Objective:To explore the predictive value of cervical length(CL)measured at 16-24 weeks of ges-tation for spontaneous preterm birth in twin pregnancies.Methods:A retrospective study was conducted on 1001 twin pregnancy cases,including 569 cases in the spontaneous preterm birth group and 432 cases in the term birth group.Univariate and multivariate Logistic regression analyses were used to identify factors associated with spon-taneous preterm birth.The predictive value of CL for spontaneous preterm birth was analyzed by the receiver op-erating characteristic(ROC)curve.Results:At 16-24 weeks of pregnancy,the CL in the spontaneous preterm birth group(3.460±0.866 cm)was significantly shorter than that in the term birth group(3.711±0.589 cm),and the difference was statistically significant(P=0.005).There were statistically significant differences in the cervical fun-neling and its morphology between the term birth group and the spontaneous preterm birth group(P<0.05).Multivariate Logistic regression analysis showed that monochorionicity(aOR 0.161,95％ CI 0.074-0.351) and CL at 16-24 weeks of pregnancy(aOR 0.655,95％ CI 0.496-0.864) were influencing factors for spontaneous preterm birth(P <0.05).ROC curve analysis indicated that a CL cutoff of 3.045 cm at 16-24 weeks of pregnancy predicted spontaneous preterm birth before 34 weeks,with a sensitivity of 90.2％ ,specificity of 64.9％ ,and an area under the curve of 0.650.Conclusions:Measurement of CL at 16-24 weeks of pregnancy is a potential predictor of spontaneous preterm birth in twin pregnancies.In addition,when establishing a prediction model for spontaneous preterm birth,future research should also consider cervical funnel morphology.

Objective To construct machine learning models to predict the incidence of linezolid-induced thrombocytopenia(LIT).Methods A total of 198 patients treated with linezolid in a hospital between January 2020 and March 2024 were retrospectively included.Firstly,the patients were divided into LIT and non-LIT groups,and the basic characteristics of the two groups were compared.Then,the variables with significant differences between the two groups were selected as potential risk factors to construct models for predicting LIT,including Logistic regression,decision tree and random forest models,and the prediction performance of the models was evaluated and compared.Results There were 52(26.3％)patients developed LIT during the treatment.The univariate analysis showed significant differences in linezolid trough concentration(Cmin),baseline platelet counts and creatinine clearance,the incidence of cerebrovascular disease,acute respiratory distress syndrome,and abdominal infection in patients with and without LIT.Among the three models built based on these variables,the random forest model has the best predictive performance.The results of variable importance analysis based on random forest model showed that Cmin,baseline platelet count and combined with acute respiratory distress syndrome had higher importance scores.Conclusions The random forest model has high accuracy in predicting the occurrence of LIT,and the risk of LIT is higher in patients with higher levels of linezolid exposure and lower baseline platelets.

Objective To investigate the effect of linezolid on platelets in patients with acute myeloid leukemia(AML)and analyze the safety profile of linezolid by comparing the platelet count and bleeding risk of linezolid during bone marrow suppression in patients after chemotherapy for AML.Methods A retrospective study was conducted on patients who underwent chemotherapy for AML in a tertiary hospital from January 2020 to November 2024.The patients treated with linezolid and those not receiving linezolid were matched in a 1∶2 ratio.The safety of linezolid during bone marrow suppression after chemotherapy for AML was analyzed in terms of platelet count＜20×109/L,＜50×109/L,minimum platelet count,total platelet transfusion volume,and clinical bleeding events.Results A total of 126 patients were enrolled,including 42 patients receiving linezolid and 84 patients not receiving linezolid.There was no significant difference between linezolid group and control group in the days for platelet count＜20×109/Land＜50×109/L.No life-threatening severe bleeding events were reported in either group.The time to platelet recovery and time to platelet count increase prolonged significantly in patients who received linezolid treatment for more than 7 days during bone marrow suppression.Albumin＜35 g/L may prolong the time to platelet count increase.Conclusions This study suggests that short-term use of linezolid for not more than 7 days is safe during bone marrow suppression in patients after chemotherapy for AML.When linezolid is used for more than 7 days,the time required for platelet recovery and platelet count increase will be significantly prolonged.In cases of albumin＜35 g/L,the time required for platelet count increase may be prolonged.These findings can inform clinical decision-making and help optimize infection management strategies for AML patients.

Objective:To explore the predictive value of cervical length(CL)measured at 16-24 weeks of ges-tation for spontaneous preterm birth in twin pregnancies.Methods:A retrospective study was conducted on 1001 twin pregnancy cases,including 569 cases in the spontaneous preterm birth group and 432 cases in the term birth group.Univariate and multivariate Logistic regression analyses were used to identify factors associated with spon-taneous preterm birth.The predictive value of CL for spontaneous preterm birth was analyzed by the receiver op-erating characteristic(ROC)curve.Results:At 16-24 weeks of pregnancy,the CL in the spontaneous preterm birth group(3.460±0.866 cm)was significantly shorter than that in the term birth group(3.711±0.589 cm),and the difference was statistically significant(P=0.005).There were statistically significant differences in the cervical fun-neling and its morphology between the term birth group and the spontaneous preterm birth group(P<0.05).Multivariate Logistic regression analysis showed that monochorionicity(aOR 0.161,95％ CI 0.074-0.351) and CL at 16-24 weeks of pregnancy(aOR 0.655,95％ CI 0.496-0.864) were influencing factors for spontaneous preterm birth(P <0.05).ROC curve analysis indicated that a CL cutoff of 3.045 cm at 16-24 weeks of pregnancy predicted spontaneous preterm birth before 34 weeks,with a sensitivity of 90.2％ ,specificity of 64.9％ ,and an area under the curve of 0.650.Conclusions:Measurement of CL at 16-24 weeks of pregnancy is a potential predictor of spontaneous preterm birth in twin pregnancies.In addition,when establishing a prediction model for spontaneous preterm birth,future research should also consider cervical funnel morphology.

Objective This study aimed to apply the integrated Promoting Action on Research Implementation in Health Services(i-PARIHS)framework to translate best evidence into clinical practice,with the goal of reducing unplanned discontinua-tion of continuous renal replacement therapy(CRRT)and providing guidance for clinical staff.Methods A systematic search was conducted for guidelines,systematic reviews,evidence summaries,and expert consensus documents related to unplanned CRRT discontinuation.Retrieved literature underwent quality appraisal,synthesis,and integration.Through evidence-based group discussions,baseline clinical audits,and FAME(Feasibility,Appropriateness,Meaningfulness,Effectiveness)-based evi-dence appraisal,implementation strategies were developed across three i-PARIHS dimensions:context,recipients,and facilita-tion.Outcomes including unplanned CRRT discontinuation rates,average length of hospital stay,mortality,and nurse competen-cy were compared before and after evidence implementation.Results After evidence extraction,synthesis,and contextual adap-tation,a site-specific evidence translation model was established,comprising 16 audit criteria with corresponding review methods.Following implementation,significant reductions were observed in unplanned CRRT discontinuation rates,average length of stay,and mortality(all P＜0.05).Nurses' nursing competency also improved significantly(P＜0.05),indicating a positive impact of the evidence translation initiative.Conclusion The i-PARIHS framework effectively reduces unplanned CRRT discontinuation and is applicable in clinical practice.The results offer evidence for improving nursing quality and offering a reference for future evidence translation initiatives in critical care.

Objective To investigate the factors affecting cerebral vasospasm in elderly patients af-ter interventional embolization of intracranial aneurysms,and to develop a nomogram prediction model.Methods A total of 307 elderly patients with intracranial aneurysms who underwent inter-ventional embolization in our hospital from May 2021 to May 2023 were recruited,and according to the occurrence of postoperative cerebral vasospasm or not,they were divided into a cerebral vasospasm group(n=63)and a non-cerebral vasospasm group(n=244).The general clinical data were compared between two groups.Univariate and multivariate logistic regression analyses were used to identify the risk factors for postoperative cerebral vasospasm in elderly patients with in-tracranial aneurysms,and then a nomogram prediction model was constructed.Results There were significant differences between the two groups in terms of age,Hunt-Hess grade,Fisher grade,and time window for surgical treatment(P＜0.01).The cerebral vasospasm group had sig-nificantly higher WBC count and IL-1β and Caspase-3 levels than the non-cerebral vasospasm group(P＜0.01).Univariate logistics regression analysis showed that seven indicators,that is,aged≥65 years,Hunt-Hess grade Ⅲ-Ⅵ,Fisher grade Ⅲ-Ⅵ,later surgical start time and in-creased WBC count and IL-1β and Caspase-3 levels were risk factors for postoperative cerebral vasospasm(P＜0.05).Multivariate logistics regression analysis indicated that above seven indica-tors were still independent risk factors for postoperative cerebral vasospasm(OR=11.372,95％CI:4.032-32.073,P=0.000;OR=12.415,95％CI:4.979-30.959,P=0.000;OR=9.568,95％CI:3.945-23.206,P=0.000;OR=2.898,95％CI:1.217-6.901,P=0.016;OR=1.762,95％CI:1.125-2.761,P=0.013;OR=1.153,95％CI:1.035-1.283,P=0.009).ROC curve analysis re-vealed that the AUC value of the nomogram model in predicting postoperative cerebral vasospasm was 0.934,with a sensitivity of 85.40％and a specificity of 90.50％.Conclusion Aged≥65 years,Hunt-Hess grade Ⅲ-Ⅵ,Fisher grade Ⅲ-Ⅵ,later surgical start time and increased WBC count and IL-1β and Caspase-3 levels have adverse effects on postoperative cerebral vasospasm in in eld-erly patients after interventional embolization of intracranial aneurysms.The nomogram model based on these factors shows certain efficacy in evaluating the occurrence of cerebral vasospasm.

Objective This study aimed to apply the integrated Promoting Action on Research Implementation in Health Services(i-PARIHS)framework to translate best evidence into clinical practice,with the goal of reducing unplanned discontinua-tion of continuous renal replacement therapy(CRRT)and providing guidance for clinical staff.Methods A systematic search was conducted for guidelines,systematic reviews,evidence summaries,and expert consensus documents related to unplanned CRRT discontinuation.Retrieved literature underwent quality appraisal,synthesis,and integration.Through evidence-based group discussions,baseline clinical audits,and FAME(Feasibility,Appropriateness,Meaningfulness,Effectiveness)-based evi-dence appraisal,implementation strategies were developed across three i-PARIHS dimensions:context,recipients,and facilita-tion.Outcomes including unplanned CRRT discontinuation rates,average length of hospital stay,mortality,and nurse competen-cy were compared before and after evidence implementation.Results After evidence extraction,synthesis,and contextual adap-tation,a site-specific evidence translation model was established,comprising 16 audit criteria with corresponding review methods.Following implementation,significant reductions were observed in unplanned CRRT discontinuation rates,average length of stay,and mortality(all P＜0.05).Nurses' nursing competency also improved significantly(P＜0.05),indicating a positive impact of the evidence translation initiative.Conclusion The i-PARIHS framework effectively reduces unplanned CRRT discontinuation and is applicable in clinical practice.The results offer evidence for improving nursing quality and offering a reference for future evidence translation initiatives in critical care.

Objective To investigate the factors affecting cerebral vasospasm in elderly patients af-ter interventional embolization of intracranial aneurysms,and to develop a nomogram prediction model.Methods A total of 307 elderly patients with intracranial aneurysms who underwent inter-ventional embolization in our hospital from May 2021 to May 2023 were recruited,and according to the occurrence of postoperative cerebral vasospasm or not,they were divided into a cerebral vasospasm group(n=63)and a non-cerebral vasospasm group(n=244).The general clinical data were compared between two groups.Univariate and multivariate logistic regression analyses were used to identify the risk factors for postoperative cerebral vasospasm in elderly patients with in-tracranial aneurysms,and then a nomogram prediction model was constructed.Results There were significant differences between the two groups in terms of age,Hunt-Hess grade,Fisher grade,and time window for surgical treatment(P＜0.01).The cerebral vasospasm group had sig-nificantly higher WBC count and IL-1β and Caspase-3 levels than the non-cerebral vasospasm group(P＜0.01).Univariate logistics regression analysis showed that seven indicators,that is,aged≥65 years,Hunt-Hess grade Ⅲ-Ⅵ,Fisher grade Ⅲ-Ⅵ,later surgical start time and in-creased WBC count and IL-1β and Caspase-3 levels were risk factors for postoperative cerebral vasospasm(P＜0.05).Multivariate logistics regression analysis indicated that above seven indica-tors were still independent risk factors for postoperative cerebral vasospasm(OR=11.372,95％CI:4.032-32.073,P=0.000;OR=12.415,95％CI:4.979-30.959,P=0.000;OR=9.568,95％CI:3.945-23.206,P=0.000;OR=2.898,95％CI:1.217-6.901,P=0.016;OR=1.762,95％CI:1.125-2.761,P=0.013;OR=1.153,95％CI:1.035-1.283,P=0.009).ROC curve analysis re-vealed that the AUC value of the nomogram model in predicting postoperative cerebral vasospasm was 0.934,with a sensitivity of 85.40％and a specificity of 90.50％.Conclusion Aged≥65 years,Hunt-Hess grade Ⅲ-Ⅵ,Fisher grade Ⅲ-Ⅵ,later surgical start time and increased WBC count and IL-1β and Caspase-3 levels have adverse effects on postoperative cerebral vasospasm in in eld-erly patients after interventional embolization of intracranial aneurysms.The nomogram model based on these factors shows certain efficacy in evaluating the occurrence of cerebral vasospasm.

Objective To observe changes of dynamic functional connectivity(dFC)of brain networks in different stages of Parkinson disease(PD).Methods Totally 52 early-stage PD patients(early PD group),36 late-stage PD patients(late PD group)and 38 healthy controls(HC group)were prospectively enrolled,and resting-state functional MRI were performed.The sliding window,independent component analysis and k-means clustering were used to extract dFC intensity and temporal properties,including fractional windows,dwell time and transition frequency.Results Network connectivity patterns within and between visual network(VIS),sensorimotor network(SMN),default mode network(DMN),cerebellar network(CB)and cognitive executive network(CEN)were altered in PD patients.Four dFC states were identified,in which connections between components in states Ⅰ and Ⅱ were compact,while in states Ⅲ and Ⅳ were sparse.The fractional window and dwell time of late PD group,early PD group and HC group successively increased under state Ⅱ,but successively decreased under state Ⅲ(all P＜0.05).Under state Ⅰ and Ⅳ,no significant difference of fractional window nor dwell time was found between early PD group and late PD group(both P＞0.05),and the above indexes under state Ⅰ were both lower than those in HC group(all P＜0.05),the fraction window under state Ⅳ was higher than that in HC group(both P＜0.05).Conclusion The temporal properties of dFC in PD patients were altered,characterized by increased tendency toward segregated states.Furthermore,fractional windows and dwell time were associated with PD disease stages,suggesting that dFC parameters might serve as novel biomarkers for assessing clinical progression of PD.

Objective To investigate the effect of linezolid on platelets in patients with acute myeloid leukemia(AML)and analyze the safety profile of linezolid by comparing the platelet count and bleeding risk of linezolid during bone marrow suppression in patients after chemotherapy for AML.Methods A retrospective study was conducted on patients who underwent chemotherapy for AML in a tertiary hospital from January 2020 to November 2024.The patients treated with linezolid and those not receiving linezolid were matched in a 1∶2 ratio.The safety of linezolid during bone marrow suppression after chemotherapy for AML was analyzed in terms of platelet count＜20×109/L,＜50×109/L,minimum platelet count,total platelet transfusion volume,and clinical bleeding events.Results A total of 126 patients were enrolled,including 42 patients receiving linezolid and 84 patients not receiving linezolid.There was no significant difference between linezolid group and control group in the days for platelet count＜20×109/Land＜50×109/L.No life-threatening severe bleeding events were reported in either group.The time to platelet recovery and time to platelet count increase prolonged significantly in patients who received linezolid treatment for more than 7 days during bone marrow suppression.Albumin＜35 g/L may prolong the time to platelet count increase.Conclusions This study suggests that short-term use of linezolid for not more than 7 days is safe during bone marrow suppression in patients after chemotherapy for AML.When linezolid is used for more than 7 days,the time required for platelet recovery and platelet count increase will be significantly prolonged.In cases of albumin＜35 g/L,the time required for platelet count increase may be prolonged.These findings can inform clinical decision-making and help optimize infection management strategies for AML patients.