OBJECTIVE To introduce the development of an intelligent prescription review decision-support system for anti-tumor drugs and assess its clinical application outcomes. METHODS Relevant data sources， including national and local pharmaceutical administration policies， clinical practice guidelines/consensus， hospital information systems data， and genetic testing results， were integrated. Adhering to the principles of structure， standardization and dynamic updating， a knowledge base covering chemotherapeutic， targeted and immunotherapeutic agents was constructed using a dual-dimensional modeling approach that combined “drug attributes” and “clinical contexts”. This knowledge base was then embedded into the hospital’s electronic medical order system to establish the prescription review decision-support system. The application and performance of the system were evaluated at Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. RESULTS A knowledge base containing 18 318 prescription review rules for anti-tumor drugs was constructed， and a closed-loop prescription review system was successfully established， encompassing pre-prescription real-time intervention， in-process interactive review， and post-prescription evaluation and analysis. From 2021 to 2024， the system generated a total of 57 879 alerts for prescriptions of five typical categories of anti-tumor drugs. For platinum-containing prescriptions， 22 577 alerts were generated， with Cisplatin for injection （lyophilized） being the most frequently alerted drug （13 445 alerts）， and “ototoxicity risk due to combined use” alerts remained high （7 682 alerts）. For methotrexate-containing prescriptions， 3 721 alerts were recorded， primarily related to “precaution-related issues” （76.4%， 2 843/3 721）. For doxorubicin-containing prescriptions， 17 301 alerts were triggered， primarily related to “dosage and administration” （14 315 alerts）. For human epidermal growth factor receptor 2-targeted agents-containing prescriptions， 1 007 alerts were issued， mostly related to “reimbursement restrictions” （956 alerts）. For programmed death-1/programmed death-ligand 1 inhibitors-containing prescriptions， the alerts increased year by year， totaling 13 273 alerts， primarily related to “inappropriate indication” （9 118 alerts）. Over the 4 years， the physician response rates to system alerts were 21.4%， 27.1%， 33.5% and 51.6%， respectively. CONCLUSIONS An intelligent decision-support system for anti-tumor drug prescription review， encompassing a closed-loop process of “real-time pre-event intervention， interactive in-event prescription review， post-event evaluation and analysis”， has been successfully constructed and implemented throughout the entire workflow. There is a discernible trend in this hospital， where the focus on monitoring anti-tumor drugs is shifting towards immunotherapy drugs. Additionally， the acceptance rate of physicians regarding prescription review opinions has been steadily increasing year by year.

Objective:To design a management system of internet of things(IoT)smart operation room based on business process reconstruction theory,and explore the application effect of that in improving management effectiveness for operation room.Methods:Aimed at the existing problems of key points in the management for operation room,the process was reconstructed on the basis of the original information system,relevant systems,workflows and standards of operation room of Fuwai Hospital of Medical Sciences and Peking Union Medical College.Then,a management system of IoT smart operation room based on business process reconstruction theory was designed.The surgical data of 13159 patients who underwent relevant operation of cardiovascular surgery from January to December 2022 were selected,and they were divided into"before-application"group(6 483 cases)and"after-application"group(6 676 cases)according to the point before and after the system was applied.Some indicators'data,which included scheduling management situation of picking up and dropping off patients by medical auxiliaries,duration of preparing anesthesia,duration of preoperative waiting,interval duration of continuous surgery and usage amount of surgical gowns under same amount of surgery,between two groups were compared.Results:The transportation efficiency of patients who underwent surgery after system was applied was(1.38±0.09)surgeries/h,which was higher than(0.99±0.09)surgeries/h before it was applied,and the difference was statistically significant(t=6.604,P<0.001).The satisfaction score of medical auxiliaries increased from 3.83(3.33,4.5)before application to 4.50(4.33,4.83)after application,and the difference was significant(Z=2.02,P<0.05).The duration of preparing anesthesia and duration of preoperative waiting after the system was applied were respectively(62.04±2.29)and(8.09±2.46)min,both of which were less than those before the system was applied,and the differences of them between two groups were statistically significant(t=2.309,2.280,P<0.05).The usage amount of surgical gowns under same amount of surgery after the system was applied was(4.11±0.57)gowns/surgery,which was less than(5.81±0.29)gowns/surgery before the system was applied,and the difference was statistically significant(t=6.489,P<0.05).Conclusion:The application of the management system of IoT smart operation room based on business process reconstruction theory can provide more safely,high-qualitatively and efficiently medical services for patients,and improve work efficiency and management effectiveness for operation room,and reduce resource consumption and operating cost.

Objective:To design a management system of internet of things(IoT)smart operation room based on business process reconstruction theory,and explore the application effect of that in improving management effectiveness for operation room.Methods:Aimed at the existing problems of key points in the management for operation room,the process was reconstructed on the basis of the original information system,relevant systems,workflows and standards of operation room of Fuwai Hospital of Medical Sciences and Peking Union Medical College.Then,a management system of IoT smart operation room based on business process reconstruction theory was designed.The surgical data of 13159 patients who underwent relevant operation of cardiovascular surgery from January to December 2022 were selected,and they were divided into"before-application"group(6 483 cases)and"after-application"group(6 676 cases)according to the point before and after the system was applied.Some indicators'data,which included scheduling management situation of picking up and dropping off patients by medical auxiliaries,duration of preparing anesthesia,duration of preoperative waiting,interval duration of continuous surgery and usage amount of surgical gowns under same amount of surgery,between two groups were compared.Results:The transportation efficiency of patients who underwent surgery after system was applied was(1.38±0.09)surgeries/h,which was higher than(0.99±0.09)surgeries/h before it was applied,and the difference was statistically significant(t=6.604,P<0.001).The satisfaction score of medical auxiliaries increased from 3.83(3.33,4.5)before application to 4.50(4.33,4.83)after application,and the difference was significant(Z=2.02,P<0.05).The duration of preparing anesthesia and duration of preoperative waiting after the system was applied were respectively(62.04±2.29)and(8.09±2.46)min,both of which were less than those before the system was applied,and the differences of them between two groups were statistically significant(t=2.309,2.280,P<0.05).The usage amount of surgical gowns under same amount of surgery after the system was applied was(4.11±0.57)gowns/surgery,which was less than(5.81±0.29)gowns/surgery before the system was applied,and the difference was statistically significant(t=6.489,P<0.05).Conclusion:The application of the management system of IoT smart operation room based on business process reconstruction theory can provide more safely,high-qualitatively and efficiently medical services for patients,and improve work efficiency and management effectiveness for operation room,and reduce resource consumption and operating cost.

This study summarizes the preoperative and intraoperative nursing experience in 5 cases of bridge-to-transplant heart transplantation with left ventricular assist device(LVAD)explant.Key points of nursing include:preoperative care and assessment of LVAD patients,preoperative discussion of the multidisciplinary team,safe transfer of patients to surgical rooms and other preoperative preparation,cardiomyocardial protection and multidisciplinary team cooperation during bridging transplantation,and intra-operative patient safety management.All 5 patients in this group successfully completed the surgery and were discharged.Pressure sores,wound infections,and other postoperative complications have not occurred.Postoperative cardiac function of 5 patients in this group were classified as New York Heart Association class Ⅰ～Ⅱ.The follow-up period for the 5 patients in this group ranged from 6 months to 6 years.The results of the most recent echocardiography follow-up showed that the left ventricular ejection fraction of all patients was all above 65％,with well prognosis.

Objective To compare the filtration effects of different models of leukocyte filters on erythrocyte suspensions,so as to provide a reference for the selection of leukocyte filters in clinic.Methods The erythrocyte suspensions prepared by Department of Blood Transfusion of The First Affiliated Hospital of Naval Medical University were used for filtration.The test was categorized into three groups based on the model of leukocyte filters,namely,AKTT-type(group Ⅰ),STTB-type(group Ⅱ),and STTA-type(groupⅢ).Each group was randomly assigned 8 bags of erythrocyte suspensions(specification 2U)with hematocrit≤55%and 10 bags of erythrocyte suspensions(specification 2U)with hematocrit>55%,and leukapheresis was applied.The quality indexes of the blood were detected before and after filtration,and the experimental data were comprehensively analyzed to evaluate the leukocyte filtration effect of various filters.Results When the hematocrit of the filtered erythrocyte suspensions was≤55%,there were significant differences in the platelet count after filtration(F=49.94,P<0.001)and filtration time(F=73.45,P<0.001)between groups,and the two indexes in group Ⅰ were superior to those in groups Ⅱ and Ⅲ.When the hematocrit of the filtered erythrocyte suspensions was>55%,there were significant differences in the platelet count after filtration(F=160.69,P<0.000 1),filtration time(F=366.09,P<0.000 1),residual leukocytes(F=4.28,P<0.05),and hemolytic rate(F=8.16,P<0.01)between groups.The platelet count after filtration and filtration time in group I were superior to those in group II and III.The indexes of residual leukocyte and hemolytic rate in groups I and II were superior to those in group III.Conclusion In order to ensure the safety and effectiveness of erythrocyte suspension transfusion,AKTT-type filter can be chosen to perform leukocyte filtration,which can further lower the blood transfusion complications.

Objective:To compare the impact of the AlignRT-based optical guidance method with the traditional marker line method on the accuracy of positioning, and explore the effect of patient′s different thoracic characteristic parameters on the precision of optical guidance positioning.Methods:A total of sixty breast cancer patients who received post breast-conserving radiotherapy at Anhui Cancer Hospital from July 2022 to September 2023 were retrospectively selected. Then these patients were equally divided into traditional cross hairs set-up (marker line group) and surface-guided set-up (SGRT group). The cone-beam CT scanning results were used as the gold standard, the three-dimensional set-up errors and the CTV-PTV target area external radiotherapy boundaries of two groups were studied comparatively. Multiple patient′s thoracic characteristic parameters were defined and the correction between each parameter and set-up error of SGRT was analyzed.Results:The mean value of three-dimensional set-up errors in the SGRT group and the marker line group was within 0.2 cm and 0.5 cm, respectively. The differences in three-dimensional set-up errors and total displacements between two groups were statistically significant ( z=-2.93, -3.21, -2.59, -4.76, P<0.05). The SGRT group reduced the CTV-PTV boundary from 0.5 cm of conventional marker line group to 0.3 cm. The thoracic aspect ratio H/W, the affected side pinch angle α1, and the healthy side pinch angle α2 were positively correlated with the x-direction posing error ( r=0.49, 0.59, 0.71, P<0.05); whereas, the affected side and the healthy side mammary gland heights D1 and D2 were negatively correlated with the z-direction posing error ( r=-0.46, -0.49, P<0.05). Conclusions:For breast-conserving postoperative radiotherapy patients, SGRT can obtain a more accurate radiotherapy set-up than the traditional marker line method, and can effectively reduce the target area externally expanded range. Meanwhile, the monitoring accuracy of SGRT is affected by the patient′s thoracic characteristic parameters, and clinical attention should be paid to breast-conserving radiotherapy patients with thick body shape, narrow body width, and small breast glands.

Objective To determine the chemical composition of TangNiaoLing Tablets by UHPLC-Q-Exactive-Orbitrap-MS/MS.Methods A Waters ACQUITY HSS T3 column(100 mm×2.1 mm,1.8 μm)was used for separation at a total flow rate of 0.2 mL/min.The mobile phase included an aqueous solution of 0.1%formic acid and acetonitrile mixed with 0.1%formic acid was supplied.The injection volume was set at 2 μL and the column oven temperature was 40℃.High-resolution mass spectrometric data were obtained by concurrently scanning the positive and negative ion modes.The identification was accomplished by inferring the empirical fragmentation patterns and comparing it with databases and references.Results 100 different chemical elements,including triterpenes,flavonoids,phenylpropanoids,phenylethanoid glycosides,iridoid glycosides,and phenols,among others were identified from the 50%methanol extract of TangNiaoLing pills.Conclusion The chemical contents of TangNiaoLing tablets were identified and analyzed using the UHPLC-Q-Exactive-Orbitrap-MS/MS method for the first time.This served as a foundation for future research into the tablets' effective components and quality control.

Objective: To evaluate the safety and efficacy of the emergency infusion protocol for universal red blood cells by analyzing its clinical application in patients treated at our hospital's war trauma and emergency center. Methods: Data were collected from 133 patients who received universal red blood cell transfusion in the war trauma center of our hospital from January 2016 to December 2024. The basic information, universal red blood cell transfusion volume, compatible blood components, transfusion volume, blood routine (Hb, Hct), liver and kidney function (ALT, AST, TBil, DBil, creatinine, etc.) and coagulation function (PT, APTT, Fib, etc.) before and after transfusion were retrospectively analyzed. Results: Among the 133 patients who received a total of 374 units of universal red blood cells, the 24-hour survival rate was 62.4% (83/133). Spearman correlation analysis showed a positive correlation between shock index and universal red blood cell transfusion volume (r=0.283, P<0.05). Patients were stratified by universal red blood cell transfusion volume (≤ 3 U vs ≥ 4 U). The low volume group had less homotypic red blood cell transfusion volume and total transfusion volume at different time points, and the difference was statistically significant: within 2 h [2(2, 4)vs 4(3, 7), P=0.033<0.05], 0~24 h [6(4, 9) vs 8(6, 14), P=0.028<0.05], total transfusion volume [13(8, 20)vs 19(12, 35), P=0.021<0.05]. No acute hemolytic transfusion reaction occurred within 24 hours after transfusion of universal red blood cell. Conclusion: Universal red blood cells are safe for use in emergency treatment. Furthermore, the shock index combined with the volume of universal red blood cells transfused can predict subsequent transfusion requirements and enables the early reservation of compatible blood, thereby preventing delayed resuscitation.

Purpose: We used bioinformatics methods and Mendelian randomization (MR) analysis to investigate the hub genes involved in acute myeloid leukemia (AML) and their causal relationship with hemolysis, to explore a new direction for molecular biology research of AML. Methods: We first differentially analyzed peripheral blood samples from 62 healthy volunteers and 65 patients with AML from the Gene Expression Omnibus database to obtain differentially expressed genes (DEGs), and intersected them with genes sourced from weighted gene co-expression network analysis (WGCNA) and the GeneCards database to obtain target genes. Target genes were screened using protein–protein interaction (PPI) network analysis and ROC curves to identify genes associated with AML. Finally, we analyzed the correlation between genes and immune cells and the relationship between toll-like receptor 4 (TLR4) and AML using MR. Results: We compared peripheral blood expression profiles using an array of 62 healthy volunteers (GSE164191) and 65 patients with AML (GSE89565) (M0:25; M1:11; M2:10; M3:1; M4:7; M4 eo t [16;16] ou inv [16]:4; M5:6; M6:1) and obtained 7,339 DEGs (3,733 upregulated and 3,606 downregulated). We intersected these DEGs with 4,724 genes from WGCNA and 1,330 genes related to hemolysis that were identified in the GeneCards database to obtain 190 target genes. After further screening these genes using the PPI network, we identified TLR4, PTPRC, FCGR3B, STAT1, and APOE, which are closely associated with hemolysis in patients with AML. Finally, we found a causal relationship between TLR4 and AML occurrence using MR analysis (p < 0.05). Conclusion We constructed a WGCNA-based co-expression network and identified hemolysis-associated AML genes.

Objective: To compare the biological characteristics of human induced pluripotent stem cell-derived platelet exosomes (hiPSC-Plt-Exos) with those of conventional apheresis platelet exosomes (Plt-Exos), specifically focusing on their differential abilities to enhance the proliferation and migration of human umbilical cord mesenchymal stem cells (hUC-MSCs). Methods: Exosomes were isolated from hiPSC-derived Plt and apheresis Plt concentrate using size exclusion chromatography. These exosomes were then characterized through nanoparticle tracking analysis (NTA), transmission electron microscopy (TEM), and Western blotting. Co-culture experiments into hUC-MSCs were conducted with hiPSC-Plt-Exos and apheresis Plt-Exos, respectively. Their effects on the proliferation and migration of hUC-MSCs were assessed via cell proliferation assays and scratch tests. Results: hiPSC-Plt-Exos and apheresis Plt-Exos exhibited comparable particle sizes, morphological features (such as the characteristic cup-shaped structure), and surface markers (including CD9 and HSP70). Notably, hiPSC-Plt-Exos demonstrated a significantly greater ability to enhance the proliferation and migration of hUC-MSCs compared to apheresis Plt-Exos (P<0.05). These differences provide critical comparative data for their application in various clinical contexts. Conclusion: This study establishes a theoretical foundation for developing precise therapeutic strategies based on hiPSC-Plt-Exos. Furthermore, it underscores the necessity of selecting the appropriate type of exosomes according to the specific disease microenvironment to achieve optimal therapeutic outcomes.