The traditional theory of "the spleen governs the dispersion of essence" refers to the spleen's pivotal role in distributing refined nutrients throughout the body. In traditional Chinese medicine （TCM）， lipids are categorized under "gaozhi （膏脂）"， and their transportation and metabolism via apolipoproteins are believed to be closely related to the spleen's dispersing function. The liver， which synthesizes apolipoproteins， is functionally linked to the spleen system in TCM. Impaired dispersion of essence by the spleen and disrupted transportation of gaozhi constitute the pathological mechanism of dyslipidemia due to spleen deficiency. Strengthening the spleen and resolving dampness is the core therapeutic principle. From the perspective of modern medicine， this may involve promoting hepatic functional recovery related to lipid metabolism， thereby enhancing lipid processing and reducing the levels of abnormally accumulated lipids in the bloodstream.

Objective: To summarize the laboratory findings of a case of hemolytic disease of the fetus and newborn (HDFN) caused by Rh system anti-c antibodies and to review the literature, so as to explore the characteristics of anti-c HDFN. Methods: The ABO blood type, Rh blood type, direct antiglobulin test (DAT) results, and the presence of unexpected antibodies and their titers were determined by serological methods. The cases of anti-c HDFN in our laboratory in China and abroad were statistically analyzed, and the incidence of severe HDFN caused by anti-c, anti-D and anti-E was compared. Results: The blood type of the child was B (Rh CcDee) with a positive DAT. Anti-c antibody was detected in both serum and eluate, with a serum antibody titer of 4. The mother’s blood type was AB (Rh CCDee) with a negative DAT, and anti-c antibody was detected in the serum with a titer of 128. Among 20 cases of anti-c HDFN, 17 were DAT positive, and 9 (45%, 9/20) underwent blood transfusion or exchange transfusion. The incidence of severe HDFN was 47.60% (10/21) for anti-c, 47.60% (10/21) for anti-D and 31.30% (5/16) for anti-E. Conclusion: Maternal pregnancy and/or blood transfusion are the main reasons for the production of Rh alloantibodies such as anti-c. The prevention and management of anti-c should be similar to that of anti-D. Rh antigen-matched (five antigens of Rh blood group) transfusion is necessary for women of childbearing age to avoid antibody production, and Rh typing and antibody screening during prenatal examination is recommended to ensure early detection, intervention and treatment.

Background There is currently limited research on the antibiotic resistance of Legionella pneumophila in China. Establishing analytical methods for antibiotic resistance phenotypes and resistance genes of Legionella pneumophila in artificial water environment is of great significance. Objective To investigate the antibiotic resistance characteristics of Legionella pneumophila isolated from artificial water environment in Zhongshan, and to provide a scientific basis for the prevention and control of Legionella infection. Methods A total of 295 strains of Legionella pneumophila isolated from central air conditioning systems and hot water systems in Zhongshan from 2012 to 2024 were collected. The minimum inhibitory concentrations (MIC) of antimicrobial agents against the strains were determined using the E-test method. Whole genome sequencing combined with bioinformatics techniques was used to analyze the antibiotic resistance genes of 16 strains of Legionella pneumophila. The phylogenetic evolutionary relationships between these strains and clonal strains from different sources worldwide were analyzed based on whole genome single nucleotide polymorphisms (wgSNPs). Results The antimicrobial susceptibility testing results showed that the highest resistance rate of Legionella pneumophila was to erythromycin (ERY) (56.9%), followed by azithromycin (AZM) (27.1%) and levofloxacin (LEV) (12.2%). The antibiotic resistance rates to rifampicin (RIF) and cefotaxime (CTX) were low, and the strains were fully susceptible to clarithromycin (CLA), ciprofloxacin (CIP), and doxycycline (DOX). Compared to the isolates from the hot water systems, those from the central air conditioning systems exhibited higher resistance rates to ERY (70.9% vs. 28.1%) and AZM (34.2% vs. 12.5%), and the differences were statistically significant (χ²=48.226, P<0.001; χ²=15.388, P<0.001). The MIC values of Lp1 isolates for four antibiotics (AZM, CLA, DOX, and CTX) were significantly higher than those of Lp2-14 isolates (Z=−3.490, P <0.001; Z=−3.035, P <0.05; Z=−2.662, P<0.05; Z=−2.973, P <0.05). The MIC values of Lp2−14 isolates for RIF were significantly higher than those of Lp1 isolates (Z=−3.190, P<0.05). The strains isolated from 2019–2024 exhibited higher MIC values for both CLA and DOX than those isolated from 2012–2018 (Z=−4.847, P <0.001; Z=−6.057, P <0.001). Whole genome sequencing analysis showed that the 16 strains of Legionella pneumophila carried antibiotic resistance genes for aminoglycosides, macrolides, cephalosporins, and penicillins. The phylogenetic analysis showed that Legionella pneumophila in this region exhibited high genetic diversity and was consistent with the epidemic trends of strains from other regions worldwide. Conclusion The isolates of Legionella pneumophila in this study are highly susceptible to most antimicrobial agents. However, the antibiotic resistance should not be ignored, and continuous monitoring of antibiotic resistance is necessary.

Objective To analyse the characteristics of spatial distribution of bed resources and bed utilization efficiency of various types of medical and health institutions in Guangxi Province in 2018-2022,and to provide a reference basis for the allocation and management of bed resources of various types of medical and health institutions.Methods Spatial autocorrelation was used to analyse the status of bed allocation in various types of medical and health institutions,and the bed efficiency index and bed utilisation model were used to evaluate the efficiency of bed utilisation.Results Bed resources per 1 000 population vary considerably across types of healthcare organisations and regions.There is no spatial correlation in the overall distribution of bed resources per 1 000 population,but there are different types of aggregation,and there will be little change in the type of aggregation and the place of aggregation from 2018 to 2022.In terms of utilisation efficiency,the bed efficiency index of maternity and child healthcare hospitals is the highest,the bed efficiency index of specialist disease prevention and treatment hospitals(institutes and stations)is the lowest,general hospitals and maternity and child healthcare hospitals are operating at high efficiency,and all other healthcare institutions are operating at low efficiency;the utilisation of bed resources in various types of healthcare institutions exists in the form of efficiency-type,turn-around-type,bed-pressure-type,and unused-type hospitals at the same time.Conclusion There is an imbalance in the allocation of bed resources in various types of medical and health institutions,with large differences in the operational and utilisation efficiencies of beds;the allocation of bed resources should be continuously optimised.

Objective To analyse the characteristics of spatial distribution of bed resources and bed utilization efficiency of various types of medical and health institutions in Guangxi Province in 2018-2022,and to provide a reference basis for the allocation and management of bed resources of various types of medical and health institutions.Methods Spatial autocorrelation was used to analyse the status of bed allocation in various types of medical and health institutions,and the bed efficiency index and bed utilisation model were used to evaluate the efficiency of bed utilisation.Results Bed resources per 1 000 population vary considerably across types of healthcare organisations and regions.There is no spatial correlation in the overall distribution of bed resources per 1 000 population,but there are different types of aggregation,and there will be little change in the type of aggregation and the place of aggregation from 2018 to 2022.In terms of utilisation efficiency,the bed efficiency index of maternity and child healthcare hospitals is the highest,the bed efficiency index of specialist disease prevention and treatment hospitals(institutes and stations)is the lowest,general hospitals and maternity and child healthcare hospitals are operating at high efficiency,and all other healthcare institutions are operating at low efficiency;the utilisation of bed resources in various types of healthcare institutions exists in the form of efficiency-type,turn-around-type,bed-pressure-type,and unused-type hospitals at the same time.Conclusion There is an imbalance in the allocation of bed resources in various types of medical and health institutions,with large differences in the operational and utilisation efficiencies of beds;the allocation of bed resources should be continuously optimised.

Objective To analyse the characteristics of spatial distribution of bed resources and bed utilization efficiency of various types of medical and health institutions in Guangxi Province in 2018-2022,and to provide a reference basis for the allocation and management of bed resources of various types of medical and health institutions.Methods Spatial autocorrelation was used to analyse the status of bed allocation in various types of medical and health institutions,and the bed efficiency index and bed utilisation model were used to evaluate the efficiency of bed utilisation.Results Bed resources per 1 000 population vary considerably across types of healthcare organisations and regions.There is no spatial correlation in the overall distribution of bed resources per 1 000 population,but there are different types of aggregation,and there will be little change in the type of aggregation and the place of aggregation from 2018 to 2022.In terms of utilisation efficiency,the bed efficiency index of maternity and child healthcare hospitals is the highest,the bed efficiency index of specialist disease prevention and treatment hospitals(institutes and stations)is the lowest,general hospitals and maternity and child healthcare hospitals are operating at high efficiency,and all other healthcare institutions are operating at low efficiency;the utilisation of bed resources in various types of healthcare institutions exists in the form of efficiency-type,turn-around-type,bed-pressure-type,and unused-type hospitals at the same time.Conclusion There is an imbalance in the allocation of bed resources in various types of medical and health institutions,with large differences in the operational and utilisation efficiencies of beds;the allocation of bed resources should be continuously optimised.

As a practical carrier for promoting the tiered diagnosis and treatment model, the medical consor-tium is of great significance for balancing medical resources and boosting medical service efficiency. The construction of medical consortiums not only improves the accessibility of high-quality medical resources for patients, but also enhances the diagnostic and treatment level of member units. Meanwhile, it provides space for the leading hospital to adjust the structure of diseases and improve the level of discipline construction. As the core of medical insurance payment reform, DRG, through indicators such as the case mix index(CMI) and the number of diagnosis related group (DRG), provides objective and quantified data support for case management and disease structure optimization, thus effectively guiding the rational allocation of medical resources and the adjustmentof diseases and surgical types within the medical consortium. Comprehensive use of DRG evaluation indicators can construct a multidimensional medical consortium construction evaluation system, provides a clear direction for medical consortium cooperation, thereby promoting the overall healthy and sustainable development of medical consortiums and achieving a win-win situation for all parties involved. This paper, based on the "1+5+1" medical consortium cooperation model centered around Peking Union Medical College Hospital, utilizes DRG indicators to analyze the benefits for patients, member hospitals, and the leading hospital during the medical consortium construction process, with the hope of providing reference for the construction of a medical consortium evaluation system.

Objective·To analyze the differences and classify hypertrophic cardiomyopathy(HCM)patients and healthy controls(HC)using short-axis cine cardiac magnetic resonance(CMR)images-derived radiomics features.Methods·One hundred HCM subjects were included,and fifty HC were randomly selected at 2∶1 ratio during January 2018 to December 2021 in the Department of Cardiology,Renji Hospital,Shanghai Jiao Tong University School of Medicine.The CMR examinations were performed by experienced radiologists on these subjects.CVI 42 post-processing software was used to obtain left ventricular morphology and function measurements,including left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV)and left ventricular end-diastolic mass(LVEDM).The 3D radiomic features of the end-diastolic myocardial region were extracted from short-axis images CMR cine.The distribution of the radiomic features in the two groups was analysed and machine learning models were constructed to classify the two groups.Results·One hundred and seven 3D radiomic features were selected and extracted.After exclusion of highly correlated features,least absolute shrinkage and selection operator(LASSO)was used,and a 5-fold cross-validation was performed.There were still 11 characteristics with non-zero coefficients.The K-best method was used to decide the top 8 features for subsequent analysis.Among them,four features were significantly different between the two groups(all P<0.05).Support vector machine(SVM)and random forest(RF)models were constructed to discriminate the two groups.The results showed that the maximum area under the curve(AUC)for the single-feature model(first order grayscale:entropy)was 0.833(95%CI 0.685?0.968)and the maximum accuracy for the multi-feature model was 83.3%with an AUC of 0.882(95%CI 0.705?0.980).Conclusion·There are significant differences in both left ventricular function and left ventricular morphology between HCM and HC.The 3D myocardial radiomic features of the two groups are also significantly different.Although single feature is able to distinguish the two groups,the combination of multi-features show better classification performance.

Objective:To explore the core issues in the implementation of"packaged payment"in China's compact county medi-cal community,in order to provide useful references for the innovative reform of medical insurance payment methods in compact coun-ty medical community.Methods:By constructing the problem system through the macro model of the health system,analyzing the re-lated literature using multidimensional scale analysis and social network analysis,and comprehensively evaluating the results using the entropy-weighted TOPSIS method,it summarizes the core issues of"packaged payment"in compact county medical community.Results:There are core issues in China's compact county medical community,such as inadequate distribution of benefits and incen-tive and constraint mechanisms within the medical community(Ci= 1.000),lack of effective supervision and assessment mechanism for medical communities(Ci= 0.732),suppressed quality and efficiency of medical services(Ci= 0.652),lagging medical informatiza-tion construction(Ci= 0.595),and incomplete supporting policy measures(Ci= 0.579).Conclusion:The"packaged payment"of com-pact county medical community can be optimized from the following three aspects:a multi-level collaborative incentive mechanism should be improved to ensure the service quality and efficiency;optimize the total amount calculation method and improve the de-tailed supporting measures;accelerate information construction and strengthen supervision and assessment management.