Objective: To explore the relationship between snack consumption and depressive symptoms in first year junior high school students with different left behind experiences in Yunnan Province, so as to provide a basis for improving depressive symptoms among first year junior high school students with different left behind experiences. Methods: From October to December 2022,a cluster random sampling method was used to select 8 500 first year junior high school students from 11 ethnic minority areas (Fugong County, Longling County, Longyang District, Luchun County, Mojiang County, Nanjian County, Qiaojia County, Shuangjiang County, Tengchong City, Yuanmou County, Zhenyuan County) in Yunnan Province for a questionnaire survey. The Chinese version of Depression Anxiety Stress Scale-21 was applied to assess depressive symptoms in first year junior high school students, and snack consumption was collected by employing food frequency questionnaire. The generalized linear model was used to analyze the association between first year junior high school students snack consumption and depressive symptoms, and the analysis was stratified according to left behind experience. Results: The detection rates of depressive symptoms among firstyear junior high school students with and without left behind experience were 36.25% and 26.91%, respectively. After controlling for confounding variables, the generalized linear model analysis showed that sweet snacks ( β=0.16, 95%CI =0.07-0.25), fast food ( β=0.14, 95%CI =0.04-0.23) and carbonated drinks ( β=0.09, 95%CI =0.01-0.17) of first year junior high school students with left behind experience (all P <0.05). Compared with those without such behavior, the risk of depressive symptoms was higher in consumption of fast food ( β=0.13, 95%CI =0.07-0.18) and carbonated drinks ( β=0.10, 95%CI =0.06-0.15)among first year junior high school students without left behind experience (both P <0.05). Conclusion Snack consumption among first year junior high school students in Yunnan may increase the risk of developing depressive symptoms, while first year junior high school students with left behind experience may have a greater risk of developing depressive symptoms.

Diabetic kidney disease （DKD） is one of the main causes of chronic kidney disease. Both traditional Chinese medicine （TCM） and western medicine have their own advantages in the prevention and treatment of DKD， but there are also many difficulties. By analysis of the difficulties faced by TCM and western medicine in the differentiation and treatment of DKD， based on the theory of "miniature masses in the renal collaterals"， combined with long-term clinical practice， "internal heat leading to mass" is proposed as the core pathogenesis of DKD. Therefore， a trinity model of "disease-syndrome-symptom" for differentiation and treatment of DKD based on the core pathogenesis has been proposed. This model highlights the status of the core pathogenesis of "internal heat leading to mass" in DKD， and conducts a three-dimensional identification from the perspectives of disease， syndrome and symptom， so as to inspire clinical practice.

ObjectiveTo investigate the quality markers of Xiaoqinglong granules（XQLG） for treating bronchial asthma using the analytic hierarchy process（AHP）-entropy weight method（EWM）， network pharmacology and high performance liquid chromatography（HPLC） content determination. MethodsEffectiveness， testability and peculiarity component data of XQLG in treating bronchial asthma were constructed through database retrieval， literature review， and network pharmacology. Subsequently， AHP-EWM was used to quantitatively identify and weight the control layer and element layer， the relevant compounds were selected as candidate quality markers based on comprehensive scores. Further comparison of reference substances and establishment of HPLC content determination method were used to determine the potential quality markers of XQLG， which were verified by molecular docking with disease targets. ResultsA total of 13 components， including glycyrrhizic acid， paeoniflorin， schisandrol A， isoliquiritigenin， 6-gingerol， ephedrine， liquiritin， albiflorin， liquiritigenin， 6-shogaol， pseudoephedrine， cinnamic acid and cinnamaldehyde， were identified as potential quality markers of XQLG by AHP-EWM. Quantitative analysis indicated that all aforementioned quality markers could be detected in 13 batches of XQLG， indicating that it had stable testability as a quality marker. Among these 13 batches of samples， ephedrine and paeoniflorin exhibited good consistency in content， while pseudoephedrine and cinnamaldehyde showed poor consistency. Molecular docking analysis revealed that the 13 compounds exhibited binding energies with the core targets -2.11 kcal·mol^-1， indicating that the 13 compounds could spontaneously bind to the disease targets， which may be the material basis for the treatment of bronchial asthma with XQLG. ConclusionIn this study， 13 compounds were screened by AHP-EWM combined with network pharmacology and HPLC as quality markers for the treatment of bronchial asthma by XQLG， laying the foundation for enhancing the quality standards of this preparation.

Objective:To evaluate knee biomechanics of patients about 12 months after anterior cruciate ligament(ACL)reconstruction during cutting and determine the abnormal biomechanical characteristics.Methods:Sixteen males about 12 months after ACL reconstruction were recruited for this study.Three-dimensional kinematic and kinetic data were collected during cutting movement.Knee joint angles and moments were calculated.Paired t-tests were used to compare the differences in knee biomechanics be-tween the surgical leg and nonsurgical leg.Results:The peak posterior ground reaction force(surgical leg:0.380±0.071;nonsurgical leg:0.427±0.069,P=0.003)and vertical ground reaction force(surgical leg:1.996±0.202,nonsurgical leg:2.110±0.182,P=0.001)were significantly smaller in the surgical leg than in the nonsurgical leg.When compared with the uninjured leg,the surgical leg demonstrated a smaller knee flexion angle(surgical leg:38.3°±7.4°;nonsurgical leg:42.8°±7.9°,P＜0.001)and larger external rotation angle(surgical leg:10.3°±2.4°;nonsurgical leg:7.7°±2.1°,P=0.008).The surgical leg also demonstrated a smaller peak knee extension moment(surgical leg:0.092±0.031;nonsurgical leg:0.133±0.024,P＜0.001)and peak knee external rotation moment(surgical leg:0.005±0.004;nonsurgical leg:0.008±0.004,P=0.015)when com-pared with the nonsurgical leg.Conclusion:The individuals with ACL reconstruction mainly showed asymmetrical movements in the sagittal and horizontal planes.The surgical leg demonstrated a smaller peak knee flexion angle,knee extension moment,and knee external rotation moment,with greater knee external rotation angle.

Randomized controlled trials （RCTs） have been widely used in clinical efficacy evaluation of traditional Chinese medicine （TCM）， but also having limitations such as high cost，time consuming， and difficulty in patient recruitment and enrollment. The introduction of matching adjusted indirect comparison （MAIC） can alleviate the problem caused by the limitation of traditional RCT methodology to some extent. This paper introduced the basic principles of MAIC， and analyzed the similarities and differences， advantages and disadvantages of the two design methods， that is the anchored and the non-anchored. By analyzing two case studies in the evaluation of TCM efficacy， which are acupuncture for paroxysmal migraine and moxibustion for diarrhea-type irritable bowel syndrome， respectively， this paper introduced the methodological characteristics of MAIC in the efficacy evaluation of TCM， explored the strengths and feasibility of MAIC in the evaluation of efficacy evidence in TCM， the evaluation of efficacy of non-pharmacological TCM therapy and the development of new Chinese medicine， and discussed the limitations of existing research， matching factors and sample size. Additionally， the paper offered prospects by combining the simulation treatment comparison method and emulated target trials， with the goal of providing recommendations and references for the clinical efficacy evaluation of TCM.

Background: Twenty-four-hour urinary free cortisol (UFC) measurement is the initial diagnostic test for Cushing’s syndrome (CS). We compared UFC determination by both direct and extraction immunoassays using Abbott Architect, Siemens Atellica Solution, and Beckman DxI800 with liquid chromatography-tandem mass spectrometry (LC-MS/MS). In addition, we evaluated the value of 24-hr UFC measured by six methods for diagnosing CS. Methods: Residual 24-hr urine samples of 94 CS and 246 non-CS patients were collected.A laboratory-developed LC-MS/MS method was used as reference. UFC was measured by direct assays (D) using Abbott, Siemens, and Beckman platforms and by extraction assays (E) using Siemens and Beckman platforms. Method was compared using Passing–Bablok regression and Bland–Altman plot analyses. Cut-off values for the six assays and corresponding sensitivities and specificities were calculated by ROC analysis. Results: Abbott-D, Beckman-E, Siemens-E, and Siemens-D showed strong correlations with LC-MS/MS (Spearman coefficient r = 0.965, 0.922, 0.922, and 0.897, respectively), while Beckman-D showed weaker correlation (r = 0.755). All immunoassays showed proportionally positive bias. The areas under the curve were 0.975 for Abbott-D, 0.972 for LCMS/MS, 0.966 for Siemens-E, 0.948 for Siemens-D, 0.955 for Beckman-E, and 0.877 for Beckman-D. The cut-off values varied significantly (154.8–1,321.5 nmol/24 hrs). Assay sensitivity and specificity ranged from 76.1% to 93.2% and from 93.0% to 97.1%, respectively. Conclusions Commercially available immunoassays for measuring UFC show different levels of analytical consistency compared to LC-MS/MS. Abbott-D, Siemens-E, and Beckman-E have high diagnostic accuracy for CS.

Objective:To explore the mediating effect of postpartum depression in fathers on their parenting competence and breastfeeding support.Methods:From March to October 2022, convenience sampling was used to select 337 fathers of infants aged 4 to 8 weeks in Wuxi Women and Enfants Care Hospital as the research subject. A survey was conducted using the Edinburgh Postnatal Depression Scale (EPDS), Chinese version of Parenting Sense of Competence Scale (C-PSOC), and maternal spouse version Partner Breastfeeding Influence Scale (PBIS). Spearman correlation was used to explore the correlation between postpartum depression in fathers and their parenting competence and breastfeeding support, and the PROCESS plugin was used for mediation effect testing.Results:A total of 337 questionnaires were distributed and 337 were collected, including 314 valid questionnaires with an effective response rate of 93.18% (314/337). Among 314 infant fathers, the EPDS, C-PSOC, and maternal spouse version PBIS scores were 3.00 (2.00, 6.00), 66.00 (62.00, 71.00), and 83.00 (74.00, 90.00), respectively. Father's parenting competence was negatively correlated with father's postpartum depression ( r=-0.435, P<0.01), and positively correlated with father's breastfeeding support ( r=0.480, P<0.01). Father's postpartum depression was negatively correlated with father's breastfeeding support ( r=-0.423, P<0.01). The mediating effect analysis showed that the mediating effect of postpartum depression in fathers between parenting competence and breastfeeding support was 0.341, accounting for 39.51% of the total effect. Conclusions:Postpartum depression in fathers is a mediating variable between their parenting competence and their breastfeeding support. Medical and nursing workers should develop perinatal education programs for fathers, enhance their parenting competence, alleviate their negative emotions, and promote their breastfeeding support.

Objective:To explore the longitudinal changes of symptom clusters and quality of life in young and middle-aged postoperative patients with cervical cancer during chemotherapy, and to clarify the correlation between the two, in order to provide reference for clinical staff symptom management and improvement of patients′ quality of life.Methods:A longitudinal study was conducted, a total of 252 young and middle-aged who underwent chemotherapy after radical cervical cancer surgery in the gynecological ward of Henan Provincial People′s Hospital from December 2022 to August 2023 were selected as the investigation objects by convenient sampling method. Data were collected at 2 d before chemotherapy (T1), 1 week after the first chemotherapy (T2), 1 week after the third chemotherapy (T3), and 1 week after the sixth chemotherapy (T4), using the general data questionnaire, the Chinese version of the Memorial Symptom Assessment Scale and the Functional Assessment of Cancer Therapy-Cervix. Exploratory factor analysis was used to extract symptom clusters from the data. The generalized estimation equation model was used to analyze the dynamic change trend and correlation between symptom clusters and quality of life.Results:A total of 221 patients with cervical cancer aged 18-59 (46.85 ± 6.50) years old were included. At T1 and T2, there were 4 symptom clusters, which were psychological symptom cluster, gastrointestinal symptom cluster, disease behavior symptom cluster and perimenopausal symptom cluster. T3 and T4 increased the neurological symptom cluster and self-image disorder symptom cluster, a total of 6 symptom clusters. The higher score of each symptom cluster, the lower total score of quality of life (Wald χ2 values were 8.08-62.70, all P<0.01). Conclusions:Young and middle-aged postoperative patients with cervical cancer suffered from multiple symptom clusters during chemotherapy, which not only remained relatively stable, but also showed a constantly changing trend. Effective dynamic management of symptoms clusters in young and middle-aged postoperative patients with cervical cancer during chemotherapy is expected to improve their quality of life.

Objective:To construct and validate a risk-scoring model for predicting delayed onset of lactogenesis stage Ⅱ (DOL Ⅱ) in mothers separated from their premature infants.Methods:This was a retrospective study. (1) Modeling group: This group enrolled 310 mothers who were separated from their premature infants after delivery at Wuxi Maternal and Child Health Hospital from December 2021 to November 2022. They were further divided into the DOL Ⅱ group (144 cases) and the non-DOL Ⅱgroup (166 cases) according to whether they had DOL Ⅱ or not. Based on the results of multivariate logistic regression analysis, each risk factor was assigned a score, and a risk prediction scoring model was established. (2) Validation group: This group included 130 mothers of premature infants who experienced mother-infant separation after delivery at Wuxi Maternal and Child Health Hospital from December 2022 to March 2023. The area under the receiver operating characteristic (ROC) curve was used to evaluate the discrimination, and the Hosmer-Lemeshow test was used to assess the goodness of fit. The Chi-square test (or Fisher's exact probability test) or Wilcoxon rank sum test were used for inter-group data comparison. Results:This risk prediction scoring model included 10 risk factors [maternal age≥35 years old, hypertensive disorders of pregnancy, anemia, gestational diabetes mellitus, preterm rupture of membrane, start breastfeeding >6 hours, postpartum admission of maternal intensive care unit, cesarean section, score of Edinburgh Postpartum Depression Scale >9.5, postpartum neutrophil-to-lymphocyte ratio ≥4.369, Fatigue Scale-14 ≥7.5, body mass index in the first trimester ≥23.719 kg/m 2, postpartum BMI≥27.661 kg/m 2,and increase of BMI during pregnancy ≥5.393 kg/m 2], with an area under the ROC curve of 0.838 (95% CI: 0.795-0.882, P<0.001), a maximum Yoden index of 0.526, a specificity of 0.825, a sensitivity of 0.701, and an optimal threshold of 4.5. After rounding the score off to the nearest whole number, those with a score≥5 were defined as at high risk of DOL Ⅱ, while those with a score<5 were at low risk. Hosmer-Lemeshow test showed χ2=3.43 and P=0.634. The positive predictive value, the negative predictive value, and the accuracy were 77.7%, 76.1%, and 76.8%, respectively. In the modeling group, 130 out of the 310 cases (41.9%) were predicted to be at high risk by the model with 101 (32.6%) experiencing DOL Ⅱ, while 180 cases (58.1%) were predicted to be at low risk with 43 (13.9%) experiencing DOL Ⅱ. Among the 130 cases in the validation group, 59 (45.4%) were predicted to be at high risk with 39 (30.0%) experiencing DOL Ⅱ, while 71 (54.6%) were predicted to be at low risk with 19 (14.6%) experiencing DOL Ⅱ. The model validation results showed that the area under the ROC curve was 0.774 (95% CI: 0.693-0.855, P<0.001) and the Hosmer-Lemeshow test showed χ2=3.09 and P=0.687, with the positive predictive value of 66.1%, the negative predictive value of 73.2%, and the accuracy of 70.0%. Conclusions:This study preliminarily establishes a risk scoring model for predicting DOL Ⅱ in mothers separated from their premature infants which is of certain predictive value and can provide a reference for developing predictive lactation support measures.

Objective To evaluate the effect of red-blue light photon assisted therapy on wound healing after flap reconstruction of limb traumatic defects.Methods A total of 146 patients who were admitted to the Ward of Microsurgery of ⅢA hospital of Shanghai from January 2020 to December 2021 and received flap reconstruction surgery for soft tissue defects of limbs were included in this prospective observational study.According to the order of admission,patients were divided into a control group(n=70)and an trial group(n=76).In the control group,a 60W thermal lamp was offered to the patients for locally heating the flaps,with continuous irradiation for 24 hours with a maintaining power of 1-2W,at an approximately 30-45 cm in distance from the flap.In the trial group,based on the thermal irradiation applied to the control group,a combined red and blue light photon irradiation therapy was offered as an additional measure,by twice a day at 20 minutes per session of blue-red light photon irradiation,at 8-12cm in distance from the flap.The two groups were compared in terms of tension of tissues around flap,incidence of infection within 7 days after surgery and the survival of flap within 2 weeks after surgery.Results The two groups showed no significant difference in terms of tissue tension between the 1st and 3rd day after surgery(P<0.05),but with significant differences on the 5th and 7th day after surgery(P>0.05).The trial group exhibited significantly lower incidence of infection within 7 days after surgery compared to that of the control group(P<0.05),and with a significantly higher flap survival rate at 2 weeks after surgery(P<0.05).Conclusion After the flap reconstruction of soft tissue defects of limbs,a red-blue light assisted photon irradiation therapy can effectively improve postoperative tissue tension around a flap,reduce infection rate and improve the survival rate of a flap.It provides an effective and safe interventional measures for postoperative care of the transferred flap.