Objective: To explore the dynamic developmental trajectories of college students class belongingness during their college years and its longitudinal predictive effects on depressive symptoms, so as to provide targeted insights for precise campus psychological interventions. Methods: In October 2021 (T1), a total of 4 720 college students from a university in Shandong Province were selected by cluster sampling method and followed up for 3 years. Surveys were conducted annually (T2: October 2022, T3: October 2023, T4: October 2024). The Class Belongingness Scale and Patient Health Questionnaire-9 (PHQ-9) were used to assess students class belongingness and depressive symptoms. Latent growth mixture modeling was employed to identify trajectories of class belonging, and multinomial Logistic regression analysis was used to examine the predictive effects of these trajectory classes on depressive symptoms. Results: Mean scores of class belongingness across T1-T4 were (73.24±11.95, 74.76±12.25, 75.25±12.38, 77.64±11.63), and the scores of depressive symptoms were [1.00 (0, 5.00), 0 (0, 3.00), 0 (0, 2.00), 0 (0, 2.00)]. The developmental trajectories of class belongingness were categorized into three types: the high-starting ascending group ( 56.61 %), the low-starting descending group (11.91%), and the medium-starting stable group (31.48%). Multinomial Logistic regression analysis showed that, compared to the medium-starting stable group, the high-starting ascending group had a lower probability of developing mild depressive symptoms ( OR=0.27, 95%CI =0.15-0.47) and moderate or above depressive symptoms ( OR=0.29, 95% CI = 0.14-0.60) (both P <0.05). Conversely, the low-starting descending group had a higher probability of developing mild depressive symptoms ( OR=2.31, 95%CI =1.65-3.22) and moderate or above depressive symptoms ( OR=7.49, 95%CI = 3.82-14.69) (both P <0.05). Conclusion Declining trajectory of class belongingness is a risk factor for depressive symptoms, while sustained upward trend may mitigate such risks.

Objective:To analyze risk factors for early trauma-induced coagulopathy (TIC) in pediatric patients with moderate-to-severe traumatic brain injury (msTBI), develop a predictive model and evaluate its predictive performance.Methods:A retrospective cohort study was conducted to analyze the clinical data of 290 pediatric patients with msTBI who were admitted to Children′s Hospital of Soochow University between January 2016 and December 2024, including 188 boys and 102 girls, aged 0.2-15.7 years [5.2(2.8, 9.3)years]. Based on the coagulation test results at admission, the patients were divided into TIC group ( n=162) and non-TIC group ( n=128). The patients were randomly allocated into training set ( n=203) and validation set ( n=87) at a ratio of 7∶3. Demographic characteristics, clinical data, vital signs, imaging findings, arterial blood gas analysis results, and coagulation profiles of the patients were collected. Univariate analysis and Lasso regression analysis were used to identify risk factors associated with early TIC in children with msTBI and multivariate Logistic regression analysis was performed to determine independent risk factors and construct a predictive model. The model′s discrimination and calibration were evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), Hosmer-Lemeshow (H-L) test, and calibration curve. Its clinical utility was assessed through decision curve analysis (DCA). Results:Significant differences were observed between the TIC group and non-TIC group in terms of age, weight, time from injury to admission, child′s Glasgow coma scale (CGCS) score, pediatric trauma score (PTS), shock index, heart rate, respiratory rate, systolic blood pressure, Rotterdam CT score, intraventricular hemorrhage, cerebral contusion, brain herniation, long bone fracture, pelvic fracture, hemopneumothorax, pulmonary contusion, intra-abdominal organ injury, actual bicarbonate, base excess, base excess in the extracellular fluid, blood glucose, hemoglobin (Hb), osmolarity, blood calcium, anion gap, blood lactate, prothrombin time, activated partial thromboplastin time, international normalized ratio, and platelet count ( P<0.05). With coagulation-related variables excluded, the following features were identified with Lasso regression including CGCS score, PTS, heart rate, systolic blood pressure, long bone fracture, blood glucose, and Hb. Multivariate Logistic regression analysis revealed that CGCS score≤8 points ( OR=3.05, 95% CI 1.65, 5.63), PTS>5 points ( OR=0.45, 95% CI 0.23, 0.89), systolic blood pressure ( OR=0.98, 95% CI 0.97, 0.99), blood glucose ( OR=1.09, 95% CI 1.01, 1.17), and long bone fracture ( OR=2.47, 95% CI 1.13, 5.42) were influencing factors for early TIC in children with msTBI ( P<0.05). The regression equation of the predictive model was established as follows: Logit[ P/(1- P)]=1.01×"CGCS score≤8 points"-0.69×"PTS>5 points"- 0.02×"systolic blood pressure"+0.89×"long bone fracture"+0.08×"blood glucose"+1.32. The ROC curve analysis showed that the training set had an AUC of 0.86 (95% CI 0.78, 0.94), with sensitivity and specificity of 76.6% and 92.5%, while the AUC was 0.80 (95% CI 0.74, 0.86), with sensitivity and specificity of 75.7% and 79.6% in the validation set. H-L test results showed a χ2 value of 8.18 ( P=0.416) in the training set and 5.30 ( P=0.216) in the validation set. The calibration curves for both sets demonstrated good agreement with the actual curves, indicating that the predicted probabilities closely matched the observed probabilities. The DCA results indicated that both the training set and validation set demonstrated positive net benefits within threshold probabilities ranges of 10%-100% and 15%-96%. Conclusions:Independent risk factors for early TIC in pediatric msTBI patients include CGCS score≤ 8 points, PTS≤5 points, low systolic blood pressure, long bone fracture, and high blood glucose. The predictive model constructed based on these factors demonstrates favorable predictive performance and clinical application value.

Objective To evaluate the application value of fascial platform versus commercial platform in transumbilical single-port laparoscopic transabdominal preperitoneal repair(TAPP)for inguinal hernia.Methods One hundred patients with inguinal hernia admitted between January and December 2024 were prospectively enrolled and randomly assigned to either the fascial platform group(n=50)or the commercial platform group(n=50)by using a random number table.The following parameters were compared between the two groups:platform establishment time,operative time,intraoperative blood loss,incision suture time,operative difficulty score,camera manipulation difficulty score,postoperative 24-hour Visual Analogue Scale(VAS)score of pain,postoperative hospital stay,total hospitalization cost,comprehensive satisfaction score,and postoperative complications.Results The fascial platform group demonstrated significantly superior outcomes compared to the commercial platform group in platform establishment time[(3.4±1.0)min vs.(8.1±1.5)min,t=-18.389,P＜0.001],operative time[(67.5±7.9)min vs.(72.2±11.5)min,t=-2.380,P=0.019],intraoperative blood loss[(8.3±4.3)ml vs.(11.1±5.7)ml,t=-2.798,P=0.006],incision suture time[(7.0±1.4)min vs.(11.8±2.7)min,t=-11.212,P＜0.001],operative difficulty score(14.4±3.6 vs.23.1±4.1,t=-11.215,P＜0.001),camera manipulation difficulty score(11.4±2.6 vs.18.3±2.5,t=-13.370,P＜0.001),VAS score of postoperative 24-hour pain(2.4±1.0 vs.3.7±1.1,t=-6.139,P＜0.001),total hospitalization cost[(15.8±1.6)thousand yuan vs.(18.3±1.6)thousand yuan,t=-7.841,P＜0.001],and comprehensive satisfaction score(7.3±1.1 vs.6.3±1.0,t=5.271,P＜0.001).However,there were no statistically significant differences in postoperative hospital stay or postoperative complication between the two groups(P＞0.05).All the patients were followed up for 1-12 months postoperatively[(5.3±1.8)months vs.(5.7±2.0)months,t=-0.945,P=0.347],with no recurrence observed in either group.Conclusions Both fascial platform and commercial platform can be used for transumbilical single-port TAPP.The fascial platform offers advantages including shorter platform establishment time,reduced incision suture time,lower operative and camera manipulation difficulty,decreased cost,less postoperative pain,and higher patient satisfaction.

Objective:To investigate the predictive value of serum β 2-microglobulin (β 2M) and pro-inflammatory cytokines for post-stroke depression (PSD) in patients with acute ischemic stroke (AIS). Methods:Patients with AIS admitted to the Department of Neurology, the Affiliated Municipal Hospital of Xuzhou Medical University from January 2020 to May 2023 were included retrospectively. At the 6-month outpatient follow-up, the Self-rating Depression Scale (SDS) was used to assess depression. Multivariate logistic regression analysis was used to determine the independent influencing factors of PSD. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of individual and combined independent influencing factors on PSD. Results:A total of 161 patients were enrolled, including 82 males (50.93%), aged 61.78±11.95 years; 47 patients (29.20%) developed PSD. Univariate analysis showed that the proportion of males, serum β 2M, interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, high-sensitivity C-reactive protein level, and baseline National Institutes of Health Stroke Scale (NIHSS) score in the PSD group were significantly different from those in the non-PSD group (all P<0.05). Multivariate logistic regression analysis showed that serum β 2M (odds ratio [ OR] 4.257, 95% confidence interval [ CI]1.441-12.574; P=0.009), IL-1β ( OR 1.415, 95% CI 1.116-1.793; P=0.004), IL-6 ( OR 1.262, 95% CI 1.020-1.561; P=0.032), and TNF-α ( OR 1.246, 95% CI 1.021-1.521; P=0.030) were the independent influencing factors of PSD. ROC curve analysis showed that the area under the curve of serum β 2M for predicting PSD was 0.753 (95% CI 0.668-0.838), with an optimal cutoff value of 2.255 mg/L. The sensitivity and specificity were 59.6% and 80.7%, respectively. When serum β 2M was combined with IL-1β, IL-6 and TNF-α for prediction, the area under the curve increased to 0.893 (95% CI 0.837-0.948). Conclusion:The serum β 2M in combination with pro-inflammatory cytokines has good predictive value for PSD.

Myocardial infarction is a serious type of myocardial ischemic disease. Traditional treatments can only alleviate clinical symptoms and cannot repair damaged myocardium. In this review, the application progress of chitosan-based composite scaffolds in myocardial repair and regeneration after myocardial infarction was reviewed. Combining chitosan with polymers, such as natural proteins and natural polysaccharides can mimic the properties of natural myocardial tissue, reducing ventricular wall stress while increasing biological activity and promoting the retention, repair or regeneration of myocardial cells. Combining chitosan with synthetic polymers and nanomaterials can promote the repair and regeneration of myocardial cells, improve the electrophysiological function of the infarcted area and resynchronise cardiac contraction.

Objective:To evaluate the diagnostic value of micro flow imaging (MFI) supported by Image Pro Plus (IPP) software for BI-RADS classification of breast nodules and the correlation between its parameters and Ki-67 expression level.Methods:A total of 205 cases of breast solid nodules with ultrasound BI-RADS classification of 4 categories were enrolled in this study. BI-RADS classification, CDFI score, MFI score, CDFI-IPP score and MFI-IPP score by IPP software were performed for each nodule. Ki-67 immunohistochemical staining of invasive ductal carcinoma was performed to analyze the correlation between MFI-IPP-VI and Ki-67 expression levels.Results:The combined BI-RADS classification for diagnosis of malignant nodules had the largest area under the ROC curve, which was significantly higher than that of BI-RADS, MFI-IPP-VI, MFI score, CDFI-IPP-VI, and CDFI score (all P<0.05). The combined BI-RADS classification had the best diagnostic efficacy for the diagnosis of malignant nodules with a sensitivity of 96.4%, specificity of 65.6% and accuracy of 82.4%. In addition, the agreement between experienced and inexperienced sonographers applying MFI-IPP-VI was higher than MFI (Kappa=0.780 vs. Kappa=0.743). The mean value of Ki-67 in invasive ductal carcinoma was 21.93%±16.37%, and Spearman's correlation analysis showed a positive correlation between MFI-IPP-VI and Ki-67 expression level ( r=0.815, P<0.05). Conclusions:MFI-IPP can assist sonographers to classify breast nodules by BI-RADS, providing an effective basis for puncture biopsy. MFI-IPP-VI offers the possibility of noninvasively predicting the expression level of Ki-67 in invasive ductal carcinoma.

Objective:To explore and verify the value of neoadjuvant rectal (NAR) score in predicting the prognosis of patients with middle and low locally advanced rectal cancer.Methods:A retrospective analysis of 207 patients with middle and low locally advanced rectal adenocarcinoma who received neoadjuvant radiotherapy and chemotherapy in Tianjin Medical University Cancer Institute & Hospital from January 2015 to December 2021 was performed. The neoadjuvant radiotherapy regimen was pelvic external irradiation of 45-50.4 Gy, 1.8 Gy/f, 5 times per week and concurrent oral capecitabine chemotherapy on days 1-14 and 22-36 during radiotherapy. Total mesorectal excision (TME) was then performed. The NAR score was calculated based on the initial clinical stage and postoperative pathological stage, and divided into the low (<8), medium (8-16) and high (>16) layers, respectively. The 3-year disease-free survival (DFS) and overall survival (OS) were calculated using the Kaplan-Meier method, and the differences in DFS and OS among different NAR score layers were compared using the log-rank test. Some patients received consolidation chemotherapy during the interval between concurrent radiotherapy-chemotherapy and surgery, even the total neoadjuvant therapy (TNT) model. Subgroup analysis was further used to verify the predictive value of the NAR score in the strengthened neoadjuvant therapy model.Results:The median follow-up of all patients was 46.0 months (range: 19.5-88.0 months), the 3-year DFS was 79.2%, and the 3-year OS was 87.4%. Univariate analysis found that the NAR score had a significant impact on the 3-year DFS and OS. The 3-year DFS of patients with low, medium, and high NAR scores were 90.3%, 86.1% and 58.7% ( P<0.001), and the 3-year OS were 94.4%, 91.7% and 74.6%, ( P<0.001), respectively. Subgroup analysis showed that the predictive value of the NAR score also applied to the strengthened neoadjuvant therapy model. The 3-year DFS of patients with low, medium, and high NAR scores were 86.9%, 83.8% and 68.3% ( P=0.044), and the 3-year OS were 92.9%, 90.7% and 85.4% ( P=0.029), respectively. Conclusion:The NAR score can effectively predict the prognosis of patients with middle and low locally advanced rectal adenocarcinoma, whether using neoadjuvant therapy or strengthened neoadjuvant therapy followed by TME surgery.

Objective:To assess the safety and efficacy of Blinatumomab in treating children with acute B-lymphoblastic leukemia（B-ALL）.Methods:The clinical data of 10 B-ALL children who were admitted to the Department of Pediatrics，the First Affiliated Hospital of Xi’an Jiaotong University from May 2022 to April 2024 and treated with Blinatumomab were analyzed retrospectively.Results:All the 10 cases had a complete remission of bone marrow and all minimal residual disease（MRD）were negative. Serious adverse events were reported after chemotherapy，including intracranial venous sinus thrombosis with acute cerebral infarction，acute pancreatitis，paralytic ileus，syndrome of abnormal secretion of antidiuretic hormone，severe pneumonia，liver injury，sepsis（β-lactamase resistant Escherichia coli，Pseudomonas aeruginosa），oral mucositis，persistent agranulocytosis with bloodstream infection. All patients interrupted chemotherapy and received Blinatumomab injections for 14 days. During treatment，there was hematological toxicity，which resulted in grade 3-4 neutropenia in 5 cases within the first 7 days. Transient low-grade fever was observed in 4 cases of non-hematological toxicity during days 1-3 of treatment. One patient experienced a headache on the 7th day of treatment，which worsened on the 14th day，but it improved with mannitol treatment. Mild liver injury was present in 3 cases. Interleukin-6 reached a peak of 71.86 pg/mL on the second day of treatment in one case，whereas it was normal in others. All patients were found to be free of cytokine release syndrome. T lymphocyte count increased in 5 patients after 14 days of Blinatumomab treatment，but B lymphocyte count and serum immunoglobulin levels declined in 10 patients. Hypogammaglobulinemia was observed in 3 of these patients. The median follow-up time was 7.8（3.0-24.0）months. All patients achieved MRD-negative complete remission and 6-month overall survival rate and progression-free survival were both 100%.Conclusion:Children with B-ALL can benefit from using Blinatumomab，which is safer than conventional chemotherapy，as a new treatment strategy for those who cannot tolerate traditional chemotherapy.

Objective:To explore the longitudinal trajectory of sleep disorders and their influencing factors in newly diagnosed breast cancer patients, and provide theoretical basis for formulating intervention measures to improve sleep quality of breast cancer patients.Methods:A longitudinal study was conducted using convenience sampling to select newly diagnosed breast cancer patients from Shandong Provincial Third Hospital and Shandong First Medical University Affiliated Provincial Hospital from April 2023 to June 2024. General information questionnaires, the Pittsburgh Sleep Quality Index (PSQI), the Concerns About Recurrence Scale (CARS), and the Distress Disclosure Index (DDI) were used for the survey. The Kruskal-Wallis H test and generalized estimating equation models were used to examine sleep disorders and their influencing factors. Results:A total of 473 valid questionnaires were collected. Among the 473 newly diagnosed breast cancer patients, 435 were female and 38 were male, aged (49.5 ± 11.0) years old. The CARS score at admission was (3.00 ± 1.12) points, with concerns about death (0.71 ± 0.67) points and concerns about female characteristics (0.81 ± 0.72) points. The DDI score at admission was (27.00 ± 10.03) points. The PSQI scores at admission, discharge, and one month after discharge were (15.34 ± 3.05), (12.12 ± 3.01), and (10.13 ± 1.78) points, respectively, the difference was statistically significant ( H =33.19, P<0.05). The PSQI scores at these three time points were positively correlated with the CARS score and concerns about death and female characteristics ( r values were 0.42-0.79, all P<0.05), and negatively correlated with the DDI score ( r =-0.41, -0.37, -0.31, all P<0.05). The generalized estimating equation model showed that female gender ( β=1.35, 95% CI 0.27-2.30), education level of junior high school or below ( β=1.89, 95% CI 0.24-3.19), severe pain ( β=1.72, 95% CI 0.32-3.12), moderate pain ( β=2.51, 95% CI 0.37-4.66), invasive special cancer ( β=2.57, 95% CI 1.67-4.07), invasive non-special cancer ( β=2.11, 95% CI 1.98-3.12), partial understanding of the condition ( β=1.91, 95% CI 1.23-3.01), concerns about death ( β=1.61, 95% CI 0.17-2.78), and concerns about femininity ( β=1.34, 95% CI 0.37-2.15) positively predicted the sleep quality index in newly diagnosed breast cancer patients (all P<0.05). Non-invasive cancer ( β=-3.82, 95% CI -6.79--3.36), lack of understanding of the condition ( β=-3.96, 95% CI -7.09--4.62), and DDI score ( β=-1.45, 95% CI -2.14--0.15) negatively predicted the sleep quality index (all P<0.05). Conclusions:The overall sleep quality of newly diagnosed breast cancer patients is low, with the lowest at admission and gradual improvement at discharge and one month after discharge. Medical staff should pay attention to high-risk patients who are female, have lower education levels, higher pain scores, poorer pathological types, and partial understanding of their condition.