“Bio-narrative integration” refers to the process in which a life subject with narrative consciousness actively reviews and reintegrates their life stories， or a subject lacking life and health narrative awareness， with the intervention of healthcare professionals， tells their own life stories and integrates them into a coherent and constantly evolving life narrative process. Starting from the keyword of bio-narrative integration， this paper proposed a classification model of narrative integration. From the perspective of life stages， it was divided into “phasic narrative integration” and “holistic narrative integration.” In terms of integrated narrative style， it was categorized as “positive narrative integration style” and “negative narrative integration style.” Regarding subjective initiative， it was classified as “active narrative integration regulation” and “passive narrative integration regulation.” Then it elaborated the significant value of narrative integration for every life subject， especially in pain relief， the improvement of life resilience， the healthy aging of the elderly， and the ultimate peace of the dying. It was advocated that healthcare practitioners should enhance their professional narrative competence， effectively guide patients to engage in bio-narrative integration regulation， and help them overcome narrative closure， thereby improving the quality of medical care.

Objective:To explore the initiation patterns of disease-modifying treatment(DMT)in patients with multiple sclerosis(MS)in Chongqing,China.Methods:The clinical and imaging data of patients with relapsing-remitting MS(RRMS)who commenced DMT(teriflunomide,dimethyl fumarate,sphingosine-1-phosphate receptor modulators,or ofatumumab)for the first time at the Depart-ment of Neurology,The First Affiliated Hospital of Chongqing Medical University from November 2018 to January 2024 were obtained.The analysis focused on the distribution,persistence rate,and safety of initial DMT prescriptions,post-treatment disease activity,and risk factors affecting disease activity.Results:A total of 138 patients with RRMS were included.The distribution of initial DMT pre-scriptions was as follows:teriflunomide(46.4%),dimethyl fumarate(20.3%),sphingosine-1-phosphate receptor modulators(21.7%),and ofatumumab(11.6%).Throughout the follow-up period,72.5%of patients complied with their initial prescription,whereas 23.2%of patients altered their treatments,predominantly transitioning to ofatumumab.No drug-related death or hospitalization was docu-mented during the use of the four DMT prescriptions.However,sphingosine-1-phosphate receptor modulators exhibited the highest in-cidence of adverse events(43.3%).An analysis of post-treatment disease activity in 115 patients indicated that 47.0%of patients dis-played disease activity.Independent risk factors for disease activity comprised incomplete recovery after the initial onset of MS(odds ratio[OR]=3.645,95%CI=1.321-10.06,P=0.013)and smoking(OR=10.052,95%CI=1.025-98.556,P=0.048).Conclusion:In the last five years,the majority of initial DMT prescriptions for patients with RRMS in Chongqing,China,were low-to moderate-efficacy drugs.A considerable percentage of patients exhibited disease activity despite commencing DMT.Prompt commencement of high-efficacy DMT may be more effective in diminishing disease activity and postponing disability progression in patients with MS.

Objective To observe the value of non-parallel transmission(non-PTX)reduced field-of-view(rFOV)echo planar imaging(EPI)sequence applied in diffusion weighted imaging(DWI)for displaying prostate lesions.Methods Conventional EPI-DWI and non-PTX rFOV-EPI-DWI were prospectively acquired in 30 patients with prostate lesions,including 22 cases of prostatic hyperplasia and 8 cases of prostate cancer.Subjective scoring of imaging quality,as well as objective evaluation on indexes including signal-to-noise ratio(SNR),contrast ratio(CR),contrast-to-noise ratio(CNR)and lesions'apparent diffusion coefficient(ADC)values were performed and compared between two kinds of DWI.Results The subjective score of non-PTX rFOV-EPI-DWI was higher than that of conventional EPI-DWI(P＜0.001).SNR,CR,CNR of non-PTX rFOV-EPI-DWI and lesions'ADC values measured on non-PTX rFOV-EPI-DWI were all higher than those of conventional EPI-DWI(all P＜0.05).Conclusion non-PTX rFOV-EPI DWI could display prostate lesions better than conventional EPI-DWI.

Objective Study on the relationship between detection of 10 driver gene mutations in non-small cell lung cancer tis-sues and clinical pathological characteristics,as well as the diagnostic value of multi gene combined models.Methods Selected 79 patients diagnosed with NSCLC in Zhongshan People's Hospital from December 2022 to April 2023 as the research objects,collected tissue samples,used PCR technology for mutation detection,obtain the detection rate of each driver gene,and explore gene mutations and NSCLC patients correlation of clinicopathological characteristics.Logistic regression method was used to es-tablish a multi-gene joint model of joint predictors and evaluate its diagnostic value.Results Among the 79 cases,the total muta-tion rate of the ten driving genes was 81.01%(64/79),Among them the mutation rate of EGFR was 54.43%(43/79),the mutation frequency of KRAS was 13.92%(11/79),the mutation rate of HER2 was 3.80%(3/79),the fusion frequency of ALK was 2.53%(2/79),the fusion frequency of ROS1 was 2.53%(2/79),the mutation rate of MET was 2.53%(2/79),the mutation rate of NRAS was 1.27%(1/79),and no mutations were detected in RET,BRAF and PIK3CA.The mutation frequency of EGFR in fe-male patients was higher than that in males(χ2=20.512,P<0.001),ALK fusion was also more common in females(χ2=192.080,P<0.001),while KRAS was the opposite.The mutation frequency in male patients was higher than that in females(χ2=4.545,P<0.05).EGFR mutations were more common in individuals＜60 years old(χ2=33.907,P<0.001),while KRAS mutations had a higher individuals in patients≥60 years old than in those＜60 years old(χ2=8.909,P<0.001).The positive mutation of EGFR was more common in stage IV patients(χ2=15.429,P<0.001).ROS1 fusion is more common in stage III b patients(χ2=4.000,P<0.05),EGFR mutation had a significantly higher mutation rate in non-smoking patients than in smoking patients(χ2=50.651,P<0.001),and ALK fusion had a higher mutation rate in smoking patients than in non-smoking patients(χ2=4.000,P<0.05).Con-structed a Logistic regression model to evaluate the diagnostic value of driver gene joint detection,and constructed a Logistic re-gression model to predict the occurrence of NSCLC in patients.The model expression was:logit(P)=-0.190+0.168 EGFR muta-tion(X1)+0.516 KRAS mutation(X2)+0.331 ALK fusion(X3)+0.403 ROS1 fusion(X4)+0.429 NRAS mutation(X5)+0.515 HER2 mutation(X6)+0.405 MET mutation(X7).The ROC curve results show that the diagnostic value of the joint prediction model for NSCLC was higher than that of a single indicator.Conclusion There is a correlation between driver gene mutation status and pathological characteristics,and the co-mutation information provided by multi-gene joint detection can make a more accurate diagnosis of NSCLC.

Evidence-based public health, as the forefront of modern public health practice, has increasingly important in public health field. However, a significant gap remains between the available evidence and its practical application. Effectively disseminating and implementing evidence-based public health practice in real-world settings has become a key challenge in contemporary public health research. In this context, Implementation Science has emerged as a vital discipline. This paper explores the critical role of Implementation Science in public health, reviews the origins and core components of the Consolidated Framework for Implementation Research (CFIR), and analyzes the current application of CFIR in public health through bibliometric methods. Additionally, it discusses specific examples to further elucidate the steps involved in using the CFIR and its application contexts. The findings indicate that since 2015, research on CFIR in public health has progressively increased, showing a continuous upward trend. CFIR applications mainly address context-specific facilitators, health decision-making, barrier and facilitator identification, and community-based participatory evaluation, predominantly employing qualitative and mixed-methods research. This paper not only reviews and analyzes the current use of CFIR in public health but also provides a detailed discussion on its application. The goal is to offer valuable insights for the development of Implementation Science research within China's public health sector.

Objective:To explore the effect of preoperative gamma-glutamyl transferase to albumin ratio (GAR) on prognosis of patients with Barcelona clinic liver cancer (BCLC)stage 0-A hepatocellular carcinoma (HCC) after microwave ablation (MWA).Methods:The clinical data of 201 patients with BCLC stage 0 to A who underwent MWA at two centers of Jiaxing Second Hospital and Shengjing Hospital of China Medical University from January 2011 to December 2018 were retrospectively analyzed, including 152 males and 49 females, aged (57.5±9.6) years. X-tile software was used to divide patients into a low GAR group ( n=84, GAR<0.9) and a high GAR group ( n=117, GAR≥0.9). Kaplan-Meier method was used for survival analysis, and log-rank test was used for survival comparison. Univariate and multivariate Cox regression analysis was used to evaluate the relationship between GAR and prognosis. Results:The cumulative survival rates at 1, 3 and 5 years postoperatively were 98.7%, 93.8%, 78.5% for the low GAR group, which were superior to that 97.2%, 87.1%, 70.2% for the high GAR group, and the difference was statistically significant ( χ2=11.89, P=0.001). The recurrence-free survival rates at 1, 3 and 5 years after surgery between the two groups was no significant difference ( χ2=1.70, P=0.192). Multivariate analysis revealed that high GAR ( HR=2.723, 95% CI: 1.508-4.914, P=0.001) was independent risk factors for overall survival after MWA in patients with BCLC stages 0 to A HCC. Male gender ( HR=1.959, 95% CI: 1.127-3.305, P=0.017) and tumor diameter ≥2 cm ( HR=1.547, 95% CI: 1.008-2.373, P=0.046) were independent risk factors for recurrence after MWA in patients with BCLC stages 0 to A HCC. Univariate analysis, GAR≥0.9 was not associated with postoperative recurrence ( HR=1.315, 95% CI: 0.869-1.989, P=0.195). Conclusion:Preoperative GAR (≥0.9) is an independent risk factor affecting overall survival in patients with BCLC stages 0 to A HCC after MWA.

BACKGROUND: Macrophage polarization anomalies and dysfunction play a crucial role in the pathogenesis of immune thrombocytopenia (ITP). Itaconate is a Krebs cycle-derived immunometabolite synthesized by myeloid cells to modulate cellular metabolism and inflammatory responses. This study aimed to evaluate the immunoregulatory effects of an itaconate derivative on macrophages in patients with ITP. METHODS: Peripheral blood-derived macrophages from patients with ITP and healthy controls were treated with 4-octyl itaconate (4-OI), a derivative of itaconate that can penetrate the cell membrane. Macrophage polarization, antigen-presenting functions, and phagocytic capability were measured via flow cytometry and enzyme-linked immunosorbent assay (ELISA). Macrophage glycolysis in patients with ITP and the metabolic regulatory effect of 4-OI were detected using a Seahorse XFe96 Analyzer. An active murine model of ITP was used to evaluate the therapeutic effects of 4-OI in vivo . RESULTS: 4-OI reduced the levels of CD80 and CD86 in M1 macrophages and suppressed the release of tumor necrosis factor-α (TNF-α) and interleukin (IL)-6 pro-inflammatory cytokines, suggesting that 4-OI could hinder the polarization of macrophages toward an M1 phenotype. We found that 4-OI pretreated M1 macrophages reduced the proliferation of CD4 + T cells and promoted the differentiation of regulatory T cells. In addition, after 4-OI treatment, the phagocytic capacity of M1 macrophages toward antibody-coated platelets decreased significantly in patients with ITP. In addition, the glycolytic function of M1 macrophages was elevated in individuals with ITP compared to those in healthy controls. 4-OI treatment downregulated glycolysis in M1 macrophages. The glycolysis inhibitor 2-deoxy-d-glucose (2-DG) also inhibited the polarization of M1 macrophages and restored their functions. In vivo , 4-OI treatment significantly increased platelet counts in the active ITP murine model. CONCLUSIONS Itaconate derivative 4-OI inhibited M1 macrophage polarization and restored impaired functions through metabolic reprogramming. This study provides a novel therapeutic option for ITP.
Macrophages/metabolism* ; Humans ; Animals ; Succinates/pharmacology* ; Mice ; Male ; Female ; Adult ; Middle Aged ; Flow Cytometry ; Tumor Necrosis Factor-alpha/metabolism* ; Enzyme-Linked Immunosorbent Assay ; Purpura, Thrombocytopenic, Idiopathic/metabolism* ; Glycolysis/drug effects* ; Metabolic Reprogramming

Objective:To explore the application value of problem-based learning (PBL) combined with mini-clinical evaluation exercise (Mini-CEX) in the development of post competency for interns in the Department of Neurology.Methods:A total of 56 interns rotating at the Department of Neurology of The First Affiliated Hospital of Chongqing Medical University from June 2023 to January 2024 were enrolled as the study subjects. They were randomly divided into a control group and an experiment group using the random number table method, with 28 interns in each group. The control group received traditional methods including small lectures and teaching rounds, while the experimental group received the PBL teaching method combined with Mini-CEX. The teaching effectiveness was evaluated through theoretical assessments, practical skill evaluations, teacher and student satisfaction surveys, and Mini-CEX scale assessments conducted at the beginning, middle, and end of the rotation for the experimental group. The data were analyzed using SPSS 23.0 software. For continuous data, the independent-samples t test or Mann-Whitney U test was used for comparison between groups. The chi-square test was used for categorical data and the Kruskal-Wallis H test for repeated-measurement data. Results:The theoretical scores [(45.36±2.67) vs. (42.00±4.29), P<0.01] and practical skill scores [(45.11±2.53) vs. (42.39±4.53), P<0.01] were significantly higher in the experimental group compared to the control group. The Mini-CEX score of the experimental group at the end of the rotation was notably higher than that at the beginning of rotation ( P<0.05), and their abilities improved continuously. The satisfaction rates of teachers and students in the experimental group were 71.43% (20/28) and 67.86% (19/28), respectively, which were significantly higher than those in the control group [39.29% (11/28) and 35.71% (10/28), P<0.05]. Conclusions:The teaching model integrating PBL and Mini-CEX can effectively enhance the post competency of interns in the Department of Neurology, thus offering a new perspective for clinical undergraduate teaching.

Objective:To explore the effect of preoperative gamma-glutamyl transferase to albumin ratio (GAR) on prognosis of patients with Barcelona clinic liver cancer (BCLC)stage 0-A hepatocellular carcinoma (HCC) after microwave ablation (MWA).Methods:The clinical data of 201 patients with BCLC stage 0 to A who underwent MWA at two centers of Jiaxing Second Hospital and Shengjing Hospital of China Medical University from January 2011 to December 2018 were retrospectively analyzed, including 152 males and 49 females, aged (57.5±9.6) years. X-tile software was used to divide patients into a low GAR group ( n=84, GAR<0.9) and a high GAR group ( n=117, GAR≥0.9). Kaplan-Meier method was used for survival analysis, and log-rank test was used for survival comparison. Univariate and multivariate Cox regression analysis was used to evaluate the relationship between GAR and prognosis. Results:The cumulative survival rates at 1, 3 and 5 years postoperatively were 98.7%, 93.8%, 78.5% for the low GAR group, which were superior to that 97.2%, 87.1%, 70.2% for the high GAR group, and the difference was statistically significant ( χ2=11.89, P=0.001). The recurrence-free survival rates at 1, 3 and 5 years after surgery between the two groups was no significant difference ( χ2=1.70, P=0.192). Multivariate analysis revealed that high GAR ( HR=2.723, 95% CI: 1.508-4.914, P=0.001) was independent risk factors for overall survival after MWA in patients with BCLC stages 0 to A HCC. Male gender ( HR=1.959, 95% CI: 1.127-3.305, P=0.017) and tumor diameter ≥2 cm ( HR=1.547, 95% CI: 1.008-2.373, P=0.046) were independent risk factors for recurrence after MWA in patients with BCLC stages 0 to A HCC. Univariate analysis, GAR≥0.9 was not associated with postoperative recurrence ( HR=1.315, 95% CI: 0.869-1.989, P=0.195). Conclusion:Preoperative GAR (≥0.9) is an independent risk factor affecting overall survival in patients with BCLC stages 0 to A HCC after MWA.

Objective To explore the value of combining apparent diffusion coefficient(ADC)heterogeneity with morphological indicators in assessing the pathological grading of non-muscle invasive bladder cancer(NMIBC).Methods The MRI images of 86 patients confirmed with NMIBC by surgical pathology were analyzed retrospectively.All patients underwent T2WI,diffusion weighted ima-ging(DWI),and dynamic contrast enhancement(DCE)examinations.Two radiologists independently measured tumor largest diam-eter(LD),actual tumor-wall contact length(ACTCL),ADCmean,ADCmin,and ADCmax values.ADC heterogeneity was calculated using the formula(ADCmax-ADCmin)/ADCmean.Differences in quantitative parameters between low-and high-grade NMIBC were compared using the Mann-Whitney U test,while differences in qualitative parameters were compared using the chi-square test.Univariate and multivariate logistic regression analyses were used to identify independent predictors of high-grade NMIBC,and receiver operating characteristic(ROC)curves were drawn to evaluate the performance of ADC heterogeneity combined with morphological indicators in assessing high-grade NMIBC.Results ADC heterogeneity and ACTCL were independent predictors for preoperative assessment of NMIBC pathological grading.The area under the curve(AUC)of ADC heterogeneity and ACTCL in assessing high-grade NMIBC were 0.843 and 0.744,respectively.The combined AUC was 0.902.The difference was statistically significant(P<0.05).Conclusion The combination of ADC heterogeneity with ACTCL can effectively improve the efficiency of preoperative assessment of NMIBC pathological grading,and providing more precise clinical decision-making and prognosis monitoring.