Background Long working hours, as a common risk factor for occupational stress, is closely related to the occurrence of depressive symptoms. Understanding how long working hours affect occupational stress and depressive symptoms will inform occupational health interventions. Objective To quantify the impact of long working hours exposure on occupational stress and depressive symptoms among Internet industry employees, translate black-box outputs into actionable insights, and demonstrate the value of interpretable machine learning for early-warning occupational-health surveillance. Methods A dataset was derived from a cross-sectional survey involving 2866 internet industry employees in China. This survey was part of the project Risk Assessment Of Long Working Hour Exposure And Its Adverse Health Effects, conducted by the National Institute for Occupational Health and Poisoning Control, Chinese Center for Disease Control and Prevention, from 2021 to 2023. Working hours, occupational stress and depressive symptoms were quantified with a set of structured questionnaires including the Core Occupational Stress Scale and the Patient Health Questionnaire. Pairwise associations were screened by Mantel tests and variance-inflation factors. Key predictors identified through feature selection were fed into six machine-learning risk-prediction models. Visual interpretation was provided by feature importance, Shapley additive explanations (SHAP) and local interpretable model-agnostic explanations (LIME), while directed causal effects and intervention impacts of prolonged working hours exposure on occupational stress and depressive symptoms were dissected with causal explanation of features techniques. Results The positive rates of occupational stress and depressive symptoms among internet employees were 12.9% and 77.8% respectively. Twelve core features for occupational stress and nine for depressive symptoms were retained after selection. After these features were supplied to six predictive algorithms and evaluated on five metrics, the Light Gradient Boosting Machine (LGBM) achieved the highest accuracy—0.89 for occupational stress and 0.79 for depressive symptoms on the hold-out test set. The feature-importance rankings converged on fatigue accumulation and life satisfaction as dominant drivers for both outcomes, whereas weekly working hours and daily overtime emerged as the principal exposure-related predictors. The SHAP summary plots revealed that longer weekly hours and daily overtime systematically elevated the probability of occupational stress. The causal feature explanation further quantified that ascending one category in weekly working hours increased the probability of occupational stress by 7.04%. Conclusion Exposure to long working hours is associated with both occupational stress and depressive symptoms among internet industry employees. Interpretable machine-learning frameworks translate these associations into transparent, defensible drivers, enabling precise identification of the pivotal factors and their interplay. This evidence base equips occupational-health practitioners with actionable insights for designing targeted prevention and intervention strategies.

Objective To explore the clinical efficacy and safety of endoscopic endonasal dorsum sellae and posterior clinoid process resection combined with pituitary hemi-transposition in the treatment of pan-sellar area lesions. Methods Clinical data from 57 patients with pan sellar diseases who underwent endoscopic transnasal resection of the posterior clinoid process combined with lateral pituitary displacement surgery in the neurosurgery department of Zhongshan Hospital, Fudan University from January 2019 to January 2025 were collected, and their clinical surgical characteristics and prognosis were analyed. Results A total of 57 patients with pan-sellar area lesions were included in this study, comprising 27 craniopharyngiomas, 7 giant suprasellar pituitary adenomas, 7 chordomas, 6 chondrosarcomas, 5 diaphragma sellae/dorsum sellae meningiomas, and 5 rare lesions. All procedures were completed successfully, and gross total or near-total resection was achieved in all patients. No new neurovascular complications occurred intraoperatively. The follow-up duration ranged from 3 to 24 months. New postoperative anterior pituitary insufficiency occurred in 3 patients (5.3%), and new posterior pituitary insufficiency requiring long-term hormone replacement therapy occurred in 4 patients (7.0%). No additional pituitary dysfunction was observed in the remaining patients. Cerebrospinal fluid rhinorrhea occurred in 1 patient (1.8%) and was successfully repaired. Intracranial infection occurred in 3 patients (5.3%) and resolved after medical treatment. Conclusion Endoscopic resection of the posterior clinoid process combined with lateral displacement of the pituitary gland can effectively expand the surgical space, while repositioning the pituitary gland can reduce the extent of skull base defects. In addition, the risk of pituitary dysfunction caused by lateral displacement of the pituitary gland is relatively low.

ObjectiveTo investigate the role and underlying mechanisms of Tongxinluo submicron powder in regulating renal PANoptosis， alleviating pathological injury in diabetic kidney disease （DKD）， reducing urinary albumin excretion， and improving renal function in DKD mice. MethodsSix 6-week-old male C57BL/Ks mice were assigned into the normal group. Eighteen 6-week-old male BKS-db；Nos3KO mice were randomly divided into three groups： model group， Tongxinluo group （0.75 g·kg^-1·d^-1）， and dapagliflozin group （0.001 g·kg^-1·d^-1）， and were administered by gavage for 12 consecutive weeks. General conditions of the mice were observed. At weeks 0， 4， 8， and 12 after administration， body weight， fasting blood glucose （FBG）， urine albumin-to-creatinine ratio （UACR）， and urinary albumin excretion rate （AER） were measured. After treatment， mice were anesthetized for sample collection. Blood was obtained by orbital enucleation and centrifuged to collect supernatant. Serum creatinine （SCr）， urea （UREA）， β₂-microglobulin （β₂-MG）， retinol-binding protein （RBP）， and serum cystatin C （CysC） were measured. Renal histopathological changes were evaluated using hematoxylin-eosin （HE） staining， periodic acid-Schiff （PAS） staining， and Masson's trichrome staining. Enzyme-linked immunosorbent assay （ELISA） was used to detect serum levels of inflammatory cytokines， including interleukin-1β （IL-1β）， interleukin-18 （IL-18）， and tumor necrosis factor-α （TNF-α）. Serum levels of superoxide dismutase （SOD）， malondialdehyde （MDA）， and glutathione peroxidase （GSH-Px） were also measured. Western blot analysis was performed to quantify the expression of key PANoptosis-related proteins in renal tissue， including Z-DNA-binding protein 1 （ZBP1）， Caspase-1， cleaved Caspase-1， gasdermin D （GSDMD） and its N-terminal fragment （GSDMD-N）， Caspase-8， cleaved Caspase-8， Caspase-3， cleaved Caspase-3， mixed lineage kinase domain-like protein （MLKL）， and phosphorylated MLKL （p-MLKL）. ResultsCompared with the normal group， the model group showed significant obesity and continuously increased blood glucose levels （P<0.05）. Renal function indicators （UREA， β₂-MG， CysC） were significantly increased （P<0.05）， and urinary albumin excretion indicators （UACR， AER） were markedly elevated （P<0.05）. Renal histopathology showed enlarged glomeruli， diffuse thickening of the basement membrane， and significant expansion of the mesangial matrix. Masson staining revealed extensive blue collagen fiber deposition， suggesting glomerulosclerosis and interstitial fibrosis. Meanwhile， serum levels of inflammatory cytokines （IL-1β， IL-18， and TNF-α） were significantly increased （P<0.05）. SOD and GSH-Px levels were decreased， while MDA levels were increased （P<0.05）. The expression of key PANoptosis-related proteins （ZBP1， cleaved Caspase-1， GSDMD， GSDMD-N， cleaved Caspase-8， Caspase-3， cleaved Caspase-3， and p-MLKL） in renal tissue was significantly upregulated （P<0.05）. After intervention， compared with the model group， renal function indicators （UREA， β₂-MG， CysC） and urinary albumin excretion indicators （UACR， AER） in the Tongxinluo group were significantly decreased （P<0.05）， and all were superior to those in the dapagliflozin group （P<0.05）. Renal pathological injury was markedly alleviated， with reduced mesangial proliferation and collagen fiber deposition. In addition， serum levels of IL-1β， IL-18， and TNF-α were significantly decreased （P<0.05）. SOD and GSH-Px levels were increased， while MDA levels were decreased （P<0.05）. Western blot results showed that the expression of key PANoptosis-related proteins （ZBP1， cleaved Caspase-1， GSDMD， GSDMD-N， cleaved Caspase-8， Caspase-3， cleaved Caspase-3， and p-MLKL） in renal tissue was significantly downregulated （P<0.05）. ConclusionTongxinluo submicron powder can inhibit renal PANoptosis in DKD mice， alleviate renal inflammatory response and pathological injury， reduce urinary albumin excretion， and improve renal function.

Objective To explore the feasibility of the endoscopic occipital transtentorial transpineal-recess (EOTT-TR) approach for treatment of craniopharyngiomas within the third ventricle. Methods The clinical and imaging data of a 54-year-old female patient with craniopharyngioma was reviewed. The patient was presented with progressive visual impairment and headache for six months. Endocrine evaluation indicated mild impairment of the pituitary-hypothalamic axis function. Imaging revealed a large solid tumor was entirely confined within the third ventricle, maximal diameter of approximately 4.7 cm. The lesion was resected via right EOTT-TR approach, which involved upward retraction of the pineal gland under the 3D endoscopy, and accessing the third ventricle through the pineal recess. Following resection, pathological diagnosis was performed, and postoperative complications were observed. Results Subtotal resection was achieved. Postoperatively, central diabetes insipidus, diplopia and upward gaze dysfunction occurred, but improved after 3 months of follow-up. MRI confirmed subtotal resection of the tumor, and the vision of the patient was improved, and the Karnofsky performance status (KPS) score increased from 80 points to 90 points at 3 months after operation. The pathological diagnosis was papillary craniopharyngioma (WHO grade Ⅰ). Conclusions The EOTT-TR approach provides a unique postero-superior to antero-inferior perspective, allowing full exposure of the third ventricle. It is particularly advantageous for treating craniopharyngiomas originating from the antero-inferior wall of the third ventricle, enabling tumor resection while preserving hypothalamic function without affecting visual acuity or visual fields. Therefore, for craniopharyngiomas strictly confined within the third ventricle, the EOTT-TR approach is a feasible surgical approach.

Objective: To evaluate the effectiveness of a family-school collaborative intervention on sleep health among fifth-grade primary school students, so as to provide scientific evidence for promoting sleep health among primary school students. Methods: From April to June 2024, a baseline survey was conducted on 342 fifth-grade students and their parents from one primary school in a district of Beijing, using the convenient sampling method. A semester of sleep health education was implemented from September to December 2024, covering cognitive, behavioral and environmental factors that affected timely bedtime; and the program took various forms, including student courses, popular-science articles for parents, and personalized feedback reports. Another primary school in the same area was conveniently selected as the control group, where 313 fifth-grade students and their parents received routine health education. The subjects were assessed for their baseline and end-point (March to June 2025) sleep conditions using sleep diaries (222 participants in the intervention group and 225 in the control group) and accelerometers (120 participants in the intervention group and 88 in the control group), respectively. The independent samples t-test and the Wilcoxon rank-sum test were used to compare characteristics between groups，and linear mixed models were employed to evaluate the intervention effects. Results: In the sleep diary evaluation, the intervention group had an earlier weekend wake up time and a smaller social jetlag than the control group at baseline ( t/Z =3.42, 7.21); in the accelerometer evaluation, the intervention group exhibited a smaller social jetlag than the control group at baseline ( Z =3.90) (all P <0.05). In the sleep diary evaluation, compared with the control group, the intervention group showed a reduced pre-to-post change in school-day bedtime ( β = -6.70), whereas the pre-to-post changes in school-day sleep duration, weekend wake-up time, weekend sleep duration, and average sleep duration were all increased at baseline and at the end ( β =8.41, 22.58, 27.03,13.74) (all P <0.05). In the accelerometer evaluation, compared with the control group, the intervention group showed reduced pre-to-post changes in school-day sleep onset time and school-day wake time ( β =-14.75, -6.24), whereas the pre-to-post change in school-day sleep duration increased at baseline and at the end ( β =8.01) (all P <0.05). Conclusion A family-school collaborative sleep health intervention may be an effective strategy for improving sleep among fifth-grade primary school students.

Objective:To analyze the characteristics of cardiovascular and cerebrovascular diseases in patients with primary aldosteronism (PA) and compare them with age-, sex-, and blood pressure-matched patients with essential hypertension (EH).Methods:This cross-sectional study was conducted at the West China Hospital of Sichuan University. Patients with PA and EH between December 2018 and December 2021 were included. Demographic characteristics, stroke events, coronary artery diseases, peripheral vascular diseases, and cardiac structure and function indicators were analyzed. Propensity score matching (PSM) was used to balance non-study data. The t-test, chi-square test, and Wilcoxon signed-rank test were used for data comparison. The cardiovascular and cerebrovascular damage in the patients with unilateral and bilateral PA were also compared. Results:A total of 336 and 369 patients with PA and EH, respectively, were enrolled in this study. One hundred and ninety-eight patients from each group were included after PSM; no significant differences were found in terms of age, gender, and blood pressure. The prevalence of stroke in the PA group was considerably higher than that in the EH group [12.6% (25/198) vs. 5.6% (11/198), P=0.014], due to the significantly greater risk of ischemic stroke [10.0% (20/198) vs. 4.5% (9/198), P=0.029]. The prevalence of hemorrhagic stroke, coronary artery disease, peripheral arterial stenosis, aorta atherosclerosis, and aneurysm in the PA group were also higher than those in the EH group, but there was no statistical significance (all P>0.05). More patients with PA had concurrent left ventricular hypertrophy [22.2% (44/198) vs. 9.1% (18/198)], left atrial enlargement [40.4% (80/198) vs. 30.3% (60/198)], ventricular septal thickening [50.0% (99/198) vs. 36.9% (73/198)], and aortic widening [21.7% (43/198) vs. 13.1% (26/198)] than those with EH (all P<0.05). Compared with the bilateral PA group, the unilateral PA group had higher prevalence of left ventricular hypertrophy [28.3% (51/180) vs. 13.4% (11/82), P=0.013]. Conclusions:Compared with well-matched patients with EH, patients with PA have significantly higher risks of cardiovascular and cerebrovascular diseases, which are mainly manifested in increased prevalence of stroke and severe damage to the cardiac structure. Patients with unilateral PA may suffer more severe cardiac damage than those with bilateral PA.

Objective To investigate the therapeutic effect of Formononetin on mice with Mycoplasma pneumoniae pneumonia(MPP)by regulating the mitogen-activated protein kinase(MAPK)/nuclear factor κB(NF-κB)signaling pathway.Methods Six-week-old SPF-grade male BALB/c mice were selected.The MPP mouse model was established as the model group by instillating Mycoplasma pneumoniae bacterial solution through the nose.On the second day after successful modeling,mice were intraperitoneally injected with 15,30,and 60 mg/kg of Formononetin and 60 mg/kg of Formononetin+20 mg/kg of Anisomycin respectively as the low-dose,medium-dose,and high-dose Formononetin groups and the high-dose Formononetin+Anisomycin group,with 12 mice in each group.Another 12 mice were intraperitoneally injected with the same amount of 0.9％sodium chloride injection as the control group.The cough frequency of mice in each group was detected through the cough induction test.The partial pressure of carbon dioxide(PCO2)and partial pressure of oxygen(PO2)in each group of mice were detected by a blood gas analyzer,and the oxygenation index(OI)was calculated.The levels of inflammatory factors in each group were detected by ELISA,and the apoptosis of lung tissue cells in each group of mice was detected by TUNEL.HE staining was performed to observe the pathological changes of lung tissues in each group.The expression of MAPK/NF-κB pathway-related proteins in the lung tissues of mice in each group was detected by Western blot method.Results The lung tissue morphology of the mice in the control group was normal.The alveolar ducts and alveolar structures of mice in the model group were damaged,the alveolar septa thickened,and there was a large amount of inflammatory cell infiltration.Compared with the model group,the lung tissue morphology was improved in the low-dose,medium-dose and high-dose Formononetin groups.The lung tissue injury in the high-dose Formononetin+Anisamycin group was more severe compared with the high-dose Formononetin group.Compared with the control group,the cough latency period in the model group was shortened,and PO2,OI,and interleukin-10(IL-10)were decreased,while the frequency of coughing,PCO2,interleukin-18(IL-18),tumor necrosis factor-α(TNF-α),apoptosis rate,and the ratios of p-P38 MAPK/P38 MAPK,p-NF-κB p65/NF-κB p65,p-extracellular signal-regulated kinase 1/2(ERK1/2)/ERK1/2,and p-C-jun N-terminal kinase(p-JNK)/JNK increased(P＜0.05).Compared with the model group,the low-,medium-and high-dose Formononetin groups had improved lung tissue morphology,prolonged cough latency,increased PO2,OI and IL-10,and reduced cough frequency.The PCO2,IL-18,TNF-α,apoptosis rate,and the ratios of p-p38 MAPK/P38 MAPK,p-NF-κB p65/NF-κB p65,ERK1/2/ERK1/2,and p-JNK/JNK decreased(P＜0.05).In the low-,medium-,and high-dose Formononetin groups,with the increase of Formononetin dose,the cough latency gradually prolonged,the cough frequency gradually decreased,and the PO2,oxygenation index,and IL-10 gradually increased.The PCO2,IL-18,TNF-α,apoptosis rate and the ratios of p-p38 MAPK/P38 MAPK,p-NF-κB p65/NF-κB p65,p-ERK1/2/ERK1/2,and p-JNK/JNK gradually decreased(P＜0.05).Compared with the high-dose Formononetin group,the high-dose Formononetin+Anisamycin group had shorter cough latency,lower PO2,OI and IL-10.The frequency of coughing,PCO2,IL-18,TNF-α,apoptosis rate,and the ratios of p-p38 MAPK/P38 MAPK,p-NF-κB p65/NF-κB p65,p-ERK1/2/ERK1/2,and p-JNK/JNK increased(P＜0.05).Conclusion Formononetin may improve lung injury in MPP mice by inhibiting the MAPK/NF-κB signaling pathway.

OBJECTIVE: To investigate the association between ABO blood types and gestational diabetes mellitus (GDM) risk. METHODS: A prospective birth cohort study was conducted. ABO blood types were determined using the slide method. GDM diagnosis was based on a 75-g, 2-h oral glucose tolerance test (OGTT) according to the criteria of the International Association of Diabetes and Pregnancy Study Groups. Logistic regression was applied to calculate the odds ratios ( ORs) and 95% confidence intervals ( CIs) between ABO blood types and GDM risk. RESULTS: A total of 30,740 pregnant women with a mean age of 31.81 years were enrolled in this study. The ABO blood types distribution was: type O (30.99%), type A (26.58%), type B (32.20%), and type AB (10.23%). GDM was identified in 14.44% of participants. Using blood type O as a reference, GDM risk was not significantly higher for types A ( OR = 1.05) or B ( OR = 1.04). However, women with type AB had a 19% increased risk of GDM ( OR = 1.19, 95% CI = 1.05-1.34; P < 0.05), even after adjusting for various factors. This increased risk for type AB was consistent across subgroup and sensitivity analyses. CONCLUSION The ABO blood types may influence GDM risk, with type AB associated with a higher risk. Incorporating it-either as a single risk factor or in combination with other known factors-could help identify individuals at risk for GDM before or during early pregnancy.
Humans ; Female ; Pregnancy ; Diabetes, Gestational/etiology* ; ABO Blood-Group System ; Adult ; Prospective Studies ; Risk Factors ; Young Adult

Objective To investigate the therapeutic effect of Formononetin on mice with Mycoplasma pneumoniae pneumonia(MPP)by regulating the mitogen-activated protein kinase(MAPK)/nuclear factor κB(NF-κB)signaling pathway.Methods Six-week-old SPF-grade male BALB/c mice were selected.The MPP mouse model was established as the model group by instillating Mycoplasma pneumoniae bacterial solution through the nose.On the second day after successful modeling,mice were intraperitoneally injected with 15,30,and 60 mg/kg of Formononetin and 60 mg/kg of Formononetin+20 mg/kg of Anisomycin respectively as the low-dose,medium-dose,and high-dose Formononetin groups and the high-dose Formononetin+Anisomycin group,with 12 mice in each group.Another 12 mice were intraperitoneally injected with the same amount of 0.9％sodium chloride injection as the control group.The cough frequency of mice in each group was detected through the cough induction test.The partial pressure of carbon dioxide(PCO2)and partial pressure of oxygen(PO2)in each group of mice were detected by a blood gas analyzer,and the oxygenation index(OI)was calculated.The levels of inflammatory factors in each group were detected by ELISA,and the apoptosis of lung tissue cells in each group of mice was detected by TUNEL.HE staining was performed to observe the pathological changes of lung tissues in each group.The expression of MAPK/NF-κB pathway-related proteins in the lung tissues of mice in each group was detected by Western blot method.Results The lung tissue morphology of the mice in the control group was normal.The alveolar ducts and alveolar structures of mice in the model group were damaged,the alveolar septa thickened,and there was a large amount of inflammatory cell infiltration.Compared with the model group,the lung tissue morphology was improved in the low-dose,medium-dose and high-dose Formononetin groups.The lung tissue injury in the high-dose Formononetin+Anisamycin group was more severe compared with the high-dose Formononetin group.Compared with the control group,the cough latency period in the model group was shortened,and PO2,OI,and interleukin-10(IL-10)were decreased,while the frequency of coughing,PCO2,interleukin-18(IL-18),tumor necrosis factor-α(TNF-α),apoptosis rate,and the ratios of p-P38 MAPK/P38 MAPK,p-NF-κB p65/NF-κB p65,p-extracellular signal-regulated kinase 1/2(ERK1/2)/ERK1/2,and p-C-jun N-terminal kinase(p-JNK)/JNK increased(P＜0.05).Compared with the model group,the low-,medium-and high-dose Formononetin groups had improved lung tissue morphology,prolonged cough latency,increased PO2,OI and IL-10,and reduced cough frequency.The PCO2,IL-18,TNF-α,apoptosis rate,and the ratios of p-p38 MAPK/P38 MAPK,p-NF-κB p65/NF-κB p65,ERK1/2/ERK1/2,and p-JNK/JNK decreased(P＜0.05).In the low-,medium-,and high-dose Formononetin groups,with the increase of Formononetin dose,the cough latency gradually prolonged,the cough frequency gradually decreased,and the PO2,oxygenation index,and IL-10 gradually increased.The PCO2,IL-18,TNF-α,apoptosis rate and the ratios of p-p38 MAPK/P38 MAPK,p-NF-κB p65/NF-κB p65,p-ERK1/2/ERK1/2,and p-JNK/JNK gradually decreased(P＜0.05).Compared with the high-dose Formononetin group,the high-dose Formononetin+Anisamycin group had shorter cough latency,lower PO2,OI and IL-10.The frequency of coughing,PCO2,IL-18,TNF-α,apoptosis rate,and the ratios of p-p38 MAPK/P38 MAPK,p-NF-κB p65/NF-κB p65,p-ERK1/2/ERK1/2,and p-JNK/JNK increased(P＜0.05).Conclusion Formononetin may improve lung injury in MPP mice by inhibiting the MAPK/NF-κB signaling pathway.