Objective To analyze the changes of levels of serum soluble growth stimulation expressed gene 2 (sST2) and albumin (ALB) in patients with chronic heart failure (CHF) and their correlation with prognosis. Methods The data of 216 patients with CHF (CHF group) and 98 healthy subjects with physical examination (healthy control group) were retrospectively analyzed. The changes in levels of serum sST2 and ALB between both groups and among different grades of New York Heart Association (NYHA), and their correlation with NYHA grading and cardiac function and their diagnostic value on the prognosis in patients with CHF were compared. Results The level of serum sST2 and LVEF value of CHF group were significantly higher than those of healthy control group (P<0.05) while the level of serum ALB was significantly lower than that of healthy control group (P<0.05). There were significant differences in the levels of serum sST2 and ALB and LVEF value among patients with different HYHA grades and pairwise comparison between the any two grades (P<0.05). Serum sST2 level in patients with CHF was positively correlated with NYHA grading (P<0.001) and was negatively correlated with LVEF (P<0.001), and serum ALB level was negatively correlated with NYHA grading (P<0.001), and was positively correlated with LVEF (P<0.001). Serum sST2 level of poor prognosis group was significantly higher than that of good prognosis group (P<0.05) while serum ALB level was significantly lower than that of good prognosis group (P<0.05). ROC curve analysis of serum sST2 combined with ALB in diagnosing poor prognosis in CHF patients showed that the AUC and sensitivity were 0.907 and 98.04%, which were higher than the single diagnosis, and the specificity was 81.82%, which was lower than the single diagnosis. Conclusion The levels of serum sST2 and ALB in patients with CHF are correlated with NYHA grading and cardiac function, and the combination of the two indicators has high diagnostic value on predicting the poor prognosis of patients.

Childhood simple obesity has become a significant public health issue in China. Modern medicine primarily relies on lifestyle interventions and often suffers from poor long-term compliance， while pharmacological options are limited and associated with potential adverse effects. Traditional Chinese Medicine （TCM） has a long history in the prevention and management of this condition， demonstrating eight distinct advantages， including systematic theoretical foundation， diversified therapeutic approaches， definite therapeutic efficacy， high safety profile， good patient compliance， comprehensive intervention strategies， emphasis on prevention， and stepwise treatment protocols. Additionally， TCM is characterized by six distinctive features： the use of natural medicinal substances， non-invasive external therapies， integration of medicinal dietetics， simple exercise regimens， precise syndrome differentiation， and diverse dosage forms. By combining internal and external treatments， TCM facilitates individualized regimen adjustment and holistic regulation， demonstrating remarkable effects in improving obesity-related metabolic indicators， regulating constitutional imbalance， and promoting healthy behaviors. However， challenges remain， such as inconsistent operational standards， insufficient high-quality clinical evidence， and a gap between basic research and clinical application. Future efforts should focus on accelerating the standardization of TCM diagnosis and treatment， conducting multicenter randomized controlled trials， and fostering interdisciplinary integration， so as to enhance the scientific validity and international recognition of TCM in the prevention and treatment of childhood obesity.

ObjectiveTo investigate the mechanism of Huazhuo Jiedu prescription in treating ulcerative colitis （UC） by regulating mitophagy. MethodsThe genes related to mitophagy and UC were retrieved from GeneCards， and then the common genes of mitophagy and UC were analyzed by metascape to identify the genes related to mitophagy in UC. Animal experiments were carried out to decipher the mechanism by which Huazhuo Jiedu prescription treated UC by regulating mitophagy. Sixty C57BL/6 male mice were randomized into normal， model， high-， medium-， and low-dose （50， 25， 12.5 g·kg^-1， respectively） Huazhuo Jiedu prescription， and mesalazine （0.52 g·kg^-1·d^-1） groups， with 10 mice in each group. After successful modeling by the dextran sulfate sodium-free drinking method， the colonic mucosal damage was observed by hematoxylin-eosin staining， and the ultracellular structure of colon mucosa was observed by transmission electron microscopy. The expression levels of mitophagy-related proteins PTEN-induced putative kinase 1 （PINK1） and Parkin protein were determined by Western blot. The expression of prohibitin 2 （PHB2）， ubiquitin-specific protease 15 （USP15）， ubiquitin-specific protease 30 （USP30） in the colon tissue was detected by immunofluorescence （IF）. ResultsAll the drug intervention groups showed ameliorated pathological manifestations of the colonic mucosa and improved mitochondrial structures in UC mice. Compared with the normal group， the model group demonstrated up-regulated protein levels of PINK1 and Parkin （P<0.05）， enhanced average fluorescence intensity of PHB2 （P<0.05）， and weakened average fluorescence intensity of USP15 and USP30 （P<0.05）. Compared with the model group， the mesalazine group and the high- and medium-dose Huazhuo Jiedu prescription groups showcased down-regulated protein levels of PINK1 and Parkin （P<0.05）， decreased average fluorescence intensity of PHB2 （P<0.05）， and enhanced average fluorescence intensity of USP15 and USP30 （P<0.05）. The low-dose Huazhuo Jiedu prescription group showed down-regulated protein levels of PINK1 and Parkin （P<0.05）， weakened average fluorescence intensity of PHB2 （P<0.05）， and enhanced average fluorescence intensity of USP15 and USP30 （P<0.05）. ConclusionHuazhuo Jiedu prescription can attenuate the intestinal mucosal injury and improve the mitochondrial cell ultrastructure in UC mice by regulating the expression of PINK1-Parkin pathway and inhibiting excessive mitophagy.

ObjectiveTo investigate the mechanism of Huazhuo Jiedu prescription in treating ulcerative colitis （UC） by regulating mitophagy. MethodsThe genes related to mitophagy and UC were retrieved from GeneCards， and then the common genes of mitophagy and UC were analyzed by metascape to identify the genes related to mitophagy in UC. Animal experiments were carried out to decipher the mechanism by which Huazhuo Jiedu prescription treated UC by regulating mitophagy. Sixty C57BL/6 male mice were randomized into normal， model， high-， medium-， and low-dose （50， 25， 12.5 g·kg^-1， respectively） Huazhuo Jiedu prescription， and mesalazine （0.52 g·kg^-1·d^-1） groups， with 10 mice in each group. After successful modeling by the dextran sulfate sodium-free drinking method， the colonic mucosal damage was observed by hematoxylin-eosin staining， and the ultracellular structure of colon mucosa was observed by transmission electron microscopy. The expression levels of mitophagy-related proteins PTEN-induced putative kinase 1 （PINK1） and Parkin protein were determined by Western blot. The expression of prohibitin 2 （PHB2）， ubiquitin-specific protease 15 （USP15）， ubiquitin-specific protease 30 （USP30） in the colon tissue was detected by immunofluorescence （IF）. ResultsAll the drug intervention groups showed ameliorated pathological manifestations of the colonic mucosa and improved mitochondrial structures in UC mice. Compared with the normal group， the model group demonstrated up-regulated protein levels of PINK1 and Parkin （P<0.05）， enhanced average fluorescence intensity of PHB2 （P<0.05）， and weakened average fluorescence intensity of USP15 and USP30 （P<0.05）. Compared with the model group， the mesalazine group and the high- and medium-dose Huazhuo Jiedu prescription groups showcased down-regulated protein levels of PINK1 and Parkin （P<0.05）， decreased average fluorescence intensity of PHB2 （P<0.05）， and enhanced average fluorescence intensity of USP15 and USP30 （P<0.05）. The low-dose Huazhuo Jiedu prescription group showed down-regulated protein levels of PINK1 and Parkin （P<0.05）， weakened average fluorescence intensity of PHB2 （P<0.05）， and enhanced average fluorescence intensity of USP15 and USP30 （P<0.05）. ConclusionHuazhuo Jiedu prescription can attenuate the intestinal mucosal injury and improve the mitochondrial cell ultrastructure in UC mice by regulating the expression of PINK1-Parkin pathway and inhibiting excessive mitophagy.

Objective: To investigate the environmental contamination of norovirus in nurseries and primary/secondary schools, so as to provide a scientific basis for effective prevention and control measures. Methods: A total of 483 external environmental samples were collected from 34 cluster outbreaks of norovirus gastroenteritis in kindergartens and primary/secondary schools in Linhai City from 2021 to 2024. Pathogen detection was conducted using a rapid nucleic acid extraction kit and realtime fluorescence RT-PCR, and the results were analyzed using the χ2 test or Fishers exact test. Results: Among the collected external environmental samples, the total positive rate of surface contamination was 13.66%. The positive rates in kindergartens and primary/secondary schools were 12.20% and 15.82%, respectively. In kindergartens, the five surfaces with the highest detection rates were desks/chairs (23.33%), toilet stool troughs (20.69%), urinal troughs (12.00%), washbasins/sinks (11.11%), and toilet mops (9.38%). In primary/secondary schools, the top five were toilet stool troughs (38.30%), urinal troughs (23.53%), toilet door handles (13.04%), toilet mops (12.50%), and drinking cups (11.11%). The difference in positive detection rates among different external environments in primary/secondary schools was statistically significant (Fishers exact probability test, P<0.01). The positive detection rate in sanitary toilets was higher than that in classroom environments (χ2=17.38), while the positive detection rate in classroom environments of kindergartens was higher than that in primary/secondary schools (χ2=5.42)(P<0.05). Conclusions Norovirus exhibits a high contamination rate in nurseries and schools, particularly in restroom areas. Strengthening sanitation and disinfection in highrisk environments, and improving hygiene awareness among children and staff, are essential for the effective prevent and control of norovirus.

Objective:To investigate intraoperative pathological findings and the interventional effects of "deep cervical lymphaticovenous anastomosis+" (dcLVA+) on deep cervical lymphatic drainage as well as the blood flow of carotid artery and jugular vein in elderly patients with cognitive impairment, and to put forward the thoughts based on the findings from the surgery.Methods:Between May 2024 and December 2024, retrospective analysis of Microsurgery Hospital, Fengcheng Hospital, Xi'an Medical College performed dcLVA+ between the deep cervical lymphatics or lymph nodes and jugular veins in 50 elderly patients with cognitive impairment (19 males and 31 females, aged 55-88 years with 69.94 years in average). Nine patients were found with Clinical Dementia Rating (CDR) score at 1 (mild), 7 with CDR score at 2 (moderate) and 34 with CDR score at 3 (severe). Intraoperative observations based on literature reviews had identified anatomical relationships between the lymphatic sacs containing cervical lymphatic chain and the carotid sheath. The lymph node count, size, distribution, thickness of fat tissue and conditions of lymphatic vessels were documented. Ultrasound was used to compare the blood flow of carotid artery and jugular vein as well as the cross-sectional areas at the planes of hyoid and cricoid cartilage before and after the closure of incisions under anaesthesia in 39 patients. Correlation analyses for Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCa), Activities of Daily Living (ADL) and Agitation behavior score before and 1 week after surgery were performed using Spearman's correlation and Wilcoxon paired tests. P<0.05 was considered statistically significant. Postoperative follow-ups were conducted via the visit of outpatient clinic and WeChat and telephone interviews. Results:In surgery, the cervical lymphatic chain was found running within an almost enclosed sac surrounding the carotid sheath. There were enlarged lymph nodes, increased fat deposition, lymphatic dilation or fibrosis in the sac. The preoperative blood flow in the carotid artery at the planes of hyoid and cricoid cartilage in the 39 patients was recorded at 150.52 ml/min±40.33 ml/min and 358.29 ml/min±129.30 ml/min, while that in the jugular vein was at 172.50 ml/min±63.94 ml/min and 317.00 ml/min±105.21 ml/min, respectively, both were far lower than the normal blood flow. There were statistically significant differences in the blood flow of carotid artery and jugular vein before and after surgery ( P<0.01). It was found that the preoperative blood flow of the internal carotid artery at the plane of hyoid was positively correlated with the preoperative scores of MMSE ( P<0.01), MoCa ( P<0.05) and ADL ( P<0.01). The blood flow of the common carotid artery at the plane of cricoid cartilage was found significantly and positively correlated with the preoperative scores of MMSE ( P<0.05). It was also noted that the blood flow of the internal carotid artery at the plane of hyoid was significantly and positively correlated with the postoperative ADL ( P<0.01) but negatively correlated with the Agitation behavior score ( P<0.05). The blood flow of the common carotid artery at the plane of cricoid cartilage was significantly and positively correlated with the postoperative scores of MMSE and MoCa ( P<0.05). The blood flow of the internal jugular vein at the plane of hyoid was negatively correlated with the Agitation behavior score ( P<0.01). The cross-sectional area of carotid artery at the plane of left hyoid was significantly and positively correlated with the MMSE score ( P<0.05). Statistically significant differences were observed in MMSE, MoCa, ADL and Agitation behavior score before and after surgery ( P<0.01). Conclusion:dcLVA+ shows a certain therapeutic benefit to the elderly patients with cognitive impairment. The intraoperatively observed pathological changes in cervical lymphatic sacs affect deep cervical lymphatic drainage and the blood flow of carotid artery and jugular vein. Further studies are necessary to find out whether the findings from this study would be the specific pathological changes and the morbidity mechanisms among the elderly patients with cognitive impairment.

Objective:To analyze the awareness of and factors influencing the adjusted national immunization schedule for the diphtheria-tetanus-acellular pertussis (DTaP) vaccine among grassroots immunization service personnel in China.Methods:Based on the snowball sampling method from January to February 2025, immunization service personnel from all provinces of China were selected from the "Tingting Experts Talk" WeChat platform, with concurrent dissemination through the "National Vaccine-Preventable Diseases Communication Group" WeChat group. The questionnaire included basic demographic characteristics and knowledge of the DTaP vaccine immunization policy (13 questions in total). Respondents who answered ≥10 questions correctly were defined as being aware of the policy adjustment. The multivariable logistic regression analysis was performed to identify factors influencing awareness.Results:A total of 8 030 valid questionnaires were collected from 29 provinces, with a valid response rate of 92.91%. The overall awareness accuracy rates among the Centers for Disease Control and Prevention (CDC) personnel and the point of vaccination (POV) staff were 74.1% and 62.5%, respectively. The awareness rate of the core points of policy adjustment among the research subjects exceeded 90%. Among the questions regarding the operational details of policy implementation, the correct rate of answering questions related to the catch-up vaccination principles was relatively low (37.1%-74.0%). The multivariate logistic regression analysis showed that, compared with those with primary titles, CDC personnel with senior titles had higher mastery of the policy adjustment, with an OR (95% CI) value of 2.238 (1.343-3.730). Compared with those engaged in disease surveillance and immunization strategy research, CDC personnel with other work types had lower awareness of the policy adjustment, with an OR (95% CI) value of 0.404 (0.195-0.833). Compared with those in western regions, with primary titles, and without relevant training, POV staff in central regions, eastern regions, with intermediate titles, with senior titles, with one relevant training session, and with ≥2 relevant training sessions had better awareness of the program adjustment, with OR (95% CI) values of 1.214 (1.085-1.358), 1.412 (1.246-1.600), 1.606 (1.446-1.784), 1.737 (1.443-2.091), 2.254 (1.509-3.366), and 2.674 (1.769-3.981), respectively. Compared with those engaged in information registration/recipient notification, POV staff with vaccination services and other work types had lower awareness of the program adjustment, with OR (95% CI) values of 0.713 (0.633-0.803) and 0.508 (0.427-0.604), respectively. Conclusion:Although grassroots immunization service personnel show an insufficient mastery of certain catch-up vaccination knowledge, they demonstrate a good understanding of overall principles and routine immunization schedules shortly after the policy adjustment, which can effectively ensure an orderly transition between old and new immunization strategies.

Objective:This study aimed to evaluate the long-term efficacy and safety of rituximab(RTX)combined with calcineurin inhibitors(CNI)in the treatment of refractory nephrotic syndrome(RNS).Methods:A total of 80 patients with steroid-dependent/resistant RNS were prospectively enrolled and randomly assigned to an observation group(RTX+CNI,n=40)and a control group(CNI monotherapy,n=40).Patients were followed up for 24 months.Dynamic comparisons were made between the two groups regarding complete remission rate,relapse rate,24-hour urinary protein,kidney injury molecule-1(KIM-1),and adverse reactions.Results:The complete remission rate(CR)in the observation group was significantly higher than that in the control group at all time points(24-month CR:100％vs 90％,P＜0.05).The 24-month relapse rate was significantly lower in the observation group compared to the control group(0％vs 10％,P＜0.05).Combination therapy significantly reduced 24-hour urinary protein levels(6 months:2.13±0.63 vs 3.86±1.01 g/24 h,P＜0.001)and the renal injury marker KIM-1(6 months:1.53±0.41 vs 2.23±0.65 ng/mL,P＜0.001),and increased the CD4+/CD8+ ratio(24 months:2.03±0.52 vs 1.72±0.41,P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(15％vs 20％,P=0.556).Conclusion:RTX combined with CNI significantly improves the long-term remission rate and reduces the risk of relapse in RNS.Its dual immunomodulatory and multi-target renal protective effects provide evidence-based support for optimizing the treatment of refractory nephrotic syndrome.

Objective:The development and application of end-of-life patient decision aids for elderly were systematically reviewed and analyzed in order to supply guidance for the design of localized patient decision aids in China.Methods:Using the Scoping Review Guidelines as a methodological framework, a systematic search was conducted across databases including China National Knowledge Infrastructure, Wanfang, China Biology Medicine, PubMed, Web of Science, Embase, Cochrane Library, CINAHL, and BIOSIS. The search period covered from the inception of these databases to October 31, 2023. Two professionally trained researchers were responsible for screening, extracting, and organizing the retrieved literature.Results:A total of 5 studies on decision aids were included. These primarily employed paper graphics, interactive web pages, or multimedia slides as formats. The content encompassed various aspects such as palliative care options along with their pros and cons, assisting patients in clarifying their personal values, encouraging patients to document their decision-making preferences, and initiating end-of-life conversations with family members. Age-friendly design strategies were adopted in 4 studies; efficacy was validated in 3 studies, and in two of these studies, significant improvements were observed in engagement of patients (or substitute decision-makers) in ACP and the consistency of decision preferences (both P< 0.05). Conclusions:End-of-life decision aids for elderly patients can improve decision-making outcomes to some extent, however, the form and quality standards of them need to be improved, and their long-term effect needs further research and verification. It is recommended that in the future, the needs for end-of-life decision-making should be properly assessed based on the health literacy level, and high-quality localized end-of-life decision aids should be developed and popularized.

Objective:To develop a culturally adapted Advance Care Planning (ACP) Decision Balance Scale for Family Members of Patients with Advanced Cancer in China, and to test its reliability and validity.Methods:Based on the transtheoretical model-decisional balance framework, the item pool was established through literature analysis, qualitative interviews, and research team discussions. After expert panel meetings and semantic debugging pre-surveys among family members of patients with advanced cancer, item screening was conducted to form the pilot scale. From October to December 2024, the scale was administered to 310 family members of inpatients with advanced cancer in five Class Ⅲ Grade A hospitals in Chongqing. SPSS and AMOS software were used for item analysis and reliability and validity testing, and the final formal scale was developed.Results:The ACP Decision Balance Scale for Family Members of Patients with Advanced Cancer consisted of 2 dimensions, perceived cost of choice and perceived benefit of choice, with a total of 12 items. The Cronbach's α coefficient of the scale was 0.875, the split-half reliability was 0.905, and the test-retest reliability was 0.856. The item-level content validity index ranged from 0.880 to 1.000, and the scale-level content validity index was 0.980. Exploratory factor analysis extracted 2 common factors, with a cumulative variance contribution rate of 65.365%. Confirmatory factor analysis showed χ 2/ df=1.743, and the model fit indices met the requirements. The scale also demonstrated good convergent validity and discriminant validity. Conclusions:The ACP Decision Balance Scale for Family Members of Patients with Advanced Cancer developed in this study demonstrated good reliability and validity. It can be used as a tool to assess the level of ACP decision-making participation of family members of patients with advanced cancer, and to systematically, comprehensively, and effectively evaluate, collect, and analyze their behavioral intentions and barriers regarding ACP decision-making.