Objective To understand the changes in self-rated health among middle-aged and elderly individuals in China and the influencing factors,providing a reference for improving health and promoting healthy aging.Methods Using data from the China Health and Aged Care Tracking Survey(CHARLS)from 2011 to 2020,this study analyzed 3595 middle-aged and elderly individuals(≥45 years old)who participated in all five rounds of the survey from 2011 to 2020.Univariate analysis and multinomial logistic regression were employed to analyze the influencing factors of self-rated health changes.Results Among the 3 595 middle-aged and elderly individuals,26.54％reported an increase in self-rated health,28.40％reported a decrease,and 45.06％reported no change.The multinomial logistic regression results indicated that compared to those with unchanged self-rated health,individuals whose self-rated health declined were more likely to have an increased number of Activities of Daily Living(ADLs),a higher number of chronic diseases,not engaging in at least 10 minutes of light physical activity per week,and a decline in life satisfaction levels.The odds ratios for these factors were 1.415(OR=1.415,95％CI:1.181～1.694),1.479(OR=1.479,95％CI:1.225～1.785),1.454(OR=1.486,95％CI:1.172～1.804),and 1.263(OR=1.237,95％CI:1.043～1.530),respectively.In contrast,individuals whose self-rated health improved,compared to those with unchanged health,were more likely to report an increase in life satisfaction levels,while an increase in ADLs and chronic diseases negatively impacted self-rated health improvement.The odds ratios for these factors were 1.698(OR=1.698,95％CI:1.425～2.023),0.769(OR=0.769,95％CI:0.646～0.915),and 0.689(OR=0.689,95％CI:0.549～0.865),respectively.Conclusion From 2011 to 2020,the self-rated health of middle-aged and elderly individuals in China has slightly declined,with a focus on improving physical health status,increasing physical activity,and addressing mental health as key areas for enhancing self-rated health among the elderly in China.

Objective:To evaluate the therapeutic role of balanced matching concept in the surgical release of moderate and severe elbow stiffness after trauma.Methods:A retrospective study was conducted to analyze the clinical data of 20 patients who had been treated by surgical release from June 2022 to January 2024 for elbow stiffness after moderate and severe trauma at Department of Orthopedic Trauma, The First Hospital Affiliated to Air Force Medical University of PLA using the balanced matching concept (combination of elbow soft tissue balance and bone matching). There were 15 males and 5 females, with an age of (33.0±8.9) years. Six left sides and 14 right sides were affected. The elbow stiffness was severe in 13 cases and moderate in 7 cases. Six patients had mainly bony stiffness, 4 patients mainly soft stiffness, and 10 patients mixed stiffness. The elbow flexion and extension, Mayo elbow performance score (MEPS) and disabilities of the arm, shoulder, and hand (DASH) score were recorded and compared before release and at the last follow-up. The recurrence of ectopic ossification, infection, iatrogenic fracture and other complications of the elbow joint of the affected limb were recorded.Results:All the 20 patients were followed up for (16.6±3.5) months. At the last follow-up, the elbow flexion and extension (121.8°±8.9° and 14.8°±8.2°) were significantly greater than those before operation (73.5°±25.7° and 47.3°±19.2°), and the MEPS and DASH scores [ (90.0±5.6) points, (5.6±3.0) points] were significantly better than those before operation [(53.0±12.8) points, (62.1±14.0) points] ( P<0.05). Iatrogenic fracture of the ulna occurred in 1 patient, and pinky numbness occurred in 1 patient after surgery. None of the patients had recurrence of ectopic ossification or wound infection. Conclusion:In the surgical release of moderate and severe elbow stiffness after trauma, the concept of balanced matching plays a positive role by facilitating the functional restoration of the elbow and reducing the incidence of complications.

Functional dyspepsia (FD), characterized by persistent or recurrent dyspeptic symptoms without identifiable organic, systemic or metabolic causes, is an increasingly recognized global health issue. The objective of this guideline is to equip clinicians and nursing professionals with evidence-based strategies for the management and treatment of adult patients with FD using traditional Chinese medicine (TCM). The Guideline Development Group consulted existing TCM consensus documents on FD and convened a panel of 35 clinicians to generate initial clinical queries. To address these queries, a systematic literature search was conducted across PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP Database, China Biology Medicine (SinoMed) Database, Wanfang Database, Traditional Medicine Research Data Expanded (TMRDE), and the Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS). The evidence from the literature was critically appraised using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The strength of the recommendations was ascertained through a consensus-building process involving TCM and allopathic medicine experts, methodologists, pharmacologists, nursing specialists, and health economists, leveraging their collective expertise and empirical knowledge. The guideline comprises a total of 43 evidence-informed recommendations that span a range of clinical aspects, including the pathogenesis according to TCM, diagnostic approaches, therapeutic interventions, efficacy assessments, and prognostic considerations. Please cite this article as: Zhang SS, Zhao LQ, Hou XH, Bian ZX, Zheng JH, Tian HH, Yang GH, Hong WS, He YY, Liu L, Shen H, Li YP, Xie S, Shu J, Zeng BF, Li JX, Liu Z, Xiao ZH, Xiao JD, Zheng PY, Huang SG, Chen SL, Fei GJ. International clinical practice guideline on the use of traditional Chinese medicine for functional dyspepsia (2025). J Integr Med. 2025; 23(5):502-518.
Dyspepsia/drug therapy* ; Humans ; Medicine, Chinese Traditional/methods* ; Practice Guidelines as Topic ; Drugs, Chinese Herbal/therapeutic use*

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Objective:To compare the safety and efficacy of 3D-printed porous bioceramic artificial bone and artificial bone substitutes in the treatment of limb bone defects.Methods:A total of 220 patients with post-traumatic limb bone defects admitted to Xijing Hospital Affiliated to Air Force Medical University of the Chinese People's Liberation Army (34 cases), the Third Hospital of Hebei Medical University (60 cases), Xi'an Honghui Hospital (28 cases), the Third Hospital of Southern Medical University (18 cases), Changsha Third Hospital (28 cases), Foshan Traditional Chinese Medicine Hospital (16 cases), Foshan Fuxing Chancheng Hospital (12 cases), and Henan Provincial Orthopaedic Hospital (24 cases) from May 2022 to October 2023 were included as research subjects. According to the manufacturing method of the bone graft material, the subjects were randomly divided into the 3D printed porous bioceramic artificial bone group (3D printing group) and the artificial bone substitute group (non-3D printing group) at a ratio of 1:1 by the envelope method. Adverse events that might be related to the surgery were selected through correlation evaluation and classified as abnormal laboratory indicators, systemic or other site symptoms and abnormalities, and local symptoms and abnormalities of the affected limb. The safety of the two groups was compared. The bone graft fusion rate, bone defect repair and healing rate, and short form 12 (SF-12) score of the two groups were calculated to evaluate the postoperative recovery.Results:Thirty-two cases were excluded (4 cases refused to use their data after reconsideration, 7 cases were not used after preoperative assessment, and 21 cases exceeded the standard for body mass index and laboratory indicators upon re-examination). A total of 188 cases were randomly divided into the 3D printing group and the non-3D printing group according to the random method, with 94 cases in each group. Among them, 11 cases in the 3D printing group and 9 cases in the non-3D printing group dropped out due to loss to follow-up. Finally, 168 cases completed the follow-up, including 83 cases in the 3D printing group and 85 cases in the non-3D printing group. In the 3D printing group, there were 53 males and 30 females, with an average age of 47.9±12.7 years; in the non-3D printing group, there were 53 males and 32 females, with an average age of 48.6±12.9 years. A total of 51 cases in the two groups experienced adverse events related to the surgery, including 13 cases of abnormal laboratory indicators (5 cases in the 3D printing group and 8 cases in the non-3D printing group), 15 cases of systemic or other site symptoms and abnormalities (9 cases in the 3D printing group and 6 cases in the non-3D printing group), and 23 cases of local symptoms and abnormalities of the affected limb (13 cases in the 3D printing group and 10 cases in the non-3D printing group). There was no statistically significant difference in the incidence of adverse events between the two groups ( P>0.05). The bone graft fusion rates of the 3D printing group and the non-3D printing group at 6 months after surgery were 99%(82/83) and 99%(84/85), respectively, and the bone defect repair and healing rates were 89%(74/83) and 89%(76/85), respectively. At the time of 12 months after surgery, the bone graft fusion rates were 99%(82/83) and 99%(84/85), respectively, and the bone defect repair and healing rates were 94%(78/83) and 92%(78/85), respectively. There was no statistically significant difference in the bone graft fusion rate and bone defect repair and healing rate between the two groups ( P>0.05). The SF-12 scores during the screening period were 27.82±2.96 points and 27.22±4.23 points in the 3D printing group and the non-3D printing group, respectively, and at 3 months after surgery were 28.08±3.13 points and 27.64±3.16 points, at 6 months after surgery were 29.42±3.10 points and 28.55±3.45 points, and at 12 months after surgery were 29.78±2.80 points and 29.58±2.94 points, respectively. There was no statistically significant difference between the groups ( P>0.05). Both groups of surgeries were successfully completed without any serious surgical or bone graft-related complications. Conclusion:The safety and efficacy of 3D-printed porous bioceramic artificial bone in the treatment of limb bone defects are not significantly different from those of currently clinically applied artificial bone substitutes.

Objective:To explore the curative effect of abdominal flap carried with combined perforating vessels in reconstruction of extra large and complicated defect in extremities.Methods:A retrospective analysis was conducted on 16 patients who were admitted to the Department of Hand Surgery, the Affiliated Traditional Chinese Medicine Hospital for treatment of extra large and complex wounds in extremities, from January 2020 to December 2023. There were 6 defects in upper limbs and 10 in lower limbs. Fourteen patients had a combination of fracture and 6 of tendon defects. The defects were large and sized from 30.0 cm×9.0 cm to 35.0 cm×15.0 cm. The defects were reconstructed by large sized abdominal flaps at 32.0 cm×10.0 cm to 36.0 cm×16.0 cm. According to the size of the defect, perforators of different arteries carried by the abdominal flap were combined by anastomosis in a manner of internal and external supercharging in order to boost the blood supply of the flap. The supercharging vessel anastomosis was as follows: one superficial circumflex iliac artery (or superficial inferior epigastric artery) was anastomosed with the contralateral branch of the deep inferior epigastric artery, with the veins were anastomosed with the corresponding veins, and the main trunk of the deep inferior epigastric artery was anastomosed end-to-end or end-to-side with the main branch of the recipient artery. Alternatively, both of the left and right superficial iliac circumflex (or inferior epigastric) arteries were directly anastomosed end-to-side or end-to-end with the main trunk or its branches in the recipient site, and the veins were anastomosed end-to-side or end-to-end with the adjacent veins. The donor site was pulled and relaxed by a pull-rod wound expander and sutured layer by layer. After surgery, routine anti-infection, anti-vasospasm, anticoagulation, enhancement of blood circulation and other symptomatic treatment were given. Postoperative follow-ups were conducted at outpatient clinic and via telephone and WeChat interviews. The colour and the sign of capillary reflux of the flap were closely observed.Results:All patients were included in the postoperative follow-up for 6-26 months, with an average of 13 months. Fifteen flaps survived after surgery. One flap had partial necrosis and the necrosis was found being caused by a thrombosis at the vessel anastomotic site. The necrotic tissue was removed and the defect was reconstructed by a flap transfer. The abdominal donor sites healed by first intention, and the navel was normal in terms of location and shape. There was no muscle hernia, except a minor scar hyperplasia. The flaps healed well, with satisfactory appearance and soft texture, without obvious bloating. The donor site healed well with partial scar formation.Conclusion:When an abdominal flap is used to reconstruct an extremely large and complex defect in extremities, the perforating vessels of different source arteries carried by the flaps can be anastomosed in a manner of combination, hence the flap can be flexibly freed, with satisfactory treatment effects.

AIM To prepare the sustained-release microspheres of ginsenosides.METHODS The sustained-release microspheres were prepared by SPG membrane emulsification technology with poly(lactic-co-glycolic acid)(PLGA)as a shell carrier.With PLGA concentration,feed rate and Span 60 concentration as influencing factors,comprehensive score for appearance,drug loading and encapsulation efficiency as an evaluation indice,the preparation process was optimized by response surface method.The morphology of sustained-release microspheres was observed,after which the particle size,drug loading and encapsulation efficiency were determined,and the in vitro drug release was investigated.RESULTS The optimal conditons were determined to be 45 s for agitation time of primary emulsion,74.68 mg/mL for PLGA concentration,11％for feed rate,and 4.18 mg/mL for Span 60 concentration,the comprehensive score was 74.98.The round sustained-release microspheres demonstrated the average particle size of 4.33 μm,drug loading of(8.24±0.13)％,and encapsulation efficiency of(74.94±1.17)％,respectively.At 336 h,ginsenosides Rg1,Rb1,Rb2 displayed the accumulative release rates of 84.12％,78.04％,65.88％,respectively.CONCLUSION This reasonable and feasible method can be used for the preparation of sustained-release microspheres of ginsenosides with good appearance and high drug loading,which can provide references for the preparation of other water-soluble drug microspheres and solution of microsphere collapse problem.

Objective:To analyze the genotypes and distribution of thalassemia in Xindu District of Chengdu,in order to provide reference for the prevention and treatment of thalassemia in this area.Methods:A total of 3 679 samples screened for thalassemia gene in Xindu District People's Hospital of Chengdu from June 2021 to April 2024 were selected as the study objects.Blood related parameters were detected by blood analyzer,hemoglobin composition was analyzed by capillary electrophoresis,and routine thalassemia gene detection was performed by PCR+flow-through hybridization.For the samples whose hematologic characteristics did not match the conventional results of thalassemia genes,the genotypes were determined by gene sequencing technology and the results were analyzed.Results:Among 3 679 samples,540 carriers were detected,the total detection rate was 14.68％.Among them,329 cases were α-thalassemia,with a total of 8 genotypes.The top 3 genotype in frequency were--SEA/αα(45.29％,149/329),-α3.7/αα(38.91％,128/329),and-α4.2/αα(6.08％,20/329).There were 197 cases of β-thalassemia,with a total of 10 genotypes,and the top 3 genotype in frequency were βCD41-42(-TCTT)/βN(29.95％,59/197),βCD17(A＞T)/βN(27.92％,55/197),and βIVSII-654(C＞T)/βN(24.87％,49/197).There were 14 cases of αβ-thalassemia,with a total of 12 genotypes,and the main were-α3.7/αα,βIVSII-654(C＞T)/βN and-α3.7/αα,βCD41-42(-TCTT)/βN.There was a rare thalassemia genotype(--SEA/HKαα).In addition,three rare abnormal hemoglobin mutations and one unreported abnormal hemoglobin mutation(HBA1:c.300+13C＞G site heterozygous mutation)were also found.Conclusion:The detection rate of thalassemia gene in this area is high and the genotype is complex.In gene diagnosis,we should pay attention to the combination of multi-technology detection to avoid missing rare genotypes.

Objective:To explore the effectiveness of digital management platform led by outpatient specialist nurses among patients with type 2 diabetes in outpatient settings.Methods:From March 2024 to March 2025, adult patients with type 2 diabetes who visited the Endocrinology Clinic at Peking Union Medical College Hospital were selected using convenience sampling. Patients were randomly assigned to the control group and intervention group using the random number table method. Patients in control group received routine education on type 2 diabetes during their clinic visits after enrollment. Intervention group was managed by nurses through a digital management platform, establishing long-term connections with patients. Based on the platform, nurses regularly provided patients with knowledge updates, promptly responded to patient inquiries, reviewed daily dietary records, monitored blood glucose data, conducted weekly telephone follow-ups, and scheduled regular clinic visits to precisely intervene in patients' lifestyles. The glycated hemoglobin (HbA1c) and self-management behavior scores were compared between two groups of patients before and after three months of intervention.Results:A total of 46 patients were enrolled and completed the 3-month follow-up, including 25 in control group and 21 in intervention group. There were no statistically significant differences in HbA1c or self-management behavior scores between the two groups of patients before intervention ( P>0.05). At three months of intervention, the HbA1c reduction in intervention group was greater than that in control group, with a statistically significant difference ( P<0.05). There was no statistically significant difference in Summary of Diabetes Self-Care Activities Scale scores between the two groups ( P>0.05). The difference in changes in diabetic foot self-screening scores between intervention group and control group was statistically significant ( P<0.05) . Conclusions:Specialist nurse-led precision health care management utilizing digital platforms can improve HbA1c and enhance self-management behaviors for diabetic foot in patients with type 2 diabetes, which is expected to be promoted and applied in the outpatient management of diabetes patients.

Objective To comparatively evaluate the diagnostic value of metagenomic next-generation sequencing(mNGS)versus conventional microbial culture in spinal infections.Methods A cross-section design was conducted on 82 consecutive patients with suspected spinal infections treated between February 2022 and January 2024 at Jiangbei Branch of First Affiliated Hospital of Army Medical University(Third Military Medical University).Microbiological culture,histopathological examination,and mNGS results from infected specimens were analyzed.Clinical diagnosis,primarily based on clinical manifestations,laboratory tests and radiologic features combined with medical history,was defined as the gold standard,and then the diagnostic performance,including sensitivity and specificity,were compared between mNGS and microbial culture.Results Among the 82 patients,definitive microbiological evidence was identified in 70 cases,and mNGS demonstrated a significantly higher detection rate than microbial culture(64 vs 36 cases,78.05％vs 43.9％,P<0.05).mNGS also obtained obviously higher sensitivity,accuracy,and negative predictive value(NPV),and notably lower positive predictive value(PPV)when compared to conventional microbial culture(all P<0.05).When stratified by infection type,mNGS obtained significantly higher sensitivity and accuracy compared to microbial culture in tuberculous spinal infections(P<0.05).For non-tuberculous spinal infections,mNGS also showed superior sensitivity to microbial culture(P<0.05).Conclusion In patients with spinal infections,mNGS demonstrates a significantly higher pathogen detection rate than conventional microbial culture.This technique can provide early and broad-spectrum pathogenic microbiological evidence for spinal infection.