Objective: To investigate the factors influencing intraoperative blood transfusion in patients with hip fractures and to develop a machine learning (ML) model for predicting this risk. Methods: A total of 424 patients with hip fractures who underwent surgical treatment between November 2022 and March 2025 in our hospital were selected. Key feature variables of intraoperative blood transfusion risk were identified using the Boruta algorithm. Four different ML algorithms—support vector machine (SVM), linear discriminant analysis (LDA), mixed discriminant analysis (MDA), and extreme gradient boosting (XGBoost)—were used to develop predictive models for intraoperative blood transfusion risk. The predictive performance of the four ML models were evaluated using accuracy, precision, receiver operating characteristic (ROC) curves, precision-recall curves (PRC), precision-recall gain curves (PRGC), and F1 scores. Shapley additive interpretation (SHAP) was used to interpret the final model. Results: Among the 424 patients, 77(18.2%) received intraoperative blood transfusion. The Boruta algorithm identified albumin (ALB), activated partial thromboplastin time (APTT), types of anesthesia, types of fracture, and hemoglobin (Hb) as key feature variables for predicting intraoperative blood transfusion risk. In model evaluation, the SVM model outperforms the other three models across multiple metrics, including the area under the receiver operating characteristic curve (AUC), recall, recall gain, accuracy, precision, F1 score, and the area under the precision-recall curve (PRC-AUC). The SVM model, interpreted and visualized based on SHAP values, effectively predicted intraoperative blood transfusion risk in patients with hip fracture. A visual online application was developed based on the SVM model (https://pbo-nomogram.shinyapps.io/blood/). Conclusion: Preoperative low ALB and Hb levels, prolonged APTT, general anesthesia, and intertrochanteric fractures are risk factors for intraoperative blood transfusion in hip fracture patients. The risk prediction model for intraoperative blood transfusion constructed based on the SVM algorithm has optimal performance, which provides new ideas and methods for the clinical early identification of hip fracture patients with high transfusion risk and the implementation of targeted interventions.

Mammalian male germline development depends on a specialized gonadal somatic microenvironment. However, itsin vitro reconstruction remains challenging. Major barriers include the generation of appropriate supporting-cell lineages, organized tissue architecture, and culture conditions that sustain germ-cell maturation. Yoshino et al. established a mouse pluripotent stem cell-derived testicular organoid model. This model reconstitutes the sex-determining region Y (Sry)-SRY-box transcription factor 9 (Sox9)‑mediated sex-determination program and generates testicular somatic cell-like cells (TesLCs). When assembled with primordial germ cell-like cells (PGCLCs), TesLCs formed seminiferous tubule-like structures and supported male germline progression toward prospermatogonia and germline stem cell-like cells (GSCLCs). After transplantation into infertile recipient testes, organoid-derived GSCLCs produced fertilization-competent sperm and generated fertile offspring. The major significance of this work extends beyond sperm production. It integrates sex determination, germ-cell fate transition, and testicular niche self-organization into an experimentally tractable organoid system. This commentary discusses the technical strategy, sex-determination mechanism, value of testicular niche reconstruction, and translational limitations of this study. It also highlights its implications for in vitro gametogenesis, male infertility modeling, and reproductive medicine.

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.

Objective:To investigate the iodine nutrition status of children aged 8 - 10 and pregnant women in Xining City, Qinghai Province.Methods:From 2019 to 2021, a stratified cluster sampling method was used to divide 7 counties (districts) under the jurisdiction of Xining City, Qinghai Province into 5 sampling areas according to east, west, south, north, and center each year. One township (town, street) was selected from each area. Forty non boarding students aged 8 to 10 from each primary school (half male and half female, age balanced) and 20 pregnant women from each township (town, street) location were selected to collect edible salt samples at home and a random urine sample to measure salt iodine and urinary iodine level. B-ultrasound was used to measure thyroid volume in children and the goiter rate was calculated.Results:A total of 6 534 samples of household edible salt were collected from children and pregnant women, with an average salt iodine concentration of 25.58 mg/kg. The coverage rate of iodized salt was 97.50% (6 371/6 534), and the qualified iodized salt consumption rate was 89.46% (5 845/6 534). A total of 4 362 urine samples were collected from children, with a median urinary iodine level of 183.10 μg/L. The difference between different years was statistically significant ( H = 20.27, P < 0.001). A total of 2 169 urine samples were collected from pregnant women, with a median urinary iodine level of 168.90 μg/L. The difference between different years was statistically significant ( H = 107.09, P < 0.001). A total of 3 336 cases of thyroid gland examination were conducted in children, including 33 cases of thyroid enlargement, with a goiter rate of 0.99%. There was a statistically significant difference between different years (χ 2 = 15.00, P < 0.001). Conclusion:From 2019 to 2021, children aged 8 to 10 and pregnant women in Xining City are at an appropriate level of iodine, and the achievements in prevention and treatment of iodine deficiency disorders still need to be continuously consolidated.

OBJECTIVE To investigate the management status of small pressure steam sterilizers in dental institu-tions across seven major regions of China and provide references for establishing standardized monitoring and eval-uation protocols for sterilization efficacy.METHODS From Aug.to Nov.2023,a convenience sampling method was employed to select 885 dental institutions of various levels from seven geographical regions.An online survey using a self-designed questionnaire was conducted to assess the management status of small pressure steam steri-lizers in dental institutions.RESULTS A total of 885 questionnaires were distributed,with 770 valid responses col-lected,covering 770 dental institutions at all levels.The survey involved 2 056 small pressure steam sterilizers,of which 43.14％were pre-vacuum type and 89.40％were benchtop models.Tertiary dental institutions had the high-est proportion of imported small pressure steam sterilizers(60.15％),with most devices in use for 5-10 years(36.88％).Secondary and low er-level institutions predominantly used domestically produced small pressure steam sterilizers(74.60％),which used for 3-5 years accounting for the highest proportion(34.29％).While 85.58％of dental institutions employed dedicated sterilization personnel,only 45.84％performed proper maintenance for small pressure steam sterilizers.Training rates were 80.00％for department of stomatology in ungraded general hospitals and primary medical institutions,76.19％in prejob and 71.43％during the work for department of sto-matology in primary clinics,respectively.CONCLUSIONS Although most dental institutions demonstrate sound policy formulation,challenges persist in equipment maintenance,policy implementation and grassroots training.Future efforts should be made on strengthening maintenance and inspection of equipment,enhancing sys-tem supervisory mechanisms,and optimizing training systems to ensure dental treatment safety.

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.

Objective:To investigate the iodine nutrition status of children aged 8 - 10 and pregnant women in Xining City, Qinghai Province.Methods:From 2019 to 2021, a stratified cluster sampling method was used to divide 7 counties (districts) under the jurisdiction of Xining City, Qinghai Province into 5 sampling areas according to east, west, south, north, and center each year. One township (town, street) was selected from each area. Forty non boarding students aged 8 to 10 from each primary school (half male and half female, age balanced) and 20 pregnant women from each township (town, street) location were selected to collect edible salt samples at home and a random urine sample to measure salt iodine and urinary iodine level. B-ultrasound was used to measure thyroid volume in children and the goiter rate was calculated.Results:A total of 6 534 samples of household edible salt were collected from children and pregnant women, with an average salt iodine concentration of 25.58 mg/kg. The coverage rate of iodized salt was 97.50% (6 371/6 534), and the qualified iodized salt consumption rate was 89.46% (5 845/6 534). A total of 4 362 urine samples were collected from children, with a median urinary iodine level of 183.10 μg/L. The difference between different years was statistically significant ( H = 20.27, P < 0.001). A total of 2 169 urine samples were collected from pregnant women, with a median urinary iodine level of 168.90 μg/L. The difference between different years was statistically significant ( H = 107.09, P < 0.001). A total of 3 336 cases of thyroid gland examination were conducted in children, including 33 cases of thyroid enlargement, with a goiter rate of 0.99%. There was a statistically significant difference between different years (χ 2 = 15.00, P < 0.001). Conclusion:From 2019 to 2021, children aged 8 to 10 and pregnant women in Xining City are at an appropriate level of iodine, and the achievements in prevention and treatment of iodine deficiency disorders still need to be continuously consolidated.

Objective:To explore the application value of the artificial intelligence (AI) morphological assisted analysis system in the pre-classification of blood cells in patients with acute myeloid leukemia, myelodysplasia-related (AML-MR).Methods:A retrospective analysis was conducted on the bone marrow and peripheral blood cell morphology of patients initially diagnosed with AML-MR at Taizhou Hospital in Zhejiang Province from September 1, 2022, to December 31, 2023. A total of 44 patients, including 25 males and 19 females, with a median age of 71 (63.5, 75.3) years. Bone marrow and peripheral blood morphology were examined using the Morphogo cell morphology assisted analysis system, with the artificial classification results serving as the gold standard. A confusion matrix was constructed to evaluate the precision, sensitivity, and specificity of the AI system in identifying various cell types in bone marrow and peripheral blood for AML-MR diagnosis. The impact of dysplastic hematopoiesis on AI pre-classification was analyzed by comparing AI and manual classification results.Results:The AI system completed the pre-classification of 44 bone marrow smears and 42 corresponding peripheral blood smears from AML-MR patients. For bone marrow smears, the precision, sensitivity, and specificity of AI in pre-classifying blast cells were 85.78%, 91.01%, and 94.58%, respectively. For peripheral blood smears, these values were 87.11%, 87.05%, and 98.29%, respectively. The precision and sensitivity of AI in pre-classifying promyelocytes were 54.26% and 46.93%, respectively, while for monocytes, they were 58.16% and 68.34%, both lower than those for blast cells. The precision and sensitivity of AI in identifying myelocytes and metamyelocytes also decreased (77.47%, 66.25% and 81.91%, 63.29%, respectively). The precision and sensitivity of AI in pre-classifying erythroblasts/proerythroblasts (67.71%, 69.89%) were lower than those for polychromatic and orthochromatic normoblasts (83.43%, 85.53% and 92.97%, 86.96%, respectively). The confusion matrix and comparative analysis of AI and manual classification indicated that the decline in AI pre-classification precision and sensitivity was due to frequent misclassification between promonocytes and monocytes, as well as between monocytes and promyelocytes. Additionally, this decline is associated with dysplasia. However, the impact of dysplasia on the AI pre-classification of mature-stage granulocytes was minimal.Conclusion:The AI system demonstrated high precision, sensitivity, and specificity in pre-classifying blast cells in bone marrow and peripheral blood smears from AML-MR patients. The AI-assisted morphological analysis system can be effectively utilized for the pre-classification of blood cells in AML-MR patients.

Objective:To explore the immunophenotypic differences between acute promyelocytic leukemia (APL) and APL-like NPM1 mutant acute myeloid leukemia (NPM1mutAML) using flow cytometry, and to investigate early diagnostic markers for differentiating APL from NPM1mutAML.Methods:A retrospective study was conducted on 72 cases of APL diagnosed at Taizhou Hospital, affiliated with Wenzhou Medical University, from February 2nd, 2018 to December 16th, 2023, including 42 male and 30 female patients with a median age of 42 (32, 57) years old. Based on morphology, 51 cases were classified as the coarse-granular type and 21 cases as the fine-granular type. Additionally, 45 cases of NPM1mutAML, comprising 20 male and 25 female patients with a median age of 58 (47, 65) years old, were included. Of these, 12 cases were classified as the coarse-granular type and 33 as the fine-granular type. Immunophenotypic analysis was performed using multiparameter flow cytometry, and all patients underwent cytogenetic analysis for chromosome karyotyping. FISH analysis was used for detecting the PML-RARα fusion gene in APL cases, and sequencing was used for identifying NPM1 mutations in NPM1mutAML patients. The antigen expression parameters (expression rate, median fluorescence intensity [MdFI], and coefficient of variation [ CV]) were analyzed using principal component analysis (PCA). The antigen expression rates were compared using the Wilcoxon rank-sum test, and the positive rates of antigens were compared using the Chi-square test. Sensitivity and specificity for diagnosis by the some antigens were evaluated using ROC curve analysis. Results:The immunophenotypic analysis revealed that the expression rates of CD123, CD64, CD13, and CD9 were significantly higher in APL compared to NPM1mutAML ( Z values of-6.72, -6.29, -5.63, -7.67, P<0.01). In the coarse-granular type, the expression rates of CD123 and CD9 in APL were also significantly higher than those in NPM1mutAML ( P<0.01). In the fine-granular type, the expression levels of CD123, CD13, CD64, and CD9 were significantly higher in APL than in NPM1mutAML ( P<0.01). ROC curve analysis showed that in the fine-granular type, the areas under the curve (AUC) for CD64, CD13, CD123, and CD9 in diagnosing APL and NPM1mutAML were 0.96, 0.89, 0.86, and 0.89, respectively ( P<0.01). In the coarse-granular type, the AUC for CD64 and CD13 were 0.49 and 0.51 ( P>0.05), while the AUC for CD123 and CD9 were 0.96 and 0.96 ( P<0.01). Principal component analysis (PCA) of antigen expression (expression rate, MdFI, CV) showed complete separation of the APL and NPM1mutAML groups. Conclusion:APL and APL-like NPM1mutAML patients exhibit distinct antigen expression profiles. Specifically, a combined detection of CD64, CD13, CD123, and CD9 can help to rapidly differentiate APL from APL-like NPM1mutAML at initial diagnosis.

OBJECTIVE To investigate the management status of small pressure steam sterilizers in dental institu-tions across seven major regions of China and provide references for establishing standardized monitoring and eval-uation protocols for sterilization efficacy.METHODS From Aug.to Nov.2023,a convenience sampling method was employed to select 885 dental institutions of various levels from seven geographical regions.An online survey using a self-designed questionnaire was conducted to assess the management status of small pressure steam steri-lizers in dental institutions.RESULTS A total of 885 questionnaires were distributed,with 770 valid responses col-lected,covering 770 dental institutions at all levels.The survey involved 2 056 small pressure steam sterilizers,of which 43.14％were pre-vacuum type and 89.40％were benchtop models.Tertiary dental institutions had the high-est proportion of imported small pressure steam sterilizers(60.15％),with most devices in use for 5-10 years(36.88％).Secondary and low er-level institutions predominantly used domestically produced small pressure steam sterilizers(74.60％),which used for 3-5 years accounting for the highest proportion(34.29％).While 85.58％of dental institutions employed dedicated sterilization personnel,only 45.84％performed proper maintenance for small pressure steam sterilizers.Training rates were 80.00％for department of stomatology in ungraded general hospitals and primary medical institutions,76.19％in prejob and 71.43％during the work for department of sto-matology in primary clinics,respectively.CONCLUSIONS Although most dental institutions demonstrate sound policy formulation,challenges persist in equipment maintenance,policy implementation and grassroots training.Future efforts should be made on strengthening maintenance and inspection of equipment,enhancing sys-tem supervisory mechanisms,and optimizing training systems to ensure dental treatment safety.