AIM: To investigate the comorbidity status of myopia and depressive symptoms among middle school students, identify key influencing factors, and establish a prediction model, thereby providing empirical evidence for the comprehensive intervention of these two conditions.METHODS: Students from 3 middle schools in Feidong county were recruited between 2022 and 2024. Myopia was defined as uncorrected visual acuity ≤5.0 with spherical equivalent refraction <-0.50 diopters(D). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale(CES-D), with a score ≥16 indicating the presence of depressive symptoms. A database was established and data were entered using EpiData software. Pearson's Chi-square test and multivariate Logistic regression analysis were performed to identify influencing factors and screen variables with R statistical software(version 4.5.2). Finally, a Stacking ensemble prediction model was constructed using Python3.13 software. RESULTS: The study included 2 476 students, consisting of 1 380 males and 1 096 females. The overall detection rate of myopia-depressive symptom comorbidity among the studied students was 14.54%. Univariate analysis showed that variables were significantly associated with the comorbidity, including family structure, grade level, sugar-sweetened beverage intake, exercise frequency, school bullying, and parental physical or verbal abuse(all P<0.05). Multivariate Logistic regression analysis identified the following risk factors: higher grade levels(8th grade: OR=1.9143, 95%CI: 1.1096-3.3024; 9th grade: OR=1.7884, 95%CI: 1.0506-3.0444; 11th grade: OR=2.1847, 95%CI: 1.1980-3.9840; 12th grade: OR=3.4606, 95%CI: 1.8250-6.5621), daily consumption of sugar-sweetened beverages more than once(OR=3.1383, 95%CI: 1.7112-5.7560), low frequency of moderate-to-vigorous exercise on weekends and holidays(mostly achievable: OR=3.3115, 95%CI: 1.009-10.8685), alcohol consumption(OR=4.4021, 95%CI: 2.7383-7.0766), daily sedentary time exceeding 10 h(OR=1.8594, 95%CI: 1.2141-2.8476), lack of puberty education(OR=3.0098, 95%CI: 2.0659-4.3848), and exposure to parental physical or verbal abuse(OR=2.4050, 95%CI: 1.1484-5.0364). Protective factors included no experience of school bullying(OR=0.0055, 95%CI: 0.0002-0.1602), no history of severe injury(OR=0.3118, 95%CI: 0.1823-0.5332), outdoor activities during class breaks(OR=0.1672, 95%CI: 0.0752-0.3719), and moderate after-school homework duration(2-3 h per day: OR=0.4802, 95%CI: 0.2620-0.8801). The constructed Stacking prediction model demonstrated good discriminative ability, with an area under the receiver operating characteristic curve(AUC)of 0.855, a sensitivity of 81.5%, and a specificity of 74.0%. Key predictive factors included alcohol consumption status, location of recess activities, unhealthy lifestyle composite index(interaction term between sedentary duration and sugar-sweetened beverage intake frequency), academic stress index(interaction term between sedentary duration and homework duration), and after-school homework duration.CONCLUSION: The comorbidity of myopia and depression among middle school students is jointly influenced by multiple factors such as lifestyle, academic pressure, and family/campus environment. It is advocated to implement a three-level intervention system that includes restricting the sale of sugar-sweetened beverages, conducting psychological screening for sedentary students, and carrying out family-school-medical collaborative management of drinking behaviors. This model can be applied to school health screening and the early identification of high-risk groups in community adolescent health management. It is suitable for middle school students in regions with similar economic levels, but not applicable to students receiving special education or those with severe organic diseases.

ObjectiveTo explore the effect and mechanism of Jianpi Xiaoai prescription （JPXA） in ameliorating the 5-fluorouracil （5-FU） resistance of colon cancer. MethodsA HCT116/5-FU resistant cell line was established. Different concentrations （10%， 15%， 20%） of JPXA-containing serum and drug-free serum were used for intervention， and 10% fetal bovine serum （10% FBS）， fibroblast growth factor receptor （FGFR） inhibitor （AZD4547）， and recombinant fibroblast growth factor 2 （FGF2） were set as the control groups. Sensitive HCT116 cells were used in the FGF2 group， while HCT116/5-FU cells were used in other groups. Drug resistance， the level of FGF2 in the cell culture medium， the mRNA level of FGF2 in cells， and the protein levels of FGF2/FGFR and phosphatidylinositol 3-kinase/protein kinase B （PI3K/Akt） were determined. The drug-resistant cells were transplanted into the axilla of nude mice to establish a tumor model. The modeled mice were allocated into model， JPXA （15 g·kg^-1）， 5-FU （0.02 g·kg^-1）， JPXA+5-FU （15 g·kg^-1+0.02 g·kg^-1）， AZD4547 （0.012 5 g·kg^-1）， and AZD4547+5-FU （0.012 5 g·kg^-1+0.02 g·kg^-1） groups. The tumor growth and the protein levels of FGF/FGFR and PI3K/Akt in each group were observed. ResultsThe survival rate of HCT116/5-FU cells decreased in all the JPXA groups with different concentrations. The cell survival rate was decreased most obviously in the 20% JPXA group. The level of FGF2 in the cell culture medium and the mRNA level of FGF2 in cells of each JXPA group decreased， and the decrease was the most significant in the 20% group （P<0.01）. HCT116/5-FU cells showed up-regulated protein levels of FGF2 and phosphorylated fibroblast growth factor receptor 1 （p-FGFR1）， but down-regulated protein level of FGFR1 （P<0.01）. JPXA down-regulated the expression of FGF2 and p-FGFR1 and up-regulated the expression of FGFR1 （P<0.05）. In addition， JPXA down-regulated the expression levels of phosphorylated protein kinase B （p-Akt） and phosphorylated mammalian target of rapamycin （p-mTOR）， while up-regulating the expression levels of Akt and Bcl-2-asociated death promoter （Bad） （P<0.05）. Animal experiments showed that the JPXA combined with 5-FU significantly inhibited the growth of drug-resistant tumors， reduced the protein levels of FGF2， p-FGFR1， phosphorylated phosphatidylinositol-3-kinase （p-PI3K）， p-Akt， and p-mTOR， and increased the expression of Bad. It indicated that JPXA can inhibit the FGF2/FGFR1 signaling in colon cancer and regulate PI3K/Akt and downstream signaling pathways. ConclusionJPXA can ameliorate the chemotherapy resistance of colon cancer through down-regulating FGF2 expression and inhibiting the activation of the PI3K/Akt signaling pathway.

Objective Based on the finite element simulation analysis of the patient's torso-spine model and combined with theoretical calculation data,an individualized scoliosis orthosis was designed,and the effectiveness of the orthosis was verified through three-dimensional(3D)printing.Methods A patient with idiopathic scoliosis was chosen as the research object.Reverse engineering technology and computer-aided technology were used to establish the torso-spine model of the patient.The finite element method was used to analyze the model,and the optimal position and magnitude of the corrective force were determined by combining literature theory calculation.Based on this,an orthosis was designed.To verify the orthopedic effect,the patient's X-rays before and after wearing the orthosis were compared and evaluated,and the patient was followed up 6 months later.Results The optimal position and magnitude of the initial corrective force were determined through theoretical calculations and finite element simulations.Specifically,a 62.95 N corrective force applied to the L3 vertebral body and the left posterior region corresponding to the upper and lower intervertebral discs in the patient's lateral curvature segment of the spine to achieve the optimal orthopedic effect.On this basis,the orthosis was designed,followed by relevant experimental tests before and after wearing the designed orthosis.By comparing X-ray images of the patient before and after wearing the orthosis and combining them with follow-up data six months later,the optimized design of the orthosis met the expected clinical requirements for orthopedic effects.Conclusions The design of orthosis needs to be personalized according to the specific situation of patients with scoliosis.This study takes a patient with idiopathic scoliosis as the research object,providing new ideas and methods for the design of orthosis for patients with idiopathic scoliosis.

VR technology can generate virtual,immersive,and interactive environments,allowing users to immerse themselves in these environments and interact with objects within them.AR technology,on the other hand,can accurately overlay virtual information onto real-world scenes,achieving a seamless integration of the virtual and the real.These two emerging technologies each possess unique advantages and exhibit broad development prospects.They have already begun to be applied in various aspects of medical education,such as basic theoretical teaching and skills training,with promising results.They can compensate for the shortcomings of traditional medical education,enhance students'learning enthusiasm and safety,and improve teaching effectiveness.However,limitations remain,such as the need for improved hardware infrastructure and a scarcity of teaching resources.Based on this,this paper systematically introduces the concepts of AR and VR technologies,reviews their application prospects,current status,advantages,and limitations in medical education,aiming to provide evidence-based support and feasible approaches for medical schools to develop digital teaching plans,promote educational reform,and drive research innovation.

Objective:To verify the prognostic value of perineural invasion and lymphovascular tumor embolus for patients with gastric cancer undergoing gastrectomy and postoperative chemotherapy, and establish a prognostic prediction nomogram model.Methods:According to 7∶3 radio, 781 gastric cancer patients were randomly divided into training cohort and internal validation cohort. One hundred fifty patients were utilized as the external validation cohort. Univariate and multivariate analysis were performed to evaluate the prognostic value of perineural invasion and lymphovascular tumor embolus, and construct the dynamic nomogram. The concordance index (C-index), net reclassification index and integrated discrimination improvement index, receiver operating characteristic curve, calibration curves and decision curve analysis were used to evaluate the nomogram.Results:Perineural invasion ( HR=1.486, 95% CI: 1.150-1.919, P<0.01) and lymphovascular tumor embolus ( HR=1.321, 95% CI: 1.030-1.693, P<0.05) were independent prognostic risk factors for patients with gastric cancer after gastrectomy and postoperative chemotherapy. C-index (training cohort: 0.734, internal validation cohort: 0.755, external validation cohort: 0.715), net reclassification index (training cohort: 0.228 for 3-year and 0.213 for 5-year OS prediction; internal validation cohort: 0.211 for 3-year and 0.279 for 5-year OS prediction; external validation cohort: 0.220 for 3-year and 0.440 for 5-year OS prediction) and integrated discrimination improvement index (training cohort: 0.051 for 3-year and 0.041 for 5-year OS prediction; internal validation cohort: 0.027 for 3-year and 0.036 for 5-year OS prediction; external validation cohort: 0.063 for 3-year and 0.153 for 5-year OS prediction) indicated that the nomogram performed better than the traditional TNM staging system ( P<0.05). Conclusions:Perineural invasion and lymphovascular tumor embolus are independent prognostic risk factors of gastric cancer patients after postoperative chemotherapy. The novel dynamic nomogram model based on perineural invasion and lymphovascular tumor embolus provides better assistance in evaluating prognosis of gastric cancer patients.

Objective:To explore brain MRI features of methylmalonic acidemia (MMA).Methods:This observational study retrospectively analyzed the clinical and imaging data of 123 patients with MMA diagnosed at Shandong Provincial Hospital Affiliated to Shandong First Medical University and Qilu Hospital of Shandong University from January 2010 to November 2022. The 123 patients were divided into 7 stages according to age of onset, neonatal period (0 to<1 month), infancy (1 month to<1 year), early childhood (1 to<4 years), preschool (4 to<7 years), school age (7 to<13 years), adolescent (13 to 17 years) and adult (>17 years). All patients underwent brain MRI scanning. The imaging performances were evaluated, including the number, location, morphology of the lesions.Results:Of the 123 patients, 40 were in the neonatal period, 29 in infancy, 13 in early childhood, 9 in preschool, 6 in school age, 13 in adolescence, and 13 in adulthood. The first symptoms of patients in the neonatal period were mainly digestive system abnormalities, such as difficulty in breastfeeding (37.5%, 15/40) and vomiting (25.0%, 10/40), with neurological symptoms gradually becoming the main manifestations from infancy. Seventy-three cases (59.3%) showed significant abnormalities on cranial MRI, including 17 cases with 33 foci in the neonatal period, 23 cases with 53 foci in infancy, 11 cases with 16 foci in early childhood, 2 cases with 2 foci in preschool, 3 cases with 7 foci in school age, 7 cases with 9 foci in adolescence, and 10 cases with 16 foci in adulthood. In neonatal period, the main manifestations were myelin dysplasia (18%,6/33), dilatation of the lateral ventricular system (18%,6/33), and pallidal bulb infarct foci (18%,6/33); in infancy, the main manifestations were hypoplasia or thinning of the corpus callosum (30%,16/53); in early childhood, the main manifestations were pallidal bulb infarct foci (38%,6/16); and the two MRI abnormalities in preschool were pallidum and thalamic infarct foci; in school age, the main manifestations were infarct foci in the chiasmatic nucleus (29%,2/7) and in the caudate nucleus (29%,2/7); in adolescence, the main manifestation was dilatation of the lateral ventricular system (33%,3/9); and in adulthood, the main manifestation was dilatation of the lateral ventricular system (19%,3/16).Conclusion:By staging the age of onset, it is found that the imaging manifestations of MMA patients show significant differences with age, suggesting that there is a dynamic nature of MMA damage to brain structures at different developmental stages.

The unique geography,climate,and natural conditions of plateaus pose significant challenges to the physical health and combat effectiveness of stationed troops.In high-altitude regions,maladaptation can lead to acute mountain sickness,such as high-altitude pulmonary edema and high-altitude cerebral edema.Previous studies have shown that gradual acclimatization is an effective strategy for preventing and mitigating altitude sickness.Additionally,non-pharmacological strategies such as intermittent hypoxia and pre-simulated altitude training have also been proven to effectively promote altitude acclimatization.Conventional acclimatization strategies take longer time and are not conducive to rapid deployment of military personnel.In this article,we review various acclimatization training for individuals entering high-altitude areas,in order to provide a reference for the research and application of scientific and efficient altitude acclimatization training strategies.

Objective:To establish a serum detection method of surface-enhanced Raman spectroscopy (SERS) combining with machine learning for early screening of colorectal cancer (CRC).Methods:Serum samples were collected from 150 CRC patients diagnosed at Jiangdu People′s Hospital, Affiliated to Yangzhou University, and also from 37 healthy subjects. Gold nanohexapod (AuNHs) arrays were prepared using an oil-water interface self-assembly method. A 5 μl serum sample was applied onto the AuNHs array. Scatheless and rapid detection for serum were performed using a Renishaw inVia Raman spectrometer at room temperature with a laser wavelength of 785 nm, exposure time of 10 s, and power of 5 mW. The raw SERS spectra were preprocessed using Savitzky-Golay smoothing, AsLS baseline correction, and Min-Max normalization with Origin 2019 software. Furthermore, the principal component analysis (PCA)-support vector machine (SVM) model was constructed using Python′s scikit-learn library. Leave-One-Out Cross-Validation (LOOCV) was used to evaluate the model′s accuracy, sensitivity, specificity, and area under the curve (AUC).Results:The AuNHs arrays exhibited uniform morphology. The relative standard deviation (RSD) of the SERS intensity at 1 080 cm -1 was 5.69%, and the RSD of the SERS intensity at 1 340 cm -1 was 6.20%. The limit of detection (LOD) of the AuNHs array was 9.42×10 -12 mol/L. The PCA-SVM model achieved an accuracy of 90.91% (170/187), sensitivity of 96.79% (181/187), specificity of 99.47% (186/187), and an AUC of 0.98. The most significant characteristic peaks distinguishing different CRC stages were at 747, 940, 1 000, 1 447, and 1 612 cm -1. Conclusion:The serum detection method based on SERS combined with machine learning can accurately screen CRC with higher accuracy, sensitivity, and specificity, demonstrating potential clinical application value.

Objective Based on the finite element simulation analysis of the patient's torso-spine model and combined with theoretical calculation data,an individualized scoliosis orthosis was designed,and the effectiveness of the orthosis was verified through three-dimensional(3D)printing.Methods A patient with idiopathic scoliosis was chosen as the research object.Reverse engineering technology and computer-aided technology were used to establish the torso-spine model of the patient.The finite element method was used to analyze the model,and the optimal position and magnitude of the corrective force were determined by combining literature theory calculation.Based on this,an orthosis was designed.To verify the orthopedic effect,the patient's X-rays before and after wearing the orthosis were compared and evaluated,and the patient was followed up 6 months later.Results The optimal position and magnitude of the initial corrective force were determined through theoretical calculations and finite element simulations.Specifically,a 62.95 N corrective force applied to the L3 vertebral body and the left posterior region corresponding to the upper and lower intervertebral discs in the patient's lateral curvature segment of the spine to achieve the optimal orthopedic effect.On this basis,the orthosis was designed,followed by relevant experimental tests before and after wearing the designed orthosis.By comparing X-ray images of the patient before and after wearing the orthosis and combining them with follow-up data six months later,the optimized design of the orthosis met the expected clinical requirements for orthopedic effects.Conclusions The design of orthosis needs to be personalized according to the specific situation of patients with scoliosis.This study takes a patient with idiopathic scoliosis as the research object,providing new ideas and methods for the design of orthosis for patients with idiopathic scoliosis.

VR technology can generate virtual,immersive,and interactive environments,allowing users to immerse themselves in these environments and interact with objects within them.AR technology,on the other hand,can accurately overlay virtual information onto real-world scenes,achieving a seamless integration of the virtual and the real.These two emerging technologies each possess unique advantages and exhibit broad development prospects.They have already begun to be applied in various aspects of medical education,such as basic theoretical teaching and skills training,with promising results.They can compensate for the shortcomings of traditional medical education,enhance students'learning enthusiasm and safety,and improve teaching effectiveness.However,limitations remain,such as the need for improved hardware infrastructure and a scarcity of teaching resources.Based on this,this paper systematically introduces the concepts of AR and VR technologies,reviews their application prospects,current status,advantages,and limitations in medical education,aiming to provide evidence-based support and feasible approaches for medical schools to develop digital teaching plans,promote educational reform,and drive research innovation.