Objective: To investigate the trend in disease burden of diabetes mellitus among population aged 15 to 39 years in China from 1990 to 2021. Methods: Data on the incidence, prevalence, mortality, and disability-adjusted life year (DALY) rate of diabetes mellitus among population aged 15 to 39 years in China from 1990 to 2021 were collected from the Global Burden of Disease Study 2021 database. The disease burden of diabetes mellitus was analyzed by gender and age. The trend in disease burden among population aged 15 to 39 years was analyzed by average annual percent change (AAPC). Results: The incidence, prevalence and DALY rate of diabetes mellitus increased from 142.63/100 000, 1 826.41/100 000, and 138.04/100 000 in 1990 to 287.68/100 000, 5 245.93/100 000, and 316.82/100 000 in 2021, respectively, showing significant upward trends (AAPC=2.313%, 3.502% and 2.734%, all P<0.05). In contrast, the mortality decreased from 0.67/100 000 in 1990 to 0.57/100 000 in 2021, demonstrating a significant downward trend (AAPC=-0.518%, P<0.05). From 1990 to 2021, the incidences (AAPC=2.404% and 2.160%), prevalences (AAPC=3.576% and 3.389%), and DALY rates (AAPC=2.936% and 2.454%) of diabetes mellitus among males and females showed upward trends (all P<0.05). The mortality among females demonstrated a downward trend (AAPC=-1.809%, P<0.05), while the trend among males was not statistically significant (P>0.05). In 2021, the age group of 20 to <25 years had a relatively high incidence of diabetes mellitus, at 525.57/105. From 1990 to 2021, the incidences (AAPC=4.064%, 3.828%, 1.757%, 1.026% and 0.810%), prevalences (AAPC=2.374%, 3.625%, 3.371%, 2.985% and 2.647%), and DALY rates (AAPC=1.045%, 2.723%, 2.787%, 2.289% and 1.876%) of diabetes mellitus in age groups of 15 to <20 years, 20 to <25 years, 25 to <30 years, 30 to <35 years, and 35 to 39 years showed upward trends (all P<0.05). Conversely, the mortality (AAPC=-2.480%, -1.164%, -0.724%, -0.979% and -1.139%) in these age groups demonstrated downward trends (all P<0.05). Conclusion The overall disease burden of diabetes mellitus among population aged 15 to 39 years in China showed an upward trend, with males and the age group of 20 to <25 years being key target populations for diabetes mellitus prevention and control.

Objective To assess the situation and influencing factors of occupational burnout among the staff at the Center for Disease Control and Prevention (CDC) in Sichuan Province. Methods A total of 1 038 CDC staff members in Sichuan Province were selected as the study subjects using the stratified random sampling method. Occupational burnout of the staff was assessed using the Maslach Burnout Inventory General Survey via an online questionnaire. Results The detection rate of occupational burnout was 42.3% (439/1 038). Binary logistic regression analysis result showed that, after controlling for confounding factors such as education level and alcohol consumption, CDC staffs aged at 20-<31, 31-<41, and 41-<51 years were at higher risk of occupational burnout compared with those ≥51 years (all P<0.05). CDC staffs with 5-<10 or ≥10 years of service had higher occupational burnout risk compared with those with <5 years (both P<0.05). CDC staffs with poor or fair health status, irregular diet, and poor sleep quality had higher risk of occupational burnout compared with those healthy, have regular diet, and good sleep quality (all P<0.05). The risk of occupational burnout increased with higher overtime frequency (all P<0.05). Conclusion Occupational burnout among CDC staffs in Sichuan Province is relatively high. Age, years of service, health status, diet, sleep quality, and overtime frequency are key influencing factors.

Objective:To explore the effect of 3D printing extravascular stent implantation on the hemodynamics of the relevant large vessels in patients with nutcracker syndrome（NCS），and to discuss the clinical safety of this new procedure.Methods:A total of 30 NCS patients admitted to Tangdu Hospital Affiliated to Air Force Military Medical University from May to December 2023 were prospectively included. All the patients were received laparoscopic 3D printing extravascular stent implantation for NCS treatment. Whether the lumbago，abdominal pain，hematuria，proteinuria and varicocele had improved after the stent implantation were observed. The inner diameter，blood flow velocity of left renal vein，abdominal aorta，superior mesenteric artery and the diameter of inferior vena cava were measured by ultrasound 1 day before surgery and 8 days after surgery，respectively.In addition，the carotid-femoral pulse wave velocity（cfPWV）was measured by a newly developed method，by which the arterial stiffness could be detected based on Doppler ultrasound. The blood flow Doppler spectra of each subject were recorded at the right common carotid artery and the right common femoral artery，respectively，then based on that，the cfPWV was automatically calculated by this new technique. The above internal diameters，blood flow velocity and cfPWV were compared before and after the laparoscopic 3D printing extravascular stent implantation.Results:Among the 30 patients，the postoperative blood flow velocity at the left renal vein compression site was significantly lower than that before surgery［（50.7 ± 14.8）cm/s vs（122.1 ± 24.1）cm/s， P<0.001）］，and the clinical symptoms，including lumbago and abdominal pain，hematuria，proteinuria and varicocele were significantly improved（all P<0.05）. There were no significant changes in the internal diameter，blood flow velocity of abdominal aorta，superior mesenteric artery and the diameter of inferior vena cava，and cfPWV before and after operation（all P>0.05）. Conclusions:The 3D printing extravascular stent implantation through laparoscope can effectively improve left renal vein compression in patients with NCS，and cause no significant change in large arterial hemodynamics，suggesting that this surgical method is a safe and reliable treatment for patients with NCS.

Objective To evaluate the efficacy of combining surgical treatment with biological agents for perianal fistulizing Crohn's disease(pfCD).Methods Sixty patients with perianal fistulizing Crohn's disease(pfCD)admitted to our hospital from May 2021 to December 2023 were randomly allocated into two groups:Treatment Group A(n=30)and Treatment Group B(n=30).Treatment Group A received pfCD surgery combined with inflix-imab(IFX)and azathioprine(AZA),while Treatment Group B underwent pfCD surgery along with ustekinumab(UST)and AZA.The CDAI score,PDAI score,and Assche score were monitored for both groups,and postoperative MRI examinations were conducted to evaluate the healing of pfCD.Results There were statistically significant differences in CDAI,PDAI,and Assche scores between pre-treatment and post-treatment comparisons within treat-ment groups A and B(P<0.05),as well as in the magnitude of change at each time point.Comparisons of CDAI,PDAI,and Assche scores at 8,16,24,and 32 weeks,and PDAI scores at 40 weeks between groups A and B using independent samples t-tests did not yield statistically significant results(P>0.05).However,significant differences were observed for CDAI and Assche scores at 40 weeks(P<0.05).Significant changes in CDAI,PDAI,and Assche scores were noted at 8,16,24,32,and 40 weeks post-treatment within both groups A and B(P<0.05).Multiple comparisons using the LSD method revealed that the changes in these scores at each time point were statistically significant(P<0.05).The data indicate a temporal trend in the changes of CDAI,PDAI,and Assche scores,with group B showing a more rapid decline compared to group A.In terms of fistula response rates,both groups A and B achieved 100%(30/30).However,the clinical healing rate of fistulas was higher in group B at 86.7%(26/30)compared to 76.7%(23/30)in group A.Conclusion The combination of surgical treatment with IFX/UST plus AZA is safe and effective for treating pfCD.However,the long-term efficacy of combining surgical treatment with UST appears to be superior.

Objective:To assess the association between possible sarcopenia and the risk for frailty in middle-aged and elderly adults in China.Methods:A prospective cohort study design was used in this study. Data were from the China Health and Retirement Longitudinal Study during 2011-2018 and the baseline data in 2011, the follow up was conducted in 2013, 2015 and 2018, respectively. Frailty index was used to evaluate frailty status, and grip strength and repetitive sitting-up time were measured to detect possible sarcopenia. Cox proportional hazards regression model was used to estimate the association between possible sarcopenia and the risk for frailty in middle-aged and older adults.Results:In a 44 884 person-years follow-up, a total of 586 cases with frailty were recorded, and the incidence density of frailty was 13.06 per 1 000 person-year. The risk for frailty was also higher in those who were aged 60 years and above ( HR=2.05, 95% CI: 1.71-2.45), had a primary school education level or below ( HR=1.55, 95% CI: 1.29-1.85), had waist-to-height ratio ≥0.5 ( HR=1.39, 95% CI: 1.11-1.75) and had depression ( HR=1.52, 95% CI: 1.28-1.81). Drinking was associated with reduced risk for frailty ( HR=0.76, 95% CI: 0.62-0.94). The risk for frailty increased ( HR=1.73, 95% CI: 1.47-2.05) in those who might has possible sarcopenia. Conclusions:In middle-aged and elderly adults, those with possible sarcopenia, lower education level, central obesity and depression might be at high risk for frailty, and early interventions for high-risk population can be taken to slow the progression of frailty.

Objective:To explore the association of central obesity, pain, their joint effect, and interaction with frailty in middle-aged and old people in China.Methods:A total of 14 359 participants aged ≥45 years in 2011, 2013 and 2015 were selected from the China Health and Retirement Longitudinal Study to construct a cohort database. Cox proportional hazards regression models were used to estimate the association of waist-to-height ratio (WHtR) and pain with the risk for frailty. Joint effect and interaction analyses were performed.Results:In the follow-up of 77 783 person-years, frailty developed in 3 198 participants, with an incidence density of 41.11 per 1 000 person-years. Compared with the Q1 level of WHtR, its Q2, Q3 and Q4 level increased risk for frailty by 17% ( HR=1.17, 95% CI: 1.05-1.31), 24% ( HR=1.24, 95% CI: 1.11-1.40), and 43% ( HR=1.43, 95% CI: 1.25-1.63), respectively. Compared with painlessness, suffering from pain increased the risk for frailty by 97% ( HR=1.97, 95% CI: 1.83-2.11), and having 1, 2, and ≥3 pain sites increased the risk by 42% ( HR=1.42, 95% CI: 1.25-1.61), 86% ( HR=1.86, 95% CI: 1.64-2.11), and 138% ( HR=2.38, 95% CI: 2.18-2.60), respectively. The results of restricted cubic spline showed that WHtR level was associated with the risk for frailty in a J-type dose-response relationship (total P<0.001, nonlinear P<0.001), and pain quantity was positively associated with the risk in a nonlinear dose-response relationship (total P<0.001, nonlinear P<0.001). Threshold effect analysis revealed that the inflection points of WHtR and pain site number were 0.46 and 2.00, respectively ( P<0.001). Joint effect analysis showed that the Q2, Q3 and Q4 levels of WHtR combined with pain increased the risk for frailty by 146% ( HR=2.46, 95% CI: 2.11-2.87), 169% ( HR=2.69, 95% CI: 2.30-3.16), and 157% ( HR=2.57, 95% CI: 2.18-3.03). Conclusions:The risk for frailty increased with the level of WHtR and the number of pain sites in middle-aged and old people, and there was joint effect between WHtR and pain. Comprehensive management and intervention of obesity and pain are significant for the early prevention of frailty.

Objective To screen out the indexes of medical insurance fund under China Healthcare Security Diagno-sis Related Groups(CHS-DRG)payment based on Delphi method and improve the efficiency of medical insurance fund supervision.Methods Using the Delphi method,32 experts in the medical insurance field were selected and 2 rounds of expert questionnaires were conducted to design an evaluation scale for the monitoring indicators of medi-cal insurance funds under CHS-DRG payment.The consultation results were evaluated from three aspects of motiva-tion,authority,and coordination.Results A medical insurance fund supervision index system based on three dimen-sions of medical insurance fund use quality,efficiency and safety supervision is constructed,including 3 first-level indicators,7 second-level indicators and 44 third-level indicators.Results The construction ofmedical insurance fund supervision index system under CHS-DRG payment should respect the actual clinical diagnosis and treatment,strengthen the intelligent supervision method,and timely intervene in medical insurance fund management risks.

Pectus excavatum (PE) is a common congenital chest malformation in children, manifested by inward depression of the anteriorthorax wall, which can compress the normal tissues and organs in the chest and cause adverse effects on the physiology and psychology of patients. Surgery is the most important means of treating PE, and with the invention of Nuss surgery, the surgical treatment of PE has entered the minimally invasive era. At present, there are many indexes to evaluate the severity of thoracic malformations in PE patients, and selecting appropriate evaluation indexes is of great significance for the formulation of surgical protocols. As a physical and mental disease, PE's deformed thoracic appearance not only affects the function of thoracic organs, but also affects the psychological state of patients. Therefore, there is still controversy over whether the role of orthopedic surgery is to improve function or cosmetic plastic surgery. At the same time, the orthopedic efficacy and postoperative complications of the existing modified and novel surgical methods need to be further observed and evaluated. In addition, the design of surgical plan and the selection of surgical timing for PE combined with other diseases are also critical and controversial issues in clinical practice. Therefore, this article explores and reviews the controversial points in the current surgical treatment of PE.

Objective:To explore the clinical and genetic characteristics of two children diagnosed with two rare genetic diseases simultaneously.Methods:Two children with comorbidity of two genetic diseases due to dual genetic mutations diagnosed at the Third Affiliated Hospital of Zhengzhou University respectively in May 2022 and March 2023 were selected as the study subjects. Clinical and genetic data of the two children were retrospectively analyzed. This study has been approved by the Ethics Committee of the Third Affiliated Hospital of Zhengzhou University (Ethic No. 2021-062-01).Results:Child 1 was a 2-year-and-4-month-old boy whose clinical manifestations included facial dysmorphism, developmental delay, short stature, microcephaly, cleft palate, cryptorchidism, hypospadias, recurrent infections and immunological abnormalities. Whole exome sequencing revealed that he had harbored a heterozygous c.6595delT (p.Y2199Ifs*65) variant of the KMT2D gene and a heterozygous c. 1892G>A (p.R631Q) variant of the PIK3R1 gene. This has led to a dual genetic diagnosis of Kabuki syndrome and PI3Kδ-related immunodeficiency type 36. Child 2 was a 15-year-old girl whose clinical manifestations included epilepsy, Albright′s hereditary osteodystrophy, long body trunk, short limbs, hypocalcemia, hyperphosphatemia and hyperparathyroidism. The child also had a family history of short stature. Whole exome sequencing revealed that she had harbored a heterozygous c. 2T>C (p.Met1? ) variant of the GNAS gene and deletion of exons 2 to 6 of the SHOX gene. The two variants have led to dual diagnose of pseudohypoparathyroidism and X-linked idiopathic short stature. Conclusion:When the clinical phenotype of a genetic disease is complex and cannot be fully explained with a single genetic variant, multiple pathogenic variants should be considered, and this may lead to the diagnosis of co-morbid genetic diseases. To adopt or supplement corresponding genetic testing in time and re-analyze the genetic data may facilitate accurate diagnosis of comorbid genetic diseases.

Thoracolumbar spine fracture often leads to severe pain, functional impairments, and neurological deficits, for which open reduction and internal fixation can effectively restore the spinal structural stability. Open decompression and reduction with internal fixation can help relieve spinal cord compression and improve spinal function in cases of concomitant cord injury. Although spinal stability can be restored through surgery, patients often face chronic pain and functional impairments postoperatively. A postoperative rehabilitation program is critical in optimizing therapeutic outcomes, reducing complications, and minimizing the risk of secondary injuries. However, current rehabilitation methods, such as physical therapy, functional training, and pain management, are confronted with problems in clinical practice, including significant variation in efficacy, poor patient adherence, and prolonged rehabilitation period. There is an urgent need for a unified rehabilitation strategy to address these problems. To this end, the Spinal Trauma Group of the Orthopedic Physicians Branch of the Chinese Medical Association and the Spine Health Professional Committee of the Chinese Human Health Technology Promotion Association organized experts from relevant fields to formulate Evidence-based guidelines for rehabilitation treatment after internal fixation of thoracolumbar spine fracture in adults ( version 2025) by integrating evidences from clinical researches and advanced rehabilitation concepts at home and abroad. A total number of 14 recommendations concerning the rehabilitation treatment with multimodal analgesia, psychological intervention, deep vein thrombosis prevention, core muscle and extremity exercise, appropriate use of braces, early weight-bearing, device-aided rehabilitation exercise, neuroregulatory therapy, rehabilitation team were put forward, aiming to standardize the post-operative rehabilitation process following internal fixation, promote the functional recovery, and enhance patients′ quality of life.