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.

Objective:To explore the value of lumbar volumetric bone mineral density (vBMD) measured by quantitative computed tomography (QCT) in predicting coronary artery calcification (CAC).Methods:This retrospective, cross-sectional study included a total of 991 patients (504 male and 487 female) who underwent coronary artery CT angiography (CTA) and chest, abdomen, or lumbar spine CT examinations at Taihe County People′s Hospital from January 2023 to June 2024. Lumbar vBMD was measured by QCT. The coronary artery calcification score (CACS) was calculated using an artificial intelligence-assisted diagnostic system. Patients were categorized into a low calcification group (CACS≤100, 592 cases) and a moderate-to-severe calcification group (CACS>100, 399 cases). Independent-sample t-tests, Mann-Whitney U tests, or χ2 tests were employed to analyze the differences in clinical data and lumbar vBMD between the two groups. Binary logistic regression was employed to control confounding factors and analyze the correlation between lumbar vBMD and moderate-to-severe CAC. Multivariate binary logistic regression was used to identify independent predictors of moderate-to-severe CAC and construct a combined prediction model. The receiver operating characteristic curve was used to evaluate the efficacy of lumbar vBMD and the combined model in predicting moderate-to-severe CAC. The comparison of the area under the curve (AUC) was conducted using the DeLong test. Results:The age, incidence of diabetes, hypertension, and osteoporosis were significantly higher in the moderate-to-severe calcification group than in the low calcification group, while lumbar vBMD was significantly lower in the former group (all P<0.05). The body mass index, smoking history, and hyperlipidemia had no statistical differences between the two groups (all P>0.05). Following adjustment for potential confounding variables, the results of binary logistic regression analysis revealed that lumbar vBMD was not significantly associated with the presence of moderate-to-severe CAC in the overall study population or in male ( OR=0.998, 95% CI 0.993-1.003, P=0.379; OR=1.000, 95% CI 0.993-1.006, P=0.918). However, lumbar vBMD was a statistically significant predictor in females ( OR=0.992, 95% CI 0.985-0.999, P=0.032). Multivariate binary logistic regression analysis further demonstrated that age ( OR=1.048, 95% CI 1.019-1.077, P=0.001), hypertension ( OR=2.649, 95% CI 1.719-4.082, P<0.001), and lumbar vBMD ( OR=0.992, 95% CI 0.984-0.999, P=0.022) were independent predictors of moderate-to-severe CAC in women. The AUC of lumbar vBMD for predicting moderate-to-severe CAC in female patients was 0.684 (95% CI 0.641-0.725), and the AUC of the combined model was 0.746 (95% CI 0.705-0.784), with a statistically significant difference ( Z=3.26, P=0.001). Conclusions:Lumbar vBMD measured by QCT is an independent predictor of moderate-to-severe CAC in women and demonstrates moderate predictive value. The predictive performance can be enhanced by integrating age and hypertension into a combined predictive model.

OBJECTIVE To evaluate the efficacy and safety of Weiyan Tongluo Granules in treating chronic atrophic gastritis(CAG)and explore its potential mechanisms.METHODS From June 2020 to December 2022,100 CAG patients with spleen defi-ciency and blood stasis syndrome were enrolled and randomly divided into a trial group(n=50)and a control group(n=50)using a random number table.The trial group received Weiyan Tongluo Granules plus a folic acid placebo,while the control group received fo-lic acid tablets plus a traditional Chinese medicine granule placebo.The treatment course for both groups was 24 weeks,with 8 and 10 dropouts in the trial and control groups,respectively.Post-treatment comparisons included OLGA/OLGIM staging reversal rates,low-grade intraepithelial neoplasia regression rate,SSDPRO-CG(Patient-Reported Outcome Scale for Chronic Gastritis in Spleen-Stomach Diseases)scores,TCM syndrome scores,and safety indicators.Serum levels of PG I,PGⅡ,PGR,and G-17 were measured via ELISA before and after treatment.Gastric mucosal p-NF-κB and CDX2 protein expression levels were analyzed by Western blot,while mRNA levels of IL-1β,IL-6,VIL1,and MUC2 were quantified via qPCR.RESULTS After treatment,the trial group showed sig-nificantly higher OLGA and OLGIM stage reversal rates than the control group(P<0.05,P<0.01),though no significant difference was observed in low-grade intraepithelial neoplasia regression.Both groups exhibited significant improvements in physiological domain scores and total SSDPRO-CG scores(P<0.01),with the trial group outperforming the control group in physiological,independence,psychological domains,and total scores(P<0.05,P<0.01).TCM syndrome scores(total and sub-items:gastric distension,pain,poor appetite,bloating)decreased significantly in both groups(P<0.01),while the trial group showed greater reductions in loose stools and dull complexion(P<0.01).After-treatment,the trial group had significantly lower TCM syndrome scores than the control group(P<0.05,P<0.01).Serum PG I,PGⅡ,PGR,G-17,gastric mucosal p-NF-κB,CDX2,and IL-1β,IL-6,VIL1,MUC2 mRNA levels improved significantly in the trial group(P<0.05,P<0.01),while the control group improved only in PGⅡ(P<0.05,P<0.01).The trial group's improvements in these biomarkers surpassed the control group's(P<0.05,P<0.01).No treatment-related adverse events occurred in either group.CONCLUSION Weiyan Tongluo Granules ameliorate gastric mucosal pathology,clinical symptoms,psychological state,and quality of life in CAG patients without significant adverse effects.Its mechanism may involve sup-pressing the NF-κB pathway to reduce IL-1β and IL-6 expression,downregulating CDX2 to inhibit VIL1 and MUC2 transcription,thereby reversing the vicious cycle of inflammation-intestinal metaplasia.

Objective To investigate the predictive value of the red cell distribution width/platelet count ratio(RPR)for lower extremity deep vein thrombosis(DVT)after transurethral resection of the prostate(TURP).Methods A total of 104 benign prostatic hyperplasia(BPH)patients who underwent TURP in the hospital from January 2022 to December 2024 were selected as the study subjects.Patients who developed postoperative lower extremity DVT were assigned to the DVT group(n=25),while those without DVT were assigned to the non-DVT group(n=79).Red cell distribution width(RDW),platelet count(PLT)and RPR at admission were compared between the two groups.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of RDW,PLT,and RPR for lower extremity DVT after TURP.Multivariate Logistic stepwise regression analysis was performed to explore influencing factors for lower extremity DVT after TURP.Results RDW and RPR in the DVT group were significantly higher than those in the non-DVT group(P<0.05),while PLT was significantly lower(P<0.05).ROC curve analysis showed that the area un-der the curve(AUC)of RDW,PLT,and RPR for predicting postoperative lower extremity DVT in BPH pa-tients were 0.749(95%CI:0.704-0.799),0.822(95%CI:0.777-0.872),and 0.913(95%CI:0.868-0.963),with cut off values of 16.64%,219.15×109/L,and 0.07,respectively.The AUC of RPR was signifi-cantly higher than that of RDW or PLT alone(Z=9.805,P<0.001,Z=11.491,P<0.001).The DVT group had higher levels of D-dimer,fibrinogen,intraoperative blood loss,and a higher proportion of patients with a history of cerebral infarction compared to the non-DVT group(P<0.05).Multivariate Logistic stepwise re-gression analysis showed that D-dimer(OR=2.280,95%CI:1.274-4.080),fibrinogen(OR=2.479,95%CI:1.220-5.041),and RPR(OR=3.885,95%CI:1.964-7.684)were independent risk factors for postop-erative lower extremity DVT(P<0.05).Conclusion The elevation of RPR is closely related to the risk of postoperative lower extremity DVT in patients with BPH,and this indicator is expected to become an impor-tant reference for predicting the risk of lower extremity DVT.

Objective:To evaluate the effect of Bu-Zhong-Yi-Qi-Tang (BZYQT) combined with low molecular weight heparin (LMWH) on lower limb deep vein thrombosis (DVT) after fracture fixation in aged rabbits.Methods:Thirty-two elderly New Zealand rabbits of either sex, aged 36 months, weighing 3.5-4.0 kg, were divided into 4 groups ( n=8 each) using the random number table method: control group (C group), fracture fixation group (F group), low molecular weight heparin group (L group) and BZYQT combined with LMWH group (BL group). A model of fixation surgery for right femoral shaft fracture was established in anesthetized rabbits in F, L and BL groups. Starting from postoperative day 1, BL group received BZYQT at 3.6 ml/kg via gavage, F and L groups received normal saline at 3.6 ml/kg via gavage, L and BL groups received subcutaneous injection of LMWH at 200 IU/kg, and all the administrations were performed daily at 08: 00 for 7 consecutive days. On postoperative day 7, ultrasound examination was performed to assess lower limb DVT. Blood samples were collected from the marginal ear vein for determination of the serum concentrations of cortisol (COR), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and endothelin-1 (ET-1) by enzyme-linked immunosorbent assay. Femoral vein specimens were obtained under anesthesia for microscopic examination of the pathological changes of the femoral vein lumen and endothelial tissues (by HE staining) and of the morphology of vascular endothelial cells (by the transmission electron microscopy). Results:Compared with C group, the concentrations of serum COR, TNF-α, IL-6 and ET-1 were significantly increased in F, L and BL groups, and the incidence of lower limb DVT within 7 days after surgery was significantly increased in F and L groups ( P<0.05). Compared with F group, the incidence of lower limb DVT within 7 days after surgery was significantly decreased in L and BL groups, and the concentrations of serum COR, TNF-α, IL-6 and ET-1 were significantly decreased ( P<0.05), and the pathological damage was significantly reduced in BL group. Compared with L group, the incidence of lower limb DVT and concentration of IL-6 were significantly decreased ( P<0.05), and pathological damage was significantly alleviated in BL group. Conclusions:BZYQT combined with LMWH can prevent the occurrence of lower limb DVT after fracture fixation in aged rabbits.

Objective:To understand the occurrence of different patterns of multimorbidity among children and adolescents aged 9-18 in Tianjin City and analyze the cumulative effects of lifestyle on these patterns of multimorbidity.Methods:From September to November 2022, a stratified cluster random sampling method was used to select students from primary schools, junior high schools, general high schools, and vocational schools in 16 districts of Tianjin to screen for height, weight, blood pressure, distant vision, and diopter. One year later, a follow-up measurement and questionnaire survey were conducted. The log-binomial model was used to analyze the strength of the association between lifestyle factors and different patterns of multimorbidity.Results:The age of 9 488 students was (12.37±2.49) years old, including 4 999 boys and 4 489 girls. The detection rates of three patterns of multimorbidity of overweight obesity and high blood pressure, overweight obesity and myopia, and overweight obesity with high blood pressure and myopia were 6.63%, 9.32%, and 4.21%, respectively. The detection rates of the three types of multimorbidity in boys were higher than those in girls (all P<0.001). The detection rate of overweight obesity and high blood pressure in suburban areas was higher than that in urban areas ( P=0.002). The detection rate of overweight obesity and myopia in suburban areas was lower than that in urban areas ( P=0.034). The detection rate of overweight obesity and myopia among those aged 9-12 years old was higher than other age groups (all P<0.001). The ARR (95% CI) for the association between favorable physical activity and the occurrence of overweight obesity and high blood pressure was 0.79 (0.68-0.92). The ARR (95% CI) for the association between favorable physical activity and the occurrence of overweight obesity with high blood pressure and myopia was 0.82 (0.67-0.99). Compared with children and adolescents with 0-2 favorable lifestyle factors, those with 4-5 favorable lifestyle factors had a lower risk of overweight obesity and high blood pressure ( ARR=0.84, 95% CI: 0.59-0.92). Conclusion:Boys aged 9-18 in Tianjin City are more prone to multimorbidity of overweight obesity and high blood pressure, overweight obesity and myopia, and overweight obesity with high blood pressure and myopia. Children and adolescents with 4-5 favorable lifestyle factors have a reduced risk of occurrence of overweight obesity and high blood pressure. Lifestyle has cumulative effects on multimorbidity of overweight obesity and high blood pressure.

Objective:To evaluate the elastic characteristics of the pulmonary trunk and its distal branches in fetuses with tetralogy of Fallot（TOF）by Doppler echocardiography.Methods:A total of 42 fetuses with TOF（TOF group）and 84 gestational age-matched normal fetuses（control group）were prospectively collected from the Second Xiangya Hospital of Central South University from August 2022 to January 2023. The severity of TOF was classified into mild TOF（Z-score≥-2），moderate TOF（-40.05）. Conclusions:Fetuses with TOF present with increased MPA-PAS and decreased stiffness in the distal PA. Histological abnormalities of the pulmonary artery wall in fetuses with TOF have been observed during pregnancy.

Objective:To investigate the feasibility of the ultrasound "triangular method" in evaluating the morphology of the aortic arch in normal mid-to-late trimester fetuses，establish the gestational age-specific reference ranges for its morphological parameters，and to analyze their correlations with gestational age（GA）and cardiac valve annulus diameters.Methods:A prospective study was conducted on 317 normal singleton fetuses at 20-38 +6 weeks of gestation from the Second Xiangya Hospital of Central South University. Morphological parameters including arch length（a+b），arch width（w），arch height（h）and arch angle（θ）were measured using the "triangular method" in the aortic arch long-axis view. Arch tortuosity（a+b/w）and height-to-width ratio（h/w）were calculated. Linear regression was used to analyze correlations between arch length，width，height and GA，the reference intervals were established. Pearson correlation was applied to assess relationships between angle，tortuosity，height-to-width ratio and GA，cardiac valve annulus diameters（aortic，pulmonary，mitral，tricuspid）. Results:Aortic arch length，width and height showed strong positive correlations with GA（ r = 0.88，0.88，0.85；all P < 0.001）. The arch angle，tortuosity，and height-to-width ratio were independent of GA（all P > 0.05），with reference values of（69.2 ± 6.1）°，1.7 ± 0.1，and 0.7 ± 0.1，respectively. These parameters also showed no significant correlations with cardiac valve annulus diameters（all P > 0.05）. Conclusions:The ultrasound "triangular method" systematically quantifies fetal aortic arch morphology. The stability of arch angle，tortuosity and height-to-width ratio during mid-to-late gestation may provide a morphological benchmark for prenatal screening of aortic arch anomalies.

Objective:To evaluate the value of the proposed interpretable denoising deep learning model-grouped sharing convolutional attention-visual transformer（GSCAViT）for classifying normal fetal echocardiograms.Methods:A total of 2 501 images from 358 fetuses who underwent cardiac ultrasound examinations at Xiangya Second Hospital of Central South University from January to November 2024 were retrospectively analyzed. GSCAViT was constructed based on fetal echocardiograms from the three-vessel and trachea view，apical four-chamber view，long-axis view of the aortic arch，bicaval view，left ventricular outflow tract view，three-vessel view and right ventricular outflow tract view were compared with both baseline and improved models in the validation set to assess the performance of the classification echocardiography in terms of accuracy，precision，recall and F1-score. Its generalizability across test sets was assessed using the area under the ROC curve（AUC），sensitivity，specificity and F1-score. The impact of image features was interpreted using SHapley Additive exPlanations（SHAP）.The effectiveness of the GSCA module was compared through visual analysis，image parameter metrics and classification performance.Results:The GSCAViT model achieved classification performance for fetal echocardiograms second only to MaxViT，with an accuracy of 97.1%，precision of 97.1%，recall of 97.0%，and an F1-score of 97.0%. In the E10，E20 and E8 test sets，the AUCs of GSCAViT for the prediction of 7 types of fetal echocardiograms were 0.994，0.928 and 0.932，the sensitivities were 99.4%，81.3% and 72.9%，the specificities were 99.7%，96.8% and 94.8%，the F1-scores were 99.4%，81.3% and 67.6%，respectively. SHAP visualization indicated that the model could identify key structural features within the images. Images processed by the denoising-guided group-sharing convolutional attention module best captured and enhanced important regional features，achieving the highest contrast-to-noise ratio，peak signal-to-noise ratio and optimal classification performance，which demonstrated the module's effectiveness.Conclusions:The proposed GSCAViT model exhibits superior performance in classifying seven types of normal fetal echocardiograms compared to the baseline and some improved models. Furthermore，SHAP visualization enhances the interpretability of the classification results，and visual comparisons，image parameter analyses，as well as classification performance metrics confirming the effectiveness of the denoising-guided group-sharing convolutional attention module in the visual transformer model.

Objective:We summarize the clinical characteristics of surgeries in which the thyroid lobe is used as a transfer flap to treat early pharyngeal fistula following total laryngectomy.We also provide useful data for improving the diagnosis and management of this condition.Methods:Retrospective analysis was conducted on data from 8 patients with pharyngocutaneous fistulas after total laryngectomy for laryn-geal and pharyngeal cancer patients admitted to Hunan Provincial People's Hospital(The First Hospital Affiliated to Hunan Normal University)between October 2016 and October 2023.The surgeons performed a double-layer repair technique that included local inversion and a purse-string suture of the fistula using the thyroid lobe as a transfer flap.Clinical data were collected to analyze postoperative outcomes.Results:All eight patients experienced successful pharyngeal fistula repair.Postoperatively,these patients were managed with nasogastric tube feed-ing,liquid diet,and prophylactic antibiotics to prevent infection.After 10 days,their diet was changed to oral liquids,and their nasogastric tubes were removed.All patients were discharged after complete recovery.Conclusions:Use of the thyroid lobe as a transfer flap in a double-layer repair technique involving local inversion of the fistula is an effective method for repairing early pharyngeal fistula after total laryngectomy.This approach offers several advantages,including ease of flap harvesting,shortened operation time,reduced patient discom-fort,high transfer flap survival rate,and rapid postoperative recovery.The clinical efficacy of this technique is well-supported,making it a re-liable option for the management of early pharyngeal leaks.