Objective : To explore the mediating effect of self-efficacy on family health and health literacy among middle-aged and elderly chronic diseases patients in rural areas, so as to provide a basis for developing targeted health literacy improvement strategies. Methods: Based on the publicly available 2021 "Survey of Chinese Residents' Psychology and Behavior" database, rural chronic diseases patients aged >45 years were selected as the study subjects. Data on demographic information, family type, and chronic diseases comorbidities were collected. The Chinese simplified Family Health Scale, General Self-Efficacy Scale, and Health Literacy Scale were used to assess family health, self-efficacy, and health literacy, respectively. Correlation analysis was employed to explore the relationships between variables, and the 4.1 Process program was used to analyze the mediating effect of self-efficacy on family health and health literacy. The Bootstrap method was applied to test the significance of the mediating effect. Results: A total of 449 participants were included, of whom 241 were male (53.67%) and 208 were female (46.33%). The majority (205 cases, 45.66%) were aged 60-<76 years. There were 168 cases (37.42%) with chronic disease comorbidities. The total score for family health was (37.96±6.25) points. The self-efficacy score was (27.28±5.40) points, the health literacy index was (27.72±8.08) points, and the health literacy proficiency rate was only 14.90% (67 patierts). Mediating effect analysis showed that family health could directly and positively influence health literacy, with a direct effect value of 0.090 (95%CI: 0.001-0.179). It could also indirectly and positively influence health literacy through self-efficacy, with a mediating effect value of 0.164 (95%CI: 0.099-0.234). The mediating effect accounted for 64.31% of the total effect. Conclusion Self-efficacy plays a positive mediating role between family health and health literacy among middle-aged and elderly chronic diseases patients in rural areas.

ObjectiveThis paper aims to investigate the protective effects of the Tanyu Tongzhi Youhua prescription（TYTZP） against myocardial ischemia/reperfusion injury in rats via regulation of the cyclic GMP-AMP synthase （cGAS）/stimulator of interferon genes （STING） signaling pathway. MethodsFifty-six 8-week-old male Sprague-Dawley （SD） rats were randomly divided into sham group， model group， ticagrelor group （32.4 mg·kg^-1）， RU320521 （RU.521cGAS inhibitors） group （5 mL·kg^-1）， groups of TYTZP with low dose （3.6 g·kg^-1）， medium dose （7.2 g·kg^-1）， and high dose （14.4 g·kg^-1）， with eight rats per group. The ticagrelor group and groups of TYTZP with different doses received pre-treatment for seven days according to their respective protocols. The RU.521 group received an intraperitoneal injection one hour before modeling. A rat model of the no-reflow phenomenon in myocardial ischemia/reperfusion injury was established by ligating the left anterior descending coronary artery in situ. Myocardial no-reflow area was determined by thioflavin staining. Histopathological morphology of myocardial tissue was observed via hematoxylin and eosin （HE） staining. Cardiac function was detected by echocardiography. Myocardial microcirculation function change was observed by using real-time myocardial contrast echocardiography. The myocardial enzyme levels in the serum were measured by serum biochemical analysis. The double-stranded DNA （dsDNA） levels were detected by using PicoGreen. The protein expression of cGAS， STING， and nuclear factor-κB （NF-κB） p65 in myocardial tissue was detected by Western blot. The levels of cardiac troponin Ⅰ （cTNⅠ）， cardiac troponin T （cTNT）， interleukin-6 （IL-6）， interleukin-1β （IL-1β）， and tumor necrosis factor-α （TNF-α） in the peripheral blood were measured by enzyme-linked immunosorbent assay （ELISA）. ResultsCompared with the sham group， the model group showed a significantly increased myocardial no-reflow area （P<0.01）. Myocardial fiber rupture and disarray and inflammatory cell infiltration were observed by HE staining. The ultrasound results indicated that left ventricular ejection fraction （LVEF） and left ventricular fractional shortening （LVFS） （P<0.01） were significantly decreased. Real-time myocardial contrast echocardiography showed that the peak time of myocardial blood perfusion was significantly prolonged （P<0.01）， and the levels of creatine kinase （CK）， creatine kinase isoenzyme （CK-MB）， lactate dehydrogenase （LDH）， cTNⅠ， cTNT， and dsDNA were significantly elevated （P<0.01）. Western blot results showed that the myocardial protein expressions of cGAS， STING， and NF-κB p65 were upregulated （P<0.01）. ELISA results showed that the inflammatory factors in the serum such as IL-6， IL-1β， and TNF-α were increased （P<0.01）. Compared with the model group， the group of the TYTZP significantly reduced the levels of myocardial enzyme， troponins， and dsDNA （P<0.01， P<0.05）， improved cardiac function and myocardial microcirculation， alleviated histopathological morphology and inflammatory infiltration， inhibited activation of the cGAS/STING pathway， reduced the expression of NF-κB p65 （P<0.01， P<0.05）， and inhibited inflammatory response. ConclusionThe TYTZP mitigates the no-reflow phenomenon in myocardial ischemia/reperfusion injury， and its mechanism is associated with inhibiting the activation of the cGAS/STING pathway and attenuating inflammatory responses.

ObjectiveThis paper aims to investigate the protective effects of the Tanyu Tongzhi Youhua prescription（TYTZP） against myocardial ischemia/reperfusion injury in rats via regulation of the cyclic GMP-AMP synthase （cGAS）/stimulator of interferon genes （STING） signaling pathway. MethodsFifty-six 8-week-old male Sprague-Dawley （SD） rats were randomly divided into sham group， model group， ticagrelor group （32.4 mg·kg^-1）， RU320521 （RU.521cGAS inhibitors） group （5 mL·kg^-1）， groups of TYTZP with low dose （3.6 g·kg^-1）， medium dose （7.2 g·kg^-1）， and high dose （14.4 g·kg^-1）， with eight rats per group. The ticagrelor group and groups of TYTZP with different doses received pre-treatment for seven days according to their respective protocols. The RU.521 group received an intraperitoneal injection one hour before modeling. A rat model of the no-reflow phenomenon in myocardial ischemia/reperfusion injury was established by ligating the left anterior descending coronary artery in situ. Myocardial no-reflow area was determined by thioflavin staining. Histopathological morphology of myocardial tissue was observed via hematoxylin and eosin （HE） staining. Cardiac function was detected by echocardiography. Myocardial microcirculation function change was observed by using real-time myocardial contrast echocardiography. The myocardial enzyme levels in the serum were measured by serum biochemical analysis. The double-stranded DNA （dsDNA） levels were detected by using PicoGreen. The protein expression of cGAS， STING， and nuclear factor-κB （NF-κB） p65 in myocardial tissue was detected by Western blot. The levels of cardiac troponin Ⅰ （cTNⅠ）， cardiac troponin T （cTNT）， interleukin-6 （IL-6）， interleukin-1β （IL-1β）， and tumor necrosis factor-α （TNF-α） in the peripheral blood were measured by enzyme-linked immunosorbent assay （ELISA）. ResultsCompared with the sham group， the model group showed a significantly increased myocardial no-reflow area （P<0.01）. Myocardial fiber rupture and disarray and inflammatory cell infiltration were observed by HE staining. The ultrasound results indicated that left ventricular ejection fraction （LVEF） and left ventricular fractional shortening （LVFS） （P<0.01） were significantly decreased. Real-time myocardial contrast echocardiography showed that the peak time of myocardial blood perfusion was significantly prolonged （P<0.01）， and the levels of creatine kinase （CK）， creatine kinase isoenzyme （CK-MB）， lactate dehydrogenase （LDH）， cTNⅠ， cTNT， and dsDNA were significantly elevated （P<0.01）. Western blot results showed that the myocardial protein expressions of cGAS， STING， and NF-κB p65 were upregulated （P<0.01）. ELISA results showed that the inflammatory factors in the serum such as IL-6， IL-1β， and TNF-α were increased （P<0.01）. Compared with the model group， the group of the TYTZP significantly reduced the levels of myocardial enzyme， troponins， and dsDNA （P<0.01， P<0.05）， improved cardiac function and myocardial microcirculation， alleviated histopathological morphology and inflammatory infiltration， inhibited activation of the cGAS/STING pathway， reduced the expression of NF-κB p65 （P<0.01， P<0.05）， and inhibited inflammatory response. ConclusionThe TYTZP mitigates the no-reflow phenomenon in myocardial ischemia/reperfusion injury， and its mechanism is associated with inhibiting the activation of the cGAS/STING pathway and attenuating inflammatory responses.

ObjectiveTo investigate the effect and mechanism of modified Sini San in ameliorating intestinal mucosal barrier by observing its effects on short chain fatty acids （SCFAs） and high mobility group protein B1 （HMGB1）/receptor of advanced glycation end products （RAGE） signaling pathways in chronic stress rats. MethodsThe 50 male SD rats were randomly divided into control group，model group，low-dose modified Sini San group （7.34 g·kg^-1·d^-1），high-dose modified Sini San group （14.68 g·kg^-1·d^-1），and Fructo-oligosaccharides group （3.15 g·kg^-1·d^-1），with 10 rats in each group. Except for the control group，all other groups were subjected to chronic unpredictable stress/social isolation to create a chronic stress model for 6 weeks. After 4 weeks of modeling，each treatment group was given corresponding drugs by gavage for 2 weeks while modeling. The control group and model group were given the same volume of physiological saline. The effects of Modified Sini San on behaviors，body weight，Bristol score in feces and fecal moisture content in chronic stress rats were observed. Hematoxylin and eosin （HE） staining was used to observe the pathological changes in the cecum. The content of SCFAs in the cecal contents of rats were detected by Gas chromatography-mass spectrometry （GC-MS）. Immunohistochemistry and Western blot were used to detect the expression of HMGB1/RAGE pathway related proteins in cecal tissue. The levels of ZO-1，Occludin，and Claudin-1 in the cecal tissue were detected by enzyme linked immunosorbent assay （ELISA）. ResultsCompared with the model group，the sucrose preference rate，total distance traveled and the number of grid crossings in the open field test of rats in the low-dose modified Sini San group were obviously increased （P<0.05， P<0.01），and the immobility time in the open field test and the immobility time in the forced swimming test of rats in the low-dose and high-dose modified Sini San groups were obviously reduced （P<0.05， P<0.01）. Meanwhile，the Bristol score and fecal moisture content of rats in the low and high dose groups of modified Sini San were obviously increased （P<0.05）. The low-dose group of modified Sini San had intact mucosal layer structure in the cecal tissue and reduced infiltration of inflammatory cells. The content of SCFAs in the cecal contents increased，with a obviously increase in the content of acetic acid，propionic acid，butyric acid，and isovaleric acid （P<0.05， P<0.01） and the expression levels of HMGB1，RAGE，Toll-like receptor 2（TLR2），Toll-like receptor 4（TLR4），tumor necrosis factor-α（TNF-α），and nuclear factor kappa-B p65（NF-κB p65） proteins in cecal tissue were significantly decreased （P<0.05， P<0.01） in low-dose group of modified Sini San. Meanwhile，the contents of ZO-1，Occludin，and Claudin-1 in the cecal tissue were obviously increased （P<0.01） in low-dose group of modified Sini San. ConclusionModified Sini San can improve the function of intestinal mucosal barrier in chronic stress rats by increasing the content of SCFAs in the intestine and inhibiting the HMGB1/RAGE pathway.

OBJECTIVE To study the efficacy of Tianjiang xueshuantong pills in the treatment of coronary heart disease. METHODS In accordance with the common pathogenesis of coronary heart disease， acute myocardial ischemia model， hyperlipidemia model， blood stasis model， and carotid artery thrombosis model were established using Wistar rats or SD rats as the experimental subjects. The effects of Tianjiang xueshuantong pills administered at high， medium， and low doses （0.6， 1.2 and 2.4 g/kg） on hemodynamic parameters and myocardial enzyme markers [lactate dehydrogenase （LDH）， creatine kinase-MB （CK- MB）]， oxidative stress factors [superoxide dismutase （SOD）， malondialdehyde （MDA）， glutathione （GSH）]， inflammatory cytokines [tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， IL-1β， monocyte chemotactic protein-1 （MCP-1）， intercellular adhesion molecule-1 （ICAM-1）]， myocardial infarction percentage， serum lipid indexes [total cholesterol （TC）， triglycerides （TG）， low-density lipoprotein （LDL）， high-density lipoprotein （HDL）]， platelet aggregation function 话：022-84845240。E-mail：jiangx@tjipr.com [maximum aggregation rate （MAR）]， and thrombus formation indexes [thrombosis time， thrombus mass， thrombus protein content， plasminogen activator inhibitor-1 （PAI-1）， and tissue-type plasminogen activator （t-PA）] were evaluated in the rat models. RESULTS In myocardial ischemia tests， Tianjiang xueshuantong pills significantly reduced the percentage of myocardial infarction and the levels of CK-MB， LDH， MDA， GSH， IL-6， TNF-α， IL- 1β， and MCP-1 in serum （P＜0.05 or P＜0.01）. In hyperlipidemia tests， high dose of Tianjiang xueshuantong pills significantly reduced the serum levels of TC， LDL and significantly increased the level of HDL in rats after 2 weeks and 4 weeks of administration. In blood stasis tests， different doses of Tianjiang xueshuantong pills significantly reduced MAR of rats （P＜0.01）. In artery thrombosis tests， high dose of Tianjiang xueshuantong pills significantly prolonged the time of thrombosis formation （P＜ 0.01）， significantly reduced the weight and protein content of thrombus and the level of PAI-1 in serum （P＜0.01）. CONCLUSIONS Tianjiang xueshuantong pills exert therapeutic effects on coronary heart disease through multi-dimensional synergistic actions， including anti-myocardial ischemia， lipid-lowering， and anti-thrombotic effects.

Objective:To search, evaluate, and summarize the best evidence for postpartum contraceptive health guidance, providing evidence-based support for clinical healthcare providers in implementing standardized contraceptive counseling and management.Methods:A systematic search was conducted across guideline repositories, professional association websites, and databases for literature related to postpartum contraception guidance, including guidelines, best practices, expert consensus, and systematic reviews, with a search timeframe from database inception to December 2023. Four researchers independently evaluated the quality of the included studies, extracted relevant data, and synthesized evidence from eligible literature.Results:According to the inclusion and exclusion criteria, 18 documents were included, comprising 5 guidelines, 2 clinical decision-making documents, 1 best practice document, 4 expert consensus statements, and 6 meta-analyses or systematic reviews. Totally 46 pieces of best evidence were summarized from 9 aspects, including health educators, health education recipients, assessment, planning, mode and content of health education, available contraceptive methods, evaluation index of health education, and considerations.Conclusion:This study systematically synthesizes the best available evidence on postpartum contraceptive health guidance. It emphasizes strengthening the competencies of clinical practitioners, supported by structured assessments and standardized guidance, to improve the feasibility and accessibility of contraceptive services. It further highlights the importance of ensuring the long-term sustainability of contraceptive plans and integrating digital tools to enhance the precision and coverage of guidance, ultimately reducing unintended and short-interval pregnancies and safeguarding women's reproductive health.

Objective:To explore the dynamic change trajectory and influencing factors of postoperative fatigue (POF) in patients with early digestive tract cancer undergoing endoscopic submucosal dissection (ESD), so as to provide theoretical basis for individualized management of such patients.Methods:Using cross-sectional survey and convenient sampling method, the patients who underwent ESD for early cancer of digestive tract in the endoscopic center of the Second Affiliated Hospital of Zhejiang University School of Medicine from January to June 2024 were selected as the research objects. The questionnaires were conducted at 30 min, 24 h, 3 days, 5 days, 7 days after ESD with Christensen's postoperative fatigue score. Spearman test was used to analyze the correlation between pain, insomnia and POF. The latent variable growth model was used to identify the potential categories of POF trajectory, and the influencing factors were analyzed by Logistic regression.Results:A total of 232 patients were finally induded, with ages of 19-94(59.53 ± 13.29) years, including 120 males and 112 femalss. The POF level of patients with early cancer of digestive tract showed a downward trend one week after operation. Three postoperative fatigue trajectories were fitted, 9.05% in moderate or severe fatigue low-speed smooth descent group (C1 group); 32.76% in moderate fatigue first decreased quickly and then slowly group (C2 group) and 58.19% in mild fatigue continuous decline group (C3 group). The result of Logistic regression analysis showed that, compared with C1 group, people without religious beliefs were morelikely to enter C2 group [ β = 1.572, OR = 4.818(1.033 - 22.465), P<0.05]; compared with C3 group, patients with high pain level and severe insomnia degree were likely to enter C1 [ β = 2.621, 0.663, OR were 13.754(2.692 - 70.283) and 1.942(1.429 - 2.638), both P<0.05] and C2 [ β = 2.010, 0.491, OR were 7.464(1.890 - 29.482) and 1.634(1.348 - 1.982), both P<0.05] group. Conclusions:There were three potential types of POF in patients with early digestive tract cancer ESD. Medical staff should pay attention to patients with severe insomnia, intense pain and religious beliefs, and give staged fatigue assessment and individualized intervention, so as to reduce the level of POF and promote rapid recovery.

Objective To verify the accuracy of Youssef's formula and evaluate whether fetal biacromial diameter(BA)and other fetal biological diameters estimated by ultrasound can be used to predict macrosomia and shoulder dystocia,so as to provide the possibility for clinical prediction of shoulder dystocia.Methods A total of 200 pregnant women with a gestational period of 37-42 weeks were examined with ultrasound within 3 days before delivery for collecting biparietal diameter(BPD),head circumference(HC),abdominal circumference(AC),humerus length(HL),femur length(FL),thoracic transverse diameter and midpoint diameter of upper arm;and the fetal BA was estimated by Youssef's formula.Neonatal BA,body mass and body length were measured within 1 day after delivery.The above data were analyzed for correlation.Newborns were grouped according to their body mass(macrosomia vs non-macrosomia)and whether they had shoulder dystocia or not(shoulder dystocia vs non-shoulder dystocia).Results(1)The fetal BA estimated by Youssef's formula was consistent with neonatal BA(P>0.05),and the estimated BA was positively correlated with BPD,HC,AC and neonatal body mass(P<0.001).(2)The BA,BA/AC and BA/HC in macrosomia group were different from those in non-macrosomia group(P<0.05).ROC curve showed that the sensitivity and specificity were 92.3%and 88.2%for macrosomia prediction when the estimated BA threshold was 16.05 cm,and those were 61.5%and 77.0%when BA/AC threshold was 0.455,and 76.9%and 72.7%when BA/HC threshold was 0.465.(3)Shoulder dystocia group had neonatal weight close to non-shoulder dystocia group(P>0.05),but higher BA/BPD,BA/HC and BA-BPD(P<0.05).ROC curve showed that the sensitivity and specificity were 100.0%and 66.8%for shoulder dystocia when BA threshold was 15.45 cm,100.0%and 80.6%when BA/BPD threshold was 1.695,100.0%and 81.6%when BA/HC threshold was 0.475,and 100.0%and 76.0%when the threshold difference between BA and BPD was 6.35 cm.Conclusion Fetal BA,BA/BPD,BA/HC,BA/AC and BA-BPD may be effective predictors of shoulder dystocia and macrosomia.

Objective:To investigate the clinical utility of functional near-infrared spectroscopy (fNIRS) in evaluating cerebral function in neonates with hypoxic-ischemic encephalopathy (HIE).Methods:This was a case-control study. Fifteen neonates with moderate to severe HIE who were admitted to the Department of Neonatal Medical Center, Children's Hospital of Fudan University from March 2023 to August 2024 and completed fNIRS testing were selected as the HIE group, and 15 full-term infants without neurological diseases and completed fNIRS testing were selected as the control group during the same period. Resting-state fNIRS data were acquired to construct cerebral functional connectivity networks and topological properties were analyzed. Statistical analyses included independent t-tests, Mann-Whitney U tests, analysis of variance, and Chi-square tests. Results:Compared with controls, the HIE group exhibited significantly reduced global functional connectivity strength [0.15 (0.05-0.26) vs. 0.24 (0.13-0.35), Z=－7.66, P<0.001]. Both groups demonstrated small-world network properties, with no intergroup difference (1.17±0.05 vs. 1.14±0.05, t=2.02, P=0.050). The HIE group showed decreased shortest path length (6.22±0.52 vs. 13.74±0.49, t=48.18, P<0.001), global efficiency (0.26±0.04 vs. 0.30±0.05, t=2.50, P=0.018) and normalized shortest path length (1.50±0.07 vs. 1.62±0.22, t=2.43, P=0.020). No differences were observed in the clustering coefficient or local efficiency between the two groups. Regional analysis revealed reduced nodal efficiency in both left (0.30±0.06 vs. 0.35±0.05, t=2.47, P=0.021) and right hemispheres (0.30±0.06 vs. 0.37±0.06, t=2.68, P=0.013) in HIE neonates compared with that of the corresponding hemispheres in the control group. The intra-group comparison showed no statistical significance in node efficiency between the left and right hemispheres (both P>0.05). Conclusion:fNIRS captures functional network signatures in HIE, demonstrating clinical potential for early detection of cerebral dysfunction in neonates with hypoxic-ischemic injury.

Objective To investigate the effects of varying pulse intervals in the programmed intermittent epidural bolus(PIEB)mode on labor analgesia in primiparous and multiparous women,and to evaluate the differ-ences in analgesic outcomes between these two groups.Methods A total of 60 primiparous and 60 multiparous women who met the inclusion criteria were recruited and randomly allocated into two groups:a 45-minute pulse interval group(P45 group,n=30)and a 60-minute pulse interval group(P60 group,n=30).Epidural labor anal-gesia was initiated when cervical dilation reached 1～3 cm.The programmed intermittent epidural bolus(PIEB)mode was started 45 minutes after analgesia commencement in the P45 group and 60 minutes after analgesia com-mencement in the P60 group.Each pulse delivered 10 ml of a solution containing 0.08%ropivacaine and 0.5 μg/ml sufentanil.Pain scores were assessed using the Visual Analog Scale(VAS)at five specific time points:baseline(t0),1 hour post-analgesia initiation(t1),2 hours post-analgesia initiation(t2),full cervical dilation(t3),and delivery(t4).Secondary outcomes included Bromage scores,the number of patient-controlled analgesia(PCA)button presses,total drug consumption,and adverse reactions.Results In primiparous women,the VAS score at t1 was significantly lower in the P45 group compared to the P60 group(P<0.05),whereas no significant differences were observed in VAS scores between the two groups at t2—t4.The median PCA press count was also significantly lower in the P45 group than in the P60 group(P<0.05).However,there were no significant differences between the groups in terms of total drug consumption,Bromage scores,or the incidence of adverse events(P>0.05).In multiparous women,no significant differences were found in VAS scores,Bromage scores,or PCA press counts between the P45 and P60 groups at any time point(P>0.05).Conversely,total drug consumption was significantly higher in the P45 group compared to the P60 group(P<0.05).Conclusions For primiparous women,a 45-minute pulse interval in the PIEB mode not only provides superior labor analgesia but also significantly reduces the frequency of PCA presses without escalating the risk or severity of motor block or adverse events.For multiparous women,the pulse interval does not substantially influence the effectiveness of labor analgesia.These findings contribute valuable new evidence for refining clinical labor analgesia protocols.