Objective: To investigate the relationship between physical development indicators and the onset and progression of myopia among children and adolescents, so as to provide theoretical support for coordinated vision and physical health management. Methods: A prospective cohort study was conducted. In September 2022, 3 102 students from grade one in primary school to grade three in junior high school (five year primary school and four year junior high school) from six schools in Huantai County, Shandong Province, were selected using multistage cluster random sampling method to participate in an epidemiological survey on myopia, with follow up completed in September 2023. Follow up value minus baseline value( d ) was used to assess changes in physical development and vision indicators. Multivariate Logistic regression analysis was used to examine the relationship between physical development indicators and the incidence of myopia. Generalized linear models were established to analyze the relationship between physical development indicators and changes in d spherical equivalent (SE) and d axial length (AL) . Results: Multivariate Logistic regression analysis showed that, after adjusting for factors such as gender, age, and baseline body mass index, the third ( Q 3)and fourth ( Q 4)quartiles of d height showed increased risks of myopia onset within one year compared to the first quartile( Q 1) ( OR =1.85,95% CI =1.18-2.88; OR =1.74,95% CI =1.09-2.78,both P ＜0.05). Results from the generalized linear model indicated that, after adjusting for confounding factors such as gender, age, and baseline SE, d SE was negatively correlated with d height and d weight in children and adolescents ( β =-0.024, 95% CI =-0.031 to -0.018; β =-0.006, 95% CI =-0.011 to -0.001), d AL was positively correlated with d height and d weight in children and adolescents ( β =0.011, 95% CI =0.008-0.013; β =0.005, 95% CI =0.003-0.007) (all P ＜0.05). Conclusions Physical development indicators in children and adolescents were associated with the onset and progression of myopia. Dynamic monitoring and early intervention of myopia should be strengthened for children and adolescents with rapid height and weight gain to achieve coordinated management of myopia and physical development.

OBJECTIVE To investigate the effects and mechanism of the Yishen paidu formula on renal fibrosis in rats with chronic renal failure （CRF） through the reactive oxygen species （ROS）/thioredoxin-interacting protein （TXNIP）/NOD-like receptor thermal protein domain associated protein 3 （NLRP3） pathway. METHODS Rats were randomly divided into control group， model group， Yishen paidu formula low-dose （Yishen paidu formula-L） group， Yishen paidu formula high-dose （Yishen paidu formula- H） group， Yishen paidu formula-H+pcDNA-NC group， and Yishen paidu formula-H+ pcDNA-TXNIP group， with 10 rats in each group. Except for control group， all other rats were fed a diet containing 0.5% adenine to establish a CRF model； the rats were then administered corresponding drugs or normal saline intragastrically or via tail vein， once daily， for 8 consecutive weeks. After the last administration， the levels of serum creatinine （Scr）， blood urea nitrogen （BUN）， ROS， superoxide dismutase （SOD）， malondialdehyde （MDA）， tumor necrosis factor-α （TNF-α）， interleukin （IL）-6， and IL-1β were measured in each group. Pathological changes in renal tissue were observed， and the protein expression levels of Collagen Ⅲ， α-smooth muscle actin （α-SMA）， transforming growth factor-β1 （TGF-β1）， TXNIP and NLRP3 in renal tissue were detected. RESULTS Compared with model group， the renal histopathological damage and fibrosis of rats in Yishen paidu formula-L group and Yishen paidu formula-H group were significantly alleviated. The levels of Scr， BUN， ROS， MDA， TNF- α， IL-6 and IL-1β， and the protein expressions of Collagen Ⅲ， α-SMA， TGF-β1， TXNIP and NLRP3 were significantly decreased， while SOD levels were significantly increased （P＜0.05）. Moreover， the changes were more pronounced in the Yishen paidu formula-H group （P＜0.05）. Compared with Yishen paidu formula-H+pcDNA-NC group， above indexes of rats in Yishen paidu formula-H+pcDNA-TXNIP group were reversed significantly （P＜0.05）. CONCLUSIONS Yishen paidu formula can inhibit renal fibrosis in CRF rats by suppressing the ROS/TXNIP/NLRP3 pathway.

Health economics evidence plays an important role in linking clinical value evidence with health resource allocation decisions in the development of clinical practice guidelines. It can not only effectively balance clinical effectiveness and economic feasibility but also avoid forming "idealized" recommendations that are detached from the affordability of the healthcare system or the burden-bearing capacity of patients. To promote guideline developers to use health economics evidence more standardizedly and fully, this paper conducts an in-depth analysis of the current application status, existing challenges, access channels, and application processes of health economics evidence in current guidelines, and on this basis, puts forward considerations and suggestions for strengthening and standardizing the application of health economics evidence in China's clinical practice guidelines.

Objective:To investigate the role of evidence-based clinical guidelines combined with "rain classroom" smart teaching in standardized residency training in endocrinology department.Methods:The 100 trainees who underwent standardized residency training in the Department of Endocrinology at Xiamen Hospital from September 2022 to September 2023 were selected as the research subjects. They were divided into groups based on the parity of their admission batches, with even-numbered batches assigned to the control group and odd-numbered batches to the experimental group, with 50 trainees in each group. The control group received traditional teaching, while the experimental group was taught using evidence-based clinical guidelines combined with "rain classroom" smart teaching. Statistical comparisons were made between the two groups in terms of exit examination scores, teaching effectiveness, teaching satisfaction, and evaluation of trainees by teachers. SPSS 22.0 was used for t test and Chi-square test. Results:The experimental group demonstrated significantly higher scores in theoretical knowledge [(25.62±3.12) vs. (22.71±3.27)], case analysis [(25.18±3.24) vs. (22.24±3.35)], clinical operation [(25.01±3.19) vs. (22.12±3.29)], and daily performance [(8.12±1.01) vs. (7.21±1.13)] compared to the control group in exit examination ( P<0.001). Additionally, the experimental group showed superior performance in self-learning [(8.57±1.12) vs. (7.64±1.24)], clinical thinking [(8.61±1.16) vs. (7.78±1.28)], evidence-based thinking [(8.52±1.13) vs. (7.69±1.26)], clinical skills [(8.49±1.17) vs. (7.61±1.23)], communication skills [(8.53±1.18) vs. (7.67±1.29)], and literature review [(8.59±1.15) vs. (7.71±1.27)], with statistically significant differences ( P<0.05). Teaching satisfaction in the experimental group (96.00%) was significantly higher than that in the control group (82.00%) ( P=0.025). The pass rates rated by teachers were higher in the experimental group in medical history collection (94.00% vs. 80.00%), physical examination (96.00% vs. 82.00%), clinical thinking (92.00% vs. 76.00%), communication skills (94.00% vs. 80.00%), literature review (96.00% vs. 84.00%), specialized skills (94.00% vs. 78.00%), and diagnosis and treatment plan formulation (92.00% vs. 74.00%), with statistically significant differences ( P<0.05). Conclusions:The implementation of evidence-based clinical guidelines combined with "rain classroom" smart teaching in the standardized residency training in endocrinology department can significantly improve the exit examination scores and teaching satisfaction of trainees, teaching effectiveness, and evaluation of trainees by teachers. This teaching method has a positive role in improving the clinical comprehensive ability of trainees such as evidence-based medical thinking and standardized clinical diagnosis and treatment.

OBJECTIVE:To systematically evaluate the clinical effectiveness of rehabilitation robots in treating lower limb motor dysfunction in patients with cerebral palsy,and to compare the differences in therapeutic effects among different robots.METHODS:PubMed,Web of Science,Embase,Cochrane Library,CNKI,CBM,VIP and WanFang databases were searched to collect randomized controlled trials on rehabilitation robotics for the treatment of motor dysfunction in patients with cerebral palsy,published from database inception to April 10,2024.The main outcome indicators included muscle strength,muscle tension,balance function,step speed,step frequency,step length,walking endurance,lower limb motor function,and activities of daily living.The above indicators were coded according to the International Classification of Functioning,Disability and Health.Meta-analysis was performed to evaluate the clinical efficacy and compare the therapeutic efficacy of different rehabilitation robots.Literature search and screening were performed by two researchers,and the quality of the included literature was evaluated using the Cochrane 5.1.0 risk of bias assessment tool.Meta-analysis was performed using RevMan 5.4 software and Stata 16.0 software.RESULTS:(1)Fifteen articles were finally included,involving 512 patients with 260 in the experimental group and 252 in the control group.(2)The Meta-analysis results showed that rehabilitation robots could improve body structure and function[standardized mean difference=0.41,95%confidence interval(CI):0.24-0.58,P<0.05],activities(standardized mean difference=0.53,95%CI:0.41-0.65,P<0.05)and participation ability(mean difference=7.86,95%CI:1.54-14.18,P<0.05).In particular,the rehabilitation robot improved lower limb muscle strength,balance function,step speed,walking endurance,lower limb gross motor function,and activities of daily living in patients with cerebral palsy,but showed insignificant effects on step frequency,step length,and muscle tension.(3)The network Meta-analysis results showed that:step speed:Innowalkpro>Gait Trainer>Lokomat>3DCalt;6-minute walk test score:Gait Trainer>Lokomat>Lokohelp>Innowalkro;Gross Motor Function Measure-88D score:Lokohelp>Lokomat>KidGo>Innowalkpro>3DCalt;Gross Motor Function Measure-88E score:Lokomat>Lokohelp>KidGo>3DCalt>Innowalkpro.CONCLUSION:Based on the International Classification of Functioning,Disability,and Health,rehabilitation robot training can improve the lower limb motor function and activities of daily living in patients with cerebral palsy.The Innowalkpro robot was more effective in improving step speed;the Gait trainer robot was more effective in improving 6-minute walk test scores;the Lokohelp robot was more effective in improving Gross Motor Function Measure-88D zone scores;and the Lokomat robot was more effective in improving Gross Motor Function Measure-88E zone scores.

AIM:To investigate whether melatonin can ameliorate acute myocardial infarction(AMI)by in-hibiting ferroptosis.METHODS:H9C2 cells were cultured in AnaeroPack system with low sugar and serum-free medium for 10 h to construct a cell model of AMI.Then cells were treated with melatonin and ferroptosis inducer erastin.The cell activity,reactive oxygen species(ROS),lipid peroxidation,mitochondrial membrane potential(MMP),and ferroptosis related protein expression were detected.A rat model of AMI induced by isoprenaline(ISO)injection was established to evaluate the effects of melatonin,in which the myocardial infarction size,cardiac injury,pathological changes,oxidative stress,iron ion and ferroptosis related protein expression were examined.RESULTS:Melatonin decreased the oxidative stress,lipid peroxidation and expression of ferroptosis protein in cardiomyocytes induced by hypoxia,but these effects could be impeded by the ferroptosis inducer erastin.Furthermore,in vivo experiments,we also found that melatonin im-proved the myocardial infarction size,cardiac injury,pathological changes,oxidative stress,and alleviated iron ion accu-mulation and ferroptosis.CONCLUSION:The cardioprotective effects of melatonin in AMI are associated with the inhi-bition of ferroptosis.

Pancreaticoduodenectomy (PD) is a primary surgical approach for treating mali-gnant tumors of the pancreatic head and the periampullary region. With the advance in medical technology in recent years, the long-term survival rate of patients undergoing PD has significantly improved, and the incidence of early perioperative complications has markedly decreased. However, current researches predominantly focuse on early postoperative complications, while, limited studies addressing long-term complications. Long-term complications after PD have a significant impact on patients′ quality of life and long-term survival. This authors systematically summarize the common long-term complications following PD, and explore their mechanisms, clinical manifestations, dia-gnostic methods, and treatment strategies, aiming to provide a reference for clinical practice.

OBJECTIVE:To systematically evaluate the clinical effectiveness of rehabilitation robots in treating lower limb motor dysfunction in patients with cerebral palsy,and to compare the differences in therapeutic effects among different robots.METHODS:PubMed,Web of Science,Embase,Cochrane Library,CNKI,CBM,VIP and WanFang databases were searched to collect randomized controlled trials on rehabilitation robotics for the treatment of motor dysfunction in patients with cerebral palsy,published from database inception to April 10,2024.The main outcome indicators included muscle strength,muscle tension,balance function,step speed,step frequency,step length,walking endurance,lower limb motor function,and activities of daily living.The above indicators were coded according to the International Classification of Functioning,Disability and Health.Meta-analysis was performed to evaluate the clinical efficacy and compare the therapeutic efficacy of different rehabilitation robots.Literature search and screening were performed by two researchers,and the quality of the included literature was evaluated using the Cochrane 5.1.0 risk of bias assessment tool.Meta-analysis was performed using RevMan 5.4 software and Stata 16.0 software.RESULTS:(1)Fifteen articles were finally included,involving 512 patients with 260 in the experimental group and 252 in the control group.(2)The Meta-analysis results showed that rehabilitation robots could improve body structure and function[standardized mean difference=0.41,95%confidence interval(CI):0.24-0.58,P<0.05],activities(standardized mean difference=0.53,95%CI:0.41-0.65,P<0.05)and participation ability(mean difference=7.86,95%CI:1.54-14.18,P<0.05).In particular,the rehabilitation robot improved lower limb muscle strength,balance function,step speed,walking endurance,lower limb gross motor function,and activities of daily living in patients with cerebral palsy,but showed insignificant effects on step frequency,step length,and muscle tension.(3)The network Meta-analysis results showed that:step speed:Innowalkpro>Gait Trainer>Lokomat>3DCalt;6-minute walk test score:Gait Trainer>Lokomat>Lokohelp>Innowalkro;Gross Motor Function Measure-88D score:Lokohelp>Lokomat>KidGo>Innowalkpro>3DCalt;Gross Motor Function Measure-88E score:Lokomat>Lokohelp>KidGo>3DCalt>Innowalkpro.CONCLUSION:Based on the International Classification of Functioning,Disability,and Health,rehabilitation robot training can improve the lower limb motor function and activities of daily living in patients with cerebral palsy.The Innowalkpro robot was more effective in improving step speed;the Gait trainer robot was more effective in improving 6-minute walk test scores;the Lokohelp robot was more effective in improving Gross Motor Function Measure-88D zone scores;and the Lokomat robot was more effective in improving Gross Motor Function Measure-88E zone scores.

Objective:To explore effect of Yishen Paidu Formula on inflammatory response in chronic renal failure(CRF)rats and role of Calcineurin/nuclear factor of activated T cell(NFAT).Methods:CRF rat model was constructed,and randomly grouped into model group,low,medium and high doses Yishen Paidu Formula groups,with 10 rats in each group,another 10 rats were fed normally as a blank group;general situation of rats was recorded;urine protein quantification kit was applied to detect 24-hour urine protein level of CRF rats in each group;serum creatinine and urea nitrogen levels of CRF rats were detected;ELISA was applied to detect serum IL-1β,IL-6 and TNF-α levels in CRF rats;pathological changes of renal tissue were observed by HE staining;Western blot was applied to detect expressions of fibroblast growth factor 23(FGF23),Klotho protein,Calcineurin,NFAT protein in renal tissue of CRF rats in each group.Results:Compared with blank group,levels of creatinine,urea nitrogen in serum,24 h urine protein in urine,IL-1β,IL-6,TNF-α in serum,and protein levels of FGF23,Calcineurin,NFAT in kidney tissue were obviously increased in model group,level of Klotho protein was obviously decreased(P<0.05).Compared with model group,levels of creatinine,urea nitrogen in serum,24 h urine protein in urine,IL-1β,IL-6,TNF-α in serum,and protein levels of FGF23,Calcineurin,NFAT in kidney tissue were obviously decreased in low,medium and high doses Yishen Paidu Formula groups,level of Klotho protein was obviously increased,which were more significant with dosage increase(P<0.05).Conclusion:Yishen Paidu Formula may alleviate inflammatory response in CRF rats by inhibiting Calcineurin/NFAT signaling pathway.

Objective:To explore effect of Yishen Paidu Formula on inflammatory response in chronic renal failure(CRF)rats and role of Calcineurin/nuclear factor of activated T cell(NFAT).Methods:CRF rat model was constructed,and randomly grouped into model group,low,medium and high doses Yishen Paidu Formula groups,with 10 rats in each group,another 10 rats were fed normally as a blank group;general situation of rats was recorded;urine protein quantification kit was applied to detect 24-hour urine protein level of CRF rats in each group;serum creatinine and urea nitrogen levels of CRF rats were detected;ELISA was applied to detect serum IL-1β,IL-6 and TNF-α levels in CRF rats;pathological changes of renal tissue were observed by HE staining;Western blot was applied to detect expressions of fibroblast growth factor 23(FGF23),Klotho protein,Calcineurin,NFAT protein in renal tissue of CRF rats in each group.Results:Compared with blank group,levels of creatinine,urea nitrogen in serum,24 h urine protein in urine,IL-1β,IL-6,TNF-α in serum,and protein levels of FGF23,Calcineurin,NFAT in kidney tissue were obviously increased in model group,level of Klotho protein was obviously decreased(P<0.05).Compared with model group,levels of creatinine,urea nitrogen in serum,24 h urine protein in urine,IL-1β,IL-6,TNF-α in serum,and protein levels of FGF23,Calcineurin,NFAT in kidney tissue were obviously decreased in low,medium and high doses Yishen Paidu Formula groups,level of Klotho protein was obviously increased,which were more significant with dosage increase(P<0.05).Conclusion:Yishen Paidu Formula may alleviate inflammatory response in CRF rats by inhibiting Calcineurin/NFAT signaling pathway.