Fangli Liu

Background: As warfarin therapy outcomes in Chinese patients can differ from those in other populations owing to differences in genotype frequencies and demographic characteristics (e.g., weight and height), this study was developed to investigate warfarin treatment patterns among Chinese patients and to propose dose optimization. Methods: This study recruited adults undergoing heart valve replacement surgery who received warfarin treatment. Several anticoagulation response-related parameters were measured in these patients and compared among major genotype subgroups. These data were used to construct a population-based pharmacometric model, and warfarin initiation dosing regimens were proposed using generative artificial intelligence (GAI)-assisted model simulation. Results: We found that those patients carrying the Vitamin K epoxide reductase complex subunit 1 (VKORC1) AA & Cytochrome P450 family 2 subfamily C member 9 (CYP2C9)*1/*1 genotype, which accounted for the majority of patients (73.3%), achieved 39% time in the therapeutic range (%TTR) within the first week of treatment, stabilizing to approximately 50% within four weeks after initiating warfarin therapy. In contrast, those patients carrying the VKORC1 AA & CYP2C9*1/*3 genotype (8.9%) exhibited more pronounced fluctuations in %TTR, while those with the VKORC1 GA & CYP2C9*1/*1 genotype (15.1%) tended to exhibit subtherapeutic %TTR. The GAI-based dosing regimen proposed in this study, consisting of higher loading doses on Days 1–5 and lower maintenance doses thereafter, was found to enable patients to achieve target international normalized ratio (INR) range within one week. Conclusion: As over 70% of Chinese patients have the VKORC1 AA/CYP2C9*1/*1 genotype, this means that most carry more than one VKORC1/CYP2C9 variant allele. On average, those patients with >1 VKORC1/CYP2C9 variant allele required lower warfarin doses and reached the therapeutic INR range more quickly than those with ≤1 variant allele. GAI-based approaches can provide value as a means of facilitating dose optimization based on modeling and simulation.

Background: With the rapid aging of the Chinese population, family caregivers play a pivotal role in the management of chronic diseases. Effective family communication is crucial for reducing caregiver burden and improving care quality. However, China lacks a generic, culturally adapted instrument to assess communication patterns in these specific settings. This study aimed to translate the Family Caregiver Communication Tool-Chronic Illness (FCCT-CI) into Chinese and evaluate its psychometric properties. Methods: Following Brislin’s translation model, the FCCT-CI was translated, back-translated, and cross-culturally adapted through expert consultation and pilot testing. From March to July 2023, a cross-sectional study was conducted with 319 family caregivers recruited via convenience sampling from a tertiary hospital in Henan Province. To ensure rigorous validation, the total sample was randomly split into two independent subsamples: Sample A ( n = 110) was used for Exploratory Factor Analysis (EFA), and Sample B ( n = 209) was used for Confirmatory Factor Analysis (CFA). Psychometric properties were evaluated using item analysis, content validity, construct validity, internal consistency, and test–retest reliability. Results: The Chinese FCCT-CI comprises 10 items across two dimensions. Exploratory Factor Analysis (Sample A) extracted two factors explaining 71.46% of the total variance. Confirmatory Factor Analysis (Sample B) demonstrated excellent model fit ( χ ² / df = 1.707, CFI = 0.988, TLI = 0.979, RMSEA = 0.058). Content validity was robust, with an S-CVI/Ave of 0.94 and I-CVI ranging from 0.80 to 1.00. The scale exhibited high reliability, with a Cronbach’s α of 0.846, split-half reliability of 0.943, and a test–retest intraclass correlation coefficient (ICC) of 0.920. Conclusion: The Chinese version of the FCCT-CI demonstrates good reliability and validity. It provides a reliable tool for assessing family communication patterns among family caregivers of patients with chronic diseases in China.

Mobile Health (mHealth) technology offers the potential to improve healthcare quality. This study aims to evaluate the effectiveness of mHealth interventions on the foot care behaviors, knowledge, and beliefs of patients with diabetes. Eleven databases were systematically searched for relevant RCTs between databases' inception and February 2025. We used Review Manager 5.4 software for meta‐analysis. Subgroup analysis, publication bias tests, and sensitivity analysis were performed. The quality of the evidence was rated according to the GRADE. A total of eight studies were included in the meta‐analysis. There was moderate‐quality evidence that compared with other traditional foot care education, mHealth interventions can effectively enhance foot care behaviors, knowledge, and beliefs among patients with diabetes. Additionally, there was low‐quality evidence that mHealth interventions can also improve patients' blood glucose levels. The findings provide preliminary reference for nurses to explore more effective auxiliary tools for patient education. However, the current evidence is of moderate and low quality, indicating that it remains necessary to focus on new evidence in the future. More high‐quality RCTs are needed to explore long‐term effects of mHealth interventions.

Aims: To explore latent profiles of social isolation in maintenance haemodialysis (MHD) patients and to analyse the factors influencing different latent profiles. Design: Multicentre cross‐sectional study. Methods: Between November 2024 to March 2025, 305 MHD patients from the haemodialysis centres of three hospitals in Henan Province, China, were recruited using a convenience sampling method. All participants completed the general information questionnaire, Lubben Social Network Scale 6 (LSNS‐6), UCLA Loneliness Scale‐6 (ULS‐6) and Personal Mastery Scale. Latent Profile Analysis (LPA) was used to classify the participants into potential subgroups with different types of social isolation. The influencing factors of profiles were explored by univariate analysis and multiple logistic regression analysis. Results: Social isolation of 305 patients can be divided into three profiles: the family‐friend dual isolation group (14.10%), friend isolation‐only group (47.54%), and social network well‐being group (38.36%). Multivariable logistic regression analysis revealed that monthly personal income, living arrangement, social participation, dialysis time, post‐dialysis fatigue, number of comorbidities, loneliness and personal mastery were identified as factors influencing the profiles. Conclusions: There is heterogeneity in social isolation among MHD patients. It is therefore necessary to implement targeted intervention measures based on the distinct characteristics of each subgroup to facilitate their social reintegration. Implications for the Profession and Patient Care: Nurses should identify differences in social isolation among MHD patients. It is necessary to establish tripartite connections between families, hospitals and communities, and develop personalised psychosocial interventions to alleviate social isolation. Implications: The study identified distinct subgroups of social isolation among MHD patients, while emphasising the impact of psychological resources such as loneliness and personal mastery on social isolation. This may offer critical insights for nurses to develop targeted interventions for patients' social health. Reporting Method: The study followed the STROBE guidelines for cross‐sectional studies. Patient or Public Contribution: No patient or public involvement.

Purpose This study aimed to evaluate the effectiveness of individualized thirst management in patients after gastric cancer surgery. Methods A quasi-experimental study was conducted at a tertiary hospital in China. Between April and June 2024, 36 postoperative gastric cancer patients experiencing thirst were enrolled as the control group and received conventional care. From July to September 2024, 37 patients were recruited as the experimental group and received a tailored thirst management program. Thirst intensity was assessed via a Numeric Rating Scale (NRS), while lip, tongue, and oral mucosa moisture levels were evaluated at multiple time points. Patient satisfaction with the nursing services was evaluated before discharge. Results Baseline characteristics, including thirst scores and oral moisture levels, showed no significant differences between the two groups (P > 0.05). At 6 h post-intervention, both groups presented reduced thirst intensity and improved oral moisture, but the differences were not statistically significant (P > 0.05). However, from the first to the third postoperative day, the experimental group presented significantly lower thirst scores (P < 0.05) and higher lip, tongue, and oral mucosa moisture scores compared to the control group (P < 0.05). Additionally, the experimental group reported significantly higher satisfaction with nursing care than the control group (P < 0.05). Conclusion Individualized thirst management is a safe and feasible intervention that effectively alleviates postoperative thirst, improves oral moisture levels, and enhances patient satisfaction in gastric cancer patients. These findings support the integration of personalized thirst management into standard postoperative care protocols.

Background: Internet addiction and non‐suicidal self‐injury (NSSI) have emerged as prominent psychological concerns among adolescents. Despite numerous investigations into the relationship between these two behaviors, the findings remain inconsistent. This study aims to elucidate the relationship between Internet addiction and NSSI among adolescents.Methods: Thirteen databases, including PubMed, Web of Science, PsycINFO, Embase, Cochrane, Scopus, ProQuest, CINAHL, MEDLINE, SinoMed, CNKI, Wanfang, and VIP, were systematically searched, covering the period from inception to October 2024. Two independent reviewers conducted study screening, data extraction, and quality evaluation of the included studies. The statistical software STATA 18.0 was utilized to conduct data analysis.Results: Forty‐one studies were included from a total of 835 articles retrieved from the databases, encompassing a sample of 284,786 adolescents. A random effects model was utilized for pooled analysis, revealing a moderate positive association between Internet addiction and NSSI (r = 0.23, 95% CI = 0.20–0.27). Furthermore, adolescents’ gender, age, and the measurement tools employed played moderating roles in the relationship between Internet addiction and NSSI. However, neither the publication year, the region, nor the adjusted versus unadjusted effect sizes moderated the relationship between the two.Conclusions: A moderate positive link exists between Internet addiction and NSSI among adolescents. Future preventive measures against NSSI among adolescents should focus more on those with internet addiction, assisting them in overcoming their addiction and establishing healthy online behavior patterns. Additionally, future longitudinal studies are needed to explore the dynamic changes between Internet addiction and NSSI among adolescents.

Background Sedentary behavior has been considered a particular risk factor for adverse health outcomes independent of exercise, becoming a widespread public health issue globally. Many studies have analyzed the effect of sedentary behavior levels on the risk of chronic kidney disease (CKD), however, previous findings have been inconsistent. This study aims to evaluate the association between sedentary behavior and the risk of CKD. Methods Eleven databases were searched for relevant cohort studies that were published between September 2024 and the databases' inception. To assess the association between sedentary behavior and risk of CKD, we calculated pooled effect sizes as relative risk (RR) with 95% CI using a random effects model. Subgroup analysis, sensitivity analysis, and publication bias analysis were performed. Results Eight cohort studies involving 996,489 participants were identified. There was significant heterogeneity in the study (I² = 58.0%, P = 0.02). Pooled results of the random effects model showed a positive correlation between sedentary behavior and the risk of CKD (RR = 1.15, 95% CI 1.08, 1.21). In addition, subgroup analysis revealed that the study area was a source of heterogeneity. Leisure-time sedentary behavior (RR = 1.26, 95% CI 1.16, 1.37) and combined sedentary behavior (RR = 1.16, 95% CI 1.08, 1.25) were positively related to risk of CKD. The result for occupational sedentary behavior (RR = 1.08, 95% CI 1.00, 1.16) suggested a borderline statistical significance. Conclusions Prolonged sedentary behavior, particularly during leisure time, is associated with an increased risk of CKD in adults, though residual confounding should be considered.

Background: Depression is a prevalent mental health problem in postmenopausal women. Given its significant impact on the quality of life and overall well-being of postmenopausal women, there is need for a comprehensive review and meta-analysis of the existing research globally. This systematic review and meta-analysis evaluated the global prevalence of depression and potential associated factors in postmenopausal women. Methods: The Cochrane Library, PubMed, EMBASE, Web of Science, MEDLINE, and PsycINFO databases were systematically searched from inception to March 22, 2023. The meta-analysis used the random-effects model to calculate the prevalence of depression rates and associated factors. In addition, subgroup analysis and sensitivity analysis were performed. Publication bias was assessed using funnel plots, Egger’s test, and nonparametric trim-and-fill tests. Results: The meta-analysis included 50 studies that involved 385,092 postmenopausal women. The prevalence of depression in postmenopausal women was 28.00% (95% CI, 25.80–30.10). Among the factors relevant to depression among postmenopausal women, marital status (OR: 2.03, 95%CI: 1.33–3.11), history of mental illness (OR: 2.31, 95%CI: 1.50–3.57), chronic disease (OR: 3.13, 95%CI: 2.20–4.44), menstrual cycle (OR: 1.42, 95%CI: 1.17–1.72), abortion numbers (OR: 1.59, 95%CI: 1.40–1.80), menopausal symptoms (OR: 2.10, 95%CI: 1.52–2.90), and hormone replacement therapy (OR: 1.76, 95%CI: 1.31–2.35) were risk factors, while physical activity (OR: 0.56, 95%CI: 0.53–0.59), number of breastfed infants (OR: 0.43, 95%CI: 0.19–0.97), menopause age (OR: 0.44, 95%CI: 0.37–0.51) were preventive factors. Conclusions: This study demonstrated that the prevalence of postmenopausal depression is high, and some risk factors and protective factors associated with it have been identified. It is necessary to improve screening and management and optimize prevention and intervention strategies to reduce the harmful effects of postmenopausal depression.

Duchenne muscular dystrophy (DMD) is a rare X‐linked recessive disorder characterized by loss‐of‐function mutations in the gene encoding dystrophin. These mutations lead to progressive functional deterioration including muscle weakness, respiratory insufficiency, and musculoskeletal deformities. Three‐dimensional gait analysis (3DGA) has been used as a tool to analyze gait pathology through the quantification of altered joint kinematics, kinetics, and muscle activity patterns. Among 3DGA indices, the Gait Profile Score (GPS), has been used as a sensitive overall measure to detect clinically relevant changes in gait patterns in children with DMD. To enhance our understanding of the clinical translation of 3DGA, we report here the development of a population nonlinear mixed‐effect model that jointly describes the disease progression of the 3DGA index, GPS, and the functional endpoint, North Star Ambulatory Assessment (NSAA). The final model consists of a quadratic structure for GPS progression and a linear structure for GPS‐NSAA correlation. Our model was able to capture the improvement in function in GPS and NSAA in younger subjects, as well as the decline of function in older subjects. Furthermore, the model predicted NSAA (CFB) at 1 year reasonably well for DMD subjects ≤7 years old at baseline. The model tended to slightly underpredict the decline in NSAA after 1 year for those >7 years old at baseline, but the prediction summary statistics were well maintained within the standard deviation of observed data. Quantitative models such as this may help answer clinically relevant questions to facilitate the development of novel therapies in DMD.

Objectives: In this study, we investigated the physical activity status and impact factors in patients after percutaneous coronary intervention in China. Methods: This cross-sectional survey was conducted from January to October 2019. A total of 260 participants were recruited in the cardiovascular department who had successfully undergone percutaneous coronary intervention after one year for physical re-examination at 2 hospitals in Henan Province. They were investigated using 5 questionnaires – the International Physical Activity Questionnaire-Long Form, the Exercise Self-efficacy Questionnaire, the Multi-dimensional Fatigue Scale, the Social Support Rating Scale, and the Hospital Anxiety and Depression scale. Results: After percutaneous coronary intervention, most patients were at low and moderate intensity physical activity and 60.8% of patients did not meet the recommended amount of guidelines. Through the analysis of the influencing factors of physical activity in patients with coronary heart disease stent implantation, the status of physical activity was affected by the NYHA classification, LVEF, exercise self-efficacy, fatigue, and social support. Conclusions: The level of physical activity of patients after percutaneous coronary intervention needs to be improved further. In clinical practice, nursing practitioners should strengthen the health education of patients' exercise rehabilitation to improve the level of physical activity and reduce the occurrence of cardiovascular events.