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.

Objective To investigate the short- and long-term prognoses and the risk factors affecting “textbook outcome” (TO) after laparoscopic pancreaticoduodenectomy (LPD) for pancreatic ductal adenocarcinoma (PDAC). Methods The clinical and follow-up data of patients diagnosed with PDAC and treated with LPD from January 2019 to December 2022 were retrospectively analyzed. The prognosis was compared between TO and non-TO groups, and univariate and multivariate logistic regression analyses were used to identify independent prognostic factors for TO. Results A total of 284 patients were enrolled in this study, including 185 cases in the TO group and 99 cases in the non-TO group. The 1-, 3- and 5-year overall survival (OS) rates of the TO and non-TO groups with PDAC were 87.3% vs. 85.9%, 52.5% vs. 38.4%, and 18.0% vs. 4.5%, respectively (P=0.020); the recurrence-free survival (RFS) rates were 74.1% vs. 65.7%, 27.1% vs. 21.0%, and 10.0% vs. 0%, respectively (P=0.042). Multivariate logistic regression analysis showed that operation time >360 min (OR=0.561, 95%CI: 0.321-0.979, P=0.042), intraoperative blood loss >400 ml (OR=0.392, 95%CI: 0.175-0.879, P=0.023), hard or tough texture of pancreas (OR=2.240, 95%CI: 1.247-4.022, P=0.007), and main pancreatic duct diameter >3 mm (OR=1.931, 95%CI: 1.126-3.312, P=0.017) were independent prognostic factors for TO. Conclusion After the learning curve, more than 60% of patients with PDAC can achieve TO after LPD. The chances of achieving TO are significantly reduced when the operation time >360 min, the intraoperative blood loss >400 ml, the texture of pancreas was soft, and the diameter of the main pancreatic duct >3 mm.

Objective To explore the possible mechanism of emodin in inhibiting proliferation,migration,and invasion of AGS cells and in suppressing the expressions of YAP1 and FOXD1.Methods Normal gastric cell GES-1 and gastric cancer cell AGS were cultured with different concentrations of emodin.CCK8 test,scratch test and Transwell assay were used to verify changes in the biological phenotype of AGS cells.TCGA database was applied to analyze expressions of HK2,YAP1 and FOXD1 in gastric cancer tissues and normal gastric tissues.Western blotting method was used to detect the impacts of emodin on HK2,YAP1 and FOXD1 proteins in AGS cells.Exogenous pyruvic acid was added to verify the changes in YAP1 and FOXD1.Results The IC50 of emodin was significantly higher in GES-1 cells than in AGS cells(P<0.05).CCK8 proliferation test,scratch test,and Transwell assay showed that emodin significantly inhibited the biological abilities of AGS(P<0.05 for comparisons).Analysis on the TCGA bioinformatics database found that the expression of key enzymes HK2 in the glycolysis pathway and oncogenes YAP1 and FOXD1 was significantly higher in gastric cancer tissues than in normal gastric tissues(P<0.05 for comparisons).Emodin significantly inhibited the protein expressions of key glycolytic enzymes HK2 and oncogenes YAP1 and FOXD1(P<0.05 for comparisons).With supplement of exogenous glycolytic metabolite pyruvate,the protein expressions of oncogenes YAP1 and FOXD1 significantly increased(P<0.05 for comparisons).Conclusions Emodin has a significant pharmacological inhibitory effect on gastric cancer AGS cells,markedly suppressing their biological phenotype.Emodin not only significantly inhibits the key enzyme HK2 in glycolysis metabolism,but also the protein expressions of oncogenes YAP1 and FOXD1.With the addition of exogenous pyruvate to enhance the glycolytic metabolic pathway,the protein expressions of oncogenes YAP1 and FOXD1 significantly increased.The above results suggest a close association of YAP1 and FOXD1 with glycolytic metabolism.Emodin may inhibit oncogenes YAP1 and FOXD1 through the glycolytic metabolism of gastric cancer AGS cells.

Objective To analyze the imaging manifestations of malignant transformation of ovarian mature teratoma.Methods The clinical data and CT and MRI imaging findings of four patients confirmed as malignant transformation of ovarian mature teratoma by operation and pathology were analyzed retrospectively.The following imaging features were assessed:size,shape,texture,enhancement degree and pattern,et al.Results Among the four cases,three lesions were located in the left ovary and one in the right ovary.The minimum size and maximum size were 87 mm×80 mm×87 mm and 171 mm×141 mm×215 mm,respectively.All of the lesions showed as round-like or ovoid cystic masses with fat-fluid level(4/4),and floating mixed density or signal masses(2/4).The demonstrated local thickening of the cyst wall(2/4)and/or soft mass growing across the wall(3/4),with significant inhomogeneous enhancement(2/3).Conclusion The malignant transformation of ovarian mature teratoma often presents as a cystic mass with fat-fluid level,and local thickening or soft mass of the cyst wall,with significant enhancement.It should be considered in the elderly patients with abnormal tumor markers and above imaging features.

The contents, application progress, application effect and optimization strategy of group pregnancy health care model were reviewed, in order to provide reference for the establishment of standardized intervention and health management practice strategies of rural women′s pregnancy care in line with China′s national conditions.

【Objective】 To explore the safety of transrectal ultrasound-guided transperineal injection of sodium hyaluronate to expand the Dirichlet gap in laparoscopic radical prostatectomy. 【Methods】 A total of 14 healthy male purebred beagle dogs were selected and randomly divided into 2 groups, with 7 in either group.The control group was treated with conventional laparoscopic radical prostatectomy, while the experimental group was treated with laparoscopic radical prostatectomy after 2.5 mL sodium hyaluronate was injected into the Dirichlet gap under the guidance of transrectal ultrasound.The total operation time, prostate separation time, intraoperative blood loss and rectal status of the 2 groups were observed. 【Results】 After the injection of sodium hyaluronate into the Dirichlet gap between the prostate and the rectum, no rectal tissue was found in the prostate, and no obvious damage was found in the posterior rectum in either groups.The postoperative hemoglobin (HGB) was [(118.70±2.56) g/L vs.(122.10±2.19) g/L, P=0.02]; the total operation time was [(141.40±9.80) min vs.(119.10±9.16) min, P<0.05]; the prostate separation time was [(24.99±1.75) min vs.(16.64±2.34) min, P<0.05]; the amount of bleeding was [(47.43±4.32) mL vs.(34.86±5.18) mL, P<0.05] in the control group and experimental group. 【Conclusion】 Laparoscopic radical prostatectomy performed after 2.5 mL of sodium hyaluronate injection into the Dirichlet gap under the guidance of transrectal ultrasound can shorten the total operation time, the separation and resection time of the prostate, and reduce the amount of bleeding, which can improve and reduce the incidence of rectal injury, and prove the feasibility of this approach for prostatic cancer.

Objective:To investigate the value of the nomogram based on quantitative parameters of dual-layer detector spectral CT and conventional CT features in preoperatively predicting tumor deposits (TDs) in colorectal cancer.Methods:This study was a case-control study. A total of 126 patients with pathologically confirmed colorectal cancer who underwent preoperative spectral CT scan from January 2022 to March 2023 in the First Affiliated Hospital of Soochow University were enrolled retrospectively. Patients were divided into TDs-positive group ( n=38) and TDs-negative group ( n=88) based on pathological results. The following conventional CT features were assessed: cT stage, cN status, uniformity of enhancement in the venous phase, pericolorectal fat invasion (PFI), maximum tumor diameter, and tumor location. The following quantitative parameters were also measured and calculated: the normalized iodine concentration (NIC) of lesions, the normalized effective atomic number (NZ eff), and the slope of the 40-100 keV spectral curve (K) in the arterial and venous phases, and the difference in NIC between the arterial and venous phases. Multivariate logistic regression analysis was used to select independent predictors of TDs and the nomogram based on spectral CT quantitative parameters and conventional CT features was constructed. The receiver operating characteristic curve was performed to evaluate the diagnostic performance of each parameter and model. DeLong test was used to compare the differences of area under the curve (AUC). Results:Statistically significant differences were found between the TDs-positive and TDs-negative groups for the cT stage, cN status, uniformity of enhancement in the venous phase, PFI, NIC, NZ eff, K in the venous phase and the difference in NIC between the arterial and venous phases ( P<0.05). After multivariate logistic regression analysis, the conventional CT feature model incorporated two features: uniformity of enhancement in the venous phase (OR=9.602, 95% CI 3.728-24.734, P=0.001) and PFI ( OR=2.881, 95% CI 1.177-7.049, P=0.020). The combined model of conventional CT features and spectral CT quantitative parameters incorporated three features: the difference in NIC between the arterial and venous phases ( OR=37.599, 95% CI 8.320-169.912, P=0.001), uniformity of enhancement in the venous phase ( OR=14.978, 95% CI 3.848-58.295, P=0.001), and PFI ( OR=4.013, 95% CI 1.320-12.760, P=0.015), and the nomogram was constructed. The AUC, sensitivity, and specificity of the nomogram for predicting TDs were 0.919 (95% CI 0.865-0.973), 84.2%, and 86.5%, respectively. The AUC of the conventional CT feature model was 0.796 (95% CI 0.707-0.885), which was lower than that of the nomogram, and the difference was statistically significant ( Z=3.87, P=0.001). Conclusion:Dual-layer spectral detector CT can be used to predict TDs in colorectal cancer preoperatively, and the nomogram based on quantitative parameters of dual-layer detector spectral CT and conventional CT features shows good diagnostic performance.

Objective Investigation of the expression and clinical significance of circular RNA hsa_circ_0003922 in endometrioid carcinoma(EEC).Methods Three EEC tissues and three normal endometrial tissues were selected for high-throughput molecular sequencing to identify specific circRNAs and related functional molecules.Additionally,36 EEC patients were selected as the experimental group,while 36 patients with benign uterine lesions served as the control group.The differentially expressed hsa_circ_0003922 was chosen as the research target,and its expression in EEC tissues and the control group was detected using real-time fluorescence quantitative PCR(RT-qPCR).The relationship between its expression level and clinical pathological features of EEC was analyzed.Furthermore,the miRNAs associated with hsa_circ_0003922 were predicted.The receiver operating characteristic(ROC)curve analysis was employed to evaluate the diagnostic value of hsa_circ_0003922 for EEC.Results The results of high-throughput molecular sequencing showed that there were 293 differentially expressed circRNAs in EEC tissues compared to the control group,including 115 upregulated and 178 downregulated circRNAs.RT-qPCR further revealed that the expression of hsa_circ_0003922 was significantly decreased in EEC tissues compared to the control group(P<0.05).The expression level of hsa_circ_0003922 was significantly negatively correlated with FIGO staging and histological grading of EEC(P<0.05).The area under the ROC curve(AUC)for hsa_circ_0003922 in distinguishing EEC patients from the control group was 0.7724(P<0.05).Conclusion The expres-sion of hsa_circ_0003922 is associated with FIGO staging and histological grading of EEC,indicating its potential as a reference index for auxiliary diagnosis,prognosis evaluation,and as a potential molecular target for adjuvant therapy in EEC.

Objective To explore the gene expression profile in paraspinal muscle degeneration(PMD)and identify key ferroptosis genes.Methods RNA sequencing was performed on paraspinal muscle tissue of 3 normal and 3 PMD patients respectively to obtain differentially expressed genes.Through protein-protein interaction(PPI)and gene functional enrichment analysis,the intersection of ferroptosis genes was identified to identify key hub genes associated with ferroptosis.The diagnostic value for PMD disease was analyzed by receiver operating characteristic(ROC)curves.Results A total of 292 differentially expressed genes were identified in PMD.Among them,125 genes were significantly downregulated and 167 genes were significantly upregulated.Bioinformatics analysis revealed that 14 differentially expressed genes were associated with ferroptosis.Among them,ferroptosis genes MUC1,ATF3 and CDKN1A were key hub genes with good specificity and sensitivity for diagnosing PMD.Functional enrichment analysis revealed that they may mediate the occurrence and progression of PMD by regulating cell apoptosis,ferroptosis and skeletal muscle tissue development and differentiation.Conclusion Ferroptosis genes MUC1,ATF3 and CDKN1A can serve as biomarkers for diagnosing PMD,providing theoretical basis for decoding the pathological mechanism of PMD and developing new drugs.