Objective: To evaluate the practical effectiveness of confidential unit exclusion (CUE) in ensuring blood safety in Zhengzhou, analyze its application characteristics and existing problems, and provide a basis for optimizing blood safety management strategies. Methods: A retrospective analysis was conducted on CUE data handled by Henan Red Cross Blood Center from January 2019 to December 2024. Parameters such as the number of cases, demographic characteristics, reasons for exclusion, and time of report were statistically analyzed and compared with those of non-CUE. Results: From 2019 to 2024, the CUE reporting rate in Zhengzhou was 0.002 6% (40/1 547 666). CUE donors were predominantly male (65.00%, 26/40), aged 18-34 years (47.50%, 19/40), had college degree orabove (50.00%, 20/40), and were employees of enterprises or public institutions (32.50%, 13/40). Among the 40 CUE blood units, only one was reactive for anti-TP, while all others were qualified. The main reasons for CUE were recent vaccination (32.50%, 13/40), medical conditions unsuitable for donation (27.50%, 11/40), and high-risk sexual behavior (17.50%, 7/40). A total of 70.00% of reports occurred within 24 hours after donation, during which none of the corresponding blood units had been released; all units reported after more than 7 days had already been issued for clinical use, with no adverse transfusion reactions reported upon follow-up. Conclusion: The confidential unit exclusion program has played an active role in establishing a supplementary information feedback channel for blood donors. The procedure can be optimized by strengthening interactive communication and confirmation before donation, improving the accuracy of donors' self-assessment, and expanding convenient and rapid information-based reporting channels.

ObjectiveTo elucidate the mechanism by which total flavonoids of Abelmoschi Corolla （TFA） treat immunoglobulin A （IgA） nephropathy （IgAN） through serum metabolomics analysis. MethodsSPF-grade male SD rats were randomly assigned into six groups （n=10）： blank， model， low-dose TFA （TFA-L， 27 mg·kg^-1）， medium-dose TFA （TFA-M， 54 mg·kg^-1）， high-dose TFA （TFA-H， 108 mg·kg^-1）， and losartan potassium （LST， 4.5 mg·kg^-1） groups. The remaining five groups， excluding the blank group， were modeled with bovine serum albumin （BSA）， lipopolysaccharide （LPS）， and carbon tetrachloride （CCl₄）. Specifically， from weeks 1 to 10， BSA was administered via gavage every other day， and a mixture of castor oil and CCl₄ was injected subcutaneously once a week， with LPS injected into the tail vein at weeks 6 and 8. After successful modeling， each intervention group was administrated with the medication prepared with distilled water once daily by gavage for a continuous period of 4 weeks. The levels of 24-hour urinary total protein （24 h UP） and serum creatinine （SCr） were quantified by kits， and the serum IgA level was determined by enzyme-linked immunosorbent assay （ELISA）. Renal pathological changes were observed by hematoxylin-eosin （HE） staining and periodic acid-Schiff （PAS） staining. Renal IgA deposition was assessed by immunofluorescence （IF）. Endoplasmic reticulum （ER） stress was observed by transmission electron microscopy. Western blot and immunohistochemistry （IHC） were employed to detect the expression of ER stress-related factors. Non-targeted metabolomics was used to screen differential metabolites for analysis， and key metabolites arachidonic acid （AA）， prostaglandin E₂ （PGE₂）， and cyclooxygenase-2 （COX-2） were validated. ResultsCompared with the blank group， the model group showed increased 24-hour urine protein （24 h UP） and serum creatinine （SCr） levels （P<0.01）， obvious renal pathological damage， elevated serum IgA level （P<0.01）， increased renal AA and PGE₂ levels （P<0.01）， and up-regulated protein levels of COX-2， glucose-regulated protein 78 （GRP78）， phosphorylated eukaryotic initiation factor 2α （P-EIF2α）， activating transcription factor 4 （ATF4）， inositol-requiring enzyme 1α （IRE1α）， and spliced X-box binding protein 1 （XBP1s） in the renal tissue （P<0.05， P<0.01）. Compared with the model group， the intervention groups showed reductions in 24 h UP and SCr levels （P<0.05， P<0.01）， alleviated renal pathological injury， decreased serum IgA level （P<0.05， P<0.01）， and reduced renal AA and PGE₂ levels （P<0.01）. Western blot and IHC results showed that TFA reduced the levels of COX-2， GRP78， P-EIF2α， ATF4， IRE1α， and XBP1s in the renal tissue （P<0.05， P<0.01）. Metabolomics results indicated that 51 commonly differential metabolites were found among the normal， model， and TFA-M groups. TFA ameliorated IgAN by affecting metabolic pathways related to the biosynthesis of arachidonic acid and arginine through L-aspartic acid， prostaglandin 2α， leukotriene B₄， leukotriene D₄， among others. ConclusionTFA can regulate the arachidonic acid metabolism pathway， thereby modulating ER stress， reducing renal damage， and ameliorating IgA nephropathy.

Objective To investigate the distribution of Streptococcus,sensitivity to commonly used antibiotics,and prognosis of the patients with bloodstream infections,and provide evidence for early diagnosis and selection of antibiotics.Methods The Streptococci i-solated from the blood samples of the First Affiliated Hospital of Nanjing Medical University from 2017 to 2022 were collected and di-vided into α-and β-hemolytic Streptococci according to the type of hemolysis.Their sensitivity to commonly used antibiotics was ana-lyzed.The differences in clinical data and prognosis between the two groups were also compared.Results A total of 314 strains of Streptococcus were isolated from 305 patients,including 270 strains of α-hemolytic Streptococcus and 44 β-hemolytic Streptococcus.The results of the drug sensitivity test showed that the proportion of Streptococcus strains with a diameter of 17-19 mm in the inhibition zone of vancomycin increased year by year.The positive alarm time of blood culture for β-hemolytic Streptococcus was significantly shorter than that for α-hemolytic Streptococcus(P＜0.001).Using 10.5 hours as the diagnostic threshold could assist in distinguishing blood-stream infections caused by α-and β-hemolytic Streptococcus.The overall mortality rate of patients with streptococcal bloodstream infec-tion was 15.1％,and there was no statistically significant difference in the mortality rate between the two groups(P=0.813).Conclu-sion The main Streptococcus causing bloodstream infections in our hospital is α-hemolytic Streptococcus.There are differences in the antimicrobial sensitivity and clinical characteristics among patients with different streptococcal bloodstream infections.The positive a-larm time of blood culture can assist in distinguishing the type of streptococcal bloodstream infections.In addition,the diameter of the inhibition zone of vancomycin against Streptococcus has drifted towards the breakpoint of drug resistance.

The construction of the close-knit medical consortium is the starting point for realizing hierarchical diag-nosis and treatment,and the construction of the close-knit medical consortium requires the formation of prob-lem-oriented and interest-oriented cooperation between different types of hospitals.It selected typical cases of cooperation between different types of hospitals in the United States,Canada,Germany and Japan,and gave the key points of cooperation between different types of hospitals,such as agreement signing and cooperation frame-work,establishment of resource sharing and cooperation mechanism,expert exchange and training,case discus-sion and remote consultation,referral and continuum of care,and effect evaluation and continuous improvement.The practice of these hospital,cooperation provides a reference for the extension of high-quality urban resources to the county level in China.

Background and purpose:Tumor microangiogenesis is an important basis for tumor growth and metastasis,and its characteristics include angiogenesis,increased vascular permeability and abnormal capillary structure.Microangiogenesis not only affects the blood supply and metabolism of tumor,but also is directly related to the invasion,prognosis and treatment response of tumor.Dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)is a non-invasive imaging technique.By quantitatively analyzing the distribution and dynamic changes of contrast agents in tumor tissues,it can reflect the microvascular density(MVD),permeability and blood perfusion of tumors.The purpose of this study was to further clarify the application value of DCE-MRI in the diagnosis and treatment of rectal cancer by in-depth analysis of the relationship between quantitative analysis parameters of rectal cancer and microangiogenesis,and to promote the popularization and optimization of this technology in clinical practice.Methods:A total of 348 patients with rectal cancer who were scheduled for surgical treatment in Xinxiang Central Hospital from January 2021 to June 2024 were selected,and rectal cancer tissue specimens and adjacent tissues(＞5 cm away from tumor margin)were collected.This study was approved by the medical ethics committee of Xinxiang Central Hospital(approval number:2021-144-01K).The quantitative analysis parameters of DCE-MRI[Rate constant(Kep),volume transport constant(Ktrans),volume fraction of contrast agent in extracellular space(VE)]and MVD in cancer tissues and adjacent tissues were compared.The quantitative analysis parameters and MVD of DCE-MRI in rectal cancer patients with different differentiation degrees and clinical stages were compared.Spearman correlation was used to analyze the correlation between DCE-MRI parameters and differentiation degree,clinical stage and MVD in patients with rectal cancer.Results:The values of Kep value,Ktrans value,Ve value and MVD were higher in rectal cancer tissues than in adjacent tissues(P＜0.05).The Kep value,Ktrans value,Ve value and MVD of patients with low differentiated and middle differentiated rectal cancer were higher than those of patients with high differentiated rectal cancer(P＜0.05).The values of Kep value,Ktrans value,Ve value and MVD of patients with low differentiated rectal cancer were higher than those of patients with middle differentiated rectal cancer(P＜0.05).The Kep value,Ktrans value,Ve value and MVD of patients with stage Ⅱ,Ⅲ and Ⅳrectal cancer were higher than those of patients with stage Ⅰ rectal cancer(P＜0.05).The Kep value,Ktrans value,Ve value and MVD of patients with stage Ⅲ and Ⅳ rectal cancer were higher than those of patients with stage Ⅱ rectal cancer(P＜0.05).The Kep value,Ktrans value,Ve value and MVD of patients with stage Ⅳ rectal cancer were higher than those of patients with stage Ⅲ rectal cancer(P＜0.05).The Kep value,Ktrans value and Ve value of rectal cancer patients were negatively correlated with the differentiation degree(r=-0.683,-0.743,-0.721,P＜0.05).The Kep value,Ktrans value and Ve value of rectal cancer patients were positively correlated with clinical stage(r=0.764,0.703,0.814,P＜0.05).The Kep value,Ktrans value and Ve value of rectal cancer patients were positively correlated with MVD(r=0.812,0.754,0.835,P＜0.05).Conclusion:DCE-MRI parameters are related to the differentiation degree,clinical stage and microangiogenesis of rectal cancer.

Objective To assess the therapeutic effect of acupuncture in depressive disorders based on current randomized controlled trials(RCTs).Method RCTs on acupuncture interventions for primary depression by searching databases including CNKI,Wanfang,VIP,Sinomed,PubMed,and Embase.Two researchers independently assessed the quality of the literature,extracted data according to the latest Cochrane Handbook for Systematic Reviews of Interventions,and cross-checked the data.Meta-analysis was performed using RevMan 5.4 software.Result A total of 52 studies were included,comprising 5277 patients.The meta-analysis results showed that acupuncture significantly improved depression symptoms as measured by the Hamilton Depression Rating Scale(HAMD)and reduced clinical inefficacy rates{HAMD-17:WMD=-2.35,95%CI[-3.04,-1.67],P<0.000 01;HAMD-24:WMD=-2.77,95%CI[-3.52,-2.03],P<0.000 01;HAMD(unspecified scale):WMD=-2.77,95%CI[-3.52,-2.03],P<0.000 01;Clinical inefficacy:RR=0.39,95%CI[0.33,0.47],P<0.000 01}.Additionally,acupuncture increased 5-HT levels(SMD=1.11,95%CI[0.67,1.55],P<0.000 01).In terms of safety,acupuncture did not increase the incidence of adverse events and reduced TESS scores{Adverse event incidence:RR=0.65,95%CI[0.47,0.89],P=0.007;TESS scores:WMD=-1.66,95%CI[-3.12,-0.20],P=0.03}.There is potential publication bias regarding clinical inefficacy and adverse events,necessitating cautious interpretation.Conclusion Based on the current evidence,acupuncture is an effective and safe treatment for depressive disorders.However,more high-quality RCTs are needed to further validate or refine these conclusions.

In January 2023, a patient with soft tissue degloving defect of right index, middle, ring and little fingers was treated in the Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital. Seven free flaps from a leg were harvested to reconstruct the defected wound of fingers in primary surgery. Flap thinning and plastic surgery were performed in stage-II surgery. Over the 22 months of postoperative follow-up, the flaps in right index, middle, ring and little fingers survived well with the colour and texture close to proximal skin. There was no obvious swelling of the flaps and sensation of the flaps recovered to S 3. The donor sites healed well and the donor leg walked normally.

The construction of the close-knit medical consortium is the starting point for realizing hierarchical diag-nosis and treatment,and the construction of the close-knit medical consortium requires the formation of prob-lem-oriented and interest-oriented cooperation between different types of hospitals.It selected typical cases of cooperation between different types of hospitals in the United States,Canada,Germany and Japan,and gave the key points of cooperation between different types of hospitals,such as agreement signing and cooperation frame-work,establishment of resource sharing and cooperation mechanism,expert exchange and training,case discus-sion and remote consultation,referral and continuum of care,and effect evaluation and continuous improvement.The practice of these hospital,cooperation provides a reference for the extension of high-quality urban resources to the county level in China.

Objective To investigate the distribution of Streptococcus,sensitivity to commonly used antibiotics,and prognosis of the patients with bloodstream infections,and provide evidence for early diagnosis and selection of antibiotics.Methods The Streptococci i-solated from the blood samples of the First Affiliated Hospital of Nanjing Medical University from 2017 to 2022 were collected and di-vided into α-and β-hemolytic Streptococci according to the type of hemolysis.Their sensitivity to commonly used antibiotics was ana-lyzed.The differences in clinical data and prognosis between the two groups were also compared.Results A total of 314 strains of Streptococcus were isolated from 305 patients,including 270 strains of α-hemolytic Streptococcus and 44 β-hemolytic Streptococcus.The results of the drug sensitivity test showed that the proportion of Streptococcus strains with a diameter of 17-19 mm in the inhibition zone of vancomycin increased year by year.The positive alarm time of blood culture for β-hemolytic Streptococcus was significantly shorter than that for α-hemolytic Streptococcus(P＜0.001).Using 10.5 hours as the diagnostic threshold could assist in distinguishing blood-stream infections caused by α-and β-hemolytic Streptococcus.The overall mortality rate of patients with streptococcal bloodstream infec-tion was 15.1％,and there was no statistically significant difference in the mortality rate between the two groups(P=0.813).Conclu-sion The main Streptococcus causing bloodstream infections in our hospital is α-hemolytic Streptococcus.There are differences in the antimicrobial sensitivity and clinical characteristics among patients with different streptococcal bloodstream infections.The positive a-larm time of blood culture can assist in distinguishing the type of streptococcal bloodstream infections.In addition,the diameter of the inhibition zone of vancomycin against Streptococcus has drifted towards the breakpoint of drug resistance.

Objective:To conduct a comparative analysis of the oxygen depletion and oxygen effect of FLASH irradiation and conventional irradiation by direct measurement of oxygen content.Methods:The oxygen content in different tissues and organs of mice was measured using a phosphorescent probe. A subcutaneous xenograft tumor model in mice was established, to receive electron-beam irradiation at different doses and dose rates. The oxygen depletion of tumor and normal tissue was analyzed, and tumor control was evaluated. The oxygen depletion of conventional irradiation and FLASH irradiation was further analyzed using an in vitro model. The survival fraction (SF) of normal cells after conventional irradiation and FLASH irradiation was calculated using colony formation assay under different partial pressures of oxygen, and the data were fitted to the oxygen enhancement ratio (OER) curve. Results:The mean oxygen content of subcutaneous xenograft tumor in mice was 1.28%, suggesting hypoxia. The mean oxygen content of normal tissue ranged from 3.51% to 6.53%, suggesting physioxia. In animal experiments, oxygen depletion was not observed during conventional irradiation. High-dose-rate (20 Gy/s) and ultra-high-dose-rate (FLASH, 40 Gy/s) irradiation produced oxygen depletion. During FLASH irradiation, with the increase of oxygen content, the oxygen depletion was 0.1-0.2 mm Hg/Gy for tumor tissue and 0.19-0.21 mm Hg/Gy for skin tissue, which tended to stabilize. FLASH irradiation maintained equivalent tumor control compared to conventional irradiation. The tumoricidal effect was significantly enhanced with the increase of oxygen content in the tissue ( t=3.46, P<0.01). In in vitro experiments, the mean oxygen depletion rate was about 0.16 mm Hg/Gy for conventional irradiation and 0.16-0.18 mm Hg/Gy for FLASH irradiation, which did not change significantly with the increase of oxygen content. FLASH irradiation was associated with an oxygen effect. When the partial pressure of oxygen decreased from physioxia to hypoxia, the OER value significantly reduced. Conclusions:Normal tissues and organs are in physioxia, which exhibits a lower oxygen content than that in the air. FLASH irradiation can consume a proportion of oxygen, producing an oxygen effect. When oxygen content decreases, the oxygen depletion rate slows down after FLASH irradiation.