Objective: To understand the current status of neglect among rural preschool children in Xi an under the multi child policy and the association with family characteristics, so as to provide a reference for preventing and reducing the occurrence of child neglect. Methods: A total of 7 052 parents of preschool children were selected using stratified cluster sampling across 9 suburban counties/districts in Xi an from March to April 2025. A questionnaire survey was administered using the Chinese Norm Scale for Neglect Assessment of Rural(Preschool) Children Aged 3-6. The t-test, Chi-quare test, and analysis of variance (ANOVA) were used for inter group comparisons. Results: The overall prevalence rate and mean score of neglect among rural preschool aged children in Xi an were 32.4% and 38.27±6.70, respectively. Statistically significant differences were detected in neglect rates and neglect degrees among preschool children of different genders and grade levels ( χ 2=30.41, 15.15, t/F =4.92,7.03, all P <0.05). Statistically significant differences were also detected in neglect rates and neglect degrees among preschool children from whether only one child, different family structures, numbers of children in a family and families with different annual incomes ( χ 2=29.22, 10.41 , 31.99, 186.47, t/F =-9.96, 5.50, 33.57, 68.63, all P <0.05). In multi child families, there was a statistically significant difference in neglect degree among children with different birth orders ( F =4.25, P <0.05), but there was no statistically significant difference in neglect rate ( χ 2=5.73, P >0.05). Among all subgroups, the highest neglect rates and neglect degrees were observed in children from multi child families(35.0%,39.00±6.71), other family types(50.0%，42.38±12.34) and families with three children(39.9%，39.50±7.43). Lower annual family income was associated with higher neglect rates and neglect degrees among preschool children( χ 2 trend =186.47， F =270.68，both P <0.05). Conclusions Under the multiple child policy, the neglect of preschool children in rural areas of Xi an is quite severe, particularly in families with multiple children and low income households. Targeted interventions should be implemented for high risk groups.

BACKGROUND: It is inaccurate to reflect the level of dust exposure through working years. Furthermore, identifying a predictive indicator for lung function decline is significant for coal miners. The study aimed to explored whether club cell secretory protein (CC16) levels can reflect early lung function changes. METHODS: The cumulative respiratory dust exposure (CDE) levels of 1,461 coal miners were retrospectively assessed by constructed a job-exposure matrix to replace working years. Important factors affecting lung function and CC16 were selected by establishing random forest models. Subsequently, the potential of CC16 to reflect lung injury was explored from multiple perspectives. First, restricted cubic spline (RCS) models were used to compare the trends of changes in lung function indicators and plasma CC16 levels after dust exposure. Then mediating analysis was performed to investigate the role of CC16 in the association between dust exposure and lung function decline. Finally, the association between baseline CC16 levels and follow-up lung function was explored. RESULTS: The median CDE were 35.13 mg/m³-years. RCS models revealed a rapid decline in forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁), and their percentages of predicted values when CDE exceeded 25 mg/m³-years. The dust exposure level (<5 mg/m³-years) causing significant changes in CC16 was much lower than the level (25 mg/m³-years) that caused changes in lung function indicators. CC16 mediated 11.1% to 26.0% of dust-related lung function decline. Additionally, workers with low baseline CC16 levels experienced greater reductions in lung function in the future. CONCLUSIONS CC16 levels are more sensitive than lung indicators in reflecting early lung function injury and plays mediating role in lung function decline induced by dust exposure. Low baseline CC16 levels predict poor future lung function.
Uteroglobin/blood* ; Humans ; Dust/analysis* ; Occupational Exposure/analysis* ; Male ; Middle Aged ; Adult ; Retrospective Studies ; Lung Injury/chemically induced* ; Coal Mining ; Biomarkers/blood* ; China/epidemiology* ; Air Pollutants, Occupational ; Female

Objective To investigate programmed death including necroptosis,apoptosis,autophagy,ferroptosis,and pyroptosis in bone marrow megakaryocytes of mice during sepsis and its impact on platelet production capacity and coagulation function in mice.Methods C57BL/6J mice were randomly divided into a sham operation group(sham group)and a sepsis model group(CLP group).Peripheral blood platelets and coagulation function were measured by abdominal aortic blood sampling at 24 h postoperatively in both sham and CLP groups.After the mice were sacrificed,long bones of both lower limbs were taken,and bone marrow megakaryocytes were extracted using megakaryocyte separation solution and immunomagnetic bead separation.Laser confocal microscopy was used to observe the activation of programmed death-related marker molecules in mouse bone marrow megakaryocytes.Flow cytometry was used to detect programmed death rate,platelet production phenotype,and platelet surface markers(CD41,CD42b,CD61)of megakaryocytes.Western blotting was used to detect the expression of programmed death-related proteins in megakaryocytes.Results Compared with the sham group,the CLP group showed significant decreases in the number of platelets during acute sepsis(24 h)(P<0.000 1),significant increases in platelet distri-bution width(PDW)and mean platelet volume(MPV)(P<0.01),significant prolonging of thrombin time(TT),prothrombin time(PT),and activated partial thromboplastin time(APTT)(P<0.000 1,P<0.001,P<0.01),and significant reduction in fibrinogen(Fib)(P<0.000 1).Compared with the Con/sham group,the LPS/CLP group exhibited significant increases in the platelet production phenotype of megakaryocyte,the number of PLP in the supernatant,and the expression levels of platelet surface markers(CD41,CD42b,CD61).The rates of megakaryocyte necroptosis/apoptosis,pyroptosis,and ferroptosis were significantly elevated at 24 h post-CLP surgery.Laser confo-cal microscopy showed significant activation of LC3,P-MLKL,Caspase-1,and Fe2+in megakaryocytes of mice after CLP surgery.Western blotting results revealed that the CLP group exhibited a significant increase in the activa-tion rate of necroptosis-related protein P-MLKL(P<0.001),a significant increase in the cleavage of pyroptosis-related proteins GSDMD and GSDMD-N(P<0.01,P<0.001,respectively),a significant increase in the expres-sion of ferroptosis-related protein ACSL4(P<0.01),and a significant decrease in the expression of GPX4(P<0.01)compared to the sham group.Additionally,the CLP group demonstrated significant increases in the expression of apoptosis-related protein Bax,the cleavage of autophagy-related protein LC3B-Ⅱ,and the expression of P62(P<0.05,P<0.001,P<0.001,respectively).Inhibition of apoptosis with programmed cell death inhibitors decreased platelet production function of megakaryocyte,while inhibition of necroptosis and pyroptosis had limited effects on platelet production function of megakaryocyte.Inhibition of ferroptosis and autophagy enhanced platelet production function of megakaryocyte.Conclusion Significant programmed death of megakaryocytes was observed during the acute phase of sepsis(24 h).Among those megakaryocytes,apoptosis is an important mechanism for the differentia-tion of platelet production phenotype and increased platelet production capacity of megakaryocyte.Overactive autophagy and ferroptosis in megakaryocytes lead to megakaryocyte dysfunction,which is an important mechanism for coagulation abnormalities in sepsis.

Objective:To explore the efficacy of intensive repetitive transcranial magnetic stimulation (irTMS) in treatment-resistant depression (TRD) and its impact on cognitive function and systemic immune-inflammation index (SII).Methods:Forty-eight TRD patients were divided into observation group and control group using random number table method, with 24 patients in each group. The observation group was treated with irTMS, and the stimulation site was the left dorsolateral prefrontal lobe. The stimulation intensity was 110% of the motor threshold, and the stimulation frequency was 15 Hz. The stimulation interval was 26 s, and 3 000 pulses were stimulated each time. Stimulating 5 times per day, with an interval of 50 min, and continuous treatment for 5 days. The total stimulation amount for 5 days was 75 000 pulses. The control group was treated with pseudo stimulation. Before treatment (T0), 5 days after treatment (T1), and 1 month after treatment (T2), 17-item Hamilton depression scale (HAMD-17) was used to assess depressive mood. Evaluating cognitive function using the Wisconsin card sorting test.A fully automated blood cell analyzer was used to detect platelet count (PLT), neutrophil count (NC), and lymphocyte count (LC), calculate the systemic immune inflammation index (SII), SII=PLT × NC/LC. Statistical analysis was conducted using SPSS 20.0 software. The comparison between two sets of repeated measurement data was performed using repeated measurement analysis of variance.Simple effect analysis was performed if the interaction effect was significant.Pearson analysis was used for correlation testing.Results:The interaction effect between the time and group of HAMD-17 scores was significant ( F=121.784, P<0.05). The results of simple effects analysis showed that the HAMD-17 scores of the observation group at T1 and T2 ((12.07±4.08) and (14.78±4.99), respectively) were lower than those of the control group ((23.78±5.87) and (24.67±7.00), P<0.05). The treatment response rate and remission rate of the observation group at T1 were higher than those of the control group ( χ2=4.090, 7.378, both P<0.05).The treatment response rate and remission rate of the observation group at T2 were higher than those of the control group ( χ2=4.463, 4.547, both P<0.05). The time and group interaction effects of the percentage of correct response and conceptualization level in the Wisconsin card sorting test were significant ( F=30.087, 20.004, P<0.05). The results of simple effects analysis showed that the percentage of correct response and conceptualization level in the observation group at T1 and T2 were higher than those in the control group (all P<0.05). The time and group interaction effect of SII was significant ( F=8.173, P<0.05). The results of simple effects analysis showed that there was no statistically significant difference in SII between the two groups at T0 ( P>0.05). The SII at T1 and T2 in the observation group was lower than that in the control group ( P<0.05). In the observation group, the changes in SII from T2 to T0 was positively correlated with the change in HAMD-17 scores ( r=0.527, P<0.05), and negatively correlated with the percentage of correct responses to the Wisconsin card sorting test ( r=-0.412, P<0.05) and the percentage of conceptualization level ( r=-0.411, P<0.05). Conclusion:irTMS is effective in treating TRD and can improve patients' cognitive function and immune inflammation damage.

Objective:To explore the efficacy of intensive repetitive transcranial magnetic stimulation (irTMS) in treatment-resistant depression (TRD) and its impact on cognitive function and systemic immune-inflammation index (SII).Methods:Forty-eight TRD patients were divided into observation group and control group using random number table method, with 24 patients in each group. The observation group was treated with irTMS, and the stimulation site was the left dorsolateral prefrontal lobe. The stimulation intensity was 110% of the motor threshold, and the stimulation frequency was 15 Hz. The stimulation interval was 26 s, and 3 000 pulses were stimulated each time. Stimulating 5 times per day, with an interval of 50 min, and continuous treatment for 5 days. The total stimulation amount for 5 days was 75 000 pulses. The control group was treated with pseudo stimulation. Before treatment (T0), 5 days after treatment (T1), and 1 month after treatment (T2), 17-item Hamilton depression scale (HAMD-17) was used to assess depressive mood. Evaluating cognitive function using the Wisconsin card sorting test.A fully automated blood cell analyzer was used to detect platelet count (PLT), neutrophil count (NC), and lymphocyte count (LC), calculate the systemic immune inflammation index (SII), SII=PLT × NC/LC. Statistical analysis was conducted using SPSS 20.0 software. The comparison between two sets of repeated measurement data was performed using repeated measurement analysis of variance.Simple effect analysis was performed if the interaction effect was significant.Pearson analysis was used for correlation testing.Results:The interaction effect between the time and group of HAMD-17 scores was significant ( F=121.784, P<0.05). The results of simple effects analysis showed that the HAMD-17 scores of the observation group at T1 and T2 ((12.07±4.08) and (14.78±4.99), respectively) were lower than those of the control group ((23.78±5.87) and (24.67±7.00), P<0.05). The treatment response rate and remission rate of the observation group at T1 were higher than those of the control group ( χ2=4.090, 7.378, both P<0.05).The treatment response rate and remission rate of the observation group at T2 were higher than those of the control group ( χ2=4.463, 4.547, both P<0.05). The time and group interaction effects of the percentage of correct response and conceptualization level in the Wisconsin card sorting test were significant ( F=30.087, 20.004, P<0.05). The results of simple effects analysis showed that the percentage of correct response and conceptualization level in the observation group at T1 and T2 were higher than those in the control group (all P<0.05). The time and group interaction effect of SII was significant ( F=8.173, P<0.05). The results of simple effects analysis showed that there was no statistically significant difference in SII between the two groups at T0 ( P>0.05). The SII at T1 and T2 in the observation group was lower than that in the control group ( P<0.05). In the observation group, the changes in SII from T2 to T0 was positively correlated with the change in HAMD-17 scores ( r=0.527, P<0.05), and negatively correlated with the percentage of correct responses to the Wisconsin card sorting test ( r=-0.412, P<0.05) and the percentage of conceptualization level ( r=-0.411, P<0.05). Conclusion:irTMS is effective in treating TRD and can improve patients' cognitive function and immune inflammation damage.

Objective To investigate programmed death including necroptosis,apoptosis,autophagy,ferroptosis,and pyroptosis in bone marrow megakaryocytes of mice during sepsis and its impact on platelet production capacity and coagulation function in mice.Methods C57BL/6J mice were randomly divided into a sham operation group(sham group)and a sepsis model group(CLP group).Peripheral blood platelets and coagulation function were measured by abdominal aortic blood sampling at 24 h postoperatively in both sham and CLP groups.After the mice were sacrificed,long bones of both lower limbs were taken,and bone marrow megakaryocytes were extracted using megakaryocyte separation solution and immunomagnetic bead separation.Laser confocal microscopy was used to observe the activation of programmed death-related marker molecules in mouse bone marrow megakaryocytes.Flow cytometry was used to detect programmed death rate,platelet production phenotype,and platelet surface markers(CD41,CD42b,CD61)of megakaryocytes.Western blotting was used to detect the expression of programmed death-related proteins in megakaryocytes.Results Compared with the sham group,the CLP group showed significant decreases in the number of platelets during acute sepsis(24 h)(P<0.000 1),significant increases in platelet distri-bution width(PDW)and mean platelet volume(MPV)(P<0.01),significant prolonging of thrombin time(TT),prothrombin time(PT),and activated partial thromboplastin time(APTT)(P<0.000 1,P<0.001,P<0.01),and significant reduction in fibrinogen(Fib)(P<0.000 1).Compared with the Con/sham group,the LPS/CLP group exhibited significant increases in the platelet production phenotype of megakaryocyte,the number of PLP in the supernatant,and the expression levels of platelet surface markers(CD41,CD42b,CD61).The rates of megakaryocyte necroptosis/apoptosis,pyroptosis,and ferroptosis were significantly elevated at 24 h post-CLP surgery.Laser confo-cal microscopy showed significant activation of LC3,P-MLKL,Caspase-1,and Fe2+in megakaryocytes of mice after CLP surgery.Western blotting results revealed that the CLP group exhibited a significant increase in the activa-tion rate of necroptosis-related protein P-MLKL(P<0.001),a significant increase in the cleavage of pyroptosis-related proteins GSDMD and GSDMD-N(P<0.01,P<0.001,respectively),a significant increase in the expres-sion of ferroptosis-related protein ACSL4(P<0.01),and a significant decrease in the expression of GPX4(P<0.01)compared to the sham group.Additionally,the CLP group demonstrated significant increases in the expression of apoptosis-related protein Bax,the cleavage of autophagy-related protein LC3B-Ⅱ,and the expression of P62(P<0.05,P<0.001,P<0.001,respectively).Inhibition of apoptosis with programmed cell death inhibitors decreased platelet production function of megakaryocyte,while inhibition of necroptosis and pyroptosis had limited effects on platelet production function of megakaryocyte.Inhibition of ferroptosis and autophagy enhanced platelet production function of megakaryocyte.Conclusion Significant programmed death of megakaryocytes was observed during the acute phase of sepsis(24 h).Among those megakaryocytes,apoptosis is an important mechanism for the differentia-tion of platelet production phenotype and increased platelet production capacity of megakaryocyte.Overactive autophagy and ferroptosis in megakaryocytes lead to megakaryocyte dysfunction,which is an important mechanism for coagulation abnormalities in sepsis.

Informed consent is an important ethical symbol in clinical research,and researchers have the responsibility to fully inform participants of the research information before conducting clinical research.However,it is difficult to obtain complete informed consent form participants or their guardians within a narrow treatment time period in clinical research conducted in emergency situations.Currently,in addition to traditional general informed consent,there are also reality-accepted informed consent,including exemption of informed consent,broad informed consent,and deferred informed consent.By introducing the origin and development process of deferred informed consent in clinical research,this paper sorted out the current application status of deferred informed consent,proposed the prerequisites for applying deferred informed consent in emergency situations,and explored the issues that need to be noted during the application process of deferred informed consent.It is hoped to provide an ethical defense and ethical procedure for the application of deferred informed consent in clinical research in emergency situations.

Objective:To explore the latent classes of recurrence risk perception in ischemic stroke patients and their relationship with health behaviors.Methods:Convenience sampling was used to select 312 patients with ischemic stroke from two ClassⅢ Grade A hospitals of Guangzhou from December 2022 to June 2023 as the research subject. Before discharge, the General Information Questionnaire, Recurrence Risk Perception Scale for Patients with Stroke, and Health Behavior Scale for Stroke Patients were used for investigation. One month later, the Health Behavior Scale for Stroke Patients was used for follow-up. Latent class analysis and multiple Logistic regression analysis were used to explore the latent classes of recurrence risk perception and their influencing factors, while multiple linear regression was used to analyze the relationship between latent classes of recurrence risk perception and health behavior at 1-month follow-up.Results:A total of 312 questionnaires were distributed, and 302 valid questionnaires were collected, with an effective response rate of 96.79%. One month later, 261 study subjects completed follow-up. The recurrence risk perception in ischemic stroke patients were divided into four classes of overall low perceived accuracy, light consequence-heavy disease-moderate perceived accuracy, heavy self-care-light diet-upper moderate perceived accuracy, and overall high perceived accuracy. Age, educational level, place of residence and monthly average income were influencing factors for different latent classes ( P<0.05). Compared with patients with overall low perceived accuracy, patients with heavy self-care-light diet-upper moderate perceived accuracy, as well as those with overall high perceived accuracy, showed better health behavior after discharge, with a statistically significant difference ( P<0.05) . Conclusions:Medical and nursing staff should provide targeted nursing interventions based on the common characteristics and individual differences of different classes of patients, helping patients correctly perceive the recurrence risk, improve health behavior, and prevent stroke recurrence.

Objective:To investigate the feasibility and value of participatory bilingual teaching in nuclear medicine teaching.Methods:With the same chapter of Nuclear Medicine as the teaching contents, the traditional method of cramming bilingual teaching was used for the clinical medical students in the class of 2014 of the seven-year program and the five-year program, and the method of participatory bilingual teaching was used for the students in the class of 2015. The methods of periodical achievement test, questionnaire survey, and final examination were used to evaluate the teaching effect of the above two teaching modes.Results:In the periodical achievement test, the participatory bilingual teaching group had significantly higher scores than the cramming teaching group in terms of mean score, case analysis, and English questions [seven-year program: (82.13±10.72), (35.74±4.13), and (23.03±3.40) vs. (79.21±11.31), (33.86±5.23), and (22.12±2.75), P<0.05; five-year program: (78.66±12.75), (34.30±5.59), and (22.45±2.91) vs. (75.29±10.81), (32.70±6.04), and (21.36±3.09), P<0.05]. The questionnaire survey showed that participatory bilingual teaching had a better degree of satisfaction than cramming teaching. The participatory bilingual teaching group had a better score than the cramming teaching group in the final examination, but with no significant difference between the two groups. Conclusions:In the teaching of nuclear medicine, the participatory bilingual teaching mode can significantly improve teaching effect and achieve the teaching goal efficiently.

Objective:To explore the value of coronary artery plaque progression parameters based on coronary CT angiography (CCTA) in predicting the occurrence of major adverse cardiovascular events (MACE) in patients with non-obstructive coronary artery disease.Methods:The study included clinical, imaging, and prognosis (MACE) parameters of non-obstructive coronary artery disease patients who underwent CCTA at the First Affiliated Hospital of Nanjing Medical University from September 2010 to December 2022. Patients were grouped based on the occurrence of MACE, and differences in clinical data, plaque baseline, and progression parameters between the two groups were compared. Univariate and multivariate Cox regression analyses were employed to identify factors that could effectively predict the occurrence of MACE in patients. Models were constructed using plaque baseline parameters, plaque progression parameters, and a combination of both. The concordance index-time curve, net reclassification improvement and integrated discrimination improvement were used to evaluate the risk stratification ability of the models.Results:A total of 258 patients were included, of whom 62 cases experienced MACE during the follow-up period. In comparison to the MACE(-) group, patients in the MACE(+) group exhibited longer lesion length, greater degree of stenosis, larger plaque total volume, calcified plaque volume, non-calcified plaque volume, fibrous plaque volume, total plaque burden, lipid-rich plaque burden, higher peri-coronary adipose tissue attenuation index (FAI), and annual change of diameter stenosis(ΔDS/y). There were also more cases of coronary artery disease reporting and data system upgrades and non-obstructive progression to obstructive status ( P<0.05). Multivariate Cox analysis revealed that FAI, ΔDS/y, and non-obstructive progression to obstructive status were independent predictors of MACE occurrence. Concordance index-time curve results indicated that the combined model had a better predictive efficacy for MACE in patients with non-obstructive coronary artery disease compared to models based on plaque baseline parameters and plaque progression parameters. Conclusion:The plaque progression parameters and FAI based on CCTA have the potential to predict the high-risk population for MACE in patients with non-obstructive coronary artery disease, demonstrating good risk stratification value.