Abstract The cooccurrence of multi disease among children and adolescents has become increasingly prominent, necessitating a shift from "single disease separate treatment" to "multi disease co prevention". Focusing on four common health problems in children and adolescents, namely, myopia, depression, overweight/obesity, and spinal abnormalities, the paper systematically reviews the association between four categories of factors, society, environment, family, and individual behavior, and the co occurrence of the aforementioned health problems. The findings indicate that particulate matter 2.5 exposure, light at night, physical inactivity, excessive screen time, and unhealthy diet constitute the primary cross dimensional risk network. Based on these findings, the paper proposes a collaborative action framework involving family, school, and society, emphasizing systematic strategies ranging from upstream environmental governance to downstream behavioral intervention, so as to provide evidence for the practice and policy making of multi disease co-prevention in children and adolescents.

Objective:To investigate the epidemiological characteristics, disease spectrum, and laboratory characteristics of human immunodeficiency virus/cytomegalovirus (HIV/CMV) co-infection, to provide references for clinical diagnosis and treatment.Methods:A cross-sectional study was conducted. Clinical information of 544 HIV/acquired immune deficiency syndrome (AIDS) patients who underwent CMV-DNA tests in Beijing Ditan Hospital in 2023 was collected. Participants were categorized into CMV-infection group (126 cases) and non-CMV-infection group (418 cases). The prevalence of CMV infection was analyzed. Univariate and multivariate logistic regression analysis were performed to identify risk factors for CMV/AIDS co-infection. The disease spectrum, laboratory characteristics, serum CMV-DNA load changes, treatment prognosis and outcomes in the CMV-infected group were evaluated. SPSS 27.0 was used for statistical analysis including the χ 2 test, Mann-Whitney U test, and Kruskal-Wallis H test. Results:The CMV infection rate among HIV/AIDS patients was 23.16% (126/544). Multivariate analysis identified low CD4 +T-lymphocyte count [<50 cells/μl; OR=27.962, 95% confidence interval( CI) 11.957-65.389] and high HIV RNA load (>1×10 5 copies/ml; OR=2.057, 95% CI 1.237-3.420) as independent risk factors for CMV co-infection in HIV/AIDS patients. Among the 126 HIV/CMV co-infected patients, CMV viremia was the most common manifestation (38.10%, 48/126), followed by CMV pneumonia (33.33%, 42/126) and CMV retinitis (11.90%, 15/126), which were mainly observed in patients with CD4 +T-lymphocyte counts <50 cells/μl. Of the patients receiving anti-CMV therapy, 80.70% (46/57) exhibited reduced CMV-DNA loads compared with baseline. Totally 29.82% (17/57) of those patients initiating antiretroviral therapy alone achieved CMV-DNA reduction compared with baseline. Overall, 80.16% (101/126) of patients achieved favorable prognosis. Conclusion:CMV co-infection is high in HIV/AIDS patients. Disease spectrum of HIV/CMV co-infection are dominated by CMV viremia and CMV pneumonia. Timely anti-CMV therapy is pivotal for reducing CMV-DNA loads and improving prognosis.

Objectives:To analyze the risk factors of atrial fibrillation in patients with non-obstructive hypertrophic cardiomyopathy(NOHCM)and explore the relationship between left ventricular/atrial volume and atrial fibrillation.Methods:Consecutive NOHCM patients admitted at Fuwai Hospital from January 2023 to January 2024 with complete clinical data,satisfactory echocardiography imaging data were included in this analysis,patients were divided into atrial fibrillation group(n=28)and non-atrial fibrillation group(n=57).Left-sided volumetric and functional parameters were measured by one-beat real-time full-volume three-dimensional echocardiography,including left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),left atrial volume(LAV).The left ventricular end-diastolic volume(LVEDVi)index,left ventricular end-systolic volume index(LVESVi)and left atrial volume index(LAVi)were calculated.Other echocardiographic parameters including interventricular septum(IVSmax)thickness,left ventricular posterior wall thickness(LVPW),and left atrial diameter(LAD)were routinely measured.Mitral valve forward flow spectrum,tissue Doppler,tricuspid regurgitation velocity,and left atrial size were used to evaluate the left ventricular diastolic function of patients,and diastolic dysfunction was classified into grade I,II,and III.Multivariate logistic regression was used to analyze the influencing factors of atrial fibrillation in patients with non-obstructive hypertrophic cardiomyopathy Results:Compared with the non-atrial fibrillation group,LVEDV([143.8±26.7]ml vs.[117.1±21.9]ml)and LVEDVi([79.4±11.9]ml/m2 vs.[64.2±10.6]ml/m2)were smaller in atrial fibrillation group(both P<0.001).Compared with the non-atrial fibrillation group,LAD([40.2±4.7]mm vs.[48.6±4.8]mm)and LAVi([37.3±8.9]ml/m2 vs.[64.4±17.1]ml/m2)were lager in atrial fibrillation group(both P<0.001).Compared with the non-atrial fibrillation group,the proportion of NYHA functional classification≥Ⅲ was higher(15.8%vs.50.0%,P<0.001),LVEF was lower([61.5±5.5]%vs.[57.6±5.0]%,P=0.002),and proportion of severe diastolic dysfunction was higher in atrial fibrillation group(P<0.001).Logistic regression analysis showed that the factors associated with atrial fibrillation in NOHCM patients were LVEDVi(OR=0.744,95%CI:0.575-0.962,P=0.024)and LAVi(OR=1.602,95%CI:1.032-2.486,P=0.036).Conclusions:LVEDVi and LAVi are related factors for atrial fibrillation in patients with non-obstructive hypertrophic cardiomyopathy.LVEDVi is negatively,while LAVi is positively associated with the occurrence of atrial fibrillation in NOHCM patients.

Objectives:To analyze the risk factors of atrial fibrillation in patients with non-obstructive hypertrophic cardiomyopathy(NOHCM)and explore the relationship between left ventricular/atrial volume and atrial fibrillation.Methods:Consecutive NOHCM patients admitted at Fuwai Hospital from January 2023 to January 2024 with complete clinical data,satisfactory echocardiography imaging data were included in this analysis,patients were divided into atrial fibrillation group(n=28)and non-atrial fibrillation group(n=57).Left-sided volumetric and functional parameters were measured by one-beat real-time full-volume three-dimensional echocardiography,including left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),left atrial volume(LAV).The left ventricular end-diastolic volume(LVEDVi)index,left ventricular end-systolic volume index(LVESVi)and left atrial volume index(LAVi)were calculated.Other echocardiographic parameters including interventricular septum(IVSmax)thickness,left ventricular posterior wall thickness(LVPW),and left atrial diameter(LAD)were routinely measured.Mitral valve forward flow spectrum,tissue Doppler,tricuspid regurgitation velocity,and left atrial size were used to evaluate the left ventricular diastolic function of patients,and diastolic dysfunction was classified into grade I,II,and III.Multivariate logistic regression was used to analyze the influencing factors of atrial fibrillation in patients with non-obstructive hypertrophic cardiomyopathy Results:Compared with the non-atrial fibrillation group,LVEDV([143.8±26.7]ml vs.[117.1±21.9]ml)and LVEDVi([79.4±11.9]ml/m2 vs.[64.2±10.6]ml/m2)were smaller in atrial fibrillation group(both P<0.001).Compared with the non-atrial fibrillation group,LAD([40.2±4.7]mm vs.[48.6±4.8]mm)and LAVi([37.3±8.9]ml/m2 vs.[64.4±17.1]ml/m2)were lager in atrial fibrillation group(both P<0.001).Compared with the non-atrial fibrillation group,the proportion of NYHA functional classification≥Ⅲ was higher(15.8%vs.50.0%,P<0.001),LVEF was lower([61.5±5.5]%vs.[57.6±5.0]%,P=0.002),and proportion of severe diastolic dysfunction was higher in atrial fibrillation group(P<0.001).Logistic regression analysis showed that the factors associated with atrial fibrillation in NOHCM patients were LVEDVi(OR=0.744,95%CI:0.575-0.962,P=0.024)and LAVi(OR=1.602,95%CI:1.032-2.486,P=0.036).Conclusions:LVEDVi and LAVi are related factors for atrial fibrillation in patients with non-obstructive hypertrophic cardiomyopathy.LVEDVi is negatively,while LAVi is positively associated with the occurrence of atrial fibrillation in NOHCM patients.

Objective:To investigate the epidemiological characteristics, disease spectrum, and laboratory characteristics of human immunodeficiency virus/cytomegalovirus (HIV/CMV) co-infection, to provide references for clinical diagnosis and treatment.Methods:A cross-sectional study was conducted. Clinical information of 544 HIV/acquired immune deficiency syndrome (AIDS) patients who underwent CMV-DNA tests in Beijing Ditan Hospital in 2023 was collected. Participants were categorized into CMV-infection group (126 cases) and non-CMV-infection group (418 cases). The prevalence of CMV infection was analyzed. Univariate and multivariate logistic regression analysis were performed to identify risk factors for CMV/AIDS co-infection. The disease spectrum, laboratory characteristics, serum CMV-DNA load changes, treatment prognosis and outcomes in the CMV-infected group were evaluated. SPSS 27.0 was used for statistical analysis including the χ 2 test, Mann-Whitney U test, and Kruskal-Wallis H test. Results:The CMV infection rate among HIV/AIDS patients was 23.16% (126/544). Multivariate analysis identified low CD4 +T-lymphocyte count [<50 cells/μl; OR=27.962, 95% confidence interval( CI) 11.957-65.389] and high HIV RNA load (>1×10 5 copies/ml; OR=2.057, 95% CI 1.237-3.420) as independent risk factors for CMV co-infection in HIV/AIDS patients. Among the 126 HIV/CMV co-infected patients, CMV viremia was the most common manifestation (38.10%, 48/126), followed by CMV pneumonia (33.33%, 42/126) and CMV retinitis (11.90%, 15/126), which were mainly observed in patients with CD4 +T-lymphocyte counts <50 cells/μl. Of the patients receiving anti-CMV therapy, 80.70% (46/57) exhibited reduced CMV-DNA loads compared with baseline. Totally 29.82% (17/57) of those patients initiating antiretroviral therapy alone achieved CMV-DNA reduction compared with baseline. Overall, 80.16% (101/126) of patients achieved favorable prognosis. Conclusion:CMV co-infection is high in HIV/AIDS patients. Disease spectrum of HIV/CMV co-infection are dominated by CMV viremia and CMV pneumonia. Timely anti-CMV therapy is pivotal for reducing CMV-DNA loads and improving prognosis.

Objective:To evaluate the pulmonary protective effect of individualized positive end-expiratory pressure (PEEP) ventilation guided by driving pressure in patients undergoing rib fracture surgery.Methods:In this prospective randomized controlled trial, 80 American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients of either sex, aged 18-64 yr, with a body mass index of 19-28 kg/m 2, who underwent elective open reduction and internal fixation of unilateral rib fractures at the Third Hospital of Hebei Medical University from March to October 2024, were selected and divided into 2 groups ( n=40 each) by the random number table method: fixed PEEP ventilation group (group C) and driving pressure-guided individualized PEEP ventilation group (group DP). Group C adopted the ventilation strategy of fixed PEEP with 5 cmH 2O. Group DP adopted the ventilation strategy guided by the driving pressure: PEEP was titrated from 10 cmH 2O, being gradually decreased to 3 cmH 2O at intervals of 1 cmH 2O. Each PEEP level was maintained for 10 respiratory cycles, and the driving pressure of the last cycle was calculated, and the PEEP that could achieve the lowest driving pressure was selected and applied. Lung ultrasound examinations were performed immediately after entering the operating room (T 0) and at 30 min after entering the anesthesia recovery room (T 3), and the lung ultrasound score was recorded. The occurrence of severe postoperative pulmonary complications within 7 days was recorded. Arterial blood gas analysis was performed at T 0, 1 h after PEEP setting (T 1), at the end of suture at the surgical site (T 2) and at T 3, and the oxygenation index was calculated. The peak airway pressure, PEEP and driving pressure were recorded at T 1 and T 2. The duration of the indwelling thoracic drainage tube use and length of postoperative hospital stay were recorded. Results:The incidence of severe postoperative pulmonary complications within 7 days after surgery was 28%(11/40) in group C and 10% in group DP, and the incidence was significantly lower in DP group than in C group ( P<0.05). Compared with group C, the lung ultrasund score was significantly decreased at T 3, the oxygenation index was increased at T 1-3, the PEEP was increased and the driving pressure was decreased at T 1-2, and the length of postoperative hospital stay was shortened in group DP ( P<0.05). Conclusions:Driving pressure-guided individualized PEEP ventilation can decrease the risk of severe postoperative pulmonary complications, alleviate postoperative lung injury and provide a certain degree of lung protection in patients undergoing rib fracture surgery.

Bacillus coagulans can utilize the hydrolyzed carbon source of agricultural waste to produce lactic acid via a homofermentative pathway. However, a significant carbon source metabolic repression effect was observed when the strain metabolized mixed sugars (glucose and xylose), reducing the productivity of lactic acid. In this study, we obtained the fermentation conditions for the simultaneous utilization of the mixed sugars by B. coagulans by changing the ratio of glucose to xylose in the medium. Through transcriptome sequencing, several key genes responsible for xylose utilization were identified. The critical role of xylose isomerase (XylA, EC 5.3.1.5) in the synchronous utilization of glucose/xylose in B. coagulans was investigated via qRT-PCR (quantitative real-time polymerase chain reaction). Subsequently, the heterologous expression and characterization of the XylA-encoding gene (XylA) were conducted. It was determined that the gene encoded a protein composed of 440 amino acid residues. The secondary structure of the encoded protein was predominantly composed of α-helixes and random coils, while the higher structure of the protein was identified as a homotetramer. Then, XylA was cloned and expressed in Escherichia coli BL21(DE3), and the recombinant protein Bc-XlyA was obtained with a molecular weight of approximately 50 kDa. The optimal pH and temperature of Bc-XylA were 8.0 and 60 ℃, respectively, and Mn²⁺, Mg²⁺, and Co²⁺ had positive effects on the activity of Bc-XlyA. The present study provides scientific data on the molecular modification of B. coagulans, offering theoretical support for the efficient utilization of xylose in the strain.
Xylose/metabolism* ; Cloning, Molecular ; Bacillus coagulans/enzymology* ; Aldose-Ketose Isomerases/metabolism* ; Fermentation ; Bacterial Proteins/metabolism* ; Glucose/metabolism*

ObjectiveTo analyze the distribution characteristics of traditional Chinese medicine （TCM） syndrome elements in different risk populations of heart failure complicated with type 2 diabetes. MethodsClinical data of 675 type 2 diabetes patients were retrospectively collected. Lasso-multivariate Logistic regression was used to construct a clinical prediction nomogram model. Based on this， 441 non-heart failure patients were divided into a low-risk group （325 cases） and a high-risk group （116 cases） according to the median risk score of heart failure complicated with type 2 diabetes. TCM diagnostic information （four diagnostic methods） was collected for both groups， and factor analysis was applied to summarize the distribution of TCM syndrome elements in different risk populations. ResultsLasso-multivariate Logistic regression analysis identified age， disease duration， coronary heart disease， old myocardial infarction， arrhythmia， absolute neutrophil count， activated partial thromboplastin time， and α-hydroxybutyrate dehydrogenase as independent risk factors for heart failure complicated with type 2 diabetes. These were used as final predictive factors to construct the nomogram model. Model validation results showed that the area under the curve （AUC） of the receiver operating characteristic （ROC） curve for the modeling group and validation group were 0.934 and 0.935， respectively. The Hosmer-Lemeshow test （modeling group P = 0.996， validation group P = 0.121） indicated good model discrimination. Decision curve analysis showed that the curves for All and None crossed in the upper right corner， indicating high clinical utility. The low-risk and high-risk groups each obtained 14 common factors. Preliminary analysis revealed that the main disease elements in the low-risk group were qi deficiency （175 cases， 53.85%）， dampness （118 cases， 36.31%）， and heat （118 cases， 36.31%）， with the primary locations in the spleen （125 cases， 38.46%） and lungs （99 cases， 30.46%）. In the high-risk group， the main disease elements were yang deficiency （73 cases， 62.93%）， blood stasis （68 cases， 58.62%）， and heat （49 cases， 42.24%）， with the primary locations in the kidney （84 cases， 72.41%） and heart （70 cases， 60.34%）. ConclusionThe overall disease characteristics in different risk populations of type 2 diabetes patients with heart failure are a combination of deficiency and excess， with deficiency being predominant. Deficiency and heat are present throughout. The low-risk population mainly shows qi deficiency with dampness and heat， related to the spleen and lungs. The high-risk population shows yang deficiency with blood stasis and heat， related to the kidneys and heart.

Objective To investigate the predictive value of edema metabolic and hematoma dynamics changes on motor and cog-nitive recovery outcomes in patients with intracerebral hemorrhage(ICH).Methods The CT data of ICH patients were collected to evaluate hematoma volume changes from admission to day 3.On day 3,multivoxel magnetic resonance spectroscopy(MRS)was per-formed with region of interest located in the edema region and contralateral normal tissue.Motor and cognitive function recovery was assessed using the simplified F-M scale and the Montreal cognitive assessment(MoCA)on day 3 and at the 3-month follow-up,respec-tively.Overall clinical outcomes were assessed using the Glasgow outcome scale(GOS),and all patients were divided into good and poor outcome groups.Clinical data and metabolic differences in the edema region between the two groups were compared,respec-tively.Logistic regression analysis and receiver operating characteristic(ROC)curves were used to identify and evaluate independent prognostic factors.Subgroup analysis were performed via stratification of hematoma location.Results The logistic regression analy-sis indicated that intraventricular extension,hematoma changes,and the ratio of N-acetyl aspartate(NAA)around the hematoma to contralateral normal brain parenchyma NAA(rNAA)were inde-pendent prognostic factors for poor outcomes(P＜0.05).The area under the curve(AUC)for each factor and the combined model were 0.69,0.73,0.79,and 0.82,respectively.In patients with ICH in the basal ganglia region,△F-M was negatively correlated with hematoma changes and positively correlated with rNAA value(P＜0.001).In patients with ICH in the thalamic and lobar regions,△MoCA was not significantly correlated with hematoma changes(P＞0.05),but was positively correlated with rNAA value(P＜0.001).Conclusion The rNAA holds predictive value for motor and cognitive recovery outcomes following standard treatment.

Objective:To evaluate the pulmonary protective effect of individualized positive end-expiratory pressure (PEEP) ventilation guided by driving pressure in patients undergoing rib fracture surgery.Methods:In this prospective randomized controlled trial, 80 American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients of either sex, aged 18-64 yr, with a body mass index of 19-28 kg/m 2, who underwent elective open reduction and internal fixation of unilateral rib fractures at the Third Hospital of Hebei Medical University from March to October 2024, were selected and divided into 2 groups ( n=40 each) by the random number table method: fixed PEEP ventilation group (group C) and driving pressure-guided individualized PEEP ventilation group (group DP). Group C adopted the ventilation strategy of fixed PEEP with 5 cmH 2O. Group DP adopted the ventilation strategy guided by the driving pressure: PEEP was titrated from 10 cmH 2O, being gradually decreased to 3 cmH 2O at intervals of 1 cmH 2O. Each PEEP level was maintained for 10 respiratory cycles, and the driving pressure of the last cycle was calculated, and the PEEP that could achieve the lowest driving pressure was selected and applied. Lung ultrasound examinations were performed immediately after entering the operating room (T 0) and at 30 min after entering the anesthesia recovery room (T 3), and the lung ultrasound score was recorded. The occurrence of severe postoperative pulmonary complications within 7 days was recorded. Arterial blood gas analysis was performed at T 0, 1 h after PEEP setting (T 1), at the end of suture at the surgical site (T 2) and at T 3, and the oxygenation index was calculated. The peak airway pressure, PEEP and driving pressure were recorded at T 1 and T 2. The duration of the indwelling thoracic drainage tube use and length of postoperative hospital stay were recorded. Results:The incidence of severe postoperative pulmonary complications within 7 days after surgery was 28%(11/40) in group C and 10% in group DP, and the incidence was significantly lower in DP group than in C group ( P<0.05). Compared with group C, the lung ultrasund score was significantly decreased at T 3, the oxygenation index was increased at T 1-3, the PEEP was increased and the driving pressure was decreased at T 1-2, and the length of postoperative hospital stay was shortened in group DP ( P<0.05). Conclusions:Driving pressure-guided individualized PEEP ventilation can decrease the risk of severe postoperative pulmonary complications, alleviate postoperative lung injury and provide a certain degree of lung protection in patients undergoing rib fracture surgery.