Objective:To establish an automatic classification approach for bone marrow cells based on microscopic hyperspectral imaging and three-dimensional spectral convolutional neural network (Spec-CNN).Methods:The research type is establishment of methodology. The study included 306 newly diagnosed patients' bone marrow smears under Wright's staining from the Department of Hematology of the First Medical Center of the PLA General Hospital from November 1st, 2013 to April 30th, 2024. The high-spectrum data and 4k image data of bone marrow cells were simultaneously collected using a microscopic hyperspectral-4k optical path integrated imaging system (with a spectral resolution of 400—1 000 nm). The high-spectrum data was used for model training, while the 4k image data recognized by morphologists was only used as a reference for labeling the high-spectrum data. The high-spectrum data set was divided into training set, validation set and test set in a ratio of 14∶6∶5. The training set and validation set were used to train and fine-tune the Spec-CNN model, and the test set was used to evaluate the model performance. The sensitivity, specificity ,accuracy ,and Kappa coefficient were calculated for comparing the manual annotation results as gold standard with the intelligent identification results of the Spec-CNN model. Five non-data set samples were used for external validation.Results:The acquired hyperspectral data and 4k imaging dataset comprised of 32 categories and 64 800 bone marrow cells. In the test set, the Spec-CNN model demonstrated weighted-average indicators on classification metrics across 32 cell types: sensitivity 87.79%, specificity 99.31%, and accuracy 98.78%, and Kappa coefficient 0.869. For external validation, the mean correct identification rate of bone marrow cells reached 83.28%.Conclusion:We successfully established an automatic classification method of bone marrow cells based on microscopic hyperspectral imaging and three-dimensional Spec-CNN. This method has a good automatic classification ability for 32 types of bone marrow nucleated cells, which has a certain auxiliary effect on improving the diagnosis efficiency of blood diseases for bone marrow morphologists.

Objective To analyze the epidemiological characteristics of mumps in Guangxi from 2012 to 2024, and to provide a scientific basis for formulating prevention and control strategies. Methods Descriptive epidemiological methods were used to analyze the incidence data of mumps in Guangxi from 2012 to 2024. Results A total of 159 873 mumps cases were reported from 2012 to 2024 in Guangxi, with an average annual reported incidence of 25.41/100 000, and no death. Mumps occurred every month, with the peak incidence mainly concentrated in April to July and October to January of the next year. There were 96,118 male cases (29.43 /100 000), and 63 755 female cases (21.07 /100 000). The male to female ratio was 1.40:1, and the difference between male and female was significant (χ²=4 321.276，P＜0.05). The annual incidence of mumps showed a certain periodic change, with the incidence peak and trough alternating every 4 - 5 years. The majority of patients were under 15 years old, accounting for 85.32% of the total number of cases. The patients mainly included students, preschool children and scattered children. The highest average incidence was in Nanning City with 40 231 cases (42.08/100 000), and the lowest was in Qinzhou City with 3 466 cases (8.16/100 000). From 2012 to 2024, a total of 210 mumps outbreaks with 4 483 cases were reported in Guangxi. Conclusion The incidence of mumps in Guangxi from 2012 to 2024 shows a periodic change and obvious seasonality. People under 15 years old are the key group at risk of mumps. The prevention and control of the epidemic of mumps in schools and kindergartens should be strengthened. It is suggested to carry out long-term monitoring of mumps as well as immune effect research, and continue to maintain a high vaccination rate of 2 doses of mumps-containing vaccines.

Objective:To explore the clinical value of plasma von Willebrand factor antigen(VWF:Ag)and VWF activity(VWF:GPIbM)based on ABO blood group in the risk assessment of deep vein thrombosis(DVT).Methods:A total of 163 patients with DVT who sought medical treatment from March 2021 to December 2022 were selected as the case group,and 135 healthy volunteers during the same period were selected as the control group.The differences of ABO blood groups,plasma VWF:Ag and VWF:GPIbM levels between the two groups were compared.Receiver operating characteristic(ROC)curves were used to evaluate the clinical value of VWF testing in predicting DVT events.Logistic regression analysis was applied to identify risk factors for DVT.Results:The levels of plasma VWF:Ag and VWF:GPIbM in the DVT group were significantly higher than those in the control group both overall and across ABO blood type subgroups(P＜0.01).Within the DVT group,the levels of plasma VWF:Ag and VWF:GPIbM in patients with non-O blood type were significantly higher than those with blood type O[VWF:Ag:219.74％±63.64％vs 162.21％±56.03％,P＜0.01;VWF:GPIbM:228.10％(185.15％,249.10％)vs 148.25％(116.48％,225.48％),P＜0.01].The area under the ROC curve(AUC)of VWF:Ag for predicting DVT events was 0.855,with a cut-off value of 142.4％,sensitivity of 82.2％and specificity of 72.6％;the AUC of VWF:GPIbM was 0.861,with a cut-off value of 141.2％,sensitivity of 84.7％,and specificity of 71.1％.Univariate analysis showed that both VWF:Ag and VWF:GPIbM were influencing factors for DVT events(P＜0.05).Multivariate logistic regression analysis indicated that VWF:Ag＞142.4％(OR=13.961,95％CI:7.654-25.464,P＜0.01)and VWF:GPIbM＞141.2％(OR=17.615,95％CI:9.155-33.892,P＜0.01)were independent risk factors for DVT events.Conclusion:Levels of VWF:Ag and VWF:GPIbM are significantly elevated in non-O blood type DVT patients.VWF:Ag＞142.4％and VWF:GPIbM＞141.2％are independent risk factors for DVT events.VWF testing based on ABO blood group aids in the precision prevention and control of DVT.

Objective:To establish an automatic classification approach for bone marrow cells based on microscopic hyperspectral imaging and three-dimensional spectral convolutional neural network (Spec-CNN).Methods:The research type is establishment of methodology. The study included 306 newly diagnosed patients' bone marrow smears under Wright's staining from the Department of Hematology of the First Medical Center of the PLA General Hospital from November 1st, 2013 to April 30th, 2024. The high-spectrum data and 4k image data of bone marrow cells were simultaneously collected using a microscopic hyperspectral-4k optical path integrated imaging system (with a spectral resolution of 400—1 000 nm). The high-spectrum data was used for model training, while the 4k image data recognized by morphologists was only used as a reference for labeling the high-spectrum data. The high-spectrum data set was divided into training set, validation set and test set in a ratio of 14∶6∶5. The training set and validation set were used to train and fine-tune the Spec-CNN model, and the test set was used to evaluate the model performance. The sensitivity, specificity ,accuracy ,and Kappa coefficient were calculated for comparing the manual annotation results as gold standard with the intelligent identification results of the Spec-CNN model. Five non-data set samples were used for external validation.Results:The acquired hyperspectral data and 4k imaging dataset comprised of 32 categories and 64 800 bone marrow cells. In the test set, the Spec-CNN model demonstrated weighted-average indicators on classification metrics across 32 cell types: sensitivity 87.79%, specificity 99.31%, and accuracy 98.78%, and Kappa coefficient 0.869. For external validation, the mean correct identification rate of bone marrow cells reached 83.28%.Conclusion:We successfully established an automatic classification method of bone marrow cells based on microscopic hyperspectral imaging and three-dimensional Spec-CNN. This method has a good automatic classification ability for 32 types of bone marrow nucleated cells, which has a certain auxiliary effect on improving the diagnosis efficiency of blood diseases for bone marrow morphologists.

Objective:To explore the clinical value of plasma von Willebrand factor antigen(VWF:Ag)and VWF activity(VWF:GPIbM)based on ABO blood group in the risk assessment of deep vein thrombosis(DVT).Methods:A total of 163 patients with DVT who sought medical treatment from March 2021 to December 2022 were selected as the case group,and 135 healthy volunteers during the same period were selected as the control group.The differences of ABO blood groups,plasma VWF:Ag and VWF:GPIbM levels between the two groups were compared.Receiver operating characteristic(ROC)curves were used to evaluate the clinical value of VWF testing in predicting DVT events.Logistic regression analysis was applied to identify risk factors for DVT.Results:The levels of plasma VWF:Ag and VWF:GPIbM in the DVT group were significantly higher than those in the control group both overall and across ABO blood type subgroups(P＜0.01).Within the DVT group,the levels of plasma VWF:Ag and VWF:GPIbM in patients with non-O blood type were significantly higher than those with blood type O[VWF:Ag:219.74％±63.64％vs 162.21％±56.03％,P＜0.01;VWF:GPIbM:228.10％(185.15％,249.10％)vs 148.25％(116.48％,225.48％),P＜0.01].The area under the ROC curve(AUC)of VWF:Ag for predicting DVT events was 0.855,with a cut-off value of 142.4％,sensitivity of 82.2％and specificity of 72.6％;the AUC of VWF:GPIbM was 0.861,with a cut-off value of 141.2％,sensitivity of 84.7％,and specificity of 71.1％.Univariate analysis showed that both VWF:Ag and VWF:GPIbM were influencing factors for DVT events(P＜0.05).Multivariate logistic regression analysis indicated that VWF:Ag＞142.4％(OR=13.961,95％CI:7.654-25.464,P＜0.01)and VWF:GPIbM＞141.2％(OR=17.615,95％CI:9.155-33.892,P＜0.01)were independent risk factors for DVT events.Conclusion:Levels of VWF:Ag and VWF:GPIbM are significantly elevated in non-O blood type DVT patients.VWF:Ag＞142.4％and VWF:GPIbM＞141.2％are independent risk factors for DVT events.VWF testing based on ABO blood group aids in the precision prevention and control of DVT.

Objective To investigate the clinical features,laboratory indicators and prognosis of patients with bacterial ascites,and to provide evidence for early clinical diagnosis and treatmen.Methods Clinical data of patients diagnosed with cirrhosis ascites from First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from January 2019 to January 2022 were retrospectively analyzed.According to diagnostic criteria,they were divided into bacterial ascites group(n=24),spontaneous bacterial peritonitis group(n=20)and control group(n=26).The clinical features,laboratory indicators and prognosis of three groups were compared.Results Cirrhosis ascites caused by hepatitis B accounted for the highest proportion.The white blood cell count,neutrophil percentage,ascites white blood cell and polymorphonuclear leukocyte count of patients in bacterial ascites group were significantly higher than those in control group(P<0.05).Gram-positive bacteria was the main pathogens causing bacterial ascites,among which staphylococcus accounts for the highest proportion.Ten cases of bacterial ascites with symptoms of infection were treated with ascites culture and anti-infection therapy.The 14 patients without symptoms of infection were given different treatment according to the development of the disease,one patient died,and the other patients improved.Conclusion The number of patients with bacterial ascites was large,and the main pathogenic bacteria was Gram-positive coccus.The combination of clinical symptoms and laboratory indicators is beneficial to the early diagnosis of bacterial ascites and the decision of treatment.

BACKGROUND:Ankylosing spondylitis is a chronic inflammatory disease with chronic rheumatic immunity.Soft tissue ossification and fusion and spinal stiffness can cause biomechanical changes. OBJECTIVE:To reconstruct the lumbar-sacral intervertebral disc in ankylosing spondylitis patients with lumbar kyphosis by finite element analysis,and to study the range of motion of each segment of T11-S1 and the biomechanical characteristics of annulus fibrosus and nucleus pulposus. METHODS:The imaging data were obtained from an ankylosing spondylitis patient with lumbar kyphosis.The original CT image data of continuously scanned spine were imported into Mimics 21.0 in DICOM format,and T11-S1 was reconstructed respectively.The established model was imported into 3-Matic software in the format of"Stl"to reconstruct the intervertebral disc,and the fibrous intervertebral disc model was obtained.The improved model was further imported into Hypermesh software,and the vertebra,nucleus pulposus,annulus fibrosus and ligament were mesh-divided.After the material properties were given,the model was imported into ABAQUS software to observe the range of motion of each vertebral body in seven different working conditions of T11-S1,and analyze the biomechanical characteristics of each segment of annulus fibrosus and nucleus pulposus. RESULTS AND CONCLUSION:(1)The range of motion of L1 vertebrae was higher than that of other vertebrae under six different working conditions:extension,forward flexion,rotation(left and right),and lateral flexion(left and right).The maximum range of motion was 2.18° during L1 vertebral flexion,and the minimum range of motion was 0.12° during L5 vertebral extension.(2)The annular fiber flexion at L2-L3 segments was greater than the extension(P<0.05),and the annular fiber flexion at L3-L4 and L4-L5 segments was less than the extension(P<0.05).The left rotation of L1-L2 annular fibers was greater than the right rotation(P<0.05).The left flexion of the annulus was greater than the right flexion in L1-L2,L2-L3,L3-L4,L4-L5 and L5-S1 segments(P<0.05).(3)The nucleus pulposus stresses of T11-L12,L1-L2,L2-L3,L3-L4 and L4-L5 segments in forward flexion were greater than in extension(P<0.05).The left rotation of T12-L1 and L3-L4 segments was smaller than the right rotation(P<0.05),and that of T11-T12,L1-L2,and L2-L3 segments was larger than the right rotation(P<0.05).The left flexion was larger than the right flexion in the T11-S1 segment.(4)It is concluded that in ankylosing spondylitis patients with lumbar kyphosis,the minimum range of motion of the vertebral body is located at the L5 vertebral body in extension.To prevent fractures,it is recommended to avoid exercise in the extension position.During the onset of lumbar kyphosis in patients with ankylosing spondylitis,the maximum stress of the annulus fibrosus and nucleus pulposus is located in the L1-L2 segment,which is fixed and will not alter with the change of body position.The late surgical treatment and correction of deformity should focus on releasing the pressure of the annulus fibrosus and nucleus pulposus in this segment to avoid the rupture of the annulus fibrosus and the injury of the nucleus pulposus.

Objective To establish a rapid and sensitive liquid chromatography-tandem mass spectrometry(LC-MS/MS)analysis method for determination of unsymmetrical dimethylhydrazine(UDMH)contents in rat plasma and investigate the toxicokinetic characteristics of UDMH in rats.Methods Twenty-two SD rats were divided into the intravenous injection of 10 mg/kg dose group(4 females)and intragastric administration groups(low,medium and high dose,with 6 rats in each group,half males and half females).The rats were given 10mg/kg by intravenous administration and 10 mg/kg,30 mg/kg,and 90 mg/kg single dose of UDMH by gavage.Blood samples were collected from the orbital venous plexus at 0 hour before administration and at different time points after administration.The plasma samples were extracted with protein precipitation and derivatization before being analyzed using the LC-MS/MS method.Separation was carried out on a ZORBAX column(4.6mm×75mm,3.5 μm),with a mobile phase composed of 0.3％acetonitrile/formic acid at a flow rate of 1 mL/min.Propranolol was used as the internal standard.An electrospray ionization(Turbo Ionspray)source was applied and the mass spectrometer was operated in a positive MRM mode.Quantitative analysis showed that the ionization source unsymmetrical dimethylhydrazine and propranolol was at m/z:192.0→148.1,m/z:260.2→116.1,respectively.The toxicokinetic parameters were analyzed with the DAS 2.1 software.Results Quantification of UDMH exhibited a good linearity within the concentration range of 50-50000 ng/mL,with a linear correlation coefficient greater than 0.9900 and a lower limit of quantification of 50 ng/mL.The average recovery rate of UDMH was 98.1％,compared with 100.5％for the internal standard propranolol hydrochloride.The inter batch precision of standard curve samples ranged from 0.7％to 6.3％,and the relative error was between-7.1％and 6.2％.The inter batch and intra batch precision of quality control samples ranged from1.8％to 19.8％,and the relative error from-9.8％to 0.2％.The main pharmacokinetic parameters of UDMH in rats exposed to 10 mg/kg,30 mg/kg,and 90 mg/kg gavage were UC(0-t):(7624.99±2569.31),(34284.04±6657.15),(84720.88±22354.80)μg/L·h,t1/2:(0.07±0.15),(2.24±1.45),(3.04±0.90)h,Tmax:(0.75±0.27),(0.51±0.29),(0.29±0.10)h,Cmax:(4454.14±1329.45),(19442.45±9121.07),(32334.35±9882.41)μg/L,F:(77.34±26.06)％,(115.92±22.51)％,(95.48±25.19)％.Conclusion The LC-MS/MS method is highly accurate and specific,and is suitable for the toxicokinetic study of UDMH in rats.Single gavage administration of UDMH results in absorption and elimination saturation at a high dose.This study provides data for toxicological studies related to UDMH.

Objective:To observe and evaluate the clinical efficacy and safety of albumin-bound paclitaxel as first-line treatment for patients with advanced pancreatic cancer in China, and to explore the prognosis-related molecules in pancreatic cancer based on next-generation sequencing (NGS) of tumor tissues.Methods:From December 2018 to December 2020, patients with locally advanced or metastatic pancreatic cancer were recruited to accept albumin-bound paclitaxel as first-line treatment in the oncology departments of 24 hospitals in East China. The primary endpoints were overall survival (OS) and treatment related adverse events, and the secondary endpoint was progression-free survival (PFS). Adverse effects were graded using Common Terminology Criteria for Adverse Events 5.0 (CTCAE 5.0). NGS sequencing on the primary or metastatic tissue samples of pancreatic cancer obtained through surgical resection or biopsy was performed.Results:This study recruited 229 patients, including 70 patients with locally advanced pancreatic cancer (LAPC) and 159 patients with metastatic pancreatic cancer (mPC). The disease control rate was 79.9% and the objective response rate is 36.3%.The common adverse effects during treatment were anaemia (159 cases), leucopenia (170 cases), neutropenia (169 cases), increased aminotransferases (110 cases), and thrombocytopenia (95 cases), and the incidence of grade 3-4 neutropenia is 12.2% (28/229). The median follow-up time was 21.2 months (95% CI: 18.5-23.1 months). The median PFS (mPFS) was 5.3 months (95% CI: 4.37-4.07 months) and the median OS (mOS) was 11.2 months (95% CI: 9.5-12.9 months). The mPFS of patients with LAPC was 7.4 months (95% CI: 6.6-11.2 months), and their mOS was 15.5 months (95% CI: 12.6-NA months). The mPFS of patients with mPC was 3.9 months (95% CI: 3.4-5.1 months), and their mOS was 9.3 months (95% CI: 8.0-10.8 months). Multivariate Cox regression analysis showed that clinical stage ( HR=1.47, 95% CI: 1.06-2.04), primary tumor site ( HR=0.64, 95% CI: 0.48-0.86), Eastern Cooperative Oncology Group Performance Status (ECOG PS) score ( HR=2.66, 95% CI: 1.53-4.65), and whether to combine radiotherapy ( HR=0.65, 95% CI: 0.42-1.00) were independent influencing factors for the PFS of these patients. The primary tumor site ( HR=0.68, 95% CI: 0.48-0.95), ECOG score ( HR=5.82, 95% CI: 3.14-10.82), and whether to combine radiotherapy ( HR=0.58, 95% CI: 0.35-0.96) were independent influencing factors of the OS of these patients. The most frequent gene mutations in these advanced stage pancreatic patients were KRAS (89.66%), TP53 (77.01%), CDKN2A (32.18%), and SMAD4 (21.84%) by NGS of tumor tissues from 87 pancreatic cancer patients with sufficient specimens. Further analysis revealed that mutations in CDKN2B, PTEN, FGF6, and RBBP8 genes were significantly associated with an increased risk of death ( P＜0.05). Conclusion:Albumin-bound paclitaxel as first-line treatment demonstrated feasible anti-tumor efficacy and manageable safety for patients with advanced pancreatic cancer in China.

Objective:To observe and evaluate the clinical efficacy and safety of albumin-bound paclitaxel as first-line treatment for patients with advanced pancreatic cancer in China, and to explore the prognosis-related molecules in pancreatic cancer based on next-generation sequencing (NGS) of tumor tissues.Methods:From December 2018 to December 2020, patients with locally advanced or metastatic pancreatic cancer were recruited to accept albumin-bound paclitaxel as first-line treatment in the oncology departments of 24 hospitals in East China. The primary endpoints were overall survival (OS) and treatment related adverse events, and the secondary endpoint was progression-free survival (PFS). Adverse effects were graded using Common Terminology Criteria for Adverse Events 5.0 (CTCAE 5.0). NGS sequencing on the primary or metastatic tissue samples of pancreatic cancer obtained through surgical resection or biopsy was performed.Results:This study recruited 229 patients, including 70 patients with locally advanced pancreatic cancer (LAPC) and 159 patients with metastatic pancreatic cancer (mPC). The disease control rate was 79.9% and the objective response rate is 36.3%.The common adverse effects during treatment were anaemia (159 cases), leucopenia (170 cases), neutropenia (169 cases), increased aminotransferases (110 cases), and thrombocytopenia (95 cases), and the incidence of grade 3-4 neutropenia is 12.2% (28/229). The median follow-up time was 21.2 months (95% CI: 18.5-23.1 months). The median PFS (mPFS) was 5.3 months (95% CI: 4.37-4.07 months) and the median OS (mOS) was 11.2 months (95% CI: 9.5-12.9 months). The mPFS of patients with LAPC was 7.4 months (95% CI: 6.6-11.2 months), and their mOS was 15.5 months (95% CI: 12.6-NA months). The mPFS of patients with mPC was 3.9 months (95% CI: 3.4-5.1 months), and their mOS was 9.3 months (95% CI: 8.0-10.8 months). Multivariate Cox regression analysis showed that clinical stage ( HR=1.47, 95% CI: 1.06-2.04), primary tumor site ( HR=0.64, 95% CI: 0.48-0.86), Eastern Cooperative Oncology Group Performance Status (ECOG PS) score ( HR=2.66, 95% CI: 1.53-4.65), and whether to combine radiotherapy ( HR=0.65, 95% CI: 0.42-1.00) were independent influencing factors for the PFS of these patients. The primary tumor site ( HR=0.68, 95% CI: 0.48-0.95), ECOG score ( HR=5.82, 95% CI: 3.14-10.82), and whether to combine radiotherapy ( HR=0.58, 95% CI: 0.35-0.96) were independent influencing factors of the OS of these patients. The most frequent gene mutations in these advanced stage pancreatic patients were KRAS (89.66%), TP53 (77.01%), CDKN2A (32.18%), and SMAD4 (21.84%) by NGS of tumor tissues from 87 pancreatic cancer patients with sufficient specimens. Further analysis revealed that mutations in CDKN2B, PTEN, FGF6, and RBBP8 genes were significantly associated with an increased risk of death ( P＜0.05). Conclusion:Albumin-bound paclitaxel as first-line treatment demonstrated feasible anti-tumor efficacy and manageable safety for patients with advanced pancreatic cancer in China.