Objective To evaluate the short-term effects of comprehensive health management interventions for stroke high-risk population screening on the prevention and treatment of ischemic stroke, and to provide reference and basis for improving and exploring health management and prevention strategies for stroke high-risk population. Methods From 2018 to 2022, 13 community health service centers in Jiading District, Shanghai were selected in the present study. Based on information push platform, stroke risk assessment and health intervention follow-up were conducted for community residents through convenience sampling. The residents were divided into a full course intervention group (intervention group) and a routine intervention group (control group) according to different health intervention measures and forms. The incidence of ischemic stroke in the two groups of survey subjects was tracked within 36 months. Results A total of 52144 subjects were included in the study. The total number of patients in the full course intervention group was 14227, with an incidence density of 577.32/100 000 (556.49/100 000-598.12/100 000), which was lower than that of the conventional intervention group (37 917), with an incidence density of 1 485.47/100 000 (1 464.99/100 000-1 505.94/100 000) (χ²=2490.212, P<0.001). The relative risk of the full course intervention group was 0.39, and the relative risk of stroke risk factors in the full course intervention group from low to high was 0.33, 0.43, 0.45, and 0.49, respectively. The incidence density of males in the full course intervention group was 660.76 (627.46/100 000 - 694.05/100 000), with a relative risk of 0.43, and the incidence density of female patients was 509.71/100 000 (483.37/100 000 - 536.05/100 000), with a relative risk of 0.35. The overall incidence density of the population under 62 years old gourp, 62-75 years old group and over 75 years old group was 197.45/100 000 (173.09/100 000 -221.80/100 000), 608.36/100 000 (580.19/100 000-636.54/100 000), and 1 025.06/100 000 (958.51/100 000-1 091.61/100 000), with relative risks of 0.51, 0.44, and 0.38, respectively. Conclusion Comprehensive health management measures can effectively reduce the short-term risk of ischemic stroke, and should be further promoted and improved to enhance the effectiveness of stroke prevention and control.

BackgroundNon-suicidal self-injury （NSSI） behavior is highly prevalent during adolescence. Previous studies have mainly focused on the relationship between NSSI behavior and emotional regulation， pain perception， reward mechanisms， and impulsivity. However， the cognitive mechanisms underlying the occurrence and maintenance of NSSI behavior have not been sufficiently explored. Adolescence is a critical period for the development of cognitive control. However， it remains unclear whether adolescents with depressive disorder accompanied by NSSI behavior have abnormal cognitive control. ObjectiveTo reveal the potential deficits in cognitive control among adolescents with depressive disorder accompanied by NSSI behavior. MethodsThis study was a case-control study including 166 adolescent patients who visited the Third People's Hospital of Lanzhou from November 2024 to May 2025 and met the diagnostic criteria for depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5）. According to whether they had NSSI behavior or not， patients were divided into the NSSI group （n=86） and the non-NSSI group （n=80）. At the same time， healthy adolescents who passed mental health screenings in five public middle schools in the northwest region were selected as the control group （n=71）. All participants completed the color-word Stroop task， and the accuracy rates and reaction time in congruent and incongruent conditions of each group were recorded， and the interference effect based on accuracy rates and reaction time was calculated. ResultsIn terms of accuracy rate， the main effect of trial type was statistically significant （F=46.900， P<0.01， ηp²=0.160）， and the interaction effect between group and trial type was also statistically significant （F=3.390， P=0.035， ηp²=0.028）. In terms of reaction time， the main effect of trial type was statistically significant （F=72.020， P<0.01， ηp²=0.240）， and the interaction effect between group and trial type was also statistically significant （F=6.400， P=0.002， ηp²=0.050）. Simple effect analysis revealed that under both congruent and incongruent conditions， the reaction time of the NSSI group was longer than those of the non-NSSI group and the control group， and the reaction time of the non-NSSI group was also longer than that of the control group （P<0.01）. There were statistically significant differences in the interference effects among three groups based on reaction time （H=10.231， P=0.006）. The interference effect in the NSSI group was higher than that in the control group （Z=3.012， P_adj=0.008） and the non-NSSI group （Z=2.453， P_adj=0.043）. There was no statistically significant difference in the interference effect among the three groups based on accuracy rate （H=5.666， P=0.059）. ConclusionAdolescents with depressive disorder accompanied by NSSI behavior exhibit cognitive control deficits beyond depressive symptoms， particularly showing impaired conflict suppression ability. ［Funded by Lanzhou Municipal Health Industry Scientific Research Project （number，A2026019）］

Objective To investigate the distribution characteristics of Klebsiella pneumoniae(KP),hyperviru-lent Klebsiella pneumoniae(hvKP),carbapenem-resistant Klebsiella pneumoniae(CRKP),and hypervirulent car-bapenem-resistant Klebsiella pneumoniae(hv-CRKP/CR-hvKP)in the environment of general intensive care unit(ICU)at medical institutions,and provide reference for environment assessment as well as healthcare-associated in-fection(HAI)prevention and control in ICU.Methods A total of 3 336 environmental specimens were collected from general ICUs of medical institutions in Shanghai in 2019 and 2023.After strain isolation,antimicrobial suscep-tibility testing and whole genome sequencing were conducted.Results The detection rate of KP was 1.59％(n=53),among which hvKP,CRKP,and hv-CRKP/CR-hvKP accounted for 37.74％(20/53),52.83％(28/53),and 24.53％(13/53)of the total detected strains,respectively.The main types of hvKP were ST11-KL64 and ST11-KL25,CRKP were ST15-KL19 and ST11-KL25,hv-CRKP/CR-hvKP were ST11-KL25 and ST11-KL64.The main carried resistance genes included fosA,oqx AB,tet(A),blaTEM-1B,blaKPC-2,qnrS11,etc.All strains carried viru-lence genes fimH,iutA,ent A,entB,entC,entD,entE,and entF,with only one strain carrying rmp A gene.Conclusion KP contamination is widespread in general ICU environment of medical institutions,predominantly ST11 and ST15,presenting a polymorphic distribution.CRKP and hvKP account for a relatively high proportion,and multidrug resistance is serious.Co-evolution of drug resistance and virulence presents in KP,and poses signifi-cant infection and pathogenic risks to patients,necessitating enhanced clinical vigilance and preparedness for poten-tial outbreaks.

OBJECTIVE To study the effects of Ro 64-6198,a selective nociceptin/orphanin FQ receptor(NOPR)agonist,on heroin self-administration and drug-seeking behavior in rats.METHODS Rats were trained to self-administer heroin intravenously at a dose of 0.05 mg·kg-1 under a fixed ratio 1(FR1)reinforcement schedule.Heroin motivation was assessed using a progressive ratio(PR)schedule.Firstly,a stable heroin self-administered rat model was established before the effects of Ro 64-6198 on heroin rewarding under the FR1 schedule were observed.After three days of self-administration recovery training,the effects of Ro 64-6198 on heroin reward motivation were observed under the PR3-4 schedule.Following extinction,the reinstatement of heroin seeking induced by either conditioned cues or heroin priming was evaluated in rats withdrawn from self-administration.The expressions of cAMP response element-binding protein(CREB)and brain-derived neurotrophic factor(BDNF)in the ventral tegmental area(VTA)were analyzed using Western blotting,while the expression of the NOPR in neurons in the VTA was examined through immunofluorescence staining.RESULTS Pretreatment with 3 mg·kg-1 Ro 64-6198 significantly reduced active responses and heroin infusions during FR1 testing,as well as decreased breakpoints,indicating reduced motivation under the PR schedule.At a dose of 1 mg·kg-1,Ro 64-6198 markedly attenuated the reinstatement of heroin-seeking behavior induced by conditioned cues or heroin priming.Furthermore,the administration of SB-612111,an NOPR antagonist,blocked the inhibitory effects of Ro 64-6198 on cue-induced heroin-seeking,although SB-612111 alone had no effect on heroin-seeking behavior.Ro 64-6198 treatment also suppressed the reduction of both phos-phorylated CREB(p-CREB)and BDNF levels in the VTA and the decreased expression of NOPR and p-CREB in dopaminergic neurons of the VTA.CONCLUSION These results demonstrate that Ro 64-6198 can mitigate heroin-seeking behavior through NOPR activation and CREB/BDNF pathway in the VTA.This study is expected to offer evidence for its potential as a clinical treatment for heroin addiction and relapse.

Objective:To observe the effect of governor vessel(GV)electroacupuncture on potassium chloride cotransport-er 2(KCC2)and γ-Aminobutyric acid type a receptor(GABAAR α 1)and to explore the possible mecha-nism of GV electroacupuncture in improving post-stroke limb spasticity(PSLS).Method:45 male SD rats of SPF grade were randomly selected into the blank group and the sham operation group,with 9 rats in each group.The remaining rats were used to make the middle cerebral artery occlusion model.On the 3rd day after the completion of modeling,the rats with limb spasticity were chosen and random-ly divided into the model group,the electroacupuncture group,and the baclofen group,with 9 rats in each group,following a series of behavioral tests.Acupuncture was provided to the electroacupuncture group at"Da-zhui","Jizhong"and"Houhui",whereas the baclofen group received a baclofen solution by gavage for 7 days.Rats in each group were observed for the changes in nerve function by the symptom score of nerve function defect,and the changes in muscle tension level were evaluated by the modified Ashworth grading score and EMG signal value change.KCC2 and GABAARα1 mRNA and protein in the cerebral cortex of rats were de-tected by qPCR and Western Blot,and changes in chloride ion content were detected with a colorimetric kit.Result:The neurological function defect score,the modified Ashworth grading score,the water content of brain tissue,the volume of cerebral infarction,and the expression of chloride ion content in the model group were all significantly increased compared with the sham operation group at the same time point(P＜0.01),while the EMG signal value,cerebral cortex KCC2 and GABAAR α 1 mRNA and protein were significantly decreased(P＜0.01).Compared with the model group,the nerve function defect score,the modified Ashworth grading score,the water content of brain tissue,the volume of cerebral infarction and the expression of chlo-ride ion content in the electroacupuncture group and the baclofen group were all decreased(P＜0.01),while the EMG signal value and KCC2,with GABAARα1 mRNA and protein expression were all increased(P＜0.01,P＜0.05,respectively);There was no significant difference in all indexes between the GV electroacupuncture group and the baclofen group(P＞0.05).Conclusion:GV electroacupuncture can increase the expression of KCC2,GABAARα1 mRNA,and protein in the cerebral cortex of rats,in order to exert the inhibitory effect of γ-aminobutyric acid,thus improving the symptoms of PSLS.

Objective:To observe the effect of governor vessel(GV)electroacupuncture on potassium chloride cotransport-er 2(KCC2)and γ-Aminobutyric acid type a receptor(GABAAR α 1)and to explore the possible mecha-nism of GV electroacupuncture in improving post-stroke limb spasticity(PSLS).Method:45 male SD rats of SPF grade were randomly selected into the blank group and the sham operation group,with 9 rats in each group.The remaining rats were used to make the middle cerebral artery occlusion model.On the 3rd day after the completion of modeling,the rats with limb spasticity were chosen and random-ly divided into the model group,the electroacupuncture group,and the baclofen group,with 9 rats in each group,following a series of behavioral tests.Acupuncture was provided to the electroacupuncture group at"Da-zhui","Jizhong"and"Houhui",whereas the baclofen group received a baclofen solution by gavage for 7 days.Rats in each group were observed for the changes in nerve function by the symptom score of nerve function defect,and the changes in muscle tension level were evaluated by the modified Ashworth grading score and EMG signal value change.KCC2 and GABAARα1 mRNA and protein in the cerebral cortex of rats were de-tected by qPCR and Western Blot,and changes in chloride ion content were detected with a colorimetric kit.Result:The neurological function defect score,the modified Ashworth grading score,the water content of brain tissue,the volume of cerebral infarction,and the expression of chloride ion content in the model group were all significantly increased compared with the sham operation group at the same time point(P＜0.01),while the EMG signal value,cerebral cortex KCC2 and GABAAR α 1 mRNA and protein were significantly decreased(P＜0.01).Compared with the model group,the nerve function defect score,the modified Ashworth grading score,the water content of brain tissue,the volume of cerebral infarction and the expression of chlo-ride ion content in the electroacupuncture group and the baclofen group were all decreased(P＜0.01),while the EMG signal value and KCC2,with GABAARα1 mRNA and protein expression were all increased(P＜0.01,P＜0.05,respectively);There was no significant difference in all indexes between the GV electroacupuncture group and the baclofen group(P＞0.05).Conclusion:GV electroacupuncture can increase the expression of KCC2,GABAARα1 mRNA,and protein in the cerebral cortex of rats,in order to exert the inhibitory effect of γ-aminobutyric acid,thus improving the symptoms of PSLS.

Objective To investigate the distribution characteristics of Klebsiella pneumoniae(KP),hyperviru-lent Klebsiella pneumoniae(hvKP),carbapenem-resistant Klebsiella pneumoniae(CRKP),and hypervirulent car-bapenem-resistant Klebsiella pneumoniae(hv-CRKP/CR-hvKP)in the environment of general intensive care unit(ICU)at medical institutions,and provide reference for environment assessment as well as healthcare-associated in-fection(HAI)prevention and control in ICU.Methods A total of 3 336 environmental specimens were collected from general ICUs of medical institutions in Shanghai in 2019 and 2023.After strain isolation,antimicrobial suscep-tibility testing and whole genome sequencing were conducted.Results The detection rate of KP was 1.59％(n=53),among which hvKP,CRKP,and hv-CRKP/CR-hvKP accounted for 37.74％(20/53),52.83％(28/53),and 24.53％(13/53)of the total detected strains,respectively.The main types of hvKP were ST11-KL64 and ST11-KL25,CRKP were ST15-KL19 and ST11-KL25,hv-CRKP/CR-hvKP were ST11-KL25 and ST11-KL64.The main carried resistance genes included fosA,oqx AB,tet(A),blaTEM-1B,blaKPC-2,qnrS11,etc.All strains carried viru-lence genes fimH,iutA,ent A,entB,entC,entD,entE,and entF,with only one strain carrying rmp A gene.Conclusion KP contamination is widespread in general ICU environment of medical institutions,predominantly ST11 and ST15,presenting a polymorphic distribution.CRKP and hvKP account for a relatively high proportion,and multidrug resistance is serious.Co-evolution of drug resistance and virulence presents in KP,and poses signifi-cant infection and pathogenic risks to patients,necessitating enhanced clinical vigilance and preparedness for poten-tial outbreaks.

Pharmacoepidemiology is an interdisciplinary field that applies epidemiological methods to study drug use,effectiveness,and associated risk in populations.Standardizing research methods in this field is crucial for ensuring research quality and promote the development of the discipline.Based on the Guide on Methodological Standards in Pharmacoepidemiology in China(2nd edition),this article interprets the relevant contents about classic research types and their derivative designs.It aims to clarify the types of study methodological designs in pharmacoepidemiology,systematically describe the characteristics and applications classical derivative designs,and compare these with research design frameworks outlined in international pharmacoepidemiological guidelines.Compared to the first edition,the second edition of the guideline has updated and detailed the types of research,updating the research design to original research(interventional research and non-interventional research),secondary research(systematic review,Meta-analysis,economic analysis,etc.),and tertiary research(umbrella review,etc.).Additionally,a variety of derivative designs have been added,including target trial emulation,nested case-control and case-cohort studies,case-crossover designs,self-controlled case series and self-controlled risk interval designs,case-population studies,interrupted time-series analysis,and case-coverage(ecological)designs for vaccine surveillance.This article strengthens the operability of the theoretical guidance of pharmacoepidemiological research methods in practice and provides a reference for conducting high-quality pharmacoepidemiological research.

ObjectiveTo compare colonoscopy compliance rates under different screening strategies, to explore ways to enhance colonoscopy compliance among residents with colorectal carcinoma. MethodsResidents aged between 50‒80 years were recruited through extensive community outreach and voluntary participation. A total of 210 630 residents who participated in the colorectal carcinoma screening program in Jiading District, Shanghai, between 2013 and 2019 were selected as the research subjects. All subjects underwent a colorectal carcinoma risk assessment questionnaire survey and two fecal occult blood tests (FOBT). Positive results in the initial screening were defined as a positive questionnaire survey or a positive result in at least one FOBT. Participants with positive initial screening results were advised to undergo colonoscopy screening in a hospital. Colonoscopy results were collected from hospital reports and physician follow-ups. Compliance with colonoscopy was analyzed under different screening strategies to identify possible factors influencing residents’ willingness to undergo the procedure. ResultsA total of 21 403 individuals (10.16%) were identified as positive with the questionnaire survey, 31 595 individuals (15.00%) tested positive with at least one FOBT. Combined questionnaire and FOBT positivity was observed in 3 501 individuals (1.66%). Among the 48 453 individuals with positive initial screening results, 17 230 (35.56%) underwent colonoscopy, and a total of 315 cases of colorectal cancer were detected. The sensitivity, specificity value of FOBT initial screening were 83.81% and 84.66%, respectively. According to the combined risk assessment and FOBT initial screening preliminary screening, the lowest colonoscopy compliance rate (25.63%) was observed among individuals with only a positive questionnaire, and the highest compliance rate (52.55%) was among those with both positive questionnaire survey and two positive FOBT results. Multivariate analysis revealed that FOBT positivity had the greatest impact on colonoscopy compliance. Those with one positive FOBT test result were 2.64 times more likely to undergo colonoscopy screening than those with negative FOBT results, while individuals with two positive FOBT results were 3.18 times more likely to do so. After adjusting for FOBT results, individuals with positive questionnaire survey results were 1.43 times more likely to undergo colonoscopy screening than those with negative results (95%CI: 1.34‒1.52). Compared to questionnaire-based risk assessment, FOBT results were more influential in determining compliance with colonoscopy. ConclusionThe choice of initial screening method significantly impacts residents’ compliance with colonoscopy. While implementing colorectal carcinoma screening programs, it is necessary to strictly adhere to screening protocols, including risk assessment and FOBT. Additionally, efforts should be made to raise public awareness, encouraging residents to actively participate in risk assessments and FOBT, thereby improving their compliance with colonoscopy.