OBJECTIVE To develope a predictive model for medication deviation risks during the hospital-to-home transition period in coronary heart disease （CHD） patients with initial treatment， aiming to assist medical staff in rapidly identifying high-risk groups for medication deviation. METHODS A total of 462 CHD patients with initial treatment from the Affiliated Hospital of North China University of Science and Technology （hereinafter referred to as “our hospital”） between January and July 2024 were enrolled. The patients were randomly divided into a modeling group and an internal validation group. The modeling group was further categorized into a medication deviation group and a non-medication deviation group based on whether medication deviations occurred. Similarly， 57 CHD patients with initial treatment from the cardiology department of our hospital between June and September 2025 were collected as an external validation group. Univariate analysis was used to screen predictive factors， followed by multivariate Logistic regression to construct the predictive model. Internal validation methods were employed to evaluate model performance， while external validation methods were used to test the model’s generalizability. RESULTS The 462 patients were divided into a modeling group （319 cases） and an internal validation group （143 cases）. In the modeling group， the medication deviation group （192 cases， 60.19%） and the non-medication deviation group （127 cases， 39.81%） were identified. Multivariate Logistic regression analysis revealed that age， medication type， medication adherence， and self-efficacy in rational medication use were predictive factors for medication deviations in CHD patients with initial treatment （ P ＜0.05）. The predictive model equation was logit P ＝ln[ P /（1－ P ） ] ＝1.321+1.732×age+4.091×medication type －4.360×medication adherence －3.081×self-efficacy in rational medication use. The model demonstrated good discrimination， with a Hosmer-Lemeshow goodness-of-fit test P -value of 0.439， an area under the receiver operating characteristic curve （AUC） of 0.870， sensitivity of 0.970， and specificity of 0.607. A risk nomogram with a total score of 350 points and a cutoff value of 110 points was plotted. The internal validation group showed an AUC o f 0.787 and a prediction accuracy of 77.6%， while the external validation group exhibited an AUC of 0.802 and a prediction accuracy of 73.7%. CONCLUSIONS This study successfully developed a predictive model for medication deviation risks during the hospital-to-home transition period in CHD patients with initial treatment. The model demonstrates excellent discrimination and predictive accuracy， effectively identifying high-risk populations for medication deviations. Age （＞70 years）， number of drug types≥5， poor medication adherence， and poor self-efficacy in rational medication use are independent risk factors for medication deviations.

BackgroundThe violent aggressive behaviors of patients with schizophrenia usually have the characteristics of suddenness， unpredictability， high severity， and great difficulty in prevention. Early identification and accurate assessment of their risk of violent aggression have significant clinical significance. ObjectiveTo construct a predictive model for the violence risk in hospitalized patients with schizophrenia， to identify the key factors influencing the occurrence of violent behavior in these patients， so as to provide references for clinical precise quantitative assessment and early intervention. MethodsA total of 200 patients with schizophrenia who were hospitalized at Taiyuan Psychiatric Hospital from March 2022 to September 2024 and met the diagnostic criteria of the International Classification of Diseases， eleventh edition （ICD-11） were collected to form the modeling cohort. They were randomly divided into a training set （n=140） and a test set （n=60） at a ratio of 7∶3. Based on the least absolute shrinkage and selection operator （LASSO） regression algorithm， the feature variables were screened and dimension-reduced. The support vector machine （SVM） from machine learning was selected for model training and prediction. The discrimination efficacy of the model was evaluated by the area under the receiver operating characteristic （ROC） curve （AUC）， accuracy， precision， sensitivity， specificity， F1 value， and Brier value. ResultsLASSO regression screening identified 16 feature variables. Pearson correlation analysis revealed a positive correlation between prior violent behavior frequency and clinical psychiatric symptom scores （r=0.580， P<0.01）， a positive correlation between hospitalization compliance and current disease status （r=0.550， P=0.003）， and a positive correlation between educational level and family per capita monthly income （r=0.367， P<0.01）. The SVM model achieved an AUC of 0.853， accuracy of 0.800， precision of 0.810， sensitivity of 0.895， specificity of 0.636， F1 value of 0.850， and Brier value of 0.168. ConclusionThe SVM model has a relatively high level of applicability and overall predictive performance in the assessment of violent risk in schizophrenia patients， which is helpful for the early identification of violent risks in such patients. ［Funded by Specialized Research Project for Enhancing the Competence of Health Professionals in Taiyuan City （number， Y2023006）］

ObjectiveTo analyze the output and efficiency of chronic disease management services for hypertension and diabetes in community health service institutions in Shanghai, to evaluate the allocation and efficiency of chronic disease management resources, and to provide references for improving the efficiency of chronic disease management in Shanghai’s communities. MethodsA total of 73 community health institutions from 15 districts of Shanghai were selected. Based on the chronic disease management resource data of community health institutions in 2019, 2021, and 2023, descriptive methods and the BCC model in Data Envelopment Analysis (DEA) were used to analyze the resource allocation, service output, and the efficiency of chronic disease management services in community health institutions in Shanghai. ResultsFrom 2019 to 2023, the indicators of resource allocation and service output of community health service institutions in Shanghai all showed upward trends. In terms of service efficiency, the average number of chronic disease patients managed by each health technician decreased from 237 to 231, and the number of patients served per 1 000 working hours decreased from 54 to 44. DEA efficiency analyses showed that the average overall efficiency increased from 0.867 in 2019 to 0.886 in 2021 and then decreased to 0.811 in 2023. The average technical efficiency decreased from 0.901 to 0.847, which was the main reason for the decline in overall efficiency. The average scale efficiency showed an initial increase followed by a decrease, rising from 0.961 in 2019 to 0.977 in 2021 and dropping back to 0.955 in 2023. The number of strong effective districts (overall efficiency=1.000) decreased from 6 in 2019 to 3 in 2023, and the efficiency differences between districts expanded. The range of overall efficiency widened from 0.622‒1.000 to 0.513‒1.000, indicating a decline in overall efficiency and an increase in inter-district heterogeneity. ConclusionFrom 2019 to 2023, the total volume of resource allocation and service output for chronic disease management in community health service institutions in Shanghai increased continuously. However, both the service output efficiency and the overall resource allocation efficiency declined, driven primarily by a decrease in technical efficiency, and accompanied by widening inter‑district disparities.

Objective: To investigate the longitudinal associations between dietary patterns in early childhood and myopia among children, so as to provide evidence for improving early childhood dietary patterns and promoting healthy ocular development among children. Methods: Participants were derived from the Ma-anshan Birth Cohort (MABC). A total of 1 432 children were included. Dietary patterns at 2.5 years of age were collected in 2017 using a food frequency questionnaire completed by parents. In 2022, cycloplegic refraction and ocular biometric parameters were measured in children aged 7-8 years. Food components were grouped into tertiles ( T1-T 3), and latent class analysis (LCA) was used to identify dietary pattern at the age of 2.5. Log-binomial regression and multiple linear regression model were applied to examine the associations of dietary patterns and their latent classes with myopia, spherical equivalent (SE), and axial length (AL). Results: The prevalence of myopia among children was 23.9%. After adjusting for covariates, the T 2 group of cereals and tubers was negatively associated with myopia rate ( RR=0.72, 95%CI =0.57-0.90) and AL ( β=-0.15, 95%CI =-0.24 to -0.05), and positively associated with SE ( β=0.21, 95%CI =0.06-0.35)(all P ＜0.05). Linear regression models showed that the T 2 group of fruits and vegetables was positively associated with AL ( β=0.09, 95%CI =0.00- 0.19 ); the T 3 group of high sugar foods ( β=0.11, 95%CI =0.00-0.21) and the T 3 group of processed foods ( β= 0.10 , 95%CI =0.00-0.19) were positively associated with AL; total scores for high sugar foods ( β=0.07, 95%CI =0.00-0.14) and processed foods ( β=0.09, 95%CI =0.01-0.17) were positively associated with AL (all P <0.05). After adjusting for sex, age, and parental myopia, the comprehensive high intake pattern was positively associated with AL ( β=0.12, 95%CI =0.00-0.23, P <0.05). After further adjusting for daily screen time and daily outdoor activity time, the association was no longer statistically significant ( β= 0.11 , 95%CI =-0.00-0.23, P >0.05). Conclusions Moderate consumption of cereals and tubers in early childhood may reduce the risk of myopia and delay AL growth. In contrast, high sugar and highly processed diets may promote AL and increase myopia risk. Establishing healthy dietary habits in early childhood and limiting intake of high sugar and processed foods is crucial for promoting ocular development in children.

ObjectiveTo observe the clinical efficacy and safety of Yanghe Xiaonang Decoction （阳和消囊汤， YXD） in the treatment of polycystic ovarian syndrome （PCOS）-related infertility with healthy qi deficiency and phlegm stasis syndrome. MethodsA total of 120 PCOS-related infertility participants with healthy qi deficiency and phlegm stasis syndrome were randomly divided into a treatment group and a control group in a 1∶1 ratio， with 60 cases in each group. The treatment group started taking YXD on the first day of the menstrual cycle， one dose daily， until the day of sexual intercourse when follicles matured and were released. Those without mature follicles or ovulation could take it until the 14th to 28th day. The control group was given oral letrozole at 2.5 mg daily starting on the 5th day of the menstrual cycle for 5 consecutive days. If the basal body temperature curve remained monophasic on the 28th day of the menstrual cycle， and no dominant follicle was detected by color Doppler ultrasound， estrogen plus progesterone or progesterone alone was administered for withdrawal bleeding， followed by a new treatment cycle. The treatment lasted for three consecutive menstrual cycles. Patients were followed up for 3 months upon confirmed pregnancy or after the completion of the 3rd treatment cycle. The clinical pregnancy rate， total effective rate， pregnancy rate， biochemical pregnancy rate， embryonic arrest rate， and ectopic pregnancy rate between the two groups were compared. Transvaginal color Doppler ultrasound was used for monitoring endometrial thickness， cyclic ovulation status， number of follicles between 2-9 mm， and the difference in transverse and longitudinal diameters of dominant follicles. The levels of endocrine hormone indicators including serum testosterone （T）， prolactin （PRL）， luteinizing hormone （LH）， follicle-stimulating hormone （FSH）， progesterone （P）， estradiol （E₂）， free testosterone （F-T）， androstenedione （ASD）， inhibin B （INH-B）， and anti-Müllerian hormone （AMH）， as well as the total traditional Chinese medicine （TCM） symptom scores before and after treatment were compared between the two groups. ResultsA total of 58 patients in each group were included in the statistical analysis. The clinical pregnancy rate in the treatment group was 39.66% （23/58）， higher than 22.41% （13/58） in the control group （P＜0.05）. The total effective rate in the treatment group was 96.55% （56/58）， higher than 79.31% （46/58） in the control group （P＜0.05）. The biochemical pregnancy rate and embryonic arrest rate in the treatment group were lower than those in the control group （P＜0.05）. The treatment group was superior to the control group in increasing endometrial thickness and reducing the number of 2-9 mm follicles at the 2nd and 3rd cycles， as well as in improving the cyclic ovulation status and the difference in transverse and longitudinal diameters of dominant follicles at the 3rd cycle （P＜0.05）. After treatment， the treatment group exhibited significant reductions in serum T， LH， F-T， ASD， INH-B， and AMH levels （P＜0.05）. The control group also showed significant decreases in LH， F-T， INH-B， and AMH levels （P＜0.05）. The levels of F-T， INH-B， and AMH in the treatment group after treatment were lower than those in the control group （P＜0.05）. The improvement of the total TCM symptom score in the treatment group was superior to that in the control group （P＜0.05）. ConclusionYXD can significantly improve the clinical pregnancy rate， reduce the rates of biochemical pregnancy and embryonic arrest， alleviate clinical symptoms， increase endometrial thickness， enhance dominant follicles， and improve endocrine hormone levels in PCOS-related infertility with healthy qi deficiency and phlegm stasis syndrome， showing good safety.

It is believed that there is a pathogenesis of yang deficiency in polycystic ovary syndrome （PCOS） infertility， and it is concluded that warm-yang method has a better effect in improving endometrial abnormality， enhancing the quality of follicles， correcting endocrine disorders， and resolving or alleviating clinical symptoms in PCOS infertility. Based on Yanghe Decoction （阳和汤）， a representative traditional Chinese medicine decoction for warming yang， Yanghe Xiaonang Decoction （阳和消囊汤） was formulated， combining with warm medicinals according to symptoms， and aerobic exercise was also advocated to help generate and develop yang qi， in order to provide ideas for clinical treatments.

Objective:To investigate the correlation between the expression level of glypican-6 (GPC6) in gliomas and the prognosis of patients, as well as the effect of GPC6 on the proliferation of glioma cells in vitro.Methods:The transcriptome sequencing (RNA-seq) data of GPC6 gene and clinical data of glioma patients were downloaded from The Cancer Genome Atlas (TCGA) database. A total of 667 patients were enrolled, and the median FPKM value of GPC6 RNA-seq was used to distinguish the low and high expression of GPC6 gene. Kaplan-Meier method was used to analyze the overall survival (OS) of GPC6 high and low expression groups in 664 patients with survival data, and log-rank test was used for inter group comparison. The postoperative tumor tissue chips were retrospectively collected from glioma patients who underwent surgery from February 2008 to October 2011, immunohistochemistry (IHC) was used to detect the expression of GPC6 protein in 147 samples, and semi-quantitative scoring ≥ 4 points or not was used to distinguish the high and low expression of GPC6 protein based on the proportion of positive cells and staining intensity. The distributions of patients with high and low expression of GPC6 protein in tumor tissues were compared between different clinical pathological features in 147 patients, and Kaplan-Meier method was used to analyze the overall survival and disease-free survival (DFS) of patients in the GPC6 protein high and low expression groups; the risk factors that affect poor OS and DFS in patients were analyzed using univariate and multivariate Cox proportional hazards models. The human glioma U251 cells were infected with lentivirus packaged with GPC6 small interfering RNA and lentivirus packaged with unrelated control sequences, namely ShGPC6 group and ShCtrl group, respectively; green fluorescent cells were counted daily and the cell proliferation fold was calculated for 5 days, and the cell proliferation curve was plotted.Results:In TCGA database, the median FPKM value of 667 glioma patients was 225.66. The median FPKM value of GPC6 gene in 515 World Health Organization (WHO) classification low-grade glioma patients was lower than that in 152 high-grade glioma patients (201.10 vs. 347.92), and the difference was statistically significant ( Z = 5.36, P < 0.001); the OS of patients in GPC6 low expression group (332 cases) was better than that in GPC6 high expression group (332 cases), and the difference was statistically significant ( P < 0.001). IHC staining of the tissue chip showed that GPC6 protein was mainly expressed in the cytoplasm and nucleus of glioma cells; high expression of GPC6 protein accounted for 31.3% (46/147) of patients. Among patients who died, relapsed, had high grading, had survival time ≤ 84 months, and had positive epidermal growth factor receptor, the proportion of patients with GPC6 protein high expression was relatively higher, and the differences were statistically significant (all P < 0.05). There were no statistically significant differences in the proportions of GPC6 protein high expression patients among patients with different genders, age ≤ 43 years old, Ki-67 positivity, and programmed death receptor ligand 1 positivity (all P > 0.05); compared to the GPC6 low expression group (101 cases), the GPC6 protein high expression group (46 cases) had worse overall survival (median OS time: 57.0 months vs. not reached) and DFS (median DFS time: 33.0 months vs. not reached), and the differences were statistically significant (both P < 0.001). Multivariate Cox regression analysis showed that high expression of GPC6 protein (high expression vs. low expression, HR = 1.86, 95% CI: 1.04-3.31, P = 0.036) was the independent risk factor for poor OS in glioma patients, but the expression level of GPC6 protein was not the independent influencing factor for DFS (high expression vs. low expression, HR = 1.55, 95% CI: 0.95-2.53, P = 0.077). After infecting U251 cells with recombinant lentivirus for 3 days, reverse transcription polymerase chain reaction detection showed that the relative expression level of GPC6 mRNA in the ShGPC6 group was lower than that in the ShCtrl group, and the difference was statistically significant ( P < 0.001), the knockdown efficiency of GPC6 reached 79.32%; under the fluorescence microscope, the number and intensity of fluorescence positive U251 cells in the ShCtrl group increased day by day after infection with recombinant lentivirus, while there was no significant change in the ShGPC6 group; starting from the second day, the proliferation rate of U251 cells in the ShCtrl group was higher than that in the ShGPC6 group, and the differences were statistically significant (all P < 0.01). Conclusions:High GPC6 expression level may associate with the high risk of death in glioma patients, and high GPC6 expression may promote the proliferation of glioma cells.

Objective To explore the effects of Danlong Xingnao Prescription on the learning and memory ability of vascular dementia(VD)model rats based onPI3K/Akt/mTOR signaling pathway;To discuss its possible mechanism.Methods VD rat model was prepared using improved bilateral common carotid artery ligation method.Modeling rats were randomly divided into model group,nimodipine group and DanlongXingnao Prescription low-,medium-,high-dosage groups(3.7,7.4,14.8 g/kg),with 10 rats in each group.The sham-operation group only separated the arteries without ligation.Each medication group was given corresponding drugs by gavage,the sham-operation group and the model group were given equal amounts of physiological saline by gavage for 4 consecutive weeks.Morris water maze was used to test the learning and memory ability of rats,morphology of the hippocampus were observed by HE staining,immunohistochemistry was used to detect microvascular density and expression of vascular endothelial growth factor(VEGF),the activity of SOD,GSH-Px and the content of MDA in liver tissue were detected by biochemical method,RT-qPCR and Western blot were used to detect the mRNA and protein expression of PI3K,Akt,mTOR,hypoxia-inducible factor-1α(HIF-1α),VEGF,Bax and Bcl-2 in hippocampal tissue.Results Compared with the sham-operation group,the latency period of evasion was significantly prolonged,and the number of platform crossings was significantly reduced in the model group(P＜0.01),the cells in the hippocampal CA1 region had irregular morphology,loose arrangement,blurred boundaries,nucleolar condensation,and a large number of neuronal necrosis,the microvascular density and VEGF expression significantly increased(P＜0.01),the SOD and GSH-Px activity in hippocampal tissue decreased(P＜0.01),MDA content increased(P＜0.01),the expressions of HIF-1α,VEGF,Bax mRNA and protein in hippocampal CA1 region increased,and PI3K,Akt,mTOR,Bcl-2 mRNA and protein expression decreased(P＜0.01).Compared with the model group,the latency period of evasion were significantly shortened,and the number of platform crossings increased in the Danlong Xingnao Prescription groups(P＜0.05,P＜0.01),neuronal damage in hippocampal CA1 region was alleviated,microvascular density and VEGF expression increased(P＜0.05,P＜0.0 1),the activities of SOD and GSH-Px in hippocampal tissue increased(P＜0.05,P＜0.01),the content of MDA decreased(P＜0.05,P＜0.01),the mRNA and protein expressions of PI3K,Akt,mTOR,HIF-1α,VEGF,Bcl-2 in hippocampal CA1 region increased(P＜0.05,P＜0.01),the expression of Bax mRNA and protein decreased(P＜0.05,P＜0.01).Conclusion Danlong Xingnao Prescription can improve the learning and memory ability of VD model rats,promote angiogenesis,inhibit oxidative stress and apoptosis.The mechanism may be related to the up-regulation of PI3K/Akt/mTOR signaling pathway in hippocampal tissue.

Objective:To evaluate long-term outcomes of endoscopic papillectomy (EP) for duodenal papillary adenomas and to identify risk factors for incomplete resection.Methods:Clinical data of 180 patients diagnosed as having duodenal papillary adenoma via postoperative pathology after EP in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2010 to December 2022 were retrospectively analyzed. Patients were divided into two groups based on their postoperative margin status: the complete resection group (negative resection margins) and the incomplete resection group (positive/uncertain resection margins). Recurrence rates were compared between the two groups, and logistic regression analysis was performed to identify risk factors for incomplete resection.Results:Among the 180 patients included in the study, 137 underwent complete resection, and 43 had incomplete resections. Recurrence rate was significantly higher in the incomplete resection group than that in the complete resection group (30.2% VS 15.3%, χ2=4.75, P=0.029). logistic regression analysis indicated that high-grade intraepithelial neoplasia was an independent risk factor for incomplete resection ( OR=2.43, 95% CI:1.12-5.26, P=0.024). Conclusion:Patients with incomplete resection after EP have a higher recurrence rate in the long-term follow-up. High-grade intraepithelial neoplasia is an independent risk factor for incomplete resection. Close surveillance and aggressive management are warranted for patients with positive or uncertain resection margins to mitigate the recurrence risk.

Polycystic ovary syndrome（PCOS） and its resulting infertility is one of the common diseases of gynecology and reproductive endocrinology. The phosphatidylinositol 3-kinase/protein kinase B（PI3K/Akt） signaling pathway is relatively well-studied in the development of intervention in PCOS， and the experiments on PCOS in rats conducted by traditional Chinese medicine through this signaling pathway is also the main direction of mechanistic research. In this paper， 20 articles published in academic journals in the past 5 years were selected through the corresponding criteria， and the objective situation and existing problems of the selected research projects were analyzed from five aspects， namely， baseline data， modeling and treatment， grouping， evaluative indexes， and pharmacodynamic indexes. It is found that there were different degrees of problems in each research project， such as the observation indicators of modeling， criteria for judging the success of the model， the treatment period， the calculation of dosage of prescription/active ingredients and specific dosage were not clearly defined， which could easily lead the bias of the results or reduce the validity of experimental data. Based on this， the list of PCOS rat experimental research operations was formed， involving five categories of experimental rats， model construction， study implementation， outcome measures and analysis and report with a total of 21 operation lists， with a view to provide a reference for the subsequent PCOS experiments related to scientific research and helping to form high-quality results.