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 compare the differences in the average transaction costs per-referral patients under different models of Integrated Delivery Systems(IDS).Methods Using a typical case sampling method,it selected referred patients from three IDS models:the county medical alliance in D City(Qinghai Province),the urban medical consortium in J District(Zhengzhou City,Henan Province),and the health management coalition in N County(Shandong Province).Structured questionnaires collected demographics,average transaction costs per-referral and cost perceptions.t-tests and ANOVA assessed cost differences;generalized linear regression identified influencing factors.Results Among 915 patients,the average transaction costs per-referral were 1 035.05 yuan(county alliance),195.31 yuan(urban consortium),and 700.97 yuan(health management coalition),with statistically significant differences(P＜0.05).The urban consortium exhibited lower time costs and specialized input costs.Key influencing factors included older age(county alliance),education level,employment status,and referral travel time(urban consortium),as well as urban-rural disparities(health management coalition).Patients'cost perceptions significantly differed across models(P＜0.05).Conclusion The urban medical consortium demonstrated the lowest patient the average transaction costs,highlighting its institutional advantage in minimizing financial burdens.

AIM:To investigate the effect of resistance exercise on the function of endothelial progenitor cells(EPCs)in type 2 diabetic rats and explore the mechanism of myokine irisin in this process.METHODS:Forty 6-week-old healthy male SD rats were selected,ten of which were used as control group,and the rest were fed with high-fat and high-sugar diet combined with streptozotocin injection for diabetic modeling.The rats were randomly divided into model group and model exercise group,with 15 rats in each group.The animals in the control and model groups were kept quiet-ly,and those of model exercise group underwent tail-loaded ladder climbing training for 12 weeks(3 times/week).72 hours after the last training,plasma,gastrocnemius and femur were separated.The irisin content of each tissue and mRNA as well as protein expression of fibronectin type Ⅲ domain-containing protein 5(FNDC5)in the gastrocnemius and femur were measured.Bone marrow endothelial progenitor cells were isolated and cultivated,and then treated with exoge-nous irisin for 48 hours.The cell viability and adhesion function of endothelial progenitor cells were detected by CCK-8 and adhesion assay,respectively.The endothelial repair ability was detected by carotid artery injury model in nude mice.The protein expression of phosphatidylinositol 3-kinase(PI3-K)/Akt/endothelial nitric oxide synthase(eNOS)signaling pathway was detected by Western blot.RESULTS:(1)In vivo experiment:compared with the control group,the model group showed a decrease in plasma,gastrocnemius muscle,and femoral irisin content,as well as a decrease in gastrocne-mius muscle FNDC5 mRNA and protein expression levels(P＜0.05).Compared with the model group,the levels of irisin in plasma,gastrocnemius muscle and femur,as well as the expression of FNDC5 mRNA and protein in gastrocnemius mus-cle,increased in the model exercise group(P＜0.05).There was no significant change in the expression of FNDC5 mRNA and protein in the femurs of each group(P＜0.05).(2)Cell experiment:① endothelial progenitor cells without irisin treatment:compared with the control group,the cell viability,adhesion function,and endothelial injury repair ability of endothelial progenitor cells reduced(P＜0.05),and the expression of PI3-K,Akt,eNOS signaling pathway down-regulated in the model group(P＜0.05).Compared with the model group,the model exercise group showed improvement in endothe-lial progenitor cell function(P＜0.05)and up-regulation of protein expression in the PI3-K/Akt/eNOS signaling pathway(P＜0.05).② Endothelial progenitor cells treated with irisin:supplementation with irisin improved the function of endotheli-al progenitor cells and increased the expression of various proteins in the PI3-K/Akt/eNOS signaling pathway in the model group and model exercise group compared with those without irisin treatment(P＜0.05).CONCLUSION:Regular resis-tance exercise can improve the function of endothelial progenitor cells in type 2 diabetic rats,and its mechanism may be re-lated to the regulation of PI3-K/Akt/eNOS signaling pathway by myokine irisin released from skeletal muscle.

AIM:To investigate the effect of resistance exercise on the function of endothelial progenitor cells(EPCs)in type 2 diabetic rats and explore the mechanism of myokine irisin in this process.METHODS:Forty 6-week-old healthy male SD rats were selected,ten of which were used as control group,and the rest were fed with high-fat and high-sugar diet combined with streptozotocin injection for diabetic modeling.The rats were randomly divided into model group and model exercise group,with 15 rats in each group.The animals in the control and model groups were kept quiet-ly,and those of model exercise group underwent tail-loaded ladder climbing training for 12 weeks(3 times/week).72 hours after the last training,plasma,gastrocnemius and femur were separated.The irisin content of each tissue and mRNA as well as protein expression of fibronectin type Ⅲ domain-containing protein 5(FNDC5)in the gastrocnemius and femur were measured.Bone marrow endothelial progenitor cells were isolated and cultivated,and then treated with exoge-nous irisin for 48 hours.The cell viability and adhesion function of endothelial progenitor cells were detected by CCK-8 and adhesion assay,respectively.The endothelial repair ability was detected by carotid artery injury model in nude mice.The protein expression of phosphatidylinositol 3-kinase(PI3-K)/Akt/endothelial nitric oxide synthase(eNOS)signaling pathway was detected by Western blot.RESULTS:(1)In vivo experiment:compared with the control group,the model group showed a decrease in plasma,gastrocnemius muscle,and femoral irisin content,as well as a decrease in gastrocne-mius muscle FNDC5 mRNA and protein expression levels(P＜0.05).Compared with the model group,the levels of irisin in plasma,gastrocnemius muscle and femur,as well as the expression of FNDC5 mRNA and protein in gastrocnemius mus-cle,increased in the model exercise group(P＜0.05).There was no significant change in the expression of FNDC5 mRNA and protein in the femurs of each group(P＜0.05).(2)Cell experiment:① endothelial progenitor cells without irisin treatment:compared with the control group,the cell viability,adhesion function,and endothelial injury repair ability of endothelial progenitor cells reduced(P＜0.05),and the expression of PI3-K,Akt,eNOS signaling pathway down-regulated in the model group(P＜0.05).Compared with the model group,the model exercise group showed improvement in endothe-lial progenitor cell function(P＜0.05)and up-regulation of protein expression in the PI3-K/Akt/eNOS signaling pathway(P＜0.05).② Endothelial progenitor cells treated with irisin:supplementation with irisin improved the function of endotheli-al progenitor cells and increased the expression of various proteins in the PI3-K/Akt/eNOS signaling pathway in the model group and model exercise group compared with those without irisin treatment(P＜0.05).CONCLUSION:Regular resis-tance exercise can improve the function of endothelial progenitor cells in type 2 diabetic rats,and its mechanism may be re-lated to the regulation of PI3-K/Akt/eNOS signaling pathway by myokine irisin released from skeletal muscle.

Objective To compare the differences in the average transaction costs per-referral patients under different models of Integrated Delivery Systems(IDS).Methods Using a typical case sampling method,it selected referred patients from three IDS models:the county medical alliance in D City(Qinghai Province),the urban medical consortium in J District(Zhengzhou City,Henan Province),and the health management coalition in N County(Shandong Province).Structured questionnaires collected demographics,average transaction costs per-referral and cost perceptions.t-tests and ANOVA assessed cost differences;generalized linear regression identified influencing factors.Results Among 915 patients,the average transaction costs per-referral were 1 035.05 yuan(county alliance),195.31 yuan(urban consortium),and 700.97 yuan(health management coalition),with statistically significant differences(P＜0.05).The urban consortium exhibited lower time costs and specialized input costs.Key influencing factors included older age(county alliance),education level,employment status,and referral travel time(urban consortium),as well as urban-rural disparities(health management coalition).Patients'cost perceptions significantly differed across models(P＜0.05).Conclusion The urban medical consortium demonstrated the lowest patient the average transaction costs,highlighting its institutional advantage in minimizing financial burdens.

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.

Acute kidney injury (AKI) is a devastating complications of end-stage of liver disease (ESLD), seriously affecting the prognosis of patients. With the deepening understanding of the pathogenesis, the definition, staging, diagnosis and treatment of ESLD with AKI have been gradually optimized. This article reviews the evolution of definition, pathogenesis, diagnosis and treatment of ESLD with AKI, to provide reference for early recognition, precise diagnosis and standardized treatment of this condition.

Purpose: This study aimed to compare and analyze the feasibility and long-term efficacy of prostatic capsule-sparing (PCS) and nerve-sparing (NS) radical cystectomy in the treatment of bladder cancer. Methods: From June 2004 to December 2021, our institution treated and followed 145 patients who underwent radical cystectomy with neobladder reconstruction for over a year. These patients were divided into 2 groups: PCS (n=74) and NS (n=71). To minimize potential biases, 1:1 propensity score matching was utilized to compare oncological outcomes, functional outcomes, and complications between the groups. Additionally, Kaplan-Meier analysis and the log-rank test were used to evaluate survival differences between the PCS and NS groups. Results: The median follow-up durations for PCS and NS were 155 and 122 months, respectively. After adjusting for propensity scores, a total of 96 patients (48 in each group) were included for further analysis. Kaplan-Meier curves showed no statistically significant differences in metastasis-free probability (P=0.206), cancer-specific survival (P=0.091), and overall survival (P=0.208). The daytime urinary control (UC) rate at 3, 6, and 12 months postoperatively was 72.9%, 91.7%, and 97.9% in the PCS group and 47.9%, 79.2%, and 91.7% in the NS group, respectively (P=0.012, P=0.083, and P=0.362). The nocturnal UC rate was 54.2%, 85.4%, and 95.8% in the PCS group, and 31.3%, 60.4%, and 83.3% in the NS group, respectively (P=0.023, P=0.006, and P=0.091). Regarding erectile function recovery, 62.5% of patients in the PCS group and 22.9% in the NS group returned to preoperative levels (P<0.001). Conclusions PCS outperformed NS in restoring UC and sexual function and did not affect oncological outcomes. However, PCS was associated with a higher risk of complications linked to bladder-neck obstruction.

Purpose: This study aimed to compare and analyze the feasibility and long-term efficacy of prostatic capsule-sparing (PCS) and nerve-sparing (NS) radical cystectomy in the treatment of bladder cancer. Methods: From June 2004 to December 2021, our institution treated and followed 145 patients who underwent radical cystectomy with neobladder reconstruction for over a year. These patients were divided into 2 groups: PCS (n=74) and NS (n=71). To minimize potential biases, 1:1 propensity score matching was utilized to compare oncological outcomes, functional outcomes, and complications between the groups. Additionally, Kaplan-Meier analysis and the log-rank test were used to evaluate survival differences between the PCS and NS groups. Results: The median follow-up durations for PCS and NS were 155 and 122 months, respectively. After adjusting for propensity scores, a total of 96 patients (48 in each group) were included for further analysis. Kaplan-Meier curves showed no statistically significant differences in metastasis-free probability (P=0.206), cancer-specific survival (P=0.091), and overall survival (P=0.208). The daytime urinary control (UC) rate at 3, 6, and 12 months postoperatively was 72.9%, 91.7%, and 97.9% in the PCS group and 47.9%, 79.2%, and 91.7% in the NS group, respectively (P=0.012, P=0.083, and P=0.362). The nocturnal UC rate was 54.2%, 85.4%, and 95.8% in the PCS group, and 31.3%, 60.4%, and 83.3% in the NS group, respectively (P=0.023, P=0.006, and P=0.091). Regarding erectile function recovery, 62.5% of patients in the PCS group and 22.9% in the NS group returned to preoperative levels (P<0.001). Conclusions PCS outperformed NS in restoring UC and sexual function and did not affect oncological outcomes. However, PCS was associated with a higher risk of complications linked to bladder-neck obstruction.

Purpose: This study aimed to compare and analyze the feasibility and long-term efficacy of prostatic capsule-sparing (PCS) and nerve-sparing (NS) radical cystectomy in the treatment of bladder cancer. Methods: From June 2004 to December 2021, our institution treated and followed 145 patients who underwent radical cystectomy with neobladder reconstruction for over a year. These patients were divided into 2 groups: PCS (n=74) and NS (n=71). To minimize potential biases, 1:1 propensity score matching was utilized to compare oncological outcomes, functional outcomes, and complications between the groups. Additionally, Kaplan-Meier analysis and the log-rank test were used to evaluate survival differences between the PCS and NS groups. Results: The median follow-up durations for PCS and NS were 155 and 122 months, respectively. After adjusting for propensity scores, a total of 96 patients (48 in each group) were included for further analysis. Kaplan-Meier curves showed no statistically significant differences in metastasis-free probability (P=0.206), cancer-specific survival (P=0.091), and overall survival (P=0.208). The daytime urinary control (UC) rate at 3, 6, and 12 months postoperatively was 72.9%, 91.7%, and 97.9% in the PCS group and 47.9%, 79.2%, and 91.7% in the NS group, respectively (P=0.012, P=0.083, and P=0.362). The nocturnal UC rate was 54.2%, 85.4%, and 95.8% in the PCS group, and 31.3%, 60.4%, and 83.3% in the NS group, respectively (P=0.023, P=0.006, and P=0.091). Regarding erectile function recovery, 62.5% of patients in the PCS group and 22.9% in the NS group returned to preoperative levels (P<0.001). Conclusions PCS outperformed NS in restoring UC and sexual function and did not affect oncological outcomes. However, PCS was associated with a higher risk of complications linked to bladder-neck obstruction.