Objective To explore the efficacy and safety of oral solution of magnesium sodium potassium sulfate in bowel preparation before colonoscopy. Methods Patients who planned to undergo colonoscopy at the digestive department of the Ninth People’s Hospital, affiliated to School of Medicine of Shanghai Jiao Tong University from January 2023 to August 2023 were selected and eligible subjects were divided into two groups: Group A took polyethylene glycol （PEG） and Group B took oral solution of magnesium sodium potassium sulfate （OSS）. The quality, drug tolerance, and safety of intestinal preparation were evaluated. The quality of bowel preparation was evaluated by the boston bowel preparation scale （BBPS）. Results The right colon BBPS score of Group B was (2.39±0.82) points, which was significantly higher than of Group A (2.11±0.43) points （P<0.05）. The overall score of Group B was higher than that of Group A （P<0.05）. OSS was easier to take than PEG, with a good taste and overall sensation. Patients were willing to use OSS to clean their bowels even when they were willing to undergo another examination （P<0.05）. There was a significant difference in nausea and vomiting symptoms between the two groups （P<0.05）, and there were no significant changes in renal function and electrolytes before and after medication in the two groups of patients. Conclusion OSS had a higher quality of bowel cleaning and was easier for patients to accept.

Objective To analyze the clinical and therapeutic characteristics of Epstein-Barr virus (EBV)-negative posttransplant lymphoproliferative disease (PTLD) with diffuse large B-cell lymphoma (DLBCL) in the context of specific cases and literature. Methods A case of EBV-negative DLBCL (GCB type) after kidney transplantation is reported. The patient was a 45-year-old male who underwent living-related kidney transplantation in 2016 and has been receiving triple immunosuppressive therapy with tacrolimus, mycophenolate mofetil and methylprednisolone since then. In 2024, the patient presented with intermittent fever, night sweats and gastrointestinal symptoms. The diagnosis was confirmed by endoscopic pathology, immunohistochemical staining and positron emission tomography/computed tomography. The R-CDOP regimen (rituximab + cyclophosphamide + liposomal doxorubicin + vincristine + dexamethasone) was used for treatment. Results The patient was diagnosed with EBV-negative DLBCL (GCB type, Ann Arbor stage Ⅳ B). After 4 cycles of R-CDOP chemotherapy, the efficacy assessment was partial remission, and the transplant kidney function remained stable. Conclusions For EBV-negative PTLD after kidney transplantation, it is necessary to break through the "virus-dependent" diagnostic thinking. In clinical practice, the focus should be on protecting the transplant kidney, and individualized treatment plans should be developed for patients.

Objective: To explore the association of outdoor activity time and sleep duration with screening myopia in primary school students, so as to provide strategies for myopia prevention. Methods: Through a convenience sampling method, a survey was conducted among 4 248 primary school students aged 7-13 years from three primary schools in Xihu District, Nanchang City, Jiangxi Province from May to July, 2023. The average daily outdoor activity time and sleep duration on both weekdays and weekends were investigated in primary school students by using a self designed questionnaire. Uncorrected visual acuity tests and non cycloplegic autorefraction were measured by professional optometrists. Inter group comparisons were conducted using the Chi square test. Logistic regression model was used to analyze the association of outdoor activity time and sleep duration with screening myopia. Results: The detection rate of screening myopia in primary school students was 33.6%, with the rate in boys (32.0%) lower than that in girls (35.3%), and the difference was statistically significant ( χ 2=5.11, P =0.02). The analysis results of Logistic regression showed that after adjusting for factors such as gender, grade and parental education level, both average daily outdoor activity time ＜2 h on both weekdays and weekends ( OR =1.27, 95% CI =1.11-1.46) and sleep duration <10 h ( OR =1.17, 95% CI =1.01- 1.35 ), as well as their combined effect ( OR =1.57, 95% CI =1.25-1.98), were associated with an increased risk of screening myopia in primary school students(all P <0.05). Subgroup analysis results indicated that compared to boys ( OR =1.46, 95% CI = 1.07 -1.99), girls( OR =1.73, 95% CI =1.22-2.44) with insufficient outdoor activity time and sleep duration had a higher risk of screening myopia(both P <0.05). Conclusions There is a negative correlation of outdoor activity time and sleep duration with screening myopia in primary school students. Outdoor activity time and extending sleep duration should be increased to reduce the risk of myopia in primary school students.

Objective: To determine the association between exposure to entertainment screen content on mobile phones and symptoms of anxiety-depression co-morbidity among college students,so as to provide evidence for mental health interventions. Methods: A baseline survey was conducted from April to May 2019. A total of 1 135 college students were selected from one university each in Shangrao City, Jiangxi Province and Hefei City, Anhui Province using cluster random sampling method. A follow up study was conducted in November 2019, resulting in 1 110 matched valid responses. Self rating questionnaires were used to assess the exposure of entertainment screen content. The Depression Anxiety Stress Scale-21(DASS-21) and the Patient Health Questionnaire-9 (PHQ-9) were used to evaluate the anxiety symptoms, depressive symptoms, and symptoms of anxiety-depression co-morbidity among college students. A multivariate binary Logistic regression model was constructed following initial intergroup comparisons with Chi-square test to determine the association between baseline exposure to mobile entertainment screen content and the risk of symptoms of anxiety depression co-morbidity at baseline and the 6 month follow up. Results: The prevalence rates of symptoms of anxiety-depression co-morbidity among college students were 25.4% and 20.6% at baseline and follow up, respectively.After adjusting for confounding factors such as gender, self rated family economic status and self rated health status, the results of multivariate binary Logistic regression analysis showed that compared with the appropriate exposure level group, the exposure of entertainment screen content on mobile phones at baseline, including frequent exposure to reading( OR =1.65,95% CI =1.14-2.39), occasional exposure to other entertainment screen content ( OR =1.46,95% CI =1.01-2.10)and frequent exposure to other entertainment screen content( OR =1.76,95% CI =1.20-2.60), increased the co-occurrence risk of symptoms of anxiety-depression co-morbidity among college students during the follow up period (all P <0.05). Conclusion Occasional or frequert exposure to mobile entertainment screen content can increase the risk of symptoms of anxiety depression co-morbidity among college students.

OBJECTIVE To analyze the selection and rationales of comparators for pharmaceutical enterprises in their medical insurance access application， so as to provide a reference for promoting communication and consensus between enterprises and medical insurance authorities in this process. METHODS The application materials for drugs outside the catalogue that passed formal review published by the National Healthcare Security Administration from 2021 to 2025 were extracted， and then content analysis was used to systematically sort out relevant information of the declared drugs and comparators； the specific situations and rationales of pharmaceutical enterprises’ selection of comparators were analyzed. RESULTS A total of 1 341 declared drug documents were collected. Data analysis showed that 1 035 （77.18%） were submitted with positive comparators and 306 （22.82%） used blank comparators； 58 drugs （4.33%） took combination therapy as the reference， and 5 drugs （0.37%） referred to non-pharmacological （or non-single pharmacological） treatment regimens. Among competitive drugs declared by multiple enterprises， 50.00% of the enterprises submitted different comparators. A total of 4 basic conditions and 39 additional conditions were extracted as the rationales for selecting positive comparators. For blank comparators， 12 drug-related factors， 2 administrative factors， and 1 other factor were identified. More than 10% of the drugs did not state the rationale for comparator selection， and over 44% of drugs using blank comparators provided only one justification. CONCLUSIONS Pharmaceutical enterprises mainly select comparators based on their own interests in the medical insurance access application， and there are deficiencies in the adequacy and standardization of their selection basis and reasoning. It is recommended that enterprises follow the principled requirements of medical insurance authorities， and fully and normatively explain the reasons for selecting comparators in combination with the characteristics of their own products. Meanwhile， it is advisable to change the current open-ended statement form of selection reasons into a closed-ended answering mode， so as to highlight the priority of selection， standardize the declaration behavior of enterprises， and reduce communication divergences between the two parties.

Objective To explore the number of peripheral blood regulatory T cells (Treg) in patients with chronic kidney disease (CKD) and its correlation with vascular calcification. Methods This was a single-center, cross-sectional, and observational study. Non-dialysis patients with CKD treated at Zhongshan Hospital, Fudan University from March 2021 to March 2022 were enrolled. Abdominal aortic calcification (AAC) was assessed using lateral abdominal X-ray. Number of Treg and cytokine levels were measured by flow cytometry. Logistic regression analysis was performed to evaluate the related factors for AAC in CKD patients. Results A total of 83 patients were included, aged 17–86 years, with 57 males (68.7%). The distribution of CKD stages was as follows: stage G1 in 7 patients (8.4%), stage G2 in 17 patients (20.5%), stage G3 in 21 patients (25.3%), stage G4 in 19 patients (22.9%), and stage G5 in 19 patients (22.9%). No AAC was observed in patients with stages G1 and G2, while the prevalence of AAC in patients with stages G3, G4, and G5 was 23.8%, 21.1%, and 26.3%, respectively. Compared with stage G1 patients, those with stages G3–5 showed decreased number of peripheral blood Treg and elevated levels of interleukin (IL)-6 and IL-17F (P＜0.05). The area under the receiver operating characteristic curve for number of peripheral blood Treg in predicting AAC in CKD patients was 0.766 (95%CI 0.652–0.879, P＝0.002). Logistic regression analysis showed that decreased number of Treg was related factor for AAC in CKD patients (OR＝0.957, 95%CI 0.922–0.992, P＝0.018). Conclusion As CKD progresses, number of peripheral blood Treg significantly decreases, which is correlated with AAC in CKD patients.

OBJECTIVE To investigate the effect of dopamine receptor 3(D3R)on fear memory induced by intense electric shocks and the possible neurobiological mechanism.METHODS ① To prevent pain threshold differences from influencing the effect of intense electric shocks,wild-type(WT)and D3R knockout mice(D3R-/-)were used in the Hargreaves test to evaluate their basal pain threshold,with the paw withdrawal latency(PWL)as the observation index.② WT and D3R-/-mice were divided into control groups and model groups,respectively.On the training day(the first day,D 1),the model groups received inescapable electric shocks(1.5 mA,10 s,10 s interval,15 cycle)while the control groups did not.Contextual fear tests were conducted on D2,D7,D10,D14,and D16 after training,with the percentage of freezing time(FT)as the observation index to evaluate fear memory acquisition induced by contextual cues.On D17,after the model groups showed no more fear responses to contex-tual cues,they were re-stimulated with low-intensity current(0.5 mA,10 s,10 s interval,15 cycle)to evoke fear memory.The two control groups did not receive any shocks.Contextual fear tests were conducted on day 18,and the FT%of each group was observed to evaluate fear memory retrieval induced by contextual cues.③ Another cohort of WT and D3R-/-mice was used to further investigate the underlying neural mechanism,with the same grouping and treatment as in ②.Real-time dynamic changes in calcium signals of dopamine(DA)neurons in the ventral tegmental area(VTA)of WT and D3R-/-mice were detected using fiber photometry during electric shocks.The fluorescence area under the curve(AUC)was used as the indicator to quantify the excitability of DA neurons.RESULTS ① In the Hargreaves test,there was no significant difference in PWL between D3R-/-mice and WT mice,indi-cating the two genotype mice had no significant differences in the basal pain threshold.② Compared with the WT control group,the percentage of FT of the WT model group significantly increased on D2,D7,D10,and D14(P<0.05).Compared with the D3R-/-control group,the percentage of FT of the D3R-/-model group significantly increased only on D2 and D7(P<0.01).Meanwhile,the percentage of the FT of D3R-/-model group was significantly lower than in the WT control group on D2,D7,D10,and D14(P<0.05,P<0.01).During memory recall(D18),the percentage of FT of the WT model and D3R-/-model groups significantly increased compared to their respective control groups(P<0.01,P<0.05),while the percentage of FT of D3R-/-model mice was significantly lower than that of WT model mice(P<0.01).③ In the fiber photometry test,during the shock period,the calcium signals of DA neurons in the VTA of WT model and D3R-/-model mice rapidly increased within the first 2 s,and then gradually decreased between 2 to 10 s.The AUC within the 2 to 10 s interval was significantly lower in D3R-/-model mice compared to WT model mice(P<0.05),indicating that the excitability of DA neurons in the VTA of D3R-/-model mice was significantly lower than that of WT-model mice.CONCLUSION D3R knockout inhibits the acquisition and recall of long-term fear memory in mice,and its neurobiological mechanism may be related to the decreased excitability of DA neurons during electric shock.

Objective:To study the health-related quality of life (HRQOL) and influencing factors of echinococcosis surgical patients included in the project management in Jingyuan County since the implementation of the Central Transfer Payment for Local Echinococcosis Prevention and Control Project (hereinafter referred to as the Echinococcosis Prevention and Control Project).Methods:Surgical patients included in the management of Echinococcosis Prevention and Control Project in Jingyuan County from January 1, 2009 to December 31, 2022 were selected as study subjects for a door-to-door questionnaire survey to collect basic information, medical treatment and diagnosis, surgical situation, postoperative follow-up and management situation, preoperative and postoperative HRQOL. Multivariate logistic regression was employed to analyze the influencing factors of HRQOL in echinococcosis surgical patients.Results:A total of 111 echinococcosis patients undergoing surgery were included, with a first visit duration [ M ( Q1, Q3)] of 8.0 (5.0, 12.0) years from symptom onset to initial consultation, and a surgical treatment duration of 8.0 (5.0, 12.0) years from diagnosis to surgical intervention. The cure rate based on postoperative efficacy observation was 81.08% (90/111). There was no statistically significant differences in the distribution of preoperative and postoperative mobility, self-care, daily activities, anxiety or depression among echinococcosis patients undergoing surgery ( P > 0.05). However, significant differences were observed in the distribution of pain or discomfort and health status scores ( P < 0.001). The results of ordinal logistic regression analysis showed that preoperative age [≥61 years old, OR (95% CI) = 0.06 (0.01, 0.56), P = 0.014], preoperative concomitant hypertension (grade Ⅱ), diabetes, and heart disease [ OR (95% CI) = 13.15 (1.80, 96.13), 57.69 (2.05, 1 620.13), 10.90 (1.27, 93.90), P < 0.05], initial lesion location in the abdominal cavity and the lesion in two or more locations [ OR (95% CI) = 30.83 (1.05, 902.45), 114.25 (7.24, 1 801.75), P < 0.05] were independent influencing factors for preoperative HRQOL in patients with echinococcosis. Postoperative comorbidities of hypertension (grade Ⅱ) and diabetes [ OR (95% CI) = 42.77 (2.39, 766.21), 901.40 (4.64, 1 740.94), P < 0.05], and postoperative complications [ OR (95% CI) = 130.61 (6.27, 2 722.24), P = 0.002] were independent influencing factors for postoperative HRQOL in patients with echinococcosis. Conclusions:The health status of patients with echinococcosis has significantly improved after surgical treatment. Preoperative factors affecting HRQOL of patients with echinococcosis include age, concomitant hypertension, diabetes, heart disease, and the initial lesion location. Postoperative influencing factors include concomitant hypertension and diabetes, as well as postoperative complications.

The concept of"musculoskeletal imbalance with soft tissue primacy"posits that tendon injury induced by intervertebral disc degeneration constitutes the core pathogenesis of spinal musculoskeletal imbalance.This study systematically elucidates the pathological mechanisms through which tendon injury leads to spinal instability by integrating traditional Chinese medicine(TCM)"musculoskeletal balance"theory with contemporary biomechanical research on disc degeneration.In the process of intervertebral disc degeneration,the change of stress distribution revealed by modern biomechanics is highly consistent with the TCM principle of"tendon impairment affecting bone".Finite element analysis revealing the"stability-instability-restabilization"process further validates the pathological progression from musculoskeletal imbalance to rebalance.This integrated TCM-Western medicine perspective establishes a novel theoretical framework for predicting disease progression and developing personalized therapeutic strategies,particularly in guiding clinical practice of"treating bone disorders through tendon regulation".

Objective To study how lipid bilayer fluidity modulates the interaction between β1 integrin and CD40L,as well as the formation of CD40L-mediated tumor cell contact interfaces.Methods Supported lipid bilayers(SLB)with different fluidities were prepared through adjusting the 1,2-dioleoyl-sn-glycero-3-[N-(5-amino-l-carboxypentyl)iminodiacetic acid]succinyl nickel salt(DGS-NTA)content.The functionalization of lipid bilayers was achieved by anchoring fluorescently labeled CD40L molecules onto the membrane surface.The contact interface formation of PC9 cells on the functionalized lipid bilayers was observed through confocal fluorescence imaging and fluorescence recovery after photobleaching(FRAP)experiments,and data of two dimensional(2D)reaction kinetics of β1 integrin and CD40L were extracted from Zhu-Golan plots.Results The diffusion coefficient of molecules in lipid bilayer was negatively correlated with DGS-NTA content.High fluidity of lipid bilayer promoted CD40L accumulation at cell contact interface and expanded the cell contact area.The 2D dissociation constants(2D Kd)of β1 integrin-CD40L complexes were approximately 13,31 and 65 molecules/μm2 for the three lipid bilayers with high,moderate and low fluidities,respectively.Conclusions High fluidity of lipid bilayers significantly facilitates diffusion and aggregation of CD40L to the cell contact interface,thus enhancing β1 integrin-CD40L interaction and the stability of cell contact interfaces.