OBJECTIVE To construct a prediction model for tacrolimus trough concentration based on population pharmacokinetics （PPK） information and machine learning， evaluate its predictive performance in clinical therapeutic drug monitoring （TDM） data， and provide evidence-based support for individualized dose adjustment of tacrolimus after renal transplantation. METHODS A retrospective cohort study design was adopted， and consecutive TDM records of kidney transplant recipients treated in the First Affiliated Hospital of University of Science and Technology of China （Anhui Provincial Hospital） from January to June 2025 were included to construct the final analysis set. Based on 29 input variables including previous TDM concentration， previous concentration/dose （ C / D ） ratio， and individual predicted exposure （IPRE）， 13 commonly used regression algorithm models and 1 weighted ensemble model were systematically compared. The dataset was split into training set and test set in an 80∶20 ratio by patient. Five-fold cross-validation based on patient grouping was performed on the training set， and the model performance was evaluated on the obtained evaluation points using the coefficient of determination （ R 2 ）， mean absolute error （MAE）， root mean square error （RMSE）， Pearson correlation coefficient （Corr） and ±20%/±30% accuracy. The SHapley Additive exPlanations （SHAP） method was used for model interpretability analysis to identify core predictive features. RESULTS A total of 809 consecutive TDM records from 83 kidney transplant recipients were included， with 66 cases in the training set and 17 cases in the test set. The SVR model showed the best performance， with R 2 of 0.649 8， MAE of 1.126 0 ng/mL， RMSE of 1.478 6 ng/mL， Corr of 0.819 1， ±20% accuracy of 59.68%， and ±30% accuracy of 79.03%. The Weighted Ensemble model and Extra Trees model ranked second and third， respectively. SHAP interpretability analysis showed that the top 6 features contributing to the prediction were IPRE， previous TDM concentration， previous C/D ratio， dose-normalized concentration， hematocrit （HCT）， and concentration-dose coefficient （ θ cd ）， among which IPRE was the core predictive feature （SHAP mean value 0.915 4）. CONCLUSIONS The machine learning model incorporating PPK information demonstrates good predictive ability for tacrolimus concentration in the current TDM cohort. SVR is the optimal model， IPRE is the core predictive feature of the model， and a few core PK-derived features （IPRE， dose-normalized concentration， θ cd ） together with clinical features （previous TDM concentration， HCT， etc.） constitute the main information sources for model prediction.

BACKGROUND Sepsis is a major global health threat and frequently leads to acute lung injury (ALI). Pyroptosis has been increasingly implicated in the inflammatory progression of sepsis-induced ALI. Sirtuin 3 (Sirt3), a mitochondrial deacetylase, can regulate inflammatory injury and cellular stress responses. However, its role in sepsis-induced ALI and pulmonary pyroptosis remains incompletely understood. METHODS Sirt3 expression was measured in peripheral blood mononuclear cells (PBMCs) and neutrophils from septic patients (n=10) and healthy controls (n=5). Wild-type (WT) and Sirt3 knockout (Sirt3−/−) mice were subjected to cecal ligation and puncture (CLP). Lung injury, inflammatory responses, transcriptomic changes, and nuclear factor-κB (NF-κB)/NLRP3/gasdermin D (GSDMD)-related signaling were evaluated. In vitro, human umbilical vein endothelial cells (HUVECs) were used to assess the effects of Sirt3 knockdown and overexpression on lipopolysaccharides (LPS)/nigericin-induced pyroptotic injury. RESULTS Sirt3 expression was reduced in circulating immune cells from septic patients. In mice, CLP decreased pulmonary Sirt3 expression, and Sirt3 deficiency aggravated lung histological injury, pulmonary edema, and systemic inflammatory responses. Transcriptomic analysis revealed enrichment of immune- and pyroptosis-related pathways in septic lungs from Sirt3−/− mice. Consistently, Sirt3 deficiency increased NF-κB/NLRP3/GSDMD-associated signaling, as shown by increased p-NF-κB/NF-κB, NOD-like receptor family pyrin domain containing 3 (NLRP3), apoptosis-associated speck-like protein containing a CARD (ASC), cleaved caspase-1, N-terminal gasdermin D (N-GSDMD), and GSDMD levels. In HUVECs, Sirt3 knockdown exacerbated LPS/nigericin-induced cell injury, whereas Sirt3 overexpression preserved cell viability and reduced lactate dehydrogenase (LDH) release. CONCLUSION Sirt3 downregulation is associated with aggravated sepsis-induced ALI and enhanced NF-κB/NLRP3/GSDMD-related pyroptotic signaling. These findings suggest that Sirt3 may serve as a potential regulatory node in endothelial inflammatory injury during sepsis-induced ALI.

Objective To investigate the effects of evolocumab in the early postoperative period after percutaneous coronary intervention(PCI)on blood lipids and inflammatory cytokines in the patients with ul-tra-high-risk atherosclerotic cardiovascular disease(ASCVD).Methods A total of 65 patients with ultra-high-risk ASCVD treated by PCI in this hospital from October 2022 to March 2023 were selected as the study subjects and divided into the observation group(n=33)and control group(n=32)according to the used drugs.The patients in the control group received the treatment of oral rosuvastatin 10 mg;on the basis of the treatment in the control group,the observation group was treated with subcutaneous injection of evolocumab 140 mg immediately after PCI.The fasting blood samples were collected before surgery,on postoperative 3 d,1,3,6 months,and the levels of inflammation and blood lipid indexes were detected and recorded.The occur-rences of cardiovascular adverse events(MACE)and other complications in postoperative 6 months were re-corded.Results The levels of LDL-C,Lp-PLA2 and lipoprotein a on postoperative 3 d,1,3,6 months in the observation group were gradually decreased,moreover were lower than those in the control group,and the differences were statistically significant(P<0.05).The levels of IL-6,homocysteine and hs-CRP on postoper-ative 3 d,1,3,6 months in the two groups were decreased,moreover the levels of various indexes in the obser-vation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The incidence rate of MACE in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05);the difference in the incidence rates of other complications between the two groups was not statistically significant(P>0.05).According to the Log Rank test,the sur-vival rate of the observation group was higher than that of the control group,and the difference was statistical-ly significant(P<0.05).Conclusion The early application of evolocumab after PCI could reduce the blood lipid level and inflammatory cytokines levels of the patients with ultra-high-risk ASCVD,and increase their survival rate.

Obesity, as a chronic recurrent disease, has become a major public health challenge in China. To implement the requirements of the Healthy China Initiative (2019—2030), under domestic guidelines or consensus statements on overweight and obesity, and in alignment with the latest scientific advances globally, the Quality control protocol for adult overweight and obesity screening in health management (examination) institutions (2025 edition) was developed. This protocol was drafted by the Health Management Center of Shanghai Changzheng Hospital and formulated through multiple rounds of deliberation by experts in China’s health examination quality control field. The protocol establishes unified standards for screening facilities, personnel qualifications, and measurement or testing procedures. It defines specific screening items, outlines a standardized screening pathway, and sets requirements for the final medical review, ensuring the scientific validity, effectiveness, and safety of the screening process. The implementation of this protocol will enhance the consistency of weight management practices for adults across health examination institutions and strengthen the quality control of overweight and obesity screening programs.

Objective Based on the WSR methodology,a three-dimensional integrated perspective of Wuli,Shi-li,and Renli dimensions was used to sort out the logical relationships and architectures among negative defensive medical governance strategies,forming the priority governance strategies for improving negative defensive medical care.Methods Based on the literature research method and the expert consultation method,the governance strate-gy and the conceptual connotation of WSR are classified into items,and the role relationship in the complex sys-tem of passive defensive medical governance is clarified through the WSR methodology.Results A collection of 40 negative defensive medicine governance strategies has been developed,comprising 8 strategies in the Wuli dimen-sion,23 strategies in the Shili dimension,and 9 strategies in the Renli dimension.Conclusion The WSR methodology provides a three-dimensional systemic perspective for governance strategies against negative defen-sive medicine.Addressing this issue requires comprehensive and systematic governance strategies.

Objective:To construct a fuzzy comprehensive evaluation model for life support equipment of hospital,so as to improve quality of management for equipment.Methods:Based on the operating status of life support equipment in Jiangmen Maternal and Child Health Care Hospital of Guangdong Province,a fuzzy comprehensive evaluation model was constructed,and the indicators of different levels were set.The index weights were calculated according to the Analytic Hierarchy Process(AHP),and the equipment management strategy was formulated based on the evaluated results.A total of 98 life support equipment in clinical use in our hospital from January 2023 to July 2024 were selected.In them,49 equipment were managed under the conventional management mode,and the other 49 equipment were managed under the assessment system management mode of the kind of life support equipment based on fuzzy comprehensive evaluation model(model management mode)according to the random number table method.The timeliness,management effect and management efficiency of the two management modes for equipment were compared.A self-made satisfaction questionnaire was used to investigate the satisfaction scores of equipment engineers,clinicians and managers of relevant departments in usage management for equipment in the equipment usage of the two management modes.Results:The timeliness of equipment early warning,the timeliness of maintenance personnel's arrival,and the timeliness of proposing maintenance opinions were respectively(0.78±0.14)min,(5.14±2.11)min,and(10.69±3.11)min in the model management mode,all which were shorter than those in the conventional management mode,and the differences were statistically significant(t=16.697,11.857,16.117,P<0.05).The regular maintenance rate of equipment adopting the model management mode was higher than that adopting the conventional management mode,and the failure rate was lower than that adopting the conventional management mode,and the differences were statistically significant(x2=12.274,12.261,P<0.05),respectively.The maintenance time of the model management mode was shorter than that of the conventional management mode,and the operation and maintenance cost of the model management mode was lower than that of the conventional management mode,and the differences were statistically significant(t=17.451,12.707,P<0.05).The scores of management efficiencies of resource allocation,technical support,environmental guarantee and information infrastructure of the model management mode were all higher than those of the conventional management mode,and the differences were statistically significant(t=12.268,14.908,16.128,13.920,P<0.05).In usage management for equipment,the satisfaction scores of equipment engineers,clinicians and managers of relevant departments for equipment management adopting the model management mode were higher than those adopting the conventional management mode,and the differences were statistically significant(t=13.118,16.209,12.557,P<0.05).Conclusion:The assessment system of hospital for life support equipment based on the fuzzy comprehensive evaluation model can enhance the quality of management and operation for equipment,and improve the service level of equipment,and increase the operational efficiency of equipment.

Objective::To systematically study the mechanisms by which Yinzhihuang (YZH), a traditional Chinese medicine, ameliorates intrahepatic cholestasis of pregnancy (ICP), a liver disorder associated with significant maternal and fetal complications.Methods::This experimental study was conducted from January 2024 to August 2024, utilizing data from public databases (Traditional Chinese Medicine Systems Pharmacology, GeneCards, Online Mendelian Inheritance in Man, DisGeNET, Proteome Xchange) alongside in vitro cell culture experiments. Network pharmacology identified active components of YZH and potential therapeutic targets for ICP. Ultra-performance liquid chromatography–mass spectrometry characterized YZH oral liquid, and its effective doses were evaluated in taurocholic acid (TCA)-induced HTR-8/SVneo cells, an in vitro ICP model. ICP-related targets were gathered from multiple databases, and hub genes were selected through bioinformatics and previously identified differentially expressed proteins. Functional annotation and pathway enrichment analyses were conducted, with validation in TCA-induced cells treated with various YZH concentrations (0.1%–5.0%) compared to controls. Molecular docking confirmed predicted interactions.Results::Using network pharmacology, 104 active compounds and 241 potential targets of YZH were identified. Integration of multiple databases yielded 1897 YZH-related therapeutic targets and 3783 ICP-associated genes. Proteomic analysis identified 227 differentially expressed proteins, from which 10 hub genes were selected; among these, APOA2, COL1A1, and ADIPOQ were significantly upregulated in ICP samples. UPLC-ESI-MS/MS detected 2022 compounds, predominantly flavonoids (25.07%, 507/2022) and phenolic acids (14.44%, 292/2022). Molecular docking demonstrated strong binding affinities between several active compounds and the hub genes. In TCA-induced HTR-8/SVneo cells, 0.5% YZH treatment significantly enhanced cell viability and modulated hub gene expression, supporting a potential multi-target mechanism.Conclusion::This study systematically explored the active components and potential targets of YZH in ICP through network pharmacology, proteomics, and in vitro validation. The findings suggest that YZH may act via the PPAR signaling pathway by modulating genes such as PPARA, PPARG, ADIPOQ, and APOA2.

Objective Explore a comprehensive and multi-level set of passive defensive medical governance strate-gies.Methods Literature related to passive defensive medical governance was retrieved,and the Ucinet social net-work analysis software was utilized to calculate indicators such as the frequency and centrality of passive defensive medical governance strategies,thereby understanding the importance of these strategies.Results The formed set of negative defensive medical governance strategies covers three levels social cogniton,institutional mechanisms and doctor-patient relationship.Among them,there are 5 governance strategies at the social cognition level,24 governance strategies at the institutional mechanism level,and 12 governance strategies at the doctor-patient rela-tionship level,totaling 41 governance strategies.Conclusion The constructed set of passive defensive medical governance strategies is scientific,practical,and comprehensive in content,providing a reference framework for medical institutions to govern passive defensive medical behaviors.

Objective Based on the WSR methodology,a three-dimensional integrated perspective of Wuli,Shi-li,and Renli dimensions was used to sort out the logical relationships and architectures among negative defensive medical governance strategies,forming the priority governance strategies for improving negative defensive medical care.Methods Based on the literature research method and the expert consultation method,the governance strate-gy and the conceptual connotation of WSR are classified into items,and the role relationship in the complex sys-tem of passive defensive medical governance is clarified through the WSR methodology.Results A collection of 40 negative defensive medicine governance strategies has been developed,comprising 8 strategies in the Wuli dimen-sion,23 strategies in the Shili dimension,and 9 strategies in the Renli dimension.Conclusion The WSR methodology provides a three-dimensional systemic perspective for governance strategies against negative defen-sive medicine.Addressing this issue requires comprehensive and systematic governance strategies.

Objective:To construct a fuzzy comprehensive evaluation model for life support equipment of hospital,so as to improve quality of management for equipment.Methods:Based on the operating status of life support equipment in Jiangmen Maternal and Child Health Care Hospital of Guangdong Province,a fuzzy comprehensive evaluation model was constructed,and the indicators of different levels were set.The index weights were calculated according to the Analytic Hierarchy Process(AHP),and the equipment management strategy was formulated based on the evaluated results.A total of 98 life support equipment in clinical use in our hospital from January 2023 to July 2024 were selected.In them,49 equipment were managed under the conventional management mode,and the other 49 equipment were managed under the assessment system management mode of the kind of life support equipment based on fuzzy comprehensive evaluation model(model management mode)according to the random number table method.The timeliness,management effect and management efficiency of the two management modes for equipment were compared.A self-made satisfaction questionnaire was used to investigate the satisfaction scores of equipment engineers,clinicians and managers of relevant departments in usage management for equipment in the equipment usage of the two management modes.Results:The timeliness of equipment early warning,the timeliness of maintenance personnel's arrival,and the timeliness of proposing maintenance opinions were respectively(0.78±0.14)min,(5.14±2.11)min,and(10.69±3.11)min in the model management mode,all which were shorter than those in the conventional management mode,and the differences were statistically significant(t=16.697,11.857,16.117,P<0.05).The regular maintenance rate of equipment adopting the model management mode was higher than that adopting the conventional management mode,and the failure rate was lower than that adopting the conventional management mode,and the differences were statistically significant(x2=12.274,12.261,P<0.05),respectively.The maintenance time of the model management mode was shorter than that of the conventional management mode,and the operation and maintenance cost of the model management mode was lower than that of the conventional management mode,and the differences were statistically significant(t=17.451,12.707,P<0.05).The scores of management efficiencies of resource allocation,technical support,environmental guarantee and information infrastructure of the model management mode were all higher than those of the conventional management mode,and the differences were statistically significant(t=12.268,14.908,16.128,13.920,P<0.05).In usage management for equipment,the satisfaction scores of equipment engineers,clinicians and managers of relevant departments for equipment management adopting the model management mode were higher than those adopting the conventional management mode,and the differences were statistically significant(t=13.118,16.209,12.557,P<0.05).Conclusion:The assessment system of hospital for life support equipment based on the fuzzy comprehensive evaluation model can enhance the quality of management and operation for equipment,and improve the service level of equipment,and increase the operational efficiency of equipment.