Objective To establish a scientific, comprehensive, and operable community resilience evaluation index system for emergent major infectious diseases. Methods Based on the social ecosystem theory, a preliminary evaluation index system was formed by using content analysis and boundary analysis. The index system was then supplemented and revised through panel discussions. The final index system and index weights were clarified by two rounds of Delphi method. Results The expert positive coefficient, expert authority coefficient, and expert coordination coefficient of the two rounds of expert consultations were examined. According to the screening principle of the ^“threshold method^”, the indicators were screened, and the weights of each indicator were determined in the second round of Delphi expert consultation. The analysis of the reliability of the indicator system showed Cronbach's α= 0.399 , indicating that the indicator system had a relatively high reliability. Factor analysis was carried out on 7 primary indicators, and the measure of sampling adequacy (MSA) values were all greater than 0.5, which passed the validity test. Conclusion A set of evaluation index system that can accurately reflect the resilience level of communities with emergent major infectious diseases has been constructed, including 7 primary indicators, 21 secondary indicators, 54 tertiary indicators, and 108 tertiary indicators, which has realized the quantitative evaluation of the hidden resilience level of communities.

Objective:To evaluate the clinical value of combined detection of placenta associated 8 (PLAC8) and platelet activating factor acetylhydrolase (PLA2G7) for early identification of sepsis and non-infectious systemic inflammatory response syndrome (SIRS).Methods:A cross-sectional study was conducted. A total of 189 febrile patients suspected infection who were admitted to Huashan Hospital, Fudan University from October 2022 to April 2023 were included. Based on etiological, laboratory test results and clinical data, patients were classified as infection or non-infection, and further classified as sepsis or non-infectious SIRS according to diagnostic criteria. Real-time fluorescence polymerase chain reaction was used to detect the mRNA levels of PLAC8 and PLA2G7 in peripheral venous blood of patients. Hematology, inflammatory markers including C-reactive protein (CRP), interleukin-6 (IL-6) and procalcitonin, sepsis-related organ failure assessment (SOFA) score, and the difference of cycle threshold (Ct) values between PLA2G7 and PLAC8 ((PLA2G7-PLAC8)ΔCt value))were compared between the sepsis and non-infectious SIRS groups. Statistical comparison was analyzed using Mann-Whitney U test, and the diagnostic performance of (PLA2G7-PLAC8)ΔCt value in discriminating sepsis from non-infectious SIRS was evaluated using receiver operating characteristic curve. Results:Among the 189 febrile patients suspected infection, there were 80 non-infectious patients, including 51 non-infectious SIRS patients, and 109 infection patients, including 53 sepsis patients. The neutrophil ratio, CRP, IL-6, procalcitonin, and SOFA score of non-infectious SIRS patients were lower than those of the sepsis group, and the differences were all statistically significant ( Z=-2.70, -3.11, -2.16, -3.76 and -2.33, respectively, all P<0.05). The (PLA2G7-PLAC8)ΔCt value in the non-infectious SIRS group was 4.38(1.41), which was lower than 8.18 (6.19) in the sepsis group, with a statistically significant difference ( U=193.50, P<0.001). The area under the receiver operating characteristic curve (AUROC) for (PLA2G7-PLAC8)ΔCt value in the differential diagnosis of sepsis and non-infectious SIRS was 0.859, with the optimal cut-off value of 5.86. The sensitivity and specificity were 82.2% and 71.9%, respectively. When combined with procalcitonin, the AUROC was 0.917, with a sensitivity of 95.6% and specificity of 70.6%. Conclusions:The (PLA2G7-PLAC8)ΔCt value in peripheral blood has good clinical value for early identification of sepsis and non-infectious SIRS, especially when combined with procalcitonin, which could further improve the accuracy of differential diagnosis.

Following the principles of evidence-based medicine,in accordance with the structure and drafting rules of standardized documents,based on literature research,according to the characteristics of chronic cough in children and issues that need to form a consensus,the TCM Guidelines for Diagnosis and Treatment of Chronic Cough in Children was formulated based on the Delphi method,expert discussion meetings,and public solicitation of opinions.The guideline includes scope of application,terms and definitions,eti-ology and diagnosis,auxiliary examination,treatment,prevention and care.The aim is to clarify the optimal treatment plan of Chinese medicine in the diagnosis and treatment of this disease,and to provide guidance for improving the clinical diagnosis and treatment of chronic cough in children with Chinese medicine.

Temporomandibular disorders (TMD) are a heterogeneous group of diseases that affect the temporomandibular joint, chewing muscle system, dental occlusion, and even various structures throughout the body, with significant characteristics of biological-psychological-social pattern. TMD related chronic pain, as the most important clinical symptom, can result in negative emotions seriously affecting patients′ quality of life and physical and mental health. Although a variety of therapies have been previously reported to treat TMD related chronic pain, there is a lack of widely recognized therapies. Professor Jason W Busse (from Michael G DeGroote National Pain Centre, McMaster University, Hamilton ON, Canada) took the lead and collaborated with multiple internationally renowned schools/hospitals of stomatology to develop an international consensus on the management of chronic pain associated with TMD, a clinical practice guideline, which took two years and was published in December 15th, 2023 in a global top journal of clinical research The British Medical Journal. This clinical practice guideline explored the comparative effectiveness of available therapies for chronic pain associated with TMD, conditionally recommended the specific intervention for different treatment or pain relief, proposed a comprehensive, agreed, and standardized clinical practice guideline. This present article describes the methodology and key elements of the clinical practice guideline to help clinicians fully understand and appropriately apply this guidance, which could provide the references for clinical practice of TMD associated chronic pain in China.

The proportion of overweight children within the obese population cannot be disregarded.Furthermore，obese children are susceptible to complications that may persist into adulthood.In order to prevent childhood obesity and manage its associated complications，it is essential to conduct appropriate assessments.In comparison to the body mass index（BMI）assessments，body composition analysis can measure the amount of adipose tissue，muscle tissue，body water，and inorganic salts.It can also assess body fat percentage，body muscle percentage，and muscle-fat ratio，which may be crucial in assessing body shape，basal metabolism，obesity and more.This enables accurate assessment and intervention.Bioelectric impedance analysis（BIA）is widely used in pediatrics as a method of analyzing body composition.However，its value in the study of obese children remains uncertain.This paper aims to summarize the value of BIA in the diagnosis and assessment of obese children and to assess its potential for screening for complications associated with childhood obesity，and reviews the performance of BIA in the assessment of obese children.

Objective:To develop a novel, flexible, dual-arm, master-slave digestive endoscopic minimally invasive surgical robot system named dual-arm robotic endoscopic assistant for minimally invasive surgery (DREAMS) and to evaluate its feasibility for endoscopic submucosal dissection (ESD) by using ex vivo porcine stomachs.Methods:A novel endoscopic robot (DREAMS) system was developed which was composed of a flexible two-channel endoscope, two flexible robotic manipulators, a master controller, a robotic arm, and a control system. A total of 10 artificial round-like lesions with diameters ranging from 15 to 25 mm were created (5 in gastric antrum and 5 in gastric body) by using fresh peeled stomach of healthy pigs as the model. Submucosal dissection was performed with the assistance of the DREAMS system by two operators. The main outcome was submucosal dissection speed, and the secondary outcomes included muscular injury rate, perforation rate, and grasping efficiency of the robot.Results:All 10 lesions were successfully dissected en bloc by using the DREAMS system. The diameter of the artificial lesions was 22.34±2.39 mm, dissection time was 15.00±8.90 min, submucosal dissection speed was 141.79±79.12 mm 2/min, and the number of tractions required by each ESD was 4.2 times. Muscular injury occurred in 4/10 cases of ESD. No perforation occurred. Conclusion:The initial animal experiment shows the DREAMS system is safe and effective.

Objective:To explore the core competency of doctors in tertiary public hospitals in regions of different income levels in China, and provide reference for promoting such competency and related policy formulation.Methods:Using multi-stage stratified cluster sampling method, 195 tertiary public hospitals in 16 provinces of China were selected from November 2021 to March 2022. 200 doctors were sampled from each hospital. A self-designed questionnaire was used to investigate the status of doctors′ core competencies, as well as the status of their postgraduate medical education and continuing medical education. According to the per capita gross regional product of each province in China Statistical Yearbook 2022, each province was divided into high, middle and low income regions, and the questionnaire data were descriptively analyzed, while χ2 test was used to compare the differences between groups. Results:A total of 32 673 valid questionnaires were collected. There were 12 135 doctors (37.14%) in China who had received comprehensive education and training of core competency in all dimensions. Among the dimensions of self-rated core competency of the surveyed doctors, there were 10 019 doctors (30.66%) with insufficient teaching ability and 438 (1.34%) with insufficient professional quality, and there was no significant difference between regions ( P>0.05). There were 2 385 (27.08%), 2 528 (27.55%) and 3 646 (24.82%) doctors in high-, middle- and low-income regions with insufficient lifelong learning ability, respectively. The proportion of doctors in middle- and high-income regions was higher than that in low-income ones ( P<0.05). There were 1 317 (15.57%), 1 290 (14.06%) and 2 719 (18.51%) doctors with insufficient knowledge and skills in high-, middle- and low-income areas, respectively. The proportion of doctors in low-income regions was higher than that in middle- and high-income regions ( P<0.05). The proportion of doctors who did not receive any kind of postgraduate medical education or continuing medical education in low-income regions was 7.33% (1 077 people), higher than that in high-income and middle- income ones ( P<0.05); 50.44% (4 442 people) of surveyed doctors in high-income regions believed that for standardized training of resident physicians (hereinafter referred to as residential training), the clinical teachers were " overworked to take this job", which was higher than that in middle- and low-income regions ( P<0.001); In middle-income regions, 46.16% (4 235 people) and 43.46% (3 987 people) believed that the salary residents and specialized physicians in standardized training (hereinafter referred to as specialized training) was too low, while 42.47% (3 897 people) and 30.44% (2 793 people) believed that the clinical practice opportunities of students were limited, both of which were higher than those in high-income and low-income regions ( P<0.001); 34.91% (5 128 people) of surveyed doctors in low-income regions believed that the investment was insufficient for training bases of residential training, 27.81% (4 085 people) of those held that training bases for specialized training were unevenly distributed, and 33.19% (4 876 people) of those held that continuing medical education was plagued by " insufficient promotion coverage, and insufficient opportunities for primary doctors", all of which being higher than those in high- and middle-income regions ( P<0.001). Conclusions:There is an obvious need to improve the core competence of doctors in the teaching ability dimension of tertiary public hospitals in China, especially in middle- and high-income regions for lifelong learning, and in low-income regions for knowledge and skills; There are differences between postgraduate medical education and continuing medical education systems in regions of different income levels in China. It is necessary to improve the competency oriented postgraduate medical education and continuing medical education systems.

In recent years,cortisol has been used as a biomarker to assess stress in dogs.To evaluate the welfare of dogs,we reviewed cortisol levels and changes in dogs under various stresses.We explored the influential factors that relieve stress in accordance with variations in cortisol levels,to improve the measures which reduce stress in dogs.It is recommended to apply cortisol measurement and behavioral observation comprehensively to evaluate stress in dogs more accurately.

Objective:To analyze the differences in clinical outcomes and toxicities between postoperative radiotherapy alone and postoperative radiochemotherapy for soft tissue sarcoma (STS), as well as the related factors affecting clinical prognosis of STS patients.Methods:Retrospective analysis of patients diagnosed with primary STS admitted to Zhejiang Cancer Hospital from May 2012 to May 2019 was performed, who received adjuvant radiotherapy after surgery, combined with or without postoperative chemotherapy. A total of 100 patients were enrolled and divided into postoperative radiotherapy group ( n=52) and postoperative radiochemotherapy group ( n=48). The median follow-up time was 65 months (24-124 months). The local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), overall survival (OS), and treatment-related toxicities were recorded in two groups. The survival rate was calculated by Kaplan-Meier analysis. Log-rank test was used for univariate analysis, and Cox model was used for multivariate analysis. Results:In multivariate analysis, the maximum tumor diameter was an independent predictor of local tumor recurrence ( HR=4.80, 95% CI=1.16-19.85, P=0.031), distant metastasis ( HR=4.67, 95% CI=1.53-14.26, P=0.007) and OS ( HR=4.10, 95% CI=1.35-12.48, P=0.013). In addition, the degree of myelosuppression in patients in postoperative radiochemotherapy was significantly higher than that in their counterparts in postoperative radiotherapy group ( P<0.001). Conclusions:In the limited number of patients, radiochemotherapy has no advantages over radiotherapy alone in distant metastasis or survival rate. Besides, it increases toxicities, but the overall tolerability is favorable. It is necessary to conduct prospective randomized studies in a large population and subgroup analysis of histological subtypes, aiming to obtain results with better reference value.

Objective:To investigate the association of cognitive impairment plus poor oral health with mortality risk in older adults.Methods:This retrospective study included 3, 706 community-dwelling older adults enrolled in the National Health and Nutrition Examination Survey between January to June 2022, of whom 1, 973 were diagnosed with cognitive impairment and poor oral health.Based on cognitive performance and oral health status, 597 were categorized as having normal cognition and normal oral health, 506 as having normal cognition and poor oral health, 149 as having cognitive impairment and normal oral health and 226 as having cognitive impairment and poor oral health.The Cox proportional hazards regression model was used to test the effects of dental caries/periodontitis or edentulism and cognitive impairment on all-cause mortality and cardiometabolic mortality after adjusting for potential confounders.Results:During a median follow-up period of 13.4 years, 978(49.6%)patients died, with 264(13.5%)of cardiometabolic diseases). Cognitive impairment, periodontitis and tooth loss were all significant predictors of all-cause mortality.However, dental caries was not correlated with mortality.When these predictors were analyzed jointly, cognitive impairment and periodontitis were associated with an 83.1% increased risk of all-cause mortality and an 87.7% increased risk of cardiometabolic mortality compared with the healthy control group.The risk of all-cause mortality was highest in the presence of both cognitive impairment and tooth loss( HR=1.701, 95% CI: 1.338-2.161). Conclusions:In middle-aged and older individuals, the concomitant presence of cognitive impairment and periodontitis or edentulism may be associated with increased mortality.