[Objective] To investigate the factors associated with alanine aminotransferase (ALT) abnormalities in multi-ethnic blood donors across five Zang autonomous prefectures in the plateau regions of Qinghai Province, and to provide evidence for ensuring blood safety and formulating screening strategies. [Methods] A retrospective analysis was performed on the ALT abnormal test results of blood donors in the Zang autonomous prefectures of Qinghai from 2022 to 2024. The correlations between ALT levels and factors including gender, age, altitude, and infectious markers were investigated. [Results] The overall ALT unqualified rate among blood donors in this region was 9.01%. Significant differences in ALT levels were observed across genders and age groups (P<0.05). Variations in ALT abnormality rates were also noted among different plateau regions (P<0.05). Overall, ALT values exhibited an increasing trend with rising altitude. The average ALT unqualified rates were 11.19% in Zang donors, 7.96% in Han donors, and 4.79% in donors from other ethnic groups (P<0.05). No statistically significant association was observed between ALT abnormality and the presence of HBV/HCV infectious markers (P>0.05). [Conclusion] In the plateau areas of Qinghai, multi-ethnic blood donors have a relatively high ALT levels and ALT unqualified rates, showing distinct regional characteristics. ALT elevation in voluntary blood donors is related to non-pathological factors such as gender, age, and dietary habits, but not to infectious indicators.

Objective:To explore the clinical application value of artificial intelligence models in identifying bleeding events and hemorrhagic points during laparoscopic pancreatic surgery.Methods:This single-center retrospective cohort study collected surgical videos of 25 patients undergoing laparoscopic pancreatic surgery at the Department of General Surgery, Peking Union Medical College Hospital from January 2022 to December 2024. Videos within 5 seconds before and after representative bleeding events were captured at 30 frames/s, with 11 666 hemorrhagic-related video frames annotated. Two algorithm models were developed: a pigment-based model and a pigment+optical flow-based model for classification and target recognition of bleeding frames. The training and test sets for the pigment-based algorithm contained 4 692 hemorrhagic and 4 309 non-hemorrhagic frames, while those for the pigment+optical flow model included 1 339 hemorrhagic and 1 326 non-hemorrhagic frames. Performance evaluation was conducted using overlap thresholds, with accuracy and recall rates as key metrics.Results:The pigment-based model achieved 93.8% accuracy (134/143) and 43.3% recall (134/310) in hemorrhagic frame classification. At an overlap threshold of 0.3, the pigment-based model showed 84.1% accuracy (433/515) and 85.4% recall (433/507) in target recognition. When the threshold was increased to 0.5, the pigment+optical flow model demonstrated 88.1% accuracy (354/402) and 89.2% recall (354/397) in hemorrhagic target recognition.Conclusions:It is difficult to distinguish active bleeding from old bleeding completely by pigment information alone. The spatio-temporal features can be effectively extracted by combining pigment and optical flow information, and the bleeding can be accurately identified and located, which has potential clinical application value.

Objective:To explore the clinical application value of artificial intelligence models in identifying bleeding events and hemorrhagic points during laparoscopic pancreatic surgery.Methods:This single-center retrospective cohort study collected surgical videos of 25 patients undergoing laparoscopic pancreatic surgery at the Department of General Surgery, Peking Union Medical College Hospital from January 2022 to December 2024. Videos within 5 seconds before and after representative bleeding events were captured at 30 frames/s, with 11 666 hemorrhagic-related video frames annotated. Two algorithm models were developed: a pigment-based model and a pigment+optical flow-based model for classification and target recognition of bleeding frames. The training and test sets for the pigment-based algorithm contained 4 692 hemorrhagic and 4 309 non-hemorrhagic frames, while those for the pigment+optical flow model included 1 339 hemorrhagic and 1 326 non-hemorrhagic frames. Performance evaluation was conducted using overlap thresholds, with accuracy and recall rates as key metrics.Results:The pigment-based model achieved 93.8% accuracy (134/143) and 43.3% recall (134/310) in hemorrhagic frame classification. At an overlap threshold of 0.3, the pigment-based model showed 84.1% accuracy (433/515) and 85.4% recall (433/507) in target recognition. When the threshold was increased to 0.5, the pigment+optical flow model demonstrated 88.1% accuracy (354/402) and 89.2% recall (354/397) in hemorrhagic target recognition.Conclusions:It is difficult to distinguish active bleeding from old bleeding completely by pigment information alone. The spatio-temporal features can be effectively extracted by combining pigment and optical flow information, and the bleeding can be accurately identified and located, which has potential clinical application value.

Objective:To analyze the safety and therapeutic efficacy of laparoscopic pancreaticoduodenectomy (LPD) and laparoscopic total pancreatectomy (LTP) in the treatment of pancreatic cancer.Methods:Clinical data of 87 patients with pancreatic head and neck cancer who underwent LPD or LTP in the Department of General Surgery at Peking Union Medical College Hospital from December 2018 to August 2023 were retrospectively analyzed. The surgical approach, operative time, intraoperative blood loss volume, conversion rate to open surgery, perioperative mortality, re-operative rate, rate of major postoperative complications, postoperative hospital stay, number of lymph nodes harvested, tumor pathological stage, R 0 resection rate, initiation of postoperative chemotherapy and survival outcomes were recorded. The follow-up period extended until September 2023. Results:Among the 87 patients, 78(89.7%) underwent LPD and 9(10.3%) underwent LTP. PV-SMV vascular resection and reconstruction was performed in 16 cases (18.4%), and 11 cases totally underwent laparoscopy. Five cases (5.7%) required conversion to open surgery. The mean operative time was 279.8±74.0 minutes, and the mean intraoperative blood loss volume was 520.1±743.2 ml. The overall length of hospital stay was 15.9±6.3 days, with a mean postoperative hospital stay of 11.5±6.0 days. The rate of major postoperative complications was 19.5%, including 4 cases (4.6%) of postoperative bile leakage, 6 cases (6.9%) of postoperative gastric emptying disorders, and 3 cases (3.4%) of postoperative bleeding. There was one case (1.1%) with secondary surgery and one case (1.1%) with perioperative death. Among LPD patients, 5 cases (6.4%) had postoperative grade B or higher pancreatic fistula. Advanced age (≥70 years) did not increase the incidence of perioperative complications. All patients achieved R 0 resection. The mean number of lymph nodes harvested was 25.9±11.4. The median time to initiation of postoperative chemotherapy was 2.13±1.43 months. The median overall survival was 16 months. Conclusions:In a high-volume center for pancreatic diseases, LPD and LTP are safe and feasible for the treatment of pancreatic cancer, which could achieve satisfactory anti-tumor efficacy and improve patients' prognosis.

Peking Union Medical College Hospital, as one of the most stressful medical institutions in China, is facing the problem of emergency department overcrowding. In order to effectively alleviate the emergency overcrowding, improve the medical quality and patients′ medical experience, the hospital firmly grasped the two incremental links of " throughput" and " output" factors, established a multidisciplinary and multi-department cooperation team, constructed a close medical alliance cooperation mode, and innovated and explored a harmonious emergency overcrowding relief mode with the goal of unblocking the " exit" of patients. The practice showed that the comprehensive measures could effectively alleviate the problem of emergency overcrowding, and improve the medical environment and medical quality.

Objective: Cardiac resynchronization therapy defibrillator (CRT-D) increases ventricular transmural dispersion of repolarization (TDR). Our work evaluated the relationship between QTc interval of TDR indicators, TpTe, TpTe/QTc ratio and rapid ventricular arrhythmia in patients with CRT-D. Methods: A total of 160 consecutive patients who received CRT-D implantation in our hospital from 2011-01 to 2013-03 were studied. The immediate post operative ECG was collected to analyze lead V5 QTc interval, TpTe and TpTe/QTc ratio for assessing its TDR. The patients were divided into 2 groups: Treatment group, the patients with ventricular tachycardia or ventricular ifbrillation received CRT-D,n=30 (18.7%) and Non-treatments group,n=130 (81.3%). All patients were followed-up for (20 ± 10) months and the rapid ventricular arrhythmia was recorded by CRT-D devices. Results: The patients in Treatment group had increased TpTe/QTc (0.24 ± 0.05) vs (0.20 ± 0.04, and TpTe (119 ± 30) ms vs (95 ± 20) ms, bothP<0.001. The QTc interval was similar between 2 groups (480 ± 60) ms vs (470 ± 70) ms,P=0.6 and QTc interval was not related to the risk of CRT-D requirement. The sensitivity and speciifcity for TpTe/QTc ≥ 0.25 predicting the risk of ventricular arrhythmia in CRT-D patients were at 47% and 91%, while TpTe ≥ 120 ms were at 40% and 95%respectively. The post CRT-D surviving curve analysis indicated that TpTe/QTc ratio and TpTe could predict the prognosis in relevant patients,P<0.001. Conclusion: The elevated TpTe and TpTe/QT ratio may increase the incidence of CRT-D requirement in patients with ventricular arrhythmia after resynchronization.

Objective To determine the diagnostic value of the change of different parts of electrocardiogram in treadmill exercise test (TET) for coronary heart disease (CHD).MethodsFrom Jan.2006 to Mar.2011,445 patients with CHD underwent treadmill exercise test and coronary angiography (CAG) in our hospital.We analyzed retrospectively the diagnostic value of the change of different parts of electrocardiogram in TET test.Results ( 1 ) There were 200 cases who had positive results during treadmill exercise test and 150 cases of them had been diagnosed of CHD by coronary angiography;The other 245 cases had negative results during treadmill exercise test and 39 cases of them had been diagnosed as CHD by coronary angiography.The sensitivity and specificity rates of treadmill exercise test in diagnosis of CHD were 79.36％( 150/189 ) and 80.47％ ( 206/256 ) respectively. ( 2 ) Of the 200 positive cases tested by coronary angiography,150 cases were diagnosed of CHD,including 22,58 and 70 cases with limb,chest and combined chest and limb leads positive results respectively.The positive rates for the groups of combined chest and limb leads and limb ST leads were significantly higher than that of the chest leads only group ( x2:6.34,3.93 ; P ＜0.05).(3)R wave amplitude of the CAG negative group after exercise (17.54 ± 2.52)mm was significantly lower than the CAG positive group ( 19.42 ± 3.46 )mm ( t =6.33,P ＜ 0.05 ).( 4 ) For the 200 cases with positive TET,there were no significant statistical difference ( P ＞ 0.05 ) on CAG positive rate between T wave normalization group [ 73.3％ (44/60) ] with and TET positive group [ 75.0％ (105/140) ].But these two groups had significantly higher ( x2:80.21,132.82 ; P ＜ 0.05 ) CAG positive rates than TET negative group [ 15.9％ (39/245) ].ConclusionThe treadmill exercise test is valuable in noninvasive diagnosis of CHD.The severity of CAG can be preliminarily estimated by analyzing the pattern of the change of different parts of electrocardiogram

Objective To evaluate the effects of reserved jejunal feeding tube during postoperative chemotherapy of gastric cancer. Methods Forty-two patients with gastric cancer underwent radical gastrectomy and going to adjuvant chemotherapy,conventional placed jejunal feeding tube. All of the patients weredivided into group A and group B randomly by pathological staging and tumor site, group A reserved jejunal feeding tube and received enteral nutrition through the tube during chemotherapy, and group B non-reservedjejunal feeding tube and been given daily diet,compared nutrition and immune indicators of two groups beforeand after chemotherapy ,compared the rate of vomiting,and observed complications long-term reserved jejunal feeding tube. Results In post-chemotherapy,nutrition and immune indicators of group A were betterthan those of group B, the difference was statistically significant (P＜0.05) ,the rate of vomiting in group Awas significantly lower than that of in group B (X2= 9.75, P＜0.01 ), no serious complieations occurred forlong-term reserved jejunal feeding tube. Conclusions Reserved jejunal feeding tube and received enteralnutrition through the tube during postoperative chemotherapy of gastric cancer can significantly improve the nutritional and immune status. It is safe and reliable, worth promoting.

Objective To evaluate the effects of cardiac resynchronization therapy with optimized dynamic AV delay.Methods The study included 63 patients who underwent implantation of biventricular pacemakers for congestive heart failure.The dynamic AV delay was optimized on the day 1 week,6 months and 12 months after pacemaker implantation.The echocardiography and ECG,6MHW,QOL and NYHA grade were evaluated at the same time.Results The best optimized AV delay was between 90 ms and 140 ms(110.45?19.47 ms).Comparing the effectiveness 1 week after CRT with the day before CRT:the LVEF increased from 18.53%?4.83% to 22.07%?6.77% with the QRS interval decreased from 138.25?28.00 ms to 129.40?6.65 ms.Comparing the effectiveness of the day before and in 6-12 months after CRT optimized AV delay,the LVFT increased from 293.27?24.79 ms to 347.57?26.21 ms.There was no difference in QRS intervals.The LVEDD was upgraded from 71.43?7.12 mm to 57.06?6.54 mm while the QOL was upgraded from 74.14?6.24 to 55.15?11.02 and the NHYA upgraded from 3.12?0.55 to 1.82?0.43.Conclusion Optimized dynamic AV delay of the pacemaker parameters enhanced the short-term and long-term efficacy of CRT.

OBJECTIVEInhibition of acetylcholinesterase (AChE) in human brain caused by phoxim or phoxim oxon, their reactivation with oxime and aging of phosphorylated AChE were studied and compared in vitro.

METHODSMicro-colorispectrophotometric assay was used to determine the activity of AChE.

RESULTSThe pI(50) of inhibition of AChE in human brain by phoxim and phoxim oxon were 5.39 and 5.77, respectively, whereas the pI(90) were 4.60 and 5.00, respectively. The reactivation rate of 0.1 mmol/L of pralidoxime (2-PAM), obidoxime (LüH(6)), trimedoxime (TMB-4) and pyramidoxime (HI-6) for phoxim-inhibited AChE in human brain was 65%, 97%, 91% and 56%, respectively, and their reactivation rate for phoxim oxon-inhibited AChE in human brain was 97%, 87%, 99% and 89%, respectively. The optimal reactivator for phoxim and phoxim oxon-inhibited AChEs was LüH(6) and TMB-4, respectively. The half aging time of phoxim and phoxim oxon inhibited phosphorylated AChEs were 39 and 28 hours, respectively, and the 99% aging time were 256 and 186 hours, respectively.

CONCLUSIONSLüH(6) or TMB-4 should be used at the earlier as possible after poisoning with phoxim and phoxim oxon, and the reactivator should be consecutively used for more than seven days, even after their acute symptoms have been well controlled.

Acetylcholinesterase ; metabolism ; Brain ; drug effects ; enzymology ; Cholinesterase Inhibitors ; pharmacology ; Cholinesterase Reactivators ; pharmacology ; Enzyme Stability ; Humans ; In Vitro Techniques ; Obidoxime Chloride ; pharmacology ; Organothiophosphorus Compounds ; pharmacology ; Oximes ; pharmacology ; Paraoxon ; pharmacology ; Pralidoxime Compounds ; pharmacology ; Time Factors ; Trimedoxime ; pharmacology