Objective To conduct hazard vulnerability analysis(HVA)in a blood bank,aimed to identify high-risk e-vents and optimize emergency management measures.Methods The risk event evaluation index system was established by referring to the Kaiser model and the situation of Guangzhou Blood Center,and risk events were ranked by risk matrix and Borda count.Results The top five events with the highest risk values identified by Kaiser model were information system e-mergencies(39.61％),extreme weather(38.03％),major public sentiment(37.86％),public health events(37.37％)and policy changes(37.24％).The results of risk matrix and Borda count revealed 1 extremely high-risk indicator as information system emergency,5 high-risk indicators with the highest risk being major public sentiment,11 medium-risk indicators with the highest risk being major medical disputes and 1 low-risk indicator as external fires.Conclusion Conducting HVA in combination with the actual situation of blood banks can effectively identify high-risk events and provide theoretical basis for improving emergency management measures.

Objective:To investigate the safety and therapeutic effect of split liver transplantation (SLT) in clinical application.Methods:This is a retrospective case-series study. The clinical data of 203 consecutive SLT, 79 living donor liver transplantation (LDLT) and 1 298 whole liver transplantation (WLT) performed at the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to July 2023 were retrospectively analyzed. Two hundred and three SLT liver grafts were obtained from 109 donors. One hundred and twenty-seven grafts were generated by in vitro splitting and 76 grafts were generated by in vivo splitting. There were 90 adult recipients and 113 pediatric recipients. According to time, SLT patients were divided into two groups: the early SLT group (40 cases, from July 2014 to December 2017) and the mature SLT technology group (163 cases, from January 2018 to July 2023). The survival of each group was analyzed and the main factors affecting the survival rate of SLT were analyzed. The Kaplan-Meier method and Log-rank test were used for survival analysis.Results:The cumulative survival rates at 1-, 3-, and 5-year were 74.58%, 71.47%, and 71.47% in the early SLT group, and 88.03%, 87.23%, and 87.23% in the mature SLT group, respectively. Survival rates in the mature SLT group were significantly higher than those in the early SLT group ( χ2=5.560, P=0.018). The cumulative survival rates at 1-, 3- and 5-year were 93.41%, 93.41%, 89.95% in the LDLT group and 87.38%, 81.98%, 77.04% in the WLT group, respectively. There was no significant difference among the mature SLT group, the LDLT group and the WLT group ( χ2=4.016, P=0.134). Abdominal hemorrhage, infection, primary liver graft nonfunction,and portal vein thrombosis were the main causes of early postoperative death. Conclusion:SLT can achieve results comparable to those of WLT and LDLT in mature technology liver transplant centers, but it needs to go through a certain time learning curve.

Objective:To investigate the safety and therapeutic effect of split liver transplantation (SLT) in clinical application.Methods:This is a retrospective case-series study. The clinical data of 203 consecutive SLT, 79 living donor liver transplantation (LDLT) and 1 298 whole liver transplantation (WLT) performed at the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to July 2023 were retrospectively analyzed. Two hundred and three SLT liver grafts were obtained from 109 donors. One hundred and twenty-seven grafts were generated by in vitro splitting and 76 grafts were generated by in vivo splitting. There were 90 adult recipients and 113 pediatric recipients. According to time, SLT patients were divided into two groups: the early SLT group (40 cases, from July 2014 to December 2017) and the mature SLT technology group (163 cases, from January 2018 to July 2023). The survival of each group was analyzed and the main factors affecting the survival rate of SLT were analyzed. The Kaplan-Meier method and Log-rank test were used for survival analysis.Results:The cumulative survival rates at 1-, 3-, and 5-year were 74.58%, 71.47%, and 71.47% in the early SLT group, and 88.03%, 87.23%, and 87.23% in the mature SLT group, respectively. Survival rates in the mature SLT group were significantly higher than those in the early SLT group ( χ2=5.560, P=0.018). The cumulative survival rates at 1-, 3- and 5-year were 93.41%, 93.41%, 89.95% in the LDLT group and 87.38%, 81.98%, 77.04% in the WLT group, respectively. There was no significant difference among the mature SLT group, the LDLT group and the WLT group ( χ2=4.016, P=0.134). Abdominal hemorrhage, infection, primary liver graft nonfunction,and portal vein thrombosis were the main causes of early postoperative death. Conclusion:SLT can achieve results comparable to those of WLT and LDLT in mature technology liver transplant centers, but it needs to go through a certain time learning curve.

Objective To investigate the expression and clinical significance of miR-34c and miR-29b in peripheral blood of patients with sensorineural hearing loss.Methods 140 patients with neurological deafness admitted to our hospital from June 2020 to June 2023 were included in the study group,and 40 healthy subjects were included in the control group during the same period.SNHL patients were categorized into 63 cases in the mildly deaf group,42 cases in the moderately deaf group,and 35 cases in the severely deaf group according to their hear-ing impairment.The expressions of miR-34c and miR-29b were detected by qRT-PCR,and VEGF,oxidative stress(TAC,SOD,MDA),NO and Cx26 were detected.Correlation analysis was performed by Pearson test,independent risk factors for SNHL severity were calculated by logistics regression algorithm,and the predictive value of miR-34c and miR-29b on the severity of SNHL patients was evaluated by ROC curve.Results Comparing the levels of NO,TAC,SOD,and Cx26 among the four groups,severe deafness groupmoderate deafness group>mild deafness group>control group(P<0.05).Comparison of miR-34c mRNA and miR-29b mRNA expression levels among the four groups,severe deafness group>moderate deafness group>mild deafness group>control group(P<0.05).Pearson's test showed that SNHL patients'peripheral blood miR-34c and miR-29b were positively correlated with VEGF and MDA,and were negatively correlated with NO,TAC,SOD and Cx26(P<0.05).negative correlation(P<0.05).Multifactorial logistic regression analysis showed that VEGF,MDA,NO,Cx26,TAC,SOD,miR-34c,miR-29b were independent factors affecting the severity of SNHL.Conclusion miR-34c and miR-29b are overexpressed in SNHL patients and can be used as serum markers for predictive assess-ment of disease severity in SNHL patients.

Objective:To investigate the effect of prone position on the prognosis of patients with severe pneumonia in intensive care unit (ICU).Methods:A retrospective cohort study was conducted. The patients with severe pneumonia admitted to the ICU of Qingdao Municipal Hospital from May 2022 to August 2023 were enrolled. The general information, etiology, underlying diseases, vital signs and laboratory indicators at ICU admission, clinical treatment and prognosis during ICU hospitalization were collected. The above clinical data of patients with different prognosis were compared. Multifactorial Logistic regression analysis was used to screen the related factors affecting survival during ICU in patients with severe pneumonia. The change in oxygenation index (PaO 2/FiO 2) of patients with severe pneumonia were observed at 1 hour before the first prone position, 1 hour after the first prone position, and 1 hour after the end of the first prone position. The effect of prone position on oxygenation in patients with severe pneumonia was analyzed. Spearman correlation analysis was used to investigate the correlation between the duration to first prone position and the change in the PaO 2/FiO 2 before and after prone position in patients with severe pneumonia. Results:Finally, a total of 144 patients with severe pneumonia were enrolled, 45 survived and 99 died during ICU hospitalization, with a mortality of 68.8%. Compared with the survival group, the patients in the death group were older [years old: 81.00 (70.75, 86.00) vs. 71.00 (60.50, 81.50), P < 0.01], the proportion of pre-existing lung disease, heart rate (HR), respiratory rate (RR), blood lactic acid (Lac) and the ratio of continuous renal replacement therapy (CRRT) were higher [ratio of pre-existing lung disease: 23.2% (23/99) vs. 8.9% (4/45), HR (bpm): 99.61±22.47 vs. 91.49±18.76, RR (times/min): 22.50 (19.75, 29.25) vs. 20.00 (17.50, 24.50), Lac (mmol/L): 2.00 (1.55, 3.25) vs. 1.60 (1.20, 1.95), CRRT ratio: 25.3% (25/99) vs. 6.7% (3/45), all P < 0.05], and the proportion of prone position was lower [41.4% (41/99) vs. 68.9% (31/45), P < 0.01]. Multifactorial Logistic regression analysis showed that age [odds ratio ( OR) = 0.946, 95% confidence interval (95% CI) was 0.912-0.980, P = 0.002] and Lac ( OR = 0.563, 95% CI was 0.340-0.930, P = 0.025) were negatively correlated with survival during ICU hospitalization in severe pneumonia patients, while prone position was positively correlated with survival ( OR = 2.551, 95% CI was 1.067-6.095, P = 0.035), indicating that prone position was beneficial for improving ICU prognosis in severe pneumonia patients. The results of PaO 2/FiO 2 at different time points in prone position showed that PaO 2/FiO 2 at 1 hour of the first prone position in the patients with severe pneumonia was significantly higher than that at 1 hour before the first prone position [mmHg (1 mmHg ≈ 0.133 kPa): 146.69 (113.92, 257.25) vs. 111.75 (70.15, 212.20), P < 0.01], indicating that the prone position had a relevant effect on the improvement of oxygenation in patients. Spearman correlation analysis showed that the duration of the first prone position in patients with severe pneumonia was significantly and positively correlated with the improvement of oxygenation at 1 hour of the first prone position ( r = 0.565, P < 0.001). Conclusions:The prone position is a therapeutic measure that can independently influence the prognosis of patients with severe pneumonia during ICU hospitalization. The prone position effectively improves oxygenation in patients with severe pneumonia and the first change in oxygenation in patients is related to the duration of the prone position.

Objective:To investigate the clinical manifestations, serological and cerebrospinal fluid test results for syphilis, imaging features, and prognoses of cerebral syphilitic gumma.Methods:The clinical data of 1 patient with cerebral syphilitic gumma admitted to Department of Neurology, Second Affiliated Hospital of Soochow University in March 2023 were retrospectively analyzed. Papers about cerebral syphilitic gumma were searched from journals in Journal Citation Reports Q1 from 2000 to 2019, journals from 2020 to 2024 in PubMed, WOS, Embase, and Scopus databases, and journals from 2000 to 2024 in Wanfang Database, CNKI, and VIP database; the clinical data of 54 patients with cerebral syphilitic gumma reported in above databases and 1 patient in our hospital were collected for pooled analysis.Results:The main clinical manifestations of 55 cerebral syphilitic gumma patients included headache (32, 58.2%), lateral limb/facial weakness (25, 45.5%), nausea and vomiting (14, 25.5%), dizziness (11, 20.0%), sensory disturbances (10, 18.2%), blurred vision (7, 12.7%), seizure (5, 9.1%)), hearing loss (5, 9.1%), tinnitus (5, 9.1%), memory loss (3, 5.5%), aphasia (3, 5.5%), dysarthria (2, 3.6%), drop attack (2, 3.6%), weakness in opening eyes (2, 3.6%), unresponsiveness (1, 1.8%), Argyll-Robertson pupil (1, 1.8%), tabes dorsalis gait (1, 1.8%), and fever (1, 1.8%). In 51 patients who reported complete serologic test results, 45 patients (88.2%) were positive for non-specific antibodies to syphilis, and all patients were positive for specific antibodies to syphilis. In 34 patients underwent cerebrospinal fluid examination, 25 (73.5%) were positive for non-specific antibodies to syphilis, and 32 (94.1%) were positive for specific antibodies to syphilis. Isolated intracranial lesion (43, 78.2%) was mostly common in imaging test, and the frequently involved cranial sites were, orderly, the frontal lobe (14, 25.5%), parietal lobe (14, 25.5%), temporal lobe (5, 9.1%), frontotemporal lobe (3, 5.5%), frontoparietal lobe (2, 3.6%), parieto-occipital lobe (2, 3.6%), nucleus pulposus (1, 1.8%), clivus (1/55, 1.8%), and cerebral peduncle of the midbrain (1, 1.8%). Thirty patients (54.5%) were misdiagnosed as having other intracranial space-occupied diseases, orderly, glioma (11, 36.7%), metastatic tumors (5, 16.7%), meningiomas (4, 13.3%), other unexplained intracranial space-occupying (4, 13.3%), brain abscess (3, 10.0%), cavernous hemangioma (1, 3.3%), intracranial lymphoma (1, 3.3%), auditory nerve and pituitary tumors (1, 3.3%). Of the 42 patients who reported prognosis after anti-syphilitic treatments, 41 had varying degrees of improvement, and one died of brain herniation.Conclusion:Because of atypical clinical manifestations and lack of clear diagnostic criteria, cerebral syphilitic gumma is often misdiagnosed as intracranial tumors; cerebral syphilitic gumma should be considered in patients with positive non-specific antibodies to syphilis/specific antibodies to syphilis in serum and cerebrospinal fluid having neurological symptoms and intracranial space-occupied foci; timely diagnosed and treated patients can prognosed well.

Objective To establish a method for the determination of thallium and its soluble compounds in workplace air using microporous filter membrane sampling and inductively coupled plasma mass spectrometry (ICP-MS). Methods Thallium and its soluble compounds in workplace air were collected using microporous filter membranes, digested with nitric acid, quantified using lutetium internal standard method, and detected by ICP-MS. Results The linear range of thallium was 0.00 to 600.00 μg/L, with the correlation coefficient of 1.000. The detection limit was 0.08 μg/L, and the lower limit of quantification was 0.26 μg/L. The minimum detection concentration and minimum quantitation concentration of thallium of 75.00 L workplace air were 1.0×10^-5 and 3.0×10^-5 mg/m³, respectively. The minimum detection concentration and minimum quantitation concentration of thallium of 480.00 L workplace air was 2.0×10^-6 and 5.0×10^-6 mg/m³, respectively. The recovery rate of spiking was 100.82%-103.44%, and the relative standard deviation within- and between-batches was 1.50%-3.32% and 1.32%-3.11%, respectively. The sample could be stored at room temperature for at least 14 days. Conclusion This method can be used for the detection of thallium and its soluble compounds in workplace air.

The NLRP3 inflammasome's core and most specific protein, NLRP3, has a variety of functions in inflammation-driven diseases. Costunolide (COS) is the major active ingredient of the traditional Chinese medicinal herb Saussurea lappa and has anti-inflammatory activity, but the principal mechanism and molecular target of COS remain unclear. Here, we show that COS covalently binds to cysteine 598 in NACHT domain of NLRP3, altering the ATPase activity and assembly of NLRP3 inflammasome. We declare COS's great anti-inflammasome efficacy in macrophages and disease models of gouty arthritis and ulcerative colitis via inhibiting NLRP3 inflammasome activation. We also reveal that the α-methylene-γ-butyrolactone motif in sesquiterpene lactone is the certain active group in inhibiting NLRP3 activation. Taken together, NLRP3 is identified as a direct target of COS for its anti-inflammasome activity. COS, especially the α-methylene-γ-butyrolactone motif in COS structure, might be used to design and produce novel NLRP3 inhibitors as a lead compound.

Objective:To explore the value of machine learning models based on multiple structural MRI features for diagnosis of Parkinson disease (PD).Methods:The clinical and imaging data of 60 PD patients (PD group) diagnosed in the Neurology Department of the Second Affiliated Hospital of Soochow University from November 2017 to August 2019 and 56 normal elderly people (NC group) recruited from the community were retrospectively analyzed. All subjects underwent brain MR imaging. Multiple structural MRI features were extracted from cerebellum, deep nuclei and of brain cortex based on different partition templates. The Mann-Whitney U test, as well as least absolute shrinkage and selection operator regression were used to select the most discriminating features. Finally, logistic regression (LR) and linear discriminant analysis (LDA) classifier combined with the 5-fold cross-validation scheme were used to construct the models based on structural features of cerebellum, deep nuclei and cortex, and a combined model based on all features. The receiver operating characteristic curves were drawn, and the diagnostic performance and clinical net benefit of each model were evaluated by the area under curve (AUC) and the decision curve analysis (DCA). Results:In total, four cerebellum (asymmetry index of Lobule Ⅵ volume, asymmetry index of Lobule ⅦB cortical thickness, asymmetry index of total gray matter volume and absolute value of right Lobule Ⅵ gray matter volume), 3 deep nuclei (absolute value of right nucleus accumbens volume, absolute and relative value of total nucleus accumbens volume) and 3 cortex features (local gyration index of left PFm, local fractal dimension of right superior frontal gyrus and sulcal depth of left superior occipital gyrus) were selected as the most discriminating features, and the related models were constructed. In validation set, the AUC of cerebellum, deep nuclei, cortex and combined models for diagnosis of PD based on LR classifier were 0.692, 0.641, 0.747 and 0.816; the AUC of cerebellum, deep nuclei, cortex and combined models for diagnosis of PD based on LDA classifier were 0.726, 0.610, 0.752 and 0.818. The diagnostic efficiency of the combined models based on LR and LDA classifiers were significantly better than those of other models ( P<0.05). The DCA curve demonstrated that the combined models based on LR and LDA classifiers showed the highest clinical net benefit. Conclusion:The combined models with all structural features of cerebellum, deep nuclei and cortex included based on LR and LDA classifiers showed favorable performance and clinical net benefit for diagnosis of PD, which have the potential application value in clinical diagnosis.

Background: Recent studies have reported that costoclavicular blocks (CCBs) can consistently block almost all branches of the brachial plexus while sparing the phrenic nerve and provide effective analgesia after shoulder surgery. We aimed to compare the efficacy of the CCB with that of the interscalene block (ISB) as the sole blocking technique for shoulder surgery. Methods: A total of 212 patients undergoing elective arthroscopic shoulder surgery were randomized to receive an ISB or CCB based on a non-inferiority design. All patients received titration sedation with propofol under monitored anesthesia during surgery. The primary outcomes were the proportion of patients with complete motor blockade of the suprascapular nerve (SSN) and incidence of hemidiaphragmatic paralysis (HDP). The secondary outcomes included block-related variables, complications, and postoperative pain scores. Results: The proportion of patients with complete motor blockade of the SSN at 20 min between the CCB and ISB groups (53% vs. 66%) exceeded the predefined non-inferiority margin of −5%, but was comparable at 30 min (87% vs. 91%). The CCB resulted in a significantly lower incidence of HDP (7.55% vs. 92.45%), Horner’s syndrome (0% vs. 18.87%), and dyspnea (0% vs. 10.38%) than the ISB. None of the patients experienced failed blocks or required conversion to general anesthesia. Pain scores were comparable between the groups. Conclusions Ultrasound-guided CCBs may be comparable to ISBs, with fewer unfavorable complications in patients with impaired lung function undergoing arthroscopic shoulder surgery.