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Differentiated instruction (DI) is a beneficial approach to addressing students’ diverse learning needs, abilities, and interests to ensure that each student has the opportunity to make academic progress. To answer the question of how teachers utilize DI in K-12 classrooms, this systematic review was based on 61 empirical studies on DI published between 2000 and 2022. It examined the current status and trends of implementing DI in K-12 education and integrated various factors involved in the process of DI, including educational levels, subjects, student difference analysis, instructional methods, content, tools, assessment methods, and instructional effectiveness. The findings indicated that (1) DI was most commonly used in primary school mathematics and language classrooms, with the majority of studies having sample sizes exceeding 100 and lasting for more than 6 months; (2) The most frequently employed form of DI was ability grouping, often grouped based on academic achievement; (3) Information technology tools and resources can empower differentiated instruction; (4) Most studies utilized standardized tests, questionnaires, and scales as evaluation tools, with a focus on the impact of DI on students’ academic achievement and skills; and (5) The effectiveness of DI was controversial and influenced by multiple factors, such as may be associated with the instructional methods. In response to these findings, the study introduces a comprehensive DI model. This model, rooted in the perspective of instructional design, elucidates the interconnected factors of DI. It serves as a valuable reference for the future design and implementation of DI, offering a practical guide for educators aiming to create inclusive and effective learning environments.

Traditional methods of tumor treatment such as surgical resection, chemotherapy, and radiation therapy have certain limitations, and their treatment effects are not always satisfactory. As a new tumor treatment method, photothermal therapy based on nanostructures has attracted the attention of researchers due to its characteristics of minimally invasive, low side effects, and inhibition of cancer metastasis. In recent years, there has been a variety of inorganic or organic nanostructures used in the field of photothermal tumor treatment, and they have shown great application prospects. In this paper, the advantages and disadvantages of a variety of nanomaterials/nanostructures as photothermal agents (PTAs) for photothermal therapy as well as their research progress are reviewed. For the sake of clarity, the recently reported nanomaterials/nanostructures for photothermal therapy of tumor are classified into five main categories, i.e., carbon nanostructures, noble metal nanostructures, transition metal sulfides, organic polymer, and other nanostructures. In addition, future perspectives or challenges in the related field are discussed.

The tumor microenvironment (TME) can aid tumor cells in evading surveillance and clearance by immune cells, creating an internal environment conducive to tumor cell growth. Consequently, there is a growing focus on researching anti-tumor immunity through the regulation of immune cells within the TME. Various bioactive compounds in traditional Chinese medicine (TCM) are known to alter the immune balance by modulating the activity of immune cells in the TME. In turn, this enhances the body’s immune response, thus promoting the effective elimination of tumor cells. This study aims to consolidate recent findings on the regulatory effects of bioactive compounds from TCM on immune cells within the TME. The bioactive compounds of TCM regulate the TME by modulating macrophages, dendritic cells, natural killer cells and T lymphocytes and their immune checkpoints. TCM has a long history of having been used in clinical practice in China. Chinese medicine contains various chemical constituents, including alkaloids, polysaccharides, saponins and flavonoids. These components activate various immune cells, thereby improving systemic functions and maintaining overall health. In this review, recent progress in relation to bioactive compounds derived from TCM will be covered, including TCM alkaloids, polysaccharides, saponins and flavonoids. This study provides a basis for further in-depth research and development in the field of anti-tumor immunomodulation using bioactive compounds from TCM.

Background Post-acute care is rapidly developing in China; yet, a payment method for post-acute care has not been established. The Patient Driven Payment Model (PDPM) is a new case-mix system developed in the United States of America for classification of skilled nursing facility patients. This study aimed to examine the validity of an adapted version of PDPM for classifying post-acute care patients in China. Methods First, 13,496 post-acute care patients in seven facilities of Jinhua City from January 2018 to December 2020 were sampled and assigned to PDPM groups according to their clinical characteristics, functional status, and special care needs. Then, the effectiveness of grouping was analyzed by the percentage of variance in resource use explained by the classification (R 2 ), the reduction in variance (RIV), the class-specific coefficients of variation (CVs), and the weighted means for each group (case-mix indexes, CMIs). Results Under the adapted version of PDPM, each patient is classified into a group for each of the four case-mix adjusted components: (1) physical therapy and occupational therapy (PT&OT), (2) speech-language pathology (SLP), (3) nursing, and (4) non-therapy ancillary (NTA). Each component utilizes different criteria for classification. The adapted PDPM explained 11.1%, 6.1%, 14.0%, and 10.6% of the variance in PT&OT, SLP, nursing, and NTA cost per day, respectively, for the sample patients (all p  < 0.001), which were similar to the results in the United States of America. The CV achieved good homogeneity in 10 PT&OT groups (CV: 0.17–0.69), 12 nursing groups (CV: 0.09–0.66), and 6 NTA groups (CV: 0.38–0.64). The CMIs of groups spanned a 9-fold range in PT&OT (CMI: 0.22–1.96), 11-fold range in nursing (CMI: 0.59–6.33), and 4-fold range in NTA (CMI: 0.72–2.91). Conclusions Our findings provide preliminary evidence that the PDPM is a reliable and valid case-mix system for classifying post-acute care patients in China, which could inform future payment policy for post-acute care in China.

Extensive research has documented the rising prevalence of adolescent depression and suicidal ideation; however, the mechanisms through which stress and coping styles influence these conditions remain unclear. This study examined the interrelationships among these variables, focusing on stress as a mediator and coping styles as moderators. A cross-sectional study was conducted with 561 Chinese adolescents (71.1% female) aged 12–18 years ( M  = 15.95, SD  = 1.90) recruited from the Psychosomatic Clinic of Hangzhou TCM Hospital. Participants completed four standardized measures: (1) the Beck Depression Inventory (BDI) for depression symptoms, (2) the Beck Scale for Suicide Ideation-Chinese Version (BSI-CV) for suicidal ideation, (3) the Adolescent Self-Rating Life Events Checklist (ASLEC) for stress assessment, and (4) the Coping Style Questionnaire (CSQ) for coping styles. Statistical analyses were conducted using SPSS and MPlus. Pearson correlation analyses were performed to examine relationships among variables. The mediating role of stress and moderating role of coping styles were tested using mediation and moderated mediation analyses with bootstrapping procedures. A total of 62.72% of study participants self-reported suicidal ideation. Depression showed significant positive correlations with stress ( r  = .51, p  < .001), suicidal ideation ( r  = .60, p  < .001), and coping style ( r  = .62, p  < .001). Stress partially mediated the relationship between depression and suicidal ideation (indirect effect = 0.19, p  < .001), accounting for 46.6% of the total effect. The moderated mediation model revealed good fit ( χ² = 3.75, df  = 2, p  < .001; RMSEA = 0.05; CFI = 0.92; TLI = 0.91). Coping styles significantly moderated the indirect effect of depression on suicidal ideation through stress ( β = − 0.53, p  < .001).. This study used a self-reporting approach, did not include longitudinal tracking of the developmental relationships between adolescent depression and suicidal ideation, and did not cover all potential factors related to stress and coping styles. These findings suggest that stress mediates the relationship between depression and suicidal ideation in adolescents, while coping styles moderate this mediated relationship. This study provides insights into the mechanisms underlying suicidal ideation in depressed adolescents and may inform targeted prevention and intervention strategies.

Background Mental disorders are increasingly prevalent, leading to increased medical expenditures. To refine the reimbursement of medical costs for inpatients with mental disorders by health insurance, an accurate prediction model is essential. Per-diem payment is a common internationally implemented payment method for medical insurance of inpatients with mental disorders, necessitating the exploration of advanced machine learning methods for predicting the average daily hospitalization costs (ADHC) based on the characteristics of inpatients with mental disorders. Methods We used data including demographic information, clinical/functional characteristics, institutional features, and cost information of 5070 hospitalized patients with mental disorders in Jinhua, China, and employed six algorithms to predict ADHC. Performance of these six algorithms was evaluated through 5- old cross-validation combined with bootstrap method to select the most suitable algorithm and identify key factors influencing ADHC. Results The random forest (RF) model demonstrated better performance (R-squared (R 2 ) = 0.6417 (95% CI, 0.6236–0.6611), root-mean-square error (RMSE) = 0.2398 (95% CI, 0.2252–0.2553), mean-absolute error (MAE) = 0.1677 (95% CI, 0.1626–0.1735), mean-absolute-percentage error (MAPE) = 0.0295 (95% CI, 0.0287–0.0304)). According to feature importance ranking, models incorporating top 11 factors (> 0.01) demonstrated comparable performance to those encompassing all variables. Top four factors (> 0.05) were level of medical institution, age, functional classification, and cognitive classification. Notably, level of medical institutions was the most significant factor across all primary models. Higher medical institutions level, patients below 20 and above 75 years old, lower functional classification, and lower cognitive classification are associated with increased ADHC. Conclusions Machine learning algorithms, particularly RF algorithm, enhance accuracy of predicting ADHC for mental health patients. The findings of this study provide evidence for setting up more reasonable insurance payment standards for inpatients with mental disorders and support resource allocation in clinical practice.

Renal interstitial fibrosis, a condition prevalent in aging humans and animals, is closely linked to the eventual development of renal failure. Establishing an animal model that exactly replicates the pathogenesis of renal interstitial fibrosis induced by natural aging in humans is crucial for advancing mechanistic studies and testing antifibrotic therapies. Implanted allogeneic or xenogeneic cells are cleared by the immune system when stem cell therapy is applied in nonimmunodeficient animal fibrosis models, affecting the effect of the intervention and making it difficult to demonstrate the survival, proliferation, differentiation, or secretion of the delivered autologous human-derived cells. This study effectively developed a model of spontaneous renal interstitial fibrosis linked to natural aging in 43-week-old NOD/SCID mice. Compared with those of 12- and 32-week-old mice, the kidneys of the model mice exhibited prominent fibrosis characteristics, accompanied by numerous fibrous septa and collagen deposition, increased COL1A1 expression, and decreased MMP9 expression. SA-β-gal activity and P21 gene expression levels increased, confirming renal cell senescence in the model mice. Additionally, an increase in α-SMA staining indicated an increase in epithelial–mesenchymal transition. More importantly, we observed TGF-β-SMAD3 pathway activation, mitochondrial dysfunction, decreased antioxidant capacity, oxidative stress, and an enhanced inflammatory response in the model group, consistent with renal interstitial fibrosis in elderly individuals. In this comprehensive investigation, we successfully developed a spontaneous mouse model of renal interstitial fibrosis and revealed the molecular pathways contributing to increased susceptibility to kidney injury and renal fibrosis in elderly individuals.

Background Patient satisfaction has been seen as a key criterion when evaluating hospitals and is one of the main focuses of the current health‐care reform in China. This paper aimed to explore patient‐ and hospital‐level factors associated with inpatient satisfaction, which can provide policy implications for the evaluation and development of a patient‐oriented health‐care system. Methods The paper analyses data from the 2017 China National Patient Survey which includes 20 300 inpatients from 131 tertiary hospitals across 31 provinces. Descriptive analysis and multivariable logistic regressions are conducted to identify key factors related to satisfaction. Results Patient sociodemographic characteristics, including gender, age, income and insurance type, are found to be strongly associated with their satisfaction of inpatient experience. In terms of institutional characteristics, hospital type, size, staffing and financial performance are also significantly correlated with inpatient satisfaction. Patients are more satisfied with specialist hospitals and large hospitals measured by the number of beds and surgeries. Hospitals with higher nurse‐to‐bed ratio also receive more satisfaction. The financial performance of hospitals, however, is negatively associated with satisfaction. Conclusion Patient satisfaction contains unique information on service quality and thus should be incorporated into the matrix of hospital evaluation. Meanwhile, differences in patient composition must be adjusted to make fair comparisons across hospitals. Moreover, future reform needs to put greater efforts in the design of comprehensive public insurance scheme, efficient hospital structure and an overall well‐functioning health‐care delivery system in order to better serve patients in China.

Immobilized metal ion affinity chromatography (IMAC) adsorbents generally have excellent affinity for histidine-rich proteins. However, the leaching of metal ions from the adsorbent usually affects its adsorption performance, which greatly affects the reusable performance of the adsorbent, resulting in many limitations in practical applications. Herein, a novel IMAC adsorbent, i.e., Cu(II)-loaded polydopamine-coated urchin-like titanate microspheres (Cu-PDA-UTMS), was prepared via metal coordination to make Cu ions uniformly decorate polydopamine-coated titanate microspheres. The as-synthesized microspheres exhibit an urchin-like structure, providing more binding sites for hemoglobin. Cu-PDA-UTMS exhibit favorable selectivity for hemoglobin adsorption and have a desirable adsorption capacity towards hemoglobin up to 2704.6 mg g−1. Using 0.1% CTAB as eluent, the adsorbed hemoglobin was easily eluted with a recovery rate of 86.8%. In addition, Cu-PDA-UTMS shows good reusability up to six cycles. In the end, the adsorption properties by Cu-PDA-UTMS towards hemoglobin from human blood samples were analyzed by SDS-PAGE. The results showed that Cu-PDA-UTMS are a high-performance IMAC adsorbent for hemoglobin separation, which provides a new method for the effective separation and purification of hemoglobin from complex biological samples.

Background Diabetes mellitus (DM), a chronic metabolic disease, severely impairs male reproductive function. However, the underpinning mechanisms are still incompletely defined, and there are no effective strategies or medicines for these reproductive lesions. Icariin (ICA), the main active component extracted from Herba epimedii , is a flavonoid traditionally used to treat testicular dysfunction. Whether ICA can improve male reproductive dysfunction caused by DM and its underlying mechanisms are still unclear. In this study, by employing metformin as a comparative group, we evaluated the protective effects of ICA on male reproductive damages caused by DM and explored the possible mechanisms. Methods Rats were fed with a high fat diet (HFD) and then intraperitoneally injected with streptozotocin (STZ) to induce diabetes. Diabetic rats were randomly divided into T2DM + saline group, T2DM + metformin group and T2DM + ICA group. Rats without the treatment of HFD and STZ were used as control group. The morphology of testicular tissues was examined by histological staining. The mRNA expression levels were determined by quantitative real-time PCR. Immunostaining detected the protein levels of proliferating cell nuclear antigen (PCNA), hypoxia-inducible factor 1-alpha (HIF-1α) and sirtuin 1 (SIRT1) in testicular tissues. TUNEL assay was performed to determine cell apoptosis in the testicular tissues. The protein expression levels of HIF-1α and SIRT1 in the testicular tissues were determined by western blot assay. Results ICA effectively improved male reproductive dysfunction of diabetic rats. ICA administration significantly decreased fasting blood glucose (FBG) and insulin resistance index (IRI). In addition, ICA increased testis weight, epididymis weight, sperm number, sperm motility and the cross-sectional area of seminiferous tubule. ICA recovered the number of spermatogonia, primary spermatocytes and Sertoli cells. Furthermore, ICA upregulated the expression of PCNA, activated SRIT1-HIF-1α signaling pathway, and inhibited intrinsic mitochondria dependent apoptosis pathway by upregulating the expression of Bcl-2 and downregulating the expression of Bax and caspase 3 . Conclusion These results suggest that ICA could attenuate male reproductive dysfunction of diabetic rats possibly via increasing cell proliferation and decreasing cell apoptosis of testis. ICA potentially represents a novel therapeutic strategy against DM-induced testicular damages.