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*

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

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.

Objective:To investigate the impact of postoperative complications on adverse outcomes following curative-intent resection for gallbladder cancer (GBC).Methods:The multi-center real-world study was conducted. The clinicopathological data of 629 patients with GBC, who were admitted to 14 medical centers including The First Affiliated Hospital of Army Medical University from the national multicenter database of Biliary Surgery Group of Elite Group of Chinese Journal of Digestive Surgery, from April 2020 to April 2024 were collected. There were 225 males and 404 females, aged (64±10)years. Patients underwent open curative-intent resection for GBC. Observation indicators: (1)surgery, postoperative complica-tions and adverse outcomes; (2) analysis of risk factors affecting postoperative adverse outcomes in patients and population attributable fraction (PAF). Missing data in predictor variables were addressed using multiple imputation with chained equations, while cases with missing outcome variables were addressed using the "multiple imputation then deletion (MID)" strategy. The severity of multicollinearity among independent variables was assessed using the variance inflation factor (VIF) test. Multivariable possion regression models with log link and robust error variance were construc-ted incorporating restricted cubic splines (3 knots) to address nonlinear relationships in continuous variables, calculating adjusted relative risk ( RR) with corresponding 95% confidence interval ( CI). Adjusted PAF was calculated for each imputed dataset using the AF package of R software, with subsequent pooling performed according to Rubin's rules. Results:(1) Surgery, postoperative complications and adverse outcomes. All 629 patients underwent curative-intent resection for GBC, of which 143 cases had postoperative complications, including 68 cases of intra-abdominal ascites, 39 cases of pulmonary infection, 21 cases of bile leakage, 12 cases of intra-abdominal hemorrhage, 11 cases of liver failure, 10 cases of pan-creatic fistula, 10 cases of wound infection, 10 cases of gastroparesis, 7 cases of cholangitis, 7 cases of sepsis. The same patient could have more than one kind of complication. Of 629 patients, there were 19 cases of postoperative 90-day death and 11 cases of missing data, 42 cases with post-operative 90-day reoperation and 7 cases with missing data, 44 cases with postoperative 90-day readmission and 3 cases with missing data, 155 cases with prolonged postoperative hospital stay and 3 cases with missing data. (2) Analysis of risk factors affecting the postoperative adverse outcomes in patients and PAF. Results of multivariate analysis showed that pulmonary infection and liver failure were independent risk factors for postoperative 90-day mortality ( RR=3.74, 12.15, 95% CI as 1.18-11.83, 1.98-74.48, P<0.05). Pulmonary infection demons-trated the highest PAF as 4.61% (95% CI as 3.94%-5.28%, P<0.05). Intra-abdominal ascites, pulmonary infection, bile leakage, and intra-abdominal hemorrhage were independent risk factors for post-operative 90-day reoperation ( RR=4.80, 3.62, 3.46, 4.99, 95% CI as 2.49-9.26, 1.42-9.21, 1.34-8.92, 1.55-16.06, P<0.05). Intra-abdominal ascites demonstrated the highest PAF as 8.65% (95% CI as 8.22%-9.08%, P<0.05). Intra-abdominal ascites, bile leakage, and liver failure were independent risk factors for postoperative 90-day readmission ( RR=6.20, 3.33, 14.33, 95% CI as 3.21-11.95, 1.33-8.35, 3.72-55.28, P<0.05). Intra-abdominal ascites demonstrated the highest PAF as 9.11% (95% CI as 8.85%-9.37%, P<0.05). Intra-abdominal ascites, pulmonary infection, bile leakage, liver failure, and wound infection were independent risk factors for prolonged postoperative hospital stay ( RR=2.29, 2.21, 2.26, 2.14, 3.35, 95% CI as 1.63-3.23, 1.41-3.46, 1.32-3.86, 1.11-4.13, 1.70-6.60, P<0.05). Intra-abdominal ascites demonstrated the highest PAF as 6.03% (95% CI as 5.71%-6.35%, P<0.05). Conclusion:Pulmonary infection is the most significant risk factor for postoperative 90-day mortality after curative-intent resection for GBC, while intra-abdominal ascites is the most significant risk factor for postoperative 90-day reoperation, postoperative 90-day readmission, and prolonged postoperative hospital stay.

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.