Objective. To develop a “knowledge-attitude-practice” questionnaire as an evaluating tool of foreigners’ cognition on TCM treatment, so as to promote the internationalization of TCM. Methods. The questionnaire was based on the “knowledge-attitude-practice” model and adjusted by expert consultation using the Delphi method. After conducting a survey among foreigners, Cronbach’s α and exploratory factor analysis were used to test the internal consistency reliability and structural validity of the questionnaire, respectively. Results. A total of 10 experts participated in two rounds of expert consultation. The recovery rates of two rounds of expert consultation form were 100.0%. The coefficient authority in two rounds of expert consultation was 0.87 and 0.88, respectively. The concentration of expert opinions in the knowledge, attitude, and practice dimensions was 3.80 to 4.70 points, 3.70 to 4.50 points, and 3.60 to 4.40 points, respectively, in the first round and 4.30 to 4.80 points, 4.10 to 4.60 points, and 4.00 to 4.50 points, respectively, in the second round. The coefficient of variation in the knowledge, attitude, and practice dimensions was 0.10–0.32, 0.16–0.29, and 0.19–0.35, respectively, in the first round and 0.09–0.19, 0.15–0.25, and 0.16–0.31, respectively, in the second round. The W value and significance test x 2 in the first round were 0.657 and 218.620 while those in the second round were 0.671 and 181.181 P < 0.001 . 8 items were deleted and 1 item was added, and other reserved items were modified according to the statistical analysis results of evaluation items and expert suggestions after the first round and there were no changes after the second round. The revised questionnaire includes three dimensions of knowledge, attitude, and practice, with a total of 30 items. After translating the questionnaire into English, it was conducted in 176 foreigners. Cronbach’s α coefficient of the total questionnaire, knowledge dimension, attitude dimension, and practice dimension was 0.908, 0.781, 0.823, and 0.918, respectively. Exploratory factor analysis extracted 3 factors with a cumulative contribution of 54.090%. After testing reliability and validity, 1 item was deleted, leaving 29 items. Conclusions. After two rounds of expert consultation based on the Delphi method, the results of expert authority, expert coordination, and expert opinions’ concentration were promising, and the expert consultation results were reliable. The “knowledge-attitude-practice” questionnaire of foreigners on TCM treatment in English had good reliability and validity and can evaluate foreigners’ cognition on TCM treatment.

Background Metabolic syndrome and obesity are risk factors for gallstones. However, these two factors often occur together, and few studies have focused on the association between metabolically healthy overweight/obesity (MHOW/MHO) and gallstones. We hypothesized that MHO individuals would be associated with the prevalence of gallstones. Methods This cross-sectional study included 125,668 participants aged 18–80 years at the Health Promotion Center of Run Run Run Shaw Hospital, Zhejiang University School of Medicine during 2017–2019 years. Each participant underwent a comprehensive health checkup. Gallstones were diagnosed by abdominal ultrasonography. Metabolically health was defined as not meeting the diagnostic criteria for metabolic syndrome (MetS). Obesity was measured by BMI. MetS and weight stratification were combined to classify the metabolism-obesity phenotypes. Logistic regression models were used to estimate adjusted odds ratios (ORs) and 95% CIs. Results Among 125,668 participants, 5486 (4.4%) had gallstones. 21407 (17.0%) were MHOW individuals, and 3322 (2.6%) were MHO individuals. MHOW (OR 1.40; 95%CI: 1.29–1.53) and MHO (OR 1.80; 95%CI: 1.53–2.12) participants were at higher risk of gallstones and had larger and more numerous gallstones than metabolically healthy normal weight participants. Obesity, MetS, premenopausal women and advanced age were significantly associated with the prevalence of gallstones. Conclusions MHOW/MHO individuals exhibited a higher risk of gallstones. In metabolically healthy individuals, the risk of gallstones increased with increasing BMI. Thus, obesity was associated with the prevalence of gallstones, even in relatively metabolically healthy adults.

We explored potential biomarkers and molecular mechanisms regarding breast cancer (BC) risk reduction after intermittent energy restriction (IER) and further explored the association between IER and BC prognosis. We identified differentially expressed genes (DEGs) in breast tissues before and after IER by analyzing the expression profile from GEO. Then, enrichment analysis was used to identify important pathways of DEGs and hub genes were selected from PPI network. After that, GEPIA, ROC, and KM plotter were used to explore the preventive and prognostic value of hub genes. It was found that FOXM1 and CXCR4 were highly expressed in BC tissues and associated with the worse prognosis. FOXM1 and CXCR4 were down-regulated after IER , which meant that FOXM1 and CXCR4 might be the most important key genes for reducing the risk and improving prognosis of BC after IER . ROC curve indicated that FOXM1 and CXCR4 also had the predictive value for BC. Our study contributed to a better understanding of the specific mechanisms in protective effects of IER on BC and provided a new approach to improve the prognosis of BC, which might provide partial guidance for the subsequent development of more effective treatments and prevention strategies.