This report described a case of hereditary thrombotic thrombocytopenic purpura (TTP) with neonatal onset. The infant presented with facial petechiae, jaundice, progressive thrombocytopenia, and persistent bleeding at puncture sites shortly after birth. Plasma ADAMTS13 activity was<1%. Whole-exome sequencing identified heterozygous variants in ADAMTS13: c.3121C>T and c.1869delT, inherited from the father and mother, respectively. The infant improved following exchange transfusion and phototherapy. Post-discharge, prophylactic fresh frozen plasma infusion was administered every 3-4 weeks. At the 2-year follow-up, no abnormalities were observed. This case highlights the importance of early recognition and intervention in neonates with unexplained thrombocytopenia, severe non-hemolytic jaundice, and anemia to ensure survival and improve prognosis.

Purpose To investigate the expression of POLR2M in colorectal cancer(CRC)and its effects on cell growth,apoptosis and invasion.Methods GEPIA2.0,TCGA and Kaplan-Meier Plotter databases were used to ana-lyze the differential expression of POLR2M in CRC tissues and normal adjacent tissues,and to evaluate its prognostic significance using the Log-rank test.Quantitative real-time PCR(qRT-PCR)was used to detect the expression of POLR2M in human colorectal cancer cell lines SW480,HCT-8,RKO,LOVO,DLD-1,HCT-116,SW620 and human normal colorectal cell line FHC.DLD-1 and RKO cells were stably transfected with lentivirus,and the POLR2M groups were up-regulated into the control group(LV-NC)and experimental group(LV-POLR2M),and the transient transfec-tion of SW620 and SW480 cells with interfering fragments of SiRNA was used to down-regulate the POLR2M groups into the control group(Si-NC)and experimental group(Si-POLR2M),and the transfection efficiency of each group was verified.CCK-8,plate cloning,Transwell and scratch healing assays were used to detect cell proliferation,invasion and migration.Flow cytometry was used to detect the effects of POLR2M on cell cycle and apoptosis.Results GE-PIA2.0,TCGA and Kaplan-Meier Plotter database analysis showed that the expression of POLR2M in colorectal cancer was significantly higher than in normal adjacent tissues(P＜0.05),and the expression of POLR2M was closely associ-ated with the histological type of colorectal cancer and lymph node metastasis(P＜0.05),but not with the age,gen-der,tumor grade and vascular invasion of patients(P＞0.05).The prognosis of patients with POLR2M overexpression was poor(P＜0.05).The results of qRT-PCR showed that compared with FHC cells,the mRNA expression of POLR2M in SW480,HCT-8,RKO,LOVO,DLD-1,HCT-116 and SW620 cell lines was increased(F=97.7,P＜0.05),and POLR2M stable overexpression and interference cell lines were successfully constructed.Compared with the LV-NC group,the viability,colony number,number of cells passing through the chamber and cell mobility of DLD-1 and RKO cells in the LV-POLR2M group were significantly increased(P＜0.05).Compared with the Si-NC group,the viability,colony number,number of cells passing through the chamber,and cell mobility of SW620 and SW480 cells in the Si-POLR2M group were significantly decreased(P＜0.05).Downregulation of POLR2M induced cell cycle arrest in G1 phase and promotes apoptosis(P＜0.05).Conclusion POLR2M may play a role as a pro-tumor gene in CRC,and its high expression can significantly promote the proliferation and invasion of CRC cells.

This study was aimed at understanding the relationships among the drug resistance and genome characteristics of group A Streptococcus in Jiangsu Province.A total of 149 group A Streptococcus strains were collected from hospitals between 2016 and 2023.Thirteen antimicrobial minimal inhibitory concentrations were detected with the micro-dilution broth method.The GAS strains were typed with emm genotyping analysis and whole genome sequencing,to determine the carriage rates of drug resistance genes and the evolutionary relationships among strains.The resistance rates of 149 GAS strains to erythromy-cin,tetracycline,and clindamycin exceeded 90％,whereas the strains showed sensitivity to 8 different antibiotics,including penicillin.Notably,the resistance rates to erythromycin,tetracycline,and clindamycin consistently increased over time.All strains were classified into 9 emm types,among which emm12 accounted for the highest proportion(77/149;51.68％).Signifi-cant statistical differences were observed among emm types,in terms of the drug resistance rate,number of resistant species,and prevalence of drug resistance genes.Furthermore,SNP evolutionary tree analysis revealed 3 distinct clusters within the GAS strains:emm12,emm1,and other emm types.emm 12 and emm1 were the dominant GAS strains in Jiangsu Province.Most isolates were resistant to erythromycin,tetracycline,and clindamycin.Differences in phenotypes and genomic characteris-tics were observed among emm types.

Objective:To evaluate the cost-effectiveness of Artificial Intelligence(AI)-assisted physician image interpretation in the screening of early-stage lung cancer(stage Ⅰ)from the perspective of the healthcare system,so as to provide evidence for screening strategy optimization.Methods:Based on community populations,a decision tree model was constructed to simulate the cost-effectiveness of two screening strategies:Al-assisted physician image interpretation and independent physician image interpretation,and the Incremental Cost-Effectiveness Ratio(ICER)was calculated.Results:In the basic analysis,the per capita costs of the AI-assisted group and the physician group were 1 483 yuan and 1 489 yuan,respectively,and the effectiveness was 17.02 Quality-Adjusted Life Years(QALYs)and 16.99 QALYs,respectively.Compared with the physician group,the AI-assisted group saved 6 yuan per case and obtained an additional 0.03 QALY per case.The ICER was negative,indicating that the AI-assisted group had an absolute advantage.Threshold analysis showed that when the inspection cost of Al-assisted physician image interpretation increased to 428 yuan per case,the average cost per case was the same between these two groups,and the ICER was 0.When the inspection cost of Al-assisted physician image interpretation was above 428 yuan,the ICER was positive,still demonstrating economic efficiency.Conclusion:AI-assisted image interpretation is cost-effective in the screening of early-stage lung cancer and can facilitate the"early detection,early diagnosis,and early treatment"of lung cancer based on improving the efficiency and accuracy of screening,so as to provide scientific support for health system resource optimization.

Objective·To investigate the clinicopathologic features,gene mutation profile,and real-world survival prognosis of diffuse large B-cell lymphoma(DLBCL)with pulmonary involvement.Methods·The clinical data of 110 patients with newly diagnosed,pathologically confirmed DLBCL and pulmonary involvement at Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,between August 2003 and December 2022 were retrospectively collected and analyzed.Evaluation of the efficacy of treatment,survival analyses,and univariate and multivariate analyses were performed in 88 patients who received a first-line regimen based on rituximab in combination with cyclophosphamide,doxorubicin/epirubicine,vincristine,and prednisone(R-CHOP).A total of 74 patients underwent targeted DNA sequencing of 55 lymphoma-related genes and were evaluated for mutations.Results·Among the 110 patients,72(65.5%)were>60 years old,52(47.3%)were female,92(83.6%)presented with Ann Arbor stage Ⅲ?Ⅳ,20(18.2%)had ECOG scores≥2,75(68.2%)had elevated lactate dehydrogenase(LDH)levels,79(71.8%)had≥2 extranodal involvements,32(31.4%)were classified as germinal center B-cell subtype,22(26.8%)were diagnosed with double expressor lymphoma,and 4(4.6%)with double-hit lymphoma.Among the patients treated with R-CHOP-based first-line regimens,the objective response rate(ORR)was 68.2%,the 5-year progression-free survival(PFS)rate was 43.7%,and the 5-year overall survival(OS)rate was 65.4%.Univariate analysis showed that elevated LDH and ECOG score≥2 were poor prognostic factors for PFS and OS,and mutations in PIM1 and CD79B were poor prognostic factors for PFS among high-frequency mutations.Multivariate analysis showed that elevated LDH was an independent adverse prognostic factor for PFS(HR=2.47,95%CI 1.28?4.77)and OS(HR=2.71,95%CI 1.21 ? 6.07).Targeted sequencing results showed that PIM1(25.7%),MYD88(24.3%),TP53(18.9%),CD79B(17.6%),KMT2D(17.6%),and TNFAIP3(16.2%)were the high-frequency mutations with mutation rates over 15%.Conclusion·Elevated LDH is an independent adverse prognostic factor for PFS and OS in DLBCL with pulmonary involvement.Mutations in PIM1,MYD88,TP53,CD79B,KMT2D,and TNFAIP3 are frequently observed in this population.

Objective:To explore the application effect of integrated root cause analysis (RCA) in the analysis of approximate administration error events, and to provide reference for the management of clinical approximate administration error events.Methods:A non-synchronous pre-and post-control study was conducted. The data of 3 cases of approximate error events of drug administration in the Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University from January to September 2021 were retrospectively analyzed. The integrated RCA was used to find out the proximal causes, and the system diagram and problem tree analysis were used to determine the root causes. The improvement measures were formulated through barrier analysis, including improving the safety barrier of hospital information system (HIS), updating the database of drug instructions in the Department of Cardiology, standardizing the barrier of nurses′ treatment and examination of medical orders, and visual management barrier. The integrated RCA improvement measures were applied to the management of approximate error events of drug administration. The improvement effect was evaluated by comparing the number of adverse events of medication errors before improvement (January to September 2021) and after improvement (September 2023 to May 2024), the error rate of HIS drug orders, the number of drug interceptions in pharmacies, the processing time of doctors′ HIS orders, and the qualified rate of medical staff 's drug knowledge assessment.Results:There were 32 medical staff in the department of cardiology before improvement, including 6 males and 26 females, aged (31.03 ± 4.29) years old. After improvement, 30 medical staff, 6 males and 24 females, aged (31.20 ± 4.37) years old. After the implementation of integrated RCA improvement, the number of adverse events of medication errors decreased from 3 cases before improvement to 0 cases after improvement. The error rate of HIS drug orders decreased from 11.83%(11/93) before improvement to 2.74%(2/73) after improvement. Improve the pre-audit system without pharmacy drug delivery interception function, improve the pre-application drug information 6 990, the number of drug interception was 0; after improvement, 7 782 pieces of drug information were claimed, and the number of drug interceptions was 78. The difference before and after improvement was statistically significant ( χ2=68.54, P<0.05). After the improvement, the doctor′s HIS doctor′s order processing time including admission, discharge, preoperative, postoperative, examination and medication, and temporary doctor′s order processing time were (1.14 ± 0.41), (1.37 ± 0.30), (0.43 ± 0.11), (0.51 ± 0.11), (0.40 ± 0.10) and (0.51 ± 0.14) min, respectively. They were lower than (4.07 ± 0.70), (3.69 ± 0.60), (1.44 ± 0.24), (2.10 ± 0.45), (1.41 ± 0.28) and (1.44 ± 0.29) min before improvement, and the differences were statistically significant ( t values were 15.21-21.42, all P<0.05). The qualified rate of drug knowledge examination of medical staff increased from 81.25%(26/32) before improvement to 100.00%(30/30) after improvement, and the difference was statistically significant ( P<0.05). Conclusions:The application of integrated RCA to analyze the approximate error events of drug administration is helpful to identify the system defects in the workflow of electronic medical order administration more comprehensively, improve work efficiency and ensure the quality and safety of medical care.

Laccase is a type of polyphenol oxidase that can catalyze the oxidation of various substances,including phenols,aromatic amines,and catecholamines.It has been widely utilized in pollutant degradation and analytical applications.However,the high cost of preparation of natural laccase and its susceptibility to environmental factors,which can lead to denaturation and inactivation,limit its practical applications.Nanozymes,which are nanomaterials that exhibit enzyme-like properties,offer advantages such as easy preparation,adjustable activity,and exceptional stability.Currently,many types of nanozymes have been developed.Inspired by the coordination of Cu2+with amino acids in the active site of natural laccase,researchers have employed coordination synthetic strategies to prepare laccase-like nanozymes.The metal nodes in these laccase-like nanozymes include copper,manganese,and cerium,while the ligands involve a variety of chemicals like nucleotides,amino acids,polypeptides,and aromatic acids.By manipulating factors such as the metal-to-ligand ratio,reducing capacity of ligands,buffer solutions,chloride ions,bromine ions,the catalytic activity of laccase-like nanozymes can be finely tuned.In this paper,laccase-like nanozymes developed through coordination strategies were categorized and summarized,along with review of their analytical applications in detection of phenolic compounds,disease biomarkers,antibiotics,pesticides,sulfur-containing pollutants,and time-temperature indicators.Furthermore,the challenges currently faced in the research of laccase-like nanozymes and future research directions were discussed.

With the increasing demand for dynamic,real-time and rapid qualitative analysis of chemical composition in areas such as emergency response and space exploration,chip-scale mass spectrometers have attracted significant attention.These devices are expected to drive the integration of mass spectrometry with micro/nano-fabrication and intelligent sensing technologies,fostering profound innovation and breakthroughs in analytical chemistry.As an excellent mass analyzer,the ion trap exhibits numerous advantages,and its miniaturization creates favorable conditions for the high-density integration of miniature mass spectrometers.However,the reduction in ion storage capacity may compromise its sensitivity and dynamic range,rendering the study of ion unidirectional ejection in highly miniaturized ion traps of significant practical importance.In this work,a research was conducted on achieving efficient ion unidirectional ejection while maintaining high mass resolution in the extremely miniature hyperbolic linear ion trap(M-HLIT)with a field radius of 1 mm,and an electric field compensation method was proposed,which combined asymmetric electrode stretching and unbalanced RF voltage to achieve high-precision optimization of the electric field composition.Simulations showed that in an ideal structure,this method achieved 100％unidirectional ejection efficiency with the mass resolution of 518,significantly outperforming traditional asymmetric structure method(365)and unbalanced voltage method(321).Following the introduction of ion ejection slots,further optimization through bidirectional stretching and electrical parameters improved the resolution to 790 while maintaining a unidirectional ejection efficiency of 93％.This method eliminated the requirement for additional excitation voltage,offering an ideal solution for the miniature mass analyzer with high detection performance of chip-level mass spectrometers.

As new evidence emerges, treatment strategies toward the functional cure of chronic hepatitis B are evolving. In 2019, a panel of national hepatologists published a Consensus Statement on the functional cure of chronic hepatitis B. Currently, an international group of hepatologists has been assembled to evaluate research since the publication of the original consensus, and to collaboratively develop the updated statements. The 2.0 Consensus was aimed to update the original consensus with the latest available studies, and provide a comprehensive overview of the current relevant scientific literatures regarding functional cure of hepatitis B, with a particular focus on issues that are not yet fully clarified. These cover the definition of functional cure of hepatitis B, its mechanisms and barriers, the effective strategies and treatment roadmap to achieve this endpoint, in particular new surrogate biomarkers used to measure efficacy or to predict response, and the appropriate approach to pursuing a functional cure in special populations, the development of emerging antivirals and immunomodulators with potential for curing hepatitis B. The statements are primarily intended to offer international guidance for clinicians in their practice to enhance the functional cure rate of chronic hepatitis B.

Objective The complex evolutionary history of the origin of medicinal blue herbs might result in the presence of adulterants, affecting the accuracy and safety of clinical medication. To provide a reference basis for the identification of medicinal blue herbs with leaves as the medicinal part, based on the leaf epidermis microstructure. Methods The species belonging to medicinal blue herbs and their close relatives (10 species from 4 genera) were systematically investigated. The leaf epidermis microstructure of these species was observed and analyzed by optical microscopy and scanning electron microscopy. A species retrieval table was established based on the microstructure characteristics. Results By combining the distribution of stomata, types of subsidiary cells, stomatal index, stomatal density, characteristics of the periclinal walls of epidermal cells, and epidermal appendages, the species Clerodendrum cyrtophyllum, Polygonum tinctorium, Isatis indigotica, I. violascens, I. costata, I. minima, Strobilanthes wallichii, S. dalzielii, S. pentstemonoides, and S. cusia can be accurately distinguished. Conclusion Microscopic characteristics of leaf epidermis can provide reference data for accurately differentiating the botanical origins of medicinal blue herbs.