Cholesterol-lowering therapy is necessary in patients with hypercholesterolaemia, particularly those at high risk of atherosclerotic cardiovascular disease(ASCVD). However, in clinical practice, it is important to avoid initiating lipid-modifying treatment indiscriminately without first identifying the underlying cause. Several key principles should be emphasized in lipid management. First, cholesterol reduction should be appropriate, avoiding excessive lowering that could lead to overcorrection. Second, comprehensive management is crucial; for patients with ASCVD, lifestyle modification, including weight reduction, smoking cessation, limiting alcohol consumption, and alleviating anxiety, as important as lipid-modifying therapy. Additionally, attention should be paid to the potential adverse effects of low cholesterol levels, which warrant close monitoring throughout treatment. Finally, further evidence is needed to address the ongoing controversies regarding certain clinical outcomes.

Cholesterol-lowering therapy is necessary in patients with hypercholesterolaemia, particularly those at high risk of atherosclerotic cardiovascular disease(ASCVD). However, in clinical practice, it is important to avoid initiating lipid-modifying treatment indiscriminately without first identifying the underlying cause. Several key principles should be emphasized in lipid management. First, cholesterol reduction should be appropriate, avoiding excessive lowering that could lead to overcorrection. Second, comprehensive management is crucial; for patients with ASCVD, lifestyle modification, including weight reduction, smoking cessation, limiting alcohol consumption, and alleviating anxiety, as important as lipid-modifying therapy. Additionally, attention should be paid to the potential adverse effects of low cholesterol levels, which warrant close monitoring throughout treatment. Finally, further evidence is needed to address the ongoing controversies regarding certain clinical outcomes.

Objective: To explore the assocation of the family environment and depressive symptoms among primary and middle school students, so as to provide suggestions for further maximizing the utility of family environment in the growth of primary and secondary school students, as well as prevention and intervention of depressive symptoms among children and adolescents. Methods: From June to July 2024, through a multistage cluster random sampling method, 8 800 primary and middle school students aged 10 to 18 from 36 schools in 3 cities (Datong, Lvliang, Linfen) in Shanxi Province. A self designed questionnaire was used to conduct a family environment survey, including family socioeconomic conditions, family structure, family parenting behavior, family member health behavior, etc; and the depression symptoms of primary and secondary school students were investigated by Patient Health Questionnaire-9. The χ 2 test and binary Logistic regression to method were used to analyze the association of the family environment with depressive symptoms among primary and secondary school students, and to analyze gender and urban-rural heterogeneity in this association. Results: The detection rate of depressive symptoms among primary and middle school students was 46.7% ( n = 4 111 ). Among them, the detection rates of depressive symptoms for male and female students were 45.7% and 47.7% respectively, and the detection rates for rural and urban students were 48.0% and 44.9% respectively. The results of binary Logistic regression model showed that in the family environment, factors such as the father s education level (junior high school: OR =0.84), self assessed family socio economic status (average: OR =0.78, good: OR =0.80), parental support and understanding (yes: OR = 0.55 ), family atmosphere (harmonious: OR =0.66), living arrangement (living only with father or mother: OR =1.31, living with parents and grandparents: OR =1.19), and family rearing style (combining punishment and reward: OR =1.42, punishment only: OR =1.25) were related to depressive symptoms in primary and middle school students in Shanxi Province ( P <0.05). From the perspective of gender heterogeneity, the living arrangement (living only with father or mother: OR =1.67, others: OR =1.67) had a statistically significant association with depressive symptoms in male students ( P <0.05). From the perspective of urban rural heterogeneity, the living arrangement (living only with father or mother: OR =1.38) had a statistically significant association with depressive symptoms in rural primary and middle school students ( P <0.05). Conclusions The family environment has an important impact on depressive symptoms in primary and middle school students. Family functioning should be fully exerted to prevent depressive symptoms in primary and middle school students.

Objective: To explore the association between school climate and suicide behavior among primary and secondary school students, so as to provide recommendations for preventing student suicide in schools. Methods: From June to July 2024, a stratified cluster random sampling method was employed to conduct a questionnaire survey on suicidal behavior and school climate among 8 722 students from 36 schools in Lüliang, Linfen, and Datong cities, Shanxi Province. The relationship between school climate and suicidal behavior was analyzed using Chi square test and binary Logistic regression, supplemented by gender heterogeneity and interaction analyses. Results: The prevalence of suicidal behavior among students in Shanxi Province was 11.1%. After adjusting for age, gender, educational stage, parents educational level, residential status, family economic condition, parents marital status and depressive symptoms, binary Logistic regression analysis revealed that peer relationships ( OR=0.72, 95%CI =0.57- 0.91 ), peer trust ( OR=0.73, 95%CI =0.58-0.92), teacher support ( OR=0.66, 95%CI =0.53-0.82), school safety ( OR=0.61, 95%CI =0.48-0.78), having more than six friends ( OR=0.64, 95%CI =0.43-0.98), and school belongingness ( OR=0.70, 95%CI =0.56-0.88) among primary and secondary school students were associated with a lower risk of suicidal behavior (all P <0.05). Students who experienced school bullying showed a higher risk of suicidal behavior ( OR=2.95, 95%CI =1.80-4.82, P <0.05). Gender specific analysis revealed that peer relationships ( OR=0.67, 95%CI =0.48-0.92), peer trust ( OR=0.66, 95%CI =0.49-0.90), and school belongingness ( OR=0.62, 95%CI =0.45-0.84) were associated with a lower risk of suicidal behavior suicide behavior in girls; teacher support ( OR=0.50, 95%CI =0.36-0.70) and having more than six friends ( OR=0.51, 95%CI =0.27- 0.96 ) were associated with a lower risk of suicidal behavior in boys, who experienced school bullying showed a higher risk of suicidal behavior ( OR=4.19, 95%CI =2.18-8.03) (all P <0.05). Interactive analysis revealed that the dual interaction between peer support and school safety could reduced the risk of suicide behavior among primary and secondary school students safety ( OR= 0.83 , 95%CI=0.70-0.99, P <0.05). Conclusions School climate is closely associated with suicidal behavior among primary and secondary school students in Shanxi Province, with gender differences present. Schools should foster a positive school environment to prevent student suicide behaviors.

As a multifactorial chronic metabolic disorder with complex causes and serious health risks, obesity has drawn significant societal and medical attention. This article systematically reviewed the latest advancements in the clinical diagnosis and treatment of obesity. A disease-centered diagnosis and treatment concept has been proposed, which combines BMI and introduces a brand-new clinical diagnosis and treatment standard centered on fat content and functional disorders, such as new diagnostic markers like adipose tissue distribution, visceral adiposity, and waist-to-height ratio, to conduct a comprehensive assessment and lifespan management of patients. In recent years, novel biomarkers and artificial intelligence (AI)-assisted diagnosis have provided new tools for the diagnosis and treatment of obesity. In terms of treatment, combined therapy based on lifestyle and behavioral intervention has been widely recognized. The advent of new weight-loss drugs, such as glucagon-like peptide-1(GLP-1), minimally invasive techniques such as endoscopic sleeve gastrectomy(ESG), which reduced surgical risks, have provided possibilities for the treatment of obesity. The current concept of obesity management has become increasingly mature, feasible, and standardized. The construction principles of a weight management center, characterized by centralized management and individualized treatment, ensure the long-term stability of body weight and promote a healthy quality of life for patients with obesity.

Objective To investigate the sputum metabolic profiles of patients with occupational coal workers' pneumoconiosis (CWP) by an untargeted metabolomics method, and to identify relevant differential metabolic pathways and potential biomarkers. Methods A total of 12 male patients with stage Ⅰ CWP were selected as the CWP group, and 16 healthy male individuals were selected as the control group, using a judgmental sampling method. Sputum metabolites of individuals in both groups were detected to perform non-targeted metabolomic analysis using the ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry. Differential metabolites (DMs) and their pathways were screened using principal component analysis, partial least squares discriminant analysis, and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. Potential biomarkers were analyzed and identified via the receiver operating characteristic curve (ROC). Results There were apparent metabolic alterations observed in sputum of CWP patients compared with healthy controls. In the positive ion mode, a total of 42 DMs were identified in sputum from CWP patients, including 19 downregulated and 23 upregulated metabolites. In the negative ion mode, a total of 25 DMs were identified in sputum from CWP patients, including 16 downregulated and 9 upregulated metabolites. KEGG enrichment analysis of sputum from CWP patients showed that seven DMs pathways were enriched in ABC transporters, histidine metabolism, phenylalanine metabolism, arachidonic acid metabolism, linoleic acid metabolism, purine metabolism, and oxidative phosphorylation, involving 26 DMs. ROC analysis indicated that 16(R)-hydroxyarachidonic acid, pyrophosphate, and 2-hydroxyphenylacetate of these 26 DMs may serve as potential biomarkers for CWP. Conclusion Sputum metabolomic profiles were altered in CWP patients compared with healthy controls. The potential biomarkers of CWP prevention and treatment are 16(R)-hydroxyarachidonic acid, pyrophosphate, and 2-hydroxyphenylacetate.

Objective:To investigate the practicality of TrueFidelity deep learning reconstruction algorithm in low-dose abdominal and pelvic CT angiography (CTA).Methods:The patients who required abdominal and pelvic CTA were prospectively included at the First Affiliated Hospital of Xi′an Jiaotong University from June 2020 to March 2021. All patients underwent low-dose CTA with a tube voltage of 80 kV and smart tube current modulation (100-720 mA). Images were reconstructed using the traditional FBP, adaptive statistical iterative reconstruction with a strength of 50% (ASIR-V 50%), TrueFidelity with medium (TF-M) and high (TF-H) strength. The CT value and standard deviation (SD value) of the abdominal aorta, psoas major muscle and subcutaneous fat in the same layer were measured, signal to noise ratio (SNR) and contrast to noise ratio (CNR) were calculated. We also introduced the measurement of skewness of CT value in psoas major muscle with uniform density. The above indexes of the four groups of reconstructed images were compared. A 5-point scoring method was used to evaluate the granularity, fuzziness and beam-hardening artifacts of all images. Objective measurement indicators, such as CT values, were tested by repeated measure ANOVA with the Bonferroni post hoc test.Results:There were forty-six patients in the study. The volume CT dose index of the scan was low at (1.09±0.31)mGy. There was no significant difference in CT values of vessels and muscles between the four groups ( P>0.05), but there was a significant difference in SD value( P<0.001). The SD value of the FBP group was the largest and that of the TF-H group was the smallest. The difference between SNR and CNR was statistically significant ( P<0.001), and the overall trend was opposite to that of the SD value. There was no significant difference in the skewness between the four groups. The granularity score of the FBP group was the largest, that of the TF-H group was the smallest, and there was a significant difference among the four groups. The score of fuzziness in the TF-H group was slightly higher than that in the other three groups, but there was no significant difference. The beam-hardening artifact score of FBP and ASIR-V 50% group was the worst, and the TF-H group was the best ( P<0.001). Conclusions:Compared with FBP and ASIR-V, TrueFidelity reconstruction algorithm provides better image quality (comprehensively considering image noise, fuzziness, uniformity, and hardening artifacts) in low-dose CT scanning of abdominal and pelvic vessels, and TF-H has the best image quality.

Objective:To evaluate the dosimetric characteristics, safety and effectiveness of magnetic resonance-guided fractionated stereotactic radiotherapy (FSRT) for brain tumors.Methods:Clinical data of 8 brain tumor patients treated with magnetic resonance-guided FSRT in the Radiotherapy Department of the First Medical Center of the PLA General Hospital from July 2023 to February 2024 were retrospectively analyzed. Online adaptive radiotherapy was adopted for all patients. Adapt-to-position (ATP) or adapt-to-shape (ATS) radiotherapy was chosen by radiologists. Each adaptation was initiated after the radiotherapy plan was re-examined. The radiotherapy fractionation plan was 21-30 Gy/3-5 F. Clinical characteristics, radiotherapy plans and plan parameters were analyzed by statistical description. Median ( Q1， Q3) was used to describe continuous data and percentage was used to describe categorical data. Results:In this study, 9 lesions were treated a total of 41 times, including 20 times (49%) of ATP plan and 21 times (51%) of ATS plan. The median target area coverage rate was 95.1% (95%, 99.8%), the median target area maximum dose rate was 1.15 (1.07, 1.31), the median conformity index (CI) was 0.75 (0.69, 0.86), the median homogeneity index (HI) was 1.09 (1.06, 1.21), and the median gradient index (GI) was 4.73 (3.36, 8.45), respectively. After ATS plan, the median reduction in gross target volume (GTV) was 8.22 cm3 (1.2, 10.1 cm3), and the median reduction in brain tissue V12 Gy was 30.46 cm3 (8.34, 31.13 cm3).The median follow-up was 3.2 months (1.4, 6.1 months). No radiation necrosis was found in any patient. There were 2 cases of acute brain edema during radiotherapy (both were mild). Except for 1 case who died due to systemic disease progression, the remaining patients had no local recurrence, and achieved good quality of life. Conclusions:The parameters of the treatment plan of magnetic resonance-guided FSRT are generally acceptable. The adaptive plan can effectively reduce the dose of normal brain tissues. It is safe and feasible to use the magnetic resonance-guided FSRT for brain tumors.

Liver sinusoidal endothelial cells (LSECs) are liver-specific endothelial cells with the highest permeability than other mammalian endothelial cells, characterized by the presence of fenestrae on their surface, the absence of diaphragms and the lack of basement membrane. Located at the interface between blood and other liver cell types, LSECs mediate the exchange of substances between the blood and the Disse space, playing a crucial role in maintaining substance circulation and homeostasis of multicellular communication. As the initial responders to chronic liver injury, the abnormal LSEC activation not only changes their own physicochemical properties but also interrupts their communication with hepatic stellate cells and hepatocytes, which collectively aggravates the process of liver fibrosis. In this review, we have comprehensively updated the various pathways by which LSECs were involved in the initiation and aggravation of liver fibrosis, including but not limited to cellular phenotypic change, the induction of capillarization, decreased permeability and regulation of intercellular communications. Additionally, the intervention effects and latest regulatory mechanisms of anti-fibrotic drugs involved in each aspect have been summarized and discussed systematically. As we studied deeper into unraveling the intricate role of LSECs in the pathophysiology of liver fibrosis, we unveil a promising horizon that pave the way for enhanced patient outcomes.