Abstract:Interventional pulmonology is a new subdiscipline of respiratory disease diagnosis and treatment by various interventional means. In recent years, a variety of new ideas, new methods and new technologies for interventional diagnosis and treatment continue to emerge, and interventional pulmonology has become an indispensable diagnosis and treatment technology for respiratory diseases. Respiratory and critical care medicine is a traditional respiratory subdiscipline that provides airway management, mechanical ventilation, and other respiratory support for critically ill patients. It provides emergency treatment and improves survival rate and quality of life. Interventional pulmonology can provide rapid and accurate diagnosis and treatment through high-definition imaging, precise positioning and minimally invasive operations. Respiratory and critical care medicine also uses oxygen therapy support, extracorporeal membrane oxygenation assistance, and other respiratory and critical care techniques to create the necessary conditions for respiratory interventional treatment. In the development of pulmonary and critical care medicine, interventional pulmonology and respiratory and critical care medicine are 2 complementary pulmonary subspecialties, which provide not only basic support for the development of other pulmonary subspecialties, but also important components and indispensable support for the rescue of war wounds. The integration of them has become the only way for respiratory and critical care medicine.

Abstract:Objective To explore the protective effect of hydroalcoholic extract of Portulaca oleracea L. (POHA) on ulcerative colitis (UC) and bone loss in mice. Methods The C57BL/6 mice were treated with dextran sulfate sodium (DSS) to establish UC model. A total of 50 mice were randomly assigned to including control group, DSS group, mesalazine (MS) group, low dose of POHA (POHAL) group, or high dose of POHA (POHAH) group. The control group freely drank drinking water, while the DSS, MS, POHAL and POHAH groups drank drinking water containing DSS for 8 weeks. Since the 2^nd week, the control group and DSS group were given normal saline by gavage. The MS group was given MS (100 mg/kg) by gavage. The POHAL group and POHAH group were given POHA (1 000 mg/kg and 2 000 mg/kg) by gavage, respectively. Body weight and disease activity index (DAI) were recorded and calculated every 2 d. On the 56^th day, the colon weight index, liver index, and spleen index were calculated, and the histological changes of colon were observed. Serum levels of bone metabolism markers and microstructure parameters of femur were detected. Results Compared with the control group, the DSS group showed significantly increased DAI score, colon weight index, liver index, and spleen index (all P＜0.01). The DSS group exhibited significant pathological damage in colon tissues and significantly increased serum levels of osteocalcin, C-terminal peptide of collagen type Ⅰ, and tartrate-resistant acid phosphatase 5b (P＜0.01). The bone loss was significant in the DSS group, manifested by markedly decreased bone mineral density (BMD), bone tissue volume to tissue volume ratio (BV/TV), trabecular bone number (Tb.N), and trabecular bone thickness (Tb.Th), and markedly increased bone surface to bone volume ratio (BS/BV) and trabecular bone separation (Tb.Sp) (P＜0.05 or P＜0.01). Compared with the DSS group, the BMD, BV/TV, Tb.N and Tb.Th of the femur in the MS group and POHAH group of mice were all increased (P＜0.05 or P＜0.01), the BS/BV all decreased (P＜0.05 or P＜0.01), and the Tb.Sp all decreased without significant differences (all P＞0.05). The above bone microstructure parameters in the POHAL group showed no significant differences compared with those in the DSS group (all P＞0.05). Conclusion POHA has protective effect on DSS-induced UC and bone loss, and the mechanism may be related to the inhibition of hyperactive bone metabolism.

Abstract:Objective To explore the effects of CDP-diacylglycerol synthase 1 (CDS1) on autophagy and amyloid deposition in hippocampal neurons of mice and the related mechanism. Methods Congo red and immunohistochemical staining were used to observe the amyloid deposition in hippocampus of amyloid precursor protein (APP)/presenilin 1 (PS1) double-transgenic mice. Lentivirus-mediated overexpression of APP was induced in HT22 cells, and Congo red staining was used to observe the amyloid deposition in HT22 cells. The protein expression levels of microtubule-associated protein 1 light chain 3 (LC3)-Ⅱ and P62 in the hippocampus of APP/PS1 double-transgenic mice and APP-overexpressed HT22 cells were detected by Western blotting. The differential protein CDS1 was screened based on the hippocampal proteomics results of APP/PS1 double-transgenic mice. The expression of CDS1 protein in hippocampal tissue of APP/PS1 transgenic mice and APP-overexpressed HT22 cells was detected by Western blotting. After lentivirus-mediated APP overexpression in HT22 cells, CDS1 was overexpressed, and the protein expression levels of LC3-Ⅱ and P62 were detected by Western blotting. Results β-amyloid protein (Aβ) was deposited in the hippocampus of APP/PS1 mice and in HT22 cells overexpressing APP. The levels of LC3-Ⅱ and P62 protein in the hippocampus of APP/PS1 double-transgenic mice and APP-overexpressed HT22 cells were significantly increased. A differential metabolic pathway, glycerophospholipid metabolic pathway, was screened by Kyoto Encyclopedia of Genes and Genomes pathway analysis in the proteomic results of APP/PS1 double-transgenic mice, and the differential protein CDS1 was obtained. Compared with wild-type C57BL/6 mice, APP/PS1 double-transgenic mice exhibited a significantly decrease in CDS1 protein expression in the hippocampus (0.46±0.07 vs 1.00±0.25, P＜0.01). Similarly, lentivirus-mediated overexpression of APP in HT22 cells resulted in decreased CDS1 protein levels compared to cells infected with empty viral vector controls (0.68±0.18 vs 1.00±0.13, P＜0.01). The autophagy flow of nerve cells was significantly restored after the CDS1 overexpression in APP-overexpressed HT22 cells (LC3-Ⅱ: 1.00±0.15 vs 0.21±0.05, P＜0.01; P62: 1.00±0.16 vs 0.67±0.10, P＜0.01), and Aβ deposition was significantly decreased. Conclusion Downregulation of CDS1 expression can induce dysfusion of autophagosome and lysosome, promoting amyloid deposition in hippocampus of mice with Alzheimer’s disease.

Abstract:Objective To employ three dimensional high-resolution vessel wall magnetic resonance imaging (3D hr-VW-MRI) for analyzing the imaging characteristics of posterior circulation non-stenotic intracranial atherosclerotic plaque and to discuss its diagnostic value in identifying culprit plaques. Methods Ninety-three patients (age ［62.94±9.70］ years old, 67 males, 26 females) with non-stenotic atherosclerosis in our hospital from Jan. 2019 to Jan. 2021 were retrospectively recruited. The imaging features of plaques, including luminal area, maximum wall thickness and minimum wall thickness at the most stenotic site, stenosis rate, plaque burden, remodeling index, eccentricity index, enhancement ratio at the most stenotic site, and intraplaque hemorrhage, were measured based on T1-weighted imaging (T1WI) and contrast-enhanced T1WI. The culprit plaque was defined as a lesion arising from the responsible vascular supply area to a fresh infarction on the diffusion weighted imaging (DWI) and T2 fluid attenuated inversion recovery (T2-FLAIR) images with accompanying ischemic stroke/transient ischemic attack (TIA). A plaque was considered to be a nonculprit plaque when it occurred in patients with presumed ischemic stroke/TIA, but without an infarct on DWI and T2-FLAIR. Results Sixty-one culprit plaques and 32 non-culprit plaques were analyzed. The proportions of patients with hyperlipidemia, National Institutes of Health stroke scale (NIHSS) score, narrowest plaque enhancement rate, and incidence of intraplaque hemorrhage in the culprit plaque group were significantly higher than those in the non-culprit plaque group (all P＜0.05). Multivariate logistic regression analyses showed that NIHSS score (odds ratio ［OR］ ＝1.799, 95% confidence interval ［CI］ 1.303-2.484, P＜0.001), enhancement ratio (OR＝1.076, 95% CI 1.027-1.128, P＝0.002) and intraplaque hemorrhage (OR＝30.708, 95% CI 2.563-367.925, P＝0.007) were associated with plaque type. Conclusion NIHSS score, enhancement ratio at the most stenotic site, and intraplaque hemorrhage are independent risk factors for culprit plaques in patients with posterior circulation non-stenotic intracranial atherosclerotic disease. These indicators may help identify such culprit plaques and could be used to screen individuals with plaques having these characteristics, thereby providing a basis for early preventive interventions.

Abstract:Objective To investigate the effect of early use of ivabradine on cardiac function in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods Eighty patients with AMI who were hospitalized in our hospital from Feb. 2020 to May 2021 were enrolled, and were randomly assigned to ivabradine group or control group (1∶1). All patients were successfully treated with emergency PCI, and the ivabradine group was treated with ivabradine combined with metoprolol after PCI, while the control group was treated with metoprolol only. Both groups were followed up for 1 year. Echocardiography-derived parameters, heart rate and myocardial markers were analyzed. Results The left ventricular ejection fraction was significantly higher in the ivabradine group than in the control group at 1 week, 3 months, and 1 year after PCI (all P＜0.05). The heart rate of the ivabradine group was significantly lower than that of the control group at 1 week after PCI (P＜0.05), while there was no significant difference in heart rates between the 2 groups at 3 months or 1 year after PCI (both P＞0.05). The brain natriuretic peptide of the ivabradine group was significantly lower than that of the control group on day 2 and day 3 after PCI (both P＜0.05). The troponin I level of the ivabradine group was significantly lower than that of the control group on day 5 after PCI (P＜0.05). Conclusion Early use of ivabradine in patients with AMI after PCI can achieve effective heart rate control, reduce myocardial injury and improve cardiac function.

Abstract:Objective To propose a clinical typing method for lumbar degenerative disease (LDD), including the diagnostic criteria for each type and the corresponding surgical treatment strategies. Methods A total of 245 LDD patients who were admitted to Department of Orthopaedics, The Second Affiliated Hospital of Naval Medical University from Jun. 2017 to May 2022 were enrolled and assigned to nerve root type (42 cases), disc herniation type (73 cases), spinal stenosis type (61 cases), spondylolisthesis type (29 cases), and local type (40 cases) according to our diagnostic criteria of clinical typing. Treatment outcomes of various groups were compared and the reliability of the typing method was assessed using consistency test. Results A total of 205 cases received surgical treatment and 40 cases received non-surgical treatment. The surgical approach was modified transforaminal lumbar interbody fusion. The patients were followed up for (20.37±6.13) months. According to Nakai’s evaluation criteria, the clinical effect was excellent in 146 (59.59%) cases, good in 89 (36.33%) cases, fair in 8 (3.27%) cases, and poor in 2 (0.82%) cases, with an excellent and good rate of 95.92%. There were no significant differences in the treatment effects among different types of LDD (P＞0.05). The results of clinical consistency evaluation confirmed that the typing method had good consistency both within observers and between observers. Conclusion This clinical typing method can help to further understand the pathogenesis of LDD, improve the accuracy of diagnosis and optimize the treatment plan.

Abstract:Objective To look for cognitive assessment paradigms and electrocardiographic (ECG) characteristics sensitive to mental fatigue through an experimental study. Methods Data were collected from 10 healthy students of the University of Shanghai for Science and Technology who participated in the 4-day National Undergraduate Electronics Design Contest, including their Stanford sleepiness scale (SSS) scores, sleep duration, cognitive task performance, and ECG signal data. Ten ECG features, including time-domain, frequency-domain, and information-domain characteristics, were extracted during cognitive tasks. The cognitive task performance and ECG features sensitive to changes in mental fatigue were analyzed. Results Significant differences were observed in SSS scores (χ²＝23.116, P＜0.001) and sleep duration (χ²＝19.608, P＜0.001) across the 4 d. For cognitive task performance, word-color congruent accuracy and word-color incongruent accuracy in the Stroop task and Single-visual target stimulus accuracy and Visual target-auditory non-target stimulus accuracy in the audiovisual competition task all showed significant negative correlations with SSS scores (all P＜0.05). Regarding ECG features, Poincaré plot SD2 during the Stroop task was positively correlated with sleep duration (P＜0.05), while Poincaré plot SD2 during the 2-back task was positively correlated with mental fatigue assessment scores and was negatively correlated with sleep duration (both P＜0.05). Conclusion The accuracy of the Stroop task and audiovisual competition task is a cognitive ability indicator sensitive to mental fatigue, while the Poincaré plot SD2 during Stroop and 2-back tasks is an ECG indicator sensitive to mental fatigue.

Abstract:Objective To investigate the prevalence and the risk factors of heart disease (HD) in adults aged ≥80 years old in China based on the data from the 8th round of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Methods A total of 7 675 adults aged ≥80 years old were enrolled from the 8^th round of CLHLS dataset. Chi-square tests were employed to examine associations between cardiovascular disease and demographic characteristics, socioeconomic status, social support, lifestyle factors, and health indicators. Logistic regression models were developed to analyze significant predictors of heart disease in the elderly. Results The prevalence of heart disease was 16% (n＝1 228) in 7 675 elderly people. Aged 90-99 years old (odds ratio ［OR］ ＝0.816), ≥100 years old (OR＝0.641), female (OR＝0.833), and low body mass index (BMI) (＜18.5 kg/m², OR＝0.778) were the protective factors for cardiovascular disease in the elderly; and high BMI (24.0 to 27.9 kg/m², OR＝1.209), rural residence (OR＝2.384), health examination (OR＝1.164), dysfunction of daily living activities (OR＝1.401), hypertension (OR＝2.143), diabetes mellitus (OR＝1.719), and history of cerebrovascular accident (OR＝2.080) were risk factors. Conclusion Male, overweight, rural residence, health examination, dysfunction of daily living activities, hypertension, diabetes mellitus, and a history of cerebrovascular accident are the risk factors for heart disease in the elderly.

Abstract:Objective To analyze the incidence and mortality of gastric cancer in countries and territories with different human development index (HDI) levels in 2022, and to understand the burden of gastric cancer globally and in China. Methods Data on gastric cancer incidence and mortality were collected from GLOBOCAN 2022 and HDI data for all countries were obtained from the Human development report 2022. Spearman correlation was applied to examine the associations between the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), mortality-to-incidence ratio (M/I), and HDI for gastric cancer. The Wilcoxon rank-sum test was used to assess the differences in ASIR and ASMR between males and females. Results In 2022, gastric cancer ranked the 5^th in both incidence and mortality among all cancer types globally. In China, gastric cancer ranked the 5^th in incidence and the 3^rd in mortality among all cancer types. The ASIR and ASMR of gastric cancer showed a descending trend from high, very high, medium to low HDI countries and territories. The ASIR of gastric cancer was positively correlated with HDI (r_s＝0.256, P＝0.001), while ASMR showed no significant correlation with HDI (r_s＝－0.008，P＝0.918). The M/I was negatively correlated with HDI (r_s＝－0.831, P＜0.001). The ASIR and ASMR of gastric cancer in males were significantly higher than those in females globally, in China, and across all HDI groups (all P＜0.05). Globally, both ASIR and ASMR of gastric cancer remained relatively stable before the age of 45, but showed a consistently rising trend after the age of 45. In China, the ASIR and ASMR of gastric cancer exceeded global average level across all age groups. Conclusion The burden of gastric cancer incidence and mortality is higher in very high and high HDI countries and territories compared to medium and low HDI countries and territories. In China, the burden of gastric cancer incidence and mortality is above the global average, highlighting the need for targeted prevention and control measures.

Abstract:Objective To investigate the correlation and lag effect between atmospheric particulate matter and the risk of hospitalization for chronic kidney disease (CKD). Methods The daily hospitalization data for CKD in 9 hospitals in Urumqi from Jan. 1, 2019, to Dec. 31, 2020, and the air pollution and meteorological data during the same period were collected. The relationship between PM_2.5 and PM₁₀ concentrations and CKD incidence was analyzed after controlling for long-term trends, meteorological factors, and potential confounding factors such as the “day of the week effect” by using the generalized additive model (GAM). The effects of single-day lag of 0-7 d (lag0-lag7) and cumulative lag of 0-7 d (lag01-lag07) were analyzed, and subgroup analyses were conducted for gender, age, and season. On the basis of the single pollutant model, other pollutants were included (at most 2 pollutants were included at a time), and a double pollutant model was constructed to evaluate the stability of the model. Results For every 10 μg/m³ increase in PM_2.5 concentration, the highest risk of CKD hospitalization occured when lagged alone at lag2 (relative risk ［RR］ ＝1.014, 95% confidence interval ［CI］ 1.006-1.023) and lagged cumulatively at lag04 (RR＝1.018, 95% CI 1.007-1.029). For every 10 μg/m³ increase in PM₁₀ concentration, the risk of CKD hospitalization was highest when lagged alone at lag0 and lagged cumulatively at lag07 (RR＝1.012, 95% CI 1.007-1.017; RR＝1.024, 95% CI 1.016-1.032). In gender stratification, for every 10 μg/m³ increase in PM_2.5 concentration, the cumulative lag at lag04 indicated that males had the highest risk of CKD hospitalization (RR＝1.023, 95% CI 1.008-1.038); for every 10 μg/m³ increase in PM₁₀ concentration, the highest risk of CKD hospitalization was observed in males when lagged alone at lag0 (RR＝1.013, 95% CI 1.006-1.020), and in females when lagged alone at lag1 (RR＝1.013, 95% CI 1.006-1.020). In age stratification, for every 10 μg/m³ increase in PM_2.5 concentration, the risk of CKD hospitalization was highest in people 65 years old with single-day lag at lag3 and cumulative lag at lag04 (RR＝1.016, 95% CI 1.007-1.026; RR＝1.022, 95% CI 1.010-1.035); for every 10 μg/m³ increase in PM₁₀ concentration, the cumulative lag at lag07 indicated that individuals aged＜65 years old and ≥65 years old had the highest risk of CKD hospitalization (RR＝1.027, 95% CI 1.017-1.037; RR＝1.015, 95% CI 1.001-1.028). In seasonal stratification, for every 10 μg/m³ increase in PM_2.5 concentration during the cold season, the risk of CKD hospitalization was highest when lagged alone at lag3 and lagged cumulatively at lag07 (RR＝1.020, 95% CI 1.011-1.029; RR＝1.025, 95% CI 1.011-1.038). For every 10 μg/m³ increase in PM₁₀ concentration during the cold season, the risk of CKD hospitalization was highest when lagged alone at lag2 (RR＝1.013, 95% CI 1.007-1.019). For every 10 μg/m³ increase in PM₁₀ concentration during the warm season, the risk of CKD hospitalization was highest when lagged alone at lag7 (RR＝1.015, 95% CI 1.006-1.024). In the dual pollutant model, the effects of PM_2.5 adjusting PM₁₀, SO₂, O₃ and CO, and PM₁₀ adjusting NO₂, SO₂, O₃, and CO on the risk of CKD hospitalization were still significant (P＜0.05). Conclusion The increase in atmospheric particulate matter concentrations of PM_2.5 and PM₁₀ can lead to an increased risk of CKD, and there is a lag effect. Men, people under the age of 65 years old, and those in cold seasons (heating periods) are more sensitive to exposure to PM_2.5 and PM₁₀.

Abstract:Hepatic encephalopathy (HE), a neuropsychiatric syndrome caused by acute or chronic liver failure or portosystemic shunting, is characterized by metabolic disturbances and varying degrees of cognitive dysfunction. HE is one of the most common complications and is the leading cause of mortality in cirrhotic patients. Although the exact pathogenesis of HE has not yet been fully elucidated, recent advances have improved our understanding of its pathophysiology, leading to evolving therapeutic strategies. This review summarizes the mechanisms underlying HE and the latest progress in its treatment, aiming to enhance the knowledge and improve diagnosis and therapy.

Abstract:Abdominal aortic aneurysm (AAA) is a degenerative vascular disease occurring in the lower segment of the aortic diaphragm, mainly manifested by irreversible dilatation of the entire artery, preferably in the elderly population. The pathogenesis of AAA is complex and involves multiple factors, with genetic variations and immune imbalances playing important roles. Its pathological changes mainly include inflammatory cell infiltration, degradation of stromal elastin, and smooth muscle cell death. Rupture of AAA is the most dangerous complication, with a high mortality. Surgery remains the only effective intervention, but carries certain risks and postoperative complications. Early intervention for small abdominal aortic aneurysms to slow down aneurysm expansion and achieve long-term survival is currently a focus of drug and technology research. This article reviews the pathogenesis of AAA and its intervention strategies, and summarizes the research on existing drugs and the use of new targets and technologies, so as to provide insights for better understanding and treatment of AAA.

Abstract:Apolipoprotein B mRNA editing enzyme catalytic polypeptide like 3A (APOBEC3A) mutation is a major driver of cervical cancer. APOBEC3A and human papilloma virus (HPV) is closely related. On the one hand, APOBEC3A can effectively inhibit HPV infection; on the other hand, it can promote the integration of HPV DNA into cervical keratinocytes. This paper reviews the complex interaction between HPV and APOBEC3A, and analyzes the involved viral mechanism and cellular signal pathway. A large number of studies have confirmed that APOBEC3A gene can effectively induce the evolution and development of a variety of malignant tumors, including cervical cancer. However, APOBEC3A protein level is not so high in cancer cells in clinic. This paper also discusses the significance and the potential therapeutic value of APOBEC3A activity in cervical cancer.

Abstract:Objective To explore the impact of policy instruments and innovation on the informatization of rural health service system. Methods Central government policy documents related to the informatization of rural health service system, publicly released between 2009 and 2023, were collected using web crawler tools. Keyword extraction was conducted through word frequency analysis and term frequency-inverse document frequency (TF-IDF) calculation. Content analysis of policy texts was carried out from the dual perspectives of policy instruments and the policy innovation process. An exponential growth model was used to fit the evolutionary trend. Results Among the 45 central policies included, policy instruments were used 178 times in total. The demand-side policy instruments accounted for the highest proportion (71 times, 39.89%), reflecting policy responsiveness to the diversified needs of rural healthcare services. The supply side policy instruments have been used a total of 51 times, with the “information system and infrastructure construction” policy instrument being the most frequently (33 times), indicating a national focus on enhancing investment in digital infrastructure and technology. In terms of the policy innovation process, policy instruments were primarily utilized during the adoption stage of policy ideas (55.06%), followed by the implementation stage (38.20%), with the initiation stage being the least influenced (6.74%). The initiation stage was relatively evenly influenced by all 3 types of policy instruments; the adoption stage was mainly influenced by demand-side instruments, while the implementation stage was dominated by supply-side instruments. This trend reflected a policy shift in recent years from value guidance toward practical operability and implementation, demonstrating alignment with the real-world needs of advancing digital technology and improving governance capacity. Conclusion Different policy instruments exhibit stage-specific effectiveness in driving informatization innovation, indicating the need to precisely align instruments with each phase of the policy innovation process to advance informatization in a targeted manner. Top-level policy documents should be refined to clearly define relevant policy concepts. Additionally, execution pathways must be detailed to accelerate infrastructure development in remote and economically disadvantaged regions.

Abstract:Objective To explore the application value of a novel portable endoscope to perform upper gastrointestinal tract examinations in primary medical units. Methods A total of 532 subjects receiving portable endoscope examination were enrolled for analysis. The primary outcome was the success rate of operation. The secondary outcomes were the operation time, examination results, polyp removal and biopsy pathology results, and the subjective evaluation. Results In 532 cases, 2 were withdrawn midway after the endoscope was inserted into the esophagus due to the patients’ inability to tolerate the examination. Additionally, 6 cases did not undergo examination of the descending part of the duodenum because of serious reactions during the procedure. Ultimately, 524 cases successfully completed the upper gastrointestinal examination, and the success rate was 98.5%. The average examination time was (4.7±1.8) min, and the average time for disposal sheath wearing and removing was (4.2±1.4) min. The most common lesions were chronic non-atrophic gastritis (85.1%, 451/530), reflux esophagitis (14.7%, 78/530) and bile reflux (14.0%, 74/530). A total of 10 cases of polyp removal were completed, and the polyp removal rate was 71.4% (10/14). Biopsy pathological diagnosis was completed in 44 cases, and the biopsy rate was 8.3% (44/530). The main discomfort symptoms during the examination were nausea (53.6%, 285/532), vomiting (51.1%, 272/532), and sore throat (38.5%, 205/532), the main discomfort symptoms after the examination were sore throat (27.8%, 148/532), nausea (19.5%, 104/532), and vomiting (14.7%, 78/532). No serious adverse events such as gastrointestinal bleeding, perforation, cardiac or pulmonary complications occurred. Conclusion The novel portable endoscope can safely and effectively complete the diagnosis and treatment of upper gastrointestinal diseases in primary medical units, while saving the decontamination process. However, the incidence of discomfort is high during examinations. Further optimization of the operation methods is needed.

Abstract:Objective To develop a military cross-cultural symptom scale (MCCSS) and evaluate its reliability and validity. Methods The dimensions and items of the scale were determined through literature analysis, questionnaire surveys, group discussions, expert consultations, and pre-experiments. Cluster sampling was employed to collect data from the participants to examine the psychometric properties of the scale. Results The MCCSS comprised 38 items across 9 factors: depression, anxiety, somatic symptoms, misanthropic tendency, sleep problems, compulsions, psychotic symptoms, stress trauma, and defensiveness. Item analysis revealed that the 37 items (except 1 forced-choice item) exhibited correlations from 0.538 to 0.875 with the total scale score (all P＜0.01), with critical ratios ranging from 5.190 to 28.149, indicating good discriminative power. The Cronbach’s α coefficients for the total scale and subscales ranged from 0.825 to 0.972, and the Spearman-Brown split-half reliability coefficients ranged from 0.747 to 0.955. The results of confirmatory factor analysis showed that χ²/df＝3.419, standardized root mean square residual＝0.033, root mean square error of approximation＝0.073, normed fit index＝0.868, incremental fit index＝ 0.903, Tucker-Lewis index＝0.887, comparative fit index＝0.902, and the scale’s first-order 9-factor model fit well. The loads of each item on the factor to which it belonged ranged from 0.597 to 0.954 (all P＜0.01). The correlation coefficients between the scale and the scale for criterion-related validity ranged from 0.392 to 0.773 (all P＜0.01), and the correlation coefficients between the scale and the scale for convergent validity ranged from 0.257 to 0.519 (all P＜0.01). Conclusion The MCCSS in this study has good reliability and validity and can be used as a mental health testing and screening tool for military personnel.

Abstract:Objective To investigate the effectiveness of continuous improvement projects based on FOCUS-PDCA on the pathogen sample submission rate before antimicrobial therapy for inpatients. Methods FOCUS-PDCA was used to improve the pathogen sample submission rate in Affiliated Hospital of Nantong University from Jun. to Jul. 2023. The inpatients from Jan. to May 2023 (before improvement) were enrolled as control group, and the inpatients from Aug. to Dec. 2023 (after improvement) were enrolled as improvement group. The utilization rate of antibiotics, the submission rate of pathogen samples, the submission rate of clinical microbial samples and the detection rate of multidrug-resistant organisms were compared between the 2 groups. Results The utilization rate of therapeutic antimicrobial agents (32.18% vs 32.93%, P＝0.003) and antimicrobial consumption intensity (39.99 defined daily dose ［DDD］/100 patient-days vs 44.19 DDD/100 patient-days) in the improvement group were significantly lower than those in the control group. The pathogen sample submission rates before antimicrobial therapy and key antimicrobial combination therapy in the improvement group were significantly higher than those in the control group (52.01% vs 23.64%, 87.74% vs 77.71%; both P＜0.001). The qualified rate of microbial specimens in the improvement group was significantly higher than that in the control group (88.77% vs 80.11%, P＜0.001). The detection rates of multidrug-resistant organisms and carbapenem-resistant Klebella pneumoniae in the improvement group were significantly lower than those in the control group (40.45% vs 48.42%, 29.65% vs 43.17%; both P＜0.001). Conclusion The continuous improvement projects based on FOCUS-PDCA can improve the pathogen sample submission rate, reduce the detection rate of multidrug-resistant organisms, and promote standardized hospital infection quality management.