Objective: To explore the influencing factors for implementation of weight management services in primary medical and healthcare institutions, so as to provide references for implementing sustainable services of weight management. Methods: From May to June 2025, Pinghu City, Zhejiang Province was selected as the survey site. Personnel responsible for weight management in primary medical and healthcare institutions were selected as the survey subjects using a combined method of purposive sampling and snowball sampling. Based on the five core domains of the consolidated framework for implementation research (CFIR), a semi-structured interview outline for weight management services in primary medical and healthcare institutions was designed. Original data was collected through face-to-face semi-structured interviews. Interview data was organized and analyzed using framework analysis. Factors affecting weight management services were quantitatively analyzed by referencing CFIR's structural rating criteria. Results: A total of 21 participants completed interviews, covering positions in nutrition, endocrinology, traditional Chinese medicine, general practice, maternal health, and public health. There were 9 males and 12 females. Fifteen participants (71.43%) were aged 35 years and above, 18 (85.71%) held a bachelor's degree or higher, and 15 (71.43%) were frontline medical staff. Fifteen factors affecting weight management services were identified across five domains: innovation, outer setting, inner setting, individuals, and implementation process. Six barrier factors were identified: difficulties in policy implementation, time-consuming interventions, limited incentive measures, lack of professional skills, unclear weight-loss plans and goal setting, and imperfect follow-up and evaluation mechanisms. Three neutral factors were identified: the development and refinement of policies and regulations, the implementation of weight management training, and the optimization of the referral process within integrated healthcare systems (medical alliances / communities). Six facilitating factors were identified: the relatively significant advantages of lifestyle interventions, collaboration and coordination across multiple departments, cooperative communication among different units within the institution, the inherent convenience of primary care settings, a strong sense of professional responsibility, and the establishment of multidisciplinary teams. Conclusions The delivery of weight management services in primary medical and healthcare institutions is influenced by a wide array of factors across multiple domains. It requires policy support, multi-department coordination, a practice-oriented training system, optimized team resource allocation, incentives, and improved professional skills of medical staff to jointly promote long-term implementation.

Objective To explore the effectiveness and safety of percutaneous coronary artery shock wave balloon angioplasty(IVL)under the guidance of intravascular ultrasound(IVUS)for the treatment of severe calcification lesions in the left main artery(LM).Methods A total of 26 patients with severe LM(mouth,body,bifurcation)calcification admitted to Jiangnan University Affiliated Hospital from October 2022 to April 2024 were included,with an average age of 72.0(61.8,75.4)years.Under the guidance of IVUS,IVL was used for pre-treatment of calcified lesions,followed by percutaneous coronary intervention(PCI)with stent/drug balloon implantation.All patients were evaluated using IVUS before and after the use of IVL and after PCI.And compare the IVUS intracavity related data before and after treatment[plaque burden(PB)、minimum lumen area(MLA)、minimum lumen diameter(MLD)]and calcification fracture number,minimum stent area(MSA),stent expansion coefficient(expansion,EXP),etc.Results There were 26 patients(2 with opening lesions,7 with body lesions,and 17 with bifurcation lesions at the end of the main trunk),including 7 with stable angina pectoris(SAP),10 with unstable angina(UA),4 with acute ST-segment elevation myocardial infarction(STEMI),and 5 with non ST-segment elevation myocardial infarction(NSTEMI).The PB at the most severe site of calcification decreased by 79.50(76.00,83.75)％compared to 80.00(76.00,83.75)％after IVL(P=0.001),MLA increased by 3.39(3.14,3.68)mm2 compared to 3.38(3.14,3.67)mm2 after IVL(P=0.039),MLD increased by 3.21(3.07,3.30)mm compared to 3.20(3.07,3.30)mm after IVL(P=0.024),and there was 100％calcification rupture(1/2 cases,2/9 cases,≥3/15 cases).The stent/drug ball was successfully implanted 100％,with EXP of(89.15±4.42)％and an MSA of 7.20(6.46,7.45)mm2.No adverse events such as death,angina or recurrent myocardial infarction occurred during the 3 months follow-up after surgery.Conclusions After evaluation by IVUS and pre-treatment with IVL,PCI was successfully completed for severe calcification lesions in LM,and IVL can be used as an option for the treatment of severe calcification in LM.

Objective To investigate the effect of Osteoporosis Self-Assessment Tool for Asia(OSTA)index on brachial ankle pulse wave velocity(baPWV)and its predictive value for peripheral atherosclerosis in menopausal women.Methods A total of 1 138 menopausal women who underwent physical examination at our hospital from January 2022 to December 2022 were enrolled in the study.General clinical data were collected,the OSTA index was calculated,and baPWV was measured.Patients were divided into the control group(n=539)and the peripheral atherosclerosis group(n=599)according to the baPWV values(peripheral atherosclerosis occurs with baPWV≥1 400 cm/s).Linear regression and Logistic regression were used to analyze the effect of OSTA index on baPWV in menopausal women.The predictive value of peripheral atherosclerosis was evaluated using the receiver operating characteristic(ROC)curve.Results The OSTA index was lower in the peripheral atherosclerosis group than that in the control group[-0.40(-2.20,1.00)vs.0.40(-0.60,1.40),P＜0.05].Univariate linear regression analysis was used to conclude that the OSTA index was an influencing factor of baPWV,and after correcting for risk factors,multivariate linear regression analysis indicated that OSTA index still affected the value of baPWV(P＜0.05).The linear regression equation was baPWV=-27.911-39.752×OSTA+6.444×SBP+7.008×DBP+11.506×HCY+27.942×Hs-CRP.Logistic regression analysis suggested that increased OSTA index was a protective factor for peripheral atherosclerosis(OR=0.664,95%CI:0.535-0.823,P＜0.001).ROC curve analysis suggested that OSTA index was-1.25 as the optimal cutoff point,which predicted peripheral atherosclerosis with an area under the curve of 0.619,a sensitivity of 36.2%and a specificity of 86.3%.Conclusion In menopausal women,OSTA index is an influential factor for baPWV,and increased OSTA index is a protective factor against peripheral atherosclerosis,which can be used to predict baPWV value.

Objective:To investigate the prevalence of hyperuricemia (HUA) in Bozidun Kirghiz township of Xinjiang Aksu region, and to explore the risk factors for the occurrence of HUA in the local area.Methods:A cross-sectional survey study was conducted by randomly selecting 9 villages in Bozidun Kirgiz Township by the whole-group sampling method and questionnaire were distributed to the households. The questionnaire included: demographic information, history of past illness, personal history, and all subjects were measured for height, weight, blood pressure, abdominal circumference, etc. The diagnostic of HUA if the serum uric acid (SUA) level >420 μmol/L in men or >360 μmol/L in women. The incidences of HUA in different age, sex, food type and life style behavior were analyzed. T test, non-parametric test and Chi-square test were used to analyze the differences among the groups, and logistic regression was used to analyze the risk factors. Results:①A total of 2 138 subjects were surveyed, among which 68 patients were with HUA, the prevalence of HUA in Bozidun Kirghiz township, Aksu region in the general population was 3.18%(68/2 138); the prevalence rate in men was 4.60%(45/978), 45 patients were identified; and the prevalence rate in women was 1.98%(23/1 160), 23 patients were identified. The peak age of HUA in male and female patients was 51~60 years old. ②The prevalence of HUA was lower in those who consumed dairy products ( χ2=6.91, P=0.017), nuts ( χ2=8.43, P=0.038) and eggs ( χ2=7.38, P=0.023), and lower in those who consumed more. Different intake of cereals ( χ2=0.87, P=0.647), meat( χ2=0.82, P=0.662), vegetables and fruits( χ2=5.22, P=0.073) had no effect on the prevalence of HUA.③In terms of different life behaviors, the prevalence of HUA in men who had been smoking was higher than those who had never smoked (57.78%, 28.89%, 13.33%, χ2=8.16, P=0.017). In the relationship between drinking and HUA, the prevalence rates of male always drinking, ever drinking and never drinking were 80.00%, 11.11% and 3.89%, respectively, the difference was statistically significant ( χ2=6.67, P=0.038). ④Multi-factor logistic regression analysis showed that high BMI, old age, high TG, increased Cr and increased WBC were risk factors for the occurrence of HUA [ OR(95% CI)=1.13(1.04, 1.23), 1.03(1.00,1.05),1.39(1.00, 1.93), 1.03(1.02, 1.05), 1.27(1.07, 1.49), all P<0.05]. Conclusion:The prevalence of HUA in Bozidun Kirgiz township in Aksu prefecture of Xinjiang is lower than that in other areas with continental climate. High BMI, old age, high TG, increased Cr and increased WBC count are risk factors for the development of HUA .

Tuberculosis （TB） and human immunodeficiency virus infection / acquired immune deficiency syndrome （HIV/AIDS） are both serious global public health threats. Early detection of infected persons and/or patients through TB/HIV bi-directional screening is crucial for prevention and control strategy in China and globally. In recent years， with the promotion and application of new TB and HIV detection technologies worldwide， TB/HIV bi-directional screening technologies and strategies have made remarkable changes. This expert consensus introduces the significance and challenges of TB/HIV bi-directional screening， summarizes important progress of research and applications， and makes recommendations on screening measures and procedures to further strengthen TB/HIV bi-directional screening in China.

Plant natural products have a wide range of pharmacological properties, not only can they be used as plant dietary supplements to meet the nutritional needs of the human body in the accelerated pace of life, but also occupy an important position in the research and development of therapeutic drugs for the treatment of tumors, inflammation and other diseases, and have been widely accepted by the public due to their good safety. However, despite the above advantages of plant natural products, limiting factors such as low solubility, poor stability, lack of targeting, high toxicity and side effects, and unacceptable odor have greatly impeded their conversion to clinical applications. Therefore, the development of new avenues for the application of new natural products has become an urgent problem to be solved at present. In recent years, with the continuous development of research, various strategies have been developed to improve the bioavailability of natural products. Among them, nanocarrier delivery system is one of the most attractive strategies at present. In past studies, a large number of nanomaterials (organic, inorganic, etc.) have been developed to encapsulate plant-derived natural products for their efficient delivery to specific organs and cells. Up to now, nanotechnology has not only been limited to pharmaceutical applications, but is also competing in the fields of nanofood processing technology and nanoemulsions. Among the various nanocarriers, liposomes are the largest nanocarriers with the largest market share at present. Liposomes are bilayer nanovesicles synthesized from amphiphilic substances, which have advantages such as high drug loading capacity and stability. Attractively, the flexible surface of liposomes can be modified with various functional elements. Functionalized modification of liposomes with different functional elements such as antibodies, nucleic acids, peptides, and stimuli-responsive moieties can bring out the excellent drug delivery function of liposomes to a greater extent. For example, the modification of functional elements with targeting function such as nucleic acids and antibodies on the surface of liposomes can deliver natural products to the target location and improve the bioavailability of drugs; the modification of stimulus-responsive groups such as photosensitizers, magnetic nanoparticles, pH-responsive groups, and temperature sensitizers on the surface of liposomes can achieve controlled release of drugs, localized targeting, and synergistic thermotherapy. In addition to the above properties, by using functionalized liposomes to encapsulate natural products with irritating properties can also effectively mask the irritating properties of natural products, improve public acceptance, and increase the possibility of application of irritating natural products. There are various strategies for modifying liposomes with functional elements, and the properties of functionalized liposomes constructed by different construction strategies differ. The commonly used construction strategies for functionalized liposomes include covalent modification and non-covalent modification. These two types of construction strategies have their own advantages and disadvantages. Covalent modification has better stability than non-covalent modification, but its operation is cumbersome. With the above background, this review focuses on the three typical problems faced by plant natural products at present, and summarizes the specific applications of functionalized liposomes in them. In addition, this paper summarizes the construction strategies for building different types of functionalized liposomes. Finally, this paper will also review the opportunities and challenges faced by functionalized liposomes to enter clinical therapy, and explore the opportunities to overcome these problems, with a view to better realizing the precise control of plant nanomedicines, and providing ideas and inspirations for researchers in related fields as well as relevant industrial staff.

The theory of yin and yang is the modest differentiation thought of the traditional Chinese medicine under the guidance of overall dialectics,and the dynamic changes of yin and yang profit and loss can reflect the life activities of the human body.In the early literature research and clinical practice,the author's team found that the"yang deficiency and yin stagnation"is the key pathogen of colorectal cancer,the yang qi is insufficient,and the metabolites of the yin such as phlegm,wetness and stasis are lost in gasification and accumulate to form a"yin tumor",which is stagnant in the intestine and forms colorectal cancer.Yang Qi is the process of normal cell metabolism to produce energy,Yang Qi is insufficient,the"yin knot"of the thing in the body polymerizes into tumors,The imbalance of yin and yang can cause changes in energy or substance metabolism in the body,and glutamine is one of the amino acid which is the largest consumption of tumor cells,and its metabolic process not only provides a material basis for tumor cell growth,but also creates an acidic microenvironment of hypoxia to promote the proliferation and growth of tumor cells.This paper discusses the characteristics of glutamine metabolism of colorectal cancer cells in detail,aiming to explain the occurrence of colorectal cancer from the pathogenesis of"yang deficiency yin knot",and to explain the scientific theory of traditional Chinese medicine in the treatment of coloral cancer with the principle of Wenyang Tongxia,aiming to provide new ideas and methods for the comprehensive treatment of CRC.

Objective:To investigate the distribution patterns of TCM syndrome elements and syndrome types in cancer-related fatigue (CRF).Methods:A cross-sectional survey was conducted on tumor patients attending the outpatient clinic and wards of the Department of Oncology, Xiyuan Hospital of China Academy of Chinese Medical Sciences from January to December 2021. Descriptive analysis was used to compare the distribution difference of TCM syndrome elements, symptoms and tongue symptoms of CRF and non-CRF patients. The TCM symptoms of CRF were clustered to summarize the common TCM syndromes of CRF.Results:A total of 306 tumor patients were finally included, of which 229 (75%) were CRF and 77 (25%) were non-CRF. Qi deficiency, blood deficiency, and cold-dampness were the most common deficiency and excess syndrome elements in CRF, and liver deficiency, yin deficiency, and blood stasis syndrome elements occurred more frequently in non-CRF than in CRF. TCM symptoms with a frequency greater than 50% in CRF patients, from high to low, were: fatigue > shortness of breath > insomnia or dreaminess > mental fatigue > forgetfulness>lazy speech > impatience, irritability, depression with sighing. The most frequent tongue symptoms, tongue coating, and pulse symptoms were respectively pale tongue, white and greasy coating or smooth white, and pulse deficiency. The symptoms with greater than 30% frequency in 77 non-CRF patients were, from highest to lowest: impatience and irritability or depression with sighing > insomnia or dreaminess > shortness of breath > dry mouth and throat > lumbar spine pain (excluding traumatic) > numbness of limbs > forgetfulness. The highest-ranked tongue, tongue coating, and pulse symptoms were pale tongue, red tongue or less coating, no coating, and thin pulse, respectively. Through clustering analysis, six common syndromes of CRF were obtained, including qi and blood deficiency syndrome, heart and liver blood deficiency syndrome, kidney yang deficiency syndrome, qi and yin deficiency syndrome, spleen deficiency and qi stagnation syndrome, and cold dampness and spleen stagnation syndrome.Conclusions:CRF is a common symptom of different types of tumors. Generally, deficiency syndrome is the main symptom. Qi deficiency and blood deficiency are the common syndrome elements. Common symptoms of high frequency and tongue and pulse are fatigue, shortness of breath, mental fatigue, forgetfulness, pale tongue and thin pulse. The common TCM syndrome types can be preliminarily summarized into 6 types: qi and blood deficiency syndrome, heart and liver blood deficiency syndrome, kidney yang deficiency syndrome, qi and yin deficiency syndrome, spleen deficiency and qi stagnation syndrome, cold dampness and spleen stagnation syndrome.

Objective:To investigate the association between cancer fatalism and optimistic attitudes among colorectal cancer patients, and how the above linkage is moderated by the involvement of patients′ opinions, the family members′ opinions and the physicians′ opinions in treatment decision-making.Methods:A cross-sectional survey was conducted on 64 patients diagnosed with colorectal cancer and awaiting radical colorectal cancer surgery in the Department of General Surgery of Beijing Friendship Hospital Affiliated to Capital Medical University, from January 2021 to December 2021. There were 38 males and 26 females, aged (61.2±13.0) years from 30 to 84 years. Cancer fatalism, optimism attitudes, and the involvement of patients′ opinions, the family members′ opinions and the physicians′ opinions in treatment decision-making were assessed. The patients′ cancer fatalism beliefs were measured by the " Chance" subscale of the Form C of the Multidimensional Health Locus of Control (MHLC-C), optimism attitudes were assessed by the Chinese version of the revised Life Orientation Test (CLOT-R), and the influence of patients′, family members′, and physicians′ opinions in the medical decision-making process was measured by a self-designed single factor scale. Measurement data of normal distribution were expressed as mean±standard deviation ( ± s). Measurement data of skewed distribution were expressed as M( Q1, Q3). Spearman correlation analysis and Chi-square test was used to examine the association between the main outcome variable (patients′ optimistic attitudes) and demographic and clinical characteristics. Interaction was examined by hierarchical linear regression analysis combined with simple slope tests. Results:Cancer fatalism was negatively associated with patients′ optimistic attitudes ( r=-0.35, P<0.01). Optimistic attitude of patients was significantly and negatively correlated with the influence of family members′ opinions on medical decision-making ( r=-0.25, P<0.05). There were significant positive correlations between the influence of patients′ and family members′ opinions ( r=0.50, P<0.01), family members′ and physicians′ opinions ( r=0.67, P<0.01), and physicians′ and patients′ opinions ( r=0.38, P<0.01) in medical decision making. Hierarchical linear regression analysis showed a negative association between cancer fatalism and optimism ( β=-0.32, P=0.01). This association was further moderated by the involvement of family members′ opinions ( β=-0.56, P<0.01) and the involvement of physicians′ opinions ( β=-0.36, P=0.04) in medical decision-making. Simple slope tests revealed that the negative impact of fatalistic attitudes on patients′ optimism attitudes may be potentiated when family members′ opinions have high influence on medical decision-making, while the negative impact may be buffered to some extent when physicians′ opinions have high influence on medical decision-making. Conclusions:Cancer fatalism had a negative effect on patients′ optimism. The high influence of physicians in treatment decision-making buffered the negative effect of cancer fatalism on optimism; the high influence of family members in treatment decision-making potentiated the negative effect of cancer fatalism on optimism. In the process of doctor-patient communication and shared decision-making, for patients with strong fatalistic attitudes, consideration should be given to appropriately increasing direct informational communication between physicians and patients and reducing excessive family intervention in medical decision-making, so as to enhance patients′ autonomy for treatment, promote optimism, and reduce the negative effects of cancer fatalism.

Objective: To describe the current status and trends in the treatment of patent ductus arteriosus (PDA) among very preterm infants (VPI) admitted to the neonatal intensive care units (NICU) of the Chinese Neonatal Network (CHNN) from 2019 to 2021, and to compare the differences in PDA treatment among these units. Methods: This was a cross-sectional study based on the CHNN VPI cohort, all of 22 525 VPI (gestational age<32 weeks) admitted to 79 tertiary NICU within 3 days of age from 2019 to 2021 were included. The overall PDA treatment rates were calculated, as well as the rates of infants with different gestational ages (≤26, 27-28, 29-31 weeks), and pharmacological and surgical treatments were described. PDA was defined as those diagnosed by echocardiography during hospitalization. The PDA treatment rate was defined as the number of VPI who had received medication treatment and (or) surgical ligation of PDA divided by the number of all VPI. Logistic regression was used to investigate the changes in PDA treatment rates over the 3 years and the differences between gestational age groups. A multivariate Logistic regression model was constructed to compute the standardized ratio (SR) of PDA treatment across different units, to compare the rates after adjusting for population characteristics. Results: A total of 22 525 VPI were included in the study, with a gestational age of 30.0 (28.6, 31.0) weeks and birth weight of 1 310 (1 100, 1 540) g; 56.0% (12 615) of them were male. PDA was diagnosed by echocardiography in 49.7% (11 186/22 525) of all VPI, and the overall PDA treatment rate was 16.8% (3 795/22 525). Of 3 762 VPI who received medication treatment, the main first-line medication used was ibuprofen (93.4% (3 515/3 762)) and the postnatal day of first medication treatment was 6 (4, 10) days of age; 59.3% (2 231/3 762) of the VPI had been weaned from invasive respiratory support during the first medication treatment, and 82.2% (3 092/3 762) of the infants received only one course of medication treatment. A total of 143 VPI underwent surgery, which was conducted on 32 (22, 46) days of age. Over the 3 years from 2019 to 2021, there was no significant change in the PDA treatment rate in these VPI (P=0.650). The PDA treatment rate decreased with increasing gestational age (P<0.001). The PDA treatment rates for VPI with gestational age ≤26, 27-28, and 29-31 weeks were 39.6% (688/1 737), 25.9% (1 319/5 098), and 11.4% (1 788/15 690), respectively. There were 61 units having a total number of VPI≥100 cases, and their rates of PDA treatment were 0 (0/116)-47.4% (376/793). After adjusting for population characteristics, the range of standardized ratios for PDA treatment in the 61 units was 0 (95%CI 0-0.3) to 3.4 (95%CI 3.1-3.8). Conclusions: From 2019 to 2021, compared to the peers in developed countries, VPI in CHNN NICU had a different PDA treatment rate; specifically, the VPI with small birth gestational age had a lower treatment rate, while the VPI with large birth gestational age had a higher rate. There are significant differences in PDA treatment rates among different units.
Infant ; Infant, Newborn ; Male ; Humans ; Female ; Ductus Arteriosus, Patent/drug therapy* ; Infant, Premature ; Cross-Sectional Studies ; Ibuprofen/therapeutic use* ; Infant, Very Low Birth Weight ; Persistent Fetal Circulation Syndrome ; Infant, Premature, Diseases/therapy*