Objective To investigate the predictive value of Mayo adhesion probability(MAP)score for intraoperative bleeding during microchannel percutaneous nephrolithotomy(PCNL), so as to provide reference for optimizing surgical decisions.Methods A retrospective analysis was conducted on the clinical data of 86 patients who underwent microchannel PCNL at our hospital during Jan.2018 and Jul. 2025.Patients were divided into two groups based on preoperative CT-derived MAP scores:MAP score＜3 group(n=45)and MAP score≥3 group(n=41).Baseline characteristics, surgical parameters and outcome measures were compared between the two groups.Univariate and multivariate logistic regression analyses were performed to identify risk factors for intraoperative bleeding(defined as a postoperative hemoglobin decrease of ≥20 g/L). Results The incidence of intraoperative bleeding was significantly higher in the MAP score≥3 group than in the MAP score＜3 group(43.9% vs.20.0%, P=0.017).Multivariate analysis identified MAP score ≥3(OR=3.045, 95%CI:1.125-9.547, P=0.019), use of anticoagulant medication(OR=3.016, 95%CI:1.251-9.257, P=0.020), establishment of multiple tracts(OR=5.445, 95%CI:1.798-17.578, P=0.003), and operation time ≥90 minutes(OR=5.697, 95%CI:1.890-13.632, P=0.001)as risk factors for intraoperative bleeding.The area under the curve for the MAP score in predicting intraoperative bleeding was 0.704.Conclusion The MAP score is an independent risk factor for intraoperative bleeding during microchannel PCNL.Preoperative assessment can help identify high-risk patients and provide a basis for optimizing surgical decision-making.

Objective:To investigate the clinicopathological characteristics and prognostic factors of biliary neuroendocrine neoplasms (NENs).Methods:The retrospective cohort study was conducted. The clinicopathological data of 36 patients who underwent surgical treatment for biliary NENs at The First Hospital of Jilin University from January 2013 to December 2023 were collected. There were 22 males and 14 females, aged (59±9)years. Observation indicators: (1) clinicopatholo-gical characteristics of patients; (2) follow-up; (3) prognostic factors analysis of patients. Compari-son of measurement data with normal distribution among multiple groups was conducted using the ANOVA. Comparison of measurement data with skewed distribution among multiple groups was conducted using the Kruskal-Wallis H test. Comparison of count data between groups was conducted using the chi-square test or Fisher exact probability. The Kaplan-Meier method was used to calculate survival rate and plot survival curve, and Log-rank test was used for survival analysis. The Cox risk regression model was used for univariate and multivariate analyses. Results:(1) Clinicopatholo-gical characteristics of patients. None of the 36 patients with biliary NENs had carcinoid syndrome. There were 11 cases with tumor located at gallbladder, 14 cases with tumor located at bile duct, and 11 cases with tumor located at ampulla of Vater. There were significant differences in weight loss and TNM stage among biliary NENs patients with different tumor location ( χ2=9.14, 6.54, P<0.05). Of the 36 patients, there were 12 cases with neuroendocrine tumors, 16 cases with neuroendocrine carcinomas, and 8 cases with mixed neuroendocrine-non-neuroendocrine neoplasms. (2) Follow-up. All 36 patients were followed up for 39(range, 10-93)months. Of the 36 patients, 19 patients experienced tumor recurrence and 16 patients experienced tumor metastasis. There were 18 patients died. The median overall survival time of 36 patients was 30 months, with the 1-, 2-, 3-year overall survival rates of 63.9%, 51.0%, and 35.7%, respectively. The 1-, 2-, 3-year recurrence-free survival rates were 47.5%, 34.1% and 21.3%, respectively. The 1-, 2-, 3-year overall survival rates of 19 patients with tumor recurrence were 55.6%, 55.6% and 27.8%, respectively. The 1-, 2-, 3-year overall survival rates of 17 patients without tumor recurrence were 71.3%, 50.4% and 42.0%, respectively. There was no significant difference in overall survival between patients with and without tumor recurrence ( χ2=0.24, P>0.05). (3) Prognostic factors analysis of patients. Results of multivariate analysis showed that pathological type as neuroendocrine carcinomas and mixed neuroendocrine-non-neuroendocrine neoplasms, non-R 0 margin were independent risk factors influencing overall survival time of patients ( hazard ratio=5.50, 5.33, 14.04, 95% confidence interval as 1.32-23.01, 1.17-24.35, 2.67-73.79, P<0.05). Conclusions:Biliary NENs lack specific clinical manifestations. Poorly differentiated neuroendocrine carcinomas are the most common pathological type. Pathological type as neuroendocrine carcinomas and mixed neuroendocrine-non-neuroendocrine neoplasms, non-R 0 margin are independent risk factors influencing prognosis of patients.

Objective To explore the disinfection effect of periodic hypochlorous acid infusion on water supply pipelines.Methods Water specimens from 6 water outlets of central sterile supply department were collected at baseline for microbial culture.After introducing a slightly acidic hypochlorous acid water generator,water speci-mens were collected every 10 days.Continuous disinfection with hypochlorous acid was carried out on the 1st-3rd day,and discontinued on the 4th-10th day.Water specimens of 6 water outlets were collected on the 1st,4th,7th,and 10th day of each cycle,in total 3 cycles.Microbial culture and metagenomic next-generation sequencing(mNGS)analysis were conducted simultaneously on all water specimens from the outlets of the endoscope cleaning tank.Results Before disinfection of the pipeline,a total of 18 bottles of water specimens were collected.Bacterial count of water specimens from 10 bottles(55.56％)was between 102 and 104 CFU/mL,mainly Sphingomonas ad-hesins and Bacillus cereus.After disinfection,only 2 out of 72 water specimens(2.78％)exceeded the bacterial lim-it.The mNGS results showed that three most dominant bacterial genera in the pre-disinfection water specimens were Sphingomonas,Methylobacterium,and Ralstonia,with stringent mapped reads number(SMRN)ranging from 10 000 to 100 000;while the most dominant bacterial genera in post-disinfection water specimens were Lacto-baci-llus,Ralstonia,Acinetobacter,and Bradyrhizobium.PCoA analysis showed that there was a statistically sig-nificant difference in β-diversity of water specimens before and after disinfection(P＜0.05).Conclusion Periodic hypochlorous acid infusion disinfection can effectively remove bacterial biofilms in water pipelines,but there is a risk of bacterial biofilm recovery during disinfection suspension.In the future,monitoring and management of medical water should be strengthened.

Objective:To reveal the differences in the transcriptome maps of brain tissues in mice subjected to Flash irradiation and conventional dose rate irradiation with electron beams and to explain the biological effect and mechanisms of Flash irradiation from multiple perspectives.Methods:Following the principle of grouping based on approximate body weights, 36 female C57BL/6J mice were divided into three groups, i. e., the control, conventional dose rate irradiation (CONV), and Flash irradiation (Flash) groups, with 12 mice in each group. Both the CONV and Flash groups received a single 15 Gy whole-brain irradiation with 9 MeV electron beams. At 3 d post-irradiation, the whole-brain tissue specimens were collected for hematoxylin-eosin (HE) staining to observe pathological changes. At 1, 3, and 10 weeks post-irradiation, the motion function, cognitive ability, depression level, and spatial memory capacity of the mice were assessed using ethology. At 1 and 10 weeks after behavioral experiments, brain tissue samples were collected and snap-frozen in liquid nitrogen for reference-based transcriptome sequencing. Accordingly, the differences in the transcriptome maps of radiation-induced brain injury between CONV and Flash groups were analyzed.Results:The HE staining-based pathological result revealed that compared to the CONV group, the Flash group exhibited reduced glial cell hyperplasia and inflammatory cell infiltration in brain tissues. Ethological research result at 1 week post-irradiation showed that the CONV group manifested a significantly decreased total traveled distance compared to the control and Flash groups ( t = 5.51, 2.38, P < 0.05) and a significantly increased immobility time compared to the control group ( t = 3.60, P < 0.05). Ethological research result at 3 weeks post-irradiation indicated that compared to the CONV group, the Flash group displayed significantly alleviated cognitive impairment ( t = 3.35, P < 0.05) and reduced depression levels ( t = 2.39, P < 0.05). Ethological research result at 10 weeks post-irradiation demonstrated that the CONV group showed the worst cognitive performance, significantly differing from the control group ( t = 4.53, P < 0.05). Transcriptome sequencing result revealed that besides immune-related pathways, the Flash group also exhibited multiple upregulated metabolic pathways and fibroblast growth factor (FGF)-related pathways compared to the CONV group. Conclusions:Compared to conventional dose rate irradiation, Flash irradiation can effectively alleviate radiation-induced brain injury in mice. This effect is associated with various metabolic pathways (including amino acid metabolism) and FGF-related pathways besides immune pathways.

Objective:To understand the basic situation of occupational internal exposure to 131I among nuclear medicine staff in Jiangsu province, and to analyze the relevant factors that contribute to the formation of internal exposure. Methods:A four-year external direct measurement of thyroid organ counting was conducted on nuclear medicine staff who underwent 131I treatment in Jiangsu province. The result were statistically analyzed, and the effective dose of accumulated internal exposure was estimated. The relationship between the detection rate of internal exposure and 10 possible factors was analyzed. Results:A total of 847 person-times were monitored during the monitoring period, of which 345 person-times were detected for 131I, with a detection rate of 40.7%. The highest individual monitoring result for internal exposure was 24.83 kBq, with an average value of 77.3 Bq and a median of 28.3 Bq among the detected individuals. The average committed effective dose of internal exposure for staff was 0.201 mSv, with a median of 0.074 mSv among the detected individuals. Conclusions:There is statistically significant difference in the detection rate of individual doses of internal exposure among nuclear medicine staff in each year. It has been observed that the main factors related to the detection rate are age, hospital grade, job position, location, whether there is an automatic dispensing operation, operating method, exposure level and length of exposure. Sufficient attention should be given to the situation of internal exposure, and further effective monitoring should be conducted on all such staff members.

Objective To analyze the changes in serum levels of Krüppel-like transcription factors(KLF11)and long non-coding RNA small nucleolar RNA host gene 12(lncRNA SNHG12)in patients with intracranial aneurysm(IA),and their predictive value for prognosis.Methods A retrospective analysis was performed on 132 IA patients(IA group)who underwent interventional embolization for IA rupture and bleeding from February 2019 to February 2023,and 60 healthy people who underwent outpatient physical examination during the same period were selected as the control group.Serum levels of KLF11 was detected by enzyme-linked immunosorbent assay(ELISA),the level of lncRNA SNHG12 was detected by real-time fluorescence quantitative PCR(qRT-PCR).According to the modified Rankin scale(MRS)score,IA patients were divided into a good prognosis group(n=98,MRS score 0～2)and poor prognosis group(n=34,MRS score 3～6).Pearson correlation analysis was used to analyze the correlation between serum KLF11,lncRNA SNHG12 and cerebral hemodynamic parameters.Logistic regression analysis was used to analyze the factors affecting the prognosis of IA patients.The receiver operating characteristic curve was used to analyze the prognostic value of serum KLF11 and lncRNA SNHG12 in IA patients.Results The serum KLF11(47.12±6.58ng/L)and lncRNA SNHG12(1.89±0.36)in the IA group were lower than those in the control group(113.89±19.35ng/L,3.24±0.58),and the differences were statistically significant(t=19.695,35.476,all P<0.05).The levels of serum KLF11 and lncRNA SNHG12 in IA group were positively correlated with cerebral blood flow,cerebral blood volume and mean transit time(rKLF11=0.722,0.627,0.752;rlncRNA SNHG12=0.630,0.714,0.766,all P<0.05),and negatively correlated with intracranial pressure(r=-0.658,-0.599,all P<0.05).The proportion of CT Fisher grade 3～4 in IA patients in the poor prognosis group was higher than that in the good prognosis group,and the postoperative complication rate was higher than that in the good prognosis group,the serum KLF11(35.98±6.11 ng/L)and lncRNA SNHG12(1.12±0.30)levels were lower than those in the good prognosis group(50.98±6.90ng/L,2.16±0.39),and the differences were statistically significant(t=4.630～14.151,all P<0.05).CT Fisher grade 3～4,postoperative complications were risk factors for poor prognosis of IA patients(Wald χ2=8.403,12.049,all P<0.001),serum KLF11,lncRNA SNHG12 were protective factors(Wald χ2=5.550,7.904,all P<0.001).The AUC(95%CI)for predicting the prognosis of IA patients with the combination of serum KLF11 and lncRNA SNHG12 was 0.921(0.889～0.942),which was higher than the single detection of serum KLF11 and lncRNA SNHG12 at 0.848(0.805～0.886)and 0.810(0.767～0.852),and the differences were statistically significant(Z=5.886,4.367,all P<0.001).Conclusion The levels of serum KLF11 and lncRNA SNHG12 in IA patients are decreased,which are related to cerebral hemodynamic parameters.The combined detection has a high evaluation value for the prognosis of IA patients.

OBJECTIVE To investigate the use of common disposable and reusable supplies for prevention and con-trol of infections in Shanghai.METHODS A survey was conducted for the use and reuse of disposable high-value consumables,disposable bronchoscopes and environmental cleaning and disinfection tools in Shanghai by using structured questionnaire.RESULTS Totally 81 medical institutions were involved in the survey,44(54.32％)of which were tertiary hospitals,and the median number of beds was 500.The orthopedic implants(70.37％),ul-trasound knife(69.14％)and endoscopic puncture instrument(66.67％)were the high-value consumables rank-ing the top 3 utilization rates.There was reuse of 18 types of high-value consumables in total among the 12 medi-cal institutions.The major causes of reuse of high-value consumables included fee less tan cost of consumables(58.33％)or being unable to included in charge items(33.33％).27.78％of the recycle high-value consumables were not treated with a dedicated disinfection and sterilization system and procedures for the disposable high-value consumables,and 33.33％did not have the report systems for related adverse reactions.49.09％of the medi-cal institutions reported to use the disposable bronchoscopes,4 of which reused them.The majority of the medi-cal institutions could carry out centralized cleaning and disinfection for the recycled floor cloths(60.81％)and cloth towels(56.76％),and 32.43％of the medical institutions reused the cloth towels by manual cleaning.The utilization rate of antiseptic wipes was 75.41％in adult intensive care unit,62.50％in neonatal intensive care unit.CONCLUSION The study reveals that there are some problems in the use of disposal and reusable supplies for prevention and control of infections,which may provide baseline data for management of the related supplies and the surveillance of disinfection of the recycled supplies so as to enhance the quality of management of hospital-asso-ciated infections.

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.

Objective To investigate the perioperative use of antimicrobial agents in class Ⅰ incisional ophthalmic surgeries in secondary first-class and above medical institutions in Shanghai City,and provide a basis for the rational use of antimicrobial agents in such surgeries.Methods Perioperative antimicrobial prophylaxis(PAP)in patients undergoing class Ⅰ incisional ophthalmic surgery reported by secondary first-class and above hospitals in Shanghai City from 2017 to 2022 was collected retrospectively.The prophylactic use rate,types,rationality of selection,and timing of use of antimicrobial agents were analyzed comprehensively.Results From 2017 to 2022,a total of 54 868 cases of class Ⅰ incisional ophthalmic surgeries were reported from secondary first-class and above hospitals in Shanghai City.The PAP rates in tertiary comprehensive hospitals,tertiary specialty hospitals,tertiary traditional Chinese medicine hospitals,and secondary comprehensive hospitals were 4.72％,1.79％,3.22％,and 6.63％,re-spectively.The overall PAP rate showed a yearly decreasing trend,from 6.39％in 2017 to 2.31％in 2021.Among different types of hospitals,the PAP rate in secondary comprehensive hospitals decreased most significantly,from 12.72％in 2017 to 0.53％in 2022.The main types of prophylactic antimicrobial use were first-,second-and third-generation cephalosporins,and quinolones.The rational selection rates of antimicrobial agents were highest in ter-tiary comprehensive hospitals(17.13％)and lowest in tertiary specialty hospitals(1.08％).The PAP rates in sys-temic veins 0.5-1 hour before surgery were highest in tertiary specialty hospitals(88.17％)and lowest in tertiary comprehensive hospitals(71.53％).The withdrawal rates of antimicrobial agents within 24 hours after surgery were highest in tertiary traditional Chinese medicine hospitals(80.87％)and lowest in tertiary specialty hospitals(13.26％).Conclusion The PAP for class Ⅰ incisional ophthalmic surgeries in secondary first-class and above medical institutions in Shanghai City still presents certain irrational phenomena in terms of antimicrobial types and administration routes.The administration rate 0.5-1 hour before surgery and withdrawal rate of antimicrobial agents within 24 hours after surgery need to be further improved.Enhanced management is necessary to promote more rational use of antimicrobial agents.

Objective This study aims to investigate controversial cases of forensic clinical re-identification of fractures,exploring the characteristics,causes,and countermeasures related to identification errors in primary bone injuries,complications,and subsequent changes.The goal is to provide identification strategies for similar cases regarding the collection of identification materials,timing,and examination method selection,ultimately establishing a paradigm for such identifications.Methods A total of 103 cases of clinical re-identification of fractures accepted by the West China Forensic Identification Center from 2020 to 2024 were collected,and the data from initial identifications and re-identifications were retrospectively analyzed.Results Male cases accounted for 69.90%of the re-identifications,with disability grade(67.96%)and injury degree(30.10%)being the primary concerns.Individual requests represented a high proportion(92.86%)in the initial assessment of disability levels,while unit or joint requests dominated the re-assessment(92.86%).The agreement rates for disability grade and injury degree were 55.26%and 59.38%,respectively.The reassessment of disability grades primarily involved fractures of limb long bones,spine,and ribs,with 75.53%of opinions resulting in downgraded disability levels.Rib,orbital,and nasal bone fractures were the main focus in injury degree reassessments,with 84.62%of opinions indicating aggravated injuries.The consistency rates for fracture identification in disability grade assessments was 92.21%,while rates for injury degree and sequelae were 65.63%and 48.94%,respectively.Inconsistencies in identifying damage facts—including the presence of fractures,distinguishing between fresh and old fractures,and determining the nature of fractures and sequelae—were primarily noted in rib,orbital,and nasal bone fractures.The utilization rate of CT metadata in initial evaluations(25.00%)was significantly lower than in re-evaluations(95.00%).The identification time for joint mobility dysfunction after fracture in re-identifications was significantly longer than in initial identifications(P=0.0002),and the identification time for cases with agreement was significantly shorter than for cases with disagreement(P=0.036).Conclusion Image data type and identification timing are critical factors that may influence the accuracy and consistency of forensic clinical identification of bone injuries.When necessary,dynamic CT metadata in conjunction with image post-processing technology can be routinely employed to identify fractures of the ribs,orbital bones,or nasal bones,thereby reducing the risk of misidentification.