ObjectiveTo systematically evaluate the application of narrative education in undergraduate nursing teaching， to understand the current application status of narrative education， and to provide a theoretical basis for the subsequent establishment of a sound narrative education system. MethodsA systematic search was conducted for studies published in Chinese and English databases on applying narrative education to undergraduate nursing teaching， with the search period ranging from database inception to February 23， 2025. Literature was screened， and relevant information was extracted. A rigorous quality evaluation was conducted on the included studies， and a descriptive analysis was performed on their content. ResultsA total of 20 papers were included， involving 3，180 research subjects， all of whom were undergraduate nursing students. The results of descriptive analysis showed that the teaching model of narrative education primarily encompassed reading narrative works， watching films and videos， performing narrative scenarios， and writing reflective journals. The course setting and content covered pre-teaching preparation and in-teaching implementation. The evaluation of teaching effectiveness included the evaluation of teachers’ teaching methods （student evaluation/self-evaluation） and the evaluation of students’ learning effectiveness （course grade evaluation/humanistic care scale/empathy scale assessment， and others）. ConclusionNarrative education combines abstract concepts with concrete clinical situations， which not only enriches students’ learning experiences but also enhances their humanistic literacy. Meanwhile， it provides teachers with opportunities to develop their narrative teaching skills， which requires them to possess profound professional knowledge and employ narrative techniques to guide students in reflection and critical thinking， thereby improving teaching quality and learning outcomes. Future efforts should consistently deepen the connotation research of narrative education and build a systematic nursing education system.

Objective To conduct a retrospective analysis of the correlation among bedaquiline(BDQ)plasma concentrations,relevant clinical factors,and disease prognosis.Methods In this retrospective study,22 patients diagnosed with rifampicin-resistant tuberculosis(RR-TB),multidrug-resistant tuberculosis(MDR-TB),or pre-extensively drug-resistant tuberculosis(pre-XDR-TB)were enrolled.These patients were admitted to the tuberculosis ward of our hospital between February 2022 and October 2024.All patients were administered a treatment regimen containing BDQ.The cohort comprised 6 RR-TB patients(27.27%),12 MDR-TB patients(54.55%),and 4 pre-XDR-TB patients(18.18%).Peripheral blood samples were collected 2 hours after the oral administration of Bedaquiline.The plasma concentration of Bedaquiline was measured using liquid chromatography-tandem mass spectrometry(LC-MS/MS).Spearman correlation analysis was performed using R studio software with the ggplot2 and corrplot packages.The factors included the blood concentration of bedaquiline,electrocardiogram QTcF(QT interval corrected by the Fridericia method),liver and kidney function parameters,weight,age,body mass index,sex,blood uric acid level,serum creatinine level,and other relevant indicators.Results In 22 patients treated with BDQ,the plasma concentration reached a peak after 1.5 weeks of administration,and gradually stabilized after 2 weeks.The plasma concentration was approximately 1-3 μg/mL.After 24 weeks of withdrawal of bedaquiline,patients were continued to monitor their bedaquiline concentration and found that BDQ blood concentration in peripheral blood was approximate 1 μg/mL up to 36 weeks.The serum concentration of BDQ was not correlated with age,body weight,BMI,ALT,AST,GGT,TDiL,urea,uric acid and QT interval,but correlated with sputum negative transformation and serum creatinine.The correlation analysis between serum concentration of BDQ and acid-fast staining of sputum smear showed,the difference was significant(r=0.35,P<0.05).In addition,the correlation analysis between serum BDQ concentration and serum creatinine showed,the difference was significant(r=0.34,P<0.05).The results of multiple linear regression analysis showed that BDQ blood concentration was positively correlated with Scr level,and Scr was an independent factor affecting BDQ blood concentration.20 cases(90.9%,20/22)were cured,1 case died of Covid-19 virus infection,1 case was recurrence.Conclusions Regimens containing bedaquiline seem to exhibit relatively high safety profiles and good tolerability among patients with rifampicin-resistant,multidrug-resistant,or pre-extensively drug-resistant tuberculosis,typically yielding favorable treatment outcomes.The BDQ shows a positive correlation with serum creatinine(SCr).Consequently,close surveillance of BDQ levels and renal function remains of utmost importance throughout the treatment course.

Objective:To explore the relationship between life events, anxiety, depression, and behavior problems in adolescents.Methods:From September to October 2022, the cluster sampling method was used to select 5 341 adolescents from 4 middle schools in Xinxiang urban area.The subjects and their parents were investigated by the adolescent self-rating life events check list (ASLEC), generalized anxiety disorder scale (GAD-7), patient health questionnaire (PHQ-9), and child behavior checklist (CBCL). SPSS 27.0 software was used for Spearman correlation analysis, and AMOS 28.0 software was used to construct the structural equation model.Results:The scores of anxiety, depression, and behavioral problems were 1 (0, 4), 1 (0, 4), and 3 (0, 10). The total score of life events was 5 (1, 13), and the dimensions scored as follows: interpersonal conflict 1 (0, 4), academic pressure 2 (0, 5), punishment 0 (0, 2), loss 0 (0, 0), health and adaptation problem 0 (0, 1), and others 0 (0, 2). There were positive correlations between life events and its dimensions, depression, anxiety and behavioral problems ( r=0.28-0.69, all P<0.01). In the overall population, anxiety and depression played parallel mediating roles in the impact of life events on behavior problems. Life events could positively predict anxiety ( β=0.68, P<0.01), and anxiety could positively predict behavior problems ( β=0.04, P=0.02). Life events could positively predict depression ( β=0.77, P<0.01), and depression could positively predict behavior problems ( β=0.18, P<0.01). The standardized total effect size of the impact of life events on behavioral problems was 0.622 (95% CI=0.564-0.675). The standardized direct effect size and indirect effect size were 0.460 (95% CI=0.374-0.539) and 0.162 (95% CI=0.108-0.218), accounting for 74.0% and 26.0%of the total effect, respectively. After stratification by gender, the results for male adolescents were consistent with the overall population, while the mediating effect of anxiety was not significant in the female adolescents. Conclusion:Life events can lead to anxiety and depression in adolescents, thereby increasing the risk of behavior problems.

Objective:To explore the characteristics of social skills and problem behaviors of children and adolescents with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), as well as the association with core symptoms.Methods:A total of 409 patients aged 5-18 years old with ASD or ADHD in the outpatient department of Nanjing Brain Hospital from 2023 to 2024, and 344 children and adolescents with typical development(TD) were recruited.All participants were matched in a ratio of 1∶1∶1 (ASD∶ADHD∶TD) according to gender and age, and 97 participants were included in each group for analysis.The Chinese version of the social skills improvement system rating scales(SSIS-RS-C) was used to evaluate social skills and problem behaviors, and autistic child behavior checklist(ABC), childhood autism rating scale(CARS), the Chinese version of the social communication questionnaire(SCQ) and the Chinese version of Swanson, Nolan, and Pelham, version Ⅳ scale-parent form(SNAP-Ⅳ) were used to evaluate the core symptoms of ASD and ADHD, respectively. SPSS 26.0 software was used to perform variance, Chi-square test, Spearman correlation analysis and multivariate Logistic regression analysis.Results:The social skills score of ASD group was lower than ADHD group ((61.53±24.26) vs (80.89±15.19), P<0.05), while the problem behavior score of ASD group was higher than ADHD group ((38.82±11.92) vs (34.00±12.45), P<0.05). In ASD group, the scores of ABC, CARS and SCQ were negatively correlated with the score of social skills ( r=-0.26--0.55, P<0.05). In ADHD group, the total score and each subscale of SNAP-Ⅳ were positively correlated with the score of problem behavior ( r=0.25-0.65, P<0.05). Multivariate Logistic regression analysis showed that empathy was a negative influencing factor of ASD ( B=-0.246, OR=0.782, P<0.05), and hyperactivity/inattention was a positive influencing factor of ASD ( B=0.589, OR=1.802, P<0.01), while only hyperactivity/inattention was a positive influencing factor of ADHD( B=0.779, OR=2.180, P<0.01). Conclusion:Children and adolescents with ASD and ADHD both have defects in social skills and problem behaviors, and these defects are associated with the core characteristics of their respective diseases.

Objective:To examine the regulatory effects of a potential antifibrotic tetrapeptide called N-acetyl-seryl-aspartyl-lysyl-proline (Ac-SDKP) on the expression of epidermal growth factor (EGFR) and signal transducer and activator of transcription 3 (STAT3) in lung tissues with fibrosis induced by silicosis in rats. This study aims to explore the potential therapeutic benefits of Ac-SDKP in the prevention and treatment of fibrotic lung diseases associated with silicosis.Methods:In January 2024, disease targets and Ac-SDKP active ingredients were predicted through GeneCards (https://www.genecards.org) and OMIM (https://www.omim.org) databases. Using R 4.2.1 software, we identified overlapping targets between pulmonary fibrosis and AC-SDKP. Cytoscape 3.10.2 was employed to visualize interactions between active chemical components and these targets, followed by GO enrichment analysis and KEGG pathway analysis using R 4.2.1. Forty healthy adult Wistar rats were selected to establish silicosis models through single-dose gavage with 50 mg/ml silica suspension (1. 0 ml per rat). The rats were randomly divided into four groups: model control group (4 weeks), silicosis model group (4 weeks), Ac-SDKP preventive treatment group (acquired via intraperitoneal injection of a micro-release pump containing Ac-SDKP [800 μg/ (kg·d) ] during modeling, maintained for 4 weeks), and Ac-SDKP anti-fibrosis treatment group (acquired via intraperitoneal injection of the same pump after 2 weeks of modeling, continued maintenance for 2 weeks). Each group contained 10 rats. The pathological changes in rat lung tissues were observed. Western blot technology was used to detect the protein expression levels of α-smooth muscle actin (α-SMA), epidermal growth factor receptor (EGFR), signal transduction and activation transcription factor 3 (STAT 3), caspase 3, and caspase 8 in lung tissues. Immunohistochemical techniques were employed to assess the expressions of EGFR, STAT3, caspase 3, and caspase 8. Overall differences between groups were compared using one-way ANOVA.Results:Compared with the control group in the silicosis model, rats in the 4-week group exhibited significant fibrotic nodules. The lung tissues of these rats showed statistically significant increases in α-SMA, EGFR, STAT 3, Caspase 3, and Caspase 8 protein expression ( P<0.05). In contrast, the Ac-SDKP prevention and anti-fibrosis treatment group demonstrated markedly reduced expression levels of these proteins compared to the 4-week silicosis model group, with statistically significant differences ( P<0.05). Immunohistochemical staining revealed that brownish-yellow expression of EGFR, STAT3, Caspase3, and Caspase8 was significantly enhanced in silicotic nodules within the silicosis model group. Conversely, this brownish-yellow expression was notably decreased in the Ac-SDKP prevention and anti-fibrosis treatment group compared to the 4-week silicosis model group. Conclusion:Ac-SDKP may exert antifibrotic effects on the lungs of rats with silicosis by regulating the EGFR/STAT3 pathway.

Objective:To analyze the clinical characteristics of warfarin-related nephropathy (WRN).Methods:Medical records of patients with WRN admitted to Linyi People′s Hospital Affiliated to Shandong Second Medical University from January 1, 2020 to December 31, 2024 were collected. The patients′ basic information (gender, age), warfarin medication details (indications, dosage, frequency, etc.), comorbidities, concomitant medication usage, international normalized ratio (INR) and serum creatinine (Scr) test results before and after the occurrence of WRN, as well as the clinical manifestations, interventions, and outcomes of WRN were extracted. The causal relationship between warfarin and renal dysfunction was evaluated according to the Adverse Drug Reaction Reporting and Monitoring Manual. The clinical data of patients were descriptively and statistically analyzed. Results:A total of 11 patients were entered in the analysis, including 7 males and 4 females; the age ranged from 49 to 85 years, with a median age of 70 years, and 9 cases were older than 60 years. The causality evaluation showed that 3 patients were definite and 8 patients were probable. All the 11 patients had at least one comorbidity, including 6 cases of heart failure, 6 cases of hypoproteinemia, 4 cases of chronic kidney disease, 3 cases of hypertension, 3 cases of pulmonary infection, and 1 case of diabetes. Seven patients were treated with warfarin combined with broad-spectrum antibiotics, 6 combined with diuretics, and 3 combined with renin angiotensin system blockers. The time from the highest INR to the highest Scr level was 0-6 days, with a median time of 2 days, and it was ≤2 days in 9 patients. Six patients had bleeding manifestations such as microscopic hematuria, melena, epistaxis, hematochezia, and skin ecchymosis. Among the 11 patients, 10 stopped warfarin immediately and 1 reduced dosage. All patients received different doses of vitamin K 1 according to the INR level. Among the 6 patients of bleeding, 4 received symptomatic treatments such as omeprazole, tranexamic acid, somatostatin, thrombin powder and octreotide, and 2 patients received hemodialysis due to high Scr level. One patient with severe anemia received blood transfusion. After 1-5 days of treatments (with a median time of 2 days), the INR in all patients decreased to <3.00, of which 5 patients continued to take warfarin, 1 changed warfarin to rivaroxaban, and 5 did not continue anticoagulation therapy. After 2 to 14 days of treatments, Scr in 8 patients recovered to the reference value range, and Scr in 3 patients was still at a high level, of which 1 patient died of unexplained cardiac arrest. Conclusions:WRN is a common adverse reaction of warfarin, with or without bleeding. After the occurrence of WRN, the drug should be stopped as soon as possible and symptomatic treatment should be given. The prognosis is generally good, but it may also lead to chronic kidney disease.

Objective:To analyze the risk factors for aspiration pneumonia m patients with post-stroke dysphagia based on quantitative analysis of videofluoroscopic swallowing study(VFSS),and to construct a prediction model and validate it in order to standardize the management of high-risk patients with post-stroke dysphagia complicating aspiration pneumonia.Method:A total of 556 patients with post-stroke dysphagia admitted to Xiamen Hospital of Beijing University of Traditional Chinese Medicine from July 2021 to June 2023 were selected for the study and divided into a modeling group(n=436)and an external validation group(n=120).The model group was divided into pneumo-nia group(n=113,25.9％)and non-pneumonia group(n=323,74.1％)according to the occurrence of aspiration pneumonia.Clinical data and VFSS results were collected for all participants.Logistic regression identified the risk factors for aspiration pneumonia,and a nomogram predictive model was constructed.Model perfonnance was evaluated using receiver operating characteristic(ROC)curves,the area under the ROC curve(AUC),and the Hosmer-Lemeshow goodness-of-fit test.External validation was conducted to assess the sensitivity,spec-ificity and consistency of the model.Result:Logistic regression analysis showed that advanced age,poor oral hygiene,tracheotomy,Penetration-As-piration Scale(PAS)grade≥5,pharyngeal residue and prolonged pharyngeal transport time were risk factors for aspiration pneumonia,and active cough and eating instruction were protective factors(P＜0.05 for both).The predictive risk index(C-index)of the nomogram prediction model was 0.957,AUC=0.957,sensitivity was 93.8％,specificity was 86.4％,and the Hosmer-Lemeshow goodness of fit test showed P=0.6.Conclusion:The predictive model can be used to predict the occurrence of aspiration pneumonia in stroke pa-tients with dysphagia.Its use in clinical practice allows for the development of targeted and individualized inter-ventions according to patient risk levels,thereby improving the quality of nursing.

Polygonatum sibiricum polysaccharide(PSP)is a polysaccharide with multiple pharma-cological activities that has been widely studied and used in the human body.However,there is cur-rently a lack of research investigating the potential advantages of PSP in poultry farming.This study investigated the effects of adding PSP to drinking water on the growth performance,antioxi-dant status,serum biochemical indicators,ileal tissue morphology,immune organs,and intestinal function of chicks.88 Hailan brown laying hens were randomly divided into 4 groups,with 22 hens in each group,namely the blank control group(CON),and fed with basic feed;The low-dose PSP group(250 mg/L),the medium dose PSP group(500 mg/L),and the high-dose PSP group(1 000 mg/L)were fed with corresponding doses of PSP through drinking water on the basis of basic feed,and the experimental period was 21 d.The initial and final body weight and immune or-gan relative quality of chicks,serum biochemical indicators,the activities of SOD,CAT,and GSH-Px,as well as the contents of T-AOC and MDA in the serum of chicks were measured;HE stai-ning method was used to observe the pathological changes of intestinal tissue slices in the ileum;Real time fluorescence quantitative PCR technology was used to detect the mRNA expression lev-els of cytokines ZO-1,Claudin-1,Occludin,Mucin-2,IL-1β,TNF-a,IFN-γ,IL-4,IL-8,and IL-10 in the ileum.The results showed that compared with the blank control group,the addition of medium dose PSP significantly increased the final relative quality(P＜0.01),the final body weight and ADG of PSP500 group chicks significantly increased(P＜0.01),and the F/G of PSP250 and PSP500 groups significantly decreased(P＜0.05 or P＜0.01).The villus height of the jejunum in the 200,500,and 1 000 mg/L PSP groups of chicks significantly increased(P＜0.05).The SOD ac-tivity significantly increased(P＜0.01),and the CAT activity in the PSP1000 group significantly increased(P＜0.01).The PSP500 and PSP1000 groups significantly reduced the mRNA expression of cytokines IL-1β,IL-4,and IFN-γ in the ileum(P＞0.05);PSP did not show significant changes in serum total protein(TP),albumin(ALB),glucose(GLU),cholesterol(T-CHO)content,and immune organ index(P＜0.05).In summary,PSP can improve growth performance,enhance an-tioxidant capacity,improve ileal morphology and epithelial barrier function,and regulate mucosal immune status.Considering the overall economic benefits,the recommended level of PSP addition is 500 mg/L.

Organoids,as a three-dimensional structural model that has been rapidly developed and widely concerned in recent years,enable the key functions and microenvironment of internal organs to be simulated in the real world,and closely reflect the physiological and pathological characteristics of the natural occurrence and metastasis of tumors,providing a new platform for disease modeling,drug research and precision medicine.This paper briefly summarizes the limitations and development prospects of organoid models,analyzes the current construction and development of organoid models of lung cancer and its applicability compared with traditional models under the holistic concept of traditional Chinese medicine and the basic theory of syndrome differentiation and treatment,and discusses the application of organoid technology in the basic research of lung cancer treatment.The advantages in screening anti-tumor Chinese medicine and drug resistance research and precision medicine provide new ideas for realizing innovative breakthroughs in traditional Chinese medicine research combined with modern science and technology.

Objective To investigate the efficacy of Ustekinumab combined with fecal microbiota transplantation in the treatment of inflammatory bowel disease(IBD)and its impact on intestinal mucosal barrier and immune function.Methods A total of 106 IBD patients treated from January 2023 to March 2024 were selected and divided into the Usteinumab group and the Usteinumab combined with fecal microbiota transplantation group(combination group)by random number table method,with 53 patients in each group.The Ustekinumab group was treated with Ustekinumab,while the combination group was treated with Ustekinumab combined with fecal microbiota transplantation.The clinical efficacy,intestinal mucosal barrier indicators,immune function indicators,scores of the Inflammatory Bowel Disease Quality of Life Questionnaire(IBDQ)and the total incidence of adverse reactions were compared between the two groups.Results The total effective rate of the combination group was 94.34%(50/53),which was higher than that of the Ustekinumab group[73.58%(39/53)](P<0.05).After treatment,the levels of endotoxin,D-lactic acid and diamine oxidase in the combination group were all lower than those in the Ustekinumab group,while the levels of CD3+,CD4+,CD4+/CD8+and the scores of IBDQ were all higher than those in the Ustekinumab group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion The clinical efficacy of Ustekinumab combined with fecal microbiota transplantation is remarkable in the treatment of IBD.It can effectively alleviate intestinal mucosal injury,promote the recovery of intestinal mucosal barrier function,improve the intestinal microbial environment,enhance the immune function of patients,effectively control the progression of the disease,and has high safety.