Objective: To construct an evaluation index system for emergency response capability of public health emergency responders at municipal and district levels in Shanghai, so as to provide a tool for capability assessment and team building of emergency responders. Methods: The framework of the evaluation indexe system for emergency response capability of public health emergency responders at municipal and district levels in Shanghai were preliminarily established through literature retrieval, policy review and research group discussion. The Delphi method was used to invite experts in the fields of emergency management, disease prevention and control or public health to participate in the consultation, and the index system was determined. The quality of the consultation was evaluated using the expert positive coefficient, authority coefficient and degree of coordination. The analytic hierarchy process was used to determine the weights of the first- and second-level indexes, and the percentage weight method was used to determine the weights of the third-level indexes. Results: A total of 20 experts participated in the consultation, including 12 males and 8 females. Sixteen experts had a master's degree or above. The mean years of practice was (16.50±5.24) years. The response rates of the two rounds of expert consultation questionnaires were 100.00% and 95.00%, respectively. The expert authority coefficient was 0.86±0.07, and Kendall's coefficients of concordance were 0.161-0.247 and 0.314-0.585, respectively (all P<0.05). The constructed evaluation index system for emergency response capability of public health emergency responders at municipal and district levels in Shanghai included 4 first-level indexes: "emergency preparedness capability" (0.193 1), "monitoring and early warning capability" (0.263 9), "emergency response capability" (0.392 3) and "emergency recovery capability" (0.150 8). Among the 15 second-level indexes, "on-site investigation" (0.084 7) and "emergency response" (0.080 5) ranked the top two in combined weight. Among the 59 third-level indexes, there were 42 common indexes, 12 municipal-level specific indexes and 5 district-level specific indexes. Conclusions The expert consultation in this study showed good expert positivity and authority. The constructed evaluation index system takes into account both the common capabilities and differentiated functional needs of public health emergency responders at municipal and district levels in Shanghai, and can provide a tool for evaluating the emergency response capability of public health emergency responders at municipal and district levels in Shanghai.

Objective To establish a sandwich enzyme-linked immunosorbent assay (ELISA) method for the quantitative detection of Chromogranin A (CHGA) in saliva, and to explore its preliminary application in the testing of saliva samples. Methods Recombinant human CHGA protein was used to immunize BALB/c mice, and monoclonal antibodies (mAbs) were prepared and screened using conventional hybridoma technology. A double-antibody sandwich ELISA detection method was constructed, and the matrix effect of saliva samples was optimized. This method was then applied to detect the concentration of CHGA in the saliva of stressed individuals. Results Twenty-one stable hybridoma cell lines secreting high affinity anti-human CHGA antibodies were obtained. A pair of detection antibodies with the best effect was selected, and the optimal coating concentration was determined to be 10 μg/mL, with the optimal dilution of detection antibodies being 1:32 000. The accuracy and reproducibility of this method were verified, with both intra-batch and inter-batch variation coefficients less than 15×, and the recovery rate between 80× and 120×. The matrix effect was further optimized to make it suitable for saliva sample detection. Saliva samples from individuals in different stress states were collected, and the CHGA levels were detected using the method established in this study, indicating its potential to reflect the intensity of stress. Conclusion A reliable saliva CHGA ELISA detection method has been successfully established, and its potential as a biomarker in stress-related research has been preliminarily explored.
Saliva/metabolism* ; Enzyme-Linked Immunosorbent Assay/methods* ; Humans ; Animals ; Mice, Inbred BALB C ; Mice ; Chromogranin A/immunology* ; Antibodies, Monoclonal/immunology* ; Female ; Male ; Reproducibility of Results ; Adult

Objective To compare the efficacy and safety of different cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) combined with endocrine therapy (ET) for the treatment of hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) advanced or metastatic breast cancer. Methods Randomized controlled trials (RCTs) on CDK4/6i for the treatment of HR+/HER2− metastatic or advanced breast cancer were retrieved from databases including PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, Wanfang, VIP, and SinoMed, with the search period ranging from database inception to August 2023. Bayesian network meta-analysis was conducted using R 4.2.0 software. Results A total of 18 RCTs from 25 articles, involving 8 031 patients and 11 treatment regimens, were included. There was no significant difference in progression-free survival (PFS) or overall survival (OS) among different CDK4/6i+ET combinations. The highest cumulative probability for PFS was observed with dalpiciclib (DAL)+fulvestrant (FUL), while ribociclib (RIB)+FUL ranked first for OS. In terms of efficacy, abemaciclib (ABE)+aromatase inhibitors (AI) and ABE+FUL ranked first in objective response rate and clinical benefit rate, respectively. Regarding safety, statistically significant difference in grade 3-4 adverse events was observed among certain types of CDK4/6i (P<0.05). Conclusion Current evidence suggests that CDK4/6i+ET is superior to ET alone for the treatment of HR+/HER2− advanced/metastatic breast cancer. Different CDK4/6i+ET combinations demonstrate comparable or similar efficacy; however, the incidence of adverse reactions is higher with combination therapy. Treatment regimens should be selected based on individual conditions.

Objective:To explore the employment experiences of coordinators of In-Hospital Organ Procurement Organization (OPO).Methods:Based on purpose sampling, 12 full-time In-Hospital OPO coordinators in Chongqing City were recruited from July to December 2020. A semi-structured and in-depth interview was performed and the data was analyzed by Colaizzi.Results:4 first-level themes were extracted, including professional identity process, negative emotional experience, improvement of professional practice competence and job expectancy. 12 second-level themes were identified including career expectations and identity confusion, professional values, shortage of respect and ratification, huge workloads, great psychological pressure, influence of the bereaved families, enhancement of the ability to communicate, improvement of problem-solving ability, improvement of team-work ability, optimization of scenario simulation, a perfection of the assessment system, a clear career path.Conclusions:In-Hospital OPO coordinators are lack of professional awareness in an initial stage. While feeling a sense of professional value, they also experience some negative emotions. Furthermore, their competences are improved in practice and they, meanwhile, express a strong desire for career development. It is suggested that the administrators could explore establishment of academic education, enhancement of psychological and social support, creation of pretty working environments and improvement of training, assessment and promotion systems to facilitate the career development of coordinators.

Objective:To differentiate the methamphetamine users according to the developmental stages of addictive behavior, and explore the characteristics of different stages in order to provid a theoretical reference for our clinical intervention.Methods:Take the male methamphetamine users in compulsory detoxification institute whom were admitted from September 2018 to December 2019 as research objects.All the objects were asked to complete clinical diagnosis, interview and questionnaire evaluation in one week.According to the developmental stages of addictive behavior, the subjects were divided into occasional use group ( n=51), regular use group ( n=95) and compulsive use group ( n=157).All subjects were evaluated using visual analogue scale(VAS), Barrett impulsiveness scale(BIS)and CogState scale.SPSS 20.0 software was used for statistical analysis, AVOVA or Kruskal-Wallis H test was used for group comparison.Multiple Logistic regression analysis was used to explore the factors associated with the development of addictive behavior. Results:(1)The compulsive use group had higher cumulative duration(24(8, 48), 12(4, 24), 22(10, 36)), average dose(6.6±3.8, 2.8±1.4, 4.5±3.4) and craving score(1(0, 5), 0(0, 1), 1(0, 3)) than the other two groups(all P<0.05).And individuals in compulsive use group had more previous heroin use experience(20.4%, 9.8%, 14.8%, P<0.05).The regular use group had more withdrawal times than the other two groups(1(1, 3), 1(0, 1), 1(1, 2), P<0.05).The total scores of Barrett impulsiveness scale(42.8±13.3, 34.5±13.6, 36.1±14.9) and the scores in all dimensions in the compulsive use group were significantly higher than those in the other two groups(motor impulsiveness: 37.5±15.8, 27.8±13.4, 29.2±17.8; attentional impulsiveness: 43.2±18.0, 39.4±17.0, 37.2±18.1; non-planning impulsiveness: 47.2±19.8, 38.8±18.7, 40.7±20.8; P<0.05) .In the compulsive use users, the ISL(16.50±4.87, 19.30±4.78, 18.33±4.91) and SEC(0.76±0.21, 0.89±0.22, 0.81±0.21) scores about cognitive assessment were significantly lower than other two groups(both P<0.05).(2)The results of multiple Logistic regression analysis showed that cumulative duration ( β=0.022, OR=1.022, 95% CI: 1.003-1.042), dosage( β=0.625, OR=1.869, 95% CI: 1.196-2.921), craving ( β=0.194, OR=1.214, 95% CI: 1.002-1.215), the total scores of Barrett impulse scale( β=0.036, OR=1.037, 95% CI: 1.013-1.061), scores of non-planning impulsiveness( β=0.040, OR=1.041, 95% CI: 1.004-1.038), scores of motor impulsiveness( β=0.033, OR=1.214, 95% CI: 1.001-1.068) were associated with the periodic grouping of addictions. Conclusions:Addictive behavior is a progressive process and methamphetamine users at different stages have different characteristics in substance use, impulsiveness and cognitive function.The development of addictive behavior is associated with the time, dosage and craving of substance use, as well as the personality impulsivity of users.And the compulsive users suffered more cognitive impairment than the other two groups. The methamphetamine users should be identified dynamically and targeted therapeutic intervention measures should be carried out to block the addictive process to achieve the goal of harm reduction.

Objective:To study the clinical characteristics and compliance of early-onset gout patients by case-control analysis.Methods:A total of 111 early-onset patients (onset age ≤35 years old) were included as Group A, and 111 non-early-onset patients (onset age >35 years old) with matched disease durationwere included as Group B. The differences ofclinical characteristics, causes of acute gout attack, dairy diet habits, compliance, and misunderstanding of the disease were compared.Results:Compared with the non-early-onsetgoutpatients, the early-onset patients had a higher proportion of obesity (63 cases vs 28 cases), family history (36 cases vs 20 cases) and tophus (39 cases vs 23 cases) and higher level of VAS scores (8.5±1.3 vs 7.6±1.7; χ2=22.988, P<0.01; χ2=5.749, P=0.016; χ2=5.729, P=0.017; t=4.639, P<0.01), lowerproportionof the first metatarsophalangeal joint involvement as the initial joint involvement (45.9%, 51 cases vs 59.4%, 66 cases; χ2=4.066, P=0.044), higher proportion of the ankle involvement as the initial joint involvement (34.2%, 38 cases vs 21.6%, 24 cases; χ2=4.386, P=0.036), higher proportion of alcohol drinkers and high fructose drinkers, which was more likely to relate to alcohol intake, strenuous exercise and high fructose intakeas trigger of the flare ( χ2=6.513, P=0.011; χ2=7.126, P=0.008; χ2=1.978, P=0.160), while the proportion of regular exercisers and on diet in the family was lower ( χ2=22.887, P<0.01; t=-4.917, P<0.01). The proportion of poor diet and medication compliance in Group A was higher than that in Group B(57.7%, 64 cases vs 38.7%, 43 cases; χ2=5.207, P=0.022; χ2=5.867, P=0.015). As for the reason for poor treatment compliance, early-onset gout patients were more worry about the side-effects of drugs than non-early onset patients ( χ2=4.190, P=0.041). There was no significant difference between the two groups in the main misunderstanding of gout. Conclusion:Although early onset gout patients are young, their condition is more serious, and compliance is poorer, this group of patients should be highly valued in clinical diagnosis and treatment.

In the field of medical education, Ethiopia has made a great progress in recent years. After systematical inquiry of Ethiopia's clinical medical education, this paper elaborates the mode of undergraduate teaching in Ethiopia from aspects of curriculum design, emphasis of contents, teaching methods and assessment methods, and also introduces the development and continuing education of Ethiopian medical students after graduation. Moreover, the "Innovative Track" clinical medical education reform proposed by Ethiopia recently is introduced as well. Therefore, characteristics and advantages of clinical teaching in Ethiopia indicate that in the process of deepening the medical education reform in China, we should learn from different countries. In this way, the development of medical education in China can be promoted better and faster.

Objective To analyze the clinical characteristics of liver injury related to edaravone in treating patients with acute ischemic stroke (AIS). Methods Among the AIS patients treated with edaravone in Vascular Surgery ICU of Xuanwu Hospital Capital Medical University from January 2014 to October 2017,9 patients were diagnosed as having liver injury associated with edaravone by active monitoring. The total number of patients treated with edaravone at the same period in Vascular Surgery ICU were obtained from the hospital information system and the incidence of liver injury associated with edaravone was calculated. The clinical data of the 9 patients were collected and analyzed retrospectively. Results The incidence of liver injury associated with edaravone was 8.7% (9/103 ). The 9 patients included 6 males and 3 females. The age of the patients was 52-83 years and their average age was (65 ± 6)years. The time for the occurrence of liver injury was 3-9 days and the average time was (6 ± 2)days. The main manifestations of liver injury were increase of alanine aminotransferase (9 cases),aspartic aminotransferase (7 cases),alkaline phosphatase (4 cases),total bilirubin (2 cases),and accompanied by rash in 1 case. Using RUCAM scale,7 patients were classified as ＂highly probable＂ and 2 patients were classified as＂probable＂. Using ＂Grade of DILI severity＂＂ standard,all the 9 patients were diagnosed as ＂mild liver injury＂. After 4-13 days of edaravone withdrawal,8 patients had normal liver function and 1 case improved. Conclusions Edaravone might cause liver injury,mainly manifesting liver dysfunction. The degree of liver injury was mild,and the prognosis was good after timely intervention.

Objective To analyze the clinical characteristics of liver injury related to edaravone in treating patients with acute ischemic stroke (AIS). Methods Among the AIS patients treated with edaravone in Vascular Surgery ICU of Xuanwu Hospital Capital Medical University from January 2014 to October 2017,9 patients were diagnosed as having liver injury associated with edaravone by active monitoring. The total number of patients treated with edaravone at the same period in Vascular Surgery ICU were obtained from the hospital information system and the incidence of liver injury associated with edaravone was calculated. The clinical data of the 9 patients were collected and analyzed retrospectively. Results The incidence of liver injury associated with edaravone was 8.7% (9/103 ). The 9 patients included 6 males and 3 females. The age of the patients was 52-83 years and their average age was (65 ± 6)years. The time for the occurrence of liver injury was 3-9 days and the average time was (6 ± 2)days. The main manifestations of liver injury were increase of alanine aminotransferase (9 cases),aspartic aminotransferase (7 cases),alkaline phosphatase (4 cases),total bilirubin (2 cases),and accompanied by rash in 1 case. Using RUCAM scale,7 patients were classified as ＂highly probable＂ and 2 patients were classified as＂probable＂. Using ＂Grade of DILI severity＂＂ standard,all the 9 patients were diagnosed as ＂mild liver injury＂. After 4-13 days of edaravone withdrawal,8 patients had normal liver function and 1 case improved. Conclusions Edaravone might cause liver injury,mainly manifesting liver dysfunction. The degree of liver injury was mild,and the prognosis was good after timely intervention.

OBJECTIVE: To investigate the toxic effects of four different kinds of aluminum compounds in rat adrenal-derived pheochromocytoma cell PC12. METHODS: PC12 cells at logarithmic growth phase were treated with four different kinds of aluminum compounds: aluminum maltolate( concentration was 0. 0,0. 1,0. 2,0. 4,0. 8 mmol / L),aluminum chloride( concentration was 0. 0,1. 0,2. 0,4. 0,8. 0 mmol/L),aluminum citrate( concentration was 0. 0,1. 0,2. 0,4. 0,8. 0mmol / L) and aluminum lactate( concentration was 0. 0,2. 0,4. 0,8. 0,16. 0 mmol / L) for 24 hours,respectively. The cell viability was determined with CCK-8 assay,and the apoptotic rate was detected by flow cytometry. RESULTS: All of the aluminum compounds suppressed the cell viability and increased apoptosis( P < 0. 01). Most of the effects were in a dose dependent manner. Comparing with the control,the minimum effective concentration of aluminum maltolate,aluminium chloride,aluminum citrate and aluminum lactate were 0. 2,2. 0,2. 0 and 4. 0 mmol / L,respectively,in cell viability( P < 0. 05); and 0. 1,2. 0,1. 0 and 2. 0 mmol/L in cell apoptosis( P < 0. 05). The 24 hours 50% inhibitory concentration of the above four aluminum compounds were( 0. 45 ± 0. 01),( 4. 02 ± 0. 39),( 5. 37 ± 0. 88) and( 6. 31 ±0. 58) mmol / L,respectively. CONCLUSION: Treatment of all four aluminum compounds had reduced cell viability and increased the percentage of cell apoptosis in a dose-dependent manner in PC12 cells. The best dose-response relation was observed in aluminum maltolate treatment group,and a relatively low dose of it was required in in-vitro toxicology study.Therefore,aluminum maltolate posed to be better reagent than the other three for in-vitro aluminum toxicity study.