BACKGROUND:Sarcopenic obesity (SO) is a complex condition characterized by the coexistence of sarcopenia and obesity, with pathophysiological mechanisms extending beyond the additive effects of either condition alone. Lifestyle intervention is considered an effective management strategy for SO; however, substantial interindividual variability in physiological status and behavioral preferences limits the implementation of personalized intervention. This study aims to evaluate the effectiveness of a knowledge graph-based lifestyle recommendation system in improving skeletal muscle mass and related outcomes in patients with SO. METHODS:This randomized controlled trial will recruit 208 patients with SO, who will be randomly assigned in a 1:1 ratio to an intervention or control group. In addition to routine lifestyle guidance, the intervention group will receive a 24-week personalized intervention delivered through the Sarcopenic Obesity-Knowledge Graph Care System (SO-KGCS), whereas the control group will receive routine health education and lifestyle advice only. The intervention period is defined as the 24-week intervention period from baseline to week 24. The primary outcome measure is skeletal muscle mass. Secondary outcome measures include grip strength, skeletal muscle mass index, body fat percentage, physical function, and quality of life. Outcomes will be assessed at baseline before randomization and at weeks 8, 16, and 24 during the 24-week intervention period. The intervention will end at week 24, after which participants will enter a 24-week post-intervention follow-up period without systematic intervention. Follow-up outcome data will be collected at week 48. DISCUSSION:This study will evaluate the effectiveness of a knowledge graph-based recommendation system in enhancing body composition, muscle strength, physical function, and quality of life in patients with SO. If effective, the SO-KGCS may provide a feasible intelligent approach for personalized chronic disease management. TRIAL REGISTRATION:ChiCTR, ChiCTR2500111882.

Objective:To develop an evaluation index system for Chinese medicine specialist nurse training effectiveness based on the Context, Input, Process, and Product (CIPP)-Kirkpatrick model, and to preliminarily assess its feasibility in practical application. Methods:From January to September 2024, a research team developed an initial indicator pool through literature reviews and semi-structured interviews using the CIPP and Kirkpatrick models as theoretical frameworks. The Delphi method was employed for two rounds of consultation. 16 experts from 6 provinces were invited, and 15 completed both rounds, to refine the indicators. Indicator weights were determined using the Analytic Hierarchy Process (AHP). The resulting index system was then preliminarily applied at one provincial Chinese medicine training base in Guangdong Province to assess the feasibility of its practical use. Results:The two rounds of expert consultation yielded effective response rates of 93.75% and 100%, with an expert authority coefficient of 0.965. Kendall's coefficients of concordance were 0.275 and 0.292, respectively (P < 0.001). The final system comprises 4 primary, 13 secondary, and 71 tertiary indicators. Among the primary dimensions, outcome evaluation received the highest weight, followed by process, context, and input evaluation. In the empirical application, the training base achieved an overall score of 82.55. The process evaluation dimension scored highest (90.99), while the outcome evaluation dimension scored lowest (75.93), with research-related indicators scoring below 35 points. Conclusion:The developed index system demonstrated good content relevance and expert consensus, while reflecting the core features of Chinese medicine syndrome differentiation-based nursing. Preliminary field application suggests that the system is feasible for identifying potential weaknesses in training programs and may serve as a practical reference for the evaluation and improvement of Chinese medicine specialist nurse training. It may also provide a contextual reference for evaluating specialist nurse training programs in other culturally specific or discipline-based practice settings.

IntroductionPrediction models for cognitive impairment offer significant advantages in public health preventive strategies in high-risk chronic kidney disease populations, but their methodological quality and applicability remain unclear. The aims of this study were to systematically review and critically appraise the existing prediction models for cognitive impairment in chronic kidney disease.MethodsPubMed, Web of Science, Embase, CINAHL, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, SinoMed, and China Science and Technology Journal Database were searched from inception to 12 October 2025. The prediction model risk of bias assessment tool was used for quality assessment, and the checklist for critical appraisal and data extraction for systematic reviews of prediction modeling studies was used for data extraction. A narrative synthesis was performed to summarize the characteristics, performance, and risk of bias of existing models. Subgroup analyses were performed stratified by outcome definitions, CKD population, and cognitive assessment tools.ResultsA total of 5,972 studies were identified, ultimately including 17 models for three outcomes: cognitive impairment (52.9%), mild cognitive impairment (11.8%), and cognitive frailty (35.3%). The reported prevalence ranged from 12.8 to 77.9% for cognitive impairment, around 50% for mild cognitive impairment, and 14.2–25.8% for cognitive frailty. Most models (58.8%) were developed in hemodialysis populations. Fifteen studies were internally validated, and 7 were externally validated. For internal validation, the AUC of cognitive impairment models ranged from 0.745 to 0.918, mild cognitive impairment models from 0.926 to 0.928, and cognitive frailty models from 0.842 to 0.945. For external validation, the AUC of cognitive impairment models ranged from 0.752 to 0.899, the mild cognitive impairment model was 0.897, and cognitive frailty models ranged from 0.832 to 0.904. All studies were rated as high risk of bias, mainly due to methodological problems in the analysis domain, with great concerns regarding applicability in 13 studies.ConclusionCurrent research on prediction models for cognitive impairment in chronic kidney disease remains in the developing stage, with heterogeneous outcome definitions and all studies at high risk of bias. Most studies are limited by methodological shortcomings.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251007577, Identifier CRD420251007577.

BackgroundIn Morocco, a persistent gap exists between recommended standards of care and routine clinical practice in hemodialysis units, largely due to the high clinical workload of nephrologists and the absence of dietitians in several public hemodialysis centers. This shortage restricts individualized dietary and lifestyle counseling. This study aimed to explore the feasibility and potential clinical relevance of a simple, nurse-led educational intervention designed for hemodialysis centers operating without nutrition specialists.MethodsA quasi-experimental, single-arm, pre–post pilot study was conducted from February to June 2025 among 30 hemodialysis patients from three Moroccan centers with no permanent or visiting dietitians. The educational program focused on dietary potassium management, fluid intake control, thirst management strategies, and basic physical activity recommendations. Outcomes included serum potassium levels, quality of life (EQ-5D-5L), and interdialytic weight gain, assessed at baseline (T0) and post–intervention (T1).ResultsSerum potassium levels significantly decreased after the intervention (p = 0.002), and the proportion of patients within the recommended range (4–5 mmol/L) increased from 36.7% at T0 to 46.7% at T1. No statistically significant changes were observed in quality of life or interdialytic weight gain.ConclusionIn this pilot study, a nurse-led educational intervention was associated with improved serum potassium control among hemodialysis patients in resource-limited settings lacking specialized nutrition personnel. However, no meaningful changes were observed in interdialytic weight gain or quality of life, suggesting that more intensive or individualized interventions may be required to influence these outcomes.

ObjectiveTo examine the heterogeneity and determinants of Traditional Chinese Medicine Health Literacy (TCM-HL) among middle-aged and older adults patients with chronic diseases and its association with disease burden and self-management and provide evidence for targeted interventions.MethodsFrom August 2025 to November 2025, a total of 550 middle-aged and older adults patients with chronic diseases were recruited as convenience samples from a tertiary Chinese medicine hospital and its nine affiliated community health service centers located in Guangdong Province, China. Data were collected using structured questionnaires, which included the TCM-HL questionnaire, the Consumer Health Activation Index (CHAI), and the Brief Patient Experience with Treatment and Self-management (Brief PETS). Latent profile analysis (LPA) was conducted using M plus 8.3 software, while univariate and multivariate logistic regression analyses were performed using SPSS 27.0 software.ResultsThe average score of TCM-HL among middle-aged and older adults patients with chronic diseases was 62.80 ± 14.42, with an average item score of items was 1.70 ± 1.40. LPA identified three categories: C1 “Low TCM-HL” (n = 104, 20.68%); C2 “Moderate TCM-HL” (n = 220, 43.47%), and C3 ‘High-TCM-HL’ (n = 179, 35.59%). Multinomial logistic regression analysis indicated that marital status, occupation, per capita household income, medical insurance, the CHAI and the PETS are the significant influencing factors of TCM-HL in this populations (p < 0.05).ConclusionThe level of TCM-HL among middle-aged and older adults patients with chronic diseases is generally low, exhibiting significant heterogeneity across various subgroups. Therefore, targeted interventions that are tailored to the specific needs of each subgroup are crucial for enhancing TCM-HL within these populations.

Type 2 diabetes is a chronic metabolic health condition that affects millions of people worldwide. Diabetes self-management education (DSME) is an effective intervention approach and the potential to enhance the health status of diabetic patients and mitigate complications to the greatest possible extent. However, no systematic synthesis or comprehensive report has been conducted to date on the impact of DSME in patients with diabetes. This review aimed to identify existing evidence on DSME care for diabetes management and the extent to which interventions are included in the evidence base. PubMed, EMBASE, Web of Science, and Cochrane library databases were searched from inception to the December 31, 2025. Systematic reviews with meta-analyses of randomized controlled trials were included, reporting an effect size to calculate the association between DSME and the outcomes related to HbA1c. Quality of each review was appraised using a Measurement Tool to Assess Systematic Reviews (AMSTAR). A total of 12 meta-analyses were included. In this study, we suggested that DSME will leads to a decrease in HbA1c (effect size [ES] = − 0.34

BackgroundInsomnia is a prevalent global health issue that significantly impacts quality of life and poses a substantial economic burden. While conventional pharmacological and non-pharmacological treatments exist, they are often limited by side effects, dependency, or low clinical applicability. Guasha therapy, a traditional Chinese medicine nursing technique, shows promise for treating insomnia, but lacks standardized, evidence-based guidelines for its clinical application.ObjectiveTo analyze the regularity of meridian and acupoint selection in the treatment of insomnia with scraping therapy by using data mining technology.MethodsA computer-based search of PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, Weipu Database(VIP), and Chinese Biomedical Literature Database (CBM) was conducted to retrieve the literature on scraping therapy for insomnia from the establishment of the database to March 15,2024.Excel was used to establish a database of acupoints for scraping therapy for insomnia, and the frequency of acupoints and meridians and the meridian tropism of acupoints were analyzed. SPSS 26.0 was used to cluster the high-frequency acupoints. The Apriori algorithm model provided by SPSS Modeler 18.0 was used to analyze the association rules of acupoint compatibility. Cytoscape 3.10.1 software was used to construct a complex network of meridian compatibility, and to analyze the core meridian of scraping in the treatment of insomnia.ResultsA total of 119 literatures were finally included, including 144 acupoints, with a total of 1121 frequencies. The most commonly used acupoints were Xinshu (BL15), Baihui (GV20), and Shenmen (HT7), and the commonly used compatibility acupoints were Xinshu-Pishu (BL20) and Xinshu-Pishu-Shenmen. The main meridians are Bladder meridian of foot-taiyang, Governor vessel, Gallbladder meridian of foot-shaoyang and Heart meridian of hand-shaoyin, which are the core meridian routes.ConclusionsData mining can effectively analyze the commonly used acupoints, acupoint compatibility rules and meridian rules of Gua Sha in the treatment of insomnia. The analysis results align with the traditional Chinese medicine principle of primarily following meridians, combining syndrome and root, enhancing the treatment effectiveness of insomnia, and providing a reference for clinical practice and research.

To analyze the development status and trend of related research in the health management of hyperuricemia and provide a theoretical basis for clinical treatment. A bibliometric analysis was conducted on hyperuricemia health management research data from 2000 to 2024 using the Web Science Core Collection database, PubMed, and SINOMED. A total of 789 articles were evaluated for specific characteristics, such as year of publication, journal, author, institution, country/region, reference, and keyword. The VOSviewer was used for co-author, co-occurrence, co-citation, and network visualization. Important sub-topics identified by bibliometric characteristics were discussed and reviewed. The number of articles published in the last 24 years has generally followed a year-on-year trend, and the total number of papers published is increasing. Over 200 affiliations from 70 countries and regions contributed papers, and PLOS ONE has the highest number of linked publications. Dalbeth N, is the author with the most publications, with an H-index of 17. Hyperuricemia, gout, management, prevalence, allopurinol, risk, and other keywords were often used. Researchers formed mature teams, and the teams’ study directions intersect and are comparable. However, these teams demonstrated a lack of communication and coordination. This study highlights research hotspots, global cooperation models, and emerging frontiers in hyperuricemia, focusing on uric acid control, disease screening, health education, and epidemiological investigation in hyperuricemia-associated complications over the past two decades. However, there is still a lack of standardized management processes and systems, and the communication between research teams needs to be enhanced.

Aim: To identify potential categories of clinical belonging among new nurses and explore the relationship between different categories and turnover intention.Design: A cross sectional study.Method: A cross sectional study was conducted among 348 new nurses from tertiary hospitals in Hainan and Guangdong provinces. A general data questionnaire, clinical belonging scale and turnover intention scale were used for examination. Further, the potential categories were used to analyse the categories of clinical belonging, and latent class analysis was utilized to analyse the relationship between different categories of clinical belonging and turnover intention.Results: The clinical sense of belonging of new nurses were divided into three groups namely C1, C2 and C3. The C1: poor clinical sense of belonging (8.7%), C2: moderate clinical sense of belonging (57.9%) and C3: rich clinical sense of belonging (33.4%). The risk of the turnover intention of new nurses with 'poor clinical sense of belonging' was 0.62 times that of new nurses with 'rich clinical sense of belonging' (OR = 0.62, p < 0.01), which was 0.24 times that of 'moderate clinical sense of belonging' (OR = 0.24, p < 0.01), the risk of the turnover intention of new nurses with 'moderate clinical sense of belonging' was 0.13 times that of new nurses with 'rich clinical sense of belonging'(OR = 0. 13, p < 0.01).Conclusions: The results of our study revealed that in order to enhance the new nurses' sense of belonging, support was most crucial when they were first encountering difficulties. To reduce turnover intention, more structured learning opportunities are also required to maximize learning for newly graduated nurses with various nursing degrees.Patient or Public Contribution: There are no patient or public contributions in this study.

Background: Although exposure to ambient air pollution has been associated with mental disorder, little is known about its potential effects on children and adolescents, especially in Chinese population. We aimed to reveal the relationship of air pollutants with hospital outpatient visits for child and adolescence psychiatry (HOVCAP) in Shenzhen.Methods: A case-crossover study based on time-series data was applied, and a distributed lag non-linear model (DLNM) was used to evaluate the non-linear and delayed effects of 4 major air pollutants (NO2, PM2.5, SO2 and O3) on HOVCAP. Least absolute shrinkage and selection operator (LASSO) regression was used to control the multicollinearity between covariates and to filter variables. Result: A total of 94,660 cases aged 3-18 were collected from 2014 to 2019 in the Mental Health Center of Shenzhen.Results of pollutants at mode value (M0) showed that in the single lag effect result, when the average daily concentration of NO2 at 24 mu g/m3, there was a significant effect on HOVCAP over lag 1, lag 4 and lag 5, respectively. The cumulative RR of NO2 M0 value to the outpatient visits were 1.438 (1.137-1.818) over lag 0-2, 1.454 (1.120-1.887) over lag 0-3, 1.466 (1.084-1.982) over lag 0-4, 1.680 (1.199-2.354) over lag 0-5, 1.993 (1.369-2.903) over lag 0-6, and 2.069 (1.372-3.119) over lag 0-7. However, PM2.5, SO2, O3 were not associated with HOVCAP over neither single lag effects nor cumulative effects. The RR values both shown an increase either when NO2 increases by 10 units or when the maximum concentration of NO2 is reached.Conclusion: Our study suggests that exposure to the normal air quality of NO2 in Shenzhen may associated with the risk of HOVCAP. However, PM2.5, SO2, O3 were not associated with HOVCAP.

目的:分析国内近十年糖尿病周围神经病变（DPN）护理研究热点及前沿，为护理人员了解和把握研究方向提供参考依据。方法:通过中国期刊全文数据库、中国生物医学文献数据库、维普、万方数据库检索2012年1月1日至2021年12月31日发表的糖尿病周围神经病变护理相关文献，运用CiteSpace软件进行可视化分析。结果:共纳入文献763篇，其中2018—2021年发文量呈显著上升趋势；发文量最多的作者是刘丹和安彩霞各4篇；发文量最多的是南京市中医院和上海市嘉定区中医医院，分别为6、5篇。经分析得出研究热点为DPN相关并发症、DPN康复护理、DPN中医特色护理技术，研究前沿是生命质量和神经功能。结论:DPN研究基础薄弱，研究者应聚焦前沿关注国际DPN护理的研究热点，助力护理研究产出前瞻性、高影响力的研究成果，改善患者临床结局。

Objective:To analyze acupoint massage treatment of diabetic peripheral neuropathy point selection rules and practices for clinical treatment to provide evidence-based.Methods:Data mining was used to retrieve the relevant literature on acupressure for diabetic peripheral neuropathy from China Journal Full Text Database, Wanfang, VIP, and China Biomedical Literature Database, with a search time frame from the date of database creation to April 27, 2022. An Excel thematic database was created, then clustering analysis was performed by SPSS 25.0.Results:A total of 104 articles were included in the literature, with 49 acupoints. The commonly used acupoints in the lower limbs were Zusanli, Sanyinjiao, Taixi, Yongquan, etc. The commonly used acupoints in the upper limbs were Hegu, Quchi and Neiguan. The commonly used acupoints in the trunk were Guanyuan, Zhongwan and Shenshu. The frequency of the five acupoints was the highest, accounting for 59.40%(335/564). The meridians were mainly the spleen meridian of foot Taiyin, the kidney meridian of foot Shaoyin and the stomach meridian of foot Yangming, among them, the frequency of the spleen meridian of foot Taiyin was the highest, accounting for 22.7%(128/564). Three effective clusters were obtained by analyzing massage acupoints and manipulations.Conclusions:According to the analysis, high-frequency acupoints are mainly distributed in the three meridians of foot Taiyin spleen meridian, foot Shaoyin kidney meridian and foot Yangming stomach meridian. In the future, acupoint selection and massage techniques can be further standardized and supplemented by acupoint massage along meridians to explore its clinical effect on diabetic peripheral neuropathy.

目的 评价情绪释放疗法对慢性病患者焦虑抑郁症状及生活质量的干预效果.方法 检索Cochrane Library、Web of Science、EMBASE、PubMed、Google schloar、CNKI、Wan Fang Data等数据库,自建库至 2022 年 3 月公开发表的有关情绪释放疗法干预慢性病患者焦虑、抑郁及生活质量的随机对照研究.研究者使用Revman 5.3 进行分析.结果 13 项研究(1723 例)符合入选标准.结果 分析显示,与常规对照组相比,情绪释放疗法有助于减轻慢性病患者焦虑水平(SMD=-1.51,95％CI:-1.85～-1.17,P<0.01)、抑郁水平(SMD=-1.92,95％CI:-2.33～-1.51,P<0.01),提高生活质量(SMD=1.44,95％CI:0.49～2.40,P<0.01).结论 当前证据表明,情绪释放疗法是改善慢性病患者焦虑、抑郁水平和生活质量的有效方法.在慢性病患者中将情绪释放疗法与常规护理疗法相比较的高质量文献较少,需要进一步研究验证情绪释放疗法的有效性.

阿片类药物是临床治疗癌性疼痛的常见药物,阿片类药物相关性便秘(OIC)在癌痛患者中十分普遍,严重影响患者的生存质量并有诱发心脑血管事件的风险,OIC的防治具有重要临床意义。本文归纳、总结了近年来癌痛OIC的中医病机认识及针刺、耳穴压贴、艾灸、穴位贴敷等中医外治法的相关进展,旨在为癌痛OIC的中医药优化干预及科学研究提供参考。

Although previous studies have suggested that meteorological factors are associated with Bell’s palsy, articles on this topic are rare and the results are inconsistent. We aim to reveal the relationship between exposure to different meteorological factors and the onset of severe Bell’s palsy (SBP) with daily data. A case-crossover study based on time-series data was applied, and the minimum risk value of each climatic factor was set as the reference value. We fitted a distributed lag non-linear model (DLNM) which applied quasi-Poisson regression to evaluate the exposure-response association and the lag-response association of meteorological factors on the occurrence of SBP. The mode value and per-decile interval value of each meteorological factor were all included in the analysis. Sensitivity analyses were conducted to test the robustness of results. A total of 863 SBP patients (474 males and 389 females) from 7 hospitals in the Shenzhen Futian District were selected from January 2009 to February 2020. The highest relations effect was tested in the cumulative exposure-response result shown as follows; mean temperature at the minimum value 15.3°C with RR of 10.370 (1.557–69.077) over lag 0 to 13; relative humidity at the 30th value 71% with RR of 8.041 (1.016–63.616) over lag 0 to 14; wind speed at the 90th value 31 (0.1 m/s) with RR of 1.286 (1.038–1.593) over lag 0; mean air pressure at the 30th value 1001.4 (pa) with RR of 9.052 (1.039–78.858) over lag 0 to 5; visibility at the 80th value 26.5 (km) with RR of 1.961 (1.005–1.423) over lag 0 to 2; average total cloud cover at the max value 100 (%) with RR 1.787 (1.014–3.148) over lag 0 to 2; sunshine duration at the 10th value 0.1 (h) with RR of 4.772 (1.018–22.361); daily evaporation shows no relationship in the cumulative result; daily average solar radiation at the minimum value 0 (W/m 2 ) with RR of 5.588 (1.184–26.382). There is a relationship between wind speed and the onset of SBP, while mean air pressure, visibility, and average total cloud cover, especially sunshine duration and solar radiation which showed a strong effect, may be associated with severe clinical symptoms of SBP. Mean temperature and relative humidity may affect the course of SBP.

综述健康信念模式、保护动机理论、格林模式和跨理论模型在糖尿病病人中的应用现状,深入剖析各个理论模型的优缺点与未来研究趋势,科学合理地将理论模型应用于不同糖尿病人群,着眼于提升病人的自我管理能力,以有效降低血糖等相关指标和减少并发症发生,提高病人的生存质量.