OBJECTIVE To study the ameliorative effect and mechanism of Forsythia suspensa-Lonicera japonica herb pair on acute lung injury （ALI） based on serum exosomal microRNA （miRNA）. METHODS The rats were randomly divided into a blank group （normal saline）， model group （nomal saline）， and F. suspensa-L. japonica herb pair group （2.55 g/kg）， with 10 rats in each group. Except for the blank group， the other groups were used to establish an ALI model by intratracheal dripping of 5 mg/ mL lipopolysaccharides. After modeling， each group was given relevant medicine/normal saline intragastrically， once a day， for 3 consecutive days. After the last medication， the pathological status of lung tissue was observed； lung wet-to-dry weight ratio and leukocyte counts in bronchoalveolar lavage fluid （BALF） were determined. The levels of inflammatory factors [tumor necrosis factor-α（TNF-α）， interleukin-1β （IL-1β）， IL-10] in BALF were determined. Exosomes were isolated from rat serum， and high- throughput sequencing technology was employed to screen differentially expressed miRNA within the exosomes， followed by Kyoto Encyclopedia of Genes and Genomes （KEGG） enrichment analysis. Based on the screened differentially expressed miRNA and the enriched KEGG pathways， in vitro cellular experiments were conducted for validation. RESULTS The animal experimental results demonstrated that after intervention with the F. suspensa-L. japonica herb pair， the wet-to-dry weight ratio， the number of leukocytes in BALF， as well as the levels of TNF-α and IL-1β in BALF of ALI rats were all significantly reduced （P＜0.01）， while the level of IL-10 was significantly increased （P＜0.01）. The results of high-throughput sequencing experiments revealed that the F. suspensa-L. japonica herb pair could significantly up-regulate the expressions of miR-345-3p， miR-194-5p， miR-653-5p， and others in exosomes. Among them， the KEGG pathways involved in the target genes of differentially expressed miRNA included the hypoxia-inducible factor-1（HIF-1） signaling pathway， among others. The results of cellular E-mail：huang.haiying@126.com validation experiments showed that overexpressed miR-345-3p could significantly elevate the level of IL-10 in the cell supernatant （P＜0.01）， while significantly reducing the levels of TNF-α and IL-1β in the cell supernatant， as well as the mRNA and protein expression levels of protein kinase B1， phosphatidylinositol 3- kinase， and HIF-1α （P＜0.01）. CONCLUSIONS F. suspensa-L. japonica herb pair can alleviate inflammatory responses and thereby exert a therapeutic effect in improving ALI by up-regulating the expression of miR-345-3p in serum exosomes and inhibiting the activity of the HIF-1 signaling pathway.

Objective To construct an evidence-based practice program of discharge preparation services for hip replacement patients based on the best evidence,and to evaluate its clinical effects,aiming to provide references for the implementation of relevant interventions.Methods Knowledge to Action Framework was used as a guide to summarise the best evidence on discharge preparation services for hip replacement patients and to select services based on clinical context.We selected 38 hip replacement patients and 17 healthcare professionals from the De-partment of Orthopaedic Surgery at a tertiary A hospital in Shanghai in September-October 2023 to conduct a baseline review,identify facilitating and hindering factors,and develop a practice protocol.We also selected 38 hip replacement patients and 17 healthcare professionals from November-December 2023 on this ward for evidence-based practice.Nurses'rates of completion of review indicators,levels of knowledge of discharge preparation ser-vices,and discharge planning competencies were compared before and after practice.Patients'readiness for dis-charge,hip function,and unplanned readmissions were also compared before and after the practice.Results After evidence-based practice,nurses'completion rates of review indicators,knowledge of discharge preparation services,and discharge planning competencies were higher than baseline levels(P＜0.05).Hip replacement patients showed a significant improvement in readiness for discharge and hip function(P＜0.001).Conclusion The implementation of an evidence-based practice program of discharge preparation services improves nurses'knowledge and skills,and also contributes to the discharge readiness and hip function of hip replacement patients.

Objective:To investigate the potential of praeruptorin A (PA) in alleviating inflammatory damage in sepsis through the inhibition of ferritin expression.Methods:C57BL/6 mice were intraperitoneally injected with lipopolysaccharide (LPS) to establish the model of sepsis. After 6 and 12 h of PA intervention, serum levels of inflammatory cytokines IL-6 and TNF-α were measured by ELISA. Kidney tissues were collected at 72 h for HE staining to assess inflammatory cell infiltration and tissue damage. Human neutrophils were divided into four groups: control, LPS, ferritin, and LPS+ ferritin groups. After 12 h of intervention, qRT-PCR was used to detect the expression of IL-6 and TNF-α mRNA. In order to observe the effect of PA on the expression of inflammatory cytokines and ferritin, human neutrophils were grouped into control, LPS, and LPS+ PA (2/3/4 μmol/L) groups. After 12 h of intervention, qRT-PCR was performed to measure the expression of IL-1β, IL-6, TNF-α, and ferritin mRNA; ELISA was used to quantify the levels of IL-1β, IL-6, and TNF-α in culture supernatants; Western blot was used to analyze the expression of ferritin. Molecular docking was conducted to verify interactions between PA and ferritin.Results:Significant inflammatory cell recruitment, tissue damage, and elevated serum levels of IL-6 and TNF-α ( P<0.01) were observed in mice with LPS-induced sepsis. PA significantly inhibited cytokine secretion ( P<0.01) and alleviated tissue injury in sepsis mice. In human neutrophil models, ferritin upregulated the expression of IL-6 and TNF-α mRNA ( P<0.01); LPS stimulation alone increased the expression of IL-1β, IL-6, TNF-α, and ferritin at both mRNA and protein levels ( P<0.01), while co-stimulation with PA (3/4 μmol/L) significantly reversed the aforementioned results ( P<0.01). Molecular docking confirmed there were interaction sites between PA and ferritin. Conclusion:PA inhibits the release of inflammatory cytokines and alleviates tissue damage in sepsis, and the potential mechanism may involve modulating ferritin expression to suppress inflammatory responses.

ObjectiveTo investigate the mechanism of Forsythiae Fructus-Lonicerae Japonicae Flos（FF） in the treatment of acute lung injury（ALI） by investigating the effects of FF on serum metabolomics of rats with ALI. MethodsThirty male SD rats were acclimated for 1 week， and 6 rats were randomly selected as the blank group. The other 24 rats were injected with lipopolysaccharide（LPS） solution by tracheal drip to establish an ALI model. After successful model establishment， the rats were randomly divided into the model group， the FF low-dose group（3.0 g·kg^-1）， the FF high-dose group（6.0 g·kg^-1）， and the dexamethasone group（5 mg·kg^-1）， with six rats in each group. The FF low- and high-dose groups and the dexamethasone group were received daily oral administration of the corresponding drug solution， and the blank group and the model group were gavaged with an equal amount of saline， treatment was administered continuously for 3 d. The pathological conditions of rat lung tissues were evaluated by hematoxylin-eosin（HE） staining， wet/dry mass ratio（W/D） of the lung tissues， and protein concentration in rat bronchoalveolar lavage fluid（BALF）. Metabolomic analysis of rat serum was performed by ultra-performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS）， combined with multivariate statistical analysis， the potential biomarkers of FF in treating ALI were screened by variable importance in the projection（VIP） value>1， P<0.05 from t-test， and log₂fold change（FC）>1 or log₂FC<-1. Kyoto Encyclopedia of Genes and Genomes（KEGG） database combined with MetaboAnalyst were used for pathway analysis of the screened differential metabolites. The protein expression levels of sphingosine-1-phosphate（S1P）， phosphatidylinositol 3-kinase（PI3K）， protein kinase B1（Akt1）， and phosphorylated Akt1（p-Akt1） were examined by Western bolt. The expression levels of interleukin（IL）-6， IL-1β， and tumor necrosis factor（TNF）-α in BALF were detected by enzyme-linked immunosorbent assay（ELISA）. ResultsCompared with the blank group， rats in the model group showed ALI pathological features such as alveolar lumen dilatation， interstitial hemorrhage and massive inflammatory cell infiltration， and the protein concentration in BALF and W/D of the lung tissues were significantly elevated（P<0.01）. Compared with the model group， the low- and high-dose groups of FF as well as the dexamethasone group exhibited reduced pulmonary bronchial hemorrhage in rats， and the protein concentration in BALF and W/D were significantly decreased（P<0.05）， and the lung injury was significantly alleviated. Analysis of rat serum metabolomics revealed that FF downregulated 38 biomarkers. Pathway enrichment analysis showed that FF primarily exerted therapeutic effects through 7 key metabolic pathways， including arginine biosynthesis， sphingomyelin metabolism， alanine， aspartate and glutamate metabolism， taurine and hypotaurine metabolism， α-linolenic acid metabolism， niacin and nicotinamide metabolism， and retinol metabolism. The results of Western bolt and ELISA showed that， compared with the blank group， the model group exhibited significantly elevated expression levels of S1P， PI3K， Akt1 and p-Akt1 proteins in the lung tissues， as well as increased expression levels of IL-6， IL-1β and TNF-α in BALF（P<0.01）. Compared with the model group， the expression levels of the aforementioned indicators were significantly downregulated in the low- and high-dose FF groups as well as the dexamethasone group（P<0.05， P<0.01）. ConclusionFF may play a role in ALI by regulating amino acid metabolism and lipid metabolism， and its mechanism may be related to the inhibition of S1P/PI3K/Akt1 signaling pathway to attenuate the inflammatory response caused by ALI.

Objective To construct an evidence-based practice program of discharge preparation services for hip replacement patients based on the best evidence,and to evaluate its clinical effects,aiming to provide references for the implementation of relevant interventions.Methods Knowledge to Action Framework was used as a guide to summarise the best evidence on discharge preparation services for hip replacement patients and to select services based on clinical context.We selected 38 hip replacement patients and 17 healthcare professionals from the De-partment of Orthopaedic Surgery at a tertiary A hospital in Shanghai in September-October 2023 to conduct a baseline review,identify facilitating and hindering factors,and develop a practice protocol.We also selected 38 hip replacement patients and 17 healthcare professionals from November-December 2023 on this ward for evidence-based practice.Nurses'rates of completion of review indicators,levels of knowledge of discharge preparation ser-vices,and discharge planning competencies were compared before and after practice.Patients'readiness for dis-charge,hip function,and unplanned readmissions were also compared before and after the practice.Results After evidence-based practice,nurses'completion rates of review indicators,knowledge of discharge preparation services,and discharge planning competencies were higher than baseline levels(P＜0.05).Hip replacement patients showed a significant improvement in readiness for discharge and hip function(P＜0.001).Conclusion The implementation of an evidence-based practice program of discharge preparation services improves nurses'knowledge and skills,and also contributes to the discharge readiness and hip function of hip replacement patients.

Objective:To investigate the potential of praeruptorin A (PA) in alleviating inflammatory damage in sepsis through the inhibition of ferritin expression.Methods:C57BL/6 mice were intraperitoneally injected with lipopolysaccharide (LPS) to establish the model of sepsis. After 6 and 12 h of PA intervention, serum levels of inflammatory cytokines IL-6 and TNF-α were measured by ELISA. Kidney tissues were collected at 72 h for HE staining to assess inflammatory cell infiltration and tissue damage. Human neutrophils were divided into four groups: control, LPS, ferritin, and LPS+ ferritin groups. After 12 h of intervention, qRT-PCR was used to detect the expression of IL-6 and TNF-α mRNA. In order to observe the effect of PA on the expression of inflammatory cytokines and ferritin, human neutrophils were grouped into control, LPS, and LPS+ PA (2/3/4 μmol/L) groups. After 12 h of intervention, qRT-PCR was performed to measure the expression of IL-1β, IL-6, TNF-α, and ferritin mRNA; ELISA was used to quantify the levels of IL-1β, IL-6, and TNF-α in culture supernatants; Western blot was used to analyze the expression of ferritin. Molecular docking was conducted to verify interactions between PA and ferritin.Results:Significant inflammatory cell recruitment, tissue damage, and elevated serum levels of IL-6 and TNF-α ( P<0.01) were observed in mice with LPS-induced sepsis. PA significantly inhibited cytokine secretion ( P<0.01) and alleviated tissue injury in sepsis mice. In human neutrophil models, ferritin upregulated the expression of IL-6 and TNF-α mRNA ( P<0.01); LPS stimulation alone increased the expression of IL-1β, IL-6, TNF-α, and ferritin at both mRNA and protein levels ( P<0.01), while co-stimulation with PA (3/4 μmol/L) significantly reversed the aforementioned results ( P<0.01). Molecular docking confirmed there were interaction sites between PA and ferritin. Conclusion:PA inhibits the release of inflammatory cytokines and alleviates tissue damage in sepsis, and the potential mechanism may involve modulating ferritin expression to suppress inflammatory responses.

Objective: To research the prevalence and influencing factors of asymptomatic arrhythmia among college students, and provide scientific basis for heart rate control and health management of asymptomatic arrhythmia among college students. Methods: Using cluster sampling method, 3 012 college students who studied in the First Clinical Medical College of Henan University of Traditional Chinese Medicine and the Second Clinical Medical College of Henan University of Traditional Chinese Medicine were selected as the research objects from September to November 2022. After entering school in autumn (September in 2022), all college students were investigated by questionnaire, and the general data and living habits of asymptomatic arrhythmia college students and normal college students were compared. Logistic regression was used to analyze the influencing factors of asymptomatic arrhythmia among college students. Results: A total of 62 patients with asymptomatic arrhythmia were found. The detection rates of the patients with body mass index(BMI)≥24.0 kg/m 2 , systolic blood pressure(SBP)≥120 mmHg, diastolic blood pressure(DBP)≥80 mmHg, family history of cardiovascular disease, smoking, drinking, exercising less than three times a week, heavy study pressure, irregular work and rest, depression tendency and anxiety tendency were 5.58%, 4.49%, 5.63%, 6.18%, 4.26%, 4.50%, 3.72%, 4.29%, 4.28%, 9.15%,9.03%, which were significantly higher than those of patients with BMI<24.0 kg/m 2, SBP＜120 mmHg, DBP<80 mmHg, no family history of cardiovascular disease, no smoking, no drinking, exercise more than three times a week, little study pressure, regular work and rest, no depression tendency and no anxiety tendency (1.20%, 1.37%, 1.35%, 1.53%, 1.55 %, 1.59%, 1.27%, 1.52%, 1.38%, 1.71%,1.71%), and the differences were statistically significant ( χ 2=45.33, 25.20, 37.74, 32.24, 16.69, 17.25, 19.57, 17.83, 22.36, 37.23,39.42, P <0.01). Logistic regression analysis showed that the higher of BMI,SBP and DBP, family history of cardiovascular disease, smoking, drinking, times of exercise, heavy study pressure, irregular work and rest, depression tendency and anxiety tendency were positively correlated with asymptomatic arrhythmia of college students ( P <0.05). Conclusions The higher of BMI and blood pressure, family history of cardiovascular diseases, bad living habits and psychological status are related to asymptomatic arrhythmia in college students. It is of great significance to control weight and blood pressure reasonably and maintain good living habits and mental state for preventing and improving asymptomatic arrhythmia.

Background Job burnout has become an important factor affecting the mental and physical health and work efficiency of college counselors, and indirectly affects the quality and development of talent cultivation for college students. Objective To explore the relationship between job stress, job crafting, and job burnout among college counselors, and to test the mediating role of job crafting between job stress and job burnout, in order to take targeted measures to alleviate job stress and job burnout of college counselors, reduce associated health risks, and improve the effectiveness of higher education. Methods An anonymous questionnaire survey was conducted among 400 counselors from social network communication groups by convenience sampling. The Counselor Work Stress Scale, Job Crafting Scale, and Maslach Burnout Inventory-General Survey were used. Harman's single-factor method was used to evaluate common method bias in the survey data. One-way ANOVA was applied to test the difference in job stress, job crafting, and job burnout among college counselors by demographic characteristics, and chi-square test was used to analyze the difference in reporting job burnout. Partial correlation analysis was used to evaluate the correlation between selected variables. Structural equation modeling was used to analyze the relationship of job stress, job crafting, and job burnout among college counselors, and Bootstrap analysis was used to test if there was a mediating effect of job crafting on the relationship between job stress and job burnout. Results Of the 390 questionnaires recovered, there were 338 valid questionnaires (86.67%). Among the included subjects, the mean scores of job stress, job crafting, and job burnout were (2.70±0.62), (3.77±0.62), and (2.09±1.09), respectively. The positive rate of job burnout was 76.9% (260/338), with a positive rate of 72.8% in exhaustion dimension and 59.8% in cynicism dimension. There were significant differences in job crafting scores among the college counselors by different genders and professional titles (P<0.05). Female counselors had significantly higher job burnout scores and positive rates than male counselors (P<0.05). The partial correlation analysis showed that job stress, work load, school evaluation and expectation, and interpersonal relationship were positively correlated with job burnout (r=0.562, 0.442, 0.473, and 0.455, respectively, P<0.01), and negatively correlated with job crafting (r=−0.271, −0.169, −0.246, and −0.247, respectively, P<0.01); job crafting, cognitive crafting, relationship crafting, and task crafting were negatively correlated with job burnout (r=−0.447, −0.452, −0.366, and −0.340, respectively, P<0.01). The modified structural equation modeling indicated that job stress negatively affected job crafting (b=−0.348, P<0.001) and positively affected job burnout (b=0.454, P<0.001); job crafting negatively affected job burnout (b=−0.459, P<0.001), and played a partial mediating role in the relationship between job stress and job burnout, and the effect value was 0.160 (95%CI: 0.102, 0.230) that accounted for 26.10% of the total effect. Conclusion Job burnout among the college counselors is prominent. Job crafting presents an inhibitory effect on job burnout. Job stress indirectly affects the occurrence of job burnout by inhibiting the generation of job crafting.

Objective To establish a safe disposal management program for home used sharps waste of insulin injection so as to provide a reference for the standardised management of sharps waste after insulin.injection.Methods Based on the model of information-motivation-behavioural skills,the safe disposal management program for insulin needles used at home was developed by literature reviews and semi-structured interviews to investigate the perceptions and requirements of patients.The program was then modified and refined by two rounds of expert consultation with Delphi method.Results The effective retrieval rates of questionnaire for two rounds of expert consultations were 88.89%and 93.75%,with an expert authority coefficient at 0.93.In the second round,the mean importance scores of the items were 4.40 to 5.00,with a coefficient of variation ranged from 0 to 0.168.The established program consisted of three primary items,six secondary items,and 20 tertiary items.Conclusion The safe disposal management program for home used sharps waste of insulin injection established from the perspectives of information,motivation and behavioural skills was scientific and practical,which offered a guidance to healthcare professionals in the clinical practices.

Objective:To develop Insulin Pen Waste Needles Disposal Behavior Scale for Diabetic Patients and test its reliability and validity.Methods:Using the model of information, motivation and behavior skills as the theoretical framework, the item pool was constructed by literature review, semi-structured interview and expert consultation, and the test scale was formed after a small sample pre-survey. In July 2022, 158 and 204 diabetes patients who self-injected insulin in Endocrinology Outpatient Department of a general hospital in Shanghai were selected by the convenient sampling method. Two questionnaires were conducted to test the reliability and validity of the scale.Results:Insulin Pen Waste Needles Disposal Behavior Scale for Diabetic Patients included four dimensions, such as disposal behavior cognition, disposal behavior motivation, disposal behavior skills, and safe disposal behavior, with a total of 16 items. Four common factors were extracted from exploratory factor analysis, and the cumulative variance contribution rate was 73.80%. Content validity index was 0.98 at the average scale level, 0.88 at the level of unanimity scale, and 0.83-1.00 at the level of each item. The results of confirmatory factor analysis showed that the scale structure was stable. The Cronbach's α coefficient of the scale was 0.908, the Cronbach's α coefficient of the four factors was 0.858-0.901, the split half reliability coefficient was 0.941, and the retest reliability coefficient was 0.819.Conclusions:The scale constructed in this study has good reliability and validity, which can provide a scientific and effective assessment tool for medical staff to evaluate the disposal behavior of discarded needles used for insulin pens in diabetic patients.