Objective To compare the clinical outcomes of subxiphoid robot-assisted thoracoscopic surgery (SRATS) and intercostal robot-assisted thoracoscopic surgery (IRATS) in the treatment of anterior mediastinal tumors. Methods A retrospective analysis was conducted on patients with anterior mediastinal tumors who underwent robot-assisted surgery in the Department of Thoracic Surgery, Gansu Provincial Hospital, from May 2020 to July 2022. According to the surgical approach, patients were divided into an SRATS group and an IRATS group. Perioperative data were compared between the two groups. Results A total of 87 patients were included. There were 41 patients in the SRATS group [23 males, 18 females; mean age, (44.51±11.28) years] and 46 patients in the IRATS group [21 males, 25 females; mean age, (46.67±8.76) years]. Compared with the IRATS group, the SRATS group had significantly less intraoperative blood loss [(24.41±6.67) mL vs. (37.93±9.23) mL, P<0.001], shorter postoperative drainage duration [(1.73±0.59) days vs. (2.54±0.50) days, P<0.001], lower postoperative drainage volume [(94.46±34.08) mLvs. (116.72±24.90) mL, P=0.001], lower visual analogue scale (VAS) pain scores on postoperative day 1 [(3.66±0.76) points vs. (4.15±0.84) points, P=0.005] and day 3 [(2.41±0.59) points vs. (2.89±0.82) points, P=0.003], shorter postoperative hospital stay [(4.12±0.81) days vs. (4.98±1.02) days, P<0.001], and lower hospitalization costs [(4.51±0.65) ten thousand yuan vs. (4.86±0.68) ten thousand yuan, P=0.020]. There were no statistical differences between the two groups in operative time or incidence of postoperative complications (P>0.05). Conclusion Both SRATS and IRATS are safe and effective for the treatment of anterior mediastinal tumors. However, SRATS is less invasive and more conducive to enhanced postoperative recovery.

Objective: To explore the relationship between socio ecological risk factors (SERF), physical activity (PA) developmental trajectories, and depressive symptoms among junior and senior high school students in Tianjin, in order to provide theoretical support for comprehensive interventions for adolescent depression. Methods: A longitudinal follow up design was adopted. In September 2022, a baseline survey was conducted using a stratified cluster random sampling method in two junior high schools and two senior high schools in Tianjin, collecting data on students basic information, SERF, PA, and depressive symptoms. Two follow up surveys were conducted in September 2023 and 2024, yielding 588 valid participants. Latent class growth analysis (LCGA) was used to identify PA developmental trajectory categories among junior and senior high school students. Logistic regression was applied to examine the associations between depressive symptoms and SERF as well as PA trajectories. Results: The detection rates of depressive symptoms among Tianjin junior and senior high school students over the three years were 26.53%, 20.24%, and 21.26 %, respectively. Depressive symptoms were positively correlated with SERF ( OR=1.04, 95%CI=1.03-1.05, P <0.05). The highest risks were observed in the individual dimension and family dimension ( OR =1.28, 1.21, both P <0.05). LCGA identified three PA trajectory groups:persistently low level (80.65%), persistently high level (4.58%), and slowly increasing group ( 14.77 %). Multivariate regression analysis showed that compared with the persistently low level PA, the slowly increasing PA significantly reduced the risk of depressive symptoms ( OR=0.44, 95%CI =0.20-0.88), while SERF still increased the risk of depressive symptoms ( OR=1.04, 95%CI =1.03-1.05) (both P <0.05). Conclusion SERF are risk factors for depression symptoms among junior and senior high school students, whereas slowly increasing PA development trajectory demonstrates a protective effect.

ObjectiveTo investigate the distribution of traditional Chinese medicine （TCM） syndrome patterns among postmenopausal women with dyslipidemia， and to examine the correlations of lipid parameters with bone mineral density （BMD） and bone metabolism markers across common TCM syndrome patterns， thereby providing a clinical reference for individualized integrative traditional Chinese and western medicine interventions stratified according to TCM syndrome patterns. MethodsA multi-center cross-sectional study was conducted among postmenopausal women aged 45-64 years with dyslipidemia. TCM syndromes were determined using a scale-based scoring method. BMD measurements were collected， and fasting venous blood samples were assayed for lipid parameters including total cholesterol （TC）， triglycerides （TG）， high-density lipoprotein cholesterol （HDL-C）， and low-density lipoprotein cholesterol （LDL-C）， and bone metabolism biomarkers including osteocalcin （OST）， total procollagen type Ⅰ N-terminal propeptide （P1NP）， alkaline phosphatase （ALP）， bone-specific alkaline phosphatase （BALP）， β-isomerized C-terminal telopeptide of type Ⅰ collagen （β-CTX）， 25-hydroxyvitamin D ［25（OH）D］， and thyroid-stimulating hormone （TSH）. Chi-square tests were used to compare the distribution of dyslipidemia across different TCM syndromes. Spearman's rank correlation analysis was performed to evaluate the correlations between TCM syndrome patterns and dyslipidemia， as well as the correlations of lipid parameters with BMD and bone metabolism markers within each syndrome pattern. ResultsA total of 506 postmenopausal women with dyslipidemia were included， comprising 172 cases of spleen-kidney yang deficiency syndrome （33.99%）， 163 cases of phlegm-turbidity obstruction syndrome （32.21%）， 118 cases of liver-kidney yin deficiency syndrome （23.32%）， 33 cases of qi stagnation and blood stasis syndrome （6.52%）， and 20 cases of yin deficiency and yang hyperactivity syndrome （3.95%）. Phlegm-turbidity obstruction syndrome was negatively correlated with TC abnormality （r=-0.120， P=0.007） and positively correlated with TG abnormality （r=0.246， P＜0.001）. Spleen-kidney yang deficiency syndrome and liver-kidney yin deficiency syndrome were both negatively correlated with TG abnormality （r=-0.101， P=0.023； r=-0.116， P=0.009， respectively）. Further correlation analysis confirmed that phlegm-turbidity obstruction syndrome was negatively correlated with TC abnormality （r=-0.120） and significantly positively correlated with TG abnormality （r=0.246）. Both the spleen-kidney yang deficiency syndrome and liver-kidney yin deficiency syndrome were negatively correlated with TG abnormality （r=-0.101 and r=-0.116， respectively）. In patients with phlegm-turbidity obstruction syndrome， HDL-C was negatively correlated with BMD at the left femoral neck （r=-0.178， P=0.023） and at left total hip （r=-0.190， P=0.015）. In patients with liver-kidney yin deficiency syndrome， TG was positively correlated with BMD at the lumbar spine （L1-L4） and left total hip （r=0.214， P=0.020； r=0.221， P=0.016， respectively）. More significant correlations were observed in patients with spleen-kidney yang deficiency syndrome， TG was positively correlated with ALP （r=0.210， P=0.006）； TC was positively correlated with TSH and 25（OH）D （r=0.153， P=0.045； r= 0.231， P=0.002， respectively）； HDL-C was positively correlated with OST and 25（OH）D （r=0.156， P=0.040； r=0.228， P=0.003， respectively）； and LDL-C was positively correlated with TSH and 25（OH）D （r=0.156， P= 0.041； r=0.182， P=0.017， respectively）. In patients with liver-kidney yin deficiency syndrome， HDL-C was negatively correlated with TSH （r=-0.204， P=0.027）. ConclusionThe association between dyslipidemia and skeletal health in postmenopausal women varies across TCM syndromes. Lipid abnormalities in women with phlegm-turbidity obstruction syndrome or liver-kidney yin deficiency syndrome are accompanied primarily by site-specific alterations in BMD， whereas those in women with spleen-kidney yang deficiency syndrome are reflected mainly in changes in bone metabolism markers. These findings suggest that targeted intervention strategies should be developed according to TCM syndrome characteristics for postmenopausal women with dyslipidemia.

ObjectiveTo investigate the distribution of traditional Chinese medicine （TCM） syndrome patterns among postmenopausal women with dyslipidemia， and to examine the correlations of lipid parameters with bone mineral density （BMD） and bone metabolism markers across common TCM syndrome patterns， thereby providing a clinical reference for individualized integrative traditional Chinese and western medicine interventions stratified according to TCM syndrome patterns. MethodsA multi-center cross-sectional study was conducted among postmenopausal women aged 45-64 years with dyslipidemia. TCM syndromes were determined using a scale-based scoring method. BMD measurements were collected， and fasting venous blood samples were assayed for lipid parameters including total cholesterol （TC）， triglycerides （TG）， high-density lipoprotein cholesterol （HDL-C）， and low-density lipoprotein cholesterol （LDL-C）， and bone metabolism biomarkers including osteocalcin （OST）， total procollagen type Ⅰ N-terminal propeptide （P1NP）， alkaline phosphatase （ALP）， bone-specific alkaline phosphatase （BALP）， β-isomerized C-terminal telopeptide of type Ⅰ collagen （β-CTX）， 25-hydroxyvitamin D ［25（OH）D］， and thyroid-stimulating hormone （TSH）. Chi-square tests were used to compare the distribution of dyslipidemia across different TCM syndromes. Spearman's rank correlation analysis was performed to evaluate the correlations between TCM syndrome patterns and dyslipidemia， as well as the correlations of lipid parameters with BMD and bone metabolism markers within each syndrome pattern. ResultsA total of 506 postmenopausal women with dyslipidemia were included， comprising 172 cases of spleen-kidney yang deficiency syndrome （33.99%）， 163 cases of phlegm-turbidity obstruction syndrome （32.21%）， 118 cases of liver-kidney yin deficiency syndrome （23.32%）， 33 cases of qi stagnation and blood stasis syndrome （6.52%）， and 20 cases of yin deficiency and yang hyperactivity syndrome （3.95%）. Phlegm-turbidity obstruction syndrome was negatively correlated with TC abnormality （r=-0.120， P=0.007） and positively correlated with TG abnormality （r=0.246， P＜0.001）. Spleen-kidney yang deficiency syndrome and liver-kidney yin deficiency syndrome were both negatively correlated with TG abnormality （r=-0.101， P=0.023； r=-0.116， P=0.009， respectively）. Further correlation analysis confirmed that phlegm-turbidity obstruction syndrome was negatively correlated with TC abnormality （r=-0.120） and significantly positively correlated with TG abnormality （r=0.246）. Both the spleen-kidney yang deficiency syndrome and liver-kidney yin deficiency syndrome were negatively correlated with TG abnormality （r=-0.101 and r=-0.116， respectively）. In patients with phlegm-turbidity obstruction syndrome， HDL-C was negatively correlated with BMD at the left femoral neck （r=-0.178， P=0.023） and at left total hip （r=-0.190， P=0.015）. In patients with liver-kidney yin deficiency syndrome， TG was positively correlated with BMD at the lumbar spine （L1-L4） and left total hip （r=0.214， P=0.020； r=0.221， P=0.016， respectively）. More significant correlations were observed in patients with spleen-kidney yang deficiency syndrome， TG was positively correlated with ALP （r=0.210， P=0.006）； TC was positively correlated with TSH and 25（OH）D （r=0.153， P=0.045； r= 0.231， P=0.002， respectively）； HDL-C was positively correlated with OST and 25（OH）D （r=0.156， P=0.040； r=0.228， P=0.003， respectively）； and LDL-C was positively correlated with TSH and 25（OH）D （r=0.156， P= 0.041； r=0.182， P=0.017， respectively）. In patients with liver-kidney yin deficiency syndrome， HDL-C was negatively correlated with TSH （r=-0.204， P=0.027）. ConclusionThe association between dyslipidemia and skeletal health in postmenopausal women varies across TCM syndromes. Lipid abnormalities in women with phlegm-turbidity obstruction syndrome or liver-kidney yin deficiency syndrome are accompanied primarily by site-specific alterations in BMD， whereas those in women with spleen-kidney yang deficiency syndrome are reflected mainly in changes in bone metabolism markers. These findings suggest that targeted intervention strategies should be developed according to TCM syndrome characteristics for postmenopausal women with dyslipidemia.

Objective To observe hierarchical differences in brain functional networks in unilateral mesial temporal lobe epilepsy(mTLE)patients with different outcomes after surgery.Methods A total of 69 unilateral mTLE patients who underwent resection of epileptogenic lesion on the affected side were retrospectively enrolled.Based on Engel classification 1 year after surgery,the patients were divided into seizure free(SF)group and non-seizure free(NSF)group.Functional connectivity gradient analysis was employed to extract principal gradient explaining the highest variance on preoperative resting-state functional MRI(rs-fMRI),then the whole-brain gradient characteristics and principal gradient values within specific functional networks were compared between groups.Results Principal gradient connected default mode network(DMN)with sensorimotor network(SMN)along a continuous axis.Compared to SF group,NSF group showed a contracted gradient range at both ends(DMN and SMN)of the functional network and weakened hierarchical differentiation,and principal gradient value of DMN was higher,while that of SMN was lower than those in SF group(both P＜0.05).Conclusion Hierarchical differences in brain functional networks in unilateral mTLE patients with different outcomes after surgery mainly present as enhanced DMN and weakened SMN in NSF ones,and the latter two might serve as important neuroimaging markers for evaluating postoperative seizure recurrence.

Objective To observe the value of machine learning(ML)models based on brain functional network features combining clinical indicators for predicting postoperative outcomes of patients with drug-resistant mesial temporal lobe epilepsy(DR-mTLE).Methods Totally 84 patients with unilateral DR-mTLE who underwent surgery were retrospectively enrolled and classified into seizure free(SF)group(n=55)and non-seizure free(NSF)group(n=29)according to one-year postoperative follow-up.Clinical data were analyzed to screen independent predictors of postoperative outcomes.Based on brain preoperative resting-state functional MRI,brain functional networks were constructed using graph theory analysis,and 587 features were extracted.Five-fold cross validation was used to divide the data into training set and test set,then the optimal brain functional network features related to postoperative outcomes of DR-mTLE patients were selected.Combining with clinically relevant independent predictors,ML models were constructed using classifiers including Gaussian process(GP),logistic regression(LR),support vector machine(SVM)and quadratic discriminant analysis(QDA),respectively,and the prediction efficacy,calibration and clinical value of each ML model were evaluated.Results Both course of disease and lesion location were clinically relevant independent predictors of postoperative outcome of DR-mTLE patients(OR=0.928,5.710,P=0.010,0.016).Four optimal brain function network features were selected,including betweenness centrality of the third zone of cerebellar vermis,degree centrality of right globus pallidus,nodal efficiency of temporal left inferior temporal gyrus and nodal clustering coefficient of left inferior parietal lobule.The average area under the curve(AUC)of GP,LR,SVM and QDA models in test set was 0.868,0.864,0.875 and 0.870,respectively.Calibration curves and decision curve analysis indicated that each ML model had good calibration and high clinical net benefit.Conclusion ML models based on brain functional network features combining with clinical indicators could be used to effectively predict postoperative outcomes in DR-mTLE patients.

Homo- or heterodimeric compounds that affect dimeric protein function through interaction between monomeric moieties and protein subunits can serve as valuable sources of potent and selective drug candidates. Here, we screened an in-house dimeric natural product collection, and panepocyclinol A (PecA) emerged as a selective and potent STAT3 inhibitor with profound anti-tumor efficacy. Through cross-linking C712/C718 residues in separate STAT3 monomers with two distinct Michael receptors, PecA inhibits STAT3 DNA binding affinity and transcription activity. Molecular dynamics simulation reveals the key conformation changes of STAT3 dimers upon the di-covalent binding with PecA that abolishes its DNA interactions. Furthermore, PecA exhibits high efficacy against anaplastic large T cell lymphoma in vitro and in vivo, especially those with constitutively activated STAT3 or STAT3^Y640F. In summary, our study describes a distinct and effective di-covalent modification for the dimeric compound PecA to disrupt STAT3 function.

Objective To explore the value of CT radiomics analysis in predicting the curative effect of extracorporeal shock wave lithotripsy(ESWL)in ureteral calculus(UC)patients.Methods A total of 126 UC patients who underwent ESWL from January 2018 to December 2023 were selected,and randomly divided into training group and validation group at a ratio of 7∶3.Forty-five UC patients from January 2024 to September 2024 were selected as external validation group and divided into two groups according to whether the residual stones were less than 4 mm after operation.There were 81 cases in the successful lithotripsy group and 45 cases in the failed lithotripsy group.The 3D Slicer software was used to outline the stone layer by layer to obtain region of interest(ROI),and 851 radiomics features were extracted.After the observer consistency test,maximum relevance and minimum redundancy(mRMR)algorithm and least absolute shrinkage and selection operator(LASSO),the radiomics features were selected,and the logistic regression model was established.The diagnostic efficiency of the model was analyzed by receiver operating characteristic(ROC)curve.Results The six optimal features were obtained from the radiomics features.The combined clinical-radiomics model showed the best prediction efficiency with area under the curve(AUC)of 0.908,0.906 and 0.908 in the training,validation and external validation groups respectively.Conclusion CT radiomics model can be used to predict the curative effect of UC patients after ESWL,and provide a basis for assisting UC patients in individualized treatment.

Objective:To investigate the current situation of knowledge, attitude and practice of medical personnel in areas with high incidence of fever with thrombocytopenia syndrome (SFTS) in Anhui Province, in order to provide a scientific basis for conducting systematic training for medical personnel.Methods:From July to August 2024, a multi-stage random sampling method was used to select medical personnel from village, township, county, and city level medical institutions in high incidence areas of SFTS in Anhui Province (Hefei City, Liu'an City, Chuzhou City, Xuancheng City) for an online questionnaire survey on their knowledge, attitude, and practice status. The survey included demographic data, knowledge, attitude, and practice related to SFTS, and a binary logistic regression model was used to analyze the influencing factors of SFTS knowledge qualification rate.Results:A total of 2 718 valid questionnaires were collected, with an effective response rate of 99.60% (2 718/2 729). Among them, 1 384 were males, accounting for 50.92%. The majority were medical personnel aged 41 to 50 years old, with undergraduate degrees, junior professional titles, working in township health centers or community health service centers, as clinical physicians, and with a working experience of no more than 10 years. They accounted for 31.97% (869/2 718), 50.48% (1 372/2 718), 35.54% (966/2 718), 38.52% (1 047/2 718), 62.33% (1 694/2 718), and 30.61% (832/2 718), respectively. The overall correct rates of medical personnel's relevant knowledge, attitude and practice were 77.52% (31 605/40 770), 94.53% (12 847/13 590) and 89.73% (12 194/13 590), respectively. There were statistically significant differences in the knowledge qualification of medical personnel of different genders, ages, education levels, professional titles, hospital levels, job positions, and years of work experience ( P < 0.05). The results of binary logistic regression analysis showed that professional title, hospital level, work position, and work experience were the influencing factors of knowledge qualification rate ( P < 0.05). Conclusions:Medical personnel have a relatively positive attitude and high level of practice towards SFTS, but their knowledge level still needs to be improved. It is recommended to provide targeted knowledge training for medical personnel in different positions to promote early detection, diagnosis, and treatment of SFTS.

OBJECTIVE To observe the effect of acupuncture combined with a modified Zhengan Xifeng Decoction on the early clinical symptoms and oxidative stress status of patients with hypertensive intracerebral hemorrhage(HICH)of liver-kidney yin defi-ciency syndrome.METHODS A total of 60 patients with hypertensive intracerebral hemorrhage(liver-kidney yin deficiency syn-drome)who successfully received 24-hour acute-phase treatment at the Department of Neurosurgery,Acupuncture and Rehabilitation Department,and wards of Kunshan Hospital Affiliated to Nanjing University of Chinese Medicine(Kunshan Traditional Chinese Medi-cine Hospital)from July 2021 to January 2023 were recruited.A randomization table generated by SPSS 22.0 software was used to di-vide the patients into a control group and an observation group,with 30 patients in each group.The control group received symptomatic treatment,conventional rehabilitation training,and modified Zhengan Xifeng Decoction,while the observation group received additional acupuncture treatment on the basis of the control group.The treatment course was 1 month for both groups.Clinical effective rate,TCM syndrome scores,motor and neurological function scores[Activity of Daily Living(ADL)scale,National Institutes of Health Stroke Scale(NIHSS),Modified Ashworth Scale(MAS),Simplified Fugl-Meyer Assessment(FMA)scale],improvement in hematoma lesions,Fraction anisotropy(FA)ratio(rFA),and serum levels of antioxidant stress response factors Kelch-like ECH-associated protein 1(Keap1)and nuclear factor-E2-related factor 2(Nrf2)were observed before and after treatment in both groups.RESULTS After treat-ment,the clinical effective rate in the observation group was significantly higher than that in the control group(P<0.05);the TCM syn-drome scores in both groups decreased significantly(P<0.05),with the observation group showing better results than the control group(P<0.05);the ADL and FMA scores in both groups reduced significantly(P<0.05,P<0.01),while the NIHSS and Ashworth Scale scores increased significantly(P<0.05,P<0.01),with the observation group showing better improvement than the control group(P<0.05);serum Keap1 levels decreased significantly in both groups(P<0.01),while Nrf2 levels enhanced significantly(P<0.05,P<0.01),with the observation group showing better improvement than the control group(P<0.05);imaging studies showed that after treat-ment,the residual hematoma volume decreased significantly in both groups(P<0.05,P<0.01),and the rFA value increased signifi-cantly(P<0.05,P<0.01),with the observation group showing better results than the control group(P<0.01).CONCLUSION On the basis of standard treatment for the acute phase,acupuncture combined with Zhengan Xifeng Decoction can significantly improve the early clinical symptoms of HICH patients with liver-kidney yin deficiency,reduce oxidative stress levels,and promote the recovery of nerve and motor functions.