Objective: To investigate the factors influencing intraoperative blood transfusion in patients with hip fractures and to develop a machine learning (ML) model for predicting this risk. Methods: A total of 424 patients with hip fractures who underwent surgical treatment between November 2022 and March 2025 in our hospital were selected. Key feature variables of intraoperative blood transfusion risk were identified using the Boruta algorithm. Four different ML algorithms—support vector machine (SVM), linear discriminant analysis (LDA), mixed discriminant analysis (MDA), and extreme gradient boosting (XGBoost)—were used to develop predictive models for intraoperative blood transfusion risk. The predictive performance of the four ML models were evaluated using accuracy, precision, receiver operating characteristic (ROC) curves, precision-recall curves (PRC), precision-recall gain curves (PRGC), and F1 scores. Shapley additive interpretation (SHAP) was used to interpret the final model. Results: Among the 424 patients, 77(18.2%) received intraoperative blood transfusion. The Boruta algorithm identified albumin (ALB), activated partial thromboplastin time (APTT), types of anesthesia, types of fracture, and hemoglobin (Hb) as key feature variables for predicting intraoperative blood transfusion risk. In model evaluation, the SVM model outperforms the other three models across multiple metrics, including the area under the receiver operating characteristic curve (AUC), recall, recall gain, accuracy, precision, F1 score, and the area under the precision-recall curve (PRC-AUC). The SVM model, interpreted and visualized based on SHAP values, effectively predicted intraoperative blood transfusion risk in patients with hip fracture. A visual online application was developed based on the SVM model (https://pbo-nomogram.shinyapps.io/blood/). Conclusion: Preoperative low ALB and Hb levels, prolonged APTT, general anesthesia, and intertrochanteric fractures are risk factors for intraoperative blood transfusion in hip fracture patients. The risk prediction model for intraoperative blood transfusion constructed based on the SVM algorithm has optimal performance, which provides new ideas and methods for the clinical early identification of hip fracture patients with high transfusion risk and the implementation of targeted interventions.

Poly(ADP-ribosyl)ation (PARylation) is a specific form of post-translational modification (PTM) predominantly triggered by the activation of poly-ADP-ribose polymerase 1 (PARP1). However, the role and mechanism of PARylation in the advancement of acute kidney injury (AKI) remain undetermined. Here, we demonstrated the significant upregulation of PARP1 and its associated PARylation in murine models of AKI, consistent with renal biopsy findings in patients with AKI. This elevation in PARP1 expression might be attributed to trimethylation of histone H3 lysine 4 (H3K4me3). Furthermore, a reduction in PARylation levels mitigated renal dysfunction in the AKI mouse models. Mechanistically, liquid chromatography-mass spectrometry indicated that PARylation mainly occurred in receptor for activated C kinase 1 (RACK1), thereby facilitating its subsequent phosphorylation. Moreover, the phosphorylation of RACK1 enhanced its dimerization and accelerated the ubiquitination-mediated hypoxia inducible factor-1α (HIF-1α) degradation, thereby exacerbating kidney injury. Additionally, we identified a PARP1 proteolysis-targeting chimera (PROTAC), A19, as a PARP1 degrader that demonstrated superior protective effects against renal injury compared with PJ34, a previously identified PARP1 inhibitor. Collectively, both genetic and drug-based inhibition of PARylation mitigated kidney injury, indicating that the PARylated RACK1/HIF-1α axis could be a promising therapeutic target for AKI treatment.

As a patented characteristic medicine of Yi ethnic minority， Pingxuan capsules have the effects of nourishing the liver and kidney， pacifying the liver， and subduing Yang. With the main indications of dizziness， headache， palpitations， tinnitus， insomnia， dreaminess， waist and knee soreness caused by liver-kidney deficiency and liver Yang upward disturbance， Pingxuan capsules are widely used in the treatment of posterior circulation ischemic vertigo， vestibular migraine， benign paroxysmal positional vertigo. However， the current knowledge is limited regarding the efficacy， syndrome differentiation， and safety of this medicine. On the basis of summarizing the experience of clinicians and the existing evidence， this study invites clinical experts of traditional Chinese and Western medicine， pharmaceutical experts， and methodological experts from relevant fields across China to conduct evidence-based evaluation of Pingxuan capsules. The evaluation follows the Specifications for the Development of Clinical Expert Consensus on Chinese Patent Medicines issued by the Standardization Office of the China Association of Chinese Medicine， and reaches 5 recommendations and 16 consensus suggestions. The consensus clarifies the clinical applications， efficacy， dose， course of treatment， combination of medicines， precautions， and contraindications of Pingxuan capsules in the treatment of vertigo and explains the safety of clinical application. This consensus is applicable to clinicians （traditional Chinese medicine， Western medicine， and integrated traditional Chinese and Western medicine） and pharmacists in tertiary hospitals， secondary hospitals， and community-level medical and health institutions across China， providing a reference for the rational use of Pingxuan capsules in the treatment of vertigo. It is hoped that the promotion of this consensus can facilitate the rational use of drugs in clinical practice， reduce the risk of drug use， and give full play to the advantages of Pingxuan capsules in the treatment of vertigo diseases. This consensus has been reviewed and published by the China Association of Chinese Medicine， with the number GS/CACM330-2023.

Objective To analyze the 18F-fluorodeoxyglucose(18F-FDG)PET/CT manifestations of autoimmune pancreatitis(AIP)and to explore the diagnostic value of 18F-FDG PET/CT in AIP.Methods Twenty-three patients with suspected AIP who underwent 18F-FDG PET/CT were retrospectively analyzed.Eleven patients were diagnosed with AIP based on the International Consensus Diagnostic Criteria(ICDC)of AIP published by the International Pancreatic Disease Association.The detection rate and diagnostic sensitivity of 18F-FDG PET/CT for pancreatic enlargement,duct stenosis,duct dilation,pseudocapsules,and extrapancreatic involvement were analyzed,along with the 18F-FDG PET/CT manifestations of AIP.Results The 18F-FDG PET/CT manifestations of 11 patients with AIP:9 patients(81.82%)showed diffuse pancreatic enlargement,and 2 patients(18.18%)had local pancreatic head enlargement.And metabolism showed diffuse or localized increase.The maximum standardized uptake value(SUVmax)for the early PET/CT was 1.7-9.1(4.52±1.92),and for the delayed PET/CT,it was 2.6-9.8(5.25±1.98),with a statistically signifi-cant difference between the two phases SUVmax(t=-7.627,P<0.001).Two patients showed duct stenosis,six had distal duct dilation,and three exhibited pseudocapsule formation.Extrapancreatic involvement occurred in ten patients(90.91%),including sclerosing cholangitis,bile duct dilation inside and outside the liver,gallbladder changes,lymph node involvement,salivary gland involvement,prostate involvement,retroperitoneal fibrosis,pulmonary lesions,arteritis,and granulomatous tissue formation,etc.Among them,the same patient may present with multiple manifestations of extrapancreatic involvement.Among the 11 patients,eight were diagnosed as AIP,two as pancreatic cancer,and one as acute pancreatitis by 18F-FDG PET/CT.The diagnostic sensitivity was 72.73%.Conclusion The 18F-FDG PET/CT of AIP demonstrates specificity in anatomical morphology and metabolic changes and can better display extrapancreatic involvement,which has unique clinical value in AIP imaging diagnosis.

Objective:To explore the effect and application of interventional measures with concept of risk management in adverse events of medical devices,and assess their effectiveness in reducing the incidence of adverse events and in enhancing patients'safety.Methods:The intervention measures with concept of risk management was adopted to carry out risk assessment and hierarchical management for medical devices,and the operating status of medical devices was monitored in real time,and the standard operating procedures of using medical device were formulated for conducting risk management for medical devices.A total of 2,222 conventional medical devices in clinical use at Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University from January 2022 to March 2024 were selected.Among them,1,064 devices(with random values≤0.48)were managed using conventional methods by stratified random sampling without proportional allocation.Another 1,158 devices(random value>0.48)applied the risk intervention management method.A comparative analysis was conducted on the incidence of adverse events of medical devices,the qualified rate of medical device cleaning and the wet package rate of the two management methods,as well as the score of medical device knowledge level of nursing staff.Results:Among the 1,158 medical devices that adopted the risk intervention management method,the incidences of adverse events in non-surgical departments,surgical departments and diagnosis-related departments were 0.69%(8/1,158),1.90%(22/1,158)and 3.11%(36/1,158),respectively.All were lower than 3.85%(41/1,064),4.98%(53/1,064),and 8.93%(95/1,064)of 1,064 medical devices under the conventional management method,respectively.The differences were statistically significant(x2=25.716,16.143,33.852,P<0.05).The incidence of adverse events at different risk levels of medical devices was lower than that of conventional management method,and the difference was statistically significant(x2=7.625,P<0.05).The qualified rate of cleaning medical device was higher than that of the conventional management method,while the rate of wetting package was lower than that of the conventional management method,and the differences were statistically significant(x2=9.091,17.540,P<0.05).The knowledge levels and total scores of nursing staffs for the composition of medical devices,usage norms,cleaning and sterilization,defect examination,maintenance and precautions of management method with risk intervention were all higher than those of conventional management method,and the differences were statistically significant(t=2.158,2.422,2.544,2.391,2.152,4.528,P<0.05).Conclusion:The intervention measure with the concept of risk management can significantly reduce the incidence of adverse events of medical device,and improve the qualified rate of cleaning medical device,and improve the knowledge level of nursing staffs for medical device.

A ketogenic diet(KD)refers to an eating pattern designed to achieve a low-calorie content,minimum carbohydrate intake,high-fat consumption,and standard protein levels.A ketogenic diet is used in clinical practice to treat conditions including heart disease,diabetes,obesity,autism,glioblastoma,and other cancers.Although a ketogenic diet has not been recommended for any neurological disorders except epilepsy,extensive recent research suggests that such a diet may have a neuroprotective effect and may thus represent a new dietary therapy for the treatment of Parkinson's disease(PD).In this review,we discuss in detail the mechanisms responsible for the neuroprotective effects of a ketogenic diet in Parkinson's disease,with the aim of providing references for future clinical and experimental studies.

A ketogenic diet(KD)refers to an eating pattern designed to achieve a low-calorie content,minimum carbohydrate intake,high-fat consumption,and standard protein levels.A ketogenic diet is used in clinical practice to treat conditions including heart disease,diabetes,obesity,autism,glioblastoma,and other cancers.Although a ketogenic diet has not been recommended for any neurological disorders except epilepsy,extensive recent research suggests that such a diet may have a neuroprotective effect and may thus represent a new dietary therapy for the treatment of Parkinson's disease(PD).In this review,we discuss in detail the mechanisms responsible for the neuroprotective effects of a ketogenic diet in Parkinson's disease,with the aim of providing references for future clinical and experimental studies.

Objective To analyze the 18F-fluorodeoxyglucose(18F-FDG)PET/CT manifestations of autoimmune pancreatitis(AIP)and to explore the diagnostic value of 18F-FDG PET/CT in AIP.Methods Twenty-three patients with suspected AIP who underwent 18F-FDG PET/CT were retrospectively analyzed.Eleven patients were diagnosed with AIP based on the International Consensus Diagnostic Criteria(ICDC)of AIP published by the International Pancreatic Disease Association.The detection rate and diagnostic sensitivity of 18F-FDG PET/CT for pancreatic enlargement,duct stenosis,duct dilation,pseudocapsules,and extrapancreatic involvement were analyzed,along with the 18F-FDG PET/CT manifestations of AIP.Results The 18F-FDG PET/CT manifestations of 11 patients with AIP:9 patients(81.82%)showed diffuse pancreatic enlargement,and 2 patients(18.18%)had local pancreatic head enlargement.And metabolism showed diffuse or localized increase.The maximum standardized uptake value(SUVmax)for the early PET/CT was 1.7-9.1(4.52±1.92),and for the delayed PET/CT,it was 2.6-9.8(5.25±1.98),with a statistically signifi-cant difference between the two phases SUVmax(t=-7.627,P<0.001).Two patients showed duct stenosis,six had distal duct dilation,and three exhibited pseudocapsule formation.Extrapancreatic involvement occurred in ten patients(90.91%),including sclerosing cholangitis,bile duct dilation inside and outside the liver,gallbladder changes,lymph node involvement,salivary gland involvement,prostate involvement,retroperitoneal fibrosis,pulmonary lesions,arteritis,and granulomatous tissue formation,etc.Among them,the same patient may present with multiple manifestations of extrapancreatic involvement.Among the 11 patients,eight were diagnosed as AIP,two as pancreatic cancer,and one as acute pancreatitis by 18F-FDG PET/CT.The diagnostic sensitivity was 72.73%.Conclusion The 18F-FDG PET/CT of AIP demonstrates specificity in anatomical morphology and metabolic changes and can better display extrapancreatic involvement,which has unique clinical value in AIP imaging diagnosis.

Objective:To explore the effect and application of interventional measures with concept of risk management in adverse events of medical devices,and assess their effectiveness in reducing the incidence of adverse events and in enhancing patients'safety.Methods:The intervention measures with concept of risk management was adopted to carry out risk assessment and hierarchical management for medical devices,and the operating status of medical devices was monitored in real time,and the standard operating procedures of using medical device were formulated for conducting risk management for medical devices.A total of 2,222 conventional medical devices in clinical use at Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University from January 2022 to March 2024 were selected.Among them,1,064 devices(with random values≤0.48)were managed using conventional methods by stratified random sampling without proportional allocation.Another 1,158 devices(random value>0.48)applied the risk intervention management method.A comparative analysis was conducted on the incidence of adverse events of medical devices,the qualified rate of medical device cleaning and the wet package rate of the two management methods,as well as the score of medical device knowledge level of nursing staff.Results:Among the 1,158 medical devices that adopted the risk intervention management method,the incidences of adverse events in non-surgical departments,surgical departments and diagnosis-related departments were 0.69%(8/1,158),1.90%(22/1,158)and 3.11%(36/1,158),respectively.All were lower than 3.85%(41/1,064),4.98%(53/1,064),and 8.93%(95/1,064)of 1,064 medical devices under the conventional management method,respectively.The differences were statistically significant(x2=25.716,16.143,33.852,P<0.05).The incidence of adverse events at different risk levels of medical devices was lower than that of conventional management method,and the difference was statistically significant(x2=7.625,P<0.05).The qualified rate of cleaning medical device was higher than that of the conventional management method,while the rate of wetting package was lower than that of the conventional management method,and the differences were statistically significant(x2=9.091,17.540,P<0.05).The knowledge levels and total scores of nursing staffs for the composition of medical devices,usage norms,cleaning and sterilization,defect examination,maintenance and precautions of management method with risk intervention were all higher than those of conventional management method,and the differences were statistically significant(t=2.158,2.422,2.544,2.391,2.152,4.528,P<0.05).Conclusion:The intervention measure with the concept of risk management can significantly reduce the incidence of adverse events of medical device,and improve the qualified rate of cleaning medical device,and improve the knowledge level of nursing staffs for medical device.

Parkinson's disease is a neurodegenerative disease associated with abnormal copper metabolism in the brain,which leads to misfolding and aggregation of α-synuclein-copper complexes,which is an important pathological sign of Parkinson's disease.Copper metabolism,i.e.,cellular metabolic processes involving copper ions,is closely related to the pathogenesis of α-synuclein aggregation,dopamine metabolism,mitochondrial dysfunction,oxidative stress,and ferroptosis in Parkinson's disease.In this review,we summarize the molecular metabolic mechanism of copper toxicity by studying the pathological role of copper metabolism in Parkinson's disease,to support our further understanding of the mechanism of action and drug development.