Objective To gain insights into the biological characteristics of different populations of Culex tritaeniorhynchus within and around the Yellow Sea wetland from the perspective of the occurrence of resistance, we investigated the levels of resistance to deltamethrin and kdr gene mutation in the wetland and its peripheral areas. Methods Specimens were collected from Cx. tritaeniorhynchus populations at two monitoring sites in the Rare Bird National Nature Reserve and Tiaozi Ni Wetland Scenic Area, and also from two populations in Yancheng City and the Liuhe District of Nanjing, and the resistance of these mosquitoes to deltamethrin was determined using the CDC biotest bottle method. For each concentration of deltamethrin assessed, a random subset of exposed specimens was selected for amplification of the kdr gene fragment, followed by Sanger sequencing to identify and analyze resistance-associated mutations. Results The LC50 levels of deltamethrin among mosquitoes from the four populations in Luhe, Yancheng, the Rare Bird National Nature Reserve and the Tiaozi Ni Wetland Scenic Area were 2.048 5, 7.798 2, 3.473 3, and 17.695 5 mg/mL, respectively, with corresponding concentrations of deltamethrin ranging from 0.005 to 5.000,0.050 to 50.000,0.050 to 25.000 and 0.050 to 50.000 mg/mL, respectively. Furthermore, the ranges of the KT50 values were 11.76-107.43, 67.05-216.30,29.77-107.43 and 28.40-329.51 min; the 1-h knockdown rates were 34.58%-99.15%, 9.52%-43.80%, 55.09%-73.01%, and 10.09%-68.07%; and the 24-h mortality rates were 12.15%-67.52%,9.52%-79.56%,13.17%-82.21%, and 11.01%-78.99%, respectively. With respect to kdr gene mutation, we assayed a total of 63,70,59, and 57 mosquitoes for the four populations, for which we detected L1014F mutation frequencies of 14.29%, 35.00%, 20.34%, and 31.58%, respectively, with a majority of these mutations being heterozygous for resistance. In addition, five adult mosquitoes were identified has having synonymous mutations at site 1011[i. e. , AAT(asparagine)mutation to AAC(asparagine)]. Conclusions Our findings revealed the clear resistance of Cx. tritaeniorhynchus to deltamethrin in the Yancheng region of the Yellow Sea wetland, and the resistance phenotype and kdr frequency of Cx. tritaeniorhynchus in the wetland environment were comparable to those of Cx. tritaeniorhynchus in the wetland environment, thereby indicating that the resistance of different populations of Cx. tritaeniorhynchus was homogeneous under the pressure of different insecticide selection within and around the wetland. However, the underlying mechanisms need to be further studied.

Objective To evaluate the effect of clinical pharmacists in prescription intervention on rivaroxaban anticoagulation within non-valvular atrial fibrillation(NVAF)patients.Methods We collected 101 NVAF patients from January to June 2022 as the control group,and 125 NVAF patients from January to June 2023 after clinical pharmacists intervention as observation group.We audited the rivaroxaban prescriptions of the two groups of patients according to the evaluation criterion of appropriateness of rivaroxaban prescriptions for NVAF patients in our hospital.The rationality of rivaroxaban prescriptions,rivaroxaban anticoagulation-related thrombotic events,and bleeding events were compared between two groups.Results Clinical pharmacists provided 105 prescription interventions for observation group patients,of which 69(65.7%)were adopted and implemented by doctors.The rational rate of rivaroxaban prescription in the observation group was significantly increased(85.7%vs.16.8%,P<0.05).There were no statistical differences between the observation group and the control group in thrombotic events and major bleeding events during hospitalization(P>0.05),with a significant difference in thrombotic events 6 months after discharged(0.8%vs.7.9%,P<0.05).Conclusion The clinical pharmacist prescription intervention can improve the rational rate of rivaroxaban prescription and reduce the risk of thrombotic and bleeding events,which is an important measure to advance the safety and effectiveness of anticoagulant therapy.

Objective:To explore the diagnostic value of cardiac color Doppler ultrasonography for left ventricular hypertrophy(LVH)complicated left heart failure(LHF).Methods:A total of 117 LVH patients complicated LHF admitted in Ningde City Hospital Affiliated to Ningde Normal College between January 2019 and January 2023(heart failure group)and 100 healthy people(control group)who underwent general physical examination in our hospital simultaneously were selected for the study.Left ventricular ejection fraction(LVEF),left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDd),early diastolic peak flow velocity/late diastolic peak flow velocity(E/A)were measured by cardiac color Doppler ultrasound in two groups.Receiver operating charac-teristic(ROC)curve was used to analyze the diagnostic value of cardiac color Doppler ultrasound indexes for LVH complicated LHF.In addition,the 117 patients with LVH and LHF were divided into mild group(n=54)and moderate to severe group(n=63)according to cardiac function class.Spearman correlation analysis was used to an-alyze the associationof cardiac color ultrasound parameters with cardiac function class.Results:Compared with par-ticipants in control group,those in heart failure group had significant lower LVEF[(47.88±4.75)％ vs.(69.81±5.64)％],and significant higher LAD[(44.03±4.88)mm vs.(27.56±2.76)mm vs.],LVEDd[(55.68±5.04)mm vs.(42.19±1.38)mm],E/A[(13.04±3.58)vs.(6.60±1.67)](P＜0.001 all).ROC analysis indicated that the area under the curve(AUC)of the combination of various parameters of cardiac ultrasound for diagnosing LVH with LHF was significantly higher than those of the single tests(Combined detection:AUC=0.901,95％CI 0.853～0.937 vs LVEF:AUC=0.644,95％CI 0.577～0.708,LAD:AUC=0.703,95％CI 0.637～0.763,LVEDd:AUC=0.633,95％CI 0.565～0.697,E/A:AUC=0.748,95％CI 0.685～0.804,Z=7.062,5.764,7.292,4.864,P＜0.001 all).Compared with patients in mild group,those in moderate to severe group had signifi-cant lower LVEF[(45.67±3.37)％ vs.(50.47±4.86)％],and significant higher LAD[(46.31±4.42)mm vs.(41.36±3.98)mm],LVEDd[(60.09±1.75)mm vs.(50.53±1.41)mm]and E/A[(13.99±2.96)vs.(11.93±3.92)](P＜0.01 all).Spearman correlation analysis indicated that LVEF was negatively correlated with cardiac function class(r=-0.474),while LAD(r=0.511),LVEDd(r=0.863),E/A(r=0.269)were positively corre-lated with cardiac function class(P＜0.01 all).Conclusion:Cardiac color Doppler ultrasound could better diagnose LVH complicated LHF,and also could effectively predict the cardiac function of patients with LVH and LHF.

Objective:To investigate the risk factors and ultrasonographic features of neonatal hepatic subcapsular haematoma (HSH).Methods:A retrospective study was conducted on five neonates diagnosed with HSH at Shaoxing Maternity and Child Health Care Hospital from June 2020 to June 2024. Clinical data, including clinical manifestations, ultrasonographic characteristics, and follow-up outcomes, and the risk factors of HSH were summarized with descriptive statistical analysis.Results:All five cases were very low/extremely low birth weight preterm infants delivered by cesarean section, with a history of birth asphyxia. Case 1 presented with hypovolemic shock postnatally and was incidentally diagnosed with HSH via abdominal ultrasound. Cases 2 and 3 were diagnosed during a routine ultrasound monitoring of the umbilical venous catheter tip position within 3 d after catheterization. Cases 4 and 5 were diagnosed by abdominal ultrasound re-examination following unsuccessful umbilical venous catheterization. Case 1 received no catheterization or external chest compression, while Cases 2, 3, and 5 received external chest compression during resuscitation. Case 2 had a history of difficult cesarean section. Cases 2 to 5 underwent umbilical venous catheterization (failed in Cases 4 and 5). Ultrasonography revealed cystic-dominant echogenicity, presenting as elongated or oval-shaped with well-defined margins, and were accompanied by varying amounts of echogenic bands and dots. Three cases had single lesions and two had multiple lesions. A total of nine hemorrhagic foci were found with four in the right posterior liver lobe, three in the right anterior lobe, and two in the left lobe. No hepatic capsule disruption was observed in any of the five cases. After immobilization, hemostasis, and supportive care, the haematoma in Case 1 completely resolved with calcification at 134 d after birth, while in the remaining four cases, the haematomas resolved completely without calcification between 17 and 62 d after birth.Conclusions:HSH may present without classical symptoms or signs. In neonates with very low/extremely low birth weight presenting hypovolemic shock, HSH should be suspected, particularly in those with perinatal trauma or a history of external chest compression during resuscitation. Abdominal ultrasound is recommended for exclusion if indicated. Ultrasound not only facilitates the diagnosis of HSH, but also enables dynamic monitoring of hematoma progression and resolution.

Objective:To preliminarily establish a sample clot warning model for coagulation screening tests using 5 machine learning methods.Methods:This cross-sectional study collected 7 401 routine screening test samples from Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, from January 1st, 2015, to August 18th, 2024, including 4 786 clotted (positive) and 2 615 qualified (negative) samples for model development. The dataset was divided into Dataset 1 and Dataset 2 based on a reagent change for APTT in December 2018, with separate models developed for each. An additional 2 493 samples (October 31st to November 8th, 2024) were used to evaluate consistency between the model and manual assessment, while 23 200 samples (October 17th to December 31st, 2024) were used for assessing real-world predictive performance. Five machine learning algorithms were employed to develop the clot prediction model: logistic regression (LR), random forest (RF), extreme gradient boosting (XGBoost), naive bayes (NB), and artificial neural network (ANN), with the ANN model constructed using two different hidden layer and neuron parameter settings. Model selection was based on AUC, accuracy, sensitivity, specificity, F1-score, PPV, and NPV, with the optimal model integrated into the LIS for validation.Results:Among the six models using 5 machine learning algorithms, XGBoost demonstrated the highest performance (AUC=0.961, sensitivity=0.945, F1-score=0.934) and robustness to reagent changes ( Z=-1.333, P=0.113). When deployed, the differences between the model's predictions and manual pre-judgment were statistically significant ( Z=-5.289 to 8.933, all P<0.01). The predictive efficacy indices AUC (95% CI), sensitivity, specificity, and accuracy of the XGBoost model deployed in real-world operation of the LIS were 0.939 (0.918—0.960), 0.958, 0.921, and 0.921 respectively. Conclusion:In this study, a clot warning model for coagulation screening samples was established based on the XGBoost algorithm, and its prediction efficacy is good, providing a foundation for intelligent pre-analytical quality control for coagulation screening tests.

Objective To evaluate the effect of clinical pharmacists in prescription intervention on rivaroxaban anticoagulation within non-valvular atrial fibrillation(NVAF)patients.Methods We collected 101 NVAF patients from January to June 2022 as the control group,and 125 NVAF patients from January to June 2023 after clinical pharmacists intervention as observation group.We audited the rivaroxaban prescriptions of the two groups of patients according to the evaluation criterion of appropriateness of rivaroxaban prescriptions for NVAF patients in our hospital.The rationality of rivaroxaban prescriptions,rivaroxaban anticoagulation-related thrombotic events,and bleeding events were compared between two groups.Results Clinical pharmacists provided 105 prescription interventions for observation group patients,of which 69(65.7%)were adopted and implemented by doctors.The rational rate of rivaroxaban prescription in the observation group was significantly increased(85.7%vs.16.8%,P<0.05).There were no statistical differences between the observation group and the control group in thrombotic events and major bleeding events during hospitalization(P>0.05),with a significant difference in thrombotic events 6 months after discharged(0.8%vs.7.9%,P<0.05).Conclusion The clinical pharmacist prescription intervention can improve the rational rate of rivaroxaban prescription and reduce the risk of thrombotic and bleeding events,which is an important measure to advance the safety and effectiveness of anticoagulant therapy.

Obesity is a well-established risk factor for thrombotic events such as venous thromboembolism， and the alterations in pharmacokinetics induced by obesity pose challenges for anticoagulation management. This article systematically reviews the advances of the use of various anticoagulants in obese patients， and finds that the dosage of low-molecular-weight heparin needs to be adjusted according to preventive or therapeutic goals in severely obese patients， the preventive dose may be increased to 40 mg， q12 h or 0.5 mg/（kg·d）， while the therapeutic dose is recommended to be reduced to 0.8 mg/（kg·d）， q12 h. Direct oral anticoagulant drugs are safe and effective for general obese patients； in severely obese patients， standard doses of rivaroxaban or apixaban may be used， warranting cautious application and consideration for therapeutic drug monitoring. In special clinical scenarios such as obesity combined with trauma， pregnancy， advanced age， or bariatric surgery， anticoagulation strategies should be individualized， with close attention to monitoring. Future research should focus on optimizing anticoagulant regimens for special populations and addressing anticoagulation management in obese patients with other embolic diseases.

Objective : To develop and to validate a combined model integrating18F-FDG PET/CT radiomics with clinical features to distinguish between lymphoma and lymphoid inflammatory hyperplasia. Methods : A retrospective study was conducted on a cohort of 232 patients diagnosed with lymphoma or lymphoid inflammatory hyperplasia. Comparative analyses of clinical and traditional imaging indicators were performed to identify inter-group differences. The clinical features were delineated and extracted using medical software including 3D-Slicer and Lifex. Selection of the features was performed to construct a PET/CT-based radiomics Logistic model, with a combined model integrating PET/CT with clinical features then used to evaluate the discriminative efficacy of these models. Results: Analysis of inter-group differences indicated that age, CTmean, and metabolic tumor volume(MTV)were effective for differentiating between lymphoma and lymphoid inflammatory hyperplasia(P<0.05). The PET/CT-based radiomics Logistic model differentiated between lymphoma and lymphoid inflammatory hyperplasia, with an area under curve(AUC) of 0.924(95%CI: 0.884-0.960) and 0.863(95%CI: 0.774-0.939) in the training and testing cohorts, respectively. The integrated Logistic model that combined PET/CT-based radiomics with clinical features to distinguish between lymphoma and lymphoid inflammatory hyperplasia achieved an AUC of 0.933(95%CI: 0.889-0.969) in the training cohort and 0.884(95%CI: 0.792-0.964) in the testing cohort. Decision curve analysis(DCA) demonstrated that the integrated model provided the greatest clinical net benefit. Conclusion The hybrid model integrating18F-FDG PET/CT radiomics with clinical features shows robust diagnostic efficacy to distinguish between lymphoma and lymphoid inflammatory hyperplasia.

Objective:To evaluate the utility of pulse oximetry-derived parameters—specifically, the pulse oximetry plethysmographic waveform area under the curve (POP AUC) and the peripheral perfusion index (PPI)—in assessing disease severity and predicting prognosis in patients with sepsis. Methods:In this prospective descriptive study, 68 patients with sepsis were categorized based on illness severity into septic shock and non-shock groups, and by 28-day outcome into survival and non-survival groups. POP AUC, PPI, and lactate (Lac) levels were recorded at 0, 24, 48, 72, and 96 hours after admission. APACHEⅡ and SOFA scores were calculated within the first 24 hours. The prognostic value of these parameters was evaluated. Results:Significant differences were observed between the septic shock and non-shock groups in POP AUC, PPI, Lac (all P < 0.05 except at 96 h), APACHEⅡ, and SOFA scores (all P < 0.05). These differences were most pronounced at admission: POP AUC0 (2475.1 ± 899.0) vs. (4260.3 ± 1028.5), PPI 0 (0.78 ± 0.74) vs. (3.13 ± 2.18), Lac 0 (4.95 ± 4.32) vs. (2.07 ± 1.55), APACHE Ⅱ (16.78 ± 5.59) vs. 11.82 ± 4.89), and SOFA (8.89 ± 3.25) vs. (5.06 ± 2.60). Optimal prognostic cut-off values were 2741.43 for POP AUC, 0.97 for PPI, 2.05 for Lac, 12.5 for APACHEⅡ, and 5.5 for SOFA. ROC curve analysis showed that at 24 hours, POP AUC and PPI had significantly larger AUC values than Lac ( P < 0.05), while no significant differences were found among other parameters. Significant differences between non-survivors and survivors were also found in POP AUC, PPI (at 0, 24, and 48 h), APACHE II, and SOFA (all P < 0.05). No significant differences were observed in PPI (72 h and 96 h) or Lac between the two outcome groups. Conclusions:POP AUC and PPI, as derived from pulse oximetry, are non-inferior to Lac, SOFA, and APACHEⅡ scores in evaluating disease severity and predicting 28-day mortality in sepsis patients. These parameters show promise as practical and non-invasive tools for clinical assessment in sepsis.

Objective To summarize the pathogen distribution and antibiotic resistance characteristics of 69 cases of necrotizing fasciitis(NF),providing evidence to support early clinical antimicrobial therapy.Methods A retrospective analysis was conducted on microbial culture and antibiotic susceptibility test results from 69 NF cases treated in the Department of Trauma Repair and Burn Plastic Surgery,Liuzhou Workers'Hospital from January 2017 to December 2023.Results A total of 77 bacterial strains were cultured,including 24 Gram-positive bacteria,48 Gram-negative bacteria,and 5 fungi.Monomicrobial infection was predominant,accounting for 66.07％of the cases.Among the Gram-positive bacteria,Staphylococcus aureus was the most common,separated out 10 strains(12.99％),followed by Streptococcus pyogenes in 5 strains(6.49％).Among the Gram-negative bacteria,Klebsiella pneumoniae(13 strains,16.88％)and Escherichia coli(10 strains,12.99％)were most frequently identified.A total of 18 multidrug-resistant strains were found,representing 23.38％of all isolates.Gram-positive bacteria were most sensitive to vancomycin,linezolid,and tigecycline,while Gram-negative bacteria showed the greatest sensitivity to meropenem,cefoperazone,and ertapenem.Conclusion In the study area,Klebsiella pneumoniae is the most common pathogen causing NF.The initial antimicrobial regimen should include vancomycin combined with meropenem,which may significantly enhance the effectiveness of infection control.