Table of Content

30 May 2025, Volume 40 Issue 5

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AI technology reshaping laboratory medicine from automation to intelligent decision-making

GONG Xiaolin, DENG Kun, WU Jun, REN Chuanli, XU Songxiao, LI Shengjie, LI Bo, YANG Dagan, SHEN Han, ZHANG Yi, CHEN Ming, WU Yongkang, LUO Huaichao, YUAN Xu, XU Huaguo, GONG Qian, LI Xin, GUAN Ming

2025, 40(5):  413-420.  DOI: 10.3969/j.issn.1673-8640.2025.05.001

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Under accelerated digital transformation in medical industry，artificial intelligence（AI） technology is profoundly changing the mode of medical services. Open-source large models represented by DeepSeek have gradually been implemented in major hospitals across the country，covering a wide range of clinical application scenarios such as patient services，clinical diagnosis and treatment，hospital management and scientific research support，and constructing a full-process smart medical ecosystem. In the field of laboratory medicine，AI also empowers the development of the discipline，demonstrating its strength and potential in the intelligent interpretation of determination reports，the optimization of determination processes and scientific research innovation. AI large models will inevitably drive the transformation of laboratory medicine from datum production to value creation，assist personalized medicine and health management through accurate diagnosis，and enhance medical efficiency. While laboratory medicine benefits from the dividends brought by AI technology，it also faces a series of challenges such as datum quality，model limitations and subsequent supervision.

Characteristics of TCR profile in multiple sclerosis patients based on high-throughput sequencing technology

CHEN Xiaoyan, MO Qianer, HUANG Fangying, HU Zipeng, YANG Shanshan, NONG Jingjing, YANG Xueli

2025, 40(5):  421-427.  DOI: 10.3969/j.issn.1673-8640.2025.05.002

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Objective To investigate the profile characteristics of complementary determining region 3 （CDR3） of T cell receptor （TCR） β chain in patients with multiple sclerosis （MS）. Methods The T cell immune repertoire sequencing data of 11 female MS patients （MS group） and 12 healthy females （healthy control group） were downloaded from the ImmuneAccess database. The TCR profiles of all research subjects were analyzed systematically，which included CDR3 frequency distribution，CDR3 length distribution，TRβ V，TRβ D and TRβ J usage frequencies，V-J combination frequency and insertion/deletion length distribution of Vdels，Jdels，D5dels，D3dels，n1ins and n2ins sites. The diversity of TCR profiles based on D50 index，Shannon index，Simpson index and Inverse simpson index was calculated. Results The diversity of TCRβ chain CDR3 in MS group was higher than that in healthy control group （P<0.01）. Compared with healthy control group，the frequency of TCRβ chain CDR3 nucleotide lengths at 57，60，63 and 66 nt in MS group was increased （P<0.05），while the CASSLRETQYF sequence in TCRβ chain CDR3 amino acid sequence was decreased （P<0.05）. There was no statistical significance in the length distribution of insertion deletion in the In and Out sequences，the utilization frequency of 20 amino acids in the 6th and 7th amino acids of TCRβ chain CDR3 and the utilization frequency of hydrophilic，neutral and hydrophobic amino acids between MS group and healthy control group（P>0.05）. There was statistical significance in the utilization frequency of TRβ V，TRβ D and TRβ J gene subfamilies between MS group and healthy control group（P<0.05）. Conclusions The TCR profile of MS group is different from that of healthy control group，which provides a reference for the diagnosis and treatment of MS patients.

Fusobacterium nucleatum promoting chemoresistance of colorectal cancer cells via lncRNA XIST

WU Yazhou, LI Hanhua, MENG Leijun, CHEN Xuefei, SUN Yuhan, WENG Wenhao, ZHENG Bing

2025, 40(5):  428-436.  DOI: 10.3969/j.issn.1673-8640.2025.05.003

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Objective To investigate the role of Fusobacterium nucleatum（Fn） in chemoresistance of colorectal cancer（CRC） cells. Methods A total of 87 CRC patients at Yangpu Hospital Affiliated to Tongji University from March 2015 to January 2017 were enrolled. CRC tissues from all the patients were collected to determine Fn abundance. Totally，20 cases were selected and classified into Fn group（10 cases with Fn infection） and NC group（10 cases without Fn infection） based on bacterial load. The relative expression of 15 candidate long non-coding RNA（lncRNA）was determined. Additionally，10 recurrent and 10 non-recurrent patients were independently selected from the 87 patients based on 3-year follow-up outcomes to compare target lncRNA expression levels. CRC cell lines（HCT116 and SW480）were classified according to experimental conditions. Cell viability was assessed by CCK-8 assay to calculate the half-maximal inhibitory concentration（IC₅₀）. Proliferative activity of CRC cell lines before and after lncRNA XIST knockdown was evaluated using CCK-8 assay. CCK-8 assay，flow cytometry and western blotting were used to analyze proliferation and apoptosis in chemoresistant CRC cell lines（HCT116/5-FU and SW480/5-FU）. Results Compared with 5-FU and OXA treatment groups，the E.coli/5-FU and E.coli/OXA groups showed no statistical significance in IC₅₀（P>0.05），whereas Fn/5-FU and Fn/OXA groups exhibited increased IC₅₀（P<0.01）. Among the 15 candidate lncRNA，lncRNA XIST showed the highest expression in Fn group，exceeding NC group（P<0.01）. Both Fn abundance and lncRNA XIST expression levels were higher in recurrence group than non-recurrence group（P<0.05）. Fn-infected CRC cell lines demonstrated increased lncRNA XIST expression compared with control group（P<0.01）. HCT116/5-FU and SW480/5-FU showed higher lncRNA XIST relative expression than HCT116 and SW480 cells（P<0.001）. The lncRNA XIST knockdown group showed reduced cell viability and IC₅₀（P<0.01），increased apoptosis rate（P<0.01），upregulated apoptosis protein（PARP，Caspase-3 and Bax）（P<0.01）and downregulated anti-apoptotic protein Bcl-2（P<0.01）. Conclusions Fn may promote chemoresistance in CRC cells through lncRNA XIST upregulation. Both Fn and lncRNA XIST could serve as potential biomarkers for predicting chemotherapy sensitivity in CRC patients.

Establishment and validation of a nomogram of recurrent respiratory infections in children with refractory asthma

RUI Jun, KONG Fei, YUAN Xuejing

2025, 40(5):  437-442.  DOI: 10.3969/j.issn.1673-8640.2025.05.004

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Objective To investigate the risk factors of recurrent respiratory infections in children with refractory asthma，and to establish and verity a nomogram model. Methods A total of 415 children with refractory asthma in acute exacerbation admitted to Nanjing University of Traditional Chinese Medicine Affiliated Hospital，Jiangsu Provincial Hospital of Traditional Chinese Medicine from January 2021 to December 2023 were enrolled and classified into recurrent respiratory infection group（76 cases）and non-recurrent respiratory infection group（339 cases）. Binary Logistic regression analysis were used to screen the risk factors of recurrent respiratory infections in children with refractory asthma. The nomogram model was constructed by rms packape of R software. The clinical applicability and diagnostic efficiency of the model were verified by receiver operating characteristic （ROC） curve，calibration curve，decision curve analysis （DCA） and clinical impact curve. Results The white blood cell （WBC） count，C-reactive protein （CRP），IgE，CD4+/CD8+ ratio，the number of asthma attacks≥3 times and the proportion of rhinitis or sinusitis in recurrent respiratory infection group were higher than those in non-recurrent respiratory infection group （P<0.05）. The platelet（PLT）count，CD4+T cell percentage （CD4+%） and CD8+T cell percentage （CD8+%） were lower than those in non-recurrent respiratory infection group （P<0.05）. Increased IgE，decreased PLT count，decreased CD4+%，combined rhinitis or sinusitis and asthma attacks≥3 times were independent risk factors for recurrent respiratory infection in children with refractory asthma （P<0.05）. Based on the above factors，the nomogram model determined that the area under curve （AUC） of recurrent respiratory infection in children with refractory asthma was 0.909，and the predicted probability of the model was consistent with the actual probability. When the threshold probability value was 0.02-0.91，the clinical net benefit was >0，and the predicted results of the model are basically consistent with the actual results. Conclusions PLT count，IgE，CD4+，whether to combine rhinitis or sinusitis and the number of asthma attacks are related to recurrent respiratory infection in children with refractory asthma. The nomogram model constructed based on the above factors can provide a reference for the identification of high-risk children and has certain clinical applicability.

Change and role of glycolipid metabolism markers in patients with benign prostatic hyperplasia

CHEN Qun, LUO Qizhi, LIANG Hongmei, WU Yuanru, HE Dahui, LIAO Guoqiang, LIN Liyun, LU Xiaojing, YANG Dandan

2025, 40(5):  443-449.  DOI: 10.3969/j.issn.1673-8640.2025.05.005

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Objective To investigate the changes of glycolipid metabolism markers in elderly patients with benign prostatic hyperplasia（BPH）and their clinical significance．Methods Totally，125 BPH patients （BPH group） and 120 healthy subjects undergoing medical checkups（control group）were enrolled from the Second People's Hospital of Longgang District and Shenzhen Huayinkang Medical Laboratory between May 2023 and December 2023. Glycolipid metabolism marker [fasting blood glucose （FBG），glycated albumin（GA），1，5-anhydroglucitol（1，5-AG），glycated hemoglobin A1c（HbA1c），total cholesterol（TC），triglyceride（TG），low-density lipoprotein cholesterol（LDL-C），high-density lipoprotein cholesterol（HDL-C），small and dense low-density lipoprotein cholesterol（sd-LDL-C），homocysteine（Hcy），lipoprotein-associated phospholipase A2 （Lp-PLA2）] as well as prostate-related indexes [the International Prostate Symptom Score（IPSS），prostate volume（PV），total prostate-specific antigen（t-PSA）and maximum urine flow rate （Qmax）] were determined. Pearson correlation analysis was used to assess the relationship between each index and the IPSS score. Logistic regression analysis was conducted to evaluate the factors influencing the occurrence of BPH. The diagnostic efficacy for BPH was assessed by receiver operating characteristic（ROC）curve. Results Compared to control group，the levels of FBG，GA，1，5-AG，HbA1c，TC，TG，LDL-C，t-PSA，IPSS scores and PV were elevated in BPH group（P<0.05）. Hcy，HDL-C levels and Qmax were decreased，with no statistical significance observed between the 2 groups for sd-LDL-C and Lp-PLA2 levels（P >0.05）. LDL-C，HDL-C，FBG，HbA1c，Qmax and t-PSA were identified as independent risk factors for the development of BPH（P<0.05）. FBG，TC，Hcy，PV and t-PSA levels showed positive correlations with IPSS scores（r values were 0.199 0，0.194 8，0.216 7，0.595 3 and 0.581 7，respectively；P=0.028 7，0.032 2，0.017 0，<0.000 1 and <0.000 1，respectively），while Qmax showed a negative correlation with the IPSS score（r=-0.366 0，P<0.000 1）. The areas under curves（AUC）for diagnosing BPH using FBG，HbA1c，HDL-C，LDL-C，Qmax and t-PSA were 0.812，0.631，0.794，0.658，0.850，0.915 and 0.983 for single and combined determinations，respectively. Conclusions Some glycolipid metabolism markers in elderly BPH patients exhibit changes and may be serve as valuable indicators for the early diagnosis and risk assessment of BPH．

Virulence characteristics of Streptococcus pneumoniae，PBP gene mutation and β-lactam resistance

YAO Ling, GAO Chunyan, LIU Minglei

2025, 40(5):  450-454.  DOI: 10.3969/j.issn.1673-8640.2025.05.006

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Objective To analyze the virulence characteristics of Streptococcus pneumoniae，penicillin-binding protein （PBP） gene mutation and β-lactam resistance. Methods Totally，25 clinical isolates of Streptococcus pneumoniae were collected from Tangshan Maternal and Child Health Hospital from January to December 2022. The isolates were identified by automatic microbial identification drug susceptibility instrument. The minimum inhibitory concentrations （MIC） of penicillin，amoxicillin，cefuroxime and ceftriaxone sodium were determined by microbroth dilution method. The virulence genes （Ply，LytA，NanA，PsaA and PspA）of Streptococcus pneumoniae were determined by polymerase chain reaction （PCR）. The correlation between PBP2b gene mutation and β-lactam resistance was analyzed. Results Among the 25 isolates of Streptococcus pneumoniae，21 （84.00%） isolates were isolated from sputum samples. Totally，10（40.00%）isolates were sensitive to β-lactam antibiotics. There were 15（60.00%）isolates resistant to β-lactam antibiotics，and the MIC of 3 isolates were 4-32 μg·mL^-1. The PBP2b positive rate of 25 isolates of Streptococcus pneumoniae was 100.00%. There were 5 resistant isolates with low MIC（1-2 μg·mL^-1），and serine-X-Y lysine was changed. There were 7 isolates with medium MIC（1-4 μg·mL^-1），and serine-X-Y lysine，serine-X-Y asparagine and lysine-threonine/serine-glycine were changed. There were 3 isolates with high MIC（4-32 μg·mL^-1），and there were changes of threonine 445/451-alanine/serine and lysune-threonine/serine-glycine in the conserved region of PBP2b coding sequence near SSN. The positive rates of nanA，LytA and Ply were 80.00%，and the positive rate of nanA+Ply+LytA model was the highest（56.00%）. Conclusions Threonine 445/451-alanine/serine and lysune-threonine/serine-glycine are related to β-lactam resistance in the conserved region of PBP2b coding sequence，and the virulence genes（nanA，LytA and Ply）are widely distributed.

Relationship between differential expression of gut microbiota structure and prognosis in patients with septic shock

MENG Huimin, YANG Junli, HAN Yongyan

2025, 40(5):  455-459.  DOI: 10.3969/j.issn.1673-8640.2025.05.007

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Objective To investigate the relationship between the differential expression of gut microbiota structure and prognosis in patients with septic shock. Methods Totally，81 critically sick patients were enrolled，including 34 cases of septic shock，who were either directly admitted to the intensive care unit（ICU）or transferred to the ICU from wards from January 2020 to January 2022. Perirectal swabs were collected from the patients during ICU admission. The gut microbiota was assessed by sequencing the V3-V4 hypervariable region of the 16S rRNA gene. Beta diversity，operational taxonomic units（OTU）and interactions of gut microbiota with the variables in the study were analyzed. OTU specifically associated with sepsis were researched in linear mixed models. Results Compared with non-septic shock group，age，C-reactive protein（CRP）level，sequential organ failure assessment（SOFA）score，acute physiology and chronic health evaluationⅡ（APACHEⅡ）score and ICU stay time were increased in septic shock group（P<0.05）. The diversity of gut microbiota was lower in the patients with septic shock（P=0.006 for Shannon's index，P<0.001 for Simpson's reciprocal）. There was a significant difference in Beta diversity between septic shock group and non-septic shock group（pseudo F=1.19，P=0.038）. After performing a linear mixed model analysis，24 OTU associated with septic shock could be retrieved，with Parabacteroides distasonis，Bilophila spp. being significantly higher in septic shock patient samples than in non-septic shock patient samples. In septic shock patients，Ezakiella and Megasphaera decreased. Conclusions Lower presence of beneficial genera and higher abundance of pathogens are observed in septic shock patients. Therefore，specific gut microbiota characteristics could predict sepsis development in ICU patients.

Effect of Helicobacter pylori infection on serum Hcy level and cognitive function in patients with vascular dementia after cerebral infarction

ZHANG Yun, ZHANG Hongyang, XU Jianke

2025, 40(5):  460-463.  DOI: 10.3969/j.issn.1673-8640.2025.05.008

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Objective To investigate the effect of Helicobacter pylori（HP）infection on serum homocysteine （Hcy） level and cognitive function in patients with vascular dementia after cerebral infarction（CI-VD）. Methods Ninety patients with CI-VD who were hospitalized from February 2020 to August 2022 were enrolled as study group，and another 90 patients without CI-VD were enrolled as control group. The general information，HP infection rate，serum Hcy level and mini-mental state examination（MMSE）scores of the 2 groups were compared. The study group was classified into positive infection group and negative infection group. Serum Hcy level and MMSE score were compared between positive and negative infection groups. The relationship between HP infection and serum Hcy level and MMSE score in patients with vascular dementia after cerebral infarction was analyzed. Results The infection rate of HP in study group was higher than that in control group，serum Hcy level was higher than that in control group，and the MMSE score was lower than that in control group（P<0.001）. The serum Hcy level of patients with HP positive infection in study group was higher than that of patients with negative infection，and the MMSE score was lower than that of patients with negative infection（P<0.001）. Serum HP infection was positively correlated with Hcy level（r=0.382，P<0.001），and it was negatively correlated with MMSE score（r=-0.396，P<0.001）. Conclusions There is a correlation between HP infection and serum Hcy level and cognitive function in patients with vascular dementia after cerebral infarction. Serum Hcy level and MMSE score can be used to assess patients' condition.

Influence of cytomegalovirus reactivation on peripheral blood γδ T cells in recipients after allogeneic hematopoietic stem cell transplantation

ZHU Jiacheng, MU Jiaoyue, MAO Minjing

2025, 40(5):  464-470.  DOI: 10.3969/j.issn.1673-8640.2025.05.009

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Objective To analyze the relationship between peripheral blood γδ T cells and cytomegalovirus （CMV） reactivation in recipients undergoing allogeneic hematopoietic stem cell transplantation（allo-HSCT）. Methods A total of 64 allo-HSCT patients from Ruijin Hospital，Shanghai Jiao Tong University School of Medicine from January 2023 to June 2023 were enrolled and followed for 1 year. Based on the presence of CMV viremia，the patients were classified into CMV reactivation group（28 cases，including 6 with refractory CMV infection）and CMV negative group（36 cases）. Totally，32 healthy adult donors were enrolled as healthy control group. The clinical data were collected. Peripheral blood γδ T cell proportions，subset distribution，differentiation status and interferon-gamma（IFN-γ） expression were analyzed alongside CMV DNA load in all the subjects. Results The incidence of acute graft-versus-host disease（GvHD）and non-cytomegalovirus herpesvirus （NCH） reactivation was higher in CMV reactivation group than that in CMV negative group（P<0.05），with no statistical significance in the other clinical parameters（P>0.05）. The proportions of γδ T cells and Vδ2− γδ T cells were higher in CMV reactivation group compared to CMV negative and healthy control groups（P<0.05）. Post-reactivation γδ T cell and Vδ2− γδ T cell proportions were increased compared to pre-reactivation stage（P<0.01）. In 6 refractory CMV infection cases，γδ T cell and Vδ2− γδ T cell proportions increased rapidly and persistently from viremia onset until 2 weeks after clearance. The CMV reactivation group showed significant differences in naive and CD45RA+ effector memory RA+（EMRA）cell proportions among γδ T cells，naive and effector memory（EM）cells in Vδ2− γδ T cells，central memory（CM）and EM cell proportions in Vδ2- γδ T cells compared to CMV negative group（P<0.05）. Co-culture of peripheral blood mononuclear cells（PBMC）with CMV-infected MRC5 cells demonstrated that the Vδ2− subset had a stronger capacity for IFN-γ secretion compared to Vδ2+γδ T cell subsets. Conclusions γδ T cells，particularly the Vδ2−γδ T cell subsets，are associated with CMV reactivation in allo-HSCT patients and produce high levels of the effector molecule IFN-γ. Vδ2− γδ T cell subset may serve as a biomarker for CMV reactivation and clearance.

Relationship between serum miR-146a-5p and miR-146b-5p expression levels and TLR4/NF-κB signaling pathway and prognosis in patients with LAA type cerebral infarction

QIAN Wenjun, WU Hongbin

2025, 40(5):  471-476.  DOI: 10.3969/j.issn.1673-8640.2025.05.010

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Objective To investigate the expressions of serum miR-146a-5p and miR-146b-5p in patients with large-artery atherosclerosis（LAA）type cerebral infarction and their relationship with Toll-like receptor 4（TLR4）/nuclear factor-kappa B（NF-κB） signaling pathway and prognosis. Methods From June 2021 to September 2023，97 patients with LAA type cerebral infarction（LAA type cerebral infarction group） and 70 healthy subjects （healthy control group） were enrolled from Yantai Yeda Hospital. The clinical data were collected，and the expressions of TLR4 mRNA and NF-κB mRNA in peripheral blood mononuclear cells（PMBC）were determined. The expression of miR-146a-5p and miR-146b-5p in serum were determined. According to the modified Rankin scale（mRS） score of 90 d after intravenous thrombolysis，they were classified into good prognosis group（62 cases） and poor prognosis group（35 cases）. Pearson correlation analysis was used to evaluate the correlation between various indicators. Using Logistic regression analysis，the influencing factors of poor prognosis in patients with LAA type cerebral infarction were evaluated. The efficacy of serum miR-146a-5p and miR-146b-5p in predicting poor prognosis of LAA type cerebral infarction was evaluated using receiver operating characteristic（ROC） curve. Results The relative expression levels of serum miR-146a-5p and miR-146b-5p in LAA type cerebral infarction group were lower than those in healthy control group（P<0.001）. Compared with good prognosis group，the relative expression levels of serum miR-146a-5p and miR-146b-5p in poor prognosis group were decreased（P<0.001），while the relative expression levels of TLR4 mRNA and NF-κB mRNA in PBMC were increased（P<0.001）. The expression of serum miR-146a-5p and miR-146b-5p in patients with LAA type cerebral infarction was negatively correlated with the expressions of TLR4 mRNA and NF-κB mRNA in PBMC（P<0.001）. Increased National Institute of Health Stroke Scale（NIHSS）score at admission，increased infarction volume and decreased relative expression levels of miR-146a-5p and miR-146b-5p were risk factors for poor prognosis in LAA type cerebral infarction patients [odds ratios（OR） were 1.950，2.359，0.625 and 0.748，95% confidence intervals（CI） were 1.204-2.538，1.517-3.394，0.531-0.711 and 0.651-0.806，respectively，P<0.05]. The areas under curves （AUC） of single and combined determinations of serum miR-146a-5p and miR-146b-5p for predicting poor prognosis in LAA type cerebral infarction patients were 0.828，0.765 and 0.903，respectively. The AUC of combined determination with NIHSS score at admission and infarction volume was 0.945. Conclusions The low expression of serum miR-146a-5p and miR-146b-5p in patients with LAA type cerebral infarction is related to the activation of TLR4/NF-κB pathway and poor prognosis，which can be used for clinical diagnosis and treatment of LAA type cerebral infarction.

Prenatal diagnosis value of BoBs technique assay for chromosomal aneuploidy abnormality：a meta analysis

XIA Yuanzhi, YIN Xiangfei, LIN Sien, LIANG Xiaoliang

2025, 40(5):  477-483.  DOI: 10.3969/j.issn.1673-8640.2025.05.011

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Objective To evaluate the value of bacterial artificial chromosome on beads（BoBs）technique in prenatal diagnosis of chromosomal aneuploidy abnormality based on meta analysis. Methods CNKI，Wanfang Data Knowledge Service platform，Pubmed，EmBase databases and Google Academic platform were researched to screen the literatures on the use of BoBs technique in prenatal diagnosis of chromosomal aneuploidy abnormality. Using the traditional G-banding karyotype analysis as gold standard，a meta analysis method was used to evaluate the efficacy of BoBs technique in diagnosing chromosomal aneuploidy abnormality by fitting summary receiver operating characteristic （SROC） curve，combining diagnostic effect size and post-test probability. Results A total of 22 literatures were included，with a total of 34 479 patients. The combined sensitivity and specificity of BoBs technique for the diagnosis of chromosomal aneuploidy abnormality were 97% and 100%，respectively. The combined positive likelihood ratio was 4.6×107，the combined negative likelihood ratio was 0.028，and the combined diagnostic odds ratio was 1.6×109. The results of SROC curve analysis showed that the area under curve （AUC） for the diagnosis of chromosomal aneuploidy abnormality by BoBs technique was 1.00[95% confidence interval （CI） was 0.99-1.00]，and the analysis results of Fagan's nomogram showed that the negative post-test probability was 1%，and the positive post-test probability was 100%. Conclusions BoBs technique has high sensitivity and specificity，which can be used for prenatal diagnosis of common chromosomal aneuploidy abnormality.

Laboratory analysis of 6 cases of acute megakaryocytic leukemia in children

LIU Min, SUN Hengjuan, DU Chengkan, XIA Min, JIANG Linlin, WENG Wenhao, ZHANG Hong

2025, 40(5):  484-488.  DOI: 10.3969/j.issn.1673-8640.2025.05.012

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Objective To analyze the laboratory diagnostic methods of acute megakaryocytic leukemia （AMKL） in children. Methods Totally，6 cases of AMKL from Shanghai Children's Hospital from January 2020 to December 2023 were enrolled for morphological FAB typing of bone marrow cells，immunophenotyping，surface associated antigen of leukemia cells，24 h culture G-banding chromosome karyotype of bone marrow cells，expressions of common fusion genes and single genes of leukemia，blood tumor mutation genes and whole transcriptomes. Results The proportion of bone marrow primitive megakaryocytes in 6 cases of AMKL was≥20%. Periodic acid-schiff stain （PAS） and alpha-naphthol acetate esterase staining （α-NAE） were both positive，while peroxidase stain （POX） and sodium fluoride inhibition test were both negative. The 6 cases all expressed cCD41，and 5 cases were CD61. Totally，3 cases had normal chromosome karyotypes，2 cases had complex chromosome karyotypes，and 1 case had structural abnormalities on chromosome 12. Five cases had WT1 gene positivity. One case of NUP98-KDM5A fusion gene was positive，and another case of CBFA2T3-GLIS2 fusion gene was positive in 2 routine blood tumor transcriptome test cases. Conclusions It is necessary to comprehensively analyze and diagnose AMKL in children by combining bone marrow cell morphology，flow cytometry immunophenotyping，cytogenetics and molecular biology determination methods，which is of significance for guiding the selection of clinical treatment plans and efficacy and prognosis judgment.

Roles of single and combined determinations of CRP，HBP，CLR and HAR in the diagnosis of bloodstream infection in elderly patients

LI Yazhou, SU Min, ZHANG Jinghao, FANG Yi, WANG Su, WANG Shiwen, ZHAO Hu

2025, 40(5):  489-492.  DOI: 10.3969/j.issn.1673-8640.2025.05.013

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Objective To evaluate the diagnostic roles of C-reactive protein （CRP），heparin-binding protein （HBP），C-reactive protein to lymphocyte ratio （CLR），heparin-binding protein to albumin ratio （HAR） in elderly patients with bloodstream infection （BSI）. Methods A total of 84 patients with BSI positive blood culture （without other types of infections）89 suspected BSI patients with negative blood culture （without other types of infections） in Huadong Hospital of Fudan University from January to December 2023 were enrolled as positive and negative blood culture group，respectively. The levels of CRP，HBP，CLR and HAR were compared between the 2 groups. Binary Logistic regression analysis and receiver operating characteristic （ROC） curve were used to analyze the auxiliary diagnostic value of each index in BSI. Results The levels of CRP，HBP，CLR and HAR in positive blood culture group were higher than those in negative blood culture group（P<0.001）. The areas under curves（AUC）of CRP，HBP，CLR and HAR single determinations in the diagnosis of BSI were 0.700，0.748，0.716 and 0.766，respectively. The AUC of HBP+CLR+HAR combined determination was 0.813，the sensitivity was 79.76%，and the specificity was 67.42%. Conclusions The levels of HBP，CLR and HAR in BSI patients are increased，and the combined determination of HBP+CLR+HAR may improve the diagnostic efficiency in the diagnosis of BSI.

Role of lactic acid/albumin ratio in short-term and long-term prognosis evaluation of ventilation therapy in AECOPD patients

XU Dandan

2025, 40(5):  493-498.  DOI: 10.3969/j.issn.1673-8640.2025.05.014

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Objective To investigate the role of blood lactic acid （Lac）/albumin （Alb） ratio in the prognostic evaluation of ventilation therapy in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. Methods A total of 235 patients with AECOPD were enrolled from Deqing County People's Hospital from March 2021 to March 2023. Baseline data were collected at admission，and Lac and Alb levels were determined to calculate Lac/Alb ratio. Based on the prognosis during ventilation therapy and a one-year follow-up，the patients were classified into short-term good prognosis group，short-term poor prognosis group，long-term good prognosis group and long-term poor prognosis group. Multivariate Logistic regression was used to analyze the factors affecting the short-term and long-term prognosis. The efficacy of ventilation therapy in AECOPD patients with poor short-term and long-term prognosis was evaluated by various indicators. Results During ventilation therapy，60 out of 235 AECOPD patients （25.53%） had poor prognosis. After a one-year follow-up，68 out of 235 AECOPD patients （28.94%） had poor prognosis. The proportion of patients aged≥60 years，mechanical ventilation，acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ）score，Lac levels and Lac/Alb ratio in short-term poor prognosis group were all higher than those in short-term good prognosis group （P<0.05），while Alb was lower（P<0.05）. There was no statistical significance in the other data between the 2 groups （P>0.05）. The areas under curves （AUC） of APACHE Ⅱ score，Lac，Alb，Lac/Alb ratio and APACHE Ⅱ score combined with Lac/Alb ratio for predicting short-term poor prognosis in AECOPD patients were 0.824，0.732，0.742，0.827 and 0.910，respectively. Age，APACHE Ⅱ score，Lac，Alb and Lac/Alb ratio were the influencing factors for the short-term prognosis of AECOPD patients （P<0.05）. The proportion of patients aged≥60 years，the proportion of patients with concomitant coronary heart disease，APACHE Ⅱ score，Lac and Lac/Alb ratio in long-term poor prognosis group were all higher than those in long-term good prognosis group （P<0.05），while Alb was lower（P<0.001）. There was no statistical significance in the other parameters between the 2 groups （P>0.05）. The AUC of APACHE Ⅱ score，Lac，Alb，Lac/Alb ratio and APACHE Ⅱ score combined with Lac/Alb ratio for predicting long-term poor prognosis were 0.835，0.745，0.776，0.844 and 0.926，respectively. APACHE Ⅱ score，coronary heart disease，Alb and Lac/Alb ratio were the influencing factors for the long-term prognosis of AECOPD patients （P<0.05）. Conclusions The Lac/Alb ratio is associated with both short-term and long-term prognosis of ventilation therapy in AECOPD patients. The Lac/Alb ratio combined with APACHE Ⅱ score，Lac and Alb have high predictive value for both short-term and long-term prognosis of ventilation therapy in AECOPD patients.

Research progress on clinical significance of monocyte distribution width in infection and inflammatory diseases

YAO Lifeng, ZHANG Ling

2025, 40(5):  503-507.  DOI: 10.3969/j.issn.1673-8640.2025.05.016

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Monocyte distribution width （MDW） is a relatively new indicator of complete blood count. Except for sepsis，the application of MDW in other diseases is still limited recently. This review briefly summarizes the definition，determination methods，reference ranges and current research on clinical significance in infection and inflammatory diseases，in order to provide a reference for the application of MDW in early diagnosis and prognosis evaluation of various diseases.