The Proctor's reporting guideline for implementation strategies represents a landmark framework in the field of implementation science, aiming to address the issue of inconsistent reporting in implementation research by standardizing the naming, definition, and operationalization of implementation strategies, thereby enhancing the credibility and utility of research findings. This paper provides an in-depth interpretation of the core connotations of this reporting guideline and illustrates its application in developing interview outlines and specifying implementation strategies, using a brief smoking cessation intervention project as a case study. Through this reporting guideline, abstract recommendations for implementation are systematically transformed into clear, multidimensional operational guides, significantly improving the transparency of strategy connotations and the replicability of actual execution. Meanwhile, the case study highlights the flexibility of the guideline, which allows researchers to adapt the content and format of strategies based on local resources and cultural contexts, thus enhancing practical adaptability while maintaining scientific rigor. However, the application of Proctor's reporting guideline still faces challenges, primarily manifested in the potential confusion surrounding the constructs of temporality and dose in practice, as well as the challenges that the inherent flexibility of the guideline may pose to the assessment of fidelity and effectiveness. Despite these limitations, the reporting guideline remains a vital tool for implementation research; future efforts should focus on optimizing its application—through refining operational guidelines, standardizing flexible adaptations, and involving stakeholders—to better guide implementation studies and continuously promote high-quality development in the field.

OBJECTIVE To establish the graded management standards for off-label use of Shenqi fuzheng injection. METHODS Systematic searches were conducted in databases including CNKI， PubMed and the Cochrane Library to retrieve guidelines/consensuses， systematic reviews/meta-analyses， and randomized controlled trials （RCTs） of Shenqi fuzheng injection. The quality of evidence was evaluated using AGREE Ⅱ， AMSTAR Ⅱ， and the Risk of Bias 1.0 tool recommended by Cochrane Collaboration， and the graded management standard for off-label use of Shenqi fuzheng injection was developed by using the Thomson grading system. RESULTS A total of 534 articles were involved， including 11 guidelines， 22 systematic reviews/meta-analysis， and 501 RCTs. They covered 79 off-label indications for Shenqi fuzheng injection： cancer-related fatigue， colorectal cancer and breast cancer， all with high-quality evidence were classified under grade A management （grade Ⅰ commendation）， allowing all physicians across the hospital to prescribe relevant treatments； five diseases， such as ovarian cancer， liver cancer， leukemia， heart failure and cerebral infarction， were classified under grade B management （grade Ⅱa commendation）， with prescription restricted to physicians with intermediate or higher professional titles in specific departments； eleven diseases， including sepsis， cervical cancer， esophageal cancer， etc.， were classified under grade C management （grade Ⅱb commendation）， requiring strict evaluation by senior physicians before prescription； the use of Shenqi fuzheng injection for other conditions was explicitly prohibited due to a lack of sufficient evidence. CONCLUSIONS Off-label use of Shenqi fuzheng injection is prevalent. The graded management standard established by evidence-based medical approach provides a scientific basis for standardizing the clinical application of traditional Chinese medicine injections and offers an operable paradigm for implementing differentiated drug use supervision in medical institutions.

OBJECTIVE: To evaluate the effectiveness of tibial nerve transection with epineurial suture and division of the common plantar digital nerve branches in the treatment of congenital macrodactyly in children. METHODS: A retrospective analysis was conducted on clinical data from 9 children with congenital macrodactyly who met the selection criteria and were admitted between January 2018 and December 2024. The cohort included 4 boys and 5 girls, aged 1-6 years (median, 3 years). Syndactyly of the second and third toes was present in 2 patients. Hypertrophy distribution was as follows: 1 case of single-ray involvement, 4 of double-ray, 1 of triple-ray, 1 of quadruple-ray, and 2 of quintuple-ray. Preoperatively, 7 cases exhibited limitations in both active and passive flexion and extension of the affected toes; in 2 cases, active movement was restricted while passive motion remained intact. All 9 children were unable to wear standard-sized footwear for the unaffected foot. Six presented with a limp, and 3 had difficulty walking. All 9 cases were moderate to severe progressive macrodactyly, and the growth rate of the affected foot was significantly faster than that of the healthy side. Six cases had undergone prior surgical interventions at other institutions, but disease progression continued postoperatively. All 9 patients underwent tibial nerve transection with epineurial suture and selective division of the common plantar digital nerve branches. At last follow-up, the foot growth rate was calculated (compared with that immediately after operation), and the changes of plantar pain sensation in the affected foot were detected before operation, immediately after operation, and at last follow-up, and the surgical efficacy was evaluated based on improvements in shoe fit and gait function. RESULTS: All 9 children were followed up 6-36 months, with an average of 18 months. All the incisions healed by first intention, and no infection or plantar ulceration occurred. At last follow-up, the growth rate of the affected foot was 0.10 (0.04, 0.14) cm/month, which was significantly slower than that of the healthy foot [0.14 (0.08, 0.18) cm/month] ( Z=3.951, P<0.001). Preoperatively, plantar pain sensation was absent in all cases; it was restored immediately after operation. At last follow-up, 6 patients had absent pain sensation, 2 had partial preservation (involving certain toes and central plantar regions), and 1 patient (with 3-year follow-up) exhibited regained sensation in multiple plantar areas. Gait improved in most cases, in which 8 children achieved normal ambulation, while 1 continued to limp due to leg-length discrepancy. Surgical efficacy were rated as excellent in 1 case, good in 7, and fair in 1. CONCLUSION Tibial nerve transection with epineurial suture combined with selective division of the common plantar digital nerve branches effectively reduces the growth rate of congenital macrodactyly in children, has minimal impact on plantar sensory function, and does not result in plantar ulcers or impaired ambulation.
Humans ; Male ; Female ; Child, Preschool ; Child ; Retrospective Studies ; Infant ; Tibial Nerve/surgery* ; Toes/surgery* ; Treatment Outcome ; Suture Techniques ; Fingers/surgery* ; Foot/innervation* ; Limb Deformities, Congenital

To address the problem of large reconstruction errors in 3D pulse signals caused by excessively small out-of-plane displacement of the contact membrane in the existing traditional Chinese medicine fingertip tactile binocular vision detection technology, this study proposes a 3D pulse image detection method based on subtle motion magnification technology and explores its application in pulse pattern recognition. Firstly, a 3D pulse image detection system based on binocular vision to obtain pulse image signals is developed as experimental data. Then, the phase motion video magnification algorithm is used to amplify the original signals, and the amplified signals are reconstructed in three dimensions to obtain 3D pulse signals. On this basis, nine features are extracted from the 3D pulse signals and features selection is performed using a two-sample Kolmogorov-Smirnov test. Finally, machine learning algorithms such as decision trees and random forests are used to identify the five types of pulse conditions: deep pulse, intermittent pulse, flooding pulse, slippery pulse, and rapid pulse. The experimental results show that compared to the methods without subtle motion magnification technology, the proposed method significantly improves waveform clarity, amplitude stability, and periodic regularity. Meanwhile, the average accuracy in pulse pattern recognition reaches 96.29%±0.26%.
Algorithms ; Imaging, Three-Dimensional/methods* ; Pattern Recognition, Automated ; Medicine, Chinese Traditional ; Motion ; Humans ; Pulse ; Signal Processing, Computer-Assisted ; Machine Learning

Abdominal aortic aneurysm (AAA) is a deadly condition of the aorta, carrying a significant risk of death upon rupture. Currently, there is a dearth of efficacious pharmaceutical interventions to impede the advancement of AAA and avert it from rupturing. Here, we investigated dihydromyricetin (DHM), one of the predominant bioactive flavonoids in Ampelopsis grossedentata (A. grossedentata), as a potential agent for inhibiting AAA. DHM effectively blocked the formation of AAA in angiotensin II-infused apolipoprotein E-deficient (ApoE^-/-) mice. A combination of network pharmacology and whole transcriptome sequencing analysis revealed that DHM's anti-AAA action is linked to heme oxygenase (HO)-1 (Hmox-1 for the rodent gene) and hypoxia-inducible factor (HIF)-1α in vascular smooth muscle cells (VSMCs). Remarkably, DHM caused a robust rise (∼10-fold) of HO-1 protein expression in VSMCs, thereby suppressing VSMC inflammation and oxidative stress and preserving the VSMC contractile phenotype. Intriguingly, the therapeutic effect of DHM on AAA was largely abrogated by VSMC-specific Hmox1 knockdown in mice. Mechanistically, on one hand, DHM increased the transcription of Hmox-1 by triggering the nuclear translocation and activation of HIF-1α, but not nuclear factor erythroid 2-related factor 2 (NRF2). On the other hand, molecular docking, combined with cellular thermal shift assay (CETSA), isothermal titration calorimetry (ITC), drug affinity responsive target stability (DARTS), co-immunoprecipitation (Co-IP), and site mutant experiments revealed that DHM bonded to HO-1 at Lys243 and prevented its degradation, thereby resulting in considerable HO-1 buildup. In summary, our findings suggest that naturally derived DHM has the capacity to markedly enhance HO-1 expression in VSMCs, which may hold promise as a therapeutic strategy for AAA.

Although clinical evidence suggests that nonalcoholic fatty liver disease is an established major risk factor for heart failure, it remains unexplored whether sleep disorder-caused hepatic damage contributes to the development of cardiovascular disease (CVD). Here, our findings revealed that sleep fragmentation (SF) displayed notable hepatic detrimental phenotypes, including steatosis and oxidative damage, along with significant abnormalities in cardiac structure and function. All these pathological changes persisted even after sleep recovery for 2 consecutive weeks or more, displaying memory properties. Mechanistically, persistent higher expression of nicotinamide adenine dinucleotide phosphate oxidase 4 (NOX4) in the liver was the key initiator of SF-accelerated damage phenotypes. SF epigenetically controlled the acetylation of histone H3 lysine 27 (H3K27ac) enrichment at the Nox4 promoter and markedly increased Nox4 expression in liver even after sleep recovery. Moreover, fine coordination of the circadian clock and hepatic damage was strictly controlled by BMAL1-dependent Sirtuin 1 (Sirt1) transcription after circadian misalignment. Accordingly, genetic manipulation of liver-specific Nox4 or Sirt1, along with pharmacological intervention targeting NOX4 (GLX351322) or SIRT1 (Resveratrol), could effectively erase the epigenetic modification of Nox4 by reducing the H3K27ac level and ameliorate the progression of liver pathology, thereby counteracting SF-evoked sustained CVD. Collectively, our findings may pave the way for strategies to mitigate myocardial injury from persistent hepatic detrimental memory in diabetic patients.

A major obstacle in type 2 diabetes mellitus (T2DM) is sleep fragmentation (SF), which negatively affects testicular function. However, the underlying mechanisms remain to be elucidated. In this study, we demonstrate that SF induces testicular damage through a mechanism involving lipid metabolism, specifically mediated by melatonin (MEL) receptor 1a (MT1). T2DM mice with SF intervention displayed several deleterious phenotypes such as apoptosis, deregulated lipid metabolism, and impaired testicular function. Unexpectedly, sleep recovery (SR) for 2 consecutive weeks could not completely abrogate SF's detrimental effects on lipid deposition and testicular function. Interestingly, MEL and MT1 agonist 2-iodomelatonin (2IM) effectively improved lipid homeostasis, highlighting MEL/2IM as a promising therapeutic drug for SF-trigged testicular damage. Mechanistically, MEL and 2IM activated FGFR1 and sequentially restrained the crosstalk and physical interaction between TAB1 and TAK1, which ultimately suppressed the phosphorylation of TAK1 to block lipid deposition and cell apoptosis caused by SF. The ameliorating effect of MEL/2IM was overtly nullified in Fgfr1 knockout (Fgfr1-KO ^+/- ) diabetic mice. Meanwhile, testicular-specific overexpression of Tak1 abolished the protective effect of FGF1^mut on diabetic mouse testis. Our findings offer valuable insights into the molecular mechanisms underlying the testicular pathogenesis associated with SF and propose a novel therapeutic approach for addressing male infertility in T2DM.

Objective To investigate the carrying status and drug resistance analysis of pathogenic bacteria in the gut of healthy population in Huadu District,Guangzhou,and provide reference for epidemiological re-search.Methods A total of 337 459 anal swabs were directly isolated and cultured from healthy individuals who underwent physical examinations from 2018 to 2023.600 anal swabs from 2022 were randomly selected for multi pathogen nucleic acid testing,direct isolation and culture,and enrichment culture.Identification of bacteria was conducted by using VITEK 2 Compact and VITEK MS,serological testing was used for determi-nation of type,and drug susceptibility testing of pathogenic bacteria was conducted.Results A total of 128 pathogenic bacteria were isolated from rectal swabs,including 52 strains of Salmonella,71 strains of Aero-monas,3 strains of Vibrio parahaemolyticus,and 2 strains of Shigella flexneri,with a total detection rate of 3.79/10 000.The detection rate of Salmonella in direct isolation and culture of 600 rectal swabs was 0.50％,the detection rate of enrichment culture was 1.00％,and the detection rate of multi-pathogen nucleic acid de-tection was 1.17％.52 strains of Salmonella were divided into 27 serotypes,and Salmonella Ⅰ 4,5,12:i:—was the dominant serotype.Aeromonas sobria was the dominant serotype in Aeromonas.The sensitivity of Salmonella to piperacillin/tazobactam,imipenem,cefepime,levofloxacin,and aztreonam was up to 92.00％or more,however,the phenomenon of multidrug resistance was severe,with a multidrug resistance rate as high as 40.38％.The resistance rate of Aeromonas to ampicillin and ampicillin/sulbactam was up to 85.00％or more,while Aeromonas was relatively sensitive to other antibiotics.Conclusion There are many species and types of intestinal pathogenic bacteria carried by healthy individuals in Huadu District,Guangzhou,with Aero-monas and Salmonella ranking first and second,and levofloxacin treatment could be preferred.The use of bac-terial culture and multi pathogen nucleic acid testing methods could improve the detection rate of intestinal pathogenic bacteria,and attention should be paid to the monitoring of intestinal pathogenic bacteria among rel-evant practitioners.

Objective:To establish fingerprints of Faeces Bombycis and simultaneously determine the content of four amino acids; To evaluate the quality of Faeces Bombycis from different regions. The fingerprint of Faeces Bombycis was established and the contents of 4 amino acids were determined.Methods:Kromasil 100-5 C18 (4.6 mm×250 mm, 5 μm) column was used for phenyl isothiocyanate (PITC) pre-column derivation-high performance liquid chromatography with acetonitrile-0.1 mol/L sodium acetate solution (pH adjusted to 6.5 with acetic acid) (7:93) mixed solution, and acetonitrile-water (4:1) mixed solution were mobile phase for gradient elution. The flow rate was 1.0 ml/min; the column temperature was 35 ℃; the detection wavelength was 254 nm; the injection amount was 5 μl. The fingerprints of 17 batches of Faeces Bombycis were established, the common peaks were identified by comparison of reference materials, and the similarity evaluation and principal component analysis (PCA) were carried out. The contents of glycine, alanine, proline and phenylalanine were determined simultaneously.Results:A total of 12 common peaks were identified from the fingerprints of Faeces Bombycis, and 12 amino acids were identified. The similarity of 17 batches of samples was greater than 0.95. PCA analysis showed that the regional difference of the quality of Faeces Bombycis was not significant. Faeces Bombycis produced in Qujing city in Yunnan Province had the highest total contents of 4 amino acids.Conclusion:The method has good repeatability and can provide reference for the quality evaluation and standard improvement of Faeces Bombycis.

Objective:To establish a quality control method for Aiye standard decoction.Methods:The ultra performance liquid chromatogrphy (UPLC) column Waters ACQUITY HSS T3 C18 (2.1 mm×150 mm,1.8 μm) was used to gradient elution by acetonitrile and 0.1% formic acid in water. 16 batches of Aiye standard decoction fingerprints were established by UPLC and the common peaks were determined in the fingerprints. The contents of 12 components were determined. The 16 batches of Aiye standard decoction were analyzed by similarity calculation, hierarchical cluster analysis (HCA), principal component analysis (PCA) and orthogonal partial least squares discriminant analysis (OPLS-DA) for analysis of differential components of Artemisiae Argyi Folium from different origins.Results:A total of 13 common peaks were marked in the fingerprints of 16 batches of Aiye standard decoction, 12 of which were identified by comparison with reference substance, including chlorogenic acid, sochlorogenic acid A, neochlorogenic acid, cryptochlorogenic acid, caffeic acid,1,3-O-Dicaffeoylquinic acid, schaftoside, isochlorogenic acid B,1,5-O-Dicaffeoylquinic acid, isochlorogenic acid C, jaceosidin and eupatilin. Similarity evaluation, PCA and HCA all classified the 16 batches of Aiye standard decoction into 2 categories. Orthogonal partial least squares discriminant analysis screened 5 differential biomarkers from 13 common peaks. The content determination results showed that the phenolic compounds and flavonoids in samples from Hubei were significantly higher than that in samples from other areas.Conclusion:This method can effectively analyze the differences in the quality of Aiye standard decoction from different origins, and provide reference for the formulation of quality standards for Aiye standard decoction and related preparations.