Organ transplantation is regarded as the pinnacle of medical achievement in the 21st century, with innovation serving as the core engine driving the advancement of transplant surgery. Taking the decades of practical exploration in organ transplantation (especially liver transplantation) in China as its main thread, this article systematically analyzes the core logic of transplant surgical innovation. This logic adheres to a three-pronged developmental pathway characterized by being clinically problem-solving oriented, patient-need centered, and critical-technology-conquering driven. By reviewing major milestones such as living donor liver transplantation, auxiliary partial orthotopic liver transplantation, combined multi-organ transplantation, and xenotransplantation, the study elucidates how surgical innovation should be grounded in resolving clinical pain points, return to medical humanism, and leverage technological iteration to foster revolutionary progress. Furthermore, the article explores the empowering role of cutting-edge technologies-including artificial intelligence, machine perfusion, and gene editing-in driving the next surgical revolution. It aims to construct a theoretical framework and provide practical insights for the future development of transplant surgery in China.

Organ transplantation is regarded as the pinnacle of medical achievement in the 21st century, with innovation serving as the core engine driving the advancement of transplant surgery. Taking the decades of practical exploration in organ transplantation (especially liver transplantation) in China as its main thread, this article systematically analyzes the core logic of transplant surgical innovation. This logic adheres to a three-pronged developmental pathway characterized by being clinically problem-solving oriented, patient-need centered, and critical-technology-conquering driven. By reviewing major milestones such as living donor liver transplantation, auxiliary partial orthotopic liver transplantation, combined multi-organ transplantation, and xenotransplantation, the study elucidates how surgical innovation should be grounded in resolving clinical pain points, return to medical humanism, and leverage technological iteration to foster revolutionary progress. Furthermore, the article explores the empowering role of cutting-edge technologies-including artificial intelligence, machine perfusion, and gene editing-in driving the next surgical revolution. It aims to construct a theoretical framework and provide practical insights for the future development of transplant surgery in China.

Objective:Time trade-off was employed to measure health state utilities associated with treatment attributes of hemophilia A patients to provide parameters for economic evaluations.Methods:Patients were recruited through patient organization and blood center of Shandong to measure health state utility values for 10 health states.Results:The utility values of preventive treatments for severe,moderate,and mild hemophilia A were 0.644,0.738,and 0.815,respectively.Compared with injections at 2-day intervals,the utility values were increased by 0.044 and 0.092 at 3-and 4-day intervals,respectively.Taking"severe hemophilia A patients injected every 2 days"as the base state,the disutility values for spontaneous bleeding and traumatic bleeding were 0.226 and 0.172.The disutility values for mild,moderate,and severe bleeding were 0.052,0.159,and 0.476,respectively,and the magnitude of the decrease gradually increased.Conclusion:Treatment attributes have an impact on patient preferences and more attention should be paid in pharmacoeconomic evaluations.

Objective:To construct a thyroid nodule segmentation model using ultrasound dynamic images and explore its potential for assisting in the screening of thyroid nodules.Methods:A total of 126 patients with thyroid nodules（comprising 150 nodules）who were diagnosed and treated at Xuzhou Cancer Hospital from April 2024 to December 2024 were prospectively enrolled. Two-dimensional ultrasound was performed to capture short-axis and long-axis video images of thyroid nodules，forming a dynamic ultrasound image dataset. The dataset was divided into training，validation，and test sets in a ratio of 6∶1∶3. After the training loss curve converged，the model that performed well on the validation set was selected for testing. Three-fold cross-validation was employed for training and testing. All 300 ultrasound videos were divided into three subsets. In each experiment，two subsets were used as the training set，and one subset was used as the test set to evaluate the model's generalization ability. A collaborative spatiotemporal diffusion model was established based on the dynamic trends and tissue texture details of thyroid nodules. Six widely used segmentation metrics were employed to evaluate the model's application capabilities.Results:The study included 126 patients with 150 thyroid nodules，300 dynamic ultrasound images，and video lengths of 3-4 seconds per nodule，resulting in 12 312 segmented images. The size of the thyroid nodules was（10.7 ± 10.6）mm（transverse diameter）×（8.4 ± 6.3）mm（anteroposterior diameter）. Among the nodules，62（41.3%）had clear boundaries，while 88（58.7%）had indistinct boundaries；61（40.7%）exhibited regular shapes，while 89（59.3%）were irregular；66（44.0%）had a taller-than-wide aspect ratio；and 70（46.7%）showed microcalcifications. The collaborative diffusion model based on dynamic ultrasound image segmentation achieved the following scores：a Jaccard score of（69.22 ± 0.03）%，a Dice score of（79.16 ± 0.18）%，a Precision score of（86.70 ± 0.17）%，a Recall score of（77.82 ± 0.04）%，an Sα score of（85.26 ± 0.01）%，and an Eθmn score of（90.58 ± 0.17）%. Compared to other models，this model demonstrated significant improvements across all evaluation metrics，achieving the highest values in each metric with increments of over 8% and 1%，respectively. Conclusions:The collaborative diffusion model with a dynamic controller，constructed based on dynamic ultrasound images of thyroid nodules，demonstrates excellent performance in ultrasound image segmentation. It improves the accuracy of thyroid nodule screening，thereby providing a valuable auxiliary diagnostic tool for clinical practice.

Objective:To propose a deep learning（DL）-based ultrasound imaging auxiliary tool for automatic segmentation and recognition of the brachial plexus（BP），and to enhance the accuracy and safety of clinical procedures.Methods:It was a multicenter study that collected 773 healthy subjects from Peking University Third Hospital and its branch campuses，the Third Medical Center of the Chinese PLA General Hospital，and Shanghai Eighth People's Hospital between August 2024 and February 2025. Brachial plexus（BP）images in the interscalene groove were captured used high-frequency ultrasound by senior sonographers，a dataset comprising 1 289 standardized images were constructed and the improved model（CHA-TransUNet）was trained. The test set was input into 6 different models（CHA-TransUNet，R50-Unet，TransUnet，SegFormer，SwinUnet，MISSFormer）for segmentation. Segmentation accuracy was evaluated using metrics including the Dice similarity coefficient（DSC），95% Hausdorff distance（HD95）and mean intersection over union（mIoU），and was compared with the segmentation results of 3 ultrasound physicians with varying experience levels（junior physicians and senior physicians）to validate the model's segmentation efficacy.Results:The CHA-TransUNet model established based on a dataset of 1 289 standardized images achieved segmentation results for the BP with a DSC of 90.15%，mIoU of 91.02%，and HD95 of 8.08. Its accuracy was higher than other mainstream models（DSC：90.15% vs. 87.60%，87.77%，81.35%，84.78%，84.55%），significantly better than junior physicians（DSC：90.15% vs. 68.73%， Z=-127.76， P<0.001），and approached the level of senior physician（DSC：90.15% vs. 86.15%， Z=-31.33， P=0.549）. The model demonstrated superior boundary recognition in complex anatomical structures（e.g.，C6/C7 nerve roots）compared to ultrasound physicians（junior and senior）（HD95：8.08 vs. 26.34，17.44，56.80）. Conclusions:This study proposes an analysis model for BP ultrasound images，CHA-TransUNet. This model achieves segmentation and recognition of the BP with relatively complex pathways and structures. The model exhibits high accuracy and stability，outperforming current mainstream network models and junior physicians while approaching the performance level of senior physicians. It assists junior physicians or trainees in more accurately identifying and localizing the BP.

Objective To determine the clinical effect of warmed iodophor for preoperative disinfection in elderly patients undergoing laparoscopic hysterectomy.Methods A total of 84 elderly patients who underwent laparoscopic hysterectomy were selected and randomly divided into the room temperature group(disinfected with iodophor at a temperature of 24℃)and the warmed group(disinfected with iodophor at a temperature of 39℃),with 42 cases in each group.The disinfection qualification status,incision infection status,nasopharyngeal temperature,awakening time,adverse reactions,intraoperative blood loss,incision drainage volume,and hidden blood loss of patients in the two groups were compared.Results There was no statistically significant difference in the disinfection qualification rate or incision infection rate between the two groups(P>0.05).At 10 minutes,30 minutes,60 minutes after disinfection and the end of the operation,the nasopharyngeal temperatures of patients in the warmed group were significantly higher than those in the room temperature group(P<0.05).The awakening time of patients in the warmed group was significantly shorter than that in the room temperature group(P<0.05),and the incidences of intraoperative hypothermia and shivering reaction after awakening were significantly lower than those in the room temperature group(P<0.05).There was no statistically significant difference in the intraoperative blood loss or incision drainage volume of patients between the two groups(P>0.05),while the hidden blood loss of patients in the room temperature group was significantly higher than that in the warmed group(P<0.05).Conclusion The iodophor at a temperature of 39℃for preoperative disinfection in elderly patients undergoing laparoscopic hysterectomy can not only ensure the disinfection effect and surgical safety,but also effectively maintain intraoperative body temperature stability,promote postoperative awakening,and reduce hidden blood loss.

Objective To construct a prediction model for the risk of peripherally inserted central venous catheter(PICC)-related bloodstream infection(CRBSI)in preterm infants,and evaluate the effect of the model.Methods 1 295 preterm infants admitted to the neonatal intensive care unit(NICU)in a hospital and received PICC intrave-nous infusion from January 2019 to October 2023 were selected as the study subjects,including 1 080 preterm in-fants from January 2019 to December 2022 in the modeling set and 215 premature infants from January to October 2023 in the validation set.Risk factors of cases were analyzed based on 24 clinical characteristics,optimized charac-teristics was selected by LASSO regression,independent risk factors for CRBSI of preterm infants during PICC in-dwelling period were identified by multiple logistic regression analysis,and nomogram model was constructed with R software.Discrimination and fitting of the model were evaluated by the area under the curve(AUC)of the receiver operating characteristic(ROC)as well as Hosmer-Lemeshow test and calibration curve,and clinical practicality of the model was evaluated by decision curve analysis(DCA).Results Multivariate logistic analysis showed that birth weight ≥1 500 g,sterile protection during catheter maintenance,and sterile cloth wrapped joints were protective factors for CRBSI during PICC indwelling period in preterm infants(OR=0.172,0.187,0.063,respectively,all P＜0.05),while puncture frequency＞2 times,catheter indwelling period＞14 days,and use of tees were inde-pendent risk factors for CRBSI during PICC indwelling period in premature infants(OR=2.533,14.128,13.256,respectively,all P＜0.05).The AUC of ROC of the modeling set was 0.953(95％CI:0.936-0.969),and that of the validation set was 0.930(95％CI:0.885-0.974),indicating good discriminability of the model.The calibra-tion curve and Hosmer-Lemeshow goodness of fit test showed that the model had good accuracy and consistency,with high net profit value,indicating that the predictive value of the model was high and with good clinical practica-lity.The statistical test result in the rationality analysis of the model was P＜0.001.Conclusion The nomogram model based on the general clinical characteristics of preterm infants as well as the basic prevention and control measures of the catheter can provide a visual and simple evaluation tool for early identification of high risk factors for CRBSI in preterm infants.

Objective To evaluate the cost-effectiveness of toripalimab plus axitinib compared to sunitinib in the first-line treatment of advanced renal cell carcinoma patients.Methods Based on the RENOTORCH trial,constructed a partitioned survival model to evaluate the long-term costs and health outcomes of toripalimab plus axitiniband sunitinib in the first-line treatment of advanced renal cell carcinoma(RCC)patients from the Chinese healthcare system perspective.The cycle length of the model was 3weeks,simulating the total cost,quality adjusted life years(QALYs),and incremental cost-effectiveness ratio(ICUR)for patients over 25 years.The costs were derived from the average bidding price of Yaozhi database in 2023 and published literature.The health state utility values were derived from clinical trials.The discount rate was 5%,and the willingness to pay(WTP)threshold was 3 times the per capita gross domestic product(GDP)in 2022.One-way and probability sensitivity analyses were used to test the robustness of the model.Results Based on the progression free survival(PFS)evaluated by the Independent Review Committee(IRC)and Investigator(IA),the ICUR values were 239 436.39 yuan/QALY and 175 440.39 yuan/QALY,respectively,both lower than the WTP threshold.One-way sensitivity analysis showed that the health state utility values of PFS status and the price of axitinib had a significant impact on the model.Probability sensitivity analysis showed that the probability of toripalimab plus axitinib being cost-effective was 63.64%and 98.03%according to the IRC and IA assessments,respectively.Conclusion Toripalimab plus axitinib was cost-effective in the first-line treatment of advanced RCC patients.

Accumulating evidence has demonstrated that nucleic acid-based therapies are promising for atherosclerosis. However, nearly all nucleic acid delivery systems developed for atherosclerosis necessitate injection, which results in rapid elimination and poor patient compliance. Consequently, oral delivery strategies capable of targeting atherosclerotic plaques are imperative for nucleic acid therapeutics. Herein we report the development of yeast-derived capsules (YCs) packaging an antisense oligonucleotide (AM33) targeting microRNA-33 (miR-33) for the oral treatment of atherosclerosis. YCs provide stability for AM33, preventing its premature release in the gastrointestinal tract. AM33-containing YCs, defined as YAM33, showed high transfection in macrophages, thus promoting cholesterol efflux and inhibiting foam cell formation by regulating the target genes/proteins of miR-33. Orally delivered YAM33 effectively accumulated within atherosclerotic plaques in ApoE ^-/- mice, primarily by transepithelial absorption via M cells in Peyer's patches and subsequent translocation via macrophages through the lymphatic system. Inhibition of miR-33 by oral YAM33 significantly delayed the progression of atherosclerosis. Moreover, oral treatment with YCs co-delivering AM33 and atorvastatin afforded significantly enhanced anti-atherosclerotic effects. Our findings suggest that yeast-based microcapsules represent an effective carrier for oral delivery of nucleic acids, either alone or in combination with existing drugs, offering a promising approach for precision therapy of atherosclerotic diseases.

Diabetic cardiomyopathy (DCM) is a medical condition characterized by cardiac remodeling and dysfunction in individuals with diabetes mellitus. Sarcoplasmic reticulum (SR) and mitochondrial Ca²⁺ overload in cardiomyocytes have been recognized as biological hallmarks in DCM; however, the specific factors underlying these abnormalities remain largely unknown. In this study, we aimed to investigate the role of a cardiac-specific long noncoding RNA, D830005E20Rik (Trdn-as), in DCM. Our results revealed the remarkably upregulation of Trdn-as in the hearts of the DCM mice and cardiomyocytes treated with high glucose (HG). Knocking down Trdn-as in cardiac tissues significantly improved cardiac dysfunction and remodeling in the DCM mice. Conversely, Trdn-as overexpression resulted in cardiac damage resembling that observed in the DCM mice. At the cellular level, Trdn-as induced Ca²⁺ overload in the SR and mitochondria, leading to mitochondrial dysfunction. RNA-seq and bioinformatics analyses identified calsequestrin 2 (Casq2), a primary calcium-binding protein in the junctional SR, as a potential target of Trdn-as. Further investigations revealed that Trdn-as facilitated the recruitment of METTL14 to the Casq2 mRNA, thereby enhancing the m⁶A modification of Casq2. This modification increased the stability of Casq2 mRNA and subsequently led to increased protein expression. When Casq2 was knocked down, the promoting effects of Trdn-as on Ca²⁺ overload and mitochondrial damage were mitigated. These findings provide valuable insights into the pathogenesis of DCM and suggest Trdn-as as a potential therapeutic target for this condition.
Animals ; Diabetic Cardiomyopathies/pathology* ; RNA, Long Noncoding/genetics* ; Myocytes, Cardiac/metabolism* ; Mice ; Calsequestrin/genetics* ; Calcium/metabolism* ; Male ; Sarcoplasmic Reticulum/metabolism* ; Methyltransferases/metabolism* ; Mice, Inbred C57BL ; Mitochondria, Heart/metabolism* ; Disease Models, Animal ; Mitochondria/metabolism*