Objective: To understand classroom environmental conditions and their association with spinal curvature abnormalities among students of primary and secondary schools in Guizhou Province, so as to provide a basis for formulating school health policies and scientific prevention and control measures for abnormal spinal curvature in students. Methods: Using a stratified random sampling method, 471 schools (2 811 classrooms) were selected annually across the province from 2022 to 2024 in order to monitor and evaluate classroom environment according to national standards. Spinal examinations were conducted for 196 606 (2022), 194 876 (2023), and 195 048 (2024) students, and χ 2 test was used to analyze the correlation of desk and chair compliance with student spinal curvature abnormalities. Results: The qualified rates of classroom blackboard illuminance uniformity ( 85.41 %) and the blackboard size (82.24%) were the highest in primary and secondary schools in Guizhou Province, while the average blackboard surface illumination qualified rate (20.10%) was the lowest. The average desk illumination (50.11%-58.63%), desk illumination uniformity (61.92%-72.27%) and qualified noise rate (50.04%-51.94%) increased significantly in 3 years; in addition, the compliance rate of desks and chairs decreased from 25.00% to 13.52%, and the differences were all statistically significant ( χ 2=42.48, 80.93, 46.09, 129.72, all P <0.05). Middle school classrooms outperformed primary schools in terms of per capita area, average blackboard illuminance, blackboard illuminance uniformity, average desktop illuminance, desktop illuminance uniformity, and noise compliance ( χ 2=311.55, 12.41, 20.64, 40.76, 10.25, 52.47), but had lower compliance for blackboard size and reflectance ( χ 2=537.29, 7.59) (all P <0.01). Urban schools had higher compliance than suburban schools for per capita area, average blackboard illuminance, average desktop illuminance, and desktop illuminance uniformity ( χ 2=73.71, 17.68, 29.30 , 36.03), but lower compliance for desk-chair suitability, blackboard size, and blackboard reflectance ( χ 2=4.72, 26.02, 5.43 ) (all P <0.05). The spinal curvature abnormality detection rate was 0.83%. A significant association was found between abnormality detection and desk-chair non compliance ( χ 2=223.85, P <0.01). Conclusions Classroom environment hygiene in Guizhou schools is suboptimal. Strengthening school environmental hygiene infrastructure and greater attention to its impact on student s health are essential.

Objective: To understand the epidemiological characteristics of abnormalities spinal curvature among children and adolescents in Karst landform in Guizhou Province, so as to provide a scientific basis for targeted comprehensive intervention. Methods: From September to December 2023, 194 875 children and adolescents aged 6-18 were selected from all countieldistricts of 9 cities (prefectures) in Guizhou Province by stratified random cluster sampling method according to the proportion of Karst landform area in Guizhou Province for carrying out spinal curvature abnormality screening, and a questionnaire survey was conducted on 139 449 students in the fourth grade and above of primary school. Binary Logistic regression was used for multivariate analysis. Results: The detection rate of abnormal spinal curvature among children and adolescents aged 6-18 in Guizhou Province was 1.13%. The detection rates of abnormal spinal curvature in areas with a high proportion of Karst landform, areas with a low proportion of Karst landform, intercalation areas, and nonKarst landform areas were 1.10%, 2.00%, 0.90%, and 0.60%, respectively. Among them, the detection rates of abnormal spinal curvature in female students (2.40%, 1.60%, 0.90%) in areas with a low proportion of Karst landform, intercalation areas and nonKarst landform were higher than those in male students (1.60%, 0.10%, 0.30) (χ2=12.66, 112.69, 30.22, all P<0.05). The detection rates of abnormal spinal curvature among senior high school students (2.00%, 4.30%, 1.40%, 1.30%) in different Karst landform distributions were successively higher than those among junior high school students (1.40%, 3.20%, 1.00%, 0.60%) and primary school students (0.70%, 0.80%, 0.60%, 0.30%) (χ2=306.11, 175.80, 14.24, 39.57, all P<0.05). The results of multivariate Logistic regression analysis showed that the detection rates of abnormal spinal curvature in both highproportion and lowproportion Karst landform areas were higher than those in nonKarst landform areas [OR(95%CI)=1.84(1.05-2.25), 1.60(1.23-2.09), both P<0.05]. Conclusion The detection rate of abnormal spinal curvature in children and adolescents aged 6-18 in Guizhou Province is related to the distribution of Karst landform, so it is necessary to strengthen screening and appropriate comprehensive interventions.

ObjectiveTo explore the potential mechanism of Erchen Decoction （二陈汤， ECD） in improving metabolic syndrome （MS） with phlegm syndrome. MethodsForty mice were randomly divided into a blank group of 10 mice and a modeling group of 30 mice. The MS model with phlegm syndrome was induced in the modeling group by high-fat diet. Thirty successfully modeled mice were randomly divided into a model group， a ECD group， and a metformin group， with 10 mice in each group. The ECD group was given 0.4 g/（kg·d） of ECD， while the metformin group was intervened with 11.1 g/（kg·d） of metformin solution， and the blank group and the model group were given 0.02 ml/（g·d） of sterilized drinking water， all by gavage， once daily for 4 weeks. Body weight， abdominal circumfe-rence， body length， Lee's index and food intake were recorded. Blood glucose and blood lipid levels including fasting blood glucose， triglycerides （TG）， total cholesterol （TC）， high-density lipoprotein cholesterol （HDL-C）， and low-density lipoprotein cholesterol （LDL-C） were measured. ELISA was used to detect serum leptin levels， while HE staining was used to observe liver pathological changes. Western Blot and q-PCR were used to detect protein and mRNA expression of hypothalamic leptin receptor （LepR）， pro melanocortin （POMC）， and neuropeptide Y （NPY） in the hypothalamus. Immunofluorescence was used to detect fluorescence expression of POMC and NPY in the hypothalamic arcuate nucleus region. ResultsPathological results showed that the mice in the model group had numerous fat vacuoles in hepatocytes and significant liver fat deposition， while the ECD and metformin groups showed reduced fat vacuoles and less liver fat deposition. Compared to those in the blank group， the mice in the model group mice showed liver fat deposition， increased body weight， abdominal circumference， Lee's index and food intake； fasting blood glucose， TG， TC， LDL-C， and serum leptin levels were elevated， while HDL-C was decreased； the expression of LepR， POMC protein levels and their mRNA expression decreased， while the protein level and mRNA expression of NPY increased； the fluorescence expression of POMC in the arcuate nucleus was reduced， while NPY fluorescence expression increased （P＜0.05 or P＜0.01）. Compared to the model group， the ECD group and metformin group showed significant improvements in the above indicators （P＜0.05 or P＜0.01）. Compared to the ECD group， the metformin group showed a reduction in body weight and NPY fluorescence expression， and an increase in HDL-C levels （P＜0.05 or P＜0.01）. ConclusionECD can downregulate serum leptin levels and improve glucose and lipid metabolism in the MS of phlegm syndrome. Its mechanism of action may be to reduce liver fat deposition and thereafter affect the expression of neuropeptides related to feeding activity in the hypothalamus.

OBJECTIVE To standardize the strategies for prevention and control of Chikungunya(CHIK)in healthcare in-stitutions so as to reduce the risk of transmission in the institutions.METHODS A working group comprising the ex-perts in hospital infection control,infectious diseases,and microbiology systematically reviewed domestic and international evidence and current guidelines,integrated China's vector ecology and healthcare realities,conducted two rounds of Delphi to achieve expert consensus,and graded the evidence and recommendation strength using the Oxford Centre for Evidence Based Medicine system.RESULTS The consensus issues 18 actionable recommendations on triage,patient mosquito-proof isolation,integrated vector control,protection of susceptible populations,environmental cleaning and disinfection,specimen management,medical textile handling,and outbreak emergency response,with each statement assigned an evi-dence level and recommendation strength.CONCLUSION This consensus is for the first time in China to provide evidence-graded strategies for control of CHIK in healthcare institutions,offering work flow-oriented,implementable guidance for clinicians,laboratorians,and infection-control personnel under different risk scenarios and enhancing the comprehensive coping capacity of the healthcare institutions.

Objective To explore the cost effectiveness of osimertinib and gefitinib in the treatment of advanced non-small cell lung cancer （NSCLC） with epidermal growth factor receptor （EGFR） mutation. Methods A total of 52 advanced NSCLC patients with EGFR mutation treated by osimertinib were selected as group A from June 2021 to August 2022 at the Chengde Central Hospital, and 52 patients treated by gefitinib were selected as group B according to the propensity score matching method in 1∶1 ratio. The treatment cost and effect of the two groups of patients were compared, and the cost-effectiveness ratio was calculated, and sensitivity analysis was conducted. Results The total effective rate of group A was higher than that of group B （90.38% vs 71.15%, χ²=6.190, P=0.013）. The drug cost and total treatment cost of group A were higher than those of group B（P<0.05）, and other direct costs were lower than those of group B （P<0.05）. The incremental cost effectiveness ratio of group A was 374.71. After the cost-effectiveness sensitivity analysis on adjusting drug costs to decrease by 10% and the total effective rate to decrease by 10% of the two groups, the sensitivity analysis results were basically consistent with the original results. Conclusion Based on the latest prices and actual case data of osimertinib and gefitinib, osimertinib was better than gefitinib in the treatment of advanced NSCLC patients with EGFR mutation. Although gefitinib had lower treatment costs, osimertinib had more cost effectiveness advantages. These findings could provide important reference for the clinical development of treatment plans for advanced NSCLC patients with EGFR mutations.

Objective To construct a model that can predict the risk of diagnosing ABO-blood group sys-tem hemolytic disease of the newborn(ABO-HDN)and to verify its effectiveness.Methods A total of 446 children with neonatal hyperbilirubinemia who met the inclusion criteria and were first diagnosed in this hos-pital from January 2022 to March 2023 were selected as the modeling group,and were divided into the develo-ping group(200 cases)and the non-developing group(246 cases)according to whether ABO-HDN was diag-nosed.Totally 17 potential influencing factors were included for univariate analysis and multi-factor analysis,and independent risk factors were included in R software to establish a Nomogram model to predict the risk of ABO-HDN.Another 105 cases of neonatal hyperbilirubinemia in the hospital from April to September 2023 were selected as the verification group.Results In the modeling group,Logistic regression analysis showed that maternal pregnancy number,prenatal serum titer,hemoglobin level,white blood cell count,creatine ki-nase level and neonatal Apgar 1 min score were all independent risk factors for ABO-HDN(P＜0.05).Multi-variate Logistic regression analysis showed that the area under receiver operating characteristic(ROC)curve of the modeling group was 0.819(95％CI:0.779-0.859),sensitivity was 0.655,specificity was 0.878.In the verification group,the area under ROC curve was 0.867(95％CI:0.800-0.933),the sensitivity was 0.803,and the specificity was 0.773.Conclusion The established predictive model scoring system can effec-tively predict the risk of ABO-HDN.

Objective:To investigate the risk of hospital death in patients with traumatic hemorrhagic shock combined with multiple organ dysfunction syndrome(MODS)predicted by discriminant analysis.Methods:This study was a single-center retrospective study. From January 2013 to May 2023, patients with traumatic hemorrhagic shock complicated with MODS admitted to Peking University People's Hospital were selected as the research objects. According to the in-hospital survival, the patients were divided into survival group (205 cases) and death group (29 cases). The general condition, injury assessment, laboratory indexes, complications and clinical scores of the two groups were compared. Wilks's Lambda stepwise discriminant analysis was used to establish a discriminant model for in-hospital death in patients with traumatic hemorrhagic shock combined with MODS. the Receiver operating characteristic curve (ROC) was drawn and the Area under the curve (AUC) was calculated. The cross-validation method was used to evaluate the accuracy of the prediction results of the established model.Results:There was a statistical difference between the survival group and the death group in terms of the main bleeding site (limbs), the time from injury to hospital admission, temperature, platelet count, prothrombin time, activated partial thrombin time, fibrinogen, albumin, serum creatinine, estimated glomerular filtration rate, uric acid, cardiac troponin I, procalcitonin, base excess, lactate to albumin ratio, glucose to albumin ratio, acute respiratory distress syndrome, acute kidney injury, acute myocardial injury, traumatic induced coagulopathy, ISS, APACHEⅡ score and SOFA scores. There are four indicators entering the final discrimination model: Prothrombin time, ISS score, estimated glomerular filtration rate, lactate to albumin ratio. The AUC for predicting the risk of death in patients with traumatic hemorrhagic shock combined with MODS was 0.791, and the 95% CI was 0.671 to 0.911. Conclusions:The established discriminant model is highly accurate in predicting the risk of hospital death in patients with traumatic hemorrhagic shock complicated with MODS. Prothrombin time, ISS score, estimated glomerular filtration rate and lactate to albumin ratio were associated with an increased risk of death from traumatic hemorrhagic shock with MODS.

Objective To investigate the effect of long non-coding RNA,LINC00839,on the malignant biological behavior of endome-trial cancer(EC)cells via regulating miR-625-5p/MSI1 axis.Methods The expression of LINC00839,miR-625-5p,and MSI1 mRNA in EC tissues and cells was detected by real-time quantitative PCR.Ishikawa cells were selected,and bioinformatics,dual-luciferase reporter gene assay,and RNA-binding protein immunoprecipitation assay were performed to verify the targeting relationship between LINC00839,MSI1,and miR-625-5p.CCK-8,colony formation assay,flow cytometry,and Transwell assay were performed to detect cell proliferation,apoptosis,migration,and invasion.Western blotting was used to detect the expression of MSI1,Bcl-2,Bax,MMP-2,and MMP-9 protein.In vivo tumor formation experiments were conducted to verify the effect of LINC00839 on transplanted tumors in nude mice.Results The expression of LINC00839 and MSI1 mRNA in EC tissues was higher,whereas the expression of miR-625-5p was lower(P＜0.05).LINC00839 and MSI1 targeted miR-625-5p.LINC00839 knockdown or miR-625-5p overexpression suppressed malignant behavior of cells(P＜0.05).Inhibition of miR-625-5p expression or overexpression of MSI1 reversed the inhibitory effect of LINC00839 knockdown or miR-625-5p overexpression on the malignant behavior of cells(P＜0.05).LINC00839 knockdown decreased the volume and mass of transplanted tumors,increased the expression of miR-625-5p,and inhibited the expression of MSI1.Conclusion LINC00839 can target the miR-625-5p/MSI1 axis and regulate the proliferation,apoptosis,migration,and invasion of EC cells.

Objective To explore the magnetic resonance(MR)imaging characteristics of joint damage caused by Chikungunya virus(CHIKV)and its correlation with pain severity,and analyze the value of T2-Mapping in asse-ssing the severity and prognosis of such damage.Methods A multicenter retrospective study design was adopted,and patients with CHIKV infection accompanied by joint pain were included in analysis.Multi-joint MR scans were performed to assess joint effusion,synovial thickening,bone marrow edema,and cartilage damage.T2-Mapping values were measured.Pain severity was assessed using the Visual Analog Scale(VAS),and imaging findings were independently assessed by two radiologists.Results A total of 131 patients were included in the study.The inci-dence of joint cavity and/or synovial sac effusion was the highest(77.1％,n=101),with knee and ankle joint effu-sion accounting for 81.2％(severe,mild-moderate were 17 and 65 cases,respectively),other joint effusion were mild.78 cases had synovial thickening(14 and 64 were severe and mild-moderate cases,respectively),27 cases had tenosynovitis,21 cases had bone marrow edema(primarily in the knee and ankle joints).19 cases had cartilage damage,114 cases presented muscle soft tissue edema(17 and 97 were severe and mild-moderate cases,respective-ly),28 cases had Kager's fat pad edema.Patients with elevated T2-Mapping values exhibited more pronounced chronic joint pain,with T2-Mapping values in the cartilage damage site increasing by 40％-60％compared with normal cartilage site(19 cases in total).The T2-Mapping value for severely damaged soft tissue was(52.3+6.7)ms,while for mildly to moderately damaged soft tissue was(42.3±5.2)ms,both significantly higher than normal refe-rence values(＜35 ms,both P＜0.05).Among 17 patients with severe soft tissue damage,12 experienced persistent pain for over one month,with statistically significant differences in T2 values compared with those with mild-mode-rate damage(P＜0.05).This further suggested that the degree of elevation in T2-Mapping values was closely related to the duration of pain and the severity of damage.After one-month follow-up,103 patients had pain relief.Among the 28 patients with ongoing pain,17 developed into subacute bone joint pain.Bone marrow edema(81.0％),ele-vation of T2-Mapping value of cartilage(89.5％),and severe synovial thickening(71.4％)were high-risk MR manifestations of subacute bone joint pain.The incidences of subacute joint cavity/sac effusion and subacute tenosy-novitis were 3.0％and 7.4％,respectively.Conclusion MR can clearly display the inflammatory and structural changes in CHIKV joint damage,and T2-Mapping values may serve as a potential imaging measurement parameter for assessing severity and prognosis of damage.

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.