Objective: To investigate factors influencing perioperative blood transfusion in patients with scarred uterus during pregnancy undergoing cesarean section, construct and validate a transfusion risk prediction model, and provide evidence for preoperative assessment and blood management. Methods: Clinical data of 405 patients undergoing cesarean section for scarred uterus during pregnancy at the First Affiliated Hospital of Xi'an Jiaotong University from January 2020 to December 2024 were retrospectively collected. The dataset was randomly divided into a training set (n=284) and a validation set (n=121) at a 7∶3 ratio. Within the training set, Firth-penalized logistic regression was employed for multivariate analysis to identify independent factors influencing perioperative blood transfusion and construct a predictive model. Model performance was evaluated in the validation set. Results: Multivariate Firth regression analysis showed that severe placenta previa (OR=75.566, 95%CI: 8.603-9979.174) and placenta accreta (OR=4.591, 95%CI: 1.120-19.416) were independent risk factors for perioperative blood transfusion, while preoperative red blood cell count (OR=0.189, 95%CI: 0.083-0.405) and fibrinogen levels (OR=0.588, 95%CI: 0.395-0.855) were protective factors. The predictive model constructed based on these four variables demonstrated good discriminatory performance, with areas under the receiver operating characteristic curves of 0.803 (95%CI: 0.740-0.867) and 0.753 (95%CI: 0.644-0.862) in the training and validation sets, respectively. Conclusion: For patients with scarred uterus during pregnancy undergoing cesarean section, severe placenta previa and placenta accreta significantly increase the risk of transfusion, while higher preoperative red blood cell count and fibrinogen levels exert a protective effect. The predictive model established in this study facilitates the identification of patients requiring transfusion, thereby enabling preoperative blood preparation and optimized blood management.

Hepatic fibrosis is a complex dynamic process caused by multiple chronic pathogenic factors， characterized by excessive accumulation of liver extracellular matrix and abnormal liver structure and function. If anti-fibrotic treatment is not performed in time， it can progress to liver cirrhosis and even liver cancer. Hepatic fibrosis has a complex pathogenesis， and previous studies mainly focused on the activation of hepatic stellate cells. Recent studies have shown that myeloid cells have the potential of multi-directional differentiation and can also participate in the development and progression of hepatic fibrosis. This article systematically reviews the role and regulatory mechanism of myeloid cells in hepatic fibrosis， in order to provide a reference for clinical diagnosis and targeted therapy.

Objective To gain insights into the biological characteristics of different populations of Culex tritaeniorhynchus within and around the Yellow Sea wetland from the perspective of the occurrence of resistance, we investigated the levels of resistance to deltamethrin and kdr gene mutation in the wetland and its peripheral areas. Methods Specimens were collected from Cx. tritaeniorhynchus populations at two monitoring sites in the Rare Bird National Nature Reserve and Tiaozi Ni Wetland Scenic Area, and also from two populations in Yancheng City and the Liuhe District of Nanjing, and the resistance of these mosquitoes to deltamethrin was determined using the CDC biotest bottle method. For each concentration of deltamethrin assessed, a random subset of exposed specimens was selected for amplification of the kdr gene fragment, followed by Sanger sequencing to identify and analyze resistance-associated mutations. Results The LC50 levels of deltamethrin among mosquitoes from the four populations in Luhe, Yancheng, the Rare Bird National Nature Reserve and the Tiaozi Ni Wetland Scenic Area were 2.048 5, 7.798 2, 3.473 3, and 17.695 5 mg/mL, respectively, with corresponding concentrations of deltamethrin ranging from 0.005 to 5.000,0.050 to 50.000,0.050 to 25.000 and 0.050 to 50.000 mg/mL, respectively. Furthermore, the ranges of the KT50 values were 11.76-107.43, 67.05-216.30,29.77-107.43 and 28.40-329.51 min; the 1-h knockdown rates were 34.58%-99.15%, 9.52%-43.80%, 55.09%-73.01%, and 10.09%-68.07%; and the 24-h mortality rates were 12.15%-67.52%,9.52%-79.56%,13.17%-82.21%, and 11.01%-78.99%, respectively. With respect to kdr gene mutation, we assayed a total of 63,70,59, and 57 mosquitoes for the four populations, for which we detected L1014F mutation frequencies of 14.29%, 35.00%, 20.34%, and 31.58%, respectively, with a majority of these mutations being heterozygous for resistance. In addition, five adult mosquitoes were identified has having synonymous mutations at site 1011[i. e. , AAT(asparagine)mutation to AAC(asparagine)]. Conclusions Our findings revealed the clear resistance of Cx. tritaeniorhynchus to deltamethrin in the Yancheng region of the Yellow Sea wetland, and the resistance phenotype and kdr frequency of Cx. tritaeniorhynchus in the wetland environment were comparable to those of Cx. tritaeniorhynchus in the wetland environment, thereby indicating that the resistance of different populations of Cx. tritaeniorhynchus was homogeneous under the pressure of different insecticide selection within and around the wetland. However, the underlying mechanisms need to be further studied.

Acute-on-chronic liver failure （ACLF） is a high-mortality syndrome that develops during the acute deterioration of chronic liver disease and is characterized by multiple organ dysfunction driven by systemic inflammation. Due to gut microbiota dysbiosis， endotoxin translocation， and amplified inflammatory responses， alcohol-related liver disease-associated ACLF （ALD-ACLF） is more pronounced and is often accompanied by a high risk of secondary infection and extrahepatic organ involvement， thereby exhibiting distinct etiological and clinical characteristics. This article systematically reviews the advances in the definitional boundaries， pathophysiological mechanisms， dynamic early warning， and prognostic assessment of ALD-ACLF， elaborates on risk stratification and key issues in clinical management， and discusses the potential impact of the dual-hit phenotype of metabolic dysfunction and alcohol-related liver disease on risk stratification in ALD-ACLF. This article also highlights the need to further strengthen etiology-oriented early identification， dynamic stratification， control of predisposing factors， and earlier intervention， in order to provide a reference for the precise assessment and individualized intervention of these patients.

Objective:Analyse the factors affecting whether the first two batches of centralized volume-based purchase of Proprietary Chinese Medicine were selected,the price difference and the rate of reduction,so as to provide a basis for improving the policy of centralized volume-based purchase of Proprietary Chinese Medicine.Methods:The first two batches of centralized volume-based purchase of Proprietary Chinese Medicine were selected for the study.Logistic regression was used to analyse the influencing factors of whether the selection was won or not.Multiple linear regression was used to analyse the influencing factors of price difference/reduction after being selected.Results:Proprietary Chinese Medicine with a high degree of acceptance by medical institutions and belonging to the category of essential medicines have a higher probability of being selected.The probability of selected products in the first batch of centralised purchase is greater for enterprises with a market share of more than 50%.In the first batch of centralized volume-based purchase of Proprietary Chinese Medicine,the price difference of injections and medicines belonging to the catalogue of essential medicines is greater.Price reductions were greater for those with low market share,low recognition by medical institutions,and a large number of enterprises in the A-competition unit and the same competition unit.In the second batch of centralised volume-based purchase of Proprietary Chinese Medicine,the price difference is greater for injections,and those with qualifications for the production of Chinese herbal medicines.the price reduction is greater in the B competitive unit.Conclusion:The centralized volume-based purchase of Proprietary Chinese Medicine has been both'quality-assured'and'price-reduced'.The centralized volume-based purchase of Proprietary Chinese Medicine has been gradually improved,and the tilt towards large enterprises has been reduced,so that the centralized volume-based purchase of Proprietary Chinese Medicine can achieve a'bottom price'.However,it is still necessary to start from the quality of identification,fair competition,and so on,and the centralized volume-based purchase of Proprietary Chinese Medicine fully linked to promote the centralized purchase of Traditional Chinese Medicine Decoction Pieces to a stable and far-reaching.

Objective:To compare the efficacy of recombinant human growth hormone (rhGH) combined with leuprorelin versus triptorelin in the treatment of girls with central precocious puberty (CPP).Methods:A total of 80 girls with CPP admitted to Wuhan No.1 Hospital from December 2020 to December 2023 were selected and divided into the control group ( n=40) and observation group ( n=40) by the balloting method (odd numbers for the control group and even numbers for the observation group). The control group was treated with triptorelin, while the observation group was treated with rhGH combined with leuprorelin. Before and after treatment, the two groups were compared in terms of growth indicators [predicted adult height (PAH), body mass index (BMI), annual average growth velocity (ΔGV), height standard deviation score for bone age (HtSDS-BA), bone age], pelvic development (ovarian volume, uterine volume, follicle diameter), bone metabolism indicators [25-hydroxyvitamin D (25(OH)D), calcitonin (CT), parathyroid hormone (PTH), osteocalcin (BGP)], mental health [Screen for Child Anxiety Related Emotional Disorders (SCARED) score, Depression Self-Rating Scale for Children (DSRSC) score], daily behavioral ability [Achenbach Child Behavior Checklist (CBCL) score], and biochemical indicators [fasting glucose, fasting insulin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E 2)]. Results:After treatment, PAH, BMI, ΔGV, and bone age increased in both groups (all P<0.05); HtSDS-BA decreased in the control group but increased in the observation group (all P<0.05). After treatment, the observation group had higher PAH, ΔGV, and HtSDS-BA, and lower bone age than the control group (all P<0.05). After treatment the ovarian volume, uterine volume, and follicle diameter were decreased. There were no statistically significant differences in ovarian volume, uterine volume, or follicle diameter between the two groups (all P>0.05). After treatment, the observation group had higher 25(OH)D level, and lower PTH and BGP levels than the control group (all P<0.05). Regarding mental health and behavioral ability, the observation group had lower SCARED and DSRSC scores, higher social competence score, and lower behavioral problem score in CBCL than the control group (all P<0.05). Additionally, the observation group had lower levels of FSH, LH, and E 2 than the control group after treatment (all P<0.05). Conclusions:Recombinant human growth hormone combined with leuprorelin in the treatment of girls with central precocious puberty can effectively improve growth indicators, mental health, daily living ability, and bone metabolism, and reduce the levels of some sex hormones.

Objective:To evaluate the diagnostic value of MRI findings in differentiating between tophus and giant cell tumors of the tendon sheath (GCTTS) in the knee.Methods:The study was a case-control study. The clinical and MRI data of patients diagnosed with knee tophus or GCTTS was retrospectively analyzed at the Affiliated Hospital of Qingdao University from September 2018 to September 2024. The study included 23 cases of tophus and 22 cases of GCTTS. MRI sequences, including T 1WI, fat-suppressed T 2WI, and proton density weighted imaging, were evaluated. Parameters including lesion signal intensity and homogeneity, margin, maximum diameter, location (inside or outside the synovial cavity), ligament/tendon involvement, ligament/tendon parenchymal changes, adjacent bone erosion, bone marrow edema, synovial hyperplasia, joint effusion, and periarticular soft tissue swelling were recorded. Independent sample t-tests, χ2 tests, or Fisher exact tests were used to compare MRI findings between the two groups. Multivariate logistic regression was performed to identify independent predictive factors. Results:Significant differences in terms of maximum diameter, location (inside or outside the synovial cavity), ligament/tendon involvement, ligament/tendon parenchymal changes, adjacent bone erosion, bone marrow edema, and periarticular soft tissue swelling between the two groups were found (all P<0.05). No significant differences for other parameters were observed (all P>0.05). Lesion location and ligament/tendon parenchymal involvement demonstrated the highest sensitivity and specificity for distinguishing the two diseases. The sensitivity and specificity values for lesion location were 0.78 and 0.95. The sensitivity and specificity values for ligament/tendon involvement were 0.78 and 1.00. Multivariate logistic regression identified lesion location (inside or outside the synovial cavity) as an independent predictor for differentiating tophus from GCTTS ( OR=31.48, 95% CI 1.58-625.69, P=0.024). Conclusion:The location of the lesion (inside or outside the synovial cavity) and involvement of ligament/tendon parenchyma are critical factors in differentiating knee tophus from GCTTS. Additionally, lesion location serves as an independent predictor for distinguishing between the two conditions.

Objective:To explore the changes of aquaporin-4 (AQP4) expression in rat astrocytes (RA) and rat model of radiation-induced brain injury (RIBI) after X-ray radiation, as well as its impact on cell functions.Methods:Logarithmic-phase RA were divided into four groups: Sham group (no treatment), AQP4 siRNA group (transfected with AQP4 lentivirus), IR group (single 20 Gy X-ray irradiation), and IR+AQP4 siRNA group (transfected with AQP4 lentivirus followed by single 20 Gy X-ray irradiation). The cell proliferation viability after radiation was detected using the CCK-8 assay. The relative expression of AQP4 mRNA in each group was measured by quantitative reverse transcription polymerase chain reaction, and the optimal AQP4 siRNA lentiviral sequence was selected for further studies. Western blot was used to detect the relative expression levels of AQP4, phosphorylated histone H2A family member X (γH2AX), autophagy-related proteins, glial fibrillary acidic protein (GFAP), proteins in the phosphatidylinositol-3-kinase (PI3K) / protein kinase B (AKT) / mammalian target of rapamycin (mTOR) pathway, and apoptosis-related proteins in cells from each group. Immunofluorescence (co-expression) staining was used to detect the expression of AQP4, γH2AX, GFAP, LC3, phosphatase and tensin homolog-induced kinase 1 (PINK1) in cells from each group, as well as the expression of AQP4 and LC3 in brain tissues from the rat RIBI model. Flow cytometry was used to detect the apoptosis rate of cells in each group. The differences between two groups were compared using the t-test, while the differences among multiple groups were evaluated using analysis of variance (ANOVA) and Tukey's multiple comparison test. Results:The proliferation viability of RA decreased to its lowest level at 24 h after irradiation. At the 24 h post-irradiation time point, the expression levels of γH2AX and AQP4 were significantly increased in the IR group compared with the Sham group. The fluorescence intensity of AQP4 in the AQP4 siRNA group was lower than that in the Sham group. The cells in the IR group showed significant enlargement and irregular morphology, with a significant increase in AQP4 fluorescence intensity, while the IR+AQP4 siRNA group showed mild cell enlargement and lower AQP4 fluorescence intensity compared with the IR group. Compared with the Sham group, the expression of microtubule-associated protein1 light chain 3 (LC3) and PINK1 proteins were decreased in the IR group, while the IR+AQP4 siRNA group showed higher expression levels compared with the IR group. Compared with the Sham group, the IR group showed increased expression of AQP4, GFAP, and sequestosome 1 (P62) proteins, decreased expression of Beclin-1 (BECN1) and LC3 proteins, and a reduced LC3-II/LC3-I ratio, while the IR+AQP4 siRNA group exhibited a restored LC3-II/LC3-I ratio. The apoptosis rate in the AQP4 siRNA group was similar to that in the Sham group, while the IR group showed a significantly increased apoptosis rate, and the IR+AQP4 siRNA group had a lower apoptosis rate than the IR group. The expression of caspase-3 (Caspase3) decreased in the IR group, while the expression of PI3K, AKT, mTOR, extracellular signal-regulated kinase (ERK)1/2, and cleaved Caspase3 protein increased; these changes were partially reversed in the IR+AQP4 siRNA group. In the rat RIBI model, the expression area and intensity of AQP4 were higher in the IR group compared with the Sham group, while LC3 expression showed the opposite pattern.Conclusions:The possible molecular mechanism of RA apoptosis caused by X-ray irradiation is that irradiation promotes the expression of AQP4, causes cell swelling, inhibits autophagy, and prevents cells from clearing damaged organelles in a timely manner, thereby promoting cell apoptosis.

Objective:To explore the effects of deep hyperthermia on chemotherapy-related adverse effects and immune-inflammatory indicators in the patients undergoing postoperative adjuvant chemotherapy for colorectal cancer.Methods:This retrospective study included 52 patients who underwent surgery for colorectal cancer at the Affiliated Zhongshan Hospital of Dalian University from September 2021 to December 2023. The patients were divided into two groups based on treatment method: the combination group ( n=29) received postoperative adjuvant chemotherapy combined with deep hyperthermia, while the chemotherapy group ( n=23) received postoperative adjuvant chemotherapy alone. Both groups were treated with the XELOX regimen (oxaliplatin + capecitabine). The degree of bone marrow suppression during treatment was assessed by analyzing peripheral blood parameters, including hemoglobin, leukocyte count, neutrophil count, and platelet count. Immune-inflammatory indicators, including complement, procalcitonin (PCT), interleukin-6 (IL-6), systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), were compared before and after treatment in both groups to evaluate the effects of deep hyperthermia on the immune-inflammatory response. Chi-square test or Fisher's exact test (two-tailed) was used to compare bone marrow suppression rates, and the immune-inflammatory indicators between the two groups were compared using t-tests or non-parametric tests, depending on whether the data conformed to a normal distribution. Results:In terms of myelosuppression, the incidence rates of moderate to severe decreases in leukocytes, neutrophils, platelets, and hemoglobin in the combination group were 31%, 31%, 21%, and 14%, respectively, compared to 52%, 61%, 48%, and 9% in the chemotherapy group. The change in PCT levels before and after treatment was significantly greater in the combination group than in the chemotherapy group ( P = 0.010). Both the combination group and the chemotherapy group showed significant reductions in SII, NLR and PLR after treatment, and the differences were statistically significant (all P < 0.05). The change in NLR before and after treatment was significantly greater in the combination group than in the chemotherapy group ( P = 0.031). Conclusions:Deep hyperthermia can alleviate chemotherapy-induced adverse effects such as thrombocytopenia and neutropenia in patients undergoing postoperative adjuvant chemotherapy for colorectal cancer. It also appears to improve the inflammatory response in these patients.

Objective:To explore the efficacy and safety of venetoclax combined with demethylating drugs and intense chemotherapy in the treatment of acute myeloid leukemia(AML).Methods:The clinical data of 76 patients with AML treated in Qilu Hospital of Shandong University Dezhou Hospital from January 2019 to March 2024 were retrospectively analyzed.Patients were divided into observation group and control group.38 patients in the observation group received venetoclax combined with demethylating drugs(decitabine or azacytidine)and 38 patients in the control group with the"3+7"intensive chemotherapy regimen.The primary endpoints of clinical observation were complete remission(CR),CR with incomplete hematologic recovery(CRi),partial remission(PR),non remission(NR),and overall response rate(ORR).Secondary endpoints were overall survival(OS)and drug safety.Results:After 2 courses of treatment,the CR+CRi rate in observation group and control group was 71.05％and 65.79％,respectively,and the ORR was 81.58％and 78.95％,respectively.After all courses of treatment,CR+CRi rate in the observation group and the control group was 73.68％and 78.95％,respectively,and the ORR was 81.58％and 84.21％,respectively,with no statistical significance between the two groups(P＞0.05).After 1 course of treatment,there were statistically significant differences in the proportion and degree of myelosuppression,the duration of neutropenia and the duration of thrombocytopenia between the two groups(P＜0.05),while there were no statistically significant differences in the occurrence of neutropenia with fever between the two groups(P＞0.05).The incidence of non-hematological adverse reactions was highest in infection(mainly pulmonary infection)and gastrointestinal reaction.Among the many adverse reactions,there were statistically significant differences in the infection and hypokalemia between the two groups(P＜0.05),the incidence of hypokalemia in observation group and control group was 42.11％and 15.79％,respectively,and the infection rate in observation group and control group was 73.68％and 94.74％,respectively.The median OS was 13.13(1.67-53.63)months in the observation group and 16.60(0.57-59.67)months in the control group.Conclusion:The combination of venetoclax and demethylating drugs has a low degree of myelosuppression,but a long recovery time,a response rate as good as that of intensive chemotherapy,and a lower infection rate.However,the incidence of hypokalemia is low in the intensive chemotherapy regimen,and the regimen significantly improves the long-term outcome of patients.