Objective: To explore the bidirectional associations among body mass index Z scores (BMI Z scores) and weight stigma with depressive symptoms in adolescents, thereby providing evidence for targeted intervention strategies. Methods: A stratified cluster random sampling method was employed to select 18 301 adolescents aged 12-18 years from all 12 prefectures (103 counties) in the Inner Mongolia Autonomous Region, and two waves of longitudinal surveys were conducted in September 2023 (T1) and September 2024 (T2) among the adolescents. Weight stigma was assessed by using a self developed questionnaire, depressive symptom was measured with the Center for Epidemiologic Studies Depression Scale (CES-D), and BMI Z scores were calculated according to the World Health Organization standards. Pearson correlation analysis was used to examine associations among variables, and cross lagged panel models were constructed to investigate the dynamic bidirectional relationships among the three variables. Results: Adolescents BMI Z scores and weight stigma with depressive symptoms all exhibited autoregressive stability across the two time points (autoregressive paths, all P <0.01). Cross lagged model comparisons indicated that the bidirectional path model achieved the best fit ( χ 2=12.65, RMSEA =0.017, CFI =1.000; △ χ 2=193.39, P <0.01), supporting dynamic bidirectional associations among the three variables. After adjusting for gender, age, subjective social status and only child status, T1 BMI Z scores among adolescents positively predicted T2 weight stigma ( β =0.061), and T1 weight stigma positively predicted T2 depressive symptoms ( β =0.608); in the reverse direction, T1 depressive symptoms predicted T2 weight stigma ( β =0.003), and T1 weight stigma predicted T2 BMI Z scores ( β =0.081) (all P <0.01). Conclusions There is a bidirectional cross lagged relationship among adolescents BMI Z scores and weight stigma with depressive symptoms, suggesting that weight stigma may serve as a key psychological variable linking obesity and depressive symptoms. Greater attention should be paid to the potential threat of weight stigma to adolescents mental health, with intervention strategies expanded from a solely physiological focus to encompass psychosocial dimensions.

Objective: To analyze the association between altitudes and nutritional status of children and adolescents, and to explore the moderating effects of dietary behaviors and physical activity, so as to provide a scientific basis for developing lifestyle interventions tailored to local conditions. Methods: From September to November 2023, physical examinations and questionnaire surveys were conducted among children and adolescents aged 7-17 in two autonomous regions, Inner Mongolia and Xizang, with a final sample of 156 511 participants by the stratified cluster random sampling method. Height and weight were measured to calculate body mass index (BMI). Sociodemographic characteristics, dietary behaviors, and physical activity were collected via questionnaires, while the altitude of each participant s school was obtained using Amap. Logistic regression was performed to examine the relationship between altitudes and nutritional status. Interaction terms and stratified analyses were applied to assess the moderating effects of dietary behaviors and physical activity. Restricted cubic spline (RCS) were used for visualization. Results: In 2023, the prevalence of wasting and overweight/obesity among children and adolescents in Xizang were 9.7% and 9.0%, respectively, compared to 2.9% and 22.0% in Inner Mongolia. Logistic regression analysis results showed that for every 1 km increase in altitude, the risk of wasting increased, while the risk of overweight/obesity decreased ( OR =1.43, 0.19, both P <0.05). The results of the stratified analysis showed that compared to those living at altitudes <1 km, children and adolescents with healthy diets showed no significant association between altitudes (1-<2 and 2-<3 km) and wasting ( OR =1.22, 0.75, both P >0.05), whereas significant associations were observed at 3-<4 and ≥4 km altitudes ( OR =2.25, 2.89, both P <0.05). In contrast, unhealthy dietary groups showed statistically significant associations across altitudes ( OR =1.18-4.04, all P <0.05), consistent with RCS results. No moderating effects were observed for physical activity on the altitude wasting association or for dietary behaviors and physical activity combined on the altitude overweight/obesity association ( P interaction =0.63, 0.10, 0.53). Conclusion Healthy dietary behaviors play a critical role in improving the nutritional status of children and adolescents and reducing regional disparities, providing a scientific foundation for public health policy formulation and implementation.

Objective: To understand the pubertal development of primary and secondary school students in urban and rural areas of the Inner Mongolia Autonomous Region in 2021, so as to provide clues for further clarification of the health hazards of early pubertal initiation. Methods: From October to November 2021, primary and secondary school students in 12 provinces and cities of Inner Mongolia were selected by stratified cluster random sampling, including 21 662 girls who had reached menarche and 10 600 boys who had their first seminal emission, as well as 46 183 girls who had not reached menarche and 78 995 boys who had not experienced their first seminal emission. The height and weight of the primary and secondary school students were measured, and the time of first seminal emission or menarche was recorded. The study used the Mann-Whitney U test to analyze the differences between urban and rural students, Spearmans rank correlation to analyze the correlation between overweight and obesity and the age of pubertal initiation, and the Logistic regression model to analyze the correlation between pubertal initiation and age of pubertal initiation. Results: The age of menarche for urban girls [(12.31±1.29) years old] was earlier than that of suburban girls [(12.43±1.24) years old], and the age of first spermatozoa for urban boys [(13.85±1.20) years old] was statistically significant compared with that of suburban boys [(13.79±1.36) years old] (t=12.76, 10.58, P<0.05). There was a negative correlation between the age of menarche and overweight/obesity among girls aged 10-14 years (r=-0.169, P<0.05), and there was no statistically significant correlation between the age of spermarche and overweight/obesity in boys aged 5-9, 10-14, and 15-20 years (r=0.122, -0.022, -0.004, P>0.05). The occurrence of menarche in overweight girls was 1.06(95%CI=1.01-1.11) times higher than that in the normal group, and 1.13(95%CI=1.06-1.20) times higher among obese girls than normalweight girls. Compared to urban areas, primary and secondary school students in suburban counties observed the onset of puberty later [OR=0.88(95%CI=0.85-0.91) for menarche, OR=0.94(95%CI=0.89-0.99) for first spermatozoa] (P<0.05). Conclusions Obesity during childhood and adolescence is associated with earlier onset of puberty among female students in Inner Mongolia, and later onset of puberty among primary and secondary school students in suburban counties compared with those in urban areas.

BACKGROUND:Although traditional screw fixation has been successful in treating ankle fractures,rigid fixation solutions tend to restrict ankle movement and delay fracture healing,whereas elastic fixation is more compatible with human mechanics and has unique advantages in patients with ankle fractures. OBJECTIVE:To compare the clinical effectiveness of elastic fixation and absolute fixation in repairing ankle fractures in the elderly with lower tibiofibular instability. METHODS:The clinical data of 108 elderly ankle fractures with lower tibiofibular instability in Hengshui People's Hospital from August 2019 to August 2021 were retrospectively collected.They were divided into screw group and elastic fixation group(n=54 per group)according to the surgical protocol,and traditional screw internal fixation and elastic internal fixation were performed respectively.The perioperative indicators,surgical results,economic benefits,and American orthopedic foot and ankle society scores were collected and compared between the two groups.Serum tumor necrosis factor-α,interleukin-8 levels,ankle cavity width,depth,and lower tibiofibular space were compared before and after surgery. RESULTS AND CONCLUSION:(1)The full weight-bearing time was shorter in the elastic fixation group than that in the screw group;the operating angle was greater in the elastic fixation group than that in the screw group,and the complication rate was lower in the elastic fixation group than that in the screw group(P<0.05).(2)Serum tumor necrosis factor-α and interleukin-8 levels in the elastic fixation group were lower than those in the screw group 3 days after surgery(P<0.05).(3)American orthopedic foot and ankle society scores in the two groups were higher than those before surgery at 6 and 12 months after surgery,and the depth and width of the inferior tibiofibular space and ankle cavity were lower than those before surgery(P<0.05);but no significant difference was detected between the two groups(P>0.05).(4)There was no significant difference in the excellent and good rate between the two groups at 12 months after surgery(P>0.05).(5)There was no significant difference in the comparison of direct non-medical costs,direct medical costs,and total costs between the two groups(P>0.05).(6)It is indicated that elastic fixation for the repair of ankle fractures with lower tibiofibular instability in the elderly can obtain effective outcomes,which can shorten the time of complete weight-bearing,diminish complications,and alleviate inflammatory stress.

Objective:To investigate the risk factors and cumulative risk of myopia in children and adolescents, providing a basis for identifying cumulative risk factors in preventing and controlling myopia.Methods:Baseline data from the mental and physical health cohort of children and adolescents established in Inner Mongolia Autonomous Region were used. A stratified random cluster sampling method was adopted to select 138 974 students from fourth to twelfth grade as participants. Distance visual exams, refractive assessments, and questionnaires were conducted on the included students. Logistic regression analysis was used to evaluate each risk factor's impact on myopia's prevalence. The number of risk factors was summed to form a cumulative risk score, and logistic regression analysis was conducted to examine the association between the cumulative risk score and the prevalence of myopia. Additionally, the association between the cumulative risk score of myopic students and their degree of refractivity was analyzed using a generalized estimating equation.Results:The study found a high prevalence of myopia among children and adolescents at baseline (70.2%). Girls exhibited a higher prevalence (74.8%) than boys (65.6%), urban areas (74.3%) surpassed suburban ones (68.6%), and the incidence was greater in high schools (80.3%) compared to middle schools (75.3%), which, in turn, was higher than in elementary schools (57.7%) (all P<0.05). Analysis of risk factors revealed that children and adolescents experiencing improper reading and writing distances ( OR=1.10, 95% CI: 1.07-1.13), excessive homework ( OR=1.09, 95% CI: 1.06-1.12), insufficient sleep ( OR=1.10, 95% CI: 1.07-1.13), having myopic father ( OR=1.98, 95% CI: 1.91-2.05), having myopic mother ( OR=2.04, 95% CI: 1.97-2.10), or using classroom chairs not matched to their height faced ( OR=1.04, 95% CI: 1.01-1.07) increased myopia risks. Additionally, the prevalence and significant odds ratio of myopia increased with the increase in cumulative risk score, with every additional unit of cumulative risk score increasing the right eye's refractive error by -0.10 D. Conclusion:The presence of multiple factors and their comprehensive score increases the prevalence of myopia in children and adolescents.

Background::Early detection of esophageal squamous cell carcinoma (ESCC) can considerably improve the prognosis of patients. Aberrant cell-free DNA (cfDNA) methylation signatures are a promising tool for detecting ESCC. However, available markers based on cell-free DNA methylation are still inadequate. This study aimed to identify ESCC-specific cfDNA methylation markers and evaluate the diagnostic performance in the early detection of ESCC.Methods::We performed whole-genome bisulfite sequencing (WGBS) for 24 ESCC tissues and their normal adjacent tissues. Based on the WGBS data, we identified 21,469,837 eligible CpG sites (CpGs). By integrating several methylation datasets, we identified several promising ESCC-specific cell-free DNA methylation markers. Finally, we developed a dual-marker panel based on methylated KCNA3 and OTOP2, and then, we evaluated its performance in our training and validation cohorts. Results::The ESCC diagnostic model constructed based on KCNA3 and OTOP2 had an AUC of 0.91 [95% CI: 0.85–0.95], and an optimal sensitivity and specificity of 84.91% and 94.32%, respectively, in the training cohort. In the independent validation cohort, the AUC was 0.88 [95% CI: 0.83–0.92], along with an optimal sensitivity of 81.5% and specificity of 92.9%. The model sensitivity for stage I–II ESCC was 78.4%, which was slightly lower than the sensitivity of the model (85.7%) for stage III–IV ESCC. Conclusion::The dual-target panel based on cfDNA showed excellent performance for detecting ESCC and might be an alternative strategy for screening ESCC.

Glucose transporter 1(GLUT1)overexpression in tumor cells is a potential target for drug therapy,but few studies have reported screening GLUT1 inhibitors from natural or synthetic compounds.With cur-rent analysis techniques,it is difficult to accurately monitor the GLUT1 inhibitory effect of drug molecules in real-time.We developed a cell membrane-based glucose sensor(CMGS)that integrated a hydrogel electrode with tumor cell membranes to monitor GLUT1 transmembrane transport and screen for GLUT1 inhibitors in traditional Chinese medicines(TCMs).CMGS is compatible with cell membranes of various origins,including different types of tumors and cell lines with GLUT1 expression knocked down by small interfering RNA or small molecules.Based on CMGS continuous monitoring technique,we inves-tigated the glucose transport kinetics of cell membranes with varying levels of GLUT1 expression.We used CMGS to determine the GLUT1-inhibitory effects of drug monomers with similar structures from Scutellaria baicalensis and catechins families.Results were consistent with those of the cellular glucose uptake test and molecular-docking simulation.CMGS could accurately screen drug molecules in TCMs that inhibit GLUT1,providing a new strategy for studying transmembrane protein-receptor interactions.

Abstract The prevalence of mental health problems in children and adolescents has been gradually increasing, which has become an important public health problem related to the future of the country and the nation. However, mental disorder rarely exists independently, and comorbidity often occurs, which brings great harm and burden to individuals, families and society. This study introduces the prevalence, burden, characteristics and manifestations of different types of comorbidity with mental disorders as the core. Then it explaines the main causes and mechanisms of comorbidity, and proposes future research directions.

Objective: To analyze the prevalence trend of scoliosis among myopic students in Inner Mongolia Autonomous Region during 2019-2022, to explore the common etiology of myopia and scoliosis co-morbidities, so as to provide a reference for the development of relevant measures. Methods: The method of stratified random cluster sampling was used to select 181 533, 141 552 , 200 987, 190 918 primary and secondary school students from 12 leagues(103 banners) in Inner Mongolia Atuonomous Region in September each year from 2019 to 2022. And scoliosis screening, vision examination and questionnaire survey were conducted among students in the included studies. The χ 2 test was used to analyze the data, and the binary multivariate Logistic regression model was used to screen the influencing factors of scoliosis and myopia co-morbidities. Results: From 2019 to 2022, the myopia rate of primary and secondary school students in Inner Mongolia Autonomous Region was 55.55%-59.72%, scoliosis rate was 1.56 %-2.81% and the rates of scoliosis and myopia co-morbidities were 1.14%-1.95%, and the difference between different years was statistically significant ( χ 2=595.01, 775.56, 461.84, P < 0.05 ). In 2022, the co-morbidity rate was higher in girls than in boys(1.32% vs 0.97%), the rate of urban areas was higher than that of rural areas(2.57% vs 0.62%), the rate of students in vocational high school and high school was higher than that in junior high school and primary school (3.82%,2.47% vs 1.70%,0.42%), the rate of over developed areas was higher than that of poor areas (1.21% vs 0.99%)( χ 2=52.19, 1 269.82, 1 361.52, 17.29, P < 0.05 ). Logistic regression analysis showed that at least 1 h of moderate and high intensity exercise every day on weekends, the number of physical education classes per week was more than 3 sessions, the height of desks and chairs was adjusted according to height, resting outdoors, limiting screen time, and strictly requiring standing and sitting posture were the negative correlated with scoliosis and myopia, and the OR value was 0.65-0.90, reading books or electronic screens while participating in cram classes, walking or riding in the car were positively correlated with comorbid scoliosis and myopia, and the OR values were 1.27 and 1.13 ( P < 0.05), respectively. Conclusion Behavioral habits severely affect scoliosis and myopic of students. Prevention and control of scoliosis and myopia co-morbidity should start with students behavioral habits, early screening and early intervention.

Objective: To investigate the prevalence of Internet addiction and depression of students, and to analyze the co-occurrence and trend, so as to provide a theoretical basis for prevention and controlling measures of Internet addiction and depression. Methods: A total of 6 317,7 152,81 808,71 180 and 89 932 students aged 10 to 24 years from 12 leagues (103 banners) in Inner Mongolia Autonomous Region were selected by stratified random cluster sampling in September each year from 2017 to 2021. The Internet Addiction Scale and the Central for Epidemiologic Studies Depression Scale(CES-D) was used to measure Internet addiction and depression. And the annual inspection rate, group difference and annual change trend in students were calculated. Multivariate linear regression and restricted cubic spline analysis were used to estimate the linear and non linear associations between Internet addiction and depression in students. Results: The Internet addiction proportion in students gradually decreased from 4.1% in 2017 to 2.1% in 2020, but increased to 3.9% in 2021. And the depressive symptoms proportion increased from 20.9% in 2017 to 28.0% in 2020 and 27.0% in 2021. The detection rate of Internet addiction and depression comorbidities remained at 1.8% to 2.5 %. The Internet addiction proportion in boys was higher than that in girls( χ 2=42.82， P <0.05). The depressive symptoms prevalence in girls was higher than that in boys( χ 2= 553.90， P <0.05). Taking reversal in prevalence of Internet addiction in urban and rural areas was observed in 2019. The detection rates of depressive symptoms and comorbidity were higher in urban areas than these in suburban counties on the whole, and the difference showed a trend of decreasing or even equalizing year by year. Internet addiction was positively correlated with depressive symptoms score ( B=1.67, 95%CI =1.64-1.71), the proportion of depressive symptoms ( OR=1.39, 95%CI =1.38-1.41) and the proportion of major depressive symptoms ( OR=1.35, 95%CI =1.33-1.36) among students in 2021 ( P <0.05). An N-shaped curve was found in the significant nonlinear associations between internet addiction and depression across sex, region and school stage. Conclusion Internet addiction and depression in students show significant linear and non-linear associations, which are consistent in different sexes, regions and school stages. Therefore, relevant measures should be made and implemented in each region, especially in suburb areas, so as to prevent the increasingly development of adolescents and children s Internet addiction and depression.