Objective: To explore the nonlinear dynamic effects of social capital, adverse childhood experiences (ACEs) and depressive symptoms on suicidal behavior among vocational high school students, so as to provide theoretical basis and practical references for formulating suicide prevention strategies. Methods: A convenience sampling method was employed to include 668 students from a vocational high school from Wuhan in March 2023. Social capital was used as the asymmetry variable, while ACEs and depressive symptoms were used as bifurcation variables, a cusp catastrophe model was constructed to analyze the nonlinear changes in suicidal behavior among vocational high school students, and its fit was compared with linear and Logistic regression models. Results: Among students in the health vocational high school in Wuhan, only suicidal ideation accounted for 8.5%, only suicide attempt for 18.6%, neither accounted for 31.9%, and both for 41.0%. Gender, left behind experience, family economic status, parental parenting styles, depressive symptoms, social capital, and ACEs were all related factors influencing suicidal behavior among vocational high school students ( χ 2/H=19.03, 13.33, 21.11, 46.70, 144.38, 24.61, 118.77, all P <0.05). Violin plots showed a bimodal distribution of suicidal behavior, indicating nonlinear variation characteristics. The cusp catastrophe model results showed that social capital was negatively correlated with suicidal behavior, but the relationship was bifurcated by ACEs ( α social capital = -0.006 , β ACEs =0.075) and depressive symptoms ( α social capital =-0.013, β depressive =0.028) (all P <0.05). When both ACEs and depressive symptoms coexisted, the impact of ACEs was stronger ( β ACEs =0.077, β depressive =0.014) (both P <0.05). The cusp catastrophe model fitted ( R 2=0.886, 0.881, 0.882) better than the linear ( R 2=0.258, 0.219, 0.258) and Logistic regression models ( R 2= 0.242, 0.211 , 0.176). Gender stratified analysis results showed that bifurcation effect of ACEs was stronger in males than in females( β boys =0.224, β girls =0.086); in females, both ACEs and depressive symptoms had a bifurcation effect, with the former showing a stronger effect ( β ACEs =0.062, β depressive =0.015) (all P <0.05). Conclusions Suicidal behavior among vocational high school students exhibits nonlinear characteristics. Improving social capital to reducing ACEs and depressive symptoms may contribute to decreasing adolescent suicidal behaviors.

Adipocytic tumors are the most common type of soft tissue tumors,which can be divided into lipomas and liposarcomas.Studies have found that benign lipomas resected from the same site can transform into liposarcomas,especially atypical lipomatous tumors(ALT),suggesting an underlying biological association.In this case,the patient underwent resection of a right neck mass in our hospital in 2017,and the pathology showed fibrolipoma.One year later,the mass recurred at the original site but was not treated.By 2023,the mass had significantly enlarged and extended deeply.MRI showed that the lesion had an unclear boundary with the surrounding fat,suggesting liposarcoma.Puncture and molecular pathology showed MDM2 gene amplification,and the diagnosis of ALT was made,which was confirmed by pathology after complete surgical resection.It can be seen that adipocytic tumors have great differences in biological behavior,and benign lipomas can transform into liposarcomas(especially ALT).Clinically,it is necessary to combine imaging,pathology and molecular detection(such as MDM2/CDK4)for differentiation to formulate treatment plans.

Objective To investigate the therapeutic effects of focused ultrasound and ATP-infrared bioeffect for non-neoplastic epithelial disorders of the vulva(NNEDV),aiming to provide references for the clinical study and selection of individualized treatment plans of NNEDV patients.Methods The clinical data of 278 NNEDV patients attending the gynecology department of some hospital from May 2020 to December 2023 were retrospectively analyzed,who were divided into an observation group receiving focused ultrasound treatment and a control group receiving ATP-infrared bioeffect treatment with the single random grouping mmethod.The observation group enrolled in 143 patients including 84 cases of lichen simplex chronicus(LSC)and 59 cases of vulvar lichen sclerosus(VLS),and the control group had 135 patients including 71 LSC cases and 64 VLS cases.Comparisons were carried out in terms of the therapeutic effect and safety in the two groups,the efficacy for LSC and VLS between and within the two groups,and the clinical symptom scores and the quality of life scores before and after treatment of the two groups.SPSS 23.0 software was used for statistical analysis.Results The two groups had no significant differences in response rate and recurrence rate(P>0.05),while the observation group had the cure rate higher and the complication rate higher than those of the control group(P<0.05).In the observation group,the overall response rates for LSC and VLS were not significantly different(P>0.05);in the control group,the overall response rate for LSC was higher than that for VLS significantly(P<0.05).The cure rate for LSC in the observation group was higher than that in the control group,with the differences being statistically significant(P<0.05);the two groups had no significant differences in the cure rate for VLS(P>0.05).The two groups had significant differences in the skin color socre,vitiligo area scoring index and skin elasticity one month,three months and six months after treatment(P<0.05),with the differences being statistically significant in the tissue structure score three months and six months after treatment(P<0.05);there were no significant differences found between the two groups in the pruritus score one month,three months and six months after treatment and in tissue structure score one month after treatment(P>0.05).In the two groups the differences were all statistically significant in the quality of life score three and six months after treatment(P<0.05);the two groups had significant differences in the quality of life score before and after treatment(P>0.05).Conclusion Focused ultrasound and ATP-infrared bioeffect are both effective for NNEDV.Focused ultrasound gains advantages in restoring the color and tissue structure of vulvar skin,and the physical therapy is the first choice for NNEDV that has failed drug therapy and risks for recurrence and canceration;ATP-infrared bioeffect with a low complication rate can be used for the patients with mild symptoms,cracked skin inflammation or those unable to tolerate ultrasound.[Chinese Medical Equipment Journal,2025,46(6):59-64]

Aim To investigate the regulatory mecha-nisms of donepezil on the expression and enzymatic ac-tivity of cytochrome P450 3A4(CYP3A4),elucidate the synergistic impact of hypoxia on CYP3A4 function,and reveal its potential association with drug-induced cardiotoxicity,particularly QT interval prolongation.Methods Western blot,co-immunoprecipitation,and gene knockdown techniques were employed to evaluate the effects of donepezil and hypoxia on CYP3A4 pro-tein expression.CYP3A4 enzymatic activity was as-sessed using an in vitro incubation system with rat liver microsomes combined with high-performance liquid chromatography(HPLC),and the half-maximal inhib-itory concentration(IC50)was determined.Results Donepezil(10 μmol·L-1)and hypoxia reduced CYP3A4 protein expression to 31.75％and 45.90％of the control levels,respectively.Both interventions activated the gp78-mediated ubiquitin-proteasome path-way,significantly increasing CYP3A4 ubiquitination levels by 2.1-fold compared to the control group,thereby promoting proteasomal degradation.Donepezil inhibited CYP3A4 enzyme activity with an IC50 of 83.4μmol·L-1,and hypoxia synergistically enhanced this inhibitory effect,reducing the IC50 to 20.79 μmol·L-1.Conclusion Donepezil downregulates CYP3A4 function through dual mechanisms involving ubiquitin-mediated proteasomal degradation and direct enzymatic inhibition.Hypoxia potentiates this effect,leading to impaired metabolism of CYP3A4 substrate drugs,ele-vated plasma drug concentrations(1.6-2.3-fold in-crease compared to normal metabolic conditions),and an increased risk of QT interval prolongation and other forms of cardiotoxicity.

Adipocytic tumors are the most common type of soft tissue tumors,which can be divided into lipomas and liposarcomas.Studies have found that benign lipomas resected from the same site can transform into liposarcomas,especially atypical lipomatous tumors(ALT),suggesting an underlying biological association.In this case,the patient underwent resection of a right neck mass in our hospital in 2017,and the pathology showed fibrolipoma.One year later,the mass recurred at the original site but was not treated.By 2023,the mass had significantly enlarged and extended deeply.MRI showed that the lesion had an unclear boundary with the surrounding fat,suggesting liposarcoma.Puncture and molecular pathology showed MDM2 gene amplification,and the diagnosis of ALT was made,which was confirmed by pathology after complete surgical resection.It can be seen that adipocytic tumors have great differences in biological behavior,and benign lipomas can transform into liposarcomas(especially ALT).Clinically,it is necessary to combine imaging,pathology and molecular detection(such as MDM2/CDK4)for differentiation to formulate treatment plans.

Aim To investigate the therapeutic effects of a newly developed Tadalafil tablet on pulmonary fi-brosis induced by paraquat(PQ)in rats,as well as its impact on histone acetylation levels in epithelial cells.Methods SD rats were randomly divided into four groups:the control group(control),the model group(PQ),the Tadalafil new tablet treatment group(N-Tad,1 mg·kg-1),and the positive control drug treatment group(Cialis,5 mg·kg-1).The model group and treatment group rats were intraperitoneally injected with PQ(30 mg·kg-1).Two hours after the initial treatment,the rats in the treatment group re-ceived N-Tad or Cialis via gavage,while the control and model groups were administered an equal volume of physiological saline by gavage once daily for 28 days.The weight gain rate and lung tissue index for each group of rats were calculated.Additionally,the effects of N-Tad treatment on lung tissue structural damage and collagen deposition in rats with PQ-in-duced pulmonary fibrosis were observed using HE stai-ning,Masson trichrome staining,and immunohisto-chemical techniques.By employing the Western blot technique,the effects of Tadalafil intervention on the expression of the epithelial marker E-cadherin(E-Cad),the stromal marker fibronectin(Fn),and the histone acetylation marker acetylated histones(Ac-his-tones)in A549 cells were observed.Results Com-pared to the control group,rats with PQ-induced pul-monary fibrosis exhibited a significant decrease in the rate of body weight growth,an increase in lung tissue index(P＜0.05),and a notable increase in the expression and distribution of the fibrosis marker alpha-smooth muscle actin(α-SMA)in lung tissue.The structure of the lung tissue was disrupted,accompanied by the deposition of interstitial collagen fibers.Both N-Tad and Cialis treatments could significantly enhance the rate of weight gain,decrease the lung tissue index,inhibit the expression of α-SMA,and reduce the depo-sition of interstitial collagen in the lung tissue of rats with pulmonary fibrosis.Notably,low-dose N-Tad treatment was comparable to high-dose Cialis treat-ment.At the cellular level,Tadalafil significantly in-hibited the high expression of Fn induced by transfor-ming growth factor beta 1(TGF-β1)in A549 cells.It also upregulated the expression of E-cadherin and sig-nificantly increased the levels of acetylated histones(P＜0.05).Conclusions N-Tad promotes histone acetylation in alveolar epithelial cells,significantly in-hibits epithelial-mesenchymal transition,increases E-cadherin expression,and improves lung tissue structur-al damage and collagen deposition caused by PQ.Ad-ditionally,it offers the advantage of a lower effective dose compared to Cialis,providing a new option for the treatment of pulmonary fibrosis.

Objective To explore the correlation of bilateral knee joint strength asymmetry with balance,walking ability,and motor function in hemiplegic stroke patients,providing a reference for clinical assessment of stroke patients.Methods A total of 46 hemiplegic stroke patients admitted to the Rehabilitation Medicine Department of People's Hospital of Shijiazhuang from February to December 2023 were selected.According to the Berg Balance Scale(BBS)scores,patients were divided into Group A(BBS score≤20,n=23)and Group B(BBS score>20,n=23).The peak torque and differences of bilateral knee flexors and extensors were compared between two groups.Isokinetic technology was used to assess the differences in peak torque of bilateral knee joints at 60°/s and 120°/s.BBS,Functional Ambulation Classification(FAC),and Fugl-Meyer Assessment of Lower Extremity(FMA-LE)were used to evaluate patients'balance,walking ability,and lower limb motor function.The correlation between bilateral knee joint peak torque and its difference with the scores of three functional scales was analyzed.Results The peak torque of knee flexors and extensors at 60°/s in group A was significantly lower than that in group B(P<0.05).At both 60°/s and 120°/s the differences in peak torque between the healthy and affected sides of knee flexors and extensors were greater than those in group B(P<0.05).At 60°/s,the difference in peak torque of bilateral knee extensors in hemiplegic stroke patients was negatively correlated with the scores of BBS,FAC,and FMA-LE(r=-0.569,-0.582,-0.606,P<0.01),as did the knee flexors(r=-0.534,-0.386,-0.458,P<0.05).At 120°/s,similar negative correlations were observed for both knee extensors(r=-0.304,-0.304,-0.443,P<0.05)and flexors(r=-0.337,-0.349,-0.370,P<0.05).Conclusions Bilateral knee joint strength asymmetry in hemiplegic stroke patients is negatively correlated with balance and walking ability.The difference in strength between the two sides of knee joint may be one of the clinical indicators for evaluating the motor function of stroke patients.

Objective To investigate the influence and threshold effect of preoperative intraocular pressure(IOP)on secondary glaucoma(SG)after pars plana vitrectomy(PPV).Methods A retrospective analysis was conducted on 88 patients with retinal detachment who developed SG after PPV(SG group)treatment at Hebei Eye Hospital from January 2020 to January 2024.Meanwhile,88 patients with retinal detachment who underwent PPV at the same hospital during the same period but did not develop SG postoperatively were selected as non-SG group in a 1:1 ratio.Univariate analysis was used to compare the differences in clinical data between the two groups.A stratified regression model was applied to analyze the correlation between postoperative characteristics and preoperative IOP.Multivariate logistic regression analysis was used to identify the factors affecting the occurrence of SG after PPV,with multicollinearity diagnosis and sensitivity analysis performed for the parameters.Additionally,the threshold effect of preoperative IOP on the risk of postoperative SG was analyzed.A predictive model was constructed based on the results of multivariate logistic regression.The receiver operating characteristic(ROC)curve was employed to evaluate the efficacy and accuracy of the predictive model,while the calibration curve and clinical decision curve were utilized to assess the consistency between the predictive model and actual conditions as well as the clinical practicality of the model.Results Compared with non-SG group,SG group had a higher proportion of patients with a history of diabetes,family history of glaucoma,a higher preoperative IOP,higher proportion of postoperative closed anterior chamber angle status,longer silicone oil tamponade duration(≥6 months),higher incidence of silicone oil emulsification(P<0.05).Postoperative anterior chamber angle status(closed)was significantly positively correlated with preoperative IOP levels(P<0.05).Multivariate logistic regression analysis showed that history of diabetes,family history of glaucoma,silicone oil emulsification,postoperative anterior chamber angle closure,silicone oil tamponade duration≥6 months,and preoperative IOP≥21 mmHg were independent risk factors for SG after PPV(P<0.05).Multicollinearity diagnosis indicated no significant collinearity among the above variables.Sensitivity analysis showed that the association tended to be null when E=5.014.With the increase of preoperative IOP,the probability of SG after PPV in patients showed an upward trend.The threshold effect analysis revealed that when preoperative IOP≥19 mmHg,the probability of SG after PPV increased significantly with the elevation of preoperative IOP(OR=2.942,95%CI 1.794-4.826,P<0.001).After adjusting for covariates,preoperative IOP remained an independent influencing factor for different degrees of SG after PPV(OR=7.392,95%CI 1.379-12.510,P=0.001).Before and after validation,the area under the ROC curves(AUCs)of the model for predicting SG after PPV were 0.987(95%CI 0.974-1.000,P<0.001)and 0.989(95%CI 0.969-1.000,P<0.001),with sensitivities of 0.9332 and 0.9545,and specificities of 0.9981 and 0.9773,respectively.Both the calibration curve and decision curve analysis demonstrated that the predictive model had good discrimination and accuracy.Conclusion Preoperative IOP is an influencing factor and a sensitive indicator for the development of SG after PPV in patients with retinal detachment.

Objective To investigate the effects of remimazolam(REM)on cerebral ischemia-reperfusion injury(CIRI)rats and the AMP-activated protein kinase(AMPK)/NOD-like receptor protein 3(NLRP3)signaling pathway.Methods One hundred rats were selected to construct the CIRI rat model(Mod)and stochastically separated into a Mod group,low,medium,and high dose remifentanil groups(REM-L,REM-M,REM-H),and high dose remifentanil+pathway inhibitor Compound C group(REM-H+Compound C),with 20 rats in each group.Another 20 healthy rats were included as the control(Ctrl)group.All rats were subjected to neurobehavioral scoring.The water content,infarct area,and oxidative stress indicators of brain tissue were detected.The morphology and apoptosis of brain tissue were observed by HE and TUNEL staining.Western blotting was applied to detect protein expression related to the AMPK/NLRP3 signaling pathway.Results Compared with the Mod group,with the increase of REM dose,the movement disorders in rats were alleviated,the overall structure of brain tissue gradually recovered,pathological damage was reduced,the area of cerebral infarction,brain water content,and apoptosis rate of brain tissue cells decreased,reactive oxygen species(ROS)level,malondialdehyde(MDA)content,and NLRP3 and Caspase-1 protein expression levels decreased,superoxide dismutase the(SOD)content and AMPK protein expression level increased(P＜0.05).Compared with the REM-H group,the REM-H+Compound C group showed aggravated motor disorders,and more severe pathological damage to brain tissue,the area of cerebral infarction,cerebral water content and apoptosis rate of brain tissue cells increased,the ROS level,MDA content and the protein expression of NLRP3 and Caspase-1 increased,while the content of SOD and the protein expression decreased(P＜0.05).Conclusion Remimazolam can enhance the antioxidant function of the body,reduce brain cell apoptosis,alleviate brain tissue injury,and thus have a certain protective effect on ischemia-reperfusion brain injury in rats,the mechanism of which may be related to the activation of the AMPK/NLRP3 signaling pathway.

Objective To explore the correlation between serum homocysteine(Hcy),25-hydroxyvitamin D[25(OH)D]and frailty with type 2 diabites mellitus(T2DM)complicated with sarcopenia.Methods From September 2021 to March 2023,210 elderly T2DM patients were selected from the Department of Geriatrics of The First People's Hospital of Yunnan Province,and divided into simple T2DM(n=99)group,mild sarcopenia(M-Sar,n=59)group and severe sarcopenia(S-Sar,n=52)group.The"Elderly Comprehensive Assessment System"was used to evaluate subjects.The influencing factors of T2DM complicated with sarcopenia were analyzed by Logistic regression.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of Hcy,25(OH)D combined with frailty in evaluating T2DM with sarcopenia.Results In T2DM,M-Sar and S-Sar groups,the age,Hcy,the risk rate of balance gait work falling and the rate of weakness increased in turn(P<0.05),while BMI,hemoglobin,25(OH)D,the rate of good nutrition,the normal rate of basic daily living,the low risk rate of falling,the rate of good balance gait function and the rate of no weakness decreased in turn(P<0.05).Logistic regression analysis showed that serum Hcy,frailty and 25(OH)D were the influencing factors of senile T2DM complicated with sarcopenia.Hcy,25(OH)D and frailty combined to predict T2DM with sarcopenia had an area under ROC carve of 0.815,with a sensitivity of 0.811 and a specificity of 0.717.Conclusions Serum Hcy,25(OH)D and frailty are closely related to T2DM combined with sarcopenia.Detection of Hcy and 25(OH)D combined with frailty score is helpful for early diagnosis of sarcopenia in primary hospitals.