BACKGROUND:In mammals,white adipose tissue stores energy,whereas brown adipose tissue dissipates energy.Conversion from White to brown/beige adipocytes is a potential therapeutic strategy to fight obesity,but the molecular mechanisms that drive this process is unclear.OBJECTIVE:To reveal the potential relationship between Hr mutation and adipocyte browning.METHODS:Ten 10-week-old male Yuyi hairless mice and 10 littermate wild-type controls were selected and changes in food intake,body mass and inguinal white adipose tissue mass were recorded.Serum levels of leptin and adiponectin were estimated by ELISA.Glucose tolerance test was used to assess glucose metabolic function and insulin tolerance test was performed to analyze insulin sensitivity.Hematoxylin-eosin staining was performed to observe pathological changes of inguinal white adipose tissue in mice.Real-time fluorescence quantitative PCR and immunofluorescent staining were performed to analyze the expression of genes and proteins associated with browning of white adipose tissue in the groin.RESULTS AND CONCLUSION:(1)Compared with wild-type mice,Yuyi hairless mice had increased brown fat content and ultimately increased glucose tolerance and insulin sensitivity.Hr mutation reduced body mass and inguinal adipose mass in mice,but food intake did not change significantly compared with wild-type mice,suggesting that there was a reduction in body mass and adipose mass but not in food intake.(2)Hematoxylin-eosin staining results showed browning of adipocytes in the inguinal white adipose tissue of Yuyi hairless mice,which became smaller,rounder and accompanied by the appearance of multilocular cells.(3)There was increased level of peroxisome proliferator-activated receptor γ coactivator 1α and activation of thyroid hormone receptor α,uncoupling protein 1,and the mitochondria-shaping genes(nuclear respiratory factor 1and mitochondrial transcription factor A),thereby promoting browning of adipocytes.Thus,Hr mutation activates the peroxisome proliferator-activated receptor γ coactivator 1α/thyroid hormone receptorα/uncoupling protein 1 signaling pathway and increases brown adipose content in mice,thereby promoting energy expenditure and thermogenesis and inhibiting obesity.

BACKGROUND:In mammals,white adipose tissue stores energy,whereas brown adipose tissue dissipates energy.Conversion from White to brown/beige adipocytes is a potential therapeutic strategy to fight obesity,but the molecular mechanisms that drive this process is unclear.OBJECTIVE:To reveal the potential relationship between Hr mutation and adipocyte browning.METHODS:Ten 10-week-old male Yuyi hairless mice and 10 littermate wild-type controls were selected and changes in food intake,body mass and inguinal white adipose tissue mass were recorded.Serum levels of leptin and adiponectin were estimated by ELISA.Glucose tolerance test was used to assess glucose metabolic function and insulin tolerance test was performed to analyze insulin sensitivity.Hematoxylin-eosin staining was performed to observe pathological changes of inguinal white adipose tissue in mice.Real-time fluorescence quantitative PCR and immunofluorescent staining were performed to analyze the expression of genes and proteins associated with browning of white adipose tissue in the groin.RESULTS AND CONCLUSION:(1)Compared with wild-type mice,Yuyi hairless mice had increased brown fat content and ultimately increased glucose tolerance and insulin sensitivity.Hr mutation reduced body mass and inguinal adipose mass in mice,but food intake did not change significantly compared with wild-type mice,suggesting that there was a reduction in body mass and adipose mass but not in food intake.(2)Hematoxylin-eosin staining results showed browning of adipocytes in the inguinal white adipose tissue of Yuyi hairless mice,which became smaller,rounder and accompanied by the appearance of multilocular cells.(3)There was increased level of peroxisome proliferator-activated receptor γ coactivator 1α and activation of thyroid hormone receptor α,uncoupling protein 1,and the mitochondria-shaping genes(nuclear respiratory factor 1and mitochondrial transcription factor A),thereby promoting browning of adipocytes.Thus,Hr mutation activates the peroxisome proliferator-activated receptor γ coactivator 1α/thyroid hormone receptorα/uncoupling protein 1 signaling pathway and increases brown adipose content in mice,thereby promoting energy expenditure and thermogenesis and inhibiting obesity.

Abstract In order to understand and analyze the current standards and application of school desks and chairs for primary and secondary schools, and to promote the healthy growth of primary and secondary school students. The article conducts a comprehensive review of the functional and dimensional standards for school furniture both domestically and internationally, and objectively analyzes the current utilization and existing issues concerning desks and chairs in schools. It further explores the multifaceted factors that influence the allocation of desks and chairs, and proposes effective countermeasures, so as to provide a reference for the risk factors of common diseases related to desks and chairs, such as myopia and abnormal spinal curvature.

Purpose To develop and validate a radiomics-clinical model that could accurately predict the recurrence of hepatocellular carcinoma(HCC)after undergoing tumor resection.Materials and Methods A total of 311 HCC patients underwent tumor resection in the Affiliated Hospital of North Sichuan Medical College from January 2015 to June 2022 were retrospectively collected,and they were randomly divided into a training cohort(n=217)and a validation cohort(n=94)in the ratio of 7∶3.Tumor and peritumoral 5 mm regions of interest were outlined on arterial and portal venous phase images and radiomics features were extracted to establish an arterio-portal radiomics model.Independent clinical risk factors associated with postoperative recurrence were explored by univariate and multivariate Cox analysis,then clinical model was established.A combined radiomics-clinical model was established by combining clinical independent risk factors and radiomics features.The area under the curve,specificity,sensitivity,net reclassification improvement and integrated discrimination improvement were used to assess the discrimination of all models.The calibration curve assessed the calibration of the model and decision curve analysis assessed the clinical utility of the model.Validation was performed by validation cohort data.Results The Rad-A5V5-clinical model had the best predictive performance for postoperative recurrence of HCC,the area under the curve,specificity and sensitivity of the validation cohort were 0.743(95%CI 0.640-0.846),0.647 and 0.717,respectively.The results of net reclassification improvement and integrated discrimination improvement showed that compared with clinical model and radiomics model,the prediction ability of Rad-A5V5-clinical model was improved the best one.The calibration curves showed that the predicted values of the Rad-A5V5-clinical model conformed the most favorably to the true values.The results of the decision curve analysis curve analyses showed that,among all models,the Rad-A5V5-clinical model would obtain the largest net benefit within a certain threshold range.Conclusion The predictive efficacy for post-tumor resection recurrence in HCC is significantly improved by incorporating tumor-peritumor radiomics features along with clinically independent risk factors.This finding offers a crucial reference point for identifying at-risk patients and tailoring individualized treatment plans.

With the intensification of global population aging,chronic disease management has gradually become a major public health issue.The article first analyzes the limitations of the traditional medical and health system and the necessity of com-prehensive health management,then introduces the considerations for the construction of a closed-loop chronic disease manage-ment system,and elaborates on the important role of the first page of medical records in the medical process.Finally,it proposes countermeasures and suggestions on how to promote the strengthening of cooperation between hospitals and community medical in-stitutions based on the quality control and extended services of the first page of medical records.This innovative service model sig-nificantly improves the efficiency and quality of chronic disease management.

Objective:To investigate gut microbiota differences between individuals with and without colorectal adenoma(CRA)and to identify gut microbes associated with CRA.Methods:This cross-sectional study analyzed the gut microbiota of 100 patients with CRA and 68 individuals without CRA(aged 40-75 years)who underwent colonoscopies between March 2021 and March 2022 at Tianjin Nankai Hospital.Fecal samples were sequenced for the V3-V4 region of the bacterial 16S rRNA gene using the Illumina NovaSeq platform.Results:Compared to the non-CRA group,the CRA group exhibited reduced relative abundances of identified and unidentified Lachnospiraceae,with increased Faecalibacterium and Streptococcus.In the non-CRA group,the relative abundances of Coprococcus,unidentified Clostridiaceae,and Clostridium were higher.LEfSe analysis revealed significant enrichment of Gammaproteobacteria,Proteobacteria,Enterobacteriales,and Faecalibacterium in the CRA group,while the non-CRA group was enriched for Moraxellaceae,Acinetobacter,and Anaerostipes.Conclusions:These findings suggest a discernible disparity in the gut microbiota structure between CRA patients and individuals without adenoma.The enrichment of potential pathogenic taxa,such as Faecalibacterium and Streptococcus,in the CRA group suggests a possible association with adenoma development.

Objective:To systematically evaluate the illness experience of patients with hepatitis B.Methods:A computer-based search was conducted in PubMed, Embase, Web of Science, Cochrane Library, Medline, China National Knowledge Infrastructure, Wanfang Data, VIP, and China Biology Medicine disc for qualitative studies related to the illness experience of patients with hepatitis B, from database inception to April 9, 2024. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was used to assess the methodological quality of the included studies. A Meta-synthesis method was adopted to summarize and integrate the results.Results:A total of 10 papers were included, from which 43 themes were extracted and summarized into nine categories, ultimately forming four integrated findings: emotional challenges and psychological struggles; changes in social adaptation after experiencing disease trauma, with different coping styles; loss of self-actualization, accompanied by a strong desire for rehabilitation information and social support; a certain degree of illness-related stigma existed among patients.Conclusions:Medical staff should pay attention to the illness experiences of patients with hepatitis B, guide them toward positive coping mechanisms, and provide a basis for developing personalized nursing strategies.

Objective:To evaluate the clinical efficacy, safety and treatment persistence of upadacitinib in Crohn's disease (CD) patients.Methods:The single-center retrospective cohort study was conducted. The patients with moderate-to-severe active CD initiating upadacitinib therapy from November 2023 to November 2024 in Nanjing Drum Tower Hospital were collected through searching the electronic medical records and paper-based patient databases. The primary outcome was the clinical remission rate at week 12. Secondary outcomes included the clinical response rate at week 12; clinical response and remission rates at weeks 4, 24 and 48; biomarker (fecal calprotectin or C-reactive protein) remission rates at all time points; as well as endoscopic remission and response rates, treatment persistence and safety evaluation.Results:A total of 44 CD patients were included, comprising 24 males (54.5%) and 20 females (45.5%). The median age was 33 (25, 40) years. The baseline Crohn's disease activity index (CDAI) score was 260.5 (225.9, 550.0) points. Patients had previously received a median of 2 (1, 2) biologic treatments. All 44 patients completed the 12-week induction therapy. With a median follow-up of 30.00 (16.25, 46.25) weeks, the clinical remission rate was 50.0% (22/44) at week 12. The clinical remission rate, clinical response rate, and biomarker remission rate were 52.3% (23/44), 88.6% (39/44) and 72.7% (32/44) respectively at week 4, and the clinical response rate and biomarker remission rate were 88.6% (39/44) and 77.2% (34/44) respectively at week 12. The clinical remission rates, clinical response rates and biomarker remission rates evolved to 43.3% (13/30), 86.7% (26/30) and 80.0% (24/30) at week 24, and further to 44.4% (4/9), 77.8% (7/9) and 77.8% (7/9) at week 48. During the follow-up period, 13 CD patients completing endoscopic evaluation, endoscopic remission and response rates were 30.8% and 23.1% respectively. CD-related surgery rate was 4.5% (2/44). Safety analysis demonstrated that the overall adverse events rate was 56.8% (25/44) including 7 patients with serious adverse events. A total of 8 patients discontinued treatment, among which 3 were due to primary loss of response, 1 due to secondary loss of response, 2 due to drug-related adverse events alone, and 2 due to concurrent primary loss of response and adverse events. The Kaplan-Meier curve for treatment persistence showed that among 39 CD patients who achieved clinical response at week 12, the continued treatment rates were 90.3% at week 12 and 85.3% at week 24 of follow-up. Two patients (5.6%) received dose escalation of upadacitinib, both of whom achieved clinical remission.Conclusion:Real-world research data demonstrate that upadacitinib exhibits significant clinical efficacy and a favorable safety profile in the treatment of moderate-to-severe active CD patients with prior biologic exposure, and no new unexpected adverse events are identified.

Objective:To investigate the effect of lung protective ventilation strategy (LPVS) combined with multimodal analgesia (MMA) on the quality of recovery after laparoscopic sleeve gastrectomy (LSG) in obese patients.Methods:A total of 270 obese patients with LSG from the Chinese People′s Liberation Army Rocket Army Characteristic Medical Center and the Beijing Enden Hospital from February 2022 to October 2023 were included. The patients were divided into 3 groups with 90 cases in each group by random number table method. Among them, the traditional group used traditional ventilation mode combined with postoperative controlled intravenous analgesia. MMA group was treated with traditional ventilation mode combined with MMA. LPVS+ MMA group was combined with LPVS and MMA. The occurrence of postoperative pulmonary complications (PPC), resting visual analog scale (VAS) scores, the number of effective patient-controlled analgesia (PCA) compressions, the dosage of sufentanil for analgesia pump, gastrointestinal ventilation time, and the incidence of postoperative nausea and vomiting were observed and compared among the three groups within 3 days after surgery.Results:Incidence of PPC in the LPVS+ MMA group [15.6%(14/90)] was lower than that of the traditional group [37.8%(34/90), P=0.001] and the MMA group [36.7%(33/90), P=0.002]. The effective times of PCA pump and the total amount of sufentanil analgesic pump used in the LPVS+ MMA group and the MMA group were significantly lower than those in the traditional group (all P<0.05). The incidence of postoperative nausea and vomiting in the LPVS+ MMA group was significantly lower than that in the traditional group ( P<0.05). The gastrointestinal ventilation time of the MMA group and the LPVS+ MMA group was significantly better than that of the traditional group (all P<0.05). The VAS scores of the LPVS+ MMA group and the MMA group were lower than those of the traditional group (mean P<0.001), and there was no statistically significant difference between the VAS scores of the three groups (all P>0.05). Conclusions:Compared with traditional ventilation mode combined with postoperative intravenous analgesia, LPVS combined with MMA can reduce the pulmonary complications after LSG in obese patients, reduce the use of opioids, improve postoperative analgesia, reduce the incidence of postoperative nausea and vomiting, and accelerate the recovery of gastrointestinal function.

Objective:To investigate the effect of lung protective ventilation strategy (LPVS) combined with multimodal analgesia (MMA) on the quality of recovery after laparoscopic sleeve gastrectomy (LSG) in obese patients.Methods:A total of 270 obese patients with LSG from the Chinese People′s Liberation Army Rocket Army Characteristic Medical Center and the Beijing Enden Hospital from February 2022 to October 2023 were included. The patients were divided into 3 groups with 90 cases in each group by random number table method. Among them, the traditional group used traditional ventilation mode combined with postoperative controlled intravenous analgesia. MMA group was treated with traditional ventilation mode combined with MMA. LPVS+ MMA group was combined with LPVS and MMA. The occurrence of postoperative pulmonary complications (PPC), resting visual analog scale (VAS) scores, the number of effective patient-controlled analgesia (PCA) compressions, the dosage of sufentanil for analgesia pump, gastrointestinal ventilation time, and the incidence of postoperative nausea and vomiting were observed and compared among the three groups within 3 days after surgery.Results:Incidence of PPC in the LPVS+ MMA group [15.6%(14/90)] was lower than that of the traditional group [37.8%(34/90), P=0.001] and the MMA group [36.7%(33/90), P=0.002]. The effective times of PCA pump and the total amount of sufentanil analgesic pump used in the LPVS+ MMA group and the MMA group were significantly lower than those in the traditional group (all P<0.05). The incidence of postoperative nausea and vomiting in the LPVS+ MMA group was significantly lower than that in the traditional group ( P<0.05). The gastrointestinal ventilation time of the MMA group and the LPVS+ MMA group was significantly better than that of the traditional group (all P<0.05). The VAS scores of the LPVS+ MMA group and the MMA group were lower than those of the traditional group (mean P<0.001), and there was no statistically significant difference between the VAS scores of the three groups (all P>0.05). Conclusions:Compared with traditional ventilation mode combined with postoperative intravenous analgesia, LPVS combined with MMA can reduce the pulmonary complications after LSG in obese patients, reduce the use of opioids, improve postoperative analgesia, reduce the incidence of postoperative nausea and vomiting, and accelerate the recovery of gastrointestinal function.