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.

Objective:In alignment with the practical teaching objectives of Diseases of the Locomotor System and the competency requirements for graduates of military medical universities, this study conducted a multidimensional modification of the traditional objective structured clinical examination (OSCE) to provide a novel training mode that enhances the effectiveness of practical teaching of this course.Methods:The traditional OSCE was modified from the four dimensions of integration, individuality, immersion, and intelligence. The first three stations were set as "diagnosis" and the last three stations were set as "operation" to reflect the "integration" of diagnosis and treatment. The last station of "operation" was set as "medical cares of combat and training injuries" to reflect "individuality" of military medical training. The method of situation creation was used to reflect "immersion", and the application of intelligent terminals reflected "intelligence". The study involved 50 trainees who were assigned to either a modified OSCE group or a traditional teaching group through a random drawing process. The teaching effectiveness was assessed through evaluation of theoretical knowledge, practical skills, and participant satisfaction. The statistical analysis was conducted by SPSS 22.0, with parametric data assessed by t-tests and non-parametric data assessed by chi-square tests. Results:Before entering the department, there were no statistically significant differences in theoretical ( P=0.832) and practical ( P=0.513) scores between the two groups of trainees. However, after the internship, the modified OSCE group demonstrated significantly enhanced scores compared to the traditional teaching group, both in theory assessment [(93.88±1.92) vs. (90.76±2.85), P=0.001] and skill assessment [(94.32±1.25) vs. (91.68±2.82), P=0.001]. Additionally, the self-assessment of clinical capability improvement by the modified OSCE group was markedly higher across all dimensions than the traditional teaching group ( P=0.001). Furthermore, the evaluation conducted by basic combat unit on the job competency of graduated trainees indicated that the modified OSCE group outperformed the traditional teaching group in basic clinical diagnosis and treatment [(4.72±0.46) vs. (3.44±0.71), P=0.001], emergency management of combat and training injuries [(4.72±0.46) vs. (3.52±0.71), P=0.001], application of information technology [(4.44±0.71) vs. (3.91±0.80), P=0.029], basic military qualities [(4.40±0.71) vs. (3.92±0.91), P=0.043], mental health and resilience [(4.36±0.70) vs. (3.68±0.85), P=0.003], and the capacity for continuous learning [(4.64±0.70) vs. (3.83±0.76), P=0.001]. Conclusions:The modified OSCE teaching mode can better meet the practical teaching requirements for Diseases of the Locomotor System in the military medical university and thus holds promise for further application.

Objective:To prepare nanoscale docetaxel-loaded lipid microbubbles(DLLM),characterize their physical and chemical properties,evaluate their biosafety and anti-tumor effects in vitro,and explore their potential as a targeted delivery system for chemotherapeutic drugs.Methods:DLLM was prepared by thin film hydration method.The morphology,particle size and distribution were characterized by transmission electron microscopy,scanning electron microscopy and particle size analyzer.The drug encapsulation efficiency was determined by high performance liquid chromatography.Human hepatoma HepG2 cells were used as a model to set up the control group(Control group),the docetaxel group(DOC group),the docetaxel-loaded lipid microbubbles group(DLLM group)and the docetaxel-loaded lipid microbubbles+ultrasound group(DLLM+US group).The cell morphology was observed by optical microscope,the cell survival rate was detected by CCK-8 method,and the apoptosis was detected by flow cytometry.The biocompatibility of microbubbles and their mediated ultrasound-enhanced anti-tumor effect were evaluated.Results:The prepared DLLM was regular spherical,with a particle size distribution range of 200-600 nm,an average particle size of 380 nm,and an encapsulation efficiency of 80.3％±2.6％.The cell viability of the DOC group and the DLLM+US group was significantly lower than that of the Control group(P＜0.01),and the apoptosis rate was significantly increased(P＜0.01).The cell viability of the DLLM+US group was lower than that of the DOC group(P＜0.05),and the apoptosis rate was higher than that of the DOC group(P＜0.05).There was no significant difference in cell viability and apoptosis rate between the DLLM group and the Control group(P＞0.05).Conclusions:The nano-scale DLLM prepared in this experiment has uniform particle size,high encapsulation efficiency,good stability and biocompatibility.DLLM can enhance the killing and pro-apoptotic effects of docetaxel on HepG2 cells under ultrasound irradiation.

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.

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 investigate the relationship between expression of secreted protein acidic and rich in cysteine (SPARC) in hormone receptor (HR) -positive breast cancer tissues and clinicopathological characteristics and axillary lymph node metastasis.Methods:The clinical data of 202 patients with breast cancer in Shaanxi Provincial Cancer Hospital were retrospectively analyzed from Mar. 2021 to Mar. 2023. The expression of SPARC protein in the lesion tissues of all subjects at admission was detected by immunohistochemistry. On the basis of molecular typing, the patients were classified into HR-positive subgroup and non-HR-positive subgroup, and the difference in SPARC protein expression in the lesion tissues at admission was compared. According to the axillary lymph node metastasis status at 1 year of follow-up, patients with HR-positive breast cancer were assigned into metastasis group and non-metastasis group, and the expression of SPARC protein in the lesion tissues at admission was compared. HR-positive breast cancer patients were divided into positive group and negative group by means of the expression of SPARC protein at admission. The clinicopathological characteristics [age, tumor size, breast cancer TNM staging, vascular tumor thrombus, histological grading, estrogen receptor (ER), progesterone receptor (PR) ] were compared.Results:The positive expression of SPARC protein was significantly higher in HR-positive subgroup than in non-HR-positive subgroup ( χ2=7.28, P<0.05), and was significantly higher in metastasis group than in non-metastasis group ( χ2=7.29, P<0.05). The expression of SPARC protein in HR-positive breast cancer tissues was significantly different between ER and PR groups ( χ2=10.89, 11.08, P<0.05), and there was no statistical significance between the other groups ( χ2=0.25, 0.36, 1.24, 1.10, 2.41, P>0.05) . Conclusion:The expression of SPARC in HR-positive breast cancer tissues is higher, and it is related to clinicopathological characteristics ER and PR and axillary lymph node metastasis.

Objective The pathophysiological process of acute high-altitude hypoxia-induced lung injury affects protein expression levels,which are mainly evaluated by Western blot.No systematic study has investigated changes in internal control proteins as calibration loading amounts.Methods Lung injury at an altitude of 6000 m was induced in a low-pressure,low-oxygen chamber for 8,24,and 72 h using C57BL/6J mice.Establishment of the model was confirmed by hematoxylin and eosin staining.Expression levels of various internal control proteins,including vinculin,α-tubulin,eukaryotic translation initiation factor 5(EIF5),β-actin,and glyceraldehyde 3-phosphate dehydrogenase(GAPDH)were detected by Western blot,and total protein expression was detected by Coomassie blue staining.Furthermore,the lung injury model in vitro was establised by using,Bronchial epithelial cell(BZAS-2B)andhunman umbilical vein endothelial cells(HUVECS)confirmed by TUNEL staining.Expression levels of internal control proteins were detected by Western blot,and total protein expression was detected by Coomassie Blue staining.Results Acute 8,24,and 72 h hypoxic models were successfully established in lung tissue,demonstrating consistent total protein expression and stable levels of the internal reference proteins vinculin,α-tubulin,EIF5,andβ-actin.GAPDH expression was elevated in the HH8 h,HH24 h,and HH72 h groups compared with the normoxia(Nor)group,but only the increase at HH72 h groups was significant.Similarly,8,24,and 48 h hypoxic models were successfully established in BEAS-2B cells and HUVECs,with consistent total protein expression.In BEAS-2B cells,expression levels of the internal reference proteins β-actin and GAPDH were consistent with the normoxic control(NC)group,while vinculin,α-tubulin,and EIF5 expression levels were significantly reduced under hypoxic conditions for up to 24 h.In HUVECs,vinculin and α-tubulin expression levels were also consistent with the NC group,while EIF5,β-actin,and GAPDH expression levels were significantly reduced at 8 h and increased at 48 h.Conclusions Acute hypoxia induces lung tissue injury,and protein expression levels of the internal reference proteins vinculin,α-tubulin,EIF5,and β-actin are stable,making them suitable internal references for Western blot.Additionally,Western blot detected differential expression levels of the internal reference proteins vinculin,α-tubulin,EIF5,β-actin,and GAPDH in BEAS-2B cells and HUVECs,as the most important in vitro lung tissue models of hypoxia-induced injury.

Objective To systematically evaluate the effect of inspiratory muscle training(IMT)on weaning outcomes in patients with weaning failure.Methods Literatures in Chinese and English were retrieved from databases such as PubMed,Cochrane Library,Web of Science,Embase,CNKI,VIP,Wanfang data and CBM for researches on the effect of IMT in mechanical ventila-tion weaning failure,from the inception of the databases to October 22,2024.The methodological quality of the researches was evaluated with PEDro scale,and data were extracted for a systematic review.Results Nine randomized controlled trials were included,published between 2011 and 2023,from Brazil,China,the United States,Iran and Australia,with a total of 499 patients.The scores of the PEDro scale ranged five to eight.The population included patients with prolonged weaning,difficult weaning and tracheostomy.The IMT methods included threshold load training and tapered flow resistance training.The training intensity was 30%to 80%of maximal inspiratory pressure(MIP),and some researches did not set the training intensity based on MIP.The pro-gression of intensity varied widely across researches.The intervention frequency ranged from five to 30 breaths per set,with at least one minute rest between sets,two to six sets per session,one to two sessions per day,and five to seven days per week.The duration of the intervention ranged from successful weaning,one week after weaning,extubation,or four days to eight weeks.Regarding the efficacy of the intervention,IMT was not benefi-cial for the duration of mechanical ventilation and intensive care unit(ICU)length of stay on weaning failure pa-tients.However,the effect of IMT on weaning successful rates,duration of weaning,MIP and mortality was in-consistent.Conclusion IMT can not improve the duration of mechanical ventilation and ICU length of stay for weaning failure pa-tients,and there is still debate regarding its effect on successful rate of weaning,duration of weaning,MIP and mortality.

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.