Objective To explore the characteristics and correlation between perivascular spaces (PVS) and diffusion tensor image analysis along perivascular spaces (DTI-ALPS) index in patients with amnestic mild cognitive impairment (aMCI). Methods A retrospective study was conducted on a total of 118 participants, including cognitive normal (CN) healthy controls and aMCI patients, recruited from the Department of Neurology, Zhongshan Hospital, Fudan University from September 2020 to September 2022. All participants underwent structural magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI). An automatic segmentation algorithm was used to quantify PVS metrics in the brain, and DTI-ALPS index was calculated based on DTI. Differences in DTI-ALPS index and PVS metrics between the CN and aMCI groups were compared. Multivariate logistic regression was used to identify independent factors influencing aMCI. Correlation analysis was performed to assess relationships among DTI-ALPS index, PVS metrics, and cognitive scores. Results A total of 80 CN healthy controls and 38 aMCI patients were included. The DTI-ALPS index was significantly lower in the aMCI group compared with the CN group (1.28±0.18 vs 1.37±0.21, P＝0.018), while differences in PVS metrics between groups were not statistically significant. Multivariate logistic regression analysis indicated that DTI-ALPS index was an independent factor affecting aMCI (OR＝0.097, 95%CI 0.011–0.833, P＝0.033). Correlation analysis revealed a positive relationship between DTI-ALPS index and MMSE score (r＝0.210, P＝0.023) as well as PVS length in the centrum semiovale (r＝0.216, P＝0.019). Conclusions The DTI-ALPS index may serve as an imaging biomarker for identifying early cognitive impairment, and patients with aMCI exhibit abnormal DTI-ALPS indices, suggesting that brain glymphatic system dysfunction may occur prior to morphological changes.

Objective: To analyze the structural changes in whole blood and apheresis platelet donations in Chinese Society of Blood Transfusion (CSBT) sentinel units from 2021 to 2025, and to provide evidence for donor recruitment and blood service management. Methods: Aggregated data reported by sentinel sites were collected and stratified according to six indicators: age, sex, donation history, donation volume, donation site, and organization mode. Pearson χ test, Cramer′V coefficient, Cochran-Armitage trend test and simple linear regression were adopted for analysis. Results: A total of 16 256 973 whole blood donations and 1 576 546 apheresis platelet donations were included. Among whole-blood donations, the proportion of donors aged 18-22 years decreased from 27.30% to 10.60%. The proportion of male donors increased from 58.81% to 63.13%; the proportion of people aged 30 and above increased from 58.40% to 75.30%; the proportion of fixed locations rose from 28.37% to 36.57%; the proportion of social groups increased from 21.69% to 39.69%. The 400-mL donations decreased from 62.12% to 53.46%, while individually initiated voluntary donations remained above 50%. Apheresis platelet donations were predominantly from males, individuals aged 30-39 years, and repeat donors; 2-treatment-unit apheresis platelet donations increased from 67.19% to 74.93%, and individually initiated donations accounted for 92.97%-96.02%. Statistically significant overall annual compositional differences were observed for all six indicators (all P<0.001), whereas linear trends for some sub-categories were not statistically significant. Conclusion: In the participating CSBT sentinel units, among whole blood donations, the proportions of donors aged 18-22 years, university-organized group donations, and donations at blood mobiles decreased, whereas the proportions of organizational group donations and donations at fixed venues increased. The apheresis platelet donation cohort is relatively mature and is evolving toward a high-efficiency donation model. Individual voluntary donation remains the primary organization mode for both donation types. Strategies such as youth donor recruitment, optimized layout of fixed donation sites, and retention of repeat donors should be strengthened to improve the resilience of blood supply.

Objective To investigate the clinical efficacy of internal decompression based on white matter tract preservation in the treatment of malignant middle cerebral artery infarction(MMCAI).Methods A retrospective analysis was conducted on 54 patients with MMCAI.Patients were divided into a study group(n=26)and a control group(n=28)according to the surgical approach.Patients in the study group underwent preoperative fusion of CT,CTP,DWI,and DTI imaging data within a neuronavigation system.This fusion visualized the spatial relationships between the infarct core(IC),ischemic penumbra,and the corticospinal tract(CST).Subsequently,IC resection combined with decompressive craniectomy(DC)was performed while protecting the CST.Patients in the control group underwent DC alone.Key outcome measures included:changes in fractional anisotropy(FA)within the affected CST projection area at 1 month postoperatively;and 6-month postoperative mRS score,mortality,and surgical complications at 6 months postoperatively.Results At 1 month postoperatively,FA in the affected CST projection area were significantly higher in the study group than in the control group(0.092±0.013 vs.0.082±0.008,P<0.05).At the 6-month follow-up,the postoperative mRS score in the study group was significantly lower than that in the control group[2.3(1.3,4.5)vs.3.9(2.4,5.5),P<0.05]and a lower mortality rate(11.5%vs.39.3%,P<0.05)compared to the control group.However,there were no statistically significant differences between the two groups in the incidence of postoperative intracranial hemorrhage,intracranial infection,or epilepsy(P>0.05).Conclusion Internal decompression based on white matter tract protection combined with DC can reduce mortality and contribute to improving function outcomes in patients with MMCAI.

Objective This research aims to establish a scientific research performance evaluation indicator system for public hospital staff,providing evaluation standards and assessment criteria for their research performances.Methods An indica-tor pool was developed through literature review.The indicators were determined through two rounds of Delphi expert consultations.Analytic Hierarchy Process(AHP)was used to calculate their weights and thus establish an indicator system.Results The indica-tor system consists of 8 primary indicators-research projects(0.193 3),talent cultivation(0.264 3),patents(0.046 2),publica-tions(0.118 5),monographs(0.068 1),awards(0.147 2),standards(0.094 3),and research errors(0.068 1)-encompassing 29 secondary indicators.The response rate of the second-round expert consultation was 0.85;the authority coefficient was 0.94;the importance rating of indicators was 4.44,and Kendall's coefficient was 0.260(P＜0.05).The consistency index(CI)and consistency ratio(CR)values were＜0.1,indicating good results.Conclusion The indicator system demonstrates scientifically good validity and feasibility.Thus it can be used to evaluate the research performances of public hospital staff,providing decision support for resource allocation and the optimization of incentive mechanisms.

Objective:To explore the safety and efficacy of intraosseous regional administration (IORA) of vancomycin for preventing infection in primary total knee arthroplasty (TKA).Methods:A total of 124 patients with knee osteoarthritis undergoing TKA between February 2024 and May 2024 at nine hospitals were enrolled. Preoperative infection prophylaxis involved either IORA (0.5 g vancomycin administered via intraosseous regional infusion before incision) or intravenous infusion (1 g vancomycin via peripheral vein). The IORA group included 15 males and 47 females with a median age of 66.5 years (range, 60.0-70.0 years), while the intravenous group included 14 males and 48 females with a median age of 66.0 years (range, 61.8-70.3 years) years. Intraoperative samples were collected including fat and synovium tissues after incision, before prosthesis placement, and after tourniquet release; distal femoral cancellous bone during femoral osteotomy; proximal tibial cancellous bone during tibial osteotomy; proximal intercondylar cancellous bone before prosthesis placement; and peripheral blood from non-infused arms at surgery initiation and after tourniquet release. Vancomycin concentrations were measured using liquid chromatography-tandem mass spectrometry. Vital sign changes were recorded from admission to 5~10 minutes post-IORA (IORA group) or post-incision (intravenous group). Follow-ups were conducted on postoperative day 1 and 3, and at 1 and 3 months, to document complications including IORA-related adverse events, periprosthetic joint infections, surgical site infections, red man syndrome, acute kidney injury, deep vein thrombosis and so on.Results:Vancomycin concentrations in bone, fat, and synovial tissue samples were significantly higher in the IORA group than in the intravenous group ( P<0.05), while vancomycin concentrations in blood samples were significantly lower in the IORA group than in the intravenous group ( P<0.05). Only 7.3%(41/558) of tissue samples in the IORA group had vancomycin concentrations below 2.0 μg/g (the minimum inhibitory concentration of vancomycin against coagulase-negative staphylococcus), compared to 59.3%(331/558) in the intravenous group (χ 2=11.285, P<0.001). In the intravenous group, 16.9%(21/124) of blood samples had vancomycin concentrations exceeding 15.0 mg/L (the threshold associated with a significantly increased risk of nephrotoxicity), while all concentrations in the IORA group were below this threshold, the difference was statistically significant (χ 2=22.943, P<0.001). There were no statistically significant difference ( P>0.05) in vital signs changes before and after vancomycin administration between the two groups. Two patients in the intravenous group experienced incision exudate, while no other related complications occurred in either group. Conclusions:Compared to the traditional intravenous infusion of 1 g vancomycin, intraosseous injection of a low dose (0.5 g) of vancomycin achieves higher local tissue concentrations in the knee joint with a lower incidence of adverse reactions and is safe for infection prophylaxis. Despite guidelines not recommending the routine use of vancomycin for preventing infection after primary TKA, intraosseous injection of 0.5 g vancomycin may be considered intraoperatively for primary TKA in the following scenarios: patients in medical institutions with a high prevalence of methicillin-resistant staphylococcus aureus (MRSA) infections, patients with potential preoperative MRSA colonization, or patients with cephalosporin allergy.

Objective:To explore the safety and efficacy of intraosseous regional administration (IORA) of vancomycin for preventing infection in primary total knee arthroplasty (TKA).Methods:A total of 124 patients with knee osteoarthritis undergoing TKA between February 2024 and May 2024 at nine hospitals were enrolled. Preoperative infection prophylaxis involved either IORA (0.5 g vancomycin administered via intraosseous regional infusion before incision) or intravenous infusion (1 g vancomycin via peripheral vein). The IORA group included 15 males and 47 females with a median age of 66.5 years (range, 60.0-70.0 years), while the intravenous group included 14 males and 48 females with a median age of 66.0 years (range, 61.8-70.3 years) years. Intraoperative samples were collected including fat and synovium tissues after incision, before prosthesis placement, and after tourniquet release; distal femoral cancellous bone during femoral osteotomy; proximal tibial cancellous bone during tibial osteotomy; proximal intercondylar cancellous bone before prosthesis placement; and peripheral blood from non-infused arms at surgery initiation and after tourniquet release. Vancomycin concentrations were measured using liquid chromatography-tandem mass spectrometry. Vital sign changes were recorded from admission to 5~10 minutes post-IORA (IORA group) or post-incision (intravenous group). Follow-ups were conducted on postoperative day 1 and 3, and at 1 and 3 months, to document complications including IORA-related adverse events, periprosthetic joint infections, surgical site infections, red man syndrome, acute kidney injury, deep vein thrombosis and so on.Results:Vancomycin concentrations in bone, fat, and synovial tissue samples were significantly higher in the IORA group than in the intravenous group ( P<0.05), while vancomycin concentrations in blood samples were significantly lower in the IORA group than in the intravenous group ( P<0.05). Only 7.3%(41/558) of tissue samples in the IORA group had vancomycin concentrations below 2.0 μg/g (the minimum inhibitory concentration of vancomycin against coagulase-negative staphylococcus), compared to 59.3%(331/558) in the intravenous group (χ 2=11.285, P<0.001). In the intravenous group, 16.9%(21/124) of blood samples had vancomycin concentrations exceeding 15.0 mg/L (the threshold associated with a significantly increased risk of nephrotoxicity), while all concentrations in the IORA group were below this threshold, the difference was statistically significant (χ 2=22.943, P<0.001). There were no statistically significant difference ( P>0.05) in vital signs changes before and after vancomycin administration between the two groups. Two patients in the intravenous group experienced incision exudate, while no other related complications occurred in either group. Conclusions:Compared to the traditional intravenous infusion of 1 g vancomycin, intraosseous injection of a low dose (0.5 g) of vancomycin achieves higher local tissue concentrations in the knee joint with a lower incidence of adverse reactions and is safe for infection prophylaxis. Despite guidelines not recommending the routine use of vancomycin for preventing infection after primary TKA, intraosseous injection of 0.5 g vancomycin may be considered intraoperatively for primary TKA in the following scenarios: patients in medical institutions with a high prevalence of methicillin-resistant staphylococcus aureus (MRSA) infections, patients with potential preoperative MRSA colonization, or patients with cephalosporin allergy.

Objective To investigate the effectiveness and safety of infarct core resection combined with decompressive craniectomy(DC)based on corticospinal tract(CST)protection in the treatment of massive cerebral infarction(MCI)with malignant brain edema.Methods This study retrospectively enrolled MCI patients with malignant brain edema who underwent internal decompression combined with DC at Xingtai Central Hospital from January 2021 to June 2024.The enrolled patients were divided into a control group and an experimental group base on the intracranial internal decompression method used.All patients underwent CT perfusion(CTP),CT angiography(CTA),diffusion-weighted imaging(DWI),and diffusion tensor imaging(DTI)within 24 h of admission.Preoperative imaging data was automatically processed using an artificial intelligence diagnostic system.For the experimental group,the imaging data was fused within a neuro-navigation system preoperatively to visualize the spatial relationships between the infarct core,ischemic penumbra,and CST and infarct core resection combined with DC was performed while protecting the CST through neuro-navigation.The control group underwent anterior temporal lobectomy combined with DC.Baseline and clinical data were collected from both groups,including gender,age,smoking history,alcohol consumption history,diabetes,hypertension,hyperlipidemia,hyperhomocysteinemia,atrial fibrillation history,responsible occluded vessel(internal carotid artery,middle cerebral artery),preoperative infarct volume on DWI,preoperative ischemic penumbra volume,preoperative the National Institutes of Health stroke scale(NIHSS)score,time from onset to surgery,intraoperative procedure duration,intraoperative blood loss,preoperative and 1-month postoperative fraction anisotropy(FA)values of the CST on the affected side,modified Rankin scale(mRS)score at 6 months postoperatively,and surgery-related complications within 1 month postoperatively(intracranial hemorrhage[operative site oozing,hemorrhagic transformation]and intracranial infection[surgical incision site infection,empyema,brain abscess,meningitis]).6-month follow-up after surgery were conducted through outpatient visit or telephone calls and prognosis of patients was evaluated using the mRS(with mRS of 0-3 defined as good prognosis,4-6 as poor prognosis,and 6 indicating death).The effectiveness indicators included FA value of the affected CST at 1 month postoperatively,good prognosis rate after surgery at 6 months,and 6-month mortality rate after surgery.The safety indicators included the incidence rates of surgical complications(intracranial hemorrhage and infection)within 1 month postoperatively.Based on preoperative DTI images,all patients were further divided into a CST-intact(infarct core did not invade CST,CST morphology intact or deformed/shifted)and a CST-damaged(infarct core invaded CST,CST disrupted or interrupted)subgroup for analysis.Results A total of 62patients(37 males,25 females,age 49-60 years,mean[55±4]years)were enrolled in this study.With 28 patients in the experimental group and 34 in the control group.(1)No significant differences were found in baseline or clinical data between the experimental and control groups(all P＞0.05),and the reoperative FA values of the affected CST were showed no significant differences(P=0.588).(2)The efficacy and safety metrics were evaluated.For the efficacy indices,at 1 month after the surgery,FA values of the affected CST increased significantly compared to preoperative values in both groups(0.409±0.051 vs.0.312±0.052 in the experimental group,and,0.381±0.048 vs.0.319±0.049 in control group;both P＜0.05),and the FA value was significantly higher in the experimental group than that in the control group(0.409±0.051 vs.0.381±0.048,P=0.030).At the 6-month follow-ups,the good prognosis rate was significantly higher in the experimental group than that in the control group(39.3％[11/28]vs.14.7％[5/34],P=0.028).No significant difference in the 6-month mortality rate were observed between the two groups(P=0.787).For the safety indices,no significant differences were found in the incidence rates of intracranial hemorrhage or intracranial infection within 1 month postoperatively between the two groups(both P＞0.05).(3)For further subgroup analysis,no significant differences were found in baseline or clinical data between the CST-damaged subgroup and the CST-intact subgroup in both the experimental and control groups(all P＞0.05).In CST-intact subgroup,FA values of the affected CST increased significantly at 1 month postoperatively compared to preoperatively in the study group(0.428±0.047 vs.0.342±0.045,P＜0.05)and the control group(0.401±0.051 vs.0.347±0.048,P＜0.05).While in the CST-damaged subgroup,no significant differences were found in FA value of the affected CST 1 month postoperatively compared with that preoperatively in both the experimental and control groups(bothP＞0.05).A significantly higher FA values 1 month postoperatively(0.428±0.047 vs.0.401±0.051,P=0.036)and good prognosis rate(9/12 vs.4/16,P=0.020)were observed in the CST-intact subgroup of the experimental group comparing with that of the control group,while there was no statistically significant difference in the 6-month mortality rate between the groups within the CST-intact subgroup(P=1.000).There were no statistically significant differences between the experimental group and the control group in both efficacy and safety indices within the CST-damaged subgroup(all P＞0.05).Conclusions Infarct core resection combining DC with CST protection demonstrates superior neurological functional improvement in comparison with anterior temporal lobectomy combining DC in treating MCI with malignant brain edema,particularly for patients with an intact CST before surgery(as indicated in patients'preoperative imaging results).This(infarct core resection combining DC with CST protection)approach does not increase the incidence of surgical complications.Prospective large sample controlled studies are required for further validation.

OBJECTIVE To evaluate the current status of bacterial contamination control and prevention measures and construction of quality control laboratory in Chinese blood station,and find out the problems and put forward the improvement suggestions.METHODS A total of 41 questionnaires were sent out for performance comparison by secretariat of working group of Chinese blood collection and supply institutions from May 2024 to Jun.2024,and 40 questionnaires were received(14 blood centers and 26 central blood stations),39 of which were valid.The questionnaire survey covered four aspects,including disinfection and surveillance,construction of quality control laboratory,sterility test for blood component and monitoring of blood transfusion reactions.The data were pro-cessed through itemized statistics and descriptive analysis.RESULTS Totally 84.62％of the blood stations used io-dine-containing disinfectants for arm disinfection of the blood donors,and the monthly monitoring was the primary frequency.Among the quality control laboratories,43.59％were registered as biosafety level 2,while 35.90％lacked biosafety registration.As for the pressure settings of the laboratories,64.10％were under normal pres-sure,15.38％under negative pressure and 17.95％under positive pressure.In the sterility test,the utilization rate of ultra clean operating tables and biological safety cabinets was 48.72％,the blood stations that did not have the indoor quality control accounted for 79.49％,and only 35.90％participated the external quality assessment.Regarding the approaches to confirm the positive result,25.64％of the blood stations adopted the re-peated tests,and 15.38％adopted the combination with positive culture bottle.The shortage of fund was the ma-jor restricted factor for the sterility test,and the confirmation of positive result was the fundamental difficulty.The blood stations with the feedback of insufficient transfusion reactions reported from hospitals ac-counted for 53.85％,while the blood stations that encountered suspected bacterial transfusion reactions with nega-tive culture results accounted for 25.64％.CONCLUSIONS The infeciton control and prevention measures and the construction of quality control laboratory vary significantly in Chinese blood stations.The incomplete biosafety registration,non-standardized sterility test operation and weak surveillance of blood transfusion reactions are the major existing problems.It is suggested that the investment should be increased to push forward the standardi-zation and complete the laboratory biosafety system,and a hospital-blood station closed loop coordination mecha-nism should be established so as to raise the blood safety.

Objective:To explore the changes of cerebral blood flow in patients with chemotherapy-related cognitive impairment using magnetic resonance pseudo-continuous arterial spin labeling (PCASL).Methods:Twenty-seven patients with invasive ductal carcinoma of the breast who were treated at Nuclear Industry 215 Hospital of Shaanxi Province from June 2019 to October 2021 were selected as the patient group. All of them received modified radical mastectomy for the affected breast cancer and were treated with EC-T chemotherapy after the operation. During the same period, 26 healthy volunteers with matched age and years of education were included as the control group. The time point before the first chemotherapy after surgery for breast cancer patients is defined as point T0, and the time point after the end of the entire chemotherapy cycle is defined as point T1. At point T0, neuropsychological scale assessment and magnetic resonance data collection were conducted for the patient group, while the control group completed the data collection of the above two indicators from June 2019 to May 2020. Subsequently, the neuropsychological scale scores and cerebral blood flow (CBF) graphs of the two groups of samples were compared. At point T1, the neuropsychological scale assessment and magnetic resonance scanning were conducted again for the patient group. The neuropsychological scale scores and CBF plots of the patient group at points T0 and T1 were longitudinally compared. Finally, based on linear regression analysis, the relationship between the differences in CBF before and after chemotherapy for breast cancer and the neuropsychological score was explored.Results:At point T0, there was no statistically significant difference in the CBF and neuropsychological scale scores between the patient group and the control group (all P>0.05). Compared with point T0, in the patient group, the scores of multiple sub-items of the Auditory Verbal Learning Test-HuaShan Version (AVLT-H) at point T1 [including immediate recall (AVLT_1), short-term delayed recall (AVLT_2), and long-term delayed recall (AVLT_3)] were significantly decreased (all P<0.05); The score of the backward digit span (BDS) also significantly decreased ( P<0.05); The time spent on the Color Trails Test (CTT) [including CTT-1 and CTT-2] significantly increased (all P<0.05); In addition, compared with point T0, in the patient group, CBF decreased in the left middle frontal gyrus, superior frontal gyrus and inferior parietal lobule at point T1 (all P<0.05, GRF corrected), and the CBF of the right superior radiative crown, anterior radiative crown, anterior limb of the internal capsule, anterior part of the corpus callosum and pusin increased (all P<0.05, corrected by GRF). The results of regression analysis indicated that ΔCTT-1 was negatively correlated with Δ left inferior parietal lobular CBF ( t=-5.741, P<0.001). Conclusions:Chemotherapy can cause changes in cerebral blood flow in patients with breast cancer, accompanied by multiple reductions in cognitive domain functions. The decreased cerebral blood flow in the left inferior parietal lobule is closely related to the decline of attention function and executive function in patients.

Objective To evaluate the cost-effectiveness of deucravacitinib in the treatment of moderate to severe plaque psoriasis from the perspective of the Chinese health system.Methods Based on POETYK PSO-1 study and related cost and utility data,a decision tree combined with Markov model was established.The model period was 10 years,and the output indicators of the model were cost and quality-adjusted life year(QALY).The evaluation index of the model was the incremental cost-effectiveness ratio(ICER).The willingness-to-pay threshold(WTP)was 3 times of China's per capita GDP in 2023.Sensitivity analysis was performed to evaluate the robustness of the model results.Results The incremental utility and incremental cost were 0.598QALYs and 130 677.51 yuan(RMB),respectively.The ICER of the two strategies was 218 487.11 yuan(RMB)per QALY gained,which was less than 3 times GDP per capita in 2023.Sensitivity analyses confirmed the robustness of the model.Conclusion Under the threshold of 3 times the GDP per capita in China,deucravacitinib is cost-effective in the treatment of moderate to severe plaque psoriasis.