Psychotherapy is one of the widely used therapies for depression.Yet there are currently no definitive biological markers as indicators of effectiveness.Using functional magnetic resonance imaging(fMRI)to assess the neuroimaging biomarkers before and after different psychological treatments for depression reveals corresponding changes in brain region activation and functional connectivity.For example,after cognitive-behavioral therapy,the prefrontal cortex of patients may be activated and dynamic functional connectivity variability may change,while mindfulness therapy may show alterations in specific temporal lobe regions.Additionally,studies exploring special populations and internet-based psychological intervention have also found changes in brain region activation and functional connectivity,providing guidance for the efficacy evaluation of corresponding psychotherapies.This article reviews the characteristic brain region or network changes in fMRI activity after different psychotherapies in depressed patients,aiming to discuss future directions for research that integrates neuroimaging with psychological treatment for depression.

Objective:The incidence of occupational burnout among emergency department healthcare workers is high,and their occupational health deserves attention.Establishing a comprehensive occupational health system in medical institutions is crucial.This study aims to understand the current status of occupational burnout among emergency department healthcare workers,analyze its influencing factors,and provide references for preventing burnout in this population. Methods:A cross-sectional survey was conducted using convenience sampling through the Questionnaire Star platform from December 2022 to January 2023 among emergency department healthcare workers.The Maslach Burnout Inventory-General Survey(MBI-GS)scale was used to assess the level of occupational burnout,and univariate analysis and binary Logistic regression analysis were employed to explore the influencing factors of burnout. Results:A total of 1 173 valid questionnaires were collected,with 946(80.65％)respondents experiencing occupational burnout.The proportions of mild-to-moderate and severe burnout were 73.57％and 7.08％,respectively.The scores for the three dimensions of burnout among emergency department healthcare workers were as follows:emotional exhaustion(EE)2.33±0.31;depersonalization(DP)1.88±0.28;low personal accomplishment(LPA)3.20±0.39.The overall score was 2.46±0.22.Factors associated with occupational burnout included being an only child(OR=1.362,95％CI-0.707 to-0.058),the average number of night shifts per month(OR=1.167,95％CI 0.091 to 0.272),and personal experience of workplace violence(OR=1.094,95％CI 0.027 to 0.195)(all P＜0.05). Conclusion:The incidence of occupational burnout is high among emergency department healthcare workers.Effective measures should be taken by management to promptly intervene,reduce burnout,and ensure the smooth functioning of emergency medical services.

Objective:To analyze the distribution and drug resistance of wound pathogenic microorganisms in outpatients of wound healing center so as to provide a basis for the standardized construction of wound healing centers.Methods:A retrospective case series study was used to analyzed the data of 365 outpatients treated at Ruijin Hospital, Shanghai Jiaotong University School of Medicine from December 2017 to October 2019. There were 220 males and 145 females, aged (58.8±18.9)years (range, 18-98 years). The patients included 92 first-visit patients and 273 re-visit patients. The culture results (positive rate of pathogenic microorganisms, bacterial species, bacterial distribution) and drug sensitivity results of the wound secretions were compared and analyzed.Results:(1) Among 365 samples of wound secretions, 198 patients were positive for pathogenic microorganisms with a positive rate of 54.3%. A total of 107 strains (51.0%) of Gram-positive bacteria were detected, mainly Staphylococcus aureus (70 strains, 33.3%); 95 strains (45.2%) of Gram-negative bacteria were detected, mainly Escherichia coli (20 strains, 9.5%), followed by Pseudomonas aeruginosa (17 strains, 8.1%); 8 strains (3.8%) of fungi were detected. (2) A total of 26 (28.3%) first-visit patients were positive for pathogenic microorganisms, and 172 (63.0%) re-visit patients were positive for pathogenic microorganisms. The rate of positive microorganism detection had significant differences between first-visit and re-visit patients ( P<0.05). (3) A total of 29 strains were detected in first-visit patients, including 16 strains (55.2%) of Gram-positive bacteria, 11 strains (37.9%) of Gram-negative bacteria and 2 strains (6.9%) of fungi. A total of 181 strains were detected in re-visit patients, including 91 strains (50.3%) of Gram-positive bacteria, 84 strains (46.4%) of Gram-negative bacteria and 6 strains (3.3%) of fungi. The microbial distribution was significantly different between first-visit and re-visit patients ( P<0.05). (4) Compared with first-visit patients, the resistance of Staphylococcus aureus isolated from the re-visit patients to spenicillin, oxacillin, ciprofloxacin, tetracycline, clindamycin, moxifloxacin, erythromycin, and levofloxacin were increased variably. No vancomycin-resistant Staphylococcus aureus was detected, indicating that the staphylococcus aureus presented in the wound was highly sensitive to vancomycin. Conclusions:Staphylococcus aureus is the most common microorganism in wound secretions in outpatients of wound healing center. The rate of positive pathogenic microorganisms in wound secretions of re-visit patients is significantly higher than that of first-visit patients, and the distribution of pathogenic microorganisms of first-visited and revisited patients differs significantly. The Staphylococcus aureus detected in re-visit patients has a higher resistance to common antibiotics compared with first-visit patients. It is suggested that timely detection of pathogenic microorganisms in outpatients and effective control and supervision of outpatient infections are important contents that cannot be ignored in the construction of wound healing center.

According to a document issued by the General Office of National Health Commission, "one person, one diagnosis, and one room" is required in the process of outpatient consultation. However, the patient will need to go to another room for dressing change after the doctor checks the wound if sticking to the conventional layout of current wound repair specialist outpatient clinic in hospitals and following the regulation of "separation of diagnosis and treatment". To allow a patient walking back and forth with the exposed wounds to different clinics or going to another clinic for dressing change with the original dressing reapplied to the wound is against the regulation of nosocomial infection control and the principle of sterility. To ensure that the layout of the outpatient clinic in the wound repair outpatient department not only conforms to the principle of "one person, one diagnosis, and one room", but also meets the characteristics of the diagnosis and treatment process of chronic wounds, this paper proposes the layout of "large space and small partition" in the wound repair clinic.

Objective:To explore the application value of flexible endoscopy and rigid endoscopy in the clinical examination of chronic sinus tract wounds with different shapes.Methods:A retrospective observational study was conducted. From January 1 to December 23, 2019, a total of 46 patients with chronic sinus tract wounds, who met the inclusion criteria were admitted to the Wound Healing Center of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, including 23 males and 23 females, aged 18-81 (48±21) years. On admission, computer tomography (CT) imaging and three-dimensional reconstruction were performed to examine the shapes of wound sinus tract and classify the wounds, with the lengths of wound sinus tract by CT imaging examination (hereinafter referred to as reference lengths) recorded. The lengths of wound sinus tract were examined and measured by rigid endoscopy and flexible endoscopy. The wounds with and without obviously curved sinus tract were classified into curve group and linear group respectively, and the deviation rates between the lengths of wound sinus tract measured by flexible endoscopy or rigid endoscopy and the reference lengths (hereinafter referred to as deviation rates of lengths) in each group were calculated. The difference between the deviation rates of lengths examined by flexible endoscopy and rigid endoscopy and the differences between the above two and the deviation rate of reference lengths (0) in each group were compared. Data were statistically analyzed with paired sample t test and Wilcoxon signed rank sum test. Results:CT imaging and three-dimensional reconstruction showed that there were 4 types of wound sinus tract, including tubular (36/46), lamellar (4/46), club-mallet (4/46), and irregular (2/46) shape. Tubular wounds were further divided into type I (23/36), type L (4/36), and type Y (9/36). Wounds with type I tubular, lamellar, and club-mallet sinus tract were classified into linear group (31/46), while those with type Y tubular, type L tubular, and irregular sinus tract were classified into curve group (15/46). In linear group, the deviation rates of lengths examined and measured by rigid endoscopy and flexible endoscopy were 0. In curve group, the deviation rate of lengths examined and measured by flexible endoscopy was 0 (0, 0.58%), which was significantly lower than 41.18% (31.68%, 48.41%) examined and measured by rigid endoscopy, Z=-3.408, P<0.01; the deviation rate of lengths examined and measured by rigid endoscopy (40±19)% was significantly higher than the deviation rate of reference lengths ( t=8.343, P<0.01), while the deviation rate of the lengths examined and measured by flexible endoscopy was similar to the deviation rate of reference lengths ( Z=-1.342, P>0.05). Conclusions:Compared with rigid endoscopy, flexible endoscopy can observe the internal characteristics of chronic sinus tract wounds in a wider range in the clinical examination of this kind of wound, especially for the exploration of curved chronic sinus tract wounds. The promotion of this method will be conducive to the diagnosis and treatment of chronic sinus tract wounds.

Statistics show that 76.74% (4 688) of 6 109 patients with chronic wounds are those over 50 years of age; the proportion of patients with underlying diseases in all age groups above 50 years ranges from 78.25% to 100.00%; among the underlying diseases of chronic wound patients, the top four diseases are diabetes mellitus , cardiovascular and cerebrovascular diseases, hypertension, and respiratory diseases. The above underlying diseases and ages of patients are the susceptibility factors of corona virus disease 2019 released by National Health Commission of China. It is an unavoidable fact that patients with chronic wounds have to go to the hospital for treatment prescribed by the physician. At the same time, we found that there were not a few patients who go far afield because of various reasons when go to the hospital for treatment. During the period of epidemic prevention and control, this kind of "go far afield" style of seeking medical treatment may increase the exposure risk during transportation. Accordingly, we convened 36 wound care clinics in different regions in Shanghai to implement the "Five Measures" to encourage patients with chronic wounds to seek medical treatment proximately. The principle of this operation is that when seeking medical treatment, trying our best to reduce as much as possible the transportation distance for patients with chronic wounds to minimize the exposure risk during the epidemic period and eventually support the epidemic prevention and control campaign.

OBJECTIVES: To discuss the demands and countermeasures for outpatients and emergency patients during the outbreak of coronavirus disease 2019 (COVID-19) in large general hospital. METHODS: By analyzing patients' demands, outpatient service system and emergency system complemented each other with the help of "internet medical" to provide online medical treatment, self-diagnosed pneumonia program, online pharmacies, outpatient appointment and online pre-examination services, open green channels for special patients, and to provide referral services for critical patients. The COVID-19 suspected patients and other common fever patients were separated from other patients. RESULTS: From January 28 to March 1, we have received 26 000 patients online, 1 856 special patients, 2 929 suspected patients and common fever patients including 31 confirmed patients, 0 case of misdiagnosis and cross-infection. CONCLUSIONS Targeting patient's demands and taking appropriate measures are effective on meeting the needs of outpatients' and emergency patients' medical services.
Betacoronavirus ; Coronavirus Infections ; epidemiology ; prevention & control ; Cross Infection ; prevention & control ; Emergency Medical Services ; organization & administration ; Health Services Needs and Demand ; Hospitals, General ; organization & administration ; Humans ; Outpatients ; Pandemics ; prevention & control ; Pneumonia, Viral ; epidemiology ; prevention & control

AIM: To identify the differentially expressed lncRNAs related to myelodysplastic syndromes by method of bioinformatics. METHODS: The GSE145733 was downloaded from GEO database; the differentially expressed lncRNAs were screened out by GEO2R. miRNA and mRNA associated with the differentially expressed lncRNAs were analyzed by the platform miRDB. lncRNA-miRNA-mRNA network was constructed and visualized by Cytoscape software. We annotated and enriched the lncRNAs to biological functions and pathways by GO and KEGG tools. RESULTS: Five differentially expressed lncRNAs were screened out. These lncRNAs were associated with 19 miRNAs and 84 mRNAs. They mainly affected the functions such as substance synthesis and transportation, gene transcription, and nervous system. CONCLUSION: We discovered the lncRNA expression characteristics in MDS patients, predicted the functions of these lncRNAs, which may provide new drug targets for the precise medication in MDS.

Objective: To study the use of a three dimensional (3D) visualization operative planning system in Ultrasound-guided percutaneous microwave ablation (US-PMWA) for large hepatic hemangiomas (LHHs). Methods: A total of 50 patients with LHHs from January 2011 to August 2018 were included in Department of Interventional Ultrasound, the First Medical Center, Chinese PLA General Hospital, including 12 males and 38 females (age from 28.0~60.0, mean age was 43.0). Fifty patients with LHHs were divided into the 3D and 2D groups (25 cases in each group). The therapeutic efficacy was assessed by contrast-enhanced imagings on follow-up. Hepatic and renal functions were studied. The complete ablation, tumor volume shrinkage and complication rates were analyzed. Results: The levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and creatinine after ablation in the 3D group were significantly lower than the 2D group [(126.7±56.4)U/L vs. (204.7±76.5)U/L; (141.0±60.8)U/L vs. (206.6±77.4)U/L; (57.3±17.6)U/L vs. (86.2±46.1)U/L; (66.6±16.6)mmol/L vs. (86.8±42.8)mmol/L, P<0.05, respectively]. Compared with the 2D group, the ablation energy, ablation time and proportion of hemoglobinuria in the 3D group were all significantly less, while the complete ablation rate was significantly higher [(93.7±3.3)% vs. (97.7±2.4)%](all P<0.05). Conclusion The 3D visualization operative planning system provided a scientific, quantifiable, and individualized therapy for LHHs using US-PMWA.

PURPOSE: Developing a risk prediction model for invasive fungal disease based on an analysis of the disease-related risk factors in critically ill patients in the intensive care unit (ICU) to diagnose the invasive fungal disease in the early stages and determine the time of initiating early antifungal treatment. METHODS: Data were collected retrospectively from 141 critically ill adult patients with at least 4 days of general ICU stay at Sun Yat-sen Memorial Hospital, Sun Yat-sen University during the period from February 2015 to February 2016. Logistic regression was used to develop the risk prediction model. Discriminative power was evaluated by the area under the receiver operating characteristics (ROC) curve (AUC). RESULTS: Sequential organ failure assessment (SOFA) score, antibiotic treatment period, and positive culture of Candida albicans other than normally sterile sites are the three predictors of invasive fungal disease in critically ill patients in the ICU. The model performs well with an ROC-AUC of .73. CONCLUSION: The risk prediction model performs well to discriminate between critically ill patients with or without invasive fungal disease. Physicians could use this prediction model for early diagnosis of invasive fungal disease and determination of the time to start early antifungal treatment of critically ill patients in the ICU.
Adult ; Candida albicans ; Critical Care* ; Critical Illness* ; Early Diagnosis ; Humans ; Intensive Care Units* ; Logistic Models ; Retrospective Studies ; Risk Factors ; ROC Curve ; Solar System