ObjectiveTo investigate the expression level of lysophosphatidyllecithin acyltransferase 4 （LPCAT4） in pancreatic cancer and its effect on the proliferation of pancreatic cancer cells. MethodsIn this study， the differentially expressed genes of patients with KRAS mutant and wild-type pancreatic cancer were analyzed by online database LinkedOmics. The LPCAT4 expression in pancreatic cancer tissues was analyzed online by the University of Alabama at Birmingham Cancer Data Analysis （UALCAN）， Sangerbox and gene expression profile interaction analysis 2 （GEPIA2）. Kaplan-Meier Plotter database was used to explore the correlation between LPCAT4 and the prognosis of patients with pancreatic cancer. The expression of LPCAT4 in human pancreatic cancer cells were detected by quantitative real-time PCR and Western blot analysis. LPCAT4 was knocked down in the high-expressing SW1990 cell line and overexpressed in the low-expressing MIA PaCa-2 cell line. The effects of LPCAT4 expression on cell proliferation were assessed using CCK-8 and EdU assays. STRING and GEPIA2 databases were used to obtain LPCAT4 binding and coexpressed genes in tumors， which were then analyzed by GO and KEGG. ResultsAnalysis of the LinkedOmics online database revealed a significant upregulation of LPCAT4 in patients with KRAS mutant pancreatic cancer compared to patients with KRAS wild-type pancreatic cancer. The online analysis of GEPIA2， UALCAN and Sangerbox 3.0 showed that the expression of LPCAT4 was higher in pancreatic cancer than in normal tissues. Analysis of the Kaplan-Meier Plotter database revealed that high LPCAT4 expression was associated with poorer prognosis in pancreatic cancer patients.Western blot and qPCR results showed that expression of LPCAT4 in pancreatic cancer cell lines was significantly higher than in normal pancreatic ductal epithelial cells. Knockdown of LPCAT4 in SW1990 cells inhibited proliferation， while overexpression in MIA PaCa-2 cells promoted proliferation. Enrichment analysis indicated that LPCAT4 was closely related to sulfur metabolism. ConclusionsLPCAT4 is highly expressed in pancreatic cancer and is associated with poor prognosis of patients. It plays a significant regulatory role in the proliferation of pancreatic cancer cells， with its expression level closely correlated with cell proliferation capacity. These findings reveal the critical role of LPCAT4 in the malignant progression of pancreatic cancer and provide important evidence for its potential as a therapeutic target.

Objective: To explore the independent and interactive effects of school green space exposure and outdoor activity duration on screening myopia among primary and secondary school students, so as to provide theoretical support for the prevention and control of screening myopia in children and adolescents. Methods: From September to November 2023, 117 487 primary and secondary school students from 497 schools were selected using a cluster random sampling method, covering 98 counties (cities, districts) in Jiangsu Province. Data on the students screening myopia status and associated health influencing factors were collected and analyzed. School green space exposure was quantified using the normalized difference vegetation index (NDVI), which was extracted with ArcGIS Pro software; meanwhile, information on students outdoor activity duration was gathered through self reported questionnaires. Multivariate Logistic regression was applied to assess the independent and interactive effects of green space exposure and outdoor activity duration on screening myopia among primary and secondary school students. Results: Univariate analysis showed that there were statistically significant differences in screening myopia detection rates among primary and secondary school students of different genders, NDVI groups, every outdoor activity duration, monitoring points, school stages, parents educational level, and whether they lived on campus or had parents with screening myopia ( χ 2=88.91-1 950.08, all P <0.05); as the school age and sedentary time increased, the detection rate of screening myopia in primary and secondary school students also increased ( χ 2 trend =8 410.15, 2 028.91, both P <0.05). Independent effects showed that compared to the low NDVI group, the medium and high NDVI groups had lower risks of screening myopia ( OR =0.93, 0.95, both P <0.05). Compared to those with outdoor activity duration<2 h/d, students with outdoor activity duration≥2 h/d had a lower risk of screening myopia ( OR =0.96, P <0.05). When stratified by school level, compared to the low NDVI group, the medium NDVI group had lower risks of screening myopia in primary and junior high schools (primary school: OR =0.91; junior high school: OR =0.88, both P <0.05). Compared to those with outdoor activity duration<2 h/d, junior high school students with outdoor activity duration≥2 h/d had a lower risk of screening myopia ( OR = 0.90, P <0.05). When stratified by monitoring site, urban primary and secondary school students in the medium and high NDVI groups and those with outdoor activity duration≥2 h/d had lower risks of screening myopia ( OR =0.92, 0.92, 0.93, all P <0.05). Interactive effects showed that when medium or high NDVI was combined with outdoor activity duration≥2 h/d, the risks of screening myopia among primary and secondary school students were lower (medium NDVI×≥2 h/d: OR =0.89; high NDVI×≥ 2 h/d : OR =0.89, both P <0.05), and the combined effect was superior to that of a single factor. Conclusion Green space exposure and outdoor activity duration have negative correlations with screening myopia among primary and secondary students, and the combined effect is better than that of a single factor.

Objective: To investigate the association between outdoor light at night (LAN) exposure and sleep quality among primary and secondary school students, and to examine the pathways of negative affects including depressive, stress and anxiety symptoms, so as to provide a theoretical basis for optimizing the school environment and enhancing the physical and mental well being of students. Methods: In December 2024, a total of 36 885 students from 154 primary and secondary schools in Suzhou, Nantong, and Changzhou were included via a stratified cluster sampling method. Sleep quality and negative affect were assessed by using the Pittsburgh Sleep Quality Index (PSQI), Center for Epidemiologic Studies Depression Scale (CES-D), Generalized Anxiety Disorder-7 (GAD-7), and Depression, Anxiety and Stress Scale-21 (DASS-21), respectively. Outdoor LAN exposure data were obtained from the national polar orbiting partnership visible infrared imaging radiometer suite nighttime light(NPP-VIIRS NTL) dataset provided by the National Earth System Science Data Center. Multivariate Logistic regression model was employed to analyze the association between LAN exposure and sleep quality across different regions, with stratification by monitoring site. Spearman correlation analysis was used to examine the relationships between LAN, negative affect, and sleep quality. The mediating role of negative affect was tested by using Model 4 of the PROCESS macro. Results: The detection rates among students were 13.95%( n =5 147) for depressive symptom, 16.72%( n =6 166) for stress symptom, and 17.49%( n =6 451) for anxiety symptom. The median outdoor LAN exposure was 28.85(19.10, 41.44)nW/(cm 2 · ( sr). After adjusting for confounders, multivariate Logistic regression analysis showed that high LAN exposure ( Q 4) was positively associated with sleep problems (urban areas: OR =1.28, 95% CI = 1.17- 1.41; rural areas: OR =1.21, 95% CI =1.07-1.36; both P <0.05). Spearman correlation analysis revealed significant positive correlations between LAN exposure, depressive symptoms, stress symptoms, anxiety symptoms, and sleep quality ( r =0.03-0.75, all P < 0.01). The mediation analysis indicated that all dimensions of negative affect significantly mediated the relationship between high LAN exposure and poor sleep quality (all P <0.01). Specifically, the indirect effects were 0.03 (95% CI =0.02-0.05) for depressive symptom, 0.05(95% CI =0.03-0.08) for stress symptom, and 0.07(95% CI =0.05-0.09) for anxiety symptom. Overall, 31.9% of the total effect was mediated by negative affect, with anxiety (14.89%) being the strongest mediator, followed by stress (10.64%) and depression(6.38%). Conclusion Reducing high levels of outdoor LAN exposure and implementing interventions targeting negative affect may contribute to improved sleep quality among primary and secondary school students.

ObjectiveTo investigate the potential mechanism of Liangxue Tuizi Formula （凉血退紫方， LXTZF） in treating Henoch-Schönlein Purpura （HSP） by examining its regulatory effect on neutrophil extracellular trap （NETs） dysregulation via the rapidly accelerated fibrosarcoma kinase （RAF）/mitogen-activated protein kinase （MEK）/extracellular signal-regulated kinase （ERK） signaling pathway. MethodsSeventy Wistar rats were randomly allocated into a blank control group （n=14） and a modeling group （n=56）. Rats in the modelling group underwent an eight-week modelling period to establish HSP rat models with blood-heat syndrome via modified ovalbumin （OVA） induction method combined with oral administration of heat-property Chinese herbal medicine. Fifty successfully modeled rats were subsequently randomly divided into five groups （n=10 per group）， model group， compound glycyrrhizin group， LXTZF group， RAF inhibitor group， and LXTZF + RAF agonist group. Additionally， 10 rats were selected from the original blank control group for the final experiment. From the 11th week of modelling， rats in the blank control group and the model group received 1 ml/（100 g·d） ultrapure water via oral administration， in addition to 0.5 ml/（kg·d） 0.9% sodium chloride solution via intraperitoneal injection. The LXTZF group and the compound glycyrrhizin group received 7.5 g/（kg·d） LXTZF granule suspension via gavage， 13.5 mg/（kg·d） compound glycyrrhizin suspension via gavage， respectively. The RAF inhibitor group received 1 mg/（kg·d） GW5074 suspension via intraperitoneal injection and ultrapure water via oral administration； the LXTZF + RAF agonist group received 7.5 g/（kg·d） LXTZF granule suspension via gavage and 1 mg/（kg·d） paclitaxel suspension via intraperitoneal injection. All administrations were performed once daily for 4 weeks. After intervention， skin tissue histopathology was examined by hematoxylin and eosin （H&E） staining， immunoglobulin A （IgA） deposition was assessed via immunofluorescence， serum levels of neutrophil elastase （NE）， tumor necrosis factor-α （TNF-α）， and vascular cell adhesion molecule-1 （VCAM-1） were measured using enzyme-linked immunosorbent assay （ELISA）， serum myeloperoxidase （MPO） level was determined by a colorimetric assay； the mRNA expression levels of RAF， MEK， and ERK in skin tissue were detected by real-time quantitative polymerase chain reaction （RT-qPCR）； and the protein expression of RAF， MEK， ERK， as well as phosphorylated MEK （p-MEK） and phosphorylated ERK （p-ERK）， were analyzed by Western Blot. ResultsSkin tissue in the blank control group rats remained normal， whereas the model group exhibited neutrophil infiltration and haemorrhage with red blood cell rupture. In all drug intervention groups， neutrophil infiltration and haemorrhagic exudation reduced markedly， with LXTZF group demonstrating the most pronounced improvement. Compared with the blank control group， rats in the model group exhibited enhanced IgA fluorescence intensity in skin tissue， elevated serum levels of NE， MPO， TNF-α and VCAM-1， increased mRNA expression of RAF， MEK， ERK1 and ERK2， as well as heightened RAF protein levels and p-MEK/MEK and p-ERK/ERK ratios （P＜0.05）. Compared with the model group， the drug intervention groups exhibited reduced IgA fluorescence intensity in skin tissue， along with decreased serum levels of NE， MPO， TNF-α， and VCAM-1 （P＜0.05）. In LXTZF group and RAF inhibition groups， reduced mRNA expression of RAF， MEK， ERK1， and ERK2 was observed in rat skin tissue， alongside decreased RAF protein levels and reduced p-MEK/MEK and p-ERK/ERK ratios （P＜0.05）. Compared with LXTZF + RAF agonist group， the compound glycyrrhizin group， LXTZF group， and RAF inhibitior group exhibited reduced IgA fluorescence intensity in skin tissue， decreased serum NE， MPO， TNF-α， and VCAM-1 levels， and decreased MEK mRNA expression and p-MEK/MEK ratio （P＜0.05）. ConclusionThe potential mechanism by which LXTZF treats Henoch-Schönlein purpura with blood heat syndrome may involve blocking the RAF/MEK/ERK signaling pathway in skin tissue， and suppressing excessive formation of NETs， thereby reducing IgA deposition in dermal microvessels and attenuating systemic inflammatory responses.

Objective To explore the predictive value of transforming growth factor beta 1(TGF-β1),chromobox homolog 7(CBX7),and soluble urokinase type plasminogen activator receptor(suPAR)for post-operative recurrence of cervical intraepithelial neoplasia after cervical conization.Methods A total of 200 pa-tients with cervical intraepithelial neoplasia admitted to the hospital from April 2020 to June 2023 were select-ed as the research subjects.All patients were treated with cervical conization.All patients were followed up for one year.According to the postoperative recurrence of cervical intraepithelial neoplasia patients after cervical conization,they were divided into the recurrence group and the non-recurrence group.Univariate and multiva-riate Logistic regression analyses were conducted to analyze the risk factors influencing the postoperative re-currence of cervical intraepithelial neoplasia after cervical conization.The receiver operating characteristic(ROC)curve was drawn to analyze the value of TGF-β1,CBX7 and suPAR in predicting the postoperative re-currence of cervical intraepithelial neoplasia after cervical conization.A nomogram model for predicting the postoperative recurrence of cervical intraepithelial neoplasia after cervical conization was established using R software and verified both internally and externally.The calibration curve and decision curve were used to ana-lyze the calibration ability and application value of the nomogram.Results The levels of TGF-β1,CBX7 and suPAR in the recurrence group were all higher than those in the non-recurrence group,and the difference was statistically significant(P<0.05).The results of multivariate Logistic analysis showed that TGF-β1,CBX7,and suPAR were all risk factors for postoperative recurrence of cervical intraepithelial neoplasia after cervical conization(P<0.05).The results of ROC curve analysis showed that the area under the curve(AUC)of the combined prediction of TGF-β1,CBX7,and suPAR for the postoperative recurrence of cervical intraepithelial neoplasia after cervical conization was higher than AUC of the individual detection of each index(Z=3.554,2.311,2.520,P<0.05).The correction curve of the nomogram model for predicting the postoperative recur-rence of cervical intraepithelial neoplasia after cervical conization approached the ideal curve(P=0.298,0.687).Conclusion The combination of TGF-β1,CBX7 and suPAR has certain value in predicting the postoperative recurrence of cervical intraepithelial neoplasia after cervical conization.

Objective To comprehensively assess the binocular function of college students with different glasses-wearing habits and myopic anisometropia using an eye-tracking-based,naked-eye 3D visual inspection system.Methods Between December 2023 and March 2024,a total of 137 myopic(equivalent spherical diopter per eye ≤-0.50 D)students were recruited at Sichuan University.They were divided into 2 groups,including a group of 78 participants who wore glasses continuously,and another group of 59 participants who did not wear glasses continuously.According to the degree of myopic anisometropia(the difference between the equivalent spherical diopters,ΔSE),the 2 groups were further divided into subgroups A(0 D＜ΔSE ≤ 1.00 D)and B(ΔSE＞1.00 D).Binocular function was examined using a naked-eye 3D display device based on human eye tracking,and the correlation between different glasses-wearing habits and myopic anisometropia and binocular visual function was analyzed.Results There was no statistically significant difference in the degree of myopic anisometropia between the continuous glasses-wearing group([1.15±1.15]D)and the non-continuous glasses-wearing group([1.20±1.15]D)(P=0.798).In addition,there was no statistically significant difference in refraction between the continuous glasses-wearing group and the non-continuous glasses-wearing group(P=0.158).There were statistically significant differences in the perceptual eye position of the right eye between the continuous glasses-wearing subgroups A and B(P＜0.05).There were statistically significant differences in coarse stereopsis between the non-continuous glasses-wearing subgroups A and B(P＜0.05).There were statistically significant differences in foveal suppression,fine stereopsis,and perceptual eye position between the continuous glasses-wearing group and the non-continuous glasses-wearing group(P＜0.05).Conclusion Both glasses-wearing habits and myopic anisometropia have effects on the binocular visual function of college students.

Objective To analyze the impact of sarcopenia on the efficacy and adverse reactions of immunotherapy combined with chemotherapy in patients with advanced gastric cancer.Methods Patients with locally advanced or metastatic gastric cancer confirmed by pathology who were not eligible for radical surgery were selected as study subjects.A body composition analyzer was used to measure the appendicular muscle mass of the patients and calculate the skeletal muscle mass index(SMI).Based on the SMI,the patients were divided into sarcopenia group and non-sarcopenia group.On the basis of nutritional intervention and comprehensive exercise therapy,the patients were administered immu-notherapy combined with chemotherapy.The efficacy and adverse reactions were evaluated.The primary endpoint was progression-free survival(PFS),and the secondary endpoints were the objec-tive response rate(ORR)and treatment-related adverse reactions.Results A total of 52 gastric cancer patients were included,with 23 in the sarcopenia group and 29 in the non-sarcopenia group.The median PFS in the non-sarcopenia group was 9.8 months(95％CI,8.9 to 12.4),and was 5.4 months in the sarcopenia group(95％CI,4.9 to 8.1).The median PFS in the non-sarcopenia group was longer than that in the sarcopenia group,and the difference was statistically significant[HR(95％CI)=0.41(0.23 to 0.73),P=0.003].The results of the multivariate Cox propor-tional hazards regression model showed that comorbidities,treatment cycles,and sarcopenia were all independent prognostic factors affecting the PFS of gastric cancer patients(P＜0.05).The ORR in the non-sarcopenia group was 48.28％(14/29),and was 17.39％(4/23)in the sarcopenia group(x2=5.276,P＜0.05).Treatment-related adverse reactions with grading ≥3 in both groups were mainly hematological toxicities.In the non-sarcopenia group,the incidence of grading ≥ 3 treat-ment-related adverse reactions was 27.59％(8/29),and the incidence of grading＜3 treatment-re-lated adverse reactions(including those with no adverse reactions)was 72.41％(21/29).In the sarcopenia group,the incidence of grading ≥3 treatment-related adverse reactions was 56.52％(13/23),and the incidence of grading＜3 treatment-related adverse reactions(including those without adverse reactions)was 43.48％(10/23).The incidence of grading ≥3 treatment-related adverse reactions in the non-sarcopenia group was lower than that in the sarcopenia group(P=0.035).Conclusion For patients with locally advanced or metastatic gastric cancer complicated with sarcopenia,the median PFS of immunotherapy combined with chemotherapy is shorter,the ORR is lower,and the incidence of treatment-related adverse reactions is increased.Therefore,ear-ly intervention for sarcopenia should be implemented to improve the quality of life of patients with advanced gastric cancer.

Metabolic dysfunction-associated steatotic liver disease(MASLD)has become the most prevalent chronic liver disease worldwide,and China is facing a severe challenge of rapidly increasing MASLD burden.Beverages,as an important modifiable factor,have become a research focus for primary prevention and lifestyle management of MASLD.This article reviews beverage consumption trends,provides an in-depth analysis of the mechanisms and health effects of sugar-sweetened beverages,alcoholic drinks,coffee,and tea on MASLD,summarizes their potential pathogenic and protective pathways,and explores comprehensive strategies including beverage intervention,lifestyle coordination,functional beverage development,psychological and behavioral mechanism regulation,and targeted population prevention.The aim is to provide theoretical basis and practical guidance for the localized and precise prevention and control of MASLD.

Nasal drug delivery efficiency is highly dependent on the position in which the drug is deposited in the nasal cavity. However, no reliable method is currently available to assess its impact on delivery performance. In this study, a biomimetic nasal model based on three-dimensional (3D) reconstruction and three-dimensional printing (3DP) technology was developed for visualizing the deposition of drug powders in the nasal cavity. The results showed significant differences in cavity area and volume and powder distribution in the anterior part of the biomimetic nasal model of Chinese males and females. The nasal cavity model was modified with dimethicone and validated to be suitable for the deposition test. The experimental device produced the most satisfactory results with five spray times. Furthermore, particle sizes and spray angles were found to significantly affect the experimental device's performance and alter drug distribution, respectively. Additionally, mometasone furoate (MF) nasal spray (NS) distribution patterns were investigated in a goat nasal cavity model and three male goat noses, confirming the in vitro and in vivo correlation. In conclusion, the developed human nasal structure biomimetic device has the potential to be a valuable tool for assessing nasal drug delivery system deposition and distribution.

Objectives:To investigate the incidence,relative risk factors and treatment strategies of rod breakage after correction and internal fixation of adult spinal deformity(ASD).Methods:The clinical data of ASD patients treated with posterior corrective operation and internal fixation in the Department of Orthopedics of Xinqiao Hospital between January 2015 and December 2019 were analyzed retrospectively.A total of 79 patients aged 45-75 years(62.1±7.7 years)were included.The follow-up period was 24-59 months(30.6±9.2 months).According to whether the rod was broken during the follow-up period,the patients were divided into rod fracture group(RF group)and rod non-fracture group(NRF group).The sex,age,body mass index(BMI),bone mineral density(BMD)T value,complications and follow-up time of the two groups were recorded.The sagittal vertical axis(SVA),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),thoracic kyphosis(TK),lumbar lordosis(LL),LL-TK value,PI-LL value,and coronal Cobb angle were measured before and after operation.The operation-related information of the two groups was collected,including operative time,intraoperative blood loss,the number of fixed fusion segments,whether three-column osteotomy,whether the lower fixed ver-tebrae involved the sacrum or pelvis,and whether there was interbody fusion.The position,time and revision operation of the broken rod in the RF group were recorded.The data of the two groups were compared and analyzed by Spearman test,and the positive parameters were further analyzed by multivariate logistic regres-sion to find potential risk factors for rod fractures.Odds ratio(OR)and 95％confidence interval(CI)were cal-culated.Results:Among the 79 patients,rod fracture occurred in 14 patients(17.7％),with bilateral fracture in 11 cases and unilateral fractures in 3 cases.The time of rod fracture occurred at 6-31 months after oper-ation(averaged 16 months),which occurred at the early stage after operation(within 24 months)in 10 patients(71.4％)and at 24 months after operation in 4 patients(28.6％).The rod fracture occurred at the osteotomy site in 11 cases and at T10-12 level in 3 cases.Spearman test showed that younger age(P=0.038),more lev-els of fusion(P＜0.001),3-column osteotomy(P＜0.001)and bigger preoperative SV A(P＜0.00 1)were correlated with rod breakage.Multivariate logistic regression analysis showed that more levels of fusion(P=0.037,OR=2.043,95％CI=1.046-3.992),3-column osteotomy(P=0.044,OR=0.113,95％CI=0.014-0.941),and bigger preop-erative SVA(P=0.006,OR=1.1 19,95％CI=1.032-1.212)were the risk factors of rod breakage after corrective surgery for ASD patients.11 patients(78.6％)underwent revision surgery because of intractable low back pain or progression of spinal deformities,and were replaced the broken rods through posterior primary incision ap-proach,combined with satellite rod technique;And meanwhile,out of which,5 patients underwent one-stage retroperitoneal approach for anterior iliac bone graft fusion and received satisfactory results during follow-up.Conclusions:The incidence of rod breakage after correction and internal fixation in ASD patients is high.More levels of fusion,3-column osteotomy,and greater preoperative SVA were significantly associated with rod fracture.The"Multi-rod technique"and anterior bone graft fusion technique can be used in the revision operation of rod fracture.