Objective To explore the effectiveness of the generative large language model MedGo in nursing decision-making for elderly patients with multimorbidity. Methods A quasi-randomized controlled trial study was conducted involving 6 junior nurses, 6 senior nurses and the MedGo model from January 1, 2025 to March 31, 2025 at the Emergency Internal Medicine Ward of Shanghai East Hospital Affiliated to Tongji University. Clinical data of 120 elderly patients with multimorbidity were analyzed to compare the performance of the three groups in four tasks (nursing diagnosis assessment, nursing intervention formulation, complication identification, and complication prevention) from three evaluation dimensions: decision-making time consumption, decision accuracy, and decision-making quality. Results In terms of decision-making time, the senior nurse group completed all four tasks faster than the junior nurse group (P＜0.01), and the MedGo group completed all four tasks faster than the junior nurse group (P＜0.001) and the senior nurse group (P＜0.001). In terms of decision-making accuracy, senior nurse group scored higher than junior nurse group in all four tasks (P＜0.001), while the MedGo group outperformed the senior nurse group only in complication identification (P＜0.001). In terms of decision-making quality, the MedGo group scored higher than junior nurse group (P＜0.001) and senior nurse group (P＜0.001) in all four tasks. Conclusions The MedGo model demonstrates advantages of high efficiency, accuracy, and quality in nursing decision-making for elderly patients with multimorbidity; senior nurses outperform junior nurses in decision-making, providing diverse references for clinical nursing decision-making.

ObjectiveTo analyze the differences in color， odor and volatile components of Citri Reticulatae Pericarpium（CRP） before and after being stir-fried with Halloysitum Rubrum， and to explore the material basis of enhancing the effect of strengthening spleen after processing and the scientific connotation of decoction pieces processed with Halloysitum Rubrum as the auxiliary material. MethodsThe volatile components of the samples before and after processing were identified and relatively quantified by headspace gas chromatography-mass spectrometry（HS-GC-MS）， and the volatile components were analyzed by principal component analysis（PCA） and orthogonal partial least squares-discriminant analysis（OPLS-DA）. According to the principle of variable importance in the projection（VIP） value>1.5， volatile differential components before and after processing were screened. And combined with intelligent sensory technologies such as colorimeter and electronic nose， the chroma and odor information of CRP before and after being stir-fried with Halloysitum Rubrum were identified. Pearson correlation analysis was used to explore the correlation between volatile differential components and chroma values. ResultsA total of 112 volatile components were identified from CRP and CRP stir-fried with Halloysitum Rubrum， of which 84 were from CRP and 97 were from CRP stir-fried with Halloysitum Rubrum. And 7 differential components were selected， including α-pinene， β-myrcene， linalool， sabinene， ocimene isomer mixture， A-ocimene， and δ-elemene. After being processed with Halloysitum Rubrum， the brightness value（L^*）， yellow-blue value（b^*） and total chromatic value（E^*_ab） of CRP were decreased（P<0.01）， and red-green value（a^*） was increased（P<0.01）， the response values of S4， S5， S10 and S13 sensors were significantly increased（P<0.05）， and the response values of S3 and S8 sensors were significantly decreased（P<0.05）. Correlation analysis showed that α-pinene and β-myrcene were negatively correlated with L^* and E^*_ab， but positively correlated with a^*. Sabinene was positively correlated with L^* and E^*_ab. Linalool was positively correlated with L^* and E^*_ab， and negatively correlated with a^*. The ocimene isomer mixture was positively correlated with the L^*. ConclusionAfter being processed with Halloysitum Rubrum， the appearance color， odor and volatile components of CRP change significantly， and α-pinene， β-myrcene， sabinene， linalool and A-ocimene are the characteristic volatile components before and after processing， which can provide references for the quality evaluation and clinical application of CRP and its processed products.

ObjectiveTo analyze the differences in color， odor and volatile components of Citri Reticulatae Pericarpium（CRP） before and after being stir-fried with Halloysitum Rubrum， and to explore the material basis of enhancing the effect of strengthening spleen after processing and the scientific connotation of decoction pieces processed with Halloysitum Rubrum as the auxiliary material. MethodsThe volatile components of the samples before and after processing were identified and relatively quantified by headspace gas chromatography-mass spectrometry（HS-GC-MS）， and the volatile components were analyzed by principal component analysis（PCA） and orthogonal partial least squares-discriminant analysis（OPLS-DA）. According to the principle of variable importance in the projection（VIP） value>1.5， volatile differential components before and after processing were screened. And combined with intelligent sensory technologies such as colorimeter and electronic nose， the chroma and odor information of CRP before and after being stir-fried with Halloysitum Rubrum were identified. Pearson correlation analysis was used to explore the correlation between volatile differential components and chroma values. ResultsA total of 112 volatile components were identified from CRP and CRP stir-fried with Halloysitum Rubrum， of which 84 were from CRP and 97 were from CRP stir-fried with Halloysitum Rubrum. And 7 differential components were selected， including α-pinene， β-myrcene， linalool， sabinene， ocimene isomer mixture， A-ocimene， and δ-elemene. After being processed with Halloysitum Rubrum， the brightness value（L^*）， yellow-blue value（b^*） and total chromatic value（E^*_ab） of CRP were decreased（P<0.01）， and red-green value（a^*） was increased（P<0.01）， the response values of S4， S5， S10 and S13 sensors were significantly increased（P<0.05）， and the response values of S3 and S8 sensors were significantly decreased（P<0.05）. Correlation analysis showed that α-pinene and β-myrcene were negatively correlated with L^* and E^*_ab， but positively correlated with a^*. Sabinene was positively correlated with L^* and E^*_ab. Linalool was positively correlated with L^* and E^*_ab， and negatively correlated with a^*. The ocimene isomer mixture was positively correlated with the L^*. ConclusionAfter being processed with Halloysitum Rubrum， the appearance color， odor and volatile components of CRP change significantly， and α-pinene， β-myrcene， sabinene， linalool and A-ocimene are the characteristic volatile components before and after processing， which can provide references for the quality evaluation and clinical application of CRP and its processed products.

Objective To evaluate the feasibility of process scale-up for the production of human prothrombin complex concentrate(PCC) by comparing the quality parameters of PCC samples obtained at different stages of process scale-up.Methods The PCC production process was scaled up sequentially through bench scale, pilot scale and production scale.Samples were collected at critical process control points across the three scales for comparative quality analysis. The final PCC products from each scale were tested in accordance with the Chinese Pharmacopoeia(VolumeⅢ, 2020 edition) to assess process stability and regulatory compliance during scale-up.Results After the first ultrafiltration step, no statistically significant differences were observed in the potency of human coagulation factor Ⅸ(FⅨ) or protein content among samples from the three scales(F = 1. 066 and 0. 590, respectively, each P > 0. 05). The FⅨ recovery rates were(69. 3 ± 10. 3)%,(73. 9 ±11. 1)%, and(69. 8 ± 7. 3)%, respectively, with no significant difference( F = 0. 330, P > 0. 05). Following solvent/detergent(S/D) treatment, the pH remained stable, and no significant differences were observed in FⅨ potency or protein content(F =1. 414 and 0. 542, respectively, each P > 0. 05). After the secondary ion-exchange chromatography step, no significant differences were found in FⅨ potency or specific activity(F = 0. 437 and 0. 201, respectively, each P > 0. 05), with FⅨ recovery rates of(90. 6 ± 6. 7)%,(82. 6 ± 4. 6)% and(87. 2 ± 6. 1)%, respectively, with no significant difference(F = 2. 513, P > 0. 05).At the bulk solution stage, no significant differences were observed in FⅨ potency or specific activity(F = 0. 187 and 0. 135,respectively, each P > 0. 05) with stable pH, and FⅨ recovery rates were(90. 6 ± 7. 5)%,(97. 2 ± 8. 3)%, and(92. 2 ± 6. 4)%,respectively, with no significant difference(F = 1. 016, P > 0. 05). After dry-heat virus inactivation, no significant differences were noted in the potency of factorsⅡ, Ⅶ, Ⅸ, and Ⅹ(F = 0. 11, 0. 473, 0. 818, and 0. 244, respectively, each P > 0. 05).The critical quality attributes of final PCC products from all three scales were consistent and complied with the requirements of Chinese Pharmacopoeia(Volume Ⅲ, 2020 edition).Conclusion The established PCC production process is stable, reliable, and reproducible, demonstrating the feasibility of process scale-up.

Objective To compare the quality and centrifugal efficiency of human plasma cryoprecipitates extracted by GQ142 high-speed tube centrifuge and BKB45 continuous flow centrifuge and the differences in the production process of human coagulation factor Ⅷ(FⅧ).Methods The main functions, parameters and work efficiency of GQ142 high-speed tube centrifuge and BKB45 continuous flow centrifuge were compared. Cryoprecipitates were extracted for FⅧ production,sampling and testing, comparing the quality, yield, and virus safety of cryoprecipitates, as well as the quality and virus safety of FⅧ production process and finished products.Results Compared with GQ142 high-speed tube centrifuge, BKB45 continuous flow centrifuge had more perfect functions and higher working efficiency. The appearance of the cryoprecipitates extracted by both centrifuges was normal, the virus safety was in accordance with the internal quality control standard, and there was no statistically significant difference in cryoprecipitates yield(t = 1. 507, P > 0. 05). The recovery rates of FⅧactivity were(48. 7 ± 4. 2)% and(49. 2 ± 5. 4)%, respectively, with no statistically significant difference(t =-0. 250, P >0. 05). There was no statistically significant difference in FⅧ potency, protein content and FⅧ specific activity among cryoprecipitate solution, post chromatographic products and ultrafiltration products(t =-1. 466,-2. 084,-0. 998,-1. 701,-1. 973, 0. 472,-0. 975, 1. 116, and-1. 215, respectively, each P > 0. 05). The recovery rates of FⅧ activity of post chromatographic products were(38. 0 ± 4. 4)% and(38. 7 ± 5. 6)%, respectively, with no statistically significant difference(t =-0. 275, P > 0. 05). The pH of ultrafiltration products was stable. The appearance of the finished products was normal, and the virus safety indicators, FⅧ potency, moisture, pH, protein content and FⅧ specific activity were all in accordance with the quality standards of Chinese Pharmacopoeia(Vol Ⅲ, 2020 edition).Conclusion Compared with GQ142 high-speed tube centrifuge, BKB45 continuous flow centrifuge can significantly improve production efficiency while ensuring the quality of cryoprecipitates and FⅧ, making it suitable for large-scale production.

Objective To compare the quality and centrifugal efficiency of human plasma cryoprecipitates extracted by GQ142 high-speed tube centrifuge and BKB45 continuous flow centrifuge and the differences in the production process of human coagulation factor Ⅷ(FⅧ).Methods The main functions, parameters and work efficiency of GQ142 high-speed tube centrifuge and BKB45 continuous flow centrifuge were compared. Cryoprecipitates were extracted for FⅧ production,sampling and testing, comparing the quality, yield, and virus safety of cryoprecipitates, as well as the quality and virus safety of FⅧ production process and finished products.Results Compared with GQ142 high-speed tube centrifuge, BKB45 continuous flow centrifuge had more perfect functions and higher working efficiency. The appearance of the cryoprecipitates extracted by both centrifuges was normal, the virus safety was in accordance with the internal quality control standard, and there was no statistically significant difference in cryoprecipitates yield(t = 1. 507, P > 0. 05). The recovery rates of FⅧactivity were(48. 7 ± 4. 2)% and(49. 2 ± 5. 4)%, respectively, with no statistically significant difference(t =-0. 250, P >0. 05). There was no statistically significant difference in FⅧ potency, protein content and FⅧ specific activity among cryoprecipitate solution, post chromatographic products and ultrafiltration products(t =-1. 466,-2. 084,-0. 998,-1. 701,-1. 973, 0. 472,-0. 975, 1. 116, and-1. 215, respectively, each P > 0. 05). The recovery rates of FⅧ activity of post chromatographic products were(38. 0 ± 4. 4)% and(38. 7 ± 5. 6)%, respectively, with no statistically significant difference(t =-0. 275, P > 0. 05). The pH of ultrafiltration products was stable. The appearance of the finished products was normal, and the virus safety indicators, FⅧ potency, moisture, pH, protein content and FⅧ specific activity were all in accordance with the quality standards of Chinese Pharmacopoeia(Vol Ⅲ, 2020 edition).Conclusion Compared with GQ142 high-speed tube centrifuge, BKB45 continuous flow centrifuge can significantly improve production efficiency while ensuring the quality of cryoprecipitates and FⅧ, making it suitable for large-scale production

Objective To analyze the tumor characteristics associated with achieving pathological complete response(pCR) and tumor prognosis in the patients undergoing laparoscopic rectal cancer surgery after neoadjuvant chemoradiotherapy(nCRT). Methods A retrospective review was conducted on clinical and pathological data of locally advanced rectal cancer(LARC) patients who underwent nCRT at Renji Hospital from January 2017 to January 2024. Factors influencing the achievement of pCR were analyzed, and the patients prognosis of pCR group and non-pCR group was compared. Results Univariate analysis, multivariate Logistic regression analysis, and receiver operating characteristic (ROC) curve analysis showed that tumor length less than 5 cm(cutoff value 5.24 cm) and baseline carcinoembryonic antigen(CEA) less than 5 μg/L(cutoff value 5.33 μg/L) were independent predictors of achieving pCR after nCRT in LARC patients. Prognostic survival analysis showed that the 3-year overall survival(OS) rate for pCR group and non-pCR group were 92.86% and 82.46%, respectively (P=0.193), and the 3-year disease-free survival (DFS) rate were 85.71% and 70.18%, respectively (P=0.141), with no statistically significant differences between the two groups. Conclusions Tumor length and baseline CEA level are independent predictors for achieving pCR after nCRT in LARC patients. Additionally, there were no statistically significant differences in 3-year OS and DFS between pCR group and non-pCR group.

Objective To investigate the expression levels of serum miR-186-5p and miR-942-5p in patients with glioma and their clinical significance.Methods A total of 98 patients with glioma who were treated in this hospital from October 2019 to December 2021 were selected as the monitored group,and 101 healthy indi-viduals who underwent physical examinations a the same time were selected as the control group.Quantitative fluorescent PCR(qPCR)method was applied to detect the expression levels of miR-186-5p and miR-942-5p in serum,and multivariate COX regression was applied to analyze the prognostic factors of glioma patients.Re-ceiver operating characteristic(ROC)curve and area under curve(AUC)were used to analyze the diagnostic value of serum miR-186-5p and miR-942-5p in glioma.Kaplan-Meier survival curve was used to analyze the re-lationship between serum miR-186-5p and miR-942-5p expression and prognosis of patients.Results The ex-pression level of serum miR-186-5p in monitored group was lower than that in the control group(P＜0.05),and the expression level of miR-942-5p was higher than that in the control group(P＜0.05).The AUC of ser-um miR-186-5p and miR-942-5p in the diagnosis of glioma alone and in combination were 0.735,0.809 and 0.895,respectively.There were significant differences in the proportion of low miR-186-5p expression and high miR-942-5p expression in serum of patients with different preoperative Karnofsky performance status(KPS)scores,World Health Organization(WHO)grades and local infiltration(P＜0.05).The 2-year surviv-al rate of patients with high expression of miR-186-5p was higher than that of patients with low expression of miR-186-5p(x2=6.455,P=0.011).The 2-year survival rate of patients with high miR-942-5p expression was lower than that of patients with low miR-942-5p expression(x2=9.858,P=0.002).miR-186-5p was a protective factor for mortality in glioma patients(P＜0.05),while miR-942-5p was a risk factor(P＜0.05).Conclusion Serum miR-186-5p expression level decreases and miR-942-5p expression level increases in glioma patients,both of which have certain diagnostic value for the occurrence of glioma.

Osteonecrosis of the femoral head(ONFH)is a disabling orthopedic disease,pathologically characterized by progressive collapse of the femoral head accompanied by destruction of the trabecular and articular cartilage structures,leading to hip joint pain and progressive functional impairment.Bone marrow mesenchymal stem cell-derived extracellular vesicles(BMSC-EVs)show great promise in tissue repair and regeneration,with low immunogenicity and tumorigenicity,and play roles in osteogenesis,angiogenesis,and immunomodulation.This review summarizes the therapeutic effects and underlying mechanisms of BMSC-EVs in ONFH,providing a theoretical basis for its treatment.

Objective Based on 25 indicators including immune factors, cell count classification, and smear results of the knee joint fluid, machine learning models were established to distinguish between osteoarthritis (OA) and rheumatoid arthritis (RA). Methods 100 OA and 40 RA patients scheduled for total knee arthroplasty were enrolled respectively. Each patient's knee joint fluid was collected preoperatively. Nucleated cells were counted and classified. The expression levels of immune factors, including tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1β), IL-6, IL-8, IL-15, matrix metalloproteinase 3 (MMP3), MMP9, MMP13, rheumatoid factor (RF), serum amyloid A (SAA), C-reactive protein (CRP), and others were measured. Smears and microscopic classification of all the immune factors were performed. Independent influencing factors for OA or RA were identified using univariate binary logistic regression, Lasso regression, and multivariate binary logistic regression. Based on the independent influencing factors, three machine learning models were constructed which are logistic regression, random forest, and support vector machine. Receiver operating characteristic curve (ROC), calibration curve and decision curve analysis (DCA) were used to evaluate and compare the models. Results A total of 5 indicators in the knee joint fluid were screened out to distinguish OA and RA, which were IL-1β(odds ratio(OR)=10.512, 95× confidence interval (95×CI) was 1.048-105.42, P=0.045), IL-6 (OR=1.007, 95×CI was 1.001-1.014, P=0.022), MMP9 (OR=3.202, 95×CI was 1.235-8.305, P=0.017), MMP13 (OR=1.002, 95× CI was 1-1.004, P=0.049), and RF (OR=1.091, 95×CI was 1.01-1.179, P=0.026). According to the results of ROC, calibration curve and DCA, the accuracy (0.979), sensitivity (0.98) and area under the curve (AUC, 0.996, 95×CI was 0.991-1) of the random forest model were the highest. It has good validity and feasibility, and its distinguishing ability is better than the other two models. Conclusion The machine learning model based on immune factors in the knee joint fluid holds significant value in distinguishing OA and RA. It provides an important reference for the clinical early differential diagnosis, prevention and treatment of OA and RA.
Humans ; Arthritis, Rheumatoid/metabolism* ; Machine Learning ; Male ; Female ; Middle Aged ; Aged ; Synovial Fluid/immunology* ; Osteoarthritis, Knee/metabolism* ; Knee Joint/metabolism* ; ROC Curve ; Diagnosis, Differential