Objective: To investigate the serological identification and blood group gene sequencing analysis of two rare cases of K phenotype producing high-frequency antigen antibodies (anti-Ku), and to study the serological interrelationship between K cells and the high-frequency antigen antibody anti-KL. Methods: Serological methods were used to identify the antigen phenotypes of the ABO, Rh, and Kell blood group systems and to screen for and identify unexpected antibodies in the two patients. The characteristics of the unexpected antibodies were verified by the indirect antiglobulin test (IAT) using papain or dithiothreitol (DTT) -treated screening cells. The titer of anti-Ku was determined via the tube method using DTT-treated plasma. The Kell blood group genotype was determined by gene sequencing. The distinctive antigenicity of K cells was validated through their reactivity with anti-KL in IAT, and absorption-elution techniques were employed to corroborate the type of anti-KL. Results: Serological findings: Case 1 was blood group O, CCDee; Case 2 was blood group A, CCDee. Both cases exhibited the Kell phenotype: K-k-, Kp (a-b-). High-frequency antigen antibodies were detected in the plasma of both patients. The reactivity of these antibodies was slightly enhanced with papain-treated screening cells but became negative with DTT-treated cells. The anti-Ku (IgG) titer for Case 1 was 64. For Case 2, the anti-Ku (IgM) titer was<1, and the anti-Ku (IgG) titer was 32. Gene sequencing revealed that both cases harbored a homozygous c.715G>T mutation in the KEL gene, corresponding to the genotype KEL02N.24, consistent with the rare K phenotype. The unique high expression of the Kx antigen on K cells was confirmed through the antibody characteristics of anti-KL. Absorption-elution techniques demonstrated that K cells could separate anti-Km and anti-Kx, thereby supporting the classification of anti-KL. Conclusion: Serological and molecular biological assays identified both patients as having the rare Kell-null (K ) phenotype. If such rare blood types go undetected in transfusion medicine, the administration of standard blood products can readily induce the production of high-frequency antigen antibodies such as anti-Ku, potentially leading to a transfusion crisis due to the subsequent difficulty in finding compatible blood. The serological relationship between K cells and anti-KL clarified the characteristic high expression of the Kx antigen on K phenotype erythrocytes and concurrently supported the typological features of the rare high-frequency antibody anti-KL. This represents the first such verified report in China.

Neurocritical care involves complex pathophysiological mechanisms, and its incidence is higher, injuries are more severe, and treatment is more challenging in high-altitude environments. This consensus, based on the latest domestic and international evidence-based medical data, establishes a standardized, goal-oriented framework for neurocritical care management applicable in high-altitude regions and nationwide. The consensus was developed following international standards for evidence quality assessment and underwent two rounds of Delphi expert consultation, resulting in 32 recommendation statements covering three parts: management systems, monitoring and assessment, and core strategies. Key updates include: advocating for the establishment of independent neurocritical care units and implementing precise tiered diagnosis and treatment based on the "Five Differences in Critical Care" concept; constructing a "trinity" multimodal brain monitoring system centered on cerebral blood flow, cerebral oxygenation, and brain function, emphasizing routine bedside transcranial Doppler ultrasound, cerebral oximetry, and continuous electroencephalography monitoring; shifting management strategies from mild hypothermia therapy to targeted temperature management, and defining the "446" target management pathway for the supercritical stage; emphasizing the assessment of static and dynamic cerebrovascular autoregulation functions through multimodal methods to achieve individualized optimal mean arterial pressure management; elevating cerebrospinal fluid management goals to the level of "glymphatic system" function maintenance; implementing a multidisciplinary collaborative, whole-process management model focusing on patients' long-term neurological functional outcomes; de-escalation criteria include multidimensional indicators such as recovery of brain structure, restoration of cerebrovascular autoregulation, improvement in cerebrospinal fluid dynamics, and reduction in biomarker levels; and integrating cutting-edge technologies like artificial intelligence into post-critical care management and rehabilitation planning. This consensus systematically integrates the entire process of neurocritical care management, reflecting the modern connotation of goal-oriented, dynamic, and multimodal integration in neurocritical care medicine. It aims to adapt to new trends such as deepening understanding of pathophysiological mechanisms, the integration of medicine and engineering, and the empowerment of artificial intelligence, thereby further advancing the discipline of critical care medicine.

Objective: To analyze the demographic evolution of China over the forthcoming decade (2026-2035) and to systematically evaluate its potential implications for voluntary blood donation practices and the equilibrium of clinical blood supply and demand. Methods: Leveraging comprehensive blood collection and utilization data from 2021 to 2025 at the national, provincial (Shandong), and municipal (Zibo) levels, we identified and examined critical determinants influencing blood management systems. The DeepSeek-V3.2 large language model was deployed to project future population age structures, and to generate quantitative estimates for hospitalization volumes, clinical blood requirements, available blood supply, and donation frequencies for the target years 2030 and 2035, thereby furnishing an evidence base for strategic planning and priority-setting. Results: DeepSeek-derived projections indicate that the proportion of China's population aged 60 years and above will surpass 27% (370 million/1 380 million) by 2030 and exceed 30% (400 million/1 350 million) by 2035, signaling a marked acceleration in population aging. This demographic shift is projected to reduce the proportion of the national population eligible to donate blood from 59.2% (835 million out of 1.41 billion) to 52% (710 million out of 1.36 billion), while the demand for blood is expected to increase by 87.8% relative to 2024, rising from 26.927 million units to 50.56 million units. Sustaining blood supply-demand balance will necessitate progressive annual increases in donation rates. Under prevailing policy frameworks, the required blood donation rate among the eligible population in Shandong Province would need to rise by 122.57% by 2035 [from 20.07‰ (1.1641 million person-times/58 million people) to 44.67‰ (2.189 million person-times/49 million people)] to potentially satisfy projected clinical requirements. Conclusion: By integrating DeepSeek-V3.2, AI predictive models, and blood donation incentive measures, it is possible to monitor population demographics, forecast clinical blood demand, manage blood supplies, and ensure the long-term sustainability of clinical blood availability. It must be acknowledged, however, that the present analysis is constrained by a limited data foundation (comprising only five annual observation points); accordingly, the projections should be interpreted as directional trend indicators or methodological illustrations rather than definitive quantitative forecasts.

Patients with lung cancer experience a heavy symptom burden during the perioperative period, which seriously affects their recovery and quality of life. Traditional symptom management models rely mainly on scheduled ward rounds during hospitalization and outpatient follow-up after discharge. However, they have limitations such as delayed symptom recognition, lack of post-discharge monitoring, and non-quantitative symptom assessment, which often lead to delayed interventions and low patient satisfaction. In recent years, the symptom management model based on electronic patient-reported outcomes (ePRO) has been increasingly valued in clinical practice. Existing high-level evidence from both domestic and international studies indicates that, through proactive monitoring, real-time alerts, and remote interventions, this model enables dynamic and continuous symptom management and helps improve patient recovery and healthcare experience. As a supplement to routine medical care, the ePRO-based symptom management model aims to enhance the quality of care rather than replace existing medical processes. To promote the standardized application of this model in perioperative lung cancer care, this consensus integrates domestic and international evidence. After multiple rounds of voting by more than 50 experts, it formulates 12 consensus statements covering the three core components, symptom monitoring, alerting, and intervention, to provide scientific and practical recommendations for clinical practice.

Objective To explore the safety and efficacy of thoracoscopy-guided thoracic paravertebral block (TPVB) in thoracoscopic pulmonary resection, and to provide strategies for enhanced recovery after surgery (ERAS) in thoracoscopic lung resection. Methods Patients who underwent thoracoscopic pulmonary resection (including sublobar resection and lobectomy) in the 987th Hospital of Joint Logistics Support Force of People's Liberation Army, General Hospital of Central Theater Command of the People’s Liberation Army, and the First Affiliated Hospital with Nanjing Medical University between May 2021 and June 2023 were prospectively enrolled. The patients were randomly allocated into three groups in a single-blind manner using a random number table. Group A (incisional nerve block group) received a subcutaneous injection of ropivacaine (0.375%, 2 mg/kg) around the incision during chest closure. Group B (ultrasound-guided TPVB group) received an ultrasound-guided injection of ropivacaine (0.375%, 2 mg/kg) at the paravertebral space after chest closure. Group C (thoracoscopy-guided TPVB group) received a thoracoscopy-guided intrathoracic injection of ropivacaine (0.375%, 2 mg/kg) at the paravertebral space during chest closure. Perioperative adverse drug reactions, pain scores, postoperative analgesic consumption, and postoperative length of hospital stay were compared among the three groups. Results A total of 180 patients were included, comprising 108 females and 72 males, with a mean age of (62.15±7.36) years. There were no statistical differences among the three groups in baseline characteristics, including age, weight, gender, prevalence of comorbidities, operative time, number of surgical incisions, number of chest tubes, or intraoperative dosages of sufentanil and propofol (P>0.05). No adverse anesthesia events occurred during surgery in any of the groups. The pressing frequency of the patient-controlled intravenous analgesia (PCIA) pump, Visual Analogue Scale (VAS) pain scores, the rate of postoperative rescue analgesic use, and the incidences of postoperative cough and dizziness in the group C were significantly lower than those in the other two groups (P<0.05). The postoperative length of hospital stay in the group B and group C was significantly shorter than that in the group A (P<0.05). Conclusion Thoracoscopy-guided TPVB during chest closure can effectively alleviate postoperative pain without increasing postoperative side effects, which facilitates the enhanced recovery after thoracoscopic lung surgery.

Objective By combining biological detection and imaging evaluation, a clinical prediction model is constructed based on a large cohort to improve the accuracy of distinguishing between benign and malignant pulmonary nodules. Methods A retrospective analysis was conducted on the clinical data of the 32 627 patients with pulmonary nodules who underwent chest CT and testing for 7 types of lung cancer-related serum autoantibodies (7-AABs) at our hospital from January 2020 to April 2024. The univariate and multivariate logistic regression models were performed to screen independent risk factors for benign and malignant pulmonary nodules, based on which a nomogram model was established. The performance of the model was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Results A total of 1 017 patients with pulmonary nodules were included in the study. The training set consisted of 712 patients, including 291 males and 421 females, with a mean age of (58±12) years. The validation set included 305 patients, comprising 129 males and 176 females, with a mean age of (58±13) years. Univariate ROC curve analysis indicated that the combination of CT and 7-AABs testing achieved the highest area under the curve (AUC) value (0.794), surpassing the diagnostic efficacy of CT alone (AUC=0.667) or 7-AABs alone (AUC=0.514). Multivariate logistic regression analysis showed that radiological nodule diameter, nodule nature, and CT combined with 7-AABs detection were independent predictors, which were used to construct a nomogram prediction model. The AUC values for this model were 0.826 and 0.862 in the training and validation sets, respectively, demonstrating excellent performance in DCA. Conclusion The combination of 7-AABs with CT significantly enhances the accuracy of distinguishing between benign and malignant pulmonary nodules. The developed predictive model provides strong support for clinical decision-making and contributes to achieving precise diagnosis and treatment of pulmonary nodules.

AIM To study the chemical constituents of Anaphalis margaritacea(L.)Benth.& Hook.f.and their antioxidant activities.METHODS Separation and purification were performed using silica gel,Sephadex LH-20 and semi-preparative HPLC,then the structures of obtained compounds were identified by physicochemical properties and spectral data.The antioxidant activity was determined by DPPH method and ABTS method.RESULTS Twenty-three compounds were isolated and identified as trans-tilidroside(1),4'-hydroxydehydrokawain(2),apigenin(3),3-O-kaempferol-3-O-acetyl-6-O-(p-coumamoyl)-α-D-glucopyranoside(4),kaempferol(5),quercetin-3-O-β-D-(6-O-Z-p-coumamoyl)-glucopyranoside(6),tiliroside(7),kaempferol-3-O-β-D-glucoside(8),3,5-dihydroxy-7,8-dimethoxyflavone(9),bis(2-ethylhexyl)adipate(10),3,5-dihydroxy-6,7,8-trimethoxyflavone(11),stigmasterol(12),myriophylloside B(13),1-hexadecanol(14),chlorogenic acid(15),4-hydroxy-N-{ 4-[3-(4-hydroxyphenyl)-E-acryloylamino]-butyl}-benzamide(16),3,6-dimethylpiperazine-2,5-dione(17),β-adenosine(18),5,6-dehydrokawain(19),kaempferol-3-O-(2",6"-di-O-E-p-coumaroyl)-β-D-glucopyranoside(20),kaempferol-3-O-(3"-O-E-p-coumaroyl)-(6"-O-E-feruloyl)-β-D-glucopyranoside(21),4,5-di-caffeoylquinic acid butyl ester(22),3,4-di-caffeoylquinic acid butyl ester(23).The IC50 values of compounds 1,7,22-23 against DPPH free radicals were(24.67±1.63)-(53.41±1.61)μmol/L,and the IC50 values of compounds 8,21-23 against ABTS+free radicals were(15.22±0.89)-(41.66±6.29)μmol/L.CONCLUSION Compounds 9,19-23 are isolated from genus Anaphalis for the first time,and 2,10,13,14,16,17,19-23 are first isolated from this plant.Compounds 1,7-8,21-23 have strong antioxidant activity.

Aim To investigate the effect of high-fat diet on the tight junction function injury of Sertoli cells through the NF-κB/NLRP3 signaling pathway in mice and to explore the underlying mechanism.Methods Male C57BL/6J mice were fed with high-fat or normal diet for five months.The body and gonadal organ weight of mice were measured,and their indices were calculated.The sperm concentration,the sperm viabili-ty,the testicular histomorphology and the expression levels of tight junction proteins ZO-1,Occludin and Claudin-11 were measured.TM4 cells were treated with palmitic acid(PA)for 24 h.Cell viability was detected by CCK-8 method.Then,TM4 cells were di-vided into different groups treated with PA(0,50,100,200 and 300 μmnol·L-1),and the expression lev-els of tight junction proteins ZO-1,Occludin and Clau-din-11 were detected by Western blot.The tight junc-tion permeability of TM4 cells were detected by transepithelial electrical resistance(TEER)and FITC-dextran.The expression levels of mRNA and proteins for the NF-κB/NLRP3 pathway-related factors were de-tected by RT-qPCR and Western blot.Results The results from animal experiments showed that high-fat diet increased body weight and seminal vesicle weight of mice,and decreased testicular index,epididymal in-dex,sperm concentration and sperm motility of mice.High-fat diet also caused testicular tissue structure damage and down-regulated the expression levels of tight junction proteins ZO-1 and Occludin,without af-fecting the expression of Claudin-11.In vitro,PA sig-nificantly down-regulated the expression levels of ZO-1,Occludin and Claudin-11 in TM4 cells,increased the cell permeability,as well as up-regulated the mRNA and protein expression levels of NLRP3/NF-κB signa-ling pathway-related factors in TM4 cells.Conclusions High-fat diet can impair the function of tight junction of testicualr Sertoli cells,and the machanism may be related to the activation of the NF-κB/NLRP3 signaling pathway,resulting in Sertoli cell inflammation in mice.

Objective: To investigate the current status of knowledge, attitudes and practices regarding drinking water among primary school students in rural areas of China, so as to provide scientific basis for implementing health interventions related to drinking water. Methods: From November to December 2023, a stratified cluster random sampling method was employed to select 6 354 fourth to sixth grade primary school students in Shanxi, Zhejiang, Jiangxi, Guangxi and Gansu for a questionnaire survey. A uniformly designed questionnaire (including basic information, drinking water-related knowledge, attitudes and practices indicators) was distributed and completed by the students themselves. The χ 2 test was used to analyze the differences in drinking water-related indicators among students of different gender and boarder, and Logistic regression was used to analyze the influencing factors of drinking water practices among students. Results: Among the indicators of drinking water knowledge, the awareness rate of appropriate daily water intake for respective student age groups was the lowest (27.90%). The awareness rate among nonresident students was significantly higher than that among boarding students (31.29%, 15.49%, χ 2=132.75, P <0.01). Regarding attitudes toward drinking water, 13.33% of the students believed that well water or tap water could be drunk directly, and 9.58% believed that going to the toilet at school was troublesome. Regarding practices, the self-reported water intake among students was 1 000 (600, 1 200) mL. The results of multifactorial Logistic regression showed that higher grades ( OR=1.60, 95%CI =1.34-1.92), nonresident students ( OR=1.32, 95%CI = 1.15 -1.52), northern region ( OR=1.43, 95%CI =1.27-1.61), knowledge of appropriate daily water intake ( OR=1.41, 95%CI =1.24-1.60), drinking temperature ( OR=1.43, 95%CI =1.28-1.60), scientific hydration methods ( OR=1.25, 95%CI =1.08- 1.44 ), and adopting scientific hydration methods regularly ( OR=1.75, 95%CI =1.50-2.04) were the independent influences on daily water intake attainment ( P <0.05). Conclusions Rural primary school students lack knowledge about healthy drinking water, have cognitive biases about safe drinking water and exhibit unhealthy drinking behavior. It is suggested that health education be carried out in combination with the characteristics of students to enhance their drinking water literacy.

Objective To evaluate the efficacy and safety of enteric-coated metformin hydrochloride capsules(Junlida?)in patients with T2DM and poor glycemic control under lifestyle interventions.Methods In this study,419 patients with T2DM were recruited from 15 research centers from July 2020 to March 2022,and randomly divided into observation(Obs)group(n=209)and control group(Con,n=210)using a multicenter,randomized,double-blind,non-inferiority trial design.Patients in the Obs group were treated with enteric-coated Metformin hydrochloride capsules(Junlida?),and patients in the Con group were treated with Metformin hydrochloride tablets(Glucophage?).The optimal effective dose of 2 g/d was achieved within 4 weeks,and the reasonable dose was maintained until the end of treatment.The treatment period was 24 weeks.HbA1c and its compliance rate,FPG,and body weight were compared between the two groups in full analysis set(FAS)and protocol set(PPS).Safety and adverse events(AE)were evaluated in safety set(SS).Results A total of 414 participants were randomized(207 cases in Obs group and 207 cases in Con group).414 cases in FAS population(207 cases in Obs group and 207 cases in Con group),and 328 cases in PPS population(164 cases in Obs group and 164 cases in Con group),and 414 cases in SS population(207 cases in Obs group and 207 cases in Con group).After treatment,HbA1c,FPG and body weight were lower in both groups(P<0.05)in FAS and PPS.HbA1c compliance rate was not significantly different between the two groups in FAS and PPS(P>0.05).The results of non-inferiority test showed that the lower limit was>-0.4%in both FAS(-0.154,95%CI-0.384～0.069)and PPS(-0.139,95%CI-0.390～0.112),and the Obs group reached non-inferiority end point.The achievement rate,compliance rate,safety index and incidence of AE were not significantly different between the two groups(P>0.05).Conclusions Junlida? demonstrated non-inferiority to Glucophage? in glycemic control and can be safely and effectively used in patients with diabetes.