Chronic refractory wound （CRW） presents significant clinical treatment challenges due to pathological characteristics such as persistent inflammation， bacterial infection， oxidative stress and inadequate angiogenesis. Astragali Radix， a traditional Chinese medicinal herb， exerts multi-target pharmacological effects on CRW through its active components， including Astragalus polysaccharides， flavonoids， and astragaloside Ⅳ， etc. Fundamental studies indicate that these components promote CRW healing by modulating inflammatory responses， inhibiting pathogen growth， improving antioxidant capacity and stimulating neovascularization. Network pharmacology and bioinformatics studies have revealed that active components of Astragali Radix target and modulate key signaling nodes such as nuclear factor-κB， phosphatidylinositol 3-kinase/Akt， AMP-activated protein kinase， and vascular endothelial growth factor receptor， as well as inflammation-angiogenesis-related pathways， thereby synergistically exerting anti-inflammatory and pro-angiogenic effect. Clinical applications have demonstrated that oral formulations （e.g.， Huangqi guizhi decoction， Danggui huangqi decoction， etc.） reduce healing time of CRW and lower inflammatory marker levels， while topical preparations （e.g.， Zizhu ointment， Huangqi shengji ointment， electrostatically spun Astragalus polysaccharide composite nanofibre dressings， etc.） significantly improve healing rates of CRW and minimize complications.

Objective To investigate the clinical manifestations of familial adenomatous polyposis(FAP).Methods The clinical data of 100 patients with FAP diagnosed in the First Affiliated Hospital of Zhengzhou University from 2011 to 2021 were analyzed retrospectively.Results The main clinical manifestations were bloody stool(44.0%),abdominal pain(40.0%),changes of stool characteristics(25.0%),abdominal distension(18.0%)and diarrhea(17.0%);The most common types of adenomas were villous tubular adenoma(44.9%)and tubular adenoma(32.1%);Extraintestinal manifestations:3 cases of desmoid fibroma,2 cases of osteoma and 1 case of lipoma.47 cases of gastric polyps and the mostly pathological type was fundic gland polyp(34.0%).18 cases of duodenal polyps including 6 cases of adenomatous polyps and most were located at descending duodenum(61.1%).Adenoma canceration occurred in 21 patients.The average age was 38.7 and the canceration mainly occurs in the rectum.The gender,family history,age of onset,number of adenomas,diameter and pathological type of adenomas were statistically compared between patients with and without canceration.It was found that there were significant differences in gender,average age of onset,number of adenoma polyps,diameter of adenoma and pathological type between the two groups(P<0.05).Conclusions FAP is mainly characterized by bloody stool and abdominal pain,with high canceration rate.The risk factors include the age of onset,the number and size of adenomas and the pathological type.The main pathological types are villous tubular adenoma and tubular adenoma.At present,preventive colorectal resection is still the most effective way to treat FAP.No matter what type of methods patients choose,they should be followed up strictly under endoscopy in order to find the lesions in time and treat if necessary.

Objective:To examine the validity and reliability of the Chinese version of the Body Acceptance by Others Scale-2(BAOS-2)in adults.Methods:Totally 616 adults(aged 18-56 years)were selected to test the structural validity,and internal consistency reliability of the scale.The Body Appreciation Scale-2(BAS-2),Func-tionality Appreciation Scale(FAS),Self-Compassion Scale(SCS),Self-Esteem Scale(SES)and Satisfaction with Life Scale(SWLS)were used as criteria to test criterion validity.A sample of 55 adults was retested 2 weeks later for the test-retest reliability.Results:The exploratory factor analysis extracted one factor,and the factor loading range of each item was 0.59-0.76.The confirmatory factor analysis showed that the factor model fit indices were acceptable(x2/df=2.99,CFI=0.91,GFI=0.90,TLI=0.89,RMR=0.04,RMSEA=0.08).The scores of the Chinese version of BAOS-2 were positively correlated with the scores of BAS-2,FAS,SCS,SES and SWLS(r=0.43-0.66,Ps＜0.001).The Cronbach a of the Chinese version of BAOS-2 was 0.90,and the test-retest reliabili-ty(ICC)was 0.65.Conclusion:The Chinese version of the Body Acceptance by Others Scale-2(BAOS-2)has i-deal validity and reliability.

Objective To explore the dilemmas faced by surrogate decision-makers of severe stroke patients in treatment decision-making,and to provide a basis for developing decision support strategies.Methods From April to December 2023,through phenomenological qualitative research with 16 surrogate decision-makers with severe stroke patients from ICU of the department of neurology in a tertiary hospital in Jing'an District,Shanghai.semi-structured in-depth interviews were used to examine the perceptions of decision-making on surrogate.Data were analyzed via Braun's style of thematic analysis.Results 4 themes and 10 sub-themes were identified.Theme 1:negative emotional dilemmas(urgent decision-making leads to anxiety,fear,and unknown stroke trajectory increases the sense of uncertainty).Theme 2:supportive environment dilemmas(lack of information support delays decision-making;lack of family support increases decision-making stress;insufficient economic support increases the burden of decision-making).Theme 3:the dilemma of weighing the pros and cons(difficult trade-offs between risk and reward,tough decisions between reality and ethics,conflicting choices of life and dignity).Theme 4:preference management dilemmas(practical difficulties in adhering to patient preferences,impediments to decision-making due to unknown patient preferences).Conclusion Surrogate decision-makers of severe stroke patients face multiple decision-making dilemmas.Healthcare professionals should provide emotional support in multiple ways and comprehensive support to reduce the decision-making dilemmas experienced by surrogate decision-makers,as well as implement death education for surrogate decision-makers and promote advance care planning to reduce their decision-making stress.

Objective To systematically evaluate the predictive value of controlling nutritional status(CONUT)score for short-term neurological function and clinical outcome of stroke.Methods Cochrane library,PubMed,Web of Science,Embase,CNKI,Wan-fang,VIP,and CBM were searched by computer to find studies on the use of CONUT score to evaluate the nutritional status and follow-up of stroke patients from the establishment of the database to April 11,2023.Literature was searched and screened independently by two researchers.The Newcastle-Ottawa scale(NOS)was used to evaluate the quality of the included studies.Stata 15.Osoftware was used for Meta-analysis.Results A total of 12 literatures were included,all of which were high quality.Meta-analysis results showed that high CONUT score(≥2)was strongly associated with poorer functional outcomes(OR=1.41,95％CI:1.25-1.60,P＜0.001,I2=49.4％),and associated with increased mortality(OR=2.85,95％CI:2.03-4.00,P＜0.001,I2=0)increase.Conclusion High CONUT score may be a predictor of neurological recovery status and survival outcome in patients after stroke,and the prognostic mechanism of CONUT score in stroke patients is unclear and needs to be confirmed by further studies.

Objective To assess the impact of DRG-based payment on inpatient costs for a single disease in a tertiary traditional Chinese medicine hospital.Methods This study focused on the inpatient information of patients with the DRG group FM19(percutaneous coronary artery stenting)in the cardiology department of a tertiary traditional Chinese medicine hospital from January 2020 to December 2021.We utilized Stata 15 statistical software and applied interrupted time series models and differ-ence-in-differences methods to evaluate the cost changes before and after DRG-based payment.Results After the implementa-tion of DRG-based payment,the annual average total cost for the FM19 group decreased by 26 503.62 yuan(P＜0.001),and the annual average cost of consumables decreased by 23 937.32 yuan(P＜0.001).The overall costs of traditional Chinese medi-cine and herbal treatments in the FM19 group significantly decreased(P＜0.05).For patients with angina,total costs,consum-able costs,and medication costs showed an overall decreasing trend;however,for patients with myocardial infarction,the reduc-tion in medication costs was not significant,while total costs and consumable costs decreased significantly.Conclusion The im-plementation of DRG-based payment for this disease type has shown significant cost control effects,with a notable decrease in the costs of traditional Chinese medicine treatments.Tertiary traditional Chinese medicine hospitals should proactively prepare to re-spond to and adapt to payment reforms.

Objective To analyze the medical services by Beijing Hospital of Traditional Chinese Medicine(TCM)and provide references for TCM hospitals to promote Internet-based medical services.Methods The data of Internet-based diagnosis and treatment,including registration,service volume,patient-doctor information,and payment items were collected from the Bei-jing Hospital of TCM from January 1,2022,to February 2023 for descriptive analysis.Results The cases of online video diag-nosis and treatment totaled 44 186,while graphic and textual consultations reached 3 231 times/person,with the registration can-cellation rates of 28.3％and 13.0％,respectively.In video diagnosis and treatment,doctors holding the professional title of As-sociate Senior Doctor or higher accounted for 66％of the total number of doctors providing online services,and they completed 75.4％of the total service volume.The service volume in the fields of psychology,dermatology,oncology,gastroenterology,re-spiratory,pediatrics,gynecology,and nephrology was higher.The number of patients taking Chinese herbal medicine was signifi-cantly higher than those taking western medicine and traditional Chinese patent medicines.Conclusion Online diagnosis and treatment partially meets patients'online medical needs but lacks TCM characteristics and integration with offline services.Therefore,more online TCM hospitals should be developed by strengthening popularization and education,optimizing functions and services,applying data in-depth,and developing high-quality online specialized clinics.

This article summarizes the current research status of health-related quality of life (HRQOL) in sepsis patients after discharge, including the current states of short-term and long-term HRQOL, influencing factors, and interventions. Recent studies have shown that both short-term and long-term HRQOL of sepsis patients after discharge are suboptimal. Given the numerous and long-lasting factors that affect HRQOL, it is recommended that individualized nursing interventions targeting these factors be implemented in clinical practice. Further research should explore effective methods to improve the HRQOL of sepsis patients.

Objective:To explore the journey map of patients with chronic constipation during fecal microbiota transplantation.Methods:This study adopted phenomenological methods. From October to December 2023, purposive sampling was used to select chronic constipation follow-up patients who underwent fecal microbiota transplantation at the Intestinal Microecology Center of Shanghai Tenth People's Hospital as respondents for semi-structured interviews. Colaizzi 7-step analysis method and NVivo 11.0 software were used for data analysis.Results:A total of 15 interviewees were interviewed. During fecal microbiota transplantation, the journey map of constipation patients included stages, mood changes, touchpoints, themes, emotional experiences and opportunities. The patient's experience and needs were summarized into three themes and ten sub-themes, including pre-transplant adaptation disorders to new environments (unfamiliarity and confusion-admission coordination disorders, anxiety and expectations-diverse complex emotions, puzzle and helplessness-asymmetric doctor and patient information), effectiveness-related psychological and social experiences in transplantation (attention and expectations-longing for positive efficacy, perception of benefits and risk avoidance, shame and inferiority-treatment stigmatization experience, questioning and despair-unrealized expectations, treatment resistance-sensitive economic burden), post-transplant transition dilemmas (inaccessible medical services-lack of continuous treatment and nursing, disease recurrence troubles) .Conclusions:This study visualizes the experiences and needs of constipation patients during microbiota transplantation through a patient journey map and identifies multidimensional issues and needs of patients. Clinical medical and nursing staff should pay attention to the needs of patients at different stages of the treatment process when formulating intervention programs to improve the quality of fecal microbiota transplantation nursing.

Objective:This article analyzed the current situation, similarities and differences and main problems of the registration and management systems of innovative medical devices in China and the United States.Methods:This article summarized the requirements and policies for the registration management of innovative medical devices in China and the United States, as well as the development and differences of the registration of innovative medical devices in China and the United States, and the main problems in the registration management of innovative medical devices in China.Results:At present, the development level of medical device industry in China and the United States was different, facing different development problems, and there were differences in the access standards and management methods of innovative medical devices. The registration management system established for innovative medical devices in China was gradually improving, and to a certain extent, it had promoted the enthusiasm of innovative product research and development and registration applications, but there were also problems such as unclear innovation evaluation scales, insufficient early intervention of review resources, and insufficient utilization of post-marketing data.Conclusions:Drawing on the beneficial experience of breakthrough device registration management in the United States, we will improve the registration management system for innovative products and shorten the review and approval cycle by clarifying the identification criteria for innovative medical devices, promoting the placement of review resources in the R&D stage, and further strengthening the use of post-marketing data and regulatory scientific research.