Abstract The prevention and control of myopia in Chinese children and adolescents has become a major public health issue. While maintaining increased outdoor activity as a cornerstone intervention, there is an urgent need to explore new complementary approaches that can be effectively implemented in both indoor and outdoor settings. In recent years, environmental spatial frequency has gained increasing attention as one of the key environmental factors influencing the development and progression of myopia. Both animal studies and human research have confirmed that indoor environments lacking mid to high spatial frequency components, often characterized as "visually impoverished", can promote axial elongation and myopia through mechanisms such as disruption of retinal neural signaling, impaired accommodative function, and altered expression of related molecules. Based on the scientific consensus, it is recommended that "enriching of environmental spatial frequency" should be integrated into the myopia prevention and control framework. Following the principles of schoolled organization, family cooperation, community involvement, and student participation, specific measures are put forward in three areas：optimizing school visual settings, improving home spatial environments, and promoting healthy visual behavior. The aim is to create "visually friendly" indoor environments as an important supplement to outdoor activity, thereby providing a novel perspective and strategy for comprehensively advancing myopia prevention and control among children and adolescents.

ObjectiveTo investigate the efficacy and safety of Babaodan Capsule （BBD） in the treatment of patients with chronic hepatitis B virus （HBV） infection with damp-heat in the liver and gallbladder comorbid with gallbladder polyps. MethodsA randomized， double-blinded， placebo-controlled single-center trial was conducted among 120 patients with chronic HBV infection who were admitted to Beijing YouAn Hospital， Capital Medical University， from August 2020 to April 2023， and they were divided into treatment group （BBD） and control group （placebo）， with 60 patients in each group. The course of treatment was 24 weeks， and follow-up assessments were conducted every 4 weeks. The primary outcome measures were the number and maximum diameter of gallbladder polyps （assessed by ultrasound）， and the secondary outcome measures included traditional Chinese medicine （TCM） syndrome score， blood lipid levels， and liver function parameters. The independent-samples t test or the Wilcoxon rank-sum test was used for comparison of continuous data between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups； the Wilcoxon rank-sum test was used for comparison of ranked data between two groups； the generalized estimating equation was used to analyze repeated measures data. ResultsAfter 8 weeks of treatment， the treatment group had a significantly smaller diameter of polyps and a significantly lower number of polyps than the control group （Z=-1.76 and -1.80， both P<0.05）， and after 24 weeks of treatment， the treatment group had a significantly higher polyp reduction rate than the control group （30.51% vs 10.91%， P<0.05）. The subgroup analysis showed that patients receiving combined antiviral therapy， male patients， patients with a diameter of polyps of <5 mm， and patients with multiple polyps tended to achieve significantly greater benefits. At week 8 of treatment， the treatment group had a significantly better TCM syndrome score than the control group （Z=-2.35， P<0.05）； after treatment， compared with the control group， the treatment group had a significantly greater increase in high-density lipoprotein （Z=-1.85， P<0.05） and significantly lower levels of alanine aminotransferase （Z=-2.06， P <0.05）， aspartate aminotransferase （Z=-2.13， P<0.05）， total bilirubin （Z=-2.12， P<0.05）， and direct bilirubin （Z=-3.09， P<0.05）. No serious adverse events were reported in either group. ConclusionBBD can effectively reduce the size of gallbladder polyps， improve TCM syndrome score， and reduce the level of bilirubin in patients with chronic HBV infection with damp-heat in the liver and gallbladder， with a favorable safety profile， and it may be more suitable for patients receiving combined antiviral therapy and specific subgroups （male patients， patients with a diameter of polyps of <5 mm， and patients with multiple polyps.

Abstract Adverse childhood experiences (ACEs) exposure is a pressing and severe global public health issue. Children and adolescents exposed to multiple ACEs are highly susceptible to toxic stress and impaired physiological functioning, which significantly jeopardize their physical and mental health. Effective prevention and intervention strategies can reduce the prevalence of ACEs and mitigate their severe impacts, thereby minimizing the long term detrimental consequences on future outcomes. The review provides a comprehensive review of intervention strategies across four dimensions: individual, family, school, and public services/policy, so as to establish a theoretical foundation for implementing effective interventions for children and adolescents exposed to adverse childhood experiences.

Background/Aims: Dysregulated cholesterol metabolism is a hallmark of hepatocellular carcinoma (HCC) that drives tumor initiation and progression. However, clinical targeting of cholesterol metabolism has yielded limited benefits due to stringent feedback in tumor cells. Identifying a central mediator capable of restoring cholesterol homeostasis within the cell’s intrinsically fine-tuned regulatory framework is urgently needed. Methods: We integrated a proteomic dataset from patients with cholesterol-dysregulated HCC into a global cholesterol metabolic regulatory network to identify potential therapeutic targets for disrupted cholesterol homeostasis. The prognostic significance of the candidate targets was further validated in an independent cohort through immunohistochemistry. Functional and mechanistic studies were conducted in vitro using HCC cell lines and in vivo using mouse models. The pharmacological efficacy of the candidate agent was evaluated in both subcutaneous and orthotopic HCC mouse models. Results: ER lipid raft-associated 1 (ERLIN1), a pivotal regulator of cholesterol metabolism reprogramming, was identified as an independent favorable prognostic indicator in HCC. ERLIN1 constrains HCC progression both in vitro and in vivo by stabilizing the INSIG1–SCAP–SREBP2 axis and maintaining the metabolic balance of intracellular cholesterol. Under hypoxia, impaired factor-inhibiting hypoxia-1-dependent hydroxylation of ASB11 at asparagine residues 90 and 92 enhances ASB11-mediated ERLIN1 degradation. Pharmacological targeting of this axis using zoledronic acid (ZoA) attenuated HCC progression by weakening the ASB11–ERLIN1 interaction and restoring cholesterol homeostasis. Conclusions ERLIN1 represents a druggable metabolic vulnerability in cholesterol-dysregulated HCC. Targeting the ASB11–ERLIN1 axis with the clinically approved ZoA reestablishes cholesterol homeostasis and offers a promising therapeutic strategy to overcome the current limitations of cholesterol-targeted HCC therapies.

ObjectiveTo investigate the predictive factors for HBsAg clearance in chronic hepatitis B （CHB） patients with a low level of hepatitis B surface antigen （HBsAg） treated with pegylated interferon α-2b （PEG-IFN-α-2b）， to establish a combined predictive model and a nomogram based on multiple factors， and to provide a reference for formulating individualized treatment regimens and predicting treatment outcome in clinical practice. MethodsA retrospective analysis was performed for 167 CHB patients with HBsAg <1 500 IU/mL who attended The Third People’s Hospital of Kunming from January 2022 to January 2024 and were treated with PEG-IFN-α-2b. According to whether clinical cure was achieved， the patients were divided into HBsAg clearance group and HBsAg non-clearance group. Related data were collected， including general information and serological/biochemical/virological indicators at different time points during treatment. The independent samples t-test was used for comparison of normally distributed continuous data， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data； the chi-square test was used for comparison of categorical data. The multivariate logistic regression analysis was used to identify independent influencing factors. The receiver operating characteristic （ROC） curve was used to assess the value of indicators used alone or in combination in predicting clinical cure， and calibration curves were plotted to assess the risk prediction model. ResultsThe univariate analysis showed that there were significant differences between the two groups in age （t=-6.839， P<0.05）， history of nucleos（t）ide analogue treatment for over 1 year （χ²=59.339， P<0.05）， genotype （χ²=4.610， P<0.05）， nonalcoholic fatty liver disease （χ²=5.319， P<0.05）， hepatitis B virus DNA status before treatment （χ²=60.861， P <0.05）， compensated liver cirrhosis （χ²=10.960， P<0.05）， HBeAg status before treatment （χ²=19.060， P<0.05）， a history of interferon treatment （χ²=8.162， P<0.05）， presence of interferon antibodies after treatment （χ²=12.858， P<0.05）， HBsAg level before treatment （Z=-7.412， P<0.05）， alanine aminotransaminase （ALT） level at baseline （Z=-6.117， P<0.05）， ALT level at 12 weeks of treatment （Z=-7.171， P<0.05）， platelet count （PLT） at 24 weeks of treatment （Z=-3.622， P<0.05）， and thyroid stimulating hormone （TSH） level at 24 weeks of treatment （Z=-2.830， P<0.05）. The multivariate logistic regression analysis showed that age （odds ratio ［OR］=1.230， P=0.007）， history of nucleos（t）ide analogue treatment for over 1 year （OR=0.008， P=0.011）， HBeAg status before treatment （OR=0.003， P=0.012）， HBsAg level before treatment （OR=1.005， P=0.014）， ALT level at baseline （OR=0.949， P=0.014）， ALT level at 12 weeks of treatment （OR=0.969， P=0.016）， PLT at 24 weeks of treatment （OR=0.969， P=0.022）， and TSH level at 24 weeks of treatment （OR=3.608， P=0.045） were independent influencing factors for HBsAg clearance at 48 weeks of treatment in CHB patients with HBsAg <1 500 IU/mL. The Hosmer-Lemeshow goodness-of-fit test yielded χ²=1.398， P=0.994， indicating that the model had good fitting. The Bootstrap method was used to perform internal validation of the nomogram model， and there was a good degree of fitting between the calibration curve and the ideal curve， with a mean absolute error of 0.029. The ROC curve analysis showed that the combination of predictive factors had an area under the ROC curve of 0.982 （95% confidence interval： 0.961 — 0.999）， with a sensitivity of 94.10% and a specificity of 93.10%， suggesting that the nomogram model had a good discriminatory ability. For the CHB patients with HBsAg <1 500 IU/mL and different features， further analysis of HBsAg clearance rate at 48 weeks of treatment showed an HBsAg clearance rate of 69.60% for those with HBsAg ≤67.65 IU/mL before treatment， 58.30% for those with a baseline ALT level of ≥62.50 U/L， 68.30% for those with an ALT level of ≥92.50 U/L at 12 weeks of treatment， 42.40% for those with PLT ≥104×10⁹/L at 24 weeks of treatment， and 48.30% for those with a TSH level of ≤1.38 μIU/mL at 24 weeks of treatment， with significant differences between the two groups （all P<0.001）. ConclusionAge， history of nucleos（t）ide analogue treatment for over 1 year， HBeAg status before treatment， HBsAg level before treatment， baseline ALT level， ALT level at 12 weeks of treatment， PLT level at 24 weeks， and TSH level at 24 weeks of treatment are independent predictive factors. The combined prediction nomogram model constructed in this study has a relatively high value in predicting clinical cure at 48 weeks of PEG-IFN-α-2b treatment in CHB patients with HBsAg<1 500 IU/mL， thereby providing a reference for selecting suitable treatment population and predicting clinical cure.

OBJECTIVE To provide guidance for the individualized use of antiepileptic drugs （AEDs） in patients with epilepsy or bipolar affective disorder.METHODS Clinical data of patients with epilepsy or bipolar affective disorder who received AEDs treatment and underwent therapeutic drug monitoring （TDM） at Xi’an International Medical Center Hospital from January 2023 to December 2025 were retrospectively collected. The baseline information， characteristics of AEDs utilization， implementation status of TDM and laboratory parameters were summarized. Spearman correlation analysis， univariate analysis and multivariate linear regression analysis were performed to identify the independent influencing factors for blood concentrations of AEDs.RESULTS A total of 1 572 patients were enrolled， including 660 males and 912 females. The majority were aged ≥60 years （30.15%）； 71.76% of patients were on monotherapy with AEDs， with valproic acid being the most commonly prescribed （51.97%）； combination therapy was predominantly a two-drug regimen （26.21%）， while three-drug regimens were rare （2.04%）. A total of 2 901 blood samples for TDM were collected， with the highest number of samples for valproic acid and levetiracetam （1 987 and 684 samples， respectively）. TDM for all five drugs was primarily conducted once； among which， the blood concentrations attainment rates exceeded 50% for patients taking valproic acid and levetiracetam， while the median blood concentrations for patients taking lamotrigine， oxcarbazepine， and carbamazepine were all below the lower limit of the therapeutic reference range. Based on the results of Spearman correlation analysis， univariate analysis， and multivariate linear regression analysis， patient gender， platelet count （PLT）， alanine transaminase （ALT）， aspartate transaminase （AST）， and total bilirubin （TBil） were found to be independent factors influencing blood concentration of valproic acid （unstandardized coefficients were －6.770 7， －0.078 6， －0.099 4， 0.083 2， －0.578 9， P ＜0.05）， while age and creatinine （CRE） were found to be independent factors influencing blood concentration of levetiracetam （unstandardized coefficients were 0.108 7， 0.047 8， P ＜0.05）.CONCLUSIONS Female gender and elevated AST levels are risk factors for increased blood concentration of valproic acid， while elevated PLT， ALT and TBil levels are associated with decreased blood concentration of valproic acid. Patients of advanced age and those with renal insufficiency bear a relatively high risk of in vivo levetiracetam accumulation.

ObjectiveTo investigate the association of alpha-fetoprotein （AFP） and prealbumin （PAB） with the 90-day prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure （HBV-ACLF）， as well as the difference in 90-day prognosis between the patients with different levels of AFP and PAB. MethodsA total of 371 HBV-ACLF patients who were hospitalized in The General Hospital of Western Theater Command from January 2018 to January 2023 were enrolled， and according to the follow-up results on day 90 after discharge， they were divided into survival group with 216 patients and death group with 155 patients. The medical record system was used to collect general data， AFP， PAB， and other related laboratory markers. The t-test was used for comparison of normally distributed continuous data between two groups； a one-way analysis of variance was used for comparison between multiple groups， and the least significant difference t-test was used for comparison between two groups. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups， and the Kruskal-Wallis H test was used for comparison between multiple groups and further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. The multivariate logistic regression analysis was used to identify the influencing factors for the prognosis of HBV-ACLF patients. The receiver operating characteristic （ROC） curve was plotted for AFP and PAB to determine their cut-off values. The Kaplan-Meier method was used to plot survival curves， and the Log-rank test was used for comparison. ResultsCompared with the death group， the survival group had significantly higher levels of hemoglobin （Hb）， PAB， AFP， and platelet count （PLT） （all P<0.05） and significantly lower age， total bilirubin （TBil）， white blood cell count （WBC）， cystatin， creatinine， urea， international normalized ratio （INR）， Model for End-Stage Liver Disease （MELD） score， proportion of patients with Child-Pugh class C， and incidence rates of ascites and hepatic encephalopathy （all P<0.05）. The multivariate logistic regression analysis showed that PAB （odds ratio ［OR］=0.985， 95% confidence interval ［CI］： 0.972‍ ‍—‍ ‍0.998， P=0.024）， AFP （OR=0.998， 95%CI： 0.996‍ ‍—‍ ‍1.000， P=0.028）， PLT （OR=0.989， 95%CI： 0.982‍ ‍—‍ ‍0.996， P=0.003）， age （OR=1.046， 95%CI： 1.018‍ ‍—‍ ‍1.075， P=0.001）， TBil （OR=1.004， 95%CI： 1.002‍ ‍—‍ ‍1.006， P<0.001）， and WBC （OR=1.237， 95%CI： 1.110‍ ‍—‍ ‍1.379， P<0.001） were independent influencing factors for 90-day prognosis in HBV-ACLF patients. According to the cut-off values of AFP and PAB on ROC curves， the patients were divided into group A with 102 patients （AFP≥73.19 ng/mL and PAB≥22.55 mg/L）， group B with 170 patients （AFP≥73.19 ng/mL and PAB<22.55 mg/L； AFP<73.19 ng/mL and PAB≥22.55 mg/L）， and group C with 99 patients （AFP<73.19 ng/mL and PAB<22.55 mg/L）. There were significant differences between these three groups in age， Hb， INR， MELD score， and Child-Pugh class （all P<0.05）. The Kaplan-Meier survival analysis showed that group A had a significantly higher 90-day cumulative survival rate than groups B and C （χ²=19.825， P<0.001）. ConclusionAFP combined with PAB can better predict the 90-day prognosis of HBV-ACLF patients， and patients with high levels of AFP and PAB tend to have a lower mortality rate on day 90.

ObjectiveTo investigate the value of albumin-bilirubin （ALBI）， easy albumin-bilirubin （EZ-ALBI）， and platelet-albumin-bilirubin （PALBI） scores in predicting 2-year survival in patients with HCV-associated hepatocellular carcinoma （HCV-HCC）. MethodsA retrospective analysis was performed for the clinical data of 174 patients with HCV-HCC who were admitted to The Third People’s Hospital of Kunming from January 2020 to January 2022， and the patients were followed up till 2 years after admission. According to the follow-up results， the patients were divided into survival group with 95 patients and death group with 79 patients. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups. Univariate and multivariate Cox proportional-hazards regression model analyses were used to investigate the influencing factors for the survival of HCV-HCC patients. The Kaplan-Meier method was used to plot survival curves and analyze the 2-year survival rate of HCV-HCC patients with different EZ-ALBI grades， and the log-rank test was used for comparison between groups. ResultsThere were significant differences between the survival group and the death group in platelet count， aspartate aminotransferase （AST）， total bilirubin， albumin （Alb）， alpha-fetoprotein （AFP）， prealbumin， prothrombin time， international normalized ratio， PALBI score， ALBI score， EZ-ALBI score， Model for End-Stage Liver Disease （MELD） score， HCV genotype， peritoneal effusion， and vascular invasion （all P<0.05）. The univariate Cox regression analysis showed that AST， Alb， AFP， ALBI score， EZ-ALBI score， PALBI score， MELD score， Barcelona Clinic Liver Cancer Staging， and peritoneal effusion were influencing factors for the survival of patients （all P<0.05）， and the multivariate Cox regression analysis showed that EZ-ALBI score （hazard ratio ［HR］=1.850， 95% confidence interval ［CI］： 1.054 — 3.247， P=0.032） and peritoneal effusion （HR=1.993， 95%CI： 1.030 — 3.858， P=0.041） were independent risk factors for the survival of HCV-HCC patients. The survival curve analysis showed that the patients with EZ-ALBI grade 1/2/3 had a 2-year survival rate of 90.9%， 60.2%， and 32.2%， respectively， and there was a significant difference in cumulative survival rate between the patients with different EZ-ALBI grades （χ²=26.294， P<0.001）. ConclusionEZ-ALBI score and the presence or absence of peritoneal effusion can be used as predictors of the survival of HCV-HCC patients.

Objective: To understand the subjective and objective comfort evaluations of students from different age groups on desks and chairs, so as to provide reference for standardized allocation and use of desks and chairs. Methods: From January to April 2024, a total of 2 446 students were selected from 26 schools in 13 districts (counties/cities) in Shanghai, Tianjin, and Wuxi from Jiangsu Province by using cluster random method, including students in kindergartens, primary schools, junior high schools,senior high schools, colleges and universities. Standardized procedures were used to measure the height and weight of participants, and the matching desks and chairs models were selected according to the height. The subjective comfort of students on matching desks and chairs was investigated, and their objective comfort was evaluated by using a self designed questionnaire. The χ 2 test was used to analyze the differences of subjective perception and objective evaluation in comfort between different types of desks and chairs. Results: About 84.1% of the students subjectively thought that large desks and small chairs were very comfortable or relatively comfortable, followed by large desks and chairs (75.7%), and the proportion of small desks and chairs was the lowest among the three types (46.2%), and the difference was statistically significant ( χ 2=722.46, P <0.01). The reporting rates of primary school, junior high school and senior high school students who subjectively considered large desks and chairs to be very comfortable/relatively comfortable were higher than that of other types of desks and chairs, and the differences were statistically significant ( χ 2=297.49, 252.82, 343.67, P <0.01). However, there was no significant difference in the subjective comfort evaluation of different types of desks and chairs among kindergarten children ( χ 2=3.21, P >0.05), and 66.3% of the students in colleges and universities felt very comfortable/relatively comfortable when they used the matching standard desks and chairs. The objective evaluation results of the comfort for the three types of desks and chairs were consistent with the subjective evaluation, but the proportions of the objective evaluation as very comfortable/relatively comfortable were higher than that of the subjective evaluation ( χ 2=20.76- 813.47, P <0.01). Conclusions Large desks and chairs, as well as large desks with small chairs are perceived comfortable, while small desks and chairs are perceived less comfortable. It is recommended to match the large desks and chairs or large desks and small chairs that are suitable for them according to the "standard", to promote physical and mental health of students.