Objective To evaluate the predictive value of different machine learning models constructed in a multicenter environment for potential organ donors and verify their clinical application feasibility. Methods The study included 2 000 inpatients admitted to five domestic tertiary hospitals from January 2020 to December 2023, who met the criteria for potential organ donation assessment. They were randomly divided into a training set and an internal validation set (7∶3). Another 300 similar patients admitted to the First Affiliated Hospital of Harbin Medical University from January 2024 to April 2025 were included as an external validation set. The area under the curve (AUC), sensitivity, specificity, accuracy and F1-score of three models were compared, and the consistency of the potential organ donor determination process was tested. Multivariate logistic regression analysis was used to identify predictive factors of potential organ donors. Decision curve analysis (DCA) was employed to verify the resource efficiency of each model, and the threshold interval and intervention balance point were assessed. Results Apart from age, there were no significant differences in other basic characteristics among the centers (all P>0.05). The consistency of the potential organ donor determination process among researchers in each center was good [all 95% confidence interval (CI) lower limits >0]. In the internal validation set, the XGBoost model had the best predictive performance (AUC=0.92, 95% CI 0.89-0.94) and the best calibration (P=0.441, Brier score 0.099). In the external validation set, the XGBoost model also had the best predictive performance (AUC=0.91, 95% CI 0.88-0.94), outperforming logistic regression and random forest models. Multivariate logistic regression showed that mechanical ventilation had the greatest impact (odds ratio=2.06, 95% CI 1.54-2.76, P<0.001). DCA indicated that the XGBoost model had the highest net benefit in the threshold interval of 0.2-0.6. The “treat all” strategy only had a slight advantage at extremely low thresholds. The recommended threshold interval, which balances intervention costs and clinical benefits, considers ≥50% positive predictive value (PPV) and ≤50 referrals per 100 high-risk patients. Conclusions The XGBoost model established in a multicenter environment is accurate and well-calibrated in predicting potential organ donors. Combined with DCA, it may effectively guide the timing of clinical interventions and resource allocation, providing new ideas for the assessment and management of organ donation after brain death.

Objective:To investigate the efficacy of azacitidine combined with CAG regimen in the treatment of acute myeloid leukemia (AML) patients who are not suitable for intensive chemotherapy.Methods:A retrospective case-series study was conducted. A total of 67 AML patients with newly diagnosed elderly, treatment-related secondary and myelodysplastic syndromes or myeloproliterative neoplasms primary transformation who were not suitable for intensive chemotherapy were selected from Heze Municipal Hospital from January 2020 to December 2023. Azacitidine combined with CAG regimen was given for treatment, and the efficacy and adverse reactions of the patients were observed.Results:Among the 67 patients, there were 32 females and 35 males with the median age [ M ( Q1, Q3)] of 68 (65, 72) years old. There were 40 cases in the high-risk group, 13 cases in the medium-risk group, and 14 cases in the low-risk group. After 1 course of treatment with azacitidine combined with CAG regimen, the overall response rate (ORR) was 38.8% (26/67), with a complete remission (CR) rate of 20.9% (14/67), a complete remission rate with incomplete recovery of blood cell count (CRi) of 11.9% (8/67), and a partial remission (PR) rate of 6.0% (4/67). After 4 courses of treatment, the ORR was 59.7% (40/67), with a CR rate of 56.7% (38/67) and a CRi rate of 3.0% (2/67). There were no PR patients. All patients in the low-risk and medium risk groups achieved at least CRi, while the ORR in the high-risk group was 40.0% (16/40). There was a statistically significant difference in efficacy between different risk groups ( P < 0.001). The patient had mild adverse reactions, mainly pain and grade 1-2 hematological adverse reactions. Conclusions:AML patients who are intolerant to intensive chometherapy are effectively treated with azacitidine combined with CAG regimen, and the adverse reactions are mild.

Objective:To explore the effect in terms of oxidative stress of combining hyperbaric oxygen (HBO) therapy with arterial thrombolysis in treating acute ischemic stroke.Methods:A total of 166 ischemic stroke survivors were divided into a 0.15MPa group (41 cases), a 0.2MPa group (42 cases), a 0.25MPa group (40 cases), and a 0.3MPa group (43 cases), using a random number table. All received arterial thrombolysis and HBO therapy at the relevant pressure for 14 days. Before and after the treatment, all were assessed using the National Institutes of Health Stroke Scale (NIHSS), and in terms of serum levels of malondialdehyde (MDA) using the thiobarbituric acid method. Superoxide dismutase (SOD) was quantified by the SOD substrate method. Total antioxidant capacity (TAC) was assayed using enzyme-linked immunosorbent assays. Interleukin-1β (IL-1β) was quantified by immunofluorescence and chemiluminescence, and tumor necrosis factor-α (TNF-α) by chemiluminescence immunoassay.Results:After the treatment there was a significant increase in all of the groups′ average NIHSS scores, but with that of the 0.15MPa group significantly higher than the other 3 groups′ averages. The average MDA, SOD, TAC, IL-1β and TNF-α levels of all of the groups had also improved, especially the average MDA score, SOD level, TAC level, IL-1β level and TNF-α level of the 0.2MPa group. In the 0.25MPa group, the average MDA, SOD, TAC, IL-1β level and TNF-α levels had also improved significantly. There was, however, no significant difference in these measurements between the 0.2 and 0.25MPa groups.Conclusions:HBO combined with arterial thrombolysis can improve neurological functioning, regulate oxidative stress, and reduce inflammatory responses in acute ischemic stroke. The best results are at an HBO pressure of 0.2 or 0.25MPa.

Objective To explore the expression of serine/threonine protein kinase 1(AKT1)and Isocho-rismatase Domain-Containing 1(ISOC1)in gastric cancer tissues and evaluate their diagnostic utility.Methods A total of 90 patients with gastric cancer who were diagnosed and treated in our hospital between March 2023 and September 2024 were recruited as the study subjects.The positive expression rates and positive scores of AKT1 and ISOC1 in cancer tissues and adjacent tissues were compared.The AKT1 and ISOC1 positive scores of gastric cancer patients with diverse characteristics were also compared.The Spearman correlation analysis was employed to exam-ine the relationship between the expression of AKT1 and ISOC1 in cancer tissues and the clinical features of gastric cancer patients.A diagnostic model for gastric cancer,integrating AKT1 and ISOC1,was established using the Logistic regression model.Receiver operating characteristic(ROC)curves were plotted to analyze the area under the curve(AUC)value,sensitivity,and specificity of AKT1,ISOC1,and their combined diagnosis for gastric cancer.Results The positive expression rates and positive scores of AKT1 and ISOC1 in cancer tissues were significantly higher than those in paracancerous tissues(P<0.05).In gastric cancer patients,the expressions of AKT1 and ISOC1 were notably higher in patients with low differentiation,clinical stage Ⅰ～Ⅱ,invasion depth T1-2,absence of lymph node metastasis,and no distant metastasis compared to those with moderate differentiation,clinical stage Ⅲ～Ⅳ,invasion depth T3-4,and presence of lymph node metastasis and distant metastasis(P<0.05).Spearman's correlation analysis indicated that AKT1 and ISOC1 were positively correlated with the degree of differ-entiation,clinical stage,lymph node metastasis,invasion degree,and distant metastasis(P<0.05).The area under the curve(AUC)values of AKT1,ISOC1,and their combined diagnosis for gastric cancer were 0.735,0.726,and 0.875 respectively(P<0.05).The sensitivities were 60.00%,56.70%,and 75.60%,while the speci-ficities were 85.60%,83.30%,and 87.80%.The AUC value of the combined detection of AKT1 and ISOC1 in the diagnosis of gastric cancer was higher than that of AKT1 or ISOC1 alone(Z=-3.003,-3.196,P<0.05).Conclusions AKT1 and ISOC1 are highly expressed in gastric cancer tissues,and their expressions are upregu-lated with the progression of the disease.The combined detection of their expression levels holds great significance for the diagnosis and prognosis assessment of gastric cancer.

Objective:To explore the effect in terms of oxidative stress of combining hyperbaric oxygen (HBO) therapy with arterial thrombolysis in treating acute ischemic stroke.Methods:A total of 166 ischemic stroke survivors were divided into a 0.15MPa group (41 cases), a 0.2MPa group (42 cases), a 0.25MPa group (40 cases), and a 0.3MPa group (43 cases), using a random number table. All received arterial thrombolysis and HBO therapy at the relevant pressure for 14 days. Before and after the treatment, all were assessed using the National Institutes of Health Stroke Scale (NIHSS), and in terms of serum levels of malondialdehyde (MDA) using the thiobarbituric acid method. Superoxide dismutase (SOD) was quantified by the SOD substrate method. Total antioxidant capacity (TAC) was assayed using enzyme-linked immunosorbent assays. Interleukin-1β (IL-1β) was quantified by immunofluorescence and chemiluminescence, and tumor necrosis factor-α (TNF-α) by chemiluminescence immunoassay.Results:After the treatment there was a significant increase in all of the groups′ average NIHSS scores, but with that of the 0.15MPa group significantly higher than the other 3 groups′ averages. The average MDA, SOD, TAC, IL-1β and TNF-α levels of all of the groups had also improved, especially the average MDA score, SOD level, TAC level, IL-1β level and TNF-α level of the 0.2MPa group. In the 0.25MPa group, the average MDA, SOD, TAC, IL-1β level and TNF-α levels had also improved significantly. There was, however, no significant difference in these measurements between the 0.2 and 0.25MPa groups.Conclusions:HBO combined with arterial thrombolysis can improve neurological functioning, regulate oxidative stress, and reduce inflammatory responses in acute ischemic stroke. The best results are at an HBO pressure of 0.2 or 0.25MPa.

Objective To explore the expression of serine/threonine protein kinase 1(AKT1)and Isocho-rismatase Domain-Containing 1(ISOC1)in gastric cancer tissues and evaluate their diagnostic utility.Methods A total of 90 patients with gastric cancer who were diagnosed and treated in our hospital between March 2023 and September 2024 were recruited as the study subjects.The positive expression rates and positive scores of AKT1 and ISOC1 in cancer tissues and adjacent tissues were compared.The AKT1 and ISOC1 positive scores of gastric cancer patients with diverse characteristics were also compared.The Spearman correlation analysis was employed to exam-ine the relationship between the expression of AKT1 and ISOC1 in cancer tissues and the clinical features of gastric cancer patients.A diagnostic model for gastric cancer,integrating AKT1 and ISOC1,was established using the Logistic regression model.Receiver operating characteristic(ROC)curves were plotted to analyze the area under the curve(AUC)value,sensitivity,and specificity of AKT1,ISOC1,and their combined diagnosis for gastric cancer.Results The positive expression rates and positive scores of AKT1 and ISOC1 in cancer tissues were significantly higher than those in paracancerous tissues(P<0.05).In gastric cancer patients,the expressions of AKT1 and ISOC1 were notably higher in patients with low differentiation,clinical stage Ⅰ～Ⅱ,invasion depth T1-2,absence of lymph node metastasis,and no distant metastasis compared to those with moderate differentiation,clinical stage Ⅲ～Ⅳ,invasion depth T3-4,and presence of lymph node metastasis and distant metastasis(P<0.05).Spearman's correlation analysis indicated that AKT1 and ISOC1 were positively correlated with the degree of differ-entiation,clinical stage,lymph node metastasis,invasion degree,and distant metastasis(P<0.05).The area under the curve(AUC)values of AKT1,ISOC1,and their combined diagnosis for gastric cancer were 0.735,0.726,and 0.875 respectively(P<0.05).The sensitivities were 60.00%,56.70%,and 75.60%,while the speci-ficities were 85.60%,83.30%,and 87.80%.The AUC value of the combined detection of AKT1 and ISOC1 in the diagnosis of gastric cancer was higher than that of AKT1 or ISOC1 alone(Z=-3.003,-3.196,P<0.05).Conclusions AKT1 and ISOC1 are highly expressed in gastric cancer tissues,and their expressions are upregu-lated with the progression of the disease.The combined detection of their expression levels holds great significance for the diagnosis and prognosis assessment of gastric cancer.

OBJECTIVE To provide suggestions and reference for enriching the selection of anti-infective medicines for children in China and promoting the establishment of the Essential Medicine List for Children in China. METHODS Descriptive analysis method was used to statistically compare the differences and similarities of anti-infective medicines included in the World Health Organization Model List of Essential Medicines for Children （EMLc）， World Health Organization Model List of Essential Medicines （EML） and National Essential Medicine List （NEML） in terms of drug category， variety， dosage form， specification， symbol mark， etc. RESULTS All anti-infective medicines of EMLc were covered by EML （85.3%）. NEML lacked the information of anti-infective medicines relatively， and contained few new categories； for example， the third-generation and above cephalosporins in EMLc were not included， and the drug dosage forms were also relatively limited （mainly tablets， capsules and injections）， but the specifications were relatively rich. CONCLUSIONS With reference to EMLc， the guidance on the use of essential medicines for children in China should be added from the aspects of age， body weight， combined medication， etc.， and the dosage forms suitable for children such as oral liquid preparations and scored tablets should be added to NEML； when updating the NEML the newer drugs suitable for children such as cefixime and dacatavir should be included. Finally， with reference to the continuity of EML and EMLc， the Essential Medicine List for Children in China should be established based on NEML to meet the drug needs of children and promote the safe use of drugs in children.

Objective:To observe the impact of core stability training in the sling exercise therapy pattern on the balance of stroke survivors.Methods:Sixty stroke survivors were randomly divided into a control group ( n=30) and an experimental group ( n=30). In addition to routine rehabilitation training, the control group received traditional core stability training, while the experimental group underwent core stability training applying the sling exercise therapy pattern. Before and after 4 weeks of training, the standing balance of both groups was evaluated using the Prokin balance trainer, with the length and area of motion recorded when performing the balance test with the eyes open and closed. Surface electromyography was used to record the average EMG (AEMG) values of the bilateral erector spinae and multifidus muscles during the balance testing. Results:After the 4 weeks of training the length and the area of progression of the center of the pressure were both significantly smaller for both groups than before the training with the eyes both open and closed. The average length and area in the experimental group were significantly less than among the controls. The AEMG values recorded during the balance tests were significantly higher than those before the intervention for both groups, with the multifidus muscle averages on the affected side significantly greater in the experimental group than among the controls when performing the balance test with the eyes closed.Conclusion:Core stability training in the sling exercise therapy pattern is superior to conventional core stability training because it can better improve the balance of stroke survivors.

Background Previous research indicated that isomers and alternatives of per- and polyfluoroalkyl substances (PFAS) probably disturb glucose metabolism; however, current epidemiological evidence on the associations of PFAS with fasting blood glucose is inconsistent. Besides, studies on the joint association of multiple components of PFAS and fasting blood glucose as well as the key component are scarce. Objective To evaluate the associations of PFAS isomers and alternatives with fasting blood glucose and their joint effects, as well as identify the key component among population without glucose metabolism problems. Methods We selected 923 adults without glucose metabolism problems or missing data from the Isomers of C8 Health Project in China (2015—2016). Serum PFAS isomers and alternatives and fasting blood glucose were measured using ultra-performance liquid chromatography coupled with tandem mass spectrometry (UPLC-MS/MS) and automatic biochemical analyzer. We applied multiple linear regression to explore the associations of 16 pollutants which were detected among over 80% participants with fasting blood glucose. Meanwhile, we utilized qgcomp and Bayesian kernel machine regression (BKMR) models to explore the joint effects of PFAS isomers and alternatives mixture on target outcome indicators and identify the key component. Results The average age among the 923 participants in this study was (62.4±13.8) years old, including 472 men (51.1%) and 451 women (48.9%). Among selected PFAS isomers and alternatives, the highest serum concentration was ∑3+4+5m-PFOS (perfluoro-3/4/5-methylheptanesulfonate) with a median concentration of 10.20 ng·mL⁻¹. The concentrations of linear perfluorooctane sulfonate (n-PFOS, 9.61 ng·mL⁻¹), perfluorooctanoic acid (PFOA, 4.55 ng·mL⁻¹), linear perfluorohexane sulfonic acid (n-PFHxS, 2.48 ng·mL⁻¹), 6:2 chlorinated polyfluorinated ethersulfonic acid (6:2 Cl-PFESA, 1.90 ng·mL⁻¹), perfluoro-6-methylheptanesulfonate (iso-PFOS, 1.85 ng·mL⁻¹), perfluorobutanoic acid (PFBA, 1.81 ng·mL⁻¹), perfluorinated n-nonanoic acid (PFNA, 1.39 ng·mL⁻¹), and perfluoro-1-methylheptanesulfonate (1m-PFOS, 1.27 ng·mL⁻¹) were higher than 1.00 ng·mL⁻¹. After being adjusted for selected confounders, PFAS isomers and alternatives were positively associated with fasting blood glucose. With 1 ln unit concentration increment of 6:2 Cl-PFESA and PFNA, the estimated changes of fasting blood glucose were 0.18 (95%CI: 0.13, 0.23) mmol·L⁻¹ and 0.24 (95%CI: 0.18, 0.30) mmol·L⁻¹, respectively. The multi-pollutant models indicated a joint association of PFAS isomers and alternatives mixture with fasting blood glucose. The BKMR models reveals that as the quantiles of mixture elevated from the 50^th to the 75^th percentile, the values of fasting blood glucose increased 0.25 (95%CI: 0.21, 0.30) mmol·L⁻¹, and the posterior inclusion probability of PFNA was 0.92, implying that PFNA was the key component. Conclusion PFAS isomers and alternatives are positively associated with fasting blood glucose. PFNA is the key component of the joint association.

Background Evidence on the association between greenness and adiposity in children and adolescents is inconsistent and mostly from developed countries. Relatively limited evidence is from China. Objective To assess the association between greenness and adiposity in children and adolescents based on satellite remote sensing data. Methods From 2016 to 2018, a cross-sectional study was conducted among 52316 children and adolescents aged 5-18 years in three cities in the Pearl River Delta region of China. Basic sociological and demographic characteristics of the population and adiposity levels were collected through questionnaires. Land Remote-Sensing Satellite (Landsat) data and moderate-resolution imaging spectroradiometer (MODIS) products were used to quantify the greenness around the schools and homes, including normalized difference vegetation index (NDVI), vegetation continuous field (VCF), soil-adjusted vegetation index (SAVI), and enhanced vegetation index (EVI) calculated within 500 m and 1000 m buffers centered around the participants' homes or schools. A restricted cubic spline function was used to assess the exposure-response relationship. After categorizing greenness levels into quartiles with the first quartile as the reference, two-level generalized linear models were applied to assess the change in body mass index z-scores (zBMI) and the risk of overweight of children and adolescents in higher quartiles relative to the lowest quartile. In addition, counterfactual framework modelling was applied to assess the potential mediation effects of PM_2.5 and NO₂, and physical activity levels on the associations between greenness and adiposity levels. Results Of the 52316 children included, 8406 (16.1%) were overweight. A non-linear negative association of the level of greenness around the homes or schools and zBMI was found, with a significant lower zBMI in children and adolescents when a certain level of greenness was reached. After adjusting for confounders, the participants in the highest quartile had a significantly lower level of zBMI and a significantly lower risk of overweight compared with those in the lowest quartile of NDVI_{500 m} and VCF_{500 m}. The estimate change (\begin{document}$b$\end{document}) for zBMI was −0.07 (95%CI: −0.10-−0.04) and the odds ratio (OR) for overweight was 0.92 (95%CI: 0.85-0.99) for the students in the highest NDVI_{500 m} quartile based on home address compared to those in the lowest quartile. Significant negative associations were also observed when 1000 m buffer, SAVI, and EVI were used. The mediation analysis showed that PM_2.5 and NO₂ partially mediated the negative association of NDVI_{500 m} with zBMI , and the proportions of mediation were 50% (95%CI: 20%-80%) and 90% (95%CI: 50%-160%), respectively while no significant mediation effect was observed for physical activity level. Conclusion Higher levels of greenness surrounding homes or schools may be associated with a reduced risk of overweight and decreased zBMI in children and adolescents, and such associations may be partially mediated by reducing air pollutant concentrations.