From the perspective of transfusion medicine and based on the vision and framework of patient blood management, this article combines the advances in basic science, blood transfusion, laboratory, and clinical medicine. It aims to systematically review the key elements and characteristics of patient fibrinogen management by maintaining and optimizing patients' hemostatic function while reducing blood transfusions. This review enriches the connotation of transfusion medicine, especially patient blood management, and provides valuable insights for clinical practice.

Objective: To explore the influencing factors of anxiety symptoms and to construct a predictive model based on machine learning algorithms, so as to provide support for the prevention and management of anxiety symptoms among junior high school students. Methods: From April to May 2023, a stratified random cluster sampling method was adopted to select 8 176 junior high school students from Zhengzhou and Shangqiu citys. All participants completed the Adolescent Self rating Life Events Checklist, the 10item Connor-Davidson Resilience Scale, the School Connectedness Scale, the Parent-Child Cohesion Questionnaire, and the 7 item Generalized Anxiety Disorder Scale. Logistic regression analysis identified the associated factors of anxiety symptoms among junior high school students. Predictive models were constructed using Logistic regression, Random Forest, and eXtreme Gradient Boosting (XGBoost) algorithms, with SHapley Additive exPlanations analysis explaining the optimal model. Results: The detection rate of anxiety symptoms among junior high school students was 16.3%. Logistic regression analysis showed that junior high school students who were female ( OR =1.22), in the ninth grade ( OR =1.27), living in urban areas ( OR =1.37), having a father with a college education or above ( OR =1.26), having a mother with a senior high school education ( OR =1.26), and experiencing higher levels of negative life events ( OR =1.05) reported a higher risk of anxiety symptoms(all P <0.05). In contrast, those with moderate family economic status ( OR =0.71), moderate academic burden ( OR =0.59), low academic burden ( OR =0.54), moderate sleep quality ( OR =0.46), good sleep quality ( OR =0.26), excellent sleep quality ( OR =0.15), higher levels of psychological resilience ( OR =0.96), higher levels of school connectedness ( OR =0.96), and higher levels of parent-child cohesion ( OR =0.98) reported a lower risk of anxiety symptoms (all P <0.05). Three machine learning models demonstrated good predictive performance for anxiety symptoms among junior high school students (all AUC>0.8), with the XGBoost model achieving the best predictive performance. SHAP analysis revealed that negative life events, sleep quality, school connectedness, psychological resilience and parent-child cohesion were the top five relevant factors for predicting anxiety symptoms. Conclusions The detection rate of anxiety symptoms among junior high school students is relatively high. The XGBoost model is the optimal predictive model for anxiety symptoms in the population. Negative life events, sleep quality, school connectedness, psychological resilience, and parent-child cohesion are significant correlates of anxiety symptoms among junior high school students.

Objective To compare the clinical efficacy of low-molecular-weight heparin anticoagulant drugs in the treatment of venous thrombosis caused by viral pneumonia.Methods The clinical data of 355 patients diagnosed with viral pneumonia patients in the First People's Hospital of Yunnan Province from December 2022 to February 2023 were collected by retrospective analysis.The patients were classified into moderate group(n=1 14),severe group(n=116),and critical group(n=125)based on the severity of viral pneumonia.The changes in coagulation indicators of the patients after treatment with low molecular weight heparin sodium injection,low molecular weight heparin calcium injection,and enoxaparin sodium injection were compared among three groups.Results Compared with before treatment,there was no statistically significant difference in white blood cells count among three groups of patients after treatment(P＞0.05);The hypersensitive C-reactive protein levels of patients in moderate group and critical group decreased(P＜0.05);The levels of D-dimer decreased in severe group and critical group of patients(P＜0.05).After treatment with low-molecular-weight heparin calcium injection,the activated partial thromboplastin and prothrombin time of patients in severe group were shortened compared to before treatment,and the D-dimer levels of patients in severe group and critical group were reduced compared to before treatment,with statistical significance(P＜0.05);After treatment with low-molecular-weight heparin sodium and enoxaparin,only critical group showed a significant decrease in D-dimer levels(P＜0.05).Conclusion Low-molecular-weight heparin calcium injection has a stronger alleviating effect on blood hypercoagulability caused by elevated D-dimer levels than low-molecular-weight heparin sodium and enoxaparin,which is beneficial for relieving patients' hypercoagulability.

Objective To explore the factors affecting the prognosis of patients with carbapenem-resistant Ente-robacterales(CRE)healthcare-associated infection(HAI)after neurosurgical procedure,construct and validate a nomogram prediction model.Methods Data of patients with CRE infection after neurosurgical procedure in a tertia-ry hospital in Shanghai from 2018 to 2023 were collected,patients were divided into death group and survival group based on prognosis.LASSO regression and multivariate COX regression analysis were adopted to screen indepen-dent risk factors and construct nomogram prediction model.Receiver operating characteristic(ROC)curve,calibra-tion curve,and decision curve analysis(DCA)were drawn based on Bootstrap internal validation method to evaluate the effectiveness of the model.Results A total of 241 patients were included in analysis,with 221 in the survival group and 20 in the death group.The LASSO and COX regression analysis results showed that gender,length of hospital stay＞30 days,decreased monocyte percentage(MONO％),and elevated creatinine(Cr)were independent risk factors for death in patients with CRE HAI after neurosurgical procedure.The nomogram prediction model for risk of death in CRE patients after neurosurgical procedure was established based on these findings.The model vali-dation results showed that at the 30th day,the calibration curve approached the ideal curve,the area under the ROC curve was 0.981(95％CI:0.947-1.000),the DC A curve showed that when the threshold of risk of death excee-ded 8.36％,there was a higher net benefit value.Conclusion The nomogram prediction model for prognosis during hospitalization in CRE HAI patients after neurosurgical procedure constructed based on LASSO-COX regression analysis has good goodness of fit and predictive performance,which can provide reference for early screening of high-risk patients and implementation of intervention measures in clinical practice.

Objective To explore the factors affecting the prognosis of patients with carbapenem-resistant Ente-robacterales(CRE)healthcare-associated infection(HAI)after neurosurgical procedure,construct and validate a nomogram prediction model.Methods Data of patients with CRE infection after neurosurgical procedure in a tertia-ry hospital in Shanghai from 2018 to 2023 were collected,patients were divided into death group and survival group based on prognosis.LASSO regression and multivariate COX regression analysis were adopted to screen indepen-dent risk factors and construct nomogram prediction model.Receiver operating characteristic(ROC)curve,calibra-tion curve,and decision curve analysis(DCA)were drawn based on Bootstrap internal validation method to evaluate the effectiveness of the model.Results A total of 241 patients were included in analysis,with 221 in the survival group and 20 in the death group.The LASSO and COX regression analysis results showed that gender,length of hospital stay＞30 days,decreased monocyte percentage(MONO％),and elevated creatinine(Cr)were independent risk factors for death in patients with CRE HAI after neurosurgical procedure.The nomogram prediction model for risk of death in CRE patients after neurosurgical procedure was established based on these findings.The model vali-dation results showed that at the 30th day,the calibration curve approached the ideal curve,the area under the ROC curve was 0.981(95％CI:0.947-1.000),the DC A curve showed that when the threshold of risk of death excee-ded 8.36％,there was a higher net benefit value.Conclusion The nomogram prediction model for prognosis during hospitalization in CRE HAI patients after neurosurgical procedure constructed based on LASSO-COX regression analysis has good goodness of fit and predictive performance,which can provide reference for early screening of high-risk patients and implementation of intervention measures in clinical practice.

Objective To compare the clinical efficacy of low-molecular-weight heparin anticoagulant drugs in the treatment of venous thrombosis caused by viral pneumonia.Methods The clinical data of 355 patients diagnosed with viral pneumonia patients in the First People's Hospital of Yunnan Province from December 2022 to February 2023 were collected by retrospective analysis.The patients were classified into moderate group(n=1 14),severe group(n=116),and critical group(n=125)based on the severity of viral pneumonia.The changes in coagulation indicators of the patients after treatment with low molecular weight heparin sodium injection,low molecular weight heparin calcium injection,and enoxaparin sodium injection were compared among three groups.Results Compared with before treatment,there was no statistically significant difference in white blood cells count among three groups of patients after treatment(P＞0.05);The hypersensitive C-reactive protein levels of patients in moderate group and critical group decreased(P＜0.05);The levels of D-dimer decreased in severe group and critical group of patients(P＜0.05).After treatment with low-molecular-weight heparin calcium injection,the activated partial thromboplastin and prothrombin time of patients in severe group were shortened compared to before treatment,and the D-dimer levels of patients in severe group and critical group were reduced compared to before treatment,with statistical significance(P＜0.05);After treatment with low-molecular-weight heparin sodium and enoxaparin,only critical group showed a significant decrease in D-dimer levels(P＜0.05).Conclusion Low-molecular-weight heparin calcium injection has a stronger alleviating effect on blood hypercoagulability caused by elevated D-dimer levels than low-molecular-weight heparin sodium and enoxaparin,which is beneficial for relieving patients' hypercoagulability.

OBJECTIVE To estimate the cost-utility of sacituzumab govitecan （SG） versus single-agent chemotherapy in the treatment of hormone receptor-positive （HR+）/human epidermal growth factor receptor 2-negative （HER2－） advanced metastatic breast cancer. METHODS From the perspective of the Chinese medical system， a three-state partitioned survival model was constructed to examine the cost-utility of SG versus single-agent chemotherapy based on TROPiCS-02 trial. The cycle length was set to 1 month， and the time horizon was 10 years. The annual discount was 5%. The model output included total costs and quality adjusted life month （QALM）， and incremental cost-effectiveness ratio （ICER） was calculated for cost-utility analysis， by setting willingness-to-pay （WTP） threshold at 3 times gross domestic product （GDP） per capita of China in 2023 （22 340 yuan/QALM）. Univariate sensitivity analyses， probability sensitivity analyses， and scenario analyses were performed to evaluate the robustness of the results and calculate the price threshold when SG had economic advantages. RESULTS SG group gained incremental 4.25 QALM and 561 570 yuan compared with single-agent chemotherapy， which resulted in an ICER of 132 102/QALM that was higher than WTP. The results of the univariate sensitivity analysis showed that the monthly average cost of SG had the greatest impact on the results； the results of probability sensitivity analysis showed that the probability of SG scheme being cost-effective at the WTP threshold was 0. The results of scenario analysis showed that the conclusions of this study were robust under different time horizons （5， 10， 15 years）. The price threshold for SG being cost-effective was 1 344 yuan per 180 mg. CONCLUSIONS Based on the perspective of Chinese medical system， SG appears to be not cost-effective compared with single-agent chemotherapy for HR+/ HER2－ advanced metastatic breast cancer at the price of 8 400 yuan per 180 mg. A substantial price cut should be taken to be cost- effective.

Grid management plays an important role in improving the efficiency of social service management. The authors explored the establishment of a nosocomial infection grid management model and implemented it at a tertiary general hospital in Shanghai. χ2 test results showed that since the hospital fully implemented the grid management model in early 2016, the number of hospital infections, surgical site infections, type I surgical incision infections, and ventilator-related pneumonia had shown a downward trend year by year. The number of inspections before the use of antibacterial drugs, the number of blood cultures submitted for fever patients, and the timing of hand hygiene compliance showed an increasing trend year by year( P<0.05), and the management of nosocomial infection was more effective than the previous period. The application of grid management model required establishment of grid organization structure, control of key links, implementation of the special personnel responsibility, formulation of a performance evaluation system, and implementation of incentive measures. The grid management model can significantly reduce the risk of hospital infection, improve the efficiency of hospital infection management, and was valuable to be applicated and promoted in medical institutions.

Objective:This paper aimed to explore the problems and solutions in the management of Investigator-Initiated Trail (IIT) in medical institutions, to provide suggestions particularly in the absence of relevant high-level policy support.Methods:By combining literature review with working practice experiences, this paper analyzed the current situation of IIT’s management and the rationale, put forward suggestions.Results:IIT related problems identified including as the responsible entities of the management, research topics selection, protocol design, continuity, research team construction, ethical review and the cultivation of research management personnel. The centralized management will help the standardized management of such projects, the training of investigators and team building, the review awareness strengthening of the ethics committee, improvement of management ability.Conclusions:IIT plays an important role in promoting the development of medical scientific research. Medical institutions should integrate resources, provide platforms, train investigators assure the quality of IITs.

Objective To understand the occurrence and risk factors of healthcare-associated infection(HAI) in a neonatal intensive care unit(NICU).Methods Neonates who were admitted to the NICU of a hospital from January 2012 to December 2014 were investigated retrospectively,risk factors for HAI were performed univariate analysis.Results A total of 760 neonates were included in the investigation,198 neonates developed 259 times of HAI,incidence of HAI was 26.05％,case incidence of HAI was 34.08％,incidence of HAI per 1 000 patient days was 9.50‰;the main infection site was lower respiratory tract (n =92,35.52％);among 259 cases of HAI,172 strains of pathogenic bacteria were isolated,the major pathogen was Acinetobacter spp.(n =40,23.26％);incidence of HAI was high in neonates with gestational age ≤32 weeks,birth weight≤1 500 g,length of hospital stay ≥10 days,duration of antimicrobial use≥10 days,mechanical ventilation,deep venous catheterization,and feeding intolerance,difference was statistically significant (all P＜0.001).Conclusion Incidence of HAI in NICU is high,effective prevention and control measures should be formulated according to its risk factors,so as to reduce the occurrence of HAI in neonates.