OBJECTIVE To investigate the clinical characteristics and risk factors for batroxobin-related severe hypofibrinogenemia （HFIB） and construct a risk prediction model. METHODS A retrospective analysis was conducted on inpatients treated with batroxobin in the First Medical Center of a tertiary hospital from January 1， 2020， to December 31， 2024. Patients were categorized into non-severe HFIB group and severe HFIB group based on the severity of HFIB. Univariate and multivariate Logistic regression analyses were performed to identify the independent influencing factors for batroxobin-related severe HFIB. A nomogram was developed using the “rms” package in R 4.5 software. The predictive performance of the model was evaluated using the receiver operating characteristic curve. Calibration was assessed via the Bootstrap resampling method， and goodness-of-fit was evaluated with the Hosmer-Lemeshow test. RESULTS A total of 1 472 patients were included in this study. Of these， 1 445 developed HFIB， yi elding an incidence of 98.17%. Furthermore， 895 were classified as severe HFIB， accounting for 60.80% of the cohort. Multivariate Logistic regression analysis showed that increased age， high initial dose per 10 kg body weight， use of maintenance dose， and concomitant glucocorticoid use were independent risk factors for batroxobin-related severe HFIB， while high baseline fibrinogen （FIB） level was identified as a protective factor. The model demonstrated an area under the curve of 0.760 （95% CI： 0.735-0.785）. The mean absolute error of the calibration curve was 0.006. The P value of the Hosmer-Lemeshow test was 0.609. CONCLUSIONS Batroxobin can rapidly and significantly reduce FIB levels and carries a risk of inducing severe HFIB. Patients with advanced age， high initial dose per 10 kg body weight， use of maintenance dose and concomitant glucocorticoid use had a higher risk of batroxobin-related severe HFIB， while high baseline FIB level had a lower risk of batroxobin-related severe HFIB. The risk prediction model developed based on these factors can be used to predict the likelihood of batroxobin-related severe HFIB.

OBJECTIVE To establish a high-risk medication list and preventive and therapeutic measures for drug-induced hypofibrinogenemia， and to provide a reference for the prevention and treatment of this condition. METHODS By integrating domestic and international case reports， retrospective case-control studies， and spontaneous adverse drug reaction reporting databases， 19 domestically marketed high-risk drugs for drug-induced hypofibrinogenemia were identified. Based on the clinical characteristics and mechanisms of these drugs， relevant risk factors were systematically reviewed， and existing treatment options were summarized， leading to the preliminary development of recommended preventive and therapeutic measures. A two-round Delphi consultation was conducted to evaluate， revise， and ultimately reach consensus on the preliminary findings， using a mean importance score of ≥3.5 points for indicators and a coefficient of variation ＜0.3 as screening criteria. RESULTS The coefficient of expert authority for both rounds of expert consultation was 0.904. In the first round， the Kendall coordination coefficients （Kendall’s W ） for the high-risk medication list and the proposed preventive and therapeutic measures were 0.390 and 0.223 （ P ＜0.05）， respectively. In the second round， the Kendall’s W were 0.227 and 0.200 （ P ＜0.05）， respectively. After two rounds of expert consultation and discussion， 11 high-risk drugs for drug-induced hypofibrinogenemia， represented by hemocoagulase and certain anti-infective agents， were ultimately identified， along with 5 preventive and therapeutic measures spanning the entire process of “pre-medication assessment， intra-medication monitoring， and bleeding event management”. CONCLUSIONS This study has established a scientific and reliable high-risk medication list， and corresponding preventive and therapeutic measures for drug-induced hypofibrinogenemia， providing a theoretical basis and practical support for the early identification， stratified management， and precise intervention of this condition.

BACKGROUND:Studies have shown that gut microbiota may affect the progression of rheumatoid arthritis.However,the causal relationship between the two is unknown.Mendelian randomization analysis of the two using published Genome Wide Association Study(GWAS)data can explore the causal relationship between gut microbiota and rheumatoid arthritis,helping to develop targeted microbial therapies and provide methods and strategies for the prevention and treatment of rheumatoid arthritis.OBJECTIVE:To explore the potential causal relationship between gut microbiota and rheumatoid arthritis using two-sample two-way Mendelian randomization method.METHODS:Gut microbiota GWAS data from the MiBio-Gen consortium and rheumatoid arthritis GWAS data from the IEU Open GWAS database(a large gene-phenotype association database developed at the MRC Integrative Epidemiology Unit(IEU)at the University of Bristol,UK)were used.Inverse variance weighting was used as the main analysis method,and MR-Egger regression method,weighted median method,weighted model and simple model method were used as supplements to study the causal relationship between gut microbiota and rheumatoid arthritis.Heterogeneity was assessed using Cochran's Q test,horizontal pleiotropy was assessed using MR-PRESSO and MR-Egger intercept tests,robustness of results was tested using leave-one method,and reverse Mendelian randomization analysis was used to assess the presence or absence of reverse causality.RESULTS AND CONCLUSION:(1)There was a causal relationship between five kinds of enteric bacteria and rheumatoid arthritis.Ruminococcus gauvreauii group(β=0.262,odds ratio[OR]=1.300,P=0.013)and Butyricimonas(β=0.001,OR=1.001,P=0.014)increased the risk of rheumatoid arthritis,while Anaerostipes(β=-0.225,OR=0.798,P=0.025),Lachnospiraceae-UCG010(β=-0.177,OR=0.838,P=0.026)and Oxalobacter(β=-0.171,OR=0.843,P=0.001)reduced the risk of rheumatoid arthritis.Sensitivity analyses showed no significant heterogeneity or horizontal pleiotropy(all P＞0.05),and leave-one-out testing confirmed the robustness of the results,while the addition of the remaining four methods other than the inverse variance weighting method further validated the reliability and stability of the results.(2)Reverse Mendelian randomization analysis did not find a causal association between rheumatoid arthritis and the five kinds of enteric bacteria identified by Mendelian randomization analysis.These findings indicate that Ruminococcus gauvreauii group and Butyricimonas may be the risk factors of rheumatoid arthritis,while Anaerostipes,Lachnospiraceae-UCG010 and Oxalobacter may be the protective factors of rheumatoid arthritis.Gut microbiota may play an important role in the pathogenesis of rheumatoid arthritis,and provide new biomarkers for the prevention and treatment of rheumatoid arthritis.In addition,for the field of biomedical research in China,we can learn from international experience and gradually establish and improve a multi-center large-scale genetic database,so as to deeply explore the relationship between gut microbiota and disease risk,and promote the development of precision medicine and personalized treatment in China.

Objective To propose a liver ultraound image classification model based on bimodal fusion and deep residual network to enhance the diagnosis accuracy of space-occupying lesions(SOLs)of liver.Methods Firstly,a liver ultrasound dataset containing 164 lesions from 100 patients was constructed,including the ultrasound and ultrasonography videos of the patients.Secondly,the parallel residual block was introduced to improve the ResNet-18 network,and the simple attention module and coordinate attention mechanism were used to extract the image features of ultrasound and echography videos,respectively.Finally,a bimodal fusion network was developed with the image features of ultrasound and sonography videos,which was combined with the improved ResNet-18 network to form an ultrasound image classification model.The ultrasound image classification model proposed underwent performance verification by ablation experiment,application evaluation,diagnosis efficacy evaluation,significance evaluation for assisting surgical operation and comparison with the existing classification models in terms of image classification ability.Results The ablation experiment results showed that the proposed model performed the best in classification speed and accuracy when compared with the existing classification models,with a floating-point operation speed of 5.328×109/s,an average accuracy of 0.941 and a calculation speed of 245.266 frames/s.The application evaluation results indicated when compared with the existing classification models the proposed model had the best convergence performance of the loss function curve and the lowest misdiagnosis rate of 7.03%.The diagnosis efficacy evaluation results proved the proposed model gained advantages over other models in diagnostic efficacy,with a sensitivity of 89.38%,a specificity of 94.12%,an accuracy of 90.85%,a positive predictive value of 97.12%and a negative predictive value of 80.00%.The significance evaluation for assisting surgical operation found when compared with the existing classification models the proposed model had the shortest end-to-end delay of 723 ms;laparoscopic hepatectomy assisted with the proposed model had the blood loss reduced by 109.832 mL when compared with the traditional laparoscopic procedure,with the difference being statistically significant(P<0.05).Conclusion The proposed model enhances the diagnosis efficiency and accuracy of ultrasond SOLs of liver,providing support for clinical diagnosis and surgical assistance.[Chinese Medical Equipment Journal,2025,46(10):9-16]

Three failures of YLY-020Y acidic oxidation potential water generator were introduced,and the causes and specific troubleshooting measures were explored.References were provided for engineers to treat similar failures.[Chinese Medical Equipment Journal,2025,46(10):118-120]

Objective To explore the effects of alpha-mangostin(α-MG)on the in vitro osteoarthritis(OA)in rat chondrocytes induced by lipopolysaccharide(LPS)and the M1 polarization of macrophages.Methods An in vitro OA model of rat chondrocytes was induced by LPS.Both rat chondrocytes and macrophages were divided into the control group(normal culture),LPS group(stimulated with 1 μg/mL LPS for 24 hours),LPS+α-MG group(stimulated with 40 μmol/L α-MG combined with 1 μg/mL LPS for 24 hours),LPS+α-MG si-NC group(transfected with 70 μg/mL si-NC and stimulated with 40 μmol/L α-MG and 1 μg/mL LPS for 24 hours),and LPS+α-MG+si-BDNF group(transfected with 70 μg/mL si-BDNF and stimulated with 40 μmol/L α-MG and 1 μg/mL LPS for 24 hours).CCK-8 assay was used to detect the proliferative viability of chondrocytes and macrophages in each group,and flow cytometry was used to detect the apoptosis of chondrocytes and the polarization of macrophages.ELISA was used to detect the levels of interleukin(IL)-1β,IL-6,and tumor necrosis factor(TNF)-α of chondrocytes in each group.Western blot was used to detect the expression of BDNF,PI3K,and Akt in chondrocytes and macrophages.Results In chondrocytes,compared with the control group,the LPS group had decreased cell proliferation rate,increased cell apoptosis rate,down-regulated expression of BDNF,PI3K and Akt proteins,and up-regulated levels of IL-1β,IL-6 and TNF-α(P<0.05);compared with the LPS group,the LPS+α-MG group showed increased cell proliferation rate,decreased cell apoptosis rate,up-regulated expression of BDNF,PI3K and Akt proteins,and down-regulated levels of IL-1β,IL-6 and TNF-α(P<0.05);compared with the LPS+α-MG+si-NC group,the LPS+α-MG si-BDNF group demonstrated decreased cell proliferation rate,increased cell apoptosis rate,down-regulated expression of BDNF,PI3K and Akt proteins,and increased levels of IL-1β,IL-6 and TNF-α(P<0.05).In macrophages,compared with the control group,the LPS group had decreased cell proliferation rate,increased proportion of M1 cells,and down-regulated expression of BDNF,PI3K and Akt proteins(P<0.05);compared with the LPS group,the LPS+α-MG group showed increased cell proliferation rate,decreased proportion of M1 cells,and up-regulated expression of BDNF,PI3K and Akt proteins(P<0.05);compared with the LPS+α-MG+si-NC group,the LPS+α-MG+si-BDNF group showed decreased cell proliferation rate,increased proportion of M1 cells,and down-regulated expression of BDNF,PI3K and Akt proteins(P<0.05).Conclusion α-MG inhibits the M1 polarization of macrophages to improve the apoptosis and inflammation of rat chondrocytes by activating the BDNF/PI3K/Akt signaling pathway.

Objective To explore the value of inflammatory load index(IBI)in the diagnosis and prognosis of gastric cancer patients.Methods Clinical data of patients who underwent gastric cancer surgery in the Department of General Surgery of the Second Hospital of Lanzhou University from January 2016 to December 2018 were retrospectively analyzed,and the patients were divided into the high IBI group and the low IBI group based on the optimal cut-off value of IBI.ROC curve was used to determine the optimal cut-off value of IBI,and the survival curve was constructed using the Kaplan-Meier method,and the differences between groups were examined using the Log-rank test.Cox regression analysis was performed to study the prognostic factors of gastric cancer patients.Results The best cut-off value for IBI diagnosis was 8.796,and the best cut-off value for prognosis was 28.75.IBI was related to the clinical case characteristics of gastric cancer patients,such as surgical access,the degree of differentiation,CK7,CK20,LMP-1,and Ki-67(P＜0.05).The results of univariate analysis showed that intraoperative bleeding,preoperative CEA,preoperative CA125,preoperative CA199,IBI,tumor diameter size,margins of incision,vascular invasion,nerve invasion,pT stage and pN stagewere the influencing factors on the prognosis of gastric cancer patients(P＜0.05).The results of multifactorial regression analysis showed that intraoperative bleeding,preoperative CEA,preoperative CA199,IBI,tumor diameter size,pT stage and pN stagewere independent risk factors affecting the prognosis of gastric cancer patients(P＜0.05).The median OS of patients in the high IBI group and low IBI group were 32.9 months and 74.8 months,respectively,with statistically significant differences(P＜0.001).Conclusion IBI is an independent risk factor for poor prognosis of patients with gastric cancer,and it has a good predictive value in diagnosis and prognosis.

This study assessed the role and mechanism of the recombinant Bacillus Calmette-Gue?rin vaccine(rBCG)with c-di-AMP adjuvant in regulating metabolism and immunity in epididymal white adipose(eWAT)in mice.Male C57BL/6 mice were intravenously immunized with BCG and rBCG,and their body weights were monitored.eWAT was isolated from the mice,and the stromal vascular fractions(SVFs)cell number was counted with a hemocytometer.Sections of mouse adipose tissue were prepared,and the size,number,and morphology of eWAT adipocytes and crown-like structure(CLS)formation were compared under a microscope after HE staining.The transcription levels of lipid metabolism-associated factors,cytokines and aging-associated genes in each group were determined with qRT-PCR.The body weights of mice gradually increased after immunization with BCG and rBCG.The proportions of eWAT increased,and the SVFs cell number decreased,in rBCG immunized mice.HE staining indicated that BCG immunization promoted hyperplasia,whereas rBCG immunization promoted hypertrophy of eWAT adipocytes;moreover,both BCG and rBCG immunization induced CLS formation in eWAT.The qRT-PCR results indicated that rBCG immunization inhibited the expression of genes associated with lipolysis and energy expenditure in eWAT.BCG immunization had little effect on cytokine transcription,whereas rBCG significantly induced the transcription of IFN-γ and IL-1Ra,and inhibited that of IL-15 and IL-2,but did not induce the expression of aging-associated genes.Thus,rBCG immunization induced eWAT adipocyte hypertrophy,which was associated with the inhibition of eWAT lipolysis and the regulation of cytokine expression.

The objective of this study was to evaluate the toxicity and safety of novel Mycobacterium tuberculosis fusion strain protein derivatives,referred to as B/R strain active proteins.In cellular experiments,RAW264.7 cells were treated with each vaccine preparation,and apoptosis rates were measured.In subsequent animal experiments,C57BL/6 mice were immunized via subcutaneous injection,and their survival and body weight changes were monitored and recorded at 2,4,8,12,and 16 weeks.The lungs and spleens were harvested to calculate organ coefficients,and pathological examinations were conducted.At the eighth week of immunization,the mice were infected with high concentrations of BCG,and pathological changes in the lungs and spleens were observed 4 weeks post-infection.The apoptosis rate at 6 hours was significantly higher in the experimental group than the PBS group(P<0.05).At 12 and 24 hours,the apoptosis rate in the experimental group remained higher than that in the PBS group,although this difference was not statistically significant.After immunization,mice in all four groups exhibited normal growth patterns,as indicated by stable body weight changes.At 4 and 12 weeks post-immunization,the lung coefficients in the protein group were significantly higher than those in the PBS group at the same time points.Additionally,the lung coefficients in the BCG group were significantly elevated across all time periods(P<0.05).The spleen coefficients in the protein and BCG groups were significantly higher than those in the PBS group at 2,4,8,12,and 16 weeks,whereas the ICD B/R group showed higher spleen coefficients than the PBS group only at week 8(P<0.05).Pathological examination revealed normal lung and spleen tissues in the PBS group.However,during the 2-8 weeks immunization period,lung and spleen tissues in all experimental groups exhibited varying degrees of damage,which gradually diminished by 12-16 weeks.Notably,no tuberculosis nodules were observed in any experimental group.After infection with high concentrations of BCG,no overt pathological changes were observed on the surfaces of the lungs and spleens in any group.Microscopic examination revealed less severe pathological changes in the lungs and spleens of mice in the experimental groups than the PBS group.Furthermore,no statistically significant differences were observed between the protein group and the BCG group.Our findings suggested that the B/R strain active proteins'toxicity and safety profiles were comparable to those of BCG,and showed immunoprotective effects.This study provides an experimental foundation for the development of a novel tuberculosis vaccine.

The intelligent development of the medical field is burgeoning,and smart healthcare has become a crucial driver for enhancing medical service efficiency and improving patient experience.However,the specific pathways through which smart healthcare improves patient experience have not been fully explained.To address this gap,this study utilizes micro-level individual data collected by the Beijing Hospitals Authority in 2023 from patients in municipal hospitals,employing the Technology Acceptance Model(TAM)to investigate the impact mechanisms of smart service construction on patient experience.The results indicate that smart services significantly improve patient experience by enhancing perceived ease of use,with this effect being particularly prominent during the treatment stage.Additionally,smart services demonstrate potential advantages in alleviating the"digital divide,"with a more pronounced optimization effect on the healthcare experience of elderly populations.Highly educated groups exhibit greater satisfaction and perceived benefits from smart services.