Objective: To investigate the correlation between social jetlag and psychological behavior in upper primary school students,so as to provide reference for sleep health promotion in primary school students. Methods: From April to June 2024, a survey was conducted among 4 341 fourth and fifth grade students from 9 public primary schools in a district in Beijing. Sleep patterns were assessed using a self designed questionnaire, while psychological behavior was evaluated using the Strengths and Difficulties Questionnaire (SDQ)(parent version). A generalized estimating equation (GEE) model was used to examine the association between different levels of social jetlag and psychological behavior problem scores in primary school students. Results: The proportions of students with social jetlag of <1.0, 1.0-<2.0, and ≥2.0 h were 57.6%, 30.6%, and 11.8%, respectively. The GEE model analysis found that after adjusting for covariates, compared with primary school students with social jetlag of <1.0 h, those with 1.0 -<2.0 and ≥2.0 h had higher scores for internalizing behavior problems [ β (95% CI ) =0.23(0.05-0.41)，0.28(0.02-0.54), P < 0.01]. Primary school students with ≥2.0 h of social jetlag had higher scores for externalizing behavior problems [ β (95% CI )=0.42 (0.13-0.71)， P <0.01]. Among boys and primary school students with an average nighttime sleep duration of ≥9 h, comparied with social jetlag of <1.0 h,those with sucial jetlag 1.0-<2.0 h had higher scores on internalizing and externalizing behavior problems[ β (95% CI )=0.32(0.07-0.56),0.51 (0.11-0.90), 0.26 (0.06-0.46)，0.58 (0.25-0.91), P <0.05]. Conclusions Greater social jetlag may be a risk factor for internalizing and externalizing behavior problems in upper primary school students. Reducing social jetlag may help decrease the occurrence of psychological behavior problems in primary school students.

Objective: To explore the association of screening myopia and sitting posture habits as well as screen viewing distance among primary school students, providing a scientific basis for myopia prevention and intervention among primary school students. Methods: From April to June 2024, a convenient sampling method was used to enroll 1 394 fourth grade students from four primary schools in a district of Beijing for vision examinations and questionnaire surveys. Logistic regression models were employed to analyze the relationship of screening myopia detection and sitting posture habits as well as viewing distance. Results: The screening myopia prevalence among primary school students was 63.8%. About 13.1% of students self reported poor sitting posture, and 47.1% selfreported a viewing distance of ≤20 cm. After adjusting for covariates including age, gender, school, sleep quality, parental myopia status, physical fitness level, daily high intensity physical activity, weekend outdoor activity time and types of after school services, Logistic regression analysis showed that students with poor sitting posture were more likely to have screening myopia than those with normal sitting posture ( OR =1.73,95% CI =1.03-2.92); students with a viewing distance of ≤20 cm were more likely to have screening myopia than those with a viewing distance of >20 cm( OR =1.32, 95% CI =1.02-1.71)( P <0.05). The association between sitting posture and screening myopia was more significant among boys( OR =2.00, 95% CI =1.03-3.88, P < 0.05 ). A multiplicative interaction was observed between sitting posture and viewing distance. Compared to primary school students with normal posture and a viewing distance of >20 cm, those with poor posture and a viewing distance of >20 cm were more likely to have screening myopia ( OR =1.82, 95% CI =1.12-2.96， P <0.05). Conclusions Both sitting posture habits and screen viewing distance are related to screening myopia in primary school students. Poor sitting posture poses a higher risk than screen distance, and the two factors exhibit an interactive effect on myopia risk.

Background Prenatal exposure to chlorinated polyfluorinated ether sulfonic acid (Cl-PFESA, commercially known as F-53B) during pregnancy has been associated with fetal growth restriction and adverse birth outcomes. These effects may be mediated by structural and functional impairments of the placenta, potentially resulting from disrupted placental angiogenesis. However, the underlying mechanisms remain unclear. Objective To explore the impact of prenatal F-53B exposure on fetal development, placental pathology, and the expression of genes involved in angiogenesis by establishing an F-53B exposure animal model. Methods A total of 48 sexually mature female SD rats aged 8 weeks were selected, along with 24 proven male breeders. The rats were acclimatized for one week before mating. Pregnant rats were assigned to four groups: control (0 mg·kg⁻¹), low-dose (0.1 mg·kg⁻¹), medium-dose (1 mg·kg⁻¹), and high-dose (5 mg·kg⁻¹). Half of the pregnant rats in each group were administered the test substance by oral gavage once daily from gestational day (GD) 5.5 to GD17.5. The fetuses and placentas were dissected and weighed, and placental efficiency was calculated as the ratio of fetal weight to placental weight, reflecting the placenta’s capacity to supply nutrients to the fetus. Placental histopathological alterations were assessed after hematoxylin and eosin (HE) staining. Quantitative real-time polymerase chain reaction (qPCR) was conducted to assess the mRNA expression levels of angiogenesis-related genes, including hypoxia-inducible factor-1α (HIF-1α), vascular endothelial growth factor A (VEGFA) and its receptor (VEGFR2), as well as downstream genes in the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway. To evaluate the potential impact of prenatal F-53B exposure on birth outcomes, including birth weight and gestational age, the remaining half of the pregnant rats in each group were continuously exposed to the test substance until delivery. Results F-53B exposure significantly reduced fetal weight across all exposure groups (P<0.05) and markedly increased the incidence of intrauterine growth restriction (P<0.01). Although placental weights did not differ significantly among groups, placental efficiency was significantly decreased in the high-dose group (P<0.05). The histological analysis after HE staining revealed disorganized trophoblast cell structure and a significant reduction in labyrinthine blood sinus area in the medium- and high-dose groups. The qPCR analysis showed that HIF-1α expression was significantly upregulated in the low-dose group (P<0.001), while VEGFA (P<0.01), PI3K (P<0.001), and AKT (P<0.05) expression levels were significantly downregulated in the medium- and high-dose groups. Conclusion Maternal exposure to F-53B during pregnancy may impair placental angiogenesis via VEGFA and its downstream PI3K/AKT signaling pathway, leading to placental pathological damage and increasing the risk of intrauterine growth restriction and reduced birth weight in fetuses.

Objective:To investigate the feasibility and effectiveness of three-dimensional visualization technology in the precise diagnosis and treatment of locally advanced differentiated thyroid cancer(DTC).Methods:A retrospective analysis was conducted on the clinical data of 196 patients with locally advanced DTC treated at the 960th Hospital of the PLA from December 2021 to August 2023. The cohort included 71 male and 125 female patients, with a mean age of 43.7 years (rangd from 18 to 77 years). All patients underwent neck-enhanced CT scans and were divided into two groups: the study group( n=102), which underwent preoperative three-dimensional visualization of CT data, and the control group( n=94), which did not. Baseline data for both groups were matched using SPSS27.0 with 1∶1 propensity score matching (PSM) and the caliper value was 0.02. A total of 49 patients were included in each group, including 35 first-time surgeries and 14 reoperation. Among the 70 first-time surgeries, 29 patients underwent robotic surgery and 41 underwent open surgery. Among the 28 reoperations, 4 underwent robotic surgery and 24 underwent open surgery. In the study group, three-dimensional visual models were used to comprehensively evaluate the tumor and metastatic lesion size, spatial location, and adjacent relationship with surrounding organs, surgical treatments were guided by these models, whereas the control group relied on two-dimensional imaging for guidance. The clinical data were statistically analyzed using SPSS27.0. Results:All operations were successfully completed. There were no statistical differences in baseline data between the two groups( P>0.05). Among first-time surgeries, the study group showed shorter operation times [175(145, 200) min vs 205(182, 249) min, P<0.001], a lower incidence of postoperative chyle leak (0 vs 8.57%, P=0.027), a higher rate of robotic surgery (48.57% vs 34.28%, P=0.225), a greater number of harvested lymph nodes [46(40, 62) vs 37(28, 56), P=0.032], a greater number of cervical lymph node metastasis[15(7, 22) vs 5(1, 14), P=0.004] and a larger diameter of metastasis lymph nodes[12(10, 16) mm vs 4(1, 10) mm, P<0.001]. There were no significant differences in intraoperative blood loss, postoperative drainage days and incidence of hypoparathyroidism( P>0.05). During the reoperation, the study group had shorter operation times[103.5(95.0, 122.5) min vs 146.50(133.25, 172.25) min, P<0.001], less intraoperative blood loss[12.50(8.75, 22.50) mL vs 30.00(17.50, 35.00) mL, P=0.021], fewer postoperative drainage days[5.00(4.00, 6.00) d vs 6.00(5.00, 7.25) d, P=0.016] and a lower incidence of hypoparathyroidism(7.14% vs 42.86%, P=0.038).The robotic surgery rate was higher in the study group (21.42% vs 7.14%, P=0.596). There were no significant differences in lymph node dissection numbers, metastatic lymph node counts, or chyle leak incidences between the two groups ( P>0.05). No acute bleeding or incision infection occurred in any patient postoperatively. Conclusion:Three-dimensional visualization technology is an effective preoperative assessment method for evaluating the resectability of tumors and metastases lesions in locally advanced DTC. It enhances the accuracy and safety of surgery for locally advanced DTC.

Objective:To investigate the feasibility and safety of implementing a domestic vehicle-mounted remote mobile robotic surgical system in thyroid surgery applications, integrated with 5G communication technology.Methods:Using the main system located on the vehicle-mounted mobile robot operating platform of the 960th Hospital of PLA Joint Logistics Support Force and the slave system of Weifang Traditional Chinese Hospital, the remote radical thyroidectomy 5G communication technology, and analyze the clinical and information transmission data of two female patients who underwent remote mobile robot thyroid cancer surgery on October 21, 2024 at Weifang Traditional Chinese Medicine Hospital.Results:The remote radical thyroidectomy was conducted by the robosurgeons utilizing a vehicle-mounted mobile robotic surgical system, and the procedure was successfully completed without necessitating intermediate open surgery. The operation durations for patient 1 and patient 2 were 135 minutes and 108 minutes, respectively, with 7 and 13 lymph nodes dissected, respectively. The average delay in surgical data transmission was recorded at 61.9 milliseconds, with no instances of signal interruption or frame loss. The procedure proceeded smoothly, without any jamming, and the audio and video transmissions were consistently clear. Follow up for 21 days after surgery showed no complications such as hoarseness, skin damage, or lymphatic fistula.Conclusion:The implementation of a vehicle-mounted remote mobile robotic surgery system for thyroid surgery has demonstrated safety and feasibility. Furthermore, the utilization of the 5G network offers rapid data transmission and minimal latency, closely approximating the therapeutic efficacy of traditional robotic thyroidectomy.

The incidence rate of aortic dissection (AD) is low, but it is highly fatal in the acute phase. Miss diagnosis and misdiagnosis can occur occasionally, resulting the miss of the best intervention time. Research on the epidemiological characteristics and of AD and related risk factors can identify high-risk groups, make screening and diagnosis as soon as possible and effectively control the changeable risk factors to reduce the incidence of AD and improve the outcome of AD cases. This paper summarizes the progress in research of the epidemiological characteristics of AD and related risk factors in order to promote early prevention and diagnosis of AD, improve the AD case management and intervention level.

Objective To understand the research status,hotspots and trends of Wuzhuyu Decoction;To provide reference for relevant research.Methods The literature related to Wuzhuyu Decoction was retrieved from CNKI,VIP,Wanfang Data and CBM databases from the establishment to February 28,2023.NoteExpress 3.6 was used to merge and deduplicate,and the author,organization and keywords were mapped and interpreted by CiteSpace 6.1.R6 software.Results A total of 822 articles were included,and the number of publications showed a wave upward trend;the top journals were New Chinese Medicine,Henan Traditional Chinese Medicine and Sichuan Traditional Chinese Medicine;the main research institutions were Beijing University of Chinese Medicine,China Academy of Chinese Medical Sciences and Shandong University of Traditional Chinese Medicine;a total of 566 authors were involved,and the authors with more publications included Wang Zhimin(12),Gong Muxin(9)and Bi Kaishun(5);high-frequency keywords included"headache","Shang Han Lun","TCM therapy"and so on.Conclusion Wuzhuyu Decoction is effective in treating chronic gastritis,hypertension and other primary diseases,which is a research hotspot in this field.It is a research trend in this field to explore its active components by high performance liquid chromatography and explain its action mechanism and target at the molecular level.

Objective To understand the research status,hotspots and trends of animal medicinal materials;To provide reference for future research.Methods The literature related to animal medicinal materials was retrieved from CNKI,VIP,Wanfang Data and CBM from January 1,2000 to April 30,2023.NoteExpress 3.6 was used to merge and deduplicate,and the author,institution and keywords were mapped and interpreted by CiteSpace 6.1.R6 software.Results A total of 1 169 articles were included,and the overall publication quantity in this field showed a stable fluctuation trend;the top journals were Lishizhen Medicine and Materia Medica Research,China Journal of Chinese Materia Medica and Modern Chinese Medicine;the main research institutions were China Academy of Chinese Medical Sciences,Changchun University of Chinese Medicine and Chinese Academy of Medical Sciences;a total of 676 authors were involved,and the authors with more publications included Zhang Hui(22),Liu Rui(15),Lin Zhe and Ma Shuangcheng(14);high-frequency keywords included"identification","TCM resources","clinical application"and so on.Conclusion Resource survey of animal medicinal materials,standardized breeding of medicinal animals,development of alternatives to rare medicinal animal resources,and construction of quality standard system for animal medicinal materials are the research hotspots in this field.The basic research of pharmacodynamic substances of animal medicinal materials based on the integrated analysis strategies of proteomics,peptideomics and transcriptomics,and the revelation of the signaling pathways and targets of animal medicinal materials from the molecular biology level are the research trends in this field.

Continuing medical education for general practitioners is an important measure to upgrade the quality of primary health care services in China, which is still facing various challenges and need to be further developed and improved. This article analyzes the status quo and existing problems of continuing medical education for general practitioners in China, and proposes suggestions based on the concept of people centered and integrated health care (PCIC), including faculty development, training contents, assessment methods, and experience learning, to provide references for the improvement of continuing medical education for general practitioners.

Objective:To investigate the short-term outcome of transoral robotic thyroidectomy.Methods:This is a retrospective case series study. The clinicopathologic characteristics and postoperative results of 107 patients who underwent transoral robotic thyroidectomies in the Department of Thyroid and Breast Surgery of the 960 th Hospital of People′s Liberation Army from May 2020 to August 2023 were retrospectively analyzed. There were 12 males and 95 females, with an age of (31.8±9.4) years (range: 11 to 55 years), including 20 benign tumors and 87 thyroid papillary carcinoma. Postoperative follow-up was carried out through returning visit and telephone, mainly to observe the recovery of postoperative complications, cosmetic effects and recurrence results. Results:All transoral robotic thyroidectomy was successfully completed without conversion to open surgery. The tumor size of thyroid papillary carcinoma patients was (5.6±2.7) mm (range: 2 to 15 mm). Furthermore, central cervical lymph node metastasis was found in 45 cases. The number of central cervical lymph nodes retrieved and metastasized ( M(IQR)) were 11 (8) (range: 3 to 26) and 1 (3) (range: 0 to 13), respectively. There was no recurrent laryngeal nerve injury and permanent hypoparathyroidism. The transient hypoparathyroidism after surgery was 8 cases. Other complications occurred as follows: postoperative infection ( n=1), left submandibular perforation ( n=1), skin scald ( n=1), and perioral numbness ( n=1), oral tear ( n=2). The postoperative stay was 6 (2) days (range: 3 to 11 days). No local lymph node recurrence or metastasis occurred after a follow-up of (22.6±10.0) months (range: 1.0 to 37.4 months). All patients were satisfied with the postoperative cosmetic results, the aesthetic effect score was 9.3 (0.2) (range: 8.4 to 9.6) one month after surgery. Conclusion:For highly screened patients with early thyroid cancer, experienced surgeons can perform a transoral robotic thyroidectomy that has excellent cosmetic results.