The ambiguity of symptom information in traditional Chinese medicine （TCM） syndrome differentiation can be amplified in the direct reasoning process from symptoms to syndromes in the absence of constraints， which affects the accuracy and stability of intelligent syndrome differentiation. TCM disease concepts， while historically rational， are structurally ambiguous in both their connotation and extension， making it difficult to serve as stable prior knowledge in intelligent modeling. In contrast， modern medical diseases， based on objective testing and quantifiable indicators， have relatively clear boundaries and reproducible standards. This study proposes a disease-syndrome combination model， adopting modern medical diseases as structural prior variables to reconstruct the hierarchical relationships among disease， symptoms， and syndromes. By applying disease constraints， effective screening of information from the four examinations and compressing the reasoning space are achieved. Furthermore， by integrating artificial intelligence technologies， such as multimodal fusion and knowledge graphs， an intelligent syndrome differentiation model driven by both prior knowledge and clinical data is constructed， providing a feasible path to enhance the accuracy of syndrome differentiation and realize the intelligentization of TCM diagnosis and treatment.

Background: and Purpose Therapeutic target selection in noninvasive brain stimulation for poststroke motor recovery typically relies on the interhemispheric inhibition model, which is effective for mildly affected patients but offers limited benefits for severely affected individuals. The mechanisms governing recovery from moderate-to-severe stroke remain poorly understood, which hinders the development of targeted interventions. Methods: We analyzed resting-state functional magnetic resonance imaging data from patients with unilateral subcortical stroke and moderate-to-severe upper limb deficits, both pre- and postintervention, along with data from healthy controls. We developed a novel dynamic lag analysis method for identifying recovery-related homotopic sensorimotor regions with altered interhemispheric interactions. To further uncover the global reorganization pathway, we developed dynamic lateralization approaches to detect large-scale functional connectivity (FC) alterations associated with the identified regions in transient lateralization states. Results: Dynamic time-lag analysis revealed significantly reduced synchronized states in the homotopic dorsal premotor cortex (PMd) post-intervention compared with pre-intervention, which correlated with motor recovery. Further dynamic lateralization analysis revealed a prolonged segregation state in patients, characterized by weakened interhemispheric and strengthened intrahemispheric interactions. In this state, patients showed decreased FC in the ipsilesional PMd and increased FC in the contralesional PMd with bilateral subcortical networks. These recoveryrelated alterations were absent in the traditional static analysis. Conclusions Dynamic analyses targeting interhemispheric interactions are valuable for understanding neural reorganization after stroke. The diminished interactions between the homotopic PMd indicate a compensatory mechanism. Importantly, a state-dependent compensatory pathway was identified, wherein the contralesional PMd assumes the functions of the ipsilesional PMd through enhanced interactions with subcortical structures, potentially guiding more effective interventions.

Objective:To explore the application and effectiveness evaluation of the "six thinking hats" thinking mode in nursing teaching rounds.Methods:A total of 65 surgical nursing interns from a tertiary hospital were selected as the research subjects. The control group received routine teaching rounds, while the observation group received teaching rounds based on the "six thinking hats" thinking mode intervention. General information, assessment results, critical thinking ability, job competence, and satisfaction with teaching effectiveness were compared between the two groups of nursing students. SPSS 22.0 statistical software was used for t-test and chi-square test. Results:Compared with the control group, the observation group showed significantly higher scores in operational skills [(92.50±2.20) vs. (89.53±2.08)] and theoretical knowledge [(89.21±1.51) vs. (86.81±2.71)] and medical record writing score [(93.17±4.05) vs. (85.20±3.19)]. The critical thinking ability score was significantly higher in the observation group than in the control group [(319.97±45.13) vs. (283.57±41.57)]. The competency score was significantly higher in the observation group than in the control group [(182.62±14.07) vs. (164.43±14.50)]. The observation group demonstrated a higher overall evaluation of teaching satisfaction.Conclusions:The "six thinking hats" thinking mode improves the ability of nursing students to analyze problems, stimulates their subjective initiative in learning, and has a positive impact on the cultivation of their comprehensive abilities, making it a feasible teaching mode.

Objective:To investigate the current status of teaching behavior of clinical nursing teachers and explore the mediation effect of organizational commitment between their work engagement and teaching behavior.Methods:This study included a total of 1 736 clinical nursing teachers who worked in grade A tertiary hospitals in Beijing City, Shanghai City, Henan Province, Hubei Province, Hebei Province, and Chongqing City from May 2022 to November 2022. Data were collected using a general information questionnaire, the Effective Teaching Behavior Scale, the Work Engagement Scale, and the Organizational Commitment Scale. Statistical description and correlation analysis were performed using SPSS 25.0 software, and mediation effect was analyzed using AMOS 25.0 software.Results:The total mean score of effective teaching behavior of 1 599 clinical nursing teachers was (4.19±0.66), the total mean score of work engagement was (5.09±1.36), and the total mean score of organizational commitment was (3.93±0.72). Pearson correlation analysis showed that work engagement and organizational commitment were positively correlated with teaching behavior ( r=0.560, 0.519, both P<0.01). Organizational commitment partially mediated the relationship between work engagement and teaching behavior, with a mediation effect value of 0.27, and the mediation effect accounted for 49.10% of the total effect. Conclusions:Work engagement is a direct predictor of the teaching behavior of clinical nursing teachers, and organizational commitment partially mediates the relationship between work engagement and teaching behavior. Administrators can promote the work engagement of clinical nursing teachers by adopting effective interventions to increase the level of organizational commitment, which in turn enhances teaching behavior.

Objective:To summarize the clinical data of single-center juvenile dermatomyositis（JDM）complicated with interstitial lung disease（ILD），and provide experience for pediatricians.Methods:Data of 61 children with JDM who were admitted to Children's Hospital affiliated to Xi'an Jiaotong University from January 2016 to May 2023 were collected. General data，clinical symptoms，chest high-resolution CT，laboratory examination and myositis antibody spectrum of the children were recorded.Results:Among the 61 children with JDM，there were 30 cases（13 males and 17 females）without ILD. The age of onset was 5.96（3.50，8.92）years and the course of disease was（11.79±20.00）months. There were 31 cases with ILD（14 males and 17 females），the age of onset was 7.42（4.50，10.08）years，and the duration of ILD was（5.47±8.09）months. There was statistical difference in the course of disease between the two groups（ P<0.05），but no statistical difference in gender and age between the two groups（ P>0.05）. Among 61 children with JDM，there were statistical differences in fever between the two groups（ P<0.05），but no statistical differences in heliotrope discoloration，gottron’s papules，calcinosis and myasthenia between the two groups（ P>0.05）. AST and FER showed statistical difference between the two groups（ P<0.05），while CK，LDH，CK-MB，ESR，C3 and C4 showed no statistical difference（ P>0.05）. All 61 cases of children were tested for myositis antibody spectrum，and there was statistical difference in anti-MDA5 antibody between the two groups（ P<0.05），but no statistical difference in the rest（ P>0.05）. There were statistical differences between the two groups in the treatment of methotrexate，hydroxychloroquine and cyclophosphamide（ P<0.05）. A total of 11 cases（36.67%）in the without ILD group were treated with biologics（8 adalimumab，2 infliximab and 1 tofacitinib），and 23 cases（74.19%）in the ILD group were treated with biologics（11 adalimumab，9 tofaciib，2 infliximab and 1 tocilizumab）. All 61 cases with JDM were followed up. Among the 30 children without ILD，1 case was lost to follow-up 2 months after treatment，and the rest were treated effectively without death. Among the 31 children with ILD，3 cases died of severe pulmonary infection with multidrug-resistant bacteria during treatment，of which 1 case was positive for anti-MDA5 antibody and 2 cases were negative for myositis specific antibody. Conclusion:JDM is more likely to be complicated with ILD，fever is more likely to occur in ILD group，and children with positive anti-MDA5 antibody are more likely to occur ILD. Biologic agents such as adalimumab and tofacitinib are effective in combination therapy. In the course of treatment，multi-drug resistant bacteria infection should be guarded against to reduce mortality.

OBJECTIVE To investigate the acute lung injury effects of pulmonary phospholipids and their phospholipase A2(PLA2)decomposition products-lysophospholipids and fatty acids-on mice.METHODS Mice were randomly assigned to the following groups:① solvent control(PBS)and PLA2;② solvent control and glycerol phospholipid groups:1,2-dioleoyl-sn-glycero-3-phosphoserine(DOPS),1,2-dipalmitoyl-sn-glycero-3-phosphoserine(DPPS),1,2-dioleoyl-sn-glycero-3-phosphoethanol-amine(DOPE),1,2-dipalmitoyl-sn-glycero-3-phosphoethanolamine(DPPE),1,2-dipalmitoyl-sn-glycero-3-phosphocholine(DPPC),and 1-stearoyl-2-oleoyl-sn-glycero-3-phosphocholine(SOPC);③ solvent con-trol and fatty acid groups:palmitic acid(PA),oleic acid;④ solvent control and lysophospholipid groups:1-oleoyl-2-hydroxy-sn-glycero-3-phosphoserine(18∶1 LysoPS),1-stearoyl-sn-glycero-3-phosphoserine(18∶0 LysoPS),1-palmitoyl-sn-glycero-3-phosphoserine(16∶0 LysoPS),1-palmitoyl-sn-glycero-3-phos-phoethanolamine(16∶0 LysoPE),1-palmitoyl-sn-glycero-3-phosphocholine(16∶0 LysoPC);⑤ solvent control,PLA2,DPPC,PA,16∶0 LysoPC,16∶0 LysoPS,and 18∶1 LysoPS.Following anesthesia,mice were administered nebulized PBS in the solvent control group,2.1 ug·kg-1 PLA2 in PBS in the PLA2 group and 2.5 mg·kg-1 of the corresponding substance in PBS in other experimental groups.For group①,survival times were recorded and survival curves were plotted.At 1 h post-treatment,lung tissues from groups ①②③④ were collected,photographed to obtain white light images,and subjected to HE staining to assess histopathological changes and pathological scoring.At 2 h post-treatment,pulmonary blood flow in group ⑤ was assessed using laser speckle contrast imaging,arterial blood gas was analyzed with a blood gas analyzer,and lung function was evaluated using whole-body pleth-ysmography.At 6 hours post-treatment,blood cells from group ⑤ were analyzed using an automated hematology analyzer.RESULTS Compared with the solvent control group,severe pathological changes were observed in lung tissues of the PLA2 group,accompanied by extensive inflammatory infiltration and interstitial thickening,with all mice succumbing within 240 min.In mice treated with glyc-erol phospholipids,alveolar structures remained clear,alveolar walls were intact and continuous,and alveolar spaces were translucent,with only occasional minor inflammatory cell infiltration in the septa.No significant pathological alterations were detected in the fatty acid groups.Minor inflammatory cell infiltration was seen in the 16∶0 LysoPE and 16∶0 LysoPC groups.However,such pathological changes as patchy hemorrhage,alveolar interstitial edema,increased alveolar wall thickness,and elevated neutrophil counts were observed in the 18∶1 LysoPS,18∶0 LysoPS,and 16∶0 LysoPS groups.Pathological scores based on HE staining were significantly increased in the 16∶0 LysoPS and 18∶1 LysoPS groups com-pared with the solvent control.The percentage of the lung tissue injury area was also markedly higher in the 16∶0 LysoPS group.A significant decrease in the mean fluorescence intensity of blood flow was observed in the 16∶0 LysoPS group.Arterial partial pressure of oxygen(pO2)was significantly reduced in the PLA2 group,while arterial partial pressure of carbon dioxide(pCO2)was markedly elevated in the 16∶0 LysoPS and 18∶1 LysoPS groups.Lung function tests revealed that the 16∶0 LysoPS group exhibited significant increases in expiratory time,end-expiratory pressure,and enhanced pause,in contrast to significant decreases in tidal volume,expired volume,and minute volume.The 18∶1 LysoPS group also exhibited a significant decline in minute volume.No significant changes in inflammatory cell concentrations were detected in blood,with the exception of neutrophils in the 16∶0 LysoPS group,which showed a significant but physiologically normal increase.CONCLUSION Pulmonary phospholipids and their PLA2-derived fatty acid metabolites do not induce severe lung injury in mice while the lyso-phospholipid metabolites,particularly lysophosphatidylserine,are found to cause significant lung injury.

Objective To evaluate the impact of intensified infection control measures on the incidence of health-care-associated infection(HAI)under the background of the reform of diagnosis-intervention packet(DIP)payment,and provide decision-making basis for HAI management under the reform of medical insurance payment.Methods The interrupted time series research design was used to collect the monitoring data of HAI in a tertiary first-class hospital from October 2021 to September 2024.The changing trend of HAI incidence was analyzed by piecewise li-near regression,and the intervention effect was evaluated by standardized infection ratio(SIR).Results From Oc-tober 2021 to September 2022,the incidence of HAI was 2.17％(95％CI:2.08％-2.26％),which dropped to 1.87％(95％CI:1.82％-1.92％)after the intervention.Piecewise linear regression analysis showed that the inci-dence of HAI decreased by 0.324％immediately after the intervention(95％CI:-0.481％--0.167％,P＜0.001),and the trend after the intervention changed significantly compared with that before the intervention(95％CI:-0.033％--0.009％,P=0.001).SIR analysis showed that the actual incidence during the entire intervention period was equivalent to 74.56％of the incidence in intervention period,gradually stabilized from 88.39％-93.81％at the beginning of the intervention to 67.03％-71.22％at the end of the study,and the intervention effect was sustained.Conclusion Intensified infection control measures under the background of the reform of DIP significantly reduce the incidence of HAI and improve the stability of infection control management,which provide new insights into the synergistic improvement of medical insurance payment and HAI management quality.

Objective To investigate the cellular characteristics in the development of retinal tumors induced by MY-CN overexpression,and to find the key proteins that play an important role in this process.Methods T-MYCN Y1 and Y2 cells cultured in vitro for 1 year and 2 years were selected for the experiment.The WERI-RB-1 cell line obtained from Shanghai Cell Bank of Chinese Academy of Sciences was taken as the mature retinoblastoma(RB)control(WERI-Rb-1 group).Untreated normal human retinal tissues were used as the control group.Cells were inoculated into a 24-well plate at a density of 1 × 104 cells per well,and the cell morphology was observed under a microscope and images were collected.Cell count was performed on the 4th,8th and 12th day after inoculation.Immunofluorescence staining was employed to de-tect the expression of the proliferation marker Ki67 and cone cell marker L/M opsin in each group.Quantitative real time polymerase chain reaction(qRT-PCR)was utilized to assess the expression of MYCN,CCNB1,CDK1,SYK,and RXRγ in cells across all groups.Proteomics analysis was performed to detect variations in protein expression profiles across groups and to identify key regulatory genes.Subsequently,cell growth and proliferation were evaluated after OTX2 knockdown by lentiviruses.Results The growth curve showed that there were(59.17±4.01)× 104 cells in the T-MYCN Y1 group,(85.14±4.54)× 104 cells in the T-MYCN Y2 group and(100.73±1.99)× 104 cells in the WERI-Rb-1 group on the 12th day of in-vitro culture(all P＜0.05).Compared with those in the control group,the positive cell rates of Ki67 and L/M opsin increased in T-MYCN Y1,T-MYCN Y2 and WERI-Rb-1 groups(all P＜0.001).The relative expression levels of MYCN mR-NAs in T-MYCN Y1,T-MYCN Y2 and WERI-Rb-1 groups were significantly higher than those in the control group(all P＜0.001).The relative expression levels of CCNB1 and CDK1 mRNAs also increased significantly in the three groups,com-pared with those in the control group(all P＜0.01).There was no significant difference in the relative expression of SYK mRNAs between T-MYCN Y1 and control groups(P＞0.05).The relative expression level of RXRγ mRNAs was significantly higher in the T-MYCN Y1 group than that in the control group(P＜0.05).The relative expression levels of SYK and RXRγmRNAs in T-MYCN Y2 and WERI-Rb-1 groups were significantly increased,compared with those in the control group(all P＜0.05).GO enrichment analysis showed that these differentially-expressed proteins were enriched into protein complex assembly and mitochondria pathways.KEGG enrichment analysis revealed that the enriched pathways of these differential-ly-expressed proteins included carbon metabolism,metabolic pathway and fatty acid degradation.Both proteomics and Western blot analyses indicated that OTX2 expression levels were the highest in the WERI-Rb-1 group,second highest in the T-MYCN Y2 group,and the lowest in the T-MYCN Y1 group(all P＜0.01).According to qRT-PCR,the expression levels of OTX2 mRNAs in T-MYCN Y1,T-MYCN Y2 and WRI-Rb-1 cells with OTX2 knockdown were lower than those in empty vec-tor controls(all P＜0.05).The growth curve of cells showed that after knocking down OTX2 in the three groups of cells,both cell growth and proliferation ability decreased significantly(all P＜0.001).Conclusion During the development of retinal tumors induced by MYCN overexpression,cells gradually exhibit characteristics similar to WERI-Rb-1 cells,which are a typical RB cell line.OTX2 plays an important role in MYCN amplification or the growth and proliferation of highly ex-pressed RB.Targeting OTX2 may become a new research direction for the treatment of RB.

Objective:To explore the application and effectiveness evaluation of the "six thinking hats" thinking mode in nursing teaching rounds.Methods:A total of 65 surgical nursing interns from a tertiary hospital were selected as the research subjects. The control group received routine teaching rounds, while the observation group received teaching rounds based on the "six thinking hats" thinking mode intervention. General information, assessment results, critical thinking ability, job competence, and satisfaction with teaching effectiveness were compared between the two groups of nursing students. SPSS 22.0 statistical software was used for t-test and chi-square test. Results:Compared with the control group, the observation group showed significantly higher scores in operational skills [(92.50±2.20) vs. (89.53±2.08)] and theoretical knowledge [(89.21±1.51) vs. (86.81±2.71)] and medical record writing score [(93.17±4.05) vs. (85.20±3.19)]. The critical thinking ability score was significantly higher in the observation group than in the control group [(319.97±45.13) vs. (283.57±41.57)]. The competency score was significantly higher in the observation group than in the control group [(182.62±14.07) vs. (164.43±14.50)]. The observation group demonstrated a higher overall evaluation of teaching satisfaction.Conclusions:The "six thinking hats" thinking mode improves the ability of nursing students to analyze problems, stimulates their subjective initiative in learning, and has a positive impact on the cultivation of their comprehensive abilities, making it a feasible teaching mode.

Objective:To investigate the current status of teaching behavior of clinical nursing teachers and explore the mediation effect of organizational commitment between their work engagement and teaching behavior.Methods:This study included a total of 1 736 clinical nursing teachers who worked in grade A tertiary hospitals in Beijing City, Shanghai City, Henan Province, Hubei Province, Hebei Province, and Chongqing City from May 2022 to November 2022. Data were collected using a general information questionnaire, the Effective Teaching Behavior Scale, the Work Engagement Scale, and the Organizational Commitment Scale. Statistical description and correlation analysis were performed using SPSS 25.0 software, and mediation effect was analyzed using AMOS 25.0 software.Results:The total mean score of effective teaching behavior of 1 599 clinical nursing teachers was (4.19±0.66), the total mean score of work engagement was (5.09±1.36), and the total mean score of organizational commitment was (3.93±0.72). Pearson correlation analysis showed that work engagement and organizational commitment were positively correlated with teaching behavior ( r=0.560, 0.519, both P<0.01). Organizational commitment partially mediated the relationship between work engagement and teaching behavior, with a mediation effect value of 0.27, and the mediation effect accounted for 49.10% of the total effect. Conclusions:Work engagement is a direct predictor of the teaching behavior of clinical nursing teachers, and organizational commitment partially mediates the relationship between work engagement and teaching behavior. Administrators can promote the work engagement of clinical nursing teachers by adopting effective interventions to increase the level of organizational commitment, which in turn enhances teaching behavior.