Objective To describe the clinical features of patients with primary sclerosing cholangitis(PSC)in China based on a nationwide multicenter patient cohort,and to investigate the risk factors for prognosis.Methods A retrospective cohort study was conducted among the patients with a confirmed diagnosis of PSC based on the electronic medical record system of seven grade A tertiary hospitals across the country,and related data were extracted.The Mann-Whitney U test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to estimate liver transplant-free survival,and the log-rank test was used for comparison of survival rate between PSC patients with different features.The Cox regression model was used to identify independent risk factors for the prognosis of PSC patients and the interactions between key factors.Results A total of 107 patients were enrolled,among whom 55.6%(55/99)had large-duct PSC and 29.0%(31/107)had comorbidity with inflammatory bowel disease(IBD).The positivity rate of anti-neutrophil cytoplasmic antibody(ANCA)was 32.9%(24/73),and 50.0%(40/80)of the patients had an increase in IgG/IgM.The median symptom-to-diagnosis interval was 1 year(<1-4.0),and 38.3%(41/107)of the patients had progressed to decompensated cirrhosis at the time of diagnosis.The median liver transplant-free survival time was 114 months(95%confidence interval[CI]:62-166),with a 5-year survival rate of 65.7%.The multivariate analysis showed that an increase in total bile acid(TBA)(hazard ratio[HR]=1.006,95%CI:1.002-1.010,P=0.001)and a prolonged symptom-to-diagnosis interval(HR=1.252,95%CI:1.059-1.480,P=0.009)were independent risk factors for prognosis.The interaction analysis showed that compared with the female patients with TBA<50 μmol/L,both male and female patients with TBA≥50 μmol/L had a significant increase in the risk of liver transplantation or death(male:HR=16.563,95%CI:2.103-130.449,P<0.001;female:HR=17.009,95%CI:2.113-136.934,P<0.001),and compared with the patients with an age of<45 years and a TBA level of<50 μmol/L,the patients with an age of≥45 years and a TBA level of≥50 μmol/L had a significant increase in the risk of liver transplantation or death(HR=10.729,95%CI:1.325-86.859,P=0.026).Compared with the female patients with an symptom-to-diagnosis interval of≤2 years,the male patients with a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.825,95%CI:1.725-13.644,P=0.003),and compared with the patients with an age of<45 years and a symptom-to-diagnosis interval of≤2 years,the patients with an age of<45 years and a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.983,95%CI:1.366-18.173,P=0.015).Conclusion Compared with the reports from Western countries,large-duct PSC is also the main type of PSC in China,but with a relatively low proportion,and there is also a relatively low proportion of patients with IBD or positive ANCA.An increase in TBA and a prolonged symptom-to-diagnosis interval are independent risk factors for prognosis,with significant interactions with age and sex.This suggests that early screening and intervention should be enhanced to improve prognosis.

Objective:To develop a clinical predictive model for dampness constitution based on laboratory testing indicators.Methods:A retrospective cohort study was conducted on 1 355 healthy individuals who underwent physical examinations at the Health Examination Center of Guangdong Provincial Hospital of Traditional Chinese Medicine from October 1 st, 2022 to October 31 st, 2023. Basic information and blood routine, blood glucose, liver function, lipid metabolism, and kidney function test results of 1 355 apparently healthy individuals were collected. According to the diagnostic criteria for dampness constitution in traditional Chinese medicine, they were divided into a dampness constitution group (683 cases, including 394 with phlegm-dampness constitution and 289 with damp-heat constitution) and a non-dampness constitution group (672 cases). Among them, there were 547 males and 136 females in the dampness constitution group, with an age of 38.0 (32.0, 45.0) years; and there were 355 males and 317 females in the non-dampness constitution group, with an age of 33.0 (27.0, 41.0) years. A total of 1 355 apparently healthy individuals were randomly divided into a training set ( n=948) and a validation set ( n=407) using computer-generated random numbers in a 7∶3 ratio. Logistic regression analysis was employed to identify risk factors associated with dampness constitution. Utilizing these identified risk factors, a predictive model was constructed and subsequently visualized. The model′s predictive accuracy, consistency, and clinical utility were assessed using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA), respectively. Results:Among 1 355 subjects, there were statistically significant differences ( P<0.05) in gender, age, body mass index (BMI), blood glucose, some indicators of renal function, some indicators of blood routine, liver function, and four indicators of lipid metabolism between the dampness constitution group and the non-dampness constitution group. Gender ( OR=0.434,95 %CI 0.253-0.738), Cr ( OR=0.981,95 %CI 0.967-0.996), BMI ( OR=1.366,95 %CI 1.290-1.450), and LDL-C ( OR=1.388,95 %CI 1.014-1.897) were independent risk factors for dampness constitution ( P<0.05). A nomogram was subsequently developed based on these identified risk factors. The areas under the ROC curves (AUC) of the training set and validation set were 0.810 (95 %CI 0.783-0.837) and 0.804 (95 %CI 0.762-0.846), respectively. Conclusion:Gender,BMI,Cr and LDL-C were risk factors for the development of dampness constitution, and the clinical predictive model has clinical application value in predicting the risk of dampness constitution.

Objective To describe the clinical features of patients with primary sclerosing cholangitis(PSC)in China based on a nationwide multicenter patient cohort,and to investigate the risk factors for prognosis.Methods A retrospective cohort study was conducted among the patients with a confirmed diagnosis of PSC based on the electronic medical record system of seven grade A tertiary hospitals across the country,and related data were extracted.The Mann-Whitney U test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to estimate liver transplant-free survival,and the log-rank test was used for comparison of survival rate between PSC patients with different features.The Cox regression model was used to identify independent risk factors for the prognosis of PSC patients and the interactions between key factors.Results A total of 107 patients were enrolled,among whom 55.6%(55/99)had large-duct PSC and 29.0%(31/107)had comorbidity with inflammatory bowel disease(IBD).The positivity rate of anti-neutrophil cytoplasmic antibody(ANCA)was 32.9%(24/73),and 50.0%(40/80)of the patients had an increase in IgG/IgM.The median symptom-to-diagnosis interval was 1 year(<1-4.0),and 38.3%(41/107)of the patients had progressed to decompensated cirrhosis at the time of diagnosis.The median liver transplant-free survival time was 114 months(95%confidence interval[CI]:62-166),with a 5-year survival rate of 65.7%.The multivariate analysis showed that an increase in total bile acid(TBA)(hazard ratio[HR]=1.006,95%CI:1.002-1.010,P=0.001)and a prolonged symptom-to-diagnosis interval(HR=1.252,95%CI:1.059-1.480,P=0.009)were independent risk factors for prognosis.The interaction analysis showed that compared with the female patients with TBA<50 μmol/L,both male and female patients with TBA≥50 μmol/L had a significant increase in the risk of liver transplantation or death(male:HR=16.563,95%CI:2.103-130.449,P<0.001;female:HR=17.009,95%CI:2.113-136.934,P<0.001),and compared with the patients with an age of<45 years and a TBA level of<50 μmol/L,the patients with an age of≥45 years and a TBA level of≥50 μmol/L had a significant increase in the risk of liver transplantation or death(HR=10.729,95%CI:1.325-86.859,P=0.026).Compared with the female patients with an symptom-to-diagnosis interval of≤2 years,the male patients with a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.825,95%CI:1.725-13.644,P=0.003),and compared with the patients with an age of<45 years and a symptom-to-diagnosis interval of≤2 years,the patients with an age of<45 years and a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.983,95%CI:1.366-18.173,P=0.015).Conclusion Compared with the reports from Western countries,large-duct PSC is also the main type of PSC in China,but with a relatively low proportion,and there is also a relatively low proportion of patients with IBD or positive ANCA.An increase in TBA and a prolonged symptom-to-diagnosis interval are independent risk factors for prognosis,with significant interactions with age and sex.This suggests that early screening and intervention should be enhanced to improve prognosis.

Objective:To develop a clinical predictive model for dampness constitution based on laboratory testing indicators.Methods:A retrospective cohort study was conducted on 1 355 healthy individuals who underwent physical examinations at the Health Examination Center of Guangdong Provincial Hospital of Traditional Chinese Medicine from October 1 st, 2022 to October 31 st, 2023. Basic information and blood routine, blood glucose, liver function, lipid metabolism, and kidney function test results of 1 355 apparently healthy individuals were collected. According to the diagnostic criteria for dampness constitution in traditional Chinese medicine, they were divided into a dampness constitution group (683 cases, including 394 with phlegm-dampness constitution and 289 with damp-heat constitution) and a non-dampness constitution group (672 cases). Among them, there were 547 males and 136 females in the dampness constitution group, with an age of 38.0 (32.0, 45.0) years; and there were 355 males and 317 females in the non-dampness constitution group, with an age of 33.0 (27.0, 41.0) years. A total of 1 355 apparently healthy individuals were randomly divided into a training set ( n=948) and a validation set ( n=407) using computer-generated random numbers in a 7∶3 ratio. Logistic regression analysis was employed to identify risk factors associated with dampness constitution. Utilizing these identified risk factors, a predictive model was constructed and subsequently visualized. The model′s predictive accuracy, consistency, and clinical utility were assessed using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA), respectively. Results:Among 1 355 subjects, there were statistically significant differences ( P<0.05) in gender, age, body mass index (BMI), blood glucose, some indicators of renal function, some indicators of blood routine, liver function, and four indicators of lipid metabolism between the dampness constitution group and the non-dampness constitution group. Gender ( OR=0.434,95 %CI 0.253-0.738), Cr ( OR=0.981,95 %CI 0.967-0.996), BMI ( OR=1.366,95 %CI 1.290-1.450), and LDL-C ( OR=1.388,95 %CI 1.014-1.897) were independent risk factors for dampness constitution ( P<0.05). A nomogram was subsequently developed based on these identified risk factors. The areas under the ROC curves (AUC) of the training set and validation set were 0.810 (95 %CI 0.783-0.837) and 0.804 (95 %CI 0.762-0.846), respectively. Conclusion:Gender,BMI,Cr and LDL-C were risk factors for the development of dampness constitution, and the clinical predictive model has clinical application value in predicting the risk of dampness constitution.

Objective To study the influence of implant depth and scanning rod lengths on the accuracy of digital impression for single-tooth implant restoration of the mandibular posterior teeth.Methods Five standard dental cast models with missing right mandibular first molar(46)were prepared with the subgingival implant depths of 0,1,3,5 and 7 mm.ITI RC and ITI RC H11 scanning rods were connected to the replacement body and placed into the seating tract for scanning.The reference data were obtained using a 3D dental scanner,and the experimental data were obtained by 10 scans of each model using a digitized intraoral scanner.Geomagic Wrap 2021 was used to analyze the model data to test the trueness and precision of the models.Results The trueness did not differ significantly among the groups(P>0.05).The implant depth of 1 mm achieved the highest impression precision(66.81±2.45 μm),and the depth of 0 mm resulted in a significantly lower precision(95.60±3.04 μm)than the depth of 1 and 3 mm.Starting from the subgingival depth of 1 mm,the precision of the scan decreased progressively with the increase of the implant depth.At the subgingival implant depth of 5 or 7 mm,the use of an extended rod significantly improved the scan precision.Conclusion For single-tooth implant restoration of the mandibular posterior teeth,the implant depth can substantially affect the accuracy of digital impression,which decreases as the implant depth increases.For a deep implant,the use of a longer scanning rod can improve the scanning accuracy.

Objective:To assess the effectiveness of a 6-month Ba Duan Jin exercise program in improving the balance of community-dwelling older adults.Methods:A two arms, parallel-group, cluster randomized controlled trial was conducted in 1 028 community residents aged 60-80 years in 40 communities in 5 provinces of China. Participants in the intervention group (20 communities, 523 people) received Ba Duan Jin exercise 5 days/week, 1 hour/day for 6 months, and three times of falls prevention health education, and the control group (20 communities, 505 people) received falls prevention health education same as the intervention group. The Berg balance scale (BBS) score was the leading outcome indicator, and the secondary outcome indicators included the length of time of standing on one foot (with eyes open and closed), standing in a tandem stance (with eyes open and closed), the closed circle test, and the timed up to test.Results:A total of 1 028 participants were included in the final analysis, including 731 women (71.11%) and 297 men (28.89%), and the age was (69.87±5.67) years. After the 3-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 3.05 (95% CI: 2.23-3.88) points ( P<0.001). After the 6-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 4.70 (95% CI: 4.03-5.37) points ( P<0.001). Ba Duan Jin showed significant improvement ( P<0.05) in all secondary outcomes after 6 months of exercise in the intervention group compared with the control group. Conclusions:This study showed that Ba Duan Jin exercise can improve balance in community-dwelling older adults aged 60-80. The longer the exercise time, the better the improvement.

Objective To study the influence of implant depth and scanning rod lengths on the accuracy of digital impression for single-tooth implant restoration of the mandibular posterior teeth.Methods Five standard dental cast models with missing right mandibular first molar(46)were prepared with the subgingival implant depths of 0,1,3,5 and 7 mm.ITI RC and ITI RC H11 scanning rods were connected to the replacement body and placed into the seating tract for scanning.The reference data were obtained using a 3D dental scanner,and the experimental data were obtained by 10 scans of each model using a digitized intraoral scanner.Geomagic Wrap 2021 was used to analyze the model data to test the trueness and precision of the models.Results The trueness did not differ significantly among the groups(P>0.05).The implant depth of 1 mm achieved the highest impression precision(66.81±2.45 μm),and the depth of 0 mm resulted in a significantly lower precision(95.60±3.04 μm)than the depth of 1 and 3 mm.Starting from the subgingival depth of 1 mm,the precision of the scan decreased progressively with the increase of the implant depth.At the subgingival implant depth of 5 or 7 mm,the use of an extended rod significantly improved the scan precision.Conclusion For single-tooth implant restoration of the mandibular posterior teeth,the implant depth can substantially affect the accuracy of digital impression,which decreases as the implant depth increases.For a deep implant,the use of a longer scanning rod can improve the scanning accuracy.

Objective:To investigate the correlation between the expression of cyclic RNA PIP5K1A (circPIP5K1A) and microRNA-124-3p (miR-124-3p) in the serum and the severity of the disease and infertility in patients with endometriosis (EM) .Methods:A total of 110 cases of EM patients admitted to Shanxi Provincial Children's Hospital (Shanxi Maternal and Child Health Hospital) from Jan. 2020 to Jan. 2022 were regarded as the research objects, and were diveded into infertility group (44 cases) and successful pregnancy group (66 cases) according to the pregnancy outcome. General data were collected and the levels of serum miR-124-3p and circPIP5K1A were compared between the two groups; Pearson correlation was applied to analyze the correlation between serum miR-124-3p and circPIP5K1A. The diagnostic value of miR-124-3p and circPIP5K1A levels in patients with stage III-V EM was evaluated by ROC curve; Logistic regression analysis was applied to analyze the factors influencing the occurrence of infertility.Results:The expression level of serum miR-124-3p in stage Ⅰ EM patients (1.06±0.21) was higher than that in stage Ⅱ (0.83±0.19), stage Ⅲ (0.65±0.12) and stage Ⅴ (0.44±0.08), and the serum miR-124-3p level decreased with the increase of r-AFS stage. The differences were statistically significant ( t=54.29, P<0.05). The expression level of circPIP5K1A (0.77±0.12) was lower than that of stage Ⅱ (0.90±0.15), stage Ⅲ (1.20±0.20) and stage Ⅴ (1.53±0.26), and increased with the increase of r-AFS stage, and the differences were statistically significant ( t=90.45, P<0.05). Pearson correlation analysis showed that the expression of circPIP5K1A and miR-124-3p in serum of EM patients was negatively correlated ( r=-0.424, P<0.05) ; the serum miR-124-3p level in infertility group was lower than that in successful pregnancy group, and the serum circPIP5K1A level in infertility group was higher than that in successful pregnancy group ( P<0.05). ROC curve results showed that the area under the curve (AUC) of serum miR-124-3p and circPIP5K1A levels in the diagnosis of stage III-V EM patients was 0.900 and 0.887 respectively. The corresponding sensitivity was 88.24%, 85.29%, and the specificity was 78.95%, 88.16%, respectively. The AUC of combined diagnosis was 0.937, the sensitivity was 82.35%, and the specificity was 90.79%. Multivariate Logistic regression analysis showed that miR-124-3p and circPIP5K1A were related factors affecting infertility ( P<0.05) . Conclusions:The expression of miR-124-3p in the serum of EM patients decreases, and the expression of circPIP5K1A increases. The combined detection of miR-124-3p and circPIP5K1A has certain diagnostic value for the patients with stage III-V EM, and they are closely related to the occurrence of infertility.

Objective To observe the value of ultrasonic parameters for predicting whether patients with cesarean scar pregnancy(CSP)would benefit from ultrasound-guided suction curettage alone.Methods Totally 140 CSP patients diagnosed by transvaginal ultrasound and initially treated with ultrasound-guided suction curettage alone were prospectively recruited and categorized into benefited group(n=103)and non-benefited group(n=37)according to bleeding during suction curettage and prognoses.The ultrasonic manifestations of CSP were observed,and the thickness of chorionic villi at the scar,as well as of residual myometrium of the anterior wall in the lower segment of the uterus,also the maximum diameter of the gestational sac were measured and compared between groups,and the parameters with quantitative data being statistically different between groups were converted into categorical predictor through analyzing of the receiver operating characteristic(ROC)curves and the optimal cut-off values.The independent predictors were selected among ultrasonic features and categorical predictor variables being statistically different between groups using multivariate logistic regression,and a combined predicting model was then constructed,and the predicting efficacy of the combined model and each categorical predictor alone was assessed according to the area under curve(AUC)and then were compared.Results Compared with non-benefited group,the gestational weeks in benefited group were smaller(P＜0.05),and the percentages of rich blood supply and the presence of embryos and fetal heartbeats were lower,with thinner chorionic villi at the scar,thicker residual myometrium and smaller maximal diameter of the gestational sac in benefited group(all P＜0.05).ROC curves analyses yielded the best cut-off value for dichotomy of chorionic villi thickness at the scar was 4.7 mm,of residual myometrium thickness was 1.8 mm and of the maximum diameter of the gestational sac was 29 mm,respectively,and then categorical predictor variable were obtained.Multivariate logistic regression showed that the transformed categorical predictors,i.e.the thickness degree of the chorionic villi at the scar,the thickness degree of the residual muscle layer and the size degree of the gestational sac,were all independent predictors of whether CSP patients would benefit from ultrasound-guided suction curettage alone(all P＜0.05).The AUC of the combined predicting model was 0.918,higher than that of each transformed categorical predictor alone(all P＜0.05).Conclusion The thickness of the chorionic villi at the scar ≤4.7 mm,the thickness of the residual muscle layer＞1.8 mm and the maximum diameter of the gestational sac≤29 mm were all independent predictors of CSP patients would benefit from ultrasound-guided suction curettage alone,and the predicting efficacy of the combined model was higher than that of each alone.

Abstract Children were vulnerable groups in major public health emergencies. In 2020, the coronavirus disease 2019 (COVID-19) pandemic was widespread in the world. The mental health of school age children has become a worldwide concern. Herein, we conducted this review to evaluate the impact of COVID-19 on the mental health of general children and special children with a high risk of psychological problems, focusing on the prevalence of anxiety, depression, and post traumatic stress disorder among school age children in different countries and regions during the COVID-19 epidemic. Considering the susceptibility between individuals and the accessibility of social resources, we further explored the child, family, and social related factors affecting the mental health of school age children. Finally, some suggestions on the construction of children s mental health service system in major public health emergencies were put forward at the national, school family community, and individual levels. Building a safe and reliable child mental health protection network required the joint efforts of all sectors of society.