Objective:To explore the application of metagenomic next-generation sequencing (mNGS) in patients with pulmonary infection after failure of empirical treatment.Methods:From September 2021 to November 2023, a total of 64 patients with pulmonary infection who failed to receive empirical treatment in the Ninth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were retrospectively analyzed, sputum and bronchoalveolar lavage fluid of patients were collected for traditional etiological detection and mNGS detection in alveolar lavage fluid, and the differences between traditional etiological detection methods and mNGS detection methods for pathogen detection in patients with pulmonary infection after failure of empirical treatment were compared.Results:In 64 patients with pulmonary infection after failure of empirical treatment, the positive rate of mNGS microbial detection in alveolar lavage fluid was higher than that of traditional etiological detection: 87.50%(56/64) vs. 57.81%(37/64), and the difference was statistically significant ( P<0.01). The most common microorganisms detected by mNGS were bacterial infections, the main bacteria were Pseudomonas aeruginosa, Klebsiella pneumoniae and Haemophilus paraininfluenzae. The detection rate of mNGS in mixed infection was higher than that of traditional etiological detection: 65.63%(42/64) vs. 15.63%(10/64), χ2 = 33.17, P<0.01. Drug resistance genes were detected by mNGS technique in 18 patients, and a total of 21 kinds of drug resistance genes were detected, 53.13%(34/64) of patients improved after antibiotic adjustment based on mNGS test results. Conclusions:mNGS technology can effectively improve the positive microbial detection rate of patients with pulmonary infection after failure of empirical treatment, and can assist in the evaluation of antimicrobial resistance genes and guide the adjustment of clinical antibiotics, so as to improve the therapeutic effect.

Objective To develop the assessment scale of proactive health behavior ability for the disabled elderly in nursing homes and to test its reliability and validity.Methods The first draft of the scale was formed by literature review,qualitative interviews and Delphi method.From December 2023 to March 2024,525 disabled elderly people from 9 nursing homes in Sichuan Province and Chongqing City were selected as the survey subjects,and item analysis and reliability and validity test were carried out on the scale.30 disabled elderly people were re-investigated after 2 weeks to calculate the retest reliability of the scale.Results The scale consisted of 4 dimensions and 27 items.Exploratory factor analysis extracted 4 common factors,with the cumulative vanance contribution rate of 65.992％,and confirmatory factor analysis showed that the modified model fitting index was within acceptable range.The content validity index at item level was 0.917-1.000,and that at scale level was 0.997.The Cronbach's α coefficient,test-retest reliability and split-half reliability of the total scale were 0.944,0.997 and 0.882,respectively.Conclusion The scale has good reliability and validity,and it can be used to evaluate the proactive health behavior ability of the disabled elderly in nursing homes.

Due to the insufficient long-term protection and significant efficacy reduction to new variants of current COVID-19 vaccines, the epidemic prevention and control are still challenging. Here, we employ a capsid and antigen structure engineering (CASE) strategy to manufacture an adeno-associated viral serotype 6-based vaccine (S663V-RBD), which expresses trimeric receptor binding domain (RBD) of spike protein fused with a biological adjuvant RS09. Impressively, the engineered S663V-RBD could rapidly induce a satisfactory RBD-specific IgG titer within 2 weeks and maintain the titer for more than 4 months. Compared to the licensed BBIBP-CorV (Sinopharm, China), a single-dose S663V-RBD induced more endurable and robust immune responses in mice and elicited superior neutralizing antibodies against three typical SARS-CoV-2 pseudoviruses including wild type, C.37 (Lambda) and B.1.617.2 (Delta). More interestingly, the intramuscular injection of S663V-RBD could overcome pre-existing immunity against the capsid. Given its effectiveness, the CASE-based S663V-RBD may provide a new solution for the current and next pandemic.

Objective This study aims to explore the formation of the dilemma of"giving care"for disabled elderly people in nursing homes from the perspective of active health.Methods Purposive sampling was used to select caregivers and disabled elderly people from a nursing home in Chongqing as research subjects from July 2022 to December 2022.One-on-one in-depth interviews were conducted and Colaizzi's 7-step thematic analysis method was employed to collect and analyze the interview data.Results 4 themes were identified:①the dominance of the"giving"care concept,including the cultural thoughts of filial piety,passive acceptance of care characteristics and consumer psychology regarding paid services;②insufficient"participation"care ability,including lack of knowledge regarding active health and a weakening of skills to promote participation;③the hindrance to"transformation"of care models,including objective limitations in terms of human resources and delays in adapting aging environments;and ④the decline in"utilization"of internal abilities,including excessive avoidance of potential risks,a heavy workload of care and poor quality of individual care.Conclusion The formation of the dilemma of"giving care"for disabled elderly people in nursing homes is affected by multiple factors such as social background,service system,supply resources,and management mode.Transforming disabled elderly individuals from a state of"passive giving care"to"active participation in their health"is an important measure to realize the concept of positive aging and healthy aging.

Objective:To evaluate the effect of mobile network platform in out-of-hospital rehabilitation of patients with total knee arthroplasty.Methods:CNKI, Wanfang, VIP, Chinese biomedical literature database, PubMed, Cochrane Library, EMbase and Web of Science database were searched by computer. To collect randomized controlled trials of out-of-hospital rehabilitation management for knee arthroplasty patients using mobile network platform. Two researchers independently screened literature, extracted data and evaluated quality according to inclusion exclusion criteria,and Stata 12.0 software was used for meta-analysis of the required documents.Results:A total of 10 articles were included for meta-analysis. A total of 933 patients were included, 471 in the intervention group and 462 in the control group. Meta-analysis showed that the knee function of patients with total knee arthroplasty managed by mobile network platform were better than those of the control group, and the difference was statistically significant(standardized mean difference( SMD) value was 1.25, 95% confidence interval( CI) 0.84-1.66, P<0.01), but the effect on improving range of motion ( SMD value was 0.29, 95% CI -0.30-0.87, P>0.1) and quality of life( SMD value was 0.90, 95% CI -0.25-2.05, P>0.1) was no difference. Conclusions:There is no obvious effect on the range of motion of the knees and quality of life, while to some extent, the application of mobile network platform in out-hospital rehabilitation management of total knee replacement patients can effectively improve the function of knees. It potentially speed up patients′rehabilitation process.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can cause acute respiratory distress syndrome, hypercoagulability, hypertension, and multiorgan dysfunction. Effective antivirals with safe clinical profile are urgently needed to improve the overall prognosis. In an analysis of a randomly collected cohort of 124 patients with COVID-19, we found that hypercoagulability as indicated by elevated concentrations of D-dimers was associated with disease severity. By virtual screening of a U.S. FDA approved drug library, we identified an anticoagulation agent dipyridamole (DIP) , which suppressed SARS-CoV-2 replication . In a proof-of-concept trial involving 31 patients with COVID-19, DIP supplementation was associated with significantly decreased concentrations of D-dimers ( < 0.05), increased lymphocyte and platelet recovery in the circulation, and markedly improved clinical outcomes in comparison to the control patients. In particular, all 8 of the DIP-treated severely ill patients showed remarkable improvement: 7 patients (87.5%) achieved clinical cure and were discharged from the hospitals while the remaining 1 patient (12.5%) was in clinical remission.

Objective? To investigate the status of self-management of discharged patients after radioactive 125I seeds implantation and analyze the possible influencing factors,so as to provide reference for postoperative continuous nursing guidance. Methods? From March to April 2018, convenient cluster sampling was used to select out of hospital tumor patients who met the inclusion criteria after 125I seed implantation in the Department of Radiation Oncology of Peking University Third Hospital within half a year. The self-designed Radiation Protection Knowledge and Self-management Behavior Evaluation Questionnaire was used to collect data through telephone follow-up and medical record review. In the self-designed part of the questionnaire, 2 particle group doctors and 2 deputy directors and 1 associate professor was invited to evaluate the content validity of the questionnaire. The total number of questionnaires was 72 and 72 valid questionnaires were collected. SPSS 21.0 statistical software was used for data entry and analysis. Results? After 125I seed implantation, the patients′ knowledge score of radiation protection outside hospital was (3.33±1.22) with a full score of 5; the self-management score of radiation protection was (27.40±9.47) with a full score of 44; the total self-management score of patients with lead-free clothing was higher than that of patients with lead-free clothing (t=5.51,P＜0.001); the self-management level of radiation protection of medical insurance patients was higher than that of self paid patients (t=2.15,P＜0.05); family economic pressure was the influencing factor of self-management of radiation protection (F=-4.41,P＜0.05); the knowledge of radiation protection was positively correlated with self-management behavior of radiation protection (r=0.544,P＜ 0.001). Multivariate linear regression analysis showed that, the family economic incorne, the total score of radiation protection knowledge, and whether they have their own lead clothing were the main influencing factor of discharged patients with cancer after 125I seeds implantation (P＜0.05). Conclusions? The knowledge of radiation protection outside the hospital and the ability of self-management of radiation protection of the patients after 125I seed implantation are medium level. The important factors influencing the self-management of radiation protection of the patients after seed implantation are whether they have their own lead clothing, family economic income, and the cognitive level of radiation protection. In order to achieve better self-management level of radiation protection, medical staff should educate patients about the hazards and protection of radiation, improve patients′ awareness of radiation protection, and encourage patients to buy lead clothing.

Objective: To evaluate left ventricular (LV) dysfunction in patients with esophageal cancer (EC) during concurrent chemoradiotherapy (CCRT) using real-time three-dimensional speckle tracking echocardiography (3D-STE) and analyze its influence factors. Methods: Thirty-one patients with EC who received CCRT were enrolled in the study.Conventional echocardiography and 3D-STE were performed pre-CCRT and during CCRT (radiotherapy dose reached 40Gy). Three-dimensional parameters including LV end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) as well as global circumferential strain (GCS) were compared between pre-CCRT and during CCRT. The independent factors on left ventricular function parameters were analyzed. Results: There was no change on LV diameters, LV volumes and LVEF during CCRT (all P>0.05), while LV diastolic function indexes were impaired compared with those of pre-CCRT, demonstrated by the decreased E/A, Em/Am, and increased E/Em(all P<0.05). 3DGLS was also significantly decreased during CCRT compared with that of pre-CCRT (P<0.05), but no significant difference was found in 3DGCS (P>0.05). Multivariate linear regression analysis manifested that cardiac V40(the percentage of cardiac volume as radiotherapy dose reached 40Gy) was an independent determinant of LV 3DGLS in patients with esophageal cancer during CCRT (P<0.05). Conclusions LV GLS provided by real-time 3D-STE could sensitively detect CCRT-induced myocardial injury. Cardiac V40 is independently associated with LV 3DGLS during CCRT, representing the impact of radiotherapy on the subclinical LV function change.

Objective A study was conducted to compare the effect of different enamel remineralization periods after erosion on the depth of brushing abrasion. Methods Ten volunteers were selected for a 4-day experiment. A total of 60 enamels were randomly assigned into six groups (A-F) and placed in intraoral palatal devices. On the first day, the palatal devices were placed in oral cavity (24 h) . On the following three days, brushing experiments were performed extraorally, two times per day. The specific experimental method of brushing follows these next steps. First, the group F specimens were covered with a film of wax, and then acid etched for 2 min. Subsequently, the film of wax was detached. The groups from A to D were brushed after remineralization at the following time intervals: group A, 0 min; group B, 20 min; group C, 40 min; group D, 60 min. Erosion and remineralization were performed on group E, but without brushing. Remineralization was performed on group F, but without acid etching and brushing. The depth of enamel abrasion was determined by a mechanical profilometer. The surface morphology of the enamel blocks was observed using a scanning electron microscope. Results 1) The depth of abrasion was different in varied enamel remineralization time after acid etching. The statistical significant differences between groups were as follows. 2) When the time of enamel remineralization after acid etching was short, the surface depression in the electron microscope was deep, and the surface morphology was rough. Conclusion Brushing immediately after acid etching would cause much serious abrasion to the enamel surface. Brushing after 60 min can effectively reduce the abrasion of acid etching enamel.

Objective To investigate Helicobacter pylori combined with N-methyl-N-nitrosourea (MNU) gavage for preparing balb/c mouse gastric cancer model.Methods Eighty balb/c mice were randomly divided into four groups after 1-week adaptive feed,normal group,model group Ⅰ,Ⅱ and Ⅲ,20 cases in each group.The model group Ⅰ,Ⅱ and Ⅲ were given Helicobacter pylori bacteria liquid (CFU=109/mL) gavage,once every other day for 5 times;then,the freshly configured MNU solution 0.15,0.3,0.6 mL gavages were in turn given,MNU and pure water allocation ratio was 5mg:3mL.Once gavage per week for continuous 10 weeks.Results The model group II had 66.67% adenocarcinoma,the model group I were gastritis with mild atypical hyperplasia,and all mice in the model group III died.Conclusion This method can prepare the gastric cancer model.