Objective To investigate the independent risk factors affecting the prognosis of chronic active antibody-mediated rejection (caAMR) after kidney transplantation. Methods A retrospective analysis was conducted on 61 patients who underwent renal biopsy and were diagnosed with caAMR. The patients were divided into caAMR group (n=41) and caAMR+TCMR group (n=20) based on the presence or absence of concurrent acute T cell-mediated rejection (TCMR). The patients were followed up for 3 years. The value of 24-hour urinary protein and estimated glomerular filtration rate (eGFR) at the time of biopsy in predicting graft loss was assessed using receiver operating characteristic (ROC) curves. The independent risk factors affecting caAMR prognosis were analyzed using the LASSO-Cox regression model. The correlation between grouping, outcomes, and Banff scores was compared using Spearman rank correlation matrix analysis. Kaplan-Meier analysis was used to evaluate the renal allograft survival rates of each subgroup. Results The 3-year renal allograft survival rates for the caAMR group and the caAMR+TCMR group were 83% and 79%, respectively. The area under the ROC curve (AUC) for predicting 3-year renal allograft loss was 0.83 ［95% confidence interval (CI) 0.70-0.97］ for eGFR and 0.78 (95% CI 0.61-0.96) for 24-hour urinary protein at the time of biopsy. LASSO-Cox regression analysis and Kaplan-Meier analysis showed that eGFR≤25.23 mL/(min·1.73 m²) and the presence of donor-specific antibody (DSA) against human leukocyte antigen (HLA) class I might be independent risk factors affecting renal allograft prognosis, with hazard ratios of 7.67 (95% CI 2.18-27.02) and 5.13 (95% CI 1.33-19.80), respectively. A strong correlation was found between the Banff chronic lesion indicators of renal interstitial fibrosis and tubular atrophy (P<0.05). Conclusions The presence of HLA class I DSA and eGFR≤25.23 mL/(min·1.73 m²) at the time of biopsy may be independent risk factors affecting the prognosis of caAMR.

Background::Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography (ERCP), the benefits and safety of high-carbohydrate fluid diet (CFD) intake 2 h before ERCP remain unclear. This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’ recovery.Methods::This prospective, multicenter, randomized controlled trial involved 15 tertiary ERCP centers. A total of 1330 patients were randomized into CFD group ( n = 665) and fasting group ( n = 665). The CFD group received 400 mL of maltodextrin orally 2 h before ERCP, while the control group abstained from food/water overnight (>6 h) before ERCP. All ERCP procedures were performed using deep sedation with intravenous propofol. The investigators were blinded but not the patients. The primary outcomes included postoperative fatigue and abdominal pain score, and the secondary outcomes included complications and changes in metabolic indicators. The outcomes were analyzed according to a modified intention-to-treat principle. Results::The post-ERCP fatigue scores were significantly lower at 4 h (4.1 ± 2.6 vs. 4.8 ± 2.8, t = 4.23, P <0.001) and 20 h (2.4 ± 2.1 vs. 3.4 ± 2.4, t= 7.94, P <0.001) in the CFD group, with least-squares mean differences of 0.48 (95% confidence interval [CI]: 0.26–0.71, P <0.001) and 0.76 (95% CI: 0.57–0.95, P <0.001), respectively. The 4-h pain scores (2.1 ± 1.7 vs. 2.2 ± 1.7, t = 2.60, P = 0.009, with a least-squares mean difference of 0.21 [95% CI: 0.05–0.37]) and positive urine ketone levels (7.7% [39/509] vs. 15.4% [82/533], χ2 = 15.13, P <0.001) were lower in the CFD group. The CFD group had significantly less cholangitis (2.1% [13/634] vs. 4.0% [26/658], χ2 = 3.99, P = 0.046) but not pancreatitis (5.5% [35/634] vs. 6.5% [43/658], χ2 = 0.59, P = 0.444). Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla (odds ratio [OR]: 0.61, 95% CI: 0.39–0.95, P = 0.028) in the multivariable models. Conclusion::Ingesting 400 mL of CFD 2 h before ERCP is safe, with a reduction in post-ERCP fatigue, abdominal pain, and cholangitis during recovery.Trail Registration::ClinicalTrials.gov, No. NCT03075280.

Objective To investigate the application effect of the self-made nerve bundle with 3 mm of spatial distance between the two ends in repair of median nerve rupture of the wrist.Methods A total of 24 patients with median nerve rupture of the wrist from July 2014 to August 2020 were included.The self-made nerve bundle with 3 mm of spatial distance between the two ends was applied,and then the epineurium was anastomosed continuously,and no nerve bundle was exposed.After 4 weeks of plaster external fixation,functional exercise was gradually strengthened.The median nerve recovery was evaluated according to Burchiel efficacy evaluation criteria.Results At the last follow-up,the sensory recovery of the middle finger reached S4 level,the functions of thumb to palm and finger to finger recovered,and the thenar eminence was full without atrophy.At the last follow-up,the median nerve recovery was excellent in 18 cases,good in 6 cases,and the excellent and good rate was 100% .Conclusion The epineural anastomosis of self-made nerve bundle with 3 mm of spatial distance between the two ends can achieve accurate counterpoint,prevent scar compression,avoid neuroma,and effectively restore the function of the median nerve.

Objective:To evaluate the gene mutation profile and prognostic significance of adult cytogenetically normal acute myeloid leukemia (CN-AML) with CEBPA-bZIP mutation. Methods:Targeted sequencing was implemented on the diagnostic bone marrow DNA samples of 141 adult CN-AML subjects with CEBPA-bZIP mutation. The nomogram model for leukemia-free survival (LFS) rate was generated by combining genetic abnormalities and clinical data. Risk stratification was conducted based on prognostic variables and the effect of risk-adjusted consolidation therapy was investigated by Kaplan-Meier method. Results:Four variables were finally included in our nomogram model after multivariate Cox analysis,and an equation for risk score calculation was obtained,risk score=1.3002×white blood cell (WBC) (≥18.77×109/L)+1.4065×CSF3R mutation positive+2.6489×KMT2A mutation positive+1.0128×DNA methylation-related genes mutation positive. According to the nomogram model,patients were further divided into low-risk group (score=0,n=46) and high-risk group (score>0,n=95). Prognostic analysis showed that the 5-year LFS rate,5-year overall survival (OS) rate,and 5-year cumulative incidence of relapse (CIR) of patients who received allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the high-risk group were 93.5％,97.1％,and 3.5％,while those in patients who received maintenance chemotherapy were 32.9％,70.5％,and 63.4％,respectively. The differences were statistically significant (all P<0.05). Allo-HSCT could significantly improve the prognosis of patients in high-risk group. However,no corresponding benefit was observed in the low-risk group. Conclusion:Adult CN-AML with CEBPA-bZIP mutation has a complex co-mutation pattern. The nomogram model based on mutations of CFS3R,KMT2A and DNA methylation-related genes together with WBC count can further divide this subset of patients into a relatively low-risk group and a relatively high-risk group. For individuals in the high-risk group,allo-HSCT is proposed as post-remission therapy. The above data will benefit the prognosis estimation and treatment decision for adult CN-AML with CEBPA-bZIP mutation.

Objective To explore the predictive value of CXC chemokine receptor 2(CXCR2)and Zonula occluden-1(ZO-1)for postoperative cerebral vasospasm in subarachnoid hemorrhage(SAH)patients with ruptured intracranial aneurysm.Methods A total of 215 SAH patients with ruptured intracranial aneurysm admitted to our hospital between May 2020 and October 2023 were recruited,and according to occurrence of postoperative cerebral vasospasm or not,they were separated into a spasm group(70 cases)and a non-spasm group(145 cases).The spasm group was further divided into mild,moderate and severe subgroups(14,38 and 18 cases,respectively).ELISA was applied to detect the serum levels of CXCR2 and ZO-1;Spearman and Pearson corre-lation analyses,multivariate logistic regression analysis,and ROC curve analysis were applied to test the correlation,influencing factors,and predictive value of indicators,and their AUC values were calculated.Results The spasm group had significantly higher CXCR2 and ZO-1 levels,inci-dence of intracranial hemorrhage,and larger proportions of Glasgow coma scale(GCS)score of 3-8 at admission,Hunt-Hess grade Ⅲ,and Fisher grades m and Ⅳ than the non-spasm group(P＜0.01).Intracranial hemorrhage volume,Hunt-Hess grade and Fisher grade were positively correlated with CXCR2 and ZO-1 levels,and the GCS score at admission was negatively correlated with the levels of the two indicators in the SAH patients with ruptured intracranial aneurysm(P＜0.01).CXCR2 and ZO-1 were independent risk factors for postoperative cerebral vasospasm in these patients(P＜0.01).The AUC value of CXCR2,ZO-1 and their combination in predicting postoperative cerebral vasospasm was 0.839(95％CI:0.780-0.898),0.813(95％CI:0.750-0.876),and 0.910(95％CI:0.869-0.951),with the combination showing better predictive per-formance(Z=2.391,Z=3.266,P＜0.05).The serum levels of CXCR2 and ZO-1 in the severe subgroup were significantly higher than those in the moderate subgroup and then followed by the mild subgroup in order,with statistical differences(P＜0.01).Conclusion Serum CXCR2 and ZO-1 levels are associated with postoperative cerebral vasospasm in SAH patients with ruptured intracranial aneurysm,and can be used as potential biomarkers for prognosis prediction.

Objective:To investigated the referral preferences of clinical doctors with prescription authority in public hospitals, and to explore the factors influencing clinical doctors′ referral decisions.Methods:A questionnaire based on discrete choice experiments was designed to investigate clinical doctors′ preferences for patient referral. A multi-stage stratified random sampling method was employed, targeting 499 clinical doctors from 25 public hospitals in Henan Province. The on-site questionnaire survey was conducted between February and March 2023. Conditional logistic regression analysis, based on parameter estimation from Cox proportional hazards models, was used to explore clinical doctors′ preferences for patient referral concerning patient condition, hospital capability to manage the patient, patient′s willingness for referral, completion of surgery or major treatment, and hospital or medical insurance policy support for referral preferences.Results:A total of 439 valid questionnaires were collected. Doctors showed a preference for referring patients with fluctuating acute and critical conditions ( β=0.81, P<0.05), patients with high risk or with moderate risk but manageable overall ( β=0.75, β=0.60, P<0.05), patients clearly expressing a desire for referral ( β=0.41, P<0.05), patients with incomplete surgery or major treatment ( β=0.66, P<0.05), and patients supported by hospital or medical insurance policies ( β=0.16, P<0.05).Conversely, doctors were reluctant to refer patients with unclear attitudes towards referral ( β=-0.93, P<0.05) or unclear hospital or medical insurance policy support ( β=-0.23, P<0.05). Conclusions:Patient condition, hospital capability to manage the patient, completion of surgery or major treatment, and patient willingness significantly influence doctors′ preferences for patient referral. Hospital support for patient referral has a minor impact on doctors′ referral preferences.

The steps for installation and withdrawal of WYD2000 field surgical lamp were introduced.The failures and causes of broken cross-arm connector of WYD2000 field surgical lamp were analyzed.The problems of WYD2000 field surgical lamp in vulnerability to breaking and difficulty in maintenance were solved by designing and manufacturing a special maintenance tool and optimizing the materials and fixing mode of cross-arm connection.References were provided for main-tenance and improvement of WYD2000 field surgical lamp.[Chinese Medical Equipment Journal,2024,45(4):116-118]

Objective To explore the modal testing method for the three-axis manned centrifuge under elastic boundary conditions with considerations on its complicated structure and high rotational inertia.Methods Modal testing was carried out with a three-axis manned centrifuge under elastic boundary conditions as the subject and a force hammer as the excitation source according to GJB 2706A-2008 Modal tests method for spacecraft and GB/T 11349.3-1992 Experimental determination of mechnical mobility measurements using impact excitation.Four times of hammering were carried out at each excitation position,and the data of the four times of hammering underwent linear average computation.Data acquisition was implemented with a three-axis accelerometer and a 64-channel data collector,and the modal data were analyzed using a frequency response function based on the Test.Lab modal test and analysis software.Results The coherence coefficient of the excitation signal was not lower than 0.8 in the 30 Hz band;the first three orders of the system's intrinsic vibrations were all torsional vibrations,with the frequencies of 9.15,15.66 and 19.22 Hz,respectively;the first order frequency of the system was about 9.15 Hz for both Z18 and Z21 excitation positions,and each of the second and third order frequencies similar situations were observed for also had a roughly equal value for the two excitation positions.Conclusion The force hammer testing method is applicable for the modal testing of the three-axis manned centrifuge,ensuring equipment safety and subject comfort.Referen-ces are provided for the following structural optimization design.[Chinese Medical Equipment Journal,2024,45(8):38-43]

Objective To design and implement a high-precision ear pulse wave physiological signal detection device for human centrifuge training to solve the problems in measurement and calibration of pilot ear pulse wave signal during human centrifuge training.Methods The high-precision ear pulse wave physiological signal detection device was composed of an ear pulse wave acquisition sensor,a signal acquisition and control unit and a host signal processing module.The ear pulse wave acquisition sensor had an ear-clip-like shape and consisted of an outer shell,an inner shell and an elastic steel plate;the signal acquisition and control unit was made up of an power supply module,a constant voltage module for the light source,a signal acquisition module,a master control module and a data transmission module,which had its software developed with an embedded system;the host signal processing module divided the signal processing into 2 phases of signal pre-processing and pulse wave signal monitoring and display.The detection performance of the device was verified by using a physiological electrical signal calibrator to test the ear pulse wave signals detected with the device;the effectiveness and stability of the device were validated by implementing human centrifuge training experiments with different loads.Results The voltage measurement error,amplitude-frequency characteristics and common mode rejection ratio detected by this device were all within the permitted ranges of JJG 760-2003 Verification Regulation for Electro Cardiac Monitor and JJG 954-2019 Verification Regulation of Digital Electroencephalographs;the device was capable of detecting the ear pulse wave signals of pilot during human centrifuge training in real time with little interference from motion and stable signal quality.Conclusion The device can accurately clarify the changes in the amplitude of the pilot's ear pulse wave during human centrifuge training and effectively reflect the changes in the pilot's cerebral blood flow under positive acceleration.[Chinese Medical Equipment Journal,2024,45(9):35-40]

Objective To study the ability of radial basis function neural network(RBFNN)with different implementations for electrical impedance tomography(EIT)under real brain shapes,to evaluate the advantages and disadvantages of different approaches,and to provide a reference for the selection of practical imaging methods.Methods COMSOL Multiphysics was used to establish a multilayer 2D model with real structure based on brain CT and an EIT simulation dataset.The effects of the exact RBFNN,the orthogonal least squares-based RBFNN(OLS RBFNN)and the K-Means-based BRFNN(K-Means RBFNN)on the image reconstruction result were explored with the dataset constructed.The root mean square error(RMSE)and image correlation coefficient(ICC)were adopted to evaluate the imaging results.Results EIT could be completed with all the three RBFNNs without noise,and the exact RBFNN had the best results with average ICC and RMSE of 0.784 and 0.467,respectively,in the test set.The OLS RBFNN had the best imaging results at a hidden node of 50,with an average ICC and RMSE of 0.788 and 0.462,respectively.The K-Means RBFNN achieved the best imaging results at noise levels of 30,40,50,60,70 and 80 dB with stable ICC and RMSE and high robustness.Conclusion All the three RBFNNs can be used for brain EIT image reconstruction with their own advantages and disadvantages,and the RBFNN has to be selected for EIT reconstruc-tion based on considerations on actual conditions.[Chinese Medical Equipment Journal,2024,45(10):1-6]