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.

ObjectiveTo compare the clinical efficacy of traditional Chinese medicine （TCM） manipulative reduction combined with small splint fixation versus surgical treatment for type A distal radius fracture （DRF） and to explore the factors influencing the choice of treatment. MethodsA multi-center retrospective study was conducted， collecting data from 1237 type A DRF patients treated in 11 hospitals in Jiangsu province from September， 2023 to April， 2025. Among them， 851 patients in the TCM group received manipulative reduction combined with small splint fixation， and 386 patients in the surgical group underwent open reduction and internal fixation. Visual analog scale （VAS） scores for pain and radiographic indicators including palmar tilt， ulnar deviation， and radial height were compared before treatment， 5-7 days after treatment， and 4-6 weeks after treatment. The wrist joint function scores including Dienst and Gartland-Werley scores at 12 weeks after treatment were recorded. Subgroup analysis was conducted for the excellent rate of Dienst and Gartland-Werley scores， stratified by age （＜50， 50-59， 60-69， ≥70 years old） and AO subtypes （A1， A2， A3）. A multivariate logistic regression model was used to identify independent factors influencing treatment choice. ResultsOn 5-7 days after treatment， the surgical group had lower VAS scores than the TCM group， while 4-6 weeks after treatment， the TCM group showed lower VAS scores than the surgical group （P＜0.01）. In terms of radiographic indicators， except for the palmar tilt before treatment being higher in the surgical group than in the TCM group （P＜0.01）， there were no significant differences in palmar tilt， ulnar deviation， and radial height at other timepoints （P＞0.05）. Twelve weeks after treatment， the surgical group had a higher average Gartland-Werley score and the excellent rate than the TCM group （P＜0.01）. Subgroup analysis showed that in patients with A2 type DRF aged 50-59 and 60-69 years old， the excellent rates of Dienst and Gartland-Werley scores in the TCM group were higher than those in the surgical group （P＜0.05）. Multivariate logistic regression analysis revealed that age， palmar tilt， ulnar deviation， and the degree of swelling on the affected side were independent factors influencing the choice of treatment （P＜0.05）. ConclusionBoth TCM manipulative reduction combined with small splint fixation and surgical treatment for type A DRF can achieve good therapeutic effects. TCM manipulative reduction combined with small splint fixation has certain advantages in medium- and long-term pain relief， especially in elderly patients， where wrist joint function recovery is more stable. Age， palmar tilt， ulnar deviation， and swelling degree are the main factors influencing the treatment choice.

Objective To develop an erythrocyte-based delivery system for butyrylcholinesterase(BChE)that is capable of prophylaxis against organophosphorus nerve agents.Methods Recombinant BChE was produced and analyzed for oligomerization via polyacrylamide gel electrophoresis(PAGE)and Western blotting.A modified hypotonic preswelling method was employed to prepare BChE-loaded erythrocytes.The drug loading capacity and encapsulation efficiency were quantified using enzyme-linked immunosorbent assay(ELISA).Catalytic activity was assessed in vitro with an activity detection kit.The system was characterized via scanning electron microscopy(SEM),flow cytometry and a hematology analyzer.Results Recombinant BChE predominantly existed as dimers(85％dimer,15％monomer).The optimized volume ratio of erythrocytes to hypotonic solution was determined as 1:7.Compared with native and empty erythrocytes,BChE-loaded erythrocytes exhibited significantly higher catalytic activity(P＜0.001).The mean corpuscular volume of BChE-loaded erythrocytes increased(P＜0.001),while the mean content of corpuscular hemoglobin and hemoglobin in erythrocytes per 100 mL decreased(P＜0.001).SEM revealed no morphological differences(biconcave disc shape).Hypotonic preswelling moderately increased erythrocyte apoptosis(P＜0.001),but no statistical difference was observed between BChE-loaded and hypotonic-treated erythrocytes(P＞0.05).CD47 expression remained unchanged compared to native erythrocytes(P＞0.05).Conclusion The modified hypotonic preswelling method can generate BChE-loaded erythrocytes that retain the characteristics of native erythrocytes while conferring catalytic activity,offering a novel strategy for clinical intervention against organophosphorus poisoning.

S-methyl-L-cysteine sulfoxide (SMCO) is a non-protein sulfur-containing amino acid with a variety of functions. There are few reports on the enzymes catalyzing the biosynthesis of SMCO from S-methyl-L-cysteine (SMC). In this study, the flavin-containing monooxygenase gene derived from Schizosaccharomyces pombe (spfmo) was heterologously expressed in Escherichia coli BL21(DE3) and the enzymatic properties of the expressed protein were analyzed. The optimum catalytic conditions of the recombinant SpFMO were 30 ℃ and pH 8.0, under which the enzyme activity reached 72.77 U/g. An appropriate amount of Mg²⁺ improved the enzyme activity. The enzyme kinetic analysis showed that the K_m and k_cat/K_m of SpFMO on the substrate SMC were 23.89 μmol/L and 61.71 L/(min·mmol), respectively. Under the optimal reaction conditions, the yield of SMCO synthesized from SMC catalyzed by SpFMO was 12.31% within 9 h. This study provides reference for the enzymatic synthesis of SMCO.
Schizosaccharomyces/genetics* ; Escherichia coli/metabolism* ; Recombinant Proteins/metabolism* ; Cysteine/biosynthesis* ; Mixed Function Oxygenases/metabolism* ; Schizosaccharomyces pombe Proteins/metabolism* ; Oxygenases/metabolism* ; Kinetics

Gastric cancer is a highly prevalent and aggressive malignancy worldwide,with generally poor prognosis.There are differences in epidemiology,clinicopathological characteristics,treatment modalities,and drug selection for gastric cancer between Eastern and Western populations.Recent advancements in targeted therapy and immunotherapy,the maturation of precision treatment concepts,and the promotion of multidisciplinary therapy have led to continuous updates in clinical research outcomes.Gastric cancer guidelines are annually updated to meet evolving diagnostic and therapeutic needs.This article compared the latest versions of three authoritative global gastric cancer guidelines[National Comprehensive Cancer Network(NCCN)clinical practice guidelines for gastric cancer 2024 version 5,European Society for Medical Oncology(ESMO)online guidelines for gastric cancer 2024,and Chinese Society of Clinical Oncology(CSCO)guidelines for gastric cancer diagnosis and treatment 2024],focusing on clinical treatment strategies for unresectable locally advanced or metastatic esophagogastric junction/gastric adenocarcinoma,and on the whole-process management and precise implementation guided by targets such as human epidermal growth factor receptor 2(HER2)expression,programmed cell death ligand 1(PD-L1)expression,mismatch repair(MMR)status,,and novel targets such as Claudin 18.2.Meanwhile,HER2-positive advanced gastric cancer has entered the era of full-line anti-HER2 treatment.Anti-HER2 antibody-drug conjugates(ADCs)has become a new option after first-line trastuzumab resistance.Immunotherapy combined with chemotherapy is regarded as a new standard for the first-line treatment of advanced gastric cancer.The diagnosis and treatment mode based on MMR status and PD-L1 expression promote the precision of immunotherapy.However,the detection of PD-L1 expression has difficulties in clinical promotion and implementation.The three guidelines in 2024 integrate the latest clinical study results,the new indication approval and the updated health care system.In particular,the CSCO gastric cancer guidelines are rewritten based on the rapid development of independently developed drugs in China and the approval of new indications.The three guidelines differ in the recommendation and adoption of targeted therapy and immunotherapy.This article showed different perspectives and focuses based on different guidelines,enriched the dimensions of clinical decision-making,helped the clinical adaptability of evidence-based guidelines to better enlightens clinical practice.

Diabetic retinopathy (DR) has long been recognized as a primary microvasculopathy disease.However, more and more studies have proved that diabetic retinal neurodegeneration (DRN) occurs in the early stage of DR, and may precede microvascular disease.Nevertheless, the association between vasculopathy and neuropathy remains unclear.Reduced contrast sensitivity, localized deficits in visual field, electrophysiological changes and thinning of retinal thickness on optical coherence tomography can occur in the early stage of DRN, the main pathological changes for those abnormalities are increased apoptosis of ganglion cells and increased reactivity of glial cells.The imbalance between pro-apoptotic molecules (such as glutamate, angiotensin Ⅱ, etc.) and neuroprotective molecules (such as pigment epithelium-derived factor, somatostatin, etc.), inflammation, and oxidative stress in retinal neurons are important causes of DRN.Strategies for treating neurodegeneration include reducing the production of anti-apoptotic molecules, inhibiting the apoptosis pathway of nerve cells, and using antioxidants and neuroprotective factors.Studies on neurodegeneration have found that early intervention can effectively control the progression of neurodegeneration and prevent the progression of DR in animal models, but there are currently few drugs available for clinical trials.Further research is needed to discover the link between vascular dysfunction and DRN and to evaluate neuroprotective agents for retinal neurodegeneration to develop effective strategies for preventing DR and delaying its progression.This article reviews the clinical detection methods, pathological mechanisms, and intervention strategies of DRN.

Diabetic retinopathy (DR) has long been recognized as a primary microvasculopathy disease.However, more and more studies have proved that diabetic retinal neurodegeneration (DRN) occurs in the early stage of DR, and may precede microvascular disease.Nevertheless, the association between vasculopathy and neuropathy remains unclear.Reduced contrast sensitivity, localized deficits in visual field, electrophysiological changes and thinning of retinal thickness on optical coherence tomography can occur in the early stage of DRN, the main pathological changes for those abnormalities are increased apoptosis of ganglion cells and increased reactivity of glial cells.The imbalance between pro-apoptotic molecules (such as glutamate, angiotensin Ⅱ, etc.) and neuroprotective molecules (such as pigment epithelium-derived factor, somatostatin, etc.), inflammation, and oxidative stress in retinal neurons are important causes of DRN.Strategies for treating neurodegeneration include reducing the production of anti-apoptotic molecules, inhibiting the apoptosis pathway of nerve cells, and using antioxidants and neuroprotective factors.Studies on neurodegeneration have found that early intervention can effectively control the progression of neurodegeneration and prevent the progression of DR in animal models, but there are currently few drugs available for clinical trials.Further research is needed to discover the link between vascular dysfunction and DRN and to evaluate neuroprotective agents for retinal neurodegeneration to develop effective strategies for preventing DR and delaying its progression.This article reviews the clinical detection methods, pathological mechanisms, and intervention strategies of DRN.

Objective To investigate the feasibility of the spatiotemporal filtering model in analysis of reported schistosomiasis cases, so as to provide insights into analysis of complicated data pertaining to schistosomiasis control. Methods Demographic and epidemiological data of reported schistosomiasis cases in Anhui Province from 1997 to 2010 were collected from Anhui Provincial Center for Disease Control and Prevention, and the annual prevalence of Schistosoma japonicum human infections was calculated. The meteorological data were captured from meteorological stations in counties (cities, districts) of Anhui Province where schistosomiasis cases were reported from 1997 to 2010 at the National Meteorological Information Center, including monthly average air temperature and precipitation. Meteorological data were interpolated using the inverse-distance weighting method, and the annual average air temperature and annual precipitation were calculated in each county (city, district). The centroid of the county (city, district) where schistosomiasis cases were reported was extracted using the software ArcGIS 10.0, and the Euclidean distance from each centroid to the Yangtze River was calculated as the distance between that county (city, district) and the Yangtze River. The global Moran’s I of the prevalence of S. japonicum human infections in Anhui Province for each year from 1997 to 2010 were calculated to analyze the spatial autocorrelation. A spatial weight matrix was constructed using Rook adjacency, and a first-order temporal weight matrix was built to quantify the relationship between disease changes over time. Subsequently, a spatiotemporal structure matrix was constructed. A negative binomial model was built based on the spatiotemporal structure matrix and data pertaining to reported schistosomiasis cases, and a linear model was created between the residual of the model and candidate set feature vectors to determine the optimal subset composition of the spatiotemporal filter through stepwise regression. Then, a spatio-temporal filtering model was constructed using the negative binomial model. Negative binomial models, Bayesian spatial models, and Bayesian spatiotemporal models were constructed and compared with the spatiotemporal filtering model to validate the performance of the spatiotemporal filtering model, and cross-validation was conducted for each model. The goodness of fit was evaluated using the deviance information criterion (DIC) and Watanabe-Akaike information criterion (WAIC), and the effectiveness of model validation was assessed using mean squared error (MSE), while the accuracy of assessment results was assessed using coefficients and their 95% confidence intervals (CI), and the computational efficiency was assessed based on the running time of the model. The four feature vectors with the largest Moran’s I values were selected to identify regions with autocorrelation through their schematic diagrams to investigate the differences in spatiotemporal patterns of specific regions. Results Of all models created, the spatiotemporal filtering model exhibited the highest goodness of fit (DIC = 3 240.70, WAIC = 3 257.80), the best model validation effectiveness (MSE = 42 617.52), and the runtime was 3.18 s, exhibiting the optimal performance. Across all modeling results, the distance from the Yangtze River showed a negative correlation with the number of reported schistosomiasis cases (coefficient values = −4.93 to −3.78, none of the 95% CIs included 0), and annual average air temperature or average precipitation posed no significant effects on numbers of reported schistosomiasis cases (both of the 95% CIs included 0). Schematic diagrams of feature vectors showed that the transmission of schistosomiasis might be associated with water systems in Anhui Province, and localized clustering patterns were primarily concentrated in the northern and western parts of schistosomiasis-endemic areas in the province. Conclusion The spatiotemporal filtering model is an effective spatiotemporal analysis characterized by simple modeling, user-friendly operation, accurate results and good flexibility, which may serve as an efficient alternative to conventional complex spatiotemporal models for data analysis in schistosomiasis researches.

Gastric cancer is a highly prevalent and aggressive malignancy worldwide,with generally poor prognosis.There are differences in epidemiology,clinicopathological characteristics,treatment modalities,and drug selection for gastric cancer between Eastern and Western populations.Recent advancements in targeted therapy and immunotherapy,the maturation of precision treatment concepts,and the promotion of multidisciplinary therapy have led to continuous updates in clinical research outcomes.Gastric cancer guidelines are annually updated to meet evolving diagnostic and therapeutic needs.This article compared the latest versions of three authoritative global gastric cancer guidelines[National Comprehensive Cancer Network(NCCN)clinical practice guidelines for gastric cancer 2024 version 5,European Society for Medical Oncology(ESMO)online guidelines for gastric cancer 2024,and Chinese Society of Clinical Oncology(CSCO)guidelines for gastric cancer diagnosis and treatment 2024],focusing on clinical treatment strategies for unresectable locally advanced or metastatic esophagogastric junction/gastric adenocarcinoma,and on the whole-process management and precise implementation guided by targets such as human epidermal growth factor receptor 2(HER2)expression,programmed cell death ligand 1(PD-L1)expression,mismatch repair(MMR)status,,and novel targets such as Claudin 18.2.Meanwhile,HER2-positive advanced gastric cancer has entered the era of full-line anti-HER2 treatment.Anti-HER2 antibody-drug conjugates(ADCs)has become a new option after first-line trastuzumab resistance.Immunotherapy combined with chemotherapy is regarded as a new standard for the first-line treatment of advanced gastric cancer.The diagnosis and treatment mode based on MMR status and PD-L1 expression promote the precision of immunotherapy.However,the detection of PD-L1 expression has difficulties in clinical promotion and implementation.The three guidelines in 2024 integrate the latest clinical study results,the new indication approval and the updated health care system.In particular,the CSCO gastric cancer guidelines are rewritten based on the rapid development of independently developed drugs in China and the approval of new indications.The three guidelines differ in the recommendation and adoption of targeted therapy and immunotherapy.This article showed different perspectives and focuses based on different guidelines,enriched the dimensions of clinical decision-making,helped the clinical adaptability of evidence-based guidelines to better enlightens clinical practice.

Objective:To find out about the sentiment about the current physical training among Air Force pilots (cadets), propose methods for optimizing their programs of physical training, and to enhance the effectiveness of training in order to improve flight adaptability.Methods:A total of 1 135 pilots (cadets) were randomly selected as the subjects and divided into 3 groups according to types of aircraft and types of personnel: group A (pilots of fighters, bombers and advanced trainers), group B (pilots of fighter bombers, transporters, helicopters, special aircraft and junior trainers), and group C (flying cadets). A questionnaire survey was conducted to collect data on current physical training among pilots and flying cadets.Results:A total of 1 135 questionnaires were distributed, with 1 086 valid responses collected, yielding an effective response rate of 95.68%. Of the 1 086 participating pilots (cadets), 209 were in Group A, 499 in Group B, and 378 in Group C.There was statistically significant difference in the frequency and duration of weekly physical training between the 3 groups ( χ2=82.23, 61.56, both P<0.001). The proportion of participants engaging in >3 h weekly physical training sessions was significantly higher in group C (71.7%) than in group A (38.8%) and group B (44.9%). Significant differences were observed in weekly training durations between group C and group A (all P<0.05), as well as between group C and group B in the training durations of <3 h and 5-7 h (all P<0.05). The percentage of subjects who trained for 5-7 h per week was the highest in group C (41.5%). In groups A and B, pilots mostly trained for 3-<5 h per week (51.7% and 39.9%, respectively). The survey on the willingness to adjust training programs revealed statistically significant differences between the 3 groups in their willingness to engage in muscle strength training, coordination training, specific ability training, and adjustment of intensities of core training ( H=46.23, 16.12, 22.03, 60.68, all P<0.001). No significant difference was observed in their willingness to have aerobic training programs adjusted ( P>0.05). Group C was significantly different from groups A and B in their preference for adjustment in training programs related to muscle strength, coordination, specific abilities, and in core training programs (all P<0.01). Group C was mostly in favor of "increasing" muscle strength, coordination, and core training while opting for "no change" in aerobic training and specific ability training. Groups A and B preferred "no change". Regarding their willingness to have training intensities revised, statistically significant differences were observed between the 3 groups ( H=15.58, 19.08, 8.17, 58.01, P<0.001, <0.001, =0.017, <0.001), but no significant difference was found in their preference for adjustment of aerobic training intensities ( P>0.05). Group C showed much more preference for intensity adjustment related to muscle strength, coordination, specific abilities, and core training programs than groups A and B (all P<0.05 or 0.01). All the 3 groups predominantly favored "no change" in training intensities. Conclusions:Pilots of different aircraft types generally meet the requirements of the current physical training programs. However, the frequency of physical training for pilots (cadets) requires more rigorous supervision. Flying cadets can adaptively engage in targeted training programs. Pilots of fighters, fighter bombers and advanced trainers should care about the intensity of aerobic training while giving more weight to load resistance physical training. Pilots of other types of aircraft should devote more effort to core training programs.