Objective: To explore the relationship between socio ecological risk factors (SERF), physical activity (PA) developmental trajectories, and depressive symptoms among junior and senior high school students in Tianjin, in order to provide theoretical support for comprehensive interventions for adolescent depression. Methods: A longitudinal follow up design was adopted. In September 2022, a baseline survey was conducted using a stratified cluster random sampling method in two junior high schools and two senior high schools in Tianjin, collecting data on students basic information, SERF, PA, and depressive symptoms. Two follow up surveys were conducted in September 2023 and 2024, yielding 588 valid participants. Latent class growth analysis (LCGA) was used to identify PA developmental trajectory categories among junior and senior high school students. Logistic regression was applied to examine the associations between depressive symptoms and SERF as well as PA trajectories. Results: The detection rates of depressive symptoms among Tianjin junior and senior high school students over the three years were 26.53%, 20.24%, and 21.26 %, respectively. Depressive symptoms were positively correlated with SERF ( OR=1.04, 95%CI=1.03-1.05, P <0.05). The highest risks were observed in the individual dimension and family dimension ( OR =1.28, 1.21, both P <0.05). LCGA identified three PA trajectory groups:persistently low level (80.65%), persistently high level (4.58%), and slowly increasing group ( 14.77 %). Multivariate regression analysis showed that compared with the persistently low level PA, the slowly increasing PA significantly reduced the risk of depressive symptoms ( OR=0.44, 95%CI =0.20-0.88), while SERF still increased the risk of depressive symptoms ( OR=1.04, 95%CI =1.03-1.05) (both P <0.05). Conclusion SERF are risk factors for depression symptoms among junior and senior high school students, whereas slowly increasing PA development trajectory demonstrates a protective effect.

OBJECTIVE To formulate Guidelines for the standardized implementation of pharmacist-managed clinics （ 2026 edition ） in response to the challenges faced by such clinics in China， including uneven development， large discrepancies in service specifications， insufficient patient awareness， and limited medical insurance coverage. METHODS Led by the Pharmaceutical Affairs Professional Committee of the Chinese Hospital Association， the Evidence-based Pharmacy Professional Committee of the Chinese Pharmaceutical Association， and the Hospital Pharmacy Professional Committee of the Cross-strait Medical and Health Exchange Association， a total of 19 domestic hospital pharmacy experts were organized. Through a systematic review of national policies and literature research， current practical experience was summarized. Consensus on the contents of the guidelines was reached after in-depth discussions. RESULTS &CONCLUSIONS The guidelines covered five sections： definition and connotation of pharmacist-managed clinics， establishment requirements， implementation and management， post competency， and practical research. Firstly， the definition and connotation included three operational forms of pharmacist-managed clinics （independent mode， physician-pharmacist joint mode， and online pharmacist-managed clinic mode） and classified service modes （specialty-specific， drug-specific， and disease-specific pharmacist-managed clinics）. The establishment requirements were further refined， covering system construction （pharmaceutical service management system， quality control and assessment mechanism）， personnel qualifications （professional credentials， continuing education and professional training， etc）， service recipients， as well as service venues and facilities. Subsequently， the implementation and management of pharmacist-managed clinics were proposed， involving service procedures， intervention measures， documentation and records， patient education and follow-up， humanistic care， as well as risk management and quality control. Finally， post competency encompassed the competency requirements for pharmacists providing services in pharmacist-managed clinics， as well as the suggestions on teaching methods； practical research encouraged the conduct of high-quality pharmaceutical practice in the setting of pharmacist-managed clinics. The guidelines provide valuable guidance for the standardized implementation of pharmacist-managed clinics in China in terms of establishment， management， teaching， and research， fill the guideline gap in this field， and can promote the high-quality development of pharmacist-managed clinics.

To further improve the post competency of application-oriented medical students, the university medical simulation center, clinical teaching base, and off-campus social practice base were linked to establish a platform. Four key points were used to explore a new training model of "one body and four bases" for application-oriented medical students. This includes problem-oriented theoretical teaching to improve the professional knowledge of medical students, hands-on practice-oriented experimental teaching to improve the clinical skills, "strengthening clinical thinking training"-oriented practice in the base to enhance clinical awareness and cultivate clinical habits, and "cultivating humanistic literacy"-oriented off-campus social practice base to improve the humanistic sentiment and professional spirit of medical students. This teaching mode lays a foundation for training high-quality application-oriented medical talents with solid knowledge and skills and comprehensive development of ability and literacy, and provides a reference for teaching and research in similar colleges and universities.

Objective:To evaluate the clinical effect of different types of aortic root replacement in adolescent patients with aortic root aneurysm by analyzing the perioperative and follow-up conditions of surgical treatment for adolescent aortic root aneurysm.Methods:The clinical data of patients aged ≤18 years who were admitted to the Beijing Anzhen Hospital from November 2012 to February 2025, diagnosed with aortic root aneurysm by ultrasound or aortic computed tomography angiography (CTA) and requiring surgical intervention, were collected retrospectively. They were divided into the valve-sparing aortic root replacement group (David operation group) and the aortic root replacement group (Bentall operation group) according to the surgical method. The perioperative results and long-term follow-up results of the two groups were analyzed. Kaplan-Meier survival curves were drawn to compare the reoperation intervention rate between the two groups.Results:A total of 25 patients were included in this study, including 17 in the Bentall group and 8 in the David group. There were no statistically significant differences in gender, age, blood routine, liver and kidney function, coagulation function, and electrolyte internal environment between the two groups (all P>0.05). There were no statistically significant differences in operation time and intensive care unit stay between the two groups (all P>0.05). Compared with the Bentall operation group, the intraoperative blood loss in the David operation group was more ( P<0.05). During the follow-up, no reoperation occurred in the Bentall operation group, while 3 patients in the David operation group had long-term re-intervention. The long-term reoperation intervention rate in the David operation group was higher than that in the Bentall group ( P=0.042), but there was no statistically significant difference in the aortic valve-related surgical intervention rate between the two groups ( P=0.15). Conclusions:For adolescent patients with aortic root aneurysm, although David operation may face long-term reoperation intervention, this intervention may not be due to the difference in surgical methods. Both Bentall operation and David operation are safe and reliable, with good perioperative results and stable medium and long-term prognosis.

The inter-hospital transport of critically ill children involves the use of professional knowledge,technology,and methods to transfer these patients between hospitals without interrupting medical monitoring and treatment.Currently,inter-hospital transport system of critically ill children in China faces challenges such as uneven distribution of medical resources,inadequate training systems,and changes in the disease spectrum.There is a lack of unified documents and guidelines,leading to new trends and challenges in inter-hospital transport.In the future,with technological innovation,regional cooperation,and the establishment of standardized processes,inter-hospital transport will become increasingly professionalized,and survival rates will be significantly improved.This article reviewed the current situation,trends,and progress of inter-hospital transport of critically ill children.

Objective:To investigate the feasibility and safety of high-speed railway (HSR) transport for critically ill pediatric patients.Methods:A single-center retrospective analysis was conducted.A total of 39 children transported via HSR (HSR group) and 420 children transported via ambulance (ambulance group) from May 2019 to December 2024 at the Seventh Medical Center of the PLA General Hospital were included.Demographic data,disease types,transport distances,and outcomes were compared between the two groups,and the vital signs,blood gas analysis,mechanical ventilation parameters,and vasoactive drug usage before and after HSR transport were also compared.Results:Over the five-year period,39 HSR transports and 420 ambulance transports were completed.No significant differences were observed in gender,age,or weight between HSR group and ambulance group( P>0.05).The proportion of circulatory system diseases was significantly higher in the HSR group (74.4% vs.55.1%, P = 0.020).HSR transports covered longer distances [855(855,1 075)km vs.84(23,273) km, P<0.001] and achieved faster speeds [150(150,216) vs.80(79,80)km/h, P<0.001].No significant differences were found in heart rate,body temperature,or diastolic pressure before and after HSR transport ( P>0.05).However,systolic blood pressure and partial pressure of oxygen increased slightly post-HSR transport [(82.97±15.44) vs.(85.15 ± 14.82)mmHg, P=0.003；(84.22±25.45)mmHg vs.(88.95±28.70)mmHg, P=0.029].Mechanical ventilation parameters remained stable during HSR transport ( P>0.05). Conclusion:HSR transport is feasible and safe for critically ill children and represents a promising option for long-distance interhospital transfers of pediatric patients.

Objective To evaluate the efficacy of a combined immunosuppression regimen in modulating rejection in genetically modified pig-to-macaque xenogeneic heart transplantation.Methods Two xenogeneic heart transplantation models were constructed using genetically modified pigs and macaques.Dynamic monitoring of recipient peripheral blood immune parameters and observation of graft pathological changes were performed.Results Regimen 1,featuring B-cell depletion,T-cell inhibition,and C3 complement suppression,reduced lymphocyte levels but failed to control acute humoral rejection and macrophage infiltration.Regimen 2,adding C5 complement inhibition and interleukin-6 inhibition to Regimen 1,more effectively lowered lymphocyte levels,inhibited acute humoral rejection and complement activation,and decreased antibody deposition.However,a late-phase cytokine storm and residual T cells emerged.Conclusions Regimen 2 reduces the hyperacute and acute rejection risks through multi-target intervention.Yet,it requires balancing medication complexity and safety.This indicates the need to optimize cellular immune regulation and adjust the plan through dynamic multidimensional monitoring.

This paper summarized the current status of infection and quality control of medical flexible endoscope (abbreviation:endoscope),which can identify that defect of the quality control of endoscopic forceps channels was a major cause of nosocomial infections of endoscopy. Based on this,a multifunctional quality control workstation with forceps channel of detecting flexible endoscope,and precision components included top ends for medical endoscopes has been developed,which can clearly display residual contaminants and damages in the forceps channels and precision components after the endoscope was reprocessed. It is contribute to enhance the quality control of reprocessing endoscope,and reduce cross-infection of endoscope.

Objective To compare the ability of single-phase,dual-phase,and triphasic models in forecasting postoperative pancreatic fistula(POPF)after pancreaticoduodenectomy(PD)using radiomics based on triphasic enhanced CT.Methods A total of 181 patients who underwent multi-phase enhanced CT prior to PD were retrospectively selected,and the collection phase included non-contrast,arterial phase(AP),and equilibrium phase(EP).3D Slicer software was utilized to segment the region of interest(ROI)for the postoperative pancreatic remnant on each phase.Radiomics feature extraction was performed using R software,followed by feature selection through least absolute shrinkage and selection operator(LASSO)regression with five-fold cross-validation to prevent model overfitting.The effective features selected were combined in a weighted linear manner to obtain a Radiomics score(Radscore).The patients were divided into training set and test set in a 7︰3 ratio.Logistic regression was employed to construct seven POPF prediction models(three single-phase,three dual-phase,and one triphasic models)based on different phase combinations.The diagnostic performance of the models was evaluated using the area under the curve(AUC)of receiver operating characteristic(ROC)curve,accuracy(ACC),sensitivity(SEN),and specificity(SPE).The DeLong test was applied to compare the differences in AUC among different models.Results After LASSO regression,24 effective features associated with POPF were selected from different phases.In the test set,the triphasic model exhibited the highest AUC and ACC(AUC=0.76,ACC=0.808).The calibration curve demonstrated the strongest agreement between the estimated probabilities and observed probabilities for the triphasic model.The decision curve analysis(DCA)curve indicated that the triphasic model had the largest threshold range with a higher net benefit.Conclusion Compared with single-phase and dual-phase models,the triphasic model based on enhanced CT provides better prediction of POPF after PD,aiding clinical decision-making and improve prognosis.

Objective To compare the accuracy of18F-fluorodeoxyglucose(18F-FDG)PET in locating the epileptogenic focus in patients with temporal lobe epilepsy using the single-patient research method based on statistical parametric mapping(SPM)at dif-ferent confidence levels,and to compare it with the asymmetry index(AI)analysis method.Methods A retrospective analysis was conducted on the clinical and imaging data of 86 patients with drug-resistant temporal lobe epilepsy and 37 healthy controls.The pri-mary epileptogenic focus were located by 18F-FDG PET,and two-sample t-test and intracranial asymmetry analysis were performed on individual patients based on SPM.The accuracy of 18F-FDG PET in locating the epileptogenic focus was compared at different confidence levels P＜0.05,P＜0.05[familywise error rate(FWE)corrected],P＜0.01,P＜0.001,respectively.The diagnostic accuracy of the SPM method at the optimal confidence level P value was compared with the AI analysis method,and the data were analyzed using the x2 test.Results The diagnostic accuracy of the two-sample t-test method were 69.77％,79.07％,67.44％ and 63.95％ at confidence levels of P＜0.05,P＜0.05(FWE corrected),P＜0.01 and P＜0.001,respectively;the diagnostic accuracy of the intracranial asymmetry analysis method were 94.19％,81.39％,79.07％,and 75.58％,respectively.There was a statistically significant differ-ence in diagnostic accuracy between the intracranial asymmetry analysis method(P＜0.05)and the two-sample t-test method P＜0.05(FWE corrected)(x2=8.482,P＜0.05);there was also a statistically significant difference in AI analysis method between the two methods(x2=4.793,P＜0.05).Conclusion The intracranial asymmetry analysis method(P＜0.05)based on SPM has a higher accuracy in locating the primary epileptogenic focus in unilateral drug-resistant temporal lobe epilepsy than those in the two-sample t-test method P＜0.05(FWE corrected)and AI analysis method.