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.

Rheumatoid arthritis （RA） is a chronic systemic autoimmune disease characterized by symmetrical polyarthritis， which may lead to joint deformity and loss of joint function in the long term， severely impairing patients' quality of life. Danggui Niantongtang， originated from Medical Revelations by Zhang Yuansu in the Jin Dynasty， has the effects of clearing heat and draining dampness， dispelling wind and alleviating pain， and serves as a classic formula for treating RA damp-heat stagnation syndrome. By searching CNKI， Wanfang， PubMed and other databases， the author systematically reviewed the clinical efficacy and experimental research of Danggui Niantongtang in the treatment of RA， and elucidated its mechanisms of action， so as to provide a valuable reference for future clinical and basic research of Danggui Niantongtang in the field of RA. Clinical studies demonstrated that Danggui Niantongtang can improve core symptoms in RA patients with the damp-heat stagnation syndrome， including joint swelling and pain， morning stiffness and limited joint mobility， decrease inflammatory markers such as C-reactive protein （CRP） and erythrocyte sedimentation rate （ESR）， and facilitate postoperative rehabilitation in RA patients undergoing total knee arthroplasty （TKA）. When combined with Western medicines such as methotrexate， it can enhance the anti-inflammatory efficacy and mitigate adverse reactions， including gastrointestinal discomfort and hepatic injury. Experimental studies revealed that this formula can modulate the inflammatory cytokine network， promote synoviocyte apoptosis， inhibit abnormal synoviocyte autophagy， suppress synovial angiogenesis， and maintain intestinal flora homeostasis. However， several limitations exist in current research， such as insufficient clinical quality， unclear interaction between mechanisms and networks， and insufficient research on dosage form optimization. In the future， high-quality clinical research， multi-omics mechanistic studies， and dosage form improvement are needed to provide scientific basis for its clinical promotion and in-depth research.

To analyze the clinical and genetic features of oculopharyngodistal myopathy (OPDM) patients and compare the phenotypic differences among various causative genes.

Purpose To explore the value of gray-scale ultrasound and contrast-enhanced ultrasound of carotid plaques combined with clinical factors in predicting the recurrence risk of ischemic stroke(IS)in patients with mild to moderate carotid stenosis.Materials and Methods A total of 101 patients with mild to moderate carotid artery stenosis who were initially diagnosed with IS in the First Medical Center of the Chinese PLA General Hospital were prospectively collected from May 2022 to August 2023.After one year of follow-up,patients were divided into recurrent group(n=33)and non-recurrent group(n=68)according to whether new IS occurred.The characteristics of plaque ultrasound and the clinical information of patients were compared between the two groups.A multivariate Logistic prediction model was established and its efficacy was evaluated.Results The results of multivariate analysis showed that low-density lipoprotein cholesterol(OR=2.116,P=0.046),C-reactive protein(OR=3.707,P=0.008),plaque internal echo(OR=7.410,P=0.029)and intraplaque neovascularization grading 3(OR=17.155,P=0.030)were independent risk factors for the recurrence of IS.The area under the curve of the model established using the above indicators was 0.825,the sensitivity and specificity were 87.50%and 65.15%,respectively.Conclusion The ultrasound features of carotid plaque are closely related to recurrent IS,which can provide an important basis for the clinical treatment of patients with mild-moderate carotid artery stenosis complicated with IS.

Objective Network pharmacology and molecular docking techniques were used to predict the potential mechanisms by which the active components of Piper nigrum(PN)regulate depressive-like behaviors in chronic restraint stress(CRS)mice.Methods The major chemical components and targets of PN were screened using the Traditional Chinese Medicine Systems Pharmacology database.Targets related to ferroptosis and depression were obtained from the Online Mendelian Inheritance in Man,GeneCards,and FerrDB databases.The intersecting targets were then subjected to Gene Ontology and Kyoto Encyclopedia of Genes and Gnomes(KEGG)pathway enrichment analyses,and molecular docking was performed to validate the binding capacities between the core targets and their corresponding active components.Finally,we established a CRS mouse model.Mice were treated with PN 75,150,and 300 mg/kg for 4 weeks,followed by behavioral assessments and reverse transcription-quantitative polymerase chain reaction(RT-qPCR)to verify the expression of core genes.Results Nine active components were screened from PN,corresponding to 27 targets,and 8377 targets related to depression and 547 targets associated with ferroptosis were screened from the databases.The intersection of these three sets resulted in 25 target genes.KEGG enrichment analysis revealed that these core targets were predominantly enriched in signaling pathways,including cholinergic synapses,serotonergic synapses,and neuroactive ligand-receptor interactions.Molecular docking result showed that the main active components of PN had strong binding affinities for the targets CHRM2,SLC6A4,PTGS2,and SLC6A2.Behavioral assessments demonstrated that PN significantly increased the sucrose preference index(P＜0.01,P＜0.001),reduced immobility time in the tail suspension and forced swimming tests(P＜0.01,P＜0.001),and enhanced exploratory behavior in the open field test(P＜0.05.P＜0.01,P＜0.001).PN significantly reduced the serum levels of inflammation markers(P＜0.05.P＜0.01,P＜0.001),as shown by enzyme-linked immunosorbent assay,and neurotransmitter analysis revealed that PN significantly increased the levels of serotonin and acetylcholine in the mouse hippocampus(P＜0.05).RT-qPCR showed that PN demonstrated the mRNA expression of SLC6A4(P＜0.05.P＜0.01,P＜0.001).Conclusions PN may improve depressive-like behavior in mice by modulating serotonin and acetylcholine levels,inhibiting inflammatory responses,participating in immune regulation,and exerting neuroprotective effects.

Objective To investigate the neuroprotective effect of Dendrobium nobile Lindl(DNL)extract in a Caenorhabditis elegans(C.elegans)model of Parkinson's disease(PD).Methods C.elegans NL5901 and 6-hydroxydopamine(6-OHDA)induced N2,BZ555,PD4521,and CB7272 C.elegans strains were treated with DNL 7.5,15,and 30 mg/L.The survival rate,basal slowing response rate,α-synuclein(α-syn)aggregation,dopaminergic neurons(DNs),mitochondrial distribution density of body wall muscle cells,and protein levels in the membrane were observed.In addition,reactive oxygen species(ROS),superoxide dismutase(SOD)and glutathione(GSH)in 6-OHDA induced N2 was detected to explore the effect of DNL on the antioxidative stress ability of PD C.elegans models.Results Compared with that in the model group,the DN fluorescence intensity was significantly increased in nematodes treated with DNL and levodopa(L-DOPA)(P＜0.05,P＜0.0001),α-syn aggregation was significantly decreased(P＜0.05,P＜0.001,P＜0.0001),the basal slowing rate(P＜0.05,P＜0.01,P＜0.001),mitochondrial density(P＜0.05,P＜0.01,P＜0.001),mitochondrial intima protein content(P＜0.05,P＜0.001,P＜0.0001),SOD content(P＜0.05),and GSH content were all increased.The ROS content was reduced in nematodes(P＜0.01).The lifespans of N2 wild-type and PD C.elegans models were prolonged after DNL treatment(P＜0.05,P＜0.01,P＜0.001).Conclusions DNL can effectively improve motor paralysis in a C.elegans PD model,improve DN degradation,inhibit α-syn aggregation and neuronal damage,increase the antioxidative stress ability,and slow the aging process in C.elegans.

Objective To investigate the neuroprotective effect of Dendrobium nobile Lindl(DNL)extract in a Caenorhabditis elegans(C.elegans)model of Parkinson's disease(PD).Methods C.elegans NL5901 and 6-hydroxydopamine(6-OHDA)induced N2,BZ555,PD4521,and CB7272 C.elegans strains were treated with DNL 7.5,15,and 30 mg/L.The survival rate,basal slowing response rate,α-synuclein(α-syn)aggregation,dopaminergic neurons(DNs),mitochondrial distribution density of body wall muscle cells,and protein levels in the membrane were observed.In addition,reactive oxygen species(ROS),superoxide dismutase(SOD)and glutathione(GSH)in 6-OHDA induced N2 was detected to explore the effect of DNL on the antioxidative stress ability of PD C.elegans models.Results Compared with that in the model group,the DN fluorescence intensity was significantly increased in nematodes treated with DNL and levodopa(L-DOPA)(P＜0.05,P＜0.0001),α-syn aggregation was significantly decreased(P＜0.05,P＜0.001,P＜0.0001),the basal slowing rate(P＜0.05,P＜0.01,P＜0.001),mitochondrial density(P＜0.05,P＜0.01,P＜0.001),mitochondrial intima protein content(P＜0.05,P＜0.001,P＜0.0001),SOD content(P＜0.05),and GSH content were all increased.The ROS content was reduced in nematodes(P＜0.01).The lifespans of N2 wild-type and PD C.elegans models were prolonged after DNL treatment(P＜0.05,P＜0.01,P＜0.001).Conclusions DNL can effectively improve motor paralysis in a C.elegans PD model,improve DN degradation,inhibit α-syn aggregation and neuronal damage,increase the antioxidative stress ability,and slow the aging process in C.elegans.

Objective:To explore the effects of a tiered-categorized-integrated training model in standardized neurology residency training.Methods:This controlled before-and-after study enrolled 109 residents who rotated in the Department of Neurology of Renji Hospital of Shanghai Jiao Tong University School of Medicine from January 2023 to June 2024. Among them, 43 residents from January to July 2023 were assigned to control group to receive the traditional training model, while 66 residents from August 2023 to June 2024 were assigned to observation group to follow the competency-oriented tiered-categorized-integrated training protocol. In the observation group, the residents were categorized into neurology specialty and non-neurology specialty groups to follow a competency-based hierarchical and progressive training approach with systematical optimization and resource integration in terms of faculty allocation, training activities, and assessment evaluations. The effectiveness of the models was evaluated through semi-annual assessments (for neurology specialty), routine assessments and end-of-rotation assessments (for non-neurology specialty), and 360-degree evaluations. SPSS 26.0 was used to perform chi-square tests and t-tests. Results:The non-neurology specialty residents in the observation group significantly outperformed the control group in the total score of end-of-rotation assessments [(90.93±4.21) vs. (86.08±8.98), P=0.004], theoretical examinations [(16.47±2.47) vs. (13.55±5.34), P=0.003], clinical skills [(9.32±0.47) vs. (9.00±0.58), P=0.004], and case analysis [(86.75±5.95) vs. (82.64±11.20), P=0.047]. The neurology specialty residents in the observation group showed a significantly higher physical examination score than the control group [(87.50±8.66) vs. (75.00±8.17), P=0.040]. Furthermore, in the 360-degree evaluation, the observation group exhibited better performance in certain assessment indicators of core competencies, including professional ability, patient management, professionalism, and communication and cooperation ( P<0.05). Conclusions:The tiered-categorized-integrated training model helps residents to better grasp basic knowledge and skills in rotations, and also enhances their core competencies such as professional ability, patient management, and communication and cooperation. This model provides a replicable practical solution for clinical departments to achieve efficient and precise rotation management within the constraints of limited resources.

Purpose To explore the value of gray-scale ultrasound and contrast-enhanced ultrasound of carotid plaques combined with clinical factors in predicting the recurrence risk of ischemic stroke(IS)in patients with mild to moderate carotid stenosis.Materials and Methods A total of 101 patients with mild to moderate carotid artery stenosis who were initially diagnosed with IS in the First Medical Center of the Chinese PLA General Hospital were prospectively collected from May 2022 to August 2023.After one year of follow-up,patients were divided into recurrent group(n=33)and non-recurrent group(n=68)according to whether new IS occurred.The characteristics of plaque ultrasound and the clinical information of patients were compared between the two groups.A multivariate Logistic prediction model was established and its efficacy was evaluated.Results The results of multivariate analysis showed that low-density lipoprotein cholesterol(OR=2.116,P=0.046),C-reactive protein(OR=3.707,P=0.008),plaque internal echo(OR=7.410,P=0.029)and intraplaque neovascularization grading 3(OR=17.155,P=0.030)were independent risk factors for the recurrence of IS.The area under the curve of the model established using the above indicators was 0.825,the sensitivity and specificity were 87.50%and 65.15%,respectively.Conclusion The ultrasound features of carotid plaque are closely related to recurrent IS,which can provide an important basis for the clinical treatment of patients with mild-moderate carotid artery stenosis complicated with IS.

Objective:To investigate the efficacy of rigid ureteroscopic laser lithotripsy combined with N-trap(RULL+N-trap),which is scoop-shaped,in the treatment of ureteral stones with a maximum diameter ≥1.5 cm.Methods:This retrospective cohort study included patients diagnosed with ureteral calculi who underwent rigid ureteroscopic lithotripsy(RULL)combined with N-Trap stone entrapment system at the Department of Urology,Peking University Third Hospital,by the same surgical team between June 2021 and September 2024.A total of 364 patients were initially enrolled.After excluding 21 patients due to missing critical outcome variables,two distinct cohorts were established:38 patients with ureteral stones measuring ≥1.5 cm in maximum diameter,and 305 patients with stones＜1.5 cm in maximum diameter.To minimize selection bias and control for confounding variables,propensity score matching(PSM)was employed.This resulted in two well-balanced groups:31 patients with stones 1.5 cm in maximum diameter and 31 patients with stones＜1.5 cm in maximum diameter,matched on baseline demographic and clinical characteristics.The primary outcomes assessed between the two groups included stone clearance.Secondary outcomes included changes in renal function indicators,specifically serum creatinine(SCr)and estimated glomerular filtration rate(GFR),and other factors like postopera-tive hospital stay and operative time.Results:In the matched cohort,the patients with stones ≥1.5 cm in maximum diameter had significantly longer operative time compared with those with smaller stones:(85.8±28.8)min vs.(62.4±24.6)min(P＜0.05).Postoperative length of hospital stay showed no significant difference:(2.26±1.79)d vs.(2.03±0.80)d(P＞0.05).The stone clearance on postoperative day one was 90.3％in the study group vs.100.0％in the control group(P＞0.05).One month postoperatively,the stone clearance was 93.5％vs.100.0％,respectively(P＞0.05).Changes in SCr were(-6.58±16.10)μmol/L vs.(-13.70±12.50)μmol/L,and changes in GFR were(5.92±14.90)mL/(min·1.73 m2)vs.(7.47±11.20)m L/(min·1.73 m2),with no statistically significant differences observed between the two groups for either renal function marker(P＞0.05).Conclusion:Ureteroscopic lithotripsy combined with N-trap is an optional method for treating ureteral stones with a maximum diameter ≥1.5 cm.The overall therapeutic efficacy is comparable,with the added benefit of significantly reducing the economic burden on patients.