Objective:To explore the structural relationship between WMSDs in the upper limbs and various risk factors in the occupational population in China, based on a large sample epidemiological survey and structural equation analysis, and to establish a structural equation model, so as to lay a foundation for the prevention and control of such diseases.Methods:The Chinese version of the Musculoskeletal Disorders Electronic Questionnaire was used to conduct a nationwide survey on the prevalence of WMSDs in the upper extremity. Six factors related to WMSDs in the upper extremity were extracted by the classification standard of adverse ergonomic factors and their source and confirmatory factor analysis, including work organization, work type, upper extremity work posture, individual factors, upper extremity fatigue and upper extremity WMSDs. The structural equation analysis was carried out and the structural equation model was established.Results:The incidence of WMSDs and fatigue in the upper limbs was 24.44% and 43.76%, respectively. The adjusted structural equation model fitting indicators were generally up to the standard (GFI=1.000, AGFI=1.000, RMSEA=0.043, NFI=0.808, TLI=0.784) . The four exogenous latent variables of work organization, work type, upper limb work posture and individual factors were correlated. There was a strong positive correlation between job type and upper limb work posture ( r=0.865) , a moderate positive correlation between work organization and job type and upper limb work posture ( r=0.570, 0.490) , and a weak negative correlation between individual factors and the other three exogenous latent variables. Upper limb work posture and individual factors had direct effects on upper limb WMSDs, and the effect coefficients were 0.10 and 0.06, respectively. Upper limb fatigue played a mediating role between work organization, work type, upper limb work posture and upper limb WMSDs. The effect coefficient was 0.46, and the composition ratios of indirect effects were 100.0%, 100.0%, and 38.3%, respectively. The direct path effect of upper limb work posture, individual factors and upper limb WMSDs was weaker than the mediating path through upper limb fatigue. Conclusion:When carrying out the prevention and control of upper limbWMSDs, it is necessary to comprehensively consider the pathogenesis path of upper limb muscle fatigue and upper limb WMSDs caused by work organization, work type, and upper limb work posture, so as to provide theoretical reference for improving the prevention and control level of such diseases.

Objective:To observe any effect of electroacupuncture on the urodynamics of rats modeling chronic urinary retention after a sacral cord injury (SCI), and to explore its regulatory effect on interstitial Cajal cells (ICCs) in the bladder and the mechanism.Methods:Seventy-five female Sprague-Dawley rats were randomly divided into a sham operation group, a model group, an electroacupuncture group, an inhibitor group, and an inhibitor plus electroacupuncture group, each of 15. On day 1 of the experiment the sacral spinal cord was completely transected at the level of the 3rd lumbar vertebra in all groups except the sham operation group. In that group the spinous processes and laminae of L 2-4 were exposed but not injured, and then sutured. On day 16, both the inhibitor group and the inhibitor plus electroacupuncture group were given intraperitoneal injections of imatinib mesylate, while the electroacupuncture group and the inhibitor plus electroacupuncture group began 14 consecutive days of electroacupuncture. After the intervention, urodynamic testing was performed on the rats in all five groups, and they were then sacrificed. Hematoxylin-eosin staining was used to observe any morphological changes in the bladder. Transmission electron microscopy was employed to assess the ultrastructure and quantity of ICCs in the bladder. And the gene and protein expression of c-Kit and stem cell factor (SCF) in bladder tissue were detected using polymerase chain reactions and western blotting. Western blotting was also applied to detect the relative expression of c-Kit phosphorylated proteins. Results:Compared with the sham group, the model and inhibitor groups showed significant differences in their urination rates, residual urine volumes, bladder volumes and compliance on the 30th day of the experiment. Compared with the model group, the rats who received electroacupuncture displayed more complete voiding, lower residual urine volume, greater bladder volume and better compliance. Compared with the electroacupuncture group, the urodynamic evaluation of the inhibitor plus electroacupuncture group indicated a significant decrease in urination rate, but a significant increase in residual urine volume, bladder volume and compliance. The SCI modeling had destroyed the morphology of the bladder detrusor muscle and the ultrastructure of the ICCs. And the number of Cajal interstitial cells and the relative expression of c-Kit, SCF, and p-c-Kit had decreased significantly. Compared with the model group, a significant improvement was observed in all urodynamic indicators, the morphology of the detrusor muscle, the ultrastructure and number of ICCs, and the relative expression of c-Kit, SCF, and p-c-Kit in the electroacupuncture groups. There were poorer urodynamic indicators, detrusor muscle morphology, ultrastructure and number of ICCs in the inhibitor plus electroacupuncture group compared with the group which received electroacupuncture alone, but there was a significant decrease in the relative expression of p-c-Kit.Conclusions:Electroacupuncture can improve the urodynamics of chronic urinary retention after sacral cord injury, at least in rats. The mechanism may be related to the benign regulation of ICCs through the bladder′s c-kit/SCF signal system.

Objective:To investigate the correlations between physical, psychological and social frailty in elderly patients with multimorbidity.Methods:This study utilized a mixed method. A questionnaire survey was conducted from February to June 2024, among elderly patients with multimorbidity attending 4 primary health care centers in urban Beijing selected by the convenience sampling method. The FRAIL Frailty Assessment Scale, WHO-5 Index of Well-Being Scale, and HALFT Scale were used to assess the patients′ physical, psychological, and social frailty, respectively. Spearman correlation analysis was used to analyze the correlation between different dimensions of frailty in elderly with multimorbidity. Logistic regression model was used to analyze the factors influencing physical, psychological and social frailty. The elderly with multimorbidity who were assessed to have at least 1 or more types of frailty in the quantitative study were selected for in-depth interviews in the form of online and offline combination. The topics of in-depth interview included the real experience of the different dimensions of frailty, the possible causes and the difficulties caused. The sample size was determined according to the principle of information saturation. Thematic analysis was used to summarize, code and analyze the interview data.Results:A total of 919 participants were included in the quantitative study, with a mean age of (74.09±6.03) years, 329(35.80%) were males and 590(64.20%) were females. The prevalence of physical, psychological, and social frailty was 17.85%(164/919), 21.44%(197/919), 11.21%(103/919), respectively. A total of 21 participants were included in the qualitative study, with a mean age (76.90±5.13)years, 5(23.81%) males and 16(76.19%) females. Spearman correlation analysis showed that physical and psychological frailty were moderately correlated ( r=0.311, P<0.001), psychological and social frailty were weakly correlated ( r=0.218, P<0.001), and physical and social frailty were weakly correlated ( r=0.267, P<0.001). Logistic regression analysis showed that the age, the number of multimorbidities, the psychological frailty and social frailty were the influencing factors for physical frailty (all P<0.05). The gender, number of multimorbidity, type of medication taken, physical frailty and social frailty were influencing factors of psychological frailty (all P<0.05). And age, number of multimorbidities, physical frailty and psychological frailty were influencing factors of social frailty (all P<0.05). A total of 3 themes were extracted through in-depth interviews, namely, "physical and psychological frailty are interrelated""physical and social frailty are interrelated", and "psychological and social frailty are interrelated". Conclusions:The physical, psychological, and social frailty in elderly patients with multimorbidity interacts with each other. Whereas the number of multimorbidities is a common risk factor for all three.

Abstract Modern western medicine typically focuses on treating specific symptoms or diseases, and traditional Chinese medicine (TCM) emphasizes the interconnections of the body’s various systems under external environment and takes a holistic approach to preventing and treating diseases. Phenomics was initially introduced to the field of TCM in 2008 as a new discipline that studies the laws of integrated and dynamic changes of human clinical phenomes under the scope of the theories and practices of TCM based on phenomics. While TCM Phenomics 1.0 has initially established a clinical phenomic system centered on Zhenghou (a TCM definition of clinical phenome), bottlenecks remain in data standardization, mechanistic interpretation, and precision intervention. Here, we systematically elaborates on the theoretical foundations, technical pathways, and future challenges of integrating digital medicine with TCM phenomics under the framework of “TCM phenomics 2.0”, which is supported by digital medicine technologies such as artificial intelligence, wearable devices, medical digital twins, and multi-omics integration. This framework aims to construct a closed-loop system of “Zhenghou–Phenome–Mechanism–Intervention” and to enable the digitization, standardization, and precision of disease diagnosis and treatment. The integration of digital medicine and TCM phenomics not only promotes the modernization and scientific transformation of TCM theory and practice but also offers new paradigms for precision medicine. In practice, digital tools facilitate multi-source clinical data acquisition and standardization, while AI and big data algorithms help reveal the correlations between clinical Zhenghou phenomes and molecular mechanisms, thereby improving scientific rigor in diagnosis, efficacy evaluation, and personalized intervention. Nevertheless, challenges persist, including data quality and standardization issues, shortage of interdisciplinary talents, and insufficiency of ethical and legal regulations. Future development requires establishing national data-sharing platforms, strengthening international collaboration, fostering interdisciplinary professionals, and improving ethical and legal frameworks. Ultimately, this approach seeks to build a new disease identification and classification system centered on phenomes and to achieve the inheritance, innovation, and modernization of TCM diagnostic and therapeutic patterns.

Objective:To analyze the current status, research hotspots, and development trends on the integration of primary care and prevention in China.Methods:This was a bibliometric analysis. Literature related to research on the integration of primary care and prevention in China was retrieved from CNIKI, Wanfang, VIP, Chinese Medical Journal Full Text Database, PubMed, and Web of Science for the period from January 1, 2015, to April 1, 2025. CiteSpace software was used to conduct a visual analysis of publication volume, authors and their collaborations, institutions, and keywords in the included literature.Results:A total of 292 domestic publications on the integration of primary healthcare and public health were analyzed. Research on primary healthcare-public health integration in China exhibited an overall upward trend from 2015 to 2025. Based on publication volume and temporal distribution, domestic research can be categorized into an exploratory phase (2015-2020) and a rapid development phase (2021-2025). The institutions publishing relevant research were predominantly universities and research centers, with a low institutional network density (0.013), indicating relative weak inter-institutional collaboration. The co-occurrence density among authors was 0.013 9. Collaboration predominantly occurred in small clusters, with limited cross-regional cooperation. Keywords that appeared frequently and had an intermediary centrality exceeding 0.1 included chronic diseases (0.40), public health (0.23),health management (0.18), and hypertension (0.17). Keyword clustering analysis showed that the top three categories mainly focused on public health, chronic diseases, and health management. Since 2024, emerging keywords with high burst intensity have included big data, health literacy, primary care hospitals, and infectious diseases.Conclusions:Research on the integration of medical and preventive care at the primary healthcare level in China has entered a stage of rapid development. Current research hotspots focus primarily on chronic disease management, the implementation status and barriers of primary healthcare and prevention integration models. Future research is expected to emphasize the application of intelligent technologies, and the enhancement of public health emergency response capacity.

Objective:To observe any effect of electroacupuncture on the urodynamics of rats modeling chronic urinary retention after a sacral cord injury (SCI), and to explore its regulatory effect on interstitial Cajal cells (ICCs) in the bladder and the mechanism.Methods:Seventy-five female Sprague-Dawley rats were randomly divided into a sham operation group, a model group, an electroacupuncture group, an inhibitor group, and an inhibitor plus electroacupuncture group, each of 15. On day 1 of the experiment the sacral spinal cord was completely transected at the level of the 3rd lumbar vertebra in all groups except the sham operation group. In that group the spinous processes and laminae of L 2-4 were exposed but not injured, and then sutured. On day 16, both the inhibitor group and the inhibitor plus electroacupuncture group were given intraperitoneal injections of imatinib mesylate, while the electroacupuncture group and the inhibitor plus electroacupuncture group began 14 consecutive days of electroacupuncture. After the intervention, urodynamic testing was performed on the rats in all five groups, and they were then sacrificed. Hematoxylin-eosin staining was used to observe any morphological changes in the bladder. Transmission electron microscopy was employed to assess the ultrastructure and quantity of ICCs in the bladder. And the gene and protein expression of c-Kit and stem cell factor (SCF) in bladder tissue were detected using polymerase chain reactions and western blotting. Western blotting was also applied to detect the relative expression of c-Kit phosphorylated proteins. Results:Compared with the sham group, the model and inhibitor groups showed significant differences in their urination rates, residual urine volumes, bladder volumes and compliance on the 30th day of the experiment. Compared with the model group, the rats who received electroacupuncture displayed more complete voiding, lower residual urine volume, greater bladder volume and better compliance. Compared with the electroacupuncture group, the urodynamic evaluation of the inhibitor plus electroacupuncture group indicated a significant decrease in urination rate, but a significant increase in residual urine volume, bladder volume and compliance. The SCI modeling had destroyed the morphology of the bladder detrusor muscle and the ultrastructure of the ICCs. And the number of Cajal interstitial cells and the relative expression of c-Kit, SCF, and p-c-Kit had decreased significantly. Compared with the model group, a significant improvement was observed in all urodynamic indicators, the morphology of the detrusor muscle, the ultrastructure and number of ICCs, and the relative expression of c-Kit, SCF, and p-c-Kit in the electroacupuncture groups. There were poorer urodynamic indicators, detrusor muscle morphology, ultrastructure and number of ICCs in the inhibitor plus electroacupuncture group compared with the group which received electroacupuncture alone, but there was a significant decrease in the relative expression of p-c-Kit.Conclusions:Electroacupuncture can improve the urodynamics of chronic urinary retention after sacral cord injury, at least in rats. The mechanism may be related to the benign regulation of ICCs through the bladder′s c-kit/SCF signal system.

Objective:To investigate the correlations between physical, psychological and social frailty in elderly patients with multimorbidity.Methods:This study utilized a mixed method. A questionnaire survey was conducted from February to June 2024, among elderly patients with multimorbidity attending 4 primary health care centers in urban Beijing selected by the convenience sampling method. The FRAIL Frailty Assessment Scale, WHO-5 Index of Well-Being Scale, and HALFT Scale were used to assess the patients′ physical, psychological, and social frailty, respectively. Spearman correlation analysis was used to analyze the correlation between different dimensions of frailty in elderly with multimorbidity. Logistic regression model was used to analyze the factors influencing physical, psychological and social frailty. The elderly with multimorbidity who were assessed to have at least 1 or more types of frailty in the quantitative study were selected for in-depth interviews in the form of online and offline combination. The topics of in-depth interview included the real experience of the different dimensions of frailty, the possible causes and the difficulties caused. The sample size was determined according to the principle of information saturation. Thematic analysis was used to summarize, code and analyze the interview data.Results:A total of 919 participants were included in the quantitative study, with a mean age of (74.09±6.03) years, 329(35.80%) were males and 590(64.20%) were females. The prevalence of physical, psychological, and social frailty was 17.85%(164/919), 21.44%(197/919), 11.21%(103/919), respectively. A total of 21 participants were included in the qualitative study, with a mean age (76.90±5.13)years, 5(23.81%) males and 16(76.19%) females. Spearman correlation analysis showed that physical and psychological frailty were moderately correlated ( r=0.311, P<0.001), psychological and social frailty were weakly correlated ( r=0.218, P<0.001), and physical and social frailty were weakly correlated ( r=0.267, P<0.001). Logistic regression analysis showed that the age, the number of multimorbidities, the psychological frailty and social frailty were the influencing factors for physical frailty (all P<0.05). The gender, number of multimorbidity, type of medication taken, physical frailty and social frailty were influencing factors of psychological frailty (all P<0.05). And age, number of multimorbidities, physical frailty and psychological frailty were influencing factors of social frailty (all P<0.05). A total of 3 themes were extracted through in-depth interviews, namely, "physical and psychological frailty are interrelated""physical and social frailty are interrelated", and "psychological and social frailty are interrelated". Conclusions:The physical, psychological, and social frailty in elderly patients with multimorbidity interacts with each other. Whereas the number of multimorbidities is a common risk factor for all three.

Objective:To analyze the current status, research hotspots, and development trends on the integration of primary care and prevention in China.Methods:This was a bibliometric analysis. Literature related to research on the integration of primary care and prevention in China was retrieved from CNIKI, Wanfang, VIP, Chinese Medical Journal Full Text Database, PubMed, and Web of Science for the period from January 1, 2015, to April 1, 2025. CiteSpace software was used to conduct a visual analysis of publication volume, authors and their collaborations, institutions, and keywords in the included literature.Results:A total of 292 domestic publications on the integration of primary healthcare and public health were analyzed. Research on primary healthcare-public health integration in China exhibited an overall upward trend from 2015 to 2025. Based on publication volume and temporal distribution, domestic research can be categorized into an exploratory phase (2015-2020) and a rapid development phase (2021-2025). The institutions publishing relevant research were predominantly universities and research centers, with a low institutional network density (0.013), indicating relative weak inter-institutional collaboration. The co-occurrence density among authors was 0.013 9. Collaboration predominantly occurred in small clusters, with limited cross-regional cooperation. Keywords that appeared frequently and had an intermediary centrality exceeding 0.1 included chronic diseases (0.40), public health (0.23),health management (0.18), and hypertension (0.17). Keyword clustering analysis showed that the top three categories mainly focused on public health, chronic diseases, and health management. Since 2024, emerging keywords with high burst intensity have included big data, health literacy, primary care hospitals, and infectious diseases.Conclusions:Research on the integration of medical and preventive care at the primary healthcare level in China has entered a stage of rapid development. Current research hotspots focus primarily on chronic disease management, the implementation status and barriers of primary healthcare and prevention integration models. Future research is expected to emphasize the application of intelligent technologies, and the enhancement of public health emergency response capacity.

Objective:To explore the structural relationship between WMSDs in the upper limbs and various risk factors in the occupational population in China, based on a large sample epidemiological survey and structural equation analysis, and to establish a structural equation model, so as to lay a foundation for the prevention and control of such diseases.Methods:The Chinese version of the Musculoskeletal Disorders Electronic Questionnaire was used to conduct a nationwide survey on the prevalence of WMSDs in the upper extremity. Six factors related to WMSDs in the upper extremity were extracted by the classification standard of adverse ergonomic factors and their source and confirmatory factor analysis, including work organization, work type, upper extremity work posture, individual factors, upper extremity fatigue and upper extremity WMSDs. The structural equation analysis was carried out and the structural equation model was established.Results:The incidence of WMSDs and fatigue in the upper limbs was 24.44% and 43.76%, respectively. The adjusted structural equation model fitting indicators were generally up to the standard (GFI=1.000, AGFI=1.000, RMSEA=0.043, NFI=0.808, TLI=0.784) . The four exogenous latent variables of work organization, work type, upper limb work posture and individual factors were correlated. There was a strong positive correlation between job type and upper limb work posture ( r=0.865) , a moderate positive correlation between work organization and job type and upper limb work posture ( r=0.570, 0.490) , and a weak negative correlation between individual factors and the other three exogenous latent variables. Upper limb work posture and individual factors had direct effects on upper limb WMSDs, and the effect coefficients were 0.10 and 0.06, respectively. Upper limb fatigue played a mediating role between work organization, work type, upper limb work posture and upper limb WMSDs. The effect coefficient was 0.46, and the composition ratios of indirect effects were 100.0%, 100.0%, and 38.3%, respectively. The direct path effect of upper limb work posture, individual factors and upper limb WMSDs was weaker than the mediating path through upper limb fatigue. Conclusion:When carrying out the prevention and control of upper limbWMSDs, it is necessary to comprehensively consider the pathogenesis path of upper limb muscle fatigue and upper limb WMSDs caused by work organization, work type, and upper limb work posture, so as to provide theoretical reference for improving the prevention and control level of such diseases.

Objective:To analyze the distribution characteristics of work-related musculoskeletal disorders (WMSDs) among the occupational population in China's key industries during the period from 2018 to 2023, and to provide data support for the formulation of targeted prevention strategies.Methods:Between January 1, 2018, and December 31, 2023, a cross-sectional epidemiological survey and a retrospective investigation were conducted in seven geographical regions of North China, East China, Central China, South China, Southwest China, Northwest China, and Northeast China, using a combination of epidemiological cross-sectional and retrospective surveys. The industries were stratified according to the degree of closeness to WMSDs, the size of the occupational population, and the importance of the national economy, and then cluster sampling was conducted according to the size of the enterprises (large, medium, and small) within each stratum. Representative enterprises were selected, and workers who had been employed for more than one year and met the inclusion criteria were selected as the study subjects. The survey subjects completed the Chinese version of the Musculoskeletal Disorders Survey Questionnaire online by scanning a QR code. A total of 88, 609 valid questionnaires were collected. Continuous data were described by means and standard deviations, and the standardized incidence rates of WMSDs were evaluated using chi-square tests to compare the standardized incidence rates of different body parts.Results:The standardized prevalence rate of WMSDs among the frontline working population in China was 36.7%, with the top three being the neck (21.37%), shoulders (18.23%), and lower back (14.92%). There was a statistically significant difference in the standardized prevalence rate of WMSDs between different body parts (χ 2=47577.82, P<0.05). The lowest standardized prevalence rate of WMSDs was found in the southeast coastal region of China (32.54%), while the highest was in the northwest (49.70%) and northeast regions (46.16%). The standardized prevalence rate of WMSDs decreased from 42.88% in 2018 to 29.94% in 2023. The micro-enterprise observation group had a higher concentration of WMSDs in the neck (20.66%), lower back (17.95%), and shoulders (17.79%), while the large enterprise observation group had a higher concentration in the neck (20.54%), shoulders (17.52%), and lower back (14.65%). Among the industries surveyed, the highest standardized prevalence rate of WMSDs was found in the healthcare industry (53.18%), followed by the toy manufacturing industry (50.54%), the automotive manufacturing industry (43.39%), general aviation services (42.71%), and the ship and related equipment manufacturing industry (40.56%). The standardized prevalence rate of WMSDs among women was significantly higher than that of men ( OR value=1.44, P<0.05). In addition, the standardized prevalence rate of WMSDs with multiple affected body parts (four or more body parts affected simultaneously) was higher, and the risk of WMSDs increased with subjective fatigue, showing a significant "S-shaped" trend (the OR value was 2.19, 3.16, 4.71, 5.49, and 3.97 when the RPE was 13, 15, 17, 19, and 20, respectively. χ 2trend=17.23, P<0.001) . Conclusion:The distribution characteristics of WMSDs in key industries in China show obvious differences in different parts, regions, time, enterprise scale, industry and population attributes. Agriculture, pharmaceutical manufacturing, packaging and decoration and other printing industries have a high proportion of WMSDs in multiple parts at the same time and in a single site. It is necessary to study and implement precise preventive measures according to specific regions, industries and enterprise scales, as well as the characteristics of multi-site WMSDs, so as to effectively protect the health and well-being of the working population.