Objective:To investigate the multimorbidity of myopia and obesity, as well as myopia and malnutrition, among children and adolescents aged 7-18 in Guangdong Province and analyze their epidemiological characteristics and related factors.Methods:A stratified random cluster sampling method was used to select 274 939 children and adolescents aged 7-18 from 21 cities in Guangdong Province in 2023. Physical examination information such as height, weight, distance vision, and diopter, as well as questionnaire survey information on dietary behavior, physical activity, screen behavior, sleep time, etc., were collected to analyze the current status and trends of multimorbidity between myopia and obesity, myopia and malnutrition. The multivariate logistic regression model was used to analyze the related factors of multimorbidity.Results:The multimorbidity rates of myopia and obesity, myopia and malnutrition in children and adolescents aged 7-18 in Guangdong Province in 2023 were 4.43% and 6.40%, respectively. The multimorbidity rates for males were 5.44% and 6.88%, respectively, which were higher than those for females, about 3.31% and 5.88% (both P<0.001). The multimorbidity rates of urban students were 5.03% and 6.73%, respectively, which were higher than those of county students at 4.03% and 6.18% (both P<0.001). The multimorbidity rates of myopia and obesity, myopia and malnutrition increased with the increase of academic stage (all P<0.001). The multimorbidity rates of myopia and obesity, as well as myopia and malnutrition, fluctuated with age, with the first decrease occurring at the age of 12. The multivariate logistic regression analysis showed that compared to children and adolescents aged 7-18 who had daily after-school tutoring <2 hours, daily screen time <2 hours, did not consume sugary drinks every day, sleep time that could meet health requirements daily, and exercised≥60 minutes of moderate-to vigorous-physical activity ≥60 minutes for at least 3 days per week, those who had daily after-school tutoring ≥2 hours ( OR=1.18, 95% CI: 1.11-1.26), daily screen time ≥2 hours ( OR=1.09, 95% CI: 1.02-1.16), consumed sugary drinks every day ( OR=1.20, 95% CI: 1.11-1.30), daily sleep time that could not meet the health requirements ( OR=1.16, 95% CI: 1.09-1.23), and no exercise per week ( OR=1.09, 95% CI: 1.01-1.18) had a higher risk of multimorbidity of myopia and obesity. Compared to children and adolescents who exercised≥60 minutes of moderate-to vigorous-physical activity ≥60 minutes for at least 3 days per week, those who exercised <3 days per week ( OR=1.20, 95% CI: 1.17-1.34) had a higher risk of multimorbidity of myopia and malnutrition. Conclusion:The multimorbidity rates of myopia and obesity, as well as myopia and malnutrition, in children and adolescents aged 7-18 in Guangdong Province are relatively low and fluctuate with age. Physical activity, screen time, consumption of sugary drinks, and sleep time may be associated with these multimorbidities.

Objective:To investigate the multimorbidity of myopia and obesity, as well as myopia and malnutrition, among children and adolescents aged 7-18 in Guangdong Province and analyze their epidemiological characteristics and related factors.Methods:A stratified random cluster sampling method was used to select 274 939 children and adolescents aged 7-18 from 21 cities in Guangdong Province in 2023. Physical examination information such as height, weight, distance vision, and diopter, as well as questionnaire survey information on dietary behavior, physical activity, screen behavior, sleep time, etc., were collected to analyze the current status and trends of multimorbidity between myopia and obesity, myopia and malnutrition. The multivariate logistic regression model was used to analyze the related factors of multimorbidity.Results:The multimorbidity rates of myopia and obesity, myopia and malnutrition in children and adolescents aged 7-18 in Guangdong Province in 2023 were 4.43% and 6.40%, respectively. The multimorbidity rates for males were 5.44% and 6.88%, respectively, which were higher than those for females, about 3.31% and 5.88% (both P<0.001). The multimorbidity rates of urban students were 5.03% and 6.73%, respectively, which were higher than those of county students at 4.03% and 6.18% (both P<0.001). The multimorbidity rates of myopia and obesity, myopia and malnutrition increased with the increase of academic stage (all P<0.001). The multimorbidity rates of myopia and obesity, as well as myopia and malnutrition, fluctuated with age, with the first decrease occurring at the age of 12. The multivariate logistic regression analysis showed that compared to children and adolescents aged 7-18 who had daily after-school tutoring <2 hours, daily screen time <2 hours, did not consume sugary drinks every day, sleep time that could meet health requirements daily, and exercised≥60 minutes of moderate-to vigorous-physical activity ≥60 minutes for at least 3 days per week, those who had daily after-school tutoring ≥2 hours ( OR=1.18, 95% CI: 1.11-1.26), daily screen time ≥2 hours ( OR=1.09, 95% CI: 1.02-1.16), consumed sugary drinks every day ( OR=1.20, 95% CI: 1.11-1.30), daily sleep time that could not meet the health requirements ( OR=1.16, 95% CI: 1.09-1.23), and no exercise per week ( OR=1.09, 95% CI: 1.01-1.18) had a higher risk of multimorbidity of myopia and obesity. Compared to children and adolescents who exercised≥60 minutes of moderate-to vigorous-physical activity ≥60 minutes for at least 3 days per week, those who exercised <3 days per week ( OR=1.20, 95% CI: 1.17-1.34) had a higher risk of multimorbidity of myopia and malnutrition. Conclusion:The multimorbidity rates of myopia and obesity, as well as myopia and malnutrition, in children and adolescents aged 7-18 in Guangdong Province are relatively low and fluctuate with age. Physical activity, screen time, consumption of sugary drinks, and sleep time may be associated with these multimorbidities.

Objective: To analyze the correlation between refractive errors and physical development indicators among primary school students aged 6 to 9, so as to provide a scientific basis for the development of effective prevention and control measures. Methods: A stratified cluster random sampling method was used to recruit 2 833 elementary school students aged 6 to 9 from Guangdong Province for vision screening, ocular biometry, and physical examinations in Octorber, 2020. The Chi square test, t-test, and ANOVA were employed to compare myopia rates and indicator values across different groups. Multiple linear regression models were used to analyze the correlations between height, weight, and body mass index (BMI) with refractive development indicators. Results: The screening myopia rate among primary school students aged 6 to 9 was 16.7%, and the myopia rate increased with age ( χ 2= 51.58 , P <0.01). The height and weight of the myopic group [(126.96±7.41)cm, (26.59±6.45)kg] were higher than those of the non myopic group [(124.76±7.77)cm, (25.42±5.87)kg] ( t =5.84, 3.65, P <0.01). The mean values of spherical equivalent (SE), axial length (AL), anterior chamber depth (ACD), and AL/corneal curvature radius (CR) ratio for students aged 6 to 9 were (-0.17±1.04)D, (22.96±0.78)mm, (3.38±0.24)mm, and (2.95±0.08), respectively, with statistically significant differences across different age and myopia severity groups ( t =37.08, 119.20, 41.54, 133.60; 935.30, 184.10, 73.95, 498.50, P < 0.01). After adjusting for gender, age, and residence, the multiple linear regression model showed that height was positively correlated with AL and CR, weight was positively correlated with ACD, and BMI was positively correlated with AL and ACD ( β = 0.191 , 0.070, 0.035, 0.013, 0.007, P <0.05). When stratified by myopia status, results for the non-myopic group were similar to the overall results, whereas in the myopic group, the correlations between height, BMI, and AL were not statistically significant ( P > 0.05). Conclusions Among primary school students aged 6 to 9, height and BMI are positively correlated with AL in the non myopic group but no similar correlation is observed in the myopic group, indicating that factors other than physical development, such as environmental and behavioral factors, should be considered for their impact on refractive development.

Osteoporotic proximal humeral fracture (OPHF) is one of the common osteoporotic fractures in the aged, with an incidence only lower than vertebral compression fracture, hip fracture, and distal radius fracture. OPHF, secondary to osteoporosis and characterized by poor bone quality, comminuted fracture pattern, slow healing, and severely impaired shoulder joint function, poses a big challenge to the current clinical diagnosis and treatment. In the field of diagnosis, treatment, and rehabilitation of OPHF, traditional Chinese and Western medicine have accumulated rich experience and evidence from evidence-based medicine and achieved favorable outcomes. However, there is still a lack of guidance from a relevant consensus as to how to integrate the advantages of the two medical systems and achieve the integrated diagnosis and treatment. To promote the diagnosis and treatment of OPHF with integrated traditional Chinese and Western medicine, relevant experts from Orthopedic Expert Committee of Geriatric Branch of Chinese Association of Gerontology and Geriatrics, Youth Osteoporosis Group of Orthopedic Branch of Chinese Medical Association, Osteoporosis Group of Orthopedic Surgeon Branch of Chinese Medical Doctor Association, and Osteoporosis Committee of Shanghai Association of Integrated Traditional Chinese and Western Medicine have been organized to formulate Expert consensus on the diagnosis and treatment of osteoporotic proximal humeral fracture with integrated traditional Chinese and Western medicine ( version 2024) by searching related literatures and based on the evidences from evidence-based medicine. This consensus consists of 13 recommendations about the diagnosis, treatment and rehabilitation of OPHF with integrated traditional Chinese medicine and Western medicine, aimed at standardizing, systematizing, and personalizing the diagnosis and treatment of OPHF with integrated traditional Chinse and Western medicine to improve the patients ′ function.

Objective: The study aims to analyze the prevalence and associated factors of myopia among 4 to 9 grade students in Guangdong Province in 2022, so as to provide a scientific basis for targeted intervention measures for myopia in children and adolescents. Methods: From September to October 2022, stratified cluster random sampling was used to select 29 095 of 4 to 9 grade students from Guangzhou, Jiangmen, and Meizhou in Guangdong Province for myopia screening and questionnaire surveys. The Chisquare test was applied to compare the differences between groups, and multivariable Logistic stepwise regression analysis was used to analyze factors associated with myopia. Results: The myopia detection rate of 4 to 9 grade students was 61.7%, with detection rates of 51.5% for 4 to 6 grade primary school students and 71.95% for 7 to 9 grade junior high school students. Multivariable Logistic regression analysis showed that higher myopia rates were detected among girls (OR=1.39, 95%CI=1.30-1.49), students with one (OR=1.82, 95%CI=1.69-1.96) or both parents having myopia (OR=2.86, 95%CI=2.56-3.18), and indoor sedentary time >6 h(OR=1.28, 95%CI=1.17-1.39) in the 4 to 6 grade. Lower myopia rates were detected in the county (OR=0.92, 95%CI=0.86-0.99) and outdoors at recess activities (OR=0.88, 95%CI=0.81-0.95). Meanwhile, higher myopia rates were detected among girls (OR=1.84, 95%CI=1.69-1.99), students with one (OR=1.87, 95%CI=1.71-2.04) or both parents having myopia (OR=3.03, 95%CI=2.63-3.50), and indoor sedentary time >6 h/d (OR=1.11, 95%CI=1.01-1.23) in the 7 to 9 grade. Lower myopia rates were detected in the county (OR=0.74, 95%CI=0.68-0.80), outdoors at recess activities (OR=0.83, 95%CI=0.76-0.91), and outdoor activity time ≥2 h/d(OR=0.87, 95%CI=0.80-0.95)(P<0.05). Conclusions The detection rate of myopia among 4 to 9 grade students in Guangdong Province is relatively high. Place of recess activities, daily outdoor activity and indoor sedentary duration are associated with myopia. Therefore, targeted intervention measures should be adopted, such as appropriately increasing outdoor activity to reduce the occurrence of myopia among primary and middle school students.

Abstract: Objective　To investigate the molecular characteristics and drug resistance of Staphylococcus aureus (SA) isolated from wounds of paatients with orthopedic trauma, and analyze the molecular subtyping, virulence genes and drug resistance of SA in wounds of patients, so as to provide reference for the prevention and treatment of wound SA infection in patients. Methods　From January 2020 to June 2022, a total of 128 SA isolates were collected from wound specimens of orthopedic trauma patients at Wuxi 9th People's Hospital Affiliated to Soochow University. Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA) were differentiated using PCR. Multilocus Sequence Typing (MLST), staphylococcal protein A (spa), staphylococcal chromatoidal cassette mec (SCCmec), and accessory gene regulator (agr) typing were performed to determine the molecular typing and presence of virulence genes and drug resistance profiles. Results　Among the 128 SA isolates, 76 (59.38%) were MRSA and 52 (40.62%) were MSSA. MRSA typing showed that, MLST was dominated by ST59 (46 strains, 60.53%), spa was dominated by t437 (52.63%), SCCmec was dominated by Ⅰ (42.11%) and Ⅳ (39.47%). MSSA typing showed that, MLST was dominated by ST188 (30.77%), spa was dominated by t189 (61.54%), agr was dominated by Ⅰ (53.85%). In MLST typing, ST59 of MRSA was higher than that of MSSA, and ST188 and ST6 of MRSA were lower than those of MSSA (χ2=36.207, 20.227, 9.984, P<0.05). In spa typing, the t437 of MRSA was higher than that of MSSA, and the t189 of MRSA was lower than that of MSSA (χ2=18.276, 32.781, P<0.05). The virulence genes showed that, the detection rates of hlb and seb in MRSA were higher than those in MSSA (χ2=47.838, 10.261, P<0.05), and the detection rates of cna and ebpS in MRSA were lower than those in MSSA (χ2=26.176, 8.305, P<0.05). Drug susceptibility test showed that, and the drug resistance rates of MRSA and MSSA to vancomycin (VAN) and linezolid (LNZ) were 0. The drug resistance rates of MRSA to oxacillin (OXA), ERY and CLI were 86.84%, 68.42% and 76.32%, which were higher than corresponding 7.69%, 42.31% and 46.15% of MSSA (χ2=78.055, 8.623, 12.200, P<0.05). The analysis of multi-drug resistant strains (MDR) showed that 76 MRSA strains were MDR strains, and 12 of 52 MSSA strains (23.08%) were MDR strains. Conclusions　The molecular characteristics of SA isolated from orthopedic trauma patients' wounds were predominantly associated with MRSA strains of ST59-t437-SCCmec Ⅰ/Ⅳ-MRSA and ST188/ST6-t189-agr Ⅰ. These strains showed higher resistance to oxacillin, erythromycin, clindamycin, and higher susceptibility to vancomycin and linezolid. Such characteristics were closely related to the carriage of virulence genes. Clinicians should pay attention to the presence of MDR MSSA and develop appropriate antimicrobial strategies based on SA's molecular characteristics and antimicrobial resistance.

Objective: To investigate the epidemiological characteristics and associated factors of scoliosis in primary and secondary school students in Guangdong, and to provide guidance for scoliosis control. Methods: Using a stratified cluster random sampling method, a total of 38 649 students aged 9-18 were selected from 132 primary and secondary schools in the Pearl River Delta and non Pearl River Delta cities for scoliosis screening and related associated factors questionnaire survey from September to October 2020. Results: A total of 1 440 students were detected with scoliosis, with a detection rate of 3.73%. The detection rate of girls was 4.90%, which was higher than that of boys at 2.66%( χ 2=386.89, P <0.01). The detection rate in the Pearl River Delta region was 4.09%, which was higher than the non Pearl River Delta region at 3.38%( χ 2=13.22, P <0.01). The detection rate in urban areas was 4.51%, which was higher than counties at 2.79%( χ 2=78.70, P <0.01). The detection rate increased with the increase of the school period, high school (5.94%)>junior high school (4.50%)>elementary school (1.35%)( χ 2=386.89, P <0.01). Multivariate Logistic regression analysis showed that region, urbanicity, gender, educational stage, exercise, using electronic mobile devices, nutritional status are the influencing factors for scoliosis ( OR=0.41-3.78, P <0.05). Conclusion The detection rate of scoliosis in primary and secondary school students in Guangdong Province varies by gender, urbanicity and educational stages. Female students, as well as junior and senior high school students should be paid more attention.

Tumor microenvironment has been widely utilized for advanced drug delivery in recent years, among which hypoxia-responsive drug delivery systems have become the research hotspot. Although hypoxia-responsive micelles or polymersomes have been successfully developed, a type of hypoxia-degradable nanogel has rarely been reported and the advantages of hypoxia-degradable nanogel over other kinds of degradable nanogels in tumor drug delivery remain unclear. Herein, we reported the synthesis of a novel hypoxia-responsive crosslinker and the fabrication of a hypoxia-degradable zwitterionic poly(phosphorylcholine)-based (

Objective:To analyze the pathological patterns, clinical features, and prognosis in patients with human immunodeficiency virus (HIV) infection complicated with kidney disease.Methods:A retrospective analysis of 21 renal damage cases in HIV-infected patients undergoing renal biopsy from June 2016 to November 2019 in Shanghai Public Health Clinical Center, Fudan University was conducted. The clinical features, renal pathological patterns, therapies and outcomes were summarized and analyzed.Results:The age of 21 patients was (45.4±11.0) years. There were 19 men and two women. The CD4 + T lymphocyte count was (473.7±218.4) cells/μL. The HIV RNA levels were measured in 20 patients, and 13 cases (65.0%) were less than 40 copies/mL. A total of 18 cases (85.7%) had initiated antiretroviral therapy before renal biopsy, and the treatment time was 12 (1, 47) months. As for the clinical diagnosis, 14 cases (66.7%) were nephrotic syndrome and seven cases (33.3%) were nephritic syndrome. Renal pathology reports showed that HIV immune-complex kidney disease was the most common pathology pattern, accounting for 42.9% (9/21), followed by podocytopathy and diabetic nephropathy, both accounting for 23.8% (5/21), respectively. The IgA nephropathy (23.8%, 5/21) was the most common subtype of HIV immune-complex kidney disease, while minimal change disease (19.0%, 4/21) was the most common one of podocytopathy. However, classic HIV-associated nephropathy was not found in the study. The follow-up period was (12.5±9.2) months. During this period, the nephropathy conditions of nine patients were improved, eight were stable, two deteriorated, and two died. Conclusions:IgA nephropathy, minimal change disease and diabetic nephropathy are the top three patterns of renal pathology in patients with HIV infection. Most cases have good prognosis after treatments. For HIV-infected patients with serious renal damage, timely kidney biopsy is vital to determine pathological pattern, and to subsequently guide the clinical treatment and evaluate the prognosis.

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.