Objective: To explore the barriers to physical activity behavior among overweight and obese children and adolescents, so as to provide evidence for developing physical activity intervention programs. Methods: From March to April 2025, 13 overweight or obese children and adolescents from one primary school and one secondary school in Nanjing were selected by purposive sampling for semi structured interviews. Guided by the capability, opportunity and motivation-behavior model, data were coded, categorized and analyzed using content analysis. Results: A total of 13 interviews were completed, with a cumulative duration of 358 minutes. Three themes and eight subthemes were identified:capability factors, including physical discomfort and limited physical fitness, weak exercise skills and insufficient behavioral regulation ability, and insufficient psychological capability; opportunity factors, including insufficient family support and negative influence, pressure from school and peer environments, and limited time resources and exercise conditions; and motivation factors, including low self efficacy and situations prone to giving up, and insufficient positive feedback and lack of attractiveness of exercise forms. Conclusions Barriers to physical activity among overweight and obese children and adolescents result from the combined effects of capability, opportunity and motivation. It is necessary to lower the threshold for initiating exercise, strengthen positive experiences and feedback, and build integrate family-school support environments to promote the initiation and maintenance of physical activity behaviors in children and adolescents.

Objective To investigate the potential of one-stop multi-modality CT in the assessment of collateral circulation and prognosis in acute ischemic stroke(AIS).Methods From February 2022 to May 2024,115 patients diagnosed with AIS at Wuzhou Red Cross Hospital were enrolled in the study.All subjects were examined with one-stop multi-modality CT at admission and received endovascular therapy.According to the collateral circulation score derived from multi-phase CT angiography(mCTA)and the modified Rankin scale score at 90 days,these patients were divided into different groups:good(n=59)vs poor(n=56)collateral circulation groups,and favorable(n=48)vs unfavorable(n=67)outcome groups.Clinical and imaging parameters were compared between these groups.Independent risk factors for collateral circulation and prognosis of AIS patients were identified through multivariate Logistic regression analysis.A prediction model for unfavorable AIS prognosis was developed based on the results of multivariate Logistic analysis,and its predictive value was assessed using receiver operating characteristic(ROC)curve analysis.Results Poor collateral circulation group exhibited higher proportions of insular ribbon and gray-white matter junction blurring as compared with good collateral circulation group(P<0.05),while the ratio of hypoperfusion intensity ratio(HIR)<0.3 was lower in poor collateral circulation group(P<0.05).Relative cerebral blood volume(rCBV)<40%,relative cerebral blood flow(rCBF)<30%,peak time(Tmax)>8 s,and Tmax>10 s volume were all significantly higher in poor collateral circulation group(P<0.05),whereas the Alberta stroke program early CT score(ASPECTS)was lower(P<0.05).Multivariate Logistic regression analysis identified ASPECTS,rCBV<40%,rCBF<30%,and Tmax>10 s as independent risk factors for poor collateral circulation(P<0.05).Unfavorable outcome group had higher rates of hemorrhage following endovascular thrombectomy and mismatch ratio<1.8 than favorable outcome group(P<0.05),with a lower HIR<0.3 ratio(P<0.05).Compared with favorable outcome group,unfavorable outcome group also showed higher admission NIHSS scores,higher percentages of rCBV<40%,rCBF<30%,Tmax>4 s,Tmax>6 s,and Tmax>10 s volumes(P<0.05),but lower mCTA collateral circulation score(P<0.05).Multivariate Logistic regression analysis indicated that admission NIHSS score,mCTA collateral circulation score,rCBV<40%,rCBF<30%,and Tmax>10 s were independent risk factors for unfavorable outcomes(P<0.05).The regression equation was formulated as:Logit(P)=-0.184+(admission NIHSS score×0.134)+(mCTA collateral circulation score×-0.415)+(rCBV<40%×0.107)+(rCBF<30%×0.089)+(Tmax>10 s×0.028).ROC curve analysis demonstrated an area under the curve of 0.775(95 CI:0.689-0.860,P<0.001)for the prediction model in assessing unfavorable AIS prognosis.Conclusion One-stop multi-modality CT has significant application value in assessing collateral circulation and predicting prognosis in AIS patients.

Objective To explore the therapeutic effect of precise disconnection of pargastric varices guided by endoscopic ultrasound in the treatment of esophagogastric variceal bleeding.Method A retrospective analysis was conducted on 20 patients with cirrhosis esophagogastric variceal bleeding treated with endoscopic ultrasound-guided precise disconnection of pargastric varices from January 1,2024 to December 31,2024.The efficacy was analyzed.Result All 20 patients successfully completed the precise disconnection of pargastric varices under the guidance of endoscopic ultrasound.The injection of tissue gel combined with the placement of spring coils(14 cases)and the injection of tissue gel alone(4 cases)successfully blocked the pargastric varices.All patients did not experience perforation,esophageal and cardia stenosis,massive bleeding,septicemia,or ectopic embolization.One patient who received tissue gel alone had slight bleeding from the pargastric varices after surgery and improved after 3 days of treatment to reduce portal vein pressure.Another one patient who received tissue gel alone had a low-grade fever and normal body temperature after 3 days of anti-infection treatment.Conclusion Precise disconnection of pargastric varices under the guidance of endoscopic ultrasound has a good therapeutic effect on esophagogastric variceal bleeding,with fewer complications such as ectopic embolization,massive bleeding,infection,and perforation.However,close follow-up observation is still needed to address the issue of pargastric varices.

OBJECTIVE To standardize the strategies for prevention and control of Chikungunya(CHIK)in healthcare in-stitutions so as to reduce the risk of transmission in the institutions.METHODS A working group comprising the ex-perts in hospital infection control,infectious diseases,and microbiology systematically reviewed domestic and international evidence and current guidelines,integrated China's vector ecology and healthcare realities,conducted two rounds of Delphi to achieve expert consensus,and graded the evidence and recommendation strength using the Oxford Centre for Evidence Based Medicine system.RESULTS The consensus issues 18 actionable recommendations on triage,patient mosquito-proof isolation,integrated vector control,protection of susceptible populations,environmental cleaning and disinfection,specimen management,medical textile handling,and outbreak emergency response,with each statement assigned an evi-dence level and recommendation strength.CONCLUSION This consensus is for the first time in China to provide evidence-graded strategies for control of CHIK in healthcare institutions,offering work flow-oriented,implementable guidance for clinicians,laboratorians,and infection-control personnel under different risk scenarios and enhancing the comprehensive coping capacity of the healthcare institutions.

Objective:To identify the relevant factors for the first-course remission of acute myeloid leukemia (AML) and to develop a predictive model as well as assess its predictive capability.Methods:Clinical data of 749 patients newly diagnosed with AML admitted to the Department of Hematology, the First Affiliated Hospital, Zhejiang University, School of Medicine from January 1, 2019, to April 30, 2023, were collected and randomly divided into training and validation sets. Multivariate logistic regression analysis was conducted to determine variables associated with complete remission in the first course of induction therapy, and a predictive model was established based on these variables. The receiver operating characteristic (ROC) curve of the predictive model was plotted, and the area under the curve (AUC) was calculated.Results:The indicators predicting the first remission course included peripheral blood white blood cell count during onset, CBF::MYH11 fusion gene, CEBPA bZIP region mutation, myelodysplastic syndrome-related gene mutation, and induction chemotherapy regimen selection as independent factors for the first remission course. The model’s area under the training and validation curves was 0.738 (95% CI: 0.696-0.780) and 0.726 (95% CI: 0.650-0.801), respectively. The Hosmer-Lemeshow test results yielded P-values of 0.993 and 0.335, respectively. Conclusion:In this study, the developed model demonstrates a strong predictive capability for the efficacy of the first course of patients with AML, providing valuable guidance to clinicians in assessing patient prognosis and selecting appropriate treatment strategies.

Objective:To investigate the correlation between frailty and immune markers in elderly patients diagnosed with heart failure with preserved ejection fraction(HFpEF).Methods:A total of 416 elderly patients with HFpEF, who were hospitalized in the Department of Geriatrics at Henan Provincial People's Hospital from March 2021 to December 2023, were selected as research subjects.The Fried frailty phenotype was employed to assess frailty.Fasting venous blood samples were collected to measure levels of CD4+ T lymphocytes, CD8+ T lymphocytes, the CD4+ /CD8+ ratio, and immunoglobulins A, M, and G. Spearman correlation analysis and multiple linear regression analysis were conducted to evaluate the relationship between frailty scores and immune markers.Results:Spearman correlation analysis revealed a significant association between frailty score and the CD4+ /CD8+ ratio( r=-0.659, P<0.001), immunoglobulin A( r=-0.454, P<0.001), immunoglobulin M( r=-0.522, P<0.001), and immunoglobulin G( r=-0.802, P<0.001).Furthermore, multiple linear regression analysis indicated that, after adjusting for confounding factors, frailty score served as a significant negative predictor of the CD4+ /CD8+ ratio( β=-0.562, P<0.001), immunoglobulin A( β=-0.366, P<0.001), immunoglobulin M( β=-0.445, P<0.001), and immunoglobulin G( β=-0.772, P<0.001).In comparison to the non-frail group, the frail group exhibited significantly lower values for the CD4+ /CD8+ ratio( β=-0.666, P<0.001)and levels of immunoglobulin A( β=-0.514, P<0.001), immunoglobulin M( β=-0.526, P<0.001), and immunoglobulin G( β=-0.814, P<0.001). Conclusions:In hospitalized elderly patients with heart failure with HFpEF, frailty serves as an independent risk factor for the reduction of the CD4+ /CD8+ ratio, as well as levels of immunoglobulin A, immunoglobulin M, and immunoglobulin G. Furthermore, the frailty score demonstrates a significant negative predictive value for these immunological markers.Therefore, it is essential to enhance our understanding of frailty and to prioritize its prevention and treatment, as this may help mitigate immune dysfunction and promote recovery in elderly patients.

This article retrospectively analyzed the involvement of clinical pharmacists in the treatment process and implementation of pharmacological supervision in a patient with septic arthritis secondary to tophi ulceration.The patient was admitted to the hospital and the emergency debridement and tophi removal were performed.Piperacillin-tazobactam,imipenem cilastatin,levofloxacin,linezolid,and vancomycin were given successively,and multiple debridement and drainage were performed,but the patient remained febrile and had recurrent infection indicators.According to the relevant guidelines and evidence-based evidence,combined with the patient's infection indicators,pathogen results and creatinine clearance rate,the clinical pharmacists recommended stopping vancomycin and changing to cefazolin,and the clinicians adopted it.After that,the patient's inflammatory indicators gradually decreased,and the body temperature stabilized.After 28 days of piperacillin-tazobactam administration,the patient developed a reduction in white blood cell count(2.34×109·L-1)and potassium(2.98 mmol·L-1).The pharmacist recommended prompt discontinuation of the drug,and the patient's white blood cell count and potassium gradually recovered.Eventually,after anti-infective treatment and surgical intervention,the patient was discharged with closure of the infected foci,conversion of multiple blood cultures to negative,and stabilisation of body temperature and renal function.This case reflects the role of clinical pharmacists in the management of drug treatment of critically ill patients,and may provide practical experience and reference for clinical treatment of such cases.

Objective To compare the application effects of different puncture techniques in the autonomous arteriovenous fistula puncture of patients undergoing hemodialysis,providing a reference for nurses in selecting puncture methods.Methods A total of 135 patients undergoing hemodialysis at a tertiary hospital in Changzhou from September 2023 to September 2024 were selected and randomly divided into 3 groups,including a multiple puncture group,a rope ladder puncture group,and a buttonhole puncture group.Follow-up was conducted every 3 months,and the first puncture success rate,puncture pain,diameter of blood scab at the puncture site,hemostasis time,and complications of arteriovenous fistula(infection,embolism,aneurysm,stenosis,intimal hyperplasia)were compared among the 3 groups.Results A total of 114 patients completed the study,with 40 in the multiple puncture group,42 in the rope ladder puncture group,and 32 in the buttonhole puncture group.The single-puncture success rate was higher in the multiple single-puncture group(99.4％)and the buttonhole puncture group(99.6％)than it in the rope-ladder puncture group(93.3％),with all P＜0.001.The scab diameter in the buttonhole puncture group(2 mm)was larger than that in the multiple single-puncture group(1 mm)and the rope-ladder puncture group(l mm),with all P＜0.001.The incidence of intimal hyperplasia in the buttonhole puncture group(34.3％)was higher than that in the multiple single-puncture group(10.0％)and the rope-ladder puncture group(11.9％),with all P＜0.05.Conclusion Each of the 3 arteriovenous fistula puncture techniques has its advantages and disadvantages.The multiple puncture group technique can improve the first puncture success rate,and it does not significantly increase the complications of arteriovenous fistula compared to the rope ladder and buttonhole techniques,making it suitable for widespread use.

This article retrospectively analyzed the involvement of clinical pharmacists in the treatment process and implementation of pharmacological supervision in a patient with septic arthritis secondary to tophi ulceration.The patient was admitted to the hospital and the emergency debridement and tophi removal were performed.Piperacillin-tazobactam,imipenem cilastatin,levofloxacin,linezolid,and vancomycin were given successively,and multiple debridement and drainage were performed,but the patient remained febrile and had recurrent infection indicators.According to the relevant guidelines and evidence-based evidence,combined with the patient's infection indicators,pathogen results and creatinine clearance rate,the clinical pharmacists recommended stopping vancomycin and changing to cefazolin,and the clinicians adopted it.After that,the patient's inflammatory indicators gradually decreased,and the body temperature stabilized.After 28 days of piperacillin-tazobactam administration,the patient developed a reduction in white blood cell count(2.34×109·L-1)and potassium(2.98 mmol·L-1).The pharmacist recommended prompt discontinuation of the drug,and the patient's white blood cell count and potassium gradually recovered.Eventually,after anti-infective treatment and surgical intervention,the patient was discharged with closure of the infected foci,conversion of multiple blood cultures to negative,and stabilisation of body temperature and renal function.This case reflects the role of clinical pharmacists in the management of drug treatment of critically ill patients,and may provide practical experience and reference for clinical treatment of such cases.

Objective:To identify prognostic factors associated with survival rates in patients with distal cholangiocarcinoma after radical surgery, and to construct a Nomogram prediction model based on these factors, as well as to perform internal validation of the model.Methods:A retrospective study was conducted on the clinical data of 162 patients (76 males and 86 females) with distal cholangiocarcinoma who underwent radical surgery at the Department of Hepatobiliary Surgery, Ningxia Medical University General Hospital from January 2011 to July 2019. The study used univariate and multivariate Cox regression analysis to identify independent risk factors and constructed a Nomogram prediction model using R software version 4.4.1. Additionally, the predictive accuracy of the model was evaluated through the C-index, the area under the receiver operating characteristic curve, and the calibration curve.Results:The median overall survival for the 162 patients was 18.4 months. The final multivariate Cox regression analysis revealed that the following factors were independent risk factors for poor postoperative prognosis in patients with distal cholangiocarcinoma: patient age [> 60 years, P = 0.004, hazard ratios ( HR) = 1.876], tumor diameter (> 2.0 cm, P < 0.001, HR = 0.174), tumor differentiation degree [moderately differentiated/moderately to highly differentiated/highly differentiated, P = 0.017, HR = 1.407], lymph node metastasis (Yes, P = 0.002, HR = 0.551), and vascular invasion (Yes, P = 0.025, HR = 1.329) (all P < 0.05). Based on these independent risk factors identified through statistical analysis, the C-index of the constructed nomogram prediction model was 0.793. The area under the receiver operating characteristic curve values for the model predicting postoperative 1-year, 3-year, and 5-year overall survival rates were 0.932, 0.771, and 0.758,respectively. Conclusions:Patient age, tumor diameter, tumor differentiation degree, lymph node metastasis, and vascular invasion are independent risk factors for poor postoperative prognosis in patients with distal cholangiocarcinoma. The final Nomogram prediction model demonstrates good predictive ability and has certain practical application potential.