BackgroundSeveral studies have confirmed that there is a relationship among parenting rearing behaviors， adolescent depression and rumination， moreover， rumination has been found to mediate the relationship between overall parenting rearing behaviors and adolescent depression， while little is known about the mediating role of rumination in the relationship between each dimension of parenting rearing behaviors and adolescent depression. ObjectiveTo explore the mediating role of rumination in the relationship between each dimension of parenting rearing behaviors and adolescent depression， so as to provide reference for the prevention of adolescent depression. MethodsIn March and April 2022， a stratified random sampling technique was utilized to select 302 students in grades 7 to 12 at a middle school in Ningxian county， Gansu Province as the research subjects. The Beck Depression Inventory-II of Chinese Version （BDI-II-C）， short-form Egna Minnen av Barndoms Uppfostran （S-EMBU） and Ruminative Response Scale （RRS） were administered to all subjects. Pearson correlation coefficients were calculated. Amos 24.0 was used to check the presence of mediation effect. ResultsA total of 302 （94.08%） completed valid questionnaires. Correlation analysis indicated that the scores of both father's and mother's emotional warmth dimension in the S-EMBU were negatively correlated with the BDI-II-C scores （r=-0.424， -0.297， P<0.01）， RRS total score （r=-0.347~-0.175， P<0.01） and RRS each factor score （r=-0.179~-0.285， P<0.01）； the scores of both father's and mother's rejection dimension in the S-EMBU were positively correlated with the BDI-II-C scores （r=0.355， 0.248， P<0.01）， RRS total score （r=0.262~0.358， P<0.01） and RRS each factor score （r=0.274~0.339， P<0.01）； the scores of both father's and mother's overprotection dimension in the S-EMBU were positively correlated with the BDI-II-C scores （r=0.286， 0.245， P<0.01）， RRS total score （r=0.175~0.333， P<0.01） and RRS each factor score （r=0.150~0.255， P<0.01）. Rumination might mediated the relationship of father's emotional warmth， father's overprotection， mother's overprotection， and mother's rejection with adolescent depression， the effect value were -0.110， 0.221， -0.121， 0.136， and the effect size were 36.07%， 100.00%， 100.00%， 100.00%. ConclusionRumination may play a mediation role in the relationship of father's emotional warmth， father's overprotection， mother's overprotection， and mother's rejection with adolescent depression. ［Funded by Shaanxi Provincial Key Research and Development Program （number， 2024SF-YBXM-078）； Reaearch and Development Fund of the First Affliated Hoapital of Xi'an JiaoTong University （number， 2022HL-23）］

AIM: To evaluate the safety and efficacy of allogeneic intrastromal lenticule implantation combined with corneal collagen cross-linking(CXL)in patients with moderate to advanced keratoconus.METHODS: A retrospective case series analysis was conducted. A total of 19 patients(20 eyes)with moderate to advanced keratoconus who underwent combined allogeneic intrastromal lenticule implantation and CXL at the Jinan Mingshui Eye Hospital from June 2021 to December 2023 were included. The uncorrected distance visual acuity(UCVA), thinnest corneal thickness, central corneal epithelial thickness, anterior corneal flat keratometry(Kf), steep keratometry(Ks), and mean keratometry(Km), as well as the first applanation time(A1T), the first applanation length(A1L), the velocity during the first applanation moment(VIN), the second applanation time(A2T), the second applanation length(A2L), the velocity during the second applanation moment(VOUT), highest concavity time(HCT), highest concavity radius(HCR), peak distance(PD), deformation amplitude(DA), stiffness parameter at first applanation(SP-A1), integrated radius(IR), central corneal thickness(CCT), intraocular pressure(IOP), corneal thickness-corrected IOP, biomechanically intraocular pressure IOP(bIOP), and corneal thickness variation rate(ARTH)were compared between the two groups before surgery and at 1 wk, 1, 3 and 6 mo after surgery.RESULTS: All patients successfully completed the surgery without any intraoperative complications. No significant differences were observed between pre-operative and post-operative measurements for UCVA or the corneal biomechanical parameters, including A1L, A2L, PD, A1T, A2T, VIN, VOUT, DA, IOP, and bIOP(all P>0.05). Significant differences were found between pre-operative and post-operative values for corneal thinnest point thickness, central corneal epithelial thickness, Kf, Ks, Km, and the corneal biomechanical parameters, including HCT, HCR, SP-A1, ARTH, IR, and CCT(all P<0.05). The anterior corneal curvature demonstrated an initial increase followed by a decrease post-operatively. Furthermore, significant differences were observed between pre-operative and post-operative values for HCT, HCR, SP-A1, ARTH, IR, and CCT(all P<0.005).CONCLUSION: Allogenic intrastromal lenticule implantation combined with corneal collagen cross-linking demonstrates favorable safety and stability in treating moderate-to-advanced keratoconus. This combined procedure effectively increases corneal thickness and rigidity, resulting in corneas that are more resistant to deformation postoperatively.

OBJECTIVE To analyze clinical switching patterns and reasons between bevacizumab biosimilar and originator drugs. METHODS The data were collected from 1 175 cancer patients treated with bevacizumab at Ruijin Hospital， Shanghai Jiao Tong University School of Medicine from January 1， 2018， to December 31， 2023. The patients were divided into originator group （n＝250） and biosimilar group （n＝925）. The switching rate， switching type and reasons of the two groups were compared. RESULTS There were no statistically significant differences in the switching rate， switching types， and the number of switches between the two groups （P＞0.05）. Single， one-way switches were the switching type in both groups. The proportion of patients in the biosimilar group who switched due to adverse events was significantly higher than originator group， while the proportion of patients who switched due to treatment costs was significantly lower than originator group （P＜0.05）. There were no statistically significant differences in the proportions of patients who switched due to efficacy and drug accessibility between the two groups （P＞0.05）. CONCLUSIONS The switching between bevacizumab biosimilar and the originator drugs mainly involves single， one- way switches. Treatment costs and drug accessibility are the main factors for the switches among users of originator drugs， while drug accessibility and adverse events are the main factors for the switches among users of biosimilar.

Objective To explore the correlation and dose-response relationship between blood lipid parameters and the risk of thyroid nodules (TNs) in euthyroid women, providing references for disease prevention. Methods A case-control study was conducted, including 1 412 euthyroid women (701 in the case group and 711 in the control group). Crude and multivariable logistic regression models were used to assess the association between blood lipid parameters and the risk of TNs, and restricted cubic spline regression was applied to explore the dose-response relationship. Results Compared with women in the lowest quartile of serum triglyceride (TG; Q1, TG≤0.92 mmol/L), the risk of TNs was 45% (OR＝1.45, 95%CI 1.06-1.98) higher for those in Q2 (TG 0.93-1.24 mmol/L), 101% (OR＝2.01, 95%CI 1.47-2.77) higher for those in Q3 (TG 1.25-1.81 mmol/L), and 67% (OR＝1.67, 95%CI 1.19-2.33) higher for those in Q4 (TG>1.81 mmol/L) after adjusting for age, body mass index (BMI) and education. For each unit increase in log₁₀TG, the risk increased by 98% (OR＝1.98, 95%CI 1.14-3.45). Moreover, the correlation remained statistically significant even after further adjustment for thyroglobulin antibody (TGAb), thyroid peroxidase antibody (TPOAb) and urinary iodine (OR＝1.75, 95%CI 1.00-3.06, P＜0.05). However, correlations of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) with the risk of TNs were not statistically significant. Restricted cubic spline regression analysis further demonstrated the non-linear dose-response relationship of TG levels with the risk of TNs. Specifically, the risk of TNs increased in a monotonic manner at lower TG concentrations (＜1.23 mmol/L), but appeared to plateau or even slightly decrease at higher levels of TG (≥1.23 mmol/L). Conclusions Among euthyroid women, higher serum TG level is associated with risk of TNs, and this correlation is non-linear.

Objective: To explore parents knowledge, vaccination attitude, and willingness influencing factors of human papillomavirus (HPV) and its vaccine for male primary and secondary school students, so as to provide a scientific basis for formulating targeted health education strategies and promoting the popularization of boys HPV vaccination. Methods: From March 3 to 14, 2025, a stratified cluster random sampling method was used to select 912 parents of boys in primary and secondary school in Bao an District, Shenzhen for a questionnaire survey. Data on their demographic characteristics, HPV related knowledge and its vaccine, vaccination attitude, and willingness were collected. Univariate analysis was performed by using the χ 2 test or t-test, and binary Logistic regression model was used to analyze related factors of HPV vaccine vaccination willingness. Results: The total awareness rate of parents knowledge related to HPV and its vaccine was 35.75%, among which the awareness rates of boys vaccine types ( 6.36% ), optimal age (21.16%), and optimal vaccination period (31.25%) were the lowest. The scores of parents knowledge and attitude related to HPV and its vaccine were (4.31±2.66) and (3.82±0.63). About 64.25% of parents expressed willingness to have boys vaccinated against HPV. The scores of knowledge and attitude related to HPV and its vaccine of parents with vaccination willingness (4.86±2.55, 4.02±0.58) were higher than those of parents without vaccination willingness (3.34±2.57, 3.46±0.55), and the differences were statistically significant ( t =8.59,13.96, both P <0.01). Logistic analysis showed that parents without raising daughters had a lower willingness to vaccinate boys against HPV ( OR=0.49, 95%CI =0.35-0.70); for each 1 increase in parents knowledge score related to HPV and its vaccine, the vaccination willingness increased by 9.0% ( OR=1.09, 95%CI =1.01-1.17); parents who were worried about boys infection risk ( OR=1.50, 95%CI =1.08-2.08) and parents who had their children vaccinated against HPV even if their classmates were not vaccinated ( OR=3.68, 95%CI =2.73-4.94) had higher willingness to vaccinate boys against HPV(all P <0.05). Conclusions Parents of boys in primary and secondary schools of Bao an District, Shenzhen have low scores of knowledge related to HPV and its vaccine.While parents show strong willingness to vaccinate boys against HPV, limited knowledge may hinder both the sustained growth of vaccination intentions and the actual implementation of vaccination practices.

Objective:To investigate the feasibility and therapeutic effects of a self-designed portable enteral nutrition (EN) kit for home EN in patients with acute pancreatitis (AP) .Methods:A total of 60 patients suffered from moderately severe AP and severe AP and needed home EN in Department of Gastroenterology of First Affiliated Hospital of Naval Medical University between April 2022 and June 2023 were enrolled. They were randomly assigned to portable EN group (observation group, n=28) and routine EN group (control group, n=29) according to random number table. All patients were given EN guidance before discharge. After discharge, all patients were given weekly telephone follow-up to guide the resolution of home EN problems. Patients were followed up from discharge to extubation. The age, gender, body mass index (BMI), disease severity, laboratory indicators (white blood cell, hemoglobin, albumin, total protein), AP related complications before discharge were recorded. During the follow-up period, changes in BMI, laboratory indicators, gastrointestinal symptoms, infection related complications, nutrition tube related complications and Barthel index were recorded. Results:all indicators in the two groups were not significantly statistically different, which comparable at baseline. During the 1-week, 2-week, 3-week and 4-week follow-up period, there was no significant difference on the incidence of infection and complications related to nutrition tube between the two groups, while the incidence of gastrointestinal symptoms in observation group was significantly lower than that in control group and the difference was statistically significant ( P<0.05). At the 3-week and 4-week follow-up, the BMI [ (22.38±3.84) vs (20.38±3.56) kg/m 2; (22.59±3.77) vs (20.54±3.37) kg/m 2], hemoglobin [ (125.00±13.46) vs (113.4±13.64) g/L; (126.20±14.37) vs (114.3±13.25) g/L], and albumin [ (40.96±3.07) vs (39.17±3.31) g/L; (41.79±2.73) vs (39.97±2.67) g/L] levels of the observation group were significantly higher than those of the control group; the living ability score of the observation group was significantly higher than that of the control group (87.32±5.85 vs 82.59±9.79; 89.64±1.31 vs 83.97±8.80) ; and all the differences were statistically significant (all P value <0.05) . Conclusions:The application of portable EN kit can help reduce the gastrointestinal symptoms of AP patients who need long-term home EN, improve nutritional status and life ability.

To implement the strategy of healthy China and promote the construction of "new medicine science", it is urgent to focus on new needs and challenges to advance the reform of medical education curricula in China. Using literature research methods, we summarize the process of modern medical education curriculum reforms in the United States, and discuss the main features of the third-round reforms—introducing the concept of value-based medicine, offering health systems science courses, and promoting the curriculum system reform from the perspectives of learning time, curriculum integration, and learning methods. Based on these features, we put forward the enlightenment for the reform of medical education curricula in China.

Objective To explore the value of non-contrast CT findings of acute ischemic stroke(AIS)for predicting early prognosis after mechanical thrombectomy.Methods Data of 161 AIS patients from clinical center 1 who underwent mechanical thrombectomy were retrospectively analyzed.The patients were divided into training set(n=113)and internal test set(n=48)at the ratio of 7∶3,while 79 AIS patients who underwent mechanical thrombectomy from clinical center 2 were retrospectively enrolled as external test set.According to the National Institutes of Health stroke scale(NIHSS)scores 7 days after thrombectomy,patients'prognosis were classified as good(＜15 points)or poor(≥15 points).Pre-treatment non-contrast CT images of patients were reviewed,and CT findings were comparatively analyzed.Independent predictors of patients'early prognosis after mechanical thrombectomy were obtained with sequential univariate and multivariate logistic regressions,and a predicting model was established and visualized as a nomogram.The receiver operating characteristic curve was drawn,and the distinction was assessed with the area under the curve(AUC),then calibration was assessed with Hosmer-Lemeshow goodness of fit test,and the net benefit was evaluated with decision curve analysis(DCA).Results Alberta stroke program early CT score(ASPECTS),hyperdense middle cerebral artery sign(HMCAS)and basal ganglia calcification were all independent predictors of early prognosis of AIS after mechanical thrombectomy(all P＜0.05).The predictive model was established combining the above 3 variables and then visualized as a nomogram to predict prognosis of AIS after mechanical thrombectomy,with AUC of 0.776 in internal test set(χ2=6.052,P=0.417)and 0.800 in external test set(χ2=2.269,P=0.811).DCA showed that the nomogram might provide clinical net benefit within certain threshold probability ranges.Conclusion ASPECTS,HMCAS and basal ganglia calcification were all independent predictors of early prognosis of AIS after mechanical thrombectomy.The nomogram originated from predicting model combining the three could be used to somewhat accurately predict poor early prognosis after mechanical thrombectomy.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective To investigate the distribution and antimicrobial resistance profiles of the common pathogens isolated from urine from 2015 to 2021 in the CHINET Antimicrobial Resistance Surveillance Program.Methods The bacterial strains were isolated from urine and identified routinely in 51 hospitals across China in the CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021.Antimicrobial susceptibility was determined by Kirby-Bauer method,automatic microbiological analysis system and E-test according to the unified protocol.Results A total of 261 893 nonduplicate strains were isolated from urine specimen from 2015 to 2021,of which gram-positive bacteria accounted for 23.8％(62 219/261 893),and gram-negative bacteria 76.2％(199 674/261 893).The most common species were E.coli(46.7％),E.faecium(10.4％),K.pneumoniae(9.8％),E.faecalis(8.7％),P.mirabilis(3.5％),P.aeruginosa(3.4％),SS.agalactiae(2.6％),and E.cloacae(2.1％).The strains were more frequently isolated from inpatients versus outpatients and emergency patients,from females versus males,and from adults versus children.The prevalence of ESBLs-producing strains in E.coli,K.pneumoniae and P.mirabilis was 53.2％,52.8％and 37.0％,respectively.The prevalence of carbapenem-resistant strains in E.coli,K.pneumoniae,P.aeruginosa and A.baumannii was 1.7％,18.5％,16.4％,and 40.3％,respectively.Lower than 10％of the E.faecalis isolates were resistant to ampicillin,nitrofurantoin,linezolid,vancomycin,teicoplanin and fosfomycin.More than 90％of the E.faecium isolates were ressitant to ampicillin,levofloxacin and erythromycin.The percentage of strains resistant to vancomycin,linezolid or teicoplanin was＜2％.The E.coli,K.pneumoniae,P.aeruginosa and A.baumannii strains isolated from ICU inpatients showed significantly higher resistance rates than the corresponding strains isolated from outpatients and non-ICU inpatients.Conclusions E.coli,Enterococcus and K.pneumoniae are the most common pathogens in urinary tract infection.The bacterial species and antimicrobial resistance of urinary isolates vary with different populations.More attention should be paid to antimicrobial resistance surveillance and reduce the irrational use of antimicrobial agents.