BackgroundGraduate students frequently face life events， many of which may adversely affect their mental well-being. However， the interaction between life events and the development of depression， anxiety， and somatic symptoms remains unclear. ObjectiveTo explore the relationship between life events and the development of depressive， anxiety and somatic symptoms in graduate students， thereby informing prevention strategies for these conditions. MethodsA sample of 6 722 newly enrolled graduate students at a comprehensive university in Southwest China from September to November 2018 was selected. The assessment was conducted using the Adolescent Self-rating Life Events Checklist （ASLEC）， the 7-item Generalized Anxiety Disorder scale-7 item （GAD-7）， the Patient Health Questionnaire Depression Scale-9 item （PHQ-9）， and the Patient Health Questionnaire-15 （PHQ-15）. Network analysis was implemented by using the bootnet and qgraph packages in the R software （version 4.2.3）， with centrality indices calculated to identify core and bridge symptoms within the network. ResultsThe study encompassed a total of 6 171 graduate students， representing 91.80% of the target population. The prevalence rates of anxiety， depressive， and somatic symptoms among graduate students were 12.59% （777/6 171）， 16.63% （1 026/6 171）， and 27.66% （1 707/6 171）， respectively. Network analysis revealed that 'academic stress' was the core symptom with the highest strength and expected influence （both values=1.207）， while 'feeling down， depressed， or hopeless' was the bridge symptom with the highest bridge strength and bridge expected influence （both values=0.454）. There was no significant difference in global network strength and edge weight between women and men （P>0.05）. ConclusionAcademic stress， emerging as the core symptom， assumes a dominant position within the symptom network and exhibits strong interactions with other negative affective states. There was no gender difference in the network structure.

Objective To explore the bi-directional dynamic associations of bullying perpetration and victimisation with psychopathological symptoms in children and adolescents.Methods The Adolescent Brain Cognitive Development(ABCD)public dataset was used.Three dimensions of bullying perpetration and victimisation and child-adolescent psychopathological symptoms:attention,externalisation and internalisation were collected from 8413 child-adolescents using the peer experiences questionnaire(EPQ)and the brief problem monitoring(BPM)questionnaire,respectively.Bidirectional dynamic associations between bullying and child-adolescent psychopathological symptoms were analysed using cross-lagged networks.Results Bullying implementation to externalising problems was a significant cross-lagged edge(OR=2.36);impulsivity was both the strongest node of out-expected influence(OEI=5.21)and bridge-expected influence(BEI=4.35),and the strongest node of in-expected influence(IEI)was threat of violence(IEI=5.61).Conclusion There is an interaction between bullying and child-adolescent pathology symptoms.Bullying perpetration exacerbates subsequent externalising problems,and impulsivity is the most likely psychopathological symptom to influence both bullying perpetration and externalising internalising problems and it is also the bridging symptom connecting the two.

The inclusion of"strengthening Party building in hospitals"in the Party Constitution during the 20th CPC Na-tional Congress has established fundamental guidelines for public hospital governance.As a critical component of China's health-care system,district-and county-level public hospitals'Party building quality directly influences both the implementation of hier-archical diagnosis systems and the preservation of public welfare values.Anchored in the overarching requirements of Party build-ing in the new context,this paper systematically evaluates the imperative for enhanced Party building in these hospitals.Address-ing prevalent challenges including the disconnection between Party initiatives and clinical operations,along with inadequate evalu-ation frameworks,we analyzed a successful"Five-Pillar Initiative"implemented at a Chongqing district-and county-level hospi-tal.Practical outcomes demonstrated that high-quality Party building has markedly advanced the hospital's disciplinary develop-ment,talent recruitment and cultivation,research and education,and patient satisfaction,generating a"multiplier effect"where-by Party leadership amplifies overall reform and development.The study proposes a three-dimensional development model(insti-tutionalization-standardization-branding)to establish sustainable mechanisms for deep Party-profession integration,offering repli-cable practices for grassroots healthcare institutions under the Healthy China initiative.

Objective To explore the bi-directional dynamic associations of bullying perpetration and victimisation with psychopathological symptoms in children and adolescents.Methods The Adolescent Brain Cognitive Development(ABCD)public dataset was used.Three dimensions of bullying perpetration and victimisation and child-adolescent psychopathological symptoms:attention,externalisation and internalisation were collected from 8413 child-adolescents using the peer experiences questionnaire(EPQ)and the brief problem monitoring(BPM)questionnaire,respectively.Bidirectional dynamic associations between bullying and child-adolescent psychopathological symptoms were analysed using cross-lagged networks.Results Bullying implementation to externalising problems was a significant cross-lagged edge(OR=2.36);impulsivity was both the strongest node of out-expected influence(OEI=5.21)and bridge-expected influence(BEI=4.35),and the strongest node of in-expected influence(IEI)was threat of violence(IEI=5.61).Conclusion There is an interaction between bullying and child-adolescent pathology symptoms.Bullying perpetration exacerbates subsequent externalising problems,and impulsivity is the most likely psychopathological symptom to influence both bullying perpetration and externalising internalising problems and it is also the bridging symptom connecting the two.

The inclusion of"strengthening Party building in hospitals"in the Party Constitution during the 20th CPC Na-tional Congress has established fundamental guidelines for public hospital governance.As a critical component of China's health-care system,district-and county-level public hospitals'Party building quality directly influences both the implementation of hier-archical diagnosis systems and the preservation of public welfare values.Anchored in the overarching requirements of Party build-ing in the new context,this paper systematically evaluates the imperative for enhanced Party building in these hospitals.Address-ing prevalent challenges including the disconnection between Party initiatives and clinical operations,along with inadequate evalu-ation frameworks,we analyzed a successful"Five-Pillar Initiative"implemented at a Chongqing district-and county-level hospi-tal.Practical outcomes demonstrated that high-quality Party building has markedly advanced the hospital's disciplinary develop-ment,talent recruitment and cultivation,research and education,and patient satisfaction,generating a"multiplier effect"where-by Party leadership amplifies overall reform and development.The study proposes a three-dimensional development model(insti-tutionalization-standardization-branding)to establish sustainable mechanisms for deep Party-profession integration,offering repli-cable practices for grassroots healthcare institutions under the Healthy China initiative.

Objective To investigate the clinical characteristics and molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae(CRKP)isolated from patients with bloodstream infections in a large tertiary-care general hospital in Southwest China.Methods A total of 131 strains of non-repeating CRKP were collected from the blood cultures of patients who had bloodstream infections in 2015-2019.The strains were identified by VITEK-2,a fully automated microbial analyzer,and matrix-assisted laser desorption ionization-time of flight(MALDI-TOF)mass spectrometry.The minimum inhibitory concentration(MIC)was determined by microbroth dilution method.The common carbapenemase resistant genes and virulence factors were identified by PCR.Homology analysis was performed by multilocus sequencing typing.Whole genome sequencing was performed to analyze the genomic characteristics of CRKP without carbapenemase.Results The 131 strains of CRKP showed resistance to common antibiotics,except for polymyxin B(1.6%resistance rate)and tigacycline(8.0%resistance rate).A total of 105(80.2%)CRKP strains carried the Klebsiella pneumoniae carbapenemase(KPC)resistance gene,15(11.4%)strains carried the New Delhi Metallo-β-lactamase(NDM)gene,and 4(3.1%)isolates carried both KPC and NDM genes.Sequence typing(ST)11(74.0%)was the dominant sequence type.High detection rates for mrkD(96.2%),fimH(98.5%),entB(100%),and other virulence genes were reported.One hypervirulent CRKP strain was detected.The seven strains of CRKP that did not produce carbapenemase were shown to carry ESBL or AmpC genes and had anomalies in membrane porins OMPK35 and OMPK36,according to whole genome sequencing.Conclusion In a large-scale tertiary-care general hospital,CRKP mainly carries the KPC gene,has a high drug resistance rate to a variety of antibiotics,and possesses multiple virulence genes.Attention should be paid to CRKP strains with high virulence.

Background::There is a need for effective and safe therapies for psoriasis that provide sustained benefits. The aim of this study was to assess the efficacy and safety of tildrakizumab, an anti-interleukin-23p19 monoclonal antibody, for treating moderate-to-severe plaque psoriasis in Chinese patients.Methods::In this multi-center, double-blind, phase III trial, patients with moderate-to-severe plaque psoriasis were enrolled and randomly assigned (1:1) to receive subcutaneous tildrakizumab 100 mg or placebo at weeks 0 and 4. Patients initially assigned to placebo were switched to receive tildrakizumab at weeks 12, 16, and every 12 weeks thereafter. Patients in the tildrakizumab group continued with tildrakizumab at week 16, and every 12 weeks until week 52. The primary endpoint was the Psoriasis Area and Severity Index (PASI 75) response rate at week 12.Results::At week 12, tildrakizumab demonstrated significantly higher PASI 75 response rates (66.4% [73/110] vs. 12.7% [14/110]; difference, 51.4% [95% confidence interval (CI), 40.72, 62.13]; P <0.001) and Physician’s Global Assessment (60.9% [67/110] vs. 10.0% [11/110]; difference, 49.1% [95% CI, 38.64, 59.62]; P <0.001) compared to placebo. PASI 75 response continued to improve over time in both tildrakizumab and placebo-switching to tildrakizumab groups, reaching maximal efficacy after 28 weeks (86.8% [92/106] vs. 82.4% [89/108]) and maintained up to 52 weeks (91.3% [95/104] vs. 87.4% [90/103]). Most treatment-emergent adverse events were mild and not related to tildrakizumab. Conclusion::Tildrakizumab demonstrated durable efficacy through week 52 and was well tolerated in Chinese patients with moderate-to-severe plaque psoriasis.Trial registration::ClinicalTrials.gov, NCT05108766.

Background Patients with schizophrenia of Yangming Fushi syndrome experience more severe symptoms,and a substantial proportion of patients derive inadequate benefit from antipsychotics and suffer from serious adverse effects,yet few studies have been conducted on the treatment of schizophrenia of Yangming Fushi syndrome with Zengye Chengqi decoction.Objective To explore the efficacy of Zengye Chengqi decoction combined with olanzapine in the treatment of schizophrenia of Yangming Fushi syndrome,in order to provide references for the treatment of schizophrenia with the combination of traditional Chinese and western medicine.Methods A total of 60 patients attending the Second Affiliated Hospital of Xinxiang Medical College from January 2022 to August 2023 and fulfilling the International Classification of Diseases(ICD-10)diagnostic criteria for schizophrenia were enrolled,and assigned into study group(n=30)and control group(n=30)using random number table methods.All patients were treated with olanzapine,and study group was given Zengye Chengqi decoction on this basis.Treatment for both groups lasted for 4 weeks.All participants were assessed using Positive and Negative Syndrome Scale(PANSS),Montreal Cognitive Assessment(MoCA)and Event-Related Potential P300 at baseline and end of treatment.The occurrence of adverse reactions was recorded at the end of treatment.Results Study group reported a higher treatment effective rate compared with control group(χ2=9.320,P=0.002).After treatment,study group detected a significant reduction in PANSS subscales and total scores(F=10.287,8.258,8.844,20.079,P<0.01),and a notable increase in scores of delayed recall and orientation domains from MoCA(F=4.463,22.255,P<0.05 or 0.01)when compared with control group,with statistical difference.For the P3 component of event-related potential,study group produced significantly larger amplitudes than control group(F=4.247,P<0.05).The incidence rate of abnormal liver function,constipation and increased body mass index(BMI)in study group was lower than those in control group(χ2=4.320,4.463,7.200,P<0.05 or 0.01).Conclusion Zengye Chengqi decoction combined with olanzapine are found to be effective in improving the psychotic symptoms and cognitive function and alleviating the adverse reactions of patients with schizophrenia of Yangming Fushi syndrome.

Objective:To investigate the relationship between the virulence and the carbapenem resistance phenotype of Klebsiella pneumoniae from blood infection,and to identify carbapenem-resistant and hypervirulent Klebsiella pneumoniae(CR-HVKP)strains.Methods:A total of 192 Klebsiella pneumoniae strains were isolated from blood culture of patients with bloodstream infections from 2016 to 2019,of which 96 isolates were carbapenem-resistant Klebsiella pneumoniae(CRKP)and 96 were carbapenem-sensitive Klebsiella pneumoniae(CSKP).The drug susceptibility was detected by VITEK-2 automatic microbial analyzer;carbapenemase genes,virulence genes and capsule typing were detected by polymerase chain reaction;the high viscosity phenotype of strains was detected by string test,and the genome characteristics of CR-HVKP were detected by whole genome sequencing.Serum killing and biofilm formation test were used to further verify the virulence of CR-HVKP.Results:There were significant differences in drug resistance to common antibiotics,except for minocycline between CSKP and CRKP isolates(all P<0.05).92 out of 96 CRKP isolates carried carbapenemase genes,mainly blaKPC-2.The string tests were positive in 4 isolates of CRKP and 36 isolates of CSKP(P<0.05).The detection rates of virulence genes Kfu,aerobictin,iutA,ybtS,rmpA,magA,allS,and capsule antigen K1 and K2 in CSKP group were significantly higher than those in CRKP group(all P<0.05).One HVKP strain was detected in the CRKP group(CR-HVKP)and 36 HVKP was detected in the CSKP group(P<0.05).The CR-HVKP strain belonged to the MLST412,serotype K57,expressed iutA,entB,mrkD,fimH,and rmpA virulence genes,and showed strong biofilm formation and significantly increased serum resistance.Whole genome sequencing results showed that this CR-HVKP isolate carried blaSHV-145,blaTEM-1,blaCTX-M-3,fosA6,oqxA5,oqxB26,and aac(3)-Ⅱd resistance genes,accompanied by abnormalities in outer membrane protein K(OmpK)35 and OmpK36.Conclusions:The drug resistance of CRKP is significantly higher than that of CSKP,while CRKP carrying fewer virulence genes in both number and types compared to CSKP.A new MLST type of carbapenem-resistant and hypervirulent Klebsiella pneumoniae strain has been detected,which requires clinical awareness and epidemiological monitoring.

Objective:To compare the clinical effectiveness between arthroscopic hollow screws combined with a suture anchor, hollow screws and proximal humerus internal locking system (PHILOS) in the treatment of split-type fractures of humeral greater tuberosity.Methods:A retrospective study was conducted to analyze the 54 patients with split-type fracture of humeral greater tuberosity who had been admitted to Department of Joint Surgery, Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University from May 2015 to August 2020. There were 17 males and 37 females with an age of (58.4±12.1) years. According to different treatment methods, they were divided into 3 groups. Group A of 18 cases was treated with arthroscopic hollow screws combined with a suture anchor, group B of 18 cases with hollow screws, and group C of 18 cases with PHILOS. The length of surgical incision, and range of shoulder motion, visual analogue scale (VAS), and American Shoulder and Elbow Surgeons (ASES) score at the last follow-up were recorded and compared between the 3 groups.Results:There was no statistically significant difference in the preoperative general information between the 3 groups, indicating the 3 groups were comparable ( P>0.05). The surgical incision in group A [(0.7±0.1) cm] was the shortest, followed by (5.0±1.4) cm in group B, and (12.8±2.1) cm in group C, showing statistically significant differences in pairwise comparison ( P<0.05). In the 3 groups at the last follow-up, respectively, the shoulder forward flexion was 159.7°±13.4°, 154.9°±16.2°, and 160.5°±12.9°, and the shoulder abduction 149.6°±11.3°, 142.4°±12.0°, and 145.1°±10.4°, showing no statistically significant difference among the 3 groups ( P>0.05); the external rotation was 41.1°±8.1°, 38.1°±7.8° and 43.7°±6.2°, showing a statistically significant difference between groups B and C ( P<0.05); the dorsal extension was T 12 (L 5 to T 6), T 12 (L 5 to T 7), and T 12 (L 3 to T 6), showing no statistically significant difference among the 3 groups ( P>0.05). There was no statistically significant difference among the 3 groups in the VAS score or ASES score at the last follow-up ( P>0.05). Respectively, there were 2, 6, and 4 patients in groups A, B and C who developed complications, showing statistically significant differences between the 3 groups ( P<0.05). Conclusions:In the treatment of split fractures of humeral greater tuberosity, arthroscopic hollow screws combined with a suture anchor, hollow screws and PHILOS can all relieve pain and restore joint function of the shoulder. However, arthroscopic hollow screws combined with a suture anchor are the most recommendable due to their advantages in minimally invasiveness and reduction in complications.