Objective To preliminarily investigate the safety and efficacy of donor pancreas needle biopsy in simultaneous pancreas-kidney transplantation. Methods Clinical data of 7 cases undergoing donor pancreas biopsy were collected retrospectively. All cases underwent donor pancreas biopsy before or during simultaneous pancreas-kidney transplantation. Frozen section or paraffin sectioning techniques were used for tissue preparation, and hematoxylin-eosin and Masson staining were performed to histologically evaluate the donor pancreas. The quality of donor pancreas was comprehensively assessed by combining histological findings with the donor's clinical data. Postoperative follow-up data of 5 simultaneous pancreas-kidney transplant recipients were collected to summarize the safety of donor pancreas biopsy and the prognosis of transplant recipients. Results The 7 pancreas donors were aged 28 to 62 years, with a body mass index ranging from 20.76 to 27.68 kg/m². Liver ultrasound indicated fatty liver in 3 cases, while pancreatic ultrasound did not reveal any significant abnormalities. Among them, biopsy was performed on 2 donors after completion of pancreatic procurement and processing, and the frozen section histology showed moderate acute pancreatitis changes (edema of acinar cells, necrosis and inflammatory cell infiltration). Combined with a serum amylase level elevated more than 3 times the upper limit of normal value, these two donor pancreases were finally discarded. The remaining 5 cases underwent biopsy immediately after pancreatic vascular anastomosis during simultaneous pancreas-kidney transplantation, and histological evaluation was performed on paraffin-embedded sections. No biopsy-related complications (such as bleeding, pancreatic fistula, etc.) occurred after transplantation. One recipient died of severe infection 2 months after transplantation, while the other 4 recipients were followed up for more than 5 years, with well-functioning transplant kidneys and pancreases. Conclusions Donor pancreas biopsy is relatively safe, and the risk of biopsy-related complications after transplantation is controllable. Comprehensive assessment of donor pancreas quality by combining histological evaluation with the donor's clinical indicators is conducive to improving the accuracy of donor pancreas selection and organ utilization.

Objective To investigate the relationship between serum metalloproteinase-2(MMP-2),total antioxi-dant capacity(T-AOC),C-reactive protein(CRP),and recurrence in inguinal hernia(IH)patients with postoperative laparoscopic total extraperitoneal repair(TEP),as well as their predictive value.Methods A total of 122 IH pa-tients undergoing TEP in the First Affiliated Hospital of Xi'an Jiaotong University from January 2019 to De-cember 2022 were selected as the observation group,and 122 healthy subjects during the same period were se-lected as the control group.The patients were followed up for 10 months,and were divided into relapse group(n=37)and recovery group(n=85)according to their recurrence situation.Serum MMP-2 levels were detec-ted by automatic biochemical analyzer,T-AOC levels were determined by chemical colorimetric method,and CRP levels were assessed by enzyme-linked immunosorbent assay.The influencing factors of TEP recurrence in IH patients were analyzed by Logistic regression.The predictive value of serum MMP-2,T-AOC and CRP for postoperative TEP recurrence in IH patients was analyzed by receiver operating characteristic(ROC)curve.Results Serum MMP-2 and CRP levels in observation group were significantly higher than those in control group(P＜0.05),and T-AOC levels were significantly lower than those in control group(P＜0.05).MMP-2 and CRP in relapse group were significantly higher than those in recovery group(P＜0.05),and T-AOC level was lower than that in recovery group(P＜0.05).The area under the curve(AUC)of serum MMP2,T-AOC and CRP in pre-dicting TEP recurrence in IH patients were 0.775,0.804 and 0.731,respectively,and the AUC of the combined pre-diction of the three was 0.887,which was better than that of each indicator alone(Z=2.597,1.983,3.275,P=0.009,0.047,0.001).Conclusion Serum levels of MMP-2,T-AOC and CRP in IH patients with postoperative TEP recurrence significantly increase,which can be used as effective indicators to predict the postoperative TEP recurrence in IH patients,and the combined prediction efficiency of the three is higher.

Objective:To investigate the characteristics of weight gain in the mid and late pregnancy of women with early pregnancy weight loss, and the relationship between weight gain and weight gain rate before the diagnosis of gestational diabetes mellitus (GDM) and GDM.Methods:A retrospective study was conducted on 2 614 singleton pregnant women who underwent prenatal care and delivered at Beijing Obstetrics and Gynecology Hospital, Capital Medical University, from January 2014 to December 2021, and whose weight decreased compared to pre-pregnancy weight by 16 weeks of gestation. The rate of weight gain in mid and late pregnancy, also weight gain and weight gain rate at each stage were analyzed. Multivariate logistic regression was used to analyze the impact of total weight gain and weight gain rate at each stage before the diagnosis of GDM on the risk of GDM.Results:The rates of weight gain in mid and late pregnancy for women with early pregnancy weight loss who were underweight, normal weight, overweight, and obese before pregnancy were (0.60±0.15), (0.59±0.18), (0.53±0.20), and (0.42±0.20) kg/week, respectively, all higher than the "Chinese Recommended Standards for Weight Gain During Pregnancy" [which are (0.37-0.56), (0.26-0.48), (0.22-0.37), and (0.15-0.30) kg/week, respectively]. The weight gain rates at each stage of mid and late pregnancy in women with early pregnancy weight loss showed a "bimodal" trend, with the first peak in weight gain rate occurring at 16-20 or 20-24 weeks of gestation [weight gain rates for underweight, normal weight, overweight, and obese women before pregnancy were 0.75 kg/week (0.44-1.00 kg/week), 0.74 kg/week (0.50-1.00 kg/week), 0.63 kg/week (0.39-0.86 kg/week), and 0.50 kg/week (0.25-0.74 kg/week), respectively] and the second peak occurring at 28-32 weeks [weight gain rates for underweight, normal weight, overweight, and obese women before pregnancy were 0.63 kg/week (0.50-1.00 kg/week), 0.63 kg/week (0.38- 0.88 kg/week), 0.60 kg/week (0.25-0.88 kg/week), and 0.50 kg/week (0.22-0.75 kg/week). As of 28 weeks and 36 weeks of gestation, 53.7% (1 404/2 614) and 77.4% (1 946/2 512) of pregnant women, respectively, reached the lower limit of the recommended weight gain for the corresponding gestational weeks. No association was found between insufficient weight gain ( aOR=0.828, 95% CI: 0.639-1.071, P=0.151) or excessive weight gain ( aOR=0.936, 95% CI: 0.598-1.465, P=0.773) before the diagnosis of GDM and the risk of GDM. However, obese women with a weight loss greater than 5% of their pre-pregnancy weight in early pregnancy and a rapid weight gain rate (> P 75) between 16-20 weeks of gestation had an increased risk of developing GDM ( aOR=32.870, 95% CI: 1.625-664.775, P=0.023). Conclusions:In clinical practice, dynamic monitoring of weight changes at various stages of pregnancy in women who lose weight in early pregnancy is recommended. Targeted weight management during mid-pregnancy for women who are obese before pregnancy and experience significant weight loss in early pregnancy may help prevent excessive gestational weight gain and decrease the risk of GDM.

Objective:To evaluate the efficacy of modified splenic arteriovenous shunt surgery at the distal pancreatic tail in combined pancreas-kidney transplantation.Methods:A retrospective analysis was conducted on 24 recipients who underwent combined pancreas-kidney transplantation with the modified splenic arteriovenous shunt at the pancreatic tail from November 2023 to October 2024 (shunt group) and 231 recipients who received conventional splenic artery and vein ligation since 2016 (ligation group). The incidence of perioperative thrombosis and severe adverse events was compared between the two groups using the chi-square test or Fisher's exact test. Independent sample t-tests were performed to assess postoperative pancreatic and renal function recovery as well as blood perfusion in 15 recipients from the shunt group and 20 from the ligation group who underwent CT perfusion imaging (CTP).Results:The incidence of perioperative splenic arteriovenous thrombosis was lower in the shunt group (0) compared to the ligation group (4.76%, 11/231), though the difference was not statistically significant ( P=0.606). One month postoperatively, the shunt group demonstrated significantly lower serum amylase levels than the ligation group (99.61±19.62 vs. 148.20±70.67 U/L, P=0.018). However, at the time of CTP examination, serum lipase (67.87±32.35 vs. 45.11±17.94 U/L, P=0.014) and creatinine levels (131.79±26.41 vs. 112.1±24.98 μmol/L, P=0.034) were significantly higher in the shunt group. Urea nitrogen levels were also significantly higher in the shunt group both one month postoperatively (11.24±4.64 vs. 8.51±3.01 mmol/L, P=0.043) and at the CTP examination (10.41±1.78 vs. 6.87±1.91 mmol/L, P=0.001). Regarding pancreatic perfusion, blood volume in both the pancreatic head (15.99 ± 3.51 vs. 20.67 ± 5.47 ml/100 g, P = 0.024) and tail (17.19±4.24 vs. 27.40±19.80 ml/100 g, P=0.039) was significantly lower in the shunt group. After one minute of splenic artery perfusion, the shunt group exhibited significantly higher splenic artery blood flow (755.85±101.50 vs. 574.00 ± 142.06 ml·min -1· (100 g) -1, P<0.001) and blood volume (58.90 ±19.93 vs. 23.21±17.02 ml/100 g, P=0.007) compared to the ligation group. These differences persisted after two minutes of perfusion (blood flow: 793.83±68.57 vs. 503.78 ± 130.80 ml·min -1· (100 g) -1, P<0.001; blood volume: 64.22±15.74 vs. 34.32±20.39 ml/100 g, P=0.002). For the transplanted kidney, the shunt group had significantly lower blood flow (113.10±28.55 vs. 232.76±113.37 ml·min -1· (100 g) -1, P<0.001), blood volume (28.95±10.79 vs. 38.36±12.38 ml/100 g, P=0.047), and capillary surface permeability (PS) (26.49±16.57 vs. 43.02±20.37, P = 0.042) in the upper pole. Similar reductions in blood flow, blood volume, and PS were observed in the middle dorsal region ( P=0.018, 0.021, and 0.048, respectively) and lower pole ( P<0.001, P=0.048, and P=0.012, respectively). Conclusion:The modified splenic arteriovenous shunt at the pancreatic tail appears to be a safe and effective approach to reducing the risk of pancreatic graft thrombosis. This technique facilitates effective diversion of pancreatic parenchymal blood flow into the splenic vein, alleviating hyperperfusion of the transplanted pancreas. While renal blood perfusion was reduced postoperatively, it did not adversely affect renal function.

Objective:To analyze the association between continuity of consultation and the management of glycosylated hemoglobin (HbA1c) in diabetes patients contracted by family doctors.Methods:This study was a cross-sectional study. From May 2022 to October 2022, three community health service centers in the urban area of Beijing were selected by convenient sampling. A total of 360 diabetes patients were selected by simple random sampling from the selected centers. Extraction of data from electronic health records were conducted to collect patient characteristics, information on the continuity evaluation indicators for patient visits (usual provider of care, UPC) in 2021 and information of monitoring and control indicators for HbA1c in 2021. The monitoring and control of HbA1c in patients with different continuity of consultations were compared. Chi-square test and logistic regression analysis were used to determine the association between continuity of consultation and HbA1c management (i.e., HbA1c monitoring and control).Results:Of the 360 patients, 167 (46.4%) were male; the age was 68.0 (60.0, 74.0) years and the number of years since diagnosis was 11.0 (7.0, 17.0) years. One hundred and fifty-nine patients (44.1%) had UPC scores below 30%, 101 patients (28.1%) had UPC scores between 30% and 50%, and 100 patients (27.8%) had UPC scores above 50%. The compliance rate for HbA1c monitoring was 66.4% (239/360), and the compliance rate for HbA1c control was 45.8% (165/360). When the UPC score was less than 30%, between 30%-50%, and greater than 50%, the HbA1c monitoring compliance rates were 53.5% (85/159), 73.3% (74/101), and 80.0% (80/100), respectively, and the HbA1c control compliance rates were 37.7% (60/159), 51.5% (52/101), and 53.0% (53/100), respectively, and the differences were statistically significant ( χ2=22.36, 7.57, P<0.05). As the UPC score increased, the likelihood of achieving HbA1c monitoring ( OR=1.020, 95% CI:1.009-1.030 , P<0.001) and control ( OR=1.012, 95% CI:1.003-1.021 ,P=0.008) targets increased. Conclusion:There is an association between the continuity of consultation and the management of HbA1c.

Objective:To evaluate the reliability and validity of the Chinese version of Consultation and Relational Empathy (CARE) Measure in the Mandarin speaking population.Methods:From March to June 2018, patient interviews and expert consultations were conducted to explore problems of CARE in Mandarin context and preliminary revisions were made to the measure, then the final adapted tool was developed. A questionnaire survey on the validity of the measure was conducted from July to August 2018, among 373 patients from three community health service centers in Beijing Chaoyang District, selected by convenience sampling. The questionnaire included general information of participants and the revised CARE measure. The results of the survey were analyzed for the reliability and validity of Chinese version of CARE measure.Results:In the culture adaptation stage, 30 word-changes and 13 phrase-changes were made to improve the cultural adaptation of CARE. A total of 373 valid questionnaires were were collected with a valid recovery rate of 100.0%. The participants had a mean age of (60.8±13.12) years, with females of 68.6% (256/373), junior high school or high school education of 58.7% (219/373), and retirees of 71.3% (266/373). The results showed that there was a significant difference in scores of each item between the high group (top 27%) and the low group (bottom 27%) ( P<0.001). There was a positive correlation between each item and the total score, with a correlation coefficient between 0.817 and 0.868 ( P<0.001). The reliability analysis results show that the Cronbach′s α of the revised CARE was 0.960. In the content validity analysis, among the 10 items, the proportion of patients who considered the item "not applicable" was between 1.1% and 4.8%, and the proportion who considered the item "important" was between 92.8% and 96.2%. In exploratory factor analysis, KMO=0.944 and Bartlett′s sphericity test P<0.001. One common factor with an eigenvalue>1 was extracted, and the cumulative variance explained by which was 73.85%, with the load value of each item of 0.815-0.909. Conclusion:The revised Chinese version of CARE measure shows good reliability and validity and it can be applied in primary care settings for Mandarin speaking population.

Objective:To analyze the validity of an enhanced nutrition management model for all pregnant women in reducing the incidence of macrosomia.Methods:This retrospective cohort study utilized data from the Beijing Birth Cohort database established by Beijing Obstetrics and Gynecology Hospital, Capital Medical University. A total of 73 193 pregnant women who underwent regular prenatal examinations and delivered at the hospital between January 2018 and December 2023 were consecutively included. From 2018 to 2020, all participants received nutrition education, and high-risk pregnancies predisposed to macrosomia were referred to nutrition clinics for further follow-up. From 2021 to 2023, obstetricians participated in nutritional assessments and gestational weight gain guidance, with repeated nutrition evaluations and education provided during early, mid, and late pregnancy. A multidisciplinary team (obstetrics and nutrition departments) collaborated to implement an enhanced nutrition management model for all pregnant women. General data, parity, gestational age at delivery, neonatal birth weight, and clinical information were collected. Annual incidences of macrosomia and low birth weight were calculated. Chi-square tests and variance analysis were used to analyzed yearly changes in macrosomia rates and evaluate the impact of the two-phase management strategies on macrosomia incidence, thereby to explore the validity of an enhanced nutrition management model for all pregnant women in reducing the incidence of macrosomia.Results:The number of deliveries included annually from 2018 to 2023 was 14 578, 15 413, 11 496, 11 146, 10 396, and 10 164, respectively. Maternal pre-pregnancy body mass indices in 2022 to 2023 were higher than those in 2018 to 2021 [(22.26±3.50) and (22.23±3.65) vs (21.87±3.27), (21.82±3.31), (21.86±3.34) and (21.94±3.39) kg/m2, respectively (all P<0.05)]. Neonatal birth weights in 2021 to 2022 were lower than those in 2018 to 2020 [(3 271±514) and (3 270±513) vs (3 323±504), (3 314±500), and (3 315±510) g], and the birth weight in 2023 was further reduced compared to that in 2018 to 2022 [(3 236±506) vs (3 323±504), (3 314±500), (3 315±510), (3 271±514) and (3 270±513) g] (all P<0.05). The incidence of macrosomia in 2021 to 2022 was lower than those in 2018 to 2020 (5.55%, 5.75% vs 6.97%, 6.68%, 6.67%), and the incidence in 2023 further decreased compared to those in 2018 to 2022 (4.16% vs 6.97%, 6.68%, 6.67%, 5.55%, 5.75%) (all P<0.05). Conclusion:The enhanced nutrition management model for all pregnant women effectively reduces the incidence of macrosomia, demonstrating significant clinical value for widespread implementation.

The study was a prospective observational study. A total of 24 patients who underwent maintenance hemodialysis (MHD) at Haidian Hospital in Beijing from May 2024 to June 2024 were included as the study subjects. The safety and efficacy of a new single-needle dialysis in MHD patients were evaluated. The reasons for using single-needle dialysis included waiting for the maturity of internal fistula(7 cases, 29.17%), autogenous arteriovenous fistula thrombosis occurred (6 cases, 25.00%), puncture difficulty occurred (7 cases, 29.17%), and pain sensitivity or elderly (4 cases, 16.67%). The results showed that the average blood flow was (155.65±5.90) ml/min, total blood volume was (35.92±2.65) L during single-needle dialysis. One patient had slight puncture leakage, and the puncture success rate was 95.83%. Relevant indicators of dialysis adequacy showed that the average urea clearance (Kt/V) was 0.90±0.42, urea reduction ratio was 58.31%±7.93%, and online real-time Kt/V monitoring average value was 0.98±0.55. The results suggest that the application of the new improved single-needle dialysis mode in MHD patients is safe and effective.

Objective:To observe the clinical efficacy of posterior vertebral column resection (PVCR) combined with double row nanomimetic bone column implantation and internal fixation in the treatment of stage Ⅲ Kümmell's disease plus kyphosis.Methods:A retrospective study was conducted to analyze the clinical data of the 12 patients with stage Ⅲ Kümmell's disease plus kyphosis who had been admitted to Department of Spine Surgery, Zhengzhou Orthopedic Hospital from March 2017 to September 2023. There were 2 males and 10 females, with an age of (63.4±6.4) years and a disease duration of (8.6±5.1) months. The injured segment was T 11 in 1 patient, T 12 in 5 ones, and L 1 in 6 ones. The preoperative spinal nerve injury was graded according to American Spinal Injury Association (ASIA): grade D in 5 cases and grade E in 7 cases. All the patients were treated with PVCR combined with double row nanomimetic bone column implantation and internal fixation. The operation time, intraoperative blood loss, shortening rate of the osteotomy area, complications during follow-up, and spinal nerve recovery at the last follow-up were recorded. The visual analogue scale (VAS) pain scores, Oswestry Disability Indexes (ODIs), and local kyphosis Cobb angles were compared between pre-surgery, 2 weeks after surgery, and the last follow-up. Results:Incisions in all the 12 patients healed at the primary stage. Their operation duration was (268.4±26.5) min, intraoperative blood loss (994.9±180.4) mL, shortening rate of the osteotomy area 3.94%±7.58%, and follow-up duration (24.1±13.5) months. At 2 weeks after surgery and the last follow-up, the VAS pain scores [(3.08±0.79) points and (1.17±0.58) points] and ODIs (27.59%±6.10% and 16.67%±2.22%) were significantly lower than those before surgery [(8.08±0.79) points and 73.14%±5.64%], and the values at the last follow-up were further significantly lower than those at 2 weeks after surgery (all P<0.05). There was no statistically significant difference in the Cobb angle at the last follow-up (5.29°±1.30°) compared with 2 weeks after surgery (4.74°±1.31°) ( P>0.05), but there was a statistically significant difference compared with the preoperative value (49.41°±4.40°) ( P<0.05). At the last follow-up, the ASIA grading in all the 12 patients recovered to grade E, with good bone healing at the fixation segment. No screw loosening or fracture was found. Two patients had a biomimetic bone column sinking of 3.5 and 4.0 mm, respectively, but their Marchi's grading was still 0. During the follow-up period, one patient developed proximal junctional kyphosis, and one patient developed an osteoporotic fracture of the proximal vertebral body at the fixed level. Conclusions:In the treatment of stage Ⅲ Kümmell's disease plus kyphosis, PVCR combined with double row nanomimetic bone column implantation and internal fixation can significantly correct the kyphosis and improve clinical symptoms, leading to good clinical efficacy.

Objective:To investigate whether exosomes derived from atorvastatin (ATV)-pretreated human umbilical cord mesenchymal stem cells (ATV-MSC-EXO) alleviate high glucose-induced injury in human retinal vascular endothelial cells (HREC) via the protein kinase B (AKT)/endothelial nitric oxide synthase (eNOS) signaling pathway.Methods:The optimal pretreatment concentration of ATV was determined using the cell counting Kit-8 (CCK-8) assay. Exosomes derived from mesenchymal stem cells (MSC-EXO) and ATV-pretreated MSC (ATV-MSC-EXO) were isolated and extracted, and their morphology and surface markers were characterized by transmission electron microscopy, nanoparticle tracking analysis, and Western blotting (WB). The uptake capacity of exosomes by human retinal vascular endothelial cells (HREC) was evaluated using a fluorescence labeling assay. In vitro cultured HREC were divided into the following groups: normal control group (NC group), high glucose group (HG group), high glucose+MSC-EXO group (MSC-EXO group), high glucose+ATV-MSC-EXO group (ATV-MSC-EXO group), high glucose+ATV-MSC-EXO+AKT inhibitor group (ATV-MSC-EXO-MK-2206-2HCL group), and high glucose+ATV-MSC-EXO+eNOS inhibitor group (ATV-MSC-EXO-L-NAME group). Cell proliferation and apoptosis were detected using CCK-8 and flow cytometry, respectively. The protein expression levels of B-cell lymphoma/leukemia-2 (Bcl-2), Bcl-2-associated protein (Bax), and Caspase-3 were measured by WB. In addition, the regulatory effects of ATV-MSC-EXO on the AKT/eNOS signaling pathway and its downstream functional molecules were analyzed by detecting the phosphorylation levels of AKT (P-AKT/AKT) and eNOS (P-eNOS/eNOS) via WB, the mRNA expression levels of AKT and eNOS by quantitative real-time polymerase chain reaction, and the concentrations of nitric oxide (NO) and endothelin-1 (ET-1) using commercial NO and ET-1 assay kits.Results:The optimal pretreatment concentration of ATV was 1 μmol/L. ATV-MSC-EXO exhibited similar morphology and particle size to MSC-EXO and were efficiently taken up by HREC. Under high glucose conditions, ATV-MSC-EXO significantly enhanced the viability of HREC ( F=83.24, P<0.000 1) and inhibited apoptosis ( F=77.39, P<0.000 1). WB analysis further confirmed that ATV-MSC-EXO upregulated the expression of the anti-apoptotic protein Bcl-2 ( F=53.17), while downregulating the pro-apoptotic proteins Bax ( F=36.49) and Caspase-3 ( F=60.75) ( P<0.001). In addition, ATV-MSC-EXO markedly increased the protein levels of P-AKT/AKT ( F=107.60) and P-eNOS/eNOS ( F=38.59), as well as the relative mRNA expression of AKT, eNOS ( F=203.60, 315.00; P<0.000 1). Furthermore, ATV-MSC-EXO promoted NO production ( F=407.40) and suppressed the relative expression of ET-1 ( F=49.76) ( P<0.000 1). Conclusion:ATV-MSC-EXO enhances the viability and inhibits apoptosis of HREC under high glucose conditions by activating the AKT/eNOS signaling pathway.