Abstract The prevention and control of myopia in Chinese children and adolescents has become a major public health issue. While maintaining increased outdoor activity as a cornerstone intervention, there is an urgent need to explore new complementary approaches that can be effectively implemented in both indoor and outdoor settings. In recent years, environmental spatial frequency has gained increasing attention as one of the key environmental factors influencing the development and progression of myopia. Both animal studies and human research have confirmed that indoor environments lacking mid to high spatial frequency components, often characterized as "visually impoverished", can promote axial elongation and myopia through mechanisms such as disruption of retinal neural signaling, impaired accommodative function, and altered expression of related molecules. Based on the scientific consensus, it is recommended that "enriching of environmental spatial frequency" should be integrated into the myopia prevention and control framework. Following the principles of schoolled organization, family cooperation, community involvement, and student participation, specific measures are put forward in three areas：optimizing school visual settings, improving home spatial environments, and promoting healthy visual behavior. The aim is to create "visually friendly" indoor environments as an important supplement to outdoor activity, thereby providing a novel perspective and strategy for comprehensively advancing myopia prevention and control among children and adolescents.

Objective To compare the gut fungal composition between gout patients and healthy individuals through high-throughput sequencing of ribosomal DNA internal transcribed spacer 1(ITS1).Methods Gout patients and healthy volunteers who visited our hospital from January 2023 to December 2024 were enrolled in this study.Then based on established medical guidelines,the gout patients were categorized into 3 groups:Group H(asymptomatic hyperuricemia,n=14),Group G(acute gouty arthritis,n=14),and Group I(intercritical period of gouty arthritis,n=15),and the healthy individuals were assigned into Group N(n=9).Fecal samples were collected from all the participants to undergo ITS1 sequencing analysis.The differences in diversity and composition of gut mycobiome,and FunGuild-derived fungal functions and nutritional status were compared among the 4 groups,and the correlation between the gut mycobiome and clinical indicators was analyzed.Results There were no significant differences in baseline features such as gender,age,glomerular filtration rate(GFR),and levels of serum creatinine(SCr)and serum urea among Group N and other gout groups,but obvious differences were observed in body mass index(BMI),erythrocyte sedimentation rate,and levels of C-reactive protein(CRP),serum uric acid(SUA),and IL-1β and IL-6(P<0.05).In terms of gut fungal diversity,ITS1 analysis showed there were no statistical differences in α-diversity or the principal coordinate analysis(PCoA)of β-diversity among the groups.However,as gout progressed,significant changes were observed in β-diversity indices,indicating a shift in the gut fungal community composition with disease advancement(P<0.05).The phyla Ascomycota,Basidiomycota,and Mucoromycotina were the dominant fungal phyla in all groups.Compared with the other 3 gout groups,the abundance of Pichia was significantly increased in Group N(P<0.05),that of Saccharomyces was in Group H(P<0.05),and that of Starmerella was in Group G(P<0.05).Correlation analysis between the gut mycobiome and clinical indices indicated that the relative abundance of Starmerella was significantly positively correlated with IL-1β(P<0.01)and IL-6(P<0.05).The relative abundance of Pichia was significantly positively correlated with IL-1β and IL-6 levels(P<0.05),and negatively correlated with serum urea level(P<0.05),and the relative abundance of Saccharomyces was negatively correlated with IL-1β and IL-6 levels(P<0.05).Conclusion There exist significant alterations in both the diversity and composition of gut fungi among patients with gout at various stages.Notably,the fluctuations in the relative abundance of Starmerella,Pichia and Saccharomyces appear to correlate with key clinical indicators.

Humans ; Urinary Bladder Neoplasms/pathology* ; Carcinoma, Transitional Cell/pathology* ; Genetic Markers ; Biomarkers, Tumor/genetics* ; Urothelium/pathology*

Individuals with type 1 diabetes or advanced type 2 diabetes suffer insufficient insulin secretion, leading to symptoms of hyperglycemia. To maintain the normal blood glucose levels, those people with diabetes must administer insulin multiple times a day. However, insulin requirements are influenced by several factors such as diet, exercise, and illness, combined with the narrow therapeutic index, making accurate insulin dosage challenging. Excessive insulin administration can even pose life-threatening risks. In addition, frequent daily insulin injections place considerable physiological and psychological burdens on patients. To tackle these challenges, researchers have embarked on the development of closed-loop insulin delivery systems. These systems adjust insulin dosages in real-time changes based on the patient’s blood glucose levels, therefore enhancing both the safety and effectiveness of insulin therapy. This review categorizes closed-loop insulin delivery systems into two types: electronic-based and material-based systems, based on their compositional attributes. The exploration of both types covers their components, developmental history, clinical applications, current pros and cons, and future directions. The relative strengths and limitations of these two categories of closed-loop insulin delivery systems are also compared and discussed.

Breast cancer is one of the most common cancers in women,but there is currently a lack of accurate prognos-tic assessment systems.The Naples Prognostic Score(NPS)is a prognostic prediction system that incorporates inflammatory and nutritional indicators.It has been proven to have important clinical utility in predicting the prognosis of patients with malignancies such as colon cancer,gallbladder cancer,endometrial cancer,and lung cancer.In recent years,research has found that NPS may be superior to TNMstaging in predicting the prognosis of breast cancer patients.It is an independent predictor of overall sur-vival(OS)and progression-free survival(PFS)in breast cancer patients.This suggests that NPS has great potential for applica-tion in predicting the prognosis of breast cancer.

Objective:To construct an evaluation indicator system for the efficiency of nursing human resources in integrated medical and elderly care institutions using Data Envelopment Analysis (DEA) and subsequently evaluate its effectiveness.Methods:This cross-sectional survey utilized literature review and investigative methods to initially establish a library of evaluation indicators for nursing human resource efficiency. The Delphi method was employed in two rounds of consultations with 17 experts from various fields, including nursing management, elderly care institution management, integrated medical and elderly care institution management, health economics management, and public health. The reliability of the indicator system was assessed based on factors such as expert enthusiasm, authority, concentration of opinions, and coordination. Adjustments, modifications, and improvements were made to the indicators based on expert opinions to establish the final indicator system. From August to December 2022, the DEA model was applied to evaluate the efficiency of 12 integrated medical and elderly care institutions in Haikou city based on this indicator system.Results:The constructed evaluation indicator system comprised 68 items divided into three levels: 9 primary indicators, 19 secondary indicators, and 40 tertiary indicators. The positive coefficients of the two rounds of expert consultations were 100% and 94.1%, with authority coefficients of 0.88 and 0.92, Kendall harmony coefficients of 0.471 and 0.348, and mean coefficients of variation of 0.16 and 0.12 ( P<0.001). DEA evaluation results for the 12 integrated medical and elderly care institutions showed that 5 were DEA effective institutions with comprehensive efficiency (OE), technical efficiency (TE), and scale efficiency (SE) values all equal to 1.000, while 7 were non-DEA effective institutions, including 4 with SE <1.000 but TE=1.000 and 3 with both SE and TE<1.000. Conclusions:The constructed evaluation indicator system demonstrates high enthusiasm, authority coefficients, and coordination in expert consultations, indicating high acceptability and comprehensive content with distinct levels and strong specialty characteristics. The DEA model′s evaluation results objectively and effectively reflect the efficiency of nursing human resources in integrated medical and elderly care institutions, demonstrating practical utility.

Objective:To review the paper on the admittance evaluation indicators of palliative care for patients with heart failure, and clarify the admittance evaluation indicators of palliative care for patients with heart failure and corresponding evaluation criteria or tools at home and abroad.Methods:Based on the framework of the scoping review, paper retrieval was carried out through computer in PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), WanFang Database, Chinese Biomedical Literature Database and VIP. The retrieval time limit was from the establishment of the database to April 30, 2022. The original research and review on the admittance evaluation of palliative care for patients with heart failure were included, and the data were independently screened and extracted by two researchers.Results:A total of 15 papers were included. The results of document integration showed that the admittance evaluation indicators of palliative care for patients with heart failure included four categories, namely, disease progress, patient needs, medical resource utilization and medical institutions. It included 12 evaluation indicators and corresponding evaluation criteria or evaluation tools, including the patient's expected survival period, cardiac function, high-risk biomarkers, exercise status, complications, advanced treatment, patient's subjective will, complex symptom relief needs, social support needs, multiple unplanned admissions, hospital stay extension, and medical institution software and hardware resources.Conclusions:The content of the admittance evaluation indicators of palliative care for patients with heart failure is comprehensive, but the evaluation criteria for some indicators are not clear, and there is no consensus on the whole. In the future, researchers can select sensitive evaluation indicators on the basis of existing research, construct the admittance evaluation indicators of palliative care for patients with heart failure, and verify it in clinical practice, so as to promote the application of palliative care in the disease management of patients with heart failure.

In recent years, with the strict management of blood glucose in diabetes patients, the risk of hypoglycemia is increasing. The occurrence of hypoglycemia will affect the physical and mental health of patients and reduce their quality of life. Therefore, in order to understand the ability of diabetes patients to prevent hypoglycemia, this article reviews the concept of hypoglycemia prevention, the importance of hypoglycemia prevention, the risk factors of hypoglycemia, the evaluation tools of hypoglycemia prevention, the current situation of hypoglycemia prevention and the ability improvement strategies, aiming to help medical and nursing staff carry out targeted nursing interventions, minimize the risk of hypoglycemia in diabetes patients, and improve the quality of life of patients.

Objective:To investigate the effect of high glucose on intracellular cholesterol content in rat glomerular mesangial cells and the underlying mechanism.Methods:Rat glomerular mesangial cells were cultured in vitro and divided into high glucose culture group (high glucose group, medium glucose concentration of 30 mmol/L) and normal glucose culture group (normal group, medium glucose concentration of 5.5 mmol/L). Lipid content was determined by oil red O staining and spectrophotometer colorimetry at 24, 36 and 48 h of culture. Intracellular protein imprinting was used to detect the expression of low density lipoprotein cholesterol receptor (LDLR) and adenosine triphosphate binding cassette A1 (ABCA1). Results:Oil red O staining showed that the intracellular lipid drops in the high glucose group were less than those in the normal group at 36 h, and there was no significant difference between the two groups at 24 h and 48 h of culture. The total cholesterol (TC) and cholesterol ester (CE) in glomerular mesangial cells of rats in the high glucose group were significantly lower than those in the normal group ( P=0.028, 0.029), while there was no significant difference in the free cholesterol (FC) between the two groups ( P=0.306). There was no significant difference in TC, CE and FC between the two groups at 24 and 48 h of culture (all P>0.05). The expression of LDLR in mesangial cells of rats in high glucose group was significantly lower than that in normal group at 24, 36 and 48 h of culture ( P=0.043, 0.004, 0.028), and the expression of ABCA1 was significantly higher than that in normal group at 24, 36 and 48 h of culture, ( P=0.050, 0.009, 0.006). Conclusions:High glucose may reduce intracellular cholesterol content in rat glomerular mesangial cells by reducing LDLR protein expression and increasing ABCA1 protein expression.

Objective:To compare and analyze the pricing units and prices of traditional Chinese medicine (TCM) medical services in 4 provinces of the Yangtze River Delta, for reference for the integrated development of TCM medical service project setting and price coordination in the Yangtze River Delta region.Methods:The medical service price project specifications published on the official websites of relevant departments in 4 provinces of the Yangtze River Delta (updated to March 2022) were obtained to extract data such as project names and pricing units. The pricing units and prices of TCM medical service projects in each province were compared and analyzed; The Jevons index method was used to analyze comparable project prices.Results:The numbers of TCM medical service projects in Shanghai, Jiangsu, Zhejiang, and Anhui were 113, 146, 117, and 198, respectively. The types of pricing units were 15, 24, 13, and 12, respectively. There were differences in the setting of pricing units, especially in acupuncture and moxibustion, which had more decomposition projects. The average price of overall medical services in the Yangtze River Delta was 9.81 times that of TCM medical services. There were differences in the prices of comparable TCM medical service projects among the four provinces. Based on Anhui province, the inter provincial Jevons index of other categories of TCM medical service projects except for TCM massage were all less than 1.00.Conclusions:There were significant differences in the pricing units and prices of TCM medical service projects in the four provinces of the Yangtze River Delta, with Anhui province having the most significant difference compared to the other three provinces; The overall price of TCM medical service projects was relatively low.