BackgroundThe occurrence rate of dangerous behaviors in patients with severe mental disorders is higher than that of the general population. In China， there is limited research on the prediction of dangerous behaviors in community-dwelling patients with severe mental disorders， particularly in terms of predicting models using data mining techniques other than traditional methods. ObjectiveTo explore the influencing factors of dangerous behaviors in community-dwelling patients with severe mental disorders and testing whether the classification decision tree model is superior to the Logistic regression model. MethodsA total of 11 484 community-dwelling patients with severe mental disorders who had complete follow-up records from 2013 to 2022 were selected on December 2023. The data were divided into a training set （n=9 186） and a testing set （n=2 298） in an 8∶2 ratio. Logistic regression and classification decision trees were separately used to establish predictive models in the training set. Model discrimination and calibration were evaluated in the testing set. ResultsDuring the follow-up period， 1 115 cases （9.71%） exhibited dangerous behaviors. Logistic regression results showed that urban residence， poverty， guardianship， intellectual disability， history of dangerous behaviors， impaired insight and positive symptoms were risk factors for dangerous behaviors （OR=1.778， 1.459， 2.719， 1.483， 3.890， 1.423， 2.528， 2.124， P<0.01）. Being aged ≥60 years， educated， not requiring prescribed medication and having normal social functioning were protective factors for dangerous behaviors （OR=0.594， 0.824， 0.422， 0.719， P<0.05 or 0.01）. The predictive effect in the testing set showed an area under curve （AUC） of 0.729 （95% CI： 0.692~0.766）， accuracy of 70.97%， sensitivity of 59.71%， and specificity of 72.05%. The classification decision tree results showed that past dangerous situations， positive symptoms， overall social functioning score， economic status， insight， household registration， disability status and age were the influencing factors for dangerous behaviors. The predictive effect in the testing set showed an AUC of 0.721 （95% CI： 0.705~0.737）， accuracy of 68.28%， sensitivity of 64.46%， and specificity of 68.60%. ConclusionThe classification decision tree does not have a greater advantage over the logistic regression model in predicting the risk of dangerous behaviors in patients with severe mental disorders in the community. ［Funded by Chengdu Medical Research Project （number， 2020052）］

In November 2023, the seventh National Nucleic Acid Vaccine Conference was held to deeply discuss the immune mechanism, safety risks, advantages, and disadvantages of nucleic acid vaccines, and review the safety and effectiveness of COVID-19 vaccines developed by nucleic acid vaccine technology. Some prospectives were formed in the meeting that in the post-pandemic era, nucleic acid vaccine technology will play a role in the following areas: dealing with pathogens that are difficult to be prevented by traditional vaccines, promoting the upgrading of traditional live attenuated vaccines, contributing to the development of multivalent and combined vaccines, and rapid response to emerging and re-emerging infectious diseases. These views point out the direction for the future development of nucleic acid vaccine technology.

Objective:To evaluate the recovery of daytime and nighttime urinary continence in patients with robotic-assisted radical cystectomy and ileal orthotopic neobladder from 1 to 60 months after surgery, and systematically analyze the influencing factors of daytime and nighttime urinary continence recovery.Methods:The convenient sampling method was used to select clinical data of 60 patients who underwent robotic-assisted radical cystectomy and ileal orthotopic neobladder by a single operator from December 2014 to January 2020 and they were followed up for daytime and nighttime use of urine pads and prognosis. A total of 44 patients were eligible for follow-up data. Satisfactory recovery of daytime and nighttime urinary continence was defined as the use of less than or equal to 1 pad, and complete recovery of daytime and nighttime urinary continence was defined as no urine leakage. The daytime and nighttime urinary continence recovery in patients with robotic-assisted radical cystectomy and ileal orthotopic neobladder was assessed at 1, 3, 6, 12, 24, 36, and 60 months. Cox regression was used to analyze the influencing factors of postoperative urinary continence recovery.Results:Cox regression multivariate analysis showed that preservation of neurovascular bundles was associated with satisfactory recovery of daytime urinary continence, satisfactory recovery of nighttime urinary continence and complete recovery of daytime urinary continence ( P<0.05) . Clevien grading of complications within 90 d could affect the satisfaction of daytime urinary control recovery. Preoperative hydronephrosis was an independent factor affecting the satisfaction of nighttime urinary continence recovery. Conclusions:Preserving neurovascular bundles is an influencing factor in promoting postoperative urinary continence recovery in patients with robotic-assisted radical cystectomy and ileal orthotopic neobladder. In addition, postoperative complications and preoperative hydronephrosis are independent factors affecting the satisfaction of daytime and nighttime urinary continence recovery, respectively, but it need to be further confirmed by multicenter prospective studies.

Objective:To explore the current situation of empathy for pain in medical students and analyze its influencing factors.Methods:This study was a cross-sectional study. From June 2018 to January 2019, convenience sampling was used to select 768 undergraduate students from 4 medical universities in Shanghai, Jiangsu Province and Zhejiang Province as the research subject. The General Information Questionnaire, the Chinese version of the Empathy for Pain Scale (EPS) , and the Chinese version of the Interpersonal Reactivity Index (IRI-C) were used for investigation. Multiple linear regression was used to analyze the influencing factors.Results:Among 768 medical students, the total score of EPS was (2.56±0.66) , of which the physical and mental discomfort reaction dimension score was (2.28±0.74) , and the empathy reaction dimension score was (3.39±0.79) . The results of multiple linear regression analysis showed that major, being the only child or not, often watching violent movies or not, and personal distress were the influencing factors of medical students' physical and mental discomfort reaction with a statistical difference ( P<0.05) , explaining 20.1% of the variation in total. Gender, grade, clinical learning experience, viewpoint selection, empathic attention and imagination were the influencing factors of the empathy reaction of medical students also with a statistical difference ( P<0.05) , explaining 19.7% of the variation in total. Conclusions:The empathy for pain of medical students is at a moderate level and is affected by many factors. Medical education should strengthen the cultivation of empathy behavior practice ability, and multi-dimensionally cultivate and evaluate students' empathy ability in combination with patients' evaluation.

Objective:To translate the Empathy for Pain Scale (EPS) and evaluate the reliability and validity of the Chinese version of EPS in medical students.Methods:The items of the Chinese version of EPS were determined by translation, back-translation, semantic analysis, expert consultation and culture adaptation. From June to October 2018, this study selected 531 undergraduate students by convenience sampling to carry out questionnaire survey. Correlation analysis and critical ratio were used to the item analysis. Validity test was implemented with the content validity, construct validity and criterion-related validity; and internal consistency was tested with the Cronbach's α value and split-half reliability.Results:The Chinese version of EPS had 12 items and two factors named as the body and mind discomfort reactions and empathy reactions with 69.059% for the total variance contribution. Content validity of items ranged from 0.83 to 1.00, and the total content validity was 0.94. The total score of the Chinese version of EPS had a positive correlation with the score of the interpersonal reactivity index (IRI-C) ( r=0.370, P< 0.01) . The Cronbach's α value of the scale was 0.914; Cronbach's α values of two dimensions, the body and mind discomfort reactions and empathy reactions, were 0.935 and 0.775 respectively. The split-half reliability of the scale was 0.896. Conclusions:The Chinese version of EPS has four scenes and two dimensions as well as a good reliability and validity which could be used to evaluate the level of empathy for pain among medical students in China.

Rotavirus is the leading cause of acute gastroenteritis in children, and vaccines are the most effective measure to control rotavirus diarrhea. Currently, two vaccines, namely Rotarix and RotaTeq, are widely used worldwide. In addition, several vaccines are licensed in some countries. This review summa-rized the effectiveness of licensed rotavirus vaccines and the potential factors which might affect the effective-ness of these vaccines. In addition, progress in novel vaccine candidates in development was also included in this review.

Objective To develop an intelligent scheduling system for surgery by setting up constraints in an intelligent working environment to achieve automatic scheduling of surgery and personnel,and to precisely match the sub-professional nurses for surgeries.Methods Scheduling constraints were set up,and finally efficient scheduling was developed.Results During the process of clinical application,the rates of error and omission for surgical schedule fell to 4.78％,the rate of surgery re-adjustment fell to 17.74％,the number of average daily operation increased,the matching degree of sub-professional surgery nurse post reached 94.71％.Conclusion The intelligent surgical scheduling system can improve the scheduling efficiency and quality,improve the utilization of the operation rooms,and improve the collaboration quality and efficiency of the sub-professional nurses.

Objective To evaluate the effect of septal flash (SF) on left ventricular function and systolic synchrony in patients with complete left bundle branch block (CLBBB) and preserved left ventricular ejection fraction (LVEF) by two-dimensional speckle-tracking imaging (2D-STI).Methods Sixty CLBBB patients with preserved LVEF were selected,and 30 healthy individuals serving as control group.The SF of CLBBB patients were evaluated using 2D-STI,and the CLBBB patients were categorized into two groups (SF group and NSF group) based on the present SF.Conventional echocadiography and 2D-STI were performed for all individuals.Results ①SF was present in 53.3％ of CLBBB patients with preserved LVEF and was not present in control group.②LV longitudinal peak stain of global (LS-G) in SF group was lower than those in both control group and NSF group (P ＜0.05),and there was no significant difference between control group and NSF group (P ＞0.05).③Compared with control group,there were significant increase of left atrial dimension and Mitral E/e'and decrease in mitral E/A and mitral e'in SF group and NSF group (P ＜0.05),while there was no significant difference between SF group and NSF group (P ＞0.05).④There was an increase in standard deviation of time to peak systolic strain for the 18 LV segments (LV-SDt) in SF group and NSF group,and the LV-SDt in SF group was higher than that in NSF group (P ＜0.01).Conclusions SF is present in 53.3 ％ of CLBBB patients,patients of CLBBB with SF have lower left ventricular systolic function and systolic synchrony.

Objective To evaluate the value of two-dimensional speckle tracking echocardiography (2D-STE) in assessing left ventricular systolic function,diastolic function and synchrony with different QRS complex duration in complete left bundle branch block (CLBBB) patients with preserved left ventricle ejection fraction (LVEF).Methods A total of 44 patients with CLBBB and LVEF≥50％ were included.All the patients were divided into two groups based on QRS duration,QRS＞150 ms as wide QRS group and 120 ms≤QRS≤150 ms as narrow QRS group.And 30 healthy people were included as control group.Two-dimensional echocardiography and 2D-STE were performed.Ieft ventricle longitudinal peak stain of global,septum and free wall (LS-G,LS-Sept,LS-Lat),standard deviation of time to peak systolic strain for the 18 left ventricular segments (SDt) and index of left yen tricular diastolic function (EDT,E/A and E/e') were measured.Results SDt values of wide QRS group and narrow QRS group were significantly higher than that of control group (both P＜0.01).And SDt of wide QRS group was significantly higher than that of narrow QRS group (P＜0.05).LVEF and LS-G in wide QRS group were significantly lower than those in both narrow QRS group and control group (all P＜ 0.05),while there was no significant difference between narrow QRS group and control group (all P＞0.05).The LS-Sept in wide QRS group and narrow QRS group were both lower than that of control group (both P ＜0.01).And LS-Sept in wide QRS group was lower than that of narrow QRS group (P＜0.01).LS-Lat in narrow QRS group was separately higher than those of both wide QRS group and control group (both P＜0.05),while there was no significant difference of LS-Lat between wide QRS group and control group (P＞0.05).Compared with control group,E/A and EDT decreased and of E/e' increased in both wide QRS group and narrow QRS group (all P＜0.05).While there was no significant difference between wide QRS group and narrow QRS group (all P＞0.05).Conclusion In patients of wide QRS CLBBB with preserved LVEF,left ventricular systolic,diastolic function and synchrony decrease,while left ventricular systolic function of patients with narrow QRS do not significantly decrease.

Objective To discuss the operating skills of transperitoneal laparoscopic radical nephrectomy(LRN).Methods From Dec 2008 to Dec 2010,105 patients with renal tumors were treated by transperitoneal LRN.Fifty-one tumors were located in left kidney,and 54 in the right kidney.The mean diameter of renal tumor was(5.8 ± 2.4)cm.There were 48 cases of T1N0M0,51 of T2N0M0,6 of T3aN0M0.During the process of transperitoneal LRN,vena genitalis was constantly used as an operative mark for seeking and ligating the renal artery and vein.The specimens were cut completely and removed through Pfannensteil incision.Results All the 105 cases were performed by transperitoneal LRN with vena genitalis marking method successfully.Twenty-eight cases of homolateral adrenal gland were resected and 16 cases of regional lymph node were cleaned.There was no serious injury of liver,spleen or bowels.The operating time ranged 44-78 min with an average of 55 min,and the blood loss was 35-600 ml with the mean of 85 ml.The post-operative length of stay was 4-11 d with an average of 6 d.Major complications included 3 cases of vessel injury,1 case with an injury of diaphragmatic muscle and 2 cases with a lymphous leakage.Post-operative staging included 44 cases of T1 N0 M0,1 of T1 N1 M0,47 of T2 N0 M0,1 of T2 N1 M0,7of T3aN0M0,1 of T3aN1 M0,2 of T4N0M0,and 2 cases with benign lesion.The patients were followed up for 9-33 months with an average of 18 months.One case had an incisional hernia,1 had a local tumor recurrence and 1 died of pulmonary metastasis.Conclusions Transperitoneal LRN with vena genitalis marking method could be safe for the treatment of renal tumors.The vena genitalis may act as a mark for the accurate location and quick ligation for the renal pedicle without serious injuries,and such patients could recover fastly with fewer complications.Pfannensteil incision has a good quality of little trauma and could meet with the need of aesthetics.