Objective: To explore the relationship of family function with sleep and externalizing problem behaviors of preschool children, so as to provide a guidance for externalizing problem prevention and intervention among preschool children. Methods: From October 2023 to January 2024, a convenience sampling method was used to select 5 138 preschool children from kindergartens in 8 districts of Wuhan City, Hubei Province. Parents completed the survey for Family Adaptability and Cohesion Scale, children s sleep habits and Child Behavior Checklist (CBCL). Spearman correlation analysis was used to examine the correlation of family function with scores of sleep quality and externalizing problem behaviors among preschool children. A mediation model analysis and bootstrap test were conducted to further investigate the mediating role of sleep quality between family function and externalizing problem behaviors. Mplus 8.7 software was used for latent profile analysis of family function. Results: The reported rates of poor sleep quality and externalizing problem behaviors among preschool children were 11.8% ( n =607), 20.0% ( n =1 026). The relevant analysis results showed that family function was negatively correlated with sleep quality and externalizing problem behaviors ( r = -0.20, -0.23), and sleep quality was positively correlated with externalizing problem behaviors ( r =0.27) ( P <0.01). The mediation effect test showed that family function negatively predicted externalizing problem behaviors ( β =-0.079) and sleep quality ( β = -0.075), while sleep quality positively predicted externalizing problem behaviors ( β =0.215) ( P <0.01). The latent profile analysis results showed that family function could be classified into 4 categories: high family function group (23.01%), upper middle family function group (44.65%), moderate family function group (26.24%) and low family function group (6.11%). Compared to high family function, the other three categories significantly positively predicted externalizing problem behaviors, and the mediating effects of sleep quality on different categories of family function were statistically significant [upper middle family function: mediation effect value was 0.022 (95% CI =0.004-0.041) and direct effect value was 0.329 (95% CI =0.263-0.396); middle family function: mediation effect value was 0.087 (95% CI =0.063-0.115) and direct effect value was 0.491 (95% CI =0.416-0.565); low family function: mediation effect value was 0.144 (95% CI =0.107-0.185) and direct effect 0.621 (95% CI =0.503-0.740)] ( P < 0.05 ). Conclusion Family function negatively predicts the externalizing problem behaviors of preschool children, and sleep quality plays a partial mediating role.

Jinlingzi San is a formula frequently used in treating pain syndrome， first recorded in the Collection of Writings on the Mechanism of Disease， Suitability of Qi， and the Safeguarding of Life as Discussed in the 'Basic Questions' written by LIU Wansu in the Jin Dynasty. Jinlingzi San is composed of 2 Chinese medicinals Toosendan Fructus and Corydalis Rhizoma with a concise composition and exact clinical efficacy， having been included in the Catalogue of Ancient Classical Formulas （Second Batch： Han Chinese Medicine）. The formula name， historic evolution， medicine origins， composition， dosage， decocting methods， and ancient and modern clinical application were sorted out and analyzed with the bibliometric method. A total of 209 pieces of information were collected from ancient books and literature. After screening， 49 pieces of effective data involving 45 ancient books were included. Results showed that the name of Jinlingzi San was first recorded in Secret Formulas of the Yang Family written by Yang Tan in the Southern Song Dynasty and developed into 3 other versions of the decoction. The Jinlingzi San included in the Collection of Writings on the Mechanism of Disease， Suitability of Qi， and the Safeguarding of Life as Discussed in the 'Basic Questions' written by LIU Wansu invariably plays a dominant role. As for the 3 other versions， although they have the same name of Jinlingzi San， their composition and indications are different from those of the original formula， which were therefore viewed as prescriptions based on Jinlingzi San and also included in the research. The medicine origins and processing of Jinlingzi San are suggested： Toosendan Fructus is the dry mature fruit of Melia toosendan of Meliaceae， and the crude is used after cleansing without putamen. Corydalis Rhizoma is the dry tuber of Corydalis yanhusuo of Papaveraceae， which is used after impurity removal， cleaning， and drying. Depending on the conversion from the measurement system in the Jin Dynasty to modern measurement， it is suggested that Toosendan Fructus and Corydalis Rhizoma （41.3 g each） are ground into fine powder， and one dose includes 12.39 g of the powder， which should be taken with an appropriate amount of wine. If wine is not suitable for the patient， the decoction can also be taken with warm water. Jinlingzi San has the effects of soothing the liver， discharging heat， and activating blood to stop pain. As recorded in ancient books， Jinlingzi San is specialized in treating heart pain caused by reversal heat， chest and abdominal pain， hypochondriac pain， jaundice， hernia， and other diseases. Modern studies have shown that modified Jinlingzi San can be used in treating diseases involving the digestive system， the integumentary system， the gynecological system， the reproductive system， and other systems and has wide clinical application in treating epigastric pain， herpes zoster， dysmenorrhea， and other diseases. This study has made clear the key information of Jinlingzi San by textual research of ancient books and literature in the hope of providing a theoretical reference for the clinical application， set prescriptions， and new drug development.

Objective:To understand the incidence and spatial-temporal distribution characteristics of hepatitis B among residents in a county of western Liaoning province from Jan 2011 to Dec 2021.Methods:Data on hepatitis B incidence were obtained from the Disease Prevention and Control Center of the county,and its crude incidence and standardized incidence were calculated.ArcGIS software was used to analyze the global spatial autocorrelation analysis and local spatial autocorrelation analysis of hepatitis B incidence in the county.A space-time scan analysis was performed using SaTScan software to identify the case distribution and spatiotemporal clustering patterns of hepatitis B incidence.Results:From Jan 2011 to Dec 2021,there were 2 978 cumulative cases of hepatitis B in the county,with a crude incidence of 69.25 per 100 000 and a standardized incidence of 70.13 per 100 000.Among different regions,Toutai Manchu Town had the highest crude incidence of hepatitis B,followed by Gaotaizi Town and Chengguan Street.The global autocorrelation showed an aggregated distribution in 2014,2016,2019,and 2021.The local autocorrelation hotspots were clustered in the central and western parts of the county,the H-H clustering areas included Toutai Manchu Town and Jiudaoling Town from 2014 to 2016,Toudaohe Manchu Town,Yizhou Street and Chengguan Street from 2017 to 2019,and Qianyang Town and Yizhou Street from 2020 to 2021.The L-L clustering areas were mostly concentrated in the southwest of the county,including Dizangsi Manchu Township,Dadingbao Manchu Township and Liulonggou Manchu Township.A total of 4 clustering areas were obtained by temporal-spatial scanning analysis,the first-level area was Zhangjiapu Township in 2017,the second-level area included Qianyang Town and Chengguan Street from 2011 to 2015,the third-level area was Gaotaizi Town from 2013 to 2016,and the fourth-level area was Toutai Manchu Town from 2014 to 2017.Conclusions:From Jan 2011 to Dec 2021,the incidence of hepatitis B among residents in a county in western Liaoning Province is mainly concentrated in the central and northwest regions.The hepatitis B cases are clustered in the central and western areas of the county,and has a trend of gradually spreading to the northern areas over time.It is necessary to pay attention to the townships with high incidence of hepatitis B and carry out effective prevention and surveillance.

Objective:To analyze the advantages of human epididymis protein 4 (HE4) compared with traditional tumor markers in the diagnosis and treatment of lung cancer.Methods:From February 2021 to June 2022, 230 lung cancer patients (138 males, 92 females; age (61.1±12.3) years), 96 benign lung disease patients (62 males, 34 females; age (60.2±14.8) years; including 43 cases of lung benign placeholder and 53 cases of pulmonary infection), and 60 healthy volunteers (40 males, 20 females; age (62.8±11.4) years) from the Second Affiliated Hospital of Soochow University were prospectively collected. Serum HE4, carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), cytokeratin 19 fragment (CYFRA21-1), pro-gastrin-releasing peptide (ProGRP) and carbohydrate antigen (CA)125 were detected by electrochemical analysis. The expression of HE4 in tumor tissues of 55 patients with lung cancer was detected by immunohistochemical method. χ2 test, Mann-Whitney U test, Kruskal-Wallis rank sum test and Bonferroni correction method were used to analyze data. The diagnostic efficiencies of HE4 and other tumor markers were evaluated by ROC curve analysis and the difference of AUCs was analyzed by Delong test. Results:The positive expression rate of HE4 in adenocarcinoma tissue was significantly higher than that in non-adenocarcinoma tissue (93.1%(27/29) vs 23.1% (6/26); χ2=28.01, P<0.001). The level of serum HE4 in the lung cancer group (70.70(51.93, 109.05) pmol/L) was significantly higher than that in the pulmonary benign placeholder group (59.80(48.20, 73.50) pmol/L) and the healthy control group (55.25(44.60, 74.25) pmol/L), and that in the pulmonary infection group (97.90(76.62, 155.00) pmol/L) was higher than that in the lung cancer group ( H=46.19, all P<0.008 (Bonferroni correction method)). The levels of serum HE4 were significantly different in age, sex, smoking, disease stage and pathological types in early stage ( z values: from -5.07 to 9.83, all P<0.05). The ROC curve analysis indicated that the optimal cut-off value of serum HE4 for diagnosing lung cancer was 79.22 pmol/L, with the sensitivity and specificity of 41.30%(95/230) and 83.33%(50/60). Compared with other traditional tumor markers, serum HE4 and CA125 showed the higher diagnostic value (AUC CA125 (0.695)>AUC HE4(0.656)>AUC CEA(0.614)>AUC CYFRA21-1(0.599)>AUC ProGRP (0.501)>AUC NSE (0.470)). The combination of HE4 with other traditional tumor markers significantly improved the diagnostic efficacy (AUC=0.750; z=2.75, P=0.006). Conclusions:HE4 is highly expressed in lung adenocarcinoma by immunohistochemistry. Serum HE4 exhibits a great application value in the differential diagnosis between benign and malignant pulmonary nodules, and plays an important role in assessment of patients′ conditions.

Objective:To design and synthesize 89Zr-deferoxamine(DFO)-G4C2, a novel molecular probe targeting programmed cell death receptor 1(PD-1), and evaluate its in vivo biodistribution and microPET/CT imaging characteristics in tumor-bearing mice. Methods:DFO-G4C2 was prepared by coupling DFO with G4C2, a monoclonal antibody targeting PD-1. The affinity and binding specificity of this amalgamation were subsequently assessed through the implementation of flow cytometry and surface plasmon resonance techniques. The molecular probe 89Zr-DFO-G4C2 was achieved by labeling DFO-G4C2 with the radioisotope 89Zr, and the labeling efficiency and in vitro stability of 89Zr-DFO-G4C2 were determined. Mouse models laden with CT26 colorectal cancer cells expressing PD-1 were established, followed by in vivo biodistribution and microPET/CT imaging studies, to explore the potential clinical value of 89Zr-DFO-G4C2. Additionally, the validity of this molecular probe was verified in 4T1 breast cancer models, affirming its efficacy as an imaging tool across different tumor models. Independent-sample t test was used to analyze the data. Results:DFO-G4C2 exhibited an affinity constant KD of (0.55±0.02) μmol/L, indicating a strong binding affinity. The binding rate to mouse PD-1 protein was determined to be (61.82±8.49)%. The labeling rate of 89Zr-DFO-G4C2 reached a high level of (98.76±0.51)%. Furthermore, the labeling rates in lysate and human serum after 144 h were measured to be (93.07±2.16)% and (83.42±3.21)%, respectively. MicroPET/CT imaging of CT26 tumor-bearing mice injected with 89Zr-DFO-G4C2 showcased pronounced radioactivity uptake in the tumor tissue. At 72 h post-injection, the tumor uptake value reached (10.47±0.34) percentage activity of injection dose per gram of tissue (%ID/g). The tumor uptake observed in the blocked experimental group, wherein an excess of unlabeled antibody was administered, was significantly lower at (6.26±1.03) %ID/g in comparison to the non-blocked group ( t=6.67, P=0.003). The in vivo biodistribution results were consistent with the observed microPET/CT imaging outcomes. MicroPET/CT imaging observations in the 4T1 breast cancer bearing mouse model were analogous to those obtained from the CT26 model. Conclusion:ImmunoPET based on the 89Zr-DFO-G4C2 molecular probe can non-invasively and visually assess the PD-1 expression level of tumors in vivo, and it is expected to be a new molecular imaging technique for immunotherapy monitoring of PD-1 inhibitors.

Objective    To summarize the surgical strategy of reoperative aortic root replacement after prior aortic valve replacement (AVR), and analyze the early and mid-term outcomes. Methods    From April 2013 to January 2020, 75 patients with prior AVR underwent reoperative aortic root replacement in Fuwai Hospital. There were 54 males and 21 females with a mean age of 56.4±12.7 years. An emergent operation was performed in 14 patients and an elective operation in 61 patients. The indications were aortic root aneurysm in 38 patients, aortic dissection involving aortic root in 30 patients, root false aneurysm in 2 patients, prosthesis valve endocarditis with root abscess in 2 patients, and Behçet's disease with root destruction in 3 patients. The survival and freedom from aortic events during the follow-up were evaluated with the Kaplan-Meier survival curve and the log-rank test. Results    The operative procedures included prosthesis-sparing root replacement in 45 patients, Bentall procedure in 26 patients, and Cabrol procedure in 4 patients. Operative mortality was 1.3% (1/75). A composite of adverse events occurred in 5 patients, including operative death (n=1), stroke (n=1), and acute renal injury necessitating hemodialysis (n=3). The follow-up was available for all 74 survivors, with the mean follow-up time of 0.5-92.0 (30.3±25.0) months. Four late deaths occurred during the follow-up. The survival rate at 1 year, 3 years and 6 years was 97.2%, 91.4% and 84.4%, respectively. Aortic events developed in 2 patients. The rate of freedom from aortic events at 1 year, 3 years, and 6 years was 98.7%, 95.0% and 87.7%, respectively. There was no difference in rate of survival or freedom from aortic events between the elective patients and the emergent patients. Conclusion    Reoperative aortic root replacement after prior AVR can be performed to treat the root pathologies after AVR, with acceptable early and mid-term outcomes.

The competency-based medical education has formed a global trend, and puts forward a greater challenge for educational design of resident training. The traditional curriculum cannot meet the goal of competency-based education as the curriculum design is lack of theoretical support. Curriculum design is the core of training content, and serves as a significant contributing factor of training outcome. Based on the six-step approach curriculum design, the theory and practice are integrated to form a curriculum design based on theoretical guidance. Through feedback evaluation, the current curriculum design is continuously improved in order to achieve a higher competency-based training quality. With the 5-year experiences and practice, preliminary reform demonstrates effectiveness. The current study hopes to share the teaching reform experiences of residency training base and provide references for colleagues of medical education.

Prostate cancer is one of the common diseases affecting men′s health. Early diagnosis and treatment can make a difference in greatly improving the prognosis of patients. At present, prostate specific antigen (PSA), the most widely used serum indicator in prostate cancer screening, plays an important role in improving the early diagnosis rate and reducing mortality, but the high sensitivity of PSA makes many non-prostate cancer patients receive unnecessary puncture biopsies or overtreatment. Compared with PSA, prostate health index (PHI) has higher diagnostic value. PHI can reduce unnecessary puncture biopsies, and evaluate the prognosis of patients after prostatectomy (RP), which can motivate patients to actively monitor and provide important information for clinicians to formulate the following treatment plan. This article reviews the diagnostic value of PHI in prostate cancer, the relationship with tumor volume, the combined diagnosis with other imaging tests, and the prognostic value for patients undergoing RP.

Objective:To explore the relationship between serum anti-Müllerian hormone (AMH) level and related clinical factors in healthy females, and establish and validate equation of correlation between age and serum AMH level for healthy females.Methods:From March 2015 to December 2016, a total of 602 females who measured serum AMH level in Department of Nuclear Medicine, the Second Affiliated Hospital of Soochow University were retrospectively enrolled. All cases had relatively complete clinical data, and were divided into healthy group (484 cases, 20-52 years) and case group (118 cases, 20-42 years; patients with menstrual disorders). Relationships between serum AMH level and estradiol (E2), tesosterone (T), follicle stimulating hormone (FSH), luetinizing hormone (LH), body mass index (BMI) of healthy group were analyzed by Spearman rank correlation. Kruskal-Wallis rank sum test was used to analyze the relationship between history of gestation and serum AMH level. Serum AMH level of health group was processed to establish predictive equation for serum AMH level. Internal ( n=27) and external ( n=37) validation group were chosen from healthy females with serum AMH level measured to validate the equation, and signed rank test was used to analyze the data. Difference between serum AMH level in case group and healthy group with corresponding age was explored by independent-sample t test. Results:Serum AMH levels were positively correlated with E2 and T ( rs values: 0.263, 0.334, both P<0.001), and negatively correlated with FSH, LH, BMI ( rs values: from -0.515 to -0.110, all P<0.005). Predictive equation was established as LogAMH=-1.208+ 0.1×age-0.000 042×age 3 ( R2=0.735, P<0.001). No statistically significant difference was found between real serum AMH levels and calculated serum AMH levels in the internal and external validation groups ( z values: -1.62 and -1.52, both P>0.05). Females in case group ( n=118) and control group ( n=446) were divided into two sub-groups respectively (<35 years and ≥35 years), and serum AMH levels of case group were lower than those of control group with corresponding age ( t values: 18.64, 11.70, both P<0.001). Conclusions:In healthy females, serum AMH level is related to some clinical data. The equation between serum AMH level and age established in the study may provide reference for clinical diagnosis and treatment.

Objective:To investigate mentor-mentee dual evaluation of the current status of mentor competency of clinical and translational research mentors, and provide the basis for mentor training focused on the mentor competences.Methods:A total of 121 clinical and translational research mentors and 170 mentees from Peking Union Medical College Hospital were enrolled. The Chinese version of the Mentor Competency Assessment (MCA) questionnaire was used to evaluate the mentor competency, including maintaining effective communication, aligning expectations, assessing understanding, fostering independence, addressing diversity, promoting professional development total 6 parts with 26 sub-items. The Likert scale was used to quantitatively evaluate the clinical and translational research mentor competency by mentor-mentee dual evaluations. And the composition and training needs of clinical and translational research mentors were investigated. SPSS 25.0 was used for t-test. Results:Seventy percent (119/170) of mentees considered the mentor guidance was very helpful, and 78.5% (95/121) of the mentors considered it necessary to carry out the mentor training. The mentee evaluation of mentor competency was significantly higher than that of mentor self-evaluation [total score (162.35±23.59) vs. (154.80±19.81), P < 0.01]. And the excellent rate of 26 sub-items by mentees and mentors were 100.0%(170/170) and 46.3%(56/121) respectively. The mentors and mentees shared the agreement of the strengths on trust-based relationship and encouraging mentees, and weaknesses on taking into account the possible prejudices in mentor-mentee relationship. Conclusion:The clinical and translational research mentors have already had good competences, but mentor training is still highly warranted. It's expected that to carry out targeted mentor training and assessment according to the mentor's competences will help to improve the construction of the medical talents training system.