[Objective] To explore the effectiveness of applying the PDCA (Plan-Do-Check-Act) cycle to enhance the compatibility rate of five Rh blood group antigen phenotypes between donors and recipients across multiple hospital campuses. [Methods] Clinical blood transfusion data from May to July 2022 were selected. Specific improvement measures were formulated based on the survey results, and the PDCA cycle management model was implemented from August 2022. The post-intervention phase spanned from August 2022 to October 2023. The Rh phenotype compatibility rate, the detection rate of Rh system antibodies, and the proportion of Rh system antibodies among unexpected antibodies were compared between the pre-intervention phase (May to July 2022) and the post-intervention phase. [Results] After the continuous improvement with the PDCA cycle, the compatibility rate for the five Rh blood group antigen phenotypes between donors and recipients from August to October 2023 reached 81.90%, significantly higher than the 70.54% recorded during the pre-intervention phase (May to July 2022, P<0.01), and displayed a quarterly upward trend (β=0.028, P<0.05). The detection rate of Rh blood group system antibodies (β=-9.839×10^-5, P<0.05) and its proportion among all detected antibodies (β=-0.022, P<0.05) showed a quarterly decreasing trend, both demonstrating a negative correlation with the enhanced compatibility rate (r values of -0.981 and -0.911, respectively; P<0.05). [Conclusion] The implementation of targeted measures through the PDCA cycle can effectively increase the compatibility rate of five Rh blood group antigen phenotypes between donors and recipients, reduce the occurrence of unexpected Rh blood group antibodies, thereby lowering the risk of transfusion and enhancing the quality and safety of medical care.

Objective To investigate dynamic changes in myocardial protein phosphorylation during the acute phase of myocardial infarction (MI) in mice. Methods Six 8-week-old C57BL/6J mice were randomly assigned to MI model (n＝3) or sham-operated control (n＝3) groups. Cardiac tissues were harvested 72 hours post-intervention for proteomic analysis. Phosphorylation modifications were systematically characterized using liquid chromatography-mass spectrometry (LC-MS). Bioinformatics analyses included differential phosphorylation screening, functional enrichment, hierarchical clustering, and protein-protein interaction network. Results LC-MS identified 1 921 differentially phosphorylated sites (20 tyrosine and 1 901 serine/threonine sites) across 851 proteins. Compared with controls, MI hearts exhibited significant phosphorylation upregulation at 1 545 sites and downregulation at 376 sites (P＜0.05). Conclusions This study delineates MI-associated phosphorylation dynamics, providing mechanistic insights and potential therapeutic targets for acute MI intervention.

Objective: To evaluate the effectiveness and safety of the tonifying spleen and reinforcing Qi (TSRQ) therapy combined with thyroid hormone replacement therapy (THRT) for treating Hashimoto’s hypothyroidism. Methods: From database foundation to January 14, 2025, PubMed, Web of Science, Cochrane, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, China Science and Technology Journal Database (VIP), and China Biomedical Literature Database (CBM) were searched for relevant information. Randomized clinical trials (RCTs) evaluating the efficacy and safety of TSRQ therapy combined with THRT for Hashimoto’s hypothyroidism were eligible for inclusion. Following quality assessment, data were analyzed using Stata 15.1 to conduct a meta-analysis and systematic review. Subgroup analysis was used to identify the sources of heterogeneity. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to evaluate the certainty of the evidence. Results: This study included 30 RCTs, comprising 2 687 patients with Hashimoto’s hypothyroidism. Overall methodological quality was acceptable, with no studies exhibiting a high risk of bias. Meta-analysis demonstrated that TSRQ therapy combined with THRT significantly enhanced serum free triiodothyronine (fT3) levels [standardized mean difference (SMD) = 0.76, 95% confidence interval (CI): 0.57 to 0.94, P < 0.001] and free thyroxine (fT4) levels (SMD = 0.86, 95% CI: 0.61 to 1.11, P < 0.001), while reducing thyroid-stimulating hormone (TSH) levels (SMD = – 0.99, 95% CI: – 1.20 to – 0.78, P < 0.001) compared with THRT alone. Furthermore, the combination therapy significantly decreased anti-thyroid peroxidase antibody (TPOAb) levels (SMD = – 1.46, 95% CI: – 1.79 to – 1.13, P < 0.001) and anti-thyroglobulin antibody (TgAb) levels (SMD = – 1.46, 95% CI: – 1.80 to – 1.11, P < 0.001). TSRQ therapy did not adversely impact the safety profile of THRT. However, while some sources of heterogeneity have been identified (e.g., specific detection methodologies, I² = 0.0%, P = 0.938), there remains a portion of unexplained heterogeneity (e.g., publication year, I² = 93.4%, P < 0.001), which has undermined confidence in these pooled estimates. The evidence ratings for fT3, fT4, and TSH were limited, and those for TPOAb and TgAb were even more limited. Conclusion TSRQ therapy combined with THRT may strengthen thyroid function and modulate immune dysregulation in patients with Hashimoto’s hypothyroidism without increasing adverse event incidence.

BACKGROUND:The pathogenesis of autoimmune hepatitis has not been clearly elucidated.Circular RNA(CircRNA)is a research hotspot in the field of RNA and is involved in the pathogenesis of many autoimmune diseases.However,the role of CircRNA in autoimmune hepatitis remains unclear. OBJECTIVE:To investigate the relationship between CircRNA(CircRNA)and concanavalin A induced liver injury in mice with autoimmune hepatitis. METHODS:Bioinformatics analysis was performed on CircRNA profiles selected by previous microarray technology,including gene ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analyses,so as to explore the potential biological functions of these differentially expressed genes.Twelve C57BL/6 mice were randomized into normal group and model group(n=6 per group).Autoimmune hepatitis model was established by tail vein injection of concanavalin A in the model group.Mice were killed at 12 hours after modeling to extract mouse liver and peripheral blood.The expression levels of CircRNAs were verified by qRT-PCR.Serum alanine aminotransferase and aspartate aminotransferase levels were detected by colorimetric method.The levels of oxidative stress indexes malondialdehyde and nitric oxide in mouse liver were detected by microplate method.The correlation between oxidative stress level and liver injury index was analyzed. RESULTS AND CONCLUSION:The results of GO analysis showed that the target genes with up-regulated CircRNAs expression were mainly involved in the biological processes of SNARE complex assembly regulation(P=0.004),their molecular functions were mainly metal ion binding(P=0.000 29),and the cell components were mainly enriched in CORVET complex(P=0.075).The biological processes involved in the down-regulated circRNAs target genes were mainly"negative regulation of pancreatic secretion"(P=0.000 42),the molecular functions were mainly"transcriptional activator activity"(P=0.025),and the cell components were mainly enriched in"extracellular components"(P=0.006).KEGG results showed that the target genes with up-regulated CircRNAs expression were mainly enriched in the"base excision-repair"signaling pathways(P=0.026).Compared with the normal group,serum alanine aminotransferase and aspartate aminotransferase levels and the levels of malondialdehyde and nitric oxide in mouse liver in the model group were significantly increased(P＜0.01).Compared with the normal group,the expression of two selected CircRNAs(mmu-circ-0001520 and mmu-circ-0001577)was increased in the model group(P＜0.05).Spearman correlation analysis showed that the expression of mmu-circ-0001520 and mmu-circ-0001577 was positively correlated with alanine aminotransferase,aspartate aminotransferase,malondialdehyde and nitric oxide.To conclude,the differential expression of CircRNAs is correlated with liver injury in autoimmune hepatitis mice.mmu-circ-0001520 and mmu-circ-0001577 are expected to be diagnostic biomarkers and therapeutic targets for autoimmune hepatitis.

Objective:To construct an artificial intelligence (AI)-assisted system based on deep learning for corneal in vivo confocal microscopy (IVCM) image recognition and to evaluate its value in clinical applications. Methods:A diagnostic study was conducted.A total of 18 860 corneal images were collected from 331 subjects who underwent IVCM examination at Renmin Hospital of Wuhan University and Zhongnan Hospital of Wuhan University from May 2021 to September 2022.The collected images were used for model training and testing after being reviewed and classified by corneal experts.The model design included a low-quality image filtering model, a corneal image diagnosis model, and a 4-layer identification model for corneal epithelium, Bowman membrane, stroma, and endothelium, to initially determine normal and abnormal corneal images and corresponding corneal layers.A human-machine competition was conducted with another 360 database-independent IVCM images to compare the accuracy and time spent on image recognition by three senior ophthalmologists and the AI system.In addition, 8 trainees without IVCM training and with less than three years of clinical experience were selected to recognize the same 360 images without and with model assistance to analyze the effectiveness of model assistance.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Renmin Hospital of Wuhan University (No.WDRY2021-K148).Results:The accuracy of this diagnostic model in screening high-quality images was 0.954.Its overall accuracy in identifying normal/abnormal corneal images was 0.916 and 0.896 in the internal and external test sets, respectively.Its accuracy reached 0.983, 0.925 in the internal test sets and 0.988, 0.929 in the external test sets in identifying corneal layers of normal and abnormal images, respectively.In the human-machine competition, the overall recognition accuracy of the model was 0.878, which was similar to the average accuracy of the three senior physicians and was approximately 300 times faster than the experts in recognition speed.Trainees assisted by the system achieved an accuracy of 0.816±0.043 in identifying corneal layers of normal and abnormal images, which was significantly higher than 0.669±0.061 without model assistance ( t=6.304, P<0.001). Conclusions:A deep learning-based assistant system for corneal IVCM image recognition is successfully constructed.This system can discriminate normal/abnormal corneal images and diagnose the corresponding corneal layer of the images, which can improve the efficiency of clinical diagnosis and assist doctors in training and learning.

Objective:To investigate the clinical value of multiparametric myocardial imaging using a dual-layer detector spectral CT in the non-invasive preoperative assessment of patients with coronary atherosclerotic heart disease (CHD) undergoing percutaneous coronary intervention (PCI).Methods:The clinical and imaging data of 90 patients who underwent coronary CT angiography (CCTA) with dual-layer spectral detector CT and invasive coronary angiography (ICA) within 30 days at the Affiliated Changshu Hospital of Nantong University from January 2021 to October 2022 were retrospectively analyzed. A total of 189 coronary arteries were included in the study cohort. The patients were divided into PCI ( n=44) and non-PCI groups ( n=46) according to whether they received PCI after evaluation with ICA. The diameter stenosis rate of the coronary arteries, myocardial iodine concentration (IC) and effective atomic number (Z eff) values were obtained from CCTA conventional and spectral images. The IC values and Z eff values of the myocardium in the areas with abnormal perfusion were compared with those in the areas with normal perfusion. The diagnostic performance of these parameters, as well as their combined model, was evaluated and compared using receiver operating characteristic (ROC) curve and area under the curve (AUC) in the pre-PCI assessment of patients with CHD. Results:Baseline patient data did not show statistically significant differences between the PCI and non-PCI groups (all P>0.05). There were statistically significant differences in IC values [(0.42±0.28) and (2.26±0.48) mg/ml] and Z eff values (7.39±0.33 and 8.50±0.25) between the myocardium areas with abnormal perfusion and the myocardium areas with normal perfusion in all patients (all P<0.001). The AUC for assessing whether patients with CHD need PCI treatment using myocardial IC and Z eff values were 0.865 and 0.853, respectively, which were significantly higher than assessment based only on lumen diameter stenosis rate (AUC=0.726, P<0.001). Conclusions:The IC and Z eff derived from myocardial spectral images can be used to diagnose myocardial perfusion abnormalities in patients with CHD. The spectral myocardial multi-parameters imaging shows promising potentials in pre-PCI assessment of patients with CHD, which can improve the efficiency of evaluation and may help to avoid unnecessarily invasive procedures.

Objective:To compare the clinical data and peripheral blood levels of CXC chemokine ligand (CXCL) 9 and CXCL10 between patients with progressive non-segmental vitiligo who were sensitive to systemic glucocorticoid treatment and those who were resistant, and to clarify key clinical factors influencing the sensitivity to systemic glucocorticoid treatment.Methods:From May 2021 to May 2023, a cohort of patients with progressive non-segmental vitiligo receiving systemic glucocorticoid treatment was established in Huashan Hospital, Fudan University. Clinical data and peripheral blood samples were prospectively collected from all enrolled patients. Standard treatment, i.e., intramuscular injections of 1 ml of compound betamethasone once a month, was administered. After 3-month treatment, the improvement of patients′ skin lesions was estimated, and the vitiligo area and severity index (VASI) score and the Vitiligo European Task Force assessment tool (VETFa) were used to evaluate the efficacy. Patients with VASI changes ≥ 0 and VETFa progression scores ≤ 0 point were included in the glucocorticoid-sensitive group (i.e., the patients′ condition was stable or improved), otherwise those with VASI changes < 0 and VETFa progression scores of 1 point were included in the glucocorticoid-resistant group. Associations of lesion locations, specific clinical markers (trichrome lesions, confetti-like depigmentation, and Koebner phenomenon), previous medication history, family history of vitiligo, etc. with the response to systemic glucocorticoid treatment were analyzed. At baseline and after 3-month treatment, peripheral blood samples were collected from the patients, and enzyme-linked immunosorbent assay was performed to detect the plasma levels of CXCL9 and CXCL10. Statistical analysis was carried out by using the chi-square test, Fisher′s exact test, binary logistic regression analysis, Mann-Whitney U test, and Wilcoxon signed-rank test. Results:A total of 142 patients with vitiligo were enrolled, and 127 completed 3-month treatment, including 77 males and 50 females. Their age at diagnosis was 18 to 65 (36.6 ± 11.4) years, and the disease duration ranged from 2 months to 58 (13.5 ± 10.7) years; 25 (19.7%) had a family history of vitiligo; the percentage of lesion area to total body surface area before treatment ranged from 1% to 70% (11.5% ± 12.7%), and the VASI score was 1% to 70% (10.8% ± 11.6%). Multivariate logistic regression analysis showed that the absence of specific clinical markers (odds ratio [ OR] = 6.900, 95% confidence interval [ CI]: 1.228, 38.757, P = 0.028), carrying a single specific clinical marker ( OR = 2.579, 95% CI: 1.012, 6.574, P = 0.047), having a history of topical glucocorticoid treatment ( OR = 2.643, 95% CI: 1.019, 6.850, P = 0.041), the absence of family history of vitiligo ( OR = 5.090, 95% CI: 1.070, 24.215, P = 0.030), and lesions on the proximal extremities ( OR = 3.767, 95% CI: 1.315, 10.793, P = 0.037) were risk factors for the resistance to systemic glucocorticoid treatment in the patients with vitiligo. After 3-month treatment, the glucocorticoid-sensitive group showed a significant decrease in plasma CXCL10 levels compared with those before treatment ( W = 571.00, P < 0.001), while there was no significant difference between the pre- and post-treatment CXCL10 levels in the glucocorticoid-resistant group ( W = 48.00, P = 0.524). Additionally, no significant difference was observed in changes of the plasma CXCL9 level before and after treatment between the glucocorticoid-sensitive and glucocorticoid-resistant groups ( P > 0.05) . Conclusions:Carrying no or a single specific clinical marker, having a history of topical glucocorticoid treatment, the absence of family history of vitiligo, and lesions on the proximal extremities appeared to be risk factors for the resistance to systemic glucocorticoid treatment in patients with progressive non-segmental vitiligo. Changes in CXCL10 levels after treatment may be used as an important evaluation indicator for determining whether patients with progressive vitiligo were resistant to systemic glucocorticoid treatment.

Peripherally-induced movement disorders (PIMD) are a group of involuntary movements that emerge after an injury to a body part outside the central nervous system. The phenomenology of PIMD encompasses both hyperkinesia and hypokinesia involving multiple parts of the body. The diagnosis of this disease mainly relies on the temporal and spatial relationship between peripheral injuries and movement disorders. The etiology, pathogenesis and treatment of PIMD have been a matter of debate. This article will review the clinical features, classification, diagnosis, treatment and possible pathogenesis of PIMD, and discuss the limitations and controversies of PIMD-related researches, aiming to advance the understanding of PIMD and avoid clinical misdiagnosis.

In clinical dentistry,addressing unique conditions such as tilted,elongated,and torsion teeth during prepa-ration can be effectively managed through digital tooth morphology design.The production of a multi-stage 3D-printed guide offered a more efficient and accurate solution.This article presented a case of significant inclination,elongation,and torsion in the maxillary and mandibular canines that were successfully treated using crown restoration modification.A crown preparation guide was fabricated based on the final form design of the restoration using the target restorative space analysis technique to ensure precise tooth preparation.A tooth preparation guide was also designed and utilized fur-ther to enhance accuracy and efficiency during complex tooth preparation.The combined application of these multi-stage guides demonstrated promising clinical prospects.

ObjectiveTo understand the use of antibiotics in inpatients and the incidence and trend of hospital infections， to explore the implementation effect of comprehensive management measures， and to provide reference for hospitals to use antibiotics reasonably. MethodsBased on the hospital infection monitoring and management system， a retrospective analysis and comparison were conducted on the use of antibiotics， submission of microbial test samples， and incidence of hospital infections among inpatients in a tertiary hospital from 2012 to 2021. ResultsFrom 2012 to 2021， the use of antibiotics showed a downward trend， from 50.82% in 2012 to 41.29% in 2021. At the same time， the use rate of restricted and special antibiotics had also decreased， and the use rate of restricted and special antibiotics in patients without hospital infection was significantly lower than that in patients with hospital infection， and the microbial testing rate was also on the rise. The annual incidence rate of hospital infection was 0.69%‒1.92%， and the annual case-time prevalence rate was 0.79%‒2.17%. The annual average rate of the above two in 10 years was 1.18% and 1.34%， respectively. The results of the exponential smoothing model also showed that the utilization rate of antibiotics was decreasing and the incidence of nosocomial infection was stable. ConclusionLarge general hospitals took comprehensive management measures to strengthen the management of rational use of antibiotics， which led to a decline in the use rate of antibacterial drugs for inpatients and an increase in the rate of microbial examination. At the same time， the overall incidence of hospital infection was relatively stable， suggesting that the comprehensive management measures of antibacterial drugs in hospitals had achieved certain results. The current measures need to be optimized in the future to continuously improve the management level of rational use of antibacterial drugs.