overall survival of SqCLC patients in TCGA database, and the prognostic index formula was established. Based on the consistency index and restricted mean survival (RMS) curve, the predictive efficacy for the survival of patients in TCGA database between prognostic index of prognostic model risk score alone and prognostic index of risk score combined with independent influencing factors was compared. R 4.0.3 software was used to construct the nomogram for predicting patients' 3-, 5- and 10-year overall survival rates.Results:Six prognosis related differentially expressed autophagy genes were screened, and a prognostic model was constructed as: risk score=PEX14×0.337+CASPASE-8×(-0.280)+TM9SF1×0.292+UBB×0.472+P4HB×0.163+CTSA×0.173. In TCGA database, the overall survival of high-risk group was worse than that of low-risk group ( P < 0.001). Time-dependent ROC curve analysis showed that the area under the curve (AUC) of the prognostic model risk score for predicting the 3-, 5- and 10-year overall survival rates of 268 patients in TCGA database was 0.715, 0.715 and 0.831, respectively. Multivariate Cox regression analysis showed that age, staging and prognostic model risk score were independent factors affecting the overall survival of SqCLC patients in TCGA database, and the prognostic index=0.998×risk score+0.725×staging+0.559×age. The RMS curve showed that compared with the prognostic model risk score, the prognostic index combined with 3 independent prognostic factors had a better effect on predicting the overall survival (consistency index: 0.68 vs. 0.65, P =0.045). Using age, staging and prognostic model risk score, a nomogram was constructed to predict the survival of patients with SqCLC, and its calibration curve was close to the ideal curve. Conclusions:A prognostic model of SqCLC based on 6 characteristic differentially expressed autophagy-related genes has been successfully established. Internal validation shows that this model combined with other clinicopathological factors could be helpful in predicting the survival of SqCLC patients.

Defining and visualizing the three-dimensional (3D) structures of pharmaceuticals provides a new and important tool to elucidate the phenomenal behavior and underlying mechanisms of drug delivery systems. The mechanism of drug release from complex structured dosage forms, such as bilayer osmotic pump tablets, has not been investigated widely for most solid 3D structures. In this study, bilayer osmotic pump tablets undergoing dissolution, as well as after dissolution in a desiccated solid state were examined, and visualized by synchrotron radiation micro-computed tomography (SR-μCT). In situ formed 3D structures at different in vitro drug release states were characterized comprehensively. A distinct movement pattern of NaCl crystals from the push layer to the drug layer was observed, beneath the semi-permeable coating in the desiccated tablet samples. The 3D structures at different dissolution time revealed that the pushing upsurge in the bilayer osmotic pump tablet was directed via peripheral "roadways". Typically, different regions of the osmotic front, infiltration region, and dormant region were classified in the push layer during the dissolution of drug from tablet samples. According to the observed 3D microstructures, a "subterranean river model" for the drug release mechanism has been defined to explain the drug release mechanism.

Objective:To explore the application of on-demand teaching in the teaching of newly recruited nurses in the Class-A tertiary hospital.Methods:A total of 84 newly recruited nurses from Beijing Shijitan Hospital Affiliated to Capital Medical University from August 2017 to August 2018 were selected as the control group, and routine teaching was used. In addition, 116 new nurses from August 2019 to August 2020 were selected as the observation group, and on-demand teaching was adopted. The results of theory and practical operation, comprehensive ability and teaching satisfaction of the two groups were compared. The software SPSS 22.0 was used for t-test. Results:The nurses in the observation group had higher scores than the control group in theory [(96.38±2.14) vs. (91.56±3.75)] and practice [(95.49±2.23) vs. (90.91±4.02)]. The scores of nurses in the observation group were higher than those in the control group in accurate implementation of doctor's orders, emergency response ability, ability to observe illness, operation level, communication ability, professional image of nurses, cooperation satisfaction with doctors and harmony with nurses ( P<0.05). The nurses in the observation group scored higher than those in the control group in teaching content, teaching method, teaching attitude, and teaching effect satisfaction ( P<0.05). Conclusion:The application of on-demand teaching in the teaching of newly recruited nurses in the Class-A tertiary hospital can significantly improve their theoretical and practical skills, and improve their comprehensive ability and teaching satisfaction.

Catalase is widely used in the food, medical, and textile industries. It possesses exceptional properties including high catalytic efficiency, high specificity, and environmental friendliness. Free catalase cannot be recycled and reused in industry, resulting in a costly industrial biotransformation process if catalase is used as a core ingredient. Developing a simple, mild, cost-effective, and environmentally friendly approach to immobilize catalase is anticipated to improve its utilization efficiency and enzymatic performance. In this study, the catalase KatA derived from Bacillus subtilis 168 was expressed in Escherichia coli. Following separation and purification, the purified enzyme was prepared as an immobilized enzyme in the form of enzyme-inorganic hybrid nanoflowers, and the enzymatic properties were investigated. The results indicated that the purified KatA was obtained through a three-step procedure that included ethanol precipitation, DEAE anion exchange chromatography, and hydrophobic chromatography. Then, by optimizing the process parameters, a novel KatA/Ca₃(PO₄)₂ hybrid nanoflower was developed. The optimum reaction temperature of the free KatA was determined to be 35 ℃, the optimum reaction temperature of KatA/Ca₃(PO₄)₂ hybrid nanoflowers was 30-35 ℃, and the optimum reaction pH of both was 11.0. The free KatA and KatA/Ca₃(PO₄)₂ hybrid nanoflowers exhibited excellent stability at pH 4.0-11.0 and 25-50 ℃. The KatA/Ca₃(PO₄)₂ hybrid nanoflowers demonstrated increased storage stability than that of the free KatA, maintaining 82% of the original enzymatic activity after 14 d of storage at 4 ℃, whereas the free KatA has only 50% of the original enzymatic activity. In addition, after 5 catalytic reactions, the nanoflower still maintained 55% of its initial enzymatic activity, indicating that it has good operational stability. The K_m of the free KatA to the substrate hydrogen peroxide was (8.80±0.42) mmol/L, and the k_cat/K_m was (13 151.53± 299.19) L/(mmol·s). The K_m of the KatA/Ca₃(PO₄)₂ hybrid nanoflowers was (32.75±2.96) mmol/L, and the k_cat/K_m was (4 550.67±107.51) L/(mmol·s). Compared to the free KatA, the affinity of KatA/Ca₃(PO₄)₂ hybrid nanoflowers to the substrate hydrogen peroxide was decreased, and the catalytic efficiency was also decreased. In summary, this study developed KatA/Ca₃(PO₄)₂ hybrid nanoflowers using Ca²⁺ as a self-assembly inducer, which enhanced the enzymatic properties and will facilitate the environmentally friendly preparation and widespread application of immobilized catalase.
Catalase ; Nanostructures/chemistry* ; Hydrogen Peroxide/metabolism* ; Enzymes, Immobilized/chemistry* ; Catalysis

Objective:To explore the status and influencing factors of positive feelings of caregivers of patients with enterostomy, so as to provide a reference for targeted interventions.Methods:From May to October 2021, convenience sampling was used to select 130 caregivers of patients with enterostomy who received follow-up visits in the Stoma Clinic of the First Affiliated Hospital of Xi'an Jiaotong University as the research subject. The survey was carried out using the General Information Questionnaire, the Positive Aspects of Caregiving (PAC) , and the Care Preparedness Scale (CPS) . A total of 130 questionnaires were distributed, and 127 valid questionnaires were recovered, with a valid recovery rate of 97.69%.Results:Among 127 caregivers of patients with enterostomy, the total score of PAC was (32.69±4.99) , and the self-affirmation dimension score was (18.39±2.84) , and the life outlook dimension score was (14.36±2.53) , and the total score of CPS was (17.76±4.36) . Multiple linear regression analysis showed that caregiver gender, education level, work status, and readiness were the influencing factors of positive feelings of caregivers of patients with enterostomy ( P<0.05) , which explained 43.7% of the total variance. Conclusions:The positive perception of caregivers of patients with enterostomy is at an upper-middle level. Nurses should formulate targeted humanistic care strategies according to the influencing factors, increase the positive feelings of caregivers, help patients adapt to the stoma as soon as possible, and then improve the quality of life of patients.

Objective:To investigate the acceptance and attitude toward a novel fecal immunochemical test (FIT) in colorectal cancer screening among populations in China.Methods:From May 2018 to May 2019, 2 474 people aged 50-74 years were recruited from five provinces of China (Zhejiang, Anhui, Jiangsu, Hunan and Yunnan). The general demographic characteristics, acceptance of the new FIT technology and operational difficulties through the whole screening process were obtained through questionnaire survey. Multivariate logistic regression model was used to analyze the factors related to difficulties encountered in sampling stool, reading and uploading results.Results:The subjects were (60.0±6.4) years old, and female, high school of above educated, unemployed/retired/other, married and with medical insurance status of “new rural cooperative medical care (NRCMC)” accounted for 61.7% (1 526), 29.0%(718), 34.3% (849), 92.7% (2 293) and 31.3%(775), respectively. The population's acceptance of the FIT technology was 94.8%. In the process of FIT screening, the percentage of occurred difficulties in sampling stool, reading and uploading results were 33.1% (819), 46.4% (1 147) and 62.9% (1 557), respectively. The main difficulties were the uncertainty about whether the sampling operation was standard (28.0%), the inability to accurately judge the result displayed (32.5%) and the need for help without using a smartphone (44.2%). The results of multivariate logistic regression model analysis showed that people aged 65-74 years old and with medical insurance status of “NRCMC” were more likely to encounter difficulties in sampling, and those who were unemployed/retired/other and living with 3 or more family members were less likely to encounter difficulties in sampling. Those aged 65-74 years old, farmers or migrant workers, and those with “NRCMC” were more likely to encounter difficulties in readingresults, and those with 3 or more family members were less likely to encounter difficulties in reading result. Those with “NRCMC” were more likely to encounter difficulties in uploading results, and those with education level of high school or above, living with more than 3 family members were less likely to encounter difficulties in uploading results.Conclusion:The acceptance of the new FIT technology is relatively high among the subjects. Age, education level, occupation, number of family members living together and medical insurance status might be related to difficulties encountered in sampling stool, reading and uploading results, and it can be further strengthened in terms of the technology and characteristics of sub-populations.

Objective:To investigate the acceptance and attitude toward a novel fecal immunochemical test (FIT) in colorectal cancer screening among populations in China.Methods:From May 2018 to May 2019, 2 474 people aged 50-74 years were recruited from five provinces of China (Zhejiang, Anhui, Jiangsu, Hunan and Yunnan). The general demographic characteristics, acceptance of the new FIT technology and operational difficulties through the whole screening process were obtained through questionnaire survey. Multivariate logistic regression model was used to analyze the factors related to difficulties encountered in sampling stool, reading and uploading results.Results:The subjects were (60.0±6.4) years old, and female, high school of above educated, unemployed/retired/other, married and with medical insurance status of “new rural cooperative medical care (NRCMC)” accounted for 61.7% (1 526), 29.0%(718), 34.3% (849), 92.7% (2 293) and 31.3%(775), respectively. The population's acceptance of the FIT technology was 94.8%. In the process of FIT screening, the percentage of occurred difficulties in sampling stool, reading and uploading results were 33.1% (819), 46.4% (1 147) and 62.9% (1 557), respectively. The main difficulties were the uncertainty about whether the sampling operation was standard (28.0%), the inability to accurately judge the result displayed (32.5%) and the need for help without using a smartphone (44.2%). The results of multivariate logistic regression model analysis showed that people aged 65-74 years old and with medical insurance status of “NRCMC” were more likely to encounter difficulties in sampling, and those who were unemployed/retired/other and living with 3 or more family members were less likely to encounter difficulties in sampling. Those aged 65-74 years old, farmers or migrant workers, and those with “NRCMC” were more likely to encounter difficulties in readingresults, and those with 3 or more family members were less likely to encounter difficulties in reading result. Those with “NRCMC” were more likely to encounter difficulties in uploading results, and those with education level of high school or above, living with more than 3 family members were less likely to encounter difficulties in uploading results.Conclusion:The acceptance of the new FIT technology is relatively high among the subjects. Age, education level, occupation, number of family members living together and medical insurance status might be related to difficulties encountered in sampling stool, reading and uploading results, and it can be further strengthened in terms of the technology and characteristics of sub-populations.