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: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:To investigate the role of ezrin-radixin-moesin-binding phosphoprotein 50 (EBP50) in renal tubular epithelial-mesenchymal transition (EMT) in diabetic nephropathy (DN).Methods:Renal tissue specimens from 24 DN patients (DN group) confirmed by medical history, clinical laboratory tests, and pathological diagnosis at the Third Hospital of Hebei Medical University and 15 adjacent normal renal tissues (control group) from 2018 to 2023 were collected. Immunohistochemical staining was performed to detect the expression of EBP50, E-cadherin, and Vimentin proteins. Additionally, 10 healthy volunteers were enrolled as a normal group, and fasting blood glucose, serum creatinine, blood urea nitrogen, and 24 h urinary protein levels were compared between DN patients and the normal group.Results:Fasting blood glucose, serum creatinine, blood urea nitrogen, and 24 h urinary protein levels were significantly higher in the DN group than in the normal group (all P<0.01). Periodic acid-schiff (PAS) staining revealed significant thickening of the glomerular basement membrane, increased extracellular matrix, vacuolar degeneration of renal tubules, and elevated extracellular matrix in the renal interstitium in the DN group. Immunohistochemistry showed higher expression of EBP50 and E-cadherin proteins in the control group than in the DN group (all P<0.01), while Vimentin expression was lower in the control group ( P<0.01). Conclusions:EBP50 is involved in the EMT process of renal tubules in DN and is associated with tubular injury.

Objective:To investigate the role of ezrin-radixin-moesin-binding phosphoprotein 50 (EBP50) in renal tubular epithelial-mesenchymal transition (EMT) in diabetic nephropathy (DN).Methods:Renal tissue specimens from 24 DN patients (DN group) confirmed by medical history, clinical laboratory tests, and pathological diagnosis at the Third Hospital of Hebei Medical University and 15 adjacent normal renal tissues (control group) from 2018 to 2023 were collected. Immunohistochemical staining was performed to detect the expression of EBP50, E-cadherin, and Vimentin proteins. Additionally, 10 healthy volunteers were enrolled as a normal group, and fasting blood glucose, serum creatinine, blood urea nitrogen, and 24 h urinary protein levels were compared between DN patients and the normal group.Results:Fasting blood glucose, serum creatinine, blood urea nitrogen, and 24 h urinary protein levels were significantly higher in the DN group than in the normal group (all P<0.01). Periodic acid-schiff (PAS) staining revealed significant thickening of the glomerular basement membrane, increased extracellular matrix, vacuolar degeneration of renal tubules, and elevated extracellular matrix in the renal interstitium in the DN group. Immunohistochemistry showed higher expression of EBP50 and E-cadherin proteins in the control group than in the DN group (all P<0.01), while Vimentin expression was lower in the control group ( P<0.01). Conclusions:EBP50 is involved in the EMT process of renal tubules in DN and is associated with tubular injury.

Objective To analyze the influencing factors of aspiration risk in patients with acute poisoning during gastric lavage,and to build and validation a prediction model of aspiration risk in patients with acute poisoning during gastric lavage.Methods Through literature search and analysis,the risk factors of aspiration during gastric lavage was summarized in patients with acute poisoning.A retrospective study was conducted on patients with acute poisoning in the emergency department of a tertiary A general hospital in Ningbo from January 2020 to June 2023.Through R 4.2.1 and Python 3.11 programming language,the random forest,logistic regression,extreme gradient boosting tree and gradient boosting decision tree algorithms in machine learning were used to establish a prediction model of aspiration risk during gastric lavage in patients with acute poisoning and carry out internal verification.The prediction effects of the 4 prediction models were evaluated by confusion matrix,calibration curve,receiver operating characteristic curve,area under curve,Kolmogorov-Smirnov value,accuracy,precision,recall rate and F1 score,and the best model was selected.Results The modeling results of the 4 machine learning algorithms show that the area under the curve of the Random Forest,Logistic Regression,Extreme Gradient Boosting Tree,and Gradient Boosting Decision Tree algorithms are 0.954(0.934～0.974),0.878(0.843～0.913),0.910(0.880～0.939),and 0.917(0.889～0.945),respectively.The internal validation results show that the area under the curve of the random forest,logistic regression,extreme gradient boosting tree,and gradient boosting decision tree algorithms are 0.910(0.864～0.955),0.877(0.824～0.931),0.849(0.790～0.908),and 0.873(0.819～0.928),respectively.Age,state of consciousness,D-dimer and the time of absorption of poison are the 3 characteristics that are particularly prominent in the order of importance of the influencing factors of aspiration during gastric lavage in patients with acute poisoning.Conclusion Among the 4 prediction models,random forest model has better prediction effect,with good discrimination ability for the risk of aspiration during gastric lavage in patients with acute poisoning,and it is convenient for clinical use,which can provide references for medical staff to take preventive treatment and care.

OBJECTIVE To explore the changes in chemical compositions and the characteristics of “fried charcoal and saving properties” based on the carbon-frying process of Sophora japonica and its bud. METHODS The slightly， moderately and heavily carbon-fried samples of S. japonica and its bud were prepared. The fingerprints of S. japonica， its bud and carbon-fried samples were established， and common peaks were identified. HPLC method was used to determine the contents of identified components and differential analysis was also performed； the differential components were screened by using chemometric methods， and their content ratios were used to characterize the “fried charcoal and saving properties” of S. japonica and its bud. RESULTS There were 9 common peaks in the fingerprints of S. japonica and its carbon-fried samples， 8 common peaks in those of S. japonica bud and its carbon-fried samples. In the fingerprints of S. japonica and its bud， and their different fried products， 6 components were identified， such as rutin， kaempferol-3-O-rutinoside， isorhamnetin-3-O-rutinoside， quercetin， kaempferol，isorhamnetin. Among them， the contents of rutin， kaempferol-3-O-rutinoside and isorhamnetin-3-O-rutinoside were the highest in slightly carbon-fried samples of S. japonica bud， and the contents of quercetin and isorhamnetin were the highest in moderately carbon-fried samples of S. japonica bud， and the contents of kaempferol were higher in moderately and healily carbon-fried samples of S. japonica bud. The chemometric results showed that the variable importance projection values of rutin and quercetin were both greater than 1. The range of rutin-quercetin content ratio between 9.00-14.00 and 3.00-6.00 respectively could characterize “fried charcoal and saving properties” of S. japonica and its bud. CONCLUSIONS There are significant differences in the chemical compositions of raw and fried products of S. japonica and its bud. Rutin and quercetin may be the differential components that affect their quality， and the ratio range of the two can be used to characterize the “fried charcoal and saving properties” of S. japonica and its bud in the future.

Objective:To compare the differences in the prevalence of mild micro-hepatic encephalopathy (MHE) among patients with cirrhosis by using the psychometric hepatic encephalopathy score (PHES) and the Stroop smartphone application (Encephal App) test.Methods:This prospective, multi-center, real-world study was initiated by the National Clinical Medical Research Center for Infectious Diseases and the Portal Hypertension Alliance and registered with International ClinicalTrials.gov (NCT05140837). 354 cases of cirrhosis were enrolled in 19 hospitals across the country. PHES (including digital connection tests A and B, digital symbol tests, trajectory drawing tests, and serial management tests) and the Stroop test were conducted in all of them. PHES was differentiated using standard diagnostic criteria established by the two studies in China and South Korea. The Stroop test was evaluated based on the criteria of the research and development team. The impact of different diagnostic standards or methods on the incidence of MHE in patients with cirrhosis was analyzed. Data between groups were differentiated using the t-test, Mann-Whitney U test, and χ2 test. A kappa test was used to compare the consistency between groups. Results:After PHES, the prevalence of MHE among 354 cases of cirrhosis was 78.53% and 15.25%, respectively, based on Chinese research standards and Korean research normal value standards. However, the prevalence of MHE was 56.78% based on the Stroop test, and the differences in pairwise comparisons among the three groups were statistically significant (kappa = -0.064, P < 0.001). Stratified analysis revealed that the MHE prevalence in three groups of patients with Child-Pugh classes A, B, and C was 74.14%, 83.33%, and 88.24%, respectively, according to the normal value standards of Chinese researchers, while the MHE prevalence rates in three groups of patients with Child-Pugh classes A, B, and C were 8.29%, 23.53%, and 38.24%, respectively, according to the normal value standards of Korean researchers. Furthermore, the prevalence rates of MHE in the three groups of patients with Child-Pugh grades A, B, and C were 52.68%, 58.82%, and 73.53%, respectively, according to the Stroop test standard. However, among the results of each diagnostic standard, the prevalence of MHE showed an increasing trend with an increasing Child-Pugh grade. Further comparison demonstrated that the scores obtained by the number connection test A and the number symbol test were consistent according to the normal value standards of the two studies in China and South Korea ( Z = -0.982, -1.702; P = 0.326, 0.089), while the other three sub-tests had significant differences ( P < 0.001). Conclusion:The prevalence rate of MHE in the cirrhotic population is high, but the prevalence of MHE obtained by using different diagnostic criteria or methods varies greatly. Therefore, in line with the current changes in demographics and disease spectrum, it is necessary to enroll a larger sample size of a healthy population as a control. Moreover, the establishment of more reliable diagnostic scoring criteria will serve as a basis for obtaining accurate MHE incidence and formulating diagnosis and treatment strategies in cirrhotic populations.

OBJECTIVE To study the correlation between processing time, chroma value and UPLC fingerprint map of Dipsaci Radix. METHODS Established the UPLC fingerprint of Dipsaci Radix. Monitored the changes of chemical components in the processing process of wine and salt processed Dipsaci Radix, spectrophotometer was used to objectively quantify the chroma value of different processed products. SPSS 20.0 and SIMCA 14.0 statistical software was used to analyze the correlation between processing time and chroma value and fingerprint. RESULTS In the process of processing, the decoction pieces color of the powder deepened and L*, b* and E* values decreased. The correlation analysis showed that the processing time was significantly correlated with the chroma value and fingerprint of decoction pieces. CONCLUSION The method of UPLC fingerprint is stabled and reliabled, combines with the objective discriminant analysis of the chroma value of the Dipsaci Radix processed products, which lay the foundation for standardizing the processing technology of wine and salt processed products and evaluating the quality of Dipsaci Radix.

ObjectiveTo investigate the transformation mechanism and content variation of saponins from Polygalae Radix before and after being boiled with licorice juice and water. MethodSimulated licorice juice boiled products and simulated water boiled products of onjisaponin B， onjisaponin Z， onjisaponin F， polygalasaponin ⅩⅩⅧ were prepared by simulated processing technology， and analyzed by ultra-performance liquid chromatography-quadrupole-electrostatic field orbitrap high resolution mass spectrometry（UPLC-Q-Exactive Orbitrap/MS）. Then the contents of onjisaponin B， onjisaponin Z， onjisaponin F， polygalasaponin ⅩⅩⅧ and tenuifolin in Polygalae Radix， licorice-boiled Polygalae Radix and water-boiled Polygalae Radix were determined by UPLC-triple quadrupole tandem mass spectrometry（UPLC-QQQ-MS/MS）. ResultDuring the boiling process with licorice juice and water， onjisaponin B could be hydrolyzed to produce 4-methoxycinnamic acid， desacylsenegin Ⅲ， polygalasaponin ⅩⅩⅧ and tenuifolin， onjisaponin Z could be hydrolyzed to produce 3，4，5-trimethoxycinnamic acid， onjisaponin TF， polygalasaponin ⅩⅩⅧ and tenuifolin， onjisaponin F could be hydrolyzed to produce 3，4，5-trimethoxycinnamic acid， onjisaponin G， polygalasaponin ⅩⅩⅧ and tenuifolin， and polygalasaponin ⅩⅩⅧ was hydrolyzed to produce tenuifolin. After being boiled with licorice juice or water， the content of onjisaponin B decreased significantly（P<0.05， P<0.01）， but the contents of onjisaponin Z， onjisaponin F， polygalasaponin ⅩⅩⅧ and tenuifolin increased significantly（P<0.05， P<0.01） in Polygalae Radix. Compared with the water-boiled products， the contents of onjisaponin Z and tenuifolin increased significantly（P<0.05， P<0.01）， and the change of tenuifolin content was the most significant in the licorice-boiled products.However， there was no significant difference in the content of onjisaponin B， onjisaponin F and polygalasaponin ⅩⅩⅧ between the water-boiled products and the licorice-boiled products. ConclusionBeing boiled with licorice juice or water can hydrolyze onjisaponin B， onjisaponin Z， onjisaponin F and polygalasaponin ⅩⅩⅧ， and generate secondary glycosides and aglycones（organic acids） through deglycosylation， which leads to obvious changes in the contents of onjisaponins after Polygalae Radix being processed.It is inferred that licorice juice can promote the hydrolysis of some onjisaponins in Polygalae Radix to onjisaponin Z and tenuifolin.This study provides an experimental basis for revealing processing mechanism of Polygalae Radix.

Objective:To analyze the correlation of fetal cervical cystic hygroma (CCH) with chromosomal and structural abnormalities and to assess the prognosis of CCH.Methods:This study retrospectively enrolled 70 fetuses with CCH diagnosed by prenatal ultrasound in the First Affiliated Hospital of Xi'an Jiao Tong University from July 2015, to December 2021. According to whether complicated by structural malformations or other anomalies, all the subjects were divided into the non-isolated and isolated CCH groups. The correlation of CCH and the gestational age at detection with chromosomal and structural abnormalities were analyzed and the prognosis of the cases were summarized using Chi-square test. Results:There were 34 isolated CCH (34/70, 49%) and 36 non-isolated CCH (36/70, 51%) among the 70 cases. In the non-isolated CCH group, there were eight cases (22%, 8/36) with abnormal heart structure, ten (28%, 10/36) with abnormal anterior abdominal wall, 16 (44%,16/36) with systemic edema and/or pleural effusion, one (3%,1/36) with craniocerebral abnormalities and one with holoprosencephaly and cardiac structural abnormalities. Eighteen out of 44 cases undergoing chromosome testing had chromosomal abnormalities, which were trisomy-18 ( n=6), trisomy-21 ( n=3), trisomy-13 ( n=3), 45,XO ( n=3), and chromosome segment duplication or deletion ( n=3). The detection rate of chromosome abnormality was higher in non-isolated CCH group comparing with isolated CCH group [59%(13/22) vs 23%(5/22), χ2=6.02, P=0.014]. There was no significant difference in the gestational age at the detection of CCH or proportion of women of advanced maternal age between the isolated and non-isolated CCH groups (both P>0.05). The ratios of isolated CCH cases with normal chromosome detected at the gestational weeks of 14-27 +6 was higher than those detected at 11-13 +6 weeks [62%(13/21) vs 17%(4/23), χ2=7.39, P=0.001]. Out of the 17 cases with isolated CCH and normal chromosomes, 12 were live births. One of the 12 cases still had a cystic mass with a diameter of 3 cm in the neck nine months after birth, and the other 11 cases had no mass at birth but one case died at the age of five months (hospitalized one week for neonatal edema),one case was found with anal atresia three days after birth and underwent operation and the remaining nine cases were normal during five months to six years follow-up. Conclusions:Non-isolated CCH is at a higher risk of chromosomal abnormalities. Isolated CCH cases detected later had higher rate of normal chromosome and often have a higher survival rate.