Objective To systematically evaluate the similarities between six-gene-modified pig red blood cells and human red blood cells in multiple dimensions, including cell morphology, hematological parameters, microbial safety and serological compatibility, and to verify the feasibility of using six-gene-modified pig red blood cells as an alternative for blood transfusion in cases of traumatic hemorrhage. Methods Blood samples from O-type human donor, six-gene-modified O-type pig and wild-type O-type pig were collected. The pig gene-modified phenotype was identified by flow cytometry. The morphology was observed using field emission scanning electron microscopy and the diameter was measured. Hematological tests, including blood routine, osmotic fragility test, adenosine triphosphate (ATP) and 2,3-diphosphoglycerate (2,3-DPG) content and partial pressure of oxygen at 50% hemoglobin saturation (P50), were conducted to assess the deformability of red blood cells. Real-time fluorescent quantitative polymerase chain reaction was used to screen for zoonotic viruses, and cross-matching was performed using column gel method, condensation amine method and saline tube method. Results The six-gene-modified pig red blood cells successfully knocked out the α-Gal, Neu5Gc and Sda antigens and expressed hCD55. Wild-type pig red blood cells expressed these three antigens but did not express human complement regulatory proteins. All three types of red blood cells presented a biconcave discoid morphology. The diameter of O-type human red blood cells was larger than that of the six-gene-modified porcine red blood cells and wild-type pig red blood cells (all P < 0.05). The average red blood cell volume and average red blood cell hemoglobin of O-type humans were higher than those of the six-gene-modified pig red blood cells, and the distribution width-variable coefficient of O-type human red blood cells was lower than that of the six-gene-modified pig red blood cells (all P < 0.05). There were no statistically significant differences in the permeability fragility, ATP content, 2,3-DPG content, P50 and red blood cell deformability indicators of the three types of red blood cells (all P > 0.05). The screening for zoonotic viruses in human and animal cells of the six-gene-modified pigs and wild-type pigs was negative. The cross-matching results showed that in the column gel method and condensation amine method, the primary and secondary sides of the six-gene-modified pig red blood cells did not agglutinate with human red blood cells, while the wild-type pig red blood cells agglutinated with human red blood cells in all cross-matching methods. Conclusions The six-gene-modified pig red blood cells are highly similar to human red blood cells in terms of morphology, key hematological parameters, energy metabolism, oxygen-carrying capacity, mechanical properties, microbial safety and serological compatibility, providing an experimental basis for the clinical transformation of xenotransfusion.

Objective To investigate the impact of phase Ⅱ cardiac rehabilitation on the rehabilitation needs and physical activity status of patients after coronary heart disease intervention.Methods A total of 90 patients with coronary heart disease who underwent percutaneous coronary intervention(PCI)in the Coronary Heart Disease Center of the hospital from August 2023 to August 2024 were selected as the research subjects.They were subjected to a 12-week standardized phase Ⅱ cardiac rehabilitation training.General data survey forms,cardiac rehabilitation scales,and the International Physical Activity Questionnaire were used for scale surveys to understand the patients' needs before and after rehabilitation and their weekly physical activity en-ergy expenditure.The cardiopulmonary exercise test gold standard,which reflects exercise capacity through three indicators-maximum oxygen uptake(VO2 max),anaerobic threshold(AT),and metabolic equivalents(MET),were used to compare the physical activity status before and after cardiac rehabilitation.Results Compared with before the implementation,after the implementation of cardiac rehabilitation,the autonomy score in-creased(21.36±1.85 vs.16.73±3.28),the process anxiety(12.60±3.87 vs.14.27±2.12)and outcome anxiety scores(2.31±1.76 vs.4.56±3.56)decreased,the level of low-intensity physical activity decreased[(2 711.62±1 487.09)min/week vs.(3 845.97±2 083.71)min/week],the levels of moderate-intensity[(1 314.67±783.54)min/week vs.(686.22±126.79)min/week],high-intensity[(1 861.33±798.27)min/week vs.(112.00±40.77)min/week],and total physical activity increased[(5 887.62±2 843.54)min/week vs.(4 644.19±2 287.16)min/week].The levels of VO2 max[(28.11±14.28)mL·min-1·kg-1 vs.(23.82±12.34)mL·min-1·kg-1],AT[(16.06±5.41)mL·min-1·kg-1 vs.(13.53±4.56)mL·min-1·kg-1],and MET[(6.89±1.59)mL·min-1·kg-1 vs.(5.78±1.21)mL·min-1·kg-1]all in-creased,with statistically significant differences(P＜0.05).Conclusion Phase Ⅱ rehabilitation after PCI can effectively improve patients' physical activity levels.

BACKGROUND:Osteoarthritis is a complex disease closely related to metabolic abnormalities.However,previous studies only involved limited blood lipid indicators and did not conduct more comprehensive blood lipid profile analysis.An in-depth exploration of the causal relationship between the seven items of blood lipids and osteoarthritis will not only help understand the pathogenesis of osteoarthritis,but also provide new research directions and clinical basis for its prevention and treatment.OBJECTIVE:To explore the causal relationship between blood lipids and osteoarthritis.METHODS:The genome-wide association analysis statistical data of 7 items of blood lipids and osteoarthritis from the IEU OPEN GWAS database were used to summarize,and significant single nucleotide polymorphisms were used as instrumental variables.The causal relationship between seven items(serum total cholesterol,triacylglycerol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,apolipoprotein B,apolipoprotein AI and apolipoprotein A1)of blood lipids and osteoarthritis(osteoarthritis,knee or hip osteoarthritis,knee osteoarthritis and hip osteoarthritis)was determined through two-sample Mendelian randomization analysis.The inverse variance weighting was the main effect,and the MR-Egger regression method and the weighted median method were the supplementary effects.Bonferroni correction and reverse Mendelian randomization analysis could ensure validity.Multivariable Mendelian randomization analysis was used to further eliminate confounding factors.A significant causal relationship between seven items of blood lipids and osteoarthritis was obtained to ensure the robustness of the analysis.Co-localization analysis was used to once again ensure the robustness of the causal relationship and identify significantly influencing gene loci,making the evidence of causality more complete.RESULTS AND CONCLUSION:(1)In the two sample Mendelian randomization analysis,the results from inverse variance weighting indicated negative correlations between osteoarthritis and the following serum lipids:total cholesterol(OR=0.937 2,95%CI=0.885 6-0.991 9,P=0.025),low-density lipoprotein cholesterol(OR=0.959 4,95%CI=0.923 6-0.996 6,P=0.033),high-density lipoprotein cholesterol(OR=0.911 2,95%CI=0.833 5-0.996 2,P=0.04),apolipoprotein B(OR=0.926 7,95%CI=0.887 7-0.967 4,P=0.000 5),and apolipoprotein AI(OR=0.951 2,95%CI=0.911 0-0.993 1,P=0.023).Additionally,total cholesterol(OR=0.892 3,95%CI=0.843 1-0.944 3,P=0.000 08),triglycerides(OR=0.938 5,95%CI=0.884 7-0.995 6,P=0.035),and apolipoprotein B(OR=0.911 6,95%CI=0.865 9-0.959 7,P=0.000 4)were negatively associated with knee or hip osteoarthritis.For knee osteoarthritis specifically,total cholesterol(OR=0.898 3,95%CI=0.841 2-0.959 3,P=0.001),high-density lipoprotein cholesterol(OR=0.881 2,95%CI=0.794 7-0.977 0,P=0.016),and apolipoprotein B(OR=0.919 0,95%CI=0.869 8-0.971 0,P=0.002)also showed negative correlations.Lastly,with respect to hip osteoarthritis,total cholesterol(OR=0.864 5,95%CI=0.797 5-0.937 3,P=0.000 4),low-density lipoprotein cholesterol(OR=0.925 6,95%CI=0.879 5-0.974 1,P=0.003),and apolipoprotein B(OR=0.888 8,95%CI=0.817 6-0.966 3,P=0.005)exhibited negative correlations.No statistically significant differences were found in the reverse Mendelian randomization analysis.(2)In the multivariable Mendelian randomization analysis,the results from inverse variance weighting indicated a negative correlation between high-density lipoprotein cholesterol and osteoarthritis(OR=0.942 7,95%CI=0.896 1-0.991 8,P=0.022).Additionally,total cholesterol(OR=0.799 8,95%CI=0.647 8-0.987 6,P=0.037)and high-density lipoprotein cholesterol(OR=0.865 1,95%CI=0.7781-0.961 9,P=0.007)were also negatively associated with knee osteoarthritis.(3)Colocalization analysis revealed that total cholesterol and low-density lipoprotein were significantly associated with osteoarthritis at single nucleotide polymorphisms rs13107325(H4 posterior probability=99.9%).(4)These findings,using international databases and non-Asian populations,provide valuable insights for early clinical diagnosis,understanding the pathogenesis,and researching prevention and treatment of osteoarthritis in Chinese biomedicine and the Chinese population.

BACKGROUND:Osteoarthritis is a complex disease closely related to metabolic abnormalities.However,previous studies only involved limited blood lipid indicators and did not conduct more comprehensive blood lipid profile analysis.An in-depth exploration of the causal relationship between the seven items of blood lipids and osteoarthritis will not only help understand the pathogenesis of osteoarthritis,but also provide new research directions and clinical basis for its prevention and treatment.OBJECTIVE:To explore the causal relationship between blood lipids and osteoarthritis.METHODS:The genome-wide association analysis statistical data of 7 items of blood lipids and osteoarthritis from the IEU OPEN GWAS database were used to summarize,and significant single nucleotide polymorphisms were used as instrumental variables.The causal relationship between seven items(serum total cholesterol,triacylglycerol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,apolipoprotein B,apolipoprotein AI and apolipoprotein A1)of blood lipids and osteoarthritis(osteoarthritis,knee or hip osteoarthritis,knee osteoarthritis and hip osteoarthritis)was determined through two-sample Mendelian randomization analysis.The inverse variance weighting was the main effect,and the MR-Egger regression method and the weighted median method were the supplementary effects.Bonferroni correction and reverse Mendelian randomization analysis could ensure validity.Multivariable Mendelian randomization analysis was used to further eliminate confounding factors.A significant causal relationship between seven items of blood lipids and osteoarthritis was obtained to ensure the robustness of the analysis.Co-localization analysis was used to once again ensure the robustness of the causal relationship and identify significantly influencing gene loci,making the evidence of causality more complete.RESULTS AND CONCLUSION:(1)In the two sample Mendelian randomization analysis,the results from inverse variance weighting indicated negative correlations between osteoarthritis and the following serum lipids:total cholesterol(OR=0.937 2,95%CI=0.885 6-0.991 9,P=0.025),low-density lipoprotein cholesterol(OR=0.959 4,95%CI=0.923 6-0.996 6,P=0.033),high-density lipoprotein cholesterol(OR=0.911 2,95%CI=0.833 5-0.996 2,P=0.04),apolipoprotein B(OR=0.926 7,95%CI=0.887 7-0.967 4,P=0.000 5),and apolipoprotein AI(OR=0.951 2,95%CI=0.911 0-0.993 1,P=0.023).Additionally,total cholesterol(OR=0.892 3,95%CI=0.843 1-0.944 3,P=0.000 08),triglycerides(OR=0.938 5,95%CI=0.884 7-0.995 6,P=0.035),and apolipoprotein B(OR=0.911 6,95%CI=0.865 9-0.959 7,P=0.000 4)were negatively associated with knee or hip osteoarthritis.For knee osteoarthritis specifically,total cholesterol(OR=0.898 3,95%CI=0.841 2-0.959 3,P=0.001),high-density lipoprotein cholesterol(OR=0.881 2,95%CI=0.794 7-0.977 0,P=0.016),and apolipoprotein B(OR=0.919 0,95%CI=0.869 8-0.971 0,P=0.002)also showed negative correlations.Lastly,with respect to hip osteoarthritis,total cholesterol(OR=0.864 5,95%CI=0.797 5-0.937 3,P=0.000 4),low-density lipoprotein cholesterol(OR=0.925 6,95%CI=0.879 5-0.974 1,P=0.003),and apolipoprotein B(OR=0.888 8,95%CI=0.817 6-0.966 3,P=0.005)exhibited negative correlations.No statistically significant differences were found in the reverse Mendelian randomization analysis.(2)In the multivariable Mendelian randomization analysis,the results from inverse variance weighting indicated a negative correlation between high-density lipoprotein cholesterol and osteoarthritis(OR=0.942 7,95%CI=0.896 1-0.991 8,P=0.022).Additionally,total cholesterol(OR=0.799 8,95%CI=0.647 8-0.987 6,P=0.037)and high-density lipoprotein cholesterol(OR=0.865 1,95%CI=0.7781-0.961 9,P=0.007)were also negatively associated with knee osteoarthritis.(3)Colocalization analysis revealed that total cholesterol and low-density lipoprotein were significantly associated with osteoarthritis at single nucleotide polymorphisms rs13107325(H4 posterior probability=99.9%).(4)These findings,using international databases and non-Asian populations,provide valuable insights for early clinical diagnosis,understanding the pathogenesis,and researching prevention and treatment of osteoarthritis in Chinese biomedicine and the Chinese population.

Objective To investigate the current status of knowledge-attitude-practice of cardiac rehabilitation in patients undergoing coronary artery bypass grafting(CABG) and analyze its influencing factors. Methods From July to November 2022, 288 patients with CABG in the coronary heart disease surgery center of Beijing Anzhen Hospital Affiliated to Capital Medical University were conveniently included, and general information questionnaire and cardiac rehabilitation knowledge and practice questionnaire were used to investigate the general situation and the level of knowledge-attitude-practice of cardiac rehabilitation in patients with coronary heart disease. Results A total of 290 questionnaires were sent out in this study, and 288 were effectively collected, with an effective recovery rate of 99.31%. The total score of the questionnaire was (106.81±13.35), and the total score rate was 62.83%, including the knowledge questionnaire scoring (39.34±9.13), belief questionnaire scoring (32.86±3.39) and behavior questionnaire scoring (34.61±3.54). The scoring rates of knowledge, attitude and practice questionnaire were 46.28%, 82.15% and 76.91%, respectively. Multiple linearregression analysis showed that patients who lived in rural areas, had education background of primary school or below, were farmers, had public health insurance, and had no previous coronary intervention, had lower levels of knowledge-attitude-practice of cardiac rehabilitation (P < 0.05). Conclusion The knowledge-attitude-practice of cardiac rehabilitation, especially the level of knowledge, in patients with CABG is needed to be improved. The factors that affect the level of knowledge-attitude-practice of cardiac rehabilitation in this population are diversified, suggesting that individual cardiac rehabilitation guidance should be implemented according to different people and local conditions, and diversified cardiac rehabilitation models should be established to improve the long-term and compliance of cardiac rehabilitation.

Objective:To explore the influencing factors of efficacy of glucocorticoids in the treatment of moderate to severe ulcerative colitis (UC) in children.Methods:A retrospective case-control study was conducted. The clinical data of 38 children with moderate to severe UC treated with glucocorticoids in Beijing Children's Hospital of Capital Medical University from January 2016 to December 2021 were analyzed. According to the response to glucocorticoids therapy, the patients were divided into steroid-intractable group and steroid-effective group. Kaplan-Meier method was used to calculate the cumulative recurrence rate. Univariate analysis was performed to analyze the differences of clinical data between the two groups, and Logistic regression was used to analyze the risk factors of steroid-intractable UC in children.Results:A total of 38 children with moderate to severe UC were enrolled, including 22 males and 16 females. The median onset age was 10.7 (8.5, 12.7) years old, and the median disease duration was 4.3 (1.1, 13.6) months. The cumulative recurrence rates of 38 UC patients at 3 months, 6 months, 1 year and 2 years after glucocorticoids treatment were 26.3%, 52.6%, 63.7% and 69.5%, respectively. There were 17 patients (44.7%) in steroid-effective group. There were 21 patients (55.3%) in steroid-intractable group, including 16 (42.1%) of steroid dependence and 5 (13.2%) of steroid resistance. In the steroid-intractable group, the PUCAI scores at baseline, on the 3rd day and 5th day of glucocorticoids treatment [65.0 (50.0, 70.0) points vs. 50.0 (37.5, 60.0) points, 25.0 (10.0, 37.5) points vs. 10.0 (10.0, 20.0) points, 25.0 (10.0, 37.5) points vs. 10.0 (5.0, 12.5) points] and early recurrence rate (85.7% vs. 35.3%) were higher than those in steroid-effective group, the recurrence time [4.0 (2.0, 5.0) months vs. 19.0 (7.5, 46.5) months] was shorter than that in steroid-effective group, albumin level at baseline [ (33.3 ± 5.5) g/L vs. (37.6 ± 5.9) g/L] was lower than that in steroid-effective group, and the differences were statistically significant (all P<0.05) . Multivariate Logistic regression analysis showed that the PUCAI score at baseline was an independent risk factor for steroid-intractable UC ( OR = 1.070, 95% CI: 1.011-1.132, P = 0.020) . Conclusions:The rates of steroid dependence and the steroid resistance are high in moderate to severe UC children. Children in the steroid-intractable group have an earlier recurrence time, a higher rate of early recurrence, and a lower albumin level at baseline. The steroid dependence and resistance are more likely to occur in children with moderate to severe UC when PUCAI score at baseline is high.

Objective:To explore the influencing factors of efficacy of glucocorticoids in the treatment of moderate to severe ulcerative colitis (UC) in children.Methods:A retrospective case-control study was conducted. The clinical data of 38 children with moderate to severe UC treated with glucocorticoids in Beijing Children's Hospital of Capital Medical University from January 2016 to December 2021 were analyzed. According to the response to glucocorticoids therapy, the patients were divided into steroid-intractable group and steroid-effective group. Kaplan-Meier method was used to calculate the cumulative recurrence rate. Univariate analysis was performed to analyze the differences of clinical data between the two groups, and Logistic regression was used to analyze the risk factors of steroid-intractable UC in children.Results:A total of 38 children with moderate to severe UC were enrolled, including 22 males and 16 females. The median onset age was 10.7 (8.5, 12.7) years old, and the median disease duration was 4.3 (1.1, 13.6) months. The cumulative recurrence rates of 38 UC patients at 3 months, 6 months, 1 year and 2 years after glucocorticoids treatment were 26.3%, 52.6%, 63.7% and 69.5%, respectively. There were 17 patients (44.7%) in steroid-effective group. There were 21 patients (55.3%) in steroid-intractable group, including 16 (42.1%) of steroid dependence and 5 (13.2%) of steroid resistance. In the steroid-intractable group, the PUCAI scores at baseline, on the 3rd day and 5th day of glucocorticoids treatment [65.0 (50.0, 70.0) points vs. 50.0 (37.5, 60.0) points, 25.0 (10.0, 37.5) points vs. 10.0 (10.0, 20.0) points, 25.0 (10.0, 37.5) points vs. 10.0 (5.0, 12.5) points] and early recurrence rate (85.7% vs. 35.3%) were higher than those in steroid-effective group, the recurrence time [4.0 (2.0, 5.0) months vs. 19.0 (7.5, 46.5) months] was shorter than that in steroid-effective group, albumin level at baseline [ (33.3 ± 5.5) g/L vs. (37.6 ± 5.9) g/L] was lower than that in steroid-effective group, and the differences were statistically significant (all P<0.05) . Multivariate Logistic regression analysis showed that the PUCAI score at baseline was an independent risk factor for steroid-intractable UC ( OR = 1.070, 95% CI: 1.011-1.132, P = 0.020) . Conclusions:The rates of steroid dependence and the steroid resistance are high in moderate to severe UC children. Children in the steroid-intractable group have an earlier recurrence time, a higher rate of early recurrence, and a lower albumin level at baseline. The steroid dependence and resistance are more likely to occur in children with moderate to severe UC when PUCAI score at baseline is high.

Objective:To compare the efficacy of combination therapy on cyclic vomiting syndrome(CVS)in children, and improve the efficacy of CVS treatment in the future.Methods:This study retrospectively analyzed patients′ medical records of CVS, which were admitted to Digestive Department of Beijing Children′s Hospital from 2012 to 2019.The treatment regimen was A(Cyproheptadine+ Doxepin+ Valproate), B(Propranolol+ Cyproheptadine), or C(Propranolol+ Amitriptyline). Meanwhile, the patients should take drugs more than three months.The clinical data of 42 cases were analyzed retrospectively, and the treatment effect after discharge was followed up by telephone until October, 2020.Results:Among the 42 cases, 17 were male and 25 were female, whose mean age of onset was (4.65±3.23) years, and the age of diagnosis was (6.79±3.58) years.The main accompanied symptoms were abdominal pain and upper gastrointestinal bleeding.Forty-two patients were moderate/severe CVS.The regimens A, B and C were observed in 7, 11, and 24 patients, respectively.The age at improvement was(8.17±4.12)years.The course of treatment was(1.37±0.96)years.The age at follow-up was(10.32±4.03)years.During the 1-year follow-up, 35 cases were effective, and the efficiency was 83.3%.Among them, 23 cases had no paroxysmal vomiting and 7 cases had no effect.There was no significant difference in therapy effects among group A, B and C. Between the effective group and non-effective group, there were statistical differences in the personal history of hiatus hernia( P=0.024), the weight at follow-up ( P=0.042), and the course of medication( P=0.020). Conclusion:The combination regimen has a higher effective rate in the treatment of CVS.There was no significant difference among the three regimens in the treatment of CVS.For children with refractory CVS, who can not be treated with combination therapy, individualized therapy should be further developed.

Objective:To analyze and summarize the application and significance of the computer-assisted surgery system in precision surgery of mediastinal tumors in children.Methods:The clinical data of 54 children that underwent mediastinal tumor resection surgery in the Affiliated Hospital of Qingdao University from August 2008 to November 2021 were collected.According to whether the Hisense CAS computer-assisted surgery system was used before the operation, the patients were divided into three-dimensional (3D) reconstruction group (29 cases, 53.70%) and two-dimensional (2D) CT group (25 cases, 46.30%). The surgical indicators, postoperative hospital stay, and the incidence of surgical complications were compared between the two groups.The t-test, Mann- Whitney U test, χ2 test or Fisher′ s exact test were carried out for statistical analysis.Simulated surgery and actual surgery were compared for both 3D reconstruction and 2D CT groups. Results:There were no significant differences in gender, age, height, weight, maximum tumor diameter and tumor location between the 3D reconstruction group and 2D CT group (all P>0.05). The operation time of the 3D reconstruction group was [(125.14±41.37) min] was shorter than that of the 2D CT group [(149.24±44.53) min] ( P=0.044). The intraoperative blood loss in the 3D reconstruction group [15.00(13.50, 25.00) mL] was less than that in the 2D CT group [36.00(30.00, 75.00) mL] ( P<0.001). In addition, the indwelling time the closed thoracic drainage tube [4.00 (3.00, 5.50) d] and postoperative hospitalization days [(8.83±3.39) d] in the 3D reconstruction group were shorter than those in the 2D CT group [7.00(5.00, 11.50) d, (11.00±4.10) d] ( P=0.001, 0.038). No significant difference in postoperative complication rates was found between the 3D reconstruction group and 2D CT group ( P>0.05). The simulated operation was consistent with the actual operation in the 3D reconstruction group. Conclusions:3D reconstruction by the computer-assisted surgery system can truly reveal the anatomical relationship between tumors and surrounding organs and blood vessels, and improve the accuracy and safety of surgical resection of mediastinal tumors in children.

Methods:Two thousand standard sections images werre collected from 2 000 clinical retrospective pediatric hip ultrasound videos from January 2019 to January 2021. All standard sections were annotated by the annotation team through the self-designed software based on Python 3.6 environment for image cross-media data annotation and manual review standardization process with unified standards. Among them, 1 753 were randomly selected for training the deep learning system, and the remaining 247 were used for testing the system. Further, 200 standard sections were randomly selected from the test set, and 8 clinicians independently completed the film reading annotation. The 8 independent results were then compared with the AI results.Results:The testing set consists of 247 patients. Compared with the clinician's measurements, the area under the receiver operating characteristic curve (AUC) of diagnosing hip joint maturity was 0.865, the sensitivity was 76.19%, and the specificity was 96.9%. The AUC of AI system interpretation under Graf detailed typing was 0.575, the sensitivity was 25.90%, the specificity was 89.10%. The 95% LoA of α-angle determined by Bland-Altman method, of -4.7051° to 6.5948° ( Bias -0.94, P<0.001), compared with clinicians' measurements. The 95% LoA of β-angle, of -7.7191 to 6.8777 ( Bias -0.42, P=0.077). Compared with those from 8 clinicians, the results of AI system interpretation were more stable, and the β-angle effect was more prominent. Conclusion:The AI system can quickly and accurately measure the Graf correlation index of standard DDH ultrasonic standard diagnosis plane.