Objective: To analyze the demographic characteristics of patients with red blood cell transfusion reactions, the usage of red blood cell preparations, and the differences in the composition ratio of adverse reactions based on multi-center data from the Haemovigilance Network, in order to reveal the clinical characteristics of red blood cell transfusion and its underlying issues. Methods: Clinical data of patients who experienced transfusion reactions after red blood cell transfusion in the Haemovigilance Network from 2018 to 2023 were collected. The demographic characteristics of patients who experienced transfusion reactions with different types of red blood cell preparations, the utilization of these preparations, and the differences of the composition ratios of transfusion reactions were analyzed. Count data were expressed as numbers (n) or percentages (%), and comparisons between groups were performed using the Chi-square test. Results: Red blood cell transfusion reactions were more common in females (53.56%), with the majority of patients aged 50-69 years (35.54%). The Han polulation accounted for the vast majority of patients (92.77%), and patients in the hematology and obstetrics/gynecology departments had a relatively high proportion of transfusion reactions (13.26% and 14.26%, respectively). Leukocyte-reduced red blood cells and suspended red blood cells were the most common types of transfusion reactions reported among red blood cell preparations. Allergic reactions and non-hemolytic febrile reactions were the most common transfusion reactions, and there were significant differences in the composition ratios of allergic reactions (χ =869.89, P<0.05) and non-hemolytic febrile reactions (χ =812.75, P<0.05) across various types of red blood cell preparations. Conclusion: There are differences in the demographic characteristics and composition ratio of transfusion reactions among different red blood cell preparations. The management of red blood cell transfusion reactions should be tailored to patient characteristics and conditions, and the selection and use of blood products should be optimized to reduce or avoid the occurrence of transfusion reactions, such as considering the use of washed red blood cells for patients with a history of transfusion allergies or those prone to allergies.

Objective:To evaluate the clinical outcomes of posterior approach vertebral column resection (VCR) osteotomy combined with titanium mesh bone-graft fusion and internal fixation for the treatment of special type stage IIIb Kummell disease.Methods:Twelve patients (3 males, 9 females) diagnosed with special type stage IIIb Kummell disease at Zhengzhou Orthopedics Hospital between October 2015 and June 2021 were enrolled. The mean age was 59.1±5.6 years (range, 53-67 years). All patients underwent VCR osteotomy, pedicle screw fixation, and posterior bone-graft fusion using titanium mesh. Preoperative and postoperative outcomes were assessed using visual analogue scale (VAS) scores, Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, American Spinal Injury Association (ASIA) grading, Cobb angle correction, and bone graft fusion rate. Intraoperative and postoperative complications were also recorded.Results:All surgeries were completed successfully. The average follow-up duration was 11.6±1.8 months (range, 10-13 months). Significant improvements were observed in VAS scores, ODI, JOA scores, and Cobb angles at both two weeks postoperatively and at the final follow-up ( P<0.05), with no significant differences between the two time points ( P>0.05). The final recovery rates were 79.5% for VAS score, 73.2% for ODI, 72.1% for JOA score, and 77.3% for Cobb angle correction. Neurological function showed marked improvement. One patient developed delayed incision healing due to fat liquefaction but recovered following physical therapy. The remaining 11 patients experienced uneventful wound healing without infection or internal fixation loosening. One patient developed postoperative deep venous thrombosis of the lower limbs, which resolved with drug therapy. Conclusion:Posterior approach VCR combined with titanium mesh bone-graft fusion and internal fixation provides an effective surgical option for stage IIIb Kummell disease characterized by fractured vertebral bodies with only the broken upper and lower endplates remaining.

Objective:To analyze the results of detection and determinants of thyroid nodules among civil pilots, and to provide evidence for health management and aeromedical support.Methods:The results of health examination and flight data of 2 451 pilots at Xiamen Airlines Co., Ltd. collected between July 1, 2021 and June 30, 2022 was retrospectively analyzed. These pilots were divided into a non-nodule group and a nodule group based on thyroid ultrasound findings. Gender,age, flying hours, body mass index, prevalence of hypertension, blood routine parameters, lipid profiles, liver and kidney function, fasting plasma glucose, and long-haul flight frequency were compared between the 2 groups. Multivariate Logistic regression was performed to identify risk factors for thyroid nodules.Results:Among the 2 397 civil pilots, 2 301 were in the non-nodule group and 96 in the nodule group, with a detection rate of 4.01%. Most of these nodules were solitary and small (<1 cm in diameter, 52.08%), and classified as Chinese Thyroid Imaging Reporting and Data System 3 (likely benign, 53.13%). Detection rates of nodules were significantly higher among clivil pilots of older age or with longer flying hours ( χ2=25.17,36.86,both P<0.001). Overweight/obesity, hypertension, hypertriglyceridemia, hyperuricemia, and frequent long-haul flights were also associated with higher prevalence of thyroid nodules ( χ2=14.81, 6.17, 10.86, 11.57, 4.12, P<0.001,=0.013, 0.001, 0.001,0.042). Multivariate Logistic regression analysis pointed to the following independent risk factors: flying hours of 10 001-15 000 ( OR=4.005, 95% CI: 1.952-8.216) and over 15 000 ( OR=5.220, 95% CI: 2.415-11.285), overweight/obesity ( OR=1.646, 95% CI: 1.052-2.576) and hyperuricaemia ( OR=1.838, 95% CI: 1.204-2.804). Conclusions:The detection rate of thyroid nodules among civil pilots is relatively low. The occurrence is linked to advanced age, hypertension, hypertriglyceridemia and long-haul flight frequency, with cumulative flying hours, overweight/obesity and hyperuricemia as key risk factors. Aviation healthcare providers and medical examiners should provide targeted guidance and interventions related to modifiable risk factors to safeguard clivil pilots′ occupational health.

Objective:To investigate the relationship between macrophage activation related factors and clini-cal symptoms of schizophrenia(SCZ).Methods:Outpatient or inpatient SCZ patients(n=166)and normal con-trols(n=71)meeting the diagnostic criteria of DSM 4th edition were selected as subjects.The psychopathological symptoms were assessed by the Positive and Negative Syndrome Scale(PANSS),and the concentrations of α-Na-Galases,MAF and IL-18 were determined by enzyme-linked immunosorbent assay(ELISA).The correlation be-tween biological indicators and clinical symptoms was analyzed and the mediation effect was tested.Results:The concentrations of α-NaGalases(P＜0.001)and MAF(P＜0.01)in SCZ group were lower than those in normal control group.In SCZ group,IL-18 was negatively correlated with α-NaGalases concentration(r=-0.24,P＜0.01).α-NaGalases was positively correlated with MAF concentration(r=0.67,P＜0.001),and the total score of PANSS positive symptom scale was positively correlated with IL-18(r=0.21,P＜0.05)and MAF concentration(r=0.22,P＜0.01).The mediating effect of α-NaGalases and MAF was statistically significant,and the relative mediating effect accounted for 25.47％.Conclusion:The increase of IL-18 level may indicate the occurrence of positive symptoms of schizophrenia,and α-NaGalases and MAF may negatively regulate the inflammatory damage effect of IL-18 on SCZ,thereby reducing the positive symptoms.

Objective:To evaluate the clinical outcomes of posterior approach vertebral column resection (VCR) osteotomy combined with titanium mesh bone-graft fusion and internal fixation for the treatment of special type stage IIIb Kummell disease.Methods:Twelve patients (3 males, 9 females) diagnosed with special type stage IIIb Kummell disease at Zhengzhou Orthopedics Hospital between October 2015 and June 2021 were enrolled. The mean age was 59.1±5.6 years (range, 53-67 years). All patients underwent VCR osteotomy, pedicle screw fixation, and posterior bone-graft fusion using titanium mesh. Preoperative and postoperative outcomes were assessed using visual analogue scale (VAS) scores, Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, American Spinal Injury Association (ASIA) grading, Cobb angle correction, and bone graft fusion rate. Intraoperative and postoperative complications were also recorded.Results:All surgeries were completed successfully. The average follow-up duration was 11.6±1.8 months (range, 10-13 months). Significant improvements were observed in VAS scores, ODI, JOA scores, and Cobb angles at both two weeks postoperatively and at the final follow-up ( P<0.05), with no significant differences between the two time points ( P>0.05). The final recovery rates were 79.5% for VAS score, 73.2% for ODI, 72.1% for JOA score, and 77.3% for Cobb angle correction. Neurological function showed marked improvement. One patient developed delayed incision healing due to fat liquefaction but recovered following physical therapy. The remaining 11 patients experienced uneventful wound healing without infection or internal fixation loosening. One patient developed postoperative deep venous thrombosis of the lower limbs, which resolved with drug therapy. Conclusion:Posterior approach VCR combined with titanium mesh bone-graft fusion and internal fixation provides an effective surgical option for stage IIIb Kummell disease characterized by fractured vertebral bodies with only the broken upper and lower endplates remaining.

Objective:To investigate the relationship between macrophage activation related factors and clini-cal symptoms of schizophrenia(SCZ).Methods:Outpatient or inpatient SCZ patients(n=166)and normal con-trols(n=71)meeting the diagnostic criteria of DSM 4th edition were selected as subjects.The psychopathological symptoms were assessed by the Positive and Negative Syndrome Scale(PANSS),and the concentrations of α-Na-Galases,MAF and IL-18 were determined by enzyme-linked immunosorbent assay(ELISA).The correlation be-tween biological indicators and clinical symptoms was analyzed and the mediation effect was tested.Results:The concentrations of α-NaGalases(P＜0.001)and MAF(P＜0.01)in SCZ group were lower than those in normal control group.In SCZ group,IL-18 was negatively correlated with α-NaGalases concentration(r=-0.24,P＜0.01).α-NaGalases was positively correlated with MAF concentration(r=0.67,P＜0.001),and the total score of PANSS positive symptom scale was positively correlated with IL-18(r=0.21,P＜0.05)and MAF concentration(r=0.22,P＜0.01).The mediating effect of α-NaGalases and MAF was statistically significant,and the relative mediating effect accounted for 25.47％.Conclusion:The increase of IL-18 level may indicate the occurrence of positive symptoms of schizophrenia,and α-NaGalases and MAF may negatively regulate the inflammatory damage effect of IL-18 on SCZ,thereby reducing the positive symptoms.

Objective:To analyze the results of detection and determinants of thyroid nodules among civil pilots, and to provide evidence for health management and aeromedical support.Methods:The results of health examination and flight data of 2 451 pilots at Xiamen Airlines Co., Ltd. collected between July 1, 2021 and June 30, 2022 was retrospectively analyzed. These pilots were divided into a non-nodule group and a nodule group based on thyroid ultrasound findings. Gender,age, flying hours, body mass index, prevalence of hypertension, blood routine parameters, lipid profiles, liver and kidney function, fasting plasma glucose, and long-haul flight frequency were compared between the 2 groups. Multivariate Logistic regression was performed to identify risk factors for thyroid nodules.Results:Among the 2 397 civil pilots, 2 301 were in the non-nodule group and 96 in the nodule group, with a detection rate of 4.01%. Most of these nodules were solitary and small (<1 cm in diameter, 52.08%), and classified as Chinese Thyroid Imaging Reporting and Data System 3 (likely benign, 53.13%). Detection rates of nodules were significantly higher among clivil pilots of older age or with longer flying hours ( χ2=25.17,36.86,both P<0.001). Overweight/obesity, hypertension, hypertriglyceridemia, hyperuricemia, and frequent long-haul flights were also associated with higher prevalence of thyroid nodules ( χ2=14.81, 6.17, 10.86, 11.57, 4.12, P<0.001,=0.013, 0.001, 0.001,0.042). Multivariate Logistic regression analysis pointed to the following independent risk factors: flying hours of 10 001-15 000 ( OR=4.005, 95% CI: 1.952-8.216) and over 15 000 ( OR=5.220, 95% CI: 2.415-11.285), overweight/obesity ( OR=1.646, 95% CI: 1.052-2.576) and hyperuricaemia ( OR=1.838, 95% CI: 1.204-2.804). Conclusions:The detection rate of thyroid nodules among civil pilots is relatively low. The occurrence is linked to advanced age, hypertension, hypertriglyceridemia and long-haul flight frequency, with cumulative flying hours, overweight/obesity and hyperuricemia as key risk factors. Aviation healthcare providers and medical examiners should provide targeted guidance and interventions related to modifiable risk factors to safeguard clivil pilots′ occupational health.

Objective:To investigate the effects and mechanisms of zinc ion-loaded composite hydrogel (hereinafter referred to as the zinc-containing hydrogel) on infected full-thickness skin defect wounds in diabetic mice.Methods:This study was an experimental study. A poly (glycerol sebacate)-co-poly(ethylene glycol)-g-catechol prepolymer/quaternized-chitosan hydrogel (hereinafter referred to as the simple hydrogel) and a solid-state zinc-containing hydrogel with porous and good adhesion by adding zinc ions to the simple hydrogel were prepared. The release rate of zinc ions from the zinc-containing hydrogel after immersion in phosphate buffer solution (PBS) for 14 days was calculated. The concentration of methicillin-resistant Staphylococcus aureus (MRSA) cultured for 2 hours with the simple hydrogel, zinc-containing hydrogel, and PBS was measured. The scavenging ability of the simple hydrogel, zinc-containing hydrogel, and PBS for 1,1-diphenyl-2-picrylhydrazyl radical 2,2-diphenyl-1-(2, 4, 6-trinitrophenyl) hydrazyl (DPPH) was detected using microplate reader to reflect the ability of oxygen free radical removal. The length of vessels formed by human umbilical vein endothelial cells (HUVECs) cultured for 24 hours with the simple hydrogel, zinc-containing hydrogel, and PBS was measured. The cell viability of L929 cells cultured for 24 hours with the simple hydrogel, zinc-containing hydrogel, and PBS was detected using the cell counting kit-8. The mouse red blood cell suspension was divided into blank control group treated with PBS, simple hydrogel group, zinc-containing hydrogel group, and Triton X-100 group treated with corresponding solution. Hemolysis was detected using microplate reader after 2 hours of treatment, and the hemolysis rate was calculated. All experiments had a sample size of 3. Twenty-one C57BL/6J mice aged 6-8 weeks were taken, and a full-thickness skin defect wound was prepared in the symmetrical position on the back spine and infected with MRSA. Mice were divided into blank control group treated with PBS, simple hydrogel group, and zinc-containing hydrogel group treated with the corresponding hydrogel. Three days after injury, bacterial concentration in the wounds were measured in all groups of mice ( n=4). On day 0 (immediately), 3, 7, and 14 after injury, the wound infection status of mice was generally observed and the wound healing rate was calculated ( n=5). Hematoxylin-eosin staining and Masson staining were used to detect new epithelium and collagen formation in the wounds of mice on day 14 after injury. Immunofluorescence staining was used to detect neovascularization and distribution of M2 macrophages in the wounds of mice. Results:After immersion for 14 days, the release rate of zinc ions of the zinc-containing hydrogel was (70.5±4.6)%. Compared with the zinc-containing hydrogel, the bacterial concentration was significantly increased after 2 hours of culture with PBS and the simple hydrogel ( P<0.05). The DPPH scavenging rate of the zinc-containing hydrogel was significantly higher than that of PBS and the simple hydrogel (with P values all <0.05). The length of vessels formed by HUVECs cultured for 24 hours with the zinc-containing hydrogel was significantly longer than that cultured with PBS ( P<0.05). Compared with PBS and the simple hydrogel, the cell viability of L929 cells cultured for 24 hours with the zinc-containing hydrogel was significantly higher ( P<0.05). After 2 hours of incubation, compared with that in Triton X-100 group, the hemolysis rate of red blood cells in blank control, simple hydrogel, and zinc-containing hydrogel groups was significantly reduced ( P<0.05); and the hemolysis rate of red blood cells in the latter three groups was similar ( P>0.05). On day 3 after injury, the bacterial concentration in the wounds of mice in zinc-containing hydrogel group was significantly lower than that in blank control and simple hydrogel groups (with P values all <0.05). From day 3 to day 14 after injury, the wounds of mice in all the three groups were gradually healing, and on day 14 after injury, the wounds of mice in the zinc-containing hydrogel group were basically healed. On day 7 after injury, the wound healing rate of mice in zinc-containing hydrogel group was (72.4±8.4)%, which was significantly higher than that of blank control and simple hydrogel groups, being (31.6±6.7)% and (44.7±5.4)%, respectively(with P values all< 0.05). On day 14 after injury, the wound healing rate of mice in zinc-containing hydrogel group was (92.7±4.3)%, which was significantly higher than (73.5±7.4)% in blank control group ( P<0.05). On day 14 after injury, compared with that in blank control and simple hydrogel groups, the newly formed epidermis in mice wound of zinc-containing hydrogel group was longer and thicker, with more collagen deposition, and a more abundant distribution of new vessels and M2 macrophages. Conclusions:The zinc-containing hydrogel exhibits good biocompatibility, oxygen free radical scavenging capacity, and antimicrobial effects both in vitro and in vivo, as well as angiogenic promotion capability. It can provide sustained release of zinc ions to promote re-epithelialization and collagen synthesis, thus enhancing the healing of infected full-thickness skin defect wounds in diabetic mice.

Objective To evaluate the effect of deep learning reconstruction algorithm combined with smart metal artifact reduction(DLMAR)on the quality of abdominal CT images in critically ill patients who are unable to raise their arms and require electrocardiographic(ECG)monitoring.Methods A total of 102 patients were retrospectively enrolled.All subjects were critically ill patients who were unable to raise their arms and required ECG monitoring.Images were reconstructed using 6 algorithms,including filtered back projection(FBP),iterative reconstruction(IR),deep learning(DL),FBP combined with smart metal artifact reduction(FBPMAR),adaptive statistical iterative reconstruction-V combined with smart metal artifact reduction(IRMAR),and DLMAR.A quantitative analysis of CT values,noise,signal-to-noise ratio(SNR),and contrast-to-noise ratio(CNR)was conducted in regions without metal artifacts and regions with metal artifacts in the liver,as well as the tissues,including those from the liver,spleen,pancreas,and aorta,between the two arms.Qualitative analysis of electrode metal artifacts,the visualization of the structures between the two arms,and image noise was performed with a 5-point scoring system(l=worst and 5=best).Results In the regions of the liver with metal artifacts,there was a significant difference between the CT values of the DLMAR group([98.5±9.8]Hounsfield units[H[J])and those of the FBP group([73.7±5.6]HU),the IR group([75.3±7.5]HU),and the DL group([66.3±11.4]HU)(P＜0.01).There was no significant difference between the CT values of the DLMAR group and those of the FBPMAR group([99.8±4.8]HU)and the IRMAR group([99.6±3.4]HU)(P＞0.05).The noise of the DLMAR group was found to be significantly lower than that of the other groups(P＜0.01).Furthermore,the SNR and CNR of the DLMAR group were also found to be higher than those of the other groups(P＜0.01).In the tissue region between the two arms,the differences in CT values among the six groups were not statistically significant(P＞0.05).The noise of the DLMAR group was lower than those of the other groups(P＜0.01),and the SNR and CNR of the DLMAR group were higher than those of the other groups(P＜0.01).In terms of the removal of metal artifacts,the scores of the FBPMAR,IRMAR,and DLMAR groups(4.27±0.32,4.44±0.34,and 4.61±0.28,respectively)were higher than those of the FBP,IR,and DL groups(1.36±0.54,1.32±0.45,and 1.24±0.46,respectively)(P＜0.01).The DLMAR group also had a higher score of 4.62±0.37 in the visualization of structures between the two arms and 4.53±0.39 in the noise reduction of images,both of which were higher than those of the other groups(P＜0.01).Conclusion DLMAR reduces artifacts,decreases noise,and improves the quality of abdominal CT imaging in critically ill patients who are unable to raise their arms and require ECG monitoring.