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.

The Expert Consensus on Clinical Application of Qinbaohong Zhike Oral Liquid in Treatment of Acute Bronchitis and Acute Attack of Chronic Bronchitis （GS/CACM 337-2023） was released by the China Association of Chinese Medicine on December 13^th， 2023. This expert consensus was developed by experts in methodology， pharmacy， and Chinese medicine in strict accordance with the development requirements of the China Association of Chinese Medicine （CACM） and based on the latest medical evidence and the clinical medication experience of well-known experts in the fields of respiratory medicine （pulmonary diseases） and pediatrics. This expert consensus defines the application of Qinbaohong Zhike oral liquid in the treatment of cough and excessive sputum caused by phlegm-heat obstructing lung， acute bronchitis， and acute attack of chronic bronchitis from the aspects of applicable populations， efficacy evaluation， usage， dosage， drug combination， and safety. It is expected to guide the rational drug use in medical and health institutions， give full play to the unique value of Qinbaohong Zhike oral liquid， and vigorously promote the inheritance and innovation of Chinese patent medicines.

Background and purpose:With the increasing use of medical imaging examinations,Computed tomography(CT)scans have become one of the primary sources of effective dose.This study analyzed the correlation between radiation dose,image quality and body composition in thyroid CT to provide a data foundation for better control of radiation dose and image quality in the future.Methods:A retrospective analysis was conducted on patients who underwent thyroid CT scans at Fudan University Shanghai Cancer Center from January 2015 to December 2019.CT values and standard deviations(SD)of the homogeneous parenchyma of the thyroid were collected,and CT values and SD values of adjacent subcutaneous fat tissue were measured with the same region of interest(ROI)size.All data were measured three times to obtain the average value,and the volume CT dose index(CTDIvol)and dose-length product(DLP)were recorded.Effective dose values and signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)for various parts were calculated.All patients underwent bone density examinations,and patient height,weight,body mass index(BMI),body surface area(BSA),and the percentage of muscle and fat in the spine and thighs were recorded.Results:A total of 104 patients were enrolled in this study.The SNR of thyroid CT images and the percentage of spinal muscle(r=0.284,P=0.004),CNR of thyroid CT images and the percentage of spinal fat(r=0.197,P=0.045),and the effective dose of thyroid CT images and age,weight,BMI,thigh fat percentage,and body surface area(r=0.221,0.247,0.260,0.262,and 0.222;P=0.024,0.011,0.008,0.007 and 0.024)were positively correlated.While,SNR and age,weight,BMI,and the percentage of spinal fat(r=-0.292,-0.198,-0.207,and-0.284;P=0.003,0.044,0.035,0.004),CNR and the percentage of spinal muscle(r=-0.197,P=0.045),and the effective dose and the percentage of thigh muscle(r=-0.262,P=0.007)were negatively correlated.Conclusion:The radiation dose in thyroid CT is correlated with female body composition.The image quality is related to female body composition,providing a data foundation for better control of radiation dose and image quality in the future.

Background and purpose:With the increasing use of medical imaging examinations,Computed tomography(CT)scans have become one of the primary sources of effective dose.This study analyzed the correlation between radiation dose,image quality and body composition in thyroid CT to provide a data foundation for better control of radiation dose and image quality in the future.Methods:A retrospective analysis was conducted on patients who underwent thyroid CT scans at Fudan University Shanghai Cancer Center from January 2015 to December 2019.CT values and standard deviations(SD)of the homogeneous parenchyma of the thyroid were collected,and CT values and SD values of adjacent subcutaneous fat tissue were measured with the same region of interest(ROI)size.All data were measured three times to obtain the average value,and the volume CT dose index(CTDIvol)and dose-length product(DLP)were recorded.Effective dose values and signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)for various parts were calculated.All patients underwent bone density examinations,and patient height,weight,body mass index(BMI),body surface area(BSA),and the percentage of muscle and fat in the spine and thighs were recorded.Results:A total of 104 patients were enrolled in this study.The SNR of thyroid CT images and the percentage of spinal muscle(r=0.284,P=0.004),CNR of thyroid CT images and the percentage of spinal fat(r=0.197,P=0.045),and the effective dose of thyroid CT images and age,weight,BMI,thigh fat percentage,and body surface area(r=0.221,0.247,0.260,0.262,and 0.222;P=0.024,0.011,0.008,0.007 and 0.024)were positively correlated.While,SNR and age,weight,BMI,and the percentage of spinal fat(r=-0.292,-0.198,-0.207,and-0.284;P=0.003,0.044,0.035,0.004),CNR and the percentage of spinal muscle(r=-0.197,P=0.045),and the effective dose and the percentage of thigh muscle(r=-0.262,P=0.007)were negatively correlated.Conclusion:The radiation dose in thyroid CT is correlated with female body composition.The image quality is related to female body composition,providing a data foundation for better control of radiation dose and image quality in the future.

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 observe the effect of intrathecal injection of TRESK overexpression adenoviruson phosphorylation of JNK and apoptosis of neurons in neuropathic pain rats.Methods Seventy-two male SD rats were randomly divided into six groups:groups C,S,NP,T,V,and NS,12 for each group.SNI was administrated to rats in groups NP,T,V and NS.TRESK adenovirus and negative virus were intrathecally injected after use of SNI in groups T and V,while equal volume of NS was injected to rats in group NS.MWT and TWL were measured at 1 day before operation(baseline,BL)and at 1,3,7 and 14 days after operation (days 1,3,7,and 14).Six rats in each group were sacrificed at D7 to determinate the expression of TRESK protein of DRG.The other rats were sacrificed at D14 to determinate neural apoptosis and the expressions of caspase3 and p-JNK of DRG.Results As compared with groups C,S and T,the expression of TRESK protein was significantly decreased at D7 in groups NP,NS and V (P＜0.05).Compared with groups C and S,MWT was significantly decreased at days 1,3,7 and 14 (P＜0.05),phosphorylation of JNK in DRG was significantly increased at D14 (P＜0.05),neuronal apoptosis rate and expressions of Caspase3 of DRG were significantly increased at D14 (P＜0.05) in groups NP,T,NS and V.Compared with groups NP,V and NS,MWT was significantly increased at time points of days 1,3,7 and 14 in group T (P＜0.05),phosphorylation of JNK of in DRG was significantly decreased at D14 in group T (P＜0.05),neuronal apoptosis rate and expression of Caspase3 of DRG were significantly decreased at D14 in group T (P＜0.05).Intrathecal injection ofpAd/CMV/VS-DEST-TRESK obviously reduced mechanical hyperalgesia,upregulated TRESK expression,and lowered JNK phosphorylation and NP in SNI rat.Conclusions Intrathecal injection of TRESK over expression adenovirus relieves NP via inhibiting JNK activation and neuronal apoptosis.

Objective To improve the nurses' compliance of elevating the head-of-bed of patients with endotracheal intubation or tracheostomy tube using mechanical ventilation, who had no contraindications of head-of-bed elevation by the installation of angle measuring device and reminding device for head-of-bed elevation, so as to reduce the incidence of ventilator-associated pneumonia (VAP). Methods A total of 575 and 473 cases of patients with endotracheal intubation or tracheostomy tube using mechanical ventilation were selected respectively rom the patients who were hospitalized in Tengzhou Central People's Hospital in Shandong Province in the year of 2014 and 2016. In 2014, before intervention, the implementation of cluster nursing and the general monitoring data of VAP were comprehensively grasped. In 2015, a total of 26 beds in ICU were installed with angle measuring device and reminding device for head-of-bed elevation. In 2016, after intervention, the implementation of cluster nursing and the general information level of the monitoring data of VAP were collected. SPSS 17.0 software was applied for data statistical analysis before and after intervention. Results The nurse compliance of head-of-bed elevation for mechanical ventilation patients was improved after intervention (χ2=1 691.675, P<0.001), as well as the incidence of VAP significantly decreased (χ2=9.248, P=0.002). The incidence of VAP millennium catheterization decreased, but the difference was not statistically significant (χ2=2.694, P=0.058). Conclusions The installation of bed angle measuring device and reminding device can effectively improve nurse compliance of head-of-bed elevation in patients with mechanical ventilation and reduce the incidence of VAP.

Objective To observe the effect of adenosine monophosphate activated protein kinase (AMPK) on attenuating inflammation in fibrosis induced hy acute ischemia reperfusion injury (IRI) in mice.Methods Forty eight male C57BL/6 mice were randomly divided into four groups:sham operation group (sham group),IRI group,AMPK inhibitor+IRI group (AMPK/IRI group) and normal saline+IRI group (NS/IRI group),12 mice each group.The mice with renal IRI were occluded for 30 min through clipping bilateral renal pedicle,then released renal perfusion.Mice in sham group were performed the separation of renal pedicle without clipping.Mice in AMPK/IRI group and NS/IRI group were respectively intraperitoneal injected AMPK inhibitor and normal saline before IRI.At the 2 d after operation,6 randomly-selected mice from each group were blooded by extraction eyeball to detect BUN and Scr.The renal histopathological changes were observed through HE staining.The mRNA expression of IL-1β,IL-6 and TNF-α was detected by real time PCR,and the level of AMPK phosphorylation was detected by Western blotting.At the 14 d after operation,Collagen 1 (COL1),α-SMA and fibronectin (FN) were detected by immunofluorescence and Western blotting in 6 remained mice from each group.The degree of kidney fibrosis was observed through sirus red staining.Results Compared with those in sham group,tubular interstitial damage was aggravated (P ＜ 0.05),BUN and Scr were increased (P ＜ 0.05),the mRNA expression of IL-1β,IL-6 and TNF-α was increased at the 2 d after operation (all P ＜ 0.05),and the level of AMPK phosphorylation was activated in IRI group and NS/IRI group (all P ＜ 0.05);the degree of kidney fibrosis and the expression of COL1,α-SMA and FN were increased obviously at the 14 d (all P ＜ 0.05).Compared with those in IRI group,in AMPK/IRI group tubular interstitial damage was aggravated (P ＜ 0.05),BUN and Scr were increased (all P ＜ 0.05),the mRNA expression of IL-1β,IL-6 and TNF-α was increased at the 2 d (all P ＜ 0.05),and the level of AMPK phosphorylation was decreased (P ＜ 0.05).Moreover,the degree of kidney fibrosis and the expression of COLI,α-SMA and FN were increased obviously at the 14 d in AMPK/IRI group (all P ＜0.05).Conclusions AMPK can ameliorate the acute renal ischemia reperfusion injury induce fibrosis in mice,and the mechanism may be related to the decrease of inflammatory reaction.

Objective To evaluate the effects of intrathecal TRESK gene recombinant adenovirus on inflammatory responses mediated by chemokine in the spinal cord of rats with neuropathic pain ( NP ) . Methods Thirty?six male Sprague?Dawley rats, weighing 200-250 g, were randomly divided into 6 groups (n=6 each) using a random number table: control group (group C); sham operation group (group S);NP group; TRESK?overexpressed adenovirus group ( group TRESK ); negative adenovirus group ( group Virus); normal saline group ( group NS) . Spinal nerve injury was produced by exposing the sciatic nerve and its branches and ligation and transection of tibial nerve and common fibular nerve in anesthetized rats. In TRESK, Virus and NS groups, pAd∕CMV∕V5?DEST?TRESK 25 μl (109IU∕ml), negative adenovirus 25 μl and normal saline 25 μl were intrathecally injected, respectively. At 1 day before operation ( base?line, T0 ) and 1, 3, 7 and 14 days after operation ( T1-4 ) , the mechanical paw withdrawal threshold ( MWT) and thermal paw withdrawal latency were measured. Six rats in each group were sacrificed after measurement of pain threshold at T3 . The L4,5 segments of the spinal cords were removed for determination of monocyte chemotactic protein?1 ( MCP?1) , MIP?2, tumor necrosis factor?alpha ( TNF?α) , interleukin?1 beta ( IL?1β) and IL?6 mRNA expression by real?time PCR. Results There was no significant difference in thermal paw withdrawal latency at each time point between groups. Compared with C and S groups, MWT at T1-4 in NP and TRESK groups and at T1-3 in Virus and NS groups were significantly decreased, and the expression of MCP?1, MIP?2, TNF?α, IL?1βand IL?6 mRNA was up?regulated in NP, TRESK, Virus and NS groups. Compared with group NP, MWT was significantly increased at T1-4, and the expres?sion of MCP?1, MIP?2, TNF?α, IL?1β and IL?6 mRNA was down?regulated in group TRESK. Conclusion The mechanism by which intrathecal TRESK gene recombinant adenovirus reduces NP is re?lated to inhibition of inflammatory responses mediated by chemokine in the spinal cord of rats.

Objective To determine the optimum dose of dexmedetomidine (DEX) for endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients when combined with propofol.Methods Ninetytwo ASA physical status Ⅰ or Ⅱ] elderly patients,aged 65-80 yr,with body mass index 18-25 kg/m2,scheduled for elective ERCP,were randomly assigned into 4 groups (n =23 each) using a random number table:fentanyl group (F group),low-dose DEX group (D1 group),medium-dose DEX group (D2 group) and high-dose DEX group (D3 group).Fentanyl 1.0 μg/kg and DEX 0.4,0.7 and 1.0 μg/kg (in normal saline 20 ml) were infused over 10 min via a pump in F,D1,D2 and D3 groups,respectively.At the end of infusion,propofol targetcontrolled infusion was started with the target plasma concentration set at 4 μg/ml,and after the mirror passed through the throat,the target plasma concentration of propofol was adjusted to 2.5 μg/ml.At 10 min after admission to the operating room,immediately after completion of fentanyl or DEX infusion,immediately after the effect-site concentration of propofol reached 4 μg/ml,immediately after the mirror passed through the throat,while pulling the stone,at end of surgery and when the patients were awake,the depth of sedation (NT value) was reccorded and the development of hypoxemia was also recorded.Arterial blood samples were collected at 10 min after admission to the operating room and at the end of operation to record PaCO2.The consumption of propofol,duration of ERCP,and emergence time were recorded.The body movement and requirement for vasoactive drugs were also recorded.Results Compared with F group, NT value and the incidence of hypoxemia were significantly decreased in D1-3 groups,PaCO2,the incidence of body movement and amount of propofol consumed were decreased in D2 and D3 groups,and the emergence time was prolonged and the requirement for atropine was increased in D3 group (P ＜0.05).Compared with D1 group,the PaCO2,NT value,incidence of body movement and amount of propofol consumed were decreased in D2 and D3 groups,the emergence time was prolonged and the requirement for atropine was increased in D3 group (P ＜ 0.05).Compared with D2 group,the consumption of propofol was decreased,the emergence time was prolonged,aud the requirement for atropine was increased in D3 group (P ＜ 0.05).Conclusion The optimum dose of dexmedetomidine is 0.7 μg/kg for ERCP in elderly patients when combined with propofol.