BackgroundNegative emotions are core predictors of adolescent mental health. While existing research has predominantly focused on the impact of risk factors such as negative life events and rumination on adolescents' emotions， the protective role of the family， particularly parental involvement， has received less attention. Consequently， the integrated mechanism connecting negative life events， rumination， parental involvement and negative emotions remains insufficiently clarified. ObjectiveTo elucidate the mechanisms linking negative life events to negative emotions in adolescents， and to verify the mediating role of rumination and the moderating role of parental involvement， so as to provide a theoretical basis for relevant prevention and intervention. MethodsA cross-sectional study was conducted in June 2025. A total of 600 adolescents from a middle school in Liangshan Yi Autonomous Prefecture， Sichuan Province， were recruited through cluster random sampling. Participants completed the Adolescent Self-rating Life Events Checklist （ASLEC）， the Rumination Response Scale （RRS）， parental involvement subscale of the Perception of Parents Scales （POPS）， and the Chinese short version of Depression Anxiety and Stress Scale （DASS-21）. Pearson correlation analysis was performed to examine the correlations among all variables. Model 4 and model 7 embedded in Process macro 4.1 were employed to separately test the mediating effect of rumination between negative life events and negative emotions of adolescents， as well as the moderating effect of parental involvement. ResultsUltimately， 534 valid questionnaires were obtained， yielding a valid response rate of 89.00%. ASLEC score and RRS score were positively correlated with DASS-21 scores （r=0.580， 0.706， P<0.01）， and ASLEC score was also positively correlated with RRS score （r=0.583， P<0.01）. Rumination acted as a partial mediator between negative life events and negative emotions， with an indirect effect of 0.531 （95% CI： 0.438–0.630）， accounting for 55.60% of the total effect. Parental involvement significantly moderated the first stage of the mediating pathway （β=-0.109， P<0.05）. ConclusionIn adolescents， rumination serves as a partial mediator in the relationship between negative life events and negative emotions， and parental involvement further moderates the predictive relationship from negative life events to rumination.

Objective:To investigate the clinicopathological features of fumarate hydratase (FH) deficiency uterine leiomyoma.Methods:The data of 38 patients with FH deficiency uterine leiomyoma were screened and analyzed. The expressions of FH, S-(2-succino)-cysteine (2SC), desmin, p16, p53, CD 10 and cell proliferation associated nuclear antigen (Ki-67) proteins were detected by immunohistochemistry, and their clinicopathological features were analyzed retrospectively. Results:(1) Clinical features: the median age of the patients was (42.5±7.4) years old. Twenty-one cases (55%) of them were myomas found in physical examination, and the median maximum diameter of the tumor was 6.0 cm (range: 5.0-7.5 cm); myomectomy was performed in 23 cases (61%), total hysterectomy with or without bilateral appendages in 15 cases (39%); laparoscopic surgery in 27 cases (71%), open surgery in 11 cases (29%); none of the patients had renal cell carcinoma. (2) Histological features: atypical nuclear cells were distributed locally or diffusely, eosinophilic nucleoli and intranuclear inclusion bodies could be seen, glass like globules could be seen in the cytoplasm, nuclear division was 0-4/10 high power field (HPF), and antler like blood vessels and pulmonary edema-like changes could be seen in the stroma. Among 38 patients with FH deficiency uterine leiomyoma, FH was negative in 37 cases (97%), and positive in 1 case (3%); 2SC, desmin, p16, p53, CD 10 and Ki-67 showed focal positive expression in 38 cases (100%), including 35 cases (92%) with Ki-67 index<10% and 3 cases (8%) with Ki-67 index ≥10%. (3) Follow-up: 4 cases (11%) recurred, and there was no death. There were significant differences in age, family history, distribution of atypical nuclei and mitosis number between recurrent group and non-recurrent group (all P<0.05). Conclusions:FH deficiency uterine leiomyoma is a rare tumor, which needs pathological examination,immunohistochemical examination and clinical history. Patients younger than 43 years old, with family history, histologically atypical diffuse nuclear distribution and mitotic number ≥3/10 HPF should be alert to the risk of recurrence.

Objective:To investigate the dynamic expression of histone methyltransferase (enhance of zeste homolog 2, EZH2) in peripheral blood B lymphocytes (CD19 +B) and memory B lymphocytes (CD19 +CD27 +B) of septic patients and its value in predicting prognosis in sepsis. Methods:From June 2018 to January 2020, 48 septic patients in the Intensive Care Unit of Shanghai East Hospital were enrolled, and 40 healthy adult volunteers were recruited as healthy controls. Septic patients were divided into the non-survivors (18 cases) and the survivors (30 cases) according to whether the patients survived at 28 days. Blood samples were collected at day 1, 3 and 7, blood routine, IL-6 and blood gas analysis were collected, and SOFA and APACHE Ⅱ scores were counted. Flow cytometry was used to detect the positive rate and the mean fluorescence intensity of EZH2 on CD19 +B lymphocytes, and the positive rate of EZH2 on CD19 +CD27 +B lymphocytes at different time points. In the healthy controls, fasting was taken only once in the morning. ROC curve was drawn and the area under the curve (AUC) was calculated to evaluate the value of expression of EZH2 on CD19 +B lymphocytes and CD19 +CD27 +B lymphocytes in predicting the prognosis of septic patients. Results:(1) Compared with the healthy controls, the positive rate and average fluorescence intensity of EZH2 on CD19 +B lymphocytes and the positive rate of EZH2 expression on CD19 +CD27 +B lymphocytes were significantly increased at day 1, 2 and 3 in septic patients ( P<0.05). Over time, the expression of EZH2 in CD19 +B lymphocytes and CD19 +CD27 +B lymphocytes increased gradually ( P<0.05). (2) Compared with the survivors, the positive rate of EZH2 on CD19 +B lymphocytes of the non-survivors was increased at day 1, but the positive rate of EZH2 on CD19 +CD27 +B lymphocytes of the non-survivors was decreased at day 3 and 7 ( P<0.05). (3) The positive rate of EZH2 on CD19 +B lymphocytes, APACHE Ⅱ score, SOFA score and IL-6 level in septic patients at day 1 were independently associated with 28-day mortality. (4) The AUC of APACHEⅡ score was 0.907 (95% CI: 0.825-0.990), and the sensitivity and the specificity were 88.89% and 76.67%. The AUC of SOFA score was 0.831 (95% CI: 0.706-0.955), and the sensitivity and the specificity was 66.67% and 86.67%; The AUC of EZH2 positive rate on CD19 +B lymphocytes were 0.799 (95% CI: 0.657-0.941), and the sensitivity and specificity were 88.89% and 80.77%, respectively, the sensitivity was better than SOFA score, and the specificity was higher than APACHEⅡ score. Conclusions:The high expression of EZH2 on B lymphocytes in septic patients is associated with poor prognosis. Dynamic monitoring of EZH2 expression on B lymphocytes has certain predictive value for sepsis.

Objective: To examine the correlation between the promoter methylation of Sterol regulatory-element binding protein-2 (SREBP-2) and miR-33a expression as well as serum markers in patients with coronary artery disease (CAD). Methods: The case-control study. 100 participants who underwent coronary angiography from August 2017 to April 2018 in TaiheHospital, Hubei University of Medicine, were recruited in this study.The methylation level of two fragments, including 12 CpG sites in the promoter region of SREBP-2, have been detected by pyrosequencing in 50 patients with coronary artery disease (CAD) and 50 non-CAD controls. Serum miR-33a level and a panel of 15 CAD related biomarkers were examined by qPCR and routine biochemistry methods. Results: Methylation level of one CpG site (F1-4 loci) in SREBP-2 promoter region were significant higher in CAD patients than in controls(4.56%±0.70% vs 3.54%±0.72%, t=-3.864, P<0.001); methylation level of F1-4 site was negatively correlates with the serum miR-33a levels and high-density lipoprotein cholesterol (HDL-C) levels(r=-0.318, P=0.001; r=-0.225, P=0.024, respectively). Furthermore, F1-4 hypermethylation was an independent risk factor of CAD, independent of age, gender, histories of hypertension, hyperlipidemia, and diabetes(OR=2.452, 95%CI=1.398-4.299, P=0.002). Conclusion These results suggest that DNA methylation and miRNA might cooperate to regulate the lipid metabolism in CAD.

Objective To compare the effect of different enteral nutritional support methods in elderly patients with severe pneumonia.Methods Elderly patients (average age over 65 years) with severe pneumonia admitted to our hospital from June 2015 to June 2018 were selected as the study subjects,and 86 patients finally completed the study.The patients were randomly divided into the control group and observation group with 43 patients in each group,and nasojejunal tubes were placed for patients in both groups.Patients in the observation group were fed with enteral nutrition emulsion through continuously-heated nutritional pump,while patients in the control group was meal served with enteral nutrition emulsion.Changes in blood biochemical parameters,immune indexes,inflammation indexes,oxygenation indexes,the GIDF and SOFA scores as well as curative effect (mechanical ventilation time and effective rate of treatment) were monitored and compared before and after 10 days of nutritional support treatment.SPSS 20.0 statistical software package was used for data analysis,and self paired t-test was used for comparison before and after intervention in the same group,x2 test was used in comparison between different groups,and the counting data was expressed as the rate (n,％).Results There was no significant difference in baseline data between patients in the two groups (P＞0.05).After ten days of intervention,compared with the control group,the levels of serum albumin and prealbumin in the observation group were higher [(31.22±2.36) g/L and (0.29±0.24) g/L,P=0.015 and P=0.023],the immune indexes were higher [IgG (13.24±0.70) g/L,P=0.020;IgM (1.43±0.19) g/L,P=0.011;CD4+/CD8+ 1.55±0.49,P=0.043],the inflammation indexes were lower [IL-6 (312.54±42.53) pg/mL,P=0.031;PCT (1.56±0.81) ng/mL,P=0.017],the oxygenation indexes were better [PaO2/FiO2 (315.58±20.37) mmHg,P=0.019],and the GIDF and SOFA scores were significantly lower[(10.6±l.2) and (8.5±1.7),P=0.041 and P=0.038].The clinical outcome showed that the mechanical ventilation time in the observation group was significantly shorter [(6.01±1.48) d vs (8.12 ± 1.17)d,P=0.039],and the total effective rate of treatment was better than the control group (67.44％ vs 41.86％,P=0.027).Conclusions Enteral nutrition support through continuously-heated nutritional pump can improve the nutritional status of elderly patients with severe pneumonia,reduce the incidence of gastrointestinal dysfunction,maintain stable organ fuction,thus resulting in better prognosis in elderly patients with severe pneumonia.

Objective:To evaluate the early diagnostic value of tissue inhibitor of matrix metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP-7) in acute kidney injury induced by sepsis.Methods:A total of 85 sepsis patients admitted to the EICU and GICU in Shanghai East Hospital from September 2017 to June 2019 were divided into theAKI group ( n=37) and the non-AKI group ( n=48) according to KIDGO diagnostic criteria, and 20 healthy volunteers were served as the control group. The clinical data were recorded and samples of urine were collected at 0 h, 6 h, 12 h, 1 d, 3 d and 7 d post sepsis. The levels of TIMP-2 and IGFBP-7 in the urine were analyzed with ELISA at different time points. Based on the receiver operating characteristic curve (ROC) and the area under the curve (AUC), the early diagnostic value of urinary TIMP-2 and IGFBP-7 in sepsis-induced AKI patients was determined. Results:Compared with the control group, the levels of TIMP-2 and IGFBP-7 of the AKI group were significantly higher at the above time points ( P<0.05), while those of the non-AKI group showed no significant differences. The levels of TIMP-2 and IGFBP-7 of the AKI group were significantly higher than the those of the non-AKI group ( P<0.05). ROC analysis showed that when the AUC of urine TIMP-2 peaked at 1 d, the sensitivity and specificity reached 97.5% and 81.2%, separately with the cutoff value of 151.23 ng/mL. Furthermore, when the AUC of urine IGFBP-7 peaked at 12 h, the sensitivity and specificity reached 100% and 72.8%, separately with the cutoff value of 14.91 ng/mL. Interestingly, when the AUC of combined TIMP-2×IGFBP-7 peaked at 12 h, the sensitivity reached 98.0% and specificity reached 91.5% with the cutoff value of 2.09 [(ng/mL) 2/1 000]. There was no significant correlation between the levels of TIMP-2 and IGFBP-7 with SOFA and APACHEⅡ score at 1 d, 3 d and 7 d post sepsis in the AKI group ( P>0.05). Conclusions:Urine TIMP-2 and IGFBP-7 have early diagnostic value in sepsis-induced AKI. Besides, the combination of the two biomarkers have superior predictive value than each single of them.

Objective:To find out the key factors that affect the clinical outcome of euploid single blastocyst transfer.Methods:This retrospective study included 956 patients' clinical data of frozen euploid single blastocyst transfer cycles for preimplantation genetic testing (PGT) in Shanghai Ji Ai Genetics and IVF Institute from January 2014 to January 2018. According to the outcome of transplantation, the patients were divided into pregnancy group ( n=509) and non-pregnancy group ( n=447), and the clinical data between the two groups were compared to screen out the key factors affecting the pregnancy rate of transplantation; at the same time, the pregnancy group was further divided into live birth subgroup and miscarriage subgroup, and the clinical data between the two subgroups were compared and the significant factors affecting the abortion were screened by logistic regression. Results:The endometrial thickness of pregnancy group was significantly thicker than that of non-pregnancy group [9(8,10) mm vs. 8(8,10) mm] ( P=0.006); the clinical pregnancy rate and the live birth rate of blastocyst with good quality were significantly higher than those with poor quality (59.2% vs. 46.3%, 50.2% vs. 37.7%) ( P=0.001). In addition, compared with miscarriage subgroup, blastocyst development time was a risk factor of abortion, and the OR value was 0.536 (95% CI=0.309-0.929). Conclusion:In the frozen embryo transfer cycles of single euploid blastocyst, the thicker endometrium, the faster development and the higher score of blastocyst are the key factors for the success of the implantation. In the process of maintaining the late pregnancy, the faster development of blastocyst (D5) has a higher live birth rate and a lower miscarriage rate.

Objective:To find out the key factors that affect the clinical outcome of euploid single blastocyst transfer.Methods:This retrospective study included 956 patients' clinical data of frozen euploid single blastocyst transfer cycles for preimplantation genetic testing (PGT) in Shanghai Ji Ai Genetics and IVF Institute from January 2014 to January 2018. According to the outcome of transplantation, the patients were divided into pregnancy group ( n=509) and non-pregnancy group ( n=447), and the clinical data between the two groups were compared to screen out the key factors affecting the pregnancy rate of transplantation; at the same time, the pregnancy group was further divided into live birth subgroup and miscarriage subgroup, and the clinical data between the two subgroups were compared and the significant factors affecting the abortion were screened by logistic regression. Results:The endometrial thickness of pregnancy group was significantly thicker than that of non-pregnancy group [9(8,10) mm vs. 8(8,10) mm] ( P=0.006); the clinical pregnancy rate and the live birth rate of blastocyst with good quality were significantly higher than those with poor quality (59.2% vs. 46.3%, 50.2% vs. 37.7%) ( P=0.001). In addition, compared with miscarriage subgroup, blastocyst development time was a risk factor of abortion, and the OR value was 0.536 (95% CI=0.309-0.929). Conclusion:In the frozen embryo transfer cycles of single euploid blastocyst, the thicker endometrium, the faster development and the higher score of blastocyst are the key factors for the success of the implantation. In the process of maintaining the late pregnancy, the faster development of blastocyst (D5) has a higher live birth rate and a lower miscarriage rate.

Objective To explore the efficacy of temporary titanium plate screwing for positional maintenance in reduction and internal fixation for displaced acetabular fractures.Methods A retrospective study was conducted of the 28 patients (28 hips) with displaced acetabular fracture who had been treated by open reduction and internal fixation from October 2013 to March 2016.They were 20 males and 8 females,aged from 24 to 68 years (average,42.3 years).The time from injury to surgery ranged from 7 to 21 days(average,14.5 days).According to the Letournel-Judet classification,there were 2 posterior column fractures,4 transverse fractures,5 posterior column plus posterior wall fractures,6 transverse plus posterior wall fractures,2 T-shaped fractures,3 anterior and posterior transverse fractures and 6 double column fractures.The posterior acetabular approach or combined anterior and posterior approach was used.In all the patients temporary titanium plate screwing was conducted to fix one side of the fracture so as to facilitate accomplishment of open reduction and internal fixation without losing the indirect anatomic reduction of the intraarticular fracture.After the open reduction and internal fixation was accomplished,the temporary screw fixation was removed in 26 patients but retained in 2 patients as needed.The reduction quality,complications and outcomes at the final follow-ups were recorded.Results All the 28 patients were followed up for 10 to 36 months (mean,15.6 months).By the Matta criteria,anatomical reduction was achieved in 26 cases,unsatisfactory reduction in one and poor reduction in one,yielding an anatomic reduction rate of 92.9％.By the improved Mere d'Aubigne & Postel criteria,the clinical outcomes at the final follow-up were excellent in 27 cases and good in one,yielding a good to excellent rate of 100％.Postoperatively,heterotopic ossification of different severities occurred in 11 cases but did not affect their joint function;transient paralysis of the sciatic nerve was reported in 6 cases but recovered 3 months after surgery.No complications like avascular necrosis of the femoral head or walking pain were observed during follow-ups.Conclusion Temporary fixation with titanium plate screws during open reduction and internal fixation for displaced acetabular fractures can effectively improve the reduction and fixation of the articular surface,leading to satisfactory short-term clinical outcomes.

Objective To explore the effect of different levels of iodine excess on morphological changes of mouse thyroid follicle and pancreatic acinar cells.Methods Sixty female mice (BALB/c) were selected and their body weight were 18-22 g.The mice were divided into 6 groups according to body weight via the random number table method,10 mice in each group.Potassium iodate was added to drinking water in exposure groups with iodine contents of 300,600,1 200,2 400,and 4 800 μg/L,while normal group (control) was given normal levels of iodine (5 μg/L) tap water.After feeding for one month,the thyroid and pancreas of the mice were harvested,and the morphology of thyroid follicle and pancreatic acinar cells were observed through light microscope and ultrastructural changes of pancreas were observed through electron microscope.Results After one month of feeding,mice in the high iodine drinking water groups,starting from the 1 200 μg/L group,thyroid follicular cavity gradually enlarged and cells became flat;swollen and vacuolar-like deformation were observed in the mouse pancreas acinar cells under light microscope.Under the electron microscope,the ultrastructure of pancreatic acinar cells changed significantly starting from the 600 μg/L group,the number of zymogens decreased,organelle degeneration and necrosis,and endoplasmic reticulum expanded.Conclusion Iodine excess can cause damage to pancreatic acinar cells in mice.