Obesity, as a chronic recurrent disease, has become a major public health challenge in China. To implement the requirements of the Healthy China Initiative (2019—2030), under domestic guidelines or consensus statements on overweight and obesity, and in alignment with the latest scientific advances globally, the Quality control protocol for adult overweight and obesity screening in health management (examination) institutions (2025 edition) was developed. This protocol was drafted by the Health Management Center of Shanghai Changzheng Hospital and formulated through multiple rounds of deliberation by experts in China’s health examination quality control field. The protocol establishes unified standards for screening facilities, personnel qualifications, and measurement or testing procedures. It defines specific screening items, outlines a standardized screening pathway, and sets requirements for the final medical review, ensuring the scientific validity, effectiveness, and safety of the screening process. The implementation of this protocol will enhance the consistency of weight management practices for adults across health examination institutions and strengthen the quality control of overweight and obesity screening programs.

Abdominal aortic aneurysm (AAA) is a deadly condition of the aorta, carrying a significant risk of death upon rupture. Currently, there is a dearth of efficacious pharmaceutical interventions to impede the advancement of AAA and avert it from rupturing. Here, we investigated dihydromyricetin (DHM), one of the predominant bioactive flavonoids in Ampelopsis grossedentata (A. grossedentata), as a potential agent for inhibiting AAA. DHM effectively blocked the formation of AAA in angiotensin II-infused apolipoprotein E-deficient (ApoE^-/-) mice. A combination of network pharmacology and whole transcriptome sequencing analysis revealed that DHM's anti-AAA action is linked to heme oxygenase (HO)-1 (Hmox-1 for the rodent gene) and hypoxia-inducible factor (HIF)-1α in vascular smooth muscle cells (VSMCs). Remarkably, DHM caused a robust rise (∼10-fold) of HO-1 protein expression in VSMCs, thereby suppressing VSMC inflammation and oxidative stress and preserving the VSMC contractile phenotype. Intriguingly, the therapeutic effect of DHM on AAA was largely abrogated by VSMC-specific Hmox1 knockdown in mice. Mechanistically, on one hand, DHM increased the transcription of Hmox-1 by triggering the nuclear translocation and activation of HIF-1α, but not nuclear factor erythroid 2-related factor 2 (NRF2). On the other hand, molecular docking, combined with cellular thermal shift assay (CETSA), isothermal titration calorimetry (ITC), drug affinity responsive target stability (DARTS), co-immunoprecipitation (Co-IP), and site mutant experiments revealed that DHM bonded to HO-1 at Lys243 and prevented its degradation, thereby resulting in considerable HO-1 buildup. In summary, our findings suggest that naturally derived DHM has the capacity to markedly enhance HO-1 expression in VSMCs, which may hold promise as a therapeutic strategy for AAA.

Objective To investigate the effects of inclined axial compressive force and flexion moment on the anterior and posterior shear stiffness of the lumbosacral segment.Methods Six fresh-frozen human cadaveric L5-S1 segments were tested under intact and two progressively impaired structural conditions:intact,a 4-mm bilateral facet joint gap,and anterior discectomy with nucleus pulposus removal plus circumferential release of the inner annular fibers(disc injury).A 300 N axial compressive force was applied either vertically downward or with a 10° or 20° anterior inclination through the disc's shear center.Anterior(0 N to 250 N)and posterior(-50 N to 0 N)shear tests were conducted using a material testing machine.These tests were repeated under a 5 N-m flexion moment.The relative motion between L5 and Si was measured using a three-dimensional motion capture system.Results In the intact state,the inclination of the axial compressive force did not significantly alter anterior or posterior shear stiffness.However,the application of a flexion moment increased anterior shear stiffness by 49.3％.Progressive structural damage resulted in incremental increases in anteroposterior shear translation and corresponding reductions in stiffness.Notably,under combined loading with axial compression and flexion moment,anterior stiffness decreased from 939 N/mm(intact)to 224 N/mm(disc injury),while posterior stiffness decreased from 572 N/mm to 217 N/mm.Within the low-load range,no significant differences in shear stiffness were observed across any structural conditions,regardless of axial force inclination or combined with a flexion moment.Conclusions This study supports the clinical view that retro-inclination of the pelvis serves as a compensatory mechanism to enhance segmental shear stability.However,this compensatory capacity gradually diminishes and ultimately fails as spinal degeneration progresses.

Objective:To investigate the effects of learning flow experience on system thinking in medical students under the mixed mode.Methods:Medical students who completed Medical Statistics of the 2022-2023 academic year were enrolled.Then learning attitudes,learning flow experience,and system thinking were investigated using SATS-36 Scale,Adolescent Learning Flow Experience Questionnaire,and Systems Thinking Scale.Linear correlation analysis explored relationships among these variables.Multiple linear regression and restricted cubic spline(RCS)model analyzed linear/non-linear relationships between learning flow experience and system thinking after adjusting for gender,major,and learning attitude.Results:Among the 349 medical students surveyed,the mean score for learning attitudes was(4.31±0.59)and for learning flow experience was(3.33±0.65),both indicating a moderate to high level.The mean score for systems thinking was(59.01±13.57),indicating a moderate level.Positive correlations were found among learning flow experience,learning attitudes,and system thinking.Significant gender and major differences were observed in learning flow experience.After controlling for gender,major,and learning attitudes,multiple linear regression analysis revealed a significant linear trend between learning flow experience and system thinking(P＜0.01).RCS model analysis indicated a significant J-shaped nonlinear relationship between learning folw experience and system thinking(P for non-linearity＜0.01).Using the median score of 3.16 as the inflection point,when the learning flow experience score was＜3.16,it had no significant effect on medical students'system thinking(P=0.51).When the score was≥3.16,system thinking increased significantly with increasing learning flow experience(Beta per SD=0.56,95%CI:0.44-0.68,P＜0.01).Conclusions:The learning flow experience of medical students under the mixed mode can promote their system thinking.When the flow experience score is≥3.16,higher levels of learning flow experience are associated with increased systems thinking.Different dimensions of learning flow experience exhibit varying strengths of correlation with systems thinking.

Operation management is an important tool to promote the high-quality development of public hospitals in China.Since the founding of New China,based on China's economic and social development and medical and health system reform,the evolution of operation management of public hospitals in China can be divided into four stages,the system building stage(1949-1978),the liberalization and revitalization stage(1979-1996),the operation mechanism reform stage(1997-2020),and the new stage of high-quality development(2021 present).The development trend of public hospital operation management in future should deepen the public welfare-oriented public hospital operation management,explore the value-oriented medical operation management model based on high-quality development and the refined operation and management model of public hospitals,so as to promote the high-quality development of public hospitals in China.

Objective:To investigate the effects of learning flow experience on system thinking in medical students under the mixed mode.Methods:Medical students who completed Medical Statistics of the 2022-2023 academic year were enrolled.Then learning attitudes,learning flow experience,and system thinking were investigated using SATS-36 Scale,Adolescent Learning Flow Experience Questionnaire,and Systems Thinking Scale.Linear correlation analysis explored relationships among these variables.Multiple linear regression and restricted cubic spline(RCS)model analyzed linear/non-linear relationships between learning flow experience and system thinking after adjusting for gender,major,and learning attitude.Results:Among the 349 medical students surveyed,the mean score for learning attitudes was(4.31±0.59)and for learning flow experience was(3.33±0.65),both indicating a moderate to high level.The mean score for systems thinking was(59.01±13.57),indicating a moderate level.Positive correlations were found among learning flow experience,learning attitudes,and system thinking.Significant gender and major differences were observed in learning flow experience.After controlling for gender,major,and learning attitudes,multiple linear regression analysis revealed a significant linear trend between learning flow experience and system thinking(P＜0.01).RCS model analysis indicated a significant J-shaped nonlinear relationship between learning folw experience and system thinking(P for non-linearity＜0.01).Using the median score of 3.16 as the inflection point,when the learning flow experience score was＜3.16,it had no significant effect on medical students'system thinking(P=0.51).When the score was≥3.16,system thinking increased significantly with increasing learning flow experience(Beta per SD=0.56,95%CI:0.44-0.68,P＜0.01).Conclusions:The learning flow experience of medical students under the mixed mode can promote their system thinking.When the flow experience score is≥3.16,higher levels of learning flow experience are associated with increased systems thinking.Different dimensions of learning flow experience exhibit varying strengths of correlation with systems thinking.

Objective To investigate the effects of inclined axial compressive force and flexion moment on the anterior and posterior shear stiffness of the lumbosacral segment.Methods Six fresh-frozen human cadaveric L5-S1 segments were tested under intact and two progressively impaired structural conditions:intact,a 4-mm bilateral facet joint gap,and anterior discectomy with nucleus pulposus removal plus circumferential release of the inner annular fibers(disc injury).A 300 N axial compressive force was applied either vertically downward or with a 10° or 20° anterior inclination through the disc's shear center.Anterior(0 N to 250 N)and posterior(-50 N to 0 N)shear tests were conducted using a material testing machine.These tests were repeated under a 5 N-m flexion moment.The relative motion between L5 and Si was measured using a three-dimensional motion capture system.Results In the intact state,the inclination of the axial compressive force did not significantly alter anterior or posterior shear stiffness.However,the application of a flexion moment increased anterior shear stiffness by 49.3％.Progressive structural damage resulted in incremental increases in anteroposterior shear translation and corresponding reductions in stiffness.Notably,under combined loading with axial compression and flexion moment,anterior stiffness decreased from 939 N/mm(intact)to 224 N/mm(disc injury),while posterior stiffness decreased from 572 N/mm to 217 N/mm.Within the low-load range,no significant differences in shear stiffness were observed across any structural conditions,regardless of axial force inclination or combined with a flexion moment.Conclusions This study supports the clinical view that retro-inclination of the pelvis serves as a compensatory mechanism to enhance segmental shear stability.However,this compensatory capacity gradually diminishes and ultimately fails as spinal degeneration progresses.

Operation management is an important tool to promote the high-quality development of public hospitals in China.Since the founding of New China,based on China's economic and social development and medical and health system reform,the evolution of operation management of public hospitals in China can be divided into four stages,the system building stage(1949-1978),the liberalization and revitalization stage(1979-1996),the operation mechanism reform stage(1997-2020),and the new stage of high-quality development(2021 present).The development trend of public hospital operation management in future should deepen the public welfare-oriented public hospital operation management,explore the value-oriented medical operation management model based on high-quality development and the refined operation and management model of public hospitals,so as to promote the high-quality development of public hospitals in China.

Comprehensively improving the new efficiency of high-quality development of public hospitals is the key top-level design for deepening the reform of public hospitals during the"14th Five-Year Plan"period.In view of the changes in the macro environment faced by public hospitals in recent years,such as the cancellation of the addi-tion of pharmaceutical consumables and the deep promotion of the reform of payment methods,as well as the out-standing problems existing at the micro level of public hospital operation,such as the separation of diagnosis and treatment business from economic operation activities,extensive decision-making methods,unreasonable alloca-tion of resources and urgent optimization of processes.By referring to relevant theories such as value management theory,a new"trinity"public hospital lean operation management model based on"integration of industry and fi-nance,lean operation and evidence-based decision-making"is explored and constructed.It breaks the relatively parallel operation barriers of clinical diagnosis and treatment business and economic operation management,innovates a new method of linear staff management with the integration of industry and finance,gives full play to the role of experts in governing hospitals,and integrates the professional committee system driven by"technology+manage-men"into the hospital decision-making staff system to provide data evidence-based basis for assisting the hospital leadership to make scientific decisions.

Objective To investigate the natural penetrating radiation levels along the Qinghai-Tibet Railway, and to preliminarily evaluate the doses received by the railway employees and passengers. Methods Natural penetrating radiation was measured at 15 typical locations with different altitudes along the railway and in the carriages of a train from Lhasa to Xining using high-pressure ionization chamber RSS131, sodium iodide radiation dose rate meter MARS1561, and neutron ambient dose equivalent rate meter LB6411. Results The levels of terrestrial gamma radiation, cosmic ray ionization components, and neutron radiation were 21.5-246.6 nGy/h, 79.8-225.5 nGy/h, and 24.5-101 nSv/h, respectively. The effective dose of natural penetrating radiation received by passengers and crew on a train from Lhasa to Xining was 4.82 μSv. Conclusion Comparison with the empirical formula and verification of method reliability confirm the accuracy of the measurement. Our results provide a primary understanding of the radiation levels along the Qinghai-Tibet Railway and the radiation doses received by passengers, which can be used as a basis for the regulatory authorities.