ObjectiveTo investigate the therapeutic effect of Astragali Radix-mediated changes in gut microbiota on treating type 2 diabetes （T2DM）. MethodsA 12-week randomized， placebo-controlled clinical trial enrolled eighty patients with newly diagnosed type 2 diabetes and poor glycemic control in the Qi deficiency type. All patients received insulin therapy. The observation group （40 cases） was administered with Astragali Radix Granules， while the control group （40 cases） received a placebo. Both treamtents were taken orally twice daily. Changes in gut microbiota were assessed by 16s rDNA sequencing. Serum glucagon-like peptide-1 （GLP-1） levels were measured using enzyme-linked immunosorbent assay （ELISA）. Glucose metabolism indicators including fasting blood glucose （FPG）， 2-hour postprandial blood glucose （2 h PG），glycated albumin（GA）， and glycated hemoglobin （HbA1c） were evaluated. Pancreatic function was evaluated using fasting C-peptide （FCP）， 2-hour postprandial C-peptide （2 h CP）， and C-peptide area under the curve （AUC_cp）. Traditional Chinese medicine （TCM） syndrome scores， clinical efficacy， and safety indicators were also observed. ResultsIn terms of glucose metabolism indicators， compared with the baseline， both groups exhibited significantly lower FPG， 2 h PG， GA and HbA1C （P<0.01），while FCP， 2 h CP and AUC_cp were significantly higher （P<0.01）. Compared with the control group after the treatment， the observation group showed significantly lower FPG， 2 h PG， GA and HbA1C（P<0.05， P<0.01），and significantly higher FCP， 2 h CP and AUC_cp （P<0.05， P<0.01）， indicating that Astragali Radix can improve glucose metabolism. In terms of the diversity of gut microbiota， no significant differences were detected in the Chao1， Shannon and Simpson indexes of the two groups compared with their respective baselines. However， compared with the post-treatment control group， the observation group demonstrated significant increases in the Chao1， Shannon and Simpson indexes （P<0.05， P<0.01）. The β-diversity analysis showed significant separation in gut microbiota composition before and after treatment in both groups， indicating that Astragali Radix can significantly alter the structure and improve the diversity of gut microbiota. At the phylum level， compared with the baseline， both groups showed a significant increase in the relative abundance of Bacteroidota（P<0.01）. The relative abundance of the potentially harmful phylum Proteobacteria was significantly lower in the observation Group after treatment （P<0.01）. Compared with the post-treatment control group， the observation group had a significantly higher relative abundance of Bacteroidota（P<0.01）. No significant difference was found in Firmicutes/Bacteroidota （F/B） ratio between the two groups after treatment， and other phyla showed no significant differences. At the genus level， compared with the baseline， the observation group exhibited a significant increase in Bacteroides （P<0.01） and a significant decrease in Escherichia-Shigella （P<0.01）， whereas no significant difference was seen in the control group . Compared with the control group after treatment， the observation group after treatment had a significantly higher relative abundance of Bacteroides （P<0.01）. No significant differences were seen in other genera. Linear discriminant analysis （LDA） identified potential characteristics taxa： in the observation group， Bacteroidota at the phylum level and Bacteroides and Dubosiella at the genus level， in the control group， Proteobacteria at the phylum level as well as Barnesiella and Staphylococcus at the genus level. Correlation analysis based on a heatmap revealed that GLP-1 levels were positively correlated with Firmicutes， F/B ratio and Fusobacterium， and negatively correlated with Bacteroidota， Proteobacteria， Bacteroides and Escherichia-Shigella. In terms of clinical efficacy， compared with the control group， the total effective rate of the observation group was significantly higher （P<0.05）. Compared with the baseline， the scores for shortness of breath， fatigue， weakness， spontaneous sweating and reluctance to speak significantly decreased in both groups （P<0.01）. Compared with the control group after treatment， the score for weakness was significantly lower in the observation group （P<0.01），indicating that Astragali Radix could improve clinical symptoms and alleviate weakness symptoms. In terms of safety， compared with the baseline， alanine aminotransferase （ALT） levels significantly decreased in both groups （P<0.05，P<0.01），indicating that Astragali Radix did not induce any significant abnormalities in liver and kidney functions. ConclusionAstragali Radix demonstrates the potential to significantly improve the gut microbiota environment in patients of newly diagnosed type 2 diabetes with Qi deficiency. The therapeutic effect may contribute to glycemic control， possibly mediated by an elevation in GLP-1 level. These findings may support its further clinical investigations and potential applications.

Objective To explore the role of resilience and stress in childhood maltreatment and adolescent depression and anxiety symptoms, and to provide a basis for adolescent psychological intervention. Methods From September to October 2022, a total of 11 217 students from four middle schools in Changsha were selected by multistage stratified sampling, and the Childhood Trauma Questionnaire, Depression–Anxiety–Stress Scales and the Resilience Scale for Chinese Adolescents were used to carry out online questionnaire survey. Results The detection rate of depressive symptoms and anxiety symptoms in adolescent was 19.43% (2 179) and 28.7% (3 224). The direct effect of childhood maltreatment on depressive symptoms was significant (β =0.09), Childhood maltreatment is a negative prediction of resilience (β = -0.57) and a positive prediction of pressure (β =0.06); Resilience can negatively predict stress (β = -0.61) and depressive symptoms (β = -0.25) (all P values <0.001); The direct effect of childhood maltreatment on anxiety symptoms was significant (β =0.03), resilience negatively predicts anxiety symptoms (β = -0.08) (all P values <0.01). Resilience and stress have a partially mediating role between childhood maltreatment and depressive symptoms, the mediation effect value was 0.39, accounting for 81.25% of the total effect. The effect values of the three pathways accounted for 29.17%, 8.33% and 43.75% of the total effect, respectively. Resilience and stress have a partial mediating effect between childhood abuse and anxiety symptoms, and the mediating effect was 0.36, accounting for 92.31% of the total effect, and the effect values of the three pathways accounted for 12.82%, 10.26% and 69.23% of the total effect, respectively. Conclusion Childhood maltreatment could affect adolescents’ depression and anxiety through the chain mediating effect of resilience and stress.

Objective:To explore the predictive value of serum Dickkopf-related protein 1 (DKK1) and chemokine 21 (CCL21) expression for the pulmonary fibrosis progression in patients with rheumatoid arthritis associated interstitial lung disease (RA-ILD).Methods:A prospective study method was used. One hundred and eight patients with RA-ILD (RA-ILD group) and 108 patients with simple rheumatoid arthritis (RA group) from September 2020 to July 2023 in Jincheng People's Hospital were selected. The patients with RA-ILD were treated with disease-modifying antirheumatic drugs and anti fibrotic drugs. Before treatment, the serum DKK1, CCL21, C-reactive protein (CRP), anti cyclic citrullinated peptide antibody (ACPA), rheumatoid factor (RF), erythrocyte sedimentation rate (ESR) salivary liquefied glycan antigen 6 (KL-6) were detected; the 28 joints disease activity score (DAS28) and Warrick score were assessed. The patients with RA-ILD were followed up for 1 year, and the occurrence of pulmonary fibrosis progression was recorded. The patients with pulmonary fibrosis progression were included in the progressive subgroup and vice versa in the stable subgroup. Multivariate Logistic regression was used to analyze the independent risk factors for predicting pulmonary fibrosis progression within 1 year in patients with RA-ILD. The predictive value of serum DKK1 and CCL21 for predicting the pulmonary fibrosis progression within 1 year in patients with RA-ILD was analyzed by receiver operating characteristic (ROC) curve. The decision curve of serum DKK1 and CCL21 to predict the pulmonary fibrosis progression within 1 year in patients with RA-ILD was plotted using the R language package.Results:The DKK1 in RA-ILD group was significantly lower than that in RA group: (76.02 ± 9.80) ng/L vs. (86.44 ± 9.26) ng/L, the CCL21 was significantly higher than that in RA group: (202.02 ± 25.86) ng/L vs. (172.42 ± 18.35) ng/L, and there were statistical differences ( P<0.01). The patients with RA-ILD were followed up for 1 year, 25 cases (23.15%) developed pulmonary fibrosis progression (progressive subgroup), and 83 cases did not develop pulmonary fibrosis progression (stable subgroup). The Warrick score, CCL21, ACPA and KL-6 in progressive subgroup were significantly higher than those in stable subgroup: (11.80 ± 3.56) scores vs. (7.75 ± 1.81) scores, (224.53 ± 27.26) ng/L vs. (195.25 ± 21.32) ng/L, (452.46 ± 38.35) kU/L vs. (414.37 ± 31.63) kU/L and (466.35 ± 42.32) kU/L vs. (416.82 ± 38.34) kU/L, the DKK1 was significantly lower than that in stable subgroup: (68.65 ± 8.24) ng/L vs. (78.24 ± 9.15) ng/L, and there were statistical differences ( P<0.01); there were no statistical differences in DAS28, RF, ERS and CRP between the two subgroups ( P>0.05). Multivariate Logistic regression analysis result showed that Warrick score, DKK1, CCL21, ACPA and KL-6 were independent risk factors for predicting pulmonary fibrosis progression within 1 year in patients with RA-ILD ( OR = 2.601, 0.752, 1.110, 1.062 and 1.038; 95% CI 1.227 to 5.517, 0.578 to 0.978, 1.019 to 1.209, 1.009 to 1.118 and 1.001 to 1.076; P<0.05). The ROC curve analysis result showed that the area under the curve of DKK1 and CCL21 for predicting pulmonary fibrosis progression within 1 year in patients with RA-ILD was 0.779 and 0.795, with optimal cutoff values of 74.750 and 207.615 ng/L. The area under the curve of DKK1 combined with CCL21 for predicting pulmonary fibrosis progression within 1 year in patients with RA-ILD was 0.873. The decision curve analysis result showed that the DKK1 combined with CCL21 for predicting pulmonary fibrosis progression within 1 year could improve the predictive value (the maximum benefit rate was 23.15%). Conclusions:Compared with RA patients, RA-ILD patients have decreased serum DKK1 levels and increased CCL21 levels. In patients with RA-ILD, the low expression of DKK1 and high expression of CCL21 are the risk factors of pulmonary fibrosis progression, and detecting serum levels of DKK1 and CCL21 can predict the risk of pulmonary fibrosis progression.

Objective:To analyze the characteristics and influential factors of ischemic stroke in young adults.Methods:This study used a retrospective research design. From May 2021 to April 2022, a total of 80 patients aged 18 to 45 years with acute ischemic stroke, who were hospitalized in the Department of Neurology of Yuncheng Central Hospital, were selected for the patient group. Additionally, 80 healthy individuals in the same age range who underwent outpatient examinations during this period were selected as the control group. The risk factors, imaging characteristics, pathological causes, severity, progression, and prognosis of ischemic stroke were analyzed.Results:The average age of the 80 patients with ischemic stroke was (39.6 ± 5.1) years. These patients included 56 male patients (70.0%) and 24 female patients (30.0%). Univariate analysis revealed statistically significant differences in the prevalence of hypertension ( χ2 = 70.45, P < 0.001), hyperlipidemia ( χ2 = 92.35, P < 0.001), hyperglycemia ( χ2 = 8.73, P < 0.001), smoking ( χ2 = 14.82, P < 0.001), alcohol consumption ( χ2 = 4.81, P < 0.001), and familial inheritance ( χ2 = 3.79, P < 0.001) between the patient and control groups. Multivariate logistic regression analysis indicated that hyperlipidemia ( OR = 6.75, 95% CI: 4.21-10.04, P < 0.001), hypertension ( OR = 5.83, 95% CI: 3.75-9.34, P < 0.001), smoking ( OR = 7.36, 95% CI: 1.37-3.04, P < 0.001), alcohol consumption ( OR = 1.57, 95% CI: 1.03-2.42, P < 0.001), familial inheritance ( OR = 1.66, 95% CI: 1.01-2.49, P < 0.001), and hyperglycemia ( OR = 2.16, 95% CI: 1.22-3.56, P < 0.001) are independent risk factors for ischemic stroke in young adults. Conclusions:Hyperlipidemia, hypertension, smoking, alcohol consumption, family history, and hyperglycemia are risk factors for ischemic stroke in young adults. It is essential to enhance the promotion of healthy living practices and to monitor patients' blood pressure and lipid levels regularly, as this can help reduce the likelihood of stroke occurrence.

Objective This study applies Roy adaptation theory to deeply explore the experience of food avoid-ance behavior in patients with inflammatory bowel disease(IBD),offering insights for developing dietary management strategies.Methods A descriptive qualitative research method was employed.By purposive sampling,24 IBD pa-tients hospitalized in the gastroenterology department of a tertiary hospital in Nanjing from July 2022 to December 2024 were selected for semi-structured interviews.Data were analyzed using a directed content analysis approach.Results This study identified 4 main themes and 11 sub-themes,encompassing overattribution leading to inappro-priate avoidance(recurrent symptoms triggering overattribution,disease staging triggering inappropriate avoidance),negative self-perception leading management struggles(illness fear diminishing self-efficacy,disease trauma eroding self-identity,knowledge deficiency constraining self-determination),functional impairment intensifying role challenges(role internalization undermining social function,social roles relinquishing dietary management),and external con-straints amplifying practical difficulties(family and friend oversight heightening dietary stress,healthcare gaps foster-ing practical helplessness,traditional beliefs restricting dietary exploration,economic hardship limiting balanced nu-trition).Conclusion The interplay of overattribution,negative self-perception,functional impairment,and external constraints in IBD patients hinders their ability to adapt to disease fluctuations,ensnaring them in the adaptive predicament of food avoidance behavior.Healthcare professionals should comprehensively address these factors by fostering accurate perceptions,enhancing psychological support,guiding effective coping strategies,and optimizing ex-ternal resources,thereby improving patients' overall adaptive capacity and promoting their recovery.

Objective This study applies Roy adaptation theory to deeply explore the experience of food avoid-ance behavior in patients with inflammatory bowel disease(IBD),offering insights for developing dietary management strategies.Methods A descriptive qualitative research method was employed.By purposive sampling,24 IBD pa-tients hospitalized in the gastroenterology department of a tertiary hospital in Nanjing from July 2022 to December 2024 were selected for semi-structured interviews.Data were analyzed using a directed content analysis approach.Results This study identified 4 main themes and 11 sub-themes,encompassing overattribution leading to inappro-priate avoidance(recurrent symptoms triggering overattribution,disease staging triggering inappropriate avoidance),negative self-perception leading management struggles(illness fear diminishing self-efficacy,disease trauma eroding self-identity,knowledge deficiency constraining self-determination),functional impairment intensifying role challenges(role internalization undermining social function,social roles relinquishing dietary management),and external con-straints amplifying practical difficulties(family and friend oversight heightening dietary stress,healthcare gaps foster-ing practical helplessness,traditional beliefs restricting dietary exploration,economic hardship limiting balanced nu-trition).Conclusion The interplay of overattribution,negative self-perception,functional impairment,and external constraints in IBD patients hinders their ability to adapt to disease fluctuations,ensnaring them in the adaptive predicament of food avoidance behavior.Healthcare professionals should comprehensively address these factors by fostering accurate perceptions,enhancing psychological support,guiding effective coping strategies,and optimizing ex-ternal resources,thereby improving patients' overall adaptive capacity and promoting their recovery.

Objective Analyze the causes of coding issues in the inpatient medical record homepage of a hospital and propose targeted improvement measures,providing a reference basis for enhancing coding quality.Methods A total of 3 000 in-patient medical records from April 1,2021,to March 31,2022(pre-intervention group)and 2 900 records from April 1,2022,to March 31,2023(post-intervention group)were selected for analysis.Quality control statistics were performed on key indica-tors,including the overall coding accuracy rate,primary diagnosis coding,secondary diagnosis coding,primary surgical proce-dure coding,and other surgical procedure coding.Results After the implementation of intervention measures,the overall accu-racy rate of the first page coding of medical records increased from 80.77％to 86.72％(P＜0.001).While,the accuracy rate for primary diagnosis coding improved from 96.90％to 98.07％(P＜0.05).The secondary diagnosis coding accuracy showed significant enhancement from 87.48％to 92.26％(P＜0.001),and primary surgical procedure coding accuracy rose from 96.50％to 98.34％(P＜0.001).Although other surgical procedure coding demonstrated improvement,the difference was not statistically significant(P＞0.05).Conclusion Through a series of measures—including standardized training for coders,es-tablishing a robust quality control system,and adopting advanced information technology—both the professionalism of coders and coding efficiency were enhanced.These interventions effectively reduced coding defects and improved the quality of medical re-cord homepage coding.

Objective To explore the value of analysis on the incidence of healthcare-associated infection(HAI)based on disease diagnosis-related grouping(DRG),case mix index(CMI),and relative weight(RW).Methods All discharged cases,DRG and HAI status in a tertiary first-class general hospital from January 1 to December 31,2023 were analyzed retrospectively.Incidences of HAI in different departments were adjusted and compared by CMI.Incidences of HAI in different DRG groups were adjusted by RW.Results Among the 47 695 cases included in the analysis,757 were HAI cases,including 225 DRG groups.The department of critical care medicine had the highest incidence of HAI(11.98％).After CMI adjustment,departments with higher incidence of HAI were main-ly the department of respiratory and critical care medicine(3.96％),department of critical care medicine(3.04％),and department of neurology(2.85％),et al.DRG groups with the top five high incidence of HAI were AH11(tracheotomy and with ventilator support ≥96 hours or extracorporeal membrane oxygenation[ECMO],accompa-nied by major complications and comorbidity[MCC],50.00％),BC29(ventricular shunt and revision surgery,31.43％),BB21(craniotomy other than trauma,accompanied by MCC,27.56％),BB11(craniotomy of brain trauma,accompanied by MCC,26.32％),and GB1A(major surgery of esophagus,stomach,and duodenum,accompanied by major or moderate complications and comorbidity,16.00％).After RW adjustment,the DRG groups with the top five high incidence of HAI were ES21(respiratory system infection/inflammation,accompanied by MCC,5.89％),BR21(cerebral ischemic disease,accompanied by MCC,5.17％),FR11(heart failure,shock,accompanied by MCC,4.80％),BC29(4.57％)and AH11(3.57％).Conclusion Analyzing the incidence of HAI based on CMI and RW can help to identify key departments and disease groups for infection prevention and control,and provide reference for precise prevention and control of HAI in the new era.

Objective:To analyze the characteristics and influential factors of ischemic stroke in young adults.Methods:This study used a retrospective research design. From May 2021 to April 2022, a total of 80 patients aged 18 to 45 years with acute ischemic stroke, who were hospitalized in the Department of Neurology of Yuncheng Central Hospital, were selected for the patient group. Additionally, 80 healthy individuals in the same age range who underwent outpatient examinations during this period were selected as the control group. The risk factors, imaging characteristics, pathological causes, severity, progression, and prognosis of ischemic stroke were analyzed.Results:The average age of the 80 patients with ischemic stroke was (39.6 ± 5.1) years. These patients included 56 male patients (70.0%) and 24 female patients (30.0%). Univariate analysis revealed statistically significant differences in the prevalence of hypertension ( χ2 = 70.45, P < 0.001), hyperlipidemia ( χ2 = 92.35, P < 0.001), hyperglycemia ( χ2 = 8.73, P < 0.001), smoking ( χ2 = 14.82, P < 0.001), alcohol consumption ( χ2 = 4.81, P < 0.001), and familial inheritance ( χ2 = 3.79, P < 0.001) between the patient and control groups. Multivariate logistic regression analysis indicated that hyperlipidemia ( OR = 6.75, 95% CI: 4.21-10.04, P < 0.001), hypertension ( OR = 5.83, 95% CI: 3.75-9.34, P < 0.001), smoking ( OR = 7.36, 95% CI: 1.37-3.04, P < 0.001), alcohol consumption ( OR = 1.57, 95% CI: 1.03-2.42, P < 0.001), familial inheritance ( OR = 1.66, 95% CI: 1.01-2.49, P < 0.001), and hyperglycemia ( OR = 2.16, 95% CI: 1.22-3.56, P < 0.001) are independent risk factors for ischemic stroke in young adults. Conclusions:Hyperlipidemia, hypertension, smoking, alcohol consumption, family history, and hyperglycemia are risk factors for ischemic stroke in young adults. It is essential to enhance the promotion of healthy living practices and to monitor patients' blood pressure and lipid levels regularly, as this can help reduce the likelihood of stroke occurrence.

Chronic kidney disease(CKD)will eventually progress to end-stage kidney disease and has become one of the common obstinate diseases in China,which becomes a serious threat to human life.Traditional Chinese medicine(TCM)shows unique advantages in treating CKD.In the view of Professor Lyu Zhiping,disharmony,in particular the disharmony of yin and yang of kidney,contributes to the core pathogenesis of CKD.Disharmony between kidney and other organs,and disharmony between kidney and exogenous pathogens together with pathological products lead to the complication of yin and yang,superficial and interior,deficiency and excess syndromes in the progression of the disease.Professor Lyu recommended that the clinical medication for CKD should be based on harmonizing therapy by harmonizing shaoyang meridian,harmonizing the spleen and stomach,and harmonizing collaterals and resolving blood stasis,thus to protect kidney function and slow down the progression of CKD.Based on years of clinical experience,professor Lyu formulated the Shen Qi Shenkang Prescription,which aims at primarily tonifying the kidney,and assisting by harmonizing the lung and spleen,clearing heat,removing dampness and eliminating turbid,thus to treat symptoms and root cause simultaneously,and then stronger clinical efficacy for CKD can be achieved.