Objective To explore the relationship between the coagulation and fibrinolysis function in the early pregnancy and the occurrence of gestational diabetes mellitus(GDM)in women with different pre pregnancy body mass indexes(BMI).Methods 290 pregnant women undergoing the prenatal check ups at the Second Affiliated Hospital of Kunming Medical University from September 2023 to February 2024 were selected.Pre pregnancy BMI,age,family genetic history,parity,parity,and early pregnancy coagulation and fibrinolysis function test results were collected.Based on whether GDM had occurred,they were divided into GDM group(n=72)and non GDM group(n=218),and further divided into low weight GDM group(n=8),low weight non GDM group(n=29),normal weight GDM group(n=39),normal weight non GDM group(n=145),overweight/obesity GDM group(n=25),overweight/obesity non GDM group(n=44)based on pre pregnancy BMI.Basic data comparison was conducted on the total population and BMI groups.Independent sample t-test or Mann Whitney U test was used for quantitative data,and chi square test or Fisher's exact probability method was used for qualitative data.Multivariate logistic regression was used to correct the influencing factors.Results After adjusting the confounding factors such as age,family history,and pre pregnancy BMI,APTT was negatively correlated with the occurrence of GDM in the overall population(P<0.05,OR=0.840),while FIB was positively correlated with GDM(P<0.01,OR=2.598).In low body weight recombination,APTT was negatively correlated with GDM(P<0.05,OR=0.483),FIB was positively correlated with GDM(P<0.05,OR=82.501),while there was no significant correlation between APTT,FIB and GDM after adjusting the age,family history,and pre pregnancy BMI;In the normal weight group,APTT was negatively correlated with GDM(P<0.01,OR=0.786)and FIB was positively correlated with GDM(P<0.05,OR=2.413).However,after adjusting the age,family history,and pre pregnancy BMI,APTT remained negatively correlated with GDM(P<0.05,OR=0.812)and FIB remained positively correlated with GDM(P<0.05,OR=2.391);In the overweight/obese group,TT was negatively correlated with GDM(P<0.05,OR=0.510),while there was no significant correlation between TT and GDM after adjusting the age,family history,and pre pregnancy BMI.Conclusion In the normal weight population,APTT is negatively correlated with the occurrence of GDM,while FIB is positively correlated with the occurrence of GDM;In the low weight and overweight/obese populations,coagulation and fibrinolysis related indicators are greatly influenced by BMI and have no significant correlation with the occurrence of GDM.

Objective:To investigate the co-occurrence patterns of psychosocial and behavioral problems among children and to identify associated influencing factors.Methods:A multicenter cross-sectional survey was conducted in 2023. A cluster random sample of 19 176 children aged 6-16 years was recruited from middle-income areas across 10 provincial capitals and municipalities in China. Psychological and behavioral problems, including anxiety, compulsive behavior, social withdrawal, depression, somatic complaints, social problems, schizoid, delinquent behaviors, hyperactivity, sexual issues, and aggression, were assessed using the Achenbach Child Behavior Checklist parent version. Co-occurrence was defined as ≥2 concurrent problems. Children were divided into 4 groups by gender and age: boys aged 6-11 years, girls aged 6-11 years, boys aged 12-16 years, and girls aged 12-16 years. Those children who had psychosocial and behavioral problems were further categorized into the single-problem group, and the co-occurrence group based on assessment results. High-frequency co-occurrence phenotypes of children′s psychosocial and behavioral problems were identified. Demographic factors, such as parental employment, education, as well as psychosocial factors like parent-child relationship, screen time and outdoor activity, were investigated. χ 2 test was used to analyze differences between groups. Multivariate Logistic regression modeling was conducted to identify potential factors. Results:Among 14 711 children (7 501 boys, 7 210 girls) who provided effective questionnaires, the detection rates of single problem in the boys aged 6-11 years, girls aged 6-11 years, boys aged 12-16 years, and girls aged 12-16 years groups were 4.9% (171/3 461), 6.2% (193/3 120), 3.9% (158/4 040), and 5.1% (208/4 090), respectively; the detection rates of co-occurrence were 7.6% (262/3 461), 7.7% (241/3 120), 4.9% (199/4 040), and 5.7% (234/4 090), respectively. The overall detection rates of co-occurrence was higher than that of single problem ( χ2=25.47, P<0.001). Among children with co-occurrence, there were varied manifestations: in the boys aged 6-11 years group, the detection rates of social withdrawal (69.8% (183/262)), schizoid-like behavior (68.3% (179/262)), and compulsive behavior (67.6% (177/262)) were relatively high; in the girls aged 6-11 years group, the detection rates of schizoid-compulsive behavior (69.3% (167/241)), delinquent behavior (65.6% (158/241)), and hyperactivity (58.9% (142/241)) were relatively high; in the boys aged 12-16 years group, the detection rates of hyperactivity (78.9% (157/199)), compulsive behavior (67.3% (134/199)), and immature behavior (57.3% (114/199)) were relatively high; in the girls aged 12-16 years group, the detection rates of schizoid-like behavior (89.7% (210/234)), immature behavior (59.0% (138/234)), and cruelty (57.7% (135/234)) were relatively high. Maternal bachelor′s degree or higher ( OR=0.78, 95% CI 0.61-0.99, P=0.038) served as co-occurrence protective factors, whereas having 1 or more siblings, increased parent-child conflict and decreased parent-child interaction time ( OR=1.24, 1.41, 1.36; 95% CI 1.02-1.52, 1.15-1.73, 1.02-1.82, all P<0.05) were co-occurrence risk factors. Conclusions:Children exhibit strong co-occurrence tendencies in psychosocial and behavioral problems. Compulsive and schizoid traits are the predominant co-occurring phenotypes for childhood and girls respectively. ?Familial environment plays a critical role, necessitating ?multidimensional clinical assessments and ?family-centered interventions.

In the field of rectal cancer treatment, transanal local excision techniques (such as transanal endoscopic microsurgery [TEM] and transanal minimally invasive surgery [TAMIS]) have gradually become an important therapeutic option for patients with rectal cancer at various stages, owing to their minimally invasive characteristics and organ-preserving advantages. For low-risk T1 stage tumors, local excision can achieve radical tumor control while preserving organ function. For some patients with high-risk T1 stage or T2-3 stage rectal cancer, the efficacy of combined chemoradiotherapy and local excision is expected to be comparable to that of radical total mesorectal excision (TME). In patients with advanced rectal cancer who achieve clinical complete response (cCR) after neoadjuvant therapy, local excision can confirm the pathological remission status. However, it is necessary to balance the risk of surgical complications against the potential benefits of organ preservation with the "watch and wait" strategy. Currently, transanal local excision techniques have broad application prospects, and comprehensive assessment of patients' overall condition, implementation of multidisciplinary collaboration, and conduct of long-term follow-up are crucial to ensuring the safety of treatment.

In the field of rectal cancer treatment, transanal local excision techniques (such as transanal endoscopic microsurgery [TEM] and transanal minimally invasive surgery [TAMIS]) have gradually become an important therapeutic option for patients with rectal cancer at various stages, owing to their minimally invasive characteristics and organ-preserving advantages. For low-risk T1 stage tumors, local excision can achieve radical tumor control while preserving organ function. For some patients with high-risk T1 stage or T2-3 stage rectal cancer, the efficacy of combined chemoradiotherapy and local excision is expected to be comparable to that of radical total mesorectal excision (TME). In patients with advanced rectal cancer who achieve clinical complete response (cCR) after neoadjuvant therapy, local excision can confirm the pathological remission status. However, it is necessary to balance the risk of surgical complications against the potential benefits of organ preservation with the "watch and wait" strategy. Currently, transanal local excision techniques have broad application prospects, and comprehensive assessment of patients' overall condition, implementation of multidisciplinary collaboration, and conduct of long-term follow-up are crucial to ensuring the safety of treatment.

Objective:To investigate the co-occurrence patterns of psychosocial and behavioral problems among children and to identify associated influencing factors.Methods:A multicenter cross-sectional survey was conducted in 2023. A cluster random sample of 19 176 children aged 6-16 years was recruited from middle-income areas across 10 provincial capitals and municipalities in China. Psychological and behavioral problems, including anxiety, compulsive behavior, social withdrawal, depression, somatic complaints, social problems, schizoid, delinquent behaviors, hyperactivity, sexual issues, and aggression, were assessed using the Achenbach Child Behavior Checklist parent version. Co-occurrence was defined as ≥2 concurrent problems. Children were divided into 4 groups by gender and age: boys aged 6-11 years, girls aged 6-11 years, boys aged 12-16 years, and girls aged 12-16 years. Those children who had psychosocial and behavioral problems were further categorized into the single-problem group, and the co-occurrence group based on assessment results. High-frequency co-occurrence phenotypes of children′s psychosocial and behavioral problems were identified. Demographic factors, such as parental employment, education, as well as psychosocial factors like parent-child relationship, screen time and outdoor activity, were investigated. χ 2 test was used to analyze differences between groups. Multivariate Logistic regression modeling was conducted to identify potential factors. Results:Among 14 711 children (7 501 boys, 7 210 girls) who provided effective questionnaires, the detection rates of single problem in the boys aged 6-11 years, girls aged 6-11 years, boys aged 12-16 years, and girls aged 12-16 years groups were 4.9% (171/3 461), 6.2% (193/3 120), 3.9% (158/4 040), and 5.1% (208/4 090), respectively; the detection rates of co-occurrence were 7.6% (262/3 461), 7.7% (241/3 120), 4.9% (199/4 040), and 5.7% (234/4 090), respectively. The overall detection rates of co-occurrence was higher than that of single problem ( χ2=25.47, P<0.001). Among children with co-occurrence, there were varied manifestations: in the boys aged 6-11 years group, the detection rates of social withdrawal (69.8% (183/262)), schizoid-like behavior (68.3% (179/262)), and compulsive behavior (67.6% (177/262)) were relatively high; in the girls aged 6-11 years group, the detection rates of schizoid-compulsive behavior (69.3% (167/241)), delinquent behavior (65.6% (158/241)), and hyperactivity (58.9% (142/241)) were relatively high; in the boys aged 12-16 years group, the detection rates of hyperactivity (78.9% (157/199)), compulsive behavior (67.3% (134/199)), and immature behavior (57.3% (114/199)) were relatively high; in the girls aged 12-16 years group, the detection rates of schizoid-like behavior (89.7% (210/234)), immature behavior (59.0% (138/234)), and cruelty (57.7% (135/234)) were relatively high. Maternal bachelor′s degree or higher ( OR=0.78, 95% CI 0.61-0.99, P=0.038) served as co-occurrence protective factors, whereas having 1 or more siblings, increased parent-child conflict and decreased parent-child interaction time ( OR=1.24, 1.41, 1.36; 95% CI 1.02-1.52, 1.15-1.73, 1.02-1.82, all P<0.05) were co-occurrence risk factors. Conclusions:Children exhibit strong co-occurrence tendencies in psychosocial and behavioral problems. Compulsive and schizoid traits are the predominant co-occurring phenotypes for childhood and girls respectively. ?Familial environment plays a critical role, necessitating ?multidimensional clinical assessments and ?family-centered interventions.

Objective:To investigate serum vitamin A and vitamin D status in children aged 2-<7 years in 20 cities in China.Methods:A cross-sectional study was conducted. A total of 2 924 healthy children aged 2-<7 years were recruited from September 2018 to September 2019 from 20 cities in China, categorized by age groups of 2-<3 years, 3-<5 years, and 5-<7 years. The demographic and economic characteristics and health-related information of the enrolled children were investigated. Body weight and height were measured by professional staff members. The serum vitamin A and vitamin D levels were detected by high-performance liquid chromatography-tandem mass spectrometry. Chi-square test and Logistic regression were applied to analyze the association between vitamin A and vitamin D deficiency and insufficiency as well as their underlying impact factors.Results:The age of the 2 924 enrolled children was 4.33 (3.42, 5.17) years. There were 1 726 males (59.03%) and 1 198 females (40.97%). The prevalences of vitamin A and vitamin D deficiency in enrolled children were 2.19% (64/2 924) and 3.52% (103/2 924), respectively, and the insufficiency rates were 29.27% (856/2 924) and 22.20% (649/2 924), respectively. Children with both vitamin A and vitamin D deficiencies or insufficiencies were found in 10.50% (307/2 924) of cases. Both vitamin A ( χ2=7.91 and 8.06, both P=0.005) and vitamin D ( χ2=71.35 and 115.10, both P<0.001) insufficiency rates were higher in children aged 3-<5 and 5-<7 years than those in children aged 2-<3 years. Vitamin A and vitamin D supplementation in the last 3 months was a protective factor for vitamin A and D deficiency and insufficiency, respectively ( OR=0.68 and 0.22, 95% CI 0.49-0.95 and 0.13-0.40, both P<0.05). The rates of vitamin A and D insufficiency was higher in children with annual household incomes <60 000 RMB than in those with annual household incomes ≥60 000 RMB ( χ2=34.11 and 10.43, both P<0.01). Northwest and Southwest had the highest rates of vitamin A and vitamin D insufficiency in children aged 2-<7 yeas, respectively ( χ2=93.22 and 202.54, both P<0.001). Conclusions:Among 20 cities in China, children aged 2-<7 years experience high rates of vitamin A and vitamin D insufficiency, which are affected by age, family economic level, vitamin A and vitamin D supplementation, and regional economic level. The current results suggest that high level of attention should be paid to vitamin A and vitamin D nutritional status of preschool children.

OBJECTIVE To investigate the effects of renally inappropriate medication （RIM） on the frailty of elderly patients with diabetes. METHODS The data of elderly patients with diabetes mellitus admitted to a third-grade class A hospital in Yunnan province from January to December 2022 were collected， and Beers criteria （2019 edition） and Chinese version of FRAIL scale were used to evaluate RIM and the frailty of the patients； the patients were divided into the trial group （with RIM） and the control group （without RIM） according to whether there was RIM. The propensity score matching was used to balance confounding factors between two groups， and the influence of RIM on the frailty of elderly diabetic patients was analyzed by the Logistic regression model. RESULTS Among the 367 patients， 80 patients （21.80%） had RIM， the drugs involved RIM were spironolactone （82.56%）， rivaroxaban （13.95%） and gabapentin （3.49%）. After reaching the balance between groups using the propensity score matching method， the incidence of frailty was 77.94% in trial group and 27.94% in control group （P＜0.001）； the difference was not statistically significant in other confounding factors between the two groups （P＞0.05）. Results of Logistic regression analysis showed that the risk of frailty in the experimental group was 3.118 times that of the control group （odds ratio was 3.118，95% confidence interval was 1.758-5.530， P＜0.001）. CONCLUSIONS RIM is a risk factor for the frailty of elderly patients with diabetes， which can be considered as an indicator for early identification and screening of the frailty of elderly diabetes patients.

Objective To analyze the relationship between the common clinical indicators and diabetic foot ulcer(DFU)in type 2 diabetes mellitus(T2DM)patients by using the cross-sectional study and to provide the reference indicators for clinical DFU monitoring and prognosis evaluation.Methods A total of 115 T2DM patients admitted to the Department of Endocrinology,the Second Affiliated Hospital of Kunming Medical University from June 2021 to June 2023 were selected as the study objects and were divided into group A(with DFU)and group B(without DFU)according to whether they had DFU.Those in group A were then divided into group A1(Wagner0-1),group A2(Wagner2-3)and group A3(Wagner4)according to Wagner classification.The differences of general data,blood pressure,blood glucose,blood lipids and other common clinical indicators among all of the groups were compared,and the correlation between DFU and the above indicators was explored.Results Diabetes duration,D-dimer(DD),systolic blood pressure and other indexes in group A were higher than those in group B and there was a statistically significant difference(P<0.05).DD was the main risk factor for DFU in T2DM patients.Diabetic course in patients with DFU was positively correlated with the age(r>0,P<0.05),and negatively correlated with fasting blood glucose(FPG)level and 2hPG level at 2 hours after meals(r<0,P<0.05).The levels of interleukin-6(IL-6)and C-reactive protein(CRP)in A1 and A2 groups were lower than those in A3 group,the levels of neutrophils and leukocytes in A1 group were lower than those in A3 group,and the high density lipoprotein cholesterol(HDL-C)in A1 group was higher than that in A2 group and there was a statistically significant difference(P<0.05).Conclusion DD and systolic blood pressure are the main risk factors for DFU,and DD is closely related to DFU.The older the patients with T2DM,the later the onset of DFU.The worse the blood glucose control,the earlier the onset of DFU.HDL-C is a protective factor for peripheral vascular disease in T2DM patients.

Diabetic foot(DF)is one of the most severe chronic complications of diabetes mellitus(DM),and it is an important cause of disability and mortality inpatients with DM.Changes in proteins in the tissues,organs and circulation of organisms can serve as microscopic reflections of the disease development process.Proteomics is an important technologyto explore the pathogenesis and treatment mechanism of dis-ease,and to find potential therapeutic targets and prognostic biomarkers of diseases.This article reviews the progress of proteomics research in DF.

Diabetes, hypertension, and dyslipidemia, collectively referred to the " Three Highs, " represent increasingly prevalent metabolic risk factors in China. Many individuals experience all three conditions concurrently, significantly heightening the risk of cardiovascular disease and mortality. Although the National Metabolic Management Center(MMC) has been established for over eight years and has its unique features, the awareness, treatment, and control rates of these diseases in China remain low, and the efficiency of community management is insufficient. According to the previous two editions of management guidelines and the most recent domestic and international diagnostic and treatment guidelines, this paper conducts an in-depth analysis of the operational experience and management strategies of the MMC. Its aim is to improve the efficiency of grassroots MMC mode management for " Three Highs" patients and ensure that patients receive more standardized management.