Objective To systematically evaluate the similarities between six-gene-modified pig red blood cells and human red blood cells in multiple dimensions, including cell morphology, hematological parameters, microbial safety and serological compatibility, and to verify the feasibility of using six-gene-modified pig red blood cells as an alternative for blood transfusion in cases of traumatic hemorrhage. Methods Blood samples from O-type human donor, six-gene-modified O-type pig and wild-type O-type pig were collected. The pig gene-modified phenotype was identified by flow cytometry. The morphology was observed using field emission scanning electron microscopy and the diameter was measured. Hematological tests, including blood routine, osmotic fragility test, adenosine triphosphate (ATP) and 2,3-diphosphoglycerate (2,3-DPG) content and partial pressure of oxygen at 50% hemoglobin saturation (P50), were conducted to assess the deformability of red blood cells. Real-time fluorescent quantitative polymerase chain reaction was used to screen for zoonotic viruses, and cross-matching was performed using column gel method, condensation amine method and saline tube method. Results The six-gene-modified pig red blood cells successfully knocked out the α-Gal, Neu5Gc and Sda antigens and expressed hCD55. Wild-type pig red blood cells expressed these three antigens but did not express human complement regulatory proteins. All three types of red blood cells presented a biconcave discoid morphology. The diameter of O-type human red blood cells was larger than that of the six-gene-modified porcine red blood cells and wild-type pig red blood cells (all P < 0.05). The average red blood cell volume and average red blood cell hemoglobin of O-type humans were higher than those of the six-gene-modified pig red blood cells, and the distribution width-variable coefficient of O-type human red blood cells was lower than that of the six-gene-modified pig red blood cells (all P < 0.05). There were no statistically significant differences in the permeability fragility, ATP content, 2,3-DPG content, P50 and red blood cell deformability indicators of the three types of red blood cells (all P > 0.05). The screening for zoonotic viruses in human and animal cells of the six-gene-modified pigs and wild-type pigs was negative. The cross-matching results showed that in the column gel method and condensation amine method, the primary and secondary sides of the six-gene-modified pig red blood cells did not agglutinate with human red blood cells, while the wild-type pig red blood cells agglutinated with human red blood cells in all cross-matching methods. Conclusions The six-gene-modified pig red blood cells are highly similar to human red blood cells in terms of morphology, key hematological parameters, energy metabolism, oxygen-carrying capacity, mechanical properties, microbial safety and serological compatibility, providing an experimental basis for the clinical transformation of xenotransfusion.

Objective:To study the effects of manual inspection and special equipment inspection for light guiding components of hard endoscope after cleaning and disinfection,so as to provide scientific data and evidence for the application of special inspection equipment of hard endoscope in Central Sterile Supply Department(CSSD).Methods:A total of 100 hard endoscopes after cleaning and disinfection,which were in CSSD of the Fifth Medical Center of Chinese PLA General Hospital during July and August 2024,were selected.Each light guiding components of hard endoscope was respectively inspected by manual method and special functional detector for endoscope(inspection method with equipment).The positive rates of fog,stains and glass shards,and overall failure rate of light guiding components of hard endoscope,as well as the difference with the effect of clinical use,between two kinds of inspection methods were compared.Results:In 100 hard endoscopes,the inspection method with equipment found 2 cases were overall failure,which fog,strains and glass shards were respectively 2,0 and 0.The overall failure rate,and the positive rates of fog,stains and glass shards of the inspection method with equipment were respectively 2%,2%,0 and 0,which all lower than overall failure rate(23%),and the positive rates of fog(17%),stains(2%)and glass shards(4%)of manual inspection.There was significant difference in overall failure rate and positive rat of fog between the two kinds of inspection methods(x2=18.286,11.399,P＜0.05).The overall failure rate that was reflected by clinical users was 3%,which was significant lower than 23%of manual inspection,and the difference of that between two methods was significant(x2=15.959,P＜0.05).Conclusion:The inspection for light guiding components of hard endoscopes after cleaning and disinfection can be carried out by manual inspection and special inspection equipment,and results of special inspection equipment is getting closer the usage effect of clinical users.It has a series of advantages include being intuitive,easy use,high accuracy,convenient observation,and archivable.

Objective To revise Guidelines for Diagnosis and Treatment of Commom Diseases of Pediatrics in Traditional Chinese Medicine·Recurrent Respiratory Tract Infections in Children through the Delphi method-based expert questionnaire survey.Methods Bsaed on a comprehensive literature review,the expert questionnaire was developed for the 2024 Edition of the guidelines.Using the Delphi method,the questionnaire was distributed in three rounds to gather expert opinions.Statistical analyses were conducted on expert positivity coefficients and consensus levels,evaluated by expert familiarity,the concentration of expert opinions,and their degree of coordination.Results After three rounds of consultation,consensus was achieved among experts regarding the terminology and definitions,diagnosis,syndrome differentiation,treatment,prevention and health related to recurrent respiratory tract infections in children.This led to the formulation of a draft version of the 2024 Edition of the guidelines for further consultation.Conclusion The participating experts were geographically diverse,held senior titles,and possessed extensive clinical experience,ensuring the credibility of the findings.Their high level of engagement throughout the survey process indicates strong motivation.The content of the expert questionnaire of the Guidelines for the Diagnosis and Treatment of Traditional Chinese Medicine in Children with Recurrent Respiratory Tract Infections in Children(2024 Edition)objectively reflects the core perspectives of the experts,and the results are authentic and reliable,providing a solid foundation for the development of the guidelines.

Objective:To explore and model risk factors in patients with major adverse cardiovascular events (MACEs) after acute type A aortic dissection (ATAAD), and to develop and validate a personalized machine learning model to assess risk factors and predict MACEs in these patients.Methods:Clinical data of patients who attended Beijing Anzhen Hospital and underwent surgical treatment for ATAAD from January 2018 to October 2022 were retrospectively analyzed. Using MACEs as the endpoint, 70% of these patients were randomly divided into the training set and the remaining 30% into the validation set. LASSO regression was applied to explore key clinical variables in the training set. The optimal predictive model was selected from nine machine learning algorithms based on area under the curve. And Shapley Additive explanations was used to elucidate the predictive model. Results:Of the 481 patients included in this study, 135 (35.6%) patients experienced an endpoint event. By combining the results of the training and validation sets, when assessing the validity of the single model with the highest predictive accuracy for the outcome, it was shown that the logistic model (0.774, 95% CI: 0.717-0.830) was the most effective in the combined effect and had a high model accuracy (0.743, 95% CI: 0.720-0.766). According to the results of the LASSO, the factors most associated with postoperative MACEs were history of cerebrovascular disease, coronary artery involvement, shock status on admission to the operating room, FDP, PLT, CPB, ascending aortic clamping, and age. Conclusion:In this study, nine machine learning models were developed to predict the occurrence of postoperative MACEs in patients with acute type A aortic dissection. The logistic model performed significantly better compared to other algorithms. Our study successfully predicted postoperative MACES and identified the factors most associated with MACEs.

In recent years, machine learning and its subset, deep learning, have made significant progress in medical image analysis. Magnetic resonance imaging (MRI) technology has become a critical tool for the diagnosis of autism spectrum disorder (ASD) by providing high-resolution data of brain structure and function. In this review, the characteristics of ASD in MRI were summarized, ASD-related MRI datasets and preprocessing methods were discussed, MRI feature selection and extraction techniques of ASD were examined, machine learning-based diagnostic approaches and their interpretablility were evaluated, and future research directions were proposed.

OBJECTIVE To explore the effect and mechanism of Zhiqiao gancao decoction （ZQGCD） on pathological angiogenesis of degenerative intervertebral disc. METHODS The rats were randomly divided into sham operation group （normal saline）， model group （normal saline）， hypoxia inducible factor-1α （HIF-1α） inhibitor （YC-1） group [2 mg/（kg·d）， tail vein injection]， and ZQGCD low-dose， medium-dose and high-dose groups [3.06， 6.12， 12.24 g/（kg·d）]， with 8 rats in each group. Except for sham operation group， lumbar disc degeneration model of rat was constructed in all other groups. After modeling， they were given relevant medicine once a day， for consecutive 3 weeks. After the last medication， pathological changes and angiogenesis of the intervertebral disc tissue in rats were observed； the levels of inflammatory factors [interleukin-1β （IL-1β）， IL-6， tumor necrosis factor-α （TNF-α）] and the expressions of angiogenesis-related proteins [HIF-1α， vascular endothelial growth factor （VEGF）， VEGF receptor 2 （VEGFR2）， angiotensin 1（Ang 1）， Ang 2] in the com intervertebral disc tissue in rats were all determined. In cell experiment， the primary nucleus pulposus cells were isolated and cultured from rats， and cellular degeneration was induced using 50 ng/mL TNF-α. The cells were divided into blank control group （10% blank control serum）， TNF-α group （10% blank control serum）， YC-1 group （10% blank control serum+0.2 mmol/L YC-1）， and 5%， 10%， 15% drug-containing serum group （5%， 10%， 15% drug-containing serum）. After 24 hours of intervention， the nucleus pulposus cells were co-cultured with HUVEC. The expressions of Collagen Ⅱ， matrix metalloproteinase-3 （MMP-3） in nucleus pulposus cells were detected. HUVEC proliferation， migration and tube forming ability were detected， and the expression levels of the HIF-1α/VEGF/Ang signal axis and angiogenesis- related proteins （add MMP-2， MMP-9） in HUVEC were detected. RESULTS Animal experiments had shown that compared with model group， the positive expression of CD31 in the intervertebral disc tissues of rats in each drug group was down-regulated （P＜ 0.05）， the levels of inflammatory factors and angiogenesis-related proteins were decreased significantly （P＜0.05）， and the pathological changes in the intervertebral disc were alleviated. Cell experiments had shown that compared with TNF-α group， the expression of Collagen Ⅱ in nucleus pulposus cells of all drug groups was significantly up-regulated （P＜0.05）， and the expression of MMP-3 was significantly down-regulated （P＜0.05）； the proliferation， migration and tubulogenesis of HUVEC were significantly weakened （P＜0.05）. The mRNA and protein expressions of HIF-1α， VEGF， Ang 2 as well as the expression of angiogenesis-related proteins （except for the expression of Ang 2 mRNA and HIF-1α， VEGFR2， Ang 2 protein in 5% drug- containing serum group） were significantly down-regulated （P＜0.05）. CONCLUSIONS ZQGCD may inhibit the HIF-1α/VEGF/ Ang signal axis to weaken the angiogenic ability of vascular endothelial cells， improve pathological angiogenesis in the intervertebral disc， and delay the degeneration of the intervertebral disc.

Objective:To construct a dynamic competency assessment system suitable for standardized training of resident physicians in the department of pediatric infectious diseases, verify its teaching practice effectiveness, and enhance the core competence of specialist physicians.Methods:Based on the Delphi method, an evaluation system was constructed. Through two rounds of expert consultation ( n=20, authority coefficient Cr=0.889-0.895), 5 primary indicators, 13 secondary indicators, and 38 tertiary indicators were established, covering dimensions such as clinical thinking, operational skills, and professional ethics. The hierarchical and progressive design and dynamic feedback mechanism were adopted. Sixty residents were randomly divide into an observation group (dynamic evaluation system) and a control group (traditional evaluation). Differences between the two groups were compared in terms of short-term teaching effectiveness (e.g., OSCE assessment and Mini CEX score) and long-term clinical competencies (e.g., exit assessment pass rate and incidence of adverse events). SPSS 24.0 was used for t-test, Mann Whitney U test, and internal consistency test (Cronbach's alpha=0.89). Results:The observation group outperformed the control group in core specialty competencies and clinical practice outcomes. In terms of core specialty competencies, the observation group had a higher response speed score for pathogen results [(4.10±0.84) vs. (3.60±0.95), P=0.042]. This indicates that the dynamic evaluation system effectively enhanced the ability of trained physicians to quickly adjust treatment plans based on pathogenic evidence. The implementation rate of infection prevention and control standards and diagnostic accuracy were also higher in the observation group compared to the control group, reflecting the advantages of this system in standardizing clinical operations and improving diagnostic levels. In terms of long-term clinical competencies, the observation group showed significantly increased exit assessment pass rate and significantly decreased incidence of medical adverse events, further verifying the continuous promotion effect of the dynamic evaluation system on the clinical competence of trained physicians. Conclusions:The dynamic evaluation system constructed in this study can effectively enhance the core specialty competencies (e.g., pathogen response and infection prevention and control) and long-term clinical competence of residents in the department of pediatric infectious diseases, providing scientific basis for optimizing the training models of specialist physicians.

Objective:To evaluate the clinical effect of different types of aortic root replacement in adolescent patients with aortic root aneurysm by analyzing the perioperative and follow-up conditions of surgical treatment for adolescent aortic root aneurysm.Methods:The clinical data of patients aged ≤18 years who were admitted to the Beijing Anzhen Hospital from November 2012 to February 2025, diagnosed with aortic root aneurysm by ultrasound or aortic computed tomography angiography (CTA) and requiring surgical intervention, were collected retrospectively. They were divided into the valve-sparing aortic root replacement group (David operation group) and the aortic root replacement group (Bentall operation group) according to the surgical method. The perioperative results and long-term follow-up results of the two groups were analyzed. Kaplan-Meier survival curves were drawn to compare the reoperation intervention rate between the two groups.Results:A total of 25 patients were included in this study, including 17 in the Bentall group and 8 in the David group. There were no statistically significant differences in gender, age, blood routine, liver and kidney function, coagulation function, and electrolyte internal environment between the two groups (all P>0.05). There were no statistically significant differences in operation time and intensive care unit stay between the two groups (all P>0.05). Compared with the Bentall operation group, the intraoperative blood loss in the David operation group was more ( P<0.05). During the follow-up, no reoperation occurred in the Bentall operation group, while 3 patients in the David operation group had long-term re-intervention. The long-term reoperation intervention rate in the David operation group was higher than that in the Bentall group ( P=0.042), but there was no statistically significant difference in the aortic valve-related surgical intervention rate between the two groups ( P=0.15). Conclusions:For adolescent patients with aortic root aneurysm, although David operation may face long-term reoperation intervention, this intervention may not be due to the difference in surgical methods. Both Bentall operation and David operation are safe and reliable, with good perioperative results and stable medium and long-term prognosis.

Objective:To construct a dynamic competency assessment system suitable for standardized training of resident physicians in the department of pediatric infectious diseases, verify its teaching practice effectiveness, and enhance the core competence of specialist physicians.Methods:Based on the Delphi method, an evaluation system was constructed. Through two rounds of expert consultation ( n=20, authority coefficient Cr=0.889-0.895), 5 primary indicators, 13 secondary indicators, and 38 tertiary indicators were established, covering dimensions such as clinical thinking, operational skills, and professional ethics. The hierarchical and progressive design and dynamic feedback mechanism were adopted. Sixty residents were randomly divide into an observation group (dynamic evaluation system) and a control group (traditional evaluation). Differences between the two groups were compared in terms of short-term teaching effectiveness (e.g., OSCE assessment and Mini CEX score) and long-term clinical competencies (e.g., exit assessment pass rate and incidence of adverse events). SPSS 24.0 was used for t-test, Mann Whitney U test, and internal consistency test (Cronbach's alpha=0.89). Results:The observation group outperformed the control group in core specialty competencies and clinical practice outcomes. In terms of core specialty competencies, the observation group had a higher response speed score for pathogen results [(4.10±0.84) vs. (3.60±0.95), P=0.042]. This indicates that the dynamic evaluation system effectively enhanced the ability of trained physicians to quickly adjust treatment plans based on pathogenic evidence. The implementation rate of infection prevention and control standards and diagnostic accuracy were also higher in the observation group compared to the control group, reflecting the advantages of this system in standardizing clinical operations and improving diagnostic levels. In terms of long-term clinical competencies, the observation group showed significantly increased exit assessment pass rate and significantly decreased incidence of medical adverse events, further verifying the continuous promotion effect of the dynamic evaluation system on the clinical competence of trained physicians. Conclusions:The dynamic evaluation system constructed in this study can effectively enhance the core specialty competencies (e.g., pathogen response and infection prevention and control) and long-term clinical competence of residents in the department of pediatric infectious diseases, providing scientific basis for optimizing the training models of specialist physicians.

Objective:To study the effects of manual inspection and special equipment inspection for light guiding components of hard endoscope after cleaning and disinfection,so as to provide scientific data and evidence for the application of special inspection equipment of hard endoscope in Central Sterile Supply Department(CSSD).Methods:A total of 100 hard endoscopes after cleaning and disinfection,which were in CSSD of the Fifth Medical Center of Chinese PLA General Hospital during July and August 2024,were selected.Each light guiding components of hard endoscope was respectively inspected by manual method and special functional detector for endoscope(inspection method with equipment).The positive rates of fog,stains and glass shards,and overall failure rate of light guiding components of hard endoscope,as well as the difference with the effect of clinical use,between two kinds of inspection methods were compared.Results:In 100 hard endoscopes,the inspection method with equipment found 2 cases were overall failure,which fog,strains and glass shards were respectively 2,0 and 0.The overall failure rate,and the positive rates of fog,stains and glass shards of the inspection method with equipment were respectively 2%,2%,0 and 0,which all lower than overall failure rate(23%),and the positive rates of fog(17%),stains(2%)and glass shards(4%)of manual inspection.There was significant difference in overall failure rate and positive rat of fog between the two kinds of inspection methods(x2=18.286,11.399,P＜0.05).The overall failure rate that was reflected by clinical users was 3%,which was significant lower than 23%of manual inspection,and the difference of that between two methods was significant(x2=15.959,P＜0.05).Conclusion:The inspection for light guiding components of hard endoscopes after cleaning and disinfection can be carried out by manual inspection and special inspection equipment,and results of special inspection equipment is getting closer the usage effect of clinical users.It has a series of advantages include being intuitive,easy use,high accuracy,convenient observation,and archivable.