BACKGROUND:The Guilu Erxian Glue consists of Testudinis Plastrum,Cornu Cervi,Lycii Fructus,and Ginseng Radix.In earlier clinical observations,it is discovered that using Guilu Erxian Glue to treat patients with liver-kidney deficiency type knee osteoarthritis effectively alleviated knee pain,increased the range of motion,and improved walking ability.However,the exact mechanism by which oral administration of Guilu Erxian Glue can produce local therapeutic effects on the knee joint is still unclear.OBJECTIVE:To investigate the effects of Guilu Erxian Glue on gut microbiota in rats with knee osteoarthritis and to evaluate its mechanism using 16S rDNA sequencing and machine learning analysis.METHODS:Totally 18 female SD rats were randomly divided into three groups:blank group,model group,and Guilu Erxian Glue group,with 6 rats in each group.A knee osteoarthritis model was prepared using the destabilization of the medial meniscus surgical method.After successful modeling,the Guilu Erxian Glue group was given a decoction of Guilu Erxian Glue by gavage,while the blank and model groups were given an equal amount of distilled water.After 28 days of continuous intervention,high performance liquid chromatography was used to detect the active ingredients of Guilu Erxian Glue.MRI imaging was used to observe the condition of rat knee articular cartilage.Fecal samples were collected;DNA was extracted using a kit,amplified and purified by PCR,and an Illumina sequencing library was constructed.The Illumina MiSeq platform was used for high-throughput sequencing to generate raw sequence data.After obtaining the raw data,QIIME2 software was used to process the data.Linear Discriminant Analysis Effect Size analysis and random forest algorithm were used to screen for differential species in microbial data.KEGG and MetaCyc functional pathway analyses were used to explore the association between key microbial communities and experimental groups.Linear discriminant analysis effect values and random forest algorithm were used to screen for differential species.Association networks were used to analyze the interactions between microbial communities,and machine learning methods were used to analyze the composition and changes of gut microbiota.RESULTS AND CONCLUSION:(1)LC-MS component identification was conducted on the traditional Chinese medicine formula of Guilu Erxian Glue,and a total of 7 effective ingredients were identified.(2)MRI imaging showed that synovitis scope of high-density shadows in rats of the Guilu Erxian Glue group was reduced,and the degeneration of medial femoral condyle cartilage was less than that in the model group.(3)16S rDNA sequencing showed that the model group rats exhibited significant microbial imbalance,with a significant decrease in the abundance of Firmicutes and Bacteroidetes at the phylum level,while the proportion of Proteobacteria increased significantly(P＜0.05).The gut microbiota structure of rats in the Guilu Erxian Glue group was significantly improved,and the proportion of Firmicutes and Bacteroidetes increased,restoring a more diverse microbiota composition,approaching that of the blank group(P＜0.05).(4)KEGG and MetaCyc functional pathway analysis showed that the Guilu Erxian Glue group significantly activated multiple metabolic pathways,including amino acid metabolism,lipid metabolism,and biotin synthesis pathways(P＜0.05).(5)The results indicate that Guilu Erxian Glue contains seven active ingredients,and the changes in gut microbiota of knee osteoarthritis rats were analyzed using 16S rDNA sequencing.Guilu Erxian Glue can significantly improve the imbalance of gut microbiota,restore the abundance of beneficial bacteria,and have a significant impact on the composition of gut microbiota,providing scientific basis for the efficacy and mechanism of Guilu Erxian Glue.

BACKGROUND:The Guilu Erxian Glue consists of Testudinis Plastrum,Cornu Cervi,Lycii Fructus,and Ginseng Radix.In earlier clinical observations,it is discovered that using Guilu Erxian Glue to treat patients with liver-kidney deficiency type knee osteoarthritis effectively alleviated knee pain,increased the range of motion,and improved walking ability.However,the exact mechanism by which oral administration of Guilu Erxian Glue can produce local therapeutic effects on the knee joint is still unclear.OBJECTIVE:To investigate the effects of Guilu Erxian Glue on gut microbiota in rats with knee osteoarthritis and to evaluate its mechanism using 16S rDNA sequencing and machine learning analysis.METHODS:Totally 18 female SD rats were randomly divided into three groups:blank group,model group,and Guilu Erxian Glue group,with 6 rats in each group.A knee osteoarthritis model was prepared using the destabilization of the medial meniscus surgical method.After successful modeling,the Guilu Erxian Glue group was given a decoction of Guilu Erxian Glue by gavage,while the blank and model groups were given an equal amount of distilled water.After 28 days of continuous intervention,high performance liquid chromatography was used to detect the active ingredients of Guilu Erxian Glue.MRI imaging was used to observe the condition of rat knee articular cartilage.Fecal samples were collected;DNA was extracted using a kit,amplified and purified by PCR,and an Illumina sequencing library was constructed.The Illumina MiSeq platform was used for high-throughput sequencing to generate raw sequence data.After obtaining the raw data,QIIME2 software was used to process the data.Linear Discriminant Analysis Effect Size analysis and random forest algorithm were used to screen for differential species in microbial data.KEGG and MetaCyc functional pathway analyses were used to explore the association between key microbial communities and experimental groups.Linear discriminant analysis effect values and random forest algorithm were used to screen for differential species.Association networks were used to analyze the interactions between microbial communities,and machine learning methods were used to analyze the composition and changes of gut microbiota.RESULTS AND CONCLUSION:(1)LC-MS component identification was conducted on the traditional Chinese medicine formula of Guilu Erxian Glue,and a total of 7 effective ingredients were identified.(2)MRI imaging showed that synovitis scope of high-density shadows in rats of the Guilu Erxian Glue group was reduced,and the degeneration of medial femoral condyle cartilage was less than that in the model group.(3)16S rDNA sequencing showed that the model group rats exhibited significant microbial imbalance,with a significant decrease in the abundance of Firmicutes and Bacteroidetes at the phylum level,while the proportion of Proteobacteria increased significantly(P＜0.05).The gut microbiota structure of rats in the Guilu Erxian Glue group was significantly improved,and the proportion of Firmicutes and Bacteroidetes increased,restoring a more diverse microbiota composition,approaching that of the blank group(P＜0.05).(4)KEGG and MetaCyc functional pathway analysis showed that the Guilu Erxian Glue group significantly activated multiple metabolic pathways,including amino acid metabolism,lipid metabolism,and biotin synthesis pathways(P＜0.05).(5)The results indicate that Guilu Erxian Glue contains seven active ingredients,and the changes in gut microbiota of knee osteoarthritis rats were analyzed using 16S rDNA sequencing.Guilu Erxian Glue can significantly improve the imbalance of gut microbiota,restore the abundance of beneficial bacteria,and have a significant impact on the composition of gut microbiota,providing scientific basis for the efficacy and mechanism of Guilu Erxian Glue.

Objective To explore the effect of a self-developed augmented multi-task sensory exer-cise intervention on perceptual-motor skills and motor coordination in children with developmental coor-dination disorder(DCD).Methods Twenty-four DCD children aged 6～7 years were included and ran-domly divided into a control group(n=12)and an experimental group(n=12).Both groups maintained their daily physical activities and took P.E.classes in school,while the experimental group additional-ly underwent a multi-task somatosensory motor intervention consisting of 3 stages.Each stage lasted for 4 weeks,3 sessions per week,with progressively increased difficulty.A self-designed data process-ing module of the somatosensory intervention system was used to collect the scores of each task(i.e.,sensory-motor evaluation),and the changes in scores of each task at each stage were analyzed.More-over,before and after the intervention,the motor coordination ability was assessed using the Move-ment Assessment Battery for Children-Second Edition(MABC-2),and the intra-and inter-group dif-ferences in MABC-2 scores were analyzed.Two weeks after the intervention,the experimental group conducted 3 sessions of motor relearning at the difficulty level of the 3rd stage to examine the effects of motor retention and relearning.Results 1)The experimental group showed a significant increase in their scores on all tasks from T1 to T5 during the enhanced multi-task somatosensory training of all the three stages(P<0.001,P<0.05).2)After the kinesthetic exercises,the experimental group had sig-nificantly higher abilities in fine motor skills,positioning&grasping and body balance compared to the control group(P<0.05),with relatively greater effect on threading beads,drawing traces,tossing and catching bags,single-leg balance,tiptoe walking and two-legged hopping(η2≥0.114).3)In the assessment of motor skill retention and relearning,the T1～T4 scores in the first retest were lower than the previous final ones(P<0.05),with no significant difference from those at the end of the second stage,but showing significantly higher T1 and T5 scores.Moreover,all the T1～T5 scores reached the level measured at the previous end of stage three after three sessions of relearning.Conclusion The augmented multi-task somatosensory practice based on perception-motor skills theory can enhance the perception-motor skills and motor coordination ability of the DCD children,with good motor skill reten-tion and recovery effectiveness after such intervention.

Objective:To investigate the status of post-traumatic stress disorder (PTSD) and its influencing factors in postoperative breast cancer patients.Methods:A convenience sampling method was used to select 410 postoperative breast cancer patients from the Provincial Hospital of the First Medical University of Shandong between January 2023 and December 2024. The PTSD Checklist-Civilian Version (PCL-C), the Connor-Davidson Resilience Scale (CD-RISC), and the Simple Coping Style Questionnaire (SCSQ) were used for assessment. Binary Logistic regression analysis was performed to analyze influencing factors.Results:A total of 410 questionnaires were distributed, and 405 valid questionnaires were returned, with an effective recovery rate of 98.78% (405/410). Among them, 150 patients were PTSD-positive. Binary Logistic regression analysis showed that educational level, monthly family income, psychological resilience, and coping style were influencing factors for PTSD in postoperative breast cancer patients ( P<0.05) . Conclusions:Low education level, low income, and negative coping style are risk factors for PTSD in postoperative breast cancer patients; positive coping style and high psychological resilience are protective factors. Clinical practitioners should develop preventive or intervention measures based on these influencing factors to reduce the occurrence of PTSD in postoperative breast cancer patients.

Objective:To explore latent profile categories of pain catastrophizing in total knee arthroplasty patients and analyze differences in kinesiophobia among different categories of patients.Methods:Convenience sampling was used to select 340 patients who underwent total knee arthroplasty at the First Affiliated Hospital of Zhengzhou University from January 2023 to June 2024. The Pain Catastrophizing Scale (PCS) and Tampa Scale for Kinesiophobia (TSK) were used to assess patients' pain catastrophizing and kinesiophobia on the third postoperative day. Latent profile analysis was employed to simulate and categorize PCS, and to compare the kinesiophobia among patients in different categories.Results:A total of 340 questionnaires were distributed, with 327 valid responses collected, resulting in a valid response rate of 96.18%. The postoperative PCS score for 327 patients was (34.76±7.59) , with 33.33% (109/327) achieving a PCS score ≥38. The mean scores for the three dimension (exaggeration, helplessness, and rumination) items were (2.91±0.93) , (2.33±0.84) , and (2.51±0.79) , respectively. The TSK score was (48.39±9.42) , with 50.46% (165/327) scoring above 37. Three latent categories of pain catastrophizing were identified, including "high exaggeration-helplessness-rumination group", accounting for 28.75% (94/327) ; "high exaggeration-moderate helplessness-rumination group", accounting for 39.45% (129/327) ; "moderate exaggeration-helplessness-high rumination group", accounting for 31.80% (104/327) . The TSK scores of the three groups of patients were (51.75±8.49) , (46.83±8.76) , and (49.29±9.04) , respectively, with statistically significant differences ( P<0.05) . Conclusions:Patients undergoing total knee arthroplasty exhibit distinct categorical characteristics in postoperative pain catastrophizing, with varying levels of kinesiophobia observed across different pain catastrophizing characteristics. Healthcare providers should conduct early assessments to identify patients' pain catastrophizing characteristics and deliver targeted interventions to improve pain catastrophizing and kinesiophobia, thereby promoting early postoperative recovery.

Objective:To investigate the predictive value of tumor morphology in hepatoce-llular carcinoma (HCC) immunotherapy.Methods:The propensity score matching and retrospective cohort study was conducted. The clinical data of 227 HCC patients who underwent immunotherapy in The First Affiliated Hospital of University of Science and Technology of China from January 2021 to December 2023 were collected. There were 203 males and 24 females, aged (57±11)years. Of the 227 patients, 93 patients with regular tumor morphology of HCC evaluated by computed tomography (CT) or magnetic resonance imaging (MRI) were divided into the regular morphology group, and 134 patients with irregular tumor morphology of HCC evaluated by CT or MRI were divided into the irregular morphology group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) analysis of factors affecting prognosis of patients; (3) prognosis of patients after propensity score matching. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of count data between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the Mann-Whitney U test. The Kaplan-Meier method was used to calculate survival rate and draw survival curve. The Log-rank test was used for survival analysis. The Cox proportional hazards regression model was used for univariate and multivariate analyses. Propensity score matching was done by the 1∶1 nearest neighbor matching method, with a caliper value of 0.02. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of 227 HCC patients undergoing immunotherapy, 164 cases were successfully matched, including 82 cases in the regular morphology group and 82 cases in the irregular morphology group. After propensity score matching, the elimination of patients who underwent radical surgical resection in the past, tumor number and alpha fetoprotein confounding bias ensured comparability between the two groups. (2) Analysis of factors affecting prognosis of patients. Results of multivariate analysis showed that body mass index ≥25 kg/m 2 and irregular tumor morphology were independent risk factors affecting overall survival time of patients ( hazard ratio=0.891, 1.870, 95% confidence interval as 0.825-0.963, 1.151-3.038, P<0.05). (3) Prognosis of patients after propensity score matching. After propensity score matching, the median progression-free survival time was 11.9(95% confidence interval as 9.2-16.1)months for patients in the regular tumor morphology group and 6.4(95% confidence interval as 4.4-8.1)months for patients in the irregular tumor morphology group, the 1-year progress-free survival rate was 48.48% for patients in the regular tumor morphology group and 22.25% for patients in the irregular tumor morphology group. There was a significant difference in progress-free survival between patients in the regular tumor morphology group and the irregular tumor morphology group ( χ2=16.000, P<0.05). The median overall survival time was 27.2(95% confidence interval as 23.7-not reached)months for patients in the regular tumor morphology group and 18.1 (95% confidence interval as 15.8-20.8)months for patients in the regular tumor morphology group, the 1-year overall survival rate was 83.27% for patients in the regular tumor morphology group and 66.98% for patients in the irregular tumor morphology group. There was a significant difference in overall survival between patients in the regular tumor morphology group and the irregular tumor morphology group ( χ2=13.400, P<0.05). Conclusions:Tumor morphology has a predictive value for the efficacy of immunotherapy for HCC. Compared with HCC patients of regular tumor morphology, immunotherapy is less effective in patients with irregular tumor morphology.

Objective:To study the allocation efficiency of private ophthalmology health resources in Shanxi,and to provide references for improving the allocation efficiency of health resources in Chinese private ophthalmology medical institutions.Methods:The resource allocation and services of 70 private ophthalmic medical institutions in Shanxi were collected through a questionnaire survey,and Data Envelopment Analysis(DEA)was used to evaluate the efficiency of health resource allocation in medical institutions of Shanxi.Results:The average values of technical efficiency,pure technical efficiency,and scale efficiency of health resource allocation in private ophthalmic medical institutions in Shanxi were 0.963,0.980,and 0.982,respectively.Among the 70 private ophthalmology institutions,7 institutions were DEA-strongly efficient in health resource allocation,26 institutions were DEA-weakly efficient,37 institutions were non-DEA efficient,15 institutions had constant return to scale,40 institutions had increasing return to scale,and 15 institutions had decreasing return to scale.The allocation of health resources in 7 cities,including Taiyuan,Datong,and Shuozhou,etc.were DEA-strongly efficient;Changzhi and Jincheng were DEA-weakly efficient,both with increasing return to scale;and Linfen was non-DEA efficient with increasing return to scale.Conclusion:The efficiency of health resource allocation in some municipalities of Shanxi needs to be improved;the level of inter-organization varied,and the problems of insufficient resources and wasted inputs coexisted.In the future,ophthalmic resources should be rationally allocated,and input and output indicators should be adjusted according to the actual situation.

Aim To investigate the effects of Congrong San(CRS)on learning and memory ability,hippocam-pal neuronal injury,and ferroptosis in rats with Alzhei-mer's disease(AD)and to explore the related mecha-nisms.Methods AD rat models were established and divided into Sham,Model,CRS low-dose,CRS medium-dose,CRS high-dose,and memantine groups.After treatment,Morris water maze,HE and Nissl staining,transmission electron microscopy,immunofluorescence staining,Western blot,and kit assays were performed to assess learning and memory ability,hippocampal neuro-nal injury,ferroptosis-related indicatorsand glucose reg-ulated protein 78 ku(GRP78)-(proteinkinaseR-li-keERkinase)PERK-(activating transcription factor 4)ATF4 pathway protein expression.Results Com-pared with the model group,rats in the CRS medium-and high-dose groups and the memantine group showed significant improvement in learning and memory abili-ty,reduced hippocampal neuronal injury,increased number of Nissl bodies,and ameliorated endoplasmic reticulum swelling and mitochondrial damage.In addi-tion,the expressions of GRP78,p-PERK/PERK,and ATF4 were downregulated,while GPX4 expression was upregulated in the CRS medium-and high-dose groups and the memantine group.Moreover,MDA content de-creased,and SOD and GSH-PX levels increased in these groups.Conclusions CRS can improve the learning and memory ability in AD rats,reduce hipp-ocampal neuronal injury and ferroptosis,and its mecha-nism may be related to the inhibition of the GRP78-PERK-ATF4 pathway,enhancement of GPX4 expres-sion,and reduction of oxidative stress levels,providing a new approach for the clinical treatment of AD.

Objective:To present an evaluation indicator system for access to cancer screening services.Methods:The evaluation indicator pool was constructed through a scoping review. The theoretical framework was constructed based on the multi-source indicators, and the qualitative expert consultation method was employed to form the initial version of the three-level evaluation indicator system. Delphi expert consultation method was conducted in two rounds to evaluate the relevance, importance, and availability of the proposed evaluation indicator system. The expert positive coefficient, authority coefficient, coordination degree of expert opinions, and concentration of expert opinions were subjected to analysis. Subsequently, the three-level evaluation indicator system for access to cancer screening services was adjusted and determined based on the boundary value method and the open opinions of experts. Finally, the combination weight method was employed to determine the weight.Results:The initial version of the indicator system comprised 3 primary (first-level) indicators, 11 secondary (second-level) indicators, and 46 tertiary (third-level) indicators. Delphi expert consultation was conducted for the initial version, and 17 experts ultimately completed it, exhibiting a positive coefficient of 100% and an authority coefficient of 0.87. In comparison to the initial round of consultation, Kendall's W coefficient ranges (0.15-0.43, all P<0.05) of relevance, importance, and availability scores for each tertiary indicator in the second round exhibited an improvement. The analysis of the importance dimension indicates that expert opinions are also more concentrated, as evidenced by an increase of 8.5% and 7.0% in the proportion of the tertiary indicators with an arithmetic mean above 8 and a full mark ratio above 0.5, respectively. The final evaluation indicator system comprises three primary indicators, with the weights of structure evaluation, process evaluation, and outcome evaluation being 0.338, 0.378, and 0.285, respectively. It also comprises 11 secondary indicators and 45 tertiary indicators. Conclusions:The evaluation indicator system developed in this article can be an effective evaluation tool for quantitative comparison of access to cancer screening services across different populations, cancer types, and before and after intervention. Furthermore, it is recommended that the system undergo continuous optimization concerning its application.

Objective:To investigate the current status and correlation between perceived stress and coping strategies among nurses in the Cardiac Intensive Care Unit (CICU) .Methods:A purposive sampling method was used to select 348 CICU nurses from ten tertiary hospitals in Beijing between March and October 2023. Data were collected using a general information questionnaire, the Chinese version of the Perceived Stress Scale (PSS), and the Simplified Coping Style Questionnaire (SCSQ) .Results:The score of the Chinese PSS among 348 nurses was (28.86±5.06). In the SCSQ, the score for positive coping was (22.71±7.57), while the score for negative coping was (8.57±4.82). Correlation analysis indicated that perceived stress was negatively correlated with positive coping strategies ( P<0.01) and positively correlated with negative coping strategies ( P<0.01). Multiple linear regression analysis showed that years of experience in the CICU, employment status, family support for work, and coping strategies were influencing factors of perceived stress ( P<0.05), explaining 50.2% of the total variance. Conclusions:CICU nurses generally experience high levels of perceived stress, and those who tend to adopt negative coping strategies report even higher stress levels. Nursing administrators should develop targeted interventions based on nurse characteristics to promote effective coping strategies and alleviate perceived stress.