Objective To explore the factors affecting the quality of psychological assistance hotline connections in Shaanxi Province, and to provide a basis for optimizing services. Methods A total of 149 calls with suicidal tendencies were included from January to March 2022, and data were collected by 31 trained assessors through standardized questionnaires (general information, suicide risk, emotional intensity, and wiring characteristics). Results The results showed that 56.38% of the callers were female, with age groups concentrated between ≤ 18 years old (29.53%) and 19-34 years old (43.62%). The call duration was mainly between 31 and 45 minutes (50.34%). Operators conducted a suicide risk assessment on the callers, with 38.9% having a comprehensive assessment, 38.9% having an incomplete assessment, and 22.1% having no assessment. The main mental disorders of the callers were depression (48.32%), anxiety (15.44%), and bipolar disorder (14.77%), with 25.50% having comorbidities of ≥ 2 disorders. Emotional scores were as follows: depression (4.11 ± 0.76), sadness (3.97 ± 1.03), and despair (3.78 ± 1.05). There were significant differences in depression, anger, despair, and sadness among the callers with different levels of danger (t=4.79, 3.35, 15.79, 4.24, all P<0.05). Women had higher levels of fear than men (t=3.10, P<0.01). The longer the call duration, the higher the level of despair (t=5.66, P<0.01). Multiple regression analysis showed that incomplete suicide risk assessment by operators (B=-2.36), general procedures for operators' connections (B=5.44), and technical factors (B=2.01) significantly affected the quality of psychological assistance hotlines (all P<0.05). Conclusion Callers with suicidal tendencies generally have serious mental and psychological problems and prominent negative emotions. Strengthening the suicide risk assessment ability of operators and standardizing processes and service attitudes are key to improving the quality of psychological assistance hotlines.

Metabolic associated fatty liver disease (MAFLD) is fundamentally driven by an imbalance in hepatic fatty-acid flux: the influx of fatty acids exceeds the liver’s capacity for disposal, resulting in excessive hepatic lipid accumulation, predominantly in the form of triglycerides (TGs). The occurrence and progression of MAFLD depend on disordered regulation across multiple metabolic steps, including fatty-acid uptake, de novo lipogenesis (DNL), fatty-acid oxidation (FAO), and very low-density lipoprotein (VLDL) export. Forkhead box protein O1 (FOXO1) is a key transcriptional regulator within the hepatic network coordinating glucose and lipid metabolism. Under metabolic stress and insulin resistance (IR), FOXO1 expression is frequently increased, whereas its inhibitory phosphorylation is reduced. These changes enhance FOXO1 nuclear localization and transcriptional activity, thereby reprogramming the expression of genes related to metabolism in the liver. Because hepatic lipid deposition is the central pathological feature of MAFLD, the functional status of FOXO1 directly influences hepatic lipid homeostasis. Growing evidence suggests that FOXO1 can exert bidirectional, environment-dependent effects on hepatic lipid accumulation; however, the molecular basis for this functional switch remains incompletely understood. This review systematically summarizes the biological functions and regulatory mechanisms of FOXO1 and its roles in hepatic lipid metabolism, with a particular focus on its crosstalk with insulin signaling. FOXO1 expression is shaped by RNA modifications and epigenetic regulation mediated by non-coding RNAs. Its transcriptional output is precisely governed by post-translational modifications—such as phosphorylation and acetylation—as well as by coordinated nucleocytoplasmic shuttling. Notably, these regulatory patterns vary markedly across nutritional states, degrees of insulin resistance, and stages of disease. In the fed state, insulin/IGF-1 signaling activates the PI3K-AKT pathway, promoting the inhibitory phosphorylation of FOXO1 and facilitating additional modifications, including acetylation, methylation, and ubiquitination. Together, these events drive FOXO1 export from the nucleus and dampen its transcriptional activity, suppressing gluconeogenesis and constraining lipogenic programs. Conversely, during fasting or when insulin signaling is weakened, FOXO1 inhibition is relieved. FOXO1 accumulates in the nucleus, binds to DNA, and regulates the transcription of downstream target genes. Mechanistically, FOXO1 can aggravate hepatic lipid accumulation by activating genes involved in TG synthesis while repressing FAO-related pathways, thereby favoring storage over oxidation. However, under specific conditions, FOXO1 may also alleviate the hepatic lipid burden by promoting TG hydrolysis and enhancing VLDL secretion, thereby reducing the net hepatic lipid load. In addition, lipotoxic signals mediated by ceramides and diacylglycerols (Cer/DAG) activate atypical protein kinase C (aPKC), further exacerbating the disruption of the AKT-FOXO1 axis. This vicious cycle ultimately produces a metabolic paradox in which increased hepatic glucose output coexists with persistent, insulin-independent lipogenesis, accelerating MAFLD progression. Importantly, FOXO1 regulation is not uniform: during early metabolic overload, insulin-mediated suppression may remain effective, whereas in advanced insulin resistance, the loss of AKT control permits sustained FOXO1 activity. Such stage-dependent dynamics may help explain why FOXO1 can either promote steatosis or, in certain contexts, support programs that facilitate lipid turnover. Accordingly, interventions should be liver-specific and tuned to the disease stage, aiming to curb maladaptive FOXO1 signaling while preserving its capacity to promote triglyceride hydrolysis and VLDL secretion when advantageous. Overall, this review offers an important perspective on MAFLD pathogenesis, emphasizing FOXO1 as a potential therapeutic target and providing a theoretical basis for developing liver-specific, disease-course-dependent precision interventions.

Purpose: Interviews play a crucial role in the medical school selection process, although little is known about interviewers’ non-verbal observable communications (NoVOC) during the interviews. This study investigates how interviewers perceive NoVOC exhibited by interviewees in two medical schools, one in Taiwan and the other in Australia. The study also explores potential cross-cultural differences in these perceptions. Methods: A 26-item questionnaire was developed using a Delphi-like method to identify NoVOC. Interviewers from the University of New South Wales, Australia, and National Yang Ming Chiao Tung University, Taiwan (n=47 and N=78, respectively) rated these NoVOC between 2018 and 2021. Factor analyses identified and validated underlying factors. Measurement invariance across countries and genders was examined. Results: A total of 125 interviewers completed the questionnaire, including 78 from Taiwan and 47 from Australia. Using exploratory factor analysis, 14 items yielded reliable three factors “charming,” “disengaged,” and “anxious” (Cronbach’s α=0.853, 0.714, and 0.628, respectively). The measurement invariance analysis indicated that the factor models were invariant across genders but significantly different between the two countries. Further analysis revealed inconsistencies in interpreting the “anxious” factor between Taiwan and Australia. Conclusion The three distinct factors revealed in this study provide valuable insights into the NoVOC that interviewers perceive and evaluate during the interview process. The findings highlight the importance of considering non-verbal communication in selecting medical students and emphasize the need for training and awareness among interviewers. Understanding the impact of non-verbal behaviors can improve selection processes to mitigate bias and enhance the fairness and reliability of medical student selection.

Purpose: Interviews play a crucial role in the medical school selection process, although little is known about interviewers’ non-verbal observable communications (NoVOC) during the interviews. This study investigates how interviewers perceive NoVOC exhibited by interviewees in two medical schools, one in Taiwan and the other in Australia. The study also explores potential cross-cultural differences in these perceptions. Methods: A 26-item questionnaire was developed using a Delphi-like method to identify NoVOC. Interviewers from the University of New South Wales, Australia, and National Yang Ming Chiao Tung University, Taiwan (n=47 and N=78, respectively) rated these NoVOC between 2018 and 2021. Factor analyses identified and validated underlying factors. Measurement invariance across countries and genders was examined. Results: A total of 125 interviewers completed the questionnaire, including 78 from Taiwan and 47 from Australia. Using exploratory factor analysis, 14 items yielded reliable three factors “charming,” “disengaged,” and “anxious” (Cronbach’s α=0.853, 0.714, and 0.628, respectively). The measurement invariance analysis indicated that the factor models were invariant across genders but significantly different between the two countries. Further analysis revealed inconsistencies in interpreting the “anxious” factor between Taiwan and Australia. Conclusion The three distinct factors revealed in this study provide valuable insights into the NoVOC that interviewers perceive and evaluate during the interview process. The findings highlight the importance of considering non-verbal communication in selecting medical students and emphasize the need for training and awareness among interviewers. Understanding the impact of non-verbal behaviors can improve selection processes to mitigate bias and enhance the fairness and reliability of medical student selection.

Hypertrophic cardiomyopathy (HCM) is a major contributor to cardiovascular diseases (CVD), the leading cause of death globally. HCM can precipitate heart failure (HF) by causing the cardiac tissue to weaken and stretch, thereby impairing its pumping efficiency. Moreover, HCM increases the risk of atrial fibrillation, which in turn elevates the likelihood of thrombus formation and stroke. Given these significant clinical ramifications, research into the etiology and pathogenesis of HCM is intensifying at multiple levels. In this review, we discuss and synthesize the latest findings on HCM pathogenesis, drawing on key experimental studies conducted both in vitro and in vivo. We also offer our insights and perspectives on these mechanisms, while highlighting the limitations of current research. Advancing fundamental research in this area is essential for developing effective therapeutic interventions and enhancing the clinical management of HCM.
Cardiomyopathy, Hypertrophic/physiopathology* ; Humans ; Animals

Objective To preliminarily design a wide-energy-spectrum CR-39 solid-state nuclear track individual neutron dosimeter with different energy sections. Methods The thickness of the converter was optimized using the Monte Carlo SRIM program to broaden the energy range of the dosimeter. The self-made wide-energy-spectrum CR-39 individual neutron dosimeter was calibrated using ²⁴¹Am-Be, ²⁵²Cf, and thermal neutron sources to evaluate its dosimetric performance, including linearity, energy response, and neutron energy resolution. Results The linear correlation coefficient of the measurement system exceeded 0.98. The relative deviations of the energy response were 35.0% for blank section and 42.0% for polyethylene section, falling within the range of −50% to + 100% and meeting the monitoring requirements. The detection sensitivity for thermal neutron dose was 67 137.2 tr·cm⁻²·mSv⁻¹, and the detection sensitivity for thermal neutron fluence was 0.98 × 10⁻³ tr·n⁻¹, demonstrating good thermal neutron detection capability. Conclusion The self-made wide-energy-spectrum CR-39 individual neutron dosimeter fundamentally meets the requirements for individual neutron dose monitoring and is suitable for individual neutron dose monitoring in the energy range of thermal neutrons (up to approximately 15 MeV).

Objective To identify the reasons why the monitored personal doses of radiation worker A in an institution exceeded the investigation level in 2023 and 2024, and remind workers to wear personal dosimeters in a standardized manner in scenarios such as work and business trips to ensure the authenticity and reliability of the monitoring data. Methods A thermoluminescence measurement system was used to read the personal dosimeters worn by radiation workers. Investigations were carried out on personnel whose doses exceeded the investigation level described in the “Specifications for individual monitoring of occupational external exposure” (GBZ 128—2019). The reasons for doses exceeding the investigation level were analyzed using additional dosimeters and conducting on-site experiments. Results In 2023 and 2024, radiation worker A recorded a total of 5 personal dose equivalents exceeding the investigation level (1.23 mSv) over a total of 8 monitoring cycles (each lasting 90 days). Following one cycle where the dose exceeded the investigation level, two additional dosimeters (each for a 30-day cycle) were issued to worker A, revealing readings below the investigation level for the 30-day monitoring cycle (0.41 mSv). The reading for the dosimeter was 2-3 μSv per time when passing through an X-ray security scanner, and approximately 2.10 mSv per time when passing through a computed tomography security scanner. Conclusion Within a 90-day monitoring cycle, a single exposure of a personal dosimeter to a computed tomography security scanner can result in a dose exceeding the investigation level. Radiation workers should avoid placing dosimeters in backpacks or suitcases that pass through computed tomography security scanners during business trips, so as to reduce the impact of security scanner irradiation on personal dose monitoring.

Objective To investigate the effect of arthroscopic exploration combined with unicompartmental replacement surgery on knee joint function in patients with knee osteoarthritis.Methods Totally 82 patients with knee osteoarthritis in our hospital from August 2021 to February 2024 were included and stochastically divided into the control group and the observed group,with 41 patients in each group.Using a single-blind design,both groups received routine treatment first,while the control group received unicompartmental replacement surgery.The observation group was treated with arthroscopic exploration combined with unicompartmental replacement.Knee joint scoring criteria(HSS),Pittsburgh Sleep Quality Index(PSQI),Visual Analog Scale(VAS)scores,quality of life,serum superoxide dismutase(SOD),malondialdehyde(MDA)and knee joint range of motion were compared between two groups.Results After treatment,HSS score,social function,physical function,overall health score,SOD and knee flexion angle increased in both groups(P＜0.05),and the observed group was even higher(t=3.821,4.027,3.706,3.957,7.481 and 3.733,P＜0.05).PSQI score,VAS score,MDA and tibiofemoral angle decreased in both groups,and the observed group was even lower(t=4.601,8.375,9.084 and 3.625,P＜0.05).Conclusion Arthroscopic exploration combined with unicompartmental replacement surgery can effectively improve knee joint function and enhance the quality of life of patients with knee osteoarthritis.

Objective:To evaluate the safety and feasibility of Da Vinci robot-assisted proximal gastrectomy (PG) for proximal gastric cancer (PGC) and adenocarcinoma of the esophagogastric junction (AEG).Method:Twenty-five patients (PGC: n=7; AEG: n=18) undergoing Da Vinci-assisted PG at the First Affiliated Hospital of Dalian Medical University from Jan 2021 to Mar 2025 were divided into (indocyanine green ,ICG) ( n=9) and non-ICG ( n=16) groups based on whether intraoperative ICG navigation was used. Perioperative outcomes and pathological data were compared. Results:All operations were successfully completed without conversion to open surgery. The median proximal resection margin was 3.0 cm (2.5-3.0) cm, and the median distal resection margin was 4.0 cm (3.0-5.0) cm. Operative time in the ICG and non-ICG groups was (294.4±41.3) min and (354.4±67.4) min, respectively, with a statistically significant difference ( t=2.760， P< 0.05). The total number of lymph nodes harvested, as well as D 1 and D 2 LN stations, was (29.3±14.8) vs. (21.8±6.3), 17.0 (10.0-24.8) vs. 14.0 (11.0-22.5), and 10.0 (2.0-17.0) vs. 7.2 (2.0-7.5) in the ICG and non-ICG groups, respectively. Although the ICG group showed a trend toward higher LN yield, the difference was not statistically significant ( P>0.05). Conclusions:Da Vinci robotic assisted proximal gastrectomy is safe and feasible for treating PGC and AEG. ICG fluorescence imaging demonstrates promising clinical value.

Objective:To investigate the prevalence and risk factors of overweight and obesity among Chinese children aged 3-18 years from 11 provinces, antonomous regions, or municipalities.Methods:This national cross-sectional community health survey utilized a multistage stratified cluster-random sampling method to recruit 193 997 nationally representative participants from 11 provinces, autonomous regions, or municipalities between January 2017 and December 2019. All participants underwent physical examinations, and their caregivers completed questionnaires assessing participants′ dietary, lifestyle, familial, and perinatal information. Multilevel multinomial logistic regression models were employed to identify the potential risk factors.Results:The cohort comprised 193 997 children (102 178 boys, 91 819 girls),aged (10±4) years. Overall prevalence rates were 30 574(15.8%)overweight children and 17 217(8.9%) obesity children. Boys exhibited higher overweight and obesity rates than girls (17.0% (17 368/102 178) vs. 14.4% (13 206/102 178), 11.3% (11 553/91 819) vs. 6.2% (5 664/91 819), χ2=249.12,1 578.69,both P<0.001). The detection rates of obesity in Tanner stage 2 and 3 were the highest in boys and girls, with 13.4%(2 231/16 665) and 8.6%(880/10 221) respectively. Risk factors for obesity included parental overweight (paternal OR=2.34 and maternal OR=2.29), annual household income of 100 000-200 000 yuan (compared with<100 000 yuan, OR=1.04), higher paternal education (compared with below high school,high school and a college education OR=1.09,1.14), birth weight >4.0 kg (≤5 and>5 years old OR=1.74, 1.44,respectively), and western food consumption≥1 time/month (compared with<1, 1-2, 3-4,>4 times/month OR=1.36, 1.30, 1.67(≤5 years), 1.19, 1.16, 1.15 (>5 years), respectively) (all P<0.05). Conversely, coarse grain intake≥1 times/week (compared with<1 times/week, every day, 3-4, 1-2 times/week OR=0.74, 0.80, 0.71 (≤5 years), 0.75, 0.87, 0.90(>5 years), respectively, all P<0.05) was associated with reduced obesity risk. Conclusions:Obesity epidemiology in children demonstrates significant heterogeneity across age, gender, geographic regions, and pubertal stages. It is necessary to establish a personalized prevention and control strategy.