Background Prehospital emergency medical personnel (PEMP) are exposed to long-term high-pressure work, which can exacerbate psychological distress and impair job satisfaction and sleep quality. However, in-depth research on the interactions among these factors is lacking. Objective To assess the status of psychological distress, job satisfaction, and sleep quality of PEMP in Guangzhou and to explore the mediating role of sleep quality in the relationship between psychological distress and job satisfaction. Methods From February to May 2025, 1085 PEMP from "120" emergency network hospitals in Guangzhou were selected using convenience sampling. Data were collected via the General Information Questionnaire, Kessler Psychological Distress Scale, Minnesota Satisfaction Questionnaire, and Pittsburgh Sleep Quality Index. Statistical analyses were performed using SPSS 25.0, and The mediation model of sleep quality in linking psychological distress and job satisfaction was constructed using AMOS 28.0. The bias-corrected Bootstrap method was employed to assessed the significance of the mediating effect. Results A total of 1063 valid responses were received (97.97% valid response rate). The mean scores were: psychological distress (27.99±10.75), job satisfaction (69.45±15.84), and sleep quality (9.82±4.47). Significant differences in the three scores were found across gender, age, monthly night shift frequency, and hospital grade (P<0.05). Higher job satisfaction was linked to lower psychological distress and better sleep quality and its dimensions, while psychological distress directly correlated with poorer sleep quality (P<0.01). Sleep quality partially mediated the relationship between psychological distress and job satisfaction, with a mediating effect of −0.195, accounting for 43.62% of the total effect. Conclusion The participants report moderate psychological distress, moderate-to-high job satisfaction, and poor sleep quality. Psychological distress directly affects job satisfaction and indirectly through its impact on sleep quality. Interventions aimed at improving sleep health and mental health are essential to improve personnel well-being and work efficiency.

Background Prehospital emergency medical personnel (PEMP) are exposed to long-term high-pressure work, which can exacerbate psychological distress and impair job satisfaction and sleep quality. However, in-depth research on the interactions among these factors is lacking. Objective To assess the status of psychological distress, job satisfaction, and sleep quality of PEMP in Guangzhou and to explore the mediating role of sleep quality in the relationship between psychological distress and job satisfaction. Methods From February to May 2025, 1085 PEMP from "120" emergency network hospitals in Guangzhou were selected using convenience sampling. Data were collected via the General Information Questionnaire, Kessler Psychological Distress Scale, Minnesota Satisfaction Questionnaire, and Pittsburgh Sleep Quality Index. Statistical analyses were performed using SPSS 25.0, and The mediation model of sleep quality in linking psychological distress and job satisfaction was constructed using AMOS 28.0. The bias-corrected Bootstrap method was employed to assessed the significance of the mediating effect. Results A total of 1063 valid responses were received (97.97% valid response rate). The mean scores were: psychological distress (27.99±10.75), job satisfaction (69.45±15.84), and sleep quality (9.82±4.47). Significant differences in the three scores were found across gender, age, monthly night shift frequency, and hospital grade (P<0.05). Higher job satisfaction was linked to lower psychological distress and better sleep quality and its dimensions, while psychological distress directly correlated with poorer sleep quality (P<0.01). Sleep quality partially mediated the relationship between psychological distress and job satisfaction, with a mediating effect of −0.195, accounting for 43.62% of the total effect. Conclusion The participants report moderate psychological distress, moderate-to-high job satisfaction, and poor sleep quality. Psychological distress directly affects job satisfaction and indirectly through its impact on sleep quality. Interventions aimed at improving sleep health and mental health are essential to improve personnel well-being and work efficiency.

OBJECTIVE To explore the effects of meropenem exposure and degradation levels on clinical efficacy in patients with purulent meningitis （PM）. METHODS A total of 131 PM patients treated with meropenem at the Affiliated Suzhou Hospital of Nanjing Medical University from January 2022 to June 2025 were prospectively included. Relevant data were collected and divided into a cured group （91 cases） and a non-cured group （40 cases） based on the efficacy. High-performance liquid chromatography-tandem mass spectrometry was used to determine the concentration of meropenem and its open-loop metabolites. Risk factors that affect efficacy were screened， and their predictive power and correlation were evaluated by univariate analysis， and multivariate Logistic regression analysis， receiver operating characteristic （ROC） curves， and correlation analysis. RESULTS Univariate analysis showed that serum creatinine， creatinine clearance rate， minimum inhibitory concentration of meropenem ≥16 μg/mL， cerebrospinal fluid red blood cell count， cerebrospinal fluid white blood cell count， cerebrospinal fluid glucose content， blood trough concentration， blood open-loop metabolite concentration/trough concentration ratio， and intrathecal injection were all correlated with efficacy （P＜0.05）. The results of multiple Logistic regression analysis showed that serum creatinine blood open-loop metabolite concentration/trough concentration ratio， intrathecal injection， and cerebrospinal fluid glucose content were influencing factors for suboptimal anti-infective ltt efficacy （P＜0.05）. ROC curve analysis showed that when the blood open-loop metabolite concentration/trough concentration ratio was greater than 2.854 （AUC＝0.647）， serum creatinine was less than 59.5 μmol/L （AUC＝0.647）， and cerebrospinal fluid glucose content was less than 3.37 mmol/L （AUC＝0.709）， the risk of treatment failure significantly increased （P＜0.05）. Correlation analysis showed that the blood trough concentration of meropenem was positively correlated with the concentration of its open-loop metabolites （R 2＝0.134 5， P＜0.000 1）. CONCLUSIONS Insufficient exposure level and rapid degradation of meropenem are key mechanisms affecting the anti-infective efficacy of PM. Elevated blood open-loop metabolite concentration/ trough concentration ratio， low serum creatinine level， lack of intrathecal injection， and low cerebrospinal fluid glucose content are independent risk factors for poor efficacy.

BACKGROUND:At present,hydroxyapatite has been used more and more widely in the field of facial fillers due to its good biocompatibility and low immunity.The main sources are divided into natural extraction and artificial synthesis.However,there are few comparative studies on natural extraction and artificial synthesis of hydroxyapatite,especially the difference in stimulating collagen secretion between the two.OBJECTIVE:To investigate the physicochemical differences between naturally derived and commercially available synthetic calcium hydroxyapatite particles and promoting collagen secretion.METHODS:(1)Natural hydroxyapatite particles from pig bones and two kinds of commercially available synthetic hydroxyapatite particles(denoted as SYN1 and SYN2)were used to characterize the microstructure and surface element content of the three kinds of materials.(2)The three kinds of materials with different mass concentrations(1,5,and 10 mg/mL)were co-cultured with human skin fibroblasts.Cell proliferation was detected by CCK-8 assay.The three kinds of materials at 5 mg/mL were co-cultured with human skin fibroblasts.Cell adhesion was observed by CCK-8 assay and scanning electron microscopy.The expression of type Ⅰ collagen was detected by RT-PCR,ELISA,and western blot assay.(3)Twelve New Zealand rabbits were selected,of which six were subcutaneously injected with a mixture of natural hydroxyapatite and 2％sodium carboxymethylcellulose gel on the back.The remaining six rabbits were subcutaneously injected with a mixture of SYN2 and 2％sodium carboxymethylcellulose gel on the back.The samples were collected 1 and 3 months after injection and stained with Masson and Sirius red.RESULTS AND CONCLUSION:(1)Scanning electron microscope showed that the crystal grains of natural hydroxyapatite particles were more regular and uniform,with holes evenly distributed between particles.The SYN1 grains were smaller and densely arranged,while the SYN2 grains were irregular.The median particle sizes of natural hydroxyapatite particles,SYN1,and SYN2 were 38,24,and 40 pm,respectively.Natural hydroxyapatite contained Mg and Zn,SYN1 did not contain Mg and Zn,and SYN2 did not contain Zn.(2)CCK-8 assay showed that 1 and 5 mg/mL of natural hydroxyapatite and SYN2 promoted the proliferation of human skin fibroblasts,while 5 and 10 mg/mL of SYN1 inhibited the proliferation of human skin fibroblasts.The number of cells adhered to the surface of natural hydroxyapatite particles was more than that of SYN1 and SYN2,and the cells on the surface of natural hydroxyapatite particles spread well,with visible filopodia.RT-PCR,ELISA,and western blot assay results showed that the expression of type Ⅰ collagen in the natural hydroxyapatite particle group was higher than that in the SYN1 group and the SYN2 group.(3)The results of Masson and Sirius red staining showed that the amount of type Ⅰ collagen in the subcutaneous tissue of the natural hydroxyapatite particle group was greater than that of the SYN2 group 1 and 3 months after injection.(4)The results show that compared with synthetic hydroxyapatite particles,natural hydroxyapatite particles have a richer distribution of trace elements and can better promote fibroblast adhesion,proliferation and collagen regeneration.

China has made remarkable achievements during the past three decades in controlling chronic hepatitis B virus infection. The overall HBsAg positivity rate dropped from 9.72% in 1992 to 5.86% in 2020. Particularly, the HBsAg positivity rate among children under five years old has dropped from 9.67% in 1992 to 0.30% in 2020. This transition is due to the universal vaccination of newborns with hepatitis B vaccine since 1992, which has averted over 40 million of HBV infections and seven million hepatitis B-related deaths. However, there are still around 75 million cases of chronic hepatitis B virus infection in China, of which about 59.78% of the infected individuals were aware of their infection status before survey, and about 30 million people have not yet been diagnosed. Among the confirmed infected individuals, 38.25% (about 17 million people) have indications for antiviral treatment, but only 17.33% (about 3 million people) are receiving antiviral treatment. Therefore, in order to accelerate the actualization of the World Health Organization's goal of eliminating viral hepatitis as a public health threat by 2030, China has taken a series of active measures in recent years, including updating clinical guidelines and expanding treatment indications to improve the coverage of diagnosis and treatment. At the same time, Chinese pharmaceutical companies and academia have made significant progress in the research and development of innovative hepatitis B therapies, laying the foundation for achieving the functional cure of chronic hepatitis B. Furthermore, China has developed a comprehensive management model for the prevention, control, and elimination of hepatitis B through evidence-based public health interventions, optimized clinical management strategies, and promotion of innovative drugs, providing valuable experience for the world.

BACKGROUND:At present,hydroxyapatite has been used more and more widely in the field of facial fillers due to its good biocompatibility and low immunity.The main sources are divided into natural extraction and artificial synthesis.However,there are few comparative studies on natural extraction and artificial synthesis of hydroxyapatite,especially the difference in stimulating collagen secretion between the two.OBJECTIVE:To investigate the physicochemical differences between naturally derived and commercially available synthetic calcium hydroxyapatite particles and promoting collagen secretion.METHODS:(1)Natural hydroxyapatite particles from pig bones and two kinds of commercially available synthetic hydroxyapatite particles(denoted as SYN1 and SYN2)were used to characterize the microstructure and surface element content of the three kinds of materials.(2)The three kinds of materials with different mass concentrations(1,5,and 10 mg/mL)were co-cultured with human skin fibroblasts.Cell proliferation was detected by CCK-8 assay.The three kinds of materials at 5 mg/mL were co-cultured with human skin fibroblasts.Cell adhesion was observed by CCK-8 assay and scanning electron microscopy.The expression of type Ⅰ collagen was detected by RT-PCR,ELISA,and western blot assay.(3)Twelve New Zealand rabbits were selected,of which six were subcutaneously injected with a mixture of natural hydroxyapatite and 2％sodium carboxymethylcellulose gel on the back.The remaining six rabbits were subcutaneously injected with a mixture of SYN2 and 2％sodium carboxymethylcellulose gel on the back.The samples were collected 1 and 3 months after injection and stained with Masson and Sirius red.RESULTS AND CONCLUSION:(1)Scanning electron microscope showed that the crystal grains of natural hydroxyapatite particles were more regular and uniform,with holes evenly distributed between particles.The SYN1 grains were smaller and densely arranged,while the SYN2 grains were irregular.The median particle sizes of natural hydroxyapatite particles,SYN1,and SYN2 were 38,24,and 40 pm,respectively.Natural hydroxyapatite contained Mg and Zn,SYN1 did not contain Mg and Zn,and SYN2 did not contain Zn.(2)CCK-8 assay showed that 1 and 5 mg/mL of natural hydroxyapatite and SYN2 promoted the proliferation of human skin fibroblasts,while 5 and 10 mg/mL of SYN1 inhibited the proliferation of human skin fibroblasts.The number of cells adhered to the surface of natural hydroxyapatite particles was more than that of SYN1 and SYN2,and the cells on the surface of natural hydroxyapatite particles spread well,with visible filopodia.RT-PCR,ELISA,and western blot assay results showed that the expression of type Ⅰ collagen in the natural hydroxyapatite particle group was higher than that in the SYN1 group and the SYN2 group.(3)The results of Masson and Sirius red staining showed that the amount of type Ⅰ collagen in the subcutaneous tissue of the natural hydroxyapatite particle group was greater than that of the SYN2 group 1 and 3 months after injection.(4)The results show that compared with synthetic hydroxyapatite particles,natural hydroxyapatite particles have a richer distribution of trace elements and can better promote fibroblast adhesion,proliferation and collagen regeneration.

China has made remarkable achievements during the past three decades in controlling chronic hepatitis B virus infection. The overall HBsAg positivity rate dropped from 9.72% in 1992 to 5.86% in 2020. Particularly, the HBsAg positivity rate among children under five years old has dropped from 9.67% in 1992 to 0.30% in 2020. This transition is due to the universal vaccination of newborns with hepatitis B vaccine since 1992, which has averted over 40 million of HBV infections and seven million hepatitis B-related deaths. However, there are still around 75 million cases of chronic hepatitis B virus infection in China, of which about 59.78% of the infected individuals were aware of their infection status before survey, and about 30 million people have not yet been diagnosed. Among the confirmed infected individuals, 38.25% (about 17 million people) have indications for antiviral treatment, but only 17.33% (about 3 million people) are receiving antiviral treatment. Therefore, in order to accelerate the actualization of the World Health Organization's goal of eliminating viral hepatitis as a public health threat by 2030, China has taken a series of active measures in recent years, including updating clinical guidelines and expanding treatment indications to improve the coverage of diagnosis and treatment. At the same time, Chinese pharmaceutical companies and academia have made significant progress in the research and development of innovative hepatitis B therapies, laying the foundation for achieving the functional cure of chronic hepatitis B. Furthermore, China has developed a comprehensive management model for the prevention, control, and elimination of hepatitis B through evidence-based public health interventions, optimized clinical management strategies, and promotion of innovative drugs, providing valuable experience for the world.

Objective:To investigate the value of radiomics signatures based on 18F-FDG PET/CT for predicting molecular classification and Ki-67 expression of breast cancer. Methods:A total of 134 female patients ((55.4±13.3) years) who underwent 18F-FDG PET/CT examination and were diagnosed with breast cancer by pathology in the First Affiliated Hospital of Soochow University from April 2016 to May 2023 were retrospectively enrolled. LIFEx software was used to extract radiomics features and the least absolute shrinkage and selection operator (LASSO) algorithm and independent-sample t test were used to screen potentially meaningful features and calculate the radiomics score, which were considered as radiomics models. Clinical characteristics were selected by supervised logistic regression and clinical models were established. Radiomics features and clinical characteristics were incorporated to logistic regression analysis to establish combined models. ROC curves were drawn and the differences among AUCs were analyzed by Delong test. Results:Among 134 patients, 22 were with triple negative breast cancer (TNBC), 47 were human epidermal growth factor receptor 2 (HER2) over-expression type, 37 were Luminal A type and the rest 28 were Luminal B type. The expression of Ki-67 was high in 85 patients, and was low in the rest 49 patients. The AUCs (95% CI) of the combined models for predicting TNBC, HER2 overexpression type, Luminal A type and Ki-67 expression were 0.843(0.770-0.900), 0.808(0.723-0.876), 0.825(0.711-0.908) and 0.836(0.762-0.894), respectively, which were higher than those of clinical models ( z values: 1.97-3.06, all P<0.05). Conclusion:The predictive model combining radiomics signatures based on 18F-FDG PET/CT and clinical characteristics can well predict the molecular classification and Ki-67 expression level of breast cancer.

Objective To investigate the relationship between the expression of Klotho,apoptosis-related factors and oxidative stress injury of the trabecular meshwork in patients with glaucoma.Methods Totally 86 patients(86 eyes)with glaucoma admitted to our hospital from October 2021 to October 2023 were selected as the study group.Tissue sam-ples of trabecular meshwork were obtained during the operation.Trabecular meshwork donor tissues(45 cases)from pa-tients with non-eye diseases were taken as the control group.Hematoxylin-Eosin(HE)staining was used to examine the histopathological characteristics,and the expression levels of Klotho,apoptosis-associated speck-like protein containing a CARD(ASC),cysteine-aspartic proteases-1(Caspase-1),superoxide dismutase(SOD)and peroxidase(POD)in trabecu-lar meshwork tissues were detected.The expression levels of Klotho,ASC,Caspase-1,SOD and POD of patients in the two groups and those expression levels in glaucoma patients with different average visual field defects were compared.The cor-relation between expression levels of Klotho,apoptosis-related proteins and oxidative stress injury of the trabecular mesh-work in glaucoma patients was analyzed by the Pearson method.Results HE staining results showed that the trabecular meshwork structure of patients in the study group was disorganized,with interlaced layers,thickened trabecular bundles and cell nucleus shrinkage,while the lamellas of trabecular meshwork tissues and trabecular cell bundles in the control group were orderly arranged,with normal forms of trabecular cells.In the study group,the expression level of Klotho in trabecular meshwork tissues was lower and the expression levels of ASC and Caspase-1 were higher than those of the con-trol group(all P＜0.05).There were statistically significant differences in the expression levels of Klotho,ASC,Caspase-1,SOD and POD in patients with different average visual field defects(all P＜0.05).With the increase in disease severity,the expressions of Klotho and SOD showed a significant decrease,while the expressions of ASC,Caspase-1 and POD showed a significant increase(all P＜0.05).Pearson correlation analysis showed that Klotho in the trabecular mesh work was negatively correlated with POD and positively correlated with SOD,while ASC and Caspase-1 were positively correlated with POD and negatively correlated with SOD(all P＜0.05).Conclusion The expression of Klotho is low in the trabec-ular meshwork tissues of patients with glaucoma,while the expressions of ASC and Caspase-1 are high.These expressions are correlated with the average visual field defect,reflecting the stress injury degree of trabecular meshwork tissues.

Objective:To explore the classification characteristics of the resilience of infertile women, and to analyze the distribution differences of each category in demographic and disease-related variables such as education level and type of infertility.Methods:Using convenient sampling method and cross-sectional survey, 400 infertile women in the Reproductive Medicine Center of the First Affiliated Hospital of Soochow University were assessed with the scale CD-RISC-10 from September 2019 to December 2020. The potential categories of resilience were analyzed, and then multivariate logistic regression was used to analyze the demographic and disease-related characteristics of different categories.Results:The resilience of infertile women can be divided into 3 potential categories: "low tenacity class" (group C1), "high tenacity class" (group C2) and "general resilience but low strength class" (group C3), accounting for 21.8% (87/400), 37.5% (150/400) and 41.8% (163/400) of the total respectively. Multivariate logistic regression analysis showed that there were significant differences in marriage duration type of infertility and the sense of fear or helplessness between group C1 and group C2 (<3.0 years vs. ≥7.0 years, P=0.019; P=0.045; P=0.015); there was a significant difference in marriage duration between group C1 and group C3 (<3.0 years vs. ≥7.0 years, P=0.039; 3.0-4.9 years vs. ≥7.0 years, P=0.024); there was a significant difference in education level between group C2 and group C3 (Junior high school or technical secondary school vs. Bachelor degree or above, P=0.003; Junior college vs. Bachelor degree or above, P=0.030). Conclusion:The resilience of infertile women has obvious sub category characteristics. There are differences in the distribution of education level, marriage duration type of infertility and the sense of fear or helplessness among different groups of infertile women. We should pay attention to the infertile women with low education level, short marriage time, primary infertility, strong sense of fear or helplessness, and adopt reasonable intervention to improve their resilience.