Objective To quantitatively assess the exposure-response association between exposure to heatwave and sudden death, estimate the attributable excess deaths, and identify potential vulnerable subgroups. Methods A time-stratified case-crossover study was conducted among residents who died from sudden death in Jiangsu Province, China between 2015 and 2021. Heatwave events in Jiangsu Province, defined using varying relative temperature thresholds and durations, were identified using temperature data from the China Meteorological Administration Land Data Assimilation System (CLDAS V2.0). Individual heatwave exposure was assessed based on each subject's residential address. The exposure-response association between heatwave and sudden death was evaluated using conditional logistic regression model combined with a Distributed Lag Nonlinear Model(DLNM). Heatwave-attributable excess deaths were estimated. Stratified analyses by sex and age were performed to assess potential effect modifications. Results Under all definitions, exposure to heatwave was significantly associated with an increased risk of sudden death, and the risk increased with the intensity of heatwave. Using the P95_3d definition (temperature exceeding the 95th percentile for ≥3 consecutive days), heatwave was significantlyassociated with a 56% increased risk of sudden death (95% CI: 31%, 86%). The population-attributable fraction of sudden death due to heatwave exposure was 1.45% (95% CI: 0.97%, 1.90%). Stratified analyses indicated no statistically significant differences in the association between heatwave exposure and sudden death across age or sex subgroups. Conclusion Heatwave exposure was associated with an increased risk of sudden death. Reducing heatwave exposure during summer may help lower the occurrence of sudden death.

AIM: To investigate the changes in serum levels of platelet-derived growth factor A(PDGFA), heme oxygenase 1(HMOX1)and suppressor of cytokine signaling 6(SOCS6)in patients with diabetic retinopathy(DR)at different stages, and their predictive value for prognosis. METHODS: Patients diagnosed with DR in Zibo No.148 Hospital from April 2023 to April 2024 were included as the study group, and patients with simple type 2 diabetes mellitus(T2DM)during the same period were included as the control group. DR patients were separated into non proliferative DR group(NPDR group)and proliferative DR group(PDR group)based on DR staging, and into good prognosis group and poor prognosis group based on prognosis. Enzyme-linked immunosorbent assay(ELISA)method was used to detect serum levels of PDGFA, HMOX1, and SOCS6, and Pearson method was performed to analyze their correlation with laboratory indicators. Multivariate logistic regression was used to explore the risk factors affecting poor prognosis in DR patients. Receiver operating characteristic(ROC)curves were plotted to explore the prognostic value of serum PDGFA, HMOX1, and SOCS6 levels for DR patients. RESULTS: Totally 128 DR patients(67 males and 61 females)with the mean age 50.65±8.57 y were included. The control group consisted of 120 T2DM patients(63 males, 57 females)with the mean age of 50.32±8.65 y. The NPDR group comprised 74 patients(39 males, 35 females)with mean age of 50.42±8.71 y; the PDR group included 54 patients(28 males, 26 females)with the mean age of 50.96±8.40 y; The good prognosis group comprised 81 patients(43 males, 38 females)with the mean age of 50.51±8.62 y; the poor prognosis group included 47 patients(24 males, 23 females)with the mean age of 50.89±8.48 y. Compared with the control group, the study group had significantly higher serum levels of PDGFA, HMOX1, and SOCS6(all P<0.05). The PDR group had significantly higher serum levels of PDGFA, HMOX1, and SOCS6 than the NPDR group(all P<0.05). The poor prognosis group had significantly higher serum levels of FBG, HbA1c, SOD, MDA, IL-6, TNF-α, PDGFA, HMOX1, and SOCS6 than the good prognosis group(all P<0.05). The serum PDGFA of DR patients was positively related to FBG, HbA1c, IL-6, and TNF-α levels(all P<0.05), HMOX1 was positively related to FBG, HbA1c, SOD, MDA, IL-6, and TNF-α levels(all P<0.05), and SOCS6 was positively related to FBG, IL-6, and TNF-α levels(all P<0.05). Elevated levels of serum PDGFA, HMOX1, SOCS6, and HbA1c were risk factors for the prognosis of DR patients(all P<0.05). The AUC values of serum PDGFA, HMOX1, and SOCS6 alone in predicting the prognosis of DR patients were 0.806, 0.822, and 0.826, respectively. The AUC of their joint prediction was 0.912, and the joint prediction was superior to individual prediction(Z joint-PDGFA=2.183, P=0.029; Z joint-HMOX1=2.308, P=0.021; Z joint-SOCS6=2.620, P=0.009). CONCLUSION: Serum PDGFA, HMOX1, SOCS6 are significantly correlated with DR staging and prognosis, all showing high predictive efficiency for the prognosis of DR patients, with certain clinical value.

AIM:To investigating the predictive value of serum delta-like ligand 4(DLL4), complement C1q/tumor necrosis factor-related protein 5(CTRP5)levels for the severity of diabetic retinopathy(DR)and visual disability.METHODS:Patients with DR admitted to Tangshan Central Hospital between January 2022 and January 2024 were enrolled. Based on disease severity, patients were divided into a proliferative DR group and a non-proliferative DR group. After one year of follow-up, patients were further categorized into a vision disability group and a non-visual disability group based on visual impairment status. Enzyme-linked immunosorbent assay(ELISA)was used to detect serum levels of DLL4 and CTRP5. The data and serum levels of DLL4 and CTRP5 were compared among patients with different medical conditions and visual disabilities. Pearson method was used to explore the correlation between serum levels of DLL4, CTRP5 and glucose and lipid metabolism indicators. Multivariate Logistic regression was performed to explore the influencing factors of visual disability in DR Receiver operating characteristic(ROC)curve was performed to explore the value of serum levels of DLL4 and CTRP5 in predicting visual disability in DR.RESULTS: This study included 245 DR patients.Ninety-five patients were in the proliferative DR group(mean age 51.61±3.44 y, 51 men and 44 women), and 150 patients were in the non-proliferative DR group(mean age 51.22±3.11 y, 86 men and 64 women). The visually disability group consisted of 39 participants(mean age 51.64±3.87 y; 21 men and 18 women), while the non-visually disability group consisted of 206 participants(mean age 51.32±3.12 y; 116 men and 90 women). Patients in the proliferative DR group exhibited longer DR duration, higher levels of FPG, TG, TC, LDL-C, and serum DLL4 and CTRP5, and lower HDL-C levels compared to the non-proliferative DR group(all P<0.05). The serum levels of DLL4 were positively correlated with FPG(P<0.001), while the serum levels of CTRP5 were prominently positively correlated with FPG, TG, TC, LDL-C, and prominently negatively correlated with HDL-C(all P<0.001). The visual disability group had longer duration of DR and higher serum levels of DLL4 and CTRP5 than the non-visual disability group(all P<0.001). The duration of DR and serum levels of DLL4 and CTRP5 were influencing factors for visual disability in DR patients(all P<0.001). The joint detection of serum levels of DLL4 and CTRP5 had a higher value in predicting visual disability in DR patients than the single indicator prediction(ZDLL4-joint=3.018, PDLL4-joint=0.003; ZCTRP5-joint=2.784, PCTRP5-joint=0.005). CONCLUSION: Serum levels of DLL4 and CTRP5 are elevated in DR patients, and are closely related to the disease condition. The joint detection of serum levels of DLL4 and CTRP5 has high value in predicting visual disability in DR patients.

OBJECTIVE To investigate and analyze the current situation and problems of the advanced personnel en-gaging in the hospital-acquired infection control during their training period and explore the existing countermeas-ures and future development.METHODS The literatures regarding to the advanced study in China were retrieved from databases,the subjects of the literatures covered infection control-related advanced study practice,discipline construction,position competence,talent cultivation,scientific research innovation,professional title evaluation,laws,regulations and development plans.From Aug.2024 to Nov.2024,a questionnaire survey and face-to-face interviews were conducted among 36 advanced study personnel from 9 provinces of China who engaged in hos-pital-acquired infection control in the First Medical Center of Chinese PLA General Hospital.Eventually,36 ques-tionnaires were retrieved,all of which were valid with a questionnaire recovery rate of 100.00％.RESULTS Among the 36 advanced study personnel of hospital-acquired infection control,58.33％were medium-grade professional ti-tle;preventive medicine(41.67％),clinical medicine(25.00％)and nursing(16.67％)ranked the top 3 majors.The personnel engaged in the infection control for more than 6 years,and the duration of the advanced study was generally 3 or 6 months.In reality,the personnel faced the choices in terms of the purposes of further education,learning approaches and learning contents.The advanced study personnel also encountered the problems of challenges from promotion,improvement of position competency,integration with clinical training,supervision and practice,as well as physiological,psychological and family pressure.CONCLUSION Aiming at the problems that the advanced study personnel are generally concerned about,such as how to scientifically and effectively carry out hospital-acquired infection control advanced study and preset and solve the problems that may encounter,it is necessary to formulate targeted training programmes so as to provide bases and enlightenment for establishment of a long-term mechanism for advanced study of infection control in China.

Objective To investigate the effect of large artery atherosclerosis(LAA)and non-LAA subtypes on the efficacy of Ginkgo Diterpene Lactone Meglumine(GDLM)in patients with acute ischemic stroke.Methods This was a post-hoc analysis of multicenter,randomized,double-blind,placebo-controlled,and parallel-group trial.A total of 3 448 patients who had acute ischemic stroke were randomly assigned in a 1∶1 ratio to receive the injection of GDLM or the placebo once day within 48 h after symptoms and continued for 14 d.The primary outcome was the proportion of patients with a modified Rankin Scale(mRS)of 0 or 1 on day 90 after randomization.Results A total of 3 448 patients were enrolled,with 1 604(46.52% )patients with non-LAA and 1 844(53.48% )with LAA.Compared to the placebo treatment.GDLM injection effectively improve the functional prognosis,with a higher proportion of mRS score of 0-1 in both non-LAA(OR=1.24,95% CI:1.02-1.51;P=0.03)and LAA(OR=1.37,95% CI:1.14-1.65;P<0.001)group.There was no significant interaction between LAA subtypes with treatment(P=0.48 for interaction).Conclusion Among patients with acute ischemic stroke in this randomized clinical trial,GDLM might improve the favorable clinical outcomes at 90 d compared with placebo,regardless of LAA subtypes.Nevertheless,it is necessary to confirm the findings in the future.

Objective:To examine the validity and reliability of the Basic Psychological Needs Satisfaction and Frustration Scale(BPNSFS)in the adult population.Methods:A total of 488 adults were recruited and random-ly divided into 2 groups.One half(n=244)was utilized for item analysis and exploratory factor analysis,while the other half(n=244)was reserved for confirmatory factor analysis.One month later,a convenient sample of 100 in-dividuals was selected for retesting.The Depression-Anxiety-Stress Scale-21(DASS-21)and the Satisfaction with Life Scale(SWLS)were employed as criterion measures.Results:Both subscales of the BPNSFS demonstrated a 3-factor structure,explaining a total variance of 60.99％and 60.31％,respectively.The 3-factor model exhibited good fit indices(x2/df=1.85,2.47;RMSEA=0.06,0.08;CFI=0.95,0.94;TLI=0.94,0.92;SRMR=0.04,0.05).Scores on both subscales and their dimensions were significantly correlated with DASS-21 and SWLS scores(|r|=0.16-0.57,Ps＜0.001).The Cronbach α coefficients for the 2 subscales were 0.87 and 0.89,with Cronbach α values for each dimension ranging from 0.73 to 0.81.The test-retest reliabilities(ICC)for the 2 sub-scales were 0.84 and 0.80,with ICC values for each dimension ranging from 0.65 to 0.83.Conclusion:The validi-ty and reliability of the Chinese version of the Basic Psychological Needs Satisfaction and Frustration Scale demon-strate good measurement properties in assessing the adult population.

OBJECTIVE:In recent years,the number of clinical research reports on acupuncture and manipulation for the treatment of greater occipital neuralgia has gradually increased,but the quality is uneven.There is currently no literature evaluating the quality of published reports,which is not conducive to the promotion of clinical use of these therapies.Therefore,this article assessed the reporting quality of randomized controlled trials on acupuncture and manipulation for greater occipital neuralgia.METHODS:Cochrane Library,PubMed,Web of Science,Embase,China National Knowledge Infrastructure(CNKI),VIP,WanFang Data,and Chinese BioMedical Literature Database(CBM)from inception to May 20,2024 were searched.The reporting quality of included randomized controlled trials was independently evaluated by two investigators using the CONSORT statement,STRICTA checklist,and Cochrane bias of risk assessment tool.A third investigator resolved any disagreement.RESULTS:A total of 62 articles were included.Based on the CONSORT statement,59.46％(22/37)of all entries had a reporting rate of less than 50％,mainly including"Identification as a randomized trial in the title(1/62,1.61％),""How sample size was determined(7/62,11.29％),""Implementation(1/62,1.61％),""Blinding(1/62,1.61％),"and"Reports of Funding(4/62,6.45％)."According to the STRICTA checklist,29.41％(5/17)of all entries had a reporting rate of less than 50％,mainly including"Details of other interventions(7/58,12.07％),""Setting and context of treatment(0/58,0％),"and"Description of participating acupuncturists(0/58,0％)."CONCLUSION:The reporting quality of randomized controlled trials on acupuncture and manipulation therapy for greater occipital neuralgia remains low.Future researchers need to make greater efforts to strictly adhere to the CONSORT statement and STRICTA checklist during trial design,implementation,and reporting.This will facilitate the standardization of research in this field and enhance the reliability and reproducibility of the research results.

Objective Based on a clinical cohort study of repeated ketamine infusions for treatment-resistant depression(TRD),this study aimed to examine differences in brain-derived neurotrophic factor(BDNF)methylation among patients with varying therapeutic responses and explore its potential role in predicting treatment efficacy.Methods A retrospective analysis was conducted on peripheral plasma BDNF levels in 83 patients with TRD before and after a 2-week course of ketamine treatment(6 injections total).The Montgomery-Asberg depression rating scale(MADRS)was used to assess treatment efficacy.BDNF methylation levels were compared between responder group and non-responder group.The effect of methylation of the target CpG site on transcriptional activity was verified by using the dual luciferase reporter gene system.Results In patients with TRD who completed six repeated ketamine infusions,the responder group showed significant improvements compared to baseline levels in both MADRS scores(25.20±7.54 vs.8.10±5.32,P<0.01)and plasma BDNF concentrations[8.74(5.26,13.46)ng/mL vs.16.59(7.41,24.46)ng/mL,P<0.01].At baseline,35 CpG sites within the BDNF gene displayed significant methylation differences between response groups(P<0.05).Two CpG sites(rs1240718851 and cg06260077)located in the BDNF promoter region demonstrated a hypermethylation-low expression correlation,and dual-luciferase reporter assays confirmed that one of these sites functionally modulates BDNF expression.Conclusions The plasma BDNF concentration in TRD patients increases with the remission of depressive symptoms.The regulation of BDNF gene expression by methylation can predict the antidepressant efficacy of repeated intravenous ketamine.

OBJECTIVE To investigate and analyze the current situation and problems of the advanced personnel en-gaging in the hospital-acquired infection control during their training period and explore the existing countermeas-ures and future development.METHODS The literatures regarding to the advanced study in China were retrieved from databases,the subjects of the literatures covered infection control-related advanced study practice,discipline construction,position competence,talent cultivation,scientific research innovation,professional title evaluation,laws,regulations and development plans.From Aug.2024 to Nov.2024,a questionnaire survey and face-to-face interviews were conducted among 36 advanced study personnel from 9 provinces of China who engaged in hos-pital-acquired infection control in the First Medical Center of Chinese PLA General Hospital.Eventually,36 ques-tionnaires were retrieved,all of which were valid with a questionnaire recovery rate of 100.00％.RESULTS Among the 36 advanced study personnel of hospital-acquired infection control,58.33％were medium-grade professional ti-tle;preventive medicine(41.67％),clinical medicine(25.00％)and nursing(16.67％)ranked the top 3 majors.The personnel engaged in the infection control for more than 6 years,and the duration of the advanced study was generally 3 or 6 months.In reality,the personnel faced the choices in terms of the purposes of further education,learning approaches and learning contents.The advanced study personnel also encountered the problems of challenges from promotion,improvement of position competency,integration with clinical training,supervision and practice,as well as physiological,psychological and family pressure.CONCLUSION Aiming at the problems that the advanced study personnel are generally concerned about,such as how to scientifically and effectively carry out hospital-acquired infection control advanced study and preset and solve the problems that may encounter,it is necessary to formulate targeted training programmes so as to provide bases and enlightenment for establishment of a long-term mechanism for advanced study of infection control in China.

OBJECTIVE:In recent years,the number of clinical research reports on acupuncture and manipulation for the treatment of greater occipital neuralgia has gradually increased,but the quality is uneven.There is currently no literature evaluating the quality of published reports,which is not conducive to the promotion of clinical use of these therapies.Therefore,this article assessed the reporting quality of randomized controlled trials on acupuncture and manipulation for greater occipital neuralgia.METHODS:Cochrane Library,PubMed,Web of Science,Embase,China National Knowledge Infrastructure(CNKI),VIP,WanFang Data,and Chinese BioMedical Literature Database(CBM)from inception to May 20,2024 were searched.The reporting quality of included randomized controlled trials was independently evaluated by two investigators using the CONSORT statement,STRICTA checklist,and Cochrane bias of risk assessment tool.A third investigator resolved any disagreement.RESULTS:A total of 62 articles were included.Based on the CONSORT statement,59.46％(22/37)of all entries had a reporting rate of less than 50％,mainly including"Identification as a randomized trial in the title(1/62,1.61％),""How sample size was determined(7/62,11.29％),""Implementation(1/62,1.61％),""Blinding(1/62,1.61％),"and"Reports of Funding(4/62,6.45％)."According to the STRICTA checklist,29.41％(5/17)of all entries had a reporting rate of less than 50％,mainly including"Details of other interventions(7/58,12.07％),""Setting and context of treatment(0/58,0％),"and"Description of participating acupuncturists(0/58,0％)."CONCLUSION:The reporting quality of randomized controlled trials on acupuncture and manipulation therapy for greater occipital neuralgia remains low.Future researchers need to make greater efforts to strictly adhere to the CONSORT statement and STRICTA checklist during trial design,implementation,and reporting.This will facilitate the standardization of research in this field and enhance the reliability and reproducibility of the research results.