“Bio-narrative integration” refers to the process in which a life subject with narrative consciousness actively reviews and reintegrates their life stories， or a subject lacking life and health narrative awareness， with the intervention of healthcare professionals， tells their own life stories and integrates them into a coherent and constantly evolving life narrative process. Starting from the keyword of bio-narrative integration， this paper proposed a classification model of narrative integration. From the perspective of life stages， it was divided into “phasic narrative integration” and “holistic narrative integration.” In terms of integrated narrative style， it was categorized as “positive narrative integration style” and “negative narrative integration style.” Regarding subjective initiative， it was classified as “active narrative integration regulation” and “passive narrative integration regulation.” Then it elaborated the significant value of narrative integration for every life subject， especially in pain relief， the improvement of life resilience， the healthy aging of the elderly， and the ultimate peace of the dying. It was advocated that healthcare practitioners should enhance their professional narrative competence， effectively guide patients to engage in bio-narrative integration regulation， and help them overcome narrative closure， thereby improving the quality of medical care.

In the era of evidence-based medicine， the progress of medical science and technology has enriched medical diagnostic tools and treatment methods， but it has also led to the loss of medical warmth and the alienation of the doctor-patient relationships. William Osler emphasized that while medical technology advances， attention should also be paid to the practice of narrative medicine and the development of physician’s narrative literacy. The view of the physician he advocated reminds us that the core of medicine still lies in the narrative connection between doctors and patients， as well as a deep understanding of human nature. By exploring the relationship between Osler’s view of the physician and narrative medicine as well as physician’s narrative literacy， this paper analyzed the methods of cultivating physician’s narrative literacy， providing references for modern medical education and practice， and assisting in the harmony and unity of science and technology and humanity.

AIM:To automatically identify and quantitatively assess myopia-related fundus structural changes by combining non-mydriatic color fundus photography with an artificial intelligence(AI)-powered quantitative fundus analysis system and to further analyze the correlations between these fundus parameters and spherical equivalent(SE), axial length(AL), and age, providing the objective basis for monitoring myopia progression and supporting the formulation of personalized myopia prevention and control strategies. METHODS:A cross-sectional study was conducted enrolling myopic patients aged 18-50 y who underwent myopia screening from March 2023 to December 2023. Patients were stratified into three groups based on SE: the -3.00 D

Infection is an important trigger for the initiation of pancreatic islet autoimmunity in type 1 diabetes mellitus （T1DM）. From the perspective of latent pathogen and dryness disorder， this study analyzes the core pathogenesis and dynamic evolution of T1DM in the subclinical and clinical stages. Combined with the T1DM "constraint， heat， deficiency， damage" state and target differentiation and treatment theory， the course of infection-induced T1DM is divided into three stages， including latent dryness， dry-heat and collateral damage. The "latent dryness" stage corresponds to the subclinical phase of T1DM， while the "dry-heat" stage corresponds to the clinical phase， and the "collateral damage" stage corresponds to the phase in which chronic complications develop. Treatment principles include supplementing deficiency and dispelling pathogen during the "latent dryness" stage， clearing heat and moistening dryness in the "dry-heat" stage， and dissolving stasis and unblocking collaterals in the "collateral damage" stage. Furthermore， syndrome-targeted and target-directed therapeutic modifications were made according to T1DM-related autoimmune activity， metabolic comorbidities， and vascular comorbidities， providing a reference for clinical management of T1DM.

Background: and Purpose Live cell-based assays (LCBA) are increasingly used for serological antibody detection due to their ability to preserve antigen conformation, offering moderately higher sensitivity than fixed cell-based assays. However, the clinical necessity of prioritizing LCBA for the detection of aquaporin-4 immunoglobulin G (AQP4-IgG) in neuromyelitis optica spectrum disorder (NMOSD) remains unclear, especially when compared to its established role in diagnosing myelin oligodendrocyte glycoprotein antibody-associated disease. Methods: We compared the performance of live cell-based assays using immunofluorescence (LCBA-IF) and fixed cell-based assays using immunofluorescence (FCBA-IF) in detecting AQP4-IgG in 90 cases of NMOSD meeting 2015 International Panel for Neuromyelitis Optica Diagnosis criteria, alongside 40 controls. Additionally, we further investigated the relationship between AQP4-IgG titers as measured by LCBA-IF and FCBA-IF and clinical parameters in NMOSD patients. Results: Results showed 96.9% agreement between LCBA-IF and FCBA-IF (Cohen’s κ=0.935), with a strong Spearman correlation (0.977, p<0.001). Both methods demonstrated 100% specificity, with LCBA-IF showing slightly higher sensitivity compared to FCBA-IF. Within LCBAIF-tested groups, statistically significant differences in annualized relapse rates were observed across all pairwise comparisons (low-titer vs. moderate-titer, low-titer vs. high-titer, and moderate-titer vs. high-titer; all p<0.050). However, this association reached statistical significance in some FCBA-IF-tested groups. Conclusions Overall, there is a strong concordance between LCBA-IF and FCBA-IF in detecting AQP4-IgG, where LCBA-IF shows slightly higher sensitivity. Furthermore, there is a potential link between elevated AQP4-IgG titers and an increased risk of relapse, and this correlation may appear more pronounced when using LCBA-IF.

Objective To analyze the factors influencing occupational health literacy (OHL), work-related musculoskeletal disorders (WMSDs), and occupational stress in medical staff, and to investigate the potential associations between OHL and WMSDs as well as occupational stress. Methods A total of 880 medical staff members from 18 medical institutions were selected as the study subjects using a probability proportional method. Data on OHL, WMSDs, and occupational stress were investigated using the National Key Populations Occupational Health Literacy Surveillance Individual Questionnaire (including the Musculoskeletal Disorders Questionnaire and the Core Occupational Stress Scale), and the influencing factors and potential relationships were analyzed. Results The OHL level was 63.1%, the prevalence of WMSDs was 88.1%, and the detection rate of occupational stress was 24.0% in the study subjects. Multivariable logistic regression analysis showed that female medical staff had lower OHL levels than males (P<0.05). Medical staff with higher education levels and those working in higher-level medical institutions had higher OHL levels (all P<0.05). Medical staff working >40-<49 hours per week and those working ≥49 hours per week had higher OHL levels than those working ≤40 hours per week (all P<0.01). Medical staff with higher education levels or longer working hours had a higher risk of WMSDs (all P<0.05). Medical staff with lower monthly personal income, longer weekly working hours, and lower OHL levels had a higher risk of occupational stress (all P<0.05), and those working night shifts had a higher risk of occupational stress than those who did not (P<0.01). Conclusion The study participants had a relatively high level of OHL, a high prevalence of WMSDs, and a low detection rate of occupational stress. It is recommended that medical institutions effectively implement occupational health promotion and support measures to improve the OHL level of medical staff, to reduce the risk of WMSDs and occupational stress.

BackgroundStressful life events are associated with subclinical depressive and anxious symptoms， which may increase the risk of subsequent depressive and anxiety disorders. However， the mechanisms linking stressful life events to subclinical emotional symptoms remain unclear. ObjectiveTo explore the clinical characteristics of individuals with subclinical depression and anxiety following stressful events， and to analyze the mechanisms by which stressful events affect subclinical depressive and anxious symptoms， so as to provide a reference for the early identification and intervention of emotional symptoms in individuals under stress. MethodsFrom December 2024 to April 2025， 80 individuals with subclinical depression and/or anxiety （study group） and 80 healthy controls were recruited via the online official accounts of Beijing Anding Hospital， Capital Medical University and Beijing Huilongguan Hospital， Capital Medical University. Participants completed the Patients' Health Questionnaire Depression Scale-9 item （PHQ-9）， the Generalized Anxiety Disorder Scale-7 item （GAD-7）， the Life Event Scale （LES）， the Self-rating Idea of Suicide Scale （SIOSS）， and the Dysfunctional Attitude Scale （DAS）. Spearman rank correlation analysis was used to examine the associations in the study group. Serial mediation analyses were conducted using model 6 of Process version 4.1， to test whether cognitive distortion and hopelessness mediated the associations of stressful life events with subclinical depressive and anxious symptoms. ResultsCompared with healthy controls， participants with subclinical depressive and anxious symptoms had higher scores on PHQ-9， GAD-7， LES， SIOSS hopelessness subscale， and DAS scores （Z/t=10.294， 9.197， 4.659， 6.918， 3.517， P<0.01）. In the study group， GAD-7 score was positively correlated with LES， DAS， and SIOSS hopelessness subscale scores （r_s=0.233， 0.465， 0.588， P<0.05）； SIOSS hopelessness subscale score was positively correlated with DAS and LES scores （r_s=0.393， 0.309， P<0.01） and cognitive distortion was positively correlated with stressful life events（r_s=0.432， P<0.01）. Stressful life events were directly associated with subclinical anxiety symptoms （β=0.040， 95% CI： 0.015–0.065， P<0.05）， and showed a significant serial indirect association with subclinical anxiety symptoms （indirect effect=0.006， 95% CI： 0.001–0.017， P<0.01）， accounting for 7.15% of the total effect. Stressful life associated with subclinical depressive symptoms （β=0.087， 95% CI： 0.060–0.115， P<0.01）， however， the indirect effect through cognitive distortion and hopelessness were not statistically significant. ConclusionAfter experiencing stressful events， individuals with subclinical depression and anxiety exhibit more pronounced cognitive distortions and hopelessness. Stressful events can both directly affect subclinical anxiety symptoms and indirectly affect them through the serial mediating effects of cognitive distortion and hopelessness. Stressful events have a direct effect on subclinical depressive symptoms， whereas the mediating effects of cognitive distortion and hopelessness are no statistically significant. ［Funded by the Training Program for the Development of High-level Public Health Technical Talents （number， Academic Leader-01-22）； www.chictr.org.cn number， ChiCTR2400093516］

Osteoporosis is a common senile bone metabolism disease， clinically characterized by decreased bone mass， destruction of bone microstructure， increased bone fragility， and easy fracture. It tends to occur in the elderly and postmenopausal women， seriously threatening the quality of life and physical and mental health of the elderly. At present， the treatment of osteoporosis is mainly based on oral western medicines， such as calcium， Vitamin D， and bisphosphonates. Still， there are drawbacks such as a long medication cycle and many adverse reactions. In recent years， due to the advantages of multi-component， multi-pathway， and multi-target， some traditional Chinese medicines and effective ingredients can regulate the osteogenic and osteoclastic differentiation process in both directions and are widely used in the prevention and treatment of osteoporosis. Hippophae rhamnoides is a commonly used herbal medicine， and its fruits are rich in flavonoids， polyphenols， fatty acids， vitamins， and trace elements， which have been proven to have a good anti-osteoporosis effect. Isorhamnetin is the main effective ingredient of Hippophae rhamnoides fruits， which has many pharmacological effects such as anti-inflammation， anti-oxidative stress， anti-aging， and anti-tumor. Studies have shown that isorhamnetin can participate in the regulation of bone metabolism and has a good anti-osteoporosis effect. However， the pharmacological effects and related mechanisms of isorhamnetin against osteoporosis have not been systematically summarized. Therefore， this paper reviewed the pharmacological effects and related mechanisms of isorhamnetin against osteoporosis by referring to relevant literature to provide more basis for the development and application of isorhamnetin.

Objective To analyze the trends in disease burden and risk factors of depression among the elderly population in China from 1990 to 2021,and to provide a theoretical basis for the prevention,treatment,and policy-making of geriatric depression in China.Methods Data on the disease burden of geriatric depres-sion in China from 1990 to 2021,including the number of incident cases,disability-adjusted life years(DALYs),incidence rate,and DALY rate,were extracted from the 2021 Global Burden of Disease(GBD)database.The Joinpoint regression model was used to analyze the trends by calculating the annual percentage change(APC)and average annual percentage change(AAPC).The autoregressive integrated moving average(ARIMA)model was employed to predict the disease burden of geriatric depression over the next five years.Population attributable fractions(PAFs)were used to describe the risk factors for geriatric depression in China in 1990 and 2021.Results From 1990 to 2021,the number of incident cases and the incidence rate of geri-atric depression in China showed an overall upward trend.The most significant increase in incidence was ob-served in the 60-64 age group,while the prevalence rate increased notably in the ≥ 95 age group.The DALY rate showed the most pronounced upward trend in the 65-69 age group.The incidence,prevalence,and DALY rates of geriatric depression were higher in women than in men.Major risk factors included child-hood sexual abuse and intimate partner violence,with the impact of intimate partner violence being particular-ly significant among women.The ARIMA model predicted that the incidence,prevalence,and DALY rates of geriatric depression in China would decline over the next five years,with a greater decline observed in women than in men.Conclusions From 1990 to 2021,the incidence,prevalence,and DALY rates of geriatric de-pression in China showed an overall upward trend,with higher rates observed in women than in men.Greater attention should be paid to the elderly female population,with a focus on early prevention to reduce the dis-ease burden of geriatric depression.

OBJECTIVES: To investigate the targets and mechanisms of 7-hydroxyethyl chrysin (7-HEC) in prevention and treatment of high-altitude cerebral edema (HACE) in rats. METHODS: Fifty-four male Wistar rats were randomly divided into normal control group, HACE model group, and 7-HEC-treated group (18 rats in each group). Except for the normal control group, rats in the two other groups were exposed to a hypobaric hypoxic chamber simulating a 7000 m altitude for 72 h to establish the HACE model. The 7-HEC-treated group was intraperitoneally injected with 7-HEC (150 mg·kg^－¹·d^－¹) for 3 consecutive days before modeling, while the model group received equivalent isotonic sodium chloride solution. Tandem Mass Tag (TMT) proteomics technology was used to detect differentially expressed proteins (DEPs) with screening criteria set at a fold change >1.2 and P<0.05. Western blotting was used to verify the expression levels of target proteins. Gene Ontology (GO) enrichment analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis, and protein-protein interaction (PPI) network analysis were performed. RESULTS: Compared with the normal control group, 256 DEPs were identified in the HACE model group. Compared with the HACE model group, 87 DEPs were identified in the 7-HEC-treated group. Among them, 19 DEPs that were dysregulated in the HACE model group were restored after 7-HEC intervention, of which seven (HSPA4, Arhgap20, SERT, HACL1, CCDC43, POLR3A, and PCBD1) were confirmed by Western blotting. GO enrichment analysis of the DEPs between the HACE model and 7-HEC-treated groups revealed their involvement in 13 biological processes, five cellular components, and two molecular functions. KEGG pathway analysis indicated associations with the mRNA surveillance pathway, Th17 cell differentiation, serotonergic synapse, RNA polymerase, protein processing in the endoplasmic reticulum, peroxisome, neuroactive ligand-receptor interaction, folate biosynthesis. PPI network analysis demonstrated that HSPA4, POLR3A, and HACL1, which were validated by Western blotting, interacted with multiple signaling pathways and ranked among the top 20 hub proteins by degree value, suggesting their potential role as core regulatory factors. Arhgap20, SERT and PCBD1 also exhibited interactions with several proteins, suggesting their potential as key regulatory proteins, whereas no interactions for CCDC43 were identified. CONCLUSIONS This study applied TMT proteomics to identify seven potential therapeutic targets of 7-HEC for the prevention and treatment of HACE. These targets may be involved in the pathogenesis of HACE through multiple pathways, including maintaining cellular homeostasis, ameliorating oxidative stress, regulating energy metabolism, and reducing vascular permeability.
Animals ; Male ; Proteomics/methods* ; Rats, Wistar ; Flavonoids/therapeutic use* ; Rats ; Brain Edema/etiology* ; Altitude Sickness/metabolism* ; Protein Interaction Maps