ObjectiveTo investigate the mechanism by which Wumeiwan suppresses the development and progression of colorectal cancer（CRC） through the regulation of fatty acid metabolic reprogramming， thereby providing new experimental evidence for the prevention and treatment of CRC. MethodsA total of 120 C57BL/6 mice were randomly divided into the blank group， model group， Wumeiwan high-， medium-， and low-dose groups（54， 27， 13.5 g·kg^-1）， and the mesalazine group（0.01 g·kg^-1）， with 20 mice in each group. Except for the blank group， all mice were subjected to azoxymethane（AOM）/dextran sulfate sodium（DSS） treatment to establish an inflammation-associated CRC model. One week after AOM injection， mice in the treatment groups received intragastric administration of the designated drugs， while the blank and model groups received an equal volume of purified water， continuing until 20 d after the intervention endpoint. Hematoxylin-eosin（HE） staining was used to observe colonic histopathological alterations， and immunohistochemistry for vascular endothelial growth factor（VEGF） was performed to evaluate neovascularization and tumor invasion. Metabolomics combined with Kyoto Encyclopedia of Genes and Genomes（KEGG） and metabolite set enrichment analysis（MSEA） was applied to identify key CRC-related metabolic pathways， which were further validated by transcriptomic Gene Ontology（GO） enrichment and gene heatmap analysis. Subsequently， Western blot was performed to determine the expression levels of core proteins in these pathways， and immunofluorescence was used to analyze their localization and co-expression patterns in tissues， thereby elucidating the mechanism of Wumeiwan from multiple biological dimensions. ResultsCompared with the blank group， mice in the model group exhibited a significant decrease in body weight and a significant increase in the disease activity index（DAI） score（P<0.05）， with pronounced colonic mucosal damage accompanied by aggravated tumor invasion. Compared with the model group， Wumeiwan intervention markedly improved body weight loss and reduced DAI score， attenuated mucosal injury， and significantly decreased VEGF expression level（P<0.05）. Multi-omics analysis revealed that differential metabolites and genes across groups were commonly enriched in fatty acid metabolism， fatty acid biosynthesis， and other lipid-related pathways. Relative to the blank group， the model group showed significant upregulation levels of fatty acid synthesis-related genes， including sterol regulatory element-binding protein 1（SREBP1）， fatty acid synthase（FASN）， stearoyl-CoA desaturase 1（SCD1）， as well as saturated fatty acids（P<0.05）. Compared with the model group， treatment with Wumeiwan significantly reduced the expression of key genes involved in fatty acid metabolic pathways， including SREBP1， FASN， and SCD1（P<0.05）. Western blot results further confirmed that proteins in this pathway were significantly elevated in the model group， whereas they were markedly downregulated following Wumeiwan treatment（P<0.05）. Immunofluorescence analysis demonstrated enhanced co-localization of SREBP1 with the cancer-associated fibroblast（CAF） marker α-smooth muscle actin（SMA） in the model group， whereas this co-localization signal was attenuated after Wumeiwan intervention（P<0.05）. ConclusionWumeiwan can improve survival outcomes and alleviate colonic pathological damage in CRC mice， its therapeutic mechanism may be closely associated with the regulation of fatty acid metabolic reprogramming mediated by the SREBP1/FASN/SCD1 signaling pathway.

Objective:To explore the effectiveness of generative artificial intelligence (GAI) -empowered interprofessional collaborative learning model in nursing psychology practical teaching for undergraduate nursing students.Methods:From November to December 2024, 109 second-year nursing students from the Xiangya School of Nursing, Central South University were selected as research subjects using convenience sampling. Two classes were randomly divided into an experimental group (55 students) and a control group (54 students) using a random draw method. Control group received a traditional teaching model based primarily on case discussion and scenario simulation teaching, while experimental group used the GAI-empowered interprofessional collaborative learning model on the basis of control group. The teaching effectiveness was evaluated using the Psychological Nursing Practice Competency Assessment Scale, Caring Ability Inventory (CAI), Readiness for Interprofessional Learning Scale (RIPLS), and Satisfaction Survey Questionnaire.Results:After teaching, experimental group's practical course assessment scores, CAI total scores, and scores in each dimension were all higher than those of control group, with statistically significant differences ( P<0.01). The RIPLS score of nursing students in experimental group after teaching was higher than that before teaching, and the difference was statistically significant ( P<0.01). 90.9% of nursing students supported the introduction of GAI into the classroom, and 90.9% of nursing students recognized the auxiliary role of GAI in achieving learning objectives, and the teaching satisfaction was 96.4%. Conclusions:This study validates the effectiveness of GAI-empowered interprofessional collaborative learning model in nursing psychology practical teaching for undergraduate nursing students, providing new ideas for nursing education reform.

Objective:To explore the trajectory of changes in electronic health literacy in young and middle-aged patients with coronary heart disease (CHD) combined with diabetes mellitus (DM) after percutaneous coronary intervention (PCI), and to analyze its relationship with unplanned readmission within 30 days.Methods:A convenience sample of 210 young and middle-aged CHD patients with DM who underwent PCI in the Department of Cardiology, Xinxiang Central Hospital, from February 2023 to June 2024 was selected. The e-Health Literacy Scale (eHEALS) was used to assess electronic health literacy at the 3rd day (T 1), 15th day (T 2), and 30th day (T 3) after PCI. Unplanned readmission within 30 days after discharge was recorded. Latent class growth model (LCGM) was used to identify categories and characteristics of electronic health literacy trajectories. Kaplan-Meier method was applied to plot the cumulative incidence of 30-day unplanned readmission, and the Log-Rank test was used to compare differences among different trajectory types. Results:A total of 207 patients completed the entire survey and follow-up, with a valid response rate of 98.57% (207/210). eHEALS scores gradually increased after PCI, with scores of (6.75±1.31), (11.55±3.31), and (15.56±5.75) at T 1, T 2, and T 3, respectively. Two potential categories were identified: persistent low-level type (85 cases, 41.06%) and gradually improving type (122 cases, 58.94%). Twenty-six patients experienced unplanned readmission within 30 days, with an incidence of 12.56%. The proportions of unplanned readmission within 30 days were 20.00% (17/85) in the persistent low-level group and 7.38% (9/122) in the gradually improving group, with a statistically significant difference (χ 2=7.268, P=0.007). Kaplan-Meier cumulative risk function analysis showed that the cumulative incidence of 30-day unplanned readmission in the gradually improving group was lower than that in the persistent low-level group, with a statistically significant difference (Log-Rank=7.683, P=0.006) . Conclusions:Young and middle-aged CHD patients with DM after PCI show trajectory characteristics in electronic health literacy. Although the electronic health literacy of some patients gradually improved after PCI, persistent low-level literacy was still common, and patients in the persistent low-level group had a higher risk of 30-day unplanned readmission, which deserves clinical attention.

Objective:To analyze the current status of investigator-initiated clinical trials in a stomatology institution and explore establishing a suitable management system.Methods:By analyzing the data of the Medical Research Registration and Filing System of the National Health Commission and using the literature review and experience analysis methods, this study proposed key points for constructing the project management system.Results:The number of IITs in stomatology institutions increased over the years, with a relatively small overall size and short execution cycles. Young and middle-aged medical personnel were the main executors of the projects. The research mainly took the form of publishing papers and applying for patents. Based on the four dimensions of demand, countermeasures, cycle, and management, integrating support platforms such as methodology clinic, data platform, and transformation clinic, and combining supervision and inspection to explore constructing an IIT whole lifecycle management system.Conclusions:The IIT whole lifecycle management system was helpful for standardized project implementation and clinical research talent cultivation. In the future, it can refine management processes, improve management efficiency, and lay the foundation for higher-level clinical research.

Objective This study aims to provide theoretical support for the formulation of thyroid nodule prevention and treatment strategies in Northwest China and to investigate the characteristics of thyroid nodules and their association with metabolic indicators in this population.Methods A cross-sectional survey was conducted by retrospectively enrolling healthy individuals who underwent routine health examinations at our hospital between January 1 and December 31,2023.A total of 38 919 participants were included.The detection rate of thyroid nodules was stratified by age and sex.Univariate and multivariate binary logistic regression analyses were performed to identify risk factors for thyroid nodules.Results Among the 38 919 participants,20 395 were men(52.4%)and 18 524 were women(47.6%).The overall detection rate of thyroid nodules was 47.1%(18 317/38 919),including 40.1%(8 187/20 395)in men and 54.7%(10 130/18 524)in women.Across all age groups,women had a significantly higher detection rate than men(P<0.001).The detection rate increased with age in both sexes(χ2trend=1392.867,P<0.001 in men;χ2trend=1521.215,P<0.001 in women).Significant differences were observed between participants with and without thyroid nodules in age,body mass index(BMI),fasting blood glucose(FBG),glycated hemoglobin(HbA1c),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),triiodothyronine(T3),thyroid-stimulating hormone(TSH),and anti-thyroglobulin antibodies(TGAB),anti-thyroid microsomal antibodies,the proportion of hypertension and central obesity(all P<0.05).Multivariate binary logistic regression analysis identified female sex(OR=2.158),older age(OR=1.040),central obesity(OR=1.144),elevated FBG(OR=1.039),hypertension(OR=1.095),elevated TGAB(OR=1.008),and elevated T3(OR=1.154)as independent risk factors for thyroid nodules(all P<0.05).Conclusion Women in Northwest China are at higher risk of developing thyroid nodules.Screening and health management should be prioritized for older individuals,those with central obesity,elevated FBG,hypertension,elevated TGAB,and elevated T3 levels.

Objective To investigate the microstructural changes of white matter in patients with relapsing-remitting multiple sclerosis(RRMS)and its correlation with clinical functional scores.Methods A total of 20 patients with RRMS(RRMS group)and 20 healthy controls(HC)(HC group)were selected and underwent diffusion tensor imaging(DTI)and expanded disability status scale(EDSS)scores.Patients with RRMS were categorized into two groups based on their EDSS scores,including MS-1 group(motor dysfunction with visual impairment)and MS-2 group(motor dysfunction).Image processing was performed via tract-based spatial statistics(TBSS).Group comparisons were executed using the t-test,while correlations were analyzed utilizing Spearman correlation.Results In the RRMS group,reduced fractional anisotropy(FA)values were accompanied by increased mean diffusivity(MD)and radial diffusivity(RD)values in the forceps major,forceps minor,bilateral cingulum,bilateral uncinate fasciculus,bilateral superior longitudinal fasciculus,bilateral inferior longitudinal fasciculus,bilateral inferior fronto-occipital fasciculus,bilateral corticospinal tract and bilateral anterior thalamic radiation compared with the HC group.Additionally,In the RRMS group,increased axial diffusivity(AD)values were noted in the forceps major,forceps minor,bilateral superior longitudinal fasciculus(temporal),right inferior fronto-occipital fasciculus,bilateral corticospinal tract and right anterior thalamic radiation compared with the HC group.Compared with the MS-2 group,the MS-1 group exhibited higher FA values in the right cingulum(cingulate gyrus part)and higher AD values in the left cingulum(cingulate gyrus part).Correlation analysis revealed negative correlations between the FA values of the forceps major,right superior longitudinal fasciculus and the motor function scores in RRMS group.Conversely,positive correlations were identified between the MD values of the forceps minor,right superior longitudinal fasciculus,right inferior fronto-occipital fasciculus,left corticospinal tract and the RD values of the forceps minor,right cingulum(hip-pocampus),right superior longitudinal fasciculus,and left corticospinal tract,as well as the motor function scores.Conclusion RRMS patients exhibit microstructural damage in white matter and are associated with motor dysfunction,which provides imaging support for the pathological mechanisms underlying motor dysfunction in RRMS patients.

Objective:To evaluate clinical outcomes of occlusion-guided vascularized folded fibula flap reconstruction with delayed implant restoration for mandibular defects after benign tumor resection.Methods:A total of 12 patients with benign mandibular tumors underwent free folded fibula flap reconstruction at the First Affiliated Hospital of Bengbu Medical University between January 2020 and December 2023, including 7 males and 5 females, aged 21-52 years. Six months after mandibular reconstruction, the internal fixation titanium plates were removed, and dental implants were placed using a preoperatively fabricated occlusal guide, followed by second-stage implant surgery and prosthetic restoration. Mandibular CT scans were obtained 6 months after reconstruction to compare the fitting accuracy between the preoperative virtual design and the actual reconstructed mandible. The implant stability quotient (ISQ) was measured 3 months after implant placement. Masticatory efficiency and Enneking lower limb function scores were evaluated at the following time points: before tumor surgery (T1), before implant placement (T2), 6 months (T3) and 9 months (T4) after implant crown restoration. One-way repeated measures ANOVA was used to analyze the masticatory efficiency and lower limb function scores.Results:The free folded fibula grafts were successfully performed via an intraoral approach in all 12 patients, with a 100% of survival rate. Mandibular defects included Brown class I in 6 cases, class II in 2 cases, and class III in 4 cases. A total of 42 implants were placed with successful osseointegration. The ISQ measured at 3 months post-placement was 64.10±4.18. At 6 months postoperatively, morphological analysis comparing the preoperative virtual surgical design with the actual postoperative reconstructed mandible revealed a reconstruction accuracy of 84.27%±4.23%. Significant differences were observed in Enneking scores and masticatory efficiency across all four time points (all P<0.001). Masticatory function showed significant improvement at T4 compared that at T2 [(88.06±3.66)% vs. (65.44±3.82)%, P<0.05]. Conclusion:Occlusal function-guided mandibular reconstruction with vascularized folded fibula flap after removal of benign mandibular tumors is a reliable method, which is associated with minimal donor-site morbidity and enables patients to restore precise occlusion and to achieve favorable masticatory efficiency.

Recent rapid developments in molecular biological techniques have allowed the use of gene editing,as a means of genome modification,for the establishment of experimental animal models,with high efficiency,accuracy,and flexibility.This article mainly summarizes the construction and application of the latest gene-editing techniques in animal models,including pigs,non-human primates and dogs.It provides a theoretical reference for the application and in-depth study of gene-editing techniques in large experimental animals,which may better simulate human diseases,and for further studies of the potential pathogenesis of biomedical and human complex diseases.

Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.