Objective: To apply network analysis for exploring the relationship of maltreatment experiences and peer relationships with school bullying among middle school students, so as to provide empirical evidences for the development of targeted intervention programs. Methods: From March to April 2024, a total of 2 119 middle school students aged 12-18 in Shantou City were selected through stratified cluster random sampling. Self administered questionnaire was used to collect data on bullying experiences, maltreatment, and peer relationships. The Glasso network model was employed to estimate network structure. Results: The strongest edge in the network of maltreatment experiences, peer relationships and school bullying was the connecting line connecting peer acceptance and peer terrorized low self esteem (edge weight=0.59) among middle school students. The network faked fraudulent victimization was the most central node in the whole network (strength=7.98). The bridge symptoms of the network were sexual abuse, property bullying of others, relational bullying victimization, and verbal bullying of others, with the strongest bridge node being sexual abuse (bridge strength=1.07). In the accuracy estimation of centrality indices, closeness centrality demonstrated the highest accuracy, followed by strength and betweenness, with coefficient of stability of 0.60, 0.44 and 0.21, respectively. The stability of the network was good. Conclusion Peer acceptance has the strongest correlation with peer fear and inferiority, and is closely related to emotional abuse and emotional neglect.

Objective:To investigate the genetic causes of fetuses with abnormal nasal bone development in early pregnancy.Methods:A retrospective study was conducted which involved 422 cases of singleton pregnancies with nasal bone development abnormalities indicated by ultrasound screening at 11 to 13 weeks and 6 days of gestation, who underwent chorionic villus sampling for prenatal diagnosis at the Prenatal Diagnosis and Genetic Center, Maternity & Child Health Hospital of Guangxi Zhuang Autonomous Region from January 2015 to May 2023. All cases underwent chromosomal karyotype analysis and single nucleotide polymorphism array (SNP-array) analysis. Based on whether other abnormal ultrasound indicators were present, the cases were divided into isolated (175 cases) and non-isolated groups (247 cases). The results of invasive prenatal diagnosis, distribution of chromosomal abnormalities, detection of copy number variation (CNV) in fetuses with nasal bone development abnormalities, the relationship between maternal age, number of abnormal ultrasound indicators and chromosomal abnormalities, and pregnancy outcomes were analyzed. Statistical analysis was performed using the Chi-square test (continuity correction Chi-square test or Fisher's exact test). Results:(1) Among the 422 cases, 262 cases (62.1%) showed no abnormalities with both detection techniques; 160 cases had abnormalities, including 145 cases (34.4%) had consistent abnormal results and types of abnormalies with the two techniques; two cases (0.5%) had chromosomal translocations detected by karyotype analysis but not by SNP-array analysis; 13 cases (3.1%) had no abnormalities detected by karyotype analysis but had abnormal SNP-array results. This study's overall detection rate of chromosomal abnormalities was 37.9% (160/422), with an additional detection rate of 4.7% (13/275) using SNP-array technology. (2) Among the 160 cases of chromosomal abnormalities, there were 140 cases of aneuploidy, 18 cases of CNV, and two cases of chromosomal translocation. The overall detection rate of chromosomal abnormalities and the detection of aneuploidy, and pathogenic CNV in the non-isolated group was higher than that in the isolated group [74.3% (130/175) vs. 12.1% (30/247), χ2=168.02; 68.0% (119/175) vs. 8.5% (21/247), χ2=163.56; 5.7% (10/175) vs. 0.8% (2/247), χ2=4.74; all P<0.05]. Eighteen cases of CNV were detected using SNP-array technology, including eight cases in the isolated group and ten cases in the non-isolated group. (3) The age of the 422 pregnant women was (33.1±5.4) years. In both isolated and non-isolated groups, the detection rate of chromosomal abnormalities was higher in women of advanced age (expected delivery age ≥35 years) than those not [isolated group: 20.0% (17/85) vs. 8.6% (14/162), χ2=6.55; non-isolated group: 82.1% (69/84) vs. 65.9% (60/91), χ2=5.92; both P=0.010]; regardless of maternal age, the detection rate of chromosomal abnormalities in the non-isolated group was significantly higher than that in the isolated group ( χ2 were 65.28 and 92.42, respectively, both P<0.001). (4) In the non-isolated group, the detection rates of chromosomal abnormalities were 69.0% (78/113) and 83.9% (52/62) when nasal bone abnormalities were combined with one or more other abnormal ultrasound indicators, respectively. When combined with increased nuchal translucency, the detection rate of fetal chromosomal abnormalities was 73.2% (71/97), higher than the detection rate when combined with other single indicators (7/16) ( χ2=5.57, P=0.020). (5) Among the 262 cases with negative karyotype analysis and SNP-array results, 241 cases (92.0%) resulted in live births, with a gestational age at delivery of 39 weeks (32-41 weeks); 12 cases (4.6%) resulted in induced labor, five cases (1.9%) resulted in miscarriage, and four cases (1.5%) were lost to follow-up. The live birth rate in the isolated group was higher than that in the non-isolated group [86.9% (213/245) vs. 20.2% (35/173), χ2=187.00, P<0.001]. Conclusions:Fetuses with nasal bone developmental abnormalities in early pregnancy have a higher detection rate of chromosomal abnormalities and CNV. Invasive prenatal diagnosis is recommended for cases of nasal bone developmental abnormalities in early pregnancy, whether isolated or non-isolated. When combined with other abnormal indicators, the genetic etiology of the fetus is more complex, and detailed genetic counseling should be provided to the patient.

Objective From the perspective of hospital grade reviewers,the evaluation index system for the clinical application of hospital medical technology is established to provide reference basis for the standardized management and continuous improvement of medical technology.Methods Based on the comprehensive application of literature analysis,Delphi expert consultation and so on,evaluation index system was established,and the weight of each index is determined by the hierarchical analysis method.Data relevant to the clinical application of medical technologies of 3 hospitals were analyzed,and the evaluation effect was evaluated using the index system by TOPSIS.Results The evaluation index system for clinical application of medical technology includes 3 first-level indicators,6 second-level indicators and 31 third-level indicators.First-level indexes include support and guarantee,organization and implementation,and quality control and management,their weights are 0.163,0.297 and 0.540,and CI=0.005.TOPSIS results showed that the effect of the 3 hospitals from high to low was hospital C,hospital A and hospital B.Conclusion The evaluation index system constructed in it is highly scientific,and the enthusiasm,authority and consistency of the experts are relatively high.This evaluation index system provides the scientific basis for standardized management and continuous improvement of medical technology,and also provides a clear evaluation criteria and basis for the hospital grade reviewers in the evaluation process.

Objective:To investigate the genetic causes of fetuses with abnormal nasal bone development in early pregnancy.Methods:A retrospective study was conducted which involved 422 cases of singleton pregnancies with nasal bone development abnormalities indicated by ultrasound screening at 11 to 13 weeks and 6 days of gestation, who underwent chorionic villus sampling for prenatal diagnosis at the Prenatal Diagnosis and Genetic Center, Maternity & Child Health Hospital of Guangxi Zhuang Autonomous Region from January 2015 to May 2023. All cases underwent chromosomal karyotype analysis and single nucleotide polymorphism array (SNP-array) analysis. Based on whether other abnormal ultrasound indicators were present, the cases were divided into isolated (175 cases) and non-isolated groups (247 cases). The results of invasive prenatal diagnosis, distribution of chromosomal abnormalities, detection of copy number variation (CNV) in fetuses with nasal bone development abnormalities, the relationship between maternal age, number of abnormal ultrasound indicators and chromosomal abnormalities, and pregnancy outcomes were analyzed. Statistical analysis was performed using the Chi-square test (continuity correction Chi-square test or Fisher's exact test). Results:(1) Among the 422 cases, 262 cases (62.1%) showed no abnormalities with both detection techniques; 160 cases had abnormalities, including 145 cases (34.4%) had consistent abnormal results and types of abnormalies with the two techniques; two cases (0.5%) had chromosomal translocations detected by karyotype analysis but not by SNP-array analysis; 13 cases (3.1%) had no abnormalities detected by karyotype analysis but had abnormal SNP-array results. This study's overall detection rate of chromosomal abnormalities was 37.9% (160/422), with an additional detection rate of 4.7% (13/275) using SNP-array technology. (2) Among the 160 cases of chromosomal abnormalities, there were 140 cases of aneuploidy, 18 cases of CNV, and two cases of chromosomal translocation. The overall detection rate of chromosomal abnormalities and the detection of aneuploidy, and pathogenic CNV in the non-isolated group was higher than that in the isolated group [74.3% (130/175) vs. 12.1% (30/247), χ2=168.02; 68.0% (119/175) vs. 8.5% (21/247), χ2=163.56; 5.7% (10/175) vs. 0.8% (2/247), χ2=4.74; all P<0.05]. Eighteen cases of CNV were detected using SNP-array technology, including eight cases in the isolated group and ten cases in the non-isolated group. (3) The age of the 422 pregnant women was (33.1±5.4) years. In both isolated and non-isolated groups, the detection rate of chromosomal abnormalities was higher in women of advanced age (expected delivery age ≥35 years) than those not [isolated group: 20.0% (17/85) vs. 8.6% (14/162), χ2=6.55; non-isolated group: 82.1% (69/84) vs. 65.9% (60/91), χ2=5.92; both P=0.010]; regardless of maternal age, the detection rate of chromosomal abnormalities in the non-isolated group was significantly higher than that in the isolated group ( χ2 were 65.28 and 92.42, respectively, both P<0.001). (4) In the non-isolated group, the detection rates of chromosomal abnormalities were 69.0% (78/113) and 83.9% (52/62) when nasal bone abnormalities were combined with one or more other abnormal ultrasound indicators, respectively. When combined with increased nuchal translucency, the detection rate of fetal chromosomal abnormalities was 73.2% (71/97), higher than the detection rate when combined with other single indicators (7/16) ( χ2=5.57, P=0.020). (5) Among the 262 cases with negative karyotype analysis and SNP-array results, 241 cases (92.0%) resulted in live births, with a gestational age at delivery of 39 weeks (32-41 weeks); 12 cases (4.6%) resulted in induced labor, five cases (1.9%) resulted in miscarriage, and four cases (1.5%) were lost to follow-up. The live birth rate in the isolated group was higher than that in the non-isolated group [86.9% (213/245) vs. 20.2% (35/173), χ2=187.00, P<0.001]. Conclusions:Fetuses with nasal bone developmental abnormalities in early pregnancy have a higher detection rate of chromosomal abnormalities and CNV. Invasive prenatal diagnosis is recommended for cases of nasal bone developmental abnormalities in early pregnancy, whether isolated or non-isolated. When combined with other abnormal indicators, the genetic etiology of the fetus is more complex, and detailed genetic counseling should be provided to the patient.

Objective From the perspective of hospital grade reviewers,the evaluation index system for the clinical application of hospital medical technology is established to provide reference basis for the standardized management and continuous improvement of medical technology.Methods Based on the comprehensive application of literature analysis,Delphi expert consultation and so on,evaluation index system was established,and the weight of each index is determined by the hierarchical analysis method.Data relevant to the clinical application of medical technologies of 3 hospitals were analyzed,and the evaluation effect was evaluated using the index system by TOPSIS.Results The evaluation index system for clinical application of medical technology includes 3 first-level indicators,6 second-level indicators and 31 third-level indicators.First-level indexes include support and guarantee,organization and implementation,and quality control and management,their weights are 0.163,0.297 and 0.540,and CI=0.005.TOPSIS results showed that the effect of the 3 hospitals from high to low was hospital C,hospital A and hospital B.Conclusion The evaluation index system constructed in it is highly scientific,and the enthusiasm,authority and consistency of the experts are relatively high.This evaluation index system provides the scientific basis for standardized management and continuous improvement of medical technology,and also provides a clear evaluation criteria and basis for the hospital grade reviewers in the evaluation process.

Objective To investigate the impact of the interaction of fasting blood glucose(FBG)and serum uric acid(SUA)on diabetic retinopathy(DR).Methods A total of 306 diabetes mellitus(DM)patients diagnosed and re-ceived comprehensive ophthalmic examination in the First Affiliated Hospital of Gannan Medical University from January 2019 to January 2021 were selected.According to the presence or absence of DR,these patients were divided into the DR group(178 patients)and the non-DR(NDR)group(128 patients).The general clinical data of patients in the two groups were compared.The least absolute shrinkage and selection operator(LASSO)regression method and multivariate Logistic regression analysis were used to screen the independent influencing factors of DR in DM patients,and the odds ratio of risk factors was calculated.The sensitivity analysis of the results was performed using the E-value method.The interaction of FBG and SUA on DR in DM patients was analyzed by an additive interaction model.The Nomogram model to predict DR in DM patients was constructed and verified internally.The receiver operating characteristic curve(ROC)was used to evalu-ate the effects of FBG,SUA and both FBG and SUA on DR in DM patients.Results Compared with the NDR group,the course of DM in the DR group was significantly longer,the proportion of patients with history of oral medication was signif-icantly lower,the proportion of patients with history of insulin therapy was significantly higher,and the levels of total cho-lesterol,triglyceride,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,blood urea nitrogen,serum creatinine,SUA and FBG were significantly higher(all P＜0.05).The history of insulin therapy,course of DM≥9.66 years,TG≥2.07 mmol·L-1,SUA ≥ 297.73 μmol·L-1 and FBG ≥8.92 mmol·L-1 were the risk factors for DR in DM pa-tients,while the history of oral medication was the protective factor for DR in DM patients.The Nomogram model based on the above independent risk factors was accurate in predicting the occurrence of DR in DM patients.SUA and FBG had inter-active effects on DR in DM patients.The value of SUA-FBG interaction in the diagnosis of DR was greater than that of both alone.Conclusion SUA≥ 297.73 μmol·L-1 and FBG ≥8.92 mmol·L-1 are the risk factors for DR in DM patients.The value of interaction of FBG and SUA in the diagnosis of DM accompanied by DR is greater than that of both alone.

Objective:To establish a set of artificial intelligence (AI) verification rules for blood routine analysis.Methods:Blood routine analysis data of 18 474 hospitalized patients from the First Hospital of Jilin University during August 1st to 31st, 2019, were collected as training group for establishment of the AI verification rules,and the corresponding patient age, microscopic examination results, and clinical diagnosis information were collected. 92 laboratory parameters, including blood analysis report parameters, research parameters and alarm information, were used as candidate conditions for AI audit rules; manual verification combining microscopy was considered as standard, marked whether it was passed or blocked. Using decision tree algorithm, AI audit rules are initially established through high-intensity, multi-round and five-fold cross-validation and AI verification rules were optimized by setting important mandatory cases. The performance of AI verification rules was evaluated by comparing the false negative rate, precision rate, recall rate, F1 score, and pass rate with that of the current autoverification rules using Chi-square test. Another cohort of blood routine analysis data of 12 475 hospitalized patients in the First Hospital of Jilin University during November 1sr to 31st, 2023, were collected as validation group for validation of AI verification rules, which underwent simulated verification via the preliminary AI rules, thus performance of AI rules were analyzed by the above indicators. Results:AI verification rules consist of 15 rules and 17 parameters and do distinguish numeric and morphological abnormalities. Compared with auto-verification rules, the true positive rate, the false positive rate, the true negative rate, the false negative rate, the pass rate, the accuracy, the precision rate, the recall rate and F1 score of AI rules in training group were 22.7%, 1.6%, 74.5%, 1.3%, 75.7%, 97.2%, 93.5%, 94.7%, 94.1, respectively.All of them were better than auto-verification rules, and the difference was statistically significant ( P<0.001), and with no important case missed. In validation group, the true positive rate, the false positive rate, the true negative rate, the false negative rate, the pass rate, the accuracy, the precision rate, the recall rate and F1 score were 19.2%, 8.2%, 70.1%, 2.5%, 72.6%, 89.2%, 70.0%, 88.3%, 78.1, respectively, Compared with the auto-verification rules, The false negative rate was lower, the false positive rate and the recall rate were slightly higher, and the difference was statistically significant ( P<0.001). Conclusion:A set of the AI verification rules are established and verified by using decision tree algorithm of machine learning, which can identify, intercept and prompt abnormal results stably, and is moresimple, highly efficient and more accurate in the report of blood analysis test results compared with auto-vefication.

Objective To develop a teaching strategy which is suitable for training talents and improving teaching quality in field of clinical gynecological oncology.Methods Seventy-eight clinical students of grade 2020 in a medi-cal university were divided into control group(n=38)and research group(n=40).The"3+2"teaching mode of team-based learning(TBL)and workshop(WS)were adopted,and the learning outcome was evaluated at preview preparation,knowledge application and the questionnaire survey of students,so as to promote the cultivation of clinical reasoning of medical students.Results Compared with traditional teaching method,TBL+WS teaching group had better academic performance.The difference of before class tests and final exams was more significant[17.53±6.15 points and(76.81±5.10)points,respectively,P＜0.001].However,among the eight dimensions of the classroom teaching questionnaire,the teaching quality dimension was the highest(97.5%).More students think that this model had a positive effect on cultivating clinical thinking and developing new knowledge.Conclu-sions This integrated teaching strategy improves the quality of obstetrics and gynecology teaching and suppots students'capacity building on clinical reasoning.

Objective To investigate the changes in the structural parameters and mechanical properties of the necrotic femoral head and compare the effects of core decompression and hone grafting with those of bone cement filling on the mechanical properties and pre-vention of articular surface collapse of the necrotic femoral head.Methods Thirty-two fresh human femoral heads were collected from patients who underwent total hip arthroplasty at our hospital between June 2020 and January 2022.The femoral heads were divided into four groups:8 femoral neck fractures(TFF group),8 osteonecrosis of the femoral head(ONFH group),8 osteonecrosis of the femoral head treated with cement percutaneous injection(CPI group),and 8 osteonecrosis of the femoral head treated with core decompression and bone graft(CDBG group).Cement filling or core decompression was performed under radiographic guidance.All samples were scanned and three-dimensionally reconstructed using micro-CT.The spatial heterogeneity of the femoral head was observed,and the bone morphometric parameters of each region of interest were calculated.Mechanical analysis was performed to evaluate the femoral head parameters of dis-placement and stress in vitro.Results Bone microarchitecture and morphometry in necrotic femoral heads were markedly altered.The biomechanical properties of the necrotic zone in the femoral head were markedly weakened.After the necrotic area was filled with bone cement,the biomechanical properties of the necrotic zone of the femoral head increased significantly.In addition,after core decompres-sion and bone grafting in the necrotic area,the biomechanical properties increased significantly in the necrotic zone of the femoral head.Conclusion Bone cement filling or bone grafting in the necrotic area can change the biomechanical mechanism of the femoral head,improve the load-supporting ability,and prevent femoral head collapse.Cement filling may be a practical approach for the treatment of osteonecrosis of the femoral head that can be useful for practicing orthopedists.

Objective:To explore the mechanism of peripheral blood mononuclear cells (PBMCs)-derived exosomes on improving endometrial receptivity by miR-1306.Methods:The models of mice with implantation disorders were prepared by subcutaneous injection of mifepristone. And they were divided into implantation disorder group and PBMCs intervention group, 12 mice in each group. The normal group was set up. PBMCs intervention group was given intrauterine injection of PBMCs-derived exosomes, while normal group and implantation disorder group were given the same volume of buffer solution. The pregnancy rates and number of embryos implantation in different groups were compared. The expression of miR-1306 in endometrial tissues was detected by RT-PCR. The levels of reactive oxygen species (ROS), interleukin-6 (IL-6), monocyte chemcattractant protein-1 (MCP-1) and superoxide dismutase (SOD) in endometrial tissues were detected by enzyme-linked immunosorbent assay. The expressions of pregnancy-related proteins in endometrial tissues were detected by Western blotting. The endometrial epithelial cells were divided into control group, experimental group, negative control group and miR-1306 inhibitor group. Except control group, cells were co-cultured with PBMCs-derived exosomes by Transwell in the other groups. The activity, proliferation and apoptosis of cells were detected by MTT, Edu and Annexin-V/PI flow, respectively. The level of ROS in cells was detected by kits. And expressions of the related proteins were detected by Western blotting.Results:The pregnancy rate [8.33% (1/12), number of embryos implantation [0(0, 0)], expression of miR-1306 in endometrial tissue (0.24±0.05) and SOD level [(5.66±0.72) U/mL] in implantation disorder group were significantly lower than those in normal group [100% (12/12), 16.50 (14.00, 19.00), 1.03±0.05, (8.69±1.21) U/mL, P<0.05], while levels of ROS [(4.87±0.39) U/mL], IL-6 [(116.51±5.78) ng/L] and MCP-1 in endometrial tissues [(36.84±3.56) μg/L], and expressions of KIR2DL4 (0.87±0.06), nuclear factor erythroid-2-related factor 2 (Nrf2, 0.76±0.06), Kelch-like ECH-associated protein1 (Keap1, 0.79±0.05), receptor interacting protein 1 (RIP1, 0.94±0.04) and RIP3 (0.86±0.05) were significantly higher than those in normal group [(2.41±0.19) U/mL, (83.79±6.68) ng/L, (12.32±2.09) ng/mL, 0.27±0.03, 0.31±0.05, 0.23±0.04, 0.34±0.03, 0.31±0.05, all P<0.05]. The pregnancy rate [75.00% (9/12)], number of embryos implantation [13.00 (13.00, 14.75)], expression of miR-1306 in endometrial tissues (0.82±0.05) and SOD level [(7.24±0.84) U/mL] in PBMCs intervention group were significantly higher than those in implantation disorder group (all P<0.05), while levels of ROS [(3.43±0.30) U/mL], IL-6 [(94.69±3.99) ng/L] and MCP-1 in endometrial tissues [(27.03±3.48) μg/L], and expressions of KIR2DL4 (0.54±0.08), Nrf2 (0.48±0.05), Keap1 (0.43±0.05), RIP1 (0.56±0.05) and RIP3 (0.49±0.03) were significantly lower than those in implantation disorder group (all P<0.05). The cells activity [(126.63±1.25)%], proliferation rate [(53.54±2.82)%] and ROS level [(3.12±0.31) U/mL] in experimental group were significantly higher than those in control group [100%, (23.18±3.07)%, (2.51±0.28) U/mL, all P<0.05], while apoptosis rate [(5.69±0.47)%], expressions of KIR2DL4 (0.36±0.06), Nrf2 (0.30±0.06), Keap1 (0.26±0.04), RIP1 (0.27±0.05) and RIP3 (0.26±0.06) were lower than those in control group [(27.13±2.97)%, 0.84±0.06, 0.75±0.05, 0.68±0.05, 0.80±0.06, 0.80±0.07, all P<0.05]. The cells activity [(83.48±5.34)%] and proliferation rate [(38.42±4.28)%] in miR-1306 inhibitor group were significantly lower than those in negative control group [(127.12±4.08)%, (53.57±2.09)%, all P<0.05], while apoptosis rate [(13.63±1.77)%], ROS level [(6.49±0.62) U/mL], expressions of KIR2DL4 (0.67±0.07), Nrf2 (0.57±0.05), Keap1 (0.50±0.05), RIP1 (0.64±0.06) and RIP3 (0.61±0.08) were significantly higher than those in negative control group [(5.71±0.78)%, (3.23±0.31) U/mL, 0.36±0.07, 0.30±0.07, 0.27±0.06, 0.28±0.07, 0.28±0.06, all P<0.05]. Conclusion:PBMCs-derived exosomes can improve pregnancy rate in mice with implantation disorders, which may improve inflammatory response by promoting miR-1306 expression and inhibiting KIR2DL4 expression, and is also related to relieving excessive oxidative stress and apoptosis of endometrium.