Coronary heart disease （CHD） has a distinct circadian rhythmicity in its onset， which is closely related to the waxing and waning of qi and blood in the channel passages of the human body. Grounded in the circadian rhythm theory of "correspondence between heaven and humankind"， this paper explores the pathogenic evolution rules of qi-blood disharmony， channel obstruction， interacting as cause and effect with circadian rhythm disorders in CHD. Clinically， CHD can be observed to attack in the early morning， at night， in the afternoon， and at fixed or unfixed circadian intervals. The pathogenesis rhythms at different time nodes can correspondingly reflect the susceptibility tendencies and pathological stress responses of the human body to core pathogeneses such as yang deficiency with cold congelation， yin deficiency with yang floating， qi and yin deficiency， and liver constraint with qi stagnation under specific temporal states. Treatment should be adapted to the season and time， regulating yin and yang in accordance with biological rhythms. It is recommended to regulate qi during the daytime by promoting ascending and dispersing to unblock the channel passages， and select the appropriate timing for administration to harness natural timing. At the Mao （卯） hour， yang ascends while yin descends， and taking medication at this time conforms to the ascending of yang qi. At the Wu （午） hour， the heart meridian is active， and taking medication at this time warms the channel passages and assists heart yang， which can be treated with modified Buzhong Yiqi Decoction （补中益气汤） or Shengyang Yiwei Decoction （升阳益胃汤）. At night， blood should be harmonized， when the channel passages are unblocked through nourishing， restraining， and searching， with Lianmei Decoction （连梅汤） combined with Dahuang Zhechong Pill （大黄䗪虫丸）. Following the temporal rhythm， the focus is put on the transitional time of day and night and the four seasons to treat disease before it arises， resonating and corresponding with the natural rhythm.

Objective:To conduct a latent profile analysis of general self-efficacy among postpartum nurses with two children and explore the influencing factors of different profiles.Methods:A stratified sampling approach was used to recruit 298 clinical nurses with two children who had resumed work from 12 public healthcare facilities in Mianyang during May and December 2023. Data were collected using a demographic questionnaire, Work-Family Conflict Scale, Nursing Stress Scale, Family Stress Scale, and General Self-Efficacy Scale. Latent profile analysis was performed via Mplus 8.3. Pearson correlation and logistic regression analyses were used to examine associations between self-efficacy, work-family conflict, nursing stress, family stress, and profile membership.Results:Data collection yielded 298 questionnaires, with 281 valid responses (94.3% response rate). Three latent profiles of general self-efficacy were identified: low efficacy group (43.8%), moderate efficacy group (42.7%), and high efficacy group (13.5%). Work position, hospital level, time since return to work, nursing stress, and family stress were significant predictors of profile membership ( P< 0.05) . Conclusions:General self-efficacy among nurses with two children post-childbirth is heterogeneous. Nursing administrators should deliver tailored interventions based on latent profile characteristics and develop individualized self-efficacy enhancement programs from both individual and organizational perspectives to improve adaptability and competency during post-return work transition.

Objective This study aims to introduce and explore the application of the medical service price online audit system,which enables pre-positioning,informatization,intelligence,and refinement of price management,ensuring the safety of medical insurance funds and protecting the legitimate rights and interests of patients.Methods Taking a tertiary hospital in Guangdong Province as an example,the application practice of the medical institution's online audit system for price management is thoroughly introduced.Results Through the real-time monitoring of charge data by the online audit system,full-process man-agement is carried out,including pre-warning,mid-intervention,and post-analysis of medical billing behavior,in order to stand-ardize clinical diagnosis and treatment practices.Conclusion By utilizing information technology and continuously improving in-telligent audit rules,the standardization of hospital charge management can be promoted,internal control construction can be strengthened,and the hospital's refinement development can be facilitated.

Objective:To investigate the effect of atosiban on hemodynamic parameters of uterine arteries and clinical effect evaluation in patients with previous implantation failure undergoing frozen-thawed embryo transfer.Methods:A retrospective cohort study was conducted to analyze 298 cycles of FET in the Department of Reproductive Medicine of the Second Affiliated Hospital of Zhengzhou University from January 2021 to June 2023. Patients were categorized into atosiban group ( n=149) and control group ( n=149) according to whether administered atosiban or not. The related indicators and clinical outcomes were compared between the two groups. Hemodynamic parameters of the uterine arteries, including bilateral uterine artery peak systolic velocity/diastolic velocity (S/D), pulsatility index (PI), resistance index (RI), and serum levels of prostaglandin F2α (PGF2α) and oxytocin were compared before and after atosiban treatment. Univariate and multivariate logistic regression analysis were applied to assess the effect of atosiban on pregnancy outcomes. The effect of atosiban on live birth rate was analyzed by age stratification. Results:The implantation rate [51.92% (135/260)], the clinical pregnancy rate [67.11% (100/149)] and the live birth rate [59.06% (88/149)] in atosiban group were significantly higher than those in control group [41.13% (102/248), P=0.015; 51.01% (76/149), P=0.005; 40.27% (60/149), P=0.001]; and the early miscarriage rate [9.00% (9/100)] was lower than that of control group [19.74% (15/76), P=0.040]. Multivariate logistic regression analysis showed that atosiban was an independent influencing factor of live birth rate ( OR=2.236, 95% CI: 1.371-3.646, P=0.001). The post-treatment right uterine artery blood flow S/D [4.61 (4.00, 5.36)], PI [1.81 (1.58, 2.05)], RI [0.79 (0.75, 0.82)], and left uterine artery blood flow S/D [4.62 (3.83, 5.61)], PI (1.84±0.38), RI [0.79 (0.74, 0.82)] were all lower than those before treatment [right S/D 4.93 (4.06, 6.04), P<0.001; PI 1.93 (1.60, 2.17), P=0.001; RI 0.80 (0.76, 0.83), P<0.001; left S/D 5.05 (4.20, 6.32), P<0.001; PI 1.95±0.43, P<0.001; RI 0.81 (0.76, 0.84), P<0.001]. Besides, the levels of PGF2α [97.01 (85.15, 109.93) ng/L] and oxytocin [41.18 (37.16, 46.78) ng/L] after treatment in atosiban group were significantly lower than those before treatment [119.71 (108.85, 129.99) ng/L, P<0.001; 51.87 (46.44, 55.54) ng/L, P<0.001). Moreover, the endometrial peristalsis waves in atosiban group were significantly less after treatment [1.00 (0.00, 2.00) times/min] than before treatment [2.00 (1.00, 3.00) times/min], and the difference was statistically significant ( P<0.001). Conclusion:Atosiban can improve uterine artery blood flow and reduce endometrial peristalsis waves in women with previous implantation failure, which increases endometrial blood perfusion. Additionally, it can also reduce the levels of PGF2α and oxytocin, and optimize the pregnancy outcome of the frozen-thawed embryo transfer.

Objective:To investigate the therapeutic effects and underlying mechanisms of intrauterine perfusion of umbilical cord blood mononuclear cells (UCB-MNCs) on thin endometrium.Methods:SPF-grade Kunming mice aged 6-8 weeks were selected. A mouse model of thin endometrium was established by infusing 95% ethanol into the uterine cavity for a duration of 5 min. Using a completely randomized grouping method, 40 female mice with regular estrous cycles were randomly divided into four groups: untreated group (no intervention, n=10), sham-operated group (operation without modeling, n=10), experimental group (intrauterine infusion of UCB-MNCs during estrus after one estrous cycle post-modeling, n=10) and negative control group (intrauterine infusion of saline during estrus after one estrous cycle post-modeling, n=10). Following the administration of UCB-MNCs or physiological saline, all groups' uterine tissues were collected two estrous cycles later during their respective estrus phases. Hematoxylin-eosin staining was used to assess endometrial morphology, measure thickness, and count glands. Western blotting and reverse transcription real-time quantitative polymerase chain reaction were utilized to measure the relative protein and mRNA expression levels of leukemia inhibitory factor (LIF), vascular endothelial growth factor (VEGF), integrin (ITG) α V, ITG β 3 and proliferating cell nuclear antigen (PCNA) in the endometrium across different groups for intergroup comparisons. Results:The endometrial thickness and the number of glands in the untreated group [(507.32±85.66) μm, 18.67±6.66] showed no statistically significant differences compared with those in the sham-operated group [(502.78±73.26) μm, 19.33±7.73, all P>0.05]. The experimental group showed significantly increased endometrial thickness [(347.71±82.24) μm vs. (118.85±29.19) μm, P<0.001] and gland number (15.00±2.65 vs. 2.00±2.00, P=0.030) compared with the negative control group. There was no statistically significant difference in the relative protein and mRNA expression levels of LIF, VEGF, ITG α v, ITG β 3, and PCNA in the endometrium between the untreated group and the sham-operated group (all P>0.05). The relative protein and mRNA expression levels of endometrial LIF, VEGF, ITG α V, ITG β 3 and PCNA of the experimental group were all significantly higher than those in the negative control group (all P<0.05). Conclusion:Intrauterine perfusion with UCB-MNCs may promote endometrial regeneration and repair, as well as improve endometrial receptivity, through the upregulation of the expression levels of PCNA, LIF, VEGF, and ITG α V, ITGβ 3.

Objective To construct a nomogram model for prolonged length of stay in patients with acute cerebral infarction(ACI)based on total cerebral small vessel disease(CSVD)burden scores,and validate its effectiveness.Methods A total of 462 ACI patients admitted to the Department of Neurology of South Taihu Hospital Affiliated To Huzhou College from January 2021 to December 2023 were selected as the study subjects.According to the ratio of 7:3,patients were divided into training group of 323 cases and validation group of 139 cases.Lasso-Logistic regression was used to analyze the risk factors for prolonged length of stay in ACI patients,construct a nomogram model and validate the model using validation data.Receiver operating characteristic(ROC)curve were used to evaluate the predictive performance of the model.Results Based on the training group data,Lasso regression screened four non-zero coefficient indicators,including baseline National Institutes of Health stroke scale(NIHSS)score,age-adjusted Charlson comorbidity index(aCCI)score,neutrophil to lymphocyte ratio(NLR)and total CSVD burden score.Multivariate Logistic regression analysis showed that baseline NIHSS score,aCCI score,NLR and total CSVD burden score were independent risk factors for prolonged length of stay in ACI patients(P＜0.05).Based on the above four indicators,a nomogram model was constructed.The results showed that the ROC curve area of the model predicted prolonged length of stay between training group and validation group were 0.812(95％CI:0.756-0.868)and 0.820(95％CI:0.730-0.909).Conclusion The nomogram model for prolonged length of stay in ACI patients based on total CSVD burden score has good predictive performance and can be used as a screening tool for evaluating the prolonged length of stay in ACI patients.

Objective:To evaluate the role of necroptosis in paclitaxel-induced cognitive dysfunction in mice.Methods:Thirty SPF healthy male C57BL/6N mice, aged 6-8 weeks, weighing 20-25 g, were divided into 3 groups ( n=10 each) using a random number table method: vehicle control group (Veh group), paclitaxel group (PTX group), and paclitaxel+ a specific inhibitor of necroptosis Necrostatin-1 group (P+ N group). In PTX group and P+ N group, paclitaxel 10 mg/kg (diluted to 5 mg/ml in anhydrous ethanol and castor oil [1∶1], and further diluted to 1 mg/ml in 0.9% normal saline before use) was intraperitoneally injected daily for 7 consecutive days to induce cognitive dysfunction. P+ N group received an intraperitoneal injection of Necrostatin-1 6.5 mg/kg (diluted to 10 mg/ml in dimethyl sulfoxide, and further diluted to 1 mg/ml in 0.9% normal saline before use) at 2 h before paclitaxel administration every other day, 4 times in total. Veh group received the equal volume of solvent at the matched time points as previously described in P+ N group. After establishment of the model, spontaneous locomotor activity was assessed using the open field test, followed by the novel object recognition test and the Morris water maze to evaluate the cognitive function. The animals were sacrificed after the end of the Morris water maze test, and the hippocampal tissues were collected for determination of the expression of necroptosis-related proteins receptor-interacting serine/threonine-protein kinase 1 (RIPK1), RIPK3, mixed lineage kinase domain-like protein (MLKL), and phospho-MLKL (p-MLKL) (by Western blot analysis) and contents of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) (double immunofluorescence staining) and for observation of the localization of programmed necrosis cells (using enzyme-linked immunosorbent assay). Results:There were no significant differences in the total distance traveled and mean movement speed in the open field test or swimming speed in the Morris water maze test among the three groups ( P>0.05). Compared to Veh group, the time spent in the central zone in the open field and time spent in the original platform quadrant were significantly shortened, the discrimination index was decreased, the escape latency was prolonged, the number of crossing the original platform was reduced, the expression of RIPK1, RIPK3, MLKL and p-MLKL was up-regulated, the contents of TNF-α and IL-1β were increased, and the number of RIPK1-positive neurons was increased in PTX group ( P<0.05). Compared to PTX group, the time spent in the central zone in the open field test and time spent in the original platform quadrant were significantly prolonged, the discrimination index was increased, the escape latency was shortened, the number of crossing the original platform was increased, the expression of RIPK1, RIPK3, MLKL and p-MLKL was down-regulated, the contents of TNF-α and IL-1β were decreased, and the number of RIPK1-positive neurons was decreased in P+ N group ( P<0.05). Conclusions:Necroptosis in hippocampal neurons can lead to neuroinflammation, thus contributeing to paclitaxel-induced cognitive dysfunction in mice.

Objective : To analyze the mediating effect of psychological resilience between occupational stress and job burnout of medical staff, so as to provide the reference for improving job burnout of medical staff. Methods: The front-line medical staff from four tertiary general hospitals in a joint logistics support center were selected as the research objects from April to June 2022 using the convenience sampling method. The data on gender, age, professional title, and working years were collected by a questionnaire survey. Occupational stress, psychological resilience, and job burnout were evaluated using the Job Stressors Scale, the Connor-Davidson Resilience Scale, and the Maslach Burnout Inventory, respectively. The mediating effect of psychological resilience between occupational stress and job burnout was analyzed using the Process procedure, and the significance of the mediating effect was analyzed using the Bootstrap method. Results: A total of 383 people were investigated, among whom 370 were females (96.61%), and 13 were males (3.39%), with a mean age of (28.97±6.56) years. The scores of occupational stress, psychological resilience, and job burnout were (347.17±157.98), (87.18±13.17), and (56.07±17.09) points, respectively. The results of mediating effect analysis showed that occupational stress could directly positively affect job burnout with a direct effect value of 0.061 (95%CI: 0.004-0.119), and it could also indirectly positively affect job burnout through psychological resilience with a mediating effect value of 0.035 (95%CI: 0.002-0.122), and the mediating effect accounted for 57.38% of the total effect. Conclusions Occupational stress can directly or indirectly affect job burnout through psychological resilience. It is suggested to strengthen the mental health training of medical staff to improve psychological resilience and reduce job burnout.

OBJECTIVE To compare the anti-hepatitis mechanisms of Abrus pulchellus subsp. cantoniensis （Hance） Verdc. （AC） and Abrus pulchellus subsp. mollis（Hance） Verdc. （AM）. METHODS SD rats were randomly divided into blank group， AC- treated group， and AM-treated group， with each group consisting of 10 rats. The rats’ orbital venous blood was collected at 5， 15， 30 minutes， and 1， 1.5， 2， 4， 6， 8， 12 hours after gavage administration of 24 g/kg of the corresponding drug （calculated by crude drug） or water， respectively. Ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry technology was utilized to identify the prototype components present in the serum. The network pharmacology method was adopted to predict the anti-hepatitis active components， key targets， and signaling pathways of AC and AM. Additionally， molecular docking technology was utilized to verify the binding activity of the core active components with key targets. RESULTS A total of 35 prototype components migrating to the blood of AC and AM were identified in the serum of administered rats， among which 24 were common components. The active components in AC， such as acetylanguidine， physcion， soyasaponin A3 and soyasaponin Ⅰ， as well as those in AM， including vicenin 3， acetylanguidine，soyasaponin Ⅰ and schaftoside， all acted on key targets such as steroid receptor coactivator， phosphatidylinositol-4，5-bisphosphate 3-kinase catalytic subunit alpha， epidermal growth factor receptor （EGFR）， and protein kinase B1（Akt1）. These components modulated pathways in cancer， EGFR tyrosine kinase inhibitor resistance， and the phosphoinositide 3-kinase （PI3K） -Akt pathway， thereby exerting anti-hepatitis effects. Furthermore， the binding energies between these active components and their key targets were all less than －5 kJ/mol. CONCLUSIONS There are differences in the active components of AC and AM against hepatitis， but their mechanisms of action are similar. Both may exert their anti-hepatitis effects through pathways in cancer， EGFR tyrosine kinase inhibitor resistance， and the PI3K-Akt pathway.

Objective: To analyze the association of sedentary types with symptom of depressive and anxiety among college freshmen, so as to provide a reference for improving the mental health of college students. Methods: From October to November 2022, all college freshmen at three colleges and universities in Anhui Province were selected by a cluster sampling method. The Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the Youth Leisure-Time Sedentary Behavior Questionnaire (YLSBQ) were used for the investigation. A binary Logistic regression analysis was conducted to investigate the relationship of different types of sedentary behavior with anxiety and depressive symptom. Results: The detection rates of anxiety and depressive symptom among college freshmen were 32.8% and 49.9%, respectively. The results of the binary Logistic regression model analysis showed that after controlling for gender, family location, parental education level, self rated family economic status and number of intimate partners, high level overall, video based, and social based sedentary time were associated with an increased risk of anxiety ( OR =1.26, 1.56, 1.27) and depressive symptom ( OR =1.42, 1.94, 1.29) among college freshmen; the association between moderate level sedentary time and depressive symptom was statistically significant ( OR =0.83) (all P <0.05). The overall trends of the association between sedentary behavior with symptom of anxiety and depressive were similar in both boys and girls. Conclusions Sedentary behavior is associated with an increased risk of anxiety and depressive symptom in college students. Reducing video based and social based sedentary behaviors is beneficial for mental health promotion in college students.