Objective: To investigate the status and influencing factors of nutritional health knowledge awareness among primary and middle school students in Wenzhou City, Zhejiang Province, so as to provide a basis for carrying out targeted nutrition health education for students. Methods: The stratified cluster random sampling method was used to select students from 48 schools across 12 counties (cities and districts) in Wenzhou City as survey subjects from October 2023 to February 2024. Basic information, parental information, and nutritional health knowledge were collected using the Questionnaire on nutritional health knowledge for School-Age Children. The awareness rate of nutritional health knowledge was analyzed. Multivariable logistic regression model was used to analyze the influencing factors for nutritional health knowledge awareness among primary and middle school students. Results: The survey included 4 405 boys, accounting for 51.42%, and 4 161 girls, accounting for 48.58%. The sample consisted of 2 497 pupils in Grades 1-3 (29.15%), 2 591 pupils in Grades 4-6 (30.25%), 1 739 junior high school students (20.30%), and 1 739 senior high school students (20.30%). The median score of nutrition health knowledge was 75.00 (interquartile range, 19.00), and the awareness rate was 4 524 (52.81%). Multivariable logistic regression analysis showed that girls (OR=1.317, 95%CI: 1.198-1.447), primary school students (Grades 1-3, OR=7.830, 95%CI: 6.444-9.513; Grades 4-6, OR=1.276, 95%CI: 1.066-1.528), and those whose mothers had an educational level above junior high school (senior high school/technical secondary school/technical school/junior college, OR=1.188, 95%CI: 1.044-1.352; bachelor' s degree or above, OR=1.194, 95%CI: 1.024-1.392) had a higher likelihood of nutrition and health knowledge awareness. Conversely, students who were overweight or obese (OR=0.798, 95%CI: 0.671-0.950), lived in school (OR=0.763, 95%CI: 0.650-0.895), and had a daily outdoor activity duration of <30 minutes (OR=0.641, 95%CI: 0.570-0.721) had a lower likelihood of nutritional health knowledge awareness. Conclusions The awareness rate of nutritional health knowledge among primary and middle school students in Wenzhou City needs to be improved, and is mainly influenced by gender, educational stage, body mass index, mother' s educational level, and outdoor activity duration. It is recommended to implement differentiated health education strategies and build a "family-school-community" linkage mechanism to improve students' nutrition health literacy.

OBJECTIVE To explore the protective effect of Jianpi Shengqing Jiangzhuo Recipe on db/db mice with diabetic kid-ney disease(DKD)and its possible mechanism.METHODS Thirty-two 8-week-old male db/db mice were randomly divided into four groups(n=8),including the model group,the Western medicine group[Dapagliflozin(1.0 mg·kg-1·d-1)],low-dose Jianpi Shengqing Jiangzhuo group(19.63 g·kg-1·d-1),and high-dose Jianpi Shengqing Jiangzhuo group(58.89 g·kg-1·d-1).Addi-tionally,8 db/m mice were used as the normal group.The mice were orally administered once a day for 10 consecutive weeks.The general survival status of the mice was observed,and the body weight,fasting blood glucose(FBG),and urine volume of the mice were dynamically monitored;urine creatinine and urine microalbumin were detected,and urine microalbumin excretion(UAE)and protein-creatinine ratio(ACR)were calculated.After the last intervention,mice were fasted for 12 h,blood was collected under anesthesia,and kidney tissue was separated;blood creatinine(Scr),serum urea nitrogen(BUN),triglycerides(TG),total cholesterol(TC),low-density lipoprotein(LDL-C),and high-density lipoprotein(HDL-C)were tested;HE and Masson staining were used to observe pathological changes in renal tissue;Oil Red O staining was used to observe the deposition of lipid droplets in the kidneys,and Image J was used for quantitative analysis;ELISA was used to detect the levels of TNF-α and IL-1β in renal tissue;Western blot was used to detect the expression of SIRT1,SREBP-1,and PPAR-α proteins in renal tissue.RESULTS Compared with the normal group mice,the body weight,FBG,Scr,TG,TC,HDL-C,LDL-C,urine volume,UAE,and ACR of the model group mice were signifi-cantly increased(P<0.05,P<0.01);the glomerular volume was significantly increased,renal fibrosis was altered,and renal lipid droplet deposition increased(P<0.01);renal TNF-α,IL-1β,SREBP-1 expression increased(P<0.01),and SIRT1 and PPAR-α expression decreased(P<0.01).Compared with the model group,the FBG levels in the Western medicine group was significantly de-creased at the 5th and 10th weeks of intervention(P<0.05,P<0.01);after the intervention,the Scr,UAE and ACR in the Western medicine group and high-dose Jianpi Shengqing Jiangzhuo group were significantly decreased(P<0.05,P<0.01),and the serum TG level in the high-dose Jianpi Shengqing Jiangzhuo group was also significantly decreased(P<0.01);the Western medicine group and the high-dose group of Jianpi Shengqing Jiangzhuo group improved renal pathological changes and lipid deposition(P<0.05,P<0.01),with decreased levels of TNF-α and IL-1β and increased expression of SIRT1 and PPAR-α proteins(P<0.05,P<0.01);high-dose group of Jianpi Shengqing Jiangzhuo decreased the expression of SREBP-1(P<0.01).CONCLUSION Jianpi Shengqing Jiangzhuo Recipe can improve proteinuria,kidney injury,renal lipid deposition as well as inflammatory reaction in DKD,which may be related to the activation of the SIRT1/SREBP-1/PPAR-α pathway to regulate lipid homeostasis.

Objective To investigate the early dynamic changes of biomarkers associated with capillary leak syndrome(CLS)in patients with severe acute pancreatitis(SAP)and their correlation with multiple organ failure(MOF).Methods A total of 171 SAP patients admitted to the West China Centre of Excellence for Pancreatitis,West China Hospital,Sichuan University between September 1,2019 and December 31,2020 were enrolled for this study.The patients were divided into MOF and non-MOF groups based on the occurrence of MOF in the first 5 days of hospitalization,and were further divided into subgroups based on the presence of moderate-to-severe intra-abdominal hypertension(IAH).We performed dynamic monitoring of the blood biomarkers(hematocrit[HCT].blood urea nitrogen[BUN].and creatinine[Cr]),plasma proteins(albumin[Alb].total protein[TP].and non-albumin plasma proteins[NAPP]),and intra-abdominal pressure.Trends in these indicators across groups were analyzed comprehensively.Results No significant differences in baseline data between the two groups were observed.The baseline data of the 2 groups were comparable.The MOF group had significantly higher rates of persistent systemic inflammatory response syndrome(SIRS)lasting 48 hours(91.3％vs.71.8％),ICU admission(70.4％vs.17.6％),and length-of-stay([32±17.7]days vs.[19.0±12.2]days)compared to those of the non-MOF group(P＜0.05).The incidences of respiratory,circulatory,and renal failures were higher in the MOF group than those in the non-MOF group,showing significant differences in circulatory failure(69％vs.3.5％)and renal failure(65.5％vs.3.5％)(P＜0.05).In the first 5 days of hospitalization,the MOF group showed significantly elevated BUN and Cr levels,while Alb and TP levels dropped rapidly upon admission and then gradually recovered.The NAPP level of the MOF group continued to decrease after admission,and on the third day after admission,the NAPP level was lower than that of the Non-MOF group,showing statistically significant difference(P＜0.001).The Alb/NAPP ratio of the MOF group decreased significantly on day 1 and then rapidly increased,showing significant differences between the groups on days 3 and 4(P=0.001).Subgroup analysis of MOF patients with moderate-to-severe IAH revealed similar trends in the dynamic changes and the overall changes in the indicators,and the difference was even more pronounced.The mixed linear model showed that the average levels of HCT,BUN,Alb/NAPP,and Alb/TP were higher and increased over time in the MOF combined with IAP subgroup(P＜0.001).Conclusion The CLS model of SAP patients is validated,confirming that CLS is a key factor in the progression from SIRS to MOF.The loss of NAPP is an early and important indicator of CLS persistence and progression to MOF.Additionally,moderate-to-severe IAH accelerates the deterioration of MOF.These findings provide valuable insights into the potential mechanisms of MOF and warrant further validation through large-scale prospective studies.

Objective Magnetic resonance angiography(MRA)offers a non-invasive and radiation-free advantage in detecting and diagnosing intracranial artery stenosis;however,it is associated with high equipment costs.Transcranial color-coded Duplex ultrasound(TCCD)combined with contrast-enhanced ultrasound(CEUS)presents advantages such as non-invasiveness,real-time dynamic monitoring,and low cost.Nevertheless,there were no reports comparing the sensitivity,specificity,diagnostic agreement with MRA,or health economic evaluation of TCCD combined with CEUS for detecting major intracranial artery stenosis.Methods From April 2023 to August 2024,a total of 55 patients suspected of having intracranial artery stenosis or occlusion were recruited at Beijing Tiantan Hospital,Capital Medical University.Both TCCD combined with CEUS and MRA were performed to evaluate the degree of stenosis in the terminal segment of the internal carotid artery,M1 and M2 segments of the middle cerebral artery,A1 and A2 segments of the anterior cerebral artery,P1 and P2 segments of the posterior cerebral artery,and the V4 segment of the vertebral artery.Intracranial artery stenosis was categorized into three groups:normal/mild,moderate,and severe/occlusion.Sensitivity,specificity,and consistency between the two methods were calculated.The Wilcoxon signed-rank test was used to compare the differences in examination costs and diagnostic time.Results Fifty-five high-risk patients(110 cerebral hemispheres in total)with suspected cerebrovascular stenosis were included(median age:46 years;69.0%male).TCCD combined with CEUS and MRA were performed simultaneously.TCCD combined with CEUS showed high sensitivity and specificity in diagnosing intracranial artery stenosis,with good consistency compared to MRA.The highest diagnostic consistency was observed in the M2 segment(Kappa=0.704)and A2 segment(Kappa=0.650),while the M1 segment showed moderate consistency(Kappa=0.569).The average cost of TCCD combined with CEUS was 240 CNY with a diagnostic duration of 21 min,compared to 722 CNY and 287 min for MRA(P<0.001,effect sizer=0.89-0.91).Conclusion Compared to MRA,TCCD combined with CEUS demonstrates higher consistency in screening for stenosis in the M2 segment of the middle cerebral artery and the A2 segment of the anterior cerebral artery.It is also more cost-effective.However,MRA has advantages in assessing deep intracranial vessels.A synergistic use of both methods can optimize the allocation of diagnostic resources for intracranial artery stenosis.It is recommended that primary healthcare institutions adopt TCCD as the initial screening tool,and,with standardized training and technical upgrades,combine it with CEUS.Complex cases should be referred for detailed evaluation by using MRA.

Background and Aims:Centrally located breast cancer(CLBC),due to its proximity to the nipple-areolar complex,has long been treated primarily with mastectomy,while the oncologic safety of breast-conserving surgery(BCS)remains controversial.This study,based on a large-scale database combined with a real-world cohort,compared the survival outcomes of BCS and mastectomy to evaluate the feasibility and oncologic safety of BCS in CLBC patients.Methods:Data of 10 325 female CLBC patients diagnosed between 2010 and 2015 were extracted from the SEER database,including 5 601 patients who underwent BCS and 4 724 who underwent mastectomy.Propensity score matching(PSM)yielded 1 951 matched pairs,and disease-specific survival(DSS)and overall survival(OS)were compared between groups.Cox regression analyses were performed to identify prognostic factors,and subgroup analyses were conducted.Additionally,an independent validation cohort from Xiangya Hospital,Central South University(2015-2016)included 221 BCS and 636 mastectomy patients,with OS and progression-free survival(PFS)assessed.Results:After PSM,baseline characteristics between groups were well balanced.Kaplan-Meier analysis demonstrated no significant differences in DSS or OS between BCS and mastectomy,and 5-,7-,and 10-year OS rates were comparable(all P＞0.05).Subgroup analyses revealed equivalent outcomes for BCS and mastectomy in patients with T1/T2 disease,different HER2 statuses,and those receiving chemotherapy,while in patients receiving radiotherapy,BCS showed significantly better DSS and OS than mastectomy(both P＜0.05).Multivariate Cox regression identified T,N,and M stage,histologic grade,molecular subtype,ER/PR status,and chemotherapy as independent prognostic factors(all P＜0.05),whereas surgical type was not(P＞0.05).The validation cohort confirmed the SEER findings,with no significant differences in OS or PFS between the two groups(both P＞0.05).Conclusions:BCS provides DSS and OS comparable to mastectomy in CLBC patients and may confer additional survival benefits when combined with radiotherapy.These findings suggest that CLBC should not be considered a contraindication to BCS,supporting BCS as a feasible and safe surgical strategy that offers valuable evidence for individualized clinical decision-making and may help improve patients' quality of life.

Objective Magnetic resonance angiography(MRA)offers a non-invasive and radiation-free advantage in detecting and diagnosing intracranial artery stenosis;however,it is associated with high equipment costs.Transcranial color-coded Duplex ultrasound(TCCD)combined with contrast-enhanced ultrasound(CEUS)presents advantages such as non-invasiveness,real-time dynamic monitoring,and low cost.Nevertheless,there were no reports comparing the sensitivity,specificity,diagnostic agreement with MRA,or health economic evaluation of TCCD combined with CEUS for detecting major intracranial artery stenosis.Methods From April 2023 to August 2024,a total of 55 patients suspected of having intracranial artery stenosis or occlusion were recruited at Beijing Tiantan Hospital,Capital Medical University.Both TCCD combined with CEUS and MRA were performed to evaluate the degree of stenosis in the terminal segment of the internal carotid artery,M1 and M2 segments of the middle cerebral artery,A1 and A2 segments of the anterior cerebral artery,P1 and P2 segments of the posterior cerebral artery,and the V4 segment of the vertebral artery.Intracranial artery stenosis was categorized into three groups:normal/mild,moderate,and severe/occlusion.Sensitivity,specificity,and consistency between the two methods were calculated.The Wilcoxon signed-rank test was used to compare the differences in examination costs and diagnostic time.Results Fifty-five high-risk patients(110 cerebral hemispheres in total)with suspected cerebrovascular stenosis were included(median age:46 years;69.0%male).TCCD combined with CEUS and MRA were performed simultaneously.TCCD combined with CEUS showed high sensitivity and specificity in diagnosing intracranial artery stenosis,with good consistency compared to MRA.The highest diagnostic consistency was observed in the M2 segment(Kappa=0.704)and A2 segment(Kappa=0.650),while the M1 segment showed moderate consistency(Kappa=0.569).The average cost of TCCD combined with CEUS was 240 CNY with a diagnostic duration of 21 min,compared to 722 CNY and 287 min for MRA(P<0.001,effect sizer=0.89-0.91).Conclusion Compared to MRA,TCCD combined with CEUS demonstrates higher consistency in screening for stenosis in the M2 segment of the middle cerebral artery and the A2 segment of the anterior cerebral artery.It is also more cost-effective.However,MRA has advantages in assessing deep intracranial vessels.A synergistic use of both methods can optimize the allocation of diagnostic resources for intracranial artery stenosis.It is recommended that primary healthcare institutions adopt TCCD as the initial screening tool,and,with standardized training and technical upgrades,combine it with CEUS.Complex cases should be referred for detailed evaluation by using MRA.

Background and Aims:Centrally located breast cancer(CLBC),due to its proximity to the nipple-areolar complex,has long been treated primarily with mastectomy,while the oncologic safety of breast-conserving surgery(BCS)remains controversial.This study,based on a large-scale database combined with a real-world cohort,compared the survival outcomes of BCS and mastectomy to evaluate the feasibility and oncologic safety of BCS in CLBC patients.Methods:Data of 10 325 female CLBC patients diagnosed between 2010 and 2015 were extracted from the SEER database,including 5 601 patients who underwent BCS and 4 724 who underwent mastectomy.Propensity score matching(PSM)yielded 1 951 matched pairs,and disease-specific survival(DSS)and overall survival(OS)were compared between groups.Cox regression analyses were performed to identify prognostic factors,and subgroup analyses were conducted.Additionally,an independent validation cohort from Xiangya Hospital,Central South University(2015-2016)included 221 BCS and 636 mastectomy patients,with OS and progression-free survival(PFS)assessed.Results:After PSM,baseline characteristics between groups were well balanced.Kaplan-Meier analysis demonstrated no significant differences in DSS or OS between BCS and mastectomy,and 5-,7-,and 10-year OS rates were comparable(all P＞0.05).Subgroup analyses revealed equivalent outcomes for BCS and mastectomy in patients with T1/T2 disease,different HER2 statuses,and those receiving chemotherapy,while in patients receiving radiotherapy,BCS showed significantly better DSS and OS than mastectomy(both P＜0.05).Multivariate Cox regression identified T,N,and M stage,histologic grade,molecular subtype,ER/PR status,and chemotherapy as independent prognostic factors(all P＜0.05),whereas surgical type was not(P＞0.05).The validation cohort confirmed the SEER findings,with no significant differences in OS or PFS between the two groups(both P＞0.05).Conclusions:BCS provides DSS and OS comparable to mastectomy in CLBC patients and may confer additional survival benefits when combined with radiotherapy.These findings suggest that CLBC should not be considered a contraindication to BCS,supporting BCS as a feasible and safe surgical strategy that offers valuable evidence for individualized clinical decision-making and may help improve patients' quality of life.

OBJECTIVE To explore the protective effect of Jianpi Shengqing Jiangzhuo Recipe on db/db mice with diabetic kid-ney disease(DKD)and its possible mechanism.METHODS Thirty-two 8-week-old male db/db mice were randomly divided into four groups(n=8),including the model group,the Western medicine group[Dapagliflozin(1.0 mg·kg-1·d-1)],low-dose Jianpi Shengqing Jiangzhuo group(19.63 g·kg-1·d-1),and high-dose Jianpi Shengqing Jiangzhuo group(58.89 g·kg-1·d-1).Addi-tionally,8 db/m mice were used as the normal group.The mice were orally administered once a day for 10 consecutive weeks.The general survival status of the mice was observed,and the body weight,fasting blood glucose(FBG),and urine volume of the mice were dynamically monitored;urine creatinine and urine microalbumin were detected,and urine microalbumin excretion(UAE)and protein-creatinine ratio(ACR)were calculated.After the last intervention,mice were fasted for 12 h,blood was collected under anesthesia,and kidney tissue was separated;blood creatinine(Scr),serum urea nitrogen(BUN),triglycerides(TG),total cholesterol(TC),low-density lipoprotein(LDL-C),and high-density lipoprotein(HDL-C)were tested;HE and Masson staining were used to observe pathological changes in renal tissue;Oil Red O staining was used to observe the deposition of lipid droplets in the kidneys,and Image J was used for quantitative analysis;ELISA was used to detect the levels of TNF-α and IL-1β in renal tissue;Western blot was used to detect the expression of SIRT1,SREBP-1,and PPAR-α proteins in renal tissue.RESULTS Compared with the normal group mice,the body weight,FBG,Scr,TG,TC,HDL-C,LDL-C,urine volume,UAE,and ACR of the model group mice were signifi-cantly increased(P<0.05,P<0.01);the glomerular volume was significantly increased,renal fibrosis was altered,and renal lipid droplet deposition increased(P<0.01);renal TNF-α,IL-1β,SREBP-1 expression increased(P<0.01),and SIRT1 and PPAR-α expression decreased(P<0.01).Compared with the model group,the FBG levels in the Western medicine group was significantly de-creased at the 5th and 10th weeks of intervention(P<0.05,P<0.01);after the intervention,the Scr,UAE and ACR in the Western medicine group and high-dose Jianpi Shengqing Jiangzhuo group were significantly decreased(P<0.05,P<0.01),and the serum TG level in the high-dose Jianpi Shengqing Jiangzhuo group was also significantly decreased(P<0.01);the Western medicine group and the high-dose group of Jianpi Shengqing Jiangzhuo group improved renal pathological changes and lipid deposition(P<0.05,P<0.01),with decreased levels of TNF-α and IL-1β and increased expression of SIRT1 and PPAR-α proteins(P<0.05,P<0.01);high-dose group of Jianpi Shengqing Jiangzhuo decreased the expression of SREBP-1(P<0.01).CONCLUSION Jianpi Shengqing Jiangzhuo Recipe can improve proteinuria,kidney injury,renal lipid deposition as well as inflammatory reaction in DKD,which may be related to the activation of the SIRT1/SREBP-1/PPAR-α pathway to regulate lipid homeostasis.

Myopia-associated optic neuropathy has become an important cause of visual impairment with the increasing prevalence of myopia in recent years.However,the mechanisms for its occurrence and development are still in primary re-search.Numerous studies suggest that structural changes in the optic disc that often occur in the progress of myopia may be closely associated with optic neuropathy.The optic disc is stretched mechanically with the growth of the axial length,resulting in changes in its morphology,biomechanics and blood flow,which may induce optic neuropathy.This review summarized the relationship between pathophysiological histostructural and biomechanical changes,including scleral con-nective tissue remodeling,peripapillary atrophy,tilt and torsion of optic disc,and thinning of lamina cribrosa and peripapil-lary scleral margin,and optic neuropathy in myopic patients,hoping to provide a new insight for early detection and pre-vention of myopia-associated optic neuropathy.

Objective:To compare the therapeutic effects of 0.05% cyclosporine and 0.1% fluorometholone eye drops in patients with moderate and severe dry eye.Methods:A randomized controlled study was conducted.Fifty-two patients (52 eyes) with moderate to severe dry eye in Tianjin Medical University Eye Hospital from August 2021 to December 2022 were enrolled and randomly divided into 0.05% cyclosporine group and 0.1% fluorometholone group by random number table method, with 26 cases (26 eyes) in each group.Patients received 0.05% cyclosporine eye drops (2 times/day) and 0.1% fluorometholone eye drops (2 times/day) combined with calf blood deproteinized extract eye drops (4 times/day) according to the grouping.Before and 1, 3 and 6 months after treatment, clinical symptoms and signs were observed and Ocular Surface Disease Index (OSDI) score, corneal fluorescein staining (CFS) score, Schirmer Ⅰ test (SⅠT), non-invasive first tear film break-up time (NIBUTf), and conjunctival goblet cell (CGC) density were recorded.Before treatment and after 6 months of treatment, changes in corneal nerves and dendritic cells (DC) were observed by in vivo confocal microscopy (IVCM).This study adhered to the Declaration of Helsinki and was approved by the Medical Ethics Committee of Eye Hospital of Tianjin Medical University (No.2021KY-17).Written informed consent was obtained from each subject. Results:Compared with the 0.1% fluorometholone group, CFS score decreased after 1 month of treatment, but SⅠT, NIBUTf and CFS score increased after 3 months of treatment, and OSDI score, SⅠT and CFS score decreased after 6 months of treatment in the 0.05% cyclosporine group, showing statistically significant differences (all at P<0.05).Compared with baseline, in the 0.05% cyclosporine group, NIBUTf increased and CFS score decreased after 1 month of treatment, OSDI score and CFS score decreased, SⅠT and NIBUTf increased after 3 and 6 months of treatment, showing statistically significant differences (all at P<0.05).In the 0.1% fluorometholone group, CFS score decreased after 3 months of treatment, OSDI score and CFS score decreased, SⅠT increased after 6 months of treatment compared to baseline, showing statistically significant differences (all at P<0.05).OSDI score and CFS score decreased, SⅠT increased after 6 months of treatment compared to 3 months of treatment in the 0.05% cyclosporine group, and the differences were statistically significant (all at P<0.05).Baseline and CGC densities after 1, 3 and 6 months of treatment were (147.66±17.29), (195.44±15.46), (210.36±19.15) and (282.09±22.63)cells/mm 2 in the 0.05% cyclosporine group and (138.09±17.29), (95.67±15.46), (117.77±19.15) and (109.13±22.63)cells/mm 2 in the 0.1% fluorometholone group, respectively, with a statistically significant overall difference ( Fgroup=11.724, P<0.001; Ftime=4.837, P=0.005).Compared with the 0.1% fluorometholone group, CGC density in the 0.05% cyclosporine group increased after 1, 3 and 6 months of treatment, with statistically significant differences (all at P<0.05).Compared with baseline, the CGC density increased in the 0.05% cyclosporine group after 1, 3 and 6 months of treatment, and the differences were statistically significant (all at P<0.05).Compared with the 0.1% fluorometholone group, the corneal nerve fiber density in the 0.05% cyclosporine group increased after 6 months of treatment, and corneal DC density, area and dendrite number decreased, showing statistically significant differences (all at P<0.05). Conclusions:Cyclosporine 0.05% eye drops combined with calf blood deproteinized extract eye drops can improve symptoms and signs in patients with moderate to severe dry eye, and the long-term effect is better than that of 0.1% fluorometholone plus calf blood deproteinized extract eye drops.