Background Sunshine duration is closely associated with population mental health and emotional states, although its relationship with mental and behavioral disorders (MBD) remains insufficiently studied. Objective To analyze the effect of sunshine duration on hospital admissions for MBD in Zigong City, Sichuan Province. Methods Hospital admission records for MBD from 10 medical institutions, meteorological data, and ambient air pollutant concentrations were collected in Zigong City from January 1, 2019 to December 31, 2024. A distributed lag non-linear model (DLNM) was employed to calculate single-day and cumulative lag effects of different sunshine duration exposures—0 h (P₀, P₅, P₂₅), 6 h (P₇₅), and 10.4 h (P₉₅)—on hospitalization risks for MBD, stratified by diagnostic category, sex, and age groups. Results This study analyzed 36597 hospital admissions for MBD in Zigong City. The exposure-response curve for sunshine duration at lag 0 d exhibited an inverted N-shaped pattern, with minimum relative risk (RR) of hospitalizations observed at 14 h sunshine duration. The immediate effects of different levels of sunshine duration on the hospitalization risk for MBD, schizophrenia, schizotypal and delusional disorders (SSDD), and neurotic, stress-related and somatoform disorders (NSSD) were significant, with the cumulative effect peaking at lags 12–13 days. For extremely short sunshine duration 0 h, the maximum relative risk (RR) values (with 95% confidence intervals, 95%CI) of hospitalization risk were 1.209 (1.001, 1.459) at lag 1 d for SSDD patients and 1.398 (1.133, 1.724) at lag 0 d for NSSD patients, respectively. The cumulative effect on hospitalization risk induced by short sunshine duration 6 h was higher than that induced by extremely short sunshine duration 0 h and long sunshine duration 10.4 h. Among populations stratified by gender and age, male patients and those aged over 70 years had higher hospitalization risks. For short sunshine duration 6 h, the cumulative RR (CRR) value (95%CI) of hospitalization risk for male MBD patients was 3.373 (1.362, 8.358) at cumulative lag 0–12 d, which was higher than that for female patients [2.943 (1.471, 5.889) at cumulative lag 0–13 d]. The population aged over 70 years was more sensitive to single-day and cumulative lag effects on hospitalization risk than other age groups. For short sunshine duration 6 h, the RR and CRR values (95%CI) of single-day and cumulative lag effects on hospitalization risk were 1.336 (1.002, 1.783) at lag 0 day and 5.085 (1.680, 15.392) at cumulative lag 0–12 d, respectively. At lag 13 d, long sunshine duration 10.4 h exposure was associated with depression hospitalizations in patients <20 years with RR=1.127 (95%CI: 1.002, 1.270). Conclusion When the daily sunshine duration is less than 14 h, it will increase the hospitalization risk of MBD in the population to varying degrees, with both single-day and cumulative lag effects. It is recommended that the public, especially vulnerable groups such as people with MBD aged 70 years and above and those with depression under 20 years, strengthen health protection to reduce the health risks caused by changes in sunshine.

Objective:To summarize clinical characteristics and prognosis of immune checkpoint inhibitor (ICI) -related Stevens-Johnson syndrome (SJS) /toxic epidermal necrolysis (TEN) .Methods:A retrospective analysis was conducted on patients diagnosed with ICI-related SJS/TEN in Zhongda Hospital, Southeast University from January 2018 to October 2023. Data on clinical manifestations, laboratory examinations, treatment and prognosis of the patients were analyzed.Results:A total of 9 patients were diagnosed with ICI-related SJS/TEN, including 8 males and 1 female, with the onset age ranging from 58 to 77 (67.56 ± 7.33) years. ICI were applied to all the 9 patients before onset of SJS/TEN. The latent period was 6 - 261 d, and the median duration was 76 d. All the patients presented with erythema as initial lesions, 3 cases with target lesions, 6 with blisters, and 5 cases with a positive Nikolsky's sign. Oral mucosal damage occurred in 7 cases, eye damage occurred in 6 cases, and urogenital damage occurred in 6 cases. All the 9 cases were treated with systematic glucocorticoids, 7 cases with intravenous immunoglobulin and 7 cases with antibiotics. Eight cases recovered and 1 case died. Among 6 patients followed for an average of 6.92 months, none achieved complete or partial remission, 3 died and 3 experienced disease progression.Conclusions:ICI-related SJS/TEN occurred with a relatively long latent period, and all the cases presented with erythema initially, with mucosal damage present in most of the cases. Management required discontinuation of ICI, and most patients recovered with corticosteroids and intravenous immunoglobulin, however, the prognosis for the primary malignancy remained poor.

Objective:To investigate the feasibility and safety of laparoscopic purse- string suture clamps combined with multi-functional seal caps for esophagojejunal Roux-en-Y anastomosis during total laparoscopic radical total gastrectomy (TLTG).Methods:This was a retrospective descriptive study of 42 patients with primary gastric malignancies who underwent TLTG at the First Affiliated Hospital of Nanjing Medical University that utilized laparoscopic purse-string suture clamps and multi-functional seal caps for esophagojejunal anastomosis between May, 2024 and January, 2025. The cohort included 33 males and 9 females, with a mean age of (67.7 ±9.5) years and a mean body mass index (BMI) of (23.9±2.9) kg/m 2. The American Society of Anesthesiologists (ASA) physical status classifications were I - II in 40 patients and III in 2 patients, and all patients were definitively diagnosed preoperatively via gastroscopy, dual-energy CT, and/or MRI. Tumor locations included the gastroesophageal junction (GEJ) in 28 cases (Siewert type II - III), the upper third of the stomach in 12 cases, and the middle third in 2 cases. The median distance of esophageal invasion was 1.3 cm, though in 10 cases this was ≥2 cm. Preoperative TNM staging was I-II in 17 patients and III in 25 patients. Surgical outcomes including operative time, anastomosis time, intraoperative blood loss, pathological results, and postoperative recovery were retrospectively analyzed. Results:All 42 operations were successful. The mean operative time was(212.5±26.4) minutes, and the average time from multi-functional seal cap placement to completion of the esophagojejunal anastomosis was (54.2±7.5) minutes. Mean intraoperative blood loss was (79.9±21.3) ml. Postoperative pathology confirmed R0 resection in all specimens, with a mean proximal esophageal margin distance of (2.1±1.6) cm. Furthermore, (51.9±15.1) lymph nodes on average were harvested from each patient; the mean time to oral intake was (149.5±41.4) hours; and the mean hospital stay was (11.3±5.4) days. Postoperative complications occurred in 6 patients: anastomotic leakage ( n=2), residual intra-abdominal infection ( n=1), pulmonary infection ( n=3), and Clavien-Dindo grade III or higher complications occurred in 2 patients. No recurrence, mortality, or anastomosis-related complications were observed within a median follow-up of 5.8 months (range 3.5-11.2). Conclusion:We find the application of the laparoscopic purse-string suture clamps and multi-functional seal caps for esophagojejunal anastomosis in TLTG to be safe and feasible, with satisfactory short-term outcomes.

Objective To analyze the correlation between serum interleukin-37(IL-37)and nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)with disease severity in chronic obstructive pulmonary disease(COPD)patients with systemic inflammatory response syndrome(SIRS),and evaluate their combined predictive value for prognosis.Methods A total of 150 patients with COPD and SIRS in Zigong First People's Hospital from January 2023 to March 2024 were selected as the study group,and 150 patients with COPD were selected as the control group.The groups were compared for general data and serum IL-37 and NLRP3 levels upon admission.The serum IL-37 and NLRP3 levels of patients with different disease severities in the study group were compared to analyze their correlation with disease severity.28-day prognosis of both groups was compared,and the serum IL-37 and NLRP3 levels of patients with poor and good prognosis in the study group were analyzed.Univariate and multivariate Logistic regression was used to assess factors influencing poor prognosis in COPD patients with SIRS.The predictive value of serum IL-37 and NLRP3 for poor prognosis was evaluated,and their interactive effects on patient outcomes were analyzed.Results The study group's serum IL-37 and NLRP3 levels were higher upon admission compared to the control group(P<0.05);serum IL-37 and NLRP3 levels in extremely severe patients were higher than those in severe,moderate,and mild patients,with severe patients higher than moderate and mild patients,and moderate patients higher than mild patients(P<0.05);serum IL-37 and NLRP3 levels at admission were positively correlated with the disease severity of COPD patients with SIRS(P<0.05);patients with poor prognosis had higher serum IL-37 and NLRP3 levels upon admission compared to those with good prognosis(P<0.05);serum IL-37 and NLRP3 levels at admission were independent risk factors for poor prognosis in COPD patients with SIRS(P<0.05);the AUC for predicting poor prognosis using serum IL-37 and NLRP3 alone were 0.805 and 0.834,respectively,while the combined AUC was 0.920,which was higher than the individual AUCs(P<0.05);interaction analysis showed that high serum IL-37 and NLRP3 levels exhibited a positive super-multiplicative interaction in the prognosis of COPD patients with SIRS(P<0.05).Conclusion Serum IL-37 and NLRP3 levels in COPD patients with SIRS were positively correlated with disease severity,and the combined serum IL-37 and NLRP3 showed high predictive efficacy for patient prognosis.

Objective:To summarize clinical characteristics and prognosis of immune checkpoint inhibitor (ICI) -related Stevens-Johnson syndrome (SJS) /toxic epidermal necrolysis (TEN) .Methods:A retrospective analysis was conducted on patients diagnosed with ICI-related SJS/TEN in Zhongda Hospital, Southeast University from January 2018 to October 2023. Data on clinical manifestations, laboratory examinations, treatment and prognosis of the patients were analyzed.Results:A total of 9 patients were diagnosed with ICI-related SJS/TEN, including 8 males and 1 female, with the onset age ranging from 58 to 77 (67.56 ± 7.33) years. ICI were applied to all the 9 patients before onset of SJS/TEN. The latent period was 6 - 261 d, and the median duration was 76 d. All the patients presented with erythema as initial lesions, 3 cases with target lesions, 6 with blisters, and 5 cases with a positive Nikolsky's sign. Oral mucosal damage occurred in 7 cases, eye damage occurred in 6 cases, and urogenital damage occurred in 6 cases. All the 9 cases were treated with systematic glucocorticoids, 7 cases with intravenous immunoglobulin and 7 cases with antibiotics. Eight cases recovered and 1 case died. Among 6 patients followed for an average of 6.92 months, none achieved complete or partial remission, 3 died and 3 experienced disease progression.Conclusions:ICI-related SJS/TEN occurred with a relatively long latent period, and all the cases presented with erythema initially, with mucosal damage present in most of the cases. Management required discontinuation of ICI, and most patients recovered with corticosteroids and intravenous immunoglobulin, however, the prognosis for the primary malignancy remained poor.

Objective:To investigate the feasibility and safety of laparoscopic purse- string suture clamps combined with multi-functional seal caps for esophagojejunal Roux-en-Y anastomosis during total laparoscopic radical total gastrectomy (TLTG).Methods:This was a retrospective descriptive study of 42 patients with primary gastric malignancies who underwent TLTG at the First Affiliated Hospital of Nanjing Medical University that utilized laparoscopic purse-string suture clamps and multi-functional seal caps for esophagojejunal anastomosis between May, 2024 and January, 2025. The cohort included 33 males and 9 females, with a mean age of (67.7 ±9.5) years and a mean body mass index (BMI) of (23.9±2.9) kg/m 2. The American Society of Anesthesiologists (ASA) physical status classifications were I - II in 40 patients and III in 2 patients, and all patients were definitively diagnosed preoperatively via gastroscopy, dual-energy CT, and/or MRI. Tumor locations included the gastroesophageal junction (GEJ) in 28 cases (Siewert type II - III), the upper third of the stomach in 12 cases, and the middle third in 2 cases. The median distance of esophageal invasion was 1.3 cm, though in 10 cases this was ≥2 cm. Preoperative TNM staging was I-II in 17 patients and III in 25 patients. Surgical outcomes including operative time, anastomosis time, intraoperative blood loss, pathological results, and postoperative recovery were retrospectively analyzed. Results:All 42 operations were successful. The mean operative time was(212.5±26.4) minutes, and the average time from multi-functional seal cap placement to completion of the esophagojejunal anastomosis was (54.2±7.5) minutes. Mean intraoperative blood loss was (79.9±21.3) ml. Postoperative pathology confirmed R0 resection in all specimens, with a mean proximal esophageal margin distance of (2.1±1.6) cm. Furthermore, (51.9±15.1) lymph nodes on average were harvested from each patient; the mean time to oral intake was (149.5±41.4) hours; and the mean hospital stay was (11.3±5.4) days. Postoperative complications occurred in 6 patients: anastomotic leakage ( n=2), residual intra-abdominal infection ( n=1), pulmonary infection ( n=3), and Clavien-Dindo grade III or higher complications occurred in 2 patients. No recurrence, mortality, or anastomosis-related complications were observed within a median follow-up of 5.8 months (range 3.5-11.2). Conclusion:We find the application of the laparoscopic purse-string suture clamps and multi-functional seal caps for esophagojejunal anastomosis in TLTG to be safe and feasible, with satisfactory short-term outcomes.

Objective:To systematically evaluate the qualitative study on the sexual health needs of patients with ostomy based on theoretical domains framework (TDF), providing reference for clinical care and practice.Methods:A comprehensive search was conducted for qualitative studies on the sexual experience of ostomy patients in the China National Knowledge Infrastructure, Wanfang Data, VIP database, China Biology Medicine, PubMed, Embase, Web of Science, Cochrane Library, Elton B. Stephens Company (EBSCO), Elsevier Scopus (SCOPUS), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, with a timeframe of from the creation of the databases to April 15, 2024. The Joanna Briggs Institute Evidence Based Healthcare Center Critical Appraisal Tool was used to evaluate the quality of eligible literature, and the theoretical domain framework was used to integrate the extracted results.Results:A total of 11 articles were included and 51 results were extracted. Based on the theoretical framework, map the sexual health needs of ostomy patients to six core areas: knowledge, skills, optimism, outcome beliefs, environment and resources, and emotions.Conclusions:Medical staff should pay attention to the sexual health needs of patients with intestinal stomas. Based on the six core areas of knowledge, skills, optimism, outcome beliefs, environment and resources, and emotions, they should deeply explore the factors that affect their sexual health, provide professional guidance and comprehensive care, and improve their sexual health level and quality of life.

Objective:To explore the clinical phenotype and genetic characteristics of children with childhood absence epilepsy caused by KMT2E gene variants. Methods:The clinical data of 1 case of KMT2E gene variant-associated childhood absence epilepsy admitted to the Department of Pediatric Neurology of Linyi People′s Hospital in January 2023 were collected and followed up, and the child and her family were genetically examined by using whole-exome sequencing and Sanger sequencing, and the pathogenicity of mutation loci was analyzed. The Online Mendelian Inheritance in Man, Human Gene Mutation Database, PubMed database, China National Knowledge Infrastructure, and Wanfang database were consulted with the search term " KMT2E" to summarize the clinical phenotype and genetics of the children with epilepsy associated with KMT2E gene variant. Results:The child is a female, presented with typical absence seizures at the age of 3 years and 8 months, with normal development, video electroencephalogram showing widespread spikes and slow waves around 3 Hz accompanied by typical absence seizures. Seizures decreased after valproic acid was applied at full dosage, and were controlled after combination with lamotrigine. Her clinical diagnosis of childhood absence epilepsy was made. The results of whole-exome sequencing showed that the child had a de novo frameshift variant c.2404dup (p.Arg802Lysfs *8) in the KMT2E gene (NM_182931.3), which had not yet been reported domestically or internationally. The c.2404dup variant was interpreted as a pathogenic variant (PVS1+PS2_Supporting+PM2_Supporting) according to the American Society of Medical Genetics and Genomics variant classification criteria and guidelines. Her parents, older brother and younger sister did not carry the variant and had a normal clinical phenotype. A total of 22 patients with epilepsy associated with KMT2E gene variants were retrieved (including this case, a total of 23 cases), including 10 females and 13 males. All of them were autosomal dominant inheritance, with 20 minor variations, including 8 frameshift variants, 7 missense variants, 2 splicing variants, 2 nonsense variants, 1 synonymous variant, and the remaining 3 cases had large fragment deletions (including 2 cases of the whole gene). Clinical manifestations mainly included epileptic seizures (5 cases of absence seizures, 7 cases of focal seizures with or without secondary tonic-clonic seizures, 9 cases of tonic-clonic seizures, 1 case of spasm seizures, 1 case of myoclonic seizures, tonic seizures, and atonic seizures, 3 cases of epileptic status, and 5 cases of refractory epilepsy, with the onset age of epilepsy ranging from neonatal to adolescence), mental retardation (21/23 cases, 4 mild, 5 moderate, and 5 severe), peculiar facial features (11/23), and autism (3/23), etc. Conclusion:KMT2E gene variant-associated epilepsy is an autosomal dominant disorder with a wide spectrum of clinical phenotypes, and the novel variant c.2404dup in the KMT2E gene identified in the present study can lead to childhood absence epilepsy, which enriches the spectrum of mutations and clinical phenotype of the KMT2E gene.

Objective: To examine the effects of high intensity interval training (HIIT) on body composition and cardiorespiratory fitness of obese primary school students, so as to provide a theoretical basis and practical reference for HIIT exercise prescription in schools. Methods: From August to December 2022, 25 obese children [age:(11.0±0.4)years, BMI:(23.3±0.8)kg/m 2] from a primary school in Shenzhen were recruited and divided into an exercise group ( n =13) and a control group ( n =12). After 12 weeks of exercise intervention [The durations of load period and intermittent period were 15 s, load exercise intensity was 100% maximal aerobic speed (MAS), and intermittent exercise intensity was 50% MAS, each time there were 2 groups× 8 rounds, and the rest between groups was 2 minutes, totaling 10 minutes, and 20 meter shuttle run test (20 m-SRT) was performed once every 4 weeks to adjust and update MAS], the changes in body composition and cardio respiratory fitness indexes of obese subjects before and after the intervention were compared. Results: After the intervention, body weight, BMI, body fat, body fat percentage, and visceral adipose tissue area of obese subjects in the exercise group decreased from (55.6±6.2)kg, (22.7±0.6)kg/m 2, (41.8±6.9)kg, ( 23.4± 5.5)% and (102.4±39.0)cm 2 to (52.3±5.8)kg, (21.1±0.8)kg/m 2, (38.6±6.3)kg, (20.2±4.5)% and (84.2±26.9)cm 2, respectively( t =8.73, 10.96, 7.02, 4.92, 4.95, P <0.05). SBP decreased from (115.4±9.7)mmHg to (112.3±8.7)mmHg ( t = 2.96 , P <0.05). The content of skeletal muscle, 20 m-SRT and VO 2max increased from (21.3±5.3)kg, (21.6±4.9) times and (39.4±2.0)mL/(kg ·min) to (21.8±5.2)kg, (31.4±6.3)times and (43.6±2.6)mL/(kg ·min), respectively ( t =-3.33, -8.37, -10.56 , P <0.05). Conclusions HIIT is an effective way to improve the body composition and cardiorespiratory fitness of obese primary school students. It is recommended that schools with the necessary conditions use this method as an intervention measure to help reduce weight and improve cardiovascular health among obese students.

Objective:To explore the therapeutic characteristics of population with gout achieving treat-to-target (T2T) indicators through real-world research and evaluate their safety.Methods:A total of 3 287 patients diagnosed with gout by rheumatologists in 21 first-class tertiary hospitals in 10 provinces, municipalities, and autonomous regions in China from January 2015 to December 2021 were included in this polycentric cross-sectional study. The database included patients′ general information, disease characteristics, and clinical application of traditional Chinese and Western medicine treatment measures. SPSS and Excel software were used for data analysis. Frequency analysis, cluster analysis, and factor analysis were used to summarize the characteristics and rules of treatment measures for patients with gout who achieved the target after treatment. The occurrence of adverse events (AE) was recorded during treatment.Results:After treatment, 691 visits (7%) achieved the serum urate (SUA) target, and the most frequent use of urate-lowering therapy (ULT) was febuxostat, followed by benzbromarone. The most common treatment options were following: GroupⅠ: traditional Chinese medicine (TCM) decoction-TCM external treatment-physical exercise-proprietary Chinese medicine; GroupⅡ: ferulic acid-nonsteroidal anti-inflammatory drugs (NSAIDs); Group Ⅲ: allopurinol-sodium bicarbonate-benzbromarone; Group Ⅳ: glucocorticoid-colchicine; Group Ⅴ: febuxostat. A total of 5 898 visits (60%) chieved manifestations of joint pain VAS scores target, and the most frequently used drug to control joint symptoms was NSAIDs. The frequency of use of drugs to control joint symptoms were 2 118 times (usage rate reached 35.9%), while the frequency of ULT were 2 504 times (usage rate reached 42.5%), which was higher than the joint symptom control drug. The most common treatment options were following: Group Ⅰ: proprietary Chinese medicine-TCM decoction-TCM external treatment-physical exercise; Group Ⅱ: NSAIDs-colchicine hormones; Group Ⅲ: allopurinol, Group Ⅳ: benzbromarone; Group Ⅴ: febuxostat. A total of 59 adverse events occurred during treatment.Conclusion:The proportions of gout patients who reach target serum urate level & good control of joint symptoms are both very low, and ULT and anti-inflammatory prescription patterns are very different from international guidelines, so it is necessary to strengthen the standardized management of gout patients. At the same time, life intervention measures account for a certain proportion of the treatment plans for the T2T population, and further exploration is needed.