Effective symptom management can alleviate the physical and psychological distress experienced by patients with cancer, improve quality of life, and contribute to treatment adherence and improve clinical outcomes. However, most existing guidelines are developed for healthcare professionals, and patients and the public have limited access to standardized and comprehensible guidance on symptom management. To address this gap and to facilitate effective communication and shared decision-making, this study proposes the development of a patient version of the cancer symptom management guideline. The development process will adhere to the methodological framework recommended by the Guidelines International Network and the World Health Organization. The GRADE approach will be employed to assess the certainty of evidence and to formulate recommendations. In addition, the process will be informed by the Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ) instrument and the Reporting Items for Practice Guidelines in Healthcare-Public or Patient Versions of Guidelines (RIGHT-PVG). This protocol outlines the establishment of the guideline working group, the identification and prioritization of key questions, evidence retrieval and appraisal, and the formulation of recommendations, with the aim of ensuring methodological rigor and transparency in the development of the patient guideline and providing methodological reference for similar guideline initiatives.

Objective:To investigate the mechanism of improving liver injury by enhancing the abundance of Akkermansia mu-ciniphila(AKK bacteria)with hepatocyte-specific Yap1 knockout during PD-1 monoclonal antibody treatment.Methods:Hepatocyte-specific Yap1 knockout mice(genotype Yap1Flox/Flox;albumin-Cre,labeled as Yap1LKO)and control mice(genotype Yap1Flox/Flox,labeled Yap1Flox),aristolocholic acidⅠ(AAⅠ)and CCl4 were used to induce liver injury,Yap1LKO mice and Yap1Flox mice were randomly di-vided into control group and PD-1 monoclonal antibody group.After the intervention,real-time PCR detected changes in the abun-dance of AKK bacteria in the fecal microbial DNA of mice,16S rRNA gene sequencing further analyzes intestinal flora changes,the livers of mice were made into wax blocks for HE staining to observe the histopathological changes of the liver.Results:Yap1Flox mice exhibited balloon-like edema degeneration of hepatocytes and infiltration of inflammatory factors in the manifold area,compared with Yap1Flox mice,Yap1LKO mice had reduced the abundance of AKK bacteria in the intestine,fibrosis of the liver,and the degree of dam-age was more serious;PD-1 monoclonal antibody treatment alone did not increase the abundance of AKK bacteria in the intestines of mice,and fibrosis appeared in the liver;however,the abundance of intestinal AKK bacteria in Yap1LKO mice treated with PD-1 mono-clonal antibody increased,the ratio(F/B value)of Firmicutes to Bacteroides at the phylum level decreased,and the morphology of he-patocytes returned to normal and the degree of liver damage decreased.Conclusion:In AAⅠ and CCl4 induced liver injury mice,he-patocyte-specific Yap1 knockout reduced the abundance of AKK bacteria in the intestine,and the degree of liver injury was more se-vere than that in Yap1Flox mice.When treated with PD-1 monoclonal antibody,hepatocyte-specific Yap1 knockout could increase the abundance of AKK bacteria in the intestine,change the composition of intestinal flora,maintain intestinal homeostasis and ameliorate liver injury.

Objective:To explore the application value of echocardiography in the management of pediatric mitral valve replacement.Methods:Thirty-three children who underwent mitral valve replacement at Union Hospital Tongji Medical College Huazhong University of Science and Technology from January 2009 to June 2023 were retrospectively analyzed. Clinical data and preoperative and postoperative echocardiographic data were collected. The differences in ultrasound parameters among preoperative，1-week postoperative，1-month postoperative and 1-year postoperative were compared.Results:Of the 33 children，there were 4 cases（12.12%）of mitral stenosis，33 cases（100%）of mitral regurgitation and 4 cases（12.12%）of mitral stenosis combined with regurgitation. Mechanical valve replacement was performed in 30 cases（90.91%）and bioprosthetic valve replacement in 3 cases（9.09%）. Compared with the preoperative period，the left atrial internal diameter and left ventricular end-diastolic internal diameter were significantly reduced at 1-week postoperatively，1-month postoperatively，and 1-year postoperatively，respectively（all P <0.05）.The left ventricular mass was significantly reduced and the left ventricular end-diastolic sphericity index was significantly increased（both P < 0.05）at 1-month postoperatively compared with preoperatively. The left ventricular ejection fraction was significantly higher at 1-year postoperatively compared with 1-week postoperatively（ P <0.05）. Conclusions:After pediatric mitral valve replacement，the left ventricular dimensions decrease，and cardiac function progressively recovers. Echocardiography is an essential tool for accurate preoperative assessment and postoperative follow-up in pediatric mitral valve replacement.

Objective:To evaluate the left ventricular（LV）function in heart transplant（HTx）patients with post-transplant diabetes（PTDM），and to examine the relevance of PTDM and LV function to the patient's prognosis.Methods:Two hundred and thirteen adult HTx patients who underwent echocardiography at Union Hospital，Tongji Medical College，Huazhong University of Science and Technology between January 2018 and January 2022 were prospectively included. The patients were divided into PTDM group（ n=86）and Non-PTDM group（ n=127）. LV function parameters were acquired using conventional and two-dimensional speckle-tracking echocardiography（2D-STE），and were compared between the two groups. The primary endpoints included all-cause mortality or transplant-related readmission. Results:Compared with Non-PTDM group，the LV mass of PTDM group was higher，the LV ejection fraction，LV global longitudinal strain（GLS），peak systolic global longitudinal strain rate，and early diastolic global longitudinal strain rate（dGLSr）were lower（all P＜0.05）. After a median follow-up period of 37.6（29.3）months，27 patients experienced clinical events. A multivariate analysis revealed that PTDM（ HR=2.198，95% CI=1.018-4.743， P=0.045）and low GLS（ HR=6.456，95% CI=2.889-14.426， P＜0.001）were independent predictors of adverse clinical events after adjustment for dGLSr，body mass index and age. After subdividing the two groups into 4 subgroups by the cutoff value of GLS（16.5%），the prognosis was worst for HTx patients with PTDM and low GLS. Conclusions:HTx patients with PTDM have worse LV systolic and diastolic function than those without PTDM. Management of HTx patients with PTDM may be improved using GLS guidance.

Objective:To investigate the mechanism of improving liver injury by enhancing the abundance of Akkermansia mu-ciniphila(AKK bacteria)with hepatocyte-specific Yap1 knockout during PD-1 monoclonal antibody treatment.Methods:Hepatocyte-specific Yap1 knockout mice(genotype Yap1Flox/Flox;albumin-Cre,labeled as Yap1LKO)and control mice(genotype Yap1Flox/Flox,labeled Yap1Flox),aristolocholic acidⅠ(AAⅠ)and CCl4 were used to induce liver injury,Yap1LKO mice and Yap1Flox mice were randomly di-vided into control group and PD-1 monoclonal antibody group.After the intervention,real-time PCR detected changes in the abun-dance of AKK bacteria in the fecal microbial DNA of mice,16S rRNA gene sequencing further analyzes intestinal flora changes,the livers of mice were made into wax blocks for HE staining to observe the histopathological changes of the liver.Results:Yap1Flox mice exhibited balloon-like edema degeneration of hepatocytes and infiltration of inflammatory factors in the manifold area,compared with Yap1Flox mice,Yap1LKO mice had reduced the abundance of AKK bacteria in the intestine,fibrosis of the liver,and the degree of dam-age was more serious;PD-1 monoclonal antibody treatment alone did not increase the abundance of AKK bacteria in the intestines of mice,and fibrosis appeared in the liver;however,the abundance of intestinal AKK bacteria in Yap1LKO mice treated with PD-1 mono-clonal antibody increased,the ratio(F/B value)of Firmicutes to Bacteroides at the phylum level decreased,and the morphology of he-patocytes returned to normal and the degree of liver damage decreased.Conclusion:In AAⅠ and CCl4 induced liver injury mice,he-patocyte-specific Yap1 knockout reduced the abundance of AKK bacteria in the intestine,and the degree of liver injury was more se-vere than that in Yap1Flox mice.When treated with PD-1 monoclonal antibody,hepatocyte-specific Yap1 knockout could increase the abundance of AKK bacteria in the intestine,change the composition of intestinal flora,maintain intestinal homeostasis and ameliorate liver injury.

Objective:To explore the application value of echocardiography in the management of pediatric mitral valve replacement.Methods:Thirty-three children who underwent mitral valve replacement at Union Hospital Tongji Medical College Huazhong University of Science and Technology from January 2009 to June 2023 were retrospectively analyzed. Clinical data and preoperative and postoperative echocardiographic data were collected. The differences in ultrasound parameters among preoperative，1-week postoperative，1-month postoperative and 1-year postoperative were compared.Results:Of the 33 children，there were 4 cases（12.12%）of mitral stenosis，33 cases（100%）of mitral regurgitation and 4 cases（12.12%）of mitral stenosis combined with regurgitation. Mechanical valve replacement was performed in 30 cases（90.91%）and bioprosthetic valve replacement in 3 cases（9.09%）. Compared with the preoperative period，the left atrial internal diameter and left ventricular end-diastolic internal diameter were significantly reduced at 1-week postoperatively，1-month postoperatively，and 1-year postoperatively，respectively（all P <0.05）.The left ventricular mass was significantly reduced and the left ventricular end-diastolic sphericity index was significantly increased（both P < 0.05）at 1-month postoperatively compared with preoperatively. The left ventricular ejection fraction was significantly higher at 1-year postoperatively compared with 1-week postoperatively（ P <0.05）. Conclusions:After pediatric mitral valve replacement，the left ventricular dimensions decrease，and cardiac function progressively recovers. Echocardiography is an essential tool for accurate preoperative assessment and postoperative follow-up in pediatric mitral valve replacement.

Objective:To evaluate the left ventricular（LV）function in heart transplant（HTx）patients with post-transplant diabetes（PTDM），and to examine the relevance of PTDM and LV function to the patient's prognosis.Methods:Two hundred and thirteen adult HTx patients who underwent echocardiography at Union Hospital，Tongji Medical College，Huazhong University of Science and Technology between January 2018 and January 2022 were prospectively included. The patients were divided into PTDM group（ n=86）and Non-PTDM group（ n=127）. LV function parameters were acquired using conventional and two-dimensional speckle-tracking echocardiography（2D-STE），and were compared between the two groups. The primary endpoints included all-cause mortality or transplant-related readmission. Results:Compared with Non-PTDM group，the LV mass of PTDM group was higher，the LV ejection fraction，LV global longitudinal strain（GLS），peak systolic global longitudinal strain rate，and early diastolic global longitudinal strain rate（dGLSr）were lower（all P＜0.05）. After a median follow-up period of 37.6（29.3）months，27 patients experienced clinical events. A multivariate analysis revealed that PTDM（ HR=2.198，95% CI=1.018-4.743， P=0.045）and low GLS（ HR=6.456，95% CI=2.889-14.426， P＜0.001）were independent predictors of adverse clinical events after adjustment for dGLSr，body mass index and age. After subdividing the two groups into 4 subgroups by the cutoff value of GLS（16.5%），the prognosis was worst for HTx patients with PTDM and low GLS. Conclusions:HTx patients with PTDM have worse LV systolic and diastolic function than those without PTDM. Management of HTx patients with PTDM may be improved using GLS guidance.

ObjectiveTo construct traditional Chinese medicine （TCM） diagnostic scale of turbid toxin syndrome in order to provide corresponding reference for the standardization of TCM syndromes and studies. MethodsWe systematically searched the Chinese Medical Dictionary （CMD）， China Knowledge Network （CNKI）， Wanfang Data Knowledge Service Platform （WF） and VIP database for TCM classics and modern literature on turbid toxin syndrome， and initially screened the four diagnosis information of turbid toxin syndrome， established a pool of information entries， and conducted a cross-sectional clinical survey. Discrete trend method， correlation coefficient method， Cronbach's coefficient method， and factor analysis method were applied to objectively screen the entries. The diagnostic scale of turbid toxin syndrome were constructed through three rounds of Delphi method expert survey to determine the scale entries， using hierarchical analysis to get the judgement matrix scores and relative weight of each entry， after passing consistency test and then isometric expansion of the relative weight of the entries to get the weight of each entry and assign the value. ResultsA total of 35 articles were included， 45 entries were obtained after the initial screening. After the clinical investigation， 12 entries were not suitable by the discrete trend method， 23 entries not suitable by correlation coefficient method， 13 entries by the internal consistency screening were removed with the Cronbach's alpha coefficient rising， and 10 entries not suitable by the factor analysis method. Twenty-two entries were retained after objective screening by the combined use of the four statistical methods. The positive coefficients of experts in the three rounds of Delphi method of expert consultation were 96.67%， the coefficients of expert authority were 0.834， 0.856， and 0.867， and the coefficients of co-ordination were 0.126， 0.326， and 0.312， respectively. After consulting with clinical experts， and three rounds of Delphi method survey and hierarchical analysis method weight assignment， the diagnostic scale entries of turbid toxin syndrome were finally established. Primary symptoms： dark red or purple and dusky tongue， yellowish greasy or dry coating （10 points）； sticky and unpleasant stools （8 points）； disharmony of tastes including halitosis， sticky and greasy taste in the mouth， dry mouth and bitter taste in the mouth （6 points）； unfavourable or yellowish or red urination （5 points）； and dark complexion （4 points）. Secondary symptoms： heavy body （3 points）； dizziness （3 points）； profuse， sticky， foul-smelling secretions （2 points）； wiry and slippery， or slippery， or slippery and rapid pulse （2 points）； feeling of hardness in the abdomen （1 point）. ConclusionUsing Delphi method combined with the hierarchical analysis method， combining qualitative and quantitative study， a diagnostic scale of turbid toxin syndrome was initially developed.

Taking chronic atrophic gastritis （CAG） as an example， the frontier technologies in data science have been introduced into the inheritance， innovation and development of traditional Chinese medicine （TCM）， providing reference for conducting real-world clinical research on specialized diseases of TCM. This paper put forward the construction of CAG data science system by elaborating the connotation of data science and its application value in TCM， and discussed the path to build CAG data science system， namely through "data acquisition-knowledge expression-knowledge reasoning" to establish CAG database， knowledge base and develop diagnosis platform differentiating diseases and syndromes. Besides， this paper analyzed the prospects of CAG data science in improving data governance ability and knowledge discovery efficiency， deepening the level of knowledge sharing， promoting interdisciplinary integration， and strengthening the integration process of industry， academia and research.

Objective To observe the value of deep learning(DL)models for automatic classification of echocardiographic views.Methods Totally 100 patients after heart transplantation were retrospectively enrolled and divided into training set,validation set and test set at a ratio of 7∶2∶1.ResNet18,ResNet34,Swin Transformer and Swin Transformer V2 models were established based on 2D apical two chamber view,2D apical three chamber view,2D apical four chamber view,2D subcostal view,parasternal long-axis view of left ventricle,short-axis view of great arteries,short-axis view of apex of left ventricle,short-axis view of papillary muscle of left ventricle,short-axis view of mitral valve of left ventricle,also 3D and CDFI views of echocardiography.The accuracy,precision,recall,F1 score and confusion matrix were used to evaluate the performance of each model for automatically classifying echocardiographic views.The interactive interface was designed based on Qt Designer software and deployed on the desktop.Results The performance of models for automatically classifying echocardiographic views in test set were all good,with relatively poor performance for 2D short-axis view of left ventricle and superior performance for 3D and CDFI views.Swin Transformer V2 was the optimal model for automatically classifying echocardiographic views,with high accuracy,precision,recall and F1 score was 92.56％,89.01％,89.97％and 89.31％,respectively,which also had the highest diagonal value in confusion matrix and showed the best classification effect on various views in t-SNE figure.Conclusion DL model had good performance for automatically classifying echocardiographic views,especially Swin Transformer V2 model had the best performance.Using interactive classification interface could improve the interpretability of prediction results to some extent.