Objective: To explore the impact of adverse childhood experiences (ACEs) on health risk behaviors (HRBs) among college students and the mediating role of psychological symptoms, so as to provide a basis for developing intervention strategies. Methods: From March to April 2023, a convenience cluster sample of 1 801 students from 12 universities in Nanning, Liuzhou, Guilin, Wuzhou of Guangxi completed an online survey. A self designed questionnaire, Adverse Childhood Experiences-International Questionnaire (ACE-IQ) and Symptom Checklist-90 (SCL-90) were used for evaluation tools. Binary Logistic regression, structural equation modeling (SEM) and Bootstrap methods were used to analyze the associations and mediating effects. Results: Overall, 71.2% of college students experienced at least one type of ACE, with emotional neglect (40.3%) and emotional abuse ( 25.2 %) having the highest detection rates. The top three HRBs were unhealthy diet (77.8%), physical inactivity (54.1%), and smoking/alcohol use (18.5%). Logistic regression showed that poor family functioning, abuse, and extra familial violence were each associated with an increased risk of smoking/alcohol use ( OR =1.14, 1.11, 1.18) and deliberate self harm ( OR =1.26, 1.19,1.30) (all P <0.05). Experience of abuse increased the risk of high risk sexual behavior and family dysfunction increaded the risk of physical inactivity, respectively ( OR = 1.07 , 1.04, both P <0.05). Mediation analysis revealed that anxiety ( β =0.20) and depression ( β = 0.09 ) partially mediated the pathway from poor family functioning to deliberate self harm; paranoia ( β =0.02) partially mediated the pathway from abuse to high risk sexual behavior; and obsessive-compulsive symptoms ( β =0.26) and depression ( β =0.10) partially mediated the pathway from extra familial violence to deliberate self harm (all P <0.05). Conclusion Psychological symptoms play a mediating role in the association between ACEs and HRBs, and mental health interventions may reduce the risk of HRBs among college students.

Methods: Sixty-two patients (2014–2019) were divided into the SC (n=32) and PC (n=30) groups. Clinical outcomes were evaluated using the Visual Analog Scale (VAS), modified Japanese Orthopedic Association (mJOA) score, and Neck Disability Index (NDI). Radiological parameters, including cervical lordosis (CL), fused segment angle (FSA), and disc height (DH), were assessed. Cage subsidence, adjacent segment degeneration (ASD), and other complications were also documented. The relationship between postoperative radiological changes and symptoms was also analyzed. Results: Both groups showed significant improvement in symptoms, with fusion achieved in all surgical segments. The SC group had a shorter operative time and reduced intraoperative blood loss. However, the SC group had a higher subsidence rate (16.7% vs. 5.6%, p=0.017). The PC group maintained better cervical alignment in terms of CL, FSA, and DH (p<0.05), with an increased incidence of dysphagia and ASD (p<0.05). Spearman correlation analyses showed that neither CL nor FSA loss at the 5-year follow-up was significantly associated with improvements in the mJOA, VAS, and NDI scores (p>0.05) in either group. Regression analyses indicated that subsidence or loss of lordosis did not correlate with the degree of postoperative symptoms (p<0.05). Conclusions Both SC and PC achieved sustained pain relief, neurological improvement, and solid fusion in three-level ACDF at the 5-year follow-up. SC demonstrated significant advantages in reducing dysphagia and ASD, while PC better maintained cervical alignment and segmental stability. Patient-specific factors should be used to guide implant selection. Further multicenter studies are required to validate these findings.

OBJECTIVE To compare the efficacy and prognosis between dapagliflozin and empagliflozin in elderly patients with heart failure （HF） complicated by cardiac pacemaker implantation.METHODS The clinical data of 237 elderly patients with HF complicated by cardiac pacemaker implantation， who were admitted to the Department of Cardiovascular Medicine at the First Affiliated Hospital of Nanyang Medical College from July 1， 2023， to January 1， 2025， were retrospectively collected. According to medication use， the patients were divided into the control group （conventional therapy， n ＝90）， dapagliflozin group （conventional therapy plus dapagliflozin， n ＝77）， and empagliflozin group （conventional therapy plus empagliflozin， n ＝70）. Cardiac function and HF-related indicators were evaluated before treatment and after 6 months of treatment among the 3 groups. The incidence of major adverse cardiovascular events （MACE）， HF rehospitalization rate， and the occurance of adverse reaction were compared among the 3 groups.RESULTS After 6 months of treatment， compared with the same group before treatment， left ventricular ejection fraction was significantly increased， 6-minute walk distance was significantly prolonged， left ventricular end-diastolic diameter and left ventricular end-systolic diameter were significantly shortened， and N-terminal pro-B-type natriuretic peptide and high-sensitivity C-reactive protein levels were significantly decreased in all 3 groups （ P ＜0.05）. The improvements in most of the above indicators were greater in the dapagliflozin and empagliflozin groups than in the control group （ P ＜0.05）， and were all greater in the empagliflozin group than in the dapagliflozin group （ P ＜0.05）. The HF rehospitalization rate was significantly lower in both dapagliflozin and empagliflozin groups than in the control group （ P ＜0.05）， and was significantly lower in the empagliflozin group than in the dapagliflozin group （ P ＜0.05）. There was no statistically significant difference in the incidence of MACE among the 3 groups （ P ＞0.05）， although the incidence was numerically lower in the dapagliflozin and empagliflozin groups than in the control group. There was also no statistically significant difference in the incidence of adverse reactions among the 3 groups （ P ＞0.05）.CONCLUSIONS Both dapagliflozin and empagliflozin can improve cardiac function and HF-related indicators and reduce the risk of HF rehospitalization in elderly patients with HF complicated by cardiac pacemaker implantation on the basis of conventional therapy， without increasing the risk of adverse reactions. Compared with dapagliflozin， empagliflozin shows more pronounced effects.

ObjectiveTo analyze the microbial culture positivity rate， pathogen spectrum， prevalence of multidrug-resistant organisms （MDROs）， and differences among donor procurement sources in corneas from the Eye Bank of Guangdong Province， and to provide evidence for eye bank quality control and the prevention of post-keratoplasty infections. MethodsThis retrospective study included 7 442 donor corneas procured by the Eye Bank of Guangdong Province and used for keratoplasty at Zhongshan Ophthalmic Center， Sun Yat-sen University， between 2018 and 2025. During surgery， donor corneoscleral rim tissue was excised for bacterial and fungal culture. Culture-positive specimens underwent microbial identification and antimicrobial susceptibility testing （AST）. Culture-positive corneas were compared across study years， pathogen categories， and donor procurement sources. ResultsOf the 7 442 donor corneas， 251 were culture-positive， corresponding to an overall culture positivity rate of 3.37%， with annual rates ranging from 1.50% to 5.31%. Among culture-positive corneas， 178 （70.92%） yielded bacteria alone， 72 （28.68%） yielded fungi alone， and 1 （0.40%） yielded both bacteria and fungi. Candida spp. and Aspergillus spp. were the predominant fungal isolates. Gram-negative bacteria were more frequently isolated than Gram-positive bacteria. The most common bacterial isolates were Acinetobacter baumannii， Staphylococcus epidermidis， Stenotrophomonas maltophilia， Enterococcus faecium， and Pseudomonas fluorescens. MDROs accounted for 75.47% of bacterial isolates， predominantly Acinetobacter baumannii， Staphylococcus epidermidis， and Enterococcus faecium， and demonstrated an increasing trend over the study period. Donor corneas procured through the Hospital Cornea Retrieval Program （HCRP） had a higher culture positivity rate than those obtained through Organ Procurement Organization （OPO） （P＜0.000 1）. Among culture-positive donor corneas， the proportion of fungal culture-positive corneas was significantly higher in the HCRP group than in the OPO group （P=0.001 5）， whereas the proportion of MDROs among bacterial culture-positive corneas was significantly higher in the OPO group than that in the HCRP group （P=0.005 2）. ConclusionsThe overall culture positivity rate of donor corneas from the Eye Bank of Guangdong Province is relatively low， indicating that the risk of microbial contamination is controlled. However， pathogen profiles and antimicrobial resistance patterns varies by procurement source. Ongoing microbiological and antimicrobial resistance surveillance， together with optimized donor risk assessment and timely reporting of culture results， may further improve eye bank quality management and help inform strategies for preventing post-keratoplasty infections.

ObjectiveTo analyze the microbial culture positivity rate， pathogen spectrum， prevalence of multidrug-resistant organisms （MDROs）， and differences among donor procurement sources in corneas from the Eye Bank of Guangdong Province， and to provide evidence for eye bank quality control and the prevention of post-keratoplasty infections. MethodsThis retrospective study included 7 442 donor corneas procured by the Eye Bank of Guangdong Province and used for keratoplasty at Zhongshan Ophthalmic Center， Sun Yat-sen University， between 2018 and 2025. During surgery， donor corneoscleral rim tissue was excised for bacterial and fungal culture. Culture-positive specimens underwent microbial identification and antimicrobial susceptibility testing （AST）. Culture-positive corneas were compared across study years， pathogen categories， and donor procurement sources. ResultsOf the 7 442 donor corneas， 251 were culture-positive， corresponding to an overall culture positivity rate of 3.37%， with annual rates ranging from 1.50% to 5.31%. Among culture-positive corneas， 178 （70.92%） yielded bacteria alone， 72 （28.68%） yielded fungi alone， and 1 （0.40%） yielded both bacteria and fungi. Candida spp. and Aspergillus spp. were the predominant fungal isolates. Gram-negative bacteria were more frequently isolated than Gram-positive bacteria. The most common bacterial isolates were Acinetobacter baumannii， Staphylococcus epidermidis， Stenotrophomonas maltophilia， Enterococcus faecium， and Pseudomonas fluorescens. MDROs accounted for 75.47% of bacterial isolates， predominantly Acinetobacter baumannii， Staphylococcus epidermidis， and Enterococcus faecium， and demonstrated an increasing trend over the study period. Donor corneas procured through the Hospital Cornea Retrieval Program （HCRP） had a higher culture positivity rate than those obtained through Organ Procurement Organization （OPO） （P＜0.000 1）. Among culture-positive donor corneas， the proportion of fungal culture-positive corneas was significantly higher in the HCRP group than in the OPO group （P=0.001 5）， whereas the proportion of MDROs among bacterial culture-positive corneas was significantly higher in the OPO group than that in the HCRP group （P=0.005 2）. ConclusionsThe overall culture positivity rate of donor corneas from the Eye Bank of Guangdong Province is relatively low， indicating that the risk of microbial contamination is controlled. However， pathogen profiles and antimicrobial resistance patterns varies by procurement source. Ongoing microbiological and antimicrobial resistance surveillance， together with optimized donor risk assessment and timely reporting of culture results， may further improve eye bank quality management and help inform strategies for preventing post-keratoplasty infections.

Objective To establish a stable,reliable,and clinically relevant porcine model of endotoxin-induced acute respiratory distress syndrome(ARDS).Methods Ten 8-month-old male Bama minipigs were deeply sedated,followed by invasive mechanical ventilation and electrocardiographic monitoring.Lipopolysaccharide(LPS)was intravenously pumped at 600 μg/(kg·h)for 3 hours,then maintained at 15 μg/(kg·h)thereafter.Dynamic monitoring was performed at five time points after LPS injection(LPS 0,1,3,5,and 8 h),including arterial blood gas analysis and chest computed tomography(CT)scans.Pathological examination of lung tissues obtained via bronchoscopic biopsy(HE staining and transmission electron microscopy)was conducted.These indicators were comprehensively used to evaluate the success of the animal model.Results At 5 hours after LPS administration,8 minipigs developed symptoms such as skin cyanosis,elevated body temperature,and respiratory distress.The oxygenation index decreased to<300 mmHg.Chest CT scans showed diffuse pulmonary infiltrates.Histopathology revealed alveolar edema and hyaline membrane formation.Transmission electron microscopy demonstrated disruption of pulmonary blood-air barrier,depletion of lamellar bodies in type Ⅱ pneumocytes,inflammatory cell infiltration,and exudation of plasma proteins and fibrin.Compared with LPS 0 h,at LPS 8 h,the oxygenation index and arterial blood pH were significantly decreased(P<0.001),while blood lactic acid and serum potassium were significantly increased(P<0.05);serum calcium and base excess were significantly decreased(P<0.05),and the lung injury score based on HE-stained lung sections was significantly increased(P<0.01).Conclusion The porcine ARDS model established by continuous LPS injection can dynamically simulate the pathophysiological characteristics and typical pathological manifestations of clinical septic ARDS,making it an effective tool to study the pathogenesis,prevention,and treatment strategies of septic ARDS.

OBJECTIVE: Humans are exposed to complex mixtures of environmental chemicals and other factors that can affect their health. Analysis of these mixture exposures presents several key challenges for environmental epidemiology and risk assessment, including high dimensionality, correlated exposure, and subtle individual effects. METHODS: We proposed a novel statistical approach, the generalized functional linear model (GFLM), to analyze the health effects of exposure mixtures. GFLM treats the effect of mixture exposures as a smooth function by reordering exposures based on specific mechanisms and capturing internal correlations to provide a meaningful estimation and interpretation. The robustness and efficiency was evaluated under various scenarios through extensive simulation studies. RESULTS: We applied the GFLM to two datasets from the National Health and Nutrition Examination Survey (NHANES). In the first application, we examined the effects of 37 nutrients on BMI (2011-2016 cycles). The GFLM identified a significant mixture effect, with fiber and fat emerging as the nutrients with the greatest negative and positive effects on BMI, respectively. For the second application, we investigated the association between four pre- and perfluoroalkyl substances (PFAS) and gout risk (2007-2018 cycles). Unlike traditional methods, the GFLM indicated no significant association, demonstrating its robustness to multicollinearity. CONCLUSION GFLM framework is a powerful tool for mixture exposure analysis, offering improved handling of correlated exposures and interpretable results. It demonstrates robust performance across various scenarios and real-world applications, advancing our understanding of complex environmental exposures and their health impacts on environmental epidemiology and toxicology.
Humans ; Environmental Exposure/analysis* ; Linear Models ; Nutrition Surveys ; Environmental Pollutants ; Body Mass Index

Naval hospitals,the backbone of naval health service system,are the key to build a world-class naval health service system.On the basis of the requirements of military transformation and high-quality development of public hospitals,this paper summarized five aspects of high-quality development of naval hospitals,including directions and regulations,support and contribution of combats,efficiency,sustainable development momentum,and the expansion of service functions.It is very important to strengthen the top-level design and policy support for naval hospitals,to improve the level of governance and innovation,and to find the right target for the naval hospital construction in naval health service system reform.

Objective To investigate the thyroid diseases in soldiers(aged 30 years and above)stationed on a certain island,and to clarify the value of ultrasonic diagnosis.Methods Thyroid ultrasonography was performed in 270 soldiers(aged≥30 years)stationed on an island by the high-frequency probe of the Mindray Z6 portable B-mode ultrasound diagnostic instrument.According to the C-TIRADS classification,the proportion of soldiers with thyroid nodules was calculated.Results Thyroid nodules were found in 50 soldiers(18.52%),including 29 cases(10.74%,cystic nodules)of C-TIRADS type 2,15 cases(5.56%,solid or cystic nodules)of C-TIRADS type 3,5 cases(1.85%,solid or cystic nodules)of C-TIRADS type 4a,and 1 case(0.37%,solid nodule)of C-TIRADS type 4b.Conclusion Thyroid ultrasound helps to analyze the causes of thyroid diseases,make grading assessment,and provide suggestions for soldiers stationed on islands.Not only does it clarify the necessity of thyroid ultrasonography in the physical examination,but also provides suggestions to improve the medical environment on islands.

OBJECTIVE: To compare clinical efficacy between side-opening and front-opening bone cement injectors in percutaneous kyphoplasty(PKP) for the management of thoracolumbar osteoporotic vertebral compression fractures(OVCFs). METHODS: A retrospective cohort study was conducted, comprising 62 patients with single-segment thoracolumbar OVCFs (T₁₁-L₂), who underwent bilateral PKP at our department during the period from June 2020 to October 2021. Patients were categorized into two groups based on the specific bone cement injector employed during the surgical procedure: the side-opening group (n=29) and the front-opening group (n=33). Among them, the side-opening group consisted of 6 male and 23 female patients, with a mean age of (73.32±9.11) years. The front-opening group included 7 male and 26 female patients, with a mean age of (71.29±10.39) years. The variables encompassed essential patient characteristics were recorded, such as gender, age, bone mineral density (BMD), and fracture level (T₁₁-L₂), as well as procedural aspects, including operation duration, cement injection volume, cement distribution type (lobular or diffuse), occurrence of cement leakage, pre-and post-operative visual analogue scale (VAS) pain scores, and vertebral compression ratio. RESULTS: All patients underwent successful surgery, with a mean follow-up duration of (15.37±3.03) months. There were no statistically significant differences in gender, age, BMD, fracture level, preoperative vertebral compression degree, and VAS scores between the side-opening group and the front-opening group (P>0.05). The operation time, the mean cement injection volumes, the distribution of bone cement within the vertebrae has no statistically significant difference between two groups(P>0.05). Both the side-opening and front-opening groups showed significant improvements in VAS scores at 3 days and 6 months after operation (P<0.05). However, there was no significant difference in VAS scores between the two groups at both 3 days and 6 months after the operation (P>0.05). CONCLUSION Side-opening bone cement injectors in bilateral PKP surgery for single-segment thoracolumbar OVCF achieve similar clinical efficacy as front-opening injectors, without significant improvement in cement distribution and containment.
Humans ; Female ; Male ; Kyphoplasty/instrumentation* ; Aged ; Bone Cements ; Fractures, Compression/surgery* ; Retrospective Studies ; Spinal Fractures/surgery* ; Thoracic Vertebrae/injuries* ; Lumbar Vertebrae/injuries* ; Osteoporotic Fractures/surgery* ; Middle Aged ; Aged, 80 and over