Objective: To evaluate the long-term effectiveness of an intelligent blood transfusion system in intraoperative blood management by comparing its performance with clinicians' decisions. Methods: A retrospective analysis of 26 760 surgical cases (2017-2024) was conducted, comparing pre- and post-implementation (2017-2019 vs 2020-2024) metrics, including transfusion prediction accuracy, rationality of blood use, and clinical outcomes. The system, powered by XGBoost, integrated patient demographics, laboratory results, and surgical data to predict red blood cell transfusion needs. Results: The intelligent blood transfusion systems achieved an accuracy of 80.62% in predicting transfusion necessity, significantly outperforming clinicians (24.83%, P<0.001). Its blood-use rationality rate was 83.92% vs 18.02% for clinicians (P<0.001). Post-implementation, major surgeries (grades Ⅲ-Ⅳ) increased while the requested blood units decreased. High physician compliance (>75%) correlated with 88.18% rationality. Conclusion: The intelligent blood transfusion system significantly improves the accuracy of transfusion decision-making, reduces excessive red blood cell use, optimizes perioperative transfusion management, and enhances the utilization of blood medical resources.

Background With the widespread application of ionizing radiation technology in non-medical fields, the number of non-medical radiation workers has steadily increased over the years. Individual dose monitoring serves as a crucial measure to safeguard the occupational health of non-medical radiation workers, as it can accurately identify occupational health risks and optimize radiation protection strategies. Objective To analyze the individual monitoring data of radiation workers from partial non-medical sectors in Shanghai from 2016 to 2023, to obtain the status of occupational radiation exposure and to provide a reference basis for non-medical radiation hygiene supervision and protection management. Methods The study subjects consisted of radiation workers from non-medical institutions in Shanghai who recieved individual dose monitoring at a Class-A radiation health technical service institution between 2016 and 2023. Under the Specifications for individual monitoring of occupational external exposure (GBZ 128-2019), thermoluminescence dosimetry was used for measuring personal dose equivalent, H_p(10), of various occupations encompassing industrial irradiation, industrial radiography, radioisotope production, accelerator operation, other industrial applications, education, and veterinary medicine. Kruskal-Wallis H test was used for comparison among multiple groups, Bonferroni method was adopted for pairwise comparison, and Mann-Kendall test was conducted for trend analysis to analyze the per-capita annual effective dose and its variation over time across different occupational categories of radiation workers. Results A total of 13728 person-times of non-medical radiation workers were monitored from 2016 to 2023, accumulating a collective effective dose of 3025.69 person-mSv. The per-capita annual effective dose M(P₂₅, P₇₅) was 0.14(0.08, 0.25) mSv. There were statistically significant differences in the per-capita annual effective dose of radiation workers in different years (H=874.826, P< 0.05). Similarly, significant variations were identified among various occupational categories (H=115.569, P< 0.05). Among them, the per-capita annual effective dose of radiological workers engaged in the production of radioactive isotopes was the highest, at 0.21(0.14, 0.32) mSv, followed by those in veterinary medicine, at 0.17 (0.11, 0.61) mSv; the difference between these two groups was not statistically significant (Z=1.231, P > 0.05), but both were significantly higher than those in other occupational categories (Z=3.913, 9.761, P<0.05). The veterinary medicine category had the highest proportion of monitored individuals with annual effective dose exceeding 1 mSv to the total number of monitored individuals(NR₁), reaching 17.12%, and the industrial radiography category showed the highest proportion of workers exposed to more than the annual investigation level 5 mSv to the total number of monitored individuals (NR₅), at 0.16%. Conclusion From 2016 to 2023, the overall individual doses of some non-medical radiation workers in Shanghai remain low, indicating well-controlled radiation levels in workplaces and low exposure risks. It is necessary to focus on radiation workers engaged in radioisotope production, veterinary medicine and industrial radiography.

(+)-Borneol, the main component of "Natural Borneol" in the Chinese Pharmacopoeia, is a high-end spice and precious medicine. Plant extraction cannot meet the increasing demand for (+)-borneol, while microbial biosynthesis offers a sustainable supply route. However, its production was extremely low compared with other monoterpenes, even with extensively optimizing the mevalonate pathway. We found that the key challenge is the complex and unusual dephosphorylation reaction of bornyl diphosphate (BPP), which suffers the side-reaction and the competition from the cellular dephosphorylation process, especially lipid metabolism, thus limiting (+)-borneol synthesis. Here, we systematically optimized the dephosphorylation process by identifying, characterizing phosphatases, and balancing cellular dephosphorylation metabolism. For the first time, we identified two endogenous phosphatases and seven heterologous phosphatases, which significantly increased (+)-borneol production by up to 152%. By engineering BPP dephosphorylation and optimizing the MVA pathway, the production of (+)-borneol was increased by 33.8-fold, which enabled the production of 753 mg/L under fed-batch fermentation in shake flasks, so far the highest reported in the literature. This study showed that rewiring dephosphorylation metabolism was essential for high-level production of (+)-borneol in Saccharomyces cerevisiae, and balancing cellular dephosphorylation is also helpful for efficient biosynthesis of other terpenoids since all whose biosynthesis involves the dephosphorylation procedure.

Objective:To explore the effects of bone mineral density (BMD) on postoperative cage subsidence in patients undergoing anterior cervical discectomy and fusion (ACDF) in different regions of the vertebrae.Methods:The study is a retrospective case-control analysis. The clinical and imaging data of 164 cervical spondylosis patients who underwent ACDF at Department of Spine Surgery, the Third Hospital of Hebei Medical University between January 2021 and June 2024 were retrospectively reviewed. Data from 147 patients (230 intervertebral spaces) constituted the analysis set, including 80 males and 67 females, with an age of (54.5±11.2) years (range: 32 to 81 years). Patients were grouped based on postoperative cage subsidence: 74 patients were included in the subsidence group, and 73 patients were included in the non-subsidence group (grouped by patients); 99 intervertebral spaces were included in the subsidence group, and 131 intervertebral spaces were included in the non-subsidence group (grouped by intervertebral space). Cage subsidence was defined as a≥3 mm loss of intervertebral height at the operated level on lateral radiographs during follow-up. Cervical BMD was assessed using Hounsfield Units (HU) values obtained from CT images. Independent sample t-test or Chi-squared test were used to compare baseline characteristics between groups. Multivariate Logistic regression analyzed the influence of HU values at different locations on cage subsidence. Receiver operating characteristic (ROC) curve analysis calculated the area under the curve (AUC) to evaluate the predictive value of HU values for cage subsidence and determine optimal thresholds. The Delong test compared the predictive differences for subsidence among HU values from different vertebral locations at the surgical fixation levels. A validation set comprising clinical data from 17 single-level surgery patients was used to further verify the accuracy of the established thresholds for predicting cage subsidence. Results:In the analysis set, there were no statistically significant differences in age, sex, body mass index, or underlying diseases between patients in the subsidence group and the non-subsidence group (all P>0.05). The HU values of subsided intervertebral spaces were lower than those of non-subsided intervertebral spaces (upper vertebra: 360.1±86.4 vs. 301.7±93.3, t=4.899, P<0.01; lower vertebra: 328.8±83.6 vs. 282.5±88.1, t=4.062, P<0.01; endplate of the upper vertebra: 604.7±150.9 vs. 521.6±125.3, t=4.446, P<0.01; endplate of the lower vertebra: 554.4±157.9 vs. 502.8±139.0, t=2.582, P=0.010). ROC curves showed that HU values at different locations of the surgical level all had predictive value for cage subsidence (upper vertebra: AUC=0.702, P<0.01; lower vertebra: AUC=0.667, P<0.01; endplate of the upper vertebra: AUC=0.657, P<0.01; endplate of the lower vertebra:AUC=0.610, P<0.01). The optimal thresholds for predicting cage subsidence for the upper vertebral body, lower vertebral body, endplate of the upper vertebra, and endplate of the lower vertebra were 325.0, 247.1, 533.1, and 547.4, respectively. However, the differences in predictive value among HU values from different vertebral locations were not statistically significant( P>0.05). In the validation set, the sensitivity and specificity of the HU value of upper vertebra for predicting cage subsidence were 6/7 and 9/10, respectively; for the lower vertebra, they were 5/7 and 9/10; for the endplate of the upper vertebra, they were 6/7 and 8/10; for the endplate of the lower vertebra, they were 5/7 and 8/10. Conclusion:The BMD of different parts of the vertebral body has potential predictive value for cage subsidence after ACDF surgery.

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Objective:To prepare a nano-barium titanate@gold Schottky junction (nano-BaTiO 3@Au) coating and investigate its effects on the adhesion, proliferation, and osteogenic differentiation of bone marrow stem cells (BMSCs), aiming to explore a titanium surface modification strategy with superior osteogenic activity. Methods:Pure titanium specimens served as the control group (Ti group). Titanium dioxide coatings were prepared on their surfaces via anodic oxidation. Nano-barium titanate (nBTO group) was further synthesized using the hydrothermal method. Gold nanoparticles were grown in situ on the nano-BaTiO 3 via high-temperature reduction of chloroauric acid using sodium citrate, yielding the nano-barium titanate@gold Schottky junction coating (nBTO@Au group). Surface morphology was observed by scanning electron microscopy (SEM). Elemental composition was analyzed using X-ray energy dispersive spectrum (EDS) and X-ray photoelectron spectroscopy (XPS). Crystal structure was analyzed using X-ray diffraction (XRD) and Raman spectroscopy. Hydrophilicity was assessed via water contact angle measurement. Specimens were co-cultured with BMSCs to evaluate biocompatibility and osteogenic properties. Cell proliferation on days 1, 3, 5, and 7 was assessed using the cell counting kit-8 (CCK-8) assay. Cytotoxicity towards BMSCs was assessed using live/dead cell staining. Cell morphology and adhesion were observed using cytoskeleton staining. Alkaline phosphatase (ALP) expression in BMSCs after 7 days was quantified using an ALP activity assay and ALP staining. Extracellular matrix mineralization after 7 days was evaluated using alizarin red staining and quantification assay. Each experiment was performed using three specimens per group. Results:Scanning electron microscopy revealed that gold nanoparticles with the diameter of(14.838±0.718) nm, uniform in size and homogeneously distributed, were successfully grown in situ on the surface of the nBTO coating. EDS and XPS confirmed the presence of Ba, Ti, O, and Au elements in the nBTO@Au composite coating. XRD and Raman spectroscopy analysis indicated that the nanostructured barium titanate (nBTO) coating was synthesized via a hydrothermal method.Water contact angle measurements showed that the contact angle was 66.8°± 0.45° for the control group, 22.55°±0.42° for the nBTO group, and 26.78°±1.15° for the nBTO@Au group, indicating good hydrophilicity of both nBTO and nBTO@Au coatings. On day 1 and day 3 of culture, the cell proliferation in the nBTO group was significantly lower than that in the control group ( P<0.05). In contrast, no significant differences were observed between the nBTO@Au group and either the control group or the nBTO group (all P>0.05). By day 5, the cell proliferation of nBTO@Au groups was significantly lower than that of the control group ( P<0.05), and the cell proliferation of nBTO group was significantly lower than that of the control group and that of the nBTO@Au group ( P<0.05). By day 7, there were no statistically significant differences in cell proliferation among all experimental groups ( F=1.62, P>0.05).Live/dead cell staining demonstrated that the cell survival rate exceeded 90% in all groups, with normal morphology and few dead cells, indicating good biocompatibility of the nBTO@Au coating. Compared to the control group, both nBTO and nBTO@Au groups promoted cell adhesion and spreading, although no significant difference in cell morphology was noted between the two modified groups. ALP staining revealed a larger stained area and deeper coloration in the nBTO@Au group. Quantitative results showed that ALP activity in the nBTO@Au group was significantly higher than that in both the nBTO and control groups ( P<0.05), and the nBTO group also exhibited significantly higher activity than the control group( P<0.05). Alizarin red staining indicated the deepest coloration in the nBTO@Au group, followed by the nBTO group, and the lightest in the control group. Quantitative analysis further confirmed that the amount of calcium nodule deposition in the nBTO@Au group was significantly greater than that in the other two groups ( P<0.05), and the nBTO group also showed significantly more deposition than the control group( P<0.05). Conclusions:This study successfully prepared an nBTO@Au coating possessing good biocompatibility and enhanced osteogenic properties.

Objective:To investigate and compare the clinical effect of anterolateral thigh perforator flap (ALTPF) with a pedicle of the oblique branch and a pedicle of the descending branch of lateral circumflex femoral artery in treatment of wounds in limbs.Methods:From December 2020 to December 2021, a retrospective analysis was performed on 53 patients who received reconstruction of wound with free ALTPF. Patients were divided into a group of ALTPF with oblique branch of lateral circumflex femoral artery (oblique branch group) and a group of ALTPF with descending branch of lateral circumflex femoral artery (descending branch group) according to the vascular pedicle. Of the blique branch group ( n=28): 12 patients had the wound in wrist, 3 in forearm, 7 in ankle and foot, and 6 in calf. The time for ALTPF reconstructive surgery after admission ranged from 0 to 25 days, with an average of 15.3 days. Among the patients, 6 received emergency treatment. The size of soft tissue defect was 5.0 cm×8.0 cm-21.0 cm×10.0 cm, and the size of flap was 6.0 cm×8.5 cm-22.0 cm×10.0 cm. Of the descending branch group ( n=25): 7 patients had the wound in wrist, 3 in forearm, 2 in upper arm, 10 in ankle and foot, and 3 in calf. The time for ALTPF reconstructive surgery after admission ranged from 0 to 22 days, with an average of 14.7 days. Among the patients, 4 received emergency treatment. The size of soft tissue defect was 12.0 cm×4.0 cm-28.0 cm×10.0 cm, and the size of flap was 13.0 cm×5.0 cm-28.0 cm×10.0 cm. The donor sites were directly sutured in layers after the surgery. The number of perforating branches in anterolateral thigh was detected by high-frequency CDU and recorded before surgery. The number, calibre, type of perforating branches observed during surgery and the size of flaps, length of the vascular pedicles of the flaps and the time for flap harvesting were recorded. Postoperative follow-up was conducted through outpatient visits, WeChat and other means. The survival of the flap, the healing of the donor site and complications were observed. The outcomes of flap reconstructive surgery were evaluated by the comprehensive score scale during follow-up. The data were analyzed using SPSS 22.0 statistical software. P<0.05 was considered statistically significant. Results:There is no significant difference in general information between the 2 groups ( P>0.05). In the oblique branch group, the length of vascular pedicle of the flaps was 5.0-15.0 (9.89±2.66) cm, the ratio of intermuscular perforator was 56.52%(26/46), and the inner diameter of perforators was 0.3-1.1 (0.67±0.20) mm and the time for flap harvesting was 22.5 (6.0-75.0) minutes. In the descending branch group, the length of vascular pedicle of the flaps was 7.0-16.0 (11.52±2.67) cm, the proportion of intermuscular perforator was 34.69%(17/49), the inner diameter of perforators of the flap was 0.3-1.2(0.70±0.23) mm and the time for flap harvesting was 35.0 (9.0-78.0) minutes. In comparison with the 2 groups, it was found that the oblique branch group had a shorter length of vascular pedicle, a higher proportion of intermuscular perforating branches and a shorter time in flap harvesting. The difference was statistically significant ( P<0.05). No statistically significant was found in the number and inner diameter of the perforating branches between the 2 groups ( P>0.05). Altogether, 51 flaps in the 2 groups survived. One flap in each group had partial necrosis at the distal end of flap, with the necrotic sizes of 5.0 cm×5.0 cm and 5.0 cm×4.0 cm, respectively, and they healed after skin grafting without obvious vascular. The survival rates of the 2 groups of flaps were 96.43% and 96.00%, respectively. The postoperative follow-up lasted for 6-18 months, with an average of 12 months. The appearance of the flaps in 10 patients was slightly bloated, and flap thinning and plastic surgery were carried out at 4-6 months after the primary flap surgery. Else, all the flaps regained protective sensation, all the donor sites and recipient sites healed well, and the donor sites of the thigh was good without pain, numbness or other discomfort. Comprehensive evaluations of the flaps were conducted at the final follow-up with the comprehensive evaluation scale for flaps. The scores of 28 patients in the oblique branch group achieved 73-98 with an average of 86.3. Twelve patients had the scores in comprehensive evaluation of excellent, 14 of good, and 2 of fair, with the excellent and good rate of 92.86%(26/28). The scores of 25 patients in the descending branch group ranged from 72-97 with an average of 85.8, of which 11 patients had the scores of comprehensive evaluation in excellent, 12 in good and 2 in fair, with the excellent and good rate of 92.00% (23/25). There was no statistically significant difference in the survival rate and comprehensive evaluation scales between the 2 groups of flaps ( P>0.05). Conclusion:ALTPF pedicled with oblique branch of lateral circumflex femoral artery has a higher number of perforating branch, a shorter harvesting time and less damage to the donor site than those of the ALTPF pedicled with descending branch of lateral circumflex femoral artery. When both oblique and descending branches of lateral circumflex femoral artery are present or with the absence of a descending perforating branch, the oblique branch of lateral circumflex femoral artery is the preferred perforating vessel for pedicle in harvesting of an ALTPF.

Objective To investigate the initial temperature sensation and pressure pain sensation in patients receiving invisible or-thodontic treatment.Methods Twenty-two patients receiving clear aligner treatment(experimental group)and 22 volunteers(control group)participated.Perceptual changes were assessed using the visual analogue scale(VAS)and quantitative sensory testing(QST).The QST employed in this study included warm detection threshold/heat pain threshold(WDT/HPT),cold detection threshold/cold pain threshold(CDT/CPT),and pressure pain threshold(PPT).Tests were conducted on teeth 21 and 31,their gums,the left hand,and the left masseter muscle.Assessments occurred at baseline,2 hours,24 hours,7 days,and 28 days after aligner placement.Re-sults In the experimental group,VAS scores peaked at 24 hours and then significantly decreased(P＜0.01).For teeth 21 and 31,the WDT and HPT of the labial attached gingiva,along with the PPT of these teeth,showed significant decreases at 24 hours and 7 days compared to baseline and the control group(P＜0.01).At 24 hours and 7 days,VAS scores were negatively correlated with the WDT and HPT of the labial attached gingiva of teeth 21 and 31(P＜0.05).Conclusion At 24 hours and 7 days post-clear aligner treatment,thermal sensitivity and pain,as well as pressure pain sensitivity,increased for the gingiva of teeth 21 and 31.Thermal sensitivity was also correlated with pain intensity.

Objective:To prepare a nano-barium titanate@gold Schottky junction (nano-BaTiO 3@Au) coating and investigate its effects on the adhesion, proliferation, and osteogenic differentiation of bone marrow stem cells (BMSCs), aiming to explore a titanium surface modification strategy with superior osteogenic activity. Methods:Pure titanium specimens served as the control group (Ti group). Titanium dioxide coatings were prepared on their surfaces via anodic oxidation. Nano-barium titanate (nBTO group) was further synthesized using the hydrothermal method. Gold nanoparticles were grown in situ on the nano-BaTiO 3 via high-temperature reduction of chloroauric acid using sodium citrate, yielding the nano-barium titanate@gold Schottky junction coating (nBTO@Au group). Surface morphology was observed by scanning electron microscopy (SEM). Elemental composition was analyzed using X-ray energy dispersive spectrum (EDS) and X-ray photoelectron spectroscopy (XPS). Crystal structure was analyzed using X-ray diffraction (XRD) and Raman spectroscopy. Hydrophilicity was assessed via water contact angle measurement. Specimens were co-cultured with BMSCs to evaluate biocompatibility and osteogenic properties. Cell proliferation on days 1, 3, 5, and 7 was assessed using the cell counting kit-8 (CCK-8) assay. Cytotoxicity towards BMSCs was assessed using live/dead cell staining. Cell morphology and adhesion were observed using cytoskeleton staining. Alkaline phosphatase (ALP) expression in BMSCs after 7 days was quantified using an ALP activity assay and ALP staining. Extracellular matrix mineralization after 7 days was evaluated using alizarin red staining and quantification assay. Each experiment was performed using three specimens per group. Results:Scanning electron microscopy revealed that gold nanoparticles with the diameter of(14.838±0.718) nm, uniform in size and homogeneously distributed, were successfully grown in situ on the surface of the nBTO coating. EDS and XPS confirmed the presence of Ba, Ti, O, and Au elements in the nBTO@Au composite coating. XRD and Raman spectroscopy analysis indicated that the nanostructured barium titanate (nBTO) coating was synthesized via a hydrothermal method.Water contact angle measurements showed that the contact angle was 66.8°± 0.45° for the control group, 22.55°±0.42° for the nBTO group, and 26.78°±1.15° for the nBTO@Au group, indicating good hydrophilicity of both nBTO and nBTO@Au coatings. On day 1 and day 3 of culture, the cell proliferation in the nBTO group was significantly lower than that in the control group ( P<0.05). In contrast, no significant differences were observed between the nBTO@Au group and either the control group or the nBTO group (all P>0.05). By day 5, the cell proliferation of nBTO@Au groups was significantly lower than that of the control group ( P<0.05), and the cell proliferation of nBTO group was significantly lower than that of the control group and that of the nBTO@Au group ( P<0.05). By day 7, there were no statistically significant differences in cell proliferation among all experimental groups ( F=1.62, P>0.05).Live/dead cell staining demonstrated that the cell survival rate exceeded 90% in all groups, with normal morphology and few dead cells, indicating good biocompatibility of the nBTO@Au coating. Compared to the control group, both nBTO and nBTO@Au groups promoted cell adhesion and spreading, although no significant difference in cell morphology was noted between the two modified groups. ALP staining revealed a larger stained area and deeper coloration in the nBTO@Au group. Quantitative results showed that ALP activity in the nBTO@Au group was significantly higher than that in both the nBTO and control groups ( P<0.05), and the nBTO group also exhibited significantly higher activity than the control group( P<0.05). Alizarin red staining indicated the deepest coloration in the nBTO@Au group, followed by the nBTO group, and the lightest in the control group. Quantitative analysis further confirmed that the amount of calcium nodule deposition in the nBTO@Au group was significantly greater than that in the other two groups ( P<0.05), and the nBTO group also showed significantly more deposition than the control group( P<0.05). Conclusions:This study successfully prepared an nBTO@Au coating possessing good biocompatibility and enhanced osteogenic properties.