Objective: To explore the latent profile characteristics of regulatory emotional self-efficacy and its relationship with non-suicidal self-injurious (NSSI) behavior among junior and senior high school students, so as to provide a basis for effectively reducing NSSI behaviors. Methods: From April to October 2023, a total of 1 217 junior and senior high school students were selected from Tongren City, Zunyi City and Qiannan Prefecture of Guizhou Province by stratified cluster random sampling method. The Scale of Regulatory Emotional Self-efficacy and the Adolescent Self-injury Scale were administered. Latent profile analysis (LPA) was employed to explore distinct profiles of regulatory emotional self-efficacy, and the Lanza, Tan, and Bray s method (LTB) was used to analyze the relationship between these profiles and NSSI behavior. Results: The prevalence rate of NSSI behavior among junior and senior high school students was 28.6%. Among males, regulatory emotional self-efficacy was categorized into two types: moderate positive expression-low negative management group (59.1%, n =353) and high efficacy group (40.9%, n =244); among females, regulatory emotional self-efficacy was classified into three categories: low efficacy group (18.4%, n =114), high positive expression-low negative management group (56.3%, n =349), and high efficacy group (25.3%, n =157). There were statistically significant differences in total NSSI scores across different potential categories of regulatory emotional self-efficacy within both males and females ( Z/H = -5.75 , 57.58, both P <0.01). The differences in NSSI prevalence rates across the potential categories of regulatory emotional self-efficacy were statistically significant for both males and females ( χ 2=38.00, 69.14, both P <0.01), and among females, the differences in NSSI prevalence rates between the high efficacy group and the low efficacy group ( χ 2=60.01) and between the high efficacy group and the high positive expression-low negative management group ( χ 2=31.34) were also statistically significant (both P < 0.016 7 ). Binary Logistic regression analysis revealed that, compared with the high efficacy group within each gender, the moderate positive expression-low negative management group among males ( OR =2.36), and both the low efficacy group and the high positive expression-low negative management group among females ( OR =6.19, 2.97), were at an increased risk of engaging in NSSI (all P <0.01). Conclusion Different latent profiles of regulatory emotional self efficacy among junior and senior high school students are associated with NSSI behavior.

Diabetic kidney disease（DKD） is a chronic kidney structural and functional disorder caused by diabetes. With the global prevalence of diabetes continuing to rise， DKD has gradually become a major cause of chronic kidney disease and end-stage renal disease（ESRD）， posing a serious threat to patients' quality of life and long-term health outcomes. Studies have shown that apoptosis plays a pivotal role in the development and progression of DKD， with its mechanisms involving abnormal activation of multiple signaling pathways such as Toll-like receptor 4（TLR4）/nuclear transcription factor-κB（NF-κB）/B-cell lymphoma-2（Bcl-2）/cysteinyl aspartate-specific proteinase（Caspase）-3， protein kinase R-like endoplasmic reticulum kinase（PERK）/eukaryotic initiation factor 2α（eIF2α）/activating transcript factor 4（ATF4）/CCAAT enhancer-binding protein homologous protein（CHOP）， phosphatidylinositol 3-kinase（PI3K）/protein kinase B（Akt）/glycogen synthase kinase-3β（GSK-3β）， Janus kinase 2（JAK2）/signal transducer and activator of transcription 3（STAT3）， adenosine monophosphate-activated protein kinase（AMPK）/mammalian target of rapamycin（mTOR） and silent information regulator 1（SIRT1）/tumor suppressor protein 53（p53）， thereby accelerating renal pathological damage in DKD. Extensive evidence-based medical studies have confirmed that traditional Chinese medicine（TCM）， leveraging its unique therapeutic advantages of multi-target， multi-component and multi-pathway approaches， has demonstrated remarkable efficacy and favorable safety profiles in treating DKD. Recent studies have demonstrated that active components of TCM can specifically target and modulate key effectors in apoptotic signaling pathways. Meanwhile， traditional compound formulations exert synergistic effects through multiple approaches such as replenishing deficiency and activating blood circulation， detoxifying and dredging collaterals， tonifying kidney essence， and removing stasis and purging turbidity， thereby comprehensively regulating critical pathological processes including endoplasmic reticulum stress and mitochondrial apoptosis pathways. This combined therapeutic approach of molecular targeting and holistic regulation provides novel strategies for delaying the progression of DKD. Based on this， this paper provides an in-depth analysis of key apoptotic signaling pathways and their regulatory mechanisms， while systematically summarizing recent research advances regarding the therapeutic effects of TCM active components， compound formulations， and proprietary Chinese medicines on DKD through modulation of these pathways， with particular emphasis on their underlying molecular mechanisms. These findings not only elucidate the modern scientific connotation and theoretical basis of TCM in treating DKD but also establish a solid theoretical and practical foundation for promoting the wider clinical application and further research of TCM in the field of DKD treatment.

Elderly patients with lung cancer have a significantly increased risk of perioperative cardiopulmonary complications due to physiological decline, high incidence of complications and reduced surgical tolerance, which directly affects postoperative recovery and long-term survival. Although the concepts of minimally invasive surgery and enhanced recovery after surgery have improved clinical outcomes, early recognition and intervention of postoperative complications in elderly patients remains a significant challenge in the field of thoracic surgery. By integrating recent literature and clinical practice, this paper systematically analyzes the pathophysiological mechanism and risk factors of perioperative cardiopulmonary complications in elderly patients with lung cancer, and discusses individualized intervention strategies based on risk stratification and multidisciplinary team, in order to provide theoretical basis and practical guidance for optimizing perioperative management and improving postoperative prognosis in elderly patients.

Objective: To evaluate the diagnostic performance of magnetic resonance spectroscopy (MRS) in discriminating fumarate hydratase-deficient (FH-d) uterine leiomyomas (ULs) from FH-preserved ULs. Materials and Methods: This study consisted of three stages, with independent cohorts recruited for each stage: 1) sample-size estimation was retrospectively performed on UL specimens (diameter ≥3 cm; age, 20–40 years) from our database with immunohistochemistry (IHC) for 2-succinocysteine (2-SC) as the reference, without genetic testing, 2) MRS sequence optimization in confirmed FH germline mutation participants with ultrasound-detected ULs (diameter ≥3 cm), without IHC analysis, and 3) prospective diagnostic test accuracy was evaluated in consecutive participants with ultrasound-detected ULs (diameter ≥3 cm;age, 20–40 years), using IHC for 2-SC for determining the FH status and subsequent genetic testing in those with positive 2-SC results to identify whether FH mutations were germline or somatic in origin. The choline and fumarate peaks in MRS were classified as positive, negative, or technical failure (TF). TFs were analyzed separately and excluded from the primary diagnostic accuracy calculations. T1-, T2-, and diffusion-weighted images were interpreted as hyperintense or hypointense. The enhancement rate and apparent diffusion coefficient were also acquired. Diagnostic performance was compared between MRS and various magnetic resonance imaging (MRI) features. Results: The optimal MRS parameters for the fumarate peak were echo time (TE) = 140 ms and an average of 256. Among the 360 prospective participants, 37 were confirmed to have FH-dULs. MRS showed positive fumarate peaks in 35 of 37 FH-dULs.After excluding six TFs, the positive fumarate peak on MRS showed 94.6% (35/37) sensitivity, 99.7% (316/317) specificity, and 99.2% (351/354) accuracy, all of which were significantly superior to those of other MRI features (P ≤ 0.002). Conclusion A positive fumarate peak on MRS may be a useful imaging biomarker for diagnosing FH-dULs.

Abstract Children s emotional and behavioral problems are characterized by a relatively high incidence, concealed manifestations, and a potential correlation with an increased risk of subsequent mental disorders. These problems have a sustained impact on children s social-emotional development, learning adaptation, and peer relationships. The study reviews the main influencing factors and their mechanisms of action regarding children s emotional and behavioral problems from three levels:individual, family, and social. Under a multi-level integrated perspective, it deepens the understanding of these mechanisms and proposes that future efforts should focus on factors such as improving physical fitness, enhancing sleep, and reducing sedentary behavior. Furthermore, it suggests strengthening collaborative interventions among schools, families, and communities to promote the early prevention of childrens emotional and behavioral problems and support their healthy development.

OBJECTIVE To provide data support and theoretical reference for drug-regulatory authorities to implement targeted supervision over internet-based pharmaceutical sales.METHODS Using keywords such as “internet-based pharmaceutical sales” and “online drug sales”， the official websites of the People’s Government， drug-regulatory authorities and databases including PKULaw and others were searched， so as to collect typical cases and public disclosure information of administrative penalties related to internet-based pharmaceutical sales from January 2014 to June 2024. Guided by accident-causation theory， the text-mining method was adopted to identify risk factors from four dimensions： human unsafe behaviors， unsafe state of substances， environmental factors and safety management. Grey relational analysis was performed to quantitatively evaluate and screen key risk factors， and targeted governance suggestions were subsequently put forward.RESULTS A total of 617 administrative penalty cases were included. The number of cases increased significantly since 2018. The regional distribution of cases presented a characteristic of “high in the east and low in the west”. Violations were mainly concentrated in the business qualification examination link， and online pharmaceutical retail enterprises were the dominant law-breaking subjects. A risk identification system for internet-based pharmaceutical sales was constructed， covering 4 primary-level， 17 secondary-level and 56 tertiary-level risk factors. Through grey relational analysis， 37 key tertiary-level risk factors （most of which belonged to the safety-management dimension） including inadequate bill management and illegal drug-advertising content， as well as 12 key secondary-level risk factors such as drug-advertising violations and non-standard drug storage， were screened out.CONCLUSIONS Inadequate capabilities and weak compliance awareness of practitioners， illegal drug advertising， non-standard drug storage and transportation， and imperfect quality-management systems of online-drug-sales enterprises and third-party platforms are prominent safety risk factors for internet-based pharmaceutical sales. It is recommended to strengthen qualification examination and competency training for practitioners， standardize drug-information display and drug advertising， improve the management system of drug warehousing and logistics， and refine institutional requirements for key links， so as to improve the supervision efficiency of internet-based pharmaceutical sales.

Objective: To explore the relationship between related factors of non-suicidal self-injury behavior (NSSI) among middle school students in Guizhou Province, so as to provide the evidence for preventing high risk behaviors in adolescents. Methods: A stratified cluster random sampling method was used to select 1 034 junior and senior middle school students from Zunyi City, Qiannan Prefecture and Tongren City in Guizhou Province from April to October in 2023. Questionnaire survey was conducted to collect information including Adolescent Self injury Scale and Family Assessment Device. The R 4.4.1 software was employed for network analysis visualization, centrality indicators, and result stability assessment. Results: The detection rate of NSSI behavior among middle school students in Guizhou province was 29.6%, with a detection rate of 25.5% for boys and 33.1% for girls, showing a statistically significant difference ( χ 2=7.07, P <0.05). There were statistically significant differences in scores of emotional communication, egoism, family rules, positive communication, problem solving, expression of positive emotions and management of negative emotions self-efficacy, and bullying victimization in various dimensions between middle school students with and without NSSI ( Z =-13.66 to -7.05, P <0.01). NSSI among middle school students was positively correlated with social/relational bullying, depression and anxiety, and there were relatively close connections in the network ( r =0.35, 0.43, 0.42, P <0.01). Centrality indicators showed that the highest in strength and closeness centrality were stress ( Z =1.29, 1.58), the highest in betweenness centrality was for emotional communication ( Z =1.91), and the highest in expected influence index was for physical bullying ( Z =1.44)( P < 0.05). Conclusions Stress, emotional communication and physical bullying have significant impacts in the network of factors related to NSSI. Social/relational bullying, depression and anxiety have strong direct correlations with NSSI behavior among middle school students.

Objective:To investigate the diagnostic value of contrast-enhanced ultrasound（CEUS）in solid pseudopapillary tumor of pancreas（SPTP），summarize the CEUS characteristics of SPTP，and to compare its CEUS enhancement with contrast-enhanced computed tomography（CECT）.Methods:In this retrospective study，baseline characteristics，basic ultrasound and CEUS images，CECT images of 70 patients diagnosed as SPTP from January 2009 to August 2023 were collected. Images were analyzed for extraction of key features and diagnostic accuracies of both CEUS and CECT were calculated. The relationships between ultrasound features and lesion size of SPTP were analyzed by Point-Biserial correlation analysis and Student t test. The diagnostic accuracy was compared by Mann-Whitney U test. Results:Iso-enhancement（55.7%，39/70）was commonly appeared in the early phase of CEUS for SPTP，while hypo-enhancement（74.3%，52/70）was the most common in the late phase. And the most common enhancement pattern was iso-hypo enhancement（41.4%，29/70）. Lesion membrane enhancement（47.1%，33/70），intralesional compartmentalization（28.6%，20/70），and intralesional vessels（25.7%，18/70）were the 3 typical signs found in CEUS for SPTP，which were correlated with lesion size（ P＜0.001）. Differences were found between the enhancement pattern of SPTP in CEUS and CECT，in which the most common enhancement patterns were hypo-hypo enhancement（41.4%，24/58）and iso-iso enhancement（29.3%，17/58）along with progressive enhancement. The diagnostic accuracies of CEUS and CECT were 71.4% and 74.1% respectively without statistically significant difference（ P=0.733）. Conclusions:CEUS shows high application value in the diagnosis of SPTP，and the accuracy of CEUS is comparable to that of CECT.

Objective:To summarize the best evidence for oral nutrition management of patients with inflammatory bowel disease (IBD) and to evaluate its effectiveness.Methods:From May 2023 to March 2024, IBD patients, the medical and nursing staff in the Department of Proctology, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, were selected as study subjects using convenience sampling method. Evidence-based nursing was used to summarize the best evidence for oral nutrition management of IBD patients, formulate review indicators, develop best evidence-based practice programs for clinical application through status review and barrier factor analysis. Effectiveness was evaluated at the system level, medical and nursing staff level, and patient level.Results:After evidence-based practice, a multidisciplinary management team and management system for oral nutrition was established at the system level. At the medical and nursing staff level, the oral nutrition knowledge score increased from [50.00 (40.00, 60.00) ] to [100.00 (85.00, 100.00) ], with a statistically significant difference ( P<0.01), and the implementation rate of the three review indicators improved from 0 to 100.00%. At the patient level, oral nutrition knowledge and attitude scores improved from [10.00 (8.00, 12.00) ] and [35.00 (31.00, 40.00) ] to [16.00 (16.00, 16.00) ] and [48.00 (45.00, 48.00) ], respectively, with statistically significant differences ( P<0.01), and the implementation rate of each of the review indicators rose above 80.00% except for indicator 6. The patients' nutrition indicators, including body mass index, waist circumference, left upper arm midpoint circumference and left hand grip strength were improved, and the difference was statistically significant ( P<0.05) . Conclusions:The implementation of evidence-based practice programs can improve the standardization of clinical work of healthcare professionals, enhance patients' nutrition knowledge and attitude, and promote their rational dietary behaviors, thus improving their nutrition status and quality of life.

Objective:To evaluate the impact of the surgical strategy of selective thoracic duct(TD) ligation established through fluorescence thoracoscopy TD imaging technology on the occurrence of chylothorax after lung cancer surgery in the elderly.Methods:A prospective cohort study was conducted.Elderly patients who underwent right lung cancer surgery in the Department of Thoracic Surgery of Beijing Hospital from October 2023 to June 2024 were enrolled as the research subjects.The surgical approaches involved pulmonary resection, systematic lymphadenectomy, and selective TD ligation using fluorescence thoracoscopy.Prior to the surgery, 0.4 mg/kg indocyanine green(ICG)was injected subcutaneously into the right inguinal region of all patients.Clinical data, surgical details, pathological information, and intraoperative TD imaging, including the course, collateral vessels, and any injuries, were collected.Postoperative chylothorax and other complications were also recorded.Results:A total of 83 patients were enrolled, of which 38 were males, and 45 were females, with a median age of 68 years raging from 60 to 83 years old, TD imaging was observed in 69 cases(83.1%)within one hour after IGC injection.Intraoperative injuries of collateral branches were visualized in 4 cases(4.8%). Among them, 2 cases had injuries in both the 2R+ 4R and the subcarinal station, while 2 others had injuries of collateral branches only in the 2R+ 4R station.These 4 patients underwent concurrent TD ligation.No TD or collateral injury was found in the remaining patients during the surgery, and the TD was not ligated, none of the patients developed chylothorax postoperatively, and no adverse reactions related to indocyanine green were observed.Conclusions:Fluorescence thoracoscopy-guided TD imaging technique can well visualize TD and its collateral injuries in elderly lung cancer surgeries, assist in the management of leaks or TD ligation, thereby effectively preventing the occurrence of postoperative chylothorax.