Abstract The issue of multimorbidity in children and adolescents is becoming increasingly prominent, but there is no consensus on the definition of multimorbidity. As research deepens, issues related to the comparability and standardization of relevant findings are gradually emerging. As a solution, a systematic review of both domestic and international research on multimorbidity is conducted, and a classification system for defining the concept of multimorbidity is proposed, offering more convenient conditions for the advancement of future research and cross study exchange.

ObjectiveTo investigate the modifiable areal unit problem （MAUP） in the spatial pattern of Pseudostellaria heterophylla production regions and reveal the impact of statistical scales on the spatial distribution characteristics of this medicinal plant species. MethodsUsing multi-source data （literature records， field surveys， and statistical data）， we systematically analyzed the spatial patterns across three administrative levels （provincial， prefectural， and county scales）. Spatial autocorrelation （Moran's I） analysis， high-low clustering （Getis-Ord General G）， and hot/cold spot analysis （Getis-Ord Gi*） were employed. ResultsThe literature-based analysis showed that the production regions of P. heterophylla presented random distribution on the provincial scale and significant aggregation on the prefectural scale. The field survey data showed that the production regions displayed random distribution on the provincial scale but significant aggregation on both prefectural and county scales. The statistical data revealed that the production regions lacked spatial autocorrelation on the provincial scale but demonstrated significant aggregation on prefectural and county scales. ConclusionMAUP effects have substantive implications for understanding and decision-making in the arrangement of medicinal plant production regions. The county scale proves to be the most sensitive and explanatory level for analyzing the spatial pattern of P. heterophylla production regions， providing a critical foundation for habitat modeling， suitability evaluation， and ecological cultivation planning of medicinal plants.

Objective To explore the efficacy of progressive exercise training based on the modified Medical Research Council dyspnea scale (mMRC) grading in respiratory rehabilitation for patients with chronic obstructive pulmonary disease (COPD) at a primary healthcare setting. Methods A total of 106 patients with COPD admitted to Zhuanqiao Community Health Service Center in Shanghai from Aug.1, 2022 to Jul. 30, 2024 were selected as research subjects. They were randomly divided into a study group and a control group in a 1∶1 ratio, with 53 patients in each group. The control group received conventional treatment, while the study group received conventional treatment combined with progressive exercise training. After 4 weeks of continuous treatment, the changes in the 6-minute walk test (6MWT), COPD assessment test (CAT) score, mMRC grading, Global Initiative for Chronic Obstructive Lung Disease (GOLD) grading and pulmonary function were compared between the two groups. Results Patients in both groups showed improvements in 6MWT distance, CAT score, mMRC grading, GOLD grading, and pulmonary function compared to baseline (P＜0.05). Moreover, the study group had better improvements in 6MWT distance, CAT score, mMRC grading, GOLD grading, and pulmonary function than the control group (P＜0.05). Conclusions Conventional treatment combined with progressive exercise training based on mMRC grading can enhance the effect of respiratory rehabilitation in patients with COPD, particularly in improving pulmonary function and exercise tolerance.

ObjectiveThrough multimodal research methods including medication rule mining， network pharmacology， molecular docking and dynamics simulation， and in vivo animal experiments， this study aims to speculate and verify the core composition （Ginseng Radix et Rhizoma Rubra-Salviae Miltiorrhizae Radix et Rhizoma-Notoginseng Radix et Rhizoma） and efficacy （Qi-invigorating and blood-activating） of the drug combination in Yitangkang Compound for improving diabetic cardiomyopathy （DCM）， investigate the interaction relationship and binding strength between core active ingredients of the drug combination and key signaling pathway targets， and further explore the mechanism by which the Qi-invigorating and blood-activating drug combination regulates the calcium signaling pathway to improve cardiac function in DCM rats. MethodsThe Ancient and Modern Medical Cases Cloud Platform was used to construct a DCM prescription database， and the "Analysis Method" module of the platform was applied to mine and summarize medication rules， thereby determining the core composition of the Qi-invigorating and blood-activating drug combination in Yitangkang. Drug-active ingredient-signaling pathway-core target-disease analysis and visualization were conducted by combining network pharmacology with the Traditional Chinese Medicine System Pharmacology Platform （TCMSP） database， SwissTargetPrediction platform， GeneCards database， MetaScape database， CytoScape software， etc. Then， molecular docking was performed via the CB-Dock2 platform， and molecular dynamics simulation of the high-binding-strength docking complexes was carried out by Gromacs software. Finally， in vivo animal experiments were carried out. Twenty-eight Sprague Dawley （SD） rats meeting the research criteria were divided into a normal group， a model group， a drug combination group （3.3 g·kg^-1）， and a Yitangkang group （20 g·kg^-1）. A type 2 diabetes mellitus （T2DM） rat model was established by high-fat diet feeding combined with intraperitoneal injection of streptozotocin （STZ）， followed by continuous feeding for eight weeks until the DCM model was successfully established. During this period， the traditional Chinese medicine （TCM） compound and drug combination were administered for prevention and treatment intervention. Meanwhile， changes in blood glucose， body weight， and heart index of each group were monitored. Cardiac function was assessed by echocardiography， and electrophysiological signals were detected by an electrocardiogram. The heart tissue was observed for pathological changes by hematoxylin-eosin （HE） and Masson staining， and the expression of L-type calcium channel （CACNA1C）， calmodulin （CALM1）， calcium/calmodulin-dependent protein kinase Ⅱδ （CAMK2D）， and neuronal nitric oxide synthase （NOS1） proteins in the calcium signaling pathway of myocardial tissue was detected by Western blot. ResultsIn 62 DCM prescriptions， Ginseng Radix et Rhizoma Rubra， Salviae Miltiorrhizae Radix et Rhizoma， and Notoginseng Radix et Rhizoma were used most frequently. Their meridian tropism mainly involved the spleen， heart， and lung， and their sweet and warm properties were prominent. The drugs for tonifying or blood-activating and stasis-resolving ranked top. In association rule analysis， （Ginseng Radix et Rhizoma Rubra， Salviae Miltiorrhizae Radix et Rhizoma）-Notoginseng Radix et Rhizoma had the highest lift. Network pharmacology obtained 75 active ingredients of the drug combination， 714 drug combination action targets， 2 702 disease targets， and 286 intersection targets. Protein-protein interaction （PPI） network predicted nine interaction component-targets （nine active ingredients and four calcium signaling pathway target genes）. Molecular docking showed the four complexes with the lowest binding energy were 2f3z-ginsenoside Re， 1cll-quercetin， 9blh-（6S）-6-（hydroxymethyl）-1，6-dimethyl-8，9-dihydro-7H-naphtho［8，7-g］benzofuran-10，11-dione， and 5vv0-miltionone Ⅱ. Dynamics simulation showed the CALM1-quercetin complex had the strongest binding affinity. The animal experiment results revealed that compared with the normal group， the model group showed significant changes in blood glucose， body weight， myocardial tissue morphology， heart index， cardiac function， electrophysiological indexes， and the expression levels of CACNA1C， CALM1， CAMK2D， and NOS1 proteins （P<0.05， P<0.01）. Compared with the model group， the Yitangkang group had a certain improvement effect on the above indexes （P<0.05， P<0.01）. Compared with the Yitangkang group， the drug combination group showed no significant difference in improving myocardial tissue morphology， heart index， cardiac function， electrophysiological indexes， and the expression of CACNA1C， CALM1， CAMK2D， and NOS1 proteins， except for blood glucose and body weight. ConclusionGinseng Radix et Rhizoma Rubra， Salviae Miltiorrhizae Radix et Rhizoma， and Notoginseng Radix et Rhizoma are the core Qi-invigorating and blood-activating drug combination in Yitangkang Compound. They have a good preventive and therapeutic effect on STZ-induced DCM in rats， and their mechanism of action may be related to the regulation of the calcium signaling pathway.

Objective To investigate the regulatory effects of plasma-derived exosomal microRNA-1306-5p(miR-1306-5p)on inflammation,apoptosis and oxidative stress in intestinal mucosal epithelial cells in sepsis,and to explore the potential mechanisms.Methods Sepsis plasma-derived exosomes and healthy plasma exo-somes were separated and divided into healthy plasma exosomes group and sepsis plasma-derived exosomes group.The exosomes were observed by electron microscopy,the physical parameters of the two groups of exo-somes were analyzed,and the expression of miR-1306-5p in the exosomes was detected.Intestinal mucosal epi-thelial cells were divided into control group,negative control group of miR-1306-5p mimic(mimic-NC group),miR-1306-5p mimic group(mimic group),mimic combined with overexpression of PLK1 empty vector group(mimic-PLK1-EV group),and mimic combined with overexpression of Polo-like kinase 1(PLK1)group(mimic+PLK1-OE group).Real-time fluorescent quantitative PCR was used to detect the mRNA expressions of miR-1306-5p and PLK1 in each group,and protein imprinting was used to detect the expressions of miR-1306-5p target genes PLK1,caspase 3,B lymphoblastoma-2(Bcl-2)and Bcl2-associated X protein(Bax).Dual luciferase reporter gene assay was used to detect the binding effect of miR-1306-5p and PLK1,and flow cytom-etry was used to detect apoptosis.The expressions of tumor necrosis factor-α(TNF-α),interleukin(IL)-1β,IL-6 and IL-8 in the supernatant of cultured cells were detected by enzyme-linked immunosorbent assay.The expressions of reactive oxygen species(ROS),malondialdehyde(MDA),glutathione(GSH)and superoxide dismutase(SOD)were detected by kit method.Results The plasma derived exosomes of sepsis and healthy plasma were ellipsoid in shape,and there was no significant difference in physical parameters(P＞0.05).Compared with the healthy plasma exosomes group,the expression of miR-1306-5p was up-regulated in the plasma derived exosomes of sepsis group(P＜0.05).PLK1 was identified as the target gene of miR-1306-5p by double luciferase reporter method.Compared with mimic-NC group,the expressions of miR-1306-5p,TNF-α,IL-6,IL-8,IL-1β,caspase3,Bax,ROS and MDA were up-regulated,the apoptosis rate was increased,and the expressions of PKL1,Bcl-2,GSH and SOD were down-regulated in mimic group(all P＜0.05).Compared with mimic+PLK1-EV group,the expressions of TNF-α,IL-6,IL-8,IL-1β,caspase3,Bax,ROS,and MDA were significantly down-regulated,the apoptosis rate was decreased,and the expressions of PKL1,Bcl-2,GSH and SOD were up-regulated in mimic+PLK1-OE group(all P＜0.05).Conclusion Plasma derived exosome miR-1306-5p in sepsis promotes inflammation,apoptosis and oxidative stress damage of intestinal mucosal epi-thelial cells by targeting PKL1 inhibition.

Breast cancer has now become the most common malignancy in women globally. Chemotherapy-induced peripheral neuropathy (CIPN) is one of the common adverse reactions in chemotherapy for breast cancer, and when severe, it can significantly impact the treatment outcomes and quality of life of patients. This article provides an overview of the incidence, influencing factors, assessment tools, and intervention strategies for CIPN in breast cancer patients, with the aim of offering a reference for healthcare professionals to enhance symptom management in breast cancer patients.

AIM:To analyze the potential catego-ries and influencing factors of self concealment in breast cancer patients.METHODS:A total of 207 breast cancer patients from two hospitals in Anhui province were conveniently selected and investigat-ed with general information questionnaire,self con-cealment scale,perceived social support scale and chronic disease stigma scale.Potential profile analy-sis was used to explore the categories and charac-teristics of self concealment,and single factor anal-ysis and logistic regression were used to analyze the influencing factors of different categories.RE-SULTS:Self concealment of breast cancer patients was divided into two categories:low self conceal-ment group and high self concealment group.Logis-tic regression analysis showed that the main care-givers,comorbidities,perceived social support and sense of shame were the influencing factors of the potential profile of self concealment of breast can-cer patients(P＜0.05).CONCLUSION:Breast cancer patients have obvious category characteristics.Medical staff should pay attention to the level of self concealment of breast cancer patients,and for-mulate precision strategies according to different categories of influencing factors.

Objective:To explore the correlation between frailty and carotid plaque stability in patients with ischemic stroke.Methods:This study was a cross-sectional study. From May to December 2023, convenience sampling was used to select 360 patients with ischemic stroke in the Department of Neurology of Affiliated Hospital of Jining Medical University and underwent carotid artery color Doppler ultrasound examination as the study subject. Patients were surveyed using the General Information Questionnaire, Barthel Index and the Edmonton Frail Scale. Carotid artery color Doppler ultrasound was used to evaluate the stability of carotid plaques in patients. Multivariate Logistic regression was used to explore the correlation between frailty and carotid plaque stability.Results:A total of 360 questionnaires were distributed, and 352 valid questionnaires were collected, with a valid response rate of 97.78%. The incidence of frailty in 352 ischemic stroke patients was 44.89% (158/352). Multivariate analysis showed that compared to stable plaques, unstable carotid plaques were an independent risk factor for frailty in patients with ischemic stroke ( OR=2.127, 95% confidence interval: 1.247-3.626) . Conclusions:Compared to stable plaques, unstable carotid plaques increase the risk of frailty in patients with ischemic stroke. Strengthening the assessment of carotid plaques in patients with ischemic stroke by nursing staff can early identify high-risk individuals for frailty, and timely carry out personalized interventions, thereby reducing the occurrence of adverse health events in patients.

Objective:To explore the effect of nursing intervention based on the health action process approach (HAPA) theory on follow-up compliance and blood glucose management of patients with diabetes retinopathy (DR) .Methods:From October 2022 to May 2023, 102 DR patients who visited the Diabetes Fundus Clinic of Shanxi Eye Hospital were selected by convenience sampling as participants. A total of 51 patients who visited from October 2022 to January 2023 were selected as control group, and 51 patients who visited from February to May 2023 were selected as observation group. Control group received routine nursing, while observation group received nursing intervention based on HAPA theory on this basis. The follow-up compliance, Chinese version of the Compliance with Annual Diabetic Eye Exams Survey (CADEES-C) score, fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hPG) and glycosylated hemoglobin (HbA1c) were compared between the two groups.Results:The compliance of DR patients in observation group after six months of follow-up was higher than that in control group, and the difference was statistically significant ( P<0.05). After six months, the CADEES-C dimension scores and total score of DR patients in observation group were higher than those in control group, and the differences were statistically significant ( P<0.05). FBG and 2hPG of DR patients in observation group were lower than those in control group after three and six months, and the differences were statistically significant ( P<0.05). After six months of intervention, there was no statistically significant difference in HbA1c between observation group and control group ( P>0.05) . Conclusions:Nursing interventions based on HAPA theory can effectively improve the follow-up compliance of DR patients, enhance their health beliefs during follow-up, and improve their blood glucose.

Objective To describe the current status of the caregiver preparedness in mothers of fetus with treatable congenital malformation,and to explore its influencing factor.Methods 210 pregnant women with fetuses diagnosed with treatable congenital malformations in the obstetrics department of a tertiary specialized hospital in Dalian were selected as the study subjects by convenient sampling method from November 2022 to August 2023.The survey was conducted using the General Situation Questionnaire,Caregiver Preparedness Scale,Simplified Coping Style Questionnaire,shortened Chinese version of the Family Resilience Assessment Scale and Social Support Rating Scale.The factors influencing the caregiver preparedness in mothers of fetus with treatable congenital malformation were analyzed using univariate analysis and multiple linear regression.Results Finally,201 mothers of fetuses with treatable congenital malformations were included in the study.The total score of caregiver preparedness was(20.47±6.29),among which the emergency response,management dimension and care stress dimension scored lower.It is concluded that education level,age,subjective support,use of social and economic resources and negative coping are the factors that affect the caregiver preparedness in mothers of fetus with treatable congenital malformation.Conclusion The caregiver preparedness in mothers of fetus with treatable congenital malformation needs to be improved.Medical staff should design a personalized and comprehensive nursing plan to intervene according to the factors,so as to improve the recovery and quality of life of children.