Objective: To examine the associations of pet ownership and daily outdoor activity duration with depressive symptoms in middle school students, so as to provide evidence for targeted prevention strategies of depressive symptoms in middle school students. Methods: Using a stratified cluster random sampling method, 83 601 middle and high school students from 103 districts and counties in Inner Mongolia Autonomous Region were selected in 2024. A questionnaire survey was conducted to collect demographic data, household pet ownership, outdoor activity duration, and depressive symptoms of the research subjects. The comparison of reporting rates of depressive symptoms among different groups of middle school students was conducted using a χ 2 test. The association between pet ownership and outdoor activity duration and depressive symptoms among middle school students was evaluated using a Logistic regression model, and stratified analysis was conducted among different genders and regions to control for potential confounding factors and evaluate the stability of the association. Results: The prevalence of depressive symptoms among middleschool students in Inner Mongolia was 17.2%. Significant differences in depressive symptom reporting rates were observed across sex, grade, ethnicity, surveillance site, parental education, menarche/spermarche status, boarding status, smoking and alcohol use, daily breakfast consumption, school bullying, continuous 30 minute headphone use in a noisy environment, and often use the Internet ( χ 2=8.07-2 672.57, all P <0.01). Both pet ownership ( OR =0.78, 95% CI =0.75-0.81) and ≥2 h/d of outdoor activity( OR =0.81, 95% CI =0.78-0.84) were inversely associated with depressive symptoms;compared to the without owning pets and < 2 h of outdoor activity daily group, students who both owned pets and engaged in ≥2 h of outdoor activity daily had an even lower risk ( OR =0.83, 95% CI =0.78-0.87)(all P <0.05). Conclusion Pet ownership and increased daily outdoor activity duration may help mitigate depressive symptoms among middle school students.

Objective Taking Chinese college students as the target group,this study detected the distribution of plantar pressure in different gait groups and analyzed the distribution characteristics of plantar pressure in in-toeing gait populations,to provide references for their orthopedic rehabilitation.Methods Ten subjects with typical in-toeing and normal and out-toeing gaits were selected to participate in the plantar pressure testing experiment.The maximum force,pressure,and contact time during natural standing and during one walking gait cycle were measured using a Zebris foot plantar pressure measurement system.Gait parameters,including step length,step width,step speed,step direction angle,gait center line,and force change curves,were collected,and a hazard analysis was conducted.Results During natural standing,the swaying interval area of the center of pressure was 939.0±252.4 mm2 for the in-toeing gait group and 1 120.2±101.6 mm2 for the out-toeing gait group,which was larger than that for the normal group(240.7±130.6 mm2).The in-toeing gait further weakens the human body's ability to maintain stability.The dynamic and static plantar pressures in the three gait groups exhibited different distribution characteristics.During static standing,the pressure center of the in-toeing gait group shifted to the hindfoot,which accounted for 70%of the plantar pressure and was higher than that of the normal group.During dynamic walking,the absolute value of peak pressure in the tripodal area of the foot in the in-toeing gait group was higher than that in the other two groups.Conclusions The in-toeing gait group had poor static maintenance ability,and to a certain extent,the distribution of plantar pressure in the foot tripodal area and plantar zone pressure were different compared with that of the normal gait.This led to poor stability,easy muscle fatigue,and ankle and knee joint injuries in the in-toeing gait group under equal-intensity exercise conditions.

Objective:To explore the construction and implementation effect of clinical-thinking patterned curriculum for parallel graduate students with "running through clinical diagnosis and treatment process."Methods:In this study, 94 Batch 2016-2017 graduate students with clinical medical professional degree in Shanxi Provincial People's Hospital were selected as the research subjects. Among them, 48 Batch 2017 parallel graduate students were selected as the experimental group. The curriculum of clinical-thinking patterned training of "running through the clinical diagnosis and treatment process" was used. In addition to participating in the degree courses and residency courses, a series of training to improve the clinical-thinking ability were introduced. And 46 Batch 2016 parallel graduate students were divided in the control group, using a traditional curriculum and only participating in degree courses and residency courses. The differences among mini-clinical evaluation exercise (Mini-CEX) scores, direct observation of procedural skills (DOPS) scores, objective structured clinical examination (OSCE) scores and students' satisfaction were compared by t test, chi-square test and repeated measures analysis of variance. Results:The Mini-CEX scores showed the average scores of other aspects except humanistic care were higher than those of the control group, and the score of communication skills was significantly higher than that of the control group [(6.55±0.98) vs. (5.77 ±1.12)], with significant differences ( t=3.62, P<0.001). In the DOPS scores, except for the skills of communication with patients, ability to consider patient's feelings and practice of occupational literacy, the average scores of other aspects of the experimental group were higher than those of the control group, and the real operation-ability score of clinical skills was significantly higher than that of the control group [(6.38 ± 1.38) vs. (5.53±1.23)], with a significant difference ( t=3.12, P=0.002). In terms of the outpatient receiving station, the emergency treatment station, the clinical thinking station①, the clinical thinking station②, the specialist skill station, the auxiliary examination station and the case writing station, their OSCE scores at different stages in the experimental group were higher than those in the control group, and in terms of clinical thinking station①, the score of the experimental group was significantly higher than that of the control group, with a significant difference ( F=6.51, P=0.012). The satisfaction rate of the experimental group in terms of curriculum was higher than that in the control group except for the future career development, and in improving logical-thinking ability, the score of the experimental group was significantly higher than that of the control group, with a significant difference ( χ2=19.18, P<0.001). Conclusion:The curriculum of clinical-thinking ability with "running through the clinical diagnosis and treatment process" can enhance the clinical practical ability of parallel graduate students, making them meet the residential academic standards as soon as possible and effectively promoting the training quality of the students.

Objective:To investigate the value of ultrasound and Ki-67 for early predicting pathological complete response (pCR) of triple negative breast cancer(TNBC) after neoadjuvant chemotherapy (NAC).Methods:Retrospective analysis was performed in 190 patients with TNBC who underwent surgery after NAC treatment at the Cancer Hospital of Fudan University from January 2019 to December 2022. All patients underwent ultrasound examination before and after 2 and 4 cycles of NAC treatment. According to the operation pathological results after NAC, the patients were divided into pCR group and non-pCR group. The differences in ultrasound and Ki-67 parameters were compared between the pCR and non-pCR groups, and binary Logistic regression analysis was performed to determine the independent predictors for pCR. The ROC curve was plotted to evaluate the diagnostic efficacy.Results:Tumor maximum diameter, relative change rates of tumor maximum diameter after 2-cycle and 4-cycle NAC (ΔD2, ΔD4), relative change rate of lymph node short diameter after 2-cycle NAC (ΔS2), T-stage, N-stage and Ki-67 showed statistically significant differences between the pCR group and the non-pCR group (all P<0.05). Logistic regression analysis showed that ΔD4, T-stage, N-stage and Ki-67 were independent predictors for pCR ( OR=1.029, P=0.011; OR=0.300, P=0.009; OR=0.653, P=0.048; OR=1.028, P=0.001). The area under the curve (AUC) of pCR was 0.804 (95% CI=0.742-0.866), the sensitivity and specificity were 67.5% and 83.2% respectively. Conclusions:The combination parameters of ΔD4, T-stage, N-stage and Ki-67 have certain clinical value for predicting pCR of TNBC.

Considering the substantial role played by dendritic cells (DCs) in the immune system to bridge innate and adaptive immunity, studies on DC-mediated immunity toward biomaterials principally center on their adjuvant effects in facilitating the adaptive immunity of codelivered antigens. However, the effect of the intrinsic properties of biomaterials on dendritic cells has not been clarified. Recently, researchers have begun to investigate and found that biomaterials that are nonadjuvant could also regulate the immune function of DCs and thus affect subsequent tissue regeneration. In the case of proteins adsorbed onto biomaterial surfaces, their intrinsic properties can direct their orientation and conformation, forming "biomaterial-associated molecular patterns (BAMPs)". Thus, in this review, we focused on the intrinsic physiochemical properties of biomaterials in the absence of antigens that affect DC immune function and summarized the underlying signaling pathways. Moreover, we preliminarily clarified the specific composition of BAMPs and the interplay between some key molecules and DCs, such as heat shock proteins (HSPs) and high mobility group box 1 (HMGB1). This review provides a new direction for future biomaterial design, through which modulation of host immune responses is applicable to tissue engineering and immunotherapy.
Biocompatible Materials/metabolism* ; Dendritic Cells/metabolism* ; Tissue Engineering ; Immunomodulation ; Adaptive Immunity

Objective:To explore the predictive value of various specific sonographic features on molecular subtypes for invasive breast carcinoma(IBC).Methods:Sonographic and clinicopathological data were retrospectively reviewed for 500 IBC patients who accepted surgical therapy in Fudan University Shanghai Cancer Center from January 2014 to March 2016. All tumors were divided into 5 molecular subtypes. The relationships of sonographic variations associated with the molecular subtypes for IBC were analyzed by univariate and multivariate Logsitic regression analyses.Results:Specific sonographic features for triple-negative subtype included regular shape ( OR=2.06, P=0.018), no spiculated/angular margin ( OR=1.98, P=0.029), posterior acoustic enhancement ( OR=2.26, P=0.005), and no calcification ( OR=2.13, P=0.006). Specific sonographic feature for human epidermal growth factor receptor-2 positive (HER2) subtype was posterior acoustic enhancement ( OR=2.23, P=0.006). Specific sonographic features for Luminal A subtype included spiculated/angular margin ( OR=2.24, P=0.001), posterior acoustic shadow ( OR=1.84, P=0.026), and no calcification ( OR=1.89, P=0.016). There were no specific sonographic features for the Luminal B with HER2 negative subtype, while that for the Luminal B with HER2 positive subtype was calcification ( OR=3.61, P<0.001). However, when used these sonographic features to predict molecular subtypes of breast cancer, the sensitivity values were 8.4%-57.3%, and positive predictive values were 9.5%-53.3%. Conclusions:The variety of sonographic features is associated with molecular subtypes of IBC.However, due to the overlap of sonographic features between different subtypes, molecular subtypes of IBC cannot be predicted by sonographic features.

OBJECTIVE：To eval uate therapeutic effic acy，safety and economical efficiency of Ginkgolide injection versus Butylphthalide injection in the treatment of ischemic stroke. METHODS ：Among the GISAA of Ginkgolide injection in the treatment of ischemic stroke of large-artery atherosclerosis ，106 patients who were given Ginkgolide injection+Asprin enteric-coated tablets but did not use butylphthalide in any dosage in previous trial group were selected as ginkgolide group ；56 patients who were given Butylphthalide injection+Ginkgolide injection+Asprin enteric-coated tablets in previous placebo group were selected as control group. The effects ，safety and economical efficiency were compared between 2 groups. Effect indexes included recurrence rate ， mortality，NIHSS score ，modified Rankin score （mRS），Barthel index and comprehensive efficacy. The safety indexes included incidence of bleeding event and adverse event during treatment. Cost-minimization analysis was used for economic evaluation. RESULTS：There was no statistical difference in recurrence rate ，mortality，NIHSS score ，the proportion of subjects with mRS 0-2，Barthel index ，comprehensive efficacy and the incidence of adverse event between 2 groups on 28th day after treatment （P＞ 0.05）. NIHSS score of ginkgolide group was better than that of control group on 7th and 14th day （P＜0.05）. Results of cost-minimization analysis showed that total cost of ginkgdide group was （13 768.19±4 981.54）yuan on 14th day of treatment ， which was significantly lower than （22 578.52±7 523.23）yuan of control group （P＜0.01）. The results of sensivity analysis indicated that the minimum lost analysis was stable. CONCLUSIONS ：For the treatment of ischemic stroke ，ginkgolide+aspirin is similar to butylphthalide+aspirin in improving clinical outcome and safety of 28 days，but is better than it in short-term efficacy of improving neurological deficit ， and better short-term economical efficiency.

Objective To evaluate the association between quantitative ultrasonographic features and clinical ,pathological and immunohistochemical features of triple negative invasive breast carcinoma( TNBC) . Methods With the ethical approval , 96 patients who were pathologically confirmed as TNBC were retrospectively reviewed . All patients were sub-grouped according to age ,tumor size ,pathological grade , Ki67 expression level and human epidermal growth factor receptor 2 ( HER-2) score .Ultrasound images were segmented for the breast carcinoma mass using a phase-based active contour model . The high-throughput radiomics features were extracted based on the two-dimensional sonographic features . There were 460 features extracted from each ultrasound image . A series of computer aided algorithms including K-svd algorithm ,sparse representation ,support vector machine ( SVM ) and radial basis function were used to determine the high-throughput sonographic features that were highly correlated to clinical ,pathological and immunohistochemical features of TNBC . The performance efficacy was expressed by accuracy and area under curve ( AUC) of the ROC curve . Results The high-throughput ultrasonographic features of invasive TNBC could predict its pathological grade ,Ki67 level and HER-2 score with the accuracy 92 .2％ -96 .9％and AUC 98 .7％ -99 .9％ . There were 82 radiomics features selected for predicting the pathological grade of TNBC , the feature with the maximum weight was the elliptic-normalized eccentricity based on morphological features . There were 100 features selected for predicting the Ki67 expression level ,the feature with the maximum weight was the standard deviation of the annular region based on the boundary texture features . There were 85 features selected for the prediction of HER-2 score ,the most powerful parameter was the intensity based on NGTDM texture features . Conclusions Quantitative high-throughput ultrasonographic features are correlated with the pathological and immunohistochemical characteristics of invasive TNBC . High-throughput ultrasonographic features are valuable in predicting biological behavior of TNBC .

Objective: To investigate the application of single-molecule PCR (SM-PCR) in the detection of plasma ctDNA for the treat-ment of patients with advanced lung adenocarcinoma. Methods: In total, 30 patients diagnosed with advanced lung adenocarcinoma were enrolled between June 2017 and May 2018. ctDNA fragments of the target genes (EGFR, KRAS, BRAF, ALK, HER2, and TP53) from the blood samples were enriched by SM-PCR, and DNA libraries were prepared. Finally, a high-throughput sequencing was performed. The EGFR detection of tumor tissue samples was performed using real-time fluorescence PCR based on the amplification refractory mutation system (ARMS) and consistency in the results of EGFR mutation detection in the plasma and tissue was compared. Results:The results of both the methods were consistent (Kappa=0.867, P<0.001). The McNemar's test also indicated that the results are not statistically different (P=0.500). Conclusions: SM-PCR can be used for the detection of plasma EGFR mutations. The target detection sites are more comprehensive and multiple mutations can be detected at the same time. Results of the analysis are more precise and can be absolutely quantified.

Objective To explore the value of layer-specific strain in assessment of left ventricular function in patients with heterozygous familial hypercholesterolemia (HeFH) with normal left ventricular ejection fraction (LVEF).Methods Thirty-four patients with diagnosed HeFH and underwent transthoracic echocardiography were included as HeFH group,while 29 healthy volunteers were taken as control group.EchoPAC software was used to obtain endocardial longitudinal strain (LSendo),myocardial longitudinal strain (LSmyo) and epicardial longitudinal strain (LSepi) of the epicardial,and then statistical analysis was performed.Results LSendo and LSmyo in HeFH group were significantly lower than those in control group (P＜0.001).LSendo and LSmyo were negatively correlated with total cholesterol and low density lipoprotein cholesterol (all P＜0.05).Conclusion Layer-specific strain of left ventricular is of great value in assessing early myocardial damage in patients with HeFH.