Objective: To understand the impact of childhood trauma on psychological distress among upper grade elemetary school students, and to explore the mediating role of leisure activities in the relationship, so as to provide a basis for developing mental health intervention strategies. Methods: From August to November 2024, a combination of convenience sampling and stratified cluster random sampling was employed to recruit 1 373 fourth to sixth grade students from four primary schools in Harbin. The Childhood Trauma Questionnaire(CTQ), a self designed leisure activity scale (including active and passive leisure activities), and the Kessler Psychological Distress Scale (K10) were used to assess childhood trauma experiences, leisure activities, and levels of psychological distress. Spearman correlation analysis and linear regression analysis were conducted to explore the relationships among childhood trauma, leisure types, leisure time, and psychological distress. Based on the mediation analysis framework proposed by Hayes (Model 4), the mediating role of leisure types in the relationship between childhood trauma and psychological distress was examined. Results: Totally 19.1% of the upper elemetary school students exhibited psychological distress, while 30.2% had experienced childhood trauma. During school days, 64.6% of the students were reported of having leisure time concentrated between 1 and 5 hours per day, whereas 67.4% reported leisure time exceeding 5 hours per day on weekends. After controlling for potential demographic confounders such as gender, grade, ethnicity, household registration, being an only child, parents educational level, co residence, and whether parents are first time married,linear regression analysis showed that childhood trauma experience had positive predictive effect on psychological distress in upper primary school students( β =0.20, P <0.01). Leisure time showed no statistically significant association with psychological distress, both on school days ( β =-0.58 to -0.56) and weekends ( β =0.26- 0.98 )(all P >0.05). Active leisure activities were negatively associated with psychological distress ( β =-0.20), while passive leisure activities were positively associated with psychological distress ( β =0.29)(both P <0.01). Leisure type partially mediated the relationship between childhood trauma and psychological distress, accounting for 11.7% of the indirect effect. Conclusion Childhood trauma experiences positively predict psychological distress in upper elementary school students, and affect psychological distress through active leisure and passive leisure.

Objective: To evaluate the efficacy and safety of ruxolitinib combined with low-dose hormone for patients with acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods: Thirty patients with aGVHD after allo-HSCT admitted to the Department of Hematology of the General Hospital of Western Theater Command from November 2021 to November 2024 were retrospectively analyzed. All patients were treated with low-dose hormone (methylprednisolone 0.3-1 mg kg -d ) combined with ruxolitinib 5-10 mg d . The efficacy and adverse reactions were observed during the follow-up period to analyze the survival outcomes of the patients. Results: A total of 30 patients with aGVHD after allo-HSCT were included in this study, consisting of 15 (50%) males and 15 (50%) females with a median age of 34 year-old (ranging from 14 to 62). Classification by disease type: there were 18 cases of acute myeloid leukemia, 4 cases of acute lymphoblastic leukemia, 4 cases of aplastic anemia, and 4 cases of myelodysplastic syndrome. Classification by aGVHD severity: there were 27 cases (90%) of Ⅱ-Ⅳ degree aGVHD and 11 cases (36.7%) of Ⅲ-Ⅳ degree aGVHD. Ruxolitinib in combination with low-dose glucocorticoid treatment yield responses in 28 (93.3%) patients, of which 27 (90%) achieved complete remission (CR), while 1 (3.3%) showed partial remission (PR). One patient (3.3%) had no response (NR), and 1 patient (3.3%) exhibited progressed disease (PD). Overall survival (OS) at 1 year of transplantation was 73.9% (95%CI 49.5% to 87.7%), progression-free survival (PFS) was 93.3% (95%CI 75.9% to 98.3%), non-relapse mortality (NRM) was 20.6% (95%CI 7.9% to 47.4%), and median survival time was 27.6 months. Conclusion: Ruxolitinib combined with low-dose hormones is safe and effective in the treatment of aGVHD after allo-HSCT.

[摘 要] 目的：探讨月见草素B调控磷脂酰肌醇3激酶（PI3K）/蛋白激酶B（AKT）/核因子-κB（NF-κB）通路对卵巢癌SKOV3细胞恶性生物学行为的影响。方法：CCK-8法测定月见草素B对SKOV3细胞的半数抑制浓度（IC50），参考IC₅₀值及相关文献确定后续实验剂量。SKOV3细胞分为对照组，月见草素B低（6.25 μmol/L）、中（12.5 μmol/L）、高（25 μmol/L）剂量组，PI3K抑制剂（LY294002）组，月见草素B高剂量 + PI3K激活剂（740Y-P）组。CCK-8法、5-乙炔基-2'-脱氧尿苷（EdU）染色法检测各组细胞增殖能力；Transwell侵袭实验、划痕实验、流式细胞术分别检测各组细胞侵袭、迁移能力与凋亡情况；RT-qPCR检测各组细胞中增殖相关基因细胞周期蛋白D1（Cyclin D1）、迁移相关基因迁移侵袭增强子1（MIEN1）及凋亡相关基因p53 mRNA表达情况；Western blotting检测各组细胞中PI3K/AKT/NF-κB通路相关蛋白p-PI3K、p-AKT、NF-κB p65的表达。结果：月见草素B处理SKOV3细胞24 h的IC₅₀值为28.70 μmol/L。与对照组相比，月见草素B低、中、高剂量组及LY294002组SKOV3细胞增殖能力、侵袭细胞数及划痕愈合率均降低（均P < 0.05），Cyclin D1、MIEN1 mRNA及p-PI3K、p-AKT、NF-κB p65蛋白表达下调（均P < 0.05），而细胞凋亡率与p53 mRNA表达则升高（均P < 0.05）；与LY294002组相比，高剂量月见草素B对SKOV3细胞增殖能力、侵袭细胞数及划痕愈合率的抑制作用更显著（均P < 0.05），对Cyclin D1、MIEN1 mRNA及p-PI3K、p-AKT、NF-κB p65蛋白的下调及对细胞凋亡率与p53 mRNA表达的上调均更明显（均P < 0.05）。与月见草素B高剂量组相比，月见草素B高剂量+740Y-P组SKOV3细胞增殖能力、侵袭细胞数及划痕愈合率升高（均P < 0.05），Cyclin D1、MIEN1 mRNA及p-PI3K、p-AKT、NF-κB p65蛋白表达上调（均P < 0.05），细胞凋亡率与p53 mRNA表达降低（P < 0.05）。结论：月见草素B可能通过抑制PI3K/AKT/NF-κB通路，抑制卵巢癌SKOV3细胞增殖、侵袭与迁移，并诱导细胞凋亡。

Objective To analyze the characteristics of capsule endoscopy(CE)in small intestinal diseases and the effect of prokinetic agents on CE,and to explore the diagnostic value of CE in small intestinal diseases.Methods Clinical data were collected from 332 patients who underwent CE in Jinshan Hospital,Fudan University between May 2020 and Mar 2024,and the etiology and endoscopic characteristics of small intestinal diseases were analyzed.Patients were categorized based on the administration of metoclopramide into the non-use group(Group A)and use group(Group B).Group A was further subdivided based on whether the CE reached the cecum,forming the non-reach group(Group c)and the reach cecum group(Group d).Then we compared the capsule gastric transit time,small intestine transit time,completion rate of the entire small intestine examination,and lesion detection rate across these groups.Additionally,the detection rates of CE were compared with those of colonoscopy,small bowel enteroscopy-CT(SBE-CT),and double-balloon enteroscopy(DBE).Results The most prevalent small intestinal lesions identified were erosions and ulcers,with Crohn's disease(CD)being the primary cause of ulcers,endoscopic ulcers exhibited atypical and diverse presentations,including aphthous and irregular ulcers.In comparison to Group A,Group B demonstrated a shorter small bowel transit time(P<0.05)and a higher lesion detection rate(P<0.05),while no significant difference was observed in the completion rate of the entire small bowel examination.Gastric emptying time and small intestinal transit time were prolonged in Group c compared with Group d(P<0.05).There was no significant difference in the diagnostic rate of terminal ileum lesions between CE and colonoscopy,while the diagnostic rate of CE was higher in patients with terminal ileum lesions under colonoscopy(P<0.05).The diagnostic rate of CE was higher than that of SBE-CT(P<0.05),and the detection rate of CE and DBE was comparable.Conclusion The morphology of small intestinal ulcers varies,and the endoscopic findings are not specific.Metoclopramide administered in real time after capsule ingestion can shorten the intestinal transit time and improve the diagnostic rate of CE.Positive lesions found during colonoscopy should be further evaluated with CE examination,the diagnostic accuracy of CE is higher than that of SBE-CT,CE and DBE have the same diagnostic value for small intestinal diseases.

Objective To observe the clinical efficacy of Qishao Huoxue Prescription in treating low back pain caused by lumbar disc herniation with qi stagnation and blood stasis syndrome.Methods Totally 80 patients of lumbar disc herniation with qi stagnation and blood stasis syndrome were divided into observation group and control group according to random number table method,with 40 cases in each group.The observation group received oral administration of Qishao Huoxue Prescription,while the control group received oral celecoxib capsules for 3 weeks.Follow-ups were conducted after 1 month and 3 month of treatment,and the clinical efficacy of two groups after 3 months of treatment was evaluated.The Visual Analog Scale(VAS)scores,Japanese Orthopaedic Association Assessment of Treatment Score(JOA),Oswestry Disability Index(ODI)and Quality of Life(SF-36)scores for pain before treatment,1 and 3 weeks after treatment,and 1 and 3 months after treatment in two groups were observed;the blood flow changes of two groups before and after 3 weeks of treatment were observed,including whole blood high shear,medium shear,and low shear viscosity,plasma viscosity,and fibrinogen(FIB);adverse reactions in both group were recorded.Results The total effective rate in the observation group was 97.5%(39/40),significantly higher than 87.5%(35/40)in the control group(P<0.05).At 1 and 3 weeks of treatment and 1 and 3 months after treatment,VAS scores and ODI scores significantly decreased compared to before treatment,while JOA scores and SF-36 scores significantly increased in both groups.The improvement in scores in the observation group was better than that in the control group(P<0.01).The observation group showed a significant decrease in blood high,medium,and low shear viscosity,PV and FIB levels after 3 weeks of treatment compared to before treatment(P<0.05),and all levels were lower than those in the control group(P<0.05).No significant adverse reactions were observed in both groups.Conclusion Qishao Huoxue Prescription can significantly improve the clinical symptoms,hemorheological indicators,and quality of life of low back pain caused by lumbar disc herniation with qi stagnation and blood stasis syndrome,with good safety.

Objective To assess coronary microvascular obstruction(MVO)after percutaneous coronary intervention in(PCI)patients with acute ST-segment elevation myocardial infarction(STEMI)and to investigate its value for patient prognosis.Methods We enrolled 97 patients who were hospitalized for acute STEMI at Wuhan Asia Heart Hospital from May 2021 to June 2024,underwent emergency PCI during hospitalization,and completed cardiac magnetic resonance(CMR)at a median of 7(5,8)days after the procedure.Patients were classified into MVO group(n=58)and non-MVO group(n=39)according to the results of CMR.Cox regression was used to analyse predictors of adverse events after PCI.Patients were followed for a median of 11.5(8.5,24.5)months for the occurrence of major adverse cardiovascular events(MACE,a composite outcome including readmission for heart failure,recurrent myocardial infarction,target vessel restenosis,target vessel revascularisation,and cardiac death)and secondary endpoint events(left ventricular remodelling,non-cardiac death).Results MVO was evidenced in 58 patients(59.79％).Multifactorial Cox regression analysis showed that MVO(HR 7.024,95％CI 1.408-35.027,P=0.017)and the proportion of inactive myocardium to the left ventricle(HR 1.066,95％CI 1.014-1.121,P=0.012)were the independent predictors factors for the incidence of adverse events in STEMI patients after PCI.The median follow-up time was 11.5(8.5,24.5)months.There was no statistically significant difference in the incidence of MACE between the MVO group and the non-MVO group(P=0.347).However,the MVO group had a higher incidence of secondary endpoints(32.76％ vs.2.56％,P＜0.001)and a higher incidence of left ventricular remodeling(29.31％ vs.2.56％,P＜0.001).Kaplan Meier survival analysis showed that the prognosis of the non-MVO group was significantly better than that of the MVO group(Log-rank P＜0.001).Conclusions MVO after PCI in patients with acute STEMI is a good predictor of clinical prognosis.

Objective To investigate the effect of different decompression methods on the efficacy of the unilateral biportal endoscopy(UBE)in the treatment of severe lumbar spinal stenosis(LSS).Methods A total of 203 elderly patients with LSS who underwent UBE treatment in our hospital from September 2021 to June 2024 were selected and divided into the unilateral group(102 cases)and the bilateral group(101 cases)according to different decompression methods.The unilateral group underwent unilateral decompression during operation,while the bilateral group underwent bilateral decompression(with bilateral decompression through the same incision and unilateral approach)during operation.The perioperative conditions,anatomical image parameters,visual analogue scale(VAS)scores,Oswestry disability index(ODI),and complications were compared between the two groups.The rehabilitation progress and complications of patients with different Charlson comorbidity index(CCI)values were compared.Results The operation time of patients in the bilateral group was longer than that in the unilateral group(P<0.05).The dural sac area and lumbar spinal canal area of patients in the bilateral group were larger than those in the unilateral group immediately after operation and 3 months after operation(P<0.05).The VAS scores and ODI 7 days and 3 months after operation of patients in the bilateral group were lower than those in the unilateral group(P<0.05).There was no statistically significant difference in the total incidence of complications between the two groups of patients(P>0.05).The first time of getting out of bed after operation and hospital stay in patients with CCI value>2 scores were longer than those in patients with CCI value≤2 scores(P<0.05).Conclusion Compared with unilateral decompression,bilateral decompression for elderly patients with severe LSS takes a longer surgical time,but it can better restore lumbar shape,alleviate pain,improve lumbar function,and has higher safety,and the milder the patient's condition,the faster the postoperative recovery.

Objective:To explore the application effect of continuous intravenous infusion of lidocaine on patients undergoing transnasal pituitary tumor resection.Methods:Ninety patients undergoing transsphenoidal pituitary tumor resection under general anesthesia from May 2022 to January 2025 were selected.The participants were randomly divided into two groups:a control group and a lidocaine group,with 45 patients in each group.Before starting anesthesia,the lidocaine group received intravenous injection of 1.5 mg/kg lidocaine,followed by continuous intravenous injection at a rate of 2 mg/(kg·h)throughout the entire surgical process.The control group received an equal amount of physiological saline.The other anesthesia regimens and drugs for the two groups of patients were consistent,and all anesthesia related drugs were stopped from infusion at the end of the surgery.Compare the intraoperative mean arterial pressure(MAP)and heart rate changes between two groups,evaluate visual analog scale(VAS)scores at different time points,postoperative opioid dosage and recovery level,and incidence of adverse reactions.Results:There was a certain degree of fluctuation in MAP and heart rate in both groups during the operation,with the lidocaine group showing a smaller level of fluctuation.There was no significant difference in MAP and heart rate levels between the two groups at T1 and T6 times(P＞0.05),while the MAP and heart rate levels in the lidocaine group were higher than those in the control group at T2,T3,T4,and T5 times(P＜0.05);Compared with the control group,there was no statistically significant difference in VAS scores between the two groups at T0 time(P＞0.05).The VAS scores of the two groups showed an upward trend at T1,T2,T3,and T4 time,and a downward trend at T5 time.However,the VAS scores of the lidocaine group were lower than those of the control group at T1,T2,T3,T4,and T5 time(P＜0.05);The dose of remifentanil administered via intravenous pump during the lidocaine group,the duration of first postoperative ventilation,and the length of hospital stay were all lower than those in the control group(P＜0.05);The incidence of nausea,vomiting,and coughing related adverse reactions in the lidocaine group was lower than that in the control group(P＜0.05).Conclusion:Lidocaine assisted intravenous anesthesia can promote stable hemodynamic fluctuations during pituitary adenoma resection surgery,reduce postoperative pain,decrease opioid dosage,shorten hospital stay,and reduce adverse reactions such as coughing,nausea,and vomiting.

Objective To observe the application effect of surgical adhesive membrane combined with modified towel placement method in patients undergoing orthopedic unilateral biportal endoscopy(UBE)operation.Methods A total of 61 patients who underwent orthopedic UBE operation in our hospital from December 2022 to September 2023 were selected and divided into the control group(31 cases,conventional surgical adhesive membrane and towel placement)and the observation group(30 cases,surgical adhesive membrane combined with modified towel placement method)according to different placement methods of membrane and towel during operation.The degree of wetting in the surgical area,vital signs,intraoperative adverse events,postoperative incision infection rate and patients'satisfaction were compared between the two groups.Results The proportions of wet sterile sheets around the surgical area and moist skin of patients in the observation group were lower than those in the control group(P<0.05).The saturation of peripheral oxygen(SpO2),heart rate(HR),mean arterial pressure(MAP)at spinal canal decompression and the end of the operation of patients in the observation group were significantly better than those in the control group(P<0.05).No postoperative incision infection occurred in the two groups,and there was no statistically significant difference in the total incidence of adverse events between the two groups(P>0.05).The patients'satisfaction in the observation group was significantly higher than that in the control group(P<0.05).Conclusion Surgical adhesive membrane combined with modified towel placement method can reduce the degree of wetting in the surgical area during orthopedic UBE operation,stabilize the patients'vital signs,and improve patients'satisfaction.

AIM To study the chemical constituents from the water fraction of rhizoma of Smilax trinervula Miq.and their biological activities.METHODS Polyamide,silica gel,Sephadex LH-20,ODS and semi-preparative HPLC were used for isolation and purification,then the structures of obtained compounds were identified by physicochemical properties and spectral data.The antitumor activities were determined by MTT mothod,and the inhibitory activities on α-glucosidase were determined by PNPG method.RESULTS Eleven compounds were isolated and identified as tyrosine(1),uridine(2),2-(2',3',4'-trihydroxybutyl)-6-(2",3",4"-trihydroxybutyl)-pyrazine(3),2-(1',2',3',4'-tetrahydroxybutyl)-6-(2",3",4"-trihydroxybutyl)-pyrazine(4),2-(1',2',3',4'-tetrahydroxybutyl)-5-(2",3",4"-trihydroxybutyl)-pyrazine(5),uracil(6),2-(1',2',3',4'-tetrahydroxybutyl)-5-(1",2",3",4"-tetrahydroxybutyl)-pyrazine(7),dioscin(8),shikimic acid(9),pyrazine(10),3,4-dihydroxyphenyethyl alcohol 8-O-β-D-glycopyranoside(11).The IC50 values of compounds 8 to human breast cancer cell MCF-7 was(2.36±0.26)μg/mL,and the IC50 values of compounds 3-5 and 7 to α-glucosidase were(1.54±0.15)-(10.53±0.38)μg/mL.CONCLUSION Compounds 1-7,10 are isolated from Smilax genus for the first time,and compound 9,11 are first isolated from this plant.Compound 8 has anti-tumor activity,and compounds 3-5,7 have α-glucosidase inhibitory activities.