Objective: To analyze the relationship between cumulative ecological risks and physical activity behaviors of junior high school students, so as to provide theoretical support for promoting the physical and mental health development of junior high school students. Methods: From March to April 2023, a multistage random cluster sampling method was used to conduct an online survey of 3 502 middle school students in Henan Province. Physical activity levels and cumulative ecological risk were measured using the Physical Activity Rating Scale-3 and the Cumulative Ecological Risk Scale. Chisquare test and multiple Logistic regression were employed to examine the distribution and influencing factors of physical exercise behaviors among different student groups. Results: Slight physical exercise had the highest proportion of physical activity in tensity among junior high school students (48.5%), with 80.4% engaging in low levels of physical activity. Only 16.8% of students exercised ≥1 time daily, and the most common frequency was 1-2 times per week (44.1%). Gender, residential area, parental education, and peer support were all significantly associated with physical activity levels among junior high school students (χ2=122.53, 6.49, 7.49, 10.17, P<0.05). Logistic regression analysis showed that higher cumulative ecological risk scores were associated with a greater likelihood of engaging in low levels of physical activity compared to high levels (OR=1.12, 95%CI=1.02-1.23, P<0.05), but no significant association was found for moderate physical activity (OR=1.08, 95%CI=0.97-1.21, P>0.05). Conclusions Junior high school students in Henan Province generally engage in insufficient physical exercise. Cumulative ecological risk negatively predicts their physical activity behaviors.

China emerges as a major country in nuclear energy development and the application of nuclear and radiologic technology. The diagnosis and treatment of acute radiation syndrom (ARS) caused by external irradiation represent a core function in the country′s medical rescue of nuclear and radiological emergencies. Clinically, ARS manifests hematopoietic, gastrointestinal, cutaneous, and central nervous system syndromes, with specific clinical manifestations, signs, severity, and prognosis strongly correlated with radiation dose. China has established a number of national and provincial centers for treating radiation-induced damage. Nevertheless, most medical staff have limited experience in ARS treatment. This consensus presents a summary of recent experience in treating ARS of China. In combination with recommendations from international organizations such as the World Health Organization (WHO), this consensus proposes key evidence of critical clinical issues of ARS, covering all links in the rescue of external irradiation-induced ARS. Initially, clinical diagnosis, syndromes, and severe degrees should be determined based on clinical symptoms and dose estimates. It is necessary to normalize clinical treatment measures for hematopoietic recovery, gastrointestinal injury treatment, infection control, symptomatic treatment, and multi-organ function preservation. To this end, this consensus offers cautions. This consensus provides principles of treatment with traditional Chinese medicine, psychological intervention, and follow-up. Additionally, it highlights multidisciplinary collaboration. It is recommended that this consensus be applied in relevant treatment centers.

China emerges as a major country in nuclear energy development and the application of nuclear and radiologic technology. The diagnosis and treatment of acute radiation syndrom (ARS) caused by external irradiation represent a core function in the country′s medical rescue of nuclear and radiological emergencies. Clinically, ARS manifests hematopoietic, gastrointestinal, cutaneous, and central nervous system syndromes, with specific clinical manifestations, signs, severity, and prognosis strongly correlated with radiation dose. China has established a number of national and provincial centers for treating radiation-induced damage. Nevertheless, most medical staff have limited experience in ARS treatment. This consensus presents a summary of recent experience in treating ARS of China. In combination with recommendations from international organizations such as the World Health Organization (WHO), this consensus proposes key evidence of critical clinical issues of ARS, covering all links in the rescue of external irradiation-induced ARS. Initially, clinical diagnosis, syndromes, and severe degrees should be determined based on clinical symptoms and dose estimates. It is necessary to normalize clinical treatment measures for hematopoietic recovery, gastrointestinal injury treatment, infection control, symptomatic treatment, and multi-organ function preservation. To this end, this consensus offers cautions. This consensus provides principles of treatment with traditional Chinese medicine, psychological intervention, and follow-up. Additionally, it highlights multidisciplinary collaboration. It is recommended that this consensus be applied in relevant treatment centers.

Objective:To investigate the ultrasonic characteristics of lymph node metastasis of papillary thyroid carcinoma and the predictive value of silent mating-type information regulation2 homolog1 (SIRT1) .Methods:90 PTC patients admitted from May. 2022 to May. 2023 were selected. According to the ultrasonography of patients with lymph node enlargement, hypoecho, unclear boundary, microcalcification and other conditions, the patients were divided into 26 cases in the LNM group and 64 cases without LNM. All patients underwent thyroid ultrasonography, and their serum samples were collected. Serum SIRT1 levels were detected by enzyme-linked immunosorbent assay (ELISA) double-antibody sandwich method. ROC was used to analyze the predictive value of ultrasonic characteristics and serum SIRT1 for LNM in PTC patients.Results:Compared with the group without lymph node metastasis, the proportion of patients with multiple tumor lesions ( P=0.001), tumor diameter ≥1 cm, hypoecho, unclear boundary and microcalcification was higher in the group with lymph node metastasis ( P<0.05). The serum SIRT1 level of LNM group (5.12±1.24) ng/mL was lower than that of (8.76±1.35) ng/mL in the other group ( P<0.05). ROC results showed that when the optimal cut-off value of serum SIRT1 was 7.59 ng/mL, the area under the curve was 0.78 (95% CI: 0.746- 0.835). The sensitivity and specificity were 79.43% and 71.56%, respectively. Multiple tumors, tumor diameter ≥1 cm ( P=0.018), unclear boundaries ( P=0.005), microcalcification ( P=0.001), and serum SIRT1 < 7.59 ng/mL ( P<0.001) had good clinical value in the evaluation of lymph node metastasis of papillary thyroid carcinoma, and the combined detection had a higher predictive value, with a sensitivity of 84.57%. Multivariate analysis showed that tumor boundaries were unclear ( OR=2.812, 95% CI: 1.220-6.482), microcalcification ( OR=4.145, 95% CI: 1.335-12.870), and serum SIRT1 decreased ( OR=2.399, 95% CI: 1.580-3.642) were independent risk factors for lymph node metastasis of papillary thyroid carcinoma ( P<0.05) . Conclusions:Lymph node metastasis of papillary thyroid carcinoma is characterized by unclear boundary and micro-calcification on ultrasound, and serum SIRT1 is decreased. The combined detection of ultrasound features and serum SIRT1 has a good predictive value in predicting lymph node metastasis in patients with papillary thyroid cancer.

Objective To explore the optimal dose of twice daily premixed insulin regimen in Chinese patients with type 2 diabetes mellitus(T2DM). Methods A total of 361 T2DM patients admitted to the department of endocrinology in Huadong hospital affiliated to Fudan university from March 2017 to October 2021 were selected. All patients received stable doses of premixed insulin twice daily and had HbA1c<7％. Continuous blood glucose monitoring confirmed that TIR was>70％ and TBR was<1％. According to different insulin formulations,it was divided into Regular/NPH 30 group (n=161),Aspart 30 group (n=156),and Lispro 25 group (n=44). Clinical characteristics,total insulin dose,pre-breakfast insulin dose,pre-dinner insulin dose,and pre-breakfast/pre-dinner insulin ratio were compared. Pearson correlation analysis was used to analyze the correlation between total insulin dose and other indicators. Multiple linear regression analysis was used to analyze the influencing factors of the total insulin dose. Results The mean dose of total insulin,pre-breakfast insulin,and pre-dinner insulin was (30.6±8.6)U/d,(18.3±5.1)U/d,and (12.3±4.2)U/d,respectively. The median of insulin dose per kg was 0.4(0.4,0.5)U/d,and pre-breakfast/pre-dinner insulin ratio was 1.5(1.3,1.8). Pearson correlation analysis showed that total insulin dose was associated with BMI,HbA1c,FPG,and ALT. Multiple linear regression analysis showed that BMI,FPG,HbA1c,and ALT were independent factors of total insulin dose. Conclusions The initial dose of premixed insulin can be allocated at a ratio of 3∶2 before breakfast and before dinner in Chinese people with T2DM,not 1∶1.

Objective To explore the optimal dose of twice daily premixed insulin regimen in Chinese patients with type 2 diabetes mellitus(T2DM). Methods A total of 361 T2DM patients admitted to the department of endocrinology in Huadong hospital affiliated to Fudan university from March 2017 to October 2021 were selected. All patients received stable doses of premixed insulin twice daily and had HbA1c<7％. Continuous blood glucose monitoring confirmed that TIR was>70％ and TBR was<1％. According to different insulin formulations,it was divided into Regular/NPH 30 group (n=161),Aspart 30 group (n=156),and Lispro 25 group (n=44). Clinical characteristics,total insulin dose,pre-breakfast insulin dose,pre-dinner insulin dose,and pre-breakfast/pre-dinner insulin ratio were compared. Pearson correlation analysis was used to analyze the correlation between total insulin dose and other indicators. Multiple linear regression analysis was used to analyze the influencing factors of the total insulin dose. Results The mean dose of total insulin,pre-breakfast insulin,and pre-dinner insulin was (30.6±8.6)U/d,(18.3±5.1)U/d,and (12.3±4.2)U/d,respectively. The median of insulin dose per kg was 0.4(0.4,0.5)U/d,and pre-breakfast/pre-dinner insulin ratio was 1.5(1.3,1.8). Pearson correlation analysis showed that total insulin dose was associated with BMI,HbA1c,FPG,and ALT. Multiple linear regression analysis showed that BMI,FPG,HbA1c,and ALT were independent factors of total insulin dose. Conclusions The initial dose of premixed insulin can be allocated at a ratio of 3∶2 before breakfast and before dinner in Chinese people with T2DM,not 1∶1.

Objective : To investigate risk factors related to coronary artery lesion( CAL) in children with Kawasaki disease． Methods : Retrospective analysis was conducted on clinical data of 144 children with Kawasaki disease. The cases were divided into two groups according to whether they had CAL or not．There were 50 children in CAL group and 94 children in non-coronary artery lesion(NCAL) group．The clinical and laboratory indicators in the two groups were analyzed and compared，and the diagnostic efficacy of these indicators for Kawasaki disease combined with CAL was analyzed by drawing the receiver operating characteristic (ROC) curve. Results : There was no statistical significant difference in age，gender，duration of fever，use time of immunoglobulin，erythrocyte sedimentation rate，C-reactive protein，serum amyloid A，N-terminal pro brain natriuretic peptide，white blood cell，hemoglobin and platelet between the two groups (P＞0. 05) ．In CAL group，the serum levels of 25-( OH) D3 and albumin were lower，while the levels of alanine transaminase，interleukin-6 and procalcitonin were higher than those in NCAL group (P＜0. 05) ．Multivariate logistic regression analysis showed that the levels of serum 25-( OH) D3 ( OR = 0. 984，95% CI:0. 974 ～0. 995) ，albumin ( OR = 0. 857，95% CI:0. 771－0. 951) ，alanine transaminase ( OR = 1. 011，95% CI : 1. 005 －1. 017) and interleukin-6 ( OR = 1. 002，95% CI : 1. 000 －1. 005 ) were significantly related with coronary artery lesion in children with kawasaki disease (P＜0. 05) ．The levels of 25-( OH) D3 ，albumin，alanine transaminase and interleukin-6 in serum had diagnostic value for Kawasaki disease combined with CAL，and the area under the curve (AUC) were 0. 660，0. 652，0. 711，and 0. 700，respectively．The AUC of combined diagnosis of four indicators was 0. 816 ． Conclution Decrease of serum 25-( OH) D3 and albumin levels，increase of serum interleukin-6 and alanine transaminase levels in children with Kawasaki disease are risk factors for CAL ，combined detection on these multi-indicators have diagnostic value for Kawasaki disease combined with CAL.

Objective:To investigate the effect of functional movement assessment on the recurrence of patients with ankylosing spondylitis (AS) after treat-to-target therapy.Methods:The clinical data of 61 patients with AS in Chengdu were collected including clinical symptoms and AS disease activity (ASDAS). After 24 weeks adalimumab treatment, motor function score of AS patients(ASDAS<1.3) was assessed by functional movement screen (FMS), then adalimumab was discontinued and the rest of the concurrent drugs were continued until the disease relapse or up to 1 year. The data of the two groups were compared using t-test analysis and Cox proportionate hazard model. Results:① The recurrence rate of patients with AS after treat-to-target therapy within 1 year follow-up was 57.4%; ② The recurrence group was younger [(27±7) vs (31±6), t=5.96, P=0.02], the ASADAS value was at the high end when adalimumab was withdrawal [(1.29±0.07) vs (0.87±0.16), t=177.31, P<0.01], and the FMS value was lower after treat-to-target [(12.9±2.7) vs (16.2±1.9), t=29.23, P<0.01], The time to reaching the treatment target was longer [(2.9±1.2) month vs (1.7±0.6) month, t=19.89, P<0.01] than the stable group; ③ The cut-off value of the FMS test of AS patients after treat-to-target therapy was 14.25 (sensitivity was 84.6%, specificity was 80%) . The time to treat-to-target was a risk factor for recurrence ( RR=2.285, P<0.05), and the FMS value after treat-to-target was a protective factor ( RR=0.625, P<0.05). Conclusion:After discontinuing the adalimumab, about half of the patients relapse. The time reaching the treatment target and the FMS value after treat-to-target therapy are the risk factors for disease recurrence.

Objective:To establish a new nurse standardized training management index system based on training transfer theory, and to provide reference for objective evaluation of standardized training management for new nurses.Methods:From August 2020 to April 2021, guided by the theory of training transfer, the standardized training management indexs for new nurses were preliminarily drawn up through literature review, semi-structured interviews. The Delphi method was used to conduct two rounds of expert consultation.Results:The effective questionnaire recovery rate of the two rounds of expert consultation was 92.00% (23/25) and 95.65% (22/23), respectively. The expert authority coefficients were 0.904 and 0.905, respectively. Kendall′s harmony coefficients were 0.228 and 0.250, respectively, both P<0.01. The final index system of standardized training management for new nurses based on training transfer theory included 4 first-level indexes, 14 second-level indexes and 59 third-level indexes. Conclusions:The new nurse standardized training management index system based on training transfer theory is scientific and reliable. It provides a tool for evaluating standardized training management of new nurses and a reference for perfecting the training management system of new nurses.

Objective:To explore the differences of immune reconstitution between peripheral blood stem cell transplantation and umbilical cord blood transplantation.Methods:A total of 300 patients (aged 18 (8, 33), 163 males and 137 females) with malignant hematological diseases who received allogeneic hematopoietic stem cell transplantation in the First Affiliated Hospital of University of Science and Technology of China from January 2018 to March 2020 were enrolled in this study, including 255 cases of umbilical cord blood transplantation and 45 cases of peripheral blood stem cell transplantation. Multicolor flow cytometry was applied to analyze lymphocyte subsets of the percentages and absolute counts in the two donor types and peripheral blood of patients after receiving hematopoietic stem cell transplantation. The differences between the two grafts were compared, and the lymphocyte subsets results were evaluated at 1, 2, 3, 4, 6, 9, 12, and 18 months after transplantation. 18-month disease-free survival (DFS) within the 300 patients under the two transplantation types were retrospectively analyzed.Results:1. The proportion of NKT cells in peripheral blood group was significantly higher than that in cord blood group (2.79% vs 0.24%, P<0.001). 2. The proportion of helper T cells in the UCBT group was higher than that in the PBSCT group, as well as the counts 6 months after transplantation ( P<0.05). 3. The proportion of NK1 cells (3 rd to 9 th month) and count (4 th to 12 th month) in UCBT group were significantly higher than those in PBSCT group ( P<0.05). 4. NKT cells in the UCBT group were lower than those in the PBSCT group (proportion and count) throughout the monitoring process ( P≤0.001). 5. The proportion of DNT cells (within 1 year) and count (within 6 months) in the UCBT group were significantly lower than those in the PBSCT group ( P<0.05). Conclusions:Compared with the peripheral blood stem cell transplantation group, the umbilical cord blood transplantation patients had a faster rate of lymphocyte reconstitution, and patients received umbilical cord blood transplantation had a stronger ability of immune reconstitution and could achieve long-term hematopoiesis.