Objective To investigate the relationship between pan-immune inflammation value(PIV)and the disease severity and outcome of acute respiratory distress syndrome(ARDS).Methods A total of 162 ARDS patients admitted to the hospital from February 2023 to February 2024 were selected as the study group,which were divided into mild group(n=52),moderate group(n=65)and severe group(n=45)ac-cording to the severity of the disease,and death group(n=37)and survival group(n=125)according to the 28 d disease outcome.Another 116 healthy people in the same hospital during the same period were selected as the control group.Neutrophil count(NEUT),platelet count(PLT),monocyte count(MONO)and lympho-cyte count(LYMPH)in peripheral blood of each group were detected,and PIV was calculated.Pearson corre-lation analysis was used to analyze the correlation between PIV and disease severity in ARDS patients.Receiv-er operating characteristic(ROC)curve was used to evaluate the diagnostic value of PIV for the disease out-come of ARDS patients.Binary Logistic stepwise regression analysis was used to analyze the related factors af-fecting the outcome of ARDS patients.Results Peripheral blood PIV in the study group was significantly higher than that in the control group(P<0.05).The severe group had a significantly higher peripheral blood PIV than the moderate disease and mild group(P<0.05),and the moderate group had a significantly higher peripheral blood PIV than the mild group(P<0.05).Pearson correlation analysis showed that PIV was nega-tively correlated with arterial partial pressure of oxygen/fraction of inspired oxygen(PaO2/FiO2)in ARDS patients(r=-0.452,P<0.001).Sequential organ failure assessment(SOFA)score,acute physiology and chronic health evaluation(APACHE)Ⅱ score,white blood cell count,C-reactive protein and PIV in the death group were significantly higher than those in the survival group(P<0.05),PaO2/FiO2 was significantly low-er than that in the survival group(P<0.05).ROC curve analysis showed that the area under the curve of PIV to diagnose the disease outcome of ARDS patients was 0.906(95%CI:0.865-0.956).Binary Logistic step-wise regression analysis showed that SOFA score>11.84 points(OR=2.591,95%CI:1.639-3.964),A-PACHEⅡ score>20.65 points(OR=3.367,95%CI:1.863-6.086),PaO2/FiO2>115.62 mmHg(OR=2.106,95%CI:1.521-2.916),PIV>465.52(OR=3.931,95%CI:2.075-7.448)were risk factors for the outcome of ARDS patients(P<0.05).Conclusion PIV is abnormally elevated in ARDS patients,and is closely related to the severity and outcome of the disease.It can be used as an effective indicator for early diag-nosis of the disease outcome in patients with ARDS.

Objective:To assess the applicability of fully automatic pipeline automated testing for internal quality control (automated quality control).Methods:Stability, assay efficiency and implementation costs of 18 biochemical tests, 5 immunoturbidimetric tests and 11 chemical illuminescent tests in the Department of Laboratory Medicine of Peking Union Hospital from January 2019 to July 2022 were evaluated using automated quality control implementation methods. The detailed method is as follows: quality control materials for biochemical, immunoturbidimetric and chemiluminescent tests were stored in the refrigerator in the pipeline which was controlled by the intermediate software, and were automatically retrieved and tested as pre-set followed by documenting and storing. The quality control setup for the biochemical tests included refreshing quality control materials daily and weekly,both of which were paralleled for 3 months. The on-line storage stability of quality control materials in the pipeline was evaluated by comparing the coefficients of variation ( CV) of the quality control results between the two patterns. Effect of automated quality control application was evaluated using 6 indicators, including the results′ variation of automatically performed and manually performed quality controls, the out-of-controlled rate, the consumption of quality control materials, the change of staff workload, the impact on the testing time of the first sample, and the failure rate of automated quality control. Results:(1) Storage stability of quality control materials in the pipeline: under the pattern of weekly refresh of the biochemical quality control materials, except for total carbon dioxide (TCO 2) (the CVs of low and high level quality control were respectively 20.24% and 21.82%) and sodium (the CV of low level quality control was 1.51%) that were greater than the allowable variation set by the laboratory, the CVs of the rest tests meet the lab requirements on the allowable variations. (2) The results′ variation of quality control in automatically performed and manually performed control patterns: in the patterns of daily refresh of biochemical quality control materials and weekly refresh of immunoturbidimetric and chemiluminescent quality control materials, the CVs of both low and high levels of quality control were lower in the automatically performed control pattern than that in manually performed pattern for 8 chemiluminescent items of dehydroepiandrosterone sulfate, estradiol, follicle stimulating hormone, luteinizing hormone, serum ferritin, serum folic acid, vitamin B12 and testosterone, 3 immunologic items of complement 3, C reactive protein and immunoglobulin G, and 10 biochemical items of alkaline phosphatase, glucose, calcium, chloride, potassium, lactate dehydrogenase, sodium, urea, low density lipoprotein cholesterol, and adenosine deaminase. The out-of-control rates of biochemistry, immunoturbidimetric and chemiluminescence tests in both quality control patterns conformed with the clinical routine work requirements. (3) Comparison of quality control materials′ consumption: compared with manually performed quality control, weekly consumption of automatically performed chemiluminescent quality control materials decreased 37.5% (from 8 ml to 5 ml); weekly consumption of automatically performed immunoturbidimetric quality control materials decreased 33.3% (from 3 ml to 2 ml). (4)Comparison of staff workload and first sample testing time: compared with manually performed quality control, automatical quality control reduced manual work by about 156 steps per week, and the daily initial testing time was earlier by 15 min on average. The failure rate was 54.5% (37/64) during the early-stage application of the automated quality control which dropped to 10.2% (13/128) in the late-stage. Conclusion:The results of automated quality control detected in the pipeline system meet the quality indicators′ requirements of the laboratory, and the application of automated quality control can improve the quality control, save costs, reduce workload, and improve work efficiency.

Objective To establish an early prediction model for the diagnosis of severe acute pancreatitis based on the improved machine learning models,and to analyze its clinical value.Methods A case-control study was conducted on 352 patients with acute pancreatitis admitted to the Gastroenterology and Hepatobiliary Surgery Departments of the Army Medical Center of PLA and Emergency and Critical Care Medicine Department of No.945 Hospital of Joint Logistics Support Force of PLA from January 2014 to August 2023.According to the severity of the disease,the patients were divided into the severe group(n=88)and the non-severe group(n=264).The RUSBoost model and improved Archimead optimization algorithm was used to analyze 39 routine laboratory biochemical indicators within 48 h after admission to construct an early diagnosis and prediction model for severe acute pancreatitis.The task of feature screening and hyperparameter optimization was completed simultaneously.The ReliefF algorithm feature importance rank and multivariate logistic analysis were used to analyze the value of the selected features.Results In the training set,the area under curve(AUC)of the improved machine learning model was 0.922.In the testing set,the AUC of the improved machine learning model reached 0.888.The 4 key features of predicting severe acute pancreatitis based on the improved Archimedes optimization algorithm were C-reactive protein,blood chlorine,blood magnesium and fibrinogen level,which were consistent with the results of ReliefF algorithm feature importance ranking and multivariate logistic analysis.Conclusion The application of improved machine learning model analyzing the laboratory examination results can help to early predict the occurrence of severe acute pancreatitis.

ObjectiveTo evaluate the quality of research and evidence related to antihypertensive Chinese patent medicines combined with western medicines for the treatment of hypertension， synthesize and update the evidence， form expert consensus， and provide evidence for clinical decision-making. MethodThe databases of China National Knowledge Infrastructure （CNKI）， WanFang Data Knowledge Service Platform （WanFang）， Vip Chinese Science and Technology Journal Database （VIP）， Chinese Biomedical Literature Service System （Sinomed）， National Library of Medicine （PubMed）， Cochrane Library， Web of Science， and US Clinical Trials Registry were searched for randomized controlled trials of antihypertensive Chinese medicine combined with western medicine for the treatment of hypertension from database construction to July 31， 2022. The quality of the literature was evaluated using the bias risk assessment tool in Cochrane Handbook 6.3. Evidence synthesis of main outcome indicators was performed using R software. The Grading of Recommendations Assessment， Development， and Evaluation profiler （GRADEprofiler） 3.6 was employed to evaluate the quality of evidence. Expert consensus was formed based on the Delphi method after two rounds of voting. Result64 pieces of literature were included， and the results of literature quality evaluation and risk of bias showed that 70.31% （45/64） of the studies indicated some risks， and 29.69% （19/64） indicated high risks. Compared with conventional western medicines， the combination of Chinese patent medicines with western medicines can significantly lower systolic pressure （SBP） and diastolic pressure （DBP）， increase the effective rate of antihypertensive， reduce the incidence of adverse reactions， endothelin-1， and traditional Chinese medicine syndrome scores. Egger's test showed that Songling Xuemaikang capsules reduced SBP and DBP. Tianma Gouteng granules reduced SBP and DBP and increased the effective rate of antihypertensive， and Xinmaitong capsules reduced SBP and increased the effective rate of antihypertensive， without significant publication bias. Songling Xuemaikang capsules increased the effective rate of antihypertensive， and Xinmaitong capsules decreased DBP， with significant publication bias. The results of the GRADE evidence quality evaluation showed that most evidence was at grades B and C. Finally， four strong recommendations and 14 weak recommendations were formed. ConclusionCompared with conventional western medicines for the treatment of hypertension， antihypertensive Chinese patent medicines combined with western medicines have advantages in reducing blood pressure and improving drug use safety， but they are mostly weak recommendations in terms of efficacy， and more high-quality evidence is needed.

Objective:To develop a task-oriented exercise(TOE)program suitable for hospitalized elderly frailty patients, and to evaluate its effects on patients' upper and lower limb mobility and activities of daily living.Methods:Using the convenience sampling method, 60 elderly frailty patients admitted to Beijing Hospital between August and December 2019 were selected and randomly divided into a TOE group and a conventional care group, with 30 in each group.In addition to conventional treatment and care, the TOE group performed task-oriented training(turning to fetch objects and multidirectional stepping), while the conventional care group performed aerobic training and resistance training.Both groups completed 10 training sessions.Baseline data of patients in both groups were assessed before intervention.Grip strength(as a measure of upper limb motor function), the motor component of the World Health Organization disability assessment schedule(WHODAS)2.0(as a measure of lower limb motor function), and the modified Barthel index(as measure of the ability to perform activities of daily living)were assessed after intervention.Results:Before intervention, the grip strength values of the TOE group and the conventional care group were(20.21±6.39)kg and(17.61±10.59)kg, and the scores of the motor component of WHODAS 2.0 were(16.07±6.64)and(20.23±1.18), respectively.After intervention, the grip strength value and the score of the motor component of WHODAS 2.0 of the TOE group were(22.13±5.97)kg and(12.86±5.17)kg, respectively, with statistically significant differences compared with those of the conventional care group, which were(19.05±9.16)kg for grip strength and(15.67±1.11)for the motor component of WHODAS 2.0( t=2.005, P=0.049; t=-18.210, P<0.001).The value of grip strength and the score of the motor component of WHODAS 2.0 were higher post-intervention than pre-intervention in the TOE group( t=5.005、-5.291, P<0.001 for both), but they showed no statistical differences in the conventional care group( t=0.247、1.614, P=0.806, 0.112).After intervention, the total modified Barthel index scores of the TOE and conventional care groups were (55.27±37.12)and(57.27±33.39), respectively, higher than the pre-intervention scores, which were(42.27±29.92)and(40.54±20.55), respectively(both P<0.05).There was no statistical difference in total Barthel score between the two groups after intervention( t=1.042, P=0.303). Conclusions:For hospitalized elderly frailty patients, the TOE program is simple, easy to implement, safe and effective, and can not only achieve the same purpose of improving the ability to perform activities of daily living as the conventional exercise program, but also improve the performance of upper and lower limb motor function more quickly.

Objective:To investigate the status quo of psychological contracts and influencing factors among members of the "1+N" family doctor teams in Shenzhen and to explore the impact of psychological contracts on job burnout.Methods:This cross-sectional study was conducted from September 30 to October 31, 2022 among 361 members of 92 family doctor teams from 92 community health service centers which provided family doctor team service in Shenzhen city. A self-designed general information questionnaire, an employee psychological contract questionnaire (including organizational responsibility and personal responsibility dimensions), and a job burnout scale (including emotional exhaustion, depersonalization, and personal accomplishment dimensions) were used in the study. T-tests, one-way ANOVA, Pearson correlation analysis, and multiple linear regression analysis were used to analyze the influencing factors of psychological contracts and job burnout.Results:Among 361 respondents, there were 299 females (82.8%) and 62 males (17.2%), and a higher proportion of general practitioners (37.5%, 129/361) and nurses (41.8%, 151/361). The total score of psychological contracts among the 361 respondents was (141.6±19.5), with organizational responsibility scoring (70.6±11.2) and personal responsibility scoring (71.0±9.3). On the job burnout scale, emotional exhaustion scored (17.89±6.82), depersonalization scored (6.51±2.54), and personal accomplishment scored (30.95±5.70). General practitioners scored lower in organizational responsibility and personal responsibility compared to other members ( F=7.341,3.119, all P<0.05), and higher in emotional exhaustion and depersonalization ( F=7.637, 2.415, all P<0.05). Members with≤5 years of work experience scored lower in personal responsibility and personal accomplishment ( F=3.656, 4.205, all P<0.05). Correlation analysis showed that scores of organizational responsibility and personal responsibility were negatively correlated with levels of emotional exhaustion and depersonalization ( r=-0.618, -0.526, all P<0.01), ( r=-0.404, -0.393, all P<0.01), and positively correlated with personal accomplishment ( r=0.500, 0.558, all P<0.01). Multiple linear regression analysis indicated that organizational responsibility negatively affected emotional exhaustion and depersonalization ( β=-0.554, -0.274, all P<0.01), and positively affected personal accomplishment ( β=0.172, P<0.05). Personal responsibility positively affected personal accomplishment ( β=0.404, P<0.01). Conclusions:The study demonstrates that general practitioners in family doctor teams in Shenzhen city have lower psychological contract levels and are more prone to emotional exhaustion and depersonalization; members with≤5 years of work experience have lower personal responsibility and accomplishment. The results indicate that enhancing organizational responsibility can reduce job burnout of members in family doctor teams.

In order to solve the problem of strong subjectivity and difficulty in quantification,clinical objectification mainly adopts the techniques of image processing,computer vision and machine learning.The acquisition and processing of prior knowledge is a key link in the objectification of inspection,as well as an important elaboration of the quantification of subjective judgment and macro performance in objectification research.However,there is still a lack of in-depth summary and parametric processing of prior knowledge.Based on the analysis of the current research status of objectification of inspection,this paper uses data mining technology to summarize the experience of TCM inspection.Moreover,the observation information can be transformed into quantifiable digital features through natural language processing and representation learning.Meanwhile,the application of deep learning can realize automatic diagnosis and analysis of observation images to improve accuracy and efficiency,and promote the process of TCM modernization.

Objective To investigate the role of sodium-glucose cotransporter 1(SGLT1)inhibitor mizagliflozin(MIZA)in autosomal dominant polycystic kidney disease(ADPKD).Methods Western blotting,quantitative polymerase chain reaction(qPCR),and immunofluorescence staining were used to determine the expression and distribution of SGLT1 in kidney tissues of PKD1-/-and PKD1+/+mice,human renal cancer adjacent tissue and ADPKD tissue.Renal cyst lining epithelial cells OX161 and renal tubular epithelial cells UCL93 were treated with MIZA,incubated at 37℃for 24,48,and 72 h,and then were subjected to methyl thiazolyl tetrazolium and colony formation assay to observe cell proliferation.The qPCR method was used to determine the mRNA levels of collagen 1α1,collagen 3α1,and fibronectin 1 in OX161 cells treated with 100 μmol/L MIZA for 48 h.The Madin-Darby canine kidney(MDCK)cell 3D cyst formation assay verified the effect of MIZA on cyst formation.The mRNA-seq technology was used to detect differentially expressed genes between UCL93 cells and OX161 cells,and between OX161 cells and OX161 cells treated with 100 μmol/L MIZA for 48 h,and then the differentially expressed genes were analyzed with Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis.Results The expression level of SGLT1 was significantly increased in the tissues of ADPKD patients and PKD1-/-mice compared to those in normal kidney tissues(P＜0.05,P＜0.01).Immunofluorescence staining revealed that SGLT1 was mainly expressed in the cystic lining epithelial cells.Additionally,MIZA inhibited the proliferation and fibrosis of polycystic kidney cells in a concentration-and time-dependent manner,and also inhibited cyst formation in 3D formation assay in vitro.The mRNA-seq analysis and KEGG enrichment analysis showed that differentially expressed genes between OX161 cells and OX161 cells cultured in 100 μmol/L MIZA for 48 h were mainly enriched in the phosphatidylinositol 3-kinase(PI3K)-protein kinase B(Akt)and mitogen-activated protein kinase(MAPK)signaling pathways,which were the same as those between OX161 cells and UCL93 cells.Conclusion The SGLT1 inhibitor MIZA may inhibit the proliferation and fibrosis of polycystic kidney cells through signaling pathways such as PI3K-Akt and MAPK,delaying the growth of polycystic kidney,and it is a potential therapeutic target for ADPKD.

Objective To investigate the effect of progesterone receptor membrane component 1(PGRMC1)mediated autophagy on the sensitivity of liver cancer cells to 125I particles irradiation.Methods Hepatoma cell lines Huh7 and LM3 were exposed to different doses(0,2,4,6 and 8 Gy)of 125I particles,and cell autophagy was observed by transmission electron microscopy(TEM).Then,autophagy inhibitor chloroquine(CQ),agonist rapamycin(Rapa),and PGRMC1 inhibitor AG-205 were used respectively to verify that PGRMC1-mediated autophagy plays a key role in the sensitivity of hepatocellular carcinoma cells to 125I particle irradiation.Cell proliferation,colony formation and apoptosis were detected by CCK-8 assay,clonal formation test and flow cytometry,respectively.The expression levels of PGRMC1,microtubule-associated protein light chain 3-Ⅰ(LC3-Ⅰ),LC3-Ⅱ and p62 were detected by Western blotting.Results Different doses of 125I particles irradiation significantly decreased the proliferation and clonogenesis of Huh7 and LM3 cells(P＜0.05),and increased the apoptotic cells(P＜0.01),in a dose-dependent manner.Compared with the 0 Gy group,the ratio of LC3-Ⅱ/LC3-Ⅰ in Huh7 and LM3 cells was obviously increased,and the expression of p62 was significantly down-regulated in the 6 Gy group.The proliferation capacity and clonal formation ability of Huh7 and LM3 cells were decreased significantly,and their apoptotic cells were increased notably in the 6 Gy+CQ group than the 6 Gy group,while the above results were on the contrary in the 6 Gy+Rapa group.The 6 Gy+AG205 group had notably decreased LC3-Ⅱ/LC3-Ⅰ ratio in the Huh7 and LM3 cells,up-regulated p62 expression,reduced cell proliferation capacity and clone formation ability,and enhanced cell apoptosis when compared with the 6 Gy group,and the above results of the 6 Gy+PGRMC1 group were opposite.Conclusion Increment of PGRMC1 induced by 125I irradiation can promote autophagy,increase the proliferation and clonogenesis,and reduce the apoptosis in hepatocellular carcinoma cells.

Objective:To investigate the correlation of LymphGen genotyping with the clinicopathologic characteristics, efficacy and prognosis in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL).Methods:A retrospective case series study was conducted. The clinicopathological data and follow-up information of 132 DLBCL patients diagnosed and treated in the First Affiliated Hospital of Soochow University from January 2016 to January 2022 were collected. LymphGen genotyping was made based on the results of second-generation sequencing. The distributions of the main subtypes in the whole group and the stratification of all clinicopathological features were analyzed. The short-term efficacy of patients with different gene subtypes was compared. Survival analysis of patients with different gene subtypes was performed by using the Kaplan-Meier method.Results:Among the 132 patients, 69 were males and 63 were females. The median age was 60 years, with the age ranging from 13 to 87 years. Hans typing: germinal center B cell (GCB) type was detected in 49 cases, non-GCB type was detected in 81 cases, and the remaining 2 cases were unknown. Ann Arbor staging: 31 cases with stage Ⅰ-Ⅱ, 89 cases with stage Ⅲ-Ⅳ, and 9 primary central nervous system lymphoma (PCNSL) cases without stage, and the remaining 3 cases with unknown stage. Among the 132 patients, 64 cases (48.5%) were genotyped with LymphGen, including 6 cases (4.5%) of MCD subtype, 18 cases (13.6%) of A53 subtype, 17 cases (12.9%) of BN2 subtype, 3 cases (2.3%) of EZB subtype, 5 cases (3.8%) of ST2 subtype, and 15 cases (11.4%) of composite subtype, and 68 cases (51.5%) of the other subtypes; N1 subtype was not detected. The differences in the proportion of MCD subtype [5.0% (3/60) vs. 4.2% (3/71)], A53 subtype [16.7% (10/60) vs. 11.3% (8/71)], BN2 subtype [6.7% (4/60) vs. 18.3% (13/71)], EZB subtype [5.0% (3/60) vs. 0 (0/71)], ST2 subtype [5.0% (3/60) vs. 2.8% (2/71)], composite subtype [18.3% (11/60) vs. 5.6% (4/71)], other types [43.3% (26/60) vs. 57.7% (41/71)] were statistically significant between the patients with lactate dehydrogenase (LDH) < 245 U/L and those with LDH ≥245 U/L ( P = 0.023). There were no statistically significant differences in genotype distribution among subgroups with different age, gender, B symptoms, Hans typing, primary site, involvement site, Ann Arbor stage, international prognostic index score/international extranodal lymphoma study group score (all P > 0.05). After 4-6 courses treatment in PCNSL patients and 6-8 courses of standard first-line treatment in non-PCNSL patients, 17 patients with BN2 subtype [including 9 cases of complete remission (CR) and 4 cases of partial remission (PR)] and 3 patients with EZB subtype (including 2 cases of CR) had the higher proportion of those achieving good treatment outcomes. However, 15 patients with the composite subtype showed the worst outcomes including 5 cases of CR, 4 cases of PR, 1 case of stable disease, 3 cases of disease progression, and 2 death cases. The CR rates of the composite subtype group, non-composite subtype group, and other groups were 33.3% (5/15), 44.9% (22/49), and 66.2% (45/68), respectively; and the difference among these groups was statistically significant ( P = 0.034). The CR rate of composite type patients with BN2 subtype was higher compared to composite subtype patients without BN2 subtype (5/8 vs. 0/7), and the difference was statistically significant ( P = 0.023); 7 patients with A53 subtype combined with other subtypes except BN2 subtype did not achieve CR; 2 cases had PR, 3 cases had disease progression and 2 cases died. The median follow-up time was 26 months (ranging from 1 to 86 months) until the last follow-up in March 2023. There were no statistically significant differences in overall survival and progression-free survival among patients with different gene subtypes (all P > 0.05). Conclusions:The distribution of gene subtypes in DLBCL patients may be correlated with LDH levels. Patients with different gene subtypes show variations in short-term efficacy. The composite type patients with A53 subtype and without BN2 subtype have poor treatment outcomes, but no differences in overall survival and progression-free survival of patients with different gene subtypes are observed.