Objective: To investigate the epidemiological characteristics, outcome patterns, and management strategies for blood donors with a positive direct antiglobulin test (DAT). Methods: A retrospective analysis was conducted on donation data from 808 386 donors from 2013 to 2023, focusing on those whose blood was discarded due to DAT positivity. Follow-up was performed on 125 DAT-positive donors, and 98 blood samples were collected. The samples were re-tested for DAT, DAT typing (IgG/C3d), and unexpected antibody screening using both the tube method and the microcolumn gel method. Results: Epidemiological characteristics: Retrospective data revealed 147 DAT-positive blood donors, yielding a positivity rate of 1/5 500. The DAT positivity rate using the tube method was 0.118‰ (49/416 893), lower than that of the microcolumn gel method at 0.25‰ (98/391 493). Among DAT-positive individuals, 44.2% (65/147) exhibited agglutination intensity<2+. Outcome analysis: The proportion of donors with positive DAT test results that converted to negative was 54.1% (53/98), with a conversion interval ranging from 8 to 117 months (mean 49.9 months). All donors in the negative conversion group had a previous DAT intensity<2+, whereas 95.6% (43/45) of the non-negative conversion group had intensity ≥2+ (P<0.001). Unexpected antibodies (anti-E, anti-M, etc.) were detected in 18 cases. Methodological differences: Review of results revealed 35 cases positive by both the DAT tube assay and microcolumn gel method. An additional 10 cases were positive by only one method: 5 were positive only by the tube assay, and 5 were positive only by the microcolumn gel method. Clinical validation: Among 14 DAT-positive donors who became negative and donated blood again, the clinical infusion efficacy of red blood cell products could be assessed in 10 cases, with 9 cases demonstrating effective infusion. Conclusion: Some DAT-positive blood donors may naturally convert to negative status, with the intensity of previous test results potentially serving as a key predictive factor for conversion. It is recommended to employ a combined approach of tube-based and microcolumn gel-based methods for retesting, concurrently screening for irregular antibodies. A tentative tiered management strategy is proposed: individuals with DAT intensity <2+ should be deferred for 12 months before retesting, while those with ≥2+ intensity should be permanently deferred.

Objective To evaluate the predictive value of different machine learning models constructed in a multicenter environment for potential organ donors and verify their clinical application feasibility. Methods The study included 2 000 inpatients admitted to five domestic tertiary hospitals from January 2020 to December 2023, who met the criteria for potential organ donation assessment. They were randomly divided into a training set and an internal validation set (7∶3). Another 300 similar patients admitted to the First Affiliated Hospital of Harbin Medical University from January 2024 to April 2025 were included as an external validation set. The area under the curve (AUC), sensitivity, specificity, accuracy and F1-score of three models were compared, and the consistency of the potential organ donor determination process was tested. Multivariate logistic regression analysis was used to identify predictive factors of potential organ donors. Decision curve analysis (DCA) was employed to verify the resource efficiency of each model, and the threshold interval and intervention balance point were assessed. Results Apart from age, there were no significant differences in other basic characteristics among the centers (all P>0.05). The consistency of the potential organ donor determination process among researchers in each center was good [all 95% confidence interval (CI) lower limits >0]. In the internal validation set, the XGBoost model had the best predictive performance (AUC=0.92, 95% CI 0.89-0.94) and the best calibration (P=0.441, Brier score 0.099). In the external validation set, the XGBoost model also had the best predictive performance (AUC=0.91, 95% CI 0.88-0.94), outperforming logistic regression and random forest models. Multivariate logistic regression showed that mechanical ventilation had the greatest impact (odds ratio=2.06, 95% CI 1.54-2.76, P<0.001). DCA indicated that the XGBoost model had the highest net benefit in the threshold interval of 0.2-0.6. The “treat all” strategy only had a slight advantage at extremely low thresholds. The recommended threshold interval, which balances intervention costs and clinical benefits, considers ≥50% positive predictive value (PPV) and ≤50 referrals per 100 high-risk patients. Conclusions The XGBoost model established in a multicenter environment is accurate and well-calibrated in predicting potential organ donors. Combined with DCA, it may effectively guide the timing of clinical interventions and resource allocation, providing new ideas for the assessment and management of organ donation after brain death.

This study aims to describe the population and regional distribution characteristics of smoking behavior among adult twins in the China Twin Registry (CNTR), as well as the concordance rates for smoking behavior in monozygotic and dizygotic twins, and estimate the heritability. The study population included adult twins in CNTR who had smoking questionnaire data. A random-effects regression model was used to describe the distribution of smoking behavior among different subgroups based on various characteristics. The concordance of smoking behavior between different zygosity groups was calculated, and heritability was estimated. A total of 28 444 twin pairs were included in this study, with an average age of (36.6±12.0) years. Among male twins, 41.2% were current smokers, while only 1.2% of females smoked. Higher smoking rates were observed among male smokers in the 50-59 age group ( z=23.0, P<0.001), northern regions ( z=2.9, P<0.01), rural areas ( z=-5.2, P<0.001), those who were divorced/widowed ( z=3.8, P<0.001), and first-born twins ( z=-4.3, P<0.001), while lower smoking rates were found in those with higher education ( z=-16.1, P<0.001) and unmarried individuals ( z=-16.0, P<0.001). The smoking concordance rate for male monozygotic twins was 69.6%, significantly higher than the 57.3% concordance rate for dizygotic twins ( χ 2=105.0, P<0.05). The heritability of smoking behavior in male twins was estimated at 28.9% (95% CI: 24.3%-33.4%). Stratified analyses showed differences in heritability across regions and age groups: the heritability in northern regions was 32.6% (95% CI: 27.3%-38.0%), higher than the 21.0% (95% CI: 12.4%-29.5%) observed in southern regions; the highest heritability of 35.1% (95% CI: 26.3%-43.9%) was found in the 18-29 age group, with heritability decreasing with age. In conclusion, the smoking rate and influencing factors in the twin population are similar to those in the general population, with unique characteristics, such as higher smoking rates in first-born twins. Genetic factors have a significant impact on smoking behavior.

Cancer stands as a significant global public health challenge,and cancer screening serves as a pivotal strategy for reducing its mortality.Presently,only a limited number of cancer types have appropriate screening methods available.Traditional single-cancer screen-ing approaches are fraught with limitations,including invasiveness,low accuracy,and poor patient compliance.Multi-cancer early detection(MCED)leveraging liquid biopsy technology enables non-invasive and efficient early detection of multiple cancers by analyzing biomarkers such as cell-free DNA,cell-free RNA,proteins,and metabolites in blood and other bodily fluids.This innovative approach substantially broadens the spectrum of detectable cancers and enhances population coverage,showcasing immense potential for improving existing can-cer screening strategies.This expert consensus comprehensively reviews the progress of liquid biopsy-based MCED,biomarker selection and detection technologies,the criteria for cancer type selection,research design and clinical utility evaluation,as well as implementation path-ways.The overarching goal of this consensus is to offer scientific guidance for further research and the widespread adoption of MCED,thereby facilitating the continuous optimization of cancer screening strategies.

Objective The aim of this study was to analyze the incidence,mortality,and epidemiological trends of malignant tumors in the cancer registration areas of Qinghai Province and provide a reference for the prevention and control strategies and meas-ures of malignant tumors.Methods According to the quality control standards for cancer registration,the data on malignant tumor in-cidence and mortality from 8 national cancer registration areas in Qinghai Province from 2014 to 2021 were collated.The crude inci-dence/mortality,age-standardized incidence/mortality rate by Chinese standard population(ASIRC/ASMRC)and World standard population(ASIRW/ASMRW),the cumulative rates(0-74 years old),and the age-specific incidence/mortality of malignant tumors were calculated for different sexes and regions.The Joinpoint 4.9.0.0 software was used to calculate the average annual percentage change(AAPC)and conduct trend analysis.Results The crude incidence of malignant tumors in the cancer registration areas of Qinghai Province from 2014 to 2021 was 221.25/100,000(243.31/100,000 for males and 198.68/100,000 for females),the ASIRC was 199.48/100,000(229.13/100,000 for males and 173.34/100,000 for females),the ASIRW was 196.38/100,000(228.32/100,000 for males and 167.97/100,000 for females).The cumulative rate for those aged 0-74 years was 21.57％;the crude mortali-ty of malignant tumors was 131.90/100,000(163.86/100,000 for males and 99.20/100,000 for females),the ASMRC was 121.07/100,000(157.33/100,000 for males and 87.45/100,000 for females),the ASMRW was 120.53/100,000(157.54/100,000 for males and 86.31/100,000 for females),and the cumulative rate for those aged 0-74 years was 12.79％.The crude incidence,ASIRC,ASIRW,crude mortality,ASMRC and ASMRW were all higher in males than those in females.Both the crude incidence and mortality of malignant tumors increased with age.The crude incidence rate increased rapidly after age 45,peaked in the 80-84 age group(2,352.29 per 100,000),and declined slightly in the 85+age group.The crude mortality increased rapidly after age 50,peaked in the 85+age group(2,305.44 per 100,000).The crude incidence(AAPC=5.68％,95％CI:3.48％-7.93％,P＜0.05)and erude mortality(AAPC=3.67％,95％CI:2.44％-4.91％,P＜0.05)of malignant tumors showed an overall upward trend from 2014 to 2021.The ASIRC(AAPC=-0.12％,95％CI:-3.70％-3.59％,P＞0.05)remained stable,while the ASMRC(AAPC=-2.81％,95％CI:-3.28％--2.03％,P＜0.05)showed a downward trend.The top five malignant tumors in terms of crude incidence were stom-ach cancer,lung cancer,liver cancer,female breast cancer,and cervical cancer,respectively;the top five malignant tumors in terms of crude mortality were stomach cancer,lung cancer,liver cancer,esophagus cancer,and colorectal cancer,respectively.Conclusion From 2014 to 2021,the incidence and mortality of malignant tumors in the Qinghai Province cancerregistration areas showed an in-creasing trend,with higher rates in males than those in females.It is recommended that targeted prevention and control measures should be implemented for people aged 45 and older,with stomach cancer,liver cancer,and cervical cancer as key cancers.

Objective The aim of this study was to analyze the incidence,mortality,and epidemiological trends of malignant tumors in the cancer registration areas of Qinghai Province and provide a reference for the prevention and control strategies and meas-ures of malignant tumors.Methods According to the quality control standards for cancer registration,the data on malignant tumor in-cidence and mortality from 8 national cancer registration areas in Qinghai Province from 2014 to 2021 were collated.The crude inci-dence/mortality,age-standardized incidence/mortality rate by Chinese standard population(ASIRC/ASMRC)and World standard population(ASIRW/ASMRW),the cumulative rates(0-74 years old),and the age-specific incidence/mortality of malignant tumors were calculated for different sexes and regions.The Joinpoint 4.9.0.0 software was used to calculate the average annual percentage change(AAPC)and conduct trend analysis.Results The crude incidence of malignant tumors in the cancer registration areas of Qinghai Province from 2014 to 2021 was 221.25/100,000(243.31/100,000 for males and 198.68/100,000 for females),the ASIRC was 199.48/100,000(229.13/100,000 for males and 173.34/100,000 for females),the ASIRW was 196.38/100,000(228.32/100,000 for males and 167.97/100,000 for females).The cumulative rate for those aged 0-74 years was 21.57％;the crude mortali-ty of malignant tumors was 131.90/100,000(163.86/100,000 for males and 99.20/100,000 for females),the ASMRC was 121.07/100,000(157.33/100,000 for males and 87.45/100,000 for females),the ASMRW was 120.53/100,000(157.54/100,000 for males and 86.31/100,000 for females),and the cumulative rate for those aged 0-74 years was 12.79％.The crude incidence,ASIRC,ASIRW,crude mortality,ASMRC and ASMRW were all higher in males than those in females.Both the crude incidence and mortality of malignant tumors increased with age.The crude incidence rate increased rapidly after age 45,peaked in the 80-84 age group(2,352.29 per 100,000),and declined slightly in the 85+age group.The crude mortality increased rapidly after age 50,peaked in the 85+age group(2,305.44 per 100,000).The crude incidence(AAPC=5.68％,95％CI:3.48％-7.93％,P＜0.05)and erude mortality(AAPC=3.67％,95％CI:2.44％-4.91％,P＜0.05)of malignant tumors showed an overall upward trend from 2014 to 2021.The ASIRC(AAPC=-0.12％,95％CI:-3.70％-3.59％,P＞0.05)remained stable,while the ASMRC(AAPC=-2.81％,95％CI:-3.28％--2.03％,P＜0.05)showed a downward trend.The top five malignant tumors in terms of crude incidence were stom-ach cancer,lung cancer,liver cancer,female breast cancer,and cervical cancer,respectively;the top five malignant tumors in terms of crude mortality were stomach cancer,lung cancer,liver cancer,esophagus cancer,and colorectal cancer,respectively.Conclusion From 2014 to 2021,the incidence and mortality of malignant tumors in the Qinghai Province cancerregistration areas showed an in-creasing trend,with higher rates in males than those in females.It is recommended that targeted prevention and control measures should be implemented for people aged 45 and older,with stomach cancer,liver cancer,and cervical cancer as key cancers.

This study aims to describe the population and regional distribution characteristics of smoking behavior among adult twins in the China Twin Registry (CNTR), as well as the concordance rates for smoking behavior in monozygotic and dizygotic twins, and estimate the heritability. The study population included adult twins in CNTR who had smoking questionnaire data. A random-effects regression model was used to describe the distribution of smoking behavior among different subgroups based on various characteristics. The concordance of smoking behavior between different zygosity groups was calculated, and heritability was estimated. A total of 28 444 twin pairs were included in this study, with an average age of (36.6±12.0) years. Among male twins, 41.2% were current smokers, while only 1.2% of females smoked. Higher smoking rates were observed among male smokers in the 50-59 age group ( z=23.0, P<0.001), northern regions ( z=2.9, P<0.01), rural areas ( z=-5.2, P<0.001), those who were divorced/widowed ( z=3.8, P<0.001), and first-born twins ( z=-4.3, P<0.001), while lower smoking rates were found in those with higher education ( z=-16.1, P<0.001) and unmarried individuals ( z=-16.0, P<0.001). The smoking concordance rate for male monozygotic twins was 69.6%, significantly higher than the 57.3% concordance rate for dizygotic twins ( χ 2=105.0, P<0.05). The heritability of smoking behavior in male twins was estimated at 28.9% (95% CI: 24.3%-33.4%). Stratified analyses showed differences in heritability across regions and age groups: the heritability in northern regions was 32.6% (95% CI: 27.3%-38.0%), higher than the 21.0% (95% CI: 12.4%-29.5%) observed in southern regions; the highest heritability of 35.1% (95% CI: 26.3%-43.9%) was found in the 18-29 age group, with heritability decreasing with age. In conclusion, the smoking rate and influencing factors in the twin population are similar to those in the general population, with unique characteristics, such as higher smoking rates in first-born twins. Genetic factors have a significant impact on smoking behavior.

Objective:To describe the distribution characteristics of alcohol consumption in adult twins in the Chinese National Twin Registry (CNTR), and further explore the influence of genetic factors on alcohol consumption in adult twins.Methods:The subjects of the study were twins registered by CNTR in 11 project areas across China from 2010 to 2018. A total of 56 966 twins (28 483 pairs) aged 18 years and above who answered questions about drinking behavior were included, and the random effect model was used to describe the population and regional distribution characteristics of alcohol consumption. Intra-pair analysis was performed to calculate the concordance rate and heritability of their alcohol consumption.Results:The age of all subjects was (36.6±12.0) years, and current drinkers accounted for 16.6% (9 461/56 966) of all subjects. In men, those aged 50-59 years, those in northern China, those living in rural area, those with low education level and those with high BMI, the proportions of current drinkers were higher. After excluding 468 pairs of twins who had stopped alcohol use and 21 764 pairs of twins who had no drink or had small amount drink, an intra-pair analysis was conducted in 4 929 pairs of same-sex twins, and found that the concordance rate of alcohol consumption was 64.0% (2 059/3 215) in monozygotic twins, and 52.6% (902/1 714) in dizygotic twins, the difference was significant ( P<0.001), and the heritability of alcohol consumption was 24.1% (95% CI: 18.9%- 29.3%). The further stratified analysis found that in southern men, the heritability was highest in those aged 40-49 years (36.1%, 95% CI: 21.6%-50.7%), while in northern men, the heritability was highest in those aged 50-59 years (34.2%, 95% CI: 18.1%-50.3%). Conclusions:In adult twins in China, there were population and regional differences in the distribution of alcohol consumption behavior, and alcohol consumption was influenced by genetic factors, and gender, age and region had potential modifying effects.

Cancer stands as a significant global public health challenge, and cancer screening serves as a pivotal strategy for reducing its mortality. Presently, only a limited number of cancer types have appropriate screening methods available. Traditional single-cancer screening approaches are fraught with limitations, including invasiveness, low accuracy, and poor patient compliance. Multi-cancer early detection (MCED) leveraging liquid biopsy technology enables non-invasive and efficient early detection of multiple cancers by analyzing biomarkers such as cell-free DNA, cell-free RNA, proteins, and metabolites in blood and other bodily fluids. This innovative approach substantially broadens the spectrum of detectable cancers and enhances population coverage, showcasing immense potential for improving existing cancer screening strategies. This expert consensus comprehensively reviews the progress of liquid biopsy-based MCED, biomarker selection and detection technologies, the criteria for cancer type selection, research design and clinical utility evaluation, as well as implementation pathways. The overarching goal of this consensus is to offer scientific guidance for further research and the widespread adoption of MCED, thereby facilitating the continuous optimization of cancer screening strategies.

Cancer stands as a significant global public health challenge,and cancer screening serves as a pivotal strategy for reducing its mortality.Presently,only a limited number of cancer types have appropriate screening methods available.Traditional single-cancer screen-ing approaches are fraught with limitations,including invasiveness,low accuracy,and poor patient compliance.Multi-cancer early detection(MCED)leveraging liquid biopsy technology enables non-invasive and efficient early detection of multiple cancers by analyzing biomarkers such as cell-free DNA,cell-free RNA,proteins,and metabolites in blood and other bodily fluids.This innovative approach substantially broadens the spectrum of detectable cancers and enhances population coverage,showcasing immense potential for improving existing can-cer screening strategies.This expert consensus comprehensively reviews the progress of liquid biopsy-based MCED,biomarker selection and detection technologies,the criteria for cancer type selection,research design and clinical utility evaluation,as well as implementation path-ways.The overarching goal of this consensus is to offer scientific guidance for further research and the widespread adoption of MCED,thereby facilitating the continuous optimization of cancer screening strategies.