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Background: Postoperative pain management remains a significant challenge for patients undergoing posterior urethroplasty (PU). In a previous study, we proposed a novel technique of combined pudendal nerve (PN) and spermatic cord (SC) block to manage pain after PU. The present trial was conducted to test the hypothesis that this technique is effective for pain control after PU and provides longer-lasting analgesia than caudal epidural block (CB). Methods: Sixty patients undergoing PU were randomized into two groups: Group NB received combined PN and SC block, and Group CB received CB. General anesthesia with a laryngeal mask was performed. The primary outcome was the postoperative analgesic duration, and the secondary outcomes included the Numeric Rating Scale (NRS) scores for pain and the number of patients with different motor scores of the lower limb at 3, 6, 12, and 24 h postoperatively. Results: Two patients in Group CB were withdrawn due to block failure. The postoperative analgesic duration was statistically longer in Group NB compared with Group CB (mean difference [95% confidence interval], 115.78 min [17.80, 213.75]; P = 0.021). The NRS scores for pain at 12 and 24 h after surgery were statistically lower in Group NB compared with Group CB. Group NB had statistically more patients with motor score 0 at 3 h postoperatively than Group CB. Conclusions: PN combined with SC block is an effective technique for postoperative analgesia in PU. This technique can achieve a longer duration of analgesia and lower pain scores, especially 12 h after surgery, than a CB. Trial registration: This study was registered in the Chinese Clinical Trial Register (registration no. ChiCTR2100042971, registration date on 2/2/2021). [ABSTRACT FROM AUTHOR]

Objective: This study investigates the associations and mediating pathways between grip strength, cognitive function, and depression in middle-aged and elderly individuals in China. Methods: Utilizing data from the 2011 China Health and Retirement Longitudinal Study (CHARLS), we employed logistic regression and mediation analysis to examine the relationships and mediating factors between grip strength, cognitive function, and depression, while adjusting for potential confounders. Results: The study included 6,841 participants, of whom 1,734 (25.35%) exhibited symptoms of depression. Our findings indicate that weak grip strength is significantly associated with an increased risk of depression (OR: 1.57, 95% CI: 1.32-1.87) among the middle-aged and elderly population. Conversely, good cognitive function was found to be protective against depression (OR: 0.94, 95% CI: 0.93-0.95). Grip strength indirectly affected depression through cognitive function, accounting for 9.4% of the total effect (β = -0.008, 95% CI [-0.013, -0.004]). This mediating effect was 23.8% in men (β = -0.013, 95% CI [-0.020, -0.007]); and 23.2% in those aged 60 years and over (β = -0.015, 95% CI [-0.022, -0.009]). Conclusion: This study highlights that weak grip strength increases risk of depressive symptoms, and adequate cognitive function can mitigate the association between weak grip strength and an increased risk of depression among middle-aged and elderly individuals in China. Psychological care for elder adults with weak grip strength and poor cognitive function should be strengthened. [ABSTRACT FROM AUTHOR]

Background: Studies have shown the positive impact of perceived social support on cognitive function among older adults in rural areas. However, existing studies often overlook the impact of different support sources. This study aimed to explore the relationship between the diverse sources of perceived social support and cognitive function. Methods: Participants were drawn from the Guizhou Rural Older Adults' Health Study (HSRO) in China. We included 791 participants who participated in a baseline survey in 2019 and a 3-year follow-up survey. Perceived social support was investigated from the six main sources (friend, relative, children, spouse, sibling, and neighbor). Hierarchical linear regression models were used to observe the effects of diverse sources of perceived social support and their combinations on cognitive function. Results: Cognitive function was positively associated with perceived support from children, friends, and neighbors. A positive association was found between cognitive function and increases in each additional source [ß = 0.75 (95%CI: 0.51, 0.98), p < 0.001]. Older adults who perceived support from both children and friends showed better cognitive function [ß = 2.53 (95%CI: 1.35, 3.72), p < 0.001]. The perception of support from spouse, siblings, and relatives did not show a statistically significant association with cognitive function among older adults in rural areas. Conclusion: This study found that the association between different sources of perceived social support and cognitive function was varied. This study provides scientific evidence that personalized support strategies may benefit in promoting cognitive health in rural older adults. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of the quadratus lumborum block (QLB) for postoperative pain management depends on the injection pathway used. There is limited research on the block area produced by intramuscular injection of local anesthesia in the quadratus lumborum muscle. This study aimed to determine the cutaneous sensory blockade area produced by an intramuscular quadratus lumborum block (QLBi) at the L2 level. Methods: Twenty patients aged 18–60 years with ASA grade I-II and a BMI of 18–30 kg/m2 who were scheduled for open inguinal hernia repair with mesh underwent ultrasound-guided QLBi injection of 20 ml of 0.5% ropivacaine. The cutaneous sensory blockade area was measured by applying a cold stimulus 1 h after the block and then measured every hour after surgery until the sensation returned to normal. The duration of a blockade is defined as the time it takes for all affected areas to fully regain normal sensation following a blockade. Pain scores (numeric rating scale, NRS) were recorded at 2, 4, 8, 12, and 24 h after surgery. Adverse reactions to QLBi were recorded 24 h after surgery. Results: All 20 patients had reduced or lost cold sensation areas. The greatest extent of cold sensation reduction occurred at T7 (10%), and the least amount of cold sensation reduction occurred at L3 (10%). The block level covered T8 (20%), T9 (30%), T10 (45%), T11 (90%), T12 (95%), L1 (100%), and L2 (15%). Eighteen patients experienced areas of sensory loss, with the highest range at T11 and the lowest at L2. The duration of the blockade was 8.9 ± 3.8 h, with a maximum of 24 h and a minimum of 5 h. One patient experienced quadriceps weakness after surgery. Conclusion: Quadratus lumborum block of intramuscular pathway can produce effective cutaneous sensory blockade, which can be used for postoperative analgesia of indirect inguinal hernia operation, and may also be beneficial to analgesia of other lower abdominal operations. However, the best method needs further confirmation to determine specific anesthesia methods for various operations. Chinese clinical trial registry: June 2, 2018; ChiCTR1800016457. [ABSTRACT FROM AUTHOR]

Background: The relationship of systolic blood pressure variability (SBPV) with Alzheimer's disease (AD) remains controversial. We aimed to explore the roles of SBPV in predicting AD incidence and to test the pathways that mediated the relationship of SBPV with cognitive functions. Methods: Longitudinal data across 96 months (T0 to T4) were derived from the Alzheimer's disease Neuroimaging Initiative cohort. SBPV for each participant was calculated based on the four measurements of SBP across 24 months (T0 to T3). At T3, logistic regression models were used to test the SBPV difference between 86 new-onset AD and 743 controls. Linear regression models were used to test the associations of SBPV with cognition and AD imaging endophenotypes for 743 non-demented participants (median age = 77.0, female = 42%). Causal mediation analyses were conducted to explore the effects of imaging endophenotypes in mediating the relationships of SBPV with cognitive function. Finally, Cox proportional hazard model was utilized to explore the association of SBPV with incident risk of AD (T3 to T4, mean follow-up = 3.5 years). Results: Participants with new-onset AD at T3 had significantly higher SBPV compared to their controls (p = 0.018). Higher SBPV was associated with lower scores of cognitive function (p = 0.005 for general cognition, p = 0.029 for memory, and p = 0.016 for executive function), higher cerebral burden of amyloid deposition by AV45 PET (p = 0.044), lower brain metabolism by FDG PET (p = 0.052), and higher burden of white matter hyperintensities (WMH) (p = 0.012). Amyloid pathology, brain metabolism, and WMH partially (ranging from 17.44% to 36.10%) mediated the associations of SBPV with cognition. Higher SBPV was significantly associated with elevated risk of developing AD (hazard ratio = 1.29, 95% confidence interval = 1.07 to 1.57, p = 0.008). Conclusion: These findings supported that maintaining stable SBP in late life helped lower the risk of AD, partially by modulating amyloid pathology, cerebral metabolism, and cerebrovascular health. [ABSTRACT FROM AUTHOR]

Purpose: To compare the standard outcomes between the PanOptix and Symfony multifocal intraocular lenses (MIOLs) in Chinese patients. Methods: This prospective observational cohort study enrolled patients with cataracts between April 2021 and December 2021 at Xiamen Eye Center Affiliated to Xiamen University. The patients were grouped in the PanOptix (TIOL group) and Symfony (EDF group) according to the IOLs implanted. Uncorrected distant, corrected distance, binocular uncorrected intermediate, and near visual acuity (UNVA), distance‐corrected intermediate and near VA (DCNVA) , defocus curve, spectacle independence, contrast sensitivity (CS), and visual disturbances were evaluated after 3 months. Results: Forty patients (80 eyes) were enrolled in the study (20/group). Three months after the operation, UNVA (0.13 ± 0.16) and DCNVA (0.08 ± 0.08) were better in the TIOL group than in the EDF group (0.22 ± 0.08 and 0.22 ± 0.08, respectively, p = 0.003 and p < 0.001, respectively). The TIOL group achieved a better‐than‐0.15‐logMAR VA from +0.5 D to −2.5 D (40 cm). VAs of the TIOL group from −1 D (100 cm) to −4 D (25 cm) were better than in the EDF group (p < 0.05). There were no significant differences in the intermediate and far vision outcomes (p > 0.05). Total near‐vision spectacle independence was higher in the TIOL group (80%) than in the EDF group (50%) (p = 0.039). Conclusion: Compared with EDF, TIOL leads to better near‐vision outcomes without significant differences for intermediate and distant vision outcomes. Trial Registration: ClinicalTrials.gov identifier: ChiCTR2100044558. [ABSTRACT FROM AUTHOR]

This study investigated the mediating role of perceived stress in long-term development of posttraumatic stress symptoms (PTSS) and emotional distress among local government officials over seven years after the Wenchuan earthquake in China. Moreover, how dysfunctional coping would impact the relationship between perceived stress and PTSS or emotional distress was examined. Data were collected one year (T1) and seven years (T2) after the earthquake. Trauma experience, PTSS, and emotional distress were measured at one year. PTSS and emotional distress were re-assessed at seven years together with perceived stress and dysfunctional coping (i.e., behavioral disengagement, denial, self-distraction, self-blame, substance use, and venting). Mediation analyses were conducted to examine the mediating role of perceived stress. Moderated mediation analyses were performed to test the moderation effect of dysfunctional coping. Perceived stress fully mediated the association of T1 emotional distress with its' T2 scores (indirect effect: B = 0.10, SE = 0.04, β = 0.11, 95% CI [0.02, 0.18]), while did not mediate the association of T1 PTSS with T2 PTSS (indirect effect: B = 0.04, SE = 0.03, β = 0.04, 95% CI [−0.02, 0.10]). Compared to a low frequency use of dysfunctional coping strategies (ps = 0.148–0.326), the detrimental effects of perceived stress on PTSS and emotional distress were stronger at higher levels of dysfunctional coping strategies (ps < 0.001). This study highlights the importance of paying attention to the adverse impacts of perceived stress and dysfunctional coping on long-term mental health outcomes among local government officials after disasters. [ABSTRACT FROM AUTHOR]

Background: Distal tibiofibular syndesmosis injury is often associated with ankle fractures in adults. Injuries to the anterior/posterior inferior tibiofibular ligament (AITFL/PITFL) may present as a mid-substance tear or as an avulsion at insertion. Tibial and fibular avulsion of the AITFL is known as Tillaux fracture and Wagstaffe fracture, respectively. Tibial avulsion of the PITFL is referred to as a Volkmann fracture, and fibular avulsion of the PITFL is still undefined and has not been reported yet. The aim of this study is to summarize the incidence of these four avulsions, that is, tibial and fibular avulsions of the AITFL and PITFL. Method: Radiography and computed tomography (CT) imaging data of all adult patients with ankle fractures treated at our hospital between November 2010 and March 2023 were retrospectively analyzed. All ankle fractures were classified according to the Weber-AO and Lauge-Hansen classification systems by two experienced radiologists and two surgeons. The incidence of the four avulsions of the AITFL/PITFL was determined. Results: In total, 1,770 ankle fractures in 1,758 patients were included in this study. The total incidence of avulsions at the four insertions of the AITFL/PITFL (occurring at one, two, or three insertions) was found to be 26.3% (465/1,770). Volkmann fracture had the highest incidence (19.9%, 353/1,770), and it was followed by Tillaux fracture (5.3%, 93/1,770), Wagstaffe fracture (3.3%, 59/1,770), and fibular avulsion of the PITFL (0.5%, 8/1,770). It is noteworthy that fibular avulsion of the PITFL has been reported here for the first time. The incidence of avulsion at one insertion was 23.6% (418/1770) and 2.7% (47/1770) at multiple insertions. Conclusion: In adult ankle fractures, avulsion occurs at the four insertions of the AITFL/PITFL in more than 25% of patients. The tibial insertion of the PITFL had the highest incidence of avulsion among the four insertions, while the fibular insertion of the PITFL had the lowest. The four types of avulsions can be isolated or in association with other avulsions. Future research studies on these four types of avulsion fractures would help in accurate diagnosis, decision-making and treatment of ankle Syndesmosis injuries. Level of evidence: Level III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Background: The repair of diabetic foot defects (DFD) is a major challenge in clinical practice. The purpose of this study was to investigate the difference in clinical efficacy of different flap techniques in repairing DFD wounds, and to compare the difference in clinical efficacy of anterolateral thigh perforator flap (ALTP) in repairing DFD and non-DFD. Methods: This study is a retrospective clinical study of different types of flap reconstruction in patients with DFD admitted to our hospital from January 2010 to December 2021. A total of 40 patients with DFD and 43 patients with non-DFD were included in this study. Detailed preoperative basic information, intraoperative details, postoperative complications and long-term follow-up results were collected. Result: The comorbidities, wound infection and wound duration of DFD group were more serious than those of non-DFD group. In addition, the incidence of complications was higher in DFD group, the wound healing time was longer, the aesthetic evaluation, the functional recovery rate of ankle joint and the sensory recovery effect of flaps were worse. Conclusion: In this study, it is concluded that different flap techniques can obtain better clinical efficacy in repairing DFD wounds. Compared with non-DFD wounds, the postoperative risk of DFD wounds using free ALTP flaps is higher, but the risk can be reduced by reasonable preoperative vascular examination. Free flap can deal with various irregular wounds and provide more options for clinical repair. Level of evidence: III, Case–control study. [ABSTRACT FROM AUTHOR]

Background: With the increasing prevalence of obesity, there is growing awareness of the impact of overweight and obesity on total hip arthroplasty (THA). Research exploring the accuracy of acetabular component orientation in THA between robotic-assisted and manual techniques across different BMI categories is insufficient. Methods: This prospective study evaluated 221 patients who underwent THA with a Robotic Interactive Orthopaedic Arm system and 252 patients who underwent manual THA between March 2022 and January 2024. The patients were divided into four groups according to their BMI. We analysed whether there were differences in the accuracy of acetabular component positioning between robotic-assisted THA and manual THA across different BMI categories. Results: In the overweight group, robotic-assisted THA achieved a significantly higher rate of abductions within the target range (73/6) than manual THA (62/28) (p = 0.000). Both abductions and anteversions within the target range were also significantly more frequent in the robotic-assisted THA group (69/10) than in the manual THA group (56/34) (p = 0.000). Among the obese patients, robotic-assisted THA showed a perfect record for anteversions within the target range (29/0), markedly outperforming manual THA (39/6) (p = 0.040). Conclusion: In the overweight (24 kg/m² ≤ BMI < 28 kg/m²) and obese (BMI ≥ 28 kg/m²) groups, robotic-assisted THA demonstrates significantly greater accuracy in acetabular component positioning compared to manual THA. This indicates that robotic-assisted technology may provide a more precise positioning of the acetabular component in overweight and obese patients. [ABSTRACT FROM AUTHOR]

Background: A combination of remimazolam and propofol could produce more stable sedation. A good medication regimen should consider not only efficacy but also safety, especially hypotension. The aim of the current study was to compare the incidence and amount of hypotension by propofol versus remimazolam-propofol combinations in day-surgery hysteroscopy. Methods: Patients were randomly assigned to receive either propofol (Group P, n = 125) or remimazolam-propofol combinations (Group RP, n = 125) at a 1:1 ratio. Intravenous injection of sufentanil 0.1ug/kg were administered before sedative medication. In group P, a bolus of 2.5 mg/kg propofol was administered. In group RP, intravenous anesthesia was commenced with 0.125 mg/kg remimazolam and 1 mg/kg propofol. After loss of consciousness, propofol was maintained at 6 mg/kg/h. The primary outcomes were the incidence and amount of hypotension during surgery. Hypotension was defined as a MAP less than 65mmHg for at least 1 min. The amount of hypotension was assessed by time-weighted average intraoperative MAP under a threshold of 65 mmHg. The secondary outcomes were various anesthesia related parameters and some adverse events. Results: In group P, 25 patients (20.0%) experienced hypotension during hysteroscopy compared with 9 patients (7.2%) in group RP, for a difference of 12.8% (RR 2.778, 95%CI [1.352–5.709]). The combination of remimazolam and propofol resulted in significantly lower TWA (Time Weighted Average) threshold 0.14 (0.10–0.56) mmHg in group RP compared to 0.31 (0.15–0.67) mmHg in group P. The total dose of propofol was nearly double in group P compared to group RP. A significantly higher frequency of injection pain and low oxygen saturation was observed in the group P than that of the group RP. Hiccup was observed only in group RP. The incidences of body movement, bradycardia and vomiting were no significant difference between groups. Conclusion: The incidence and amount of hypotension by remimazolam-propofol combinations was significantly less than that by propofol sedation in day-surgery hysteroscopy. The optimization of medication regimen would attenuate the harm of hypotension and contribute to patients' rapid recovery in day surgery. Trial registration : Chinese Clinical Trial Registry, ChiCTR2400079888 (date: 15/01/2024), [ABSTRACT FROM AUTHOR]

Background: The neonatal outcomes across different percentiles of birth weight for gestational age are still unclear. Methods: This retrospective cohort study was conducted within 57 tertiary hospitals participating in the Chinese Neonatal Network (CHNN) from 25 provinces throughout China. Infants with gestational age (GA) 24+0-31+6 weeks who were admitted within 7 days after birth were included. The composite outcome was defined as mortality or any one of neonatal major morbidities, including necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage (IVH), cystic periventricular leukomalacia (cPVL), severe retinopathy of prematurity (ROP), and sepsis. Multivariable logistic regressions using generalized estimating equation approach were conducted. Results: A total of 8380 infants were included with a mean GA of 30 (28–31) weeks. Of these, 1373 (16.5%) were born at less than 28 weeks, while 6997 (83.5%) had a GA between 28 and 32 weeks. Our analysis indicated that the risk of composite outcomes was negatively associated with birth weight for gestational age, and compared to the reference group, the multiple-adjusted ORs (95%CI) of composite outcomes were 4.89 (3.51–6.81) and 2.16 (1.77–2.63) for infants with birth weight for gestational less than 10th percentile and 10th -30th percentile, respectively. The ORs (95%CI) of mortality, NEC, BPD, severe ROP, and sepsis in infants with birth weight for gestational age at 10th-30th percentile were 1.94 (1.56–2.41), 1.08 (0.79–1.47), 2.48 (2.03–3.04), 2.35 (1.63–3.39), and 1.39 (1.10–1.77), respectively. Conclusion: Our study suggested that the risk of adverse neonatal outcomes increased significantly when the birth weight for gestational age was below the 30th percentile. Regular monitoring and early intervention are crucial for these high-risk infants. [ABSTRACT FROM AUTHOR]

To address challenges in screening for chronic kidney disease (CKD), we devised a deep learning-based CKD screening model named UWF-CKDS. It utilizes ultra-wide-field (UWF) fundus images to predict the presence of CKD. We validated the model with data from 23 tertiary hospitals across China. Retinal vessels and retinal microvascular parameters (RMPs) were extracted to enhance model interpretability, which revealed a significant correlation between renal function and RMPs. UWF-CKDS, utilizing UWF images, RMPs, and relevant medical history, can accurately determine CKD status. Importantly, UWF-CKDS exhibited superior performance compared to CTR-CKDS, a model developed using the central region (CTR) cropped from UWF images, underscoring the contribution of the peripheral retina in predicting renal function. The study presents UWF-CKDS as a highly implementable method for large-scale and accurate CKD screening at the population level. [ABSTRACT FROM AUTHOR]

Background: Sarcopenia is an aging-related disorder characterized by a loss of muscle mass and function. Calf circumference (CC) is a useful surrogate marker of muscle mass and function. This prospective study was designed to investigate the association between CC and all-cause mortality during a follow-up for 5 years in the Chinese centenarians. Methods: The China Hainan Centenarian Cohort Study (CHCCS) is conducted in 18 cities and counties of Hainan, China. Results: All 231 centenarians had a mean age of 103.03 years. Survival participants had a longer CC and were often living alone compared with others (P<0.05 for all). Multivariate Cox regression models showed that CC was negatively associated with all-cause mortality (P < 0.05 for all). Participants with a longer CC had a lower mortality risk compared with others [Exp(β): 0.918; 95%confidence interval: 0.863–0.977]. Participants with a longer CC had a lower mortality risk whether they were males or females and lived with family members or alone. Conclusion: CC was negatively associated with all-cause mortality and could be an indicator of future mortality among the Chinese centenarians. Further researches should focus on preventing a decline in the CC in order to promote human longevity. [ABSTRACT FROM AUTHOR]

Aim: To develop a nomogram‐based predictive model of tooth survival by comprehensively analysing clinical and radiographic risk factors of tooth loss (TL). Materials and Methods: In this study, 3447 teeth of 131 subjects who underwent non‐surgical periodontal treatment were examined retrospectively within a mean follow‐up period of 11.6 years. The association of risk factors including clinical and radiographic parameters with TL was assessed using univariate and multivariate Cox regression analyses. A nomogram‐based predictive model was developed, and its validation and discriminatory ability were analysed. Results: In all, 313 teeth were lost in 94 patients in this study (overall tooth loss [OTL] 9.08%; 0.21 teeth/patient/year). Male, heavy smoking, molar teeth, probing depth (PD), attachment loss (AL), tooth mobility and radiographic bone loss were significantly associated with TL (p <.05). A gradient effect of tooth mobility on TL increased from degree I to III versus none (p <.0001). The area under the curve (AUC) of the model was 0.865. Calibration curve and decision curve analysis demonstrated good performance and high net benefit, respectively. Conclusions: Adopting a specific nomogram could facilitate the prediction of tooth survival and the development of tailored treatment plans in Chinese patients with advanced periodontitis. [ABSTRACT FROM AUTHOR]

Importance: Epidemiological evidences regarding the association between whole grain intake and the risk of new-onset hypertension are still controversial. Objective: We aimed to investigate the relationship between whole grain intake and new-onset hypertension and examine possible effect modifiers in the general population. Methods: A total of 10,973 participants without hypertension from the China Health and Nutrition Survey were enrolled, with follow-up beginning in 1997 and ending in 2015. Whole grain intake was assessed by 3 consecutive 24-h dietary recalls combined with a household food inventory. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression model after adjusting for potential risk factors. Results: During a median follow-up of 7.0 years, 3,733 participants developed new-onset hypertension. The adjusted HRs (95% CIs) were as follows: for quartile 2 (HR: 0.52; 95% CI: 0.47–0.57), quartile 3 (HR: 0.46; 95% CI: 0.42–0.51), and quartile 4 (HR: 0.35; 95% CI: 0.31–0.38), compared with quartile 1. Different types of whole grain types, including wheat (adjusted HR, 0.35; 95% CI, 0.32–0.39), maize (adjusted HR, 0.50; 95% CI, 0.42–0.59), and millet (adjusted HR, 0.38; 95% CI, 0.30–0.48), showed significant associations with a reduced risk of hypertension. The association between whole grain intake and new-onset hypertension was stronger in individuals with older age (P for interaction < 0.001) and higher BMI (P for interaction < 0.001). Conclusion: Higher consumption of whole grains was significantly associated with a lower risk of new-onset hypertension. This study provides further evidence supporting the importance of increasing whole grain intake for hypertension prevention among Chinese adults. [ABSTRACT FROM AUTHOR]

Our study examines the impact of informal care on healthcare utilization, focusing on caregiver types, urban-rural, and gender differences. Analyzing data from the China Health and Retirement Longitudinal Study and using fixed effects models, we discovered complementary effects between informal care and healthcare. Specifically, spousal care increased inpatient care use, adult child care boosted both inpatient and outpatient use, and dual care from children and spouses showed the most significant impact on healthcare use. The association between informal care and healthcare use varied across gender or urban-rural residence. Our findings highlight the importance of caregivers in accessing healthcare services. [ABSTRACT FROM AUTHOR]

Competency‐based teasing has been identified as a risk factor for children's depressive symptoms. However, the specific psychological mechanisms mediating this relationship are not well understood, especially in the context of Chinese culture. This study examined the relationship between competency‐based teasing, subsequent depressive symptoms, and the possible mediating role of positivity in Chinese children by using parallel process latent growth curve modelling. Gender differences were also explored. A sample of 4376 Chinese children (55.1% boys; age: M = 9.98 years, SD = 0.88) completed measurements of the relevant constructs on five occasions across 2 years, using half‐year intervals. The findings revealed that competency‐based teasing was significantly positively associated with subsequent depressive symptoms in Chinese children. Furthermore, positivity mediated this relationship in girls, but not in boys. The results suggest that positivity‐cultivating and gender‐specific interventions may be effective to reduce the risk of depressive symptoms in Chinese children. [ABSTRACT FROM AUTHOR]

To assess if the impacts of prenatal maternal stress (PNMS) on neonatal physical development including birth weight and body length vary by trimesters, and to explore the mediating effect of sleep quality in the relationships. A total of 2778 pregnant women were included from the Shanghai Maternal‐Child Pairs Cohort. PNMS and sleep quality were measured in the first trimester (12–16 gestational weeks) and third trimester (32–36 gestational weeks) using the Life Event Scale for Pregnant Women (LESPW) and Pittsburgh Sleep Quality Index, respectively. And total LESPW scores were classified into three groups: high stress (≥75th percentile), medium stress (≥25th and <75th percentile), and low stress (<25th percentile). Multiple linear and logistic regressions were employed to examine the associations between PNMS and birth weight, and bootstrap were utilized to explore the mediating effects of maternal sleep. Higher (adjusted odds ratio, aOR = 1.521; 95% confidence interval (CI), 1.104–2.096) and medium (aOR = 1.421; 95% CI, 1.071–1.885) PNMS and stress from subjective events (aOR = 1.334; 95% CI, 1.076–1.654) in the first trimester were significantly associated with elevated risk for large for gestational age. Maternal severe negative objective events stress (OE3) in the third trimester were negatively associated with birth weight (β = −0.667; 95% CI, −1.047∼−0.287), and maternal sleep latency during this period acted as a mediator in the association (indirect effect: β = −0.0144; 95% CI, −0.0427∼−0.0003). Besides, a significant negative correlation between total LESPW score (β = −0.022; 95% CI, −0.038∼−0.006; per 100 score) and body length in the third trimester was also observed. The impact of PNMS on neonatal birth weight varies by stress types and exposure timing. Prolonged maternal sleep latency in the third trimester correlated with lower birth weight, and mediating the link of OE3 and birth weight, which might indicate a critical period of vulnerability to the effects of PNMS on neonatal physical development. [ABSTRACT FROM AUTHOR]

Aim: To examine the level and influencing factors of discharge readiness among patients with oesophageal cancer following oesophagectomy and to explore its association with post‐discharge outcomes (post‐discharge coping difficulty and unplanned readmission). Background: Oesophageal cancer is common and usually treated via oesophagectomy in China. The assessment of patient's discharge readiness gradually attracts attention as patients tend to be discharged more quickly. Design: Prospective observational study. The STROBE statement was followed. Methods: In total, 154 participants with oesophageal cancer after oesophagectomy were recruited in a tertiary cancer centre in Southern China from July 2019 to January 2020. The participants completed a demographic and disease‐related questionnaire, the Quality of Discharge Teaching Scale and Readiness for Hospital Discharge Scale before discharge. Post‐discharge outcomes were investigated on the 21st day (post‐discharge coping difficulty) and 30th day (unplanned readmission) after discharge separately. Multiple linear regressions were used for statistical analysis. Results: The mean scores of discharge readiness and quality of discharge teaching were (154.02 ± 31.58) and (138.20 ± 24.20) respectively. The quality of discharge teaching, self‐care ability, dysphagia and primary caregiver mainly influenced patient's discharge readiness and explained 63.0% of the variance. The low discharge readiness could predict more risk of post‐discharge coping difficulty (r = −0.729, p < 0.01) and unplanned readmission (t = −2.721, p < 0.01). Conclusions: Discharge readiness among patients with oesophageal cancer following oesophagectomy is influenced by various factors, especially the quality of discharge teaching. A high discharge readiness corresponds to good post‐discharge outcomes. Implications for the Profession and Patient Care: Healthcare professionals should improve the discharge readiness by constructing high‐quality discharge teaching, cultivating patients' self‐care ability, mobilizing family participation and alleviating dysphagia to decrease adverse post‐discharge outcomes among patients with oesophageal cancer. Patients or Public Contribution: Patients with oesophageal cancer after oesophagectomy who met the inclusion criteria were recruited. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To investigate empirically the direct effect and potential mechanism of family resilience on patient‐reported outcomes among young stroke dyads in China. Background: Young patients with stroke have been becoming an important public health issue. According to relevant theories and previous studies, we found that family resilience might play an important role in patient's symptoms. However, it is less clear about the specific relationship and potential mechanisms of these two variables. Design: We used a prospective cross‐sectional design. Methods: A multi‐item questionnaire was used to assess the constructs of interest. Researchers progressively constructed and validated conditional process models. The PROCESS macro was used to verify the research hypotheses. Results: A total of 560 questionnaires were collected in this study. We found that family resilience of stroke patients and their spouses had a direct effect on the physical, psychological and social aspects of patient‐reported symptoms. We further revealed that caregiver preparedness partially mediated the relationship between family resilience and patient's symptoms in stroke patient‐spouse dyads, while perceived social support moderated the relationship between caregiver preparedness and patient's symptoms. Finally, we observed that the impact of caregiver readiness and social support on patients' symptoms predominantly manifested in physical and physiological outcomes. Conclusions: Our research provides evidence about the positive impact of family resilience on patient‐reported symptoms in young stroke dyads. Meanwhile, it further revealed how caregiver preparedness and perceived social support may play out in the relationship. Practice Implications: Our research introduces a novel perspective and pathway to enhance short‐term recovery outcomes for patients. It also furnishes clinicians and nurses with evidence to guide the implementation of interventions aimed at improving patient health outcomes and facilitating smoother transitions from the hospital to home. Impact: What problem did the study address? Families play a crucial role in a patient's recovery process from illness, with family resilience serving as an important force for families to overcome adversity. However, the impact on patient symptoms and the underlying mechanisms of this relationship are uncertain. Empirical research is required to validate these aspects. What were the main findings? Family resilience has a positive impact on the physical, psychological and social aspects of patient‐reported symptoms in young stroke dyads. Both the actor effect and partner effect are supported. The impact of caregiver readiness and social support on patient‐reported symptoms is primarily observed in physical and physiological outcomes. Where and on whom will the research have an impact? This study offers a novel approach to enhance the short‐term recovery of stroke patients. The researchers believe that the findings of this study will play an even more significant role during patients' transition from the hospital to home. Reporting Method: This study followed the STROBE statement of cross‐sectional studies. Patient or Public Contribution: The study was conducted by patients, their spouses, healthcare professionals and the research team. [ABSTRACT FROM AUTHOR]

This study aims to investigate whether generational differences in intergenerational caregiving patterns (caring for parents only, caring for grandchildren only, and caring for parents and grandchildren simultaneously) are associated with cognitive health disparities among the sandwich generation within four-generation families, drawing upon the theories of intergenerational solidarity and intergenerational stake. Moreover, this study seeks to identify mediators that help explain these disparities. A nationally representative sample of 8,065 respondents was drawn from the 2011 and 2018 waves of the China Health and Retirement Longitudinal Study. The findings reveal that the sandwich generation caring for grandchildren only, as well as those caring for grandchildren and parents simultaneously, exhibit better cognitive health. However, caregiving for parents only is not significantly related to their cognitive health. This study identifies the inability to reduce depressive symptoms as a mediator explaining the insignificant association between caregiving for parents only and the cognitive health of the sandwich generation. The findings underscore the importance of offering support to the sandwich generation within four-generation families to enhance their cognitive health. Moreover, it is imperative to distinguish between different intergenerational caregiving patterns based on generational differences among the sandwich generation, with a specific emphasis on allocating public resources aimed at promoting cognitive health for those engaged in caring for parents. [ABSTRACT FROM AUTHOR]

Background: There are limited data on the effect of different sutures and surgical approaches on the quality of pancreaticojejunostomy in minimally invasive pancreaticoduodenectomy (MIPD). This study compares the incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) between the use of barbed sutures (BSs) and conventional sutures (CSs). Methods: A retrospective cohort study was conducted on 253 consecutive patients who had undergone MIPD from July 2016 to April 2023. Patients were excluded if conversion to open surgery or open anastomosis was necessary. 220 patients were enrolled and divided into BS (n = 148) and CS (n = 72) groups. After 1:1 propensity score matching (PSM), 67 cases remained in each group. Univariate and multivariate analyses identified factors associated with CR-POPF. Comparisons were also made between laparoscopic (LPD) and robotic (RPD) pancreaticoduodenectomy. Results: After PSM, BSs were associated with significantly lower rates of CR-POPF (7.5 vs. 22.4%, P = 0.015) and severe complications (Clavien–Dindo ≥ III) (7.5vs. 19.4%, P = 0.043). No significant differences were found in operative time, length of postoperative hospital stay, or other major morbidities. Multivariate analyses revealed BMI ≥ 22 kg/m2 (OR = 5.048, 95% CI: 1.256–20.287, P = 0.023) and the use of BSs (OR = 0.196, 95% CI: 0.059–0.653, P = 0.008) as the independent predictors of CR-POPF. There were no significant differences in postoperative outcomes between the LPD and RPD groups, but RPD was associated with significantly shorter operative time (402.8 min vs. 429.4 min, P = 0.015). Conclusions: In conclusion, using BSs for PJ during MIPD is feasible and has the potential to reduce CR-POPF and severe complications. [ABSTRACT FROM AUTHOR]

Background: The effect of tumor budding (TB) on the prognosis of patients with esophageal squamous cell carcinoma (ESCC) after endoscopic submucosal dissection (ESD) remains unclear. We evaluated the long-term outcomes of patients with superficial ESCC after ESD and the risk factors of TB for the long-term prognosis. Methods: We conducted a retrospective study in a Chinese hospital. All patients with ESCC treated by ESD and reported TB were included consecutively. Comparative analyses were conducted in three parts: specimen analysis, follow-up analyses of unmatched patients, and propensity score-matched (PSM) patients. Cox proportional hazard regression models were constructed to identify risk factors for overall survival and recurrence-free survival (RFS). Results: A total of 437 patients were enrolled [154 TB and 283 no tumor budding (NTB)], and 258 patients (52 TB and 206 NTB) were included in the follow-up analysis. Results showed that the invasion depth, differentiation type, and positive vascular invasion (all p < 0.001) of the TB group were significantly different from the NTB group. The all-cause mortality and the median RFS time between the two groups were comparable. RFS rate at 5 years were 84.6% and 80.6%, respectively (p = 0.43). Cox analyses identified that having other cancers but not TB, as a risk factor independently associated with overall survival and RFS after ESD. Conclusion: TB tends to be associated with invasion depth, differentiation type, and positive vascular invasion. However, it might not affect the long-term outcomes of patients with superficial ESCC after ESD when other high-risk factors are negative. [ABSTRACT FROM AUTHOR]

Objective: The Surgical Apgar Score quantifies three intraoperative parameters: lowest heart rate, lowest mean arterial pressure, and estimated blood loss (EBL). This scoring system predicts postoperative complications based on these measured factors. The aim of this study was to investigate the value of modified Surgical Apgar Score (mSAS) in predicting postoperative complications in patients with rectal cancer treated with robotic surgery in order to improve the survival and quality of life of rectal cancer patients. Methods: The study included patients with rectal cancer who underwent robotic surgery in the Department of Gastrointestinal Surgery at the First Affiliated Hospital of Nanchang University from January 2015 to December 2023. In minimally invasive surgery, we developed a modified Surgical Apgar Score (mSAS) tailored for robotic rectal cancer surgery, incorporating an adjusted threshold for EBL. This threshold was derived from quartile analysis of a cohort of 524 patients, with a median EBL of 100 mL (IQR 80–130 mL). We analyzed the association of postoperative complications with low mSAS. Results: This study included 524 patients, of which 91 (17.4%) experienced complications and 22 (4.2%) suffered severe complications. mSAS of 6 provided maximal Youden index and were determined as the cut-off values. The area under the ROC curve for predicting complications using the mSAS was 0.740. Univariate and multivariate analyses indicated that an older age, lower tumor localization, longer operation time, radiotherapy alone, combined chemoradiotherapy, and lower mSAS as independent risk factors for complications. The AUC of the prediction nomogram was 0.834 (95% CI 0.774–0.867). The calibration curve demonstrated excellent concordance with the nomogram, indicating the prediction curve ft the diagonal well. Conclusion: This study suggests that mSAS might be a valuable predictive indicator for postoperative complications following robotic rectal cancer surgery, with potentially higher clinical utility. [ABSTRACT FROM AUTHOR]

Objectives Informal care provided by adult children is of great importance for older adults' well-being in China. This paper investigates and compares the functional transitions among older adults living in rural areas who receive care from daughters' and from sons' families. Methods This study utilizes the "Well-being of Elderly Survey in Anhui Province" (WESAP) from 2001 to 2021. Our sample included 2,797 individuals aged 60 years or older. Functional status was based on the activities of daily living and the instrumental activities of daily living. We employed a random-effects ordered logit model to examine the functional transitions among the older adults. Results Receiving care from daughters' families is significantly associated with a lower likelihood of functional decline compared to receiving care from sons' families in rural China. The advantage associated with daughter care becomes more pronounced among older individuals with a severe functional difficulty compared to those with a mild or moderate functional difficulty. The difference is prevalent among older adults aged 75 and older, with less wealth or multiple chronic diseases, or who live alone. Furthermore, among those with severe functional difficulties, the daughter advantage is more significant for fathers as compared to mothers. Discussion Nowadays, daughters' families can provide high-quality informal care, often surpassing that offered by sons' families. This daughter advantage becomes even more significant among older adults who have a higher need for family care, such as those with severe disabilities and limited financial resources. [ABSTRACT FROM AUTHOR]

Background and aims: This study aimed to examine the cumulative effects of body mass index (BMI), body roundness index (BRI), pulse pressure (PP), triglycerides (TG), high-density lipoprotein cholesterol (HDL) and fasting plasma glucose (FPG) on Type 2 diabetes (T2D) morbidity. Methods: A total of 78,456 participants aged older than 45 years were extracted from basic public health services in China. During the 2-year follow-up, 6,942 individuals had developed T2D. The binary logistic regression models and multinomial logistic regression models were conducted to investigate the effects of cumulative metabolic parameters on incident T2D, prediabetes regression and progression. Results: We found statistically deleterious impacts of exposure to high cumulative BMI, BRI, PP, TG and low cumulative HDL on T2D morbidity and prediabetes progression. Compared to the group with low cumulative of all five parameters, the adjusted ORs for new-onset T2D for participants presenting with 1–2, 3, and 4–5 elevated metabolic parameters were 1.41(1.31,1.52), 1.93(1.74,2.13) and 2.21(1.94,2.51), respectively. There was additive interaction between FPG level and cumulative metabolic parameters with T2D. Compared with participants with the lowest quartile of FPG and low cumulative of all 5 parameters, those with the highest quartile of FPG and high cumulative of 4–5 parameters had a 14.63 [95% CI (12.27, 17.42)] higher risk of incident T2D. Conclusions: Participants with more numbers of high-cumulative metabolic parameters were associated with a higher risk of incident T2D and prediabetes progression. A high level of normal FPG could enhance these risks. [ABSTRACT FROM AUTHOR]

Objectives PsA is the most prevalent coexisting condition associated with psoriasis. Early-stage PsA patients always present unspecific and subtle clinical manifestations causing delayed diagnosis and leading to unfavourable health outcomes. The application of US enables precise identification of inflammatory changes in musculoskeletal structures. Hence, we constructed US models to aid early diagnosis of PsA. Methods This was a cross-sectional study carried out in the Department of Dermatology at West China Hospital (October 2018–April 2021). All participants underwent thorough US examinations. Participants were classified into the under 45 group (18 ≤ age ≤ 45 years) and over 45 (age >45 years) group and then randomly grouped into derivation and test cohort (7:3). Univariable logistic regression, least absolute shrinkage and selection operator, and multivariable logistic regression visualized by nomogram were conducted in order. Receiver operating characteristic (ROC), calibration curve, decision curve analysis (DCA) and clinical impact curve analysis (CICA) were performed for model verification. Results A total of 1256 participants were included, with 767 participants in the under 45 group and 489 in the over 45 group. Eleven and 16 independent ultrasonic variables were finally selected to construct the under 45 and over 45 model with the area under the ROC of 0.83 (95% CI 0.78–0.87) and 0.83 (95% CI 0.78–0.88) in derivation cohort, respectively. The DCA and CICA analyses showed good clinical utility of the two models. Conclusion The implementation of the US models could streamline the diagnostic process for PsA in psoriasis patients, leading to expedited evaluations while maintaining diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Objectives To elucidate the longitudinal reciprocal association between RA and chronic obstructive pulmonary disease (COPD) and the mediating role of systemic inflammation in the association. Methods A total of 403 045 participants from UK Biobank were enrolled in this study. A cross-lagged panel model was used to investigate the longitudinal reciprocal association between RA and COPD. Cox proportional hazards regression and logistic regression models were also conducted to examine the association between baseline RA and COPD during follow-up, and vice versa. Causal mediation analysis was then performed to explore the mediating roles of 160 systemic inflammatory biomarkers in the bidirectional association. Results At baseline, 4755 (1.2%) and 6989 (1.7%) individuals were diagnosed with RA and COPD, respectively. After adjusting for the covariates, the result of a cross-lagged panel model revealed a bidirectional association between RA and COPD (β = 0.018, P  < 0.001 for the RA→COPD path; β = 0.010, P  < 0.001 for the COPD→RA path). In the non-COPD population, the risk of future COPD was increased in RA patients [Cox model: hazard ratio (HR) 1.65 (95% CI 1.50, 1.83); logistic model: odds ratio (OR) 1.85 (95% CI 1.66, 2.07)]. In the non-RA population, baseline COPD was associated with a higher risk of RA during follow-up [Cox model: HR 1.67 (95% CI 1.44, 1.92); logistic model: OR 1.70 (95% CI 1.47, 1.97)]. Five inflammatory factors mediated the RA→COPD path and CRP mediated the COPD→RA path (false discovery rate < 0.05). Conclusions A significant bidirectional association exists between RA and COPD and it is partially mediated by systemic inflammation. [ABSTRACT FROM AUTHOR]

Background: With the rapid increase of chest computed tomography (CT) images, the workload faced by radiologists has increased dramatically. It is undeniable that the use of artificial intelligence (AI) image‐assisted diagnosis system in clinical treatment is a major trend in medical development. Therefore, in order to explore the value and diagnostic accuracy of the current AI system in clinical application, we aim to compare the detection and differentiation of benign and malignant pulmonary nodules between AI system and physicians, so as to provide a theoretical basis for clinical application. Methods: Our study encompassed a cohort of 23 336 patients who underwent chest low‐dose spiral CT screening for lung cancer at the Health Management Center of West China Hospital. We conducted a comparative analysis between AI‐assisted reading and manual interpretation, focusing on the detection and differentiation of benign and malignant pulmonary nodules. Results: The AI‐assisted reading exhibited a significantly higher screening positive rate and probability of diagnosing malignant pulmonary nodules compared with manual interpretation (p < 0.001). Moreover, AI scanning demonstrated a markedly superior detection rate of malignant pulmonary nodules compared with manual scanning (97.2% vs. 86.4%, p < 0.001). Additionally, the lung cancer detection rate was substantially higher in the AI reading group compared with the manual reading group (98.9% vs. 90.3%, p < 0.001). Conclusions: Our findings underscore the superior screening positive rate and lung cancer detection rate achieved through AI‐assisted reading compared with manual interpretation. Thus, AI exhibits considerable potential as an adjunctive tool in lung cancer screening within clinical practice settings. [ABSTRACT FROM AUTHOR]

Background: This study explored the significance of consolidation maintenance chemotherapy after concurrent chemoradiotherapy with different regimens in patients with esophageal squamous cell carcinoma. Method: A prospective randomized controlled phase III clinical trial was designed and registered in the China Clinical Trials Registry (Registration number: ChiCTR‐TRC‐12002719). Survival data were analyzed in terms of intention‐to‐treat (ITT) and per‐protocol (PP) sets for patients undergoing cisplatin and 5‐fluorouracil (PF) (group A), or cisplatin and paclitaxel (TP) (group B). Results: The incidence risk of grade III–IV leukopenia in group B was higher than in group A (49.2% vs. 25.5%, p = 0.012). The survival rates at 1, 2, 3, and 5 years were 83.8%, 62.6%, 53.1%, and 41.3%, respectively. Consolidation chemotherapy after concurrent chemoradiation therapy had no benefit on median progression‐free survival (PFS) (p = 0.95) and overall survival (OS) (p = 0.809). According to the ITT analysis, the median PFS in group A and group B was 28.6 months and 30.3 months (X2 = 0.242, p = 0.623), while the median OS was 31.0 months and 50.3 months (X2 = 1.25，p = 0.263). For the PP analysis, the median PFS in group A and group B were 28.6 months and 30.3 months (p = 0.584), while the median OS was 31.0 months and 50.3 months (p = 0.259), respectively. Patients receiving consolidation chemotherapy did not show significant OS benefits (46.9 months vs. 38.3 months; X2 = 0.059, p = 0.866). Conclusion: Similar PFS and OS were found between PF and TP regimens with concurrent chemoradiotherapy. Consolidation chemotherapy did not show any significant OS benefits. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to explore the barriers and facilitators underlying the healthcare digital divide by using qualitative methodologies, integrated with the Capabilities, Opportunities, Motivations, and Behaviors (COM‐B) as well as the Behavior Change Wheel (BCW) theoretical frameworks. Methods: To conduct a thorough analysis, semi‐structured，in‐depth interviews were orchestrated among a cohort of older patients who had experiences with digital healthcare systems. Data were meticulously analyzed via Colaizzi's seven‐step methodological procedure. Results: Nine barriers were elucidated, including physical limitation, inadequate training and support, self‐imposed denial, failure to rebuild the digital healthcare environment, equipment constraints, deficits in communication and feedback, skepticism regarding data accuracy and validity, sense of social deprivation, and network information boycott. Conversely, eleven facilitators were identified, encompassing peer modeling, availability of training and support, reconstructive efforts toward the digital healthcare environment, mandatory usage, familial influence, media impact, scientific publicity and education, enhancement of self‐efficacy, sense of social participation, perceived convenience, and access to healthful information. Conclusion: Based on the COM‐B and BCW models, healthcare organizations may be able to improve their digital healthcare support systems (capabilities), technical design, network speed, and equipment configuration (opportunities), as well as focus on "human‐computer integration," the parallel existence of digital technology and humanistic care, and taking into account the issues of information security, accuracy, and human rights equality (motivation) while benefiting the patients, in order to bridge the healthcare digital divide for the older adults. [ABSTRACT FROM AUTHOR]

We aimed to analyze the effects of exclusive breastfeeding duration on the occurrence and course of pneumonia in infants aged up to 6 months. Prospective case-control study. This study was conducted from August 2020 to August 2022 at a maternity and child health hospital in China. A total of 218 infants up to 6 months of age with pneumonia were included in the analyses. Health data were obtained using a hospitalization information system or an interview-based questionnaire. Univariate and multivariate logistic regression analyses were performed to analyze the data. The incidence of pneumonia, hospitalization duration, and costs to participants were significantly affected by the duration of exclusive breastfeeding (p < 0.01). The incidence of pneumonia among participants with different exclusive breastfeeding durations also differed significantly (p < 0.01). The shorter the duration of exclusive breastfeeding, the higher the incidence of pneumonia among infants. We found that the longer the exclusive breastfeeding duration in infants up to 6 months of age, the lower the recurrence of pneumonia, the shorter the hospital stay, and the lower the hospital costs. The rate of exclusive breastfeeding for infants up to 6 months of age should be increased as much as possible to reduce the occurrence of pneumonia and hospital costs. [ABSTRACT FROM AUTHOR]

Although parental psychological control has been well-documented as a significant predictor of social anxiety among adolescents, few studies examine how changes in parental psychological control and adolescent social anxiety are reciprocally related at the within-person level, especially in Chinese culture. This longitudinal study examined reciprocal relations between parental psychological control and social anxiety, and the potential mediating role of self-concept clarity, by disentangling between- and within-person effects. A total of 4731 students (44.9% girls; Mage = 10.91 years, SD = 0.72) participated in a four-wave longitudinal study with 6-month intervals. Results from random intercept cross-lagged panel modeling indicated that parental psychological control directly predicted social anxiety, and vice versa. Parental psychological control indirectly predicted social anxiety via self-concept clarity, and social anxiety also indirectly predicted parental psychological control via self-concept clarity. These findings reveal a vicious cycle of mutual influence between parental psychological control and adolescent social anxiety in Chinese youth, and highlight the crucial role of self-concept clarity in the interplay between parenting and adolescent social functioning. [ABSTRACT FROM AUTHOR]

With the seeming end of the COVID-19 epidemic, international focus is rethinking its spillover consequences, such as on the routine provision and usage of healthcare. This study uses China's national death records to estimate the potential spillover effects of the COVID-19 pandemic on the mortality of non-COVID diseases in China, such as chronic diseases and mental disorders. A longitudinal study. Using the difference-in-difference strategy, our results showed a sizeable increase in total non-COVID deaths and mortality from cardiovascular diseases, chronic kidney disease, diabetes, mental diseases, and suicide. Notably, the deaths from diabetes and suicide increased by 4.60% and 7.08%, respectively, relative to the regions without pandemic cases in the first outbreak and escalated by 3.57% and 5.00%, respectively, when the control group switched to the same period in 2019. These results documented adverse spillover effects of COVID-19 on mortality of non-COVID diseases, suggesting inadequate provision and utilization of regular healthcare. The government and healthcare industry should adopt expedient policies for non-epidemic diseases and reallocate health resources to mitigate future pandemics like COVID-19. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the age- and sex-specific associations of comorbidities with stroke and MI and further calculate the population-attributable fractions (PAFs) of five comorbid diseases for stroke and myocardial infarction (MI) by age and sex. This is a prospective cohort study. This study leveraged data from a sub-cohort of the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project. Participants aged 35–75 years without a prevalent stroke and MI were enrolled from January 2016 to December 2020, with follow-up through December 2021. Five common comorbidities were collected at baseline, and the study outcome was hospitalization for stroke and MI identified from the Inpatients Registry. Of 100,873 participants, the mean age was 54.2 (±10.2) years, 34.2% were ≥60 years old, and 60.8% were women. After a median follow-up of 3.52 years, 4156 participants had stroke/MI. The strengths of the associations between hypertension, diabetes, and obesity with stroke/MI were higher in younger individuals than in seniors, and obesity had a more hazardous impact on stroke/MI in men than in women. The five comorbidities collectively explained a higher population attributable fraction (PAF) for stroke/MI in the young group (51.5[46.9, 55.7] %) than in the senior group (41.3[37.0, 45.4] %), in men (45.6[40.9, 49.9] %) than in women (41.1[36.1, 45.7] %). Most of the common comorbidities were significantly associated with stroke and MI. Several age and sex differences in the impacts of comorbidities on stroke/MI were observed, highlighting the importance of age- and sex-specific preventive strategies to reduce premature stroke and MI. [Display omitted] [ABSTRACT FROM AUTHOR]

BACKGROUND: The flow reaching the vocal folds may be lower than that at the output of high-flow nasal cannula (HFNC) system. This could be due to upper-respiratory obstruction, oxygen leakage, or other factors. The objective of this study was to observe the effect of flow through a nasopharyngeal airway on intrapharyngeal pressure (IPP) in subjects undergoing fiberoptic bronchoscopy (FOB). METHODS: Patients scheduled for FOB were invited to participate. Measurements were performed at flows of 0-60 L/min; the subjects wore WN-N95 folding medical protective masks (N95) and either underwent FOB or not. IPP at each flow was recorded following 15 s of ventilation, and the cross-sectional area (CSA) of the gastric sinus was measured before and after FOB. Hypoxemia, reflux aspiration, and other pertinent events were recorded. RESULTS: Sixty subjects undergoing FOB at the Affiliated Hospital of Jiaxing University participated in this trial from October 2022-September 2023. IPP increased significantly with an increase in flow and also increased after placing the N95 mask with the same flow (P < .001). When results from before to after FOB were compared, the difference in CSA was statistically significant 263.6 (220.7-300.5) mm² vs 305.5 (275.4-329.5) mm², P < .001, but the difference in the risk of reflux aspiration was not statistically significant (0% vs 6.7%, P = .13). Complication rates during treatment were 8.3% for hypoxemia, 0% for reflux aspiration, 1.7% for hypertension, 1.7% for hypotension, 6.7% for tachycardia, 5% for bradycardia, and 10% for postoperative nausea and vomiting. CONCLUSIONS: HFNC can provide effective oxygen therapy for people undergoing FOB, and increases in IPP with flow in the range of 0-60 L/min may not increase the risk of reflux aspiration. [ABSTRACT FROM AUTHOR]

Background: China's rapidly aging population presents challenges for cognitive health and mental well-being among the older adults. This study examines how the number of children affects cognitive function in middle-aged and older adults and whether depressive symptoms mediate this relationship. Methods: This study analyzed data from waves 1 to 5 (2011–2020) of the China Health and Retirement Longitudinal Study (CHARLS), involving 5932 participants aged 45 and older. Participants were grouped by the number of children: childless, only child and multiple children. We used Logarithmic Generalized Linear Models (LGLMs) to explore the relationships among the number of children, depressive symptoms, and cognitive function. Indirect effect coefficients and 95% bias-corrected and accelerated confidence intervals (BCaCI) were estimated using Simultaneous Equation Models (SEM) with three-stage least squares (3SLS) and the bootstrap method to assess the mediating effect of depressive symptoms. Results: In middle-aged and older adults, a negative association was observed between the number of children and overall cognitive functioning (all p < 0.01). This association remained significant even after adjusting for covariates in groups with three (β = −0.023, p < 0.05) and four or more children (β = −0.043, p < 0.001). Conversely, the positive association between the number of children and depression also persisted after adjusting for covariates, although it weakened as the number of children increased (all p < 0.01). Depressive symptoms consistently correlated negatively with overall cognitive function (p < 0.001) and partially mediated the relationship between the number of children and cognitive function (pMe = 20.36%, p < 0.05). The proportion of the mediating effect attributed to depression was more pronounced in middle-aged and older adults who had experienced the loss of children (pMe = 24.31%) or had two children (pMe = 25.39%), with stronger mediating effects observed in males (pMe = 48.84%) and urban residents (pMe = 64.58%). Conclusions: The findings indicate that depressive symptoms partially mediate the relationship between the number of children and cognitive function in middle-aged and older adults in China. These results highlight the significance of considering mental health factors when studying cognitive function in this demographic. Notably, in families without children and those with two children, depressive symptoms play a crucial role in explaining the decline in cognitive function. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effectiveness and safety of Qishen Yiqi Dripping Pill (QSYQ) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods: This multicentre prospective cohort study was conducted at 40 centers in China. Patients with ACS after PCI entered either the QSYQ or Western medicine (WM) groups naturally based on whether they had received QSYQ before enrollment. QSYQ group received QSYQ (0.52 g, 3 times a day for 12 months) in addition to WM. The primary endpoint included cardiac death, non-fatal myocardial infarction, and urgent revascularization. The secondary endpoint included rehospitalization due to ACS, heart failure, stroke, and other thrombotic events. Quality of life was assessed by the Seattle Angina Questionnaire (SAQ). Results: A total of 936 patients completed follow-up of the primary endpoint from February 2012 to December 2018. Overall, 487 patients received QSYQ and WM. During a median follow-up of 566 days (inter quartile range, IQR, 517–602), the primary endpoint occurred in 46 (9.45%) and 65 (14.48%) patients in QSYQ and WM groups respectively [adjusted hazard ratio (HR) 0.60, 95% confidence interval (CI) 0.41–0.90; P=0.013]. The secondary endpoint occurred in 61 (12.53%) and 74 (16.48%) patients in QSYQ and WM groups, respectively (adjusted HR 0.76, 95% CI 0.53–1.09; P=0.136). In sensitivity analysis, the results still demonstrated that WM combined with QSYQ reduced the risk of the primary endpoint (HR 0.67, 95% CI 0.46–0.98; P=0.039). Moreover, QSYQ improved the disease perception domain of the SAQ (P<0.05). Conclusion: In patients with ACS after PCI, QSYQ combined with WM reduced the incidence of the primary endpoint. These findings provide a promising option for managing ACS after PCI and suggest the potential treatment for reducing the risk of primary endpoint included cardiac death, non-fatal myocardial infarction, and urgent revascularization through intermittent administration of QSYQ (Registration No. ChiCTR-OOC-14005552) [ABSTRACT FROM AUTHOR]

Background: In total knee arthroplasty (TKA), the practical use of patient-specific instrumentation (PSI) has been reported previously with both advantage and disadvantage. The application of artificial intelligent (AI) forces overwhelmingly development of medical industries, while the impact of AI on PSI efficiency remains unknown. Thus, this study aimed to assess the efficiency of Intelligent-PSI (i-PSI) in TKA, compared with the conventional instrumentation-TKA (CI). Methods: 102 late-stage OA patients who met inclusive criteria were recruited in this prospective randomized controlled trial and separated into two groups (i-PSI vs. CI). In both groups, an AI preoperative planning engine was applied for surgery decision making. In CI group, conventional instrumentation was applied for bony resection, while resection of i-PSI group was completed with i-PSI. A convolutional neural network was applied to automatically process computer tomography images and thus produced i-PSI. With the help of three-dimension printing, the workflow of production was largely simplified. AI-driven preoperative planning guided resection and alignment decisions. Resection measurement, perioperative radiography and perioperative clinical outcomes were analyzed to verify efficiency of i-PSI. Results: In resection outcomes, smaller deviation of lateral and medial distal femoral resection were found in i-PSI group than CI group (P = 0.032 and 0.035), while no difference was found in other resection planes. In radiography outcomes, postoperative coronal alignments of i-PSI group, including postoperative Hip–knee–ankle axis (HKA) (P = 0.025), postoperative HKA outliners (P = 0.042), Femoral coronal alignment (FCA) (P = 0.019) and Joint line convergence angle (JLCA) (P = 0.043) showed closer to neutral position than CI group. Moreover, Femoral sagittal alignment (FSA) of i-PSI group showed closer to neutral position than CI group(P = 0.005). No difference was found in other alignments. In clinical outcomes, i-PSI group seemed to cost more surgical time than CI group (P = 0.027), while others showed no differences between the two groups. Conclusion: Intelligent Patient-specific Instrumentation in TKA achieved simplified production flow than conventional PSI, while also showed more accurate resection, improved synthesis position and limb alignment than conventional instrumentation. Above all, this study proved that i-PSI being an applicable and promising tool in TKA. [ABSTRACT FROM AUTHOR]

Background: Depression is a prevalent perioperative psychiatric complication among elderly hip fracture patients. Esketamine has rapid and robust antidepressant effects. However, it is unknown whether it can alleviate depressive symptoms in elderly patients who undergo hip fracture surgery. This study aimed to explore whether the adjunctive esketamine in patient-controlled intravenous analgesia (PCIA) could improve depressive symptoms in elderly patients undergoing hip fracture surgery. Methods: A single-center, prospective, double-blind and randomized controlled clinical trial was carried out from July 2022 to August 2023 at the Wenzhou People's Hospital among 90 patients, aged ≥ 65 years with hip fracture undergoing elective surgery. Participants were randomly allocated to either the esketamine group (group S) or the control group (group C). In Group S, patients were administered 0.5 mg/kg of esketamine as a PCIA adjuvant for 48 h, while the control group received saline. The primary outcome was the assessment of depressive symptoms using the Geriatric Depression Scale-15 (GDS-15) on postoperative day 2. The secondary outcomes were assessments of depressive symptoms on postoperative day 7 and postoperative day 30, serum levels of brain-derived neurotrophic factor (BDNF) and 5-hydroxytryptamine (5-HT), postoperative pain intensity, the number of effective PCIA presses, sufentanil consumption, and adverse events. Results: The prevalence and GDS-15 scores of depression were significantly lower in group S on postoperative day 2 (28.6% vs. 53.5%; 3.5 ± 1.8 vs. 4.3 ± 1.7, P < 0.05). In group S, the number of effective PCIA presses was significantly lower on postoperative day 2 than that in group C [2(1–4) vs. 1(0–2), P<0.05]. Higher levels of BDNF (23.8 ± 1.7 ng/mL vs. 25.3 ± 2.0 ng/mL, P < 0.05) and 5-HT (219.5 ± 19.5 ng/mL vs. 217.0 ± 22.2 ng/mL, P < 0.05) in the blood were observed on postoperative day 2 in group S. Conclusion: In elderly patients aged ≥ 65 years undergoing hip fracture surgery, the administration of adjunctive esketamine in PCIA could improve depressive symptoms and increase levels of BDNF and 5-HT in the blood. Trial registration: Chinese Clinical Trial Registry, ChiCTR2200061956 (Date: 13/07/2022). [ABSTRACT FROM AUTHOR]

Background: Rimegepant, a small molecule calcitonin gene-related peptide (CGRP) receptor antagonist, is indicated for acute and preventive migraine treatment in the United States and other countries. However, there is a lack of prospective real-world evidence for the use of rimegepant in Chinese migraine patients. Methods: This was a single-arm, prospective, real-world study. While taking rimegepant to treat migraine attacks as needed, eligible participants were asked to record their pain intensity, functional ability, and accompanying symptoms for a single attack at predose and 0.5, 1, 2, 24, and 48 h postdose via a digital platform. Adverse events (AEs) during the rimegepant treatment period were recorded and analysed. The percentages of participants who experienced moderate to severe pain at predose and 0.5, 1, 2, 24, and 48 h postdose were assessed. Additionally, the percentages of participants who reported better/good outcomes in terms of pain intensity, functional ability, and accompanying symptoms at 0.5, 1, 2, 24, and 48 h postdose were analysed. In addition, the total cohort (full population, FP) was stratified into a prior nonresponder (PNR) group to observe the effectiveness and safety of rimegepant for relatively refractory migraine and a rimegepant and eptinezumab (RE) group to observe the effectiveness and safety of the combination of these drugs. Results: By November 24th, 2023, 133 participants (FP, n = 133; PNR group, n = 40; RE group, n = 28) were enrolled, and 99 participants (FP, n = 99; PNR group, n = 30; RE group, n = 23) were included in the analysis. Rimegepant was effective in treating migraine in the FP and both subgroups, with a significant decreasing trend in the percentages of participants experiencing moderate to severe pain postdose (p < 0.05) and a marked increase in the percentages of participants who reported better/good outcomes in terms of pain intensity, functional ability, and accompanying symptoms at 0.5, 1, 2, 24, and 48 h postdose compared with predose. AEs were reported by 6% of participants in the FP, and all AEs were mild. Conclusions: In the real world, rimegepant is effective in the acute treatment of migraine patients in China. The low incidence rate of AEs highlighted the favourable tolerability profile of rimegepant. Trial registration: Clinicaltrials.gov NCT05709106. Retrospectively registered on 2023-02-01. [ABSTRACT FROM AUTHOR]

Background: Temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) is typically resistant to pharmacological interventions; however, achieving seizure freedom is possible through surgery. Our objective was to focus on the pregnancy and seizure outcomes during pregnancy of women with TLE-HS, and aim to identify predictors of seizure control. Methods: The West China Registry of Pregnancy of Women with Epilepsy (WCPR_EPi) was a monocentric prospective cohort study of women with epilepsy (WWE). We screened women with TLE-HS in this database. Their clinical profile, anti-seizure medication (ASM) use, and pregnancy outcomes were extracted from the records of the registry (2010–2023). Results: Out of 2320 WWE followed up, 47 pregnancies in women with TLE-HS were identified and analyzed. Seizure exacerbation occurred in 40.4% of pregnancies, and seizure freedom was present in 34.0% of these during pregnancy. Factors associated with seizure exacerbation during pregnancy was ASM non-adherence (odds ratio [OR] =7.00, 95% confidence interval [CI] 1.43–34.07, P=0.016). The surgery group showed a significantly higher seizure freedom rate (OR = 6.87, 95% CI 1.02–46.23, P=0.016) and lower rate of induced labor (0.0% vs 26.5%, P=0.047) compared to the medically-treated group alone. Caesarean section was chosen in 77.1% of cases due to seizure concerns, with comparable in epilepsy-related (n=20) and obstetric causes (n=24). No major congenital malformations were reported. Conclusions: Surgical treatment before pregnancy appears to offer a higher chance of seizure freedom compared to medication alone. Most of women with TLE-HS can deliver healthy offspring regardless of suboptimal seizure control and unwarranted concerns. [ABSTRACT FROM AUTHOR]

Background: The exploration of optimizing cardiopulmonary function and athletic performance through high-intensity metabolic exercises (HIMEs) is paramount in sports science. Despite the acknowledged efficacy of HIMEs in enhancing cardiopulmonary endurance, the high metabolic stress imposed on the cardiopulmonary system, especially for amateurs, necessitates a scaled approach to training. Objective: The aim of this study is to ascertain whether adjustments in the initiation posture and the adoption of an appropriate breathing strategy can effectively mitigate the cardiopulmonary stress induced by HIMEs without compromising training efficacy. Methods: Twenty-two subjects were recruited into this study. The post-exercise heart rate (PHR) and post-exercise oxygen consumption rate (POCR) were collected within 30 min after exercise. A two-way ANOVA, multi-variable Cox regression, and random survival forest machine learning algorithm were used to conduct the statistical analysis. Results: Under free breathing, only the maximum POCR differed significantly between standing and prone positions, with prone positions showing higher stress (mean difference = 3.15, p < 0.001). In contrast, the regulated breathing rhythm enhanced performance outcomes compared to free breathing regardless of the starting position. Specifically, exercises initiated from prone positions under regulated breathing recorded a significantly higher maximum and average PHR than those from standing positions (maximum PHR: mean difference = 13.40, p < 0.001; average PHR: mean difference = 6.45, p < 0.001). The multi-variable Cox regression highlighted the starting position as a critical factor influencing the PHR and breathing rhythm as a significant factor for the POCR, with respective variable importances confirmed by the random survival forest analysis. These results underscore the importance of controlled breathing and starting positions in optimizing HIME outcomes. Conclusions: Regulated breathing in high-intensity exercises enhances performance and physiological functions, emphasizing the importance of breathing rhythm over starting position. Effective training should balance exercise volume and technique to optimize performance and minimize stress, reducing overtraining and injury risks. [ABSTRACT FROM AUTHOR]

Many Chinese migrant older adults are more prone to mental health problems due to their "migrant" status. During the COVID-19 pandemic, restrictions on their mobility exacerbated these conditions. Mental health is a crucial dimension of healthy aging. Network analysis offers a novel method for exploring interactions between mental health problems at the symptom level. This study employs network analysis to examine the interactions between comorbid depressive and anxiety symptoms across different stages of the COVID-19 pandemic. Surveys were conducted from September 2019 to January 2020 (T1), September 2020 to January 2021 (T2), and September 2021 onwards (T3). Depression and anxiety symptoms were measured by the Patient Health Questionnaire-9 (PHQ-9) and the Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Expected Influence (EI) and Bridge Expected Influence (Bridge EI) were used to identify central and bridge symptoms in the network. Network stability and accuracy tests were performed. Among the Chinese migrant older adults, the anxiety prevalence was 18.50% at T1, 21.11% at T2, and 9.38% at T3. The prevalence of depression was 26.95% at T1, 55.44% at T2, and 60.24% at T3. The primary central symptoms included 'Afraid something will happen' (A2), 'Irritability' (A6), 'Panic' (A7), 'Feeling of worthlessness' (D6), 'Anhedonia' (D1), and 'Feeling of fear' (A5). The major bridge symptoms included 'Feeling of fear' (A5), 'Panic' (A7), 'Irritability' (A6), 'Fatigue' (D4), 'Anhedonia' (D1), and 'Depressed or sad mood' (D2). Differences in network structure were observed across the periods. The network analysis further revealed the evolving relationships between central and bridge symptoms over time, highlighting the importance of targeted intervention strategies for central and bridge symptoms of comorbid depression and anxiety at different periods. [ABSTRACT FROM AUTHOR]

Background: To date, the relationship between the Transesophageal Echocardiography (TEE) monitoring indicator tricuspid annular plane systolic excursion (TAPSE) and the incidence of postoperative acute kidney injury (AKI) in Coronary Artery Bypass Grafting(CABG) patients remains unknown. The main objective of this study was to explore the relationship between the TAPSE and the incidence of AKI in CABG patients. Methods: This was a multicenter prospective cohort study was conducted between September 2021 and July 2022. Among 266 patients aged at least 18 years who underwent elective CABG, 140 were included. Results: We measured TAPSE via M-mode TEE via the mid-esophageal (ME) right ventricle(RV) inflow-outflow view (60°). All echocardiographic measurements were performed three separate times at each time point: T0 (before the start of CABG), T2 (approximately 5 ∼ 10 min after neutralization of protamine) and T3 (before leaving the operating room), and then averaged. Serum creatinine was measured 1 day before and within 7 days after CABG. There was no statistically significant association between the TEE-monitoring indicator TAPSE and the incidence of postoperative AKI in patients who underwent CABG. Conclusions: The TAPSE was not significantly correlated with postoperative AKI incidence and could not predict the early occurrence of postoperative AKI in CABG patients. TEE needs more evaluation for clinical efficacy of predicting the early occurrence of postoperative AKI in isolated CABG. [ABSTRACT FROM AUTHOR]

Introduction: Total knee arthroplasty (TKA) is accompanied by severe postoperative pain, which is reported to be an important cause of chronic pain. Ultrasound-guided adductor canal block (ACB) combined with infiltration between the popliteal artery and posterior capsular of the knee (IPACK) has been proven to have a better effect on relieving acute pain after TKA. However, whether it has a significant effect on the incidence of chronic pain after TKA has not been reported. This trial was designed to investigate the effect of ultrasound-guided ACB combined with IPACK on the incidence and intensity of chronic pain after TKA. Methods: In this prospective, randomized, double-blind, placebo-controlled study, 100 subjects scheduled for TKA were randomly (1:1) divided into two groups: the ropivacaine group and the placebo group. Patients in each group received ultrasound-guided ACB + IPACK procedures with 0.25% ropivacaine or equal volume normal saline. All patients received multimodal analgesia. Pain intensity was assessed using the Numerical Rating Scale (NRS). The primary outcome was the incidence of chronic pain at 3 months after TKA by telephone follow-up. In addition, pain intensity in early resting and mobilized states, chronic pain intensity, the time to first rescue analgesia; opioid consumption; CRP and IL-6 after the operation; length of postoperative hospital stay; and cost of hospitalization and postoperative complications; as well as the function of the knee in the early stage after the operation, were recorded. Results: Ninety-one participants were included in the final analysis. At 3 months, the incidence of chronic pain was 30.4% in the ropivacaine group, significantly lower than 51.1% in the placebo group. Compared with the placebo group, the ACB + IPACK with ropivacaine group had significantly lower pain scores at 4 hours, 8 hours, 16 hours, and 24 hours after the operation; increased the knee range of motion at 8 hours and 24 hours after the operation; and a significantly decreased incidence of chronic pain at 3 months after the operation. During the follow-up period, there were no nerve block-related complications in either group. Conclusion: In the context of multimodal analgesia protocols, ACB combined with IPACK before surgery decreases the incidence and intensity of chronic pain 3 months after TKA compared with placebo injection. In addition, it reduces the NRS scores, whether at rest or during mobilization, and improves knee function within 24 hours after TKA. Trial registration: This trial was registered in the China Clinical Trial Center (registration number ChiCTR2200065300) on November 1, 2022. [ABSTRACT FROM AUTHOR]

Background: Sleep problems are common in early childhood and may be affected by parental adverse childhood experiences (ACEs). However, few studies have examined the longitudinal effect of parental ACEs on offspring sleep problems and the underlying mechanism. This study examined parents' psychological distress and harsh discipline (psychological aggression and corporal punishment) as mediators in the longitudinal pathway from parental ACEs to offspring sleep problems. Methods: The participants included 617 3-year-old children (mean age of 43.13 months, SD = 3.82) and their parents (mean age of 33.24 years, SD = 4.01) from Wuhu, China. The participants completed an online questionnaire on ACEs, psychological distress, and demographic characteristics in September 2022 (Time 1). Parents completed another online questionnaire in September 2023 (Time 2) on harsh discipline and offspring sleep problems. A path model was used to examine the associations. Results: Parental ACEs did not directly predict offspring sleep problems. Psychological distress (β = 0.041, 95% CI [0.005, 0.111]) and harsh discipline in the form of psychological aggression (β = 0.019, 95% CI [0.006, 0.056]) separately mediated the relationship between parental ACEs and offspring sleep problems. Psychological distress and psychological aggression also played a serial mediating role in the association of parental ACEs with offspring sleep problems (β = 0.014, 95% CI [0.007, 0.038]). Conclusions: Our findings showed the importance of psychological distress and psychological aggression in the intergenerational effect of trauma on offspring sleep problems. Specific interventions aimed at improving mental health and parenting practices should be provided for parents who were exposed to ACEs. [ABSTRACT FROM AUTHOR]

Background: Lacunes, a characteristic feature of cerebral small vessel disease (CSVD), are critical public health concerns, especially in the aging population. Traditional neuroimaging techniques often fall short in early lacune detection, prompting the need for more precise predictive models. Methods: In this retrospective study, 587 patients from the Neurology Department of the Affiliated Hospital of Hebei University who underwent cranial MRI were assessed. A nomogram for predicting lacune incidence was developed using LASSO regression and binary logistic regression analysis for variable selection. The nomogram's performance was quantitatively assessed using AUC-ROC, calibration plots, and decision curve analysis (DCA) in both training (n = 412) and testing (n = 175) cohorts. Results: Independent predictors identified included age, gender, history of stroke, carotid atherosclerosis, hypertension, creatinine, and homocysteine levels. The nomogram showed an AUC-ROC of 0.814 (95% CI: 0.791-0.870) for the training set and 0.805 (95% CI: 0.782-0.843) for the testing set. Calibration and DCA corroborated the model's clinical value. Conclusion: This study introduces a clinically useful nomogram, derived from binary logistic regression, that significantly enhances the prediction of lacunes in patients undergoing brain MRI for various indications, potentially advancing early diagnosis and intervention. While promising, its retrospective design and single-center context are limitations that warrant further research, including multi-center validation. [ABSTRACT FROM AUTHOR]