ObjectiveTo investigate the effects of different antiplatelet therapy regimens （aspirin versus clopidogrel at specific doses） on cognitive function， blood biomarkers and brain imaging biomarkers when used prophylactically in patients with cerebral small vessel disease （CSVD）. MethodsA randomized controlled trial was conducted involving 160 CSVD patients who were randomly assigned to four groups： aspirin group （ASA）， low-dose clopidogrel group （CLOP-50）， standard-dose clopidogrel group （CLOP-75）， and control group （HC）. Cognitive function ［auditory verbal learning test-immediate recall （AVLT-IR）， auditory verbal learning test-short-delay recall （AVLT-SDR）， auditory verbal learning test-long-delay recall （AVLT-LDR）， hamilton anxiety rating scale （HAMA）， and hamilton depression rating scale （HAMD）， ADL（activities of daily living scale ）， （ascertain dementia 8-item questionnaire，AD8）］， blood biomarkers ［platelet count （PLT） and mean platelet volume （MPV）］， and CSVD-related imaging biomarkers ［white matter hyperintensities （WMH） and cerebral microbleeds （CMB）］ were assessed in all groups at baseline and at the 6-month follow-up. ResultsAfter 6 months of treatment， within-group comparisons showed that， compared with baseline， the ASA group had significantly increased scores on the AVLT immediate recall （AVLT-IR）， short-delay recall （AVLT-SDR）， and long-delay recall （AVLT-LDR） （P<0.05）. The CLOP-75 group showed significantly decreased HAMA and HAMD scores （P<0.05）， along with a significant increase in AVLT-LDR scores （P<0.05）. The number of CMBs increased from baseline in both the ASA and CLOP-75 groups （P<0.05）， whereas no statistically significant changes in blood biomarkers were observed in either group. By contrast， the CLOP-50 and HC groups showed no significant changes in cognitive function， blood biomarkers， or CSVD-related imaging biomarkers compared with baseline （all P<0.05）. Comparisons between groups showed that the AVLT-LDR scores and the number of CMBs increased faster in the ASA group than in the HC group （β=-0.187， P=0.04； β=-0.805， P<0.001）. In addition， the rate of CMB increase was also faster in the ASA group than in the CLOP-50 group （β=-0.695， P<0.01）. The ADL scores increased faster in the HC group than in the ASA group （β=0.170， P=0.02）. The AD8 scores decreased faster in the CLOP-75 group than in the HC group （β=-0.128， P=0.04）， but the rate of CMB increase in the CLOP-75 group was also faster than that in the HC group （β=0.604， P=0.04）. ConclusionIn CSVD patients， aspirin 100 mg or clopidogrel 75 mg improves cognitive function but increases the risk of cerebral hemorrhage. Clopidogrel 50 mg shows no short-term clinical benefit or imaging improvement.

Objective To investigate the risk factors of secondary traumatic coagulopathy in patients with traffic trauma.Methods A total of 122 patients with traffic trauma in Department of Emergency Surgery,the First Affiliated Hospital of Anhui Medical University(Dongcheng Hospital)from April 2022 to March 2023 were retrospectively collected.Patients were divided into the occurrence group(n=30)and the non-occurrence group(n=92).Body temperature,acidosis,hematoma enlargement after head CT examination,Glasgow coma score(GCS),trauma severity score(ISS),platelet count(PLT)and hemoglobin(Hb)at admission were collected and compared between the two groups.Multivariate Logistic regression was used to analyze risk factors of secondary traumatic coagulopathy in traffic trauma patients,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of related factors for secondary traumatic coagulopathy.Results The body temperature,GCS,PLT and Hb in the occurrence group were lower than those in the non-occurrence group,while the ISS,incidence of acidosis and the incidence of increased hematoma after CT examination were higher than those in the non-occurrence group(all P<0.05).Multivariate Logistic regression analysis showed that low GCS,low Hb level,high ISS,acidosis and increased hematoma after head CT examination were risk factors at admission(P<0.05).The area under ROC curve(AUC)of the five factors combined for secondary traumatic coagulopathy in traffic trauma patients was 0.963,sensitivity was 83.3%and specificity was 96.7%.Conclusion Decreased GCS and Hb on admission,high ISS,acidosis and increased hematoma during head CT review are risk factors for secondary traumatic cotting disorder in traffic trauma patients,and the combination of these factors has high predictive value.

In order to establish a simple,sensitive and specific diagnostic method for the simultane-ous detection of Mycoplasma hyorhinis(Mhr)and Mycoplasma hyopneumoniae(Mhp)in swine,specific primers and probes were designed using the Mhr p37 and Mhp p36 gene sequences as the target genes,and the dual LFD-RPA rapid test was established by screening the primers and probes,optimizing primer ratios and evaluating its effectiveness through the sensitivity,reproduc-ibility and clinical sample testing.The sensitivity,specificity,reproducibility and clinical samples were evaluated.The results showed that the established dual LFD-RPA assay could complete the amplification in 15 min at 39 ℃,and its optimal primer ratio was 1.6∶0.8,and the lowest detection limits were up to 3.63 and 3.60 copies/μL,respectively;the reproducibility was stable;and there was no cross-reactivity with Pasteurella multocida,Bordetella bronchiseptica,Haemophilus pa-rasuis,Actinobacillus pleuropneumoniae,Escherichia coli.The test successfully established a dual LFD-RPA assay,which can detect Mhr and Mhp simultaneously,and is simple,sensitive and spe-cific without relying on specialized equipment,and is suitable for carrying out on-site rapid diagno-sis of Mhr and Mhp.

Objective It investigates the current status of negative defensive medical behavior tendencies among medical students and explores influencing factors,aiming to provide evidence for improving medical students' propensity for negative defensive medical practices.Methods In February 2023,a cluster sampling approach was employed to recruit 297 medical students from a medical college-affiliated hospital in Province H.Descriptive statistics,chi-square tests,and correlation analyses were conducted to assess negative defensive medical behavior tendencies.Structural equation modeling(SEM)was utilized to explore multidimensional influencing factors.Results 45％of medical students demonstrated high-level negative defensive medical behavior tendencies.Statistically significant differences were observed between genders(x2=5.569,P＜0.05)and only-child/non-only-child groups(x2=6.104,P＜0.05).Positive correlations were identified between negative defensive medical behaviors and role stress(r=0.217,P＜0.01),negative organizational environment evaluation(r=0.395,P＜0.01),and negative social environment evaluation(r=0.405,P＜0.01).Only-child status was confirmed as an influencing factor(β=-0.123,P=0.036).Negative organizational environment evaluation(β=0.504,P＜0.001)and negative social environment evaluation(β=0.193,P=0.039)showed significant positive effects.Conclusion Immediate interventions-including role-specific risk allocation,organizational ecosystem reconstruction,and social environment governance-require urgent implementation to address early-stage behavioral deviance,counteract the solidification of defensive medical thinking patterns,and reduce predispositions toward negative professional behaviors among medical trainees.

Objective To investigate the risk factors of secondary traumatic coagulopathy in patients with traffic trauma.Methods A total of 122 patients with traffic trauma in Department of Emergency Surgery,the First Affiliated Hospital of Anhui Medical University(Dongcheng Hospital)from April 2022 to March 2023 were retrospectively collected.Patients were divided into the occurrence group(n=30)and the non-occurrence group(n=92).Body temperature,acidosis,hematoma enlargement after head CT examination,Glasgow coma score(GCS),trauma severity score(ISS),platelet count(PLT)and hemoglobin(Hb)at admission were collected and compared between the two groups.Multivariate Logistic regression was used to analyze risk factors of secondary traumatic coagulopathy in traffic trauma patients,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of related factors for secondary traumatic coagulopathy.Results The body temperature,GCS,PLT and Hb in the occurrence group were lower than those in the non-occurrence group,while the ISS,incidence of acidosis and the incidence of increased hematoma after CT examination were higher than those in the non-occurrence group(all P<0.05).Multivariate Logistic regression analysis showed that low GCS,low Hb level,high ISS,acidosis and increased hematoma after head CT examination were risk factors at admission(P<0.05).The area under ROC curve(AUC)of the five factors combined for secondary traumatic coagulopathy in traffic trauma patients was 0.963,sensitivity was 83.3%and specificity was 96.7%.Conclusion Decreased GCS and Hb on admission,high ISS,acidosis and increased hematoma during head CT review are risk factors for secondary traumatic cotting disorder in traffic trauma patients,and the combination of these factors has high predictive value.

In order to establish a simple,sensitive and specific diagnostic method for the simultane-ous detection of Mycoplasma hyorhinis(Mhr)and Mycoplasma hyopneumoniae(Mhp)in swine,specific primers and probes were designed using the Mhr p37 and Mhp p36 gene sequences as the target genes,and the dual LFD-RPA rapid test was established by screening the primers and probes,optimizing primer ratios and evaluating its effectiveness through the sensitivity,reproduc-ibility and clinical sample testing.The sensitivity,specificity,reproducibility and clinical samples were evaluated.The results showed that the established dual LFD-RPA assay could complete the amplification in 15 min at 39 ℃,and its optimal primer ratio was 1.6∶0.8,and the lowest detection limits were up to 3.63 and 3.60 copies/μL,respectively;the reproducibility was stable;and there was no cross-reactivity with Pasteurella multocida,Bordetella bronchiseptica,Haemophilus pa-rasuis,Actinobacillus pleuropneumoniae,Escherichia coli.The test successfully established a dual LFD-RPA assay,which can detect Mhr and Mhp simultaneously,and is simple,sensitive and spe-cific without relying on specialized equipment,and is suitable for carrying out on-site rapid diagno-sis of Mhr and Mhp.

Objective It investigates the current status of negative defensive medical behavior tendencies among medical students and explores influencing factors,aiming to provide evidence for improving medical students' propensity for negative defensive medical practices.Methods In February 2023,a cluster sampling approach was employed to recruit 297 medical students from a medical college-affiliated hospital in Province H.Descriptive statistics,chi-square tests,and correlation analyses were conducted to assess negative defensive medical behavior tendencies.Structural equation modeling(SEM)was utilized to explore multidimensional influencing factors.Results 45％of medical students demonstrated high-level negative defensive medical behavior tendencies.Statistically significant differences were observed between genders(x2=5.569,P＜0.05)and only-child/non-only-child groups(x2=6.104,P＜0.05).Positive correlations were identified between negative defensive medical behaviors and role stress(r=0.217,P＜0.01),negative organizational environment evaluation(r=0.395,P＜0.01),and negative social environment evaluation(r=0.405,P＜0.01).Only-child status was confirmed as an influencing factor(β=-0.123,P=0.036).Negative organizational environment evaluation(β=0.504,P＜0.001)and negative social environment evaluation(β=0.193,P=0.039)showed significant positive effects.Conclusion Immediate interventions-including role-specific risk allocation,organizational ecosystem reconstruction,and social environment governance-require urgent implementation to address early-stage behavioral deviance,counteract the solidification of defensive medical thinking patterns,and reduce predispositions toward negative professional behaviors among medical trainees.

Objective:To investigate the clinical value of multiparametric myocardial imaging using a dual-layer detector spectral CT in the non-invasive preoperative assessment of patients with coronary atherosclerotic heart disease (CHD) undergoing percutaneous coronary intervention (PCI).Methods:The clinical and imaging data of 90 patients who underwent coronary CT angiography (CCTA) with dual-layer spectral detector CT and invasive coronary angiography (ICA) within 30 days at the Affiliated Changshu Hospital of Nantong University from January 2021 to October 2022 were retrospectively analyzed. A total of 189 coronary arteries were included in the study cohort. The patients were divided into PCI ( n=44) and non-PCI groups ( n=46) according to whether they received PCI after evaluation with ICA. The diameter stenosis rate of the coronary arteries, myocardial iodine concentration (IC) and effective atomic number (Z eff) values were obtained from CCTA conventional and spectral images. The IC values and Z eff values of the myocardium in the areas with abnormal perfusion were compared with those in the areas with normal perfusion. The diagnostic performance of these parameters, as well as their combined model, was evaluated and compared using receiver operating characteristic (ROC) curve and area under the curve (AUC) in the pre-PCI assessment of patients with CHD. Results:Baseline patient data did not show statistically significant differences between the PCI and non-PCI groups (all P>0.05). There were statistically significant differences in IC values [(0.42±0.28) and (2.26±0.48) mg/ml] and Z eff values (7.39±0.33 and 8.50±0.25) between the myocardium areas with abnormal perfusion and the myocardium areas with normal perfusion in all patients (all P<0.001). The AUC for assessing whether patients with CHD need PCI treatment using myocardial IC and Z eff values were 0.865 and 0.853, respectively, which were significantly higher than assessment based only on lumen diameter stenosis rate (AUC=0.726, P<0.001). Conclusions:The IC and Z eff derived from myocardial spectral images can be used to diagnose myocardial perfusion abnormalities in patients with CHD. The spectral myocardial multi-parameters imaging shows promising potentials in pre-PCI assessment of patients with CHD, which can improve the efficiency of evaluation and may help to avoid unnecessarily invasive procedures.

Objective To establish a mouse model treated with busulfan and to investigate its effects on the metabo-lism of spermatogonial stem cells(SSCs)of mouse testis.Methods C57BL/6J male mice with age of 8 weeks were injected with 10 mg/kg of busulfan intraperitoneally,then Thy1 positive cells were selected by immunomagnetic beads on day 0,day 5 and day 10 and followed by identification for purity and metabolomic analysis.Results The testis weight ratio decreased and the tissue structure of testis was damaged(P＜0.05).Based on the results of principal component analysis(PCA)and partial least squares discriminant analysis(PLS-DA),there were signifi-cant metabolic differences between the sample groups treated for 0 d,5 d and 10 d.A total of 89 differential metabolites were identified including glutathione(GSH),arginine and unsaturatedfatty acids(UFAs),and their important metabolic pathways involved glycerophospholipid metabolism,arginine and proline metabolism.Conclu-sions Affecting the specific metabolic pathway may result in obvious reproductive toxicity and lead to decrease of testicular weight as well as tissue structure damage in mice.Metabolomic analysis showed that the potential repro-ductive toxicity mechanism of SSCs may be related to the metabolic pathways such as lipid metabolism,arginine and proline metabolism.

Abstract: Objective To explore the risk factors for macrolide unresponsive mycoplasma pneumoniae pneumonia (MUMPP) in children and to develop a model for predicting the risk of MUMPP. Methods Children with mycoplasma pneumoniae pneumonia admitted to the Pediatric Department of Leshan People's Hospital who met the inclusion criteria from March 1, 2023, to December 1, 2023, were retrospectively selected and divided into the responsive group and unresponsive group according to their reactions to macrolides. General patient data, laboratory tests, and imaging findings were collected and compared. Logistic regression analysis was used to analyze the risk factors of the Macrolide unresponsive mycoplasma pneumoniae pneumonia, and R language (R4.2.3) to establish the nomogram model. The goodness of fit, discriminative ability, calibration, and clinical utility of the model were assessed using the Hosmer-Lemeshow goodness of fit test, receiver operating characteristic (ROC) curve analysis, calibration curve analysis, and decision curve analysis, respectively. Results A total of 224 patients were included in the analysis of children. Among them, 156 (70%) were randomly selected as the training set, and the remaining 68 cases (30%) were used as the validation set. Logistic regression analysis revealed that pleural effusion (OR=6.986, 95%CI 1.362-35.847), highest temperature before admission (OR=3.095, 95%CI 1.487-6.439), neutrophil count (OR=1.294, 95%CI:1.103-1.519), C-reactive protein (OR=1.030, 95%CI 1.002-1.058), and procalcitonin (OR=2.899, 95%CI:1.353-6.214) were independent risk factors for MUMPP in children (all P<0.05). A nomogram was established using R software. The Hosmer-Lemeshow goodness of fit tests for the training set and the validation set were χ2=4.018 and χ2=4.657 (all P>0.05), indicating a good fit of the model. The AUC values for the training set and validation were 0.825 (95%CI: 0.755-0.894) and 0.828 (95%CI 0.729-0.928), respectively, suggesting good discriminative ability of the model. Calibration curve analysis suggested that the model had good predictive performance, while decision curve analysis indicated a high clinical application value of the predictive model. Conclusions Pleural effusion, highest body temperature before admission, neutrophil count, C-reactive protein, and procalcitonin are independent risk factors for MUMPP in children. The prediction model constructed based on the above variables has high predictive efficacy and clinical application value.