Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:To investigate the distribution of CGG repeat numbers in the FMR1 gene among reproductive-age women in China, providing data reference for carrier screening and genetic counseling of Fragile X syndrome. Methods:This cross-sectional study recruited 16 610 reproductive-age women from 12 medical institutions between July 2022 and October 2023. Peripheral venous blood samples (3 mL) were collected, and genomic DNA was extracted. The number of CGG repeats in the FMR1 gene was determined using the triplet-primed polymerase chain reaction (TP-PCR) combined with capillary electrophoresis technology. Statistical analyses were performed to assess the prevalence and distribution of CGG repeat expansions. Results:Among 16 610 women of childbearing age, 5 684 (34.220%) women had the same number of CGG repeats in the two alleles of FMR1 gene, and 10 926 (65.780%) women had different numbers of repeats in the two alleles. Among the 33 220 FMR1 alleles in 16 610 women of reproductive age, the most common CGG repeat numbers were 29 [48.645% (16 160/33 220)] and 30 [26.276% (8 729/33 220)], while the most frequent CGG genotype was CGG 29/29 [24.726% (4 107/16 610)]. The CGG repeat numbers of FMR1 gene were normal in 16 498 women (99.326%). Among the 112 women (0.674%) with CGG repeat abnormities, 96 (0.578%) women were classified as intermediate carriers, 15 (0.090%) as premutation carriers, and 1 (0.006%) as a full mutation carrier, whose CGG genotype was (36, >200). Conclusion:In the general reproductive-age female population in China, the normal CGG repeat numbers of the FMR1 gene account for 99.326%, while the intermediate carrier rate is 0.578%, and the combined carrier rate of the premutation and full mutation types is 0.096%.

This case report describes the diagnostic and therapeutic management of a 67-year-old fe-male with a 40-year history of Sj?gren disease(SjD)who was hospitalized for evaluation of recurrent fever lasting over one month.The patient's initial diagnosis of SjD was established four decades earlier based on clinical manifestations,serological findings,and evidence of glandular damage.Her clinical presenta-tion included recurrent parotid gland enlargement accompanied by sicca symptoms,notably persistent xerostomia and xerophthalmia,followed by progressive dental caries.Serological studies demonstrated positivity for antinuclear antibodies,anti-SSA/Ro,and anti-α-fodrin antibodies.Objective assessments confirmed significant ocular involvement(Schirmer's test≤5 mm/5 min)and pulmonary interstitial changes on chest CT,consistent with the 2016 American College of Rheumatology and European League Against Rheumatism(ACR/EULAR)classification criteria for SjD.The patient's condition remained sta-ble under low-dose corticosteroids and disease-modifying anti-rheumatic drugs(DMARDs)until the re-cent onset of prolonged fever,necessitating evaluation for fever of unknown origin.Differential diagnoses considered disease flare,infection,and malignancy.The European Sj?gren's Syndrome Disease Activity Index(ESSDAI)score was 5 points,indicating moderate systemic disease activity.Initial laboratory in-vestigations revealed no evidence of infection,and empirical anti-infective therapy proved ineffective.No-tably,despite the absence of lymphadenopathy,laboratory findings including borderline positive IgM λ M-protein,elevated lactate dehydrogenase,hyperferritinemia,and increased β2-microglobulin levels raised suspicion for lymphoproliferative disorders,given the established association between SjD and lymphoma.Bone marrow aspiration showed no significant abnormalities,but PET/CT imaging detected hypermetabolic lesions in the left breast and right distal femur,suggesting potential malignancy.Subse-quent histopathological examination of the breast lesion confirmed non-Hodgkin's lymphoma(NHL),specifically diffuse large B-cell lymphoma(DLBCL)of the germinal center B-cell(GCB)subtype.Treatment with R-CHOP chemotherapy(rituximab,cyclophosphamide,doxorubicin,vincristine,and prednisone)induced complete metabolic remission after three cycles.However,she subsequently developed treatment-related complications,including myelosuppression and pulmonary infection.This case underscores the importance of maintaining a high index of suspicion for atypical site involvement in SjD patients,particularly when lymphoma risk factors are present.Comprehensive differential diagnosis should include lymphoma and other malignancies,and the diagnostic value of PET/CT and histopatholog-ical examination in disease evaluation is emphasized.SjD complicated by breast lymphoma is exceptional-ly rare,and its pathogenesis may involve lymphocytic infiltration,abnormal activation of lymphocytes,formation of ectopic germinal centers in the breast,and eventual malignant transformation.These mecha-nisms require further investigation through clinical and basic research studies.

Objective:To analyze the therapeutic effect of a virtual reality (VR)-based accommodation training device on accommodative excess visual fatigue.Methods:A case-control study was conducted.A total of 20 normal subjects (20 eyes) and 20 patients with accommodative excess visual fatigue (20 eyes) were recruited at Zhongshan Ophthalmic Center, Sun Yat-sen University between January and December 2022.The study consisted of two phases.In the first phase, the effect of watching videos with VR glass on the subjects' subjective and objective visual function was evaluated.Normal subjects wore VR device to watch a 2D video for 30 minutes, and assessments were performed before and after viewing.These assessments included binocular accommodation/convergence function (accommodation response, accommodative convergence to accommodation ratio [AC/A]), tear film function (first tear film break-up time), subjective symptoms (visual fatigue score), and basic visual health parameters including best corrected visual acuity (BCVA) and intraocular pressure (IOP).In the second phase, the improvement in subjective and objective visual fatigue metrics with the VR-based accommodation training device was investigated.Patients with visual fatigue were divided into a traditional training group using traditional flipper lenses and a VR training group using the VR accommodation training device, with 10 eyes in each group.The effects of the VR accommodation training device on indicators such as accommodative sensitivity, accommodation response, convergence function, visual fatigue score, acceptability score, system usability score, BCVA, and IOP were evaluated and compared between the two groups.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Zhongshan Ophthalmic Center, Sun Yat-sen University (No.IIT2021007).Written informed consent was obtained from each subject.Results:In normal subjects, there was no statistically significant difference in first tear film break-up time, distance phoria, near phoria, AC/A, accommodative response, BCVA, or IOP before and after 30 minutes of continuous viewing of 2D video using VR glass ( t=1.155, 1.360, 4.479, 1.979, -1.249, -3.017, 2.211; all P>0.05).The visual fatigue score remained unchanged at (1.00±0.00) points before and after viewing.Among the subjects with visual fatigue, there were statistically significant differences in binocular accommodative sensitivity, dominant eye accommodative sensitivity, and BCVA before and after using the VR accommodation training device ( F=8.693, 4.078, 4.942; all P<0.05).Ocular accommodation sensitivity at 8 weeks after training was improved compared with 1 week after training, and BCVA at 4 weeks after training was improved compared with before training, and the differences were statistically significant (both P<0.05).In the VR training group, the average tear film break-up time, first tear film break-up time, and BCVA increased and the visual fatigue score decreased compared with before training, the differences were statistically significant (all P<0.05).In the traditional training group, the accommodation sensitivity of the dominant eye increased after training compared with before training, with a statistically significant difference ( P<0.05). Conclusions:Watching 2D videos with VR glass for 30 minutes does not induce subjective or objective symptoms of visual fatigue.The VR-based accommodation training paradigm effectively improves accommodative sensitivity and alleviates subjective symptoms of visual fatigue in individuals with accommodative excess visual fatigue.

Objectives:To explore whether short-course radiotherapy (SCRT)-based total neoadjuvant therapy (TNT) combined with PD-1 inhibitors could further promote tumor regression and improve the prognosis.Methods:This is a prospective, multicenter, two-arm randomized controlled, seamless phase Ⅱ/Ⅲ trial for proficient mismatch repair or microsatellite stable (pMMR/MSS) locally advanced rectal cancer (LARC). Eligible patients were randomly assigned to the iTNT (TNT+PD-1) group or the TNT group. Patients in the TNT group received SCRT (5 Gy×5) followed by 4 cycles of CAPOX or 6 cycles of mFOLFOX chemotherapy, with the iTNT group receiving SCRT followed by the same regime in combination with 4 cycles of Sintilimab. Total mesorectal excision (TME) surgery or watch and wait (W&W) was performed after neoadjuvant therapy and then 2 cycles of same regimen as before were recommended. The primary endpoints are the complete response (CR) rate for phase Ⅱ trial and 3-year disease-free survival (DFS) for phase Ⅲ trial. A total of 588 patients will be enrolled for the phase Ⅱ/Ⅲ trial. Short-term efficacy and safety data from the initial 100 treated patients were analyzed as planned.Results:From 2022-8-31 to 2023-5-24 the initial 100 patients were enrolled from 10 hospitals in China, 76.0%(76/100) patients were male, and the median age was 61 years (21-74 years). More patients had tumors located in the lower rectum (78.0%, 78/100), staged T3-4 (97.0%, 97/100) and N1-2 (93.0%, 93/100), and about half of the tumors invaded the mesorectal fascia (52.0%, 52/100) and with extramural vascular invasion (51.0%, 51/100). Analyses were performed according to the per-protocal (PP) set. All patients in the iTNT group ( n=52) and the TNT group ( n=48) completed SCRT; The 4-cycle chemotherapy±Sintilimab completion rates were 86.5% and 100.0% in the iTNT and TNT groups, respectively. In the iTNT group, 82.7% (43/52), 11.5% (6/52), and 5.8% (3/52) of the patients received 4, 3, and 2 cycles of PD-1 inhibitor. After TNT, 68 patients underwent radical surgery and 15 patients achieved cCR and adopted W&W. The pathological complete response (pCR) rates were 48.5% (16/33) and 17.1% (6/35) in the iTNT and TNT groups, with CR rates of 50.0% (25/50) and 26.1% (12/46), respectively. The incidence of treatment-related grade 3-4 adverse events was 26.9% (14/52, iTNT group) and 18.8% (9/48, TNT group), with thrombocytopenia and leukopenia being the most common. Among patients receiving immunotherapy, grade 3 immunotherapy-related adverse events occurred in 2 (3.8%, 2/52) patients: one case was pancreatitis, another case was hepatitis combined with myositis and myocarditis. Conclusion:The preliminary results show that SCRT-based TNT combined with PD-1 inhibitors could further improve the CR rate for LARC without unexpected serious adverse events.

Objective To evaluate the clinical outcome of neurosurgical robot-assisted stereotactic puncture and drainage for brain abscess.Methods A retrospective analysis was conducted on the clinical data of 53 patients with brain abscess admitted to our hospital from January 2018 to December 2024.Among them,29 cases underwent craniotomy for abscess resection(craniotomy group),while 24 cases received neurosurgical robot-assisted stereotactic puncture and drainage(robot-assisted group).The operation time,intraoperative blood loss,decompressive craniectomy rate,proportion of postoperative antibiotic regimen adjustment,postoperative hospital stay,incidence of postoperative complications,mortality rate and Glasgow outcome scale(GOS)scores 6 months after surgery of patients were compared between the two groups.Results Compared with the craniotomy group,the robot-assisted group demonstrated significantly shorter operation time,less intraoperative blood loss,and lower incidence of postoperative complication,the differences were all statistically significant(P<0.05).However,there were no statistically significant differences in terms of decompressive craniectomy rate,postoperative hospital stay,mortality rate,GOS score,or proportion of the postoperative antibiotic regimen adjustment between the two groups(P>0.05).Conclusion As a precise and minimally invasive surgical method,neurosurgical robot-assisted stereotactic puncture and drainage for patients with brain abscess can effectively improve the operational efficiency,shorten the operation time,reduce intraoperative injury,and lower the risk of postoperative complications.It has high clinical application value and potential for widespread adoption.

Autism spectrum disorder(ASD),characterized by unknown etiology and high heterogeneity,ne-cessitates precise diagnostic and intervention strategies.Neuroimaging techniques have shown great promise in un-covering the neural mechanisms of ASD,providing a foundation for aided diagnosis and transcranial magnetic stim-ulation(TMS)interventions.This review highlights that integrating multimodal neuroimaging and developing indi-vidualized indices with developmental specificity can significantly improve the accuracy of ASD diagnosis and clas-sification.Furthermore,TMS interventions guided by functional connectivity derived from functional magnetic reso-nance imaging(fMRI)offer a personalized approach to ASD treatment.

To provide scientific guidance and standardization for perioperative clinical nursing practice in patients undergoing percutaneous renal biopsy, relevant evidence on percutaneous renal biopsy nursing care was systematically retrieved and synthesized through an evidence-based approach. After two rounds of Delphi expert consultation and expert panel discussions, expert consensus on perioperative clinical nursing standards for patients undergoing percutaneous renal biopsy (hereinafter referred to as the "Consensus") was developed. The Consensus includes three primary themes: preoperative care, intraoperative care, and postoperative care, encompassing 21 secondary themes. It is characterized by scientific rigor, practical applicability, and comprehensiveness, and serves as a valuable reference and guide for clinical nursing professionals across medical institutions.

Objective:To seek any correlation between hypoesthesia and sensory disturbance to motor function among stroke survivors.Methods:One hundred and two stroke survivors with hyperalgesia were treated with sinusoidal alternating current at 2000Hz, 250Hz or 5Hz to stimulate the fingers and toes on their healthy and hemiplegic sides. Current perception thresholds (CPTs) and pain tolerance thresholds (PTTs) were recorded. The correlation between the degree of sensory disturbance in the hemiplegic limb and muscle strength was explored.Results:①The degree of sensory impairment in those who had suffered a cerebral hemorrhage was significantly greater than among those with cerebral infarction, without significant difference in pain tolerance between different genders and affected sides. ②All of the patients with sensory impairment showed significantly higher CPT and PTT values at the different frequencies, with a positive correlation between them. ③The CPT values of the affected hand and foot at the different frequencies were negatively correlated with muscle strength on the affected side.Conclusions:Both CPT and PTT can usefully represent the degree of sensory disturbance after a stroke. The CPT values of patients with different types of stroke are significantly different, and the degree of sensory disturbance is correlated with the muscle strength of the affected side. Therefore, it is helpful for prognostic judgment and individualized rehabilitation treatment planning by quantifying the degree of sensory disturbance.

The fat mass and obesity associated gene(FTO),a crucial RNA N6-methyladenosine(m6 A)demethylase,has been reported to influence the expression of glutathione peroxidase 4(GPX4)by modu-lating m6A modifications.GPX4 is a key molecule inhibiting ferroptosis,and the activation of ferroptosis signaling has been demonstrated to significantly reduce lipid accumulation in both mouse primary adipo-cytes and high fat diet fed mice.However,the specific m6A modification sites within the Gpx4 mRNA re-main undefined,and the regulatory role of Gpx4 during mouse adipocyte differentiation is also unclear.Through bioinformatic analysis combined with validation by methylated RNA immunoprecipitation sequen-cing(MeRIP)-qPCR and single-base elongation-and ligation-based qPCR amplification method(SE-LECT)assays,a key m6A modification site in Gpx4 mRNA was identified at 303 bp downstream from its transcription start site.CRISPR-Cas9-mediated knockdown of Gpx4 in 3T3-L1 cells,followed by adipo-genic induction,revealed that Gpx4 knockdown significantly reduced intracellular lipid droplet accumula-tion as assessed by Oil Red O staining(P＜0.001).RT-PCR and Western blotting analyses further dem-onstrated significantly decreased expression of key adipogenic differentiation genes(C/ebpα,Pparγ,Lpl,Fabp4)(P＜0.001).To investigate the temporal specificity of Gpx4 regulation,the GPX4 inhibitor RSL3(100 nmol/L)was administered during different stages of adipogenic differentiation.Results showed that RSL3 treatment specifically during the mitotic clonal expansion phase significantly suppressed the expression of adipogenic genes(Fabp4,Pparγ,Adipoq)and impeded adipogenesis.In summary,this study not only identifies a key m6A modification within the mouse Gpx4 mRNA but,more important-ly,reveals that GPX4 plays a critical regulatory role in 3T3-L1 adipocyte differentiation.These findings establish a link between the FTO-m6A-GPX4-ferroptosis regulatory axis and adipocyte differentiation,providing novel theoretical insights into the pathological mechanisms of obesity and identifying potential therapeutic targets.