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 observe the clinical efficacy of Tongyuan acupuncture combined with Tiaoqi Huoxue Jieyu Decoction in treating stroke in recovery period of qi deficiency and blood stasis complicated by liver stagnation syndrome.Methods A total of 80 patients with stroke in recovery period were randomly divided into observation group and control group,40 cases in each group.The control group was intervened by conventional western medicine and rehabilitation training,the observation group was treated by Tongyuan acupuncture combined with Tiaoqi Huoxue Jieyu Decoction on the basis of the treatment in the control group.The course of treatment covered one month continuously.After one month of treatment,the clinical efficacy of the two groups was evaluated,and the changes of scores in the patients of the two groups before and after treatment as follows were observed,including Mini-Mental State Examination(MMSE),muscle strength and National Institutes of Health Stroke Scale(NIHSS),as well as Pittsburgh Sleep Quality Index(PSQI),Activity of Daily Living Scale(ADL),and traditional Chinese medicine(TCM)syndrome.The changes of procalcitonin(PCT),tumor necrosis factor α(TNF-α),and interleukin 6(IL-6)levels before and after treatment were compared between the two groups.The safety and occurrence of adverse reactions in the two groups were also evaluated.Results(1)The total effective rate was 95.00%(38/40)in the observation group and 77.50%(31/40)in the control group.The efficacy of the observation group was superior to that of the control group,the difference being statistically significant(P<0.05).(2)After treatment,the TCM syndrome scores of patients in the two groups improved significantly(P<0.05),and the improvement in the observation group was significantly superior to that in the control group,with statistically significant differences(P<0.05).(3)After treatment,the MMSE scores of patients in the two groups improved significantly(P<0.05),and the improvement in the observation group was significantly superior to that in the control group,the difference being statistically significant(P<0.05).(4)After treatment,the muscle strength scores and NIHSS scores of patients in the two groups improved significantly(P<0.05),and the improvement in the observation group was significantly superior to that in the control group,with statistically significant difference(P<0.05).(5)After treatment,the PSQI scores and ADL scores of the patients in the two groups improved significantly(P<0.05),and the improvement in the observation group was significantly superior to that in the control group,with statistically significant difference(P<0.05).(6)After treatment,the PCT,TNF-α,and IL-6 levels of patients in the two groups improved significantly(P<0.05),and the improvement in the observation group was significantly superior to that in the control group,with statistically significant difference(P<0.05).(7)The incidence rate of adverse reactions was 10.00%in the observation group and 5.00%in the control group.The intergroup comparison showed that the difference being not statistically significant(P>0.05).Conclusion Tongyuan acupuncture combined with Tiaoqi Huoxue Jieyu Decoction in treating stroke in recovery period of qi deficiency and blood stasis complicated by liver stagnation syndrome can significantly improve patients'cognitive function,neurological function and muscle strength of limbs,enhance patients'sleep quality and living ability,and adjust the normal physiological state of the body,thus improving patients'quality of life.

Objective To evaluate the safety and efficacy of valve-in-valve transcatheter mitral valve replacement(ViV-TMVR)in patients with bioprosthetic valve degeneration who are at high surgical risk.Methods This study is a multi-center,retrospective cohort analysis of 20 consecutive patients who underwent transseptal ViV-TMVR using the Edwards SAPIEN 3 transcatheter heart valve(THV).The primary endpoints include technical success and procedural success,both defined according to the Mitral Valve Academic Research Consortium(MVARC)criteria,as well as mortality and functional change assessed based on New York Heart Association(NYHA)classification at 30-days and six months post-procedure.Clinical follow-up assessments are conducted at 30-days and six months.Results From February 2021 to October 2022,a total of 20 patients with symptoms of bioprosthetic valve degeneration were enrolled across nine sites in China.The patients had a mean age of(73.5±5.5)years,with 85.0％being females and 70.0％classified as NYHA class Ⅲ/Ⅳ.The study achieved a 100.0％technical success rate and a 90.0％procedural success rate finally.All patients remained alive during the 30-day follow-up period.However,six months post-intervention,two patients(10.0％)were re-hospitalized due to heart failure,and sadly,one of them(5.0％)died.None of the patients reported any adverse events related to ViV-TMVR during the follow-up period.Notably,there was a significant improvement in NYHA class compared to baseline(P=0.0004)at six-month follow-ups.Conclusions The transseptal ViV-TMVR technique proved to be highly successful and was associated with significant improvement in NYHA class function.These findings strongly suggest that it serves as a safe and efficient treatment alternative for high-risk patients suffering from bioprosthetic valve degeneration.

Aim To investigate the mechanism of ac-tion of Qingre Zhixue granules in the treatment of IgA vasculitic nephritis(IgAVN)based on network phar-macology and animal experiments.Methods The ac-tive ingredients and targets of Qingre Zhixue granules were screened out by TCMSP database.The disease targets of IgAVN were retrieved by Disgenet,Gene-cards OMIM and TTD databases.The intersection tar-gets were obtained by WeChat online database,and the information was imported into Cytoscope 3.7.1 soft-ware and STRING analysis platform to construct a drug-active component-therapeutic target network.Based on the core targets,GO and KEGG pathway enrichment a-nalysis was performed through the Metascape database to select key targets and core active components.The results of network pharmacology were verified by ani-mal experiments.The animal model of IgAVN was con-structed by the combination of disease and syndrome.The urine red blood cells and 24-hour urine protein of IgAVN model rats after intervention of Qingre Zhixue granules were detected.HE staining and IgA immuno-fluorescence deposition of renal tissue were observed.Western blot and qRT-PCR were used to detect the ex-pression of core targets in renal tissue.Results Net-work pharmacology showed that 109 active ingredients,402 drug targets,1 285 disease targets and 113 inter-section targets were obtained.The core targets screened by protein interaction and network topology a-nalysis were IL6,TNF,VEGFA,etc.The core drug ingredients were quercetin,paeoniflorin,luteolin,kaempferol and baicalein.A total of 2 545 gene func-tions were enriched by GO,and 164 gene pathways were enriched by KEGG.Qingre Zhixue granules could treat IgAVN by regulating TNF signaling pathway,MAPK signaling pathway,IL-17 signaling pathway,HIF-1 signaling pathway,Toll receptor signaling path-way,NF-κB signaling pathway and apoptosis.Animal experiments showed that compared with the blank group,the urine red blood cells and 24-hour urine pro-tein quantification in the model group increased(P＜0.05);the expression of serum IL-6,TNF-α and VEGF-α increased(P＜0.05).HE staining showed glomerular mesangial proliferation,capillary lumen ste-nosis,accompanied by a small amount of inflammatory cell infiltration,glomerular IgA immunofluorescence deposition;the expression of TNF-α,p-p65,p-p38 protein and TNF-α mRNA in renal tissue increased(P＜0.05).After the intervention of Qingre Zhixue gran-ules,urine red blood cells and 24-hour urine protein decreased(P＜0.05).The changes of renal HE stai-ning were improved and glomerular IgA deposition was reduced.TNF-α,p-p65,p-p38 protein and TNF-αmRNA in renal tissue decreased(P＜0.05).Conclu-sions The active ingredients such as quercetin,peony glycoside and luteolin Qingre Zhixue granules regulate TNF signaling pathway,MAPK signaling pathway,IL-17 signaling pathway and reduce IL-6,TNF-α and VEGF-α in the treatment of IgAVN.

Objective:To evaluate the relationship between transverse sinus stenosis (TSS) and cerebral blood flow in normal adults based on four-dimensional flow (4D Flow) MRI.Methods:The study was a cross-sectional study. Totally 81 normal volunteers who underwent magnetic resonance venography (MRV) and 4D Flow MRI were prospectively enrolled at Beijing Friendship Hospital, Capital Medical University from January 2020 to December 2022. Based on MRV evaluation of transverse sinus dysplasia, the volunteers were divided into a dysplasia group (26 cases) and a non-dysplasia group (55 cases); The area of the stenosis and the normal transverse sinus at the distal end were measured. The degree of TSS and the bilateral average transverse sinus stenosis (BA-TSS) were calculated. TSS was determined using TSS levels of 1/3, 1/2, and 2/3 as thresholds, and was divided into three groups: no TSS group, unilateral TSS group, and bilateral TSS group, with 28, 39, and 14 cases, 37, 37, and 7 cases, and 43, 36, and 2 cases, respectively. Based on 4D Flow MRI, the blood flow of the internal carotid artery, vertebral artery, superior sagittal sinus, straight sinus, and transverse sinus distal and proximal ends were measured. The cerebral blood flow (bilateral internal carotid artery blood flow+bilateral vertebral artery blood flow), venous sinus return blood flow 1 (superior sagittal sinus blood flow+straight sinus blood flow), return blood flow 2 (sum of bilateral transverse sinus distal end blood flow), return blood flow 3 (sum of bilateral transverse sinus proximal end blood flow), and the ratio of return blood flow to cerebral blood flow were calculated. Independent sample t-test was used to compare the differences between the group with and without transverse sinus dysplasia; Single factor analysis of variance was used to compare the differences between the TSS free group, unilateral TSS group, and bilateral TSS group. Based on single factor linear regression, the relationships between BA-TSS and blood flow parameters were analyzed.Results:There was no statistically significant difference in various blood flow parameters between the group with and without transverse sinus dysplasia (all P>0.05). When using 1/3, 1/2, and 2/3 as thresholds, there was no statistically significant difference in various blood flow parameters between the non TSS group, unilateral TSS group, and bilateral TSS group (all P>0.05). BA-TSS was linearly positively correlated with cerebral blood flow (β=0.986, 95% CI 0.108-1.865, P=0.028), but not linearly correlated with return blood flow 1, 2, and 3 (all P>0.05). The degree of BA-TSS was linearly negatively correlated with return blood flow 1/cerebral blood flow (β=-0.001, 95% CI -0.002-0, P=0.009) and return blood flow 2/cerebral blood flow (β=-0.001, 95% CI -0.002-0, P=0.018), but not with return blood flow 3/cerebral blood flow ( P=0.076). Conclusion:The BA-TSS degree in normal adults is positively correlated with cerebral blood inflow and negatively correlated with the proportion of venous sinus outflow.

Objective:To investigate the protocol and clinical efficacy of hair follicle-bearing microskin (HF-MS) transplantation in the treatment of hypertrophic scars.Methods:Prospective randomized controlled trial. From January to November 2024, patients with hypertrophic scars were recruited from the Medical Cosmetic Center of Affiliated Hangzhou First People’s Hospital with Westlake University School of Medicine and the Department of Plastic and Reconstructive Surgery of Ningbo Sixth Hospital. Patients were randomly divided into the observation group and the control group using a random number table. In the observation group, 1.0 mm punch decompression was performed on the hypertrophic scar area, followed by implantation of HF-MS extracted from the scalp donor site using follicular unit excision (FUE) into the decompression pores. The control group underwent only 1.0 mm punch decompression. Vancouver scar scale (VSS) scores (total score 0-15, higher scores indicating more severe scarring) were assessed preoperatively and at 1, 3, and 6 months postoperatively. Efficacy at 6 months, improvement in hypertrophic scar area, hair survival rate (observation group), adverse reactions, and patients’ satisfaction rates were evaluated. Categorical data were expressed as frequency (%) and analyzed using chi-square tests; normally distributed measurement data were expressed as Mean ± SD and analyzed using independent samples t-tests. Results:A total of 50 patients were included (25 per group), with 22 males and 28 females, aged 18-60 years (mean age: 33 years). The effective rate was 92% (23/25) in the observation group and 68% (17/25) in the control group, showing a statistically significant difference ( P<0.05). Preoperative VSS scores did not differ significantly between the observation and control groups [(6.67±3.19) vs. (7.12±2.89), P>0.05]. At 1, 3, and 6 months postoperatively, the observation group had VSS scores of (5.48±2.60), (4.64±2.39), and (3.80±2.10), respectively, compared to (6.36±2.53), (5.84±2.28), and (5.32±2.09) in the control group. The 6-month postoperative VSS scores differed significantly between groups ( P<0.05). Preoperative hypertrophic scar areas showed no significant difference [(5.75±2.83) cm 2 vs. (6.91±3.31) cm 2,P>0.05]. At 6 months postoperatively, the observation group had significantly smaller scar areas than the control group [(3.15±1.55) cm 2 vs. (5.37±2.93) cm 2,P<0.01]. The average hair survival rate in the observation group was 41% at 6 months. Adverse reactions occurred in 3 cases in the observation group (2 skin indurations, 1 hyperpigmentation) and 7 cases in the control group (4 hyperpigmentation, 2 skin atrophy, 1 skin induration). The observation group had a significantly lower adverse reaction rate [12% (3/25) vs. 28% (7/25), P<0.05]. Patient satisfaction rates were 88% (22/25) in the observation group and 64% (16/25) in the control group ( P<0.05). Conclusion:HF-MS transplantation demonstrates definitive clinical efficacy in treating hypertrophic scars, effectively improving scar morphology, clinical symptoms, and patient quality of life.

As the application of immune checkpoint inhibitors(ICIs)in the perioperative treatment of melanoma is increasingly introduced at earlier stages,it presents a critical opportunity for the development and clinical translation of neoadjuvant therapy.The results of phaseⅠ/Ⅱ clinical trials on neoadjuvant ICI therapy for melanoma demonstrate that neoadjuvant ICIs effectively improve the pathologic re-sponse rate in melanoma patients.Recent studies have shown that combining ICIs with other treatment modalities,including radiotherapy,chemotherapy,and targeted therapies,can enhance antitumor efficacy of neoadjuvant treatment for patients with melanoma.Optimizing treatment regimens,managing adverse events,identifying and addressing pseudoprogression,and handling cases of oligoprogression have become key areas of research in incorporating ICI regimens into neoadjuvant treatment for patients with melanoma.The search for bio-markers to monitor immunotherapy efficacy is expected to become a major focus of future research.This article provides a review of the re-search progress,controversies,and challenges in the application of ICIs in the neoadjuvant treatment of melanoma,and discusses future re-search directions,aiming to offer insights into the clinical application and development of ICIs in melanoma neoadjuvant therapy.

Objective To observe the value of deep progressive reconstruction(DPR)algorithm for reconstructing whole-body 18 F-FDG PET images.Methods Totally 67 patients who underwent whole-body 18 F-FDG PET/CT were retrospectively enrolled.PET data of 30 s,60 s,90 s and 120 s per bed in equipment list were reconstructed using ordered subset expectation maximization(OSEM)and DPR algorithms,respectively.Finally 7 groups of reconstructed images were obtained,including OSEM_30,OSEM_60 and OSEM_120,also DPR_30,DPR_60,DPR_90 and DPR_120 groups.The subjective scores,also objective evaluation indexes,i.e.the maximum and mean standard uptake values(SUV)of lesions and livers,namely SUVmax and SUVmean,were compared,and target-to-background ratio(TBR),signal-to-noise ratio(SNR),contrast-to-noise ratio(CNR)and coefficient of liver variation(CVliver)were calculated.Taken results based in OSEM_120 group as references,Bland-Altman plot was drawn to explore the consistency of SUV of lesions and livers obtained based on DPR_30,DPR_60 and DPR_90 groups with those in OSEM_120 group.Results Under the same acquisition time,subjective scores,SUVmax and SUVmean of lesions,TBR,SNR,CNR and CVliver in DPR_30,DPR_60 and DPR_120 groups were superior to those in corresponding OSEM_30,OSEM_60 and OSEM_120 groups(all P＜0.001).Compared with OSEM_120 group,subjective scores and SNR decreased but TBR and CVliver increased in DPR_30 group,while subjective and objective evaluation results in DPR_60 group and DPR_90 group increased(all P＜0.05)or being not significantly different from those in OSEM_120 group(all P＞0.05).No significant difference of liver SUV mean was found among 7 groups(P=0.955).SUVmax and SUVmean of lesions and livers obtained based on DPR_30,DPR_60 and DPR_90 groups were in good agreement with those oibtained based on OSEM_120 group.Conclusion Using DPR algorithm to reconstruct whole-body 18 F-FDG PET image could shorten acquisition time under the premise of ensuring image quality.

ObjectiveTo investigate the application of the novel inflammatory factor adsorption column CA280 combined with low-dose plasma exchange （LPE） in patients with acute-on-chronic liver failure （ACLF）. MethodsA prospective cohort study was designed， and a total of 93 ACLF patients who were admitted to The Ninth Hospital of Nanchang from June 2023 to January 2025 were enrolled and randomly divided into DPMAS+LPE group with 50 patients and CA280+LPE group with 43 patients. In addition to comprehensive medical treatment， the patients in the DPMAS+LPE group received DPMAS and LPE treatment， and those in the CA280+LPE group received CA280 and LPE treatment. The two groups were observed in terms of routine blood test results， liver function parameters， renal function markers， electrolytes， coagulation function parameters， cytokines， adverse events， and 28-day prognosis before surgery （baseline）， during surgery （DPMAS or CA280）， and after surgery （after sequential LPE treatment）. The paired t-test was used for comparison of normally distributed continuous data before and after treatment within each group， and the independent-samples t test was used for comparison between groups； the Wilcoxon signed-rank test was used for comparison of non-normally distributed continuous data before and after treatment within each group， and the Mann-Whitney U test was used for comparison between groups. The chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups， and the Spearman test was used for correlation analysis. ResultsAfter CA280 treatment， the ACLF patients had significant reductions in the levels of cytokines （IL-6， IL-8， IL-10， TNF-α， and IFN-γ）， liver function parameters （ALT， AST， ALP， TBil， DBil， Alb， and glutathione reductase）， and the renal function marker urea nitrogen （all P<0.05）， and in terms of coagulation function parameters， there were significant increases in prothrombin time， activated partial thromboplastin time （APTT）， thrombin time， and international normalized ratio （INR） and significant reductions in prothrombin activity （PTA） and fibrinogen （FIB） （all P<0.05）. Compared with the DPMAS+LPE group， the CA280+LPE group showed better improvements in the serum cytokines IL-8 （Z=-2.63， P=0.009）， IL-10 （Z=-3.94， P<0.001）， and TNF-α （Z=-1.53， P=0.023）， and the two artificial liver support systems had a similar effect in improving liver function （ALT， AST， GGT， GR， TBil， and DBil） （all P >0.05）， but the CA280+LPE group showed a significantly greater reduction in Alb （Z=-2.08， P=0.037）. CA280+LPE was more effective in reducing uric acid （Z=-2.97， P=0.003）. Compared with DPMAS+LPE， CA280+LPE treatment resulted in a significant reduction in INR （Z=-4.01， P<0.001）， a significant increase in APTT （Z=-2.53， P=0.011）， and significant greater increases in PTA （Z=-6.28， P<0.001） and FIB （Z=-3.93， P<0.001）. There were no significant differences in the incidence rates of adverse reactions and the rate of improvement at discharge between the two groups （all P>0.05）. The Spearman correlation analysis showed that IL-6 was significantly correlated with WBC （r=0.22， P=0.042）， TBil （r=0.29， P=0.005）， and FIB （r=-0.33， P=0.003）； IL-8 was positively correlated with APTT （r=0.37， P<0.001） and INR （r=0.25， P=0.013）； TNF-α was significantly correlated with WBC （r=0.40， P<0.001） and TBil （r=0.34， P<0.001）. ConclusionCompared with DPMAS， CA280 combined with LPE can effectively clear proinflammatory cytokines and improve liver function in ACLF patients， but it has a certain impact on Alb and coagulation function. This regimen provides a new option for the individualized treatment of ACLF and can improve the short-term prognosis of patients， but further studies are needed to verify its long-term efficacy.

The continuous accumulation of plastic waste such as polyethylene in the environment has caused serious environmental pollution issues.Considering the high similarity in the molecular structure of petroleum and polyolefin,it is feasible to apply rare earth-zeolite catalysts in polyolefin plastic upcycling,which is commonly used in fluid catalytic cracking(FCC)in the field of petroleum refining.In this study,Ce-modified HY(Ce-HY)zeolites were synthesized and characterized by a series of analytical methods,such as high-angle annular dark-field scanning transmission electron microscopy(HAADF-STEM),Fourier infrared spectroscopy(FT-IR),X-ray photoelectron spectroscopy(XPS),etc.When introducing 5% Ce species into HY zeolites,the 5Ce-HY showed excellent catalytic performance in the catalytic cracking of low-density polyethylene(LDPE),which achieved 98.4% LDPE conversion with 91.5% selectivity of gaseous alkanes at 300℃,and 75.4% of them were isoparaffins.In addition,the effect of the location of rare earth species in Y zeolites on the catalytic performance was explored by fine X-ray diffraction(XRD)in the range of 11°-13°and in situ-Raman analyses.The Ce species located in the supercage of Y zeolites were more important,which enhanced the adsorption capacity and accessibility of substrate molecules,thus facilitating the entire catalytic cracking process.This method could be used to detect the location of rare earth elements in Y zeolites to understand the mechanism of rare earth catalysis.