From the natural-philosophical model of medicine in ancient Greece to the modern bio-psycho-social par-adigm,the evolution of medical models has always been shaped by philosophy.In classical antiquity,medicine and philosophy were closely intertwined;the natural-philosophical model,exemplified by Hippocrates,emphasized the human body as an integrated whole.During the Renaissance,the rise of experimental science challenged traditional philosophical systems and pushed medicine toward empirical investigation.In the late twentieth century,the bio-psycho-social model emerged to address the limitations of the purely biomedical approach.In the twenty-first centu-ry,the advent of artificial intelligence is driving a new transformation in medicine and continually prompting reflec-tion on the future direction of medical models and their underlying philosophical significance.

Objective:To explore the effect of chronic intermittent hypoxia(CIH)on learning and memory dysfunc-tion in rats,as well as the expression of high mobility group box-1(HMGB1)and nuclear transcription factor-KB(NF-κB)in the hippocampus region.Methods:The CIH rat model was established,and forty SD rats were randomly divid-ed into four groups:normoxia group,hypoxia for 4 weeks group(CIH4 group),hypoxia for 8 weeks group(CIH8 group),and hypoxia for 12 weeks group(CIH12 group).Morris water maze was used to assess the learning memory ability of rats,and immunohistochemistry and ELISA were used to detect the expression of HMGB1 and NF-κB in the hippocampus of rats.Results:Compared with the normoxia group,the CIH12 and CIH8 groups had longer escape la-tency,the number of crossing the platform and the residence time in the quadrant of the platform were significantly shortened,but there was no significant difference in the CIH4 group.Additionally,there was no significant expression of HMGB1 and NF-κB in the hippocampal region of the normoxia group,but little expression was observed in CIH4 group,and significantly expressed in CIH8 group and CIH12 group,and the expression of CIH12 group was significantly higher than that of CIH8 group.Conclusion:CIH can lead to a decline in learning and memory function in rats,and the longer time of intermittent hypoxia led to the more significant effect on their learning and memory function.In addi-tion,CIH also leads to increased expression levels of HMGB1 and NF-κB in the hippocampus region,and the expres-sion increased more significantly after hypoxia for 12 weeks,comparing to hypoxia for 8 weeks.

Objectives To explore the establishment and effects of a multilevel and inter-disciplinary management scheme for specialist nurses.Methods The multilevel and inter-disciplinary management scheme included establishing the pyramid hierarchical training model,exploring superimposed training mechanism for specialist nurses with horizontal expansion,vertical extension,and deep development,and constructing stereoscopic clinical evaluation and quantitative assessment system.Four hundred-forty two specialized nurses have been recruited to join the multilevel and inter-disciplinary management scheme from July 2021 to August 2023.The core competencies of specialized nurses were compared before and after the implementation of management scheme.Results The quality development of specialized nursing have been improved,and the total scores and the scores of 3 dimensions(research innovation,management,and professional development)in core competencies of specialized nurses after the intervention of multilevel and inter-disciplinary management scheme were higher than those before(P＜0.05).Conclusion The multilevel and inter-disciplinary management scheme can effectively improve the core competencies of specialized nurses,and promote the high-quality development of specialized nursing.

OBJECTIVE To investigate whether Moslae herba oil has penetration enhancing effect on the active components of Evodia rutaecarpa and its ability to promote transdermal absorption.METHODS In vitro transdermal experiments were performed u-sing the diffusion pool and the isolated skin of rats.Using various components of Evodia rutaecarpa as indicators,HPLC was deter-mined to calculate the umulative penetration amount of each component.Changes in the skin and cuticle layers were observed by HE staining,immunohistochemical staining,and ATR-FTIR.GC-MS was used to measure Moslae herba oil components after administration.RESULTS Moslae herba oil showed the penetration-enhancing effect on various components in Evodia rutaecarpa.Compared with the postive drug nitrogenone,the cumulative penetration amounts of hyperoside,evodiamine and rutae-carpine were greater.In addition,the sesquiterpene composition and thymol in the Moslae herba oil were more likely to be stored in the skin,which could disturb the lipid structure of the cuticle layer and promote the penetration of drugs.CONCLUSION The results provide reference for the selection of transdermal absorption agent.

Endometriosis(Endometriosis,EMs)is a disease caused by abnormal colonization of the endometrial stroma or glands to sites other than the coated mucosa of the uterine cavity.Phospho-lipid inositol 3 kinase(phosphoinositide 3-kinase,PI3K)/protein kinase B(protein kinase B,Akt)sig-naling pathway is involved in the process of focal blood vessel formation,cell autophagic apoptosis,migration and invasion,and is one of the classic pathways regulating the pathological characteris-tics of EMs.The characteristics of multi-compo-nent,multi-target and multi-pathway of TCM have significant advantages in the treatment of EMs.Some TCM active components and TCM com-pounds can interfere with the PI3K/Akt signaling pathway,thus inhibiting the treatment of endome-triotic tissues,reducing pain and alleviating fibrotic lesions.By explaining the connection between the key targets of PI3K/Akt signaling pathway and EMs,this paper summarizes and summarizes the re-search status of EMs by regulating PI3K/Akt signal pathway in home and abroad,aiming to provide a new perspective and idea for the use of traditional Chinese medicine and compound to treat EMs.

Objective:To gain a deeper understanding of the cognitive differences between lactating women and obstetric nurses regarding their breastfeeding counselling abilities.Methods:This study was a descriptive phenomenology qualitative study. From October 2021 to June 2022, purposive sampling was used to select 11 lactating women who received breastfeeding counselling and 13 obstetric nurses who provided breastfeeding counselling services in Department of Obstetrics at Peking Union Medical College Hospital for semi-structured interviews. Giorgi analysis method was used to extract and analyze data.Results:The cognitive differences between lactating women and obstetric nurses regarding breastfeeding counselling abilities were mainly manifested in four aspects, namely breastfeeding knowledge and skills, counselling practice ability, improving counselling ability, and personality traits.Conclusions:Lactating women and obstetric nurses have cognitive differences in breastfeeding counselling abilities. Obstetric nurses should improve their breastfeeding counselling skills based on the needs of lactating women and provide personalized breastfeeding counselling services.

OBJECTIVE To investigate the improvement effects of Arisaema Cum Bile on Parkinson’s disease （PD） model mice and its potential mechanism. METHODS Sixty male C57BL/6J mice were randomly divided into normal group， model group， Arisaema Cum Bile low-dose group [0.39 g/（kg·d）]， Arisaema Cum Bile high-dose group [1.56 g/（kg·d）] and positive control drug Levodopa tablet group [80 mg/（kg·d）]， with 12 mice in each group. Except that normal group was given constant volume of normal saline， other groups were given 1-methyl-4-phenyl-1，2，3，6-tetrahydropyridine [MPTP，35 mg/（kg·d）] intraperitoneally for 5 consecutive days to induce subacute PD model； after modeling， they were given relevant medicine continuously for 7 d； rod climbing test and line suspension test were performed 1 d before modeling， on the 5th day of modeling and after the last medication. The number of tyrosine hydroxylase （TH）-positive neurons in the substantia nigra of mice were measured by immunofluorescence； the levels of interleukin 1β （IL-1β） and tumor necrosis factor α（ TNF-α） in serum and the levels of IL- E-mail：qhwang668@sina.com 1β， TNF-α， cyclooxygenase-2 （COX-2） and inducible nitric oxide synthase （iNOS） in the substantia nigra of mice were measured by enzyme-linked immunosorbent assay. The expression levels of cAMP-dependent protein kinase catalytic subunit α （PKA C-α）， glutathione peroxidase 4 （GPX4） and ferritin heavy chain polypeptide 1 （FTH1） proteins in the substantia nigra of mice was measured by Western blot. RESULTS After last medicine， compared with the normal group， mice in the model group had significantly longer pole-climbing time （P＜0.01）， significantly lower line suspension scores （P＜0.01）， significantly fewer TH-positive neurons in the substantia nigra （P＜0.01）， significantly higher serum concentrations of IL-1β and TNF-α and nigrostriatal concentrations of IL-1β， TNF-α， COX-2 and iNOS （P＜0.01）， while lower protein expression levels of GPX4， PKA C-α and FTH1 in the substantia nigra （P＜0.05 or P＜0.01）. Compared with the model group， the above indexes of mice were significantly returned in Arisaema Cum Bile high-dose group （P＜0.05 or P＜ 0.01）. CONCLUSIONS Arisaema Cum Bile can improve motor impairment and reduce apoptosis of nigrostriatal TH neurons in MPTP-induced PD mice， and has neuroprotective effects on model mice； this may be related to its inhibition of neuroinflammation and the inhibition of ferroptosis by up-regulating PKA signaling pathway.

Objective This study conducted the ARIMA model to analyze the cost structure and trend of inpatients with diabetes in a grade-A tertiary hospital and provide scientific basis for effectively controlling diabetes hospitalization expenses and reduce patient's economic burden.Methods The data of 18 371 inpatients with diabetes from 2012 to 2022 in a grade-A tertiary hospital were collected.We collected inpatient data of diabetes from 2012 to 2021 to fit the average inpatient expenses and drug proportion,and used data 2022 to verify the effect of model prediction.We predicted the average inpatient expenses and drug proportion from 2023 to 2025.Results The difference between the predicted value and the actual value was small,and the mean absolute percentage error was within the acceptable range.ARIAM model could be used to predict the expenses of diabetes.Conclusion The average cost of hospitalization showed a decreasing trend,and"the five colors,one map,one index"manage-ment model has achieved results.The proportion of drugs decreased obviously,but the composition of hospitalization expenses should be further optimized.The research of expenses prediction based on diabetes needs to be depended.

Objective:To explore the effect of online and offline blended teaching in gynecology and obstetrics nursing.Methods:From February to July 2021, 139 second-year nursing undergraduates from the Chinese Academy of Medical Sciences & Peking Union Medical College in 2019 were selected as the research subject by the convenience sampling. The online and offline blended teaching was applied in the course of gynecology and obstetrics nursing. A self-designed questionnaire was used to investigate the evaluation of undergraduate nursing students on teaching preparation, teaching implementation and teaching effect.Results:A total of 87.05% of the students had a very good/good experience of using the online learning platform. 99.28% of students could watch online videos before class. 97.84% of the students were very satisfied/satisfied with the teaching.Conclusions:The online and offline blended teaching is conducive to improving students' autonomous learning ability, promoting the understanding and mastery of obstetrics and gynecology nursing knowledge, and improving learning interest.

Objective:To explore the breastfeeding guidance experience of international board certified lactation consultants (IBCLC) in China, so as to provide reference for promoting breastfeeding guidance in China.Methods:This study adopted a descriptive phenomenological approach. From October 2021 to June 2022, purposive sampling was used to select 15 IBCLC from 8 provinces and cities who provided breastfeeding support. The semi-structured in-depth interview was used for data collection, and the Giorgi method was used to analyze the data and extract themes.Results:A total of 4 themes were extracted, namely, a sense of need, a sense of meaning and value, a sense of resistance at work and a sense of expectation for the future.Conclusions:The needs of the public and the improvement of IBCLC guidance capabilities are the foundation for providing breastfeeding guidance. The realization of self-worth and the attention and support of family, society, and hospital managers are conducive to the development of breastfeeding guidance.