Objective: To explore the association between takeout fast foods and sugar sweetened beverage consumption with co-occurrence of anxiety and depressive symptoms among first year junior high school students in Yunnan Province, so as to provide theoretical basis for the prevention of anxiety and depressive symptoms co-occurrence among adolescents. Methods: A random cluster sampling involving 8 500 first year junior high school students in 11 counties in Yunnan Province was conducted by a questionnaire survey from October to December 2022. The Depression Anxiety Stress Scale-21 (DASS-21) was applied to assess anxiety and depressive symptoms in first year junior high school students. Chi-square test was used to compare the anxiety-depression co-occurrence symptoms of first year junior high school students with different demographic characteristics. The association between takeout fast foods and sugar sweetened beverage consumption with co-occurrence of anxiety and depressive symptoms of adolescents was analyzed by binary Logistic regression models. Results: The detection rate of co-occurrence of anxiety and depression symptoms among first year junior high school students in Yunnan Province was 26.92%. After controlling for demographic variables and other confounders, takeout fast foods and sugar sweetened beverage consumption( OR=1.50, 95%CI =1.27-1.77) was associated with anxiety-depression co-occurrence symptoms among first year junior high school students in Yunnan Province ( P <0.01). Stratified analysis showed that both Han ( OR=1.37, 95%CI =1.07-1.77) and ethnic minorities ( OR=1.60, 95%CI =1.29-2.00) exhibited statistically significant associations between takeout fast foods and sugar sweetened beverage consumption with co-occurrence of anxiety and depressive symptoms(both P <0.05). Conclusions Takeout fast foods and sugar sweetened beverage consumption increases the risk of co-occurrence of anxiety and depressive symptoms among first year junior high school students in Yunnan Province. It is recommended to strengthen guidance on the consumption of such products among junior high school students to prevent co-occurrence of anxiety and depressive symptoms.

This paper summarizes Professor WANG Yaoxian's experience in treating diabetic kidney disease （DKD） from the perspective of spleen and stomach based on the "internal heat leading to concretions" theory. It is considered that internal heat leading to concretions constitutes the core pathogenesis of DKD， with the spleen and stomach serving as the source of internal heat； therefore， treatment should be based on regulating the spleen and stomach. In the early stage of DKD， dysfunction of the spleen and stomach leads to the initial generation of internal heat. Common syndrome patterns include gastrointestinal heat accumulation and constrained heat in the liver and stomach， for which modified Gegen Qinlian Decoction （葛根芩连汤） can be used to clear heat bind while modified Dachaihu Decoction （大柴胡汤） is used to clear stomach and soothe liver， respectively. In the middle stage of DKD， weakness of the spleen and stomach results in the initial formation of concretions and conglomerations. Common patterns include spleen deficiency with prevalence of dampness and deficiency of both the spleen and kidney. Treatment emphasizes strengthening the spleen and resolving dampness， raising yang and boosting the stomach with modified Shengyang Yiwei Decoction （升阳益胃汤）， or supplementing spleen and boosting kidney， dissipating bind and dispe-ring concretions with modified Shenqi Dihuang Decoction （参芪地黄汤）， respectively. In the late stage of DKD， it is characterized by spleen and stomach depletion， and rampant accumulation of turbidity and toxin， and the common syndrome patterns are damp-turbidity obstruction in the middle jiao （焦） and spleen-kidney yang deficiency. Treatment aims to remove turbidity and harmonize the stomach， or to warm the kidney and strengthen the spleen while elimina-ting turbidity， using modified Dahuang Gancao Decoction（大黄甘草汤） and Jupi Zhuru Decoction （橘皮竹茹汤） or modified Baoyuan Decoction （保元汤） and Lizhong Decoction （理中汤）， respectively. In clinical practice， appropriate formulas and medications are flexibly selected according to specific syndromes.

Objective: To analyze the trend in disease burden attributable to insufficient physical activity among residents in Zhejiang Province from 1990 to 2021, so as to provide evidence for developing targeted prevention and control strategies. Methods: Data on years of life lost due to premature mortality (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY) due to insufficient physical activity among residents of Zhejiang Province were collected from the Global Burden of Disease (GBD) 2021 database. The average annual percentage change was used to analyze the trends in YLL, YLD, and DALY rates from 1990 to 2021. Results: YLL, YLD, and DALY rates attributable to insufficient physical activity among residents of Zhejiang Province increased from 42.65/105, 11.12/105, and 53.77/105 in 1990 to 85.67/105, 31.56/105, and 117.23/105 in 2021, respectively, showing an upward trend (AAPC=2.267%, 3.428%, and 2.517%, all P<0.05). From 1990 to 2021, the YLL, YLD, and DALY rates attributable to insufficient physical activity were consistently higher in females than in males. Both males and females demonstrated upward trends in YLL (AAPC=2.631%, 2.031%), YLD (AAPC=3.711%, 3.268%), and DALY (AAPC=2.840%, 2.303%) rates (all P<0.05). From 1990 to 2021, the YLL, YLD, and DALY rates were highest in the ≥70 years age group. From 1990 to 2021, 15-<50 and ≥70 years age groups showed upward trends in YLL (AAPC=0.439%, 0.818%), YLD (AAPC=3.102%, 1.351%), and DALY (AAPC=1.749%, 0.932%) rates (all P<0.05). The 50-<70 years age group exhibited an increasing trend in YLD rate (AAPC=1.222%), while declining trends in YLL (AAPC=-1.400%) and DALY (AAPC=-0.663%) (all P<0.05). In both 1990 and 2021, the top five diseases attributable to insufficient physical activity in Zhejiang Province were stroke, diabetes, colorectal cancer, ischemic heart disease, and chronic kidney disease. Compared to 1990, the DALY rates for these five diseases increased in 2021, with change rates of 89.20%, 164.84%, 110.67%, 223.40%, and 80.95%, respectively. Conclusions From 1990 to 2021, the overall disease burden attributable to insufficient physical activity in Zhejiang Province showed an upward trend. The disease burden was relatively high among females, the elderly, and for chronic diseases such as stroke, while premature mortality burden declined among residents aged 50-<70 years.

Objective To explore the prevalence of knee osteoarthritis and the influencing fac-tors of comorbidities in people aged ≥60 years old in Chengdu area.Methods A retrospective study was conducted for 168 patients aged ≥ 60 years old with knee osteoarthritis in the hospital from May 2021 to June 2023.Relevant materials of patients with knee osteoarthritis were collected,and preva-lence of the disease was analyzed.Patients were divided into comorbidity group(n=92)and non-co-morbidity group(n=76)based on the comorbidity status.Logistic regression analysis was used to ex-plore the influencing factors of comorbidities.Results Among 168 patients aged ≥60 years old with knee osteoarthritis,there were 107 females(63.69％)and 61 males(36.31％);66 patients(39.29％)were aged 60 to 70 years old,and 102 patients(60.71％)were older than 70 years old;81 patients(48.21％)resided in rural area,and 87 patients(51.79％)resided in urban area;92 patients(54.76％)had one comorbidity at least,specifically including 53 cases of dyslipidemia,38 cases of cardiovascular and cerebrovascular diseases,35 cases of hypertension,28 cases of type 2 diabetes,13 cases of chronic kidney disease,and 11 cases of depression.There were significant differences in age,duration of knee osteoarthritis,body mass index,occupation,history of knee surgery,time of daily physical exercise,knee joint function score,and the proportion of cases preferring spicy and greasy food between the comorbidity group and the non-comorbidity group(P＜0.05).Multivariate Logis-tic regression analysis showed that age(OR=1.561,95％ CI,1.183 to 2.078),body mass index(OR=2.439,95％ CI,1.740 to 3.225),occupation(OR=1.446,95％ CI,1.065 to 1.944),duration of knee osteoarthritis(OR=2.680,95％ CI,1.830 to 3.447),history of knee surgery(OR=1.772,95％ CI,1.313 to 2.336),time of daily physical exercise(OR=1.691,95％ CI,1.221 to 2.174),knee joint function score(OR=2.023,95％ CI,1.573 to 2.859),and prefer-ence for spicy and greasy food(OR=1.842,95％ CI,1.195 to 2.841)were influencing factors of comorbidities in patients with knee osteoarthritis(P＜0.05).Conclusion The knee joint function of people aged ≥60 years old in Chengdu area is poor,and the incidence of complications is high.It is necessary to strengthen the health management of patients with knee osteoarthritis,encourage active exercise,maintain a healthy diet and normal body weight,and reduce the impact of knee os-teoarthritis on their qualities of life.

Objective: To analyze the prevalence and determinants of comorbid overweight/obesity and elevated blood pressure among primary and secondary school students in Yangzhou City, and to explore the association between sleep patterns, eating behavior and the comorbidity of overweight/obesity and elevated blood pressure, so as to provide reference for developing prevention strategies targeting common comorbidities in students. Methods: By using stratified cluster random sampling, a total of 8 735 primary and secondary school students were selected from 36 schools in six counties of Yangzhou from October to November 2023. Students underwent physical examinations and a questionnaire survey was conducted using the questionnaire on students health status and influencing factors. The Chi square test was used to compare the detection rate of comorbid overweight/obesity and elevated blood pressure in different groups of primary and secondary school students. The Logistic regression model was used to explore the association between sleep and dietary behaviors and their combined effects and coexistence. Results: The detection rate of comorbid overweight/obesity and elevated blood pressure among primary and secondary school students in Yangzhou was 9.85%, which was higher among boys (12.14%) than girls (7.59%)( χ 2=50.86, P <0.01). After controlling for gender, residence, educational stage, parental education, smoking, drinking, and moderate to vigorous exercise, multivariate Logistic regression analysis showed that irregular breakfast consumption and inadequate daily sleep were associated with a higher risk of comorbidities compared with regular breakfast consumption and adequate daily sleep among overall and primary school students (overall: OR =1.52, 95% CI =1.18- 1.96 , primary school students: OR =2.79, 95% CI =1.61-4.82)(both P <0.05). From the perspective of primary school students of different genders, the risk of comorbidities in girls who consumed breakfast irregularly and had inadequate daily sleep was 3.59 times higher than that in girls who consumed breakfast irregularly and had inadequate daily sleep (95% CI =1.65-7.82, P <0.01). Conclusion The sleep patterns and breakfast behaviors of primary and secondary school students are found to be associated with comorbid overweight/obesity and elevated blood pressure, especially in primary school girls.

BACKGROUND: Valvular heart disease (VHD) has become increasingly common with the aging in China. This study aimed to evaluate regional differences in the clinical features, management strategies, and outcomes of patients with VHD across different regions in China. METHODS: Data were collected from the China-VHD Study. From April 2018 to June 2018, 12,347 patients who presented with moderate or severe native VHD with a median of 2 years of follow-up from 46 centers at certified tertiary hospitals across 31 provinces, autonomous regions, and municipalities in Chinese mainland were included in this study. According to the locations of the research centers, patients were divided into five regional groups: eastern, southern, western, northern, and central China. The clinical features of VHD patients were compared among the five geographical regions. The primary outcome was all-cause mortality or rehospitalization for heart failure. Kaplan-Meier survival analysis was used to compare the cumulative incidence rate. RESULTS: Among the enrolled patients (mean age, 61.96 years; 6877 [55.70%] male), multiple VHD was the most frequent type (4042, 32.74%), which was mainly found in eastern China, followed by isolated mitral regurgitation (3044, 24.65%), which was mainly found in northern China. The etiology of VHD varied significantly across different regions of China. The overall rate of valve interventions was 32.67% (4008/12,268), with the highest rate in southern China at 48.46% (205/423). In terms of procedure, the proportion of transcatheter valve intervention was relatively low compared to that of surgical treatment. Patients with VHD in western China had the highest incidence of all-cause mortality or rehospitalization for heart failure. Valve intervention significantly improved the outcome of patients with VHD in all five regions (all P  <0.05). CONCLUSIONS: This study revealed that patients with VHD in China are characterized by significant geographic disparities in clinical features, treatment, and clinical outcomes. Targeted efforts are needed to improve the management and prognosis of patients with VHD in China according to differences in geographical characteristics. REGISTRATION ClinicalTrials.gov , NCT03484806.
Aged ; Female ; Humans ; Male ; Middle Aged ; China/epidemiology* ; Heart Valve Diseases/therapy* ; Kaplan-Meier Estimate ; Tertiary Care Centers ; Treatment Outcome

Diabetic kidney disease （DKD） is one of the main causes of chronic kidney disease. Both traditional Chinese medicine （TCM） and western medicine have their own advantages in the prevention and treatment of DKD， but there are also many difficulties. By analysis of the difficulties faced by TCM and western medicine in the differentiation and treatment of DKD， based on the theory of "miniature masses in the renal collaterals"， combined with long-term clinical practice， "internal heat leading to mass" is proposed as the core pathogenesis of DKD. Therefore， a trinity model of "disease-syndrome-symptom" for differentiation and treatment of DKD based on the core pathogenesis has been proposed. This model highlights the status of the core pathogenesis of "internal heat leading to mass" in DKD， and conducts a three-dimensional identification from the perspectives of disease， syndrome and symptom， so as to inspire clinical practice.

Objective To identify the basic and clinical questions of the Guidelines for Preventive Treatment of Diseases in Endometriosis based on the Delphi method.Methods Based on the preliminary literature review,preliminary pan-research and expert interviews,the questions of the Guidelines for Preventive Treatment of Diseasesin in Endometriosis were drafted.Totally 15 experts were selected for two rounds of Delphi method expert correspondence and the results were statistically analyzed to finalize the questions for inclusion in the guidelines.Results A total of 65 entries were finally identified for inclusion in the guideline questions and condensed into 8 guideline questions.The quality control of the two rounds of Delphi method was good.The positive coefficient of experts in both rounds was 100%.The coefficient of authority of experts was>0.70.In the degree of Delphi coordination,the mean coefficients of variation were 0.23 and 0.26,and the coefficients of Kendall's concordance were 0.510 and 0.309,respectively(P<0.05).Conclusion This study uses two rounds of Delphi method to determine the issues included in the Guidelines for Preventive Treatment of Diseases in in Endometriosis,laying a solid foundation for the subsequent development of the guidelines.

Objective To explore the application effect of periodic feedback method in pelvic floor function exercise for patients with low anal preservation.Methods A total of 83 rectal cancer patients with low anal preservation admitted to Zhejiang Cancer Hospital from December 2023 to February 2024 were selected as subjects.They were divided into control group(n=42)and experimental group(n=41)by using a random number table method.The control group received routine health education,while experimental group received guidance on periodic feedback method-based pelvic floor exercises.The compliance with pelvic floor muscle exercises,symptom scores for low anterior resection,and quality of life improvement were compared between two groups.Results After intervention,compliance with pelvic floor exercises was higher,symptom scores for low anterior resection was reduced,overall quality of life was improved in experimental group compared to control group(P＜0.05).Conclusion Periodic feedback method can enhance compliance with pelvic floor exercises and improve overall quality of life for rectal cancer patients with low anal preservation.

Objective:To evaluate the clinical value of 11C-methyl- L-methionine (MET) PET/MR in the differential diagnosis between neoplastic and non-neoplastic brain lesions. Methods:From July 2017 to May 2022, a total of 34 patients (19 males, 15 females, age 8-81 years) who received 11C-MET PET/MR imaging for suspected brain tumors in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were retrospectively enrolled. Postoperative pathological or clinical follow-up results were used as the gold standard. Diagnostic performance of 11C-MET PET/MR and contrast-enhanced MRI was evaluated by ROC curve analysis and Delong test, as well as the diagnostic performance of PET metabolic parameters (SUV and target to background ratio (TBR)), MRI multi-sequence parameters (cerebral blood flow (CBF), relative CBF (rCBF), apparent diffusion coefficient (ADC), relative ADC (rADC), choline/creatine (Cho/Cr) and choline/ N-acetylaspartate (Cho/NAA)) and their combination. Results:A total of 35 lesions of 34 patients were enrolled, including 12 (34.3%) non-neoplastic lesions and 23(65.7%) neoplastic lesions. The diagnostic sensitivity, specificity, and accuracy for 11C-MET PET/MR were 91.3%(21/23), 12/12, and 94.3%(33/35), in contrast to 16/18, 2/10, and 64.3%(18/28) for contrast-enhanced MRI. Maximum TBR (TBR max) showed the highest discriminative value (AUC=0.877, 95% CI: 0.692-1.000). The combination of TBR max, minimum ADC (ADC min), rCBF, and Cho/NAA could achieve a higher diagnostic performance (AUC=0.918, 95% CI: 0.816-1.000), although the difference was not statistically significant ( Z=-0.42, P=0.676). Conclusion:Multiple quantitative parameters of 11C-MET PET/MR are beneficial to distinguish neoplastic from non-neoplastic brain lesions, and their combination may improve the diagnostic confidence.