Background Staff in biosafety laboratories (BSL) are more likely to experience occupational burnout and other psychological issues due to their unique working environment and high job demands. However, current research in this field tends to focus on overall analyses, overlooking the internal differences within this group. Objective To explore latent profiles of occupational burnout among BSL workers and their influencing factors, providing a reference for targeted burnout interventions. Methods In 2022, cluster random sampling was used to select 8023 BSL workers in Xinjiang. Data were collected via a questionnaire survey, including a self-designed general information questionnaire, the Maslach Burnout Inventory-General Survey (MBI-GS), and the Effort-Reward Imbalance (ERI) scale, to analyze demographic characteristics, occupational burnout, and job stress status. After data cleaning, latent profile analysis (LPA) was applied to identify burnout profiles, followed by K-means clustering for verification. Logistic regression was used to analyze influencing factors with burnout profiles as the dependent variable. Results After excluding invalid questionnaires, 7924 valid questionnaires were retained, with an recovery rate of 98.77%. The LPA results indicated that occupational burnout among BSL staff was categorized into three latent profiles: a low burnout profile (2208 individuals, 27.86%), a moderate burnout profile (4636 individuals, 58.51%), and a high burnout profile (1080 individuals, 13.63%). A similar grouping was derived from K-means clustering analysis (28.71%, 53.37%, and 17.92%), and a Sankey diagram demonstrated significant overlap between the two classification results. Statistically significant differences were observed across the three latent profiles in all three dimensions of burnout: emotional exhaustion, cynicism, and reduced personal accomplishment. The final logistic regression model revealed that the influencing factors exhibited characteristics of partial overlap and partial differentiation. Among the common influencing factors, the shared protective factors included: age ≥50 years (OR_{moderate burnout}=0.42, OR_{high burnout}=0.45), monthly income of 4000-6000 RMB (OR_{moderate burnout}=0.83, OR_{high burnout}=0.71), good sleep quality (OR_{moderate burnout}=0.70, OR_{high burnout}=0.13) and very good sleep quality (OR_{moderate burnout}=0.51, OR_{high burnout}=0.12), and engaging in physical exercise ≥5 times per week (OR_{moderate burnout}=0.74, OR_{high burnout}=0.48). The protective effects were more pronounced for the high burnout profile. The common risk factors included: 21–30 years of service (OR_{moderate burnout}=1.38, OR_{high burnout}=3.00), ≥31 years of service (OR_{moderate burnout}=1.47, OR_{high burnout}=3.39), working in "other positions" (OR_{moderate burnout}=1.46, OR_{high burnout}=1.56), and occupational stress (ERI>1) (OR_{moderate burnout}=2.62, OR_{high burnout}=3.25), with the risk effects being more significant for the high burnout profile. Regarding differentiated influencing factors, protective factors exclusively associated with the moderate burnout profile included having an associate degree (OR=0.70) and engaging in physical exercise 3-4 times per week (OR=0.74). For the high burnout profile, exclusive protective factors included age 40-50 years (OR=0.56), while exclusive risk factors included having a senior professional title (OR=1.85), holding a managerial role (OR=1.78), a high number of night shifts per month (OR=2.66), and a very high number of night shifts per month (OR=3.93). Conclusion BSL workers exhibit three distinct latent burnout profiles. Occupational burnout requires greater attention, and targeted prevention and intervention strategies should be developed based on worker subtypes.

Objective:To explore the phenotypic heterogeneity among patients harboring identical pathogenic variants in the dystrophin ( DMD) gene by analyzing clinical and imaging data from 7 pairs of male twins with dystrophinopathy. Methods:Clinical and laboratory data of 14 (7 pairs) male twins diagnosed with dystrophinopathy through genetic testing among 1 767 patients at Peking University First Hospital from January 2017 to October 2024 were collected. Eleven patients underwent thigh muscle magnetic resonance imaging (MRI), and muscle biopsies were performed in at least 1 case of each pair.Results:Among the 7 pairs of twin patients, 2 pairs had Duchenne muscular dystrophy, and 5 pairs had Becker muscular dystrophy. In terms of variant types, 4 pairs had in-frame deletions, while the remaining 3 pairs had duplication variants, frameshift variants, and nonsense variants, respectively. Clinically, 6 individuals had asymptomatic hypercreatine kinasemia, and 8 had varying degrees of limb weakness. Among the 5 pairs of symptomatic twins, there were differences in the degree of limb weakness. Four individuals showed no significant abnormalities in thigh muscle MRI, 7 showed fat infiltration mainly in the bilateral gluteus maximus and adductor magnus muscles, and 2 pairs of twins had obvious differences in the degree of fat infiltration in muscle MRI. Muscle biopsies revealed dystrophic or mild myopathic pathological changes, with 2 individuals showing severe loss of dystrophin, while the others had partial loss.Conclusions:Dystrophinopathy exhibits significant individual differences. Even among individuals with highly similar genetic background, clinical and imaging manifestations caused by the same pathogenic variant also vary.

Pulmonary anthrax is an acute zoonotic infectious disease caused by Bacillus anthracis infecting the human body. Humans can be infected by coming into contact with diseased animals and their products or by consuming diseased animals. According to the different infection routes, it can be classified into cutaneous anthrax, pulmonary anthrax and intestinal anthrax, etc. Among them, cutaneous anthrax is the most common, while case reports of pulmonary anthrax are rare. This article analyzes the clinical data of a case of occupational pulmonary anthrax diagnosed by metagenomic next-generation sequencing (mNGS) and successfully treated, so as to provide a reference for the clinical treatment of pulmonary anthrax.

Case 1 A 68-year-old male patient presented with poor appetite persisting for over 2 months and had been diagnosed with liver cancer 7 days prior. He was admitted to Liaocheng Second People′s Hospital on October 17, 2017. On October 18, 2017, at 8:00, the patient underwent transcatheter arterial chemoembolization under local anesthesia. At 17:30, the patient developed a fever. At 20:00, "port wine-colored" urine was noted during catheterization, prompting transfer to the intensive care unit (ICU) for enhanced treatment. Case 2 A 67-year-old male patient with a previous diagnosis of hilar cholangiocarcinoma presented to the Emergency Department of Liaocheng Second People′s Hospital at 17:40 on March 25, 2025, due to "unconsciousness for one hour". Routine blood testing revealed significantly decreased white blood cells, red blood cells, and platelets. Considering the critical condition, the patient was transferred to the ICU. At 19:30, "port wine-colored" urine was observed in the urinary catheter. Both cases showed evident signs of hemolysis in blood samples, rapid disease progression, with fatal outcomes occurring within a short period. Blood cultures from both patients signaled positive in anaerobic bottles. Identification using the bioMérieux VITEK 2 COMPACT ANC card confirmed Clostridium perfringens. Bloodstream infections caused by Clostridium perfringens leading to such severe intravascular hemolysis are rare. The disease course is notoriously aggressive. In clinical practice, early recognition of this infection is paramount.

Pulmonary anthrax is an acute zoonotic infectious disease caused by Bacillus anthracis infecting the human body. Humans can be infected by coming into contact with diseased animals and their products or by consuming diseased animals. According to the different infection routes, it can be classified into cutaneous anthrax, pulmonary anthrax and intestinal anthrax, etc. Among them, cutaneous anthrax is the most common, while case reports of pulmonary anthrax are rare. This article analyzes the clinical data of a case of occupational pulmonary anthrax diagnosed by metagenomic next-generation sequencing (mNGS) and successfully treated, so as to provide a reference for the clinical treatment of pulmonary anthrax.

Case 1 A 68-year-old male patient presented with poor appetite persisting for over 2 months and had been diagnosed with liver cancer 7 days prior. He was admitted to Liaocheng Second People′s Hospital on October 17, 2017. On October 18, 2017, at 8:00, the patient underwent transcatheter arterial chemoembolization under local anesthesia. At 17:30, the patient developed a fever. At 20:00, "port wine-colored" urine was noted during catheterization, prompting transfer to the intensive care unit (ICU) for enhanced treatment. Case 2 A 67-year-old male patient with a previous diagnosis of hilar cholangiocarcinoma presented to the Emergency Department of Liaocheng Second People′s Hospital at 17:40 on March 25, 2025, due to "unconsciousness for one hour". Routine blood testing revealed significantly decreased white blood cells, red blood cells, and platelets. Considering the critical condition, the patient was transferred to the ICU. At 19:30, "port wine-colored" urine was observed in the urinary catheter. Both cases showed evident signs of hemolysis in blood samples, rapid disease progression, with fatal outcomes occurring within a short period. Blood cultures from both patients signaled positive in anaerobic bottles. Identification using the bioMérieux VITEK 2 COMPACT ANC card confirmed Clostridium perfringens. Bloodstream infections caused by Clostridium perfringens leading to such severe intravascular hemolysis are rare. The disease course is notoriously aggressive. In clinical practice, early recognition of this infection is paramount.

Objective:To explore the phenotypic heterogeneity among patients harboring identical pathogenic variants in the dystrophin ( DMD) gene by analyzing clinical and imaging data from 7 pairs of male twins with dystrophinopathy. Methods:Clinical and laboratory data of 14 (7 pairs) male twins diagnosed with dystrophinopathy through genetic testing among 1 767 patients at Peking University First Hospital from January 2017 to October 2024 were collected. Eleven patients underwent thigh muscle magnetic resonance imaging (MRI), and muscle biopsies were performed in at least 1 case of each pair.Results:Among the 7 pairs of twin patients, 2 pairs had Duchenne muscular dystrophy, and 5 pairs had Becker muscular dystrophy. In terms of variant types, 4 pairs had in-frame deletions, while the remaining 3 pairs had duplication variants, frameshift variants, and nonsense variants, respectively. Clinically, 6 individuals had asymptomatic hypercreatine kinasemia, and 8 had varying degrees of limb weakness. Among the 5 pairs of symptomatic twins, there were differences in the degree of limb weakness. Four individuals showed no significant abnormalities in thigh muscle MRI, 7 showed fat infiltration mainly in the bilateral gluteus maximus and adductor magnus muscles, and 2 pairs of twins had obvious differences in the degree of fat infiltration in muscle MRI. Muscle biopsies revealed dystrophic or mild myopathic pathological changes, with 2 individuals showing severe loss of dystrophin, while the others had partial loss.Conclusions:Dystrophinopathy exhibits significant individual differences. Even among individuals with highly similar genetic background, clinical and imaging manifestations caused by the same pathogenic variant also vary.

Objective To investigate the predictive value of inflammatory cells and clinical features in the prognosis of immune checkpoint inhibitors (ICIs) treating non-small cell lung cancer (NSCLC).Methods The data of 163 cases of stage Ⅲ and Ⅳ NSCLC patients treated with the ICIs in this hospital from January 1,2017 to December 31,2022 were collected.The CT examination was conducted after 6-8 weeks treatment.The pa-tients were divided into the objective remission group[complete remission (CR)+partial remission (PR)]and non-objective remission group[stable disease (SD)+progressed disease (PD)],disease control group (CR+PR+SD) and non-disease control group (PD),persistent clinical benefit group (DCB) and non-DCB group.The differences in clinical features and inflammatory cells indicators were compared among the differ-ent groups.The receiver operating characteristic (ROC) curve was adopted to evaluate the predictive efficiency of the inflammatory cells indicators for DCB.The influencing factors analysis of progression free survival (PFS) time and overall survival (OS) time adopted the Cox regression analysis.Results The lymphocyte count (ALC) in the disease control group was higher than that in the non-disease control group.The neutro-phil to lymphocyte ratio (NLR),platelet-lymphocyte ratio (PLR) and mononuclear lymphocyte ratio (MLR) were lower than those in the non-disease control group.The proportions of squamous cell carcinoma,stage Ⅲ,ECOG score 0-1 point,adverse reactions in the DCB group were higher than those in the non-DCB group (P<0.05),the PLT count,NLR,PLR and MLR were lower than those in the non-DCB group (P<0.05). The ROC curve analysis results showed that PLT,NLR,PLR and MLR could serve as the indicators for pre-dicting DCB,the area under of ROC curve (AUC) was 0.633,0.602,0.635 and 0.604 respectively,the opti-mal cut off values were 187×109/L (P=0.004),5.0 (P=0.026),235 (P=0.003) and 0.35 (P=0.024) re-spectively.The multivariate Cox regression analysis showed that non-squamous carcinoma including adenocar-cinoma (HR=1.565,95％CI:1.057-2.316) and other pathologic types (HR=2.285,95％CI:1.326-3.936),ECOG score 2-3 points (HR=2.375,95％CI:1.652-3.415),AMC≥0.65×109/L (HR=1.847,95％CI:1.160-2.938) and PLR≥235 (HR=1.557,95％CI:1.016-2.386) were the independent risk factors for short PFS.The ECOG score 2-3 points (HR=4.615,95％CI:2.882-7.391),AMC≥0.65×109/L (HR=5.161,95％CI:2.984-8.925) and PLR ≥235 (HR=1.732,95％CI:1.059-2.833) were the independent risk fac-tors for short OS (P<0.05),and having adverse reactions (HR=0.472,95％CI:0.294-0.757) was the independ-ent protective factor for short OS (P<0.05).Conclusion Lower PLT,AMC,NLR,MLR and PLR,higher ALC,squamous cell carcinoma,TNM stage Ⅲ,ECOG score 0-1 point and immunotherapy related adverse reactions could prompt that the prognosis is good in ICIs treating advanced NSCLC.PLT,NLR,PLR and MLR could serve as the indicators for predicting DCB.

Purpose/Significance To deeply analyze the research progress on the application of medical knowledge graph in the field of stroke,to discuss the problems of the development of stroke knowledge graph in China,and to put forward suggestions for the construc-tion of stroke knowledge graph.Method/Process By reviewing and analyzing the relevant literature,the application of medical knowledge graph in the field of stroke is sorted out and summarized.Result/Conclusion There are still many deficiencies in the development of stroke knowledge graph in China,and in the future,in-depth research can be carried out from four aspects,namely,expanding the ap-plication scope of knowledge graph,promoting the fusion of knowledge graph,developing more efficient algorithms,and upgrading to cog-nitive graph by joint artificial intelligence(AI).

Objective:To investigate the clinical characteristics of prostatic abscesses (PA)primarily presenting as urinary retention in the elderly patients and the therapeutic effect of TURP.Methods:A retrospective analysis was conducted on the case records of four elderly patients with PA who presented primarily with urinary retention and were admitted to our hospital between July 2020 and August 2022. The median age of the four patients was 68.0 (62.0, 77.0) years, all of whom were admitted to the hospital due to progressive difficulty of urination and inability to urinate. All four patients exhibited chills and high fever, with three cases presenting prior to admission and one case post-admission. One patient developed secondary sepsis, and 2 patients experienced perineal pain. Two patients had a history of diabetes, and 2 had a history of hypertension. The rectal digital examination of these four patients revealed prostate enlargement, with 2 cases of tenderness and one case of fluctuation sensation on the prostate. Blood and urine bacterial cultures were carried out in 4 patients, of which 3 patients were positive of blood culture with 2 cases of Escherichia coli and one case of Klebsiella pneumoniae, 2 patients were positive of the urine culture with one case of Escherichia coli and one case of Klebsiella pneumoniae, and one patient was negative of blood and urine culture.Serum C-reactive protein (CRP)and procalcitonin (PCT) increased in these 4 patients, with 118-190 mg/L and 1.39-13.45 ng/ml respectively. One of the 4 patients had elevated serum PSA levels, with a value of 16.95 ng/L, while the remaining 3 patients had normal serum PSA levels. The median international prostate symptom score (IPSS) score before surgery was 31.5(28.7, 34.3) points for these 4 patients, and the median quality of life (QOL) score was 5.0(4.2, 5.8) points. The transabdominal ultrasound examination of these 4 patients showed that the prostate was enlarged and the echo of the prostate was uneven, and the hypoechoic area in the prostate was found in 2 cases. On plain CT scan of the prostate in these cases, the prostate was enlarged, and there was an area of uneven reduction in density. MRI plain scan of the prostate in 2 cases showed abscess in the peripheral zone of the prostate. Among the 4 cases of PA, 3 cases were diagnosed before operation. The size of abscess was 1.7-5.8 cm, including one case of multiple abscess. Another case of PA was found during TURP for benign prostatic hyperplasia. Four patients were undergoing TURP after antibiotic treatment. During the operation, the pus cavity was found at the prostatic capsule, and the pus cavity wall at the urethral side was removed to make the pus cavity fully open. Three-chamber F20 Foley catheter was placed in the urethra eventually.Results:The operation was successfully completed in these 4 patients, and the operation time was 30 to 90 minutes. Postoperative pathology reported benign prostatic hyperplasia with acute/chronic inflammatory cell infiltration. One patient developed fever on the day after operation, with the highest temperature of 38.6 ℃, and improved after pharmaceutical treatment. Urinary catheter was retained for 5 days postoperatively. Five days after surgery, the urinary catheter was removed and all 4 patients had unobstructed urination. One patient experienced transient urinary incontinence caused by urinary tract infection, which improved after 2 weeks of treatment with increased water intake and oral antibiotics. One month after the operation, the abscess cavity of all patients was completely disappeared and urination was smooth. One-month postoperative follow-up revealed complete resolution of abscess cavities in all patients by prostate CT. The median postoperative IPSS was 13.5(8.5, 17.0)( P=0.0286), and the median QOL score was 1.0(0.3, 1.8)( P=0.0284), both showing statistically significant differences compared to preoperative values. Over the follow-up period ranging from 19 to 44 months, no abscess recurrence was noted in the 4 cases, and retrograde ejaculation was noted in 2 cases. Complications such as urethral stricture, urinary incontinence, and urinary retention did not occur. One patient developed epididymitis and orchitis 6 weeks post-surgery, which improved following 2 weeks of conservative treatment. Conclusions:The symptoms of elderly PA patients primarily presenting as urinary retention were severe. TURP can relieve the symptoms of lower urinary tract obstruction while draining the pus cavity, and the therapeutic effect is satisfactory.