Objective: To explore the association of outdoor activity time and sleep duration with screening myopia in primary school students, so as to provide strategies for myopia prevention. Methods: Through a convenience sampling method, a survey was conducted among 4 248 primary school students aged 7-13 years from three primary schools in Xihu District, Nanchang City, Jiangxi Province from May to July, 2023. The average daily outdoor activity time and sleep duration on both weekdays and weekends were investigated in primary school students by using a self designed questionnaire. Uncorrected visual acuity tests and non cycloplegic autorefraction were measured by professional optometrists. Inter group comparisons were conducted using the Chi square test. Logistic regression model was used to analyze the association of outdoor activity time and sleep duration with screening myopia. Results: The detection rate of screening myopia in primary school students was 33.6%, with the rate in boys (32.0%) lower than that in girls (35.3%), and the difference was statistically significant ( χ 2=5.11, P =0.02). The analysis results of Logistic regression showed that after adjusting for factors such as gender, grade and parental education level, both average daily outdoor activity time ＜2 h on both weekdays and weekends ( OR =1.27, 95% CI =1.11-1.46) and sleep duration <10 h ( OR =1.17, 95% CI =1.01- 1.35 ), as well as their combined effect ( OR =1.57, 95% CI =1.25-1.98), were associated with an increased risk of screening myopia in primary school students(all P <0.05). Subgroup analysis results indicated that compared to boys ( OR =1.46, 95% CI = 1.07 -1.99), girls( OR =1.73, 95% CI =1.22-2.44) with insufficient outdoor activity time and sleep duration had a higher risk of screening myopia(both P <0.05). Conclusions There is a negative correlation of outdoor activity time and sleep duration with screening myopia in primary school students. Outdoor activity time and extending sleep duration should be increased to reduce the risk of myopia in primary school students.

Objective: To analyze the mediating effects of loneliness and depressive symptoms on family functioning and life satisfaction among rural elderly patients with chronic diseases, so as to provide the basis for improving the life satisfaction of this population. Methods: Rural elderly patients with chronic diseases aged ≥60 years in Qiannan Buyi and Miao Autonomous Prefecture, Guizhou Province were selected using a multi-stage stratified random cluster sampling method from June to September 2022. Basic information such as gender, age, and chronic diseases were collected. Family function, life satisfaction, loneliness and depressive symptoms were evaluated using Family Care Index Scale, the Satisfaction with Life Scale, the b-item Revised VCLA Loneliness Sale and the 15-item Geriatric Depression Scale, respectively. The structural equation model was constructed using Amos software to analyze the mediating effects of loneliness and depressive symptoms on the relationship between family function and life satisfaction. The Bootstrap method was employed to test the mediating effects. Results: A total of 1 145 rural elderly patients with chronic diseases were recruited, including 517 males (45.15%) and 628 females (54.85%). Among the participants, 657 individuals (57.38%) were aged 60-<71 years, and 540 individuals (47.16%) had three or more chronic diseases. The scores for family function, life satisfaction, loneliness, and depressive symptoms were (3.90±1.18), (18.88±5.25), (12.88±2.99), and (6.65±2.26), respectively. Mediating effect analysis showed that family function had a direct positive effect on life satisfaction (β=0.179, 95%CI: 0.126-0.231). It also indirectly positively influenced the life satisfaction of rural elderly patients with chronic diseases through the independent mediating effect of depressive symptoms (β=0.035, 95%CI: 0.021-0.054) and the chained mediating effect of loneliness and depressive symptoms (β=0.021, 95%CI: 0.013-0.030). The mediating effect of depressive symptoms accounted for 14.89% of the total effect, while the chained mediating effect of loneliness and depressive symptoms accounted for 8.94% of the total effect. Conclusion Good family function can directly enhance the life satisfaction of rural elderly patients with chronic diseases and can also indirectly improve their life satisfaction by reducing loneliness and depressive symptoms.

Objective:To explore the clinical phenotypes and hematological characteristics of β-thalassemia combined with α-globin gene triplet.Methods:A retrospective case analysis study was conducted, taking individuals diagnosed with thalassemia who sought for outpatient services in No 1 people′s hospital of Chenzhou affiliated to South China University from August 10, 2021, to December 31, 2023 as study objectives. Among them, there were 8 768 males and 11 707 females, aged 31.5 (23.0, 46.0) years old. Blood analysis were analyzed by hematology analyze.The hemoglobin(Hb) Hb A, HbA 2,Hb F bands were analyzed by Capillary electrophoresis method, and the genotypes of thalassemia were analyzed by high-throughput sequencing technology.Hematological parameters between different genotypes of thalassemia were analyzed using t-tests and calibrated t-tests for data analysis. Results:A total of 27 cases of beta thalassemia combined with alpha globin triplet were detected, The average hemoglobin (Hb) of 11 cases of β Codon41/42 (-CTTT)/β N combined with ααα anti 4.2 (3.7) (92±16)g/L was lower than that of β Codon41/42 (-CTTT)/β N(112±11)g/L, and the difference was statistically significant ( t=3.97, P0.05). The average Hb of 8 cases of β IVS-Ⅱ-654 (CT)/β N combined with ααα anti 4.2 (3.7)(85±21) g/L was lower than that of β IVS-Ⅱ-654 (CT)/β N(116±12) g/L, and the difference was statistically significant ( t=4.05, P0.05). Conclusion:When the mutation site is at Codon41/42 (-CTTT) or IVS-Ⅱ-654 (CT), β-thalassemia combined with alpha globin triplet can make the clinical manifestations of β-thalassemia at this site more pronounced.

Objective To study the application effects of a hypertension self-management intervention program based on the chronic illness trajectory framework(CITF).Methods A total of 100 hypertension pa-tients treated at Qiandongnan Miao and Dong Autonomous Prefecture People's Hospital and hypertension management demonstration sites from July 2023 to July 2024 were selected as study subjects.They were ran-domly divided into a study group and a control group(50 cases in each group)using a random number table method.The control group received conventional intervention,including basic measures such as hypertension education,dietary management,psychological counseling,medication guidance,and blood pressure monitoring.The study group received a personalized self-management intervention program based on CITF.Blood pres-sure,medication adherence,hypertension knowledge level,and chronic disease management self-efficacy were compared between the two groups at baseline(before intervention)and 3 months after intervention(after in-tervention).Results After the intervention,systolic and diastolic blood pressure decreased in both groups compared to pre-intervention levels,with the study group showing lower values than the control group(P<0.05).The scores of hypertension knowledge level scale(HK-LS),MMAS-8,and chronic disease management self-efficacy scale increased in both groups compared to pre-intervention levels,with the study group scoring higher than the control group(P<0.05).Conclusion The CITF-based self-intervention program effectively improves patients'blood pressure levels,enhances health knowledge level,medication adherence,and chronic disease self-management efficacy,promoting proactive disease coping and strengthened self-management.

Objective The pathogenic characteristics of Escherichia coli(E.coli)in bacterial infections were analyzed using a combination of multiple molecular typing techniques in order to provide evidence for the management of clinical medication safety.Methods Samples from some bacterial infection-related cases in a district of Chongqing in 2021 were collected.A total of 30 E.coli strains were selected by a completely random method,and phoA gene PCR assay was performed for identification.Molecular typing of the strains was analyzed using pulsed-field gel electrophoresis(PFGE)and multilocus sequence typing(MLST).Antimicrobial susceptibility testing was conducted to determine the drug resistance of the strains,and four β-lactamase-encoding genes(blaCTX-M,blaTEM,blaSHV,blaZ)were selected to detect the carriage of resistance genes.Results All 30 E.coli strains displayed the phoA gene target band.Their PFGE banding patterns,with a similarity of 50%～98%,could be classified into 8 clusters.Cluster C was the dominant group,accounting for 53.3%(16/30).C1 and C2 exhibited high genetic correlation,indicating a close phylogenetic relationship.One E.coli strain could not be assigned a sequence type(ST)by MLST,while the remaining 29 E.coli isolates were classified into 16 different STs,demonstrating a polymorphic distribution.Among them,10 isolates belonged to ST131(10/30,33.33%).Evolutionary analysis of the 10 ST131 E.coli strains revealed their distribution across different branches,indicating varying degrees of genetic relatedness.Antimicrobial susceptibility testing revealed that all 30 E.coli strains exhibited varying degrees of resistance,with the highest resistance rate observed against the β-lactam antibiotic ampicillin(25/30,83.33%).Among them,60.0%were multidrug-resistant bacteria(MDRB).These MDRB strains exhibited 16 distinct resistance profiles,displaying a scattered distribution without a dominant resistance pattern.50.0%(9/18)of the MDRB strains exhibited six-drug resistance,while the most drug-resistant strain showed eight-drug resistance.Furthermore,the blaCTX-M gene carriage rate among the 30 E.coli strains was 86.67%(26/30),while no blaZ gene was detected.Conclusion E.coli related to bacterial infections from a Chongqing district exhibited diverse PFGE/MLST patterns and significant drug resistance.The application of multiple molecular typing techniques can reveal the genetic diversity,evolutionary relationships,and antimicrobial resistance characteristics of pathogenic bacteria.Countermeasures It is recommended to enhance the molecular typing and drug resistance surveillance network for pathogenic bacteria,establish an early warning mechanism,and implement hierarchical management of antibiotics,thereby improving targeted prevention and epidemic traceability capabilities for key drug-resistant bacteria such as ST131.

Objective To explore the current status and its influencing factors of electronic health literacy of caregivers of total laryngectomy patients and its influencing factors.Methods A total of 145 caregivers of total laryngectomy patients who were admitted to The First Affiliated Hospital of Naval Medical University from August 2018 to August 2023 were selected by convenience sampling.A questionnaire survey was conducted on these caregivers by demographic data questionnaire,electronic health literacy scale(e-HLS),and general self-efficacy scale.Results The average total score of electronic health literacy among the caregivers was 25.09±5.31.One-way analysis of variance showed that there were significant differences in the scores of e-HLS among caregivers with different age,education level,self-efficacy,frequency of online health information search,and disease course(P<0.05).Multivariate logistic regression analysis showed that age,education level,self-efficacy,frequency of online health information search,and disease course were the main factors affecting the electronic health literacy of caregivers of total laryngectomy patients.Conclusion Electronic literacy of caregivers of total laryngectomy patients is at a low level,and it was affected by many factors.Appropriate guidance can be provided to caregivers with low electronic health literacy,so as to improve the electronic health literacy of caregivers and the quality of care for total laryngectomy patients.

Objective To compared the clinical efficacy of mechanical thrombectomy and standard medication therapy in the treatment of patients with acute vertebrobasilar arterial occlusive mild stroke.Methods The clinical data of a total of 105 patients with acute vertebrobasilar arterial occlusive mild stroke,who were admitted to the Tianchang Municipal People's Hospital of China from January 2019 to December 2023,were retrospectively analyzed.According to the therapeutic scheme,the patients were divided into mechanical thrombectomy group(n=37)and standard medication therapy group(n=68).Based on the age,sex,onset-to-admission interval,National Institutes of Health Stroke Scale(NIHSS)score,the propensity score matching with 1∶1 ratio was conducted for the patients.The clinical outcome was compared between the two groups.Results After propensity score matching,a total of 68 patients were enrolled in this study,with 34 patients in each group.The mean age was(68.3±11.9)years,45 patients(66.2％)were male,and the median NIHSS score was 2 points.No statistically significant differences in the baseline data existed between the two groups(all P＞0.05).In the standard medication therapy group,10 patients(29.4％)developed early deterioration of the neurological functions,and the median NIHSS score was 12 points,all the 10 patients received salvage mechanical thrombectomy,and 9 patients achieved a successful recanalization.Follow-up check at 90 days after surgery showed that modified Rankin scale(mRS)score of 0-1 point was seen in one patient,and 0-2 points was seen in 2 patients.The proportions of 90-day mRS score of 0-1 point and 0-2 points in the mechanical thrombectomy group were remarkably higher than those in the standard medical therapy group(67.6％vs.41.2％and 85.3％vs.61.8％respectively,both P＜0.05).No statistically significant differences in the hemorrhagic transformation rate(5.9％vs.8.8％)and 90-day mortality(5.9％vs.14.7％)existed between the two groups(both P＞0.05).Conclusion Compared with standard medication therapy,the mechanical thrombectomy can improve the clinical prognosis of patients with acute vertebrobasilar arterial occlusive mild stroke and will not increase the incidence of surgical complications.Therefore,acute vertebrobasilar occlusive mild stroke may be a good indication for mechanical thrombectomy treatment.

Objective To investigate the impacts of knocking-down Keratin 17(KRT17)on proliferation,apoptosis and epithelial mesenchymal transition(EMT)of bladder cancer cells by regulating Wnt/β-catenin signaling pathway.Methods The expression of KRT17 mRNA and protein in bladder cancer tissue,adjacent tissue,bladder cancer cell lines(5637,T24 and UM-UC-3)and human immortalized urothelial cell line SV-HUC-1 were detected by qRT-PCR and Western blot assay.Immunohistochemical staining was used to detect the expression of KRT17 in the tissues.Cells transfected with NC siRNA and KRT17 siRNA were labeled as the NC siRNA group and the KRT17 siRNA group,respectively.T24 cells treated with 20 mmol/L LiCl were labeled as the LiCl group.T24 cells transfected with KRT17 siRNA and treated with 20 mmol/L LiCl were labeled as the KRT17 siRNA+LiCl group.The non transfected cells were used as the blank group.CCK-8,cloning formation experiment and flow cytometry were applied to detect cell proliferation and apoptosis.QRT-PCR was applied to detect KRT17 mRNA expression.Western blot assay was applied to detect the expression levels of KRT17,β-catenin,Cyclin D1,EMT related proteins Vimentin,E-cadherin and Snail1 proteins.Results The expression of KRT17 mRNA and protein was greatly increased in bladder cancer tissue and cells(P＜0.05).The cell proliferation,colony count,KRT17 mRNA and protein expression,β-catenin,Cyclin D1,Vimentin,and Snail expression were lower in the KRT17 siRNA group than those in the NC siRNA group and the blank group,while apoptosis and E-cadherin expression were higher(P＜0.05).LiCl reversed the inhibition of KRT17 knockdown on the malignant behavior of bladder cancer.Conclusion Knocking-down KRT17 inhibits the proliferation and EMT of bladder cancer cells and promotes their apoptosis by inhibiting Wnt/β-catenin signaling pathway.

Objective:To compare and analyze the efficacy of bilateral and unilateral posterior vocal cord resection with CO 2 laser under endoscopy in the treatment of bilateral vocal cord paralysis. Methods:This case series study retrospectively analyzed the data of 110 patients with bilateral vocal cord paralysis who underwent endoscopic CO 2 laser posterior cordotomy at the Department of Otolaryngology-Head and Neck Surgery, the First Affiliated Hospital of Naval Medical University, from October 2016 to January 2023. The cohort consisted of 36 males [mean age (45.5±9.1) years, range 24-72 years] and 74 females [mean age (47.2±10.1) years, range 22-67 years]. Among them, 47 patients underwent simultaneous bilateral posterior cordotomy (bilateral cordotomy group), while 63 patients underwent unilateral posterior cordotomy (unilateral cordotomy group). Pre-and postoperative indicators, including swallowing function, glottal size, and vocal function (subjective and objective assessments), were compared between the two surgical approaches. The Wilcoxon signed-rank test was used to analyze changes in swallowing function, glottal size, and vocal function (subjective and objective assessments) within each group before and after surgery, whereas the Mann-Whitney U test was utilized to assess differences between groups. Results:Postoperative follow-up was 1-5 years [median follow-up time was 1.6 (1.3, 2.0) years].The one-time extubation rate was 71.4%(45/63)in the unilateral posterior vocal cord resection group and 87.2%(41/47)in the bilateral posterior vocal cord resection group, significantly higher in the bilateral group ( χ2=3.94, P<0.05). One week after surgery, the swallowing function score of unilateral cordotomy group was 2 (1, 2.5) points, which was significantly better than that of bilateral cordotomy group [2 (1.5, 3) points, Z=-2.118, P<0.05], and the swallowing function score of both groups returned to normal 3 months after surgery. There were no significant differences in preoperative glottic closure during inhalation, auditory perceptual evaluation (GRBAS), objective voice analysis, and Voice Handicap Index-10 (VHI-10) between the two groups ( P>0.05). Postoperatively, the maximum transverse diameter of the posterior glottis during inspiration in the unilateral cordotomy group was 4.49 (4.24, 4.77) mm, significantly smaller than that in the bilateral cordotomy group, which was 5.05 (4.52, 5.62) mm ( Z=-4.103, P<0.05). Among the GRBAS parameters, G (grade of hoarseness), B (breathiness), and A (asthenia), as well as VHI-10 scores and objective voice analysis parameters [jitter, shimmer, harmonic-noise ratio (HNR), and maximum phonation time (MPT)], were significantly better in the unilateral cordotomy group compared to the bilateral cordotomy group, with statistically significant differences ( P<0.05). Conclusions:Unilateral posterior vocal cord resection using CO 2 laser is simple and feasible for the treatment of bilateral vocal cord paralysis, with shorter recovery time, maximal preservation of laryngeal phonatory function, and fewer complications compared to bilateral resection. However, the one-time extubation rate is higher with bilateral resection, reducing the need for a second surgery and associated patient discomfort. This study offers guidance for clinical decision-making in the surgical management of bilateral vocal cord paralysis.

Objective:To analyze the expression of heat shock protein 90α (HSP90α) in pancreatic cancer tissues and its potential diagnostic value for pancreatic cancer.Methods:A retrospective study was conducted on surgical specimens and clinical data from 99 patients with pancreatic cancer who were treated at Qingdao Municipal Hospital from January 2018 to May 2023, including 58 males and 41 females, with the age of (63.5±23.5) years. Among them, 44 patients (44.4%) were used for pathological examination and prognostic analysis, while 55 patients (55.6%) were tested for plasma HSP90α levels to evaluate its diagnostic efficacy for pancreatic cancer. Blood samples from 119 healthy individuals undergoing routine physical examinations at the same hospital during the same period were collected, including 74 males and 45 females, with the age of (50.5±25.5) years, and plasma HSP90α levels were measured. Immunohistochemistry (IHC) was performed to detect the expression of HSP90α in cancerous and adjacent non-cancerous tissues. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic performance of HSP90α, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and carbohydrate antigen 125 (CA125) for pancreatic cancer. Survival analysis was conducted using the Kaplan-Meier method, and the log-rank test was used to compare survival rates. The correlation between HSP90α positive expression in cancer tissues and mutant p53 positive expression was analyzed using Spearman correlation analysis.Results:Immunohistochemical analysis showed that the positive expression rate of HSP90α in pancreatic cancer tissues was 81.8%(36/44), higher than that in adjacent non-cancerous tissues 13.6%(6/44)( χ2=19.82, P<0.01). HSP90α positive expression in pancreatic cancer tissues was positively correlated with mutant p53 positive expression (correlation coefficient was 0.57, P<0.001). The median plasma HSP90α level in the pancreatic cancer group ( n=55) was 83.30 (48.30, 212.00) μg/L, which was significantly higher than that in the normal control group ( n=119), with a median of 37.00 (29.20, 43.50) μg/L, showing a statistically significant difference ( Z=-7.34, P<0.001). The area under the ROC curve (AUC) for plasma HSP90α in diagnosing pancreatic cancer was 0.85 (95% CI: 0.77-0.92), with an optimal cutoff value of 53.52 μg/L, yielding a sensitivity of 69.1% (38/55) and a specificity of 98.3% (117/119). The AUC for HSP90α in diagnosing pancreatic cancer was higher than that of CEA, CA19-9, and CA125. In the immunohistochemical analysis of cancer tissues, the one-year cumulative survival rate of the HSP90α-negative group ( n=8) was 87.5%, which was significantly higher than that of the HSP90α-positive group ( n=36), which was 18.8%( χ2=12.74, P<0.001). Conclusions:HSP90α is highly expressed in pancreatic cancer tissues, which is positively correlated with mutant p53 positive expression. Patients with positive HSP90α expression have a poorer prognosis. HSP90α demonstrates good diagnostic performance for pancreatic cancer and holds potential for clinical application.