To explore the risk factors for multiple bronchoalveolar lavages in children with necrotizing pneumonia (NP) and construct a prediction model. To analyze the clinical data of patients with NP from January 2019 to June 2025, and divided into a Single- Bronchoalveolar lavage (BAL) group and Multiple-BAL group, analyze and construct the model. The single-BAL group had 139 patients, the multiple-BAL group 196. The incidence of sputum plug obstruction and bronchial erosion with necrosis was greater in the multiple-BAL group (P < 0.05). The platelet distribution width (PDW), lactate dehydrogenase (LDH) in the multiple-BAL group were greater (P < 0.05). Sputum plug obstruction, bronchial mucosal erosion and necrosis with softening, fibrinogen (FIB) < 2.84 g/L, PDW > 9.5%, and LDH > 576 U/L are risk factors for multiple alveolar lavages in pediatric patients with NP. The combined model had an AUC of 0.801, indicating good discrimination. The combined model showed good predictive performance after Bootstrap validation. The presence of sputum plug obstruction, bronchial mucosal erosion and necrosis with softening, FIB < 2.84 g/L, PDW > 9.5%, and LDH > 576 U/L are risk factors for multiple bronchoalveolar lavages in pediatric patients with NP. Identified 5 risk factors for multiple-BAL in pediatric NP, and built a quantifiable guiding model. Fills the gap of no multiple-BAL criteria in pediatric NP, integrating pathology and hematological indicators. Optimizes treatment, reduces burden, and facilitates clinical standardization.

During pregnancy, the body's hemorrhagic and coagulation system undergoes significant changes. Reference intervals for coagulation parameters may vary across different study populations and with different testing instruments. This study aimed to establish reference intervals for coagulation parameters in non-pregnant and pregnant women in China. Between January 2023 and February 2024, blood samples from 879 pregnant women and 253 healthy non-pregnant women were tested. The parameters tested included activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen (FBG), D-dimer, fibrin/fibrinogen degradation products (FDP), Plasminogen (PLG), thrombin-antithrombin complex (TAT), thrombomodulin (TM), plasmin-α2 plasmin inhibitor complex (PIC), and tissue plasminogen activator/plasminogen activator inhibitor-I complex (t-PAIC). Reference intervals were established using a non-parametric method. The values of PT, INR, APTT, and TT decreased, while the concentrations of fibrinogen, D-dimer, FDP, PLG, TM, TAT, PIC, and t-PAIC increased significantly with advancing gestational age. Distinct reference intervals were established for healthy non-pregnant women and for women in the first, second, and third trimesters of pregnancy. Most intervals differed significantly across these groups. Reference intervals for non-pregnant women and pregnant women in different trimesters vary. Description of the reference intervals according to trimester of pregnant women in China will help clinicians recognise abnormality and inform medical decision-making.

Diabetic retinopathy (DR) is a leading cause of vision loss, yet conventional retinal screening remains costly and resource-intensive. This study developed and validated machine-learning (ML) models using routine laboratory data to provide a cost-effective, accessible alternative for DR risk stratification and triage. We analyzed data from 750 patients (363 T2DM; 387 DR) and externally validated the findings with 451 additional cases. Fifty hematological and biochemical parameters were screened. Six algorithms were trained via five-fold cross-validation, with XGBoost emerging as the top performer. Model interpretability and feature selection were conducted using SHapley Additive exPlanations (SHAP) and ablation analysis. The XGBoost model achieved high discriminative performance (AUC = 0.87). Feature ablation identified a streamlined set of four key predictors-total cholesterol (TC), blood urea nitrogen (BUN), fibrinogen (FIB), and glucose (GLU)-maintaining an AUC of 0.87. External validation confirmed robustness (AUC = 0.86) with balanced sensitivity (0.73) and specificity (0.80). Decision curve analysis indicated significant clinical utility, while SHAP provided individualized prediction transparency. Routine laboratory parameters effectively power ML models for DR prediction. The resulting web-based XGBoost tool offers an interpretable, accessible solution for adjunct risk scoring and early triage, particularly beneficial for prioritizing high-risk patients in community and primary-care settings where specialized retinal imaging is unavailable.

Oxygen desaturation index and fibrinogen: An independent association in sleep-disordered breathing - A retrospective cross-sectional study.

Objective:To investigate the preoperative coagulation characteristics and postoperative changes in patients with primary hyperparathyroidism（PHPT）. Methods:A retrospective analysis was conducted on the clinical data of 55 PHPT patients treated at Beijing Chaoyang Hospital, including preoperative and postoperatively（1 week） serum calcium, serum phosphorus, parathyroid hormone（PTH）, 25-hydroxyvitamin D, prothrombin time（PT）, activated partial thromboplastin time（APTT）, fibrinogen（FIB）, thrombin time（TT）, D-dimer（D-Dimer）, and thromboelastography（TEG） parameters such as coagulation index（CI）, reaction time（R）, kinetic time（K）, maximum amplitude（MA）, and lysis at 30 minutes（LY30）. The preoperative coagulation status and the impact of postoperative biochemical changes on coagulation function were analyzed. Results:All 55 patients successfully underwent parathyroid tumor resection, pathological findings were 41 cases of adenoma（74.5%）, 12 cases of atypical tumor（21.8%）, and 2 cases of carcinoma（3.6%）. The median preoperative serum calcium and PTH levels were 2.67 mmol/L and 171.60 pg/mL, respectively. All patients had PT, APTT, FIB, TT, CI, MA, K, and LY30 values within normal ranges, but 11 patients（20.0%） exhibited reduced preoperative R values. Compared to the normal R-value group, the reduced R-value group had shorter APTT, higher D-Dimer, and higher CI values, with statistically significant differences（P<0.05）, suggesting a hypercoagulable state preoperatively. One week postoperatively, the median serum calcium and PTH levels significantly decreased to 2.14 mmol/L and 35.10 pg/mL, respectively（P<0.05）. Except for a slight increase in D-Dimer, PT, APTT, FIB, TT, CI, MA, K, and LY30 values remained stable within normal ranges. The differences in APTT, D-Dimer, and CI values between the reduced R-value group and the normal R-value group were no longer statistically significant（P>0.05）. Conclusion:Some PHPT patients exhibit a hypercoagulable state with reduced R values preoperatively, and surgical resection of parathyroid tumor helps improve coagulation function in these patients.

This investigation reports the effects of Lactiplantibacillus plantarum CQPC03 (LP-CQPC03) on preventing thrombus formation and reducing intestinal oxidative stress and inflammation in a carrageenan-induced mouse thrombosis model. High-throughput 16S rRNA sequencing determined the composition of intestinal microorganisms. Biochemical reagents, section observations, and quantitative polymerase chain reaction (qPCR) identified mouse serum and tissue-related markers. Experimental findings show that LP-CQPC03 enhances activated partial thromboplastin time (APTT) and decreases thrombin time (TT), fibrinogen (FIB), and prothrombin time (PT). LP-CQPC03 also significantly reduces black tail severity in thrombotic mice. Moreover, LP-CQPC03 lowers malondialdehyde (MDA), tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), nuclear factor kappa-B (NF-κB), and interleukin-1 beta (IL-1β) levels in thrombotic mouse serum, while increasing superoxide dismutase (SOD) and catalase (CAT) activities. Hematoxylin and eosin (H&E) pathological analysis reveals that LP-CQPC03 lessens tissue damage caused by tail vein thrombosis. In the colon tissues of thrombotic mice, LP-CQPC03 up-regulates the mRNA expression of copper/zinc superoxide dismutase (Cu/Zn-SOD), manganese superoxide dismutase (Mn-SOD), and CAT, while down-regulating NF-κB p65, IL-6, TNF-α, and interferon gamma (IFN-γ). In tail vein vascular tissues, LP-CQPC03 also suppresses the mRNA expression of NF-κB p65, intercellular cell adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and E-selectin. Gut microbiota sequencing results show that LP-CQPC03 increases the population of beneficial bacteria and decreases harmful ones. These findings demonstrate that LP-CQPC03 prevents thrombosis in mice, reduces oxidative stress and intestinal inflammation, and regulates gut microbiota by increasing beneficial bacteria. A high concentration of LP-CQPC03 shows a better effect, comparable to heparin.

Tranexamic acid (TXA) is a hemostatic agent used in posterior lumbar interbody fusion (PLIF). However, reports on its use in patients on preoperative anticoagulants are scarce. This study evaluates the safety and efficacy of preoperative 1 g TXA in such patients. This study retrospectively analyzed the medical records of patients who underwent PLIF and had received anticoagulants within 1 week before surgery between January 2021 and June 2023. After general anesthesia, at 15 min before skin incision, patients who received intravenous TXA were recorded as the observation group (n = 31), and those who did not were recorded as the control group (n = 29). The main observation indicators included surgical time, intraoperative blood loss (IBL), postoperative drainage volume (PDV), number of blood transfusions, red blood cell count (RBC), hemoglobin (HB), and hematocrit (HCT) on the postoperative 1st, 4th, 7th, and last-test days. The secondary observation indicators included postoperative incision healing, number of lower limb deep vein thrombosis (DVT), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), platelet count (PLT) and postoperative hospital stay. The surgeries were successfully completed. The incisions healed as grade A, and no DVT occurred. The IBL and PDV in the observation group were significantly lower than those in the control group (p < 0.05). There were no significant differences between the two groups in surgical time or blood transfusions (p > 0.05). The multivariate linear regression analysis revealed that the surgical segment and TXA were independent influencing factors for IBL and PDV, while age, body mass index, gender, coexisting hypertension, disease type, and anticoagulant type were not. Subgroup multivariate analysis further confirmed that anticoagulant type was not an independent influencing factor of IBL or PDV. There were no statistically significant differences between the two groups in RBC, HB, or HCT at any postoperative time point (p > 0.05). There was no significant difference in postoperative PT, APTT, TT, FIB, PLT, or postoperative hospital stay between the two groups (p > 0.05). For patients undergoing PLIF with preoperative anticoagulation, TXA administration appears safe and significantly reduces perioperative blood loss.

To develop a machine learning-based classification model to aid in the early diagnosis of diabetic microvascular complications. This study analyzed clinical and laboratory data from 1,498 patients, categorized into two groups: diabetes alone and diabetes with microvascular complications. Independent risk factors for complications were identified through intergroup comparison, collinearity analysis, and logistic regression. Nine machine learning models were subsequently developed and compared. A comprehensive evaluation of the binary classification performance of the Gradient Boosting Decision Tree (GBDT) model was performed. Urea, fibrinogen (FIB), prothrombin time (PT), D-dimer (DD), creatine kinase MB isoenzyme (CKMB), lipoprotein(a) (Lpa), activated partial thromboplastin time (APTT), triglycerides (TG), and cholinesterase (CHE) were identified as independent risk factors for diabetic microvascular complications. Among the nine predictive models constructed, the GBDT model demonstrated superior performance across multiple metrics, including the area under the receiver operating characteristic curve (AUC) and sensitivity, indicating strong generalization ability on the validation set. Further evaluation confirmed its consistent and robust predictive performance across training, validation, and test datasets. Calibration curve analysis showed good agreement between predicted probabilities and actual outcomes. Decision curve analysis demonstrated the model's clinical utility, and the Kolmogorov-Smirnov (KS) curve indicated excellent discriminatory power. The GBDT model, constructed based on the identified risk factors, exhibits outstanding predictive performance and promising application potential. It provides important theoretical support and a practical tool for the early identification and targeted intervention of diabetic microvascular complications.

This study aims to investigate the predictive value of the fibrinogen-to-high-density lipoprotein cholesterol ratio (FHR) in relation to sub-clinical diabetic peripheral neuropathy (sDPN) in individuals diagnosed with type 2 diabetes mellitus (T2DM). A cohort of 281 patients with T2DM was admitted to the Neurology Department of Jiangxi Provincial People's Hospital between January and December 2023. Within this population, 148 patients were diagnosed with sDPN. The clinical profiles, inflammatory biomarkers, and nerve conduction velocities or current perception thresholds (CPTs) were compared between the two distinct groups. A logistic regression analysis was performed to identify the risk factors for sDPN. The predictive performance of each factor was assessed using a receiver operating characteristic (ROC) curve analysis. The FHR was compared among three groups, which were based on the severity of peripheral neuropathy (PN). Patients with sDPN exhibited significantly elevated levels of fibrinogen (FIB), fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), the monocyte-to-lymphocyte ratio (MLR), and the platelet-to-lymphocyte ratio (PLR), along with diminished high-density lipoprotein cholesterol (HDL-C) levels, compared to patients without sDPN. Univariate and multivariate logistic regression analyses indicated that age, FIB levels, HbA1c, HDL-C, and MLR were significant risk factors that contributed to the onset of sDPN in T2DM patients. The ROC curve analysis indicated that the FHR had an area under the curve (AUC) of 65%. The optimal cutoff value for the FHR was 2.65, exhibiting a specificity of 62.4% and a sensitivity of 63.5%. The composite model incorporating the FHR demonstrated superior reclassification performance (net reclassification improvement (NRI) = 0.416, p = 0.001, 95% CI 0.180-0.650) and integrated discrimination improvement (IDI = 0.053, p < 0.001, 95% CI 0.001-0.015) compared to the basic model (age +HbA1c + MLR). Nonparametric test analysis showed significant differences in the FHR among the three groups. The more severe the PN, the higher the FHR. The FHR may serve as a valuable early diagnostic marker for sDPN in T2DM.

Establishment of trimester-specific reference intervals for hemostatic and hematologic indices and their associations with adverse pregnancy outcomes.

The purpose of this paper is to evaluate the diagnostic accuracy of High Sensitivity- C Reactive Protein (HS-CRP), D-dimer, and Fibrinogen (FIB) for diagnosing DVT. A total of 515 patients were included in the study, among which 67 cases were confirmed as DVT-positive based on diagnostic evaluation, providing a reliable sample size for assessing biomarker performance. This study primarily focuses on evaluating diagnostic performance, while also exploring the prognostic relevance of these biomarkers in relation to disease severity and progression, where the primary endpoint is defined as the detection accuracy of DVT based on biomarker positivity across the study groups, and secondary observations include associations between biomarker levels and extent of thrombus involvement. Patients with DVT who had been diagnosed and treated at the hospital were first recruited as research participants and split into three groups. Group 1 was diagnosing with HS-CRP test, group 2 diagnosing with D-dimer test and group 3 diagnosing with FIB test. Statistical analysis techniques such as the independent t-test and Logistic regression analysis were used to examine the detection rate. The data show that the efficacies of HS-CRP, D-dimer, and FIB for diagnosing DVT seem to be promising right now. DVT is one of the most prevalent symptoms of venous thromboembolism, and new investigations have shown that spine injuries, lower leg injuries, and physical trauma to the abdomen are all independent risk factors. Authors found that FIB and Hs-CRP are probable indicators of DVT in ankle fracture victims. DVT may develop in people with an elevated FIB, hs-CRP, fibrinogen, and high-energy damage, which are all independent risk factors.

Objective: To evaluate the predictive value and clinical utility of thrombelastography (TEG) combined with coagulation parameters for adverse pregnancy outcomes (APOs). Methodology: A retrospective analysis was conducted on the clinical data of 186 pregnant women admitted to the Department of Obstetrics in Affiliated Hospital of Chengde Medical College between January 2022 and June 2025. Based on pregnancy outcomes, patients were classified into the APO group and the normal pregnancy outcome group. Baseline characteristics, TEG parameters, and coagulation parameters were compared between groups. Pearson correlation analysis was performed to assess associations between TEG and coagulation parameters in the APO group. Results: No significant differences were observed between the two groups in baseline characteristics such as age, gravidity, parity, and gestational weight gain (all P &gt; 0.05), indicating comparability. Regarding TEG parameters, the APO group showed lower R values and higher maximum amplitude (MA) and coagulation index (CI) values compared with the normal outcome group (P &lt; 0.05, respectively). For coagulation parameters, fibrinogen (FIB) and D-dimer (D-D) levels were significantly elevated, while antithrombin III (AT-III) levels were decreased in the APO group (P &lt; 0.05, respectively). Conclusion: The combination of TEG and coagulation parameters demonstrates higher predictive efficiency for APOs than either method alone, providing a reliable basis for the early identification of high-risk populations and guiding clinical intervention strategies.

Longitudinal assessment of hemostatic adaptations in pregnant mares: Evidence of a physiological hypercoagulable state.

ObjectiveThis study aimed to evaluate the clinical efficacy of Jia Wei Shoutai Wan (JWSTW) combined with dydrogesterone in patients with threatened abortion (TA) complicated by endometrial cavity fluid (ECF).MethodsThis was a prospective, single‐center, randomized controlled trial. A total of 130 patients with TA and ECF admitted to our hospital from January to November 2022 were screened. Thirteen patients did not meet the inclusion criteria, and five refused to participate, leaving 112 eligible participants. Using a random number table, patients were assigned to a control group (dydrogesterone alone, n = 56) or a combination group (dydrogesterone plus JWSTW, n = 56). Both groups received continuous treatment for 14 days. During follow‐up, 3 patients withdrew and 6 were excluded, resulting in 103 cases included in the final analysis (control group, n = 50; combination group, n = 53). The primary outcomes were ECF area and Traditional Chinese Medicine (TCM) syndrome scores (vaginal bleeding, lower abdominal pain, fatigue and tiredness, knee soreness, and lumbago) after 14 days of treatment. Secondary outcomes included serum levels of progesterone (P), β‐human chorionic gonadotropin (β‐HCG), and estradiol (E2); coagulation indices [D‐dimer (D‐D), fibrinogen (FIB), and prothrombin time (PT)]; clinical efficacy; and adverse reactions.ResultsAfter treatment, the combination group showed significantly lower TCM symptom scores and a smaller ECF area (p < 0.05). Serum levels of P, β‐HCG, and E2 were higher in the combination group, while D‐D and FIB levels were lower and PT was longer compared with the control group (p < 0.05). Adverse reactions were monitored, including premature rupture of membranes, postpartum hemorrhage, placental adhesion, preterm delivery, and placenta previa. The total incidence was 8.00% in the control group (4/50) and 3.77% in the combination group (2/53), with no statistically significant difference between the groups (p = 0.360). The overall clinical efficacy of the combination group was superior to that of the control group (p < 0.05).ConclusionJWSTW combined with dydrogesterone may be beneficial for treating TA with ECF by improving clinical symptoms, optimizing hormone and coagulation profiles, and reducing ECF without increasing adverse reactions.

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is an autoimmune disorder characterized by necrotizing inflammation of small vessels. This study investigates the relationship among macrophage migration inhibitory factor (MIF), coagulation parameters, and thrombotic events in AAV. Plasma and urine samples obtained from 45 AAV patients and 16 healthy controls were analyzed. Then, the MIF levels were quantified via enzyme-linked immunosorbent assay. Afterwards the coagulation markers (prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen (FIB), fibrin degradation products (FDP), and prothrombin activity (PTA)), renal function (estimated glomerular filtration rate (eGFR)), and disease activity (Birmingham Vasculitis Activity Score (BVAS)) were assessed. Finally, the thrombotic events were radiologically confirmed. The plasma MIF levels were significantly elevated in AAV patients when compared to healthy controls (716.35 vs. 293.26 pg/mL, P < .05). Beyond demonstrating the associations with disease severity and renal function (which had a positive correlation with BVAS (r = 0.391, P = .008) and a negative correlation with eGFR (r = -0.298, P = .047)), MIF further exhibited inverse relationships with high-density lipoprotein cholesterol (r = -0.334, P=.043). Notably, plasma MIF had significant positive correlations with multiple coagulation parameters, which included PT (r = 0.351), INR (r = 0.346), APTT (r = 0.380), FIB (r = 0.374), and FDP (r = 0.301) (all, P < .05), and a negative correlation with PTA (r = -0.346, P = .020). Complementing these findings, urinary MIF levels were inversely correlated to thrombin time (r = -0.367, P = .039), collectively reinforcing the role of MIF in thromboinflammatory dysregulation. Although plasma MIF correlates with thromboinflammatory dysregulation, its predictive value for thrombosis warrants validation in larger cohorts. Cite this article as: Lv T, Li Y, Xu L, Hao J. Plasma macrophage migration inhibitory factor as a biomarker of thromboinflammatory dysregulation in anti-neutrophil cytoplasmic antibody-associated vasculitis. Arch Rheumatol. 2026;41(2):108-116.

Nationwide expert survey on transfusion and coagulation management strategies for bleeding critically ill patients in China.

[Objective] To assess the value of the serum levels of sestrin 2 (SESN2), heme oxidase 1 (HO-1), and soluble hemoglobin scavenger receptor (sCD163) for the prediction of intrauterine fetal hypoxia in pregnant women with gestational hypertension disorder (HDCP). [Methods] A total of 250 pregnant women with HDCP who were diagnosed and treated at this hospital from January 2023 to December 2024 were selected as the HDCP group, and 150 pregnant women with normal pregnancies who underwent prenatal examination at this hospital. Changes in the levels of serum SESN2, HO-1 and sCD163 in the two groups were observed, the levels of each index in pregnant women with HDCP of different severities were compared, and based on whether intrauterine fetal hypoxia occurred, the patients were split into two groups: those with intrauterine hypoxia and those without. The factors influencing intrauterine fetal hypoxia in pregnant women with HDCP and the predictive efficacy of serum SESN2, HO-1 and sCD163 levels for predicting intrauterine fetal hypoxia in pregnant women with HDCP were analyzed. [Results] The HDCP group had significantly higher levels of serum SESN2 and sCD163 than the normal pregnancy group (P&lt;0.01), while the normal pregnancy group had significantly lower levels of serum HO-1 (P&lt;0.01). Serum SESN2 and sCD163 levels were substantially greater in the severe preeclampsia group than in the moderate preeclampsia and gestational hypertension groups (P&lt;0.01), while the mild preeclampsia and gestational hypertension groups had significantly lower serum HO-1 levels (P&lt;0.01). Serum HO-1 levels in the mild preeclampsia group were significantly lower than those in the gestational hypertension group (P&lt;0.01), while serum SESN2 and sCD163 levels were significantly higher than those in the latter group (P&lt;0.01). While the intrauterine hypoxia group's prothrombin time and HO-1 levels were significantly lower than those of the nonintrauterine hypoxia group (P&lt;0.01), the intrauterine hypoxia group's levels of serum D-dimer, fibrinogen (FIB), SESN2, and sCD163 were significantly higher. Multivariate logistic regression analysis revealed that elevated D-dimer, FIB, SESN2 and sCD163 levels were risk factors for intrauterine hypoxia in pregnant women with HDCP (P&lt;0.05), whereas elevated prothrombin time and HO-1 levels were protective factors for intrauterine hypoxia in pregnant women with HDCP (P&lt;0.05). The AUCs of individual and combined detection of serum SESN2, HO-1, and sCD163 for predicting intrauterine fetal hypoxia in pregnant women with HDCP were 0.825 (95%CI: 0.769–0.872), 0.869 (95% CI: 0.815–0.919), and 0.849 (95% CI: 0.797–0.892), 0.962 (95% CI: 0.928–0.983), and the AUC of the combined detection was significantly greater than that of SESN2 (Z=4.668, P&lt;0.001), HO-1 (Z=4.878, P&lt;0.001), and sCD163 (Z=4.226, P&lt;0.001) single detection. [Conclusion] SESN2, HO-1 and sCD163 are involved in the occurrence and development of HDCP and are closely related to the severity of HDCP. The combined detection of these three indicators is helpful for determining the intrauterine hypoxia status of a fetus.

To investigate the effectiveness of evidence-based intervention strategies in managing postpartum hemorrhage following vaginal delivery. This was a prospective, observational quality-improvement evaluation conducted among 120 women who experienced postpartum hemorrhage after vaginal delivery. Two nursing strategies were compared consecutively: a conventional nursing routine and a structured evidence-based nursing protocol developed from current literature and clinical guidelines. Outcomes assessed included postpartum blood loss, coagulation indicators [prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), and fibrinogen (FIB)], adverse events, self-care ability, nursing satisfaction, emotional status [Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS)], and quality of life. Compared with the routine nursing phase, the evidence-based nursing phase was associated with lower bleeding volume at 0.5, 2, 12, and 24h postpartum (P < 0.05). After 5 days of nursing care, PT, TT, and APTT were shorter, and FIB levels were higher (P < 0.05). The frequency of adverse events was lower (10.0% vs. 23.3%), while self-care ability, nursing satisfaction, and quality-of-life scores were higher. Both phases showed decreases in SAS and SDS scores, with greater improvement observed in the evidence-based phase (P < 0.05). An observational study of quality-improvement demonstrated a significant association between the implementation of a standardized evidence-based nursing protocol and reduced postpartum hemorrhage, improved coagulation profiles, lower incidence of adverse events, and improved psychosocial outcomes. These results should be validated in future randomized controlled trials.

The focal lesions were the significant clinical challenge for brucellosis, a widespread infectious disease. The aim of this study was to investigate the risk factors for focal lesions in brucellosis, thereby providing support for clinical diagnosis and treatment. A total of 339 brucellosis patients were recruited, including 147 patients with focal complications and 192 patients without focal complications. The patient's medical records were reviewed, and laboratory findings were recorded. All the data were analyzed using SPSS 27.0. Spondylitis (65.99%) was the main focal complication in the 147 brucellosis patients. The percent of CD3+ cells and CD3+ CD4+ cells, the levels of neutrophil, monocyte, platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), IL-6, IL-10, IL-12p70, and FIB (fibrinogen) showed a statistically upward trend, while the absolute counts of CD+ 19 cells, CD16+ CD56+ cells and the percent of CD16+ CD56+ cells were significantly decreased in patients with focal complication (p < 0.05). Percent of CD3+ CD4+ cells (odds ratio [OR]: 1.033, 95% confidence interval [CI]: 1.003-1.063, p = 0.030), MLR (OR: 38.115, 95% CI: 2.396-606.305, p = 0.010), and FIB (OR: 1.363, 95% CI: 1.089-1.705, p = 0.007) were the independent risk factors for focal complications in brucellosis patients in the multivariate logistic regression analysis and the areas under curve (AUC) of receiver operating characteristic for the three factors were 0.576, 0.640, and 0.641, respectively. The AUC for the model including these three indicators was 0.716, and the risk of focal lesions increased almost three times in patients with value above the cutoff value. CD3+ CD4+ cell percent, MLR and FIB were the independent risk factors for focal lesions in human brucellosis.

PurposeNormal coagulation is essential for maternal safety during pregnancy and delivery. Thalassemia may influence coagulation parameters, however, its effects during pregnancy remain incompletely characterized. This study aimed to evaluate maternal coagulation profiles in pregnant women with thalassemia in South China.Patients and MethodsThis retrospective observational study included 53 pregnant women with thalassemia and 352 pregnant women without thalassemia who delivered at a tertiary medical center in South China. Singleton pregnancies with gestational age of ≥ 37 weeks were analyzed. Women with other hematological disorders, pregnancy complications affecting coagulation, or abnormal cardiac, liver, or renal function were excluded. Primary outcomes were maternal coagulation indices - activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen (FIB), international normalized ratio (INR), and platelet count (PLT) - and were assessed in early and late pregnancy. Perinatal outcomes were also evaluated as secondary outcomes.ResultsWomen with thalassemia had lower TT in early pregnancy (P = 0.007) and higher PLT in both early and late pregnancy (P < 0.001) compared with women without thalassemia. From early to late pregnancy, APTT, PT, and INR decreased whereas TT and FIB increased in both groups (P < 0.01). PLT decreased only in the non-thalassemia group (P < 0.001). Changes in APTT (P = 0.02) and FIB (P = 0.025) were modestly more pronounced in the thalassemia group. Maternal anemia was more frequent among women with thalassemia (P < 0.001), while other perinatal outcomes were comparable between groups.ConclusionPregnancy in women with thalassemia is associated with modest differences in coagulation parameters compared with women without thalassemia. Importantly, these variations remained within clinically acceptable ranges and were not associated with adverse perinatal outcomes. The findings provide reassuring information and contribute to a better understanding of physiological coagulation adaptation in pregnant women with thalassemia.