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 provide guidance for the individualized use of antiepileptic drugs （AEDs） in patients with epilepsy or bipolar affective disorder.METHODS Clinical data of patients with epilepsy or bipolar affective disorder who received AEDs treatment and underwent therapeutic drug monitoring （TDM） at Xi’an International Medical Center Hospital from January 2023 to December 2025 were retrospectively collected. The baseline information， characteristics of AEDs utilization， implementation status of TDM and laboratory parameters were summarized. Spearman correlation analysis， univariate analysis and multivariate linear regression analysis were performed to identify the independent influencing factors for blood concentrations of AEDs.RESULTS A total of 1 572 patients were enrolled， including 660 males and 912 females. The majority were aged ≥60 years （30.15%）； 71.76% of patients were on monotherapy with AEDs， with valproic acid being the most commonly prescribed （51.97%）； combination therapy was predominantly a two-drug regimen （26.21%）， while three-drug regimens were rare （2.04%）. A total of 2 901 blood samples for TDM were collected， with the highest number of samples for valproic acid and levetiracetam （1 987 and 684 samples， respectively）. TDM for all five drugs was primarily conducted once； among which， the blood concentrations attainment rates exceeded 50% for patients taking valproic acid and levetiracetam， while the median blood concentrations for patients taking lamotrigine， oxcarbazepine， and carbamazepine were all below the lower limit of the therapeutic reference range. Based on the results of Spearman correlation analysis， univariate analysis， and multivariate linear regression analysis， patient gender， platelet count （PLT）， alanine transaminase （ALT）， aspartate transaminase （AST）， and total bilirubin （TBil） were found to be independent factors influencing blood concentration of valproic acid （unstandardized coefficients were －6.770 7， －0.078 6， －0.099 4， 0.083 2， －0.578 9， P ＜0.05）， while age and creatinine （CRE） were found to be independent factors influencing blood concentration of levetiracetam （unstandardized coefficients were 0.108 7， 0.047 8， P ＜0.05）.CONCLUSIONS Female gender and elevated AST levels are risk factors for increased blood concentration of valproic acid， while elevated PLT， ALT and TBil levels are associated with decreased blood concentration of valproic acid. Patients of advanced age and those with renal insufficiency bear a relatively high risk of in vivo levetiracetam accumulation.

Objective:To evaluate the early efficacy and safety of the exclusively transnasal endoscopic approach and the combined transconjunctival-endoscopic approach in the resection of benign orbital apex lesions.Methods:A retrospective analysis was conducted on 51 patients who underwent transnasal endoscopic resection of benign lesions in the orbital apex at Peking University Third Hospital from May 2021 to December 2024. The study population was composed of 17 males and 34 females, with the age of (39.4±12.4) years (range: 4 to 65 years). Pathology diagnoses were identified as orbital cavernous hemangioma (OCH, n=38), schwannoma ( n=8), solitary fibrous tumor ( n=1), mucocele ( n=1), optic nerve sheath meningioma ( n=1), pseudotumor ( n=1), and organized hematoma ( n=1). Two surgical approaches were compared as the exclusively transnasal endoscopic resection ( n=27) and the combined transconjunctival-endoscopic approach (combined approach, n=24). Preoperative and postoperative evaluations were conducted for the best corrected visual acuity (BCVA), visual field, intraocular pressure (IOP), and exophthalmos before and after surgery. Demographic characteristics, tumor features, and postoperative complications were analyzed between the two surgical groups. Differences in Orbital Resection by Intranasal Technique (ORBIT) stage between the two surgical approaches were analyzed. SPSS 27.0 software was used for statistical analysis. Results:Among the 51 patients, 3 schwannomas underwent intracapsular resection (1 via exclusively transnasal endoscopic approach, and 2 via combined approach), and the remaining 48 patients underwent complete tumor resection. Significant postoperative improvements were observed in BCVA, visual field, IOP and exophthalmos ( t value was 2.96, 4.34, 4.85, and 4.63, respectively, all P<0.05). The combined approach required longer operative time but showed comparable intraoperative blood loss. Tumors resected via the combined approach were larger in volume, though not statistically significant. Postoperative complications (e.g., diplopia, mydriasis) were more frequent in the combined approach group but resolved within a short-term period. There was no significant difference in ORBIT stage between the two groups ( P=0.178). Conclusions:Both exclusively transnasal and combined transconjunctival-endoscopic approaches prove safe and effective for benign orbital apex lesions resection. The combined approach ensures complete tumor removal.

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 construct three-class （insufficient， normal， excessive） and two-class （insufficient， normal） models for predicting plasma concentration of valproic acid （VPA）， and compare the performance of these two models， with the aim of providing a reference for formulating clinical medication strategies. METHODS The clinical data of 480 patients who received VPA treatment and underwent blood concentration test at the Xi’an International Medical Center Hospital were collected from November 2022 to September 2024 （a total of 695 sets of data）. In this study， predictive models were constructed for target variables of three-class and two-class models. Feature ranking and selection were carried out using XGBoost scores. Twelve different machine learning algorithms were used for training and validation， and the performance of the models was evaluated using three indexes: accuracy， F1 score， and the area under the working characteristic curve of the subject （AUC）. RESULTS XGBoost feature importance scores revealed that in the three-class model， the importance ranking of kidney disease and electrolyte disorders was higher. However， in the two-class model， the importance ranking of these features significantly decreased， suggesting a close association with the excessive blood concentration of VPA. In the three-class model， Random Forest method performed best， with F1 score of 0.704 0 and AUC of 0.519 3 on the test set； while in the two-class model， CatBoost method performed optimally， with F1 score of 0.785 7 and AUC of 0.819 5 on the test set. CONCLUSIONS The constructed three-class model has the ability to predict excessive VPA blood concentration， but its prediction and model generalization abilities are poor； the constructed two-class model can only perform classification prediction for insufficient and normal blood concentration cases， but its model performance is stronger.

Objective:To explore the factors influencing the non-reversal of mild cognitive impairment (MCI) after a first stroke.Methods:A total of 243 first stroke patients with MCI were enrolled at the First Affiliated Hospital of Zhengzhou University from March 2020 to March 2023. The patients were followed up for one year to assess the reversal of MCI. Patients who did not undergo reversal and those who did undergo reversal were included in non-reversal group and reversal group, respectively. General information of non-reversal group and reversal group was compared. Binary Logistic regression was used to analyze the factors influencing the non-reversal of MCI after a first stroke.Results:After one year of follow-up, the non-reversal rate was 25.10% (61/243) among 243 first stroke patients with MCI. Binary Logistic regression analysis showed that older age, history of diabetes, high National Institute of Health Stroke Scale (NIHSS) score at admission, left-sided lesions, and modified Fazekas grade 3 were risk factors for non-reversal of MCI after a first stroke ( P<0.05), while educational level of college degree or above was a protective factor ( P<0.05) . Conclusions:Older age, history of diabetes, high NIHSS score at admission, left-sided lesions, and modified Fazekas grade 3 are risk factors for non-reversal of MCI after a first stroke, while an educational level of college degree or above is a protective factor.

Objective To evaluate the clinical efficacy of Shanghai-style pediatric tuina combined with visceral acupoint manipulation in children with adenoid hypertrophy(AH)of lung-spleen qi deficiency type.Methods Sixty-six AH children with lung-spleen qi deficiency treated at Foshan Hospital of Traditional Chinese Medicine from December 2023 to December 2024 were randomized into trial group(n=33,receiving Shanghai-style tuina+visceral acupoint manipulation)and control group(n=33,receiving conventional tuina)for 2 weeks.Traditional Chinese medicine(TCM)syndrome scores(primary/secondary symptoms),Disease-Specific Quality of Life for Children with Obstructive Sleep Apnea 18-item Survey(OSA-18)scores,and endoscopic adenoid obstruction scores were observed before and after treatment,and the clinical efficacy and safety were evaluated.Results(1)After two weeks of treatment,the total effective rate was 93.94％(31/33)in the trial group versus 72.73％(24/33)in the control group.The intergroup comparison(by chi-square test)showed that the efficacy in the trial group was superior to that in the control group(P＜0.05).(2)After treatment,both groups showed reduction in the primary TCM symptom score and secondary TCM symptom score(P＜0.01),with greater reductions in the trial group(P＜0.05 or P＜0.01).(3)After treatment,OSA-18 scores were decreased in both groups(P＜0.01),with greater reductions in the trial group(P＜0.01).(4)After treatment,adenoid obstruction scores were improved in both groups(P＜0.01),with superior outcomes in the trial group(P＜0.05).(5)No adverse events(e.g.,myalgia,pruritus,allergy)were reported in either group.Conclusion Shanghai-style tuina combined with visceral acupoint manipulation effectively improves clinical symptoms and quality of life in AH children with lung-spleen qi deficiency syndrome,demonstrating high safety.

OBJECTIVE To explore the association of Helicobacter pylori infection with the expression levels of Ki67,caudal type homeobox transcription factor 2(CDX-2)and p53 protein in the gastric cancer patients so as to provide bases for improvement of prognosis of the gastric cancer patients.METHODS Totally 113 patients who were diagnosed with gastric cancer by gastroscopic examination and were treated in Shijiazhuang People's Hospital from Jan.2020 to Jan.2024 were assigned as the gastric cancer group,84 of whom were complicated with H.py-lori infection(the Hp-positive group),and 29 were negative for Hp(the Hp-negative group).Meanwhile,125 patients who had chronic atrophic gastritis were assigned as the non-gastric cancer group.The gastric mucosa tis-sue specimens were collected through gastroscopy,and the expression levels of Ki67,CDX-2 and p53 protein were detected.RESULTS The positive rate of H.pylori infection of the gastric cancer group was 74.34％,higher than 54.40％of the non-gastric cancer group(P＜0.05).The positive rate of H.pylori was higher in the gastric canc-er patients with lymphatic metastasis,infiltration depth of T3 to T4 and TNM stage of Ⅲ to Ⅳ stage than in the gastric cancer patients without lymphatic metastasis,infiltration depth of T1 to T2 and TNM stage of Ⅰ to Ⅱ stage(P＜0.05).The positive expression rates of gastric mucosa tissue Ki67,CDX-2 and p53 protein of the gastric cancer group were respectively 69.91％,52.21％and 79.65％,higher than 47.20％,0 and 24.00％of the non-gastric cancer group,there were significant differences(P＜0.05).The positive expression rates of gastric mucosa tissue Ki67,CDX-2 and p53 protein of the Hp-positive group were higher than those of the Hp-negative group(P＜0.05).CONCLUSION The gastric cancer is associated with the H.pylori infection and the expressions of Ki67,CDX-2 and p53.The H.pylori infection may lead to the abnormal expressions of Ki67,CDX-2 and p53 in gastric mucosa tissues of the gastric cancer patients,which is also associated with the clinicopathologic features.

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.