BackgroundThe existing tools in China for assessing psychiatric nurses' knowledge， attitude and practice towards the use of protective restraint do not sufficiently consider the specialty in psychiatric practice， and the scale items are somewhat cumbersome to use， which together restrict their further promotion and application. Accordingly， there is an urgent need for developing a more scientific assessment tool. ObjectiveTo construct a scale for assessing psychiatric nurses' knowledge， attitude and practice towards the use of protective restraint and to verify its reliability and validity， so as to provide a generic tool for the assessment. MethodsBased on the theoretical framework of the knowledge-attitude-practice model， the preliminary scale was formed through systematic literature review， qualitative interview and Delphi method. From July to December 2021， a stratified sampling was utilized to select 729 psychiatric nurses from tertiary， secondary and primary （including unclassified medical institutions and grassroots hospitals） psychiatric hospitals in Guangdong Province. The formal scale was developed through item analysis， exploratory factor analysis and confirmatory factor analysis. The validity of the scale was evaluated by content validity and structure validity， and the reliability was verified by procedures including Cronbach's α coefficient， test-retest reliability， and split-half reliability. ResultsA total of 12 items of three dimensions （knowledge， attitude， practice） were included in the scale for assessing psychiatric nurses' knowledge， attitude and practice towards the use of protective restraint. The scale-level content validity index （S-CVI） was 0.941， and the item-level content validity index （I-CVI） ranged from 0.812 to 1.000. Exploratory factor analysis extracted three common factors， and the cumulative variance contribution rate was 62.948%. The confirmatory factor yielded adequate fit. Cronbach's α coefficient was found to be 0.887 for the scale， 0.819 for knowledge dimension， 0.842 for attitude dimension， and 0.831 for practice dimension. The split-half reliability and test-retest reliability for the scale were 0.712 and 0.922， respectively. ConclusionThe scale shows satisfactory reliability and validity， which can be used to assess psychiatric nurses' knowledge， attitude and practice towards the use of protective restraint. ［Funded by Guangdong Clinical Teaching Base Teaching Reform Research Project （number， 2021JD119）］

Objective To investigate the role of transcranial magnetic stimulation(TMS)in the modulation of abnormal functional status and damage characteristics of key brain regions in adult patients with anisometropic amblyopia via the resting-state functional magnetic resonance imaging(rs-fMRI)technique.Methods Single(left)eyes of 20 adult refractive amblyopia patients were included in this study and randomly divided into a surgical group[Implantable Collamer Lens(ICL)surgery]and a TMS combined group(TMS treatment on top of the surgical group),with 10 patients in each group.In both groups,the visual a-cuity of patients was examined before and after treatment via international standard visual acuity charts to evaluate the therapeu-tic effect.Moreover,patients in both groups underwent an fMRI examination once before and after treatment,and local coher-ence(ReHo),amplitude at low frequency(ALFF),and ratio amplitude at low frequency(fALFF)algorithms were used to char-acterize the functional state and response characteristics of the brain regions in the acquired f MRI images.Results Compared with that before treatment,the visual acuity of patients in both groups significantly improved after treatment and was signifi-cantly greater than the pretreatment corrected visual acuity(P＜0.05).Compared with that in the two groups after treatment,the improvement in visual acuity in the TMS combined group was greater than that in the surgical group(P＜0.05).There was no difference in the ReHo or fALFF values before and after treatment between the TMS combined group and surgical group.Compared with those before treatment,the ipsilateral frontal ALFF values were increased in the surgical group after treatment,and the ipsilateral cerebellar ALFF values were decreased in the TMS combined group.Compared with those in the surgical group,the ipsilateral frontal lobe and superior frontal gyrus ReHo values decreased,the contralateral temporal lobe and superior temporal gyrus ALFF values decreased,and the contralateral occipital lobe and cuneiform lobe fALFF values increased after treatment in the TMS combined group(all P＜0.05).Conclusion The improvement in spontaneous brain activity in pa-tients with anisometropic amblyopia in the surgical group and in the TMS combined group was significant.ICL implantation may act by activating the ipsilateral frontal lobe,ICL implantation in combination with TMS may act by improving cerebellar func-tion,increasing the excitability of the contralateral occipital and cuneate lobes,modulating neuronal activity in the adjacent cor-tex of the occipital lobe and in the other visually related cortices(ipsilateral frontal and contralateral temporal lobes),and correc-ting the difference in excitability between the two eyes of the patients.and correcting the excitability differences between the pa-tient's two eyes.

Cancer is the leading cause of death worldwide. Drugs play a pivotal role in cancer treatment, but the complex biological processes of cancer cells seriously limit the efficacy of various anticancer drugs. Autophagy, a self-degradative system that maintains cellular homeostasis, universally operates under normal and stress conditions in cancer cells. The roles of autophagy in cancer treatment are still controversial because both stimulation and inhibition of autophagy have been reported to enhance the effects of anticancer drugs. Thus, the important question arises as to whether we should try to strengthen or suppress autophagy during cancer therapy. Currently, autophagy can be divided into four main forms according to its different functions during cancer treatment: cytoprotective (cell survival), cytotoxic (cell death), cytostatic (growth arrest), and nonprotective (no contribution to cell death or survival). In addition, various cell death modes, such as apoptosis, necrosis, ferroptosis, senescence, and mitotic catastrophe, all contribute to the anticancer effects of drugs. The interaction between autophagy and these cell death modes is complex and can lead to anticancer drugs having different or even completely opposite effects on treatment. Therefore, it is important to understand the underlying contexts in which autophagy inhibition or activation will be beneficial or detrimental. That is, appropriate therapeutic strategies should be adopted in light of the different functions of autophagy. This review provides an overview of recent insights into the evolving relationship between autophagy and cancer treatment.
Antineoplastic Agents/therapeutic use* ; Apoptosis ; Autophagy/physiology* ; Humans ; Necrosis/drug therapy* ; Neoplasms/therapy*

ObjectiveBy comparing the difference of volatile components of the decoction pieces before and after being processed by braising method of Jianchangbang and steaming method included in the 2020 edition of Chinese Pharmacopoeia， the influence of processing methods on the flavor formation of Polygoni Multiflori Radix （PMR） was compared. MethodHeadspace-gas chromatography-mass spectrometry （HS-GC-MS） was used to detect the volatile components of 30 batches of PMR samples from 3 origins with 3 processing methods. The GC was performed under programmed temperature （starting temperature of 40 ℃， rising to 150 ℃ at 5 ℃·min^-1， and then rising to 195 ℃ at 10 ℃·min^-1） with high purity helium as carrier gas and the split ratio of 10∶1. Mass spectrometry conditions were electron impact ion source （EI） and the detection range of m/z 50-650， the peak area normalization method was used to calculate the relative mass fraction of each component. The chromaticity values of different processed products were measured by a precision colorimeter， the relationship between chromaticity values and relative contents of volatile components was investigated by OriginPro 2021， principal component analysis （PCA） and orthogonal partial least squares-discriminant analysis （OPLS-DA） were performed on the sample data by SIMCA14.1. The differential components of different processed products of PMR were screened according to the principle of variable importance in the projection （VIP） value>1.5， and the material basis of different odor formation of PMR and its processed products was explored. ResultA total of 59 volatile components were identified， among which 34 were raw products， 33 were braised products， and 27 were steamed products. PCA and OPLS-DA results showed that there were significant differences between the three， but there was no significant difference between samples from different origins of the same processing method. Color parameters of a^*， b^*， E^*ab had no significant correlation with contents of volatile components， while L^* was negatively correlated with contents of 2-methyl-2-butenal， 2-methyltetrahydrofuran-3-one and 2，3-dihydro-3，5-dihydroxy-6-methyl-4（H）-pyran-4-one （P<0.05）. The contents of pungent odor components such as caproic acid， nonanoic acid and synthetic camphor decreased after processing， while the contents of sweet flavor components such as 2-methyl-2-butenal， furfural and 5-hydroxymethylfurfural increased after processing， and the contents of furfural， 5-methyl-2-furanmethanol， 5-hydroxymethylfurfural and other aroma components in the braised products were significantly higher than that in the steamed products. ConclusionHS-GC-MS can quickly identify the volatile substance basis that causes the different odors of PMR and its processed products. The effect of processing methods on the odor is greater than that of origin. There is a significant correlation between the color parameter of L^* and contents of volatile components， the "raw" taste of PMR may be related to volatile components such as caproic acid， pelargonic acid and synthetic camphor， the "flavor" after processing may be related to the increase of the contents of 2-methyl-2-butenal， furfural， 5-hydroxymethylfurfural， methyl maltol and furfuryl alcohol.

Reflex tests are ordered when a particular test result indicates that additional testing should be performed according to the guidelines or the feedback process formulated by clinical consultation. The application scope of the reflex tests involves various subspecialties of laboratory medicine. The clinical application needs the support of qualified laboratory doctors, comprehensive information and financial system, clinical guidelines, and so on. Active application of reflex tests can promote the standardization of evidence-based medicine in clinical practice, save medical resources, and shorten the diagnosis and treatment time of patients.

Objective:To investigate the clinical characteristics and change trend of patients with perianal lesions before or after Crohn′s disease (CD) diagnosed.Methods:From January 2008 to September 2018, at The Tenth People′s Hospital Affiliated to Tongji University, the clinical data of 747 hospitalized CD patients were retrospectively collected, 293 patients were PCD patients. The clinical characteristics of PCD patients before or after CD diagnosed were analyzed and the change trend was followed. T test, Mann-Whitney U test, and Chi-square test were performed for statistical analysis. Multivariate logistic regression analysis was used to analyze factors associated with perianal lesions onset time. Spearman correlation analysis was used to analyze the change trend of clinical characteristics. Results:Before CD diagnosis, 86.3% (253/293) PCD patients had perianal lesions. The median follow-up time (range) was 72 months (36 to 108 months). Compared with the patients presented with perianal lesions after CD diagnosis, the onset age of patients with perianal lesions before CD diagnosis was younger ((36.0±12.6) years vs. (24.2±10.2) years), and the rates of male (62.5%, 25/40 vs. 77.9%, 197/253), non-structuring and non-penetrating type (32.5%, 13/40 vs. 56.9%, 144/253) and perianal surgery (55.0%, 22/40 vs.76.7%, 194/253) were high, but low rate of abdominal surgery (37.5%, 15/40 vs. 13.0%, 33/253), and the differences were statistically significant ( t=2.630, χ2=4.442, 8.379, 8.379 and 15.081; all P<0.05). The results of logistic multivariate analysis showed that before CD diagnosis, non-structuring and non-penetrating type was more common than structuring type (odds ratio ( OR)=0.447, 95% confidence interval ( CI) 0.207 to 0.962, P=0.039) and penetrating type ( OR=0.264, 95% CI 0.089 to 0.780, P=0.016). The short disease duration of CD ( OR=0.981, 95% CI 0.968 to 0.995, P=0.008), structuring type ( OR=2.239, 95% CI 1.040 to 4.822, P=0.039) and penetrating type ( OR=3.788, 95% CI 1.281 to 11.198, P=0.016) were the risk factors of perianal lesions after CD diagnosed. The number of PCD patients ( r=0.964, P<0.01) and the proportion of biological agents ( r=0.879, P<0.01) increased with years, while PCD duration ( r=-0.828, P<0.01) and the rate of abdominal surgery significantly decreased with years ( r=-0.882, P<0.01). The proportion of biological agents was negatively correlated with the rate of abdominal surgery ( r=-0.770, P=0.006). Conclusions:The perianal lesions should be closely monitored in adult CD patients with short disease duration, structuring type and penetrating type for early diagnosis and treatment. Biological agents can improve the clinical outcomes of PCD.

OBJECTIVE： To evaluate the therapeutic efficacy and safety of 2 kinds of selective Janus kinase 1 （JAK-1） inhibitor Upadacitinib and Filgotinibfor in the treatment of rheumatoid arthritis， and to provide evidence-based reference for clinical treatment. METHODS： Retrieved from PubMed， Medline， Embase， the Cochrane library， CBM， CJFD， Wanfang database and VIP， RCTs about placebo （control group） versus Upadacitinib or Filgotinibfor （trial group） in the treatment of rheumatoid arthritis on the basis of methotrexate or other antirheumatic drugs were collected during the establishment of the database to Jan. 2019. Meta-analysis of therapeutic efficacy [the proportion of patients with remission rate of 20％ （ACR20）， ACR50， ACR70 according to the criteria of American Rheumatism Association， the proportion of patients with 28-joint disease activity score （DAS28）＜3.2] and safety [the incidence of adverse event （AE）， severe adverse event （SAE）， infection， severe infection， herpes zoster， liver injury] were conducted by using Rev Man 5.3 software after data extraction and quality evaluation with Cochrane system evaluator manual 5.1.0. RESULTS： A total of 8 RCTs were included， involving 2 738 patients. Meta-analysis showed that the proportion of patients with ACR20 [OR＝3.37，95％CI（2.80，4.05），P＜0.001]， ACR50 [OR＝3.78，95％CI（2.98，4.78），P＜0.001] and ACR70 [OR＝4.31，95％CI（3.05，6.09），P＜0.001]， the proportion of patients with DAS28＜3.2 [OR＝3.86，95％CI（2.98，5.00），P＜0.001]， the incidence of AE [OR＝1.33，95％CI（1.11，1.61）， P＝0.002]， the incidence of infection [OR＝1.43，95％CI（1.12，1.81），P＝0.004] in trial group were significantly higher than control group； there was no statistical significance in other indexes （P＞0.05）. CONCLUSIONS： JAK-1 inhibitors Upadacitinib and Filgotinib can improve the effect indexes of ACR20， ACR50 and ACR70 and the proportion of patients with DAS28＜3.2 of rheumatoid arthritis patients； it can not increase the incidence of SAE， severe infection， herpes zoster， liver injury， but can increase the risk of AE and infection.

Objective To compare the clinical application value of the real-time fluorescence PCR method and flow cytometry method for detecting human leukocyte antigen B27(HLA-B27).Methods Blood HLA-B27 level in 225 patients with suspected ankylosing spondylitis was detected by using real-time fluorescence PCR method and flow cytometry method.The detection results were compared and analyzed between the two methods.Results The results of 95.1% sample were identical detected by two methods without statistically significant difference(P>0.05).Taken the results of flow cytometry as reference, the sensitivity of real-time fluorescence PCR for detecting HLA-B27 was 94%, the specificity was 96%.Gene sequencing was performed if results of a sample detected by two methods were different, which was identical with the result detected by real-time fluorescence PCR.Conclusion Both methods for detecting HLA-B27 all have high sensitivity and specificity.Real-time fluorescence PCR method is more superior to the flow cytometry method in the results accuracy.

In order to compensate for the deficiencies of current medical education, improve the comprehensive quality of medical students, the First Clinical College, Tongji Medical College of Huazhong University of Science and Technology took the lead in carrying out the health management practice of rela-tives and friends, and made a beneficial exploration of humanistic education for medical students. Relatives and friends were regarded as the specific practice objects, and by telephone and network at school, face-to-face communication during the vacation, medical students established, managed and track the health records of relatives and friends. The students could practice while learning, which made medical students, in im-proving the knowledge structure, enhance their emotional communication with friends and relatives, improve their doctor-patient communication ability, establish the concept of humanistic care, and cultivate their occupation moral respect for life and their dedication to medicine and the sense of responsibility and mission to the society. It provides a new strategy for medical humanities education.

Objective To establish the MALDI-TOF-MS technique platform for detecting Cytochrome P450 gene polymor-phismfrom of patients.Methods Collected 53 EDTA anticoagulation peripheral blood samples from October 2013 to June 2014 in Peking Union Medical College Hospital.The whole genomic DNA was extracted from patients’peripheral blood. Used MALDI-TOF-MS to identify the SNP polymorphism of CYP2C9*2(rs1799853),CYP2C9*3(rs1057910),CYP2C19*2(rs4244285),CYP2C19*3(rs4986893),CYP2C19*4(rs28399504),CYP2C19*5(rs56337013)and CYP2C19*17 (rs12248560).To verify the above SNP polymorphism by Sanger sequencing method.Results The MALDI-TOF-MS could perform 53 samples on two cytochrome gene and 7 SNP locus simultaneously.In all the 53 patients,25 AG,6 AA and 22 GG genotypes were identified in CYP2C19*2(rs4244285),the allele frequency of A genotype was 34.9%.4 AG and 49 GG genotypes were identified in CYP2C19*3 (rs4986893),the allele frequency of A genotype was 3.8%.5 CA and 48 AA gen-otypes were identified in CYP2C9*3 (rs1057910),the allele frequency of C genotype was 4.7%.No mutation loci were i-dentified in CYP2C9*2 (rs1799853),CYP2C19*4 (rs28399504),CYP2C19*5 (rs56337013)and CYP2C19*17 (rs12248560).All the identification data were confirmed by Sanger sequencing.The coincidence rate was 100%.Conclusion The MALDI-TOF-MS technique platform for the cytochrome enzyme SNP was established.This platform has high throughput and accurate characteristics.It has important clinical application value for the treatment of personalized medicate.