As the important source of bone cells, osteoblasts are involved in bone formation and repair, and play a key role in maintaining bone balance. If the osteogenic differentiation process in vivo is disrupted, a variety of bone-related diseases may occur. Natural products, which have a wide range of sources, a wide variety of physiological activities, and few toxic side-effects, have been found in recent years to be able to regulate osteoblast differentiation. Based on the sources of natural products, this paper reviews the intervention of natural products from plant, animal and microbial sources on osteogenic differentiation, aiming to provide a theoretical basis for natural products in the treatment of bone diseases.

The United States has established a perfect specialist training system for developmental and behavioral pediatrics (DBP), while the DBP specialist training system in China is still in the early stage of development and has been constantly improved. This article analyzes and compares the current status of DBP specialist training system between the United States and China from the aspects of training pattern, eligibility criteria, training plans and contents, assessment and evaluation, and certification. With reference to the training system in the United States, we can further improve the DBP specialist training system in China by perfecting the training system and related documents, constructing reasonable eligibility criteria, establishing a training pattern guided by post competency, improving the DBP assessment and evaluation system based on competency, and enhancing the certification of DBP physicians.

Non-alcoholic fatty liver disease is a common chronic liver disease in clinical practice. In recent years, with increasing social attention to the health of women and the elderly, the prevention and treatment of non-alcoholic fatty liver disease after menopause has increasingly become a research hotspot in metabolic diseases. This study explores the pathogenesis and treatment method of non-alcoholic fatty liver disease in postmenopausal women based on the theory of "deficient qi and stagnation" and combined with the physiological and pathological characteristics of postmenopausal women and the Western medicine understanding of non-alcoholic fatty liver disease. We believe that the pathogenesis of non-alcoholic fatty liver disease in postmenopausal women is rooted in the "deficient qi" caused by depletion of liver and kidney essence and blood. The imbalance between the physical and functional aspects of the liver due to this "deficient qi" is the primary factor, while the "stagnation" of phlegm and blood stasis is the manifestation. Furthermore, the "deficient qi" and "stagnation" reinforce each other, with the deficiency leading to stagnation and stagnation exacerbating the deficiency, thus accelerating the progression of the disease. The treatment approach should be one that combines nourishing deficiency and resolving stagnation, addressing both root cause and maifestations. Given the female characteristic of "the liver as the innate organ" and the post-menopausal physiological state of "gradual decline of kidney essence", it is important to focus on nourishing the liver and kidneys, nurturing the liver′s physical body while maintaining its function, and also promoting the circulation of qi, resolving phlegm, and invigorating blood circulation to remove blood stasis. This approach aims to reduce the accumulation of lipids in the liver, offering a new perspective and approach for the treatment of non-alcoholic fatty liver disease in post-menopausal women with traditional Chinese medicine.

In order to strengthen the supervision of the use of drugs in hospitals，the Sichuan Academy of Medical Sciences· Sichuan Provincial People’s Hospital took the lead in compiling the Principles for the Rational Use of National Key Monitoring Drugs （the Second Batch） with a number of experts from multiple medical units in accordance with the Second Batch of National Key Monitoring Rational Drug Use List （hereinafter referred to as “the List”） issued by the National Health Commission. According to the method of the WHO Guidelines Development Manual， the writing team used the Delphi method to unify expert opinions by reading and summarizing the domestic and foreign literature evidence of related drugs， and applied the evaluation， formulation and evaluation method of recommendation grading （GRADE） to evaluate the quality of evidence formed， focusing on more than 30 drugs in the List about the evaluation of off-label indications of drugs， key points of rational drug use and key points of pharmaceutical monitoring. It aims to promote the scientific standardization and effective management of clinical medication， further improve the quality of medical services， reduce the risk of adverse drug reactions and drug abuse， promote rational drug use， and improve public health.

ObjectiveTo construct a quantitative differentiation model of traditional Chinese medicine （TCM） syndromes by taking primary osteoporosis （POP） with kidney yang deficiency syndrome as an example， and to provide methodological reference for the standardization of syndrome differentiation. MethodsHigh-frequency clinical features of POP were screened by descriptive statistical analysis， and strong association features of POP were obtained by association rule algorithm. On this basis， a latent structure （latent tree） model was established through latent structure analysis， and the implicit and explicit variables （features） related to POP with kidney yang deficiency syndrome were comprehensively clustered， and the clustering results were interpreted by the indexes of mutual information and cumulative information coverage， to explore the primary and secondary symptoms， and to deduce the categories of POP with kidney yang deficiency syndrome based on the probability of the features appearing in the various latent categories. Based on the categories， the clinical feature scores and identification thresholds were calculated， and the syndrome differentiation model of POP with kidney yang deficiency was initially constructed by combining the comprehensive judgment rules. Finally， the results of TCM professionals' judgment were used as the gold standard to further evaluate the effectiveness of the model in assisting the syndrome differentiation. ResultsThe 32 features strongly associated with POP were obtained， and the Bayes information critedon score of the further constructed latent tree model was -15291.93. Based on the mutual information and the cumulative information coverage， the main symptoms of POP with kidney yang deficiency syndrome were bone weakness， fatigue， pale tongue， clear urine， frequent nocturnal urination， cold limbs， thin pulse， white coating， and secondary symptoms were weakness， loss of libido， loose stool， frequent urination， lumbar and knee weakness， and fear of cold. From the probability of the occurrence of each clinical feature in different latent categories of POP with kidney yang deficiency syndrome， the state was introduced as S0 category （none/mild kidney yang syndrome）/ S1 category （moderate kidney yang syndrome）/ S2 category （severe kidney yang syndrome）. Optimizing the preliminary rules of state identification and refining the state of S1 category， the results showed that among 970 patients with POP， there were 520 patients having no/mild kidney yang deficiency syndrome， 224 patients with moderate to mild kidney yang deficiency syndrome， 81 patients with moderate to severe kidney yang deficiency syndrome， and 145 patients with severe kidney yang deficiency syndrome. During the evaluation and validation process， the correct rate of the model assessment index was 0.8835， while the sensitivity was 0.7181， and the specificity was 0.9437. ConclusionCombined with the latent structure analysis of the association rule， the syndrome differentiation model for POP with kidney yang deficiency could be constructed， and the model shows a good quantitative identification effect， which can provide methodological supports for clinicians to improve the efficiency and accuracy of TCM diagnosis.

The incidence of augmented renal clearance (ARC) in intensive care patients (ICU) is exceptionally high, and these patients are often co-morbid with infection. The occurrence of ARC will significantly increase the clearance rate of antibiotics, making it difficult for conventional doses to reach effective therapeutic concentrations and affect the patient's anti-infective treatment effect and prognosis. It can be seen that it is crucial to formulate a reasonable dosing regimen for ICU patients with ARC. Regrettably, few reports in China about the adjustment strategy of antibiotic dosing regimens for ARC patients. Therefore, this article reviews the domestic and foreign literature for reference to provide evidence for medical personnel to adjust the dose of antibacterial drugs for such patients.

Objective:To construct an evaluation index system for the core competence of hospital specialist service operation assistants and provide reference for the evaluation of such competence.Methods:From January to March 2022, literature analysis and behavioral event interviews were used to initially establish a core competence evaluation index system of hospital specialist service operation assistants, based on the Donabedian model. Subsequently, the Delphi expert consultation method was applied to conduct correspondence consultation, inviting experts to evaluate the contents and importance of the index system, using analytic hierarchy process to determine the weights of the indexes at all levels.Results:Two rounds of expert consultation were carried out, and the valid recovery rate of the questionnaire was 100%. The familiarity coefficient of the second round of correspondence was 0.87, the basis of judgment coefficient was 0.90, and the authority coefficient was 0.89. The final evaluation index system for core competence of hospital specialist service operation assistant consisted of 3 first-level indexes, 13 second-level indexes and 81 third-level indexes. The weight of the first-level index structure index was 0.266, and the highest weight among the second-level indexes was the operational development ability (0.083), while the highest weight among the third-level indexes of operational development ability was the comprehensive coordination ability (0.193); The weight of the first-level index process index was 0.405, and the corresponding second-level and third-level indexes with the highest weight were department operation practice work (0.157) and reasonable resource allocation (0.303), respectively; The weight of the first-level index result index was 0.329, and the corresponding second-level and third-level indexes with the highest weight were the weight of medical quality and safety (0.103) and drug adverse reaction reporting rate (0.237), respectively.Conclusions:The evaluation index system constructed in this study proves scientific and reasonable in weight assignment, proving a reference for the management of the specialist service operation assistants.

Objective To analyze the application value of Acapella positive expiratory pressure therapy combined with high-frequency chest wall oscillation sputum expulsion in children with severe pneumonia,and provide theoretical reference for the formulation of treatment plans for severe pneumonia.Methods From April 2022 to April 2023,120 children with severe pneumonia were selected from the Children's Respiratory Department of the Second Affiliated Hospital of Wenzhou Medical University.According to different treatment plans,the children were divided into traditional airway clearance group,Acapella positive expiratory pressure therapy group,high-frequency chest wall oscillation treatment group,and Acapella positive expiratory pressure therapy combined with high-frequency chest wall oscillation treatment group,with 30 cases in each group.The duration of pneumonia symptom remission and hospitalization,as well as the difference of pulmonary function index and inflammatory factors before and after treatment were compared.Results Compared with traditional airway clearance group,Acapella positive expiratory pressure therapy group,high-frequency chest wall oscillation treatment group,the disappearance time of pulmonary rales,the recovery time of body temperature,the time of cough relief and the length of stay of children in the Acapella positive expiratory pressure therapy combined with high-frequency chest wall oscillation treatment group were significantly shortened[the disappearance time of pulmonary rales(days):4.85±0.78 vs.8.47±2.36,5.22±2.12,5.38±1.56,the recovery time of body temperature(days):3.51±1.04 vs.7.84±2.34,4.45±1.92,4.76±1.59,the time of cough relief(days):7.45±2.15 vs.13.59±4.08,8.88±3.35,8.72±2.59,the length of stay(days):3.78±0.63 vs.8.29±2.07,5.02±1.44,4.96±1.25,all P<0.05].The disappearance time of pulmonary rales,the recovery time of body temperature,the time of cough relief,and the length of stay in Acapella positive expiratory pressure therapy group and high-frequency chest wall oscillation treatment group were shorter than those in traditional airway clearance group(all P<0.05).Forced expiratory volume in one second(FEV1),forced vital capacity(FVC)and FEV1/FVC after treatment were significantly higher than before treatment,and the inflammatory factors tumor necrosis fact-α(TNF-α),hypersensitive C-reactive protein(hs-CRP)and white blood cell count(WBC)were significantly lower than before treatment.After treatment,FEV1,FCV and FEV1/FVC in the Acapella positive expiratory pressure therapy combined with high-frequency chest wall oscillation treatment group were significantly higher than those in the traditional airway clearance group,Acapella positive expiratory pressure therapy group and high-frequency chest wall oscillation treatment group[FEV1(L):3.65±1.33 vs.2.28±0.45,2.94±0.63,2.99±0.72,FVC(L):4.56±1.84 vs.2.94±0.83,3.46±1.28,3.65±1.34,FEV1/FVC:(72.36±8.84)％ vs.(59.84±4.05)％,(62.35±5.22)％,(64.59±5.58)％,all P<0.05].The pulmonary function indexes of children in Acapella positive expiratory pressure therapy group and high-frequency chest wall oscillation treatment group were higher than those in traditional airway clearance group(all P<0.05).After treatment,the levels of serum inflammatory factors in the Acapella positive expiratory pressure therapy combined with high-frequency chest wall oscillation treatment group were significantly lower than those in the traditional airway clearance group,Acapella positive expiratory pressure therapy group,high-frequency chest wall oscillation treatment group[TNF-α(ng/L):14.62±4.55 vs.29.44±6.13,18.09±5.33,17.52±4.42,hs-CRP(mg/L):21.41±3.65 vs.48.67±8.39,40.24±6.42,37.24±5.12,WBC(×109/L):13.42±3.67 vs.19.29±6.45,15.43±5.34,14.22±4.14,all P<0.05],the serum inflammatory factor indexes of Acapella positive expiratory pressure therapy group,high-frequency chest wall oscillation treatment group were lower than those of traditional airway clearance group(all P<0.05).Conclusion Acapella positive expiratory pressure therapy combined with high-frequency chest wall oscillation sputum expulsion is effective in the treatment of severe pneumonia in children,which can shorten the time of sputum improvement and hospital stay,reduce the level of inflammatory factors,improve the pulmonary function of the children,and promote the rehabilitation process of the children.

Objective:To apply broaden-and-build theory to the family nursing of children with asthma, and observe its effect on children's condition control, main caregivers' negative emotion and family function.Methods:This study is a historical control study. The control group included 148 groups of children's families who were treated in the Child Respiratory Department of the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from January 2019 to June 2020, and the observation group included 122 groups of children's families who were hospitalized from January to July 2021. The control group implemented the routine in-hospital nursing and continuous nursing plan, while the observation group implemented the asthma family broaden-and-build nursing model. We observed the recurrence of the two groups of children six months after discharge, assessed the asthma control of the two groups using the Childhood Asthma Control Test, evaluated the depression, anxiety and stress of the main caregivers before and six months after discharge using the Depression Anxiety Stress Scale, and assessed the family function using the Family Assessment Device.Results:The number of recurrence and rehospitalization of children in the observation group was less than that in the control group, the duration of attack was shorter than that in the control group, and the score of Childhood Asthma Control Test was higher than that in the control group, with statistical differences ( P<0.05). Six months after discharge, the scores of anxiety, depression and stress of the main caregivers in the observation group were significantly lower than those in the control group, and the difference was statistical ( P<0.05). The score of family communication and emotional intervention in the observation group was lower than that in the control group before discharge, and the scores of children's families in the observation group in all dimensions of family function were lower than those in the control group six months after discharge, and the differences were statistically significant ( P<0.05) . Conclusions:Asthma family broaden-and-build nursing model can effectively control the condition of asthma in children, reduce the negative emotions of main caregivers, and improve their family functions.

Objective:To evaluate the effectiveness of staged modular theory and practice lectures in laparoscopic training.Methods:In this study, a large group of medical students and a large group of residents were selected, and each of the two groups was divided into an experimental group and a control group respectively. The experimental group received staged modular theory and practice lectures based on the conventional trainings, and the control group only underwent conventional laparoscopic skills training and instruction. Before and after the training, the completion time of 6 basic laparoscopic operations, laparoscopic suture time, suture quality and the number of accidental injuries were recorded and scored in each group according to the assessment criteria. SPSS 26.0 was used for statistical analysis of the assessment data. Independent samples t-test or Mann-Whitney U test was used for inter-group comparison between the two large groups, and paired samples t-test or Wilcoxon sign rank sum test was used for intra-group comparison before and after the training. Results:Compared with the control group, the experimental group of medical students that had undergone staged modular theory and practice lectures had a shorter time to complete basic laparoscopic operations, faster speed of suturing ( t=6.18, P<0.001) and higher quality of suturing ( t=4.17, P<0.001) and fewer accidental injuries ( Z=-2.03, P=0.043); the experimental group of residents that had undergone staged modular theoretical and practical lectures had a shorter time to complete basic laparoscopic operations, faster speed of suturing ( t=3.31, P=0.002) and higher quality of suturing ( t=3.68, P=0.001) and fewer accidental injuries ( Z=-2.44, P=0.015). Conclusion:The staged modular theory and practice lectures are able to further improve the quality of basic laparoscopic skills training.