Objective: To investigate the prevalence of overweight and obesity among children and adolescents in Yangzhou City, and its association with screen behaviors, so as to provide scientific evidence for weight management among students. Methods: In May 2025, an electronic questionnaire survey was conducted among children and adolescents in Yangzhou City. A total of 3 722 participants were selected from grades 4 to 12 in 18 primary and secondary schools (108 classes) by using stratified cluster random sampling. The Chi square test was used to compare the differences in the detection rates of overweight and obesity among children and adolescents with 5 types of screen behaviors (watching TV, playing electronic games, scrolling short videos, screen based learning, electronic socializing) in different time groups each day (never, >0~<2 h, ≥2 h). Multivariate Logistic regression analysis was performed to examine the associations of five types of screen behaviors, presence of electronic devices in the bedroom, and screen use during meals on the weight status of children and adolescents. Results: The prevalence of overweight and obesity among children and adolescents was 37.3%. For all five types of screen behaviors, the differences in the distribution of overweight and obesity detection rates among children and adolescents across the three time spent categories were statistically significant ( χ 2=30.76- 70.78 , all P <0.01). After adjusting for confounding factors, multivariate Logistic regression analysis revealed that frequent or always using screens during meals( OR =1.63, 95％ CI =1.14~2.31), playing video games ( OR =1.28, 95% CI =1.11-1.48), browsing short videos ( OR =1.29, 95％ CI=1.09-1.54), and screen based learning ( OR =1.26, 95％ CI =1.10-1.44) were significantly associated with overweight and obesity among children and adolescents (all P <0.05). Conclusions Excessive screen use is positively correlated with the incidence of overweight and obesity in children and adolescents. Targeted interventions on screen behaviors among children and adolescents are therefore warranted.

The pathogenesis of pulmonary fibrosis (PF) is complex. It is characterized by myofibroblast hyperplasia and deposition of collagen protein. Indoleamine 2,3-dioxygenase 1 (IDO1) is expressed in lung fibroblasts and epithelial cells, but its functions in lung homeostasis and diseases remain elusive. Here, we characterize the critical role of IDO1 in PF patients and bleomycin (BLM)-induced PF mouse models. We find that IDO1 is significantly upregulated in the fibrotic lungs of patients and mice, showing a positive correlation with genes characteristic of fibrosis. Functionally, IDO1 knockout inhibits lung fibroblast proliferation, differentiation, mitochondrial biogenesis, and mitochondrial oxidative phosphorylation. Conversely, IDO1 overexpression and accumulation of kynurenine (Kyn) exacerbate progressive lung fibrosis. Mechanistically, IDO1-deletion activated profound mitochondrial fusion-enhanced potentially the capacity for fatty acid oxidation, along with activation of de novo glycolytic serine/glycine synthesis pathways and mitochondrial one-carbon metabolism. Wedelolactone (WEL), a small molecule IKK inhibitor, is found to strongly bind to IDO1 and effectively protect mice from PF in an IDO1-dependent manner. Collectively, this study characterizes a promotor role for IDO1 in PF and suggests a potential avenue of targeting IDO1 to treat lung diseases.

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Objective:To investigate the clinical efficacy and safety of lapatinib combined with chemotherapy for middle and advanced esophageal cancer.Methods:A retrospective cohort study was conducted. A total of 91 patients with middle and advanced esophageal cancer who received treatment in the Fifth People's Hospital of Huai'an from January 2022 to December 2022 were selected. According to the treatment method, all patients were divided into the control group (46 cases receiving carboplatin and albumin paclitaxel chemotherapy) and the observation group (45 cases receiving lapatinib based on chemotherapy regimen of the control group). The clinical efficacy, tumor marker levels, immune function indicators, quality of life, and adverse reactions between the 2 groups were compared.Results:There were no statistically significant differences in the baseline data between the control group and the observation group (all P > 0.05). The objective remission rate [66.67% (30/45) vs. 45.65% (21/46)] and the disease control rate [93.33% (42/45) vs. 76.09% (35/46)] of the observation group were higher than those of the control group, and the differences were statistically significant ( χ2 = 4.08, P = 0.043; χ2 = 5.20, P = 0.023). After treatment, tumor abnormal protein [(102±9) μm 2vs. (112±10) μm 2], cytokeratin 19 fragment 21-1 [(22.5±2.8) ng/ml vs. (24.2± 3.0) ng/ml], carbohydrate antigen 199 [(127±14) U/ml vs. (145±17) U/ml], tumor specific growth factor [(60±5) U/ml vs. (66±5) U/ml] levels and esophageal cancer patient supplementary scale score [(37±4) points vs. (40±4) points] in the observation group were lower than those in the control group, and the differences were statistically significant (all P < 0.05). After treatment, the observation group had a higher proportion of CD3 + cells [(71±6) % vs. (66±5)%)], CD4 +/CD8 + ratio (1.85±0.22 vs. 1.71±0.23), and Karnofsky functional status score [(88±6) points vs. (85±6) points] compared to those in the control group, and the differences were statistically significant (all P < 0.05). There was no statistically significant difference in the incidence of adverse reactions between the 2 groups [17.39% (8/46) vs. 26.67% (12/45), χ2 = 1.14, P = 0.285]. Conclusions:Lapatinib combined with carboplatin and albumin paclitaxel chemotherapy regimen for middle and advanced esophageal cancer can effectively improve efficacy and patients' quality of life by enhancing immune function and reducing tumor marker levels. Its medication safety can be ensured.

Objective To analyze the expression levels and the clinical significance of serum interleukin(IL)-4,IL-5,IL-6,IL-13 and IL-17 in children with mycoplasma pneumoniae(MP)infection accompanied by airway hyperresponsiveness(AHR).Methods A total of 120 children diagnosed with MP infection pneumonia and admitted to Nantong First People's Hospital between June 2022 and April 2024 were enrolled in the study group.According to whether their MP infection pneumonia was accompanied by AHR,the participants were divided into an AHR group(n=41)and a non-AHR group(n=79).An additional 90 healthy children undergoing physical examination were included in the control group.Baseline data,fractional exhaled nitric oxide(FeNO),tidal breathing lung function—including the ratio of volume at peak tidal expiratory flow to total expiratory volume(VPTEF/VE),the ratio of time to peak tidal expiratory flow to total expiratory time(TPTEF/TE),and inspiratory-to-expiratory time ratio(TI/TE)—as well as the levels of serum IL-4,IL-5,IL-6,IL-13 and IL-17 were compared among the 3 groups.The correlation between serum IL-4,IL-5,IL-6,IL-13 and IL-17 and clinical data of children with MP infection pneumonia accompanied by AHR was analyzed.Logistic regression analysis was used to identify the independent influencing factors of AHR in children with MP infection pneumonia.Receiver operating characteristic(ROC)curves were plotted to assess the diagnostic value of serum IL-4,IL-5,IL-6,IL-13 and IL-17 for MP infection pneumonia accompanied by AHR in children.Results Significant differences were observed among the AHR,non-AHR,and control groups in white blood cell(WBC)count,neutrophil percentage,eosinophil(EOS)count,platelet(PLT)count,C-reactive protein(CRP),FeNO,VPTEF/VE,TPTEF/TE,TI/TE,forced vital capacity(FVC),and forced expiratory volume in one second(FEV?)(all P<0.05).Serum IL-4,IL-5,IL-6,IL-13 and IL-17 levels showed significant differences among the 3 groups(P<0.05).Correlation analysis showed that these cytokines were positively correlated with WBC count,neutrophil percentage,EOS count,CRP,and FeNO(P<0.05),and negatively correlated with VPTEF/VE,TPTEF/TE,TI/TE,FVC,and FEV1(P<0.05).Binary logistic regression analysis identified neutrophil percentage(odds ratio[OR]=1.923;95%CI,1.496-2.472),EOS count(OR=3.074;95%CI,1.228-7.693),CRP(OR=2.382;95%CI,1.854-3.061),FeNO(OR=1.931;95%CI,1.635-2.281),VPTEF/VE(OR=0.294;95%CI,0.200-0.432),TPTEF/TE(OR=0.358;95%CI,0.177-0.722),TI/TE(OR=0.399;95%CI,0.221-0.722),IL-4(OR=1.064;95%CI,1.019-1.111),IL-5(OR=1.234;95%CI,1.095-1.390),IL-6(OR=1.013;95%CI,1.001-1.025),IL-13(OR=1.058;95%CI,1.005-1.113),IL-17(OR=1.759;95%CI,1.293-2.393),and allergy history(OR=2.989;95%CI,1.058-8.447)as independent factors associated with with AHR in children with MP infection pneumonia(P<0.05).ROC curves revealed that the areas under the ROC curves(AUC)of serum IL-4,IL-5,IL-6,IL-13 and IL-17 for predicting AHR in children with MP infection pneumonia were 0.815,0.769,0.782,0.793,and 0.815,respectively,with the sensitivities being 85.37%,75.61%,87.80%,75.61%,and 80.49%,and 95%CI being 0.739-0.892,0.677-0.861,0.679-0.867,0.715-0.882 and 0.732-0.899,respectively.Conclusion The levels of serum IL-4,IL-5,IL-6,IL-13,and IL-17 in children with MP infection pneumonia and AHR are abnormally elevated.These cytokines may serve as valuable biomarkers for assessing the risk of AHR in children with MP infection pneumonia.

Objective To evaluate the application of flipped classroom(FC)approach in endocrine system integrated course for students from 4+4 clinical medicine pilot class at Peking Union Medical College(PUMC).Methods The study included the students of 4+4 clinical medicine pilot class grades 2019-2023 in PUMC.The students of grades 2019-2021(n=77)served as the control receiving traditional teaching method,while the students of grades 2022 and 2023(n=76)were selected as the experimental group,which were taught by FC approach.The selected teaching content is thyroid theme.The scoring rates of thyroid related questions in the final exam were as-sessed and a questionnaire survey was conducted to evaluate teaching satisfaction and effectiveness.Results The scoring rates of experimental group were significantly higher as compared to that of control group(P＜0.05).Over 90％of the students in the experimental group strongly satisfied or satisfied with the teaching content arrangement,design form,classroom atmosphere,teacher-student interaction of FC and expressed willingness to continue with this methodology.In addition,over 90％of the students strongly agreed or agreed that FC stimulated learning inter-est,improved self-learning ability,strengthened the connection between theory and clinical practice,inspired clini-cal reasoning,enhanced the abilities to analyze and solve problems,and cultivated communication and teamwork skills.Conclusions The application of FC approach in endocrine system integrated course achieved excellent teaching outcomes with high satisfaction of the students.

Extensive epigenetic reprogramming involves in memory CD8+ T-cell differentiation. The elaborate epigenetic rewiring underlying the heterogeneous functional states of CD8+ T cells remains hidden. Here, we profile single-cell chromatin accessibility and map enhancer-promoter interactomes to characterize the differentiation trajectory of memory CD8+ T cells. We reveal that under distinct epigenetic regulations, the early activated CD8+ T cells divergently originated for short-lived effector and memory precursor effector cells. We also uncover a defined epigenetic rewiring leading to the conversion from effector memory to central memory cells during memory formation. Additionally, we illustrate chromatin regulatory mechanisms underlying long-lasting versus transient transcription regulation during memory differentiation. Finally, we confirm the essential roles of Sox4 and Nrf2 in developing memory precursor effector and effector memory cells, respectively, and validate cell state-specific enhancers in regulating Il7r using CRISPR-Cas9. Our data pave the way for understanding the mechanism underlying epigenetic memory formation in CD8+ T-cell differentiation.
CD8-Positive T-Lymphocytes/metabolism* ; Cell Differentiation ; Chromatin/immunology* ; Animals ; Mice ; Immunologic Memory ; Epigenesis, Genetic ; SOXC Transcription Factors/immunology* ; NF-E2-Related Factor 2/immunology* ; Mice, Inbred C57BL ; Gene Regulatory Networks ; Enhancer Elements, Genetic

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.