With the increasingly complex global health and safety situation, in order to establish a strong global health and safety governance system, promote international cooperation and ensure public health and safety, the member countries of the World Health Organization initiated the revision of the International Health Regulations (2005). After the amendment of the International Health Regulations (2005) was adopted on 1 June 2024, China, as one of the contracting parties, urgently needs to promote the domestic rule of law and the foreign-related rule of law as a whole, realise the effective connection between domestic law and this regulation, and promote the transformation and application of international law. Compared with the original regulations, the Amendment has adjusted and improved relevant health measures, strengthened the construction of the public health service system, and further clarified the responsibilities and obligations of both the World Health Organization and the Parties, which has led to the application of the amendment to the International Health Regulations (2005) in China. Therefore, it is necessary to improve the domestic health law and regulation system, strengthen domestic core capacity building, deepen international cooperation and promote global governance, and strive to promote the solution of these problems.

Objective: This study conducts a text analysis of the policy documents related to Medical Consortium issued at the national level, identify the structural characteristics and utilization of Chinese Medical Consortium policy instruments, evaluate their alignment with policy objectives, uncover the structural contradictions in policy design, and provide a basis for optimizing the Medical Consortium system. Methods: This study systematically searched national-level Medical Consortium policy documents from the PKU Law Database, CNKI Government Document Database using keyword like Medical Consortium. A two-dimensional "policy instrument-policy objective" analytical framework was constructed based on policy instrument theory to quantitatively analyze the frequency, distribution characteristics, and interactive relationships between policy instruments and objectives. Results: A total of 50 national-level Me-dical Consortium policy documents from 2009 to 2024 were included, with 56% issued solely by single departments. The policy text analysis results showed that the government could use diverse policy instruments to achieve objectives, but the structural imbalances existed, environmental policy instruments accounted for the highest proportion (46.48%), mainly focusing on institutional safeguards (27.27%) and organizational governance (22.73%), with minimal focus on public awareness guidance (6.82%). Supply-side policy instruments (38.38%) overly relied on IT infrastructure development (24.77%) and rational allocation of medical resources (24.77%), with insufficient attention to workforce capacity building (9.17%) and financial input (4.59%). Demand-side policy instruments constituted only 15.14%, dominated by health insurance payment (37.21%) and pilot program promotion (32.56%), while market-oriented instruments such as service outsourcing (9.30%) were rarely used. Interaction analysis revealed that policy instruments were concentrated on enhancing primary care service capacity but provided inadequate support for optimizing allocation of medical resources, which indicated a misalignment between policy instruments and policy objective. Conclusion: Chinese Medical Consortium policies exhibit weak interdepartmental coordination and structural imbalances, characterized by excessive reliance on environmental and supply-side instruments, underuse of demand-side tools, and internal misalignment within instrument categories. And policy instruments and objectives are not well matched. To address these issues, future policy formulation should strengthen cross-departmental collaboration, diversify policy instruments, optimize their internal structures, and improve the alignment between instruments and objectives.

Objective: To explore the spousal correlations of total cholesterol (TC), total triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), and to investigate the reasons behind these spousal correlations. Methods: Participants and data were from the baseline survey of family-based cohort studies in Fangshan, Beijing and Tulou, Fujian. The origin of spousal correlations were explored from perspectives of convergence, assortative mating, social homogamy. Pearson ' s correlation and generalized linear models (GLM) were used to estimate the spousal correlation. Convergence was assessed by Pearson ' s correlation between the phenotypic differences between couples and the duration of marriage, with GLM used for further validation. Pearson ' s correlation of genetic risk scores (GRS) and couple-specific Mendelian randomization (MR) were calculated to assess the genetic correlation and possible causal relationships between spouses. Two-independent-sample t-tests were used to compare GRS consistency across subgroups divided by education attainment, couple-specific MR and Q statistics used to test assortative mating in subgroups and intergroup differences. Results: In the study, 342 couples (287 couples from Fangshan and 55 couples from Fujian) were included, with the average age of (64.91±8.76) years. Spousal correlations of TC, TG, HDL-C, and LDL-C showed statistically significant associations both before and after adjusting for covariates, with effect sizes of 0.229 (95%CI: 0.125-0.327), 0.257 (95%CI: 0.155-0.354), 0.179 (95%CI: 0.074-0.280), and 0.181 (95%CI: 0.076-0.282). For convergence, for each additional year of marriage, ΔTC increased by 0.016 mmol/L (95%CI: 0.001-0.033 mmol/L), and ΔLDL-C increased by 0.017 mmol/L (95%CI: 0.002-0.031 mmol/L). For assortative mating, GRS correlations and results of couple specific MR didn ' t show any statistical significance. For social homogamy, no differences in GRS or assortative mating were found between subgroups stratified by education attainment. Conclusion: The blood lipid in participants exhibit spousal phenotypic correlations, however, no effects of convergence, assortative mating or social homogamy were observed. More independent studies with larger sample sizes are warranted to further validate these findings in the future.

Objective: To investigate the association between the triglyceride-glucose (TyG) index and the incidence and mortality of cardiovascular disease (CVD) in a large population-based cohort. Methods: Participants aged 40-79 years without a history of CVD at baseline were drawn from the CHinese Electronic health Records Research in Yinzhou (CHERRY) study between January 1, 2010, and May 31, 2020. The TyG index was calculated using baseline triglyceride and fasting blood glucose. Cox proportional hazards models were used to assess the association between the TyG index and the composite outcome of CVD (incidence and mortality), adjusting for age, gender, education, region, smoking status, body mass index, systolic blood pressure, and total cholesterol. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated. Nonlinear associations between the TyG index and CVD were further evaluated using restricted cubic splines, and subgroup analyses by gender and age were conducted to explore potential differences. Results: A total of 226 406 individuals were included, with a mean age of (55.0±9.7) years at baseline, 46.8% of whom were men, and a median TyG index of 8.68. Over a median follow-up of 7.99 years, 9 815 (4.34%) participants experienced CVD incidence or mortality. After adjusting for age, gender, education, region, smoking status, body mass index, systolic blood pressure and total cholesterol, the risk of CVD increased with higher TyG index levels (P < 0.001). The risk in the highest TyG quartile (TyG>9.10) was 42% higher than in the lowest quartile (TyG≤8.32) (HR=1.42, 95%CI: 1.34-1.51). Individuals under 60 years had a higher HR for CVD compared with those aged 60 years and above (HR: 1.71 vs. 1.27, P < 0.05). Restricted cubic spline analysis revealed a reverse L-shaped association between the TyG index and CVD risk in the overall population (P < 0.001 for nonlinear trend), with risk increasing after the TyG index exceeded 8.67. However, the threshold varied by gender, with a lower threshold in women (8.51) than in men (8.67). Conclusion: A significant nonlinear relationship was revealed between the TyG index and CVD risk, with a threshold effect. The risk of CVD increased once the TyG index surpassed a certain threshold, with a lower threshold in women than in men. These findings suggest that cardiovascular risk prediction and interventions based on the TyG index should be gender-stratified, and early intervention for individuals under 60 years old might have important public health implications.

Objective: To develop outcome indicators for the implementation of comprehensive interventions targeting the multimorbidity of myopia and obesity in children and adolescents, providing a basis for the co-prevention of multimorbidity and the outcome measurement of implementation research in children and adolescents. Methods: Based on the RE-AIM framework, a preliminary set of indicators was constructed. The Delphi method was employed, with experts scoring and providing feedback on the proposed indicators via questionnaires. After each round of consultation, expert enthusiasm index, authority coefficient, coordination degree, and consensus level were calculated. Expert opinions were collected and analyzed to modify, delete, or add indicators based on consultation results and screening criteria. Two Delphi rounds were conducted until consensus was achieved. Results: A total of 28 experts participated actually in both rounds. The Kendall' s W coefficients for the two rounds of expert consultation were 0.352 (χ²=413.952, P < 0.001) and 0.499 (χ²=405.044, P < 0.001), both statistically significant. The final outcome indicators for implementation research on comprehensive interventions for myopia and obesity comorbidity in children and adolescents included five primary dimensions with 13 secondary and 20 tertiary indicators. The dimension of reach included the number of children and adolescents involved, participant representativeness, and full-course participation representativeness. The dimension of effectiveness included multimorbidity incidence, myopia incidence, spherical equivalent, body mass index (BMI), overweight and obesity prevalence, waist-to-height ratio, comprehensive health knowledge score, and comprehensive health behavior score. The dimension of adoption covered school representativeness and representativeness of school nurses and teachers involved in implementation. The dimension of implementation included fidelity, content modification, and cost. The dimension of maintenance included individual health outcomes and organizational sustainment. Conclusion: This study developed implementation outcome indicators for comprehensive interventions targeting multimorbidity of myopia and obesity among the children and adolescents based on the RE-AIM framework. These indicators can serve as a reference for optimizing intervention research strategies related to common multimorbidity among children and adolescents in China.

Objective: To describe the prevalence of myopia and pre-myopia among preschool children aged 5-6 years in ten provinces or municipalities (hereinafter referred to as province) of China, and to provide a reference for the prevention and control of myopia, and the allocation of related health resources. Methods: Convenience sampling was used to select preschool children aged 5-6 years from 21 cities in 10 provinces (including 8 provinces and 2 municipalities) in China. Cycloplegic autorefraction was conducted. The distribution of myopia and pre-myopia was described using frequencies and percentages. The Chi-square test was used to compare the differences in the prevalence of myopia and pre-myopia between regions with different varying economic development levels and between boys and girls, with a significance level of α=0.05. Results: A total of 12 926 preschool children aged 5-6 years were surveyed. The myopia prevalence was 5.5%, and the overall prevalence of myopia and pre-myopia was 43.4%. Boys had higher rates of myopia and overall prevalence of myopia and pre-myopia than girls (5.7% vs. 5.2%, 46.4% vs. 40.1%), though the difference in myopia prevalence was not statistically significant. Stratified analysis by the province, there was no statistically significant differences in the prevalence of myopia between boys and girls in any province (P>0.05), but in 8 provinces, the prevalence of myopia in boys was slightly higher than in girls. The overall prevalence of myopia and pre-myopia in boys was higher than in girls across all the 10 provinces, with 5 provinces showing statistically significant differences (P < 0.05). The investigated areas were divided into two categories, relatively more-developed areas and relatively less-developed areas, based on per capita gross domestic product (GDP). In 6 provinces, there was no statistically significant difference in the prevalence of myopia between the two categories of areas. In 2 provinces, the prevalence was higher in relatively more-developed areas, and in 2 provinces, it was higher in relatively less-developed areas. In 4 provinces, there was no statistically significant difference in the overall prevalence of myopia and pre-myopia between the two categories of areas with relatively more-developed and relatively less-developed areas. In 3 provinces, the prevalence was higher in relatively more-developed areas, and in 3 provinces, it was higher in relatively less-developed areas. Conclusion: The prevalence of myopia and pre-myopia among preschool children aged 5-6 years is relatively high. Boys show higher overall prevalence of myopia and pre-myopia than girls, but there is no significant difference in the prevalence of myopia. There is no consistent association between the level of economic development and the incidence of myopia and pre-myopia in each province.

Objective: To identify genetic etiology of ischemic stroke (IS) based on pleiotropy of obesity related genes. Methods: A discordant sib-pair study was designed based on the Fangshan family cohort in Beijing. Body mass index (BMI) polygenic risk score (PRS) was first constructed under different P values. Using the polygenic transmission disequilibrium test (pTDT), we then compared the actual BMI genetic risk of siblings with IS to their expected risk, to analyze whether higher BMI was over-transmitted to siblings with IS. The single nucleotide polymorphism (SNP) that comprised the PRS over-transmitted with IS and that corresponded to the highest heritability of IS were identified as a pleiotropy SNPs set between BMI and IS. This set was then utilized as a candidate set to identify and verify risk SNPs asso-ciated IS by transmission disequilibrium test. Finally, we identified independent genomic risk loci and mapped to genes, we then explored the biological function of the identified risk loci and genes by functional annotation and pathway enrichment. Results: A total of 541 participants were enrolled, with an average age of (58.4±8.1) years, including 326 discordant sib pairs of ischemic stroke. Compared with non-IS participants, IS participants with males, education level below junior high school, hypertension and hyperlipidemia accounted for a higher proportion (P < 0.05). For all the BMI PRS, we found that the actual genetic risk of BMI in siblings with IS was higher than their expectation, suggesting that genetic risk associated with high BMI was over-transmitted with IS. Compared with other SNP sets, the set (P < 5×10^-4) corresponded to the best analytical statistics of pTDT and the highest heritability of IS and was identified as the pleiotropy SNP set between BMI and IS. Within this set, there were 45 SNPs having linkage and association with IS, which were located in 43 independent genomic risk loci and mapped to 40 genes. These genes were significantly enriched in the lipid metabolism pathway. The rs2232852 corrected by multiple tests was mapped to CYB5R1 and ADIPOR1, which were related to lipid metabolism and the ferroptosis pathway. Conclusion: Pleiotropy between BMI-related genes and IS was observed. Forty-five SNPs were found with linkage and association with IS in the pleiotropy gene set and mapped to 40 genes, which were functionally enriched in lipid metabolic pathways. The rs2232852 corrected by multiple tests during association analysis validation was mapped to CYB5R1 and ADIPOR1, which were related to lipid metabolism and the ferroptosis pathway, suggesting that lipid metabolism and ferroptosis played an important role in the development of IS.

Objective: To explore the relationship between obesity indicators and DNA methylation clocks acceleration, and to analyze their temporal sequence. Methods: Data were obtained from two surveys conducted in 2013 and 2017-2018 by the Chinese National Twin Registry. Peripheral blood DNA methylation data were measured using the Illumina Infinium Human Methylation 450K BeadChip and EPIC BeadChip. DNA methylation clocks/acceleration metrics (GrimAA, PCGrimAA and DunedinPACE) were calculated using the DNA methylation online tool (https://dnamage.genetics.ucla.edu/) or R code provided by researchers. Obesity indicators included weight, body mass index (BMI), waist circumference, waist-hip ratio, and waist-height ratio. A total of 1 070 twin individuals were included in the cross-sectional analysis, comprising 378 monozygotic (MZ) twin pairs and 155 dizygotic (DZ) twin pairs for within-pair analysis. Mixed-effects models were used to examine the associations between obesity indicators and DNA methylation clocks, as well as their acceleration measures. The longitudinal analysis included 314 twin individuals, comprising 95 MZ twin pairs and 62 DZ twin pairs for within-pair analysis. Cross-lagged panel models were applied to further explore the temporal relationships between obesity and DNA methylation clock indicators. All analyses were conducted both in the full twin sample and separately within MZ and DZ twin pairs. Results: In the cross-sectional analysis population, monozygotic twins accounted for 71.0%, males for 68.0%, and the mean chronological age was (49.9±12.1) years. In the longitudinal analysis population, monozygotic twins accounted for 60.5%, males for 60.8%, with a mean baseline chronological age of (50.4±10.2) years and a mean follow-up duration of (4.6±0.6) years. Except for the waist-to-hip ratio, which was significantly higher at follow-up compared with baseline, no statistically significant differences were observed in the means of other obesity indicators between baseline and follow-up. Correlation analysis revealed that weight, BMI, waist circumfe-rence, waist-hip ratio (WHR), and waist-height ratio (WHtR) were positively correlated with DunedinPACE in all the twins, with WHtR showing the strongest association (β=0.21, 95%CI: 0.11 to 0.31). Weight and BMI were negatively associated with GrimAA (β=-0.03, 95%CI: -0.05 to -0.01; β=-0.07, 95%CI: -0.12 to -0.02), while weight was negatively associated with PCGrim- AA (β=-0.02, 95%CI: -0.03 to 0.00). However, within-twin-pair analyses showed no statistically significant correlations. Cross-lagged panel model analysis indicated that higher baseline weight might lead to increased GrimAA at follow-up, while elevated baseline weight, BMI, and waist circumference might increase PCGrimAA. Higher baseline WHR was associated with increased DunedinPACE at follow-up. Conclusion: Obesity indicators correlate with DNA methylation clock acceleration metrics. Baseline obesity may influence changes in certain DNA methylation clock indicators over time, suggesting that obesity could exert long-term health effects by accelerating DNA methylation aging. However, these associations may be confounded by shared genetic or environmental factors among the twins.

Objective: To evaluate the effect of lifestyle interventions based on mobile health technology on gestational weight gain among overweight or obese pregnant women, to explore the influencing factors of the intervention effect, and to provide scientific evidence for weight management during pregnancy. Methods: The randomized controlled trial (RCT) design was used. From April 2024 to August 2024, 200 singleton overweight or obese pregnant women aged 18-40 years in early pregnancy were recruited and stratified block-randomized according to body mass index (BMI) categories, age, and parity. The control group received routine prenatal care, while the intervention group received lifestyle interventions based on mobile health technology, which included biweekly face-to-face or telephone sessions; weekly recording of dietary behavior goals with personalized feedback on WeChat public account; 6 000 steps per day and 150 minutes of brisk walking per week; and weekly weight recording with personalized feedback. Based on the intention-to-treat principle, generalized linear mixed models were used to analyze the effects on weight gain and weight gain rate up to 24-28 gestational weeks, gestational diabetes mellitus (GDM), and dietary and physical activity behaviors. Additionally, subgroup analysis and interaction analysis were conducted to explore whether intervention effects on weight gain varied by different maternal characteristics. Results: The mean age of the women in the intervention and control groups was (30.49± 3.99) years and (29.83±3.95) years, respectively, with gestational weeks at enrollment being (11.35±1.61) weeks and (11.26±1.52) weeks. No statistically significant differences were observed in the baseline characteristics between the two groups (P>0.05). In the study, 10 and 12 participants were lost to the follow-up in the intervention and control groups, respectively, with 178 women completing the midterm follow-up. At the midterm follow-up (24-28 weeks), the weight gain in the intervention and control groups was (5.00±3.72) kg and (6.57±4.28) kg, respectively. After adjusting for age, parity, gravidity, region, pre-pregnancy BMI categories, and socioeconomic status, the between-group difference was -1.63 kg (95%CI: -2.80 to -0.46; P=0.007). The adjusted between-group difference in weight gain rate was -0.07 kg/week (95%CI: -0.11 to -0.02; P=0.005). Compared with the control group, the intervention group had lower fasting blood glucose at the oral glucose tolerance test (OGTT) by 0.19 mmol/L (95%CI: 0.04 to 0.33; P=0.013). No significant difference was observed in GDM incidence between the two groups. Among different subgroups based on characteristics, such as age, region, socioeconomic status, and parity, there was no statistically significant dif-ference in the effect on weight gain. Conclusion: The lifestyle interventions based on mobile health technology effectively controlled weight gain up to 24-28 gestational weeks among overweight or obese women and improved fasting blood glucose level. This has significant public health implications for improving the health of overweight or obese pregnant women in China.

Objective: To describe the prevalence of perinatal death in Tongzhou District of Beijing, and to estimate the association between maternal periconceptional supplementation of folic acid or multiple micronutrients containing folic acid and perinatal mortality rate. Methods: A retrospective cohort study was conducted based on the maternal and child care system in Tongzhou District of Beijing. The subjects were 94 490 perinatal who were born during January 2013 to December 2018. The information on perinatal outcomes and maternal periconceptional supplementation of folic acid or multiple micronutrients containing folic acid were collected. The Poisson log-linear model was used to estimate the association between maternal periconceptional folic acid or multiple micronutrients supplementation and perinatal mortality rate. Results: The overall perinatal mortality rate was 2.71‰. The perinatal mortality rates for maternal nutrients supplementation containing folic acid and no supplementation during periconceptional period were 2.63‰ and 3.43‰, respectively, and the difference in rates was not statistically significant [crude risk ratio (cRR) = 0.77, 95%CI: 0.54-1.14]. After adjusting for potential confounding factors including ethnicity, age, education level, occupation, household registration, parity, numbers of fetuses, gestational age, pregnant with assisted reproductive technology, delivery year and pre-pregnancy body mass index, the rates remained not statistically significant [adjusted risk ratio (aRR) = 0.93, 95%CI: 0.77-1.13]. The perinatal mortality rates were 2.23‰ and 2.99‰ for pure folic acid and multi-nutrients supplements containing folic acid, respectively, and the difference in rates was statistically significant (cRR = 1.34, 95% CI: 1.02-1.76). The rates difference remained statistically significant after adjusting for potential confounders (aRR = 1.31, 95% CI: 1.06-1.62). Additionally, the perinatal mortality rates differences among the non-supplementation group and the supplementation group with variate timing of initiation (pre-conception or post-conception) or frequency of supplementation (low-frequency or high-frequency) were not statistically significant, regardless of adjusting for confounders. Conclusion: The overall perinatal mortality rate was lower than the national average level in Tongzhou District of Beijing. Maternal periconceptional supplementation of pure folic acid or micronutrients containing folic acid had no impact on perinatal mortality. The association between maternal periconceptional supplementation of multiple micronutrients containing folic acid and perinatal mortality rate need further research.

Objective: To describe the current status of responsive caregiving behavior of infant mothers, to analyze their influencing factors and pathways using the information-motivation-behavioral skills (IMB) model, and to provide a basis for further interventions related to responsive caregiving behaviors and comprehensive promotion of early childhood development. Methods: This study was a cross-sectional survey using convenience sampling. Questionnaires were used to collect basic information about mothers and their infants, as well as data on mothers' responsive caregiving behavior, knowledge of responsive caregiving, social support, and parenting self-efficacy. Multivariate linear regression models were employed to analyze the influencing factors of responsive caregiving behavior, and structural equation modeling was used to analyze the pathways of these influencing factors. The criterion for inadequate responsive caregiving is defined as scores not exceeding the lower quartile (P₂₅) of the total score. Results: Among 510 mothers of aged 0-12 months infants in Weifang City, the average score for responsive caregiving behavior was 16.41±3.99. The proportion of inadequate responsive caregiving was 25.7%. Mothers in the insufficient responsive caregiving group had lower scores in knowledge (7.70±1.41), social support (57.92±15.16), and parenting self-efficacy (30.36±6.48) compared with those in the sufficient group, with statistically significant differences (P < 0.001). Logistic regression analysis indicated that the influencing factors for responsive caregiving included the level of know-ledge about responsive parenting [adjusted OR (aOR)=0.795, 95%CI: 0.566-0.838], social support (aOR=0.979, 95%CI: 0.961-0.996), and parenting self-efficacy (aOR=0.894, 95%CI: 0.857-0.932). Structural equation modeling revealed that knowledge of responsive caregiving (β=0.089, P=0.031), social support (β=0.153, P=0.001), and parenting self-efficacy (β=0.296, P < 0.001) were directly related to responsive caregiving behavior. Additionally, knowledge of responsive caregiving indirectly affected responsive caregiving behavior through parenting self-efficacy (β=0.095, P=0.014), and social support indirectly affected responsive caregiving behavior through parenting self-efficacy (β=0.497, P < 0.001). Conclusion: The current level of responsive caregiving behavior among mothers of 0-1-year-old infants in Weifang City is not satisfactory. Future development of responsive caregiving interventions should focus on providing caregivers with relevant knowledge of responsive caregiving based on their needs. Additionally, it is essential to offer social support from multiple aspects to enhance caregivers' parenting self-efficacy, thereby promoting improvements in responsive caregiving behavior.

Objective: To investigate the association between metabolic dysfunction-associated steatotic liver disease (MASLD) and the risk of adverse pregnancy outcomes, and to analyze the impact of the type and severity of cardiometabolic risk factor (CMRF) abnormalities on this association. Methods: A retrospective cohort study was conducted among primiparous women with singleton pregnancies who had registered at Beijing Friendship Hospital from March 10, 2020, to December 31, 2022. A total of 2 623 women were included. Basic characteristics and delivery outcomes were documented, liver ultrasound and relevant prenatal examinations were performed, and adverse pregnancy outcomes were diagnosed. Modified Poisson regression models were used to analyze the association between MASLD and adverse pregnancy outcomes. The relationship between the type or severity of CMRF abnormalities in MASLD and the risk of adverse pregnancy outcomes was also explored. Results: After adjusting for confounding factors including age, gestational weight gain, and education level, MASLD was associated with an increased risk of cesarean section (RR=1.531, 95%CI: 1.304-1.799, P < 0.001), gestational diabetes mellitus (GDM; RR=2.409, 95%CI: 1.948-2.979, P < 0.001), pregnancy-associated hypertension (PAH; RR=3.062, 95%CI: 2.069-4.533, P < 0.001), preterm birth (RR=2.145, 95%CI: 1.342-3.429, P=0.001), and large for gestational age (LGA; 2.224, 95%CI: 1.599-3.095, P < 0.001). However, no significant associations were found for small for gestational age or postpartum hemorrhage. After adjusting for other CMRF abnormalities, the risk of adverse pregnancy outcomes varied among MASLD pregnant women with different CMRF abnormalities: the body mass index abnormal group had higher risks of cesarean section, GDM, PAH, preterm birth, and LGA; the glucose abnormal group had an increased risk of GDM; the blood pressure abnormal group had a higher risk of PAH; the high density lipoprotein cholesterol abnormal group had higher risks of cesarean section, GDM, and PAH; and the triglyceride abnormal group was associated with higher risks of GDM and preterm birth. Additional, as the severity of CMRF abnormalities increased, the risks of cesarean section (RR=1.199, 95%CI: 1.112-1.292, P < 0.001), GDM (RR=1.478, 95%CI: 1.345-1.624, P < 0.001), PAH (RR=1.626, 95%CI: 1.367-1.934, P < 0.001), preterm birth (RR=1.384, 95%CI: 1.120-1.710, P=0.003), and LGA (RR=1.422, 95%CI: 1.224-1.650, P < 0.001) continued to rise. Conclusion: MASLD during pregnancy is associated with an increased risk of multiple adverse pregnancy outcomes, and the type and severity of CMRF abnormalities significantly influence this association. These results suggest that attention should be paid to the specific CMRF abnormalities when diagnosed MASLD, as this may help to facilitate targeted interventions and reduce the risk of adverse pregnancy outcomes.

Objective: To describe the epidemiological characteristics of 22 common respiratory pathogens in patients with pneumonia in Yinzhou, Ningbo, from January 1, 2015 to December 21, 2024. Methods: The test data of 22 common respiratory pathogens in patients diagnosed with pneumonia or lung infection in the Yinzhou Regional Health Information Platform from January 1, 2015 to December 21, 2024 were collected. The positive cases, positive rates, and positive proportions were calculated. The epidemiological characteristics were described by the year, sex, age group, season, and coronavirus disease 2019 (COVID-19) pandemic period. Results: A total of 77 531 pneumonia patients were included, with 492 696 respiratory pathogen tests performed. The number of respiratory pathogen tests and positive cases of pneumonia patients in Yinzhou showed an upward trend. In the study, 34.63% of the pneumonia patients tested positive for at least one pathogen, and the pathogen non-detection rate decreased from 79.44% in 2015 to 58.38% in 2024. The overall pathogen positive rate was 9.12%, which decreased during the COVID-19 pandemic and had not returned to the historical level after the COVID-19 pande- mic. The positive rate was highest in children aged 6-17 years (13.99%), and lowest in the elderly over 60 years (4.16%). The top 3 highest number of positive cases was Mycoplasma pneumoniae, influenza A virus, and influenza B virus; the top 3 highest positive rates of pathogen tests were Mycoplasma pneumoniae (25.26%), rhinovirus (12.02%), and Bordetella pertussis (11.66%). The pathogen spectrum proportion in men was similar to that in women, only showing a higher ratio of Mycobacterium tuberculosis and a slightly lower ratio of Mycoplasma pneumoniae (P < 0.001). Mycoplasma pneumoniae, respiratory syncytial virus, and rhinovirus infections were more common in children, while influenza virus, Mycobacterium tuberculosis, and Streptococcus pyogenes infections were more common in adults and the elderly (P < 0.001). Influenza virus and human metapneumovirus infections were more common in winter, rhinovirus and Bordetella pertussis infections were more common in spring, and Mycoplasma pneumoniae infections were relatively more common in fall (P < 0.001). After the COVID-19 pandemic, the proportions of rhinovirus, respiratory syncytial virus, and human metapneumovirus infections in the pneumonia patients increased signi-ficantly, reaching 7.53%, 4.26%, and 2.25%, respectively, while the proportions of influenza B virus and Mycobacterium tuberculosis infections decreased to 4.14% and 2.80%, respectively (P < 0.001). Conclusion: In the past decade, the scale of respiratory pathogen infection in the pneumonia population in Yinzhou had expanded significantly, and there were differences in distribution by the year, gender, age group, and season. The respiratory pathogen spectrum in pneumonia patients after the COVID-19 pandemic had a trend of diversification.

Objective: To analyze the characteristics of Hashimoto thyroiditis (HT) and Graves disease (GD), two autoimmune thyroid diseases aged 10-59 in Qingdao City from 2022 to 2024, and to provide scientific basis for making targeted prevention and treatment measures. Methods: A cross-sectional study design was adopted, based on the data of the Regional Health Information Platform in Qingdao, the confirmed cases of HT and GD from 2022 to 2024 were included, and combined with the data of the seventh population census, the three-year and annual prevalence rates of HT and GD were calculated, and the time trend of annual prevalence was analyzed by Cochran-Armitage trend test. The distribution characte-ristics of HT and GD prevalence in different age groups and regions were analyzed, and Chi-square test was used to compare the differences between the groups. Results: The total number of HT patients among women aged 10-59 in Qingdao City from 2022 to 2024 was 40 362. The proportion of HT patients in 30- 34 years old was the highest (19.83%). The proportion of HT patients in Huangdao District was the highest (17.72%). The three-year prevalence of HT was 1 206.53/100 000. In 2022-2024, the annual prevalence of HT increased significantly (P < 0.001), from 385.32/100 000 in 2022 to 1 206.32/ 100 000 in 2024. The three-year prevalence of HT was significantly different in age distribution (P < 0.001). The three-year prevalence of HT in 25-29 years (2 354.44/100 000) and 35-39 years (2 022.20/100 000) was higher than that in other age groups, showing a bimodal distribution. There were significant differences in the three-year prevalence of HT in different regions (P < 0.001), among which the three-year prevalence of HT in Shinan District was the highest (2 392.90/100 000), followed by Licang District (1 492.41/100 000), and Laixi City was the lowest (659.940/100 000). The total number of GD patients was 2 095, among which the proportion of GD patients in the 35-39 age group was the highest (15.42%), and the proportion of GD patients from Jimo District was the highest (12.27%). From 2022 to 2024, the three-year prevalence rate of GD was 62.63/100 000, and the annual prevalence rate of GD showed an increasing trend (P < 0.001), from 20.33/100 000 in 2022 to 62.63/100 000 in 2024. There were significant differences in the prevalence of GD by age (P < 0.001). The three-year prevalence of GD reached the highest value in the 25-29 age group (98.90/100 000), followed by the 35-39 age group (85.21/100 000), and the lowest in the 10-14 age group (14.43/100 000). In the regional distribution, there were significant differences in the 3-year prevalence of GD (P < 0.001). Laoshan District had the highest three-year prevalence of GD (107.58/100 000), followed by Shinan District (97.83/100 000) and Huangdao District (28.92/100 000). Conclusion: The three-year pre-valence of HT and GD in females aged 10-59 years in Qingdao City from 2022 to 2024 is low, but the annual prevalence is on the rise, and the three-year prevalence of HT and GD in females aged 25-39 years is higher than that in other age groups, so it is necessary to strengthen the screening and monitoring of this population.

Objective: To construct a tripartite game model involving the government, the public, and the pharmaceutical industry alliance during public health emergencies, revealing the dynamic mechanisms of health-related information quality regulation and exploring effective strategies to optimize the information dissemination environment through reward-punishment mechanisms. Methods: Based on evolutionary game theory, a tripartite evolutionary game model was established, integrating strategy spaces, payoff functions, and parameter definitions for each stakeholder. The pharmaceutical industry alliance ' s strategies included publishing high- or low-quality information (α), the public ' s strategies encompassed rational analysis or passive response (β), and the government's strategies involved regulatory enforcement or inaction (γ). Key parameters, such as economic benefits (I_yy), regulatory costs (C_zf), penalties (F_yy), and incentives (P_yy), were quantified to reflect real-world scenarios. Replicator dynamic equations and Jacobian matrices were derived to analyze the stability of equilibrium points, while MATLAB 2016a simulations were conducted to validate the model under varying initial conditions (e.g., I_yy=100, 150, 200; P_yy=0, 20, 35; F_yy=0, 10, 20). Sensitivity analyses examined the impact of critical parameters on system evolution, by 50 iterative simulations to observe convergence patterns. Results: The study revealed three key findings: (1) Public rational discernment (β) significantly influenced the pharmaceutical industry ' s strategy. Simulations demonstrated that increasing I_qz(benefits of information acquisition) reduced C_qz (cognitive costs), elevating β from 0.4 to 0.8 and driving α (high-quality information probability) to stabilize at 1. (2) Government regulatory intensity (γ) correlated positively with the social hazards of low-quality information. When F_yy+ P_yy>I_yy, speculative behaviors decreased, achieving equilibrium at α=1. (3) Dual stable equilibria emerged: a high-quality equilibrium (α=1, β=1, γ=0) with lower regulatory costs and a low-quality equilibrium (α=0, β=0, γ=1) associated with higher social risks. Phase diagrams illustrated path dependency, where initial α < 0.5 led to the low-quality equilibrium unless dynamic penalties (F_yy>20) and incentives (P_yy>30) were enforced. Conclusion: A "carrot-stick" collaborative governance framework is proposed, emphasizing categorized regulation, AI-enabled auditing, and dynamic penalty systems. Future research should integrate emotional utility functions to address irrational decision-making impacts, thereby enhancing the adaptability of health information regulatory systems.

Objective: To comprehensively investigate how the willingness of patients with type 2 diabetes mellitus to use E-health technologies, such as the application (APP) or Wechat mini-programs and the underlying influencing factors works for its mechanisms. Methods: Based on the extended technology acceptance model, a cross-sectional questionnaire survey was conducted among 559 patients with type 2 diabetes from six provinces or municipalities in the eastern, central, and western regions of China from November to December 2024. The survey aimed to investigate the patients' willingness to use APP or Wechat mini-programs and the influencing factors. Correlation analysis and structural equation modeling methods were used to analyze the influencing factors of patients ' willingness to use and to explore the mechanisms. Results: A total of 559 patients were surveyed, with an average willingness score of 10.68 (out of a total score of 15). Age and education level were found to be influencing factors of willingness to use, younger age and higher education (high school/college) were significantly associated with stronger willingness to use (P < 0.05). Spearman correlation analysis revealed that perceived usefulness, perceived ease of use, disease perception, social support, self-efficacy, and external cues were positively correlated with willingness to use, while perceived barriers were negatively correlated (all P < 0.05). Structural equation modeling demonstrated direct effects of perceived usefulness (β=0.375, P < 0.001), disease perception (β=-0.240, P < 0.001), self-efficacy (β=0.313, P=0.019), social support (β=-0.336, P=0.042), and external cues (β=0.609, P < 0.001) on willingness to use. Perceived ease of use indirectly influenced willingness through perceived usefulness (total effect=0.374). Self-efficacy affected usage intention partially mediated by disease perception, external cues influenced intention through perceived usefulness, and perceived barriers impacted intention via perceived usefulness, with external cues exhibiting the strongest total effect (β=0.672). All these effects were statistically significant (P < 0.05). Conclusion: Patients with type 2 diabetes mellitus have a high willingness to use E-health technologies like APP or Wechat mini-programs, particularly younger individuals and those with high school/college education. Increasing perceived usefulness, self-efficacy, and external promotion can enhance willingness to use. However, higher disease perception and higher social support are associated with decreased willingness to use. Perceived ease of use and self-efficacy can also affect willingness to use through multiple mechanisms.

Objective: To analyze the association between healthcare workers mental health, institutional supplies and facilities, inter-organizational coordination during infectious disease outbreaks, and the healthcare institution resilience. Methods: An online questionnaire survey was conducted among the healthcare workforce from 146 institutions in Beijing from January 13, 2023 to February 9, 2023, and a total of 1 434 eligible respondents were included. The sample comprised 408 responses from tertiary hospitals, 117 from secondary hospitals, and 909 from primary care institutions. The resilience indicator for healthcare institutions was defined as the degree to which medical services met patient demands, with influencing factors including physical factors, such as material shortages and facility space adaptation or expansion, organizational factors such as information sharing and patient referral, and psychological factors were evaluated using job satisfaction (extrinsic satisfaction, intrinsic satisfaction), burnout (emotional exhaustion, depersonalization, reduced personal accomplishment), and depression status. Ordered multiclassification Logistic regression was used to examine the impact of various factors on the degree to which healthcare services met patient needs; additionally, demographic factors that might influence institutional resilience were controlled. Results: During the emergency response phase, 93% of hospitals maintained the capacity to meet patient needs, though tertiary hospitals demonstrated significantly higher rates of service inadequacy (21.05%). Material shortages were reported across all institutions, with tertiary hospitals experiencing more frequent multi-item shortages. Inter-institutional collaboration patterns revealed substantial variation: 87.50% of primary care facilities, 42.86% of secondary hospitals, and 31.58% of tertiary hospitals. Healthcare workers across all levels reported mild depressive symptoms and moderate-to-severe burnout levels. Regression analysis showed high satisfaction (overall satisfaction β=0.04, extrinsic satisfaction β=0.06, and intrinsic satisfaction β=0.08), low degree of job burnout (emotional exhaustion β=-0.04, depersonalization β=-0.07 and reduced personal accomplishment β=0.01), low degree of depression (β=-0.06) were significantly associated with higher healthcare institution resilience. In addition, material shortages were significantly associated with lower resilience, and renovation and expansion of treatment spaces, and information sharing, were all associated with higher resilience. Demographic factors (age, gender, marital status, educational background, etc.) had no significant impact on resilience. Conclusion: Mental health status significantly influences healthcare institution resilience. As human resources constitute the core asset of healthcare institutions, strategic optimization of workforce allocation and psychological support interventions can effectively strengthen resilience. Moreover, healthcare institution resilience is positively impacted by orderly material supply chains, timely resource distribution, and adaptive reconfiguration of clinical spaces. Finally, facilitating information sharing also enhances institutional resilience.

Objective: To explore the prospective association between physical activity level and mortality risk in Chinese adults with chronic obstructive pulmonary disease (COPD). Methods: Based on the China Kadoorie Biobank (CKB) who had COPD at the baseline survey, this study employed the Cox proportional hazards regression model to estimate the prospective associations between the overall physical activity, different intensities (low-level, moderate-to-vigorous-level), and types (occupational, non-occupational) of physical activity level and the risks of all-cause and cause-specific mortality, such as vascular diseases, cancer, and respiratory diseases. Based on the quintiles of physical activity level, participants were divided into five groups (Q1-Q5), with the lowest quintile group (Q1) as the reference group. Hazard ratio (HR) and 95% confidence interval (95%CI) were calculated for the remaining. In our study, we also performed sensitivity and subgroup analyses, including age, gender, self-rated health status, severity of COPD, etc. Results: Among 33 588 COPD patients at the baseline survey, 8 314 (22.2%) deaths were documented during an average follow-up of (11.1±3.1) years. Negative linear associations between the overall physical activity level and mortality risk from all-cause, vascular, and respiratory diseases were observed (P trend for linear correlation being < 0.001, 0.002, < 0.001). Compared with the lowest quintile group of total physical activity (Q1), the hazard ratios (HR) and 95% confidence intervals (CI) for all-cause mortality, vascular disease mortality, and respiratory disease mortality in the highest quintile group (Q5) were 0.77 (0.70, 0.85), 0.77 (0.65, 0.91), and 0.58 (0.48, 0.71), respectively. The low-level and moderate-to-vigorous-level physical activity were negatively associated with all-cause mortality in the COPD patients (P trend for linear correlation: 0.002, < 0.001, respectively). Compared with the lowest quintile group of low-intensity and moderate-to-vigorous intensity physical activity (Q1), the HRs (95%CI) for all-cause mortality in the highest quintile group (Q5) were 0.89 (0.82, 0.97) and 0.79 (0.72, 0.87), respectively. The occupational and non-occupational physical activity were also found to have a linear inverse association with all-cause mortality risk among the COPD patients (P trend < 0.001 and 0.015, respectively). Compared with the lowest quintile group of occupational and non-occupational physical activity (Q1), the HR (95%CI) for all-cause mortality in the highest quintile group (Q5) were 0.69 (0.61, 0.78) and 0.91 (0.84, 0.98), respectively. The associations between overall physical activity and all-cause mortality risk were stronger for patients aged 60 and above, female, and who reported poor health status (P for interaction: 0.028, 0.012, 0.010). The protective effect of total physical activity was also applicable to the COPD patients of varying severity. Conclusion: Physical activity could reduce the mortality risk in a dose-response relationship among COPD patients, regardless of its intensity and type, especially among individuals aged 60 and above, females, and those with poor self-report health status.

Objective: To describe the trend of changes in the disease burden of age-related hearing loss in China and globally from 1990 to 2021, to forecast the prevalence and years lived with disability (YLD) rates of age-related hearing loss from 2022 to 2036, and to provide a reference for the prevention and control of the disease burden associated with age-related hearing loss. Methods: Using the Global Burden of Disease 2021 (GBD2021) data, this study selected age-standardized prevalence rate (ASPR) and YLD as indicators. The disease burden and long-term trends of age-related hearing loss in China and globally from 1990 to 2021 were described by different socio-demographic index (SDI) and gender. Joinpoint regression was used to calculate the average annual percent change (AAPC) to assess the trend changes in the disease burden. Decomposition analysis was applied to explore the relative impacts of aging, population growth, and epidemiological changes on the variation in disease burden. An autoregressive integrated moving average (ARIMA) model was used to forecast the age-standardized pre-valence rate and YLD rates from 2022 to 2036. Results: The prevalence of age-related hearing loss in China in 2021 was 82 162.49 (73 288.08-89 187.21) per 100 000, higher than the global SDI level of 66 238.16 (59 982.54-72 669.82) per 100 000, the high SDI region ' s level of 57 650.42 (52 059.12-63 889.02) per 100 000, the upper-middle SDI region ' s level of 69 115.59 (62 494.18- 75 340.64) per 100 000, the middle SDI region ' s level of 72 365.56 (65 181.43-78 912.01) per 100 000, the lower-middle SDI region ' s level of 64 439.66 (58 368.22-71 468.27) per 100 000, and the low SDI region ' s level of 61 725.25 (55 749.18-68 477.67) per 100 000. The age- related hearing loss YLD rate in China was 2 762.98 [95% uncertainty interval (UI): 1 855.28-3 880.68] per 100 000, higher than the global SDI level of 2 236.75 (95%UI: 1 511.56-3 155.88) per 100 000, the high SDI region ' s level of 1 805.79 (95%UI: 1 212.69-2 577.17) per 100 000, the upper-middle SDI region ' s level of 2 316.58 (95%UI: 1 557.53-3 274.87) per 100 000, the middle SDI region ' s level of 2 480.99 (95%UI: 1 678.17-3 489.24) per 100 000, the lower-middle SDI region ' s level of 2 313.28 (95%UI: 1 578.35-3 271.50) per 100 000, and the low SDI region ' s level of 2 383.55 (95%UI: 1 623.66-3 365.68) per 100 000. From 1990 to 2021, both the prevalence and YLD rate of age-related hearing loss in China showed an increasing trend, rising by an average of 0.18% (95%CI: 0.16%-0.19%) and 0.29% (95%CI: 0.27%-0.30%) per year, respectively. The rates of increase in prevalence were the same for both men and women, with men showing a 0.18% increase (95%CI: 0.17%-0.19%, P < 0.001) and women showing a 0.18% increase (95%CI: 0.16%-0.19%, P < 0.001). However, the YLD rate increase was faster in men than in women, with men experiencing a 0.32% increase (95%CI: 0.27%-0.37%, P < 0.001) and women experiencing a 0.27% increase (95%CI: 0.26%-0.28%, P < 0.001). Decomposition analysis showed that population growth was the main factor driving the increase in prevalence and YLD rate globally and across different SDI regions. However, aging was the primary factor contributing to the increase in prevalence and YLD rate in China. ARIMA model predictions suggested that the prevalence and YLD rate of age-related hearing loss would continue to rise from 2022 to 2036, with the predicted prevalence and YLD rate in 2036 reaching 89 723.99 per 100 000 and 2 872.47 per 100 000, respectively. Conclusion: The prevalence and disease burden of age-related hearing loss in individuals aged 60 and above in China rank first globally. From 1990 to 2021, both the prevalence and YLD rate of age-related hearing loss have shown a continuous upward trend, consistently surpassing the levels observed in various SDI regions worldwide. The prevalence and disease burden of age-related hearing loss are particularly significant among elderly men. Moreover, projections indicate that the disease burden of age-related hearing loss will continue to rise over the next 15 years. Therefore, it is urgent to pay close attention to age-related hearing loss in this specific population, and early intervention measures are crucial to reduce the disease burden associated with age-related hearing loss.

Objective: To investigate the prevalence of asthenopia and dry eye, and to further explore the potential occupational hazard factors, so as to provide a theoretical basis for their prevention and control. Methods: A cross-sectional survey was conducted on the selected respondents. For visual display terminal (VDT) workers in employing organizations such as banks, colleges, and government departments, an online questionnaire independently developed by the research group was used for population surveys. Information including general information, work-related situations, work environment, visual health, and ergonomic factors was collected. The respondents were analyzed according to whether they suffered from asthenopia and dry eye. Relevant factors of asthenopia and dry eye were screened through t-test and Chi-square test. Subsequently, binary Logistic regression analysis was carried out to determine the risk factors of asthenopia and dry eye among the VDT workers. Results: The overall prevalence of asthenopia was 52.5% (235/448) and dry eye was 36.8% (165/448). There were no significant diffe-rences in the prevalence of asthenopia and dry eye among different genders, age groups, and groups of length of service in VDT work. However, the highest prevalence of dry eye was observed in underweight individuals (42.9%), followed by normal weight (40.6%), overweight (28.0%), and obese indivi-duals (17.4%). There was a significant difference in the prevalence of dry eye among different body mass index (BMI) groups (χ²=9.505, P=0.023). The lowest prevalence of asthenopia was observed among securities industry employees (22.6%), while higher rates were found in employees in companies (59.5%) and other employing organizations (68.8%). A significant difference in the prevalence of asthenopia among different employing organizations (χ²=14.832, P=0.022). The result of Logistic regression showed that a longer length of service in VDT work (OR=1.006, P < 0.001), a longer duration of VDT after working hours (OR=1.002, P=0.032), a too-bright monitor (OR=2.875, P=0.022), glare during work (OR=1.500, P=0.038), a louder noise in work environment (OR=1.586, P=0.012), work-related musculoskeletal disorders (WMSDs) (OR=4.366, P < 0.001) and other factors were independent risk factors of asthenopia, while wearing frame glasses (OR=0.452, P=0.037) was an independent protective factor. Glare during work (OR=2.198, P < 0.001), WMSDs (OR=2.226, P=0.001) and other factors were independent risk factors of dry eye, while overweight (OR=0.448, P=0.006), obesity (OR=0.228, P=0.032) were independent protective factors of dry eye. Conclusion: The prevalence of asthenopia and dry eye among VDT workers is relatively high, and it is associated with multiple risk factors. During prevention and control, attention should be paid to taking reasonable breaks during work, controlling glare, and strengthening visual health training and promotion.

Objective: To explore the distribution and clearance of ^99mTc labeled diethylenetriamine pentaacetic acid (^99mTc-DTPA) in different brain regions of adult rats after administration through brain extracellular space (ECS) pathway. Methods: After the injection of a volume of 2 μL and radioactive activity of about 3.7 MBq (100 μCi) of ^99mTc-DTPA into the caudate nucleus and thalamus of SD rats through stereotactic positioning of rat brain, the single photon emission computed tomography/computed tomography (SPECT/CT) for small animals was used for imaging at different time points, and the dyna-mic distribution and clearance of the tracer in the whole body were observed continuously. The SD rats were injected with ^99mTc-DTPA into thalamus and caudate nucleus respectively for biological distribution in vivo. They were put to death 4 h later. Their blood and urine were collected. The brain, cerebellum, heart, liver, spleen, lung, and kidney were taken and weighed by γ counter to measure its radioactivity. Results: SPECT/CT imaging results showed that after ^99mTc-DTPA was administered through brain ECS, the radioactivity was concentrated in the brain, kidney and bladder. The tracer administered to the left caudate nucleus was preferentially drained to the right cerebellum, while the tracer administered to the right caudate nucleus was preferentially drained to the left cerebellum. There was a phenomenon of “contralateral cerebellar dominant drainage” in the caudate nucleus. The thalamic area preferentially drained to the ipsilateral cerebellum after administration. Four hours after administration via ECS, high radioactive uptake appeared in urine, cerebellum and brain, followed by blood and kidney. The radioactive uptake values of heart, liver, spleen and lung were low, which were mainly excreted through urinary system. Conclusion: Intracerebral ECS administration is a promising method of administration, but there are significant differences in distribution and clearance in different brain regions. This study further expands the content and significance of “ECS regions”, and also provides an important theoretical foundation for the treatment of encephalopathy and the research of new drugs through brain ECS in the future.

Objective: To construct a long non-coding RNA (lncRNA) model based on ferroptosis and predict the prognosis of non-small cell lung cancer (NSCLC) patients after radiotherapy, to develop a comprehensive framework that integrates genomic data with clinical outcomes, and to identify lncRNA associated with ferroptosis and evaluate their predictive power for patient survival and progression-free survival following radiotherapy. Methods: This study commenced by acquiring standardized transcriptome data from primary tumors and normal tissues, along with corresponding clinical information, from the cancer genome atlas (TCGA) database. This dataset provided a robust foundation for identifying differentially expressed genes (DEGs) related to ferroptosis. These analyses helped pinpoint specific pathways and biological processes involved in ferroptosis, such as glutathione metabolism, lipid signaling, oxidative stress, and reactive oxygen species (ROS) metabolism. Subsequently, univariate and multivariate Cox regression analyses were conducted to construct a predictive model based on lncRNA associated with ferroptosis. The goal was to differentiate between the high-risk and low-risk groups of NSCLC patients who had undergone radiotherapy. By incorporating these lncRNA into the model, we aimed to provide a more accurate prediction of patient outcomes. The performance of the model was validated by comparing the survival rates and progression-free survival between the high-risk and low-risk groups. Additionally, differences in gene expression patterns and pathway activities between these two groups were examined to further validate the model's effectiveness. Results: Our analysis revealed that the differentially expressed genes related to ferroptosis were significantly enriched in several key pathways, including ferroptosis itself, glutathione metabolism, lipid signaling, and processes involving oxidative stress and ROS metabolism. Based on these findings, we constructed a prognostic model using 14 lncRNA that showed strong associations with ferroptosis. Further data analysis demonstrated that these lncRNA could independently predict the prognosis of NSCLC patients after radiotherapy. Specifically, age, stage, and gender were used as clinical pathological variables, and the results indicated that the high-risk group of NSCLC patients had a poorer prognosis following radiotherapy. This finding underscores the potential of the model to serve as a valuable tool for predicting prognosis for NSCLC patients undergoing radiotherapy. Conclusion: The risk model developed in this study can independently predict the prognosis of NSCLC patients after radiotherapy. This model provides a solid basis for understanding the role of ferroptosis-related lncRNA in the prognosis of NSCLC patients following radiotherapy. Furthermore, it offers clinical guidance for combining radiotherapy with ferroptosis-targeted treatments, potentially improving therapeutic outcomes for NSCLC patients. The integration of genomic and clinical data in this study highlights the importance of personalized medicine approaches in oncology, paving the way for more precise and effective treatment strategies.

Objective: To analyze the changes of intestinal flora in patients with benign and malignant colorectal tumors in high altitude areas and to compare them with the normal population in low altitude areas. Methods: The clinical data of 61 patients who underwent colonoscopy in the People' s Hospital of Tibet Autonomous Region from 2020 to 2022 were collected as the high altitude group. According to the colonoscopy results, they were divided into control group (29 cases), non-adenomatous polyp group (12 cases), adenoma group (10 cases), colorectal cancer group (10 cases). 17 patients who had negative colonoscopy results in the Peking University Third Hospital during the same period were collected as the low altitude control group. Before bowel preparation for colonoscopy, the fecal samples were collected. Then the DNA of bacteria in the fecal samples was extracted. The V3-V4 variable region of the 16S rRNA gene was PCR amplified and high-throughput sequenced. The species diversity of fecal flora was analyzed. Results: Alpha diversity analysis showed that the species diversity of samples from the high altitude colorectal cancer group differed statistically from that of the high altitude non-adenomatous polyp group and the low altitude control group, and the species diversity of colorectal samples from the high altitude colorectal cancer group was higher than that of the other two groups. While beta diversity showed no significant difference among the five groups. Differences were found in phylum level analysis that the abundance of Actinobacteriota in the low altitude control group was significantly lower than those in each group of the high altitude area, while the abundance of Actinobacteriota in the colorectal cancer group was significantly lower than those in the other 3 groups of the high altitude area. Differences were found in genus level analysis that the abundance of Bacteroides, Phascclarctobacterium and Lachnoclostridium in the low altitude control group was significantly higher than those of all the groups in the high altitude area; the abundance of Blautia and Collinsella in the high altitude control group was the highest. Lactobacillus was not detected in the low altitude control group, while there was a highly significant difference (P < 0.05) in the level of Lactobacillus in the four groups of high altitude area, and the abundance of Lactobacillus was significantly higher in the control group than those of the other three groups. In the four groups of samples at high altitude, the abundance of Bifidobacterium decreased significantly, while the abundance of Christensenellaceae_R-7_group increased significantly. Conclusion: Compared with the high and low altitude controls, the diversity and abundance of intestinal flora in patients with colorectal benign and malignant tumors at high altitudes are different. And the abundance of species are also diffe-rent at the phylum and genus levels, suggesting that altitude factors may have some influence on intestinal flora.

Objective: To describe the epidemiological characteristics and changes of febrile seizure (FS) among children under 6 years old in Ningbo City, Zhejiang Province from 2015 to 2021. Methods: Based on the Ningbo Regional Health Information Platform, a dynamic cohort was established using vaccination registration information, and the cases of FS were identified by the diagnostic results of Chinese terms or International Classification of Diseases 10th revision (ICD-10) R56.0 code in the electronic medical records. The first visit of FS during the observation period was defined as a new case, and a recurrence case was defined as the case with a visit interval of more than 7 days. The 95% confidence interval (CI) of FS incidence density was calculated by the Poisson distribution. Results: From January 2015 to June 2020, there were 1.3 million children under 6 years old in Ningbo, with male accounting for 52.87%. The median follow-up time was 2.83 (1.55-4.00) years. During the follow-up period, 12 776 new onset cases had FS, with more males than females, with an overall incidence density of 4.34 (95%CI 4.27-4.40)/1 000 person-years and a recurrence rate of 21.63%. There was a higher incidence density in children who were male, born in Ningbo and of non-mobility. The incidence density of FS was higher in urban areas than in rural and rural-urban fringe areas, and the incidence density was different among districts and counties. The peak density was found in children aged 18-23 months [8.42 (95%CI 8.11-8.74)/1 000 person-years]. From 2015 to 2019, the incidence density increased with calendar year (P_trend < 0.001), and the highest was 5.62 (95%CI 5.43-5.81) /1 000 person-years. The incidence density of FS decreased significantly during the period between 2020 and 2021. The incidence density was higher in winter. Conclusion: From 2015 to 2019, the overall incidence density of FS in children under 6 years old in Ningbo City presented an increasing trend. More attention should be paid to the health education, the improvement of the health maintenance model, the enhancement of the cognition of FS, the identification and treatment of FS among high-risk population and regions so as to prevent its recurrence and reduce the disease burden during the corona virus disease 2019 (COVID-19) epide-mic.

Objective: To compare the pregnancy outcomes of surviving fetuses in monochorionic diamniotic (MCDA) twin pregnancies after selective feticide or spontaneous single intrauterine fetal demise (sIUFD), and to explore the influencing factors of prognosis. Methods: A total of 219 cases of intra-uterine death of one fetus in MCDA twin pregnancies admitted to Peking University Third Hospital from September 2010 to August 2021 were collected. According to the mode of fetal death, they were divided into the spontaneous sIUFD group (120 cases) and the selective feticide group (99 cases). Data on the maternal conditions during pregnancy, the situation of the intrauterine-dead fetus, and pregnancy outcomes were collected for retrospective case-analysis. Results: The live-birth rates of surviving fetuses in the spontaneous sIUFD group and the selective feticide group were 85.0% and 81.8% respectively, and the total perinatal survival rates of surviving fetuses were 73.3% and 81.8% respectively, and there were no statistically significant differences. Compared with the spontaneous sIUFD group, the selective feticide group had a greater gestational week at delivery, and lower rate of preterm birth before 37 weeks, neonatal asphyxia, and early neonatal mortality. Using the gestational week at delivery as the outcome variable, Cox regression analysis showed that the mode of fetal death was not a risk factor affecting the gestational week at delivery of the surviving fetus, while gestational hypertension and the gestational week of fetal death were independent risk factors affecting the gestational week at delivery of the surviving fetus. Using preterm birth before 37 weeks, intrauterine death of the surviving fetus, and abnormal neonatal cranial ultrasound as outcome variables respectively, unconditional logistic regression analysis showed that the mode of fetal death, the gestational week of fetal death, the position of the dead fetus, and fetal complications were independent risk factors affecting the outcomes of the above-mentioned surviving fetuses. According to the results of the univariate analysis, the above risk factors were included in the multivariate regression analysis, and the results were the same as those of the univariate analysis. Conclusion: For MCDA twin pregnancy patients with severe twin-related complications, the prognosis of surviving fetuses after selective feticide is better. The proactive intrauterine intervention and treatment are of great significance for improving the prognosis of surviving fetuses.

Objective: To identify predictors of adverse pregnancy outcomes (APOs) in patients with systemic lupus erythematosus (SLE). Methods: A retrospective analysis was conducted on 318 SLE patients who delivered at Peking University People' s Hospital from May 2016 to September 2021. These patients were categorized into two groups The APOs group (n=85) and the non-APOs group (n=233). Various factors, including disease duration, clinical manifestations, laboratory parameters, and systemic lupus erythematosus disease activity index 2000 (SLEDAI-2000) scores, were analyzed for their association with APOs. SPSS 26.0 software was used to analyze the data. Results: The mean age of SLE patients in this study was (24.65±5.26) years. Among the 318 pregnancies studied, 302 (302/318, 94.97%) resulted in live births, while 16 (16/318, 5.03%) cases ended in stillbirths, with no neonatal deaths reported. Among the live births, 206 (206/302, 68.21%) were full-term infants, 65 (65/302, 21.52%) cases were small for gestational age (SGA), and 31 (31/302, 10.26%) cases were preterm. The SLEDAI-2000 scores were significantly higher in the APOs group compared with the non-APOs group (5.82±4.97 vs. 3.74±3.72, t=4.019, P=0.001), suggesting greater disease activity as a risk factor. Similarly, glucocorticoid doses were markedly higher in the APOs group [12.50 (7.50, 50.00) mg vs. 10.00 (5.00, 15.00) mg, P < 0.001], underscoring the link between disease severity and APOs. Univariate analysis revealed that lupus nephritis (31.76% vs. 21.03%, χ²=3.946, P=0.047), thrombocytopenia (24.71% vs. 9.01%, χ²=13.380, P < 0.001), hypocomplementemia (36.47% vs. 26.03%, χ²=4.847, P=0.028), antiphospholipid antibody positivity (20.00% vs. 11.16%, χ²=4.163, P=0.041), and absence of pregnancy treatment (21.18% vs. 11.59%, χ²=4.713, P=0.030) were associated with increased APOs risk. Multivariate Logistic regression identified thrombocytopenia (OR=2.671, 95%CI 1.309-5.449, P=0.007), hypocomplementemia (OR=1.935, 95%CI 1.104-3.393, P=0.021), and antiphospholipid antibody positivity (OR=2.153, 95%CI 1.054-4.399, P=0.035) as independent predictors of APOs. Conclusion: These findings highlight that certain clinical and laboratory features, including thrombocytopenia, hypocomplementemia, and antiphospholipid antibody positivity, are critical independent predictors of APOs in SLE patients. The study underscores the importance of close monitoring and proactive management of these risk factors to improve pregnancy outcomes in SLE patients.

Objective: To analyze the fitness of zirconia and lithium disilicate glass-ceramic onlays fabricated with direct and indirect computer-aided design and computer-aided manufacturing (CAD/CAM) technology in vitro. Methods: In the study, 48 standardised typodont left mandibular first molars received standardised onlay preparation. Then, all the specimens were randomly divided into 4 groups. There were 12 specimens in each group. The preparation quality was checked under the stereomicroscope. All the specimens were fixed in typodonts. Subsequently, the typodonts were fixed in the dental simulators to simulate the oral conditions. In groups A and B, the digital impressions were obtained by using the intraoral scanner. In groups C and D, conventional impressions of polyether impression material were obtained according to the instructions of the manufacturer using individual trays. The stone casts were made with type Ⅳ gypsum later. Then, all casts were digitized with the model scanner. Based on the data obtained from the scan, onlay restorations of all the groups were designed using the corresponding software, the simulated cement thickness was set to 50 μm. Then, the final onlays restorations of all the groups were machined with the milling machines in lab. The fabrication materials were different in groups. The specimens of groups A and C were fabricated with zirconia. While, the specimens of groups B and D were fabricated with lithium disilicate glass-ceramic. The marginal gap and internal gap of all restorations were analyzed by 3D replica technique, for each measurement, the specimen was digitised using the model scanner. Results: The marginal gap of the onlays fabricated with indirect digital impressions were smaller than that with direct digital impressions (P < 0.05). At the same time, the internal gap of the onlays fabricated with indirect digital impressions were smaller than that with direct digi-tal impressions (P < 0.05). The marginal gap was larger in distal gingival than that in the other regions in all the groups (P < 0.05). Different fabrication materials, zirconia or lithium disilicate reinforced glass-ceramic, had no effect on onlay marginal and internal fit (P>0.05). Conclusion: The marginal and internal adaptation of the onlays fabricated with indirect digital impressions was better than with direct digital impressions. Zirconia and lithium disilicate reinforced glass-ceramic had no effect on the onlay adaptation.

Hip fractures are common in elderly patients and are associated with significant morbidity and mortality, often referred to as the "last fracture of life". These fractures frequently result in a loss of functional independence. Evidence suggests that early surgical intervention can reduce mortality. The selection of treatment modality should take into account factors such as the type of fracture, the patient' s age, and overall health status. This case report discusses an 88-year-old female patient who sustained an unstable intertrochanteric fracture of the left femur following a fall. She underwent closed reduction and internal fixation using an InterTAN intramedullary nail, resulting in a satisfactory postoperative recovery. Sixteen months following the surgical procedure, the patient presented with progressive pain in the left hip and ambulatory difficulties, absent from any evident trauma. Radiographic analysis identified a fracture of the left femoral neck accompanied by some degree of acetabular bone degradation attributable to the implant. Subsequently, the patient underwent removal of the internal fixation device and received a hemiarthroplasty. The postoperative course was uneventful, with marked improvements in both pain levels and functional capacity. This case underscored the intricate nature of femoral neck fractures following the internal fixation of intertrochanteric fractures. Contributing factors may include advanced age, osteoporosis, and stress shielding induced by the implant. In patients presenting with hip pain or gait disturbances months to years post-intertrochanteric fracture surgery, the potential for a new fracture should be consi- dered, even in the absence of an explicit traumatic incident. Radiographic imaging is imperative to exclude the presence of a fracture, particularly in individuals with high-risk factors such as advanced age, osteoporosis, alcohol abuse, and a history of hormone therapy. Management of such cases may necessitate the removal of internal fixation devices and the implementation of hemiarthroplasty or total hip arthroplasty, contingent upon the patient ' s surgical tolerance. Crucially, anti-osteoporosis therapy serves as a vital preventive strategy. Considering the high-risk profile of elderly patients with hip fractures, diligent follow-up and timely intervention are paramount to mitigating complications and mortality, thereby enhancing the quality of life for these patients. This case highlights the critical need for increased vigilance and comprehensive management of elderly patients with hip fractures to enhance treatment outcomes and improve prognosis.