ObjectiveTo perform metabolic associated fatty liver disease （MAFLD） screening among individuals attending community health institutions， to identify the patients at a low， moderate or high risk of advanced liver fibrosis based on fibrosis-4 index （FIB-4） and liver stiffness measurement （LSM） measured by liver transient elastography， and to implement stratified management. MethodsA cross-sectional study was conducted among 630 individuals attending Beijing Baizhifang Community Health Service Center from January to July 2024， and they were divided into MAFLD group and non-MAFLD group. According to body mass index （BMI）， the MAFLD group was further divided into lean MAFLD group （BMI<23 kg/m²） and non-lean MAFLD group （BMI≥23 kg/m²）. The above groups were compared in terms of demographic features， laboratory markers， hepatic steatosis， and LSM. Fibrosis risk stratification was performed for MAFLD patients based on FIB-4 and LSM， and a closed-loop management system involving referral to tertiary hospitals and follow-up at community health institutions was implemented. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. ResultsThere were 445 individuals （70.6%） in the MAFLD group and 185 individuals （29.4%） in the non-MAFLD group. Compared with the non-MAFLD group， the MAFLD group had a significantly lower proportion of male individuals （χ²=4.299， P<0.05）， a significant reduction in the level of high-density lipoprotein cholesterol （Z=3.484， P<0.05）， and significant increases in body weight （Z=-7.366， P<0.05）， BMI （Z=-9.740， P<0.05）， waist circumference （Z=-6.397， P<0.05）， hip circumference （Z=-6.935， P<0.05）， alanine aminotransferase （ALT） （Z=-2.765， P<0.05）， fasting blood glucose （Z=-3.646， P<0.05）， triglyceride （TG） （Z=-6.569， P<0.05）， total cholesterol （Z=-2.033， P<0.05）， low-density lipoprotein cholesterol （Z=-2.935， P<0.05）， controlled attenuation parameter （CAP） （Z=-19.784， P<0.05）， and LSM （Z=-5.703， P<0.05）. Within the MAFLD group， there were 124 individuals （27.9%） in the lean MAFLD group and 321 individuals （72.1%） in the non-lean MAFLD group. Compared with the non-lean MAFLD group， the lean MAFLD group had significantly lower body weight （Z=-12.414， P<0.05）， BMI （Z=-16.363， P<0.05）， waist circumference （Z=-7.733， P<0.05）， hip circumference （Z=-8.595， P<0.05）， ALT （Z=-2.835， P<0.05）， aspartate aminotransferase （Z=-1.972， P<0.05）， TG （Z=-2.407， P<0.05）， CAP （Z=-4.429， P<0.05）， degree of steatosis （χ²=16.588， P<0.05）， and LSM （Z=-3.908， P<0.05）. Based on the results of FIB-4 and LSM， 76 patients at a moderate or high risk of liver fibrosis should be referred to a higher-level hospital for further management. ConclusionThe detection rate of MAFLD reaches 70.6% among the individuals attending community health institutions， among whom 76 （17.1%） should be referred to a higher-level hospital. Establishing a liver fibrosis risk stratification and management system based on FIB-4 and LSM among MAFLD individuals in communities provides a practical pathway for chronic disease management and referral system construction in community health institutions.

Objective:To conduct a scope review of relevant studies on the application of virtual reality (VR) technology in breast cancer patients, identifying the basic content of interventions, outcome indicators, and application effects, with the aim of providing a reference for clinical healthcare professionals applying this technology.Methods:Based on the research methodology for scope reviews, a computer search was conducted in Chinese and English databases, including China National Knowledge Infrastructure, Wanfang Database, VIP, China Biology Medicine disc, PubMed, Web of Science, Cochrane Library, and Embase, with the search period extending to August 31, 2023. A categorical analysis of the included literature was conducted.Results:A total of 15 articles were included, primarily discussing the effects of VR technology on breast cancer patients' physical health, psychological well-being, cognitive function, and quality of life. Intervention frequencies were mainly once or twice daily, or twice weekly, with intervention durations ranging from 10 to 90 minutes and intervention periods from 2 to 12 weeks. VR interventions were found to improve physical function, psychological health, and cognitive function to some extent, increase patient rehabilitation adherence and satisfaction, and improve quality of life.Conclusions:VR technology can be an effective tool to support the treatment of breast cancer patients. However, the design of intervention protocols needs improvement. Future large-sample, multi-center, long-term follow-up randomized controlled trials are needed to verify the application effects of VR technology for breast cancer patients and promote its clinical application.

Objective:To conduct a scope review of relevant studies on the application of virtual reality (VR) technology in breast cancer patients, identifying the basic content of interventions, outcome indicators, and application effects, with the aim of providing a reference for clinical healthcare professionals applying this technology.Methods:Based on the research methodology for scope reviews, a computer search was conducted in Chinese and English databases, including China National Knowledge Infrastructure, Wanfang Database, VIP, China Biology Medicine disc, PubMed, Web of Science, Cochrane Library, and Embase, with the search period extending to August 31, 2023. A categorical analysis of the included literature was conducted.Results:A total of 15 articles were included, primarily discussing the effects of VR technology on breast cancer patients' physical health, psychological well-being, cognitive function, and quality of life. Intervention frequencies were mainly once or twice daily, or twice weekly, with intervention durations ranging from 10 to 90 minutes and intervention periods from 2 to 12 weeks. VR interventions were found to improve physical function, psychological health, and cognitive function to some extent, increase patient rehabilitation adherence and satisfaction, and improve quality of life.Conclusions:VR technology can be an effective tool to support the treatment of breast cancer patients. However, the design of intervention protocols needs improvement. Future large-sample, multi-center, long-term follow-up randomized controlled trials are needed to verify the application effects of VR technology for breast cancer patients and promote its clinical application.

Objective:To investigate the pathway of self-disclosure to posttraumatic growth in patients after cervical cancer surgery, and to provide reference for improving the level of posttraumatic growth in patients.Methods:A convenient sampling method was used to investigate 300 patients with cervical cancer after surgery in Shandong Provincial Hospital Affiliated to Shandong First Medical University from June to November 2022 by using general data questionnaire, Distress Disclosure Index (DDI), Connor-Davidson Resilience Scale (CD-RISC), the Shortened Chinese Version of the Family Resilience Assessment Scale (FRAS-C) and the Posttraumatic Growth Inventory (PTGI) in a cross-section study.Results:A total of 290 valid questionnaires were collected, with an effective recovery rate of 96.7%. The patients were aged 23-70(48.13 ± 10.39) years. The scores of self-disclosure, resilience, family resilience and posttraumatic growth were (46.41 ± 9.82), (67.06 ± 14.63), (108.18 ± 11.06) and (58.24 ± 17.86) respectively. The results of pathway analysis showed that self-disclosure could not only directly predict posttraumatic growth, but also indirectly predict posttraumatic growth through the mediating role of resilience and family resilience, and the chain mediating role of resilience and family resilience, respectively. The direct effect of self-disclosure on posttraumatic growth was 0.236(95% CI 0.138-0.335), and the chain mediating effect of family resilience and resilience between self-disclosure and posttraumatic growth was 0.036(95% CI 0.018-0.060). Conclusions:Medical staff should not only consider the direct influence of self-disclosure on posttraumatic growth, but also pay attention to improve the resilience and family flexibility of patients after cervical cancer surgery, so as to promote their posttraumatic growth.

Objective:To explore the effects of phased goal directed fluid therapy (GDFT) during anesthesia surgery on tissue perfusion and cognitive function in patients undergoing radical lung cancer surgery.Methods:A total of 108 lung cancer patients were prospectively selected and randomly divided into a control group and a study group using a random number table method. The control group received classical restrictive liquid therapy, while the study group received staged GDFT. We compared the surgical time, intraoperative blood loss, colloid fluid dosage, crystalloid fluid dosage, total output, and urine volume between two groups of patients; Two groups of patients were compared in terms of oxygenation index (OI), respiratory index (RI), central venous oxygen saturation (ScvO 2), lactate (Lac), central venous arterial carbon dioxide partial pressure difference (Pcv-aCO 2), oxygen supply index (DO 2I), and oxygen uptake rate (O 2ERe) before anesthesia induction (T 0), before single lung ventilation (T 1), 1 hour of single lung ventilation (T 2), immediate resumption of dual lung ventilation (T 3), 30 minutes of dual lung ventilation (T 4), and after surgery (T 5); The Mini Mental State Examination (MMSE) was used to evaluate the cognitive function scores of two groups of patients 1 day before surgery and 1 and 3 days after surgery, while recording the incidence of cognitive dysfunction (POCD) and pulmonary complications (including pulmonary infection, acute lung injury, pulmonary embolism, pulmonary edema, atelectasis, etc.) within 3 days after surgery. Results:The amount of crystal fluid and urine output in the research group was significantly lower than that in the control group, while the amount of colloidal fluid was significantly higher than that in the control group (all P<0.05). The OI of the study group T 1-T 5 was significantly higher than that of the control group, while the RI of T 2-T 5 was significantly lower than that of the control group (all P<0.05). The ScvO 2 of the study group T 1 to T 5 was significantly higher than that of the control group, and the Lac was significantly lower than that of the control group (all P<0.05); The MMSE scores of both groups of patients were significantly lower than those before surgery on day 1 and 3 after surgery, and the MMSE scores of the study group were significantly higher than those of the control group on day 1 and 3 after surgery (all P<0.05). The incidence of POCD within 3 days after surgery in the study group was 16.67%(9/54), lower than 37.04%(20/54) in the control group (χ 2=5.704, P=0.017); The incidence of pulmonary complications in the study group was lower than that in the control group (5.56% vs 22.22%, χ 2=4.955, P=0.026). Conclusions:The application of staged GDFT during anesthesia in patients undergoing radical lung cancer surgery can further improve tissue perfusion, improve microcirculation and oxygen supply-demand balance of systemic organs and tissues, including the brain, alleviate perioperative brain function damage, and reduce the occurrence of postoperative POCD compared to conventional liquid therapy.

After decades of development,protein and peptide drugs have now grown into a major drug class in the marketplace.Target identification and validation are crucial for the discovery of protein and peptide drugs,and bioinformatics prediction of targets based on the characteristics of known target proteins will help improve the efficiency and success rate of target selection.However,owing to the developmental history in the pharmaceutical industry,previous systematic exploration of the target spaces has mainly focused on traditional small-molecule drugs,while studies related to protein and peptide drugs are lacking.Here,we systematically explore the target spaces in the human genome specifically for protein and peptide drugs.Compared with other proteins,both suc-cessful protein and peptide drug targets have many special characteristics,and are also significantly different from those of small-molecule drugs in many aspects.Based on these features,we develop separate effective genome-wide target prediction models for protein and peptide drugs.Finally,a user-friendly web server,Predictor Of Protein and Peptide drugs'therapeutic Targets(POPPIT)(http://poppit.ncpsb.org.cn/),is established,which provides not only target prediction specifically for protein and peptide drugs but also abundant annotations for predicted targets.

Objective:To explore the diagnostic accuracy of bedside ultrasound measurement of limb skeletal muscle thickness for intensive care unit-acquired weakness (ICU-AW) in patients receiving mechanical ventilation.Methods:A prospective observational study was conducted. Patients receiving mechanical ventilation admitted to the emergency ICU of Cangzhou Central Hospital from June 2018 to March 2020 were enrolled. The demographic data were collected. Medical Research Council (MRC) score was used to assess muscle strength and to determine the presence of ICU-AW once the patients were awake. The thicknesses of biceps brachii (BB), flexor carpi radialis (FCR), rectus femoris (RF) and tibialis anterior (TA) were measured by bedside ultrasound. The difference of each index was compared between the patients in ICU-AW group and in non-ICU-AW group. Receiver operator characteristic (ROC) curves were plotted to examine the values of the thicknesses of these four muscles in diagnosing ICU-AW.Results:Forty-one patients receiving mechanical ventilation (15 patients with ICU-AW, 26 patients without ICU-AW) were recruited. Compared with the non-ICU-AW group, the MRC score, the thicknesses of FCR, RF and TA were lower in the ICU-AW group [MRC score: 36 (30, 40) vs. 60 (56, 60), FCR (cm): 1.09±0.19 vs. 1.30±0.28, RF (cm): 1.57±0.58 vs. 2.23±0.58, TA (cm): 1.76±0.33 vs. 2.21±0.43, all P < 0.05], and the length of ICU stay was longer [days: 15 (9, 26) vs. 10 (4, 12), P < 0.05]. Although the thickness of BB was also lower in the ICU-AW group, there was no statistical difference between the two groups (cm: 2.45±0.57 vs. 2.70±0.61, P = 0.205). ROC curve showed that the thicknesses of FCR, RF and TA had diagnostic values for ICU-AW [area under ROC curve (AUC) and 95% confidence interval (95% CI) was 0.742 (0.582-0.866), 0.787 (0.631-0.899), 0.817 (0.665-0.920), respectively, all P < 0.01]. The thicknesses of BB couldn't diagnose ICU-AW (AUC = 0.597, 95% CI was 0.433-0.747, P = 0.296). Conclusion:The thicknesses of FCR, RF and TA measured by bedside ultrasound in patients with mechanical ventilation had diagnostic values for ICU-AW, while the thickness of BB could not diagnose ICU-AW.

Objective:To monitor the susceptibility of common used antimicrobial agents against nosocomial Gram-negative bacilli in 2018 across China.Methods:Prospective collection of Gram-negative bacilli from 13 teaching hospitals nationwide from January to December 2018. The minimal inhibitory concentration (MICs) of antibiotics such as meropenem was determined by agar dilution methods and broth microdilution methods. Interpretation of results using the Clinical and Laboratory Standards Institute(CLSI) 2019 M100S (29th Edition) standard. Data were analyzed by using WHONET-5.6 software.Results:A total of 1 214 non-repetitive Gram-negative bacilli were collected, accounting for 96.7% (1 174/1 214) of blood and sterile body fluid samples. The activity of antimicrobial agents against 871 strains of Enterobacteriaceae was as follows in descending order of susceptible rate: amikacin (93.2%, 812/871), meropenem (92.0%, 801/871), ertapenem (88.9%, 774/871), imipenem (88.4%, 770/871), piperacillin-tazobactam (84.0%, 732/871), cefoperazone-sulbactam (83.1%, 724/871), cefepime (71.4%, 622/871), minocyline (68.9%, 600/871), ceftazidime (66.9%, 583/871), levofloxacin (54.4%, 474/871).The resistance rates of Escherichia coli to the third generation cephalosporins were 61.5% (155/252) (ceftriaxone) and 60.7% (153/252) (cefotaxime), respectively. The resistance rates of Klebsiella pneumoniae to the third generation cephalosporins were 56.6% (126/222) (ceftriaxone) and 57.9% (129/222) (cefotaxime), respectively. The incidence of extended-spectrum β lactamase (ESBLs) positive E. coli and K. pneumoniae was 50.2% (127/252) and 18.2% (40/222), respectively. Over 95% of all the ESBLs positive strains were susceptible to imipenem and meropenem. The incidence of carbapenem-resistant Escherichia coli and Klebsiella pneumoniae was 2.8% (7/252) and 20.4% (45/222), respectively. For Enterobacter cloacae, Klebsiella aerogenes, Citrobacter freundii, the most susceptible agent were tigecycline (96.3%-100%), followed by amikacin (94.9%-97.1%), meropenem (89.8%-96.6%)and imipenem (89.8%-94.9%).The susceptibility of Proteus mirabilis, Morganella morganii and Serratia marcescens to meropenem and amikacin was over 90%.A total of 67 strains of carbapenems resistant enterobacteriaceae(CRE) were detected. Modified carbapenem inactivation method showed, 45 strains were serine carbapenemase and 20 were metalloenzymes. The susceptibility of Pseudomonas aeruginosa to meropenem and imipenem were 73.2% (112/153) and 66.0% (101/153), respectively. Acinobacter baumannii has the highest sensitivity to colistin (100%, 163/163), followed by tigecycline (87.1%, 142/163).Compared with other sources of infection, specimens of bloodstream infections were less resistant to Klebsiella pneumoniae (17.6%, 27/153 vs 21.7%, 15/69) and Acinetobacter baumannii (68.3%, 71/104 vs 71.2%, 42/59). Escherichia coli (2.5%,4/198 vs 0%,0/54) and Pseudomonas aeruginosa (37%, 33/89 vs 18.8%, 12/64) have a high proportion of carbapenem resistance. Conclusions:Carbapenems still maintain high antibacterial activity against Enterobacteriaceae bacteria, especially strains producing only ESBLs. Carbapenem-resistant Klebsiella pneumoniae should be given sufficient attention. Carbapenemase is the most important drug resistance mechanism of carbapenem-resistant Enterobacteriaceae in China.

Large population-based cohort study is an important resource for population disease prevention and control, the results of which provide scientific basis for individualized treatment and precise prevention, and it is also the key strategic content of precision medicine. The Chinese Preventive Medicine Association coordinated experienced researchers from the Chinese Academy of Medical Sciences and other professional institutes to write up the group standard entitled Technical specification of management for field investigation in large population-based cohort study (T/CPMA 001-2019). Based on the research of large population-based cohort study in China and the principle of scientific, normative, applicable, and feasible, the standard proposed six aspects of management requirements including institutional arrangement, personnel composition, equipment, materials, documents and finance, as well as the basic requirements of the on-site investigation, the requirements of each position and the overall quality control requirements, etc.. The standard aims to guide the large population-based cohorts that have been or intended to be established in China, including national cohorts, regional population cohorts, and special population cohorts, hence to improve scientific research level, accelerate scientific research output and provide localization basis for disease prevention and control in China.

Objective To investigate the changes in the expression of phosphatidylinositol 3?kinase(PI3?K),mammalian target of rapamycin (mTOR)and Beclin?1 in the hippocampus of normal rats and intermittent hypoxia rats with cerebral ischemia/reperfusion ,so as to explore the role of PI3K/mTOR/autophagy pathway in global cerebral ischemia/reperfusion injury aggravated by intermittent hypoxia. Methods A total of 80 healthy male Wistar rats were randomly divided into sham operation group(SO group,n=20),merely ischemia/reperfusion group(I/R group,n=20),intermittent hypoxia for 7?day ischemia/reperfusion group(IH7+I/R group,n=20),and intermittent hypoxia for 21?day ischemia/reperfusion group(IH21+I/R group,n=20). IH7+I/R group and IH21+I/R group were respectively given intermittent hypoxia for 7 days and 21 days before ischemia/reperfusion. The cerebral ischemia/reperfusion model was established by modified Pulsinelli four?vessel occlusion method. The morpholog?ical changes of nerve cells in hippocampal CA1 region were observed by HE staining and electron microscope. The protein expressions of PI3?K, mTOR and Beclin?1 of nerve cells in hippocampal CA1 region were detected by immunohistochemical staining and RT?PCR. The learning memory capacity of rats were assessed by the Morris water maze test. Results Compared with SO group,I/R group increased the never cells morphology damages,reduced the number of survival neurons,and declined the ability of learning and memory(P<0.05). Immunohistochemistry showed that the number of PI3?K immunoreactive cell,mTOR immunoreactive cell and Beclin?1 immunoreactive cell increased in I/R group compared with S0 group(P<0.05). RT?PCR showed that the expressions of PI3?K,mTOR and Beclin?1 increased in I/R group compared with S0 group(P<0.05). Compared with I/R group,intermittent hypoxia groups increased the never cells morphology damages,decreased the number of survival neu?rons,and declined the ability of learning and memory(P<0.05). Immunohistochemistry showed that the number of PI3?K immunoreactive cell, mTOR immunoreactive cell and Beclin?1 immunoreactive cell increased in IH7+I/R and IH21+I/R groups compared with I/R group(P<0.05). RT?PCR showed that the expressions of PI3?K,mTOR and Beclin?1 increased in IH7+I/R and IH21+I/R groups compared with I/R group(P<0.05),and the changes were more significant in IH21+I/R group(P<0.05). Conclusion Intermittent hypoxia can aggravate neurological injury after ischemia,which is related to PI3K/mTOR/autophagy pathway activation.