Objective: To investigate the mediating role of vaccine literacy between vaccine knowledge and vaccine hesitancy and the moderating role of parental education level, so as to provide references for adjusting vaccination strategies. Methods: From May to December 2024, a stratified random sampling method was used to select 10 community hospitals in Guiyang and Zunyi City, Guizhou Province. A total of 1 401 parents of children aged 0-6 years were surveyed regarding their socio demographic characteristics, vaccine knowledge, vaccine literacy, and vaccine hesitancy levels. Data were analyzed using common method bias tests, Spearman correlation analysis, mediation and moderation effects tests. Results: The mean score for vaccine knowledge, vaccine literacy and vaccine hesitancy were (2.96±1.11, 14.25±2.64, 39.12±4.93) among the 1 401 participants. Mediating effect analysis showed that both parental vaccine knowledge ( β =1.28, 95% CI =1.08-1.49) and vaccine literacy ( β =0.75, 95% CI =0.66-0.84) positively predicted vaccine hesitancy (both P <0.01). Meanwhile, vaccine literacy accounted for 28.1% of the total effect of mediation between knowledge and vaccine hesitancy. In the moderated effects analysis, education level positively predicted vaccine literacy ( β =0.40, 95% CI =0.24-0.57), and education level moderated the pathway of vaccine knowledge on vaccine hesitancy ( β = 0.28 , 95% CI =0.05-0.52) (both P <0.01). Conclusions Vaccine literacy partially mediates the relationship between vaccine knowledge and vaccine hesitancy. Parental education level positively moderates the prediction of vaccine knowledge on vaccine hesitancy score.

Objective: To investigate the association between the physical fitness index (PFI) and symptoms of depressive, anxiety and stress symptoms among college students, providing a reference for mental health interventions. Methods: From June to September 2025, combined convenience and cluster random sampling approach was used to administer questionnaire surveys and perform physical fitness tests on 2 712 college students from Zhejiang Chinese Medical University. The Depression Anxiety Stress Scales-21 Items (DASS-21) was used to assess mental health status. Chi square test and multivariate Logistic regression analysis were used to determine the associations between the PFI and the PFI component indicators with depressive, anxiety and stress symptoms. Results: The prevalence of depressive, anxiety and stress among college students were 24.26%, 33.22% and 13.68%, respectively. Statistically significant differences in the prevalence of these symptoms were detected across groups differing in sleep quality, physical activity, weekly breakfast frequency, and history of low back or neck pain ( χ 2=9.33-151.83, all P <0.05). After adjusting for confounding factors, Logistic regression revealed that the moderate and high PFI groups had significantly reduced risks of depressive and anxiety compared to the low PFI group ( OR =0.73, 0.63; 0.61, 0.72, all P <0.05). Poor speed (50 m run) and lower body strength (standing long jump) emerged as common risk factors affecting anxiety and depressive symptoms in both male and female college students (all P <0.05). Increased muscle strength (sit up for 1 min) in female students reduced the risk of depressive ( OR =0.81), anxiety ( OR =0.85), and stress symptoms ( OR =0.79) (all P <0.05). Enhanced lung capacity in male students decreased the risk of depressive ( OR =0.84) and anxiety symptoms ( OR =0.85) (both P <0.05). Conclusions The PFI is negatively correlated with depressive and anxiety symptoms among college students with notable gender differences. Insufficient speed and lower body explosive power represent common risk factors for mental health among male and female college students.

Objective:To investigate the impact of proximal versus total gastrectomy on survival outcomes in patients with advanced upper gastric cancer following neoadjuvant therapy, aiming to provide evidence-based guidance for optimal surgical approach selection.Methods:A retrospective cohort study was conducted to collect clinical data from 114 patients with upper gastric cancer who underwent surgical treatment after neoadjuvant therapy in the PLA General Hospital between November 2014 and November 2023, consisting of 96 males and 18 females, with an age range of 41 to 78 years and a median age of 64 years. According to the extent of surgical resection, 44 patients underwent proximal gastrectomy (PG), and 70 patients underwent total gastrectomy (TG). Propensity score matching was used to match patients with advanced upper gastric cancer who received proximal gastrectomy or total gastrectomy after neoadjuvant therapy based on factors such as gender, age, surgical approach, BMI, ypT stage, ypN stage, tumor size, R0 resection status, neoadjuvant therapy cycles, and neoadjuvant therapy regimen, with a 1∶1 matching ratio. In the end, 44 patients in the PG group and 44 patients in the TG group were successfully matched and analyzed. The primary outcomes were overall survival (OS) and disease-free survival (DFS), while secondary outcomes included operative duration, R0 resection rate, complication rate, total number of lymph nodes dissected, number of lymph nodes dissected in each group, and lymph node metastasis rate. Data analysis was performed using SPSS 25.0, and survival curves were generated using the Kaplan-Meier (K-M) method.Results:After propensity score matching, the operative time in the TG group was significantly longer than that in the PG group [(222.0±42.5) min vs (257.0±62.0) min, χ2=3.07, P=0.003], while the differences in other baseline characteristics between the two groups were not statistically significant ( P>0.05). In terms of postoperative complications, the incidence of Clavien-Dindo grade II or higher complications was 29.5% in the PG group and 34.1% in the TG group ( P=0.819), indicating no significant difference. The 5-year overall survival (OS) rates were 55.8% for the PG group and 49.5% for the TG group ( P=0.592), showing no statistically significant difference. Lymph node metastasis rates in the TG group were 5.71% (4/70) in group 4d, 4.29% (3/70) in group 5, 2.86% (2/70) in group 6, and 2.86% (2/70) in group 12a. Conclusions:For patients with advanced upper gastric cancer who undergo proximal gastrectomy or total gastrectomy following neoadjuvant therapy, there is no significant difference in perioperative complications and long-term survival rates. Therefore, proximal gastrectomy is a safe and reliable option for these patients, allowing partial preservation of gastric function and potentially improving quality of life.

AIM:To investigate the role of Epac/Rap1 signaling pathway in hypoxia-reoxygenation injury in H9c2 cells,and to explore the mechanism of vitexin regulating the Epac/Rap1 signaling path-way to protect cardiomyocytes from hypoxia-reoxy-genation injury.METHODS:The oxygen glucose de-privation(OGD)model was established using H9c2 cardiomyocytes to simulate hypoxia-reoxygenation injury.The experiment was randomly divided into 7 groups:Normal control group,OGD group,OGD+VT group,OGD+8-CPT+VT group,OGD+ESI-09+VT group,OGD+8-CPT+VT+H-89 group,OGD+ESI-09+VT+H-89 group.Cell viability was measured by MTT.LDH was used to detect cell damage.The ex-pression levels of Epac1 and its downstream Rap1-GTP,CaMK Ⅱ and ERK proteins in H9c2 cells were detected by Western blot.The expression of Epac1 and Rap1 proteins in H9c2 cardiomyocytes was de-tected by immunofluorescence.The mRNA expres-sion of Rap1 and Epac1 in H9c2 cardiomyocytes was quantitatively determined by real-time PCR.Calcium ion fluorescence probe(Fluo-3 AM)was used to detect intracellular[Ca2+]i content.The in-teraction between Epac1 and Rap1 in cells were de-tected by Co-IP.RESULTS:Compared with the nor-mal control group,after hypoxia for 5 h and reoxy-genation for 1 h,the release of LDH,cell viability,Epac1 protein expression,Rap1 activation and RAP1-GTP up-regulation of H9c2 cardiomyocytes in OGD group were significantly increased.VT(10μmol/L)significantly inhibited the activation of Epac1 in H9c2 cardiomyocytes after OGD,and then inhibited the expression of downstream Rap1 ac-tive form Rap1-GTP.In addition,the expression of CaMK Ⅱ protein was down-regulated,but ERK phosphorylation was increased,and intracellular calcium overload was alleviated.Epac1 agonist 8-CPT could counteract the effect of VT,and Epac1 in-hibitor(ESI-09)combined with VT had synergistic effect.PKA inhibitor(Hmur89)had no effect on the expression of Epac1 and its downstream related proteins in cardiomyocytes.CONCLUSION:Hypoxia-reoxygenation can mediate the activation of Epac1/Rap1 signal pathway in cardiomyocytes.VT can pro-tect cardiomyocytes from hypoxia-reoxygenation in-jury by inhibiting Epac1/Rap1 signal pathway,down-regulating CaMK Ⅱ protein expression and promoting ERK phosphorylation.

Objective:To explore and analyze the clinical features and prognostic factors of secondary intestinal diffuse large B-cell lymphoma(SI-DLBCL),in order to provide reference for the basic research and clinical diagnosis and treatment of secondary lymphoma of rare sites in the field of hematology.Methods:The clinical data of 138 patients with SI-DLBCL admitted to Fujian Medical University Union Hospital from June 2011 to June 2022 were collected and sorted,the clinical and pathological features,diagnosis,treatment and prognosis were analyzed.Cox regression risk model was used to conduct univariate and multivariate analysis on the prognostic risk factors.Results:Among the 138 patients with SI-DLBCL included in this study,85(61.59％)were male,53(38.41％)were female,the median age of onset was 59.5(16-84)years,the clinical manifestations lacked specificity,the first-line treatment regimen was mainly chemotherapy(67.39％),94 cases(68.12％)received chemotherapy alone,40 cases(28.98％)were treated with chemotherapy combined with surgery,and 4 cases(2.90％)were treated with surgery alone.The median follow-up time was 72(1-148)months.Among the 138 patients with SI-DLBCL,79(57.25％)survived,34(24.64％)died,25 cases(18.12％)lost to follow-up,the PFS rates of 1-year,3-year and 5-year were 57.97％,49.28％and 32.61％,and the OS rates of 1-year,3-year and 5-year were 60.14％,54.35％and 34.06％,respectively.The results of univariate Cox regression analysis showed that age,Lugano stage and IPI score were the influencing factors of OS in SI-DLBCL patients,and age,Lugano stage and IPI score were the influencing factors of PFS in SI-DLBCL patients.The results of multivariate Cox analysis showed that Lugano stage was an independent prognostic factor affecting OS and PFS in SI-DLBCL patients.Conclusion:Patients with SI-DLBCL are more common in middle-aged and elderly men,and the early clinical manifestations lack specificity,and the first-line treatment regimen is mainly R-CHOP chemotherapy,and Lugano stage is an independent prognostic factor affecting OS and PFS in SI-DLBCL patients.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To analyze the literature on artificial intelligence in forensic research from 2012 to 2022 in the Web of Science Core Collection Database,to explore research hotspots and developmen-tal trends.Methods A total of 736 articles on artificial intelligence in forensic medicine in the Web of Science Core Collection Database from 2012 to 2022 were visualized and analyzed through the litera-ture measuring tool CiteSpace.The authors,institution,country(region),title,journal,keywords,cited references and other information of relevant literatures were analyzed.Results A total of 736 articles published in 220 journals by 355 authors from 289 institutions in 69 countries(regions)were identi-fied,with the number of articles published showing an increasing trend year by year.Among them,the United States had the highest number of publications and China ranked the second.Academy of Forensic Science had the highest number of publications among the institutions.Forensic Science Inter-national,Journal of Forensic Sciences,International Journal of Legal Medicine ranked high in publica-tion and citation frequency.Through the analysis of keywords,it was found that the research hotspots of artificial intelligence in the forensic field mainly focused on the use of artificial intelligence technol-ogy for sex and age estimation,cause of death analysis,postmortem interval estimation,individual identification and so on.Conclusion It is necessary to pay attention to international and institutional cooperation and to strengthen the cross-disciplinary research.Exploring the combination of advanced ar-tificial intelligence technologies with forensic research will be a hotspot and direction for future re-search.

Ruxolitinib， a small molecule inhibitor， selectively targets Janus kinase （JAK） by competitively binding to adenosine triphosphate on the catalytic site of the JAK1 and JAK2 domain， thereby inhibiting JAK activation and signal transducer and activator of transcription （STAT） phosphorylation and prevents the expressions of the JAK-STAT signaling pathway. Oral ruxolitinib has demonstrated promising efficacy for myelofibrosis and polycythemia vera. The topical Ruxolitinib cream， approved by the US FDA as the first non-segmental vitiligo home treatment drug， is set to be launched in domestic medical pioneer areas in August 2023 and is expected to bring about a breakthrough in the treatment of vitiligo. Clinical cases have also shown that Ruxolitinib cream has significant curative effects on atopic dermatitis， alopecia areata， and other conditions， indicating great application prospects.

Social behavior is extremely important for the physical and mental health of individuals, their growth and development, and for social development. Social behavioral disorders have become a typical clinical representation of a variety of psychiatric disorders and have serious adverse effects on the development of individuals. The prefrontal cortex, as one of the key areas responsible for social behavior, involves in many advanced brain functions such as social behavior, emotion, and decision-making. The neural activity of prefrontal cortex has a major impact on the performance of social behavior. Numerous studies demonstrate that neurons and glial cells can regulate certain social behaviors by themselves or the interaction which we called neural microcircuits; and the collaboration with other brain regions also regulates different types of social behaviors. The prefrontal cortex (PFC)-thalamus projections mainly influence social dominance and social preference; the PFC-amygdala projections play a key role in fear behavior, emotional behavior, social exploration, and social identification; and the PFC-nucleus accumbens projections mainly involve social preference, social memory, social cognition, and spatial-social associative learning. Based on the above neural mechanism, many studies have focused on applying the non-invasive neurostimulation to social deficit-related symptoms, including transcranial magnetic stimulation (TMS), transcranial electrical stimulation (TES) and focused ultrasound stimulation (FUS). Our previous study also investigated that repetitive transcranial magnetic stimulation can improve the social behavior of mice and low-intensity focused ultrasound ameliorated the social avoidance behavior of mice by enhancing neuronal activity in the prefrontal cortex. In this review, we summarize the relationship between neurons, glial cells, brain projection and social behavior in the prefrontal cortex, and systematically show the role of the prefrontal cortex in the regulation of social behavior. We hope our summarization will provide a reference for the neural mechanism and effective treatment of social disorders.

Objective:To evaluate the application effect of a new type of laparoscopic multi-degree-of-freedom surgical instrument in the training of basic surgical skills and analyze the learning curve.Methods:The teaching records of the trainees who received training in the training base of laparoscopic surgeons in Chinese People′s Liberation Army General Hospital from January to October, 2023 were collected. The 50 trainees were randomly divided into conventional instrumentation group and new instrumentation group with 25 trainees in each group according to the random number table method before the training. According to the research design, five modules such as "accurate bean clamping, plum blossom pile bean clamping, ferrule positioning, threading with both hands, sewing and knotting" were trained. After the training, they were assessed and the completion time of each module was recorded. The comparison of the changes of the completion time of the two groups of students before and after training was statistically analyzed by differences-in-differences(DID) method, and the fitting analysis of learning curve was analyzed by cumulative summation method .Results:Before the training, there was no statistically significant difference in the time required to complete five modules between the two groups of trainees (all P>0.05). After the training, the time to complete the five modules in both groups was reduced compared to before the training (accurate bean clamping: (63.7±9.3) seconds vs. (85.4±18.2) seconds, t=2.38, P=0.035; plum blossom pile bean clamping: (45.2±6.8) seconds vs. (103.1±57.2) seconds, t=8.77, P=0.047; ring positioning: (78.5±19.1) seconds vs. (126.2±26.3) seconds, t=6.96, P=0.019; threading with both hands: (63.3±21.2) seconds vs. (105.8±27.9) seconds, t=3.43, P=0.015; sewing and knotting: (160.2±79.5) seconds vs. (228.9±96.6) seconds, t=4.58, P=0.008).The average time required to complete the five modules was shorter in the new instrument group compared to the conventional instrument group (DID for accurate bean clamping=37.66, t=2.43, P=0.007; DID for plum blossom pile bean clamping=58.42, t=3.03, P=0.013; DID for ferrule positioning=28.33, t=2.83, P=0.031; DID for threading with both hands=48.89, t=2.10, P=0.042; DID for sewing and knotting=54.78, t=3.57, P=0.012). In the learning curves for the plum blossom pile bean clamping, ferrule positioning, and sewing and knotting modules, the new instrument group required fewer class hours to reach proficiency compared to the conventional instrument group (plum blossom pile bean clamping: 3 class hours vs. 4 class hours; ferrule positioning: 4 class hours vs. 5 class hours; sewing and knotting: 3 class hours vs. 5 class hours). In the accurate bean clamping and threading with both hands modules, both the conventional and new instrument groups crossed the learning curve at the 5 th class hour, but there was a statistically significant difference in the slopes of the curves between the two groups (accurate bean clamping: t=-2.85, P=0.004; threading with both hands: t=-2.66, P=0.008). Conclusion:The new type of laparoscopic multi-degree-of-freedom surgical instruments can improve the learning effect and shorten the learning curve in laparoscopic training teaching, which shows good application effect and has the possibility of clinical trial.