Real-world study (RWS), based on multi-source data from real medical environments, is gradually becoming an important supplement to traditional randomized controlled trials, and its application in the field of transfusion medicine is becoming increasingly widespread. This article systematically reviews the definition and methodological system of RWS, examines its application cases in clinical blood transfusion research, and discusses the advantages, limitations, and future research directions of RWS, aiming to provide a reference for evidence-based research in blood transfusion medicine.

Real-world study (RWS), based on multi-source data from real medical environments, is gradually becoming an important supplement to traditional randomized controlled trials, and its application in the field of transfusion medicine is becoming increasingly widespread. This article systematically reviews the definition and methodological system of RWS, examines its application cases in clinical blood transfusion research, and discusses the advantages, limitations, and future research directions of RWS, aiming to provide a reference for evidence-based research in blood transfusion medicine.

Andrographolide sulfonate (AS) is a sulfonated derivative of andrographolide extracted from Andrographis paniculata (Burm.f.) Nees, and has been approved for several decades in China. The present study aimed to investigate the novel therapeutic application and possible mechanisms of AS in the treatment of rheumatoid arthritis. Results indicated that administration of AS by injection or gavage significantly reduced the paw swelling, improved body weights, and attenuated pathological changes in joints of rats with adjuvant-induced arthritis. Additionally, the levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and IL-1β in the serum and ankle joints were reduced. Bioinformatics analysis, along with the spleen index and measurements of IL-17 and IL-10 levels, suggested a potential relationship between AS and Th17 cells under arthritic conditions. In vitro, AS was shown to block Th17 cell differentiation, as evidenced by the reduced percentages of CD4⁺ IL-17A⁺ T cells and decreased expression levels of RORγt, IL-17A, IL-17F, IL-21, and IL-22, without affecting the cell viability and apoptosis. This effect was attributed to the limited glycolysis, as indicated by metabolomics analysis, reduced glucose uptake, and pH measurements. Further investigation revealed that AS might bind to hexokinase2 (HK2) to down-regulate the protein levels of HK2 but not glyceraldehyde-3-phosphate dehydrogenase (GAPDH) or pyruvate kinase M2 (PKM2), and overexpression of HK2 reversed the inhibition of AS on Th17 cell differentiation. Furthermore, AS impaired the activation of phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT) signals in vivo and in vitro, which was abolished by the addition of lactate. In conclusion, AS significantly improved adjuvant-induced arthritis (AIA) in rats by inhibiting glycolysis-mediated activation of PI3K/AKT to restrain Th17 cell differentiation.
Animals ; Th17 Cells/immunology* ; Diterpenes/pharmacology* ; Arthritis, Rheumatoid/metabolism* ; Proto-Oncogene Proteins c-akt/immunology* ; Glycolysis/drug effects* ; Cell Differentiation/drug effects* ; Phosphatidylinositol 3-Kinases/genetics* ; Rats ; Male ; Rats, Sprague-Dawley ; Humans ; Andrographis paniculata/chemistry* ; Arthritis, Experimental/drug therapy* ; Interleukin-17/immunology* ; Signal Transduction/drug effects*

BackgroundThe adolescent mood disorders become more prevalent， imposing progressively greater perceived and actual caregiving burdens on caregivers， while the current health education resources， delivery formats and training programs remain insufficient in addressing their needs. ObjectiveTo evaluate the effect of structured health education on the caregiver burden associated with adolescent mood disorders， thereby informing evidence-based strategies for alleviating the burden. MethodsA total of 195 caregivers of adolescent inpatients with mood disorders admitted to a tertiary general hospital in Mianyang from June 1， 2020 to July 31， 2022 were consecutively enrolled and randomly assigned to either the research group （n=99） or the control group （n=96） using random number table method. Both groups received routine health education. In addition， the research group participated in a structured health education program comprising three modules covering disease knowledge， medication management， coping with family stress， and guidance for daily living. Upon admission， baseline information regarding both caregivers and adolescent inpatients was collected though a self-administered questionnaire. Caregiver Strain Index （CSI） was administered to assess caregiver burden at admission， discharge， and 1， 3 and 6 months post-discharge. A self-designed health education feedback questionnaire was administered on the day of discharge to evaluate caregivers' feedback on the health education. At 6 months post-discharge， data on any hospital readmission were collected. ResultsUltimately， 85 caregivers （85.86%） in the research group and 84 caregivers （87.50%） in the control group completed the study. Generalized estimating equation analysis revealed significant time effects and group-by-time interaction effects on CSI scores between the two groups （Wald χ²=790.347， 10.047， P<0.05 or 0.01）. There was no statistically significant difference between the two groups in terms of access to disease information， trust preference and core information needs （P>0.05）. Additionally， caregivers in the research group reported significantly better understanding of the disease-related knowledge and higher ratings on the effectiveness of health education when compared to the control group， with statistically significant differences （P<0.01）. ConclusionIn contrast to routine health education， structured health education may help alleviate caregiving burden among caregivers of adolescents with mood disorders.［Funded by Sichuan Medical Association Project （number， Q190004）］

Information on patients with rifampicin-resistant pulmonary tuberculosis (RR-PTB) in Yangzhou City from 2012 to 2020 was obtained from the Information System of the Chinese Center for Disease Control and Prevention. The epidemic characteristics of RR-PTB patients were analyzed by using χ2 test. The average annual registered incidence rate of RR-PTB patients in Yangzhou City from 2012 to 2020 was 0.57/100 000, and the difference between the registered incidence rates in each year was statistically significant ( χ2=29.326, P<0.001). The proportion of re-treated patients (64.8%) was higher than that of newly treated patients (35.2%, χ2=50.593, P<0.001). The registered incidence rate in males (0.91/100 000) was higher than that in females (0.24/100 000, χ2=80.566, P<0.001). The age distribution showed that the highest incidence rate was in the age group≥60 years (0.96/100 000) and the lowest was in the age group 0-<45 years (0.31/100 000, χ2=55.853, P<0.001). From 2012 to 2020, Baoying County had the largest number of registered RR-PTB patients (44 cases), and its registered incidence rate (0.64/100 000) was only lower than that of Guangling District (0.98/100 000). The registered incidence rate of RR-PTB patients in Baoying County during 2016—2020 also increased significantly compared to 2012—2015 ( P=0.001). Logistic regression was used to analyze the factors related to the treatment outcome of RR-PTB patients. The results showed that patients aged≥60 years and those classified as the re-treatment were risk factors for successful treatment of RR-PTB patients ( P<0.05). In summary, males, people aged≥60 years, patients classified as the re-treatment, and residents of Baoying County should be the key populations for RR-PTB epidemic prevention and control in Yangzhou City.

Objective To evaluate the surgical treatments of refractory sclerosing peritonitis related peritoneal dialysis.Methods Clinical data of 15 patients with refractory sclerosing peritonitis related to peritoneal dialysis treated in the General Surgery Department of the 900th Hospital of the Joint Logistics Support Force of the People's Liberation Army from June 30,2014 to May 30,2018.Among them,5 cases underwent"open abdomen peritoneal catheter removal+intestinal adhesiolysis+abdominal infection flushing and drainage with catheter",4 cases underwent"laparoscopic peritoneal catheter removal+intestinal adhesiolysis+abdominal infection flushing and drainage with catheter",3 cases underwent"laparoscopic peritoneal dialysis catheter removal+abdominal infection flushing and drainage with catheter",2 cases underwent"open abdomen peritoneal dialysis catheter removal+abdominal infection flushing and drainage with catheter",and 1 case underwent"laparoscopic examination combined with laparotomy exploration and removal of lower abdominal catheter+intestinal adhesiolysis+abdominal infection flushing and drainage with catheter".Age,gender,clinical symptoms,abdominal CT examination,peripheral blood routine,blood biochemistry,blood C-reactive protein(CRP),white blood cells,biochemistry,and aetiology of peritoneal dialysis fluid were collected and followed up,and the therapeutic effect was evaluated.Results 15 patients were transferred to the Department of Surgery after ineffective treatment in the Department of Internal Medicine.Preoperatively(after 5 days of antibiotic treatment)compared to before antibiotic treatment,there were no significant changes in blood WBC,blood NEUT％,CRP,and peritoneal fluid WBC(P＞0.05).Laparoscopic exploration or laparotomy exploration was performed,during which the peritoneal dialysis catheter was removed and the abdominal infection focus was cleared.A pelvic cavity washout drainage tube was left in place postoperatively.Fourteen patients had a good recovery after surgery,with effective control of peritonitis symptoms and no complications such as intestinal obstruction or enterocutaneous fistula.After the removal of the peritoneal dialysis catheter,all patients switched to hemodialysis.A comparison of inflammatory markers before and after surgery showed a significant decrease after surgery.Three days postoperatively compared to before surgery(after 5 days of antibiotic treatment),there were no significant changes in blood WBC,blood NEUT％,CRP,and peritoneal fluid WBC(P＞0.05).Seven days postoperatively compared to before surgery(after 5 days of antibiotic treatment),there was a significant decrease in blood WBC[(7.43±2.65)× 109/L VS(10.17±5.24)× 109/L],blood NEUT％[(88.23±9.02)％VS(85.07±11.57)％],and CRP[(152.88±113.01)mg/L VS(114.49±92.97)mg/L](P＜0.05);the peritoneal fluid WBC at 7 days postoperatively showed no significant change compared to before surgery(after 5 days of antibiotic treatment)(P＞0.05).The cases were followed up for at least 22 months,and 13 patients did not experience peritonitis or intestinal obstruction again.One patient died 39 days after surgery due to multiple organ failure,and one patient died from other causes after a 2-year follow-up.Conclusion For refractory sclerosing peritonitis related peritoneal dialysis that is ineffective in medical conservative treatment,On the basis of reasonable and effective antibiotics to control infection,surgical intervention should be actively carried out and surgical methods such as surgery should be used to control the progress of peritonitis,reduce mortality and improve the cure rate.

Objective To investigate the correlation between serum long non-coding RNA FGD5-AS1(ln-cRNA FGD5-AS1),microRNA-103a-3p(miR-103a-3p)and puerperal infection(PI)in patients with gesta-tional diabetes mellitus(GDM)in late pregnancy.Methods A total of 168 late pregnancy GDM patients who were hospitalized and delivered in the hospital from January 2022 to June 2023 were retrospectively selected as the experimental group,and the patients were separated into an infected group(96 cases)and an uninfected group(72 cases)based on whether they had PI.At the same time,120 late pregnant women who underwent prenatal examination in the hospital and had normal gestational blood glucose were selected as the control group.Real-time fluorescence quantitative PCR(qRT-PCR)was applied to detect the expression levels of ln-cRNA FGD5-AS1 and miR-103a-3p.Multivariate Logistic regression was applied to analyze the influencing factors of PI in late pregnancy GDM patients.StarBase website was applied to analyze the relationship between lncRNA FGD5-AS1 and miR-103a-3p.Pearson was applied to analyze the correlation between lncRNA FGD5-AS1 and miR-103a-3p.Receiver operating characteristic(ROC)curve was applied to evaluate the value of ln-cRNA FGD5-AS1 and miR-103a-3p in predicting the occurrence of PI.Results There was a statistically sig-nificant difference in the expression levels of serum lncRNA FGD5-AS1 and miR-103a-3p between the experi-mental group and the control group(P＜0.05),the expression level of serum lncRNA FGD5-AS1 in the infec-ted group was obviously higher than that in the uninfected group(P＜0.05),but the expression level of ser-um miR-103a-3p in the infected group was obviously lower than that in the uninfected group(P＜0.05).The expression level of lncRNA FGD5-AS1 was an independent risk factor for PI in late-pregnancy GDM patients(P＜0.05),and the expression level of miR-103a-3p was an independent protective factor for PI in late-preg-nancy GDM patients(P＜0.05).There was a negative correlation between lncRNA FGD5-AS1 and miR-103a-3p expression level(r=-0.409,P＜0.001).The efficacy of the combined detection of lncRNA FGD5-AS1 and miR-103a-3p for predicting PI in late pregnancy GDM patients was superior to that of serum lncRNA FGD5-AS1 and miR-103a-3p alone(P＜0.05).Conclusion LncRNA FGD5-AS1 is an independent risk factor for PI in late pregnancy GDM patients,while miR-103a-3p is an independent protective factor for PI in late pregnancy GDM patients.The combined detection has higher value for predicting PI in late pregnancy GDM patients.

Mechanical ventilation(MV)provides life support for critically ill respiratory patients,but in the meantime can cause fatal ventilator-induced lung injury(VILI),and the latter remains a major challenge in respiratory and critical care medicine,because the pathological mechanism has not been fully elucidated.Recent studies show that on the one hand,in the lung with VILI,there exists airway collapse at multi-sites of an individual airway,which can not be explained by traditional airway collapse models.But on the other hand,under MV conditions,airway smooth muscle cells(ASMC)exhibit abnormal mechanical behaviors,accompanied by regulation of Piezo1 expression and endoplasmic reticulum stress.These phenomenons indicate that the MV-induced abnormal mechanical behavior of ASMC is closely related to multiple airway collapse and VILI.Therefore,by studying the MV-induced changes of ASMC mechanical behaviors and their relationship with airway collapse in lung injury,as well as the related mechanochemical signal coupling process,it is expected to reveal a novel mechanism of MV-associated airway collapse and lung injury from the perspective of cell mechanics.In this review,the recent research progress of airway collapse during MV,the regulation of ASMC mechanical behavior by MV-related high stretch,especially the related mechanochemical signal coupling mechanism is summarized.These advances may provide a novel insight for exploring the roles of ASMC abnormal mechanical behavior in the pathological mechanism of VILI,alternative targets of drug intervention for prevention and treatment of VILI,as well as for optimizing the ventilation mode in clinical practice.

BACKGROUND:If quadriceps femoris muscle is not effectively rehabilitated,the strength of quadriceps femoris muscle in patients with intertrochanteric fractures will gradually decline,even causing lower limb muscle atrophy.As a result,postoperative complications such as pain in the affected thigh and inflexibility of the hip and knee joints will occur. OBJECTIVE:To evaluate the effect of universal stepwise rehabilitation training of quadriceps femoris muscle on the postoperative rehabilitation of intertrochanteric fracture of the femur,and to investigate the efficacy of quadriceps femoris rehabilitation in the postoperative rehabilitation of intertrochanteric fractures of the femur. METHODS:A retrospective analysis was performed to analyze the data of 48 patients operated for intertrochanteric fracture of the femur who were rehabbed by applying a quadriceps femoris rehabilitation program between October 2016 and February 2022.Rehabilitation training included isotonic and isometric contraction training of quadriceps femoris muscle,and the time of exercise was from the 1st to the 12th week of the postoperative period.Patient's Hip function was evaluated using hip joint mobility score in Merle D'Aubigne and Postel evaluation system,WOMAC lower extremity function score,and Harris hip joint function score.The Visual Analog Scale was used to assess patients'pain.The Hospital Anxiety and Depression Scale was used to assess the patient's psychological status.Changes in quadriceps muscle strength were also measured. RESULTS AND CONCLUSION:The average healing time of the fracture was(9.78±1.65)weeks.At 4 weeks postoperatively,the patient's hip function significantly improved compared with that at the preoperative period(P＜0.01),the Visual Analog Scale scores for pain evaluation decreased(P＜0.01),quadriceps femoris muscle strength increased(P＜0.01),and the Hospital Anxiety and Depression Scale scores decreased(P＜0.05).At 12 weeks postoperatively,as the rehabilitation training continued,the patient's hip function and pain symptoms further improved compared with those at 4 weeks postoperatively(P＜0.05),quadriceps femoris muscle strength further recovered(P＜0.05),and the Hospital Anxiety and Depression Scale scores further decreased(P＜0.01).At 24 weeks postoperatively,the rehabilitation training had been stopped,the patient's hip joint function and muscle strength were well maintained,and no obvious amyotrophy occurred in the quadriceps femoris muscle,and there were no significant differences between 12 and 24 weeks postoerpatively(P＞0.05).No complications and adverse events occurred during postoperative rehabilitation.To conclude,the application of universal stepwise functional rehabilitation model of quadriceps femoris muscle in the early postoperative period of intertrochanteric formal fracture is helpful for the recovery of hip joint function,increasing muscle strength,and promoting fracture healing to a certain extent.