Objective: To investigate the level and influencing factors of mental health literacy among middle school students in Taizhou City, Zhejiang Province, so as to provide the basis for the development of mental health education and intervention. Methods: Middle school students were selected from six counties (districts) in Taizhou City using the random cluster sampling method. Demographic information, disease history, learning status, and relationship with parents were collected through questionnaire surveys. The level of mental health literacy was investigated using the Structured Mental Health Literacy Questionnaire for Middle School Students. The influencing factors for mental health literacy was analyzed using a multiple linear regression model. Results: A total of 7 173 middle school students were surveyed, including 4 273 junior high school students (59.57%) and 2 900 high school students (40.43%), and had a mean age of (15.52±1.49) years. There were 3 644 male students (50.80%) and 3 529 female students (49.20%). The median score of mental health literacy was 83.00 (interquartile range, 23.00) points. Multiple linear regression analysis revealed that older age (β'=0.074), female gender (β'=0.038), living in urban areas (β'=0.029), good family economic status (β'=0.061), engaging in sports (β'=0.122), having a good relationship with the father (β'=0.128), and having a good relationship with the mother (β'=0.094) were associated with higher mental health literacy scores among middle school students; while having a history of disease (β'=-0.144) and learning difficulties (β'=-0.178) were associated with lower mental health literacy scores. Conclusion The level of mental health literacy among middle school students in Taizhou City is relatively good, and is influenced by demographic characteristics, disease history, sports participation, learning and relationships with parents.

Objective To investigate the clinical significance of neutrophil-to-lymphocyte ratio (NLR)in assessing response to cardiac resynchronization therapy(CRT)in elderly patients.Methods Clinical data of 105 elderly patients with chronic heart failure(CHF)who had received CRT at our hospital from January 2006 to January 2017 were retrospectively analyzed,and patients were divided into a no-response group(n=42)and a response group(n=63)according to CRT outcomes after 6 months.General clinical data were compared between the two groups.Factors influencing response to CRT were analyzed by logistic regression model analysis.The receiver-operating characteristic(ROC)curve was used to assess the predictive value of NLR in response to CRT.Results Compared with the response group,the no-response group had increased baseline levels of initial QRS width,serum creatinine(Scr) and uric acid(UA)(P ＜0.05).There was no significant difference in left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter (LVESD),the New York Heart Association (NYHA) functional classification,neutrophil count,lymphocyte count and NLR between the two groups before CRT(P＞0.05).After 6 months of CRT,the LVEDD,NYHA functional class,neutrophil count and NLR were higher,and LVEF and lymphocyte count were lower in the no-response group than in the response group(P ＜0.05).The difference in NLR between 6 months after CRT and before CRT(△NLR)was higher in the no-response group than in the response group(P ＜0.05).Multi-factor Cox regression analysis showed that NLR (OR =1.895,95％CI:1.538～5.284,P =0.031)and △NLR(OR =2.579,95％CI:2.110～8.329,P =0.005) were independent risk factors for CRT (HR =1.590,95 ％ CI:1.215 ～ 2.146,P =0.013).ROC curve analysis showed that ROCAUC of △NLR in the no-response group was 0.891,95％CI:0.832～0.937,which was higher than that at 6 months after CRT(0.813,95 ％ CI:0.765～0.864)(Z=2.712,P＜0.05).Conclusions The increase in NLR after CRT may be an early sign for noresponse to CRT,and dynamic monitoring of NLR should be promoted to assess the prognosis of patients undergoing CRT.

Objective To compare patients'satisfaction and comfort associated with automated breast volume scanner(ABVS),handheld ultrasound(HHUS)and mammography(MMG).Methods Five hundred and twenty-eight women who performed ABVS examination and previously had undergone MMG and HHUS were enrolled.BMI,bra size,with or without lesion,lesion size,pain score of MMG,ABVS and HHUS were documented and analyzed.Results The pain score of MMG was significantly higher than that of ABVS[4.0(2.0,6.0)vs 2.0(1.0,4.0)](P <0.05).92.4% of the cases were preferred for the ABVS examination,which was higher than that for the MMG(45.5%),and was similar to HHUS(94.7%).Bra size,BMI,with or without lesion and lesion size could affect the pain degree of ABVS.Conclusions Routine use of ABVS will be well tolerated by patients than MMG.

Objective:To evaluate the relationship between preoperative serum bilirubin concentrations and postoperative delirium (POD) in the patients undergoing knee or hip replacement.Methods:Medical records from 413 patients undergoing knee or hip arthroplasty were selected from August 2020 to October 2023 at Qingdao Municipal Hospital using a nested case-control design based on the PNDABLE study cohort. The patients were divided into POD group ( n=77) and non-POD group ( n=336) according to whether POD occurred. Univariate analysis was used to analyze the influencing factors. Logistic regression was used to identify the risk factors for POD. The significance of mediation effect was tested. The receiver operating characteristic curve was drawn to evaluate the accuracy of risk factors in predicting POD. Results:There were significant differences in age, education time, ratio of diabetes history, Memorial Delirium Assessment Scale score, total bilirubin concentration, direct bilirubin concentration, indirect bilirubin concentration, Aβ 42 concentration, p-tau concentration, t-tau concentration, Aβ 42/p-tau ratio and Aβ 42/t-tau ratio between POD group and non-POD group ( P<0.05). The results of logistic regression analysis showed that preoperative serum total bilirubin, direct bilirubin and indirect bilirubin were risk factors for POD ( P<0.05). The results of mediation effects showed that the concentration of total tau protein in CSF partly mediated the relationship between high serum total bilirubin, direct bilirubin and indirect bilirubin concentrations and POD. The area under the receiver operating characteristic curve of total bilirubin, direct bilirubin and indirect bilirubin combined with CSF biomarker concentrations in predicting POD was 0.83 ( P<0.001). Conclusions:Preoperative elevated concentrations of total bilirubin, direct bilirubin and indirect bilirubin are risk factors for POD in the patients undergoing knee or hip replacement. CSF t-tau concentration has a partly mediating role in the association between serum total bilirubin, direct bilirubin and indirect bilirubin concentrations and the development of POD.

Objective To investigate the safety and efficacy of endoscopic varices ligation(EVL) plus endoscopic varices sclerotherapy(EVS)for esophageal varices hemorrhage in patients with liver cirrhosis. Methods Fifty?two liver cirrhosis patients with esophageal varices bleeding were randomly divided into EVL group(n=24)and EVLS group(n=28)according to random numbers generated by computer after first EVL. The EVL group continued undergoing EVL, and the EVLS group was treated by EVS. The interval of treatment was 2 weeks till varices disappeared. All patients were followed up for 18 months with endoscopy and endoscopic ultrasonography(EUS). The efficacy,changes of esophageal varices and perforating veins, varices recurrence and rebleeding were observed. Results There was no significant difference of complete cure rate between EVLS group and EVL group[67.9%(19/28)VS 62.5%(15/24),P>0.05]. The mean session of treatment(2.68±1.0 VS 1.83±0.7,P<0.05), and perforating veins obliteration rate after treatment in EVLS group was higher than that in EVL group[70.8%(17/24)VS 23.8%(5/21),P<0.05]. During 18 months of follow?up,there was no significant difference of rebleeding rate between the two groups[3.6%(1/28)VS 12.5%(3/24),P>0.05],and the varices recurrence rate was higher in EVL group than that in EVLS group[77.3%(17/22)VS 44.0%(11/25), P<0.05]. Child?Pugh class B patients in EVL group had a higher varices recurrence rate compared to that in EVLS group[75.0%(9/12)VS 31.5%(5/16), P<0.05]. Endoscopic recurrences occurred in patients with non?occlusive perforating veins. Conclusion EVL plus EVS sequential procedure is safe and effective for treatment of esophageal varices hemorrhage,especially for Child?Pugh class B patients.Perforating veins may play a key role in the development of esophageal varices and recurrence after endoscopic therapy. EUS findings can direct the endoscopic therapy and predict the variceal recurrence.

OBJECTIVE: To assess the value of next-generation sequencing-based copy number variation sequencing (CNV-seq) for the detection of copy number variations (CNVs) in prenatal diagnosis. METHODS: The results of single nucleotide polymorphism array (SNP-array) for prenatal diagnosis from May 2018 to December 2020 were reviewed. Selected cases of CNVs of clinical significance or low-percentage mosaic aneuploidies were included. Preserved DNA samples of amniotic fluid DNA were detected by CNV-seq. The results of CNV-seq and CMA were analyzed. RESULTS: A total of 16 488 data of SNP-array were re-analyzed, and 343 DNA samples were selected for the CNV-seq assay. All samples were successfully analyzed. Compared with the SNP-array, the proportion of full concordance, partial concordance and missed detection was 91.5% (314/343), 1.2% (4/343) and 7.3% (25/343), respectively. The non-detection zones of CNV-seq were confirmed, which have encompassed the SHOX gene and AZFc region. CONCLUSION With a high accuracy and wide genome-wide coverage, CNV-seq is worthy for a wide application in prenatal diagnosis, though the limitation of testing should be taken into consideration, and the appropriate prenatal diagnosis method should be selected for different populations to reduce the occurrence of birth defects.
Aneuploidy ; DNA ; DNA Copy Number Variations ; Female ; High-Throughput Nucleotide Sequencing ; Humans ; Pregnancy ; Prenatal Diagnosis/methods*

OBJECTIVE: To explore the genetic basis for four patients suspected for Marfan syndrome (MFS). METHODS: Four male patients with suspected MFS and their family members who were treated at West China Second Hospital of Sichuan University from September 12, 2019 to March 27, 2021 were selected as the study subjects. Peripheral venous blood samples were collected from the patients and their parents or other pedigree members for the extraction of genomic DNA. Whole exome sequencing was carried out, and candidate variants were validated by Sanger sequencing. The pathogenicity of the variants was determined based on the guidelines from the American College of Medical Genetics and Genomics (ACMG). RESULTS: Genetic testing revealed that all four patients have harbored variants of the FBN1 gene, including c.430_433del (p.His144fs) deletional variant in exon 5, c.493C>T (p.Arg165*) nonsense variant in exon 6, c.5304_5306del (p.Asp1768del) deletional variant in exon 44 and c.5165C>G (p.Ser1722Cys) missense variant in exon 42. According to the ACMG guidelines, the c.430_433del and c.493C>T were classified as pathogenic variants (PVS1+PM2_Supporting+PP4; PVS1+PS1+PS2+PM2_Supporting+PP4). c.5304_5306del and c.5165C>G were classified as likely pathogenic variants (PS2+PM2_Supporting+PM4+PP4; PS2_Moderate+PS1+PM1+PM2_Supporting). CONCLUSION The c.430_433del and c.5304_5306del variants of the FBN1 gene identified in this study were unreported previously. Above results have enriched the variation spectrum of the FBN1 gene and provided a basis for genetic counseling and prenatal diagnosis of patients with MFS and acromicric dysplasia.
Female ; Pregnancy ; Humans ; Male ; Exons ; China ; Family ; Genetic Counseling ; Genetic Testing ; Marfan Syndrome/genetics* ; Mutation ; Fibrillin-1/genetics*