[Objective] To evaluate the risk of bacterial contamination of platelets apheresis and improve the clinical diagnosis rate of transfusion-transmitted bacterial infections. [Methods] A retrospective analysis was conducted on 11 cases involving bacterial contamination detected in apheresis platelets during quality inspections at our center from 2021 to 2023, as well as cases of transfusion-transmitted bacterial infection (TTBI) caused by platelet transfusion. The return of positive platelet bacteria test results and clinical transfusion adverse reactions were statistically analyzed. [Results] There were 9 donors with bacteria-contaminated platelets, of which 3 were reported as clinical transfusion reaction, 4 were detected by quality sampling, and 2 were identified by appearance detection before transfusion. The bacterial contamination rate of platelets was about 0.08% (9/10 762). The contaminated platelets were involved in 11 cases of TTBI, with an incidence of TTBI of approximately 0.05% (11/21 916). Only 3 cases of transfusion reactions were clinically reported, while the rest were case tracking with positive results of platelet bacterial test from quality sampling. The clinical return rate of TTBI was 27.27% (3/11), with an average reporting time of 8.12 hours after the occurrence of transfusion reactions. The majority of the contaminated platelets were detected at the end stage of storage, with 55.56% (5/9) of platelets collected on the 4th day after collection. Partial contaminated platelets were identified through quality sampling, with a positive rate of 2.78% (4/144). [Conclusion] The platelet bacterial contamination rate is high, but with low clinical return rate. It is recommended to conduct routine platelet bacterial monitoring and improve clinical diagnostic level.

Objective To investigate the influence of comorbidities on the prognosis of patients with status epilepticus， to develop Improved Comorbidity Burden Index （ICBI） based on Comorbidity Burden Index （CBI）， and to analyze the practicality of ICBI in assessing nonconvulsive status epilepticus in western China.Methods A total of 396 patients with status epilepticus who were treated in Department of Neurology， Intensive Care Unit， and Emergency Department， West China Hospital， Sichuan University， from December 2016 to December 2022 were enrolled， and all patients met the latest diagnostic criteria for status epilepticus issued by the International League Against Epilepsy （2015 edition）. SPSS 22.0 was used to perform a statistical analysis， and a Logistic regression analysis was used to investigate the influencing factors for in-hospital death and poor prognosis （with a Glasgow Outcome Scale score of 1-3）. CBI score was modified into ICBI score， with the addition of three comorbidities （immune system disorder， thyroid dysfunction， and hypoproteinemia） and consolidation of overlapping items， and the total score was calculated with each comorbidity contributing 1 score. The MedCalc-generated receiver operating characteristic （ROC） curve was used to analyze predictive value， and the area under the ROC curve （AUC） was used to reflect the diagnostic value of ICBI scale.Results Among the 396 patients with status epilepticus included in the study， 43 （10.9%） died in hospital and 114 （28.8%） had a poor prognosis. Digestive system diseases， respiratory system diseases， kidney and urinary system diseases， electrolyte/acid-base imbalance， infection， and immune system disorders were risk factors for in-hospital death of patients with status epilepticus. Digestive system diseases， respiratory system diseases， kidney and urinary system diseases， electrolyte/acid-base imbalance， hypoglycemia/hyperglycemia， infection， coagulation and blood disorders， nervous system disease， cardiovascular diseases， musculoskeletal disorders， and immune system disorders were risk factors for poor prognosis in patients with status epilepticus. The ROC curve analysis showed that ICBI>3 had an AUC of 0.914 in predicting in-hospital death， with a specificity of 71.37% and a sensitivity of 97.67% （P<0.000 1）， and ICBI>3 had an AUC of 0.882 in predicting poor prognosis， with a specificity of 81.56% and a sensitivity of 79.82% （P<0.000 1）. There were 327 patients with convulsive status epilepticus， among whom 41 patients died， and ICBI>3 had an AUC of 0.915 in predicting in-hospital death （P<0.000 1）. There were 100 patients with a poor prognosis， and ICBI>3 had an AUC of 0.867 in predicting poor prognosis （P<0.000 1）.Conclusion The in-hospital mortality rate is 10.9% in patients with status epilepticus in Sichuan， China， and ICBI>3 has a certain value in predicting in-hospital death and poor prognosis in patients with status epilepticus. There is no significant difference in ICBI score between convulsive status epilepticus and nonconvulsive status epilepticus.
Prognosis

The interaction of gut microbiota and its metabolites with the host not only plays an important role in maintaining gut homeostasis and host health, but also is a key link in responding to pathogen infections. A thorough understanding of the changes in gut microbiota and its metabolites during infection, as well as their role and mechanism in host defense against infection, is helpful to guide anti-infection treatment. This review focuses on the role of gut microbiota and their metabolites in host defense against bacterial, fungal, and viral infections, and reveals that they can exert anti-infection effects through resistance mechanisms (inducing antimicrobial substances, training immunity, inhibiting pathogen respiration, directly neutralizing pathogens, immune regulation) and tolerance mechanisms (altering energy metabolism patterns of microbiota, cell proliferation and tissue damage repair, maintaining physiological signal transduction in extraintestinal organs, inflammation regulation, maintaining the integrity of the intestinal barrier), and also summarizes measures to regulate gut microbiota against pathogen infections, in order to provide more ideas for novel anti-infection prevention and treatment strategies targeting gut microbiota and its metabolites.

Objective:To describe and analyze suicide risk of patients with schizophrenia,major depressive disorder,and bipolar disorder.Methods:A total of 2 016 patients with schizophrenia,903 patients with major de-pressive disorder,and 381 patients with bipolar disorder from inpatients,clinics,or communities who met the diag-nostic criteria of the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition were recruited.All patients were interviewed by psychiatrists using the Mini International Neuropsychiatric Interview to diagnose mental disor-ders and assess suicide risk,as well as Clinical-Rated Dimensions of Psychosis Symptom Severity(CRDPSS)to as-sess symptoms.Differences and risk factors of suicide risk among three types of mental disorders were explored u-sing multivariate logistic regression analysis.Results:In the past one month,37 patients with schizophrenia(1.8％),516 patients with major depressive disorder(57.1％),and 102 patients with bipolar disorder(26.8％)had suicide risk.Compared with patients with schizophrenia,suicide risk in patients with major depressive disorder(OR=36.50)and bipolar disorder(OR=20.10)increased.Female(OR=1.87),smoking(OR=1.76),family history of suicide(OR=5.09),higher score of CRDPSS hallucination(OR=1.80),and higher score of CRDPSS depression(OR=1.54)were risk factors of suicide risk of patients.Conclusions:Suicide risk of patients with ma-jor depressive disorder and bipolar disorder is higher than that of patients with schizophrenia.In clinical practice,it is important to regularly assess suicide risk of patients.Patients who experience symptoms of hallucination and de-pression should be paid more attention to.

Background Occupational stress is an important public health problem in the military. At present, there are few studies about occupational stress of officers and soldiers of the armed forces in China, especially the effects of plateau related environmental factors on occupational stress. Objective To understand current status and identify influencing factors of occupational stress among officers and soldiers stationed in plateaus, and provide a scientific basis for managing occupational stress. Methods In April 2023, stratified cluster sampling was used to recruit troops by deployed altitudes ranging from 500 to 3000 m into two strata of low altitude (＜2500 m) and high altitude (≥2500 m) based on the medical definition of plateau. Two regimental units were randomly selected from each stratum respectively, and one battalion unit was randomly selected from each regimental unit with all the officers and soldiers. Four selected battalion units were surveyed with a total of 2284 officers and soldiers. We designed a general questionnaire to collect their basic information, and distributed effort-reward imbalance questionnaires to evaluate occupational stress. We used logistic regression to identify potential influencing factors of occupational stress. Results Positive occupational stress was reported in 508 plateau-stationed officers and soldiers, with a prevalence rate of 22.2%. The total effort-reward imbalance score and the dimensional scores of effort, reward, and overcommitment in M (P₂₅, P₇₅) were 0.9 (0.7, 1.0), 16.0 (13.0, 19.0), 36.0 (33.0, 39.0), and 18.0 (15.0, 19.0), respectively. There were significant differences in the positive rate of occupational stress by gender, age, military service length, marital status, only child or not, physical fitness condition, reporting underlying diseases or not, exercise frequency before conscription, psychological changes after entering the plateaus, and having altitude sickness or not (P <0.05). The results of logistic regression showed that being female (OR=1.532, 95%CI: 1.061, 2.213), only child (OR=1.281, 95%CI: 1.038, 1.581), and with underlying diseases (OR=1.950, 95%CI: 1.340, 2.839) were associated with a higher risk of occupational stress. While setting 0 to <3 years of military service as the control group, the risk of occupational stress was higher in subgroups of 3 to 9 years (OR=1.380, 95%CI: 1.113, 1.710) and ≥9 years (OR=2.141, 95%CI: 1.461, 3.137). The participants reporting nervousness or fear (OR=1.728, 95%CI: 1.133, 2.635) and agitation or euphoria (OR=1.380, 95%CI: 1.113, 1.710) had a higher risk of reporting occupational stress than those with no psychological changes after entering the plateaus. Meanwhile, those who had regular exercise (OR=0.670, 95%CI: 0.492, 0.913) before enlistment, good physical fitness condition (OR=0.572, 95%CI: 0.426, 0.767) and excellent physical fitness condition (OR=0.502, 95%CI: 0.366, 0.688) had a lower risk of occupational stress. Conclusion Officers and soldiers in plateaus generally report a high rate of occupational stress. Female, military service length ≥3 years, being only child, with underlying diseases, nervousness/ fear or agitation/ euphoria after entering plateaus are risk factors for elevated occupational stress in this group; while good or excellent physical fitness condition and frequent exercise before enlistment are protective factors for occupational stress. Therefore, it is necessary to pay attention to the occupational stress problems in officers and soldiers stationed in plateaus and provide targeted intervention measures.

Objective To explore the reliability and safety of continuous monitoring of vital signs in patients using wireless wearable monitoring devices after video-assisted thoracoscopic surgery (VATS) for lung cancer. Methods The patients undergoing VATS for lung cancer in West China Hospital, Sichuan University from May to August 2023 were prospectively enrolled. Both wireless wearable and traditional wired devices were used to monitor the vital signs of patients after surgery. Spearman correlation analysis, paired sample t test and ratio Bland-Altman method were used to test the correlation, difference and consistency of monitoring data measured by the two devices. The effective monitoring rate of the wireless wearable device within 12 hours was calculated to test the reliability of its continuous monitoring. Results A total of 20 patients were enrolled, including 15 females and 5 males with an average age of 46.20±11.52 years. Data collected by the two monitoring devices were significantly correlated (P<0.001). Respiratory rate and blood oxygen saturation data collected by the two devices showed no statistical difference (P>0.05), while heart rate measured by wireless wearable device was slightly lower (=−0.307±1.073, P<0.001), and the blood pressure (=1.259±5.354, P<0.001) and body temperature(=0.115±0.231, P<0.001) were slightly higher. The mean ratios of heart rate, respiratory rate, blood oxygen saturation, blood pressure and body temperature collected by the two devices were 0.996, 1.004, 1.000, 1.014, and 1.003, respectively. The 95% limits of agreement (LoA) and 95% confidence interval of 95%LoA of each indicator were within the clinically acceptable limit. The effective monitoring rate of each vital signs within 12 hours was above 98%. Conclusion The wireless wearable device has a high accuracy and reliability for continuous monitoring vital signs of patients after VATS for lung cancer, which provides a security guarantee for subsequent large-scale clinical application and further research.

Objective To study the RHD genotyping of primary screening RhD negative population in Beijing,and an-alyze the serological characteristics of different genotypes and the distribution of Rh phenotypes.Methods From August 2022 to January 2024,204 RhD negative samples in our hospital were initially screened by microplate or microcolumn agglu-tination method.RhD antigen phenotype was identified by saline tube method,and RhD negative confirmation test was per-formed by microcolumn gel-indirect antiglobulin technology.RHD genotyping was performed by polymerasing chain reaction-sequence specific primmer(PCR-SSP)method and sequencing technology,and the phenotypic frequency and gene frequen-cy were calculated.Results The distribution of Rh serologic phenotypes in 204 RhD negative samples were 112 cases of ccee(54.90%)>73 cases of Ccee(35.78%)>9 cases of CCee(4.41%)>6 cases of ccEe(2.94%)>4 cases of CcEe(1.96%).A total of 7 RHD genotypes were detected in this study,including 129 cases of RHD?01N.01(63.24%),44 ca-ses of RHD?01EL.01(21.57%),26 cases of RHD?01N.03(12.75%),2 cases of RHD?01N.16(0.98%),1 case of RHD?06.03.01(0.49%),1 case of weak RHD?15(0.49%)and 1 case of RHD?13.01/RHD?01N.01(0.49%).The frequency and phenotype distribution of Rh blood group antigen gene were consistent with Hardy-Weinberg equilibrium(P>0.05).Conclusion The RHD gene is polymorphic in the primary screening RhD negative population in Beijing,and the most common RhD negative genotype is RHD?01N.01,and the RHD variant is RHD?01EL.01.This study may provide data to support the clinical implementation of genotype-matched blood transfusions.

Objective To investigate the correlation between random urinary albumin-to-creatinine ratio(ACR)and 24 hour urine total protein quantification(24h UTP)in patients with immunoglobulin A nephropathy(IgAN),and analyze the consistency of these methods in clinical diagnosis.Methods A total of 230 patients with primary IgAN admitted to Peking University Shenzhen Hospital from January 2019 to December 2020 were selected as the research subjects.Correlation analysis and intraclass correlation coefficient(ICC)were used to assess the correlation between ACR and 24h UTP and their consistency in clinical diagnosis.Subgroup analysis was performed using different chronic kidney disease(CKD)stages and urine protein levels.Receiver operating characteristic(ROC)curves were plotted with 24h UTP=0.5 g/24h,1.0 g/24h and 3.5 g/24h as boundary points to determine the optimal cut-off values for ACR.Results There was a positive correlation between ACR[0.79(0.41～1.45)g/g]and 24h UTP[1.02(0.58～1.80)g/24h]in patients with IgAN(r=0.85,P<0.01),and the consistency in clinical diagnosis between the two methods was moderate(ICC=0.63,P<0.01).Subgroup analysis revealed that the correlation and consistency between ACR and 24h UTP was not affected by CKD stages,with correlation coefficients(r)of different CKD staging ranging from 0.76 and 0.86(all P<0.01)and ICC values ranging from 0.53 and 0.72 across different CKD stages.However,it was affected by urine protein level.When 24h UTP was≤0.5 g/24h,there was no significant correlation between ACR and 24h UTP(r=0.08,P>0.05).In subgroups with 24h UTP≤0.5 g/24h,0.5 g/24h<24h UTP≤1 g/24h and 24h UTP>3.5 g/24h,the consistency between the two methods was negligible(all ICC<0.20).ROC curve results showed that when 24h UTP=0.5 g/24h,1.0 g/24h and 3.5 g/24h,the optimal cut-offvalues of ACR were 0.30 g/g,0.57 g/g and 1.28 g/g,respectively.Conclusion In IgAN patients,ACR cannot simply replace 24h UTP for urine protein level evaluation.Especially when 24h UTP≤1 g/24h and 24h UTP>3.5 g/24h,ACR may not accurately reflect the true urine protein level.

Objective:To investigate the value of systemic inflammatory response syndrome (SIRS), pediatric sequential organ failure assessment (pSOFA) and pediatric critical illness score (PCIS) in predicting mortality of pediatric sepsis in pediatric intensive care units (PICU) from Southwest China.Methods:This was a prospective multicenter observational study. A total of 447 children with sepsis admitted to 12 PICU in Southwest China from April 2022 to March 2023 were enrolled. Based on the prognosis, the patients were divided into survival group and non-survival group. The physiological parameters of SIRS, pSOFA and PCIS were recorded and scored within 24 h after PICU admission. The general clinical data and some laboratory results were recorded. The area under the curve (AUC) of the receiver operating characteristic curve was used to compare the predictive value of SIRS, pSOFA and PCIS in mortality of pediatric sepsis.Results:Amongst 447 children with sepsis, 260 patients were male and 187 patients were female, aged 2.5 (0.8, 7.0) years, 405 patients were in the survival group and 42 patients were in the non-survival group. 418 patients (93.5%) met the criteria of SIRS, and 440 patients (98.4%) met the criteria of pSOFA≥2. There was no significant difference in the number of items meeting the SIRS criteria between the survival group and the non-survival group (3(2, 4) vs. 3(3, 4) points, Z=1.30, P=0.192). The pSOFA score of the non-survival group was significantly higher than that of the survival group (9(6, 12) vs. 4(3, 7) points, Z=6.56, P<0.001), and the PCIS score was significantly lower than that of the survival group (72(68, 81) vs. 82(76, 88) points, Z=5.90, P<0.001). The predictive value of pSOFA (AUC=0.82) and PCIS (AUC=0.78) for sepsis mortality was significantly higher than that of SIRS (AUC=0.56) ( Z=6.59, 4.23, both P<0.001). There was no significant difference between pSOFA and PCIS ( Z=1.35, P=0.176). Platelet count, procalcitonin, lactic acid, albumin, creatinine, total bilirubin, activated partial thromboplastin time, prothrombin time and international normalized ratio were all able to predict mortality of sepsis to a certain degree (AUC=0.64, 0.68, 0.80, 0.64, 0.68, 0.60, 0.77, 0.75, 0.76, all P<0.05). Conclusion:Compared with SIRS, both pSOFA and PCIS had better predictive value in the mortality of pediatric sepsis in PICU.

Objective The objective of this study was to establish a mouse model of allergic rhinoconjunctivitis and investigate the role of the NLRP3 signaling pathway in allergic rhinoconjunctivitis.Methods Thirty-three female C57 mice(SPF)were randomLy divided into 3 groups:the control group,the experimental group,and the NLRP3-/-group.On days 0,4,7,14,and 21,the experimental group and NLRP3-/-group received a 0.2 mL intraperitoneal injection of medicine containing OVA(100 μg)and adjuvant Al(OH)3(4 mg),respectively.After an interval of 3 days,each eye and nose were dosed with 10 μL of 5%OVA for five consecutive days a week to induce allergic symptoms.During sensitization and excitation stages,the control group was replaced with an equiva-lent amount of PBS.Ocular and nasal symptoms were observed and scored.The levels of OVA-specific IgE,IL-4,IL-17,and IL-18 in serum were measured using ELISA,while changes in palpebral conjunctiva and nasal mucosa were assessed by hematoxylin-eosin staining.The expression of NLRP3 mRNA in conjunctival tissue and nasal mucosa was determined using real-time PCR analysis.Statistical analysis was performed using SPSS17.0 software with P<0.05 considered as statistically significant difference.Results The experimental group and NLRP3-/-group exhibited induced nasal and ocular allergic symptoms.In the experimental group,the duration of nasal allergy symptoms was(10.500±1.080)days,while the duration of eye allergy symptoms was(20.300±2.058)days.In the NLRP3-/-group,the duration of nasal allergy symptoms was(13.400±1.955)days,and for eye allergy symp-toms it was(20.900±2.132)days.The duration of nasal allergies in the NLRP3-/-group significantly exceeded that in the experimental group(P<0.05),whereas there were no significant differences observed in eye allergy durations between these two groups(P>0.05).Levels of OVA-specific IgE,IL-4,and IL-17 were significantly higher in both the experimental and NLRP3-/-groups compared to those in the control group(P<0.05).Additionally,serum IL-18 content increased significantly in the experimental group when compared with both control and NLRP3-/-groups(P<0.05).Conjunctival tissue lesions as well as nasal mucosa damage were evident in both experimental and NLRP3-/-groups.mRNA expression levels of NLRP3 within conjunctival tissue and nasal mucosa from the experimental group showed a significant increase when compared to those from both control and NLRP3-/-groups(P<0.05).Conclusion Allergic rhinoconjunctivitis pathogenesis is influenced by various factors;however,the involvement of NLPR3 signaling pathway promotes its development.