Objective To investigate the bidirectional causal relationship between circulating amino acid levels and the risk of myasthenia gravis(MG)using Mendelian randomization(MR).Methods A two-sample Mendelian randomization a-nalysis was conducted using publicly available genome-wide association study(GWAS)genetic data,with validation from GWAS data from different sources to assess the robustness of the results.Five models were used for the two-sample bidirectional MR anal-ysis,and odds ratios(OR)were calculated to evaluate the causal relationship between the levels of nine circulating amino acids and MG risk.Sensitivity analyses,heterogeneity tests,and pleiotropy tests were performed to assess the robustness of the results.The causal effect estimated by the inverse variance weighted(IVW)method was the primary result,and the IVW-estimated causal effects were further validated using data from different GWAS sources to assess robustness.Results Genetically predicted high-er circulating glutamine levels were significantly associated with a lower risk of MG[OR(95％CI)=0.696(0.524,0.926),P=0.012 7,IVW model].Validation analyses using GWAS data from various sources also demonstrated a significant negative associa-tion between genetically predicted higher circulating glutamine levels and MG risk[OR(95％CI)=0.321(0.178,0.581),P=1.67x10-1,IVW model].Moreover,genetically predicted higher MG risk was associated with lower levels of circulating glutamine and alanine(β=-0.178±0.009,P=0.049;β=-0.013±0.007,P=0.048,IVW model,respectively).Conclusion Genetic evidence reveals a potential bidirectional causal relationship between circulating amino acid levels and MG risk.Further studies are required to elucidate the mechanisms underlying this relationship.

BACKGROUND:Previous studies found that the proliferative scar-specific long non-coding RNA lncRNA HSFAS is a novel biomarker that can be used in the diagnosis of hypertrophic scar,but how it functions in hypertrophic scar is not clear. OBJECTIVE:To investigate the role and mechanism of lncRNA HSFAS in hypertrophic scar.METHODS:Fresh scar tissue and surrounding normal skin tissue samples from three patients with hypertrophic scar were collected,and tissue immunofluorescence was used to detect the expression of lncRNA HSFAS in frozen sections of two skin tissues. Primary fibroblasts were isolated from proliferative scarred skin tissue and normal skin tissue and cultured by enzyme digestion method. Quantitative real-time PCR was used to detect the mRNA expression of lncRNA HSFAS in cells. The proteins bound to lncRNA HSFAS were detected by RNA pull-down combined mass spectrometry. GO and KEGG were used to analyze the main functions and pathways of lncRNA HSFAS involved in hypertrophic scar progression. The targeted binding of lncRNA HSFAS to proteins was determined by catRAPID and RPISeq website analysis. RESULTS AND CONCLUSION:Compared with normal skin tissue and fibroblasts from normal skin tissue,the expression of lncRNA HSFAS in human hypertrophic scar tissue and primary fibroblasts from hypertrophic scar tissue was significantly increased (P<0.05). There were 510 proteins clearly bound to lncRNA HSFAS by RNA pull-down combined mass spectrometry. The results of GO and KEGG analyses showed that these proteins were mainly involved in RNA splicing and processing,chromosome synthesis and separation,and cell cycle. Among them,the proteins involved in RNA splicing and processing included scaffold attachment factor B2 and DICER1,and the binding fraction with lncRNA HSFAS was higher. The results of bioinformatics analysis showed that lncRNA HSFAS was bound to scaffold attachment factor B2 and DICER1 proteins. To conclude,lncRNA HSFAS may affect gene expression by interacting with scaffold attachment factor B2 and DICER1 proteins to regulate RNA splicing and processing modification,thus promoting the occurrence and development of hypertrophic scar.

Objective To investigae microbial community structure of lower respiratory tract in severe hospital-acquired pneumonia(SHAP)patients in intensive care unit(ICU)using metagenomic next-generation sequencing(mNGS).Methods mNGS was performed on bronchoalveolar lavage fluid(BALF)of 84 patients with SHAP.Patients were grouped based on age,smoking status,underlying diseases and duration of artificial airway.The differences in α diversity,β diversity,microbial composition and community structure of airway microbiota were compared between different groups.The differential airway microbiota associated with artificial airway were screened,and microbial co-occurrence networks was constructed to observe the interaction in microorganisms.Results Results of α diversity analysis revealed that diversity and evenness of the microbial community were higher in young adults compared to those of middle-aged patients,while microbial diversity and evenness were significantly reduced in patients with comorbid stroke.In the group of artificial airway treatment,the diversity and uniformity of microorganisms decreased as the duration of artificial airway treatment increased.The diversity was the lowest when the artificial airway treatment lasted for more than 3 days.β diversity analysis confirmed that there were significant differences in the distinct microbial community structures between the>3 days support group and the non-intubated and≤3 days support cohorts.Acinetobacter baumannii was dominant in all groups.The bacterial diversity was significantly higher in the middle-aged group,the non-smoking group,the group without artificial airway therapy,the group without diabetes mellitus,the group with artificial airway therapy≥3 days and the group with chronic lung disease than those of other groups.In particular,pseudomonas aeruginosa,corynebacterium striatum and veillonella parvula were enriched in these groups.Difference analysis showed that there were significant differences in pseudomonas aeruginosa and corynebacterium striatum between the group with artificial airway treatment>3 days,the group without artificial airway therapy and the group with artificial airway treatment≤3 days.Network co-occurrence showed that there may be synergistic or antagonistic relationships between some microorganisms.Conclusion The microbial diversity of the lower respiratory tract in patients with SHAP significantly decreases in the elderly,those with concurrent stroke and those receiving artificial airway treatment.For these groups,rational use of antibiotics should be adopted to guide precise anti-infection treatment.

Objective:To characterize the brain structure of Chinese children with autism spectrum disorder (ASD) using artificial intelligence automatic brain segmentation technique, and to analyze the correlation between the characteristics of the brain structure and the degree of brain development.Methods:A case-control study.The data of 52 children who were diagnosed with ASD according to the diagnostic criteria for ASD in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition of the United States at the Department of Psychology of Qingdao University Affiliated Women and Children′s Hospital from January 2023 to April 2024 were prospectively analyzed.Meanwhile, 48 gender- and age-matched typically developing (TD) children in Qingdao were also included.The three-dimensional T1 weighted imaging sequences of all patients were obtained using a GE 3.0T magnetic resonance imaging scanner.Automated brain segmentation techniques were used to obtain the standardized volumes of each brain structure (the ratio of the absolute volume of the brain structure to the whole brain volume).Two-independent-samples t and Mann-Whitney U tests were used to compare the standardized volumes of different brain regions between the 2 groups.Pearson and Spearman correlation analyses were used to depict the correlations between volume data of brain areas with significant differences and Gesell Developmental Scale scores. Results:Compared with those in the TD group, the volumes of the left grey matter[25.45%(0.70%) vs.25.16%(1.05%)], the right grey matter [(25.89±0.71)% vs.(25.51±0.73)%], the right lateral orbitofrontal cortex [(0.62±0.03)% vs.(0.59±0.05)%], the right medial orbitofrontal cortex[(0.48±0.04)% vs.(0.46±0.04)%], the right pars triangularis [(0.38±0.07)% vs.(0.35±0.05)%], the left hippocampus [0.22%(0.04%) vs.0.20%(0.02%)], the right hippocampus [0.23%(0.04%) vs.0.22%(0.02%)], the left parahippocampal gyrus [0.15%(0.03%) vs.0.14%(0.02%)], the right parahippocampal gyrus [(0.15±0.02)% vs.(0.14±0.02)%], the left fusiform gyrus [(0.82±0.08)% vs.(0.78±0.08)%], the right superior temporal gyrus [(0.96±0.10)% vs.(0.90±0.09)%], the left insular lobe [(0.54±0.03)% vs.(0.53±0.04)%], the right insular lobe [(0.55±0.03)% vs.(0.53±0.04)%], the right inferior parietal cortex [(1.40±0.16)% vs.(1.33±0.12)%], the right precuneus cortex [(0.99±0.09)% vs.(0.94±0.09)%], the right putamen [(0.37±0.04)% vs.(0.35±0.03)%], the left pallidum [(0.14±0.01)% vs.(0.13±0.01)%], the right pallidum [0.14%(0.02%) vs.0.13%(0.01%)], and the right thalamus [(0.51±0.04)% vs.(0.49±0.03)%] were significantly increased in the ASD group (all P<0.05).Nonetheless, the volumes of the left pericalcarine cortex [(0.19±0.04)% vs.(0.20±0.04)%] and the corpus callosum posterior region [0.05%(0.01%) vs.0.06%(0.01%)] in the ASD group were considerably smaller than those in the TD group (all P<0.05).Correlation analysis showed that the right thalamus volume was negatively correlated with the Gesell-adaptation development quotient in children with ASD ( r=-0.276, P=0.048).The volumes of the left fusiform gyrus and left pericalcarine cortex were negatively correlated with the Gesell-fine motor development quotient in children with ASD ( r=-0.290, P=0.037; r=-0.368, P=0.007). The right precuneus cortex volume was negatively correlated with the Gesell-personal and social competence development quotient in children with ASD ( r=-0.396, P=0.007). Conclusions:Children with ASD show abnormalities in the volumes of multiple brain regions, and some brain regions are related to the degree of brain development.Automatic brain segmentation technology based on artificial intelligence can rapidly and directly measure and display the volume of brain structures in both ASD and TD children.

Objective To investigae microbial community structure of lower respiratory tract in severe hospital-acquired pneumonia(SHAP)patients in intensive care unit(ICU)using metagenomic next-generation sequencing(mNGS).Methods mNGS was performed on bronchoalveolar lavage fluid(BALF)of 84 patients with SHAP.Patients were grouped based on age,smoking status,underlying diseases and duration of artificial airway.The differences in α diversity,β diversity,microbial composition and community structure of airway microbiota were compared between different groups.The differential airway microbiota associated with artificial airway were screened,and microbial co-occurrence networks was constructed to observe the interaction in microorganisms.Results Results of α diversity analysis revealed that diversity and evenness of the microbial community were higher in young adults compared to those of middle-aged patients,while microbial diversity and evenness were significantly reduced in patients with comorbid stroke.In the group of artificial airway treatment,the diversity and uniformity of microorganisms decreased as the duration of artificial airway treatment increased.The diversity was the lowest when the artificial airway treatment lasted for more than 3 days.β diversity analysis confirmed that there were significant differences in the distinct microbial community structures between the>3 days support group and the non-intubated and≤3 days support cohorts.Acinetobacter baumannii was dominant in all groups.The bacterial diversity was significantly higher in the middle-aged group,the non-smoking group,the group without artificial airway therapy,the group without diabetes mellitus,the group with artificial airway therapy≥3 days and the group with chronic lung disease than those of other groups.In particular,pseudomonas aeruginosa,corynebacterium striatum and veillonella parvula were enriched in these groups.Difference analysis showed that there were significant differences in pseudomonas aeruginosa and corynebacterium striatum between the group with artificial airway treatment>3 days,the group without artificial airway therapy and the group with artificial airway treatment≤3 days.Network co-occurrence showed that there may be synergistic or antagonistic relationships between some microorganisms.Conclusion The microbial diversity of the lower respiratory tract in patients with SHAP significantly decreases in the elderly,those with concurrent stroke and those receiving artificial airway treatment.For these groups,rational use of antibiotics should be adopted to guide precise anti-infection treatment.

Objective:To gain an in-depth understanding of the psychological safety experiences and changes of new nurses in Neurosurgery Department, providing insights for improving their psychological safety.Methods:A purposive sampling method was used to select new nurses from the Neurosurgery Department at Zhejiang Enze Medical Center Enze Hospital in July to August 2023. Semi-structured interviews were conducted, and Colaizzi's 7-step analysis method was applied to organize and analyze the interview data, summarizing and refining the themes.Results:A total of eleven new nurses from the Neurosurgery Department were included in the study. A total of five themes were identified: insufficient awareness of psychological safety, self-doubt, lack of interpersonal safety, fear and worry, and coping and adaptation.Conclusions:New nurses in Neurosurgery Department often experience a lack of psychological safety during their development. It is crucial to focus on their stage-specific characteristics, enhance new nurse training, create a safe environment, assist them in adopting correct coping strategies, and improve their mental health.

Cardiovascular disease has become a significant cause of death in cancer patients,partly due to the cardiovascular toxicity of cancer treatments.The referral of cardio-oncology can improve the cardiovascular health of cancer patients,and develop strategies for prevention,management,and treatment of cardiovascular toxicity induced by cancer treatment.This article summarizes the strategies and status in the referral of cardio-oncology,and proposes development suggestions for the referral model of cardio-oncology,in order to improve the awareness of medical staffin implementing referral of cardio-oncology and provide a basis for promoting the development of the referral model of cardio-oncology.

Objective: To investigate the association between screen time (ST) during leisure time and anxiety-depression symptoms among middle school students, so as to provide a basis for formulating relevant intervention measures. Methods: From November to December 2023, a stratified cluster random sampling method was used to select 2 542 students from junior and senior high school in Taiyuan City. A self designed questionnaire, the Generalized Anxiety Disorder Scale (GAD-7), and the Patient Health Questionnaire (PHQ-9) were used to investigate ST and anxiety/depression symptoms among middle school students. The Logistic regression model was used to explore the association of ST with symptoms of anxiety and depression, as well as with anxiety and depression comorbiditles (CAD). Results: The detection rates of anxiety symptoms, depression symptoms, and CAD were 13.69%, 15.77%, and 10.11%, respectively. The median ST was 2.00 h/d [interquartile range ( IQR =2.38) for weekly averages], with 0.33 h/d ( IQR =1.67) on work days and 5.00 h/d ( IQR=5.50) on rest days. Logistic regression analysis indicated that the total ST of mobile phones during rest days ( OR =1.07, 1.10, 1.11) and the averages ST of mobile phones over a week ( OR = 1.20 , 1.22, 1.29), as well as the total ST of all screen types during rest days ( OR =1.04, 1.04, 1.05) and the averages ST of all screen types over a week ( OR =1.08, 1.09, 1.21) were positively correlated with anxiety symptoms, depression symptoms, and CAD (all P <0.01). Conclusions Among middle school students in Taiyuan City, screen time is positively correlated with symptoms of anxiety or depression and the comorbidity of anxiety and depression, especially smartphone screen time and weekend screen use. Therefore, measures should be implemented to reduce unnecessary screen time among middle school students, especially the use of mobile phones, in order to mitigate the occurrence of anxiety and depression.

Objective: To examine the relationship between self-management behaviors and time perspective among patients with comorbid diabetes, so as to provide the evidence for improving self-management behaviors among patients with comorbid diabetes. Methods: The patients with comorbid diabetes who were registered in the chronic disease health management system of Minhang District, Shanghai Municipality in 2021, followed up regularly, and lived in Meilong Town were recruited. Demographic information and family history of diabetes were collected through questionnaire surveys. Time perspective and self-management behaviors were assessed using the Zimbardo Time Perspective Inventory and Diabetes Self-Management Behavior Scale, respectively. The relationship between self-management behaviors and time perspective was analyzed using a multivariable ordinal logistic regression model. Results: A total of 907 patients with comorbid diabetes were enrolled, including 472 males (52.04%) and 435 females (47.96%). There were 652 cases aged 65 years and above, accounting for 71.89%. In terms of the types of time perspective, 280 patients were future-oriented (30.87%), 236 were balanced (26.02%), 162 were sensation-seeking (17.86%), 123 were fatalistic (13.56%), and 106 were negative (11.69%). In terms of the self-management behaviors, 46 patients were good (5.07%), 643 were moderate (70.89%), and 218 were poor (24.04%). Multivariable ordinal logistic regression analysis showed that after adjusting for age, gender, educational level, marital status, occupation status, monthly income, and family history of diabetes, the patients with comorbid diabetes who had a future-oriented time perspective had better self-management behaviors (OR=1.874, 95%CI: 1.204-2.915). Conclusion The self-management behaviors among patients with comorbid diabetes are moderate to poor, and patients with a future-oriented time perspective can better engage in self-management behaviors.

Objective To explore the impact of seasonal and temperature variations on fasting blood glucose(FPG)in patients with type 2 diabetes(T2DM).Methods A retrospective analysis was conducted on clinical data of 31 994 T2DM patients managed by community health service center in Minhang District,Shanghai,from January 1,2020 to October 31,2023.The effect of seasonal and temperature variations on FPG levels and blood glucose control was investigated in T2DM patients.Results A total of 72 334 FPG tests were conducted in 31 994 T2DM patients,with an average of 2.26 tests per person.The number of tests conducted in spring,summer,autumn and winter were 15 558,34 018,21 929 and 829,respectively.The FPG levels of T2DM patients were lower in summer and autumn compared to those of winter and spring(P<0.05),while the FPG control rates were higher in summer and autumn compared to those of winter and spring(Bonferroni-corrected,P<0.008).There were no significant differences in FPG levels and blood glucose control rates between spring and winter,or between summer and autumn.The results of the multilevel mixed-effect Logistic model analysis with FPG control status as the dependent variable revealed that the risk of uncontrolled FPG in T2DM patients during winter and spring was 47%(aOR=1.465,95%CI:1.156-1.855)and 51%(aOR=1.510,95%CI:1.384-1.645),respectively,which was higher than that of autumn.The levels of FPG and the incidence of FPG abnormalities reached peak in February and reached the trough in September.Both the FPG levels and the incidence of FPG abnormal exhibited a trend of increasing with the decrease of temperature,and with a lag effect observed.Spearman rank correlation test indicated that there was a negative correlation between FPG levels and incidence of abnormal FPG and the monthly average daily temperature one month lagged(rs=-0.951,P＜0.001 and rs=-0.944,P＜0.001).Conclusion FPG levels of T2DM patients exhibit a pronounced seasonal pattern of elevation during winter and spring,accompanied by a reduction in blood glucose control rates.FPG levels and the prevalence of abnormal FPG exhibit a negative correlation with the monthly average daily temperature,and there is a lag effect.