Objective: To assess the clinical application value of a prediction model for red blood cell (RBC) demand in surgical procedures. Methods: Demographic data, laboratory parameters, anesthesia and transfusion records, and model prediction data were retrospectively collected from surgical patients at the First Medical Center of Chinese PLA General Hospital between 2018 and 2024. Statistical analysis was performed using the Chi-square test, t-test, and Mann-Kendall trend test. Results: From 2018 to 2024, the predictive model for RBC demand in surgical procedures was used to evaluate a total of 112 293 surgeries. During this period, the model call rate (77.49%-98.91%, P<0.05), compliance rate (56.81%-84.92%, P<0.05), and prediction accuracy rate (66.82%-94.17%, P<0.05) all showed significant upward trends. The total blood usage across the hospital (13645.4-7723.5 units, P<0.05) and the average blood usage per surgery (0.21-0.1 units, P<0.05) exhibited overall downward trends. Postoperative average hemoglobin levels in the non-compliance group (112.1-105.3 g/L in the non-compliance group vs 106.9-92.7 g/L in the compliance group, P<0.05) and the intraoperative excessive transfusion rate (5.06%-6.05% in the non-compliance group vs 0.09%-0.04% in the compliance group, P<0.05) were significantly higher in the non-compliance group compared to the compliance group. Conclusion: The predictive model for RBC demand in surgical procedures has played a positive role in conserving blood resources, optimizing blood resource allocation, and reducing intraoperative risks.

Diabetic retinopathy(DR)remains the leading cause of vision loss in patients with diabetes. Current anti-vascular endothelial growth factor(VEGF)therapies are limited by inadequate response in some patients and the necessity for repeated intravitreal injections, underscoring the urgent need for novel therapeutic targets. Angiopoietin-like protein 4(ANGPTL4), a multifunctional secreted protein, has emerged as a critical regulator in the pathogenesis and progression of DR, positioning it as a promising interventional target. This review systematically elaborates the biological characteristics of ANGPTL4, with a focus on its expression dynamics, molecular mechanisms, and regulatory networks rolesin the development of DR. Furthermore, the prospects of ANGPTL4-targeted therapeutic strategies are discussed, aiming to offer new insights and directions for understanding DR pathogenesis, advancing multi-target drug development, and improving clinical management.

This paper introduces a real-world cohort research model for community-acquired pneumonia （CAP） based on the Jiangsu Traditional Chinese Medicine （TCM） Dominant Diseases Diagnosis and Treatment Data Platform. Firstly， data cleaning is performed by standardizing diagnosis， symptoms， treatment and imaging， intelligently extracting unstructured information， and cleaning and constructing a standardized database. Secondly， for cohort establishment， CAP patients across the province are screened in accordance with CAP diagnostic criteria to build a high-quality disease-specific cohort. Lastly， in terms of protocol design， the characteristics of TCM research and the CAP disease profile are considered to determine appropriate inclusion and exclusion criteria， estimate sample size， define interventions， outcomes and economic evaluations， providing a reference for real-world TCM research on CAP.

This paper introduces a real-world cohort research model for community-acquired pneumonia （CAP） based on the Jiangsu Traditional Chinese Medicine （TCM） Dominant Diseases Diagnosis and Treatment Data Platform. Firstly， data cleaning is performed by standardizing diagnosis， symptoms， treatment and imaging， intelligently extracting unstructured information， and cleaning and constructing a standardized database. Secondly， for cohort establishment， CAP patients across the province are screened in accordance with CAP diagnostic criteria to build a high-quality disease-specific cohort. Lastly， in terms of protocol design， the characteristics of TCM research and the CAP disease profile are considered to determine appropriate inclusion and exclusion criteria， estimate sample size， define interventions， outcomes and economic evaluations， providing a reference for real-world TCM research on CAP.

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 investigate the distribution of IgM anti-A/B titers among group O whole blood donors in Jiangsu, establish a low-titer threshold, and analyze the demographic characteristics of low-titer donors, so as to provide data for recruiting low-titer group O whole blood (LTOWB) donors. Methods: Plasma samples from 1 009 group O whole blood donors were tested for IgM anti-A and anti-B titers using the microplate technique. The distribution of antibody titers was analyzed to establish a low-titer threshold. The distribution trends of titers across different demographic groups were also analyzed. Results: The peak titer for anti-A, anti-B were 64 (31.5%), 4 (23.8%), respectively, The proportion of donors with both anti-A and anti-B titers below 64 was 97.3% (982/1 009). The mean anti-A titer was higher than anti-B titer. Anti-A titers were higher in female donors than in male donors (P<0.05). The anti-A titers differed significantly among different age groups (P<0.05). However, no significant difference in titers was observed based on the number of donations (P>0.05). Conclusion: A titer of 64 can be used as the reference threshold of LTOWB in Jiangsu. Male donors of appropriate age are more suitable than female donors for establishing an emergency panel of LTOWB mobile donors.

Objective Exploring the mechanism of"Wushen acupuncture"in alleviating chronic fatigue in rats from the perspective of mitophagy.Methods Forty male Wistar rats were randomly allocated into a normal group and a modeling group,where the latter employed a protocol combining exhaustive swimming with tail-clamping stimuli to induce a rat model of chronic fatigue.Post-modeling,the normal group was subdivided randomly into a blank group and a presumed control group with specifics requiring clarification.Meanwhile,the modeling group was further randomized into a model group,a"Wushen acupuncture"group that underwent acupuncture at the Baihui and Sishencong points,and a non-acupoint control group,in which acupuncture was applied to 5 mm behind houshencong which is non-meridian,non-acupoint sites on the rats' heads and necks.The modeling and treatment outcomes in rats are assessed via the tail suspension test.Protein relative expression levels of adenosine 5'-monophosphate-activated protein kinase(AMPK),mammalian target of rapamycin(mTOR),and peroxisome proliferator-activated receptor γ coactivator 1-alpha(PGC-1α)in rat skeletal muscle were detected using Western blot.Meanwhile,the relative mRNA expression levels of PTEN induced putative kinase 1(PINK1)and Parkin were measured by Real-Time PCR.Results In contrast to the baseline cohort,rats in the induced fatigue model displayed a reduction in struggles,struggle duration,swaying frequency,and swaying duration(P<0.05).When juxtaposed against the fatigue-induced model group,the"Wushen acupuncture"intervention cohort manifested a substantial increase in these behavioral parameters(P<0.05).Furthermore,relative to the"Wushen acupuncture"intervention group,the non-acupoint control cohort showed a decrease in struggles,struggle duration,swaying frequency,and swaying duration(P<0.05).Versus the baseline group,the fatigue-induced model cohort demonstrated a marked decrease in the relative expression levels of AMPK,PGC-1α,PINK1,and Parkin mRNA in skeletal muscle tissue(P<0.05),alongside an increase in mTOR protein expression(P<0.05).Compared to the fatigue-induced model group,the"Wushen acupuncture"intervention led to an increase in the relative expression levels of AMPK,PGC-1α,PINK1,and Parkin mRNA(P<0.05),and a decrease in mTOR protein expression(P<0.05).When juxtaposed against the"Wushen acupuncture"intervention group,the non-acupoint control cohort showed decreased relative expression levels of AMPK,PGC-1α,PINK1,and Parkin mRNA(P<0.05),and increased mTOR protein expression(P<0.05).Conclusion The"Wushen acupuncture"have been shown to enhance the alleviation of chronic fatigue symptoms in rat models and modulate the functionality of mitochondrial autophagy.This therapeutic effect is believed to be mechanistically linked to the regulation of both the PINK1/Parkin pathway and the AMPK/mTOR signaling cascade.

Objective To investigate the distribution and antimicrobial resistance profiles of common pathogens isolated from cerebrospinal fluid(CSF)in CHINET program from 2015 to 2021.Methods The bacterial strains isolated from CSF were identified in accordance with clinical microbiology practice standards.Antimicrobial susceptibility test was conducted using Kirby-Bauer method and automated systems per the unified CHINET protocol.Results A total of 14 014 bacterial strains were isolated from CSF samples from 2015 to 2021,including the strains isolated from inpatients(95.3％)and from outpatient and emergency care patients(4.7％).Overall,19.6％of the isolates were from children and 80.4％were from adults.Gram-positive and Gram-negative bacteria accounted for 68.0％and 32.0％,respectively.Coagulase negative Staphylococcus accounted for 73.0％of the total Gram-positive bacterial isolates.The prevalence of MRSA was 38.2％in children and 45.6％in adults.The prevalence of MRCNS was 67.6％in adults and 69.5％in children.A small number of vancomycin-resistant Enterococcus faecium(2.2％)and linezolid-resistant Enterococcus faecalis(3.1％)were isolated from adult patients.The resistance rates of Escherichia coli and Klebsiella pneumoniae to ceftriaxone were 52.2％and 76.4％in children,70.5％and 63.5％in adults.The prevalence of carbapenem-resistant E.coli and K.pneumoniae(CRKP)was 1.3％and 47.7％in children,6.4％and 47.9％in adults.The prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)and Pseudomonas aeruginosa(CRPA)was 74.0％and 37.1％in children,81.7％and 39.9％in adults.Conclusions The data derived from antimicrobial resistance surveillance are crucial for clinicians to make evidence-based decisions regarding antibiotic therapy.Attention should be paid to the Gram-negative bacteria,especially CRKP and CRAB in central nervous system(CNS)infections.Ongoing antimicrobial resistance surveillance is helpful for optimizing antibiotic use in CNS infections.

Objective To investigate the antimicrobial resistance of clinical isolates from elderly patients(≥65 years)in major medical institutions across China.Methods Bacterial strains were isolated from elderly patients in 52 hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program during the period from 2015 to 2021.Antimicrobial susceptibility test was carried out by disk diffusion method and automated systems according to the same CHINET protocol.The data were interpreted in accordance with the breakpoints recommended by the Clinical and Laboratory Standards Institute(CLSI)in 2021.Results A total of 514 715 nonduplicate clinical isolates were collected from elderly patients in 52 hospitals from January 1,2015 to December 31,2021.The number of isolates accounted for 34.3％of the total number of clinical isolates from all patients.Overall,21.8％of the 514 715 strains were gram-positive bacteria,and 78.2％were gram-negative bacteria.Majority(90.9％)of the strains were isolated from inpatients.About 42.9％of the strains were isolated from respiratory specimens,and 22.9％were isolated from urine.More than half(60.7％)of the strains were isolated from male patients,and 39.3％isolated from females.About 51.1％of the strains were isolated from patients aged 65-＜75 years.The prevalence of methicillin-resistant strains(MRSA)was 38.8％in 32 190 strains of Staphylococcus aureus.No vancomycin-or linezolid-resistant strains were found.The resistance rate of E.faecalis to most antibiotics was significantly lower than that of Enterococcus faecium,but a few vancomycin-resistant strains(0.2％,1.5％)and linezolid-resistant strains(3.4％,0.3％)were found in E.faecalis and E.faecium.The prevalence of penicillin-susceptible S.pneumoniae(PSSP),penicillin-intermediate S.pneumoniae(PISP),and penicillin-resistant S.pneumoniae(PRSP)was 94.3％,4.0％,and 1.7％in nonmeningitis S.pneumoniae isolates.The resistance rates of Klebsiella spp.(Klebsiella pneumoniae 93.2％)to imipenem and meropenem were 20.9％and 22.3％,respectively.Other Enterobacterales species were highly sensitive to carbapenem antibiotics.Only 1.7％-7.8％of other Enterobacterales strains were resistant to carbapenems.The resistance rates of Acinetobacter spp.(Acinetobacter baumannii 90.6％)to imipenem and meropenem were 68.4％and 70.6％respectively,while 28.5％and 24.3％of P.aeruginosa strains were resistant to imipenem and meropenem,respectively.Conclusions The number of clinical isolates from elderly patients is increasing year by year,especially in the 65-＜75 age group.Respiratory tract isolates were more prevalent in male elderly patients,and urinary tract isolates were more prevalent in female elderly patients.Klebsiella isolates were increasingly resistant to multiple antimicrobial agents,especially carbapenems.Antimicrobial resistance surveillance is helpful for accurate empirical antimicrobial therapy in elderly patients.

Objective:To investigate the predictive value of endothelial activation and stress index(EASIX)for the prognosis of patients with mantle cell lymphoma(MCL).Methods:A retrospective analysis was conducted to assess prognosis and compare the clinical features of patients diagnosed with MCL who were admitted to the Affiliated Hospital of Xuzhou Medical University from January 2010 to June 2023,had therapeutic indications and received standard treatment.Results:A total of 66 patients were included and divided into high EASIX group and low EASIX group,according to a cutoff value of 0.97 determined by the receiver operating characteristic(ROC)curve.Multivariate Cox regression analysis showed that prealbumin＜0.2 g/L,high EASIX,and ECOG PS score ≥2 were independent risk factors influencing overall survival(OS)in MCL patients.The median OS of patients in the high and low EASIX group was 13.0 and 37.5 months,and the median progression-free survival was 8.8 and 26.0 months,respectively.The proportions of patients with ECOG PS score ≥2 and prealbumin＜0.2 g/L at onset significantly increased in the high EASIX group compared to those in the low EASIX group.Conclusion:At the time of initial diagnosis,EASIX can serve as an independent prognostic indicator impacting OS in patients with MCL.Furthermore,patients in the high EASIX group experience a poorer prognosis and shorter survival duration compared with those in the low EASIX group.