ObjectiveTo investigate the mechanism of topical treatment of allergic contact dermatitis （ACD） mice with Portulacae Herba based on the nuclear factor E₂-related factor 2 （Nrf2）/heme oxygenase-1 （HO-1）/nuclear factor-κB （NF-κB） signaling pathway. MethodsA total of 70 6-week-old specific pathogen free （SPF） female Kunming mice were adaptively fed for 1 week and randomly divided into blank group， model group， compound dexamethasone acetate cream group （2.075×10^-2 g·g^-1）， blank matrix cream group， low-dose Portulacae Herba cream group （0.1 g·g^-1）， high-dose Portulacae Herba cream group （0.2 g·g^-1）， and Portulacae Herba + inhibitor group （0.2 g·g^-1 + 30 mg·kg^-1 ML385）， with 10 mice in each group. One day before the experiment， the mice were shaved on the neck and back. Except for the blank group， the mice in the other groups were treated with 2，4-dinitrochlorobenzene （DNCB） to establish an ACD model. After respective administration， the skin lesion of the mice was scored， and the histopathological changes of the skin were stained with hematoxylin-eosin （HE）. Enzyme-linked immunosorbent assay （ELISA） was used to detect the levels of interleukin-6 （IL-6）， interleukin-1β （IL-1β）， reactive oxygen species （ROS）， superoxide dismutase （SOD） activity， and malondialdehyde （MDA） in serum of mice. The expression of Nrf2/HO-1/NF-κB signaling pathway-related proteins in mouse skin tissue was detected by immunohistochemistry （IHC）， Western blot， and real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. ResultsCompared with the blank group， the mice in the model group had an increased skin lesion score （P<0.01）， severe pathological damage to skin tissue， increased content of IL-1β， IL-6， ROS， and MDA in their serum （P<0.01）， and decreased content of SOD （P<0.01）. In addition， the mRNA and protein expression levels of Nrf2， HO-1， and nuclear factor-κB inhibitor α （IκBα） in skin tissue were up-regulated （P<0.01）， while the protein expression levels of phosphorylated （p）-IκBα and p-NF-κB p65 and the mRNA expression of NF-κB p65 were down-regulated （P<0.01）. Compared with the model group and the blank matrix cream group， the mice treated with Portulacae Herba had a decreased skin lesion score （P<0.01）， reduced pathological damage to skin tissue， decreased content of IL-1β， IL-6， ROS， and MDA in their serum （P<0.01）， and increased content of SOD （P<0.01）. Additionally， the mRNA and protein expression levels of Nrf2， HO-1， and IκBα in skin tissue were down-regulated （P<0.05，P<0.01）， and the protein expression levels of p-IκBα and p-NF-κB p65 and the mRNA expression of NF-κB p65 were up-regulated （P<0.05，P<0.01）. Compared with the Portulacae Herba + inhibitor group， the high-dose Portulacae Herba cream group had a decreased skin lesion score （P<0.01）， alleviated pathological damage to skin tissue， decreased content of IL-1β， IL-6， ROS， and MDA in the serum of mice （P<0.05，P<0.01）， and increased content of SOD （P<0.01）. The protein expression levels of Nrf2， HO-1， and IκBα and the mRNA expression of Nrf2 and HO-1 in skin tissue were up-regulated （P<0.05，P<0.01）， and the protein expression levels of p-IκBα and p-NF-κB p65 and the mRNA expression of NF-κB p65 were down-regulated （P<0.05）. ConclusionPortulacae Herba can improve DNCB-induced ACD skin damage in mice by regulating the Nrf2/HO-1/NF-κB signaling pathway.

OBJECTIVE To study the effects and mechanism of Portulaca oleracea cream on skin pruritus and barrier function in allergic contact dermatitis （ACD） mice. METHODS Low-concentration and high-concentration P. oleracea creams were prepared， with the P. oleracea extract solution （1 g/mL， calculated by crude drug） concentrations of 10% and 20%. Sixty BALB/c mice were randomly allocated into blank group， model group， Mometasone furoate cream group （positive control）， blank matrix cream group， P. oleracea low-concentration and high-concentration cream groups. Except for blank group， ACD model was induced in each group using 2，4-dinitrochlorobenzene solution. The blank group and model groups received normal saline， while the remaining groups were treated with their respective creams， once a day， at a dose of approximately 0.5 g per application， continuously for 14 days. At 24 h post-final administration， skin lesions of mice were observed and scored； pathological changes of skin tissue were observed； serum levels of immunoglobulin E（IgE） and tumor necrosis factor-α （TNF-α） were quantified. mRNA expression of MAS-related G protein-coupled receptors （including MrgprA3， MrgprC11， and MrgprD） in dorsal root ganglion （DRG） was assessed； while protein expressions of skin barrier function-related proteins Claudin-1 and Occludin in skin tissues were determined. RESULTS Compared with blank group， mice in the model group exhibited severe skin damage， characterized by loss of epidermal architecture， hyperkeratosis of the skin tissue， and the infiltration of a large number of inflammatory cells. The skin injury scores， as well as the serum levels of IgE and TNF-α， and the mRNA expression levels of MrgprA3， MrgprC11， and MrgprD in DRG， were all significantly elevated compared to the blank group （P＜0.05 or P＜0.01）； in contrast， the protein expression levels of Claudin-1 and Occludin in the skin tissue were markedly reduced （P＜0.05）. Compared with model group， mice in P. oleracea low-concentration and high- concentration cream groups demonstrated significant alleviation of skin damage， as evidenced by reduced epidermal hyperplasia， mitigated spongiosis in the dermis， and decreased infiltration of inflammatory cells； these quantitative indicators were almost significantly reversed （P＜0.05 or P＜0.01）. No significant differences were observed in the aforementioned skin injuries， pathological alterations， or quantitative indicators between the blank matrix cream group and the model group. CONCLUSIONS P. oleracea may ameliorate skin lesions and restore skin barrier function of ACD mice， the mechanism of which may be associated with downregulating mRNA expressions of MrgprA3， MrgprC11 and MrgprD in DRG， and up-regulating the protein expressions of Claudin-1 and Occludin in skin tissue.

BackgroundNon-suicidal self-injury （NSSI） behavior among adolescents has become a global public health concern. Anxiety and depression are considered key factors influencing NSSI behavior， while social support may play a protective role in alleviating emotional and behavioral issues. However， existing research has primarily focused on the direct impact of individual factors on NSSI behavior， with insufficient exploration of the combined effects of anxiety， depression and social support. ObjectiveTo investigate the direct effect of anxiety on NSSI， the mediating role of depression and the moderating role of social support in relationship between anxiety and NSSI behavior， thus to provide references for the prevention and intervention of NSSI behavior among adolescents. MethodsIn February 2022， a total of 40 820 students in grades 7 to 12 across 10 middle schools in a district of Chengdu were selected as participants， and they were assessed using Generalized Anxiety Disorder Scale-7 item （GAD-7）， Patient's Health Questionnaire Depression Scale-9 item （PHQ-9）， Social Support Scale for Urban Students （SSSUS） and Adolescent Self-Harm Scale （ASHS）. Pearson correlation analysis was conducted to examine the correlations between scale scores among adolescents with NSSI behaviors. Mediation and moderation analyses were performed using Process 3.5 in SPSS， and the significance was tested with bootstrapping. The interaction was visualized by using simple slope analysis. ResultsAmong 34 534 （84.60%） valid respondents， 542 adolescents （1.57%） reported engaging in NSSI behavior. Significant differences in gender， GAD-7 scores， PHQ-9 scores， and SSSUS scores were observed between NSSI behavior group and non-NSSI group （χ²/t=62.889， 71.120， 94.365， -41.464， P<0.01）.Adolesents with NSSI showed positive correlations between GAD-7 scores and both ASHS and PHQ-9 scores （r=0.158， 0.166， P<0.01）. PHQ-9 scores were positively correlated with ASHS scores （r=0.364， P<0.01）， but negatively correlated with SSSUS scores （r=-0.290， P<0.01）. SSSUS scores were negatively correlated with ASHS scores （r=-0.247， P<0.01）. Depression partially mediated the relationship between anxiety and NSSI behavior， with an effect size of 0.544 （95% CI： 0.162~0.944）， accounting for 35.79% of the total effect. Social support moderated the relationship between depression and NSSI bahavior， with an effect value of -0.082 （95% CI： -0.135~-0.029）. ConclusionAnxiety not only directly influences NSSI bahavior among adolescents， also indirectly exacerbates it through depression， while social support mitigates the impact of depression on NSSI behavior. ［Funded by Youth Project of National Natural Science Foundation of China （number， 82401812）； Project of Health Commission of Sichuan Province （number， 24LCYJPT18）］

BackgroundThe distressingly high prevalence of depressive symptoms among adolescents exerts profound impacts on their physical and psychological development， urgently necessitating effective preventive interventions. Existing studies， however， have predominantly focused on isolated risk factors， neglecting to construct an integrated model that systematically disentangles the intricate relationships linking parenting styles， learning burnout， and childhood trauma to adolescent depressive symptoms. Moreover， the potential protective roles of social support and psychological resilience in this context remain insufficiently elucidated. ObjectiveTo construct a structural equation model encompassing multiple pathways to unravel the comprehensive mechanisms through which negative parenting styles， childhood trauma， learning burnout， psychological resilience， and social support collectively influence adolescent depressive symptoms， thereby providing evidence-based intervention strategies. MethodsA stratified sampling technique was utilized to recruit 5 865 students from 12 middle schools in Chengdu City， Sichuan Province from March to May 2022. Participants were assessed using the following validated instruments： the Short-form Egna Minnen av Barndoms Uppfostran （s-EMBU）， the Childhood Trauma Questionnaire-Short Form （CTQ-SF）， the Adolescent Student Burnout Inventory， the Patients' Health Questionnaire Depression Scale-9 item （PHQ-9）， the Social Support Rating Scale （SSRS），and the Connor-Davidson Resilience Scale （CD-RISC）. A partial least squares structural equation modeling （PLS-SEM） approach was employed to construct a predictive framework examining the complex network of pathways through which negative parenting styles， childhood trauma， learning burnout， psychological resilience，and social support collectively influence depressive symptoms in adolescents. ResultsThe PHQ-9 scores demonstrated significant positive correlations with the scores on s-EMBU overprotection subscale （r=0.272， P<0.01）， s-EMBU rejection subscale （r=0.368， P<0.01）， CTQ-SF （r=0.288， P<0.01） and Adolescent Student Burnout Inventory （r=0.587， P<0.01）. Conversely， significant negative correlations were observed between PHQ-9 scores and both SSRS （r=-0.532， P<0.01） and CD-RISC scores （r=-0.418， P<0.01）. Negative parenting styles （β=0.113， 95% CI： 0.087-0.138） and learning burnout （β=0.339， 95% CI： 0.315-0.364） emerged as significant positive predictors of depressive symptoms， with childhood trauma mediating the relationship between negative parenting styles and depressive symptoms （effect size=0.018， 95% CI： 0.013-0.024）. Social support servesed as a mediating pathway between negative parenting styles and depressive symptoms （β=0.080， 95% CI： 0.069-0.092）， as well as between negative parenting styles and childhood trauma （β=0.041， 95% CI： 0.032-0.050）. It also functioned as an intermediary pathway linking learning burnout to depressive symptoms （β=0.092， 95% CI： 0.081-0.104） and connecting learning burnout with childhood trauma （β=0.048， 95% CI： 0.037-0.058）. Additionally， psychological resilience serveed as a mediating pathway between negative parenting styles and depressive symptoms （β=0.004， 95% CI： 0.002-0.007）， between learning burnout and depressive symptoms （β=0.037， 95% CI： 0.023-0.052）， and between childhood trauma and depressive symptoms （β=0.003， 95% CI： 0.001-0.006）. ConclusionLearning burnout exerts a direct effect on adolescent depressive symptoms. Negative parenting styles influence depressive symptoms both directly and indirectly through childhood trauma. Furthermore， social support and psychological resilience serve as mediator linking negative parenting styles and learning burnout to depressive symptoms in adolescents. ［Funded by Science and Technology Project of the Health Commission of Sichuan Province （number， 24LCYJPT18）］

With the acceleration of population aging in China,the management of elderly patients with diabetes has become a critical issue in the field of public health.By integrating international evidence-based medical research data with the specific conditions of China,the 2024 edition of Guideline for the management of diabetes mellitus in the elderly in China proposes individualized diagnosis and treatment strategies for elderly patients with diabetes.This article gives a systematic interpretation of the guideline from a nursing perspective,with a focus on the core contents closely associated with nursing practice,and it also elaborates on the implications for nursing work,summarizes and analyzes the challenges in the management of elderly patients with diabetes,and proposes corresponding strategies,in order to provide a theoretical basis and practical guidance for implementing nursing management of elderly patients with diabetes among clinical nurses.

Objective:To investigate the role of Golgi protein 73(GP73)in the diagnosis of primary biliary cholangitis(PBC)and its association with disease progression and therapeutic efficacy monitoring.Methods:Serum samples were collected from 70 PBC pa-tients,36 patients with liver diseases other than autoimmune liver disease(non-AILD group),and 40 healthy controls(HC group),and ELISA was used to measure the serum level of GP73.For the inpatients with PBC,serum samples were collected before and after treat-ment to measure GP73.Results:There was a significant difference in the distribution of serum GP73 concentration between the PBC group,the non-AILD group,and the HC group(P<0.001),and the receiver operating characteristic(ROC)curve showed that GP73 had an area under the ROC curve of 0.839 in the diagnosis of PBC.Serum GP73 level was positively correlated with aspartate amino-transferase(AST)(r=0.337,P=0.009),alkaline phosphatase(ALP)(r=0.380,P=0.003),total bilirubin(r=0.330,P=0.010),and direct bilirubin(r=0.371,P=0.004),while it was negatively correlated with prothrombin activity(r=-0.329,P=0.036)and cholinesterase(r=-0.518,P<0.001).The PBC patients with liver cirrhosis had a significantly higher serum GP73 level than those without liver cirrhosis(P=0.002).There was no significant difference in GP73 content between the patients with positive anti-mitochondrial antibodies-M2,anti-BCOADC-E2PDC-E2 OGDC-E2 antibodies,and anti-SPl00 antibodies and those with negative antibodies.The PBC patients had significant reductions in the serum levels of AST,ALP,gamma-glutamyl transpeptidase,and GP73 after liver-protecting treatment and improvement in cholestasis(P<0.05).Conclusion:GP73 plays an important role in the diagnosis,disease progression,and efficacy monitoring of PBC and is expected to become a potential disease marker for PBC.

Objective:To investigate the efficacy and safety of endovascular therapy (EVT) for early neurological deterioration (END) in patients with minor stroke due to acute anterior circulation large vessel occlusion.Methods:Consecutive patients with mild stroke due to acute anterior circulation large vessel occlusion admitted to Mianyang Central Hospital from October 2015 to October 2023 were included retrospectively. Minor stroke was defined as a baseline National Institutes of Health Stroke Scale (NIHSS) score <6. END was defined as an increase of ≥4 in NIHSS score compared to baseline within 12 hours of onset. According to whether EVT was performed or not, they were divided into EVT group and standard medical treatment (SMT) group. At 90 days after onset, the modified Rankin Scale was used to evaluate the outcome. 0-1 was defined as excellent outcome (primary outcome measure) and 0-2 was defined as good outcome (secondary outcome measure). The safety endpoints included symptomatic intracranial hemorrhage (sICH) within 72 hours after EVT and all-cause mortality within 90 days. Multivariate logistic regression analysis was used to determine the correlation between EVT and clinical outcome. Results:A total of 164 patients with minor stroke due to acute anterior circulation large vessel occlusion were included. Eighty-four patients (51.2%) developed END, of which 52 (61.9%) underwent EVT and 32 (38.1%) received SMT; 60 patients (71.4%) had excellent outcome, and 64 (76.2%) had good outcome. There was no significant difference in demographic and baseline clinical data between the EVT group and the SMT group. The excellent outcome rate of the EVT group at 90 days after onset showed a trend higher than that of SMT group (78.8% vs. 59.4%; χ2=3.680, P=0.055), but there was no significant difference in the good outcome rate and safety endpoints between the two groups. Multivariate logistic regression analysis showed that after adjusting for confounding factors, EVT was significantly and independently associated with excellent outcome at 90 days (odds ratio 4.955, 95% confidence interval 1.331-22.284; P=0.024). Conclusion:For patients with minor stroke due to anterior circulation large vessel occlusion who experience END, EVT may improve their functional outcome without increasing the risk of sICH and mortality.

Objective To investigate the impact of healthy eating patterns on the mortality rate and in-cidence rates of end-stage kidney disease(ESKD)and cardiovascular disease(CVD)in the patients with chronic kidney disease(CKD)by meta analysis.Methods The studies on the relationship between the dietary patterns on the mortality,and the incidence rates of ESKD and CVD in the patients with CKD were retrieved from PubMed,Embase,Cochrane Library,CNKI,Wanfang Database and VIP Database.The retrieval time was from the database establishment to January 2023.The two researchers independently screened the literatures,ex-tracted the data and conducted the literature quality evaluation.The RevMan5.3 software was used for the meta-analysis of the included literatures.Results A total of 10 studies were included in this study,involving 27 291 patients.The results showed that the mortality(HR=0.70,95％CI:0.57-0.87,Z=3.18,P=0.001)and the ESKD incidence rate(HR=0.80,95％CI:0.71-0.91,Z=3.44,P＜0.001)and CVD inci-dence rate(HR=0.77;95％CI:0.61-0.97,Z=2.21,P=0.003)had statistical differences between the pa-tients with high dietary score and the patients with low dietary score.Conclusion Persisting in the healthy dieta-ry patterns could decrease the mortality rate,and incidence rates of ESKD and CVD in the patients with CKD.