Objective To explore the role of resilience and stress in childhood maltreatment and adolescent depression and anxiety symptoms, and to provide a basis for adolescent psychological intervention. Methods From September to October 2022, a total of 11 217 students from four middle schools in Changsha were selected by multistage stratified sampling, and the Childhood Trauma Questionnaire, Depression–Anxiety–Stress Scales and the Resilience Scale for Chinese Adolescents were used to carry out online questionnaire survey. Results The detection rate of depressive symptoms and anxiety symptoms in adolescent was 19.43% (2 179) and 28.7% (3 224). The direct effect of childhood maltreatment on depressive symptoms was significant (β =0.09), Childhood maltreatment is a negative prediction of resilience (β = -0.57) and a positive prediction of pressure (β =0.06); Resilience can negatively predict stress (β = -0.61) and depressive symptoms (β = -0.25) (all P values <0.001); The direct effect of childhood maltreatment on anxiety symptoms was significant (β =0.03), resilience negatively predicts anxiety symptoms (β = -0.08) (all P values <0.01). Resilience and stress have a partially mediating role between childhood maltreatment and depressive symptoms, the mediation effect value was 0.39, accounting for 81.25% of the total effect. The effect values of the three pathways accounted for 29.17%, 8.33% and 43.75% of the total effect, respectively. Resilience and stress have a partial mediating effect between childhood abuse and anxiety symptoms, and the mediating effect was 0.36, accounting for 92.31% of the total effect, and the effect values of the three pathways accounted for 12.82%, 10.26% and 69.23% of the total effect, respectively. Conclusion Childhood maltreatment could affect adolescents’ depression and anxiety through the chain mediating effect of resilience and stress.

Objective To explore the clinical efficacy and safety of endoscopic endonasal dorsum sellae and posterior clinoid process resection combined with pituitary hemi-transposition in the treatment of pan-sellar area lesions. Methods Clinical data from 57 patients with pan sellar diseases who underwent endoscopic transnasal resection of the posterior clinoid process combined with lateral pituitary displacement surgery in the neurosurgery department of Zhongshan Hospital, Fudan University from January 2019 to January 2025 were collected, and their clinical surgical characteristics and prognosis were analyed. Results A total of 57 patients with pan-sellar area lesions were included in this study, comprising 27 craniopharyngiomas, 7 giant suprasellar pituitary adenomas, 7 chordomas, 6 chondrosarcomas, 5 diaphragma sellae/dorsum sellae meningiomas, and 5 rare lesions. All procedures were completed successfully, and gross total or near-total resection was achieved in all patients. No new neurovascular complications occurred intraoperatively. The follow-up duration ranged from 3 to 24 months. New postoperative anterior pituitary insufficiency occurred in 3 patients (5.3%), and new posterior pituitary insufficiency requiring long-term hormone replacement therapy occurred in 4 patients (7.0%). No additional pituitary dysfunction was observed in the remaining patients. Cerebrospinal fluid rhinorrhea occurred in 1 patient (1.8%) and was successfully repaired. Intracranial infection occurred in 3 patients (5.3%) and resolved after medical treatment. Conclusion Endoscopic resection of the posterior clinoid process combined with lateral displacement of the pituitary gland can effectively expand the surgical space, while repositioning the pituitary gland can reduce the extent of skull base defects. In addition, the risk of pituitary dysfunction caused by lateral displacement of the pituitary gland is relatively low.

To summarize the clinical experience of Professor LIU Shangyi in treating pruritus vulvae. It is believed that women have the physiological characteristics of liver and kidney as the root， and their pubic area is easily attacked by wind-dampness pathogenic qi， so the core mechanism of pruritus vulvae is proposed as wind-dampness accumulation and deficiency of liver and kidney. The core treatment method is to dispel wind-dampness and nourish the liver and kidneys， and modify the Danggui Decoction （当归饮子） to form a self-prescribed Yinyang Formula （阴痒方） as the basic prescription to treat pruritus vulvaen.

Objective::To evaluate the early pregnancy loss (EPL) rates in women with and without low molecular weight heparin (LMWH) treatment during early pregnancy.Methods::A retrospective, non-randomized study was conducted at Guangzhou Women and Children’s Medical Center between June 2019 and March 2022, involving women diagnosed with polycystic ovary syndrome (PCOS). All participants conceived following standard preconception care and voluntarily chose either the control group or the LMWH intervention group during the first month of pregnancy. The intervention was administered throughout the entire first trimester. Early and final pregnancy outcomes were recorded, with a particular focus on EPL rates. In addition, venous blood samples and clinical data were collected to compare hormonal profiles, blood lipid levels, and anthropometric parameters between the two groups. Statistical analyses included the two-tailed unpaired Student’s t-test, Mann–Whitney U test, Chi-square test, and Kaplan–Meier survival analysis. A value of P < 0.050 was considered statistically significant. Results::Thirty-eight women in the LMWH group and 102 women in the control group were included. The EPL rates in the LMWH and control groups were 5.3% (2/38) and 26.5% (27/102), respectively ( χ2 = 7.582, P = 0.006, odds ratio ( OR) = 0.154, 95% confidence interval ( CI): 0.035-0.685). The age ( P = 0.005), PCOS subtype ( P = 0.012), and levels of total cholesterol ( P = 0.003), and high-density lipoprotein ( P = 0.018) were significantly different between these two groups. Continued follow-up was performed to observe the long-time effects of LMWH treatment in early pregnancy. Seventy-three patients were successfully delivered, 23 patients in the LMWH group and 50 patients in the control group. There was no significant difference between the LMWH and control groups in gestation length, bleeding during delivery, birth weight, gender of the newborn, or mode of delivery. In addition, Kaplan-Meier curve analysis revealed that LMWH treatment may decrease the risk of EPL in PCOS patients in the first trimester ( χ2 = 4.144, P = 0.040). Conclusion::LMWH treatment during early pregnancy may reduce the EPL rate in women with PCOS.

Objective::To compare the analgesic effects of ibuprofen administered orally via two modes combined with a conventional, patient-controlled intravenous analgesia pump on maternal pain after cesarean section (CS).Methods::This prospective, randomized, controlled study enrolled females who underwent CS from August 2022 to August 2023 at Peking University First Hospital, Beijing, China. Participants were randomly assigned to either an as-needed ibuprofen group (300 mg orally upon request) or a scheduled ibuprofen group (300 mg every 12 hours for 48 hours). The primary outcomes assessed were postoperative pain levels using the Wong-Baker Faces Pain Scale-Revised and cumulative oxycodone consumption at multiple time points up to 48 hours post-delivery. Secondary outcomes included recovery parameters (time to first flatus, ambulation, and lactation initiation), patient satisfaction with pain control, and postpartum depression scores evaluated by the Edinburgh Postnatal Depression Scale on postoperative day 3. Normally distributed data analyzed with t-tests; non-normal data with Mann-Whitney U tests; categorical variables with chi-square or Fisher’s exact tests (SPSS 26.0, P < 0.05). Results::After excluding 61 non-eligible cases, 339 patients were included (171 as-needed vs. 168 scheduled). The scheduled group showed significantly better pain control at 12 hours (4.00 (2.00-5.50) vs. 4.00 (4.00-6.00), P < 0.001), 24 hours (4.00 (2.00-4.00) vs. 4.00 (2.00-6.00), P < 0.001), and 36 hours (2.00 (2.00-4.00) vs. 4.00 (2.00-4.00), P < 0.001), and 48 hours (2.00 (2.00-4.00) vs. 2.00 (2.00-4.00), P = 0.004) post-delivery and lower levels of oxycodone consumption at 36 hours (10.20 (8.20-13.35) vs. 11.00 (8.80-14.40), P = 0.042) and 48 hours (12.40 (10.40-15.95) vs. 13.80 (11.00-16.00), P = 0.020) postpartum compared with those in the as-needed group. Additionally, the time to the return of bowel movements was shorter in the scheduled group than in the as-needed group (23.50 (16.94, 31.47) vs. 27.00 (19.88, 35.97), P = 0.004). Differences in post-delivery ambulation, lactation initiation, satisfaction levels, and depression scores were not significantly different between the two groups. Conclusion::The results of this study promote the use of ibuprofen (scheduled oral administration) combined with a conventional, patient-controlled intravenous analgesia pump for achieving better post-CS pain control than an as-needed dosage regimen.Registration::Chinese Clinical Trial Registry, ChiCTR2400082474.

Objective:To investigate the application and effect of a competency-oriented teaching model in standardized nutritional diagnosis and treatment training for clinical physicians.Methods:A blended teaching method combining online and offline lectures was used to teach core knowledge and skills of clinical nutrition among clinical physicians by implementing a step-by-step "popularization-strengthening-deepening" strategy. The number of nutritional consultations, the improvement in nutritional diagnosis and treatment among clinical physicians, and the degree of satisfaction after training were used as assessment indices.Results:Compared with the data in 2021, the number of annual nutritional consultations was increased by 21.41% in 2022 and 53.18% in 2023. A total of 281 clinical physicians received online deepening course training, among whom 237 (84.34%) completed the online clinical nutrition knowledge test, with a mean score of (86.17±5.48) points and a pass rate of 81.86% (194/237). The online training received a satisfaction rate of 80.39%.Conclusions:The training program designed with competency-based objectives, systematic content, and diverse methodologies can significantly enhance the standardized thinking and capabilities of clinical physicians in nutritional diagnosis and treatment.

Objective:To explore the value of paediatric age-adjusted shock index（SIPA）in early identification of septic shock in children，and to evaluate the relationship between SIPA and disease severity and prognosis.Methods:The infected children admitted to the department of critical care medicine of the Children's Hospital Affiliated to Capital Institute of Pediatrics from May 2023 to July 2024 were collected. Dynamic assessment was performed 0 to 6 hours after admission. Patients diagnosed with sepsis without septic shock were classified as the sepsis group and those diagnosed with sepsis with septic shock were classified as the septic shock group. According to whether the blood pressure of the children decreased，they were divided into two groups：compensated septic shock group and decompensated septic shock group. The difference of SIPA among the three groups was analyzed，and the predictive value of SIPA on case fatality rate，lactate level，pediatric critical illness score，ventilator utilization rate and length of hospital stay were analyzed.Results:Among 203 children with sepsis，112 were males and 91 were females. There were 146 cases in the sepsis group，37 cases in the compensated septic shock group and 20 cases in the decompensated septic shock group. There was no significant difference between the three groups in gender（ P>0.05），but there was a statistically significant difference in age（ χ 2=32.905， P<0.001）. There was no significant difference in age between the sepsis group and the compensated septic shock group（ P>0.05）. The age of sepsis group and decompensated septic shock group，compensated septic shock group and decompensated septic shock group were statistically significant（ χ 2=29.431， P<0.001； χ 2=19.764， P=0.001）. The proportion of increased SIPA was statistically different among the three groups，with both the compensated septic shock group and the decompensated septic shock group being higher than the sepsis group（ χ2=20.383， P<0.001； χ2=33.600， P<0.001）. The decompensated septic shock group was higher than the compensated septic shock group（ χ2=6.555， P=0.01）. SIPA was correlated with case fatality rate，lactate level，pediatric critical illness score，ventilator use rate and length of stay of the children，with statistically significant differences（ P<0.05）. Conclusion:The increase of SIPA can be used for the early identification of septic shock in children，and it has a certain early warning value for the prognosis assessment of sepsis and septic shock.

This study investigated the infection status,drug resistance,and molecular characteristics of Shiga toxin-producing Escherichia coli(STEC)in domestic goats in Chengkou county,Chongqing.In August 2023,283 fecal samples were collected from households in Chengkou county.After enrichment with EC broth and inoculation onto selective media,samples that tested positive for stx1/stx2 were selected for further isolation.The positive strains were investigated with antimicrobial susceptibility testing and whole genome sequencing.According to the whole genomic sequences,the stx subtypes,serotypes,multi-locus sequence types,virulence genes,drug resistance genes,and phylogenetic relationships of the STEC strains were analyzed.Forty-six strains of STEC were isolated from 283 goat fecal samples,thus resulting in a detection rate of 16.25%.The 46 STEC strains were categorized into 12 O∶H serotypes,among which O76∶H19 and O8∶H7 predominated,each represented by 9 strains.Five STEC strains were identified as serotype O157∶H7.The 46 STEC strains were categorized into 11 sequence types(STs),among which ST675 and ST196 predominated,each represented by nine strains,accounting for a 19.57%proportion.The strains were categorized into 7 stx subtypes,among which stx1c(26/46,56.52%),followed by stx2k(9/46,19.57%)predominated.All nine Stx2k-STEC strains were identified as serotype O8∶H7 and sequence type ST196.In antimicrobial susceptibility testing,2 STEC strains were resistant to ampicillin,one strain was resistant to ampicillin/sulbactam,one strain was resistant to cefazolin,and one strain was resistant to cefoxitin.Nine Stx2k-STEC strains were found to carry the beta-lactam resistance gene blaEC-18.Antimicrobial sensitivity tests revealed that the nine Stx2k-STEC strains were sensitive to all 15 tested antibiotics.Moreover,phylogenetic analysis indicated that the 9 Stx2k-STEC strains were remarkably similar but showed high genetic diversity with respect to that of the Stx2k-STEC strains isolated from other regions in China.Goatsare an important animal reservoir for STEC in theChengkou district of Chongqing,and novel sequence type Stx2k-STEC strains distinct from those found in other regions of China were identified in this region.

Background and Aims:Laparoscopic hiatal hernia repair with mesh reinforcement combined with fundoplication has become the standard surgical approach for treating moderate to severe cases.However,intraoperative and postoperative complications remain a significant concern.This study was conducted to explore the causes of common complications and their prevention and management strategies through retrospectively analyzing clinical data from a single center to optimize perioperative care and improve surgical safety.Methods:The clinical data of 432 patients who underwent laparoscopic hiatal hernia repair with mesh and fundoplication at the Sixth Affiliated Hospital of Sun Yat-sen University from January 2018 to December 2023 were retrospectively analyzed.All procedures were performed by the same surgical team using the standardized seven-step protocol for laparoscopic repair.Postoperative care followed the enhanced recovery after surgery pathway.The incidences of intraoperative and postoperative complications were recorded,and univariate analysis was used to identify risk factors for major postoperative complications.Results:The overall complication rate was 15.3％among 432 patients.The most common intraoperative complication was bleeding(6.9％),primarily from the inferior phrenic vessels(3.2％),short gastric vessels(1.6％),and parenchymal organ injuries(1.9％).The most frequent postoperative complication was dysphagia(12.0％),followed by pneumothorax(3.2％),hernia recurrence(1.9％),mesh infection or erosion(0.7％),gas-bloat syndrome(6.3％),and gastroparesis(0.9％).Most complications were relieved through conservative treatment,endoscopic dilation,or interventional procedures.Two patients with persistent dysphagia underwent reoperation to remove the fundoplication wrap.The median follow-up period was 34 months,with a 6.0％loss to follow-up rate and no perioperative mortality.Univariate analysis showed that patients aged ≥50 years and those who underwent Nissen fundoplication had significantly higher rates of postoperative dysphagia(both P＜0.05).Conclusion:Laparoscopic hiatal hernia repair with mesh and fundoplication is generally safe and effective.However,intraoperative vascular injuries and postoperative dysphagia require special attention.Accurate dissection and identification of anatomical layers are critical during surgery.Surgical strategy should be tailored based on patient age and esophageal motility,with partial fundoplication(Toupet or Dor)preferred when appropriate.Combined with enhanced postoperative recovery protocols,standardized mesh placement and fixation can reduce complication rates and improve long-term outcomes.

BACKGROUND:It has been found that anterior knee pain is related to the biomechanics of the lower limbs,but there is still a lack of research on the effects of gluteal muscle training on the knee joint and daily activities of the lower limbs.OBJECTIVE:To investigate the effects of gluteal muscle activation exercise therapy on the muscle strength of hip and knee joint muscle groups and pain in young male patients with anterior knee pain.METHODS:Twenty-five young male patients with anterior knee pain were enrolled and randomly divided into two groups:gluteal muscle activation group(n=12)and blank control group(n=13).The gluteal muscle activation group performed gluteal muscle activation exercises,40 minutes each,3 times/week,for 6 weeks.The blank control group did not perform any intervention.Assessments were conducted at the time of enrollment and again after 6 weeks.The relative peak torque,total work,ratio of flexors and extensors,and muscle endurance values of the affected hip and knee joints were evaluated through isokinetic flexion and extension tests at 60(°)/s and 180(°)/s.At the same time,floors at which climbing was stopped in the stair-climbing test were detected and the visual analog scale score was assessed.RESULTS AND CONCLUSION:(1)Isokinetic knee extension and flexion test:For the hip joint,the gluteal muscle activation group showed a significant increase in the relative peak torque at 60(°)/s and 180(°)/s by 29.74%and 25.95%respectively after intervention(P=0.022,P=0.024);the blank control group showed a 12.12%decrease in muscle endurance at 180(°)/s compared to before intervention(P=0.000).For the knee joints,the gluteal muscle activation group had a significant increase in the relative peak torque at 60(°)/s and 180(°)/s by 18.69%and 7.27%respectively after intervention(P=0.006,P=0.033);there were no significant changes in the blank control group before and after intervention(P>0.05).(2)Stair-climbing test:The number of floors climbed to cessation in the gluteal muscle activation group was(6.41±6.1)floors,which was higher than that in the blank control group(P=0.024),and increased by 33.11%compared with before intervention(P=0.016);there were no significant changes in all the indicators of the blank control group before and after intervention(P>0.05).(3)Pain assessment:After intervention,the visual analogue scale score of the gluteal muscle activation group was significantly lower than that of the blank control(P=0.036),and also decreased compared to before intervention(P=0.000);there were no significant changes in the blank control group before and after intervention(P>0.05).To conclude,the 6-week gluteal activation exercise therapy can improve the explosive power and endurance of the lower limb muscles,and reduce the degree of anterior knee pain.For patients with anterior knee pain,gluteal muscle training is necessary to promote recovery.