Objective: To explore whether the long-term and frequent use of citrate anticoagulants negatively affects the bone metabolism balance of female frequent plateletpheresis donors, so as to better protect their health. Methods: A total of 65 female plateletpheresis donors and 55 female whole-blood donors from Guangzhou Blood Center (May to December 2024) were enrolled as experimental and control groups respectively, stratified into age subgroups (18-39 years and 40-60 years). Serum levels of 25-hydroxyvitamin D [25(OH)D], procollagen type I N-terminal propeptide (PINP), osteocalcin (OC), and type I collagen carboxy-terminal telopeptide (CTX) were measured. Differences in bone metabolism markers between experimental and control groups across age subgroups were compared. ANOVA was used to analyze dose-response relationships between donation age, annual apheresis donation frequency, and biochemical indicators. Results: In the 40-60 age subgroup, 25(OH)D levels were significantly lower in the experimental group (P<0.05), exhibiting a linear increase with age and a linear decrease with annual donation frequency. No significant differences in CTX or PINP levels were observed between experimental and control groups in either age subgroup. Conclusion: High-frequency plateletpheresis donation does not disrupt bone metabolic balance in female donors. However, it is associated with reduced vitamin D levels in female donors aged >40 years, potentially increasing the risk of osteoporosis. Vitamin D supplementation is recommended for high-frequency female plateletpheresis donors in this age group.

Objective To evaluate the role of distortion product otoacoustic emissions (DPOAE) testing in evaluating early hearing loss among noise-exposed workers. Methods A total of 174 noise-exposed workers in a metal shipbuilding enterprise were selected as the research subjects by the convenience sampling method. Pure tone audiometry (PTA), DPOAE and the level of noise exposure were conducted on the workers. The rank correlation analysis was used to analyze the correlation between DPOAE amplitude and PTA threshold. The multilevel model was used to analyze the effects of gender, age, noise exposure intensity, cumulative noise exposure (CNE), hearing loss classification and PTA threshold on DPOAE results. Results At the frequencies of 0.50, 1.00, 2.00, 3.00, 4.00, 6.00 and 8.00 kHz, the DPOAE amplitude was negatively correlated with the PTA threshold (rank correlation coefficients were -0.12, -0.48, -0.47, -0.18, -0.23, -0.44, -0.19, respectively, all P<0.01). At the most frequencies, DPOAE amplitude was negatively correlated with age and CNE (all P<0.05). The results of multilevel model analysis showed that there were significant differences in DPOAE amplitudes at certain frequencies across gender, age, noise intensity, CNE, and hearing loss classification (all P<0.05). Significant differences in DPOAE responses were found among different CNE and hearing loss groups (all P<0.01). Conclusion DPOAE testing can objectively reflect the hearing status of noise-exposed workers and could be considered for inclusion in routine hearing monitoring to facilitate early detection of noise-induced hearing loss.

Objective To compare the in vitro degradation rate,cytotoxicity,in vivo osteogenic ability,and in vivo biotoxicity of a new type of biodegradable implant material Zn-2Cu-xSr(x=0,0.5,and 1 wt.％)alloy and evaluate its application prospects in the orthopedic field.Methods The in vitro degradation ability of Zn,Zn-2Cu,Zn-2Cu-0.5Sr,Zn-2Cu-1Sr,and Ti materials was evaluated by pH moni-toring and material degradation rate.Cell proliferation experiment and cytoskeleton fluorescence staining were used to compare the in vitro cell compatibility of Zn,Zn-2Cu,Zn-2Cu-0.5Sr,Zn-2Cu-1Sr,and blank control.Micro-computed tomography(CT)scanning and bone min-eral density detection were used to evaluate the in vivo osteogenic ability of Zn,Zn-2Cu,Zn-2Cu-0.5Sr,and Zn-2Cu-1Sr.HE staining was used to compare the in vivo biotoxicity of Zn-2Cu-1Sr and blank control.Results There were no statistical differences in the pH values between the Zn,Zn-2Cu,Zn-2Cu-0.5Sr,Zn-2Cu-1Sr,and Ti groups(P＞0.05).The degradation rate in the Zn-2Cu-0.5Sr group was signifi-cantly lower than that in the Zn-2Cu-1Sr and Zn-2Cu groups(P＜0.05).The cell proliferation rate in the blank control group was signifi-cantly lower than that in the Zn-2Cu-0.5Sr and Zn-2Cu-1Sr groups(P＜0.05).The bone mineral density in the Zn-2Cu-1Sr group was significantly higher than that in the Zn-2Cu and Zn-2Cu-0.5Sr groups(P＜0.05).HE staining showed no abnormal or pathological mor-phology in the rats'heart,liver,lung,and kidney tissues in the Zn-2Cu-1Sr group.Conclusion Adding trace amounts of Cu and Sr to Zn can reduce the degradation rate and improve the biocompatibility and osteogenic ability of the material.

Objective To establish a human luminal breast cancer stem cell(BCSC)model and investigate the inhibitory effects of astragaloside Ⅳ(AS-Ⅳ)on BCSC growth.Methods MCF-7 breast cancer cells were cultured in stem cell-specific medium to induce BCSC formation.The BCSCs were then divided into a blank control group and an AS-Ⅳ treatment group,both groups were given PBS or AS-Ⅳ treatment.Morphological changes were observed after intervention.The therapeutic efficacy of AS-Ⅳ was evaluated using 3D spheroid formation and cell viability assays.Transcriptomic profiling and gene expression analysis were performed to elucidate the underlying mechanisms.Results Compared with the MCF7 breast cancer cells,MCF7 breast cancer stem cell mammospheres exhibited accelerated growth(P＜0.01)and significantly increased expression of the stemness marker ALDH1A1(P＜0.01).Further comparison with the blank control group revealed that astragaloside Ⅳ(AS-Ⅳ)treatment significantly inhibited MCF7 breast cancer stem cell proliferation(P＜0.001)and slowed mammosphere growth(P＜0.01).Transcriptomic analysis demonstrated that differentially expressed genes(DEGs)induced by stem cell modeling and AS-Ⅳ intervention were enriched in the cellular senescence signaling pathway.AS-Ⅳ intervention substantially increased the number of SA-β-gal-positive cells(P＜0.01).RT-PCR analysis confirmed that AS-Ⅳsignificantly upregulated mRNA expression of IL-1α(P＜0.01),P21(P＜0.001),and P53(P＜0.05)in MCF7 breast cancer stem cells.Conclusion Astragaloside Ⅳ suppresses the growth of human luminal breast cancer stem cells by inducing cellular senescence.

Objective To compare the in vitro degradation rate,cytotoxicity,in vivo osteogenic ability,and in vivo biotoxicity of a new type of biodegradable implant material Zn-2Cu-xSr(x=0,0.5,and 1 wt.％)alloy and evaluate its application prospects in the orthopedic field.Methods The in vitro degradation ability of Zn,Zn-2Cu,Zn-2Cu-0.5Sr,Zn-2Cu-1Sr,and Ti materials was evaluated by pH moni-toring and material degradation rate.Cell proliferation experiment and cytoskeleton fluorescence staining were used to compare the in vitro cell compatibility of Zn,Zn-2Cu,Zn-2Cu-0.5Sr,Zn-2Cu-1Sr,and blank control.Micro-computed tomography(CT)scanning and bone min-eral density detection were used to evaluate the in vivo osteogenic ability of Zn,Zn-2Cu,Zn-2Cu-0.5Sr,and Zn-2Cu-1Sr.HE staining was used to compare the in vivo biotoxicity of Zn-2Cu-1Sr and blank control.Results There were no statistical differences in the pH values between the Zn,Zn-2Cu,Zn-2Cu-0.5Sr,Zn-2Cu-1Sr,and Ti groups(P＞0.05).The degradation rate in the Zn-2Cu-0.5Sr group was signifi-cantly lower than that in the Zn-2Cu-1Sr and Zn-2Cu groups(P＜0.05).The cell proliferation rate in the blank control group was signifi-cantly lower than that in the Zn-2Cu-0.5Sr and Zn-2Cu-1Sr groups(P＜0.05).The bone mineral density in the Zn-2Cu-1Sr group was significantly higher than that in the Zn-2Cu and Zn-2Cu-0.5Sr groups(P＜0.05).HE staining showed no abnormal or pathological mor-phology in the rats'heart,liver,lung,and kidney tissues in the Zn-2Cu-1Sr group.Conclusion Adding trace amounts of Cu and Sr to Zn can reduce the degradation rate and improve the biocompatibility and osteogenic ability of the material.

With the increasingly wide application of herbal medicines and dietary supplements worldwide,herb-induced liver injury(HILI)has become an important etiology of drug-induced liver injury.Due to the diverse manifestations of HILI,the difficulty in medical history collection,and the lack of specific biomarkers,how to identify suspected patients and make a correct diagnosis has become a major challenge in practice.Causality assessment is commonly used in the diagnosis of HILI,but there is still a lack of prospective cohort studies with a large sample size.In addition,further studies are needed to search for the specific biomarkers for the diagnosis of HILI.The diagnosis and differential diagnosis of HILI are challenging,and currently there is still no universally accepted uniform and standard method for the diagnosis of all-cause HILI.

Cancer has become a major life-threatening disease globally.In recent years,precision therapy for cancer has gradually emerged,and significant success has been achieved with targeted therapies,immune checkpoint inhibitors,and the newly emerging antibody-drug conjugates(ADC).The development of ADC has been rapid,with up to 15 ADC drugs currently approved worldwide.However,the hepatotoxicity of ADC has gained increasing attention,with reports of fatal hepatotoxic events.In this article,we briefly reviewed the ADC approved globally,summarized the liver-related adverse events and hepatotoxic manifestations reported in current clinical trials of ADC,and compiled research on possible hepatotoxicity mechanisms.Our aim is to assist clinicians in understanding and managing the hepatotoxicity characteristics of ADC,enabling timely identification of patients at risk of hepatotoxicity and implementing effective measures to manage these risks,thus reducing and preventing serious adverse events.

Objective To explore the regional differences in nursing human resource allocation and the dynamic evolution in the western region,in order to provide a scientific and effective basis for the balanced allocation of nursing human resources.Methods Dagum's Gini coefficient,kernel density estimation method and Markov chain were employed to analyze the regional differences,dynamic evolution and trend prediction of nursing human resource allocation in 12 provinces(autonomous regions and municipalities)in western China from 2011 to 2020.Results From the point of view of regional differences,the overall regional differences in the allocation of nursing human resources are on a downward trend and stem mainly from intra-regional differences;the overall regional differences between urban and rural areas stem mainly from inter-regional differences.From the perspective of dynamic evolution,nursing human resources have been continuously upgraded and the absolute difference in the allocation level has gradually increased.From the perspective of trend prediction,the transferring probability between different types of nursing human resource allocation in the west is low,and spatial factors have a polarizing effect on it.Conclusion The level of nursing human resources allocation in the western region has gradually increased,and the overall development goes towards the level of equalization,and the level of nursing human resources allocation in each type is stable and significantly affected by spatial factors.The government should establish regional,urban,and county nursing specialty alliances as well as innovative information-based nursing service models,and implement nursing talent training mechanisms to improve the balanced allocation of nursing human resources in the western region.

Objective To analyze the current status and quality of existing obstetrics and gynecology enhanced recovery after surgery(ERAS)guidelines/consensus,understand the evidence-based practices in this field,and provide a basis for clinical decision-making.Methods A systematic search of PubMed,CNKI,and other databases,as well as NGC,SIGN,and websites of anesthesia societies domestically and internationally was conducted to obtain relevant guidelines and consensus on ERAS for gynecological surgery.The search was conducted from inception to July 1,2023,and the AGREE Ⅱ and RIGHT tools were used to analyze the current status and quality of the included guidelines/consensus,as well as to conduct a summary of the recommendations.Results A total of 5 guidelines and 10 consensus statements were included.The publication years were from 2018 to 2023,originating from the United States,China,Canada,and the United Kingdom.In the 6 areas evaluated using AGREEⅡ,clarity(66.06％)scored highest,followed by scope and purpose(56.67％),involvement of stakeholders(42.02％),and editorial independence(37.64％)with scores above 30％.The scores for rigor of development(26.88％)and applicability(4.17％)were relatively low.The same items among different evaluators indicated good consistency.The results of the scores in each area were as follows:A-level 2,B-level 13,and no C-level.Two high-quality guidelines were selected.The average RIGHT reporting rate was 44.38％.Subgroup analysis showed that guidelines were higher than consensus statements in the areas of rigor of development and applicability(P＜0.05),and that using GRADE was higher than not using(P＜0.05).The areas of rigor of development and clarity were higher in foreign guidelines than domestic guidelines(P＜0.05),and using evidence grading tools was higher than not using(P＜0.05).The summary of the recommendations showed that the quality of the evidence supporting the recommendations was uneven,and some recommendations were not specific enough.Conclusion The quality of the 15 included ERAS guidelines/consensus in obstetrics and gynecology is uneven,and 2 of them can be used as high-quality guidelines for clinical reference.The quality of evidence-based guidelines in foreign countries is higher,and the use rate of GRADE in foreign guidelines is high,most of which can provide clear recommendation strength and evidence level.Chinese guidelines/consensus are of lower quality compared to overseas,and methodology and report quality need further improvement.Overall,it is still necessary to strengthen the formulation of methods and reporting standards,improve the quality of evidence,and refine specific recommendations.

Cancer has become a major life-threatening disease globally.In recent years,precision therapy for cancer has gradually emerged,and significant success has been achieved with targeted therapies,immune checkpoint inhibitors,and the newly emerging antibody-drug conjugates(ADC).The development of ADC has been rapid,with up to 15 ADC drugs currently approved worldwide.However,the hepatotoxicity of ADC has gained increasing attention,with reports of fatal hepatotoxic events.In this article,we briefly reviewed the ADC approved globally,summarized the liver-related adverse events and hepatotoxic manifestations reported in current clinical trials of ADC,and compiled research on possible hepatotoxicity mechanisms.Our aim is to assist clinicians in understanding and managing the hepatotoxicity characteristics of ADC,enabling timely identification of patients at risk of hepatotoxicity and implementing effective measures to manage these risks,thus reducing and preventing serious adverse events.