Objective:To explore the relationship between serum thymic stromal lymphopoietin (TSLP) levels and the occurrence of pruritus as well as interstitial lung diseases (ILD) in patients with dermatomyositis (DM) or clinically amyopathic dermatomyositis (CADM) .Methods:A retrospective analysis was conducted on the clinical data from 61 diagnosed DM/CADM patients at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine between February 2019 and March 2022. Thirty-five age- and sex-matched healthy individuals were included as controls. Serum TSLP and anti-melanoma differentiation-associated gene 5 (MDA5) antibody levels were measured using enzyme-linked immunosorbent assay (ELISA) . A multiplexed flow cytometry assay was performed to detect the serum levels of 12 cytokines, including interferon (IFN) -α2, IFN-γ, interleukin (IL) -4, IL-5, etc. Pruritus severity in DM/CADM patients was assessed using the visual analog scale (VAS) . Relationships of serum TSLP levels with skin lesions, inflammatory markers, and the severity of ILD were analyzed using GraphPad Prism 8.0.1 and R (version 4.3.2) software.Results:Among the 61 patients with DM/CADM, 18 were males (13 with DM and 5 with CADM) and 43 were females (30 with DM and 13 with CADM) , with ages of 53.08 ± 14.97 years and disease duration of 6.27 ± 4.27 months. No significant differences were observed in sex or age between the DM/CADM group and the healthy control group (both P > 0.05) . Of the 61 patients, 15 (24.59%) were positive for anti-MDA5 antibodies, and 31 (51.67%) had ILD, including 11 with acute/subacute interstitial pneumonia (A/SIP) . The pruritus VAS score ( M[ Q1, Q3]) among the 61 patients was 3 (0, 6) points; 20 patients (32.79%) reported no pruritus, while 11 (18.32%) , 17 (27.87%) , and 13 (21.31%) experienced mild, moderate, and severe pruritus, respectively. Serum TSLP levels were significantly higher in the DM/CADM patients than in the healthy controls (91.0 [34.6, 273.0] vs. 25.0 [0.0, 83.5] pg/ml, Z = 1 502.50, P < 0.001]. The TSLP levels were significantly positively correlated with serum levels of alanine aminotransferase (ALT) , lactate dehydrogenase, C-reactive protein, erythrocyte sedimentation rate and ferritin, and significantly negatively correlated with pruritus VAS scores, eosinophil percentages, and eosinophil counts (all P < 0.05) . Serum TSLP levels were significantly higher in the anti-MDA5 antibody-positive patients than in the anti-MDA5 antibody-negative patients (273.0 [103.8, 2 576.0] pg/ml vs. 67.4 [16.9, 218.7] pg/ml, P = 0.002) , as well as in the patients with A/SIP than in those without A/SIP (390.0 [168.2, 2 869.6] vs. 67.5 [21.8, 235.9] pg/ml, P < 0.001) . ROC analysis showed that the combined detection of serum TSLP levels and anti-MDA5 antibodies had a higher predictive value for A/SIP in DM/CADM patients (AUC = 0.922) than either the detection of anti-MDA5 antibodies (AUC = 0.831) or TSLP (AUC = 0.824) alone did. Conclusions:Serum TSLP levels were significantly higher in patients with DM/CADM than in healthy controls, with particularly higher levels observed in anti-MDA5 antibody-positive patients and patients with coexisting A/SIP, and were correlated with several indicators of disease activity. The combination of serum TSLP levels and anti-MDA5 antibodies provided greater predictive value for A/SIP than either of them alone did.

Objective:To explore the relationship between serum thymic stromal lymphopoietin (TSLP) levels and the occurrence of pruritus as well as interstitial lung diseases (ILD) in patients with dermatomyositis (DM) or clinically amyopathic dermatomyositis (CADM) .Methods:A retrospective analysis was conducted on the clinical data from 61 diagnosed DM/CADM patients at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine between February 2019 and March 2022. Thirty-five age- and sex-matched healthy individuals were included as controls. Serum TSLP and anti-melanoma differentiation-associated gene 5 (MDA5) antibody levels were measured using enzyme-linked immunosorbent assay (ELISA) . A multiplexed flow cytometry assay was performed to detect the serum levels of 12 cytokines, including interferon (IFN) -α2, IFN-γ, interleukin (IL) -4, IL-5, etc. Pruritus severity in DM/CADM patients was assessed using the visual analog scale (VAS) . Relationships of serum TSLP levels with skin lesions, inflammatory markers, and the severity of ILD were analyzed using GraphPad Prism 8.0.1 and R (version 4.3.2) software.Results:Among the 61 patients with DM/CADM, 18 were males (13 with DM and 5 with CADM) and 43 were females (30 with DM and 13 with CADM) , with ages of 53.08 ± 14.97 years and disease duration of 6.27 ± 4.27 months. No significant differences were observed in sex or age between the DM/CADM group and the healthy control group (both P > 0.05) . Of the 61 patients, 15 (24.59%) were positive for anti-MDA5 antibodies, and 31 (51.67%) had ILD, including 11 with acute/subacute interstitial pneumonia (A/SIP) . The pruritus VAS score ( M[ Q1, Q3]) among the 61 patients was 3 (0, 6) points; 20 patients (32.79%) reported no pruritus, while 11 (18.32%) , 17 (27.87%) , and 13 (21.31%) experienced mild, moderate, and severe pruritus, respectively. Serum TSLP levels were significantly higher in the DM/CADM patients than in the healthy controls (91.0 [34.6, 273.0] vs. 25.0 [0.0, 83.5] pg/ml, Z = 1 502.50, P < 0.001]. The TSLP levels were significantly positively correlated with serum levels of alanine aminotransferase (ALT) , lactate dehydrogenase, C-reactive protein, erythrocyte sedimentation rate and ferritin, and significantly negatively correlated with pruritus VAS scores, eosinophil percentages, and eosinophil counts (all P < 0.05) . Serum TSLP levels were significantly higher in the anti-MDA5 antibody-positive patients than in the anti-MDA5 antibody-negative patients (273.0 [103.8, 2 576.0] pg/ml vs. 67.4 [16.9, 218.7] pg/ml, P = 0.002) , as well as in the patients with A/SIP than in those without A/SIP (390.0 [168.2, 2 869.6] vs. 67.5 [21.8, 235.9] pg/ml, P < 0.001) . ROC analysis showed that the combined detection of serum TSLP levels and anti-MDA5 antibodies had a higher predictive value for A/SIP in DM/CADM patients (AUC = 0.922) than either the detection of anti-MDA5 antibodies (AUC = 0.831) or TSLP (AUC = 0.824) alone did. Conclusions:Serum TSLP levels were significantly higher in patients with DM/CADM than in healthy controls, with particularly higher levels observed in anti-MDA5 antibody-positive patients and patients with coexisting A/SIP, and were correlated with several indicators of disease activity. The combination of serum TSLP levels and anti-MDA5 antibodies provided greater predictive value for A/SIP than either of them alone did.

Bacterial multi-drug resistance (MDR) is a global challenge in the fields of medicine and health, agriculture and fishery, ecology and environment. The cross-region spread of antibiotic resistance genes (ARGs) among different species is one of the main cause of bacterial MDR. However, there is no effective strategies for addressing the intensifying bacterial MDR. The CRISPR-Cas system, consisting of clustered regularly interspaced short palindromic repeats (CRISPR) and CRISPR associated proteins, can targetedly degrade exogenous nucleic acids, thus exhibiting high application potential in preventing and controlling bacterial MDR caused by ARGs. This review briefly introduced the working mechanism of CRISPR-Cas systems, followed by discussing recent advances in reducing ARGs by CRISPR-Cas systems delivered through mediators (e.g. plasmids, bacteriophages and nanoparticle). Moreover, the trends of this research field were envisioned, providing a new perspective on preventing and controlling MDR.
Anti-Bacterial Agents ; Bacteriophages/genetics* ; CRISPR-Cas Systems ; Drug Resistance, Bacterial/genetics* ; Plasmids/genetics*

Objective To explore the effectiveness and feasibility of internet-based structured group cognitive behavior therapy (I-GCBT) in patients with mild depressive disorder.Methods In this randomized controlled trial,based on a random number table which was generated from spss20.0,96 patients with mild depressive disorder were randomized to I-GCBT(n=64) and face-to-face group cognitive behavior therapy(GCBT,n=32).I-GCBT and GCBT patients were assessed by HAMD17,HAMA,Global Assessment of Functioning Scale,GAF and 16 Items Quick Inventory of Depressive Symptomatology-Self Report,QIDS-SR16 at baseline,4th week,8th week and 12th week.The differences between I-GCBT and GCBT were analyzed by repetitive measure analysis of variance and chi-square test.Results (1)There was no significant difference between I-GCBT and GCBT on demographics,duration of past depression history,baseline of HAMD17,GAF and QIDS-SR16,but a significantly higher HAMA seen in GCBT (t=-2.08,P=0.04).(2) The interaction of times and groups was significant in GAF (F=4.09,P＜0.01) but not in HAMD17,HAMA and QIDS-SR16 (F=0.69,P＞0.05;F=0.95,P＞0.05;F=0.64,P＞0.05).In all measurement scales,Time main effects were significant (HAMD17∶ F=32.81,P＜0.01;HAMA∶ F=20.86,P＜0.01;GAF∶ F=105.98,P＜0.01;QIDS-SR16∶ F=25.27,P＜0.01).The symptoms remission rate of the overall patients was 62％ (43/69) after 12 weeks treatment,lower in I-GCBT (57％,25/44) and higher in GCBT (72％,18/25).There was no significant difference between two groups (x2=1.57,P=0.21).(3) The overall dropout rate was 26％ during the 12-weeks treatment specifically 29％(15/51) in I-GCBT and 20％(6/30) in GCBT without significant difference in-between (x2=0.87,P=0.35).97％(58/60) patients rated the treatment as acceptable (I-GCBT∶ 97％(35/36),GCBT∶ 96％ (23/24)),and the difference of acceptability between two groups was not significant (x2=0.09,P=0.78).Conclusion The effectiveness and feasibility of I-GCBT are comparable to GCBT for mild depressive disorder.And the treatment adherence of I-GCBT seems good.

Objective To explore the effectiveness and feasibility of internet-based structured group cognitive behavior therapy (I-GCBT) in patients with mild depressive disorder.Methods In this randomized controlled trial,based on a random number table which was generated from spss20.0,96 patients with mild depressive disorder were randomized to I-GCBT(n=64) and face-to-face group cognitive behavior therapy(GCBT,n=32).I-GCBT and GCBT patients were assessed by HAMD17,HAMA,Global Assessment of Functioning Scale,GAF and 16 Items Quick Inventory of Depressive Symptomatology-Self Report,QIDS-SR16 at baseline,4th week,8th week and 12th week.The differences between I-GCBT and GCBT were analyzed by repetitive measure analysis of variance and chi-square test.Results (1)There was no significant difference between I-GCBT and GCBT on demographics,duration of past depression history,baseline of HAMD17,GAF and QIDS-SR16,but a significantly higher HAMA seen in GCBT (t=-2.08,P=0.04).(2) The interaction of times and groups was significant in GAF (F=4.09,P＜0.01) but not in HAMD17,HAMA and QIDS-SR16 (F=0.69,P＞0.05;F=0.95,P＞0.05;F=0.64,P＞0.05).In all measurement scales,Time main effects were significant (HAMD17∶ F=32.81,P＜0.01;HAMA∶ F=20.86,P＜0.01;GAF∶ F=105.98,P＜0.01;QIDS-SR16∶ F=25.27,P＜0.01).The symptoms remission rate of the overall patients was 62％ (43/69) after 12 weeks treatment,lower in I-GCBT (57％,25/44) and higher in GCBT (72％,18/25).There was no significant difference between two groups (x2=1.57,P=0.21).(3) The overall dropout rate was 26％ during the 12-weeks treatment specifically 29％(15/51) in I-GCBT and 20％(6/30) in GCBT without significant difference in-between (x2=0.87,P=0.35).97％(58/60) patients rated the treatment as acceptable (I-GCBT∶ 97％(35/36),GCBT∶ 96％ (23/24)),and the difference of acceptability between two groups was not significant (x2=0.09,P=0.78).Conclusion The effectiveness and feasibility of I-GCBT are comparable to GCBT for mild depressive disorder.And the treatment adherence of I-GCBT seems good.

OBJECTIVE:To determine the median effective dose (ED50) of propofol with single intravenous injection in alcohol dependence or withdrawal model rats,and to observe the anaesthetic effect of 2-fold ED50 propofol. METHODS:Fifty SD rats were divided into drinking group(n＝23)and control group(n＝27)based on whether the consumption of alcohol was greater than 3.0 g/(kg·d). Drinking group continued to drink freely and intermittently to establish alcohol dependence model. Control group was only given drinking water for ethanol elution 16 rats were randomly selected from each group to determine ED50 of propofol with single intravenous injection by sequential method,and initial dose was 6.02 mg/kg. After eluting for a week,alcohol dependence rats stopped drinking for 24 hours and had alcohol withdrawal symptoms to establish alcohol withdrawal model. ED50 of propofol in alcohol withdrawal group and control group were determined with same method. After eluting for a week,anaesthetic effect [disappearance time and reappearance time of forepaw righting reflex(FRR),time of activity complete recovery] of 2-fold ED50 propofol with single intravenous injection were observed in alcohol dependence group,alcohol withdrawal group and control group,and corresponding time point and the frequency of respiration before administration were also observed. Changes of liver function indexes(serum albumin,alanine transaminase,total bilirubin,γ glutamyl transaminopeptidase)and liver histomorphology were observed 48 h after medication,10 in each group. RESULTS:ED50 of propofol in alcohol dependence model rats was 9.563 mg/kg,which was higher than 5.623 mg/kg of control group. ED50 of propofol in alcohol withdrawal model rats was 4.086 mg/kg,which was lower than 5.297 mg/kg of control group. Compared with control group,reappearance time of FRR was prolonged significantly in alcohol dependence group and alcohol withdrawal group (P＜0.05). There was no statistical significance in disappearance time of FRR or activity complete recovery time (P＞0.05). The frequency of respiration during FRR disappearance was lower than before propofol injection,FRR reappearance and activity complete recovery (P＜0.01). After intravenous injection of 2-fold ED50 propofol,reappearance time of FRR in alcohol dependence group and alcohol withdrawal group were longer than control group(P＜0.05)；the alcohol dependence group was longer than the alcohol withdrawal group(P＜0.05).The time of activity complete recovery in alcohol dependence group was longer than control group and alcohol withdrawal group (P＜0.05). The frequency of respiration in 3 groups during FRR disappearance were all lower than before propofol injection,FRR reappearance and activity complete recovery(P＜0.01). There was no significant difference in the change of liver function indexes or liver histomorphology. CONCLUSIONS:ED50 of propofol is increased in alcohol dependence rats,while ED50 of propofol is decreased in alcohol withdrawal rats. 2-fold ED50 of propofol has no significant toxicity to liver function.

Objective To analyze the negative experience from medical practice of medical students by Balint group case study,and to explore new approach for training doctor-patient communication skills.Methods 10 times of Balint group activities were held in Zhongshan Hospital of Fudan University,with one case each time.Grounded theory approach were applied for analyzing discussion record.Results The cases were occurred in doctor-patient interaction,teamwork,conflict between one's personal life and vocational development planning.Trigger events involved doctor-patient conflict,conflict of values,decision making problem while conffronted with incurable patients,role ambiguity,unfair treatment.Topics of discussion included emotional experience with patients,career development orientation,medical teamwork,clinical education of medical student.Conclusion Through practice of Balint group,medical students in teaching hospital can improve their awareness of complicating psycho-social problem of patients and themselves,as well as handling it.And it can improve the professional identity,professional growth and professional self-identity.

Objective To investigate nursing undergraduates' career maturity and its influencing factors.Methods A total of 467 nursing undergraduates from a certain comprehensive university were investigated with general informarion questionnaire,Undergraduate Career Maturity Inventory and Undergraduate Specialty Commitment.Results The mean score of career maturity was (3.12 ±0.29).The highest score and lowest score was (3.74 ± 0.45 ) for professional reference and (2.53 ± 0.61 ) for professional value,respectively.Nursing undergraduates' career maturity was influenced by grade,hometown,father' s education,participation and organization of social association activity,and specialty commitment ( P ＜ 0.05,P ＜ 0.01 ).Conclusions Career maturity of nursing undergraduates is generally well,but its overall level is rather low.Nursing undergraduates' career maturity is influenced by grade,hometown,father' s education,participation and organization of social association activity,and specialty commitment.