Objective:To describe and analyze suicide risk of patients with schizophrenia,major depressive disorder,and bipolar disorder.Methods:A total of 2 016 patients with schizophrenia,903 patients with major de-pressive disorder,and 381 patients with bipolar disorder from inpatients,clinics,or communities who met the diag-nostic criteria of the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition were recruited.All patients were interviewed by psychiatrists using the Mini International Neuropsychiatric Interview to diagnose mental disor-ders and assess suicide risk,as well as Clinical-Rated Dimensions of Psychosis Symptom Severity(CRDPSS)to as-sess symptoms.Differences and risk factors of suicide risk among three types of mental disorders were explored u-sing multivariate logistic regression analysis.Results:In the past one month,37 patients with schizophrenia(1.8％),516 patients with major depressive disorder(57.1％),and 102 patients with bipolar disorder(26.8％)had suicide risk.Compared with patients with schizophrenia,suicide risk in patients with major depressive disorder(OR=36.50)and bipolar disorder(OR=20.10)increased.Female(OR=1.87),smoking(OR=1.76),family history of suicide(OR=5.09),higher score of CRDPSS hallucination(OR=1.80),and higher score of CRDPSS depression(OR=1.54)were risk factors of suicide risk of patients.Conclusions:Suicide risk of patients with ma-jor depressive disorder and bipolar disorder is higher than that of patients with schizophrenia.In clinical practice,it is important to regularly assess suicide risk of patients.Patients who experience symptoms of hallucination and de-pression should be paid more attention to.

Objective The aim of this study was to evaluate the effects of collagen modification on the osteogenic performance of different surface-modified titanium,including alkaline etching,alkaline etching followed by silaniza-tion,and alkaline etching followed by dopamine modifi-cation.The proliferation,adhesion,and osteogenic differ-entiation abilities of MC3T3-E1 cells on the surfaces with collagen modification were analyzed and compared.Methods Collagen was immobilized on the surfaces of pure titanium(Ti-C),alkaline-etched titanium(Ti-Na-C),alkaline-etched and silanized titanium(Ti-A-C),and alkaline-etched and dopamine-modified titanium(Ti-D-C),with pure titanium(Ti)as the control group.The surface morphology was observed by scanning electron microscopy(SEM),and the surface elemental composition was analyzed by X-ray photoelectron spectroscopy(XPS).Contact angle measurements were conducted to evaluate the hydrophilicity of the surfaces.MC3T3-E1 cells were cultured on the surfaces,and their proliferation,adhesion,and osteogenic differentiation abilities were assessed using CCK-8 assay,laser scanning confocal microscope,alkaline phosphatase(ALP)staining,Alizarin red staining and quantitative analysis,as well as real-time quan-titative polymerase chain reaction(RT-qPCR)to evaluate the mRNA expression levels of osteogenic-related genes,includ-ing ALP,typeⅠcollagen(COL-1),osteocalcin(OCN),osteopontin(OPN).Results SEM and XPS results confirmed the successful immobilization of collagen on the titanium surfaces,with the Ti-Na-C group exhibiting a higher amount of col-lagen modification.Contact angle measurements showed improved hydrophilicity of the surfaces after collagen modifica-tion.CCK-8 results indicated good compatibility of the materials with MC3T3-E1,with enhanced cell proliferation on the collagen-modified surfaces.Cell fluorescence staining revealed better cell spreading on the collagen-modified surfaces,and ALP and Alizarin red staining results suggested that the Ti-Na-C group exhibited the best osteogenic performance,with significantly higher absorbance values in the Alizarin red quantification analysis.RT-qPCR analysis showed that the Ti-Na-C group had the highest expression of the osteogenic-related gene OPN.Conclusion Among the different colla-gen modification approaches employed in this study,collagen modification on alkaline-etched titanium surfaces showed the most conducive effects on MC3T3-E1 cell adhesion,spreading,proliferation,and osteogenic differentiation.This ap-proach can be considered as the optimal collagen modification strategy for enhancing osteogenesis on titanium surfaces.

BACKGROUND:Early identification of patients requiring ventilator support will be beneficial for the outcomes of botulism.The present study aimed to establish a new scoring system to predict mechanical ventilation(MV)for botulism patients. METHODS:A single-center retrospective study was conducted to identify risk factors associated with MV in botulism patients from 2007 to 2022.Univariate analysis and multivariate logistic regression analysis were used to screen out risk factors for constructing a prognostic scoring system.The area under the receiver operating characteristic(ROC)curve was calculated. RESULTS:A total of 153 patients with botulism(66 males and 87 females,with an average age of 43 years)were included.Of these,49 patients(32.0%)required MV,including 21(13.7%)with invasive ventilation and 28(18.3%)with non-invasive ventilation.Multivariate analysis revealed that botulinum toxin type,pneumonia,incubation period,degree of hypoxia,and severity of muscle involvement were independent risk factors for MV.These risk factors were incorporated into a multivariate logistic regression analysis to establish a prognostic scoring system.Each risk factor was scored by allocating a weight based on its regression coefficient and rounded to whole numbers for practical utilization([botulinum toxin type A:1],[pneumonia:2],[incubation period≤1 day:2],[hypoxia<90%:2],[severity of muscle involvement:grade II,3;grade III,7;grade IV,11]).The scoring system achieved an area under the ROC curve of 0.82(95%CI 0.75-0.89,P<0.001).At the optimal threshold of 9,the scoring system achieved a sensitivity of 83.7%and a specificity of 70.2%. CONCLUSION:Our study identified botulinum toxin type,pneumonia,incubation period,degree of hypoxia,and severity of muscle involvement as independent risk factors for MV in botulism patients.A score≥9 in our scoring system is associated with a higher likelihood of requiring MV in botulism patients.This scoring system needs to be validated externally before it can be applied in clinical settings.

AIM: To investigate the efficacy and safety of ZKY001 eye drops with different concentrations in the treatment of corneal epithelial defects(CED)after primary pterygium excision.METHODS: This was a multicenter, randomized, double-blinded, placebo-controlled phase II clinical trial. From March 15, 2022 to November 14, 2022, patients with primary pterygium who had undergone surgery were recruited from 12 tertiary hospitals across China. Using block randomization, 178 patients(178 eyes)were randomly assigned to 3 groups in a 1:1:1 ratio: 0.002% ZKY001 group(n=59), 0.004% ZKY001 group(n=59), and placebo group(n=60, receiving ZKY001 sham eye drops). Subjects in each group received 1 drop of the study drug 4 times per day for 4 d. The percentage of CED area recovery from baseline, the first complete healing time of CED area, the number of first complete healing cases of CED, and changes in visual analogue scale(VAS)scores for eye discomfort including eye pain, foreign body sensation, tearing and photophobia were observed.RESULTS: In terms of improvement in CED, there were no statistically significant differences among the three groups including the first healing time of CED, the percentage improvement in CED area compared to baseline, and the percentage of first healing cases at different follow-up visits(all P>0.05). Numerically, the first healing time of CED was shorter in the test groups compared to the placebo group(67.87±21.688 h for the 0.002% ZKY001 group, 61.48±22.091 h for the 0.004% ZKY001 group, and 68.85±20.851 h for the placebo group). On D1 morning, the percentage improvement in CED area compared to baseline was maximally different from the placebo group, and the numerical difference advantage was maintained at subsequent follow-up visits. The number of first healing cases in the CED area at different follow-up visits was higher in the test groups than the placebo group. In terms of improvement in ocular discomfort, the total VAS scores were lower in the test groups compared to the placebo group, mainly due to reductions in foreign body sensation and pain scores. At D3, the 0.004% ZKY001 group showed statistically significant improvement in foreign body sensation(P<0.017). In terms of safety, the overall incidence of adverse events was low(9.0%)and similar among groups.CONCLUSION: The use of ZKY001 eyedrops after primary pterygium surgery can safely improve the CED repair, and alleviate postoperative symptoms caused by CED.

Objective:To observe the clinical efficacy and safety of Tongren Niuhuang Qingxin Pills combined with telmisartan tablets in the treatment of hypertensive vertigo syndrome of phlegm-heat disturbance.Methods:Randomized controlled trial was conducted. Totally 80 patients with hypertension vertigo and phlegm-heat disturbance syndrome were selected from March 2021 to August 2022 at Beijing Tongrentang Hospital of Traditional Chinese Medicine as the observation objects. They were randomly divided into two groups using a random number table method, with 40 cases in each group. The control group received oral telmisartan tablets, while the experimental group received Tongren Niuhuang Qingxin Pills in addition to the control group. Both groups were treated for 28 days and followed up for 1 month. The patients' room blood pressure before and after treatment was measured, and TCM syndrome scores were evaluated. The dizziness assessment rating scale (DARS) was used to evaluate the severity of dizziness, adverse reactions during treatment were recorded, drug safety was observed, and clinical efficacy was evaluated.Results:The total effective rate of the experimental group was 85.0% (34/40), and that of the control group was 7.5% (3/40), with statistical significance between the two groups ( χ2=48.32, P<0.001). Compared with before treatment, the experimental group had SBP [(136.63 ± 6.01) mmHg vs. (159.30 ± 9.01) mmHg, t=-21.00] and DBP [(84.48 ± 4.36) mmHg vs. (95.30 ± 3.75) mmHg, t=-13.80] after treatment; after treatment, SBP [(137.34 ± 6.39) mmHg vs. (158.00 ± 10.06) mmHg, t=-5.28] and DBP [(86.08 ± 4.43) mmHg vs. (95.18 ± 6.61) mmHg, t=-8.09] decreased in the control group ( P<0.01), but there was no statistical significance between the two groups after treatment ( P>0.05). After treatment, the TCM syndrome scores in the experimental group (8.68 ± 3.39 vs. 15.12 ± 3.03, Z=-6.61) were lower than those in the control group ( P<0.001), and DARS score [(8.53 ± 3.93) vs. (12.20 ± 3.95), Z=-3.63] was lower than that in the control group ( P<0.001). After treatment, the therapeutic effect index of TCM syndromes in the experimental group improved compared to before treatment in the same group. The therapeutic effect index of each symptom, from high to low, was as follows: rotation of oneself or visual objects>numbness of limbs>dry stool>dizziness and dizziness>liking cold drinks>bitter and dry mouth>red urine>red tongue, yellow coating, and greasy tongue>vomiting sticky and turbid phlegm>tinnitus>smooth pulse. There were no significant adverse reactions during the treatment of the two groups. Conclusion:Tongren Niuhuang Qingxin Pills combined with telmisartan can reduce the blood pressure of patients with hypertensive vertigo syndrome of phlegm-heat disturbance, improve the vertigo symptoms and TCM syndromes of patients, and the efficacy evaluation is superior to that of telmisartan alone.

Objective:To investigate the clinical features and outcomes of adolescence-onset methylmalonic acidemia (MMA) and explore preventive strategies.Methods:This was a retrospective case analysis of the phenotypes, genotypes and prognoses of adolescence-onset MMA patients. There were 55 patients diagnosed in Peking University First Hospital from January 2002 to June 2023, the data of symptoms, signs, laboratory results, gene variations, and outcomes was collected. The follow-ups were done through WeChat, telephone, or clinic visits every 3 to 6 months.Results:Among the 55 patients, 31 were males and 24 were females. The age of onset was 12 years old (range 10-18 years old). They visited clinics at Tanner stages 2 to 5 with typical secondary sexual characteristics. Nine cases (16%) were trigged by infection and 5 cases (9%) were triggered by insidious exercises. The period from onset to diagnosis was between 2 months and 6 years. Forty-five cases (82%) had neuropsychiatric symptoms as the main symptoms, followed by cardiovascular symptoms in 12 cases (22%), kidney damage in 7 cases (13%), and eye disease in 12 cases (22%). Fifty-four cases (98%) had the biochemical characteristics of methylmalonic acidemia combined with homocysteinemia, and 1 case (2%) had the isolated methylmalonic acidemia. Genetic diagnosis was obtained in 54 cases, with 20 variants identified in MMACHC gene and 2 in MMUT gene. In 53 children with MMACHC gene mutation,1 case had dual gene variants of PRDX1 and MMACHC, with 105 alleles. The top 5 frequent variants in MMACHC were c.482G>A in 39 alleles (37%), c.609G>A in 17 alleles (16%), c.658_660delAAG in 11 alleles (10%), c.80A>G in 10 alleles (10%), c.567dupT and c.394C>T both are 4 alleles (4%). All patients recovered using cobalamin, L-carnitine, betaine, and symptomatic therapy, and 54 patients (98%) returned to school or work.Conclusions:Patients with adolescence-onset MMA may triggered by fatigue or infection. The diagnosis is often delayed due to non-specific symptoms. Metabolic and genetic tests are crucial for a definite diagnosis. Treatment with cobalamin, L-carnitine, and betaine can effectively reverse the prognosis of MMA in adolescence-onset patients.

Objective:To evaluate the relationship between the preoperative sleep quality and postoperative delirium (POD) in elderly patients.Methods:Three hundred and eighty-nine patients of either sex, aged 65-90 yr, with American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, who underwent elective knee/hip arthroplasty under combined spinal-epidural anesthesia in Qingdao Municipal Hospital from May 2022 to October 2023, were selected. The Pittsburgh Sleep Quality Index scale was applied at 1 day before surgery to assess the sleep quality within 1 month before surgery. The cerebrospinal fluid (CSF) specimens 2 ml were withdrawn from the subarachnoid space before anesthesia for determination of the concentrations of biomarkers (β-amyloid), total tau protein [t-tau], and phosphorylated tau protein [p-tau]) by enzyme-linked immunosorbent assay. Patients were divided into POD group and non-POD group based on whether delirium occurred within 7 days after surgery. Logistic regression was used to identify the risk factors for POD, and the sensitivity analysis was used to test the stability of the regression models. The mediation model was used to examine whether CSF biomarkers mediated the link between sleep quality and POD. The accuracy of preoperative sleep quality and CSF biomarker concentrations in predicting the occurrence of POD was evaluated by plotting the receiver operating characteristic curve and calculating the area under the curve.Results:Two hundred and seventy-nine patients were finally included, with 33 patients in POD group and 246 patients in non-POD group. The results of logistic regression analysis showed that shorter sleep duration, use of hypnotics, daytime dysfunction within 1 month before surgery, elevated t-tau concentrations in CSF, and elevated p-tau concentrations in CSF were risk factors for POD after adjusting for multiple confounding factors such as age, sex, body mass index, years of education, Mini-Mental State Examination score, and VAS score. The results of mediating effect showed that the effect of use of hypnotics and daytime dysfunction within 1 month before surgery on POD was partially mediated by p-tau concentrations in CSF (>10%). The area under the curve of combination of daytime dysfunction, sleep duration, use of hypnotics within 1 month before surgery, and CSF biomarker concentrations in predicting POD was 0.979.Conclusions:Shortened sleep duration, use of hypnotic, and daytime dysfunction with 1 month before surgery are risk factors for POD in elderly patients, and the association between use of hypnotics and daytime dysfunction and POD is partially mediated by p-tau in CSF.

Objective To primarily investigate the indoor radon concentrations in the urban and rural dwellings in Yinchuan, China, and to estimate the effective dose. Methods A total of 67 dwellings, which included 49 urban households and 18 rural households in Yinchuan, were selected to cumulatively measure the indoor radon concentrations for more than 3 months using solid state nuclear track detection. Results The arithmetic mean, geometric mean, median, and range of indoor radon concentrations in urban and rural areas in Yinchuan were 64 Bq/m³, 59 Bq/m³, 57 Bq/m³, and 25-172 Bq/m³, respectively. Surveillance sites with an indoor radon concentration higher than 100 Bq/m³ accounted for 7.5%. Indoor radon concentrations in rural areas were higher than those in urban areas. Indoor radon concentrations were highest in winter and lowest in summer. The effective dose of indoor radon exposure among residents in Yinchuan was 1.86 mSv/a. Conclusion The results of indoor radon concentrations measured in this investigation in Yinchuan are significantly higher than those measured in the 1990s. The annual effective dose is higher than the mean levels in the world and China.

Objective:To design and develop a swallowing function training system suitable for stroke patients with swallowing disorders, and investigate patients' acceptance of the system based on sufficient experience.Methods:This system was jointly designed by a multidisciplinary team, targeting stroke patients with swallowing disorders. By combining virtual reality (VR) technology, it achieved visual and interesting knowledge guidance, systematic and targeted swallowing function training, and real-time, feedback based on supervision and review. From March to May 2022, convenience sampling was used to select 39 stroke patients with swallowing disorders from Beijing Chaoyang Hospital affiliated with Capital Medical University. On the basis of fully experiencing the system, the system was evaluated from seven dimensions, including perceived usefulness, perceived ease of use, perceived ease of learning, perceived applicability, perceived security, perceived satisfaction, and intention to use.Results:The acceptance evaluation score of the rehabilitation training system for 39 stroke patients with swallowing disorders was 162 (147, 170). There were statistically significant differences in the acceptance evaluation scores of the rehabilitation training system for patients with different levels of education, job types, cumulative time spent using smartphones every day, and willingness to learn swallowing training, whether they understood VR devices or technologies, and whether they considered swallowing training important ( P<0.05) . Conclusions:This system benefits from the visualization effect and a good sense of immersion of VR technology. Compared to traditional methods, it increases the fun, immersion, and feedback of the rehabilitation training process, and patients have a high acceptance of the system, which can be promoted and used.

ObjectiveTo investigate a cluster epidemic of coronavirus disease 2019 （COVID-19） infections in a school in Longchuan County， Yunnan Province， and further guide the prevention and control of COVID-19 in the border area. MethodsAccording to the Protocol on Prevention and Control of Novel Coronavirus Pneumonia （8th Edition）， an epidemiological investigation was performed on all COVID-19 cases to collect the information on demographics， onset， diagnosis and treatment， prognosis， and epidemiological history. Close contacts were also tracked to determine the transmission chains. ResultsIn this cluster epidemic， a total of 37 COVID-19 cases were identified， including 32 females and 5 males aged from 13 to 25 years， who were 35 students and 2 teachers. The student cases were found in four classes of two grades. Furthermore， gene sequencing showed that all cases had been infected with delta variants， belonging to the same transmission chain that was not related to the previous epidemics in Dehong Prefecture. In additionally， a total of 2 127 close contacts were found. After 21 days of centralized quarantine for medical observation， all close contacts tested negative for SARS-CoV-2. In the COVID-19 cases， only one case remained positive for SARS-CoV-2， while the other 36 cases were successfully treated and became negative. ConclusionThis school cluster is caused by the border villagers who contacted the water polluted with SARS-CoV-2. It warrants more strict management of students from border villages and their belongings to prevent similar epidemics in school settings.