Objective To investigate the relationship of neutrophil to lymphocyte ratio (NLR) and homocysteine (Hcy) with risk of coronary artery lesion progression in patients with hypertension. Methods The data of 306 patients with hypertension who received coronary angiography from January 2020 to January 2025 were included for retrospective investigation. The patients were divided into a non-progression group (175 cases) and a progression group (131 cases) based on the 6-month Gensini progression rate. The relationship between NLR and Hcy and coronary artery lesion progression was analyzed. Results Binary logistic regression analysis was applied to control confounding factors. After adjusting for confounding factors using Model1, Model2, and Model3, it was found that NLR and Hcy at admission were independently associated with the progression of coronary artery lesion in hypertensive patients [adjusted OR (95% CI) = 1.77 (1.48-2.11), 4.26 (2.71-6.69), P<0.001]. Receiver operating characteristic (ROC) curve revealed that the area under the curve of the combination of Hcy and NLR was 0.814 in predicting the progression of coronary artery lesion in hypertensive patients, which was higher than that of Hcy or NLR (Z/P=5.328, 2.077/<0.05). Conclusion Cardiovascular disease risk factors NLR and Hcy are independently associated with coronary artery lesion progression in patients with hypertension. Early detection of NLR and Hcy is helpful to predict the progression of coronary artery lesion.

OBJECTIVE To analyze the prototype components absorbed into blood and brain of Lithocarpus litseifolius leaves， so as to provide a reference for clarifying the pharmacological material basis of its prevention and treatment of central nervous system dis eases. METHODS The ethanol extract of L. litseifolius leaves， as well as the gastric lavage fluid and perfusion solution were prepared. Using rats as subjects， plasma samples of intestinal wall metabolism， intestinal flora metabolism and hepatic metabolism were prepared via in situ intestinal perfusion and closed intestinal loop method； while comprehensive metabolic plasma samples， brain tissue samples， and cerebrospinal fluid samples were collected after intragastric administration. UPLC-HRMS technology was utilized to analyze and identify chemical components and prototype components absorbed into blood and brain of L. litseifolius leaves. RESULTS A total of 66 chemical constituents were identified in L. litseifolius leaves， primarily consisting of flavonoids， organic acids， and others. A total of 16， 13， 11， and 5 prototype components were identified in intestinal wall metabolism， intestinal flora metabolism， hepatic metabolism， and comprehensive metabolic plasma samples， respectively. Additionally， 4 prototype components were detected in brain tissue and 9 in cerebrospinal fluid. Phloridzin， trilobatin， phloretin-2- O -malonyl hexoside， and phloretin were identified as common components across all sample types. CONCLUSIONS Prototype components absorbed into blood and brain of L. litseifolius leaves， such as phloridzin， trilobatin， phloretin， and other components may serve as the pharmacological material basis for their therapeutic effects on central nervous system diseases.

Objective:To systematically compares the medial plantar venous flap (MPVF) and the lateral toe flap (LTF) reconstruction of digit-pulp defect, aiming to establish whether there exist significant differences between the 2 flaps in flap survival rate, two-point discrimination (TPD), score of Vancouver Scar Scale (VSS) and score of digit-pulp defect reconstruction evaluation.Methods:With a prospective cohort design, this study enrolled 36 patients who were admitted in Department of Hand Surgery, Longgang Eighth People's Hospital of Shenzhen for digit-pulp defects with bone or tendon exposure between January 2024 and September 2024. According to the random grouping method, participants were divided into 2 groups. The MPVF group comprised 18 patients (21 digits) of 13 males (15 digits) and 5 females (6 digits), aged 13-58 (mean 44±12) years. The MPVF group included 9 left and 12 right digits, with distribution as follows: 2 thumbs, 5 index fingers, 7 middle fingers, 5 ring fingers and 2 little fingers. The soft tissue defect area ranged from 2.0 cm × 1.0 cm to 9.2 cm × 3.3 cm (mean 6.69 cm 2± 6.69 cm 2). Flap dimensions ranged from 2.1 cm×1.1 cm to 9.5 cm×3.5 cm (mean 7.54 cm 2±7.22 cm 2). Donor sites were closed primarily or by full-thickness skin grafts harvested from the leg. The LTF group included 18 patients (21 digits) of 15 males (17 digits) and 3 females (4 digits), aged 22-62 (mean 41±12) years. The affected digits in LTF group comprised 12 left and 9 right digits, with a distribution of: 3 thumbs, 9 index fingers, 5 middle fingers, 2 ring fingers and 2 little fingers. The area of soft tissue defect ranges from 1.4 cm × 1.0 cm to 3.9 cm × 1.8 cm (mean 3.93 cm 2± 1.80 cm 2). Flap dimensions ranged from 1.5 cm×1.2 cm to 4.0 cm×1.9 cm (mean 4.52 cm 2±1.89 cm 2). Donor sites were closed primarily, or by full-thickness skin grafts harvested through extension of proximal wound extension or from calf for defect coverage. Patients were contacted for postoperative follow-up by telephone or WeChat to arrange a visit of outpatient clinic or a home visit by surgeon. Statistical analysis was conducted to compare the 2 groups regarding: gender, age and flap dimensions, flap survival rate at 2 weeks after surgery and TPD of flaps, VSS scores, and digit-pulp defect reconstruction evaluation scale scores at 4 months and 6 months postoperatively. P<0.05 indicates a statistically significant difference. Results:The comparative analysis revealed no statistically significant differences between 2 groups in baseline characteristics: gender distribution ( χ2=0.53, P=0.47), mean age ( t=0.75, P=0.46), flap dimensions ( t=1.86, P=0.08), confirming a demographic and surgical parameter equivalence in subsequent outcome comparisons ( P>0.05). All flaps survived at 2 weeks after surgery. All skin grafts at donor sites demonstrated complete viability with uneventful primary wound healing. At 4 months after surgey, the TPD in the MPVF group were 14.71 mm±1.90 mm and 7.81 mm±1.78 mm, respectively, compared to 14.48 mm±1.57 mm and 7.67 mm±1.39 mm in the LTF group at 6 months after surgery. The VSS scores were 1.67±1.11 and 1.29±0.72 for MPVF versus 1.86±1.15 and 1.38±0.81 for LTF at corresponding time points. The digit-pulp defects reconstruction evaluation scale scores showed 88.43±2.62 and 91.43±3.59 for MPVF versus 88.19±2.70 and 91.19±3.50 for LTF. Statistical analysis revealed no significant differences (all P>0.05) at 2 postoperative time points. Conclusion:The MPVF demonstrated non-inferior clinical efficacy to the LTF in reconstruction of digit-pulp defects, with comparable outcomes in flap survival rate at 2 weeks, and in TPD, VSS scores, digit-pulp defect reconstruction evaluation scale scores at 4 months and at 6 month after surgey.

[Objective]To investigate the etiology and pathological mechanisms of prediabetes based on the theory of"excessive earth stagnation,"thereby expanding novel therapeutic approaches for prediabetes management.[Methods]Integrating classical Chinese medical literature with contemporary clinical insights,this study elucidates the correlation between Dunfu(thickened stagnation)and excessive earth stagnation and its pivotal role in prediabetes pathogenesis,and proposes the therapeutic strategies.[Results]The Dunfu mechanism documented in The Inner Canon of the Yellow Emperor demonstrates significant correlation with the"spleen-earth stagnation"pathological state in prediabetes,which primarily disrupts the ascending-descending dynamic of Qi in middle-Jiao and contributes to glucose metabolism dysregulation.Dunfu(thickened stagnation)acts as a quintessential manifestation of excessive earth stagnation.When Dunfu develops,damp-heat pathogens accumulate,causing retention of food essence and further aggravating earth stagnation,the retained food and essence transforming into dampness,heat and phlegm.These turbid pathogens obstruct the middle-Jiao,impairing spleen function and Qi-blood flow,eventually generating heat that scorches the Zang-Fu organs.This progression from Pidan to Xiaodan underscores Dunfu as the root pathology.Treatment should prioritize resolving stagnation,clearing heat and eliminating turbidity,with tailored Zang-Fu syndrome differentiation to restore Beihua(preparation and transformation).[Conclusion]"Excessive earth stagnation"is the core pathological mechanisms of prediabetes,leading to retention of food essence and further aggravation earth stagnation,and the treatment should prioritize resolving stagnation.Treating prediabetes based on"excessive earth stagnation"has clinical guidance significance.

Objective To develop a virtual reality rehabilitation support system and evaluate its effects on improving discharge readiness in caregivers of laryngectomy patients.Methods The system is equipped with a virtual reality-based home nursing skills guidance module for post-laryngectomy patients and an evidence-based artificial intelligence Q&A module.A convenience sampling method was adopted to select 64 caregivers of patients who underwent laryngectomy for the first time in the otorhinolaryngology head and neck surgery department of a tertiary A hospital in Beijing from July 2024 to January 2025 for a systematic study on application effects.To avoid cross-contamination between an experimental group and a control group,ward-based grouping was applied.A coin toss was used to assign Ward 1 to an experimental group and Ward 2 to a control group,with 32 cases in each group.The experimental group received discharge guidance based on the virtual reality technology,while the control group was provided with conventional verbal and written discharge instructions.The readiness for hospital discharge and the quality of discharge teaching scores of caregivers were compared between the 2 groups after the intervention.Results No sample detachment.After the intervention,the patient caregivers in the experimental group scored significantly higher than those in the control group in terms of discharge readiness and quality of discharge guidance,with a statistically significant difference(P＜0.001).Conclusion This study developed the virtual reality rehabilitation system for laryngeal cancer patients demonstrated good feasibility and effectiveness.The application of this system for discharge education significantly improved discharge readiness of caregivers and quality of discharge guidance for post-laryngectomy patients.It also helped with the optimization of health education models,enhancement of nursing resource utilization efficiency,and improvement of transitional care.

OBJECTIVES: To investigate the expression patterns and prognostic value of lipid metabolism-related genes in breast cancer. METHODS: RNA sequencing data and clinical information were obtained from The Cancer Genome Atlas breast cancer (TCGA-BRCA) dataset, including 1100 breast cancer tissue samples (18 paired with adjacent tissues) and 112 normal breast tissue samples. Differentially expressed lipid metabolism-related genes were screened from a predefined set of 2043 genes using Bioconductor in R, with a false discovery rate <0.05 and |log2(fold change)|>2. Eligible samples were randomly divided into a training cohort (n=651) and a validation cohort (n=431) at a 6∶4 ratio. Prognostic lipid metabolism-related genes were identified using univariate Cox regression (P<0.005) and further refined via LASSO regression. A risk score model was constructed using multivariate Cox regression, and patients were stratified into high- and low-risk groups based on the median risk score. The model's performance was evaluated using Kaplan-Meier survival analysis with the log-rank test and time-dependent receiver operating characteristic (ROC) curves. A nomogram integrating age, TNM stage, clinical grade, and risk score was developed and validated using calibration curves and the concordance index. Immune cell infiltration was quantified using an immune scoring algorithm, and weighted gene co-expression network analysis (WGCNA) was applied to identify key modules associated with immune cell infiltration. Finally, to validate the function of the key gene ALDH2, small interfering RNA targeting ALDH2 was transfected into breast cancer cells, and its effects on invasion and migration were assessed using Transwell invasion and wound healing assays. RESULTS: A total of 185 differentially expressed lipid metabolism-related genes were identified. Univariate Cox and LASSO regression analyses identified three genes-ALDH2, CYP21A2, and IL24-which were incorporated into the multivariate Cox model. The prognostic model based on these genes demonstrated good predictive performance in both cohorts: patients in the high-risk group had significantly shorter overall survival (P<0.01), and the area under the ROC curve for predicting 1-, 3-, and 5-year survival rates was above 0.64. Analysis of the tumor microenvironment revealed an immunosuppressive phenotype in the high-risk group, characterized by reduced infiltration of several anti-tumor immune cells and downregulation of key immune checkpoint molecules such as PDCD1 and CTLA4. WGCNA suggested an association between ALDH2 and immune cell infiltration. Functional experi-ments confirmed that ALDH2 knockdown significantly enhanced the migration and invasion abilities of breast cancer cells. CONCLUSIONS This study established and validated a pro-gnostic model for breast cancer based on lipid metabolism-related genes. It revealed that low ALDH2 expression is closely associated with poor prognosis and immunosuppression, suggesting its potential as a prognostic biomarker and therapeutic target in breast cancer.

Objective:To explore the specialty work engagement dilemma among wound therapists in non-specialist clinics, so as to provide a reference basis for improving wound therapists' work engagement and reducing job burnout.Methods:This study was a phenomenological study. Semi-structured interviews with 12 wound therapists in non-specialist clinics from 12 hospitals were conducted between May and July 2024 using purposive sampling. Colaizzi seven-step method was used for data analysis and topic refinement.Results:A total of five themes and 13 sub-themes were extracted, including the role change dilemma (focus dispersion due to transfer of positions in clinical departments, and identity challenges due to adjustment of the field of job posting) , career development dilemma (reduced motivation due to obstacles to in-depth development in specialized fields, and limited conditions for scientific research training and implementation impeding the recognition and return of work) , support environment dilemma (insufficient medical insurance support increased job burden, lack of hospital support reduced work efficiency, lack of team support weakened work focus, poor self-support limited the depth of work engagement, lack of support from patients and their families increased the difficulty of maintaining work motivation) , pros and cons weighing dilemma (unclear delineation of risk and responsibility, difficult to weigh risk and benefit) , dilemma of whole-course management of disease (lack of communication between hospitals weakened the continuity of work, lack of home follow-up increased the uncertainty of the work) .Conclusions:Specialty work engagement dilemmas among wound therapists in non-specialist clinics are influenced by a variety of factors. It is necessary for medical institutions, healthcare workers and patients' families to work together to create a favorable working environment for wound therapists in order to promote the high-quality development of wound therapy nursing services in China.

Objective:To identify the classification of neck and shoulder dysfunction in patients after neck lymph node dissection for head and neck tumors and analyze the characteristics of these dysfunctions.Methods:A convenience sampling method was used to select patients who underwent neck lymph node dissection and visited the Head and Neck Cancer Rehabilitation Nursing Clinic at Beijing Tongren Hospital, Capital Medical University, from March to May 2024. General data questionnaires, neck function indicators, and shoulder function symptom questionnaires were used for investigation.Results:A total of 113 patients who underwent neck lymph node dissection for head and neck tumors were included in the study. The top three neck dysfunction indicators with the highest occurrence rates were abnormal neck extension (87.6%, 99/113) , abnormal neck bending on the affected side (84.1%, 95/113) , and abnormal neck rotation on the affected side (84.1%, 95/113) . The top three shoulder dysfunction indicators with the highest occurrence rates were: abnormal shoulder flexion on the affected side (83.2%, 94/113) , abnormal shoulder abduction on the affected side (81.4%, 92/113) , and abnormal horizontal shoulder abduction on the affected side (80.5%, 91/113) . Using 18 indicators of neck and shoulder dysfunction as clustering variables, patients were classified into three groups: severe dysfunction group (53.1%, 60/113) , moderate dysfunction group (35.4%, 40/113) , and mild dysfunction group (11.5%, 13/113) . The differences in disease type and neck and shoulder function indicators between the three groups were statistically significant ( P<0.05) . Conclusions:Neck and shoulder dysfunction in patients after neck lymph node dissection for head and neck tumors is relatively severe, primarily manifesting as an abnormal range of motion. Healthcare providers should strengthen neck and shoulder function assessments in these patients and consider a range of motion exercises as a key rehabilitation program.

Psychological factors have become significant contributors to the onset and progression of insomnia. This article explored the treatment of insomnia from the perspective of “liver governs wei qi （defensive qi）”. The concept of “liver governs wei qi （defensive qi）” is summarized in three aspects， firstly， the liver assists the spleen and stomach in transformation and transportation， governing the generation of wei qi； secondly， the liver aids lung qi diffusion and dispersion， governing the distribution of wei qi； thirdly， the liver regulates circadian rhythms， governing the circulation of wei qi. It is proposed that the clinical treatment of insomnia should focus on the following methods： for regulating the liver to harmonize the five viscera， and facilitate the circulation of wei qi， medicinals entering the liver channel include Chaihu （Bupleuri radix）， Baishao （Paeoniae Radix Alba）， Zhizi （Gardeniae Fructus）， and Suanzaoren （Ziziphi Spinosae Semen） could be commonly used； for nourishing the liver， the treatment should align with the day-night rhythm， and herbs such as Baihe （Lilium）， Hehuan （Albizia julibrissin）， and Yejiaoteng （Polygoni multiflori caulis） are commonly used； for soothing the liver and address both mental and physical health to calm wei qi， treatment should advocate verbal counseling， psychological regulation， and health education. Ultimately， this treatment approach can free liver qi to flow， soothe qi movement， restore the motion of wei qi， regulate during day and night， balance yin and yang， and resolve insomnia effectively.

Objective:To visually analyze the research literature on the analysis of TCM compounds; To explore the research hotspots and trends in this field.Methods:The literature related to the disassembly analysis of TCM compounds was retrieved from CNKI, Chongqing VIP, Wanfang Data, SinoMed, and China Medical Journal Full-text Database from January 1, 1981 to December 31, 2024. CiteSpace 6.4.R1 software was used to visualize the number of articles, authors, institutions and keywords, and to draw the cooperation network diagram of authors and institutions, keyword co-occurrence, clustering, timeline and burst map.Results:A total of 1 728 Chinese articles were included, and the number of publications showed a fluctuating upward trend. A comparatively high number of publications was in 2007 and 2016, followed by a slight decline but maintained at a high level. There is a trend of recovery in 2024. The author with the highest number of articles was Professor Fang Zhaoqin, and the institution with the highest number of articles was Beijing University of Chinese Medicine. High frequency keywords included rats, compatibility, experimental research, cell apoptosis, TCM compound, and a total of 19 clusters and 25 emergent keywords were formed.Conclusions:The research contents and methods of the research on the disassembly of TCM compounds are relatively rich, and there are many explorations on classical prescriptions. The study of disassembled prescriptions has played a driving role in the modernization of TCM compounds. In the future, high-quality cooperation between regions, institutions, and authors, combination with modern medicine and scientific methods, will further improve the quality of research in this field.