ObjectiveTo construct a family-centered care model for children with tuberculosis based on the double ABC-X model, and to evaluate its clinical effects. MethodsFrom December 2022 to October 2023, 64 newly admitted children with tuberculosis who met the criteria and their caregivers were recruited from the tuberculosis department of Shanghai Public Health Clinical Center were randomly divided into an experimental group (32 cases) and a control group (32 cases).The control group was given a conventional health care, while the experimental group was given a family-centered health care intervention based on the double ABC-X model, in which a multidisciplinary care team provided personalized information and emotional support for the caregivers and their children. Medication adherence of the children, caregiver’s teading burden, and disease management competence were compared between the 2 groups. ResultsA total of 29 cases in the experimental group and 27 cases in the control group completed the intervention. At 12 weeks of intervention, the medication adherence score (7.72±0.45 vs 7.41±0.50, P<0.05) and disease management competence score (36.97±7.85 vs 31.56±7.30, P<0.05) were higher in the experimental group than that in the control group while the caregiving burden score (31.79±13.40 vs 40.04±9.01, P<0.05) and difficulty of disease management score (30.41±12.41 vs 38.56±9.48, P<0.05) were lower than that in the control group. At 24 weeks of intervention, the medication adherence score (7.34±0.97 vs 6.70±1.14, P<0.05) and disease management competence score (42.07±6.93 vs 35.63±7.32, P<0.05) were higher in the experimental group than that in the control group as well, but the caregiving burden score (31.62±11.72 vs 39.63±10.17, P<0.05) and difficulty of disease management score (30.59±10.87 vs 37.81±9.32, P<0.05) were lower than that in the control group. ConclusionFamily-centered care based on the double ABC-X model can effectively promote medication adherence among children with tuberculosis, reduce caregivers’ care burden and disease management difficulties, and improve caregiver’s disease management competence.

Objective: To analyze the current status and influencing factors of postpartum depression symptoms among elderly multipara, so as to provide a basis for health management among elderly pregnant women. Methods: Multipara aged ≥35 years who underwent 42-day postpartum check-ups in Hangzhou Gynecology and Gynecology Hospital from October 2023 to October 2024 were selected as survey subjects using convenience sampling method. Demographic information, sleep quality and feeding methods data were collected using questionnaires. The postpartum depressive symptoms, parenting stress, and social support levels were assessed using the Chinese version of the Simplified Edinburgh Postnatal Depression Scale, Parenting Stress Inventory-Short Form, and Perceived Social Support Scale, respectively. Factors affecting postpartum depression symptoms among elderly multipara were analyzed through multivariable logistic regression model. Results: A total of 355 elderly multipara were surveyed. The average age was (38.19±2.10) years. There were 228 cesarean deliveries (64.23%) in this pregnancy. There were 21 cases (5.92%) of unplanned pregnancy and 21 cases (5.92%) of preterm birth. The parenting stress score was (72.56±11.08) points, and the social support score was (60.42±8.50) points. Postpartum depression symptoms was detected in 106 elderly multipara, with a detection rate of 29.86%. Multivariable logistic regression analysis showed that monthly household income per capita (≥5 000 yuan, OR=0.470, 95%CI: 0.281-0.785), unplanned pregnancy (yes, OR=2.619, 95%CI: 1.427-4.809), preterm delivery (yes,OR=4.105, 95%CI: 1.848-9.113), poor sleep quality (yes, OR=3.556, 95%CI: 1.659-7.595), feeding methods (mixed feeding, OR=1.483, 95%CI: 1.030-2.135; artificial feeding, OR=4.510, 95%CI: 2.018-10.070), parenting stress (OR=1.206, 95%CI: 1.162-1.441), and social support (OR=0.255, 95%CI: 0.111-0.420) were factors affecting postpartum depression symptoms among elderly multipara. Conclusion The detection rate of postpartum depression symptoms among elderly multiparas is relatively high, is associated with family economic status, pregnancy planning status, preterm delivery, sleep quality, feeding methods, parenting stress, and social support levels.

Objective:To explore the relationship between intolerance of uncertainty and internet addiction among college students, as well as the mediating roles of negative cognitive bias and difficulties in emotion regulation.Methods:In September 2022, 1 762 college students were assessed with intolerance uncertainty scale, negative cognitive process bias questionnaire, difficulties in emotion regulation scale and internet addiction test. SPSS 24.0 software was used for descriptive statistics and correlation analysis. AMOS 23.0 was used to construct a multiple mediation model, and Bootstrap method was used for mediation effects testing.Results:(1) The score of intolerance of uncertainty was 34.00 (28.00, 40.00), the score of negative cognitive bias was 42.00 (34.00, 50.00), the score of difficulties in emotion regulation was 26.00 (20.00, 32.00), and the score of internet addiction was 36.00 (28.00, 46.00). (2)The Spearman correlation analysis showed that intolerance of uncertainty, negative cognitive bias, difficulties in emotion regulation, and internet addiction were significantly positively correlated with each other ( r=0.343-0.626, P<0.01). (3) The results of the path analysis indicated that the direct effect of intolerance of uncentainty on internet addiction was not significant, and the total indirect effect was 0.402(95% CI=0.354-0.451).The indirect effect of negative cognitive bias was 0.253(95% CI=0.200-0.305), accounted for 62.94%(0.253/0.402) of the total indirect effect.The indirect effect of difficulties in emotion regulation was 0.052 (95% CI=0.033-0.076), accounted for 12.93%(0.052/0.402) of the total indirect effect.And the chain mediating effect of negative cognitive bias and difficulties in emotion regulation was 0.097(95% CI=0.068-0.131), accounted for 24.13%(0.097/0.402) of the total indirect effect. Conclusion:Intolerance of uncertainty is significantly positively correlated with internet addiction, and its effects on internet addiction are individually mediated by negative cognitive bias and difficulties in emotion regulation, as well as their chain mediating effects.

Objective To provide strategies and suggestions for the development of clinical research in children's spe-cialized hospitals.Methods With a Class A tertiary children's specialty hospital in Shanghai as an example,the SWOT model is used to analyze the strengths,weaknesses,opportunities,and threats of clinical research development in the hospital,and to propose corresponding strategies and suggestions.Results The hospital has distinguished disciplinary advantages,tremendous strength in scientific research,a strong team of talents,and steady progress in the construction of clinical research center.The weaknesses include imperfect clinical research management system,imperfect informatization construction,and insufficient allo-cation of full-time management personnel.There are now opportunities of high policy support,increasing funding support,the shift in clinical demand,and good prospects for development of investigator-initiated trials(IIT).The hospital is also faced with the threat of difficulty in conducting pediatric clinical research and fierce competition among similar hospitals.Conclusion We could promote the development of pediatric clinical research by incentivizing the conduction of clinical research,strengthening the construction of clinical research system,improving the clinical research capabilities,and building a collaborative network for ped-iatric multicenter clinical research.

This paper explores the logic of scientific research management system of public hospitals in the new era,i-dentifying its connotations,principles,and pathways.From a value perspective,the system underscores the integration of effi-ciency and equity.In terms of governance logic,it advocates a shift from a single government-centric approach to a collaborative model that includes both government and market operation logics.The principles guiding transformation advocate for combination of ethical and market considerations,balance of rights and responsibilities,and integration of individual self-efficacy and organi-zational support.In terms of pathway selection,the paper proposes a comprehensive strategy that begins with forging a unified sci-entific research vision,serving as the foundation for creating a pedagogical organization to foster continuous learning,and the im-plementation of performance assessments based on core value.These strategies aim to modernize and enhance the efficiency of the scientific research management system in public hospitals.

Objective The purpose of this article is to summarize and review the current status of the construction of clinical research evaluation systems in domestic public hospitals,identify existing problems in the evaluation system,and propose development strategies and suggestions.Methods Retrieved relevant articles,dissertations and policies from the past five years(2018-2022),screened the titles,viewed the full texts of 52 selected papers and their references,and summarized them.Results The"five-only"indicators have long been an important indicator for evaluating clinical research in public hospitals,but in today's scientific research environment and policy environment,the"five-only"evaluation system has revealed its utilitarian draw-backs and gradually evolved into a hindrance to scientific research.It is urgent to break through the"five-only"orientation and establish a clinical research evaluation system oriented towards"transforming and applying transformation of scientific research achievements".Conclusion The evaluation system for clinical research should break the previous"five-only"evaluation model based on quantity-oriented scientific research evaluation.We can draw on the framework of the research output,influence,and environment indicators in the UK's REF Excellence Framework model,combine the American APT system and the Chinese STEM indicator dimensions,explore multi-outcome evaluation,integrate developmental indicators,and continuously improve the indica-tor system and application methods in practice to promote the development of clinical research in public hospitals.

The clinical practice guidelines of traditional Chinese medicine （TCM） have problems such as limited clinical application and unclear implementation effects， which may be related to the lack of clinical practice evidence. To provide reliable and precise evidence for clinical practice， this article proposes a model of combining TCM guidelines with real-world study， which includes 4 steps. Firstly， during the implementation process of the guidelines， a high-quality research database is established. Secondly， the recommendations in the guidelines are evaluated based on the established database in multiple dimensions， including applicability， effectiveness， safety， and cost-effectiveness， and thus their effectiveness in practical applications can be determined. Thirdly， based on the established database， core prescriptions are identified， and the targeted populations and medication plans are determined. That is， the best treatment regimen is established based on the analysis of abundant clinical data regarding the effects of different medication frequencies， dosages， and duration on efficacy. Fourthly， the guidelines are updated according to the real-world evidence. The research based on this model can provide real-world evidence for ancient and empirical prescriptions， improving their application in clinical practice. Moreover， this model can reduce research costs and improve research efficiency. When applying this model， researchers need to pay attention to the quality of real-world evidence， ensuring that it can truly reflect the situation in clinical practice. In addition， importance should be attached to the clinical application of guideline recommendations， ensuring that doctors can conduct standardized diagnosis and treatment according to the guidelines. Finally， full-process participation of multidisciplinary experts is encouraged to ensure the comprehensiveness and scientificity of the study. In conclusion， the application of this model will contribute to the development of TCM guidelines responsive to the needs of clinical practice and achieve the goal of promoting the homogenization of TCM clinical diagnosis and treatment.

Objective:To understand the major cognition, major choice motivation and the relationship between the two of medical students, and provide references and suggestions for the selection of talents in various majors of medical schools and the effective development of enrollment work.Methods:This study selected undergraduates of Batch 2019 from Peking University Health Science Center as the survey objects, conducted a questionnaire survey on their major cognition, major choice motivation and influencing factors, and used principal component analysis and Spearman rank correlation analysis.Results:The study found that the major cognition scores of 640 undergraduates of Batch 2019 from Peking University Health Science Center were clinical medicine (3.24±0.89) > stomatology (2.89±1.00) > basic medicine (2.66±1.02) > pharmacy (2.54±0.97) > preventive medicine (2.29±0.93) > nursing medicine (2.21±0.99) > medical laboratory (1.98±0.95) > medical English (1.95±0.93). Six major motivation factors for professional choice were school and professional strength, professional learning and job prospects, own factors, Peking University sentiments and the influence of others, medical factors, school policies, and the contribution rates were 34.60%, 12.97%, 7.42%, 6.00%, 5.59% and 5.37%, respectively. Major cognition scores and major choice motivation factors were positively correlated with each other to some extent.Conclusions:At present, students' major cognition level of medical majors still has a large room for improvement, and the motivational factors of major choice are more complicated, among which "the school and professional strength" and "the prospects of study and work" are important factors. Medical schools should focus on strengthening major publicity, improving students' major cognition, attracting aspiring students to apply for medical majors from many aspects, and improving the training quality of medical professionals.

Antenatal hydronephrosis（AHN）is the most common congenital anomalies of kidney and urinary tract（CAKUT）detected through prenatal ultrasound screening.Approximately two-thirds of AHN are physiological and can be relieved spontaneously after birth，while AHN may be aggravated in some cases，resulting in deterioration of kidney function or severe complications and requiring surgical intervention.Currently，there is a lack of consensus on the prenatal and postnatal management of AHN，making it crucial to stratify the risk for affected children and establish appropriate follow-up plans.This article reviews the clinical assessment and management of AHN in prenatal and postnatal settings based on domestic and international literature，with the goal of raising AHN awareness among families of high-risk children and alleviating anxiety and excessive intervention for families of low-risk children，ultimately promoting individualized diagnosis and treatment.

Objective:To observe the prevention and control effect of 1% atropine on the progression of form deprivation myopia (FDM) in guinea pigs and the potential biological mechanism.Methods:Sixty-nine 3-week-old tricolor guinea pigs with normal refraction were randomly divided into a normal control group ( n=19), a FDM group ( n=19), a FDM+ atropine group ( n=19), and an atropine group ( n=12). No intervention was given to guinea pigs in normal control group.The FDM model was established by covering the right eye of guinea pigs with a semitransparent latex facemask for 4 weeks in FDM and FDM+ atropine groups.For the FDM+ atropine group, 1% atropine gel was topically administered to the form-deprived right eyes once a day for 4 weeks.For the atropine group, the right eye was treated with 1% atropine gel once a day for 4 weeks.Refraction and axial length of guinea pigs were measured by retinoscopy and ophthalmic A-scan ultrasonography respectively at baseline, experiment week 2 and week 4.In experiment week 4, eyeballs were enucleated to make sections via the paraffin wax processing procedure, and the microstructural and ultrastructural changes of the sclera were observed under the light microscope and transmission electron microscope, respectively.The isobaric tags for relative and absolute quantitation labeling combined with liquid chromatography-tandem mass spectrometry were used to identify the differentially expressed proteins.Use and care of the animals complied with the Regulation for the Administration of Affairs Concerning Experiment Animals by State Science and Technology Commission.The study protocol was approved by the Institutional Animal Care and Use Committee of Tianjin Medical University (No.TJYY2020111028). Results:There were statistically significant differences in the diopter of guinea pigs at different time points among the four groups ( Fgroup=138.892, P<0.001; Ftime=167.270, P<0.001). Compared with normal control group, the diopter of guinea pigs in FDM group at experiment weeks 2 and 4, and FDM+ atropine group at experiment week 4 developed toward myopia, showing statistically significant differences (all at P<0.001). Compared with FDM group, the diopter of guinea pigs in FDM+ atropine group at experiment weeks 2 and 4 developed toward hyperopia, showing statistically significant differences (both at P<0.001). There were statistically significant differences in the axial length of guinea pigs at different time points among the four groups ( Fgroup=32.346, P<0.001; Ftime=353.797, P<0.001). The axial lengths of FDM group at experiment weeks 2 and 4 and FDM+ atropine group at experiment week 4 were longer than those of normal control group, and the axial lengths in FDM+ atropine group at experiment weeks 2 and 4 were shorter than those in FDM group, and the differences were statistically significant (all at P<0.001). The collagenous fibers of posterior sclera of guinea pigs were loose and disordered in FDM group, and were regular in FDM+ atropine group.The posterior scleral thickness of normal control group, FDM group, FDM+ atropine group and atropine group was (141.74±16.98), (101.46±9.15), (112.74±6.24) and (134.30±18.19) μm, respectively, with a statistically significant difference ( F=6.709, P=0.005). The posterior sclera was significantly thinner in FDM group than in normal control group and FDM+ atropine group (both at P<0.05). The diameter of posterior scleral collagen fiber gradually increased from inside to outside in normal control group, FDM+ atropine group and atropine group, and the diameters of the inner, middle and outer posterior scleral collagen fibers were smaller in FDM group than in normal control group.Proteomic analysis revealed 85 differentially expressed proteins (fold change>1.30) between FDM group and normal control group, FDM+ atropine group and FDM group, of which 38 were up-regulated and 47 were down-regulated after atropine treatment.Gene Ontology enrichment analysis showed that biological processes mainly involved were biological regulation, cell process, localization and metabolic process.Molecular function mainly involved were binding, catalytic activity, molecular function regulator, structural molecule activity and transporter activity.Cell components mainly involved were in cellular anatomical entity, intracellular and protein-containing complex. Conclusions:Atropine can increase the diameter of scleral collagen fibers in guinea pigs of FDM model, improve the arrangement of scleral collagen fiber, inhibit scleral thinning.The mechanism of atropine to control myopia progression is closely related to the tight junction between scleral cells, cytoskeleton and extracellular matrix remodeling.