: To analyze the prevalence of anemia and iron deficiency among primary and secondary school students in Rural Nutrition Improvement Program areas of Guizhou Province in 2023, and to explore the related factors, so as to provide evidence for Rural Nutrition Improvement Program optimization. Methods: In September 2023, a stratified random cluster sampling strategy was used to select 40 rural compulsory education schools with rural nutrition improvement program in five counties of Guizhou Province. School level questionnaire was employed to collect information of basic characteristics and school meal implementation. A total of 7 826 primary and secondary school students aged 6-16 underwent anthropometry and hemoglobin (Hb) determination; serum ferritin (SF) was additionally measured in a random subsample of 1 795 pupils. Students in Grade 3 and above also completed a questionnaire covering demographic characteristics, dietary behaviours and nutrition knowledge. Group comparisons were conducted by Chi square test or Fisher s exact test, and multivariable Logistic regression models were constructed to identify factors associated with anemia and iron deficiency. Results: The overall Hb level was (133.21±12.95)g/L, with an anemia prevalence of 7.17%. The overall SF level was (69.58±59.01)μg/L, with an iron deficiency prevalence of 2.73%. Multivariable analysis showed that stunting ( OR =1.88), school menus without nutrient calculation ( OR =1.61) and absence of menu planning software in the current semester ( OR =2.34) independently increased anemia risk, whereas obesity reduced it ( OR =0.54) (all P <0.05). Girls ( OR =4.16) and Grades 7-9 ( OR =5.93) increased iron deficiency risk (both P <0.05). Compared with rarely eating fresh vegetables, students with consuming <3 kinds per day ( OR =0.08) or exactly 3 kinds per day ( OR =0.06) had lower iron deficiency risks (both P <0.05). Conclusions Anemia and iron deficiency are prevalent among primary and secondary school students in Guizhou. Targeted intervention measures should be implemented for key populations to enhance the effectiveness of nutrition improvement program.

Autoimmune hepatitis （AIH） is an immune-mediated chronic liver inflammatory disease with unknown pathogenesis， and intestinal barrier dysfunction is considered an important factor. Meanwhile， there are sex and age differences in the incidence rate of AIH， suggesting that hormone may be involved in regulation. On this basis， this article focuses on the association between estrogen， intestinal barrier， and immune homeostasis， systematically reviews the evidence that estrogen deficiency disrupts intestinal barrier homeostasis， and further summarizes the potential mechanism of estrogen in regulating the development and progression of AIH via intestinal barrier.

Establishing a three-generation family cohort enables the investigation of the effects of genetic, epigenetic, lifestyle, and parenting factors in the grandparental (F0) and parental (F1) generations on the growth, development, and disease onset and progression of the offspring (F2). It facilitates further exploration of the biological mechanisms underlying the impact of intergenerational factors on the health of the offspring (F2), providing evidence for the formulation of public health policies and measures related to child health management and infant and young child care. Currently, the development of multi-generational cohorts in China remains in a preliminary stage, with no systematic multi-generational research framework yet established. Drawing on prior evidence-based scientific research, existing cohort studies, and the practical experience of multidisciplinary experts in maternal and child health, this consensus defines the scope of three-generation family cohorts regarding their definition, significance, key technologies, and application scenarios. It provides technical recommendations for establishing relevant cohorts, aiming to support research areas such as the intergenerational transmission of childhood diseases, the maternal intrauterine environment, and the tracing of family rearing environments. This will facilitate the early prevention and control of diseases manifesting in childhood and adulthood, ultimately promoting the comprehensive and healthy development of children.

AIM: To analyze the relationship between obesity-related indicators, blood lipid levels and primary open angle glaucoma(POAG)and explore its risk factors. METHODS:Patients with POAG treated in the hospital from March 2022 to March 2024 were selected as the POAG group, and healthy people in the same period were selected as the non-POAG group. The obesity related indicators [body mass index(BMI), waist circumference, waist-to-hip ratio], blood lipid levels [serum total cholesterol(TC), triglyceride(TG), high-density lipoprotein(HDL-C), low-density lipoprotein(LDL-C)] and general clinical data of the two groups were compared. The binary Logistic regression analysis was used to analyze the risk factors affecting the occurrence of POAG, and the ROC curve was established to analyze the efficiency of various variables in predicting the occurrence of POAG.RESULTS:A total of 54 POAG patients and 54 non-POAG subjects were included. The POAG group had a mean age of 50.30±5.73 y(29 males, 25 females), and the non-POAG group had a mean age of 50.28±5.72 y(28 males, 26 females).The BMI, intraocular pressure, waist circumference, waist-to-hip ratio, and TG levels in the POAG group were higher than those in the non-POAG group, while the HDL-C level was lower than that in the non-POAG group(all P<0.001). High BMI, high waist circumference, high waist-to-hip ratio, and high TG were identified as risk factors for POAG(all P<0.05), whereas high HDL-C was a protective factor(P<0.05).The AUCs for BMI, waist circumference, waist-to-hip ratio, TG, HDL-C, and the combined prediction were 0.885, 0.873, 0.707, 0.777, 0.664, and 0.974, respectively; the sensitivities were 0.815, 0.833, 0.730, 0.637, 0.663, and 0.944, respectively; and the specificities were 0.852, 0.759, 0.711, 0.789, 0.752, and 0.889, respectively. These results indicate that the combined multi-index prediction had the best performance, with good sensitivity and specificity.CONCLUSION:Obesity-related indicators such as high BMI, high waist circumference, high waist-to-hip ratio, and dyslipidemia(high TG, low HDL-C)are associated risk factors for POAG. The combined multi-index prediction model including BMI, waist circumference, waist-to-hip ratio, TG, and HDL-C demonstrates the best performance in POAG risk assessment, with both high sensitivity and specificity, providing a scientific basis for early clinical screening and intervention.

ObjectiveTo investigate the risk factors for plastic bronchitis （PB） in children with Mycoplasma pneumoniae pneumonia （MPP） and to construct a predictive model. MethodsPropensity score matching （1∶4 nearest neighbor matching） was used to balance baseline data between the two groups. Univariate and multivariate Logistic regression analyses were performed to identify independent risk factors. Various machine learning algorithms were applied to build predictive models， and model performance was evaluated using receiver operating characteristic curves， decision curves， and calibration curves. SHapley Additive exPlanations （SHAP） method was used for model interpretation. ResultsAfter matching， baseline characteristics were comparable between the two groups. Compared with the non-PB group， the PB group had significantly longer fever duration， higher incidence of pleural effusion and right upper lobe involvement， and higher levels of procalcitonin （PCT）， D-dimer， lactate dehydrogenase （LDH）， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， immunoglobulin E （IgE）， and red blood cell count in bronchoalveolar lavage fluid （BALF） （all P<0.05）， while lymphocyte and eosinophil counts in blood were significantly lower （P<0.05）. Multivariate Logistic regression showed that PCT>0.207 μg/L， LDH>386.25 U/L， right upper lobe involvement， and red blood cell count in BALF>1 500×10⁶ were independent risk factors. Among machine learning models， the gradient boosting machine （GBM） model achieved an area under the curve of 0.786 in the validation set， demonstrating the best generalization ability. SHAP analysis validated the importance of the above variables. ConclusionThe four indicators above have independent predictive value for PB occurrence， and the GBM model shows certain clinical risk stratification capability.

Objective: To analyze the trends in mortality and life lost among residents in Jinshan District, Shanghai Municipality from 2003 to 2023, so as to provide the evidence for developing injury prevention and control strategies and optimizing public health resource allocation. Methods: Data on injury mortality in Jinshan District from 2003 to 2023 were collected through Jinshan District Death Cause Registration System. Crude mortality was calculated, and standardized by the Sixth National Population Census in 2010. Potential years of life lost (PYLL), potential years of life lost rate (PYLLR), and average years of life lost (AYLL) were used to analyze life loss. Annual percent change (APC) was used to analyze the trends of injury mortality and life lost Results: From 2003 to 2023, the standardized mortality of injury in the total population, males, and females in Jinshan District were 34.39/105, 43.01/105, and 25.52/105, respectively, showing downward trends (APC=-3.270%, -3.913%, and -2.108%, all P<0.05). The standardized mortality of injury in males was higher than that in females (P<0.05). The crude mortalities of injury in age groups of 0-<15, 15-<30, 30-<45, 45-<60, and ≥60 years were 8.45/105, 16.94/105, 23.59/105, 39.05/105, and 127.70/105, respectively, showing an upward trend with increasing age (P<0.05). From 2003 to 2023, except for the ≥60 years group, the crude mortalities of injury in other age groups showed downward trends (APC=-6.539%, -4.426%, -7.846%, and -5.185%, all P<0.05). From 2003 to 2023, the top two causes of injury death in the total population were traffic accidents and falls, with crude mortalities of 17.88/105 and 15.81/105, respectively. Among them, the crude mortality of traffic accidents showed a downward trend (APC=-4.478%, P<0.05), while the crude mortality of falls showed an upward trend (APC=5.467%, P<0.05). From 2003 to 2023, PYLL, PYLLR, and AYLL of injury in the total population showed downward trends (APC=-6.685%, -6.710%, and -7.225%, all P<0.05). Conclusions From 2003 to 2023, the injury mortality and life lost in Jinshan District showed downward trends. Males and the elderly are the key populations for prevention and control, and falls are the key cause of death for prevention and control.

Objective:To investigate the effectiveness, safety and feasibility of transumbilical laparoendoscopic single-site surgery (TU-LESS) for abdominal wall endometriosis (AWE) lesion resection.Methods:A total of 11 patients who underwent AWE lesion resection via TU-LESS at The First Affiliated Hospital of Nanjing Medical University from January 2022 to May 2024 were enrolled. The size, invasion depth of the lesion, horizontal distance from the lesion center to the original surgical scar, vertical distance from the lesion to the skin, body mass index (BMI), the thickness of abdominal wall fat, operative time, intraoperative blood loss, perioperative complications, postoperative pathology, postoperative incision healing and recurrence were recorded and analyzed.Results:All 11 patients in this study had a history of cesarean section, 10 of whom had transverse incision and 1 had longitudinal incision. The age was (35.0±6.2) years old. BMI was (25.0±4.0) kg/m 2, with the highest being 33.9 kg/m 2. The lesion size was (24.7±12.1) mm, with an average horizontal distance from the lesion center to the original surgical scar of (11.6±6.0) mm. The abdominal wall fat thickness was (21.4±5.8) mm, and the vertical distance from the lesion to the skin was (14.5±7.9) mm. There were a total of 12 lesions in the 11 patients. Among them, 1 lesion extended to the peritoneum inferiorly, 5 lesions extended to the rectus abdominis inferiorly, 5 lesions reached the anterior sheath of the rectus abdominis inferiorly, and 1 lesion was completely located within the abdominal wall fat. The operative time was (84.2±35.4) minutes, and the intraoperative blood loss was (9.0±4.2) ml. The postoperative incision healing of all patients was grade A. The anatomical structure of their umbilical region remained normal, free from any scarring, which contributed to the high satisfaction levels expressed by the patients. Postoperative pathological examination confirmed endometriosis with negative surgical margins, and no recurrence had been observed during follow-up. Conclusion:TU-LESS for AWE lesion resection is safe and feasible, particularly suitable for patients with lesions located far from the original surgical scar, deep lesion location, thick abdominal wall fat, and multiple focal leisons.

Objective:To explore the clinicopathological characteristics and prognosis of fumarate hydratase-deficient uterine leiomyoma (FH-dUL).Methods:Clinical data and follow-up information for 117 patients with FH-dUL diagnosed through surgical pathology and immunohistochemistry in the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2024, were collected. A control group of 130 patients with common uterine leiomyomas was also included. The differences between the two groups in clinical, imaging, and pathological characteristics were compared. Additionally, recurrence rates, fertility outcomes for FH-dUL patients, and the incidence of renal cancer in FH germline mutation carriers were monitored.Results:(1) Comparison of clinicopathological characteristics: the median age of 117 FH-dUL patients was 35 years, and the median age at first diagnosis of uterine leiomyomas was 29 years, both significantly younger than the control group (41 and 36 years; both P<0.01). The FH-dUL group showed significantly higher incidences of uterine myomectomy, multiple leiomyomas, diffusion restriction on pelvic magnetic resonance imaging diffusion weighted imaging, and typical pathological features (candelabra-like vessels, bizarre nuclei, cytoplasmic eosinophilic globules, perinuclear halo, cellular atypia) and higher ultrasound blood flow score (all P<0.05). Of the 30 FH-dUL patients who underwent genetic testing, 9 had germline mutations, 3 had somatic mutations, and 6 had mutations of unclear origin. Among the 9 FH gene germline mutation patients, 2 had already developed renal cell carcinoma. (2) Recurrence analysis: among the 56 patients who underwent uterine myomectomy, 22 (39.3%, 22/56) experienced recurrence during follow-up, compared to 12 (21.8%, 12/55) of the 55 patients in the control group, the difference between the two groups was statistically significant ( P=0.046). Multivariate binary logistic regression analysis showed that cellular leiomyomas ( OR=9.489, 95% CI: 1.740-51.755; P=0.009) and multiple uterine leiomyomas ( OR=10.709, 95% CI: 1.354-84.683; P=0.025) were significant risk factors for recurrence in FH-dUL. (3) Fertility analysis: among the 66 FH-dUL patients who underwent fertility-preserving surgery, 16 had the intention to have fertility desire, only 2 (2/16) completed their fertility plans during follow-up. Conclusions:Clinicopathological features and imaging features help to differentiate FH-dUL from common type uterine fibroids, but lack specificity, and the diagnosis of FH-dUL is based on immunohistochemistry. The recurrence rate after resection of FH-dUL is high, and cellular and multiple leiomyomas are important predictors of recurrence. It is crucial to perform genetic testing, genetic counseling, drug treatment to prevent recurrence, fertility guidance, and long-term comprehensive management after surgery for FH-dUL management.

Objective:To investigate the impact of correcting rotational subluxation through circumferential fusion and transforaminal lumbar interbody fusion (TLIF) on postoperative coronal plane imbalance in degenerative scoliosis.Methods:A retrospective analysis was conducted on the data of 108 patients with type A degenerative scoliosis in the Nanjing classification who underwent primary multi-segment posterior column osteotomy (PCO) with deformity correction and internal fixation at Nanjing Gulou Hospital from June 2017 to June 2021. Patients were divided into two groups based on the presence of preoperative rotational subluxation: the rotational subluxation group and the non-rotational subluxation group. The rotational subluxation group consisted of 60 patients, with 8 males and 52 females, aged 63.7±5.5 years (range, 56-75 years). The non-rotational subluxation group included 48 patients, with 5 males and 43 females, aged 64.4±5.2 years (range, 53-72 years). Within the rotational subluxation group, depending on whether TLIF was performed on the rotational subluxation segment, they were further categorized into the TLIF group and the PCO group. The TLIF group comprised 28 patients, while the PCO group had 32 patients. Full-spine anteroposterior and lateral X-rays were taken preoperatively, postoperatively, and at the last follow-up to measure coronal balance types and radiographic parameters. The differences in the lumbar Cobb angle, coronal balance distance (CBD), and the Cobb angle of the lumbosacral curve (Cobb-Fra angle) were compared between the rotational subluxation group and the non-rotational subluxation group, as well as between the TLIF group and the PCO group.Results:The average surgery duration ranged from 200 to 310 min, with a mean of 235±47 min. The intraoperative blood loss ranged from 700 to 2,400 ml, with an average of 950±355 ml. The number of fused segments in the rotational subluxation group was 7.6±2.1, ranging from 5 to 11 segments, while in the non-rotational subluxation group, it was 7.4±2.0, ranging from 5 to 10 segments. Postoperatively, 13%(8/60) of patients in the rotational subluxation group developed type C coronal imbalance, significantly higher than the 2%(1/48) in the non-rotational subluxation group. The immediate postoperative and final follow-up lumbar Cobb angles, CBD, and Cobb-Fra angles in the rotational subluxation group were 20.60°±10.73° and 20.33°±10.92°, 22.53±16.45 mm and 18.53±17.31 mm, 13.14°±4.40° and 11.23°±4.92°, respectively, which were higher than those in the non-rotational subluxation group (13.92°±7.02° and 12.92°±6.64°, 18.62±17.44 mm and 8.83±8.95 mm, 11.91°±3.03° and 9.52°±3.30°), with statistical significance ( P<0.05).. Among patients in the rotational subluxation group, the probability of new-onset coronal imbalance postoperatively was 4%(1/28) in the TLIF group, which was lower than the 22%(7/32) in the PCO group, with a statistically significant difference (χ 2=4.330, P=0.037). The immediate postoperative and final follow-up lumbar Cobb angles, CBD, and Cobb-Fra angles in the PCO group were 25.63°±11.00° and 25.13°±11.04°, 27.37±18.95 mm and 25.25±18.67 mm, 15.50°±3.62° and 14.08°±4.77°, respectively, which were significantly higher than those in the TLIF group (14.86°±6.96° and 14.86°±5.37°, 17.08±10.94 mm and 10.86±7.86 mm, 10.14°±3.37° and 8.46°±2.66°), with statistical significance ( P<0.05). Conclusion:For patients with Type A degenerative scoliosis combined with rotational subluxation according to the Nanjing classification, performing a 360-degree circumferential release and interbody fusion at the segment with rotatory subluxation can reduce the risk of developing new postoperative coronal imbalances.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.