BackgroundAs a high prevalence disorder， schizophrenia has caused significant burden to family and society due to the impairment of occupational and social function. Currently， the dominant vocational training model in China follows a paternalistic， clinician-led decision-making approach. Although it improves patients' social function to some extent， it undermines their autonomy and treatment adherence. Therefore， it is urgently necessary to explore a new intervention method to enhance treatment compliance and social function in patients. ObjectiveTo explore the impact of shared decision-making oriented vocational training on social function in hospitalized schizophrenia patients， so as to provide references for rehabilitation interventions. MethodsA total of 68 patients diagnosed with schizophrenia according to the International Classification of Diseases， tenth edition （ICD-10） criteria were consecutively enrolled from January to June 2024 at The Third People's Hospital of Wenjiang Distric， Chengdu. Participants were randomly allocated into the research group （n=34） and the control group （n=34） using a random number table method. Both groups received routine rehabilitation training， while the research group received shared decision-making oriented vocational training for 12 weeks， 2 times a week for 2 hours each time. Before and at the 4^th and 12^th week of intervention， two groups were evaluated by General Self-Efficacy Scale （GSES）， Stigma Scale for Mental Illness （SSMI）， Scale of Social function of Psychosis Inpatients （SSFPI） and Inpatient Psychiatric Rehabilitation Outcome Scale （IPROS）. ResultsA total of 63 participants completed the study， with 30 cases in the research group and 33 cases in the control group. Repeated measures ANOVA revealed statistically significant time effects and interaction effects in both groups for GSES， SSMI， SSFPI and IPROS scores （F=20.451， 16.022； 26.193， 12.944； 23.957， 5.023； 11.776， 3.985， P<0.05 or 0.01）， while no significant group effects were observed （F=0.188， 0.742， 1.878， 0.474， P>0.05）. At the 12^th week of intervention， there were statistically significant differences in GSES， SSMI， SSFPI and IPROS scores between the two groups. ConclusionShared decision-making oriented vocational training may help to improve social function in patients with schizophrenia. ［Funded by 2023 Chengdu Medical Research Project （number， 2023468）］

Objective:To evaluate the impact of implementing a regional hierarchical medical management model based on the medical internet of things (medical IoT) on the frequency of emergency department visits and hospitalizations, as well as related medical expenses, in patients with chronic obstructive pulmonary disease (COPD).Methods:This retrospective study included COPD patients enrolled in the regional hierarchical medical management system based on Medical IoT across 21 community health service centers in Songjiang District, Shanghai, between July 2017 and May 2018. Utilizing patient data from the year prior to enrollment as the baseline, changes in the number of emergency visits, hospitalizations, and associated medical costs during the first and second years of management were compared. Changes for patients receiving drug treatment were also analyzed.Results:A total of 973 COPD patients were enrolled. The mean age was 75.2±17.0 years, and 64.34% (626/973) were male. Compared to baseline, all COPD patients in the first year of management showed significant reductions: emergency visits decreased by 33.67%, total emergency costs by 45.60%, hospitalizations by 27.15%, and total hospitalization costs by 25.42%. In the second year, reductions were: emergency visits by 28.08%, total emergency costs by 36.10%, hospitalizations by 35.26%, and total hospitalization costs by 18.13% (all P<0.05). Among patients receiving drug therapy, reductions in the first year were: emergency visits by 39.66%, total emergency costs by 47.54%, hospitalizations by 25.19%, and total hospitalization costs by 28.40%. In the second year, reductions were: emergency visits by 46.98%, total emergency costs by 45.99%, hospitalizations by 41.98%, and total hospitalization costs by 24.94% (all P<0.05). No significant differences were observed before and after management for patients without drug treatment. Conclusion:The implementation of the regional hierarchical medical management model based on Medical IoT significantly reduced the frequency of emergency visits and hospitalizations, as well as related costs, for COPD patients.

Objective:To evaluate the dosimetric characteristics of intensity-modulated proton therapy (IMPT) and photon volumetric modulated arc therapy (VMAT) in radiation therapy planning for patients with bilateral breast cancer after breast-conserving surgery.Methods:On the computed tomography localization images of 18 patients with bilateral breast cancer, target volumes and organs at risk were contoured to develop both IMPT and VMAT plans for each patient. Two IMPT plans were designed based on the clinical target volume (CTV) with robust optimization (RO-IMPT) and the planning target volume (PTV) without RO (NonRO-IMPT), respectively. The RO-IMPT, NonRO-IMPT, and VMAT plans were normalized such that the prescription dose could cover 95% of the target volume. The dosimetric parameters of target volumes and organs at risk were evaluated, and the dosimetric characteristics of the two techniques were compared.Results:In terms of target volumes, the RO-IMPT group showed significantly lower D1%, Dmean, and homogeneity index (HI) and a significantly higher D99% of the CTV than those of the PTV in the VMAT group ( t=-8.96, -8.21, -8.13, 4.96, P<0.05). The NonRO-IMPT group showed significantly lower D1%, Dmean, and HI and a significantly higher conformity index of the PTV than those of the PTV in the VMAT group ( t=-7.75, -6.25, -6.11, 7.53, P<0.05). In terms of organs at risk, the two IMPT groups showed significantly lower values than the VMAT group for the V5- V30 and Dmean of the whole lungs, V5- V40 and Dmean of the heart, D1% and Dmean of the left anterior descending coronary artery, D1% of the spinal cord, Dmean of normal tissues, and Dmean of the skin ( t= -28.47 to -3.25, P<0.05). There was no significant difference in any other evaluation indices ( P>0.05). Conclusions:Both IMPT and VMAT can meet the clinical requirements of radiotherapy plans following breast-conserving surgery for bilateral breast cancer. IMPT has apparent advantages over VMAT in protecting organs at risk.

Objective To explore the changes in trabecular meshwork cell types and cellular communication patterns in primary open-angle glaucoma(POAG).Methods The POAG single-cell dataset GSE135337(including the trabecular meshwork samples of 3 cynomolgus macaque monkeys with POAG and 3 healthy cynomolgus macaque monkeys,data upda-ted to 2023)was downloaded from the Gene Expression Omnibus(GEO),two groups of samplesare named the POAG group and the control group.The downscaling,clustering,grouping,and visualization of data were performed using the Seurat package in R.The cellular communication pattern was analyzed by using the CellChat package in R to identify the differences in the cellular communication pattern between the POAG group and the control group.Meanwhile,the differen-tial gene analysis was performed based on the transcriptome sequencing(RNA-seq)dataset GSE27276(including the atrial horn tissue samples from 17 POAG patients and 19 healthy individuals,data updated to 2023)from the GEO to identify spe-cific cellular communication signaling changes.Results There were no significant differences in the cell types between the control group and the POAG group,including trabecular meshwork cells,macrophages,melanocytes,pericytes,Schlemm's canal cells,myelinating Schwann cells,nonmyelinating Schwann cells,smooth muscle cells,and vascular en-dothelial cells.There was a significant difference in the cellular communication intensity between the POAG group and the control group.The expression of macrophage migration inhibitory factor(MIF)-CD74,C-X3-C motif chemokine ligand 1(CX3CL1)-C-X3-C motif chemokine receptor 1(CX3CR1),and HBB in the POAG group was significantly up-regulated compared with the control group,while the expression of secreted phosphoprotein 1(SPP1)-(ITGA8+ITGB1),SPP1-(IT-GA4+ITGB1),IGF2-IGF2R,CCL8-CCR1,and CCL8/26/24/2-ACKR2 in the POAG group was significantly down-regulated compared with the control group.The RNA-seq analysis results confirmed that the expression levels of HBB,HBD,HBA,and CD74 were higher in the POAG group than in the control group.Conclusion The up-regulation of MIF-CD74 and the down-regulation of SPP1-(ITGA8+ITGB1)and SPP1-(ITGA4+ITGB1)in trabecular meshwork tissues may participate in the fibrotic process,which may be a potential pathogenic mechanism of POAG.

Objective:To evaluate the dosimetric characteristics of intensity-modulated proton therapy (IMPT) and photon volumetric modulated arc therapy (VMAT) in radiation therapy planning for patients with bilateral breast cancer after breast-conserving surgery.Methods:On the computed tomography localization images of 18 patients with bilateral breast cancer, target volumes and organs at risk were contoured to develop both IMPT and VMAT plans for each patient. Two IMPT plans were designed based on the clinical target volume (CTV) with robust optimization (RO-IMPT) and the planning target volume (PTV) without RO (NonRO-IMPT), respectively. The RO-IMPT, NonRO-IMPT, and VMAT plans were normalized such that the prescription dose could cover 95% of the target volume. The dosimetric parameters of target volumes and organs at risk were evaluated, and the dosimetric characteristics of the two techniques were compared.Results:In terms of target volumes, the RO-IMPT group showed significantly lower D1%, Dmean, and homogeneity index (HI) and a significantly higher D99% of the CTV than those of the PTV in the VMAT group ( t=-8.96, -8.21, -8.13, 4.96, P<0.05). The NonRO-IMPT group showed significantly lower D1%, Dmean, and HI and a significantly higher conformity index of the PTV than those of the PTV in the VMAT group ( t=-7.75, -6.25, -6.11, 7.53, P<0.05). In terms of organs at risk, the two IMPT groups showed significantly lower values than the VMAT group for the V5- V30 and Dmean of the whole lungs, V5- V40 and Dmean of the heart, D1% and Dmean of the left anterior descending coronary artery, D1% of the spinal cord, Dmean of normal tissues, and Dmean of the skin ( t= -28.47 to -3.25, P<0.05). There was no significant difference in any other evaluation indices ( P>0.05). Conclusions:Both IMPT and VMAT can meet the clinical requirements of radiotherapy plans following breast-conserving surgery for bilateral breast cancer. IMPT has apparent advantages over VMAT in protecting organs at risk.

Objective To explore the changes in trabecular meshwork cell types and cellular communication patterns in primary open-angle glaucoma(POAG).Methods The POAG single-cell dataset GSE135337(including the trabecular meshwork samples of 3 cynomolgus macaque monkeys with POAG and 3 healthy cynomolgus macaque monkeys,data upda-ted to 2023)was downloaded from the Gene Expression Omnibus(GEO),two groups of samplesare named the POAG group and the control group.The downscaling,clustering,grouping,and visualization of data were performed using the Seurat package in R.The cellular communication pattern was analyzed by using the CellChat package in R to identify the differences in the cellular communication pattern between the POAG group and the control group.Meanwhile,the differen-tial gene analysis was performed based on the transcriptome sequencing(RNA-seq)dataset GSE27276(including the atrial horn tissue samples from 17 POAG patients and 19 healthy individuals,data updated to 2023)from the GEO to identify spe-cific cellular communication signaling changes.Results There were no significant differences in the cell types between the control group and the POAG group,including trabecular meshwork cells,macrophages,melanocytes,pericytes,Schlemm's canal cells,myelinating Schwann cells,nonmyelinating Schwann cells,smooth muscle cells,and vascular en-dothelial cells.There was a significant difference in the cellular communication intensity between the POAG group and the control group.The expression of macrophage migration inhibitory factor(MIF)-CD74,C-X3-C motif chemokine ligand 1(CX3CL1)-C-X3-C motif chemokine receptor 1(CX3CR1),and HBB in the POAG group was significantly up-regulated compared with the control group,while the expression of secreted phosphoprotein 1(SPP1)-(ITGA8+ITGB1),SPP1-(IT-GA4+ITGB1),IGF2-IGF2R,CCL8-CCR1,and CCL8/26/24/2-ACKR2 in the POAG group was significantly down-regulated compared with the control group.The RNA-seq analysis results confirmed that the expression levels of HBB,HBD,HBA,and CD74 were higher in the POAG group than in the control group.Conclusion The up-regulation of MIF-CD74 and the down-regulation of SPP1-(ITGA8+ITGB1)and SPP1-(ITGA4+ITGB1)in trabecular meshwork tissues may participate in the fibrotic process,which may be a potential pathogenic mechanism of POAG.

Objective:To evaluate the impact of implementing a regional hierarchical medical management model based on the medical internet of things (medical IoT) on the frequency of emergency department visits and hospitalizations, as well as related medical expenses, in patients with chronic obstructive pulmonary disease (COPD).Methods:This retrospective study included COPD patients enrolled in the regional hierarchical medical management system based on Medical IoT across 21 community health service centers in Songjiang District, Shanghai, between July 2017 and May 2018. Utilizing patient data from the year prior to enrollment as the baseline, changes in the number of emergency visits, hospitalizations, and associated medical costs during the first and second years of management were compared. Changes for patients receiving drug treatment were also analyzed.Results:A total of 973 COPD patients were enrolled. The mean age was 75.2±17.0 years, and 64.34% (626/973) were male. Compared to baseline, all COPD patients in the first year of management showed significant reductions: emergency visits decreased by 33.67%, total emergency costs by 45.60%, hospitalizations by 27.15%, and total hospitalization costs by 25.42%. In the second year, reductions were: emergency visits by 28.08%, total emergency costs by 36.10%, hospitalizations by 35.26%, and total hospitalization costs by 18.13% (all P<0.05). Among patients receiving drug therapy, reductions in the first year were: emergency visits by 39.66%, total emergency costs by 47.54%, hospitalizations by 25.19%, and total hospitalization costs by 28.40%. In the second year, reductions were: emergency visits by 46.98%, total emergency costs by 45.99%, hospitalizations by 41.98%, and total hospitalization costs by 24.94% (all P<0.05). No significant differences were observed before and after management for patients without drug treatment. Conclusion:The implementation of the regional hierarchical medical management model based on Medical IoT significantly reduced the frequency of emergency visits and hospitalizations, as well as related costs, for COPD patients.

OBJECTIVE To explore the mechanism of improvement effect of Chanbao zhichuang suppository(CBZCS)on hemorrhoids in rats through network pharmacology and metabolomics.METHODS A hemorrhoid model was established by subcutaneous injection of rhododendron oil to induce anal swelling.SD rats were divided into blank group(NC group,0.32 g/kg vaseline),model group(Model group,0.32 g/kg vaseline),CBZCS low-,medium-,and high-dose groups(CBZCS-L,CBZCS-M,CBZCS-H groups,with dosages of 0.16,0.32,and 0.64 g/kg respectively),and Mayinglong musk hemorrhoids suppository group(Positive group,0.32 g/kg),with 9 rats in each group.Anal administration was performed at 6,12,24,48,and 72 hours after modeling.After the last administration,the pathological changes of the anal tissues in rats were observed,and the serum levels of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in rats were detected.Differential metabolite analysis and enrichment analysis were conducted by metabolomics methods,and the target proteins of CBZCS in treating hemorrhoids were obtained by network pharmacology.The core metabolic pathways were screened by interaction and enrichment analysis of differential metabolites and proteins,and the core proteins were experimentally verified.RESULTS Compared with the NC group,the anal tissues of the Model group showed obvious lesions,and the levels of IL-6 and TNF-α in the serum were significantly increased(P＜0.05);compared with the Model group,the pathological damage of the anal tissues in the treatment groups was alleviated to varying degrees,and serum levels of IL-6 in CBZCS-H group,CBZCS-M group,and Positive group as well as serum levels of TNF-α in CBZCS-H group were significantly reduced(P＜0.05).The metabolomics results showed that 34 differential metabolites were screened from the anal tissues of rats,and 22 of them showed a return after CBZCS administration.The differential metabolites mainly enriched in arachidonic acid metabolism,histidine metabolism,and glycerophospholipid metabolism.Through the network pharmacology,138 intersection genes of CBZCS against hemorrhoids were determined.The analysis results showed that differential metabolites and target proteins were mainly enriched in the arachidonic acid metabolism pathway,and the regulation of this pathway might be related to cyclooxygenase-2(COX-2),Myc proto-oncogene protein(c-MYC),cytochrome P450 1B1(CYP1B1),interleukin-1β(IL-1β),and IL-6 protein expression.The experimental verification results showed that the expression levels of key proteins(COX-2,c-MYC,CYP1B1,IL-6,IL-1β)in the anal tissues of the Model group were significantly higher than those in the NC group(P＜0.05),and the levels of the above proteins in the anal tissues of CBZCS-H group and Positive group were significantly lower than those in the Model group(P＜0.05).CONCLUSIONS The mechanism of CBZCS in treating hemorrhoids may be to inhibit the expression of COX-2,c-MYC and CYP1B1 proteins,thereby inhibiting arachidonic acid metabolism and reducing the release of inflammatory factors IL-6 and IL-1β.

In China, the survival rate of liver cancer remains low while the mortality rate is high. Effectively reducing the burden of liver cancer is still a major challenge in the field of public health and chronic disease prevention in the Chinese population. Optimizing screening strategies for liver cancer remains a profound approach to secondary prevention worthy of continuous exploration. To address this pressing issue, the Bureau of Disease Control and Prevention of the National Health Commission commissioned this guideline. The National Cancer Center of China initiated the guideline development and convened a multidisciplinary expert panel and working groups. Following the World Health Organization Handbook for Guideline Development, this guideline integrated the most up-to-date evidence of liver cancer screening, China′s national conditions, and existing practical experience in liver cancer screening. Evidence-based recommendations on the target population, screening technologies, surveillance strategies, and other key points across the process of liver cancer screening and surveillance management were provided. This guideline would help standardize the practice of liver cancer screening in China.

In China, the survival rate of liver cancer remains low while the mortality rate is high. Effectively reducing the burden of liver cancer is still a major challenge in the field of public health and chronic disease prevention in the Chinese population. Optimizing screening strategies for liver cancer remains a profound approach to secondary prevention worthy of continuous exploration. To address this pressing issue, the Bureau of Disease Control and Prevention of the National Health Commission commissioned this guideline. The National Cancer Center of China initiated the guideline development and convened a multidisciplinary expert panel and working groups. Following the World Health Organization Handbook for Guideline Development, this guideline integrated the most up-to-date evidence of liver cancer screening, China's national conditions, and existing practical experience in liver cancer screening. Evidence-based recommendations on the target population, screening technologies, surveillance strategies, and other key points across the process of liver cancer screening and surveillance management were provided. This guideline would help standardize the practice of liver cancer screening in China.