OBJECTIVE To construct a classification prediction model for vancomycin blood concentration， and to optimize its precision dosing strategies. METHODS Patient records meeting inclusion criteria were extracted from the Medical Information Mart for Intensive Care database. Following data cleaning and preprocessing， a final cohort of 9 902 patient was analyzed. Feature selection was performed through correlation analysis and the Boruta feature selection algorithm. Vancomycin blood concentrations were discretized into three categories based on clinical therapeutic windows： low （＜10 μg/mL）， intermediate （10-20 μg/mL）， and high （≥20 μg/mL）. Six machine learning algorithms were employed to construct classification models： tabular prior-data fitted network （TabPFN）， logistic regression （LR）， random forest （RF）， extreme gradient boosting （XGBoost）， support vector machine （SVM）， K-nearest neighbors （KNN）. Model performance was evaluated using 10-fold cross-validation （10-CV）， with primary metrics including： accuracy， balanced accuracy， precision macro， recall macro， macro F1， area under the receiver operating characteristic curve （OvR-AUC）. Shapley Additive Explanations （SHAP） was adopted to analyze the direction and magnitude of the impact that different features had on the model’s predictive outcomes. RESULTS The results showed that the RF and TabPFN models performed the best （with accuracy of 0.741 4 and 0.737 7， and OvR-AUC of 0.907 0 and 0.895 8， respectively）. XGBoost model exhibited moderate performance， while LR， SVM， and KNN models demonstrated relatively poor performance. Confusion matrix heatmap analysis revealed that both RF and TabPFN achieved higher accuracy in predicting high- concentration cases but exhibited slightly lower performance in the low and medium concentration categories. Bootstrap with 10-CV revealed that the RF model demonstrated stable performance across various evaluation metrics （accuracy： 0.741 4； balanced accuracy： 0.740 3； precision macro： 0.732 1； recall macro： 0.736 0； macro F1： 0.736 0； OvR-AUC： 0.907 0）， indicating good classification performance and generalization ability. SHAP analysis revealed that creatinine， urea nitrogen， daily cumulative dose and administration frequency of vancomycin， which were key predictors， had a significant impact on the prediction results. CONCLUSIONS RF and TabPFN models demonstrate certain advantages in the classification prediction of vancomycin trough blood concentrations； however， their performance in the low to moderate concentration categories still requires improvement.

Patients with acute heart failure (AHF) often experience dyspnea, and monitoring and quantifying their breathing patterns can provide reference information for disease and prognosis assessment. In this study, 39 AHF patients and 24 healthy subjects were included. Nighttime chest-abdominal respiratory signals were collected using wearable devices, and the differences in nocturnal breathing patterns between the two groups were quantitatively analyzed. Compared with the healthy group, the AHF group showed a higher mean breathing rate (BR_mean) [(21.03 ± 3.84) beat/min vs. (15.95 ± 3.08) beat/min, P < 0.001], and larger R_RSBI_cv [70.96% (54.34%-104.28)% vs. 58.48% (45.34%-65.95)%, P = 0.005], greater AB_ratio_cv [(22.52 ± 7.14)% vs. (17.10 ± 6.83)%, P = 0.004], and smaller SampEn (0.67 ± 0.37 vs. 1.01 ± 0.29, P < 0.001). Additionally, the mean inspiratory time (TI_mean) and expiration time (TE_mean) were shorter, TI_cv and TE_cv were greater. Furthermore, the LBI_cv was greater, while SD1 and SD2 on the Poincare plot were larger in the AHF group, all of which showed statistically significant differences. Logistic regression calibration revealed that the TI_mean reduction was a risk factor for AHF. The BR_ mean demonstrated the strongest ability to distinguish between the two groups, with an area under the curve (AUC) of 0.846. Parameters such as breathing period, amplitude, coordination, and nonlinear parameters effectively quantify abnormal breathing patterns in AHF patients. Specifically, the reduction in TI_mean serves as a risk factor for AHF, while the BR_mean distinguishes between the two groups. These findings have the potential to provide new information for the assessment of AHF patients.
Humans ; Heart Failure/diagnosis* ; Prognosis ; Respiration ; Wearable Electronic Devices ; Acute Disease

【Objective】 To evaluate the efficacy and safety of plasma-derived human coagulation factor Ⅷ (FⅧ) in the treatment of patients with hemophilia A. 【Methods】 A multi-center and open, SAT(single-arm trials) clinical study was conducted. A total of 54 subjects with hemophilia A were enrolled in 5 research centers. FⅧ was injected according to the subjects' weight, severity of disease and other factors, and the transfusion efficiency of FⅧ activity at 10 min after the first infusion of the first bleeding event was taken as the main efficacy indexes. The improvement scores of bleeding symptoms and signs within 24 h after the first infusion of the first bleeding event were the secondary efficacy indexes. The pathogenic microbial indexes and FⅧ inhibitors were detected on 90(th) and 180(th) day after treatment. 【Results】 The transfusion efficiency of FⅧ activity of 54 subjects at 10 min after the first infusion was 171.9% on average, with median of 169.5%, both higher than the target value of 100%. Within 24 h after the first infusion, the improvement of bleeding symptoms and signs of the subjects were scored, among which 19 cases (35.2%) were "obvious", 35 cases (64.8%) were "good", and the total clinical effective rate reached 100%. Five subjects (9.3%) had six drug-related adverse events. On 90(th) and 180(th) day after treatment, hepatitis B surface antigen, hepatitis C antibody, HIV antibody, treponema pallidum antibody and FⅧ inhibitors were detected, and no negative to positive cases were found. 【Conclusion】 After infusion, the FⅧ preparation can significantly improve the FⅧ activity level in hemophilia A patients in a short period of time, which has high infusion efficiency and can achieve better treatment efficacy, and can also effectively control and relieve bleeding symptoms and signs, with good overall safety.

Objective To investigate the clinical effect of No ha la hu(Mongolian medicine abdominal massage)combined with Ni ru ha(Mongolian medicine enema)in the treatment of incomplete intestinal obstruction.Methods A total of 80 patients with incomplete intestinal obstruction admitted to the department of emergency and critical care medicine of Inner Mongolia International Mongolian Hospital from April 2020 to April 2022 were selected as the study objects,they were randomly divided into control group and observation group,40 cases in each group.The control group was treated with routine modern medicine,and the observation group was treated with mongolian medicine No ha la hu combined with Ni ru ha on the basis of routine treatment.Specific methods:the patient supine position,both lower limbs flexion,natural calm breathing,the doctor stands on the patient's right side,applies a little butter to the palm of his hand,rub hands,massages the abdomen with the middle finger and ring finger at acupoints such as ileocecal point,small intestine point,small intestine point,small intestine point and lower clockwise direction point.Massage the abdomen with the palm for about 20 minutes,once a day for 3 days.No ha la hu was given after the treatment of Ni ru ha(Rhubarb 250 g,Cold water stone 150 g,Sanai 100 g,Facial alkali 100 g,Hyacinth 50 g,Terminalia chebula 50 g),the patients should lie on the left side,raise the buttocks about 10 cm,insert the enema into the rectum 15-20 cm,take the Mongolian medicine Liuweian powder 12 g and warm water 50-100 mL for enema,once a day for 3 days.The difference of relieving time of abdominal pain and distension,time of exhaustion,time of fasting,and time of hospital stay between the two groups were compared,and the clinical effect was observed.Results Relieving time of abdominal pain,abdominal distension,time of exhaust and time of hospital stay in the observation group were significantly shorter than those in the control group[abdominal pain relief time(hours):5.3±1.8 vs.8.1±1.6,abdominal distension relief time(hours):3.2±1.5 vs.6.5±1.9,time of exhaust(days):2.6±1.7 vs.4.1±2.1,hospital stay(days):8.3±2.9 vs.10.1±2.1,all P<0.05],time of fasting in the observation group were shorter than those in the control group(days:2.9±0.5 vs.3.1±0.6,the difference was not statistically significant(all P>0.05).The effective rate of the observation group was significantly higher than that of the control group[92.5％(37/40)vs.75.0％(30/40),P<0.05].Conclusion On the basis of routine treatment of western medicine,the treatment of incomplete intestinal obstruction by Mongolian medicine No ha la hu combined with Ni ru ha is more effective,which can effectively restore gastrointestinal function,relieve abdominal pain and other symptoms,and shorten the time of exhaust.

【Objective】 To explore the recruitment and retention strategy of blood donors by investigating the age composition of blood donors in some areas of China, so as to promote blood donation and enhance clinical blood supply. 【Methods】 Through the working platform of Practice Comparison Working Group of China’s Mainland Blood Collection and Supply Institutions, the average age and age composition of blood donors from 22 blood centers were collected, and statistical analysis was conducted after eliminating invalid data. 【Results】 The median average age of blood donors during the survey year was 30.02.The median age in 2.89% of the blood centers was lower than 25. The average age of different genders was statistically significant only in 2018(P<0.05). Fot first-time blood donors, the median constituent ratio of donors <25 and ≥25 years old was 54.53% and 44.28%, with median retention rate at 10.30% and 9.61%, respectively. The median overall participation rate of blood donors was 2.7%, with median participation rate of blood donors <25 years old at 5.1%. 【Conclusion】 The recruitment and retention of blood donor is crucial to enhance clinical blood supply. Blood donors <25 years old, with a longer period for future donation, should be the main target of blood donation recruitment. Meanwhile, the revision of upper age limit for blood donation is another important initiative to grow the blood donor pool.

Objective:To investigate the value of machine learning-based computed tomography (CT) images radiomics analysis in preoperative evaluation of surgical portal vein-superior mesenteric vein (PV-SMV) invasion in patients with pancreatic ductal adenocarcinoma (PDAC).Methods:The retrospective study was conducted with 156 consecutive PDAC patients who were underwent surgery at the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University between January 2010 and July 2021. There were 95 males and 61 females, with the age of (65.7±8.2) years. Patients were randomly split into training set and validation set by a ratio of 3∶2. Minimum redundancy maximum relevance was used to select radiomic features, which were extracted from contrast-enhanced CT images. Five machine learning classifiers were developed, and those models' area under the curve (AUC) values were compared with the conventional radiologic-feature-based evaluation.Results:Ninety-four and 52 patients were included into the training set and validation set, respectively. Their PV-SMV invasion rates were confirmed by intraoperative exploration with 31.9%(30/94) and 40.3%(25/61), respectively. Five models: LASSO regression, random forest, support vector machine, k-nearest neighbor and Naive Bayesian, were established based on ten features from CT images radiomics, and LASSO regression model achieved the highest AUC value compared with the other four models (all P<0.05). Compared with the conventional radiologic evaluation, the LASSO regression model had higher AUC (0.920 vs. 0.752) and sensitivity (92.0% vs. 86.5%)(both P<0.05). Conclusion:Machine learning-based CT images radiomics analysis can be used to evaluate PV-SMV invasion status preoperatively in PDAC. The LASSO regression model showed better performance than the conventional radiologic evaluation.

Cardiac hypertrophy is a common physiological or pathological process, and pathological cardiac hypertrophy can lead to heart failure, sudden death, etc. The role of microRNA (miRNA or MIR) in myocardial hypertrophy has gradually attracted public attention. miR-1 plays a certain protective role in the occurrence of cardiac hypertrophy. miR-133 is a key factor in the establishment of mast gene program, which is very important for the development of myocardial hypertrophy. Carvedilol and other drugs can regulate the expression of miR-133. miR-208a plays an important physiological role in the cardiovascular system, and its expression level changes dynamically in a variety of cardiovascular diseases such as cardiac hypertrophy, which is closely related to the progression and prognosis of the disease. The expression of miR-199a is up-regulated in pressure-overload cardiac hypertrophy, and it is found that miR-199a can inhibit autophagy of cardiomyocytes and induce the occurrence of cardiac hypertrophy. miR-200c can protect cardiomyocytes through a variety of pathways. miRNA may become an important biomarker or drug therapeutic target for cardiac hypertrophy. With the deepening of the research on non-coding RNAs including miRNA, its regulation on the occurrence of cardiac hypertrophy and the pathological process of heart failure will be further revealed.

（正）结肠代食管术（esophageal replacement with colon，ERC）被称作食管外科“皇冠上的明珠”，也是食管重建的最后一种选择。ERC 手术操作复杂，吻合口瘘等并发症发生率较高，一直没有得到广泛开展[1]。传统 ERC 手术常选择经右侧胸腹联合切口，手术创伤较大、术后恢复慢、术后肋间神经损伤等并发症较多，但随着胸腔镜微创技术的日益发展，我们使用胸腔镜微创技术游离胸腔食管并清扫纵隔淋巴结，开腹横结肠代食管行消化道重建，该技术可减少手术创伤、减轻术后疼痛，加速康复。本视频在于展示胸腔镜辅助食管癌根治横结肠代食管术手术入路、操作技巧。

Objective The aim of this research was to produce apparatus of urinary diversion using silk-fibroin loading rab-bit adipose stem cells,and assess the effect of urinary diversion in a rabbit model.Methods Adipose stem cells were obtained and cultured in vitro,and flow cytometry analysis was performed to determine the adipose stem cells.These cultured adipose stem cells were used to seed on the silk-fibroin scaffolds,and after being incubated in the conditioned medium for 7 days,the a-bove compounds were made into apparatus of urinary diversion.This apparatus of urinary diversion was implanted into 20 rab-bits with radical cystectomy to develop urinary diversion.Five rabbits from each experimental group were euthanized at the spe-cific time points(1,2,3,4 months postoperatively),and the implants were harvested for histological and immunohistochemical a-nalysis.In the control group,silk-fibroins with unseeded cells(only silk-protein scaffolds)were also made into apparatus of uri-nary diversion and then used as urinary diversion on another 5 rabbits with the same process.Results Rabbits adipose stem cells were isolated and cultured successfully,and determined by flow cytometry.The silk-fibroin scaffolds were synthesized suc-cessfully.All rabbits were alive in the experimental group until the time of sacrifice.Histological and immunohistochemical anal-ysis showed multilayer uroepithelium coverage in the luminal surface of apparatus of urinary diversion,and as time went on,epi-thelial layers increased continuously.In the control group,all animals were dead within 3 weeks,and urine leakage,severe in-flammatory reaction and tissue destruction were found by autopsy.Conclusion The present experiment has successfully used silk-fibroin loading rabbit adipose stem cells to construct apparatus of urinary diversion,and demonstrates the feasibility of this kind of apparatus for urinary diversion in a rabbit model,which provides some experimental basis for clinical applications.

Objective To construct the Hut78 cell line with EZH2 gene knocked into by CRISPR/Cas9 system. Methods The EZH2 expression vector pMD-18T-EZH2 with homologous arm and the sgRNA expression vector pSpCas9 (BB)-2A-Puro-sgRNA, which could cut the double stranded genomic DNA, were constructed, and the two vectors were co-transfected into Hut78 cells. Then the expression of EZH2 mRNA was detected by qPCR, and the expressions of EZH2 and H3K27me3 proteins were detected by Western blot assay. Results The pMD-18T-EZH2 and pSpCas9(BB)-2A-Puro-sgRNA recombinant vectors were confirmed by DNA sequencing. When Hut78 cells were transfected with the two recombinant plasmid, qPCR results showed that the expression of EZH2 mRNA was significantly increased, and Western blot analysis showed that the expressions of EZH2 and H3K27me3 proteins were significantly increased. Conclusion EZH2 gene is successfully knocked into Hut78 cells by CRISPR/Cas9 system.