[Objective] To explore the strategy of blood management in patients with massive transfusion in the frigid plateau region. [Methods] The treatment process of a patient with liver rupture in the frigid plateau region was analyzed, and the blood management strategy of the frigid plateau region was discussed in combination with the difficulties of blood transfusion and literature review. [Results] The preoperative complete blood count (CBC) test results of the patient were as follows: RBC 3.14×10¹²/L, Hb 10⁶ g/L, HCT 30.40%, PLT 115.00×10⁹/L; coagulation function: PT 18.9 s, FiB 1.31 g/L, DD > 6 μg/mL, FDP 25.86 μg/mL; ultrasound examination and imaging manifestations suggested liver contusion and laceration / intraparenchymal hematoma, splenic contusion and laceration, and massive blood accumulation in the abdominal cavity; it was estimated that the patient's blood loss was ≥ 2 000 mL, and massive blood transfusion was required during the operation; red blood cell components were timely transfused during the operation, and the blood component transfusion was guided according to the patient's CBC and coagulation function test results, providing strong support and guarantee for the successful treatment of the patient. The patient recovered well after the operation, and the CBC test results were as follows: RBC 4.32×10¹²/L, Hb 144 g/L, HCT 39.50%, PLT 329.00×10⁹/L; coagulation function: APTT 29.3 s, PT 12.1 s, FiB 2.728 g/L, DD>6 μg/mL, FDP 25.86 μg/mL. The patient was discharged after 20 days, and regular follow-up reexamination showed no abnormal results. [Conclusion] Individualized blood management strategy should comprehensively consider the patient’s clinical symptoms, the degree of hemoglobin decline, dynamic coagulation test results and existing treatment conditions. Efficient and reasonable patient blood management strategies can effectively improve the clinical outcomes of massive transfusion patients in the frigid plateau region.

Knee osteoarthritis (KOA) is a prevalent degenerative joint disease characterized by synovial inflammation, cartilage loss. Often manifesting as joint pain and limited mobility, it severely affects the quality of life of patients. Traditional treatment methods such as pharmacological injections and surgical interventions primarily aim to alleviate symptoms but have limited effects on cartilage repair. Human umbilical cord mesenchymal stem cells (hUC-MSCs), due to their anti-inflammatory and chondrogenic capabilities, is considered a new hope for the treatment of KOA. This article synthesizes the latest research findings from both domestic and international sources to discuss the theoretical basis for the clinical application of hUC-MSCs in treating KOA, clinical study design, and efficacy evaluation. It also addresses the challenges in the clinical application of hUC-MSCs and explores future directions, in the hope of providing feasible theoretical support for the treatment of KOA with hUC-MSCs.

In recent years, growing interest has been directed toward the application of platelet derivatives in regenerative medicine, cell therapy and targeted drug delivery. This article analyzes the basis and classification of platelet derivatives, discusses their clinical applications, and addresses main challenges such as the quantification and standardization of preparation process— particularly when used as individualized biologics, as well as the uncertainty and lack of comparability across experimental results. Countermeasures and improvements are provided, suggesting that standardized and normative management may offer new opportunities for the clinical use of platelet derivatives.

Pre-admission is a critical initiative to optimize medical service processes and alleviate the challenge of "difficult access to healthcare. "However, there is currently a lack of standardized protocols for pre-admission procedures. This study aims to systematically analyze key nodes and risk factors in pre-admission process design and propose optimization strategies, providing a foundation for policy formulation and hospital practices. By constructing a "forward-reverse" dual-process model of pre-admission and identifying risk points based on stakeholder theory (patients, hospitals, healthcare administration, and insurance), the study reveals that while pre-admission can reduce the average length of stay, improve bed turnover rates, and enhance patient satisfaction, it also presents risks such as cross-period financial settlement, challenges in insurance policy adaptability, demands for information system integration, and the need for defining medical safety boundaries. To optimize the pre-admission process and mitigate these risks, this study explores framework improvements in areas including eligibility criteria, mode selection, cost settlement, transition between pre-admission and inpatient status, and cancellation of pre-admission, offering practical guidance for public hospitals. The authors argue that pre-admission requires tripartite collaboration among hospitals, insurers, and healthcare administrations: hospitals should establish top-level design, continuously refine processes, and implement dynamic risk assessment mechanisms; insurance providers should support cross-period settlement policies; and healthcare administrations should issue guiding policies or standardized protocols. Through multi-department coordination and collaborative efforts, the optimization and innovation of pre-admission processes can be advanced, ultimately delivering more efficient and convenient healthcare experiences for patients.

Circulating tumor cells (CTCs) have the ability to sow tumors and can be found in the peripheral blood of patients with precancerous lesions and healthy people. However, CTCs are not currently screened in the donors blood. A large number of allogeneic blood transfusions occurred worldwide each year, and allogeneic blood transfusions expose recipients to the risk of transmission and affect tumors associated with donor CTCs. Although leukocyte filtration can not completely remove tumor cells in the blood, it can effectively reduce the number of white blood cells in the blood and reduce their proliferation ability. Blood irradiation can effectively destroy the DNA of CTCs in the blood, and inhibit the occurrence and metastasis of tumors caused by the infusion of allogeneic blood containing CTCs. Therefore, we should pay attention to the potential risk of CTCs on clinical transfusion, and strengthen the preclinical treatment of blood to avoid donor-related tumor infection in blood recipients due to clinical transfusion.

Objective To evaluate the accuracy,sensitivity,specificity and economy of HLA-B*5801 gene polymorphisms detection in predicting allopurinol-related severe drug eruption before receiving allopurinol treatment using rapid health technology assessment(rHTA),to provide clinicians and policymakers with an efficient and convenient evidence-based basis.Methods PubMed,Cochrane Library,Web of Science,Embase,WanFang Data,CNKI databases and the official website of health technology assessment(HTA)agency were electronically searched to collect HTA reports,systematic reviews/Meta-analyses and pharmacoeconomic literature on the HLA-B*5801 gene polymorphisms detection from inception to December 31,2023.Two reviewers independently screened studies,extracted data,assessed the included studies'quality,and analyzed and summarised the results.Results A total of 16 literature were included,of which 5 systematic reviews/Meta-analyses and 11 pharmacoeconomic studies.The results showed that the HLA-B*5801 gene mutation rate was significantly higher in patients presenting with severe drug eruption than in the allopurinol-tolerant group(P＜0.05).Two studies reported the sensitivity and specificity of the HLA-B*5801 gene polymorphisms assay for predicting severe drug eruption,the sensitivity of 0.78,0.93,and specificity of 0.96,0.89,respectively.The economic study showed that HLA-B*5801 gene polymorphisms detection before allopurinol treatment was cost-effective in Chinese Han,Korean,Thai populations,but not in British,American(Caucasian or Hispanic),Singaporean and Malaysian populations.Conclusion HLA-B*5801 gene polymorphisms detection before allopurinol treatment and guiding drug use according to the screening results in Chinese Han population can reduce the risk of severe drug eruption and treatment costs.

Objective:To investigate the occurrence of chronic pain in patients with inguinal hernia after herniorrhaphy, analyze the risk factors of pain occurrence and establish a nomogram model.Methods:Using the convenient sampling method, a total of 390 patients who underwent inguinal herniorrhaphy in Xinxiang Central Hospital from June 2021 to December 2022 were selected. They were divided into the chronic pain group and the non-chronic pain group based on whether postoperative chronic pain occurred. Logistic regression analysis was applied to identify risk factors for postoperative chronic pain, and the nomogram model was established using R4.2.3 software package and rms software package.Results:Among 390 patients with inguinal hernia, a total of 73 patients experienced postoperative chronic pain, with the incidence of 18.72%. Logistic regression analysis showed that recurrent inguinal hernia surgery, hernia ring defect diameter less than or equal to 37.5px, incarceration, use of repair materials and postoperative incision infection were risk factors for chronic pain ( P<0.05). Based on the above factors, a risk prediction model was established. The area under the receiver operating characteristic curve for the test subject was 0.751 (95% CI: 0.612-0.753), the Hosmer-Lemeshow test results showed χ 2=5.572, P=0.473, and the correction curves were all close to the ideal curve. Conclusions:Postoperative chronic pain is common in patients with inguinal hernia and there are many risk factors. The nomogram model established in this study can provide basis for formulating nursing strategies to some extent.

Objective:To evaluate the clinical effect of the position pillows for neuraxial anesthesia.Methods:This was a prospective randomized controlled trial. Four hundred and twelve patients regardless of gender, aged ≥18 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, who underwent elective surgery under neuraxial anesthesia at Peking University Third Hospital from February to October 2023, were selected and divided into 2 groups ( n=206 each) using a random number table method: pillow group (P group) and control group (C group). Group C underwent the conventional procedure for neuraxial anesthesia. The patients were placed in a position using the position pillow on the basis of oral education before routine anesthesia in group P. The success rate of puncture at first attempt, puncture time and position placement time were recorded. The adjustment of position, body movement and occurrence of discomfort during the puncture were also recorded. The visual analogue scale score was used to evaluate the level of anxiety before positioning, after positioning and after anesthesia. The visual analogue scale score was used to evaluate the patient′s comfort and the operator′s satisfaction with position after the anesthesia was completed. Results:Compared with group C, the time for positioning was significantly shortened, the anxiety level was decreased after positioning and after anesthesia, the rate of improvement in anxiety was increased, the scores for the patient′s comfort and the operator′s satisfaction with position were increased ( P<0.05), and no significant changes were found in the success rate of puncture at first attempt, puncture time and incidence of body movement during the puncture and incidence of the adjustment of position ( P>0.05). No discomfort was observed in either group during the puncture. Conclusions:This new type of position pillows for the neuraxial anesthesia can not only optimize the effect of position placement, but also improve the patients′ comfort.

Objective:To investigate the ultrasonographic features and genetic etiology of complex talipes equinovarus (TE) in fetuses.Methods:This retrospective study enrolled 95 cases of complex TE (TE complicated by other abnormalities) who were diagnosed by prenatal ultrasound in the Third Affiliated Hospital of Zhengzhou University from March 2018 to December 2022. Chromosome karyotype analysis and/or chromosomal microarray analysis (CMA) [or copy number variation-sequencing (CNV-seq)] were performed on all cases for prenatal genetic diagnosis and those with normal results were further tested by whole exome sequencing (WES). Prenatal ultrasonographic and genetic features of complex TE in fetuses were summarized. Complicated abnormalities in the fetuses were classified into nine categories according to the involved system or site and based on each category these subjects were divided into with or without the corresponding complicated abnormalities groups. Besides, these cases were also divided into single-system and multi-system abnormality groups based on the number of involved systems or sites of complicated abnormalities. The detection rates of WES abnormality (pathogenic or likely pathogenic variants) and the overall detection rate of genetic abnormality [karyotype abnormality detected by chromosome karyotype analysis, pathogenic or likely pathogenic copy number variations (CNVs) detected by CMA (or CNV-seq), and pathogenic or likely pathogenic variation detected by WES] were compared between different groups using Chi-square test or Fisher's exact test. Results:Abnormal chromosome karyotypes were identified in 10 (24.4%) of 41 cases receiving chromosome karyotype analysis, pathogenic and likely pathogenic CNVs were found in seven (7.6%) of 92 cases by CMA (or CNV-seq). WES was performed on 37 cases with negative results of chromosomal karyotype analysis and CMA (or CNV-seq) and the detection rate of pathogenic and likely pathogenic variants was 43.2% (16/37). The detection rate of WES abnormality was higher in the fetuses with musculoskeletal abnormalities than in those without the abnormalities [71.4% (15/21) vs. 1/16, Fisher's exact test, P<0.001], while in those with other postural abnormalities was higher than that in the group without other postural abnormalities [12/16 vs. 19.0% (4/21), Fisher's exact test, P=0.001]. The genetic causes of complex TE were identified in 34.7% (33/95) of the fetuses by the sequential genetic diagnosis using chromosome karyotype analysis, CMA (or CNV-seq), and WES. The overall detection rate of genetic abnormality was higher in the group with multi-system abnormality than in the group with single-system abnormality [48.9% (22/45) vs. 22.0% (11/50), χ2=7.55, P=0.006], in the group with musculoskeletal system abnormalities and without [46.8% (22/47) vs. 22.9% (11/48), χ2=5.98, P=0.014], and in the group with other postural abnormality and without [47.2% (17/36) vs. 27.1% (16/59), χ2=3.99, P=0.046]. Nine cases that were considered isolated TE on initial ultrasound were corrected to a complex diagnosis on subsequent ultrasound examinations. Of all the involved system or site, the neurologic abnormalities were the most diverse (13 kinds) and had a diversity of ultrasound presentations. Conclusions:Genetic diagnosis should be performed when prenatal ultrasound suggests fetal complex TE. WES is conducive to improving the prenatal detection rate of monogenic diseases, especially in fetuses complicated by musculoskeletal abnormalities. Isolated TE fetuses require serial ultrasound examinations to correct the diagnosis in time and genetic testing should be performed if necessary. Additional attention should be paid to the TE fetus for comorbid neurologic abnormalities at the time of ultrasonography to rule out TE as an intrauterine harbinger of neuromuscular disease.

Objective:To explore the differences in gut microbiota and immune factors in fecal lysate of children with different clinical subtypes of Mycoplasma pneumoniae pneumonia (MPP). Methods:Children aged 3-14 years with MPP who visited Shanghai Ninth People′s Hospital from March 2023 to February 2024 were selected and divided into general group (GMPP group) and severe group (SMPP group) based on the severity of the condition. They were also divided into non-refractory group (NRMPP group) and refractory group (RMPP group) based on treatment response. 16S rRNA sequencing was used to analyze the characteristics of gut microbiota, and MSD electrochemiluminescence method was used to determine the levels of immune factors in fecal lysate. Differences in the clinical characteristics, gut microbiota, and fecal immune factors were analyzed. Spearman correlation analysis was performed. Receiver operating characteristic(ROC) curve was used to analyze the evaluation and predictive value of gut microbiota in clinical classification of MPP.Results:Among the 64 children with MPP, there were 34 cases in the GMPP group and 30 cases in the SMPP group. There were statistically significant differences between the two groups in terms of fever duration, presence or absence of hypoxemia, C-reactive protein(CRP), D-Dimer, and chest CT scores ( t=-4.94, P<0.001; χ2=5.33, P=0.021; z=-2.93, P=0.003; z=-3.93, P<0.001; z=-4.10, P<0.001). Among the 64 children with MPP, there were 50 cases in the NRMPP group and 14 cases in the RMPP group. There were statistically significant differences in age, fever duration, and chest CT scores between the two groups ( t=-3.21, P=0.002; t=-5.28, P<0.001; z=-2.95, P=0.003). There was no statistically significant difference in the alpha diversity analysis of gut microbiota between GMPP group and SMPP group( P>0.05). There was a statistically significant difference in beta diversity analysis between the two groups of gut microbiota ( R2=0.06, P=0.001). Species difference analysis showed that the relative abundance of Bifidobacterium in the SMPP group was significantly lower than that in the GMPP group, while the relative abundance of Blautia and Ruminococcus gnavus was significantly higher than that in the GMPP group, with statistical significance ( z=5.21, P<0.001, Q=0.039; z=1.56, P<0.001, Q=0.039; z=2.08, P=0.007, Q=0.700). There was no statistically significant difference in the alpha diversity analysis of gut microbiota between NRMPP and RMPP group( P>0.05). There was a statistically significant difference in beta diversity analysis between the two groups of gut microbiota ( R2=0.05, P=0.001). Analysis of species differences showed that the relative abundance of Bifidobacterium and Subdoligranulum in the RMPP group was significantly lower than that in the NRMPP group, while the relative abundance of Blautia and Ruminococcus gnavus was significantly higher than that in the NRMPP group, with statistical significance( z=3.44, P=0.012, Q=0.638; z=3.64, P=0.040, Q=0.638; z=5.80, P=0.001, Q=0.338; z=5.46, P=0.015, Q=0.638). The level of fecal immune factors IL-10 and IL-1β were statistically significant between GMPP group and SMPP group( z=-1.96, P=0.050; z=-2.46, P=0.014). The level of fecal immune factors IFN-γ, IL-10, IL-1β, IL-8, and TNF-α were statistically significant between NRMPP group and RMPP group ( z=-2.20, P=0.028; z=-2.17, P=0.030; z=-2.00, P=0.046; z=-2.14, P=0.032; z=-2.22, P=0.027). Sperman correlation analysis showed that Bifidobacterium was negatively correlated with fever duration and chest CT score ( r=-0.35, P=0.005; r=-0.30, P=0.017); Blautia was positively correlated with D-Dimer, fever duration, and chest CT score ( r=0.33, P=0.008; r=0.37, P=0.003; r=0.40, P=0.001); Ruminococcus gnavus and TNF-α, IL-10, IL-4, and IL-6 were negatively correlated ( r=-0.34, P=0.001; r=-0.29, P=0.021; r=-0.28, P=0.024; r=-0.28, P=0.027). ROC curve analysis showed that the area under curve(AUC) of Bifidobacterium abundance for assessing the severity of MPP was 0.767 (95% CI: 0.649-0.885, P<0.001). The AUC of Blautia abundance for assessing the severity of MPP was 0.774 (95% CI: 0.658-0.889, P<0.001), and the AUC for predicting treatment response to MPP was 0.787 (95% CI: 0.655-0.919, P=0.001). Conclusions:The levels of fecal immune factors vary among children with different clinical subtypes of MPP. The relative abundance analysis of Bifidobacterium and Blautia in the gut microbiota of children with MPP may have certain clinical value for evaluating the severity of MPP, adopting adjuvant therapy, and predicting treatment response.