ObjectiveTo analyze the factors influencing meropenem-related liver injury （MRLI） and to explore their clinical predictive value. MethodsA retrospective case-control study was conducted， and the Chinese Hospital Pharmacovigilance System （CHPS） was used to establish a retrieval scheme. A total of 1 625 hospitalized cases using meropenem from January 2018 to December 2022 were collected. Patients were divided into case group （n=62） and control group （n=1 563） based on the presence or absence of liver injury. Clinical data and laboratory indicators from both groups were collected and analyzed. The t-test was used for comparison of normally distributed continuous data between the two groups， while the Mann-Whitney U test was used for comparison of continuous data not conforming to a normal distribution. The chi-square test was used for comparison of categorical data between the two groups. A multivariate Logistic regression analysis was performed to identify the influencing factors for MRLI. A Logistic regression equation was established， and the predictive value of these factors was assessed using the receiver operating characteristic （ROC） curve. ResultsThe results of univariate analysis indicated that the rates of male patients， hypoproteinemia， shock， intensive care unit （ICU） admissions， sepsis， and liver， gallbladder， and cardiovascular diseases， the levels of alanine aminotransferase （ALT）， alkaline phosphatase （ALP）， gamma-glutamyl transpeptidase （GGT）， aspartate aminotransferase （AST）， creatinine （CREA）， and procalcitonin （PCT）， and the number of hospitalization days were significantly higher in the case group than in the control group （P<0.05）， and that the platelet levels in the case group were significantly lower than those in the control group （P<0.05）. The multivariate Logistic regression analysis showed that male sex （odds ratio ［OR］=2.080， 95% confidence interval ［CI］： 1.050 — 4.123， P=0.036）， admission to the ICU （OR=8.207， 95%CI： 4.094‍ ‍—‍ ‍16.453， P<0.001）， comorbidity with gallbladder disease （OR=8.240， 95%CI： 3.605‍ ‍—‍ ‍18.832， P<0.001）， ALP （OR=1.012， 95%CI： 1.004‍ ‍—‍ ‍1.019， P=0.004）， GGT （OR=1.010， 95%CI： 1.005‍ ‍—‍ ‍1.015， P<0.001）， and PLT （OR=0.997， 95%CI： 0.994‍ ‍—‍ ‍0.999， P=0.020） were the influential factors for MRLI. The areas under the ROC curve of ALP， GGT， and PLT were 0.589， 0.637， and 0.595， respectively， and the AUC of them combined was 0.837. ConclusionMale sex， ICU admission， comorbidity with gallbladder disease， increased ALP， increased GGT， and decreased PLT were influencing factors for MRLI， and a combination of factors has a better predictive value for the occurrence of MRLI.

Objective: To understand sleep quarity among primary and middle school students in Shenzhen City, so as to provide data support for sleeping quality improvement. Methods: A survey was conducted among 8 742 children selected from two 12 year schools in Longhua District of Shenzhen City, by purposive sampling method from December 22, 2020 to January 15, 2021. The general information was investigated with the self designed questionnaire, and sleep disturbance was investigated and evaluated with the Sleep Disturbance Scale for Children (SDSC). And Chi square test was applied for data analysis. Results: About 47.61 % of primary and middle school students in Shenzhen City reported sleep disturbance, 10.84% of students had moderate to severe sleep disturbance. The overall rate of sleep disturbance and moderate and to severe sleep disturbance among primary school students (48.03%, 10.04%), junior middle schools (45.89%, 11.30%), senior middle schools (52.61%, 16.83%) were found of statistically significant differences ( χ 2=8.89, 27.05, P <0.05). The time to fall asleep for primary school students, junior school students and senior school students at night during the study period were 22:00-23:00 (90.35%), 22:00-23:00 (62.37%), and 23:00-01:00 (61.44%), respectively, and the time to fall asleep of the different stages students were found of statistically significant differences ( χ 2=1 470.17, P <0.01). About 41.04% of students could fall asleep within 15 minutes and 50.57% could fall asleep within 15 to 30 minutes, and the differences in the latency for different stages students to fall asleep at night were of statistical significance ( χ 2=82.92, P <0.01); 8.03% of primary and middle school students had a night sleep time of over 9 hours, and 45.97 % had a night sleep time of 8-9 hours, and the differences in the night sleep time among different stages students were of statistical significance ( χ 2=1 292.86, P <0.01). Conclusions The main sleep problems among primary and secondary school students in Shenzhen City are insufficient sleep and poor sleep quality. The relevant departments should emphasize the sleep health education among children and their parents, so as to improve their sleep quality.

Bipolar affective disorder refers to a category of mood disorders characterized clinically by the presence of both manic or hypomanic episodes and depressive episodes.Lithium stands out as the primary pharmacological intervention for managing bipolar affective disorder.However,its therapeutic dosage closely approaches toxic levels.Toxic symptoms appear when the blood lithium concentration surpasses 1.4 mmol/L,typically giving rise to gastrointestinal and central nervous system reactions.Cardiac toxicity is rare but serious in cases of lithium poisoning.The study reports a case of a patient with bipolar affective disorder who reached a blood lithium concentration of 6.08 mmol/L after the patient took lithium carbonate sustained-release tablets beyond the prescribed dosage daily and concurrently using other mood stabilizers.This resulted in symptoms such as arrhythmia,shock,impaired consciousness,and coarse tremors.Following symptomatic supportive treatment,including blood dialysis,the patient's physical symptoms gradually improved.It is necessary for clinicians to strengthen the prevention and recognition of lithium poisoning.

BACKGROUND:Jaws are most vulnerable to osteoporosis.Adipose-derived mesenchymal stem cells and bone morphogenetic protein 2 have the effect of promoting bone regeneration in osteoporosis.However,the repair effect of bone morphogenetic protein 2 modified adipose-derived mesenchymal stem cells on alveolar bone defects in osteoporosis is rarely reported. OBJECTIVE:To explore the repair effect of adipose-derived mesenchymal stem cells overexpressing bone morphogenetic protein 2 on alveolar bone defects in osteoporosis rats. METHODS:(1)The rat adipose-derived mesenchymal stem cells were infected with lentivirus overexpressing bone morphogenetic protein 2 gene,and identified by detecting the expression of green fluorescent protein and bone morphogenetic protein 2.(2)Osteoporosis rat model was established by ovariectomy.A 3 mm×3 mm×3 mm cylindrical defect was prepared at the first molar position on both sides of the upper jaw.(3)Gelatin sponge was implanted in rats of the sham operation group and osteoporosis group.In the adipose-derived stem cell group,the adipose-derived mesenchymal stem cells infected with empty vector lentivirus and gelatin sponge complex were implanted.In the adipose-derived mesenchymal mesenchymal stem cell group overexpressing bone morphogenetic protein 2,a complex of adipose-derived mesenchymal stem cells overexpressing bone morphogenetic protein 2 and gelatin sponge was implanted.Relevant indexes were tested one month later. RESULTS AND CONCLUSION:(1)The transfection efficiency of the adipose-derived mesenchymal stem cell group and adipose-derived mesenchymal stem cell group overexpressing bone morphogenetic protein 2 reached more than 70%.Compared with the adipose-derived mesenchymal stem cell group,the level of bone morphogenetic protein-2 protein in the adipose-derived mesenchymal stem cell group overexpressing bone morphogenetic protein-2 was significantly higher(P<0.05).(2)A large amount of new bone could be seen in the bone defect area of the sham operation group.Compared with the sham operation group,the osteoporotic group had a small amount of new bone formation;the new bone area was significantly reduced,and alkaline phosphatase,osteocalcin,and bone morphogenetic protein 2 mRNA and protein levels were significantly reduced.Compared with the osteoporosis group,the adipose-derived mesenchymal stem cell group and the adipose-derived mesenchymal stem cell group overexpressing bone morphogenetic protein 2 had a large number of new bone formation;the area of new bone was significantly increased,and the levels of alkaline phosphatase,osteocalcin,and bone morphogenetic protein 2 mRNA and protein were significantly increased.Moreover,the adipose-derived mesenchymal stem cell group overexpressing bone morphogenetic protein 2 was superior to the adipose-derived mesenchymal stem cell group(all P<0.05).(3)The results showed that bone morphogenetic protein 2 was less expressed in the alveolar bone of osteoporosis rats,and adipose-derived mesenchymal stem cells overexpressing bone morphogenetic protein 2 could promote osteogenesis and regeneration of alveolar bone defects in osteoporosis rats.

Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.

Objective To improve the survival rate and life quality of peritoneal dialysis(PD)patients,we es-tablished a retraining model based on ADDIE model,including optimizing the content,form and frequency.Methods From January 1,2022 to May 3,2023,based on the 5 stages of ADDIE model,we investigated the needs of pa-tients,invited 55 experts in the peritoneal dialysis field to design the final draft of the retraining model through 2 rounds of Delphi expert consultations,and 23 peritoneal dialysis patients were preexperimented to evaluate and re-vise the retraining model.Results The questionnaire recovery rates of the 2 rounds of expert consultation were 100％and 96.36％,respectively.The coordination coefficients of the first-level catalog were 0.379 and 0.384,and the coordination coefficients of the second-level catalog were 0.446 and 0.427,respectively.The Chi-square test showed that P＜0.05,indicating statistical significance.The content of the retraining model included 4 sections,33 subdirectories and 9 training forms,which were combined online and offline.The training frequency was different due to the different contents,and the single content of a single training form was mainly 15 min.Conclusion The PD patient retraining model constructed in this study is scientific,reliable and innovative.Its content is easy to un-derstand and diverse in forms.The training duration and frequency are in line with the memory rule,and the eval-uation takes into account both process and result.

Abstract Prevention and control of myopia requires comprehensive measures. Based on the system established earlier, the system is revised and upgraded. The original system emphasizes comprehensive measures and proposes to focus on both the symptoms and root causes. These measures are summarized into six aspects, three address the root cause measures including health education, glasses optics and visual environment, and three address symptoms measures including eye exercises, physical therapy and drugs. The paper is comprehensively supplemented and analyzes the primary and the secondary, and promotes physical therapy from treating the symptoms to treat both the symptoms and the root causes. These improvement measures will help promote the prevention and control of myopia in children and adolescents.

Objective:To explore the development trajectory and influencing factors of self compassion in elderly patients with first stroke hemiplegia, in order to provide a theoretical basis for adopting more targeted intervention measures at different stages and early identification of elderly stroke hemiplegia patients with sustained low self compassion.Methods:This was a prospective longitudinal study. Convenience sampling method was used to select 247 elderly patients with first-episode stroke admitted to Sanya Central Hospital (Hainan Third People′s Hospital) from January to December 2022 and who were assessed as semi-disabled (Barthel index was 40-99 ) before discharge. The baseline data of patients were collected by general information questionnaire, self-compassion scale, simplified fear of disease progression scale and social support rating scale. The self-compassion level of patients was evaluated before discharge, 1 month after discharge, 3 months after discharge and 6 months after discharge.The latent class growth model (LCGM) was used to identify the development trajectory of self-compassion, and multivariate Logistic regression was used to analyze the predictors of different development trajectory categories.Results:Ultimately, 219 patients completed the entire investigation and follow-up. There were 132 males and 87 females, aged (69.74 ± 4.05) years old. The self-compassion level of patients before discharge, 1 month after discharge, 3 months after discharge and 6 months after discharge were (72.37 ± 11.53), (74.65 ± 13.26), (76.84 ± 12.11), (79.45 ± 13.64) points, and there were positive correlation between scores ( r values were 0.29-0.55, all P<0.05). Three different trajectory change categories were identified by LCGM, namely high-level stable group (29%,63/219), low-level delayed decline group (23%, 51/219), and medium-level elevated group (48%, 105/219).Multivariate Logistic regression analysis showed that per capita monthly income<2 000 yuan ( OR=2.857, 95% CI 1.093-7.464, P<0.05), high comorbidities ( OR=5.625, 95% CI 1.971-16.051, P<0.01), high fear of disease progression ( OR=1.167, 95% CI 1.080-1.261, P<0.01), and low social support ( OR=00.763, 95% CI 0.595-0.979, P<0.05) were more likely to enter the low-level delayed decline group, and high school education( OR=4.429, 95% CI 1.479-13.265, P<0.01) and high social support ( OR=1.120, 95% CI 1.043-1.202, P<0.01) were more likely to enter the middle-level rise group. Conclusions:The development trend of self-compassion in elderly stroke patients with semi-disability can be divided into three different trajectories: high-level stable group, low-level delayed decline group and medium-level elevated group. Low income level, more comorbidities and fear of disease progression are not conducive to the development of self-compassion after discharge, while high education level and social support are conducive to the improvement of self-compassion after discharge. Medical staff can formulate targeted intervention programs to improve patients′ self-compassion based on the above influencing factors.

Objective:To explore the prognosis efficacy of psycho-cardiological therapy and management on patients with coronary atherosclerosis disease (CAD).Methods:This was a clinical randomized controlled study. This study included inpatients with CAD at the cardiology department in Beijing Anzhen Hospital, Capital Medical University from August 2021 to January 2024. The patients enrolled in this study were asked for basic information, and received measurements for depression, anxiety, sleep quality and living quality by the scales of Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder scale-7 (GAD-7), Athens Insomnia Scale (AIS), EuroQol 5-dimension 5-level (EQ-5D-5L) respectively. The patients were randomly grouped into a regular treatment group and a psycho-cardiological treatment group which included WeChat management or antidepressant/antianxiety medical therapy according to the situation. After the patients discharging from hospital for 2, 4, 12, 24, 48, 72, and 96 weeks, professional cardiovascular doctors would follow up by telephone, WeChat, and outpatient department, including scales (2-48 weeks), and cardiac events (2-96 weeks). Kaplan-Meier survival curve and multivariate Cox proportional hazards model were used for analyzing the association between psycho-cardiological treatment and cardiac events.Results:This study recruited a total of 552 patients with CAD, aged 61.0(54.0, 67.0) years, and 379 (68.7%) were male. There were 279(50.5%) in the regular treatment group and 273(49.5%) in the psycho-cardiological treatment group. After treatment for 4, 12 and 48 weeks, the PHQ-9 score in psycho-cardiological was significantly lower than the regular treatment group; After treatment for 12 weeks, the EQ-5D-5L effective value in psycho-cardiological group was higher than the regular treatment group; After treatment for 2, 4, 12, 24 and 48 weeks, the EQ-5D-5L VAS score in psycho-cardiological group was higher than the regular therapy group (all P<0.05). The Kaplan-Meier survival curve showed that, during the different follow-up periods, the rate of cardiac events in psycho-cardiological treatment group was lower than regular treatment group (log-rank P<0.001). The multivariate Cox proportional hazards model adjusted the factor of age, the psycho-cardiological treatment contributed to reducing the cardiac events rate by 80.3% ( HR=0.197, 95% CI: 0.067-0.582, P=0.003). Conclusion:Psycho-cardiological treatment is beneficial for improving psychological stress, living quality, and reducing cardiac events, and helps to improve prognosis and psycho-cardiological rehabilitation in CAD patients.

Objective:To investigate the effect of 980 nm semiconductor laser preablation of urethra mucosa at the prostatic tip in small volume benign prostatic hyperplasia (BPH).Methods:The case data of 120 patients diagnosed with small volume BPH in the Yan′an University Affiliated Hospital from June 2020 to June 2022 were retrospectively analyzed, and they were divided into improved group and conventional group according to different treatment methods, with 60 cases in each group. Patients in the improved group were treated with 980 nm semiconductor laser preablation of urethra mucosa at the prostatic tip, and patients in the conventional group were treated with 980 nm semiconductor laser vaporization of prostate. The sexual function of the patients was evaluated by the international erectile function index-5(IIEF-5) score, erectile hardness score (EHS) and retrograde ejaculation before surgery and 1, 3, 6, and 12 months after surgery. International prostate symptom scale (IPSS), quality of life (QOL) score, the maximum urine flow rate (Qmax) and postvoid residual urine (PVR) were used to evaluate urinary control function. The incidence of urinary incontinence, bladder neck contracture and other complications were compared between the two groups. Measurement data were expressed as mean±standard deviation ( ± s), and t-test was used for comparison between groups. The count data were expressed as cases and percentage, and Chi-square test was used for comparison between groups. Results:There was no significant difference in PVR, Qmax, IPSS score, QOL score, IIEF-5 score and EHS score between two groups ( P>0.05). In terms of PVR, Qmax, IPSS score, QOL score, IIEF-5 score and EHS score at 1, 3, 6 and 12 months after surgery, all these parameters were significantly improved compared with the preoperative, the differences were statistically significant ( P< 0.05). However, there was no significant difference between the two groups ( P> 0.05). There was no significant difference in IIEF-5 score and EHS score between the two groups during postoperative follow-up and before and after operation ( P> 0.05). The incidence of retrograde ejaculation rate in the improved group was lower than that in the conventional group during the follow-up 1, 3, 6 months after surgery, and the difference was statistically significant ( P<0.05). In the follow-up 1, 3 months after surgery, the incidence of stress urinary incontinence in the improved group was lower than that in the conventional group, the differences were statistically significant ( P< 0.05). At follow-up 6, 12 months after surgery, the rates of stress urinary incontinence were similar between the two groups, and the difference was not statistically significant ( P> 0.05). In the follow-up 12 months after surgery, there were 2 cases (3.33%) of bladder and neck contracture in the improved group, and 8 cases (13.33%) in the conventional group, the difference was statistically significant ( P<0.05). Conclusions:The effect of 980 nm semiconductor laser preablation of urethra mucosa at the prostatic tip in small volume BPH patients is similar to that of conventional vaporization, and the operation time is short. At the same time, the proximal 1 cm tissue of the verticulae and the integrity of the bladder neck are preserved, and the internal and external sphincter of the urethra are protected, thus improving the immediate postoperative urinary control rate and the incidence of retrograde ejaculation in small volume BPH patients.