OBJECTIVE To analyze the reliability of Xpert MTB/RIF(referred to as Xpert)in detecting rifampicin resistance under varying bacterial loads of Mycobacterium tuberculosis(MTB)so as to reference for clinical diag-nosis and treatment.METHODS A total of 3 050 mycobacterial culture-positive test results from Jan.2016 to Dec.2023 at the First Affiliated Hospital of Xiamen University were selected.After excluding 220 non-tubercu-lous mycobacteria cases,2 830 culture-positive specimens underwent Xpert testing,with 2 412 positive and 418 negative cases.Based on MTB bacterial load,specimens were divided into four treatment groups-high,medi-um,low and very low-with 552,916,656 and 288 cases,respectively.Solid phenotypic drug susceptibility testing(DST)was performed on 1 801 MTB strains that were both culture-positive and Xpert-positive.RESULTS The positive rates of rifampicin in the high,medium,low and very-low treatment groups were 10.33％(57/552),11.14％(102/916),8.54％(56/656)and 8.68％(25/288),respectively.Using the solid phenotypic drug sus-ceptibility testing results as the reference standard,the specificity and negative predictive value of Xpert for detec-ting rifampicin resistance in all four bacterial load groups exceeded 96％,with no statistically significant differ-ences observed.No significant difference in sensitivity was noted among the groups(P=0.053),though the high bacterial load group exhibited relatively lower sensitivity at 84.62％(44/52),while the very-low bacterial load group showed the lowest sensitivity at 76.00％(19/25),which was lower than the medium bacterial load group's 94.05％(79/84).The positive predictive values(PPV)across all groups were generally low but without statisti-cally significant differences(P=0.239),with the high and very-low bacterial load groups registering PPVs of 77.19％(44/57)and 76.00％(19/25),respectively.The concordance rates of Xpert and solid phenotypic drug susceptibility testing were consistently high among all four bacterial load groups,including 94.95％(395/416),97.51％(666/683),96.75％(477/493)and 94.26％(197/209),respectively,with no significant difference(P=0.052).The Kappa values from high to very-low bacterial load groups were 0.778,0.889,0.831 and 0.727,re-spectively.Among the strains with discordant results between Xpert and phenotypic drug susceptibility testing,the rifampicin result consistency rates between Xpert and gene chip were 81.82％(9/11),100.00％(9/9),100.00％(2/2)and 25.00％(1/4),respectively for the high to very-low bacterial load groups.CONCLUSIONS When the bacterial load of MTB is very low,the Xpert assay demonstrates a higher probability of both false-posi-tive and false-negative results for rifampicin resistance,followed by high bacterial loads.The most reliable detec-tion of rifampicin resistance occurs with medium bacterial loads.

This paper reviews the current situation of massive open online course (MOOC) construction both domestically and internationally, highlighting the similarities, differences, and limitations of MOOC construction across nations. Based on the full-cycle MOOC construction of the "clinical epidemiology" course at Southern Medical University, including course design, resource integration, online deployment, and teaching evaluation, this study explored the significance, implementation path, and challenges of MOOC construction. This paper also reflects on the activation of teaching content, teacher-student interaction, and teaching mode, aiming to provide a reference for the construction and continuous enhancement of MOOC in China.

OBJECTIVE To analyze the reliability of Xpert MTB/RIF(referred to as Xpert)in detecting rifampicin resistance under varying bacterial loads of Mycobacterium tuberculosis(MTB)so as to reference for clinical diag-nosis and treatment.METHODS A total of 3 050 mycobacterial culture-positive test results from Jan.2016 to Dec.2023 at the First Affiliated Hospital of Xiamen University were selected.After excluding 220 non-tubercu-lous mycobacteria cases,2 830 culture-positive specimens underwent Xpert testing,with 2 412 positive and 418 negative cases.Based on MTB bacterial load,specimens were divided into four treatment groups-high,medi-um,low and very low-with 552,916,656 and 288 cases,respectively.Solid phenotypic drug susceptibility testing(DST)was performed on 1 801 MTB strains that were both culture-positive and Xpert-positive.RESULTS The positive rates of rifampicin in the high,medium,low and very-low treatment groups were 10.33％(57/552),11.14％(102/916),8.54％(56/656)and 8.68％(25/288),respectively.Using the solid phenotypic drug sus-ceptibility testing results as the reference standard,the specificity and negative predictive value of Xpert for detec-ting rifampicin resistance in all four bacterial load groups exceeded 96％,with no statistically significant differ-ences observed.No significant difference in sensitivity was noted among the groups(P=0.053),though the high bacterial load group exhibited relatively lower sensitivity at 84.62％(44/52),while the very-low bacterial load group showed the lowest sensitivity at 76.00％(19/25),which was lower than the medium bacterial load group's 94.05％(79/84).The positive predictive values(PPV)across all groups were generally low but without statisti-cally significant differences(P=0.239),with the high and very-low bacterial load groups registering PPVs of 77.19％(44/57)and 76.00％(19/25),respectively.The concordance rates of Xpert and solid phenotypic drug susceptibility testing were consistently high among all four bacterial load groups,including 94.95％(395/416),97.51％(666/683),96.75％(477/493)and 94.26％(197/209),respectively,with no significant difference(P=0.052).The Kappa values from high to very-low bacterial load groups were 0.778,0.889,0.831 and 0.727,re-spectively.Among the strains with discordant results between Xpert and phenotypic drug susceptibility testing,the rifampicin result consistency rates between Xpert and gene chip were 81.82％(9/11),100.00％(9/9),100.00％(2/2)and 25.00％(1/4),respectively for the high to very-low bacterial load groups.CONCLUSIONS When the bacterial load of MTB is very low,the Xpert assay demonstrates a higher probability of both false-posi-tive and false-negative results for rifampicin resistance,followed by high bacterial loads.The most reliable detec-tion of rifampicin resistance occurs with medium bacterial loads.

This paper reviews the current situation of massive open online course (MOOC) construction both domestically and internationally, highlighting the similarities, differences, and limitations of MOOC construction across nations. Based on the full-cycle MOOC construction of the "clinical epidemiology" course at Southern Medical University, including course design, resource integration, online deployment, and teaching evaluation, this study explored the significance, implementation path, and challenges of MOOC construction. This paper also reflects on the activation of teaching content, teacher-student interaction, and teaching mode, aiming to provide a reference for the construction and continuous enhancement of MOOC in China.

Mixed reality technology combines the benefits of virtual reality and augmented reality to provide a new experience of virtual and real-world interaction, demonstrating great potential in nursing education. This paper reviews the application progress of mixed reality in basic nursing teaching, clinical skills training, personalized learning pathways, and teamwork, and looks ahead to future developments, innovations, and challenges of mixed reality technology to advance nursing education.

Mixed reality technology combines the benefits of virtual reality and augmented reality to provide a new experience of virtual and real-world interaction, demonstrating great potential in nursing education. This paper reviews the application progress of mixed reality in basic nursing teaching, clinical skills training, personalized learning pathways, and teamwork, and looks ahead to future developments, innovations, and challenges of mixed reality technology to advance nursing education.

As a physical treatment technique, modified electro-convulsive therapy (MECT) is used to treat mental and certain neurological disorders by causing seizures with short, suitable electrical currents applied to the brain while the patient is under general anesthesia and muscle relaxants. MECT is recognized for its therapeutic efficacy and clinical safety, rendering it one of the most prevalent interventions in psychiatric care. To enhance clinical outcomes and minimize adverse effects, this consensus document delineates the indications, therapeutic parameters, therapeutic procedures, potential adverse effects, and associated management strategies for MECT. These guidelines are informed by the latest clinical research and expert consensus, integrating evidence-based medicine methodologies. The objective is to furnish clinicians with precise operational guidelines and to advance the standardization of MECT practices in clinical settings.

As a physical treatment technique, modified electro-convulsive therapy (MECT) is used to treat mental and certain neurological disorders by causing seizures with short, suitable electrical currents applied to the brain while the patient is under general anesthesia and muscle relaxants. MECT is recognized for its therapeutic efficacy and clinical safety, rendering it one of the most prevalent interventions in psychiatric care. To enhance clinical outcomes and minimize adverse effects, this consensus document delineates the indications, therapeutic parameters, therapeutic procedures, potential adverse effects, and associated management strategies for MECT. These guidelines are informed by the latest clinical research and expert consensus, integrating evidence-based medicine methodologies. The objective is to furnish clinicians with precise operational guidelines and to advance the standardization of MECT practices in clinical settings.

Objective:To explore the caregiving feelings and needs of caregivers of children with β-thalassemia major.Methods:A semi-structured interview was conducted with 14 caregivers of children with β-thalassemia major who were treated at the Affiliated Hospital of Youjiang Medical University for Nationalities from December 2022 to March 2023, and the data were analyzed using the Colaizzi 7-step analysis method.Results:Caregivers of children with β-thalassemia major felt a greater burden of care, including declining physical and mental health, disruption of daily life rhythms and heavy financial burden. And their caregiving needs included psychological and emotional support, guidance on the physical and mental health of children, assurance of a stable blood supply and medical and social support.Conclusions:Caregivers of children with β-thalassemia major have a heavy burden of care and face various nursing difficulties in the daily care of children. Medical staff should actively take measures to meet their care needs and improve their care quality and quality of life.

Objective:The Self-Compassion Scale(SCS)is used to evaluate self-compassion in general popu-lation.The study was designed to evaluate the validity and reliability of the Chinese version of SCS in patients with eating disorders.Methods:Ten experts in the related disciplines completed the content validity evaluation.A total of 136 patients who met the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5)eating dis-order diagnostic criteria were surveyed with SCS to evaluate structural validity.Using the Rosenberg Self-Esteem Scale(SES),Satisfaction with Life Scale(SWLS),and Eating Disorder Examination Questionnaire 6.0(EDE-Q 6.0)as gold criterion,the criterion validity of SCS was measured.Twenty patients were selected for retesting to e-valuate test-retest reliability.Results:The item-level content validity index(I-CVI)of each item was between 0.70 and 1.00,and the average scale-level content validity index(S-CVI/Ave)was 0.96,indicating good content validi-ty.Factor analysis indicated a good fit for the six-factor model with reasonable factor loadings:x2/df=1.70,RM-SEA=0.07,CFI=0.92,TLI=0.91.The Chinese version of the SCS had an ICC of 0.31 with both SES and SWLS,and a negative correlation with EDE-Q 6.0 scores(r=-0.32).The test-retest reliability of the scale was 0.80.Conclusion:The Chinese version of the SCS has moderate validity and high reliability in patients with eating disorders,and can provide a clinical measure tool for psychological assessment in the Chinese population with eating disorders.