Objective: To explore the influencing factors of anxiety symptoms and to construct a predictive model based on machine learning algorithms, so as to provide support for the prevention and management of anxiety symptoms among junior high school students. Methods: From April to May 2023, a stratified random cluster sampling method was adopted to select 8 176 junior high school students from Zhengzhou and Shangqiu citys. All participants completed the Adolescent Self rating Life Events Checklist, the 10item Connor-Davidson Resilience Scale, the School Connectedness Scale, the Parent-Child Cohesion Questionnaire, and the 7 item Generalized Anxiety Disorder Scale. Logistic regression analysis identified the associated factors of anxiety symptoms among junior high school students. Predictive models were constructed using Logistic regression, Random Forest, and eXtreme Gradient Boosting (XGBoost) algorithms, with SHapley Additive exPlanations analysis explaining the optimal model. Results: The detection rate of anxiety symptoms among junior high school students was 16.3%. Logistic regression analysis showed that junior high school students who were female ( OR =1.22), in the ninth grade ( OR =1.27), living in urban areas ( OR =1.37), having a father with a college education or above ( OR =1.26), having a mother with a senior high school education ( OR =1.26), and experiencing higher levels of negative life events ( OR =1.05) reported a higher risk of anxiety symptoms(all P <0.05). In contrast, those with moderate family economic status ( OR =0.71), moderate academic burden ( OR =0.59), low academic burden ( OR =0.54), moderate sleep quality ( OR =0.46), good sleep quality ( OR =0.26), excellent sleep quality ( OR =0.15), higher levels of psychological resilience ( OR =0.96), higher levels of school connectedness ( OR =0.96), and higher levels of parent-child cohesion ( OR =0.98) reported a lower risk of anxiety symptoms (all P <0.05). Three machine learning models demonstrated good predictive performance for anxiety symptoms among junior high school students (all AUC>0.8), with the XGBoost model achieving the best predictive performance. SHAP analysis revealed that negative life events, sleep quality, school connectedness, psychological resilience and parent-child cohesion were the top five relevant factors for predicting anxiety symptoms. Conclusions The detection rate of anxiety symptoms among junior high school students is relatively high. The XGBoost model is the optimal predictive model for anxiety symptoms in the population. Negative life events, sleep quality, school connectedness, psychological resilience, and parent-child cohesion are significant correlates of anxiety symptoms among junior high school students.

Osteonecrosis of femoral head （ONFH） is a disease that causes osteocyte death due to interruption of blood supply of the femoral head， which may cause symptoms such as joint movement disorders， pain， and even femoral head collapse. Currently， the commonly used methods for treating ONFH in clinical practice are accompanied by problems such as long-term side effects， inaccurate efficacy， technical limitations， and complication risks. Traditional Chinese medicine （TCM） has shown unique advantages of holistic regulation， mild side effects， and symptom alleviation. A review of the related literature shows that Salviae Miltiorrhizae Radix et Rhizoma， as a representative Chinese herbal medicine for activating blood and resolving stasis， has the effects of activating blood， resolving stasis， dredging meridians， and relieving pain. Its active ingredients （such as salvianolic acid B， tanshinone Ⅱ_A， and tanshinone Ⅰ） interfere with bone metabolism balance， osteogenesis and differentiation， and improve bone microcirculation and bone microstructure. Salviae Miltiorrhizae Radix et Rhizoma is often combined with the herbal medicines with the effects of tonifying the liver and spleen or activing blood to form herb pairs （such as Salviae Miltiorrhizae Radix et Rhizoma-Angelicae Sinensis Radix， Salviae Miltiorrhizae Radix et Rhizoma-Chuanxiong Rhizoma， and Salviae Miltiorrhizae Radix et Rhizoma-Drynariae Rhizoma）， which enhances the efficacy through synergistic effects. In the application of TCM compound formulas， Bushen Huoxue prescription， Bushen Huoxue capsules， Gubi Tongxiao granules， and Shenggu Zaizao pills can regulate signaling pathways such as Wnt/β-catenin， Hedgehog， Notch， transforming growth factor（TGF）-β₁/Smads， and mitogen-activated protein kinase （MAPK） through multiple targets to significantly improve bone metabolism and hip joint function， playing an important role in preventing and treating ONFH. Through a review of available studies， this paper systematically explains the outstanding advantages of the active ingredients， herb pairs， and compound formulas of Salviae miltiorrhizae Radix et Rhizoma in the prevention and treatment of ONFH. The mechanisms may be related to factors such as promoting osteoblast generation and inhibiting osteoclast formation， increasing osteogenic differentiation， promoting angiogenesis， increasing bone density， inhibiting inflammatory response， and regulating signaling pathways. In the future， modern technology can be employed to optimize dosage forms， and high-quality clinical research should be conducted to further clarify its mechanism of action and promote the precise application of TCM. This review aims to provide more thinking directions for the application of Salviae miltiorrhizae Radix et Rhizoma in preventing and treating ONFH.

The incidence of chronic venous disease(CVD)is significantly higher in the elderly population compared to non-elderly individuals,with more severe disease manifestations.Additionally,elderly CVD patients often have comorbid conditions such as cardiovascular diseases,making the evaluation process more complex and increasing treatment difficulty.Currently,there are no established recommendations in China for the diagnosis and treatment of CVD in individuals aged 60 and above.Against this backdrop,the Peripheral Vascular Disease Management Branch of the Chinese Geriatric Society has developed the Chinese Expert Consensus on the Diagnosis and Treatment of Chronic Venous Disease in the Elderly based on domestic and international guidelines,relevant evidence-based medical research,and the physiological and clinical characteristics of the elderly population in China.This consensus aims to provide an important reference for improving the diagnosis and treatment of CVD in elderly patients in China.

Tooth preparation, as an irreversible surgical procedure, critically determines the long-term efficacy of dental restorations. Traditional preparation techniques, heavily reliant on operators′ unaided visual estimation and empirical skills, suffer from inherent subjectivity and the inability to quantitatively verify preparation dimensions. These limitations render them inadequate to meet the sub-100-micron linear precision required for contemporary minimally invasive and esthetic restorations, which often feature maximum preparation depths below 1 mm. Emerging digital solutions, such as depth-specific preparation guides based on target restorative space analysis, have achieved reported preparation accuracies of approximately 50 μm by integrating arithmetic calculations and real-time verification of preparation depth as the pivotal geometric parameter. Further advancements, including real-time intraoral scanning-based preparation monitoring systems, are now being applied to ultra-thin and extreme-thin veneer restorations, offering a more precise and efficient paradigm for depth control. To comprehensively evaluate the efficacy of current digital tooth preparation protocols, this article systematically compares digital guidance technologies with conventional methods across three dimensions: time efficiency, economic cost, and clinical efficacy. It critically examines the synergistic use of visual magnification tools, emphasizing the necessity of concurrently addressing" visual clarity" and "enhancement of manual skill stability and precision". Notably, the target restorative space (TRS)-guided digital preparation technique under dental microscopy employs preparation depth as the master geometric parameter throughout multi-stage workflows. By combining microscopic visualization with rigid depth-specific guides, this method enables real-time verification of preparation depth, achieving unprecedented intraoperative precision. The integration of next-generation non-contact high-precision intraoral scanning systems further elevates accuracy from the sub-100-micron level to a tens-of-microns precision scale, paving the way for ultra-precise tooth preparation. These innovations in digital guidance systems not only redefine clinical standards but also herald the evolution of "digitally guided prosthodontics"as a transformative frontier in restorative dentistry.

Objective::This study aimed to assess the impact of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor treatment immediately after percutaneous coronary intervention (PCI) on the myocardial salvage index (MSI) in patients with anterior ST-segment elevation myocardial infarction (STEMI) 5-10 d after the procedure.Methods::The early PCSK9 inhibitor thERapy Following pErcutaneous Coronary inTervention (PERFECT) trial is a prospective randomized controlled trial. From January 2021 to December 2023, 32 patients with anterior STEMI from Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, and Shanghai Tenth People’s Hospital were enrolled in the PERFECT trial. Patients were randomly assigned in a 1∶1 ratio to the PCSK9 inhibitor group ( n = 16) or the control group ( n = 16), and their baseline data were collected. Patients in the PCSK9 inhibitor group (ie, alirocumab group) received a subcutaneous injection of PCSK9 inhibitor (alirocumab, 75 mg) immediately after PCI based on conventional treatment. In the control group, patients received only conventional treatment. The primary endpoint was the MSI measured by cardiovascular magnetic resonance 5-10 d after PCI. The secondary endpoints included the left ventricular ejection fraction measured by cardiovascular magnetic resonance 5-10 d after PCI and the time to peak of creatine kinase isoenzyme-MB and high-sensitivity cardiac troponin T. Safety endpoints included any clinical adverse events that occurred during the 6-month follow-up period. Results::Baseline data during admission showed no intergroup significance. No significant difference in MSI (55.54% ± 14.80% vs. 44.72% ± 15.42%, P = 0.056) and left ventricular ejection fraction (51.24% ± 8.91% vs. 44.99% ± 8.84%, P = 0.060) was observed. Additional, there was no significant difference in the time to peak of creatine kinase isoenzyme-MB ((12.97 ± 5.67) h vs. (14.31 ± 7.04) h, P = 0.557) and high-sensitivity cardiac troponin T ((21.03 ± 12.46) h vs. (21.44 ± 9.99) h, P = 0.920) between the 2 groups. During the 6-month follow-up period, only 1 patient in the PCSK9 inhibitor group developed cerebral hemorrhage 6 months after PCI. Conclusions::Early treatment with alirocumab did not exhibit a significant increase in MSI at 5-10 d in patients with anterior STEMI. Larger trials are necessary to evaluate the impact of early administration of PCSK9 inhibitors after myocardial infarction.

OBJECTIVE To analyze the clinical characteristics of Brucellar spondylitis(BS)and provide references for clinical diagnosis and treatment.METHODS A retrospective analysis was conducted on the data of 123 patients with BS admitted to the Second Affiliated Hospital of Inner Mongolia Medical University from Jan.1,2015 to Jun.30,2024.The data included demographic characteristics,epidemiological history,clinical manifestations,la-boratory indicators,imaging features and treatment regimens.The clinical characteristics of BS were summarized.RESULTS Among the 123 patients with BS,there were 96 males and 27 females,with an average age of(59.19±11.71)years.The patients were predominantly farmers(74.80％),and 65.04％reported a history of livestock contact.All patients presented with local vertebral pain,mainly involving the lumbar region(56.10％),accompanied by systemic symptoms such as fever(34.96％)and fatigue(95.12％).Laboratory tests showed an abnormal plateletocrit rate of 93.50％,an abnormal C-reactive protein rate of 87.80％and an abnormal erythro-cyte sedimentation rate of 82.11％.Etiological examinations revealed a positive bacterial culture rate of 73.17％,with positive rates of 92.06％and 95.24％for the Rose Bengal plate agglutination test and tube agglutination test,respectively,and a total positive rate of 95.45％for enzyme-linked immunosorbent assay.Imaging examina-tions found a total of 308 involved vertebrae,with an average of(2.50±1.06)vertebrae involved per patient.Lumbar vertebra involvement was the highest(82.11％)and 42.28％of patients had paravertebral abscesses.In terms of treatment,45.53％of patients received comprehensive treatment with medication and surgery,and 91.06％achieved good outcomes.CONCLUSIONS Patients in high-incidence areas of brucellosis may not have a clear history of livestock contact,and atypical cases should be kept vigilant.Blood routine tests,CRP and ESR of-ten show abnormal manifestations in patients with BS.Lymphocyte count,platelet-to-lymphocyte ratio and mono-cyte-to-lymphocyte ratio have certain reference values in assessing the extent of spinal involvement in patients.

Objective To explore the functional connectivity(FC)changes of hippocampus and amygdala in type 2 diabetes mellitus(T2DM)patients with erectile dysfunction(DMED),and the central pathological neural mechanisms underlying DMED.Methods 61 T2DM patients who visited Department of Endocrinology,Nanjing First Hospital,Nanjing Medical University from January 2020 to December 2021 were selected and divided into a simple T2DM group(n=30)and a combined DMED group(n=31).Another 47 healthy individuals were selected as control group(NC).The international erectile function scale(IIEF-5)was used to evaluate the erectile function.Resting-state functional magnetic resonance imaging(rs-fMRI)data were acquired from all participants.MRI data were preprocessed by the DPABI software package.Bilateral hippocampus and amygdala were selected as regions of interest(ROI)and the whole brain FC values were calculated.The FC values of brain regions between groups were tested by two-sample t-test with REST software package.Results Left hippocampus as ROI:compared with the NC group,FC values of the left superior temporal gyrus increased in the T2DM group,FC values of the left superior frontal gyrus,left inferior temporal gyrus,left posterior central gyrus and rectus gyrus decreased in the DMED group.Compared with the T2DM group,FC values of the left inferior parietal gyrus,left supramarginal gyrus,left middle occipital gyrus and right posterior central gyrus decreased in the DMED group.Right hippocampus as ROI:compared with the NC group,FC values of the right middle temporal gyrus and right rolandic operculum increased while FC values of the right calcarine fissure decreased in the T2DM group;FC values of bilateral anterior cingulate gyrus,right middle temporal gyrus and left rectus gyrus decreased in the DMED group.Compared with the T2DM group,FC values of the left middle frontal gyrus,left inferior parietal gyrus and right inferior temporal gyrus decreased in the DMED group.Left amygdala as ROI:compared with the NC group,FC values in the left parahippocampal gyrus,left fusiform gyrus and right insula increased in the T2DM group;FC value of the left middle temporal gyrus decreased in the DMED group.Compared with the T2DM group,FC values of the left middle frontal gyrus and left supramarginal gyrus decreased in the DMED group.Right amygdala as ROI:compared with the NC group,FC values of the left insula,right parahippocampal gyrus,right superior temporal gyrus and right supramarginal gyrus increased while FC values in the right caudate decreased in the T2DM group;FC values of the right middle frontal gyrus,left rectus gyrus and left middle occipital gyrus decreased in the DMED group.Compared with the T2DM group,FC values of the left middle frontal gyrus and left inferior parietal gyrus decreased in the DMED group.Conclusions DMED patients have abnormalities in the hippocampus,amygdala and other brain regions,especially the frontal lobe functional cortex,which may be related to changes in their brain function.

Objective To investigate the impact of eccentric placement for various types of artificial aortic valves on downstream flow dynamics.Methods A physiological pulsatile circulation simulation system was employed and particle image velocimetry(PIV)was utilized to analyze the downstream flow field variations for bioprosthetic and mechanical valves under two placement conditions:centralized placement(0 mm)and eccentric placement(1 mm).Hemodynamic parameters such as velocity,vorticity,and viscous shear stress were assessed to evaluate the flow field characteristics.Results By analyzing the flow field variations at four characteristic time points,namely,early systole,acceleration phase,peak systole,and deceleration phase,a significant difference in flow field distribution between bioprosthetic and mechanical valves was observed.The bioprosthetic valve exhibited a centrally symmetric jet with a higher flow velocity,whereas the mechanical valve displayed a three-jet structure with a lower central flow velocity.Under eccentric placement,the blood flow in the aortic sinus region was sluggish,with a reduction in average velocity,hindering the formation and maintenance of vortices.During the peak systolic phase,the maximum viscous shear stresses in the sinus region for the bioprosthetic and mechanical valves were 0.45 and 0.67 Pa,respectively,approaching the threshold for endothelial cell damage.Conclusions Eccentric placement of both mechanical and bioprosthetic valves resulted in reduced sinus blood flow velocity and diminished viscous shear stress,creating favorable conditions for thrombus formation.In clinical practice,careful attention should be given to the placement of valve replacement to prevent eccentric placement.

OBJECTIVE To analyze the clinical characteristics of Brucellar spondylitis(BS)and provide references for clinical diagnosis and treatment.METHODS A retrospective analysis was conducted on the data of 123 patients with BS admitted to the Second Affiliated Hospital of Inner Mongolia Medical University from Jan.1,2015 to Jun.30,2024.The data included demographic characteristics,epidemiological history,clinical manifestations,la-boratory indicators,imaging features and treatment regimens.The clinical characteristics of BS were summarized.RESULTS Among the 123 patients with BS,there were 96 males and 27 females,with an average age of(59.19±11.71)years.The patients were predominantly farmers(74.80％),and 65.04％reported a history of livestock contact.All patients presented with local vertebral pain,mainly involving the lumbar region(56.10％),accompanied by systemic symptoms such as fever(34.96％)and fatigue(95.12％).Laboratory tests showed an abnormal plateletocrit rate of 93.50％,an abnormal C-reactive protein rate of 87.80％and an abnormal erythro-cyte sedimentation rate of 82.11％.Etiological examinations revealed a positive bacterial culture rate of 73.17％,with positive rates of 92.06％and 95.24％for the Rose Bengal plate agglutination test and tube agglutination test,respectively,and a total positive rate of 95.45％for enzyme-linked immunosorbent assay.Imaging examina-tions found a total of 308 involved vertebrae,with an average of(2.50±1.06)vertebrae involved per patient.Lumbar vertebra involvement was the highest(82.11％)and 42.28％of patients had paravertebral abscesses.In terms of treatment,45.53％of patients received comprehensive treatment with medication and surgery,and 91.06％achieved good outcomes.CONCLUSIONS Patients in high-incidence areas of brucellosis may not have a clear history of livestock contact,and atypical cases should be kept vigilant.Blood routine tests,CRP and ESR of-ten show abnormal manifestations in patients with BS.Lymphocyte count,platelet-to-lymphocyte ratio and mono-cyte-to-lymphocyte ratio have certain reference values in assessing the extent of spinal involvement in patients.

Digital technologies have become an integral part of complete denture restoration. With advancement in computer-aided design and computer-aided manufacturing (CAD/CAM), tools such as intraoral scanning, facial scanning, 3D printing, and numerical control machining are reshaping the workflow of complete denture restoration. Unlike conventional methods that rely heavily on clinical experience and manual techniques, digital technologies offer greater precision, predictability, and efficacy. They also streamline the process by reducing the number of patient visits and improving overall comfort. Despite these improvements, the clinical application of digital complete denture restoration still faces challenges that require further standardization. The major issues include appropriate case selection, establishing consistent digital workflows, and evaluating long-term outcomes. To address these challenges and provide clinical guidance for practitioners, this expert consensus outlines the principles, advantages, and limitations of digital complete denture technology. The aim of this review was to offer practical recommendations on indications, clinical procedures and precautions, evaluation metrics, and outcome assessment to support digital restoration of complete denture in clinical practice.
Humans ; Denture, Complete ; Computer-Aided Design ; Denture Design/methods* ; Consensus ; Printing, Three-Dimensional