Objective:To identify the risk factors for acute graft-versus-host disease (aGVHD) in patients with acute myeloid leukemia (AML) undergoing haploidentical hematopoietic stem cell transplantation (HID-HSCT) .Methods:A total of 141 AML patients who underwent HID-HSCT at the Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, from January 2020 to July 2021 were included. The cumulative incidence of aGVHD was analyzed using the Fine-Gray competing risk model, with relapse and death as competing events, to compare differences between groups. Potential risk factors were evaluated by univariable and multivariable Cox proportional hazards regression analyses to determine their independent effects on aGVHD.Results:Among the 141 patients, 86 (61.0%) were male and 55 (39.0%) were female, with a median age at transplantation of 34 years. Within 100 days post-transplant, 59 patients developed grade Ⅱ-Ⅳ aGVHD, whereas 86 patients experienced no or grade Ⅰ aGVHD (the grade 0-Ⅰ aGVHD group) . Survival analysis showed that the 3-year overall survival was 68.7% (95% CI: 57.7%-81.9%) in the grade Ⅱ-Ⅳ aGVHD group, compared with 78.8% (95% CI: 70.4%-88.3%) in the grade 0 - Ⅰ aGVHD group, with the difference not being statistically significant ( P=0.190) . Univariable analysis identified donor age ( P=0.020, HR=1.020, 95% CI: 1.000-1.040) and the female donor-male recipient sex combination ( P=0.033, HR=1.980, 95% CI: 1.160-3.380) as risk factors for grade Ⅱ-Ⅳ aGVHD. Multivariable analysis confirmed that donor age ( P=0.005, HR=1.026, 95% CI: 1.008-1.047) and the female donor-male recipient sex combination ( P=0.002, HR=2.339, 95% CI: 1.354-4.037) were independent risk factors for aGVHD. Patients receiving grafts from donors aged >45 years had a significantly higher 100-day cumulative incidence of grade Ⅱ-Ⅳ aGVHD compared with those receiving grafts from donors ≤45 years [54.7% (95% CI: 42.3%-67.0%) vs 31.6% (95% CI: 21.0%-42.1%) , P=0.006]. Similarly, patients with the female donor-male recipient sex combination had a higher 100-day cumulative incidence of grade Ⅱ-Ⅳ aGVHD than those with other sex combinations [56.8% (95% CI: 40.4%-73.1%) vs 36.9% (95% CI: 27.5%-46.3%) , P=0.015]. Conclusion:Older donor age and the female donor-male recipient sex combination remain independent risk factors for aGVHD in patients with AML undergoing HID-HSCT.

Chronic obstructive pulmonary disease (COPD) poses a significant public health challenge in China due to its high prevalence and substantial disease burden. Primary healthcare institutions (PHIs) serve as the cornerstone for COPD prevention and management. However, they currently face critical challenges, including inadequate diagnostic capacity, suboptimal treatment standardization, and limited patient awareness. In recent years, national efforts have initiated the development of a primary-level COPD prevention and management network. Key strategies include incorporating COPD into the Fundamental Public Health Service Program (FPHSP), strengthening lung function screening, promoting tiered diagnosis and treatment systems, establishing central-local coordination mechanisms, and implementing National Major Public Health Service Programs. Future directions necessitate focused efforts on: constructing integrated prevention and treatment models; optimizing the two-way referral system; enhancing screening for high-risk populations; leveraging digital health empowerment; and establishing a multi-dimensional quality evaluation system. These concerted actions are essential to build a comprehensive, high-quality COPD healthcare management system within primary care settings, ultimately contributing to the goals of the Healthy China Initiative (2019-2030).

Objective To investigate the effects of Esketamine(S-KET)on the proliferation,migration,invasion,and Wnt/β-catenin signaling pathway of liver cancer cells.Methods Hep G2 liver cancer cells were separated into Control group,low,medium,and high concentration treatment groups(S-KET-L,S-KET-M,S-KET-H groups),and high concentration treatment group(S-KET-H+LiCl group);Edu was applied to detect cell proliferation;scratch experiment was applied to detect cell migration;Transwell experiment was applied to detect cell invasion.Western blot was applied to detect the expression of nuclear proliferation antigen markers(Ki-67),Cyclin D1,matrix metalloproteinase 2(MMP-2),matrix metalloproteinase 9(MMP-9),Wnt1,and β-catenin proteins;nude mouse transplanted tumor was applied to detect the effect of Esketamine on the growth of liver cancer transplanted tumors;immunohistochemistry was applied to detect the expression of Wnt1 and β-catenin proteins.Results Compared with the Control group,the Edu positive rate,Ki-67,Cyclin D1,scratch healing rate,number of cell invasions,the expression of MMP-2,MMP-9,Wnt1,and β-catenin proteins in Hep G2 cells in the S-KET-L,S-KET-M,and S-KET-H groups were obviously reduced(P＜0.05);compared with the S-KET-H group,the Edu positive rate,Ki-67,Cyclin D1,scratch healing rate,number of cell invasions,the expression of MMP-2,MMP-9,Wnt1,and β-catenin proteins in Hep G2 cells in Hep G2 cells in the S-KET-H+LiCl group were significantly increased(P＜0.05);the results of nude mouse tumor transplantation experiment showed that compared with the Control group,the S-KET group mice showed slow tumor growth,reduced tumor mass and volume,and significantly reduced expression of Wnt1 and β-catenin proteins(P＜0.05).Conclusion Esketamine can inhibit the proliferation,migration,and invasion of liver cancer cells by inhibiting the Wnt/β-catenin signaling pathway.

Objective:To evaluate the safety and feasibility of double-port laparoscopic cholecystectomy (LC) combined with transcystic common bile duct (CBD) exploration using ultrafine choledochoscopy on patients with gallbladder stones and common bile duct stones.Methods:Clinical data of 35 patients undergoing double-port LC combined with transcystic CBD exploration using ultrafine choledochoscopy in Anhui No.2 Provincial People’s Hospital from December 2021 to June 2024 were retrospectively analyzed, including 8 males and 27 females, aged (45.8±18.1) years. In all patients, the diameter of the gallbladder duct was greater than 3 mm, the maximum diameter of the stones was less than 10 mm, and the number of stones was less than 5, and the gallbladder ducts were normal. Magnetic resonance cholangiopancreatography (MRCP) was used to measure the diameter of CBD, the number and the maximum diameter of stones. The operative time, intraoperative blood loss, postoperative anal exhaust time, postoperative hospital stay and complications (including abdominal infection, biliary tract infection, bile leakage, bleeding, etc.) of all patients were analyzed. The incidence of bile duct stenosis, residual stone or stone recurrence were followed up by telephone or outpatient review.Results:MRCP measurement indicated that the common bile duct diameter of patients was (8.1±1.3) mm. Single CBD stone occurred in 27 cases (77.1%, 27/35), and the mean maximum diameter of CBD stones was (3.9±1.3) mm. All patients successfully underwent the procedure. The operative time was (80.1±10.9) min, the intraoperative blood loss was (25.5±10.2) ml, the recovery time of postoperative anal exhaust was (17.3±4.7) h, and the postoperative hospital stay was (2.5±0.6) d. There were no complications such as abdominal and biliary tract infection, bile leakage and bleeding. All patients were followed up for 1-30 months, with a median follow-up time of 12 months. No biliary stricture, residual stones or recurrence occured during the follow-ups.Conclusion:In selected cases, double-port LC combined with transcystic CBD exploration using ultrafine choledochoscopy could be safe and feasible, with less trauma, quick recovery and short operative time.

Objective To analyze the main epidemiological characteristics of fungal infection in this hospital in the past 7 years,and to provide reference for clinical treatment and prevention and control strategies of fun-gal infection.Methods The fungal data and clinical data of related patients isolated from clinical samples in Peking Union Medical College Hospital from early January 2018 to the end of May 2024 were selected,and the main epidemiological characteristics of fungal infection in this hospital were identified and described through multi-angle statistical analysis.Results A total of 4 479 patients with filamentous fungal infection were en-rolled.The proportion of male patients[57.5％(2 576/4 479)]was higher than that of female patients[42.5％(1 903/4 143)],mainly distributed in internal medicine,Intensive Care Unit(ICU)and emergency de-partment,among which internal medicine accounted for the highest proportion[50.0％(2 241/4 479)].About 90.0％of the specimens were from the lower respiratory tract,in addition to specimens from skin and soft tis-sue,tissue,ear and blood culture.In terms of seasonal distribution,there are more patients in winter.The fun-gi were mainly composed of Aspergillus,Mucor,Cerdosporium,Fusarium and Penicillium,among which As-pergillus was the most abundant,accounting for 74.6％of the total.Aspergillus fumigatus was the most a-bundant Aspergillus,accounting for 42.5％of the total Aspergillus(1 418/3 340).Among the related infec-tions caused by mold,Aspergillus was the most common in the lower respiratory tract,accounting for 76.8％.Among them,Aspergillus fumigatus accounted for the highest proportion(33.6％).98.6％of the molds infected the ear were Aspergillus,of which Aspergillus niger and Aspergillus terreus were the most common.Skin infections are mainly caused by Sporothrix schenckii,Trichophyton rubrum,Microsporum ca-nis.The results of in vitro drug sensitivity test showed that the four common Aspergillus isolated in this hos-pital were sensitive to voriconazole,and amphotericin B had better antifungal activity against Mucorales in vitro.Conclusion Based on the main epidemiological characteristics of fungal infections in this hospital,it is recommended that special attention be paid to the admission of patients in the respiratory department during the peak infection period in autumn and winter.In the treatment of fungal infections in different regions and on different body parts,attention should be paid to the differences in the distribution of bacterial species.

Objective To investigate the relationship between the expression of nuclear factor ⅠB(NFⅠB)in myeloid cells and intestinal inflammation by constructing NFⅠB conditional gene knockout(cKO)mice.Methods Human Protein Atlas database,Genotype-Tissue Expression database,and FANTOM5 database were used to investigate the expression of NFⅠB in inflammatory cells.NFⅠB-floxed mice were constructed using CRISPR/Cas9 technology and hybridized with LyZ2-Cre transgenic mice.Myeloid specific NFⅠB cKO mice(NFⅠBfl/flLyz2-Cre)were obtained by self-crossing the progeny.After the genotype identification of mice by agarose gel electrophoresis,4 NFⅠB cKO mice of C57BL/6N strain were selected as experimental group,and 4 non-cKO mice were selected as control group.Both groups were induced with 2.5％dextran sulfate sodium salt(DSS)under the same condition to establish a chronic colitis model,and the severity of colitis was evaluated by clinical manifestations and histopathology.Results Analysis showed that NFⅠB was expressed in both myeloid granulocytes and monocytes,and the highest expression was found in neutrophils.NFⅠB cKO mice were successfully constructed using CRISPR/Cas9 technology and Cre-loxP system.DSS-induced enteritis NFⅠB cKO mice developed diarrhea,gross blood stools,reduced activity,and weight loss in a short time.The gross examination of the intestines showed that the colon of the NFⅠB cKO mice was significantly shorter than that of the non-cKO mice([8.23±0.35]cm vs[10.30±0.36]cm,P＜0.01).Intestinal H-E staining showed changes in mucosal glandular structure and connective tissue hyperplasia with extensive inflammatory cell infiltration in NFⅠB cKO mice.The histological score of NFⅠB cKO mice was significantly higher than that of non-cKO mice(4.25±0.50 vs 0.50±0.58,P＜0.01).Intestinal immunohistochemical staining showed that more CD11b positive cells were recruited in NFⅠB cKO mice than non-cKO mice.Conclusion Myeloid specific NFⅠB cKO mice have been successfully constructed,and NFⅠB in myeloid cells can reduce infiltration of immune cells(granulocytes or/and monocytes)to inhibit intestinal inflammation.

OBJECTIVE T o explore the long-term effect of multidimensional evidence-based interventions based on i-PARIHS theoretical framework on reduction of incidence of central line-associated bloodstream infections(CLABSI)in pediatric intensive care units(PICU)of pediatrics department and evaluate the impact on nurses'compliance to taking the interventions and use intensity of catheters.METHODS By means of quasi-experimental design,the multidimensional intervention system covering multidisciplinary collaboration,standardized operation procedures,information system optimization and hierarchical training was established and staged for implementa-tion of 5 years(from T0 baseline stage to T3 maintenance stage).The variations in implementation rates of cathe-ter maintenance(daily maintenance,dressings change,catheter removal)were analyzed by Chi-square test,and the change of incidence of CLABSI was monitored with the use of statistical process control U chart.RESULTS The nurses'compliance to operations was remarkably improved(P＜0.05)o The implementation rate of dressings change continuously increased from 52.91％in T0 to81.62％in T3(x2=72.444,P＜0.001),the implementa-tion rate of catheter removal increased from 48.72％to 79.31％(x2=8.179,P=0.042).The incidence rate of CLABSI decreased from 1.92％0 in 2019 to 0.5％0 in 2022,and the control chart showed that most of the months fluctuated within control limits.CONCLUSIONS The multidimensional evidence-based interventions can achieve a long term control of CLABSI by raising the nurses' compliance to operations.The information monitoring and closed-loop management are crucial to maintenance of the interventional effect,and the risk early warning system should be optimized with the combination of artificial intelligence technology.

BACKGROUND:The blood-brain barrier is an important structure that protects the central nervous system,and the study of the effects of high glucose on the blood-brain barrier is important for the prevention of high glucose-induced damage to the central nervous system.OBJECTIVE:To investigate the potential effect of high glucose on the blood-brain barrier function of hCMEC/D3 human brain microvascular endothelial cells.METHODS:hCMEC/D3 cells were cultured in regular sugar medium(glucose concentration of 25 mmol/L)and high-sugar medium(glucose concentration of 55 mmol/L).The morphology of cells in each group was observed by light microscopy.CCK-8 assay was used to detect changes in cell viability.A monolayer blood-brain barrier model was established using hCMEC/D3 cell line with Transwell chamber device.Changes in cell transmembrane resistance were monitored daily.The permeability of cell monolayers was detected by phenol red permeability.Flow cytometry was used to detect the apoptosis rate of the cells.Western blot assay was used to detect the expression of Bcl-2,Bax,Caspase-3,ZO-1,Occludin,Claudin-1,and histone deacetylase 4.The levels of histone deacetylase in cell supernatant were detected by ELISA.The expression of histone deacetylase 4 in cells was detected by immunofluorescence.RESULTS AND CONCLUSION:(1)The cell viability of high sugar group was significantly lower than that of control group(P＜0.000 1).(2)The cells of the control group were in a good growth state,interwoven into a dense mesh,with interconnections between synapses.The cell growth of high glucose group was suppressed,and the connection of inter-cellular synapses was reduced.(3)Compared with the control group,the transmembrane resistance value of the high glucose group was reduced(P＜0.05);phenol-red permeability of the monolayer cell membrane was increased(P＜0.05);cell apoptosis rate was increased(P＜0.01);the expression of Bax protein was increased(P＜0.000 1);the expression of Caspase-3 protein had no significant change(P＞0.05);the expression of Bcl-2,ZO-1,Occludin,Claudin-1,and histone deacetylase 4 proteins was decreased(P＜0.01,P＜0.001,P＜0.01,P＜0.000 1,P＜0.01);the fluorescence expression of histone deacetylase 4 was decreased(P＜0.001)in the high glucose group.(4)The level of histone deacetylase 4 in the cell supernatant of the high glucose group was lower than that of the control group(P＜0.05).The results show that high glucose induces the increased apoptosis and enhances permeability of hCEMCE/D3 cells,and its mechanism may be related to the decreased expression level of histone deacetylase 4.

Objective To evaluate the impact of the"Surgical Quality and Safety Improvement Initiative"by analyzing changes in surgical quality and safety indicators at a tertiary hospital in Tianjin,and to provide policy recommendations for further enhancing surgical quality improvement pathways.Methods Surgical quality and safety monitoring data from 2022 to 2024 were collected from a tertiary hospital in Tianjin.Interrupted time series analysis(ITSA)was employed to assess the effects of im-provement measures on surgical quality and safety outcomes.Results Following implementation of the initiative,perioperative complication rates showed a declining trend(β3=-0.051,P＜0.05),unplanned reoperation rates significantly decreased(β2=-0.121,P＜0.05),and surgical mortality rates markedly declined(β2=-0.086,P＜0.05),indicating that the man-agement measures effectively improved hospital surgical quality and safety over the study period.Conclusion The"Surgical Quality and Safety Improvement Initiative,"which established a comprehensive,staff-involved pathway for continuous surgical quality improvement,successfully enhanced surgical quality and safety.Recommendations include emphasizing frontline staff par-ticipation in quality management,strengthening data monitoring and feedback systems,implementing reasonable performance in-centives to motivate systemic improvement,and leveraging health information technology to support refined surgical management.

Objective To analyze the distribution characteristics and influencing factors of ultra-long hospitalization in malignant tumor patients and to explore strategies to reduce the average length of stay and enhance the efficiency of medical re-source utilization.Methods Ultra-long hospitalization was defined as the 99th percentile of hospital stay duration(P99=31 days).Data from patients discharged with malignant tumors in a specialized cancer hospital in 2024 were collected.The distribu-tion characteristics and influencing factors were analyzed using chi-square tests and logistic stepwise regression.Results Among the 36 097 patients with malignant tumors,the average length of stay was 4.95 days,with 375 cases classified as ultra-long hospi-talizations,accounting for 1.04％.These patients were predominantly over 55 years old,with a higher proportion of males.Pa-tients with stage Ⅲ malignant tumors,primary tumors classified as T2～T3,and primary sites in the esophagus,pancreas,and maxillofacial regions had a higher incidence of ultra-long hospitalizations.Significant factors influencing ultra-long hospitalization included treatment modality,complications(OR=20.319),number of discharge diagnoses(OR=6.915),ICU transfers(OR=4.714),unplanned reoperations(OR=4.416),tumor type,extent,and stage.Conclusion Medical institutions are advised to address the influencing factors of ultra-long hospitalizations by optimizing diagnostic and treatment processes,enhan-cing quality control systems,establishing early warning mechanisms,and strengthening information systems.These measures aim to improve the standardization of malignant tumor diagnosis and treatment,ensuring patient safety.