Objective: To evaluate the effectiveness of school-family-community comprehensive intervention aimed at reducing sugar sweetened beverage(SSB) consumption among primary and secondary school students, so as to provide scientific basis for relevant departments to formulate campus sugar reduction measures for primary and secondary school students. Methods: In October 2023, a multi stage random cluster sampling method was used to select four primary schools (grade 4) and four junior high schools (grade 7) in Nanjing City, and they were randomly divided into the intervention group ( n =1 601) and the control group ( n = 1 433 ) (primary and secondary schools). The intervention group received a one year comprehensive intervention activity with the theme of “drinking less SSBs and enjoying a healthy life” for one consecutive year. The measures included the school conducting health education courses (once a month, 15 minutes each time), environmental support (posting promotional posters, changing them once a month), class bulletin board and interest projects (once a semester); interventions for families included conducting parent lectures (once per semester 30 min each time), new media (once a month) and hand in hand activities (once per semester); community carried out square promotion and create a supportive environment (post promotional posters and replace them once a month). The control group did not receive any intervention measures except regular health education classes. Self administered questionnaires were used to collect knowledge, attitudes, and intake of SSB at the baseline and after the intervention among primary and secondary school students. Results: After the intervention, the proportion of students in the intervention group with an SSB related knowledge awareness rate of 60% or above was 91.4%, which was higher than that of the control group (81.9%) ( χ 2=60.35, P < 0.01 ). The reporting rate of the behavior of choosing to drink beverages when thirsty in the intervention group was 25.4%, which was lower than that of the control group (33.3%); the reporting rates of informing parents about the hazards of sugar sweetened beverages and paying attention to nutrition labels were 62.0% and 78.0% respectively, both of which were higher than those of the control group (52.3%, 65.9%); the reporting rate of having sugar sweetened beverages at home frequently was 43.7% in the intervention group, which was lower than that of the control group (62.3%); the reporting rate of parents restricting the consumption of sugar sweetened beverages was 84.1%, which was higher than that of the control group (78.4%) ( χ 2= 22.66, 29.05, 54.40, 104.84, 16.24, all P <0.05). The reporting rate of students in the intervention group who consumed sugar sweetened beverages more than 4 times per week was 21.5%, which was lower than that of the control group (28.6%), and the difference was statistically significant ( χ 2=20.36, P <0.01). Conclusion The comprehensive intervention of school-family-community can effectively improve primary and secondary school students knowledge and attitudes regarding SSBs and reduce their consumption of these beverages.

ObjectiveTo construct an actor-network for integrating physical activity into rehabilitation services based on the World Health Organization Rehabilitation in Health Service System framework and actor-network theory (ANT). MethodsContent analysis was employed using the six building blocks of health service systems as the theoretical framework. Actors related to rehabilitation services were extracted and categorized into a rehabilitation actor pool, while a physical activity actor pool was formed based on four major physical activity scenarios. Actors from both pools were integrated, deduplicated and classified to form a final list of integrated actors. Using ANT, the construction process of the actor network integrating physical activity into rehabilitation was analyzed through the four stages of translation: problematization, interessment, enrollment and mobilization. ResultsA dynamic integration network was constructed, comprising human actors (patients, rehabilitation professionals, researchers, sports coaches, government departments, medical institutions, community organizations and industry media, etc.) and non-human actors (assistive devices, sports infrastructure, smart equipment, information systems, online exercise guidance systems, laws and regulations, strategic documents, and exercise prescriptions, etc.). The study identified maximizing rehabilitation outcomes as the mandatory passage point and elaborated on the critical role of government departments as focal actors in coordinating various stakeholders. ConclusionThe integration of physical activity into rehabilitation services is a dynamic network constructed by diverse actors through a process of translation. ANT provides an operational theoretical framework for cross-departmental governance of rehabilitation policies in China, promotes the spatial expansion of the rehabilitation field, and drives its transformation toward a networked and ecological system. The government needs to play a leading role in facilitating role reconstruction and synergy among heterogeneous actors in both the sports and rehabilitation sectors through mechanism design, to create a bidirectional empowerment mechanism that fosters mutual progress and ensures the sustainable development of integrated services.

Objective To investigate the causal relationship between immune cells and various molecular subtypes of breast cancer (BC) by using two-sample Mendelian randomization (MR). Methods This study employed a two-sample MR analysis, with 731 immune cell types from the GWAS catalog as the exposure factors and four BC molecular subtypes (HR+/HER2−, HR+/HER2+, HR−/HER2+, and HR−/HER2−) from the BCAC Consortium as the outcome variables. For causal inference, inverse variance weighting (IVW) was employed as the primary analytical method, alongside multiple consistency validation approaches, including MR-Egger, weighted median, weighted mode, simple mode, and Bayesian weighted Mendelian randomization. Reverse MR and sensitivity analyses were employed to effectively evaluate and exclude potential biases and interference from reverse causality. Results Significant causal associations were identified for specific immune cell phenotypes across subtypes. In HR+ BC, the HER2+ subtype was associated with seven immunophenotypes (five protective and two risk increasing), whereas the HER2− subtype was associated with eight immunophenotypes (four protective and four risk increasing). In HR− BC, the HER2+ subtype was associated with five immunophenotypes (one protective and four risk increasing), and the HER2− subtype (triple-negative BC) was associated with seven immunophenotypes (six protective and one risk-increasing). CD28+CD45RA−CD8+ T cells and naive CD8+ T cells have a bidirectional causal relationship with HR+/HER2+ breast cancer, Whereas the expression of CD8 on CD39+CD8+ cells also has a bidirectional relationship with HR+/HER2− breast cancer. Furthermore, CD4−CD8− NKT cells exhibited opposing effect directions in HER2+ versus HER2− subtypes. Conclusion From a genetic perspective, this study confirms the existence of subtype-specific causal associations between immune cell phenotypes and distinct molecular subtypes of BC, revealing heterogeneity in immune regulation.

Diabetic kidney disease （DKD） is one of the common microvascular complications of diabetes mellitus （DM） and a primary cause of chronic kidney disease （CKD） and end-stage renal disease （ESRD）. Inflammation is currently a hot topic in exploring the pathogenesis of DKD. Macrophages， T cells， interleukins， tumor necrosis factor， NOD-like receptor protein 3 （NLRP3） inflammasome， Janus kinase/signal transducer and activator of transcription （JAK/STAT） signaling pathway， and nuclear factor-kappa B （NF-κB）-related signaling pathway all play a role in regulating the inflammation of DKD and accelerating its progression. Astragali Radix， a Chinese herbal medicine， is widely used in the treatment of DKD and possesses strong anti-inflammatory effects. Studies have revealed that active ingredients of Astragali Radix， including polysaccharides， astragaloside Ⅳ， total flavonoids， calycosin， and quercetin， can regulate multiple signaling pathways to ameliorate the microinflammatory state and alleviate kidney damage， thereby slowing down the progression of DKD. This article systematically reviews the factors influencing the inflammation in DKD and analyzes recent research findings and mechanisms concerning active ingredients of Astragali Radix in the management of DKD inflammation， aiming to offer novel insights and directions for the prevention， treatment， and research of DKD.

Objective: To analyze factors impacting mental health status of medical students based on ecological systems theory, so as to provide reference for the mental health promotion system for medical students. Methods: In June 2024, 1 760 medical school students randomly selected from 19 different kinds of medical colleges in eastern China by stratified cluster were surveyed using questionnaires and expert interviews. Descriptive statistics, cross analysis, hierarchical linear regression analysis, structural equation models were used for data analysis. Results: Medical school students had higher satisfaction with the school (65.85%) and a great sense of perceived social support (57.16%). Furthermore, 91.14% of the students had normal interpersonal relationships. However, 44.89% reported that their mental health was impacted by high level of depression. The hierarchical linear regression analysis showed that the mental health outcomes of the medical students were positively predicted by higher perceived social support scores ( β =-11.40), institutional satisfaction ( β =-4.85 ), and lower help seeking stigma scores ( β =9.31) ( P <0.05). The structural equation modeling showed that the status of both perceived social support and self help seeking stigma had significant impacts on depression severity ( β =-0.32, -0.53) and interpersonal relationship sensitivity ( β =-0.31, 0.58) among medical students ( P <0.01).Through expert interviews, collaborations between the school and the tripartite organization (families, universities and society) was of growing importance. Conclusions Perceived social support and self stigma have a significant impact on the mental health status of medical students. The problem of self stigma of medical students should be paid attention to. Therefore, families, universities and society should work together to improve the mental health of medical students.

OBJECTIVE To investigate the effects of Tripterygium wilfordii multiglycoside （TWM） on renal injury in diabetic nephropathy （DN） rats through tumor protein p53/microRNA-214 （miR-214）/UNC-51-like kinase 1 （ULK1） axis. METHODS Male SD rats were randomly divided into normal group （n＝6） and modeling group （n＝28）； the modeling group was fed with high fat and high glucose plus intraperitoneal injection of streptozotocin to establish DN model. The modeled rats were randomly divided into model group， valsartan group [8.33 mg/（kg·d）] and TWM group[6.25 mg/（kg·d）]， with 8 rats in each group. Rats in each group were gavaged with the corresponding medication or normal saline， once a day， for 6 consecutive weeks. After the last medication， liver and renal function indexes [24 h urinary total protein （24 h-UTP）， blood urea nitrogen （BUN）， serum creatinine （SCr）， albumin （ALB）， alanine transaminase （ALT）]， blood lipid indexes （triglycerides， total cholesterol） and blood glucose index （fasting blood glucose） in urine/blood sample of rats were detected in each group. Renal pathologic change was observed， protein and mRNA expressions of p53， ULK1， Beclin-1 and microtubule-associated protein 1 light chain 3 （LC3）， and expression of miR-214 in renal tissue were also determined. RESULTS Compared with the normal group， the renal tubular epithelium of rats in the model group showed obvious edema， cell swelling， accompanied by lymphocyte infiltration； the levels of 24h-UTP， BUN， SCr， ALT and glycolipid indexes， the expressions of p53 protein and mRNA， as well as the expression of miR-214 in rats in the model group and administration groups were significantly increased or up-regulated， while ALB level， LC3-Ⅱ/LC3-Ⅰ， the expressions of LC3 mRNA， the expressions of ULK1， Beclin-1 protein and mRNA were significantly decreased or down-regulated （P＜0.01）. Compared with the model group， the histopathological damage of the kidney in rats was improved in administration groups； the levels of 24 h-UTP， BUN， SCr， ALT and glycolipid indexes， the expressions of p53 protein and mRNA， as well as the expression of miR-214 were all significantly decreased or down-regulated， while ALB level， LC3-Ⅱ/LC3-Ⅰ， the expressions of LC3 mRNA， the expressions of ULK1 and Beclin-1 protein and mRNA were significantly increased or up-regulated （P＜0.01）. CONCLUSIONS TG can alleviate renal damage in DN rats， and improve their liver and renal function， as well as glucose and lipid levels. These effects may be related to the regulation of the p53/miR-214/ULK1 axis and the restoration of cellular autophagy.

Objective To explore the mechanism of IgA nephropathy(IgAN)caused by multi-glycosides of Tripterygium wilfordii(GTW)through the regulation of Silent information regulatory factor 1(SIRT 1)/nuclear transcription factor E2-related factor 2(Nrf 2)/antioxidant enzyme heme oxygenase 1(HO-1)signaling pathway.Methods Forty-five male SD rats were selected and randomly divided into two groups:the blank group(n=9)and the model group(n=36).In addition to the blank group,the BSA+CCl4+LPS group was used.At the end of 12 weeks,two rats were randomly selected for verification,and the model was successfully established.The 34 model rats were randomly divided into 3 groups:the model group(n=10),prednisone group(n=12),and GTW group(n=12).Urine,blood and kidney tissues were harvested 4 weeks after drug administration.Urinary erythrocyte number,24-h urinary protein quantification(24 h-UTP),alanine transaminase(ALT),serum albumin(ALB),urea nitrogen(BUN),and blood creatinine(SCr)were performed for each group;the protein expression of SIRT1,Nrf2,HO-1 and PINK1 was detected by Western blotting analysis;real-time polymerase chain reaction(RT-PCR)detection of SIRT1,Nrf2,HO-1 and PINK1 mRNA expression in rat kidney tissue;and detection of IgA deposition in the renal mesangial area by immunofluorescence.Kidney histopathological changes were observed in all the rats by hematoxylin-eosin(HE)staining.Results The results compared with those in the blank group,the urinary red blood cell count and 24 h-UTP,ALT,BUN,and SCr levels were significantly greater(P<0.01);The ALB level was significantly lower(P<0.01);renal tissue SIRT1,Nrf2,HO-1,PINK1 protein and mRNA expression were significantly lower(P<0.01);IgA deposition in the mesentery was obvious;renal pathological damage was severe;and the difference was statistically significant. Compared with those in the model group,urinary red blood cell counts and 24 h-UTP,ALT,BUN,and SCr levels in the prednisone and GTW groups were significantly lower (P<0.01);ALB levels were significantly greater (P<0.01);SIRT1,Nrf2,HO-1,PINK1 protein and mRNA expression were significantly greater (P<0.01);IgA deposition in the mesangial area was reduced,and renal pathology was improved,with statistically significant difference. Conclusions GTW may alleviate oxidative stress injury,protect renal function,and improve renal injury by activating the SIRT 1/Nrf 2/HO-1 signaling pathway.

The study explored the therapeutic effect and mechanism of the compound composed of tangerine peel,plum,agrimony and hawthorn on Eimeria tenella in chicks.In the experiment,144 chicks were divided into six groups:the blank group,the model group,the diclazuril group,and the high-dose,medium-dose and low-dose traditional Chinese medicine compound groups.The 14-day-old chickens were infected,the body weight and mortality were recorded,and the samples were dis-sected at 21 days of age.The anticoccidial effect of Chenpi compound at different doses was evalua-ted by calculating anticoccidial index,feed conversion rate and detecting serum cytokine levels and related mRNA expression levels.The results showed that the anticoccidial index of the middle dose group was 172.86,and the anticoccidial index of the low dose group was 158.98.In the middle and low dose groups,the levels of IL-1β,IL-6 and MDA in serum decreased significantly,while the levels of IL-4,IL10,T-AOC,SOD,CAT and GSH-Px increased significantly,and the mRNA ex-pression levels of related inflammation and antioxidant pathways changed.Further studies found that the medium-dose compound can regulate the ChTLR15/ChMyD88/ChNF-κB/ChNLRP3/Caspase-1 inflammatory signaling pathway,activate the Nrf2/Keap1/HO-1 antioxidant signaling pathway,and enhance the body's anti-inflammatory and antioxidant capacity;at the same time,it can increase the expression of intestinal tight junction ZO-1 and Occludin,repair the damaged in-testinal barrier,and play an anticoccidial role.The results showed that the middle dose of tangerine peel compound had a good effect in the treatment of coccidiosis,and its mechanism involved the regulation of anti-inflammatory and antioxidant pathways.

Objective To investigate the value of fragmented QRS complex(fQRS)in the electro-cardiogram,heart rate variability(HRV)and LVEF in evaluating the prognosis in patients with dilated cardiomyopathy(DCM).Methods A retrospective analysis was conducted on 59 DCM pa-tients admitted in the Second Affiliated Hospital of Wannan Medical College from January 2020 to December 2023.According to the occurrence of MACE during 6-month follow-up period,they were classified into a poor prognosis group(26 cases)and a good prognosis group(33 cases).Clin-ical baseline data,positive rate of fQRS,HRV and LVEF were compared between the two groups.Time-domain measurements of HRV included standard deviation of normal NN intervals(SDNN),standard deviation of the averages of NN intervals in all 5 min segments of the entire recording(SDANN),mean of the standard deviation of NN intervals for all 5 min segments of the entire recording(SDNN index),root mean square of standard deviation of NN intervals(r-MSSD)and HRV triangular index.Spearman/Pearson correlation analysis was performed to analyze the correlation of prognosis of DCM with positive rate of fQRS,HRV and LVEF.ROC curve was drawn to analyze the efficiency of fQRS,HRV and LVEF in predicting the prognosis of DCM.Results The poor prognosis group exhibited significantly higher positive rate of fQRS and obvi-ously reduced SDNN,SDANN,SDNN index,r-MSSD,triangular index and LVEF when compared with the good prognosis group(P＜0.01).Correlation analysis suggested that poor prognosis of DCM was positively correlated with the positive rate of fQRS(P＜0.01),and negatively with SDNN,SDANN,SDNN index,r-MSSD,triangular index and LVEF(P＜0.05,P＜0.01).ROC curve analysis revealed that the AUC value of above indicators in turn in predicting the prognosis of DCM was 0.718,0.7 56,0.7 62,0.807,0.858,0.805 and 0.747,respectively,and the AUC value of their combination was 0.980(P＜0.01).Conclusion fQRS,HRV and LVEF have important cor-relation with poor prognosis of DCM patients.Their combination can be used as an effective mark-er for clinical evaluation and prediction of poor prognosis of DCM.

Objective:To measure the length and curvature of the external auditory canal (EAC) centerline using a three-dimensional (3D) measurement method based on high-resolution computed tomography (HRCT).Methods:A retrospective analysis was conducted on HRCT images of healthy EAC from 49 patients (64 ears) examined at the Sixth Medical Center of the PLA General Hospital from June to October 2024. The cohort included 25 males (28 ears) and 24 females (36 ears), aged 22-78 years (mean age 47.3 years), categorized into age groups: 18-30 years (20 ears), 31-60 years (22 ears), and 61-80 years (22 ears). The EAC comprised 29 left and 35 right ears. 3D reconstruction of the EAC was performed using medical software (3D Slicer), and the central curve of the EAC was extracted using an improved measurement method to determine its length and curvature. Statistical analysis was performed using Origin Pro 2023 software to compare differences across genders, sides, and age groups.Results:The measurements of EAC length and curvature revealed that the EAC was significantly longer in males than in females (27.46 mm vs. 25.44 mm, P=0.014) and longer on the right side than on the left (27.99 mm vs. 25.87 mm, P=0.031). No statistically significant difference in EAC length was observed among the different age groups ( P>0.05). Furthermore, no statistically significant differences in EAC curvature were found regarding gender, side, or age group (all P>0.05). Conclusion:The HRCT-based 3D reconstruction technique enables the establishment of a rapid and effective automated workflow for extracting the central curve of the EAC and systematically measuring its length and curvature. The data obtained provide a reference and methodological support for further research on anatomical variations of the human EAC and its potential clinical applications, such as the design of otological instruments or surgical planning.