Objective:To discuss the correlation between homocysteine(Hcy)and inflammatory responses as well as oxidative stress,and to analyze its role in the occurrence and development of acute ischemic stroke(AIS).Methods:Thirty-eight patients with their first incidence of AIS were selected as AIS group,and according to the principles of case-control study,45 healthy individuals undergwent routine health examination during the same period were selected as control group.The levels of homocysteine and inflammatory cytokine interleukin(IL)-6,and tumor necrosis factor α(TNF-α)in serum of the subjects in two groups were detected by enzyme-linked immunosorbent assay(ELISA)method;the level of highly sensitive C-reactive protein(hs-CRP)of the subjects in two groups was detected by immunoturbidimetry;the levels of malondialdehyde(MDA)and activities of superoxide dismutase(SOD)in serum of the subjects in two groups were detected by chemical colorimetry;Pearson's correlation analysis was used to analyze the correlation between serum Hcy level and levels of inflammatory markers and oxidative stress indicators of the AIS patients.Results:Compared with control group,the levels of Hcy,hs-CRP,TNF-α,IL-6,and MDA in serum of the patients in AIS group were significantly increased(P<0.05),while the activity of SOD was significantly decreased(P<0.05).The level of Hcy in serum of the AIS patients was positively correlated with the levels of hs-CRP,TNF-α,IL-6,and MDA(r=0.615,P<0.05;r=0.632,P<0.05;r=0.598,P<0.05;r=0.612,P<0.05),and negatively correlated with the activity of SOD(r=-0.325,P<0.05).Conclusion:The Hcy level in serum of the AIS patients is closely associated with the inflammatory factors and oxidative damage.Hcy can promote the production of oxidative free radicals and inflammatory factors and cause damage to the endothelial cells and play a significant clinical role in the occurrence and development of AIS.

Objective:To investigate the clinical effectiveness of Piezocision combined with a microporous technique in accelerating periodontal tissue reconstruction during the anterior migration of mandibular molars in adults.Methods:A prospective, randomized, controlled study was conducted on 30 adult orthodontic patients recruited from Shaoxing Hospital of Traditional Chinese Medicine between January 2020 and September 2022. The inclusion criteria were patients who were unable to retain their first molars due to severe caries or long-term absence and were not suitable for implantation. Using the random number table method, the patients were randomly assigned to two groups: a simple orthodontic control group (Group A, n = 15) and a group that received Piezocision combined with a microporous technique (Group B, n = 15). After treatment, a comparison was made between the two groups in terms of mesial movement distance of the mandibular second molar, plaque index, gingival index, periodontal pocket depth, width of keratinized gingiva, gingival recession, clinical attachment loss, mesial root resorption of the mandibular second molar, alveolar bone height (measured as the distance from the center of the lower incisor to the anterior margin of the chin, referred to as the LM-AC distance), mandibular bone height (measured by the distance from the distal or mesial surface of the root to the alveolar bone margin, denoted as the CEJ-AC distance), and orthodontic satisfaction. Results:The mesial movement distances of the mandibular second molar in Group A patients were (0.86 ± 0.13) mm, (2.75 ± 0.24) mm, (3.54 ± 0.24) mm, and (4.67 ± 0.13) mm at 4, 6, 8, and 12 weeks, respectively. These values were significantly greater than those observed in Group B, which were (0.43 ± 0.06) mm, (1.27 ± 0.14) mm, (1.85 ± 0.53) mm, and (2.65 ± 0.06) mm ( t = 6.83, 14.13, 18.24, 23.78, all P < 0.001). Prior to treatment, there were no statistically significant differences in plaque index, gingival index, periodontal pocket depth, width of keratinized gingiva, gingival recession, or clinical attachment loss between the two groups (all P > 0.05). After treatment, Group A did not exhibit statistically significant differences in plaque index, gingival index, width of keratinized gingiva, and gingival recession compared with baseline values (all P > 0.05). However, in Group A, periodontal pocket depth and clinical attachment loss significantly increased compared with pretreatment levels ( t = -2.57, -7.50, both P < 0.05). After treatment, Group B exhibited significantly increased values for periodontal pocket depth, width of keratinized gingiva, gingival recession, and clinical attachment loss compared with baseline levels ( t = -8.66, -5.57, -45.33, -9.72, all P < 0.001). Furthermore, these values were significantly higher in Group B compared with those in Group A ( t = -4.28, -3.18, 10.00, 10.69, all P < 0.001). A statistically significant difference was also observed between the two groups in terms of mesial root resorption of the mandibular second molar ( t = 4.14, P < 0.001). However, there was no statistically significant difference in LM-AC distance between the two groups after treatment ( P > 0.05). Conclusion:The combination of Piezocision and a microporous technique can effectively accelerate the anterior migration of mandibular molars in adults while maintaining the health of periodontal tissues. This approach holds great potential for clinical promotion.

Objective:To construct an evaluation the index system of entrustable professional activities for resident training doctors in psychiatric department,and to provide reference for formulating training strategies and assessment standards.Entrustable professional activities refers to the ability of trainees to perform and complete spe-cific clinical tasks independently after they have been trusted.Methods:Through documental analysis and semi-structured interviews,the item database of entrustable professional activities for psychiatric resident training physi-cians was established.Delphi consultation was conducted among 63 experts in the field of psychiatry from 7 national resident training bases and 3 medical colleges in China.Indicators were comprehensively screened and sorted out,and indicators at all levels and their weights were determined by the analytic hierarchy process.Results:A hierarchi-cal evaluation index system of entrustable professional activities for psychiatric resident training doctors was con-structed,including 4 first-level indicators,17 second-level indicators and 68 third-level indicators.The weights of the first-level,second-level and third-level indicators were determined.Conclusion:The evaluation index system of en-trustable professional activities is comprehensive and systematic,which is suitable for clinical work and convenient for practical application.It could provide quantitative standards for the assessment of psychiatric residents and pro-mote the improvement of training quality.

Objective:To investigate the cognitive function and its influencing factors among residents in Qingdao city.Methods:The 5 311 research subjects over 65 years old were selected from Qingdao by simple random sampling and stratified sampling. All subjects were investigated by AD8 dementia early screening questionnaire and community screening instrument dementia (CSI-D) to evaluate the prevalence of cognitive decline in this study.The score of AD8 dementia early screening questionnaire ≥2 points or the score of CSI-D ≤7 points was considered to be cognitive decline. Mann-Whitney U test, Chi-square test, Fisher exact probability method, univariate and multivariate Logistic regression analysis and Bootstrap verification were performed using SPSS 26.0 software. Results:Among 5 311 subjects, 1 899 subjects had normal cognitive function (35.76%) and 3 412 subjects had cognitive decline (64.24%). The age of the cognitive decline group was significantly higher than that of the normal group ( P<0.01). There were significant differences in gender, educational level, rural residents, marital status, chronic medical history, hypertension, rheumatoid arthritis, cerebrovascular disease, intervertebral disc disease, ischemic heart disease, monthly household income and alcohol consumption between the two groups (all P<0.05). Univariate Logistic regression analysis showed that female ( β=0.313, OR=1.367, 95% CI=1.221-1.530), age ( β=0.052, OR=1.053, 95% CI=1.043-1.063), rural residents ( β=0.850, OR=2.340, 95% CI=2.042-2.682), widowed ( β=0.557, OR=1.745, 95% CI=1.500-2.029), chronic medical history ( β=0.290, OR=1.336, 95% CI=1.191-1.498), hypertension ( β=0.134, OR=1.143, 95% CI=1.020-1.281), rheumatoid arthritis ( β=0.458, OR=1.581, 95% CI=1.222-2.046), cerebrovascular disease ( β=0.584, OR=1.794, 95% CI=1.352-2.380), intervertebral disc disease ( β=0.578, OR=1.782, 95% CI=1.370-2.319), ischemic heart disease ( β=0.501, OR=1.651, 95% CI=1.272-2.143) were the risk factors for cognitive decline. Higher education level, higher monthly household income and abstinence ( β=-0.244, OR=0.783, 95% CI=0.619-0.992) were protective factors for cognitive decline. Multivariate logistic regression analysis showed that age ( β=0.035, OR=1.036, 95% CI=1.025-1.047), rural residents ( β=0.215, OR=1.239, 95% CI=1.047-1.468), chronic medical history ( β=0.191, OR=1.210, 95% CI=1.067-1.372), cerebrovascular disease ( β=0.480, OR=1.616, 95% CI=1.195-2.187), intervertebral disc disease ( β=0.456, OR=1.578, 95% CI=1.190-2.094) were risk factors for Alzheimer's disease. Higher education level and higher monthly household income were protective factors for Alzheimer's disease. Conclusion:The elderly with chronic diseases, low income and low education level may be at the high risk of cognitive function decline, which should be paid attention to in early screening and intervention.

Objective:To investigate the current status of endoscopic treatment for gastroesophageal varices in portal hypertension in China, and to provide supporting data and reference for the development of endoscopic treatment.Methods:In this study, initiated by the Liver Health Consortium in China (CHESS), a questionnaire was designed and distributed online to investigate the basic condition of endoscopic treatment for gastroesophageal varices in portal hypertension in 2022 in China. Questions included annual number and indication of endoscopic procedures, adherence to guideline for preventing esophagogastric variceal bleeding (EGVB), management and timing of emergent EGVB, management of gastric and isolated varices, and improvement of endoscopic treatment. Proportions of hospitals concerning therapeutic choices to all participant hospitals were calculated. Guideline adherence between secondary and tertiary hospitals were compared by using Chi-square test.Results:A total of 836 hospitals from 31 provinces (anotomous regions and municipalities) participated in the survey. According to the survey, the control of acute EGVB (49.3%, 412/836) and the prevention of recurrent bleeding (38.3%, 320/836) were major indications of endoscopic treatment. For primary [non-selective β-blocker (NSBB) or endoscopic therapies] and secondary prophylaxis (NSBB and endoscopic therapies) of EGVB, adherence to domestic guideline was 72.5% (606/836) and 39.2% (328/836), respectively. There were significant differences in the adherence between secondary and tertiary hospitals in primary prophylaxis of EGVB [71.0% (495/697) VS 79.9% (111/139), χ2=4.11, P=0.033] and secondary prophylaxis of EGVB [41.6% (290/697) VS 27.3% (38/139), χ2=9.31, P=0.002]. A total of 78.2% (654/836) hospitals preferred endoscopic therapies treating acute EGVB, and endoscopic therapy was more likely to be the first choice for treating acute EGVB in tertiary hospitals (82.6%, 576/697) than secondary hospitals [56.1% (78/139), χ2=46.33, P<0.001]. The optimal timing was usually within 12 hours (48.5%, 317/654) and 12-24 hours (36.9%, 241/654) after the bleeding. Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1, most hospitals used cyanoacrylate injection in combination with sclerotherapy [48.2% (403/836) and 29.9% (250/836), respectively], but substantial proportions of hospitals preferred clip-assisted therapies [12.4% (104/836) and 26.4% (221/836), respectively]. Improving the skills of endoscopic doctors (84.2%, 704/836), and enhancing the precision of pre-procedure evaluation and quality of multidisciplinary team (78.9%, 660/836) were considered urgent needs in the development of endoscopic treatment. Conclusion:A variety of endoscopic treatments for gastroesophageal varices in portal hypertension are implemented nationwide. Participant hospitals are active to perform emergent endoscopy for acute EGVB, but are inadequate in following recommendations regarding primary and secondary prophylaxis of EGVB. Moreover, the selection of endoscopic procedures for gastric varices differs greatly among hospitals.

Objective:To investigate the efficacy and safety of high intensity focused ultrasound(HIFU)com-bined with endometrial thermal Balloon ablation(TBEA)in the treatment of menorrhagia associated with adenomy-osis(AM).Methods:A retrospective cohort study was performed on clinical data of 77 patients with menorrhagia associated with adenomyosis(AM)in Mianyang Central Hospital from January 2021 to December 2022.According to different treatment methods,they were divided into HIFU combined with TBEA(HIFU+TBEA group,n=26)and HIFU combined with gonadotropin-releasing hormone agonist(GnRH-a)and levonorgestrel-releasing intrauterine system(LNG-IUS)(HIFU+drug group,n=51).The pictorial blood loss assessment chart(PBAC)at different fol-low-up time after HIFU ablation was used as the main outcome index,dysmenorrhea score(NRS),serum CA125 level,re intervention rate,treatment effectiveness rate and adverse reactions were used as the secondary out-come indexes.Evaluate the efficacy and safety of HIFU combined with TBEA in the treatment of menorrhagia as-sociated with AMby comparing the difference of outcome indexes between two groups before and after treatment at different times.Results:Compared with pre-treatment,the PBAC score,NRS score and CA125 level were signif-icantly decreased after treatment in both groups(P<0.05).Compared with HIFU+drug group,PBAC score of HIFU+TBEA group decreased more at 6,9 and 12 months after treatment(P<0.05),but there was no signifi-cant difference in PBAC score at 1 and 3 months after treatment(P>0.05).There was no significant difference in NRS scores between the two groups at 1,3,6,9 and 12 months after treatment(P>0.05).There was no signifi-cant difference in reintervention rate between HIFU+TBEA group(11.54% )and HIFU+drug group(21.57% )after treatment(P>0.05).There was no significant difference in treatment effectiveness between HIFU+TBEA group(80.77% )and HIFU+drug group(70.59% )(P>0.05).The adverse reactions of the two groups after treatment were graded as SIR A-B,and no serious adverse events occurred.Conclusions:The combination of HIFU and TBEA has good efficacy and safety in the treatment of AM,and can be used as a long-term manage-ment program for patients with no fertility needs,especially for AM patients with menorrhagia,which also has good clinical application value.

Objective:To investigate the efficacy and safety of high intensity focused ultrasound(HIFU)com-bined with endometrial thermal Balloon ablation(TBEA)in the treatment of menorrhagia associated with adenomy-osis(AM).Methods:A retrospective cohort study was performed on clinical data of 77 patients with menorrhagia associated with adenomyosis(AM)in Mianyang Central Hospital from January 2021 to December 2022.According to different treatment methods,they were divided into HIFU combined with TBEA(HIFU+TBEA group,n=26)and HIFU combined with gonadotropin-releasing hormone agonist(GnRH-a)and levonorgestrel-releasing intrauterine system(LNG-IUS)(HIFU+drug group,n=51).The pictorial blood loss assessment chart(PBAC)at different fol-low-up time after HIFU ablation was used as the main outcome index,dysmenorrhea score(NRS),serum CA125 level,re intervention rate,treatment effectiveness rate and adverse reactions were used as the secondary out-come indexes.Evaluate the efficacy and safety of HIFU combined with TBEA in the treatment of menorrhagia as-sociated with AMby comparing the difference of outcome indexes between two groups before and after treatment at different times.Results:Compared with pre-treatment,the PBAC score,NRS score and CA125 level were signif-icantly decreased after treatment in both groups(P<0.05).Compared with HIFU+drug group,PBAC score of HIFU+TBEA group decreased more at 6,9 and 12 months after treatment(P<0.05),but there was no signifi-cant difference in PBAC score at 1 and 3 months after treatment(P>0.05).There was no significant difference in NRS scores between the two groups at 1,3,6,9 and 12 months after treatment(P>0.05).There was no signifi-cant difference in reintervention rate between HIFU+TBEA group(11.54% )and HIFU+drug group(21.57% )after treatment(P>0.05).There was no significant difference in treatment effectiveness between HIFU+TBEA group(80.77% )and HIFU+drug group(70.59% )(P>0.05).The adverse reactions of the two groups after treatment were graded as SIR A-B,and no serious adverse events occurred.Conclusions:The combination of HIFU and TBEA has good efficacy and safety in the treatment of AM,and can be used as a long-term manage-ment program for patients with no fertility needs,especially for AM patients with menorrhagia,which also has good clinical application value.

Objective:To investigate the efficacy and safety of high intensity focused ultrasound(HIFU)com-bined with endometrial thermal Balloon ablation(TBEA)in the treatment of menorrhagia associated with adenomy-osis(AM).Methods:A retrospective cohort study was performed on clinical data of 77 patients with menorrhagia associated with adenomyosis(AM)in Mianyang Central Hospital from January 2021 to December 2022.According to different treatment methods,they were divided into HIFU combined with TBEA(HIFU+TBEA group,n=26)and HIFU combined with gonadotropin-releasing hormone agonist(GnRH-a)and levonorgestrel-releasing intrauterine system(LNG-IUS)(HIFU+drug group,n=51).The pictorial blood loss assessment chart(PBAC)at different fol-low-up time after HIFU ablation was used as the main outcome index,dysmenorrhea score(NRS),serum CA125 level,re intervention rate,treatment effectiveness rate and adverse reactions were used as the secondary out-come indexes.Evaluate the efficacy and safety of HIFU combined with TBEA in the treatment of menorrhagia as-sociated with AMby comparing the difference of outcome indexes between two groups before and after treatment at different times.Results:Compared with pre-treatment,the PBAC score,NRS score and CA125 level were signif-icantly decreased after treatment in both groups(P<0.05).Compared with HIFU+drug group,PBAC score of HIFU+TBEA group decreased more at 6,9 and 12 months after treatment(P<0.05),but there was no signifi-cant difference in PBAC score at 1 and 3 months after treatment(P>0.05).There was no significant difference in NRS scores between the two groups at 1,3,6,9 and 12 months after treatment(P>0.05).There was no signifi-cant difference in reintervention rate between HIFU+TBEA group(11.54% )and HIFU+drug group(21.57% )after treatment(P>0.05).There was no significant difference in treatment effectiveness between HIFU+TBEA group(80.77% )and HIFU+drug group(70.59% )(P>0.05).The adverse reactions of the two groups after treatment were graded as SIR A-B,and no serious adverse events occurred.Conclusions:The combination of HIFU and TBEA has good efficacy and safety in the treatment of AM,and can be used as a long-term manage-ment program for patients with no fertility needs,especially for AM patients with menorrhagia,which also has good clinical application value.

Objective:To explore the impact of adverse childhood experience on self-injury behavior and the mediating role of self hating in adolescents.Methods:A cross-sectional survey was conducted in 6 high schools and 5 middle schools in Shandong Province from August 1 to December 31, 2022, using the adverse childhood experience questionnaire, self-hating scale and non-suicidal self-injury behavior rating questionnaire for adolescents. A total of 7 313 questionnaires were collected, of which 6 948 were valid. SPSS 22.0 software was used for Spearman correlation analysis, and biased-corrected non-parametric percentile Bootstrap method was used to test the significance of mediating effect.Results:(1) The scores of adverse childhood experience(4.0(2.0, 6.0)), self-hating (22.0 (13.0, 29.0)) and self-injury behavior (12.0 (7.0, 19.0)) in adolescents with self-injury behavior were higher than those without self-injury behavior(0(0, 2.0), 2.0(0, 9.0), 0(0, 1.0)), and the differences were statistically significant ( Z=-21.700, -22.654, -29.519, all P<0.001). (2) Adverse childhood experience was positively correlated with self-hating ( r=0.46, P<0.01) and self-injury behavior ( r=0.47, P<0.01). Self-hating was positively correlated with self-injury behavior ( r=0.51, P<0.01). (3) Adverse childhood experience directly predicted self-injury behavior with a direct effect of 0.163 (95% CI =0.127-0.200, P<0.01)and the effect size of 53.80%(0.163/0.303).Adverse childhood experiences indirectly predicted self-injury behavior through self-hating, with an indirect effect of 0.140 (95% CI=0.122-0.160, P<0.001) and the effect size of 46.20%(0.140/0.303).The total effect was 0.303 (95% CI=0.270-0.336, P<0.001). Conclusions:There is a close relationship between adverse childhood experiences, self-hating and self-injury behavior in adolescents. Adverse childhood experiences can directly predict self-injury behavior, and can also indirectly affect self-injury behavior through self-hating.

Objective To explore the correlation value of high-resolution MRI on the cause,location and degree of nerve root com-pression and clinical symptoms of lumbar intervertebral foramen stenosis.Methods Patients with sciatic neuralgia underwent con-ventional MRI examination of the lumbar spine before treatment.MRI thin layer(1 mm)intervertebral disc axial scan was performed on patients with suspected L4/L5 and L5/S1 intervertebral foramen stenosis,and the value of conventional MRI and high-resolution MRI on intervertebral foramen stenosis location,etiology and Elisabeth typing was compared and analyzed.Intervertebral foramen mor-phometric indicators,nerve root length and short diameter were measured on high-resolution MRI post-processed images and their correlation with visual analogue scale(VAS)scores of clinical symptoms was analyzed.Results Sixty-one patients were effectively diagnosed with intervertebral foramen stenosis and nerve root compression after surgery or conservative treatment.The diagnosis rate of conventional MRI for the cause of intervertebral foramen stenosis was 75.4％,and the diagnosis rate of high-resolution MRI post-processed was 91.8％.The Elisabeth typing of lumbar intervertebral foramen stenosis was positively correlated with clinical symp-toms,while the nerve root short diameter and peri-nerve fat space area were negatively correlated with VAS score.Conclusion High-resolution MRI is significantly better than conventional MRI for the diagnosis of nerve root compression in intervertebral fora-men stenosis.It visually shows the location,cause and degree of nerve root compression,which can better guide the clinical and accu-rate minimally invasive surgery.