Objective: To retrospectively compare the impact of different intraoperative transfusion strategies for platelets and cryoprecipitate on perioperative blood usage and clinical outcomes in patients undergoing orthotopic heart transplant (OHT), thereby providing a reference for perioperative patient blood management. Methods: The clinical data of 65 patients who had undergone OHT at our hospital between 2020 and 2025 were retrospective collected. Patient demographics, underlying chronic conditions, and perioperative (preoperative, intraoperative, and postoperative) laboratory blood test results were analyzed. The transfusion volumes of intraoperative red blood cells, plasma, platelets, and cryoprecipitate were examined. Univariate and multivariate logistic regression models were employed to identify factors associated with perioperative outcomes. Results: A total of 65 patients received allogeneic blood transfusion during the perioperative period. The ultilization of intraoperative platelets and cryoprecipitate was as follows: simultaneous transfusion of both platelets and cryoprecipitate (at a 1∶1 ratio) was administered in 42 patients (64.62%), platelets alone in 12 patients (18.46%), and cryoprecipitate alone in 11 patients (16.92%). Patients who received simultaneous transfusion of platelets and cryoprecipitate (1∶1) (n=42) had a shorter ICU length of stay (32.45±10.18 d), while those who received either platelets or cryoprecipitate alone (n=23) had a significantly longer ICU length of stay (68±15.97 d). Patients receiving simultaneous intraoperative transfusion of platelets and cryoprecipitate also required fewer units of allogeneic red blood cells intraoperatively (median=4 units) and had a lower mortality rate (16.7%) than those receiving either product alone (26.1%), with a statistically significant difference (P=0.023). Multivariate logistic regression analysis indicated that the volume of cryoprecipitate transfused was an independent protective factor against postoperative allogeneic red blood cell transfusion (OR=0.344, 95% CI [0.177, 0.829], P=0.0159). Multivariate logistic regression also identified cryoprecipitate transfusion volume as an independent protective factor for ICU length of stay (OR=0.877, 95% CI [0.719, 0.986], P=0.0008), which was in line with the multivariate Cox regression results. Conclusion: In patients undergoing OHT, the intraoperative transfusion strategy for platelets and cryoprecipitate influences the volume of perioperative allogeneic red blood cell transfusion and patient mortality. Intraoperative cryoprecipitate transfusion volume is an independent protective factor against both postoperative allogeneic red blood cell transfusion and prolonged ICU length of stay. The establishment of a multidisciplinary collaborative blood management model, combined with the modification of perioperative blood utilization practices and the implementation of a comprehensive patient blood management strategy, can holistically ensure perioperative patient safety.

Objective To evaluate the safety and efficacy of CT-guided percutaneous transhepatic gallbladder drainage(PTGBD)in treatment of high-risk acute cholecystitis(AC)patients.Methods CT-guided PTGBD was performed in 29 patients with high-risk AC.The therapeutic results were evaluated by comparing the preoperation and postoperation clinical manifestations and laboratory results.Results The implantation of PTGBD catheter was successfully accomplished with single procedure in all patients.Complica-tions occurred in 2 cases,including abdominal pain in 1 case and a small amount of gallbladder bleeding in 1 case,and the incidence of complications was 6.9%.Compared with preoperation,the pain number rating scale(NRS)score,temperature(T),white blood cell count(WBC),C-reactive protein(CRP),total bilirubin(TBIL),alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were significantly decreased 3 days after PTGBD(P<0.001).Except for 1 case of choledocholithiasis with continuous abdominal pain after PTGBD,the postoperation symptoms of the other patients were significantly relieved.Followed up for 3 months,2 cases of calculous AC recurred after PTGBD,and the recurrence rate of cholecystitis was 25.0%.Conclusion For high-risk AC,the CT-guided PTGBD is a safe and effective treatment method,and it can remarkably relieve the clinical symptoms.Patients with calculous AC have higher risk of recurrence and might benefit from definitive cholecystectomy.

BACKGROUND:De novo adipose regeneration induced by small extracellular vesicles has become a promising method for repairing soft tissue defects.However,due to different animal models and small extracellular vesicle application dosages,it is difficult to quantitatively compare the therapeutic effect of small extracellular vesicles from various sources on adipose regeneration. OBJECTIVE:To compare the regenerative effects of small extracellular vesicles derived from stem cells and small extracellular vesicles from tissue. METHODS:Small extracellular vesicles derived from adipose-derived stem cells and from adipose tissue were isolated by ultracentrifugation.The particle number,particle size,morphology,and protein expression of small extracellular vesicles were identified by nanoparticle tracking analysis,transmission electron microscopy and western blot assay.A quantitative and evaluative subcutaneous model for adipose regeneration in C57 mice was established using a customized silicone tube.The regenerative effects of induced de novo adipose were compared by cell counting and hematoxylin-eosin staining. RESULTS AND CONCLUSION:(1)Small extracellular vesicles derived from adipose-derived stem cells and from adipose tissue were isolated by ultracentrifugation.Both small extracellular vesicles were round-shape in transmission electron microscopy with particle size between 50-200 nm,and abundant with the small extracellular vesicles marker protein CD81,CD63 and TSG101.(2)An equal number of small extracellular vesicles were mixed with matrigel in customized silicone tubes,implanted subcutaneously in the back of mice to establish a cell-free and quantifiable adipose regeneration model.(3)On days 3 and 7 after implantation,the results of cell counting and hematoxylin-eosin staining showed that both small extracellular vesicle groups recruited more host cells than the blank group,and the small extracellular vesicles derived from adipose tissue group were superior to the small extracellular vesicles derived from adipose-derived stem cell group.(4)4 weeks after implantation,hematoxylin-eosin staining of the contents in silicone tubes showed that small extracellular vesicles induced de novo adipose regeneration in vivo,and the small extracellular vesicles derived from adipose tissue group were superior to the small extracellular vesicles derived from adipose-derived stem cell group.The above results indicated that small extracellular vesicles derived from tissues have a superior effect on inducing de novo adipose regeneration compared to small extracellular vesicles derived from stem cells.

Traditional Chinese medicine （TCM） pharmacology （PTCM） is a discipline that studies the interactions between Chinese medicines and the human body， as well as their underlying mechanisms， under the guidance of TCM theories while employing modern scientific techniques and methods. This article reviews the historical development and achievements of the PTCM discipline at the Institute of Chinese Materia Medica， China Academy of Chinese Medical Sciences， and outlines the reform measures undertaken in recent years to advance the construction of the graduate course system in PTCM. Building upon the foundation of the "Special Topics in PTCM" course， the curriculum has been expanded through reforms to include a series of self-designed courses， such as foundational advanced courses， experimental pharmacology courses， pharmacological research tools courses， and applied TCM research courses. Along with enriching the graduate course system， the study explores innovative approaches and methods for graduate education and teaching in PTCM， and reflects on the challenges in course system construction and teaching， serving as a reference for improving the quality of graduate training， promoting the development of the PTCM discipline， and advancing teaching reform practices.

Background: Immunochemotherapy has demonstrated a promising efficacy for a variety of B-cell lymphoma but has limited efficacy for Epstein–Barr virus-positive (EBV +) diffuse large B-cell lymphoma (DLBCL) that is refractory or relapsed to conventional chemotherapy regimens. Considering higher programmed death-ligand 1 (PD-L1) expres‑ sion in the subset of patients with DLBCL with positive EBV, we speculated that PD-1 inhibitors plus chemotherapy may be an alternative regimen in patients with refractory/relapsed EBV + DLBCL. Methods: This retrospective study included six adult patients diagnosed with refractory EBV + DLBCL resistant to first-line immunochemotherapy regimens (R-CHOP). These patients received PD-1 inhibitors plus chemotherapy as second-line treatment. Results: The final analysis included six patients (four men and two women (median age, 50 years; range, 39–83 years)). Four patients were diagnosed with Epstein–Barr virus (EBV) + DLBCL, and two had DLBCL associated with chronic inflammation. Over a median follow-up of 20 months (range, 2–31 months), the objective response rate was 83% (5/6) and the complete remission rate was 67% (4/6). No severe immune-related adverse reactions occurred, and only a mild rash was reported, which did not necessitate the discontinuation of therapy. Conclusion The combination of PD-1 inhibitors and chemotherapy offers promising results as a second-line treat‑ ment for patients with refractory EBV + DLBCL that is resistant to first-line immunochemotherapy regimens. These preliminary findings warrant further investigation in larger clinical trials to validate the efficacy and safety of this therapeutic approach.

Objective:To retrieve, evaluate, and integrate the best evidence for early ambulation in patients undergoing open lumbar surgery.Methods:A systematic search was conducted in databases including UpToDate, British Medical Journal (BMJ) Best Practice, Guidelines International Network (GIN), The National Institute for Health and Care Excellence (NICE), The Agency for Healthcare Research and Quality (AHRQ), Scottish Intercollegiate Guidelines Network (SIGN), Registered Nurses' Association of Ontario (RNAO), Medlive, North American Spine Society (NASS), Best Practice in General Surgery Group from the University of Toronto, ERAS? Society, PubMed, Embase, Web of Science, Medline, CNKI, and Wanfang. The search included literature on early ambulation post-open lumbar surgery, such as guidelines, expert consensus, evidence summaries, recommended practices, systematic reviews, and high-quality original research. The search period was from January 1, 2014, to June 20, 2023. Two researchers independently evaluated the quality of the literature and extracted relevant data.Results:A total of 23 articles were included, comprising three guidelines, two systematic reviews, six expert consensus statements, seven randomized controlled trials, one quasi-experimental study, and four cohort studies. The evidence was categorized into six themes: multidisciplinary team collaboration, health education, facilitation measures, pre-activity assessment, activity content, and safety assurance, resulting in 25 evidence-based recommendations.Conclusions:This study summarizes 25 best evidence-based recommendations for early ambulation in patients undergoing open lumbar surgery. Healthcare providers are advised to apply these recommendations in clinical practice while considering the specific clinical context and individual patient differences. Multidisciplinary collaboration is essential to develop personalized early ambulation plans.

Objective:To explore the correlation between defecation disorders and diet in patients undergoing sphincter-preserving surgery for rectal cancer.Methods:This study was a cross-sectional survey. From 2021 to 2023, convenience sampling was used to select 159 patients with rectal cancer who underwent sphincter-preserving surgery at Peking University Third Hospital as participants. The General Information Questionnaire, Food Frequency Questionnaire, and Defecation Questionnaire were used for the survey.Results:The incidence of defecation disorders in 159 patients with rectal cancer after sphincter-preserving surgery was 74.2% (118/159), and the types of defecation disorders with high to low incidence were "frequent defecation (96/159, 60.4%) " "constipation (37/159, 23.3%) " "diarrhea (33/159, 20.8%) " and "fecal incontinence" (24/159, 15.1%). Diets were clustered into 9 categories (vegetables and fruits, carbohydrate staple foods, red meat foods, gas producing foods, dairy products, white meat foods, dessert foods, high-fat foods, and spicy and stimulating foods). Binomial Logistic regression analysis showed that red meat foods and gas producing foods were the influencing factors of frequent defecation ( P<0.05), red meat foods was the influencing factor of diarrhea ( P<0.05), and carbohydrate staple foods was the influencing factor of fecal incontinence ( P<0.05) . Conclusions:The incidence of defecation disorders in patients with rectal cancer after sphincter-preserving surgery is relatively high, and the intake of red meat foods, gas producing foods, and carbohydrate staple foods should be appropriately controlled. Clinical medical and nursing staff should pay close attention to the diet of elderly patients.

Objective:To explore the incidence of low anterior resection syndrome (LARS) in patients undergoing sphincter-preserving surgery for rectal cancer and analyze related factors.Methods:This study was a cross-sectional survey. From 2021 to 2023, convenience sampling was used to select 195 patients with rectal cancer who underwent sphincter-preserving surgery at Peking University Third Hospital as participants. The patients were surveyed using the General Information Questionnaire, LARS Scale, Visual Analog Score, and Chinese version of Insomnia Severity Index.Results:A total of 195 questionnaires were distributed, and 156 valid questionnaires were collected, with a valid response rate of 80.00% (156/195). The incidence of LARS in 156 rectal cancer patients with sphincter-preserving surgery was 36.54% (57/156), and the incidence of severe LARS was 15.38% (24/156). Binomial Logistic regression analyses showed that gender ( OR=0.445, P=0.034) and preoperative neoadjuvant chemoradiotherapy ( OR=6.343, P<0.01) were influencing factors for the occurrence of LARS in patients with rectal cancer after sphincter-preserving surgery. Preoperative neoadjuvant chemoradiotherapy ( OR=3.322, P=0.047) and intraoperative prophylactic stoma ( OR=4.855, P=0.035) were influencing factors for severe LARS. LARS score was positively correlated with anxiety score ( r=0.238, P=0.003) and total insomnia score ( r=0.168, P=0.036) in patients with rectal cancer who underwent sphincter-preserving surgery. Conclusions:Preoperative neoadjuvant chemoradiotherapy is an independent risk factor for postoperative LARS and severe LARS in rectal cancer patients undergoing sphincter-preserving surgery. LARS is correlated with patients' anxiety and insomnia.

Objective:To investigate the types and number of symptom clusters in patients undergoing sphincter-preserving surgery for rectal cancer and explore the influencing factors of these symptom clusters.Methods:Totally 192 patients who underwent sphincter-preserving surgery for rectal cancer in the Department of General Surgery at Peking University Third Hospital between January 2021 and January 2023 were selected by convenience sampling. A general information questionnaire, Post-sphincter-preserving Surgery Symptom Questionnaire, and the International Physical Activity Questionnaire-Short Form (IPAQ-SF) were used for data collection.Results:A total of 192 questionnaires were distributed, with 159 valid questionnaires returned. Exploratory factor analysis on 18 symptoms with an incidence rate of over 10.0% identified five primary symptom clusters: the psychological symptom cluster, increased defecation cluster, fatigue-pain cluster, sleep disturbance cluster, and constipation-related cluster. Logistic regression analysis showed that postoperative duration was an influencing factor for the psychological symptom cluster ( P<0.05) ; preoperative radiotherapy and postoperative duration were influencing factors for the increased defecation cluster ( P<0.05) ; postoperative chemotherapy was an influencing factor for the fatigue-pain cluster ( P<0.05) ; and weekly sedentary time was an influencing factor for the sleep disturbance cluster ( P<0.05) . Conclusions:Patients undergoing sphincter-preserving surgery for rectal cancer experience multiple symptom clusters. Preoperative radiotherapy and prolonged sedentary behavior increase the risk of symptom clusters, and different postoperative periods are associated with varying risks for different symptom clusters. However, physical activity levels do not appear to influence the occurrence of symptom clusters. Healthcare providers should implement targeted interventions based on the symptom clusters and their influencing factors to reduce the incidence of symptoms in patients.

Background and purpose:Primary adrenal intravascular large B-cell lymphoma(IVLBCL)is rare and highly aggressive.Unfortunately,comprehensive and sufficient understanding of the disease is lacking.This study investigated the clinicopathological and molecular genetic characteristics of adrenal IVLBCL.Methods:Adrenal IVLBCL cases diagnosed from 2012 to 2023 were collected from Department of Pathology,Fudan University Shanghai Cancer Center.The clinical and histopathological features,immunophenotype,treatment and prognosis were analyzed.The molecular genetic characteristics were detected using next-generation sequencing(NGS).This study was approved by the Ethics Committee of Fudan University Shanghai Cancer Center(Ethics number:050432-4-2307E).Results:All of the 5 patients were male,with median age 52 years(ranged 50-82 years).Two cases had low-grade fever,1 case had abdominal pain,1 case was found by physical examination,and the information of the remaining one was unknown.Peripheral blood test showed elevated serum lactate dehydrogenase in 2 cases and adrenal dysfunction in 2 cases.On initial diagnosis,imaging tests displayed adrenal enlargement or masses with increased fluorodeoxyglucose(FDG)uptake.Bilateral adrenal glands were involved in 4 cases and only the right adrenal gland was involved in the other case.Morphologically,large atypical lymphocytes were confined to blood vessels,and fibrinous necrosis was observed in some cases.Immunohistochemical study revealed that CD20 was positive in all cases.Ki-67 proliferation index was high,all above 80%.80%(4/5)of the cases were of non-germinal-center B-cell-like(non-GCB)phenotype,100%(4/4)of the cases had MYC/BCL2 double expression.Endothelial cell markers staining indicated that most of the tumor cells were confined within the blood vessels in all cases.Follow-up data were available in 3 patients.One patient who underwent only surgical resection died 5 months after diagnosis,one achieved complete remission after surgery plus R-CHOP,and the other diagnosed by biopsy achieved a partial remission after R-CHOP.The 1-year overall survival rate was 66.7%,and overall survival was 5-87 months.NGS testing in 1 case showed missense mutations in MYD88 V217F,TP53,CDH1,ARID1B,MSH3,MLH3,PTPRK,CD22 and FLCN.Conclusion:Adrenal IVLBCL is rare and tends to occur in the middle-aged and elderly male.The majority of our patients were non-GCB phenotype,often accompanied by MYC/BCL2 double expression,and MYD88 non-L265P mutation was detected.Early diagnosis of adrenal IVLBCL is difficult due to its diverse clinical symptoms and lack of specificity.It is of great importance to accumulate more cases and further understand the clinicopathological and molecular genetic characteristics of this rare disease,which might not only help with early diagnosis,timely treatment and improvement of prognosis,but also provide a theoretical basis for further understanding the pathogenesis and development of the disease and exploring therapeutic targets.