Objective: To investigate the mobility of vaccination personnel in community health service centers in Zhejiang Province from 2012 to 2022, so as to provide reference for strengthening the construction of the vaccination team in grassroots healthcare institutions and enhancing the quality of vaccination services. Methods: From May to July 2023, one district and one county were randomly selected from each of the 11 cities in Zhejiang Province as survey sites. Two vaccination clinic of community health service centers were selected from each site for investigation. Data on the staffing and mobility of vaccination personnel were collected to analyze the composition, vacancy rate, net inflow rate, and channels for mobility among vaccination personnel. Results: In 2022, there were 192 vaccination personnel positions established across 44 vaccination clinics, with 203 staff members on duty, with 178 in-service and officially employed staff, resulting in a vacancy of 5 positions and a vacancy rate of 2.60%. There were 184 females, accounting for 90.64%. The majority were aged 20 to <41 years old, with 140 individuals representing 68.97%. There were 128 individuals with a bachelor's degree, making up 63.05%, and 110 with intermediate professional titles, accounting for 54.19%. From 2012 to 2022, a total of 102 vaccination personnel flowed in and 68 flowed out, with a net inflow rate of 20.12%. The net inflow rate of vaccination personnel in urban areas was 12.38%, which was lower than that in rural areas (32.81%, P<0.05). The flow ratio was 100.59%, with the flow ratio of vaccination personnel in urban areas being 126.67% and that in rural areas being 57.81%. Both the inflow and outflow vaccination personnel were mainly aged 20 to <31 years old (71.57% and 52.94%), with a bachelor's degree (73.53% and 61.76%), a junior professional title (70.59% and 55.88%), and no permanent position (62.75% and 61.76%). The main inflow channels for vaccination personnel was the recruitment of people, accounting for 70.57%; the main outflow channels were job transfer and resignation, accounting for 57.35% and 27.94% respectively. Conclusions From 2012 to 2022, the number of vaccination personnel in cornmunity health service centers in Zhejiang Province increased, but the personnel turnover was relatively high. Moreover, there were issues such as high personnel mobility in urban areas and instability in the ranks of young and junior professional title holders.

Microbial communities such as those residing in the human gut are highly diverse and complex, and many with important implications for health and diseases. The effects and functions of these microbial communities are determined not only by their species compositions and diversities but also by the dynamic intra- and inter-cellular states at the transcriptional level. Powerful and scalable technologies capable of acquiring single-microbe-resolution RNA sequencing information in order to achieve a comprehensive understanding of complex microbial communities together with their hosts are therefore utterly needed. Here we report the development and utilization of a droplet-based smRNA-seq (single-microbe RNA sequencing) method capable of identifying large species varieties in human samples, which we name smRandom-seq2. Together with a triple-module computational pipeline designed for the bacteria and bacteriophage sequencing data by smRandom-seq2 in four human gut samples, we established a single-cell level bacterial transcriptional landscape of human gut microbiome, which included 29,742 single microbes and 329 unique species. Distinct adaptive response states among species in Prevotella and Roseburia genera and intrinsic adaptive strategy heterogeneity in Phascolarctobacterium succinatutens were uncovered. Additionally, we identified hundreds of novel host-phage transcriptional activity associations in the human gut microbiome. Our results indicated that smRandom-seq2 is a high-throughput and high-resolution smRNA-seq technique that is highly adaptable to complex microbial communities in real-world situations and promises new perspectives in the understanding of human microbiomes.
Humans ; Gastrointestinal Microbiome/genetics* ; Bacteriophages/physiology* ; High-Throughput Nucleotide Sequencing ; Sequence Analysis, RNA/methods* ; Bacteria/virology*

ObjectivesTo analyze the trends in mortality and disease burden of colorectal cancer (CRC) among the registered residents in Danyang City, Jiangsu Province, from 2013 to 2023, and to provide a scientific basis for developing CRC prevention and control strategies. MethodsMortality surveillance data on CRC among the registered residents in Danyang City from 2013 to 2023 were collected and analyzed. Crude mortality rate (CMR), age-standardized mortality rate (ASMR), years of life lost (YLL) due to premature death, and YLL rate were calculated. The annual percentage change (APC) and average annual percent change (AAPC) of CMR, ASMR and YLL rate were calculated with Joinpoint Regression Program 4.9.0.1. ResultsA total of 1 920 deaths from colorectal cancer were recorded in Danyang City during 2013‒2023, with an average annual CMR of 21.75/100 000, which showed an upward trend (APC=6.47%, 95%CI: 4.21%‒8.79%, P<0.001), with higher CMR observed in males than that in females. The overall ASMR by Chinese standard population was 12.10/100 000, with no obvious temporal trends (APC=1.37%, P=0.364). ASMR increased with age, particularly after 45 years. The total YLL due to CRC was 34 711 person-years, with an average YLL rate of 3.93‰. The YLL rate showed a significant upward trend from 2013 to 2023 (APC=4.96%, 95%CI: 4.08%‒18.16%, P<0.001) in Danyang City. ConclusionThe mortality rate of colorectal cancer in Danyang City is relatively high and has shown a rising trend, resulting in an increasing disease burden on the residents year by year. Continued efforts to strengthen CRC prevention and control are needed, particularly targeting males and the elderly population.

Objective To investigate the mechanism of hearing loss caused by tympanic membrane(TM)per-foration.Methods We constructed a full ear finite element model,and the personalized finite element model of TM perforation was constructed to simulate hearing loss caused by TM perforation.The difference between the displace-ment response of the basement membrane and the baseline was applied to simulate hearing loss,and the contribution of various components of the middle ear to hearing loss was analyzed to study the mechanism of hearing loss caused by TM perforation.Results If the coupling of the round window membrane and the middle ear air was removed,the hearing loss at the low frequency was about 40 dB,while the high-frequency was the same as the baseline.Re-moval of the coupling between the inner side of the eardrum and the middle ear cavity resulted in a reduction in par-tial low-frequency hearing and an increase in high-frequency hearing loss.The continuous disconnection between the air in the external auditory canal and the air in the middle ear cavity increased the low-frequency hearing loss.How-ever,after the removal of the coupling between the round window membrane and the middle ear air and the connec-tion between the middle ear air and the lateral side of the TM,the original hearing loss of 40 dB at low-frequency dropped to 10 dB.While the removal of the coupling between the middle ear cavity air and the ossicular chain had no significant impact on hearing loss.Conclusion TM perforation may cause hearing loss by both the reduction of sound transmission and the reduction of sound pressure difference between the two sides of TM.The round window membrane can counteract the influence of the hearing loss caused by TM perforation.

Objective:This study aimed to explore whether there are abnormalities in the kynurenine pathway in patients with depression and suicidal ideation, and their dynamic relationship with clinical symptoms.Methods:According to the DSM-5 diagnostic criteria, a total of 68 patients with depression were prospectively enrolled, including 28 males and 40 females, aged( M ( Q1, Q3)) 22.0 (17.3, 47.8) years, who were the inpatients in the Division of Mood Disorders of Shanghai Mental Health Center from July 2019 to July 2022. The depressed patients were divided into groups with ( n=41) or without suicidal ideation ( n=27) based on whether they chose "weak" or "moderate to strong" suicidal ideation in questions 4 and 5 of the Beck Scale for Suicide Ideation (BSI). And 72 gender-matched healthy controls were also enrolled, including 29 males and 43 females, aged 25.5 (24.0, 36.8) years. Hamilton Depression Rating Scale-24 (HAMD 24), Hamilton Anxiety Rating Scale (HAMA), and BSI were used to evaluate the depression symptoms, anxiety symptoms, and suicidal ideation of depressed patients. All the participants received fasting venous blood collection to measure the levels of kynurenine metabolites in plasma. Among them, depressed patients with suicidal ideation were followed up, and the assessment s of depression symptoms, anxiety symptoms, and suicidal ideation, as well as kynurenine metabolites measurements, were repeated at the end of the 2nd and 4th weeks. Ultra-high performance liquid chromatography-triple quadrupole mass spectrometry was used to measure the levels of kynurenine metabolites in plasma. The hematological indicators were log-transformed, Z-score standardized, and false discovery rate correction was used for multiple comparisons of different metabolites. The relationship between baseline kynurenine metabolites and scale scores was analyzed. The relationship between kynurenine metabolites and scale scores during the follow-up process was analyzed by a linear mixed-effects model. Results:The peripheral picolinic acid (0.39±0.87 vs -0.23±1.09, t=3.89), 3-hydroxykynurenine/kynurenine (3-HK/KYN) (0.38±0.85 vs -0.09±1.01, t=2.98) and 3-HK (0.31±0.81 vs 0.14±1.04, t=2.78) of patients with depression were lower than those of healthy controls (both P<0.05). No statistically significant difference was found between patients with depression with or without suicidal ideation in kynurenine metabolites. In patients with depression and suicidal ideation, baseline HAMD 24 and HAMA scores were positively correlated with plasma 3-HK (HAMD 24: r=0.38; HAMA: r=0.39) and 3-HK/KYN (HAMD 24: r=0.34; HAMA: r=0.37) levels (all P<0.05). After adjusting for age and gender factors, a linear mixed-effects model was established for the follow-up scale scores, and kynurenine metabolite levels of this group of patients, and the results showed that the positive effect of HAMA score on 3-HK/KYN during follow-up was statistically significant ( B=0.04, t=2.46, P<0.05). Conclusion:There are abnormalities in the kynurenine pathway of tryptophan metabolism in patients with depression. 3-HK and 3-HK/KYN are related to the severity of depression and anxiety in patients with depression and suicidal ideation, among which 3-HK/KYN, representing the activity of kynurenine-3-monooxygenase, is dynamically associated with anxiety level.

Objective:To analyze the influencing factors of incision infection in patients undergoing colorectal cancer surgery under the standards of enhanced recovery after surgery, to establish a prediction model for the risk of postoperative incision infection and to evaluate its efficacy, providing a reference for surgical site caring of colorectal cancer patients under enhanced recovery after surgery precisely.Methods:A cross-sectional survey was used, 285 patients who underwent colorectal tumor surgery in the Department of Gastrointestinal Surgery of the First Affiliated Hospital of Xinjiang Medical University and the First Department of Gastrointestinal Surgery and the Second Department of Gastrointestinal Surgery of Xinjiang Uygur Autonomous Region Cancer Hospital from July 2023 to January 2024 were prospectively selected as the study subjects by the convenience sampling method, 225 cases were used as the modeling group and 60 cases were selected as the external validation group. The preoperative data, intraoperative data and postoperative data of subjects were collected. Postoperative incision infection was taken as the outcome index. Univariate analysis and multivariate Logistic regression analysis were used to screen the independent risk factors of postoperative incision infection of patients with colorectal tumors, and drew a nomogram, Hosmer-Lemeshow test and receiver operating characteristic (ROC) curve were used to verify the model.Results:The modeling group consisted of 131 males and 94 females aged (58.42 ± 16.24) years old. There were 35 males and 25 females in the external validation group, with an age of (57.16 ± 16.28) years. Multivariate analysis showed that malnutrition ( OR=6.614, 95% CI 2.008-21.789), length of hospital stay ( OR=1.058, 95% CI 1.004-1.114), interleukin-6 ( OR=1.041, 95% CI 1.021-1.062), and lymphocyte count ( OR=0.275, 95% CI 0.093-0.813) were independent risk factors for incision infection (all P<0.05). The area under the ROC curve of the modeling group was 0.921, the 95% CI was 0.754-0.902, the optimal cut-off value was 0.461, the sensitivity was 0.782, and the specificity was 0.785, concordance index of calibration curve was 0.971. External validation results showed that area under the ROC curve was 0.828, the 95% CI was 0.754-0.902, the optimal cut-off value was 0.438, the sensitivity was 0.745 and the specificity was 0.783. Conclusions:Under the enhanced recovery after surgery, the risk prediction model established in this study has good effect in predicting postoperative incision infection, which can provide a reference for early identification of high-risk patients with postoperative incision infection after colorectal cancer surgery.

Objective:To analyze the influencing factors of incision infection in patients undergoing colorectal cancer surgery under the standards of enhanced recovery after surgery, to establish a prediction model for the risk of postoperative incision infection and to evaluate its efficacy, providing a reference for surgical site caring of colorectal cancer patients under enhanced recovery after surgery precisely.Methods:A cross-sectional survey was used, 285 patients who underwent colorectal tumor surgery in the Department of Gastrointestinal Surgery of the First Affiliated Hospital of Xinjiang Medical University and the First Department of Gastrointestinal Surgery and the Second Department of Gastrointestinal Surgery of Xinjiang Uygur Autonomous Region Cancer Hospital from July 2023 to January 2024 were prospectively selected as the study subjects by the convenience sampling method, 225 cases were used as the modeling group and 60 cases were selected as the external validation group. The preoperative data, intraoperative data and postoperative data of subjects were collected. Postoperative incision infection was taken as the outcome index. Univariate analysis and multivariate Logistic regression analysis were used to screen the independent risk factors of postoperative incision infection of patients with colorectal tumors, and drew a nomogram, Hosmer-Lemeshow test and receiver operating characteristic (ROC) curve were used to verify the model.Results:The modeling group consisted of 131 males and 94 females aged (58.42 ± 16.24) years old. There were 35 males and 25 females in the external validation group, with an age of (57.16 ± 16.28) years. Multivariate analysis showed that malnutrition ( OR=6.614, 95% CI 2.008-21.789), length of hospital stay ( OR=1.058, 95% CI 1.004-1.114), interleukin-6 ( OR=1.041, 95% CI 1.021-1.062), and lymphocyte count ( OR=0.275, 95% CI 0.093-0.813) were independent risk factors for incision infection (all P<0.05). The area under the ROC curve of the modeling group was 0.921, the 95% CI was 0.754-0.902, the optimal cut-off value was 0.461, the sensitivity was 0.782, and the specificity was 0.785, concordance index of calibration curve was 0.971. External validation results showed that area under the ROC curve was 0.828, the 95% CI was 0.754-0.902, the optimal cut-off value was 0.438, the sensitivity was 0.745 and the specificity was 0.783. Conclusions:Under the enhanced recovery after surgery, the risk prediction model established in this study has good effect in predicting postoperative incision infection, which can provide a reference for early identification of high-risk patients with postoperative incision infection after colorectal cancer surgery.

Objective:This study aimed to explore whether there are abnormalities in the kynurenine pathway in patients with depression and suicidal ideation, and their dynamic relationship with clinical symptoms.Methods:According to the DSM-5 diagnostic criteria, a total of 68 patients with depression were prospectively enrolled, including 28 males and 40 females, aged( M ( Q1, Q3)) 22.0 (17.3, 47.8) years, who were the inpatients in the Division of Mood Disorders of Shanghai Mental Health Center from July 2019 to July 2022. The depressed patients were divided into groups with ( n=41) or without suicidal ideation ( n=27) based on whether they chose "weak" or "moderate to strong" suicidal ideation in questions 4 and 5 of the Beck Scale for Suicide Ideation (BSI). And 72 gender-matched healthy controls were also enrolled, including 29 males and 43 females, aged 25.5 (24.0, 36.8) years. Hamilton Depression Rating Scale-24 (HAMD 24), Hamilton Anxiety Rating Scale (HAMA), and BSI were used to evaluate the depression symptoms, anxiety symptoms, and suicidal ideation of depressed patients. All the participants received fasting venous blood collection to measure the levels of kynurenine metabolites in plasma. Among them, depressed patients with suicidal ideation were followed up, and the assessment s of depression symptoms, anxiety symptoms, and suicidal ideation, as well as kynurenine metabolites measurements, were repeated at the end of the 2nd and 4th weeks. Ultra-high performance liquid chromatography-triple quadrupole mass spectrometry was used to measure the levels of kynurenine metabolites in plasma. The hematological indicators were log-transformed, Z-score standardized, and false discovery rate correction was used for multiple comparisons of different metabolites. The relationship between baseline kynurenine metabolites and scale scores was analyzed. The relationship between kynurenine metabolites and scale scores during the follow-up process was analyzed by a linear mixed-effects model. Results:The peripheral picolinic acid (0.39±0.87 vs -0.23±1.09, t=3.89), 3-hydroxykynurenine/kynurenine (3-HK/KYN) (0.38±0.85 vs -0.09±1.01, t=2.98) and 3-HK (0.31±0.81 vs 0.14±1.04, t=2.78) of patients with depression were lower than those of healthy controls (both P<0.05). No statistically significant difference was found between patients with depression with or without suicidal ideation in kynurenine metabolites. In patients with depression and suicidal ideation, baseline HAMD 24 and HAMA scores were positively correlated with plasma 3-HK (HAMD 24: r=0.38; HAMA: r=0.39) and 3-HK/KYN (HAMD 24: r=0.34; HAMA: r=0.37) levels (all P<0.05). After adjusting for age and gender factors, a linear mixed-effects model was established for the follow-up scale scores, and kynurenine metabolite levels of this group of patients, and the results showed that the positive effect of HAMA score on 3-HK/KYN during follow-up was statistically significant ( B=0.04, t=2.46, P<0.05). Conclusion:There are abnormalities in the kynurenine pathway of tryptophan metabolism in patients with depression. 3-HK and 3-HK/KYN are related to the severity of depression and anxiety in patients with depression and suicidal ideation, among which 3-HK/KYN, representing the activity of kynurenine-3-monooxygenase, is dynamically associated with anxiety level.

Objective:To construct a value evaluation framework for high-value medical consumables,providing a guidance for medical insurance access and hospital access management scenarios in China.Methods:It conducted literature review,qualitative in-terviews and quantitative surveys.A total of 12 experts were invited for qualitative interviews,while 100 experts from four fields of health technology assessment,medical insurance,hospital management,and clinical practice participated in the quantitative survey.Through those process,it generated the composition of the value framework and the scoring of each item.Differences in ratings be-tween different scenarios and experts were analyzed through chi-square tests.The recommendation level for each item was graded.Re-sults:A comprehensive value evaluation framework for high-value medical consumables was established,which included 6 core dimen-sions,comprised 16 items for secondary dimensions and 50 items for tertiary dimensions.It showed significant differences between the medical insurance access and hospital access scenarios,as well as among different fields of experts in the same scenario.furthermore,grading the items in two scenarios.The medical insurance access scenario had 8 highly recommended items,and the hospital access scenario had 24 highly recommended items.Conclusion:Value evaluation should encourage multi-dimensional assessments and inter-disciplinary participation,continually improving the management of high-value medical consumables in medical insurance and hospital access.