Objective: To evaluate the impact of international pooled procurement mechanisms, which are primarily represented by the United Nations Children ' s Fund (UNICEF) and the Pan American Health Organization (PAHO), on the procurement prices of vaccines. Methods: Based on 14 497 vaccine procurement transaction records collected from 188 different countries spanning the period from 2013 to 2024, this research employed a high-dimensional fixed effects model along with an event study metho-dology to accurately identify the price effects and dynamic temporal trends, while simultaneously conducting a multidimensional heterogeneity analysis. Results: (1) The baseline model demonstrated that, when compared to the independent self-procurement conducted by individual nations, utilizing pooled procurement through the UNICEF significantly reduced the average vaccine prices by 27.6% (β=-0.323, P < 0.01). The PAHO mechanism similarly exhibited an initial price reduction potential of approximately 30.9% (β=-0.370, P=0.052). (2) The event study method strictly validated the parallel trend assumption (joint significance test of pre-treatment coefficients: F=0.27, P=0.845). Dynamic tracking revealed that a price reduction of approximately 30.0% (β=-0.356, P < 0.01) was achieved exactly in the year of transitioning from self-procurement to pooled procurement, and this reduction effect remained persistently stable in subsequent years. (3) Heterogeneity tests revealed a significant "pro-poor" effect of pooled procurement: the price reduction margin obtained by small-scale buyers (38.5%, β=-0.487, P < 0.01) was significantly higher than that of large-scale buyers (22.5%, β=-0.255, P < 0.01). The marginal price reduction coefficient for non-Global Alliance for Vaccines and Immunization (GAVI) eligible countries (β=-0.418, P < 0.01) was substantially larger than that for GAVI eligible countries (β=-0.118, P < 0.05). The high-income country group experienced the most substantial price drop (β=-0.475, P < 0.01). (4) The supply-side moderating effect analysis indicated that UNICEF' s collective bargaining power maintained robustness across diverse market structures, showing no statistically significant attenuation despite increases in market concentration (interaction term β=0.095, P>0.10). Conclusion: Institutionalized pooled procurement mechanisms are capable of significantly reducing vaccine prices. For those countries that are currently in the immunization financing transition period, as well as those facing high self-procurement benchmark prices, participating in an efficient international pooled procurement platform serves as a critical institutional arrangement to replace external financial aid and to effectively maintain the long-term affordability of vaccines.

Objective: To evaluate priority target countries and formulate context-specific cooperation modalities for China ' s bilateral international collaboration on human papillomavirus (HPV) vaccines, thereby furnishing an evidence-based reference for optimizing China ' s bilateral vaccine cooperation stra-tegies and contributing to global health equity. Methods: Using a previously established index system designed for selecting preferred countries in China ' s international vaccine cooperation, we comprehensively applied a weighted-scoring approach to quantitatively rank 29 Phases 3 and 4 Global Alliance for Vaccines and Immunization (Gavi) eligible countries in HPV vaccine cooperation. Based on 5 first-level index (legal and regulatory factors, economic factors, political factors, social factors, and technological factors) scores, a hierarchical K-means hybrid method was used for clustering the countries. Hierarchical clustering was initially utilized to explore the underlying data structure and determine the optimal number of clusters, followed by K-means clustering to precisely categorize the evaluated nations based on their multidimensional characteristics. Results: The top10 countries were mostly Asian countries. African countries were mostly in the lower ranks. The countries were clustered into three types: (1) Technology transfer priority (n=3: Indonesia, Viet Nam, Uzbekistan), characterized by above-average economic, techno-scientific and political scores, robust vaccine-import volumes, non-negligible domestic manufacturing capacity and high political stability—recommended for priority collaboration; (2) Basic assistance (n=25), approximating mean indicator values, typically low-population or low-income economies suitable for aid-based or concessional-procurement models; (3) High barrier (n=1: India), exhibiting high socio-demographic and scientific base yet minimal legal-regulatory scores, indicating large demand, established vaccine industry, but formidable registration barriers. Policy recommendations included: concessional product export plus clinical-trial cooperation with Indonesia, with prospective licensing and technology transfer; clinical-trial collaboration with Viet Nam; and licensing/technology-transfer schemes with Uzbekistan. Conclusion: Indonesia, Viet Nam, and Uzbekistan are identified as the priority target countries for China ' s bilateral international cooperation on HPV vaccines. For these technology-transfer priority nations, cooperation should be strategically conducted through diverse modalities encompassing vaccine product export, clinical trial collaboration, authorized licensing, and technology transfer.

Objective: Using the China Family Panel Studies (CFPS, 2012-2022), this study aimed to characterize changes in the distribution of usual sources of care and in subjective perceptions among Chinese adults, and to examine the associations of subjective perceptions and income change with next-wave transitions in usual source of care. Methods: This was a retrospective longitudinal observational study based on adult CFPS data from 2012, 2014, 2016, 2018, 2020, and 2022. We first described temporal trends in three types of usual source of care (primary care, hospitals, and clinics), as well as trends in residents' subjective perceptions of healthcare providers, and in relative income change. We then constructed person-period samples from adjacent survey waves and analyzed two transition processes separately: outflow from primary care among baseline primary care users and inflow to primary care among baseline non-primary care users. Key predictors were prior-wave satisfaction, perceived medical competence, and relative income change; the income-change variable was defined based on changes in relative income group within the same wave and same province sample. Descriptive analyses applied cross-sectional weights; the main regressions were unweighted binary Logistic models with individual-level cluster-robust standard errors, reporting odds ratios (OR), 95% confidence intervals (95% CI), and P va-lues. Results: The pooled sample comprised 135 986 observations from 34 010 individuals. From 2012 to 2022, the proportion using primary care as the usual source of care declined from 43.49% to 30.34%, whereas the hospital share rose from 34.06% to 46.81%. The decline in primary care was steeper during 2012-2018 (43.49% to 33.72%) and persisted at a slower pace thereafter (33.72% to 30.34%). Across adjacent survey waves, primary care outflow increased from 35.47% to 45.22%, while primary care inflow decreased from 30.09% to 19.60%, indicating simultaneous increases in exits and decreases in entries. Subjective perceptions improved for all three provider types over time; however, the relative gap between primary care and hospitals widened on perceived medical competence, and primary care shifted from a slight advantage over clinics to a clear disadvantage in composite subjective perceptions. The proportion of residents with unchanged relative income group rose from 50.64% to 60.33%. In multivariable models, each one-unit increase in satisfaction with primary care was associated with 7.5% lower odds of leaving primary care (OR=0.925, P < 0.001). In contrast, each one-unit increase in perceived medical competence of non-primary care providers was associated with 5.3% lower odds of moving into primary care (OR=0.947, P < 0.001). Compared with stable relative income group, upward relative income-group mobility, particularly low-to-high movement, was associated with higher odds of outflow from primary care and lower odds of inflow to primary care (outflow OR=1.166; inflow OR=0.840), whereas downward relative income-group mobility, especially high-to-low movement, showed the opposite pattern (outflow OR=0.785; inflow OR=1.371). Conclusion: Primary care utilization in China continued to decline, with increased outflow from primary care and reduced inflow to primary care occurring simultaneously. Residents ' subjective perceptions were associated with different considerations in retention in versus movement into primary care: the former was more closely related to satisfaction, whereas the latter was more closely related to perceived medical competence. People with upward relative income-group mobility showed a lower inclination to use primary care. Hierarchical care policy should address both entry into and retention in primary care by strengthening continuity of care, reinforcing service capability and institutional design, and aligning payment incentives.

Objective: One of the explicit goals of public hospital salary reform is to gradually and steadily narrow the salary gap among public hospitals. This study, taking public hospitals at different administrative levels as its starting point, seeks to investigate the differences in the formation mechanisms of performance-based pay. Methods: From June to November 2024, a purposeful sampling strategy was adopted. A total of 43 in-depth interviews were conducted across 14 public hospitals located in a certain municipality directly under the central government. These hospitals covered three administrative tiers: the national level, the provincial and ministerial level, and the prefectural and municipal level. All interview data were analyzed using grounded theory methodology. Results: Through three-level coding, a total of seven core categories were extracted: external constraints, strategic positioning, market capabilities, business structure, incentive systems, management capabilities, and personnel characteristics. These seven factors jointly influenced performance-based salary distribution in public hospitals, but their specific manifestations and interactions showed marked differences across hospitals at different administrative levels. Specifically, public hospitals at higher administrative levels might be fully exempt from wage total amount constraints, or, even when operating within the total framework, still retained a considerably large distributable space. Relying on their high-level strategic positioning, these hospitals developed strong market capabilities and a business structure dominated by high-pricing medical services. They adopted a metric-based, incremental incentive model that allocated rewards directly to individual physicians, with the incentive scope covering the entire chain of medical care, education, and research. In contrast, public hospitals at lower administrative levels faced triple constraints: insufficient bargaining power in the healthcare market, limited and unstable patient sources, and a single compensation pathway heavily reliant on service volume. Their business structure was mainly composed of low-pricing projects with limited profitability. Consequently, they were forced to adopt a position-based performance model, where the incentive scope narrowed to basic medical quality, leaving these hospitals struggling with fragile incentives and persistent talent loss. Conclusion: Public hospitals at different administrative levels present structural differences in their mechanisms for determining performance-based salaries. During the top-down transmission of reform policies, the hierarchical institutional environment, together with stratified market capabilities and management capacities, acts as a multi-layer filter. This filtering process leads to heterogeneous policy performances across different hospital tiers.

Objective: To assess the spatial accessibility of pediatric healthcare resources in Beijing and to develop an optimization model for resource allocation under a fixed additional resource constraint, with the aim of exploring optimal allocation strategies for 2025 and 2030. Methods: Using communities as the unit of analysis, this study integrated data on Beijing ' s child population in 2020 and pediatric healthcare resources in 2022. An improved two-step floating catchment area (2SFCA) method was applied to measure spatial accessibility. Based on projected child population data for 2025 and 2030, an optimization model was constructed to minimize regional disparities in accessibility. Under the constraint of a fixed total number of additional resources, optimal spatial allocation schemes were derived and compared with a conventional population-based allocation approach. Results: In 2022, Beijing had 4 704 pediatric beds and 4 011 pediatric physicians. The mean spatial accessibility for pediatric beds and pediatric physicians was 1.17 and 0.97, respectively, with a standard deviation of 2.78 for bed accessibility, exhibiting a clear spatial pattern of higher accessibility in central districts and lower accessibility in suburban districts. In the same year, the number of pediatric physicians per 1 000 children in Beijing reached 1.52, already exceeding the targets for 2025 and 2030; therefore, no additional increase in total physician numbers was required. Under the 2025 optimization scenario, the mean accessibility of pediatric beds increased to 1.68, with the standard deviation declining to 2.45, indicating a reduction in regional disparities. Under the 2030 scenario, the mean accessibility further increased to 2. 31, with a standard deviation of 2.56, reflecting continued improvement in accessibility. The optimization model identified Daxing District, Tongzhou District, and Mentougou District as priority districts for additional bed allocation, whereas the conventional population-based approach allocated more resources to Daxing District, Haidian District, and Tongzhou District. While the two approaches showed general consistency in overall spatial allocation, the optimization model more effectively addressed inter-district disparities in accessibility. Conclusion: Significant spatial disparities were identified in the distribution of pediatric healthcare resources in Beijing. The accessibility-oriented optimization approach, under a fixed resource constraint, improved the alignment between supply and demand and reduced regional inequities. It served as a useful complement to conventional population-based allocation methods and provided quantitative evidence to support refined planning and dynamic adjustment of pediatric healthcare resources. Given that the total number of pediatric physicians has already met national targets, leveraging integrated medical consortium and multi-site practice policies to promote the mobility of qualified pediatric physicians toward underserved areas represents a promising pathway toward structural optimization of spatial resource distribution.

Objective: To systematically investigate the associations between umbilical cord blood protein expression profiles and early infant neurodevelopment using a prospective birth cohort, to identify potential early biomarkers through high-throughput proteomics, and to explore underlying biological mechanisms, thereby providing scientific evidence for early identification of neurodevelopmental risks and understanding the molecular basis of neurodevelopmental deviations in general populations. Methods: Based on the Peking University Birth Cohort in Tongzhou, this study enrolled 96 children who completed ages and stages questionnaires, third edition (ASQ-3) assessments at 1 and 3 years of age. Participants were classified into an abnormal group (n=42) and a control group (n=54) according to ASQ-3 screening results. Non-targeted quantitative proteomics was performed on cryopreserved umbilical cord blood plasma samples collected at birth. Differential expression analysis, principal component analysis (PCA), orthogonal partial least squares discriminant analysis (OPLS-DA), and weighted gene co-expression network analysis (WGCNA) were conducted to identify differentially expressed proteins, followed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) functional enrichment analyses. The fold change (FC) was calculated. Independent samples t-test was used for statistical comparison, with Benjamini-Hochberg method applied to calculate false discovery rate (FDR) for multiple testing correction. Results: Proteomic analysis identified 8 214 common proteins, among which 385 proteins were differentially expressed (P < 0.05, |log₂FC| >0.585), including 189 proteins upregulated and 196 proteins downregulated in the abnormal group. PCA and OPLS-DA revealed systematic differences in protein expression patterns between the two groups. WGCN A identified 10 co-expression modules, with the yellow module showing significant negative correlation with ASQ-3 abnormal grouping (r=-0.233, P=0.024) and the pink module positively correlating with communication domain scores (r=0.342, P=0.003). Enrichment analyses demonstrated that differential proteins and key modules were primarily enriched in two functional categories: (1) genetic information processing pathways, including ribosome, spliceosome, and mRNA processing; and (2) cytoskeleton organization and Wnt signaling pathways. These pathways held significant biological relevance in the pathogenesis of neurodevelopmental disorders. Conclusion: Perturbations in proteins associated with genetic information processing and cytoskeleton/Wnt signaling pathways in umbilical cord blood may represent important molecular characteristics of early neurodevelopmental screening abnormalities in infants. This study provides potential peripheral blood biomarker combinations for early identification of neurodevelopmental risks in general populations and offers novel insights into the biological mechanisms underlying neurodevelopmental deviations. Future research should validate these findings in larger-scale cohorts and elucidate specific functional mechanisms of key proteins through experimental studies.

Objective: To describe the incidence density of intussusception and its distribution characteristics across different ages, genders, and time periods among resident children aged 0-3 years in Jiangsu Province from 2018 to 2023, providing a scientific basis for health administrative departments in the region to formulate prevention and control strategies and measures for intussusception in children aged 0-3 years. Methods: A retrospective cohort study was conducted using data from the Jiangsu Regional Health Information Platform (RHIP). Resident children aged 0-3 years born between January 1, 2018, and December 31, 2023, were included. Suspected cases were identified by retrieving the International Statistical Classification of Diseases and Related Health Problems, 10 revision (ICD-10) code "K56.1" and semantically related keywords for "intussusception" from the original text using a regular expression matching algorithm. An incident case was defined as the first occurrence of the disease during the study period. Follow-up person-years were calculated using the exact person-time method. The Poisson distribution was applied to estimate the overall and subgroup incidence densities and their 95% confidence intervals (CI). Poisson regression models were constructed to calculate incidence rate ratio (IRR) and examine the effects of age (in months) and seasonal differences on incidence density. Results: A birth cohort comprising 2 252 691 children aged 0-3 years was established, accumulating a total follow-up of 5 316 389.55 person-years. During the study period, 2 650 incident cases of intussusception were identified, including 1 600 boys (60.4%) and 1 050 girls (39.6%). The overall incidence density was 49.8 (95%CI: 47.9-51.7) per 100 000 person-years. The incidence density was 57.8 (95%CI: 54.9-60.6) per 100 000 person-years for boys and 41.2 (95%CI: 38.7-43.7) per 100 000 person-years for girls, with a statistically significant difference between the sexes. Seasonal variations were observed, with peaks occurring in summer and winter. The incidence density exhibited a unimodal pattern, peaking at 8 months (98.5 per 100 000 person-years). The median age of onset was 19.2 months [interquartile range (IQR): 11.4-26.6 months]. Conclusion: This large retrospective cohort study based on the Jiangsu RHIP clarified the epidemiological characteristics of intussusception among local children aged 0-3 years from 2018 to 2023. Boys and children aged 8 months to 3 years were identified as high-risk populations for intussusception, with peak incidence occurring in summer and winter. These findings provide evidence-based support for health authorities to formulate targeted strategies for early surveillance, prevention, and healthcare resource allocation.

Objective: To identify joint trajectory patterns of direct and indirect maternal mortality ratios (MMR) at the country level from 2000 to 2021, and to compare phase-specific changes during the millennium development goals (MDG, 2000 to 2015) and the sustainable development goals (SDG, 2015 to 2021) periods, as well as differences in health system and policy environments across trajectory groups. Methods: Data on maternal mortality among women aged 15-49 years in 204 countries and territories from 2000 to 2021 were obtained from the Global Burden of Disease (GBD) Study. Direct cause MMR and indirect cause MMR at five time points (2000, 2005, 2010, 2015, and 2021) were jointly analyzed using longitudinal K-means clustering (k=2-6). The optimal number of clusters was determined by the Calinski-Harabasz (CH) index. Based on the clustering results, a piecewise linear mixed effects model with random intercepts was fitted with a knot in 2015 to estimate the baseline intercept in 2000 and period-specific slopes for the MDG and SDG phases. For 2021, health system and policy-related indicators, including antenatal care coverage (≥4 visits, ANC4), proportion of women with a demand for contraception that are using a modern method, cesarean section rate, female human immunodeficiency virus (HIV) prevalence, in facility delivery rate, skilled birth attendance, and an abortion legality index were compared across clusters using the Kruskal-Wallis H test. All tests were two-sided, and P < 0.05 was considered statistically significant. Results: The CH index peaked at k=3 (CH=342.63), classifying the 204 countries and territories into three joint trajectory clusters: high burden (n= 66), medium burden (n=88), and low burden (n=50). In 2021, direct MMR was 334.6 (95%CI: 282.5- 386.7), 65.6 (95%CI: 50.4-80.7), and 5.4 (95%CI: 3.7-7.0) per 100 000 live births in the high, medium, and low burden clusters, respectively; indirect MMR was 33.6 (95%CI: 27.9-39.2), 18.2 (95%CI: 13.5-22.9), and 0.9 (95%CI: 0.6-1.3) per 100 000 live births, respectively. The piecewise mixed effects model showed significant declines in direct MMR during the MDG period in all clusters (slopes: -0.020, -0.016, and -0.036; P < 0.001), whereas declines slowed and became non-significant during the SDG period (-0.011, 0.011, and -0.006; P > 0.05). For indirect MMR, modest increases were observed during the MDG period in the high and medium burden clusters (0.029 and 0.015; P < 0.05), with no significant change in the low burden cluster (P > 0.05). During the SDG period, indirect MMR increased markedly in the medium burden cluster (slope: 0.121; 95%CI: 0.092-0.151; P < 0.001), while remaining broadly stable in the high and low burden clusters (P > 0.05). Health system and policy indicators differed significantly across the clusters (P < 0.001): the high burden cluster showed lower ANC4 coverage, lower in facility delivery and skilled birth attendance, lower demand for contraception satisfied by modern methods, and higher female HIV prevalence; the medium burden cluster achieved near universal in facility delivery and skilled birth attendance but had a higher cesarean section rate; the low-burden cluster generally showed more favorable indicator profiles and a higher abortion legality index. Conclusion: Distinct joint trajectories of direct and indirect maternal mortality were observed globally from 2000 to 2021. While reductions in direct maternal mortality were substantial during the MDG era, progress broadly slowed and plateaued during the SDG era. Meanwhile, the pronounced rise in indirect maternal mortality in medium-burden countries during the SDG period suggests potential structural risk accumulation even when overall MMR appears stable. Incorporating joint direct-indirect trajectories into routine monitoring may facilitate stage and cluster specific prioritization of maternal health interventions.

Objective: To investigate the associations between maternal exposure to cold and heat exposure during the three months before pregnancy and early pregnancy and the risk of congenital heart disease (CHD) in offspring, and to identify critical exposure windows and modifying factors. Methods: This nationwide cohort study included women aged 20-49 years with complete pregnancy outcome follow-up from the National Free Pre-pregnancy Check-ups Project (NFPCP) database between January 1, 2014 and April 21, 2020. Meteorological data from the European Centre for Medium-Range Weather Forecasts Reanalysis v5 (ERA5) dataset were linked to residential addresses. Cold and heat exposure were defined based on relative thresholds stratified by climate zone: heat and cold were defined as temperatures above the 90th percentile or below the 10th percentile, respectively, of the location-specific temperature distribution during each exposure window. Cox proportional hazards models were used to analyze the associations between cold and heat exposure during the three months before pregnancy and early pregnancy and the risk of CHD, and to calculate hazard ratios (HR) and 95% confidence intervals (CI) after adjusting for maternal age, body mass index (BMI), education level, geographical region, conception season, and relative humidity. Stratified analyses were performed to examine the effects of age, BMI, and fetal sex on the associations between cold and heat exposure and the risk of CHD. Results: A total of 6 322 635 women aged 20-49 years with complete pregnancy outcome follow-up were included, and 1 478 cases of CHD were diagnosed among their offspring. The analysis showed that heat exposure during the three months before pregnancy was significantly associated with an increased risk of CHD in offspring (HR=1.49, 95%CI: 1.23-1.80); while no significant association was found for heat exposure during early pregnancy. No significant association was observed for cold exposure during the three months before pregnancy and early pregnancy (three months before pregnancy: HR=0.93, 95%CI: 0.77-1.14; early pregnancy: HR=0.95, 95%CI: 0.79-1.16). Stratified analyses showed that the risk of CHD associated with heat exposure during the three months before pregnancy was increased in women aged ≥30 years (HR=2.18, 95%CI: 1.54-3.10) and in male fetuses (HR=1.73, 95%CI: 1.31-2.29); the risk of CHD associated with heat exposure during early pregnancy was significantly increased in women with BMI ≥24 kg/m² (HR=1.86, 95%CI: 1.21-2.87). Conclusion: Heat exposure during the three months before pregnancy might increase the risk of congenital heart disease in offspring, and this risk was elevated in both women aged ≥30 years and male fetuses. Furthermore, heat exposure during early pregnancy significantly increased the risk of congenital heart disease in offspring among women with BMI ≥24 kg/m². No significant association was observed between cold exposure and the risk of congenital heart disease.

Objective: To describe the myopia prevalence and spherical equivalent among primary school students in a district of Anhui Province in 2019, to analyze their changes in 2020 and 2024, to obtain baseline data, and to explore the potential impact of changes in screen time on vision, providing scientific evidence for myopia prevention and control strategies. Methods: This cross-sectional study included all the primary school students who underwent vision screening in 2019 (baseline period), 2020 (period of increased screen time), and 2024 (period of slightly resumed screen time). Data on grade, gender, uncorrected distance visual acuity, and refraction were extracted from the screening database. Noncycloplegic refraction was assessed using an FKR-710 autorefractor to measure sphere and cylinder, and uncorrected distance visual acuity was assessed using an K238-AZ LCD visual acuity chart. The spherical equivalent was calculated as sphere + 0.5 × cylinder. Myopia was defined as uncorrected distance visual acuity < 5.0 in either eye with a corresponding spherical equivalent ≤ -0.50 D. Myopia prevalence and spherical equivalent were described using percentage and mean with 95%confidence interval (CI). The Chi-square test and One-way analysis of variance were used to compare myopia prevalence and spherical equivalent across different years, followed by stratified analysis by grade. Results: A total of 183 204 students were screened: 45 294 in 2019, 52 922 in 2020, and 84 988 in 2024. In 2019, the myopia prevalence was 30.8%(95%CI: 30.4%, 31.2%), higher in girls (33.7%) than in boys (28.4%) and increased with grade (P < 0.001), rising from 11.0%in Grade 1 to 35.7%in Grades 2-6. Compared with 2019, the myopia prevalence in 2020 increased by 4.3 (3.7, 4.9) percentage points to 35.1%(P < 0.001). By 2024, it further increased by 6.7 (6.2, 7.2) percentage points from the 2020 level to 41.8%(P < 0.001). In grade-stratified analyses, compared with 2019, Grade 1 students showed the largest increase in 2020; compared with 2020, Grade 1 students showed the smallest subsequent increase in 2024. Quantitative analysis of spherical equivalent showed that the mean spherical equivalent in 2020 was -0.72 D, representing a myopia shift of -0.21 D (-0.23 D, -0.19 D) compared with the 2019 level (P < 0.001); by 2024, the mean spherical equivalent was -0.68 D, indicating a hyperopic shift of 0.04 D (0.02 D, 0.06 D) compared with the 2020 level (P < 0.001). Further grade-stratified analyses indicated that the mean spherical equivalent for Grade 1 students in 2024 (0.08 D) had nearly returned to the 2019 level (0.09 D). Conclusion: The myopia prevalence among primary school students in the study area was 30.8%in 2019, higher than the global level and approximately twice that of the United States and four times that of Germany, indicating that myopia prevention and control among primary school students remains challenging. The myopia prevalence in 2020 and 2024 was higher than in 2019, suggesting that lifestyle changes, such as increased screen time, affect the short-term visual status. Younger students experienced the greatest increase in myopia prevalence in 2020 and the mildest subsequent increased in 2024, and their spherical equivalent in 2024 had almost recovered to the 2019 level, but not for older students. These findings indicate greater ocular plasticity in younger students, i.e. more sensitive to negative exposures and easier to recover after removing such exposures, warranting further investigation on the underlying mechanisms. Additionally, patterns of higher myopia prevalence in girls than in boys and a gradual increase with grade support previous studies, also enhancing the reliability of the relevant results in our study.

Objective: To investigate the distribution characteristics of myopia among primary and secondary school students in Inner Mongolia Autonomous Region in 2020, and to comprehensively analyze its influencing factors at both school and individual levels, thereby providing scientific evidence for developing targeted myopia prevention and control strategies. Methods: A multistage stratified random cluster sampling method was employed to conduct vision examinations and questionnaire surveys among students from fourth grade to senior high school in Inner Mongolia Autonomous Region, collecting information on students' visual habits, school and family environmental factors. A multilevel regression model was used to analyze the factors influencing myopia detection rates at both school and individual levels. Results: A total of 130 601 students were included, with a myopia prevalence rate of 68.42%. The prevalence was higher among females (72.75%) than males (64.13%), in urban areas (73.63%) than in suburban counties (66.38%), and overall rates increased with educational level (trend test χ²=4 545.53, P < 0.001). Multilevel analysis revealed that at the individual level, female gender (OR=1.553), higher grade level (junior high OR=2.049, senior high OR=3.061), homework duration ≥1 h after school (≥1 h OR=1.050, ≥2 h OR=1.079), poor close-up vision habits (OR=1.059), prolonged close-up vision activities (0.5 h OR=1.070, ≥1 h OR=1.061), infrequent desk/chair height adjustments based on height (OR=1.006), and parental myopia (one parent OR=1.822, both parents OR=2.412) were risk factors for myopia; while ethnic minority status (Mongolian OR=0.956, other ethnicities OR=0.929), daily outdoor activity exceeding 2 hours (OR=0.986), performing eye exercises (1 session OR=0.891, ≥2 sessions OR=0.920), and adequate sleep (OR=0.925) served as protective factors. At the school level, qualified blackboard reflectance ratio (OR=0.874) and qualified blackboard surface illuminance uniformity (OR=0.973) were associated with reduced myopia risk among students. The model indicated that the included variables collectively explained approximately 31.04% of the variance at the school level. Conclusion: The prevalence of myopia among primary and secondary school students in Inner Mongolia Autonomous Region remains high, with influencing factors distributed across multiple levels including individual and school contexts. Comprehensive prevention strategies are recommended, focusing on female students, older grades, and those with genetic predispositions while intensifying interventions on modifiable factors like outdoor activities and visual habits. Improving classroom lighting environments is also crucial to reduce students' myopia risk.

Objective: To evaluate the genetic nurture effect of parental genotypes on the risk of ischemic stroke (IS) in offspring and to elucidate the parental origin-specific differences in this effect. Methods: This study utilized data from the "Family Cohort of Common Chronic Non-communicable Diseases in Rural Areas of Northern China". A total of 530 core families and sibling pairs were selected, comprising 1 005 offspring. Single nucleotide polymorphisms (SNPs) within the CTNNA gene family (CTNNA1, CTNNA2 and CTNNA3) were detected. Using offspring as the unit of analysis, parental non-transmitted alleles were inferred based on Mendelian inheritance principles. Rigorous quality control was implemented for genotype imputation, ensuring high reliability of the inferred data. Linear mixed-effects models were constructed to estimate the genetic nurture effect of non-transmitted alleles on offspring IS. These models compared differences between genetic nurture effects and individual genetic effects, distinguished between paternal and maternal effects, and calculated the statistic η to assess the relative magnitude of parental effects. Results: A total of 1 005 offspring from 530 families were included, comprising 308 IS patients (30.6%) with a mean age of 56.3 years. Sixteen independent SNPs associated with IS genetic nurture effects were identified (9 in CTNNA2, 6 in CTNNA3, and 1 in CTNNA1). The effect sizes ranged from -0.282 to 0.480, with rs117741773 (CTNNA2) showing the strongest effect (0.480, 95%CI: 0.278-0.682). Only four of these SNPs exhibited concurrent individual genetic effects, which acted in the opposite direction to the genetic nurture effects. Parent-of-origin specific analysis revealed that 12 SNPs exhibited genetic nurture effects from a single origin: 4 showed exclusively paternal effects (effect size: -0.298 to 0.945; η: 1.21 to 63.83), and 8 showed exclusively maternal effects (effect size: -0.489 to 0.602; η: 0.03 to 0.44). Conclusion: This study provides evidence that multiple IS susceptibility loci within the CTNNA gene family exhibit significant genetic nurture effects. The findings highlight the complex interplay between inherited genetics and the family environment. The heterogeneity of these effects based on parental origin underscores the significant role of parent-specific genetic nurture in the etiology of IS, offering new insights for understanding the missing heritability in stroke genetics.

Objective: To systematically evaluate the association between anticoagulant therapy and long-term outcomes (all-cause mortality, stroke recurrence, and hemorrhage events) in elderly patients with cardiogenic stroke, thereby providing evidence for clinical decision-making. Methods: A retrospective cohort study design was adopted. A total of 567 elderly patients with cardiogenic stroke from Liang-xiang Hospital in Fangshan District, Beijing, were followed up for 4 years. The primary outcomes included all-cause mortality, stroke recurrence, and hemorrhage events (including intracranial hemorrhage, gastrointestinal bleeding, urinary system bleeding, gingival bleeding, and skin and mucosal hemorrhage). Multivariable Logistic regression was used to analyze the association between anticoagulant therapy and each outcome. All statistical analyses were performed using R software (version 4.2.2). Results: A total of 567 elderly patients were included in this study, with a mean age of (73.92±9.70) years and 49.74% being male. Among them, 142 patients (25.04%) received anticoagulant therapy. During the follow-up period, 266 deaths occurred (crude mortality rate: 46.91%), 107 patients had stroke recurrence (cumulative recurrence incidence: 18.87%), and 28 patients experienced bleeding events (cumulative hemorrhage incidence: 4.94%). Multivariable Logistic regression showed that elderly patients with cardiogenic stroke who received anticoagulant therapy had a significantly lower risk of death (OR=0.22, 95%CI: 0.12, 0.41, P < 0.001). No significant association was found between anticoagulant therapy and the risk of stroke recurrence or hemorrhage (P>0.05). Conclusion: Anticoagulant therapy is beneficial in reducing the risk of all-cause mortality in elderly patients with cardiogenic stroke, and no evidence was found that anticoagulant therapy increases the risk of stroke recurrence or hemorrhage. The study supports considering anticoagulant therapy to improve long-term survival in elderly patients with cardiogenic stroke, and larger prospective studies are still needed to further validate the findings.

Objective: To independently evaluate the discrimination of the light version of biological age (Light BioAge) model for predicting all-cause mortality, to explore the association of the difference on Light BioAge and chronological age (AgeDiff) with the composite outcomes of cardiovascular disease (CVD), and to assess the performance of CVD risk prediction using the Light BioAge instead of chronological age in a large Chinese 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. Harrell' s concordance index (C-index) was employed to assess the discrimination of Light BioAge in predicting all-cause mortality across the overall population and sex-specific subgroups. Cox proportional hazards models were used to assess the association between AgeDiff and the composite outcome of CVD onset and death, adjusting for chronological age, sex, education, region, smoking status, body mass index, systolic blood pressure, total cholesterol, and high-density lipoprotein cholesterol. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated. Restricted cubic spline (RCS) regression was used to further analyze the potential nonlinear association between AgeDiff and CVD outcomes. Light BioAge was introduced to replace chronological age in the World Health Organization (WHO) non-laboratory CVD risk model to evaluate the discrimination and calibration in predicting 10-year CVD risk. Results: A total of 226 406 adults were included, with a mean age of 55.0 years at baseline, 53.2% of whom were women. During a median follow-up of 7.39 years (cumulative 1 562 141 person-years), 11 703 deaths (7.49 per 1 000 person-years) and 9 815 CVD events (6.30 per 1 000 person-years) occurred. The median Light BioAge and AgeDiff were 49.31 and -5.19 years, respectively, suggesting an underestimation of chronological age. Although the Light BioAge model demonstrated good discrimination for predicting all-cause mortality in the overall population (C-index: 0.742, 95% CI: 0.738-0.746), discrimination was lower in men (0.722, 95%CI: 0.714-0.730) than in women (0.755, 95%CI: 0.749-0.761). After adjusting for confounders, the risk of CVD events showed an elevated trend with increasing AgeDiff (P_trend < 0.001). Compared with the lowest quartile of AgeDiff, the risk of CVD events in the highest quartile increased by 21% in men (HR=1.21, 95%CI: 1.12-1.30) and 27% in women (HR=1.27, 95%CI: 1.17-1.38). RCS regression further indicated that in the overall population, the risk of CVD events increased with AgeDiff. Besides, no significant thre-shold effect was observed in sex-specific subgroups (P for non-linearity >0.05). Replacing chronological age with the Light BioAge in the WHO model did not improve discrimination; however, it significantly enhanced calibration. Calibration improvement was especially evident in women: while chronological age overestimated risk by 20.5% [expected/observed ratio (EOR)=1.205, 95%CI: 1.167-1.246), the Light BioAge reduced this to a marginal 2.1% underestimation (EOR=0.979, 95%CI: 0.948-1.012). Conclusion: The discrimination of the Light BioAge in predicting all-cause mortality seems good, and a wider AgeDiff indicates higher cardiovascular risk in this large population-based Chinese cohort. Replacing chronological age with biological age in the WHO non-laboratory model significantly improved calibration for women.

Objective: To identify real-world physical activity patterns in older adults using objective measurements from wearable devices, and to analyze the associations between these patterns and gut microbiota composition. Methods: Based on data collected from a real-world health management project, a total of 743 participants from Eastern, Central, and Northern China were enrolled between January 2018 and June 2025. A 180-day objective physical activity dataset prior to fecal sampling was collected via smart wearable devices to extract features including mean daily steps, coefficient of variation of steps, and the proportion of active days. Fecal samples underwent 16S ribosomal RNA (rRNA) gene (V3-V4 region) amplicon sequencing to obtain genus-level relative abundance matrices. Covariates, including demographics, lifestyle, and chronic disease history, were collected via questionnaires and physical examinations. The discriminative dimensionality reduction via learning a tree (DDRTree) algorithm combined with K-means clustering was applied to identify physical activity phenotypes. Alpha diversity was evaluated using the Shannon index (Kruskal-Wallis test), and beta diversity was assessed using covariate-adjusted permutational multivariate analysis of variance (PERMANOVA) based on Bray-Curtis distance. Multivariable linear regression with false discovery rate (FDR) correction was used to screen differential taxa. A microbial risk score (MRS) was constructed based on taxa with a raw P < 0.05, defined as the difference between the standardized abundance of beneficial and harmful taxa. Co-occurrence networks were constructed to evaluate micro-ecological topological structures. Results: The cohort comprised 381 (51.3%) individuals aged 60-74 years and 362 (48. 7%) aged ≥75 years. Compared with the 60-74 group, the ≥75 group had higher prevalences of hypertension (45.9% vs. 36.7%, P=0.045) and heart disease (34.0% vs. 25.2%, P=0.032), higher systolic blood pressure (median 130 mmHg vs. 120 mmHg, P < 0.001), and fewer mean daily steps (median 6 200 steps vs. 7 000 steps, P < 0.001). Clustering identified three activity patterns: active group (n=143, 19.2%; high steps, low variation, high adherence), moderate group (n=429, 57.7%), and irregular group (n=171, 23.0%; low steps, high variation, low adherence). The active group exhibited the lowest prevalences of hypertension (35.0%) and heart disease (21.7%), and the lowest systolic blood pressure (mean 124.4 mmHg), whereas the irregular group showed the highest values (51.5%, 40.4%, and 127.6 mmHg, respectively). Alpha diversity showed no significant differences among the groups. After adjusting for covariates, physical activity patterns showed no statistically significant effect on beta diversity (R²=0.003 7, P=0.115). Compared with the irregular group, two genera in the active group showed significant differences (P < 0.05). Specifically, the relative abundance of Roseburia in the active group was significantly lower than that in the irregular group (P < 0.05), and the relative abundance of Butyricimonas was also significantly lower than that in the moderate group (P < 0.01). However, these differences did not remain statistically significant after FDR correction. The MRS exhibited a significant gradient distribution across the groups, with the active group scoring the highest (P < 0.001). Co-occurrence network analysis revealed that the active group had the highest network density and proportion of positive correlations (84.5%), whereas the irregular group had the lowest (60.3%). Conclusion: Physical activity patterns identified from wearable device data are associated with gut microbiota composition and ecological network characteristics in older adults. Active and regular physical activity patterns indicate a higher MRS and more stable microbial co-occurrence networks, suggesting potential associations between activity regularity and gut microbial ecology, though causal inference requires longitudinal confirmation.

Objective: To provide empirical evidence for optimizing meal assistance policies and strengthening their role in supporting the health of older adults, this study took Shandong Province as a case to examine the policy logic and practical challenges of meal assistance services for older adults. Methods: A combination of policy tool text analysis and qualitative interviews was employed. For the policy tool analysis, 59 policy documents related to meal assistance for older adults at the central and Shandong provincial levels from 2013 to 2024 were selected and categorized using a three-part framework, with policy provisions coded and analyzed as units. Qualitative interviews were conducted in two rounds, from August to October 2023 and again in January 2026, across eight urban and rural sample sites within Shandong' s three major economic circles, involving 17 providers of meal assistance services for older adults; the interview data were coded and analyzed using thematic analysis. Finally, the two sets of data, including policy tools and implementation themes, were integrated through a comparative approach. Results: The development of meal assistance policies for older adults in Shandong Province can be broadly divided into three stages: The initial stage, the growth stage, and the deepening stage. Overall, policy tools exhibited a balanced emphasis on supply-oriented and environment-oriented instruments, while demand-oriented instruments remained relatively insufficient. Interview findings indicated that urban areas had primarily adopted a "government subsidy + market operation" model, while rural areas mainly relied on happiness homes, village collective resources, and public welfare positions to deliver meal assistance services. However, both urban and rural areas faced common challenges, including a mismatch between financial subsidies and operational costs, a shortage of professional staff, weak motivation for social participation, insufficient expression of demand and sustained spending by older adults, and limited implementation capacity at the grassroots level. Meanwhile, some meal assistance sites showed early signs of health-oriented meal assistance practices, such as adjusting menus according to older adults 'dietary preferences, chewing ability, and chronic disease conditions, reducing oil and salt in meal preparation, and exploring meal delivery and health education activities. Nevertheless, these efforts remained largely experience-based and fragmented, and had not yet developed into a standardised model. Conclusion: Meal assistance services for older adults are not only a livelihood initiative to ensure access to warm meals for older adults, but also a crucial entry point for promoting balanced diets, maintaining functional capacity, and achieving healthy aging. Future efforts should focus on refining a tiered and categorized subsidy mechanism, optimizing the differentiated supply structure between urban and rural areas, enhancing demand-side mobilization and social collaboration, strengthening grassroots governance and quality supervision, and facilitating the transition of meal assistance services from project-based provision to an institutionalized and sustainable model.

Objective: To systematically evaluate the association between perioperative hyperglycemia and postoperative prognosis in esophageal squamous cell carcinoma (ESCC) patients using large-scale, multicenter real-world data. Methods: A total of 5 952 patients with ESCC who underwent radical esophagectomy were consecutively included in this retrospective cohort study from the Anyang Cancer Hospital in Anyang, Henan Province (January 2012 to December 2017) and the Cancer Hospital of Shantou University Medical College in Shantou, Guangdong Province (August 2009 to December 2018). Perioperative fasting glucose data were obtained from the hospital information system. The perioperative period was divided into preoperative and postoperative phases: Preoperative hyperglycemia was defined as a mean fasting glucose level ≥7.0 mmol/L from day 14 to day 2 before surgery, and postoperative hyperglycemia was defined as a mean fasting glucose level ≥7.0 mmol/L from day 2 to day 14 after surgery. The primary outcome was overall survival (OS), and secondary outcomes included 30 d/90 d postoperative mortality and in-hospital complications. Multivariable Cox proportional hazards models were used to assess the association between perioperative hyperglycemia and OS, with adjusted hazard ratios (HR) and 95% confidence intervals (CI) calculated. Results: The maximum follow-up period was 12 years. The prevalence of preoperative and postoperative hyperglycemia was 6.7% and 18.3%, respectively. Patients with preoperative hyperglycemia had a lower 5-year OS rate than those without (57.3% vs. 65.0%), with an adjusted HR of 1.41 (95%CI: 1.19-1.68). The patients with postoperative hyperglycemia also had reduced 5-year survival (61.8% vs. 66.4%), with an adjusted HR of 1.39 (95%CI: 1.22-1.58). Joint analysis showed that compared with patients without hyperglycemia, those with hyperglycemia in either the preoperative or postoperative phase alone had an elevated mortality risk (HR=1.24, 95%CI: 1.07-1.43), while the patients with hyperglycemia in both phases had the highest mortality risk (HR=1.86, 95%CI: 1.49-2.32). Stratified analysis revealed that BMI significantly modified the association between hyperglycemia and adverse prognosis (P_interaction=0.010), with the association being particularly pronounced in patients with BMI ≥24.0 kg/m². Additionally, perioperative hyperglycemia was associated with poorer short-term postoperative outcomes. Conclusion: Perioperative hyperglycemia is an independent risk factor for long-term survival in ESCC patients undergoing curative esophagectomy. These findings suggest that enhanced routine glucose monitoring and control during perioperative management of ESCC may help improve long-term patient outcomes.

Objective: Based on protection motivation theory (PMT), this study aimed to examine the current status of e-cigarette cessation intention and cessation behavior, as well as their associated factors, among adult e-cigarette users in China. Methods: This was a cross-sectional study. The data were derived from a nationwide "E-cigarette Use Survey" conducted in 2023, covering 31 provinces (municipality, autonomous region) in China. A total of 550 current e-cigarette users aged 18-44 years were selected as the study population. After adjusting for sociodemographic variables, multiple linear regression models were used to identify factors associated with e-cigarette cessation intention, while binary Logistic regression models were applied to examine factors associated with e-cigarette cessation behavior. In addition, subgroup analyses were conducted according to smoking status to explore potential differences among exclusive e-cigarette users and dual users of e-cigarettes and combustible cigarettes. Results: The mean score of e-cigarette cessation intention was 3.52±0.96, and 31.64% of participants reported having attempted to quit e-cigarettes. After adjustment for covariates, cessation intention was associated with both the threat appraisal and coping appraisal pathways within the PMT framework. Specifically, in the threat appraisal pathway, severity (β=0.14) and vulnerability (β=0.12) were positively associated with cessation intention, whereas perceived extrinsic rewards (β=-0.12) were negatively associated. In the coping appraisal pathway, both response efficacy (β=0.26) and self-efficacy (β=0.28) were positively associated with cessation intention. Regarding cessation behavior, only severity (OR=1.58) in the threat appraisal pathway was positively associated, and cessation intention was also positively associated with cessation behavior. Subgroup analyses further showed that, regardless of smoking status, cessation intention was positively associated with both the threat appraisal pathway (β=0.20, β=0.31) and the coping appraisal pathway (β=0.23, β=0.21). Conclusion: PMT provides a valuable theoretical framework for understanding e-cigarette cessation among adults. Factors related to the threat appraisal pathway are associated not only with cessation intention but also with actual cessation behavior. More-over, the associations of PMT-related factors vary across different smoking status subgroups. These findings suggest that future e-cigarette control policies and interventions could focus on enhancing risk perception and cognitive awareness, and develop more targeted cessation strategies for specific subgroups.

Objective: To examine the impact of effective health information acquisition on hemophilia-related health literacy among adult caregivers of children and adolescents with hemophilia in China, and to provide evidence-based recommendations for improving adult caregivers' hemophilia-related health literacy. Methods: Data were derived from the 2024 nationwide multicenter cross-sectional survey, "Health Literacy Survey of Hemophilia Patients in China". A total of 856 adult caregivers of children and adolescents with hemophilia were recruited through convenience sampling. To explore the differences in hemophilia-related health literacy and effective health information acquisition levels among caregivers across different demographic characteristics, univariate ANOVA and independent-samples t test were adopted for statistical analysis. The bootstrap method was employed to test the mediating role of effective health information acquisition in the relationship between hemophilia-related health literacy and its influencing factors. Results: The overall level of hemophilia-related health literacy among caregivers of minor patients with hemophilia was relatively low, with an average score of 11.87±2.92. Only 20.68% of the caregivers for underage patients with hemophilia had acquired hemophilia-related health literacy. Univariate ANOVA analysis indicated that marital status, educational attainment, annual household income, registered residence location, and employment status significantly influenced adult caregivers ' hemophilia-related health literacy (P < 0.05). The utilization rate of various health information channels by caregivers of underage hemophilia patients exceeded 70%. Over 95% of the caregivers reported obtaining hemophilia-related health information from medical staff and hemophilia patient organizations. While, the caregivers demonstrated relatively low overall effective health information acquisition (34.43±16.50). The level of effective health information acquisition was related to educational attainment, place of household registration and employment status. Caregivers with higher educational attainment, urban household registration and full-time employment had a higher level of effective health information acquisition, and the differences were statistically significant (P < 0.05). The mediation analysis showed that the level of effective health information acquisition was positively correlated with hemophilia health literacy (P < 0.01), and effective health information acquisition played a partial mediating role between "education attainment" and "hemophilia health literacy", "employment status" and "hemophilia health literacy", and "place of household registration" and "hemophilia health literacy" (P < 0.05). Higher educational attainment and favorable employment status not only directly improved health literacy, but also indirectly enhanced it by promoting effective information acquisition. Compared with urban household registration, rural household registration had a negative impact on health literacy in patients with hemophilia. Meanwhile, effective information acquisition also exerted a partial mediating effect between registered residence location and health literacy. Conclusion: The hemophilia-related health literacy among caregivers of underage hemophilia patients is relatively low. Enhancing adult caregivers' effective health information acquisition of health information will improve their hemophilia-related health literacy. Tailored strategies to optimize effective health information acquisition for adult caregivers with varying sociodemographic characteristics could indirectly contribute to improved health literacy outcomes.

Objective: To assess the association between personal temperature exposure and oxygen saturation (SpO₂) during sleep in chronic obstructive pulmonary disease (COPD) patients, to analyze potential susceptibility factors and to provide a scientific basis for the adoption of effective measures to safeguard the health of susceptible populations. Methods: In this prospective panel study, 96 stable COPD patients were recruited. From March 2021 to September 2023 in Beijing, all participants completed 202 nights (from 20:00 to 08:00) of dynamic real-time SpO₂ monitoring during sleep, simultaneously monitoring personal exposure level to temperature, alongside environmental humidity and other key air pollutant data. Based on previous clinical studies, SpO₂ < 90% was defined as desaturation to assess the risk of hypoxic events occurring during sleep. Linear mixed-effects models and generalized linear mixed-effects models were used to analyze the association between personal temperature exposure and SpO₂ during sleep, as well as the risk of oxygen desaturation. Interaction models were constructed to evaluate susceptibility factors. Results: During the study, the average personal temperature exposure was (27.5± 2.6) ℃, with a temperature range from 16.5 ℃ to 40.0 ℃. Short-term exposure to personal temperature was associated with a decline in SpO₂ and an increased risk of oxygen desaturation during sleep in the COPD patients. The effect of temperature exposure was strongest at lag 0-30 min, with a 0.24% (95%CI: -0.28%, -0.20%) decrease in SpO₂, and with an odds ratio (OR) of oxygen desaturation was 1.26 (95% CI: 1.12, 1.42) for each interquartile range (IQR, 6.0 ℃) increase in temperature. Besides, the patients exposed to medium and high humidity levels were more likely to be affected by temperature exposure compared with the patients exposed to low humidity levels. Personal temperature exposure had a stronger effect on SpO₂ during sleep in the patients with global initiative for chronic obstructive lung disease (GOLD) Ⅲ-Ⅳ compared with the patients with GOLD Ⅰ-Ⅱ (P_interaction < 0.05). Conclusion: From 16.5 ℃ to 40.0 ℃, personal temperature exposure is associated with SpO₂ decline during sleep in COPD patients. There was a significant synergistic amplification between temperature and humidity, patients were more susceptible to damage under high temperature and high humidity conditions. Moreover, patients with poorer lung function are more significantly affected by temperature.

Objective: To explore differences in the Big Five personality traits among patients with type 2 diabetes mellitus (T2DM) in relation to demographic characteristics and health education preferences and to provide evidence for personalized health education strategies. Methods: In September 2023, a cluster sampling method was used to recruit patients with T2DM from seven community health service centers in Shandong Province, China. Data were collected using a questionnaire survey. The 10-item Big Five Inventory (BFI-10) and a self-developed health education preference questionnaire were used for the assessment. Latent profile analysis (LPA) was conducted to identify personality classifications among the patients. Chi-square tests were applied to compare differences in health education preferences across personality groups, and stratified binary Logistic regression analysis was performed to examine the association between personality classification and health education preferences. Results: A total of 612 patients were included and categorized into three personality groups: Regular-balanced type (69.8%), introverted-sensitive type (6.4%), and proactive-adaptive type (23.8%). In the univariate analysis, the proportion of patients in the proactive-adaptive group who preferred peer patients as health education providers was significantly lower than that in other personality groups (χ²=6.123, P=0.047). In contrast, patients in the introverted-sensitive group showed a significantly higher preference for health education content that included psychological support than other personality groups (χ²=8.566, P=0.014). In the Logistic regression analysis, using the regular-balanced type as the reference group, proactive-adaptive patients were less likely to prefer peer patients with diabetes as health education providers (OR=0.491, 95%CI: 0.279-0.866, P=0.014). Regarding health education content, proactive-adaptive patients demonstrated a lower preference for research-frontier information (OR=0.565, 95%CI: 0.376-0.848, P=0.006). In terms of educational delivery settings, introverted-sensitive patients were less likely to prefer mobile applications as a means of receiving health education (OR=0.374, 95%CI: 0.165-0.848, P=0.019). When the proactive-adaptive type as the reference group, introverted-sensitive patients showed a significantly higher preference for psychological support content (OR=2.122, 95%CI: 1.029-4.380, P=0.042). Conclusion: Personality traits exhibit substantial heterogeneity among patients with T2DM, and different personality classifications are associated with distinct health education preferences. Personality traits may serve as an important reference for developing individualized health education strategies; however, their effectiveness in improving intervention outcomes requires further validation through future studies.

Objective: To explore the relationship between family trauma, school bullying and adolescent suicidal behavior, and the regulatory role of DRD2 gene polymorphism. Methods: A total of 98 adolescent patients with depressive disorders who visited our hospital from June 2022 to June 2024 were selected. They were divided into the non-suicide group (n=62) and the suicide group (n=36) based on their suicide behavior in the previous 6 months and their attitudes towards suicide behavior. The general data of the two groups were compared. The relationship between each genotype and suicide behavior, the influencing factors of suicide behavior, the interaction between family trauma and school bullying on suicide behavior, and the regulatory effects of depression and genetic polymorphisms were analyzed. The possible regulatory effects of depression and genetic polymorphisms were also investigated. Results: Compared with the non-suicide group, the duration of illness, non-suicidal self-harm behavior, family trauma, school bullying, anxiety, depression scores in the suicide group increased, while the life meaning score decreased (P < 0.05). The genotype A2A2 was associated with an increased risk of suicidal behavior compared to genotype A1A1 (P < 0.05). In the recessive model, the genotype A2A2 was associated with an increased risk of suicidal behavior compared to genotype A1A1 and A1A2 (P < 0.05); in the additive model, there were significant associations between the genotypes A1A1, A1A2, A2A2 and suicidal behavior (P < 0.05). Non-suicidal self-harm behavior, family trauma, school bullying, depression, and the A2A2 genotype were independent risk factors for suicidal behavior, while life meaning was an independent protective factor. Family trauma > 54.78 points and school bullying > 10.37 points had a multiplicative (OR=6.585, 95%CI: 5.478-7.367) and additive (OR=7.849, 95%CI: 7.231-8.294) interaction effect on adolescent suicidal behavior. Depression exerted a regulatory effect between family trauma (β=0.092, 95%CI: 0.084-0.103), school bullying (β=0.090, 95%CI: 0.081-0.098) and suicidal behavior. In the additive genetic model, the TaqⅠA gene had a significant regulatory effect on "family trauma, school bullying → depression → suicidal behavior" in adolescents with the A1A2/ A2A2 genotype. Conclusion: The risk of suicidal behavior is higher in adolescents with both family trauma and school bullying, and depression plays a part of the mediating effect. The TaqⅠA polymorphism of DRD2 gene has a significant regulatory effect on adolescents carrying A2 allele.

Objective: To investigate the effect of long non-coding RNA (LncRNA) differentiation antagonizing non-protein coding RNA (DANCR) on the immune microenvironment of glioma cells by regulating the miR-656/bone morphogenetic protein receptor type 1A (BMPR1A) axis. Methods: The expression levels of DANCR, miR-656 and BMPR1A in glioma cells were detected by quantitative real-time polymerase chain reaction (qRT-PCR). The U87 cells were transfected or co-transfected to form the following groups: sh-DANCR (transfected with sh-DANCR), overexpression (pcDNA 3.1) DANCR (transfected with pcDNA 3.1 DANCR), NC sh (transfected with negative control sh), pcDNA 3.1 (transfected with pcDNA 3.1 vector), sh-DANCR + miR-656 inhibitor (co-transfected with sh-DANCR and miR-656 inhibitor), sh-DANCR + NC inhibitor (co-transfected with sh-DANCR and NC inhibitor), sh-DANCR + pcDNA 3.1 BMPR1A (co-transfected with sh-DANCR and pcDNA 3.1 BMPR1A), and sh-DANCR + pcDNA 3.1 (co-transfected with sh-DANCR and pcDNA 3.1 BMPR1A). The untreated U87 cells were used as the blank group. The proliferation of U87 cells was detected by CCK-8; invasion and migration were detected by Transwell assay; apoptosis was detected by flow cytometry; the expression of DANCR, miR-656, and BMPR1A mRNA in cells was detected by qRT-PCR; the targeting relationship between DANCR and miR-656 was verified by dual-luciferase; and BMPR1A and immune escape factors [programmed death receptor 1 (PD-1) and programmed death-ligand 1 (PD-L1)] were detected by Western blot. Results: The mRNA expressions of DANCR and BMPR1A in U87, A172, LN229 and U251 cells were significantly increased, while the expression of miR-656 was significantly decreased compared with those in NHA cells (P < 0.05). Compared with the blank group and sh-DANCR group, the proliferation rate, invasion, migration number, DANCR, BMPR1A mRNA, BMPR1A, PD-1, PD-L1 expression of U87 cells in the sh-DANCR group were obviously reduced, while the apoptosis rate and miR-656 expression were obviously increased (P < 0.05). Compared with the pcDNA 3.1 group, the proliferation rate, invasion, migration number, DANCR, BMPR1A mRNA, BMPR1A, PD-1, and PD-L1 expression of U87 cells in the pcDNA 3.1 DANCR group were obviously increased, while the apoptosis rate and miR-656 expression were obviously reduced (P < 0.05). Compared with the sh-DANCR +NC inhibitor group, the proliferation rate, invasion, migration number, BMPR1A mRNA, BMPR1A, PD-1, and PD-L1 expression of U87 cells in the sh-DANCR+miR-656 inhibitor group were obviously increased, and the apoptosis rate and miR-656 expression were obviously reduced (P < 0.05), while the expression of DANCR was not obvious (P>0.05). Compared with the sh-DANCR+pcDNA 3.1 group, the proliferation rate, invasion, migration number, BMPR1A mRNA, BMPR1A, PD-1, and PD-L1 expression of U87 cells in the sh-DANCR+pcDNA 3.1 BMPR1A group obviously increased, and the apoptosis rate obviously decreased (P < 0.05), while here was no statistically obvious difference in miR-656 expression and DANCR expression (P>0.05). DANCR and miR-656 had a targeted negative regulatory relationship. Conclusion: LncRNA DANCR improves the immune microenvironment of glioma cells and inhibits the malignant behavior development of cancer cells by regulating the miR-656/BMPR1A axis.

Objective: To delineate differences in lymphocyte subset expression between patients with infectious pneumonia and immune-related interstitial lung disease (IRILD), to assess the immune status across distinct pneumonia types, and to provide novel laboratory markers through immunological profiling to effectively differentiate pneumonias. Methods: A total of 78 patients sequentially enrolled from Peking University People' s Hospital between January 2023 and March 2024 were stratified into three groups: 27 with infectious pneumonia, 27 with isolated immune-related interstitial lung disease (IRILD), and 24 with IRILD complicated by infection. Fifty age-matched healthy individuals undergoing routine physical examinations during the same period served as controls. Peripheral lymphocyte subsets were quantified in all subjects by multiparametric flow cytometry. Results: There was no statistically significant difference in age between the pneumonia patients and the healthy control group in this study (P>0.05). Analysis of laboratory parameters revealed that compared with the IRILD group, the infectious pneumonia group demonstrated significantly elevated levels of neutrophils, C-reactive protein, procalcitonin (PCT), erythrocyte sedimentation rate (ESR), D-dimer, and fibrinogen (P < 0.05), while the IRILD with superimposed infection group exhibited significantly increased levels of PCT, ESR, and immunoglobulin G (P < 0.05). At the lymphocyte subset level, compared with the control group, the infectious pneumonia group exhibited significantly decreased counts of T cells, B cells, natural killer (NK) cells, CD4⁺T cells, and the CD4⁺/CD8⁺ ratio (P < 0.05). Similarly, compared with the control group, the IRILD group showed significantly reduced counts of T cells, B cells, CD4⁺T cells, and the CD4⁺/CD8⁺ ratio (P < 0.05). Furthermore, compared with the control group, the IRILD-with-infection group demonstrated significantly lower counts of T cells, B cells, NK cells, CD4⁺T cells, and CD8⁺T cells (P < 0.05). Compared with the IRILD group, the infectious pneumonia group had a significantly lower NK cell count (P < 0.05). Additionally, compared with the IRILD group, the IRILD-with-infection group displayed significantly reduced counts of NK cells and CD8⁺T cells (P < 0.05). Conclusion: The study revealed significant variations in lymphocyte subset profiles among the distinct pneumonia groups, providing novel insights with potential diagnostic value for differentiating between pneumonia types.

Objective: Next-generation sequencing (NGS) technology was used to analyze the gene mutation profile of lymph node metastases in renal cell carcinoma, and the molecular characteristics associated with poor prognosis were found, providing new ideas for mechanism research and treatment. Methods: Retrospective clinical data collection was conducted on 31 patients with lymphoid metastatic renal cell carcinoma and 21 patients with non-metastatic renal cell carcinoma. A total of 81 formalin-fixed paraffin-embedded tissue samples were retrieved from the Department of Pathology, including primary tumor, lymph node metastasis, and distant metastasis samples. The gene mutation profiles of the patients were examined using next-generation sequencing technology. The patients were followed up to analyze the correlation between lymph node metastasis and patient prognosis. Results: The lymph node metastasis group showed differences in tumor size (P=0.006), World Health Organization (WHO)/International Society of Urological Pathology (ISUP) grade (P=0.002), T stage (P=0.003) and tumor thrombus (P=0.025) compared with non-metastatic renal cell carcinoma. The most commonly mutated genes in our cohort were the tumor suppressor genes VHL (38%), PBRM1 (22%), and SETD2 (20%). More-over, copy number variations were associated with tumor metastasis, and some mutation features were highly similar to known mutation patterns. There was a difference in mutation frequency between the patients in the metastasis group and samples in the non-metastasis group. The mutation frequency of most genes in the metastasis group was higher, however, Reactome pathway enrichment analysis did not show statistically significant differences in the shared enriched pathways between the two groups. There was a strong degree of concordance between the tumor' s primary and metastatic foci in the same patient, and genomic indicators [such as purity, ploidy, weighted-genomic integrity index (WGII), and intra-tumor heterogeneity (ITH)] as well as clonal and subclonal composition analysis further supported this consistency. The overall survival (OS) was higher in the patients without metastases (P=0.041), and specific gene mutations (such as IGF2R, JUN, EPHA5, and FH) were associated with poorer prognosis. To facilitate distant metastasis, lymph nodes might function as a "metastatic pool". Conclusion: The multigene NGS evaluates multiple relevant markers simultaneously, revealing several genetic alterations in the patients with lymphatic metastatic renal cell carcinorma. NGS-based molecular analysis can assist clinicians in assessing a patient' s prognosis and identifying novel, potentially therapeutic mechanisms.

Objective: To explore the promotion of dynamic distraction on osteogenic differentiation of human bone marrow mesenchymal stem cells (hBMMSCs) in three-dimensional culture. Methods: Dynamic stretching in a three-dimensional culture for hBMMSCs was achieved with proportions set at 5%, 10%, and 20%, a frequency of 0.5 Hz, and a dynamic stretching duration of 2 hours per day. Static culture was used as the control group. Deformation of hBMMSCs induced by dynamic stretching was observed through cytoplasmic fluorescence staining. After 7 days of dynamic stretching culture, the impact of dynamic stretching on the viability of hBMMSCs was observed through cell live/dead staining. The effect of dynamic stretching on the osteogenic differentiation of hBMMSCs was observed through alkaline phosphatase (ALP) staining and the expression of osteogenic related genes and proteins after 7 days of dynamic stretching culture. Results: Dynamic stretching in a three-dimensional culture for hBMMSCs was successfully constructed, which could achieve different durations, frequencies, and ratios of dynamic stretching. Dynamic stretching led to deformation of hBMMSCs, and the greater the stretching ratio, the more pronounced the cell deformation, transitioning from a circular to a flat oval shape. After 7 days of dynamic stretching culture, hBMMSCs in the static control group and dynamic stretching groups were mostly green stained live cells, with only a few red stained dead cells. The difference in the proportion of live cells between the groups was not statistically significant (P>0.05). The ALP staining in the dynamic stretching group was deeper than that in the static control group, and the number of ALP staining positive cells observed under the microscope was higher. The expression of osteogenic related genes and proteins increased after 7 days of dynamic stretching culture, and the difference was statistically significant (P < 0.05). Among them, the dynamic stretching group with 10% had the deepest ALP staining, the highest number of positive cells, and the most significant increase in the expression of osteogenic related genes and proteins compared with the static control group. Conclusion: Dynamic stretching caused deformation of hBMMSCs without a significant impact on cell viability, and it could effectively promote the osteogenic differentiation of hBMMSCs.

Objective: To investigate the etiology of chronic sialadenitis, and to analyze their clinical and imaging characteristics. Methods: This retrospective analysis reviewed the clinical and imaging data of patients with chronic sialadenitis who underwent sialendoscopy at the Peking University Hospital of Stomatology between January 2021 and August 2023. Inclusion criteria: (1) with a history of recurrent swelling of major salivary glands; (2) complete medical records with detailed information about potential causes; (3) sialography images were available; and (4) patients had undergone interventional endoscopy. Exclusion criteria: (1) salivary stones; (2) juvenile recurrent parotitis; (3) IgG4-related sialadenitis; (4) Sjögren syndrome; and (5) neoplastic diseases. Based on the latest research results and clinical data, chronic sialadenitis was classified into radioactive iodine-induced sialadenitis (RAIS), allergy-related sialodochitis (ARS), adult chronic recurrent parotitis (ACRP), sialadenosis with sialodochitis, and idiopathic sialadenitis. Idiopathic sialadenitis was defined as a type of chronic sialadenitis with duct stenosis of unknown etiology (allergic causes, autoimmune disorders, radioactive iodine exposure, history of "parotitis" in childhood, etc.). The proportions of five types of sialadenitis were calculated, and their relationships with age, gender, type of affected glands, number of affected glands, duration of symptoms, and imaging characteristics were statistically analyzed. Results: A total of 544 consecutive patients diagnosed with chronic sialadenitis were enrolled in this study. They consisted of 192 males and 352 females, and their ages ranged from 14 to 83 years [mean age: (47.44±13.52) years]. Idiopathic sialadenitis accounted for the largest proportion (71.7%, 390 cases), followed by ARS (12.5%, 68 cases), RAIS (6.4%, 35 cases), ACRP (4.8%, 26 cases), and sialadenosis with sialodochitis (4.6%, 25 cases). Among the 2 176 available glands of the 544 patients, 1 120 (51.5%) glands were affected, including 880 (78.6%) parotid glands and 240 (21.4%) submandibular glands. These five types of sialadenitis exhibited significant differences in gender, age, type and number of affected glands, and duration of symptoms (P < 0.05). Among them, RAIS patients showed the lowest male to female ratio (male ∶ female=1 ∶ 4.83), ARCP patients were the youngest [(32.50±8.60) years], and RAIS and ARS patients had relatively higher number of affected glands. Sialography showed ductal atresia in 23.2% of affected glands with ARIS, "snowflake" pattern in 46.5% of affected glands with ARS, "punctate and globular" ectasia of terminal ducts in 80.4% of affected glands with ARCP, and clustered branch ducts in 71.4% of affected glands with sialadenosis with sialodochitis. Moreover, stenosis and/or dilatation of the main and branch ducts represented the most typical sialography appearance of idiopathic sialadenitis. Conclusion: Idiopathic sialadenitis, RAIS, ARS, ACRP, and sialadenosis with sialodochitis are the five common types of chronic sialadenitis. Among these, idiopathic sialadenitis is the most common type of chronic sialadenitis. Clarification of the etiology, clinical manifestations and imaging characteristics of chronic sialadenitis is important for clinicians to develop personalized treatment plans and improve treatment outcomes.

Objective: Cardiac fibroblasts (CFs) play a central role in myocardial remodeling and fibrosis. Efficient isolation of CFs is a prerequisite for investigating related mechanisms. However, current methods for isolating primary adult mouse CFs suffer from prolonged processing time, low yield, and poor viability. This study aims to establish a rapid, high-yield, and stable isolation protocol for adult mouse CFs by optimizing the synergistic effect of enzymatic digestion and mechanical dissociation parameters. Methods: Using the gentleMACS^® Octo Dissociator with Heaters, we selected different types and concentrations of collagenase, trypsin, and nuclease as the enzymatic digestion system for CFs extraction. We explored the optimal extraction conditions and compared the results with the commercial Multi Tissue Dissociation Kit 2. The cell yield was quantified using a high-content imaging analysis system by counting the number of adherent cells per field after 72 h of culture. The CFs purity was assessed using immunofluorescence staining for vimentin. The trans-differentiation activity of the CFs was evaluated with transforming growth factor β1 (TGF-β1). Results: Omitting any component of the digestion solution (collagenase Ⅱ/Ⅳ, trypsin or DNaseⅠ), significantly prolonged extraction time and reduced cell yield. In contrast, the optimized protocol outperformed the commercial kit, reducing digestion time by 32.2 min and significantly increasing cell yield, and with comparable obtained CFs purity. After TGF-β1 stimulation, CFs exhibited enhanced proliferative capacity and upregulated expression of α-smooth muscle actin (α-SMA), collagen type Ⅰ (ColⅠ), and fibronectin (FN), confirming the differentiation potential of CFs isolated via the optimized method. Conclusion: This study systematically optimized an enzymatic digestion method combining collagenase, trypsin, and nuclease in conjunction with mechanical dissociation using a tissue dissociator, leading to the efficient and stable isolation of adult mouse CFs. By fine-tuning enzyme concentrations and digestion conditions, we successfully reduced processing time, improved cell yield, and enhanced cell viability compared with conventional isolation methods. These findings validate the physiological relevance of the isolated CFs and demonstrate that the optimized protocol provides a reliable and reproducible method for studying myocardial fibrosis and remodeling. This protocol can serve as a valuable tool for researchers investigating CFs biology and its role in cardiovascular diseases.

Systemic lupus erythematosus (SLE) and lymphoma are two different diseases. However, they might mimic each other sometimes. Here, we reported a case of bone marrow infiltration as initial manifestation of large B-cell lymphoma that mimiced SLE. The patient was an elderly female whose chief complaints were edema and bilateral lower limb fatigue for one month. Initially, she was prescribed thyroid hormone supplementation and albumin infusion for hypothyroidism and hypoproteinemia, respectively. The edema was improved, but fatigue worsened and the patient was bedridden. Then further examinations revealed anemia, thrombocytopenia, elevated lactate dehydrogenase (LDH), abnormal coagulation function, positive urinary protein, reduced complement C3 and C4, and positive antinuclear antibodies. Based on the above manifestations and laboratory findings, the diagnosis of SLE was considered. After administering 40 mg/d of methylprednisolone, the patient' s edema, platelet count and LDH levels were improved, whereas her fatigue worsened to the point where she had difficulty turning in bed. When the dose of glucocorticoid tapered to 40 mg/d of prednisone, the LDH levels elevated and platelet counts decreased. The treatment response was inconsistent with SLE. In order to clarify and confirm the diagnosis, bone marrow puncture was performed and showed large B-cell lymphoma with bone marrow infiltration of 27.5% tumor cells. Enlargement of superficial lymph node or visceral organ is common clinical manifestation of lymphoma. However, our present case was bone marrow infiltration lonely without enlargement of lymph node and organ, and it is referred to as bone marrow lymphoma (BML). BML can be classified into primary bone marrow lymphoma (PBML) and secondary bone marrow lymphoma (SBML). PBML is a rare and primary tumor in the bone marrow without involvement of lymph nodes, liver, spleen and any other organs. It is easy to be misdiagnosed or missed diagnosis due to the absence of specific clinical presentation. Bone marrow examination is required and important to make the diagnosis of PBML. Diffuse large B-cell lymphoma is the most common type of PBML. SBML is caused by lymphoma in other parts of the body and invasion of bone tissue. Most of BML patients have a poor prognosis and require rapid diagnosis and treatment. The patient we reported only took two months from onset of symptoms to death. This case indicated that it was crucial to revisit the diagnostic and therapeutic strategies when treatment response was not consistent with the diagnosis.

Gout is a metabolic disorder caused by abnormalities in purine metabolism and/or impaired uric acid excretion. It is characterized by the deposition of monosodium urate crystals in joints or connective tissues, leading to recurrent episodes of acute arthritis. Gout can be categorized into two major types based on its etiology: primary and secondary. The majority of gout cases are associated with impaired uric acid excretion. The natural course of gout can be divided into three stages: (1) asymptomatic phase; (2) acute arthritis phase and intercritical phase; (3) chronic gouty arthritis and tophaceous phase. Acute gouty arthritis typically presents with sudden, severe joint pain, accompanied by redness, swelling, warmth, and tenderness of the affected joint and surrounding soft tissues. When large joints are involved, joint effusion may occur. Acute gouty arthritis often develops at night or in the early morning, is self-limiting, and usually resolves within two weeks. The most common site of acute gout flare-ups is the first metatarsophalangeal joint, followed by the midfoot, ankle, knee, wrist, fingers, and elbow joints. Acute gout attacks rarely affect the axial joints. Pain in these affected areas is often accompanied by limited function, significantly impacting a patient' s daily activities and quality of life. Uncommon sites of gout involvement, as well as gout with normal serum uric acid levels, can easily lead to misdiagnosis. Therefore, a comprehensive diagnosis requires a detailed medical history, physical examination, laboratory tests, and imaging studies. This case report describes a 19-year-old male who was admitted with recurrent anterior chest pain. The diagnosis at another hospital suggested ankylosing spondylitis. Physical examination revealed significant tenderness, redness, and swelling of the bilateral sternoclavicular joints, with local warmth and mildly restricted movement. MRI of the sacroiliac joints showed no significant abnormalities, and serum uric acid levels were normal. Chest dual-energy CT scans revealed multiple tophi in the sternum, bilateral clavicles, scapulae, multiple ribs, and along the edges of the sternum. Based on the patient' s medical history, physical findings, and imaging studies, a diagnosis of gout was confirmed. Treatment included urate-lowering therapy, pain management, and dietary adjustments. During a two-year follow-up period, the patient did not experience recurrent anterior chest pain, and multiple serum uric acid tests consistently showed levels below 300 μmol/L. Repeat chest dual-energy CT scans indicated significant reduction of tophi in the sternoclavicular joints and other affected areas.