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 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.

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 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 conduct an analysis on objective data of tongue manifestations and complexions among college students with yang deficiency constitution and balanced constitution,thus to explore the correlation between yang deficiency constitution and the objective data of tongue manifestations and complexions among college students.Methods From August 2023 to January 2024,data collection was carried out in 325 cases of yang deficiency constitution(yang deficiency group)and 175 cases of balanced constitution(balanced group)from college students of Hunan University of Chinese Medicine,Central South University,Hunan Normal University,Hunan University and Changsha University of Science and Technology in Hunan Province.YM-MA-Ⅰ digital detection system for tongue manifestations and complexions of traditional Chinese medicine(TCM)was utilized for data collection and image analysis,and the differences in the Lab parameters of tongue color,tongue shape,tongue coating color,complexions,and lip color were compared between yang deficiency group and balanced group.Of the Lab parameters,letter"L"stands for luminance,which expresses the luminance from absolute black to absolute white,and takes the value of 0-100;letter"a"and letter"b"stand for two color channels,letter"a"represents the color from dark green to grey then to bright pink,and takes a value from-128 to 127,and letter"b"represents the color from bright blue to grey then to yellow,and also takes a value from-128 to 127.Results(1)The analysis of tongue manifestations showed that in comparison with the balanced group,enlarged tongue(72.62％),tooth-marked tongue(83.69％),and greasy coating(59.38％)were frequently seen in the yang deficiency group,and the differences were all statistically significant(P＜0.05 or P＜0.01).(2)The analysis of complexions showed that in comparison with the balanced group,lusterless complexion(79.08％)and pale lip(42.15％)were frequently seen in the yang deficiency group,with statistically significant differences(P＜0.01).(3)The yang deficiency group had higher L value of tongue color,L value of tongue coating color,L value of complexions,and L and b values of lip color than the balanced group,and the differences were all statistically significant(P＜0.05),indicating that the tongue color,complexions,and lip color of the yang deficiency group were all pale.Conclusion The objective data and image analysis of tongue manifestations and complexions can accurately identify the population of yang deficiency constitution from college students,and the results will provide approaches and references for the identification of other TCM constitutions from the population.

Objective:To summarize the clinical characteristics of focal cerebral arteriopathy (FCA) in children, and to analyze its influencing factor of prognosis.Methods:A retrospective cohort study was conducted. Clinical data from 40 children with FCA who were hospitalized at the Department of Neurology, Beijing Children′s Hospital, Capital Medical University, from September 2015 to August 2024 were collected. A centralized follow-up was conducted in October 2024 via outpatient clinics or the internet. The pediatric stroke outcome measure (PSOM) was used to evaluate their outcomes. Based on the PSOM, the children were further divided into a group with normal neurological function and another group with abnormal neurological function. Differences between groups were analyzed using the Mann-Whitney U test and Fisher exact test. Univariate Logistic regression analysis was performed to identify the influencing factors for neurological outcomes in children with FCA. Results:A total of 40 children were included, with 20 males and 20 females, and the onset age of 9.2 (6.8, 12.5) years. Among them, 12 cases (30%) had a history of varicella within 1 year before onset. There were 23 cases (58%) presenting with transient ischemic attack (TIA) or recurrent fluctuating symptoms of onset, while 3 cases (8%) developed progressive stroke within the first month of onset. The M1 segment of the middle cerebral artery was the most commonly affected vascular site, with a total of 16 cases (40%). Arterial occlusion occurred in 8 cases (20%). Lumbar puncture was completed in 36 children, and white blood cell counts in cerebrospinal fluid was increased in 6 cases. All 23 patients who completed magnetic resonance vessel wall imaging (VWI) showed circular enhancement of the arterial wall. A total of 28 patients (70%) received antiplatelet or anticoagulation therapy, and 16 patients (40%) received hormone therapy. At admission, the pediatric National Institute of Health Stroke Scale (PedNIHSS) score was 6.0 (2.0, 8.8) points, which decreased to 0.5 (0, 3.0) points at discharge. The follow-up duration was 1.6 (0.8, 4.9) years, with 1 case lost to follow-up. There was 1 case presenting with recurrence course manifesting as TIA. Among the 39 cases who completed the follow-up, 23 cases (59%) were assessed as neurologically normal by PSOM, while 16 cases (41%) were assessed as neurologically abnormal. Among the 29 cases who completed the imaging review, magnetic resonance angiography (MRA) review in 23 cases indicated stability or improvement in the original arterial stenosis, with 6 cases experiencing transient worsening of arterial stenosis early in the disease course (within 2 months), which later improved. Arterial stenosis progression occurred in 6 cases at the final review of 29 cases who completed the imaging review, with 1 case developing progressive cerebral arteriopathy. The proportion of patients with headache, altered consciousness, and aphasia in the abnormal neurological function group, as well as the PedNISS scores at admission and discharge, were all higher than those in the normal neurological function group (all P<0.05). Univariate Logistic regression analysis revealed that only a PedNISS score>6 points at onset was an influencing factor for abnormal neurological function ( OR=20.58, 95% CI 3.93-107.70, P<0.001). Conclusions:Childhood FCA often presents with fluctuating onset, and the proximal segment of the middle cerebral artery is frequently affected. Progression of arterial stenosis is common within 2 months of the disease course, but clinical progression and new ischemic lesions are uncommon. Most patients have a favorable long-term prognosis. PedNIHSS score>6 points at admission is related to abnormal neurological function outcomes.

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 investigate the effects and underlying mechanisms of a spray prepared from exosomes derived from M2 macrophages induced by interleukin-4 （IL-4） and tantalum particles （Ta） on the healing of pressure ulcers. Methods Bone marrow-derived macrophages were polarized into M2 macrophages using IL-4 or Ta, and exosomes （Exo-IL-4/Exo-Ta） were extracted. The regulatory effects of Exo-IL-4/Exo-Ta on M1 macrophage phenotypes and fibroblast matrix secretion were evaluated in vitro. Proteomic analysis was conducted to explore the biological processes and regulatory networks associated with Exo-Ta. A rat pressure ulcer model was used to assess the effects of Exo-IL-4/Exo-Ta spray on wound healing rate, inflammatory cell infiltration, and collagen deposition. Results In vitro, Exo-IL-4/Exo-Ta induced the polarization of M1 macrophages to M2 macrophages, reduced the secretion of pro-inflammatory factors, and promoted the expression of anti-inflammatory substances. Additionally, Exo-IL-4/Exo-Ta enhanced the production of collagen and fibronectin in fibroblasts. Proteomic analysis revealed that Exo-Ta primarily participated in biological processes such as energy metabolism and macromolecule biosynthesis. In vivo, Exo-IL-4/Exo-Ta spray accelerated wound healing, reduced inflammatory infiltration, and improved tissue remodeling in the rat pressure ulcer model. Conclusion Exosome sprays derived from M2 macrophages could accelerate pressure ulcer healing by modulating inflammation and promoting tissue regeneration, which demonstrated excellent clinical application potential.

ObjectiveTo explore the effects of the Tibetan medicine Sanwei Doukoutang （SWDK） on cognitive dysfunction in mice suffering from Alzheimer's disease （AD） and its related mechanism. MethodsFifty SPF 5 × FAD mice were randomly divided into model group， total ginsenoside group（0.04 g·kg^-1）， high-， medium-， and low-dose groups of SWDK （32.60， 16.30， 8.15 g·kg^-1）， with 10 mice in each group， and ten wild-type mice of the same age were used as the normal group， male and female in 1∶1. Gavage administration was performed once daily for 8 weeks. The Morris water maze test and contextual fear memory experiment were used to observe learning and memory function. Hematoxylin-eosin （HE） staining was utilized to observe the changes in the pathomorphology of brain tissue in mice. The levels of synaptophysin （SYP） and postsynaptic dense substance 95 （PSD95） in mice serum were detected by enzyme-linked immunosorbent assay （ELISA）. The positive expression of brain-derived neurotrophic factor（BDNF） in the dentate gyrus （DG） region of mouse brain tissue was observed by immunohistochemistry （IHC）. The protein levels of BDNF， Wnt family member 3A（Wnt3a）， and β-catenin were detected in the hippocampus of mice by Western blot. ResultsCompared with the normal group of mice， the model group of mice had significantly more complex swimming routes and lower swimming speed （P<0.01）， significantly lower percentage of time spent in the target quadrant （P<0.01）， and a significantly lower percentage of freezing time （P<0.05）. The number of neurons in the hippocampal region of mice was obviously reduced and unevenly arranged. The levels of SYP and PSD95（P<0.01） in the serum of mice were reduced， and the positive expression of BDNF in the DG region of the brain tissue of mice was reduced. The levels of hippocampal BDNF， Wnt3a， and β-catenin proteins in the hippocampus of mice were obviously reduced （P<0.05， P<0.01）. Compared with the model group， the mice in the SWDK group and the total ginsenoside group had significantly shorter swimming routes， the high- and medium- dose SWDK groups significantly higher swimming speeds （P<0.01）， significantly higher percentage of time spent in the target quadrant （P<0.01）， obviously higher percentage of Freezing time （P<0.05）， and obviously more neurons in the hippocampal region of the mice with tighter arrangement. The mice had elevated levels of serum SYP （P<0.05， P<0.01）， PSD95 （P<0.01）， increased BDNF-positive cells in the DG region of brain tissue， and obviously elevated levels of BDNF， Wnt3a， and β-catenin proteins in the hippocampus of mice （P<0.05， P<0.01）. ConclusionSWDK can significantly improve the cognitive dysfunction of AD mice， and its mechanism may be related to regulating the Wnt/β-catenin signaling pathway， which promotes BDNF expression and thereby enhances synaptic plasticity， allowing neuronal signaling to be restored.