Metabolites produced as intermediaries or end-products of microbial metabolism provide crucial signals for health and diseases, such as metabolic dysfunction-associated steatotic liver disease (MASLD). These metabolites include products of the bacterial metabolism of dietary substrates, modification of host molecules (such as bile acids [BAs], trimethylamine-N-oxide, and short-chain fatty acids), or products directly derived from bacteria. Recent studies have provided new insights into the association between MASLD and the risk of developing chronic kidney disease (CKD). Furthermore, alterations in microbiota composition and metabolite profiles, notably altered BAs, have been described in studies investigating the association between MASLD and the risk of CKD. This narrative review discusses alterations of specific classes of metabolites, BAs, fructose, vitamin D, and microbiota composition that may be implicated in the link between MASLD and CKD.

Objective:To analyze the characteristics of highly cited articles on spine and spinal cord injuries published in Chinese Journal of Trauma (hereinafter referred to as the "Journal") from 1985 to 2024. Methods:All the articles related to spine and spinal cord injuries published in the Journal from 1985 to 2024 were retrieved from the Wanfang Database and the articles with citation frequency ≥15 times were defined as highly cited, with the retrieval cut-off date of April 15, 2025. For articles related to spine and spinal cord injuries, the total publication count, number of cited articles, total citation frequency, average citation frequency per article, number of fund-supported articles were recorded and analyzed. For the highly cited articles among them, the total number of articles, types of literature, distribution periods, number of fund-supported articles, core authors, institution distribution, region distribution, frequency of and key words were also statistically analyzed.Results:From 1985 to 2024, the Journal published 1 182 articles on spinal and spinal cord injuries, of which 993 (84.01%) were cited, with a total citation frequency of 10 739 and an average of 10.81 citations per article. A total of 388 articles (32.83%) were supported by research funds. There were 184 highly cited articles on spinal and spinal cord injuries, with the following characteristics: (1) The most common type of highly cited literature was original articles (150 articles, 81.52%), while consensus and guideline articles achieved the highest average citation rate (44.75 citations per article). (2) The period 2015-2019 had the highest number of highly cited articles, accounting for 33.70%. (3) Fifty-four highly cited articles (29.35%) were supported by research funds, including 19 by national-level funds and 35 by funds of other levels. (4) Among the highly cited articles, 8 (4.35%) were authored by one person, and 176 (95.65%) were co-authored by two or more persons. Sixty-two authors who published ≥3 highly cited articles were identified as core authors. (5) A total of 123 highly cited articles (66.85%) were authored by researchers affiliated with a single institution, whereas 61 articles (33.15%) were the result of inter-institutional collaboration. Fifteen first-author institutions published≥3 highly cited articles. (6) Regions with ≥15 highly cited articles were Zhejiang Province (28 articles), Chongqing Municipality (23 articles), Guangdong Province (18 articles), Shaanxi Province (18 articles), Jiangsu Province (16 articles), and Shanghai Municipality (15 articles). (7) The top five key words in the highly cited articles were "spinal fractures" (71 times), "thoracic vertebrae" (45 times), "lumbar vertebrae" (44 times), "spinal cord injuries" (27 times), and "vertebroplasty" (27 times).Conclusions:Over the 40-year period, original articles constitute the majority of highly cited articles on spine and spinal cord injuries in the Journal, while consensus and guideline articles demonstrate the highest average citation frequency. Nearly 30% of the highly cited articles receive research funding support. Core authors and institutions show a relatively concentrated distribution, with spinal fractures, spinal cord injuries, and vertebroplasty emerging as research hotspots in the field.

Objective:To evaluate the epidemiological protective effect of a booster dose of acellular DTP vaccine (DTaP) against pertussis in 6-year-old children.Methods:A retrospective cohort study was conducted to compare the incidence of pertussis in 6-year-old children who received DTaP versus DT vaccine boosters in 2023 over a two-year period from May 2023 to May 2025. The protective effect of the fifth dose of DTaP against pertussis in 6-year-old children was evaluated.Results:A total of 960 participants were enrolled in this study, including 480 children in the experimental group who received the fifth dose of DTaP vaccine and 480 children in the control group who received the DT vaccine booster. Baseline characteristics were balanced between the two groups. There were six confirmed cases of pertussis in the experimental group, with a reported incidence rate of 1.25%. In the control group, 14 pertussis cases were reported, with a reported incidence rate of 2.92%. The protective effectiveness(VE) of the DTaP vaccine against pertussis was 57.14% (95% CI:-10.59%-83.39%). For 6-year-old children who completed the booster immunization, the incidence data of pertussis were collected from the 14 th day after vaccination (i.e., the study day 0). Based on the annual cumulative incidence rate, the VE of DTaP against pertussis at 6, 12, 18, and 24 months after vaccination was 100%, 63.80% (95% CI:-14.49%-88.55%), 64.59% (95% CI: 1.17%-87.31%), and 57.60% (95% CI:-10.80%-83.78%), respectively. In the DTaP group, the annual cumulative incidence rate of 12 to 24 months did not show a significant upward or downward trend ( Z=-0.995, P=0.320). Conclusion:Boosting 6-year-old children with the DTaP vaccine provides measurable protection against pertussis. The protective efficacy is significant in the early stage (0 to 6 months) after vaccination, and it still remains effective at 12 to 24 months.

Objective:To investigate the prevalence and risk factors of overweight and obesity among Chinese children aged 3-18 years from 11 provinces, antonomous regions, or municipalities.Methods:This national cross-sectional community health survey utilized a multistage stratified cluster-random sampling method to recruit 193 997 nationally representative participants from 11 provinces, autonomous regions, or municipalities between January 2017 and December 2019. All participants underwent physical examinations, and their caregivers completed questionnaires assessing participants′ dietary, lifestyle, familial, and perinatal information. Multilevel multinomial logistic regression models were employed to identify the potential risk factors.Results:The cohort comprised 193 997 children (102 178 boys, 91 819 girls),aged (10±4) years. Overall prevalence rates were 30 574(15.8%)overweight children and 17 217(8.9%) obesity children. Boys exhibited higher overweight and obesity rates than girls (17.0% (17 368/102 178) vs. 14.4% (13 206/102 178), 11.3% (11 553/91 819) vs. 6.2% (5 664/91 819), χ2=249.12,1 578.69,both P<0.001). The detection rates of obesity in Tanner stage 2 and 3 were the highest in boys and girls, with 13.4%(2 231/16 665) and 8.6%(880/10 221) respectively. Risk factors for obesity included parental overweight (paternal OR=2.34 and maternal OR=2.29), annual household income of 100 000-200 000 yuan (compared with<100 000 yuan, OR=1.04), higher paternal education (compared with below high school,high school and a college education OR=1.09,1.14), birth weight >4.0 kg (≤5 and>5 years old OR=1.74, 1.44,respectively), and western food consumption≥1 time/month (compared with<1, 1-2, 3-4,>4 times/month OR=1.36, 1.30, 1.67(≤5 years), 1.19, 1.16, 1.15 (>5 years), respectively) (all P<0.05). Conversely, coarse grain intake≥1 times/week (compared with<1 times/week, every day, 3-4, 1-2 times/week OR=0.74, 0.80, 0.71 (≤5 years), 0.75, 0.87, 0.90(>5 years), respectively, all P<0.05) was associated with reduced obesity risk. Conclusions:Obesity epidemiology in children demonstrates significant heterogeneity across age, gender, geographic regions, and pubertal stages. It is necessary to establish a personalized prevention and control strategy.

Objective:To characterize the epidemiology, antimicrobial susceptibility, and molecular mechanisms of carbapenem-resistant Enterobacterales (CRE) carrying multiple carbapenemase genes in China, and to provide evidence for infection control and antibiotic stewardship.Methods:From 2016 to 2023, 115 CRE isolates harboring at least two carbapenemase genes were collected from 41 hospitals in 18 provinces across China. Species identification, antimicrobial susceptibility testing, and whole-genome sequencing were performed. Multilocus sequence typing (MLST) and capsular typing were conducted using Kleborate, plasmid replicon types were identified with PlasmidFinder, and a core genome phylogenetic tree was constructed.Results:The majority of isolates belonged to Klebsiella spp. (80.0%, 92/115), followed by E. cloacae (8.7%, 10/115) and E. coli (6.1%, 7/115). The isolates were mainly from Hebei, Beijing, Shandong, and Hunan (60.9%, 70/115), and sputum was the predominant specimen (43.5%, 50/115). The most common genotype was bla KPC+bla NDM (73.0%, 84/115), primarily in Klebsiella spp. (79.8%, 67/84), followed by bla NDM+bla IMP (15.7%, 18/115). The prevalent plasmid replicon types were IncFII (77.5%, 86/111), IncFIB (68.5%, 76/111), IncR (51.4%, 57/111), and IncX3 (20.7%, 23/111). Notably, 88.6% (31/35) of ST11-KL64 K. pneumoniae strains co-harbored IncFII, IncFIB, and IncR plasmids simultaneously. Between 2016 and 2022, the dominant subtype among Klebsiella spp. isolates was bla KPC-2+bla NDM-1 (56.2%, 36/64). In 2023, the bla KPC-2+bla NDM-13 subtype (29.5%, 19/64) emerged and exhibited clonal transmission (single nucleotide polymorphism 2?74 bp) in Hebei, Beijing, and Jilin. Susceptibility testing showed widespread resistance to β-lactams (90.2%-100%). Aztreonam-avibactam, tigecycline, and colistin retained high activity, with susceptibility rates of 90.16%-98.36%. Conclusions:In China, the majority of clinical Enterobacteriaceae strains that harbor multiple carbapenemases are Klebsiella spp. co-producing KPC and NDM enzymes. Dissemination is driven by both clonal expansion of ST11-KL64 and horizontal transfer of IncFII, IncFIB, and IncR plasmids. The recent emergence and regional clonal spread of the bla KPC-2+bla NDM-13 genotype underscore the urgent need for strengthened surveillance and containment measures.

Objective To investigate the relationship between serum programmed cell death 4(PDCD4),platelet-derived growth factor-BB(PDGF-BB)levels and atherosclerotic cardiovascular disease(ASCVD)in patients with type 2 diabetes mellitus(T2DM).Methods A total of 238 T2DM patients admitted to 3201 Hospital from January 2022 to August 2024 were selected as the T2DM group,and 120 healthy volunteers who visited the hospital for physical examination during the same period were selected as the control group.T2DM patients were divided into ASCVD group(82 cases)and non-ASCVD group(156 cases)according to the presence or absence of ASCVD.The serum levels of PDCD4 and PDGF-BB were detected by enzyme-linked immunosorbent assay.Multivariate unconditional Logistic regression was used to analyze the relationship be-tween serum PDCD4 and PDGF-BB levels and ASCVD in T2DM patients.Receiver operating characteristic curve was used to analyze the predictive efficiency of serum PDCD4 and PDGF-BB levels for ASCVD in T2DM patients.Results Compared with the control group,the serum levels of PDCD4 and PDGF-BB were signifi-cantly increased in the T2DM group(P<0.05).The incidence of ASCVD in the 238 patients with T2DM was 34.45%(82/238).Compared with the non-ASCVD group,the ASCVD group had significantly higher serum levels of PDCD4 and PDGF-BB(P<0.05).Hypertension,hyperlipidemia,high glycosylated hemoglobin,high PDCD4 and high PDGF-BB were independent risk factors for ASCVD in T2DM patients(P<0.05).The area under the curve of serum PDCD4 and PDGF-BB levels combined to predict ASCVD in T2DM patients was 0.873,which was larger than 0.790 and 0.780 predicted by serum PDCD4 and PDGF-BB levels alone(P<0.05).Conclusion The serum levels of PDCD4 and PDGF-BB are increased in patients with T2DM,which are independent risk factors for ASCVD.The combination of PDCD4 and PDGF-BB has a high predictive efficiency for ASCVD in patients with T2DM.

The success of"New Medical Sciences"in higher education requires effective tools in evalua-ting students'performance in courses.Previously,we reported a teamwork(T),critique(C)and ap-preciation(A)(TCA)ideological and political model,a teaching model widely applied in Basic Medical courses.TCA is an abbreviation derived from Tricarboxylic Acid Cycle in Biochemistry as an analogy for nurturing the abilities of thinking and teamwork(T),critique(C)and appreciation(A),which hope-fully could provide students with moral norms for cognition,science and life.This paper further explores the tools to assess the educational outcomes of the TCA model,by which teachers can collect feedback and reflect on teaching quality and effectiveness.Addressing the challenges of individual differences in large classes,fragmented learning feedback,and the difficulty of measuring meta-cognition in educational evaluation,this study employs strategies of value-added assessment,matrix assessment and norm-transfer-able assessment to evaluate the TCA abilities from the aspects of thinking quality,thinking creativity,co-operation ability,iterative thinking,dialectical thinking and job responsibility.By modifying/using 18 e-valuation tools in Education and Psychology,we have established a rubric system composed of 30 primary indicators(with 11 newly designed,10 partly modified and 9 directly adopted),along with 49 secondary indicators and 98 tertiary indicators to enhance the feasibility of the evaluation process.This rubric sys-tem was applied to Biochemistry teaching among the five-year-program undergraduates at Air Force Medi-cal University.Specifically,thinking and teamwork are evaluated by creative works from"the magic bio-chemical-circle",while critiques are assessed in large classes under the guidance of basic and clinical teachers,coupled with appreciation measured by job responsibility in a task-driven virtual reality(VR)project.The results indicate that Biochemistry teaching not only accumulates knowledge in students,but also achieves the goals in nurturing values and cognition.The inclusion of creative performance evalua-tion,cooperative learning and clinical case studies,can enhance students'interpersonal skills,coopera-tion,quality of thinking,creative thinking,iterative thinking and dialectical thinking to varying degrees.TCA-based Biochemistry teaching has a long-lasting impact on character education,and is capable of in-ducing positive long-term changes in students'cognition and lifestyle.Taken together,with the help of this rubric system,teachers can promptly acknowledge the effectiveness of their teaching,thereby facilita-ting their teaching strategies.

Abnormal expression of CMTM4 protein is closely related to tumour occurrence,development and prognosis.Although the important role of CMTM4 in tumours has been gradually manifested,its spe-cific mechanism of action in cervical cancer remains unclear.The aim of this study was to investigate the relationship between CMTM4 expression and clinicopathological features in cervical cancer and study its mechanism.Immunohistochemistry and Western blot were used to detect the expression level of CMTM4 in cancer tissues and paracancerous tissues,and it was found that CMTM4 was significantly under-ex-pressed in cervical cancer tissues(P＜0.001).The chi-square test analysed the relationship between high and low CMTM4 expression and the clinical and pathological characteristics of cervical cancer pa-tients and results found that CMTM4 expression was correlated with the number of births,HPV infection status,pathological type,FIGO stage and lymph node metastasis.Data from Western blot and RT-qPCR found that CMTM4 protein and mRNA levels in HaCaT cells were significantly higher than that of C-33A cells,HeLa cells,U14 cells,and HT-3 cells.Among them,the most significant change in CMTM4 ex-pression was observed in C-33A cells,so the C-33A cell line was selected for subsequent overexpression experiments.CCK-8 analysis found that the proliferation ability of C-33A cervical cancer cells in the pcDNA-CMTM4 group was significantly lower than that in the pcDNA-NC group(P＜0.001).Flow cy-tometry and Western blot results indicated that CMTM4 overexpression promoted apoptosis(P＜0.001),significantly increased Bax(P＜0.001)and cleaved caspase 3(P＜0.05)protein levels,and significant-ly decreased Bcl-2 protein level(P＜0.01).Western blot results further found that CMTM4 overexpres-sion significantly reduced the protein levels of p-PI3K(P＜0.001)and p-AKT(P＜0.01),but did not affect the protein levels of PI3K and AKT(P＞0.05).The above findings indicated that CMTM4 gene expression was down-regulated in cervical cancer,and CMTM4 overexpression inhibited cervical cancer cell proliferation and induced apoptosis by inhibiting the PI3K/AKT pathway.Therefore,CMTM4 may be used as a biological marker for screening cervical cancer.

Objective To explore the association between psychological resilience and internet addiction among senior primary school students,so as to provide a scientific basis for formulating strategies for preventing internet addiction and enhancing psychological resilience in this group.Methods A stratified cluster sampling method was employed.In May 2021,a total of 1 618 fourth-and fifth-grade students from 5 primary schools in Jiading District,Shanghai were surveyed on psychological resilience and internet addiction through questionnaires.Independent sample t-tests,chi-square tests,and Logistic regression models were used for data analysis.Results Among the 1 618 students,the prevalence rate of internet addiction was 8.8%(142 students).The total score of psychological resilience(t=6.215,P<0.001)and the scores of three dimensions,namely family support(t=3.509,P<0.001),goal focus(t=6.965,P<0.001),and positive perception(t=5.887,P<0.001),of those reported with internet addiction were all significantly lower than those without internet addiction.Multivariate logistic regression analysis showed that compared with individuals with low psychological resilience,those with moderate(aOR=0.395,95%CI:0.267-0.584,P<0.001)and high psychological resilience(aOR=0.167,95%CI:0.077-0.365,P<0.001)had a lower probability of internet addiction.The three sub-dimensions of psychological resilience,namely goal focus,positive perception and family support,also showed a statistically significant negative association with internet addiction in these students.Conclusion Nearly one-tenth senior primary school students in Jiading District self-reported internet addiction.Higher levels of psychological resilience were associated with a lower probability of internet addiction among senior primary school students.Focusing on enhancing the goal focus,positive perception and family support dimensions in psychological resilience may be of great significance for preventing internet addiction among senior primary school students.

Objective:To report the nationwide surveillance results of pathogenic profiles and antimicrobial resistance patterns of Gram-positive bloodstream infections in China in 2023.Methods:The clinical isolates of Gram-posttive bacteria from blood cultures were collected in member hospitals of National Bloodstream Infection Bacterial Resistant Investigation Collaborative System（BRICS）during January to December 2023. Antimicrobial susceptibility testing was performed using the dilution method recommended by the Clinical and Laboratory Standards Institute（CLSI）. Statistical analyses were conducted using WHONET 5.6 and SPSS 25.0 software.Results:A total of 4 385 Gram-positive bacterial isolates were obtained from 60 participating center. The top five pathogens were Staphylococcus aureus（ n=1 544，35.2%），coagulase-negative Staphylococci（ n=1 441，32.9%）， Enterococcus faecium（ n=574，13.1%）， Enterococcus faecalis（ n=385，8.8%），and α-hemolytic Streptococci（ n=187，4.3%）. The prevalence of methicillin-resistant Staphylococcus aureus（MRSA）and methicillin-resistant coagulase-negative Staphylococci（MRCNS）was 26.2%（405/1 544）and 69.8%（1 006/1 441），respectively. Notably，all Staphylococci remained susceptible to glycopeptide or daptomycin. Staphylococcus aureus demonstrated excellent susceptibility（>97.0%）to cephalobiol，rifampicin，trimethoprim-sulfamethoxazole，linezolid，minocycline，tigecycline，and eravacycline. No Enterococcus exhibiting resistance to linezolid were detected. Glycopeptide resistance was uncommon but more frequent in Enterococcus faecium（resistance to vancomycin and teicoplanin：both 1.7%）compared to Enterococcus faecalis（both 0.3%）. The detection rates of MRSA and MRCNS exhibited significant regional variations across the country（ χ2=17.674 and 148.650，respectively，both P<0.001）. No vancomycin-resistant Enterococci were detected in central China. Institutional comparison demonstrated higher prevalence of MRSA（ χ2=14.111， P<0.001）and MRCNS（ χ2=4.828， P=0.028）in provincial hospitals than that in municipal hospitals. Socioeconomic analysis identified elevated detection rates of both MRSA（ χ2=18.986， P<0.001）and MRCNS（ χ2=4.477， P=0.034）in less developed regions（per capita GDP