The COVID-19 not only affects physical health, but its long-term mental health effects are also receiving increasing attention. While numerous studies have examined the prevalence of post-COVID mental health conditions, critical gaps remain in understanding how distinct trajectories of acute-phase symptoms differentially predict long-term psychiatric outcomes. This study aims to explore the severity, duration, and trajectory patterns of early symptoms of Covid-19 infection and analyze their association with anxiety and depression symptoms 2 years after infection. We conducted a retrospective cohort study of 1,038 medical staff infected with COVID-19 at Suqian First People’s Hospital before December 2022 in July and August 2024. Information on early symptoms of infection, as well as anxiety and depression symptoms 2 years after infection were collected through questionnaires. We used 13 COVID-19 symptom checklists to evaluate the presence or absence of early symptoms in patients with COVID-19. We used standardized scales to assess anxiety (Generalized Anxiety Disorder-7[GAD-7]) and depression (Patient Health Questionnaire-9[PHQ-9]), the group-based trajectory model(GBTM) to analyze the trajectory patterns of early symptoms. We use logistic regression model to analyze the relationship between trajectory pattern and anxiety and depression symptoms after 2 years of infection. We first analyze the relationship between them in unadjusted model, and then further adjust the covariates including social demographic and clinical information such as gender, age and complication. The prevalence of anxiety was 23.5

This study aims to assess the levels of anxiety and depression among healthcare workers two years post COVID-19 infection and to validate the reliability and validity of the PHQ-9 and GAD-7 scales in this population. This cross-sectional study was conducted in June 2024 using a simple random sampling approach to survey healthcare institution workers. A total of 1038 valid samples were collected, and anxiety and depression levels were assessed using the PHQ-9 and GAD-7 scales. Participants included healthcare workers such as doctors, nurses, administrative staff, and students. Data analysis included descriptive statistics, correlation analysis, univariate, and multivariate analyses to explore the effects of variables such as occupation and gender on anxiety and depression. Long COVID was reported in 50.8% of participants. Occupational categories significantly influenced anxiety and depression levels: compared to students (reference group), doctors, nurses, and administrative staff exhibited significantly lower scores. Non-long COVID participants showed significantly lower anxiety and depression scores than those with long COVID. Additionally, the PHQ-9 and GAD-7 scales demonstrated high reliability and validity among COVID-19 population. Two years after COVID-19 infection, anxiety and depression levels among healthcare institution workers remain significantly influenced by occupational category and long COVID status. For healthcare workers, particularly those with long COVID and student groups, policymakers and healthcare administrators should consider optimizing mental health support systems. This includes implementing regular mental health screenings, providing personalized psychological interventions, offering counseling services, reducing work-related stress, and promoting the use of mental health assessment tools to improve the psychological well-being of this population.

BackgroundMost studies have explored the relationship between serum total folate and nonalcoholic fatty liver disease (NAFLD) in adults, but there has been no study on the relationship between different folate forms and hepatic steatosis or liver stiffness in adolescents.ObjectiveTo investigate the association of different folate forms with hepatic steatosis or liver stiffness in adolescents, and further explore the intermediary role of BMI in this relationship.MethodsThe cross-sectional study included 549 participants from the 2017-2018 National Health and Nutrition Inspection Survey (NHANES) survey cycle who had complete data. Four folate data (red blood cell folate, serum total folate, 5-methyl-tetrahydrofolate and folic acid) were included in our study. Controlled attenuation parameters (CAP) and liver stiffness came from the results of liver ultrasound transient elastography. We used linear regression to analyze the relationship between different forms of folate and CAP or liver stiffness, and logistic regression to analyze the relationship between different forms of folate and NAFLD or significant fibrosis. We also used restricted cubic splines to analyze the nonlinear relationship between different forms of folate and NAFLD or significant fibrosis. Finally, we used regression-based intermediary analysis to distinguish the direct and BMI-mediated effects of folate on CAP or liver stiffness. All the analyses adjusted the relevant covariates.ResultsThe means of CAP and liver hardness in this study were 223.02dB/m and 5.03kPa, respectively. We found that in model 2, there was a negative correlation between serum total folate (β: -18.53; 95%CI: -29.32 to -7.73) or 5-methyltetrahydrofolate (β: -14.13; 95%CI: -28.98 to -7.86) and CAP. However, when the BMI was further adjusted in model 3, this negative correlation no longer existed (serum total folate: β: -8.36; 95%CI: -17.69 to 0.97; 5-methyltetrahydrofolate: β: -8.05; 95%CI: -17.19 to 1.09). Similarly, we found a negative correlation between serum total folate or 5-Methyl-tetrahydrofolate and liver stiffness in model 2. There was no significant correlation between red blood cell folate or folic acid and CAP or liver stiffness in either model 2 or model 3. The nonlinear relationship between different folate forms and NAFLD or significant fibrosis was not significant. It is estimated that 76% of the total association between serum total folate and CAP is mediated by BMI. The mediating proportion of BMI in the total correlation between serum total folate and liver stiffness was 50%. Similarly, we found that BMI significantly mediated the relationship between 5-Methyl-tetrahydrofolate and CAP or liver stiffness, with a mediating ratio of 77% and 49%, respectively.ConclusionOur results show that serum total folate or 5-Methyl-tetrahydrofolate are negatively correlated with hepatic steatosis or liver stiffness in adolescents, and BMI plays major mediating role in this relationship. Our findings emphasize the importance of monitoring the concentration of serum folate, not just the serum total folate concentration.

EuroSCORE II is one of the most widely utilized cardiovascular surgery risk scoring systems. Recently, a new online score calculator, namely the German Registry of Acute Aortic Dissection Type A (GERAADA), was launched to predict 30-day surgical mortality for acute type A aortic dissection (ATAAD) patients. The aim of this study is to evaluate the predictive performance of these two scores. We calculated the two scores for 1346 ATAAD patients from January 2012 to December 2021. The overall performance was evaluated using Brier scores and Hosmer-Lemeshow statistics. Receiver Operating Characteristic (ROC) curves were employed to assess diagnostic ability, and the standardized mortality ratio (SMR) was utilized to evaluate calibration. The GERAADA score and EuroSCORE II predicted 30-day mortality rates of 14.7% and 3.1%, respectively, while the observed rate was 12.5%. The predictive ability of EuroSCORE II (AUC 0.708, 95% CI: 0.664–0.792) was superior to that of the GERAADA score (0.648, 95% CI: 0.605–0.692). The GERAADA score had higher sensitivity but lower specificity than EuroSCORE II. And the GERAADA score may overestimate mortality (0.76, 95% CI: 0.65–0.89), while EuroSCORE II may underestimate the mortality rate (3.17, 95% CI: 2.92–3.44). The EuroSCORE II was superior in predicting surgical mortality among ATAAD patients. But the observed 30-day mortality rate certified a good calibration for the GERAADA score.

法医学属实践性学科,传统法医教学中缺乏专门的辩证思维能力训练,导致学生专业理论和操作强而思维分析和推理能力弱,在面对新问题、疑难复杂案例或科学难题的处理中表现为思维狭窄,不利于高素质综合型人才的培养.唯物辩证法是马克思主义哲学的核心部分,是关于事物的普遍联系和全面发展的科学,其对大学生的多种思维能力的发展、专业技能学习、综合素质提高均有指导作用.文章在系统性回顾法医人才唯物辩证思维能力培养现状的基础上,提出在法医教学中引入唯物辩证法元素,有助于学生早期形成唯物辩证思维方式,并为其在以心理素质、专业能力、科研能力、创新能力等为代表的综合素质发展中保驾护航.

Headaches during pregnancy and the post-partum period may be due to either an exacerbation of a pre-existing neurological presentation, a new pregnancy-related process, or a non-pregnancy related condition. Key physiologic changes during pregnancy and the post-partum period contribute to the vulnerability of this patient population and the increased risk of complications.Review causes of headaches in pregnant and post-partum patients as well as neuroimaging techniques performed.Headaches are a common complaint for pregnant and post-partum patients. For pregnant patients, a range of serious causes must be considered including cerebral venous thrombosis, posterior reversible encephalopathy syndrome and stroke. Primary headaches are responsible for most post-partum headaches, however other causes also include pre-clampsia, cerebral venous thrombosis and post-dural headache. Determining the optimal imaging technique in this vulnerable population remains a challenge given the scarce guidelines.The greatest difficulty while evaluating pregnant and post-partum patients presenting with an acute headache in an emergency setting is to determine whether the headache is due to a primary disorder such as migraines or is secondary to an underlying, sometimes serious pathology. The following review explores evidenced-based diagnosis of headache in this particular setting.

Background: Pulmonary hypertension (PH) is a complex and progressive cardiopulmonary disorder with poor prognosis and limited therapeutic treatments. Recent evidence suggests that RNA binding proteins (RBPs) participate in the pathogenesis of human and experimental pulmonary arterial hypertension. Quaking (QKI) as an important RBPs is involved in mRNA biogenesis, export, decay and translation. However, the biological significance of QKI in phenotypic transformation of PASMCs in PH as well as in abnormal pulmonary vascular remodeling remain elusive. Methods: We assessed the expression pattern, phenotypic transformation effect, and mechanism of QKI in rodent Su/Hx-induced PH model, Human PAH samples and in HPASMCs. Results: Elevated protein expression level of QKI was found in animal PH and human PAH samples, thus in hypoxic HPASMCs. Inhibition of QKI attenuated proliferation and phenotype switching in HPASMCs. Mechanistically, QKI was found to mediate STAT3 mRNA stabilization by binding to its 3’Untranslated Region (3’-UTR). Downregulation of QKI attenuated STAT3 expression in PASMCs, while overexpression of STAT3 in PASMCs was widely regarded to be involved in the progression of PH. In addition, as a transcription factor, STAT3 was identified to bound to miR-146b promoter to induce its expression, while miR-146b was proved to promote smooth muscle reprogramming through inhibiting STAT1 and TET2 expression during pulmonary vascular remodeling. Conclusions: Our study demonstrates the QKI-STAT3-miR-146b pathway as a novel mechanistic insights into hypoxic reprogramming that permits vascular remodeling, and thus provides proof of concept for anti-remodeling therapy through the direct modulation this axis in PH.

Background To reveal detailed histopathological changes, virus distributions, immunologic properties and multi-omic features caused by SARS-CoV-2 in the explanted lungs from the world's first successful lung transplantation of a COVID-19 patient. Materials and methods A total of 36 samples were collected from the lungs. Histopathological features and virus distribution were observed by optical microscope and transmission electron microscope (TEM). Immune cells were detected by flow cytometry and immunohistochemistry. Transcriptome and proteome approaches were used to investigate main biological processes involved in COVID-19-associated pulmonary fibrosis. Results The histopathological changes of the lung tissues were characterized by extensive pulmonary interstitial fibrosis and haemorrhage. Viral particles were observed in the cytoplasm of macrophages. CD3(+)CD4(-) T cells, neutrophils, NK cells, gamma/delta T cells and monocytes, but not B cells, were abundant in the lungs. Higher levels of proinflammatory cytokines iNOS, IL-1 beta and IL-6 were in the area of mild fibrosis. Multi-omics analyses revealed a total of 126 out of 20,356 significant different transcription and 114 out of 8,493 protein expression in lung samples with mild and severe fibrosis, most of which were related to fibrosis and inflammation. Conclusions Our results provide novel insight that the significant neutrophil/ CD3(+)CD4(-) T cell/ macrophage activation leads to cytokine storm and severe fibrosis in the lungs of COVID-19 patient and may contribute to a better understanding of COVID-19 pathogenesis.

Paraquat (PQ) is a widely used herbicide which can cause high mortality to humans. However, relatively few studies focus on metabolic feature of PQ intoxication for investigating the underlying mechanisms. Here we performed non-targeted metabolomics profiling of serum samples from acute and chronic PQ intoxicated mouse models by gas chromatography time-of-flight mass spectrometry (GC-TOF/MS) to identify metabolic feature and characteristic metabolites of acute and chronic PQ intoxication. Results showed that 3-indolepropionic acid (IPA) and pathway of glycine, serine, and threonine metabolism were significantly altered after acute PQ intoxication; 2-hydroxybutyric acid and the ratio of L-serine/glycine were of significance between acute and chronic PQ intoxication. Then targeted metabolomics profiling was conducted by liquid chromatography-mass spectrometry (LC-MS) analysis to confirm the changes of IPA after acute PQ intoxication. Moreover, IPA-producing gut bacteria in feces were quantified by qRT-PCR to explain the varied IPA serum concentration. Clostridium botulinum and Peptostreptococcus anaerobius were significantly suppressed after acute PQ intoxication. The data suggested that PQ caused oxidative damage partially through suppression of anti-oxidative metabolite producing gut bacteria. In conclusion, we identified characteristic metabolites and pathway of acute and chronic PQ intoxication which could be potential biomarkers and therapeutic targets.

Facial approximation plays a vital role in personal identification when other methods cannot be applied, and the study on facial soft tissue thickness (FSTT) is important to allow more accurate facial approximation. The Cone-Beam CT (CBCT) is considered to be an accurate approach in assessing FSTT, however only few studies have assessed the FSTT norms by CBCT in Chinese populations. The aim of this study was to (1) establish forensic measurement approach on a 3D model reconstructed by CBCT image; (2) obtain FSTT norms from the adults of Yangtze River delta Han population; (3) determine the impacts of sex, age, BMI as well as malocclusion type on FSTT and (4) form a FSTT database through CBCT. A total of 60 facial landmarks were primarily established from 3D reconstructed models from CBCT images of 424 healthy Han adults (130 males and 294 females) aged from 21 to 50 years in Yangtze River delta region and measurements were carried out. The multivariate analysis of variance test and multiple linear regressions test showed that the FSTT values on most landmarks were significantly different between sexes and BMI, and males showed greater values, expect for the landmarks distributed in malarzygomatic areas. Simultaneously, BMI mostly affected the landmarks located in zygomatic region. Besides, only a few landmarks were influenced by age. Interestingly, several periodontal landmarks were influenced by malocclusion types, thus the impact of malocclusion types on FSTT requires attention. Finally, the validation analysis suggested that measurement approach is an important factor for FSTT.

A 32-year-old man presented to the dentist to receive root canal therapy. During the treatment, a C+ file dropped and was accidentally swallowed by the patient. No foreign body was found by emergency gastroscopy that day. The next day, abdominal radiograph showed a cross-shaped high-density shadow in the lower right abdomen (Figure 1, arrow) and the shadow did not move obviously in the radiographic reexaminations during the following 3 days. The patient did not complain of any discomfort. On the fifth day, computed tomography (CT) of the abdomen and pelvis indicated a hyperdense structure located in the ileocecal region (Figures 2 and 3, arrow). The hyperdense structure was confirmed by colonoscopy to be the C+ file, which had lodged in the appendix after the attempt to extract it with biopsy forceps failed.Figure 2CT of the abdomen and pelvis, indicating a hyperdense structure located in the ileocecal region 5 days after the C+ file was swallowed (arrow).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3CT of the abdomen and pelvis, indicating a hyperdense structure located in the ileocecal region 5 days after the C+ file was swallowed (arrow).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Foreign body in the appendix. Foreign bodies in the gastrointestinal tract are common findings in emergency departments worldwide. In many instances, a small foreign body may successfully pass through the entire gastrointestinal tract and exit in the feces.1Ye H. Huang S. Zhou Q. et al.Migration of a foreign body to the rectum: a case report and literature review.Medicine (Baltimore). 2018; 97: e11512Crossref PubMed Scopus (10) Google Scholar Occasionally, gastrointestinal perforation occurs because of sharp edges or points that the foreign body may have.2Gardner A.W. Radwan R.W. Allison M.C. et al.Double duodenal perforation following foreign body ingestion.BMJ Case Rep. 2017; (http://doi.org/10.1136/bcr-2017-223182.)Crossref PubMed Scopus (4) Google Scholar The patient underwent a peritoneoscopic appendectomy to remove the appendix, which was swelling and congestive with the C+ file obstructing the lumen of the middle part of the appendix. The patient had no postoperative complications.

Kinship testing based on genetic markers has valuable practical applications. Short tandem repeat polymorphisms (STRPs) can have large number of alleles, and become the dominant marker for kinship identification. However, the high mutation rates affect the identification accuracy. Thus, accurate investigation of the mutation rate of STR loci in different populations is crucial for the reliability of phylogenetic relationships. In present study, forensic parameters and mutation rates (include 95% CI) of 23 short tandem repeats (STR) loci (D3S1358, D1S1656, D2S441, D10S1248, D13S317, D16S539, D18S51, D2S1338, CSF1PO, TH01, vWA, D21S11, D7S820, D5S818, TPOX, D8S1179, D12S391, D19S433, FGA, D22S1045, PentaE, PentaD and DYS391) were investigated through PowerPlex® Fusion System in Fujian Han population. The high level of CDP (0.999999999999999999999999992) and CPE (0.999999993) indicated the panel was high efficiency in forensic DNA identification and paternity testing. In mutation analysis, 43 mutation cases were found through 54,124 parent-child meiotic transfers. The observed mutation rates ranged from 0 (D3S1358, D1S1656, D13S317, TH01, D19S433 and D22S1045) to 0.0025 (PentaE and FGA). The overall mutation rate across all loci was 0.0008 and the average mutation rate for the 23 loci was estimated to be 0.00078 per meiosis. The vast majority of mutations were single-step (88.4%) mutation and also include double-step (9.3%) and triple-step (2.3%) mutations. Paternal mutation rate was more common than maternal mutation rate with a ratio of 7.2:1. In addition, mutation rates indicated positive correlation (r = 0.633, p = 0.009) with the expected heterozygosity (He).

In forensic science, the determination of diatoms bears several goals, for example to estimate the post mortem interval (PMI), to determine the cause of death of a corpse found in water as well as to further locate the suspected drowning site. However, to identify diatoms using morphological method beyond the genus level is difficult and requires expert knowledge. During the last decade, a new concept of DNA barcode is becoming a promising approach to identify the taxa of diatoms. In the present study, we performed a diatom morphological analysis covering 10 different water areas in Nanjing section of the Yangtze River. The diatoms were classified to the ‘genus’ level by using optical microscope and electron microscope. According to the morphological study results, we further designed and analyzed the 18S rDNA sequences as barcodes at the ‘species’ level. Our study established the morphological and DNA barcoding profile for the diatoms in Nanjing section of the Yangtze River for the first time which will be of great significance for the using of diatoms in forensic application. The results indicated that detailed analysis of selected diatom DNA barcodes can be used as a useful tool for forensic applications.

•The 19 STR loci are highly polymorphic and informative in the studied populations.•Our study reveals a distinct characteristic of 4 eastern Chinese populations.•Data obtained from 19 STR loci is reflected by population migration in history.

OBJECTIVE:To describe characteristic of hand-wrist bone development in adolescents of 14 years old in China, and to estimate trend of bone development of them.METHODS:A total of 109 adolescents of 14 years was selected as subjects (males: 53, females: 56). X-rays examination of their left hand-wrist bone were performed and analyzed. The development characteristics of each position in accordance with Gu's mapping of skeletal age were compared with Gu's results and ours.RESULTS:Compared with Gu's, osteoepiphysis of distal radius, the first metacarpal bone, the fourth proximal phalanx were more advanced in boys, osteoepiphysis of distal radius, the second-fifth metacarpal bones, the first-fifth proximal phalanxs, and the second-fifth middle phalanxs were more advanced in girls.CONCLUSION:The results suggested that a forward trend of 14 years old adolescents bone development currently exists in our country, especially in girls. As an important age of criminal responsibility, this forward trend of development of bones among adolescents currently should be kept in mind when estimating bone age of criminals.

From the viewpoint of ecology,this paper analyzed the principal part and major points of urban ecological environmental system in Nanjing,and established the evaluation indices related to the ecological environment.By layered processing the evaluation indices,the indiecs system of urban ecological environmental quality was established,and the significance and function of this system was explained.Analytic Hierarchy Process(AHP) was applied to judge the weight of each evaluation index,and to calculate the comprehensive assessment values of evaluation indices system.The urban ecological environmental quality level was graded according to the comprehensive assessment values,and the results were actually coincided with the situation of Nanjing.Overall,the ecological environmental quality of Nanjing was improved step-by-step,the environmental pollution was obviously lessened,but the natural environment was gradually worsened,especially under the influence of natural disasters.This study established an effective method for the ecological evaluation of urban environment,which would benefit to the establishment of ecological cities in China.

OBJECTIVE:To research the connection of the minor's bone age and chronological age and age for penal responsibility, to discuss the application of Gu's Atlas and Li Guozhen's Percent Numeration to measure the bone age in the cases of immature criminals and the applying value. METHODS:33 healthy youths, 12-19 years old, were selected, whose left wrists were photographed with X-rays. According to the radiographic appearance of the maturity indicators, the bone age of every person was determined respectively by the Gu's Atlas and Li Guozhen's Percent Numeration, and then compared with his/her chronological age. CMH test and Pearson test were used to evaluate precision and accuracy on concluding the immature age for penal responsibility. RESULTS:Li Guozhen's Percent Numeration was more precise than Gu's Atlas on extrapolating the chronological age of the youth, P<0.005. On extrapolating the age for penal responsibility, the accuracy of the former was 90.91%, and the latter was 78.79%, but the statistic result did not show significant difference (P>0.1). CONCLUSION:Both measurements can apply in determining the criminal cases of immature youths.