ObjectiveTo systematically evaluate the application of narrative education in undergraduate nursing teaching， to understand the current application status of narrative education， and to provide a theoretical basis for the subsequent establishment of a sound narrative education system. MethodsA systematic search was conducted for studies published in Chinese and English databases on applying narrative education to undergraduate nursing teaching， with the search period ranging from database inception to February 23， 2025. Literature was screened， and relevant information was extracted. A rigorous quality evaluation was conducted on the included studies， and a descriptive analysis was performed on their content. ResultsA total of 20 papers were included， involving 3，180 research subjects， all of whom were undergraduate nursing students. The results of descriptive analysis showed that the teaching model of narrative education primarily encompassed reading narrative works， watching films and videos， performing narrative scenarios， and writing reflective journals. The course setting and content covered pre-teaching preparation and in-teaching implementation. The evaluation of teaching effectiveness included the evaluation of teachers’ teaching methods （student evaluation/self-evaluation） and the evaluation of students’ learning effectiveness （course grade evaluation/humanistic care scale/empathy scale assessment， and others）. ConclusionNarrative education combines abstract concepts with concrete clinical situations， which not only enriches students’ learning experiences but also enhances their humanistic literacy. Meanwhile， it provides teachers with opportunities to develop their narrative teaching skills， which requires them to possess profound professional knowledge and employ narrative techniques to guide students in reflection and critical thinking， thereby improving teaching quality and learning outcomes. Future efforts should consistently deepen the connotation research of narrative education and build a systematic nursing education system.

POEMS syndrome is a rare condition associated with plasma cell disorders， and it often involves multiple systems and has diverse clinical manifestations. This article reports two cases of POEMS syndrome with hepatosplenomegaly as the initial manifestation. During the course of the disease， the patients presented with lower limb weakness， hepatosplenomegaly， lymph node enlargement， ascites， hypothyroidism， positive M protein， and skin hyperpigmentation， and ¹⁸F-FDG PET-CT imaging revealed bone lesions mainly characterized by osteolytic changes and plasma cell tumors. There was an increase in the serum level of vascular endothelial growth factor. The patients were finally diagnosed with POEMS syndrome， and the symptoms were relieved after immunomodulatory treatment.

Objective:To explore the safety and short-term efficacy of single-port robotic transanal total mesorectal excision (SPr-taTME).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of six patients who underwent SPr-taTME at Daping Hospital of Army Medical University from October to November 2024 were collected. There were 3 males and 3 females, aged (65±5)years. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) follow-up. Measurement data with normal distribution were represen-ted as Mean± SD, measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Intraoperative situations. All patients successfully underwent SPr-taTME without conversion to laparotomy or blood transfusion. There was no intraoperative complication such as accidental hemorrhage or adjacent organ injury. No intra-operative adverse events or mortality occurred. The operation time of the 6 patients was 286(range, 240?400)minutes. The time of transanal platform setup and robotic docking was (21±10)minutes, transanal dissection time was (97±45)minutes, and transabdominal dissection time was (90±35)minutes. The volume of intraoperative blood loss was (47±14)mL. Among the six patients, 1 case underwent synchronous transanal and transabdominal surgery, while 5 cases underwent non-synchronous procedures. Specimens were extracted transanally in 5 cases and via an auxiliary abdominal incision in 1 case. The single-port robotic platform was utilized for the abdominal surgery in 3 cases, while laparoscopy was used in 3 cases. Splenic flexure mobilization was performed in 3 cases and omitted in the other 3 cases. Three patients underwent hand-sewn sigmoid colon-anal anastomosis, 1 case underwent modified Bacon pull-through anastomosis, 1 case received stapled sigmoidorectal anastomosis, 1 case underwent sigmoid colostomy without anastomosis due to significant bowel edema. Two cases didn′t undergo intestinal stoma, 2 cases underwent virtual ileostomy, 1 case underwent ileostomy, and 1 case underwent sigmoid colostomy. (2) Postoperative situations. All patients started water drinking and out‐of‐bed activities on postoperative day 1 and liquid diet intake on postoperative day 2. The time to postoperative first flatus was 1(range, 1?3)days, and duration of postoperative hospital stay was (8±2)days.The total number of lymph nodes dissected was 13±2, with the number of positive lymph nodes as 0(range, 0?3) and the distance of distal resection margin as (23±8)mm. Pathological examination of 6 patients showed 1 case in stage T1N0, 2 cases in stage ypT0N0, 1 case in ypT1N0, 1 case in ypT3N1, and 1 case in ypT0N1. The degree of mesorectal integrity was complete in 5 patients and nearly complete in 1 patient. The surgical specimens of 6 patients showed negative in distal, proximal and circumferential margin. (3) Follow-up. All 6 patients completed the 30-day postoperative follow-up. None of the patients experienced postoperative complication such as bleeding, intestinal obstruction or anastomotic leakage. There was no readmission within 30 days after surgery. Digital rectal examination or colonoscopy on postoperative 30 day confirmed no anastomosis-related complications, including stenosis, dehiscence or anastomotic leakage. All 6 patients survived.Conclusion:The SPr-taTME is safe and feasible, with satisfactory short-term efficacy.

Organoids,as a three-dimensional structural model that has been rapidly developed and widely concerned in recent years,enable the key functions and microenvironment of internal organs to be simulated in the real world,and closely reflect the physiological and pathological characteristics of the natural occurrence and metastasis of tumors,providing a new platform for disease modeling,drug research and precision medicine.This paper briefly summarizes the limitations and development prospects of organoid models,analyzes the current construction and development of organoid models of lung cancer and its applicability compared with traditional models under the holistic concept of traditional Chinese medicine and the basic theory of syndrome differentiation and treatment,and discusses the application of organoid technology in the basic research of lung cancer treatment.The advantages in screening anti-tumor Chinese medicine and drug resistance research and precision medicine provide new ideas for realizing innovative breakthroughs in traditional Chinese medicine research combined with modern science and technology.

Objective To investigate the efficacy of Ustekinumab combined with fecal microbiota transplantation in the treatment of inflammatory bowel disease(IBD)and its impact on intestinal mucosal barrier and immune function.Methods A total of 106 IBD patients treated from January 2023 to March 2024 were selected and divided into the Usteinumab group and the Usteinumab combined with fecal microbiota transplantation group(combination group)by random number table method,with 53 patients in each group.The Ustekinumab group was treated with Ustekinumab,while the combination group was treated with Ustekinumab combined with fecal microbiota transplantation.The clinical efficacy,intestinal mucosal barrier indicators,immune function indicators,scores of the Inflammatory Bowel Disease Quality of Life Questionnaire(IBDQ)and the total incidence of adverse reactions were compared between the two groups.Results The total effective rate of the combination group was 94.34%(50/53),which was higher than that of the Ustekinumab group[73.58%(39/53)](P<0.05).After treatment,the levels of endotoxin,D-lactic acid and diamine oxidase in the combination group were all lower than those in the Ustekinumab group,while the levels of CD3+,CD4+,CD4+/CD8+and the scores of IBDQ were all higher than those in the Ustekinumab group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion The clinical efficacy of Ustekinumab combined with fecal microbiota transplantation is remarkable in the treatment of IBD.It can effectively alleviate intestinal mucosal injury,promote the recovery of intestinal mucosal barrier function,improve the intestinal microbial environment,enhance the immune function of patients,effectively control the progression of the disease,and has high safety.

Objective:To investigate the outcomes of natural cycle (NC) and modified natural cycle (MNC) assisted reproductive technology (ART) in patients with diminished ovarian reserve (DOR), and to provide a scientific basis for individualized treatment strategies for DOR patients.Methods:A retrospective cohort analysis was performed on the clinical data of DOR patients who underwent ART at the Center for Reproductive Medicine of the Department of Obstetrics and Gynecology, Peking University Third Hospital from January 1, 2015 to December 31, 2023. Patients were divided into the NC group ( n=801) and the MNC group ( n=385) based on their treatment protocol. The primary outcomes were cycle cancellation rate and oocyte retrieval rate. Secondary outcomes included clinical pregnancy rate and live birth rate per fresh embryo transfer cycle and frozen-thawed embryo transfer cycle, cumulative pregnancy rate and cumulative live birth rate per started cycle and per transfer cycle, as well as laboratory parameters such as the number of retrieved oocytes, the number of two pronuclei (2PN) fertilized oocytes, the number of transferable embryos, and transferable embryo formation rate. Further, multivariate logistic regression was used to analyze the impact of the treatment protocol on pregnancy and live birth outcomes. Results:There were no statistically significant differences between the NC and MNC groups in terms of general characteristics such as age, body mass index, and baseline hormone levels (all P>0.05). The cycle cancellation rate was significantly higher in the NC group [19.10% (153/801)] than in the MNC group [10.65% (41/385), P<0.001], and the oocyte retrieval rate was significantly lower in the NC group [66.31% (431/650)] than in the MNC group [74.86% (259/346), P=0.005]. The number of retrieved oocytes [1 (0,1)], the number of 2PN fertilized oocytes [1 (0,1)], and the number of transferable embryos [0 (0, 1)] were also significantly lower in the NC group than in the MNC group [1 (1, 2), P<0.001; 1 (1, 1), P<0.001; 0 (0, 1), P<0.001]. However, there were no statistically significant differences in 2PN fertilization rate and transferable embryo formation rate between the NC and MNC groups (all P>0.05). In both fresh embryo transfer cycles and frozen-thawed embryo transfer cycles, there were no statistically significant differences in clinical pregnancy rate and live birth rate between the NC and MNC groups (all P>0.05). The cumulative pregnancy rate per started cycle and transfer cycle, the cumulative live birth rate per started cycle and per transfer cycle were also not significantly different between the NC and MNC groups (all P>0.05). Multivariate logistic analysis showed no significant association between NC and clinical pregnancy or live birth compared with MNC. Conclusion:While MNC to some extent reduced the cycle cancellation rate and improved oocyte retrieval rates compared with NC, it did not ultimately improve pregnancy outcomes in DOR patients.

Objective To conduct a retrospective analysis of the correlation among bedaquiline(BDQ)plasma concentrations,relevant clinical factors,and disease prognosis.Methods In this retrospective study,22 patients diagnosed with rifampicin-resistant tuberculosis(RR-TB),multidrug-resistant tuberculosis(MDR-TB),or pre-extensively drug-resistant tuberculosis(pre-XDR-TB)were enrolled.These patients were admitted to the tuberculosis ward of our hospital between February 2022 and October 2024.All patients were administered a treatment regimen containing BDQ.The cohort comprised 6 RR-TB patients(27.27%),12 MDR-TB patients(54.55%),and 4 pre-XDR-TB patients(18.18%).Peripheral blood samples were collected 2 hours after the oral administration of Bedaquiline.The plasma concentration of Bedaquiline was measured using liquid chromatography-tandem mass spectrometry(LC-MS/MS).Spearman correlation analysis was performed using R studio software with the ggplot2 and corrplot packages.The factors included the blood concentration of bedaquiline,electrocardiogram QTcF(QT interval corrected by the Fridericia method),liver and kidney function parameters,weight,age,body mass index,sex,blood uric acid level,serum creatinine level,and other relevant indicators.Results In 22 patients treated with BDQ,the plasma concentration reached a peak after 1.5 weeks of administration,and gradually stabilized after 2 weeks.The plasma concentration was approximately 1-3 μg/mL.After 24 weeks of withdrawal of bedaquiline,patients were continued to monitor their bedaquiline concentration and found that BDQ blood concentration in peripheral blood was approximate 1 μg/mL up to 36 weeks.The serum concentration of BDQ was not correlated with age,body weight,BMI,ALT,AST,GGT,TDiL,urea,uric acid and QT interval,but correlated with sputum negative transformation and serum creatinine.The correlation analysis between serum concentration of BDQ and acid-fast staining of sputum smear showed,the difference was significant(r=0.35,P<0.05).In addition,the correlation analysis between serum BDQ concentration and serum creatinine showed,the difference was significant(r=0.34,P<0.05).The results of multiple linear regression analysis showed that BDQ blood concentration was positively correlated with Scr level,and Scr was an independent factor affecting BDQ blood concentration.20 cases(90.9%,20/22)were cured,1 case died of Covid-19 virus infection,1 case was recurrence.Conclusions Regimens containing bedaquiline seem to exhibit relatively high safety profiles and good tolerability among patients with rifampicin-resistant,multidrug-resistant,or pre-extensively drug-resistant tuberculosis,typically yielding favorable treatment outcomes.The BDQ shows a positive correlation with serum creatinine(SCr).Consequently,close surveillance of BDQ levels and renal function remains of utmost importance throughout the treatment course.

Objective:To explore the relationship between life events, anxiety, depression, and behavior problems in adolescents.Methods:From September to October 2022, the cluster sampling method was used to select 5 341 adolescents from 4 middle schools in Xinxiang urban area.The subjects and their parents were investigated by the adolescent self-rating life events check list (ASLEC), generalized anxiety disorder scale (GAD-7), patient health questionnaire (PHQ-9), and child behavior checklist (CBCL). SPSS 27.0 software was used for Spearman correlation analysis, and AMOS 28.0 software was used to construct the structural equation model.Results:The scores of anxiety, depression, and behavioral problems were 1 (0, 4), 1 (0, 4), and 3 (0, 10). The total score of life events was 5 (1, 13), and the dimensions scored as follows: interpersonal conflict 1 (0, 4), academic pressure 2 (0, 5), punishment 0 (0, 2), loss 0 (0, 0), health and adaptation problem 0 (0, 1), and others 0 (0, 2). There were positive correlations between life events and its dimensions, depression, anxiety and behavioral problems ( r=0.28-0.69, all P<0.01). In the overall population, anxiety and depression played parallel mediating roles in the impact of life events on behavior problems. Life events could positively predict anxiety ( β=0.68, P<0.01), and anxiety could positively predict behavior problems ( β=0.04, P=0.02). Life events could positively predict depression ( β=0.77, P<0.01), and depression could positively predict behavior problems ( β=0.18, P<0.01). The standardized total effect size of the impact of life events on behavioral problems was 0.622 (95% CI=0.564-0.675). The standardized direct effect size and indirect effect size were 0.460 (95% CI=0.374-0.539) and 0.162 (95% CI=0.108-0.218), accounting for 74.0% and 26.0%of the total effect, respectively. After stratification by gender, the results for male adolescents were consistent with the overall population, while the mediating effect of anxiety was not significant in the female adolescents. Conclusion:Life events can lead to anxiety and depression in adolescents, thereby increasing the risk of behavior problems.

Objective:To explore the characteristics of social skills and problem behaviors of children and adolescents with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), as well as the association with core symptoms.Methods:A total of 409 patients aged 5-18 years old with ASD or ADHD in the outpatient department of Nanjing Brain Hospital from 2023 to 2024, and 344 children and adolescents with typical development(TD) were recruited.All participants were matched in a ratio of 1∶1∶1 (ASD∶ADHD∶TD) according to gender and age, and 97 participants were included in each group for analysis.The Chinese version of the social skills improvement system rating scales(SSIS-RS-C) was used to evaluate social skills and problem behaviors, and autistic child behavior checklist(ABC), childhood autism rating scale(CARS), the Chinese version of the social communication questionnaire(SCQ) and the Chinese version of Swanson, Nolan, and Pelham, version Ⅳ scale-parent form(SNAP-Ⅳ) were used to evaluate the core symptoms of ASD and ADHD, respectively. SPSS 26.0 software was used to perform variance, Chi-square test, Spearman correlation analysis and multivariate Logistic regression analysis.Results:The social skills score of ASD group was lower than ADHD group ((61.53±24.26) vs (80.89±15.19), P<0.05), while the problem behavior score of ASD group was higher than ADHD group ((38.82±11.92) vs (34.00±12.45), P<0.05). In ASD group, the scores of ABC, CARS and SCQ were negatively correlated with the score of social skills ( r=-0.26--0.55, P<0.05). In ADHD group, the total score and each subscale of SNAP-Ⅳ were positively correlated with the score of problem behavior ( r=0.25-0.65, P<0.05). Multivariate Logistic regression analysis showed that empathy was a negative influencing factor of ASD ( B=-0.246, OR=0.782, P<0.05), and hyperactivity/inattention was a positive influencing factor of ASD ( B=0.589, OR=1.802, P<0.01), while only hyperactivity/inattention was a positive influencing factor of ADHD( B=0.779, OR=2.180, P<0.01). Conclusion:Children and adolescents with ASD and ADHD both have defects in social skills and problem behaviors, and these defects are associated with the core characteristics of their respective diseases.

Objective:To examine the regulatory effects of a potential antifibrotic tetrapeptide called N-acetyl-seryl-aspartyl-lysyl-proline (Ac-SDKP) on the expression of epidermal growth factor (EGFR) and signal transducer and activator of transcription 3 (STAT3) in lung tissues with fibrosis induced by silicosis in rats. This study aims to explore the potential therapeutic benefits of Ac-SDKP in the prevention and treatment of fibrotic lung diseases associated with silicosis.Methods:In January 2024, disease targets and Ac-SDKP active ingredients were predicted through GeneCards (https://www.genecards.org) and OMIM (https://www.omim.org) databases. Using R 4.2.1 software, we identified overlapping targets between pulmonary fibrosis and AC-SDKP. Cytoscape 3.10.2 was employed to visualize interactions between active chemical components and these targets, followed by GO enrichment analysis and KEGG pathway analysis using R 4.2.1. Forty healthy adult Wistar rats were selected to establish silicosis models through single-dose gavage with 50 mg/ml silica suspension (1. 0 ml per rat). The rats were randomly divided into four groups: model control group (4 weeks), silicosis model group (4 weeks), Ac-SDKP preventive treatment group (acquired via intraperitoneal injection of a micro-release pump containing Ac-SDKP [800 μg/ (kg·d) ] during modeling, maintained for 4 weeks), and Ac-SDKP anti-fibrosis treatment group (acquired via intraperitoneal injection of the same pump after 2 weeks of modeling, continued maintenance for 2 weeks). Each group contained 10 rats. The pathological changes in rat lung tissues were observed. Western blot technology was used to detect the protein expression levels of α-smooth muscle actin (α-SMA), epidermal growth factor receptor (EGFR), signal transduction and activation transcription factor 3 (STAT 3), caspase 3, and caspase 8 in lung tissues. Immunohistochemical techniques were employed to assess the expressions of EGFR, STAT3, caspase 3, and caspase 8. Overall differences between groups were compared using one-way ANOVA.Results:Compared with the control group in the silicosis model, rats in the 4-week group exhibited significant fibrotic nodules. The lung tissues of these rats showed statistically significant increases in α-SMA, EGFR, STAT 3, Caspase 3, and Caspase 8 protein expression ( P<0.05). In contrast, the Ac-SDKP prevention and anti-fibrosis treatment group demonstrated markedly reduced expression levels of these proteins compared to the 4-week silicosis model group, with statistically significant differences ( P<0.05). Immunohistochemical staining revealed that brownish-yellow expression of EGFR, STAT3, Caspase3, and Caspase8 was significantly enhanced in silicotic nodules within the silicosis model group. Conversely, this brownish-yellow expression was notably decreased in the Ac-SDKP prevention and anti-fibrosis treatment group compared to the 4-week silicosis model group. Conclusion:Ac-SDKP may exert antifibrotic effects on the lungs of rats with silicosis by regulating the EGFR/STAT3 pathway.