Icodextrin peritoneal dialysis solution may produce cytotoxic α-dicarbonyl degradation products during heat sterilization, which must be monitored and controlled. The study established an o-phenylenediamine (OPD) derivatization HPLC-MS/MS method for the detection of these degradation products, enabling qualitative and quantitative analysis of α-dicarbonyl degradation products in icodextrin peritoneal dialysis solution. The results indicated that the main α-dicarbonyl degradation products in icodextrin peritoneal dialysis solution are 3-deoxyglucosone (3-DG), 3-deoxygalactosone (3-DGal), 4-deoxyglucosone (4-DG), and 3,4-dideoxyglucosone-3-ene (3,4-DGE), along with two monocarbonyl degradation products, furfural and 5-hydroxymethylfurfural. The quantitative method for 3-DG, 3-DGal, 3,4-DGE and their structural analog, glucosone, was validated. 3-DG, 3-DGal, and glucosone exhibited good linear relationships within the range of 5-150 ng/mL, while 3,4-DGE showed good linearity in the range of 1-150 ng/mL. The spiked recovery rates for all compounds were between 86.8% and 100.0%. The detection limits for glucosone, 3-DG, and 3-DGal were approximately 2.4 ng/mL, and approximately 0.5 ng/mL for 3,4-DGE. The method established in this study can accurately determine α-dicarbonyl degradation products in icodextrin peritoneal dialysis solution, providing an important basis for the quality control.

Parkinson's disease （PD） is a neurodegenerative disorder primarily characterized by motor dysfunction. Traditionally， its main clinical features include resting tremor， muscular rigidity， bradykinesia， and postural balance disorders. However， an increasing number of studies have shown that its non-motor symptoms （NMS） exert an even greater impact on patients' quality of life than motor symptoms， severely affecting daily functioning and increasing the burden on families and society. Among these， depression is one of the most common and most debilitating NMS， with statistics indicating that the incidence of depression among PD patients reaches as high as 40%-50%. The pathological mechanisms are complex， involving the interplay between degenerative changes in dopaminergic neurons and disruptions in emotional regulatory circuits， which poses a substantial challenge to clinical treatment. Traditional Chinese medicine （TCM）， characterized by holistic regulation and multi-target intervention， has demonstrated significant advantages in the treatment of PD and depression， offering new insights for managing PD-depression comorbidity. This study integrates research extracted from multiple databases， including PubMed， Web of Science， Google Scholar， and China National Knowledge Infrastructure （CNKI）， that investigates the potential mechanisms of PD and depression as well as TCM-based treatments for these conditions. The aim is to elucidate the shared pathological mechanisms underlying PD and depression and to explore the therapeutic potential of TCM in effectively combating PD-depression comorbidity through these shared mechanisms， thereby providing valuable insights for the development of targeted therapies.

ObjectiveTo explore the mechanisms through which Si Junzitang （SJZD） ameliorates Alzheimer's disease （AD） induced by scopolamine （SCOP） in mice and the PC12 cell model induced by H₂O₂ based on the Kelch-like ECH-associated protein 1 （Keap1）/nuclear factor erythroid 2-related factor 2 （Nrf2）/heme oxygenase-1 （HO-1） signaling pathway. MethodsIn the animal experiments， an AD model was established in mice by intraperitoneal injection of SCOP （3 mg·kg^-1）. Morris water maze and open field tests （OFT） were conducted to assess learning and memory abilities. Hematoxylin-eosin （HE） staining and Nissl staining were performed to observe pathological changes in neurons. Immunofluorescence was used to detect amyloid β-protein_1-42 （Aβ_1-42） expression， and immunohistochemistry was employed to detect phosphorylated （p）-Tau expression. Transmission electron microscopy （TEM） was employed to observe ultrastructural changes in hippocampal neurons and synapses. Biochemical methods were used to measure the levels of acetylcholine （ACh）， acetylcholinesterase （AChE）， superoxide dismutase （SOD）， malondialdehyde （MDA）， catalase （CAT）， and lactate dehydrogenase （LDH）. Real-time PCR and Western blot were employed to measure the mRNA and protein levels of molecules in the Keap1/Nrf2/HO-1 pathway in the hippocampus. In the cell experiments， a PC12 cell model of oxidative damage model was established with H₂O₂. Cell count kit-8 （CCK-8） assays and flow cytometry were adopted to measure cell viability and apoptosis rates， and Western blot was employed to quantify the expression levels of proteins in the Keap1/Nrf2/HO-1 pathway. ResultsThe animal experiments showed that compared with the model group， the SJZD and donepezil groups showed shortened escape latency （P<0.01）， increased time in the target quadrant and platform crossings， and increased movement distance and duration in the central area of the open field （P<0.05， P<0.01）. HE and Nissl staining showed more organized neurons and increased Nissl bodies in the drug intervention groups （P<0.05， P<0.01）， and the Aβ_1-42 and p-Tau expression levels were downregulated （P<0.05， P<0.01）. TEM revealed reduced ultrastructural damage in hippocampal neurons and synapses in the drug intervention groups. In addition， the drug intervention groups showed declined levels of MDA， LDH， and AChE （P<0.05， P<0.01）， elevated levels of SOD， CAT， and ACh （P<0.05， P<0.01）， reduced Keap1 expression and increased Nrf2， HO-1， and NQO1 expression in the hippocampus （P<0.05， P<0.01）. The cell experiments showed that compared with the model group， the SJZD-containing serum increased the cell viability （P<0.05， P<0.01）， and decreased total apoptosis rates （P<0.05， P<0.01）. The drug intervention groups showed upregulated protein levels of Nrf2 and HO-1 and downregulated protein level of Keap1 （P<0.05， P<0.01）. ConclusionSJZD demonstrates protective effects against SCOP-induced AD in mice and H₂O₂-induced damage in PC12 cells through antioxidant mechanisms mediated by the Keap1/Nrf2/HO-1 pathway.

Objective To develop and validate a safety assessment scale for early mobilization in lung transplant patients after surgery.Methods From September 2022 to April 2023,a preliminary scale was constructed using literature analysis,expert meetings,and the Delphi method.From June 2023 to May 2024,a convenience sampling was used to select 135 patients admitted to the lung transplant center of a tertiary general hospital in Jiangsu Province.Item analysis,reliability analysis,and validity analysis were applied to adjust the items,forming the final scale.Results The post-operative early mobilization safety assessment scale for lung transplant patients includes 5 dimensions(consciousness level,vital signs,disease-related factors,mobility,and nutritional status)and 18 items.The inter-rater reliability of the scale is 0.985;the overall content validity index is 0.853;the split-half reliability is 0.716.The area under the receiver operating characteristic curve for predicting adverse events within 72 hours of mobilization is 0.845,with a 95％confidence interval of 0.767 to 0.917(P＜0.001).The optimal cutoff value is 18.5,with a sensitivity of 0.735 and a specificity of 0.782.Conclusion The developed safety assessment scale for early mobilization in lung transplant patients after surgery demonstrates good reliability and validity,and it can serve as a clinical tool to assess the safety of early mobilization activities in these patients.

Objective:To analyze and explore the selection of secondary intervention strategies for residual issues following congenital aortic valve disease surgery in children, as well as to evaluate their prognostic efficacy.Methods:A retrospective analysis was conducted on the clinical data of 41 children with residual issues after congenital aortic valve disease surgery, who were treated at the Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, between January 2013 and August 2024. Among them, 25 were male and 16 were female, with a mean age of(116.8±45.1)months and a mean weight of(40.0±20.2)kg. The mean interval for secondary intervention was(60.0±36.4)months. The residual issues included aortic valve insufficiency(20 cases), aortic valve stenosis(11 cases), and combined aortic valve insufficiency and stenosis(10 cases).Results:Secondary interventions included aortic valve repair(7 cases), mechanical valve replacement(20 cases), Ross procedure(13 cases), and Ozaki procedure(1 case). Additionally, 5 cases with left ventricular outflow tract stenosis underwent concomitant Konno surgery.One case of early postoperative in-hospital death occurred, with a mortality rate of 2.4%, primarily due to acute left heart failure and multiple organ dysfunction. The average follow-up period for surviving children was( 64.6±34.5) months(5-147 months), with no mid- to long-term mortality. Follow-up results showed that In surviving children, the left heart showed significant reduction in size postoperatively, with the LVEDD Z-score decreasing from 1.24±2.23 before surgery to -0.97±1.48( P=0.001). Postoperative LVEF 0.66±0.06 showed no significant difference compared to pre-reintervention 0.68±0.10( P=0.140). In aortic stenosis(AS) patients, the peak transvalvular pressure gradient decreased from(69.5±19.8) mmHg(1 mmHg=0.133 kPa) preoperatively to(25.1±10.9) mmHg postoperatively( P=0.003). In aortic insufficiency(AI) patients, the width of the aortic regurgitation jet decreased from(5.8±1.1) mm preoperatively to(2.7±1.1) mm postoperatively( P=0.012). 97.5% of children maintained mild-to-moderate aortic regurgitation(jet width <4 mm), with only 1 case of moderate regurgitation(jet width 4.4 mm)remaining under close observation.Two children underwent reoperation on the aortic valve, with a tertiary intervention rate of 5.0%. One case underwent redo commissurotomy 21 months after aortic valve repair due to recurrent stenosis, and the other underwent mechanical valve replacement 34 months after the Ozaki procedure due to leaflet calcification and infective endocarditis. Mid-term follow-up revealed good cardiac function recovery in surviving children, with 87.5% achieving NYHA functional class Ⅰ/Ⅱ. Conclusion:Due to the demands of growth and development and the degenerative nature of valve tissue, residual issues are inevitable in the mid- to long-term following congenital aortic valve disease surgery in children, often necessitating secondary intervention. Given the lack of suitable autologous valve tissue, the use of aortic valve replacement has significantly increased in secondary interventions. The Ross procedure, as an ideal secondary intervention, demonstrates satisfactory mid-term follow-up outcomes. For children with high-risk factors for the Ross procedure, mechanical valve replacement also yields favorable prognoses.

Objective:To adapt and validate the Chinese version of the Supervisory Relationship Questionnaire(SRQ)and evaluate its psychometric properties among supervisees.Methods:Item analysis,exploratory factor anal-ysis(EFA)and confirmatory factor analysis(CFA)were conducted on data from 888 supervisees recruited via on-line platform.Test-retest reliability over a four-week interval was examined in a randomly selected subset of 70 su-pervisees.An additional sample of 367 supervisees completed the Supervisory Relationship Scale(SRS)to evaluate criterion validity.Results:The revised SRQ contained 65 items and 6 factors.Both exploratory factor analysis and confirmatory factor analysis supported six-factor structure(safe base,structure,commitment,reflective education,role model and formative feedback),explaining 66.52％of the variance,with factor loadings of the items ranging from 0.58 to 0.83.The revised SRQ had six factors with good fit indices(x2/df=1.31,GFI=0.81,NFI=0.87,CFI=0.97,TLI=0.90,IFI=0.91,RMSEA=0.03,SRMR=0.05).The scores of the revised SRQ were positively correlated with the scores of SRS(ICC=0.96,P＜0.01).The Cronbach α coefficient of the revised SRQ was 0.97,and the test-retest reliability coefficient(ICC)was 0.74.Conclusion:The SRQ-C demonstrates sound psy-chometric properties,including structural validity,criterion-related validity,internal consistency,and temporal stabil-ity.It is a reliable and valid instrument for assessing supervisory relationships from the supervisee perspective.

Objective:To explore the clinical features and genetic mutation sites of 28 patients with Congenital fibrinogen disorders (CFDs).Methods:A total of 28 unrelated CFDs patients admitted to Wenzhou People′s Hospital from June 2018 to April 2023 were enrolled into this research. A total of 2.7 mL of peripheral blood was collected from each patient for coagulation function tests, which included thrombin time (TT), fibrinogen activity (Fg: C), fibrinogen antigen (Fg: Ag), and gene detection. The Sanger sequencing method was employed to verify variations in the fibrinogen (Fg) protein-coding gene across 28 patients. Bioinformatics analyses, including harmfulness analysis, conservation analysis across different species, and spatial simulation predictions of variant proteins, were conducted by PolyPhen-2, PROVEAN, SnapGene, and Pymol softwares on the variant sites of these patients. Pathogenicity ratings for the detected variant sites were performed in accordance with the Standards and Guidelines for the Interpretation of Sequence variants by the American College of Medical Genetics and Genomics (ACMG) (hereafter referred to as the ACMG Guidelines). This study received approval from the Ethics Committee of Wenzhou People′s Hospital (Approval No. KY-2023-269), and informed consent was obtained from all participants before enrollment.Results:The clinical and genetic characteristics of 28 patients with CFDs in this study were as follows. ①Clinical data: Among the 28 patients, 2 cases were diagnosed with type I CFDs, while 26 cases were diagnosed with type II CFDs. And 50.0% (14/28) of the patients exhibited no clinical manifestations, while 28.6% (8/28) presented with bleeding manifestations, and 7.1% (2/28) exhibited thrombus manifestations, 3.6% (1/28) experienced both bleeding and thrombosis. Among female patients, 13.0% (3/23) exhibited a history of habitual abortion. All patients demonstrated TT and a significant decrease in Fg: C. ②Sanger sequencing revealed a total of 10 types of heterozygous variations in the FGA, FGB, and FGG genes across 28 patients, distributed among 9 loci. The variation at the γ c. 902G>A/c.901C>T accounted for the highest proportion (35.7%, 10/28), followed by the Bβ c. 569 A>G (28.6%, 8/28). ③Biological informatics analysis: the Aα c. 180+ 1G>T mutation was predicted to be highly deleterious. And the Aα c. 104G>A, Bβ c. 425T>G, Bβ c. 586C>T, and γ c. 902G>A/c.901C>T variations were also predicted to be harmful. Conservation analysis indicates that the 9 variant sites were highly conserved among homo sapiens, musculus, ovis aries, scrofa, and rattus. Spatial conformation analysis revealed that some variations lead to an increase or decrease in the number of hydrogen bonds. ④ACMG guideline rating analysis: Among the ten variations in the Fg protein-coding genes FGA, FGB, and FGG identified in 28 patients, 9 variations (Aα c. 104G>A, Aα c. 180+ 1G>T, Bβ c. 425T>G, Bβ c.569A>G, Bβ c. 586C>T, Bβ c. 643G>A, γ c. 901C>T, γ c. 902G>A, γ c. 1001A>C) were classified as pathogenic, while one variation (γ c. 908C>G) was classified as likely pathogenic. Conclusion:In this study, the majority of CFDs patients are diagnosed with type II CFDs, with 50% presenting clinical symptoms predominantly manifesting as bleeding, thrombosis, and recurrent miscarriage. The mutation hotspots are mainly located in exon 2 of FGA, exon 4 of FGB, and exon 8 of FGG.

A 57-year-old male patient with lung adenocarcinoma accompanied by brain metastasis received radiotherapy and chemotherapy with poor efficacy. Subsequently, he was given camrelizumab at a dose of 200 mg intravenously once every 21 days, combined with intermittent chemotherapy or targeted drug therapy. After 22 months, the patient developed right eye pain with visual loss. Slit lamp examination showed a transverse oval shallow ulcer with clear boundary, clean surface and a maximum diameter of about 6 mm in the center of the cornea of the right eye, with positive fluorescein staining. Immune-related corneal ulcers due to camrelizumab were considered. Camrelizumab was discontinued, and the patients′ ocular symptoms were gradually improved after systemic and local glucocorticoid and corneal repair drugs were given. Seven months later, due to the patient did not follow the doctor′s advice to replace eye drops, overuse of glucocorticoid occurred, resulting in perforation of the original ulcer. The glucocorticoid-containing eye drops was discontinued, the patient underwent amniotic membrane grafting combined with amniotic membrane patching on the right eye, and the patient's condition was improved.

Objective To develop and validate a safety assessment scale for early mobilization in lung transplant patients after surgery.Methods From September 2022 to April 2023,a preliminary scale was constructed using literature analysis,expert meetings,and the Delphi method.From June 2023 to May 2024,a convenience sampling was used to select 135 patients admitted to the lung transplant center of a tertiary general hospital in Jiangsu Province.Item analysis,reliability analysis,and validity analysis were applied to adjust the items,forming the final scale.Results The post-operative early mobilization safety assessment scale for lung transplant patients includes 5 dimensions(consciousness level,vital signs,disease-related factors,mobility,and nutritional status)and 18 items.The inter-rater reliability of the scale is 0.985;the overall content validity index is 0.853;the split-half reliability is 0.716.The area under the receiver operating characteristic curve for predicting adverse events within 72 hours of mobilization is 0.845,with a 95％confidence interval of 0.767 to 0.917(P＜0.001).The optimal cutoff value is 18.5,with a sensitivity of 0.735 and a specificity of 0.782.Conclusion The developed safety assessment scale for early mobilization in lung transplant patients after surgery demonstrates good reliability and validity,and it can serve as a clinical tool to assess the safety of early mobilization activities in these patients.

Objective:To investigate the current status of standardized residency training (SRT) teaching activities at Zhongshan Hospital affiliated to Fudan University, and to explore optimization strategies.Methods:We collected behavioral data from the SRT course selection platform and resident questionnaire survey data throughout 2024. Descriptive analysis, chi-square test, Mann-Whitney U test, and multivariable logistic regression analysis were performed. Results:A total of 170 teaching sessions were conducted in 2024, with interactive practice-based sessions accounting for 42.35% and lecture-based sessions accounting for 47.06%. According to 536 questionnaires, residents' overall satisfaction with teaching activities scored 87.83 points (high satisfaction, ≥85 points; moderate satisfaction, <85 points). The proportion of high satisfaction with interactive practice-based sessions was significantly higher than that with lecture-based sessions (82.81% vs. 75.46%, P=0.034). The enrollment for weekday evening courses filled up significantly faster than that for weekday daytime courses [4 (2, 6) seconds vs. 12 (8, 15) seconds, P<0.001]. Interactive practice-based sessions [odds ratio ( OR)=1.6, 95% CI=1.1-2.3, P=0.018] and weekday evening sessions ( OR=1.4, 95% CI=1.0-2.0, P=0.048) significantly improved resident satisfaction. Conclusions:Optimizing course formats and scheduling can enhance the quality of SRT teaching activities.