Objective: To investigate the objective characteristics of tongue manifestation in different stages of damp-heat syndrome in diabetic kidney disease (DKD). Methods: A cross-sectional study enrolled 134 patients with DKD G3-5 stages who met the diagnostic criteria for damp-heat syndrome in DKD. The patients were treated at Dongzhimen Hospital, Beijing University of Chinese Medicine, from May 2023 to January 2024. The patients were divided into three groups: DKD G3, DKD G4, and DKD G5 stage, with 53, 33, and 48 patients in each group, respectively. Clinical general data (gender, age, and body mass index) and damp-heat syndrome scores were collected from the patients. The YZAI-02 traditional Chinese medicine (TCM) AI Tongue Image Acquisition Device was used to capture tongue images from these patients. The accompanying AI Open Platform for TCM Tongue Diagnosis of the device was used to analyze and extract tongue manifestation features, including objective data on tongue color, tongue quality, coating color, and coating texture. Clinical data and objective tongue manifestation characteristics were compared among patients with DKD G3-5 based on their DKD damp-heat syndrome status. Results: No statistically significant difference in gender or body mass index was observed among the three patient groups. The DKD G3 stage group had the highest age (P<0.05). The DKD G3 stage group had a lower score for symptoms of poor appetite and anorexia(P<0.05) than the DKD G5 group. No statistically significant difference was observed in damp-heat syndrome scores among the three groups. Compared with the DKD G5 stage group, the DKD G3 stage group showed a decreased proportion of pale color at the tip and edges of the tongue (P<0.05). The DKD G4 stage group exhibited an increased proportion of crimson at the root of the tongue, a decreased proportion of thick white tongue coating at the root, a decreased proportion of pale color at the tip and edges of the tongue, an increased hue value (indicating color tone) of the tongue color in the middle, an increased brightness value (indicating color lightness) of the tongue coating color in the middle, and an increased thickness of the tongue coating (P<0.05). No statistically significant difference was observed in other tongue color proportions, color chroma values, body characteristics, coating color proportions, coating color chroma values, and coating texture characteristics among the three groups. Conclusion Tongue features differ in different stages of DKD damp-heat syndrome in multiple dimensions, enabling the inference that during the DKD G5 stage, the degree of qi and blood deficiency in the kidneys, heart, lungs, liver, gallbladder, spleen, and stomach is prominent. Dampness is more likely to accumulate in the lower jiao, particularly in the kidneys, whereas heat evil in the spleen and stomach is the most severe. These insights provide novel ideas for the clinical treatment of DKD.

Addressing the enduring challenge of evaluating traditional Chinese medicines (TCMs), the integrated evidence chain-based effectiveness evaluation of TCMs (Eff-iEC) has emerged. This paper explored its capacity through a demonstration study that evaluated the effectiveness evidence of six commonly used anti-hepatic fibrosis Chinese patent medicines (CPMs), including Biejiajian Pill (BP), Dahuang Zhechong Pill (DZP), Biejia Ruangan Compound (BRC), Fuzheng Huayu Capsule (FHC), Anluo Huaxian Pill (AHP), and Heluo Shugan Capsule (HSC), using both Eff-iEC and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. The recognition of these CPMs within the TCM academic community was also assessed through their inclusion in relevant medical documents. Results showed that the evidence of BRC and FHC received higher assessments in both Eff-iEC and GRADE system, while the assessments for others varied. Analysis of community recognition revealed that Eff-iEC more accurately reflects the clinical value of these CPMs, exhibiting superior evaluative capabilities. By breaking through the conventional pattern of TCMs effectiveness evaluation, Eff-iEC offers a novel epistemology that better aligns with the clinical realities and reasoning of TCMs, providing a coherent methodology for clinical decision-making, new drug evaluations, and health policy formulation.

Objective:To investigate the current situation of kinesiophobia in patients with in vitro fertilization and embryo transfer and to analyse its influencing factors, so as to provide a reference for the intervention research on kinesiophobia in patients with embryo transfer.Methods:Patients in the first trimester of pregnancy after in vitro fertilization and embryo transfer in the Women's Hospital, School of Medicine, Zhejiang University from August to October 2024 were selected by convenience sampling method, and the general information questionnaire, Tampa Scale of Kine-siophobia (TSK), General Perceived Self-Efficacy Scale (GSES), the Brief Illness Perception Questionnaire (BIPQ) and Social Support Rating Sca1e (SSRS) were used as research tools for cross-sectional investigation, and the influencing factors were analysed by univariate and multiple linear regression.Results:A total of 318 pregnant women in the early stage were finally included, with an average age of (33.11 ± 4.55) years old. The TSK score was (40.40 ± 4.22) points, the GSES score was (25.64 ± 5.25) points, the BIPQ score was (34.30 ± 9.97) points, the SSRS score was (37.98 ± 5.65) points, among which 79.25%(252/318) cases had kinesiophobia. Multiple linear regression analysis showed that age, educational level, exercise frequency before transplantation, self-efficacy, and disease perception were important influencing factors of kinesiophobia in the early pregnancy of in vitro fertilization-embryo transfer patients ( t values were -3.39 to 3.11, all P<0.05). Conclusions:The incidence of kinesiophobia in embryo transfer patients is at a medium to high level, and nursing staff should pay attention to patients with young age, low education level and low daily exercise, and at the same time improve patients′self-efficacy and control of disease perception, reduce the occurrence of kinesitophobia in early pregnancy, improve mental state during pregnancy and promote their health.

Objective To explore the quantitative electroencephalography(qEEG)characteristics of the prefrontal cortex in patients with mild cognitive impairment(MCI)during digital screening tasks for MCI screening.Methods A total of 592 MCI patients(MCI group)and 317 normal cognitively elderly individuals(control group)were recruited from 40 communities in Nanjing,Jiangsu Province,from July to August,2024.All participants were as-sessed using Montreal Cognitive Assessment-Beijing Version(MoCA-BJ).Prefrontal EEG data were collected using a portable EEG device,and power spectral analysis was performed via Fast Fourier Transform.An XG-Boost algorithm was employed to construct an MCI identification model based on qEEG power features,and the model's performance was evaluated using receiver operating characteristic(ROC)curve.Results Compared with the control group,prefrontal δ,α,and β band power increased during screening tasks in MCI group(P<0.05);δ power was negatively correlated with MoCA-BJ total scores,and visuospatial/executive func-tion,attention and delayed recall scores(r=-0.269,-0.169,-0.133,-0.171,P<0.001);α power was negative-ly correlated with MoCA-BJ total scores,attention and delayed recall scores(r=-0.113,-0.075,-0.091,P<0.05).The XGBoost model based on δ and α power was excellent in MCI identification,with an area under the curve of 0.91,accuracy of 0.81,precision of 0.89,F1 score of 0.84,recall of 0.80,and specificity of 0.81.Conclusion MCI patients exhibit increased power in the prefrontal δ and α frequency bands during digital screening tasks,which is associated with cognitive decline.An XGBoost model based on qEEG power features can enable early prediction of MCI.

Objective To explore the quantitative electroencephalography(qEEG)characteristics of the prefrontal cortex in patients with mild cognitive impairment(MCI)during digital screening tasks for MCI screening.Methods A total of 592 MCI patients(MCI group)and 317 normal cognitively elderly individuals(control group)were recruited from 40 communities in Nanjing,Jiangsu Province,from July to August,2024.All participants were as-sessed using Montreal Cognitive Assessment-Beijing Version(MoCA-BJ).Prefrontal EEG data were collected using a portable EEG device,and power spectral analysis was performed via Fast Fourier Transform.An XG-Boost algorithm was employed to construct an MCI identification model based on qEEG power features,and the model's performance was evaluated using receiver operating characteristic(ROC)curve.Results Compared with the control group,prefrontal δ,α,and β band power increased during screening tasks in MCI group(P<0.05);δ power was negatively correlated with MoCA-BJ total scores,and visuospatial/executive func-tion,attention and delayed recall scores(r=-0.269,-0.169,-0.133,-0.171,P<0.001);α power was negative-ly correlated with MoCA-BJ total scores,attention and delayed recall scores(r=-0.113,-0.075,-0.091,P<0.05).The XGBoost model based on δ and α power was excellent in MCI identification,with an area under the curve of 0.91,accuracy of 0.81,precision of 0.89,F1 score of 0.84,recall of 0.80,and specificity of 0.81.Conclusion MCI patients exhibit increased power in the prefrontal δ and α frequency bands during digital screening tasks,which is associated with cognitive decline.An XGBoost model based on qEEG power features can enable early prediction of MCI.

Objective:To investigate the current situation of kinesiophobia in patients with in vitro fertilization and embryo transfer and to analyse its influencing factors, so as to provide a reference for the intervention research on kinesiophobia in patients with embryo transfer.Methods:Patients in the first trimester of pregnancy after in vitro fertilization and embryo transfer in the Women's Hospital, School of Medicine, Zhejiang University from August to October 2024 were selected by convenience sampling method, and the general information questionnaire, Tampa Scale of Kine-siophobia (TSK), General Perceived Self-Efficacy Scale (GSES), the Brief Illness Perception Questionnaire (BIPQ) and Social Support Rating Sca1e (SSRS) were used as research tools for cross-sectional investigation, and the influencing factors were analysed by univariate and multiple linear regression.Results:A total of 318 pregnant women in the early stage were finally included, with an average age of (33.11 ± 4.55) years old. The TSK score was (40.40 ± 4.22) points, the GSES score was (25.64 ± 5.25) points, the BIPQ score was (34.30 ± 9.97) points, the SSRS score was (37.98 ± 5.65) points, among which 79.25%(252/318) cases had kinesiophobia. Multiple linear regression analysis showed that age, educational level, exercise frequency before transplantation, self-efficacy, and disease perception were important influencing factors of kinesiophobia in the early pregnancy of in vitro fertilization-embryo transfer patients ( t values were -3.39 to 3.11, all P<0.05). Conclusions:The incidence of kinesiophobia in embryo transfer patients is at a medium to high level, and nursing staff should pay attention to patients with young age, low education level and low daily exercise, and at the same time improve patients′self-efficacy and control of disease perception, reduce the occurrence of kinesitophobia in early pregnancy, improve mental state during pregnancy and promote their health.

Objective:To explore the real experience and needs of successful aging among urban elderly people who participated in intergenerational raising.Methods:This study was a qualitative study. From February to April 2023, purposive sampling was used to select 10 elderly individuals from Fanjingjiayuan Community in Changqing District, Jinan City who participated in intergenerational raising as the research subject. Semi-structured interviews and face-to-face nonverbal behavior observation methods were used to collect data, while Colaizzi's 7-step analysis method was used to summarize, analyze the data and extract themes.Results:A total of three themes and 10 sub-themes were extracted, namely positive psychological feelings (self-realization, obtaining emotional support, health benefits), negative psychological feelings (intergenerational raising pressure, decreased life satisfaction, mental stress, physical and mental exhaustion), and the need to promote successful aging (family support, community support, policy support) .Conclusions:Urban elderly people who participate in intergenerational raising have both negative and positive psychological experiences. Families and society should pay attention to the psychological feelings of participating in intergenerational raising of elderly people in urban communities, so as to promote successful aging of the elderly people.

Objective To systematically evaluate the experiences of drug self-management in elderly patients with multiple chronic illnesses,so as to provide references for the development of personalized drug self-management intervention programs.Methods Qualitative research on drug self-management experiences of elderly patients with multiple chronic diseases was retrieved from PubMed,Cochrane Library,Embase,CINAHL,Web of Science,Scopus,CNKI,Wanfang,VIP and SinoMed.The retrieval time limit is from the establishment of the databases to November 2023.The qualitative research quality evaluation criteria of the Joanna Briggs Institute Evidence-based Health Care Center in Australia was used to evaluate quality of studies.The results were integrated by meta-integration method.Results A total of 9 studies were included,and 33 research results were extracted,and 4 integrated results and 12 categories were synthesized.The integration results included the objective dilemmas and challenges of drug self-management,the low level of drug literacy,willingness to engage in positive behavior attempts,need of multi-party assistance.Conclusion The objective dilemmas of drug self-management and low level of drug literacy in elderly patients with multimorbidity will seriously affect their health outcomes.Medical staffs should pay attention to the different experiences of patients in the process of drug self-management,identify the needs of patients,formulate targeted intervention support strategies,and improve the level of drug self-management in elderly patients.

In clinical application, a microneedle system that continuously delivers drugs is of great value for the delivery of some vaccines and hormone drugs. In this study, a controlled-release chitosan-based microneedle array (PVA/CS-MN) was designed, combining microneedle patches with drugs for controlled-release of drugs. Here we report the optimization of the preparation process of PVA/CS-MN. The appearance, morphology, mechanical properties, dissolution and swelling properties, and in vitro penetration properties of the MN arrays were characterized. The PVA/CS-MN prepared by the optimal process showed good morphology and mechanical properties. PVA/CS-MN can smoothly open microchannels on the skin and achieve controllable dissolution and swelling functions. Ascorbic acid (l-ascorbic acid) was used as a model drug to prepare a Vc-PVA/CS-MN. In vitro transdermal diffusion experiments showed that the Vc-PVA/CS-MN released about 57% of the drug within 1 h. About 66.7% of the drug was slowly released within 12 h, and a total of 92% of the drug was released after 7 days. The controllable sustained-release properties and excellent drug delivery efficiency of PVA/CS-MN provide a new option for sustained transdermal drug delivery.
Ascorbic Acid ; Chitosan ; Delayed-Action Preparations ; Drug Delivery Systems ; Hormones ; Vaccines

Objective:To study the inter-fraction setup errors, intra-fraction movement of patients and its influence on dosimetry, position repeatability of the supraclavicular area, and the plastic stability of the vacuum cushion and styrofoam when one of the three fixation method are applied in the clinical radiotherapy of breast cancer. The three fixation method include acuum negative pressure pad (VP), acuum negative pressure pad combined with a breast bracket (VB), and polyurethane styrofoam combined with a breast bracket (PB).Methods:A total of 96 breast cancer patients who received radiotherapy at Jiangsu Cancer Hospital during 2019-2021 were collected prospectively for study. They were randomly divided into three groups (VP, VB, and PB). Cone-Beam CT and a planning system were used to obtain inter-fraction setup errors, intra-fraction movement of patients and its influence on dosimetry, position repeatability of supraclavicular area, and the plastic stability of vacuum pad and polyurethane tyrofoam.Results:In the left-right (LR) direction, there were no statistical differences in the inter-fraction setup errors among the three groups. In the superior-inferior (SI) direction, inter-fraction setup errors of the PB group were smaller than those of the VB group (3.02 ± 2.04, 3.65 ± 2.64, t=2.35, P=0.031). In the anterior-posterior (AP) direction, the inter-fraction setup errors of both the VB and PB groups were smaller than those of the VP group (3.36 ± 2.93, 3.14 ± 0.98, 4.03 ± 2.55, t=2.29, 3.11, P< 0.05). In the AP direction, the intra-fraction movement of patients of the VP and PB groups were less than that of the VB group (1.31 ± 0.95, 1.24 ± 0.89, 1.88 ± 1.33, t=-2.04, -2.31, P< 0.05). Moreover, the intra-fraction movement of patients had no statistical effect on the dosimetric distribution ( P> 0.05), and the breast bracket did not improve the position repeatability of the supraclavicular region ( P>0.05). In addition, the plastic stability of polyurethane styrofoam was significantly better than that of the acuum negative pressure pad ( t=2.43-5.63, P< 0.05). Conclusions:The inter-fraction setup errors and intra-fraction movement of patients with breast cancer can be reduced by using PB. Compared to an acuum negative pressure pad, polyurethane styrofoam can keep plastic stability throughout the treatment of the patients.