ObjectiveTo explore the relationship between negative life events and depression severity in adolescent patients with depressive disorder， as well as the chain mediating role of insomnia symptoms and quality of life. Methods374 outpatient patients and hospitalized patients with adolescent depressive disorders were enrolled. The Adolescent Life Event Scale （ASLEC）， the Insomnia Severity Index （ISI）， the World Health Organization Quality of Life Questionnaire Short Form （WHOQOL-BREF）， and the Center for Epidemiology Depression Scale （CES-D） were used to evaluate the negative life event situation， insomnia symptoms， quality of life level and depression severity of the subjects， respectively. In addition， the PROCESS 4.0 macroprogram was used to analyze the chain mediating effect of insomnia symptoms and quality of life between negative life events and depression severity in patients with adolescent depressive disorder. ResultsThe results of correlation analysis showed that there was a significant correlation between negative life events and insomnia symptoms， quality of life， and depression severity （all P<0.05）. In addition， the results of chain mediation showed that negative life events had a significant direct effect on depression severity， with an effect size of 0.12 （P<0.001）. Insomnia symptoms and quality of life played a mediating role in the relationship between negative life events and depression severity in patients with adolescent depressive disorders， with indirect effect sizes of 0.062 （95%CI： 0.040-0.087） and 0.091 （95%CI： 0.059-0.123）， respectively. It could also play a chain mediation role， and the effect size was 0.039 （95%CI： 0.024-0.057）. ConclusionNegative life events experienced by patients with adolescent depressive disorder not only directly affect the severity of depressive symptoms， but may also indirectly exacerbate depression through insomnia symptoms and quality of life.

Objective To investigate the association between birth weight and dementia risk and the mediating roles of chronic diseases,and to assess potential biological pathways underlying the birth weight-associated dementia risk based on large-scale proteomics.Methods We used data from 279 743 participants aged 40 to 69 years enrolled in the UK Biobank.Birth weight was categorized into low birth weight(≤2 500 g),normal birth weight(2 500-3 999 g),and macrosomia(≥4 000 g).Multivariable Cox proportional hazards regression models were used to assess the associations between birth weight categories and all-cause dementia and its subtypes(Alzheimer's disease and vascular dementia).Proteomics analyses were conducted to identify proteins and the potential pathways involved.Results Low birth weight was associated with higher risks for all-cause dementia and its subtypes.The hazard ratios were 1.18(95%CI,1.08-1.30)for all-cause dementia,1.14(95%CI,1.00-1.31)for Alzheimer's disease,and 1.22(95%CI,1.01-1.48)for vascular dementia.A non-linear relationship was observed between birth weight and dementia risk(P for nonlinearity<0.001).Certain cardiometabolic diseases in middle-aged adults,such as diabetes,stroke,hypertension,and dyslipidemia,played a significant mediating role in the relationship between low birth weight and dementia risk,with the mediation proportion being 6.3%to 15.8%.Proteomic analyses identified 21 proteins linked to both low birth weight and all-cause dementia risk,which were significantly enriched in the pathways for viral protein interaction with cytokines and cytokine receptors,adipocytokine signaling,and cytokine-cytokine receptor interaction.Conclusion Low birth weight is positively associated with dementia risk.Cardiometabolic diseases in middle-aged adults may mediate the relationship between low birth weight and dementia risk.A number of proteins and the associated pathways underscore the relationship between low birth weight and dementia risk.

Objective To investigate medical students’demand for knowledge about healthcare-associated infec-tion(HAI),explore the opportunity and method of setting up curriculum about nosocomiology.Methods 447 medi-cal students who were about to start clinical practice were investigated through questionnaires.Results 434 (97.09%) questionnaires were available.152 (35.02%)medical students had access to knowledge about HAI,148 (34.10%) knew or learnt six-step hand-washing method,80 students understood six-step hand-washing method through media and society (n=65,81 .25%)or school curriculum (n=15,18.75%).95.62% of students hoped to set up curric-ulum about nosocomiology,354 (81 .57%)students preferred this discipline to be set up before clinical probation;55.07% of students hoped this course should be set up as a practice course,44.93% thought that theory and prac-tice should be combined.Occupational precaution measures as well as methods of disinfection and isolation were the most interesting knowledge among them.Conclusion Nosocomiology should be an obligatory course in medical col-leges,the semester before clinical practice is the best time for this course,the curriculum should combine theory with practice.

Objective To evaluate the efficacy and surgical technique of percutaneous transforaminal endoscopic lumbar intervertebral disc discectomy (TES) for senile lumbar intervertebral disc protrusion.Methods Twenty-three patients with senile lumbar intervertebral disc protrusion were admitted to percutaneous TES from April 2009 to April 2010. Surgical segments included L4-5 in 11 cases, L5-S1 in 9cases,L3-4 in 3 cases. There were 10 contained and 13 non-contained,6 disc herniation in or out of the foramen and 1 recurred. Nine simple cases were treated by TES and 14 cases with narrow foramens treated by intervertebral foraminal plasty at the same time. Visual analogue scale (VAS),Oswestry disability index (ODI) and the modified MacNab criteria were employed to evaluate the clinical outcome. Results There was no dural matter tear and intraoperative neurovascular injury. Two patients suffered transient hyperalgia in lower limbs which were healed after 1 week by conservative treatments. All patients were followed up with mean period of 6-12(9.53 ± 3.02) months. The VAS of sciatica decreased from(8.3 ± 1.2) scores preoperatively to (3.7 ±2.1) scores at three days postoperatively and ( 1.5 ± 1.2) scores at the last follow-up visit (P＜0.01). The ODI decreased from 53.3 ± 24.0 preoperatively to 26.2 ± 15.0 at three days postoperatively and 20.4 ± 6.0 at the last follow-up visit(P＜ 0.01). There were 18 excellent,3 good and 2 fair outcomes according to modified MacNab criteria with the excellent to good rate of 91.3% (21/23). Conclusion TES is applicable for senile lumbar intervertebral disc protrusion, which has the advantages of minimal invasion, less haemorrhage,early function recovery and it is a safe and effective method.

Objective To explore clinical the characteristics and countermeasures of osteoporotic vertebral fractures treated with percutaneous vertebroplasty. Methods From March 2005 to March 2008,64 patients (totally 86 vertebra) with osteoporotic vertebral fractures undergoing percutaneous vertebroplasty were retrospectively analyzed. The level of fracture was between T5 to L5. The symptomatic fractured vertebrae were determined with combination of regional pain, X-rays and MR images. The postoperative effect were evaluated by the visual analog score (VAS) and Oswestry disability index (ODI). Results All the patients were followed up 12 - 23 ( 13.40 ± 1.03 ) months. The VAS decreased from (8.3 ± 1.2) scores to bdfore surgery (2.3 ± 1.4) scores after surgery and to (2.5 ± 1.1 ) scores at the last follow-up time(P ＜ 0.01 ). The ODI decreased from (62.0 ± 2.3 ) scores before surgery to (23.1 ± 2.5 ) scores after surgery and to ( 26.3 ±2.4) scores at the last follow-up time (P ＜0.01). The back pain of all patients were relieved to different degrees postoperatively. No severe complications including pulmonary embolism occurred. Conclusions The key point is to find the symptomatic fractured vertebrae not only based on preoperative X-rays but also the MR images, especially fat-compressing MR images. Only when the fractured vertebrae demonstrate low intensity on T1WI MR image and high intensity on T2WI or fat-compressing MR image can be considered new fractures. The injection should reach the new fractured part and if necessary the bilateral approaches should be considered and the injection can be separated for several steps in multi-segments fracture. PMMA should be injected after the bone cements are solid enough so as not to develop complications such as pulmonary embolism.