Blood transfusion is an important life-support measure in modern medicine. As clinical demand for transfusion continues to rise, blood supply remains under persistent strain, making the efficient utilization of this precious medical resource a critical component of blood management. Accurate prediction of transfusion needs is of great significance for optimizing blood resource allocation and conserving blood products. Traditional transfusion decision-making relies on clinical experience and simplified scoring systems, which are insufficient to meet the demands of precision medicine. Machine learning (ML) technology can integrate multidimensional data—including demographic characteristics, laboratory indicators, surgical information, and dynamic physiological waveforms—to construct high-performance predictive models, offering a new approach to transfusion prediction. This article systematically reviews the application progress of ML in transfusion prediction across clinical scenarios such as trauma, the perioperative period, and obstetrics. In trauma, ML has been applied to early massive transfusion prediction, prehospital transfusion decision-making, and precise prediction in pediatric trauma. In the perioperative field, applications span specialties including traumatic brain injury, orthopedic surgery, cardiovascular and major vascular surgery, and hepatic surgery. In obstetrics, models can effectively predict postpartum hemorrhage and transfusion requirements associated with cesarean section. Studies have shown that algorithms such as random forest, gradient boosting machines, and deep neural networks achieve area under the receiver operating characteristic curve (AUC) values of 0.83-0.98 in massive transfusion prediction, 0.75-0.97 in perioperative scenarios, and 0.80-0.89 in obstetric transfusion prediction—significantly outperforming traditional scoring tools. However, current studies are generally limited by single-center retrospective designs, insufficient external validation, and inadequate reporting standards; limited model interpretability and challenges in clinical integration further constrain practical translation. Future research should focus on constructing multicenter data cohorts, integrating multimodal data, conducting prospective implementation studies, and deeply embedding models within electronic health record systems, thereby advancing the application of ML to optimize clinical transfusion decision-making.

Objective To investigate the current status of hypertension in the old adults living in urban city and rural areas in Qinghai Plateau and analyze the related influencing factors in order to provide data and evidence for targeted formulation of preventive and control measures for the pop-ulation.Methods Cluster-random sampling was used to subject 1372 elderly people(aged ≥60 years)from 8 urban areas and 25 natural villages in Xining City,Qinghai Province.Questionnaires were used to collect their demographic data,body mass index(BMI),history of chronic diseases,and lipid-related indicators.According to complicated with hypertension or not,they were divided into a hypertension group(615 cases)and a non-hypertension group(757 cases).SPSS 26.0 soft-ware was employed to perform statistical analyses with descriptive analysis and multivarlate un-conditional logistic regression analysis.Results Among the 1372 elderly persons,615 participants had hypertension,and the overall prevalence was 44.8％,and that in urban area and rural area was 50.1％and 38.5％,respectively,with significant difference(P＜0.01).Statistical differences were observed between those with and without hypertension in terms of age,BMI,and proportions of coronary heart disease(CHD),diabetes and stroke(P＜0.05,P＜0.01).In the urban populations,there were obvious differences in marital status,BMI,and proportions of CHD and diabetes be-tween those with and without hypertension(P＜0.01).For the rural populations,notable differ-ences were observed in age and proportions of CHD and diabetes between those with and without hypertension(P＜0.05,P＜0.01).Multivariate unconditional logistic regression analysis revealed that urban areas,obesity,CHD and diabetes were risk factors for hypertension in the elderly living in the urban and rural areas(OR=1.622,95％CI:1.299-2.026,P=0.000;OR=0.564,95％CI:0.315-1.006,P=0.042;OR=0.604,95％CI:0.417-0.874,P=0.008;OR=0.472,95％CI:0.328-0.678,P=0.000;OR=0.474,95％CI:0.334-0.673,P=0.000).Obesity,CHD and diabetes were risk factors for hypertension in those in the urban areas(OR=0.553,95％CI:0.317-0.963,P=0.036;OR=0.506,95％CI:0.320-0.800,P=0.004;OR=0.458,95％CI:0.303-0.692,P=0.000),and CHD and diabetes were risk factors in those in the rural areas(OR=0.382,95％CI:0.219-0.666,P=0.001;OR=0.452,95％CI:0.253-0.807,P=0.007).Conclusion There is sig-nificant difference in the prevalence of hypertension between the elderly living in the urban city and rural areas in Qinghai Plateau.The old adults with overweight,obesity,and complication of CHD and diabetes are prone to developing hypertension.

SUMMARY Hip fractures are common in elderly patients and are associated with significant morbidity and mortality,often referred to as the"last fracture of life".These fractures frequently result in a loss of functional independence.Evidence suggests that early surgical intervention can reduce mortality.The selection of treatment modality should take into account factors such as the type of fracture,the patient's age,and overall health status.This case report discusses an 88-year-old female patient who sustained an unstable intertrochanteric fracture of the left femur following a fall.She underwent closed reduction and internal fixation using an InterTAN intramedullary nail,resulting in a satisfactory postoperative recovery.Sixteen months following the surgical procedure,the patient presented with progressive pain in the left hip and ambulatory difficulties,absent from any evident trauma.Radiographic analysis identified a fracture of the left femoral neck accompanied by some degree of acetabular bone degradation attributable to the im-plant.Subsequently,the patient underwent removal of the internal fixation device and received a hemiar-throplasty.The postoperative course was uneventful,with marked improvements in both pain levels and functional capacity.This case underscored the intricate nature of femoral neck fractures following the internal fixation of intertrochanteric fractures.Contributing factors may include advanced age,osteoporo-sis,and stress shielding induced by the implant.In patients presenting with hip pain or gait disturbances months to years post-intertrochanteric fracture surgery,the potential for a new fracture should be consi-dered,even in the absence of an explicit traumatic incident.Radiographic imaging is imperative to exclude the presence of a fracture,particularly in individuals with high-risk factors such as advanced age,osteo-porosis,alcohol abuse,and a history of hormone therapy.Management of such cases may necessitate the removal of internal fixation devices and the implementation of hemiarthroplasty or total hip arthroplasty,contingent upon the patient's surgical tolerance.Crucially,anti-osteoporosis therapy serves as a vital pre-ventive strategy.Considering the high-risk profile of elderly patients with hip fractures,diligent follow-up and timely intervention are paramount to mitigating complications and mortality,thereby enhancing the quality of life for these patients.This case highlights the critical need for increased vigilance and compre-hensive management of elderly patients with hip fractures to enhance treatment outcomes and improve prognosis.

Objective Tetanus is a serious infectious diseases with high mortality,which is an important global public health issue.This study aims to analyze the epidemiological burden and changing trends of tetanus in China from 1990 to 2021,providing a basis for disease prevention and control.Methods Epidemiological indicators and global socio-demographic index(SDI)related to tetanus in China were retrieved and collected from the 2021 Global Burden of Disease database(GBD 2021).The trend analysis of the incidence rate,mortality rate and disability-ad-justed life years(DALYs)rate of tetanus in China from 1990 to 2021 was conducted by Joinpoint 5.3 software.Results From 1990 to 2021,the age-standardized incidence rate(ASIR),age-standardized mortality rate(ASMR),and age-standardized disability-adjusted life years(DALYs)rate of tetanus in China decreased significantly(average annual percent change[AAPC]＜0,P＜0.001),with males being significantly higher than females.The crude incidence rate,crude mortality rate,and crude DALYs rate for all age groups showed overall declining trends,with the lar-gest decline in the 0-14 years age group.In 2021,the crude incidence rate,crude mortality rate,and crude DALYs rate of tetanus in the population aged 70-years were higher than those in the population aged 0-14,15-49,and 50-69 years groups.The ASIR,ASMR,and age-standardized DALYs rate of tetanus in China in 2021 were lower than the global level,only higher than those in the high SDI regions.Conclusion From 1990 to 2021,the disease burden of tetanus in China varied with gender and age,with an overall declining trend over time.It is necessary to strengthen tetanus health education for males and the ≥70 years population,and to improve the overall level of pri-mary prevention measures for tetanus.

Objective To investigate the efficacy and safety of regional citrate anticoagulation(RCA)in continuous blood purification(CBP)treatment during the shock and infection phases of severe burns.Methods A retrospective analysis was conducted on the clinical data of 64 patients who received RCA-CBP treatment at the Burns Reseaich Institute,the First Affiliated Hospital of Army Medical University from Jan-uary 2015 to January 2024.The patients were divided into the burn shock phase(burn duration<2 days,n=18)and the burn infection phase(burn duration≥2 days,n=46)according to the start time of CBP treat-ment.General datas,total body surface area burned(TBSA),abbreviated burn severity index(ABSI),hemato-crit(HCT)at the start of CBP treatment,platelet count(PLT),activated partial thromboplastin time(APTT),serum creatinine,urea nitrogen,total bilirubin,acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,Child-Pugh score,filter usage time for each CBP treatment,the incidence of unplanned treatment termination,blood gas analysis,and adverse e-vents were compared between the two groups.Results Compared with the burn shock phase,the levels of HCT and PLT in the burn infection phase were lower,the levels of urea nitrogen and the incidences of shock,hyperlactatemia and hypoxemia were higher,the filter usage time was longer,and the incidence of unplanned treatment termination was lower,the differences were statistically significant(P<0.05).The results of mult-ivariate COX regression analysis showed that the burn shock phase was a protective factor for the filter usage time(P<0.05).Among the 64 patients,citrate accumulation occurred in 2 patients(3.1%),both of which were septic shock combined with hyperlactatemia during the burn infection stage.Patients with acid-base im-balance and electrolyte disorder were corrected after adjusting the treatment.There were 5 new bleeding e-vents,all of which were caused by the primary diseases.Conclusion RCA is safe and effective for CBP treat-ment in severe burned patients and can be used as a routine anticoagulant method.

SUMMARY Hip fractures are common in elderly patients and are associated with significant morbidity and mortality,often referred to as the"last fracture of life".These fractures frequently result in a loss of functional independence.Evidence suggests that early surgical intervention can reduce mortality.The selection of treatment modality should take into account factors such as the type of fracture,the patient's age,and overall health status.This case report discusses an 88-year-old female patient who sustained an unstable intertrochanteric fracture of the left femur following a fall.She underwent closed reduction and internal fixation using an InterTAN intramedullary nail,resulting in a satisfactory postoperative recovery.Sixteen months following the surgical procedure,the patient presented with progressive pain in the left hip and ambulatory difficulties,absent from any evident trauma.Radiographic analysis identified a fracture of the left femoral neck accompanied by some degree of acetabular bone degradation attributable to the im-plant.Subsequently,the patient underwent removal of the internal fixation device and received a hemiar-throplasty.The postoperative course was uneventful,with marked improvements in both pain levels and functional capacity.This case underscored the intricate nature of femoral neck fractures following the internal fixation of intertrochanteric fractures.Contributing factors may include advanced age,osteoporo-sis,and stress shielding induced by the implant.In patients presenting with hip pain or gait disturbances months to years post-intertrochanteric fracture surgery,the potential for a new fracture should be consi-dered,even in the absence of an explicit traumatic incident.Radiographic imaging is imperative to exclude the presence of a fracture,particularly in individuals with high-risk factors such as advanced age,osteo-porosis,alcohol abuse,and a history of hormone therapy.Management of such cases may necessitate the removal of internal fixation devices and the implementation of hemiarthroplasty or total hip arthroplasty,contingent upon the patient's surgical tolerance.Crucially,anti-osteoporosis therapy serves as a vital pre-ventive strategy.Considering the high-risk profile of elderly patients with hip fractures,diligent follow-up and timely intervention are paramount to mitigating complications and mortality,thereby enhancing the quality of life for these patients.This case highlights the critical need for increased vigilance and compre-hensive management of elderly patients with hip fractures to enhance treatment outcomes and improve prognosis.

Objective To investigate the current status of hypertension in the old adults living in urban city and rural areas in Qinghai Plateau and analyze the related influencing factors in order to provide data and evidence for targeted formulation of preventive and control measures for the pop-ulation.Methods Cluster-random sampling was used to subject 1372 elderly people(aged ≥60 years)from 8 urban areas and 25 natural villages in Xining City,Qinghai Province.Questionnaires were used to collect their demographic data,body mass index(BMI),history of chronic diseases,and lipid-related indicators.According to complicated with hypertension or not,they were divided into a hypertension group(615 cases)and a non-hypertension group(757 cases).SPSS 26.0 soft-ware was employed to perform statistical analyses with descriptive analysis and multivarlate un-conditional logistic regression analysis.Results Among the 1372 elderly persons,615 participants had hypertension,and the overall prevalence was 44.8％,and that in urban area and rural area was 50.1％and 38.5％,respectively,with significant difference(P＜0.01).Statistical differences were observed between those with and without hypertension in terms of age,BMI,and proportions of coronary heart disease(CHD),diabetes and stroke(P＜0.05,P＜0.01).In the urban populations,there were obvious differences in marital status,BMI,and proportions of CHD and diabetes be-tween those with and without hypertension(P＜0.01).For the rural populations,notable differ-ences were observed in age and proportions of CHD and diabetes between those with and without hypertension(P＜0.05,P＜0.01).Multivariate unconditional logistic regression analysis revealed that urban areas,obesity,CHD and diabetes were risk factors for hypertension in the elderly living in the urban and rural areas(OR=1.622,95％CI:1.299-2.026,P=0.000;OR=0.564,95％CI:0.315-1.006,P=0.042;OR=0.604,95％CI:0.417-0.874,P=0.008;OR=0.472,95％CI:0.328-0.678,P=0.000;OR=0.474,95％CI:0.334-0.673,P=0.000).Obesity,CHD and diabetes were risk factors for hypertension in those in the urban areas(OR=0.553,95％CI:0.317-0.963,P=0.036;OR=0.506,95％CI:0.320-0.800,P=0.004;OR=0.458,95％CI:0.303-0.692,P=0.000),and CHD and diabetes were risk factors in those in the rural areas(OR=0.382,95％CI:0.219-0.666,P=0.001;OR=0.452,95％CI:0.253-0.807,P=0.007).Conclusion There is sig-nificant difference in the prevalence of hypertension between the elderly living in the urban city and rural areas in Qinghai Plateau.The old adults with overweight,obesity,and complication of CHD and diabetes are prone to developing hypertension.

Objective Tetanus is a serious infectious diseases with high mortality,which is an important global public health issue.This study aims to analyze the epidemiological burden and changing trends of tetanus in China from 1990 to 2021,providing a basis for disease prevention and control.Methods Epidemiological indicators and global socio-demographic index(SDI)related to tetanus in China were retrieved and collected from the 2021 Global Burden of Disease database(GBD 2021).The trend analysis of the incidence rate,mortality rate and disability-ad-justed life years(DALYs)rate of tetanus in China from 1990 to 2021 was conducted by Joinpoint 5.3 software.Results From 1990 to 2021,the age-standardized incidence rate(ASIR),age-standardized mortality rate(ASMR),and age-standardized disability-adjusted life years(DALYs)rate of tetanus in China decreased significantly(average annual percent change[AAPC]＜0,P＜0.001),with males being significantly higher than females.The crude incidence rate,crude mortality rate,and crude DALYs rate for all age groups showed overall declining trends,with the lar-gest decline in the 0-14 years age group.In 2021,the crude incidence rate,crude mortality rate,and crude DALYs rate of tetanus in the population aged 70-years were higher than those in the population aged 0-14,15-49,and 50-69 years groups.The ASIR,ASMR,and age-standardized DALYs rate of tetanus in China in 2021 were lower than the global level,only higher than those in the high SDI regions.Conclusion From 1990 to 2021,the disease burden of tetanus in China varied with gender and age,with an overall declining trend over time.It is necessary to strengthen tetanus health education for males and the ≥70 years population,and to improve the overall level of pri-mary prevention measures for tetanus.

Objective To investigate the effect of tetrandrine(Tet)on injury of primary human articular chondro-cytes induced by interleukin-1β(IL-1β).Methods Human articular chondrocytes were divided into control group,IL-1β group,hypoxia inducible factor(HIF-1α)inhibitor group[2-methoxyestradiol(2-ME2)group],Tet groups containing low,medium and high concentrations.Each group has six replicated samples.MTT assay was used to de-tect the viability of cells;cell apoptosis was detected by flow cytometry;the level of inflammatory related factors like tumor necrosis factor-α(TNF-α),matrix metalloproteinase 3(MMP-3),inducible nitric oxide synthase(iNOS),cyclooxygenase-2(COX-2)and the activity of antioxidant factors like super oxide dismutase(SOD)and glutathione peroxides(GPx)in cells were detected by ELISA;Western blot was used to detect the expression of HIF-1α and VEGF in cells.Results Compared with the control group,the apoptosis rate,level of TNF-α,MMP-3,iNOS,COX-2 and the protein expression of HIF-1α and VEGF in IL-1β group all increased,the cell survival rate and the activity of SOD and GPx significantly decreased(P＜0.05);compared with IL-1β group,the apoptosis rate,the level of TNF-α,MMP-3,iNOS,COX-2 and the protein expression of HIF-1α and VEGF in 2-ME2 group and Tet groups with low,medium,and high concentration significanthy decreased(P＜0.05).The cell survival rate and the activity of SOD and GPx significantly increased(P＜0.05).Conclusions Tetrandrine attenuates IL-1β-in-duced injury of human articular chondrocytes.

Objective To analyze the management and countermeasures of adverse nursing events in a municipal tertiary hospital in Guangxi Zhuang Autonomous Region.Methods The adverse nursing events in 2023 in a municipal tertiary hospital in Guangxi were retrospectively analyzed.Logistic regression analysis was utilized to identify the causes of these adverse events and propose suitable countermeasures.Results In 2023,a total of 121 adverse nursing events were recorded,with falls being the most prominent(42 cases,accounting for 34.71％),followed by drug extravasation,drug safety incidents and unplanned ex-tubation,accounting for 13.22％,9.92％,and 7.44％respectively.Logistic regression analysis revealed that factors such as age ≥70 years,coexisting diseases,Basel Index score ≤40,pain score ≥4,tube slip risk assessment ≥10,RASS sedation score ≥3,NGASR score ≥9,lost risk assessment score ≥ 7,GCS Coma Scale score ≤8,Stress Injury Assessment Scale score ≤10,and Morse score ≥45 were associated with the risk of adverse nursing events.In addition,inadequate awareness of nursing risks among nursing staff,ineffective patient health education methods,and non-compliance to nursing protocols were identified as primary causes of adverse nursing events.Conclusion Advanced age,combined with other diseases,and hospitali-zation scale assessment results are critical factors for adverse nursing events.Lack of nursing responsibility and risk awareness among nursing staff,inadequate system implementation,and irregular operations can increase the risk.Hospitals should optimize management systems and work processes,enhance nursing staff training,and develop targeted preventive measures for adverse nursing events to improve the quality of nursing management and reduce the risk of adverse nursing events.