BackgroundAnxiety exhibits a rising prevalence among college students. Investigating the mechanisms through which family function relates to anxiety and examining the moderating role of emotion regulation strategies within this context hold substantial implications for promoting mental health among college students. However， existing research has not sufficiently elucidated the complex interplay among family function， emotion regulation， and anxiety among college students. Further research is warranted to clarify the underlying mechanisms linking family function to anxiety outcomes and to examine the potential moderating role of emotion regulation strategies in this causal pathway. ObjectiveTo explore the relationship between family function and anxiety among lower-grade college students， and to validate the moderating role of emotion regulation strategies in this relationship， thereby offering evidence-based insights for anxiety reduction interventions in this population. MethodsIn March 2023， a total of 1 980 first- and second-year students from a comprehensive university in Shanghai were selected using the cluster sampling method. A self-designed demographic questionnaire， the Emotion Regulation Questionnaire （ERQ）， the Family Adaptability and Cohesion Evaluation Scale Ⅱ-Chinese Version （FACES Ⅱ-CV）， and the Symptom Checklist-90 （SCL-90） were utilized for assessment. Pearson correlation analysis and Spearman correlation analysis were employed to test the correlations of each variable. Hierarchical linear regression analysis was conducted to certify the moderating role of emotion regulation strategies in the relationship between family function and anxiety. ResultsCompared with female students， male students scored significantly lower on ERQ cognitive reappraisal （t=-5.793， P<0.01） but significantly higher on ERQ expressive suppression （t=8.359， P<0.01）. For lower-grade college students， scores on adaptability and cohesion subscales of FACES Ⅱ-CV showed a positive association with cognitive reappraisal in ERQ （r=0.251， 0.302， P<0.01）， while simultaneously displaying negative correlations with both expressive suppression in ERQ （r=-0.113， -0.154， P<0.01） and anxiety in SCL-90 （r=-0.243， -0.202， P<0.01）. Notably， anxiety scores in SCL-90 were inversely related to cognitive reappraisal scores in ERQ （r=-0.159， P<0.01） but directly associated with expressive suppression scores in ERQ （r=0.171， P<0.01）. Hierarchical regression analysis indicated that cognitive reappraisal significantly moderated the relationship between family cohesion and anxiety （β=-0.421， P<0.01）. ConclusionThe cognitive reappraisal strategy serves as a moderator in the relationship between family cohesion and anxiety， potentially mitigating the escalation of anxiety levels associated with family dysfunction. ［Funded by Science and Technology Development Fund of Shanghai Pudong New Area （number， PKJ2023-Y21）］

Objective:To assess the viability of reducing radiation dose, contrast media volume, injection flow rate and contrast medium concentration (quadruple low-dose protocol) by utilizing virtual monoenergetic images (VMI) in photon-counting detector CT (PCD-CT) for aortic CT angiography (CTA), while maintaining image quality in comparison to images obtained from energy-integrating detector CT (EID-CT).Methods:From April 2024 to June 2024, a total of 40 participants who underwent aortic CTA on PCD-CT were prospectively enrolled in the experimental group (PCD-CT group), while 40 patients with similar baseline characteristics who had previously undergone aortic CTA using EID-CT were retrospectively selected for the conventional group (EID-CT group). The EID-CT group used a tube voltage of 90 kVp, a contrast media volume of 60 ml of contrast, an injection flow rate of 3 ml/s, and a contrast concentration of 350 mgI/ml; the PCD-CT group used the QuantumPlus mode, with a tube voltage of 140 kVp, a total amount of iodine in the contrast media of 140 mgI/kg, and an injection flow rate=contrast media volume/(delay time+scan time), and a contrast media concentration of 320 mgI/ml. VMIs in PCD-CT group were reconstructed in 5-keV intervals ranging from 45 to 65 keV. The effective radiation dose and contrast injection protocols were recorded and compared between two groups. Objective image quality assessment was performed for each group. CT attenuation, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured at five anatomical locations (ascending aorta, aortic arch, descending aorta, abdominal aorta, and right common iliac artery), and image noise was recorded. Subjective image quality was independently evaluated by two readers using a 5-point Likert scale in a blinded manner. Based on data normality, the one-way ANOVA or Kruskal-Wallis test was used for image quality assessment, with Bonferroni-corrected post-hoc analysis for multiple comparisons.Results:There were no significant differences in the baseline characteristics between two groups (all P0.05). The PCD-CT group demonstrated significantly lower effective radiation dose [(3.88±0.65) mSv vs. (5.97±1.15)mSv], contrast media volume [(29.25±4.56) ml vs. 60 ml], and injection rate [(2.65±0.42) ml/s vs. 3 ml/s] than the EID-CT group, with reductions of 35%, 51%, and 12%, respectively (all P0.001). For objective image quality, except for the ascending aortic CT attenuation, the CT attenuation, SNR, and CNR of other vessels in the 55 keV PCD-CT group were comparable to those in the EID-CT group. Additionally, the difference in image noise between these two groups was not statistically significant ( P0.05). Concerning subjective image quality, at 55 keV, the PCD-CT group had similar image noise scores and vessel attenuation scores (both P0.05) and better visualization of renal artery branching ( P=0.001) compared to the EID-CT group. Conclusion:In comparison to EID-CT, the use of a 55 keV image in PCD-CT for aortic CTA has demonstrated reductions in radiation dose, contrast media volume, injection flow rate and contrast medium concentration, while maintaining image quality.

Objective:To evaluate the feasibility of head and neck vascular imaging using photon-counting detector computed tomography (PCD-CT) combined with a “quadruple lows” protocol—characterized by low contrast media volume, low iodine concentration, low injection rate, and low radiation dose—and to compare the image quality with that obtained by energy-integrating detector CT (EID-CT).Methods:A total of 105 patients with suspected cerebrovascular disease were prospectively enrolled at the First Affiliated Hospital of Zhengzhou University between April and June 2024. Patients were randomly assigned to three groups ( n=35). Group A underwent conventional head and neck CTA using EID-CT. Group B underwent PCD-CT with a protocol involving ultra-low contrast media volume, low iodine concentration, and low injection rate. Group C underwent PCD-CT with the full “quadruple low” protocol. Objective image quality parameters—including CT attenuation, image noise (standard deviation, SD), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR)—were measured at the ascending aorta, common carotid artery, internal carotid artery, vertebral artery, basilar artery, posterior cerebral artery, and middle cerebral artery. Two radiologists independently rated subjective image quality using a 5-point Likert scale. Differences among groups were analyzed using one-way ANOVA and the Kruskal-Wallis test. Results:Compared to Group A [contrast volume: (42.78±6.64)ml], contrast agent volume was significantly reduced in Groups B and C[ (26.26±4.45) ml and (26.54±3.83)ml, respectively], demonstrating reductions of 39% and 38% (both P<0.01). The iodine concentration was 320 mg/ml in Groups B and C, lower than 350 mg/ml in Group A (8.5%). The injection rate was also reduced in Groups B and C [(3.39±0.61) and (3.55±0.51)ml/s, respectively] compared to Group A [(4.28±0.66) ml/s], with reductions of 21% and 17% (both P<0.01). The effective dose (ED) was similar between Groups A and B [(1.40±0.15) vs. (1.40±0.19)mSv, P>0.05], while Group C demonstrated a significantly lower ED [(0.99±0.09) mSv], with a reduction of 30% compared to Group A and 29% compared to Group B (both P<0.01).In terms of objective image quality, significant differences in image noise (SD) were observed among the three groups at the vertebral artery, internal carotid artery, posterior cerebral artery, and middle cerebral artery (all P<0.05). Groups B and C showed significantly lower SD compared to Group A ( P<0.05), with no significant difference between B and C ( P>0.05). SNR was significantly higher in Groups B and C than in Group A at multiple vascular segments (all P<0.05). CNR differed only at the internal carotid artery, where Groups B and C demonstrated superior performance compared to Group A ( P<0.05).Subjective image quality scores showed no significant difference between Groups A and C ( P>0.05), while Group B had significantly higher scores than both A and C ( P<0.05). All images were deemed diagnostically acceptable. Conclusion:Compared with conventional EID-CT, PCD-CT combined with a “quadruple lows” protocol enables substantial reductions in contrast media and radiation dose while further improving image quality in head and neck CTA.

Objective To compare the early clinical efficacy of arthroscopic bridge suture combined with strengthening thread fixation for posterior cruciate ligament(PCL)tibial insertion avulsion frac-tures and traditional open double-row anchor suture fixation,and to explore a safe,effective,and min-imally invasive reduction and fixation method for PCL tibial insertion fractures in knee joint under ar-throscopy.Methods This study was a retrospective study.Sixty patients with PCL tibial insertion frac-tures(Meyers&McKeever types II-IV)and admitted to the Department of Orthopedics of Kunming Hospital of Traditional Chinese Medicine between June 2021 and June 2023 were included,and ran-domly divided into a traditional group(age:39.56±3.24 years,male/female:16/14)and a minimally in-vasive group(age:40.32±4.38,male/female:18/12),each of 30,according to their admission or-der.All patients were of Grade III positive in the drawer test before surgery.The traditional group un-derwent posterior medial inlay incision,reduction under direct vision and double-row anchor suture fix-ation,while the minimally invasive group underwent reduction under total arthroscopy,suture-bridge suture at the tendon-bone junction of PCL,and one anchor suture placed at the femoral insertion of PCL,with the anchor suture line serving as the reinforcing suture.Then,the anchor and suture-bridge suture lines were respectively pulled into the two tunnels behind the tibia from the front and then pulled out from the front of the tibia,and the reinforcing suture was knotted in front of the tib-ia.The bridge suture line was fixed in front of the tibia with an external row anchor.Six months after surgery,both groups were evaluated the efficacy using the posterior drawer test and Lysholm score.Re-sults At the follow-up six months after the surgery,both groups had good fracture healing,with one wound infection and delayed healing in the traditional group and total one-stage heal in the other group.According to the physical examination 6 months after surgery,all were negative in the posterior drawer test,except one of degree II positive in the traditional group.Moreover,the average Lysholm score of the traditional group increased from 65.23±3.48 before surgery to 87.64±4.58 points after surgery(P<0.05),while that of the minimally invasive group increased from 64.35±2.52 to 86.82±2.58(P<0.05),showing no significant differences between the two groups(P>0.05).Conclusion Both techniques in this study can achieve excellent surgical outcomes in the treatment of posterior cruciate ligament avulsion fractures at the tibial insertion site.

Objective To compare the early clinical efficacy of arthroscopic bridge suture combined with strengthening thread fixation for posterior cruciate ligament(PCL)tibial insertion avulsion frac-tures and traditional open double-row anchor suture fixation,and to explore a safe,effective,and min-imally invasive reduction and fixation method for PCL tibial insertion fractures in knee joint under ar-throscopy.Methods This study was a retrospective study.Sixty patients with PCL tibial insertion frac-tures(Meyers&McKeever types II-IV)and admitted to the Department of Orthopedics of Kunming Hospital of Traditional Chinese Medicine between June 2021 and June 2023 were included,and ran-domly divided into a traditional group(age:39.56±3.24 years,male/female:16/14)and a minimally in-vasive group(age:40.32±4.38,male/female:18/12),each of 30,according to their admission or-der.All patients were of Grade III positive in the drawer test before surgery.The traditional group un-derwent posterior medial inlay incision,reduction under direct vision and double-row anchor suture fix-ation,while the minimally invasive group underwent reduction under total arthroscopy,suture-bridge suture at the tendon-bone junction of PCL,and one anchor suture placed at the femoral insertion of PCL,with the anchor suture line serving as the reinforcing suture.Then,the anchor and suture-bridge suture lines were respectively pulled into the two tunnels behind the tibia from the front and then pulled out from the front of the tibia,and the reinforcing suture was knotted in front of the tib-ia.The bridge suture line was fixed in front of the tibia with an external row anchor.Six months after surgery,both groups were evaluated the efficacy using the posterior drawer test and Lysholm score.Re-sults At the follow-up six months after the surgery,both groups had good fracture healing,with one wound infection and delayed healing in the traditional group and total one-stage heal in the other group.According to the physical examination 6 months after surgery,all were negative in the posterior drawer test,except one of degree II positive in the traditional group.Moreover,the average Lysholm score of the traditional group increased from 65.23±3.48 before surgery to 87.64±4.58 points after surgery(P<0.05),while that of the minimally invasive group increased from 64.35±2.52 to 86.82±2.58(P<0.05),showing no significant differences between the two groups(P>0.05).Conclusion Both techniques in this study can achieve excellent surgical outcomes in the treatment of posterior cruciate ligament avulsion fractures at the tibial insertion site.

Objective To investigate the effect of Scutellarin(Scu)regulating miR-26a-3p/Survivin molecular axis on myocardial ischemia/reperfusion injury(MIRI)in rats and its mechanism.Methods Fifty SD rats were randomly divided into sham group,model group,scutellarin group(Scu),miR-26a-3p agomir group(agomir)and scutellarin+miR-26a-3p agomir group(Scu+agomir)with 10 rats in each group.The animal model of MIRI was established by ligating the anterior descending coronary artery.The rats in each group were given 20 mg/kg Scu or 10 nmol agomir before and during operation,respectively,and the rats in sham group and model group were given the same amount of solvent.At 48 h after operation,the cardiac function of rats was examined by echocardiography.The pathological changes of myocardial tissue were detected by HE staining.The levels of myocardial injury markers creatine kinase isoenzyme MB(CK-MB),lactate dehydrogenase(LDH)and cardiac troponin I(cTnI)in serum and the contents of oxidative markers Malondialdehyde(MDA),superoxide dismutase(SOD)and glutathione peroxidase(GSH-Px)in myocardial tissue were detected by biochemical kit.The apoptosis of rat cardiomyocytes was detected by TUNEL staining.The mRNA expression levels of miR-26a-3p and Survivin in rat myocardium were detected by qRT-PCR.Expression levels of Survivin,cyclin-dependent kinase inhibitor(p21)and cleaved-caspase 3 were detected by Western blot.Results Compared with sham group,the pathological damage of myocardial tissue in the model group was serious,the levels of cardiac function LVEDP and serum CK-MB,LDH and cTnI significantly increased(P<0.01),and the levels of LVESP,LVEF and LVFS significantly decreased(P<0.01).The apoptosis level and MDA level of myocardial tissue significantly increased(P<0.01),while the SOD and GSH-Px levels significantly decreased(P<0.01).Meanwhile,the expression levels of miR-26a-3p and cleaved-caspase 3 protein significantly increased(P<0.01),the p21 protein and Survivin mRNA and protein expression levels significantly decreased(P<0.01).Compared with model group,the pathological injury of myocardium in Scu group was significantly improved,the levels of cardiac function LVEDP and serum CK-MB,LDH and cTnI significantly decreased(P<0.01),and the levels of LVESP,LVEF and LVFS significantly increased(P<0.01).The apoptosis level and MDA level of myocardial tissue significantly decreased(P<0.01),while the SOD and GSH-Px levels significantly increased(P<0.01).Meanwhile,the expression levels of miR-26a-3p and cleaved-caspase 3 protein significantly decreased(P<0.01),the p21 protein and Survivin mRNA and protein expression levels significantly increased(P<0.01).However,intervention with miR-26a-3p agomir could significantly reverse the improvement effect of Scu on MIRI in rats.Conclusion Scu can improve cardiac function and myocardial injury and inhibit myocardial cell apoptosis in MIRI rats,and its mechanism may be related to the regulation of miR-26a-3p/Survivin molecular axis.

Rare diseases pose significant diagnostic and therapeutic challenges,carrying a high disease burden,their management critically reflects a nation's public health resilience.Currently,China faces key challenges such as scarce treatments,fragmented services,and low drug accessibility in rare disease care,which urgently require systemic solutions.Digital-intelligent technology as a key breakthrough are expected to resolve the challenges in this field.Although its application in the field of rare diseases is gradually expanding,there is a lack of systematic compilation of studies to elucidate how to precisely enhance the precision,synergy and sustainability of diagnosis and treatment.The key challenges in rare disease care concentrate in four areas:inefficiency in prenatal screening,uneven distribution of medical resources,low efficiency in social organization collaboration,and ineffective information dissemination.The"4C"strategy,based on digital-intelligent technology,can address these issues:①coordination,boost prenatal screening awareness and capacity via digital-intelligent platforms to strengthen prevention;②cooperation,deepen collaboration within specialist networks,empowering institutions to enhance diagnostic capacity;③co-creation,empower support organizations to optimize resources,efficiency;④cognition,minimize information dissipation through efficient platforms,improving patient and family quality of life.This establishes an integrated digital-intelligent rare disease model encompassing"screening-diagnosis-treatment-care".

Rare diseases pose significant diagnostic and therapeutic challenges,carrying a high disease burden,their management critically reflects a nation's public health resilience.Currently,China faces key challenges such as scarce treatments,fragmented services,and low drug accessibility in rare disease care,which urgently require systemic solutions.Digital-intelligent technology as a key breakthrough are expected to resolve the challenges in this field.Although its application in the field of rare diseases is gradually expanding,there is a lack of systematic compilation of studies to elucidate how to precisely enhance the precision,synergy and sustainability of diagnosis and treatment.The key challenges in rare disease care concentrate in four areas:inefficiency in prenatal screening,uneven distribution of medical resources,low efficiency in social organization collaboration,and ineffective information dissemination.The"4C"strategy,based on digital-intelligent technology,can address these issues:①coordination,boost prenatal screening awareness and capacity via digital-intelligent platforms to strengthen prevention;②cooperation,deepen collaboration within specialist networks,empowering institutions to enhance diagnostic capacity;③co-creation,empower support organizations to optimize resources,efficiency;④cognition,minimize information dissipation through efficient platforms,improving patient and family quality of life.This establishes an integrated digital-intelligent rare disease model encompassing"screening-diagnosis-treatment-care".

Objective:To investigate the effects of Yangxue Qingnao granules combined with oxiracetam on cognitive function, psychiatric symptoms, and levels of inflammatory factors in patients with Alzheimer's disease. Methods:This study used a prospective design and included 100 patients with Alzheimer's disease who received treatment at the Department of Neurology, Shangluo Traditional Chinese Medicine Hospital, from January 2021 to June 2023. The patients were randomly divided into two groups: a control group and an observation group ( n = 50 per group). The control group received oxiracetam treatment, while the observation group received Yangxue Qingnao granules in addition to oxiracetam. All patients underwent treatment for 12 weeks and were followed up for 24 weeks. Levels of inflammatory factors (C-reactive protein, amyloid-β1-42, interleukin σ), oxidative stress responses (superoxide dismutase, malondialdehyde, glutathione peroxidase, heme oxygenase-1), psychiatric symptoms (assessed by the Behavioral Pathology in Alzheimer's Disease Rating Scale), and cognitive function (measured using the Alzheimer's Disease Assessment Scale-Cognitive Subscale and the Mini-Mental State Examination) were compared between the two groups before and after treatment. The response rate was also compared between the two groups. Data were statistically analyzed using SPSS 24.0, using t-tests for measurement data and chi-square tests for categorical data. Results:After treatment, the serum levels of C-reactive protein, amyloid-β1-42, interleukin σ, superoxide dismutase, and malondialdehyde as well as Alzheimer's Disease Assessment Scale-Cognitive Subscale and Behavioral Pathology in Alzheimer's Disease Rating Scale scores in the observation group were (2.50 ± 0.31) mg/L, (83.77 ± 19.77) ng/L, (80.10 ± 30.11) ng/L, (55.10 ± 4.42) kU/L, (3.33 ± 0.32) μmol/L, (13.26 ± 2.62), and (5.86 ± 1.14), respectively. All of these values were significantly lower than those in the control group [(4.53 ± 0.50) mg/L, (109.31 ± 24.19) ng/L, (148.53 ± 42.00) ng/L, (63.51 ± 4.25) kU/L, (4.87 ± 0.24) μmol/L, (17.90 ± 3.35), (10.16 ± 2.49), t = 24.40, -5.78, 9.36, 9.69, -27.22, -7.71, 11.10, all P<0.01]. The serum levels of glutathione peroxidase and heme oxygenase-1 as well as Mini-Mental State Examination scores in the observation group were (95.21 ± 5.43) U, (14.33 ± 1.58) μg/L, and (26.40 ± 1.11), respectively, which were significantly higher than those in the control group [(80.24 ± 5.33) U, (10.87 ± 1.24) μg/L, (23.53 ± 3.32) points, t = 13.91, 12.18, 5.79, all P<0.01]. Conclusions:Yangxue Qingnao granules combined with oxiracetam shows positive effects on improving behavioral symptoms, cognitive function, and overall clinical efficacy in patients with Alzheimer's disease.

Objective:To explore school-refusing adolescents'subjective experience of helpful interventions in family-doctor-school meetings.Methods:Semi-structured interviews were conducted with 12 school-refusing ado-lescents after they participated in family-doctor-school meetings to understand the psychological interventions they perceived.Thematic analysis was used to analyze the transcripts and construct a thematic framework of useful inter-ventions.Results:Six themes were identified by thematic analysis:fairness and restraint of doctors,emotions and demands being heard,negotiate based on facts,proper science popularization,helping us check resources and vie-wing things more three-dimensionally.Conclusion:Family-doctor-school meeting facilitate effective communication between home and school,providing a supportive environment that helps school-refusing adolescents express their e-motions and demands and prepare for returning to school.