ObjectiveTo explore the effect of blood flow restriction training (BFRT) under different intensities combined with low-intensity resistance training (LIRT) on motor function in stroke patients with frailty. MethodsFrom August, 2024 to August, 2025, 200 elderly ischemic stroke patients with frailty from Affiliated Hospital, North China University of Science and Technology were randomized into control group and observation groups 1, 2 and 3, with 50 cases in each group. All the groups received 30% 1RM resistance training. In addition, the observation groups received BFRT of 40%, 50% and 60% arterial occlusion pressure (AOP), respectively. Before training, and four and eight weeks after training, their motor function was evaluated with Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and Fugl-Meyer Assessment-Lower Extremities (FMA-LE), grip strength, 10-Metre Walk Test (10MWT) and Berg Balance Scale (BBS); Fried Frailty Phenotype (FFP) was used to assess frailty status; and the score of modified Ashworth Scale (MAS), blood pressure and resting heart rate were recorded. ResultsOne case dropped out in each group. For the scores of FMA-UE and FMA-LE, the grip strength of both hands, the time of 10MWT and the score of BBS, the main effects of group and time, and interaction effect were all significant (F > 2.745, P < 0.05); four weeks after training, the above indexes were better in the observation groups than in the control group (P < 0.05); eight weeks after training, the scores of FMA-UE and FMA-LE, the grip strength of both hand and the score of BBS were better in the observation group 3 than in the observation groups 1 and 2 (P < 0.05), and the time of 10MWT was better in the observation group 3 than in the observation group 1 (P < 0.05). For the score of FFP, the main effect of group was significant (F = 688.360, P < 0.001), however, the effects of time and interaction were not significant (P > 0.05). For the score of MAS, the main effect of group was significant (F = 7.171, P = 0.008), however, the effects of time and interaction were not significant (P > 0.05). For the blood pressure and resting heart rate, the main effects of group and time, and interaction effect were not significant (P > 0.05). ConclusionBFRT under different intensities combined with LIRT can safely improve the motor function, grip strength, walking ability in elderly stroke patients, and 60% AOP may be more effective.

Objective: To explore the dynamic developmental trajectories of college students class belongingness during their college years and its longitudinal predictive effects on depressive symptoms, so as to provide targeted insights for precise campus psychological interventions. Methods: In October 2021 (T1), a total of 4 720 college students from a university in Shandong Province were selected by cluster sampling method and followed up for 3 years. Surveys were conducted annually (T2: October 2022, T3: October 2023, T4: October 2024). The Class Belongingness Scale and Patient Health Questionnaire-9 (PHQ-9) were used to assess students class belongingness and depressive symptoms. Latent growth mixture modeling was employed to identify trajectories of class belonging, and multinomial Logistic regression analysis was used to examine the predictive effects of these trajectory classes on depressive symptoms. Results: Mean scores of class belongingness across T1-T4 were (73.24±11.95, 74.76±12.25, 75.25±12.38, 77.64±11.63), and the scores of depressive symptoms were [1.00 (0, 5.00), 0 (0, 3.00), 0 (0, 2.00), 0 (0, 2.00)]. The developmental trajectories of class belongingness were categorized into three types: the high-starting ascending group ( 56.61 %), the low-starting descending group (11.91%), and the medium-starting stable group (31.48%). Multinomial Logistic regression analysis showed that, compared to the medium-starting stable group, the high-starting ascending group had a lower probability of developing mild depressive symptoms ( OR=0.27, 95%CI =0.15-0.47) and moderate or above depressive symptoms ( OR=0.29, 95% CI = 0.14-0.60) (both P <0.05). Conversely, the low-starting descending group had a higher probability of developing mild depressive symptoms ( OR=2.31, 95%CI =1.65-3.22) and moderate or above depressive symptoms ( OR=7.49, 95%CI = 3.82-14.69) (both P <0.05). Conclusion Declining trajectory of class belongingness is a risk factor for depressive symptoms, while sustained upward trend may mitigate such risks.

Objective To explore the differences in inflammatory cytokine levels between adolescent patients with unipolar and bipolar depressive disorders.Methods A total of 32 patients aged 15-24 years with major depressive disorder(unipolar group),53 patients with bipolar depressive episodes(bipolar group),and 25 healthy controls(control group)were enrolled.The 17-item Hamilton depression scale(HAMD-17),Hamilton anxiety scale(HAMA),and 32-item hypomania checklist(HCL-32)were used to assess the clinical symptoms of the patients.The levels of inflammatory cytokines in all samples were measured using the enzyme-linked immunosorbent assay(ELISA)method.Results Compared with the unipolar group,the bipolar group had an earlier age of onset,a longer total disease duration,a shorter current episode duration,lower HAMD scores,and higher HCL-32 scores,with significant differences(P<0.05).There were significant differences in the levels of interleukin-1β(IL-1β),IL-6,interferon-γ(INF-γ),tumor necrosis factor-α(TNF-α),tumor necrosis factor receptor 2(TNFR2),IL-4,IL-10,and IL-13 among the three groups of subjects(P<0.05).Pairwise comparison showed that compared with the control group,both unipolar and bipolar groups exhibited the significant elevations in pro-inflammatory cytokines IL-1β,IL-6,and TNF-α(all P<0.05)and remarkable reductions in the anti-inflammatory cytokines IL-4,IL-10,and IL-13(all P<0.05).The levels of INF-γ and TNFR2 were significantly higher in the bipolar group than in the control group(P<0.05).Compared with the unipolar group,the levels of INF-γ[43.25(29.27,53.63)pg/mL vs.62.76(39.27,89.16)pg/mL]and IL-13[16.92(14.74,24.02)pg/mL vs.22.29(17.35,36.52)pg/mL]were significantly increased in the bipolar group.Multivariate logistic regression analysis showed that IL-13(OR=1.078,95％CI:1.011-1.150,P=0.022)was independently associated with bipolar depressive disorder.Conclusion Adolescents with unipolar and bipolar depressive disorders exhibit changes in inflammatory cytokines,and the IL-13 and INF-γ are higher in bipolar depressive episodes than in major depressive disorder.Higher levels of IL-13 are associated with bipolar depressive disorder.

Objective:To analyze risk factors for early trauma-induced coagulopathy (TIC) in pediatric patients with moderate-to-severe traumatic brain injury (msTBI), develop a predictive model and evaluate its predictive performance.Methods:A retrospective cohort study was conducted to analyze the clinical data of 290 pediatric patients with msTBI who were admitted to Children′s Hospital of Soochow University between January 2016 and December 2024, including 188 boys and 102 girls, aged 0.2-15.7 years [5.2(2.8, 9.3)years]. Based on the coagulation test results at admission, the patients were divided into TIC group ( n=162) and non-TIC group ( n=128). The patients were randomly allocated into training set ( n=203) and validation set ( n=87) at a ratio of 7∶3. Demographic characteristics, clinical data, vital signs, imaging findings, arterial blood gas analysis results, and coagulation profiles of the patients were collected. Univariate analysis and Lasso regression analysis were used to identify risk factors associated with early TIC in children with msTBI and multivariate Logistic regression analysis was performed to determine independent risk factors and construct a predictive model. The model′s discrimination and calibration were evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), Hosmer-Lemeshow (H-L) test, and calibration curve. Its clinical utility was assessed through decision curve analysis (DCA). Results:Significant differences were observed between the TIC group and non-TIC group in terms of age, weight, time from injury to admission, child′s Glasgow coma scale (CGCS) score, pediatric trauma score (PTS), shock index, heart rate, respiratory rate, systolic blood pressure, Rotterdam CT score, intraventricular hemorrhage, cerebral contusion, brain herniation, long bone fracture, pelvic fracture, hemopneumothorax, pulmonary contusion, intra-abdominal organ injury, actual bicarbonate, base excess, base excess in the extracellular fluid, blood glucose, hemoglobin (Hb), osmolarity, blood calcium, anion gap, blood lactate, prothrombin time, activated partial thromboplastin time, international normalized ratio, and platelet count ( P<0.05). With coagulation-related variables excluded, the following features were identified with Lasso regression including CGCS score, PTS, heart rate, systolic blood pressure, long bone fracture, blood glucose, and Hb. Multivariate Logistic regression analysis revealed that CGCS score≤8 points ( OR=3.05, 95% CI 1.65, 5.63), PTS>5 points ( OR=0.45, 95% CI 0.23, 0.89), systolic blood pressure ( OR=0.98, 95% CI 0.97, 0.99), blood glucose ( OR=1.09, 95% CI 1.01, 1.17), and long bone fracture ( OR=2.47, 95% CI 1.13, 5.42) were influencing factors for early TIC in children with msTBI ( P<0.05). The regression equation of the predictive model was established as follows: Logit[ P/(1- P)]=1.01×"CGCS score≤8 points"-0.69×"PTS>5 points"- 0.02×"systolic blood pressure"+0.89×"long bone fracture"+0.08×"blood glucose"+1.32. The ROC curve analysis showed that the training set had an AUC of 0.86 (95% CI 0.78, 0.94), with sensitivity and specificity of 76.6% and 92.5%, while the AUC was 0.80 (95% CI 0.74, 0.86), with sensitivity and specificity of 75.7% and 79.6% in the validation set. H-L test results showed a χ2 value of 8.18 ( P=0.416) in the training set and 5.30 ( P=0.216) in the validation set. The calibration curves for both sets demonstrated good agreement with the actual curves, indicating that the predicted probabilities closely matched the observed probabilities. The DCA results indicated that both the training set and validation set demonstrated positive net benefits within threshold probabilities ranges of 10%-100% and 15%-96%. Conclusions:Independent risk factors for early TIC in pediatric msTBI patients include CGCS score≤ 8 points, PTS≤5 points, low systolic blood pressure, long bone fracture, and high blood glucose. The predictive model constructed based on these factors demonstrates favorable predictive performance and clinical application value.

Objective To explore the differences in inflammatory cytokine levels between adolescent patients with unipolar and bipolar depressive disorders.Methods A total of 32 patients aged 15-24 years with major depressive disorder(unipolar group),53 patients with bipolar depressive episodes(bipolar group),and 25 healthy controls(control group)were enrolled.The 17-item Hamilton depression scale(HAMD-17),Hamilton anxiety scale(HAMA),and 32-item hypomania checklist(HCL-32)were used to assess the clinical symptoms of the patients.The levels of inflammatory cytokines in all samples were measured using the enzyme-linked immunosorbent assay(ELISA)method.Results Compared with the unipolar group,the bipolar group had an earlier age of onset,a longer total disease duration,a shorter current episode duration,lower HAMD scores,and higher HCL-32 scores,with significant differences(P<0.05).There were significant differences in the levels of interleukin-1β(IL-1β),IL-6,interferon-γ(INF-γ),tumor necrosis factor-α(TNF-α),tumor necrosis factor receptor 2(TNFR2),IL-4,IL-10,and IL-13 among the three groups of subjects(P<0.05).Pairwise comparison showed that compared with the control group,both unipolar and bipolar groups exhibited the significant elevations in pro-inflammatory cytokines IL-1β,IL-6,and TNF-α(all P<0.05)and remarkable reductions in the anti-inflammatory cytokines IL-4,IL-10,and IL-13(all P<0.05).The levels of INF-γ and TNFR2 were significantly higher in the bipolar group than in the control group(P<0.05).Compared with the unipolar group,the levels of INF-γ[43.25(29.27,53.63)pg/mL vs.62.76(39.27,89.16)pg/mL]and IL-13[16.92(14.74,24.02)pg/mL vs.22.29(17.35,36.52)pg/mL]were significantly increased in the bipolar group.Multivariate logistic regression analysis showed that IL-13(OR=1.078,95％CI:1.011-1.150,P=0.022)was independently associated with bipolar depressive disorder.Conclusion Adolescents with unipolar and bipolar depressive disorders exhibit changes in inflammatory cytokines,and the IL-13 and INF-γ are higher in bipolar depressive episodes than in major depressive disorder.Higher levels of IL-13 are associated with bipolar depressive disorder.

Objective:To evaluate the diagnostic value of micro flow imaging (MFI) supported by Image Pro Plus (IPP) software for BI-RADS classification of breast nodules and the correlation between its parameters and Ki-67 expression level.Methods:A total of 205 cases of breast solid nodules with ultrasound BI-RADS classification of 4 categories were enrolled in this study. BI-RADS classification, CDFI score, MFI score, CDFI-IPP score and MFI-IPP score by IPP software were performed for each nodule. Ki-67 immunohistochemical staining of invasive ductal carcinoma was performed to analyze the correlation between MFI-IPP-VI and Ki-67 expression levels.Results:The combined BI-RADS classification for diagnosis of malignant nodules had the largest area under the ROC curve, which was significantly higher than that of BI-RADS, MFI-IPP-VI, MFI score, CDFI-IPP-VI, and CDFI score (all P<0.05). The combined BI-RADS classification had the best diagnostic efficacy for the diagnosis of malignant nodules with a sensitivity of 96.4%, specificity of 65.6% and accuracy of 82.4%. In addition, the agreement between experienced and inexperienced sonographers applying MFI-IPP-VI was higher than MFI (Kappa=0.780 vs. Kappa=0.743). The mean value of Ki-67 in invasive ductal carcinoma was 21.93%±16.37%, and Spearman's correlation analysis showed a positive correlation between MFI-IPP-VI and Ki-67 expression level ( r=0.815, P<0.05). Conclusions:MFI-IPP can assist sonographers to classify breast nodules by BI-RADS, providing an effective basis for puncture biopsy. MFI-IPP-VI offers the possibility of noninvasively predicting the expression level of Ki-67 in invasive ductal carcinoma.

Objective:To explore and verify the value of neoadjuvant rectal (NAR) score in predicting the prognosis of patients with middle and low locally advanced rectal cancer.Methods:A retrospective analysis of 207 patients with middle and low locally advanced rectal adenocarcinoma who received neoadjuvant radiotherapy and chemotherapy in Tianjin Medical University Cancer Institute & Hospital from January 2015 to December 2021 was performed. The neoadjuvant radiotherapy regimen was pelvic external irradiation of 45-50.4 Gy, 1.8 Gy/f, 5 times per week and concurrent oral capecitabine chemotherapy on days 1-14 and 22-36 during radiotherapy. Total mesorectal excision (TME) was then performed. The NAR score was calculated based on the initial clinical stage and postoperative pathological stage, and divided into the low (<8), medium (8-16) and high (>16) layers, respectively. The 3-year disease-free survival (DFS) and overall survival (OS) were calculated using the Kaplan-Meier method, and the differences in DFS and OS among different NAR score layers were compared using the log-rank test. Some patients received consolidation chemotherapy during the interval between concurrent radiotherapy-chemotherapy and surgery, even the total neoadjuvant therapy (TNT) model. Subgroup analysis was further used to verify the predictive value of the NAR score in the strengthened neoadjuvant therapy model.Results:The median follow-up of all patients was 46.0 months (range: 19.5-88.0 months), the 3-year DFS was 79.2%, and the 3-year OS was 87.4%. Univariate analysis found that the NAR score had a significant impact on the 3-year DFS and OS. The 3-year DFS of patients with low, medium, and high NAR scores were 90.3%, 86.1% and 58.7% ( P<0.001), and the 3-year OS were 94.4%, 91.7% and 74.6%, ( P<0.001), respectively. Subgroup analysis showed that the predictive value of the NAR score also applied to the strengthened neoadjuvant therapy model. The 3-year DFS of patients with low, medium, and high NAR scores were 86.9%, 83.8% and 68.3% ( P=0.044), and the 3-year OS were 92.9%, 90.7% and 85.4% ( P=0.029), respectively. Conclusion:The NAR score can effectively predict the prognosis of patients with middle and low locally advanced rectal adenocarcinoma, whether using neoadjuvant therapy or strengthened neoadjuvant therapy followed by TME surgery.

Objective: To analyze the current status and hotspots of the construction of healthy cities, so as to provide the reference for promoting healthy city construction. Methods: Retrieve relevant articles on the construction of healthy cities from CNKI and Web of Science databases until December 2024. Count the number of publications, countries/regions of publication, and research institutions. Keyword co-occurrence maps were drawn by using CiteSpace 6.3.R1 software, and combined cluster analysis to summarize the main research hotspot themes. Results: A total of 1 120 articles were retrieved. Among them, there were 670 English articles, with the first one published in 2006, and the peak number (109 articles) of publications was reached in 2021. There were 426 Chinese articles, with the first one published in 1996, and the peak number (62 articles) of publications was reached in 2020. The overall number of publications showed an upward trend. Among the English articles, China, the United States, and the United Kingdom ranked the top three in terms of the number of publications, with 171, 97, and 80 articles, respectively. Wuhan University, the University of Hong Kong, and Peking University were the top three core institutions, with 18, 17, and 14 articles, respectively. High-frequency keywords included "healthy cities", "physical activity", "healthy city", "city", "built environment", "health", and "public health". The main research hotspot themes encompassed four aspects: mental health and the built environment, public health policies, climate change and urban sustainability, and the multidimensional complex relationships of health determinants. Among the Chinese articles, China had the highest number of publications, with 422 articles (99.06%). Tongji University, Tsinghua University, and Nanjing University were the top three core institutions, with 30, 11, and 8 articles, respectively. High-frequency keywords were "healthy cities", "urban planning", "public health", "built environment", "indicator system", and "influencing factors". The main research hotspot themes included three aspects: urban planning and spatial layout, the comprehensive practice and policy framework of healthy city construction, and the interaction between health activities and the built environment. Conclusions The number of publications on the construction of healthy cities has increased, and both Chinese and English articles focus on public health and the built environment. Construction of healthy cities has interdisciplinary characteristics.

Objective To evaluate the application value of fascial platform versus commercial platform in transumbilical single-port laparoscopic transabdominal preperitoneal repair(TAPP)for inguinal hernia.Methods One hundred patients with inguinal hernia admitted between January and December 2024 were prospectively enrolled and randomly assigned to either the fascial platform group(n=50)or the commercial platform group(n=50)by using a random number table.The following parameters were compared between the two groups:platform establishment time,operative time,intraoperative blood loss,incision suture time,operative difficulty score,camera manipulation difficulty score,postoperative 24-hour Visual Analogue Scale(VAS)score of pain,postoperative hospital stay,total hospitalization cost,comprehensive satisfaction score,and postoperative complications.Results The fascial platform group demonstrated significantly superior outcomes compared to the commercial platform group in platform establishment time[(3.4±1.0)min vs.(8.1±1.5)min,t=-18.389,P＜0.001],operative time[(67.5±7.9)min vs.(72.2±11.5)min,t=-2.380,P=0.019],intraoperative blood loss[(8.3±4.3)ml vs.(11.1±5.7)ml,t=-2.798,P=0.006],incision suture time[(7.0±1.4)min vs.(11.8±2.7)min,t=-11.212,P＜0.001],operative difficulty score(14.4±3.6 vs.23.1±4.1,t=-11.215,P＜0.001),camera manipulation difficulty score(11.4±2.6 vs.18.3±2.5,t=-13.370,P＜0.001),VAS score of postoperative 24-hour pain(2.4±1.0 vs.3.7±1.1,t=-6.139,P＜0.001),total hospitalization cost[(15.8±1.6)thousand yuan vs.(18.3±1.6)thousand yuan,t=-7.841,P＜0.001],and comprehensive satisfaction score(7.3±1.1 vs.6.3±1.0,t=5.271,P＜0.001).However,there were no statistically significant differences in postoperative hospital stay or postoperative complication between the two groups(P＞0.05).All the patients were followed up for 1-12 months postoperatively[(5.3±1.8)months vs.(5.7±2.0)months,t=-0.945,P=0.347],with no recurrence observed in either group.Conclusions Both fascial platform and commercial platform can be used for transumbilical single-port TAPP.The fascial platform offers advantages including shorter platform establishment time,reduced incision suture time,lower operative and camera manipulation difficulty,decreased cost,less postoperative pain,and higher patient satisfaction.