Objective:To analyze the cause and epidemiological characteristics of an outbreak of cutaneous anthrax in Caoxian County, Heze City, Shandong Province, and to provide scientific basis for anthrax prevention and control.Methods:Using on-site epidemiological investigation methods and the "Anthrax Epidemiological Case Investigation Form", case investigations were conducted based on the epidemiological contact history and close contacts of suspected anthrax cases reported by the national health care system ( n = 83). Scorched skin smears, diseased cattle tissues, soil samples from the slaughter site and smears from slaughter utensils were collected from cases for Real-time PCR testing and pathogenic bacteria isolation and culture, respectively. Anthrax determination criteria were carried out with reference to "Anthrax Diagnosis" (WS 283-2020). Results:A total of 13 cases of cutaneous anthrax were found in this outbreak, including 12 clinically diagnosed cases and one confirmed case (positive Real-time PCR test and isolation of a strain of Bacillus anthracis). The epidemiological investigation determined that the source of infection in this outbreak was diseased cattle, the transmission route was through slaughter of diseased cattle, contact with contaminated utensils and related cattle products, and the patients were mainly engaged in occupations related to cattle slaughter or cattle product collection and sale. A total of 84 samples were collected, including 13 skin scabs, 64 environmental samples and 7 beef samples. Thirty-six positive PCR tests were performed, with a positive rate of 42.86% (36/84). Among them, 100.00% (13/13) were positive for skin scab smear specimens, 29.69% (19/64) for environmental samples and 4/7 for beef samples. A total of 8 strains of Bacillus anthracis were isolated, including 6 environmental specimens, 1 suspected case and 1 beef strain, with an overall detection rate of 9.52% (8/84). Eighty-three close contacts were investigated. Thirteen households involved in the epidemic were disinfected by spraying (200 ml/m 2) with chlorine-containing disinfectant (5 000 mg/L), and a total of 40 households involved in the epidemic were disinfected, covering an area of about 10 765 m 2. Forty-five pieces of suspected contaminated clothing were burned and disposed of, and 152 pieces of kitchenware were soaked. Conclusions:Slaughter of infected cattle, contact with contaminated utensils and related cattle products are the main causes of this skin anthrax outbreak. Strengthening market supervision, deepening inter-animal epidemic prevention, carrying out publicity and education on anthrax prevention and control, and enhancing practitioners' awareness of disease prevention is the key to prevent anthrax from occurring.

From September 2020 to August 2021, 34 general practice trainees in Xuanwu Hospital, Capital Medical University were were randomly divided into the control group and trial group with 17 in each group. The control group adopted the traditional clerkship method for outpatient clinical teaching; the trial group independently received patients with the supervision of clinical instructors, and the Leicester assessment package (LAP) was used for evaluation and training. The performance of two groups were assessed using the Beijing General Practitioner's Graduation Assessment and Admissions Patient Score Sheet. The LAP training was also given to control group at the late stage of the study, and the application of LAP was assessed with a questionnaire survey in two groups of trainees. The results showed that the performance of trial group was better than that of control group in terms of medical history collection [(23.12±1.05) vs. (21.18±0.88), t=-5.82, P<0.01 ], physical examination [(24.88±1.62) vs. (23.12±1.58), t=-3.22, P< 0.01 ], case analysis [(22.94±0.90) vs. (20.82±0.73), t=-7.55, P<0.01 ] and total score [(86.59±2.65) vs. (80.12±2.45) t=-7.40, P<0.01]. For assessment of LAP, all 34 trainees gave 5 points in items of improving patient care, knowledge and skills, communication skills, professional quality, reception skills, clinical thinking, clinical judgment, decision-making skills, and learning interest with the application of LAP in outpatient clinical teaching; the satisfaction of the trainees on the pertinence, teaching effect and LAP training method of the instructing physicians was 100% (34/34). It is suggested that the application of LAP for evaluation and implementation in general practice outpatient teaching will help to improve the teaching quality and the patient receiving ability of general practitioners.

Objective:To survey the needs and requirements of the general practice department in general hospitals from the perspective of grassroots health care personnel.Methods:From July 2020 to February 2022, a qualitative study on needs and requirements for the general practice department in general hospitals was conducted. Twenty eight participants from community health service centers in Beijing, Xi′an and Guangzhou were selected for the in-depth interviews.Results:The participants expressed their opinions and suggestions on the community needs and requirements for general practice department in general hospitals as follows. (1) The necessity of establishing department of general practice in general hospitals: the general hospitals had advantages to meet the medical needs of the community; the teaching and training should be focus on the way of thinking in the general practice, while the training needs for research ability was less required. (2) The cooperation between general hospital and its community teaching base: to implement the joint teaching rounds and joint home visits were effective ways for collaboration, which may ensure the quality of clinical faculty in the community bases. (3)The training needs of the community: rational use of drugs was most required, sub-specialty training was another concern for general practitioners in grassroots level. (4) The requirements for general practice department in the general hospital: in addition to complete organizational structure, daily teaching work needs to be implemented, and horizontal and vertical connection to relevant health institutions also need to be strengthened. Meanwhile, the teaching work should be a considerable part in the department performance assessment, and excellent clinical ability was also required to facilitate the effective referral of patients from the community.Conclusions:The study shows the necessity of establishing department of general practice in general hospitals, and various needs from the community teaching base, which providing reference for improving the construction of general practice department in the future.

Objective:To develop a Beijing norm of Memory and Executive Screening (MES) scale to facilitate its further promotion and application in the future.Methods:Study subjects were selected based on the inclusion and exclusion criteria, including patients who visited the memory clinic of Xuanwu Hospital of Capital Medical University from March 20, 2017 to January 6, 2021, and normal people recruited simultaneously from community, and trained and qualified investigators conducted questionnaire surveys through face-to-face interviews. Then strict quality control, data collection and statistical analysis were performed.Results:A total of 607 participants were included, including 239 normal people, 293 individuals with subjective cognitive decline (SCD), and 75 individuals with mild cognitive impairment (MCI). There was a negative correlation between the scores of MES and age ( r=-0.19, P<0.001), but a positive correlation between scores of MES and education level ( r=0.29, P<0.001). The optimal cut-off value of this scale in Beijing was 86 points, the area under curve (AUC) of the cut-off value to distinguish MCI was 0.847 (normal people vs MCI) and 0.826 (SCD vs MCI), and after adding demographic variables, AUC showed slight increase (0.847 to 0.850 and 0.826 to 0.847), whereas the differences were not statistically significant ( Znormal peoplevsMCI=0.49, ZSCDvsMCI=1.21, P>0.05). And there was no statistically significant difference between MES and Montreal Cognitive Assessment scales in diagnostic power for normal people and people with MCI ( Zscale alone=1.03, Zafter adding demographic variables=1.13, P>0.05). Conclusions:The MES scale has a better distinguishing power for MCI, and its optimal cut-off value in Beijing is 86 points, which is different from previous studies. In the future, the sample size needs to be further expanded to verify this norm.

Objective:To investigate the therapeutic value of modified multipoint drainage for biliary complications after liver transplantation.Methods:A total of 125 patients treated by endoscopic retrograde cholangiopancreatography (ERCP) for biliary complications after liver transplantation in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from May 2018 to May 2020 were enrolled. Patients were divided into endoscopic retrograde biliary drainage (ERBD) group ( n=67, treated with multiple drainage of bile duct stent) and modified multipoint drainage group [ n=58, treated with ERBD combined with endoscopic nasobiliary drainage (ENBD)] by random number table. Modified multipoint drainage group were further randomly divided into two groups, modification group 1, 31 cases, where nasobiliary ducts were cut proximal to duodenal papilla after one week under endoscopy and modification group 2, 27 cases, where they were cut proximal to duodenal papilla after two weeks under endoscopy. The changes of serological indexes in 2 weeks after the operation in three groups were compared, and the incidence of short-term and long-term complications were analyzed. Results:The serological indexes were improved in patients at 1 d, 7 d and 14 d after ERCP, especially in modified multipoint drainage groups. Two weeks after the operation, the improvement of serological indexes in modification group 2 was better than that in modification group 1. Incidence of recent complications including cholangitis, hyperamylasinemia, and pancreatitis in the ERBD group were higher than those in modification group 1 [32.84% (22/67) VS 12.90% (4/31), 46.27% (31/67) VS 19.35% (6/31), 20.90% (14/67) VS 3.23% (1/31), all P<0.05] and modification group 2 [32.84% (22/67) VS 11.11% (3/27), 46.27% (31/67) VS 22.22% (6/27), 20.90% (14/67) VS 3.70% (1/27), all P<0.05]. ERBD group had a higher incidence of long-term complications including recurrent biliary infection and jaundice than modification group 1 [ 58.21% (39/67) VS 35.48% (11/31), P=0.036; 49.25% (33/67) VS 25.81% (8/31), P=0.027] and modification group 2 [58.21% (39/67) VS 11.11% (3/27), P<0.001; 49.25% (33/67) VS 25.93% (7/27), P=0.038]. The incidence of recurrent biliary infection in modification group 1 was higher than that in modification group 2 [35.48% (11/31) VS 11.11% (3/27), P=0.030]. Conclusion:Multiple drainage with indwelling nasal bile duct by ERCP can effectively reduce the short-term and long-term complications and improve the recovery of serological indexes for patients with biliary complications after liver transplantation. It is suggested that the nasobiliary duct should be retained for 2 weeks and then transformed into a built-in tube to continue drainage.

Objective:To investigate the knowledge status of Alzheimer′s disease (AD) and its influencing factors among community medical and nursing staff in Beijing.Methods:By using a convenient sampling method, 5 community health service centers in Beijing (3 in the urban area and 2 in the suburbs) were selected for survey sites from September 2016 to December 2017. A face-to-face questionnaire survey on the awareness and knowledge of AD was conducted among 270 health care staff of above 5 centers. The Alzheimer′s Disease Knowledge Scale (ADKS, 7 dimensions) and the self-designed questionnaire (influencing factors) were used for survey.Results:The mean score of 270 participants was 19.6±2.7, and the passing rate (≥18) was 80.7% (218/270). The scores of the seven dimensions ranged from low to high were care 45.4±22.7, symptoms 57.0±22.3, risk factors 60.7±19.4, life effects of AD 65.6±24.9, assessment and diagnosis 66.9±18.3, duration of disease 77.9±20.6, treatment and management 82.5±18.2. Multivariate analysis showed that the experience of caring for patients with dementia (β=1.072, P=0.03) was the influencing factor of the total ADKS scores. For single dimension of AKDS, the experience of caring for patients with dementia (β=0.348, P=0.01) and participating in dementia training (β=0.233, P=0.03) were the influencing factors of the dimension "life effects of AD"; the experience of caring for patients with dementia (β=0.459, P=0.01) and the visiting frequency of patients with dementia (β=0.154, P=0.02) were the influencing factors of the dimension "symptoms". Finally, the working years (β=0.124, P<0.01) of the staffs was the influencing factor of the dimension "duration of disease". Conclusion:In Beijing community health service centers, the knowledge of AD among medical and nursing staff is not sufficient, which are associated with the lack of the experience of taking care for dementia patients, not participating in dementia training, low visiting frequency of dementia patients and the less working years. Targeted training should be taken to improve their knowledge of AD.

Increasing evidence indicates that brain-derived neurotrophic factor(BDNF), especially its BDNFVal66Met gene polymorphism, plays an important role in cognitive function of Alzheimer's disease(AD), with its effects on cognition function confirmed by a large number of studies.Therefore, this article reviews the clinical application of BDNF and BDNFVal66Met for Alzheimer's disease(AD), aiming to examine their practical value and effects on AD.

Objective To observe the effects of mesenchymal stem cells (BMSCs) on the expression of Bcl2 and Bax in atrophied muscles.Methods Immature rats (80～ 100 g) were anesthetized to collect marrow from their femurs and tibias.BMSCs were isolated from the marrow,cultured and purified using the whole bone marrow adherence method.Their right hindlimbs were immobilized fiom the thigh to the paw with the knee in extension and the ankle in plantar flexion.After the modeling,24 of the male rats were divided into a sham-operation group,a BMSC group and a phosphate buffer solution (PBS) group,each of 8.The BMSC and PBS groups were injected with either approximately 106 BMSCs or an equal volume of PBS into the belly of the soleus muscle after they had been immobilized for 48 hours,while the control group did not undergo any treatment except for the injection of PBS.All of the rats were sacrificed for analysis after 14 days.Results The BMSCs were mainly spindle cells,showing radial colony arrangement.They grew vigorously and could passage in a continuous and stable manner over 10 passages.At the 4th passage the BMSCs were positive for CD44 (95.84％) and CD90 (96.00％),but negative for CD34 and CD45.Western blotting assay demonstrated that the expression of Bax protein as measured in grey-scale value (0.41±0.08)in the BMSC group was significantly lower than in the PBS group (0.63±0.10),but significantly higher than in the control group (0.14±0.11) on average.The expression of Bcl-2 (0.47±0.14) was also significantly higher in the BMSC group than in the PBS group (0.22-± 0.13),but significantly lower than in the control group (0.81 ± 0.06).Conclusion Bone marrow mesenchymal stem cells can upregulate the expression of anti-apoptotic Bcl-2 protein and downregulate that of the apoptotic Bax protein when injected early into the belly of a muscle in an immobilized limb.

Absent in melanoma 2(AIM2),as a cytoplasmic DNA sensor,can perceive the cytoplasmic dsDNA which released by the cells infected with DNA virus or bacteria.AIM2 will be raised by Apoptosis-associated speck-like protein containing a CARD to produce inflammation complex,activate of Caspase-1,promote the maturation,and secretion of IL-1β and IL-18,or lead to pyroptosis.AIM2 plays an importation role in initiating immunity.Recent research shows that AIM2 has an influence on the occurrence and progress in tumor,it acts as a tumor suppressor and inhibits tumor progression in liver and breast carcinoma;However,AIM2 shows the carcinogenic effect of promoting tumor development on cervical carcinoma and oral squamous cell carcinoma.These results contribute to the diagnosis and prognosis of malignant tumor.

Objective To observe the effects of treadmill training at different intensities on the expression of p-AKT in rats' gastrocnemius muscles after focal cerebral ischemia,and to investigate whether intensive training is beneficial for the recovery of motor function.Methods Left middle cerebral artery occlusion (MCAO) was induced in 120 male Wistar rats using the intraluminal thread method,and they were divided into an MCAO group (no training),a normal training group (treadmill training once a day for 30 min) and an intensive training group (treadmill training twice a day for 60 min),each of 30 rats.There was also a sham control group with 30 members not given MCAO or training.The four groups were further divided into 3 day,7 day and 14 day subgroups.Five rats randomly selected from each subgroup were sacrificed for hematoxylin-eosin staining after 4％ paraformaldehyde treatment.Neurological function was evaluated using Zausinger scores,and the expression of p-Akt was detected by western blotting.Results No significant differences in Zausinger scores were observed between the intensive training group and the normal training group after 1,3 or 7 days of training.However the average Zausinger score in the intensive training group was significantly higher than in the normal training group after 14 d of treadmill training.After 7 d and 14 d of treadmill training the average cross-sectional area of the gastrocnemius muscles in the sham group was significantly higher than in the other three groups.The average area of the intensive training group was significantly larger than that of the normal training group.The expression of p-Akt in the gastrocnemius was significantly increased in the intensive training group compared with the normal training group in the 7 day and 14 day subgroups.Conclusion Treadmill training can improve the expression of p-Akt in atrophied gastrocnemius muscles caused by MCAO.Intensive training is more effective for the recovery of muscle function.