Objective: To analyze the developmental trajectories of clustered health risk behaviors and their association with self-esteem and lonelinesss among junior high school students, so as to provide a reference for formulating comprehensive prevention and control measures of health risk behaviors among adolescents. Methods: In October 2023, 1 165 first year junior high school students from two schools of Jishou City in Hunan Province were selected by convenient sampling method for three follow up surveys (T1:October 2023; T2:April 2024; T3:October 2024). The Adolescent Health Risk Behavior Questionnaire, Rosenberg Self esteem Scale and Loneliness Scale were used to assess health risk behaviors, self esteem and loneliness, respectively. Latent growth curve modeling and latent growth mixture modeling were applied to analyze the developmental trajectories of clustered health risk behaviors among junior high school students. Logistic regression was used to analyze the association of the developmental trajectories of clustered health risk behaviors with self esteem and loneliness among junior high school students. Results: The overall developmental trajectories among junior high school students showed a declining trend (intercept=0.15, slope=-1.65, both P <0.05), with three heterogeneous categories:low risk improvement group ( n =862, 74.0%), moderate risk stable group ( n =260, 22.3%), and high risk deterioration group ( n =43, 3.7%). After adjusting the status of the left behind individuals，using the low risk improvement group as the reference category in multinomial Logistic regression analysis, results indicated that higher loneliness scores among junior high school students increased the risks of belonging to the moderate risk stable group ( OR=1.02, 95%CI =1.00- 1.04 ) and the high risk deterioration group ( OR=1.04, 95%CI =1.00-1.08), while higher self esteem scores reduced the risks of belonging to the moderate risk stable group ( OR=0.93, 95%CI =0.91-0.96) and the high risk deterioration group ( OR=0.88, 95%CI =0.83-0.94) (all P <0.05). Conclusions The overall trend of clustered health risk behaviors among junior high school students gradually improves, and the self esteem and loneliness are significant correlative factors. Targeted intervention measures should be developed for the junior high school students, with a focus on enhancing their self esteem and alleviating loneliness.

Objective: To explore the impact of adverse childhood experiences (ACEs) on health risk behaviors (HRBs) among college students and the mediating role of psychological symptoms, so as to provide a basis for developing intervention strategies. Methods: From March to April 2023, a convenience cluster sample of 1 801 students from 12 universities in Nanning, Liuzhou, Guilin, Wuzhou of Guangxi completed an online survey. A self designed questionnaire, Adverse Childhood Experiences-International Questionnaire (ACE-IQ) and Symptom Checklist-90 (SCL-90) were used for evaluation tools. Binary Logistic regression, structural equation modeling (SEM) and Bootstrap methods were used to analyze the associations and mediating effects. Results: Overall, 71.2% of college students experienced at least one type of ACE, with emotional neglect (40.3%) and emotional abuse ( 25.2 %) having the highest detection rates. The top three HRBs were unhealthy diet (77.8%), physical inactivity (54.1%), and smoking/alcohol use (18.5%). Logistic regression showed that poor family functioning, abuse, and extra familial violence were each associated with an increased risk of smoking/alcohol use ( OR =1.14, 1.11, 1.18) and deliberate self harm ( OR =1.26, 1.19,1.30) (all P <0.05). Experience of abuse increased the risk of high risk sexual behavior and family dysfunction increaded the risk of physical inactivity, respectively ( OR = 1.07 , 1.04, both P <0.05). Mediation analysis revealed that anxiety ( β =0.20) and depression ( β = 0.09 ) partially mediated the pathway from poor family functioning to deliberate self harm; paranoia ( β =0.02) partially mediated the pathway from abuse to high risk sexual behavior; and obsessive-compulsive symptoms ( β =0.26) and depression ( β =0.10) partially mediated the pathway from extra familial violence to deliberate self harm (all P <0.05). Conclusion Psychological symptoms play a mediating role in the association between ACEs and HRBs, and mental health interventions may reduce the risk of HRBs among college students.

OBJECTIVE To systematically evaluate the quality of the Heat-clearing and symptom-relieving formula and screen potential marker components that influence the quality of the formula. METHODS The contents of 11 components （calycosin-7- O - β -D-glucoside， ononin， hyperoside， isoquercitrin， baicalin， baicalein， cryptotanshinone， tanshinone Ⅱ A ， tanshinone Ⅰ， senkyunolide A， ferulic acid） in the Heat-clearing and symptom-relieving formula were determined by high-performance liquid chromatography-tandem mass spectrometry （HPLC-MS/MS）. Using the contents of the aforementioned components as variables， cluster analysis （CA）， principal component analysis （PCA）， and orthogonal partial least squares-discriminant analysis （OPLS-DA） were conducted using OriginPro 2024 software and SIMCA 14.1 software； marker components affecting the quality of the Heat-clearing and symptom-relieving formula were then screened based on the criteria of variable importance in the projection （VIP） value＞1 and P ＜0.05. The comprehensive evaluation of 20 batches of samples was carried out using the entropy weight-technique for order preference by similarity to ideal solution（TOPSIS） and grey correlation analysis （GCA） methods. RESULTS The contents of the above 11 components were 7.993-72.866， 4.542-31.228， 727.666-1 901.884， 496.846-1 293.279， 1 995.501-6 779.150， 54.500-241.280， 150.302-304.339， 79.698-189.206， 257.118-682.418， 5.498-21.687， 7.524-26.935 μg/g. CA， PCA and OPLS-DA results showed that 20 batches of samples were grouped into 2 categories. Q1， Q3， Q4， Q7-Q9， Q12， Q15， Q16 were grouped into one category， and the rest were grouped into another category； VIP values of ferulic acid， tanshinone Ⅱ A ， baicalin， cryptotanshinone， calycosin-7- O - β -D-glucoside and ononin were all greater than 1 （ P ＜0.05）. Both the entropy weight-TOPSIS and GCA methods showed that the samples ranked in the top 11 according to the euclidean distance and relative correlation degree were Q2， Q5， Q6， Q10， Q11， Q13， Q14， Q17-Q20. CONCLUSIONS The established HPLC-MS/MS method is rapid， accurate and highly sens itive. Combined with chemical pattern recognition analysis， entropy weight-TOPSIS and GCA methods， this method can be used to evaluate the quality of the Heat-clearing and symptom-relieving formula. Ferulic acid， tanshinone Ⅱ A ， baicalin， cryptotanshinone， calycosin-7- O - β -D-glucoside and ononin may be the marker components that affect the quality of this formula. The overall quality of 11 batches of the Heat-clearing and symptom-relieving formula， including Q17， is relatively superior.

Background Climate change poses a significant threat to public health. In China, relevant health intervention research is still in its early stages, and evidence for evaluating the effectiveness of regional climate change health adaptation strategies and measures is scarce. Objective To investigate the level of climate change-related health literacy among residents in Shenzhen, implement targeted health interventions, and assess the intervention effects as well as their influencing factors. Methods From July 2023 to January 2024, 4 communities were randomly selected in Shenzhen, and a total of 896 community residents were enrolled and divided into an intervention group (444 participants) and a control group (452 participants). Baseline and follow-up surveys on climate change-related health literacy were conducted among residents for both groups. During the period between the two surveys, the intervention group received targeted health interventions. Health literacy—comprising 3 dimensions: basic health knowledge and concepts, basic health skills, and healthy lifestyles—was defined as achieving ≥80% of the total score. A differences-in-differences model was adopted to analyze the impact of the intervention, and multiple linear regression was used to explore the factors influencing the intervention effect. Results The baseline survey showed that 240 out of the 896 surveyed residents (26.79%) possessed climate change health literacy. For the 3 dimensions, the number of residents and the proportions with corresponding literacy in descending order were: basic health skills (521, 58.15%), healthy lifestyles (345, 38.50%), and basic health knowledge and concepts (44, 4.91%). After the intervention, the intervention group showed a 3.19% increase in the total health literacy score, a 3.55% increase in basic health knowledge and concepts, and a 4.24% increase in basic health skills (t=2.79, 2.77, and 2.47 respectively) (P<0.05). No significant change was observed in healthy lifestyle scores (t=0.70, P>0.05). Further analysis showed that awareness of the “dual carbon goals” and occupation were significantly associated with the intervention effect on overall health literacy (P<0.05). For basic health knowledge and concepts, occupation, history of chronic diseases, and awareness of the “dual carbon goals” had statistically significant effects on the intervention outcomes (P<0.05). Regarding basic health skills, awareness of the “dual carbon goals” significantly influenced the intervention effect (P<0.001). In terms of healthy lifestyles, gender, educational level, occupation, and awareness of climate change were significantly associated with the intervention effect (P<0.05). Conclusion The climate change-related health literacy among community residents in Shenzhen is in urgent need of improvement. Health interventions can effectively enhance residents' basic health knowledge and concepts, basic health skills, and overall literacy level. In the future, it is necessary to strengthen the popularization of climate change health knowledge based on different population characteristics and further optimize intervention strategies, to comprehensively improve residents' health adaptation capacity to climate change.

Childhood simple obesity has become a significant public health issue in China. Modern medicine primarily relies on lifestyle interventions and often suffers from poor long-term compliance， while pharmacological options are limited and associated with potential adverse effects. Traditional Chinese Medicine （TCM） has a long history in the prevention and management of this condition， demonstrating eight distinct advantages， including systematic theoretical foundation， diversified therapeutic approaches， definite therapeutic efficacy， high safety profile， good patient compliance， comprehensive intervention strategies， emphasis on prevention， and stepwise treatment protocols. Additionally， TCM is characterized by six distinctive features： the use of natural medicinal substances， non-invasive external therapies， integration of medicinal dietetics， simple exercise regimens， precise syndrome differentiation， and diverse dosage forms. By combining internal and external treatments， TCM facilitates individualized regimen adjustment and holistic regulation， demonstrating remarkable effects in improving obesity-related metabolic indicators， regulating constitutional imbalance， and promoting healthy behaviors. However， challenges remain， such as inconsistent operational standards， insufficient high-quality clinical evidence， and a gap between basic research and clinical application. Future efforts should focus on accelerating the standardization of TCM diagnosis and treatment， conducting multicenter randomized controlled trials， and fostering interdisciplinary integration， so as to enhance the scientific validity and international recognition of TCM in the prevention and treatment of childhood obesity.

Purpose: In this study, the neural communication patterns between hypothalamic structures and cortical areas in girls diagnosed with central precocious puberty (CPP) were explored. Endocrine profiles were incorporated to clarify the pathophysiological interactions between cerebral networks and hormonal regulation. The hypothalamus was designated as the key focus area for connectivity analysis. Methods: Fifty-seven girls (37 CPP, 20 non-CPP) were recruited from the Pediatric Development Clinic at the Second Affiliated Hospital of Anhui Medical University. The collected data included demographic information, gonadotropin-releasing hormone stimulation tests, and magnetic resonance imaging scans. Hypothalamic functional connectivity (FC) was analyzed using predefined region of interest coordinates, and correlations between hormone levels and FC values were assessed. Results: Compared to the non-CPP group, the CPP group exhibited elevated baseline follicle-stimulating hormone (FSH), baseline luteinizing hormone (LH), peak FSH, peak LH, and peak LH/FSH ratios. Patients with CPP exhibited enhanced neural synchronization linking the right lateral hypothalamic effector zone to the right superior frontal gyrus (displaying a borderline significant correlation with peak LH concentrations), concurrent with diminished functional coupling of the right lateral hypothalamic efferent to the right fusiform/supramarginal gyri. The left lateral hypothalamic projections demonstrated amplified connectivity with the right cuneus. No FC differences were observed in the medial hypothalamus. Conclusion Abnormal lateral hypothalamus FC patterns were identified in CPP girls and were particularly linked to peak LH levels. The findings offer novel insights into the neuroendocrine mechanisms underlying CPP.

This study explores methodological issues in the design， evaluation， and reporting of randomized controlled trials （RCTs） under the concept of "syndrome dominating disease". The discussion focuses on key aspects including the adaptability of trial design， the screening of research participants， the standardization of syndrome differentiation， the balance between intervention individualization and standardization， the integration of multi-dimensional outcome measures， and the limitations of existing evaluation and reporting tools when applied to this type of research， along with corresponding recommendations and future perspectives. Regarding research design， it is recommended to select or draw upon innovative design concepts such as basket trials and subgroup-based dynamic/static parallel-group designs， in order to innovate the design format of RCTs. Meanwhile， criteria for participant screening， TCM syndrome differentiation， and disease classification should be standardized. The balance should be appropriately achieved between intervention individualization and standardization， and a multidimensional assessment system encompassing TCM syndromes， disease-specific outcomes， and patient-reported outcomes should be established. For risk of bias assessment and research reporting， it is recommended，to develop specialized assessment and reporting tools based on existing instruments， in order to standardize the assessment and reporting of study findings. Future research may further explore the potential applications of artificial intelligence in the study design， risk-of-bias assessment， and reporting quality assessment of RCTs based on the "syndrome dominating disease" model， with a particular focus on methodological optimization， data integration， and enhancement of research quality.

This study explores methodological issues in the design， evaluation， and reporting of randomized controlled trials （RCTs） under the concept of "syndrome dominating disease". The discussion focuses on key aspects including the adaptability of trial design， the screening of research participants， the standardization of syndrome differentiation， the balance between intervention individualization and standardization， the integration of multi-dimensional outcome measures， and the limitations of existing evaluation and reporting tools when applied to this type of research， along with corresponding recommendations and future perspectives. Regarding research design， it is recommended to select or draw upon innovative design concepts such as basket trials and subgroup-based dynamic/static parallel-group designs， in order to innovate the design format of RCTs. Meanwhile， criteria for participant screening， TCM syndrome differentiation， and disease classification should be standardized. The balance should be appropriately achieved between intervention individualization and standardization， and a multidimensional assessment system encompassing TCM syndromes， disease-specific outcomes， and patient-reported outcomes should be established. For risk of bias assessment and research reporting， it is recommended，to develop specialized assessment and reporting tools based on existing instruments， in order to standardize the assessment and reporting of study findings. Future research may further explore the potential applications of artificial intelligence in the study design， risk-of-bias assessment， and reporting quality assessment of RCTs based on the "syndrome dominating disease" model， with a particular focus on methodological optimization， data integration， and enhancement of research quality.

Objective:To explore the effectiveness of find-organize-clarify-understand- select-plan-do-check-act (FOCUS-PDCA) cycle management in improving the accuracy of Nutritional Risk Screening 2002 (NRS 2002) scoring in inpatients.Methods:This study was a retrospective study. Data from a continuous quality improvement project, namely Improving the Accuracy of Nutritional Risk Screening for Inpatients from People's Hospital of Longhua in 2021 were selected. The NRS 2002 scores of newly admitted patients from 8 departments with relatively high nutritional risk (departments of gstroenterology, neurology, nephrology, respiratory medicine, oncology and hematology, neurosurgery, gastrointestinal surgery, and critical care medicine) from April 10, 2021 to April 29, 2021 (before intervention) were collected. The NRS 2002 scores were evaluated by a multidisciplinary nutrition support team in terms of accuracy and error types. Possible issues in the process of nutritional screening were analyzed and mitigated using the FOCUS-PDCA cycle management method. The NRS 2002 scores from July 18, 2021 to August 8, 2021 (after intervention) were collected in real time to summary the data on accuracy and error types and to evaluate the effect of FOCUS-PDCA.Results:The accuracy of NRS 2002 score in the 8 departments was increased from 52.97% (294/555) to 81.13% (473/583) after intervention, and the difference was statistically significant ( χ2=102.606, P<0.001). The accuracy of nutritional status impairment score was 64.14% before intervention, compared with 90.57% after intervention ( χ2=114.484, P<0.001). The accuracy of disease severity score was 78.56%, compared with 89.54% after intervention( χ2=25.736, P<0.001). The false-negative rate was 68.02% before intervention and 31.87% after intervention, and the difference was statistically significant ( χ2=31.501, P<0.001). Conclusion:FOCUS-PDCA can improve the accuracy of NRS 2002 scoring in inpatients, reduce the risk of failing to identify patients at nutritional risk, and contribute to further nutritional diagnosis and treatment.

eIF3a is a N ⁶-methyladenosine (m⁶A) reader that regulates mRNA translation by recognizing m⁶A modifications of these mRNAs. It has been suggested that eIF3a may play an important role in regulating translation initiation via m⁶A during infection when canonical cap-dependent initiation is inhibited. However, the death of animal model studies impedes our understanding of the functional significance of eIF3a in immunity and regulation in vivo. In this study, we investigated the in vivo function of eIF3a using eIF3a knockout and knockdown mouse models and found that eIF3a deficiency resulted in splenic tissue structural disruption and multi-organ damage, which contributed to severe sepsis induced by Lipopolysaccharide (LPS). Ectopic eIF3a overexpression in the eIF3a knockdown mice rescued mice from LPS-induced severe sepsis. We further showed that eIF3a maintains a functional and healthy immune system by regulating B cell function and quantity through m⁶A modification of mRNAs. These findings unveil a novel mechanism underlying sepsis, implicating the pivotal role of B cells in this complex disease process regulated by eIF3a. Furthermore, eIF3a may be used to develop a potential strategy for treating sepsis.