Objective:To investigate the physical and mental experience, treatment compliance and use barriers of patients with insomnia in using digital cognitive behavioral therapy for insomnia (dCBT-I) in order to provide qualitative evidence for the development and application optimization of the dCBT-I technology paradigm.Methods:From July to November 2021, a semi-structured interview outline was used to conduct in-depth interviews with the dCBT-I users ( n=10) to record their original feelings about the use of dCBT-I. Interpretative phenomenology's text analysis was used to explore the participants' experience and cognition of dCBT-I. Results:Text analysis and key information calibration were carried out on the verbatim transcripts of semi-structured interview recordings, and three core themes were extracted, namely stickiness factor, use barrier and optimization direction, as well as eight sub-themes, namely professionalism, accessibility, benefit experience, difficulty in task execution, instruction generalization, difficulty in software operation, enrich treatment content and personalized guidance.Conclusion:The present study showed that participants were receptive to the dCBT-I intervention and would be benefited from it.However, dCBT-I still needs to be optimized and improved to reduce the operating difficulty and explore more appropriate timing of manual intervention.

Immune checkpoint inhibitors(ICIs)have become the most widely used drugs in tumor immunotherapy, with ipilimumab and nivolumab as their representatives.However, the use of immune checkpoint inhibitors has brought about many immune-related adverse events, of which myocarditis is one of the most fatal adverse reactions.The pathogenesis of immune checkpoint inhibitor-associated myocarditis is not fully understood, mainly involving autoimmune T lymphocyte infiltration, regulatory T-cell dysfunction, cytokines, autoantibody production, genetic factors, the gut microbiome, etc.The treatment and management of immune checkpoint inhibitor-associated myocarditis require concerted efforts of multidisciplinary experts.

Objective To analyze the clinical characteristics of the recipients infected with cryptococcus neoformans after renal transplantation. Methods Clinical data of 9 patients infected with cryptococcus neoformans after renal transplantation were retrospectively analyzed, including the infection site, clinical manifestations, mycological, histopathological, imaging examination results, treatment process and clinical prognosis. Results Nine recipients were treated with routine triple immunosuppressive therapy of tacrolimus (FK506) + mycophenolate mofetil (MMF)+prednisone. The median time of onset was 6 years (1-13 years) after operation. Among them, 1 case was diagnosed with cryptococcal meningitis, 5 cases of cryptococcal meningitis complicated with cryptococcal pneumonia, 2 cases of cryptococcal pneumonia and 1 case of cutaneous cryptococcal infection. Cryptococcal pneumonia was clinically manifested as fever, cough, expectoration, shortness of breath and chest pain, etc. Chest CT demonstrated the signs of nodules and pleural effusion, etc. The diagnosis was mainly confirmed by lung biopsy and negative ink staining of the alveolar lavage fluid. Clinical manifestations of cryptococcal meningitis primarily included fever and paroxysmal headache accompanied by vomiting, which was mainly confirmed by blood culture and negative ink staining of the cerebrospinal fluid. Cutaneous cryptococcal infection was characterized by a mass in the right shoulder, which was confirmed by skin biopsy. All patients were given with standard antifungal therapy including amphotericin B and fluconazole, and immunosuppressive therapy at a reduced dosage. Among 9 recipients, 1 recipient died, and the other recipients obtained excellent clinical prognosis. Conclusions Cryptococcus neoformans infection dominantly occurs in the middle and late stage after renal transplantation presenting with non-specific clinical symptoms. Blood culture, lung biopsy and cerebrospinal fluid examination should be timely performed to validate the diagnosis of this disease. Standard anti-fungal therapy can reduce the mortality rate.

Objective To explore the effect of amlodipine atorvastatin calcium tablets in the treatment of patients with hypertension and coronary heart disease complicated with carotid atherosclerosis .Methods From August 2013 to August 2017,280 patients with hypertension and coronary heart disease complicated with carotid atherosclerosis in the Second People＇s Hospital of Ji＇nan were selected,and they were divided into two groups by envelope randomization packet mode,with 140 cases in each group.The control group was treated with amlodipine benzenesulfonate.The observation group was treated with amlodipine atorvastatin calcium tablets .The incidence of adverse reactions,diastolic blood pressure (DBP) level,systolic blood pressure (SBP) level,total effective rate,hs-CRP,TC,TG,HDL-C,LDL-C,IMT,PV were compared between the two groups.Results There were no statistically significant differences in PV,IMT,SBP and DBP between the two groups (t ＝1.150,0.861,0.195,0.637,all P＞0.05).The incidence rate of adverse reactions (2.86%),DBP level[(78.95 ±3.11)mmHg],SBP level[(121.63 ±5.42)mmHg],total effective rate (96.43%),hs-CRP levels[(4.15 ±1.65)mg/L],TC level [(3.28 ±1.98)mmol/L],TG level[(1.22 ±0.34)mmol/L],HDL-C level[(1.98 ±0.75)mmol/L],LDL-C level[(1.33 ±0.54)mmol/L],IMT[(1.12 ±0.05)mm],PV[(0.11 ±0.03)cm3]in the observation group were better than those in the control group (χ2＝22.630,t＝15.839,37.209,χ2＝25.053,t＝20.056,7.381,8.659,15.110,21.951,15.665,12.951,all P＜0.05).Conclusion The effect of amlodipine atorvastatin calcium tablets in the treatment of patients with hypertension and coronary heart disease complicated with carotid atherosclerosis is remarkable.

Objective To summarize the preliminary experience of donor liver protection and function evaluation for organ donation after citizen's death. Methods Clinical data of 35 donors from organ donation after citizen's death and 33 recipients were retrospectively analyzed. Donor liver procurement and clinical prognosis of the recipients were summarized. According to serum level of sodium ion (serum sodium) before organ procurement, all recipients were divided into the serum sodium <155 mmol/L, 155-160 mmol/L and 161-180 mmol/L groups. The incidence of liver graft dysfunction early after liver transplantation was statistically compared among three groups. Results In 35 donors,27 cases were Chinese type Ⅱ and 8 cases were Chinese type Ⅲ. Thirty-three donor livers were used for liver transplantation, and the remaining 2 cases of donor livers were excluded due to congestive cirrhosis. In 33 liver transplantation recipients, 30 cases were successfully recovered. The liver function was gradually restored at postoperative 7-14 d, and normal liver function was obtained during long-term follow-up. Postoperatively, 3 recipients died including 2 cases dying from portal vein thrombosis and 1 case from pulmonary infection complicated with multiple organ failure. The incidence of early liver graft dysfunction of the recipients after liver transplantation was 18%, 23% and 4/5 in the serum sodium <155 mmol/L, 155-160 mmol/L and 161-180 mmol/L groups, respectively. Statistical significance was observed between the 161-180 mmol/L and <155 mmol/L groups (P<0.05). Conclusions Timely protection of donor liver, accurate evaluation and maintenance of liver function play a pivotal role in enhancing the utilization rate of donor liver, maintaining liver function and yielding good efficacy for transplantation.

This paper explored the educational reform of dispensing Chinese drugherbs. The education reform included implementing the project of teaching methods, implementing modern experimental methods, cultivating comprehensive quality of students, training students' creative thinking, and stimulating the initiative of students. All these strategies could improve the quality of teaching and make students' comprehensive abilities meet the demand.

Objective To investigate the safety and efficacy of hepatitis B surface antigen (HBsAg) positivity of the donors on graft survival and liver complications in HBsAg (+) renal transplant recipients.Methods We retrospectively evaluated 96 HBsAg (+) patients who received HBsAg(+) donor kidney transplant fellow-up during 20～ 139 months,in order to observe the renal allograft dysfunction,liver dysfunction and others complications.Results All 96 patients underwent renal transplantation successfully in our hospital.during the follow-up period,18 cases accepted entecavir-treated,one case lost graft function,two cases died,one of them developed drug resistance and liver function failure,the other because of cancer of the liver.Twenty-three of the 78 lamivudinetreated patients (29.5％) developed drug resistance in 7～96 months,and 3 cases developed liver function failure,2 cases died and one cured,15 of the 19 cases who been salvage treated with entecavir was successful and well tolerated after 1 year,2 cases who been salvage treated with adefovir and lamivudine with HBV DNA-negative after 12 months and 23 months.The 5-year patient/graft rates of patients who been treated with lamivudine and entecavir were 88.5％/84.6％ and 88.9％/83.3％ respectively.Conclusion It is safe and feasible for renal transplantation from HBsAg(+) donors to HBsAg(+) recipients with antiviral treatment,patients would require lifelong anti-viral suppression and strictly follow-up,which is important for patient and graft survival,anti-viral drugs resistance and the liver complications should be closely monitored and treated.

OBJECTIVETo understand the syphilis infection and its high risk factors among men who have sex with men (MSM) recruited from different channels.

METHODSSupported by the China-Gates Foundation HIV program from July to December 2011, we cooperated with community based organizations to conduct syphilis testing intervention among MSM from 14 cities (Beijing, Shanghai, Tianjin, Chongqing, Harbin, Shenyang, Qingdao, Xi'an, Nanjing, Wuhan, Hangzhou, Changsha, Kunming, and Guangzhou) and one province (Hainan province). Participants were recruited from different channels by the staff of local CBOs, Demographic (e.g. age, marital status, and education) and behavioral (e.g. condom use and sexual partners) data were collected using anonymous questionnaires. Blood samples were also collected to test for syphilis. A total of 34 100 MSM participated in the survey. Participants were excluded from data analysis (1 399, 4.1%) if they did not receive syphilis tests or they completed less than 80.00% of the key questions in the survey. Chi-square tests were used to understand the socio-demographic and behavioral differences between each group. Results of syphilis tests were also compared. Logistic regression models were used to test the statistical significance of these differences.

RESULTSA total of 32 701 MSM were enrolled and received syphilis testing. The average age of participates was 30.96 ± 9.57. And among them, 2 284 cases (7.0%) were recruited from gay bathhouses, 4 774 (14.6%) from gay bars, 6 266 (19.2%) from the internet, 1 997 (6.1%) from the parks/toilets and 17 380 (53.1%) from other channels. MSM recruited from the bathhouses had the highest syphilis infection rate than other 4 groups: gaybars (4.5%, 216/4 774), internet (6.7%, 422/6 266), parks/toilets (8.3%, 166/1 997), other channels (6.4%, 1 103/17 380) (χ² = 164.58, P < 0.001). The multivariate logistic regression analysis showed that being > 20 years of age (P < 0.001), having more than 2 homosexual partners in recent 3 months (8.0% (1 408/17 714), OR (95% CI) = 1.44 (1.04-1.98)), having no sex with females in past 3 months (6.8% (1 446/21 276), OR (95% CI) = 1.25 (1.07-1.46)), and not using condom at last anal sex (8.0% (769/9 668), OR (95% CI) = 1.13 (1.03-1.25)) were associated with a higher probability of being infected with syphilis. Whereas MSM married (7.2% (456/6 305), OR (95% CI) = 0.84 (0.73-0.98)), having a college or a higher education (5.3% (829/15 684), OR (95% CI) = 0.60 (0.53-0.67)), being local residents (6.5% (1 843/28 185), OR (95% CI) = 0.73 (0.61-0.87)) and living in the local province of project cities (6.6% (170/2 593), OR (95% CI) = 0.67 (0.53-0.85)) were protective factors.

CONCLUSIONMSM who were recruited from gay bathhouses have a higher rate of syphilis infection than those in channels relatively. They are older, with low education levels and high-risk sexual behaviors. Tailored interventions are required in the future, especially for MSM from gay bathhouses.

Adult ; China ; Condoms ; Demography ; Homosexuality, Male ; Humans ; Logistic Models ; Male ; Risk Factors ; Safe Sex ; Sexual Behavior ; Sexual Partners ; Surveys and Questionnaires ; Syphilis ; Universities

Anesthesiology rotation is an important part in resident standardization training of surgery. However, there are many problems in the teaching process. For example, the key points of teaching is not clear, the process of teaching is not coherent, and teachers and students lack interaction. The Rotation Record is introduced in order to solve those problems. The Rotation Record effectively reflects the fundamental process and major learning point of anesthesiology department which contains three items: the usage and recording of instrument; the communication and the basic knowledge and operating skills of anesthesia. The Rotation Record can initiate learning activity, emphasize important contents, supervise and urge teaching and improve the learning effect. By introducing Rotation Record, the assessment results in the surgical residency in anesthesiology has greatly improved compared to the previous ones, and has effectively improved the teaching quality of anesthesia.

Objective To understand the syphilis infection and its high risk factors among men who have sex with men(MSM) recruited from different channels. Methods Supported by the China-Gates Foundation HIV program from July to December 2011, we cooperated with community based organizations to conduct syphilis testing intervention among MSM from 14 cities(Beijing, Shanghai, Tianjin, Chongqing, Harbin, Shenyang, Qingdao, Xi'an, Nanjing, Wuhan, Hangzhou,Changsha, Kunming, and Guangzhou) and one province(Hainan province).Participants were recruited from different channels by the staff of local CBOs, Demographic(e.g. age, marital status, and education) and behavioral(e.g. condom use and sexual partners) data were collected using anonymous questionnaires. Blood samples were also collected to test for syphilis. A total of 34 100 MSM participated in the survey. Participants were excluded from data analysis(1 399, 4.1%) if they did not receive syphilis tests or they completed less than 80.00%of the key questions in the survey. Chi-square tests were used to understand the socio-demographic and behavioral differences between each group. Results of syphilis tests were also compared. Logistic regression models were used to test the statistical significance of these differences.Results A total of 32 701 MSM were enrolled and received syphilis testing. The average age of participates was 30.96±9.57. And among them, 2 284 cases(7.0%)were recruited from gay bathhouses, 4 774(14.6%)from gay bars, 6 266(19.2%)from the internet,1 997(6.1%) from the parks/toilets and 17 380(53.1%)from other channels.MSM recruited from the bathhouses had the highest syphilis infection rate than other 4 groups:gaybars(4.5%,216/4 774),internet(6.7%,422/6 266), parks/toilets(8.3%,166/1 997),other channels(6.4%,1 103/17 380)(χ2=164.58,P<0.001).The multivariate logistic regression analysis showed that being>20 years of age(P<0.001),having more than 2 homosexual partners in recent 3 months(8.0%(1 408/17 714),OR(95%CI)=1.44(1.04-1.98)), having no sex with females in past 3 months(6.8%(1 446/21 276),OR(95%CI)=1.25(1.07-1.46)), and not using condom at last anal sex (8.0%(769/9 668),OR(95%CI)=1.13(1.03-1.25)) were associated with a higher probability of being infected with syphilis. Whereas MSM married(7.2%(456/6 305),OR(95%CI)=0.84(0.73-0.98)), having a college or a higher education (5.3%(829/15 684),OR(95%CI)=0.60(0.53-0.67)),being local residents (6.5%(1 843/28 185),OR(95%CI)=0.73(0.61-0.87)) and living in the local province of project cities(6.6%(170/2 593),OR (95%CI)=0.67(0.53-0.85)) were protective factors.Conclusion MSM who were recruited from gay bathhouses have a higher rate of syphilis infection than those in channels relatively. They are older, with low education levels and high-risk sexual behaviors. Tailored interventions are required in the future, especially for MSM from gay bathhouses.