Objective: To understand the association between weight-adjusted-waist index (WWI) and cardiopulmonary endurance among middle school students, so as to provide references for the improvement of cardiopulmonary endurance levels in adolescents. Methods: From June 2015 to December 2018 by using the method of purposive sampling, height, weight, waist circumference, and 20 m shuttle-run tests were measured among 44 870 adolescents aged 13-18 from Northeast, North, East, South, Southwest and Northwest of China. The WWI of the adolescents and the maximum oxygen uptake (VO 2max ) were calculated indirectly. The t-test and one way analysis of variance were used for comparison, and the curve regression analysis method was adopted to analyze the relationship between WWI and VO 2max . Results: For Chinese middle school students aged 13-18, the WWI was (9.35±1.02), the number of 20 m shuttle-run was (38.89±18.14) times, and VO 2max was (39.96±5.88) mL/(kg ·min -1 ). The differences of VO 2max between WWI quartile arrays of boys aged 13-18 were statistically significant ( F=15.19, 9.00, 14.97, 20.48, 28.13, 10.13 , P <0.01), girls had the same trend ( F=23.36, 16.61, 33.45, 32.96, 18.23, 19.36, P <0.01). There was an inverted U shaped curve relationship between WWI and cardiopulmonary endurance. When WWI was 8.5, the VO 2max level reached the highest, which was 40.07 mL/(kg ·min -1 ). Compared with girls, WWI in boys had a more significant impact on cardiopulmonary endurance. Conclusion Maintaining optimal WWI levels may enhance adolescents cardiopulmonary endurance.

Objective: To explore relationship of sleep quality with overweight and obesity among middle school students, so as to provide a reference basis for improving adolescent sleep health. Methods: From September to December 2023, 5 713 middle school students aged 13 to 18 were selected by stratified cluster random sampling method in six regions, including Shanghai, Suzhou, Taiyuan, Wuyuan, Xingyi and Urumqi. Sleep quality survey was conducted on middle school students by Pittsburgh Sleep Quality Index. Height and weight were measured, and World Health Organization s standards for growth and development of children and adolescents was used to evaluate their nutritional status. Both χ 2 test and Logistic regression analysis were used to analyze the association between sleep quality and nutritional status of middle school students. Results: The non compliance detection rate of sleep quality was 38.4% among girls, but 29.2% among boys, and the difference was of statistical significance( χ 2=54.08, P < 0.01 ). The detection rate of substandard sleep quality was 34.2% in the group with normal nutritional status, 38.3% in the group with overweight, 43.7% in the group with obesity and 26.0% in the group with emaciation, and the difference in the rates of substandard sleep quality among middle school students of different nutritional status was statistically significant ( χ 2=68.15, P <0.01). Logistic regression analysis showed that, after controlling for mental health and physical activity, the detection rate of substandard sleep quality in the obese groups was 1.30 times higher than that in the normal group, respectively( OR =1.30, 95% CI =1.06- 1.59 , P <0.01). Conclusions Sleep quality is correlated with overweight and obesity among middle school students, and there are gender differences. Intervention policies should be formulated according to the characteristics of different genders.

To compare the differences in clinical features and treatment choices between peripheral spondyloarthritis(pSpA) and axial spondyloarthritis(axSpA), and better understand the clinical characteristics and medication needs of pSpA.

Objective:To explore the clinical characteristics,treatments,and pregnancy outcomes of pregnant women with malignant ovari-an tumors.Methods:We retrospectively analyzed the clinical data of 11 patients with pregnancies complicated by malignant ovarian tu-mors,including the pathological types,clinical staging,surgical methods,pregnancy outcomes,and follow-up results from January 2012 to December 2022.Results:Among the eleven patients followed up until October 2023,six had primary ovarian tumors and five had metastat-ic ovarian tumors.Among the six primary ovarian tumors,five were epithelial tumors(one in stage ⅠA,two in stage ⅠC,one in stage ⅢA,one in stage ⅡB)and one was a malignant germ cell tumor(stage ⅠA).Four patients were diagnosed at stage Ⅰ:one in early pregnancy who continued the pregnancy and underwent tumor surgery post-delivery,and three in late pregnancy who under went tumor surgery dur-ing cesarean section or postpartum.Two patients were diagnosed at stage Ⅲ:one in early pregnancy with surgery after the termination of pregnancy,and one in late pregnancy with surgery during a cesarean section.Five patients had successful births,including two premature and three full-term births,all alive and healthy.The six patients with primary ovarian tumors were followed up for 18-133 months,and all survived.Five patients had ovarian metastatic tumors,including four cases of Krukenberg tumors and one of a cervical tumor.Two patients were diagnosed in the first trimester and underwent tumor reduction post-abortion.One patient was diagnosed in the second trimester,had to continue the pregnancy,and underwent tumor reduction post-delivery.Two patients were diagnosed in the third trimester:one under-went cesarean section and ovarian tumor resection simultaneously,and the other underwent tumor resection post-delivery.Three patients had successful births,all premature but alive.One of the five patients with ovarian metastatic tumors was lost to follow-up;the remaining four were followed up for 3-22 months,and all deceased.Conclusions:The prognosis for patients with pregnancies complicated by ovarian primary tumors is favorable,whereas the prognosis for patients with pregnancies complicated by ovarian metastatic tumors is poor,neces-sitating greater clinical attention.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

Objective To analyze the application value of the American Society of Anesthesiologists (ASA) classification in treating patients with percutaneous nephrolithotomy (PCNL) under local anesthesia for upper urinary tract calculi. Methods A total of 80 patients with PCNL under local anesthesia for upper urinary tract calculi were divided into high-risk group (ASA Ⅲ to Ⅳ level) with 36 cases and low-risk group (ASA Ⅰ to Ⅱ level) with 44 cases according to ASA classification, and perioperative indicators (operation time, intraoperative blood loss and hospital stay), stone clearance rate, inflammatory factors[C reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)], score of the Visual Analogue Scale (VAS) for pain, and the incidence of complications were compared between the two groups. Results Hospital stay in the low-risk group was significantly shorter than that in the high-risk group (P < 0.05); the stone clearance rate was 93.18% in the low-risk group, which was significantly higher than 75.00% in the high-risk group (P < 0.05). Before surgery, the levels of serum CRP, IL-6 and TNF-α in the high-risk group were significantly higher than those in the low-risk group (P < 0.05); one day after surgery, the levels of serum CRP, IL-6 and TNF-α in the high-risk group were significantly higher than those in the low-risk group (P < 0.05). On the first, the third, and the fifth day after surgery, the VAS score in the high-risk and low-risk groups decreased significantly, and the VAS score in the low-risk group was significantly lower than that in the high-risk group (P < 0.05). Incidence rate of complications in the low-risk group was 4.54%, which was significantly lower than 19.44% in the high-risk group (P < 0.05). Conclusion Application of PCNL under local anesthesia in treating patients with upper urinary tract calculi of ASA Ⅰ to Ⅲ has milder inflammation and pain when compared to those of ASA Ⅲ to Ⅳ, and the incidence rate of complications is relatively low.

Objective:To evaluate the efficacy and safety of sodium hyaluronate gel in preventing adhesion after prophylactic enterostomy.Methods:One hundred and twenty four patients from 6 hospitals were enrolled in this prospective multi-center randomized controlled trial. Patients were randomized into the study group ( n=59) or the control group ( n=65).All patients underwent prophylactic enterostomy. Patients of study group received odium hyaluronate gel for adhesion-prevention,while those in control group did not receive any adhesion-prevention treatment. The incidence of moderate to severe adhesion around the incision in the stoma area were evalutated during stoma reduction surgery. Results:The incidence of moderate to severe adhesion around the incision in the stoma area was 6.3% in the study group, the difference was statistically significant ( P<0.05) compared to that of the control group (32.6%). Conclusion:Sodium hyaluronate gel can safely and effectively reduce the incidence of moderate and severe adhesions after abdominal surgery.

BACKGROUND: Concerns exist regarding the potential development of tuberculosis in patients with rheumatoid arthritis (RA) treated with biological and targeted drugs. We assessed systematically whether biological therapy increased the risk of tuberculosis in patients with RA by meta-analysis of randomized controlled trials (RCTs). METHODS: A systematic literature search was conducted in PubMed, Embase, the Cochrane Library, and China Biology Medicine disc for RCTs evaluating biological therapy in patients with RA from inception through August 2021. Traditional meta-analysis and network meta-analysis were performed to compare the risk of tuberculosis for each biologics class in patients with RA. Peto odds ratio (Peto OR) and its 95% confidence interval (CI) were calculated as the primary effect measure. RESULTS: In total, 39 studies with 20,354 patients were included in this meta-analysis, and 82 patients developed tuberculosis. The risk of tuberculosis was increased in patients treated with biologics compared with non-biologics (Peto OR: 3.86, 95% CI: 2.36-6.32, P < 0.001). Also, tumor necrosis factor-α (TNF-α) inhibitors had a higher probability of developing tuberculosis than placebo (Peto OR: 3.98, 95% CI: 2.30-6.88, P < 0.001). However, network meta-analysis demonstrated that there was no significant difference in the risk of tuberculosis for each biologics class in patients with RA. Noticeably, tuberculosis was significantly more common in patients treated with a high dose compared with patients receiving a low dose of tofacitinib (Peto OR: 7.39, 95% CI: 2.00-27.31, P = 0.003). CONCLUSION This meta-analysis demonstrates the evidence of an elevated risk of tuberculosis in patients with RA treated with TNF-α inhibitors, and a dose-dependent elevated risk of tuberculosis in patients treated with tofacitinib.
Antirheumatic Agents/adverse effects* ; Arthritis, Rheumatoid/drug therapy* ; Humans ; Network Meta-Analysis ; Pharmaceutical Preparations ; Randomized Controlled Trials as Topic ; Tuberculosis/drug therapy*

To investigate the relationship between serum C-reactive protein (CRP) levels and work impairment in patients with ankylosing spondylitis (AS) based on real-world evidence. Outpatients with confirmed AS at Chinese PLA General Hospital were recruited consecutively by Smart-phone SpondyloArthritis Management System (SpAMS) from April 2016 to April 2018. The relationship between CRP and work productivity and activity impairment questionnaire (WPAI) were evaluated. Five hundred and fifty-one outpatients with AS in paid employment were recruited. The presenteeism, overall work impairment, and activity impairment rates increased by 1.4% (1.1%, 1.8%), 1.1% (0.5%, 1.6%), and 1.7% (1.3%, 2.1%), respectively, for every 10 mg/L increase in the CRP level (all P value<0.01). However, the CRP level was not associated with absenteeism after adjusting for covariates [0.5%(-0.4%, 1.0%), P>0.05]. There is a significant association between increased serum CRP levels at baseline and the previous 7-day work impairment in patients with AS. Higher CRP levels contribute to worse presenteeism, overall work impairment, and activity impairment rates, which suggests the necessity of monitoring CRP on treatment, and also indicates that anti-inflammatory therapy may be effective for improving work productivity.

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.