Background Gestational weight gain is closely related to maternal and infant health outcomes. Pregnant women are simultaneously exposed to four metals—lithium (Li), vanadium (V), uranium (U), and bismuth (Bi)—through inhalation of fine particulate matter and consumption of contaminated food and water. Existing studies suggest that exposure to these metals may be associated with gestational weight gain. However, no study has yet explored the complex relationships between exposure to mixtures of these four metals and weight gain at different stages of pregnancy. Objective To investigate the associations between mixed exposure to Li, V, U, and Bi in early pregnancy and the average weekly gestational weight gain during both early pregnancy and mid-to-late pregnancy. Methods This prospective study recruited eligible women in early pregnancy from an obstetrics clinic of a tertiary hospital in Jinan, China, between September 2021 and July 2023. Pre-pregnancy weight, current weight (at 11⁺⁰ to 13⁺⁶ weeks of gestation), and spot urine samples (≥5.0 mL) were collected at enrollment. Urinary concentrations of Li, V, Bi, and U were determined using inductively coupled plasma mass spectrometry. Participants were followed up in late pregnancy (≥28 weeks of gestation) to collect information on physical activity via questionnaire; weight measurements at the last antenatal visit (35⁺⁰ to 37⁺⁶ weeks of gestation) were obtained from the hospital information system. After adjusting for covariates, multiple linear regression and generalized additive models were used to assess the associations of individual metals with weekly weight gain in early pregnancy and in mid-to-late pregnancy. Bayesian kernel machine regression (BKMR) and quantile-based g-computation (Qgcomp) were applied to evaluate the joint effects of the metal mixture exposure on weekly weight gain at the two gestational stages. Results A total of 313 pregnant women were included. The geometric means of urinary Li, V, U, and Bi concentrations were 37.07, 0.20, 0.06, and 0.04 μg·L⁻¹, respectively; after creatinine adjustment, the corresponding values were 46.82, 0.25, 0.07, and 0.05 μg·g⁻¹ (Cr). The mean weekly gestational weight gain was (0.19±0.25) kg in early pregnancy and (0.53 ± 0.18) kg in mid-to-late pregnancy. Both multiple linear regression and generalized additive models showed that urinary V concentration was positively associated with average weekly gestational weight gain in early pregnancy, while no significant associations were found for other metals or for gestational weight gain in mid-to-late pregnancy. In the BKMR model with early-pregnancy weight gain as the outcome, V had the strongest association [posterior inclusion probability (PIP)=0.773]. When other metals were fixed at their medians, V showed a positive non-linear association with the outcome. A significant single-metal effect of V and its interaction with Li were observed. Compared with the 50th percentile of the metal mixture, the average weekly weight gain in early pregnancy increased by 0.016 (95%CI: 0.003, 0.029) and 0.018 (95%CI: 0.001, 0.036) at the 60th and 65th percentiles, respectively; conversely, at the 25th percentile, it decreased by 0.026 (95%CI: 0.002, 0.050). Overall, the joint effect of the metal mixture on early- pregnancy weight gain showed an upward trend. In the BKMR model for mid-to-late pregnancy gestational weight gain, all PIPs were<0.5, and no significant single-metal effects, interactions, or joint effects were identified. Qgcomp results confirmed a positive association between the metal mixture and early-pregnancy weight gain (b=0.031, 95%CI: 0.010, 0.051; P<0.01), with V contributing the highest positive weight (0.71). No significant association was found for weight gain in mid-to-late pregnancy (b=0.007, P=0.339). Conclusion Higher levels of co-exposure to the Li, V, Bi, and U metal mixture during early pregnancy may be associated with increased average weekly weight gain in early pregnancy. Among these metals, V exhibits a predominant role and appears to interact with Li. No association is observed between early-pregnancy metal mixture exposure and average weekly gestational weight gain in mid-to-late pregnancy. These findings suggest that monitoring and managing metal exposure during early pregnancy may be crucial for the rational regulation of gestational weight gain.

Objective: To analyze the characteristics of first-visit cases of herpes zoster in Zhoushan City, Zhejiang Province from 2021 to 2023, so as to provide the reference for improving herpes zoster prevention and control measures. Methods: Data on the incidence and vaccination of first-visit herpes zoster cases at all levels of public medical institutions in Zhoushan City from 2021 to 2023 were collected through the Zhoushan Comprehensive Health Information Platform and Zhoushan Immunization Program Information Management System. The incidence and outpatient proportion were calculated. The population distribution, seasonal distribution, and clinical consultation status of first-visit herpes zoster cases were described. Results: From 2021 to 2023, a total of 15 156 first-visit herpes zoster cases were reported in Zhoushan City, with an average annual incidence of 5.36‰. The incidences for each year were 5.78‰, 5.29‰ and 5.02‰, respectively, and the outpatient proportions were 0.15%, 0.14% and 0.11%, respectively, showed decreasing trends (both P<0.05). The number of doses of recombinant herpes zoster vaccine or live attenuated herpes zoster vaccine administered were 130, 312, and 633, respectively. The main consultation department was dermatology, with 11 004 cases (72.60%). The primary clinical diagnosis was visceral herpes zoster, with 5 901 cases (38.94%). A total of 1 936 cases (12.77%) had at least one underlying medical condition. The mean age of onset was (56.08±16.23) years, and the incidence showed an upward trend with increasing age (P<0.05). There were 7 386 male cases and 7 770 female cases, with a male-to-female ratio of 0.95∶1. The incidence among males aged ≥50 years was lower than that among females (6.53‰ vs. 8.69‰, P<0.05). The onset of the disease exhibited a significant seasonal pattern, with a peak period from June 21st to August 21st, covering 75% of the cases Conclusions From 2021 to 2023, the incidence and outpatient proportion of herpes zoster in Zhoushan City decreased. Summer was the peak season for onset, and women and the elderly were the key populations. It is necessary to strengthen the collaborative diagnostic and treatment capabilities of key departments such as dermatology and enhance the enthusiasm for vaccination among key populations.

Objective To achieve a preliminary understanding of the current situation of clinical laboratories in Guangdong Province,and discuss how to establish a sound investigation system,and utilize quality indicators to improve laboratory quality through the inves-tigation and analysis of data from 16 clinical laboratory quality indicators issued by the National Center for Clinical Laboratories.Meth-ods The questionnaire was issued by Clinet-EQA system and the basic information and quality indicator information during 2023 were collected.SPSS 20.0 software was used for statistical analysis according to different specialty categories and hospital grades.The 13 quality indicators measured in rate-based units were evaluated by sigma measurement.The P75,P50 and P25 percentiles of the overall distribution of each quality index were used to explore the optimal,appropriate and minimum quality specifications.Results A total of 577 laboratories participated in this survey.In addition to the implementation rate of internal quality assessment and the inter-laboratory comparison rate,the median sigma(σ)value of 11/13 quality indicators was greater than 3σ,and some of them even reach the level of 6σ,and there were disparities between hospital laboratories at different grades.The turnaround time(TAT)of the whole process of emergency examination was significantly less than those of inpatient and outpatient,TAT before emergency examination was controlled within 20 min,TAT before outpatient examination was within 30 min,and TAT before inpatient examination was within 42 min.The optimal quality specifications of 8 out of 13 indicators reached 6σ level,while the minimum quality specifications of 2 out of 13 indica-tors were lower than 3σ level.Conclusion In Guangdong Province,the overall level of quality indicators in the post-analytical of clin-ical laboratories was superior to that in the pre-analytical and analytical process.It should be essential to continuously monitor quality indicators and actively adopt improvement measures for those laboratories with unsatisfactory results,so as to enhance the examination quality of laboratories.

Objective To investigate the relationships between adolescents'body mass index(BMI),blood pressure(BP),and myopia and provide a scientific basis for the formulation of myopia prevention and control measures.Methods Adolescent students who par-ticipated in physical fitness surveillance in Chenghua District,Chengdu,from 2014 to 2023 were selected as the study population.A cross-sectional study was conducted using multiple logistic regression,adjusting for age,sex,BP,and pulse as covariates.A Cox model was employed to examine the relationship between obesity and myopia.Additionally,for the 2023 dataset,characterized by the largest sample size and most complete data,a mediation analysis was performed with mean BP as the mediator.Results Annual cross-sectional analysis from 2014 to 2023 revealed a significant positive association between obesity and myopia,with OR and 95％CI of 1.16(1.10-1.22),1.15(1.08-1.21),1.19(1.12-1.26),1.11(1.04-1.18),1.10(1.05-1.15),1.10(1.05-1.16),1.07(1.03-1.12),1.10(1.05-1.15),1.12(1.07-1.17),and 1.11(1.06-1.15),respectively.Similarly,cohort analysis showed a significant positive association between obesity and myopia(HR=1.09,95％CI:1.01-1.19).Mediation analysis indicated that BP accounted for 21.2％of the total effect of obesity on myopia.Conclusion Obesity facilitates the onset of myopia,and weight reduction can help decrease the likelihood of latter.Furthermore,BP mediates the impact of obesity on myopia.Implementing BP-lowering interventions in obese populations may aid in the prevention of myopia.

Objective To observe the effect of a Jianpi Huayu Jiedu formula on the NLRP3-mediated pyroptosis pathway in gastric precancerous lesion(GPL)associated with Helicobacter pylori(Hp)infection.Methods A GPL mouse model was prepared using Hp suspension gavage combined with Atp4a gene-deficient mice.The Jianpi Huayu Jiedu formula was administered as an intervention.Gastric mucosal tissue pathological damage was observed using hematoxylin and eosin(HE)staining.The presence of intestinal metaplasia(IM)was assessed using Alcian Blue-Periodic Acid Schiff(AB-PAS)staining.Ultrastructural changes in cell organelles were observed using transmission electron microscopy.Enzyme-linked immunosorbent assay(ELISA)was used to measure levels of gastrin-17(G-17),pepsinogen I(PGI),and proinflammatory cytokines IL-1β and IL-18.The expression of molecules related to the pyroptosis pathway was detected using Western blot and real-time quantitative PCR(RT-qPCR).Results Compared to the control group,Hp-related GPL mice exhibited gastric mucosal atrophy accompanied by IM and dysplasia.Damage to mitochondria and endoplasmic reticulum in parietal cells was observed.Levels of G-17,PGI,and proinflammatory cytokines IL-1β and IL-18 were elevated.The expression of molecules related to the pyroptosis pathway was increased.The Jianpi Huayu Jiedu formula significantly reduced gastric mucosal tissue pathological damage in GPL mice,decreased G-17 and PGI levels,mitigated inflammatory responses,and downregulated the expression of molecules related to the pyroptosis pathway.Conclusion The Jianpi Huayu Jiedu formula may exert its effects by inhibiting the NLRP3-mediated pyroptosis signaling pathway,thereby alleviating or even reversing the pathological damage of gastric mucosa in Hp-related GPL.

Objective To compare the diagnostic performance of two syphilis reverse testing protocols recommended by the U.S.Centers for Disease Control and Prevention(USCDC)and the European Centre for Disease Prevention and Control(ECDC)within maternal and child populations,and to explore the factors contributing to false-positive results in chemiluminescent immunoassays(CLIA).Methods A retrospective analysis was performed on serological test results from 109,003 patients collected between 2021 and 2023.All participants were initially screened for specific syphilis antibodies using CLIA,and those with positive results underwent confirmatory testing with both the toluidine red unheated serum test(TRUST)and the Treponema pallidum particle agglutination assay(TPPA).The kappa statistic was employed to assess the diagnostic agreement between the USCDC and ECDC protocols,while also analyzing the distribution patterns of CLIA false-positive results across varying S/CO value ranges and demographic groups.Results Both protocols achieved a syphilis positivity rate of 0.34%.The hospital's high-prevalence syphilis screening program identified no cases with CLIA-positive or TRUST-positive but TPPA-negative results,suggesting high specificity in this population.The two protocols demonstrated perfect agreement with a Kappa value of 1.0,indicating no significant difference in diagnostic performance between maternal and child populations.CLIA exhibited a true positive rate of 71.04%,which was positively correlated with S/CO values:21.88%when 1.010.The highest false positive rate for CLIA(38.75%)was observed among young adults,while the largest proportion of false positives-reaching 40.00%—was associated with pregnancy and abortion status.Conclusions The two reverse detection methods for syphilis exhibit comparable diagnostic efficacy in women and children from populations with low syphilis prevalence.CLIA demonstrates high sensitivity;however,when the S/CO ratio is less than 10,particularly in adult women of childbearing age,clinicians should remain vigilant for potential false-positive results to prevent misdiagnosis and unnecessary medical interventions.