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.

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 effect of slow intravenous infusion of low-dose mannitol on the hemodynamics of patients after cardiopulmonary bypass.Methods:Prospective, continuous inclusion of 62 patients after cardiac surgery under cardiopulmonary bypass. By random number method, they were divided into normal treatment group(group C) with 29 cases and mannitol treatment group(group M) with 33 cases. Group C was treated according to the postoperative routine treatment measures. On the basis of conventional treatment, group M received intravenous infusion of 20% mannitol injection 0.25 g/kg at 1、8、24 hours after operation, and the intravenous infusion time was 60 minutes each time. According to the hemodynamic changes during the two groups of treatment, the effect of slow intravenous infusion of low-dose mannitol on patients after cardiopulmonary bypass under cardiopulmonary bypass was analyzed.Results:In group M, CI and SVI were significantly increased after use of mannitol than before, with statistical significance( P<0.01). SVRI showed a downward trend, and the changes were statistically significant after use of mannitol( P<0.01). PAWP increased first and then decreased after operation, and the changes were statistically significant after mannitol use than before( P<0.05). RAP and MPAP had no significant changes after the first use of mannitol, but the changes after the latter two use mannitol were statistically significant than before( P<0.05). Repeated-measurement data analysis of variance was performed on the hemodynamic parameters of each group, and the results were all P<0.01. Conclusion:Postoperative slow intravenous infusion of low-dose mannitol optimizes hemodynamic status, increases stroke volume, reduces cardiac preload, improves systemic and pulmonary circulation resistance, and promotes recovery of postoperative cardiopulmonary function.

Objective:To explore the influence of inhalation injury on fluid resuscitation of massive burn patients during shock stage.Methods:A total of 74 massive burn patients (65 males and 9 females, aged 21 to 65 years) admitted to the Second Affiliated Hospital of Air Force Medical University ( n=57) and Yan′an University Affiliated Hospital ( n=17) from May 2009 to December 2019 were enrolled in this retrospective cohort study. Patients were divided into inhalation injury group ( n=56) and non-inhalation injury group ( n=18) based on clinical symptoms, vital signs, and results of bronchofibroscopy. Then 26 patients in inhalation injury group and 13 patients in non-inhalation injury group were 1∶2 matched by case-control matching based on the difference of total burn surface area. The total fluid replacement coefficient, crystalloid replacement coefficient, colloid replacement coefficient, glucose input volume, ratio of crystalloid to colloid, urine volume, and cumulative ratio of input to output volume during the first 24 h post injury, the second 24 h post injury, and the third 24 h post injury, heart rate, respiratory rate, mean arterial pressure (MAP), and hematocrit (HCT) at post injury hour (PIH) 24, 48, and 72 were recorded and compared between the two groups. Data were statistically analyzed with analysis of variance for repeated measurement and Bonferroni correction, t test, Fisher′s exact probability test, and Mann-Whitney U test. Results:(1) After matching, during the first to third 24 h post injury, the total fluid replacement coefficient and glucose input volume of patients in inhalation injury group were significantly higher than those in non-inhalation injury group ( F=4.202, 10.671, P<0.05 or P<0.01). During the first, second, and third 24 h post injury, the total fluid replacement coefficient, crystalloid replacement coefficient, colloid replacement coefficient, and ratio of crystalloid to colloid were similar between the patients in two groups( t=-1.336, -1.452, -1.998; -0.148, 0.141, 0.561; 0.916, -0.046, -0.509; -1.024, 0.208, 0.081, P>0.05). During the first, second, and third 24 h post injury, the glucose input volume of patients in inhalation injury group were respectively (2 996±1 176), (2 659±1 030), and (2 680±1 509) mL, which were significantly higher than (2 125±898), (1 790±828), and (1 632±932) mL in non-inhalation injury group ( t=-2.334, -2.639, -2.297, P<0.05). (2) After matching, in overall comparison between groups, during the first to third 24 h post injury, the urinary output volumes and cumulative ratios of input to output volume of patients in inhalation injury group were significantly lower or higher than those in non-inhalation injury group, respectively ( F=12.158, 9.111, P<0.01). At PIH 24, 48, and 72, heart rate of patients in inhalation injury group were significantly higher than those in non-inhalation injury group ( F=4.675, P<0.05). There were no statistically significant differences in heart rate, respiratory rate, MAP, and HCT between patients in the two groups at PIH 24 and 48 ( t=-0.039, -1.688, 1.399, 1.299, -1.741, 0.754, -0.677, 0.037, P>0.05). During the first and second 24 h post injury, the urine volume and cumulative ratio of input to output volume of patients in inhalation injury group were respectively significantly lower and higher than those in non-inhalation injury group ( turine volume=2.421, 2.876, tcumulative ratio of input to output volume=-2.687、-2.943, P<0.05 or P<0.01). At PIH 72, the heart rate and HCT of patients in inhalation injury group ( (114±13) times/min, 0.42±0.06) were significantly higher than those in non-inhalation injury group ( (98±18) times/min, 0.38±0.06, t=-3.182, -2.123, P<0.05 or P<0.01), there were no statistically significant differences in respiratory rate and MAP between the patients in two groups ( t=0.359, 1.722, P>0.05). During the third 24 h post injury, there were no statistically significant differences in urine volume and cumulative ratio of input to output volume between the patients in two groups ( t=1.664, -1.895, P>0.05). Conclusions:The presence of inhalation injury can lead to increased fluid requirement in massive burn patients during shock stage. An appropriate increase of fluid volume in the fluid resuscitation of burn patients combined with inhalation injury would be beneficial for maintaining ideal urine output.

Objective To explore the prognostic values of telomerase reverse transcriptase promoter (TERTp) mutation and 1p/19q co-deletion in newly-diagnosed O6-methylguanine-DNA methyltransferase (MGMT) promoter un-methylated/isocitrate dehydrogenase (IDH) wild-type glioblastoma multiform (GBM). Methods A total of 82 patients pathologically newly-diagnosed MGMT promoter un-methylated/IDH wild-type GBM, admitted to our hospitals from March 2016 to November 2018, were included in this study. TERTp mutations (TERTp wild-type and TERTp mutation [C228 mutation and C250 mutation]) in GBM specimens were detected by PCR sequencing, 1p/19q co-deletion in GBM specimens was detected by fluorescence in situ hybridization (FISH), and clinical data, adverse reactions and prognoses of patients with different molecular typing were compared. Results There were 33 patients in the TERTp wild type group with mean age of 48 years, and 49 patients in the TERTp mutation group with mean age of 59 years; the difference of age was significant (P<0.05); there were no statistical differences in gender distribution, Karnofsky performance status (KPS) scores, tumor sites and surgical resection degrees between the two groups (P>0.05). There were 8 patients with 1p/19q co-deletion and 74 patients without 1p/19q co-deletion; no significant differences in above clinical parameters were noted between the two groups. There were no statistically significant differences in the incidences of bone marrow suppression, digestive tract response and fatigue, disease progression rate, or survival rate between patients from TERTp wild type group and TERTp mutation group, and between patients with 1p/19q co-deletion and patients without 1p/19q co-deletion (P>0.05). No significant differences in above clinical parameters, disease progression rate, and survival rate were noted between patients with C228 mutation and C250 mutation (P>0.05). Conclusion TERTp typing and 1p/19q co-deletion status do not have prognostic value in newly-diagnosed MGMT un-methylated/IDH wild-type GBM patients; patients with TERTp mutations have older age than wild-type patients; patients with C250 mutation trend to have higher survival rate than those with C228 mutation.

Objective To assess the effect of psychological group on improving the learning attitude of interns in the pediatric clinical practice.Methods This study included 67 medical students who enrolled during 2012 to 2013 and had done the clinical pediatrics in the Second Affiliated Hospital of Shantou University Medical College.The students carried out pediatric clinical practice as requested.Based on the practice of pediatric practice,the psychological group counseling was conducted by voluntary participation.Each psychological group consisted of 5 or 6 students and performed once a week.Each time of psychological group lasted for 1.5 hours and 6 times in total.The students were divided into intervention group and non-intervention group according to whether they participated in psychological group.Each student filled in the Pediatric Clinical Internship Attitude Assessment Form and the College Student Personality Questionnaire at the first week and the last week of pediatric clinical practice.SPSS 17.0 was applied to conduct Chi square test and t test.Results There were 33 students in the intervention group and 40 students in the non-intervention group.The effective rate of questionnaires for intervention group and non-intervention group were 100％ and 85％,respectively.The mental state of pediatric interns between two groups was not different before and after the pediatric clinical practice (P＞0.05).Before pediatric clinical practice,the learning attitude score between two groups was not different [(83.82 ± 8.39) vs.(84.39 ± 8.29),t=-0.28,P=0.781].After pediatric clinical practice,the learning attitude score of pediatric interns who used psychological group teaching model was better than that of pediatric interns who used traditional teaching model [(88.91 ± 7.40) vs.(75.03 ± 11.19),t=-5.969,P=0.000].Conclusion Psychological group can help medical students to develop empathy toward sick children and their parents,and then improve their learning attitude in pediatric practice.The results of this study can provide a preliminary basis for the popularization of psychological group in the whole process of medical internship.

BACKGROUND: Human umbilical cord mesenchymal stem cells (HUMSCs) can differentiate into insulin-producing cellsafter induced by chemical drugs or co-culture methods, but insulin secretion is extremely low. Therefore, to inducemature pancreatic beta cell differentiation from stem cells by adenovirus transfection of specific genes involved in thedevelopment of pancreas is a research hotspot in recent years.OBJECTIVE: To study the differentiation potential of HUMSCs into insulin-producing cells after transfection withmusculoaponeurotic fibrosarcoma oncogene homologue A (MafA).METHODS: Ad-MafA-EGFP was transferred into passage 3 HUMSCs. After 7 days of induction, changes of cellmorphology were observed by inverted phase contrast microscope. Expression of pancreatic cell-specific genes(glucagon, PDX1, Nkx2.2) was detected by PCR technique.RESULTS AND CONCLUSION: After Ad-MafA-EGFP transfection, no significant morphological changes were observedin the HUMSCs under inverted phase contrast microscope. It was confirmed by fluorescence microscope thatAd-MafA-EGFP was transferred into the HUMSCs. After induction, the expression of human pancreatic precursorcell-related genes, including glucagon, PDX1 and Nkx2.2, was increased as detected by PCR. To conclude, thesefindings could provide experimental evidence for further differentiation and maturation of pancreatic β cells fromHUMSCs.

Pylorus obstruction caused by foreign bodies in the gastric anrum and granulomatous inflammation is rarely seen.The clinical symptoms of this disease are unspecific.Combination of X-ray radiography,computed tomography and gastroscopy could make definite diagnosis.Differential diagnosis between pylorus obstruction and peptic ulcer,gastric cancer and duodenal obstruction should be done before operation.On April 13,2012,a patient with pylorus obstruction caused by foreign bodies in the gastric anrum and granulomatous inflammation was treated at the Second Hospital of Jiaxing,the imaging characteristics of the disease were summarized to provide referrence for the diagnosis and treatment of this disease.

Acetyl-CoA C-acetyltransferase (AACT) is the first enzyme in the terpene synthesis pathway, catalyzed two units of acetyl-CoA to acetoacetyl-CoA. In order to study the tanshinone biosynthesis in Salvia miltiorrhiza, a novel AACT gene, SmAACT, was cloned using cDNA microarray and RACE strategy. The full length cDNA of SmAACT is 1 623 bp (accession No. EF635969), which contained a 1 200 bp open reading frame (ORF) encoding a 399 amino acid protein. Nine introns were found in the genomic sequence. SmAACT was upregulated by YE and Ag+ elicitors both with cDNA microarray and quantitative RT-PCR analyses along with the accumulation of tanshinones. Sequence homology comparison and phylogenetic analysis all suggested that SmAACT belonged to the class of acetyl-CoA C-acetyltransferase. The transcription level of SmAACT was relatively higher in root than that in stem and leaf tissues. SNP analysis revealed that SmAACT was highly variable in the region of 6 to 9 introns with 33 SNPs in the 600 bp region, there are 5 SNPs in the cDNA region while they are all synonymous cSNPs. Some special genotypes were found in Salvia miltiorrhiza from different areas. SmAACT will be an useful gene for further analyze the mechanism of gene regulation among the tanshinones biosynthesis.

Objective To evaluate the biocompatibility of ZSM-5 zeolite and provide an experimental basis for developing the first-aid hemostatic agent.Methods According to Chinese evaluation standards on medical devices and biological tests,the cytotoxicity in vitro,hemolysis test,acute toxicity of system,pyrogen test,intracutaneous stimulation,sensitization and micronucleus test were studied in ZSM-5 zeolite.In order to find out the side-effect of the zeolite granules' remains left in the wounds to body,muscle implantation test was studied.Results There were no obvious cytotoxity,hemolysis reaction.Acute tocicity,pyrogen reaction,intraeutaneous stimulation,sensitization and potential mutagenesis in themicronucleus test were observed.Their results were a11 consistent with the Chinese biological evaluation of medical devices.Obvious inflammatory reaction was observed when ZSM-5 zeolite was implanted in muscle for 12 weeks.Conclusion The ZSM-5 zeo1ite has reliable biocompatibility.But zeolite can cause inflammatory reaction when it is remained in the wound surface for long term.