OBJECTIVE To evaluate the safety of fondaparinux in pregnancy and provide reference for its rational clinical application. METHODS A search was conducted in databases including CNKI， Wanfang， PubMed， Embase， and Elsevier （the search time was from the construction of the database to December 17， 2024） to collect case report literature on fondaparinux use during pregnancy. Patient demographic information， fondaparinux use during pregnancy， concomitant medications， clinical manifestations， and treatment details were extracted for descriptive statistical analysis. RESULTS A total of 17 case reports regarding the use of fondaparinux during pregnancy were collected， involving 42 patients from 11 countries and 47 pregnancy records. Among these， 20 cases involved the use of fondaparinux for the prevention of pregnancy-related venous thromboembolism （VTE）， while 27 cases were fondaparinux treatment due to related conditions. A total of 29 occurrences of the patients were treated with fondaparinux due to a （family） history of VTE. Nine occurrences of complicated pregnancies were reported， and 35 patients had records of comorbidities or relevant medical histories. The adverse events that occurred during pregnancy with the use of fondaparinux include postpartum hemorrhage （7 cases） and excessive anticoagulation caused by inappropriate dosage （1 case）. Among the 7 cases of postpartum hemorrhage， 3 cases had a blood loss of no less than 1 000 mL （including 2 cases with uterine atony）， 3 cases had a drug discontinuation time of ≤12 h. CONCLUSIONS Based on the existing literature， the safety of fondaparinux during pregnancy is generally manageable， with the main adverse event being postpartum hemorrhage. The dosage， interval between discontinuation，comorbidities/medical history， and concomitant medications of fondaparinux may be the main causes of its adverse events.

Objective: To analyze factors impacting mental health status of medical students based on ecological systems theory, so as to provide reference for the mental health promotion system for medical students. Methods: In June 2024, 1 760 medical school students randomly selected from 19 different kinds of medical colleges in eastern China by stratified cluster were surveyed using questionnaires and expert interviews. Descriptive statistics, cross analysis, hierarchical linear regression analysis, structural equation models were used for data analysis. Results: Medical school students had higher satisfaction with the school (65.85%) and a great sense of perceived social support (57.16%). Furthermore, 91.14% of the students had normal interpersonal relationships. However, 44.89% reported that their mental health was impacted by high level of depression. The hierarchical linear regression analysis showed that the mental health outcomes of the medical students were positively predicted by higher perceived social support scores ( β =-11.40), institutional satisfaction ( β =-4.85 ), and lower help seeking stigma scores ( β =9.31) ( P <0.05). The structural equation modeling showed that the status of both perceived social support and self help seeking stigma had significant impacts on depression severity ( β =-0.32, -0.53) and interpersonal relationship sensitivity ( β =-0.31, 0.58) among medical students ( P <0.01).Through expert interviews, collaborations between the school and the tripartite organization (families, universities and society) was of growing importance. Conclusions Perceived social support and self stigma have a significant impact on the mental health status of medical students. The problem of self stigma of medical students should be paid attention to. Therefore, families, universities and society should work together to improve the mental health of medical students.

Hirsutine,an indole alkaloid extracted from the traditional Chinese herb Uncaria,has exhibits diverse pharmaco-logical activities,including antihypotensive,antiinfective,and cardioprotection.In cervical cancer,breast cancer,colon cancer,and oth-er malignant tumors,hirsutine has effects on anti-tumor by regulating cell apoptosis,immune regulation and other pathways,laying the foundation for the application of hirsutine in the field of cancer therapy.This article reviews relevant literature both domestically and internationally to elucidate the research progress of hirsutine in anti-tumor therapy,providing new ideas and strategies for cancer treat-ment.

BackgroundPrevious studies have found that patients with generalized anxiety disorder （GAD） have impaired performance in executive function， and group cognitive behavioral therapy （CBT） has been shown to be effective in alleviating negative affect in patients with GAD， while its efficacy on executive function remains unclear. ObjectiveTo explore the efficacy of group CBT on anxiety symptom and executive function in GAD patients， so as to provide references for the rehabilitation program for GAD. MethodsA total of 80 consecutive patients with GAD who were hospitalized in Sleep and Psychosomatic Medical Center of Shiyan Taihe Hospital from March 2021 to August 2022 and met the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） diagnostic criteria for GAD were enrolled， and they were assigned into study group （n=40） and control group （n=40） using random number table methods. All patients were subjected to routine medication treatment and regular health education， based on this， study group received group CBT once a week （6 weeks， 60 to 90 minutes per session）. At the enrollment and after 6 weeks of treatment， patients were assessed using Hamilton Anxiety Scale （HAMA） and Frontal Assessment Battery （FAB）. ResultsANOVA with repeated measures on HAMA score revealed a significant time effect （F=1 870.320， P<0.01）， no significant group effect and no significant time×group interaction effect （F=1.254， 0.293， P>0.05）. Significant time effect， group effect and time×group interaction effect were reported on FAB scores （F=311.190， 4.399， 7.021， P<0.05 or 0.01）. Further analysis indicated that FAB scores of both groups after treatment were higher than those at baseline （t=200.569， 115.401， P<0.01）.And the FAB score of study group was higher than that of control group after treatment （t=-3.211， P<0.01）. ConclusionGroup CBT combined with medication treatment for GAD may alleviate the anxiety symptoms and improve executive function in GAD patients. ［Funded by Shiyan Science and Technology Bureau Pilot Scientific Research Project （number， 21Y21）］

ObjectiveTo investigate the effect of Shugan Quyu Jiedu prescription （SGQYJDF） on inducing ferroptosis in hepatocellular carcinoma cells based on the tumor protein 53 （p53）/solute carrier family 7 member 11 （SLC7A11）/glutathione peroxidase 4 （GPX4） pathway. MethodMHCC97H cells were divided into the blank serum group （10% blank serum medium）， SGQYJDF-containing serum low concentration group （5% SGQYJDF-containing serum and 5% blank serum medium）， SGQYJDF-containing serum medium concentration group （7.5% SGQYJDF-containing serum and 2.5% blank serum medium）， SGQYJDF-containing serum high concentration group （10% SGQYJDF-containing serum medium） and sorafenib group （sorafenib concentration of 10 μmol·L^-1 in 10% blank serum medium）. After 24 hours of intervention， the cell survival rate was detected by cell counting kit-8 （CCK-8） assay. The cell proliferation ability was detected by 5-ethynyl-2′-deoxyuridine （EdU） staining. The intracellular ferrous ion （Fe²⁺） level was detected by ferrous ion fluorescent probe （FerroOrange） staining. The intracellular malondialdehyde （MDA） and glutathione （GSH） levels were detected by colorimetric assays. The ultrastructure of mitochondria was observed by transmission electron microscopy. The expression levels of ferroptosis-related proteins p53， SLC7A11 and GPX4 were detected by Western blot. ResultIn terms of cell viability， compared with the blank serum group， the SGQYJDF group showed a dose-dependent decrease in the survival rate of MHCC97H cells. Effect of the medium and high concentrations of SGQYJDF on the survival rate of MHCC97H cells were significantly decreased （P<0.01）. Additionally， the results of the EdU assay showed that both the medium and high concentrations of SGQYJDF were able to inhibit the proliferation ability of MHCC97H cells （P<0.05， P<0.01）. Regarding the biochemical indicators of ferroptosis， compared to the blank serum group， the medium and high concentrations of SGQYJDF were able to dose-dependently increase the intracellular Fe²⁺ level （P<0.01）. The low， medium， and high concentrations of SGQYJDF were able to dose-dependently decrease the level of GSH in MHCC97H cells （P<0.01） and increase the level of MDA in the cells （P<0.05， P<0.01）. In terms of pathway-related protein expression， compared to the blank serum group， the medium and high concentrations of SGQYJDF could significantly increase the expression of p53 （P<0.01）. The low， medium， and high concentrations of SGQYJDF could significantly decrease the expression of GPX4 （P<0.01）. The high concentration of SGQYJDF could decrease the expression of SLC7A11 （P<0.01）. In terms of the cell morphology of ferroptosis， compared with the blank serum group， transmission electron microscopy revealed that the low concentration of SGQYJDF caused mitochondrial deformation， while the medium and high concentrations of SGQYJDF resulted in reduced mitochondrial volume， increased double-layer membrane density， and decreased mitochondrial cristae. These features were similar to those of sorafenib-induced ferroptosis. Furthermore， compared with the sorafenib group， the high concentration of SGQYJDF showed no statistically significant differences in cell survival rate， proliferation ability， Fe²⁺ level， MDA level， and GSH level. ConclusionThe results suggest that SGQYJDF may induce ferroptosis and inhibit proliferation in hepatocellular carcinoma MHCC97H cells by upregulating the expression of p53， suppressing the expressions of GPX4 and SLC7A11， downregulating the level of GSH， and leading to the accumulation of intracellular Fe²⁺ and MDA.

Objective To develop an evidence-based practice program for ICU eye care and evaluate its application effect using Stetler model of research utilization.Methods The systematic search was carried out in domestic and foreign guid elines,systematic reviews,evidence summaries,expert consensuses on eye care for ICU patients.The quality of the included literature was evaluated and the evidence was summarized.The evidence based on expert advice,clinical context and stakeholder opinions was screened.According to Stetler model of research utilization,the evidence translation/application was formulated from 3 aspects,including method,level and type of evidence application,and the evidence translation was implemented using a stepwise trial design.Five ICUs in a tertiary hospital in Zhejiang Province were selected,and the order of enrollment of each ICU was determined by computer-generated random numbers from April to september,2022.In the first month,all ICUs were in pre-evidence-based practice period,and in the second month,an ICU was trained and entered the evidence-based practice period.Until the 6th month,all ICUs entered the evidence-based practice period.Then the rate of ocular symptoms and implementation rate of eye care measures were compared before and after EBP.Results A total of 1 540 patients were included.With regard to the implementation rate of eye care measures,the rate of lubricant use and suspected ocular infection management in patients at high risk for ocular complications in evidence-based practice period was significantly higher compared with pre-evidence-based practice period(P＜0.001),and no statistically significant difference was found in the rate of eyelid closure.The incidence of conjunctival exposure,subconjunctival hemorrhage,conjunctival congestion,and ocular discharge in non-neurology critical care patients decreased compared with pre-evidence-based practice period(P＜0.05),and the incidence of conjunctival edema and conjunctival congestion in NICU patients decreased compared with pre-evidence-based practice period as the intervention continued(P＜0.001).Conclusion Evidence-based practice in eye care for ICU patients using Stetler model of research utilization can standardize the practice of eye care for ICU patients and improve the quality of care.

Based on the discussions in the The Inner Canon of Yellow Emperor （《黄帝内经》）， it is proposed that in the course of the disease， "bind" represents the initial stage of pulmonary nodules， while "accumulation" represents the final form. In terms of the pathogenesis， "two colds interacting" represented by "body cold" and "cold fluid retention" are the prerequisites for the formation of pulmonary nodules， while "disorder of qi" represented by "fainting" is the core of the formation. The specific manifestation is the disturbance of pivot of shaoyang （少阳） or shaoyin （少阴）， resulting in a complex of cold and heat， and then phlegm and stasis are suddenly generated and further formed into nodules. Therefore， the treatment principle should be to regulate the cardinal mechanism， dissolve phlegm and blood stasis. Depending on the complex degree of cold and heat， it is suggested to use Chaihu Guizhi Decoction （柴胡桂枝汤）， Chaihu Guizhi Ganjiang Decoction （柴胡桂枝干姜汤）， or Chaihu Xianxiong Decoction （柴胡陷胸汤） for disturbance of shaoyang pivot， while for shaoyin pivot dysfunction， modified Mahuang Fuzi Xixin Decoction （麻黄附子细辛汤） or Shengjiang Powder （升降散） can be used.

This study summarizes the application of automatic recognition technologies for patient-ventilator asynchrony(PVA)during mechanical ventilation.In the early stages,the method of setting rules and thresholds relied on manual interpretation of ventilator parameters and waveforms.While these methods were intuitive and easy to operate,they were relatively sensitive in threshold setting and rule selection and could not adapt well to minor changes in patient status.Subsequently,machine learning and deep learning technologies began to emerge and develop.These technologies automatically extract and learn data characteristics through algorithms,making PVA detection more robust and universal.Among them,logistic regression,support vector machines,random forest,hidden Markov models,convolutional autoencoders,long short-term memory networks,one-dimensional convolutional neural networks,etc.,have all been successfully used for PVA recognition.Despite the significant advancements in feature extraction through deep learning methods,their demand for labelled data is high,potentially consuming significant medical resources.Therefore,the combination of reinforcement learning and self-supervised learning may be a viable solution.In addition,most algorithm validations are based on a single dataset,so the need for cross-dataset validation in the future will be an important and challenging direction for development.

Objective:To analyze the risk factors for fetal growth restriction (FGR) in late pregnancy of patients with gestational hypertension (HDP) and establish a predictive model.Methods:A retrospective collection of clinical data was conducted on 315 late pregnancy HDP patients at Affiliated Hospital of Jining Medical University from January 2021 to December 2022. The patients were divided into FGR group and non FGR group based on whether FGR occurred. We collected clinical data of HDP patients and used univariate and multivariate logistic regression analysis to evaluate the risk factors for FGR in late pregnancy of HDP patients and establish a prediction model. Hosmer Lemeshow tested the goodness of fit of the model. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of the predictive model for FGR in late pregnancy of HDP patients.Results:The incidence of late pregnancy FGR in 315 patients with HDP was 26.35%(83/315). Univariate analysis showed that the pre pregnancy body mass index (BMI) of the FGR group was lower than that of the non FGR group, and the systolic blood pressure, diastolic blood pressure, umbilical artery pulsatility index (PI), resistance index (RI), and end systolic flow velocity/end diastolic flow velocity ratio (S/D) were higher than those of the non FGR group (all P<0.05). Multivariate logistic regression analysis showed that a decrease in BMI before pregnancy and an increase in systolic blood pressure, diastolic blood pressure, PI, RI, and S/D were independent risk factors for FGR in late pregnancy in HDP patients (all P<0.05). The predictive equation for late pregnancy FGR in HDP patients was y=-4.246+ 0.062×pre-pregnancy BMI+ 0.080×systolic blood pressure+ 0.102×diastolic blood pressure+ 0.716×PI+ 1.200×RI+ 0.382×S/D. The Hosmer Lemeshow test showed P>0.05, indicating a good goodness of Fit. The ROC curve analysis showed that the area under the curve, sensitivity, and specificity of the model for predicting FGR in late pregnancy of HDP patients were 0.939(95% CI: 0.907-0.963), 86.75%, and 87.07%, respectively. Conclusions:Pre-pregnancy BMI, blood pressure, and umbilical artery blood flow parameters are influencing factors for the occurrence of FGR in late pregnancy in HDP patients. The model established based on these factors has high predictive value for FGR in late pregnancy in HDP patients.

Objective:To evaluate the value of contrast-enhanced ultrasound (CEUS) in the diagnosis of solid intraductal papilloma (sIDP) of breast by comparing with fibronenoma of breast (FA).Methods:The CEUS data of 62 cases of sIDP patients and 94 cases of FA patients that confirmed by pathology in the First Affiliated Hospital of Soochow University from October 2016 to January 2021 were retrospectively analyzed. The patients were divided into sIDP group and FA group according to the pathological results. The enhancement speed, enhancement degree, enhancement uniformity, whether the edge after enhancement was polished, whether the enhancement range was enlarged, whether there was a ring unenhanced area in the inner edge of the lesion and whether the inner edge of the unenhanced area was polished were observed in the two groups. SonoLiver software was used to perform offline analysis of the dynamic process of CEUS in the two groups respectively, the enhancement sequence diagram of the lesions was obtained. The pathological result was taken as the gold standard, univariate analysis was applied, and the parameters with statistical significance between the two groups were included in multivariate Logistic regression analysis to establish a differential diagnosis model. The diagnostic efficiency of sIDP was analyzed by ROC curve and diagnostic model.Results:Compared with the FA group, CEUS in the sIDP group mostly showed fast forward, high enhancement, and the enhancement sequence was mostly centrifugal. After CEUS, the lesion edges in the sIDP group were mostly accompanied by unenhanced areas and the inner edges of the unenhanced areas were not intact, and the differences between the two groups were statistically significant (all P<0.05). Binary Logistic regression showed that age, enhancement degree and enhancement order were independent risk factors for sIDP diagnosis. The ROC curve showed that the area under the ROC curve of age, enhancement degree and enhancement sequence combined for the diagnosis of sIDP was 0.874 (95% CI=0.812-0.922), the accuracy was 76.9%, the sensitivity was 67.7%, the specificity was 83.0%, the positive predictive value was 72.4%, and the negative predictive value was 79.6%. Conclusions:There are significant differences in age, enhancement degree and enhancement sequence between sIDP and FA patients. The three-parameter combination can improve the diagnostic efficiency of sIDP.