Objective: To investigate the association between sleep duration and depressive symptoms in children and adolescents, so as to provide scientific evidence for promoting mental health and preventing depression among relevant populations. Methods: A total of 2 192 children and adolescents aged 10-17 years with complete data from the 2018 China Family Panel Studies Database were included. Eight item Center for Epidemiologic Studies Depressive Scale(CES-D8) was used to assess participants depressive levels, and sleep duration was assessed via questionnaire. Multivariate Logistic regression model was used to analyze the association between different sleep duration categories and depressive symptom occurrence among children and adolescents. A restricted cubic spline(RCS) model analyzed the dose response relationship between sleep duration and the risk of depressive symptoms occurrence and segmented Logistic regression models to identify dose response effects. Results: Among the surveyed children and adolescents, 524(23.91%) exhibited depressive symptoms. Compared to those with sufficient sleep, children aged 10-12 years had a higher risk of depressive symptoms on average per day( OR =1.66, 95% CI =1.19-2.33) and during weekdays( OR =1.76, 95% CI =1.26-2.46), as well as in adolescents aged 13-17 years on a daily basis( OR =1.40，95% CI =1.06-1.85) and during weekdays( OR = 1.48，95% CI =1.12-1.95), and excessive sleep in adolescents on rest days was also significantly associated with higher risk of depressive symptoms( OR =1.65，95% CI =1.11-2.43)(all P <0.05). RCS analysis results indicate that children s sleep duration exhibits a linear negative correlation with the risk of depressive symptoms(all P nonlinear >0.05), while adolescents sleep duration showed a U shaped association with depressive symptoms(all P nonlinear <0.05) on a daily basis, during weekdays and weekends, with potential threshold effects at 10.00, 9.88, and 9.60 hours, respectively. Conclusions Sleep duration among children and adolescents is associated with depressive symptoms, with notable age related differeneces. It is recommended to develop targeted age specific interventions to reduce the risk of depressive symptoms in children and adolescents.

Calcineurin inhibitor（CNI） is potent immunosuppressive agents and serve as cornerstone therapies in the treatment of organ transplantation and autoimmune diseases， with cyclosporine A and tacrolimus being the representative drugs. Long-term use of CNI can lead to drug-induced hyperglycemia， severely affecting patients’ prognosis. The pathogenesis involves multilevel pathological alterations： at the pancreatic β-cell level， CNI directly damage β-cell by inducing calcium overload， oxidative stress， and mitochondrial dysfunction， suppressing the expression of key insulin synthesis factors and promoting apoptosis； in peripheral tissues， CNI interfere with insulin receptor substrate phosphorylation and inhibit the phosphatidylinositol 3 kinase/protein kinase B signaling pathway， resulting in decreased glucose uptake and insulin resistance； additionally， CNI can also induce β-cell injury by suppressing the secretion and receptor signal transduction of glucagon-like peptide-1， as well as by activating the nuclear factor kappa B pathway to promote inflammatory responses. Clinical studies demonstrate that the incidence of CNI-associated hyperglycemia is closely related to drug type， dosage， and individual patient factors. For high-risk patients， dose adjustment of CNI， switching to agents with lower metabolic toxicity when necessary， and selection of appropriate glucose-lowering regimens based on glycemic levels are recommended. Future research should further elucidate the molecular mechanisms of CNI metabolic toxicity and optimize individualized pharmacotherapy strategies to improve long-term patient outcomes.

Objective To understand the status of body image disturbance and its influencing factors in patients with ankylosing spondylitis (AS), so as to provide a scientific basis for the clinical management of AS. Methods A total of 353 AS patients admitted from January 2022 to December 2024 were selected as research subjects. Chinese version of Body Image Disturbance Questionnaire (BIDQ) was used to investigate the body image disturbance in AS patients. Single factor analysis was performed by t test and analysis of variance, and multiple factors were analyzed by multivariate linear regression. Results The total score of BIDQ in 342 AS patients was (25.01±4.22). Multivariate linear regression analysis results showed that self-paid medical expense, nighttime VAS score and negative emotion PANAS score could positively predict body image disturbance in AS patients (standardized regression coefficient=0.413, 0.413, 0.460, P<0.05), and PSSS score, positive emotion PANAS score and exercise management CDSSM score could negatively predict body image disturbance (standardized regression coefficient=-0.245, -0.134, -0.247, P<0.05). Conclusion The body image disturbance in AS patients is worthy of clinical attention. Nighttime pain, negative emotion and self-paid medical treatment can increase the risk of body image disturbance. Positive emotion, social support and high self-management level of exercise behavior can reduce the formation of body image disturbance, which can provide new ideas for clinical management of AS patients.

Objective: To investigate the association of the joint effect of body fat levels and dyslipidemia with cardiovascular structural abnormalities in children, so as to provide a scientific reference for the early prevention of cardiovascular damage. Methods: Based on the data from the second follow up (October 2021 to January 2022) of the Huantai Children Cardiovascular Health Follow up Cohort, 1 308 children with complete data were included. The fat mass percentage (FMP), fat mass index (FMI), subcutaneous fat mass (SFM) and visceral fat mass (VFM), left ventricular mass index (LVMI), relative wall thickness (RWT), thickening of carotid intima-media thickening (cIMT) , left ventricular hypertrophy (LVH) and left ventricular geometric remodeling (LVG), triglyceride (TG), total cholesterol (TC) ,high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were obtained. Multivariable Logistic regression model was used to analyze the associations of FMP, FMI, SFM and VFM with thickening of cIMT, LVH and LVG. The joint effects of these body fat indicators and dyslipidemia on the aforementioned cardiovascular outcomes were further explored. Restricted cubic spline model was used to examine the dose response relationships between body fat levels and cardiovascular structural abnormalities. Results: Elevated body fat levels were significantly associated with an increased risk of cardiovascular structural abnormalities, exhibiting J shaped dose response relationships (all P <0.05). Compared with the group with normal body fat and normolipidemia, the risks of thickening of cIMT, LVH, and LVG in the group with elevated FMP combined with dyslipidemia were higher[ OR (95% CI )=11.70 (6.49-21.27), 5.53 (2.97-10.17), 2.33 (1.30-4.05)]; in the group with elevated FMI combined with dyslipidemia, the corresponding risks were higher[ OR (95% CI )= 11.68 (6.43-21.38), 6.98 (3.73-12.92), 2.65 (1.50-4.61)]; in the group with elevated SFM combined with dyslipidemia, the corresponding risks were higher[ OR (95% CI )=10.55 (5.83-19.24), 5.11 (2.71-9.45), 1.99 (1.11- 3.46 )]; and in the group with elevated VFM combined with dyslipidemia, the corresponding risks were higher[ OR (95% CI )=12.44 (6.76-23.14), 6.17 ( 3.31 -11.38), 2.30 (1.30-3.99)] (all P <0.05). Sex stratified analyses showed that the risk of thickening of cIMT in the combined exposure group of all four body fat indicators and dyslipidemia was significantly higher in girls than in boys (all P <0.01). Conclusions Elevated body fat levels and dyslipidemia have a combined effect in children, collectively increasing the risk of cardiovascular structural abnormalities. Prevention of cardiovascular damage in children should focus on both adiposity management and blood lipid regulation.

Background: High-mobility group box protein 1 (HMGB1) is a chromatin-binding protein involved in arthritis, ischemia, sepsis, atherosclerosis, neurodegenerative disorders, meningitis, and cancer. HMGB1 exhibits dual roles in cancer, acting as either a tumor suppressor or oncoprotein depending on context. Objective: This research aimed to elucidate HMGB1’s functional significance in cutaneous squamous cell carcinoma (cSCC). Methods: We overexpressed HMGB1 in cSCC cell lines using recombinant adenovirus and examined its effects on cell proliferation, colony formation, and cell migration. Results: Immunohistochemical analysis revealed elevated HMGB1 expression levels in cSCC tissue relative to normal epidermis. To assess the influence of HMGB1, we employed recombinant adenoviruses expressing HMGB1 to transduce SCC cell lines (SCC12 and SCC13). Enhanced HMGB1 expression significantly promoted cellular proliferation and colony formation capacity.Notably, HMGB1 overexpression elevated the levels of proliferation regulators, including P63, SOX2, CDK4 and CDK6. Furthermore, HMGB1 overexpression substantially enhanced tumor invasiveness, accompanied by upregulation of epithelial-mesenchymal transition (EMT) biomarkers. Mechanistically, overexpression of HMGB1 enhanced transforming growth factor-β signaling by increasing phosphorylation of SMAD2/3, the key mediators of EMT. Conclusion These data imply that HMGB1 acts as a tumor-promoting factor in cSCC.

OBJECTIVE To optimize the risk matrix assessment model for management of hospital-associated infec-tion based on analytic hierarchy process(AHP)and evaluate the application effect of the model after optimization.METHODS By means of AHP,the model was optimized by constructing the quantitative evaluation indexes weight system for consequence severity induced by hospital-associated infection from Feb.2023 to Jul.2023.Taken The Affiliated Hospital of Guizhou Medical University as an example,the risk for occurrence of hospital-associated in-fection in 20 internal medicine departments was evaluated,the risk grades were determined,and the application effect of the risk assessment model was evaluated after the optimization.RESULTS The weight system indexes for severity of consequences due to hospital-associated infection included surgical site infection(18.03％),treatment outcomes(49.50％),increased length of hospital stay(11.52％),increased hospitalization cost(6.43％)and variable coefficient of monthly morbidity(14.53％).Ward 2 of emergency internal medicine department,neurolo-gy department,Ward 1 of emergency internal medicine department and hematopoietic stem cell transplantation de-partment were the extremely high risk departments acquired by the risk assessment model.The risk assessment was carried out for the extremely high risk departments,and the Ward 1 of emergency internal medicine depart-ment was determined as the department that the risk coping strategies were taken in priority after the risk value was adjusted.CONCLUSION The risk matrix assessment model can be optimized by establishing the weight sys-tem of quantitative indexes for risk assessment based on AHP,the model achieves remarkable application effect,and the result of risk assessment is reliable and has significance for clinical guidance.

Objective:To evaluate the efficacy of two different approaches:direct anterior approach(DAA)and posterolateral approach(PLA)in total hip arthroplasty(THA).Methods:This study adopted a retrospective cohort study design,included to analyse 128 cases of THA patients who were received in our hospital from January 2021 to January 2024.Patients were divided into PLA group(n=61)and DAA group(n=67)according to different approach methods.Perioperative indicators,Harris hip joint function score,anteversion and abduction angles of acetabular prosthesis and incidence of complications were compared between the two groups.Results:Compared with PLA group,DAA group had longer surgical time,less intraoperative blood loss,shorter surgical incision length and shorter postoperative hospital stay(P＜0.05).Compared with the PLA group at 1 month(T2)to 6 months(T4)after surgery,DAA group had higher Harris hip joint function score(P＜0.05).Conclusion:Compared with PLA,DDA is used in THA,although the surgery time is longer,it can achieve a similar recovery effect in anteversion and abduction angles,which helps to shorten the surgical incision length and postoperative hospital stay,reduce intraoperative blood loss and achieve better hip joint function recovery.

Objective To investigate changes and clinical significance of serum cytokine signaling inhibitor-1(SOCS-1),soluble myeloid triggering receptor-2(sTREM-2)and ATP citrate lyase(ACLY)in patients with pulmonary Klebsiella pneumoniae infection.Methods A total of 100 patients infected with Klebsiella pneumoniae were selected as the infection group,and 70 healthy subjects in our hospital were selected as the control group.According to the pneumonia severity index(PSI)score,patients of the infection group were divided into the severe group(PSI>90,32 cases)and the mild group(PSI≤90,68 cases).The expression levels of SOCS-1,sTREM-2 and ACLY in the infection group and the control group were detected by enzyme-linked immunosorbent assay.Pearson method was used to analyze the relationship between serum levels of SOCS-1,sTREM-2,ACLY and PSI scores in the infection group.Multivariate Logistic regression analysis was performed to analyze factors affecting the disease status of patients with pulmonary Klebsiella pneumoniae infection.The diagnostic value of serum levels of SOCS-1,sTREM-2 and ACLY in patients with Klebsiella pneumoniae infection was analyzed by receiver operating characteristic curve(ROC).Results The levels of white blood cell(WBC)count,procalcitonin(PCT),C-reactive protein(CRP),serum SOCS-1,sTREM-2 and ACLY were higher in the infection group than those in the control group(P＜0.01).In infection group,serum levels of SOCS-1,sTREM-2 and ACLY were positively correlated with PSI scores(r=0.419,0.373,0.391,P＜0.05).Serum levels of SOCS-1,sTREM-2 and ACLY were higher in the severe group than those in the mild group(P＜0.01).The elevated serum SOCS-1,sTREM-2 and ACLY were risk factors for severe disease in patients with pulmonary Klebsiella pneumoniae infection(P＜0.05).The areas under the curve(AUC)of SOCS-1,sTREM-2 and ACLY alone and in combination for the diagnosis of severe pulmonary Klebsiella pneumoniae infection were 0.787,0.837,0.847 and 0.929,respectively,and the combined diagnostic efficiency was the highest.Conclusion Serum SOCS-1,sTREM-2 and ACLY are elevated in patients with pulmonary Klebsiella pneumoniae infection,and their expression levels are related to the condition of patients with pulmonary Klebsiella pneumoniae infection.The combined detection of the three is better than testing alone for severe pulmonary Klebsiella pneumoniae infection.

OBJECTIVE To offer a reference for the treatment of Mycobacterium iranicum infection by analyzing the diagnosis and management of a single case alongside literature-reported cases.METHODS Through case report and literature reviews,this study synthesized the clinical features,therapeutic regimens,and patient outcomes of those infected with M.iranicum.RESULTS In the single case documented in this report,subsequent to clinical pharmacists'involvement in the consultation,the patient was prescribed a therapeutic regimen comprising levofloxacin(0.5 g,qd,ivgtt)+Clarithromycin sustained-release tablets(1 000 mg,qd,po)+Ethambutol tablets(0.75 g,qd,po).The patient exhibited clinical improvement and was discharged after treatment.This article integrated 12 published studies,encompassing 13 patients(7 male and 6 female),of whom 69.23%were aged≥50 years.Patients infected with M.iranicum exhibited non-specific clinical manifestations and imaging features,with pulmonary infection as the primary presentation.Antimicrobial susceptibility test revealed that M.iranicum was susceptible to multiple agents,including amikacin,clarithromycin,linezolid,and ethambutol.The three-drug combination therapy was the most frequently employed regimen.In terms of clinical outcomes,there were 9 cases(69.23%)of clinical cure,3 cases(23.08%)of bacteriological negativity conversion,and 1 case(7.69%)of treatment failure.CONCLUSIONS For M.iranicum infection,a triple-drug therapeutic regimen consisting of three agents with distinct mechanisms of action selected from amikacin,clarithromycin,moxifloxacin,levofloxacin,minocycline,ethambutol,and other relevant drugs may represent a relatively optimal strategy.

OBJECTIVE To optimize the risk matrix assessment model for management of hospital-associated infec-tion based on analytic hierarchy process(AHP)and evaluate the application effect of the model after optimization.METHODS By means of AHP,the model was optimized by constructing the quantitative evaluation indexes weight system for consequence severity induced by hospital-associated infection from Feb.2023 to Jul.2023.Taken The Affiliated Hospital of Guizhou Medical University as an example,the risk for occurrence of hospital-associated in-fection in 20 internal medicine departments was evaluated,the risk grades were determined,and the application effect of the risk assessment model was evaluated after the optimization.RESULTS The weight system indexes for severity of consequences due to hospital-associated infection included surgical site infection(18.03％),treatment outcomes(49.50％),increased length of hospital stay(11.52％),increased hospitalization cost(6.43％)and variable coefficient of monthly morbidity(14.53％).Ward 2 of emergency internal medicine department,neurolo-gy department,Ward 1 of emergency internal medicine department and hematopoietic stem cell transplantation de-partment were the extremely high risk departments acquired by the risk assessment model.The risk assessment was carried out for the extremely high risk departments,and the Ward 1 of emergency internal medicine depart-ment was determined as the department that the risk coping strategies were taken in priority after the risk value was adjusted.CONCLUSION The risk matrix assessment model can be optimized by establishing the weight sys-tem of quantitative indexes for risk assessment based on AHP,the model achieves remarkable application effect,and the result of risk assessment is reliable and has significance for clinical guidance.