The study aims to evaluate the potential clinical application of combined 15 bile acids （BAs） using liquid chromatography-tandem mass spectrometry （LC-MS/MS） and 17 trace elements using inductively coupled plasma mass spectrometry （ICP-MS） in the auxiliary predictive diagnosis of Alzheimer's disease （AD）.
Methods
A total of 72 patients diagnosed with AD in the Neurology and Cognitive Disorder Departments of the Third affiliated Hospital of Shenzhen University from 2021 to 2022 were enrolled in the AD group， and 70 healthy individuals undergoing physical examinations during the same period were included as the control group. Quantification of 15 BAs in serum was performed using LC-MS/MS， while 17 trace elements in whole blood were quantified using ICP-MS. The differences in BAs and trace element levels between AD patients and healthy controls were compared. Logistic regression models were constructed for combined diagnostic analysis， and receiver operating characteristic （ROC） curves were plotted to evaluate the diagnostic value of these biomarkers in AD.
Results
Methodological validation confirmed that the analytical performance of LC-MS/MS and ICP-MS met the stringent standards required by the assay kits. In the biomarker analysis comparing AD group and healthy controls， significantly lower levels of lithocholic acid （LCA）， ferrum （Fe）， and strontium （Sr）were observed in AD group （P＜0.05）. Conversely， levels of magnesium （Mg）， calcium （Ca）， manganese（Mn）， copper （Cu）， selenium （Se）， and lithium （Li） were significantly higher in AD patients （P＜0.05）.The combined diagnostic model of LCA with Fe and Sr demonstrated good predictive ability， with an area under the curve （AUC） of 0.82， sensitivity of 93.8%， and specificity of 56.1%. Another model combining Mg， Ca， Mn， Cu， and Se also exhibited good predictive performance， with an AUC of 0.80， sensitivity of 83.3%， and specificity of 68.3%.
Conclusion
This study reveals significant imbalances in BAs and trace elements in patients with AD， particularly the decreased levels of LCA， Fe， and Sr， and the increased levels of Mg， Ca， Mn， Cu， and Se. These changes have the potential to serve as predictive biomarkers for AD， providing new insights into the biological pathways involved in the disease and offering potential avenues for early diagnosis.
To investigate the correlation between the international normalized ratio（INR） and outcomes in patients with sepsis-associated acute kidney injury（SA-AKI）using data from the Medical Information Mart for Intensive Care-Ⅳ （MIMIC-Ⅳ）.
Methods
Using a retrospective queue design，information on adult SA-AKI patients with ICU admission records was extracted from the MIMIC-Ⅳ 2.0.Restricted cubic spline models and multivariable Cox proportional hazards regression were employed to evaluate the nonlinear relationship between INR levels and mortality. Patients were stratified by an ICU admission 24-hour INR cutoff for Kaplan-Meier survival analysis.
Results
Elevated INR was independently associated with increased mortality （adjusted HR=1.73， 95%CI： 1.59～1.88， P＜0.001）， and it shows a non-linear relationship with the prognosis of SA-AKI patients （P＜0.001）， with a cutoff value of 1.4.
Conclusion
High INR is an independent risk factor for predicting in-hospital mortality in SA-AKI patients. In the treatment process of SA-AKI patients， attention should be paid to the comprehensive evaluation of INR levels and other indicators.
To analyze the risk factors for adverse pregnancy outcomes in patients with preeclampsia （PE） and to develop and validate a predictive model.
Methods
This retrospective study included data from patients diagnosed with preeclampsia （PE） who delivered at the Third Affiliated Hospital of Zhengzhou University-Henan Provincial Maternal and Child Health Hospital from January 2021 to March 2024. Patients were categorized into adverse and non-adverse outcome groups based on the occurrence of adverse pregnancy outcomes. After screening， univariate and multivariate logistic regression analyses were used to evaluate clinical data. Independent risk factors identified were then utilized to develop a nomogram and construct a predictive model via R software 4.2.1. The receiver operating characteristic curve was calculated， and the model's discrimination， calibration， and clinical utility were assessed through the area under the curve （AUC） and Hosmer-Lemeshow （H-L） test. Internal validation of the predictive model was performed using the bootstrap resampling method and ten-fold cross-validation.
Results
A total of 472 PE patients were included in this study to construct the model， comprising 428 patients with adverse pregnancy outcomes and 44 without. Multivariate logistic regression analysis identified independent risk factors for adverse pregnancy outcomes in PE patients （P＜0.05）， including gestational age at onset ≤34 weeks， peak diastolic blood pressure during pregnancy ≥110 mmHg， abnormal umbilical artery blood flow， positive urine protein analysis， serum uric acid ＞369 μmol/L， and lactate dehydrogenase ＞246 U/L. Based on these independent risk factors， a clinical predictive model was constructed， yielding an AUC of 0.942 （95% CI：0.909～0.975）. The optimal cutoff value was 0.836， with a specificity of 84.1% and sensitivity of 92.1%. The H-L goodness-of-fit test indicated good calibration of the model （χ2=4.969， P=0.761）. Decision curve analysis shows that the model can achieve higher net benefits in clinical decision-making. The model validation shows that the model has good generalization ability and practical application value.
Conclusion
Based on clinical data， this study identified 6 independent risk factors to construct a predictive model for adverse pregnancy outcomes in preeclampsia patients. The model demonstrated strong predictive performance， with an AUC of 0.942 and good calibration （P=0.761）， indicating substantial potential for clinical application.
To analyze the global distribution， sequence types （ST）， and epidemiological characteristics of antibiotic-resistant genes among global Enterococcus faecium， providing insights for antimicrobial agent usage and nosocomial infection control.
Methods
A total of 3256 genomic sequences of Enterococcus faecium were obtained from the national center of biotechnology information（NCBI） website. Nucleotide sequences were extracted from GenBank files using Perl， and annotation was conducted using Prodigal. Quality filtering of each genome was performed with CheckM v1.1.3 and Quest 5.0.2 software， resulting in 2235 high-quality genomes for further analysis. A structured antibiotic-resistant genes （ARGs） database was constructed， and genomic sequences were aligned against it using blastn for detailed ARGs distribution analysis. 7 Enterococcus faecium housekeeping gene sequence and profile files were obtained from the pubMLST website and underwent blastn alignment to determine ST results. Strain information， including isolation time， country， host， and sample sourcewas extracted from GenBank files using Perl for comprehensive analysis.
Results
Multilocus sequence typing results revealed ST17 as the predominant global sequence type， with 104 strains detected （6.9%）. ARGs detection indicated that 99.7%of strains harbored aminoglycoside-resistant genes， and 94.0% carried macrolide/lincosamide/streptogramin B-resistant genes.
Conclusions
Global Enterococcus faecium ST is predominantly characterized by ST17，while in China， ST78 is predominant. The most prevalent ARG globally and in China is aac（6）-I， conferring resistance to aminoglycosides. Strengthening monitoring and research on ARGs carriage is imperative to standardize antimicrobial usage， enhance surveillance and control of Enterococcus faecium infections in healthcare settings， and prevent widespread occurrence.
To establish and verify the reference intervals of neutrophil to lymphocyte ratio （NLR）， platelet to lymphocyte ratio （PLR） and lymphocyte to monocyter ratio （LMR） in the elderly over 60 years of age in Nanjing area.
Methods
A total of 851 healthy elderly people who underwent physical examination in Lanyuan Community Health Service Center of Xuanwu District in Nanjing from January to December 2021 were selected as the research subjects by complete randomization method. There were 378 males in the male group and 473 females in the female group， aged from 60 to 89 years old. NLR， PLR and LMR were calculated according to the parameters of blood cell analysis， and the reference intervals of NLR， PLR and LMR were established and the established reference intervals were verified.
Results
NLR showed the rule of male higher than female. PLR and LMR showed the rule of female higher than male， and the differences were statistically significant （P＜0.05）. Therefore， the reference intervals for peripheral blood NLR， PLR and LMR in apparently healthy elderly over 60 years old were established according to gender：For male NLR is 0.83～3.09， PLR is 53.08～162.67， LMR is 2.95～10.42； for female NLR is 0.75～2.91， PLR is 55.55～173.57， LMR is 3.54～11.64. After verification， the set reference interval is effective.
Conclusion
The reference intervals of NLR， PLR and LMR in peripheral blood of elderly people over 60 years old in Nanjing area were established and verified， which provided a reference for the clinical application of NLR， PLR and LMR in elderly people in Nanjing area.
Digestive tract malignancies， a heterogeneous group of tumors affecting the gastrointestinal system and associated organs， pose significant threats to global health. Hypoxia-inducible factor 1 （HIF-1）， an oxygen-sensitive transcriptional activator， dynamically regulates gene expression in response to intracellular oxygen fluctuations. This master regulator drives tumor cell adaptation to hypoxic microenvironments through transcriptional control of critical biological processes， including glycolytic reprogramming and metastatic progression， thereby establishing HIF-1 as an attractive target for gastrointestinal cancer treatment. This article provides a review of the effects of HIF-1 on cellular glucose metabolism， tumor metastasis， and targeted therapy in digestive tract tumor igenesis.
To establish a multidimensional evaluation framework for medical students' labor competency， aiming to enhance pedagogical effectiveness， improve healthcare workforce adaptability， and promote holistic development in medical education.
Methods
The Delphi method，analytic hierarchy process， and questionnaire methods were used to analyze the connotation of medical students' labor competency， determine the evaluation indicators and weights of medical students' labor competency， and conduct evaluation through statistical methods such as factor analysis and structural equation modeling.
Results
A medical student labor competency index system was determined， which consists of 3 primary domains， 12 subdomains and 31 measurable indicators. The 3 primary domains and their weights are professional values （0.448）， applied knowledge （0.249）， clinial-community skills （0.303）.
Conclusion
This rigorously validated labor competency evaluation system demonstrates excellent reliability and cross-institutional applicability， providing theoretical reference for improving labor education evaluation in medical universities.
The main professional courses of clinical medicine majors in medical colleges is the main channel for carrying out ideological and political education （IPE） in courses. The construction of IPE in courses is also an important requirement for the construction of Double First-Class majors. In this context，explore the effectiveness and significance of IPE construction in professional courses.
Methods
From January 2021 to December 2023， the construction and practice of IPE integrated into professional courses （taking surgery as an example） were carried out simultaneously， with an emphasis on strengthening the development of teaching teams for IPE in courses. Efforts were made to fully explore the ideological and political materials in various professional fields， systematically design the content of IPE， and apply it to different stages of professional learning， including theoretical teaching， clinical clerkships， and internships. After the completion of the courses， the effectiveness of IPE for students was evaluated through a combination of formative assessment and summative assessment.
Results
Through the above practices， students' interest in professional courses has gradually deepened， leading to improvements in their performance in theoretical courses and skill operations.Overall satisfaction among teachers， students， and patients has also increased.
Conclusion
The strategic incorporation of IPE into surgical education significantly strengthens both professional competence and ethical awareness， effectively addressing the dual demands of medical excellence and ideological cultivation in China's new era of medical education.
