Objective: To retrospectively assess whether a lower hematocrit level (between 18% and 20%) had any impact on the safety of patients undergoing therapeutic plasma exchange (TPE), and to further determine the threshold for red blood cell supplementation prior to TPE. Methods: Clinical data from 181 adult patients who underwent TPE treatment at the Department of Blood Transfusion of our hospital from March 2023 to July 2024 were collected. The patients were divided into a study group of 44 patients (Hct ≥18% and <20%) and a control group of 137 patients (Hct≥20%). In two groups, blood volume-related safety indicators including respiration rate, heart rate, systolic blood pressure, and blood oxygen saturation levels before and after TPE were compared using t-test. Between-group differences in the grading of adverse reactions such as allergies and hypotension were analyzed using chi-square test. Results: A total of 659 TPE treatments were performed on 181 patients, with 169 TPE treatments on 44 patients in the study group (Hct≥18% and <20%) and 490 TPE treatments on 137 patients in the control group (Hct≥20%). There were no statistically significant differences in age, gender, BMI category, and the presence of cardiac insufficiency between the two groups. In the study group, there were no statistically significant differences in safety indicators such as respiration rate, heart rate, systolic blood pressure, and blood oxygen saturation level before and after TPE. In the control group, there were no statistically significant differences in heart rate and systolic blood pressure before and after TPE, but there were statistically significant differences in respiration rate and blood oxygen saturation level (P<0.05). There were no statistically significant differences in the grading of adverse reactions such as allergic reactions and hypotension between the two groups. Conclusion: For adult patients with stable conditions, maintaining a lower hematocrit level (Hct ≥18% and <20%) during TPE is relatively safe. It is feasible to lower the TPE red blood cell supplementation threshold to 18%≤Hct<20%，which may save blood resources while potentially benefit patients by avoiding unnecessary red blood cell transfusion.

Objective: To evaluate the efficacy and safety of the single-use hemoperfusion device (UA230) in treating refractory gout (RG) via plasma perfusion. Methods: Thirty-four RG patients aged 18-65 years were recruited and randomly divided into a control group (febuxostat therapy, n=17) and an experimental group (plasma perfusion combined with febuxostat therapy, n=17). Differences in serum uric acid (SUA) levels and urate-lowering rates between the two groups were analyzed using t-tests. Between-group differences in incidence of adverse reactions were analyzed using chi-square tests. Results: At 7 and 14 days post-treatment, SUA levels in the experimental group were significantly lower than those in the control group, with a higher urate-lowering rate (all P<0.05). However, no statistically significant differences in SUA levels or urate-lowering rate were observed at 28 days post-treatment (all P>0.05). The incidence of adverse reactions showed no significant difference between the two groups (χ =0.15, P>0.05). Conclusion: The single-use hemoperfusion device (UA230), combined with plasma perfusion technology, is a safe and effective treatment for RG. It may serve as a novel therapeutic approach for RG patients in clinical practice.

Objective:To explore the regulation mechanism of the quorum sensing regulator AphA on the functional activity of type Ⅵ secretion system VflT6SS2 in Vibrio fluvialis. Methods:Western Blot analysis was used to detect the relative expression and secretion of VflT6SS2 signature component hemolysin-coregulated protein (Hcp) in wild type (WT), Δ aphA, and corresponding complementary strains. Quantitative reverse transcription PCR and luminescence activity assay of the promoter- lux fusion system was used to measure the mRNA expression levels and promoter activity of the VflT6SS2 core and accessory gene-cluster representative genes tssB2, hcp ( tssD2) and vgrG ( tssI2), and the quorum sensing regulator HapR in WT and Δ aphA strains. A point mutation experiment combined with a luminescence activity assay was used to verify the regulatory binding site of AphA in the tssD2b promoter region. Electrophoretic mobility shift assay (EMSA) was used to determine AphA binding to the hapR promoter. Results:The mRNA expression levels of tssB2, hcp( tssD2), vgrG ( tssI2), and hapR as well as the protein expression and secretion levels of Hcp in Δ aphA strain, were significantly higher than those in the WT strain. The promoter activities of the VflT6SS2 core cluster, tssD2a, tssI2a, and hapR were higher in Δ aphA strain than in the WT strain, while the promoter activity of tssD2b showed the opposite trend. The promoter sequence analysis of tssD2a and tssD2b found significant differences in the region from -335 bp to -229 bp, and two potential AphA binding sites on tssD2b. The promoter activity of tssD2b decreased significantly after the point mutation of the two potential AphA binding sites. EMSA results showed that AphA binds directly to the promoter region of hapR. Conclusions:AphA indirectly inhibits the regulation of the VflT6SS2 core and accessory gene clusters at the promoter level by directly repressing the expression of hapR. AphA showed opposite regulation patterns for tssD2a and tssD2b, and AphA could positively regulate the expression of tssD2b by directly binding to the tssD2b promoter region (-335 bp to -229 bp).

Objective To investigate the risk warning indicators for postoperative admission to the intensive care unit(ICU)in patients with ureteral calculi combined with urinary sepsis.Methods The clinical data of 288 patients with ureteral calculi combined with sepsis diagnosed and treated in the First Hospital of Fujian Medical University from October 2020 to October 2023 were retrospectively analyzed,including gender,age,length of hospitalization,clinical conditions[body mass index(BMI),diabetes,hypertension,systemic inflammatory response syndrome(SIRS)score,sequential organ failure assessment(SOFA),quick SOFA(qSOFA)],general indicators[white blood cell count(WBC),body temperature,respiratory rate,heart rate],and degree of hydronephrosis.The patients were divided into two groups:those admitted to the ICU and those not admitted to the ICU after the operation.The differences in the above clinical data between the two groups of patients were compared.Univariate and multivariate Logistic regression analyses were used to screen out the risk factors affecting the admission of patients with ureteral calculi combined with sepsis to the ICU,and the receiver operator characteristic curve(ROC curve)of the subjects was plotted to analyze the predictive efficacy of each risk factor on the admission of patients to the ICU.Results Finally,263 patients were enrolled,out of which 43 patients(16.35％)were admitted to ICU,and all patients recovered and were discharged.Compared with the group not admitted to the ICU,the length of hospitalization in the group admitted to the ICU was significantly longer(days:8.42±1.50 vs.5.51±1.19),and the proportion of patients with diabetes mellitus,the SIRS score,the SOFA score,the qSOFA score,the proportion of patients with body temperatures>39.4℃ or<35.8℃,respiratory rate>20 beats/min,heart rate>90 bpm,and the proportion of patients with severe hydronephrosis were all significantly higher[diabetes mellitus:44.19％(19/43)vs.27.27％(60/220),SIRS scores:3(2,4)vs.2(1,3),SOFA score:7(5,9)vs.4(3,6),qSOFA score:2(1,3)vs.0(0,1),and body temperature>39.4℃ or<35.8℃:44.19％(19/43)vs.25.91％(57/220),respiratory rate>20 beats/min:37.21％(16/43)vs.21.82％(48/220),heart rate>90 bpm:48.84％(21/43)vs.29.55％(65/220),severe hydronephrosis:72.09％(31/43)vs.17.28％(38/220),all P<0.05].Multivariate Logistic regression analyses showed that SOFA score,qSOFA score,and degree of hydronephrosis were independent risk factors for admission to the ICU,with odds ratios(OR)of 1.486,3.546,and 4.423,respectively,along with 95％confidence intervals(95％CI)of 1.146-1.925,1.949-6.543,and 2.355-8.305,P values were 0.003,<0.001,<0.001.ROC analysis showed that,the AUC of SOFA score was the largest of 0.824,the AUC of qSOFA was similar to that of SOFA(0.802 vs.0.824),and the specificity of hydronephrosis was the highest of 82.7％.The joint diagnosis of qSOFA and the degree of hydronephrosis were combined to establish a joint prediction model.The goodness-of-fit test was performed using the Hosmer-Lemeshow test,revealingχ2=8.942,P=0.257>0.05.This indicated that the predictive model of the joint index was well calibrated,and the ROC curves showed improved diagnostic efficacy of the joint index and were superior to that of the SOFA score(AUC:0.889 vs.0.824,P=0.047).Conclusion The qSOFA and the degree of hydronephrosis were independent risk factors for postoperative ICU admission in patients with ureteral calculi combined with urinary sepsis,and the combined diagnosis of the two may provide a good early warning of the risk of ICU admission in such patients.

Objective:Parathyroidectomy(PTX)is an effective treatment for refractory secondary hyperparathyroidism(SHPT),but it can lead to hungry bone syndrome(HBS),significantly threatening the health of maintenance haemodialysis(MHD)patients.While previous studies have analyzed the risk factors for HBS post-PTX,the predictive performance and clinical applicability of these risk models need further validation.This study aims to construct and validate a risk prediction model for HBS in MHD patients with SHPT post-PTX. Methods:A retrospective analysis was conducted on 368 MHD patients with SHPT who underwent PTX at Changsha Jieao Nephrology Hospital from January 2020 to December 2021.Patients were divided into a HBS group and a non-HBS group based on the occurrence of HBS.General data,surgical information,and biochemical indicators were compared between the 2 groups.Multivariate logistic regression was used to identify factors influencing HBS,and a risk prediction model was established.The model's performance was evaluated using receiver operator characteristic(ROC)curves,decision curves,and calibration curves.External validation was performed on 170 MHD patients with SHPT who underwent PTX at the Third Xiangya Hospital of Central South University from January to December 2022. Results:The incidence of HBS post-PTX in MHD patients with SHPT was 60.60%.Logistic regression analysis identified preoperative bone involvement(OR=3.908,95%CI 2.179 to 7.171),preoperative serum calcium(OR=7.174,95%CI 2.291 to 24.015),preoperative intact parathyroid hormone(iPTH)(OR=1.001,95%CI 1.001 to 1.001),preoperative alkaline phosphatase(ALP)(OR=1.001,95%CI 1.000 to 1.001),and serum calcium on the first postoperative day(OR=0.006,95%CI 0.001 to 0.038)as independent risk factors for HBS(all P<0.01).The constructed risk prediction model demonstrated good predictive performance in both internal and external validation cohorts.The internal validation cohort showed an accuracy of 0.821,sensitivity of 0.890,specificity of 0.776,Youden index of 0.666,and area under the curve(AUC)of 0.882(95%CI 0.845 to 0.919).The external validation cohort showed an accuracy of 0.800,sensitivity of 0.806,specificity of 0.799,Youden index of 0.605,and AUC of 0.863(95%CI 0.795 to 0.932). Conclusion:Preoperative bone involvement,serum calcium,iPTH,ALP,and serum calcium on the first postoperative day are influencing factors for HBS in MHD patients with SHPT post-PTX.The constructed risk prediction model based on these factors is reliable.

Objective We aimed to establish and evaluate a rat model of post-infectious irritable bowel syndrome(PI-IBS)with the pattern of liver depression and spleen deficiency coupled with dampness.Methods First,200 rats were randomly divided into the normal group,the infection group,the infection+stress group,the infection+stress+external dampness group,and the acetic acid+stress group(n=40 rats per group)for eight weeks.The rats were treated with Trichinella spiralis infection,chronic restraint stress,an artificial high-humidity climate,and/or acetic acid enema.Weight growth rate,24-hour food intake and water intake,and the fecal moisture percentage were recorded.The open field test and the sucrose consumption test were used to determine the behavioral characteristics of rats in each group.The abdominal withdrawal reflex(AWR)test was used to determine visceral sensitivity.The contents of 5-hydroxytryptamine(5-HT)and aquaporin 4(AQP4)in colon tissue were detected by ELISA.Results Compared with the normal group,the weight growth rate of rats in the infection+stress+external dampness group and the acetic acid+stress group was lower from Week 1 to Week 8 of modeling.The 24-hour food intake of rats in the infection+stress+external dampness group and the infection+stress group was lower than that in the normal group from Week 2 to Week 8 of modeling.At the end of week 2 of modeling,the 24-hour water intake of rats in the infection+stress+external dampness group,the acetic acid+stress group,and the infection+stress group was lower than that in the normal group.The fecal moisture percentage of rats in the infection+stress+external dampness group was higher than that in the normal group at the end of Week 1,6,and 8(P＜0.05).At the end of Week 4 of modeling,the total distance in the open field test in the infection+stress+external dampness group and the acetic acid+stress group was shorter than that in the normal group.The sugar preference rate in the infection+stress+external dampness group was lower than that in the normal group at the end of 1,4,and 8 weeks and lower than that in the acetic acid+stress group at the end of Week 4 and 8(P＜0.05).The AWR scores of rats in the infection+stress+external dampness group were higher than those in the normal group after week 1 at 60 and 80 mmHg(1 mmHg≈0.133 kPa),after Week 4 at 40,60,and 80 mmHg,and after Week 6 and 8 at 20,40,and 80 mmHg(P＜0.05).At the end of Week 2 and 4,a large number of inflammatory cells were infiltrated in the colonic mucosa of the intervention groups,and the inflammation score was higher than that of the normal group(P＜0.05).At the end of weeks 6 and 8,the inflammatory cell infiltration in the intestinal mucosa of the intervention groups was not obvious,and the colonic mucosa returned to normal.At the end of weeks 6 and 8,the 5-HT content was higher in the infection+stress group,the infection+stress+external dampness group,and the acetic acid+stress group than in the normal group(P＜0.05).After Week 4,the AQP4 content was lower in the infection+stress+external dampness group and the acetic acid+stress group than that in the normal group(P＜0.05).After week 6,compared to the normal group,the AQP4 content was lower in all groups except for the acetic acid+stress group,and the AQP4 content in the infection+stress+external dampness group was lower than that in the acetic acid+stress group.After week 8,only in the infection+stress+external dampness group the AQP4 content was lower than in the normal group(P＜0.05).Conclusion The combination of Trichinella spiralis infection,chronic restraint stress,and an artificial high-humidity climate can be used to prepare a relatively stable and reliable rat model of PI-IBS with the pattern of liver depression and spleen deficiency with dampness.

OBJECTIVE To construct a double helix model for evaluating the job competency of licensed pharmacists in retail pharmacies， and to provide a reference for building a talented team of licensed pharmacists and promoting the high-quality development of pharmaceutical care. METHODS Based on the competency iceberg model and double helix structure theory， literature analysis and the Delphi method were adopted to explore the model indicators； questionnaires were designed to survey licensed pharmacists in retail pharmacies from Shandong Province. The exploratory factor analysis was used to correct the model indicators and establish a double helix model for evaluating the job competency of licensed pharmacists in retail pharmacies， which was examined by validation factor analysis. RESULTS The recovery rate of the questionnaires in the two rounds of expert consultation was greater than 90%， the expert authority coefficients were both more than 0.86， and the overall Kendall’s W values were 0.288 and 0.510， respectively； after the correction of the exploratory factor analysis， the double helix model for evaluating the job competency of licensed pharmacists in retail pharmacies was established， which contained 4 first-level indexes such as occupational literacy， occupational knowledge， occupational competency and internal motivation， and 23 second-level indexes. The model contained occupational knowledge and occupational competency in the explicit competency chain， occupational literacy and internal motivation in the implicit competency chain， and policy support， incentive mechanism， education and training as the hydrogen bonds connecting the two main chains. The validation factor analysis showed that the model’s goodness of fit index， comparative fit index， and normed fit index all exceeded 0.9； the reliability of the combination of the four first-level indexes ranged from 0.89 to 0.95； the average variance extracted ranged from 0.58 to 0.75， and Cronbach’s α coefficients for both the overall model and the first-level indicators were all greater than 0.84. CONCLUSIONS The constructed double helix model for evaluating the job competency of licensed pharmacists in retail pharmacies is scientific， reasonable and practical.

BACKGROUND:The specific molecular mechanism of the transformation from normal healthy people to acute cervical spondylotic radiculopathy has not been clear,which needs to be further studied. OBJECTIVE:To investigate the differential expression of serum proteomics between normal healthy people and patients with acute cervical spondylotic radiculopathy,and to find and identify potential specific serum markers between them. METHODS:The serum samples of eight patients with acute cervical spondylotic radiculopathy and eight normal healthy people were collected,and the proteomic screening and analysis were performed by tandem mass tag combined with liquid chromatography-tandem mass spectrometry technology,in order to explore and identify serum proteins differentially expressed in patients with acute cervical spondylotic radiculopathy. RESULTS AND CONCLUSION:A total of 183 significantly differential proteins were screened by tandem mass tag technology,and 11 significantly differential proteins were identified(P＜0.05).Compared with normal healthy people,three differential proteins were significantly up-regulated,including human leukocyte antigen-A,secretoglobin family 1a member 1,and protein 4-hydroxyphenylpyruvate dioxygenase,and seven differential proteins were significantly down-regulated,such as immunoglobulin heavy constant gamma 3,skin factor,and myosin light chain 3,in patients with acute cervical spondylotic radiculopathy.Gene ontology enrichment analysis showed that these differential proteins participated in antigen binding,immunoglobulin receptor binding and other molecular functions.Protein-protein interaction analysis showed that among the common differential proteins between normal healthy people and patients with acute cervical spondylotic radiculopathy,HLA-A,HPD,PSMA3,DMKN,SCGB1A1,and MYL3 were located at the nodes of the functional network,and were closely related to the systems of body immunity,cellular inflammatory response,energy metabolism,and mechanical pressure.The significantly differential proteins HLA-A,HPD and MYL3 were verified by western blot,and the results were consistent with those of proteomics.To conclude,tandem mass tag combined with liquid chromatography-tandem mass spectrometry technology can be used to find the differentially expressed proteins in serum between normal healthy people and patients with acute cervical spondylotic radiculopathy.It is preliminarily believed that HLA-A,HPD and MYL3 may be specific serum markers of acute cervical spondylotic radiculopathy,providing a new direction for further research on its pathogenesis.

BACKGROUND:Anterior subtotal corpectomy,decompression and fusion is a conventional method to treat cervical degenerative diseases.A titanium cage is an important implant to maintain the stability of the cervical spine after subtotal corpectomy.In recent years,many patients have complications such as titanium cage sinking,which are highly controversial. OBJECTIVE:To investigate the internal biomechanical relationship between the tilt angle of the titanium cage and postoperative titanium cage subsidence after anterior subtotal cervical corpectomy,decompression and fusion. METHODS:A three-dimensional finite element model of the C4-C6 segment was established by CT images of a normal human cervical spine,in which the anterior subtotal resection,decompression and fusion of the C5 vertebral body were simulated,and titanium cages with different tilt angles(-6° to-1° negative angle,that is,the front edge of titanium cage is shorter than the rear edge of titanium cage;1° to 6° positive angle,that is,the front edge of titanium cage is longer than the rear edge of titanium cage)were placed.After setting the boundary conditions,preloads of 50,100 and 150 N were applied respectively on the C4 vertebral body.The stress value of each contact point between the titanium cage and C4 lower-end plate and C6 lower-end plate(seven stress contact points on the contact surface of titanium mesh)was recorded and statistical analysis was conducted. RESULTS AND CONCLUSION:(1)The tilt angles of the titanium cage of the positive angle group and negative angle group under 50,100 and 150 N stress respectively were found by Mann Whitn test,with P<0.05,which was statistically significant.The dispersion coefficients of the positive angle group were smaller than those of the negative angle group under 50,100 and 150 N stress conditions.(2)Under 50,100 and 150 N stress conditions,the Wilcoxon sign rank test in the positive angle group of titanium cage tilt angle found that when the angle was set to 1° to 5°,the difference was not statistically significant(P>0.05).However,when the tilt angle of the titanium cage was set to 6°,the difference was statistically significant(P<0.05).(3)Under 50,100 and 150 N stress conditions,the Wilcoxon sign rank test in the negative angle group of titanium cage tilt angle found that when the tilt angle was set to-1° to-6°,the difference was not statistically significant(P>0.05).(4)It is concluded that in the sagittal position,the titanium cage with a positive tilt angle is more stable than with a negative tilt angle,which is more suitable for clinical use.The tilt angle of the titanium cage is relatively stable in the range of 1° to 5°.When the tilt angle is 6°,the stability starts to decline,which is easy to cause complications of titanium cage sinking after surgery.It is more suitable to select the titanium cage with a tilt angle of 1° to 5° according to the clinical situation during surgery to improve the efficacy.