Objective: To explore the association between takeout fast foods and sugar sweetened beverage consumption with co-occurrence of anxiety and depressive symptoms among first year junior high school students in Yunnan Province, so as to provide theoretical basis for the prevention of anxiety and depressive symptoms co-occurrence among adolescents. Methods: A random cluster sampling involving 8 500 first year junior high school students in 11 counties in Yunnan Province was conducted by a questionnaire survey from October to December 2022. The Depression Anxiety Stress Scale-21 (DASS-21) was applied to assess anxiety and depressive symptoms in first year junior high school students. Chi-square test was used to compare the anxiety-depression co-occurrence symptoms of first year junior high school students with different demographic characteristics. The association between takeout fast foods and sugar sweetened beverage consumption with co-occurrence of anxiety and depressive symptoms of adolescents was analyzed by binary Logistic regression models. Results: The detection rate of co-occurrence of anxiety and depression symptoms among first year junior high school students in Yunnan Province was 26.92%. After controlling for demographic variables and other confounders, takeout fast foods and sugar sweetened beverage consumption( OR=1.50, 95%CI =1.27-1.77) was associated with anxiety-depression co-occurrence symptoms among first year junior high school students in Yunnan Province ( P <0.01). Stratified analysis showed that both Han ( OR=1.37, 95%CI =1.07-1.77) and ethnic minorities ( OR=1.60, 95%CI =1.29-2.00) exhibited statistically significant associations between takeout fast foods and sugar sweetened beverage consumption with co-occurrence of anxiety and depressive symptoms(both P <0.05). Conclusions Takeout fast foods and sugar sweetened beverage consumption increases the risk of co-occurrence of anxiety and depressive symptoms among first year junior high school students in Yunnan Province. It is recommended to strengthen guidance on the consumption of such products among junior high school students to prevent co-occurrence of anxiety and depressive symptoms.

Based on the theory of diseased collaterals and the progression pattern of diabetic kidney disease （DKD）， this paper proposes a staged treatment system based on the "three states of kidney collaterals" including collateral distention， collateral bi （痹） and collateral accumulation. In the collateral distention stage， the primary pathogenesis is heat damaging the kidney collaterals and collateral vessel dilation， corresponding to the early state of DKD characterized by hyperfiltration and microalbuminuria； the clearing method is suggested， and Shenling Jiangtang Formula （参苓降糖方） can be used to promote the remission of proteinuria by ameliorating insulin resistance and regulating intestinal microecology. In the collateral bi stage， the core pathogenesis lies in the binding of phlegm and stasis， and the formation of concretions and conglomerations in the kidney collaterals， corresponding to massive proteinuria and the decline of renal function， for which the unblocking method should be taken， using Jinchan Yishen Tongluo Formula （金蝉益肾通络方） and Qingre Xiaozheng Formula （清热消癥方） to alleviate renal pathological damage by regulating the autophagy-lysosome pathway and repairing mitochondrial energy metabolism. The collateral accumulation stage is characterized by the internal retention of turbid toxins and accumulations of concretions in the kidney collaterals， corresponding to renal fibrosis and end-stage renal disease （ESRD）； the dispersion method is suggested， and Yiqi Tongluo Xiezhuo Formula （益气通络泄浊方） and Shenyan Fangshuai Fluid （肾炎防衰液） can be used to inhibit extracellular matrix accumulation and delay the progressive loss of renal function. Collateral deficiency runs through the entire course of the disease and is closely related to cellular senescence and the imbalance of the ubiquitin-proteasome/autophagy system. The concept of the "three states of kidney collaterals" integrates the evolution of traditional Chinese medicine pathogenesis with modern pathological staging， forming a whole-course intervention system of "staging-syndrome differentiation-target-formula"， thereby providing novel insights for prevention and treatment of DKD using integrated traditional Chinese and western medicine.

Objective:To document any effect of repeated high-frequency repetitive transcranial magnetic stimulation (rTMS) using double-cone coils on the lower limb motor function of stroke survivors.Methods:A total of 40 stroke survivors were randomly divided into an rTMS group and a sham stimulation group, each of 20. The rTMS group received rTMS at 10Hz with a double-cone coil, while a coil that produced sound but no magnetic stimulation was used with the sham group. The treatments were administered daily, five times a week, for three weeks. Before as well as after 1, 2 and 3 weeks of treatment, lower limb motor function, balance, and the root mean square (RMS) and median frequency (MF) of the rectus femoris and tibialis anterior muscles were evaluated using the Fugl-Meyer lower extremity assessment (FMA-LE), the Berg Balance Scale (BBS), the Modified Barthel Index (MBI), Brunnstrom staging, the TecnoBody balance assessment system, and surface electromyography.Results:Compared with the sham stimulation group, the BBS score of the rTMS group was significantly higher after 2 weeks of treatment, and both the FMA-LE and BBS scores were significantly higher after 3 weeks. The average Brunnstrom stage in the sham group had increased significantly after 3 weeks, but in the rTMS group it had increased after 2 weeks. By 3 weeks there were no significant differences between the two groups. In terms of movement control, the average motion ellipse area in the rTMS group was significantly smaller than among the sham group after 2 weeks, and after 3 weeks the average motion trajectory length was significantly shorter than in the sham group. The average RMS of the rectus femoris in the rTMS group was significantly higher than the sham group′s average after 3 weeks of treatment, indicating improved muscle activation.Conclusions:High-frequency rTMS using a conical coil can effectively improve the lower limb motor function and balance ability of stroke survivors, demonstrating promising clinical application potential.

Objective To analyze the risk factors of osteoporosis and its correlation with lipid metabolism in patients with type 2 diabetes mellitus(T2DM).Methods A total of 400 patients with T2DM hospitalized in the Department of General Medicine of our hospital were enrolled in this study from May 2020 to June 2023 and divided into T2DM simple group(n=200)and OP combined group(OP group,n=200)according to whether they had OP.DBP,SBP,FPG,HbA1c,TC,TG,HDL-C,LDL-C,calcium(Ca),and phosphorus(P)were compared between the two groups.Bone mineral density(BMD)of lumbar spine and left femoral neck were detected by bone densitometry,and osteocalcin(OC)and calcitonin(CT)were detected by RIA method.Results Compared with T2DM group,the TC,LDL-C,and SBP increased(P<0.05),while Ca,P,OC,and CT decreased in OP group(P<0.05).Pearson correlation analysis showed that Ca,P,OC and CT were negatively correlated with TC and LDL-C(P<0.05).Logistic stepwise regression analysis showed that SBP,TC,LDL-C,Ca,P,OC and CT were the risk factors for OP in T2DM patients.Conclusions SBP,TC,LDL-C,Ca,P,OC and CT are risk factors for OP in patients with T2DM,Ca,P,OC and CT are negatively correlated with TC and LDL-C.

Objective To analyze the virulence genes and antibiotics resistance of Escherichia coli(E.coli)isolates cause urinary tract infection(USI)in children,and further understand the epidemiological characteristics of E.coli isolates in children with USI.Methods Children with urinary system infection admitted to Quanzhou Maternity and Child Health Care Hospital&Children's Hospital from January to December 2021 were collected.E.coli was isolated from urine,and the drug sensitivity of the E.coli to 15 commonly used clinical antibiotics was detected by instruments.Among them,33 strains of E.coli that showed Extended-spectrum beta-lactamase(ESBL)production were increased,genomic DNA was extracted,and the whole genome sequence of the strains was analyzed by high-throughput sequencing technology.Results In the gene sequence analysis of 33 strains of E.coli,86 virulence genes were obtained,and the bacterial structural virulence genes accounted for the most(43/86),including capsular,fimbriae and cell-membrane system,followed by functional virulence genes and toxigenic genes,while fimH,fdeC and terC virulence genes had the highest detection rates.In the analysis of drug resistance,Cefazolin(96.97%)was the most resistant,and carbapenems were also found to be resistant.In addition,39 inactivation genes,18 target alteration genes and 51 e?ux system genes were obtained.The most information related to antibiotic e?ux(1 273/1 815),mainly RND and MFS superfamily e?ux pumps.There were 19～43 drug resistance genes in each E.coli genome.A variety of β-lactamase resistance genes were found,in which CTX-M/EC/TEM gene family dominated.Conclusion In the urine isolation of ESBL-producing E.coli in USI children,the β-lactamase should continue to be monitored.Virulence genes fimH,fdeC,terC and acrAB/emrAB/mdtABC-TolC e?ux pump gene detected higherratio,should be more attention.

Objective:To document any effect of repeated high-frequency repetitive transcranial magnetic stimulation (rTMS) using double-cone coils on the lower limb motor function of stroke survivors.Methods:A total of 40 stroke survivors were randomly divided into an rTMS group and a sham stimulation group, each of 20. The rTMS group received rTMS at 10Hz with a double-cone coil, while a coil that produced sound but no magnetic stimulation was used with the sham group. The treatments were administered daily, five times a week, for three weeks. Before as well as after 1, 2 and 3 weeks of treatment, lower limb motor function, balance, and the root mean square (RMS) and median frequency (MF) of the rectus femoris and tibialis anterior muscles were evaluated using the Fugl-Meyer lower extremity assessment (FMA-LE), the Berg Balance Scale (BBS), the Modified Barthel Index (MBI), Brunnstrom staging, the TecnoBody balance assessment system, and surface electromyography.Results:Compared with the sham stimulation group, the BBS score of the rTMS group was significantly higher after 2 weeks of treatment, and both the FMA-LE and BBS scores were significantly higher after 3 weeks. The average Brunnstrom stage in the sham group had increased significantly after 3 weeks, but in the rTMS group it had increased after 2 weeks. By 3 weeks there were no significant differences between the two groups. In terms of movement control, the average motion ellipse area in the rTMS group was significantly smaller than among the sham group after 2 weeks, and after 3 weeks the average motion trajectory length was significantly shorter than in the sham group. The average RMS of the rectus femoris in the rTMS group was significantly higher than the sham group′s average after 3 weeks of treatment, indicating improved muscle activation.Conclusions:High-frequency rTMS using a conical coil can effectively improve the lower limb motor function and balance ability of stroke survivors, demonstrating promising clinical application potential.

Objective To investigate the reciprocal relationships between trajectories of depressive symptoms(DS)and cognitive function(CF)and to provide a basis for formulating comprehensive management for depression and cognitive impairment among older adults.Methods Group－based dual trajectory modelling was performed to identify dual trajectories of DS and CF usinglongitudinal data from the Chinese Health and Retirement Longitudinal Study.Results 3076 older adults were included in the analysis.Four trajectories of DS(DS1~DS4)were determined:constantly low(30.7%),mild increasing lightly(46.7%),moderately decreasing(19.0%),and constantly high(3.6%);four trajectories of CF(CF1~CF4):persistently high(8.3%),suboptimal slowly decline(51.8%),middle rapidly decline(33.8%)and low rapidly decline(6.1%).Compared with DS 1,the elderly in DS 2~4 were more likely to experience CF 3 and CF 4.Using CF 1 as a reference,the elderly in CF 2~4 were more likely to follow DS 2~4.Conclusion GBMDT captures the degree of overlap and dynamic developmental associations between developmental trajectories for DS and CF among Chinese elderly.

Objective:To understand the epidemiological characteristics of injury deaths in local residents in Nanjing from 2009 to 2023, and provide evidence for the development of injury prevention and control strategies.Methods:The injury mortality data in Nanjing from 2009 to 2023 were analyzed based on the death cause surveillance system. In the recorded 33 542 injury death cases, 19 906 (59.35%) were men, and 13 636 (40.65%) were women. The crude mortality rate, age-standardized mortality rate, age-specific mortality rate, cause-eliminated life expectancy (CELE), potential gains in life expectancy (PGLEs) and life loss rate, were calculated. Joinpoint 5.0 software was used to estimate the average annual percentage change (AAPC) and its 95% CI to assess temporal trends of injury deaths. Results:In Nanjing, the crude injury mortality rate showed an upward trend (AAPC=2.11%), while the age-standardized mortality rate exhibited a downward trend (AAPC=-1.27%) from 2009 to 2023. The ranking of injury deaths in all causes of death declined from the 4 th in 2009 to the 6 th in 2023. The crude and age-standardized injury mortality rates in men were consistently higher than those in women. The primary cause of injury deaths was fall (31.42%). Drowning was the primary cause of injury deaths in age group 0-14 years (35.94%), while traffic accident was the primary cause in age group 15-64 years. For residents aged ≥65 years, fall was the primary cause of injury deaths. From 2009 to 2023, the CELE (AAPC=0.61%, 95% CI: 0.34%-0.89%, P<0.05) and the PGLEs (AAPC=1.73%, 95% CI: 0.21%-3.29%, P<0.05) showed increasing trends. The PGLEs and life loss rate due to injury were consistently higher in men than in women, but the AAPC of PGLEs and life loss rate was higher in women. Conclusions:From 2009 to 2023, the age-standardized injury mortality rate decreased, but the life loss due to injury deaths showed an upward trend in Nanjing, indicating that injury still has non-negligible negative impact on life expectancy.

Objective: To explore the relative importance of different food attributes and levels in food decision making of school aged children, and to understand their meal preferences, so as to provide the evidence for formulating precise intervention strategies for dietary behaviours of school aged children. Methods: From May to June 2024, a total of 854 children aged 11 to 15 years old were selected from 2 middle schools (each school in urban and rural areas) in both Hubei Province and Anhui Province by stratified cluster random sampling method to conduct a D-optimal discrete choice experiment. The mixed Logit model was used to analyze children s preference for meal attributes and different levels, and to calculate the relative importance (RI) of attributes and willingness to pay (WTP) in meal choices. Results: The included five food attributes had statistical significance on meal choice of school aged children ( P <0.05). The relative importance of food attributes affecting the meal choices of school aged children in descending order were dining mode ( RI =31.26%), food varieties ( RI =30.56%), cooking method( RI =23.84%), taste( RI =8.06%) and price ( RI =6.27%). Among them, school aged children preferred home cooked meals ( β =0.74) (WTP=86.3 yuan),varied foods(grain/tubers+vegetables+fish, meat, eggs and beans) ( β =0.61) (WTP=71.9 yuan), fried/roasted cooking ( β =0.51) and spicy taste ( β =0.33).Price was negatively correlated with meal choices( β =-0.01) ( P <0.05). Based on residential area and body mass index (BMI), the stratified analysis showed that dining mode was highest in the relative importance for rural children with overweight and obese children ( RI =31.28%,34.17%), both of whom preferred home cooked meals ( β =0.76, 0.91), and meals containing fish, meat, eggs and beans with grain/tubers or grain/tubers and vegetables in terms of food choice (area: β =0.53, 0.53 ; BMI: β =0.55, 0.56) ( P <0.05). Conclusions School aged children have different preferences for different attributes of meals. The quality of school meals should be improved,the cost of buying healthy meals should be reduced,targeted family health education should be carried out,and healthy cooking methods should be advocated.

Objective To investigate the effects of continuous caloric restriction(CCR)and low carbon ketogenic diet(LCK)on glucose and lipid metabolism and cardiopulmonary function in overweight patients with type 2 diabetes mellitus(T2DM).Methods In this study,90 patients with T2DM and overweight who received treatment in our hospital from May 2020 to May 2021 were randomly selected as research objects,and 90 patients were randomly divided into control(Con,n=30)group,CCR group(n=30),and LCK group(n=30).After 3 monthes,the body mass index(BMI),changes of blood glucose,blood lipid,heart function and lung function of the three groups were compared.Results After treatment,the BMI,fasting plasma glucose,2-hour postprandial blood glucose,hemoglobin A1c,fasting insulin,insulin resistance index,total cholesterol,triglycerides,low-density lipoprotein cholesterol,average systolic ejection velocity,shortening rate of left ventricular circumference,vital capacity/weight decreased in turn(P<0.05),high-density lipoprotein cholesterol,fasting C-peptide increased in turn(P<0.05).Compared with Con group,the cardiac ejection time,left ventricular ejection fraction,vital capacity and forced expiratory volume in the first second in CCR and LCK groups increased after treatment(P<0.05),while the average systolic ejection rate,left ventricular circumference shortening rate and vital capacity/weight decreased(P<0.05).Conclusions Both CCR and LCK can improve the cardiopulmonary function of overweight T2DM patients,and LCK can improve BMI and glucose and lipid metabolism more effectively.