Objective: To analyze the developmental trajectories of clustered health risk behaviors and their association with self-esteem and lonelinesss among junior high school students, so as to provide a reference for formulating comprehensive prevention and control measures of health risk behaviors among adolescents. Methods: In October 2023, 1 165 first year junior high school students from two schools of Jishou City in Hunan Province were selected by convenient sampling method for three follow up surveys (T1:October 2023; T2:April 2024; T3:October 2024). The Adolescent Health Risk Behavior Questionnaire, Rosenberg Self esteem Scale and Loneliness Scale were used to assess health risk behaviors, self esteem and loneliness, respectively. Latent growth curve modeling and latent growth mixture modeling were applied to analyze the developmental trajectories of clustered health risk behaviors among junior high school students. Logistic regression was used to analyze the association of the developmental trajectories of clustered health risk behaviors with self esteem and loneliness among junior high school students. Results: The overall developmental trajectories among junior high school students showed a declining trend (intercept=0.15, slope=-1.65, both P <0.05), with three heterogeneous categories:low risk improvement group ( n =862, 74.0%), moderate risk stable group ( n =260, 22.3%), and high risk deterioration group ( n =43, 3.7%). After adjusting the status of the left behind individuals，using the low risk improvement group as the reference category in multinomial Logistic regression analysis, results indicated that higher loneliness scores among junior high school students increased the risks of belonging to the moderate risk stable group ( OR=1.02, 95%CI =1.00- 1.04 ) and the high risk deterioration group ( OR=1.04, 95%CI =1.00-1.08), while higher self esteem scores reduced the risks of belonging to the moderate risk stable group ( OR=0.93, 95%CI =0.91-0.96) and the high risk deterioration group ( OR=0.88, 95%CI =0.83-0.94) (all P <0.05). Conclusions The overall trend of clustered health risk behaviors among junior high school students gradually improves, and the self esteem and loneliness are significant correlative factors. Targeted intervention measures should be developed for the junior high school students, with a focus on enhancing their self esteem and alleviating loneliness.

Purpose: In this study, the neural communication patterns between hypothalamic structures and cortical areas in girls diagnosed with central precocious puberty (CPP) were explored. Endocrine profiles were incorporated to clarify the pathophysiological interactions between cerebral networks and hormonal regulation. The hypothalamus was designated as the key focus area for connectivity analysis. Methods: Fifty-seven girls (37 CPP, 20 non-CPP) were recruited from the Pediatric Development Clinic at the Second Affiliated Hospital of Anhui Medical University. The collected data included demographic information, gonadotropin-releasing hormone stimulation tests, and magnetic resonance imaging scans. Hypothalamic functional connectivity (FC) was analyzed using predefined region of interest coordinates, and correlations between hormone levels and FC values were assessed. Results: Compared to the non-CPP group, the CPP group exhibited elevated baseline follicle-stimulating hormone (FSH), baseline luteinizing hormone (LH), peak FSH, peak LH, and peak LH/FSH ratios. Patients with CPP exhibited enhanced neural synchronization linking the right lateral hypothalamic effector zone to the right superior frontal gyrus (displaying a borderline significant correlation with peak LH concentrations), concurrent with diminished functional coupling of the right lateral hypothalamic efferent to the right fusiform/supramarginal gyri. The left lateral hypothalamic projections demonstrated amplified connectivity with the right cuneus. No FC differences were observed in the medial hypothalamus. Conclusion Abnormal lateral hypothalamus FC patterns were identified in CPP girls and were particularly linked to peak LH levels. The findings offer novel insights into the neuroendocrine mechanisms underlying CPP.

Objective To explore the evaluation value of thyroid function indicators[thyroid stimulating hormone(TSH),free thyroxine(FT4),free triiodothyronine(FT3)]combined with transcranial Doppler ultrasound(TCD)and carotid ultrasound in the assessment of vascular stenosis in atherosclerotic cerebral infarction(ASCI),providing a reference for clinical targeted treatment.Methods A total of 182 patients with ASCI admitted to Handan Frist Hospital from October 2021 to September 2023 were selected and all of them underwent TCD,carotid artery ultrasound and thyroid function examination.Digital subtraction angiography was used as the gold standard to analyze the evaluation effect of TCD and carotid artery ultrasound combined with TSH,FT4 and FT3 in vascular stenosis of ASCI.Results Among the 182 patients with ASCI,DSA confirmed 64 cases(35.16％)with mild internal carotid artery stenosis,69 cases(37.91％)with moderate stenosis,29 cases(15.93％)with severe stenosis,and 20 cases(10.99％)with complete occlusion.There was no statistically significant difference in clinical data among groups with different degrees of vascular stenosis(P＞0.05).The peak systolic velocity(PSV)and end-diastolic volume(EDV)of the internal carotid artery in different groups with different degrees of vascular stenosis showed an increasing trend with the severity of vascular stenosis,while the pulse index(PI),resistance index(RI),and diameter(D)showed a decreasing trend(P＜0.05).In different groups with different degrees of vascular stenosis,TSH and FT4 levels increased with the severity of stenosis,while FT3 levels decreased(P＜0.05).TSH and FT4 were positively correlated with the degree of vascular stenosis,while FT3 was negatively correlated(P＜0.05).TSH and FT4 were positively correlated with PSV and EDV,and negatively correlated with RI,PI,and D.FT3 was positively correlated with RI,PI,and D,and negatively correlated with PSV and EDV(P＜0.05).The combined evaluation of RI,PI,D,PSV,EDV,TSH,FT4,and FT3 yielded the highest area under the curve(AUC)value of 0.941 for assessing ASCI vascular stenosis(P＜0.05).Conclusion The combination of TCD,carotid ultrasound,and thyroid function tests have high value in the assessment of ASCI vascular stenosis.The joint evaluation of RI,PI,D,PSV,EDV,TSH,FT4 and FT3 is beneficial for diagnosing different degrees of vascular stenosis,providing a reference for clinical treatment.r clinical treatment.

Objective To investigate the prevalence of Schistosoma japonicum infections in wild rodents in schistosomiasis-endemic areas of China, so as to provide insights into formulation of technical guidelines for monitoring of and the precise control strategy for S. japonicum infections in wild rodents during the elimination phase. Methods Two administrative villages where schistosomiasis was historically highly prevalent were selected each from Dongzhi County, Anhui Province, and Duchang County, Jiangxi Province as study villages. Wild rodents were captured from study villages with baited traps or cages at night in June and September, 2021. The number of rodents captured was recorded, and the rodent species was characterized based on morphologi-cal characteristics. Liver tissues were sampled from captured rodents for macroscopical observation of the presence of egg granu- lomas, and S. japonicum infection was detected simultaneously using liver tissue homogenate microscopy, examinations of mesenteric tissues for parasites, and modified Kato-Katz thick smear technique (Kato-Katz technique). A positive S. japonicum infection was defined as detection of S. japonicum eggs or adult worms by any of these methods. The rate of wild rodent capture and prevalence of S. japonicum infections in wild rodents were compared in different study villages and at different time periods, and the detection of S. japonicum infections in wild rodents was compared by different assays. Results The overall rate of wild ro- dent capture was 8.28% (237/2 861) in Dongzhi County, and the wild rodent capture rates were 9.24% (133/1 439) and 7.31% (104/1 422) in two study villages (χ² = 3.503, P = 0.061), and were 8.59% (121/1 409) and 7.99% (116/1 452) in June and September, 2021, respectively (χ² = 0.337, P = 0.561). The overall rate of wild rodent capture was 3.72% (77/2 072) in Duchang County, and the wild rodent capture rates were 6.91% (67/970) and 0.91% (10/1 102) in two study villages (χ² = 51.901, P < 0.001), and were 4.13% (39/945) and 3.37% (38/1 127) in June and September, 2021, respectively (χ² = 0.815, P = 0.365). Rattus norvegicus was the predominant rodent species captured in both counties, accounting for 70.04% (166/237) of all captured wild rodents in Dongzhi County and 88.31% (68/77) in Duchang County. No S. japonicum infection was detected in wild rodents captured in Duchang County. Nevertheless, the overall prevalence of S. japonicum infections was 51.05% (121/237) in wild rodents captured in Dongzhi County, with prevalence rates of 50.38% (67/133) and 51.92% (54/104) in two study villages (χ² = 0.098, P = 0.755), and 54.31% (63/116) and 47.93% (58/121) in September and June, 2021, respectively (χ² = 0.964, P = 0.326). Of 237 wild rodents captured in Dongzhi County, there were 140 (59.07%) rodents with visible hepatic egg granulomas, 117 (49.47%) tested positive for S. japonicum eggs by liver tissue homogenate microscopy, 34 (14.35%) tested positive for S. japonicum eggs with Kato-Katz technique; however, no adult S. japonicum worms were detected in mesenteric tissues. In addition, hepatic egg granulomas were found in all wild rodents tested positive for S. japonicum eggs with liver tissue homogenate microscopy. Conclusions The rate of wild rodent capture and prevalence of S. japonicum infection in wild rodents vary greatly in schistosomiasis-endemic areas of China, and the prevalence of S. japonicum infection is slightly higher in wild rodents captured in autumn than in summer. Liver tissue is recommended as the preferred sample for surveillance of S. japonicum infection in wild rodents, and a combination of macroscopical observation of hepatic egg granulomas and liver tissue homogenate microscopy may be a standard method for surveillance of S. japonicum infection in wild rodents.

L-tyrosine is one of the 20 amino acids that make up proteins and is an essential amino acid for mammals, often used as a nutritional supplement. The conventional methods for synthesizing L-tyrosine have some problems such as the production of many by-products, high requirements for production conditions, and environmental pollution. In this study, we designed and constructed a multi-enzyme cascade for the synthesis of L-tyrosine with alanine, glutamate, ammonium chloride, and phenol as substrates. Initially, the sources of glutamate oxidase, alanine aminotransferase, and tyrosine phenol lyase were screened and analyzed, which was followed by the identification of the rate-limiting enzyme in the reaction process. A colorimetric screening method was established, and the rate-limiting enzyme DbAlaA was engineered to enhance its activity by 40.0%. Subsequently, the reaction conditions, including temperature, pH, cell concentration, and surfactant and coenzyme dosages, were optimized. After optimization, the yield of L-tyrosine reached 9.93 g/L, with a alanine conversion rate of 54.90%. Finally, a feed-batch fermentation strategy was adopted, and the yield of L-tyrosine reached 56.07 g/L after 24 h, with a alanine conversion rate of 65.22%. This study provides a reference for the whole-cell catalytic synthesis of L-tyrosine and its industrialization.
Tyrosine/biosynthesis* ; Escherichia coli/metabolism* ; Tyrosine Phenol-Lyase/genetics* ; Multienzyme Complexes/metabolism* ; Fermentation

Objective To investigate the relationship between serum levels of interferon-inducible protein 10(IP-10)and S100 calcium-binding protein A8(S100A8)and the prognosis of patients with severe pneumo-nia(SP).Methods A total of 315 SP patients admitted to the hospital from January 2021 to December 2023 were selected as the SP group,and 315 non-SP patients admitted to the hospital during the same period were selected as the non-SP group.According to the prognosis of SP patients 28 d after admission,they were divided into good prognosis group(199 cases)and poor prognosis group(116 cases).Enzyme-linked immunosorbent assay was used to detect serum IP-10 and S100A8 levels in SP patients.Pearson correlation analysis was used to analyze the correlation between IP-10,S100A8 levels and infection indicators[high-sensitivity C-reactive protein(hs-CRP),procalcitonin(PCT),interleukin-6(IL-6)].Multivariate Logistic regression was used to analyze the influencing factors of poor prognosis in SP patients.Receiver operating characteristic(ROC)curve was used to analyze the value of hs-CRP,PCT,IP-10 and S100A8 levels in predicting the poor prognosis of SP patients.Results The serum levels of IP-10,S100A8,hs-CRP,PCT and IL-6 in SP group were higher than those in non-SP group(P＜0.05).Paerson correlation analysis showed that serum IP-10 level in SP group was positively correlated with hs-CRP,PCT and IL-6(r=0.744,0.757,0.740,P＜0.05).S100A8 level was posi-tively correlated with hs-CRP,PCT and IL-6(r=0.769,0.718,0.744,P＜0.05).There were significant differences in oxygenation index,acute physiology and chronic health evaluation Ⅱ score,clinical pulmonary in-fection score and levels of hs-CRP,PCT,IP-10 and S100A8 between the poor prognosis group and the good prognosis group(P＜0.05).Multivariate Logistic regression analysis showed that hs-CRP,PCT,IP-10 and S100A8 were risk factors for poor prognosis in SP patients,and oxygenation index was a protective factor(P＜0.05).The ROC curve showed that the area under curve(AUC)of the combination of hs-CRP,PCT,IP-10 and S100A8 in predicting poor prognosis of SP patients was 0.965,which was greater than the AUC of the four alone(Zhs-CRP=4.009,ZPCT=4.022,ZIP-10=3.696,ZS100A8=3.309,P＜0.05).Conclusion The serum lev-els of IP-10 and S100A8 are up-regulated in SP patients.The combination of IP-10 and S100A8 has a high pre-dictive value for poor prognosis in SP patients.

Objective:To analyze the psychometric properties of the short-form Extended Barthel Index (EBI) in assessing ability in the activities of daily living (ADL).Methods:Data describing 295 discharged patients with stroke or traumatic brain injury were collected retrospectively, including their demographics, diagnoses, and functional assessments (EBI, FIM, MBI and MoCA). Then, data on 120 of them were used to construct short-form EBI models based on item-total advantage indices, while the remaining 175 patients served as a validation set to evaluate the acceptability, responsiveness, reliability, validity, and outcome consistency of the models. The optimal model was selected as the recommended short-form EBI.Results:The short-form EBI comprises seven items: personal hygiene, dressing/undressing, wheelchair-bed transfer, walking, social interaction during walking, problem-solving, and memory/learning/orientation, with each item scored 0-4 (total range: 0-28). The short-form EBI demonstrated good acceptability, with median and mean scores near the scale′s midpoint and no significant ceiling or floor effects. Its responsiveness (d=0.19) surpassed that of the original EBI (d=0.14). Moreover, the short-form EBI showed excellent reliability (Cronbach′s α=0.885; SEM=9.11) and validity, explaining 95.4% of the variance in EBI scores (adj. R 2=0.954). Concurrent validity with the EBI was strong (ρ=0.975, P≤0.001), and criterion validity with ρ=0.956 for FIM, 0.889 for MBI, and 0.806 for MoCA. The short-form and the original EBI exhibited good agreement [ICC=0.967 (95% CI: 0.769-0.989); score difference: 6.48±6.56]. Conclusions:The short-form EBI demonstrates excellent acceptability, responsiveness, reliability, validity, and outcome consistency, making it a practical tool for ADL assessment in cases of stroke or traumatic brain injury.

Objective:To explore the effectiveness of the"full-chain"integrated medical and elderly care service model in addressing key issues in medical-nursing services such as weak medical support capacity and insufficient provision of community-and home-based medical-nursing services.Methods:The development pathway for the"full-chain"integrated medical-elderly care service standardization system,encompassing core components such as operational mechanisms,smart platforms,policy documents,and quality control systems was systematically outlined.Effectiveness based on dimensions including service coverage,quality improvement,talent development,and social benefits was evaluated.With standardization as the core driver,the'1234567'management model was innovatively implemented.Results:The model leveraged the downward allocation of high-quality resources from tertiary general hospitals to strengthen subdistrict community health service centers.By collaborating with subdistrict elderly-care service centers,it established"subdistrict medical-elderly care and wellness service centers".These centers enhanced the capabilities of"community-embedded elderly-care complexes",including community daytime care centers,established two-way referral channels between medical and elderly care services,aligned with healthcare demands to provide elderly individuals with reliable medical support.It reduced the burden on families and society,stimulated market vitality,boosted domestic demand,promoted the development of integrated medical-elderly care and wellness initiatives,thereby advancing the silver economy.With provincial government endorsement,the model had been applied to 203 communities across 37 counties by the end of 2024.Conclusion:The established"full-chain"integrated medical-elderly care service model facilitates regional high-quality development in integrated care by consolidating healthcare group resources and seamlessly connecting the service chain across hospitals,nursing homes,community institutions,and home-based settings,thereby creating a practical paradigm for comprehensive elderly care service delivery.

Objective:To evaluate the clinical characteristics of Crohn's disease (CD) patients with secondary upper gastrointestinal fistulas and analyze risk factors for recurrence.Methods:A restrospective observational research method was performed. Clinical data of CD patients with secondary upper gastrointestinal fistulas treated at Eastern Theater General Hospital of PLA from January 2010 to August 2024 were analyzed. Based on postoperative recurrence of upper gastrointestinal fistulas, the patients were divided into recurrence group and non-recurrence group. Differences in clinical data between the two groups were compared, and further multivariate Logistic regression analysis was used to identify the risk factors for fistula recurrence.Results:A total of 72 CD patients with secondary upper gastrointestinal fistulas were included, consisting of 48 males and 24 females, with a mean age of 39±12 years and a disease duration of 97±56 months, accounting for 2.8% of all CD patients undergoing surgeries during the same period. Among these patients, 75 upper gastrointestinal fistulas from 72 patients were identified, including 67 patients of simple duodenal fistula, 2 of simple gastric fistula, and 3 of double fistulas (2 of double duodenal fistulas and 1 of duodenal fistula combined with gastric fistula) .The preoperative diagnostic positivity rates were 55.6% (40/72) for gastroscopy, 54.2% (39/72) for upper gastrointestinal contrast imaging, 22.2% (16/72) for abdominal CT, and 22.2% (16/72) for colonoscopy. A history of biologic therapy was present in 33.3% (24/72) of patients, but none achieved fistula healing. All 72 patients underwent surgical treatment, with primary lesion surgical approaches including resection with anastomosis (37 patients, 51.4%) and resection with stoma (35 patients, 48.6%). Except for one gastric fistula treated by resection, all other fistulas underwent primary repair. During a median follow-up of 69 (40, 113) months, 8 patients (11.1%) required reoperation due to recurrent upper gastrointestinal fistulas (classified as the recurrence group), while the remaining 64 patients were assigned to the non-recurrence group. Univariate analysis revealed that the recurrence group had a higher proportion of patients aged 30-40 years ( P = 0.003), malnutrition ( P = 0.040), and anastomosis near the duodenum ( P = 0.047), but a lower proportion of postoperative biologic use ( P = 0.007) .Multivariate Logistic regression analysis showed that malnutrition and anastomosis near the duodenum were not the risk factors for duodenal fistula recurrence (both P > 0.05) . Conclusions:Upper gastrointestinal fistulas secondary to CD are rare, predominantly presenting as simple duodenal fistulas. Diagnosis primarily relies on gastroscopy and gastrointestinal contrast imaging. Biologic therapy shows poor efficacy, and most patients do not recur after the primary repair surgery of duodenal fistulas.

Objective To explore the use of T2-fluid attenuated inversion recovery(FLAIR)sequences with a shorter TR to significantly reduce examination time without compromising diagnostic accuracy and image quality,and to obtain satisfactory brain gray and white matter contrast images via adjusting the TE.Methods A total of 60 patients underwent brain MR were selected,and each patient was scanned using two different T2-FLAIR sequences.The scan parameters for sequence A group were TR 9 000 ms,inversion time(TI)2 500 ms,and TE 120 ms.For sequence B group,the scan parameters were TR 6 000 ms,TI 2 000 ms,and TE 120-200 ms(with 20 ms intervals),respectively,and all images data were labeled as B1 to B5.A double-blind method was used to observe the images from both groups,with a 5-point rating scale.The signal-to-noise ratio(SNR),contrast-to-noise ratio(CNR)of brain gray and white matter,and the contrast of brain gray and white matter were measured,respectively.SPSS 26.0 statistical software was used for subjective and objective evaluations of the images from both groups.Results For subjective evaluation,there were statistically significant differences in image quality with TE ranged from 120 to 200 ms in B group(H=41.4,P＜0.05).In pairwise comparisons,images from B3 group(TE 160 ms)showed no statistically significant difference compared to A group in subjective evaluations by two physicians(P＞0.05).For objective evaluation,A group exhibited significantly higher SNR compared to B group.Among the images in B group with TE ranged from 120 to 200 ms,SNR decreased gradually with increased TE,while CNR and contrast increased progressively(P＜0.05).Specifically,there were no statistically significant differences between B3 and A groups in terms of CNR and contrast(P＞0.05).Conclusion T2-FLAIR sequences with a shorter TR can significantly reduce examination time.By adjusting the TE,satisfactory brain gray and white matter contrast images can be obtained.When TE is 160 ms,the contrast of brain gray and white matter is optimal,and the SNR of the images meets the requirements for clinical diagnosis.