Objective To analyze the current status and influencing factors of occupational burnout among medical staff in Dongguan City. Methods A total of 1 007 medical staff from eight hospitals in Dongguan City were selected as the study subjects using the stratified sampling method. The Maslach Burnout Inventory-Human Service Survey and Moral Injury Symptom Scale (Healthcare Professionals Edition) were used to assess occupational burnout and moral injury among these study subjects. Binary logistic regression analysis was conducted to identify the influencing factors of occupational burnout. Results The detection rate of occupational burnout among the medical staff was 46.2%, and the detection rate of moral injury was 48.1%. The result of binary logistic regression analysis showed that after controlling for confounding factors such as age, marriage status, educational level, religious belief, professional title, and hospital characteristics, male medical staff had a higher risk of occupational burnout than female staff (P<0.01). Medical staff with ≤10 years of work experience had a higher risk of occupational burnout than those with >10 years of work experience(P<0.01). Additionally, medical staff with moral injury had a higher risk of occupational burnout than those without moral injury (P<0.01). Conclusion Occupational burnout is relatively common among medical staff in Dongguan City and is influenced by factors such as gender, working years, moral injury, and others.

BACKGROUND:Bone tissue defects are one of the most common diseases in orthopedics,and the current treatments for this disease are inadequate.The development of tissue engineering brings new hope for bone defect repair:by regulating the release of bioactive substances and the process of vascularization and neurogenesis at the defect site,it can effectively improve the microenvironment of bone tissue and promote osseointegration,which is the most promising research idea for large-size bone defect repair. OBJECTIVE:To explore the research progress of regulating bone microenvironment changes in bone defect repair in recent years from the effects of bioactive substances,vascularization and neurotization on three aspects of bone microenvironment changes,and to provide new ideas and strategies for the treatment of large-size bone defects. METHODS:The search terms"bone tissue engineering,angiogenesis,neurotization,cytokines,bone morphogenetic protein,vascular endothelial growth factor,neuropeptides,bone microenvironment"in Chinese and English were used to search for articles on the influence of changes in the bone microenvironment and their application in bone tissue engineering published from January 1,2001 to December 31,2022 on CNKI,WanFang,Web of Science,Science Direct,and PubMed.Finally,109 articles were included for review. RESULTS AND CONCLUSION:(1)The bone microenvironment is essential for the induction of bone tissue stem cell growth and differentiation,and mainly consists of the extracellular matrix of the bone tissue seeds and the biochemical factors required for intercellular interactions,the local blood circulation network and the surrounding nerve tissue.(2)Bone defect repair is a continuous process divided into multiple phases that overlap and are mediated by multiple cytokines,and the same cytokine can have mutually synergistic or antagonistic effects in one or more healing phases.(3)Neovascular regeneration is key to initiating bone repair,as neovascularisation not only provides essential nutrients,osteoblasts and growth factors for bone repair,but is also a gateway for repair cells to enter the injury zone.(4)In addition to regulating the type,dose and timeliness of vascular-inducing factor release to achieve blood transport reconstruction.The study of differential release delivery systems of multiple factors and the application of gene transfer technology will be the future research direction to solve large bone defects.(5)Neuropeptides can bind to relevant receptors and act on specific signaling pathways to guide vascular growth and influence bone healing,bone regeneration and the balance between osteogenesis and osteolysis through a variety of pathways.(6)In the establishment of neuralized tissue-engineered bone,the role of changes in the bone tissue microenvironment and neuromodulation is bidirectional.Cytokines in the bone matrix can participate in neuronal signaling pathways through the blood-nerve barrier.Neuropeptides secreted by glial cells act on the bone microenvironment,affecting bone healing,bone regeneration and the balance between osteogenesis and osteolysis.(7)There are still many questions regarding the regulation of the bone microenvironment by bioactive substances and the processes of vascularization and neurogenesis,such as the rapid diffusion and degradation of cytokines in the body and their loss of activity,the temporal and spatial distribution of angiogenesis-related growth factors,and the establishment of neurogenesis through the body's feedback regulatory mechanism,which need to be improved by subsequent studies.

Vestibular schwannomas (VSs) are the most common cerebellopontine tumors. The natural history of smaller-sized VSs (<30 mm) has been well-studied, leading to the recommendation of a “watch and wait” approach. However, large VSs (>30 mm) have not been extensively studied, mainly because of their rarity. As such, most patients are conventionally offered surgery which carries a significant risk of neurological morbidity. Here, we report a case of a giant VS (>40 mm) in a 30-year-old man who regressed spontaneously. He was lost to follow-up for 18 years and, upon re-presentation, the symptomatology drastically improved and repeat imaging demonstrated a marked reduction in tumor size. Referring to similar cases in other studies, we postulate that most large and giant VSs undergo a phase of growth and stasis, followed by regression due to shifts in the balance between tumorigenic and regressive factors. Taken together with emerging molecular data, further studies are required to better understand the history of large and giant VSs to shape more personalized treatment options. This potentially includes non-operative management as a tenable option.

Objective:To construct a geriatric comprehensive health evaluation system, and establish the norm of corresponding score.Methods:The methods of Delphi survey was implemented to develop the geriatric comprehensive health evaluation system.The weight coefficients of the items were calculated and assigned according to the expert-graded importance score and Saaty analytic hierarchy process.Reliability and validity of the system were examined.Goodness of fit was evaluated by confirmatory factor analysis.The demarcation norm of geriatric comprehensive health score was established based on an empirical study of 2, 118 non-hospitalized elderly population.Results:During the process of Delphi expert consultation and item analysis, nine items were deleted and two items were added.In the end, the 29-item comprehensive geriatric health evaluation system was developed, which included three dimensions of physiology, psychology, as well as social support and environment.The Cronbach's α coefficient of the evaluation system was 0.709.The exploratory factor analysis-extracted ten common factors meet ten second-level items.Confirmatory factor analysis indicated that the goodness of fit of the system was good.Geriatric health status was divided into five grades of very poor, poor, general, good and excellent by 0.5 to 1 standard deviation.The demarcation norm of geriatric comprehensive health score for different age and gender was established accordingly.Conclusions:The reliability and validity of the geriatric comprehensive health evaluation system are satisfactory.The construction of comprehensive health evaluation system and the establishment of the norm can facilitate the quantitative assessment of geriatric health status, and provide a reference for the screening and grading of individual health status in the elderly.

Metabolic regulation has been proven to play a critical role in T cell antitumor immunity. However, cholesterol metabolism as a key component of this regulation remains largely unexplored. Herein, we found that the low-density lipoprotein receptor (LDLR), which has been previously identified as a transporter for cholesterol, plays a pivotal role in regulating CD8

Objective:To understand the current situation of medical humanistic quality of standardized trainees for hospitalizations in Chongqing, and put forward the corresponding educational countermeasures and suggestions. Methods: According to the method of convenient sampling, 5 resident doctors standardized training base were selected with half a random, then 110 trainees were randomly selected to conduct a cognition investigation about the medical humanistic quality. EpiData 3. 0 was adopted for double entry data and SPSS22. 0 software was used for analyzing data. Results:There were 98. 06％ of standardized trainees for hospitalizations paid more attention to medical humanistic quality. In the selection of medical humanistic quality courses, 81. 55％ of the trainees chose The Doctor-patient Relationship, 77. 67％ of the trainees chose The Medical Psychology. In the evaluation of the importance of medical humanistic quality to the clinical work, 96. 12％ of the standardized trainees for hospitalizations believed that it was important. Conclusion: In order to improve the medical humanistic quality of the standardized trainees for hospitalizations, all aspects should be taken seriously:it should make efforts from the trai-nees' self-awareness, the teaching teachers' attention to the medical humanistic quality and the medical humanis-tic quality environment provided by the training base.

Objective To analyze genetic characteristics of HIV isolated from men who have sex with men(MSM) in Beijing and predict the epidemic trend in this population.Methods All of the HIV gene sequences in our laboratory obtained from MSM in Beijing were used,which were aligned with all of the HIV gene sequences from MSM and other populations in China downloaded from Los Alamos HIV Database.Phylogenetic trees were constructed by using software PhyML 3.0,based on which the relationships of prevalent HIV strains between Beijing MSM and other populations in China were further explored.The evolution rate,the time of most recent common ancestor (tMRCA),the epidemic parameters,the reproductive number (R0) were calculated by using software BEAST to predict HIV evolution and epidemic characteristics.Results Multiple HIV subtypes,including subtype B,CRF01_AE and CRF07_BC,were found to be prevalent among MSM in Beijing.In ML tree constructed based on strains from the whole country,three clusters including B-1,CRF01_AE-1,and CRF01_AE-2 were found among the MSM in Beijing (accounting for 40％).At least three independent introduction of B 1 cluster strains into Beijing MSM were found,which were at March 1991 (July 1984-February 1997),January 1994 (January 1989-January 1998),April 1991 (August 1984-January 1996).For CRF01_AE strains,two clusters including CRF01_AE-1 and CRF01_AE-2 were introduced into the population at December 2000 (March 1998-January 2003) and December 2001 (January 2000-July 2003) respectively.The population epidemiology of HIV in Beijing MSM was reconstructed based on sequences.The CRF01_AE-1 cluster spread more quickly than the other two clusters,and the evolution rate was higher.Conclusion Multiple HIV subtypes were found prevalent among MSM in Beijing.Although subtype B strain was introduced into Beijing MSM earlier than CRF01_AE strain,CRF01_AE strain increased more quickly than subtype B strain.More research and control of the CRF01_AE prevalence will be helpful for prevention and control of HIV epidemic in MSM in Beijing.

Neutralizing antibodies are considered to be an important protective parameter used in HIV-l vaccine evaluation.However,the exact role that neutralizing antibodies plays in controlling the disease progression of HIV-1 infected peoples is still undetermined.In this paper,we compared the protective function of the neutralizing antibody response in the plasma from LTNP and TP against clade B and clade C pseudoviruses.No difference in the neutralizing activities between the plasma from LTNP and TP was found,which was consistent with the most recent reports.In addition,no correlations between the titer or breadth and CD4+ or viral load in HIV-1 infected individuals were found.The protective roles played by neutralizing antibodies in controlling disease progression of HIV-1 infected people need to be considered in a new viewpoint.

OBJECTIVE: The large sample retrospective cohort study were used to compare the diagnostic efficiency of PET/CT with conventional work-up (CWU) for evaluating nasopharyngeal carcinoma (NPC) distant metastasis. METHOD: Five hundred and fourteen patients with NPC were divided into PET/CT group and CWU group according the method of detecting distant metastasis. Chest film, abdominal ultrasonography, and bone scan were used in CWU group. Then the diagnostic efficiency of the two groups was compared. RESULT: Two hundred and sixteen patints were enrolled in PET/CT group and two hundred and nineteen-eight ones in CWU group. There were 28 out of 412 suspicious patients in CWU group were confirmed, another 3 patients confirmed without positive findings, compared with PET/CT group that all 32 suspicious patients were confirmed. The sensitivity and specificity of PET/CT were 100.0% (32/32) and 100.0% (184/184), as compared to 90.3% (28/31) and 94.8% (253/267) with CWU respectively, while there was no statistical significance. Further research found out that the percentage of patients with multiple distant metastatic sites and multiple organ metastases was higher in PET/CT group (P < 0.05), and similarly of patients with distant metastasis in N2-3 stages (P < 0.01). CONCLUSION Our results suggest that PET/CT appears to be slightly superior to conventional work-up in assessment of distant metastasis in NPC patients, but CWU is still a cheap and practical method.
Aged ; Carcinoma ; Cohort Studies ; Female ; Fluorodeoxyglucose F18 ; Humans ; Male ; Middle Aged ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; diagnosis ; secondary ; Positron-Emission Tomography ; methods ; Radiopharmaceuticals ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Ultrasonography