Objective: To explore the effects of the school based integrated horticulture curriculum intervention on 24 hour activity behaviors among third grade primary school students, so as to provide reference for promoting children s health. Methods: In September 2023, a convenience sampling method was used to select 90 third grade primary school students from a primary school in Changsha. Participants were randomly assigned to an intervention group ( n =45) and a control group ( n =45) using a random number table. From February to May 2024, the intervention group received a 12 week integrated curriculum intervention, consisting of two 60 minute sessions per week and covering horticultural practice, home-school collaborative tasks and nutrition knowledge education. The control group continued with routine labor education courses. The triaxial accelerometer and multi sensor sleep monitoring device were used to objectively measure light intensity physical activity (LPA), moderate to vigorous physical activity (MVPA), screen based sedentary behavior (SSB) and sleep (SLP), durations in both groups. Data were analyzed using generalized estimating equations (GEE) and Mann-Whitney U tests. Results: The time, group and interaction effects of MVPA time and SLP time before and after intervention in two groups of primary school students were not statistically significant (Wald χ 2=1.54, 2.97, 0.85 ; 0.75, 1.05, 0.48), and the group effect of LPA time (Wald χ 2=1.24) and the time and group effects (Wald χ 2=3.02, 1.18 ) were not statistically significant (all P >0.05). There were statistically significant time and interaction effects for LPA time, as well as interaction effect for SSB time in two groups of primary school students before and after intervention (Wald χ 2=4.78, 3.95, 12.60, all P <0.05). After intervention, LPA time of intervention group [152.23(59.15, 245.80)min] was higher than that of control group [120.70(29.90, 201.20)min], and SSB time of intervention group [55.50(30.00, 125.50)min] was lower than that of control group [220.00(60.00, 285.00)min], with statistically significant differences ( Z =-2.46, -4.48, both P <0.05). Conclusion The school horticulture curriculum effectively enhances daily LPA and reduces SSB among third grade primary school students.

With the deepening of population aging and the rising prevalence of chronic diseases among the elderly in China， the traditional elderly care models are facing challenges. This paper proposed a community-integrated medical-nursing-rehabilitation-care service model， characterized by “integration， flexibility， community orientation， and demand orientation.” This model optimizes and combines various service resources such as healthcare， elderly care， rehabilitation， and nursing at the community level， providing more comprehensive and targeted services for the elderly with chronic diseases in the community. However， a series of challenges existed in dimensions such as the service integration， benefit distribution， resources and funds， as well as policies and systems， hindering the sustainable development of the community-integrated medical-nursing-rehabilitation-care service model. Future efforts should focus on constructing a more standardized collaborative system， clarifying standards for resource investment and benefit distribution， as well as strengthening policy guidance， financial support， and talent team development.

Colorectal cancer has an insidious onset， and some patients have already developed local invasion or metastasis at the time of diagnosis， which affects treatment strategy selection and survival prognosis. The tumor microenvironment is not only the basic condition for tumor cell survival but also the core regulatory factor driving their local invasion and distant metastasis. This article reviewed the mechanisms by which traditional Chinese medicine regulates the tumor microenvironment to inhibit colorectal cancer metastasis. It was found that traditional Chinese medicine active ingredients such as astragalus polysaccharides， leonurine， kaempferol， etc.， as well as traditional Chinese medicine formulas such as Jianpi jiedu formula， can inhibit colorectal cancer metastasis by regulating key links of the tumor microenvironment， including immunosuppression， inflammatory response， intestinal microecological disorder， abnormal angiogenesis， and extracellular matrix homeostasis imbalance. However， current related research was still mainly based on cell and animal experiments， with limited clinical evidence-based data， and mechanistic studies mostly focued on single signaling pathways. Future research should integrate multi-omics technologies and systems biology methods to systematically elucidate the key targets and action networks through which traditional Chinese medicine regulates the colorectal cancer tumor microenvironment to combat metastasis.

Objective To optimize the dose distribution of postoperative brachytherapy for linear keloids,and to investigate the effects of the number of radiation sources n,source-to-skin distance d,and source spacing a on dose distribution,thereby providing a reasonable radiation source arrangement scheme for radiotherapy in narrow and elongated wound areas.Methods A one-dimensional idealized model was established.Based on the inverse-square law,dose distributions were calculated under combinations of differentn(4,6,8,10)and d(from 0.3 to 2.0 cm).The proportions of dose-effective areas(90%-110%of the prescribed dose)and penumbra areas(20%-80%of the prescribed dose)were analyzed to evaluate the rationality of dose distribution.Results When d/a slightly exceeded 0.5,the proportion of the effective area reached its peak,and the proportion of the penumbra area was relatively low.An excessively small d/a led to cold spots in the irradiated area,while an excessively large d/a expanded the penumbra area.Increasing n significantly reduced the penumbra range and improved dose homogeneity.Conclusion The dose distribution is most reasonable when d/a is slightly greater than 0.5,and a multi-source arrangement(n≥6)is preferred to enhance dose homogeneity.This study provides guidance for parameter optimization in brachytherapy for keloids.

Objective To explore the time-varying pattern of potential symptoms in breast cancer patient before and after chemotherapy,and further analyze its influencing factors,aims to provide reference for clinical nursing practice.Methods 233 cases of breast cancer in a tertiary A hospital in Ningxia from June to October,2023 were selected as the research subjects.By the general information questionnaire and the Chinese version of Anderson Symptom Assessment Scale,the potential change of symptoms of breast cancer patients undergoing chemotherapy 1-3 days before the first chemotherapy(T1,233 cases)and 7-14 days after the third or fourth chemotherapy(T2,225 cases)was analyzed.Results 225 cases of breast cancer patients completed 2 surveys,and their symptom characteristics before and after chemotherapy can be divided into 2 categories:a high symptom troubled group and a low symptom troubled group.The high-symptom troubled group has strong stability,and the probability of maintaining the original group is 85.20％,while the low-symptom troubled group is more inclined to change to the high-symptom troubled group,and the transition probability is 26.60％.Logistic regression analysis showed that the mass was located on the left side,and the patients who obtained disease knowledge mainly through the Internet were more likely to change from the high symptom troubled group to the low symptom troubled group,while the patients who were employed,with unsatisfactory sleep at night,and never exercised were more likely to change from the low symptom troubled group to the high symptom troubled group.Conclusion The symptoms of breast cancer patients before and after chemotherapy are heterogeneous.Patients who are on the job,have unsatisfied sleep at night and never exercise are more likely to change from the low-symptom troubled group to the high-symptom troubled group,which suggests that medical staff should identify potential high-risk groups at an early stage,and make full use of the predictive function of symptom characteristics to carry out individualized management based on the dynamic monitoring of symptoms according to different types of population characteristics,so as to reduce the burden of symptoms and improve their quality of life.

AIM:To investigate the role and mechanism of cell death-inducing DNA fragmentation factor al-pha(DFFA)-like effector B(Cideb)in promoting palmitic acid(PA)-induced lipid deposition in human hepatoblastoma HepG2 cells.METHODS:The HepG2 cells were divided into control group,model group,negative control silencing(siR-NC)group and Cideb silencing(siR-Cideb)group.The cells were treated with PA to establish a cellular model of lipid deposition.Specific siRNAs were used to silence the expression of Cideb,and the intracellular lipid content was mea-sured.Lipid deposition was observed by oil red O staining.RT-qPCR and Western blot were used to detect the expression levels of Cideb,sterol regulatory element-binding protein 1c(SREBP1c),acetyl-CoA carboxylase 1(ACC1),fatty acid synthase(FAS),stearoyl-CoA desaturase 1(SCD1)and AMP-activated protein kinase α(AMPKα)in the cells.The ef-fects of Cideb overexpression on HepG2 cells were observed by transfection with a Cideb eukaryotic expression plasmid.RESULTS:Compared with control group,the cells in PA model group presented lipid deposition,significantly increased triglyceride(TG)and total cholesterol(TC)content,elevated expression levels of Cideb,SREBP1c,ACC,FAS and SCD1,and decreased expression of AMPKα(P＜0.05).Compared with siR-NC group,the cells in siR-Cideb group pre-sented decreased lipid deposition,reduced intracellular TG and TC content,decreased SREBP1c,ACC,FAS and SCD1 expression levels,and increased AMPKα expression(P＜0.05).The overexpression of Cideb increased the lipid deposi-tion,TG and TC content,and the expression levels of SREBP1c,ACC,FAS and SCD1 in HepG2 cells,but decreased the expression of AMPKα(P＜0.05).CONCLUSION:Reduction of Cideb alleviates PA-induced lipid deposition in HepG2 cells by down-regulating the SREBP1c/ACC/FAS/SCD1 pathway and up-regulating the AMPKα pathway.

Objective To explore the effect of progressive intensity muscle training on joint function and inflammatory response after arthroscopic rotator cuff tear surgery.Methods Totally 226 patients with rotator cuff tear injuries and admitted to Shaoxing Traditional Chinese Medicine Hospital between April 2020 and April 2022 were selected,and randomly divided into a study group and a control group,each of 113,using a double-blind random number table.After the arthroscopic surgery,the study group received progressive intensity muscle strength training,while the control group was given routine functional training and rehabilitation.Before and 8 weeks after surgery,both groups were evaluated us-ing the Constant Murley shoulder joint function(CMSJF),Unilaterally Controlled Latin Assets(UCLA),and Fugl Meyer scale(FMA).Moreover,their Activities of Daily Living(ADL)score,se-rum inflammatory factors,and upper limb function score were compared.Results Before surgery,there was no significant difference between the two groups in the average CMSJF score,UCLA score,EMA score,ADL score and the range of motion(ROM)(P>0.05).However,8 weeks after the surgery,all the above values improve significantly,with significantly greater improvement in the study group than the control group(P<0.05).Moreover,before the surgery,there was no significant difference be-tween the two groups in the serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),interleu-kin-10(IL-10)and transformative growth factor-β(TGF-β)(P>0.05).However,8 weeks after the surgery,a significant increase was observed in the average IL-10 and TGF-β,with a significant de-crease in the average TNF-α and IL-6(P<0.05 for both).Conclusion After arthroscopic surgery for ro-tator cuff tear,progressive muscle strength training has a significant clinical effect on relieving pain,promoting muscle function and strength,and improving the function of the affected limb.

Objective:To analyze the equity of elderly care institution resource allocation in Northeast China and its influencing factors,and provide certain reference for the further development of elderly care care in Northeast China.Methods:The total amount of nursing institution resource allocation and the per capita old and above per 1 000 km2 were summarized by using general descriptive analysis.The Lorenz curve,Gini coefficient,and Theil index were calculated to evaluate the equity of nursing institution resource allocation.Results:Jilin Province did not have an advantage in the total allocation of elderly care insitution resources in Northeast China.In terms of resource allocation per 1 000 km2,Heilongjiang Province still has considerable room for improvement.The overall arc of the Lorenz curve for allocating resources by geographical area has become smaller year by year,while the overall arc of the Lorenz curve for allocating resources by population has become larger year by year.Conclusion:The equity of allocating institution home resources by population has generally weakened over the years,while the equity of allocating elderly care institution resources by geographical area has generally strengthened over the years.The development pressure of nursing care in Liaoning Province is relatively large,and efforts should be made to enhance the fairness of nursing home resource allocation.

Objective To develop a core outcome set(COS)for clinical effectiveness trials of heart failure with preserved ejection fraction(HFpEF).Methods Outcome measures were collected through database literatures search,clinical experts questionnaire survey and semi-structured patients interview.Then,the outcome measures pool was constructed and domains were divided.Candidate outcome measures of COS were screened through two rounds of Delphi survey.Finally,a consensus meeting was held to determine COS and reach a consensus.Results A total of 317 outcome measures which could be divided into 6 domains were collected through literature research,questionnaire survey and semi-structured interview.15 candidate outcome measures of COS were screened through two rounds of Delphi survey.Finally,the consensus meeting reached consensus on a COS with 6 entries.Conclusion In this study,a COS for clinical effectiveness trials of HFpEF was developed,which is conducive to the standardization of efficacy evaluation.

Objective To optimize the dose distribution of postoperative brachytherapy for linear keloids,and to investigate the effects of the number of radiation sources n,source-to-skin distance d,and source spacing a on dose distribution,thereby providing a reasonable radiation source arrangement scheme for radiotherapy in narrow and elongated wound areas.Methods A one-dimensional idealized model was established.Based on the inverse-square law,dose distributions were calculated under combinations of differentn(4,6,8,10)and d(from 0.3 to 2.0 cm).The proportions of dose-effective areas(90%-110%of the prescribed dose)and penumbra areas(20%-80%of the prescribed dose)were analyzed to evaluate the rationality of dose distribution.Results When d/a slightly exceeded 0.5,the proportion of the effective area reached its peak,and the proportion of the penumbra area was relatively low.An excessively small d/a led to cold spots in the irradiated area,while an excessively large d/a expanded the penumbra area.Increasing n significantly reduced the penumbra range and improved dose homogeneity.Conclusion The dose distribution is most reasonable when d/a is slightly greater than 0.5,and a multi-source arrangement(n≥6)is preferred to enhance dose homogeneity.This study provides guidance for parameter optimization in brachytherapy for keloids.