To explore the application effect of the clinical basic integration teaching mode constructed by case studies and the MOOC platform in obstetrics and gynecology internship teaching in the face of public health emergencies.One hundred ten clinical medical students of grade 2020 were selected as the experimental group, and 110 clinical medical students of grade 2021 were selected as the control group. The experimental group adopted the online teaching mode combined with case studies and the MOOC platform, while the control group adopted the offline traditional probation teaching method. Comprehensive test and questionnaire were used to evaluate and compare the teaching effect of the two groups of students.P < 0. 05). However, the score of professional knowledge was lower than that of the control group (P < 0. 05). The results of questionnaire survey showed that the satisfaction of the experimental group in stimulating learning interest, enhancing problem solving ability, enhancing communication and clinical thinking ability, enhancing team cooperation awareness and independent innovation ability was higher than that of the control group (P < 0.01). The satisfaction of teacher-student interaction was also better (P < 0.05). However, in terms of strengthening theoretical understanding, the satisfaction of the experimental group was lower than that of the control group, but with no significant difference (P > 0.05).The experimental group was found to be superior to the control group in the quality assessment of complete medical record writing and the ability assessment of diagnosis and analysis of typical obstetrics and gynecology cases (During the epidemic period, we designed a new online teaching mode, which can be applied to the probation teaching of obstetrics and gynecology. In our study, compared with traditional offline teaching, the new online teaching mode could improve students’ ability of case writing and case analysis. However, more teaching practice is needed to complete this online teaching mode.The online version contains supplementary material available at 10.1186/s12909-022-03854-1. In recent years, with the development of the internet, online teaching has started to become a norm in colleges and universities. However, a lot of online classes are concerned with teaching the extra-curricular knowledge, frontier knowledge, as well as ideological and political education. Most colleges and universities still adopt the offline teaching mode, called lecture-based learning. According to the teachers, classroom teaching continues to be the main teaching mode for non-computer majors, especially the clinical teaching for clinical medicine interns. There are many other forms of offline teaching are in common use,such as small group teaching, peer teaching, PBL and TBL. Because of the interns need to see the patient and make a face-to-face conversation, small group teaching mode is the most commonly used. With the gradual advancements in education and teaching reform from simple offline teaching to online teaching and then to a hybrid model consisting of a mixture of both these modes, clinical teaching is also facing great changes and challenges. The discipline of obstetrics and gynecology involves women’s privacy, patients are often reluctant to cooperate with clinical teaching during clinical probation, and the opportunities for students to observe and practice are significantly reduced. So there is a need for alternative forms of teaching, even in the absence of a pandemic. All the clinical medicine interns of 2020 grade of The First Affiliated Hospital of The University of South China were taught online at home during the COVID-19 pandemic. We constructed a clinical basic integrated teaching model combining case studies and the MOOC platform, after designing, deducting, modifying, and simulating, which was successfully introduced into the clinical internship model of obstetrics and gynecology. As the epidemic had been gradually controlled in China, the traditional novitiate teaching mode was restored in our university. That means the clinical medicine interns of 2021 grade was taken the offline courses in the school. The teaching effect between the two grades was evaluated by the means of a comprehensive test and a questionnaire survey to find and improve the teaching method of probation under the new mode. The purpose of this paper is to discuss the advantages and disadvantages of this new online teaching mode, and to improve its methodology to better serve the specific implementation of online teaching.P > 0.05). And no one had contracted the COVID-19 in both groups.We selected the 110 clinical interns of grade 2020 of the First Affiliated Hospital of The University of South China as the experimental group, who were asked not to come to school to avoid contracting COVID-19. The experimental group accepted the new online teaching mode combining case studies and the MOOC platform from February to July 2020. The 110 clinical interns of grade 2021 were selected as the control group, who accepted the traditional internship face-to-face teaching mode from February to July 2021, when the epidemic had been gradually brought under control in China. There were 59 men and 51 women in the experimental group, with an average age of 22.21 ± 0.38 years, and 57 men and 53 women in the control group, with an average age was 21.96 ± 0.79 years. There was no significant difference in the age, gender, education background, and other general parameters between the two groups  as the media and were introduced to the course materials on the MOOC platform. The students first learned the basic theoretical knowledge of diseases, then entered the teaching module of case studies of corresponding diseases, and finally returned to the theoretical summary. The specific implementation plan of the online case study teaching module has been outlined as follows Fig. .Fig. 1OnThe teachers were instructed to determine the course content, select one or two typical cases related to obstetrics and gynecology. One student for each case was selected to play the part of Standardized patient (SP), and three or four students were selected to act as residents to conduct a doctor-patient conversation. The SP could preview the typical cases provided by the teacher in advance, while other members in the squad would be required to prepare the disease-related content. This process of preparing for the classes was to be completed by the students independently.After the theoretical learning module of the MOOC platform, the SP selected in advance and the resident doctors played the case roles, and obtained clinical data of patients through a detailed history consultation. This process was the primary component of the online course for novices, which trained the students to collect medical history data.The group members made diagnosis on the basis of the information obtained from the consultation, formulated treatment plan, and had a conversation with the SP about the condition of admission, simulating the clinical diagnosis and treatment processes throughout the whole exercise. This stage was the challenging part of the online course, aiming at cultivating students’ clinical thinking ability and training them in communication.The SP and other watching team members first evaluated the integrity of the resident clinical activities and whether they were performed correctly, then the teacher’s evaluation of the students would be supplemented, including the clinical manifestations, diagnosis, differential diagnosis and treatment of the case. Meanwhile the teacher could answer any questions the students might have and, if necessary, introduce new concepts and knowledge to broaden the students’ horizons.The team members would be asked to write a medical record for each case to improve students’ ability to write medical records, and the teacher evaluated the medical record writing. This stage could be carried out after class.The control group adopted the traditional teaching mode, which was taught collectively by the teachers according to the syllabus, the students simulated medical work, such as following the clinical team teacher to check the patient and observing how the teacher asking questions about patient’s symptoms and past health.At the end of the internship, the students were tested on basic professional knowledge, the ability to write complete medical records and their quality, and the ability to diagnose and analyze typical obstetrics and gynecology cases, with a total score of 100 points for each.For an inspection of the students’ grasp of theoretical knowledge, a questionnaire consisting of 50 questions with 2 points for each question was evaluated by deputy senior teachers from the department of obstetrics and gynecology using a unified grading system. Students were required to complete 10 complete medical records during probation, with one copy for each course content. The last two complete medical records of each student during the probation period were scored by the teacher and their average score was taken as the score of medical record writing to investigate the students’ writing ability. Typical cases of obstetrics and gynecology were selected as case analysis questions to investigate the clinical thinking and case analysis ability of the students.On the basis of the previous questionnaire survey , the stuP < 0.05 was considered statistically significant.The data collected were entered into a Microsoft Excel spreadsheet and statistically analyzed . Measurement data were expressed as x ± s. X is the mean and s is the standard deviation. Two independent sample T tests were used for comparison between groups. Counting data were expressed as percentages, and the chi-square test was adopted for the same. P < 0. 05). However, the score of professional knowledge was lower than that of the control group (P < 0. 05), as recorded in Table The experimental group was found to be superior to the control group in the quality assessment of complete medical record writing and the ability assessment of diagnosis and analysis of typical obstetrics and gynecology cases (P < 0.01). The satisfaction degree of teacher-student interaction in the experimental group was higher than that in the control group, and the difference was again statistically significant (P < 0. 05). In terms of strengthening theoretical understanding, the satisfaction of the experimental group was lower than that of the control group, but the difference was not statistically significant (P > 0. 05). These results have been tabulated in Table After the final examination, a total of 220 questionnaires were distributed to all the probationary students, with a recovery rate of 100%. All of them were valid questionnaires. The results of the experimental group in the evaluation of the teaching mode to stimulate interest in learning, strengthen problem solving ability, enhance communication and clinical thinking ability, strengthen the consciousness of team cooperation and the capacity for independent innovation satisfaction were higher than that in the control group; differences were significant statistical significance (Clinical probation is very important in the growth process of medical students. It is a preliminary practice for medical students in the theoretical stage of clinical disciplines to consolidate the theoretical knowledge they have gained. It is the key medium for the integration of theory and practice, and an important bridge for the transition from medical students to interns. Traditional probation teaching is given priority, which consists of teachers actively imparting knowledge and the students passively accepting the information . Watchin‘Obstetrics and Gynecology’ is a required clinical specialty course for medical students in colleges and universities. It is a highly practical subject. As one of the four main disciplines of clinical medicine, obstetrics and gynecology is a specialized subject studying physiological and pathological changes of the female reproductive system and fertility regulation . This coIn the COVID-19 period of 2020, when classes were suspended, the online teaching mode stands out among the numerous means of teaching reform and becomes the only way of teaching in colleges and universities during the pandemic. With the continuous popularity of internet, online teaching has become a norm in clinical practice teaching . This stWith the rapid development of information technology, the course teaching mode of the MOOC platform has been widely used . This moIn the clinical practice classes, the main teaching mode is group teaching, and they are more flexible and diversified. These are the first steps for medical students in their transition to become doctors, and these classes enable them to lay a solid foundation of basic theory and operation skills and cultivate correct clinical thinking, which plays an indispensable role in medical practice. Case study teaching can provide training for students’ subjective initiative in learning, mobilize learning enthusiasm , and culIn the new teaching mode we set up, case study teaching required students to conduct independent after-class learning according to the teaching content and key points specified by the teacher before class. Because of previewing and consulting materials in advance, students’ enthusiasm for learning could be significantly improved, and their ability of previewing theoretical knowledge and consulting materials could be cultivated as well. Because of the psychology of exploring unknown things, students often had a strong interest in case simulation. Before case simulation, the teacher would help students review the theoretical knowledge again with the help of the MOOC platform, and put forward the key points and difficulties to deepen their understanding. By acting as SP, students could not only stand in the shoes of the patients and experience their feelings but also understand the occurrence and performance of diseases through the process of imitation. The students acting as the visiting doctors were asked to communicate with the SP and discuss the appropriate diagnosis and treatment plan through division of labor and cooperation. After the play, the two sides evaluated each other. In this process, the students’ sense of experience and participation was stronger than the traditional face-to-face teaching, and the students’ enthusiasm significantly improved. In the teaching process of case studies, such role-playing exercises, group case consultation simulation and case discussion were carried out, and the group’s plans were analyzed and summarized, so that the classroom became a place for teachers and students to interact in ways which included discussion and reporting, answering questions and solving doubts , formed Case study teaching required teachers to select corresponding representatives, typical, targeted and authentic clinical cases according to the teaching progress, comprehensively analyze and summarize the clinical data, and complete the teaching of writing typical cases , which cIn this study, by comparing the teaching method of combining case studies and the MOOC platform in probation classes with traditional probation teaching, the assessment results showed that the quality assessment of complete medical record writing and the ability assessment of diagnosis and analysis of typical obstetrics and gynecology cases were better than the control group, but the score of professional basic knowledge was lower than that of the control group. The reason might be that the students of grade 2020 completed the major theoretical courses on the internet by themselves through the teaching videos on the MOOC platform during COVID-19, lacking the sense of participation, teacher’s supervision and the atmosphere of studying together with other students, which affected the completion of students’ theoretical learning to some extent. This is consistent with the idea of Liu Xinli and Zhang Li et al. , 19According to the results of the questionnaire survey, the experimental group was superior to the control group in terms of satisfactory teaching methods, improved the interest in obstetrics and gynecology, and the ability of teamwork, language expression, analyzing and solving problems, clinical thinking, literature retrieval, and independent learning. This showed that the teacher should create a variety of forms of teaching activities by enriching the teaching resources, such as the preparation before class, roles playing, class discussion, after-school case writing, etc., which helped the student to complete the study in the relaxed and happy classroom atmosphere, aroused the students’ interest in learning, enhanced the interaction with the exchange of students and teachers, and developed better clinical ability capacity. This is similar to the conclusion of Feng Rong et al.  However,This study was tested only in a very specific scenario with a small group of students from one university, the time period was short, the number of the subject was small. Moreover, there are certain differences from year to year, with younger students being relatively more receptive to online instruction because they may have been exposed to it since childhood, so more practice is still required to further improve and perfect the teaching plan, this can be accomplished through optimization of teaching schemes, reforms in the online teaching mode, conducting the personalized teaching, improve the quality of online probation teaching of obstetrics and gynecology.In conclusion, during the epidemic period, we designed a new online teaching mode, which can be applied to the probation teaching of obstetrics and gynecology. In our study, compared with traditional offline teaching, the new online teaching mode could improve students’ ability of case writing and case analysis. However, more teaching practice is needed to complete this online teaching mode.Additional file 1.


Background: Stem cells (SCs) therapy for intervertebral disc degeneration (IDD) has been studied for nearly 20 years and it is an important part of regenerative medicine and tissue engineering research, as well as a current research hotspot and challenge. Although the volume of literature has shown an annual growth trend, there is no literature available for bibliometric and clinical analysis of the content of multiple databases in this field.Methods: The articles were obtained from the WOSCC, Scopus, Pubmed, and ClinicalTrials on 27 December 2021. Three scientometric software  were used to perform bibliometric and knowledge-map analysis.Results: We included 867 articles from WOSCC, 716 articles from Scopus and 6 clinical studies from ClinicalTrials for literature analysis. Our results showed that China was the country with the highest number of publications, with the United States (US) being the leader in terms of international collaborations and the number of citations. Sakai D, Grad S and Hoyland JA had made outstanding contributions for their high productivity and the quality articles. Spine was the most published and most cited journal, in addition to Spine Journal and Biomaterials, which were also more authoritative journals and had received high citations. All of them had received high citations. Keyword co-occurrence studies suggested that the current hotspots were in mechanistic studies, including inflammation, apoptosis, exosome, autophagy, and others. Some studies had also investigated tissue-engineered scaffolds of SCs to better repair degenerated discs. Clinical studies were relatively scarce. Direct injection of Mesenchymal Stem Cells (MSCs) into degenerated discs for the treatment of Degenerative disc disease (DDD) was the current direction of research.Conclusion: This study demonstrates the global research hotspots, trends and clinical use of SCs in the treatment of IDD. It can help scholars to quickly understand the current status and hotspots of research in this field, and also provide some guidance and reference for those who are currently researching in this area. Intervertebral disc degeneration (IDD) is a chronic degenerative disease that causes an imbalance in the internal environment of the disc and affects the overall mobility of the spine . It is wBibliometrics is a tool that statistical and mathematical methods are used to evaluate trends and hotspots in the field of published literature and studies . DiffereThe bibliometric search was conducted in the Web of science, Scopus and Pubmed database on 27 December 2021. The search strategy can be seen in In the WOSCC, the results of the search were downloaded as “Full Record and Cited References” and the file format was “Plain Text” and “Windows UTF-8.” The former was processed and imported into bibliometric software for further analysis, while the latter was uploaded directly to the network for online analysis. In the Scopus, the files in “CSV” format were downloaded for subsequent analysis. The Carrot2 provided direct access to the clustering results for keywords in Pubmed , which ahttp://lert.co.nz/map/).The WOSCC and Scopus databases included its own analysis function for authors, affiliations, countries, publication titles and year of publication. The downloaded data was imported into Microsoft Excel 2016 for statistical analysis. We adopted VOSviewer 1.6.17, CiteSpace 5.8.R.1 and Scimago Graphica to recognize the network maps of journals, authors, countries/regions, institutions, cited references, co-cited references and keywords. In addition, Citespace was used to depict dual-map overlays of journals and identify keywords with a strong burst strength for exploring emerging topics. The mapping of the world was done through an online website  was used to search for current clinical studies of SCs therapy for IDD. The disease was “Degenerative Disc Disease,” the intervention was “Stem Cells” and the status was all studies.The The included literature was published from 2003 to 2021, of which the most was this year. As can be seen from When the country/region contributions to the field were counted , it was By using the VOSviewer to visualise cooperation between countries, different colours represent different clusters and there is close cooperation between countries in each cluster, with the active countries in the WOSCC data clustered into 8 categories and the Scopus data clustered into 7 categories. The WOSCC results showed that England, Finland, Germany, India, Portugal, South Korea and Spain were grouped in cluster 1 and there was a strong link between them. China was placed in the third cluster and the United States in the fourth . HoweverA total of 3300 authors were found in WOSCC and 2607 in Scopus for this research area . The thrA visual analysis of the authors’ collaborations was performed using the VOSviewer software. In WOSCC, the important authors were divided into 9 clusters . The firHowever, in Scopus, important authors were divided into 11 clusters , each inSpine  and Spine journal  were the two most widely published journals in the field . It was clear that Biomaterials was the more authoritative journal in the stem cell field.The results of both databases showed that he field . AlthougSpine had the highest total link strength in the network , followed by Biomaterials , indicating their important role in the field of journals  embedded in Atelocollagen gel into the intervertebral disc of a model rabbit and found it to be efficient in alleviating IDD  into the nucleus pulposus (NP) of patients with IDD (The first literature in this field appeared in 2003 and was published in t of IDD . The firting IDD . The impr of IDD . Orozco,with IDD . This apwith IDD .Biomaterials in 2003 and 2006 respectively received the highest total co-citation link strength and researchers can look to these two publications for lessons (Spine, who demonstrated in a rabbit model that MSCs have the potential to differentiate into NP cells (Co-cited references disclosed how often two articles were cited together by other articles, and this can be seen as the basis of knowledge in a specialized area . Sakai D lessons . This ar lessons . It provNP cells . There wNP cells .Keyword co-occurrence analysis can be used to identify interests and hotspots in the field and to look for cutting-edge trends, aiding scientists to provide direction in a wide range . The freEarly research SCs therapy for IDD was associated with chondrogenic differentiation , affectiClinicalTrials.gov, as a database offered by the US National Library of Medicine, contains a collection of reference clinical trials conducted around the world on a variety of conditions and diseases . We haveThis study is the first relatively systematic bibliometric and visual analysis for SCs in IDD and provides some insight for scholars studying this field. But it still has some limitations. Although this article searched WOSCC, Scopus and Pubmed and conducted some analysis, it was independent and did not sufficiently incorporate the data. The study only included articles whose language was English, ignoring non-English articles, and only original studies and reviews were included, all of which resulted in the analysis not being fully comprehensive. The database is updated in real time, which leads to the possibility that our results may differ from those available at the time of publication. Fewer studies were included for clinical studies and there were no complete conclusions. Therefore, it remains important to keep abreast of the latest and neglected literature to gain a comprehensive understanding of current hotspots and future trends, while further research is needed in clinical research methods to clarify efficacy.Spine is the most published and most cited journal, in addition to Spine Journal and Biomaterials, which are also more authoritative journals and have received high citations. All of them have received high citations. Keyword co-occurrence studies suggest that the current hotspots are in mechanistic studies, including inflammation, apoptosis, exosome, and autophagy. Some studies have also investigated tissue-engineered scaffolds of SCs to better repair degenerated discs. Clinical studies are relatively scarce. Direct injection of MSCs into degenerated discs for the treatment of DDD is the current direction of research, but large, multicentre clinical studies are still needed to demonstrate the efficacy, and safety of this method.This study demonstrates the global research hotspots, trends and clinical use of SCs in the treatment of IDD. Annual publication trends in this study are increasing, with China being the most published country and the US being the largest contributor, both of whom are ahead of the curve in this field. Sakai D, Grad S and Hoyland JA have made outstanding contributions and are recognized by other scholars for their high productivity and the quality of their research.


With the steady rise of China's agricultural production and management level, the market of ecological agricultural products has developed rapidly, and consumers are increasingly concerned about ecological agricultural products. Consumers' cognition and purchase intention are the keys to determine their future development. This research is aimed at ensuring that consumers have access to high-quality ecological agricultural products, thereby promoting the supply and production of ecological agricultural products, minimizing agricultural carbon emissions, and providing information on sustainable food pricing. Based on the research status at home and abroad, this study combines the questionnaire survey method to study the influencing factors and willingness to pay of consumers purchasing ecological agricultural products. A total of 601 online questionnaires from consumers in Harbin, a city in northeastern China, were collected, and statistical factor analysis, principal component analysis, and regression analysis were used to study the influencing factors of consumers' purchase of ecological agricultural products from both positive and negative aspects, and in-depth analysis of the reasons why consumers refuse to pay, get the most real willingness to pay and related influencing factors, and quantify the influence of various variables on consumers' purchasing behavior was done. On this basis, a logit model of survival analysis is constructed to study the premium payment level of consumers for ecological agricultural products, and the payment premium is 24.95%. The research results show that married, who have purchased ecological agricultural products, the higher the understanding of ecological agricultural products, the consumers who buy ecological agricultural products in farmers' markets, Meituan and community group purchases, and the households with higher monthly consumption of agricultural products have a significant positive correlation with consumers' purchase of ecological agricultural products. The higher the education level, the older the age, and the larger the family size were significantly negatively correlated with consumers' purchase of ecological agricultural products. As a large agricultural country, China is a world leader in the quantity and variety of agricultural products , and theCurrently, agricultural products research is focused on low-carbon agricultural products , 8, orgaBy studying the influencing factors and willingness to pay of consumers' purchase of ecological agricultural products, this paper believes that the core of consumers' purchase is health value and environmental value. With the frequent occurrence of food safety accidents in China, the basic requirement that consumers are willing to pay a premium for is the health and safety brought by its high quality , 28. SeuBased on the research of other scholars and the actual situation of Chinese consumers, this study divides the factors influencing consumers' purchasing behavior of ecological agricultural products into five parts: demographic characteristics, awareness of ecological agricultural products and purchasing channels, factors influencing the purchase of ecological agricultural products, and consumers' purchasing experience and willingness to pay. Through statistical analysis of data in these five areas, key factors influencing consumers' purchase of ecological agricultural products were identified. We collected basic research data through questionnaires, applied statistical theory to test the reliability and validity of the collected data, conducted factor analysis and regression analysis on the influencing factors and came up with the degree of influence of each variable factor on consumers' purchasing behavior, and quantified the consumers' willingness to pay premium for purchasing ecological agricultural products through CVM method. The study of these factors will have important practical significance for the sustainable development of ecological agricultural products and can provide decision support for the market pricing of ecological agricultural products.Consumers' willingness to pay is the personal evaluation of consumers for a specific commodity with a strong subjective evaluation. Consumers are the final purchasers and monetary payers of agricultural products, if ecological agricultural products want to achieve the desired market effect should be based on the establishment of consumer-centered modern marketing concept, many foreign scholars have studied the demand system of agricultural products from the perspective of consumers' willingness to pay. Market research has been conducted to understand consumer demand and purchasing power of agricultural products to explore consumer demand and willingness to pay for organic agricultural products , 30, 31.Some typological or consumer segmentation studies , 37 and The purchase decision process is a decision-making process in which consumers analyze and evaluate a product internally and then make a choice to buy it –51. The Many early scholars proposed some typical theories and models, such as the theory of rational behavior , theory The research data in this paper were collected through a structured questionnaire, which was designed according to the content of the study into five sections: demographic characteristics, awareness of ecological agricultural products and purchase channels, factors influencing the purchase of ecological agricultural products, and consumer purchase experience and willingness to pay. The questionnaire was measured using the Likert 5-point scale method , with a Basic research data were collected by distributing questionnaires to Harbin City, Heilongjiang Province, the capital city of northern China, and a total of 601 valid questionnaire data were received. The demographic characteristics of consumers were first analyzed, as detailed in The demographic characteristics of the consumers include information on gender, education level, marital status, age, and total monthly household income. The results show that about 43.93% of the respondents are male and the remaining 56.07% are female. There are differences in the education level of consumers in this survey, including 37 people with junior high school (and below) education, accounting for 0.62%; 76 people with high school education, accounting for 12.65%; 124 people with technical secondary, accounting for 20.63%; and 269 people with bachelor's degree, accounting for 44.76%. The number of people with master's degree or above was 95, accounting for 15.81%. Married consumers are the main group of agricultural products purchasing, which is representative for the study of consumers' willingness to purchase. The 366 consumers in this study have married marital status, accounting for 60.9%, and 39.1% are unmarried. The age distribution of the respondents varies greatly, with the most represented age group being between 21 and 30 years old, accounting for 40.77% of the sample respondents, followed by 51 to 60 years old, accounting for 17.64%, which are usually middle-aged and elderly people who are responsible for household chores and have a greater demand for agricultural products. The sample conducted a statistical survey of the respondents' intrahousehold situation, and the results showed that the largest number of households with 2-3 members (55.9%), the largest number of households without children (54.7%), and the number of elderly people with 2 members (33.44%). In addition, the sample also counted the occupational distribution and income of the respondents. The largest number of respondents (26.62%) worked in institutions , and most of them had a household income between 473 and 1100$, accounting for 38.94% of the total number of respondents in the sample.Through the survey, it could be found that 339 respondents are the main members of the family shopping for food, accounting for 56.41%, while 408 people (67.89%) have actually purchased ecological agricultural products, accounting for a large proportion, which proves that the analysis of the willingness of the interviewed group to purchase agricultural products is representative and scientific; 71.71% of consumers prefer to use farmers' markets, supermarkets 71.71% of the consumers prefer farmers' markets, supermarkets, and traditional e-commerce websites as traditional purchasing locations. There are differences in the results of the survey on the satisfaction of daily purchased agricultural products, with the majority of consumers being more satisfied with the general agricultural products and average. According to the survey on ecological agricultural products, the number of people who have a certain degree of knowledge about ecological agricultural products is 448, accounting for 74.3%, while the remaining 25.7% of consumers have less knowledge, and there is still great room for improvement in the knowledge of ecological agricultural products; the statistical results on the channels of understanding ecological agricultural products show that the proportion of those who are recommended by common media  and friends  is the highest, accounting for 49.7%. This is greatly related to the rapid development of the Internet and the national publicity of ecological agricultural products.In order to test the reliability of the empirical data, a consistency analysis was performed using the statistical knowledge Cronbach's alpha coefficient. The alpha coefficient mainly tests the stability of the scale, and the level of reliability coefficient reflects the level of stability of the scale, and its reliability depends on each factor in the study. The value obtained was 0.916, which is higher than the critical value of 0.70, ensuring the reliability of the scale. Various statistical methods and techniques such as factor analysis, principal component analysis, regression analysis, and survival analysis were used to analyze the quantitative data collected by the structured questionnaire.Prior to principal component analysis, the statistical results of the questionnaire on consumer attitudes toward ecological agricultural products were tested for data applicability using the Kaiser-Mayer-Olin (KMO) and Bartlett's test of sphericity . The staBy correlating the contribution of the factors, a gravel plot was drawn for their eigenvalues, and the number of main factor sequences was classified by observing the magnitude of the slope between the factors. The results shown in Next, principal component analysis was used as the extraction method, and the converged component matrix was finally obtained by normalized orthogonal rotation before the iteration and then factor rotation afterwards, as shown in The classification can be displayed according to the results in the table, and these indicators can be divided into two categories according to the high load. C1-C7 has a larger load on the first factor, and combined with the problem setting, ecological agricultural products are more nutritious, healthier, better in taste, higher in satisfaction, and safer than general agricultural products. It can be concluded that consumers support ecological agricultural products, so they are named as “willing to pay” consumers. C8-C15 has a large load on the second factor, and it is concluded that consumers are opposed to ecological agricultural products, so they are named as “unwilling to pay” consumers, which can reflect the existence of such consumers that may exist in ecological agricultural products. The lack of understanding of the phenomenon leads to the formation of opposition to consumption, these consumers are potentially huge consumption power in the market.There are many factors that affect whether consumers choose to buy ecological agricultural products. In this paper, variables such as consumer basic information and socioeconomic attributes are selected as explanatory variables, and a binary logit-based consumer choice behavior model is established. Whether to choose ecological agricultural products is the dependent variable. Other variables are independent variables. In the model, the values of independent variables and dependent variables are multi-level.Y, it is defined that those with willingness to pay are assigned a value of 1 , and those without willingness to pay are assigned a value of 0 . The dependent variable X =  is an n-dimensional variable related to the occurrence of Y.When x1,x2, ⋯ xn takes a specific value, the probability of occurrence of Y( = 1) isFor the independent variable Y = 1, that is, willingness to pay, as the reference point, the regression results obtained by the application software SPSS 26.0 are shown in Taking The binary logit regression results show that for basic information of consumers, from the regression results, it can be seen that the marital status is married, the family size is large, and the number of children is significantly and positively correlated with whether they are willing to accept ecological agricultural products. Married people are more willing to accept ecological agricultural products. The survey shows that married people with a stable family life are happier. These people think more long-term, and they are more inclined to invest more in food quality and health care for the elderly and children. The educational level and age are significantly negatively correlated with whether they are willing to accept ecological agricultural products. To buy ecological agricultural products and their partners or parents are the main buyers, the cognition level of the highly educated respondents on ecological agricultural products is inconsistent with the actual consumption behavior. Therefore, their higher ecological cognition level and willingness to consume does not translate into actual purchase behavior. This conclusion is also consistent with the research results of Ping et al.  and MingFor consumers' cognitive level and purchase experience, the regression results showed that purchase experience, understanding level, farmers' market purchase, Meituan (community group purchase), and monthly amount spent on agricultural products were significantly and positively correlated with whether they were willing to accept ecological agricultural products. Consumers who have purchased ecological agricultural products put forward higher requirements on the taste, quality, and safety of the agricultural products they purchase in the future. Consumers who have more exposure to ecological agricultural products, especially those who have had experience in purchasing ecological agricultural products, are more willing to choose ecological agricultural products again, and their demand for ecological agricultural products will increase. The higher consumers' knowledge of ecological agricultural products indicates that consumers with higher knowledge of the nutritional value of ecological agricultural products are more willing to buy ecological agricultural products. Consumers who buy ecological agricultural products in two types of channels, namely farmers' markets and Meituan (community group buying), are more willing to accept ecological agricultural products. The possible reason is that consumers think ecological agricultural products sold in farmers' markets are more reliable in terms of safety and quality, and they can see the freshness of ecological agricultural products at the time of purchase and avoid decay and occurrence of damage due to remote transportation from online shopping. However, consumers who choose Meituan (community group buying) may belong to people who are busy with their daily work and do not have free time to go to farmers' markets and other field purchases, so this way of shopping provides convenience for consumers. The more money they spend on agricultural products each month, the more they can accept ecological agricultural products, which means that ordinary agricultural products cannot meet consumers' demand for quality, so they are willing to choose safer and healthier ecological agricultural products to eat.Through the survey on the factors that consumers think the price of ecological agricultural products is high refer to , more thT is positive is determined as the survival function. The survival function S and the distribution function G are related by S = 1 − G. If the distribution function S is assumed to be normally distributed, the survival function can be expressed asThe product chosen for this study is ecological rice because rice is the most important food in the diet of people in China and the world, and ecological rice is highly representative as an important part of ecological agricultural products in China. Applying the logit model in survival analysis to estimate the consumer's payment premium for ecological agricultural products, the survival function of WTP can be derived from the parameter values, and further, the expected value of WTP can be obtained. The probability function when the response case of consumer's response to the initial bid amount δ is the scale parameter and γ is the shape parameter.where At this point, the resulting likelihood function iswhere YES represents the number of consumers who responded affirmatively to the prompted amount and NO represents the number of consumers who responded negatively to the prompted amount. α = 1/(γ − 1), β0 is a constant term, and β1, β2, ⋯βi is the coefficient of influence factor X1, X2, ⋯Xi.In the above equation, In order to derive the final magnitude of consumers' willingness to pay, the logit model in survival analysis is applied to estimate consumers' payment premium for ecological agricultural products, and the survival function of WTP can be derived based on the parameter values to further obtain the expected value of WTP.The survival function of the logit model fitted to the survival data isThe WTP expectation is calculated by the formula:max is 65%, and it is brought into the average willingness to pay calculation formula, and the survival analysis function is run through the program, and the scale parameters and shape parameters of the logit model are calculated by using SAS software to obtain δ = 0.139 and γ = 0.361, and the expected value of WTP is 24.9466 when brought into the model, which means that consumers are willing to pay more for ecological agricultural products than general agricultural products 24.95%. Using the writing program to obtain the impact results of each attribute, the model results of survival analysis were obtained by running the logit model through SAS. The impact of each attribute variable on willingness to pay can be obtained based on the analysis in the table, as shown in After reviewing the existing studies on double-bounded dichotomies and thinking deeply about them , 70, theRegarding basic information, gender, education level, marital status, age, monthly household income, number of children in the household, and number of elderly in the household had a significant effect on willingness to pay. Gender has a significant effect on willingness to pay and is positively correlated, indicating that women are more willing to pay a premium for ecological agricultural products, and women tend to be more willing to choose ecological agricultural products as the main role of household chores in the family. Marital status is positively correlated with willingness to pay, indicating that married consumers are more willing to pay extra price for ecological agricultural products; the number of children in the household is significantly and positively correlated with willingness to pay, and families with more children are more willing to pay more price for ecological agricultural products. The number of elderly people in the household is positively correlated with willingness to pay, and the more elderly people in the household, the more likely the household is to pay a premium price for ecological agricultural products. Educational attainment, age, and monthly household income were negatively correlated with willingness to pay for ecological agricultural products, indicating that consumers with higher educational attainment were less willing to pay a premium for ecological agricultural products, and older consumers were less willing to pay an extra price for ecological agricultural products. Consumers with higher monthly household income were not willing to pay a premium for ecological agricultural products. More than 85% of consumers believed that the high price of ecological agricultural products was due to the increased cost of packaging, low yield, increased production, labor and distribution costs, and better quality of ecological agricultural products. Among these factors, better quality of ecological agricultural products had the greatest impact on the high price of ecological agricultural products.Regarding the factors influencing the purchase of ecological agricultural products, the two main factors FAC1-1 (supportive) and FAC2-1 (opposed) extracted by factor analysis had a more significant effect on willingness to pay. Among them, FAC1-1 is positively correlated with willingness to pay, indicating that consumers with positive attitudes toward ecological agricultural products are more willing to pay extra price for ecological agricultural products, and the results are also consistent with the actual; FAC2-1 is negatively correlated with willingness to pay, indicating that consumers with negative attitudes toward ecological agricultural products are not willing to pay premium price for ecological agricultural products, and this part of consumers are potential future buyers of consumers of ecological agricultural products.Marital status has a significant positive correlation with the purchase of ecological agricultural products. Married consumers, as the main purchasers of ecological agricultural products, have a greater tendency to purchase ecological agricultural products, so they are more willing to purchase ecological agricultural products, while children, as the main concern group of families and even society, parents pay much attention to them in terms of food safety and food health. The results show that there is a significant positive correlation between the number of children and the purchase of ecological agricultural products, which is consistent with the actual situationConsumers who have purchased ecological agricultural products are positively related to their purchase intentions, which is also consistent with consumers' choice behavior. Consumers who have not purchased ecological agricultural products have certain limitations in their knowledge and they cannot have a comprehensive understanding of themConsumers with higher understanding of ecological agricultural products are more willing to accept ecological agricultural products because they are aware of the nutritional value of ecological agricultural products and the ecological value in the social sense, thus prompting their purchaseIn terms of the channel of understanding ecological agricultural products on choosing ecological agricultural products, consumers who buy ecological agricultural products at farmers' markets and Meituan and community group purchases are more willing to accept ecological agricultural products, while the opposite result exists for consumers who buy agricultural products at other locations and tend to be reluctant to accept ecological agricultural productsThe higher the monthly consumption of agricultural products, the greater the tendency of households to choose ecological agricultural products. The likely situation is that consumers have average feelings about the general agricultural products they buy, which cannot meet their daily needs for agricultural products, and therefore choose to buy higher quality ecological agricultural products. This is consistent with their findings Based on the data analysis and model results, it could be concluded that consumers' marital status, number of children in the household, ecological agricultural products purchasing experience, knowledge of ecological agricultural products, channels of purchasing ecological agricultural products, education level, age, and household size have significant influence on choosing ecological agricultural products. Education level, age, and household size were significantly and negatively correlated with consumers' purchase of ecological agricultural products. Although consumers with higher education level have more rational judgment and clearer understanding of ecological agricultural products and thus are more inclined to choose ecological agricultural products, the results show a negative correlation, which may be due to the fact that those with higher education level have less time and energy to shop for ecological agricultural products due to their more important work in society, while their partners or parents act as the main purchasers. The level of awareness of ecological agricultural products and the actual consumption behavior of the respondents with high education are nonconsistent; therefore, their higher level of ecological awareness and consumption intention do not translate into actual purchasing behavior. This finding is also consistent with the findings of Ping  and MingThe two main factors FAC1-1 (supportive) and FAC2-1 (opposed) extracted by factor analysis had a relatively significant effect on willingness to pay. Among them, FAC1-1 is positively correlated with willingness to pay, indicating that consumers with positive attitudes toward ecological agricultural products are more willing to pay extra price for ecological agricultural products, and the results are also consistent with the reality; FAC2-1 is negatively correlated with willingness to pay, indicating that consumers with negative attitudes toward ecological agricultural products are not willing to pay extra price for ecological agricultural products, and if this group of consumers can in the future If this group of consumers can realize the significance of ecological agricultural products for health and social sustainability in the future, they are likely to switch to buying ecological agricultural products.Among all the questions on the reasons for refusing to buy ecological agricultural products, the most common reasons are that consumers believe that general agricultural products are sufficient to meet their current daily needs and that ecological agricultural products are too expensive, accounting for 26.89% and 28.05%, respectively. Some consumers think that the market supervision department should strengthen the supervision of ecological agricultural products.This paper takes ecological agricultural products as the research object, collects information about 601 consumers' cognitive status and willingness to pay for ecological agricultural products in Harbin through an online questionnaire survey, analyzes the factors influencing their purchase of ecological agricultural products by establishing a binary logit consumer choice behavior model, and analyzes the factors influencing consumers' payment premium for ecological agricultural products through survival and finally calculates the average payment premium of consumers premium; the following conclusions are mainly obtained.Consumers' knowledge of ecological agricultural products is not high, and there is still more room for consumers' awareness of ecological agricultural products and sellers' publicity and popularization. By broadening consumers' access to information, a portion of consumers who are dissatisfied with the existing general agricultural products may be converted into consumption power to purchase ecological agricultural products; more than half of the consumers who have never purchased agricultural products are the key potential consumers of ecological agricultural products. Regarding the knowledge of ecological agricultural products, 71.8% of consumers do not know much about ecological agricultural products and still have cognitive bias, thinking that ecological agricultural products are only general agricultural products beautifully packaged and sold at high prices. However, through the purchase channels, we can find that with the popularity of Internet and the important role played by cell phones in daily life, it has become a mainstream channel to learn about ecological agricultural products through Internet.Based on the regression results of the survival analysis model, the factors that influence consumers' willingness to pay were analyzed. For basic information: consumers who often go to supermarkets are willing to pay more for ecological agricultural products; consumers who are less satisfied with the general agricultural products they buy are willing to pay more for ecological agricultural products; consumers who have bought ecological agricultural products and know more about ecological agricultural products are also willing to pay more for ecological agricultural products; consumers who learn about ecological agricultural products through friends and the Internet are also willing to pay more for ecological agricultural products. Consumers who learn about ecological agricultural products through friends and the Internet are also willing to pay extra for ecological agricultural products. Consumers who are optimistic and supportive of ecoproducts are more willing to pay, while those who are opposed to eco-products are less willing to pay, and the results are consistent with reality. Not the main member of the family is more inclined to accept ecological agricultural products; women and single are relatively more willing to accept ecological agricultural products. Age, however, is negatively correlated with the degree of acceptance. Meanwhile, consumers with higher education level and higher income are relatively more willing to pay. Finally, consumers' payment premium for ecological agricultural products is 24.95%, which means that consumers in Harbin can accept that purchasing ecological agricultural products is 24.95% more expensive than general agricultural products, then the market price of ecological agricultural products is suggested to be about 24.95% more expensive than general agricultural products.At this stage, consumers' understanding of ecological agricultural products is limited and still at the level of superficial awareness and less exposure. Consumers' perception of cost performance directly determines consumers' attitude and selection behavior, and the higher the level of perception, the easier consumers are to make acceptance behavior. Consumers' awareness of ecological agricultural products largely depends on the publicity power of the society. With the popularity of the Internet and the important role of cell phones in daily life, the market can increase the degree of purchase by improving online information propaganda and refreshing the traditional impression of ecological agricultural products. In addition, with the development of online selling of ecological agricultural products in full swing, choosing e-commerce form for online selling is another new way.The role of market promotion remains the focus of the future. The direction of government support often represents the future direction of industrial development, and the credibility and policy support of the government can effectively promote the development of special ecological agricultural products. Ecological agricultural products manufacturers and farmers need to better cater to the diverse needs of consumer groups, so as to lock in target consumers and finally achieve accurate marketing. To do so, consumers can directly access information about enterprises and ecological agricultural products, which provides convenience for enterprises to enhance their visibility and promote ecological agricultural products brands, and it is more conducive to the realization of international brand marketing of agricultural products.In this paper, a comprehensive statistical approach is used to study the influencing factors of consumers' purchase of ecological agricultural products, and an in-depth analysis of the reasons for consumers' refusal to pay is conducted to arrive at the most realistic willingness to pay and the related influencing factors, and a survival analysis model is constructed to study the level of premium payment. In this study, only the selected factors were investigated and studied to derive the influence of these factors on consumers' purchase of ecological agricultural products. The next study will continue to focus on other aspects of factors that may have an impact on consumers' purchase of ecological agricultural products, such as marketing methods and government regulation, to further explore the extent of the role of other influencing factors, so as to achieve on-demand supply. In addition, the location of this study is Harbin City, Heilongjiang Province, which is representative but may have some geographical limitations. Therefore, in order to achieve the universality and extensiveness of the research results, more regions will be studied in the future, so as to provide a basis for the marketing of ecological agricultural products producers and government policies.


The improvement of grain processing capacity is crucial to the realization of grain security. Enterprises are important grain processing bodies and their productivity directly determines grain processing capacity. Chinese grain processing enterprises still have difficulties, and how to further improve grain processing capacity and the total factor productivity of grain processing enterprises may be an important aspect. We used the meta-frontier Malmquist index to measure the total factor productivity of grain enterprises as well as judge the change trend and regional gap, applying the classical regression model to test the convergence of China’s overall and regional grain enterprises’ total factor productivity. This research finds that the total factor productivity of grain processing enterprises increased by 1.18% annually during the sample period, and that of the central region rose more quickly than the other areas of China. Technical progress contributes more to enterprises’ total factor productivity, but technical efficiency may become a key factor in determining it. The difference in the growth rate of the grain processing enterprises’ total factor productivity among different ones in the eastern and western regions is gradually narrowing, while that of the central region is gradually expanding; there is an obvious technological catch-up effect between and within the regions, especially in the central area of China. Grain is not only a crucial material basis for human survival, but also an important guarantee for ensuring national security in China. However, achieving grain security is not only dependent on the stability of grain production and stocks, but also closely related to its processing capacity. Since 2004, China’s grain output has grown every year. The grain output was 633 million tons in 2021, an increase of 34.97% compared to 2004. The grain processing industry, as a key link in the entire grain industrial chain, can turn production into supply and achieve a balance between production and sales, which plays an increasingly important role in promoting farmers’ employment and income, as well as agricultural value added and efficiency, and in addition to rural prosperity and development  . A value greater than 0 indicates positive spatial correlation; less than 0 indicates spatial negative correlation; equal to 0 is uncorrelated, that is, randomly distributed in space; and the absolute value of Moran’s I measures the degree of spatial correlation. The larger  the absolute value, the stronger (weaker) the spatial correlation  .We measured and decomposed the TFP of 245 grain enterprises in the eastern, central, and western regions from 2014 to 2017 under the two fronts of the non-parametric meta-frontier and the group frontier; compared and analysed the regional differences in grain enterprises’ TFP; and tested the convergence of eastern, central, and western grain enterprises’ TFP. The following conclusions were drawn: First, the TFP of China’s grain processing enterprises shows a growth trend, and the regional gap is obvious, mainly due to the differences within the region. The average annual growth rate of grain enterprises’ TFP in China and the eastern, central, and western regions was 1.18%, 0.90%, 1.41%, and 1.15%, respectively. The growth rate of grain processing enterprises’ TFP in the central region was significantly higher than that in the eastern and western ones. The regional disparity in the growth of grain enterprises’ TFP showed an evolution trend of first rising and then decreasing and it was mainly caused by hyper-variable density, followed by intra-regional disparity. Second, the TFP growth of Chinese grain enterprises is driven by TP. All Chinese grain enterprises have a development pattern in which TE deteriorates and TP increases, but the contribution of TE is greater than that of TP from 2014–2015, and the proportion of TE deterioration in the decline in the TFP of grain enterprises from 2016–2017 is much larger than that of technological regression, indicating that the level of TE is a key way to promote the growth of grain enterprises’ TFP. The more important method is to optimize the factor allocation of grain processing enterprises. Third, differences in TE between regions directly lead to differences in grain enterprises’ TFP and the TE of grain enterprises is in the range of 0.8418 to 0.8890 in the sample period. The TE level in the central region is the highest, followed by the eastern region, and the level is lowest in the western region. Fourth, the difference in the TFP growth rate of grain enterprises among different enterprises in the eastern and western regions is gradually narrowing while that of the central one is gradually expanding and there is an obvious technological catch-up effect between and within the regions, especially in the central one. Specific to the 30 provinces, it can be seen that the TFP growth of grain enterprises in each province is negatively correlated and the degree of spatial correlation gradually increases with time.Further discussion is presented as follows. First, the sample size may be insufficient, as we selected a sample of 245 leading enterprises among the national key leading agricultural ones. It should be noted that these are examples with strong production capacity and the judgement on the trend of the TFP of Chinese grain enterprises may be somewhat biased. Second, there is a lack of comparison of the efficiency of the main grain-producing areas; this paper divides the regions into eastern, central, and western regions according to the traditional division method, and does not divide the main grain-producing areas. The main reason is that the distribution of grain enterprises is too concentrated, which leads to a lack of necessary research samples in some main grain-producing areas. Third, this paper focuses on the comparison of TFP growth rates, which means that more consideration is given to the relative value of TFP changes; we did not analyse and compare the absolute value of grain enterprises’ TFP, which is different from previous research that uses more data from the China Statistical Yearbook. We used the sample of grain enterprises as an emphasis point sample, which allowed us to analyse China’s agricultural TFP from another level and provide other evidence. Of course, this is also the direction of any future improvements of the paper.We propose the following policy implications. First, governments in various regions of China must focus on improving the grain enterprises’ TFP in formulating relevant policies and reflect the differences, give full play to the specialties of grain production and processing in different regions, and strive to improve the overall grain processing capacity. Second, improving TE is an important way to promote the growth of the TFP of grain enterprises, and there is great room and potential for improving the TE of grain enterprises at this stage; therefore, to further optimize the allocation of enterprise factors, in addition to the investment of enterprise capital and labour, the more important element is the input of agricultural raw materials, especially to improve the substitution elasticity of factors such as capital, labour, and raw materials. Third, governments should strengthen intra-regional technical cooperation and exchanges, thereby promoting the flow of technical elements across regions and reducing differences between and within regions.


Crosstalk between cardiovascular system and kidney becomes apparent when failure in one system adversely impacts the other in a negative loop. The term cardiorenal syndrome became more popular in the past 10 years and commonly refers to the collective dysfunction of heart and kidney resulting in a cascade of feedback mechanism causing damage to both organs and is associated with adverse clinical outcomes. Indeed, a large number of patients with acute decompensated heart failure present with various degrees of heart and kidney dysfunction.Recently, cardiorenal syndrome has been categorized into 5 clinical subtypes that reflect the pathophysiology, the time frame, and the nature of concomitant cardiac and renal dysfunction . This clGabbin et al. reviewed in vitro options and advances mimicking the dynamic organ-organ crosstalk. For example, human induced pluripotent stem cells in combination with microfluidic chips represents a powerful tool with potential to recapitulate the characteristics of cardiorenal syndrome in vitro, thus offering a platform for therapy development. Human cohorts, animal models and human cell cultures together offer complementary approaches to study how complex hemodynamic, biochemical and hormonal factors contribute to the development of the cardiorenal syndrome. Often neglected in this heart-kidney crosstalk, mitochondria rapidly sense and respond to a wide range of stress stimuli. Shi et al. reviewed in vitro and animal studies that have identified an important role of mitochondrial dysfunction in heart failure and chronic kidney disease. They also discuss the current research evidence supporting that mitochondrial dysfunction is involved in various types of cardiorenal syndrome.To study this syndrome, some mouse and rat models are available in which both cardiac and renal dysfunction are induced , but theCaravaca Perez et al. have associated Galectin-3, a well-known inflammatory marker , a multifunctional protein with major functions as binding/transport for all vitamin D metabolites but also fatty acid transport, and immune system , which was related to higher all-cause mortality in patients with coronary artery disease undergoing percutaneous coronary intervention. In another study, Palazzuoli et al. as for them proposed that chronic kidney disease severity is related to adverse event occurrence, however, its impact may differ among different renal function trajectories and subtypes during hospitalization. Consequently, persistent deterioration and transient improvement of renal function appear to be the two patterns associated with increased risk.In addition to biomarkers, clinical parameters are followed and used to evaluate the course of the disease. For example, Minh et al. point that despite their widespread use in the congestive heart failure, the evidence for intravenous loop diuretic administration is not as robust as many other treatments for heart failure and its advantages may be outweighed by the substantial risk of electrolyte disturbances and worsening renal function. Further, there is no consensus on the time point for early starting of add-on therapy and for the preferred diuretic combination. In their design and rationale paper, the authors lay out a new clinical study, the diuretic resistance acute heart failure (DR-AHF) trial, to demonstrate the efficacy of the timely intense loop diuretic monotherapy and tolvaptan combination treatment in the early stage of congestive heart failure with renal dysfunction and provide the clinical evidence of diuretic resistance.Because it is a complex multifactorial disease, our knowledge on the cardiorenal syndrome is constantly improved, and so are our therapeutic strategies. Thereby, This collection of publications offers a sample of advances in the field of cardiorenal syndrome, from bench side to bed side. It covers cell culture models, cellular response to stress, biomarkers, clinical parameters and improvement of clinical practice. Further collections or review are still needed to improve our comprehension of this syndrome. For example, to cover the discovery and the biology of biomarkers emerging in related fields , 12–17, LC wrote the editorial. GK and EM-M have revised it for interpretation and content. All authors contributed to the article and approved the submitted version.LC is a co-shareholder of Reelin Therapeutics Inc. and co-inventor of a patent related to anti-Reelin strategies . The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Nurses play an important role in the management of chronic diseases. Here, we discuss the components of a novel system aimed at empowering patients living with chronic diseases, such as chronic obstructive pulmonary disease (COPD), in a context of precariousness for patients and health personnel, including nurses. This project aimed to evaluate the impact of nursing consultation and remote monitoring on the quality of life in patients with COPD. Two essential elements were linked to promote patient empowerment, which included a network of relationships among the community, hospital, and academic institutions as well as the promotion, contextualization, and co-management of therapeutic education programs among patients. Our results are applicable to all countries with vulnerable populations. Since the beginning of the 21st century, the increased incidence of noncommunicable diseases (NCDs), also known as chronic diseases, has been responsible for a massive increase in functional disability and mortality worldwide [The CCM is considered the most appropriate and widely used model for managing chronic diseases, particularly diabetes, chronic obstructive pulmonary disease (COPD), and cardiovascular disease, as it recognizes the central role of patients . Since 2The CCM and eHealth CCM were developed as a multidimensional solution to a complex problem. Both models rely on a team of motivated professionals, including nurses, who play a fundamental front-line role in educating patients and ensuring the continuity of care, thereby supporting patient–caregiver relationships and collaborative practices. Despite these advantages, the essential elements of effective collaborations have not yet been identified in these models. The strength-based nursing and healthcare (SBNH) approach, which was developed by Laurie Gottlieb promotes a notion of developing relationships, working with people based on their strengths and abilities, and enhancing individual control and decision-making, thereby highlighting the eight essential values for effective collaboration .However, Beaglehole indicated that most studies on service organizations providing quality chronic care delivery were conducted in high income countries . TherefoHerein, we discuss the results of a thesis project entitled “Neith program”, which aimed to improve the quality of life in patients with COPD in Lebanon and evaluate the impact of a nursing consultation and remote monitoring program on their quality of life and skills. First, the literature was reviewed to identify the essential components of a self-management program for patients with COPD. This was the basis for conducting a systematic review-type scoping review. Patient involvement was privileged in the ongoing implementation of this program; therefore, we conducted a phenomenological qualitative study to explore the life experience of these patients in Lebanon. The results of these two studies allowed the development of an intervention plan. To evaluate the feasibility and acceptability of this intervention in the Lebanese population, we conducted a feasibility study.The results of this program showed that patients with COPD in Lebanon prefer to be actively involved in the management of their disease, but their constant critical living environment, involving health, economics, politics, and security, diminished their capabilities to express their involvement. Capacity alone is inadequate for enabling people to achieve their goals. Positive conversion factors are needed to transform patients’ capacities into capabilities . Based oThis article presents the combination of the eHealth CCM and SBNH along with an overview of the Neith program. Finally, we proposed the components of a system that promote the capabilities of patients living with a chronic disease in a precarious context.The eHealth CCM and SBNH were selected for this study. Both models were based on the social learning theory  of Bandura (1977); the concept of self-efficacy, i.e., the patient has an active role in his/her care, is the central tenet of these models. However, none of the models fully consider this complex process. Although the eHealth CCM requires productive interactions between a team of practitioners and patients, it is not the optimal method to ensure a productive interaction; hence, the requirement for the SBNH approach was indicated by Lorie Gottlieb.Herein, we discuss McLennan’s (1995) concept of pluralism, which suggests that nursing researchers should consider other theories, concepts, and disciplines to understand a broader perspective of the discipline . AccordiIn 2011, Kolcaba K. and Kolcaba R. recommended that an integrative method can be used to combine two theories as long as the combination met the eight compatibility criteria. In addition, one or more of the pairings must be based on nursing to ensure a nursing perspective. This caveat is important for ensuring that any research is firmly grounded in the nursing perspective and can be identified as a nursing study rather than simply a study conducted by nurses .Accordingly, the eight heuristic criteria for determining the compatibility of the SBNH with eHealth CCM were examined. These criteria were; shared assumptions, cultural applicability, disciplinary boundaries, nursing education, focus of care, process or product distinction, shared values, and scientific orientation .Both models describe human beings as holistic. The eHealth CCM recognizes the central role of the patient in his or her care, a role that implies responsibility for his or her own health. Similarly, the SBNH views the individual as a unique being who functions as an integrated whole and has the capacity for growth, transformation and self-healing .In both models the person’s environment extends to include family, friends or even community and public resources. The person’s environment according to the SBNH contains powerful energies that act on the particular strengths and deficits that will determine how a person survives or succumbs in a given environment. The eHealth CCM views the person’s environment as the totality of public and community resources that influence the health of individuals . FurtherBoth theories have universal cultural applicability. They apply to all people regardless of age, beliefs, culture, ethnicity, and socio-demographic level. Neither of them stipulates any restriction.Although the two models chosen belong to two different disciplines, eHealth CCM from the social discipline and SBNH from the discipline of nursing, they are considered related as they both belong to the humanities and social sciences.Laurie Gottlieb’s work focuses on the development of strengths-based nursing as an approach to practice, leadership, management, and education. This approach is the result of an evolution of thinking about what nursing is and how nurses should fulfill their social mandate of health and healing.The Chronic Care Model does not belong in nursing theory, but patients and health systems around the world have benefited from Ed Wagner’s commitment to transforming healthcare. Best known for its innovation in chronic disease care, the CCM is widely recognized for its ability to guide health care teams in the management of patients with chronic diseases.The two models chosen in our study focus closely on chronic disease management. The eHealth CCM and SBNH envision patient learning in a collaborative dynamic that applies to all people regardless of age, culture, ethnicity, and socio-demographic level.Both models focus on process outcomes. Indeed, the primary outcome of the eHealth CCM is overall health behavior and effective self-management of chronic disease, while the SBNH envisions a collaborative dynamic in which the nurse understands how a person learns so that learning environments can be developed that allow patients to identify their resources and acquire new ones.In both models, the ultimate goal is that the patient adopts a self-management posture. Moreover, these models emphasize not only the place of factors purely intrinsic to the person in adopting a behavior, but also other extrinsic factors, notably the environment in which the person evolves and the social relationships that are implemented.Both models were designed based on Bandura’s social learning theory. As a result, we conclude that the two models are comparable and that the criteria are met for the integration of the eHealth CCM and SBNH.A Venn diagram was used to illustrate the association and intersection between these models, thus creating new perspectives .The Neith research program aimed to evaluate the impact of nursing consultation and remote monitoring on the quality of life in patients with COPD in Lebanon. Three studies were conducted within the program framework, which led to the development of a patient-centered intervention.First, a scoping review was conducted to identify the components of a self-management program on patients with COPD. The four components of the self-management programs included in our scoping review were as follows: initiation stage, educational sessions, support, and monitoring methods . Second,Throughout the implementation of the Neith program, the eHealth CCM and SBNH were useful for determining objectives, developing research questions and methods, and analyzing results. The purpose of this research program was based on the first concept underlying the SBNH , i.e., “healing and health,” which suggests that illness can be an opportunity to promote health through restoration , learning, and empowerment. In our program, we considered the uniqueness, holism, and indivisibility from a phenomenological perspective, which was the basis for the method of the second study in this program. Similarly, in the intervention, the patient, their family, and nurse developed an education plan that was adapted to the uniqueness of each individual.However, based on the results of our research program, a lack of support, particularly government support, emerged as a factor limiting the empowerment of patients and thus hindered the capabilities of patients with chronic diseases. Therefore, we proposed various components to strengthen the empowerment of patients with chronic diseases, such as COPD, in a context of precariousness and permanent challenges and crises .Gottlieb stated that a patient who is capable of self-determination is more likely to respect his/her choices and control his/her own health and care decisions. To achieve self-determination, a person must meet the following three requirements: autonomy, willingness to relate, and competence . The feaSelf-determination refers to the process through which a person makes his/her own decisions ; howeverThe results of our previous qualitative study showed the extent to which participants living in low-resource settings turn to their families; this is somewhat expected in a cultural context wherein the family is still considered the primary support . This coMoreover, the fact that patients mostly relied on their families rather than the community indicates that the awareness of available local governmental and nongovernmental health resources in LMICs such as Lebanon is an important aspect of patient education, as reported by Gagnayre and D’Ivernois  and WHO.The community services in Lebanon have increased owing to the political situation, wherein international aid  is offered to individuals rather than the government. The challenging economic situation in Lebanon hinders the ability of individuals to obtain medicines. This is because of restricted availability and/or high and nonrefunded prices as well as lack of access to hospital care due to high costs, making it necessary to increasingly link patients to the community through “relay services.” These services can be implemented in primary health care centers or other institutions in the localities. Computerized patient file systems are currently in place in some university hospitals in Lebanon, thereby facilitating the link between these relay services and hospital systems.Individuals in LMICs such as Lebanon face multiple challenges that can hinder their access to healthcare. In this context, telehealth could help democratize access to healthcare and reduce healthcare costs . SimilarIn some precarious contexts, healthcare systems usually emphasize the management of acute illnesses instead of chronic diseases. Moreover, due to budgetary restrictions and staff constraints, the role of nurses in hospitals or primary healthcare centers largely focuses on providing care rather than education for patients; this mostly depends on their workload.Currently, a satisfactory care plan cannot be achieved without educational support for the patient and their caregivers. Further, discharging the patient from the hospital without the knowledge and skills necessary for this transition is considered ethically unacceptable . TherefoA recent systematic review highlighted the importance of an approach known as “rapid predischarge education”, which may be effective in facilitating the hospital-to-home transition, thereby increasing patients’ skills and compliance and preventing or reducing early readmissions . AccordiTo date, the educational sessions that can provide the best improvement in a therapeutic education program remain unclear. However, the results of our feasibility study revealed that breathing and physical exercises and lifestyle sessions showed the highest acceptability rate .The shortage of nurses has led to an increase in the number of patients assigned to each nurse, which reduces the time devoted to individual patient needs  and makeA WHO report stated that healthcare professionals must be trained to deliver therapeutic education at two levels: a “basic” level for professionals and an “advanced” level for coordinators delivering therapeutic education . HoweverOwing to the impact of universities  on the sPeople with chronic diseases need to reorganize their lives and are confronted with new learning situations related directly to the disease and indirectly to the uncertainty of the disease . Our preOur findings strongly suggest that in cases of limited resources, learning is primarily based on the experiences of patients living with the disease ,27. AccoBased on the results of the research program Neith, a lack of government support emerged as a factor limiting the empowerment of patients with chronic diseases. Therefore, we proposed establishing a network of relationships that ensures collaborations with the patient as a basic component of a system promoting the empowerment of patients with chronic diseases, in a context of precariousness and permanent challenges and crises . We suggest implementing relay services to the community using telehealth to facilitate the link between the hospital and the community and incorporating community services within academic institutions, which could provide a service to the community while acting as a training ground for students within the university campus.The components proposed in this article are the result of the authors’ reflections on the axes that could strengthen the empowerment of patients with chronic diseases, in a context of precariousness and permanent challenges. Other elements could be added to give this proposal a more complete perspective.Encouraging governments and policy makers to implement new models for linking hospitals, communities, and academic institutions to achieve better quality of life in patients with chronic diseases remains a challenge. To fulfill the expectations of patients living with chronic diseases such as COPD, it is necessary to increase the awareness of the need for systematic approaches among political authorities and health professionals.Future research is warranted to evaluate the impact of models such as the eHealth CCM on the quality of life in patients living with a chronic disease in a precarious context and to assess the practical implementation of new programs to overcome these challenges.