Objective: To explore the setting of gray zone of Treponema pallidum (TP) testing by retrospective analysis of blood donors with single reagent reactive anti-TP results, so as to improve blood utilization and supply safety. Methods: Blood samples were collected from 112 blood donors previously deferred due to single reagent reactive TP antibody results between January 2020 and December 2023, and subjected to dual ELISA reagents and TPPA test. The gray zone panel analysis was performed on the two ELISA reagents currently used in our department. The detection rate at each concentration of the gray zone panle was counted, and the corresponding concentrations for C , C , and C and gray zone cut-off were calculated. Results: Among the 50 samples deferred by reagent 1, 19 were confirmed reactive and 31 non-reactive in supplementary testing. Among the 62 samples deferred by reagent 2, 12 were confirmed reactive and 50 non-reactive in supplementary testing. For reagent 1, the detection rate of was 56% for S/CO≥1 and 20% for 0.5≤S/CO<1, retrospectively. For reagent 2, the detection rate was 27% for S/CO≥1 and 12.5% for 0.5≤S/CO<1, retrospectively. The detection rate for S/CO≥1 was higher than those for 0.5≤S/CO<1 for both reagents. All the 112 samples were negative in TPPA test. The C concentration of reagent 1 was 1.51 mIU/mL, and the concentration range of C ±20% was 1.21-1.81 mIU/mL. The C concentration of reagent 2 was 1.45 mIU/mL, and the concentration range of C ±20% was 1.16-1.74 mIU/mL. The C and C concentration of both reagents were within the C ±20% range, suggesting that the gray zone cutoff for both Reagent 1 and Reagent 2 should be set at S/CO=0.8 (80% of the CO value). Conclusion: All anti-TP single reagent reactive samples with S/CO value within the gray zone was tested negative by TPPA. It is necessary to consider the rationality and necessity of establishing the gray zone, so as to ensure blood safety and improve the utilization rate of blood resources.

OBJECTIVE To investigate the influence of CYP2C19 gene polymorphism on platelet function and inflammatory cytokines in elderly patients with ischemic stroke， and to analyze potential factors associated with poor prognosis. METHODS A retrospective study was conducted on elderly patients with ischemic stroke admitted to our hospital from June 2024 to June 2025， wh o underwent CYP2C19 genotype testing and received antiplatelet therapy with clopidogrel. The levels of platelet function indicators and inflammatory cytokines before and after treatment were compared among patients with different metabolic phenotypes. Based on the prognosis at 6 months post-treatment， patients were divided into poor prognosis group and good prognosis group. Univariate analysis was performed on general data， metabolic phenotype， the levels of platelet function indicators and inflammatory cytokines. Variables with P ＜0.05 and the levels of inflammatory cytokines before treatment were included in a multivariate Logistic regression analysis to identify independent risk factors for poor prognosis. Multiple linear regression was used to further analyze the relationship between metabolic phenotypes and inflammatory cytokines. RESULTS A total of 448 elderly patients with ischemic stroke were included； among them， 162 cases were normal metabolic phenotype， 218 were intermediate metabolic phenotype， and 68 were poor metabolic phenotype. No rapid or ultrarapid metabolic phenotypes were observed. After treatment， platelet aggregation rate， the levels of P-selectin and platelet activated complex-1 （PAC-1）， high-sensitivity C-reactive Protein （hs-CRP）， interleukin-1β （IL-1β）， IL-6 and tumor necrosis factor-α （TNF-α） in the normal metabolic phenotype group， intermediate metabolic phenotype group， and poor metabolic phenotype group （except for platelet aggregation rate， and the levels of P-selectin and PAC-1 in the poor metabolic phenotype group） were significantly lower than those before treatment in the same group. Moreover， the above indicators in the normal metabolic phenotype group were significantly lower than those in the intermediate and poor metabolic phenotype groups at the corresponding time， and the levels of platelet function indicators in the intermediate metabolic phenotype group were significantly lower than those in the poor metabol ic phenotype group at the corresponding time （ P ＜0.05）. Univariate and multivariate Logistic regression analyses showed that combined with hypertension， combined with diabetes mellitus， and intermediate or poor metabolic genotypes were independent risk factors for poor prognosis in elderly patients with ischemic stroke （ P ＜0.05）. Multiple linear regression analysis showed that serum levels of hs-CRP， IL-1β， IL-6 and TNF-α before treatment were significantly higher in patients with intermediate and poor metabolic genotypes compared to those with normal metabolic genotype （ P ＜0.05）， with a greater magnitude of increase in inflammatory cytokines observed in the patients with poor metabolic genotype. CONCLUSIONS The elderly ischemic stroke patients with CYP2C19 intermediate and poor metabolic genotypes have poor inhibition effect on platelet and higher levels of inflammatory cytokines than normal metabolic genotype； CYP2C19 gene polymorphism， and in combination with hypertension and diabetes， can be used as independent predictors of poor prognosis.

AIM:To automatically identify and quantitatively assess myopia-related fundus structural changes by combining non-mydriatic color fundus photography with an artificial intelligence(AI)-powered quantitative fundus analysis system and to further analyze the correlations between these fundus parameters and spherical equivalent(SE), axial length(AL), and age, providing the objective basis for monitoring myopia progression and supporting the formulation of personalized myopia prevention and control strategies. METHODS:A cross-sectional study was conducted enrolling myopic patients aged 18-50 y who underwent myopia screening from March 2023 to December 2023. Patients were stratified into three groups based on SE: the -3.00 D

Objective: To analyze the status of Treponema pallidum (TP) infection among blood donors in Hefei area by evaluating anti-TP reactive donors, and to provide data support for blood screening strategies, evaluation of reagent application, and public health prevention and control strategies. Methods: TPPA confirmation test were performed on 338 anti-TP positive samples of voluntary blood donors at Anhui Blood Center from February to April 2022, July to October 2022, February to June 2023. RPR tests were conducted on samples positive for TPPA. The test results, co-reactivity of TP with HBV, HCV, and HIV, and demographic characteristics of the donors were statistically analyzed. Results: The unqualified rate of anti-TP among blood donors in Hefei area was 0.30% (405/133 587), and the positive rate for TPPA was 67.46% (228/338). Among the TPPA-positive donors, 31.67% were RPR-positive. The co-positive rates of HBV, HCV and HIV in anti-TP reactive blood donors were 0.74% (3/405), 0.49% (2/405), and 1.73% (7/405), respectively, with HIV copositivity being the most common. Most co-positive donors were males aged 31-50 years with a high school education or lower, and all were first-time whole blood donors. Conclusion: The anti-TP unqualified rate among blood donors in Hefei area is at a low-to-mederate level. HIV is the most common co-infection with TP among anti-TP positive donors. The majority of co-infected donors are middle-aged men donating whole blood for the first time.

OBJECTIVE To evaluate the cost-effectiveness of finerenone combined with standard of care （SoC） in the treatment of heart failure with mildly reduced ejection fraction （HFmrEF） or preserved ejection fraction （HFpEF）. METHODS Based on a phase Ⅲ clinical trial， a Markov model was constructed from the perspective of China’s healthcare system to compare the treatment outcomes of finerenone combined with SoC regimen versus SoC regimen alone in the treatment of different cardiac functional statuses of HFmrEF/HFpEF. Using quality-adjusted life year （QALY） as the health output index， 3 times China’s per capita GDP in 2023 as the willingness-to-pay （WTP） threshold， a simulation was conducted with a 3-month cycle length and a 10- year time horizon， incorporating an annual discount rate of 5%. The dynamic changes across various stages of HFmrEF/HFpEF treated with finerenone combined with SoC versus SoC alone were simulated to evaluate the long-term effectiveness and costs of the two treatment strategies. Additionally， one-way sensitivity analysis and probabilistic sensitivity analysis were performed， to test the robustness of the results. RESULTS The incremental cost-effectiveness ratio （ICER） of the finerenone combined with SoC regimen versus SoC regimen alone was 179 504.75 yuan/QALY， which was below the WTP threshold set in this study， indicating that the finerenone combined with SoC regimen possessed certain economic advantages. The results of one-way sensitivity analysis showed that the utility value of NYHA Ⅱ status， the drug price of finerenone， the discount rate， and the probability of hospital transfer for both groups had a great influence on ICER， but did not affect the robustness of the model. The probabilistic sensitivity analysis also confirmed the robustness of the model. CONCLUSIONS Under the WTP threshold set in this study， finerenone combined with SoC is cost-effective in the treatment of HFmrEF/HFpEF， compared with the SoC regimen.

Objective To analyze the status quo and related factors of treatment compliance in elderly patients with advanced gastric cancer complicated with cancer pain. Methods Three hundred and ten elderly patients with advanced gastric cancer from January 2021 to June 2024 were selected, and their general data were collected. Hospital Anxiety and Depression Scale (HADS), Beliefs about Medicines Questionnaire (BMQ), Numerical Rating Scale (NRS) and 8-item Morisky Medication Adherence Scale (MMAS-8) were adopted to investigate the psychological status, necessity of medication belief, degree of cancer pain and treatment compliance. Univariate analysis, correlation analysis and multivariate logistic regression analysis were used to describe and analyze the treatment compliance status and related factors in elderly advanced gastric cancer with cancer pain. Results A total of 310 patients were divided into group A (good compliance, 93 cases), group B (moderate compliance ,102 cases) and group C (poor compliance , 115 cases) by means of compliance degree. There were significant differences in education level , pain duration and intensity and analgesic category (P<0.05). Treatment compliance was associated with education level, analgesic category, psychological status, medication belief and pain degree (P<0.05). The necessity of medication belief and pain duration and degree were influencing factors of treatment compliance. Conclusion The treatment compliance in advanced gastric cancer with cancer pain is poor, and can be affected by the necessity of medication belief and duration and degree of pain.

ObjectiveTo investigate the effects of Chaihu and Longgu Mulitang （CLMT） on hippocampal neural damage in the mouse model of depression via the extracellular signal-regulated protein kinase （ERK）/cAMP-response element-binding protein （CREB） signaling pathway. MethodsSeventy-eight male C57BL/6 mice were randomly allocated into normal control， model， low/medium/high-dose （2.89， 5.78， and 11.56 g·kg^-1， respectively） CLMT， and paroxetine （10 mg·kg^-1） groups. A depression model was established by chronic unpredictable mild stress （CUMS） combined with social isolation. Behavioral tests were carried out to evaluate depressive-like behaviors. Hematoxylin-eosin staining and Nissl staining were performed to assess hippocampal morphology and neuronal damage. Immunofluorescence was employed to detect glial fibrillary acidic protein （GFAP） and ionized calcium-binding adapter molecule 1 （Iba1）. Real-time PCR was employed to measure the mRNA levels of ERK and CREB. Western blot was employed to determine the expression of ERK/CREB pathway proteins and brain-derived neurotrophic factor （BDNF） in the hippocampal tissue. Molecular Operating Environment （MOE） software was used for molecular docking to evaluate the interactions between CLMT components and target proteins. ResultsCompared with the normal control group， the model group showed decreased sucrose preference （P0.01）， increased tail-suspension immobility time （P0.01）， decreased activity in the central region of the open field test （P0.01）， and decreased activity in the middle and open-arm region of the elevated plus maze test （P0.01）. The hippocampal area in the model group showed wrinkled cells and a reduction in the number of cells， neurons with reduced sizes and Nissl bodies， enhanced fluorescence intensity of GFAP and Iba1 （P0.01）， and down-regulated expression of phosphorylated （p）-ERK， p-CREB， and BDNF （P0.05， P0.01） and mRNA levels of ERK and CREB （P0.01）. Compared with the model group， the CLMT group showed increased body weight （P0.05， P0.01）， restored cell morphology， with only a small number of ruptured cells， normal neuronal structure and morphology with obvious nuclei and abundant Nissl bodies， weakened fluorescence intensity of GFAP and Iba1 （P0.05， P0.01）， up-regulated mRNA levels of ERK and CREB （P0.05， P0.01） and protein levels of phosphorylated （p）-ERK， p-CREB， and BDNF in the hippocampal tissue （P0.05， P0.01）. The results of molecular docking indicated that nine active ingredients in CLMT had good binding affinity with ERK and CREB. ConclusionCLMT may ameliorate the hippocampal nerve injury in the mouse model of depression by regulating the ERK/CREB pathway.

Objective To analyze the impact of chronic obstructive pulmonary disease(COPD)on coronary plaque burden in elderly patients.Methods A total of 120 COPD patients admitted to the Hongqi Hospital Affiliated to Mudanjiang Medical University from January 2022 to December 2024 were prospectively enrolled and served as the COPD group.Another 120 healthy volunteers were recruited as the control group during the same period.The general clinical data and coronary plaque burden were compared between the two groups.Pearson linear correlation analysis was used to investigate the correlation between forced expiratory volume in the first second(FEV1)and coronary plaque burden as well as left ventricular ejection fraction(LVEF).Multiple linear regression analysis was employed to identify the influencing factors of total coronary plaque bur-den and calcified plaque burden.Results The COPD group had significantly larger smoking ratio and higher levels of high-sensitivity C-reactive protein(hs-CRP)and IL-6,but obviously lower LVEF and FEV1 levels than the control group(P＜0.01).Notably increased total coronary plaque burden(38.30±8.22 vs 24.61±5.56,P＜0.01),calcified plaque burden(21.11±6.57 vs 12.54±3.65,P＜0.01)and non-calcified plaque burden(17.19±5.39 vs 12.07±3.92,P＜0.01)were observed in the COPD group than the control group.FEV1 was negatively correlated with coro-nary plaque burden,calcified plaque burden,and non-calcified plaque burden,and positively corre-lated with LVEF(P＜0.01).Multiple linear regression analysis showed that FEV1 and IL-6 were influencing factors for both total coronary plaque burden(P＜0.01)and coronary calcified plaque burden(P＜0.01),and FEV1 was an influencing factor of non-calcified plaque burden in coronary arteries(P＜0.01).Conclusion COPD promotes the development of coronary plaque burden.So,for COPD patients,it is necessary to strengthen the monitoring and early prevention of coronary plaque burden.

Objective To analyze the distribution of pathogenic bacteria,changes in serum levels of long non-coding ribonucleic acid(lncRNA)nuclear enriched abundant transcript 1(NEAT1),Ga-lectin-3,and monocyte chemotactic protein-1(MCP-1),and their relationship with cardiac func-tion in patients with chronic heart failure(CHF)complicated with pulmonary infection(PI).Methods A total of 278 CHF patients treated in the Second Cardiovascular Ward of the Third Affiliated Hospital of Henan University of Chinese Medicine from January 2020 to February 2022 were recruited,and according to the occurrence of PI or not,they were divided into a PI group(98 cases)and a non-PI group(180 cases).The distribution of pathogenic bacteria in the PI group was analyzed.ROC curves were plotted to evaluate the predictive value of serum indicators for PI in CHF patients.Results Among the 98 CHF patients with PI,161 strains of pathogenic bacteria were detected,with Gram-negative(G-)bacteria most prevalent,accounting for 114 strains(70.8％).Serum levels of lncRNA NEAT1,Galectin-3,and MCP-1 were significantly higher in the PI group than the non-PI group(P＜0.01).Pearson correlation analysis showed that serum levels of lncRNA NEAT1,Galectin-3,and MCP-1 were positively correlated with cardiac function(r=0.794,r=0.523,r=0.709,P＜0.01).ROC curve analysis revealed that the combined detec-tion of serum lncRNA NEAT1,Galectin-3,and MCP-1 had the highest predictive value for PI in CHF patients than each indicator alone,and the AUC value,sensitivity,and specificity of the com-bined detection was 0.926,84.54％,and 92.78％,respectively(P＜0.01).Conclusion Gram-negative bacteria are predominant type of pathogenic bacteria in CHF patients with PI.Serum levels of lncRNA NEAT1,Galectin-3,and MCP-1 are increasing with the occurrence of infection and worsening of cardiac function.Combined detection of these indicators provides higher predic-tive value for PI in CHF patients.

BACKGROUND:The utilization of miniscrews for assisting in molar distalization with clear aligners is a commonly adopted clinical approach.However,treatment outcomes may be influenced by the implantation position of miniscrew and the hooks in various tooth location.OBJECTIVE:To analyze the biomechanical effects of hooks at different tooth positions and the assistance of buccal and palatal miniscrews in distalizing molars with clear aligners by using the finite element method.METHODS:By integrating volunteer cone beam CT and Itero intraoral scan data,high-precision finite element models were constructed to simulate the combined use of miniscrews and hooks to assist in the distalization of the maxillary first and second molars with clear aligners,aiming for a designed distalization magnitude of 0.2 mm.Four conditions were established based on the placement of buccal or palatal miniscrews,as well as the located of hooks at the canine or first premolar.The buccal anchorage screw was used in combination with hooks on the buccal side of the canine;the buccal anchorage screw was used in combination with hooks on the buccal side of the first premolar;the palatal anchorage screw was used in combination with hooks on the lingual side of the canine,and the palatal anchorage screw was used in combination with hooks on the lingual side of the first premolar.Analysis using ANSYS software was conducted to evaluate the three-dimensional displacement trends of maxillary teeth and the maximum equivalent stress on the periodontal ligament under each condition.RESULTS AND CONCLUSION:(1)Regardless of whether hooks were placed on canines or first premolars,palatal miniscrews had been shown to enhance the distal movement of maxillary molars and reduce the mesial movement of premolars as well as the labial tipping tendency of anterior teeth,compared to buccal miniscrews.The maximum equivalent stress in the periodontal ligament of molars was increased,while that of anterior teeth was decreased.(2)Regardless of whether the miniscrews were located on the buccal or palatal side,compared with hooks at the first premolar,when hooks were done at the canine,the labial inclination trend of the anterior teeth was reduced,the distal movement of the molars was reduced,the mesial movement of the premolars was increased,and the maximum equivalent stress of the molar and the periodontal membrane of the anterior teeth was reduced.(3)Regardless of whether miniscrews were located on the buccal or palatal side,and the hooks were located on the canine or the first premolar,the molar could not achieve overall movement.(4)The results show that clear aligner combined with palatal miniscrews and hooks at the first premolar are more conducive to improving the efficiency of maxillary molar distalization,but attention should be paid to protecting the anterior tooth miniscrews and molar torque control;clear aligner combined with palatal miniscrews and hooks at the canine is more conducive to reducing the labial tipping tendency of anterior teeth,but the efficiency of molar distalization will be relatively reduced.