Osteoarthritis （OA） and stroke are common clinical diseases that reduce patients' quality of life and place a burden on families and society. Ruyi Zhenbaowan， a classic prescription in Tibetan medicine， have the functions of clearing heat， awakening the brain and opening orifices， relaxing tendons and promoting meridian circulation， and eliminating yellow water. Clinically， they are used to treat osteoarthritis， post-stroke sequelae， neuropathic pain， and other related conditions. Modern pharmacological studies have demonstrated their anti-inflammatory， analgesic， and nerve-repairing effects. However， current research remains insufficient regarding the appropriate indications， timing， and efficacy of this medicine in treating relevant diseases. To enhance clinicians' understanding of this medicine and promote its standardized and rational clinical use， a panel of national experts， including clinical specialists， Tibetan medicine practitioners， pharmacologists， and methodologists， formulated this consensus based on clinical experience and evidence-based practice. The Cochrane systematic review framework， the Grading of Recommendations Assessment， Development and Evaluation （GRADE） system， and the nominal group method were employed to generate seven graded recommendations and 19 consensus-based suggestions. These recommendations clearly define the key points in the clinical application of Ruyi Zhenbaowan， including therapeutic indications， dosage and administration， treatment duration， and medication safety. The consensus specifically addresses the clinical efficacy， appropriate timing of administration， dosage strategies， treatment cycles， and combination medication strategies for treating osteoarthritis and stroke and provides an overview of safety considerations. The aim is to provide standardized guidance for hospitals and healthcare institutions nationwide to ensure the rational application of Ruyi Zhenbaowan in the treatment of osteoarthritis and stroke， reduce medication-related risks， and further leverage its clinical advantages. This consensus has been approved and issued by the China Association of Chinese Medicine， with the standard number GS/CACM 369-2024.

Objective To develop a highly sensitive and rapid nucleic acid detection method for the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2). Methods We designed,developed,and manufactured an integrated disposable device for SARS-CoV-2 nucleic acid extraction and detection.The precision of the liquid transfer and temperature control was tested.A comparison between our device and a commercial kit for SARS-Cov-2 nucleic acid extraction was performed using real-time fluorescence reverse transcription polymerase chain reaction(RT-PCR).The entire process,from SARS-CoV-2 nucleic acid extraction to amplification,was evaluated. Results The precision of the syringe transfer volume was 19.2±1.9 μL(set value was 20),32.2±1.6(set value was 30),and 57.2±3.5(set value was 60).Temperature control in the amplification tube was measured at 60.0±0.0 ℃(set value was 60)and 95.1±0.2 ℃(set value was 95)respectively.SARS-Cov-2 nucleic acid extraction yield through the device was 7.10×106 copies/mL,while a commercial kit yielded 2.98×106 copies/mL.The mean time to complete the entire assay,from SARS-CoV-2 nucleic acid extraction to amplification detection,was 36 min and 45 s.The detection limit for SARS-CoV-2 nucleic acid was 250 copies/mL. Conclusion The integrated disposable devices may be used for SARS-CoV-2 Point-of-Care test(POCT).

Objective:To analyze the effect of problem-based learning (PBL) combined with case-based learning (CBL) and clinical pathway (CP) teaching methods in standardized residency training in department of hepatobiliary surgery.Methods:A total of 64 residents who received the standardized residency training in the Department of Hepatobiliary Surgery in Shaanxi Provincial People's Hospital from July 2018 to July 2019 were selected and divided into the observation group and the control group. The control group used PBL + CBL teaching methods, while the observation group adopted PBL + CBL + CP teaching methods. The after-department examination scores and the teaching cognition scores of the two groups were compared. SPSS 15.0 was used for t-test and Chi-square test. Results:The after-department examination scores of the two groups were compared. Compared with the control group, the examination scores of professional theories, case analysis and operation skills in the observation group were significantly higher, and the difference was statistically significant ( t = 6.98, 7.85, 7.01, P < 0.05). In terms of recognition of teaching, the observation group was significantly higher than the control group, and the difference was statistically significant ( t = 9.14, P < 0.05). Conclusion:The PBL + CBL + CP teaching is conducive to the comprehensive and systematic mastery of knowledge and the rapid establishment of scientific clinical thinking. It has a strong scientific and systematic nature and is worthy of promotion.

Objective:To explore the effect sense of security and self-control on parent-child cohesion and externalizing problem behaviors in primary and middle school students.Methods:A total of 1 402 primary and middle school students were investigated with the problem behavior frequency scale(PBFS), family adaptability and cohesion scale(FACES-CV), security questionnaire(SQ) and brief self-control scale(BSCS). SPSS 25.0 and PROCESS v2.16 were used for statistical analysis, and common method deviation test, Pearson correlation analysis and intermediary effect analysis were used in the analysis.Results:Parent-child cohesion of primary and middle school students was positively correlated with security and self-control ( r=0.279, 0.303, both P<0.01), which was negatively correlated with externalizing problem behaviors ( r=-0.154, P<0.01). Security was positively correlated with self-control ( r=0.567, P<0.01). Security, self-control and externalizing problem behaviors were negatively correlated ( r=-0.147, -0.250, both P<0.01). The security and self-control of primary and middle school students played a partial mediating role between parent-child cohesion and externalizing problem behaviors.The mediating effect consisted of two paths: one was parent-child cohesion-self-control-externalizing problem behaviors, the other was parent-child cohesion-security-self-control-externalizing problem behaviors. The effect values of these two paths accounted for 20.52% and 20.26% of the total effect respectively. Conclusion:Parent-child cohesion not only directly affects the externalizing problem behaviors of primary and middle school students, but also indirectly affects the externalizing problem behavior through the independent mediating effect of self-control and the chain mediation of security-self-control.

Objective:To explore the effect of mobile health management model in patients with acute myocardial infarction after percutaneous coronary intervention (PCI) under the background of "Internet +".Methods:From July 2018 to March 2020, convenience sampling was used to select 124 patients with acute myocardial infarction who underwent PCI successfully in the First Affiliated Hospital of Zhengzhou University as the research object. According to the random number table method, the patients were divided into the observation group and the control group, 62 cases in each group. The control group received routine nursing after surgery, and the observation group was given the mobile health management model under the background of "Internet +" on the basis of the control group. Self-management Scale for Patients Undergone Coronary Artery Stent Implantation, Hamilton Depression Scale (HAMD) , Hamilton Anxiety Scale (HAMA) , and Nursing Satisfaction Questionnaire were used to evaluate the effect of the intervention.Results:After six months of intervention, the scores of each dimension of the Self-management Scale for Patients Undergone Coronary Artery Stent Implantation in the observation group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . After six months of intervention, the HAMD and HAMA scores of the observation group were lower than those of the control group, and the differences were statistically significant ( P<0.05) . After six months of intervention, the nursing satisfaction of the observation group was higher than that of the control group, and the difference was statistically significant ( P<0.05) . Conclusions:The mobile health management model under the background of "Internet +" is conducive to improving the self-management ability of patients with acute myocardial infarction after PCI, reducing patients' depression and anxiety, and increasing patients' satisfaction with nursing.

Objective:In general, patients with seropositive rheumatoid arthritis (RA) are considered to show an aggressive disease course. However, the relationship between the two subgroups in disease severity is controversial. Our study is aimed to compare the clinical characteristics and prognosis of double-seropositive and seronegative RA in China through a real-world large scale study.Methods:RA patients who met the 1987 American College of Rheumatology (ACR) classification criteria or the 2010 ACR/European Anti-Rheumatism Alliance RA classification criteria, and who attended the 10 hospitals across the country from September 2015 to January 2020, were enrolled. According to the serological status, patients were divided into 4 subgroups [rheumatoid factor (RF)(-) anti-cyclic citrullinated peptide (CCP) antibody (-), RF(+), RF(+) anti-CCP antibody(+), anti-CCP antibody(+)] and compared the disease characteristics and treatment response. One-way analysis of variance was used for measurement data that conformed to normal distribution, Kruskal-Wallis H test was used for measurement data that did not conform to normal distribution; paired t test was used for comparison before and after treatment within the group if the data was normally distributed else paired rank sum test was used; χ2 test was used for count data. Results:① A total of 2 461 patients were included, including 1 813 RF(+) anti-CCP antibody(+) patients (73.67%), 129 RF(+) patients (5.24%), 245 RF(-) anti-CCP antibody(-) patients (9.96%), 74 anti-CCP antibody(+) patients (11.13%). ② Regardless of the CCP status, RF(+) patients had an early age of onset [RF(-) anti-CCP antibody(-) (51±14) years old, anti-CCP antibody(+) (50±15) years old, RF(+) anti-CCP antibody(+) (48±14) years old, RF(+)(48±13) years old, F=3.003, P=0.029], longer disease duration [RF(-) anti-CCP antibody(-) 50 (20, 126) months, anti-CCP antibody(+) 60(24, 150) months, RF(+) anti-CCP antibody(+) 89(35, 179) months, RF(+) 83(25, 160) months, H=22.001, P<0.01], more joint swelling counts (SJC) [RF(-) anti-CCP antibody(-) 2(0, 6), Anti-CCP antibody(+) 2(0, 5), RF(+) anti-CCP antibody(+) 2(0, 7), RF(+) 2(0, 6), H=8.939, P=0.03] and tender joint counts (TJC) [RF(-) anti-CCP antibody(-) 3(0, 8), anti-CCP antibody(+) 2(0, 6), RF(+) anti-CCP antibody(+) 3(1, 9), RF(+) 2(0, 8), H=11.341, P=0.01] and the morning stiff time was longer [RF(-) anti-CCP antibody(-) 30(0, 60) min, anti-CCP antibody(+) 20(0, 60) min, RF(+) anti-CCP antibody(+) 30(10, 60) min, RF(+) 30(10, 60) min, H=13.32, P<0.01]; ESR [RF(-) anti-CCP antibody(-) 17(9, 38) mm/1 h, anti-CCP antibody(+) 20(10, 35) mm/1 h, RF(+) anti-CCP antibody(+) 26(14, 45) mm/1 h, RF(+) 28(14, 50) mm/1 h, H=37.084, P<0.01] and CRP [RF(-) anti-CCP antibody(-) 2.3 (0.8, 15.9) mm/L, Anti-CCP antibody(+) 2.7(0.7, 12.1) mm/L, RF(+) anti-CCP antibody(+) 5.2(1.3, 17.2) mm/L, RF (+) 5.2(0.9, 16.2) mm/L, H=22.141, P<0.01] of the RF(+)patients were significantly higher than RF(-) patients, and RF(+) patients had higher disease severity(DAS28-ESR) [RF(-) anti-CCP antibody(-) (4.0±1.8), anti-CCP antibody(+) (3.8±1.6), RF(+) anti-CCP antibody(+) (4.3±1.8), RF(+) (4.1±1.7), F=7.269, P<0.01]. ③ The RF(+) anti-CCP antibody(+) patients were divided into 4 subgroups, and it was found that RF-H anti-CCP antibody-L patients had higher disease severity [RF-H anti-CCP antibody-H 4.3(2.9, 5.6), RF-L anti-CCP antibody-L 4.5(3.0, 5.7), RF-H anti-CCP antibody-L 4.9(3.1, 6.2), RF-L anti-CCP antibody-H 2.8(1.8, 3.9), H=20.374, P<0.01]. ④ After 3-month follow up, the clinical characteristics of the four groups were improved, but there was no significant difference in the improvement of the four groups, indicating that the RF and anti-CCP antibody status did not affect the remission within 3 months. Conclusion:Among RA patients, the disease activity of RA patients is closely related to RF and the RF(+) patients have more severe disease than RF(-) patients. Patients with higher RF titer also have more severe disease than that of patients with low RF titer. After 3 months of medication treatment, the antibody status does not affect the disease remission rate.

The in-depth advancement of the new era reforms such as new urbanization and rural revitalization strategies has transformed the characteristics and resource structure of rural villages. The traditional village health resources allocation models based on administrative divisions needed to evolve and achieve fair allocation and higher efficiency, and better meet the needs of rural primary health services. The authors sorted out the current status of village health resources allocation models. Based on such concepts as regional integration, and such key elements as demographics, population, health needs and information technology, the authors proposed the village-level health resources allocation model and selection strategy, under the three regional integration theories of township-village integration, village-area integration, and village leadership assistance. Their efforts aim at providing new perspectives for better protection and promotion of health of rural residents.

Objective:To explore the correlation between early exercise capacity, mental state and quality of life in patients with acute myocardial infarction after percutaneous coronary intervention (PCI) .Methods:Using the convenient sampling method, a total of 120 patients with acute myocardial infarction treated by PCI who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2020 to January 2021 as the research objects. Exercise cardiopulmonary test system, Positive and Negative Emotion scale and SF-36 were used to investigate.Results:In 120 patients with acute myocardial infarction, oxygen uptake at anaerobic threshold after PCI was (8.11±0.95) ml/ (kg·min) , peak metabolic capacity was (3.04±0.12) METs, peak oxygen uptake was (10.97±1.25) ml/ (kg·min) and the metabolic equivalent at the anaerobic threshold was (2.25±0.12) METs. The early exercise capacity of patients with acute myocardial infarction after PCI was positively correlated with positive emotions and quality of life ( P<0.01) , and negatively correlated with negative emotions ( P<0.01) . Conclusions:There is a positive correlation between early exercise ability and positive emotions and quality of life in patients with acute myocardial infarction after PCI.

[Abstract] Objective: To explore the mechanism of TRIM21 regulating the proliferation of ovarian cancer cells and the resistance of PARP inhibitors by activating Wnt/β-catenin signaling pathway. Methods: Eight pairs of ovarian cancer tissues and cervical epithelial tissues that surgically removed at Yan'an People's Hospital from January 2018 to January 2019 were collected for this study. And the tissues were classified into resistant group and non-resistant group (4 case/group) according to whether the patients were resistant to PARP inhibitor (nilapanib). Ovarian cancer cell lines CAOV3, SKOV3, OVCAR3, ES-2, HO8910, A2780 and OV2008 were also collected for this study. qPCR and Western blotting (WB) were used to detect the expression levels of TRIM21 and β-catenin in the above mentioned tissues and cell lines. Cell lines with TRIM21 overexpression and knockdown were constructed. CCK-8 method was used to detect the proliferation activity of ovarian cancer cells in each group, TOP/FOP dual luciferase assay was used to detect the effect of TRIM21 on Wnt signaling pathway activation, qPCR and WB were used to detect the effect of TRIM21 on mRNA and protein levels of β-catenin, which was further verified by Wnt pathway inhibitor XAV-939. Results: The expression level of TRIM21 in ovarian cancer tissues was significantly higher than that in cervical epithelial tissues (P<0.01), and its expression was more higher in the drug-resistant tissues (P<0.01). TRIM21 expression was the highest in ES-2 cells but comparatively low in CAOV3 and A270 cells (all P<0.01). After TRIM21 knockdown, the expression of TRIM21 in ES-2 cells was significantly decreased, and the cell proliferation was significantly reduced (all P<0.01). After overexpressing TRIM21, the proliferative capacity of ovarian cancer CAOV3 cells was significantly increased (P<0.01), and the antitumor effect of nilaparib was inhibited; TRIM21 overexpression could regulate Wnt/β -catenin pathway activation, while β -catenin knockdown or Wnt/β -catenin inhibitor XAV-939 could significantly reverse the effect of TRIM21 in ovarian cancer. Conclusion: TRIM21 can enhance the proliferation of ovarian cancer cells via regulating Wnt/β-catenin pathway, it plays a certain role in the process of drug resistance of PARP inhibitor nilapani.

The reflective ability of nursing staff has been paid more and more attention, nurses' reflection can promote professional competence development, which also can improve clinical practice ability, knowledge expansion ability and innovation ability. Therefore this article reviews the current situation on nurses′ reflection, the assessment tools, the modes, forms, methods and types, future prospects of clinical nurses reflective practice, in order to provide reference and basis for the relevant research on the reflection practice of clinical nursing staff in China.