OBJECTIVE To form an expert consensus addressing clinical issues regarding the use of parenteral direct thrombin inhibitors （DTIs） in special populations. METHODS Led by the Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital（the Affiliated Hospital of UESTC）， a multidisciplinary working group was formed comprising experts from multiple fields， including clinical pharmacy， cardiac surgery， obstetrics， pediatrics and evidence-based medicine. Through literature review and the Delphi method， clinical questions regarding the efficacy and safety of parenteral DTIs used in special populations were identified. A structured design was adopted using the “Population-Intervention-Comparison-Outcome” （PICO） framework；systematic searches were conducted in CJFD， PubMed， Embase and other databases. Relevant evidence from randomized controlled trials，cohort studies and systematic reviews were included and synthesized. Evidence quality was assessed using the Grading of Recommendations Assessment，Development and Evaluation （GRADE） approach， and recommendations were formulated through three rounds of Delphi surveys and expert consensus meetings. RESULTS &CONCLUSIONS Seven clinical questions were ultimately selected （with a consensus rate exceeding 90%）， resulting in the formulation of seven recommendations on the use of parenteral DTIs in special populations， including children， pregnant women， patients with hepatic or renal impairment， patients with mesenteric venous thrombosis， and individuals with thrombophilia. These recommendations clarify the preferred agents， dosing ranges， monitoring parameters， and safety management strategies for parenteral DTIs in these special populations. This expert consensus， which is formulated based on the best available evidence， provides evidence-based guidance for standardized and individualized use of parenteral DTIs in special populations.

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.

The health and well-being of the elderly have become a focal point for all sectors of society. As an effective means of preventing and controlling infectious diseases, vaccination plays a critical role in safeguarding human health. For older adults, timely and scientifically guided vaccination can significantly reduce the risk of serious illnesses while alleviating the associated economic burdens and pressure imposed on society. However, in practice, deficiencies in policy support, accessibility of vaccination services, and public awareness hinder some elderly individuals from fully benefiting from the protective effects of vaccines. This paper analyzes current vaccination practices for the elderly globally and proposes strategies to improve vaccination coverage, providing a scientific basis for advancing effective vaccination initiatives for this demographic in China.

Vaccination has become one of the key public health interventions for reducing child mortality. With the implementation of the expanded programme on immunization, the number of vaccine types children need to receive is increasing, necessitating further optimization of childhood immunization strategies. The World Health Organization recommends simultaneous vaccination as one of the core strategies for optimizing childhood immunization schedules. This article analyzes the current status, challenges, and prospects of simultaneous vaccination strategies for children in China, aiming to provide a scientific basis for promoting and implementing strategies for the simultaneous administration of multiple vaccines to children.

Objective: This study aims to investigate the anatomical relationship among the nerve roots, intervertebral space, pedicles, and intradural rootlets of the cervical spine for improving operative outcomes and exploring neuroventral decompression approach in posterior endoscopic cervical discectomy (PECD). Methods: Cervical computed tomography myelography imaging data from January 2021 to May 2023 were collected, and the RadiAnt DICOM Viewer Software was employed to conduct multiplane reconstruction. The following parameters were recorded: width of nerve root (WN), nerve root-superior pedicle distance (NSPD), nerve root-inferior pedicle distance (NIPD), and the relationship between the intervertebral space and the nerve root (shoulder, anterior, and axillary). Additionally, the descending angles between the spinal cord and the ventral (VRA) and dorsal (DRA) rootlets were measured. Results: The WN showed a gradual increase from C4 to C7, with measurements notably larger in men compared to women. The NSPD decreased gradually from the C2–3 to the C5–6 levels. However, the NIPD showed an opposite level-related change, notably larger than the NSPD at the C4–5, C5–6, and C7–T1 levels. Furthermore, significant differences in NIPD were observed between different age groups and genders. The incidence of the anterior type exhibited a gradual decrease from the C2–3 to the C5–6 levels. Conversely, the axillary type exhibited an opposite level-related change. Additionally, the VRA and DRA decreased as the level descended, with measurements significantly larger in females. Conclusion A prediction of the positional relationship between the intervertebral space and the nerve root is essential for the direct neuroventral decompression in PECD to avoid damaging the neural structures. The axillary route of the nerve root offers a safer and more effective pathway for performing direct neuroventral decompression compared to the shoulder approach.

The health and well-being of the elderly have become a focal point for all sectors of society. As an effective means of preventing and controlling infectious diseases, vaccination plays a critical role in safeguarding human health. For older adults, timely and scientifically guided vaccination can significantly reduce the risk of serious illnesses while alleviating the associated economic burdens and pressure imposed on society. However, in practice, deficiencies in policy support, accessibility of vaccination services, and public awareness hinder some elderly individuals from fully benefiting from the protective effects of vaccines. This paper analyzes current vaccination practices for the elderly globally and proposes strategies to improve vaccination coverage, providing a scientific basis for advancing effective vaccination initiatives for this demographic in China.

Vaccination has become one of the key public health interventions for reducing child mortality. With the implementation of the expanded programme on immunization, the number of vaccine types children need to receive is increasing, necessitating further optimization of childhood immunization strategies. The World Health Organization recommends simultaneous vaccination as one of the core strategies for optimizing childhood immunization schedules. This article analyzes the current status, challenges, and prospects of simultaneous vaccination strategies for children in China, aiming to provide a scientific basis for promoting and implementing strategies for the simultaneous administration of multiple vaccines to children.

Objective:To evaluate the efficacy and safety of DCAG(decitabine,cytarabine,anthracyclines,and granulocyte colony-stimulating factor)regimen in the treatment of patients with relapsed/refractory(R/R)acute myeloid leukemia(AML).Methods:The clinical data of 64 R/R AML patients received treatment at Chinese PLA General Hospital from January 1st,2012 to December 31st,2022 were retrospectively analyzed.Primary endpoints included efficacy measured by overall response rate(ORR)and safety.Secondary endpoints included overall survival(OS),event-free survival(EFS)and duration of response(DOR).The patients were followed from enrollment until death,or the end of last follow-up(June 1st,2023),whichever occurred first.Results:Sixty-four patients who failed prior therapy were enrolled and completed 1 cycle,and 26 and 5 patients completed 2 and 3 cycles,respectively.Objective response rate was 67.2％[39:completeremission(CR)/CR with incomplete hematologic recovery(CRi),4:partial remission(PR)].With a median follow-up of 62.0 months(1.0-120.9),the median overall survival(OS)was 23.3 and event-free survival was 10.6 months.The median OS was 51.7 months(3.4-100.0)in responders(CR/CRi/PR)while it was 8.4 months(6.1-10.7)in nonresponders(P＜0.001).Grade 3-4 hematologic toxicities were observed in all patients.Four patients died from rapid disease progression within 8 weeks after chemotherapy.Conclusion:The DCAG regimen represents a feasible and effective treatment for R/R AML.

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.