OBJECTIVE To analyze the risk factors contributing to piracetam-associated thrombocytopenia and develop a predictive model for risk prediction. METHODS The electronic medical record information of inpatients treated with piracetam was collected retrospectively from the First Affiliated Hospital of Guangxi Medical University from January 2021 to December 2023， including gender， age， underlying diseases， combined medication， and laboratory data， etc. Patients were divided into the occurrence group and the non-occurrence group according to whether thrombocytopenia occurred， and the differences in clinical data between the two groups were compared. The independent risk factors were determined through univariate/multivariate Logistic regression analysis. A nomogram was drawn to visually present the independent risk factors， and a risk prediction model was constructed. The predictive efficacy of the model was evaluated using the receiver operating characteristic （ROC） curve， Bootstrap internal validation and calibration curve. RESULTS A total of 224 patients were included， among which 196 cases were in the non- occurrence group and 28 cases in the occurrence group. The incidence of thrombocytopenia was 12.50%. The results of the univariate Logistic regression analysis showed that the proportion of patients using three or more combined antibiotics and the level of serum creatinine in the occurrence group were significantly higher than those in the non-occurrence group， while the level of hemoglobin was significantly lower （P＜0.05）. The results of the multivariate Logistic regression analysis revealed that the use of three or more combined antibiotics， low hemoglobin level and high serum creatinine level were independent risk factors for piracetam-associated thrombocytopenia （P＜0.05）. The constructed risk prediction model was LogitP＝ －1.114+1.256×three or more combined antibiotics－0.017×hemoglobin level+0.009×serum creatinine level. The AUC of the ROC curve of this model was 0.757， and the optimal cut-off value was 0.474； the AUC of the ROC curve of the Bootstrap internal validation was 0.733； the apparent curve and the bias-corrected curve were close to the ideal curve. CONCLUSIONS The use of three or more antibiotics， along with low hemoglobin level and high serum creatinine level， are identified as independent risk factors for piracetam-associated thrombocytopenia. The developed risk prediction model demonstrates good predictive value.

Objective To assess the impact of the"one hospital with multiple districts"model on the quality of care and operational efficiency of inpatient surgical services in a tertiary care general hospital.Methods With 2019(before reform)and 2023(after implementation)serving as the observation nodes,the branch hospital district was designated as the intervention group and the main hospital district was allocated tothe control group.An empirical analysis was conducted with the method of Difference-in-Differences(Dl D),and the model robustness was verified by parallel trend test and placebo test.Fourteen core indicators were selected from four dimensions:medical capability,safety management,service efficiency and cost control,to assess the effect.Results After the reform,the medical capabilityindicators and service efficiency indicators were significantly optimized(P＜0.1);the mortality rate,the infection rate in class l incisionand 7-day readmission rate in the safety management indicators were significantly reduced(P＜0.1),but the rate of complications of inpatients undergoing elective surgery was significantly increased(P=0.007);the average hospitalization expenses,the average drug expenses and the average consumable expenses in the cost control indicators were significantly reduced(P＜0.10),and the increase in the average surgery cost was not statistically significant(P=0.765).Conclusion The"one hospital with multiple districts"model has achieved economies of scale through the integration and allocation of resources,improving medical capacity and operational efficiency without negative impact on cost control.

AIM:To investigate the immunosuppressive effects of M2-like tumor-associated macrophages(M2-TAMs)on CD8+T cells within the tumor microenvironment of esophageal cancer.METHODS:Multiplex fluores-cence immunohistochemistry was used to analyze the distribution of immune cells in esophageal cancer tissues.An in vitro co-culture system was established,and flow cytometry along with Calcein-AM/PI staining was employed to assess the im-pact of M2-TAMs on CD8+T cell function.The GEPIA database was utilized to evaluate the prognostic significance of PDCD1 expression in esophageal cancer patients and to analyze the correlations between gene expressions.Immunohisto-chemistry(IHC)was performed to detect the expression of TGF-β1 in esophageal cancer tissues.Flow cytometry and en-zyme-linked immunosorbent assay(ELISA)were used to measure PD-1,IFN-γ and TNF-α expression in CD8+T cells fol-lowing treatment with a TGF-β1 inhibitor.RESULTS:Compared with early-stage(stage I)esophageal cancer patients,the patients with advanced disease(stages Ⅱ to Ⅳ)exhibited dynamic changes in the infiltration of CD4+T cells,CD8+T cells,Tregs,and M2-TAMs within tumor tissues,with significant correlations observed among these cell populations(P<0.05).The distribution of M2-TAMs and Tregs was positively correlated with poor prognosis(P<0.05),while that of CD8+T cells was negatively correlated(P<0.05).In contrast,CD4+T cell infiltration showed no significant association with clinical outcomes(P>0.05).Co-culture of CD8+T cells with M2-TAMs resulted in significant downregulation of CD107a,granzyme B,IFN-γ and TNF-α expression(P<0.01).Additionally,M2-TAM-treated CD8+T cells co-cultured with esophageal cancer cells led to reduced apoptosis of cancer cells.High expression of PDCD1 was significantly associated with poor prognosis(P<0.05),and significant correlations were observed between CD8A and PDCD1 expression,as well as between TGF-β1 and CD274 gene expression(P<0.01).TGF-β1 was also significantly associated with CD163+macro-phage infiltration and the progression of esophageal cancer(P<0.05).Treatment with a TGF-β1 inhibitor in the M2-TAM and CD8+T cell co-culture system significantly down-regulated PD-1 expression and increased the secretion of IFN-γ and TNF-α(P<0.01).CONCLUSION:The TGF-β1 derived from M2-TAMs inhibits the antitumor activity of CD8+T cells in the esophageal cancer microenvironment,suggesting potential therapeutic targets for overcoming immunosuppression in esophageal cancer.

AIM:To investigate the immunosuppressive effects of M2-like tumor-associated macrophages(M2-TAMs)on CD8+T cells within the tumor microenvironment of esophageal cancer.METHODS:Multiplex fluores-cence immunohistochemistry was used to analyze the distribution of immune cells in esophageal cancer tissues.An in vitro co-culture system was established,and flow cytometry along with Calcein-AM/PI staining was employed to assess the im-pact of M2-TAMs on CD8+T cell function.The GEPIA database was utilized to evaluate the prognostic significance of PDCD1 expression in esophageal cancer patients and to analyze the correlations between gene expressions.Immunohisto-chemistry(IHC)was performed to detect the expression of TGF-β1 in esophageal cancer tissues.Flow cytometry and en-zyme-linked immunosorbent assay(ELISA)were used to measure PD-1,IFN-γ and TNF-α expression in CD8+T cells fol-lowing treatment with a TGF-β1 inhibitor.RESULTS:Compared with early-stage(stage I)esophageal cancer patients,the patients with advanced disease(stages Ⅱ to Ⅳ)exhibited dynamic changes in the infiltration of CD4+T cells,CD8+T cells,Tregs,and M2-TAMs within tumor tissues,with significant correlations observed among these cell populations(P<0.05).The distribution of M2-TAMs and Tregs was positively correlated with poor prognosis(P<0.05),while that of CD8+T cells was negatively correlated(P<0.05).In contrast,CD4+T cell infiltration showed no significant association with clinical outcomes(P>0.05).Co-culture of CD8+T cells with M2-TAMs resulted in significant downregulation of CD107a,granzyme B,IFN-γ and TNF-α expression(P<0.01).Additionally,M2-TAM-treated CD8+T cells co-cultured with esophageal cancer cells led to reduced apoptosis of cancer cells.High expression of PDCD1 was significantly associated with poor prognosis(P<0.05),and significant correlations were observed between CD8A and PDCD1 expression,as well as between TGF-β1 and CD274 gene expression(P<0.01).TGF-β1 was also significantly associated with CD163+macro-phage infiltration and the progression of esophageal cancer(P<0.05).Treatment with a TGF-β1 inhibitor in the M2-TAM and CD8+T cell co-culture system significantly down-regulated PD-1 expression and increased the secretion of IFN-γ and TNF-α(P<0.01).CONCLUSION:The TGF-β1 derived from M2-TAMs inhibits the antitumor activity of CD8+T cells in the esophageal cancer microenvironment,suggesting potential therapeutic targets for overcoming immunosuppression in esophageal cancer.

By using a literature review,explores the characteristics,classifications,development trends,and benefits of U.S.multi-hospital systems,with MD Anderson Cancer Center as a case.It offers recommendations for China's multi-campus public hospitals,including clarifying functional roles,enhancing standardized management,advancing information construction,and establishing a flexible management framework.These strategies aim to im-plement an integrated development model,optimize medical resource allocation,and promote balanced regional healthcare services.

By using a literature review,explores the characteristics,classifications,development trends,and benefits of U.S.multi-hospital systems,with MD Anderson Cancer Center as a case.It offers recommendations for China's multi-campus public hospitals,including clarifying functional roles,enhancing standardized management,advancing information construction,and establishing a flexible management framework.These strategies aim to im-plement an integrated development model,optimize medical resource allocation,and promote balanced regional healthcare services.

Objective To assess the impact of the"one hospital with multiple districts"model on the quality of care and operational efficiency of inpatient surgical services in a tertiary care general hospital.Methods With 2019(before reform)and 2023(after implementation)serving as the observation nodes,the branch hospital district was designated as the intervention group and the main hospital district was allocated tothe control group.An empirical analysis was conducted with the method of Difference-in-Differences(Dl D),and the model robustness was verified by parallel trend test and placebo test.Fourteen core indicators were selected from four dimensions:medical capability,safety management,service efficiency and cost control,to assess the effect.Results After the reform,the medical capabilityindicators and service efficiency indicators were significantly optimized(P＜0.1);the mortality rate,the infection rate in class l incisionand 7-day readmission rate in the safety management indicators were significantly reduced(P＜0.1),but the rate of complications of inpatients undergoing elective surgery was significantly increased(P=0.007);the average hospitalization expenses,the average drug expenses and the average consumable expenses in the cost control indicators were significantly reduced(P＜0.10),and the increase in the average surgery cost was not statistically significant(P=0.765).Conclusion The"one hospital with multiple districts"model has achieved economies of scale through the integration and allocation of resources,improving medical capacity and operational efficiency without negative impact on cost control.

Objective Ultrasound categories of Breast Imaging Reporting and Data System(BI-RADS)are an important outcome used in the evaluation of the characteristics of breast lesions.In this study,we aim to explore the potential influencing factors that may cause the progression of BI-RADS categories.Methods Based on the cervical cancer and breast cancer screening cohort in Shuangliu District,Chengdu from 2015 to 2021,we collected ultrasound and questionnaire results.Progression was defined as changing from BI-RADS category 1 or 2 to 3 or above,or from the initial screening result of BI-RADS 3 or above to a higher category in subsequent ultrasound screenings.The Cox proportional hazards regression model was used to explore potential influencing factors for BI-RADS classification progression.A restricted cubic spline was used to explore the nonlinear association between the variables and the risk of progression.Results A total of 7 069 participants were included in the analysis and followed up for 23 580 person-years.Compared with other age groups,the proportion of participants of BI-RADS category 3 and above was highest in the 40-44 age group(24.83％).Cox regression analysis showed that postmenopausal women had a lower risk of BI-RADS progression than premenopausal women did(hazard ratio[HR]:0.65,95％confidence interval[CI]:0.44-0.97).In postmenopausal women,late menopause(HR=1.16,95％CI:1.03-1.30)was identified as a risk factor for BI-RADS progression.Obesity in premenopausal women was negatively associated with the risk of progression(HR=0.43,95％CI:0.21-0.88).Conclusion The risk factors for progression in ultrasound BI-RADS categories overlap with the risk factors for breast cancer.A risk score based on the high-risk factors for BI-RADS progression can be constructed to optimize screening programs for high-risk populations and improve the efficiency of breast cancer screening.

Objective To investigate the clinical features of the spectrum of upper gastrointestinal diseases in children and to provide assistance in the prevention,diagnosis and treatment of upper gastrointestinal diseases in children.Methods Clinical data of 424 children aged 2 months to 14 years who were hospitalised for gastroscopy in the paediatrics department of the First People's Hospital of Yunnan Province from January 2018 to June 2023 were collected,and retrospective analyses were performed for the children's clinical presentation,gastroscopy results,and HP infections.Results The symptoms of vomiting and diarrhea in infants were significantly different from those in preschool and school age groups(P＜0.05).The positive rate of lesions under gastroscopy was 96.46％.The main diseases found were non-atrophic gastritis(222 cases),bile reflux gastritis(42 cases),non-atrophic gastritis with erosion(30 cases),duodenitis(25 cases),reflux esophagitis(15 cases)and others(75 cases).Helicobacter pylori(HP)was detected in 300 of the 424 cases,and 105 cases were HP positive,with a detection rate of 35.00％.Conclusion Abdominal pain was the main symptom of upper gastrointestinal diseases in school-age and pre-school children.Vomiting and diarrhea were the main symptoms of upper gastrointestinal diseases in infants.There was no gender difference in HP infection,but there was a difference in age.

Objective:To discuss the effect of sialic acid-binding immunoglobulin-like lectin-15(Siglec15)derived from M2 tumor-associated macrophages(M2-TAMs)on promoting the malignant biological behavior of the esophageal squamous cell carcinoma(ESCC)through bioinformatics analysis,and to validate the findings through cell experiment.Methods:The Tumor Immune Estimation Resource(TIMER)online Database was used to analyze the expression differences and immune infiltration of Siglec15 in pan-cancer and adjacent normal tissues.Real-time fluorescence quantitative PCR(RT-qPCR)method was used to detect the expression levels of Siglec15 mRNA in M2-TAMs and ESCC EC109 and KYSE150 cells.Based on the non-contact co-culture of M2-TAMs and ESCC cells,the following groups were set up,such as EC109/KYSE150 group,EC109/KYSE150+si-NC group(transfected with si-NC sequence),and EC109/KYSE150+si-Siglec15 group(transfected with si-Siglec15#1 and si-Siglec15#2 sequences).CCK-8 method was used to detect the proliferation activities of the cells in various groups;wound healing assay was used to detect the wound healing rates of the cells in various groups;Transwell chamber assay was used to detect the numbers of migration and invasion cells in various groups;flow cytometry was used to detect the apoptotic rates of the cells in various groups.Results:The bioinformatics analysis results showed that compared with adjacent normal tissue,the expression levels of Siglec15 mRNA in pan-cancer tissues such as esophageal cancer,colon cancer,and head and neck squamous cell carcinoma tissues were increased(P＜0.05 or P＜0.01),and the expression level of Siglec15 mRNA in esophageal cancer tissue was significantly positively correlated with the infiltration of the macrophages(P＜0.05).Compared with the EC109 cells and KYSE150 cells,the expression level of Siglec15 mRNA in M2-TAMs was significantly increased(P＜0.01).There was no significant difference in the proliferation rate of the cells among EC109/KYSE150 group,EC109/KYSE150+si-NC group,and EC109/KYSE150+si-Siglec15 group(P＞0.05).Compared with EC109/KYSE150 group,after treated for 24 and 48 h,the wound healing rate of the cells in EC109/KYSE150+si-NC group was increased(P＜0.01),the numbers of migration and invasion cells were increased(P＜0.05),and the apoptotic rate was decreased(P＜0.01).Compared with EC109/KYSE150+si-NC group,the wound healing rates of the cells in EC109/KYSE150+si-Siglec15#1 group and EC109/KYSE150+si-Siglec15#2 group were decreased(P＜0.05),the numbers of migration and invasion cells were decreased(P＜0.05),and the apoptotic rates of the cells had no significant difference(P＞0.05).Conclusion:Siglec15 derived from M2-TAMs may be a key factor in promoting the migration and invasion of the ESCC cells.