Objective:To evaluate the protective effectiveness (VE) of the acellular pertussis vaccine (aPV) against pertussis in children aged 2 months to 6 years.Methods:A test-negative case-control study was conducted among children aged 2 months to 6 years who sought medical care for cough and underwent pertussis nucleic acid testing at sentinel surveillance hospitals in Zhejiang Province in 2024. Cases were defined as those with positive pertussis nucleic acid test results, while controls were test-negative individuals matched 1∶1 based on propensity scores using the caliper matching method. Conditional logistic regression models were used to calculate odds ratios ( ORs) and VEs. Results:Among the 658 participants, 31.76% (209 cases) tested positive for pertussis. After propensity score matching, 203 cases and 203 controls were included in the analysis. The VE of 1-2, 3, and 4 doses of aPV against pertussis was 52.46% (95% CI:-39.82%-83.84%), 65.22% (95% CI: 6.86%-87.02%), and 72.21% (95% CI: 34.33%-88.24%), respectively. For pertussis-related hospitalization, the VE of 1-3 and 4 doses was 80.95% (95% CI:31.38%-94.71%) and 86.79% (95% CI: 51.89%-96.37%). The VE for those who completed 4 doses of vaccination and had intervals of less than 2 years, 2 years, 3 years, and 4 years or more after vaccination were 91.15% (95% CI: 67.61%-97.58%), 84.70% (95% CI: 43.71%-95.84%),56.23% (95% CI:-47.58%-87.02%), and 49.92% (95% CI:-83.74%-86.35%), respectively. Conclusion:The VE of aPV against pertussis in children aged 2 months to 6 years increases with the number of doses administered, and it is more effective in preventing hospitalization due to pertussis. The VE declines rapidly over time after the last dose. It is recommended to follow the new pertussis immunization program for timely and full vaccination.

Objective:To explore the relationship between suicide attempts,school bullying,and psychological resilience in children and adolescents with major depressive disorder(MDD)and school bullying and psychological resilience.Methods:A total of 784 patients with MDD aged 10 to 18 years were included.The Chinese version of the Olweus Bullying Victimization Questionnaire,Adolescent Psychological Resilience Scale,and a suicide attempt assessment were utilized to evaluate school bullying,psychological resilience,and suicide attempt.Stepwise logistic regression was applied to identify the associated factors of suicide attempts.Results:The occurrence of suicide at-tempts in children and adolescents with MDD was positively associated with physical bullying(OR=1.85,95％CI:1.14-3.02)and indirect bullying(OR=1.48,95％CI:1.06-2.04),and negatively associated with higher levels of goal focus(OR=0.62,95％CI:0.45-0.85)and positive cognition(OR=0.62,95％CI:0.45-0.85)at higher levels.Conclusion:Bullying significantly increases the risk of suicide attempts in children and adolescents with MDD,while higher psychological resilience could mitigate this risk.

Objective:To explore the relationship between suicide attempts,school bullying,and psychological resilience in children and adolescents with major depressive disorder(MDD)and school bullying and psychological resilience.Methods:A total of 784 patients with MDD aged 10 to 18 years were included.The Chinese version of the Olweus Bullying Victimization Questionnaire,Adolescent Psychological Resilience Scale,and a suicide attempt assessment were utilized to evaluate school bullying,psychological resilience,and suicide attempt.Stepwise logistic regression was applied to identify the associated factors of suicide attempts.Results:The occurrence of suicide at-tempts in children and adolescents with MDD was positively associated with physical bullying(OR=1.85,95％CI:1.14-3.02)and indirect bullying(OR=1.48,95％CI:1.06-2.04),and negatively associated with higher levels of goal focus(OR=0.62,95％CI:0.45-0.85)and positive cognition(OR=0.62,95％CI:0.45-0.85)at higher levels.Conclusion:Bullying significantly increases the risk of suicide attempts in children and adolescents with MDD,while higher psychological resilience could mitigate this risk.

Objective:To evaluate the protective effectiveness (VE) of the acellular pertussis vaccine (aPV) against pertussis in children aged 2 months to 6 years.Methods:A test-negative case-control study was conducted among children aged 2 months to 6 years who sought medical care for cough and underwent pertussis nucleic acid testing at sentinel surveillance hospitals in Zhejiang Province in 2024. Cases were defined as those with positive pertussis nucleic acid test results, while controls were test-negative individuals matched 1∶1 based on propensity scores using the caliper matching method. Conditional logistic regression models were used to calculate odds ratios ( ORs) and VEs. Results:Among the 658 participants, 31.76% (209 cases) tested positive for pertussis. After propensity score matching, 203 cases and 203 controls were included in the analysis. The VE of 1-2, 3, and 4 doses of aPV against pertussis was 52.46% (95% CI:-39.82%-83.84%), 65.22% (95% CI: 6.86%-87.02%), and 72.21% (95% CI: 34.33%-88.24%), respectively. For pertussis-related hospitalization, the VE of 1-3 and 4 doses was 80.95% (95% CI:31.38%-94.71%) and 86.79% (95% CI: 51.89%-96.37%). The VE for those who completed 4 doses of vaccination and had intervals of less than 2 years, 2 years, 3 years, and 4 years or more after vaccination were 91.15% (95% CI: 67.61%-97.58%), 84.70% (95% CI: 43.71%-95.84%),56.23% (95% CI:-47.58%-87.02%), and 49.92% (95% CI:-83.74%-86.35%), respectively. Conclusion:The VE of aPV against pertussis in children aged 2 months to 6 years increases with the number of doses administered, and it is more effective in preventing hospitalization due to pertussis. The VE declines rapidly over time after the last dose. It is recommended to follow the new pertussis immunization program for timely and full vaccination.

OBJECTIVE To build a Tibetan-language medication service platform based on"internet+"and evaluate its effect on improving medication compliance and safety of Tibetan patients with chronic disease.METHODS Medication guidance contents of commonly used drugs in the outpatient department were summarized,translated and recorded in Tibetan-language or video to form a"text-audio-video"multi-dimensional"internet+"Tibetan-language medication service platform.A total of 387 Tibetan outpatients with chronic disease in our hospital after the implementation of"internet+"Tibetan-language medication service platform(from January 2024 to June 2024)in our hospital were selected as the intervention group,and 387 Tibetan outpatients before the implementation(from January 2023 to June 2023)were selected as the control group.Patients in the control group received conventional window-based Chinese-language medication services,while patients in the intervention group received both conventional window-based Chinese-language medication service and"internet+"Tibetan-language medication service.The medication compliance of patients was evaluated using the 12-item Medication Compliance Scale.A six-level causality assessment was conducted as the principles for analyzing adverse drug reactions(ADR)set by the National Center for ADR Monitoring.Additionally,statistics were compiled on the occurrence of ADR that were assessed as"definite""probable"or"possible"in the causality assessment.RESULTS The proportion(31.0%)of patients with good medication compliance and compliance scores[39.0(37.0,42.0)]of patients in the intervention group were significantly better than control group[7.0%,21.0(19.0,23.0)](P＜0.05).There were no statistically significant differences in the incidence of various types of ADR or the overall incidence between the two groups(P＞0.05).CONCLUSIONS The"internet+"Tibetan-language medication service platform is constructed successfully;the service can effectively improve the medication compliance of Tibetan-language patients,but its effect on improving the medication safety of patients is limited.

Objective:To investigate the therapeutic effect of sequential therapy with butylphthalein on acute cerebral infarction and mild-to-moderate increases in middle cerebral artery blood flow in patients.Methods:The clinical data of 92 patients with acute cerebral infarction and mild-to-moderate increases in middle cerebral artery blood flow who received treatment at the Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from January 2018 to October 2021 were retrospectively analyzed. These patients were divided into a study group and a control group using a random number table method. The control group was given an intravenous infusion of butylphthalein sodium chloride injection, while the study group took oral butylphthalein soft capsules after intravenous infusion of butylphthalein sodium chloride injection. The baseline data, hemodynamics, neurological function, and clinical outcomes were compared between the two groups. At 90 days after treatment, the National Institutes of Health Stroke Scale (NIHSS), the Activity of Daily Living Scale (ADL), and the modified Rankin Scale (mRS) were used to evaluate clinical outcomes. Transcranial Doppler ultrasound (TCD) examination was performed to evaluate hemodynamic changes.Results:A total of 92 patients completed all the observation indices as required, including 48 patients in the study group and 44 patients in the control group. There were no significant differences in demographics, vascular risk factors, laboratory results, NIHSS score, ADL score, or arterial hemodynamics of the diseased brain between the two groups (all P > 0.05). At 90 days after treatment, the NIHSS score in the study group was significantly lower than that in the control group [(4.00 ± 1.95) points vs. (4.91 ± 2.08) points; t =-2.16, P = 0.033]. The ADL score in the study group was significantly higher than that in the control group [(82.71 ± 9.56) points vs. (76.25 ± 11.47) points; t = 2.94, P = 0.004]. The good rate of outcomes in the study group was significantly higher than that in the control group [70.83% (34/48) vs. 50.00% (22/44); χ2 = 4.18, P = 0.041]. There were significant differences in the peak systolic velocity [(152.33 ± 9.58) cm/s vs. (157.41 ± 11.77) cm/s; t = 2.27, P = 0.025] and the mean velocity [(90.00 ± 8.30) cm/s vs. (94.45 ± 9.07) cm/s; t = -2.46, P = 0.016] of the middle cerebral artery between the study and control groups. The difference in pulsitility index between the two groups was not statistically significant [(0.97 ± 1.06) vs. (1.01 ± 1.21); t = 1.69, P = 0.093]. Compared with the poor outcome group, patients in the good outcome group had lower NIHSS and ADL scores after discharge (both P < 0.001), and the proportion of patients who received sequential therapy with butylphthalein in the good outcome group was higher [(60.70% (34/56) vs. 38.90% (14/36); χ2 = 4.18, P = 0.041]. Conclusion:Sequential therapy with butylphthalein can reduce neurological deficits, promote neurological function recovery, improve the hemodynamics of diseased blood vessels, and greatly improve daily living activities in patients with acute cerebral infarction complicated by mild to moderate increases in middle cerebral artery blood flow.

Objective:To analyze the impact of the implementation of the policy of centralized volume-based procurement of dental implant consumables on the prevention and control of corruption risk in public hospitals, and provide reference for improving the construction of corruption risk prevention and control in public hospitals.Methods:Develop a survey questionnaire for three entities: the Discipline Inspection Commission of public hospitals, dental implant doctors in public hospitals, and dental implant consumables distribution enterprises. The questionnaire content for the Discipline Inspection Commission of public hospitals mainly included the impact of the implementation of the policy of centralized volume-based procurement of dental implant consumables on the prevention and control of hospital integrity risks, as well as the development of supporting policies in hospitals; The questionnaire content for dental implant doctors mainly included their understanding of the centralized volume-based procurement policy, their communication with distribution companies, and their awareness of integrity; The questionnaire content for dental implant consumables distribution enterprises mainly included the situation of the distribution enterprises entering the centralized volume-based procurement catalog for implants, and the subsequent adjustment of business strategies.Using convenience sampling method, a questionnaire survey was conducted from February to June 2023 on the Discipline Inspection Commission of public hospitals in Zhejiang Province, dental implant doctors in public hospitals nationwide, and distribution enterprises of dental implant consumables in Zhejiang Province. Descriptive analysis was conducted on the questionnaire data.Results:Effectively collected 16 questionnaires filled out by the Discipline Inspection Commission leaders of public hospitals in Zhejiang Province. Among them, the Discipline Inspection Commission leaders of 11 public hospitals believed that the implementation of the policy of centralized volume-based procurement of dental implant consumables could reduce the existing corruption risks of public hospitals, 1 believed that it would create new corruption risks, and 4 believed that both aspects of the impact existed; 12 leaders believed that the policy′s strengthening of corruption risk prevention and control was mainly reflected in squeezing implant prices, reducing selection and procurement risks, and reducing red envelopes and kickbacks. 270 questionnaires from dental implant doctors in public hospitals were effectively collected. Regarding the implementation of the centralized volume-based procurement policy, 187 people believed that it would inhibit the development of the dental implant industry, 148 people expected their personal salaries to decrease, 78 people would participate more in lectures and training organized by enterprises, and 39 people would recommend implant systems outside the centralized volume-based procurement catalog to patients; 140 people were unable to accurately grasp all the contents of the " Nine Guidelines on Integrity for Staff of Medical Institution" ; Only 202 people believed that compliance contact with distribution companies could only be based on listening to their introduction to the implant system. 23 questionnaires were effectively collected from dental implant consumables distribution companies. Among them, 22 companies would reduce their expenses in maintaining relationships with clinical doctors after the implementation of the centralized procurement policy, and 14 companies would reduce their sales position expenses. All distribution companies believed that the phenomenon of medical institution staff receiving red envelopes and kickbacks would decrease or disappear after the implementation of the centralized volume-based procurement policy.Conclusions:The implementation of the policy of centralized volume-based procurement of dental implant consumables is beneficial for reducing the existing corruption risks in public hospitals, but if regulatory oversight is inadequate, new corruption risks will arise in the early stages of policy implementation. Public hospitals should improve the supporting system for centralized volume-based procurement of dental implant consumables, standardize the procurement process of dental implant consumables outside the centralized volume-based procurement catalog, strengthen supervision and inspection of centralized procurement, and further strengthen corruption risk prevention and control by implementing anti-corruption education.

As one of the important contents and links of doctor-patient communication, the quality of breaking bad news will affect the development of doctor-patient relationship. Bad news informed not only involves the feedback of clinical medical diagnosis results, but also involves special knowledge training and clinical experience accumulation, as well as ethical, legal, social custom and other factors. At present, it is still a difficult problem troubling physicians in the medical environment. From the different perspectives of doctors, patients and family members, this paper sorted out the domestic and international status of breaking bad news, revealed its internal dilemmas, and summarized the informing strategies to cope with these dilemmas, with a view to providing references for hospital managers and medical staff to earlier identify and properly inform, helping both doctors and patients to get rid of the dilemma of notification and improve the doctor-patient relationship.

Background As an environmental pollutant, 1-bromopropane (1-BP) is ubiquitous in the living environment. However, its health effects on the general population are still unclear. Objective To assess the associations between urinary 1-BP metabolite and blood routine indices in a Chinese community population. Methods A total of 3512 community residents aged 18-80 years from the baseline of the Wuhan-Zhuhai cohort were included in our study. The demographic characteristics, disease history, and lifestyles of the participants were collected through questionnaires. Height, weight, blood pressure, and other anthropometrics were collected through physical examination. Blood routine indicators were tested using an automated hematology analyzer. Urinary 1-BP metabolite N-Acetyl-S-(n-propyl)-L-cysteine (BPMA) was measured by ultra-high-performance liquid chromatography coupled with electrospray ionization tandem mass spectrometry. Generalized linear models and logistic regression models were used to assess the associations of urinary BPMA with blood routine indices and the risks of abnormal blood routine indices, respectively. Besides, stratified analysis and effect modification analysis were further conducted to investigate the effects of individual characteristics and lifestyles on the associations of urinary BPMA with blood routine indices. All models were adjusted for gender, age, and other potential confounders. Results The mean age of the study population (30.1% male) was (52.78±12.77) years. The median (P₂₅, P₇₅) level of urinary BPMA adjusted for urinary creatinine was 0.90 (0.50, 1.73) mg·mol⁻¹. In the analysis with target indicator as continuous variable, each 1-unit increase in natural logarithm-transformed urinary BMPA level was associated with a 0.078×10⁹ L⁻¹, 0.031×10⁹ L⁻¹, 0.307%, 3.518 g·L⁻¹, and 2.469×10⁹ L⁻¹ decrease in white blood cell, lymphocyte, lymphocyte percentage, mean corpuscular hemoglobin concentration, and platelet levels, respectively (all Ps<0.05); and with a 0.440%, 1.140 fL, 0.014 fL, and 0.020 increase in hematocrit, mean corpuscular volume, and natural logarithm-transformed levels of mean platelet volume and mean platelet volume/platelet, respectively (all Ps<0.05). The categorical analysis across quartiles of BPMA level showed that BPMA was inversely associated with lymphocyte percentage, mean corpuscular hemoglobin concentration, and platelet levels in a dose-dependent manner (all P_trend<0.05), and positively related to hematocrit, mean corpuscular volume, mean platelet volume, and mean platelet volume/platelet levels in a dose-dependent manner (all P_trend<0.05). Body mass index, smoking, and drinking modified the associations of urinary BPMA level with red blood cell, mean corpuscular hemoglobin concentration lymphocyte percentage, and hemoglobin (all Ps<0.05). In addition, urinary BPMA was associated with an increased risk of abnormal increase in mean corpuscular volume (OR=1.316, 95%CI: 1.171-1.478) and red blood cell volume distribution width (OR=1.255, 95%CI: 1.030-1.528), and abnormal decrease in mean corpuscular hemoglobin concentration (OR=1.200, 95%CI: 1.035-1.392). Conclusion Exposure to 1-BP of the general population is associated with decreased white blood cells and platelets, as well as abnormal change of blood cell morphology or function.

This paper introduced a case of ethical conflict between the principle of benefit and the principle of respect in the formulating treatment and nursing plan for patient with chronic wound nonunion by specialist nurses, and used the "structured analysis form of clinical nursing ethics" designed by the Third Affiliated Hospital of Guangzhou Medical University to conduct ethical analysis and ethical decision-making, and solve the clinical nursing ethical problems of complex nursing cases. The practice of the case showed that under the situation of ethical conflict in making nursing treatment plan for patient, the application of structured ethical analysis of clinical nursing is helpful to improve nurses’ ethical decision-making ability and strengthen their ethical thinking. It is suggested to strengthen nurses’ ethical thinking in clinical nursing, continuously improve nurses’ ethical decision-making ability, and cultivate core nursing technology integrating science and humanities, thus to enhance nursing value.