Objective To explore the role in sleep staging from blood volume pulse(BVP)and triaxial acceleration(ACC)of body movement obtained by wristband.Methods The BVP and ACC obtained by Empatica E4 wristband were used from all 100 cases of sleep disorder subjects in the DREAMT public database.Two frequency domain characteristics(eS,LF/HF)and one time domain characteristic(vA)of the BVP baseline and the activity counts(CS)of the ACC were used for sleep-awakening classification based on random forest.Results The results of sleep-awakening classification of all 100 cases of sleep disorder subjects were obtained by leaving-one-out strategy.The accuracy is 79.8%and the Kappa coefficient is 0.56 by 4 features from BVP and ACC;the accuracy is 70.4%and the Kappa coefficient is 0.36 by 3 features of BVP;the accuracy is 75.1%and the Kappa coefficient is 0.47 based on activity counts.Conclusion The BVP and ACC obtained by the wristband can be used for the rough estimation of sleep and awakening for sleep disorder subjects,among which the importance of ACC is higher than that of BVP.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:To investigate the application value of dual-energy computer tomo-graphy (CT) multi-parameter imaging in predicting the pathological grade of pancreatic ductal adeno-carcinoma (PDAC).Methods:The retrospective cohort study was conducted. The clinicopatholo-gical data of 147 patients with PDAC who were admitted to The Fifth Affiliated Hospital of Wenzhou Medical University from January 2017 to August 2023 were collected. There were 102 males and 45 females, aged (59±10)years. All patients underwent preoperative dual-energy CT examination and postoperative histopathological examination. The 147 patients were divided into a training set of 103 cases and a test set of 44 cases by stratified random sampling at a ratio of 7∶3. The training set was used to construct the prediction model, and the test set was used to verify the effectiveness of prediction model. Observation indicators: (1) analysis of factors affecting the pathological grade of PDAC patients in the training set; (2) construction and evaluation of the fusion prediction model for pathological grade of PDAC. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test. Univariate and multivariate analyses were conducted using the Logistic regression model. The performance of the model was evaluated by receiver operating characteristic (ROC) curve, and the area under the curve (AUC), accuracy, sensitivity and specificity were calculated. The Delong test was used to analyze the effec-tiveness of model. The calibration curve and decision curve of Hosmer-Lemeshow test were used to evaluate the consistency and clinical application value of the nomogram, respectively. Results:(1) Analysis of factors affecting the pathological grade of PDAC patients in the training set. Results of multivariate analysis showed that tumor cystic necrosis, vascular invasion, standardized iodine concentration (NIC) in venous phase, effective atomic number (Zeff) in venous phase, and energy spectrum curve slope (λ HU) in venous phase were all independent factors affecting the pathological grade of PDAC patients in the training set ( odds ratio=4.326, 3.887, 4.155, 5.389, 3.164, 95% confidence interval as 1.167-16.033, 1.111-13.592, 1.707-10.113, 1.284-22.613, 1.247-8.028, P<0.05). (2) Construction and evaluation of the fusion prediction model for pathological grade of PDAC. Accor-ding to the results of multivariate analysis, tumor cystic necrosis, vascular invasion, NIC in venous phase, Zeff in venous phase and λ HU in venous phase were all included to construct the clinical-imaging fusion prediction nomogram model. The AUC, accuracy, sensitivity and specificity of the fusion prediction model in the training set were 0.938 (95% confidence interval as 0.896-0.981), 87.38%, 89.74% and 85.94%, respectively. The above indicators of the fusion prediction model in the test set were 0.893 (95% confidence interval as 0.802-0.985), 84.09%, 82.35% and 85.19%, respectively. Results of Delong test showed that there was no significant difference in AUC between the training set and the test set ( Z=0.343, P>0.05). Results of Hosmer-Lemeshow test showed that the fusion prediction model had a good fit in the training set and the test set ( χ2=3.042, 7.545, P>0.05). Results of calibration curve showed that the predictive ability of the fusion prediction model was good. Conclusions:Multiple parameters in venous phase of the dual-energy CT can be used as imaging markers for preoperative evaluation of the pathological grade of patients with PDAC. Establishing a clinical-imaging fusion prediction model can effectively predict the pathological grade of PDAC.

Objective To establish a forensic age inference method based on age-related changes in maxillofacial CBCT imaging of Han population in North China.Methods CBCT imaging data of Han people aged 7～50 years were collected from September 2021 to September 2023.Mimics 17.0 software was used to perform 3D reconstruction on 480 cases that met the inclusion criteria(420 cases in the experimental group,60 cases in the blind test group,with a 50%male-to-female ratio)and obtain measured values for 16 indicators.The data were then statistically analyzed using SPSS 27.0 to identify age-related significant indicators and establish regression equations.Results Regression equations based on age-related significant indicators were established for different genders and age intervals.The accuracy of the equations decreased as the age interval increased.The blind test accuracy rates of regression equations for males across different age groups ranged between 62.6%and 80.6%,while for females,they ranged between 55.3%and 76.6%.Conclusion This study enriches maxillofacial skeletal data for Chinese population and establishes multivariate age inference regression equations based on significant indicators of age-related changes in maxillofacial CBCT,providing a new reference basis and inference method for forensic age assessment.

Objective To establish a forensic age inference method based on age-related changes in maxillofacial CBCT imaging of Han population in North China.Methods CBCT imaging data of Han people aged 7～50 years were collected from September 2021 to September 2023.Mimics 17.0 software was used to perform 3D reconstruction on 480 cases that met the inclusion criteria(420 cases in the experimental group,60 cases in the blind test group,with a 50%male-to-female ratio)and obtain measured values for 16 indicators.The data were then statistically analyzed using SPSS 27.0 to identify age-related significant indicators and establish regression equations.Results Regression equations based on age-related significant indicators were established for different genders and age intervals.The accuracy of the equations decreased as the age interval increased.The blind test accuracy rates of regression equations for males across different age groups ranged between 62.6%and 80.6%,while for females,they ranged between 55.3%and 76.6%.Conclusion This study enriches maxillofacial skeletal data for Chinese population and establishes multivariate age inference regression equations based on significant indicators of age-related changes in maxillofacial CBCT,providing a new reference basis and inference method for forensic age assessment.

Objective:To investigate the application value of dual-energy computer tomo-graphy (CT) multi-parameter imaging in predicting the pathological grade of pancreatic ductal adeno-carcinoma (PDAC).Methods:The retrospective cohort study was conducted. The clinicopatholo-gical data of 147 patients with PDAC who were admitted to The Fifth Affiliated Hospital of Wenzhou Medical University from January 2017 to August 2023 were collected. There were 102 males and 45 females, aged (59±10)years. All patients underwent preoperative dual-energy CT examination and postoperative histopathological examination. The 147 patients were divided into a training set of 103 cases and a test set of 44 cases by stratified random sampling at a ratio of 7∶3. The training set was used to construct the prediction model, and the test set was used to verify the effectiveness of prediction model. Observation indicators: (1) analysis of factors affecting the pathological grade of PDAC patients in the training set; (2) construction and evaluation of the fusion prediction model for pathological grade of PDAC. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test. Univariate and multivariate analyses were conducted using the Logistic regression model. The performance of the model was evaluated by receiver operating characteristic (ROC) curve, and the area under the curve (AUC), accuracy, sensitivity and specificity were calculated. The Delong test was used to analyze the effec-tiveness of model. The calibration curve and decision curve of Hosmer-Lemeshow test were used to evaluate the consistency and clinical application value of the nomogram, respectively. Results:(1) Analysis of factors affecting the pathological grade of PDAC patients in the training set. Results of multivariate analysis showed that tumor cystic necrosis, vascular invasion, standardized iodine concentration (NIC) in venous phase, effective atomic number (Zeff) in venous phase, and energy spectrum curve slope (λ HU) in venous phase were all independent factors affecting the pathological grade of PDAC patients in the training set ( odds ratio=4.326, 3.887, 4.155, 5.389, 3.164, 95% confidence interval as 1.167-16.033, 1.111-13.592, 1.707-10.113, 1.284-22.613, 1.247-8.028, P<0.05). (2) Construction and evaluation of the fusion prediction model for pathological grade of PDAC. Accor-ding to the results of multivariate analysis, tumor cystic necrosis, vascular invasion, NIC in venous phase, Zeff in venous phase and λ HU in venous phase were all included to construct the clinical-imaging fusion prediction nomogram model. The AUC, accuracy, sensitivity and specificity of the fusion prediction model in the training set were 0.938 (95% confidence interval as 0.896-0.981), 87.38%, 89.74% and 85.94%, respectively. The above indicators of the fusion prediction model in the test set were 0.893 (95% confidence interval as 0.802-0.985), 84.09%, 82.35% and 85.19%, respectively. Results of Delong test showed that there was no significant difference in AUC between the training set and the test set ( Z=0.343, P>0.05). Results of Hosmer-Lemeshow test showed that the fusion prediction model had a good fit in the training set and the test set ( χ2=3.042, 7.545, P>0.05). Results of calibration curve showed that the predictive ability of the fusion prediction model was good. Conclusions:Multiple parameters in venous phase of the dual-energy CT can be used as imaging markers for preoperative evaluation of the pathological grade of patients with PDAC. Establishing a clinical-imaging fusion prediction model can effectively predict the pathological grade of PDAC.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective To systematically evaluate the value of optical coherence tomography angiogra-phy (OCTA) for detecting the vessel density (VD) changes after open-angle glaucoma (OAG) surgery.Meth-ods The studies on OCTA for detecting the VD changes after OAG surgery were searched in the CNKI,WanFang,VIP,SinoMed,PubMed,Embase and Web of Science databases from the database establishment to May 2024.Literature screening,data extraction and risk of bias assessment of included studies were conducted independently by two reviewers.Descriptive analysis was adopoted for the systematic evaluation,the meta a-nalysis was conducted by using the R software and mean difference (MD) and its 95％CI were calculated.Re-sults A total of 13 studies were included,involving 472 patients with 500 tested eyes.The results of meta-a-nalysis showed that compared with pre-surgery,VD around the optic nerve head (ONH) and in nasal superi-or,temporal inferior,temporal superior,superior temporal and superior nasal regions at postoperative 6 months were significantly decreased.VD in the perimacular,perimacular superior hemisphere,permacular su-perior hemisphere,perimacular superior and permacular superior regions at postoperative 6 months were sig-nificantly increased.Conclusion OCTA could effectively detect the postoperative VD changes in the patients with OAG and predict postoperative visual function changes in glaucoma,and could serve as an effective test means for assessing the clinical treatment effect of the patients with OAG.

Objective:To analyze the mutation characteristics of Kirsten rat sarcoma virus oncogene homology (KRAS) gene in patients with appendiceal adenocarcinoma and its relationship with the activity of Ras Raf Mitogen activated protein kinase/extracellular regulated protein kinase (MAPK/ERK) signaling pathway.Methods:A total of 41 patients with appendiceal adenocarcinoma who were treated in the Lishui Central Hospital from January 2014 to January 2020 were selected as the observation group, and 50 patients with Appendicitis who were operated at the same time were randomly selected as the control group. Clinical and follow-up data were collected, and the mutation of the KRAS gene in the patient′s tissue was measured using the snapshot method. The expression of key proteins in the MAPK/ERK signaling pathway in cancer tissue was measured using Western blotting (WB) assay. We compared the clinical characteristics and prognosis of patients with KRAS mutation and non KRAS mutation appendiceal adenocarcinoma.Results:The KRAS gene mutation rate in the observation group was higher than that in the control group (41.5% vs 10.0%), and the expression levels of p-ARAF/ARAF, p-MEK1/MEK1, and p-ERK1/ERK1 proteins were also higher than those in the control group. The differences between the groups were statistically significant (all P<0.05). The protein expression levels of p-ARAF/ARAF, p-MEK1/MEK1, p-ERK1/ERK1 in KRAS mutation patients in the observation group were significantly higher than those in non KRAS mutation patients. The proportion of stage IV, positive rates of carcinoembryonic antigen (CEA), carbohydrate antigen (CA)199 and CA125 in KRAS mutation patients were higher than those in non KRAS mutation patients, and the survival time and progression free survival time were shorter than those in non KRAS mutation patients, with statistical significance (all P<0.05). Conclusions:The mutation rate of KRAS in appendix adenocarcinoma is high, and the activation of MAPK/ERK signaling pathway caused by KRAS mutation may play a role in the pathogenesis of appendix adenocarcinoma, which has the value of in-depth research.

Objective To investigate the clinical characteristics and prognosis of patients with acute aortic dissection (AAD) and hypertension,and explore other related prognostic factors in AAD.Methods The present study enrolled consecutive patients diagnosed with AAD who were admitted to Peking University People's Hospital between January 2000 to December 2015.Patients diagnosed with AAD by CT angiography,aortography or magnetic resonance imaging within 14 days of onset were included.Patients with infectious diseases,haematological diseases,malignancies,autoimmune diseases and patients without clearly clinical diagnosis or incomplete data were excluded.The patients were initially divided into two groups based on their history of hypertension,and their clinical characteristics were compared and analyzed.We further divided AAD patients into survival group and death group according to their in-patient outcomes,and factors related to their prognoses were analyzed.Logistic regression analysis was applied to analyze the independent risk factors related to hospital death in AAD patients with P＜0.05 as the significant value.Results The hypertensive group contained 237/346 cases included (68.45％),patients in this group were generally older than their non-hypertensive counterparts,accompanied by increased prevalence of comorbidities (coronary heart diseases or diabetes) and a statistical significant elevated admission blood pressures (systolic and diastolic,P＜0.05).No significant difference were found between the groups in terms of white blood cell and platelet count,D-dimer,neutrophil to lymphocyte ratio(NLR),fibrinogen,serum creatinine and serum lipid profiles (P＞0.05).Hypertensive patients were less likely to receive surgical treatment compared with those without hypertension(P＜0.05),with increased risk of in-hospital mortality (P＞0.05).Further logistic regression analysis revealed the presence of hypertension did not independently predict in-hospital mortality of AAD patients.Factors such as age,Stanford classification of the AAD,NLR and platelet counts were found to have independent predictive values for in-hospital mortality (P＜0.05).Conclusion AAD patients with hypertension are generally older,have more comorbidities such as coronary heart diseases and diabetes.The presence of hypertension itself is not directly associated with in-hospital mortality in AAD patients,while the Stanford classification,age,NLR and platelet counts are independent risk predictors.