Objective: To explore the association between the HLA antibody positivity rate in female blood donors and pregnancy history, number of pregnancies, interval from the last pregnancy to blood donation, and age, to identify associated variables using a univariate generalized additive model (GAM), and to further analyze the predictive role of characteristic variables for HLA antibody positivity using a random forest model. Methods: HLA antibody detection was performed on 391 female blood donors using the Luminex immunomagnetic bead method. The correlation between pregnancy-related factors and HLA antibodies was analyzed using the Chi-square test. Based on R software, a univariate GAM was first constructed to analyze the association types between characteristic variables and the HLA antibody positivity rate, followed by the construction of a random forest model to evaluate the predictive value of the variables. Results: Among the 391 female blood donors without a transfusion history, the overall HLA antibody positivity rate was 26.34%. The positivity rate in donors with a pregnancy history was significantly higher than that in those without (30.09% vs 9.72%, P<0.05), and HLA antibody positivity rate increased linearly with the number of pregnancies (P<0.05). In the univariate GAM, age and number of deliveries exhibited a non-linear association with the HLA antibody positivity rate (the positivity rate increased sharply between 25-35 years of age and stabilized after 3 deliveries). Besides, the interval from the last pregnancy to blood donation showed a linear association with the HLA antibody positivity rate, and the positivity rate decreased as the interval prolonged (P<0.05). In the random forest model, age (mean decrease gini=29.26) and interval from the last pregnancy to blood donation (mean decrease gini=22.02) were core predictive variables: age was more conducive to identifying positive samples, while the interval from the last pregnancy to blood donation was more helpful for excluding negative samples. The number of deliveries (mean decrease accuracy=16.98) made a significant contribution to predicting positive samples, whereas the number of abortions had no impact. The model had an AUC of 0.583 (95% CI: 0.593 8-0.770 2), indicating a certain predictive value. Conclusion: The associated variables identified by the univariate GAM model, including age, interval from the last pregnancy to blood donation, and number of deliveries, provide a basis for key variables in the random forest model. All three variables have predictive value for HLA antibody positivity, which can provide evidence-based support for personalized transfusion management and stratified screening of female blood donors in this region.

The diagnosis of schizophrenia usually relies on the assessment of clinical symptoms,and the search for objective biomarkers is particularly important for the diagnosis and treatment of the disease.Since the retina can reflect the state of the central nervous system,more and more studies are focusing on retina-specific alterations in neuropsychiatric disorders.This review summarizes recent studies on the retinal nerve layer,vascular characteristics,and electrophysiological features in patients with schizophrenia,showing that patients with schizophrenia often have thinner retinal ganglion cell-inner plexiform layer and retinal nerve fiber layer.The changes in the retinal layers vary in different stages of schizophrenia.Studies of the fundus vasculature in schizophrenic patients have also suggested the presence of altered retinal vascular density and microvascular morphology in schizophrenic patients.Studies of electroretinography suggest that patients in the acute phase of schizophrenia tend to exhibit reduced a-wave amplitudes of cone cells,while those at genetic high risk often show a tendency for reduced b-wave amplitudes of rod cells.However,the current retina-related studies in schizophrenia mostly focus on clinical manifestations,with fewer studies on related mechanisms and inconsistent findings.This review attempts to discuss a variety of potential pathophysiological mechanisms,including trans-synaptic retrograde degeneration hypothesis,neurotransmitter disturbance,genetics,brain structural changes,and metabolism,in the context of the retinal nerve layer,microcirculation,and electrophysiology alterations,in order to provide new insights into the pathophysiological mechanisms and objective biomarkers of schizophrenia.

Objective To investigate the distribution of plantar pressures and bone stresses of the foot with high,normal and low arch morphologies,and reveal the influence of arch morphology on foot biomechanical properties.Methods A total of 127 young females were recruited.The foot type was classified by collecting the morphological data of the foot with the three-dimensional(3D)foot scanner,and three types of the foot arch morphology were selected for analysis.The geometric model of foot bone was obtained by CT scanning,so as to establish the biomechanical finite element model of the foot.A load of 50％human body weight was applied to the model to simulate the state of bipedal standing.Results The calculated plantar contact area was compared with the measured results,and the relative error values were smaller than 10％,which proved the validity of the finite element model.The peak plantar pressure under three types of arch morphologies was located in the hind foot region,and the heel pressure of high-and low-arched foot was higher than that of normal-arched foot.Compared with normal-arched foot,high-arched foot showed a significant increase in stress in the hind foot area,the peak stress of soft tissues was 299.45％higher,and the peak bone stress was 93.19％higher.For low-arched foot,the plantar contact area increased by 13.28％and calcaneal stress increased by 98.09％.The peak bone stresses of high-,normal-and low-arched foot were located at the talus,which were 9.903,19.921 and 36.308 MPa,respectively.Conclusions This study supports the association between abnormal arch morphology,foot pain and foot diseases,and provides a basis and direction for the design of orthopedic insoles and arch support structures for abnormal feet.

Objective To investigate the distribution of plantar pressures and bone stresses of the foot with high,normal and low arch morphologies,and reveal the influence of arch morphology on foot biomechanical properties.Methods A total of 127 young females were recruited.The foot type was classified by collecting the morphological data of the foot with the three-dimensional(3D)foot scanner,and three types of the foot arch morphology were selected for analysis.The geometric model of foot bone was obtained by CT scanning,so as to establish the biomechanical finite element model of the foot.A load of 50％human body weight was applied to the model to simulate the state of bipedal standing.Results The calculated plantar contact area was compared with the measured results,and the relative error values were smaller than 10％,which proved the validity of the finite element model.The peak plantar pressure under three types of arch morphologies was located in the hind foot region,and the heel pressure of high-and low-arched foot was higher than that of normal-arched foot.Compared with normal-arched foot,high-arched foot showed a significant increase in stress in the hind foot area,the peak stress of soft tissues was 299.45％higher,and the peak bone stress was 93.19％higher.For low-arched foot,the plantar contact area increased by 13.28％and calcaneal stress increased by 98.09％.The peak bone stresses of high-,normal-and low-arched foot were located at the talus,which were 9.903,19.921 and 36.308 MPa,respectively.Conclusions This study supports the association between abnormal arch morphology,foot pain and foot diseases,and provides a basis and direction for the design of orthopedic insoles and arch support structures for abnormal feet.

Objective:To explore the clinical and pathological features of EBV-positive diffuse large B cell lymphoma (EBV +DLBCL) and to analyze the prognostic significance of CD30 expression in this entity. Methods:A retrospective analysis was conducted from 34 cases of EBV +DLBCL and 198 cases of EBV -DLBCL diagnosed and treated at the First Affiliated Hospital of Nanjing Medical University, from January 2017 to June 2023. Based on CD30 expression, 34 patients with EBV +DLBCL were categorized into CD30-positive and CD30-negative groups. Fisher exact test and Kaplan-Meier survival curves were employed to analyze the relationship between CD30 expression and clinicopathological parameters as well as its prognostic implications. Chi-square tests were used to compare the clinicopathological features between EBV +DLBCL and EBV -DLBCL. Results:There were 19 males and 15 females with a median age of 69.5 (15-83) years in the EBV +DLBCL group. Compared with EBV -DLBCL, EBV +DLBCL was more likely to present with clinical features such as B symptoms ( χ2=23.818, P<0.001), Ann Arbor stage Ⅲ-Ⅳ ( χ2=8.540, P=0.003), ECOG (Eastern Cooperative Oncology Group Performance Status) score 2-4 ( χ2=6.722, P=0.010), IPI score 3-5 ( χ2=9.953, P=0.002), and involvement of more than one extranodal site ( χ2=6.825, P=0.009). Additionally, EBV +DLBCL exhibited higher frequencies of elevated LDH ( χ2=4.307, P=0.038), CRP ( χ2=5.596, P=0.018), and β2-MG ( χ2=7.008, P=0.008) levels. Histopathologically, EBV +DLBCL was more commonly of the non-GCB subtype ( χ2=12.421, P<0.001), with higher frequencies of CD30-positive ( χ2=62.706, P<0.001),CD10-negative ( χ2=8.687, P=0.003),bcl-6-negative ( χ2=11.123, P<0.001), and bcl-2-negative ( χ2=22.779, P=0.003) expression. Using 20% as the positive threshold for CD30, the CD30-positive group had a higher proliferation index ( P=0.045). No significant differences were observed in overall survival between the two groups. Conclusions:EBV +DLBCL is more prevalent in the elderly and often exhibits aggressive clinical features. The expression of CD30 is not associated with the overall prognosis of EBV +DLBCL.

In order to fully consider the physiological characteristics and movement mechanism of the human body under the premise of ensuring the function and practicality of the product,the human-fabric contact finite element model based on biomechanical feedback plays an important role in the design of'people-oriented'health protection products.This review focuses on the design of protective products made of flexible materials,and discusses the application status and development trend of human finite element model in the design of protective products.The construction process of finite element models of different parts of the human body in recent years is summarized from the perspective of human biomechanics.Secondly,from the contact models established between the human head,torso,upper limbs and lower limbs and protective devices,the application status and challenges of finite element method in the design of health protective products are sorted out.Finally,the problems existing in the use of finite element method in such researches are discussed.It is pointed out that in the context of pursuing accuracy,real-time and realism,finite element contact models with the advantages of high efficiency,precision and reusability still have a broad application prospect.

The aim of this study is to identify the cause of death of a South China tiger cub at the Meihuashan breeding institute of Fujian Province.Pathogenic bacteria were isolated and cultured from liver,spleen,lung and other tissue samples of the dead South China tiger aseptically.The iso-lated bacteria were identified through morphological observation,biochemical characterization,sequence analysis of housekeeping gene gyrB,virulence gene detection,animal pathogenicity test and drug sensitivity test.A pathogenic Aeromonas hydrophila strain,designated FJ/Tiger-201809 was successfully isolated from the trachea of dead South China tiger.The nucleotide sequence ho-mology between the isolate and 11 strains of Aeromonas gyrB ranged from 91.2％to 99.1％,with the highest homology of 99.1％observed with Aeromonas hydrophila(AF208251.1).Genetic evo-lution analysis showed that the isolated strain FJ/Tiger-201809 was in the same evolutionary branch as other reference strains of Aeromonas hydrophila and was closely related.The pathoge-nicity test in mice showed artificial infection of mice with the strain resulted in varying degrees of lesions in several organs of the mice,and the median lethal dose(LD50)was 1 × 107.8 CFU/mL.Virulence gene test results showed that the isolate FJ/Tiger-201809 carried two virulence genes,aer and act.The results of drug sensitivity test showed that FJ/Tiger-201809 was highly sensitive to enrofloxacin and ampicillin among 18 commonly used antibiotics,relatively sensitive to penicil-lin G and doxycycline,and resistant to the other 14 antibiotics.In conclusion,this study isolated and identified a strain of Aeromonas hydrophila from a dead South China tiger with multiple drug resistance and strong pathogenicity,which provided an important reference for the prevention and control of bacterial diseases in South China tiger.

Objective To explore the factors influencing cognitive frailty in elderly inpatients with chronic heart failure(CHF)during hospitalisation,8 prediction models were developed with various machine learning algorithms to identify the best model as a guidance for medical staff on clinical interventions.Methods Convenience sampling method was used to select 650 elderly CHF inpatients who stayed in our hospital between September 2023 and June 2024 as the study objects in the cross-sectional investigation.A total of 607 patients had completed the study.The patients were divided into a cognitive frailty group and a non-cognitive frailty group according to the presence or absence of cognitive frailty.Variables were initially screened using univariate analysis and stepwise Logistic regression.The total sample was then randomly divided into a training set(n=424)and a testing set(n=183)of a 7:3 ratio.Eight predictive models were created using the algorithms of neural network(NN),k-nearest neighbour(KNN),linear discriminant analysis(LDA),support vector machine(SVM),naive Bayes(NB),logistic regression,decision tree(DT)and random forest(RF)on the training set.The predictive performance of the models was compared using the data of the testing set.Results The prevalence of cognitive frailty in elderly CHF inpatients was 48.3%.Results of Logistic regression showed that age,marital status,education,body mass index,multi-morbidity,nutritional status,medication,frequency of weekly exercise and the living conditions were the key factors(P<0.05).The overall accuracy in classification of the eight predictive models ranged from 0.803 to 0.847,with F1-values of 0.778 to 0.833,precision of 0.848 to 0.897,and recall rate of 0.700 to 0.778.The area under the receiver operating characteristic curve was 0.820 to 0.901.Conclusion Of the eight predictive models,the prediction model created with LDA shows the best performance and prediction in terms of comprehensive prediction metrics,while the prediction model created with NN shows the worst performance in comprehensive prediction.

Objective To explore and analyze the adverse drug event(ADE)signals associated with pembrolizumab and to provide a reference for the real-world safety of drug use on elderly patients.Methods ADE reports of pembrolizumab in the general population and elderly population were collected from the FDA Adverse Event Reporting System(FAERS)for the period between January 1st,2019,and June 30th,2024.Multiple signal detection methods(ROR,PRR,MHRA)were employed for data mining.Classification and statistical analysis were performed using the System Organ Class(SOC)and Preferred Term(PT)from the MedDRA(Version 27.1)dictionary.Results A total of 966 signals were identified in the general population,spanning 24 SOCs,while 593 signals were detected in the elderly population,spanning 23 SOCs.Comparative visualization analysis of critical PTs under four major SOCs revealed no significant abnormal signals in elderly patients.Conclusion A comprehensive and multidimensional analysis of the ADE data from the FAERS database indicates that pembrolizumab appears to be relatively safe for use in elderly patients.

OBJECTIVE To observe the clinical efficacy of Zhenshi Burn Ointment on postoperative wound healing of simple anal fistula and explore its potential mechanism of action.METHODS A total of 60 patients with low-position simple anal fistula of damp-heat pouring downward type admitted to the Department of Anorectum,Nanjing Hospital of Chinese Medicine Affiliated to Nan-jing University of Chinese Medicine from May to December 2023 were selected as the research subjects and randomly divided into an experimental group and a control group,with 30 cases in each group.After surgery,the control group was given sterilized vaseline gauze for external application,and the experimental group was given Zhenshi Burn Ointment for external application.The course of treatment for both groups was 30 d.After treatment,the postoperative wound healing time,wound healing rate,pain score,wound granulation growth and secretion,and changes in TCM syndrome score were compared between the two groups.The pathological sec-tions of wound granulation tissue were compared 14 d after surgery.The transcription levels of COL1A1,type Ⅲ collagen(COL3A1),epidermal growth factor(EGF),and fibroblast growth factor(FGF2)in granulation tissue were detected by qPCR.The expression lev-els of proteins related to MEK/ERK signaling pathway were detected by Western blot.RESULTS Compared with the control group,the wound healing rates of the experimental group were significantly increased at 7,14,21,and 30 d after surgery(P<0.01),and the wound healing time was significantly shortened(P<0.01).At 7 d after surgery,the pain score of the experimental group was signifi-cantly lower than that of the control group(P<0.05).At 7 and 14 d after surgery,the granulation growth score of the wound in the ex-perimental group was significantly lower than that of the control group(P<0.01).At 14 d after surgery,the secretion score of the ex-perimental group was significantly lower than that of the control group(P<0.01).At 14 and 30 d after surgery,the total score of TCM syndrome in the experimental group was significantly better than that in the control group(P<0.05).At 14 d after surgery,the patho-logical improvement of granulation tissue in the wound in the experimental group was better than that in the control group,and the con-tent of collagen fiber and type I collagen(Collagen I)was significantly higher than that in the control group(P<0.01).The mRNA contents of COL1A1,COL3A1,EGF,and FGF2 were significantly higher than those in the control group(P<0.05,P<0.01);the levels of p-MEK1/2 and p-ERK1/2 proteins were higher than those in the control group(P<0.05).CONCLUSION Zhenshi Burn Ointment has a good effect on promoting postoperative anal fistula wound healing,which may be related to upregulating growth factor expression,promoting collagen regeneration,and activating MEK/ERK pathway.