Objective: To explore the relationship between snack consumption and depressive symptoms in first year junior high school students with different left behind experiences in Yunnan Province, so as to provide a basis for improving depressive symptoms among first year junior high school students with different left behind experiences. Methods: From October to December 2022,a cluster random sampling method was used to select 8 500 first year junior high school students from 11 ethnic minority areas (Fugong County, Longling County, Longyang District, Luchun County, Mojiang County, Nanjian County, Qiaojia County, Shuangjiang County, Tengchong City, Yuanmou County, Zhenyuan County) in Yunnan Province for a questionnaire survey. The Chinese version of Depression Anxiety Stress Scale-21 was applied to assess depressive symptoms in first year junior high school students, and snack consumption was collected by employing food frequency questionnaire. The generalized linear model was used to analyze the association between first year junior high school students snack consumption and depressive symptoms, and the analysis was stratified according to left behind experience. Results: The detection rates of depressive symptoms among firstyear junior high school students with and without left behind experience were 36.25% and 26.91%, respectively. After controlling for confounding variables, the generalized linear model analysis showed that sweet snacks ( β=0.16, 95%CI =0.07-0.25), fast food ( β=0.14, 95%CI =0.04-0.23) and carbonated drinks ( β=0.09, 95%CI =0.01-0.17) of first year junior high school students with left behind experience (all P <0.05). Compared with those without such behavior, the risk of depressive symptoms was higher in consumption of fast food ( β=0.13, 95%CI =0.07-0.18) and carbonated drinks ( β=0.10, 95%CI =0.06-0.15)among first year junior high school students without left behind experience (both P <0.05). Conclusion Snack consumption among first year junior high school students in Yunnan may increase the risk of developing depressive symptoms, while first year junior high school students with left behind experience may have a greater risk of developing depressive symptoms.

OBJECTIVE To predict and validate the mechanisms of Chaiqi yigan granules （CQYG） improving hepatocellular carcinoma （HCC）. METHODS The signaling pathways of CQYG intervention in HCC were predicted using network pharmacology. A mice model of transplanted hepatocellular carcinoma was established by injecting H22 hepatoma cells into the axilla. Successfully modeled mice were randomly divided into model group （normal saline）， sorafenib group （positive control， 50 mg/kg）， and CQYG low-， medium- and high-dose groups （24.83， 49.66， 99.32 g/kg）， with 10 mice in each group. Mice in each group were administered the corresponding drug solution or normal saline intragastrically， once a day， for 14 consecutive days. After last administration， pathological morphological changes in the tumor tissues of mice were observed in each group. Immunohistochemical staining was performed to detect the expression of the nuclear proliferation antigen Ki-67 in tumor tissues of mice. Western blot assay was used to measure the expression of proteins related to epithelial-mesenchymal transition （EMT） [N-cadherin， E-cadherin， Vimentin， matrix metalloproteinase 7 （MMP7）] and the mitogen-activated protein kinase （MAPK） signaling pathway [p38 MAPK， phosphorylated p38 MAPK， c-Jun N-terminal kinase （JNK）， phosphorylated JNK， extracellular regulated protein kinase 1/2 （ERK1/2）， phosphorylated ERK1/2] in tumor tissue of mice. RESULTS Network pharmacology analysis revealed that metabolic pathways， pathways in cancer， and the MAPK signaling pathway were key signaling pathways through which CQYG exert their anti-hepatocellular carcinoma effects. In animal experiments， the tumor tissues of mice in the model group exhibited dense tumor cells and vigorous growth. Compared with model group， CQYG high-dose group showed a decreased density of tumor cells in the tumor tissues of mice. Moreover， the expression levels of Ki-67， N-cadherin， MMP7 and Vimentin proteins， along with the phosphorylation levels of ERK1/2 and JNK proteins， were all significantly reduced （ P ＜0.05）. The expression level of E-cadherin protein was significantly increased （ P ＜0.05）， the phosphorylation level of p38 MAPK protein was increased， the difference was not statistically significant （ P ＞0.05）. CONCLUSIONS CQYG can inhibit EMT by regulating the MAPK signaling pathway， thereby suppressing tumor cell invasion and metastasis and ultimately exerting a therapeutic effect in improving HCC.

ObjectiveHepatocellular carcinoma (HCC) represents 90% of all primary liver cancers. The main risk factors associated with HCC include viral hepatitis (B and/or C), alcohol abuse, and metabolic dysfunction-associated steatotic liver disease (MASLD), which progressively advance to liver fibrosis, cirrhosis, and ultimately evolve into HCC. Surgical resection represents the most effective treatment for HCC, while recent advances in immunotherapy, including immune checkpoint inhibitors and adoptive cell therapies, have provided improved treatment prospects for patients with unresectable HCC. However, the complex metabolic heterogeneity of HCC limits the therapeutic efficacy. Metabolic intermediates acyl-CoA not only provide energy and substrates for numerous biochemical reactions but also serve as donors for protein lysine acylation, a major class of post-translational modification (PTM). Therefore, a deeper understanding of the molecular mechanisms underlying protein lysine acylation and hepatocarcinogenesis is urgently needed. MethodsThe levels of protein lysine acylation and silence information regulator 5 (SIRT5) expression levels in clinical HCC samples were analyzed by Western blot. Quantitative malonylome and succinylome of HCC samples were analyzed by antibody-based affinity enrichment coupled with tandem mass spectrometry. The proliferation of HCC cells was analyzed with Cell Counting Kit-8 (CCK-8) assays, the apoptosis was quantified by Annexin V-FITC/propidium iodide (PI) staining coupled with flow cytometry, and the ability of cells to migrate was assayed by Transwell assays. The enzymatic activity of glutathione S-transferase Mu 1 (GSTM1) was quantified. Transgenic mice with hepatic overexpression of SIRT5 were constructed using CRISPR-Cas9, and primary hepatocarcinogenesis was induced by administration of diethylnitrosamine. ResultsWestern blot analysis indicated that the expression level of SIRT5 was elevated in clinical samples from HCC patients, and the levels of lysine malonylation, glutarylation, and succinylation were significantly reduced in HCC tissues. Knockout of SIRT5 in MHCC-97H and MHCC-97L hepatoma cells suppressed cell proliferation, and increased the percentage of apoptotic cells significantly. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses of the differentially malonylome and succinylome of HCC samples revealed significant enrichment in two major classes of biological processes: core energy metabolism (e.g., glycolysis/gluconeogenesis, tricarboxylic acid metabolic process, fatty acid beta oxidation) and detoxification and oxidative stress response (e.g., response to toxic substance, chemical carcinogenesis, reactive oxygen species (ROS)). SIRT5 removes malonylation from lysine residues in GSTM1 and restores its detoxification activity, which is crucial for the survival of hepatocytes under stressed conditions. More importantly, in vivo experiment indicated that hepatic-specific overexpression of SIRT5 in mice accelerated diethylnitrosamine-induced liver fibrosis and hepatocarcinogenesis, indicating the critical role of SIRT5 in HCC progression. ConclusionThis study highlights the previously unrecognized SIRT5-GSTM1 axis as a key regulator in hepatocarcinogenesis, and suggests a potential target for the treatment of patients with HCC.

Definitive chemoradiotherapy (dCRT) has become a cornerstone in the treatment of locally advanced esophageal cancer; however, local control remains suboptimal, and persistent lesions or locoregional recurrences after treatment are not uncommon. For patients without distant metastases but with local failure, whether surgical intervention can still offer curative potential remains a major clinical dilemma. Salvage esophagectomy (SE) offers potential long-term survival for selected patients, but this procedure is performed in the context of severe fibrosis, impaired local blood supply, and obscured anatomical planes following chemoradiotherapy, resulting in significantly higher perioperative risk compared to primary esophagectomy. Consequently, controversies exist regarding patient selection, preoperative restaging, choice of surgical approach, extent of lymphadenectomy, gastrointestinal reconstruction, and perioperative management. In recent years, with the refinement of restaging modalities such as PET/CT, the accumulation of experience in high-volume centers, and emerging evidence from clinical studies, the clinical role of SE has gradually shifted from a "high-risk salvage measure" to a "selective curative strategy aimed at achieving long-term survival in carefully selected patients". Nevertheless, standardized guidelines for patient selection, technical approaches, and perioperative management are still lacking. Based on current evidence and clinical experience, experts organized by the Integrated Esophageal Cancer Committee of Chinese Anti-Cancer Association systematically reviewed key issues regarding SE, including its definition, indications, preoperative evaluation, choice of surgical approach, lymphadenectomy, gastrointestinal reconstruction, and perioperative management, and formulated a Chinese expert consensus. This consensus aims to provide guidance for standardized assessment, appropriate referral, individualized surgical decision-making, and optimized perioperative management of patients with locoregional failure after dCRT. Ultimately, this will increase the likelihood of R0 resection, reduce the risk of severe complications, and promote the safer, more judicious, and standardized implementation of SE in high-risk scenarios.

Against the backdrop of the rapid development of multicenter and interdisciplinary collaboration in medical research， establishing a standardized and efficient ethical collaborative review and mutual recognition system constitutes not only an urgent priority for advancing multi-institutional joint research but also a crucial measure in response to national policy orientations. Based on Jiangsu Province’s innovative practices in the field of ethical collaborative review， and through an analysis of common challenges in this field globally， this paper systematically put forward implementation strategies to ensure review quality and efficiency. These strategies encompassed establishing a regional ethics alliance to achieve resource integration and constructing supporting legal frameworks to strengthen institutional guarantees. Meanwhile， it was also crucial to enhance team professionalism， optimize multi-party collaboration models， and establish sustainable communication mechanisms， ultimately forming a scalable collaborative development framework for ethical review. The research outcomes can provide decision-making references and operational paradigms for the optimization and upgrading of the cross-institutional medical research ethics management system in China.

Objective:To evaluate the clinically curative effect of intervention treatment of electronic bronchoscope in treating tracheobronchial tuberculosis at clinical activity stage.Methods:Sixty patients with tracheobronchial tuberculosis at clinical activity stage(type I,II,III and VI)who admitted to Liuzhou People's Hospital from September 2020 to September 2023 were selected,and they were divided into drug group(anti-tuberculosis drug treatment)and combination group(anti-tuberculosis drug treatment+interventional treatment with electronic bronchoscope)by the random number table method,with 30 cases in each group.The curative effects of the two groups were observed,and the negative conversion rate of sputum bacteria,clinical symptom scores(cough symptom,expectoration symptom)before and after treatment,Modified British Medical Research Council Dyspnea Scale(mMRC)score between two groups were compared,and the differences in indicators of pulmonary function such as forced expiratory volume in the first second(FEV1),forced vital capacity(FVC)and maximum voluntary ventilation(MVV)between the two groups also were compared.And then,the incidence of complications was calculated.Results:During the 1,2 and 3 months of follow-up,there were respectively 21 cases,27 cases and 30 cases occurred negative conversion of sputum bacteria in 30 patients of the combination group,and there were respectively 15 cases,18 cases and 23 cases occurred negative conversion of sputum bacteria in 30 patients of the drug group.At the 1st month of follow-up,the negative conversion rate of sputum bacteria in combination group was higher than that in drug group,while there was no statistically significant difference between the two groups(P＞0.05).At the 2nd and 3rd month of follow-up,the negative conversion rate of sputum bacteria in the combination group was higher than that in the drug group,and the differences were statistically significant(x2=7.200,7.925,P<0.05).The effective rate of treatment of the combination group was 100%,which was higher than 80%of the drug group,and the difference of that between two groups was significant(x2=6.667,P<0.05).After 2 months of treatment,the mMRC score,cough symptom score and expectoration symptom score of the combination group were all lower than those of the drug group,and the differences were statistically significant(t=3.504,3.950,3.530,P<0.05).The improvement effects of FEV1,FVC and MVV of the combination group were all better than those of the drug group,and the differences were statistically significant(t=6.626,4.966,4.097,P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion:Anti-tuberculosis drug therapy combined with electronic bronchoscopy intervention has a good therapeutic effect in clinically active tracheobronchial tuberculosis.

Objective:To study the prevalence and spatio-temporal distribution characteristics of Keshan disease in Qingyang City, Gansu Province, and provide scientific basis for formulating targeted prevention and control strategies and optimizing resource allocation.Methods:The data of patients with Keshan disease from January 2022 to December 2024 were obtained from the Qingyang Center for Disease Control and Prevention, and the population data were obtained from the Statistics Bureau of Qingyang City. Global and local spatial autocorrelation analysis was performed using GeoDa 1.16.0 software to identify four spatial clustering areas: high-high, low-low, low-high, and high-low. Spatio-temporal aggregation analysis was conducted using SaTScan 10.1.3 software.Results:The prevalence rates of Keshan disease in Qingyang City from 2022 to 2024 were 7.11/100 000, 6.68/100 000, and 6.14/100 000, respectively. Global spatial autocorrelation analysis showed that the prevalence rates of Keshan disease in Qingyang City from 2022 to 2024 showed a positive spatial correlation (Moran′s I > 0, Z > 1.96, P < 0.05), with the highest spatial correlation in 2024 (Moran′s I = 0.46, Z = 8.02, P = 0.001). Local spatial autocorrelation analysis showed that from 2022 to 2024, the number of townships (towns) exhibiting high-high clusters of Keshan disease in Qingyang City was 15, 11, and 11, respectively. These clusters were primarily concentrated in the southeastern townships (towns) of Qingyang City that boder the Ziwu Mountain. Low-low clusters were primarily concentrated in most townships (towns) of Zhenyuan County and Xifeng District of Qingyang City, as well as some townships (towns) in the northwest of Huachi County. Spatio-temporal scanning analysis showed that the high prevalence rate cluster was concentrated in 2022, covering 44 townships (towns) in 5 counties, mainly distributed in the southeast of Qingyang City. The low prevalence rate cluster was concentrated in 2024, covering 26 townships (towns) in 3 counties (districts), and distributed in the western of Qingyang City. Conclusion:There is a significant spatial clustering of Keshan disease in Qingyang City, and the high prevalence rate cluster is located in the southeast of Qingyang City, which is a key area for prevention and control of Keshan disease in the future.

Objective To explore the effects of different concentrations of simvastatin on nerve regeneration after sciatic nerve injury.Methods Rats were randomly divided into the normal group,the control group,the low-dose group and the high-dose group,with 3 rats in each group.Except for the normal group,adult rat sciatic nerve crush injury models were established in the other groups.Rats in the normal group and the control group were orally administered with water,while those in the low-dose group and high-dose group were orally administered with 98%simvastatin at dosages of 4 mg/mL and 40 mg/mL,respectively.The sciatic nerve regeneration in rats was evaluated by sciatic function index(SFI),HE staining,luxol fast blue(LFB)staining and immunofluorescence staining,etc.Results The SFI of rats in the high-dose group 7 days and 14 days after surgery were higher than those in the control group(P<0.05);there was no significant difference in SFI of rats between the low-dose group and the control group 7 days and 14 days after surgery(P>0.05).HE staining and LFB staining results showed that compared with the control group,the number of neurons of rats in the high-dose group increased,the nerve fibers and myelin were clearer and denser,and the nerve function was significantly restored;while no significant improvement was observed in the sciatic nerve of rats in the low-dose group.The immunofluorescence staining results showed that compared with the control group,the immunofluorescence intensity in the high-dose group increased,while that in the low-dose group decreased,the differences were statistically significant(P<0.05).Conclusion High-dose simvastatin can promote peripheral nerve regeneration by regulating the expression of M2 macrophages.

Objective To investigate the correlation between serum ferritin(SF)and 25-hydroxyvitamin D[25-(OH)D]and cervical vascular plaque and cardiac metabolism index(CMI)in elderly patients with nonal-coholic fatty liver disease(NAFLD).Methods 128 elderly patients with NAFLD in the hospital were selected as study group,and 80 healthy subjects with physical examination were included in control group.The levels of SF and 25-(OH)D were compared between study group and control group and among patients with different lesion degrees.According to the presence or absence of formation of carotid artery plaque,the patients were classified into plaque group(n=36)and non-plaque group(n=92),and the clinical data,SF,25-(OH)D and CMI were compared.The multiple factors affecting the cervical vascular plaque formation in elderly patients with NAFLD and the correlation of SF and 25-(OH)D levels with cervical vascular plaque and CMI were analyzed.Results Serum SF in study group was significantly higher than that in control group(P<0.05)while 25-(OH)D level was signifi-cantly lower than that in control group(P<0.05).SF level was manifested as fatty liver groupsteatohepatitis group>liver cirrhosis group(P<0.05).The BMI,diabetes mellitus,hyperlipidemia,serum ALT,AST,LDL-C,SF,FPG,FINS,HOMA-IR,CMI and NFS in plaque group were significantly higher than those in non-plaque group(P<0.05)while serum 25-(OH)D level was significantly lower than that in non-plaque group(P<0.05).Multi-variate Logistic regression analysis showed that increased BMI,serum LDL-C,SF,CMI and NFS were risk factors for carotid artery plaque formation in elderly patients with NAFLD(P<0.05),and serum 25-(OH)D level was a protective factor(P<0.05).Correlation analysis showed that SF was positively correlated with carotid artery plaque and CMI in NAFLD patients(P<0.05),and serum 25-(OH)D level was negatively correlated with carotid artery plaque and CMI(P<0.05).Conclusion Serum SF and 25-(OH)D are related to the progression of NAFLD,and may affect the cervical vascular plaque formation and cardiac metabolism.Serum SF and 25-(OH)D can be used as observation indicators for the diagnosis and treatment of vascular lesions in patients with NAFLD.

Objective:To investigate the disparities in breast cancer burden and changing epidemiological trends between China and the United States(US)from 1990 to 2021 and identify the key driving factors.Methods:The Global Burden of Disease database(1990-2021)was utilized to analyze breast cancer incidence,mortality,and disability adjusted life years(DALYs)in China and the US;we also assessed the as-sociations with risk factors(e.g.,obesity and smoking)through regression models and spatiotemporal analysis.Results:China's breast can-cer age-standardized incidence rate(ASIR)surged from 9.08/100,000 in 1990 to 19.36/100,000 in 2021,whereas the US ASIR declined from 44.37/100,000 to 37.49/100,000.Regarding the age-standardized mortality rate(ASMR),China saw a marginal reduction from 4.70/100,000 to 4.40/100,000,whereas the US experienced a significant decline from 13.03/100,000 to 9.28/100,000,narrowing the mortality gap from 2.8-fold to 2.1-fold.Key risk factors contributing to mortality and DALYs included smoking,exposure to secondhand smoke,low physical activity,high red meat and alcohol intake,elevated fasting blood glucose levels,and high body mass index.The rising cancer incidence in China is associated with the westernization of lifestyles and changes in fertility patterns,whereas the United States has achieved a dual de-cline in both incidence and mortality rates through widespread screening and control of hormone replacement therapy.Conclusions:Both the incidence and mortality rates of breast cancer in China rank among the highest globally,with incidence rates still increasing,indicating severe issues in prevention and control.In contrast,although the incidence rate in the US is higher than that in China,it shows a declining trend.To alleviate the growing burden of breast cancer,China must further enhance the intensity and coverage of breast cancer screening.