Objective: To examine the changing trajectories of sleep problems and teacher support among first year middle school students and their covariant relationship,so as to provide theoretical basis for the prevention strategy of sleep problems for the first year junior high school students. Methods: In September 2020, a multistage cluster random sampling method was used to select 1 027 first year junior high school students from two schools of Anshun and Guiyang cities in Guizhou Province for survey and follow up assessments (T1:September 2020, T2:October 2020, T3:November 2020, T4:December 2020). The Student Perceived Teacher Support Behavior Questionnaire and Pittsburgh Sleep Quality Index Scale were administered to assess sleep problems and teacher support among first year junior high school students. Spearman correlation analysis was used to examine the relationship between sleep problems and teacher support. A multivariate latent growth curve model was employed to analyze the changing trajectories and covariant relationship between teacher support and sleep problems, followed by a multi group analysis. Results: For first year junior high school students, teacher support scores at T1-T4 were 4.00 (3.47, 4.53), 4.00 (3.47, 4.58), 3.95 (3.47, 4.61) and 4.00 (3.48, 4.67), respectively; sleep problem scores were 0.83 (0.50, 1.17), 0.67 (0.50, 1.17), 0.83 (0.50, 1.17) and 0.67 (0.33, 1.17), respectively. Spearman correlation analysis revealed that teacher support and sleep problems were negatively correlated across all four period ( r =-0.28 to -0.14, all P <0.01). Teacher support perceived by students showed a linear increasing trend (intercept=3.98, slope=0.02), while sleep problems showed a linear decreasing trend (intercept=0.86, slope= -0.02 ) (all P <0.05). The multivariate latent growth model indicated that the rate of increase in teacher support after enrollment effectively predicted the rate of decrease in sleep problem levels ( β=-0.34, P <0.01). Multigroup analysis showed that the covariant relationship was not moderated by gender or boarding status (both P >0.05). Conclusions The increase in teacher support experienced by first year junior high school students during the transition period after enrollment, accompanied by a reduction in sleep problems, constitutes a dynamic protective process. The process is not moderated by gender or boarding status.

Objective: Previous studies have discovered a correlation between cigarette smoking and cortical thickness and surface area, but the causal relationship remains unclear. The objective of this investigation is to scrutinize the causal association between them. Methods: To derive summary statistics from a genome-wide association study (GWAS) on cortical thickness, surface area, and four smoking behaviors: 1) age of initiation of regular smoking (AgeSmk); 2) smoking initiation (SmkInit); 3) smoking cessation (SmkCes); 4) cigarettes per day (CigDay). Linkage disequilibrium score regression (LDSC) was employed to examine genetic association analysis. Furthermore, for traits with significant genetic associations, Mendelian randomization (MR) analyses were conducted. Results: The LDSC analysis revealed nominal genetic correlations between AgeSmk and right precentral surface area, left caudal anterior cingulate surface area, left cuneus surface area, left inferior parietal surface area, and right caudal anterior cingulate thickness, as well as between CigDay and left caudal middle frontal surface area, between SmkCes and left entorhinal thickness, and between SmkInit and left rostral anterior cingulate surface area, right rostral anterior cingulate thickness, and right superior frontal thickness (rg=-0.36–0.29, p<0.05). MR analysis showed a unidirectional causal association between left caudal middle frontal surface area and CigDay (βIVW=0.056, pBonferroni=2×10-4). Conclusion Left caudal middle frontal surface area has the potential to serve as a significant predictor of smoking behavior.

Objective: Previous studies have discovered a correlation between cigarette smoking and cortical thickness and surface area, but the causal relationship remains unclear. The objective of this investigation is to scrutinize the causal association between them. Methods: To derive summary statistics from a genome-wide association study (GWAS) on cortical thickness, surface area, and four smoking behaviors: 1) age of initiation of regular smoking (AgeSmk); 2) smoking initiation (SmkInit); 3) smoking cessation (SmkCes); 4) cigarettes per day (CigDay). Linkage disequilibrium score regression (LDSC) was employed to examine genetic association analysis. Furthermore, for traits with significant genetic associations, Mendelian randomization (MR) analyses were conducted. Results: The LDSC analysis revealed nominal genetic correlations between AgeSmk and right precentral surface area, left caudal anterior cingulate surface area, left cuneus surface area, left inferior parietal surface area, and right caudal anterior cingulate thickness, as well as between CigDay and left caudal middle frontal surface area, between SmkCes and left entorhinal thickness, and between SmkInit and left rostral anterior cingulate surface area, right rostral anterior cingulate thickness, and right superior frontal thickness (rg=-0.36–0.29, p<0.05). MR analysis showed a unidirectional causal association between left caudal middle frontal surface area and CigDay (βIVW=0.056, pBonferroni=2×10-4). Conclusion Left caudal middle frontal surface area has the potential to serve as a significant predictor of smoking behavior.

Purpose To develop and validate a nomogram based on 18F-FDG PET/CT for predicting spread through air space(STAS)in stage IA lung adenocarcinoma(LUAD),providing imaging support for surgical decision-making.Materials and Methods This retrospective study analyzed 155 patients with pathologically confirmed stage IA LUAD from the Fifth People's Hospital of Chongqing,Affiliated Hospital of Zunyi Medical University and Cavalier Hospital(December 2019 to December 2023).Patients were stratified into STAS-positive and STAS-negative groups based on postoperative histopathological evaluation.Univariate and multivariate binary Logistic regression analyses identified risk factors for STAS from clinical characteristics,PET/CT semantic features,and metabolic parameters.A nomogram predicting preoperative STAS status was developed and internally validated using bootstrap resampling.Model performance was assessed in training and internal validation sets using receiver operating characteristic analysis,calibration curves and decision curve analysis.Results Among 155 stage IA LUAD patients,20(12.9%)were STAS-positive.Multivariate analysis identified tumor mean diameter(OR=0.618,P=0.024),solid component proportion(OR=2.678,P=0.033),and maximum standardized uptake value(OR=3.437,P=0.028)as independent STAS predictors.The nomogram demonstrated excellent discrimination,with areas under the curve of 0.912(95%CI 0.855-0.942)and 0.843(95%CI 0.805-0.923)in training and validation sets,respectively.Hosmer-Lemeshow goodness-of-fit test indicated satisfactory calibration(χ2=5.591,P=0.693).Decision curve analysis showed substantial net clinical benefit across threshold probabilities of 5%-91%.Conclusion The nomogram incorporating tumor diameter,solid component proportion,and maximum standardized uptake value from 18F-FDG PET/CT effectively predicts STAS status in stage IA LUAD,demonstrating high preoperative predictive performance.

The study aims to investigate the effects of adding different proportions of Codonopsis radix compound crude extracts to the rabbit diet on growth performance,immune status,intesti-nal enzyme activity,structure,and microbial composition.A total of 96 5-week-old New Zealand White rabbits were randomly divided into 4 groups,with 6 replicates per group.The control group(BC)was fed a basal diet,while the experimental groups(CM-H and CM-L)were fed a basal diet supplemented with 1 000 mg/kg and 500 mg/kg of Codonopsis radix compound crude extracts,re-spectively.The antibiotic group(CK)was fed a basal diet supplemented with 300 mg/kg of keto-tifen.The experimental period was 42 days.Blood samples were collected at days 21 and 42,and se-rum biochemical and immune markers were determined.Intestinal segments and contents were col-lected at day 42 for analysis of intestinal health.The results showed that compared with the BC group,the average daily gain,feed-to-gain ratio,and diarrhea rate were significantly higher(P＜0.05)in the CM-H and CM-L groups.The total cholesterol(Tchol)content in the serum was sig-nificantly lower in the CM-H group at day 21 and the CM-L group at day 42(P＜0.05).The high-density lipoprotein(HDL)was significantly higher in the CM-H and CM-L groups than in the CK group at day 42(P＜0.05),and the total protein(TP)in the serum was significantly higher in the CM-H and CM-L groups than in the BC group(P＜0.05).The IgG and IgM levels in the serum were significantly higher in the CM-H and CM-L groups than in the BC group(P＜0.05).In the CM-H and CM-L groups,the content of acetic acid in the colon was significantly higher than that in the BC group(P＜0.05).The content of propionic acid in the colon of the CM-L group was also significantly higher than that in the BC group(P＜0.05).The content of α-amylase in the duode-num,the content of trypsin in the duodenum,the pancreas,and the ileum of the CM-H group were significantly higher than those in the BC group(P＜0.05),and the content of trypsin in the duode-num of the CM-H group was significantly higher than those in the BC group and the CM-L group(P＜0.05).Compared with the BC group,the content of GPX1 in the ileum and jejunum of the CM-L group and the ileum of the CM-H group was significantly increased(P＜0.05),and the length of the villi in the duodenum of the CM-H group was significantly increased(P＜0.05).Compared with the BC group,the expression level of ZO-1 in the ileum of the CM-H group was significantly upregulated(P＜0.05),and the expression level of Claudin in the jejunum of the CM-H group and the CM-L group was significantly higher than that in the CK group(P＜0.05).The high-throughput sequencing results showed that the Sob index was significantly higher in the CM-L group compared to the BC group(P＜0.05).At the phylum level,the Firmicutes and Bacteroid-ota phyla were the main phyla.At the genus level,Akkermansia and Ruminococcus were the main genera.The relative abundance of Papillibacter and Eubacterium_ruminantium_group in the CM-L group was significantly higher than that in the CK group(P＜0.05).In summary,adding a Codonopsis radix compound crude extract to the diet can improve the growth performance,immu-nity,antioxidant capacity,integrity of intestinal mucosal structure,enzyme activity in the intestine,and increase the diversity of microorganisms in the blind intestine when the diet is supplemented with 500 mg/kg of Codonopsis radix compound crude extract.

Objective:To investigate the significance of dynamic quantitative detection of(cytomegalovirus)CMV antibodies in assessing the risk of fetal CMV infection.Methods:A total of 171 pregnant women with positive/weakly positive CMV IgM antibody ELISA screening results from Huizhou Central People's Hospital from August 2019 to March 2022 were selected as the study objects.IgM and IgG levels were measured by electrochemical luminescence(ECLIA),and re-examined 2 to 4 weeks later;at the same time,CMV nucleic acid was detected by real-time PCR fluorescent probe,and the fetal outcome was followed up.Results:In 171 cases,135 CMV IgM antibody ELISA(+)/ECLIA(-)specimens were positive for IgG antibodies and had stable levels after 2～4 weeks,one case was diagnosed with severe β thalassemia at 19+5 weeks,and the remaining fetuses were in good condition.There were 36 cases of IgM antibody ELISA(+)/ECLIA(+)specimens,one was negative for IgG antibody;35 cases had positive IgM antibody and stable IgG antibody level after 2～4 weeks,the fetus was in good condition;one case had IgM antibody level decreased and IgG antibody level increased significantly,urinary CMV DNA level gradually decreased,and was diagnosed as disseminated congenital CMV infection.Conclusion:The false positive rate of CMV IgM antibody detected by ELISA method is significantly higher than that of ECLIA method,and the dynamic quantitative detection can effectively eliminate interference.Maternal women with significant changes in CMV IgM,IgG antibodies and urinary DNA levels are at high risk of intrauterine infection and had a high probability of fetal congeni-tal CMV infection.

Objective To analyze the composition and distribution characteristics of death causes among elderly inpa-tients in a municipal hospital based on Diagnosis-Related Groups(DRG).This analysis aims to provide data support for the treat-ment and management of diseases in elderly patients and for the development of related disciplines,ultimately aiming to reduce the mortality rate of elderly patients.Methods A total of 1 811 death cases of elderly inpatients(aged≥60 years)were extrac-ted from the medical record management system and DRG operation analysis system of a prefecture-level tertiary hospital between January 1,2022,and December 31,2024.Information from the inpatient medical records'front page and DRG grouping data were matched.A retrospective analysis was conducted on 1,587 cases with hospitalization durations of 60 days orless included in DRG groups using Excel 2021.Results Elderly inpatients accounted for more than 80% of the total deaths.The deaths were mainly caused by three major categories:respiratory diseases and dysfunctions(35.03%),circulatory system diseases and dys-functions(25.27%),and nervous system diseases and dysfunctions(14.43%).The internal medicine treatment group had the highest number of deaths,followed by the surgical operation group,and then the non-operating room operation group.Among eld-erly deceased patients,83.68% had complications or comorbidities,with 85.47% having severe complications or comorbidities,mainly in patients aged 70 and above.Conclusion Elderly patients are the primary population group at risk of death.Based on the disease characteristics of elderly deceased patients in different age groups,hospitals should focus on strengthening the devel-opment of geriatrics departments,advance disciplinary technologies,and enhance patient satisfaction to provide comprehensive and personalized diagnosis and treatment,thereby supporting healthy aging.

Objective:To observe the effect of Liuzijue on post-stroke fatigue patients with the type of Qi deficiency and blood stasis and the effect of pulmonary function.Method:From March 2022 to March 2023,a total of 68 post-stroke fatigue patients with Qi deficiency and blood stasis who were hospitalized in the Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine and met the criteria were selected,the patients were divided into therapy group(n=34)and control group(n=34)according to random number table.The control group was treated with conventional reha-bilitation combined with conventional respiratory therapy,the therapy group was treated with conventional reha-bilitation combined with Liuzijue,30 minutes/time,5 times/week,a total of 12 weeks.The fatigue severity scale score(FSS),Qi Deficiency Syndrome and Blood Stasis factor diagnostic scale score,vital capacity(VC),forced vital capacity(FVC),peak expiratory flow(PEF),and maximal voluntary ventilation(MVV)were assessed in both groups before and after treatment.Result:After 12 weeks of treatment,the FSS scores and the Qi deficiency syndrome and blood stasis factor di-agnostic scale score exhibited significant differences in the therapy group compared with those before treatment(P＜0.05),and significant improvement compared with those in the control group(P＜0.05).The significant differ-ences were found in the VC、FVC、PEF and MVV of both two groups between before and after treatment(P＜0.05),and the degree of improvement was more pronounced in the therapy group.Conclusion:The Liuzijue applied to post-stroke fatigue patients with Qi deficiency and blood stasis can better improve the fatigue score and Qi deficiency syndrome and blood stasis score,as well as improve the level of pulmonary function of patients,which is worthy of clinical application.

Objective:To develop the Home-based Self-management Efficacy Questionnaire for Stable Chronic Obstructive Pulmonary Disease (COPD) Patients and test its reliability and validity.Methods:Guided by the individual and family self-management theory and self-management efficacy theory, a preliminary questionnaire was developed through literature analysis, semi-structured interviews, and expert inquiries. From September to November 2022, convenience sampling was used to select stable COPD patients of the Respiratory Department of Tongji University Shanghai Pulmonary Hospital as participants for investigation for project analysis and exploratory factor analysis of the questionnaire. From December 2022 to January 2023, a survey was conducted on stable COPD patients who visited the Respiratory Department of Tongji University Shanghai Pulmonary Hospital and Yancheng Third People's Hospital to conduct confirmatory factor analysis and reliability testing on the questionnaire.Results:A total of 220 and 290 questionnaires were distributed respectively, and 214 and 280 valid questionnaires were collected, with effective response rates of 97.27% (214/220) and 96.55% (280/290), respectively. The Home-based Self-management Efficacy Questionnaire for COPD Patients included six dimensions and 28 items. The questionnaire's total Cronbach's α coefficient was 0.910, and the half-confidence coefficient was 0.806. The content validity index at the questionnaire level was 0.928, and the content validity index at the item level was 0.800 to 1.000. The exploratory factor analysis showed that a total of six common factors were extracted, with a cumulative variance contribution rate of 63.943%. Confirmatory factor analysis showed that the model fitted well and the questionnaire factor structure was stable.Conclusions:The the Home-based Self-management Efficacy Questionnaire for Stable COPD has been developed with good reliability and validity, providing a reference for medical and nursing staff to evaluate the home self-management efficacy of stable COPD patients.

Objective:To develop an evaluation index system for discharge preparation management in elderly patients with hip fractures, providing a reference for clinical discharge planning.Methods:Guided by the operational definition of discharge readiness, a preliminary index system was constructed through literature review, semi-structured interviews, and expert group discussions. Using purposeful sampling, 22 experts were recruited for two rounds of expert consultation conducted between July and August 2024. The final index system was established based on expert consensus.Results:The effective response rates for the two Delphi rounds were 95.65% (22/23) and 100.00% (22/22) , respectively. The rates of feedback comments were 77.27% (17/22) and 40.91% (9/22) . The expert authority coefficients were 0.955 and 0.934, and the Kendall's coordination coefficients were 0.129 and 0.104, respectively (both P<0.01) . The final index system consisted of four first-level indicators, 16 second-level indicators, and 39 third-level indicators. Conclusions:The constructed evaluation index system demonstrates good scientific rigor and practical applicability. It can serve as a reference for the discharge preparation management of elderly patients with hip fractures.