ObjectiveTo explore the ethical issues and coping strategies in the diagnosis and treatment of 46, XY disorders of sex development （46, XY DSD） under a multidisciplinary team （MDT） model， and to deepen the understanding of relevant ethical issues while accumulating experience. MethodsA retrospective collection was conducted on the data of children with 46, XY disorders of sex development under a single-center MDT model from January 2017 to December 2024， and the ethical issues involved in the diagnosis and treatment process were analyzed. ResultsA total of 24 MDT discussion documents involving 20 children were collected， including 17 with female social gender and 3 with male social gender. The age ranged from 0.5 to 15.8 years， with children under 8 years accounting for 75%. The ethical issues primarily involved how to ensure adequate informed consent， whether surgery was necessary and its timing， and whether gender selection is reasonable and its timing. Among the 10 children raised as females who completed the gender role psychological scale assessment， 5 demonstrated masculine tendencies， all of whom had pathogenic genetic variants. Furthermore， only 1 patient changed the social gender to male. ConclusionThe diagnosis and treatment of 46, XY DSD is relatively complex， requiring multidisciplinary collaboration. This process involves numerous ethical issues and necessitates adhering to medical ethical principles. Ensuring adequate informed consent is crucial， especially for younger children. The surgery and its timing selection must adhere to the principles of beneficence， non-maleficence， and leaving room for the future. Gender selection constitutes a focus and challenge in diagnosis and treatment. Psychological scales and genetic etiologies are conducive to judgments regarding gender selection， yet multiple factors in the real world may interfere with the gender selection.

Objective: To investigate the effects of platelet-derived PD-L1 released during storage on T cell proliferation, apoptosis, and cytokine expression. Methods: Apheresis platelets were stored with agitation at 22℃. Platelet supernatant was collected on days 1, 3, 5, and 7 of storage, and then co-cultured with human CD4 and CD8 mixed T cells isolated by magnetic bead sorting. CCK8 assay was used to detect T cell proliferation; flow cytometry was applied to determine T cell apoptosis as well as the expression levels of IFN-γ and GZMB. Additionally, Western blot was employed to examine alterations in downstream signaling molecules of the PD-1 receptor. Results: With the prolongation of platelet storage time, the inhibitory effect of platelet storage medium on T cell proliferation was gradually enhanced, accompanied by suppressed expression of IFN-γ and GZMB, whereas the apoptosis level of T cells increased progressively. Treatment with PD-1 antibody or PD-L1 antibody partially blocked the regulatory effects of platelet storage medium on T cell proliferation, apoptosis, and the expression of IFN-γ and GZMB. Western blot results showed that the phosphorylation levels of p-SHP1 and p-SHP2 were significantly upregulated, whereas p-AKT expression was downregulated in T cells co-cultured with platelet storage medium. Intervention with PD-1 or PD-L1 antibody could partially reverse the above changes in protein expression. Conclusion: During platelet storage, platelet-derived PD-L1 in the storage medium promotes T cell apoptosis and inhibits T cell proliferation as well as the expression of related cytokines in a time-dependent manner. Therefore, platelet-derived PD-L1, as an important immune regulatory mediator, may be involved in transfusion-related immunomodulation (TRIM).

Objective: To construct a prediction model for sleep disorders in shift workers of a chemical fiber enterprise, so as to provide the basis for early identification and prevention of sleep disorders in shift workers. Methods: Shift workers were sampled from a chemical fiber enterprise in Tongxiang City, Zhejiang Province using a cluster sampling method from August 2022 to July 2024. Demographic information, length of service and average weekly working hours were collected through questionnaire surveys. Depressive symptoms, anxiety symptoms and sleep disorders were evaluated using the Pittsburgh Sleep Quality Index, Patient Health Questionnaire and Generalized Anxiety Disorder Questionnaire, respectively. The shift workers were randomly divided into a training set and a validation set at a ratio of 7∶3. Predictive factors were selected using a multivariable logistic regression model based on the training set, and a nomograph model for prediction of sleep disorders in shift workers was established. The predictive values of the model were evaluated using the receiver operating characteristic (ROC) curve and calibration curve based on the training set and validation set. Results: Totally 673 shift workers were included, with a median age of 32 (interquartile range, 12) years. There were 493 males, accounting for 73.25%. There were 471 (69.99%) workers in the training set and 202 (30.01%) workers in the validation set. There were 274 workers with sleep disorders, accounting for 40.71%. The equation for the prediction model was ln[p/(1-p)]=-8.391+1.906×average weekly working hours+1.822×depressive symptoms+1.667×anxiety symptoms. The area under the ROC curve was 0.769 (95%CI: 0.661-0.835) for the training set and 0.655 (95%CI: 0.593-0.737) for the validation set, and Hosmer-Lemeshow test showed a good fitting effect (both P>0.05). Conclusion The nomograph model constructed by average weekly working hours, depressive symptoms and anxiety symptoms can be used to predict the risk of sleep disorders in shift workers of a chemical fiber enterprise.

Objective: To investigate the epidemiological characteristics and spatial-temporal clustering of scarlet fever in Wenzhou City, Zhejiang Province from 2015 to 2024, so as to provide a basis for prevention and control for scarlet fever. Methods: The data of scarlet fever cases in Wenzhou City from 2015 to 2024 were collected from the Surveillance System of China Information System for Disease Control and Prevention. Descriptive epidemiological methods were used to analyze the temporal, demographic, and regional distribution characteristics of scarlet fever. Spatial autocorrelation and spatio-temporal scanning analyses were employed to examine the spatial-temporal clustering of scarlet fever. Results: A total of 1 731 cases of scarlet fever were reported in Wenzhou City from 2015 to 2024, with an average annual reported incidence of 2.08/100 000 , showing a declining trend (AAPC=-11.037%, P<0.05). Incidence peaks occurred from April to June and from November to January of the following year, with seasonal indices all exceeding 100%. The average annual reported incidence was higher in males than in females (2.43/100 000 vs. 1.70/100 000, P<0.05). The cases were mainly children aged ≤10 years, with 1 662 cases accounting for 96.01%. Lucheng District, Ouhai District and Taishun County had the top three average annual reported incidences of scarlet fever, at 7.17/100 000, 5.18/100 000 and 4.73/100 000, respectively. Spatial autocorrelation analysis showed that, spatial clustering of scarlet fever cases in the periods 2015 to 2019 and 2021 to 2024 (Moran's I>0, all P<0.05). Spatio-temporal scanning analysis identified a primary-type clustering and a secondary-type clustering of scarlet fever in Wenzhou City from 2015 to 2024. The primary-type clustering was centered on Wutian Subdistrict in Ouhai District, covering 19 townships / subdistricts, with a clustering period from January 2015 to December 2019. The secondary-type clustering was centered on Xiaocun Town in Taishun County, covering 42 townships / subdistricts, with a clustering period from April 2018 to June 2019. Conclusions The incidence of scarlet fever in Wenzhou City from 2015 to 2024 showed an overall declining trend, with a high incidence among school-aged children and distinct spatial-temporal clustering. Peaks in cases occurred from April to June and from November to January of the following year. Focused prevention and control efforts are recommended in Lucheng District, Ouhai District, and Taishun County.

Objective:To investigate the radiographic changes of calcification of transverse atlantal ligament by clinical case study and improve the understanding of it.Methods:A retrospective analysis was performed to identify the clinical cases of transverse atlantebral ligament calcification. Eleven cases in the orthopedic department of our hospital from January 2015 to December 2022 were identifiled.Results:In this study, a total of 11 patients with calcification of atlas transverse ligament, which showed crowned dens sign (CDSig). Five patients were males and 6 were females, with an average age of 79.9 years (70~89 years). The average follow-up time was 44.7 months (14~89 months), 7 cases had no significant change in calcification, and 4 patients had aggravated calcification. These 11 patients accounted for 28 clinical visits in total, with the primary reasons for consultation as follows: 7 visits were related to cerebrovascular diseases, 6 visits were due to respiratory diseases, 5 visits were for surgical conditions. None of the patients reported a history of "acute neck pain".Conclusion:When patients with CDSig are complicated by acute neck pain, crowned dens syndrome should be considered on the basis of exclusion of malignant diseases such as meningitis. Calcification of the transverse atlanto-vertebral ligament is closely related to age, and calcification develops slowly, and may become worse with age.

We report the clinical course from birth to adolescence of a patient carrying a compound heterozygous variation in the ectonucleotide pyrophosphatase/phosphodiesterase family member 1(ENPP1) gene. The patient was diagnosed with generalized arterial calcification of infancy shortly after birth, and subsequently with autosomal recessive hypophosphatemic rickets type 2 at the age of 11 years. Following effective blood pressure control, treatment with neutral phosphate, calcitriol, and vitamin D was initiated. During follow-up, no progression of vascular calcification was observed. Through this case report and a review of relevant literature, we aim to enhance clinicians′ understanding of this rare condition.

Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.

Objective: To evaluate the effects of a multidisciplinary weight management intervention, so as to provide a reference for the formulation of overweight and obesity intervention measures. Methods: From April to September 2025, overweight and obese residents aged 18-60 years who participated in a weight loss competition at the Health Management Center of Beilun People's Hospital in Ningbo City were selected as study subjects. They were divided into a control group and an intervention group. The control group received conventional weight management, while the intervention group received the multidisciplinary integrated weight management in addition to the conventional weight management, for a total intervention period of 8 weeks. Weight, body mass index (BMI), waist circumference, hip circumference, waist-to-hip ratio, fasting blood glucose (FBG), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and blood pressure were collected before and after the intervention through physical examinations and laboratory tests. The generalized estimating equations (GEE) method was employed to analyze the differences in indicators between the two groups before and after the intervention. Results: The control group comprised 241 participants, including 161 females (66.80%), with a mean age of (35.66±7.80) years. The intervention group consisted of 127 participants, including 86 females (67.72%), with a mean age of (36.80±7.05) years. No statistically significant differences were observed between the two groups at baseline in terms of age, gender, weight, BMI, or waist-to-hip ratio (all P>0.05). Results from the GEE analysis indicated significant interactions between group and time for weight, BMI, waist circumference, and hip circumference (all P<0.05) with greater reductions in these parameters observed in the intervention group compared to the control group before and after the intervention. Similarly, significant interactions between group and time were observed for FBG, TG, TC, and LDL-C (all P<0.05), with the intervention group demonstrating larger decreases in these markers compared to the control group. However, no statistically significant interactions between group and time were observed for waist-to-hip ratio, HDL-C, systolic blood pressure, and diastolic blood pressure (all P>0.05). Following the intervention, a weight loss exceeding 10% was achieved by 13 participants (5.39%) in the control group and 62 participants (48.82%) in the intervention group. The proportion of individuals with a weight loss exceeding 10% was significantly higher in the intervention group compared to the control group (P<0.05). Conclusion Compared to conventional weight management, multidisciplinary integrated weight management demonstrated greater efficacy in improving weight-related indicators and blood glucose, blood lipids, and enhancing weight loss outcomes among overweight and obese residents.

Protrusive facial deformities, characterized by the forward displacement of the teeth and/or jaws beyond the normal range, affect a considerable portion of the population. The manifestations and morphological mechanisms of protrusive facial deformities are complex and diverse, requiring orthodontists to possess a high level of theoretical knowledge and practical experience in the relevant orthodontic field. To further optimize the correction of protrusive facial deformities, this consensus proposes that the morphological mechanisms and diagnosis of protrusive facial deformities should be analyzed and judged from multiple dimensions and factors to accurately formulate treatment plans. It emphasizes the use of orthodontic strategies, including jaw growth modification, tooth extraction or non-extraction for anterior teeth retraction, and maxillofacial vertical control. These strategies aim to reduce anterior teeth and lip protrusion, increase chin prominence, harmonize nasolabial and chin-lip relationships, and improve the facial profile of patients with protrusive facial deformities. For severe skeletal protrusive facial deformities, orthodontic-orthognathic combined treatment may be suggested. This consensus summarizes the theoretical knowledge and clinical experience of numerous renowned oral experts nationwide, offering reference strategies for the correction of protrusive facial deformities.
Humans ; Orthodontics, Corrective/methods* ; Consensus ; Malocclusion/therapy* ; Patient Care Planning ; Cephalometry

Patients with periodontal disease often require combined periodontal-orthodontic interventions to restore periodontal health, function, and aesthetics, ensuring both patient satisfaction and long-term stability. Managing these patients involving orthodontic tooth movement can be particularly challenging due to compromised periodontal soft and hard tissues, especially in severe cases. Therefore, close collaboration between orthodontists and periodontists for comprehensive diagnosis and sequential treatment, along with diligent patient compliance throughout the entire process, is crucial for achieving favorable treatment outcomes. Moreover, long-term orthodontic retention and periodontal follow-up are essential to sustain treatment success. This expert consensus, informed by the latest clinical research and practical experience, addresses clinical considerations for orthodontic treatment of periodontal patients, delineating indications, objectives, procedures, and principles with the aim of providing clear and practical guidance for clinical practitioners.
Humans ; Consensus ; Orthodontics, Corrective/standards* ; Periodontal Diseases/complications* ; Tooth Movement Techniques/methods* ; Practice Guidelines as Topic