OBJECTIVE To optimize the extraction process of Shenye buyi formula. METHODS Based on the quality by design （QbD） concept， the contents of rutin， nuciferine， sinapine thiocyanate， liquiritin，and glycyrrhizic acid ammonium salt， as well as the extract yield， were selected as the critical quality attributes （CQAs） for the extraction process of Shenye buyi formula. The fishbone diagram combined with the failure model and effect analysis method was adopted to determine the water addition， extraction time and extraction times as critical process parameters （CPPs）. High-performance liquid chromatography was employed to detect the contents of rutin， nuciferine， sinapine thiocyanate， liquiritin， and glycyrrhizic acid ammonium salt. The analytic hierarchy process-entropy weight method was used to comprehensively assign weights to the content of the five components including rutin and the extract yield. The Box-Behnken response surface method was employed to fit the mathematical model between CQAs and CPPs， screen the operational space of the extraction process， and validate it. RESULTS The optimal operational space of the extraction process was 9.5 to 12 times the amount of water added， the extraction time was 1 to 1.7 hours， and the extraction times were 3. Upon verification，the comprehensive scores of the optimal extraction process within the operational space were 89.79 and 84.93， respectively. CONCLUSIONS The extraction process of the Shenye buyi formula can be applied to the development and production of its granule preparations.

BackgroundAdverse childhood experiences （ACEs） are strong predictors of psychopathology across the lifespan， exerting extensive adverse effects on physical and mental health during early development. While ACEs increase the risk of childhood psychopathology， sleep quality and impair cognitive function， the early neurobiological mechanisms mediating ACE-induced cognitive impairment remain unclear. ObjectiveTo explore the association between ACEs exposure and the risk of psychopathology， sleep disorders， and cognitive function， and to examine the mediating role of the putamen volume in the relationship between ACEs and cognitive function from a neurodevelopment perspective. MethodsData were obtained from the Adolescent Brain Cognitive Development （ABCD） study， comprising 10 572 children aged 9 to 10. Participants were categorized into five groups based on the cumulative score of ACEs reported by their parents and the children themselves： no-exposure group （0 types of ACEs）， the one-exposure group， the two-exposure group， the three-exposure group， and the high-risk exposure group （≥ 4 types of ACEs）. Logistic regression analysis was employed to evaluate the association between ACEs and psychopathological symptoms ［T score of the Child Behavior Checklist （CBCL） ≥ 65］. Multiple linear regression analysis was ultilized to analyze the correlations between ACEs and the scores of the Sleep Disturbance Scale for Children （SDSC）， the NIH Toolbox Cognition Battery （NIHTB-CB）， as well as the multiple structures in the cerebral cortex and subcortex. The Bootstrap method was applied to test the mediating effect of the putamen volume between ACEs and neurocognitive function. ResultsAfter adjusting for confounders， ACEs cumulative score was correlated with children's psychopathological symptoms in a dose-response manner. Compared with the no-exposed group， the high-risk exposure group had a 2.08-fold （OR=2.080， 95% CI： 1.401–3.088） increased risk of internalizing problems and a 3.13-fold （OR=3.132， 95% CI： 1.703–5.760） increased risk of externalizing problems， and the risk of conduct problems was 4.68 times that of the no-exposed group （OR=4.681， 95% CI： 2.528–8.669）. ACEs cumulative score positively predicted the total score of SDSC （β=0.080， 95% CI： 0.059–0.102）， with relatively stronger predictive effects on sleep-wake transition disorder （β=0.086， 95% CI： 0.063–0.109） and sleep onset and maintenance disorder （β=0.066， 95% CI： 0.043–0.089）. In terms of neurocognition and brain structure， ACEs cumulative score negatively predicted the overall cognitive composite score （β=-0.025， 95% CI： -0.050–-0.001）， the crystallized cognitive composite score （β=-0.035， 95% CI： -0.060–-0.010）， the volume of the left putamen nucleus （β=-0.025， 95% CI： -0.046– 0.003）， and the volume of the right putamen nucleus （β=-0.023， 95% CI： -0.044– 0.003）. The total putamen volume played a partial mediating role between ACEs and the overall cognitive composite score， the effect value was -0.002 （95% CI： -0.004–-0.001）， accounting for 7.49% of the total effect. ConclusionACEs exposure may increase the risk of psychopathological and sleep disturbances in children and may impair neurocognitive function. Reduced putamen volume may serve a potential neurobiological pathway underlying the impact of ACEs on childhood cognition. ［Funded by National Natural Science Foundation of China-Young Scientists Program （number， 82401763）； Sichuan University West China Hospital Full-time Postdoctoral Research and Development Fund Project （number， 2023HXBH084）］

Objective To summarize the operation experience of 1 case of ultra-long-distance single-port robotic-assisted laparoscopic renal cyst decortication using a domestic robotic system,and provide references for the development of long-distance telesurgery.Methods The procedure was performed using a domestically produced single-port robotic system.The distance between the main control end and the patient end was 2 400 km.The operation was conducted remotely via a 5G network and a 100 Mbps dedicated line provided by China Telecom.The surgeon controlled the robotic arm remotely.Results The surgery was completed smoothly within a duration of 32 min.The real-time latency was(90±20)ms.Blood loss during the operation was 10 mL,and no drainage tube was placed.The patient recovered smoothly and returned to the ward without any complications.Conclusion It is safe and feasible for the domestically produced single-port robotic system to implement ultra-long-distance telesurgery.This approach facilitates the decentralization of advanced medical resources and helps mitigate disparities in healthcare access.

Objective To establish an expert consensus on in-hospital transfer safety management for patients undergoing invasive mechanical ventilation,providing guidance for clinical medical teams to conduct standardized transfers,reduce transfer risks,and ensure patient safety.Methods Through systematic searching,screening,evaluation,and summary of evidence related to in-hospital transfer safety management for patients on invasive mechanical ventilation,we extracted recommendations to form a preliminary draft of the expert consensus.From July to October 2024,totally 2 rounds of expert consultations,and 2 rounds of expert reviews were conducted,and the content was refined and finalized based on expert feedback.Results The final consensus encompasses 9 aspects,including transfer assessment and decision-making,pre-transfer preparation of medical staff,pre-transfer patient preparation,pre-transfer equipment preparation,pre-transfer medication preparation,monitoring and intervention during transfer,emergency events and management,transfer handover and documentation,and post-transfer management.Conclusion This consensus demonstrates strong practicality and operability,offering professional guidance for enhancing the safety of in-hospital transfers for patients on invasive mechanical ventilation.

Objective:To sinicize the Obsessive and Compulsive Behaviors Scale of Mothers in Postpartum Period Regarding Baby Care (OCBS-MPPRBC) to test its reliability and validity, and to provide an evaluation tool for evaluating the degree of compulsive behaviors of postpartum mothers regarding baby care.Methods:Following the principles of Brislin translation, back translation and cross-cultural adaptation, the Chinese version of OCBS-MPPRBC was formed. A convenient sampling method was used to investigate 360 women in Mianyang Central Hospital from November 2023 to February 2024, and to test the reliability and validity of the Chinese version OCBS-MPPRBC. The critical ratio method and the total correlation analysis method were used for item analysis, the reliability test was based on Cronbach α coefficient and half-reliability method, and the content validity index, exploratory factor analysis, confirmatory factor analysis and aggregate validity were used for validity test. Results:A total of 352 women aged 21-41 (31.55 ± 3.17) years who met the exclusion criteria were included. The Chinese version of OCBS-MPPRBC contained 9 items, and 2 common factors were extracted by exploratory factor analysis, and the cumulative total variance contribution rate was 65.523%. The content validity index of the scale level was 0.89, the content validity index of each item level was 0.86-1.00, and the Cronbach α coefficient of the total scale was 0.844, and the half-folded reliability was 0.759. The results of confirmatory factor analysis showed that the fitting index of the Chinese version of the OCBS-MPPRBC model was better. Conclusions:The Chinese version of the OCBS-MPPRBC scale has good reliability and validity, and has good operability, which can be used to evaluate the degree of compulsive behavior of postpartum mothers about baby care in China.

AIM:To investigate the effect of fenofibrate(FF)on the heart of rats with high-altitude heart dis-ease-induced right ventricular hypertrophy(H-RVH),and to explore the mechanisms and associated signaling pathways.METHODS:A total of 36 six-week-old male SD rats were randomly divided into control,model(H-RVH),and FF inter-vention(H-RVH+FF)groups with 12 rats each.A rat model of H-RVH was established by single subcutaneous injection of Sugen 5416(20 mg/kg)and exposure to a hypoxic condition(5 000 m above sea level)for 21 d in all groups except the control group.The rats in H-RVH+FF group were given FF(60 mg·kg-1·d-1)through gavage,while those in control and model groups received equal volume of saline once daily for 21 d.Rat heart gross morphology was observed,and the heart volume and weight,right ventricular weight and other hypertrophy indexes were measured in each group at the end of the experiment.A right heart floating catheter was used for measuring pulmonary artery and right ventricular pressure.Cardi-ac function was checked through cardiac ultrasonography.The serum levels of atrial natriuretic peptide(ANP),N-termi-nal pro-brain natriuretic peptide(NT-proBNP),free fatty acids(FFA),and myocardial tissue glucose(Glu)in all groups of rats were detected.The protein expression of peroxisome proliferator-activated receptor α(PPARα),fatty acid binding protein 1(FABP1),carnitine palmitoyl transferase 1a(CPT1a),pyruvate dehydrogenase kinase(PDK),and pyruvate dehydrogenase(PDH)were detected through Western blot.RESULTS:(1)Compared with the control group,the H-RVH group showed a significant increase in heart morphology and weight and increases in heart weight/body weight(HW/BW),heart volume,right ventricular weight/heart weight(RVW/HW),and Fulton index(FI)(P<0.05).Cardiac mor-phology,volume,heart weight,and HW/BW significantly decreased in the fenofibrate intervention group compared with the H-RVH group(P<0.05).RVW/HW and FI also decreased.(2)The right heart float catheter test showed that the mean right ventricular pressure(mRVP)and mean pulmonary artery pressure(mPAP)significantly increased in the H-RVH group compared with the control group(P<0.01).The increases in mRVP and mPAP were reversed in rats in the fe-nofibrate intervention group compared with the H-RVH group.(3)Cardiac ultrasonography showed that compared with the control group,the H-RVH group had significantly increased right ventricular anterior wall(RVAW)and right ventricular posterior wall(RVPW)thickness(P<0.01),significantly decreased right ventricular end-diastolic diameter(RVEDD),and right ventricular end-diastolic length(RVEDL)(P<0.01).In addition,pulmonary artery acceleration time(PAAT)was reduced,ejection time(PAET)was prolonged,and PAAT/PAET ratio decreased(P<0.01).Compared with the H-RVH group,the fenofibrate intervention group showed significant decreases in RVAW and RVPW(P<0.05),increases in RVEDD and RVEDL,and an increase in PAAT/PAET ratio.(4)The kit assay showed that the levels of ANP and NT-Pro BNP in serum were significantly higher in the H-RVH group than in the control group(P<0.05),while the levels of both were lower in the fenofibrate intervention group.The levels of serum FFA and myocardial tissue Glu levels(P<0.05)were significantly higher in the H-RVH group than in the control group.The levels of serum FFA and myocardial tissue Glu level were significantly lower in the fenofibrate intervention group than in the H-RVH group(P<0.05).(5)Western blot results showed that the expression levels of PPARα,FABP1,CPT1a,and PDH in the myocardial tissues of rats in the H-RVH group were significantly reduced(P<0.01),whereas the expression level of PDK significantly increased relative to those of the control group(P<0.01).All the effects on the above indices in the H-RVH group can be significantly re-versed by fenofibrate intervention(P<0.05).CONCLUSION:Fenofibrate exerts a protective effect on the hearts of rats with right ventricular hypertrophy associated with high-altitude heart disease by activating PPARα/FABP1/CPT1a,en-hancing fatty acid oxidation,inhibiting PDK,and activating PDH to promote the aerobic oxidation of glucose.Hence,the medication can ameliorate glucose-lipid metabolism disorders.

A porous composite scaffold is prepared through freeze-drying method using sodium alginate as the matrix and calcium citrate double salt as the functional enhancer.To thoroughly investigate the structure and properties of the composite scaffold,advanced instruments including Fourier transform infrared spectrometer,X-ray diffractometer,scanning electron microscope,and thermogravimetric analyzer are utilized for comprehensive structural characterization.Meanwhile,key properties such as porosity,mechanical performance,swelling ratio,gel fraction,and in vitro degradation rate are systematically tested and analyzed.The results show that the composite of sodium alginate and calcium citrate double salt is a physical complex.The porosity of the scaffold mainly ranges from 200 to 600 μm,and as the addition of double salt increases,the pore size firstly increases and then slightly decreases,while the pore distribution become more uneven.In terms of mechanical properties,with the gradual increase of the content of double salt in the scaffold,the mechanical properties of the scaffold are significantly improved.However,its swelling ratio and gel fraction exhibit decreasing trends.Additionally,the degradation rate of the alginate scaffold is relatively fast,while the addition of calcium citrate double salt does not significantly improve the degradation rate.This study not only provides valuable insights into the preparation and property research of porous composite scaffold composed of sodium alginate/calcium citrate double salt,but also offers important reference for their potential applications in biomedicine.

Objective To understand the current situation and dynamic changing trends of healthcare-associated infection(HAI)in a tertiary first-class hospital in the northwest of Hunan Province from 2015 to 2024,and provide scientific basis for optimizing infection control strategies.Methods A single-day cross-sectional survey method was employed to investigate the HAI prevalence rates of hospitalized patients on the given survey day each year from 2015 to 2024.The standardized survey protocol on prevalence rate issued by the National Medical Institution Infec-tion Surveillance Network was strictly adhered,lanqingting real-time HAI monitoring management platform was adopted to retrieve cases from the hospital information system,and R4.2.2 was applied for statistical analysis.Results From 2015 to 2024,the prevalence rate of HAI decreased from 3.03％in 2015 to 1.76％in 2024(Z=-3.37,P＜0.001),and the HAI case prevalence rate decreased from 3.55％in 2015 to 2.20％in 2024(Z=-2.81,P=0.005).Department of critical care medicine continuously had the highest HAI case prevalence rate,which presented a downward trend over time(Z=-2.84,P=0.004).The main site of HAI was lower respiratory tract,accounting for 39.36％to 48.15％,bloodstream infection increased from 3.57％in 2015-2016 to 10.60％in 2023-2024(Z=2.41,P=0.016).A total of 302 strains of HAI pathogens were detected,including 212 strains(70.20％)of Gram-negative bacteria,mainly Pseudomonas aeruginosa(n=55,18.21％),Escherichia coli(n=45,14.90％),Acinetobacter baumannii(n=33,10.93％),and Klebsiella pneumoniae(n=31i,10.26％).65 strains(21.52％)of Gram-positive bacteria were identified,with Enterococcus faecium(n=19,6.29％)and Staphylococcus aureus(n=18,5.96％)accounting for the highest proportions.25 fungal strains(8.28％)were detected,mainly Candi-da albicans(n=11,3.64％).The use rate of antimicrobial agents showed a downward trend over the past decade(Z=-4.01,P＜0.001).Therapeutic antimicrobial use accounting for 82.42％,and its proportion increased over time(Z=6.02,P＜0.001).Prophylactic antimicrobial use accounted for 16.42％,showing a decreasing trend(Z=-2.75,P＜0.001).The pathogen detection rate presented an upward trend over the past decade(Z=13.01,P＜0.001).Conclusion The prevalence rate and case prevalence rate of HAI present a downward trend in this hospi-tal.In the future,it is necessary to establish a monitoring data-based dynamic analysis mechanism,achieve timely feedback and intervention in data monitoring,pay attention to high-risk links in department of critical care medicine,implement precise prevention and control mearsures,perform targeted prevention and control for lower respiratory tract,urinary tract,and bloodstream infection,optimize diagnosis and treatment processes,use antimicrobial agents rationally,and pay attention to the prevalence trend of Gram-negative bacteria.

In recent decades,the incidence of human papillomavirus(HPV)-associated oropharyngeal squamous cell carcinoma(OPSCC)has shown a marked increase.Significant changes have also occurred in the OPSCC diagnosis and treatment paradigm.Deter-mining HPV status prior to treatment is now essential,and radiotherapy/chemotherapy,immunotherapy,and minimally invasive surgical techniques have progressively emerged as key modalities for managing OPSCC.However,alongside these paradigm shifts,a comprehen-sive technical consensus guiding the entire diagnostic and therapeutic process for OPSCC patients is currently lacking.Given China's large population base and the rising incidence of OPSCC,an expert panel convened to develop a clinical technical consensus on OPSCC diagno-sis and management tailored to China's specific context.This consensus aims to further enhance and standardize understanding of OPSCC management techniques among relevant healthcare professionals.

Objective:To systematically evaluate and integrate qualitative research from nurses on perceptions and feelings of elder self-neglect, with the aim of providing a reference for early identification, prevention, and intervention of elder self-neglect by nursing staff.Methods:Qualitative research of nurses' perceptions and feelings of elder self-neglect was systematically searched in the Cochrane Library, PubMed, Embase, Web of Science, China National Knowledge Infrastructure, WanFang Data, VIP, and China Biology Medicine disc by computer. The search period was from database establishment to March 31, 2024. The quality of the literature was evaluated according to the quality evaluation criteria for qualitative research of the Australia Joanna Briggs Institute Evidence-Based Health Care Center. The aggregate integration approach was used to integrate the findings of the study.Results:A total of eight papers were included to distill 30 findings, and similar findings were generalized and integrated to form 11 categories and synthesized into three integrated findings, including nurses' perception of elder self-neglect, manifestations of elder self-neglect from nurses' perspectives, and influencing factors of elder self-neglect from nurses' perspectives.Conclusions:Nurses should understand the manifestations and influencing factors of elder self-neglect, improve own professionalism, and help the elderly establish positive coping mechanisms to promote healthy aging.