BACKGROUND:Myocardial hypertrophy often leads to severe cardiovascular diseases and is difficult to diagnose due to its early stages being hard to detect.Circulating inflammatory proteins have been found to be significantly associated with cardiovascular diseases,yet the specific mechanisms linking them to myocardial hypertrophy remain unclear.OBJECTIVE:To investigate the relationship between circulating proteins and myocardial hypertrophy using multiple Mendelian randomization approaches.METHODS:Utilizing data from 91 circulating inflammatory proteins in the GWAS Catalog database and the latest myocardial hypertrophy data from the R11 FinnGen database,we employed bidirectional two-sample Mendelian randomization,multivariate Mendelian randomization,and Genome-Wide Association Studies co-localization to investigate the causal relationship between circulating inflammatory proteins and myocardial hypertrophy.The accuracy of the results was verified through sensitivity tests including MR-PRESSO,Cochran's Q test,MR-Egger intercept assessment,leave-one-out analysis,and funnel plot analysis.RESULTS AND CONCLUSION:In the results of two-sample Mendelian randomization,the primary method used for evaluation was the Inverse Variance Weighting(IVW)approach.It was found that the level of T-cell surface glycoprotein CD6 isoform(IVW:P=0.046,OR=0.74,95％Cl:0.66-1.00),level of slit chemokine(IVW:P=2.1×10-2,OR=0.74,95％CI:0.556-0.95),level of Delta and Notch-like epidermal growth factor-related receptor(IVW:P=3.7×10-4,OR=0.66,95％CI:0.49-0.87),level of interleukin-2(IVW:P=3.8×103,OR=0.667,95％CI:0.50-0.88),and sulfotransferase 1A1(IVW:P=1.42×102,OR=0.80,95％CI:0.67-0.96)had a unidirectional causal effect on cardiac hypertrophy.(2)Among the findings in multivariate Mendelian randomization,the levels of the CD6 isoform of T-cell surface glycoprotein(IVW:P=1.39×102,OR=0.81,95％CI:0.69-0.96)and the levels of Delta and Notch-like epidermal growth factor-related receptor(IVW:P=3.7×10-2,OR=0.73,95％CI:0.55-0.98)were positive,indicating that the results remained significant after excluding the effects of other circulating inflammatory proteins that had an impact on myocardial hypertrophy.(3)In colocalization,T-cell surface glycoprotein CD6 isoform levels had H3+H4=0.96,with the most significant single nucleotide polymorphism being rs59570070,suggesting an intrinsic link between T-cell surface glycoprotein CD6 isoform levels and myocardial hypertrophy.(4)Sensitivity results showed no abnormalities,indicating no heterogeneity or pleiotropic effects influencing the results.(5)These results verified that T cell surface glycoprotein CD6 isoforms,Slit chemokine,Delta and Notch-like epidermal growth factor-related receptors,interleukin-2,and sulfotransferase 1A1 had a unidirectional causal effect on myocardial hypertrophy.T cell surface glycoprotein CD6 isoforms and Delta and Notch-like epidermal growth factor-related receptors had the deepest impact,suggesting that there may be related pathways between T cell surface glycoprotein CD6 isoforms and myocardial hypertrophy.Mendelian randomization studies require large amounts of clinical data and therefore often use European samples from international databases for analysis.Since this analytical method has significant advantages in causal inference,precision medicine,and cross-population validation,its research results still hold great significance for the medical development in China.As Mendelian randomization research deepens,it also promotes the collection and analysis of clinical data in China to some extent.In the future,we can further analyze key protein mechanisms,combine multiomics and clinical validation,develop an inflammatory marker monitoring system and novel anti-inflammatory therapies,thereby promoting the prevention and control of cardiovascular diseases and the development of personalized medicine.

BackgroundPatients with depressive episode and schizophrenia have a high risk of suicide. The sleep electroencephalogram power spectral density characteristics of patients with depressive episode accompanied by suicidal behavior and those with schizophrenia may be different， but there is currently a lack of direct comparative studies on these two groups of patients. ObjectiveTo compare the sleep electroencephalogram power spectral density between depressive episode and schizophrenic patients with suicidal behavior， in order to provide references for exploring predictive indicators of suicidal behavior. MethodsFrom June 2018 to December 2020， 20 patients with depressive episode and 20 patients with schizophrenia who had committed suicide within the past month and were treated at the outpatient department of Shenzhen Kangning Hospital were selected. All of them met the diagnostic criteria for depressive episode or schizophrenia as defined in the International Classification of Diseases， tenth edition （ICD-10）. Using a random sampling method， 20 volunteers with matching gender and age to the patient groups were selected from the Cuiping community in Shenzhen as the control group. The subjective sleep of the patients was evaluated using the Insomnia Severity Index （ISI）， the Dysfunctional Belief and Attitude about Sleep （DBAS）， the Disturbing Dreams and Nightmare Severity Index （DDNSI）， and the Epworth Somnolence Scale （ESS）. The objective sleep of the patients was assessed using polysomnography. The sleep electroencephalogram was filtered and the power spectral density of the brain wave was analyzed and processed for all the subjects. The subjective and objective sleep conditions of the two patient groups were compared， and the sleep electroencephalogram power spectral density of the patient groups and the control group were also compared. ResultsA comparison of subjective and objective sleep conditions between patients with depressive episode accompanied by suicidal behavior and patients with schizophrenia accompanied by suicidal behavior showed no statistically significant differences （P>0.05）. Comparisons of sleep electroencephalogram power spectral density in the W stage （average power of α wave， total power of δ wave， average power of δ wave， average power of θ wave）， N1 stage （average power of β wave， total power of α wave， total power of δ wave）， N2 stage （total power of α wave， average power of α wave， total power of δ wave， average power of δ wave）， N3 stage （average power of α wave， average power of δ wave）， and R stage （total power of α wave， average power of α wave， total power of δ wave， average power of δ wave） between patients with depressive episode accompanied by suicidal behavior， patients with schizophrenia accompanied by suicidal behavior， and the control group showed statistically significant differences （P<0.05 or 0.01）. The total power of δ wave in the W stage and the average power of β wave and δ wave in the N1 stage were higher in two patient groups were higher than those of the control group. The total power of α wave and the average power of α wave in the N2 stage were lower than those of the control group， while the average power of δ wave was higher than that of the control group. The average power of α wave in the N3 stage of both patient groups were lower than that of the control group， while the average power of δ wave was higher than that of the control group. The total power and average power of α wave in the R stage were lower than those of the control group， while the total power and average power of δ wave were higher than those of the control group. All the differences were statistically significant. Patients with depressive episode accompanied by suicidal behavior had higher average powers of α wave， δ wave， and θ wave in the W stage compared with the control group， while the total power of α wave in the N1 stage was lower in the former group. All these differences were statistically significant （P<0.05）. ConclusionThe depressive episode patients accompanied by suicidal behavior have highly overlapping sleep electroencephalogram abnormal patterns with those of schizophrenia patients， mainly manifested as a general decrease in α wave power （N2， N3， R stage） and a general increase in δ wave power （W， N1， N2， N3， R stage） as well as β wave power in N1 stage. At the same time， patients with depressive episode accompanied by suicidal behavior also show specific changes， including an increase in the average power of α and θ waves during the wakefulness period （W stage）， and a decrease in the total power of α wave in N1 stage. ［Funded by Guangdong Province High-level Clinical Key Specialty （with supporting funds from Shenzhen City） （number， SZGSP013）； Shenzhen Key Medical Discipline （number， SZXK041）； Shenzhen Clinical Medicine Research Center Project （number， 20210617155253001）］

Objective To explore an artificial intelligence (AI)-based method for automated hand hygiene monitoring and to compare the effectiveness of three algorithms (UniFormerV2, TDN, C3D) in recognizing hand hygiene steps in surgical settings, thereby aiding hospital infection control. Methods From April to October 2024, we non-invasively collected 641 video recordings of healthcare staff performing hand hygiene at four-bay scrub sinks in two tertiary hospitals using overhead HD cameras. The dataset was annotated by five trained experts for model training and validation. Results Following training on 385 samples, internal validation (n=119) showed the C3D model achieved 81% accuracy, 87% recall, and an 83% F1-score. The TDN model achieved 93%, 91%, and 92% for the same metrics. The UniFormerV2 model outperformed both, with an accuracy, recall, and F1-score of 93%—an improvement of over 10 percentage points compared to traditional CNNs (TDN, C3D). It also achieved an 84% accuracy in external validation, demonstrating strong generalization. Conclusion The UniFormerV2 model is more accurate than CNN-based models for hand hygiene step recognition and shows robust performance in external validation. It presents a viable tool for healthcare facilities to enhance hand hygiene management, ultimately improving medical quality and patient safety.

BACKGROUND:Myocardial hypertrophy often leads to severe cardiovascular diseases and is difficult to diagnose due to its early stages being hard to detect.Circulating inflammatory proteins have been found to be significantly associated with cardiovascular diseases,yet the specific mechanisms linking them to myocardial hypertrophy remain unclear.OBJECTIVE:To investigate the relationship between circulating proteins and myocardial hypertrophy using multiple Mendelian randomization approaches.METHODS:Utilizing data from 91 circulating inflammatory proteins in the GWAS Catalog database and the latest myocardial hypertrophy data from the R11 FinnGen database,we employed bidirectional two-sample Mendelian randomization,multivariate Mendelian randomization,and Genome-Wide Association Studies co-localization to investigate the causal relationship between circulating inflammatory proteins and myocardial hypertrophy.The accuracy of the results was verified through sensitivity tests including MR-PRESSO,Cochran's Q test,MR-Egger intercept assessment,leave-one-out analysis,and funnel plot analysis.RESULTS AND CONCLUSION:In the results of two-sample Mendelian randomization,the primary method used for evaluation was the Inverse Variance Weighting(IVW)approach.It was found that the level of T-cell surface glycoprotein CD6 isoform(IVW:P=0.046,OR=0.74,95％Cl:0.66-1.00),level of slit chemokine(IVW:P=2.1×10-2,OR=0.74,95％CI:0.556-0.95),level of Delta and Notch-like epidermal growth factor-related receptor(IVW:P=3.7×10-4,OR=0.66,95％CI:0.49-0.87),level of interleukin-2(IVW:P=3.8×103,OR=0.667,95％CI:0.50-0.88),and sulfotransferase 1A1(IVW:P=1.42×102,OR=0.80,95％CI:0.67-0.96)had a unidirectional causal effect on cardiac hypertrophy.(2)Among the findings in multivariate Mendelian randomization,the levels of the CD6 isoform of T-cell surface glycoprotein(IVW:P=1.39×102,OR=0.81,95％CI:0.69-0.96)and the levels of Delta and Notch-like epidermal growth factor-related receptor(IVW:P=3.7×10-2,OR=0.73,95％CI:0.55-0.98)were positive,indicating that the results remained significant after excluding the effects of other circulating inflammatory proteins that had an impact on myocardial hypertrophy.(3)In colocalization,T-cell surface glycoprotein CD6 isoform levels had H3+H4=0.96,with the most significant single nucleotide polymorphism being rs59570070,suggesting an intrinsic link between T-cell surface glycoprotein CD6 isoform levels and myocardial hypertrophy.(4)Sensitivity results showed no abnormalities,indicating no heterogeneity or pleiotropic effects influencing the results.(5)These results verified that T cell surface glycoprotein CD6 isoforms,Slit chemokine,Delta and Notch-like epidermal growth factor-related receptors,interleukin-2,and sulfotransferase 1A1 had a unidirectional causal effect on myocardial hypertrophy.T cell surface glycoprotein CD6 isoforms and Delta and Notch-like epidermal growth factor-related receptors had the deepest impact,suggesting that there may be related pathways between T cell surface glycoprotein CD6 isoforms and myocardial hypertrophy.Mendelian randomization studies require large amounts of clinical data and therefore often use European samples from international databases for analysis.Since this analytical method has significant advantages in causal inference,precision medicine,and cross-population validation,its research results still hold great significance for the medical development in China.As Mendelian randomization research deepens,it also promotes the collection and analysis of clinical data in China to some extent.In the future,we can further analyze key protein mechanisms,combine multiomics and clinical validation,develop an inflammatory marker monitoring system and novel anti-inflammatory therapies,thereby promoting the prevention and control of cardiovascular diseases and the development of personalized medicine.

ObjectiveTo investigate the mechanism underlying the effects of three formulas of the method of warming Yang and relieving depression on anxiety- and depression-like behaviors in the mice subjected to a two-hit paradigm of maternal separation （MS） combined with restraint stress （RS）. MethodsNeonatal mice were randomly assigned into the following groups： Blank control， MS alone， model （MS+RS）， warming Yang （WY，5.85 g·kg^-1）， relieving depression （RD，12.03 g·kg^-1）， warming Yang and relieving depression （WYRD，16.71 g·kg^-1）， and fluoxetine groups （2.6 mg·kg^-1）. MS was conducted on postnatal day 5 （PD5）. Weaning and preventive drug administration were carried out on PD21， and restraint stress was applied on PD90. Anxiety- and depression-like behaviors were assessed using the open field test （OFT）， the elevated zero maze test and tail suspension test （TST）. High-performance liquid chromatography with electrochemical detection （HPLC-ECD） was employed to measure the levels of neurotransmitters， including 5-hydroxytryptamine （5-HT） and dopamine （DA）， in the hippocampus. Real-time quantitative polymerase chain reaction （Real-time PCR） was used to detect the mRNA expression levels of 5-HT_1A receptor （5-HT_1AR）， serotonin transporter （SERT）， monoamine oxidase A （MAOA）， glucocorticoid receptor （GR）， adrenocorticotropic hormone （ACTH）， corticotropin-releasing hormone （CRH）， brain-derived neurotrophic factor （BDNF）， and tyrosine kinase receptor B （TrkB）. Immunohistochemistry （IHC） was applied to assess the protein expression levels of 5-HT_1AR， 5-HT_2A receptor （5-HT_2AR）， 5-HT_2C receptor （5-HT_2CR）， GR， and CRH receptor 1 （CRHR1）. The protein expression levels of BDNF and TrkB in the hippocampus were measured using the fully automated protein expression analysis system （Simple Wes）. ResultsIn the behavioral tests， compared with the blank control group， the model group exhibited significant increases in locomotor distance and central area crossings （P<0.05， P<0.01）in OFT， as well as a significant increase in immobility time in the TST （P<0.05）. Compared with the model group， the RD， WYRD， and fluoxetine groups all showed significantly reduced central area crossings （P<0.05， P<0.01）. Regarding neurotransmitter levels， compared with the blank control group， the model group had significantly decreased hippocampal epinephrine （E） and dopamine （DA） content （P<0.05， P<0.01）. Compared with the MS group， the model group showed significant decreases in hippocampal norepinephrine （NE）， E， and 5-HT content （P<0.05， P<0.01）. Compared with the model group， the WY group decreased hippocampal NE， DA， and 5-HT content （P<0.01）， while the RD， WYRD， and fluoxetine groups exhibited significantly increased hippocampal E content （P<0.01）. At the molecular level， compared with the blank control and MS groups， the model group showed significant increases in mRNA levels of 5-HT_1AR， SERT， MAOA， ACTH， and CRH （P<0.01）， and significant decreases in mRNA levels of tryptophan hydroxylase （TPH）， GR， BDNF， and TrkB （P<0.01）. Protein expression of 5-HT_1AR， 5-HT_2AR， and 5-HT_2CR was also significantly elevated （P<0.05， P<0.01） in the model group. Compared with the model group， the RD group showed significant decreases in SERT， MAOA， and CRH mRNA （P<0.05， P<0.01）， significant increases in TPH， BDNF， and TrkB mRNA （P<0.01）， significantly reduced protein expression of 5-HT_1AR， 5-HT_2AR， and 5-HT_2CR （P<0.05）， and significantly increased GR protein expression. The WY group showed a significant increase in ACTH mRNA expression （P<0.01）. The fluoxetine group exhibited significant decreases in MAOA and CRH mRNA （P<0.05， P<0.01）， significant increases in TPH， BDNF， and TrkB mRNA （P<0.01）， significantly reduced 5-HT_2AR protein expression （P<0.01）， and significantly increased GR protein expression（P<0.05）. ConclusionThe method of warming Yang and relieving depression can ameliorate anxiety- and depression-like behaviors in two-hit mice. Its mechanism may be associated with the BDNF/TrkB signaling pathway， as well as the HPA axis and serotonergic system.

ObjectiveTo analyze the research hotpots and development trends of international nursing ethical decision-making in the past 10 years by bibliometric methods. MethodsLiterature related to nursing ethical decision-making published in the Web of Science core collection database from 2014 to 2023 was retrieved. VOSviewer 1.6.18 software was utilized to visually present and analyze data regarding the number of publications， journal sources， countries of origin， author information， research institutions， key terms， co-cited references， and others. ResultsA total of 149 articles were included， involving 85 source journals， of which Nursing Ethics and BMC Medical Ethics were the most prolific. The number of publications on nursing ethical decision-making showed an overall upward trend， with the United States leading other countries in the number of publications. These publications involved 567 authors from 302 research institutions， and the degree of inter-institutional collaboration was relatively low. Keyword clustering， timeline overlay， and density analysis revealed that current research hotspots and trends included the ethical issues and decision-making in clinical nursing practice， the ethical decision-making level and competence of university nursing undergraduates， the ethical decision-making of nursing managers， and ethical decision-making dilemmas encountered by nursing staff during public health emergencies. ConclusionResearch on nursing ethical decision-making is gradually deepening but remains fragmented， lacking sustainability and collaboration. The ethical decision-making levels and competencies of university nursing students， as well as the field of ethical decision-making among nursing managers， may emerge as novel research hotspots in the future. Henceforth， it is necessary to strengthen in-depth exchanges among authors and institutions， pay close attention to international research frontiers， and enhance both the depth and breadth of research.

Objective To investigate the status quo of indwelling needles use in the hospitals at all lev-els in Chongqing city,and to evaluate the normalization and safety of indwelling needles use by referring to Nursing Practice Standards for Intravenous Therapy.Methods A self-designed questionnaire was used in July 2023 to conduct a cross-sectional survey on the use of indwelling needles in the hospitals at all levels in Chongqing city.Results A total of 30 807 patients in 77 hospitals were included,among them 62.67%used indwelling needles.The closed type indwelling needles accounted for 88.87%and the safety type indwelling needles accounted for 41.74%.Non-needle infusion connectors accounted for 37.78%,and steel needle con-nected with heparin caps accounted for 51.69%.95.66%of puncture site was in the upper limb,the non-cor-rosive drug infusion accounted for 87.57%,and the complications occurrence rate was 2.46%.Among the 6 419 surveyed nurses,75.51%removed indwelling needles based on clinical indications.There were statistically significant differences in the usage rates of closed type indwelling needles and non-needle infusion connectors among hospitals at different levels(P<0.05).There were also statistically significant differences in the inci-dence rates of complication and phlebitis(P<0.05).Conclusion The overall application of indwelling needles in the hospitals at all levels in Chongqing city is generally standardized,but the use of safety type indwelling needles and needle-free infusion connectors still needs to be improved.

Objective:To compare the efficacy of intranasal nebulized remimazolam versus esketamine for preoperative sedation in pediatric patients.Methods:In this randomized double-blind controlled trial, 90 pediatric patients scheduled for elective surgery with general anesthesia at Fuyang People′s Hospital between October 2024 and January 2025, were divided into 3 groups ( n=30 each) using a simple randomization: remimazolam group (group R), esketamine group (group S) and normal saline group (group C). Group R received intranasal nebulization of remimazolam 1.5 mg/kg, group S received intranasal nebulization of esketamine 1 mg/kg, and group C received intranasal nebulization of normal saline 0.05 ml/kg. Primary outcome: The preoperative anxiety was assessed using the modified Yale Preoperative Anxiety Scale before intranasal drug administration (baseline), at 10 and 20 min after administration, and before anesthesia induction. Secondary outcomes included sedation level (Ramsay Sedation Scale score), satisfaction with intranasal administration acceptance, parental separation anxiety and mask acceptance, development of emergence agitation, emergence time, time of recovery from anesthesia, and nausea and vomiting and increased secretions. Results:Compared to group C, the incidence of anxiety was significantly decreased at 10 and 20 min after intranasal nebulization and before anesthesia induction, the level of sedation was deepened (to light sedation), and the satisfaction with intranasal administration acceptance was decreased in group R ( P<0.017), the incidence of anxiety was significantly decreased before anesthesia induction, the level of sedation was deepened (to deep sedation), and the satisfaction with intranasal administration acceptance was increased in group S ( P<0.017), and the satisfaction with parental separation anxiety and mask acceptance and anesthesiologists′ satisfaction were significantly increased in R and S groups( P<0.017). Compared to group R, the incidence of anxiety was significantly increased at 10 min after intranasal nebulization (7 cases [23%] versus 20 cases [67%]), the level of sedation was lighter at 10 min after intranasal nebulization, the level of sedation was deeper, and the satisfaction with intranasal administration acceptance was increased in group S ( P<0.017). Compared to groups C and R, the emergence time and time of recovery from anesthesia were significantly prolonged in group S ( P<0.017). There was no significant difference in the incidence of emergence agitation, nausea and vomiting and increased secretions or in parental satisfaction among three groups ( P>0.05). Conclusions:Both intranasal nebulized remimazolam and esketamine can produce good preoperative sedation in pediatric patients. Compared to esketamine, remimazolam provides a more appropriate level of sedation with a faster onset and does not prolong the recovery from anesthesia, making it more suitable for preoperative sedation in minor procedures.

Non-human primate animal models are core tools for the study of highly pathogenic microorganisms and are irreplaceable in the fields of pathology and drug discovery.However,anatomical sampling of non-human primate infection models in high-level biosafety laboratories carries potential risk and related risk assessment and control measures require clarification.Based on biosafety regulations and practical experience,we systematically discuss the risk control strategies of anatomical operations with respect to personal protection,instrument selection,anatomical specifications,documentation,and personnel training.Our review will help to improve the management of high-level biosafety laboratories,reduce the risk of pathogen escape and human infection,and provide support for the safe research of highly pathogenic microorganisms.

Bacterial reinfection in the lungs of patients with influenza virus(IV)is a key factor leading to serious illness and death.The adverse consequences caused by co-infection with IV and Streptococcus pneumoniae(SPN)impose a serious burden on patients.However,the specific pathogenesis is complex,how to make better use of the mouse animal model of IV/SPN co-infection for subsequent basic research is of great significance.This article reviews the selection of animals,the selection of pathogen types,the selection of different modeling times,the identification of the co-infection model,and its applications in the IV/SPN co-infection model,so as to provide a reference for the selection of animal models of IV/SPN co-infection in the future.