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 investigate the prevalence of thyroid nodules in the physical examination population in Mianyang region and analyze its association with metabolic syndrome. Methods A retrospective study was conducted on 9 978 individuals who underwent health examinations at our hospital from January 2024 to May 2025. Thyroid examinations were performed using color Doppler ultrasound to analyze the prevalence of thyroid nodules in this population. Clinical data of all subjects were collected, and logistic regression analysis was employed to assess the association between metabolic syndrome and the risk of thyroid nodule development. Results The prevalence of thyroid nodules in the physical examination population of Mianyang region was 17.98% (1 794/9 978). The logistic regression results showed that after adjusting for gender, age, BMI, occupation, consumption of non-iodized salt, staying up late, daily sleep duration, anxiety, and depression, metabolic syndrome (OR=6.593, 95% CI: 3.961-10.975) was associated with thyroid nodules (P<0.05). Conclusion The prevalence of thyroid nodules among the physical examination population in the Mianyang area is 17.98%, and metabolic syndrome remains associated with the risk of thyroid nodules after effectively controlling for confounding factors.

Background Microparticles (MPs) are one of the main medium of inflammatory reaction with an important role in atherosclerotic progression. Studies on association of air pollution exposure and levels of peripheral blood MPs are limited among human. Objective To evaluate the effects of short-term exposure to air pollution on levels of peripheral blood MPs. Method A panel of 73 healthy adults was followed with 4 repeated follow-ups in Beijing, China, from November 2014 to January 2016. During each visit, we collected questionnaire information, fasting venous blood, urine, and exposures to fine particulate matter (PM_2.5), black carbon, nitric oxide, nitrogen dioxide, nitrogen oxide, sulfur dioxide, carbon monoxide, and ozone. We used linear mixed-effect models to analyze associations of air pollution exposure with levels of total MPs (TMPs) and MPs derived from various cells. Stratified analysis was conducted by levels of C-reactive protein (CRP) and malondialdehyde (MDA). Results The results showed significant associations between air pollution exposure and peripheral blood TMPs at 2 h-6 d prior to the follow-ups (P<0.05), while no statistical associations were found for MPs derived from different cell types. Significant increases in TMPs of 7.8% (95%CI: 0.7%, 15.3%) and 14.3% (95%CI: 2.8%, 27.2%) were observed with each interquartile range (IQR) increase in PM_2.5 (IQR=64.9 μg·m⁻³) at prior 18 h and NO (IQR=40.5 μg·m⁻³) at prior 48 h. Among participants with low levels of CRP and MDA, significantly positive associations were observed between air pollution exposure and levels of TMPs (P<0.05). Conclusion Short-term exposure to air pollution is significantly associated with increased levels of circulating MPs in healthy adults, and in people with lower systemic inflammation, peripheral blood MPs levels are more easily affected after exposure to air pollutants.

OBJECTIVE To construct a risk prediction model for nonattainment plasma concentration of zonisamide in children with epilepsy， and to provide evidence for individualized dosing.METHODS Children with epilepsy who received standardized zonisamide treatment orally in Kunming Children’s Hospital were retrospectively selected as research subjects. Those treated from May 2022 to May 2024 were included in the modeling cohort， and those treated from June 2024 to January 2025 were included in the external validation cohort. According to plasma concentration， children were divided into therapeutic group and nonattainment group. Independent influencing factors for nonattainment plasma concentration of zonisamide were screened by collinearity diagnosis， univariate analysis， Lasso regression and random forest， based on which a nomogram risk prediction model was constructed and validated. Finally， the Shapley additive explanations （SHAP） method was used to interpret the features of the nomogram risk prediction model.RESULTS A total of 945 children with epilepsy were included in this study. There was no statistically significant difference in baseline data between the modeling cohort （531 cases） and the external validation cohort （414 cases） （ P ＞0.05）， indicating comparability. Through multi-stage feature screening， seven influencing factors were finally included to construct the prediction model， namely gender， age， dosage， aspartate transferase， total bilirubin， uric acid and vitamin D. The corrected area under the curve of the model was 0.799 in the modeling cohort and 0.762 in the external validation cohort， showing good calibration and clinical applicability. SHAP analysis showed that gender， dosage， total bilirubin， age and aspartate transferase were the top five important variables affecting model prediction.CONCLUSIONS The nomogram risk prediction model for nonattainment plasma concentration of zonisamide constructed in this study has stable predictive performance. Clinically， the risk of nonattainment plasma concentration can be quickly assessed by combining the child’s gender， age， dosage， liver and kidney function， and vitamin D， and the dosing regimen can be adjusted in time.

Objective:To prepare aldolylated hyaluronic acid-modified antimicrobial carbon dots (AHA-CDs) eye drops and evaluate its antibacterial activity against Staphylococcus aureus in vitro and in vivo. Methods:AHA-CDs eye drops were synthesized by modifying small particle size positively charged carbon dots and introducing aldehyde-based hyaluronic acid.The AHA-CDs were characterized by transmission electron microscopy, Fourier transform infrared spectroscopy, and X-ray photoelectron spectroscopy.The antibacterial activity of AHA-CDs against Staphylococcus aureus was evaluated using the microdilution method, plate counting, and live-dead bacteria fluorescence staining in vitro.The mouse bacterial keratitis model was established by removing the corneal epithelium after ring drilling and inoculating Staphylococcus aureus.Eighteen conventional female C57BL/6 mice aged 6-8 weeks were selected and divided into a blank control group, an AHA-CDs-treated group and a tobramycin-treated group of 6 mice each using random number table method, and the mice were treated with phosphate buffer saline, 80 μg/ml AHA-CDs, and 80 μg/ml tobramycin eye drops three times daily for 5 consecutive days accordingly to assess antibacterial activity against Staphylococcus aureus in vivo.Another 12 mice were divided into an AHA-CDs group and a normal control group using the random number table method, with 6 mice in each group, which were treated with 80 μg/ml AHA-CDs and phosphate buffer saline for 7 days.The mice were then sacrificed.Their eyeballs were removed and stained with hematoxylin-eosin to observe and compare the morphology and integrity of the eyeballs between the two groups to evaluate the treatment's biosafety.The use and care of the animals complied with the principles of the ARRIVE guidelines.The study protocol was approved by the Ethics Committee of the Experimental Animal Care of Henan Eye Hospital (No.HNEECA-2022-17). Results:The successful preparation of AHA-CDs was demonstrated by transmission electron microscopy, Fourier transform infrared spectroscopy, and X-ray photoelectron spectroscopy. In vitro studies showed that the minimum inhibitory concentration of AHA-CDs against Staphylococcus aureus was approximately 8 μg/ml, which effectively inhibited bacterial growth at a lower concentration.Plate counting results showed that only 20% of the bacteria survived after 10 minutes of treatment with AHA-CDs.Fluorescence staining of live/dead bacteria showed obvious red fluorescence signals after 4 hours of treatment with AHA-CDs and SP-CDs. In vivo studies showed that, after 5 days of treatment with AHA-CDs eye drops, the corneas of mice with bacterial keratitis were obviously transparent, and the corneal epithelium was basically repaired.In contrast, the tobramycin-treated group exhibited incomplete epithelial repair and mild corneal edema. In vivo safety evaluation revealed that the eye tissue morphology remained intact and no structural abnormalities were observed after AHA-CDs treatment. Conclusions:AHA-CDs eye drops have superior antibacterial effects in vivo and in vitro, and inactivate bacteria rapidly and effectively.

Objective:To analyze the underlying issues and root causes of primary healthcare resource allocation in China,to identify the key elements of the current mismatch in primary healthcare resource allocation,and to propose targeted optimization strategies.Methods:Utilizing the fuzzy set Qualitative Comparative Analysis(fsQCA)method to conduct a comprehensive investigation on the fundamental drivers of misallocation in the provision of primary healthcare resources in China,along with the associated grouping patterns.Results:From 2011 to 2021,the overall misallocation of primary medical and health resources in 31 provinces and cities of China showed a downward trend,with the average value decreasing from 0.801 to 0.661.There were 8 configuration paths to improve the optimal allocation of primary medical resources,including 2 biased factors-driven,4"system,society,and population"three-way synergistic types,and 2 multi-factor comprehensive synergistic types.Conclusion:It is recommended that all provinces need to adhere to the principle of government leadership and promote comprehensive reform of the medical and healthcare sector,with particular consideration given to the specific medical needs of the elderly.Furthermore,it is essential to implement the strategic guiding principle of diversified and synergistic development,with the objective of promoting a balanced distribution of high-quality medical resources.

Central venous access device associated skin impairment is a common complication of indwelling central venous catheters in cancer patients. To further enhance the standardization of nursing staff's practice of central venous access device associated skin impairment, a clinical nursing practice guideline for central venous access device associated skin impairment in cancer patients was developed through the Delphi expert consultation and expert meeting methods in accordance with the methodology for developing evidence-based nursing practice guidelines. Recommendations cover four aspects of management requirements, assessment, prevention, and management of central venous access device associated skin impairment, providing a practical basis for clinical healthcare professionals to make scientific decisions on central venous access device associated skin impairment.

With the increasingly stringent requirements of international standards for the stability of clinical samples,there has been a significant rise in clinical laboratories'demand for sample stability research.To ensure the accuracy of laboratory test results,conducting research and verification work related to sample stability has become particularly urgent.However,there is currently a lack of unified standards for clinical sample stability studies both domestically and internationally.In order to better promote the resach and validation of sample stability in clinical laboratroy projects,this review summarized the latest progress in sample stability research methods by reviewing relevant literature and guidelines.It recommends referencing guidance from international organizations in clinical sample stability studies,such as the cress checklist for reporting stability studies and the"recommendations for the design of stability studies for clinical samples"issued by the European Federation of Clinical Chemistry and Laboratory Medicine(EFLM).Laboratories should select either continuous experimental design or discrete experimental design based on their practical circumstances when conducting such research.

Objective:To evaluate the clinical significance of morular metaplasia (MM) in fertility-preserving treatment for young patients with endometrial hyperplasia and grade 1 endometrial endometrioid carcinoma.Methods:Clinical data was retrospectively collected from patients diagnosed with endometrial hyperplasia or grade 1 endometrial endometrioid carcinoma under 40 years old who underwent progestin-based fertility-sparing treatmentat in Tianjin Medical University General Hospital between January 2018 and November 2022.Patients were divided into the MM group (37 cases) and the non-MM group (63 cases) based on pathological findings. Clinical characteristics, hysteroscopic features, treatment efficacy and fertility outcomes were compared between the two groups. The MM group was further stratified into three subgroups based on the timing of MM occurrence:(1) MM-Bef group ( n=10): MM was present in the initial endometrial curettage or hysteroscopic biopsy pathology before fertility-sparing treatment and disappeared after treatment; (2) MM-Sus group ( n=14): MM persisted consistently before and after therapy;(3) MM-Aft group ( n=13): MM was absent before therapy but appeared after treatment. The risk factors which had impact on the treatment outcomes of the patients were analyzed using univariate and multivariate Cox regression analysis. Results:The rate of polycystic ovary syndrome were higher in the MM group than the non-MM group [51% (19/37) vs 27% (17/63), P=0.014]. The complete response (CR) rate was significantly lower in the MM group than in the non-MM group [73% (27/37) vs 95% (60/63), P=0.006], and the median time to CR was significantly longer in the MM group (6.0 vs 5.0 months, P=0.005).Multivariate analysis identified that MM-Sus ( HR=0.355, 95% CI:0.174-0.723; P=0.004) and MM-Aft ( HR=0.314, 95% CI:0.145-0.681; P=0.003) were independent risk factors for delayed CR in fertility-sparing treatment. The patients in the MM group and non-MM group underwent hysteroscopic biopsy for 76 and 131 times. "Gravel-like change" was a more frequent hysteroscopic manifestation in the MM group than that in the non-MM group [18% (14/76) vs 2% (2/131), P<0.001]. Conclusions:Patients in the MM group have poorer treatment outcomes than patients in the non-MM group. MM-Sus and MM-Aft are risk factors for fertility-preserving treatment in young patients with endometrial hyperplasia or grade 1 endometrial endometrioid carcinoma. "Gravel-like change" is the characteristic hysteroscopic manifestations of MM.

The hemodynamics within the aortic lumen is highly complex,and the mechanical stimuli generated by blood flow play a crucial role in the occurrence and progression of aortic dilation disease.Endothelial cells,as key components of the vascular endothelium,respond precisely to microenvironmental changes caused by blood flow through mechanoreceptors,including ion channels,receptor tyrosine kinases,and membrane structures.These mechanoreceptors convert mechanical stresses into biochemical signals,thereby affecting the physiological functions and pathological changes of blood vessels.In recent years,significant advances have been made in understanding the mechanisms by which endothelial mechanoreceptors are involved in aortic dilation diseases.This review summarizes the research progress of mechanoreceptor-mediated endothelial cell function in regulating aortic dilation diseases and provides a perspective on future research directions,with the aim of offering new insights and potential targets for the development of clinical treatment strategies.