Objective: To explore the micro associations and key bridge nodes between physical fitness indicators and anxiety/depressive symptoms among college students using network analysis, so as to provide a theoretical foundation for promoting physical and mental health of college students. Methods: From September to October 2025, a combination of purposive sampling and cluster sampling was employed to select 2 158 college students from three universities in Xuzhou City. Seven physical fitness indicators were measured and standardized according to the National Student Physical Health Standard. The Generalized Anxiety Disorder Scale-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9) were used to assess anxiety and depressive symptoms. Independent samples t-test was used for intergroup comparisons of physical fitness indicators and psychological symptom scores. A gaussian graphical model (GGM) was constructed to calculate node and bridge strength, followed by stability analyses. Results: The detection rates of anxiety and depressive symptoms among college students were 21.3% and 24.5%, respectively. Male participants demonstrated superior performance in physical fitness indicators such as vital capacity, 50 meter sprint, and standing long jump compared to female participants, whereas females exhibited better results in the sit and reach test ( t =48.35, -44.82 , 70.21, -16.51, all P <0.01). Regarding psychological indicators, female participants showed higher scores of anxiety and depressive symptoms than males ( t =-4.15, -4.46, both P <0.01). Physical fitness and psychological symptoms were predominantly negatively correlated. "feeling tired" and "not being able to stop or control worrying" were the symptoms with the highest centrality in the network of physical fitness and phychological symptoms among college students (standardized strengths were 2.15 and 1.98, respectively). Among the bridge indicators, the "1 000 m (male)/800 m (female) run" exhibited the highest strength (0.85), outperforming "vital capacity" (0.35); it was linked to the symptom cluster primarily by negatively predicting "feeling tired" (edge weight=-0.38). The network stability was excellent of physical fitness and phychological symptoms among college students (correlation stability coefficient= 0.60 ). Conclusions Endurance capacity serves as the most critical bridge connecting physical and mental health, and its decline is closely related to intensified feelings of fatigue. Colleges should prioritize endurance training as a core target for promoting college students mental health.

Objective:To evaluate the effect of the integrated physician-nurse management model on postoperative care in preschool children undergoing laparoscopic appendectomy (LA) .Methods:A total of 64 preschool children who underwent LA were selected by convenience sampling from the pediatric surgery department of Xuzhou Children's Hospital Affiliated to Xuzhou Medical University between November 2023 and June 2024. They were randomly assigned to either the intervention group or the control group (32 cases in each). The control group received routine postoperative care, while the intervention group received additional care based on the integrated physician-nurse management model. Postoperative pain scores at 4, 8, 12, 24, and 36 hours after surgery, as well as parental satisfaction, were compared between the two groups.Results:A total of 60 children completed the study, with 30 in each group. Post-intervention, the intervention group had lower pain scores at all five postoperative time points (4, 8, 12, 24, and 36 hours) compared to the control group, and the differences were statistically significant ( P<0.05). Additionally, the parental satisfaction rate in the intervention group was higher than that in the control group with statistically significant difference (χ 2=6.667, P<0.05) . Conclusions:The integrated physician-nurse management model effectively reduces postoperative pain in preschool children undergoing LA and improves parental satisfaction, supporting its clinical promotion and application.

Objective To analyze the status quo and high-risk factors of hemorrhagic transformation(HT)in patients with acute cerebral infarction(ACI)treated with alteplase(rt-PA).Methods A total of 462 patients with ACI who were admitted to Hai'an People's Hospital and treated with rt-PA from June 2019 to June 2023 were retrospectively emrolled.According to the occurrence of HT,the patients were assigned to HT group(n=31)or non-HT group(n=431).The clinical data of the two groups were compared,and high-risk factors of HT in ACI patients treated with rt-PA were analyzed.Results The incidence of HT was 6.71%(31/462).Multivariate logistic analysis showed that increased systolic blood pressure(SBP),severe cerebral small vessel disease(CSVD),and increased neutrophil-to-lymphocyte ratio(NLR)were the high-risk factors of HT in patients with ACI after treatment with rt-PA(P＜0.05).Conclusion There is a high incidence of HT in patients with ACI after treatment with rt-PA,the levels of SBP,CSVD and NLR are the influencing factors,and they can provide a basis for prediction and clinical intervention.

Objective:To evaluate the effect of the integrated physician-nurse management model on postoperative care in preschool children undergoing laparoscopic appendectomy (LA) .Methods:A total of 64 preschool children who underwent LA were selected by convenience sampling from the pediatric surgery department of Xuzhou Children's Hospital Affiliated to Xuzhou Medical University between November 2023 and June 2024. They were randomly assigned to either the intervention group or the control group (32 cases in each). The control group received routine postoperative care, while the intervention group received additional care based on the integrated physician-nurse management model. Postoperative pain scores at 4, 8, 12, 24, and 36 hours after surgery, as well as parental satisfaction, were compared between the two groups.Results:A total of 60 children completed the study, with 30 in each group. Post-intervention, the intervention group had lower pain scores at all five postoperative time points (4, 8, 12, 24, and 36 hours) compared to the control group, and the differences were statistically significant ( P<0.05). Additionally, the parental satisfaction rate in the intervention group was higher than that in the control group with statistically significant difference (χ 2=6.667, P<0.05) . Conclusions:The integrated physician-nurse management model effectively reduces postoperative pain in preschool children undergoing LA and improves parental satisfaction, supporting its clinical promotion and application.

Spinal cord injury (SCI) is a serious nervous system disease that usually leads to the impairment of the motor, sensory, and autonomic nervous functions of the spinal cord, and it places a heavy burden on families and healthcare systems every year. Due to the complex pathophysiological mechanism of SCI and the poor ability of neurons to regenerate, the current treatment scheme has very limited effects on the recovery of spinal cord function. In addition, due to their unique advantages, exosomes can be used as carriers for cargo transport. In recent years, some studies have confirmed that treatment with mesenchymal stem cells (MSCs) can promote the recovery of SCI nerve function. The therapeutic effect of MSCs is mainly related to exosomes secreted by MSCs, and exosomes may have great potential in SCI therapy. In this review, we summarized the repair mechanism of mesenchymal stem cells-derived exosomes (MSCs-Exos) in SCI treatment and discussed the microRNAs related to SCI treatment based on MSCs-Exos and their mechanism of action, which is helpful to further understand the role of exosomes in SCI.

Objective To explore the predictive value of baseline serum electrolyte levels for adverse prognosis in patients with severe traumatic brain injury(sTBI)in Lanzhou Plateau Area.Methods A total of 210 sTBI patients admitted to our hospital were enrolled,and then divided into good progno-sis group(91 cases)and poor prognosis group(119 cases)according to clinical outcome.The clinical data and serum electrolyte levels were compared between the two groups.Multivariate logistic regres-sion analysis was used to analyze the influencing factors of poor prognosis,and ROC curve was plot-ted to analyze the predictive value of the influencing factors.Results There were significant differ-ences in diabetes,GCS score,serum calcium and magnesium levels between the two groups(P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that diabetes(OR=3.483,95％CI:1.452-8.357),GCS score(OR=0.464,95％CI:0.3 6 3-0.594),hypocalcemia(OR=6.243,95％CI:3.353-11.626)and hypermagnesemia(OR=9.985,95％CI:1.251-19.701)were the influencing factors for poor prognosis of sTBI patients.ROC curve analysis showed that the AUC val-ue was 0.702(95％CI:0.635-0.763)in hypocalcemia and 0.565(95％CI:0.495-0.633)in hy-permagnesemia for the prediction.Conclusion Diabetes,low GCS score,hypocalcemia and hypermag-nesemia are risk factors for poor prognosis of sTBI patients at high altitude.Hypocalcemia has good predictive value in the prediction and can be used as an independent predictor.

Objective:To standardize the management of pediatric Investigator-Initiated Trails (IIT) and improve the execution quality, this study takes a tertiary hospital for children in Shanghai as an example to analyze and summarize the main quality problems in the implementation of pediatric IIT projects and provide appropriate suggestions.Methods:From 2020 to 2022, based on the quality indicators of the IIT project of Shanghai Jiao Tong University School of Medicine, and combined with the characteristics of pediatrics, a centralized monitoring method was used to conduct spot checks and evaluations on the IIT project of a tertiary hospital for children in Shanghai.Results:From 2020 to 2022, a total of 77 IIT projects were inspected, including 27 in the initiation stage, 36 in the execution stage, and 14 in the conclusion stage. In terms of ethical compliance, there are issues with researchers′ weak ethical awareness and non-standard signing of informed consent in the pediatric IIT project. The main problems in terms of execution quality and science include non-standard CRF table design, insufficient awareness of safety management, lack of emphasis on research registration and specialized data management, randomization and blind methods. There are issues with low enrollment rate and low funding execution rate in terms of execution progress.Conclusions:There are certain quality problems during the execution of pediatric IIT projects. Strengthen the establishment of an effective process management and supervision system to improve the quality management of pediatric IIT research processes is needed.

Objective:To explore the critical issues in the construction of management and supporting system of Investigator-Initiated trials (IIT) in pediatrics.Methods:Through summarizing related literature and considering the current status of pediatric clinical research, the critical issues in the construction of management and support system, for instance, the responsibility, training model, and performance evaluation in Europe and U. S. were evaluated, decision-making suggestions were put forward based on domestic pediatric IIT management system.Results:Besides IIT, clinical trials on children′s drugs are also supported by the pediatric clinical research management system in Europe and U. S.. The supporting service covers research consultation, ethical review, research design, trial implementation, patient education, risk control, and investigator training. The organizational structure and management system are relatively mature. Clinical trials are the majority of clinical research in children′s hospitals in China. Main issues identified in the construction of the management and supporting system include ethical review for pediatric clinical research, professional investigator training, multicenter cooperation scheme, performance assessment, and incentive strategies.Conclusions:Taking account into the current status of pediatric IIT in China, it is urgent to accelerate the training of pediatric investigators, set up standard IIT project management team, build the professional project management platform and Electronic Data Capture System, and promote the transformation of research outcomes. Finally, the whole process management of pediatric IIT will be developed to facilitate the development of pediatric medicine.

Objective:To investigate the predictive role of dynamic changes of plasma biomarkers in patients with viral and mycoplasma community-acquired pneumonia (CAP).Methods:From January 2020 to June 2020, 141 patients with viral and mycoplasma CAP in People's Hospital of Ningxia Hui Autonomous Region were enrolled. Pneumonia severity index (PSI) scores [grade Ⅰ-Ⅱ(PSI score ≤ 70), grade Ⅲ (PSI score 71-90) and grade Ⅳ-Ⅴ(PSI score ≥ 91)], serum amyloid A (SAA), hypersensitive C-reactive protein (hs-CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) on the 1 day after admission were compared between the different pathogens (viral and mycoplasma) or different disease severity. The change in level of SAA, hs-CRP on the third day (Δ 3 d = 1 d-3 d) were compared among different disease outcome groups (patients were divided into improved group, stable group and exacerbation group based on PSI scores or lung CT images on the third day). The change in the level of SAA, hs-CRP on the seventh day (Δ 7 d = 1 d-7 d) were compared among different disease prognosis groups (patients were divided into survival group and death group based on 28-day survival data). The receiver operating characteristic curve (ROC) were drawn to evaluate the value of SAA in the evaluation of disease and prediction prognosis. Results:The level of SAA in mycoplasma group (43 cases) was significantly higher than that in virus group (98 cases) on the 1 day after admission. There were no significant differences in other plasma biomarkers between the two groups. The more severe the illness, the higher the SAA level on the 1 day after admission. The trends of other plasma biomarkers in the two groups were consistent with SAA. The levels of SAA in the patients with exacerbation of the virus group and mycoplasma group (12 cases, 9 cases) were significantly higher than those of the improved group (57 cases, 26 cases) and the stable group (29 cases, 8 cases). SAA increased gradually in the exacerbation group, decreased gradually in the improved group, and slightly increased in the stable group. ΔSAA 3 d were differences among three groups. The change trend of hs-CPR was consistent with SAA. The level of SAA in the death group was higher than that in the survival group on the seventh day. SAA increased in the death group and decreased in survival group with time from hospital admission. There were differences according to ΔSAA 7 d between death group and survival group. The change trend of hs-CPR was consistent with SAA. ROC curve showed that the value of SAA was better than hs-CRP in assessing the severity of patients on admission day, and the area under ROC curve (AUC) was respectively 0.777 [95% confidence interval (95% CI) was 0.669-0.886], 0.729 (95% CI was 0.628-0.830). The value of ΔSAA 3 d was better than SAA on the third day predicting disease trends, and AUC was respectively 0.979 (95% CI was 0.921-1.000), 0.850 (95% CI was 0.660-1.000). hs-CRP on the third day and Δhs-CRP 3 d had no predictive value. Both SAA on the seventh day and ΔSAA 7 d have predictive value for prognosis. AUC was respectively 0.954 (95% CI was 0.898-0.993) and 0.890 (95% CI was 0.689-1.000). SAA on the seventh day and ΔSAA 7 d were better than hs-CRP on the seventh day. Δhs-CRP 7 d have no predictive value. Conclusions:SAA is a sensitive and valuable indicator for CAP patients with viruses and mycoplasma. Dynamic monitoring of SAA can evaluate the patient's progression, prognosis, and assist diagnosis and treatment.

Objective:To analyze the tendency of incidence and mortality of mechanical injuries among Chinese residents from 1990 through 2019 and to estimate the age-period-cohort effect.Methods:Based on the Global Burden of Disease (GBD) 2019 database, the incidence and mortality data of mechanical injuries among Chinese residents from 1990 to 2019 were extracted. The trends of age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) of mechanical injuries among Chinese residents by gender was analyzed using the joinpoint regression model, and the annual percent change (APC) and average annual percent change (AAPC) were calculated. The age-period-cohort model was used to quantitatively assess the effects of age, period, and cohort on ASIR and ASDR for mechanical injuries.Results:① Overall tendency: from 1990 to 2019, the ASIR of mechanical injuries showed an increasing trend (540.95/100 000 in 1990 vs. 815.34/100 000 in 2019), and the ASDR first increased slightly and then decreased (2.62/100 000 in 1990 vs. 2.87/100 000 in 2005 vs. 1.77/100 000 in 2019) among Chinese residents. During the observation period, ASIR and ASDR for mechanical injuries of male were higher than female. ② Joinpoint regression model analysis showed that the ASIR of mechanical injuries had a fluctuating trend of increasing first and then decreasing and then rising rapidly among Chinese residents from 1990 to 2019 (AAPC = 1.42%, t = 9.59, P < 0.001). The ASIR of the Chinese male showed a slight decrease and then continued to increase (AAPC = 1.47%, t = 8.72, P < 0.001), while the ASIR of the Chinese female showed a rapid rising at first, then rapidly declining and then rising again (AAPC = 1.31%, t = 12.11, P < 0.001). From 1990 to 2019, the ASDR of mechanical injuries showed a fluctuating downward trend of first decreasing, then increasing, and then rapidly decreasing among Chinese residents (AAPC = -1.39%, t = -6.72, P < 0.001). The decrease rate of ASDR among male was as same as that among all population (AAPC = -1.44%, t = -7.29, P < 0.001), but the decrease rate of ASDR in female was relatively slow (AAPC = -1.08%, t = -4.54, P < 0.001). ③ Age-period-cohort model analysis showed that, with the increase of age, the risk of mechanical injuries among the overall population, male and female in China increased, then decreased, and then increased rapidly. The first small peak was at the age of 45-49 years old in male and 65-69 years old in female. The overall death risk showed an increasing trend with age, with a slowly increasing trend before 75 years old, and a sudden increase after 75 years old. The peak age of death risk was between 90 and 94 years. In terms of period effect, the risk of mechanical injuries showed a gradually increasing trend with time among the overall population, male, and female in China, and the risk of death showed a trend of decreasing first and then rapidly increasing and then decreasing. In terms of cohort effect, the risk of mechanical injuries among the overall population, male, and female in China showed a gradual upward trend with the increase in the birth year, and the risk of death showed an M-shaped trend. Conclusions:From 1990 to 2019, the incidence of mechanical injuries showed an increasing trend, and the mortality increased first and then decreased. Although the disease burden has improved, it is still high. More attention needs to be paid to the prevention and control of mechanical injuries, especially in the young population.