Osteoarthritis （OA） and stroke are common clinical diseases that reduce patients' quality of life and place a burden on families and society. Ruyi Zhenbaowan， a classic prescription in Tibetan medicine， have the functions of clearing heat， awakening the brain and opening orifices， relaxing tendons and promoting meridian circulation， and eliminating yellow water. Clinically， they are used to treat osteoarthritis， post-stroke sequelae， neuropathic pain， and other related conditions. Modern pharmacological studies have demonstrated their anti-inflammatory， analgesic， and nerve-repairing effects. However， current research remains insufficient regarding the appropriate indications， timing， and efficacy of this medicine in treating relevant diseases. To enhance clinicians' understanding of this medicine and promote its standardized and rational clinical use， a panel of national experts， including clinical specialists， Tibetan medicine practitioners， pharmacologists， and methodologists， formulated this consensus based on clinical experience and evidence-based practice. The Cochrane systematic review framework， the Grading of Recommendations Assessment， Development and Evaluation （GRADE） system， and the nominal group method were employed to generate seven graded recommendations and 19 consensus-based suggestions. These recommendations clearly define the key points in the clinical application of Ruyi Zhenbaowan， including therapeutic indications， dosage and administration， treatment duration， and medication safety. The consensus specifically addresses the clinical efficacy， appropriate timing of administration， dosage strategies， treatment cycles， and combination medication strategies for treating osteoarthritis and stroke and provides an overview of safety considerations. The aim is to provide standardized guidance for hospitals and healthcare institutions nationwide to ensure the rational application of Ruyi Zhenbaowan in the treatment of osteoarthritis and stroke， reduce medication-related risks， and further leverage its clinical advantages. This consensus has been approved and issued by the China Association of Chinese Medicine， with the standard number GS/CACM 369-2024.

Objective To explore the expression of leukemia inhibitory factor receptor(LIFR)in patients with non-ST-segment elevation myocardial infarction(NSTEMI)and its possible associa-tion with myocardial remodeling.Methods A total of 188 patients with acute myocardial infarc-tion who underwent coronary angiography in our hospital from January 2023 to November 2024 were prospectively enrolled and divided into a control group(94 cases)and an NSTEMI group(94 cases)according to being diagnosed with NSTEMI or not.General clinical data of the patients were collected,and the correlation between serum LIFR level and other indicators was analyzed using linear regression analysis.Results Compared with the control group,the NSTEMI group had significantly higher ratios of smoking history,elevated levels of LIFR,NT-proBNP,cTnⅠ,Cr and UA,increased WBC count,but lower LVEF value[48.94％vs 13.83％,P＜0.01;5.82(4.23,8.11)mmol/L vs 0.97(0.60,1.41)mmol/L,P＜0.01;2.53(1.24,9.71)pg/L vs 0.03(0.02,0.04),P＜0.01;18.57(4.11,250.00)ng/L vs 0.00(0.00,0.00)ng/L,P＜0.01;82.50(68.00,121.25)μmol/L vs 68.50(53.00,88.25)μmol/L,P＜0.01;411.00(349.00,521.25)μmol/L vs 337.00(286.75,406.00)μmol/L,P＜0.01;10.21(8.71,13.09)× 109/L vs 6.22(4.67,7.46)× 109/L,P＜0.01;47.00(38.00,54.00)％vs 59.00(56.00,60.00)％,P＜0.01].Serum LIFR level in the patients was posi-tively correlated with NT-proBNP,cTnⅠ,Cr and WBC count(β=1.403,95％CI:10 597.867-17 327.087,P=0.000;β=0.232,95％CI:114.558-1769.808,P=0.026;β=0.336,95％CI:0.164-0.617,P=0.001).Conclusion LIFR may be involved in the development of myocardial remode-ling and heart failure after myocardial infarction through its role in inflammation.

Objective To explore the influencing factors of hypothermia after extraperitoneal laparoscopic radical prostatectomy in prostate cancer patients over 80 years old,so as to improve the effectiveness of treatment.Methods The clinical data of 26 cases of prostate cancer patients over 80 years old who underwent extraperitoneal laparoscopic radical prostatectomy in Shanghai 411 hospital from January 2021 to December 2023 were analyzed retrospectively.The incidence of postoperative hypothermia was investigated.Univariate and multivariate Logistic regression analyses were used to analyze the related factors of postoperative hypothermia in elderly patients.Results The incidence of hypothermia was 61.54%(16/26).Univariate analysis indicated that body mass index(BMI),intraoperative thermal insulation,intraoperative infusion volume,operation time,and anesthesia time were related to the occurrence of postoperative hypothermia in elderly patients(all P<0.05).Multivariate Logistic regression analysis indicated that BMI≤24,intraoperative infusion volume>2 000 ml,anesthesia time>3 h and operation time>2.5 h were high risk factors for postoperative hypothermia in patients over 80 years old.Conclusion The independent influencing factors of hypothermia after extraperitoneal laparoscopic prostatectomy for selected prostate cancer patients over 80 years old are BMI,intraoperative infusion volume,duration of anesthesia,and operation time.These factors should be paid more attention during perioperative period in order to improve clinical safety.

Hematopoietic stem cell transplantation is currently the primary treatment for malignant hematologic diseases. However, due to complex factors, patients are prone to exhibiting multiple symptoms that interact to form symptom clusters, significantly impacting their quality of life and the outcomes of transplantation. This paper elaborates on the composition, evaluation tools, influencing factors, and nursing interventions of symptom clusters in hematopoietic stem cell transplant patients, aiming to provide guidance for the clinical management of symptom clusters in these patients.

Objective:To investigate the effect of a blended teaching mode based on medical knowledge graph and artificial intelligence (AI) teaching assistant on students' learning effectiveness and systematic thinking ability in teaching of pathogens and immunology.Methods:A controlled experimental design was employed, involving 114 clinical medical students ("5+3" integrated) enrolled in 2023 at Tianjin Medical University. They were divided into experimental group ( n=57) and control group ( n=57) based on their classes. A blended online-offline teaching mode based on medical knowledge graph and AI teaching assistant was used in the experimental group, and a blended online-offline teaching mode based on the online resources of this course was used in control group. Teaching effectiveness was assessed by comparing the scores of four chapter quizzes and the final exam between the two groups, as well as by analyzing student questionnaire responses. Data were analyzed using t test and χ2 test. Results:The experimental group achieved significantly higher scores in all four chapter quizzes and the final exam compared to the control group [(78.77±19.65) vs. (69.47±22.95), (84.56±14.02) vs. (76.49±16.20), (81.89±13.60) vs. (73.13±16.52), (81.56±21.28) vs. (73.16±16.27), (69.75±13.30) vs. (64.10±14.93), all P<0.05]. The questionnaire survey showed that 74.07% students ( n=40) believed that this blended teaching model stimulated their learning interest, 74.07% ( n=40) students believed that this blended teaching model enhanced their learning initiative, 81.48% ( n=44) students believed that this blended teaching model could help them construct the relationship between the old and new knowledge and thus improved memory retention, and 81.48% students b( n=44) elieved that this blended teaching model helped them integrate and summarize knowledge and construct systematic knowledge framework to improve their learning effectiveness. Conclusions:The blended teaching mode based on medical knowledge graph and AI teaching assistant is beneficial for cultivating students' systematic thinking ability and is helpful to improve their learning efficiency and effectiveness.

Hematopoietic stem cell transplantation is currently the primary treatment for malignant hematologic diseases. However, due to complex factors, patients are prone to exhibiting multiple symptoms that interact to form symptom clusters, significantly impacting their quality of life and the outcomes of transplantation. This paper elaborates on the composition, evaluation tools, influencing factors, and nursing interventions of symptom clusters in hematopoietic stem cell transplant patients, aiming to provide guidance for the clinical management of symptom clusters in these patients.

Objective To explore the expression of leukemia inhibitory factor receptor(LIFR)in patients with non-ST-segment elevation myocardial infarction(NSTEMI)and its possible associa-tion with myocardial remodeling.Methods A total of 188 patients with acute myocardial infarc-tion who underwent coronary angiography in our hospital from January 2023 to November 2024 were prospectively enrolled and divided into a control group(94 cases)and an NSTEMI group(94 cases)according to being diagnosed with NSTEMI or not.General clinical data of the patients were collected,and the correlation between serum LIFR level and other indicators was analyzed using linear regression analysis.Results Compared with the control group,the NSTEMI group had significantly higher ratios of smoking history,elevated levels of LIFR,NT-proBNP,cTnⅠ,Cr and UA,increased WBC count,but lower LVEF value[48.94％vs 13.83％,P＜0.01;5.82(4.23,8.11)mmol/L vs 0.97(0.60,1.41)mmol/L,P＜0.01;2.53(1.24,9.71)pg/L vs 0.03(0.02,0.04),P＜0.01;18.57(4.11,250.00)ng/L vs 0.00(0.00,0.00)ng/L,P＜0.01;82.50(68.00,121.25)μmol/L vs 68.50(53.00,88.25)μmol/L,P＜0.01;411.00(349.00,521.25)μmol/L vs 337.00(286.75,406.00)μmol/L,P＜0.01;10.21(8.71,13.09)× 109/L vs 6.22(4.67,7.46)× 109/L,P＜0.01;47.00(38.00,54.00)％vs 59.00(56.00,60.00)％,P＜0.01].Serum LIFR level in the patients was posi-tively correlated with NT-proBNP,cTnⅠ,Cr and WBC count(β=1.403,95％CI:10 597.867-17 327.087,P=0.000;β=0.232,95％CI:114.558-1769.808,P=0.026;β=0.336,95％CI:0.164-0.617,P=0.001).Conclusion LIFR may be involved in the development of myocardial remode-ling and heart failure after myocardial infarction through its role in inflammation.

Objective:To investigate the effect of a blended teaching mode based on medical knowledge graph and artificial intelligence (AI) teaching assistant on students' learning effectiveness and systematic thinking ability in teaching of pathogens and immunology.Methods:A controlled experimental design was employed, involving 114 clinical medical students ("5+3" integrated) enrolled in 2023 at Tianjin Medical University. They were divided into experimental group ( n=57) and control group ( n=57) based on their classes. A blended online-offline teaching mode based on medical knowledge graph and AI teaching assistant was used in the experimental group, and a blended online-offline teaching mode based on the online resources of this course was used in control group. Teaching effectiveness was assessed by comparing the scores of four chapter quizzes and the final exam between the two groups, as well as by analyzing student questionnaire responses. Data were analyzed using t test and χ2 test. Results:The experimental group achieved significantly higher scores in all four chapter quizzes and the final exam compared to the control group [(78.77±19.65) vs. (69.47±22.95), (84.56±14.02) vs. (76.49±16.20), (81.89±13.60) vs. (73.13±16.52), (81.56±21.28) vs. (73.16±16.27), (69.75±13.30) vs. (64.10±14.93), all P<0.05]. The questionnaire survey showed that 74.07% students ( n=40) believed that this blended teaching model stimulated their learning interest, 74.07% ( n=40) students believed that this blended teaching model enhanced their learning initiative, 81.48% ( n=44) students believed that this blended teaching model could help them construct the relationship between the old and new knowledge and thus improved memory retention, and 81.48% students b( n=44) elieved that this blended teaching model helped them integrate and summarize knowledge and construct systematic knowledge framework to improve their learning effectiveness. Conclusions:The blended teaching mode based on medical knowledge graph and AI teaching assistant is beneficial for cultivating students' systematic thinking ability and is helpful to improve their learning efficiency and effectiveness.

Chronic obstructive pulmonary disease(COPD)has become a common chronic disease in the adult in recent years,and more attention has been gradually paid to its prevention and treatment.This paper reviewed the clinical studies about the effect of traditional Chinese medicine(TCM)exercise therapy on COPD,and indicated that TCM exercise therapy can improve the rehabilitation of COPD patients.TCM exercise therapies,such as Tai Chi,Wuqinxi,Baduanjin,and Liuzijue,have been shown to significantly improve lung function,inflammation levels,and exercise capacity in COPD patients in recent studies.Tai Chi significantly improves patient's respiratory problems although lung function indices are not changed.Liuzijue enhances the strength and endurance of respiratory muscles and limbs.Baduanjin helps to improve patient's cognitive and emotional states.Overall,TCM exercise therapy provides an effective rehabilitation option for COPD patients.However,more clinical controlled trials are needed to further confirm their effectiveness and to develop appropriate rehabilitation programs for COPD patients.

ObjectiveTo investigate the effects of spleen-Yin deficiency on gastrointestinal absorption， water metabolism and intestinal flora in rats with spleen-Yin deficiency syndrome. MethodA rat model of spleen-Yin deficiency syndrome was established by using the composite factors， including irregular meat and vegetable diet， weight-bearing fatigue swimming and gavage with warm-heat injury-Yin drugs. The changes of body weight， food intake， water intake and duration of swimming in the blank and model groups were observed. Hematoxylin-eosin（HE） staining was used to observe the histopathological damage of the stomach and colon. Urinary excretion rate of D-xylose was determined by phloroglucinol method. The content of gastrin（GAS） in serum was determined by enzyme-linked immunosorbent assay（ELISA）. The relative expression levels of vasoactive intestinal peptide（VIP）， aquaporin 3（AQP3） and AQP4 in gastric tissues were detected by Western blot. The relative mRNA expression levels of VIP， AQP3 and AQP4 in gastric tissues were detected by Real-time fluorescence quantitative polymerase chain reaction（Real-time PCR）， and the changes of intestinal flora were analyzed by 16S rDNA sequencing. ResultCompared with the blank group， the results of general physical signs showed that the body weight and food intake of rats in the model group were significantly decreased， the water intake was significantly increased（P<0.05， P<0.01）， and the duration of swimming was significantly decreased（P<0.01）. Pathological examination results showed that in the mucosa of gastric tissues of rats in the model group appeared to be misaligned， the mucosa of colonic tissues could be seen to be obviously thinned or mutilated， and the epithelial cells appeared to be necrotic or even exfoliated. Compared with the blank group， the urinary D-xylose excretion rate of rats in the model group was significantly decreased（P<0.01）， and the serum GAS content was significantly decreased（P<0.05）. Compared with the blank group， Western blot results showed that the relative expression level of VIP protein in gastric tissues of rats in the model group was significantly decreased， while the relative expression levels of AQP4 and AQP3 proteins were significantly increased（P<0.01）. Compared with the blank group， Real-time PCR results showed that the relative expression level of VIP mRNA in gastric tissues of rats in the model group was significantly decreased（P<0.01）， and the relative mRNA expression levels of AQP3 and AQP4 were significantly increased（P<0.05， P<0.01）. Compared with the blank group， the results of intestinal flora analysis showed that the number of operational taxonomic units（OTUs） and α-diversity increased and β-diversity decreased significantly in the model group， the abundance of Porphyromonadaceae was increased significantly， and the abundance of Oscillibacter_ruminantium was decreased significantly（P<0.05）. Spearman correlation analysis showed that Porphyromonadaceae was significantly positively correlated with AQP4 protein level， while Oscillibacter_ruminantium was significantly positively correlated with VIP protein level， and negatively correlated with AQP3 and AQP4 protein levels（P<0.05）. Linear discriminant analysis effect size（LEfSe） analysis results showed that there were significant differences in a variety of intestinal bacteria between groups， and the intestinal bacteria of the model group were significantly enriched in the phylum/order/family/genus of Elusimicrobia， Betaproteobacteria， Burkholderiales， Sutterellaceae and Parasutterella（P<0.05）. ConclusionSpleen-Yin deficiency syndrome can weaken the digestion and absorption capacity of gastrointestinal tract， and cause the disturbance of water metabolism and intestinal flora. AQP4， AQP3 and VIP protein levels of gastric mucosa are closely related to Porphyromonadaceae and Oscillibacter_ruminantium. And AQP4， AQP3 and VIP may be involved in the regulation of intestinal flora in order to affect the physiological function of spleen governing transportation and transformation.