Acute lung injury (ALI) has been a kind of acute and severe disease that is mainly characterized by systemic uncontrolled inflammatory response to the production of huge amounts of reactive oxygen species (ROS) in the lung tissue. Given the critical role of ROS in ALI, a Fe₃O₄ loaded bovine serum albumin (BSA) nanocluster (BF) was developed to act as a nanomedicine for the treatment of ALI. Combining with NIR irradiation, it exhibited excellent ROS scavenging capacity. Significantly, it also displayed the excellent antioxidant and anti-inflammatory functions for lipopolysaccharides (LPS) induced macrophages (RAW264.7), and Sprague Dawley rats via lowering intracellular ROS levels, reducing inflammatory factors expression levels, inducing macrophage M2 polarization, inhibiting NF-κB signaling pathway, increasing CD4⁺/CD8⁺ T cell ratios, as well as upregulating HSP70 and CD31 expression levels to reprogram redox homeostasis, reduce systemic inflammation, activate immunoregulation, and accelerate lung tissue repair, finally achieving the synergistic enhancement of ALI immunotherapy. It finally provides an effective therapeutic strategy of BF + NIR for the management of inflammation related diseases.

To address the challenges associated with traditional medical treatment modalities that hinder the efficiency of healthcare delivery,and to facilitate the sharing of medical service information across multiple campuses via mobile platforms,the First Affiliated Hospital to Zhejiang University School of Medicine has proactively leveraged digital intelligence to innovate its medical service model.This program involved the development of a comprehensive process guidance service applet on the Alipay platform specifically for outpatient services.The applet offers intelligent support services,standardizes electronic authentication processes,coordinates medical resources across various hospital locations,and establishes an integrated service delivery system that seamlessly combines online and offline interactions.This approach has optimized the outpatient treatment process,enhanced the patient experience,and fostered standardized management of medical services across multiple campuses.

Objective:To investigate the current situation of knowledge, attitude and practice of medical personnel in areas with high incidence of fever with thrombocytopenia syndrome (SFTS) in Anhui Province, in order to provide a scientific basis for conducting systematic training for medical personnel.Methods:From July to August 2024, a multi-stage random sampling method was used to select medical personnel from village, township, county, and city level medical institutions in high incidence areas of SFTS in Anhui Province (Hefei City, Liu'an City, Chuzhou City, Xuancheng City) for an online questionnaire survey on their knowledge, attitude, and practice status. The survey included demographic data, knowledge, attitude, and practice related to SFTS, and a binary logistic regression model was used to analyze the influencing factors of SFTS knowledge qualification rate.Results:A total of 2 718 valid questionnaires were collected, with an effective response rate of 99.60% (2 718/2 729). Among them, 1 384 were males, accounting for 50.92%. The majority were medical personnel aged 41 to 50 years old, with undergraduate degrees, junior professional titles, working in township health centers or community health service centers, as clinical physicians, and with a working experience of no more than 10 years. They accounted for 31.97% (869/2 718), 50.48% (1 372/2 718), 35.54% (966/2 718), 38.52% (1 047/2 718), 62.33% (1 694/2 718), and 30.61% (832/2 718), respectively. The overall correct rates of medical personnel's relevant knowledge, attitude and practice were 77.52% (31 605/40 770), 94.53% (12 847/13 590) and 89.73% (12 194/13 590), respectively. There were statistically significant differences in the knowledge qualification of medical personnel of different genders, ages, education levels, professional titles, hospital levels, job positions, and years of work experience ( P < 0.05). The results of binary logistic regression analysis showed that professional title, hospital level, work position, and work experience were the influencing factors of knowledge qualification rate ( P < 0.05). Conclusions:Medical personnel have a relatively positive attitude and high level of practice towards SFTS, but their knowledge level still needs to be improved. It is recommended to provide targeted knowledge training for medical personnel in different positions to promote early detection, diagnosis, and treatment of SFTS.

Objective:To investigate the current situation of knowledge, attitude and practice of medical personnel in areas with high incidence of fever with thrombocytopenia syndrome (SFTS) in Anhui Province, in order to provide a scientific basis for conducting systematic training for medical personnel.Methods:From July to August 2024, a multi-stage random sampling method was used to select medical personnel from village, township, county, and city level medical institutions in high incidence areas of SFTS in Anhui Province (Hefei City, Liu'an City, Chuzhou City, Xuancheng City) for an online questionnaire survey on their knowledge, attitude, and practice status. The survey included demographic data, knowledge, attitude, and practice related to SFTS, and a binary logistic regression model was used to analyze the influencing factors of SFTS knowledge qualification rate.Results:A total of 2 718 valid questionnaires were collected, with an effective response rate of 99.60% (2 718/2 729). Among them, 1 384 were males, accounting for 50.92%. The majority were medical personnel aged 41 to 50 years old, with undergraduate degrees, junior professional titles, working in township health centers or community health service centers, as clinical physicians, and with a working experience of no more than 10 years. They accounted for 31.97% (869/2 718), 50.48% (1 372/2 718), 35.54% (966/2 718), 38.52% (1 047/2 718), 62.33% (1 694/2 718), and 30.61% (832/2 718), respectively. The overall correct rates of medical personnel's relevant knowledge, attitude and practice were 77.52% (31 605/40 770), 94.53% (12 847/13 590) and 89.73% (12 194/13 590), respectively. There were statistically significant differences in the knowledge qualification of medical personnel of different genders, ages, education levels, professional titles, hospital levels, job positions, and years of work experience ( P < 0.05). The results of binary logistic regression analysis showed that professional title, hospital level, work position, and work experience were the influencing factors of knowledge qualification rate ( P < 0.05). Conclusions:Medical personnel have a relatively positive attitude and high level of practice towards SFTS, but their knowledge level still needs to be improved. It is recommended to provide targeted knowledge training for medical personnel in different positions to promote early detection, diagnosis, and treatment of SFTS.

To address the challenges associated with traditional medical treatment modalities that hinder the efficiency of healthcare delivery,and to facilitate the sharing of medical service information across multiple campuses via mobile platforms,the First Affiliated Hospital to Zhejiang University School of Medicine has proactively leveraged digital intelligence to innovate its medical service model.This program involved the development of a comprehensive process guidance service applet on the Alipay platform specifically for outpatient services.The applet offers intelligent support services,standardizes electronic authentication processes,coordinates medical resources across various hospital locations,and establishes an integrated service delivery system that seamlessly combines online and offline interactions.This approach has optimized the outpatient treatment process,enhanced the patient experience,and fostered standardized management of medical services across multiple campuses.

Objective:To explore the factors influencing electronically-delivered cognitive behavioral therapy for insomnia (e-CBTI) selection among patients with insomnia, and to provide empirical evidence for the clinical promotion of e-CBTI.Methods:Between November 2022 and July 2023, a convenience sampling method was employed to collect samples from 38 public hospitals and their surrounding communities. A total of 756 insomnia patients aged 18-65 years were included in the study. Based on their choice to participate in e-CBTI treatment, patients were divided into two groups: 605 patients (605/756,80.0%) chose to participate in e-CBTI treatment, while 151 patients (151/756,20.0%) did not. Rater-rated structured clinical interviews were applied in the current study, assessing individual′s insomnia symptoms, mental disorders, other sleep disorders, and suicidality and self-injury. The chi-square test and logistic regression were applied in data analyses.Results:Compared to the control group, the e-CBTI group had a higher proportion of females (χ 2=4.29) and a higher educational level (χ 2=5.76), while the proportion of living in rural areas was lower (χ 2=6.87), all with P<0.05. Additionally, the e-CBTI group exhibited a higher proportion of daytime symptoms compared to the control group, including decreased attention or memory (χ 2=16.42), impaired function or performance (χ 2=6.75), mood changes (χ 2=4.71), and reduced enthusiasm, energy, or motivation (χ 2=4.77), all with P<0.05. The e-CBTI group also showed a higher tendency for delayed sleep phase (χ 2=6.61), generalized anxiety disorder (χ 2=6.22), suicidal ideation (χ 2=10.45), and non-suicidal self-injury (χ 2=5.19), all with statistically significant differences ( P<0.05). Multivariate logistic regression analysis revealed that the type of residence ( OR=0.53, 95 %CI=0.29-0.95), educational level ( OR=2.42, 95 %CI=1.34-4.37), decreased attention or memory ( OR=1.95, 95 %CI=1.11-3.42), impaired function or performance ( OR=1.80, 95 %CI=1.15-2.82), and suicidal ideation ( OR=3.12, 95 %CI=1.29-7.58) remained significant influential factors in the selection of e-CBTI. Insomnia′s nighttime symptoms, including difficulty falling asleep, difficulty maintaining sleep, and early morning awakenings, were not associated with the inclination to choose e-CBTI. Conclusions:Daytime symptoms of insomnia and suicidal ideation are significant factors that prompt insomnia patients to choose e-CBTI.

Objective:To explore the application effect of the milestone evaluation system based on ACGME core competencies in the standardized training of residents in the department of rheumatology and immunology.Methods:A modified Milestone Evaluation Scale was developed for the department of rheumatology and immunology. Self evaluation and mentor evaluation were conducted on 150 residents who received standardized training in grades 1-3 before May 2023. The results were collected and statistically analyzed. One-way analysis of variance and t-test were performed using SPSS 27.0. Results:The self-evaluation and mentor evaluation scores of all residents increased with the training years. Self-evaluation scores were significantly higher than mentor evaluation scores ( P<0.05) for the medical knowledge ( t=2.95, P=0.006), diagnosis and treatment ability ( t=2.57, P=0.015), and learning ability ( t=2.67, P=0.015) of grade 2 residents and the learning ability ( t=2.87, P=0.007) of grade 3 residents. There were no significant differences in the baseline score and ability improvement of residents from different institutions ( P>0.05). Conclusions:The milestone evaluation system is an effective tool for training, assessing, and providing feedback to residents in rheumatology and immunology, and provides essential feedback to resident training bases regarding the training effectiveness. The method is worth promoting.

Objective To observe the effect of coronary reperfusion therapy on the differential ex-pression of plasma exosomal miRNAs in patients with acute myocardial infarction(AMI).Meth-ods Three elderly male AMI patients undergoing coronary reperfusion therapy in our hospital from October to November 2022 were recruited in this study.The venous blood samples were col-lected at admission and 2 and 24 h after recanalization.MiRNA-sequencing was used to screen the differentially expressed miRNAs which were commonly expressed in the plasma exosomes of the 3 patients.Bioinformatics analysis was performed on the target genes,and then the differentially expressed miR-499a-5p was verified by qPCR.Results Compared with the plasma exosomal miRNAs at admission,there were 418 up-regulated and 406 down-regulated miRNAs at 2 h after operation,and 320 up-regulated and 225 down-regulated miRNAs at 24 h after operation(P＜0.05);Compared with the miRNAs at 2 h after operation,there were 344 up-regulated and 350 down-regulated ones at 24 h after operation(P＜0.05).Kyoto Encyclopedia of Genes and Ge-nomes enrichment analysis showed that the differentially expressed miRNAs were enriched in phosphatidylinositol-3-kinase-protein kinase B,hypoxia-inducible factor 1,and vascular smooth muscle contraction pathways.Gene Ontology analysis indicated that the molecular functions of dif-ferentially expressed miRNA target genes were mainly enriched in protein binding and DNA bind-ing;cellular components were mainly enriched in cell membrane and cytoplasm;and biological processes were mainly enriched in signaling and transcription of DNA templates.The miR-499a-5p level was significantly lower at 2 h postoperatively than at admission[(0.577±0.020)vs(1.000± 0.023),P＜0.05],and at 24 h postoperatively than at 2 h postoperatively[(0.068±0.006)vs(0.577±0.020),P＜0.05].Conclusion Plasma exosomal miRNAs can be used as a biomarker for early diagnosis of elderly AMI patients and for predicting the efficacy of reperfusion therapy.

In recent years， the potential anti-tumor effects of metformin have attracted widespread attention in the field of cancer treatment. This article summarizes the research progress of metformin in the treatment of malignant tumors，finding its potential application in the treatment of malignant tumors in the digestive system （biliary tract cancer，gastric cancer，esophagus cancer，colorectal cancer，pancreatic cancer，liver cancer） and reproductive system （prostate cancer，ovarian cancer，breast cancer， cervical cancer），non-small cell lung cancer，renal cell carcinoma，and melanoma. Metformin can inhibit the proliferation of tumor cells and extend the overall survival of patients. Its mechanisms of action include，but are not limited to，inhibiting the activity of mitochondrial complex Ⅰ，activating adenosine monophosphate-activated protein kinase/p53 signaling pathway，and blocking the cell cycle. Additionally，the combined use of metformin with chemotherapy drugs has shown potential for reducing toxicity and enhancing efficacy. It can enhance the sensitivity of biliary tract cancer，ovarian cancer，and melanoma cells to chemotherapy drugs， improve the drug resistance of gastric and colorectal cancer cells to chemotherapy，and reduce the toxic reactions of breast cancer patients during chemotherapy. Metformin is also used as an immunomodulator，applied in the immunotherapy of patients with esophagus cancer，colorectal cancer，cervical cancer，non-small cell lung cancer，and melanoma.

Objective:To explore the factors influencing electronically-delivered cognitive behavioral therapy for insomnia (e-CBTI) selection among patients with insomnia, and to provide empirical evidence for the clinical promotion of e-CBTI.Methods:Between November 2022 and July 2023, a convenience sampling method was employed to collect samples from 38 public hospitals and their surrounding communities. A total of 756 insomnia patients aged 18-65 years were included in the study. Based on their choice to participate in e-CBTI treatment, patients were divided into two groups: 605 patients (605/756,80.0%) chose to participate in e-CBTI treatment, while 151 patients (151/756,20.0%) did not. Rater-rated structured clinical interviews were applied in the current study, assessing individual′s insomnia symptoms, mental disorders, other sleep disorders, and suicidality and self-injury. The chi-square test and logistic regression were applied in data analyses.Results:Compared to the control group, the e-CBTI group had a higher proportion of females (χ 2=4.29) and a higher educational level (χ 2=5.76), while the proportion of living in rural areas was lower (χ 2=6.87), all with P<0.05. Additionally, the e-CBTI group exhibited a higher proportion of daytime symptoms compared to the control group, including decreased attention or memory (χ 2=16.42), impaired function or performance (χ 2=6.75), mood changes (χ 2=4.71), and reduced enthusiasm, energy, or motivation (χ 2=4.77), all with P<0.05. The e-CBTI group also showed a higher tendency for delayed sleep phase (χ 2=6.61), generalized anxiety disorder (χ 2=6.22), suicidal ideation (χ 2=10.45), and non-suicidal self-injury (χ 2=5.19), all with statistically significant differences ( P<0.05). Multivariate logistic regression analysis revealed that the type of residence ( OR=0.53, 95 %CI=0.29-0.95), educational level ( OR=2.42, 95 %CI=1.34-4.37), decreased attention or memory ( OR=1.95, 95 %CI=1.11-3.42), impaired function or performance ( OR=1.80, 95 %CI=1.15-2.82), and suicidal ideation ( OR=3.12, 95 %CI=1.29-7.58) remained significant influential factors in the selection of e-CBTI. Insomnia′s nighttime symptoms, including difficulty falling asleep, difficulty maintaining sleep, and early morning awakenings, were not associated with the inclination to choose e-CBTI. Conclusions:Daytime symptoms of insomnia and suicidal ideation are significant factors that prompt insomnia patients to choose e-CBTI.