ObjectiveTo evaluate the effectiveness of stone needle thermocompression and massage compared to flurbiprofen gel patch in relieving chronic musculoskeletal pain in the shoulder and back， and to explore the potential mediating mechanism through muscle elasticity. MethodsA total of 120 patients with chronic musculoskeletal pain in the shoulder and back were randomly assigned to either stone needle group or flurbiprofen group， with 60 patients in each. The stone needle group received stone needle thermocompression and massage for 30 minutes， three times per week； the flurbiprofen group received flurbiprofen gel patch twice daily. Both groups were treated for 2 weeks. Pain improvement， as the primary outcome， was assessed using the Global Pain Scale （GPS） at baseline， after 2 weeks of treatment， and again 2 weeks post-treatment. To explore potential mechanisms， a mediator analysis was conducted by measuring changes in superficial and deep muscle elasticity using musculoskeletal ultrasound at baseline and after the 2-week treatment period. ResultsThe stone needle group showed significantly greater pain relief than the flurbiprofen group 2 weeks post-treatment. After adjusting for confounders related to pain duration， the between-group mean difference was -8.8 ［95% CI （-18.2， -0.7）， P＜0.05］. Part of the therapeutic effect was mediated by changes in deep muscle elasticity， with a mediation effect size of -1.5 ［95% CI （-2.0， -0.9）， P = 0.024］， accounting for 17.9% of the total effect. ConclusionStone needle thermocompression and massage can effectively relieve chronic musculoskeletal pain in the shoulder and back， partly through a mediating effect of improved deep muscle elasticity.

Objective: To explore the association between sleep quality and dry eye symptoms in adolescents,so as to provide the evidence for reducing the prevalence of dry eye symptoms. Methods: The study population was adolescents aged 12-24 years from the Psychology and Behavior Investigation of Chinese Residents (PBICR) survey, which was conducted from 20 June to 31 August 2022. A stratified random sampling and quota sampling method was used to select 6 456 adolescents within mainland China. The Ocular Surface Disease Index (OSDI) and Brief version of the Pittsburgh Sleep Quality Index (B-PSQI) were used to assess dry eye symptoms and sleep quality. Multiple Logistic regression model was used to explore the relationship between sleep quality and dry eye symptoms in adolescents. The influence of gender on the association was explored by using interaction terms. Results: A total of 2 815 adolescents reported having dry eye symptoms, with a prevalence of 43.6%. Logistic regression analysis results showed an increased risk of exacerbation of dry eye symptoms in adolescents with poor sleep quality. The OR (95% CI ) for mild, moderate, and severe dry eye symptoms groups were 1.39(1.16-1.67), 1.52(1.28-1.81), and 2.35(2.02-2.72), respectively, compared with the ocularly normal group ( P <0.05). There was a significant interaction between sleep quality and gender on dry eye symptoms in adolescents ( P <0.01). Conclusions Sleep quality is associated with dry eye symptoms in adolescents, and those with poor sleep quality have a higher risk of dry eye symptoms. The effect of sleep quality on dry eye symptoms is greater in boys.

Background and Aims:Accurate early pathogen diagnosis is a breakthrough for improving the prognosis of infectious pancreatic necrosis(IPN)patients.However,there is currently a lack of efficient methods for early identification of IPN in clinical settings.This study was performed to assess the application value of next-generation sequencing technology based on metagenomic capture(MetaCAP)in the pathogen diagnosis of IPN. Methods:A prospective study was conducted on 29 patients suspected of having acute necrotizing pancreatitis at Xiangya Hospital of Central South University between January and July 2024.Blood samples were tested using MetaCAP and conventional pathogen culture.The results of peritoneal fluid pathogen culture were used as the gold standard to compare the diagnostic efficacy of the two methods. Results:Due to three cases lacking peritoneal fluid culture results,a total of 26 cases were included in the final analysis.The overall mortality rate was 23.1％(6/26).During hospitalization,9 cases(34.6％)were diagnosed with IPN.The sensitivity and negative predictive value of MetaCAP for diagnosing IPN were significantly higher than those of conventional pathogen culture(77.8％vs.11.1％,P=0.031;86.7％vs.65.2％,P=0.032),while the differences in specificity(76.5％vs.88.2％,P=0.689)and positive predictive value(63.6％vs.33.3％,P=0.347)between the two methods were not statistically significant.The average detection time for MetaCAP was 33(20-49)h,while microbial culture took 125(45-142)h,with a significant difference(P＜0.001).The average cost for blood MetaCAP testing was 2 500 yuan per case,but it accounted for only 1.19％of the average hospitalization cost. Conclusion:MetaCAP has significant value in the early pathogen diagnosis of IPN,with a shorter detection time,good testing efficacy,and health-economic value,demonstrating a promising clinical application prospect.

Heat stroke (HS), also known as severe sunstroke, is one of the most serious heat-related disorders, characterized by rapid onset, rapid progression, aggressive condition, and high morbidity and mortality. The occurrence and development of HS are closely related to pathophysiological processes such as inflammation, oxidative stress, cell death, and coagulation failure. With the gradual discovery of the pathogenic mechanisms of HS, some drugs or therapeutic approaches targeting its molecular regulatory pathways have shown clinical promise. This review intends to provide an overview of research advances in HS types, pathogenic mechanisms, preclinical and clinically relevant therapeutic strategies, as well as to highlight the potential clinical applications of HS-related biomarkers and therapeutic targets with a view to informing the clinical management of HS.

Objective:To investigate the prevalence of overweight and obesity among first-year junior high school students in Beijing and to analyze their influencing factors.Methods:A questionnaire survey and physical examinations were conducted among first-year junior high school students from 9 schools across 6 districts in Beijing selected by multi-stage random cluster sampling method from September 2017 to December 2018. The questionnaire included demographic and family information, maternal pregnancy and childbirth conditions, dietary behavior, and physical activity. Height and weight were measured by trained investigators. The overweight and obesity were classified according to the Chinese School-age Children and Adolescents Overweight and Obesity Screening BMI Classification Standards (WGOC standards). The influencing factors were analyzed with univariate and multivariate logistic regressions. Results:A total of 1 467 questionnaires were returned and 1 411 were valid with an effective rate of 96.2%. Among the 1 411 respondents, there were 784 boys (55.6%) and 627 girls (44.4%), with an average age of (12.36±0.52) years. The overweight rates for boys and girls were 23.6% (185/784) and 13.7% (86/627), respectively, while the obesity rates were 24.0% (188/784) and 14.4% (90/627), respectively. Univariate and multivariate logistic regression revealed that female gender, 13-year-old age group, and preterm birth were negatively correlated with overweight and obesity ( OR=0.428, 0.722, 0.531; P<0.05). Maternal gestational hypertension, daily egg consumption, and weekly screen time≥7 hours were positively correlated with overweight and obesity ( OR=1.879, 1.574 and 2.088, 1.251; P<0.05). Conclusions:The prevalence of overweight and obesity among first-year junior high school students in Beijing is relatively high, which are positively or negatively associated with gender, age, preterm birth, maternal gestational hypertension, daily egg consumption and weekly screen time.

Objective:To investigate the application value of metagenomic next-genera-tion sequencing (mNGS) in pathogenic diagnosis of suspected infected severe acute pancreatitis (SAP).Methods:The prospective study was conducted. The clinical data of 25 patients with suspected infected SAP who were admitted to the Xiangya Hospital of Central South University from May to September 2023 were collected. Upper limb venous blood samples of all the patients were collected for both of mNGS and routine pathogen microbial culture. Observation indicators: (1) grouping situations of the enrolled patients; (2) comparison of the diagnostic efficiency of mNGS and routine pathogen microbial culture; (3) results of peripheral blood pathogen microbial testing and peri-pancreatic effusion microbial culture; (4) testing time and cost. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3). Count data were expressed as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Results:(1) Grouping situations of the enrolled patients. A total of 25 patients were selected for eligibility. There were 18 males and 7 females, aged 48(40,59)years. The duration of hospital stay of 25 patients was 30(20,50)days. The etiologies of 25 patients included 14 cases of hyperlipidemic pancreatitis, 8 cases of biliary pancreatitis, 1 case of alcohol-induced acute pancreatitis, and 2 cases of pancreatitis caused by other causes. Of the 25 patients, there were 17 cases with infected pancreatic necrosis (IPN) including 7 cases of death, and 8 cases with sterile pancreatic necrosis including no death. (2) Comparison of the diagnostic efficiency of mNGS and routine pathogen microbial culture. The positive rates of mNGS and routine pathogen microbial culture in diagnosis of suspected infected SAP were 72.0%(18/25) and 32.0%(8/25), respectively, showing a significant difference between them ( χ2=8.01, P<0.05). The sensitivity and negative predic-tive value of mNGS and routine pathogen microbial culture in diagnosis of IPN were 94.1%(16/17), 35.3%(6/17) and 85.7%(6/7), 35.3%(6/17), showing significant differences between them ( χ2=12.88, 5.04, P<0.05). The specificity and positive predictive value of mNGS and routine pathogen microbial culture in diagnosis of IPN were 75.0%(6/8), 75.0%(6/8) and 88.9%(16/18), 75.0%(6/8), showing no significant difference between them ( χ2=0, 0.82, P>0.05). (3) Results of peripheral blood pathogen microbial testing and peripancreatic effusion microbial culture. Of the 17 patients with IPN, 36 strains of pathogenic bacteria were detected by mNGS, and 6 strains were detected by routine pathogen microbial culture. There were 16 of 17 patients with IPN showing positive mNGS pathogenic testing, of which 13 cases were consistent with the pathogenic testing results of peri-pancreatic effusion microbial culture, showing a consistency rate of 76.5%(13/17). There were 6 pati-ents with IPN showing positive routine pathogen microbial culture, with a consistency rate of 35.3%(6/17) to peripancreatic effusion microbial culture. (4) Testing time and cost. Testing time of mNGS and routine pathogen microbial culture were (43±17)hours and (111±36)hours, showing a signifi-cant difference between them ( t=9.31, P<0.05). Testing cost of mNGS was (2 267±0)yuan/case, accoun-ting for 1.7% of the hospitalization expenses of (133 759±120 744)yuan/case. Testing cost of routine pathogen microbial culture was (240±0)yuan/case, accounting of 0.2% of the hospitalization expenses. Conclusion:mNGS has important value for early pathogenic diagnosis of suspected infected SAP, and has a high timeliness.

Objective:To investigate the genetic, clinical, and post-treatment characteristics of patients with glycogen storage disease type Ⅲ (GSD Ⅲ).Methods:A retrospective cohort analysis was performed on the genetic and clinical data of 26 cases with GSD Ⅲ who visited the Children's Hospital affiliated with Fudan University from June 2017 to December 2023. The patients were divided into non-missense variation and missense variation groups according to the types of mutation in the AGL gene.The correlation between genotype and phenotype was analyzed. All patients were treated with uncooked cornstarch after diagnosis. The changes before and after treatment were compared in patients who underwent more than twelve months of follow-up. A P value of <0.05 was used to denote statistical significance. Results:Among the 26 cases enrolled, 13 were female and 13 were male, and the median age of diagnosis was 28 (6 to 134) months. A total of thirty-five different types of AGL gene variation were detected, with c.1735+1G＞T (9/52, 17.3%) as the hotspot variation. The common clinical manifestations were elevated aminotransferases (26/26, 100%), hepatomegaly (25/26, 96.2%), fasting hypoglycemia (25/26, 96.2%), hyperketonemia (16/18, 88.9%), hypertriglyceridemia (TG) (20/26, 76.9%), elevated CK (16/25, 64.0%), and an abnormal electrocardiogram (12/16, 75.0%). Four cases (15.4%) had symptoms of myopathy at diagnosis. Liver biopsy was performed in eighteen cases, among whom 83.3% (15/18) had liver fibrosis≥S2. The number of cases with elevated levels of CK ( P＝0.031) and ALT ( P＝0.038)was pronounced in the non-missense variation group compared to that in the missense variation group. There were no statistically significant differences in age, height, liver size, degree of fibrosis, fasting blood glucose (Glu) and TG ( P>0.05). The median follow-up time of 14 cases was 40.5 (20-73) months, with improvement in body stature, reduced liver size, decreased ALT and TG, and improved Glu. However, four (28.6%) cases had new myopathy symptoms with raised CK ( P<0.05) and with advancing age, increased ALT diminished while CK level elevated ( P<0.05). Conclusions:The common clinical manifestations at the early stage of the GSD Ⅲdiagnosis are elevated aminotransferases, hepatomegaly, fasting hypoglycemia, hyperketonemia, high triglycerides, elevated CK, and fibrotic liver in China. Myopathy symptoms may arise following uncooked cornstarch treatment; however, there is significant improvement in height, liver-related, and metabolic parameters.

Objective To study the characteristics of spontaneous speech pauses in individuals with mild to moderate Alzheimer's disease(AD).Methods A total of 20 patients with AD,exhibiting a Minimum Mental State Examination(MMSE)score ranging from 10 to 20 and a disease duration of 6 months to 5 years,were selected for the AD group.Twenty five cognitively normal and mentally healthy participants were chosen as the control group.Spontaneous speech was elicited from each participant,and 1-minute continuous audio recordings were used to tally pause counts categorized by duration into short pauses(0.25 s≤t＜0.50 s),medium pauses(0.50 s≤t＜0.90 s),long pauses(0.90 s≤t＜2.00 s),and silences(＞2.00 s).Mean values of each pause type were computed for in-ter-group and intra-group comparisons.Correlation and regression analyses between MMSE scores and pause counts were conducted within the AD group.Results Significant statistical differences were observed between the AD and control groups concerning the counts of short pauses,long pauses,and silences(P＜0.05).Within the AD group,significant differences were found in the counts of short pauses versus medium pauses and short pauses versus long pauses(P＜0.05).In the AD group,the count of medium pauses positively predicted MMSE scores(β=0.515,P＜0.05),whereas the count of silences negatively predicted MMSE scores(β=-0.626,P＜0.01).Conclusion Individuals with AD exhibit a higher frequency of longer duration pauses in spontaneous speech and a lower frequen-cy of shorter duration pauses.Higher cognitive functioning in AD patients is associated with increased occurrences of shorter pauses,whereas lower cognitive functioning is linked to more extended pauses.

Objective To analyze the potential distribution and quality zoning of Gentiana farreri Balf.f.;To provide a theoretical basis for the conservation,sustainable utilization,and domestication of this Tibetan medicine resource.Methods The MaxEnt model and geographic information system software ArcGIS 10.2 were used to conduct ecological suitability zoning of Gentiana farreri Balf.f.in China through searching online specimen libraries and field investigations.SPSS25.0 software was used to construct a relationship model between indicator components and ecological factors,combined with ArcGIS software spatial analysis technology,to form a quality zoning of Gentiana farreri Balf.f.medicinal material.Results The primary environmental factors influencing the ecological suitability of Gentiana farreri Balf.f.were altitude,precipitation in May,April and December,and the mean monthly diurnal temperature range.The most suitable growth areas for Gentiana farreri Balf.f.were predominantly found at the junction of Gansu,Sichuan and Qinghai provinces,certain parts of Tibet,and selected regions of Sichuan.The southern part of Tibet and the southwestern part of Sichuan were identified as having higher comprehensive quality of Gentiana farreri Balf.f.medicinal materials.Conclusion The findings of this study can serve as a reference for the production planning and quality assessment of Gentiana farreri Balf.f.

Cervical cancer is a malignant tumor of the female reproductive system, which is closely related to persistent infection with high-risk human papillomavirus (HPV). Locally advanced cervical cancer (LACC) refers to cervical cancer of stage IB3 to IVA [International Federation of Gynecology and Obstetrics (FIGO) 2018 staging], characterized by tumor diameter greater than 4 cm or invasion of adjacent tissues. The standard treatment for LACC is concurrent chemoradiotherapy, with cisplatin as the preferred chemotherapeutic agent. However, there is still a clinical need for further improvement of the overall prognosis of LACC, and exploring effective adjuvant treatment strategies after concurrent chemoradiotherapy to increase the cure rate and quality of life of LACC patients is an important topic in clinical practice. This article reviews the types, indications, effects and existing problems of adjuvant treatment after concurrent chemoradiotherapy for LACC.