Objective To investigate the 30-day mortality risk factors in elderly patients with heart failure with reduced ejection fraction (HFrEF) after isolated coronary artery bypass grafting (CABG) and to construct a nomogram for predicting mortality risk. Methods A retrospective analysis of elderly (≥70 years) HFrEF patients undergoing isolated CABG at Tianjin Chest Hospital from 2010 to 2024 was performed. Simple random sampling in R software was used to divide the dataset into training and validation sets in a 7 : 3 ratio. The training set was further divided into survivors and non-survivors. Univariate logistic regression was performed to identify differences between groups, followed by multivariate logistic regression to select independent risk factors for death and to establish a death-risk nomogram, which underwent internal validation. The predictive value of the nomogram was assessed by plotting receiver operating characteristic (ROC) curves, calibration curves, and decision-curve analyses for both the training and validation sets. Results A total of 656 patients were included. The training set consisted of 458 patients (survivors 418, deaths 40); the validation set consisted of 198 patients (survivors 180, deaths 18). In the training set, univariate analysis showed significant differences between survivors and deaths for creatinine (Cr) level, brain natriuretic peptide (BNP), maximum Cr, intra-aortic balloon pump (IABP) use, assisted ventilation, reintubation, hyperlactatemia, low cardiac output syndrome, and renal failure (P<0.05). After multivariable logistic regression, five independent risk factors were identified: IABP use (OR=3.391, 95%CI 1.065-11.044, P=0.038), reintubation (OR=15.991, 95%CI 4.269-67.394, P<0.001), hyperlactatemia (OR=8.171, 95%CI 2.057-46.089, P=0.007), Cr (OR=4.330, 95%CI 0.997-6.022, P=0.024), and BNP (OR=1.603, 95%CI 1.000-2.000, P=0.010). Accordingly, a nomogram predicting mortality risk was constructed. The ROC and calibration analyses indicated good predictive value: area under the curve (AUC) in the training set was 0.898 (95%CI 0.831-0.966) and in the validation set was 0.912 (95%CI 0.805-1.000). Calibration and decision-curve analyses showed good agreement and clinical utility. Conclusion The nomogram incorporating IABP use, reintubation, hyperlactatemia, creatinine, and BNP provides good predictive value for 30-day mortality after CABG in elderly patients with HFrEF and demonstrates potential clinical utility.

Objective: To investigate the association between different digital media usage types and depressive symptoms among junior and senior high school students, so as to provide a scientific reference for making precise mental health prevention and intervention strategies for adolescents. Methods: In October 2024, a convenience cluster sample of 3 225 students was collected from 2 junior high schools and 2 senior high schools in Shenyang City. Participants were investigated for its daily usage duration of various digital media types and depressive symptoms. Cochran-Armitage trend test was used to examine trend in depressive symptom detection rates across digital media usage types. Multivariate Logistic regression model was employed to assess associations, with stratified analyses by gender and educational stage. Results: The daily usage durations for educational/learning, social/chatting, gaming, and video/music/novel digital media were 30.0(12.1, 60.0), 22.9(9.3, 50.0), 17.1(0.0, 50.0), and 22.9(8.6, 55.7) minutes for junior and senior high school students, respectively. The detection rate of depressive symptoms was 46.1%. Among them, the detection rate of depressive symptoms of girls (49.8%) was higher than that of boys (42.3%), and that of senior high school students (53.2%) was higher than that of junior high school students (39.7%), and the differences were statistically significant ( χ 2= 18.35, 59.02, both P <0.01). Cochran-Armitage trend test revealed significant upward trends in depressive symptom detection rates with increasing usage of non educational digital media (social/chatting: Z =4.77; gaming: Z =3.24; video/music/novel: Z =7.30, all P <0.01). Logistic regression analysis showed that, compared to usage <1 h/d, using social/chatting digital media for 1-<2 h/d ( OR =1.66), 2-<3 h/d ( OR =1.80), and ≥3 h/d ( OR =2.68), gaming for 1-<2 h/d ( OR =1.48), 2-<3 h/d ( OR =1.90), and ≥3 h/d ( OR =2.93), and video/music/novel for 1-<2 h/d ( OR =1.76), 2-<3 h/d ( OR =2.00), and ≥3 h/d ( OR = 3.48) were all significantly associated with increased risks of depressive symptoms (all P <0.01). Conclusions Excessive use of non-educational digital media is a risk factor for depressive symptoms in adolescents. Regulating usage duration is beneficial for promoting adolescent mental health.

Objective: To explore the regulatory role of paternal involvement in parenting in the association between parental adverse childhood experiences (ACEs) and autism like behavioral problems in children aged 3-6, so as to provide a basis for intervention strategies targeting the intergenerational health effects of ACEs. Methods: A longitudinal study design was used to select 1 780 children aged 3-6 from 12 kindergartens in Wuhu City, Anhui Province in June 2021 as the subjects of the baseline survey by convenient sampling, and the follow up surveys were conducted once every six months, for a total of two follow ups. Pearson correlation analysis was used to examine the association of parental ACEs and paternal involvement in parenting with autism like behavioral problems in children. A binary Logistic regression model was used to explore the association between parental ACEs and autism like behavioral problems in children. Based on stratification, the potential role of paternal involvement in the association between parental ACEs and autism like behavioral problems in children aged 3-6 was explored. Results: Autism like behavioral problem score in children aged 3-6 was positively correlated with the total score ACEs of parents as well as scores of emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, community violence, peer bullying, and family dysfunction( r =0.18,0.16,0.18,0.14,0.06,0.05,0.12,0.18,0.09,all P <0.05). Autism like behavioral problem score in children was negatively correlated with score of paternal involvement in parenting( r =-0.16, P <0.01). After adjusting for covariates such as gender, age, and birth weight of children, binary Logistic regression analysis showed that children whose parents had experiences of childhood emotional abuse, physical abuse, sexual abuse, community violence, peer bullying, or family dysfunction had higher risks of developing autism like behavioral problems than those in the non exposed group ( OR =3.29, 3.28, 6.71, 2.34, 4.08, 2.02, all P <0.01). In the group with low paternal involvement in parenting, all dimensions of parental ACEs(emotional abuse, physical abuse, sexual abuse, community violence, peer bullying, and family dysfunction) were significantly associated with an increased risk of autism like behavioral problems in children ( OR =1.84-8.34, all P <0.05). In contrast, in the group with high paternal involvement in parenting, no statistically significant associations were found between any dimension of parental ACEs and children s autism like behavioral problems ( OR =0.57-1.82, all P >0.05). Conclusion A high level of paternal involvement in parenting can reduce the adverse effects of parental ACEs on the occurrence of autism like behaviors in preschool children.

Background and Objectives: Patients with dilated cardiomyopathy (DCM) tend to be accompanied by biventricular impairment. We hypothesized that the combination of the aortic pulsatility index (API) and pulmonary artery pulsatility index (PAPI) could refine risk stratification in DCM. Methods: We studied 120 consecutive patients with advanced DCM who underwent right heart catheterization (RHC). The primary outcome was all-cause mortality within 1 year after RHC. We used the receiver operating characteristic curve to determine the optimal cut-off of API and PAPI to predict outcomes. Results: The optimal cut-offs of API (1.02) and PAPI (2.16) were used to classify patients into four groups. There were significant differences in left ventricular ejection fraction (LVEF) and tricuspid annular plane systolic excursion (TAPSE) among the four groups (both p<0.05).When delineating API by LVEF above or below the median (28%), the cumulative rate of survival in patients with API <1.02 was lower than that of those with API ≥1.02 in both higher and lower LVEF groups (both p<0.05). Similar trends were observed when delineating PAPI using TAPSE higher or lower than the cut-off (17 mm) (both p<0.05). The cumulative rate of survival in the API <1.02 and PAPI <2.16 group was lower than that in the API ≥1.02 and/or PAPI ≥2.16 (all p<0.05). Conclusions API and PAPI could add additional prognostic value to LVEF and TAPSE, respectively. The combination of API and PAPI could provide a comprehensive assessment of biventricular function and refine risk stratification.

Objectives:Coronary slow flow(CSF)has long been regarded as a marker of coronary microvascular dysfunction(CMD).This study aims to evaluate the diagnostic value of CSF for CMD in patients with angina and nonobstructive coronary arteries(ANOCA).Methods:The study data were derived from the ANOCA-CMD prospective cohort study.All enrolled patients underwent coronary angiography and concurrent coronary physiological assessments in the left anterior descending artery using pressure-wire and thermodilution techniques to obtain coronary flow reserve(CFR)and the index of microcirculatory resistance(IMR).Based on the results,CMD was classified into four subtypes:CMD with elevated IMR(IMR≥25),CMD with reduced CFR(CFR<2.5),CMD with either reduced CFR or elevated IMR(CFR<2.5 or IMR≥25),and CMD with both reduced CFR and elevated IMR(CFR<2.5 and IMR≥25).The corrected thrombolysis in myocardial infarction(TIMI)frame count(CTFC)in the left anterior descending artery was calculated from coronary angiography images,with CSF defined as CTFC>27.This study evaluated the correlation between CTFC,CFR,and IMR,and investigated the diagnostic value of CSF for CMD in ANOCA patients.Results:A total of 103 ANOCA patients were enrolled in this study,with a mean age of(64.2±10.6)years,and 53.4％were female.Among them,57 patients(55.3％)were diagnosed with coronary slow flow.Patients with slow flow had higher IMR(P<0.001)and CFR(P=0.041).Similarly,the proportion of CMD with elevated IMR was higher in the slow flow group(P<0.001),while the proportion of CMD with reduced CFR was lower(P=0.044).There was no significant difference between the groups in the proportions of CMD with either reduced CFR or elevated IMR or CMD with both reduced CFR and elevated IMR(all P>0.05).CTFC was positively correlated with hyperemic mean transit time(r=0.424,P<0.001),IMR(r=0.430,P<0.001),and CFR(r=0.211,P=0.032).The area under the curve(AUC)of CTFC for diagnosing CMD with elevated IMR was 0.721(95％CI:0.623-0.819)with an accuracy of 67％(57％,76％),for diagnosing CMD with reduced CFR was 0.610(95％CI:0.499-0.720)with an accuracy of 60％(50％,70％),for diagnosing CMD with either reduced CFR or elevated IMR was 0.549(95％CI:0.425-0.673)with an accuracy of 47％(37％,57％),and for diagnosing CMD with both reduced CFR and elevated IMR was 0.582(95％CI:0.471-0.693)with an accuracy of 47％(37％,57％).Thus,CSF demonstrated limited diagnostic values across all subtypes of CMD.Conclusions:In ANOCA patients,CSF cannot serve as an effective diagnostic marker for CMD.Therefore,in clinical practice,the slow flow phenomenon should not be directly equated with the presence of coronary microvascular dysfunction in ANOCA patients.

Objective To investigate the value of predicting microsatellite instability(MSI)status in endometrial cancer based on whole-tumor apparent diffusion coefficient(ADC)histogram.Methods The data of 131 endometrial cancer patients who underwent preoperative MRI examination and were confirmed by pathology were retrospectively analyzed.According to the pathological immu-nohistochemical results,they were divided into microsatellite stability(MSS)group(103 cases)and MSI group(28 cases).The whole-tumor volume of interest(VOI)was outlined using ITK-SNAP software,and ADC histogram analysis was performed using uAI Research Portal software.The t-test or Mann-Whitney U-test were used to compare the differences between the two groups,and multifactorial logistic regression analysis was used to screen independent predictors for the above parameters with differences.The area under the curve(AUC),sensitivity and specificity were calculated using the receiver operating characteristic(ROC)curve.Results The ADC histogram parameters that were statistically significant between groups were ADC10th,ADC90th,ADCmaximum,ADCmedian,ADCmean,ADCrange,ADCinterquartile range,ADCuniformity,ADCvariance,ADCenergy,ADCentropy,ADCtotal energy,ADCroot mean square,ADCmean absolute deviation,ADCrobust mean absolute deviation,all the above parameters were significantly smaller in the MSI group than in the MSS group.Further multifactorial logistic regression analysis results showed that ADCmedian[odds ratio(OR)=1.019,P=0.020]and ADCroot mean square(OR=0.977,P=0.005)were independent predictors of the MSI status in endometrial cancer.The results of ROC curve showed that the AUC of ADCmedian and ADCroot mean square for predicting MSI status were 0.699 and 0.731,respectively,and the AUC of combining the two parameters to predict MSI status was 0.760,with a sensitivity of 57.14%and a specificity of 86.41%.Conclusion The parameters of ADCmedian and ADCroot mean square based on whole-tumor ADC histogram can be used to predict the MSI status of endometrial cancer,and the combined use of these two parameters helps to improve the efficacy of predicting MSI.

Objective·To construct an interpenetrating network hydrogel(HMGL)that can induce hypoxia in situ,investigate its effects on promoting the secretion of extracellular matrix in nucleus pulposus cells(NPCs),and evaluate its potential in the treatment of intervertebral disc degeneration.Methods·HMGLs capable of long-term in situ hypoxia induction were prepared by a two-step polymerization method.Hypoxic hydrogels with laccase concentrations of 5 U/mL and 10 U/mL,namely HMGL-5 and HMGL-10,were constructed,whereas a hyaluronic acid methacryloyl(HAMA)hydrogel served as the control.The molecular structures of HAMA and gelatin grafted with vanillin(GelVA)were verified by 1H nuclear magnetic resonance spectra(1H NMR)and Fourier transform infrared spectroscopy(FTIR).The microstructures of the hydrogels were observed by scanning electron microscope(SEM),and the mechanical properties of the hydrogels were tested by a rotational rheometer and a dynamic mechanical analyzer(DMA).The induced hypoxic behaviors of the hydrogels were detected by an oxygen consumption fluorescent probe.The biocompatibility of the hydrogels was tested by live/dead staining and the cell counting kit 8(CCK-8)assay,and the expression of hypoxia-inducible factor-1α(HIF-1α)and type Ⅱ collagen(Col Ⅱ)in NPCs was detected by immunofluorescence staining.A rat model of intervertebral disc degeneration was established,and hydrogels loaded with NPCs were injected into degenerated intervertebral discs to evaluate their repair effects.Disc height and disc water content changes were detected by X-ray imaging and magnetic resonance imaging(MRI),and the integrity of disc structure and proteoglycan levels were detected by histological staining.Results·Structural characterization demonstrated that the materials had been successfully prepared.SEM showed that the three hydrogels all had a loose and porous structure,and their elastic moduli increased with the decrease of pore size.Hypoxia test results indicated that the hypoxia-inducing ability of HMGL-10 hydrogel was the strongest.In vitro experimental results showed that the three hydrogels all had good biocompatibility.Compared with the HAMA hydrogel,the HIF-1α of NPCs was significantly activated in the HMGL-10 hydrogel.The expression levels of HIF-1α and Col Ⅱ in the HMGL-10 hydrogel group were 3.38 and 4.15 times higher than those in the HAMA hydrogel group.In vivo experimental results showed that the integrity,height,and water content of the intervertebral discs in the hypoxia hydrogel group were all superior to those in the other treatment groups.Conclusion·The in situ hypoxia-inducing hydrogel effectively activates HIF-1α,promotes extracellular matrix secretion,and demonstrates superior regenerative potential for intervertebral disc repair.

Objective:To investigate the optimal processing technology for Sophorae Fructus Carbonisata(char-coal-processed immature fruit of Sophora japonica)by integrating thermal analysis,response surface methodology(RSM),and intelligent sensory technology.Methods:The thermal analysis technology was used to simulate the processing process of traditional Chinese medicine(TCM),the pyrolysis characteristics of Sophorae Fructus powder were studied,and the processing process was discussed by intelligent sensory analysis to determine the temperature range.Using the contents of genistein,kaempferol,and quercetin as comprehensive evaluation indices,the RSM was applied to optimize the processing technology for Sophorae Fructus Carbonisata.Results:The optimal process-ing technology for Sophorae Fructus Carbonisata was identified as:Stir-frying temperature was 290 ℃,Stir-frying time was 14 min.Conclusion:The integrated approach of thermal analysis-RSM and intelligent sensory technology has successfully established an accurate predictive model for active components in Sophorae Fructus.The optimized processing technology not only enhances the reproducibility of charcoal processing but also lays a foundation for the formulation of national quality standards for this TCM.

Objective:To investigate the relationship between the level of angiotensin Ⅱ type 1 receptor autoantibody (AT1-AA) in the uterine fluid and the thickness of endometrium in infertile women with chronic endometritis.Methods:A case-control study was conducted to select 122 patients who underwent hysteroscopy and endometrial tissue biopsy at Assisted Reproduction Center, Taiyuan Central Hospital due to infertility from March 2023 to January 2024 as the study subjects. According to the results of hysteroscopy and endometrial tissue biopsy, the patients were divided into 52 cases in the infertility group with normal endometrium (NE infertility group) and the chronic endometritis combined with infertility group (CE infertility group) with 70 cases. Enzyme-linked immunosorbent assay was used to detect the level of AT1-AA in uterine fluid of the two groups. General clinical data, AT1-AA absorbance value of uterine fluid and uterine related indexes of the two groups were analyzed, and the correlations between AT1-AA level and the variation of indexes were analyzed.Results:Gravidity (median: 1 vs 1; Z=7.029, P=0.030) and parity (median: 0 vs 0; Z=12.258, P=0.002) in CE infertility group were higher than those in NE infertility group. There was AT1-AA in the uterine fluid, and the level of AT1-AA in CE infertility group was significantly higher than that in NE infertility group (median: 2.07 vs 1.44; Z=3.099, P=0.029). The endometrial thickness of CE infertility group was lower than that of NE infertility group (median: 6.0 vs 7.0 mm; Z=-2.179, P=0.029), and there were no statistical differences in other indexes between the two groups (all P>0.05). Further correlation analysis showed that there were no correlation between the level of AT1-AA in uterine fluid and parity, endometrial thickness, gravidity in NE infertility group (all P>0.05). However, the level of AT1-AA in uterine fluid of CE infertility group was positively correlated with parity (Spearman′s r=0.339, P=0.004), and negatively correlated with endometrial thickness (Spearman′s r=-0.499, P<0.001), but not correlated with gravidity ( P>0.05). Conclusions:AT1-AA is present in the uterine fluid of infertile women. The elevated level of AT1-AA in uterine fluid of infertile women with CE is related to the thinning of the endometrium.

Objective:To analyze the access pathway,regulatory process and payment of digital therapies in various countries,so as to provide references and materials for the development of digital therapies in China.Methods:By using literature research method,text analy-sis method and comparative analysis method,it combed domestic and international policies related to digital therapy,described the policy support status of digital therapy in each country,and comparatively analyzed the differences in the definition,regulation and payment of digi-tal therapy products in each country.Results:The US,Germany,UK,Japan,South Korea,and other countries have introduced frame-works to define,categorize,and approve digital therapies,distinguishing them from other digital health products.China also includes digital therapies in its national planning,with Hainan leading in supportive policies.Regulatory processes slightly differ by country but generally in-volve determining risk levels and conducting comparative analysis.Currently,only the UK,Germany,Japan,etc.,offer health insurance reimbursement for digital therapies.Conclusion:Internationally,there are mature policy frameworks and experiences for digital therapies,and China can learn from the international experiences,while exploring the path of digital therapies with Chinese characteristics and continue to improve the policies of digital therapies and to meet the needs of patients.