Objective: To explore the association between types of obesity and 10-year risk of atherosclerotic cardiovascular disease (ASCVD) among hypertensive patients, so as to provide the basis for formulating ASCVD prevention strategies for hypertensive patients. Methods: From January to December 2021, hypertensive patients who were under follow-up management and completed health examinations at three community health service centers in Linping District, Hangzhou City were selected by a cluster sampling method. Basic information, lifestyle, disease history, height, weight, waist circumference (WC), and blood biochemical indicators were collected through health examination data. Based on assessments of body mass index (BMI) and WC, participants were categorized into four types: non-obese, general obesity only, central obesity only, and combined obesity. The Prediction for ASCVD risk in China (China-PAR) was used to assess 10-year ASCVD risk, which was categorized as low, moderate, and high risk. Multivariable logistic regression models were used to analyze the association between different types of obesity and ASCVD risk among hypertensive patients. Results: A total of 10 408 hypertensive patients were included, with a median age of 68.00 (interquartile range, 10.00) years. There were 4 301 (41.32%) males and 6 107 (58.68%) females. The proportions of non-obese, general obesity only, central obesity only, and combined obesity were 34.93% (3 635 individuals), 22.85% (2 378 individuals), 4.32% (450 individuals), and 37.90% (3 945 individuals), respectively. There were 3 389 (33.52%) cases at high risk of ASCVD. Among them, high ASCVD risk was observed in 1 107 (30.45%), 896 (37.68%), 122 (27.11%), and 1 364 (34.58%) patients with non-obese, general obesity only, central obesity only, and combined obesity, respectively. Multivariable logistic regression analysis showed that after adjusting for gender, age, smoking, drinking, physical activity, and diabetes, the risk of high ASCVD in hypertensive patients with general obesity only and combined obesity was 1.383 times (95%CI: 1.235-1.548) and 1.225 times (95%CI: 1.109-1.354) that of non-obese hypertensive patients, respectively. Conclusions General obesity only and combined obesity can increase the 10-year high risk of ASCVD among hypertensive patients. It is necessary to strengthen comprehensive management of body weight and WC among hypertensive patients to reduce the risk of ASCVD.

Objective: To analyze the process of handling a pulmonary tuberculosis(TB) outbreak among senior high school students in a boarding school in Chongqing, as well as to investigate the underlying causes of the outbreak, so as to provide evidence to inform TB prevention and control strategies in school settings. Methods: From November 2023 to April 2024, an epidemiological investigation was conducted into the TB outbreak in a grade 12 class from a boarding high school. Suspected cases were screened using symptom screening, tuberculin skin test (TST), and chest X-ray examinations. Confirmed cases underwent individual epidemiological interviews and sputum culture; Cultured positive mycobacterial strains were subjected to whole genome sequencing after identification as Mycobacterium tuberculosis. Results: A total of 10 active pulmonary TB cases were identified, all from the same class, yielding a student attack rate of 16.67%. Three isolates were culture positive, as well as all strains were of L2 type，and the WGS analysis of the strains suggested a common transmission chain. Excluding the index case, four additional cases were detected through symptom driven health care visits. Notably, 70% of patients presented with "chest tightness and chest pain" symptoms, and 50% had "cough" symptoms,but none were detected during morning health checks or tracking of absences due to illness. A total of 326 contacts were identified and underwent three rounds of screening and one follow up examination. In the initial screening, 35 close contacts from the same class showed strong TST positivity, corresponding to a strong positivity rate of 55.56%, significantly higher than the 20.76% observed among casual contacts ( χ 2=29.80, P <0.01). Among the 35 strongly TST positivvity close contacts and five individuals with moderate TST positivity whose induration had increased by ≥10 mm over two years, none received timely preventive treatment initially; five of them were subsequently diagnosed with active TB within three months. Following this, 25 individuals initiated preventive therapy, resulting in a preventive treatment initiation rate of 62.50%. Among TST negative classmates who converted to strong positivity on repeat TST testing at three months, 75.00% started preventive treatment, but only 22.22% completed the full course. Conclusion Inadequate implementation of morning health checks and cause tracking for absenteeism due to illness, poorly standardized screening procedures, and delayed preventive treatment may have been key factors contributing to the spread of the outbreak.

This article reports a diagnostically and therapeutically challenging case of small intestinal marginal zone lymphoma. The patient presented with recurrent abdominal pain as the chief complaint, and imaging revealed multifocal small bowel wall thickening with high uptake, multisegmental luminal stenosis, and proximal dilation. Initial diagnostic workup, including gastroscopy, colonoscopy, and enteroscopy with biopsy, failed to establish a definitive diagnosis. Empirical anti-tuberculosis therapy was ineffective. A repeat enteroscopic biopsy performed over eight months after symptom onset eventually confirmed the diagnosis of mucosa-associated lymphoid tissue (MALT) extranodal marginal zone lymphoma. Despite three different chemotherapy regimens, the patient's intestinal obstruction symptoms persisted, with imaging still showing multifocal bowel wall thickening and hypermetabolic activity. A critical diagnostic dilemma arose regarding whether the PET/CT-positive lesions represented residual lymphoma or fibrotic scarring, whether further chemotherapy adjustments were warranted, and whether surgical resection was necessary. Multidisciplinary discussion concluded that imaging had limited discriminatory value in this scenario and that surgical intervention should be pursued if feasible. The patient successfully underwent partial small bowel resection, with postoperative pathology confirming no residual lymphoma but significant fibrotic changes. The patient has since resumed a normal diet, with body weight nearly restored to pre-illness levels. This case highlights that fibrotic transformation is a common sequela of treated marginal zone lymphoma and that PET/CT may misleadingly suggest residual disease, potentially leading to unnecessary chemotherapy. Timely surgical intervention is crucial in such scenarios.

OBJECTIVES: Digitally collect data on the preparation space of the molar occlusal surface for full crown restoration and analyze the minimum preparation spaces and areas prone to insufficient preparation. METHODS: A total of 846 molars (excluding third molars) designated for repair with zirconium dioxide crowns were selected. All molars were prepared by using the fixed-depth groove method under visual guidance. A digital impression was collected, and the occlusal surface of the preparation was divided into regions: mesiobuccal area, mesiolingual area, distobuccal area, distolingual area, mesial marginal ridge, and distal marginal ridge. Image measurement software (3Shape Unite) was employed to record the smallest preparation space on the molar occlusal surface, and a space of <1 mm was defined as insufficient preparation. The chi-square test was utilized for the statistical analysis of data. RESULTS: Significant differences were observed in the areas with the smallest preparation space on the occlusal surface of molars across different quadrants (P<0.05). Notably, the area with the smallest preparation space on the occlusal surface of the maxillary first molar was most frequently found in the mesiobuccal area, whereas the smallest preparation spaces on other molars were predominantly located in the distolingual area. The insufficient preparation of the occlusal surface occurred in 41.0% (347 cases) of teeth. The distribution of prone areas corresponded with the distribution of the smallest spatial areas. CONCLUSIONS Although the fixed-depth groove method is employed, the preparation space on the molar surface unavoidably remains uneven under visual guidance. The identification of the areas prone to minimum preparation spaces can serve as a valuable guide for clinicians to prevent insufficient preparation.
Humans ; Molar/anatomy & histology* ; Crowns ; Zirconium

Objective: To explore the association between physical activity, anxiety symptoms and academic performance among junior high school students, so as to provide data support for optimizing school physical education and health work and formulating physical activity guidelines. Methods: From September to December 2022, a convenience cluster sampling method was used to survey 2 800 junior high school students in a middle school from Anqing City, Anhui Province. Data were collected on the students anxiety symptoms, academic performance, 24 hour physical activity [moderate to vigorous intensity physical activity(MVPA), light intensity physical activity(LPA), sedentary behavior(SB), and sleep(SLP) duration] as well as demographic characteristics. Compositional data analysis was used to explore the associations between 24 hour physical activity, anxiety symptoms and academic performance among junior high school students, and to predict the optimal time use combination pattern. Results: Among the junior high school students, 16.0% (447 students) reported anxiety symptoms, and 42.0% (1 175 students) achieved excellent or good academic performance. Compositional data analysis showed that increased SLP duration was associated with both reduced anxiety symptoms ( β =-0.18) and decreased academic performance ( β =-0.03) among junior high school students; increased MVPA duration was correlated with fewer anxiety symptoms ( β =-0.02) and lower academic performance ( β =-0.13); in contrast, increased SB duration was linked to more anxiety symptoms ( β =0.09) and higher academic performance ( β =0.09) (all P <0.01). LPA duration exhibited a non linear relationship with anxiety symptoms and academic performance in junior high school students (all P >0.05). The time use combination pattern corresponding to the lowest anxiety symptoms and highest academic performance (top 5%) in adolescents was 611 (520-640) minutes of SLP, 258 (230-320) minutes of SB, 454 (280-610) minutes of LPA, and 117 (20-200) minutes of MVPA per day. Conclusions The 24 hour physical activity of junior high school students is associated with anxiety symptoms and academic performance. Therefore, it is recommended to increase the time spent on SB, MVPA, and LPA for junior high school students, while reducing SB.

Objective: To delineate the epidemiologic profile of rifampicin resistant pulmonary tuberculosis (RR-PTB) among students in Chongqing, so as to provide evidence for effectively controlling RR-PTB outbreaks in schools. Methods: Individual level surveillance records of 395 student RR-PTB cases reported from 2015 to 2024 were extracted from the China Information System for Disease Control and Prevention. The Joinpoint regression analysis was employed to quantify temporal trends in the registration rate of student RR-PTB cases, and the comparison of RR-PTB registration rates with different demographic characteristics and different regions was performed using Chi-square test. Results: From 2015 to 2024, a total of 395 student RR-PTB cases were identified, with the registration rate ranged from 0.07 per 100 000 to 1.47 per 100 000, showed a fluctuating upward trend ( AAPC= 35.22%, t =4.13, P <0.01). A turning point was detected in 2017, rates rose during 2015-2017 (APC=295.23%， t =4.62， P < 0.01 ) and plateaued thereafter (APC=-0.47%， t =-0.12， P =0.91). The proportion of RR-PTB cases occurring among students increased both among all RR-PTB cases (1.54% in 2015, 7.48% in 2024) and all student pulmonary tuberculosis cases (0.20% in 2015, 7.17% in 2024), with significant linear trends ( χ 2 trend =33.55,159.98, both P <0.01). The majority of cases were enrolled in senior high school (50.38%), classified as retreatment (53.92%), of Han ethnicity (75.95%), and diagnosed with multidrug resistant tuberculosis(53.16%). There were significant differences in the composition of different ethnicity, registration category and resistance pattern between different years( χ 2=23.47, 17.23, 59.64，all P <0.05). The South-Eastern Wuling Mountainous Region exhibited the highest notification rate (3.96 per 100 000), whereas the western region had the lowest rate ( 0.47 per 100 000). County level jurisdictions reported higher rates than district level ones (2.16 per 100 000 vs 0.63 per 100 000 ). Statistically significant differences were observed in the RR-PTB reported rates among students across different districts and counties( χ 2=418.05,167.05,both P <0.01). Conclusions From 2015 to 2024, the registration rate of detected student RR-PTB cases in Chongqing showed an increasing trend. Students have become one of the key populations for drug resistant TB prevention and control. Intensified health education and active case finding should be implemented to enhance proactive surveillance capabilities.

Objective To investigate the status quo of health management behaviors in elderly patients with type 2 diabetes mellitus(T2DM)complicating chronic complications and the influencing factors based on health ecology theory.Methods The convenience sampling method was used to select elderly patients with T2DM complicating chronic complications in the Shanghai City from January to July 2022 as the respondents.Based on the health ecology theory,the five aspects of personality traits,psychological and behavioral traits,family and community interpersonal networks,living and working conditions and policy environment were in-vestigated.The Pearson correlation coefficient was used to analyze the correlation of various variables.The hi-erarchical linear regression was used to analyze the influencing factors of health management behaviors in eld-erly patients with T2DM complicating chronic complications.Results A total of 272 questionnaires were dis-tributed and 264 valid questionnaires were recovered,with an effective recovery rate of 97.06％(264/272).There were statistically significant differences in DSMB-Oscores among the patients with different chronic complications number,sleep quality,per capita monthly household income and medical payment methods(P＜0.05).The DSMB-Oscore in elderly patients with T2DM complicating chronic complications was positively correlated with HLSCP,DES,PACIC and CIRS scores(P＜0.05),and negatively correlated with the PAID-5 score(P＜0.05).Conclusion The health management behaviors of elderly patients with T2DM complicating chronic complications is jointly affected and acted by many factors,and it is necessary to identify and manage the related influencing factors from different aspects and different levels.

Objective To investigate the effects of sleep deprivation on the firing activity of hippocampal parvalbumin-expressing interneuron(PV-IN)of mice during trace eyeblink conditioning(tEBC)training and during recovery sleep.Methods A total of 15 PV-Cre mice were randomly assigned into a sleep deprivation group(n=8)and a control group(n=7).After daily tEBC training,the sleep deprivation group experienced 1.5 h of sleep deprivation followed by 1.5 h of recovery sleep,and the control group mice were allowed to sleep freely,for 5 consecutive days.Multichannel recording and optogenetic techniques was applied to identify the hippocampal PV-IN in vivo.Results The sleep deprived mice failed to show significant increase in the incidence of conditioned eyeblink response(CR)across 5 training days(P>0.05).On training days 3～5,the CR incidence was significantly lower in the sleep deprived mice than the control mice(P<0.05).The enhancement of conditioned stimulus(CS)-evoked firing activity in hippocampal PV-INs during tEBC training was significantly lower in the sleep deprived mice when compared to the control mice(P<0.05).The sleep deprived mice obtained notably strengthened firing activity of hippocampal PV-INs peri sharp wave ripple events during recovery sleep period when compared with the pre-training sleep period(P<0.05),and the enhancement was remarkably greater than that in the control mice(P<0.05).Sleep deprivation had no obvious effects on the firing activity of hippocampal non PV-IN during either tEBC training or recovery sleep(P>0.05).Conclusion Sleep deprivation produces dual effects on the firing activities of hippocampal PV-INs during tEBC training and recovery sleep.These effects may be the cellular mechanisms of tEBC memory formation and consolidation disorders caused by sleep deprivation.

Objective To evaluate the application efficacy of structured symptom intervention program in patients with chronic kidney disease(CKD)during the peri-dialysis period.Methods A non-simultaneous control study was conducted on 151 peri-dialysis outpatients having not yet initiated dialysis and being followed up who were subjected with convenience sampling from Department of Nephrology of Second Affiliated Hospital of Army Medical University from April to September 2024.According to the time period of their visits,the patients who visited from April to June 2024 were assigned into a control group(n=75),and those from July to September 2024 into an experimental group(n=76).The control group received conventional symptom intervention(telephone symptom reporting+health education),while the experimental group received the intervention as the control group and a structured symptom intervention program covering 4 evidence-based modules:symptom identification,assessment,intervention,and outcome.The efficacy of above treatments was evaluated before and at 3 months after intervention.Dialysis symptom index was used to assess the degree of symptom distress and the number of symptoms.MOS 36-Item Short Form Health Survey(SF-36)was employed to evaluate the quality of life.The differences in clinical indicators and endpoint events were compared between the 2 groups after intervention.Results The experimental group obtained more significant reduction in the total score of symptom distress than the control group(P=0.021).After intervention,the number of symptoms was decreased in both groups(P<0.001),but no statistical difference was observed between the groups.The score of mental health dimension in SF-36 was obviously improved in the experimental group(P=0.004),which was notably better than that in the control group(P=0.033).The experimental group exhibited significantly higher prealbumin level than the control group(P=0.019),and stable albumin level,which was significantly decreased in the control group(P=0.035).The incidence of endpoint events was remarkably lower in the experimental group than the control group(P=0.028).Conclusion The structured symptom intervention program implements intervention through a closed-loop symptom module,which can effectively alleviate the symptom distress of patients during the peri-dialysis period,improve mental health and reduce the short-term risk for endpoint events.

Objective:To explore the predictive value of T cell subtype characteristics and peripheral blood inflammatory indicators in patients with liver cancer for myelosuppression after hepatic artery infusion chemotherapy.Methods:A total of 115 patients with primary hepatocellular carcinoma who received transcatheter arterial chemoembolization (TACE) treatment in the Department of Oncology of Taizhou Jiangyan Traditional Chinese Medicine Hospital from May 2022 to May 2024 were enrolled as the research subjects. According to whether myelosuppression occurred after TACE treatment, the patients were divided into a non-myelosuppression group ( n=93) and a myelosuppression group ( n=22). The clinical data, the proportions of T cell subsets before TACE treatment, and the differences in the levels of peripheral blood inflammatory indexes were compared between the two groups. Spearman correlation analysis and multivariate logistic regression analysis were used to screen out the influencing factors of myelosuppression after TACE treatment in patients with primary hepatocellular carcinoma. The receiver operator characteristic (ROC) curve was used to analyze the efficacy of each influencing factor in predicting the myelosuppression of patients. Results:There were no statistically significant differences in age, sex, history of hypertension, body mass index, type of hepatitis virus infection, status of hypersplenism, Barcelona staging, Child-Pugh classification of liver function, number of TACE treatments, and the proportion of CD8 + T cells between the patients in the myelosuppression group and non-myelosuppression group (all P>0.05). However, there were statistically significant differences in diabetes ( χ2=3.94, P=0.047), history of alcohol consumption ( χ2=5.47, P=0.019), the longest diameter of the tumor ( Z=2.31, P=0.021), the presence of ascites ( χ2=4.10, P=0.043), the proportion of CD4 + T cells ( t=4.66, P<0.001), the ratio of CD4 +/CD8 + ( t=4.98, P<0.001), the neutrophil/lymphocyte ratio (NLR) ( t=4.98, P<0.001), the monocyte/lymphocyte ratio (MLR) ( t=2.31, P=0.023), and the systemic immune inflammation index (SII) ( t=5.31, P<0.001). Spearman correlation analysis showed that diabetes ( r=0.19, P=0.048), history of alcohol consumption ( r=0.22, P=0.019), the presence of ascites ( r=0.19, P=0.043), the longest diameter of the tumor ( r=0.22, P=0.020), NLR ( r=0.39, P<0.001), MLR ( r=0.30, P=0.001), and SII ( r=0.36, P<0.001) were all positively correlated with myelosuppression after TACE treatment in patients with primary hepatocellular carcinoma, while the proportion of CD4 + T cells ( r=-0.37, P<0.001) and the ratio of CD4 +/CD8 + ( r=-0.40, P<0.001) were negatively correlated with myelosuppression after TACE treatment in patients with primary hepatocellular carcinoma. Multivariate logistic regression analysis showed that the ratio of CD4 +/CD8 + ( OR=0.01, 95% CI: 0.01-0.11, P=0.002) was an independent protective factor for myelosuppression after TACE treatment in patients with primary hepatocellular carcinoma, and NLR ( OR=1.82, 95% CI: 1.31-5.60, P=0.013) and SII ( OR=1.03, 95% CI: 1.01-1.05, P=0.002) were both independent risk factors for myelosuppression after TACE treatment in patients with primary hepatocellular carcinoma. ROC curve analysis showed that the areas under the curve (AUCs) of the ratio of CD4 +/CD8 +, NLR, and SII for predicting myelosuppression after TACE treatment in patients with primary hepatocellular carcinoma alone were 0.79 (95% CI: 0.70-0.89), 0.78 (95% CI: 0.65-0.92), and 0.76 (95% CI: 0.65-0.87), respectively. The AUC of the combined prediction of the three was 0.91 (95% CI: 0.83-0.99), which was higher than that of the ratio of CD4 +/CD8 + ( Z=4.21, P<0.001), NLR ( Z=4.36, P<0.001), and SII ( Z=4.48, P<0.001) for prediction alone. Conclusions:The ratio of CD4 +/CD8 +, as well as NLR and SII levels before TACE treatment are independent factors influencing the occurrence of myelosuppression after treatment in patients with primary hepatocellular carcinoma, and are expected to be important indicators for predicting myelosuppression after hepatic artery infusion chemotherapy in patients with primary hepatocellular carcinoma.