ObjectiveTo investigate the mechanism by which Luoshi Neiyi prescription treats endometriosis （EMs） through the Toll-like receptor 4 （TLR4）/nuclear factor-κB （NF-κB） signaling pathway. MethodsAnimal experiments were conducted with 50 female SD rats， which were randomized into a sham operation group （10 rats） and a modeling group （40 rats）. An autologous endometrial transplantation method was used for the modeling of EMs. The 36 successfully modeled rats were randomly allocated into four groups （n=9 each）： The model group， the low-dose （7.87 g·kg^-1） Luoshi Neiyi prescription group， the high-dose （15.74 g·kg^-1） Luoshi Neiyi prescription group， and the dienogest （0.20 mg·kg^-1） group. The physiological status and ectopic lesion volumes of rats in each group were observed. Hematoxylin-eosin （HE） staining was used to observe the morphology of the eutopic endometrial tissue. Enzyme-linked immunosorbent assay （ELISA） was employed to measure the levels of inflammatory factors including interleukin-1β （IL-1β） and prostaglandin E₂ （PGE₂） in the serum of EMs rats. Immunohistochemistry was used to detect the expression of matrix metalloproteinase-9 （MMP-9） and vascular endothelial growth factor A （VEGFA） in the eutopic endometrial tissue. Western blot was adopted to determine the protein levels of TLR4， myeloid differentiation factor 88 （MyD88）， phosphorylated nuclear factor-κB （p-NF-κB）/NF-κB， MMP-9， and VEGFA in the eutopic endometrial tissue. In the cell experiments， the cell-counting kit-8 （CCK-8） assay was employed to screen the optimal concentration of Luoshi Neiyi prescription-containing serum， and a scratch assay was performed to assess the migration ability of iheESCs cells. Interventions with Luoshi Neiyi prescription-containing serum， resatorvid （TAK-242， a TLR4 inhibitor）， and lipopolysaccharides （LPS， a TLR4 agonist） were conducted， and Western blot was used to detect the expression of proteins related to the TLR4/NF-κB signaling pathway. ResultsThis experiment successfully replicated 36 EMs rat models. Compared with the sham operation group， the model group exhibited visible ectopic lesions on the abdominal wall and an increase in the writhing response score （P<0.01）. Furthermore， HE staining revealed the model group exhibited a thickened eutopic epithelium， stromal cell disarrangement， and evident infiltration of inflammatory cells. In addition， the model group showed elevated serum levels of IL-1β and PGE₂ （P<0.05， P<0.01）， increased positive expression of MMP-9 and VEGFA in the ectopic endometrial tissue （P<0.01）， and up-regulated protein levels of TLR4， MyD88， p-NF-κB/NF-κB， MMP-9， and VEGFA in the ectopic endometrial tissue （P<0.05， P<0.01）. Compared with the model group， all treatment groups exhibited a reduction in the ectopic lesion volume （P<0.01）. Furthermore， the writhing response scores were decreased in the high-dose Luoshi Neiyi prescription group and the dienogest group （P<0.05， P<0.01）. The pathological state of the ectopic endometrial tissue was alleviated to varying degrees in the treatment groups. Low-dose Luoshi Neiyi prescription reduced serum PGE₂ levels， and high-dose Luoshi Neiyi prescription and dienogest decreased serum IL-1β and PGE₂ levels in EMs rats （P<0.05， P<0.01）. The treatment groups showed decreased positive expression of MMP-9 and VEGFA in the ectopic endometrial tissue （P<0.05， P<0.01） and down-regulated protein levels of TLR4， MyD88， p-NF-κB/NF-κB， MMP-9， and VEGFA in the ectopic endometrial tissue （P<0.05， P<0.01）. The cell experiments showed that 5%， 10%， and 20% Luoshi Neiyi prescription-containing sera significantly reduced the viability and inhibited the migration of iheESCs. Compared with the control group， 5%， 10%， and 20% Luoshi Neiyi prescription-containing serum groups and the TAK-242 group showed reduced protein levels of TLR4， MyD88， p-NF-κB/NF-κB， MMP-9， and VEGFA （P<0.01）. Compared with the control group， the LPS group showed increased expression of the above proteins （P<0.01）. Compared with the LPS group， the LPS+5%， 10%， and 20% Luoshi Neiyi prescription-containing serum groups showed reduced expression of the above proteins （P<0.05， P<0.01）. ConclusionLuoshi Neiyi prescription may modulate the TLR4/NF-κB signaling pathway to reduce the inflammatory response and histopathological damage in the eutopic endometrium and suppress the adhesive， invasive， and angiogenic biological processes in the ectopic endometrial tissue， thereby exerting its therapeutic effect on EMs.

Abstract To clarify the service targets, service contents, and safeguard mechanisms of the basic public service program for student vision health management, the study grounded in the current status of child and adolescent myopia prevention and control in China and integrated with the practical experience and innovative practices of Wuhan National Demonstration Area for Student Vision Health Management, takes education as the main thread and schools as the base, consolidating resources from multiple stakeholders including education administrative departments, schools, families, and professional technical service institutions. Centering on four core components—vision health education, monitoring and record keeping, risk prevention and control, and dynamic management, the study constructs a multi tiered basic public service system for vision health management of primary and secondary school students. It further proposes the use of an intelligent management platform and a "three tier color coded early warning" mechanism (red, yellow, blue) to prevent and control student myopia at the source, providing schools with replicable and operable implementation pathways to enhance the level of student vision health management.

Objective To explore the mediating effect of empowerment ability between type D personality and self-management behavior of patients with diabetes mellitus(DM).Methods A total of 738 patients with type 2 diabetes mellitus(T2DM)hospitalized in the Department of Endocrinology of three tertiary hospitals in Hainan Province from December 2022 to May 2023 were selected and divided into Type D personality(Type D,n=104)group and T2DM group(n=634).The general data,biochemical indexes,scores of negative emotion(NA),social inhibition(SI),empowerment ability,and scale of DM self-management activities(SDSCA)were compared between the two groups,and the correlation between type D personality,empowerment ability and self-management ability was analyzed.The mediating effect model was used to analyze the mediating effect of empowerment ability on the four self-management behaviors of patients with type D personality,and the chain mediating effect model was used to analyze the relationship between type D personality,empowerment ability,self-management behaviors and HbA1c.Results Compared with the T2DM group,HbA1c,proportion of rural residence,proportion of complications≥3,proportion of education level of junior high school or above,proportion of monthly income<3000 yuan,and NA and SI scores were significantly higher in the Type D group(P<0.05).The empowerment ability and scores of healthy diet,regular exercise,blood glucose monitoring and medication compliance were lower in the Type D group than in the T2DM group(P<0.05).Spearman correlation analysis showed that the empowerment ability score was positively correlated with the scores of healthy diet,regular exercise,blood glucose monitoring and medication compliance(P<0.05).NA and SI scores were negatively correlated with empowerment ability score,healthy diet,regular exercise,blood glucose monitoring and medication compliance(P<0.05).The results of model analysis with empowerment ability as the mediating variable showed that type D personality had direct,indirect and total effects on regular exercise,blood glucose monitoring,medication compliance and SDSCA total score(P<0.05),and indirect and total effects on regular diet score(P<0.05).The mediating effect of empowerment ability was significant(Bootstrap CI did not include 0).The chain mediating effect analysis showed that type D personality could indirectly affect HbA1c through empowerment ability,healthy diet(γ=0.389,95%CI 0.206～0.591),and medication compliance(γ=0.149,95%CI 0.040～0.265),and the effect proportion was 39.4%and 14.1%,respectively.Conclusions Type D personality can indirectly influence self-management behavior through the mediating effect of empowerment,and simultaneously affecting HbA1c through the chain effect of empowerment,diet,and medication behavior.

Objective:To investigate the correlations among diabetes-related distress, self-management behavior, empowerment, and glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes mellitus (T2DM) .Methods:A convenience sampling method was used to recruit a total of 1 927 hospitalized patients with T2DM from the Endocrinology Departments of five tertiary general hospitals in Hainan, Jiangsu, and Henan Provinces between December 2022 and December 2023. General demographic and clinical data were collected. The Problem Areas in Diabetes 5 (PAID-5), the Summary of Diabetes Self Care Activities (SDSCA), and the Diabetes Empowerment Scale-Short Form (DES-SF) were used to evaluate patients' psychological distress, self-management behaviors, and empowerment levels. Pearson correlation analysis was performed to examine the relationships among diabetes-related distress, empowerment, self-management behaviors, and HbA1c levels.Results:Pearson correlation analysis showed that diabetes-related distress was negatively correlated with empowerment ( r=-0.119, P<0.001) and the total score of self-management behavior ( r=-0.106, P<0.001), and positively correlated with HbA1c levels ( r=0.103, P<0.001). Empowerment was positively correlated with self-management behavior ( r=0.538, P<0.001) and negatively correlated with HbA1c levels ( r=-0.170, P<0.001). Self-management behavior was negatively correlated with HbA1c levels ( r=-0.165, P<0.001) . Conclusions:Diabetes-related distress, empowerment, and self-management behavior are all associated with glycemic control. Future research and interventions should focus on enhancing patients' self-management abilities, strengthening empowerment, and providing psychological support in order to improve glycemic outcomes and offer a more comprehensive and effective management approach for patients with T2DM.

Objective:To construct univariate and multivariate relapse free survival (RFS) prediction models for breast cancer patients with diabetes mellitus type 2 (T2DM) and to compare and select the model with higher predictive performance.Methods:A total of 912 breast cancer patients treated at the First Affiliated Hospital of Dalian Medical University from January 2010 to December 2016 were included, of which 202 patients had T2DM and 710 patients did not. Kaplan-Meier survival curve was drawn based on whether patients had T2DM, and log-rank test was performed based on whether patients had T2DM. All patients were randomly divided into a training set ( n=640) and a validation set ( n=272) at a ratio of 7∶3. Univariate and multivariate Cox proportional risk regression models were used to analyze RFS in breast cancer patients with the survival package. The "rms" package was employed to construct univariate and multivariate RFS prediction models for breast cancer patients with T2DM. Clinical decision curves and calibration curves were used to validate the models. The receiver operator characteristic (ROC) curve was used to compare and analyze the prediction performance of the two models. Results:There were no statistically significant differences between the training set and the validation set patients in terms of age, T2DM, surgical approach, axillary management methods, T stage, N stage, molecular sub-type, estrogen receptor (ER) 1, ER2, progesterone receptor (PR) , ER and PR consistency, Ki67, human epidermal growth factor receptor 2 (HER2) (all P>0.05) . There was a statistically significant difference in histological grade ( χ2=7.59, P=0.022) . Survival analysis showed that the 5-year RFS rate was 83.7% in patients with T2DM and 92.3% in patients without T2DM ( χ2=16.61, P<0.001) . Univariate analysis revealed that age ( HR=1.04, 95% CI: 1.03-1.06, P<0.001) , T2DM ( HR=2.31, 95% CI: 1.49-3.55, P<0.001) , surgical approach ( HR=2.39, 95% CI: 1.20-4.77, P=0.013) , axillary management methods ( HR=2.62, 95% CI: 1.72-3.98, P<0.001) , T stage (T 2: HR=2.13, 95% CI: 1.36-3.31, P<0.001; T 3: HR=6.90, 95% CI: 3.35-14.22, P<0.001) , N stage (N 2: HR=3.87, 95% CI: 2.12-7.07, P<0.001; N 3: HR=8.61, 95% CI: 4.71-15.75, P<0.001) , molecular sub-type (Luminal B: HR=2.74, 95% CI: 1.17-6.36, P=0.019; HER2 +: HR=3.64, 95% CI: 1.38-9.58, P=0.009; TNBC: HR=4.40, 95% CI: 1.71-11.34, P=0.002) , ER1 (>10%: HR=0.57, 95% CI: 0.37-0.90, P=0.016) , ER2 ( HR=0.57, 95% CI: 0.37-0.89, P=0.015) , and PR ( HR=0.56, 95% CI: 0.37-0.86, P=0.008) were all factors influencing RFS in breast cancer patients. Multivariate analysis demonstrated that age ( HR=1.04, 95% CI: 1.02-1.06, P<0.001) , T2DM ( HR=1.82, 95% CI: 1.16-2.85, P=0.009) , T stage (T 2: HR=1.60, 95% CI: 1.01-2.54, P=0.046; T 3: HR=2.64, 95% CI: 1.22-5.72, P=0.014) , N stage (N 2: HR=3.72, 95% CI: 2.01-6.88, P<0.001; N 3: HR=5.34, 95% CI: 2.78-10.25, P<0.001) , and ER1 (>10%: HR=0.63, 95% CI: 0.39-0.99, P=0.046) were independent factors influencing RFS in breast cancer patients. Based on the 10 and 5 variables with P<0.05 in the univariate and multivariate analyses respectively, the nomograms of the univariate and multivariate prediction models were constructed to evaluate the influence of factors such as T2DM on the postoperative RFS of breast cancer patients. Clinical decision curves and calibration curves indicated that both models had high predictive value for RFS in breast cancer patients, and the predictive results were highly consistent with the actual observed results. ROC curve analysis showed that there was no statistically significant difference in the area under the curve (AUC) of the two models for predicting the RFS rates of breast cancer patients in the training set and validation set at 36, 60, and 84 months (all P>0.05) , indicating that the predictive efficacy of the two models was comparable. The multivariate model is more suitable for clinical application because it uses fewer variables. Conclusions:Breast cancer patients with T2DM have poorer prognosis. Age, T2DM, T stage, N stage, and ER1 are independent factors influencing postoperative RFS in breast cancer patients. The multi-factor prediction model of RFS in breast cancer patients based on T2DM is more suitable for clinical application due to its higher predictive efficacy and fewer variables.

Objective To explore the mediating effect of empowerment ability between type D personality and self-management behavior of patients with diabetes mellitus(DM).Methods A total of 738 patients with type 2 diabetes mellitus(T2DM)hospitalized in the Department of Endocrinology of three tertiary hospitals in Hainan Province from December 2022 to May 2023 were selected and divided into Type D personality(Type D,n=104)group and T2DM group(n=634).The general data,biochemical indexes,scores of negative emotion(NA),social inhibition(SI),empowerment ability,and scale of DM self-management activities(SDSCA)were compared between the two groups,and the correlation between type D personality,empowerment ability and self-management ability was analyzed.The mediating effect model was used to analyze the mediating effect of empowerment ability on the four self-management behaviors of patients with type D personality,and the chain mediating effect model was used to analyze the relationship between type D personality,empowerment ability,self-management behaviors and HbA1c.Results Compared with the T2DM group,HbA1c,proportion of rural residence,proportion of complications≥3,proportion of education level of junior high school or above,proportion of monthly income<3000 yuan,and NA and SI scores were significantly higher in the Type D group(P<0.05).The empowerment ability and scores of healthy diet,regular exercise,blood glucose monitoring and medication compliance were lower in the Type D group than in the T2DM group(P<0.05).Spearman correlation analysis showed that the empowerment ability score was positively correlated with the scores of healthy diet,regular exercise,blood glucose monitoring and medication compliance(P<0.05).NA and SI scores were negatively correlated with empowerment ability score,healthy diet,regular exercise,blood glucose monitoring and medication compliance(P<0.05).The results of model analysis with empowerment ability as the mediating variable showed that type D personality had direct,indirect and total effects on regular exercise,blood glucose monitoring,medication compliance and SDSCA total score(P<0.05),and indirect and total effects on regular diet score(P<0.05).The mediating effect of empowerment ability was significant(Bootstrap CI did not include 0).The chain mediating effect analysis showed that type D personality could indirectly affect HbA1c through empowerment ability,healthy diet(γ=0.389,95%CI 0.206～0.591),and medication compliance(γ=0.149,95%CI 0.040～0.265),and the effect proportion was 39.4%and 14.1%,respectively.Conclusions Type D personality can indirectly influence self-management behavior through the mediating effect of empowerment,and simultaneously affecting HbA1c through the chain effect of empowerment,diet,and medication behavior.

Objective:To investigate the correlations among diabetes-related distress, self-management behavior, empowerment, and glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes mellitus (T2DM) .Methods:A convenience sampling method was used to recruit a total of 1 927 hospitalized patients with T2DM from the Endocrinology Departments of five tertiary general hospitals in Hainan, Jiangsu, and Henan Provinces between December 2022 and December 2023. General demographic and clinical data were collected. The Problem Areas in Diabetes 5 (PAID-5), the Summary of Diabetes Self Care Activities (SDSCA), and the Diabetes Empowerment Scale-Short Form (DES-SF) were used to evaluate patients' psychological distress, self-management behaviors, and empowerment levels. Pearson correlation analysis was performed to examine the relationships among diabetes-related distress, empowerment, self-management behaviors, and HbA1c levels.Results:Pearson correlation analysis showed that diabetes-related distress was negatively correlated with empowerment ( r=-0.119, P<0.001) and the total score of self-management behavior ( r=-0.106, P<0.001), and positively correlated with HbA1c levels ( r=0.103, P<0.001). Empowerment was positively correlated with self-management behavior ( r=0.538, P<0.001) and negatively correlated with HbA1c levels ( r=-0.170, P<0.001). Self-management behavior was negatively correlated with HbA1c levels ( r=-0.165, P<0.001) . Conclusions:Diabetes-related distress, empowerment, and self-management behavior are all associated with glycemic control. Future research and interventions should focus on enhancing patients' self-management abilities, strengthening empowerment, and providing psychological support in order to improve glycemic outcomes and offer a more comprehensive and effective management approach for patients with T2DM.

Objective:To construct an evidence-based prediction model for early recurrence after surgery of hepatocellular carcinoma (HCC) based on Meta-analysis and to do external validation study.Methods:The literatures in Chinese National Knowledge Infrastructure, Wanfang, VIP, Chinese Science Citation Database (CSCD), Chinese Social Science Citation System (CCSCI), PubMed, Web of Science and IEEE databases between January 2019 and December 2023 were searched based on the subject words. According to the inclusion and exclusion criteria, 9 literatures were included to screen the risk factors affecting the early recurrence of HCC. When the same risk factor was found in ≥5 included literatures, Meta-analysis was performed by using Review Manager 5.4.1 software. External validation data were collected from 401 patients with primary HCC who underwent surgery in Liaoning Cancer Hospital between March 2014 and March 2017. The patients were divided into early recurrence group (176 cases) and early non-recurrence group (225 cases) according to whether they relapsed 2 years after surgery. The OR values of all risk factors obtained in the Meta-analysis were converted into modeling, and postoperative early recurrence rate of HCC in the Meta-analysis was used to calculate β 0, and finally the logistic model was obtained. The OR value was incorporated into the logit (P) model, and the morbidity (P) of the external validation data was calculated. Taking the recurrence 2 years after surgery or not as the dependent variable and P as the independent variable, the receiver operating characteristic (ROC) curve was drawn to calculate the area under the curve (AUC). Results:A total of 8 risk factors for early HCC recurrence were screened out from 9 literatures (x 1: alpha-fetoprotein ≥ 400 ng/ml; x 2: tumor number ≥ 2; x 3: the longest tumor diameter ≥ 5 cm; x 4: Barcelona staging B-C; x 5: microvascular invasion; x 6: moderate to low differentiation; x 7: incomplete capsule; x 8: nonanatomic hepatectomy). The Meta-analysis included 1 757 HCC cases, with 960 postoperative early recurrences and an early recurrence rate of 45.36%, finally the β 0 value was -0.201. The predictive model for 2-year recurrence of HCC was constructed and calculated as logit (P) = -0.201+0.835x 1+0.905x 2+0.783x 3+1.008x 4+0.765x 5+0.831x 6+1.533x 7+0.940x 8. Analysis of variance by external validation data showed that the differences in ascites, alpha-fetoprotein, tumor number, tumor diameter, Barcelona staging, microvascular invasion, tumor differentiation degree, capsule invasion, resection type, and systemic inflammation index were statistically significant between early recurrence group and early non-recurrence group (all P < 0.05). ROC curve analysis showed that AUC of postoperative early recurrence of HCC predicted by the model was 0.718, (95% CI: 0.689-0.753), the optimal cut-off value was 3.11, the Yoden index was 0.288, the sensitivity was 69.32%, and the specificity was 69.56%. Conclusions:The evidence-based prediction model constructed based on Meta-analysis for postoperative early recurrence of HCC has a high predictive value. However, further verification and optimization with big data is still needed.

Objective:To explore the relationship between normal serum creatinine(Scr) level and diabetic kidney disease(DKD) in patients with type 2 diabetes mellitus(T2DM).Methods:This was a prospective cohort study. Patients with yet not DKD who were regularly followed up at six centers of Li′s United Clinic in Taiwan, China from January 1, 2002 to December 31, 2018 were selected. At baseline, clinic information and lab tests were collected. According to whether the patients developed DKD during the follow-up period, they were divided into DKD group and non-DKD(NDKD) group. The exposure factor was the Scr(μmol/L) value, and it was used as a categorical variable. According to the quartiles of Scr, they were divided into 4 groups: Q1 group(Scr<57.68 μmol/L), Q2 group(57.68 μmol/L≤Scr<68.51 μmol/L), Q3 group(68.51 μmol/L≤Scr<80.44 μmol/L) and Q4 group(Scr≥80.44 μmol/L). The Cox regression model was used to explore the relationship between Scr level and the incidence of DKD. Receiver operating characteristic(ROC) curve was used to analyze the predictive effect of normal level Scr on DKD. Results:A total of 2 202 T2DM patients without DKD at baseline were included. After a follow-up period of(5.2±2.17) years, there were 966 patients in the DKD group and 1 236 patients in the NDKD group. Compared with the NDKD group, the DKD group had older age, longer duration of diabetes, higher BMI, SBP, DBP, LDL-C, Scr, and UACR(all P<0.05). Cox regression analysis results showed that compared with the Q1 group as the reference, the risk of developing DKD in the Q2, Q3, and Q4 groups after adjusting for confounding factors was 1.394, 1.688, and 2.821 times higher, respectively(all P<0.05). ROC curve analysis results showed that the area under the curve(AUC) for predicting DKD occurrence using normal serum creatinine level was 0.70(95% CI 0.678-0.722), with an optimal cutoff value of 74.27 μmol/L, sensitivity of 0.54, and specificity of 0.76. The cumulative risk plot showed that after adjusting for confounding factors, patients in the Q4 group had a higher cumulative risk of developing DKD compared to the Q1, Q2, and Q3 groups(all P<0.05). Conclusion:Scr is an independent risk factor for developing DKD in patients with T2DM. The higher the Scr level, the greater the risk, especially when Scr is greater than 74.27 μmol/L.

Objective To explore the predictive effect of empowerment and theory of planned behavior(TPB)on the four core behaviors of type 2 diabetes mellitus(T2DM)self-management,and analyze the influence path of TPB model and behavioral intention on the four core behaviors.Methods A total of 500 T2DM patients who were hospitalized in the Endocrinology Department of three tertiary general hospitals in different provinces from December 2022 to May 2023 were selected for investigation.Hierarchical multiple regression analysis was used to explore the predictive effects of empowerment and TPB models on self-management behaviors.Bootstrap method was used to analyze the influence path of TPB model and behavior intention on self-management behaviors.Results Empowerment had a predictive effect on self-management behavior,which was improved after the addition of TPB,with medication R2=0.194,blood glucose monitoring R2=0.308,regular diet R2=0.337 and regular exercise R2=0.343,respectively.Mediation effect analyses revealed that attitude,subjective norm,and perceived behavioral control were observed to predict behavior intention across the four behaviors,and the three except through the behavior intention indirectly affect behavior,can also directly affect the behavior.Conclusions Empowerment can predict self-management behavior,and adding TPB to this can improve the prediction effect.Attitude,subjective norms and perceived control can indirectly or directly affect self-management behavior through behavioral intention.