To systematically analyzed the reporting status of core elements in publicly available clinical practice guideline(hereafter referred to as "guideline") protocols published domestically and internationally over the past decade, identified existing problems, and provided evidence to inform the standardized writing and publication of future guideline protocols.

Objective To explore the relationship between levels of retinol binding protein (RBP) and lipoprotein (a) [Lp(a)], and obesity and the occurrence risk of cardiovascular disease in population with prehypertension (PH). Methods A total of 301 patients with PH who were admitted to the First Affiliated Hospital of Anhui University of Science and Technology for physical examination from July 2021 to July 2024 were selected as the study subjects. The levels of serum RBP and Lp(a) were determined, and the waist circumference (WC) and body mass index (BMI) were measured to evaluate the obesity of patients. All patients were followed up. According to whether cardiovascular disease occurred during the follow-up period, they were classified into a study group (with cardiovascular disease) and a control group (without cardiovascular disease). The effects of serum RBP and Lp(a) levels, WC and BMI on the risk of cardiovascular disease were analyzed. Results The follow-up results showed that 53 out of 301 cases developed cardiovascular disease. The levels of RBP, Lp(a), WC, and BMI in the study group were higher than those in the control group (P<0.05). Receiver operating characteristic curve revealed that the areas under the curves of RBP, Lp(a), WC, and BMI for predicting the cardiovascular disease were 0.823, 0.741, 0.768, and 0.841, respectively. Serum RBP, Lp(a), WC, and BMI were influencing factors of the occurrence of cardiovascular disease (P<0.05). Conclusion RBP, Lp(a), WC, and BMI are the influencing factors for the occurrence of cardiovascular disease in patients with prehypertension. These four indicators have certain predictive value on the occurrence of cardiovascular disease.

Albumin is widely used in clinical practice， and the rationality of trial design directly affects the reliability of research findings and clinical application value. This article reviews the key statistical considerations in the design of albumin clinical trials， including the selection of primary endpoints， the establishment of statistical hypotheses and non-inferiority margins， clinical evaluation criteria for ascites improvement， sample size， and interim analyses， in order to provide methodological guidance for clinical researchers to optimize clinical trial design and enhance its scientific rigor and feasibility.

[Objective] To explore the relationship between neutrophil activation under cardiopulmonary bypass (CPB) and the incidence of cardiac surgery-associated acute kidney injury (CS-AKI). [Methods] This prospective cohort study enrolled adult patients who scheduled for cardiac surgery under CPB at West China Hospital between May 1, 2022 and March 31, 2023. The primary outcome was acute kidney injury (AKI). Blood samples (5 mL) were obtained from the central vein before surgery, at rewarming, at the end of CPB, and 24 hours after surgery. Neutrophils were labeled with CD11b, CD54 and other markers. To assess the effect of neutrophils activation on AKI, propensity score matching (PSM) was employed to equilibrate covariates between the groups. [Results] A total of 120 patients included into the study, and 17 (14.2%) developed AKI. Both CD11b⁺ and CD54⁺ neutrophils significantly increased during the rewarming phase and the increases were kept until 24 hours after surgery. During rewarming, the numbers of CD11b⁺ neutrophils were significantly higher in AKI compared to non-AKI (4.71×10⁹/L vs 3.31×10⁹/L, Z=-2.14, P<0.05). Similarly, the CD54⁺ neutrophils counts were also significantly higher in AKI than in non-AKI before surgery (2.75×10⁹/L vs 1.79×10⁹/L, Z=-2.99, P<0.05), during rewarming (3.12×10⁹/L vs 1.62×10⁹/L, Z=-4.34, P<0.05), and at the end of CPB (4.28×10⁹/L vs 2.14×10⁹/L, Z=-3.91, P<0.05). An analysis of 32 matched patients (16 in each group) revealed that CD11b⁺ and CD54⁺ neutrophil levels of AKI were 1.74 folds (4.83×10⁹/L vs 2.77×10⁹/L, Z=-2.72, P<0.05) and 2.34 folds (3.32×10⁹/L vs 1.42×10⁹/L, Z=-4.12, P<0.05), respectively, of non-AKI at rewarming phase. [Conclusion] Neutrophils are activated during CPB, and they can be identified by CD11b/CD54 markers. The activated neutrophils of AKI patients are approximately 2 folds of non-AKI during the rewarming phase, with disparity reached peak between groups during rewarming. These findings suggest the removal of 50% of activated neutrophils during the rewarming phase may be effective to reduce the risk of AKI.

To introduce and analyze guideline terminology related to clinical question formulation, evidence retrieval and appraisal, and recommendation development.

Objective:To investigate changes in behavior and hippocampal and prefrontal cortical myelin basic protein(MBP) in model mice with post-traumatic stress disorder(PTSD).Methods:Thirty-two clean-grade male C57BL/6J mice were randomly divided into control group, PTSD 3 d group, PTSD 7 d group and PTSD 14 d group based on matching body mass, with 8 mice in each group. The mice in PTSD 3 d, 7 d and 14 d groups were decapitated at 3 d, 7 d, and 14 d after modeling.The PTSD mouse model was established through conditioned foot shock and single prolonged stress. Anxious- and depressive-like behaviors of mice were assessed by the open field test(OFT). The mouse step-through passive avoidance experiment was used for electric shock training and learning and memory retention. Myelin morphology alterations in the hippocampus and prefrontal cortex of the mouse were examined via myelin staining.The expression levels of MBP were quantified using Western blot and immunohistochemical staining techniques. All experimental data were analyzed and visualized using GraphPad Prism 8.0.2 and SPSS 25.0, the multi groups comparison of behavioral and molecular indicator data was conducted by one-way ANOVA, and the correlation between MBP relative protein expression level and behavioral indicators was analyzed by Pearson correlation analysis.Results:(1) Behavioral results: in OFT, there were significant differences in total distance, average speed, time of stationary and times of entering the central area among all groups( F=16.72, 16.74, 7.37, 5.93, all P<0.05).The total distance and the average speed time of PTSD 3 d, 7 d, 14 d group were all lower than those in control group(all P<0.05).In the mouse step-through passive avoidance experiment, significant differences were observed across all groups in terms of total distance traveled, average speed, dark box entries, and activity time( F=52.78, 55.47, 9.07, 24.88, all P<0.05).All the indexes of PTSD 3 d group and PTSD 7 d group were all higher than those in control group and PTSD 14 d group(all P<0.05).(2)Myelin staining revealed statistically significant differences in the myelin staining areas of the hippocampal CA1 region and the prefrontal cortex across all groups( F=6.67, 5.77, all P<0.05). The stained myelin area in the CA1 region of the hippocampus in the PTSD 3 d group((123.30±11.62)μm 2)was significantly lower compared to the control group((153.00±2.61)μm 2)( P<0.05). The stained myelin area in the prefrontal cortex of the PTSD 3 d group((119.50±9.26)μm 2)was significantly lower compared to that in the control group((154.80±12.40)μm 2)( P<0.05). (3) Western blot results demonstrated significant variations in the expression levels of myelin basic protein (MBP) within the hippocampus and prefrontal cortex across all experimental groups ( F=10.15, 5.28, all P<0.05). The expression levels of MBP in the hippocampal tissue of the PTSD 3 d group (0.89±0.07), PTSD 7 d group (0.90±0.14), and PTSD 14 d group (0.85±0.13) were significantly lower compared to those in the control group(1.17±0.02)(all P<0.05). The expression levels of MBP protein in the prefrontal cortex of the PTSD 3 d group(0.73±0.16) and PTSD 7 d group (0.70±0.12)were significantly lower compared to those in the control group (0.94±0.04)(all P<0.05). (4) Immunohistochemical staining revealed significant variations in the number of MBP-positive cells within the hippocampal CA1 region and the prefrontal cortex across all groups ( F=39.32, 21.81, both P<0.05). The quantity of MBP-positive cells in the hippocampal tissue of mice in the PTSD 3 d group((187.10±1.12)/mm 2)and PTSD 7 d group((193.10±2.18) /mm 2)was significantly reduced compared to the control group((204.80±3.25)/mm 2)(all P<0.05). The quantity of MBP-positive cells in the prefrontal cortex of the PTSD 7 d group((183.90±1.71)/mm 2) was significantly reduced compared to the control group((191.60±1.04) /mm 2)( P<0.05). Conclusion:The PTSD model mice showed anxious- and depression-like behavior, impaired learning and memory ability, and myelin damage in the hippocampus and prefrontal cortex.

Objective To investigate the risk factors for mortality and bleeding complications in extracorporeal membrane oxygenation(ECMO)treated patients and to evaluate the impact of thrombocytopenia severity on the prognosis of ECMO therapy.Methods A total of 153 patients who received ECMO treatment at Peking University Third Hospital between January 2013 and September 2024 were en-rolled in this study.The patients were divided into death group(n=97)and recovery group(n=56)based on their final outcomes.Additionally,the patients were categorized into bleeding group(n=104)and non-bleeding group(n=49)based on the occurrence of bleeding complications during ECMO.Clinical baseline characteristics and extreme laboratory values during ECMO were compared be-tween groups.Logistic regression was used to analyze the risk factors for mortality and bleeding.The patients were further divided,based on the initial platelet(PLT)values on the day of catheter placement and the lowest platelet count during ECMO,into normal group(PLT≥ 100× 109/L),moderate reduction group[PLT=(50～99)× 109/L],and severe reduction group(PLT＜50× 109/L).Kaplan-Meier analysis was used to compare survival rates among these groups.The patients in the moderate and severe reduction groups were further divided into a platelet transfusion group and a non-transfusion group,and the outcomes and complication rates were com-pared.Results The recovery group had a higher proportion of myocarditis,higher minimum values of PLT,Hb,and Fib,and higher initial PLT values,while the maximum values of lactic dehydrogenase(LDH),total bilirubin(T-Bil),prothrombin time(PT),and procalcitonin(PCT)were lower(all P＜0.05)with significant differences.Logistic regression showed that age and maximum PCT were independent risk factors for mortality(OR=1.025 and 1.015 respectively,all P＜0.05).The bleeding group had longer ECMO dura-tions,more plasma transfusions,lower minimum Hb values,and higher maximum values of WBC,neutrophils(Neu),and APTT(all P＜0.05)with statistical differences.The minimum PLT value,maximum WBC value,and maximum APTT value were independent risk factors for bleeding complications(OR=0.986,1.062,and 1.004 respectively,all P＜0.05).Kaplan-Meier analysis showed that the patients in the severe reduction group had lower survival rates,regardless of whether the grouping was based on initial or minimum platelet counts(all P＜0.05).Platelet transfusion improved the mortality in the severe reduction group(P＜0.05)but had no effect on the moderate reduction group.Conclusion Age and peak value of PCT are the risk factors for mortality in ECMO patients,while mini-mum PLT count,peak value of WBC and APTT are the risk factors for bleeding complications.Early intervention for infection and in-flammation during ECMO may improve the outcome of patients.Severe thrombocytopenia during ECMO therapy increased the risk of mortality,and targeted platelet transfusion may improve the survival of these patients.

Objective:To analyze the correlation between near work, screen time, outdoor time and myopia in children based on objective monitoring technology and to explore the influencing factors related to myopia in children.Methods:A cross-sectional study was conducted.From October 2022 to March 2023, the purposive sampling method was used to select 596 children in Grade 2 and Grade 3 from two primary schools in Shandong Province as study subjects.Eye-Monitor technology of eye-use behavior based on artificial intelligence was used to quantify parameters of near work, screen time and outdoor time.The eye-use behavior parameters were compared within each subject and between non-myopic and myopic children on weekdays and weekends.A multivariate binary logistic regression model was constructed to analyze the influencing factors related to myopia.The study protocol was approved by the Medical Ethics Committee of the Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine (No.HEC-HY-2022023KY).Written informed consent was obtained from the legal guardian of each subject.Results:For each subject, the proportion of near work time on weekdays was greater than on weekends, the proportion of time spent looking at cell phones, computer screens, and outdoor activities was smaller, the duration of single continuous near eye use was longer, the tilt angle of the head in sitting position was greater, and the light intensity was stronger, showing statistically significant differences ( t=19.427, -9.964, -5.916, -10.470, 2.211, 2.898, 15.061; all P<0.05).During weekdays, compared with the non-myopia group, the myopia group had longer total near work duration, longer single continuous near eye use duration, shorter outdoor activity duration, closer eye use distance, larger proportion of near work time, and smaller proportion of outdoor activity time, showing statistically significant differences (all P<0.05).During weekends, compared with the non-myopia group, the myopia group had longer time spent looking at cell phones and computer screens, shorter outdoor activity time, greater proportion of time spent looking at cell phones and computer screens, and smaller proportion of outdoor activity time, with statistically significant differences (all P<0.05).During weekdays, after adjusting for confounding factors, longer single continuous near eye use duration ( OR=1.138, 95% CI: 1.086-1.192, P<0.001) was the risk factor for myopia, and longer working distance ( OR=0.906, 95% CI: 0.847-0.970, P=0.004) and longer outdoor activity time ( OR=0.127, 95% CI: 0.023-0.703, P=0.018) were protective factors for myopia.During weekends, after adjusting for confounding factors, longer time spent on looking at cell phone screens ( OR=2.437, 95% CI: 1.460-4.068, P<0.001) and longer time spent on looking at computer screens ( OR=2.260, 95% CI: 1.283-3.979, P=0.005) were risk factors for myopia, and longer outdoor activity time ( OR=0.624, 95% CI: 0.416-0.934, P=0.022) was the protective factor for myopia. Conclusions:The eyes with continuous near work, prolonged use of smartphone and computer screens, closer eye use distance, and less time spent outdoors have been confirmed to be significantly correlated with myopia based on objective monitoring data.When formulating intervention measures for myopia prevention and control in children, it is advocated to further pay attention to control the distance and duration of near work on weekdays and strengthen screen time management on weekends.

Objective:To investigate changes in behavior and hippocampal and prefrontal cortical myelin basic protein(MBP) in model mice with post-traumatic stress disorder(PTSD).Methods:Thirty-two clean-grade male C57BL/6J mice were randomly divided into control group, PTSD 3 d group, PTSD 7 d group and PTSD 14 d group based on matching body mass, with 8 mice in each group. The mice in PTSD 3 d, 7 d and 14 d groups were decapitated at 3 d, 7 d, and 14 d after modeling.The PTSD mouse model was established through conditioned foot shock and single prolonged stress. Anxious- and depressive-like behaviors of mice were assessed by the open field test(OFT). The mouse step-through passive avoidance experiment was used for electric shock training and learning and memory retention. Myelin morphology alterations in the hippocampus and prefrontal cortex of the mouse were examined via myelin staining.The expression levels of MBP were quantified using Western blot and immunohistochemical staining techniques. All experimental data were analyzed and visualized using GraphPad Prism 8.0.2 and SPSS 25.0, the multi groups comparison of behavioral and molecular indicator data was conducted by one-way ANOVA, and the correlation between MBP relative protein expression level and behavioral indicators was analyzed by Pearson correlation analysis.Results:(1) Behavioral results: in OFT, there were significant differences in total distance, average speed, time of stationary and times of entering the central area among all groups( F=16.72, 16.74, 7.37, 5.93, all P<0.05).The total distance and the average speed time of PTSD 3 d, 7 d, 14 d group were all lower than those in control group(all P<0.05).In the mouse step-through passive avoidance experiment, significant differences were observed across all groups in terms of total distance traveled, average speed, dark box entries, and activity time( F=52.78, 55.47, 9.07, 24.88, all P<0.05).All the indexes of PTSD 3 d group and PTSD 7 d group were all higher than those in control group and PTSD 14 d group(all P<0.05).(2)Myelin staining revealed statistically significant differences in the myelin staining areas of the hippocampal CA1 region and the prefrontal cortex across all groups( F=6.67, 5.77, all P<0.05). The stained myelin area in the CA1 region of the hippocampus in the PTSD 3 d group((123.30±11.62)μm 2)was significantly lower compared to the control group((153.00±2.61)μm 2)( P<0.05). The stained myelin area in the prefrontal cortex of the PTSD 3 d group((119.50±9.26)μm 2)was significantly lower compared to that in the control group((154.80±12.40)μm 2)( P<0.05). (3) Western blot results demonstrated significant variations in the expression levels of myelin basic protein (MBP) within the hippocampus and prefrontal cortex across all experimental groups ( F=10.15, 5.28, all P<0.05). The expression levels of MBP in the hippocampal tissue of the PTSD 3 d group (0.89±0.07), PTSD 7 d group (0.90±0.14), and PTSD 14 d group (0.85±0.13) were significantly lower compared to those in the control group(1.17±0.02)(all P<0.05). The expression levels of MBP protein in the prefrontal cortex of the PTSD 3 d group(0.73±0.16) and PTSD 7 d group (0.70±0.12)were significantly lower compared to those in the control group (0.94±0.04)(all P<0.05). (4) Immunohistochemical staining revealed significant variations in the number of MBP-positive cells within the hippocampal CA1 region and the prefrontal cortex across all groups ( F=39.32, 21.81, both P<0.05). The quantity of MBP-positive cells in the hippocampal tissue of mice in the PTSD 3 d group((187.10±1.12)/mm 2)and PTSD 7 d group((193.10±2.18) /mm 2)was significantly reduced compared to the control group((204.80±3.25)/mm 2)(all P<0.05). The quantity of MBP-positive cells in the prefrontal cortex of the PTSD 7 d group((183.90±1.71)/mm 2) was significantly reduced compared to the control group((191.60±1.04) /mm 2)( P<0.05). Conclusion:The PTSD model mice showed anxious- and depression-like behavior, impaired learning and memory ability, and myelin damage in the hippocampus and prefrontal cortex.

Objective:To analyze the correlation between near work, screen time, outdoor time and myopia in children based on objective monitoring technology and to explore the influencing factors related to myopia in children.Methods:A cross-sectional study was conducted.From October 2022 to March 2023, the purposive sampling method was used to select 596 children in Grade 2 and Grade 3 from two primary schools in Shandong Province as study subjects.Eye-Monitor technology of eye-use behavior based on artificial intelligence was used to quantify parameters of near work, screen time and outdoor time.The eye-use behavior parameters were compared within each subject and between non-myopic and myopic children on weekdays and weekends.A multivariate binary logistic regression model was constructed to analyze the influencing factors related to myopia.The study protocol was approved by the Medical Ethics Committee of the Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine (No.HEC-HY-2022023KY).Written informed consent was obtained from the legal guardian of each subject.Results:For each subject, the proportion of near work time on weekdays was greater than on weekends, the proportion of time spent looking at cell phones, computer screens, and outdoor activities was smaller, the duration of single continuous near eye use was longer, the tilt angle of the head in sitting position was greater, and the light intensity was stronger, showing statistically significant differences ( t=19.427, -9.964, -5.916, -10.470, 2.211, 2.898, 15.061; all P<0.05).During weekdays, compared with the non-myopia group, the myopia group had longer total near work duration, longer single continuous near eye use duration, shorter outdoor activity duration, closer eye use distance, larger proportion of near work time, and smaller proportion of outdoor activity time, showing statistically significant differences (all P<0.05).During weekends, compared with the non-myopia group, the myopia group had longer time spent looking at cell phones and computer screens, shorter outdoor activity time, greater proportion of time spent looking at cell phones and computer screens, and smaller proportion of outdoor activity time, with statistically significant differences (all P<0.05).During weekdays, after adjusting for confounding factors, longer single continuous near eye use duration ( OR=1.138, 95% CI: 1.086-1.192, P<0.001) was the risk factor for myopia, and longer working distance ( OR=0.906, 95% CI: 0.847-0.970, P=0.004) and longer outdoor activity time ( OR=0.127, 95% CI: 0.023-0.703, P=0.018) were protective factors for myopia.During weekends, after adjusting for confounding factors, longer time spent on looking at cell phone screens ( OR=2.437, 95% CI: 1.460-4.068, P<0.001) and longer time spent on looking at computer screens ( OR=2.260, 95% CI: 1.283-3.979, P=0.005) were risk factors for myopia, and longer outdoor activity time ( OR=0.624, 95% CI: 0.416-0.934, P=0.022) was the protective factor for myopia. Conclusions:The eyes with continuous near work, prolonged use of smartphone and computer screens, closer eye use distance, and less time spent outdoors have been confirmed to be significantly correlated with myopia based on objective monitoring data.When formulating intervention measures for myopia prevention and control in children, it is advocated to further pay attention to control the distance and duration of near work on weekdays and strengthen screen time management on weekends.