Objective: To explore the causal link of cumulative ecological risk and future orientation with health risk behaviors among higher vocational college students, so as to provide reference for reducing and preventing health risk behaviors among higher vocational college students. Methods: A longitudinal follow up study was conducted on 612 students using convenience sampling from 2 vocational colleges in Hunan Province. The Cumulative Ecological Risk Scale, Future Orientation Scale, and Health Risk Behavior Scale were used during three follow up visits (T1: September 2022, T2: June 2023, T3: March 2024), and a cross lagged panel model was constructed to examine the longitudinal causal relationship of cumulative ecological risk, future orientation and health risk behaviors. Analysis of longitudinal intermediary effect between variables by Bootstrap. Results: The cumulative ecological risk scores of T1, T2 and T3 among higher vocational college students were (2.94±1.44,2.99±1.63,3.02±1.54), future orientation scores (40.49±4.71,41.51±5.72,41.06±4.35) and health risk behavior scores (3.73±2.01,3.49±2.00,3.23±2.00). The results of repeated measures ANOVA showed that the future orientation score of T2 was higher than that of T1, and the main effect of measurement time was statistically significant ( F=5.09，P＜0.01,η 2=0.02). The health risk behavior score of T1 was higher than that of T2, and the health risk behavior score of T2 was higher than that of T3, and the main effect of measurement time was statistically significant ( F=10.12，P＜0.01,η 2=0.03).The cross lagged model showed good adaptability, with χ 2/df =7.20 ( P <0.01), relative fitting indicators GFI=0.98, CFI=0.99, TLI=0.96, IFI=0.99, NFI =0.99, and absolute fitting indicator RMSEA =0.06. Among them, the T1, T2 cumulative ecological risk showed negatively predictive effects on T2, T3 future orientation ( β =-0.24, -0.47 ), and T1, T2 cumulative ecological risk positively predicted T2, T3 health risk behavior ( β =0.20, 0.24), while T1, T2 future orientation negatively predicted T2, T3 health risk behavior ( β =-0.25, -0.18) ( P ＜0.01). Bootstrap test analysis found that T2 future orientation had a longitudinal mediating effect ( β=0.04, P ＜0.01) on the T1 cumulative ecological risk and T3 health risk behavior. Conclusions The accumulation of ecological risk among higher vocational college students can positively predict health risk behaviors, while future orientation can negatively predict healthrisk behaviors. Moreover, future orientation plays a longitudinal mediating role between accumulated ecological risks and health risk behaviors.

With the main pathological features of glomerulosclerosis and interstitial fibrosis， renal fibrosis is a key pathological process causing chronic kidney disease to progress to end-stage disease. As a cellular autophagic process， mitochondrial autophagy plays a crucial role in maintaining mitochondrial mass and functional stability. Mitochondrial dysfunction is considered to be one of the key factors driving the progression of fibrosis. Phosphatase and tension protein homologue （PTEN） induce various signalling pathways such as putative kinase 1/parkin， Nip3-like protein X/Bcl-2 interacting protein 3， and FUN14 structural domain-containing protein 1 to activate mitochondrial autophagy to participate in the regulation of fibrogenic factors， amelioration of oxidative stress， and inhibition of inflammatory response and apoptosis， which in turn effectively slows down the progression of renal fibrosis. Studies have shown that traditional Chinese medicine monomers and compound preparations， including phenolics， terpenoids， ketones， and alkaloids， can regulate mitochondrial autophagy-related signalling pathways and achieve significant clinical efficacy in intervening in the progression of renal fibrosis for the treatment of chronic kidney disease. This paper summarized the mechanism of mitochondrial autophagy and the research progress of traditional Chinese medicine intervention in renal fibrosis to provide new ideas for the study of the mechanism of traditional Chinese medicine in treating renal fibrosis.

With the main pathological features of glomerulosclerosis and interstitial fibrosis， renal fibrosis is a key pathological process causing chronic kidney disease to progress to end-stage disease. As a cellular autophagic process， mitochondrial autophagy plays a crucial role in maintaining mitochondrial mass and functional stability. Mitochondrial dysfunction is considered to be one of the key factors driving the progression of fibrosis. Phosphatase and tension protein homologue （PTEN） induce various signalling pathways such as putative kinase 1/parkin， Nip3-like protein X/Bcl-2 interacting protein 3， and FUN14 structural domain-containing protein 1 to activate mitochondrial autophagy to participate in the regulation of fibrogenic factors， amelioration of oxidative stress， and inhibition of inflammatory response and apoptosis， which in turn effectively slows down the progression of renal fibrosis. Studies have shown that traditional Chinese medicine monomers and compound preparations， including phenolics， terpenoids， ketones， and alkaloids， can regulate mitochondrial autophagy-related signalling pathways and achieve significant clinical efficacy in intervening in the progression of renal fibrosis for the treatment of chronic kidney disease. This paper summarized the mechanism of mitochondrial autophagy and the research progress of traditional Chinese medicine intervention in renal fibrosis to provide new ideas for the study of the mechanism of traditional Chinese medicine in treating renal fibrosis.

Objective:To investigate the effect of insulin-like growth factor 1 (IGF-1) on acute lung injury in septic mice and its underlying molecular mechanism.Methods:Twenty SPF male C57BL/6J mice aged 6-8 weeks were randomly (random number) divided into the sham-operated group, sham-operated + IGF-1 group, sepsis group and sepsis + IGF-1 group, with 5 mice in each group. IGF-1 [60 μg/(kg·d)] was injected via the tail vein for 3 consecutive days in the sham-operated + IGF-1 group and sepsis + IGF-1 group, and mice in the sham-operated group and sepsis group were injected with an equal volume of saline. The tissue of the upper lobe of the right lung was taken to calculate the wet-to-dry ratio, and the upper lobe of the left lung was subjected to HE staining to analyze pathological changes and evaluate lung injury. The levels of interleukin (IL)-6 and IL-1β in the bronchoalveolar lavage fluid (BALF) and serum of mice were detected by ELISA. The expression of p-PI3K, PI3K, p-AKT and AKT in lung tissues was determined via Western blotting. The quantitative data with a normal distribution and homogeneity of variance were compared between the two groups by two independent sample t test. Results:Lung volume was reduced in the sepsis group than in the sham-operated group, obvious surface congestion, dark red color, large bruises and hemorrhagic foci were observed under the pericardium, and the wet-to-dry ratio was significantly elevated ( P<0.05). Compared with the sepsis group, the sepsis + IGF-1 group had slightly increased lung volume, less congestion, darker red color, fewer bruises and hemorrhagic foci, and a lower wet-to-dry ratio ( P<0.05). There was no significant change in lung tissue morphology in the sham-operated + IGF-1 group compared with the sham-operated group. HE staining and lung histopathological scores showed that lung tissue was significantly damaged in the sepsis group than the sham-operated group ( P<0.001), and the pathological score of lung tissue was less damaged in the sepsis + IGF-1 group compared with the sepsis group ( P<0.01). The ELISA results demonstrated that the serum levels of IL-6 and IL-1β were markedly decreased in the sepsis + IGF-1 group than in the sepsis group [(26.22±1.60) pg/mL vs. (45.61±7.85) pg/mL, P<0.05; (87.99±11.80) pg/mL vs. (181.26±10.11) pg/mL, P<0.001]. Moreover, the IL-6 and IL-1β contents in the BALF of the sepsis + IGF-1 group were notably lower than those in the BALF of the sepsis group [(7.67±0.42) pg/mL vs. (20.25±0.43) pg/mL, P<0.001; (17.00±6.08) pg/mL vs. (108.61±5.18), pg/mL P <0.001]. Western blot analysis revealed that the expression of p-PI3K, PI3K, p-AKT and AKT in the lung tissues of mice in the sepsis+IGF-1 group were markedly lower than that in the sepsis group [(0.71±0.05) vs. (1.21±0.09), P<0.05; (0.57±0.08) vs. (1.24±0.22), P<0.01; (0.29±0.07) vs. (1.10±0.04), P<0.001; (0.65±0.17) vs. (1.19±0.07), P<0.01]. Conclusion:IGF-1 ameliorates sepsis-induced acute lung injury in mice, and its protective effect may be achieved by inhibiting the PI3K/AKT pathway.

Objective:To propose policy recommendations for the compensation mechanism of high-quality development of municipal public hospitals.Methods:Taking the municipal public hospitals in Shanghai as the research object,the aspects of financial subsidies,the structure of medical service income,investment in scientific research and education,and other social compensations were examined to conduct a systematic simulation of the operation of the average municipal public hospital in Shanghai under different policy intervention scenarios.Results:If the current conditions remain unchanged,the average municipal public hospital in Shanghai will face a deficit starting in 2032,the proportion of income from examinations and laboratory tests will surpass that of medical service income in 2026 and 2031,respectively.If the hospitals follow a plan of Combination Plan 3,4,and 5,the average municipal public hospital in Shanghai will be able to break even from 2023 to 2033,and the structure of medical service income will be significantly optimized.Conclusion:To establish a new compensation mechanism for high-quality hospital development that enhances medical services,it is recommended to optimize the structure of government financial compensation,explore rational pricing strategies based on categories,increase investment in scientific research and education while paying attention to the transformation of scientific and technological achievements,expand compensation channels for public hospitals,and improve relevant laws and regulations.

Objective:To investigate the status of post-traumatic stress disorder (PTSD) and its influencing factors in postoperative breast cancer patients.Methods:A convenience sampling method was used to select 410 postoperative breast cancer patients from the Provincial Hospital of the First Medical University of Shandong between January 2023 and December 2024. The PTSD Checklist-Civilian Version (PCL-C), the Connor-Davidson Resilience Scale (CD-RISC), and the Simple Coping Style Questionnaire (SCSQ) were used for assessment. Binary Logistic regression analysis was performed to analyze influencing factors.Results:A total of 410 questionnaires were distributed, and 405 valid questionnaires were returned, with an effective recovery rate of 98.78% (405/410). Among them, 150 patients were PTSD-positive. Binary Logistic regression analysis showed that educational level, monthly family income, psychological resilience, and coping style were influencing factors for PTSD in postoperative breast cancer patients ( P<0.05) . Conclusions:Low education level, low income, and negative coping style are risk factors for PTSD in postoperative breast cancer patients; positive coping style and high psychological resilience are protective factors. Clinical practitioners should develop preventive or intervention measures based on these influencing factors to reduce the occurrence of PTSD in postoperative breast cancer patients.

Objective:To investigate the status of post-traumatic stress disorder (PTSD) and its influencing factors in postoperative breast cancer patients.Methods:A convenience sampling method was used to select 410 postoperative breast cancer patients from the Provincial Hospital of the First Medical University of Shandong between January 2023 and December 2024. The PTSD Checklist-Civilian Version (PCL-C), the Connor-Davidson Resilience Scale (CD-RISC), and the Simple Coping Style Questionnaire (SCSQ) were used for assessment. Binary Logistic regression analysis was performed to analyze influencing factors.Results:A total of 410 questionnaires were distributed, and 405 valid questionnaires were returned, with an effective recovery rate of 98.78% (405/410). Among them, 150 patients were PTSD-positive. Binary Logistic regression analysis showed that educational level, monthly family income, psychological resilience, and coping style were influencing factors for PTSD in postoperative breast cancer patients ( P<0.05) . Conclusions:Low education level, low income, and negative coping style are risk factors for PTSD in postoperative breast cancer patients; positive coping style and high psychological resilience are protective factors. Clinical practitioners should develop preventive or intervention measures based on these influencing factors to reduce the occurrence of PTSD in postoperative breast cancer patients.

Objective:In order to establish benchmark values for new medical service items,it aims to investigate the predictive models and influencing elements that affect the work relative value unit in clinical surgical items in China.Methods:Generalized Linear Model(GLM)and BP neural network techniques were used to investigate influencing factors and build prediction models using the National Medical Service Project Technical Specification(2023 Edition)as the value database.Results:The average relative value of human resource usage was 41.9,with a total of 6 011 items across 16 systems and anesthesia.The GLM's mean prediction error was 4%and its linear correlation coefficient was 0.997.The top 5 predictor variables in terms of importance were technical complexity(0.45),risk level(0.30),physician time(0.08),number of physicians(0.06),and nurse time(0.03).With a mean prediction error of 1.5%,the neural network model obtained a correlation coefficient of 0.996.Technical difficulty(0.20),physician time(0.20),perfusionist time(0.19),risk level(0.15),and medical technician time(0.06)were the top five predictors.Conclusion:Both types of predictive models are well-fitted and valid,and future medical service items can provide relative values of human resource consumption,creating an integrated relative point system.

Objective:To investigate the levels of social support, self-disclosure, and demoralization in postoperative patients with chronic osteomyelitis, and to explore the mediating effect of social support between self-disclosure and demoralization.Methods:This cross-sectional study used convenience sampling to select 390 postoperative patients with chronic osteomyelitis who were treated at the Trauma Center of the Affiliated Provincial Hospital of Shandong First Medical University from June 2022 to October 2023. The General Information Questionnaire, Distress Disclosure Index (DDI), Social Support Rating Scale (SSRS), and the Mandarin Version of the Demoralization Scale (DS-MV) were used to survey the patients. Structural equation modeling was used to analyze the mediating mechanism of social support between self-disclosure and demoralization.Results:A total of 390 questionnaires were distributed, with 380 valid responses (effective response rate was 97.44%). Among the 380 patients, the DDI score was (33.88±14.57), SSRS score was (34.83±8.90), and DS-MV score was (47.27±4.23). Both self-disclosure and social support directly and negatively predicted demoralization ( P<0.05). Social support partially mediated the relationship between self-disclosure and demoralization, with an indirect negative effect of -0.600, accounting for 64.45% of the total effect. Conclusions:Social support serves as a mediating variable between self-disclosure and demoralization in postoperative patients with chronic osteomyelitis. Clinical healthcare providers should encourage patients to express their feelings, enhance their self-disclosure, and strengthen their social support systems to reduce demoralization.

OBJECTIVE To establish a multi-index quantitative detection method,and to evaluate the quality difference of Gleditsia sinensis from different producing areas.METHODS The contents of protocatechuic acid,vanillic acid,isoscopoletin,scoparone,isovitexin,fustin,taxifolin,fisetin,quercetin,kaempferol,echinocystic acid,betulinic acid,β-sitosterol and stigmasterol were detected by high performance liquid chromatography-quantitative analysis of multi-components by single marker(HPLC-QAMS).The chromatographic column was Kromasil C18,the mobile phase was 0.2％phosphoric acid-acetonitrile solution(gradient elution),the detection wavelengths were 254,360,210 nm for different index components,the column temperature was 30 ℃,the flow rate was 1.0 mL/min,and the sample injection volume was 10 μL.The contents of extract and total ash were detected according to the method of Chinese Pharmacopoeia.The quality differences of 30 batches of G.sinensis(No.S1-S30)from different producing areas were evaluated by chemometrics,weighted technique for order preference by similarity to an ideal solution(TOPSIS)analysis and Logistic regression model.RESULTS The linear ranges of 14 components were 1.55-77.50,0.71-35.50,0.28-14.00,0.96-48.00,1.77-88.50,0.09-4.50,4.65-232.50,1.49-74.50,0.37-18.50,1.18-59.00,7.35-367.50,3.58-179.00,0.49-24.50 and 0.21-10.50 μg/mL,respectively(all r＞0.999).The RSDs of precision,stability(24 h)and repeatability were less than 2.00％;the average recoveries were 96.99％-100.13％(all RSDs＜2.00％),and the relative correction factor had good repeatability.The contents of extract and total ash were 4.2％-12.5％and 0.5％-2.3％,respectively.There was no significant difference in the content of 14 components measured by QAMS method and extemal standard method(P＞0.05).The results of chemometrics showed that 30 batches of samples were clustered into 3 categories:S1 to S11 form one category,S12 to S20 form another category,and S21 to S30 constitute the third category.Echinocystic acid,betulinic acid,taxifolin,kaempferol,isovitexin,scoparone and protocatechuic acid may be the differential components affecting the quality of G.sinensis from different producing areas.The analysis results of the weighted TOPSIS method revealed that relative closeness(Jb)for 30 batches of G.sinensis ranged from 0.144 5 to 0.721 8,with S27 achieving the highest value(Jb)of 0.721 8.The analysis results of the Logistic regression model showed that S21-S30 batches of samples were of superior grade,S1-S11 were of intermediate grade,and S12-S20 were of inferior grade.CONCLUSIONS The established HPLC-QAMS method is simple and accurate.The comprehensive evaluation method is objective and comprehensive,and can be used to evaluate the quality difference of G.sinensis from different producing areas.