Objective: To identify research priorities on physical and mental comorbidity among children and adolescents in Zhejiang Province, so as to provide a theoretical base for improving their physical and mental health. Methods: In May 2025, 77 experts in the fields of health and education from 11 cities in Zhejiang Province were selected by convenient sampling method to participate in the first round of expert consultation. In June, 2025, snowball sampling was used to expand to 194 experts for the second round of consultation, and it was convenient to select 21 students from primary schools to high schools in Zhejiang Province and 29 parents to empower the evaluation criteria. It applied the Child Health and Nutrition Research Initiative (CHNRI) method in a structured process, which encompassed the definition of the research field, generation of research ideas, scoring, and quantitative ranking of priorities. Research ideas were evaluated against 6 predefined criteria: effectiveness, safety, answerability, feasibility, sustainability, and scientific significance. Results: After 2 rounds of structured consultations, 81 research ideas on physical and mental comorbidity among children and adolescents were established and classified into 7 subthemes: epidemiological characteristics and influencing factors, optimization of primary service systems and policies, comprehensive intervention strategies for physical and mental comorbidity, biological mechanisms and clinical research, the impact of education and environment on physical and mental health, special populations and social support, and digital and technology driven disease prevention and intervention. The top 10 research priorities primarily centered on the subdomain of "epidemiological characteristics and influencing factors" (5 items). The top 3 research priorities were "the association between outdoor activity duration and the incidence of common diseases (including mental disorders) among children and adolescents" "the impact of outdoor activity duration on the physical and mental health of adolescents" "comprehensive intervention strategies for myopia, obesity, and their comorbidities among children and adolescents". Conclusion The framework of priority issues in the field of psychosomatic comorbidity of children and adolescents in Zhejiang Province based on CHNRI method provides a reference for optimizing the allocation of provincial research resources.

ObjectiveTo explore the vascular endothelial injury in male mice caused by exposure to polystyrene microplastics （PS-MPs） and the intervention effect of luteolin on vascular remodeling. Additionally， to investigate the mechanism through the oxidative system and metabolomics. MethodsThirty-two C57BL/6 mice （6-8 weeks old） were randomly divided into the saline group （saline group）， the 0.1 mg/kg PS-MPs exposure group （0.1PS-MPs group）， the 1 mg/kg PS-MPs exposure group （1PS-MPs group）， and the 1 mg/kg PS-MPs + luteolin treatment group （1PS-MPs + Lut group）， with 8 mice in each group. After 8 weeks of intervention， the body weight， blood pressure， aortic organ coefficient， and aortic histopathological changes of mice in each group were detected； the total cholesterol （TC）， triglyceride （TG）， and high-density lipoprotein cholesterol （HDL-C） lipid metabolism-related indicators in the aorta of mice were detected； the reactive oxygen species （ROS）， glutathione （GSH）， and malondialdehyde （MDA） oxidative stress-related indicators were detected； the endothelin （ET-1）， nitric oxide （NO）， vascular endothelial growth factor A （VEGF-A）， vascular cell adhesion molecule-1 （VCAM-1/CD106）， and intercellular adhesion molecule-1 （ICAM-1/CD54） endothelial function-related indicators and serum metabolomics were detected. ResultsCompared to the saline group， exposure to PS-MPs resulted in pathological thickening of the mouse aorta， increased aortic organ coefficient， and elevated blood pressure. Lipid metabolism-related indicators， including TC and TG， were elevated， while HDL-C was reduced， indicating lipid metabolism disorder in mice. Oxidative stress markers such as ROS and MDA increased， whereas GSH decreased， demonstrating oxidative damage. Vascular endothelial inflammation and injury markers， including ET-1， VEGF-A， VCAM-1， and ICAM-1， were upregulated， while the vasodilatory substance NO was downregulated， confirming endothelial injury. Furthermore， serum metabolomics results revealed that PS-MPs exposure induced endothelial damage by disrupting metabolic pathways such as the citrate cycle. Compared to the PS-MPs group， luteolin significantly reversed these effects， attenuating oxidative stress and lipid metabolism disorders， and effectively repairing endothelial injury. ConclusionPS-MPs induce vascular toxicity through oxidative stress and lipid metabolism. Luteolin effectively alleviates endothelial damage and vascular remodeling.

Objective To describe the clinical characteristics and nutritional management status of hospitalized elderly patients with multimorbidity in a tertiary hospital's geriatric center in 2024, and to analyze the correlation between nutritional status and hospitalization outcomes, thereby providing a basis for optimizing nutritional management pathways for this population. Methods A retrospective study was conducted, including 2 937 elderly patients with multimorbidity. Data on general information, clinical indicators, nutritional risk screening and assessment, nutritional therapy, and costs were collected for descriptive analysis. The relationship between nutritional status (based on BMI and serum albumin levels) and hospitalization outcomes was explored. Results The average age of the patients was (77.45±10.70) years, with 57.17% being male. The average number of chronic diseases diagnosed was (11.56±5.08) per patient, and 26.01% were critically ill. The nutritional risk screening rate was 80.40%, with a screening positivity rate of 33.44%. The nutritional assessment rate was 31.63%, and the malnutrition prevalence was 23.08%. The low BMI group had the longest median hospital stay [15 (9.75, 22) days] and the highest hospitalization costs [15 057.2 (8 980.48, 28 160.46) CNY]. Serum albumin levels were negatively correlated with hospital stay duration (rs=-0.276, P< 0.01) and hospitalization costs (rs=-0.276, P<0.01). Conclusion Hospitalized elderly patients with multimorbidity are characterized by multiple comorbidities and high healthcare resource consumption. While the nutritional risk screening rate is relatively high, there remains room for improvement in nutritional assessment and therapy. It is necessary to strengthen standardized management throughout the entire process. Nutritional status is a significant variable affecting hospital stay duration and costs, with poorer nutritional status significantly associated with prolonged hospitalization and higher costs, suggesting that it may be an important factor influencing hospitalization outcomes.

AIM:To investigate the preventive and therapeutic effects of sesamin(SES)on fatty liver disease in rats with hypertension combined with dyslipidemia,and to explore the potential mecha-nisms based on mRNA-seq.METHODS:Spontane-ously hypertensive rats(SHRs)were fed a high-fat,high-cholesterol diet to establish a rat model of hy-pertension combined with dyslipidemia,and then treated with SES for 16 weeks continuously.The ex-periment was divided into four groups:WKY,SHR,Model,and Model+SES(160 mg·kg-1·d-1).Blood pressure was measured using the tail-cuff method.Body weight was monitored,and body mass index was calculated.Liver morphology was detected by ultrasound,and liver thickness was measured.Liver wet weight was weighed,and liver index was calcu-lated.Liver volume was detected by the water dis-placement method.Serum triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),alanine aminotransferase(ALT),aspartate amino-transferase(AST),and total bile acids(TBA)were de-tected by ELISA.Liver sequencing analysis was per-formed using mRNA-seq.Liver histomorphological changes were observed by HE staining.The degree of hepatic steatosis was observed by Oil Red O stain-ing,and the degree of hepatic fibrosis was observed by MASSON staining.The mRNA expression of Al-dh1a7,Nnmt,Irs2,Pltp,and Scd was detected by q-PCR.The protein expression of Scd,Nnmt,AMPK,p-AMPK,PPARα,and PPARγ was detected by Western blotting.RESULTS:After 16 weeks of continuous SES administration to rats with hypertension combined with dyslipidemia,blood pressure was significantly reduced(P＜0.01),and body weight was decreased.Serum TG,TC,and LDL-C levels were decreased,while HDL-C levels were increased.Serum ALT and AST levels were decreased.Liver weight,organ in-dex,liver thickness,and liver volume were de-creased.The degree of hepatic steatosis and hepat-ic fibrosis was improved.A total of 545 differentially expressed mRNAs were identified in the livers of rats in each group,of which 278 were upregulated and 267 were downregulated.Among the 27 com-monly differentially expressed mRNAs,five mRNAs related to lipid metabolism were screened,namely Aldh1a7,Nnmt,Irs2,Pltp,and Scd.KEGG enrich-ment analysis showed that the enriched pathways were AMPK and PPAR.Further validation revealed that in the SES-treated group,the mRNA expression of Scd in the liver was decreased,while the mRNA expression of Nnmt was increased.The protein ex-pression of Scd was decreased,while the protein ex-pression of Nnmt,AMPK,p-AMPK,PPARα,and PPARγ was increased.CONCLUSION:SES has preven-tive and therapeutic effects on fatty liver disease in rats with hypertension combined with dyslipidemia,and its mechanism of action may be related to the reduction of Scd expression levels in the liver and the increase in the expression of Nnmt,AMPK,p-AMPK,PPARα,and PPARγ.

Barrett's esophagus(BE),a precancerous state of esophageal adenocarcinoma,poses a major challenge for prevention and treatment owing to its complex mechanism of inflammation-cancer transformation and the lack of effective clinical treatment and torsion strategies.Building upon the"preventing disease progression"theory,this study aimed to address the critical clinical challenge of intercepting the pathological progression during the inflammation-cancer transformation of BE by proposing an innovative"two critical nodes-three stages"pathomechanism framework.The pathogenesis of BE originates from liver depression and qi stagnation.The pathological progression evolves through two critical nodes:liver depression transforming into heat and heat transforming into blood stasis,representing a three-stage evolutionary pattern of qi stagnation,heat transformation,and blood stasis formation.Acidic bile salts,acting as a pathogenic toxin,permeate the entire process and catalyze carcinogenesis.Based on this understanding,the therapeutic principles of"treatment from the liver"and"truncation and torsion"were established,emphasizing stage-specific interventions.For the qi stagnation stage,treatment focuses on soothing the liver and regulating qi,as well as moistening,harmonizing,and descending the qi.This is achieved by combining modified Chaihu Shugan Powder with Xuanfu Daizhe Decoction,while using pungent and drying herbs cautiously and supplementing them with light and floral herbs.In the heat transformation stage,the strategy aims to clear the liver and drain heat while protecting yin and harmonizing the stomach,employing modified Huaganjian combined with Yiguanjian and supplemented with Jinlingzi Powder to clear depressed fire.For the blood stasis formation stage,treatment involves activating blood and resolving stasis,combined with supporting healthy qi and removing toxins.This is achieved using a modified Gexia Zhuyu Decoction,supplemented with Liujunzi Decoction,and additions such as Radix Salviae Miltiorrhizae and turtle carapace to disperse nodules and reduce masses.This theoretical framework establishes a diagnostic and therapeutic model characterized by the integration of disease mechanisms with pathology and the mutual reference of macro-level signs with micro-level indicators.It provides a comprehensive clinical practice pathway,complete with principles,methods,formulas,and herbs,for the stage-specific interception of inflammation-cancer transformation in BE using traditional Chinese medicine.

Objective:To evaluate the clinical value and safety of an intraperitoneal chemotherapy port technique in patients with gastric cancer and peritoneal metastases undergoing intraperitoneal chemotherapy.Methods:This was a retrospective, descriptive case analysis. From November 2022 to October 2024, patients diagnosed with gastric cancer and peritoneal metastases at Wuxi Branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine with an expected survival >3 months, underwent laparoscopic exploration combined with implantation of an intraperitoneal chemotherapy port [PORT-A-CATH II system (Model 21-4055-24)] implantation. The procedure was as follows: (1) after laparoscopic exploration, a 4-cm skin incision was made at a predetermined site and a subcutaneous pocket created by dissecting to the muscle fascia and removing subcutaneous fat as needed to position the port septum 0.5-1.0 cm from the skin surface; (2) under direct laparoscopic visualization, the abdominal cavity was punctured and a guidewire inserted, followed by an 8.5 Fr sheath, through which a catheter with three trimmed side holes was placed after removal of the sheath; (3) the catheter length in the abdominal cavity was adjusted to 25–30 cm and the catheter trimmed, and connected to the port base, ensuring it extended beyond the connector's visible hole; (4) the whole port was placed within the subcutaneous pocket, and non-absorbable sutures used to create a double purse-string suture at the catheter's abdominal entry, forming an anti-reflux ring; (5) non-absorbable sutures were used to securely fix the port to the fascia through its four base holes and the exposed catheter segments on the fascia sutured and buried; (6) patency was confirmed by injecting saline and followed by intermittent skin closure provided there was no bleeding; and (7) the catheter tip was positioned in the pelvic cavity under laparoscopic guidance. Postoperatively, the patients underwent normothermic intraperitoneal and systemic treatment. The port infusion protocol involved disinfecting the skin (>10 cm diameter) around the port, confirming the puncture site, inserting a Huber needle vertically at 90° to the port base, infusing 100 mL saline to ensure patency, followed by continuous infusion of 1000 mL paclitaxel solution, and sealing with 20 mL saline before removing the needle. No saline flushing was required between chemotherapy infusions. The primary outcomes were the incidence and management of complications post-port implantation.Results:The study cohort comprised 225 patients with gastric cancer and peritoneal metastases. Using standardized port implantation and postoperative puncture procedures, the complication rate during follow-up was 14.2% (32/225), including effusion in 14 patients (6.2%), port infection in 10 (4.4%), incision dehiscence in four (1.8%), port inversion in two (0.9%), hematoma in one (0.4%), and catheter rupture in one (0.4%). Seventy-five percent (24/32) of patients with complications recovered and continued using the port after conservative treatments (e. g., aspiration of effusions, antibiotic therapy, incision management), whereas the remaining 25.0% (8/32) with complications required surgical removal of the port because the treatment was ineffective. The presence of preoperative ascites ( P=0.019) and peritoneal cancer index score>15 ( P=0.038) were significantly associated with development of complications. Conclusions:Our standardized procedure for intraperitoneal chemotherapy port implantation is safe and feasible for patients with gastric cancer and peritoneal metastases, having a low overall complication rate. Most complications can be successfully managed with conservative treatment, the device thus providing reliable support for intraperitoneal chemotherapy.

Objective:To explore the relationship between childhood abuse, pleasure experience, sleep quality and self-injury behavior in adolescents with depressive disorder.Methods:One hundred and twenty adolescent patients with depressive disorder hospitalized in the Fourth People's Hospital of Hefei City from January 2021 to February 2024 were selected as the study group, as well as 120 healthy controls matched with the patients' age, gender and education level were selected as the control group.The adolescent non-suicidal self-injury assessment questionnaire, Pittsburgh sleep quality index, temporal experience of pleasure scale, and childhood trauma questionnaire were used for assessment. Statistical analysis was performed using SPSS 26.0 software. Independent sample t-test was used for comparison between the two groups. Pearson correlation analysis was used to analyze correlations between scale scores. Chain mediating modeling was used with the PROCESS macro program. Results:The differences of the study group and the control group in childhood abuse ((53.33±15.21), (39.07±11.81), t=8.081, P<0.001), pleasure experience ((85.60±15.77), (67.44±19.46), t=7.941, P<0.001), self-injury behavior ((29.01±9.89), (3.76±0.49), t=8.811, P<0.001), sleep quality ((12.24±4.15), (6.56±4.05), t=10.711, P<0.001), and depression ((30.62±7.97), (5.88±3.28), t=31.451, P<0.001) were all statistically significant. The self-injury behavior of the study group was positively correlated with the sleep quality ( r=0.487, P<0.001) and childhood abuse ( r=0.553, P<0.001), and negatively correlated with the pleasure experience ( r=-0.483, P<0.001). Childhood abuse had a negative predictive effect on pleasure experience ( β=-0.491, P<0.001), there was a positive predictive effect of childhood abuse on sleep quality ( β=0.363, P<0.001), there was a negative predictive effect of pleasure experience on sleep quality ( β=-0.321, P<0.001), there was a simultaneous predictive effect of childhood abuse, pleasure experience and sleep quality on self-injury behaviors predictive effect ( β=0.343, P<0.001, β=-0.211, P<0.001, β=0.208, P<0.001).The total effect of childhood abuse on self-injury behavior mediated by pleasure experience and sleep quality was 0.555(95% CI=0.448-0.663), and the direct effect was 0.343(95% CI=0.219-0.468).The mediating effect of pleasure experience between childhood abuse and self-injury behavior was 0.104(95% CI=0.007-0.196), accounting for 18.74% of the total effect, the mediating effect of sleep quality between childhood abuse and self-injury behavior was 0.075(95% CI=0.028-0.133), accounting for 13.51% of the total effect, and the chain mediating effect of pleasure experience and sleep quality between childhood abuse and self-injury behavior was 0.033(95% CI=0.011-0.060), accounting for 5.95% of the total effect. Conclusion:Sleep quality and pleasure experience exert the chain mediating effect between the childhood abuse and self-injury behavior in adolescents with depressive disorders.

With the rapid development of medical big data and artificial intelligence,Clinical Prediction Models(CPMs)have become pivotal tools for disease prevention,diagnosis,and treatment.Current research predominantly focuses on the economic analysis of pharmacological or public health interventions,yet a comprehensive methodological framework for the economic evaluation of CPMs has been notably absent.The Guidelines for Economic Evaluation of Clinical Prediction Models(hereafter the Guidelines),jointly initiated by the Chinese Research Hospital Association and Peking University,Tsinghua University,and Capital Medical University,adheres to the WHO Handbook for Guideline Development and the Reporting Items for Practice Guidelines in Healthcare(RIGHT)standards.A multidisciplinary collaboration,including a steering committee,expert panel,secretariat,and external review group,was established to develop the guideline following evidence-based principles and procedures.Consensus recommendations were formulated through the Delphi method.It describes the background,objectives,target group,and the development methodology and process,ensuring the entire compilation process of the Guidelines is transparent and standardized.Through comprehensive evidence retrieval,systematic evidence appraisal,and a scientific approach to forming recommendations,the scientific rigor and validity of the Guidelines were further enhanced.

Objective To explore the changes in task-state brain region activation of stroke patients using functional near-infrared spectroscopy(fNIRS)in the treatment of upper limb motor function with brain-computer interfaces(BCI).Methods From April to October,2024,40 stroke patients in Linyi People's Hospital were randomly divided into control group and BCI group,with 20 cases in each group.Both groups received conventional rehabilitation therapy.The control group underwent low-frequency electrotherapy before conventional treatment,while BCI group received BCI therapy before conventional treatment,for four weeks.Fugl-Meyer Assessment-Upper Extremities(FMA-UE)and modified Barthel Index were used to evaluate the upper limbs motor function before and after treatment.A"wrist movement task"was designed to detect the level of oxyhemoglobin(HbO?)in the regions of interest(ROI)during the task.Results After treatment,the scores of MBI and FMA-UE increased in both groups(|t|>8.904,P<0.001),and were higher in BCI group than in the control group(|t|>2.584,P<0.05).The HbO? level in the premotor cortex/sup-plementary motor area(PMC/SMA)increased after treatment in BCI group(t=-3.965,P<0.01),and was high-er in BCI group than in the control group(t=-3.630,P<0.01).The difference of HbO? level in PMC/SMA be-fore and after treatment correlated with both the difference of MBI score(r=0.498,P<0.05)and the difference of FMA-UE score(r=0.799,P<0.001).Conclusion BCI can further improve the upper limb motor function of stroke patients on the basis of conventional treat-ment and enhance the cortical activation of PMC/SMA.

Objective:To explore the relationship between childhood abuse, pleasure experience, sleep quality and self-injury behavior in adolescents with depressive disorder.Methods:One hundred and twenty adolescent patients with depressive disorder hospitalized in the Fourth People's Hospital of Hefei City from January 2021 to February 2024 were selected as the study group, as well as 120 healthy controls matched with the patients' age, gender and education level were selected as the control group.The adolescent non-suicidal self-injury assessment questionnaire, Pittsburgh sleep quality index, temporal experience of pleasure scale, and childhood trauma questionnaire were used for assessment. Statistical analysis was performed using SPSS 26.0 software. Independent sample t-test was used for comparison between the two groups. Pearson correlation analysis was used to analyze correlations between scale scores. Chain mediating modeling was used with the PROCESS macro program. Results:The differences of the study group and the control group in childhood abuse ((53.33±15.21), (39.07±11.81), t=8.081, P<0.001), pleasure experience ((85.60±15.77), (67.44±19.46), t=7.941, P<0.001), self-injury behavior ((29.01±9.89), (3.76±0.49), t=8.811, P<0.001), sleep quality ((12.24±4.15), (6.56±4.05), t=10.711, P<0.001), and depression ((30.62±7.97), (5.88±3.28), t=31.451, P<0.001) were all statistically significant. The self-injury behavior of the study group was positively correlated with the sleep quality ( r=0.487, P<0.001) and childhood abuse ( r=0.553, P<0.001), and negatively correlated with the pleasure experience ( r=-0.483, P<0.001). Childhood abuse had a negative predictive effect on pleasure experience ( β=-0.491, P<0.001), there was a positive predictive effect of childhood abuse on sleep quality ( β=0.363, P<0.001), there was a negative predictive effect of pleasure experience on sleep quality ( β=-0.321, P<0.001), there was a simultaneous predictive effect of childhood abuse, pleasure experience and sleep quality on self-injury behaviors predictive effect ( β=0.343, P<0.001, β=-0.211, P<0.001, β=0.208, P<0.001).The total effect of childhood abuse on self-injury behavior mediated by pleasure experience and sleep quality was 0.555(95% CI=0.448-0.663), and the direct effect was 0.343(95% CI=0.219-0.468).The mediating effect of pleasure experience between childhood abuse and self-injury behavior was 0.104(95% CI=0.007-0.196), accounting for 18.74% of the total effect, the mediating effect of sleep quality between childhood abuse and self-injury behavior was 0.075(95% CI=0.028-0.133), accounting for 13.51% of the total effect, and the chain mediating effect of pleasure experience and sleep quality between childhood abuse and self-injury behavior was 0.033(95% CI=0.011-0.060), accounting for 5.95% of the total effect. Conclusion:Sleep quality and pleasure experience exert the chain mediating effect between the childhood abuse and self-injury behavior in adolescents with depressive disorders.