Objective: To explore the related factors of type 2 diabetes mellitus (T2DM) in overweight and obese children and adolescents, so as to provide scientific evidence for early screening and making targeted comprehensive prevention and control strategies. Methods: A total of 332 overweight and obese children and adolescents aged 6-18 years who visited the department of pediatric endocrinology of a tertiary hospital in Liaoning Province from February 2023 to July 2025 were selected. A case control design was adopted, and the subjects were divided into the case group (overweight/obese children and adolescents with T2DM, n =166) and the control group (overweight/obese children and adolescents without diabetes, n =166) based on 1∶1 propensity score matching. Information on demographic characteristics, dietary and lifestyle behaviors was collected through questionnaires. Multivariate Logistic regression analysis was used to analyze the related factors of T2DM in overweight and obese children and adolescents. Results: The average body mass index of overweight and obese children and adolescents was (28.50±5.23)kg/m 2. Multivariate Logistic regression analysis showed that family history of diabetes ( OR=6.71, 95%CI =3.35-14.05), age at onset of weight gain <6 years ( OR=4.08, 95%CI =2.13-8.13), hyperphagia ( OR=2.46, 95%CI =1.25-4.97), and preference for fried foods ( OR= 2.42 , 95%CI =1.21-4.99) were associated with an increased risk of T2DM in overweight and obese children and adolescents (all P < 0.05). In contrast, vitamin D supplementation during pregnancy ( OR=0.50, 95%CI =0.25-0.99), frequent sun exposure during pregnancy of mothers ( OR=0.48, 95%CI =0.24-0.97), breastfeeding ( OR=0.35, 95%CI =0.18-0.66), vitamin D supplementation after 3 years of age ( OR=0.31, 95%CI =0.14-0.68), and active commuting to school ( OR=0.29, 95%CI =0.15-0.58) were associated with a reduced risk of T2DM in overweight and obese children and adolescents (all P <0.05). Conclusions The occurrence of T2DM in overweight and obese children and adolescents is closely related to early onset obesity, genetic background, dietary behaviors, and physical activity. A continuous comprehensive prevention and control strategy from pregnancy to school age should be established to reduce the risk of the disease.

Purpose This study aimed to explore the mucinous phenotype characteristics,key points of differenti-al diagnosis and prognosis of invasive non-mucinous adenocarcinoma(INMA)and invasive mucinous adenocarcinoma(IMA)under the WHO(2021)lung adenocarcinoma classification.Methods We retrospectively collected clinico-pathological data from 522 cases of lung adenocarcinoma,including 425 INMA(66 with mucin secretion,259 without mucin secretion)and 97 IMA.Immunohistochemical(IHC)staining using the EnVision method was performed on the mucin-secreting adenocarcinoma to assess expression of TTF-1,HNF4α,MUC1,MUC4,MUC5AC,MUC5B,and MUC6.Unsupervised clustering analysis was conducted to explore phenotypic subgroups.Results 522 patients with lung adenocarcinoma ranged from 32 to 83 years old(median:61).251 cases(48.1％)were male and 271 cases(51.9％)were female.Clustering analysis divided lung adenocarcinomas into two major groups:one characterized by TTF-1-/HNF4α+and gastric-type mucins MUC5AC+/MUC6+,predominantly IMA;the other,TTF-1+/HNF4α-/MUC4+,largely INMA.A three-marker IHC panel(TTF-1,HNF4α,MUC6)distinguished IMA from mucinous IN-MA with an area under the ROC curve(AUC)of 0.957(95％CI:0.928-0.986)and a Youden's index of 0.860.Further cluster analysis of INMA cases identified four phenotypic subgroups.Prognostic analysis demonstrated that pa-tients with advanced-stage mucin-secreting INMA had significantly shorter overall survival(OS)and progression-free survival(PFS)than those without mucin secretion(5-year OS:57.1％ vs 81.8％,P=0.004;3-year PFS:40.9％ vs 62.4％,P=0.004).No significant survival differences were noted among INMA subgroups stratified by varying mucin proportions.Multivariate analysis identified pathological stage,tumor necrosis,KRAS mutation,and TTF-1 negativity as independent adverse prognostic factors for both OS and PFS in mucinous INMA.Conclusion A three-marker im-munohistochemical panel of TTF-1,HNF4α,and MUC6 is recommended to distinguish IMA from mucinous INMA.Mucus component portends a worse prognosis in advanced INMA,with necrosis,KRAS mutations,and TTF-1 negativi-ty serving as independent adverse prognostic factors in mucinous INMA.

Objective To study the therapeutic effects of Yigan Fupi decoction(YGFP)on irritable bowel syndrome(IBS)and its mechanism of action in repairing the intestinal barrier and reducing IBS sensitivity through the PKA/PKC-CREB pathway.Methods Baby rats separated from their mother were randomly divided into a model control(M)and a YGFP group,while baby rats without maternal separation were used as a normal control(N)group.The YGFP group was given YGFP for 4 weeks.Abdominal withdrawal reflux was used to evaluate intestinal sensitivity.Liquid chromatography tandem mass spectrometry and ELISA were used to detect bile acid metabolite concentrations and serum levels of interleukin(IL)-6 and CXCL1,respectively.HE staining was used to observe pathological changes in the colon,and Western Blot and immunohistochemistry were used to analyze the relative protein expression levels of PKA,PKC,CREB,5HT2AR,5-HT7R,ZO-1,and Claudin 1.Results Compared with the normal control group,the M group showed a significantly decreased visceral pain threshold,significantly increased levels of total bile acid metabolites,IL-6,and CXCL1,significantly increased relative expression of PKA,PKC,CREB,5HT2AR,and 5-HT7R,and significantly decreased relative expression of ZO-1 and Claudin 1.Compared with the M group,the YGFP group showed a significantly increased visceral pain threshold,significantly reduced levels of total bile acid metabolites,IL-6,and CXCL1,significantly reduced relative expression of PKA,PKC,CREB,5HT2AR,and 5-HT7R,and increased relative expression of ZO-1 and Claudin 1.Conclusions YGFP effectively improved IBS through a mechanism that may involve repair of the intestinal barrier and reduced sensitivity through the PKA/PKC-CREB pathway.

Purpose This study aimed to explore the mucinous phenotype characteristics,key points of differenti-al diagnosis and prognosis of invasive non-mucinous adenocarcinoma(INMA)and invasive mucinous adenocarcinoma(IMA)under the WHO(2021)lung adenocarcinoma classification.Methods We retrospectively collected clinico-pathological data from 522 cases of lung adenocarcinoma,including 425 INMA(66 with mucin secretion,259 without mucin secretion)and 97 IMA.Immunohistochemical(IHC)staining using the EnVision method was performed on the mucin-secreting adenocarcinoma to assess expression of TTF-1,HNF4α,MUC1,MUC4,MUC5AC,MUC5B,and MUC6.Unsupervised clustering analysis was conducted to explore phenotypic subgroups.Results 522 patients with lung adenocarcinoma ranged from 32 to 83 years old(median:61).251 cases(48.1％)were male and 271 cases(51.9％)were female.Clustering analysis divided lung adenocarcinomas into two major groups:one characterized by TTF-1-/HNF4α+and gastric-type mucins MUC5AC+/MUC6+,predominantly IMA;the other,TTF-1+/HNF4α-/MUC4+,largely INMA.A three-marker IHC panel(TTF-1,HNF4α,MUC6)distinguished IMA from mucinous IN-MA with an area under the ROC curve(AUC)of 0.957(95％CI:0.928-0.986)and a Youden's index of 0.860.Further cluster analysis of INMA cases identified four phenotypic subgroups.Prognostic analysis demonstrated that pa-tients with advanced-stage mucin-secreting INMA had significantly shorter overall survival(OS)and progression-free survival(PFS)than those without mucin secretion(5-year OS:57.1％ vs 81.8％,P=0.004;3-year PFS:40.9％ vs 62.4％,P=0.004).No significant survival differences were noted among INMA subgroups stratified by varying mucin proportions.Multivariate analysis identified pathological stage,tumor necrosis,KRAS mutation,and TTF-1 negativity as independent adverse prognostic factors for both OS and PFS in mucinous INMA.Conclusion A three-marker im-munohistochemical panel of TTF-1,HNF4α,and MUC6 is recommended to distinguish IMA from mucinous INMA.Mucus component portends a worse prognosis in advanced INMA,with necrosis,KRAS mutations,and TTF-1 negativi-ty serving as independent adverse prognostic factors in mucinous INMA.

Objective To study the therapeutic effects of Yigan Fupi decoction(YGFP)on irritable bowel syndrome(IBS)and its mechanism of action in repairing the intestinal barrier and reducing IBS sensitivity through the PKA/PKC-CREB pathway.Methods Baby rats separated from their mother were randomly divided into a model control(M)and a YGFP group,while baby rats without maternal separation were used as a normal control(N)group.The YGFP group was given YGFP for 4 weeks.Abdominal withdrawal reflux was used to evaluate intestinal sensitivity.Liquid chromatography tandem mass spectrometry and ELISA were used to detect bile acid metabolite concentrations and serum levels of interleukin(IL)-6 and CXCL1,respectively.HE staining was used to observe pathological changes in the colon,and Western Blot and immunohistochemistry were used to analyze the relative protein expression levels of PKA,PKC,CREB,5HT2AR,5-HT7R,ZO-1,and Claudin 1.Results Compared with the normal control group,the M group showed a significantly decreased visceral pain threshold,significantly increased levels of total bile acid metabolites,IL-6,and CXCL1,significantly increased relative expression of PKA,PKC,CREB,5HT2AR,and 5-HT7R,and significantly decreased relative expression of ZO-1 and Claudin 1.Compared with the M group,the YGFP group showed a significantly increased visceral pain threshold,significantly reduced levels of total bile acid metabolites,IL-6,and CXCL1,significantly reduced relative expression of PKA,PKC,CREB,5HT2AR,and 5-HT7R,and increased relative expression of ZO-1 and Claudin 1.Conclusions YGFP effectively improved IBS through a mechanism that may involve repair of the intestinal barrier and reduced sensitivity through the PKA/PKC-CREB pathway.

Objective:To construct an indicator system for a nursing science and technology innovation curriculum guided by innovation competence, in order to provide a reference for cultivating innovation ability in nursing students.Methods:The overall research period was from March to December 2024. A nursing innovation curriculum indicator framework was initially developed through literature analysis and brainstorming. From October to December 2024, 19 experts from nine hospitals or universities across five provinces and cities were selected via purposive sampling to participate in two rounds of Delphi consultation. Revisions were made based on expert feedback.Results:Both rounds of expert consultation achieved a 100% response rate. The authority coefficient of the experts was 0.92. The final indicator system included four curriculum elements: course content, course objectives, teaching methods, and assessment, encompassing 14 first-level indicators and 40 second-level indicators.Conclusions:The innovation-oriented indicator system for nursing science and technology education demonstrates good scientific validity and reliability. It offers a foundational framework for advancing innovation-focused nursing education and curriculum design.

Objective:To construct an indicator system for a nursing science and technology innovation curriculum guided by innovation competence, in order to provide a reference for cultivating innovation ability in nursing students.Methods:The overall research period was from March to December 2024. A nursing innovation curriculum indicator framework was initially developed through literature analysis and brainstorming. From October to December 2024, 19 experts from nine hospitals or universities across five provinces and cities were selected via purposive sampling to participate in two rounds of Delphi consultation. Revisions were made based on expert feedback.Results:Both rounds of expert consultation achieved a 100% response rate. The authority coefficient of the experts was 0.92. The final indicator system included four curriculum elements: course content, course objectives, teaching methods, and assessment, encompassing 14 first-level indicators and 40 second-level indicators.Conclusions:The innovation-oriented indicator system for nursing science and technology education demonstrates good scientific validity and reliability. It offers a foundational framework for advancing innovation-focused nursing education and curriculum design.

Objective To explore the chain-mediating effect of anxiety and maladaptive coping strategies on perceived social support and post-traumatic stress disorder(PTSD)in primary caregivers of children with acute leukemia.Methods Two hundred primary care-givers of children with acute leukemia treated in the Pediatric Hematology Department of Shengjing Hospital of China Medical University between September 2022 and April 2023 were selected.A general information questionnaire,Perceived Social Support Scale,Self-Rating Anxiety Scale,Trait Coping Style Questionnaire,and Post-Traumatic Stress Disorder Checklist-Civilian Version were used for the survey.Pearson's correlation analysis was performed to determine the relationships between anxiety,maladaptive coping,perceived social sup-port,and PTSD.The chain-mediating effect was determined by structural equation modeling using Analysis of Moment Structures software and the Bootstrap method.Results PTSD was negatively correlated with perceived social support(r=-0.179,P＜0.05)and positively correlated with anxiety and maladaptive coping(r=0.762,P＜0.01;r=0.423,P＜0.01).Anxiety and maladaptive coping had chain-me-diating roles in the relationship between perceived social support and PTSD.Conclusion Perceived social support can indirectly affect the PTSD level of a caregiver through the chain-mediating effect of anxiety and maladaptive coping strategies.In clinical practice,enhancing caregivers perception of social support can alleviate anxiety,promote positive coping strategies,reduce negative coping strate-gies,and effectively reduce the risk of developing PTSD.

Objective To explore the chain-mediating effect of anxiety and maladaptive coping strategies on perceived social support and post-traumatic stress disorder(PTSD)in primary caregivers of children with acute leukemia.Methods Two hundred primary care-givers of children with acute leukemia treated in the Pediatric Hematology Department of Shengjing Hospital of China Medical University between September 2022 and April 2023 were selected.A general information questionnaire,Perceived Social Support Scale,Self-Rating Anxiety Scale,Trait Coping Style Questionnaire,and Post-Traumatic Stress Disorder Checklist-Civilian Version were used for the survey.Pearson's correlation analysis was performed to determine the relationships between anxiety,maladaptive coping,perceived social sup-port,and PTSD.The chain-mediating effect was determined by structural equation modeling using Analysis of Moment Structures software and the Bootstrap method.Results PTSD was negatively correlated with perceived social support(r=-0.179,P＜0.05)and positively correlated with anxiety and maladaptive coping(r=0.762,P＜0.01;r=0.423,P＜0.01).Anxiety and maladaptive coping had chain-me-diating roles in the relationship between perceived social support and PTSD.Conclusion Perceived social support can indirectly affect the PTSD level of a caregiver through the chain-mediating effect of anxiety and maladaptive coping strategies.In clinical practice,enhancing caregivers perception of social support can alleviate anxiety,promote positive coping strategies,reduce negative coping strate-gies,and effectively reduce the risk of developing PTSD.

Objective To develop and validate a deep learning-based segmentation model for low-dose cervical spine X-ray,aiming to address the insufficient segmentation accuracy in low-dose protocols while balancing radiation protection and diagnostic accuracy.Methods A total of 1 363 patients cervical spine X-ray images data were collected.A dose-attenuation mathematical simulation sys-tem was constructed to generate 14 122 dynamic low-dose cervical spine images incorporating quantum noise,contrast degradation,and blur artifacts.A neural network model was developed for automated segmentation of low-dose cervical spine X-ray using this dataset.Results Within the dose range of 50%to 7.5%,the average reults of automatic segmentation by the neural network model and manual segmentation for each group were as follows:50%dose group,intersection over union(IoU)=0.98 vs 0.93(P=0.707)and Dice coefficient(Dice)=0.99 vs 0.96(P=0.749);10%dose group,IoU=0.97 vs 0.87(P=0.201)and Dice=0.99 vs 0.93(P=0.219);7.5%dose group,IoU=0.97 vs 0.67(P<0.01)and Dice=0.98 vs 0.80(P<0.01).Conclusion The developed deep learning model achieved robust cervical spine segmentation(IoU>0.96,Dice>0.98)below diagnostic dose thresholds[peak signal-to-noise ratio(PSNR)<38 dB,structural similarity index(SSIM)<0.65].Under ultra-low-dose conditions(PSNR=27.710 dB,SSIM=0.274),it demonstrated a 44.78%IoU improvement and 22.5%Dice improvement over manual segmentation.This model enables minimal radia-tion exposure while preserving diagnostic performance,confirming its theoretical feasibility for low-dose X-ray image analysis and clinical research potential.