Objective: To analyze the developmental trajectories of clustered health risk behaviors and their association with self-esteem and lonelinesss among junior high school students, so as to provide a reference for formulating comprehensive prevention and control measures of health risk behaviors among adolescents. Methods: In October 2023, 1 165 first year junior high school students from two schools of Jishou City in Hunan Province were selected by convenient sampling method for three follow up surveys (T1:October 2023; T2:April 2024; T3:October 2024). The Adolescent Health Risk Behavior Questionnaire, Rosenberg Self esteem Scale and Loneliness Scale were used to assess health risk behaviors, self esteem and loneliness, respectively. Latent growth curve modeling and latent growth mixture modeling were applied to analyze the developmental trajectories of clustered health risk behaviors among junior high school students. Logistic regression was used to analyze the association of the developmental trajectories of clustered health risk behaviors with self esteem and loneliness among junior high school students. Results: The overall developmental trajectories among junior high school students showed a declining trend (intercept=0.15, slope=-1.65, both P <0.05), with three heterogeneous categories:low risk improvement group ( n =862, 74.0%), moderate risk stable group ( n =260, 22.3%), and high risk deterioration group ( n =43, 3.7%). After adjusting the status of the left behind individuals，using the low risk improvement group as the reference category in multinomial Logistic regression analysis, results indicated that higher loneliness scores among junior high school students increased the risks of belonging to the moderate risk stable group ( OR=1.02, 95%CI =1.00- 1.04 ) and the high risk deterioration group ( OR=1.04, 95%CI =1.00-1.08), while higher self esteem scores reduced the risks of belonging to the moderate risk stable group ( OR=0.93, 95%CI =0.91-0.96) and the high risk deterioration group ( OR=0.88, 95%CI =0.83-0.94) (all P <0.05). Conclusions The overall trend of clustered health risk behaviors among junior high school students gradually improves, and the self esteem and loneliness are significant correlative factors. Targeted intervention measures should be developed for the junior high school students, with a focus on enhancing their self esteem and alleviating loneliness.

Objective To investigate the incidence trends and influencing factors of non-alcoholic fatty liver disease (NAFLD) -related cirrhosis in China, predict future disease burden, and provide evidence for public health prevention strategies. Methods Based on the Global Burden of Disease (GBD) 2021 database, we employed joinpoint regression analysis to analyze NAFLD-related cirrhosis trends in China from 1990 to 2021, quantified influencing factors using age-period-cohort modeling, and predicted future incidence through Bayesian age-period-cohort analysis. Results The age-standardized incidence rates (ASIRs) of NAFLD-related cirrhosis showed a persistent increase from 1990 to 2021, with annual percentage changes (APCs) of 0.70% for male and 0.79% for female(both P<0.05). Age-effects revealed a U-shaped variation pattern, peaking in the 60-69 age group. Period effects indicated an incidence peak during 2017-2021. Cohort effects showed the most prominent risk in the 1992-1996 birth cohort. Projections suggested ASIR would further increase to 578.40 and 930.61 per 100 000 population for males and females, respectively, by 2030. Conclusions The disease burden of NAFLD-related cirrhosis continues to worsen in China, with future incidence rates projected to keep rising. Priority attention should be given to middle-aged and elderly populations and sex differences, with targeted prevention and control measures needing to be developed.

Objective To investigate the palmitoyltransferase (PATs) activity during different developmental stages of Plasmodium falciparum and to explore the impact of PATs activity on intra-erythrocytic replication and gametocytogenesis, so as to provide insights into development of novel antimalarial targets. Methods The PATs activity was measured using the click chemistry method during different developmental stages of P. falciparum, including rings, trophozoites, schizonts, and gametocytes. P. falciparum-infected erythrocytes were divided into three groups, including a control group, a dimethyl sulfoxide (DMSO) group, and a 2-bromopalmitate (2-BP) group. Erythrocytes in the control group were incubated in normal culture media, and cells in DMSO and 2-BP groups were exposed to DMSO or 2-BP at a final concentration of 10 μmol/L to examine the inhibitory effect of 2BP on the PATs activity. The growth curve analysis and gametocyte production assay were employed to investigate changes in asexual proliferation and gametocyte production of P. falciparum following inhibition of the PATs activity with 2-BP, and transcriptomics sequencing was performed to examine the impact of inhibition of the PATs activity with 2-BP on transcriptional levels of P. falciparum and possible mechanisms. Results The green fluorescence intensity of PATs varied across developmental stages of P. falciparum (F = 38.120, P < 0.001), with a higher fluorescence intensity seen in trophozoites (35.680 ± 8.439), merozoites (33.380 ± 9.030) and gametocytes (21.540 ± 8.654), and a lower intensity in ring bodies (10.720 ± 3.183) (all P values < 0.05). The green fluorescence intensities were 8.738 ± 1.576, 8.633 ± 1.827 and 4.911 ± 0.318 in the control group, DMSO group, and 2-BP group 4 days post-culture (schizont stage), respectively (F = 91.490, P < 0.001), and the PATs activity was significantly inhibited post-treatment with 2-BP (P < 0.05). The areas under the time curve for the parasitemias were 25.700 ± 0.696, 28.630 ± 3.062 and 8.370 ± 1.751 in the control group, DMSO group, and 2-BP group following inhibition of the PATs activity during the asexual stage of P. falciparum (F = 83.440, P < 0.001), and the parasitemia was lower in the 2-BP group than in the control group and the DMSO group (both P values < 0.001). In addition, the asexual stage development was delayed in the 2BP group, with abnormal morphology seen. The numbers of merozoites were 18.050 ± 4.362, 18.200 ± 3.517 and 14.020 ± 4.320 in each schizont in the control group, DMSO group and 2-BP group, respectively (H = 39.100, P < 0.001), and the merozoite number was significantly lower in the 2-BP group than in the control group and the DMSO group (both P_adjusted values < 0.001). The areas under the time curve for P. falciparum gametocyte production were 18.900 ± 0.384, 18.240 ± 0.177 and 7.507 ± 0.201 in the control group, the DMSO group, and the 2-BP group following inhibition of the PATs activity, respectively (F = 1 677.000, P < 0.001), and the proportion of gametocyte production was statistically lower in the 2-BP group than in the control group and DMSO group (both P values < 0.001). The formation and maturation of gametophytes were blocked in the 2-BP group, and most of them were arrested in the middle and late stages. Following 2-BP treatment, significantly down-regulated genes during the asexual stage of P. falciparum were significantly enriched in cell cycle regulation, mitosis, DNA damage/response and structural organization, and significantly down-regulated genes during the gametocyte stage were significantly enriched in biological processes of cell cycle (mitosis and G1/S transition), RNA regulation and metabolism (such as carbon catabolite repression 4-negative on TATA-less) and cell development and differentiation. Conclusion The palmitoylation modification plays an important role in the asexual reproduction and gametocyte generation and development of P. falciparum.

OBJECTIVE To study the efficacy of Tianjiang xueshuantong pills in the treatment of coronary heart disease. METHODS In accordance with the common pathogenesis of coronary heart disease， acute myocardial ischemia model， hyperlipidemia model， blood stasis model， and carotid artery thrombosis model were established using Wistar rats or SD rats as the experimental subjects. The effects of Tianjiang xueshuantong pills administered at high， medium， and low doses （0.6， 1.2 and 2.4 g/kg） on hemodynamic parameters and myocardial enzyme markers [lactate dehydrogenase （LDH）， creatine kinase-MB （CK- MB）]， oxidative stress factors [superoxide dismutase （SOD）， malondialdehyde （MDA）， glutathione （GSH）]， inflammatory cytokines [tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， IL-1β， monocyte chemotactic protein-1 （MCP-1）， intercellular adhesion molecule-1 （ICAM-1）]， myocardial infarction percentage， serum lipid indexes [total cholesterol （TC）， triglycerides （TG）， low-density lipoprotein （LDL）， high-density lipoprotein （HDL）]， platelet aggregation function 话：022-84845240。E-mail：jiangx@tjipr.com [maximum aggregation rate （MAR）]， and thrombus formation indexes [thrombosis time， thrombus mass， thrombus protein content， plasminogen activator inhibitor-1 （PAI-1）， and tissue-type plasminogen activator （t-PA）] were evaluated in the rat models. RESULTS In myocardial ischemia tests， Tianjiang xueshuantong pills significantly reduced the percentage of myocardial infarction and the levels of CK-MB， LDH， MDA， GSH， IL-6， TNF-α， IL- 1β， and MCP-1 in serum （P＜0.05 or P＜0.01）. In hyperlipidemia tests， high dose of Tianjiang xueshuantong pills significantly reduced the serum levels of TC， LDL and significantly increased the level of HDL in rats after 2 weeks and 4 weeks of administration. In blood stasis tests， different doses of Tianjiang xueshuantong pills significantly reduced MAR of rats （P＜0.01）. In artery thrombosis tests， high dose of Tianjiang xueshuantong pills significantly prolonged the time of thrombosis formation （P＜ 0.01）， significantly reduced the weight and protein content of thrombus and the level of PAI-1 in serum （P＜0.01）. CONCLUSIONS Tianjiang xueshuantong pills exert therapeutic effects on coronary heart disease through multi-dimensional synergistic actions， including anti-myocardial ischemia， lipid-lowering， and anti-thrombotic effects.

The esophagogastric junction serves as a natural anti-reflux barrier and possesses a complex anatomical configuration composed of several key components, including the lower esophageal sphincter, diaphragmatic crura, His angle, and phrenoesophageal ligament. Alterations in these anatomical structures or dysfunction thereof may predispose individuals to gastroesophageal reflux disease (GERD). In response to such structural and functional impairments, various therapeutic strategies have been developed. Surgical intervention is currently regarded as an effective approach for fundamentally addressing GERD, with commonly employed techniques including laparoscopic fundoplication, magnetic sphincter augmentation, and endoscopic radiofrequency ablation. The author classifies the anti-reflux mechanisms at the esophagogastric junction into intramural and extramural components, and based on this classification, systematically reviews and evaluates the indications and clinical applications of major surgical interventions for GERD, aiming to provide clinicians with evidence-based guidance for selecting appropriate therapeutic modalities.

Objective:To analyze the developmental trajectories of depressive symptoms in middle school students and their relationship with school connection and self-efficacy,and to provide evidence for the prevention of early adolescent depressive symptoms.Methods:In March(T1),June(T2),December(T3),809 middle school students were followed up in 2023 using the Patient Health Questionnaire-9(PHQ-9),School Connection Scale(SCS)and General Self-Efficacy Scale(GSES).The heterogeneity of the developmental trajectory of depressive symptoms in early adolescents was analyzed by the latent variable growth mixed model(LGMM),and the relation-ship between the developmental trajectory of depressive symptoms and school connection and self-efficacy was ana-lyzed by multiple logistic regression.Results:LGMM results showed that the development trajectory of early de-pressive symptoms in adolescents could be divided into:"low level-remission group"(65.3％),"low level-stable group"(28.6％)and"medium level-worsening group"(6.1％).Logistic regression analysis showed that male students(OR=0.62,95％CI=0.44-0.86)and school connection(OR=0.91,95％CI=0.88-0.94)were the protective factors in the"low level-stable group".Boys(OR=0.26,95％CI=0.13-0.53),school connection(OR=0.93,95％CI=0.88-0.98),and self-efficacy(OR=0.90,95％CI=0.85-0.96)were the protective fac-tors in the"medium level-worsening".Conclusion:There is heterogeneity in the developmental trajectory of early adolescent depressive symptoms,and school connection and self-efficacy are protective factors for the development of early adolescent depressive symptoms.

The esophagogastric junction serves as a natural anti-reflux barrier and possesses a complex anatomical configuration composed of several key components, including the lower esophageal sphincter, diaphragmatic crura, His angle, and phrenoesophageal ligament. Alterations in these anatomical structures or dysfunction thereof may predispose individuals to gastroesophageal reflux disease (GERD). In response to such structural and functional impairments, various therapeutic strategies have been developed. Surgical intervention is currently regarded as an effective approach for fundamentally addressing GERD, with commonly employed techniques including laparoscopic fundoplication, magnetic sphincter augmentation, and endoscopic radiofrequency ablation. The author classifies the anti-reflux mechanisms at the esophagogastric junction into intramural and extramural components, and based on this classification, systematically reviews and evaluates the indications and clinical applications of major surgical interventions for GERD, aiming to provide clinicians with evidence-based guidance for selecting appropriate therapeutic modalities.

Objective To investigate the incidence of hip fracture among the elderly in communities,explore related influencing factors,and develop and validate a risk prediction model.Methods A stratified sampling method was used to collect sociodemographic data,lifestyles and risk factors in hip fracture between January 2023 and January 2024 among the elderly residents in communities in Deyang.With random splitting,479 elderly people(68.00%)were assigned to the model training set,and 221(32.00%)to the model validation set.In the model training set,the participants were divided into a fracture group and a non-fracture group based on hip fracture or not.Data from both groups were compared,and R software(version 4.3.1)was employed to develop and validate the risk prediction model.Results A total of 700 elderly residents in communities were included,62 of them had hip fracture within one year yielding a cumulative incidence rate of 8.86%.The risk prediction model identified six predictors:frequent consumption of preserved foods,daily exercise time,daily sunlight exposure,osteoporosis,times of fall within a year,and with≥20 pieces of natural teeth.In the training set,the model achieved an AUC of 0.945(95%CI:0.908-0.982),with a sensitivity of 88.89%and a specificity of 89.40%.The calibration curve demonstrated a good agreement between predicted and actual values,indicating a strong calibration.Decision curve analysis(DCA)showed a positive net benefit.In the validation set,the AUC was 0.892(95%CI:0.784-0.999),with a sensitivity of 82.35%and a specificity of 93.63%,confirming a good model fit and predictive performance.The calibration curve exhibited a strong consistency,and DCA indicated a positive net benefit.Conclusion The developed risk prediction model for hip fracture in elderly community residents demonstrates a strong predictive value.It provides a practical reference for community workers and healthcare professionals to screen and assess the risk of hip fracture among the elderly residents in communities.

Objective:To analyze the developmental trajectories of depressive symptoms in middle school students and their relationship with school connection and self-efficacy,and to provide evidence for the prevention of early adolescent depressive symptoms.Methods:In March(T1),June(T2),December(T3),809 middle school students were followed up in 2023 using the Patient Health Questionnaire-9(PHQ-9),School Connection Scale(SCS)and General Self-Efficacy Scale(GSES).The heterogeneity of the developmental trajectory of depressive symptoms in early adolescents was analyzed by the latent variable growth mixed model(LGMM),and the relation-ship between the developmental trajectory of depressive symptoms and school connection and self-efficacy was ana-lyzed by multiple logistic regression.Results:LGMM results showed that the development trajectory of early de-pressive symptoms in adolescents could be divided into:"low level-remission group"(65.3％),"low level-stable group"(28.6％)and"medium level-worsening group"(6.1％).Logistic regression analysis showed that male students(OR=0.62,95％CI=0.44-0.86)and school connection(OR=0.91,95％CI=0.88-0.94)were the protective factors in the"low level-stable group".Boys(OR=0.26,95％CI=0.13-0.53),school connection(OR=0.93,95％CI=0.88-0.98),and self-efficacy(OR=0.90,95％CI=0.85-0.96)were the protective fac-tors in the"medium level-worsening".Conclusion:There is heterogeneity in the developmental trajectory of early adolescent depressive symptoms,and school connection and self-efficacy are protective factors for the development of early adolescent depressive symptoms.

Objective: To explore the causal link of cumulative ecological risk and future orientation with health risk behaviors among higher vocational college students, so as to provide reference for reducing and preventing health risk behaviors among higher vocational college students. Methods: A longitudinal follow up study was conducted on 612 students using convenience sampling from 2 vocational colleges in Hunan Province. The Cumulative Ecological Risk Scale, Future Orientation Scale, and Health Risk Behavior Scale were used during three follow up visits (T1: September 2022, T2: June 2023, T3: March 2024), and a cross lagged panel model was constructed to examine the longitudinal causal relationship of cumulative ecological risk, future orientation and health risk behaviors. Analysis of longitudinal intermediary effect between variables by Bootstrap. Results: The cumulative ecological risk scores of T1, T2 and T3 among higher vocational college students were (2.94±1.44,2.99±1.63,3.02±1.54), future orientation scores (40.49±4.71,41.51±5.72,41.06±4.35) and health risk behavior scores (3.73±2.01,3.49±2.00,3.23±2.00). The results of repeated measures ANOVA showed that the future orientation score of T2 was higher than that of T1, and the main effect of measurement time was statistically significant ( F=5.09，P＜0.01,η 2=0.02). The health risk behavior score of T1 was higher than that of T2, and the health risk behavior score of T2 was higher than that of T3, and the main effect of measurement time was statistically significant ( F=10.12，P＜0.01,η 2=0.03).The cross lagged model showed good adaptability, with χ 2/df =7.20 ( P <0.01), relative fitting indicators GFI=0.98, CFI=0.99, TLI=0.96, IFI=0.99, NFI =0.99, and absolute fitting indicator RMSEA =0.06. Among them, the T1, T2 cumulative ecological risk showed negatively predictive effects on T2, T3 future orientation ( β =-0.24, -0.47 ), and T1, T2 cumulative ecological risk positively predicted T2, T3 health risk behavior ( β =0.20, 0.24), while T1, T2 future orientation negatively predicted T2, T3 health risk behavior ( β =-0.25, -0.18) ( P ＜0.01). Bootstrap test analysis found that T2 future orientation had a longitudinal mediating effect ( β=0.04, P ＜0.01) on the T1 cumulative ecological risk and T3 health risk behavior. Conclusions The accumulation of ecological risk among higher vocational college students can positively predict health risk behaviors, while future orientation can negatively predict healthrisk behaviors. Moreover, future orientation plays a longitudinal mediating role between accumulated ecological risks and health risk behaviors.