ObjectiveTo analyze the output and efficiency of chronic disease management services for hypertension and diabetes in community health service institutions in Shanghai, to evaluate the allocation and efficiency of chronic disease management resources, and to provide references for improving the efficiency of chronic disease management in Shanghai’s communities. MethodsA total of 73 community health institutions from 15 districts of Shanghai were selected. Based on the chronic disease management resource data of community health institutions in 2019, 2021, and 2023, descriptive methods and the BCC model in Data Envelopment Analysis (DEA) were used to analyze the resource allocation, service output, and the efficiency of chronic disease management services in community health institutions in Shanghai. ResultsFrom 2019 to 2023, the indicators of resource allocation and service output of community health service institutions in Shanghai all showed upward trends. In terms of service efficiency, the average number of chronic disease patients managed by each health technician decreased from 237 to 231, and the number of patients served per 1 000 working hours decreased from 54 to 44. DEA efficiency analyses showed that the average overall efficiency increased from 0.867 in 2019 to 0.886 in 2021 and then decreased to 0.811 in 2023. The average technical efficiency decreased from 0.901 to 0.847, which was the main reason for the decline in overall efficiency. The average scale efficiency showed an initial increase followed by a decrease, rising from 0.961 in 2019 to 0.977 in 2021 and dropping back to 0.955 in 2023. The number of strong effective districts (overall efficiency=1.000) decreased from 6 in 2019 to 3 in 2023, and the efficiency differences between districts expanded. The range of overall efficiency widened from 0.622‒1.000 to 0.513‒1.000, indicating a decline in overall efficiency and an increase in inter-district heterogeneity. ConclusionFrom 2019 to 2023, the total volume of resource allocation and service output for chronic disease management in community health service institutions in Shanghai increased continuously. However, both the service output efficiency and the overall resource allocation efficiency declined, driven primarily by a decrease in technical efficiency, and accompanied by widening inter‑district disparities.

ObjectiveType 2 diabetes mellitus (T2DM) often causes severe hepatic metabolic complications, dominated by metabolic associated fatty liver disease (MAFLD). Persistent hepatic steatosis and oxidative stress further trigger steatohepatitis and progressive liver damage, increasing the mortality risk of diabetic patients. Aerobic exercise effectively improves hepatic lipid metabolism and antioxidant capacity, but poor patient adherence restricts its long-term clinical application. Mitochondrial-derived mitochondrial open reading frame of the 12S rRNA type-c (MOTS-c) is a key peptide regulating insulin sensitivity and hepatic redox homeostasis. This study aimed to explore the protective mechanism of MOTS-c against T2DM-related liver injury and its combined beneficial effect with aerobic exercise via the NRF2/PPARγ signaling axis. This study aimed to investigate whether MOTS-c cooperates with aerobic exercise to alleviate T2DM-associated hepatic oxidative stress and metabolic dysfunction by activating the NRF2/PPARγ axis, and to clarify the molecular and transcriptomic characteristics of their combined intervention. MethodsStable MOTS-c overexpression and knockdown HepG2 cell lines were constructed using lentiviral transfection. An oleic acid-induced cellular lipid accumulation model and NRF2-knockout cell model were applied to verify the NRF2-dependent mechanism ofMOTS-c. Intracellular lipid deposition, triglyceride levels, antioxidant enzyme activities, and the expression of NRF2/PPARγ pathway-related genes and proteins were detected. In vivo, a T2DM rat model with obvious hepatic steatosis was established via a high-fat and high-sucrose diet combined with streptozotocin injection. Model rats received aerobic exercise, MOTS-c intraperitoneal injection, or combined intervention. We detected systemic glycolipid metabolic indicators, hepatic histopathological changes, and the expression of core proteins in the hepatic NRF2/PPARγ axis. Hepatic transcriptomic sequencing was performed to screen differentially expressed genes (DEGs) and enrich key pathways co-regulated by MOTS-c and aerobic exercise. ResultsCellular results showed that MOTS-c overexpression significantly reduced oleic acid-induced lipid deposition, enhanced antioxidant enzyme activity, and upregulated NRF2 and PPARγ expression. Conversely, MOTS-c knockdown aggravated hepatic lipid accumulation and oxidative damage and inhibited NRF2/PPARγ pathway activation. NRF2 knockout completely eliminated the protective effects of MOTS-c on lipid metabolism and redox balance, confirming its NRF2-dependent regulatory mechanism. In T2DM rats, both MOTS-c supplementation and aerobic exercise effectively improved insulin resistance, corrected glycolipid metabolic disorders, and alleviated hepatic steatosis, while consistently activating the hepatic NRF2/PPARγ axis. Compared with single intervention, the combined treatment showed a better improvement trend in hepatic metabolic and oxidative injury, without definitive synergistic effects. Transcriptomic analysis revealed that the co-regulated DEGs of MOTS-c and aerobic exercise were primarily enriched in lipid metabolism and PPAR signaling pathways, with multiple antioxidant and lipid-regulating genes significantly modulated by combined intervention. ConclusionMOTS-c exhibits obvious exercise-mimetic hepatoprotective effects in T2DM. It activates the hepatic NRF2/PPARγ axis to strengthen antioxidant defense, stabilize lipid metabolism, and relieve T2DM-associated hepatic steatosis and oxidative damage. Furthermore, MOTS-c produces additive beneficial effects with aerobic exercise, showing a superior intervention trend on diabetic liver dysfunction. This study identifies the NRF2/PPARγ axis as the core mechanism of MOTS-c-regulated hepatic protection, elucidates the transcriptomic basis of combined intervention, and provides a reliable theoretical basis and potential therapeutic target for clinical intervention in T2DM-complicated MAFLD.

The compilation explanation for the Expert Consensus on Clinical Application of Ruyi Zhenbao pills systematically expounds the formulation methods and evidence-based basis of this consensus. In response to the weak clinical application evidence and ambiguous indications of Ruyi Zhenbao pills， the Institute of Basic Research in Clinical Medicine of China Academy of Chinese Medical Sciences， Wangjing Hospital of China Academy of Chinese Medical Sciences， and Dongzhimen Hospital of Beijing University of Chinese Medicine invited 39 experts from 31 medical institutions across China to complete the compilation through multi-disciplinary collaboration. The compilation strictly adheres to the World Health Organization （WHO） guidelines for guideline development and the GRADE evidence grading system. The work process covered the construction of clinical questions （a total of 30 clinical questions were determined based on expert voting results）， evidence retrieval （covering Chinese and English databases and gray literature）， safety assessment （integrating drug monitoring data and clinical research）， and the formation of recommendation opinions and consensus suggestions （18 recommendation opinions were reached through the GRADE grid method， and 22 consensus suggestions were reached through majority voting rules）. The results show that the consensus clearly states that this medicine is suitable for knee osteoarthritis， gouty arthritis， rheumatoid arthritis， neuropathic pain， and sequelae of stroke. In terms of safety， the adverse reactions are mainly gastrointestinal reactions such as nausea， vomiting， and abdominal pain. Pregnant women and those allergic to the ingredients of this medicine are contraindicated. The compilation process underwent three rounds of expert reviews and adopted methods such as nominal group technique and Delphi method to ensure the rigor of the consensus compilation process. It provides a paradigm for the formulation of expert consensus on clinical application of Tibetan medicine through the academic promotion and dynamic revision.

Objective:To examine the relationships between perceived organizational support in job resources, self-efficacy in personal resources, and teaching commitment based on the job requirement-resource model, and to explore the path of influencing clinical teachers' teaching commitment.Methods:Using the convenience sampling method, 463 clinical teachers from 16 university-affilicated hospitals in Shandong Province, China were selected as the study subjects. Surveys were conducted using the Perceived Organizational Support Scale, Self-efficacy Scale, and Teaching Commitment Scale. A statistical analysis was performed using SPSS 26.0. A structural equation model was constructed using AMOS 26.0 to test the mediation effect.Results:①The level of teaching commitment of clinical teachers was relatively high, with a total score of (45.25±9.21) points. The total score of perceived organizational support was (38.22±9.75) points, and the total score of self-efficacy was (112.27±17.30) points. ②Perceived organizational support and self-efficacy were positively correlated with teaching commitment ( r=0.59, r=0.65, both P<0.01). ③ Perceived organizational support had significant and direct positive effects on teaching commitment and self-efficacy ( β=0.36, β=0.51, both P<0.01). Self-efficacy significantly and positively affected teaching commitment ( β=0.47, P<0.01). Self-efficacy played a significant and partial mediating role in the effect of perceived organizational support on teaching commitment (standardized mediating effect value of 0.239, P<0.01), and the mediating effect percentage was 39.83%. Conclusions:Perceived organizational support not only directly predicts clinical teachers' teaching commitment, but also indirectly affects teaching commitment through self-efficacy. University-affiliated hospital administrators should pay attention to clinical teachers' perceived organizational support to improve their self-efficacy and teaching commitment, thereby ensuring teaching quality.

With the rapid development of generative artificial intelligence(GAI)technologies,their widespread application in academic research and writing is continuously expanding the boundaries of sci-entific inquiry.However,this trend has also raised a series of ethical and regulatory challenges,inclu-ding issues related to authorship,content authenticity,citation accuracy,and accountability.In light of the growing involvement of AI in generating academic content,establishing an open,controllable,and trustworthy ethical governance framework has become a key task for safeguarding research integrity and maintaining trust within the academic community.This expert consensus outlines ethical requirements across key stages of AI-assisted academic writing-including topic selection,data management,citation practices,and authorship attribution.It aims to clarify the boundaries and ethical obligations surrounding AI use in academic writing,ensuring that technological tools enhance efficiency without compromising in-tegrity.The goal is to provide guidance and institutional support for building a responsible and sustainable research ecosystem.

Objective:To investigate the significance of urinary 8-oxo-7, 8-dihydroguanosine(8-oxoGuo)in assessing the short-term prognosis of sepsis in frail elderly patients.Methods:We conducted a cross-sectional study involving 62 frail elderly patients diagnosed with sepsis who were admitted to the Emergency Intensive Care Unit(EICU)at Beijing Hospital between March 2021 and March 2022.Based on their 28-day prognosis, the patients were categorized into two groups: those who died and those who survived.Upon admission, we collected urine samples and clinical data from both groups.We employed isotope dilution high-performance liquid chromatography-mass spectrometry to measure the levels of the RNA oxidation marker 8-oxoGuo in the urine.Results:A total of 62 frail elderly patients[aged(85.1±6.3)years]diagnosed with sepsis were included in the study, comprising 36 patients in the 28-day mortality group and 26 patients in the survival group.Univariate analysis revealed that the survival group had significantly lower body temperature, blood calcitonin(PCT)levels, sequential organ failure assessment(SOFA)scores, and urinary 8-oxoGuo levels compared to the mortality group.Additionally, the survival group exhibited a higher mean arterial pressure(MAP)than the mortality group, with all differences reaching statistical significance(all P<0.05).Spearman correlation analysis indicated that urinary 8-oxoGuo levels were positively correlated with both PCT and SOFA scores in frail elderly sepsis patients( r=0.426, 0.768, both P<0.05).Furthermore, logistic regression analysis identified urinary 8-oxoGuo and SOFA as independent risk factors for 28-day mortality in this population( OR=1.936, 1.427; P=0.006, 0.002).The area under the receiver operating characteristic curve(AUC)for urinary 8-oxoGuo and SOFA in predicting the 28-day prognosis of frail elderly sepsis patients was 0.761 and 0.741, respectively, both demonstrating statistical significance(both P<0.001). Conclusions:Our findings suggest that urinary 8-oxoGuo possesses strong predictive value for the short-term prognosis of sepsis in this vulnerable population.

Objective:To investigate the changes in sympathetic nerve activity after lower limb immobilization and the role of sympathetic nerve in regulating disuse atrophy of skeletal muscles.Methods:The experiment was divided into the following 3 parts: ① Twelve 8-week-old male C57 mice were randomly divided into a blank control group and a hind limb fixation group ( n=6). The blank control group received no intervention while the hind limb fixation group received splint fixation of the hind limbs for 2 weeks before the musculoskeletal multi-dimensional characterization was completed at the behavioral, pathological and molecular levels. ② Thirty-six 8-week-old male C57 mice were selected and randomly divided into a control group and 5 hind limb fixation groups (for 1, 3, 5, 7 and 14 days) ( n=6). The control group was fed normally until 14 days without any intervention while the 5 hind limb fixation groups were sampled after fixation for 1, 3, 5, 7 and 14 days, respectively. The level of norepinephrine in the serum and the expression level of tyrosine hydroxylase (TH), a marker of sympathetic nerve activity in the paraventricular nucleus of hypothalamus (PVN), were detected to observe the plasticity of sympathetic nerve activity. ③ Eighteen 8-week-old male C57 mice were selected and randomly divided into a blank control group, a hind limb fixation group and a hind limb fixation plus medication group ( n=6). The blank control group received no intervention while the 2 fixation groups were injected with phosphate buffer (PBS) and propranolol hydrochloride solution for 2 consecutive weeks, respectively. The parameters related to the skeletal muscles were compared between the 3 groups. Results:① Compared with the control group, the mass and function of skeletal muscles in the hind limb fixation group were statistically significantly decreased ( P<0.05). ② The levels of serum norepinephrine [(3.27±1.03) ng/mL, (9.21±1.05) ng/mL, (6.36±0.88) ng/mL, (3.84±1.00) ng/mL, and (3.91±0.75) ng/mL] and the PVN TH levels (42.00%±5.38%, 61.67%±5.57%, 55.82%±3.11%, 50.90%±2.53%, and 39.17%±9.07%) in the 5 hind limb fixation groups (for 1, 3, 5, 7 and 14 days) were significantly higher than those in the control group [(1.81±0.72)] ng/mL and 23.33%±5.50%] ( P<0.05). ③ The wet weight of the gastrocnemius muscle [(93.50±4.32) mg] and the cross-section area of the tibial anterior muscle [(1,180.00±95.09) μm 2] in the hind limb fixation plus medication group were increased significantly compared with those in the hind limb fixation group [(80.83±9.99) mg and (907.80±121.00) μm 2] ( P<0.05). Conclusions:Overactivation of the sympathetic nervous system occurs in the mice model of skeletal muscle disuse atrophy after hind limb fixation. Inhibition of sympathetic nerve activity may reduce the severity of skeletal muscle atrophy at the lower limbs.

Objective To investigate the relationship between plasma dipeptidyl peptidase 4 (DDP4) level and the progression of abdominal aortic aneurysm. Methods Forty-three patients with abdominal aortic aneurysm admitted to Baoji Central Hospital from January 2020 to May 2021 were selected. The follow-up was conducted at least 12 months,the absolute measurement of the maximum anterior-posterior diameters of the aneurysm and the rate of progression were obtained based on the first and last computed tomography angiography data,and the patients were divided into the progression group (with the rate of progression≥0.5 mm/year) and the progression-free group (with the rate of progression<0.5 mm/year) according to the rate of the abdominal aortic aneurysm progression. The clinical characteristics of the two groups were compared. Plasma DDP4 levels were detected by enzyme-linked immunosorbent assay. The correlation between plasma DDP4 and the rate of abdominal aortic aneurysm progression was analyzed by Pearson correlation and multiple linear regression. The predictive performance of plasma DDP4 on abdominal aortic aneurysm progression was analyzed by Logistic regression model and receiver operating characteristic (ROC) curve. Results The thickness of intracavitary thrombus (P=0.046) and the rate of abdominal aortic aneurysm progression (P<0.001) in the progression group were greater/faster than those in the the progression-free group,and the plasma level of DDP was significantly higher than that in the progression-free group (P<0.001). Multivariate Logistic regression analysis showed that plasma DDP4 level was an independent predictor of abdominal aortic aneurysm progression (P<0.05). Pearson correlation analysis showed that plasma DDP4 level was positively correlated with the rate of abdominal aortic aneurysm progression (r=0.517,P<0.001). After adjusting for other confounding factors,multiple linear regression showed that there was still a significantly positive correlation between plasma DDP4 level and abdominal aortic aneurysm progression rate (β=0.312,95％CI:0.002 to 0.484,P=0.048). The area under the curve of baseline plasma DDP4 level for predicting abdominal aortic aneurysm progression was 0.840 (95％CI:0.704 to 0.976),with corresponding cutoff value of 13.89 pg/mL,specificity of 85.7％,and sensitivity of 79.3％. Conclusion Elevated plasma DDP4 levels in patients with abdominal aortic aneurysm are associated with a higher risk of aneurysm progression. Plasma DDP4 is expected to be a predictive biomarker for abdominal aortic aneurysm progression.

Objective:To examine the relationships between perceived organizational support in job resources, self-efficacy in personal resources, and teaching commitment based on the job requirement-resource model, and to explore the path of influencing clinical teachers' teaching commitment.Methods:Using the convenience sampling method, 463 clinical teachers from 16 university-affilicated hospitals in Shandong Province, China were selected as the study subjects. Surveys were conducted using the Perceived Organizational Support Scale, Self-efficacy Scale, and Teaching Commitment Scale. A statistical analysis was performed using SPSS 26.0. A structural equation model was constructed using AMOS 26.0 to test the mediation effect.Results:①The level of teaching commitment of clinical teachers was relatively high, with a total score of (45.25±9.21) points. The total score of perceived organizational support was (38.22±9.75) points, and the total score of self-efficacy was (112.27±17.30) points. ②Perceived organizational support and self-efficacy were positively correlated with teaching commitment ( r=0.59, r=0.65, both P<0.01). ③ Perceived organizational support had significant and direct positive effects on teaching commitment and self-efficacy ( β=0.36, β=0.51, both P<0.01). Self-efficacy significantly and positively affected teaching commitment ( β=0.47, P<0.01). Self-efficacy played a significant and partial mediating role in the effect of perceived organizational support on teaching commitment (standardized mediating effect value of 0.239, P<0.01), and the mediating effect percentage was 39.83%. Conclusions:Perceived organizational support not only directly predicts clinical teachers' teaching commitment, but also indirectly affects teaching commitment through self-efficacy. University-affiliated hospital administrators should pay attention to clinical teachers' perceived organizational support to improve their self-efficacy and teaching commitment, thereby ensuring teaching quality.