OBJECTIVE: To investigate the correlation between nucleated red blood cell (NRBC) level on the first day of intensive care unit (ICU) admission and 28-day mortality in adult septic patients, and to evaluate the value of NRBC as an independent predictor of death. METHODS: Single-cell transcriptomic analysis was performed using the GSE167363 dataset from the Gene Expression Omnibus (including 2 healthy controls, 3 surviving septic patients, and 2 non-surviving septic patients). A retrospective clinical analysis was conducted using the America Medical Information Mart for Intensive Care-IV (MIMIC-IV) database, including adult patients (≥ 18 years) with first-time admission who met the Sepsis-3.0 criteria, excluding those without NRBC testing on the first ICU day. The demographic information, vital signs, laboratory test indicators, disease severity score and survival data on the first day of admission were collected. The restricted cubic spline (RCS) curve was used to determine the optimal cut-off value of NRBC for predicting 28-day mortality in patients. Patients were divided into low-risk and high-risk groups based on this cut-off value for intergroup comparison, with Kaplan-Meier survival curve analysis conducted. Independent risk factors for 28-day mortality were analyzed using Logistic regression and Cox regression analysis, followed by the construction of regression models. RESULTS: NRBC were detected in the peripheral blood of septic patients by single-cell transcriptomic. A total of 1 291 sepsis patients were included in the clinical analysis, with 576 deaths within 28 days, corresponding to a 28-day mortality of 44.6%. RCS curve analysis showed a nonlinear relationship between the first-day NRBC level and the 28-day mortality. When NRBC ≥ 1%, the 28-day mortality of patients increased significantly. Compared to the low-risk group (NRBC < 1%), the high-risk group (NRBC ≥ 1%) had significantly higher respiratory rate, heart rate, sequential organ failure assessment (SOFA), and simplified acute physiology score II (SAPSII), and significantly lower hematocrit and platelet count. The high-risk group also had a significantly higher 28-day mortality [49.8% (410/824) vs. 35.5% (166/467), P < 0.05], and shorter median survival time (days: 29.8 vs. 208.6, P < 0.05). Kaplan-Meier survival curve showed that compared with the low-risk group, the survival time of high-risk group was significantly shortened (Log-rank test: χ ² = 25.1, P < 0.001). After adjusting for potential confounding factors including body mass, temperature, heart rate, respiratory rate, mean arterial pressure, serum creatinine, pulse oximetry saturation, hemoglobin, hematocrit, Na⁺, K⁺, platelet count, and SOFA score, multivariate regression analysis confirmed that NRBC ≥ 1% was an independent risk factor for 28-day mortality [Logistic regression: odds ratio (OR) = 1.464, 95% confidence interval (95%CI) was 1.126-1.902, P = 0.004; Cox regression: hazard ratio (HR) = 1.268, 95%CI was 1.050-1.531, P = 0.013]. CONCLUSIONS NRBC ≥ 1% on the first day of ICU admission is an independent risk factor for 28-day mortality in septic patients and can serve as a practical indicator for early prognostic assessment.
Humans ; Sepsis/blood* ; Intensive Care Units ; Risk Factors ; Retrospective Studies ; Prognosis ; Male ; Female ; Hospital Mortality ; Middle Aged ; Aged

Objective To conduct a reliability and validity analysis of the quantitative diagnostic criteria for hysterosalpingography(HSG)in clinical trials.Methods Questionnaire survey method was used for this study.A test questionnaire scale was constructed based on the imaging data of 10 patients who had received HSG.Fifteen medical workers engaged in HSG-related clinical and scientific research work were invited to score the test questionnaire according to quantitative diagnostic criteria.Internal consistency testing,correlation analysis,and exploratory factor analysis were used to evaluate the reliability and validity of the quantified diagnostic criteria.Results The overall Cronbach's α coefficient for this quantitative diagnostic criteria was 0.834.The Cronbach's α coefficients for the three evaluation functions,including tubal patency,tubal adhesion and pelvic adhesion,were 0.722,0.627 and 0.724 respectively.The Spearman-Brown split-half reliability coefficient was 0.859,and the Guttman split-half coefficient was 0.830.The inter-rater reliability measured by the Kendall W coefficient was 0.806(P＜0.05).The analysis indicated that the evaluation function for pelvic adhesion was suitable for factor analysis(KMO value=0.573,Bartlett Spherical test P=0.003).Two common factors were extracted(characteristic root being set at 1),and the cumulative variance interpretation rate was up to 74.74％.These factors were named as"items with low ambiguity"and"items with potential ambiguity"respectively.Conclusion The overall reliability and validity of this quantitative diagnostic criteria are satisfactory,it can meet the requirements of HSG-related clinical trials and has the potential for clinical promotion.

Objective To summarize the clinical experience of using 3D planar guide plate combined with bundle diameter technology for extracorporeal pre-fenestration in treating complex thoracoabdominal aortic diseases.Methods The clinical data of 31 patients with complex thoracoabdominal aortic diseases,who were treated with 3D planar guide plate combined with bundle diameter technology of extracorporeal pre-fenestration at the First Affiliated Hospital of Soochow University of China from January 2017 to February 2024,were retrospectively analyzed.The patients' preoperative thin-layer chest and abdominal vascular CTA data were imported into specialized software and to create a 3D planar guide plate.Under the guidance of 3D planar guide plate technology,precise extracorporeal pre-fenestration of aortic covered stent was performed,and combined with bundle diameter technology the endovascular repair of complex thoracoabdominal aortic disease was accomplished.Results Successful operation was accomplished in all patients,and two patients had failed visceral artery reconstruction surgery.The median follow-up time was 55 months,with a technical success rate of 97.6％.The postoperative follow-up blood flow patency rate was 100％,and the phase Ⅰ patency rate of branch arteries was 98％.Three patients experienced internal leakage after surgery,and none of them developed paraplegia or died during the perioperative period.Conclusion In treating complex thoracoabdominal aortic diseases,the use of 3D planar guide plate combined with bundle diameter technology of extracorporeal pre-fenestration is simple,safe and effective,with good short-term therapeutic effect,although its long-term efficacy need to be further investigated.

Developmental dysplasia of hip(DDH)usually occurs in children,and delayed diagnosis of DDH might lead to serious complications and influence long-term prognosis.The application of artificial intelligence(AI)in medical images helps to quantitatively individualize image data,reduce bias generated by manual analysis and achieve early and accurate diagnosis of children DDH.The research progresses of AI in imaging diagnosis of children DDH were reviewed in this article.

The current transformation of the tripartite linkage of medical treatment has gradually shifted towards collaborative development and governance among medical care,medical insurance,and medicine,necessitating a clear understanding of the internal mechanisms underpinning this collaboration and governance to lay a theoretical foundation for practical exploration.Drawing on synergetics theory,it delves into the self-organizing characteristics of the collaborative development and governance among the tripartite system,grasping its fundamental operational laws.Through a questionnaire survey of the main functional departments in each field of the tripartite system to verify the rationality of the sequence parameters selected for the study.It ultimately identifies the order parameters as the value standard centered on health,the interest contract focused on public interest,new system for mobilizing resources nationwide,the innovative capacity of the pharmaceutical industry,and the rigorous accountability system.Furthermore,it systematically expounds on the self-organizing evolution process of the collaborative development and governance among the tripartite system,thereby revealing the inherent mechanisms of its collaborative development and governance.It proposes countermeasures and suggestions for establishing and improving diversified collaboration mechanisms,innovating monitoring and early warning mechanisms,and fostering positive feedback mechanisms,aiming to facilitate more scientific and efficient collaborative development and governance among the tripartite system.

Objectives:To explore whether short-course radiotherapy (SCRT)-based total neoadjuvant therapy (TNT) combined with PD-1 inhibitors could further promote tumor regression and improve the prognosis.Methods:This is a prospective, multicenter, two-arm randomized controlled, seamless phase Ⅱ/Ⅲ trial for proficient mismatch repair or microsatellite stable (pMMR/MSS) locally advanced rectal cancer (LARC). Eligible patients were randomly assigned to the iTNT (TNT+PD-1) group or the TNT group. Patients in the TNT group received SCRT (5 Gy×5) followed by 4 cycles of CAPOX or 6 cycles of mFOLFOX chemotherapy, with the iTNT group receiving SCRT followed by the same regime in combination with 4 cycles of Sintilimab. Total mesorectal excision (TME) surgery or watch and wait (W&W) was performed after neoadjuvant therapy and then 2 cycles of same regimen as before were recommended. The primary endpoints are the complete response (CR) rate for phase Ⅱ trial and 3-year disease-free survival (DFS) for phase Ⅲ trial. A total of 588 patients will be enrolled for the phase Ⅱ/Ⅲ trial. Short-term efficacy and safety data from the initial 100 treated patients were analyzed as planned.Results:From 2022-8-31 to 2023-5-24 the initial 100 patients were enrolled from 10 hospitals in China, 76.0%(76/100) patients were male, and the median age was 61 years (21-74 years). More patients had tumors located in the lower rectum (78.0%, 78/100), staged T3-4 (97.0%, 97/100) and N1-2 (93.0%, 93/100), and about half of the tumors invaded the mesorectal fascia (52.0%, 52/100) and with extramural vascular invasion (51.0%, 51/100). Analyses were performed according to the per-protocal (PP) set. All patients in the iTNT group ( n=52) and the TNT group ( n=48) completed SCRT; The 4-cycle chemotherapy±Sintilimab completion rates were 86.5% and 100.0% in the iTNT and TNT groups, respectively. In the iTNT group, 82.7% (43/52), 11.5% (6/52), and 5.8% (3/52) of the patients received 4, 3, and 2 cycles of PD-1 inhibitor. After TNT, 68 patients underwent radical surgery and 15 patients achieved cCR and adopted W&W. The pathological complete response (pCR) rates were 48.5% (16/33) and 17.1% (6/35) in the iTNT and TNT groups, with CR rates of 50.0% (25/50) and 26.1% (12/46), respectively. The incidence of treatment-related grade 3-4 adverse events was 26.9% (14/52, iTNT group) and 18.8% (9/48, TNT group), with thrombocytopenia and leukopenia being the most common. Among patients receiving immunotherapy, grade 3 immunotherapy-related adverse events occurred in 2 (3.8%, 2/52) patients: one case was pancreatitis, another case was hepatitis combined with myositis and myocarditis. Conclusion:The preliminary results show that SCRT-based TNT combined with PD-1 inhibitors could further improve the CR rate for LARC without unexpected serious adverse events.

Objective:To investigate the effect of olanzapine (OLZ) on the differentially-expressed circRNAs in prefrontal cortex of schizophrenia mouse models and predict the target genes.Methods:SPF grade C57BL/6 mice, 7~8 weeks-old, 20 male mice and 45 female mice were recruited and breeded offspring.Forty-four double-stimulation induced schizophrenia-like mouse models, the offspring mice exposed to dual stress were divided into the schizophrenia group(SZ group, n=23) and the olanzapine intervention group (SZ+ OLZ group, n=21), while the mice raised under normal conditions served as the control group (NC group, n=22). Whole transcriptome sequencing was used to sequence the expression level of RNAs from the prefrontal cortex of the mice. RT-qPCR was applied to verify the differentially-expressed circRNAs, then the target genes of miRNAs which have binding site to verified circRNAs were predicted. Results:RNA-seq results showed that there were 137 differentially-expressed circRNAs compared with NC group, 62 were significantly high-expressed and 75 were low-expressed. circRNA_06886 showed significant low-expressed in SZ group compared with NC group( Z=-3.259, P<0.01), and significant high-expressed in SZ+ OLZ group compared with SZ group( Z=-4.765, P<0.01). Bioinformatics analysis of miRNA target genes showed that the target genes were involved in the pathways related to neural pathways such as dopamine, glutamate and MAPK signaling pathways. Conclusions:There are differentially expressed circRNAs in the prefrontal cortex of schizophrenia mouse models, and circRNA_06886 is low-expressed in the prefrontal cortex of schizophrenia mice, Camk2b-201 and Plcb1-003 are the potential genes of circRNA_06886 involved in the regulation of schizophrenia pathogenesis by dopamine pathway.

Cerebral venous sinus thrombosis(CVST)is a rare disease of the venous system and a major cause of cerebral venous stroke.Systemic anticoagulation remains the key to the treatment of CVST,with heparin-bridged vitamin K antagonists being the traditional treatment of choice in the acute phase with the wide application of vitamin K antagonists,the disadvantages of narrow therapeutic window,food-drug interactions,and the need for frequent monitoring of the internationalized normative ratio(INR)have been exposed,whereas direct oral anticoagulants do not have the above mentioned problems under the same efficacy,so whether direct oral anticoagulants can replace vitamin K antagonists has become a major research hotspot.This article mainly focuses on the research progress of direct oral anticoagulants in CVST and the research progress of vitamin K antagonists and direct oral anticoagulants in CVST anticoagulation therapy in terms of effectiveness and safety.

Objective:To investigate whether there is a causal relationship between atopic dermatitis(AD)and ankylosing spondylitis(AS).Methods:Genetic data of AD and AS were extracted from genome-wide association studies(GWAS)by Mendelian randomization(MR),and inverse variance-weighted(IVW)analysis was used as main analysis,supplemented by weighted median,MR-Egger,weighted mode,etc,and verified by a series of sensitivity analyses.Results:IVW analysis of AD by AS:OR=1.015,95％CI:1.005～1.025,P=0.004.IVW analysis of AD for AS:OR=1.001,95％CI:1.000～1.002,P=0.120.Conclusion:AS has a statisti-cally small causal relationship on AD,and AD has no causal effect on AS.