To explore the comorbidity patterns and influencing factors of chronic diseases in middle-aged and elderly people in China, so as to provide new ideas for the development of corresponding chronic disease prevention and control strategies and measures.

Using data from the China Health and Retirement Longitudinal Study (CHARLS) 2018, after excluding samples with missing variables for 14 chronic diseases, a final sample of 19,390 individuals aged 45 and older was included. The Apriori algorithm from association rule analysis was utilized to explore the comorbidity patterns among middle-aged and elderly individuals in China. The occurrence of chronic comorbidity (two or more chronic diseases or three or more chronic diseases) was taken as the dependent variable, and the independent variable was determined according to the five dimensions of social determinants of health. 5 696 samples were included after deletion of the missing values, and the influential factors of chronic comorbidity were analyzed by univariate χ² test and multiple logistic regression.

The prevalence of comorbid chronic diseases among middle-aged and elderly individuals in our country was 55.4%. The most common comorbidity patterns were arthritis or rheumatic diseases and hypertension. Association rule analysis identified 24 strong rule combinations, with the most common binary association being gastrointestinal or digestive system diseases with arthritis or rheumatic diseases, and the most common ternary association being gastrointestinal or digestive system diseases, hypertension, and arthritis or rheumatic diseases.The results of the multivariate analysis showed that both two or more chronic diseases and three or more chronic diseases were significantly associated with increased risk factors, including: age 60-80 years (two or more chronic diseases: OR=1.479, 95% CI: 1.244-1.759; three or more chronic diseases: OR=1.526, 95% CI: 1.267-1.839), age >80 years (OR=1.545, 95% CI: 1.144-2.087; OR=1.591, 95% CI: 1.175-2.154), depressive symptoms (OR=1.435, 95% CI: 1.267-1.626; OR=1.382, 95% CI: 1.216-1.570), having a pension (OR=1.350, 95% CI: 1.141-1.598; OR=1.332, 95% CI: 1.118-1.586), and residence in central (OR=1.268, 95% CI: 1.096-1.470; OR=1.269, 95% CI: 1.088-1.479) or western regions (OR=1.217, 95% CI: 1.062-1.395; OR=1.198, 95% CI: 1.038-1.382).Conversely, factors associated with a reduced risk of chronic multimorbidity included alcohol consumption (two or more chronic diseases: OR=0.811, 95% CI: 0.707-0.930; three or more chronic diseases: OR=0.837, 95% CI: 0.724-0.968), 6-8 hours of night sleep (OR=0.806, 95% CI: 0.702-0.926; OR=0.792, 95% CI: 0.688-0.912), more than 8 hours of night sleep (OR=0.738, 95% CI: 0.635-0.858; OR=0.745, 95% CI: 0.637-0.872), self-rated general health (OR=0.357, 95% CI: 0.307-0.414; OR=0.343, 95% CI: 0.299-0.392), and self-rated good health (OR=0.136, 95% CI: 0.114-0.163; OR=0.117, 95% CI: 0.096-0.142).

It is suggested that the prevention and intervention of chronic comorbidity should be multidimensional, and the health care personnel should take into account the comorbidity of patients and the problem of multiple drug use in the formulation of comorbidity treatment plan.

To explore the epidemiological characteristics of human brucellosis in Inner Mongolia from 2021 to 2023 and the spatial variation of meteorological factors affecting its incidence, providing a scientific basis for prevention, control, and public health resource allocation.

The de-identified human brucellosis case data from January 1st, 2021 to December 31st, 2023, were collected from the Inner Mongolia Center for Disease Control and Prevention. Descriptive analysis was used to study three distributions of human brucellosis in Inner Mongolia. A mixed local autoregressive geographical weighted regression model analyzed the monthly spatial autocorrelation and heterogeneity of brucellosis. The model’s fitting effect was compared with spatial autoregressive, geographical weighted regression, and local autoregressive geographical weighted regression models.

From 2021 to 2023, 56,483 cases of brucellosis in Inner Mongolia, with a peak incidence from March to July. The incidence in males was 53.67 per 100,000, significantly higher than in females (χ² = 25.803，P<0.05). Farmers comprised the largest proportion of cases. The highest incidence occurred in people aged 41 to 60 (43.60 per 100,000). Brucellosis incidence in Inner Mongolia showed a positive spatial correlation, with high-incidence areas mainly in the east and west. The Mixed GWR-LSAR model had the best fit. The effects of wind speed, temperature, pressure, and evaporation varied spatially.

Brucellosis in Inner Mongolia exhibited seasonal, demographic, and spatial patterns, with varying meteorological impacts across months and regions. Therefore, prevention and control strategies should be targeted and regional to effectively reduce the risk.

To analyze the relationship between smoking status and risk of cardiovascular diseases among Henan Huixian residents.

The baseline survey data and follow-up data of participants aged 30-79 years recruited in Huixian County, Henan, through the China Chronic Disease Prospective Research Project were used. Cox proportional hazard regression models were used to analyze the association between smoking status and risk of cardiovascular diseases.

A total of 59 865 cases were included in the cohort and followed up for a total of 586 851.81 person years (average 9.20 years). We documented 17 142 cases of cardiovascular diseases, 5 959 cases of ischemic heart diseases, 7 717 cases of cerebral infarction and 1 387 cases of intracerebral hemorrhage. The smoking rate of men (65.29%) was much higher than that of women (0.34%). Cox multivariate analysis showed, compared with nonsmokers, current smokers had higher risk of cardiovascular diseases (HR=1.178, 95% CI: 1.118-1.241), ischemic heart diseases (HR=1.291, 95% CI: 1.177-1.417) and cerebral infarction (HR=1.297, 95% CI: 1.203-1.398). Among current smokers, those who smoked more than 20 cigarettes per day or those who started smoking at the age of less than 20 years old had higher risk of cardiovascular diseases, ischemic heart diseases and cerebral infarction.

Smoking can effectively decrease the risk of cardiovascular diseases. It is necessary to strengthen the control and intervention of smoking behavior in order to curb the epidemic trend of cardiovascular disease.

To investigate the association between blood and urine biomarkers and genetic risks of primary glaucoma using Mendelian randomization analysis.

This study utilized summary data from large - scale genome-wide association studies to extract eligible instrumental variables and primarily employed the inverse variance weighted (IVW) method for analysis. The results were validated through Cochran’s Q statistic, MR - Egger regression intercept, MR - PRESSO, and the leave - one - out method.

MR analysis showed that the total protein (IVW: OR=1.399, 95% CI: 1.000-1.958, P=0.049), glycated hemoglobin (IVW: OR=0.650, 95% CI: 0.512-0.824, P<0.001), and glucose (IVW: OR=0.587, 95% CI: 0.368-0.938, P=0.026) were causally related to primary glaucoma. Reverse MR analysis further found a causal relationship between primary angle - closure glaucoma and total protein (IVW: OR=0.990, 95% CI: 0.980-0.999, P=0.045), indicating a bidirectional causal relationship between total protein and primary angle - closure glaucoma. The results were validated without finding heterogeneity or horizontal pleiotropy.

Total protein may be a potential risk factor for primary angle - closure glaucoma, while glycated hemoglobin and glucose may serve as protective factors against primary open -angle glaucoma. Total protein and albumin are potential biomarkers for primary angle -closure glaucoma. This study provides information on biomarkers that can be further investigated, offering new insights and strategies for the early diagnosis, personalized treatment, and prevention of glaucoma.

To analyze the epidemiological characteristics, influential factors, and the risk of reinfection in patients with hand, foot and mouth disease (HFMD) in Xining, Qinghai, 2008-2023, and to provide scientific evidence for preventing HFMD reinfection in Xining and Qinghai-Tibet plateau regions.

The incidence data of HFMD in Xining from May 1, 2008 to December 31, 2023 were collected from the China Information System for Disease Control and Prevention to establish a database of cases of HFMD reinfection by filtering and organizing. Descriptive epidemiological method was used to describe the epidemiological characteristics of the reinfection cases, and the Kaplan-Meier method was utilized to assess the cumulative hazard probability of HFMD reinfection after initial infection, and Cox proportional hazards regression model was employed to conduct a comprehensive analysis of the risk of HFMD reinfection through both univariate and multivariate perspectives.

A total of 493 HFMD reinfection cases were reported in Xining 2008-2023, the reinfection incidence was 2.67% (493/18 472), and the cumulative risk for the reinfection was 3.00%. 486(98.58%) cases were infected twice, and 7 cases (1.42%) were infected three times. The Kaplan-Meier curve demonstrated that the cumulative risk of reinfection increased sharply within 30 months after the first infection, and with 74.44% of cases reinfected within 30 months. The Cox proportional hazards regression model analysis revealed that the risk of HFMD reinfection was lower in males compared to females (HR=0.822, 95% CI: 0.684-0.988), in children aged ≥3 years compared to those aged <3 years(HR=0.586, 95% CI: 0.445-0.771). The risk of HFMD reinfection was higher in kindergarten children (HR=5.551, 95% CI: 2.278-13.525) and scattered children (HR=6.897, 95% CI: 2.769-17.184) compared to other population groups, and in children residing in urban areas (HR=1.531, 95% CI: 1.222-1.917) compared to those in rural areas.

The reinfection rate of HFMD is relatively high in Xining. People living in urban areas, initially infected with enterovirus 71(EV71), boys under the age of 3, and scattered children have higher risk of HFMD reinfection. Targeted intervention measures ought to be implemented for these high-risk groups in order to effectively mitigate the reinfection incidence of HFMD.

To analyze the changes in mortality and DALYs of cancer attributed to high Body-Mass Index (BMI) from 1990 to 2021 in China, to provide scientific basis for formulating prevention and control strategies for cancer.

Data on mortality and DALY rates attributed to high BMI in China from 1990 to 2021 were extracted from the Global Burden of Disease(GBD) 2021 database. The Joinpoint software was used to analyze the trends of these mortality and DALY rates, while age-period-cohort models were employed to investigate the effects of age, period, and cohort.

Compared with 1990, the standardized mortality rate and DALY of cancer attributed to high BMI in China showed an upward trend in 2021, with increases of 106.62% and 102.27%, respectively, and AAPCs of 2.4% and 2.3%. From 1990 to 2021, the mortality rate and DALY of cancer attributed to high BMI in various age groups in China showed an upward trend, with a significantly faster increase in the 25- and 60-79-year-old age groups. The global changes in the standardized mortality rate of cancer attributed to high BMI among Chinese populations, including men and women, from 1990 to 2019 were 1.92(95% CI: 1.80-2.04), 2.74(95%CI: 2.60-2.88), and 0.94(95% CI: 0.80-1.07), respectively; The global changes in standardized DALY rates were 1.97(95% CI:1.86-2.08), 2.76(95% CI:2.62-2.90), and 1.02(95% CI:0.93-1.11), respectively.

From 1990 to 2021, the burden of cancer attributed to high BMI in China shows an upward trend, with the most rapid growth among males and people aged 60-79 years. Effective strategies for the prevention and control of overweight and obesity should be implemented to reduce the burden of cancer.

To explore the causal relationship between left and right handgrip strength and the onset of cognitive decline, providing a reference for developing strategies to prevent cognitive decline in the elderly.

Genome-wide data for left and right handgrip strength were obtained from the UK Biobank, while genome-wide data for cognitive function were sourced from a meta-analysis conducted by the Cognitive Genomics Consortium. The study employed three regression models: Inverse-Variance Weighted (IVW), MR-Egger regression, and Weighted Median, to conduct Mendelian randomization analyses on the causal relationship between left and right handgrip strength and cognitive function.

The IVW model results demonstrated a positive causal relationship between right handgrip strength (β=0.08, 95% CI: 0.03-0.14, P=0.004), left handgrip strength (β=0.08, 95% CI: 0.01-0.14, P=0.017), and cognitive function.

The findings of this study support a positive causal relationship between left-hand grip strength, right-hand grip strength, and cognitive function.

To investigate the association between the expression of mucin-5B(MUC5B) gene and its locus polymorphisms rs2075853, rs4963053, and rs2014486 with coal worker’s pneumoconiosis(CWP).

The study analyzed age and years of service from 506 subjects (comprising 143 healthy individuals, 132 dust-exposed workers, 121 stage I CWP patients, and 110 stage II CWP patients) collected at the Guiyang City Public Health and Medical Center from February 2020 to October 2023. Gene expression levels were assessed using real-time quantitative polymerase chain reaction（qRT-PCR）. Receiver operating characteristic(ROC) curves were plotted, and the area under the ROC curve (AUC) was calculated to evaluate the predictive value of MUC5B for CWP. Genotyping of MUC5B rs2075853, rs4963059, and rs2014486 was performed using a MassARRAY Analyzer, and the association between the three single nucleotide polymorphisms (SNPs) genotypes’ distribution frequency and the risk of CWP was analyzed.

Significant statistical differences were observed among the groups in terms of age (H=242.198, P<0.001), years of service (H=315.822, P<0.001). Expression levels of MUC5B were significantly reduced in stage I and II CWP patients compared to the healthy and dust-exposed groups (H=34.491, P<0.001). ROC curve analysis indicated that MUC5B could serve as an auxiliary diagnostic marker for CWP (AUC=0.755, 95% CI: 0.682-0.828, P<0.001). Furthermore, haplotype analysis revealed that the CG haplotype constructed from rs4963059 and rs2014486 was more frequent in CWP patients, showing a significant association (odds ratio OR=1.719, 95% CI: 1.074-2.751, χ²=5.201, P<0.05), suggesting that the CG haplotype constructed by rs4963059 and rs2014486 loci was associated with an increased risk of coal workers’ pneumoconiosis.

The CG haplotype constructed by MUC5B gene rs4963059 and rs2014486 is closely related to the risk of developing coal workers’ pneumoconiosis.

The exact causal association between dietary intake and attention deficit hyperactivity disorder (ADHD) is unclear, and this study used two-sample, two-way Mendelian randomization (MR) to conduct causal association analyses between them.

Single nucleotide polymorphism (SNP) loci associated with dietaryintake were extracted from the pooled data of genome-wide association studies (GWAS) as instrumental variables (IV). Causal associations between dietary intake and ADHD were analyzed using the TwoSampleMR package in R software. The main methods used included inverse variance weighting (IVW), MR Egger and weighted median tests. Cochran’Q, MR-Egger, and the "leave-one-out" method were used for heterogeneity test, pleiotropy test, and sensitivity analysis, respectively.

The IVW results showed that avocado (OR=0.309, 95% CI: 0.132-0.719), celery (OR=0.503, 95%CI: 0.380-0.905), mutton/lamb (OR=0.349, 95% CI: 0.170-0.715), shellfish (OR=0.083, 95% CI: 0.011-0.638), grapefruit (OR=0.175, 95% CI: 0.043-0.711) and oily fish (OR=0.687, 95% CI: 0.492-0.960) were negatively associated with the development of ADHD, and naan bread (OR=4.109, 95% CI: 1.079-15.648), average weekly intake of spirits (OR=3.320, 95% CI: 1.419-7.767), intake of artificial sweetener added to cereal (OR=5.064, 95% CI: 1.507-17.017), and standard Tea (OR=1.004, 95% CI: 1.002-1.007) were positively associated with the development of ADHD.

Increased intake of avocado, celery, mutton/lamb, shellfish, grapefruit, and oily fish reduced the risk of ADHD, whereas increased intake of naan bread, average weekly spirits intake, Intake of artificial sweetener added to cereal, and standard tea raised the risk of ADHD.

To explore the mediating effect of physical function and nutritional status between sleep quality and frailty in rural elderly people based on Gobbens frailty integration model.

From July to September 2023, multi-stage stratified cluster random sampling was used to select the elderly aged ≥60 years old in rural areas of Xinjiang, and questionnaire survey and body measurement were used to investigate the study. AMOS 28.0 software was used to establish the structural equation model (SEM) and test the mediating effect.

(1) Frailty scores of the rural elderly were 40.00 (34.00,46.00), sleep quality scores were 7.00 (5.00,9.00), physical function scores were 9.00 (7.00,10.00), nutrition scores were 13.00 (12.00,14.00); (2) The score of sleep quality of the rural elderly was positively correlated with the score of frailty, and negatively correlated with the score of physical function and nutritional status (r=0.405, -0.222, -0.125, P<0.001). The score of physical function was negatively correlated with the score of frailty, and positively correlated with the score of nutritional status (r= -0.220, 0.216, P<0.001). Frailty score was positively correlated with nutritional status score (r= -0.071, P=0.024); (3) Physical function and nutritional status played a mediating role between sleep quality and frailty, accounting for 15.76% of the total effect.

Physical function status and nutritional status play an intermediary role in the sleep quality and frailty of the rural elderly. Through early identification of sleep problems, physical function status and nutritional status can be improved, delaying or even reversing the occurrence of frailty.

To analyze the levels of acrylamide in 2-5 years old children of three regions in China and assess the exposure risk.

The survey was conducted on 31 healthy children aged 2-5 years old in Guangxi Zhuang Autonomous Region, Heilongjiang and Sichuan Province. We collected the whole food consumed by the children during the survey period using the dual meal method, analyzed the acrylamide exposure level. Then the margin of exposure (MOE) assessment was used to evaluate the carcinogenic and non-carcinogenic risks by using BMDL10 (0.31 mg/(kg·bw·d)) and NOAEL (0.2 mg/(kg·bw·d)) as toxicity reference points.

This survey investigated 13 girls and 18 boys in three regions of China, aged between 26 to 58 months, with the weight range of 11.0 to 20.0 kg and the height range of 87.0 to 115.1 cm. A total of 187 food samples were collected, including 96 mixed diet samples, 61 liquid dairy product samples, and 30 infant formula samples. The average levels of acrylamide from the three types of samples were 9.54 μg/kg, 0.80 μg/kg, and 1.03 μg/kg. The average exposure levels were 0.624 μg/(kg bw·d), 0.04 μg/(kg bw·d), and 0.04 μg/(kg bw·d).The high exposure levels of acrylamide (P₉₅) increased to 2.974 μg/(kg bw·d), 0.234 μg/(kg bw·d), and 0.13 μg/(kg bw·d). The number of average MOE and high MOE (P₉₅) for non-carcinogenic risk of acrylamide are 299 and 67, while the number of average MOE and high MOE (P₉₅) for carcinogenic risk are 463 and 104.

The number of MOE for both non carcinogenic and carcinogenic risks of acrylamide in the diet of 31 young children are less than 10 000, and the number of MOE for high non carcinogenic risks is less than 100. Therefore, it is necessary to pay special attention to the health risks caused by dietary intake of acrylamide in young children.

To explore the effects of different sequential strength and endurance training on body composition and cardiorespiratory endurance of primary school students, and to provide theoretical basis for scientific guidance of primary school students’ fitness and improvement of children’s physical health. Subjects 60 boys in grade 5 of a primary school in Beijing (age: 10.22 y±0.73 y; height: 150.23 cm±9.63 cm; weight:45.71 kg±8.09 kg; BMI: 20.25 kg/m²±4.77 kg/m²).

The subjects were divided into three groups: simple endurance group (n=20), RE group (n=20) and ER group (n=20). Three groups of subjects were trained for 12 weeks, 3 times a week. Maximum oxygen uptake, body composition, lung function and other indicators were tested before and after intervention.One-way ANOVA and Paired Sample T-Test were used for statistical analysis.

After 12 weeks of exercise training intervention, there was no significant difference in the growth rate ofthe weight of the subjects between the three groups (Egroup: 2.78±7.23; REgroup: 4.00±7.20; ER groupin the same period: 3.47±7.94)(P>0.05).Compared with the simple endurance group, the percentage of physical fitness (Egroup: 10.69±3.34; RE group: 16.38±6.34; ER group: 23.15±10.30) was significantly decreased (P<0.01), and the ER group was better than the RE group (P<0.05). The muscle growth rate (Egroup: 6.84 ± 2.91; RE group: 12.58 ± 3.68; the ER group: 10.63±2.91) in the same period group was higher than the simple endurance group (P<0.01), and the RE group was higher than the ER group (P<0.05).The growth rate of vital capacity (Egroup: 12.71±4.64; RE group: 20.35±4.22; the ER group: 17.76±5.51) in the same period group was higher than that in the endurance group (P>0.05).There was no significant difference in the growth rate of vital capacity body mass index between the three groups (E group: 9.43±8.23; RE group: 16.55±7.96; the same period ER group: 13.44±10.26) (P>0.05).The maximum oxygen uptake growth rate (Egroup: 7.06±2.55; RE group: 14.10±4.12; the ER group: 11.26±4.04) in the same period group was higher than the endurance group (P>0.05).

Concurrent training is superior to simple endurance training in improving children’s body composition and cardiopulmonary endurance. The endurance-strength training sequence can effectively reduce the body fat content, the training sequence of strength-endurance can effectively increase the content of skeletal muscle and the improvement of children’s cardiopulmonary function is not related to the training sequence.

To analyze the associated factors affecting depressive symptoms in middle school students and to construct a risk prediction line graph model to assess the risk of developing depressive symptoms in middle school students.

A total of 1 088 middle school students were selected to participate in the monitoring and intervention project of common diseases and health influencing factors in Zhongmu County, Zhengzhou City, using the information collected from the questionnaires. A multivariate logistic regression analysis was employed to identify the factors that influenced the occurrence of depressive symptoms, and a column graph was established to predict the risk of depressive symptoms in middle school students.

The prevalence of depressive symptoms among middle school students reached 28.50%. Female students (OR=2.051,95% CI：1.475-2.851), living in school (OR=1.496,95% CI：1.069-2.093), abnormal family (OR=1.615,95% CI：1.013-2.530), beaten and scolded by parents within one month (OR=3.516,95% CI：2.159-5.726), smoking (OR=2.044,95CI：1.298-3.219), serious injury within one year (OR=2.576,95CI：1.225-5.417), bullying(OR=3.276,95CI：1.113-9.643), internet addiction (OR=7.421,95CI：4.624-11.909) can increase the risk of depressive symptoms in middle school students. Average daily fruit intake in a week (<1time/day: OR=0.513,95% CI：0.306-0.863; ≥1time/day: OR=0.500,95% CI：0.290-0.863), reduce the risk of depressive symptoms in middle school students. The Nomogram model based on the above factors had good differentiation (AUC=0.752) and accuracy (Hosmer-Lemeshow test result χ²=3.657, P>0.05).

Middle school students who are girls, live in school, abnormal families, beaten by parents within one month, seriously hurt within one year, smoking, bullying and Internet addiction are more likely to have depressive symptoms. The column-chart can be used to predict the risk of depression symptoms in middle school students effectively, so as to take timely intervention measures for high-risk groups.

To translate the Chinese version of Personal Experience Scale (PECK-SF) into Chinese and test its reliability and validity in primary and secondary school students in China.

The Chinese version of PECK-SF was used to investigate the bullying victimization of 10 250 primary and secondary school students over 9 years old, and exploratory factor analysis and confirmatory factor analysis were conducted respectively. The Center of Epidemiological Studies Depression Scale for Children (CES-DC) and the School Connectedness Scale (SCS) were used as criterion scales.

Item analysis showed that the scores of all items in Chinese version of PECK-SF were significantly positively correlated with the total score of the scale (r=0.548-0.704, P<0.001). Exploratory factor analysis showed that the 4-factor cumulative variance explanation rate was 64.709%. The results of confirmatory factor analysis showed that the scale fitting index was good (RMSEA=0.066, RMR=0.009, GFI=0.952, AGFI=0.929, CFI=0.941). The Chinese version of PECK-SF total scale and score by each dimension were positively correlated with CES-DC scores (r=0.273-0.492, P<0.001), and negatively correlated with SCS scores (r= -0.198——0.347, P<0.001). The Cronbach’s α coefficient of this scale is 0.879, and the split-half reliability is 0.764.

The Chinese version of PECK-SF has good reliability and validity and can be used as a bullying victimization assessment tool for primary and secondary school students over 9 years old.

To develop a questionnaire of menstrual health literacy for adolescent women and evaluate its reliability and validity to provide a scientific basis for evaluating the level of adolescent menstrual health literacy.

The initial questionnaire was compiled by combining literature search, semi-structured interview and Delphi expert consultation, and the test questionnaire was formed after revising items through item analysis and exploratory factor analysis.1545 middle and high school students were selected by convenient sampling method to test the reliability and validity of the questionnaire.

The adolescent health literacy questionnaire consisted of 4 primary indicators, 15 secondary indicators, 41 tertiary indicators and 60 measurement questions. Cronbach’s α coefficient of the total questionnaire was 0.890, and the broken half reliability was 0.853, indicating good reliability of the questionnaire.Most of the three indexes of the questionnaire were more than 85% suitable for inclusion, and 95% of the measurement questions had I-CVI value >0.80, indicating good content validity.The results of confirmatory factor analysis showed that the validity of the questionnaire structure was basically acceptable.The questionnaire response validity was measured based on the hypothesis that people with higher knowledge satisfaction and healthier lifestyle had higher questionnaire scores, and the results showed that the questionnaire response validity was good.

The adolescent menstrual health literacy questionnaire developed in this study has good reliability and validity, and can be used to evaluate the level of adolescent female menstrual health literacy.

To investigate the status of drug resistance of Mycobacterium tuberculosis(M.tuberculosis) isolated from drug resistance monitoring stations in Changsha from 2021 to 2023, and to provide reference for the control effect of drug-resistant tuberculosis.

The positive specimens from designated medical institutions in Changsha were collected and sent to our hospital together with the basic information of patients for further M.tuberculosis drug susceptibility test. Drug susceptibility tests were performed on all samples by proportional method, including 8 drugs, such as RFP, INH, EMB, SM, OFX, PAS, TH, KM, etc, and the qualitative data were analyzed by χ² test.

Among the 3 037 isolates, 2 534 were fully sensitive and 503 were drug-resistant, and the total drug resistance rate was 16.56%. Among them, 316 were single drug resistant, and the drug resistance rate was 10.41%. There were 81 multi-drug resistant strains (2.67%) and 106 poly-drug resistant strains (3.49%). The drug resistance sequences of any drug were INH, SM and RFP, 9.02%, 6.98% and 3.65%, respectively. The top three of multi-drug resistant patterns were INH+RFP (0.66%), INH+RFP+SM (0.4%) and INH+RFP+SM+EMB (0.36%), respectively. The top three poly-drug resistant patterns were INH+SM (1.15%), INH+TH1321 (0.4%) and INH+EMB (0.2%), respectively. In addition, from year of 2021 to 2023, the resistance of M.tuberculosis to RFP, EMB, and TH1321 drugs in Changsha area showed a decreasing trend year by year (P<0.05), but the overall resistance rate of patients in Changsha urban area was significantly higher than that in other districts and counties.

Compared with other provinces and cities, the overall drug resistance rate of tuberculosis patients in Changsha is low, but the drug resistance rate of tuberculosis in Changsha urban area is significantly higher than that in other districts and counties, which should arouse the attention of relevant departments.

To analyze the influencing factors of the first visit of elderly people at the grassroots level in China, and further implementing graded diagnosis and treatment policies.

Based on the 2020 CLASS data, 4 444 elderly people were included, and a chi square test was used to analyze the influencing factors of their primary diagnosis behavior. A random forest model was used to rank the importance of variables with significant impact.

The elderly who living in the eastern region (OR=1.791,95% CI:1.421-2.256) and the central region (OR=1.438,95% CI:1.121-1.846), having a general self-evaluation (OR=1.869,95% CI:1.501-2.327) and self-assessment health (OR=2.342,95% CI:1.869-2.936), having two kinds of chronic diseases (OR=1.379,95% CI:1.174-1.621) and more than two kinds of chronic diseases (OR=2.648,95% CI:2.236-3.137), using health intelligent devices (OR=1.192,95% CI:1.032-1.377), using basic health services(OR=1.756,95% CI:1.527-2.020), college degree or above (OR=1.480,95% CI:1.088-2.012), and Internet access (OR=1.184,95% CI:1.015-1.381) are more willing to go to the grass-roots level for first diagnosis.

The first visit rate of elderly people at the grassroots level still needs to be improved. It is necessary to strengthen the publicity effect of grassroots first visit, improve the utilization rate of grassroots health services, encourage elderly people to use health intelligent devices, increase the construction of grassroots medical and health institutions in western regions, and correctly guide elderly people to form good medical habits.

To understand the status and problems of rehabilitation resource allocation in the system of the China Disabled Persons Federation and provide a reference for the rational allocation of rehabilitation resources in the system of the China Disabled Persons Federation.

Based on the health resource density index and rank sum ratio method, the rehabilitation resource allocation status of the disabled person's federation system in 31 provinces (municipalities) in my country in 2022 was comprehensively measured, analyzed, and evaluated.

The regression equation of Probit and RSR was RSR= -0.779+0.255*Probit value (F=1 206.958, P≤0.001), indicating that the regression line equation was statistically significant and representative. According to the optimal grading principle of the rank sum ratio method, the rehabilitation resource allocation status of the disabled person's federation system in my country was divided into three grades, with Probit>6 in 5 provinces and cities such as Shanghai, and a good allocation status; 4<Probit<6 in 22 provinces and cities (autonomous regions) such as Heilongjiang, and a medium allocation status; Probit<4 in 4 provinces and cities (autonomous regions) such as Tibet, and a poor allocation status.

The overall situation of rehabilitation resource allocation in the system of the disabled person's federation is good, but there is still a lack of total amount and differences between the East and West. Optimizing the inter-regional flow mechanism of rehabilitation service resources, improving the diversified pattern of rehabilitation resources in some provinces (cities), and promoting the efficient development of rehabilitation resource allocation are recommended.

To investigate the effect of sleep quality on suicide risk among medical students and the role of depression and academic stress in the relationship.

A questionnaire survey of 3 521 current medical students was conducted using the Pittsburgh Sleepiness Scale, the Patient Health Questionnaire Depression Scale, the Beck Suicidal Ideation Scale, and the Academic Stress Score. SPSS 26.0 was applied for descriptive statistics, independent samples t-test, ANOVA and correlation analysis of the data, and PROCESS plug-in was used for the moderated mediation test.

Sleep quality index positively predicted suicide risk（β=0.315）; depression partially mediated the association between sleep quality and suicide risk (β=0.233, 95% CI: 0.174-0.297), with a mediating effect accounting for 74.19% of the total effect; academic stress moderated the first half path of the mediation model (β=0.093), i.e., moderated the effect of sleep quality on depression.

Sleep quality increases the risk of suicide among medical students by affecting depression; reducing academic stress reduces the effect of sleep quality on depression among medical students.

To explore the relationship between the interaction of health literacy and mobile phone dependence and sub-health status of college students, so as to provide evidence-based evidence for improving sub-health status of college students.

Cluster sampling was used to investigate the social demographic characteristics, health literacy, mobile phone dependence and sub-health of college students in Shandong Second Medical University. logistic regression model was used to analyze the correlation between each factor and sub-health status, and the interaction between health literacy and mobile phone dependence and sub-health status was analyzed.

The total detection rates of mobile phone dependence and sub-health were 83.8% (461/550) and 66.7% (367/550), respectively. After adjusting relevant variables, logistic regression analysis found that college students with low health literacy and dependence on mobile phones had the highest risk of sub-health, which was 31.901 times that of college students with high health literacy and no dependence on mobile phones, and the college students without mobile phone dependence and high health literacy were taken as the reference group, and mobile phone dependence and medium and low health literacy had positive synergistic interactions with sub-health, OR values were 5.030 (95% CI: 3.079 - 8.217) and 8.014 (95% CI: 4.404 - 14.583). The calculated relative values of RERI, AP and SI didn’t meet the conditions and cannot indicate the existence of additive interaction.

The interaction between health literacy and mobile phone dependence is associated with sub-health status of college students, which can be used as an evidence-based basis to improve health.

To explore the potential categories and influencing factors of complication risk perception in inpatient with type 2 diabetes mellitus.

A total of 400 patients with type 2 diabetes mellitus who were hospitalized in three tertiary-level hospitals in Tangshan city from August 2023 to January 2024 were randomly selected and included in the whole group. General information questionnaire, Risk Perception Survey-Diabetes Mellitus, Connor-Davidson Resilience Scale, Brief Illness Perception Questionnaire were used for investigation. Using multi-categorical logistic regression analysis to explore the influencing factors.

Inpatients with type 2 diabetes could be divided into high confidence low disease risk perception group (40.25%), appropriate risk perception group (40%), and high concern high disease risk perception group (19.75%). Multi-categorical logistic regression analysis showed that high disease perception score(OR=0.808, 95% CI:0.762-0.858)was a protective factor for the high confidence low disease risk perception group, high psychological resilience score(OR=1.159, 95% CI:1.087-1.235)was a risk factor for the high confidence low disease risk perception group; educational attainment of college and above (OR=23.567, 95% CI:2.807-198.242),havingdiabetes complications(OR=3.408,95% CI:1.315-8.834), high disease perception score (OR=1.320, 95% CI:1.202-1.451)were risk factors for the high concern high disease risk perception group, the main access to diabetes knowledge was healthcare professionals(OR=0.101, 95% CI:0.029-0.355)and high psychological resilience score (OR=0.817, 95% CI:0.747-0.894)were protective factors for the high concern high disease risk perception group.

Perceived risk of complications in inpatients with type 2 diabetes can be categorized into 3 classes, and there are obvious classification characteristics among groups. Healthcare professionals can implement precise measures for different categories of patients to improve their level of perceived risk of complications.

To explore the effects of tooth loss and denture use on cognitive impairment in the elderly.

Based on the data of China Health and Retirement Longitudinal Study (CHARLS), over 60-year-old elderlies were selected as the research subjects.Logistic regression was conducted to explore the effects of tooth loss, denture use on cognitive impairment in elderly and subgroup analysis, and interaction analysis were performed for gender and social participation.

A total of 4 372 elderly people were enrolled, and the rate of cognitive impairment was 16.20% (709/4 372). Older age, female, rural living, lower education, no spouse, with depressive symptoms, and without social-participation are risk factors for cognitive impairment. Group of non-total tooth loss without dentures (OR=1.382; 95% CI: 1.145-1.669) and group of total tooth loss without dentures (OR=2.074; 95% CI: 1.186-3.627) were associated with an increased risk of cognitive impairment. The results of subgroup analysis showed that the male population with non-total tooth loss and no dentures (OR=1.413; 95% CI: 1.077-1.853), with total tooth loss and no dentures (OR=2.600; 95% CI: 1.263-5.352) was still associated with an increased risk of cognitive impairment, while the female with non-total tooth loss and no dentures (OR=1.363; 95% CI: 1.046-1.776) was significantly associated with an increased risk of cognitive impairment.The non-social-participation-group with non-total tooth loss and no dentures (OR=1.475; 95% CI: 1.123-1.937), with total tooth loss and no dentures (OR=2.720; 95% CI: 1.294-5.715) were associated with an increased risk of cognitive impairment.There was no interaction between tooth loss, denture use, genderand social participation in the incidence of cognitive impairment(P>0.05).

The combination of tooth loss and denture use is an independent influence factor for cognitive impairment. The use of dentures can reduce the adverse effects of tooth loss on cognitive dysfunction, especially for those with partial tooth loss. The elderly should be encouraged to retain natural teeth, restore missing teeth in time. Although there is no interaction between tooth loss, denture use and social participation, older adults are suggested to take part in social activities.

To study the rifampicin resistance, genotypic characteristics and clustering of Mycobacterium tuberculosis in Ningxia from 2020-2023.

98 strains of Mycobacterium tuberculosis were tested for rifampicin resistance using the GeneXpert MTB/RIF method, and the strains were genotyped by the McSpoligotyping method and analyzed by clustering at the MIRU-VNTRplus website.

The risk of developing rifampicin-resistant TB was significantly increased in retreatment patients (OR=33.22, 95% CI: 3.11-355.43, P<0.05), and TB patients from Zhongwei and Wuzhong cities showed a higher risk of rifampicin resistance (OR=19.42, 95% CI: 1.12-336.75, P<0.05; OR=43.25, 95% CI: 1.76-1062.70, P<0.05). 98 strains of Mycobacterium tuberculosis were typed by McSpoligotyping to present three lineages, with the largest lineage being the Beijing-type 80 strains (81.63%); the non-Beijing-type accounted for 18 strains (18.37%), of which 12 strains were of the T-type (12.24%), 1 strain of the U-type (1.02%), and the newly 5 strains (5.10%) were newly discovered or undefined genotypes. The Beijing type was widely distributed in all cities of Ningxia, with only the Beijing type in Guyuan and Shizuishan, and the T-type and newly discovered or undefined genotypes were mostly found in Zhongwei, Wuzhong and Yinchuan. Cluster analysis showed that the 98 strains were divided into two genetic clusters, Beijing-type and non-Beijing-type, with SIT1 accounting for the largest proportion of Beijing-type in the clusters (75.51%), T1-type in the non-Beijing-type, and the remaining 9 strains (9.18%) were independent scattered genotypes, with a cluster rate of 90.82% (89/98).

Health education has been actively carried out for retreatment patients and high-risk areas in the Ningxia region to improve treatment adherence, and TB screening and drug resistance surveillance has been strengthened in Zhongwei and Wuzhong cities. In addition, Mycobacterium tuberculosis is genetically polymorphic in this region, and Beijing SIT 1 is the main prevalent strain. Strengthening the monitoring of this gene and understanding its mode of transmission is important for controlling the spread of tuberculosis, slowing down the development of drug resistance, and ultimately improving the public health situation in the region.

To understand the epidemiological characteristics of student TB patients in the province and analyze their spatial aggregation, 2018-2023, and to further optimize the TB prevention and control measures in schools in the province, as well as to provide scientific reference bases for the relevant departments to formulate practical and effective TB prevention and control policies in schools.

From the “Infectious Disease Reporting Information Management System”, the case data of tuberculosis patients whose current address was within the counties (cities and districts) under the jurisdiction of Guizhou Province and whose occupations were students from January 1, 2018 to December 31, 2023 were derived according to the date of onset, and the epidemiological characteristics and spatial aggregation of tuberculosis among students were analyzed by using Excel 2010, SPSS 26 0 and Arc GIS 10 7 software, SPSS 26.0 and Arc GIS 10.7 software to organize and analyze the epidemiological characteristics and spatial aggregation of students' tuberculosis.

There were 23 699 cases of tuberculosis among students in Guizhou Province from 2018 to 2023, with an average annual registration rate of 40.67/100 000, showing a decreasing trend (trend χ²=1 244, P<0.001). The registration time was mainly concentrated in March-April and August-September each year; the regional distribution was mainly concentrated in Bijie City, Qiandongnan Prefecture, and Zunyi City; the age was mainly 15-19 years old (60.15%); the source of the patients was the largest proportion of referrals (40.08%), and the diagnostic results were mainly pathogenetically negative (65.80%), and the overall delayed rate of consultation for student TB patients during 2018-2023 was 49.01%.The global Moran's I values of student TB registration rates in Guizhou Province during 2018-2023 were all >0, ranging from 0.135 to 0.221, and all were statistical significance (P<0.05). The results of local autocorrelation analysis showed that there were different types of aggregation in the province's aggregation zones in each year, and the number of “high-high” aggregation zones in 2018-2023 were: 3, 2, 5, 4, 3, 4, and the number of “low-low” aggregation zones were: 3, 2, 5, 4, 3, and 4, respectively. The number of “high-low” agglomerations in 2018-2023 are: 3, 2, 5, 4, 3, 4, the number of “low-low” agglomerations in 2018-2023 are: 18, 15, 11, 9, 4, 5, the number of “high-low” agglomerations in 2018-2023 are: 0, 0, 1, 1, 1, 2, 4, the number of “low-high” agglomerations in 2018-2023 are: 1, 1, 2, 1, 1, 1, 1.

Guizhou Province, the student tuberculosis patient registration rate is a year-on-year decline in the trend of three inter-distribution is obvious, and the student tuberculosis patient registration non-uniform distribution between areas, and there is obvious spatial aggregation. It is recommended to strengthen active detection in schools, to strengthen health education, and to increase the prevention and control of tuberculosis in schools in areas of aggregation.

To analyze the genotypes and characteristics of HIV-1 transmission network of newly reported HIV/AIDS cases aged 50 and above in Yubei District of Chongqing and provide evidence for effective HIV-1 transmission prevention in Yubei District.

Blood sample of newly reported cases aged 50 and above in 2020-2023 were collected for genetic analysis, partial Pol gene sequences were obtained to construct molecular transmission network. The factors associated with the subjects entering network and characteristics of cluster were further analyzed.

A total of 351 Pol gene sequences were obtained and 9 HIV-1 genotypes were detected. CRF07_BC (57.0%, 200/351) was the major subtypes, followed by CRF08_BC(19.4%, 68/351), the rate of network entry was 57.3%, and 44 clusters were formed. The number of nodes in clusters was between 2-25. People aged 60 and above (60-69years old: aOR=2.25, 95% CI: 1.34-3.80; 70-79years old: aOR=2.93,95% CI: 1.52-5.65), with local household registration in Yubei (aOR=3.10, 95% CI: 1.74-5.52) and genotype CRF07_BC (aOR=2.57, 95% CI: 1.47-4.50) were more likely to have internet access. The proportion of high-risk spreaders was higher among males than among females.

CRF07_BC and CRF08_BC are the major genotypes of HIV/AIDS in people aged 50 years and abovein Yubei District, and CRF07_BC is the genotype of key transmission cluster with high transmission risk.We should strengthen the intervention for the high-risk elderly, and monitor the molecular network dynamically to guide the precise intervention.

To explore the characteristics of HIV molecular transmission network of men who have sex with men (MSM) among newly reported HIV cases in Jinan, China.

The plasma samples of newly reported HIV-1 MSM in Jinan from 2022 to 2023 were collected. The pol region gene was amplified using nested PCR followed by sequencing. The obtained sequences were used to construct phylogenetic tree and molecular transmission network. The related factors for participants entering a cluster were analyzed. Drug resistance mutations were identified and analyzed using the online software of HIV drug resistance database of Stanford University.

This study obtained 207 sequences and identified 15 HIV-1 subtypes. The dominant subtypes were CRF07_BC (76/207, 36.7%) and CRF01_AE (74/207, 35.7%), followed by B subtypes (21/207, 10.1%), CRF114_0155 (9/207, 4.3%), and CRF55_01B (8/207, 3.9%). Setting 1.5% as the gene distance threshold, a total of 15 molecular clusters were formed by 42 sequences, with a transmission network entry rate of 20.3%. Multivariate Logistic Analysis results showed that MSM with college or above education level and CD4 count>500 cells/μl were more likely to enter the molecular transmission network. Among the 207 participants, 11(5.3%) were detected with drug resistance mutations, including 2 with PI resistance mutations, 6 with NRTI resistance mutations, 2 with NNRTI resistance mutations, and 2 with INSTI resistance mutations. One participant was detected with both NRTI and NNRTI resistance mutations.

The gene subtypes of newly reported HIV cases are diverse, mainly were CRF07_BC and CRF01_AE. MSM with younger age and higher education level are active populations in the HIV transmission network. HIV transmission network monitoring is a long-term and continuous work, and it is necessary to strengthen the traceability of key populations in the network and provide more effective intervention strategies to reduce the HIV transmission.

To analyze the reasons of late HIV diagnosis in Chengdu, and to provide scientific basis for promoting early detection.

A cross-sectional survey was used, and the questionnaires were conducted among HIV/AIDS cases in 9 districts in Chengdu. The socio-demographic data, AIDS knowledge awareness, health seeking habits, testing behavior and other information were collected. The chi-square test and binary Logistic regression model were used to analyze the influencing factors. In-depth interviews were conducted, and the sample size was determined according to the principle of "information saturation".

A total of 757 HIV/AIDS cases were investigated, of which 258 (34.1%) were found late diagnosis. Multivariate Logistic regression analysis showed that the risk of late diagnosis was higher in age group 30-49 years old (aOR=3.350, 95% CI: 1.725-6.506) and ≥50 years old (aOR=3.913, 95% CI: 1.876-8.161) than 18-29 years old. Passive detection (aOR=2.002, 95% CI: 1.098-3.649) had a higher risk of late diagnosis than active detection. High school education or higher (aOR=0.472, 95% CI: 0.289-0.770) had a lower risk of late diagnosis than middle school education or lower. Among the 258 late diagnosis cases, 218 (84.5%) never had the idea of HIV testing in the past, mainly because they had not heard of AIDS (106 cases/48.6%) and felt that AIDS was far away from them (82 cases/37.6%). Among the 40 cases who had ever considering taking an HIV test, 17 (42.5%) did not take, mainly because they were worried about their privacy being exposed (12 cases/70.6%), worried about what others think during the test process (7 cases/41.2%), and worried about being discriminated against if they tested positive (7 cases/41.2%). In-depth interviews were conducted on 16 patients with late diagnosis. The reasons for late diagnosis mainly included: never heard of AIDS, serious misunderstanding of AIDS cognition, lack of risk perception awareness, and fluke mentality.

In order to effectively reduce the level of late HIV diagnosis, it is necessary to promote high-quality AIDS health education, improve the awareness of AIDS knowledge and risk perception after high risk behaviors, and encourage people with high risk behaviors to take the initiative to receive HIV testing as soon as possible. Building a supportive social environment to avoid giving up active testing for fear of discrimination is also essential.

To explore the association between disulfidptosis related genes (DRGs) and the prognosis of breast cancer patients and establish a risk prognosis model and verify it, and provide new biomarkers for the prognosis of breast cancer patients.

CNV landscape was drawnin R language. DRGs of co-correlations and differences were identified.The risk score prognostic model was constructed by using univariate Cox regression analysis and Lasso-Cox regression analysis. Kaplan-Meier survival curve,ROC curve and calibration curve for the model was drawn.A nomogram prognostic prediction model was constructed by combining the clinical features.

A risk prognostic model of breast cancer patients composed of 8 DRGs was constructed, and AUC of the ROC curve at 1,3, and 5 years was 0.809,0.848,0.883. DCA showed that the model could better predict breast cancer prognosis.

This research department has constructed a risk score model with 8 DRGs, which has a good prognostic value and can provide a new direction for the study of breast cancer prognosis.

To explore the association between Triglyceride Glucose-Body Mass Index (TyG-BMI) and the risk of developing type 2 diabetes mellitus (T2DM).

The data were obtained from the natural population cohort of Shanghai suburbs established from April 2016 to September 2017 (Songjiang subcohort). 29,351 nondiabetic subjects with normal blood glucose levels aged 20-74 years at baseline were included in the analysis. The association and dose-response relationship between baseline TyG-BMI level and the risk of developing T2DM were assessed by Cox proportional risk regression model and restricted cubic spline model. Covariates such as gender and age were stratified according to their covariates and their interaction with TyG-BMI was analyzed.

A total of 584 men and 777 women were initially diagnosed with T2DM after a median follow-up time of 6.98 years. After correcting for confounders, the Cox regression model showed a 58% increase in the risk of T2DM incidence for every 1 SD increase in TyG-BMI (HR=1.58, 95% CI: 1.50-1.66). After grouping TyG-BMI by quartiles and then including it as a categorical variable in the Cox regression model analysis, the risk of T2DM incidence increased progressively in the Q2, Q3, and Q4 groups with HR (95% CI) of 1.42 (1.15-1.75), 2.02(1.66-2.46), and 3.47(2.88-4.19), respectively (P_trend<0.001), using the Q1 group as the control. Restricted cubic spline plots showed a nonlinear association between TyG-BMI and the risk of T2DM incidence (P_nonlinear =0.048). In addition, subgroup analyses showed that the association between TyG-BMI and the risk of developing T2DM was significantly higher in young and middle-aged (less than 60 years old) residents than in older residents (P_interaction < 0.05).

Under normal blood glucose levels, baseline TyG-BMI was positively associated with the risk of developing T2DM, and this association was more significant in the young and middle-aged groups.

To analyze the design flaws and statistical issues present in medical papers submitted to core domestic journals, and to explore strategies for improving the quality of medical papers and submission acceptance rates.

A questionnaire survey was conducted to collect data on submissions to domestic core medical journals between January 2021 and December 2023. Quantitative empirical and qualitative analyses were performed.

A total of 306 clinical medicine research papers and 328 basic medicine research papers were included in the analysis. There was a statistically significant difference in the acceptance rates between these two categories (P<0.001), while no significant difference was found concerning the acceptance rates of papers supported by different levels of funding (P>0.05). Observational studies constituted 71.40% of all submissions; however, their acceptance rate was lower than that of experimental studies (43.75% vs. 53.66%, P<0.05). Various deficiencies were identified in the methodological design and statistical analysis reporting of the manuscripts. The main issues included unclear description of study design types, inadequate matching between groups, insufficient modeling and validation, neglect of sample size calculation, and errors in result reporting.

Significant flaws exist in the research design and statistical analysis reporting of medical manuscripts, with a considerable gap compared to internationally recognized medical reporting standards. Hospitals and medical schools should strengthen training in the latest medical research standards and statistical knowledge to improve the quality of academic papers and enhance research outcomes.

To evaluate the effectiveness of case study-modularized teaching design method in undergraduate nursing students.

Undergraduate nursing students in the class of 2020 of a medical university were selected as research subjects, and a parallel controlled trial was designed with case study-modularized teaching in the intervention group and traditional teaching methods in the control group, and the evaluation of teaching effectiveness was conducted by anonymous questionnaires and final grades.

The scores, learning attitudes, course cognition, teaching satisfaction, and self-learning effect evaluation of students in the intervention group were better than those in the control group (P<0.05), and the teaching method was especially effective in improving students’ comprehensive application ability.

The case study modularized teaching method used in the teaching of medical statistics is popular among students, with high course satisfaction and self-learning effect evaluation, which can improve the comprehensive application ability of students, and the teaching effect is remarkable.