[Objective] To explore the effectiveness of applying the PDCA (Plan-Do-Check-Act) cycle to enhance the compatibility rate of five Rh blood group antigen phenotypes between donors and recipients across multiple hospital campuses. [Methods] Clinical blood transfusion data from May to July 2022 were selected. Specific improvement measures were formulated based on the survey results, and the PDCA cycle management model was implemented from August 2022. The post-intervention phase spanned from August 2022 to October 2023. The Rh phenotype compatibility rate, the detection rate of Rh system antibodies, and the proportion of Rh system antibodies among unexpected antibodies were compared between the pre-intervention phase (May to July 2022) and the post-intervention phase. [Results] After the continuous improvement with the PDCA cycle, the compatibility rate for the five Rh blood group antigen phenotypes between donors and recipients from August to October 2023 reached 81.90%, significantly higher than the 70.54% recorded during the pre-intervention phase (May to July 2022, P<0.01), and displayed a quarterly upward trend (β=0.028, P<0.05). The detection rate of Rh blood group system antibodies (β=-9.839×10^-5, P<0.05) and its proportion among all detected antibodies (β=-0.022, P<0.05) showed a quarterly decreasing trend, both demonstrating a negative correlation with the enhanced compatibility rate (r values of -0.981 and -0.911, respectively; P<0.05). [Conclusion] The implementation of targeted measures through the PDCA cycle can effectively increase the compatibility rate of five Rh blood group antigen phenotypes between donors and recipients, reduce the occurrence of unexpected Rh blood group antibodies, thereby lowering the risk of transfusion and enhancing the quality and safety of medical care.

Objective To investigate the therapeutic effect of Gypenoside L(Gyp-L)on diabetic retinopathy(DR)rats and its effect on the p38 mitogen-activated protein kinase(MAPK)signaling pathway.Methods Rats were divided into 6 groups(n=12):blank group,model group,low,medium,high dose group and combination group.The blank group was normal control rats,and the other groups were DR rat models.Rats in the blank group and model group were intragastrically administered with sodium carboxymethyl cellulose.Rats in the low,medium and high dose group were ga-vaged with 50,100,and 200 mg·kg-1·d-1 of Gypenoside L solution,respectively.Rats in the combination group were gavaged with 200 mg·kg-1·d-1 of Gypenoside L solution,and 2 mg·kg-1·d-1 of p38 MAPK agonist Anisomycin was in-jected into the tail vein.The rats in each group were gavaged with a volume of 2 mL per day for a total treatment period of 4 weeks.After the treatment,fundus photography was performed on the rats in each group,and retinal tissues were stained with hematoxylin and eosin(HE).Fasting blood glucose was measured using a Roche blood glucose meter,and se-rum insulin levels were measured using an ELISA kit.Retinal superoxide dismutase(SOD),catalase(CAT),glutathione peroxidase(GSH-Px),malondialdehyde(MDA),tumor necrosis factor-α(TNF-α),interleukin(IL)-1 β,and IL-6 levels were measured according to the instructions of the kit.Western blot was used to detect the protein levels of p38 MAPK,p-p38 MAPK,p65 nuclear factor-κB(NF-κB),p-p65 NF-κB,inducible nitric oxide synthase(iNOS),and cyclooxygenase(COX-2)in the retina.Results Compared with the model group,the blood glucose level was decreased,the serum insu-lin level was increased,the fundus neovascularization was reduced,the retinal damage was alleviated,the retinal SOD,CAT and GSH-Px levels were increased,the MDA level was decreased,the TNF-α,IL-1β and IL-6 levels were decreased,and the p-p38 MAPK,p-p65 NF-κB,iNOS and COX-2 protein levels were decreased in the low,medium and high dose group(all P＜0.05).Compared with the high dose group,the blood glucose level in the combination group was increased,the serum insulin level was decreased,the fundus neovascularization increased,the retinal damage was aggravated,the ret-inal SOD,CAT and GSH-Px levels were decreased,the MDA level was increased,the TNF-α,IL-1[3 and IL-6 levels were in-creased,and the p-p38 MAPK,p-p65NF-κB,iNOS and COX-2 protein levels were increased(all P＜0.05).Conclusion This study shows that Gypenoside L can reduce inflammation and oxidative stress by blocking the p38 MAPK signaling path-way,thereby playing a role in the treatment of DR.

Objective To investigate the effects of sample transport and sorting system on the detection results of common clinical bio-chemical and immunological items carried out in our laboratory.Methods A total of 25 patients admitted to Zidong Hospital of Jiangsu Provincial Hospital of Traditional Chinese Medicine in June 2024 were included in this study,and four blood samples were collected from each patients using vacuum blood vessels with separation gel containing coagulant.These samples were transferred to the laboratory department through manual transport or pneumatic logistics transmission,and the manual sorting approach or intelligent blood vessel sorting system was used to encode the samples.The effects of different sample transportation methods and sorting methods on the detec-tion results of 46 clinical biochemical parameters,12 tumor markers and 5 thyroid hormone items,which were carried out in our labora-tory,were analyzed and compared.Results No significant change on hemolytic index(HI)was found through pneumatic tube system(PTS)and intelligent blood vessel sorting system(P＞0.05).The results of AST,CK-MB,α-HBDH,and LDH in clinical biochemical parameters following PTS were significantly different from those in artificial transport group(all P＜0.05).Both the results of Cyfra21-1 and NSE in immunological items in the samples after PTS transport were significantly different from those obtained by either manual transport or intelligent sorting system,with statistical significance(all P＜0.05).Conclusion PTS basically meets the requirements of clinical laboratories,but it can lead to the increase of AST,CK-MB,α-HBDH and LDH in clinical biochemistry,as well as Cyfra21-1 and NSE in immunology,which needs to be further improved,refined,and validated in order to meet the clinical requirements.

Objective To explore the correlation between cold-induced RNA binding-protein(CIRP)and NF-κB levels with cognitive dysfunction in elderly patients with ischemic cerebral small vessel disease.Methods 135 elderly patients with ischemic cerebral small vessel disease admitted to our hospital from March 2021 to June 2024 were selected as research subjects.They were divided into a cognitive normal group(n=48)and a cognitive impairment group(n=87)based on whether cognitive dysfunction occurred.Multiple linear regression was used to analyze the relationship between cognitive impairment and inflammatory indicators,while the dose-response relationship of CIRP and NF-κB with cognitive impairment were estimated using restricted cubic spline method.The cognitive impairment group was further divided into mild cognitive impairment group(n=30),moderate cognitive impairment group(n=32),and severe cognitive impairment group(n=25)based on the severity of the condition.Ordered regression analysis was used to investigate the impact of CIRP and NF-κB on patient's condition;ROC curve was used to evaluate the predictive value of CIRP and NF-κB for moderate to severe cognitive impairment,and explore the mediating role of inflammation related factors between CIRP/NF-κB and mini-mental state examination(MMSE)scores.Results TNF-α,IL-6,IL-1β,CIRP and NF-κB are all factors affecting cognitive impairment(P＜0.05).CIRP and NF-κB were significantly positively correlated with TNF-α,IL-4,IL-10,IL-1β,MCP-1,TGF-β1 and hs CRP(P＜0.05),and significantly negatively correlated with TGF-β1(P＜0.05).The correlation of CIRP and NF-κB levels with cognitive impairment showed a non-linear dose-response relationship(P＜0.05).There was still an independent correlation(P＜0.05)of TNF-α,IL-6,IL-1β,CIRP and NF-κB with the severity of cognitive impairment.High levels of CIRP and NF-κB showed a synergistic effect with high levels of TNF-α,IL-6 and IL-1 β.The AUC value of CIRP and NF-κB for predicting severe cognitive impairment were 0.745 and 0.792,respectively,with a combined prediction AUC of 0.840.TNF-α,IL-4,IL-10,IL-1β,MCP-1,TGF-β1 and hs CRP play a mediating regulatory role between MMSE score and CIRP/NF-κB.Conclusion CIRP and NF-κB participate in the regulation of inflammatory responses and are closely related to cognitive dysfunction and severity of elderly patients with ischemic cerebrovascular disease.Monitoring the changes of CIRP and NF-κB are beneficial for clinical evaluation of patients' cognitive function.

Objective To investigate the protective effect of Danggui Shaoyao powder on ovarian function in cyclophospha-mide induced premature ovarian failure rats by regulating the adenosine monophosphate-activated protein kinase(AMPK)/mam-malian target of rapamycin(mTOR)signaling pathway.Methods Seventy-two rats were randomly divided into control group,model group,low-dose Danggui Shaoyao powder(L-Danggui Shaoyao powder,6.11 g/kg)group,medium dose Danggui Shaoyao powder(M-Danggui Shaoyao powder,12.22 g/kg)group,high-dose Danggui Shaoyao powder(H-Danggui Shaoyao powder,24.44 g/kg)group,and H-Danggui Shaoyao San+AMPK agonist AICAR(H-Danggui Shaoyao powder+AICAR,24.44 g/kg Danggui Shaoyao powder+200 mg/kg AICAR)group,with 12 rats in each group.The number of follicles at different stages was observed.ELISA,HE staining,TUNEL kit,and Western blot were used to detect FSH,E2,AMH,LH levels,ovarian tissue pathological changes,cell apoptosis,and expression of AMPK/mTOR pathway related proteins.Results Compared with Con-trol group,the FSH,LH,number of blocked follicles,apoptosis rate,Bax,Caspase-3,and p-AMPK/AMPK protein expression were higher in model group,while E2,AMH,primordial,primary,secondary,and antral follicles,Bcl-2,and p-mTOR/mTOR protein expression were lower(all P＜0.05).Compared with model group,FSH,LH,number of blocked follicles,apoptosis rate,Bax,Caspase-3,and p-AMPK/AMPK protein expression were lower in L,M,and H-Danggui Shaoyao powder groups,while E2,AMH,primordial,primary,secondary,and antral follicles,Bcl-2,and p-mTOR/mTOR protein expression were higher(all P＜0.05).Compared with the H-Danggui Shaoyao powder group,FSH,LH,number of blocked follicles,apoptosis rate,Bax,Caspase-3,and p-AMPK/AMPK protein expression were higher in H-Danggui Shaoyao powder+AICAR group,while E2,AM H,primordial,primary,secondary,and antral follicles,Bcl-2,and p-mTOR/mTOR protein expression were lower(allP＜0.05).Conclusion The improvement of ovarian function in cyclophosphamide induced premature ovarian failure rats by Dang-gui Shaoyao powder may be related to AMPK/mTOR pathway inhibition.

Objective:To explore the correlation between the expression of fucosylated proteins in colonic epithelium (abbreviated as colonic fucosylation level) and the clinical efficacy of ustekinumab (UST) in patients with Crohn′s disease (CD).Methods:From January 2022 to November 2023, CD patients who were hospitalized at Department of Gastroenterology, the Second Affiliated Hospital of Wenzhou Medical University and received the treatment of UST ≥24 weeks (CD group) and patients with colon polyps (colon polyps control group) were retrospectively enrolled. Baseline data of the patients were collected. Harvey-Bradshaw index for Crohn′s disease (HBI) and simple endoscopic score for Crohn′s disease (SES-CD) were applied to assess clinical and endoscopic disease activities, respectively. The colonic fucosylation level was detected by immunofluorescence staining in the CD group at weeks 0 and 24 after UST treatment and at diagnosis in the colon polyps control group (baseline). The levels of C-reactive protein (CRP) and fecal calprotectin (FC) were also assessed. A linear regression model was performed to analyze the correlation between the baseline colonic fucosylation levels and the clinical characteristics in CD patients. At week 24, the clinical efficacy of UST treatment was evaluated, clinical remission was defined as HBI ≤4, biological remission was defined as CRP<5 mg/L and(or) FC≤250 μg/g, and mucosal healing was defined as SES-CD≤2.Based on the efficacy of UST treatment, the CD group was further divided into clinical remission subgroup and clinical non-remission subgroup, biological remission subgroup and biological non-remission subgroup, and mucosal healing subgroup and mucosal non-healing subgroup. The differences in colonic fucosylation level between the subgroups were compared. Multivariate binary logistic regression model was used to analyze the impacts of the baseline clinical characteristics on clinical efficacy at week 24 of UST treatment in the CD group. Mann-Whitney U test and Wilcoxon matched-pair test were used for statistical analysis. Results:A total of 60 patients in the CD group and 72 patients in the colon polyps control group were enrolled. The baseline colonic fucosylation level of CD group was lower than that of the colon polyps control group (25.81 (15.55, 29.70) vs. 29.57 (27.32, 32.96)), and the difference was statistically significant ( Z=-5.02, P<0.001). The results of multiple linear regression analysis showed that the baseline colonic fucosylation level of the CD group was negatively correlated with the baseline FC level ( β=-13.80, 95% confidence interval (95% CI): -20.59 to -7.00, P<0.001). The colonic fucosylation level at week 24 of the CD group was higher than that at week 0 (28.53 (24.54, 32.32) vs. 25.81 (15.55, 29.70)), and the difference was statistically significant ( Z=4.75, P<0.001). The colonic fucosylation levels at week 24 of the clinical remission subgroup, the biological remission subgroup, and the mucosal healing subgroup were higher than those of the clinical non-remission subgroup, the biological non-remission subgroup, and the mucosal non-healing subgroup, respectively (29.1 (27.9, 33.0) vs. 19.6 (16.3, 31.9), 29.5 (27.3, 33.0) vs. 19.6 (17.5, 27.5), 29.6 (28.4, 33.0) vs. 23.4 (17.5, 28.4)), and the differences were statistically significant ( Z=3.35, 3.78, 4.63; all P<0.001). The results of multivariate binary logistic regression analysis showed that the baseline colonic fucosylation level was the independent influencing factor of the rate of clinical remission, biological remission and mucosal healing at week 24 after UST treatment in the CD group ( OR=1.30 (95% CI: 1.05 to 1.61), 1.24 (95% CI: 1.01 to 1.52), 1.57 (95% CI: 1.16 to 2.12); P=0.018, 0.037 and 0.003). Conclusion:The baseline level of colonic fucosylation in CD patients is correlated with the clinical efficacy at week 24 of UST treatment, suggesting its potential utility in predicting the efficacy of UST treatment in CD patients.

Objective To investigate the effects of low-dose esketamine on catheter-related bladder discomfort(CRBD)in elderly male patients after ureteroscopic lithotripsy(URL).Methods 90 elderly male patients with URL from October 2023 to Jun 2024 were selected and randomly divided into group A(esketamine group)and group B(control group),45 cases in each.After induction of general anesthesia,group A received intravenous infusion of 0.15 mg/kg esketamine hydrochloride diluted with saline to 10 mL,while group B received an equal volume of saline.The occurrence and severity of CRBD were recorded at T0(immediately after catheter removal),T1(30 min after catheter removal),T2(2 h after catheter removal),and T3(6 h after catheter removal)time points.The neurocognitive status and the incidence of perioperative neurocognitive disorder(PND)were assessed using the mini-mental state examination(MMSE)score one day before surgery and 6 h after surgery.Relevant indicators during the perioperative period and in the postanesthesia care unit(PACU)observation period were recorded for both groups.Results There were no statistically significant differences in anesthesia duration,recovery time,dosages of propofol and remifentanil between the two groups(P>0.05).Compared with group B,group A showed significantly lower CRBD incidence rate at T0,T1,T2 and T3 time points,and the severity rate of CRBD at T0,and T1 time points in group A was significantly lower than that in group B,the differences were statistically significant(P<0.05).Group A also had higher MMSE scores and lower PND incidence rate 6 h after surgery compared to group B,the differences were statistically significant(P<0.05).Compared with group B,group A required fewer tramadol hydrochloride administrations at T0,exhibited higher Ramsay sedation scale(RASS)scores,and lower Visual analog the scale(VAS)scores and Richer agitation-sedation Scale(SAS)scores,the differences were statistically significant(P<0.05).No adverse reactions were observed in either group after surgery.Conclusion Low-dose esketamine can effectively reduce the incidence and severity of early CRBD in elderly male patients after URL,which may be related to its minimal impact on postoperative cognitive function and better sedative and analgesic effects.

Objective To explore the correlation between cold-induced RNA binding-protein(CIRP)and NF-κB levels with cognitive dysfunction in elderly patients with ischemic cerebral small vessel disease.Methods 135 elderly patients with ischemic cerebral small vessel disease admitted to our hospital from March 2021 to June 2024 were selected as research subjects.They were divided into a cognitive normal group(n=48)and a cognitive impairment group(n=87)based on whether cognitive dysfunction occurred.Multiple linear regression was used to analyze the relationship between cognitive impairment and inflammatory indicators,while the dose-response relationship of CIRP and NF-κB with cognitive impairment were estimated using restricted cubic spline method.The cognitive impairment group was further divided into mild cognitive impairment group(n=30),moderate cognitive impairment group(n=32),and severe cognitive impairment group(n=25)based on the severity of the condition.Ordered regression analysis was used to investigate the impact of CIRP and NF-κB on patient's condition;ROC curve was used to evaluate the predictive value of CIRP and NF-κB for moderate to severe cognitive impairment,and explore the mediating role of inflammation related factors between CIRP/NF-κB and mini-mental state examination(MMSE)scores.Results TNF-α,IL-6,IL-1β,CIRP and NF-κB are all factors affecting cognitive impairment(P＜0.05).CIRP and NF-κB were significantly positively correlated with TNF-α,IL-4,IL-10,IL-1β,MCP-1,TGF-β1 and hs CRP(P＜0.05),and significantly negatively correlated with TGF-β1(P＜0.05).The correlation of CIRP and NF-κB levels with cognitive impairment showed a non-linear dose-response relationship(P＜0.05).There was still an independent correlation(P＜0.05)of TNF-α,IL-6,IL-1β,CIRP and NF-κB with the severity of cognitive impairment.High levels of CIRP and NF-κB showed a synergistic effect with high levels of TNF-α,IL-6 and IL-1 β.The AUC value of CIRP and NF-κB for predicting severe cognitive impairment were 0.745 and 0.792,respectively,with a combined prediction AUC of 0.840.TNF-α,IL-4,IL-10,IL-1β,MCP-1,TGF-β1 and hs CRP play a mediating regulatory role between MMSE score and CIRP/NF-κB.Conclusion CIRP and NF-κB participate in the regulation of inflammatory responses and are closely related to cognitive dysfunction and severity of elderly patients with ischemic cerebrovascular disease.Monitoring the changes of CIRP and NF-κB are beneficial for clinical evaluation of patients' cognitive function.

Objective To investigate the effects of low-dose esketamine on catheter-related bladder discomfort(CRBD)in elderly male patients after ureteroscopic lithotripsy(URL).Methods 90 elderly male patients with URL from October 2023 to Jun 2024 were selected and randomly divided into group A(esketamine group)and group B(control group),45 cases in each.After induction of general anesthesia,group A received intravenous infusion of 0.15 mg/kg esketamine hydrochloride diluted with saline to 10 mL,while group B received an equal volume of saline.The occurrence and severity of CRBD were recorded at T0(immediately after catheter removal),T1(30 min after catheter removal),T2(2 h after catheter removal),and T3(6 h after catheter removal)time points.The neurocognitive status and the incidence of perioperative neurocognitive disorder(PND)were assessed using the mini-mental state examination(MMSE)score one day before surgery and 6 h after surgery.Relevant indicators during the perioperative period and in the postanesthesia care unit(PACU)observation period were recorded for both groups.Results There were no statistically significant differences in anesthesia duration,recovery time,dosages of propofol and remifentanil between the two groups(P>0.05).Compared with group B,group A showed significantly lower CRBD incidence rate at T0,T1,T2 and T3 time points,and the severity rate of CRBD at T0,and T1 time points in group A was significantly lower than that in group B,the differences were statistically significant(P<0.05).Group A also had higher MMSE scores and lower PND incidence rate 6 h after surgery compared to group B,the differences were statistically significant(P<0.05).Compared with group B,group A required fewer tramadol hydrochloride administrations at T0,exhibited higher Ramsay sedation scale(RASS)scores,and lower Visual analog the scale(VAS)scores and Richer agitation-sedation Scale(SAS)scores,the differences were statistically significant(P<0.05).No adverse reactions were observed in either group after surgery.Conclusion Low-dose esketamine can effectively reduce the incidence and severity of early CRBD in elderly male patients after URL,which may be related to its minimal impact on postoperative cognitive function and better sedative and analgesic effects.

Objective To analyze the application characteristics,trends,and special advantages of anti-infection research using the Bayesian method,and to provide methodological reference for the development of anti-infection research.Methods PubMed,CNKI and WanFang Data were electronically searched for the studies on anti-infection using Bayesian method published from January 1,2015 to November 21,2023.The relevant information of publication time,anti-infection type,sample size,Bayesian characteristics and Bayesian application pattern were analyzed descriptively and reviewed.Results A total of 86 studies were included,of which 41.9％were observational studies,only 7.0％were enterprise-initiated studies,and 48.8％were mentioning prior information studies.There was no domestic intervention study.The application characteristics and advantages of Bayesian method in intervention study,observational study and pharmacokinetic study are different.In intervention researches and observational researches,the application of Bayesian design decision and the application of Bayesian analysis and estimation accounts for 69.2％and 52.8％at most,respectively.Conclusions The Bayesian method is flexible,can be used for small sample sizes and complex model research,and can deal with uncertainty.In intervention studies in the field of anti-infection in China,the Bayesian method has not been applied widely.Only a handful of studies applying Bayesian method have been initiated by companies.In the future,it is still necessary to promote the advantages and application scenarios of Bayesian methods in the field of anti-infection research and strengthen the standardization of the application of Bayesian method.