OBJECTIVES: To investigate the chain mediating role of family care and emotional management in the relationship between social support and anxiety among rural primary school students. METHODS: A questionnaire survey was conducted among students in grades 4 to 6 from four counties in Hunan Province. Data were collected using the Social Support Rating Scale, Family Care Index Scale, Emotional Intelligence Scale, and Generalized Anxiety Disorder -7. Logistic regression analysis was used to explore the influencing factors of anxiety symptoms. Mediation analysis was conducted to assess the chain mediating effects of family care and emotional management between social support and anxiety. RESULTS: A total of 4 141 questionnaires were distributed, with 3 874 valid responses (effective response rate: 93.55%). The prevalence rate of anxiety symptoms among these students was 9.32% (95%CI: 8.40%-10.23%). Significant differences were observed in the prevalence rates of anxiety symptoms among groups with different levels of social support, family functioning, and emotional management ability (P<0.05). The total indirect effect of social support on anxiety symptoms via family care and emotional management was significant (β=-0.137, 95%CI: -0.167 to -0.109), and the direct effect of social support on anxiety symptoms remained significant (P<0.05). Family care and emotional management served as significant chain mediators in the relationship between social support and anxiety symptoms (β=-0.025,95%CI:-0.032 to -0.018), accounting for 14.5% of the total effect. CONCLUSIONS Social support can directly affect anxiety symptoms among rural primary school students and can also indirectly influence anxiety symptoms through the chain mediating effects of family care and emotional management. These findings provide scientific evidence for the prevention of anxiety in primary school students from multiple perspectives.
Humans ; Female ; Male ; Social Support ; Anxiety/etiology* ; Child ; Students/psychology* ; Emotions ; Logistic Models

Objective To assess the efficacy of a novel inguinal tourniquet in healthy individuals and to investigate the relationship between localized inguinal compression and femoral artery blood flow occlusion.Methods A self-controlled study was conducted.From November 9 to November 30,2024,11 volunteers were recruited at the Third Medical Center of Chinese PLA General Hospital.Three compression methods--finger pressure,a novel groin tourniquet,and a SAM junction tourniquet(SJT)—were applied bilaterally to the inguinal region until distal blood flow signals disappeared.Each compression method was tested in 22 trials with a 5-minute interval between operations.Differences in hemostatic efficacy between bilateral inguinal regions and across compression methods were compared.Subsequently,the novel tourniquet was incrementally pressurized in 120 mmHg multiples using an integrated pressure device to analyze trends in popliteal artery blood flow velocity.Observational indicators included the internal pressure of the tourniquet pressurization device,peak systolic velocity(PSV)of popliteal artery,inguinal surface pressure magnitude,inguinal surface pressure distribution,and pain scores(assessed using a single-dimensional numerical rating scale).Results No statistically significant difference was observed in the minimum pressure required to occlude femoral artery blood flow bilaterally(P>0.05).The success rates of femoral artery blood flow occlusion at the inguinal region were 100%for the novel inguinal tourniquet,SJT,and finger pressure.The novel inguinal tourniquet induced the highest pain scores,ranging from 5 to 8.A significant reduction in PSV of popliteal artery was noted when the intra-tourniquet pressure reached 360 mmHg and 480 mmHg(P<0.05),with a 95%hemostasis efficacy observed within the range of 360-600 mmHg.No significant association was observed between the recovery of popliteal artery blood flow after limb movement and inguinal pressure distribution(P>0.05).The PSV of popliteal artery exhibited the strongest negative correlation with the average pressure within the inguinal compression area(r=-0.79,P<0.001),with a linear regression fitting line of y=69.69-0.13x(P<0.001,R2=0.58).Conclusions The novel inguinal tourniquet effectively occludes femoral artery blood flow within a pressure range of 360-600 mmHg,accompanied by moderate-to-severe pain.Its hemostatic mechanism mainly relies on increasing the mean pressure within the inguinal compression area.

Objective To investigate the clinical effect of superficial temporal artery-middle cerebral artery anastomosis(STA-MCA)in the treatment of patients with occlusive cerebrovascular disease.Methods A total of 74 patients with occlusive cerebrovascular disease admitted to our hospital were included and divided into the observation group and control group according to the random number table method,with 37 cases in each group.Patients in the control group received conservative treatment,and patients in the observation group received STA-MCA.After 3 months of follow-up,the cerebral blood flow indexes(including cerebral blood flow of anterior cerebral artery,and peak time)before treatment and 3rd day,1st month and 3rd month after treatment were observed,the modified Rankin scores before treatment and 3rd day and 1 month after treatment were recorded,and the revascularization and occurrence of complications after treatment were recorded.Results At 1 month and 3 months after treatment,the cerebral blood flow of anterior cerebral artery in the two groups increased and the peak time was shortened,and the cerebral blood flow of anterior cerebral artery in the observation group was higher than that in the control group,and the peak time was shorter than that in the control group,with statistically significant differences(P<0.05).The modified Rankin scores of the two groups 1 month after treatment were lower compared with those before treatment,and the modified Rankin score of the observation group was lower than that of the control group,with statistically significant differences(P<0.05).At 1 month after treatment,the proportions of patients with grades 0 and 1 of vascular reconstruction in the observation group were lower than those in the control group,and the proportions of patients with grades 2 and 3 were higher than those in the control group,with statistical significant differences(P<0.05).At 3 months after treatment,the proportions of patients with grades 0 and 1 of vascular reconstruction in the observation group were lower than those in the control group,and the proportion of patients with grade 3 of vascular reconstruction was higher than that in the control group,with statistically significant differences(P<0.05).There was no statistically significant difference in the total incidence of complications after treatment between the two groups(P>0.05).Conclusion STA-MCA has a good clinical effect in the treatment of patients with occlusive cerebrovascular disease,which is conducive to improving the cerebral blood flow indexes and promoting the recovery of neurological function and vascular reconstruction,with safety and reliability.

Objective To observe the efficacy and safety of Morinda officinalis oligosaccharides in the continuation treatment of mild and moderate depression.Methods An open,single-arm,multi-center design was adopted in our study.Adult patients with mild and moderate depression who had received acute treatment of Morinda officinalis oligosaccharides were enrolled and continue to receive Morinda officinalis oligosaccharides capsules for 24 weeks,the dose remained unchanged during continuation treatment.The remission rate,recurrence rate,recurrence time,and the change from baseline to endpoint of Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA),Clinical Global Impression-Severity(CGI-S)and Arizona Sexual Experience Scale(ASEX)were evaluated.The incidence of treatment-related adverse events was reported.Results The scores of HAMD-17 at baseline and after treatment were 6.60±1.87 and 5.85±4.18,scores of HAMA were 6.36±3.02 and 4.93±3.09,scores of CGI-S were 1.49±0.56 and 1.29±0.81,scores of ASEX were 15.92±4.72 and 15.57±5.26,with significant difference(P＜0.05).After continuation treatment,the remission rate was 54.59％(202 cases/370 cases),and the recurrence rate was 6.49％(24 cases/370 cases),the recurrence time was(64.67±42.47)days.The incidence of treatment-related adverse events was 15.35％(64 cases/417 cases).Conclusion Morinda officinalis oligosaccharides capsules can be effectively used for the continuation treatment of mild and moderate depression,and are well tolerated and safe.

Objective To establish a rapid high performance liquid chromatography-tandem mass spectrometry(HPLC-MS/MS)method for the determination of linezolid and vancomycin in trace plasma/serum from pediatric patients with severe infection.Methods The plasma/serum specimens(10 μL)were precipitated by methanol,then the supernatant was injected for detection directly.The internal standards were linezolid-D3 and norvancomycin.The chromatographic separation was performed with gradient elution on a Kinetex? EVO C18 column(30.0 mm × 2.1 mm,2.6 μm)using water and acetonitrile,each containing 0.1％formic acid,as mobile phase.The flow rate was 0.5 mL·min-1 and column temperature was 40 ℃.The injection volume was 2 μL and the total run time was 2 min.For mass spectrometry,electrospray ionization source was chosen,positive ion monitoring was used with multi-reaction monitoring(MRM)mode.The selectivity,lower limit of quantification(LLOQ)& calibration curve,accuracy & precision,recovery,matrix effect,stability,cross detection of plasma and serum samples,evaluation of hemolytic and hyperlipidemic effect were investigated.Results The retention times of linezolid,vancomycin,internal standard linezolid-D3 and norvancomycin were 1.18,1.03,1.17 and 1.01 min,respectively.The calibration curves of linezolid and vancomycin were y=8.95 × 10-1x+3.49 × 10-3(r=0.997 1)and y=3.13 × 10-1x+6.93 × 10-2(r=0.997 4),with the linear ranges of 0.2-25.6 μg·mL-1 and 1-128 μg·mL-1,and the lower limits of quantification were 0.2 μg·mL-1 and 1 μg·mL-1,respectively.The intra-run and inter-run precisions relative standard deviation(RSD)were both less than 9.55％.The average extraction recoveries of the two drugs were 96.24％-104.57％.The RSDs of internal standards-normalized matrix effect were no more than 7.58％.Plasma and serum matrix samples could be cross-detected.The maximum tolerable hemolysis degree of linezolid and vancomycin were 2％and 5％,respectively,and the hyperlipidemic effect did not affect the quantitation.The stability of the samples was good under test conditions.This method was successfully applied to the analysis of plasma samples from 28 pediatric patients with severe infection in our hospital.Conclusion This assay is sample-saving,simple,rapid,accurate and robust,widely used,which can be applied to combination medication studies of linezolid and vancomycin and their therapeutic drug monitoring in pediatric patients.

Objective To establish a method for determination of aspirin(ASP)and salicylic acid(SA)in plasma of children with kawasaki disease by high performance liquid chromatography-isotope dilution mass spectrometry(HPLC-IDMS).Methods The samples were pre-treated by precipitation protein method with organic solvent.ASP-D4 and SA-D4 were used as isotope internal standards.Chromatographic column:Phenomenex Kinetex? XB C18(2.6 mm × 50.0 mm,3.0μm);flow phase:0.1％formic acid-water(A)and acetonitrile(B),gradient elution;flow speed:0.5 mL·min-1;injection volume:6 μL.The detection method of mass spectrometry was negative ion mode,multireaction monitoring mode for quantitative analysis.Results The linear range of aspirin was 1.02-4 000 ng·mL-1(r2=0.995 4),and lower limit of quantification(LLOQ)was 1.02 ng·mL-1.The linear range of salicylic acid was 1.28-5 000 ng·mL-1(r2=0.998 5),and LLOQ was 1.28 ng·mL-1.Accuracy,precision,matrix effect and stability were in line with the provisions of Chinese Pharmacopoeia(2020 edition).Conclusion This study determined the blood concentration of aspirin and salicylic acid in children with HPLC-IDMS,which is rapid,simple,stable,economical,and high specificity.It can be applied to therapeutic drug monitoring of aspirin and salicylic acid in clinical children with kawasaki disease.

Objective To establish a high performance liquid chromatography-tandem mass spectrometry(HPLC-MS/MS)method for therapeutic drug monitoring(TDM)of digoxin in children.Methods The plasma samples 10 μL were precipitated protein by acetonitrile.Then,the analytes were gradient eluted on a Phenomenex Kinetex EVO C18 column(30.0 mm × 2.1 mm,2.6 μm)by HPLC-MS/MS with mobile phase consisted of water(0.05％formic acid and 2 mmol·L-1 ammonium acetate)-methanol at the flow rate of 0.55 mL·min-1.The mass detection was performed in positive ionization mode using the electrospray ionization(ESI)source.Dynamic multiple reaction monitoring mode(dMRM)was used to quantify at m/z 798.6→651.5(digoxin)and m/z 801.6→654.5(digoxin-d3),respectively.The selectivity,standard curve,precision and extraction recoveries,matrix effect,and stability were investigated.Results The retention time of both digoxin and internal standard was 1.39 min.The linear range of digoxin in human plasma was among 0.25-8.00 ng·mL-1,a typical standard curve was y=18.08 × 10-2x+29.71 × 10-4(r2=0.995 77).The intra-day and inter-day accuracies of digoxin were less than 15％Extraction recovery rate was 91.00％-99.50％.Stability studies showed good results.Matrix factor normalized by internal standard was within acceptance criteria.The measurement results were in line with the national requirement of External quality evaluation.This method was fully verified and applied to determine the plasma digoxin concentrations of 65 pediatric patients.Conclusion This LC-MS/MS method was simple,rapid and accurate.It is approved appropriate and practical for the therapeutic drug monitoring of digoxin in routine clinical laboratory practice,especially for children.

Objective To establish a high performance liquid chromatography-tandem mass spectrometry(HPLC-MS/MS)method for simultaneous determination of meropenem,linezolid,voriconazole and posaconazole in children with small volume of plasma,and to use the method in children therapeutic drug monitoring(TDM).Methods The plasma samples were precipitated protein by methanol.And then,the analytes were gradient eluted on an EVO-C18 column by HPLC-MS/MS with mobile phase consisted of water(0.1％formic acid)-acetonitrile(0.1％formic acid)at the flow rate of 0.5 mL·min 1.Ions were monitored in the multiple reaction monitoring(MRM)mode,using positive ion electrospray ionization(ESI).Results Meropenem had a good liner relationship in 0.5-64.0 μg·mL-1(r=0.999 2),0.2-25.6 μg·mL-1 for linezolid and voriconazole(r=0.999 2,r=0.999 9),and 0.1-12.8 μg·mL-1 for posaconazole(r=0.998 9).Accuracy,precision,matrix effect and stability studies all met the requirements.This method was fully verified,and applied to determine the plasma antimicrobial concentrations of 49 pediatric patients.Conclusion The method is simple,rapid,sensitive and suitable for children's plasma concentration monitoring of four antimicrobials.

This study was aimed at understanding the etiological and genetic characteristics of Yersinia enterocolica isolated in Jiangsu Province between 2005 and 2019.All 110 identified strains of Y.enterocolica were from patients with foodborne diar-rhea in Jiangsu Province,or from pigs,dogs,cattle,sheep,poultry,flies,or food.Virulence genes,biological serotypes,drug resistance,multilocus sequence typing(MLST),and core genome multilocus sequence typing(cgMLST)based on whole-genome sequencing were performed.The strains included 27 pathogenic strains(24.5％)and 83 non-pathogenic strains(75.5％).Non-pathogenic strains accounted for a high proportion,particularly among strains from patients(15/16,93.8％).The biological serotypes of pathogenic strains were mainly type 3/O∶3(26/27,96.3％).Non-pathogenic strains included 1A/O∶8 type(23/83,27.7％),1 A/O∶5 type(14/83,16.9％),and the other four biological serotypes(excluding unknown se-rotypes).Pathogenic strains were dominated by type 3/O∶3(26/27,96.3％),and more than 80％of these strains were sensi-tive to 19 antibiotic types.Whole-genome sequencing indicated that the pathogenic strains were all ST135 type,whereas the non-pathogenic strains were more diverse and scattered.HierCC clustering analysis grouped all strains into three clus-ters:pathogenic strains were in one cluster,and strains from patients were found in all three clusters.In conclusion,the Y.enterocolica strains from patients were primarily non-patho-genic.Non-pathogenic strains showed richer epigenetic and ge-netic diversity than pathogenic strains.The monitoring of these strains should be strengthened to decrease the risk of human infection.

Objective To achieve intelligent recognition and segmentation of common craniocerebral inju-ries(hereinafter referred to as"segmentation")by training convolutional neural network DeepLabV3+model based on CT images of blunt craniocerebral injury(BCI),and to explore the value of deep learning in automated diagnosis of BCI in forensic medicine.Methods A total of 5 486 CT images of BCI from living persons were collected as the training set,validation set and test set for model training and performance evaluation.Another 255 CT images of BCI and 156 normal craniocerebral CT images from living persons were collected as the blind test set to evaluate the ability of the model to seg-ment the five types of craniocerebral injuries including scalp hematoma,skull fracture,epidural hema-toma,subdural hematoma,and brain contusion.Another 340 BCI and 120 normal craniocerebral CT images from cadavers were collected as the new blind test set to explore the application value of the model trained by living CT images in the segmentation of BCI in cadavers.The five types CT images of all BCI except the blind test set were manually labeled;then,each dataset was inputted into the model to train the model.The performance of the model was evaluated and optimized based on the loss function and accuracy curves of the training set and validation set,and the generalization ability was evaluated based on the Dice value of the test set.According to the accuracy,precision and F1 value of the blind test set,the segmentation performance of the model for five types of BCI was evaluated.Results After training and optimizing the model,the average Dice values of the final optimal model to scalp hematoma,skull fracture,epidural hematoma,subdural hematoma and brain contusion segmen-tation were 0.766 4,0.812 3,0.938 7,0.782 7 and 0.858 1,respectively,all greater than 0.75,meeting the expected requirements.External validation showed that the F1 values were 93.02%,89.80%,87.80%,92.93%and 86.57%in living CT images,respectively;83.92%,44.90%,76.47%,64.29%and 48.89%in cadaveric CT images,respectively.The above suggested that the model was able to accu-rately segment various types of craniocerebral injury on living CT images,while its segmentation ability was relatively poor on cadaveric CT images,but still able to accurately segment scalp hematoma,epidu-ral hematoma and subdural hematoma.Conclusion Deep learning model trained on CT images can be used for BCI segmentation.However,the direct use of living persons'BCI models for the identifica-tion of cadaveric BCI has some limitations.This study provides a new approach for intelligent segmen-tation of virtual anatomical data for BCI.