Objective: To characterize perioperative dynamic changes in immune-cell phenotypes and inflammatory cytokines in patients undergoing CPB (cardiopulmonary bypass) cardiac surgery, and to explore their associations with postoperative outcomes. Methods: In this prospective cohort study, 120 adult patients who underwent elective cardiac surgery under CPB at West China Hospital from May 2022 to March 2023 were enrolled. Perioperative immune-cell phenotypes and concentrations of 40 inflammation-related cytokines were measured. The primary outcomes were the sequential organ failure assessment (SOFA) score at 24 h after surgery and ΔSOFA (the peak SOFA score within 48 h after surgery minus the preoperative SOFA score). Secondary outcomes included major adverse cardiovascular events (MACE), acute kidney injury (AKI), respiratory failure, severe liver injury, and infection. Results: The mean age of enrolled patients was 57±10 years. Of these, 52% (62/120) were male and 90% (108/120) underwent valve surgery. During the rewarming to the end of CPB, neutrophil counts rapidly increased (7.39×10 /L vs preoperative 3.07×10 /L, P<0.001), with significant upregulation of CD11b (7.30×10 /L vs preoperative 3.05×10 /L, P<0.001) and CD54 (7.15×10 /L vs preoperative 2.99×10 /L, P<0.001). Lymphocyte counts increased at the end of CPB (1.75×10 /L vs preoperative 1.12×10 /L, P<0.001) but decreased significantly at 24 h after surgery (0.59×10 /L vs preoperative 1.12×10 /L, P<0.001). Plasma analysis showed that multiple pro-inflammatory cytokines increased during CPB and remained elevated up to 24 h after surgery; five chemokines and the anti-inflammatory cytokine IL-10 peaked at the end of CPB. The SOFA score increased from 1 (1, 2) preoperatively to 7 (5, 10) at 24 h after surgery, with a ΔSOFA of 6 (4, 8). Within 30 days after surgery, 48 patients (40.0%) developed AKI, 17 (14.2%) developed infection, 4 (3.3%) developed severe liver injury, 3 (2.5%) developed respiratory failure, and 3 (2.5%) experienced MACE. During the 2-year follow-up, 8 patients (6.7%) experienced MACE and 5 (4.2%) died. Conclusion: Multi-organ dysfunction is common after cardiac surgery under CPB (median ΔSOFA, 6), accompanied by perioperative activation of multiple immune-cell subsets and upregulation of pro-inflammatory, anti-inflammatory, and chemotactic mediators. This study provides data-driven evidence and research clues for further investigation of the associations between CPB-related immune perturbations and postoperative organ dysfunction and clinical outcomes.

OBJECTIVE: To explore the genetic etiology of 46 Chinese pedigrees affected with Hereditary multiple exostoses (HME) and provide genetic counseling and reproductive intervention. METHODS: Whole-exome sequencing and Sanger sequencing were carried out on 87 patients from the 46 pedigrees to analyze the variants of EXT1 and EXT2 genes. Pathogenicity of the variants was assessed based on the guidelines from the American College of Medical Genetics and Genomics and Association for Molecular Pathology (ACMG/AMP). Prenatal diagnosis and preimplantation genetic testing (PGT) were provided for couples with identified pathogenic mutations. This study was approved by the Medical Ethics Committee of the hospital (Ethics No.: LL-SC-SG-2014-010). RESULTS: In total 17 and 22 pathogenic variants were respectively identified in the EXT1 and EXT2 genes, among which 5 EXT1 and 12 EXT2 variants were unreported previously. Three patients with no family history were found to harbor de novo variants of the EXT1 gene. Twenty nine couples had opted for PGT or underwent prenatal diagnosis following natural conception, and 17 healthy babies were born. CONCLUSION This study has clarified the genetic etiology of 45 HME pedigrees and identified 17 novel variants, which has enriched the mutational spectrum of the EXT1 and EXT2 genes. Reproductive intervention through PGT and prenatal diagnosis have prevented the recurrence of HME in these families.
Humans ; Female ; Male ; Pedigree ; Exostoses, Multiple Hereditary/diagnosis* ; N-Acetylglucosaminyltransferases/genetics* ; Adult ; Exostosin 1 ; Asian People/genetics* ; Genetic Testing ; Exostosin 2 ; Mutation ; China ; Prenatal Diagnosis ; Pregnancy ; Genetic Counseling ; Preimplantation Diagnosis ; Exome Sequencing ; East Asian People

Work serves as a critical means of obtaining resources, facilitating personal growth, realizing self-worth, and engaging in social interactions. However, work-related diseases pose significant threats to workers’ health and productivity, and impose considerable economic burdens. This article categorized work-related diseases into six major types, including musculoskeletal disorders, mental and behavioral disorders, cardiovascular and metabolic diseases, digestive system diseases, reproductive system diseases, and non-specific respiratory diseases, and summarized their risk factors, assessment methods, policy regulation, and prevention and control measures. Current research in this field predominantly relies on cross-sectional studies, which present limitations in causal inference and potential risks of bias. Future studies should expand sample sizes, optimize research designs, and establish multidimensional evaluation systems to comprehensively assess the health and economic impacts of work-related diseases. It is recommended to enhance the translation of research findings into practice, thereby providing a scientific basis for the occupational health protection system and promoting the well-being and sustainable development of the working population.

Objective:To assess the professional knowledge proficiency of mainstream large language models (LLMs) in medical laboratory education and to explore their potential as educational aids for medical laboratory technology students.Methods:A comprehensive evaluation was conducted using 400 authentic questions from the 2023 Chinese National Clinical Medical Laboratory Technician Qualification Examination. Five LLMs (Copilot, Grok, Yuanbao, Doubao, and Kimi) were tested through two-round interactions using zero-shot prompting and interaction-optimized prompting strategies. The accuracy of answers and the quality of generated content were evaluated. Performance disparities were analyzed using Cochran's Q test. Content quality was scored through the CLEAR framework (completeness, lack of false information, evidence-based reasoning, appropriateness, relevance).Results:In the first-round test, Doubao achieved the highest overall accuracy rate (375/400). The overall accuracy rates of Doubao and Yuanbao significantly outperformed Copilot and Kimi ( P<0.001). After the second-round interactive optimization, the accuracy rate of Kimi significantly improved ( P<0.05), whereas other LLMs showed slight improvements ( P>0.05). Doubao still had the highest overall accuracy rate (380/400). The overall accuracy rates of Doubao and Yuanbao significantly outperformed Copilot ( P<0.005). Evaluation based on the CLEAR framework revealed that Yuanbao, Doubao, and Kimi significantly outperformed foreign models in the dimensions of evidence-based reasoning ( P<0.003) and completeness ( P<0.05), demonstrating standardized citation of authoritative evidence and superior content quality. Conclusions:The tested LLMs possess extensive medical laboratory knowledge. The accuracy of their answers and the quality of the generated content can be improved through single-question input, specifying evidence requirements, and enabling advanced reasoning functions. Domestic LLMs are comparable to foreign LLMs in terms of accuracy, and have significant advantages in the dimensions of evidence-based reasoning and completeness. LLMs can serve as auxiliary tools for learning professional knowledge in medical laboratory technology.

Objective:To explore the application effect of 3D technology-assisted teaching based on "four-in-one" flipped classroom in clinical teaching of neurosurgery, and provide a basis for optimizing the medical education mode.Methods:A total of 50 students from the Second Clinical College were selected between June 2020 and June 2024, including eight-year program medical students and postgraduate neurosurgery students. The control group ( n=25) received the conventional teaching mode. The experimental group ( n=25) was taught using the "four-in-one" flipped classroom combined with 3D technology, including characteristic textbooks with 3D model drawings, Internet platforms (video libraries and virtual simulation modules), mobile interactive terminals (real-time question and answer), and virtual simulation technology. Effectiveness was evaluated through theoretical assessment (e.g., neuroanatomy and clinical application ability, with a total score of 100 points), operational assessment (e.g., surgical design and aseptic concept, with a total score of 100 points), and a teaching quality questionnaire. Independent samples t-test was conducted using SPSS 22.0. Results:The total score of theoretical assessment was higher in the experimental group than that in the control group [(86.52±5.21) vs. (73.56±6.32), P<0.001], with the largest difference observed in case analysis questions [(26.03±3.65) vs. (22.22±3.50), P=0.001]. In the operational assessment, the experimental group performed better in "surgical process design" [(26.30±4.14) vs. (21.44±3.45), P<0.001] and "aseptic concept" [(8.18±0.98) vs. (6.64±0.79), P<0.001]. The teaching quality questionnaire showed that the experimental group scored higher in "clinical practice skill enhancement" [(23.13±1.39) vs. (21.45±1.86), P=0.001] and "self-directed learning motivation" [(21.84±1.60) vs. (19.75±1.45), P<0.001]. Conclusions:The combination of "four-in-one" flipped classroom and 3D technology can significantly improve the teaching effectiveness of neurosurgery, especially in the cultivation of clinical thinking and practical abilities. This approach is worth promoting.

Neonatal sepsis is a global health problem that seriously affects the body health and life safety of newborns. It has a higher incidence in preterm infants,especially for early-onset sepsis (EOS) within 72 hours of birth. The diagnosis of neonatal EOS requires a series of examinations,and early and accurate diagnosis can improve clinical outcomes and reduce antibiotic overuse in a timely manner. At present,the commonly used biomarkers and traditional blood culture methods for EOS diagnosis have certain shortcomings,so it is urgent to find new molecular diagnostic methods. This article summarizes and compares the early and novel diagnostic methods of neonatal EOS,in order to provide a reference for clinical practice.

Objective:To explore the effects of Levothyroxine Sodium (L-T4) treatment on coagulation function and adverse pregnancy outcomes in patients with hypothyroidism during pregnancy in early and mid-to-late pregnancy.Methods:A total of 120 patients with hypothyroidism during pregnancy who were treated by L-T4 in Linyi Central Hospital from Mar. 2021 to Mar. 2024 were included, and their clinical data were retrospectively analyzed. According to the gestational age of the patients at the time of treatment, 64 cases with a gestational age of <12 weeks were included in the early pregnancy group, and 56 cases with a gestational age of ≥12 weeks were included in the mid-to-late pregnancy group. The serum thyroid hormone indexes, coagulation function indexes, adverse pregnancy outcomes, and neuropsychological development of the offspring were compared between the two groups. Statistical analyses were conducted using independent/paired t-tests and chi-square tests.Results:After treatment, there were no significant differences in the thyroid hormone indexes and coagulation function indexes between the early pregnancy group and the middle and late pregnancy group ( P>0.05). The incidence of fetal growth restriction and gestational hypertension in the early pregnancy group was 10.94% (7/64) and 17.19% (11/64), and that in the middle and late pregnancy group was 26.79% (15/56) and 33.93% (19/56), respectively. The incidence in the early pregnancy group was significantly lower than that in the middle and late pregnancy group ( χ2=5.010, 4.464, P<0.05). The developmental quotient (DQ) of the offspring in the early pregnancy group at 6 months of age in various areas of neuropsychological development (social behavior, language, adaptability, fine motor skills and gross motor skills) was significantly higher than that in the middle and late pregnancy group. The DQ of the first trimester group was (97.82±7.25) points, (94.59±6.85) points, (95.87±8.02) points, (96.08±7.25) points, and (98.34±8.07) points. The DQ of the second trimester group was (92.54±7.06) points, (90.45±6.14) points, (91.01±7.51) points, (91.24±7.08) points, and (92.74±7.38) points. The DQ of the first trimester group was significantly higher than that of the second trimester group ( t=4.029, 3.466, 3.411, 3.688, 3.946, P<0.05) . Conclusion:L-T4 treatment in early or mid- to late-pregnancy patients with gestational hypothyroidism can effectively improve their thyroid hormone levels and coagulation function, but treatment in early pregnancy is beneficial to reduce the incidence of adverse pregnancy outcomes such as fetal growth restriction and alleviate the impact of the disease on the neuropsychological development of offspring.

Objective:To explore the application effect of 3D technology-assisted teaching based on "four-in-one" flipped classroom in clinical teaching of neurosurgery, and provide a basis for optimizing the medical education mode.Methods:A total of 50 students from the Second Clinical College were selected between June 2020 and June 2024, including eight-year program medical students and postgraduate neurosurgery students. The control group ( n=25) received the conventional teaching mode. The experimental group ( n=25) was taught using the "four-in-one" flipped classroom combined with 3D technology, including characteristic textbooks with 3D model drawings, Internet platforms (video libraries and virtual simulation modules), mobile interactive terminals (real-time question and answer), and virtual simulation technology. Effectiveness was evaluated through theoretical assessment (e.g., neuroanatomy and clinical application ability, with a total score of 100 points), operational assessment (e.g., surgical design and aseptic concept, with a total score of 100 points), and a teaching quality questionnaire. Independent samples t-test was conducted using SPSS 22.0. Results:The total score of theoretical assessment was higher in the experimental group than that in the control group [(86.52±5.21) vs. (73.56±6.32), P<0.001], with the largest difference observed in case analysis questions [(26.03±3.65) vs. (22.22±3.50), P=0.001]. In the operational assessment, the experimental group performed better in "surgical process design" [(26.30±4.14) vs. (21.44±3.45), P<0.001] and "aseptic concept" [(8.18±0.98) vs. (6.64±0.79), P<0.001]. The teaching quality questionnaire showed that the experimental group scored higher in "clinical practice skill enhancement" [(23.13±1.39) vs. (21.45±1.86), P=0.001] and "self-directed learning motivation" [(21.84±1.60) vs. (19.75±1.45), P<0.001]. Conclusions:The combination of "four-in-one" flipped classroom and 3D technology can significantly improve the teaching effectiveness of neurosurgery, especially in the cultivation of clinical thinking and practical abilities. This approach is worth promoting.

Objective:To explore the effects of Levothyroxine Sodium (L-T4) treatment on coagulation function and adverse pregnancy outcomes in patients with hypothyroidism during pregnancy in early and mid-to-late pregnancy.Methods:A total of 120 patients with hypothyroidism during pregnancy who were treated by L-T4 in Linyi Central Hospital from Mar. 2021 to Mar. 2024 were included, and their clinical data were retrospectively analyzed. According to the gestational age of the patients at the time of treatment, 64 cases with a gestational age of <12 weeks were included in the early pregnancy group, and 56 cases with a gestational age of ≥12 weeks were included in the mid-to-late pregnancy group. The serum thyroid hormone indexes, coagulation function indexes, adverse pregnancy outcomes, and neuropsychological development of the offspring were compared between the two groups. Statistical analyses were conducted using independent/paired t-tests and chi-square tests.Results:After treatment, there were no significant differences in the thyroid hormone indexes and coagulation function indexes between the early pregnancy group and the middle and late pregnancy group ( P>0.05). The incidence of fetal growth restriction and gestational hypertension in the early pregnancy group was 10.94% (7/64) and 17.19% (11/64), and that in the middle and late pregnancy group was 26.79% (15/56) and 33.93% (19/56), respectively. The incidence in the early pregnancy group was significantly lower than that in the middle and late pregnancy group ( χ2=5.010, 4.464, P<0.05). The developmental quotient (DQ) of the offspring in the early pregnancy group at 6 months of age in various areas of neuropsychological development (social behavior, language, adaptability, fine motor skills and gross motor skills) was significantly higher than that in the middle and late pregnancy group. The DQ of the first trimester group was (97.82±7.25) points, (94.59±6.85) points, (95.87±8.02) points, (96.08±7.25) points, and (98.34±8.07) points. The DQ of the second trimester group was (92.54±7.06) points, (90.45±6.14) points, (91.01±7.51) points, (91.24±7.08) points, and (92.74±7.38) points. The DQ of the first trimester group was significantly higher than that of the second trimester group ( t=4.029, 3.466, 3.411, 3.688, 3.946, P<0.05) . Conclusion:L-T4 treatment in early or mid- to late-pregnancy patients with gestational hypothyroidism can effectively improve their thyroid hormone levels and coagulation function, but treatment in early pregnancy is beneficial to reduce the incidence of adverse pregnancy outcomes such as fetal growth restriction and alleviate the impact of the disease on the neuropsychological development of offspring.

Objective:To screen and extract relevant evidence on the management of malnutrition in pediatric cancer patients and provide a best evidence summary.Methods:A systematic search was conducted across multiple websites and databases, including UpToDate, BMJ Best Practice, WHO website, Guidelines International Network, National Institute for Health and Care Excellence, National Guideline Clearinghouse, PubMed, Web of Science Core Collection, Embase, Cochrane Library, China National Knowledge Infrastructure, China Biology Medicine disc, Wanfang Data and others, for evidence on nutritional management of malnutrition in pediatric cancer patients. The search included literature from inception to August 31, 2023. Literature was selected following strict inclusion and exclusion criteria by researchers trained in evidence-based nursing courses. The quality of the selected literature was evaluated, and evidence was extracted and summarized.Results:A total of 11 articles were included, comprising two clinical decision papers, three guidelines, one evidence summary, two systematic reviews, and three expert consensus documents. The evidence was summarized into 24 evidence across five main areas: multidisciplinary team approach, nutritional risk screening and assessment, nutrient intake, dietary and nutritional education, and enteral and parenteral nutrition support.Conclusions:This study provides a best evidence summary for the nutritional management of malnutrition in pediatric cancer patients, offering evidence-based support for clinical practice among healthcare professionals.