Objective To study the effect of incorporating comprehensive geriatric assessment(CGA)into the whole-process WeChat-based case health management in elderly population who took annual physical examinations,thereby to improve their ability in health self-management.Methods A randomised controlled trial was conducted to select 100 elderly people who took annual physical examinations in our hospital from July 2022 to June 2023.The elderly were randomly divided into a control group and an trial group,with 50 people per group.CGA was applied to both groups,but the control group was under conventional health management,while the trial group received the incorporation of CGA into a whole-process WeChat-based case health management.The self-rated abilities for health practices scale(SRAHP)was used to compare the scores between the two groups before intervention,at 3,6 and 12 months after intervention.The scores of fatigue,resistance,ambulation,illnesses&loss of weight scale(FRAIL)and the mini nutritional assessment-short form(MNA-SF)were compared between the two groups before intervention and at 12 months after intervention.Incidence of falls was also evaluated after intervention.Results All the participants completed the study.Repeated measures analysis of variance showed that total SRAHP scores had statistical significances in main effect on time,group and interaction(Ftime=193.451,P<0.001;Fgroup=23.661,P<0.001;Finteraction=29.970,P<0.001).Further analysis revealed that the elderly in trial group had higher total scores in SRAHP than those in the control group at 6 and 12 months after intervention(both P<0.001).At 12 months after intervention,the trial group showed better scores in FRAIL and MNA-SF than the control group(both P<0.05)as well as with a lower incidence of falls(P<0.05).Conclusion Incorporation of CGA into a comprehensive WeChat-based case health management,over a long-term,can effectively enhance the ability in health self-management among elderly individuals who take annual health examinations,improve frailty and nutritional status and reduce the incidence of falls.The health self-management discovered from this study provides a valuable reference for health management among the elderly people who take annual physical examinations.

Objective:To explore the effect of proxy online health information seeking based on theory of planned behavior(TPB) of rural maternal for breast feeding guidance. The aim is to provide a theoretical basis for improving the rate of exclusive breast feeding among rural mothers.Methods:Using a quasi experimental research method and convenience sampling method, the study selected postpartum women and their primary caregivers who gave birth at Maoming Dianbai Maternal and Child Health Care hospital from October 2023 to April 2024 as the research subjects. According to the admission time, 47 parturients and their primary caregiver who gave birth between October and December 2023 were designated as the control group, while 50 parturients and their primary caregiver who gave birth between January and April 2024 were designated as the observation group. The control group received routine breast feeding education, while the observation group received proxy online health information seeking based on TPB breast feeding guidance. Compared the breast feeding knowledge, self-efficacy, family support, as well as the electronic health literacy and breast feeding knowledge of the primary caregivers of two groups of postpartum women.Results:The final control group included 40 maternal and their primary caregivers, while the observation group included 47 each. The maternal age of the control group was (36.73 ± 4.36) years, while that of the observation group was (35.96 ± 3.24) years. The main caregivers for the control group of parturients were 5 males and 35 females, aged 61.00 (59.00, 62.00) years old. There were 8 males and 39 females in the observation group, aged 62.00 (59.00, 64.00) years. After 6 months of intervention, the scores of breast feeding knowledge, self-efficacy, and family support were 14.00(12.00, 16.00), 45.67 ± 9.49, 3.00(3.00, 4.00) in the intervention group, more than those in the control group 7.00(2.00, 10.75), 37.15 ± 8.12, 2.00(2.00, 3.00) points, the differences were statistically significant between the two groups ( Z=-6.55, -5.68, t=-4.45, all P<0.05); the primary caregivers' electronic health literacy and breast feeding knowledge scores were 31.45 ± 4.92 and 14.00 (11.00, 16.00), respectively, higher than those of the control group family members 28.68 ± 4.46 and 4.50 (2.00, 9.75). The differences were statistically significant ( t=-3.38, Z=-7.19, both P<0.05). The pure breast feeding rate at 1 week, 3 months and 6 months postpartum were 70.2%(33/47), 63.8%(30/47), 59.6%(28/47) in the intervention group, more than those in the control group 47.5%(19/40), 37.5%(15/40), 27.5%(11/40), the differences were statistically significant between the two groups ( χ2=4.64, 6.00, 8.99, all P<0.05). Conclusions:Proxy online health information seeking based on TPB can effectively strengthen the health information searching ability of primary caregivers of rural maternal, and help rural maternal improve breastfeeding knowledge, self-efficacy and family support to promote exclusive breast feeding.

Objective:To investigate the application effects of electroacupuncture at Chang'an acupoint combined with stimulation of Huatuo Jiaji acupoint on non-specific low back pain. Methods:A retrospective analysis was conducted on the clinical data of 200 patients with non-specific low back pain admitted to the Hanzhong Hospital of Traditional Chinese Medicine from October 2021 to October 2022. The patients were divided into two groups based on different treatment methods: a control group and an observation group, with 100 patients in each group. The control group received conventional electroacupuncture treatment, while the observation group received electroacupuncture at the Chang'an acupoint and stimulation of Huatuo Jiaji acupoint. Both groups were treated for three treatment courses. Clinical efficacy was compared between the two groups. Results:The total response rate in the observation group was 97% (97/100), which was significantly higher than the 84% (84/100) in the control group ( χ2 = 9.83, P = 0.002). After treatment, both groups showed an increase in the Japanese Orthopaedic Association score for low back pain (both P<0.05) compared with before treatment. The Japanese Orthopaedic Association score in the observation group was significantly higher than that in the control group [(23.54 ± 1.81) vs. (20.75 ± 1.57), t = 11.64, P<0.001]. Conclusions:Electroacupuncture at the Chang'an acupoint combined with stimulation of the Huatuo Jiaji acupoints is effective in relieving pain, improving lumbar function, and enhancing clinical outcomes in patients with non-specific low back pain.

Objective To observe the value of artificial intelligence iterative reconstruction(AIIR)for low-dose chest CT images of infants with congenital heart disease.Methods Totally 262 infants with congenital heart disease who would undergo chest CT scanning were prospectively enrolled and randomly divided into low-dose group(n=142)and conventional dose group(n=120).Chest CT scanning with tube voltage of 80 kVp and tube current of 10 mAs was performed in low-dose group,and hybrid iterative reconstruction(HIR,group A)and AIIR(group B)were used to reconstruct images,respectively.In conventional dose group,chest CT scanning with tube voltage of 80 kVp and tube current of 100 mAs was performed,and HIR was used to reconstruct images(group C).Then subjective and objective evaluation on image quality were performed,the results were compared among 3 groups,and the value of AIIR was analyzed.Results Significant differences of image quality and clarity of displaying structures were found among 3 groups(all P＜0.001).Among them,except for the clarity of interlobar fissure,no significant difference of subjective scores was found between low-dose AIIR images and conventional dose HIR images(all corrected P＞0.05),while subjective scores of low-dose HIR images were all lower than those of low-dose AIIR images and conventional dose HIR images(all corrected P＜0.05).Significant differences of standard deviation(SD),signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were found among 3 groups(all P＜0.001)and between each 2 groups(all corrected P＜0.05).The effective dose of low-dose group and conventional dose group was 0.09(0.08,0.10)and 0.85(0.75,1.03)mSv,respectively,and the former was lower than the latter(Z=-13.942,P＜0.001).Conclusion Using AIIR could obtain low-dose chest CT images of infants with quality comparable to conventional chest CT images.

Objective:To analyze the latent profile characteristics of self-management ability in patients with metabolic-associated fatty liver disease (MAFLD) and explore its influencing factors.Methods:This was a cross-sectional study. A total of 311 patients with metabolic-associated fatty liver disease (MAFLD) were selected from the First Affiliated Hospital of Sun Yat-sen University (including those receiving treatment and undergoing physical examinations) between August and October 2024. Data were collected using a general information questionnaire, the self-management Scale for Patients with Non-Alcoholic Fatty Liver Disease, and the Social Support Rating Scale. After excluding 51 patients due to incomplete questionnaire responses or logical inconsistencies, 260 patients were finally included in the analysis. Latent profile analysis was used to identify potential categories of patients′ self-management abilities. With the latent categories as the dependent variable and items with P<0.05 in univariate analysis as independent variables, a multivariate logistic regression analysis (with the "poor self-management group" as the reference group) was performed to explore the influencing factors. Results:Among the 260 participants included in the study, three potential categories of self-management behaviors were finally identified, namely the active self-management group with 106 cases (40.8%), the moderate self-management group with 118 cases (45.4%), and the passive self-management group with 36 cases (13.8%).Results of multivariate logistic regression analysis showed that, compared with the passive self-management group:Patients who resided in rural areas ( OR=0.130, 95% CI: 0.040-0.420), often stayed up late ( OR=0.200, 95% CI: 0.060-0.590), or had an average daily sleep duration of≤5 hours ( OR=0.160, 95% CI: 0.050-0.510) had a significantly lower probability of belonging to the "active self-management group";In contrast, patients with an education level of senior high school or above ( OR=7.530, 95% CI: 1.740-34.160) or a higher total score of social support ( OR=1.120, 95% CI: 1.030-1.210) had a significantly higher probability of being in the "active self-management group" (all P<0.05). Conclusion:There is heterogeneity in self-management ability among patients with metabolic associated fatty liver disease (MAFLD). Residential area, educational level, frequency of staying up late, average daily sleep duration, and social support are influencing factors of patients′ self-management ability.

Objective: To analyze the epidemiological characteristics and changing trends of non suicidal self injury (NSSI) behaviors among middle school students in Jiading District of Shanghai, from 2015 to 2023, so as to provide a basis for the development of NSSI prevention and control measures among students. Methods: Using a stratified cluster random sampling method, a total of five times for Shanghai Adolescent Health Risk Behavior Surveys were conducted for every two years in Jiading District of Shanghai from 2015 to 2023. A total of 5 231 middle school students from junior high schools and senior high schools were selected for questionnaire surveys. Intergroup comparisons were performed using the x 2 test or the χ 2 trend test, and the JointPoint 5.0 software was used to analyze the changing trends, with the annual percent change (APC) used for evaluation. A binary Logistic regression model was employed to analyze the related factors of NSSI behavior among middle school students. Results: In 2023, the reported NSSI rate among middle school students in Jiading District was 14.2%. The rate was significantly higher among junior high school students (17.1%) than that among senior high school students (11.1%), and higher among females (19.2%) than that among males (10.0%) ( χ 2=10.04, 23.21, both P <0.01). From 2015 to 2023, the overall reported NSSI rate showed an increasing trend, rising from 8.6% in 2015 to 14.2% in 2023 ( χ 2 trend =22.25), with an APC of 6.64% ( t =3.49), and the APC for girls was 9.79 % ( t =3.20) (all P <0.05). Among students reporting NSSI, the proportion experiencing ≥6 episodes increased from 10.8% in 2015 to 19.2% in 2023 ( χ 2 trend =6.57, P <0.05). Multivariate Logistic regression analysis indicated that girls, junior high school students, those with insomnia, depressive emotion and drinkers had higher risks of NSSI, compared to boys, senior high school students, those without insomnia, non depressive emotion students and non drinkers ( OR =1.71, 1.96, 3.44, 4.76, 1.77, all P < 0.05 ). Conclusions The reported rate of NSSI among middle school students in Jiading District of Shanghai, increased annually from 2015 to 2023, and the proportion of repeated NSSI also showed an upward trend. Early intervention measures targeting middle school students, especially junior high school students and females, should be implemented to prevent and control its occurrence and development.

Intervertebral disc degeneration (IDD) is largely attributed to impaired endogenous repair. Nucleus pulposus-derived stem cells (NPSCs) senescence leads to endogenous repair failure. Small extracellular vesicles/exosomes derived from mesenchymal stem cells (mExo) have shown great therapeutic potential in IDD, while whether mExo could alleviate NPSCs senescence and its mechanisms remained unknown. We established a compression-induced NPSCs senescence model and rat IDD models to evaluate the therapeutic efficiency of mExo and investigate the mechanisms. We found that mExo significantly alleviated NPSCs senescence and promoted disc regeneration while knocking down thioredoxin (TXN) impaired the protective effects of mExo. TXN was bound to various endosomal sorting complex required for transport (ESCRT) proteins. Autocrine motility factor receptor (AMFR) mediated TXN K63 ubiquitination to promote the binding of TXN on ESCRT proteins and sorting of TXN into mExo. Knocking down exosomal TXN inhibited the transcriptional activity of nuclear factor erythroid 2-related factor 2 (NRF2) and activator protein 1 (AP-1). NRF2 and AP-1 inhibition reduced endogenous TXN production that was promoted by exosomal TXN. Inhibition of NRF2 in vivo diminished the anti-senescence and regenerative effects of mExo. Conclusively, AMFR-mediated TXN ubiquitination promoted the sorting of TXN into mExo, allowing exosomal TXN to promote endogenous TXN production in NPSCs via TXN/NRF2/AP-1 feed-forward circuit to alleviate NPSCs senescence and disc degeneration.

Objective To study the effect of incorporating comprehensive geriatric assessment(CGA)into the whole-process WeChat-based case health management in elderly population who took annual physical examinations,thereby to improve their ability in health self-management.Methods A randomised controlled trial was conducted to select 100 elderly people who took annual physical examinations in our hospital from July 2022 to June 2023.The elderly were randomly divided into a control group and an trial group,with 50 people per group.CGA was applied to both groups,but the control group was under conventional health management,while the trial group received the incorporation of CGA into a whole-process WeChat-based case health management.The self-rated abilities for health practices scale(SRAHP)was used to compare the scores between the two groups before intervention,at 3,6 and 12 months after intervention.The scores of fatigue,resistance,ambulation,illnesses&loss of weight scale(FRAIL)and the mini nutritional assessment-short form(MNA-SF)were compared between the two groups before intervention and at 12 months after intervention.Incidence of falls was also evaluated after intervention.Results All the participants completed the study.Repeated measures analysis of variance showed that total SRAHP scores had statistical significances in main effect on time,group and interaction(Ftime=193.451,P<0.001;Fgroup=23.661,P<0.001;Finteraction=29.970,P<0.001).Further analysis revealed that the elderly in trial group had higher total scores in SRAHP than those in the control group at 6 and 12 months after intervention(both P<0.001).At 12 months after intervention,the trial group showed better scores in FRAIL and MNA-SF than the control group(both P<0.05)as well as with a lower incidence of falls(P<0.05).Conclusion Incorporation of CGA into a comprehensive WeChat-based case health management,over a long-term,can effectively enhance the ability in health self-management among elderly individuals who take annual health examinations,improve frailty and nutritional status and reduce the incidence of falls.The health self-management discovered from this study provides a valuable reference for health management among the elderly people who take annual physical examinations.

Objective To explore the effect of stratified out-of-hospital health management led by case health manager on the health behaviour ability of the patients with chronic diseases.Methods A convenience sampling method was employed to select 481 patients with chronic diseases who underwent physical examinations at outpatient department of a Tier-IIIA hospital from April 2022 to April 2023.A health management team led by case health managers conducted questionnaire survey to investigate the individual characteristics of the patients,established personal record based on the physical examination,and implemented stratified out-of-hospital health management for the patients.The intervention lasted for 12 months.The health behaviour ability and chronic disease self-management efficacy of the patients before and after the intervention were compared with.Results After the case manager-led stratified out-of-hospital health management,the health behaviour ability of patients with chronic diseases was stronger than that before the implementation,the self-management efficacy of chronic diseases was better than that before the implementation,and the patients'satisfaction was higher than that before the implementation(all P<0.001).Conclusion Stratified out-of-hospital health management led by a case health manager can improve the health behaviour ability and self-management efficacy of the patient with chronic diseases,thereby improve the patients'satisfaction.

Objective To explore the effect of stratified out-of-hospital health management led by case health manager on the health behaviour ability of the patients with chronic diseases.Methods A convenience sampling method was employed to select 481 patients with chronic diseases who underwent physical examinations at outpatient department of a Tier-IIIA hospital from April 2022 to April 2023.A health management team led by case health managers conducted questionnaire survey to investigate the individual characteristics of the patients,established personal record based on the physical examination,and implemented stratified out-of-hospital health management for the patients.The intervention lasted for 12 months.The health behaviour ability and chronic disease self-management efficacy of the patients before and after the intervention were compared with.Results After the case manager-led stratified out-of-hospital health management,the health behaviour ability of patients with chronic diseases was stronger than that before the implementation,the self-management efficacy of chronic diseases was better than that before the implementation,and the patients'satisfaction was higher than that before the implementation(all P<0.001).Conclusion Stratified out-of-hospital health management led by a case health manager can improve the health behaviour ability and self-management efficacy of the patient with chronic diseases,thereby improve the patients'satisfaction.