To investigate the association between sleep-related phenotypes and the risk of malignancy in pulmonary nodules, and to provide complementary evidence from a general population cohort and genetic analyses.

The exploration and pilot studies of applying blockchain to drug supply chain show great potential in promoting information sharing, collaboration competence among the actors, regulatory efficiency, and etc. In the future, with the help of blockchain, the optimization of the entire supply chain for orphan drugs is expected to be realized. However, there is no such exploration in China at present. This paper systematically sorts out the whole process of supply chain for orphan drugs and the existing problems of the chain. The article concludes that at present, blockchain is mainly used in the " circulation" and " use" of the drug supply chain. It helps to improve the traceability of drugs, to cope with the problem of counterfeit drugs, to enable actors of the drug supply chain to form a collaborative network in optimizing resource allocation, and to improve the operation and supervision efficiency of the supply chain. In the future, the application faces challenges such as high costs in system conversion, lack of personnel awareness, and incomplete supporting systems. Based on the three dimensions of technology, practice, and research, this paper also looks into the future and suggests for the future use of blockchain in the supply chain of orphan drugs by constructing a practice model, the so called DI-GIVE (Digital, Intelligence, Government′s supervision, Innovation, Views of variety, Evaluation-based) hoping to innovate the supply chain of orphan drugs and to ensure the drug use for the patients with rare diseases in China.

BACKGROUND:Research has shown that endoplasmic reticulum stress-induced autophagy of neurons in the ischemic penumbra is a key link in cerebral ischemia-reperfusion injury.Autophagy mediated by the dissociation and activation of endoplasmic reticulum transmembrane proteins PERK,IRE1 α,ATF6,and GRP78/BIP plays an important role in neuronal outcomes.Traditional Chinese medicine can regulate endoplasmic reticulum stress-autophagy,reduce neuronal damage or death,and exert neuroprotective effects.OBJECTIVE:To explore the role of endoplasmic reticulum stress-autophagy in cerebral ischemia-reperfusion injury and the research progress in the regulatory mechanisms of traditional Chinese medicine.METHODS:A literature retrieval was conducted in CNKI and PubMed for relevant literature related to endoplasmic reticulum stress,autophagy,cerebral ischemia-reperfusion injury,and regulation by traditional Chinese Medicine published from January 2015 to May 2024.The search terms were"cerebral ischemia-reperfusion injury,ischemic stroke,brain injury,endoplasmic reticulum stress,autophagy,traditional Chinese medicine,compounds,signaling pathways,saponins,polyphenols,alkaloids"in Chinese and English,respectively.Any literature that is inconsistent with the research content,outdated,or duplicated was excluded.A total of 1197 relevant literature were retrieved,and 71 articles were ultimately included.RESULTS AND CONCLUSION:(1)Numerous studies have suggested that endoplasmic reticulum stress-autophagy is closely related with cerebral ischemia-reperfusion injury.(2)The active ingredients and compound formulas of traditional Chinese medicine monomers can regulate the expression of endoplasmic reticulum stress-autophagy related proteins,alleviate neuronal damage,and exert neuroprotective effects by regulating signal pathways such as PERK-eIF2α-ATF4,IRE1α-ASK1-JNK,and IRE1α-XBP.

Pseudopleuronectes yokohamae is an important marine economic fish species in northern China and is vulnerable to various pathogens during the breeding process.To investigate the viru-lence of Edwardsiella tarda on Pseudopleuronectes yokohamae and elucidate the role of miRNAs in their interaction,we conducted pathological analyses on various tissues of Pseudopleuronectes yokohamae larvae pre-and post-infection with Edwardsiella tarda.Subsequently,Illumina high-throughput sequencing was employed to identify and functionally characterize differentially ex-pressed miRNAs in liver and kidney tissues.The results demonstrated that infection with Ed-wardsiella tarda led to ulceration,hemorrhaging,significant hepatomegaly,nephromegaly,and as-cites in the abdominal cavity.Histopathological examination revealed swollen hepatocytes with vac-uolization,minor blood cell infiltration,and enlarged renal corpuscles with signs of cellular lysis.miRNA sequencing analysis indicated that 24 miRNAs were significantly upregulated and 45 miR-NAs were significantly downregulated in the liver,while in the kidney,6 miRNAs were upregulat-ed and 58 were downregulated following infection.Functional enrichment analysis revealed signifi-cant enrichment of differentially expressed miRNAs in Toll and IMD signaling pathways,HIF-1 signaling pathway,Rap1 signaling pathway,MAPK signaling pathway,and Apelin signaling path-way.These findings suggest the involvement of these miRNAs in host metabolism,pathogen rec-ognition,and immune response in the interaction between Pseudopleuronectes yokohamae and Ed-wardsiella tarda.This research lays a foundation for elucidating the mechanisms underlying bacte-rial disease susceptibility and resistance in Pseudopleuronectes yokohamae.

OBJECTIVE The aim of the study was to investigate and analyze the resource allocation and surveillance status of hospital-associated infections in secondary and above healthcare facilities in Anhui province.METHODS Secondary and above healthcare institutions in 16 cities were selected in Mar.2023 by convenient sampling meth-od,and self-designed questionnaire was administered by'wenjuanxing'to investigate the characteristics of health-care facilities,the management and surveillance of hospital-acquired infections.RESULTS A total of 302 medical facilities,including 88 tertiary and 195 comprehensive facilities,completed the survey.All tertiary healthcare fa-cilities set up the independent departments for hospital-associated infections,while 12.15%of secondary health-care facilities did not.Totally 17.22%of healthcare facilities did not meet the standard requirements of ratio of full-time equivalents to beds,while the unqualified rate of tertiary healthcare facilities(25.00%)was higher than that of secondary healthcare facilities(14.02%).The full-time equivalents were mainly in nursing(64.89%),and relatively insufficient in other specialties.All tertiary healthcare facilities had carried out comprehensive surveil-lance,however,secondary healthcare facilities still needed to be improved.The allocation ratio of surveillance in-formation for system hospital-associated infection was 37.42%in tertiary healthcare facilities,but only 18.69%in secondary.CONCLUSIONS The hospital-associated infection management system of certain healthcare facilities in Anhui province still calls for improving,more personnel numbers and specialties are required.Besides,the con-struction of information system urgently needs to be strengthened.At the same time,more attention should be paid to secondary healthcare facilities,which should be supplied for more resources,carry out basic monitoring work to reduce hospital-associated infections and ensure patients'safety.

OBJECTIVE To evaluate the changes in monitoring indicators related to healthcare-associated infections(HAIs)management in Anhui Province in 2018 and 2022,to provide a scientific basis for optimizing HAI control strategies.METHODS A cross-sectional survey was conducted in 2019 and 2023 across 48 secondary and tertia-ry medical institutions,HAI data were collected and analyzed.RESULTS The two-year averages of monitoring indi-cators were as follows:the incidence rate of HAIs was 0.66％,the prevalence rate of HAIs was 1.69％,the inci-dence rate of surgical site infection for class I incisions was 0.20％,the antibiotic usage rate was 44.59％,the pathogen detection rate for therapeutic antibiotics was 43.76％,the incidence rate of catheter-related blood-stream infection(CRBSI)was 0.64‰,the incidence rate of ventilator-associated pneumonia(VAP)was 5.81‰,and the incidence rate of catheter-associated urinary tract infection(CAUTI)was 0.79‰.By 2022,significant im-provements were observed in most indicators(P＜0.05).Compared to tertiary hospitals,secondary hospitals ex-hibited low rates of hospital infection incidence,prevalence,class I incision infections,antibiotic utilization and CRBSI,but high rates of VAP and CAUTI(P＜0.05).CONCLUSIONS Significant improvements have been made in monitoring indicators related to HAI managements in Anhui Province.However,secondary hospitals still need to enhance their capabilities of monitoring indicators and detecting pathogens.

OBJECTIVE To assess the influence of hospital-associated carbapenem-resistant Klebsiella pneumoniae(CRKP)infection on direct economic burden of the intensive care unit(ICU)patients so as to provide bases for optimization of infection control strategies.METHODS A total of 242 patients who were detected with CRKP were chosen from 5426 patients who were hospitalized in ICUs of Fuyang People's Hospital from Jan.2021 to Dec.2024,the enrolled patients were recruited as the research subjects and were divided into the CRKP infection group with 48 cases and the non-CRKP infection group with 194 cases according to the status of hospital-associated infec-tions.The direct economic burden due to the CRKP infection was analyzed by propensity score matching(PSM)method.RESULTS The isolation rate of CRKP was 39.93％(242/606),the incidence of hospital-associat-ed infections was 0.88％(48/5426),ventilator-associated pneumonia were dominant,accounting for 43.75％.To-tally 44 pairs were matched in a 1∶1 ratio by PSM.After the matching,the median total hospitalization costs of the CRKP infection group was 226,079.17 yuan per case,more than 121,615.56 yuan per case in the non-CRKP infection group(P＜0.05).The burden of western medicine costs was the highest composition of the costs,which was increased by 39,166.45 yuan per case,and the cost of antibiotics was increased by 5251.20 yuan per case(all P＜0.05).The length of hospital stay extended by 11.00 days per case due to hospital-associated infec-tions(40.00 days vs.29.00 days,P＜0.05).CONCLUSIONS The direct economic burden of the ICU patients is re-markably increased due to the hospital-associated CRKP infection,which is mainly from the increase of west-ern medicine costs and extension of hospital stay.It is crucial to optimize the use of antibiotics and reduce the inva-sive procedures(such as removing ventilators as early as possible)so as to reduce the direct economic burden.

Objective:To identify the relevant factors for the first-course remission of acute myeloid leukemia (AML) and to develop a predictive model as well as assess its predictive capability.Methods:Clinical data of 749 patients newly diagnosed with AML admitted to the Department of Hematology, the First Affiliated Hospital, Zhejiang University, School of Medicine from January 1, 2019, to April 30, 2023, were collected and randomly divided into training and validation sets. Multivariate logistic regression analysis was conducted to determine variables associated with complete remission in the first course of induction therapy, and a predictive model was established based on these variables. The receiver operating characteristic (ROC) curve of the predictive model was plotted, and the area under the curve (AUC) was calculated.Results:The indicators predicting the first remission course included peripheral blood white blood cell count during onset, CBF::MYH11 fusion gene, CEBPA bZIP region mutation, myelodysplastic syndrome-related gene mutation, and induction chemotherapy regimen selection as independent factors for the first remission course. The model’s area under the training and validation curves was 0.738 (95% CI: 0.696-0.780) and 0.726 (95% CI: 0.650-0.801), respectively. The Hosmer-Lemeshow test results yielded P-values of 0.993 and 0.335, respectively. Conclusion:In this study, the developed model demonstrates a strong predictive capability for the efficacy of the first course of patients with AML, providing valuable guidance to clinicians in assessing patient prognosis and selecting appropriate treatment strategies.

Objective To evaluate the effectiveness of active screening in improving the detection rate of carbape-nem-resistant Enterobacterales(CRE)in the intensive care units(ICUs).Methods From July 2023 to June 2024,active screening of rectal swab CRE was conducted on ICU patients in 10 hospitals.ICU patients who underwent ac-tive screening from July 2023 to June 2024 were selected as the study group,while those who did not undergo active screening from July 2022 to June 2023 were selected as the control group.Difference in CRE detection rates between the two groups of patients was compared.Results A total of 7 803 ICU patients were included in the study group,744 CRE strains were detected,with a detection rate of 9.53％,out of which 304 CRE strains were detected through routine detection(detection rate 3.90％),3 707 patients underwent active screen,440 CRE strains were detected(detection rate 11.87％).7 561 ICU patients were included in the control group,out of which 250 CRE strains were detected through routine detection,with a detection rate of 3.31％.There was a statistically significant difference in the overall detection rate of CRE between two groups of patients(x2=246.18,P＜0.001).In the study group,CRE detection rate of active screening(11.87％)was higher than that of routine detection(3.90％),with statistically significant difference(x2=264.26,P＜0.001).A total of 17 CRE strains were detected from the study group.The proportions of Klebsiella pneumoniae(80.92％vs 73.41％)and Serratia marcescens(2.30％vs0.23％)in the routine detection group were both higher than in the active screening group,while the proportion of Escherichia coli in the routine detection group was lower(8.22％vs 19.55％),all with statistically significant differences(all P＜0.05).Conclusion The prevalence of CRE in ICUs is relatively high,with a wide range of bac-terial species.Active screening can improve the detection rate of CRE.

Foot torsion stiffness refers to the foot's ability to resist deformation when subjected to torsional forces,and such characteristics play a crucial role in the prevention of sports injuries and design of athletic footwear.This review systematically summarizes the biomechanical research progress of foot torsion and shoe torsion,as well as the research and application of multi-segment foot models in foot-shoe torsion.The findings indicate that foot torsional stiffness significantly impacts lower limb kinematics,kinetics,and athletic performance.Optimizing this stiffness can improve stress distribution,reduce injury risk,and enhance performance.The future researches should focus on refining measurement techniques to enhance reliability and efficiency in clinical applications,providing a scientific foundation for sports injury prevention and footwear design.