Objective:To investigate feedback on teaching effectiveness and optimization strategies for flipped classrooms in pediatric probation of eight-year clinical medicine programs, and to provide insights for enhancing the educational quality of pediatric probation.Methods:From June to September 2022, eight-year clinical medicine students from the class of 2018 undergoing pediatric probation were included in the study using purposive sampling. The subjects participated in one-on-one, offline, semi-structured, in-depth interviews to provide feedback on traditional lectures and flipped classroom teaching. The sample size was determined based on the principle of data saturation, with nine students participating in-depth interviews. NVivo 12 software was used for coding and classifying the interview data, which were then analyzed using thematic framework analysis to identify key themes.Results:Analysis of the interview data revealed three themes and ten sub-themes. Specifically, theme 1: The flipped classroom enhanced learning effectiveness but increased students' workload; theme 2: The current pediatric probation was scientifically designed but could be improved; theme 3: Several strategies exist for optimizing the flipped classroom teaching in pediatric probation.Conclusions:The flipped classroom in pediatric probation is in its early stages. While offering some benefits, further exploration and optimization are needed in curriculum design, student motivation, and supervision and evaluation methods.

Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder in women of childbearing age, which can cause metabolic disorders, cardiovascular disease, ovarian cancer, uterine cancer and other complications, seriously endangering the health of the body. China has become one of the countries with the fastest increasing prevalence of PCOS, but its complex pathogenesis leads to highly heterogeneous clinical manifestations, making it difficult to completely cure. Therefore, clarifying the potential pathogenesis of PCOS is of great significance for early clinical screening, diagnosis, treatment, and prognosis. Recent studies have shown that long noncoding RNA (lncRNA) plays a dual role in the pathogenesis of PCOS and is a potential novel biomarker and intervention target. The characteristics of multi-component, multi-target, and multi-pathway action in Traditional Chinese Medicine (TCM) are consistent with the biological properties of lncRNA, which have diverse types, dual roles, and diverse locations. However, research on lncRNA mediated PCOS and how TCM can improve PCOS by regulating lncRNA is relatively scattered, which is not conducive to the recognition of its clinical value. Therefore, this article provides a systematic review of the dual regulatory mechanism, clinical value, and TCM intervention research of lncRNA in the occurrence and development of PCOS, aiming to clarify how lncRNA affects the occurrence and development of PCOS and potential treatment strategies, in order to provide new ideas for the clinical prevention and treatment of PCOS.

Objective To investigate the current situation of personnel training,material alloca-tion,process implementation and quality monitoring of gastrointestinal endoscopy cleaning and disin-fection in medical institutions at all levels in Yangzhou City,so as to provide reliable data for further improving the quality management of digestive endoscopy cleaning and disinfection in the city.Meth-ods According to the latest industry standards,a questionnaire was designed to carry out an online questionnaire survey on the status quo of digestive endoscopy cleaning and disinfection in 74 medical institutions of different levels in Yangzhou City,and the results were analyzed.Results 50％of the city's hospitals adopt the way of self-training within the department,and only 22 people have obtained the provincial or above professional cleaning and disinfection certificate.In 21.62％of hospitals,cleaning and disinfection personnel were not assessed before starting work.13.51％of the hospitals did not use purified water for terminal rinsing,and 44.59％of the hospitals did not have a cleaning and disinfection machine.79.73％of hospitals recorded by hand.71.62％of the hospitals failed to carry out standard cleaning quality monitoring,83.78％of the hospitals did not implement biofiltra-tion monitoring method.In addition,in the biological monitoring in 2023,14.86％of hospitals had the problem of excessive microorganisms.Conclusion The implementation of endoscope cleaning and disinfection standards varied significantly among medical institutions in Yangzhou,with level one and level two hospitals posing potential hospital infection risks.It is recommended to establish a pro-fessional entry system for endoscope cleaning and disinfection personnel citywide,increase investment in hardware facilities,and strictly enforce monitoring standards.

Objective:To evaluate the application effects of two different item response modes in the Worker-Occupation Fit Inventory (WOFI) .Methods:From June to October 2022, a stratified cluster sampling method was adopted to collect and evaluate on-site data on worker-occupation fit among medical workers in two tertiary grade A general hospitals in Sichuan Province and Henan Province (1162 participants). Ordinal categorical item response (hierarchical item response) and dichotomous item response are two commonly used item response modes in psychometric measurement. Item response theory was used to analyze and compare the evaluation effects of the two item response modes in the WOFI. The generalized partial credit model and the 2-parameter logistic model were used to compare the item difficulty, discrimination, and scale information volume under different response modes.Results:The discrimination values range of the items in the WOFI under the hierarchical item response and dichotomous item response modes was 0.98 to 2.06 and 1.24 to 2.72, respectively, and the item difficulty values range was -4.61 to 1.15 and -1.25 to 0.08, respectively. Under the hierarchical item response mode, the amount of information on the WOFI was concentrated in the range of θ (the real ability or trait level of the subject) of -4 to 2, while under the dichotomous item response mode, it was concentrated in the range of θ of-2 to 2. The scale information volume was insufficient when θ was greater than 2 for both response modes. Conclusion:The discrimination of the items of the WOFI is relatively close under the two item response modes, and the overall information volume meets the evaluation criteria. However, under the hierarchical item response mode, the item difficulty range and information volume distribution are wider. Therefore, the WOFI is more effective and reliable when using the hierarchical item response mode.

Objective:To explore the association between spicy food intake and the risk for cardio/cerebrovascular diseases.Methods:Data were collected from the China Kadoorie Biobank project conducted in Pengzhou, Sichuan Province. Using the Cox proportional hazards regression model, we analyzed the associations of the frequency of spicy food intake, spicy level, types of spicy food, and the age when regular intake of spicy food began (intake in 1 day/week), with the risk for cardio/cerebrovascular disease. Furthermore, the associations with the risks for ischemic heart disease (IHD) and cerebrovascular diseases, as well as the risk of ischemic stroke (IS) and hemorrhagic stroke (HS) were analyzed.Results:A total of 54 859 study participants were included in the study, in whom 49 320 had spicy food intake (89.90%). In these participants, 37 680 (68.69%) had spicy food intake in 6-7 days/week, 5 036 (9.18%) had spicy food intake in 1-5 days/week, and 6 604 (12.03%) had spicy food intake once a week; 5 539 (10.10%) had never/almost never had spicy food intake. After adjusting for multiple confounding factors, compared with those who never/almost never had spicy food intake, intake of spicy food was associated with reduced risks for IHD (intake in 6-7 days/week: HR=0.86, 95% CI: 0.78-0.95), cerebrovascular diseases (intake in 6-7 days/week: HR=0.88, 95% CI: 0.81-0.96), and IS (intak in 6-7 days/week: HR=0.85, 95% CI: 0.76-0.95). With the increase of spicy food intake frequency, the risk for cardio/cerebrovascular disease decreased (intake in 1-5 days/week: HR=0.91, 95% CI: 0.85-0.98; intake in 6-7 days/week: HR=0.89, 95% CI: 0.84-0.94) (trend test P<0.001). However, no statistical association was found between spicy food intake and the risk for HS. In terms of spicy level, after adjusting for multiple confounding factors, compared with those who never/almost never had spicy food intake, intake of spicy food was associated with reduced risk for cardio/cerebrovascular disease (moderate: HR=0.86, 95% CI: 0.82-0.90) and cerebrovascular disease (moderate: HR=0.90, 95% CI: 0.84-0.97). With the increase of spicy level, the risk for IHD decreased (moderate: HR=0.86, 95% CI: 0.79-0.93; strong: HR=0.84, 95% CI: 0.74-0.95) (trend test P<0.001). After adjusting for multiple confounding factors, compared with those who never/almost never had spicy food intake, intake of any type of spicy food was associated with reduced risk for cardio/cerebrovascular disease, IHD, and cerebrovascular disease. Regulat intake of spicy food from age 0-10 years was associated with reduced risk for cardio/cerebrovascular disease, IHD, and cerebrovascular disease. Regular intake of spicy food from age 11-20 years reduced the risk for cardio/cerebrovascular disease and IHD. There was no significant association between the regular intake of spicy food from age 21-79 years and the risks for cardio/cerebrovascular disease, IHD and cerebrovascular disease. Conclusion:The intake of spicy food could reduced the risk for cardio/cerebrovascular diseases, IHD, cerebrovascular diseases and IS in residents aged 30-79 years in Sichuan.

Objective:To investigate the effect of physical activity on mortality risk in patients with chronic obstructive pulmonary disease (COPD) in Sichuan Province.Methods:Based on baseline data from 2004 to 2008 from the China Kadoorie Biobank project site in Pengzhou City, Sichuan Province, a total of 8 501 COPD patients aged 30-79 years were enrolled and followed up for a long period to determine mortality outcomes. Quartiles were used to group physical activity levels. The Cox proportional hazards regression model was used to analyze the effect of physical activity level on mortality outcomes.Results:As of December 31, 2017, the cumulative follow-up of the participants totaled 85 600.58 person-years (mean follow-up duration: 10.07 years). During this period, a total of 2 000 deaths were recorded, yielding a cumulative mortality rate of 23.53%. Among these deaths, 665 were attributed to COPD, corresponding to a cumulative mortality rate of 7.82%; and 1 116 were attributed to cardiovascular and cerebrovascular disease (CVD), corresponding to a cumulative mortality rate of 13.13%. The Cox proportional hazards regression model analysis revealed that, after adjusting for confounding factors, total physical activity was associated with a reduced risk of mortality from COPD, CVD, and all causes in patients with COPD. Compared with the low-level group of total physical activity, the medium-high-level group had the lowest risk of COPD mortality, with an HR of 0.39 (95% CI: 0.30-0.49). The high-level group had the lowest risk of CVD death and all-cause death, with HRs of 0.46 (95% CI: 0.37-0.56) and 0.55 (95% CI: 0.48-0.64), respectively. The lowest risk of COPD death and CVD death was found in the medium-high level of work-based physical activity group, with HRs of 0.36 (95% CI: 0.28-0.46) and 0.43 (95% CI: 0.36-0.51), respectively; the risk of all-cause mortality was lowest in the medium-high and high-level groups, with HRs values of 0.53 (95% CI: 0.46-0.61) and 0.53 (95% CI: 0.45-0.61). The risk of COPD death was lowest in the high-level transportation physical activity group, with an HR of 0.66 (95% CI: 0.53-0.83), and the risk of CVD and all-cause death was lowest in the medium-high level group, with HRs of 0.63 (95% CI: 0.53-0.76) and 0.73 (95% CI: 0.64-0.84), respectively. The risk of COPD death and CVD death was the lowest in the high-level domestic physical activity group, with HRs of 0.66 (95% CI: 0.49-0.89) and 0.76 (95% CI: 0.61-0.95), respectively, and the risk of all-cause death was the lowest in the medium-high level group, with an HR of 0.82 (95% CI: 0.72-0.94). There is no statistical association between leisure physical activity and the risk of death from three types of diseases. Conclusions:Total physical activity, including work-based, transportation-based, and domestic physical activity, reduced the risk of COPD, CVD, and all-cause mortality in patients with COPD in Sichuan Province. The magnitude of mortality risk was influenced by the type and level of physical activity.

Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder in women of childbearing age, which can cause metabolic disorders, cardiovascular disease, ovarian cancer, uterine cancer and other complications, seriously endangering the health of the body. China has become one of the countries with the fastest increasing prevalence of PCOS, but its complex pathogenesis leads to highly heterogeneous clinical manifestations, making it difficult to completely cure. Therefore, clarifying the potential pathogenesis of PCOS is of great significance for early clinical screening, diagnosis, treatment, and prognosis. Recent studies have shown that long noncoding RNA (lncRNA) plays a dual role in the pathogenesis of PCOS and is a potential novel biomarker and intervention target. The characteristics of multi-component, multi-target, and multi-pathway action in Traditional Chinese Medicine (TCM) are consistent with the biological properties of lncRNA, which have diverse types, dual roles, and diverse locations. However, research on lncRNA mediated PCOS and how TCM can improve PCOS by regulating lncRNA is relatively scattered, which is not conducive to the recognition of its clinical value. Therefore, this article provides a systematic review of the dual regulatory mechanism, clinical value, and TCM intervention research of lncRNA in the occurrence and development of PCOS, aiming to clarify how lncRNA affects the occurrence and development of PCOS and potential treatment strategies, in order to provide new ideas for the clinical prevention and treatment of PCOS.

Most cancers are currently incurable, partly due to abnormal post-translational modifications (PTMs). In this study, we initially used multiple myeloma (MM) as a working model and found that SUMOylation activating enzyme subunit 1 (SAE1) promotes the malignancy of MM. Through proteome microarray analysis, SAE1 was identified as a potential target for bioactive colcemid or its derivative colchicine. Elevated levels of SAE1 were associated with poor clinical survival and increased MM proliferation in vitro and in vivo. Additionally, SAE1 directly SUMOylated and upregulated the total protein expression of p27, leading to LLPS-mediated nuclear export of p27. Our study also demonstrated the involvement of SAE1 in other types of cancer cells, and provided the first monomer crystal structure of SAE1 and its key binding model with colchicine. Colchicine also showed promising results in the Patient-Derived Tumor Xenograft (PDX) model. Furthermore, a controlled clinical trial with 56 MM patients demonstrated the clinical efficacy of colchicine. Our findings reveal a novel mechanism by which tumor cells evade p27-induced cellular growth arrest through p27 SUMOylation-mediated nuclear export. SAE1 may serve as a promising therapeutic target, and colchicine may be a potential treatment option for multiple types of cancer in clinical settings.

Objective: To explore the influencing factors for implementation of weight management services in primary medical and healthcare institutions, so as to provide references for implementing sustainable services of weight management. Methods: From May to June 2025, Pinghu City, Zhejiang Province was selected as the survey site. Personnel responsible for weight management in primary medical and healthcare institutions were selected as the survey subjects using a combined method of purposive sampling and snowball sampling. Based on the five core domains of the consolidated framework for implementation research (CFIR), a semi-structured interview outline for weight management services in primary medical and healthcare institutions was designed. Original data was collected through face-to-face semi-structured interviews. Interview data was organized and analyzed using framework analysis. Factors affecting weight management services were quantitatively analyzed by referencing CFIR's structural rating criteria. Results: A total of 21 participants completed interviews, covering positions in nutrition, endocrinology, traditional Chinese medicine, general practice, maternal health, and public health. There were 9 males and 12 females. Fifteen participants (71.43%) were aged 35 years and above, 18 (85.71%) held a bachelor's degree or higher, and 15 (71.43%) were frontline medical staff. Fifteen factors affecting weight management services were identified across five domains: innovation, outer setting, inner setting, individuals, and implementation process. Six barrier factors were identified: difficulties in policy implementation, time-consuming interventions, limited incentive measures, lack of professional skills, unclear weight-loss plans and goal setting, and imperfect follow-up and evaluation mechanisms. Three neutral factors were identified: the development and refinement of policies and regulations, the implementation of weight management training, and the optimization of the referral process within integrated healthcare systems (medical alliances / communities). Six facilitating factors were identified: the relatively significant advantages of lifestyle interventions, collaboration and coordination across multiple departments, cooperative communication among different units within the institution, the inherent convenience of primary care settings, a strong sense of professional responsibility, and the establishment of multidisciplinary teams. Conclusions The delivery of weight management services in primary medical and healthcare institutions is influenced by a wide array of factors across multiple domains. It requires policy support, multi-department coordination, a practice-oriented training system, optimized team resource allocation, incentives, and improved professional skills of medical staff to jointly promote long-term implementation.

ObjectiveTo evaluate the effectiveness of stone needle thermocompression and massage compared to flurbiprofen gel patch in relieving chronic musculoskeletal pain in the shoulder and back， and to explore the potential mediating mechanism through muscle elasticity. MethodsA total of 120 patients with chronic musculoskeletal pain in the shoulder and back were randomly assigned to either stone needle group or flurbiprofen group， with 60 patients in each. The stone needle group received stone needle thermocompression and massage for 30 minutes， three times per week； the flurbiprofen group received flurbiprofen gel patch twice daily. Both groups were treated for 2 weeks. Pain improvement， as the primary outcome， was assessed using the Global Pain Scale （GPS） at baseline， after 2 weeks of treatment， and again 2 weeks post-treatment. To explore potential mechanisms， a mediator analysis was conducted by measuring changes in superficial and deep muscle elasticity using musculoskeletal ultrasound at baseline and after the 2-week treatment period. ResultsThe stone needle group showed significantly greater pain relief than the flurbiprofen group 2 weeks post-treatment. After adjusting for confounders related to pain duration， the between-group mean difference was -8.8 ［95% CI （-18.2， -0.7）， P＜0.05］. Part of the therapeutic effect was mediated by changes in deep muscle elasticity， with a mediation effect size of -1.5 ［95% CI （-2.0， -0.9）， P = 0.024］， accounting for 17.9% of the total effect. ConclusionStone needle thermocompression and massage can effectively relieve chronic musculoskeletal pain in the shoulder and back， partly through a mediating effect of improved deep muscle elasticity.