Diabetic kidney disease（DKD） is a chronic kidney structural and functional disorder caused by diabetes. With the global prevalence of diabetes continuing to rise， DKD has gradually become a major cause of chronic kidney disease and end-stage renal disease（ESRD）， posing a serious threat to patients' quality of life and long-term health outcomes. Studies have shown that apoptosis plays a pivotal role in the development and progression of DKD， with its mechanisms involving abnormal activation of multiple signaling pathways such as Toll-like receptor 4（TLR4）/nuclear transcription factor-κB（NF-κB）/B-cell lymphoma-2（Bcl-2）/cysteinyl aspartate-specific proteinase（Caspase）-3， protein kinase R-like endoplasmic reticulum kinase（PERK）/eukaryotic initiation factor 2α（eIF2α）/activating transcript factor 4（ATF4）/CCAAT enhancer-binding protein homologous protein（CHOP）， phosphatidylinositol 3-kinase（PI3K）/protein kinase B（Akt）/glycogen synthase kinase-3β（GSK-3β）， Janus kinase 2（JAK2）/signal transducer and activator of transcription 3（STAT3）， adenosine monophosphate-activated protein kinase（AMPK）/mammalian target of rapamycin（mTOR） and silent information regulator 1（SIRT1）/tumor suppressor protein 53（p53）， thereby accelerating renal pathological damage in DKD. Extensive evidence-based medical studies have confirmed that traditional Chinese medicine（TCM）， leveraging its unique therapeutic advantages of multi-target， multi-component and multi-pathway approaches， has demonstrated remarkable efficacy and favorable safety profiles in treating DKD. Recent studies have demonstrated that active components of TCM can specifically target and modulate key effectors in apoptotic signaling pathways. Meanwhile， traditional compound formulations exert synergistic effects through multiple approaches such as replenishing deficiency and activating blood circulation， detoxifying and dredging collaterals， tonifying kidney essence， and removing stasis and purging turbidity， thereby comprehensively regulating critical pathological processes including endoplasmic reticulum stress and mitochondrial apoptosis pathways. This combined therapeutic approach of molecular targeting and holistic regulation provides novel strategies for delaying the progression of DKD. Based on this， this paper provides an in-depth analysis of key apoptotic signaling pathways and their regulatory mechanisms， while systematically summarizing recent research advances regarding the therapeutic effects of TCM active components， compound formulations， and proprietary Chinese medicines on DKD through modulation of these pathways， with particular emphasis on their underlying molecular mechanisms. These findings not only elucidate the modern scientific connotation and theoretical basis of TCM in treating DKD but also establish a solid theoretical and practical foundation for promoting the wider clinical application and further research of TCM in the field of DKD treatment.

Objective To explore the effectiveness of the generative large language model MedGo in nursing decision-making for elderly patients with multimorbidity. Methods A quasi-randomized controlled trial study was conducted involving 6 junior nurses, 6 senior nurses and the MedGo model from January 1, 2025 to March 31, 2025 at the Emergency Internal Medicine Ward of Shanghai East Hospital Affiliated to Tongji University. Clinical data of 120 elderly patients with multimorbidity were analyzed to compare the performance of the three groups in four tasks (nursing diagnosis assessment, nursing intervention formulation, complication identification, and complication prevention) from three evaluation dimensions: decision-making time consumption, decision accuracy, and decision-making quality. Results In terms of decision-making time, the senior nurse group completed all four tasks faster than the junior nurse group (P＜0.01), and the MedGo group completed all four tasks faster than the junior nurse group (P＜0.001) and the senior nurse group (P＜0.001). In terms of decision-making accuracy, senior nurse group scored higher than junior nurse group in all four tasks (P＜0.001), while the MedGo group outperformed the senior nurse group only in complication identification (P＜0.001). In terms of decision-making quality, the MedGo group scored higher than junior nurse group (P＜0.001) and senior nurse group (P＜0.001) in all four tasks. Conclusions The MedGo model demonstrates advantages of high efficiency, accuracy, and quality in nursing decision-making for elderly patients with multimorbidity; senior nurses outperform junior nurses in decision-making, providing diverse references for clinical nursing decision-making.

OBJECTIVE To analyze the incidence of cyclosporine （CsA）-associated acute kidney injury （AKI） in hospitalized patients， identify influencing factors， and construct a risk prediction model. METHODS A single-center retrospective study was conducted， enrolling clinical data from hospitalized patients treated with CsA at the First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital from January 2018 to July 2024. The patients were classified into AKI group and non-AKI group based on the occurrence of CsA-related AKI. Univariate analysis and multivariate Logistic regression analysis were used to identify independent risk factors for CsA-related AKI， and a risk prediction model was constructed and its performance was evaluated. RESULTS A total of 439 patients were included， of whom 54 developed CsA-related AKI， with an incidence rate of 12.30%. The occurrence of CsA-associated AKI was positively correlated with concurrent bacterial pulmonary infection， cytomegalovirus viremia， respiratory failure， renal insufficiency， gastrointestinal bleeding， and peripheral central venous catheterization （odds ratios of 763.750， 16.944， 41.933， 236.806， 17.537 and 212.789， respectively； P ＜0.05）； while uric acid， prealbumin， and calcium levels were negatively associated with it （odds ratios of 0.983， 0.967 and 0.058， respectively； P ＜0.05）. The prediction model constructed based on the above factors yielded a χ 2 value of 10.254 （ P ＞0.05） in the Hosmer-Lemeshow test. The average area under the curve （AUC） from 10-fold cross-validation was 0.885. The AUC of the receiver operating characteristic curve was 0.883， with a sensitivity of 84.3% and a specificity of 80.4%， respectively， at the optimal cutoff value of 0.1. CONCLUSIONS Six factors， including concurrent bacterial pulmonary infection and cytomegalovirus viremia， are positively associated with the occurrence of CsA-related AKI； while uric acid， prealbumin， and calcium levels are negatively associated. The Logistic regression model constructed based on these factors demonstrates good predictive performance and can assist clinic in conducting early risk assessment and personalized interventions.

Objective: To investigate the associations between 24 hour activity and the quality of life (QoL) in children with autism spectrum disorder (ASD), and to explore their isotemporal substitution effects, providing a reference for developing intervention strategies of their QoL. Methods: From March to June 2025, 288 children with ASD from 7 special education schools in Jinan were selected by using a cluster random sampling method. The 24 hour activity was measured by using ActiGraph wGT3X-BT triaxial accelerometers, and their QoL was assessed by applying a parent proxy Pediatric Quality of Life Inventory. Multiple linear regression was employed to analyze the associations between 24 hour activity and QoL in children with ASD. Isotemporal substitution analysis was applied to analyze the dose response relationship of 24 hour activity time and the QoL scores in children with ASD. Results: Within the 24 hour activities of children with ASD, the daily time spent in sleep, sedentary behavior (SB), light physical activity (LPA), and moderate to vigorous physical activity (MVPA) were 610.49，605.80，195.49，28.22 minutes, respectively. Multiple linear regression analysis showed that, after controlling for confounding factors such as gender, age, and parental education level, the proportion of time spent in MVPA was positively associated with QoL scores ( β =1.75) in children with ASD, whereas the proportion of time spent in SB was negatively associated with QoL scores ( β =-1.00)(both P <0.01). In the dose response relationship, reallocating time from sleep, SB, and LPA to MVPA was associated with an improvement in QoL in children with ASD, with increased scores of 1.38, 1.55, 1.47, respectively; conversely, the reverse substitution was associated with a decline in QoL, and the scores decreased by 2.31, 2.99 and 2.68, respectively, with the latter demonstrating a more pronounced effect(all P <0.05). Conclusions Enhancing the QoL for children with ASD should be grounded in the overall balance of 24 hour activity. Time reallocation strategies should be implemented with an emphasis on relatively increasing MVPA and reducing SB.

Objective: To apply network analysis for exploring the relationship of maltreatment experiences and peer relationships with school bullying among middle school students, so as to provide empirical evidences for the development of targeted intervention programs. Methods: From March to April 2024, a total of 2 119 middle school students aged 12-18 in Shantou City were selected through stratified cluster random sampling. Self administered questionnaire was used to collect data on bullying experiences, maltreatment, and peer relationships. The Glasso network model was employed to estimate network structure. Results: The strongest edge in the network of maltreatment experiences, peer relationships and school bullying was the connecting line connecting peer acceptance and peer terrorized low self esteem (edge weight=0.59) among middle school students. The network faked fraudulent victimization was the most central node in the whole network (strength=7.98). The bridge symptoms of the network were sexual abuse, property bullying of others, relational bullying victimization, and verbal bullying of others, with the strongest bridge node being sexual abuse (bridge strength=1.07). In the accuracy estimation of centrality indices, closeness centrality demonstrated the highest accuracy, followed by strength and betweenness, with coefficient of stability of 0.60, 0.44 and 0.21, respectively. The stability of the network was good. Conclusion Peer acceptance has the strongest correlation with peer fear and inferiority, and is closely related to emotional abuse and emotional neglect.

OBJECTIVES: The prevalence of overweight and obesity among children and adolescents continues to rise, becoming one of the most serious global public health issues of the 21st century. Given the differing growth and development environments between urban and rural children, associated risk factors also vary. This study aims to explore the distribution characteristics and influencing factors of overweight and obesity among urban and rural primary and secondary school students in Hunan Province, providing scientific evidence for targeted interventions. METHODS: A stratified, randomized cluster sampling method was used to select participants. A total of 197 084 students from primary and secondary schools across 14 prefectures in Hunan Province underwent physical examinations and questionnaire surveys. Population and spatial distribution characteristics of overweight and obesity were analyzed. Spatial distribution maps and spatial autocorrelation analyses were conducted using ArcGIS. Multivariate Logistic regression was used to identify influencing factors for overweight and obesity. RESULTS: The overall overweight and obesity rates among students in Hunan Province were 14.7% and 10.9%, respectively. Both rates were higher in urban areas than in rural counties (16.0% vs 13.9% for overweight; 12.1% vs 10.2% for obesity). Among both urban and rural students, boys had higher rates of overweight and obesity than girls. Higher-grade students had a higher overweight rate but a lower obesity rate than lower-grade students. In urban areas, the overweight and obesity rates of Han Chinese primary and secondary school students are lower than those of ethnic minority students (both P<0.05). In rural areas, the obesity rate of Han primary and secondary school students is lower than that of ethnic students (P<0.05). Across cities and prefectures, urban overweight and obesity rates ranged from 14.7% to 18.7% and 8.4% to 20.6% respectively, while rural rates ranged from 10.9% to 17.2% and 6.6% to 13.7% respectively. Spatial autocorrelation analysis revealed high-value clusters of overweight/obesity in urban areas of Changde and Zhangjiajie, and in rural areas of Loudi, Huaihua, and Shaoyang. Multivariate Logistic regression showed that gender, school stage, ethnicity, frequency of fresh vegetable intake, and sleep duration were associated with overweight and/or obesity in both urban and rural students. In urban students, frequency of fried food and fresh fruit intake, breakfast habits, physical activity on weekdays and holidays, and screen time on computers were also significant. In rural students, TV viewing time and sedentary duration were additional relevant factors. CONCLUSIONS The situation of overweight and obesity among primary and secondary school students in Hunan Province remains concerning. Greater attention should be paid to regions with high-value clusters of overweight/obesity, and targeted interventions should be developed based on urban-rural differences in influencing factors.
Humans ; China/epidemiology* ; Adolescent ; Male ; Female ; Rural Population/statistics & numerical data* ; Child ; Overweight/epidemiology* ; Students/statistics & numerical data* ; Urban Population/statistics & numerical data* ; Risk Factors ; Prevalence ; Obesity/epidemiology* ; Surveys and Questionnaires ; Pediatric Obesity/epidemiology* ; Schools

Objective:To investigate the current status of treatment delay and analyze its influencing factors in patients with breast cancer-related lymphedema.Methods:Using convenience sampling, 218 patients with breast cancer-related lymphedema from The First Affiliated Hospital of Zhengzhou University between April 2024 and January 2025 were enrolled. The General Information Questionnaire, Lymphedema Self-Management Support Scale for Breast Cancer Survivors (LSMS-BCs), Brief Illness Perception Questionnaire for Breast Cancer-related Lymphedema (BIPQ-BCRL), Perceived Barriers to Health Care-Seeking Decision-Chinese (PBHSD-C), and Health Literacy Scale for Chronic Patients (HLSCP) were used to conduct a cross-sectional survey. Logistic regression identified predictors of treatment delay, with model fit assessed by the Hosmer-Lemeshow test. Discriminative ability was evaluated using receiver operating characteristic (ROC) curve analysis.Results:The study included 218 female BCRL patients, aged (58.31 ± 10.54) years. Among 218 patients, 76 experienced treatment delay, the incidence of treatment delay was 34.8% (76/218). Independent risk factors included junior high school education or below, no regular arm circumference measurement, low self-management support scores, low illness perception scores, high perceived barriers to healthcare-seeking scores, and low health literacy scores (Wald χ2 values were 7.75-15.15, all P<0.05). The Hosmer-Lemeshow test indicated good model fit ( χ2=6.21, P>0.05). The combined predictive model demonstrated significantly better discrimination than individual factors, the area under the curve of ROC was 0.846 ( P<0.01). Conclusions:The incidence of treatment delay is relatively high among breast cancer-related lymphedema patients. Nursing staff should pay special attention to patients with a junior high school education or below, no regular arm circumference measurement, low LSMS-BCs scores, low BIPQ-BCRL scores, high PBHSD-C scores and low HLSCP scores, implement timely interventions to reduce treatment delay in lymphedema patients.

Objective To explore the effectiveness of the peripheral arterial calcification scoring system(PACSS)based on computed tomography angiography(CTA)in assessing renal function in patients with peripheral arterial disease(PAD).Methods The clinical data,CTA imaging data,and laboratory results from PAD patients who underwent lower limb artery CTA examination were retrospectively collected.The PACSS was utilized to score the calcification in both lower limb arteries.Participants were categorized into three groups based on their estimated glomerular filtration rate(eGFR)(normal group:eGFR≥90 mL/min;mild renal dysfunction group:eGFR 60-89 mL/min,and moderate to severe renal dysfunction group:eGFR＜60 mL/min).The demographic data,clinical symptoms,and comorbidities among the three groups were compared by analysis of variance(ANOVA).The Spearman correlation coefficient was employed to evaluate the relationship between eGFR,cystatin C,and PACSS score.Results The age(P＜0.001)and PACSS score(P＜0.05)of patients with renal dysfunction were significantly higher than those of patients with normal renal function.However,there were no significant differences in gender,prevalence of diabetes,hypertension,or severe limb ischemia.Spearman correlation analysis showed that eGFR was negatively correlated with PACSS score(r=-0.18 in the right lower limb,P=0.037,r=-0.24 in the left lower limb,P=0.006).In contrast,cystatin C was positively correlated with PACSS score(r=0.26 in the right lower limb,P＜0.001,r=0.22 in the left lower limb,P=0.002).Conclusion The PACSS score of lower limb artery in PAD patients is corre-lated with the severity of renal dysfunction.This finding may facilitate early warning and clinical intervention for PAD patients with renal dysfunction.

Objective:To evaluate the optimization effects of ciprofol-based intravenous anesthesia in elderly patients undergoing retroperitoneal laparoscopic radical nephrectomy.Methods:This study was a prospective randomized controlled study. Eighty elderly patients scheduled for elective retroperitoneal laparoscopic radical nephrectomy were randomized to receive either ciprofol-based (group C) or propofol-based intravenous anesthesia (P group), with 40 patients in each group. Anesthesia was induced by intravenous injection of ciprofol 0.4 mg/kg and maintained by intravenous infusion of ciprofol and remifentanil during operation in group C. In group P, anesthesia was induced by intravenous injection of propofol 1.5 mg/kg and maintained by intravenous infusion of propofol and remifentanil during operation. The onset time of sedative effect following anesthesia induction, hypotension and injection pain during induction and intraoperative hypotension were recorded.Results:Compared to P group, the incidence of hypotension and injection pain during induction was significantly decreased (28% vs 10%, 60% vs 18%, P<0.05); although the difference in the incidence of intraoperative hypotension was not statistically significant (25% vs 15%, P>0.05), the RR was 0.6; no significant change was found in the onset time of sedative effect following anesthesia induction in C group ( P>0.05). Conclusions:Compared to propofol-based intravenous anesthesia, ciprofol-based intravenous anesthesia has certain optimization effects in elderly patients undergoing retroperitoneal laparoscopic radical nephrectomy.