Objective To construct and implement a swallowing disorder assessment and management program for tracheal intubated patients after extubation based on the 4R crisis management theory,providing standardized and scientific interventions for oral feeding.Methods Utilizing the expert meeting method with the 4R crisis management theory framework,a swallowing disorder assessment and management program was developed for post-extubation tracheal intubated patients.A convenience sampling method was employed to select patients with tracheal intubations treated from July to December 2023 in the emergency ICU,central ICU,and cardiovascular surgery ICU of a tertiary hospital in Zhejiang Province.The patients treated from October to December were assigned to an experimental group(n=68),while those treated from July to September were designated as a control group(n=58).The experimental group received the 4R crisis management-based intervention,whereas the control group received standard ICU assessment and management.Outcomes indicators included the incidence of post-extubation swallowing disorders,time to first oral intake,incidence of aspiration during initial feeding,nasogastric and nasointestinal tube placement duration,incidence of aspiration pneumonia during hospitalization,re-intubation rates,ICU readmission rates,ICU stay duration,and total hospitalization days.Results Of the initially recruited subjects,68 in the experimental group and 54 in the control group were included in the final analysis.After the intervention,the experimental group exhibited significantly lower rates of post-extubation swallowing disorders,shorter time to first liquid oral intake,aspiration incidence during first feeding,shorter durations of nasogastric and nasointestinal tube placement,aspiration pneumonia,ICU readmission compared to the control group(P＜0.05).No significant differences were observed between the groups in time to first regular oral intake,re-intubation rates(P＞0.05).Conclusion The risk management program for dysphagia following tracheal extubation based on the 4R crisis management theory is scientifically robust and safe,offering a valuable reference for clinical assessments and management of swallowing and eating post-extubation in tracheal intubated patients.

Objective To construct and implement a swallowing disorder assessment and management program for tracheal intubated patients after extubation based on the 4R crisis management theory,providing standardized and scientific interventions for oral feeding.Methods Utilizing the expert meeting method with the 4R crisis management theory framework,a swallowing disorder assessment and management program was developed for post-extubation tracheal intubated patients.A convenience sampling method was employed to select patients with tracheal intubations treated from July to December 2023 in the emergency ICU,central ICU,and cardiovascular surgery ICU of a tertiary hospital in Zhejiang Province.The patients treated from October to December were assigned to an experimental group(n=68),while those treated from July to September were designated as a control group(n=58).The experimental group received the 4R crisis management-based intervention,whereas the control group received standard ICU assessment and management.Outcomes indicators included the incidence of post-extubation swallowing disorders,time to first oral intake,incidence of aspiration during initial feeding,nasogastric and nasointestinal tube placement duration,incidence of aspiration pneumonia during hospitalization,re-intubation rates,ICU readmission rates,ICU stay duration,and total hospitalization days.Results Of the initially recruited subjects,68 in the experimental group and 54 in the control group were included in the final analysis.After the intervention,the experimental group exhibited significantly lower rates of post-extubation swallowing disorders,shorter time to first liquid oral intake,aspiration incidence during first feeding,shorter durations of nasogastric and nasointestinal tube placement,aspiration pneumonia,ICU readmission compared to the control group(P＜0.05).No significant differences were observed between the groups in time to first regular oral intake,re-intubation rates(P＞0.05).Conclusion The risk management program for dysphagia following tracheal extubation based on the 4R crisis management theory is scientifically robust and safe,offering a valuable reference for clinical assessments and management of swallowing and eating post-extubation in tracheal intubated patients.

In the context of Chinese narrative medicine,narrative thinking is a thinking mode in medical thinking,which is as important as evidence-based thinking,and is also the cornerstone of patient life safety and healthcare quality.Taking"narrative traditional Chinese medicine(TCM)"in the"Chinese narrative medicine discourse system"as the framework,this paper explored the narrative thinking contained in the theory of TCM("observing phenomena to capture essence","acting by combining and integrating","the ease of mind and body","narrative prescription",and"syndrome differentiation and treatment"),the life and health narrative literacy("life-preserving literacy","interpersonal narrative connection awareness"),as well as professional narrative thinking("ability to handle things","ability to deal with things","combination of the four diagnostic methods","treating the disease from its root",and"coordination of body and spirit")possessed by TCM practitioners.Besides,it clarified the important value of narrative thinking in improving healthcare quality,while proposed suggestions for the mechanism of medical education,teaching content,and teaching method based on the concept of Chinese narrative medicine.Looking forward to inspiring more contemporary medical educators and clinical practitioners to value the cultivation of narrative thinking and the practice of narrative medicine.

Objective:To improve the method for the determination of related substances in vidarabine monophos-phate.Methods:The analysis was performed on an ChromCore AQC18 column(4.6 mm × 150 mm,5 μm)with mobile phase A of an aqueous solution containing 0.01 mol·L-1 tetrabutylammonium hydroxide and 0.1 mol·L-1 potassium dihydrogen phosphate and mobile phase B of methanol by gradient elution at the flow rate of 1.0 mL·min-1.The column temperature was maintained at 30 ℃ and the UV detection wavelength was set at 258 nm.Results:Related substances were effectively separated from the principal component.Vidarabine mono-phosphate and its four impurities showed a good linear relationship in the self-concentration ranges(r＞0.999 9).The average recoveries and were 95.0％-99.2％with RSDs(n=9)of 1.0％-4.4％related substances in vidar-abine monophosphate and 91.8％-102.1％with RSDs of 0.5％-4.8％(n=9)for vidarabine monophosphate for injection,respectively.Conclusion:The improved method is simple,rapid and specific,and can be used for the determination of related substances in vidarabine monophosphate.

Starting from the inheritance and development of Chinese philosophy of life and Traditional Chinese Medicine (TCM) wisdom through the Chinese narrative medicine practice, this paper discussed the inheritance and correspondence relationship between the text reading ability in Chinese narrative medicine practice and the "four diagnostic" in TCM wisdom, narrative regulation and the "mind-body philosophy" in TCM, as well as the narrative wisdom and the "Tao produces one" in the Chinese philosophy of life. By analyzing the stories of contemporary doctors’ practice of narrative wisdom, this paper clarified that the Chinese narrative medicine system is a new model of medical education and clinical practice constructed by absorbing the essence elements of Chinese traditional life wisdom and TCM culture, and integrating the concept of western narrative medicine. It advocated for Chinese scholars to actively build the discipline of "narrative traditional Chinese medicine", constantly translate and introduce the achievements to foreign countries, and create a good narrative ecology of TCM.

Transcriptional phenotypic drug discovery has achieved great success,and various com-pound perturbation-based data resources,such as connectivity map(CMap)and library of inte-grated network-based cellular signatures(LINCS),have been presented.Computational strategies fully mining these resources for phenotypic drug discovery have been proposed.Among them,the fundamental issue is to define the proper similarity between transcriptional profiles.Tra-ditionally,such similarity has been defined in an unsupervised way.However,due to the high dimensionality and the existence of high noise in high-throughput data,similarity defined in the tra-ditional way lacks robustness and has limited performance.To this end,we present DrSim,which is a learning-based framework that automatically infers similarity rather than defining it.We evalu-ated DrSim on publicly available in vitro and in vivo datasets in drug annotation and repositioning.The results indicated that DrSim outperforms the existing methods.In conclusion,by learning tran-scriptional similarity,DrSim facilitates the broad utility of high-throughput transcriptional pertur-bation data for phenotypic drug discovery.The source code and manual of DrSim are available at https://github.com/bm2-lab/DrSim/.

Objective: To investigate the characteristics, temporal trend of silicosis, and provide basis for risk assessment and precise prevention and control of occupational diseases. Methods: Using descriptive statistics to analyze the reported cases of silicosis by SPSS 20.0 software. Reported silicosis cases, the constituent ratio, the incidence age and the working age at onset were analyzed by a linear trend test. Analyzing the variation trends of regional, industry, economic type and enterprise scale distributions by the chi-square trend test. Moreover, using Moran's I method for spatial autocorrelation analysis and trend-surface analysis. Results: (1) During 2006 to 2015, Guangdong province had reported 1, 428 cases of silicosis, mainly gathered in Foshan, Zhongshan, Guangzhou, Shenzhen, which included 1391 male cases accounting for 97.41%. And the average incidence age was 45 (39, 51) . The average working age of onset was 9 (5.5, 15) . In economic type distribution, the private economy took the main part, accounting for 59.1%. In enterprise scale distribution, it was dominated by small and medium enterprises (SMEs) , accounting for 32.4% and 37.3% respectively. In industry distribution, most cases were gathered in materials and mining industry, accounting for 32.1% and 22.9% respectively. (2) The number of silicosis cases, the incidence age and the working age of onset showed a rising trend (P<0.01) . Meanwhile, the constituent ratios of medium-sized enterprises and building materials industry were increasing (P<0.05) . The annual variation trends of regional, economic type and age distributions were not statistically significant (P> 0.05) . (3) The spatial distribution trend showed an inverted U type, which was firstly raised and then declined from south to north and from east to west. The distribution characteristic demonstrated some high-high cluster areas, including Chancheng, Nanhai, Shunde, Panyu, Dongguan, Pengjiang, and Zhongshan. While Wuhua showed a high-low outlier form (P<0.01) . Conclusion Silicosis cases, age and working age of onset were on the rise, as well as the industry and enterprise scale distributions of occupational diseases presented a certain trend in Guangdong province from 2006 to 2015. There were high-high cluster and high-low outlier phenomena in spatial distribution with spatial correlation. Therefore, our work of silicosis epidemic trend and distribution may provide some bases for the occupational disease risk assessment and control.

Objective To analyze the monitoring results on plague from 2013 to 2017 in Guizhou Province,to master the epidemic dynamics of the plague and to provide a basis for developing countermeasures.Methods Using a retrospective analysis method,plague monitoring data from 9 monitoring sites in Xingyi City,Anlong County,Ceheng County,Xingren County,Pan County,Liuzhi Special Zone,Si'nan County,Dejiang County and Yanhe County in Guizhou Province from 2013-2017 were collected and analyzed.Results In 2013-2017,there were no plague F1 antigen and F1 antibody.A total of 3 575 murine animals were captured indoors,with Rattus norvegicus as the dominant species,accounting for 49.99％ (1 787/3 575).Rattus norvegicus and Mus musculus were common species,accounting for 35.64％ (1 274/3 575) and 11.36％ (406/3 575),respectively;the density of indoor rat was 3.48％(3 575/102 641),there was no significant difference in rat density between different years (x2 =3.655,P ＞ 0.05).A total of 1 674 murine animals were captured outdoors,and the Rattus norvegicus was the dominant species,accounting for 34.29％ (574/1 674).S.serrata and Rattus norvegicus were common species,accounting for 18.28％ (306/1 674) and 13.20％ (221/1 674),respectively;the density of outdoor rat was 1.67％ (1 674/100 180),there was no significant difference in rat density between different years (x2 =6.241,P ＞ 0.05).A total of 9 541 murine animals were examed and 2 270 rats with flea were detected,the flea infestation rate of rat was 23.79％,the rat body flea index was 1.019 4,Xenopsylla cheopi was the dominant flea species and the index was 0.557 3.Conclusions The plague natural focus of Guizhou is at a quiescent stage.The plague monitoring work should be strengthened,health education should be done well,and plague epidemics should be stricdy prevented.

Objective To investigate the content of cadmium in shellfish in Guangdong Province and make dietary exposure assessment of cadmium in shellfish.Methods The shellfish samples were collected from Pearl River Delta,Eastern and Western Guangdong Province using random sampling method.Point assessment method was used to evaluate the exposure of dietary cadmium intake from shellfish.The risk of dietary cadmium exposure from shellfish were evaluated.Results Three hundred and seven samples were included in the analysis.The median concentration of cadmium in shellfish was 0.630 mg/kg and the exceeding standard rate was 23.8％ (73/307).The exceeding standard rates in Eastern Guangdong,Western Guangdong and Pearl River Delta were 19.4％ (13/67),23.5％ (16/68),and 25.6％ (44/172),respectively.The corresponding median concentration of cadmium were 0.530,0.806 and 0.853 mg/kg,and the difference was not statistically significant (x2 =0.94,P ＞ 0.05).The average (P50) and high level (P97.5) daily intake of cadmium from shellfish by the total survey population was 0.957 μg/d,and 4.511 μg/d,respectively.The monthly intake of cadmium associated with shellfish calculated from average and P97.5 exposure doses accounted for 1.91％ and 9.02％ of PTMI,respectively.Conclusion The cadmium content of some shellfish in Guangdong Province exceeded the standard.However,the cadmium intake from shellfish by the survey population was not high.

Objective To explore the effects of surface functionalized multi-walled carbon nanotubes (FMWCNTs) on the cytotoxicity of human peripheral blood mononuclear cell (PBMC).Methods Five different types of MWCNTs (hydroxylated,carboxylated,aminated,nickel-plated and pristine MWCNTs (P-MWCNTs)) with the same diameter and length were evaluated the dispersion and characterizations in physiological salt solution by transmission electron microscopy.PBMC were isolated by density gradient centrifugation from human peripheral blood,and 5 types of MWCNTs were ultrasonically dispersed in serum-containing medium respectively.After incubation with PBMC for 12,24,48 or 72 h,cytotoxicity was detected by CCK-8 kits.Results All the MWCNTs had well dispersion,especially the F-MWCNTs.Cytotoxicity results showed that all types of MWCNTs could induced PBMC death,and presented dose-dependence manner and a certain degree of time-dependence manner.Compared with the P-MWCNTs,F-MWCNTs changed cytotoxicity statistically,with the hydroxylated,carboxylated,aminated MWCNTs weakened,aminated MWCNTs significant (P＜0.05),nevertheless the nickel-plated MWCNTs increased.Compared with the P-MWCNTs (25 μg/ml),cell viability of PBMC after 24 and 48 h incubation with the same dose of nickelplated MWCNTs both decreased,and the differences was statistically significant (P＜0.01,P＜0.05).Conclusions The functional group modification affects not only the MWCNTs dispersion in medium,but also the cytotoxicity of the MWCNTs on PBMC.