BACKGROUND:Pulmonary arterial hypertension is a destructive cardiopulmonary disease for which there is no cure.An association between plasma proteins and pulmonary arterial hypertension has been suggested,but the causal relationship has not been specifically elucidated.OBJECTIVE:To elucidate the causal relationship between plasma proteome and pulmonary arterial hypertension using a two-sample Mendelian randomization method,thereby searching for potential therapeutic targets for pulmonary arterial hypertension.METHODS:Plasma Protein Gene-Wide Association Analysis Statistics for 4 907 Aptamer Measurements in 35 559 Icelanders from the Icelandic Database;Genome-wide association analysis statistics for pulmonary arterial hypertension were obtained from the Finn Gen database,version R9,including 234 cases and 265 626 controls.Analyses were performed using Mendelian randomization and Bayesian co-localization analysis,the findings were examined using sensitivity analyses,and protein-protein interaction network maps were constructed to explore the causal relationship between plasma proteins and pulmonary arterial hypertension.RESULTS AND CONCLUSION:(1)The results of inverse variance weighting,maximum likelihood and Wald ratio methods showed 19 proteins causally associated with pulmonary arterial hypertension(P＜0.05).Among them,10 plasma proteins,including Beta-1,3-N-acetylglucosaminyltransferase manic fringe(odds ratio[OR]=0.12,95％confidence interval[CI]0.02-0.61,P=0.01)and interferon alpha/beta receptor 1(OR=0.45,95％CI 0.24-0.84,P=0.012),might be associated with a reduced risk of pulmonary arterial hypertension.In contrast,nine plasma proteins,such as glucoside xylosyltransferase 1(OR=3.48,95％CI 1.51-8.00,P=0.003)and plasminogen(OR=42.78,95％CI 2.49-734.31,P=0.01),might be associated with an increased risk of pulmonary arterial hypertension.After the false discovery rate was corrected,19 proteins remained significantly associated with pulmonary arterial hypertension.(2)Multiple sensitivity analyses such as the MR-Egger intercept test and leave-one-out method showed no horizontal multiplicity or heterogeneity in the results of the study,indicating the stability of the study's results.(3)Bayesian co-localization analysis showed that six plasma proteins,including plasminogen(PPH4=1.0)and glucoside xylosyltransferase 1(PPH4=0.94),had PPH4＞0.8,suggesting that plasma proteins and the genome-wide association study of pulmonary arterial hypertension had similar causal variance in terms of genetic association.(4)By constructing a protein-protein interaction network map,plasminogen,Annexin A1,fibrinogen gamma chain and matrix metalloproteinase 7 were found to be core proteins.(5)The article used Mendelian randomization analysis to reveal a potential causal association between 4 907 plasma proteins and pulmonary arterial hypertension,suggesting that plasma proteins may be potential therapeutic targets for pulmonary arterial hypertension.The core proteins identified in the study also provide a theoretical basis for further in-depth study of the pathophysiological mechanisms of pulmonary arterial hypertension.Secondly,analyses using the large-scale international databases of Iceland and FinnGen provide new research directions and treatment ideas for pulmonary arterial hypertension in specific populations and environments,as well as ideas and methods that can be used to prevent and treat pulmonary arterial hypertension in China.

ObjectiveTo analyze the epidemiological characteristics of a local dengue fever cluster outbreak in Qingpu District of Shanghai in 2024, and to provide a reference for subsequent dengue fever prevention and control. MethodsSeven confirmed local dengue fever cases reported through the National Notifiable Infectious Diseases Surveillance System in Qingpu District of Shanghai in 2024 were selected as the research subjects. Descriptive epidemiological methods were used to conduct investigation and analysis from the aspects of onset, medical treatment and reporting, clinical symptoms, travel and contact history within 15 days before onset, and activity trajectories. ResultsA total of 7 cases were identified in this outbreak. None of the cases had a travel history to dengue-endemic areas within 15 days prior to onset, while all had shared exposure environments and mosquito bite histories, indicating a local clustered transmission pattern. The main clinical manifestations included fever (100.00%) and myalgia (42.86%). All 7 cases were positive for dengue virus serotype 2 (DENV-2) by nucleic acid testing. Genetic sequencing showed that the virus strains belonged to the Cosmopolitan genotype and were most closely related to the epidemic DENV strains circulating in southern China in recent years. ConclusionThis outbreak might be a local secondary infection caused by the short-term stay of dengue fever-infected individuals, and the possible source of importation was dengue fever endemic areas in southern China.

BACKGROUND:Pulmonary arterial hypertension is a destructive cardiopulmonary disease for which there is no cure.An association between plasma proteins and pulmonary arterial hypertension has been suggested,but the causal relationship has not been specifically elucidated.OBJECTIVE:To elucidate the causal relationship between plasma proteome and pulmonary arterial hypertension using a two-sample Mendelian randomization method,thereby searching for potential therapeutic targets for pulmonary arterial hypertension.METHODS:Plasma Protein Gene-Wide Association Analysis Statistics for 4 907 Aptamer Measurements in 35 559 Icelanders from the Icelandic Database;Genome-wide association analysis statistics for pulmonary arterial hypertension were obtained from the Finn Gen database,version R9,including 234 cases and 265 626 controls.Analyses were performed using Mendelian randomization and Bayesian co-localization analysis,the findings were examined using sensitivity analyses,and protein-protein interaction network maps were constructed to explore the causal relationship between plasma proteins and pulmonary arterial hypertension.RESULTS AND CONCLUSION:(1)The results of inverse variance weighting,maximum likelihood and Wald ratio methods showed 19 proteins causally associated with pulmonary arterial hypertension(P＜0.05).Among them,10 plasma proteins,including Beta-1,3-N-acetylglucosaminyltransferase manic fringe(odds ratio[OR]=0.12,95％confidence interval[CI]0.02-0.61,P=0.01)and interferon alpha/beta receptor 1(OR=0.45,95％CI 0.24-0.84,P=0.012),might be associated with a reduced risk of pulmonary arterial hypertension.In contrast,nine plasma proteins,such as glucoside xylosyltransferase 1(OR=3.48,95％CI 1.51-8.00,P=0.003)and plasminogen(OR=42.78,95％CI 2.49-734.31,P=0.01),might be associated with an increased risk of pulmonary arterial hypertension.After the false discovery rate was corrected,19 proteins remained significantly associated with pulmonary arterial hypertension.(2)Multiple sensitivity analyses such as the MR-Egger intercept test and leave-one-out method showed no horizontal multiplicity or heterogeneity in the results of the study,indicating the stability of the study's results.(3)Bayesian co-localization analysis showed that six plasma proteins,including plasminogen(PPH4=1.0)and glucoside xylosyltransferase 1(PPH4=0.94),had PPH4＞0.8,suggesting that plasma proteins and the genome-wide association study of pulmonary arterial hypertension had similar causal variance in terms of genetic association.(4)By constructing a protein-protein interaction network map,plasminogen,Annexin A1,fibrinogen gamma chain and matrix metalloproteinase 7 were found to be core proteins.(5)The article used Mendelian randomization analysis to reveal a potential causal association between 4 907 plasma proteins and pulmonary arterial hypertension,suggesting that plasma proteins may be potential therapeutic targets for pulmonary arterial hypertension.The core proteins identified in the study also provide a theoretical basis for further in-depth study of the pathophysiological mechanisms of pulmonary arterial hypertension.Secondly,analyses using the large-scale international databases of Iceland and FinnGen provide new research directions and treatment ideas for pulmonary arterial hypertension in specific populations and environments,as well as ideas and methods that can be used to prevent and treat pulmonary arterial hypertension in China.

Objective Explore a comprehensive and multi-level set of passive defensive medical governance strate-gies.Methods Literature related to passive defensive medical governance was retrieved,and the Ucinet social net-work analysis software was utilized to calculate indicators such as the frequency and centrality of passive defensive medical governance strategies,thereby understanding the importance of these strategies.Results The formed set of negative defensive medical governance strategies covers three levels social cogniton,institutional mechanisms and doctor-patient relationship.Among them,there are 5 governance strategies at the social cognition level,24 governance strategies at the institutional mechanism level,and 12 governance strategies at the doctor-patient rela-tionship level,totaling 41 governance strategies.Conclusion The constructed set of passive defensive medical governance strategies is scientific,practical,and comprehensive in content,providing a reference framework for medical institutions to govern passive defensive medical behaviors.

Objective Based on the WSR methodology,a three-dimensional integrated perspective of Wuli,Shi-li,and Renli dimensions was used to sort out the logical relationships and architectures among negative defensive medical governance strategies,forming the priority governance strategies for improving negative defensive medical care.Methods Based on the literature research method and the expert consultation method,the governance strate-gy and the conceptual connotation of WSR are classified into items,and the role relationship in the complex sys-tem of passive defensive medical governance is clarified through the WSR methodology.Results A collection of 40 negative defensive medicine governance strategies has been developed,comprising 8 strategies in the Wuli dimen-sion,23 strategies in the Shili dimension,and 9 strategies in the Renli dimension.Conclusion The WSR methodology provides a three-dimensional systemic perspective for governance strategies against negative defen-sive medicine.Addressing this issue requires comprehensive and systematic governance strategies.

Objective Explore a comprehensive and multi-level set of passive defensive medical governance strate-gies.Methods Literature related to passive defensive medical governance was retrieved,and the Ucinet social net-work analysis software was utilized to calculate indicators such as the frequency and centrality of passive defensive medical governance strategies,thereby understanding the importance of these strategies.Results The formed set of negative defensive medical governance strategies covers three levels social cogniton,institutional mechanisms and doctor-patient relationship.Among them,there are 5 governance strategies at the social cognition level,24 governance strategies at the institutional mechanism level,and 12 governance strategies at the doctor-patient rela-tionship level,totaling 41 governance strategies.Conclusion The constructed set of passive defensive medical governance strategies is scientific,practical,and comprehensive in content,providing a reference framework for medical institutions to govern passive defensive medical behaviors.

Objective Based on the WSR methodology,a three-dimensional integrated perspective of Wuli,Shi-li,and Renli dimensions was used to sort out the logical relationships and architectures among negative defensive medical governance strategies,forming the priority governance strategies for improving negative defensive medical care.Methods Based on the literature research method and the expert consultation method,the governance strate-gy and the conceptual connotation of WSR are classified into items,and the role relationship in the complex sys-tem of passive defensive medical governance is clarified through the WSR methodology.Results A collection of 40 negative defensive medicine governance strategies has been developed,comprising 8 strategies in the Wuli dimen-sion,23 strategies in the Shili dimension,and 9 strategies in the Renli dimension.Conclusion The WSR methodology provides a three-dimensional systemic perspective for governance strategies against negative defen-sive medicine.Addressing this issue requires comprehensive and systematic governance strategies.

Objective To understand the molecular epidemiological characteristics and hypervirulence evolution trend of ST11 carbapenem-resistant Klebsiella pneumoniae(CRKP)isolated from medical institutions in Shanghai,and provide scientific basis for formulating the prevention and control measures of drug-resistant organisms.Methods A total of 201 strains of CRKP isolated from 12 medical institutions in Shanghai from 2021 to 2022 were collected.Antimicrobial susceptibility testing and whole genome sequencing were performed.The concatenated data was used for multilocus sequencing typing(MLST),serum typing(wzi typing),as well as analysis of resistance and viru-lence genes.Results All 201 CRKP strains were multidrug-resistant organisms(MDROs).These strains were al-most completely resistant to carbapenems,cephalosporins,and quinolones.Drug resistance gene analysis showed that 93.03％of CRKP strains carried KPC gene.201 CRKP strains were divided into 6 ST types and 10 capsule wzi types,with ST11-KL64(n=104)being the dominant type,followed by ST15-KL19(n=54).52.24％(n=105)of CRKP carried rpmA/rpmA2+iucA+iutA+iroN genes.Conclusion CRKP isolated from medical institutions in Shanghai is mainly ST11-KL64 type with severe multidrug resistance,and more than half of the strains are hyper-virulent carbapenem-resistant Klebsiella pneumoniae(hv-CRKP).It is necessary to continuously strengthen the monitoring of the molecular characteristics of CRKP,so as to prevent outbreaks of healthcare-associated infection.

Objective:The prediction model of postoperative recurrence of ovarian endometriosis cyst(OEM)was constructed to provide a reference for evaluating postoperative recurrence of OEM patients.Methods:The clinical,pathological and follow-up data of 342 patients who underwent the initial laparoscopic ovarian cystectomy for OEM at The Second Hospital of Hebei Medical University from January 1,2017 to October 31,2021 were retro-spectively analyzed.Based on univariate and multivariate Cox regression analysis,the relevant factors affecting OEM recurrence were identified.According to the results of multivariate analysis,a nomogram was drawn.The C index and receiver operating characteristic(ROC)curve were used to test the efficiency of the prediction model.Results:The 2-year recurrence rate of OEM patients was 20.4%and the 5-year recurrence rate was 35.2%.Uni-variate and multivariate Cox regression analysis showed that menstrual cycle(HR 0.916,95%CI 0.860-0.976,P=0.006),delivery≥1(HR 0.376,95%CI 0.171-0.827,P=0.015),CA125≥100 U/ml(HR 1.790,95%CI 1.167-2.746,P=0.008),total cyst diameter≥10 cm(HR 2.254,95%CI 1.318-3.854,P=0.003),and postoperative medications(HR 0.434,95%CI 0.292-0.644,P=0.000)were associated with OEM recurrence and were included in the no-mogram prediction model.The C-index of the nomogram prediction model was 0.710(95%CI 0.665-0.754),and the area under the curve(AUC)of the ROC for OEM patients with recurrence at 2 years after surgery was 0.786 and 0.708 at 5 years.Conclusions:In this study,we developed a nomogram to predict the probability of recur-rence at 2 years and 5 years for OEM patients under 45 years who underwent conservative surgery,which has i-deal predictive performance and helps clinicians to screen high-risk patients,and thus give high-risk OEM patients additional attention and intervention.

Objective To evaluate the impact of different methods of harvesting palatal connective tissue on patients' postoperative pain at the palatal donor site.Methods A total of 30 patients were included.The control group was de-epithelialized free gingival graft technique group,and the experimental group was the single-incision technique group.The keratinized gingival width of the recipient site,number of vertical incisions,number of teeth,donor site mucosa thickness,graft width,graft length,graft thickness,operation time and amount of anesthetic were recorded.The postoperative quality of life rating scale and visual analog scale were completed and statistical analysiswas performedon the results by SPSS 26.0.Results The postoperative quality of life score of the experimental group was significantly lower than that of the control group,and there was no significant difference in the total VAS score of the donor site.In terms of the total postoperative pain level after mucogingival surgery,the number of vertical incisions and graft thickness were positively correlated with the pain.Palate mucosal thickness was negatively correlated with postoperative pain levels.Conclusion In mucogingi-val surgery,the degree of postoperative pain in the donor palatal region of the patient is independent of the choice of de-epithelialized free gingival graft technique or single-incision technique to obtain subepithelial connective tissue.The surgeon should also give compre-hensive considerationsto the anatomical factors of the patient's donor site,surgical technical level and experience,and aesthetic require-ments when selecting the surgical method.