Objective: To explore the association between the cumulative effect of body mass index (BMI) in childhood and the frequency of elevated blood pressure and cumulative burden of blood pressure, so as to provide a basis for preventing high blood pressure in children. Methods: Data were derived from the "Cardiometabolic Risk Cohort Study" conducted from 2012 to 2018, which included all students from three nine year schools (comprising primary and secondary school) in Zigong City. A total of 1 583 students with normal blood pressure at baseline were included in the study. Questionnaires and physical examinations were administered to collect demographic information, BMI, systolic blood pressure (SBP), and diastolic blood pressure (DBP). Follow up surveys were conducted annually. To measure cumulative effects, the total area under the BMI curve (BMI-AUCt), cumulative burden of SBP (CB-SBP), and cumulative burden of DBP (CB-DBP) were calculated using the trapezoidal rule. Multinomial Logistic regression models were employed to analyze the relationship between BMI-AUCt and the frequency of elevated blood pressure during the follow up period. Additionally, multiple linear regression models combined with restricted cubic splines (RCS) were used to explore the dose response relationships of BMI-AUCt with CB-SBP and CB-DBP, respectively. Results: At baseline, the median ( IQR ) values for BMI, SBP and DBP of the students were 15.0(14.2, 16.1) kg/m 2 ，89.0(87.0, 90.0) mmHg and 58.0(54.0, 60.0 ) mmHg, respectively. During follow up, the median( IQR ) BMI, SBP and DBP for students with 0, 1 and ≥2 occurrences of high blood pressure were: 14.8(14.0, 15.9), 15.2(14.3, 16.3), 15.8(14.9, 17.0) kg/m 2; 89.0(87.0, 90.0),89.0(87.0,90.0), 89.0(87.0, 90.0)mmHg; 58.0(54.0, 60.0), 58.0(54.0, 59.5), 59.0(56.0, 59.0) mmHg. Results from the multinomial Logistic regression model, after adjusting for baseline age, sex, school, overweight/obesity status and number of measurements showed that compared to students with 0 occurrence of high blood pressure during follow up, for every 1 unit increase in BMI-AUCt, the risk of having 1 occurrence and ≥2 occurrences of high blood pressure increased by 4%( OR =1.04) and 6%( OR =1.06), respectively(both P <0.05). Multiple linear regression combined with restricted cubic splines(RCS) revealed non linear dose response relationships between BMI-AUCt and both CB-SBP and CB-DBP(all P trend <0.01, all P non linearity <0.01). Specifically, BMI-AUCt was positively correlated with CB-SBP when BMI-AUCt exceeded 30.08 kg/m 2×year( β =0.13) and with CB-DBP when BMI-AUCt exceeded 48.41 kg/m 2×year( β =0.12)(both P <0.01). Conclusions Children with a higher cumulative BMI may face an increased risk of cumulative blood pressure burden. It is necessary to enhance dynamic monitoring of children s BMI and blood pressure for reducing the risk of elevated blood pressure in childhood.

The shortage of donor organs is the primary factor limiting the availability of liver transplantation (LT) and is a leading cause of death among patients on the waiting list. The reuse of liver allografts, while rare, represents a significant and unconventional donor resource, offering a promising strategy to expand the donor pool. This approach has been documented in international literature, demonstrating favorable surgical outcomes and long-term follow-up results. Here, we report the first case of liver allograft reuse in the Liver Transplantation Center, Department of General Surgery, Huashan Hospital, Fudan University. In this case, the first recipient underwent orthotopic LT for acute liver failure and hepatic encephalopathy. However, their condition deteriorated on the seventh postoperative day, culminating in brain death. Following evaluation and maintenance, the liver allograft was successfully re-transplanted into a second recipient, who had undergone LT six days earlier but experienced acute hepatic artery embolism leading to rapid liver function deterioration. The second recipient's liver function recovered smoothly after surgery, and they were discharged on the 28th postoperative day. This case highlights the significant value of liver allograft reuse in expanding the donor pool and providing life-saving options for critically ill patients requiring urgent LT.

The shortage of donor organs is the primary factor limiting the availability of liver transplantation (LT) and is a leading cause of death among patients on the waiting list. The reuse of liver allografts, while rare, represents a significant and unconventional donor resource, offering a promising strategy to expand the donor pool. This approach has been documented in international literature, demonstrating favorable surgical outcomes and long-term follow-up results. Here, we report the first case of liver allograft reuse in the Liver Transplantation Center, Department of General Surgery, Huashan Hospital, Fudan University. In this case, the first recipient underwent orthotopic LT for acute liver failure and hepatic encephalopathy. However, their condition deteriorated on the seventh postoperative day, culminating in brain death. Following evaluation and maintenance, the liver allograft was successfully re-transplanted into a second recipient, who had undergone LT six days earlier but experienced acute hepatic artery embolism leading to rapid liver function deterioration. The second recipient's liver function recovered smoothly after surgery, and they were discharged on the 28th postoperative day. This case highlights the significant value of liver allograft reuse in expanding the donor pool and providing life-saving options for critically ill patients requiring urgent LT.

Objective To investigate the mechanism and clinical significance of miR-18a-5p and retinoid acid receptor-related orphan receptor-α(RORA)in the proliferation and progression of colorectal cancer(CRC)cells.Methods The expressions of miR-18a-5p and RORA in CRC cells and tissues were detected via qRT-PCR,FISH,and IHC.Cell proliferation capability was detected through EdU and CFSE assay,cell apoptosis by flow cytometry assay,and cell migration and invasion abilities by cell scratch and Transwell invasion assays,respectively.The targeted regulation of miR-18a-5p on RORA was further verified via dual-luciferase reporter assay,cell function rescue test,RT-PCR,and Western blot assay.Finally,bioinformatics was used to explore the molecular mechanism of miR-18a-5p promoting malignant proliferation,invasion,and progression of CRC via regulating RORA.Results miR-18a-5p exhibited a high expression in CRC tissues and cells(P<0.05)and promoted the proliferation,migration,and invasion of CRC cells(P<0.05).In addition,RORA served as the target gene of miR-18a-5p,and its overexpression effectively reduced the promoting function of miR-18a-5p in the malignant biological phenotype of CRC cells(P<0.05).The expression of RORA in CRC tissues showed a significantly positively correlation with the infiltration of CD8+T cells and the expression of its surface marker protein CD8A.Conclusion The targeted regulation of RORA by miR-18a-5p promotes the proliferation and progression of CRC.The miR-18a-5p/RORA regulatory pathway possibly contributes to the immune microenvironment of CRC,which can be a potential therapeutic target for CRC.

Objective: To assess the association of adverse experiences and subsequent incidence of depressive symptoms among middle school students in Liangshan, so as to provide a basis for preventing the occurrence of depression symptoms among middle school students. Methods: In October 2021, a convenient sampling combined with cluster random sampling method was employed to select 888 students from three high schools (junior first year and second year, senior first year) in Liangshan for a questionnaire survey. In March 2023, a followup survey was conducted to collect data on adverse experiences (such as school bullying, domestic violence, and lack of parental understanding). Depressive symptoms were assessed using the Chinese version of the Center for Epidemiologic Studies Depression Scale (CES-D). Logistic regression model analysis was used to examine the relationship between the number of adverse experiences at baseline and the incidence of depressive symptoms during the followup period. Results: The detection rate of depressive symptoms among middle school students was 9.4% at followup. School bullying (OR=2.26, 95%CI=1.37-3.73), domestic violence (OR=2.56, 95%CI=1.55-4.21), and lack of parental understanding (OR=1.91, 95%CI=1.15-3.16) at baseline were positively associated with the incidence of depressive symptoms at followup (P<0.05). Compared with participants with no adverse experiences at both baseline and followup, those with adverse experiences at both baseline and followup were more likely to exhibit depressive symptoms at followup, regardless of the type of adverse experiences (P<0.01). The incidence of depressive symptoms increased with the increase of baseline adverse experiences (P<0.01). Compared to the participants with no adverse experiences at both baseline and followup, those with adverse experiences at baseline but not at followup did not show a statistically significant difference in the likelihood of developing depressive symptoms at followup (OR=0.78, 95%CI=0.13-4.80, P>0.05). Conclusions Adverse experiences increase the risk of developing depressive symptoms among middle school students. Participants who have reversed adverse experiences show no increased risk of depressive symptoms compared to those with no adverse experiences. Measures should be taken to prevent the occurrence of depression symptoms among middle school students based on their adverse experiences during their middle school years.

A 62-year-old man with hepatocellular carcinoma began to take tyrosine kinase inhibitor(TKI)lenvatinib orally.After taking the medicine for a week,the patient developed watery diarrhea 2 to 3 times a day.The patient received the first dose of tislelizumab.After 20 days,the patient's diarrhea worsened,nearly 40 times a day.Lenvatinib was discontinued and the second dose of tislelizumab was received,while the diarrhea was not significantly relieved.Treatments were given upon the symptoms and diarrhea was alleviated so that lenvatinib was restarted,diarrhea aggravated again and the drug was discontinued.Acute colitis complicated with colon erosion was diagnosed by colonoscopy which was presumed to be immure-associated colitis caused by programmed cell death protein 1(PD-1).The patient was admitted to hospital for liver transplantation.After the administration of immunosuppressive drugs against graft rejection,the diarrhea gradually cleared.Diarrhea caused by anti-PD-1 antibody is usually mild.In this case,mild diarrhea caused by TKI developed rapidly into severe colitis after the first dose of anti-PD-1 antibody.Mechanism of the increasing rate of adverse effect caused by the combined use of TKI and anti-PD-1 antibodies worth further discussion.

Objective:To describe functional disability rate of anxiety disorders in Chinese community adults and explore related risk factors of functional disability.Methods:To conduct in-depth data analysis on China Mental Health Survey(CMHS).The diagnostic tool for anxiety disorders was the Composite International Diagnostic Inter-view-3.0,according to the Diagnostic and Statistical Manual for Mental Disorders,Fourth Edition(DSM-Ⅳ).The World Health Organization Disability Assessment Schedule,2nd edition,was the functional disability assessment standard for anxiety disorders.Weighted 12-month functional disability rate of DSM-Ⅳ anxiety disorder with co-morbidities and only anxiety disorder in population and those in patients,as well as days of partial disability were calculated.The effects of anxiety disorders comorbid other mental disorders and physical diseases and demographic factors on the severity and occurrence of functional disability were analyzed by multiple linear regression and logis-tic regression.Results:The functional disability rate of anxiety disorder with comorbidities in population was 1.7％,and 42.2％in patients,in which constituent rate of grade-four disability was the highest as 84.1％.The functional disability rate of only anxiety disorder in population was 0.3％,and 17.8％in patients.The medians of days of partial disability days in the past 30 days were from 0 to 14.42.Multiple linear regression showed a positive association between comorbid anxiety disorder with other mental disorders and physical diseases(β=0.24),comor-bid other mental disorders and physical diseases(β=0.21),physical diseases(β=0.18),comorbid anxiety disor-der and physical diseases(β=0.15),comorbid anxiety disorder with other mental disorders(β=0.08),other men-tal disorders(β=0.07),only anxiety disorder(β=0.06),lower education level(β=0.12),lower economic status(β=0.08),older age(β=0.06),non-marital status(β=0.06),male(β=0.02)and the severity of functional dis-ability.Logistic regression showed that comorbid anxiety with other mental disorders and physical diseases(OR=64.07),comorbid anxiety disorders with other mental disorders(OR=36.75),comorbid other mental disorders with physical diseases(OR=20.60),comorbid anxiety with physical diseases(OR=18.88),anxiety disorder(OR=9.20),other mental disorders(OR=6.65),physical diseases(OR=4.00),65 years old and over(OR=4.40),50 to 64 years old(OR=2.33),low economic status(OR=2.10),illiterate and below primary school educational level(OR=1.89),middle economic status(OR=1.70),elementary school educational level(OR=1.59),non-marital status(OR=1.47),male(OR=1.16)were the risk factors of the occurrence of functional disability.Conclusion:Comorbidity of anxiety disorders and other mental disorders,and physical diseases increases severity and occurrence of functional disability.Comorbidity,male,gender,older age,lower economic and educa-tional level and non-marital are risk factors of anxiety disorder functional disability.

Objective:To describe disability rates of dementia in community residents aged 65 years and over in China,and explore related risk factors of disability.Methods:This study conducted an in-depth data analysis of the China Mental Health Survey.World Health Organization Disability Assessment Schedule 2.0(WHODAS 2.0)was used to assess dementia disability,Community Screening Interview for Dementia(CSID)and Geriatric Mental Status Examination(GMS)were used for dementia screening and diagnosing.Univariate analysis was used to calcu-late the weighted disability rates of dementia in population and in patients,and their population distribution.Multiple linear regression and logistic regression were used to analyze the risk factors of the occurrence of dementia disability and its severity.Results:The weighted disability rate of dementia was 2.1％in population,and 38.6％in pa-tients.The disability rates of comorbid dementia in population and in patients were higher than those of patients with only dementia.Female,older age,lower education level,lower economic status,and lower cognitive test scores in CSID had higher disability rates of dementia in population.Female and urban resident had higher disability rates of dementia in patients.Multiple linear regression showed economic status(β=0.11),gender(β=0.11),age(β=0.10),and treatment in the last 12 months(β=-0.20)were statistically associated with WHODAS 2.0 scores.Multiple logistic regression showed female(OR=2.81)and treatment in the last 12 months(OR=2.38)were statistically associated with disability.Conclusions:Persons with low economic status,female and elderly peo-ple are the high-risk groups for dementia disability.It should be paid attention to prevent dementia and its conse-quential disabilities.

Objective:To characterize the injury to the ipsilateral ankle joint after low energy spiral fracture of the distal tibia.Methods:A retrospective study was conducted to analyze the 80 patients with distal tibial spiral fracture who had been treated at Department of Traumatic Orthopedics, Affiliated Hospital of Jining Medical University from March 2010 to March 2021. There were 61 males and 19 females with an age of (43.5±12.5) years. Their mean follow-up time was 67.0 (38.5, 90.0) months. All patients underwent preoperative X-ray examination, 64 ones preoperative CT examination, and 30 ones preoperative MRI examination. Of the 80 patients, 3 received conservative treatment with plaster external fixation, 3 closed reduction and intramedullary nail fixation, and 74 plate fixation. Statistically analyzed were incidence of posterior malleolus fracture, characteristics of posterior malleolus fracture lines, normal matching rate of the ipsilateral ankle joint, positive rate of intraoperative Cotton test or stress external rotation test of ipsilateral ankle joint, positive rates of passive pronation-external rotation and supination-external rotation stress tests during follow-up, incidences of short-term ankle pain (≤2 years) and medium-long term pain (>2 years) after operation, injuries to the anterior inferior tibiofibular ligament, the deep medial malleolus deltoid ligament and the posterior malleolus, and incidence of ankle injury.Results:The diagnostic rate for posterior malleolus fracture was 16.3% (13/80) on X-ray film, 60.9% (39/64) on CT and 76.7% (23/30) on MRI. 74.5% (35/47) of the posterior malleolus fracture lines opened on the lateral side. The normal matching rate of the ipsilateral ankle joint was 96.3% (77/80). The positive rates of intraoperative Cotton test and stress external rotation test were 34.8% (8/23) and 7.1% (1/14), respectively. The positive rates of passive pronation-external rotation and supination-external rotation stress tests during follow-up were 46.2% (12/26) and 34.6% (9/26). The incidences of postoperative short term (≤2 years) and medium-long term (>2 years) ankle pain were 37.7% (29/77) and 20.8% (16/77). MRI examination showed that the rates of injury to the anterior inferior tibiofibular ligament, deep medial malleolus deltoid ligament and posterior malleolus were 80.0% (24/30), 80.0% (24/30) and 76.7% (23/30). The incidence of ankle injury was 88.8% (71/80).Conclusions:It is highly probable that spiral fracture of the distal tibia is complicated with ipsilateral ankle injury. The medial malleolus, lateral malleolus, and posterior malleolus are prone to the following hidden injuries while the ankle joint is normally matched in the most cases: injury to the deep deltoid ligament in different degrees, rupture of the inferior tibiofibular anterior ligament and posterior malleolus fracture. Therefore, the ankle injury is likely to be missed in diagnosis. The secondary torsion injuries to the pronation-external rotation and supination-external rotation at the leg are likely to cause ipsilateral ankle injury.

The passing of ethical review is a necessary conditions and prerequisite for the development of life science and medical research involving humans. At present, some medical and health institutions have no or insufficient ethical review capabilities. The lack of ethical review ability has become a bottleneck restricting the development of life science and medical research involving humans. According to documents such as Opinions on Deepening the Reform of the Review and Approval System and Encouraging the Innovation of Pharmaceutical and Medical Devices, Opinions on Strengthening the Ethical Governance of Science and Technology, institutions can entrust competent institutional ethics review committees or regional ethics review committees in writing to conduct ethical review. Entrustment ethical review provides a viable solution for institutions that need to carry out life science and medical research involving humans but do not have an ethics (review) committee or the ethics (review) committee is not competent to review. To conduct the entrustment ethical review, the entrustment between the principal and the trustee is required. According to The Measures for Ethical Review of Life Sciences and Medical Research Involving Humans, if medical and health institutions and their ethical review committees do not accept the formal entrustment to provide the ethical review opinions for other institutions, the local health authorities at or above the county level will impose administrative penalties and sanctions on the relevant institutions and personnel in accordance with the law. Signing the entrustment ethical review contract, implementing legal compliance entrusted ethical review to protect the rights and interests of the trustee and the principal, and protect the research participants.