BackgroundAs a high prevalence disorder， schizophrenia has caused significant burden to family and society due to the impairment of occupational and social function. Currently， the dominant vocational training model in China follows a paternalistic， clinician-led decision-making approach. Although it improves patients' social function to some extent， it undermines their autonomy and treatment adherence. Therefore， it is urgently necessary to explore a new intervention method to enhance treatment compliance and social function in patients. ObjectiveTo explore the impact of shared decision-making oriented vocational training on social function in hospitalized schizophrenia patients， so as to provide references for rehabilitation interventions. MethodsA total of 68 patients diagnosed with schizophrenia according to the International Classification of Diseases， tenth edition （ICD-10） criteria were consecutively enrolled from January to June 2024 at The Third People's Hospital of Wenjiang Distric， Chengdu. Participants were randomly allocated into the research group （n=34） and the control group （n=34） using a random number table method. Both groups received routine rehabilitation training， while the research group received shared decision-making oriented vocational training for 12 weeks， 2 times a week for 2 hours each time. Before and at the 4^th and 12^th week of intervention， two groups were evaluated by General Self-Efficacy Scale （GSES）， Stigma Scale for Mental Illness （SSMI）， Scale of Social function of Psychosis Inpatients （SSFPI） and Inpatient Psychiatric Rehabilitation Outcome Scale （IPROS）. ResultsA total of 63 participants completed the study， with 30 cases in the research group and 33 cases in the control group. Repeated measures ANOVA revealed statistically significant time effects and interaction effects in both groups for GSES， SSMI， SSFPI and IPROS scores （F=20.451， 16.022； 26.193， 12.944； 23.957， 5.023； 11.776， 3.985， P<0.05 or 0.01）， while no significant group effects were observed （F=0.188， 0.742， 1.878， 0.474， P>0.05）. At the 12^th week of intervention， there were statistically significant differences in GSES， SSMI， SSFPI and IPROS scores between the two groups. ConclusionShared decision-making oriented vocational training may help to improve social function in patients with schizophrenia. ［Funded by 2023 Chengdu Medical Research Project （number， 2023468）］

ObjectiveTo identify high-risk factors and high-risk process of nosocomial infection， and then take targeted prevention and control measures to improve nosocomial infection management. MethodsWe identified and determined the risk factors associated with nosocomial infection by using an expert brainstorming method， and then conducted risk assessment of the factors in the outcomes and process by using a semi-quantitative method. ResultsA total of 31 experts participated in the risk factor assessment. Risk assessment scores showed that nosocomial infection due to multi-drug resistant bacteria was the highest risk in the outcomes of nosocomial infection. Lack of isolation for airborne/droplet transmission， needle/sharp instrument injury， inadequate identification of infection risk and response measures in construction engineering， and insufficient implementation of infection control system were extremely high risk factors in the process of nosocomial infection. ConclusionPrevention and control should be strengthened on multi-drug resistant bacteria and catheter-related infections. The role of multidisciplinary team （MDT） in the prevention and control of nosocomial infection should be enhanced in medical practice. Risk assessment may facilitate the resource allocation and improve hand hygiene behavior.

Objective:To investigate the expression of programmed death ligand 1 (PD-L1) in rectal cancer tissues and the correlation of PD-L1 expression with clinicopathological characteristics and overall survival of patients.Methods:The clinical data of 200 newly treated rectal cancer patients in Shanxi Provincial Cancer Hospital from January 2014 to December 2015 were retrospectively analyzed. The expression of PD-L1 in rectal cancer tissues was detected by immunohistochemistry. The correlations of PD-L1 expression with gender, age, tumor T stage, lymph node metastasis, tumor differentiation, histological type, tumor TNM stage, neutrophil-to-lymphocyte ratio (NLR) and overall survival of patients were analyzed.Results:The positive expression rate of PD-L1 was 24% (48/200). The positive expression rate of PD-L1 was high in patients with lymph node metastasis and high NLR (≥ 3.5) (both P < 0.05). The 5-year overall survival rate in PD-L1-positive group was 42%, and the PD-L1-negative group was 59%, and the difference between the two groups was statistically significant ( P < 0.05). The results of multivariate analysis showed that lymph node metastasis ( HR = 3.456, 95% CI 2.148-5.556, P < 0.01), NLR ≥ 3.5 ( HR = 1.871, 95% CI 1.169-2.996, P = 0.009), and PD-L1-positive expression ( HR = 2.187, 95% CI 1.373-3.484, P = 0.001) were independent adverse influencing factors for the overall survival of rectal cancer patients. Conclusion:PD-L1 is highly expressed in rectal cancer tissues, and the positive expression of PD-L1 is associated with poor overall survival of patients.

ObjectiveTo investigate related factors for stone recurrence after endoscopic minimally invasive gallbladder-preserving cholecystolithotomy, and to establish a nomogram model for predicting the risk of stone recurrence after surgery based on independent risk factors. MethodsA retrospective analysis was performed for the clinical data of 144 patients with gallstones who underwent endoscopic minimally invasive gallbladder-preserving cholecystolithotomy in Qinghai University Affiliated Hospital from January 2012 to January 2018, and according to postoperative stone recurrence, the patients were divided into non-recurrence group and recurrence group. The chi-square test was used for comparison of categorical data between two groups. LASSO and logistic regression analyses were used to analyze independent risk factors for postoperative stone recurrence, and the corresponding nomogram prediction model was plotted according to regression coefficient. The calibration curve was plotted to evaluate the reliability of the predictive nomogram; Harrell consistency index was used to quantify the discriminatory performance of the predictive nomogram; the receiver operating characteristic (ROC) curve was used to evaluate the sensitivity, specificity, and area under the ROC curve (AUC) of this predictive nomogram. ResultsAll 144 patients underwent successful endoscopic minimally invasive gallbladder-preserving cholecystolithotomy, among whom 14 patients (9.7%) experienced stone recurrence after surgery. The multivariate analysis showed that family history (odds ratio ［OR］= 3.245, 95% confidence interval ［CI］: 0.752-13567, P=0.104), regular diet (OR=3.752, 95% CI: 1.067-14.141, P=0.041), stone homogeneity (OR=5.871, 95% CI: 1636-25.390, P=0.010), and medication compliance (OR=0.225, 95% CI: 0.057-0.799, P=0.024) were independent risk factors for recurrence. The nomogram model had an index of concordance (C-index) of 0.835 (95% CI: 0.732-0.938) in the modeling sample and 0.7925 in the verification sample, suggesting that the nomogram model in this study had good accuracy and discrimination. The predictive nomogram had an AUC of 0.835, suggesting that this nomogram had a relatively high predictive value. ConclusionFamily history, regular diet, stone homogeneity, and medication compliance are independent risk factors for stone recurrence after endoscopic minimally invasive gallbladder-preserving cholecystolithotomy, and the nomogram constructed based on these independent risk factors may help to predict the risk of postoperative stone recurrence.

COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread across the globe, posing an enormous threat to public health and safety. Traditional Chinese medicine (TCM), in combination with Western medicine (WM), has made important and lasting contributions in the battle against COVID-19. In this review, updated clinical effects and potential mechanisms of TCM, presented in newly recognized three distinct phases of the disease, are summarized and discussed. By integrating the available clinical and preclinical evidence, the efficacies and underlying mechanisms of TCM on COVID-19, including the highly recommended three Chinese patent medicines and three Chinese medicine formulas, are described in a panorama. We hope that this comprehensive review not only provides a reference for health care professionals and the public to recognize the significant contributions of TCM for COVID-19, but also serves as an evidence-based in-depth summary and analysis to facilitate understanding the true scientific value of TCM.

The clinical manifestations,serum and cerebrospinal fluid (CSF) results,EEG and imaging findings of 4 cases of encephalitis with positive leucine-rich glioma inactivated protein 1 (LGI1)antibody admited from March 2017 to January 2019 were retrospectively analyzed.All 4 patients were males with a mean age of (42±17) years.Two patients had faciobrachial dystonic seizure(FBDS)as the main symptom,and 3 patients had epilepsy.There were normal blood sodium and no memory deficits in all 4 patients.The LGI1 antibody was positive in the serum and negative in the CSE.The longest diagnosis time was 5 months.The head MRIs were normal in 3 patients;and abnormal signals in the right basal ganglia were found in one case,and the lesicl became smaller after the treatment.Chest CT,abdominal CT,and pelvic CT did not detect tumors.All patients were treated with gamma globulin and glucocorticoids,they all had good prognosis.LGI1 antibody-positive encephalitis is mainly characterized by epilepsy. ldentifying FBDS would be helpful for early diagnosis.Timely treatments often result in good clinical prognosis.

The clinical data of 4 patients with atypical neurosyphilis (NS) mimicking viral encephalitis (VE) admitted to Beijing Ditan Hospital from July 2015 to January 2020 were retrospectively analyzed. All the 4 patients were males with an average age of (43±8) years. The patients manifested with mental and behavior disorders and cognitive impairment. Three patients had epilepsy and 1 patient had fever. The treponemal pallidum particle agglutination (TPPA) , fluorescent treponemal antibody-absorption test (FTA-ABS) -IgG and toluidine red unheated serum test (TRUST) were all positive in blood and the cerebral spinal fluid (CSF) , and white blood cell count and protein level in CSF were all evaluated. The head MRIs were all abnormal, 3 of which showed hyperintensity in fluid attenuated inversion recovery (FLAIR) and T2-weighted image located in limbic system and 1 showed hyperintensity in the bilateral cortex and the subcortical areas. All patients improved evidently and the lesions became smaller after penicillin treatment. Atypical NS mimicking VE is rare, and at early diagnosis and timely treatments can contribute to a good clinical prognosis.

Objective:To investigate the effect of high mobility group box-1 protein (HMGB1)-nuclear factor-κB (NF-κB) signaling pathway on autophagy and chemosensitivity of human hepatocellular carcinoma cells and its possible mechanism.Methods:Human hepatocellular carcinoma BEL-7402 cells were cultured in vitro and divided into control group (BEL-7402 cells without any treatment), doxorubicin group, recombinant human HMGB1+doxorubicin group, anti-HMGB1 neutralizing antibody+doxorubicin group, pyrrolidine dithiocarbamate+doxorubicin group and 3-methyladenine + doxorubicin group. The methyl thiazolyl tetrazolium (MTT) method was used to detect cell proliferation inhibition rate. Western blot method was used to detect the expressions of HMGB1 and NF-κB subunit p-p65 protein, the autophagy-related proteins Beclin-1, LC3Ⅰ, LC3Ⅱ and apoptosis-related protein bcl-2. Enzyme labeling method was used to detect Caspase-9 and Caspase-3 activity.Results:The cell proliferation inhibition rates in the control group, doxorubicin group, recombinant human HMGB1+doxorubicin group, anti-HMGB1 neutralizing antibody+doxorubicin group, pyrrolidine dithiocarbamate+doxorubicin group and 3-methyladenine+doxorubicin group were (1.31±0.16)%, (47.80±6.30)%, (31.60±5.68)%, (67.20±6.83)%, (66.60±6.27)%, and (68.60±11.19)%, respectively, and the difference was statistically significant ( F = 75.91, P < 0.01), suggesting that doxorubicin had a proliferation inhibitory effect on BEL-7402 cells; the expression levels of HMGB1 were 1.17±0.11, 1.37±0.15, 1.43±0.15, 0.70±0.09, 1.27±0.12, 1.29±0.18, and the difference was statistically significant ( F = 18.70, P < 0.01), suggesting that doxorubicin could increase the expression of HMGB1 in BEL-7402 cells, and the anti-HMGB1 neutralizing antibody could block or attenuate this effect; after pretreatment with recombinant human HMGB1, the proliferation inhibitory effect of doxorubicin on BEL-7402 cells was weakened; after pretreatment with anti-HMGB1 neutralizing antibody, pyrrolidine dithiocarbamate and 3-methyladenine, the proliferation inhibitory effect of doxorubicin on BEL-7402 cells was enhanced. Compared with the control group, the expression of p-p65 protein in the doxorubicin group, recombinant human HMGB1+doxorubicin group and 3-methyladenine+doxorubicin group increased (all P < 0.05). The expression of p-p65 protein in the recombinant human HMGB1+doxorubicin group, anti-HMGB1 neutralizing antibody+doxorubicin group and pyrrolidine dithiocarbamate+doxorubicin group was lower than that in the doxorubicin group (all P < 0.05). Compared with the control group, the expression of bcl-2 protein in doxorubicin group, anti-HMGB1 neutralizing antibody+doxorubicin group, pyrrolidine dithiocarbamate+doxorubicin group and 3-methyladenine+ doxorubicin group decreased (all P < 0.05), and the activity of Caspase-9 and Caspase-3 was enhanced (all P < 0.05); after adding recombinant human HMGB1 pretreatment, the expression of bcl-2 protein in the cells increased compared with doxorubicin alone, and the activity of Caspase-9 and Caspase-3 was weakened (all P < 0.05). The expression levels of autophagy-related protein Beclin-1 in the control group, doxorubicin group, recombinant human HMGB1+doxorubicin group, anti-HMGB1 neutralizing antibody+doxorubicin group, pyrrolidine dithiocarbamate+doxorubicin group, and 3-methyl adenine+doxorubicin group were 0.77±0.12, 0.92±0.07, 1.29±0.10, 0.51±0.03, 0.49±0.06, and 0.42±0.05, and the difference was statistically significant ( F = 97.01, P < 0.01). The expression levels of LC3Ⅱ were 0.24±0.04, 0.39±0.04, 0.49±0.07, 0.23±0.05, 0.20±0.06, and 0.20±0.05, and the difference was statistically significant ( F = 26.98, P < 0.01). Conclusion:The activation of HMGB1-NF-κB signaling pathway can reduce the chemosensitivity of hepatocellular carcinoma cells to doxorubicin, and its mechanism may be related to the regulation of autophagy and down-regulation of doxorubicin inducing apoptosis of hepatocellular carcinoma cells.

Objective:To investigate the characteristics of Parkinson's disease (PD)combined with orthostatic hypotension (OH)and the impact of the condition on cognitive function.Methods:A total of 210 PD patients admitted to Beijing Tiantan Hospital were consecutively enrolled.Demographic data and clinical characteristics were recorded.Patients were divided into the PD with OH (PD-OH)group and the PD without OH (PD-NOH)group based on blood pressure values measured in both the supine and upright positions.Cognitive function of PD patients was evaluated using the Mini-Mental State Examination (MMSE)and Montreal Cognitive Assessment (MoCA)scales.Results:Of 210 PD patients, 68 (32.4%)had OH.Patients in the PD-OH group had a higher mean age (69.7±8.9 years vs.62.1±11.3 years), longer disease duration [5.0 (3.0-8.0)years vs.4.0 (2.0-6.0)years], a higher incidence of diabetes (30.9% vs.17.4%), higher levels of fasting blood glucose (5.3±1.1 mmol/L vs.5.0±1.0 mmol/L)and glycated hemoglobin A1c (6.1±0.9% vs.5.7±0.7%), and more advanced Hoehn-Yahr staging [stage 2.5 (2.0-3.0) vs.stage 2.0 (1.5-2.5)]than the PD-NOH group ( P<0.05). The total scores of the MMSE and MoCA scales were lower in the PD-OH group than in the PD-NOH group (25.1±4.9 scores vs.26.8±4.0 scores, 19.4±5.4 scores vs.21.4±5.3 scores, P<0.05). A comparison of each cognitive domain of the MMSE scale between the two groups revealed that the scores of attention and calculation (3.7±1.7 scores vs.4.2±1.3 scores), delayed recall (2.1±1.0 scores vs.2.5±0.8 scores)and visuospatial ability (0.6±0.5 scores vs.0.7±0.5 scores)were lower in the PD-OH group than in the PD-NOH group ( P<0.05). A comparison of each cognitive domain of the MoCA scale between the two groups displayed that the scores of visuospatial and executive function (2.4±1.6 scores vs.2.9±1.7 scores)and delayed recall (1.3±1.4 scores vs.2.3±1.6 scores)were lower in the PD-OH group than in the PD-NOH group ( P<0.05). Logistic regression analysis showed that age ( OR=1.061, 95% CI: 1.022-1.102, P=0.002)and score of delayed recall of the MoCA scale ( OR=0.690, 95% CI: 0.498-0.955, P=0.025)were independent related factors for PD-OH. Conclusions:Compared with patients without OH, PD-OH patients are older and have a longer duration, increased disease severity, and a higher incidence of and more serious diabetes mellitus.Age is an independent related factor for PD-OH.Cognitive function is significantly impaired in PD-OH patients, and delayed recall is an independent related factor for PD-OH.

Objective: To investigate the efficacy and feasibility of laparoscopic resection for gastric gastrointestinal stromal tumor (GIST) in unfavorable location by comparing with open surgery. Methods: Clinicopathological and follow-up data of 176 patients with gastric GIST in unfavorable location admitted at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to December 2017 were analyzed retrospectively. There were 94 males and 82 females, aging of (57.4±12.7) years (range: 20-90 years). Of the 176 patients, 64 underwent laparoscopic surgery (laparoscopic group) and 112 underwent open surgery (open group). One-to-one propensity score matching (PSM) was performed to balance the covariance between laparoscopic group and open surgery group. Before PSM, the differences between the two group in tumor size and modified National Institutes of Health risk classification were significant. After PSM, there were 63 pairs (63 cases in laparoscopic group and 63 cases in open group) and the baseline characteristics were comparable between the two groups(P>0.05). The difference of short-term outcome between the two groups were compared using t test, χ² test or Wilcoxon rank-sum test. The survival curve was established by Kaplan-Meier method and the Log-rank test was used to compare the survival of the two groups. Results: The operation time of laparoscopic group was shorter ((141.6±100.6) minutes vs. (100.4±67.7) minutes, t=2.681, P=0.008), the hospitalization cost was higher ((5.2±0.7) ten thousand yuan vs. (4.2±0.8) ten thousand yuan, t=7.357, P=0.000) than open group. The time to first flatus ((49.1±8.2) hours vs. (71.0±4.6) hours, t=-18.482, P=0.000) and preoperative hospital stay ((10.3±6.0) days vs. (14.8±7.6) days, t=-3.717, P=0.000) was shorter in laparoscopic group. With a median follow-up time of 44 months (range: 10 to 154 months), the 1-, 3-, 5-year relapse-free survival rates in the laparoscopic group and open group were 98.3%, 92.1%, 92.1% and 100%, 86.3%, 83.2%, respectively (χ²=0.696, P=0.404). The 1-, 3-, 5-year overall survival rates in the laparoscopic group and open group were 96.6%, 94.7%, 94.7% and 100%, 91.1%, 81.4%, respectively (χ²=0.366, P=0.545). Conclusions In experienced medical centers, laparoscopic resection is safe and feasible for GIST in unfavorable location. Compared to open surgery, laparoscopic resection achieves a faster postoperative recovery and a similar long-term prognosis.