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）］

Background Prenatal chronic psychological stress may increase the risk of allergic diseases in children, and eczema is the most common allergic disease in children, the pathogenesis of which is not yet fully understood. Objective To preliminarily clarify the changes in offspring intestinal flora after chronic stress exposure during pregnancy in rats that increases offspring immune imbalance and eczema susceptibility. Methods Thirty SPF-grade adult female SD rats were selected and randomly divided into a model group and a control group (n=15). Sixteen male rats were randomly divided into a model mating group and a control mating group (n=8). A 28-day chronic unpredictable mild stress (CUMS) model during pregnancy was established. On the 7th day of stress, male and female rats were caged in a ratio of 3:1. Blood samples were collected from female rats in each group via angular vein on the 1st day before stress, and on the 7th, 14th, 21st, and 28th days after stress. The content of plasma corticosterone during pregnancy was determined by enzyme-linked immunosorbent assay (ELISA). For the offspring rats, an eczema model was constructed using 2,4-dinitrochlorobenzene (DNCB). The number of scratching times of the offspring rats within 5 min was recorded. The offspring rats were divided into 4 groups: DNCB-CUMS group (MM), DNCB-control group (MC), solvent control-CUMS group (CM), and blank control group (CC), with 8 rats in each group. The eczema was induced once every 3 days, and the induction period was 12 d. The expression level of immunoglobulin E (IgE) in the serum of offspring rats after the eczema induction experiment were determined by ELISA. The concentrations of tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), interleukin-2 (IL-2), interleukin-4 (IL-4), and interleukin-13 (IL-13) in the serum were quantified by multi-parameter flow cytometry. The composition and abundance of intestinal microbiota in the feces of offspring rats were detected by 16S rRNA high-throughput sequencing technology. Results The plasma corticosterone concentrations in the model group were higher than those in the control group on the 7th and 21st days of stress (P<0.05). On the 14th and 21st days of stress, the 1% sucrose preference percentages of female rats in the model group were lower than that in the control group. On the 7th, 14th, and 21st days of stress, the horizontal movement scores of female rats in the model group and the vertical movement scores on the 7th and 14th days were lower than those in the control group (P<0.05). After 6, 9, and 12 d of model building, the scratching frequencies in the MC group and MM group were significantly higher than those in the CC group and CM group (P<0.05). Moreover, there were differences in the contents of cytokines including IFN-γ, IL-2, TNF-α, IL-4, IL-13, and IgE among the offspring rat groups (P<0.05). The CM group and MM group led to an increase in the contents of TNF-α, IL-4, IL-13, and IgE cytokines (P<0.05), while the MM group caused a decrease in the contents of IFN-γ and IL-2 (P<0.05). After the eczema induction experiment, the α-diversity analysis showed that the Simpson index and Shannon index in the CM were higher than those in the CC (P<0.05), indicating that CUMS during the pregnancy of female rats could increase the species abundance of their offspring. The abundances of Prevotella and Lactobacillus in the CM group decreased (P<0.05). Conclusion Intestinal dysbiosis in offspring due to chronic prenatal psychological stress, which may be one of the mechanisms linking maternal stress to immune imbalance and increased susceptibility to eczema in offspring.

Objective: To understand the indoor light at night (LAN) exposure intensity during sleep among children and adolescents in Shanghai, so as to provide a basis for exploring potential health risks and formulating effective interventions. Methods: From April to December in 2024, a total of 628 students in grades 4-7 were recruited from three schools in Shanghai. A portable illuminance meter was used to measure LAN for one week, and participants recorded their sleep time. The Kruskal-Wallis H- test was used for comparison between groups, and the error bar chart was used to show the trend and variation range of average LAN exposure intensity in different sleep periods. Results: The indoor LAN exposure intensity of children and adolescents in Shanghai was [2.4(0.8, 5.9)lx] during sleep, and 28.8% of children and adolescents were exposed to indoor LAN≥5 lx. There was no significant differences in indoor LAN exposure intensity between boys [2.4(1.0, 5.9)lx] and girls [2.3(0.7, 5.9)lx] ( Z=-0.86, P > 0.05 ). The indoor LAN exposure intensity of primary school students [2.9(1.1, 6.6)lx] was higher than that of junior high school students [1.0(0.3, 3.1)lx] ( Z =-5.87), and indoor LAN exposure intensity of students in the main urban area [3.2(1.1, 7.8)lx] was higher than that of rural students [1.6(0.5, 4.3)lx] ( Z =-5.23)(both P <0.05). The indoor LAN exposure intensity showed an overall decreasing trend during sleep of children and adolescents ( tau=-0.81, P =0.02), with a slight increase before waking up. Conclusions Indoor LAN exposure intensity among children and adolescents in Shanghai is generally high, especially among primary school students and students living in the main urban area. Health policy and education should be strengthened to reduce the impact of LAN on children and adolescent health.

Objective To analyze the clinical application of the Donabedian-based structure-process-result three-dimensional quality evaluation model for the prevention of stress injury in bone tumor surgery.Methods A total of 284 patients with bone tumor who were admitted to The Second Affiliated Hospital of Naval Medical University from January 2022 to December 2023 were enrolled and assigned to two groups according to the random number table.The control group received routine nursing.In the observation group,the Donabedian-based structure-process-result three-dimensional quality evaluation model was applied to prevent the stress injury in bone tumor surgery.The indexes of the two groups were compared and analyzed.Results Before intervention,there was no significant difference in scores between the two groups(P>0.05).After intervention,the scores of stress injury behavior,skill and knowledge in the observation group were higher than those in the control group(P<0.05).The incidence of stress injury in the observation group was lower than that in the control group(P<0.05).There was significant difference in nursing satisfaction between the two groups(P<0.05).Conclusion Donabedian-based structure-process-result three-dimensional quality evaluation model can not only enhance the self-care ability of the patients undergoing bone tumor surgery,but also prevent stress injury,thus improving patient satisfaction.

Objective To investigate the impact of the precision health management model on liver fibrosis,adipocytokines,and metabolic indicators in patients with non-alcoholic fatty liver dis-ease(NAFLD).Methods A total of 600 NAFLD patients were selected as study subjects and divid-ed into conventional group and precision group according to different intervention methods,with 300 patients in each group.The conventional group received routine health management,while the preci-sion group received intervention through the precision health management model.Comparisons were made between the two groups in terms of obesity indicators[waist-to-hip ratio(WHR),body mass in-dex(BMI),body fat rate(BFR),degree of obesity],fatty liver grading,liver stiffness measure-ment(LSM),and liver fibrosis indicators[laminin(LN),type Ⅳ collagen(C Ⅳ),hyaluronic acid(HA),type Ⅲ procollagen(PC Ⅲ)],hepatic adipocytokines[nuclear factor-κB(NF-κB),adi-ponectin(APN),irisin,tumor necrosis factor-α(TNF-α)],and lipid metabolism indicators[tri-glycerides(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),total cholesterol(TC)]levels.Results After the intervention,the levels of WHR,BFR,BMI,degree of obesity,LSM,as well as LN,C Ⅳ,HA,PC Ⅲ,NF-κB,TNF-α,TG,LDL-C,and TC in both groups were lower than those before the intervention,and the precision group showed lower levels than the conventional group,with statistically significant differences(P＜0.05).After the intervention,the fatty liver grading in both groups was better than before intervention,and the precision group showed better fatty liver grading than the conventional group,with statistically signif-icant differences(P＜0.05).After the intervention,the levels of APN,irisin,and HDL-C in both groups were higher than those before the intervention,and the precision group showed higher levels than the conventional group,with statistically significant differences(P＜0.05).Conclusion The precision health management model can effectively improve the degree of obesity,fatty liver grading,and liver fibrosis status in NAFLD patients,reduce LSM,and regulate the levels of adipocytokines and lipid metabolism indicators,yielding significant effects.

OBJECTIVE To explore the effect and mechanism of the alcoholic extract from Scabiosa comosa against hepatic fibrosis （HF）. METHODS Intragastrical administration of carbon tetrachloride was given to induce HF model. By observing the pathological changes in liver tissue， mRNA and protein expressions of HF indexes [α-smooth muscle actin （α-SMA）， collagen type Ⅰ] and phosphoinositide 3-kinase （PI3K）/protein kinase B （Akt） pathway-related factors were detected， and the improvement effects and possible mechanism of low-dose， medium-dose and high-dose （50， 100， 200 mg/kg） of alcoholic extract from S. comosa on HF model rats were investigated. Drug-containing serum was prepared by intragastrical administration of alcoholic extract from S. comosa at a concentration of 1 800 mg/（kg·d） （calculated by the amount of raw material）. The effects of drug- containing serum of alcoholic extract from S. comosa on the expression of miRNA-21 were observed through the intervention of HSC-T6 cells with low， medium and high concentrations of drug-containing serum of alcoholic extract from S. comosa （diluted to 10%， 15%， 20%）. miRNA-21 mimics or inhibitors were used to transfect HSC-T6 cells， and the mRNA and protein expressions of factors related to the PI3K/Akt signaling pathway were detected. RESULTS The results of in vivo experiments showed that low， medium and high doses of alcoholic extract from S. comosa significantly ameliorated the histopathological changes in liver tissue of HF rats， and the percentage of collagen was significantly reduced （P＜0.01）； mRNA and protein expressions of the indicators related to HF as well as PI3K and Akt were significantly reduced （P＜0.01）， and mRNA and protein expressions of phosphatase and tensin homolog deleted on chromosome ten （PTEN） were increased in liver tissue of rats （P＜0.01）. The results of in vitro experiments showed that drug-containing serum of alcoholic extract from S. comosa significantly inhibited the expression of miRNA-21 at low， medium and high concentrations （P＜0.01）； whereas after transfection with miRNA-21 mimics， it was found that miRNA-21 mimics significantly increased mRNA and protein expressions of PI3K and Akt （P＜0.01）， while significantly decreased mRNA and protein expressions of PTEN （P＜0.01）； after transfection with miRNA-21 inhibitor， the changes of above indexes were opposite to the above results （P＜0.01）. CONCLUSIONS Alcoholic extracts of S. comosa may inhibit the PI3K/Akt signaling pathway by affecting the expression of miRNA-21， so as to achieve the effect of anti-hepatic fibrosis.

Abstract Airborne microorganisms, especially pathogenic microorganisms, are easily transmitted through dust and droplets, leading to various infectious diseases. The study summarizes the status of airborne microbial pollution, potential exposure levels, particle size, and species distribution of microorganisms, discusses the impact of airborne microorganisms on human health, and analyzes specific factors affecting campus air microorganisms from four aspects:climate, anthropogenic factors, time, and space, to provide a scientific basis for formulating effective improvement measures, improving air quality and safeguarding the health of teachers and students.

Objective To explore the application value of telmisartan combined with calcium dobesilate in patients with non-dipper hypertension complicated with type 2 diabetes mellitus(T2DM).Methods A total of 260 patients with non-dipper hypertension complicated with T2DM in the endocrinology department of our hospital were selected in this study from January 2021 to December 2022.All the patients were randomly divided into telmisartan group(Tel,n=110)and telmisartan+calcium dobesilate group(Tel+Cal-dob,n=150).The blood pressure level,blood pressure rhythm changes,brachial flow mediated dilatation(FMD),carotid radial pulse wave velocity(crPWV),vasomotor factors[nitric oxide(NO),endothelin-1(ET-1),vascular endothelial growth factor(VEGF)]and the incidence of adverse reactions were compared between the two groups.Results There was no significant difference in general data and biochemical indexes between the two groups(P>0.05).After 3,6 and 12 months of treatment,the FMD and NO were higher,while the dSBP,dDBP,24 hSBP,24 hDBP,nSBP,nDBP,crPWV,ET-1 and VEGF were lower than before treatment in both groups(P<0.05).After 3,6 and 12 months of treatment,the FMD and NO were higher,while dSBP,dDBP,24 hSBP,24 hDBP,nSBP,nDBP,crPWV,ET-1 and VEGF were lower in Tel+Cal-dob group than in Tel group(P<0.05).After 3,6 and 12 months of treatment,the conversion rates of dipper blood pressure were higher in Tel+Cal-dob groupthan in Tel group(P<0.05).There was no significant difference in the incidence of adverse effects between the two groups(P>0.05).Conclusion Telmisartan combined with calcium dobesilate is effective in the treatment of patients with non-dipper hypertension complicated with T2DM.

Objective:To investigate the effects of dexmedetomidine and urapidil on postoperative extubation stress response, postoperative shivering, and cerebral oxygen metabolism in patients with hypertensive intracerebral hemorrhage.Methods:A total of 120 patients with hypertensive intracerebral hemorrhage admitted to the Seventh People′s Hospital of Hebei Province from January 2021 to December 2022 were selected as the research subjects. They were randomly divided into an observation group (60 cases) and a control group (60 cases) according to the random number table method. All patients underwent intracranial hematoma removal surgery under general anesthesia combined with bone flap decompression surgery for treatment. The observation group patients received sedation and analgesia with dexmedetomidine and urapidil after surgery, while the control group patients received sedation and analgesia with dexmedetomidine after surgery. The differences in vital signs, stress indicators, cerebral oxygen and cerebral glucose metabolism, and adverse reactions between two groups of patients were compared.Results:There was no statistically significant difference in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and bispectral index (BIS) between the two groups after entering the room (T 0) and before anesthesia medication (T 1) (all P>0.05). The HR, SBP, DBP, and BIS of the observation group were significantly lower than those of the control group at extubation (T 2), immediately after extubation (T 3), 1 minute after extubation (T 4), and 3 minutes after extubation (T 5), and the differences were statistically significant (all P<0.05). There was no statistically significant difference in various stress indicators between the two groups of patients at T 0 (all P>0.05), while the stress indicators of the observation group were significantly lower than those of the control group at T 5 (all P<0.05). There was no statistically significant difference in the cerebral oxygen uptake rate (CERO 2) and cerebral arteriovenous blood glucose difference (AVDG) between the two groups of patients at T 0 (all P>0.05), while the CERO 2 and AVDG in the observation group at T 5 were significantly higher than those in the control group (all P<0.05). There was no statistically significant difference in the incidence of hypoxemia, hypotension, and bradycardia between the two groups of patients after surgery (all P>0.05). The incidence of postoperative shivering in the observation group was lower than that in the control group ( P<0.05). The Glasgow Coma Index of both groups of patients after surgery was higher than that before surgery (all P<0.05), and there was no statistically significant difference in Glasgow Coma Index between the two groups before and after surgery (all P>0.05). Conclusions:Dexmedetomidine and Urapidil have significant improvement effects on postoperative extubation stress response, postoperative shivering, and cerebral oxygen metabolism in patients with hypertensive intracerebral hemorrhage. It is recommended to promote them clinically.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.