Objective To explore the causal relationship between immune cells and heart failure (HF), and the mediating role of serum metabolites, in order to identify potential biomarkers and therapeutic targets. Methods We employed a two-sample Mendelian randomization (MR) analysis method based on genome-wide association study (GWAS) data, analyzing the direct and indirect effects of 731 types of immune cells and 1 400 metabolites on HF. We selected valid instrumental variables and conducted statistical analyses using R software. The primary analysis was performed using the inverse variance weighted method, supplemented by MR-Egger analysis and weighted median method. The stability of the results was assessed through tests such as Cochran’s Q test. Results Our research found a negative causal relationship between PD-L1 on CD14−CD16+ and HF. Sensitivity analysis supported this result. The reverse MR analysis did not find an effect of HF on PD-L1 on CD14−CD16+, indicating that PD-L1 on CD14−CD16+ might play a unidirectional role in reducing the risk of HF. Further mediation MR analysis showed that PD-L1 on CD14−CD16+ might influence the risk of HF onset by regulating the levels of sphingomyelin (d17:1/14:0, d16:1/15:0), with a mediation effect ratio of 6.7%. Conclusion PD-L1 on CD14−CD16+ may reduce the risk of HF by elevating the levels of sphingomyelin (d17:1/14:0, d16:1/15:0), which provides a new perspective for understanding the pathogenesis of HF.

Marine work environment is associated with unique risk factors,such as high salinity,high humidity,noise and vibration,and chemical pollution.Males make up the majority of marine workers.Prolonged exposure to these environmental factors may have adverse effects on male fertility,resulting in sperm quality reduction,endocrine disorder,and reproductive organ damage.Therefore,the potential harm of marine work environment to male reproductive health deserves attention.This review focused on the key exposure factors in marine work environment,and systematically explored the factors affecting male fertility,mechanisms,and physiological pathways.The aim is to provide scientific evidences to improve marine work environment,develop protective measures,and safeguard the reproductive health of workers,while also offering guidance for future research in this field.

BackgroundPrevious studies have identified a close relationship among psychological neglect and abuse， negative affect， different stages of adolescence， and suicidal ideation. However， the mechanisms underlying the impact of psychological abuse and neglect on suicidal ideation among left-behind adolescents remain unclear， and this field of research is still in its relative infancy. ObjectiveTo explore the relationship between psychological neglect/abuse and suicidal ideation among left-behind adolescents， as well as the mediating role of negative affect and the moderating effect of different stages of adolescence， so as to provide insights for preventing and intervening suicidal ideation in this population. MethodsFrom November 2021 to May 2022， a cluster random sampling technique was utilized to select 2 309 left-behind adolescents in western China. Assessments were conducted using the Child Psychological Abuse and Neglect Scale （CPANS）， the Positive and Negative Suicide Ideation （PANSI） and the Positive and Negative Affect Schedule for Children （PANAS-C）. Spearman correlation coefficients were calculated across all samples， and Process 4.1 was employed to test the mediating role of negative affect and the moderating role of different stages of adolescence in the pathway linking psychological abuse/neglect to suicidal ideation. ResultsA total of 2 119 left-behind adolescents （mean age： 14.94±1.20 years） completed the study， with males comprising 51.34% （1 088/2 119） and females 48.66% （1 031/2 119）.Among left-behind adolescents， scores on CPANS psychological neglect subscale showed positive correlations with both psychological abuse subscale scores and PANAS-C negative affect subscale scores （r=0.446， 0.496， P<0.01）. Additionally， CPANS psychological neglect and psychological abuse subscale scores were also positively correlated with PANSI scores （r=0.487， 0.508， P<0.01）. Furthermore， PANAS-C negative affect subscale scores demonstrated a positive correlation with PANSI scores （r=0.499， P<0.01）. Negative affect partially mediated the relationship between psychological abuse/psychological neglect and suicidal ideation， with effect sizes of 0.166 （95% CI： 0.141~0.191） and 0.131 （95% CI： 0.112~0.152）. Different stages of adolescence moderated the latter part （negative emotion → suicidal ideation） of the indirect mediation path from psychological neglect to suicidal ideation through negative affect （β=-0.066， P<0.01）. ConclusionBoth psychological neglect and psychological abuse may influence suicidal ideation among left-behind adolescents via negative affect. Moreover， different stages of adolescence may moderate the indirect path from psychological neglect to suicide ideation through negative affect.

Objective To compare the application value of different nutritional assessment tools for peritoneal dialysis patients.Methods A total of 147 patients who were hospitalized for peritoneal dialysis in The Second Affiliated Hospital of Naval Medical University between Oct.2022 and Oct.2023 were enrolled by convenience sampling method.The nutritional assessment was carried out by using 3 assessment tools,including 7-point subjective global assessment(7-SGA),malnutrition inflammation score(MIS)and controlling nutritional status(CONUT).Correlation analyses were conducted between the nutritional assessment results and anthropometric measurements and blood biochemical indexes.Results The incidence of malnutrition assessed by 7-SGA,MIS,and CONUT were 53.74%(79/147),48.30%(71/147),and 76.19%(112/147),respectively.Both 7-SGA and MIS assessment revealed that the incidence of malnutrition in peritoneal dialysis patients＞60 years old was significantly higher than that in patients≤60 years old(both P＜0.01).Grouped by 7-SGA results,the body mass index(BMI),skeletal muscle mass,skeletal muscle mass index,phase angle,grip strength,upper arm circumference,upper arm muscle circumference,skinfold thickness,albumin and prealbumin levels in malnourished peritoneal dialysis patients were significantly lower than those in well-nourished peritoneal dialysis patients(all P＜0.05).The 7-SGA score was negatively correlated with age(P＜0.05),and was positively correlated with BMI,skeletal muscle mass,skeletal muscle mass index,phase angle,grip strength,upper arm circumference,upper arm muscle circumference,skinfold thickness,albumin,prealbumin,total protein,creatinine,and hemoglobin(all P＜0.05).Conclusion The incidence of malnutrition in peritoneal dialysis patients varies with the assessment tools used.7-SGA score has high correlation with anthropometric and blood biochemical indexes,and is effective,reliable,and practical.It is a good tool for nutritional assessment in patients undergoing peritoneal dialysis.

Objectives:This study aims to explore the causal relationships between immune cells and serum metabolites in the development of coronary heart disease(CHD)using Mendelian randomization(MR)methods.Methods:We conducted a two-sample MR analysis utilizing data from the FinnGen Project's genome-wide association study(GWAS)on CHD,alongside data on metabolites and immune cells from the GWAS catalog.For the identified associated metabolites,we further employed mediation MR methods to evaluate their mediating roles in the influence of immune cells on CHD.Results:The MR analysis indicated that three immune cells(IgD-CD24-%B cell,CD11b on CD14+monocyte,HLA DR on DC)had stable causal relationship with CHD(under the premise of inverse variance weighted[IVW]method P<0.05,both MR-Egger and weighted median methods also showed P<0.05).Furthermore,these immune cells were associated with CHD through four metabolites(N-acetylneuraminic acid levels,the ratio of desmethyltaurine to taurine,X-24801 and X-18779).Conclusions:This study reveals the causal relationships between immune cells and serum metabolites in the pathogenesis of CHD,providing new biomarkers for early prediction and risk assessment of CHD.

Objective:To construct classification models of traumatic brain injury (TBI) based on the injury data collected at the scene of the accidents and validate its efficacy.Methods:A retrospective cohort study was conducted to analyze the pre-hospital treatment data of 368 TBI patients admitted to the Second Affiliated Hospital of Army Military Medical University from January 2019 to December 2023, including 243 males and 125 females, aged 18-82 years [(48.1±20.8)years]. The patients′ Glasgow coma scale (GCS) scores were 3-15 points [11.0(3.0, 15.0)points] at emergency medical service arrival. The patients were randomly assigned to the training set ( n=257) and test set ( n=111) at a ratio of 7∶3. According to the admission diagnosis, the patients fell into the mild TBI group ( n=62), medium TBI group ( n=137), severe TBI group ( n=120), and extremely severe TBI group ( n=49). In the training set, 44 patients fell into mild TBI group, 98 into medium TBI group, 82 into severe TBI group and 33 into extremely severe TBI group, while in the test set, 18 patients fell into mild TBI group, 39 into medium TBI group, 38 into severe TBI group and 16 into extremely severe TBI group. The following 12 kinds of injury data, including MARCH [massive hemorrhage (M), airway obstruction (A), respiratory failure (R), circulatory failure (C) and hypothermia (H)], GCS, pre-hospital index (PHI), shock index (SI), reverse SI multiplied by GCS (rSIG), optic nerve sheath diameter (ONSD) measured by ultrasound, scalp and skull injuries were collected at the scene of the accidents. Three machine algorithm including random forest (RF), support vector machine (SVM) and logistic regression (LR) were used to construct scene data-based TBI classification models. The accuracy rate, precision rate, recall rate, F1 value and area under receiver operating characteristic (ROC) curve (AUC) of the 3 models were used to verify the efficiency of the models for TBI classification. Shapley additive explanations (SHAP) method was used to interpret the results of the optimal model. The 12 kinds of injury data in the models were sorted according to their contribution to the TBI classification and the injury data with greater contribution were selected. Results:In the test set, the accuracy rate of the RF, SVM and LR models was 0.93, 0.92 and 0.87, respectively; the precision rate was 0.93, 0.92 and 0.89, respectively; the recall rate was 0.93, 0.92 and 0.87, respectively; the F1 value was 0.93, 0.92 and 0.87, respectively. In the mild, medium, severe and extremely severe TBI groups in the test set, the AUC of the RF model was 0.96 (95% CI 0.92, 0.98), 0.98 (95% CI 0.94, 0.99), 0.97 (95% CI 0.95, 0.98), and 0.97 (95% CI 0.96, 0.98), respectively; the AUC of the SVM model was 0.90 (95% CI 0.88, 0.94), 0.95 (95% CI 0.92, 0.97), 0.96 (95% CI 0.94, 0.98), and 0.95 (95% CI 0.92, 0.99), respectively; the AUC of the LR model was 0.90 (95% CI 0.83, 0.96), 0.90 (95% CI 0.84, 0.95), 0.96 (95% CI 0.95, 0.98), and 0.95 (95% CI 0.94, 0.97), respectively. The RF model demonstrated optimal discriminative performance for TBI classification. As the SHAP′s interpretation of the RF model indicated, among the 12 kinds of injury data, those with greater contributions to the TBI classification were GCS, rSIG, SI, PHI, respiratory failure, ONSD, and circulatory failure in sequence. Conclusions:Of the scene data-based TBI classification models, the RF model achieves good predictive performance for TBI classification when compared with the SVM model and LR model. Besides, GCS, rSIG, SI, PHI, respiratory failure, ONSD and circulatory failure contribute significantly to the classification of TBI in the RF model, which may assist emergency medical personnel in field triage and management of TBI at accident scenes.

Objective:To investigate the diagnostic value of metagenomic next-generation sequencing (mNGS) for pyogenic spinal infections.Methods:A total of 255 patients diagnosed with pyogenic spinal infections were enrolled between September 2022 and September 2024 at Qingdao University Affiliated Hospital, Fuzhou Second General Hospital, First Affiliated Hospital of Nanchang University, Shandong University Affiliated Public Health Clinical Center, and the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Among them, 155 were male and 100 were female, with an average age of 62.5±14.2 years (ranging from 13 to 90 years). All patients had samples of infected tissue and/or pus collected for microbial culture and mNGS testing. The number, types, and positive rates of pathogens detected by microbial culture and mNGS were compared. Using culture results as the gold standard, receiver operating characteristic (ROC) curve analysis was performed for mNGS testing and the combined method of mNGS and microbial culture, calculating the area under the curve (AUC) and 95% CI. Results:All 255 cases were clinically diagnosed as pyogenic spinal infections, with 194 cases providing microbiological evidence. The most common Gram-positive bacterium was Staphylococcus aureus, while the most common Gram-negative bacterium was Escherichia coli. A total of 33 pathogenic microorganisms were detected by mNGS, while microbial culture detected 18 pathogenic microorganisms. The positive rate of mNGS was 72.2% (184 out of 255), which was significantly higher than that of 30.2% (77 out of 255) for microbial culture, showing a significant difference (χ 2=90.150, P<0.001); the positive rate of mNGS combined with microbial culture was 76.1% (194 out of 255) with significant difference compared to mNGS alone (χ 2=8.100, P<0.001). Among 178 culture-negative samples, the detection rate of mNGS was 65.7% (117 out of 178); among 77 culture-positive samples, the detection rate of mNGS was 87.0% (67 out of 77), and 97.0% (65 out of 67) of the detected pathogens matched the culture results at the species level. The AUCs of the ROC curves for mNGS testing and the combination of mNGS with microbial culture were 0.606 [95% CI (0.534, 0.678)] and 0.671 [95% CI (0.606, 0.736)], respectively, with significant differences compared to microbial culture ( P=0.007; P=0.007). Conclusions:mNGS demonstrates superior performance over conventional culture in identifying pathogens in pyogenic spinal infections. Moreover, combining mNGS with culture further improves diagnostic yield, supporting its integration into clinical practice.

OBJECTIVE To understand the distribution and drug susceptibility rates of clinical Nocardia isolates so as to provide bases for standardized clinical diagnosis and treatment.METHODS The characteristics of clinical dis-tribution of the Nocardia strains that were isolated from The Second Affiliated Hospital of Fujian Medical Univer-sity between Aug.2019 and Aug.2024 were retrospectively analyzed.The isolated strains were identified by means of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry(MALDI-TOF MS),16S rRNA and rpoB gene sequencing were performed for the strains with low score,and the drug susceptibility testing was carried out by broth micro dilution method.RESULTS Totally 35 strains of Nocardia were isolated from clinical specimens in the five years,11 of which were Nocardia cyriacigeorgica,4 were Nocardia asiatica,3 were No-cardia farcinica,3 were Nocardia brasiliensis,3 were Nocardia sputorum,2 were Nocardia nova,2 were No-cardia otitidiscaviarum,2 were Nocardia beijingensis,2 were Nocardia concava,1 was Nocardia abscessus,1 was Nocardia pseudobrasiliensis,and 1 was Nocardia terpenica.Totally 85.71％of the strains were isolated from lower respiratory tract specimens including sputum,bronchoalveolar lavage fluid,bronchial brushing and lung puncture tissues,and 11.43％were isolated from skin and soft tissues.It was basically same in the male to female ratio for the patients with Nocardia infections,there were 18 cases of male and 17 cases of female.The elderly patients were dominant,and the patients aged more than 60 years old accounted for 51.43％.The strains were mainly isolated from respiratory medicine department and critical care medicine department.The drug sus-ceptibility rates of all the isolated strains to amikacin and linezolid were 100％,the drug susceptibility rates to sul-famethoxazole-trimethoprim were 97.14％,and the drug susceptibility rates to tobramycin,ceftriaxone and imi-penem were 80％,65.71％and 62.86％,respectively;the drug resistance rates to clarithromycin and ciprofloxa-cin were 65.71％and 62.86％,respectively.Among the major species of isolated Nocardia strains,the N.cyri-acigeorgica strains were all sensitive to sulfamethoxazole-trimethoprim,linezolid,tobramycin,amikacin,imipen-em and ceftriaxone,the strains were resistant to ciprofloxacin,and the drug resistance rate to clarithromycin reached up to 81.82％.CONCLUSIONS N.cyriacigeorgica is the predominant species of isolated Nocardia strains.The pulmonary infection is the major type of infection.There is little difference in the male to female ratio among the patients with Nocardia infection,and the elderly patients are dominant.Amikacin,linezolid and sulfame-thoxazole-trimethoprim are the most sensitive drugs,and the drug resistance rates of the stains to clarithromycin are high.

Objective To study the clinical characteristics and medication patterns of Wangbi Tablets in treating patients with knee osteoarthritis(KOA)in the real world and to analyze the advantages and specific features of Chinese patent medicines in treating advantage disease.Methods A prospective case registry study was conducted,registering 3 000 patients from 30 TCM and Western medicine hospitals across China from April 2019 to December 2021.Data on gender,age,BMI,Chinese medicine staging(CMS),K-L grading,medication duration,VAS score,medical history and combined medication were collected for descriptive analysis.Comparisons were made between different stages and between single-use and combined-use groups.The Apriori algorithm was used for association analysis of combined medications.Results A total of 2 999 patients were included,with 2 063 females(68.79%)and 936 males(31.21%).The average age was(56.89±8.90)years.The average BMI was(23.80±2.88)kg/m2.The proportion of patients in CMS I was 512(17.07%),with a VAS median score of 8,while the proportion of patients in CMS Ⅱ was 2 181(72.73%),with a VAS median score of 6.The proportion of patients in CMS Ⅲ was 306(10.20%),with a VAS median score of 3;316 cases(10.54%)were classified as K-L grade I,2 477 cases(82.59%)as grade Ⅱ,204 cases(6.80%)as grade Ⅲ,and 2 cases(0.07%)as grade Ⅳ.Medication analysis indicated that the single-use group(1507 cases,50.25%)was larger than the combined-use group(1 492 cases,49.75%).In terms of the number of drugs used in combination,one(39.01%)and two(38.14%)were the main types;in terms of medication types,combination therapy with Western medicine(62.27%)and simultaneous use of Western medicine and other Chinese materia medica(26.14%)were the main methods;the top three drugs with the highest frequency of combination use were glucosamine capsules,imrecoxib tablets and sodium hyaluronate injection.The top three drug combinations with the highest support were"Huoxue Zhishang Powder+imrecoxib tablets","glucosamine capsules+imrecoxib tablets"and"glucosamine capsules+sodium hyaluronate injection".Inter-group comparisons showed that the medication duration for Wangbi Tablets in CMS I was longer than in CMS Ⅱ and CMS Ⅲ(P<0.01).The proportion of patients on monotherapy in CMS I(62.11%)was higher than in CMS Ⅱ(46.54%)and CMS Ⅲ(56.86%)(P<0.001).Among patients in CMS I(16.41%)and CMS Ⅲ(21.24%),the highest proportion used one combined medication,whereas in CMS Ⅱ,the highest proportion was for those using two combined medications(20.50%).In all three groups,CMS I(19.53%),CMS Ⅱ(33.70%)and CMS Ⅲ(30.72%),the highest proportion of combined medications was Western medicine.Conclusion More than half of the patients treated KOA with Wangbi Tablets alone.Approximately one-fifth of the patients were in CMS I,with a median pain score of 8.The average duration of medication for patients in CMS I,CMS Ⅱ and CMS Ⅲ decreases,and there is no obvious pattern in the medication method at different stages;combination therapy is represented by"Huoxue Zhishang Powder+imrecoxib tablets"and"glucosamine capsules+imrecoxib tablets".

ObjectiveTo explore the effects of the Tai Chi training on bone density， bone turnover markers， and heart rate variability for people with high-risk osteoporosis， and to provide evidence for the prevention of osteoporosis at early stage. MethodsSixty-six cases of people with high risk of osteoporosis were included， and they were divided into 33 cases each in the intervention group and the control group using the random number table method. The control group received osteoporosis health education three times a week， and the intervention group received Tai Chi training under the guidance of a trainer three times a week for 40 mins each time on the basis of the control group， and both groups were intervened for 12 weeks. Dual-energy X-ray absorptiometry was used to measure the bone density of L₁~L₄ vertebrae， bilateral femoral necks and bilateral total hips in the two groups before and after the intervention； enzyme-linked immunosorbent assay was used to determine bone turnover markers before and after the intervention， including pro-collagen type Ⅰ pro-amino-terminal prepropyl peptide （P1NP） and β-collagen type Ⅰ cross-linking carboxy-terminal peptide （β-CTX）. Seven cases with good compliance in the intervention group were selected. After wearing the heart rate sensor， they successively performed Tai Chi training and walking activities recommended by the guideline for 20 mins each， and the heart rate variability （HRV） during exercise was collected， including time-domain indexes such as standard deviation of normal sinus intervals （SDNN）， root-mean-square of the difference between adjacent RR intervals （RMSSD）， frequency-domain metrics such as low-frequency power （LF）， high-frequency power （HF）， and low-frequency/high-frequency power ratio （LF/HF）， as well as nonlinear metrics such as approximate entropy （ApEn）， sample entropy （SampEn）. ResultsFinally， 63 cases were included in the outcome analysis， including 30 cases in the intervention group and 33 cases in the control group. After the intervention， the differences of L₁~L₄ vertebrae， bone density of bilateral femoral neck and bilateral total hip in the intervention group were not statistically significant when compared with those before intervention （P＞0.05）， while the bone density of all parts of the control group decreased significantly compared with that before intervention （P＜0.05）， and the difference in the bone density of the L₁~L₄ vertebrae， bilateral femoral neck， and the right total hip before and after the intervention of the intervention group was smaller than that of the control group （P＜0.05）. The differences in P1NP and β-CTX between groups before and after intervention was not statistically significant （P＞0.05）. Compared with walking exercise， LF decreased， HF increased and LF/HF decreased during Tai Chi exercise （P＜0.05）； the time domain indexes and non-linear indexes between groups had no statistically significant difference （P＞0.05）. ConclusionTai Chi exercise can maintain lumbar， hip， and femoral bone density and improve sympathetic/parasympathetic balance in people at high risk for osteoporosis， but cannot significantly improve bone turnover markers.