Objective:To investigate whether intermittent fasting alleviates insulin resistance in a polycystic ovary syndrome(PCOS) mouse model through the regulation of autophagy.Methods:Fifty 3-week-old female C57BL/6J mice were randomly assigned into the following groups using a random number table: normal control(NC) group( n=10), maintained on a standard chow diet; high-fat diet(HFD) group( n=10) fed a diet with 60% of calories derived from fat; and PCOS model group( n=30), established by combining a HFD with dehydroepiandrosterone(DHEA) administration. Successful modeling was confirmed by disrupted estrous cycles, hyperandrogenism, and polycystic ovarian morphology. The PCOS model mice were further divided into three groups: PCOS group( n=9), PCOS with intermittent fasting group(PCOS+ IF, n=9), and PCOS with intermittent fasting plus the autophagy inhibitor 3-methyladenine(3-MA) group(PCOS+ IF+ 3-MA, n=9). Autophagy levels were assessed by detecting markers LC3 and p62 and observing autophagosomes via transmission electron microscopy. Glucose tolerance test(GTT) and insulin tolerance test(ITT) were performed, and the area under the curve(AUC) was calculated to evaluate insulin resistance. Western blotting was used to detect phosphorylation levels of phosphatidylinositol 3-kinase(PI3K), protein kinase B(Akt), mammalian target of rapamycin(mTOR), and p70S6 kiase(p70S6K). Results:Compared with the NC group, the PCOS model group showed absent estrous cycles, significantly elevated serum testosterone, sex hormone binding globulin, and luteinizing hormone(LH) levels( P<0.001), and polycystic ovarian changes on hematoxylin-eosin staining, confirming successful model establishment. Immunohistochemistry, transmission electron microscopy, and Western blotting demonstrated that autophagy levels were increased in the PCOS+ IF group compared with the PCOS group, while 3-MA administration reduced the intermittent fasting - induced autophagy. The AUC values for both GTT and ITT were significantly lower in the PCOS+ IF group than those in the PCOS group( P<0.001, P=0.003), but increased in the PCOS+ IF+ 3-MA group compared to the PCOS+ IF group( P<0.001, P=0.020). Western blotting analysis showed that phosphorylation levels of PI3K, Akt, mTOR, and p70S6K were significantly decreased in the PCOS+ IF group compared with the PCOS group( P=0.002, P=0.001, P=0.001, and P<0.001, respectively), and increased in the PCOS+ IF+ 3-MA group compared with the PCOS+ IF group( P=0.021, P=0.041, P=0.047, and P=0.024, respectively). Conclusions:Intermittent fasting alleviates insulin resistance in a PCOS mouse model through inhibitiing PI3K/Akt/mTOR signaling pathway and promoting autophagy.

Objective To review the research of safe injection protocols for peripheral norepinephrine(pNE),to make clear the main contents of safe injection protocols and the compliance of clinical implementation protocols,and to provide reference for clinical nurses to use drugs safely.Methods Systematic searches were conducted in the PubMed database,the Embase database from the Netherlands,the Web of Science,the Cochrane library,CNKI,Wanfang database,VIP,and the China biomedical literature database for studies related to safe injection protocols for pNE.The search period extended from the establishment of the databases to April 30,2024.Two researchers conducted data extraction and summary analysis of the included literature.Results A total of 10 articles were incorporated,including 2 guidelines,4 observational retrospective cohort studies,2 observational prospective cohort studies,2 ambispective cohort study.All documents provide a complete safe injection scheme of pNE,and its main contents were as follows:the drug concentration should be diluted to 8～64 mg/L;the injection dose should be small,and the maximum dose should not exceed 0.5 μg·kg-1·min-1 or 25 μg/min;a short infusion time was appropriate,among which 4 schemes require≤24 hours;intravenous catheters should be large-bore models,mainly 16,18 and 20 G;selection of infusion sites with favorable venous conditions of upper limb should be selected for injection;during infusion,regular and effective monitoring was required,and the frequency of monitoring should be once an hour,not exceeding a maximum of 2 hours;observation of the puncture site,and must assess whether there was blood return to the venous pathway,develop an emergency plan for drug extravasation.Several studies provided the compliance analysis of the protocol.The items with the highest compliance were using the drug concentration specified in the protocol,with the highest implementation rate of 100.0%.The items with low compliance were:using ultrasonic catheterization or evaluation,with minimum 26.6%;monitor according to the specified time frequency,with a minimum of 36.0%;selection of infusion sites,with a minimum of 65.0%.Conclusion The pNE is safe and feasible in emergency situations,but it comes with numerous risks and limitations.Norepinephrine(NE)should be administered at low concentrations and small doses,using large-caliber venous indwelling needles,and choosing optimal injection sites.Ultrasound assessment and localization can be used if conditions permit.Short-term infusion is preferred,and effective monitoring should be conducted at regular intervals during the infusion.Emergency plans for drug extravasation should be established.Developing safe injection protocols can reduce the incidence of adverse events such as extravasation.

Objective To investigate the current situation of the attitude and practical ability of hospice care in the terti-ary cancer hospital of Zhejiang Province,so as to provide reference for managers to explore more effective hospice care support.Methods Using convenience sampling selected 278 clinical nurses from Zhejiang Cancer Hospital.From June to August 2024,the general data questionnaire,hospice care attitude scale and self-assessment practice scale of hospice care were used to survey nurses with questionnaires,and the related factors affecting practical ability and the correlation between attitudes and practical a-bility were analyzed.Results The hospice attitude score of 278 nurses in the hospice co-photography mode was(88.43±12.01),and the average score of entries was(3.54±0.48).The total score of the hospice Practical ability scale was(61.87±12.42),and the average score of the items was(3.64±0.73).Nurses'age,education background,previous experience in ca-ring for end-stage patients and their families,and self-assessment of competence in hospice care were the main influencing factors of nurses'practical ability score(all P＜0.05).There was a positive correlation between clinical nurses'practice ability score and hospice attitude score,the correlation coefficient r=0.176,P＜0.05.Conclusion Under the mode of hospice co-care,the attitude of nurses in Zhejiang Province is above the middle level,and the practical ability of nurses needs to be further improved,the higher the attitude of nurses,and the nurses'practical ability of hospice care is strong.Nursing managers should carry out professional training to promote the attitude of nursing staff,so as to improve the practical ability of nurses in hospice care.

Objective To analyze temporal trends in infectious disease burden among Chinese elderly(≥60 years)using data from the Global Burden of Disease Study(GBD 2021),evaluate age-period-cohort effects on disease burden,predict trends through 2045,and propose evidence-based medication management strategies.Methods We conducted a threefold analysis of infectious disease burden from 1990 to 2021 using Joinpoint regression to identify temporal trends,Age-Period-Cohort(APC)modeling to disentangle epidemiological effects,and Nordpred projections for 2045 disease burden estimates.Results Over 32 years,all infectious disease categories except HIV/AIDS and sexually transmitted infections demonstrated significant declines.Enteric infections showed the most rapid reductions in mortality(AAPC=-7.85,P﹤0.001)and disability-adjusted life year rates(DALYR;AAPC=-7.18,P﹤0.001).We also found a significant decrease in the incidence of tropical diseases and malaria(AAPC=-6.77,P﹤0.001).APC analysis found that the age effect was mostly negative in terms of the annual percentage change in mortality and DALYR for each disease,except for HIV/AIDS,with an overall decline in period risk over time,and a generally higher risk of morbidity and mortality for the early birth cohort,and an overall decline in the risk of each disease as the year of birth progressed,but the risk of HIV/AIDS death and DALY period and cohort risks trended upward.While the overall risk for certain diseases was slightly higher in males compared to females,the trends were largely consistent across both sexes.In terms of projections,the absolute prevalence of respiratory infections and tuberculosis in terms of number of cases and age-standardized rates,and the growth of the disease burden of HIV/AIDS were particularly prominent,making them important health challenges for the future.The burden of disease in the elderly often results in issues such as potential polypharmacy,which must be addressed to improve medication management.Conclusions China has achieved remarkable progress in reducing infectious disease burdens among older adults,though HIV/AIDS and sexually transmitted infections present an escalating public health threat.These findings advocate for enhanced surveillance systems,age-specific prevention strategies,and precision medication protocols to optimize therapeutic outcomes in geriatric populations.

Objective:To investigate the clinical effect of near-infrared autofluorescence (NIRAF) imaging combined with nano-carbon in the identification of parathyroid gland.Methods:A total of 80 patients with thyroid cancer requiring bilateral thyroidectomy plus single/bilateral central area lymphatic dissection were prospectively enrolled in the Department of Thyroid and Breast Surgery of the Shenzhen Third People′s Hospital from January 2020 to June 2023. Two groups were divided in order of time of admission. In the combined group (40 cases), the parathyroid glands were identified by NIRAF+ nano-carbon negative imaging. The nano-carbon group (40 cases) was negatively developed with nano-carbon alone. The detection rate and accuracy of parathyroid gland and the changes of parathyroid hormone (1 d and 6 months after operation) were compared between the two groups.Results:There was no significant difference in the detection rate of parathyroid glands between the two groups ( P=0.65), and the accuracy rate in the combined group was higher than that in the nano-carbon group, the difference was statistically significant (χ 2=8.79, P=0.003). The level of parathyroid hormone in the combined group was higher than that in the nano-carbon group 1 day after surgery, and the difference was statistically significant ( Z=-1.19, P=0.03). There was no significant difference in parathyroid hormone levels between the two groups 6 months after operation ( P=0.18). Conclusions:NIRAF imaging combined with nano-carbon negative imaging can improve the accuracy of intraoperative parathyroid identification, and may reduce the incidence of temporary postoperative hypoparathyroidism.

Objective:To investigate the clinical effect of near-infrared autofluorescence (NIRAF) imaging combined with nano-carbon in the identification of parathyroid gland.Methods:A total of 80 patients with thyroid cancer requiring bilateral thyroidectomy plus single/bilateral central area lymphatic dissection were prospectively enrolled in the Department of Thyroid and Breast Surgery of the Shenzhen Third People′s Hospital from January 2020 to June 2023. Two groups were divided in order of time of admission. In the combined group (40 cases), the parathyroid glands were identified by NIRAF+ nano-carbon negative imaging. The nano-carbon group (40 cases) was negatively developed with nano-carbon alone. The detection rate and accuracy of parathyroid gland and the changes of parathyroid hormone (1 d and 6 months after operation) were compared between the two groups.Results:There was no significant difference in the detection rate of parathyroid glands between the two groups ( P=0.65), and the accuracy rate in the combined group was higher than that in the nano-carbon group, the difference was statistically significant (χ 2=8.79, P=0.003). The level of parathyroid hormone in the combined group was higher than that in the nano-carbon group 1 day after surgery, and the difference was statistically significant ( Z=-1.19, P=0.03). There was no significant difference in parathyroid hormone levels between the two groups 6 months after operation ( P=0.18). Conclusions:NIRAF imaging combined with nano-carbon negative imaging can improve the accuracy of intraoperative parathyroid identification, and may reduce the incidence of temporary postoperative hypoparathyroidism.

Objective To explore the relationship between systemic immune-inflammation index(SII),red blood cell distribution width(RDW),25-hydroxy-vitamin-D[25(OH)D]levels and frailty index in elderly pa-tients with type 2 diabetes mellitus(T2DM).Methods A total of 197 elderly patients with T2DM admitted to the hospital from March 2023 to March 2024 were collected as the research subjects.The patients were divided into the frailty group(106 cases)and the non-frailty group(91 cases)according to the scores of the clinical frailty scale.The clinical data and the levels of SII,RDW and 25(OH)D of the two groups were compared.Pearson correlation analysis was used to analyze the correlations between the levels of SII,RDW and 25(OH)D and the frailty index of elderly patients with T2DM.Logistic regression was used to analyze the influencing factors of frailty in elderly patients with T2DM.Results Compared with the non-frailty group,the proportion of women,the history of falls within 1 year,and the age of the frailty group increased,while the body mass in-dex and the proportion of men decreased,and the differences were statistically significant(P＜0.05).The SII and RDW levels in the non-frailty group were lower than those in the frailty group,and the 25(OH)D level was higher than that in the frailty group,and the differences were statistically significant(P＜0.05).Pearson correlation analysis showed that SII and RDW levels were positively correlated with frailty index,and 25(OH)D level was negatively correlated with frailty index in elderly T2DM patients(P＜0.05).Logistic regression analysis showed that female,age ≥ 74.25 years old,SII≥ 938.36,RDW≥ 15.19％,and 25(OH)D≥48.42 nmol/L were independent risk factors for frailty in elderly T2DM patients(P＜0.05).Conclusion The levels of SII,RDW and 25(OH)D in elderly patients with T2DM are related to the frailty index.

Objective:To investigate whether intermittent fasting alleviates insulin resistance in a polycystic ovary syndrome(PCOS) mouse model through the regulation of autophagy.Methods:Fifty 3-week-old female C57BL/6J mice were randomly assigned into the following groups using a random number table: normal control(NC) group( n=10), maintained on a standard chow diet; high-fat diet(HFD) group( n=10) fed a diet with 60% of calories derived from fat; and PCOS model group( n=30), established by combining a HFD with dehydroepiandrosterone(DHEA) administration. Successful modeling was confirmed by disrupted estrous cycles, hyperandrogenism, and polycystic ovarian morphology. The PCOS model mice were further divided into three groups: PCOS group( n=9), PCOS with intermittent fasting group(PCOS+ IF, n=9), and PCOS with intermittent fasting plus the autophagy inhibitor 3-methyladenine(3-MA) group(PCOS+ IF+ 3-MA, n=9). Autophagy levels were assessed by detecting markers LC3 and p62 and observing autophagosomes via transmission electron microscopy. Glucose tolerance test(GTT) and insulin tolerance test(ITT) were performed, and the area under the curve(AUC) was calculated to evaluate insulin resistance. Western blotting was used to detect phosphorylation levels of phosphatidylinositol 3-kinase(PI3K), protein kinase B(Akt), mammalian target of rapamycin(mTOR), and p70S6 kiase(p70S6K). Results:Compared with the NC group, the PCOS model group showed absent estrous cycles, significantly elevated serum testosterone, sex hormone binding globulin, and luteinizing hormone(LH) levels( P<0.001), and polycystic ovarian changes on hematoxylin-eosin staining, confirming successful model establishment. Immunohistochemistry, transmission electron microscopy, and Western blotting demonstrated that autophagy levels were increased in the PCOS+ IF group compared with the PCOS group, while 3-MA administration reduced the intermittent fasting - induced autophagy. The AUC values for both GTT and ITT were significantly lower in the PCOS+ IF group than those in the PCOS group( P<0.001, P=0.003), but increased in the PCOS+ IF+ 3-MA group compared to the PCOS+ IF group( P<0.001, P=0.020). Western blotting analysis showed that phosphorylation levels of PI3K, Akt, mTOR, and p70S6K were significantly decreased in the PCOS+ IF group compared with the PCOS group( P=0.002, P=0.001, P=0.001, and P<0.001, respectively), and increased in the PCOS+ IF+ 3-MA group compared with the PCOS+ IF group( P=0.021, P=0.041, P=0.047, and P=0.024, respectively). Conclusions:Intermittent fasting alleviates insulin resistance in a PCOS mouse model through inhibitiing PI3K/Akt/mTOR signaling pathway and promoting autophagy.

Objective:To investigate the changes in and correlations between melanin-concentrating hormone (MCH) and androgen levels in the serum of patients with polycystic ovary syndrome (PCOS), aiming to provide a novel research perspective for its diagnosis.Methods:A cross-sectional study. A total of 307 subjects were enrolled from the physical examination center and endocrinology clinic of the Affiliated Hospital of Zunyi Medical University from June 2023 to June 2024. The cohort comprised 114 healthy controls and 193 patients with PCOS, diagnosed according to the Rotterdam criteria. The patients were grouped into four phenotypes: Phenotype A (hyperandrogenemia [HA]+ovulatory dysfunction [OA]+polycystic ovarian morphology [PCOM], n=44), Phenotype B (HA+OA, n=50), Phenotype C (HA+PCOM, n=46), and Phenotype D (OA+PCOM, n=53). Clinical data were collected for all subjects. Serum MCH levels were determined by enzyme-linked immunosorbent assay. The relationship between MCH and androgen-related risk factors for PCOS was analyzed using Spearman partial correlation analysis and stepwise multiple linear hierarchical regression. Binary logistic regression was used to analyze factors influencing PCOS onset. The diagnostic value of MCH for PCOS was evaluated using a receiver operating characteristic (ROC) curve. Results:There were no significant differences in age and height between the healthy control group and the PCOS phenotypic groups (both P>0.05). MCH levels [17.63 (12.69, 22.00), 17.31 (11.05, 20.09), 17.82 (11.47, 19.40), 16.50 (11.14, 19.41) μg/L vs. 12.14 (9.78, 15.05) μg/L], homeostatic model assessment of insulin resistance, fasting plasma glucose, fasting serum lisulin, body mass index, and weight were significantly higher across all four PCOS phenotypes (A, B, C, and D) than in healthy controls (all P<0.05), whereas sex hormone-binding globulin (SHBG) contents were significantly lower ( P<0.05). Free androgen index (FAI), total testosterone (TES) and dehydroepiandrosterone (DHEA) levels were significantly higher in PCOS phenotypes A, B, and C than in the control group and PCOS phenotype D (all P<0.05). Spearman partial correlation analysis revealed no significant correlation between MCH and TES, DHEA, or FAI in healthy controls and patients with non-HA PCOS (all P>0.05). However, in PCOS patients with HA, MCH showed a significant positive correlation with TES and DHEA ( r=0.227 and 0.196, respectively; both P<0.05), but not FAI ( P>0.05). Stepwise multiple linear hierarchical regression analysis showed that MCH was positively correlated with TES, DHEA and luteinizing hormone and negatively correlated with SHBG (all P<0.05). Binary logistic regression indicated that an increase in MCH may be a potential risk factor for PCOS occurrence ( OR=1.113, 95% CI 1.012-1.224, P=0.028). ROC analysis showed that MCH has diagnostic value for PCOS ( P<0.05), with an area under the curve of 0.713. Conclusion:Serum MCH is closely related to FAI, TES, and DHEA levels in PCOS patients and may play an important role in the etiology and progression of the syndrome.

County medical community serves as pivotal instruments for the hierarchical diagnostic and treatment system. Since their nationwide implementation in December 2023, there has been a pressing demand for governance theories to direct practical applications. Based on polycentric-collaborative governance theory, this study articulated a framework that modeled county medical community as accountable care organizations, anchored by a foundation of primary health care and a polycentric-collaborative governance structure. The framework encompassed critical dimensions, including problem orientation, diverse governance actors, multi-dimensional governance mechanisms, governance objectives, and evaluative metrics. This research also introduced 17 governance instruments, delineated 13 priority action fields, and pinpointed 5 potential reform areas, with a pronounced focus on bolstering governance capacity through value-based payment reforms and technological underpinnings of digital innovation. The framework′s viability and efficacy have been substantiated through a case study in Zhejiang Province. The framework presented herein could offer a comprehensive and systematic guide for county medical community practice, capturing the essence of the reform through a problem-oriented lens, fostering multi-actor involvement, and ensuring the harmonization of multi-dimensional governance mechanisms, thereby fortifying the reform′s systematic, integrative, and collaborative attributes.