Abstract In order to explore the influence of different environmental endocrine disruptors (EEDs) on the onset of youth in children and adolescents, the study introduces the advance trend of the onset of youth in children and adolescents at home and abroad, and the influence of EEDs, such as bisphenol A, organophosphate esters, phthalic acid esters, per and polyfluoroalkyl substances, which children and adolescents often contact on the onset of youth. The related mechanisms are expounded from the aspects of direct interference of EEDs on neuroendocrine axis, hormone simulation and antagonism mediated by receptors, epigenetic programming changes, indirect pathways mediated by obesity and inflammation, etc., in order to provide scientific basis for formulating preventive measures for abnormal puberty onset of children and adolescents in EEDs exposure and promote their health.

Objective:To identify the health management needs of caregivers' for adolescent patients with scoliosis based on the journey map, and provide a reference for improving the medical experience and optimizing the whole-journey care level.Methods:On the basis of literature review, combined with semi-structured interview method and group discussion method, we conducted semi-structured interview with the main caregivers of 13 adolescent scoliosis patients in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology in June to October 2024, analyzed the data and drew a journey map.Results:A total of 13 respondents who met the inclusion and exclusion criteria were recruited, including 5 men and 8 women, with an age range of 32 to 45 years. Caregivers' health management needs were summarized from three dimensions: tasks, emotions, and pain points, following a timeline.Through the visualization of the journey map, the caregiver's cognitive gaps during the covert phase, information anxiety and decision-making dilemmas, need for early diagnosis and treatment, and challenges in symptom management ect. in the entire journey of health management were presented, and fifteen themes were summarized.Conclusions:The needs of caregivers for the journey of health management of postoperative adolescent idiopathic scoliosis patients are diversified, and should be demand-oriented to provide precise care support, improve medical experience, and provide ideas and methods for research on postoperative patient health management service optimization.

Background and Aims:Body mass index(BMI),an important indicator of nutrition and health,is closely associated with postoperative complications.This study was performed to investigate the relationship between preoperative BMI and severe complications in patients undergoing liver resection for hepatolithiasis,aiming to provide preoperative guidance for clinicians,reduce the risk of postoperative complications,and ensure surgical safety and efficacy.Methods:The clinical data of 484 patients with hepatolithiasis who underwent liver resection between May 2006 and December 2022 at the First Affiliated Hospital of Army Medical University and Beijing Tsinghua Changgung Hospital were retrospectively collected.Patients were classified into low BMI group(≤18.4 kg/m2),normal BMI group(18.5-24.9 kg/m2),and high BMI group(≥25.0 kg/m2)based on preoperative BMI.Baseline characteristics,overall complications,severe complications,and other postoperative outcomes were compared between the normal BMI group and the low group as well as the high BMI group.Risk factors for severe complications after liver resection were analyzed.Results:Among the 484 patients,79(16.3％)were in the low BMI group,328(67.8％)in the normal BMI group,and 77(15.9％)in the high BMI group.The high BMI group had significantly higher ASA score,preoperative albumin level,and proportion of hypertension compared to the normal BMI group(all P＜0.05).Baseline characteristics in the low BMI group showed no significant differences compared to the normal BMI group(all P＞0.05).The incidence rates of overall complications were not significantly among the three groups(P＞0.05).However,the high BMI group had significantly higher incidence rates of severe complications(Clavien-Dindo grade Ⅲ-Ⅳ),postoperative infections,liver failure,and bile leakage compared to the normal BMI group;the low BMI group had significantly higher rates of perioperative blood transfusion,postoperative infections,liver failure,and reoperation compared to the normal BMI group(all P＜0.05).Univariate and multivariate Logistic regression analyses identified high BMI and preoperative total bilirubin ≥54 pmol/L as independent risk factors for severe complications after liver resection in patients with hepatolithiasis(both P＜0.05).Conclusion:Preoperative BMI is closely associated with the occurrence of complications after liver resection in patients with hepatolithiasis,with high BMI being an independent risk factor for severe complications.To mitigate the risk of severe complications,clinical practice should prioritize monitoring and management of individuals with high BMI and other risk factors

Objective To investigate the prognostic factors of leptomeningeal metastasis of lung adenocarcinoma without driving gene.Methods Retrospectively collected the clinical data of lung adenocarcinoma patients with leptomeningeal metastasis without driving gene in the affiliated Cancer Hospital of Xinjiang Medical University from January 1,2011 to December 31,2023,and followed up their survival time.Results Among the 58 patients with leptomeningeal metastasis of lung adenocarcinoma,the survival time was 0-38.0months,the median overall survival time(mOS)was 5.0months,and the one-year survival rate was 25.9％.33 patients received antineoplastic therapy,and the survival time of patients receiving antineoplastic therapy was significantly longer than that of patients with-out antineoplastic therapy(8.0months vs 2.0months,P=0.006).Among them,12 patients received chemotherapy combined with whole brain radiotherapy.The mOS of patients who received chemotherapy combined with radiotherapy and those who did not receive chemother-apy combined with radiotherapy were 6.0 and 3.0months(P=0.098).21 patients received only systemic chemotherapy,and the mOS of patients receiving chemotherapy alone and chemotherapy combined with radiotherapy were 6.0 and 8.0months(P=0.497).The survival time of patients less than 60 years old at the time of diagnosis of LM was prolonged(8.0months vs 2.0months,P=0.011).Whether pa-tients received antineoplastic therapy or not was an independent prognostic factor for patients with lung adenocarcinoma LM(HR=0.489,95％CI:0.281-0.849).Conclusion Age＜60 years old and antineoplastic therapy can prolong the prognosis of patients with lepto-meningeal metastasis of lung adenocarcinoma with negative driver gene,and antineoplastic therapy is an independent factor affecting the prognosis of patients.

Single-cell assay for transposase-accessible chromatin sequencing(scATAC-seq)is a power-ful technique for studying cellular heterogeneity and gene regulatory networks,widely applied in epigenet-ic research.However,the complexity of data analysis workflows and high programming requirements have limited its broader adoption among non-programmer researchers.To address this issue,we developed Sig-nac.UIO,a modular and visual scATAC-seq analysis platform based on the R Shiny framework,integra-ting mainstream tools such as Signac and Seurat.The platform includes ten key modules covering quality control,cell filtering,dimensionality reduction,clustering,differential analysis,cell annotation,path-way enrichment,motif analysis,and transcription factor footprinting.Through a graphical user interface,users can perform full analyses and obtain interactive visualization results.The platform's stability and u-tility have been validated using a public PBMC dataset and it is currently deployed online(https://xula-bgdpu.org.cn/Signac.UIO),providing an efficient and user-friendly tool for single-cell epigenomics re-search.

Background/Aims: Dexamethasone (DEX) is a widely used exogenous therapeutic glucocorticoid in clinical settings. Its long-term use leads to many side effects. However, its effect on metabolic disorders in individuals on a high-fat diet (HFD) remains poorly understood. Methods: In this study, HFD-fed mice were intraperitoneally injected with DEX 2.5 mg/kg/day for 30 days. Lipid metabolism, adipocyte proliferation, and inflammation were assayed using typical approaches. Results: DEX increased the epididymal fat index and epididymal adipocyte size in HFD-fed mice. The number of epididymal adipocytes with diameters > 70 μm accounted for 0.5% of the cells in the control group, 30% of the cells in the DEX group, 19% of the cells in the HFD group, and 38% of all the cells in the D+H group. Adipocyte proliferation in the D+H group was inhibited by DEX treatment. Adipocyte enlargement in the D+H group was associated with increased the lipid accumulation but not the adipocyte proliferation. In contrast, the liver triglyceride and total cholesterol levels and their metabolism were downregulated by the same treatment, indicating the therapeutic potential of DEX for nonalcoholic fatty liver disease. Conclusions DEX synergizes with HFD to promote lipid deposition in adipose tissues. A high risk of obesity development in patients receiving HFD and DEX treatment is suggested.

Background/Aims: Dexamethasone (DEX) is a widely used exogenous therapeutic glucocorticoid in clinical settings. Its long-term use leads to many side effects. However, its effect on metabolic disorders in individuals on a high-fat diet (HFD) remains poorly understood. Methods: In this study, HFD-fed mice were intraperitoneally injected with DEX 2.5 mg/kg/day for 30 days. Lipid metabolism, adipocyte proliferation, and inflammation were assayed using typical approaches. Results: DEX increased the epididymal fat index and epididymal adipocyte size in HFD-fed mice. The number of epididymal adipocytes with diameters > 70 μm accounted for 0.5% of the cells in the control group, 30% of the cells in the DEX group, 19% of the cells in the HFD group, and 38% of all the cells in the D+H group. Adipocyte proliferation in the D+H group was inhibited by DEX treatment. Adipocyte enlargement in the D+H group was associated with increased the lipid accumulation but not the adipocyte proliferation. In contrast, the liver triglyceride and total cholesterol levels and their metabolism were downregulated by the same treatment, indicating the therapeutic potential of DEX for nonalcoholic fatty liver disease. Conclusions DEX synergizes with HFD to promote lipid deposition in adipose tissues. A high risk of obesity development in patients receiving HFD and DEX treatment is suggested.

Objective:To explore the association between the systemic immune-inflammation index (SII) and obesity metabolic phenotypes, as well as metabolic features in children and adolescents.Methods:A cross-sectional study was conducted using the random cluster sampling method from March 2023 to May 2024. Children and adolescents aged 9-17 years in Guangzhou were surveyed through questionnaires, physical measurements, and blood tests. According to BMI and metabolic status, participants were classified into normal-weight groups [metabolically healthy normal weight (MHNW) and metabolically unhealthy normal weight (MUNW)] and overweight/obese groups [metabolically healthy overweight/obese (MHO/O) and metabolically unhealthy overweight/obese (MUO/O)]. After natural log-transformation of SII values (lnSII), multinomial logistic regression was used to assess the association between SII and obesity metabolic phenotypes, while binary logistic regression was applied to assess the relationship between SII and metabolic phenotypes in the overweight/obese subgroup. Linear regression model and restricted cubic spline (RCS) were employed to examine the relationship between SII and metabolic features among the entire population.Results:A total of 3 749 participants were included. After adjusting for covariates, for every unit increase in lnSII, the risk of MHO/O and MUO/O increased by 93% ( OR=1.93, 95% CI: 1.56-2.40, P<0.001) and 156% ( OR=2.56, 95% CI: 2.02-3.25, P<0.001), respectively. In the overweight/obesity subgroup, for every unit increase in lnSII, the risk of MUO/O increased by 37% ( OR=1.37, 95% CI: 1.01-1.87, P=0.045). Linear regression model and RCS showed that lnSII was positively correlated with systolic blood pressure (SBP) and diastolic blood pressure (DBP) (SBP: β=1.39, 95% CI: 0.67-2.11, P<0.001; DBP: β=1.27, 95% CI: 0.79-1.75, P<0.001). lnSII also had a non-linear relationship with triglyceride ( Pnonlinear=0.032) and high-density lipoprotein cholesterol ( Pnonlinear=0.002). Conclusion:Elevated SII levels are associated with unfavorable obesity metabolic phenotypes, higher blood pressure, and altered lipid profiles in children and adolescents. SII may be a potential driving factor for metabolic heterogeneity in children and adolescents.

Objective:To identify the health management needs of caregivers' for adolescent patients with scoliosis based on the journey map, and provide a reference for improving the medical experience and optimizing the whole-journey care level.Methods:On the basis of literature review, combined with semi-structured interview method and group discussion method, we conducted semi-structured interview with the main caregivers of 13 adolescent scoliosis patients in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology in June to October 2024, analyzed the data and drew a journey map.Results:A total of 13 respondents who met the inclusion and exclusion criteria were recruited, including 5 men and 8 women, with an age range of 32 to 45 years. Caregivers' health management needs were summarized from three dimensions: tasks, emotions, and pain points, following a timeline.Through the visualization of the journey map, the caregiver's cognitive gaps during the covert phase, information anxiety and decision-making dilemmas, need for early diagnosis and treatment, and challenges in symptom management ect. in the entire journey of health management were presented, and fifteen themes were summarized.Conclusions:The needs of caregivers for the journey of health management of postoperative adolescent idiopathic scoliosis patients are diversified, and should be demand-oriented to provide precise care support, improve medical experience, and provide ideas and methods for research on postoperative patient health management service optimization.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.