Background/Aims: Liver transplantation (LT) following total hepatectomy is a life-saving treatment for hepatocellular carcinoma (HCC). The HCC recurrence after LT hinders the effectiveness of the procedure. The objective of this study is to develop a pre-operative risk stratification model based on a liquid biopsy. Methods: We conducted a comprehensive multi-omics study of 260 HCC patients from three centers, including clinical data, low-coverage whole-genome sequencing of cell-free DNA (cfDNA) from plasma, as well as whole-exome, single-nucleus RNA, and spatial transcriptomics from matched tumor and non-tumor tissues. Results: We identified cfDNA-derived copy number alteration (CNA) signatures associated with post-transplant recurrence. By integrating cfDNA-derived CNA profiles with single-cell transcriptomic data, we traced recurrence-associated cfDNA to a distinct subpopulation of malignant cells within the primary tumor. These cells were embedded in a pro-metastatic microenvironment of specialized endothelial subtypes and cancer-associated fibroblasts. Notably, most recurrence-associated lesions were detectable in cfDNA prior to liver transplantation (LT). Building on these insights, we developed the ZJU Criteria based on CNA fragments and tumor markers, a pre-LT risk prediction tool that integrates conventional clinical factors with cfDNA-derived CNA signatures, and validated it using internal and independent external cohorts. Conclusion Our findings suggest that post-transplant recurrence commonly originates from advanced subclones that emerge late during tumor evolution. The ZJU Criteria provides an accurate, non-invasive strategy that significantly improves pre-LT risk stratification and clinical decision-making for patients with HCC.

ObjectiveTo evaluate a novel nomogram based on contrast-enhanced MRI radiomics combined with clinical variables for the preoperative prediction of perineural invasion （PNI） in intrahepatic cholangiocarcinoma （ICC）. MethodsThe clinical data of 59 ICC patients were retrospectively collected. According to postoperative pathology reports， the patients were divided into the non-PNI group （n = 33） and the PNI group （n = 26）. Regions of interest （ROI） were delineated from five MRI sequences. Radiomics features were then extracted and filtered to select those with the strongest discriminative power for PNI identification. These selected features were used to construct a radiomics model， which subsequently generated a quantitative radiomics score （radiomics score， Radscore）. Univariate analysis was applied to identify clinical variables associated with PNI， and the glm function was subsequently used to construct clinical and combined models. Finally， the models were evaluated using receiver operating characteristic （ROC） curves， calibration curves， and decision curve analysis （DCA）. The combined model was then visualized as a nomogram. ResultsThe clinical model included age， carbohydrate antigen 19-9 （CA19-9）， red blood cell distribution width， and albumin， whereas the Radscore included five radiomic features. The areas under the ROC curves （AUCs） for the clinical and radiomics models were 0.717 （95%CI： 0.586-0.848） and 0.896 （95%CI： 0.820-0.973）， respectively， whereas the combined model further improved its AUC to 0.917 （95% CI：0.848-0.987）. The calibration curves and DCA showed that the nomogram was well calibrated and provided the greatest net clinical benefit. ConclusionThe novel nomogram may serve as a basis for preoperative prediction of PNI status， thereby assisting clinical decision-making and guiding personalized treatment.

Objective: To analyze the structural changes in whole blood and apheresis platelet donations in Chinese Society of Blood Transfusion (CSBT) sentinel units from 2021 to 2025, and to provide evidence for donor recruitment and blood service management. Methods: Aggregated data reported by sentinel sites were collected and stratified according to six indicators: age, sex, donation history, donation volume, donation site, and organization mode. Pearson χ test, Cramer′V coefficient, Cochran-Armitage trend test and simple linear regression were adopted for analysis. Results: A total of 16 256 973 whole blood donations and 1 576 546 apheresis platelet donations were included. Among whole-blood donations, the proportion of donors aged 18-22 years decreased from 27.30% to 10.60%. The proportion of male donors increased from 58.81% to 63.13%; the proportion of people aged 30 and above increased from 58.40% to 75.30%; the proportion of fixed locations rose from 28.37% to 36.57%; the proportion of social groups increased from 21.69% to 39.69%. The 400-mL donations decreased from 62.12% to 53.46%, while individually initiated voluntary donations remained above 50%. Apheresis platelet donations were predominantly from males, individuals aged 30-39 years, and repeat donors; 2-treatment-unit apheresis platelet donations increased from 67.19% to 74.93%, and individually initiated donations accounted for 92.97%-96.02%. Statistically significant overall annual compositional differences were observed for all six indicators (all P<0.001), whereas linear trends for some sub-categories were not statistically significant. Conclusion: In the participating CSBT sentinel units, among whole blood donations, the proportions of donors aged 18-22 years, university-organized group donations, and donations at blood mobiles decreased, whereas the proportions of organizational group donations and donations at fixed venues increased. The apheresis platelet donation cohort is relatively mature and is evolving toward a high-efficiency donation model. Individual voluntary donation remains the primary organization mode for both donation types. Strategies such as youth donor recruitment, optimized layout of fixed donation sites, and retention of repeat donors should be strengthened to improve the resilience of blood supply.

AIM:To investigate the clinical effects of tirofiban and butylphthalide combined with stent thrombectomy in the treatment of patients with acute cerebral infarction in the ultra-time win-dow.METHODS:A total of 100 patients with ACI beyond time window admitted to our hospital from January 2021 to January 2023 were randomly grouped into the control group(50 cases,treated with stent thrombectomy)and the study group(50 cases,treated with tirofiban and butylphthalide combined with stent thrombectomy),clinical data of patients were collected,and the clinical efficacy,blood lipid levels,coagulation function,neurologi-cal function,quality of life,and incidence of ad-verse reactions were compared between the two groups.RESULTS:Compared with the control group,the total effective rate of the study group obviously increased(P＜0.05).Before treatment,there was no obvious difference between the two groups in triacylglycerol(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),prothrom-bin time(PT),activated partial thromboplastin time(APTT),D-dimer(D-D),fibrinogen(FIB),NIHSS score and Barthel index scale(BI)score of patients with ACI beyond time window(P＞0.05).After treat-ment,the TG,TC,LDL-C,FIB,D-D,and NIHSS score of ACI patients in both groups decreased(P＜0.05),while HDL-C,PT,APTT,and BI score increased(P＜0.05),and the above indicators improved more ob-viously in the study group(P＜0.05).There was no obvious difference in the total incidence of adverse reactions between the two groups(P＞0.05).CON-CLUSION:The combination of tirofiban and bu-tylphthalide with stent thrombectomy in the treat-ing ACI beyond time window has a definite effect,which can improve the blood lipid level,coagula-tion function and neurological function of patients,and help to improve the quality of life of patients,with good safety.

Purpose Based on the WHO(5th edition)classification of cervical adenocarcinoma and Silva infiltra-tion pattern classification,this study explores the value of etiological classification and Silva classification in the clinical treatment and prognosis prediction of cervical adenocarcinoma.Methods The clinical and pathological features of 112 cases of cervical invasive adenocarcinoma were reviewed.Through HE morphological classification,immunohistochemi-cal detection,and Silva classification of infiltration pattern,the related factors and prognosis of patients were statistical-ly analyzed.Results The median age of 112 patients was 46.5 years(30-80 years),with a maximum tumor diame-ter of 0.35-9.0 cm and an average diameter of 3.2 cm.Most patients showed vaginal bleeding after sexual inter-course.89 cases were HPV-associated adenocarcinoma(HPVAs),18 cases were non HPV-associated adenocarcinoma(NHPVAs).There were 5 cases of other types of adenocarcinomas of the uterine cervix,including 4 cases of endome-trial adenocarcinoma and 1 case of serous adenocarcinoma.There were 5 cases(4.5％)of Silva A pattern,30 cases(26.8％)of Silva B pattern,and 77 cases(68.7％)of Silva C pattern.112 cases were followed up for a median time of 34 months(15-78 months),with 16 deaths and 20 metastases.The progression-free survival(PFS)(P＜0.001)and overall survival(OS)(P=0.001)in the NHPVA group were significantly lower than those in the HPVA group.All cases with Silva A and Silva B pattern had a favorable prognosis and survived without tumor.Of the cases with Silva C pattern,16 died after recurrence.The PFS and OS of patients with Silva C type were lower than those of Silva A type and B type(P＜0.05).Conclusion The fifth edition of WHO classification of cervical adenocarcinoma revealed the correlation between etiology and morphology.Silva classification is of great significance for accurately predicting progno-sis and guiding treatment.

Objective:To construct a stable oral squamous cell carinoma(OSCC)cell line overexpressing miR-181a-5p,and to ob-serve the effects of miR-181a-5p on the biological behavior of the cells.Methods:miR-181a-5p lentivirus and the control virus vec-tor were respectively constructed and respectively transfected into OSCC CAL-27 cells.The stablely transfected cells(OE)and con-trol cells(NC)were screened out by purinomycin.The fluorescence of the cells was observed by laser confocal microscopy.The ex-pression of miR-181a-5p and Bcl-2 was detected by qRT-PCR and the expression of target protein Bcl-2 was detected by Western blot.The invasion,migration and proliferation ability of the cells were detected by cell scratch,Transwell assay and clonal formation assay.qRT-PCR was used to detect the expression of the related genes of cell invasion and migration.Results:It was found that the expression level of miR-181a-5p in OE cells was significantly higher than that in NC and untransfected control cells(P＜0.01).The expression of Bcl-2 in OE cells was significantly decreased.The invasion,migration and proliferation of OE cells were decreased.In ad-dition,the expression levels of MMP2,MMP9,Vimentin and Ki67 in OE cells were decreased,while E-cadherin was increased(P＜0.01).Conclusion:Overexpression of miR-181a-5p can significantly inhibit the proliferation,invasion and migration OSCC cells.

AIM:To investigate the clinical effects of tirofiban and butylphthalide combined with stent thrombectomy in the treatment of patients with acute cerebral infarction in the ultra-time win-dow.METHODS:A total of 100 patients with ACI beyond time window admitted to our hospital from January 2021 to January 2023 were randomly grouped into the control group(50 cases,treated with stent thrombectomy)and the study group(50 cases,treated with tirofiban and butylphthalide combined with stent thrombectomy),clinical data of patients were collected,and the clinical efficacy,blood lipid levels,coagulation function,neurologi-cal function,quality of life,and incidence of ad-verse reactions were compared between the two groups.RESULTS:Compared with the control group,the total effective rate of the study group obviously increased(P＜0.05).Before treatment,there was no obvious difference between the two groups in triacylglycerol(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),prothrom-bin time(PT),activated partial thromboplastin time(APTT),D-dimer(D-D),fibrinogen(FIB),NIHSS score and Barthel index scale(BI)score of patients with ACI beyond time window(P＞0.05).After treat-ment,the TG,TC,LDL-C,FIB,D-D,and NIHSS score of ACI patients in both groups decreased(P＜0.05),while HDL-C,PT,APTT,and BI score increased(P＜0.05),and the above indicators improved more ob-viously in the study group(P＜0.05).There was no obvious difference in the total incidence of adverse reactions between the two groups(P＞0.05).CON-CLUSION:The combination of tirofiban and bu-tylphthalide with stent thrombectomy in the treat-ing ACI beyond time window has a definite effect,which can improve the blood lipid level,coagula-tion function and neurological function of patients,and help to improve the quality of life of patients,with good safety.

Purpose Based on the WHO(5th edition)classification of cervical adenocarcinoma and Silva infiltra-tion pattern classification,this study explores the value of etiological classification and Silva classification in the clinical treatment and prognosis prediction of cervical adenocarcinoma.Methods The clinical and pathological features of 112 cases of cervical invasive adenocarcinoma were reviewed.Through HE morphological classification,immunohistochemi-cal detection,and Silva classification of infiltration pattern,the related factors and prognosis of patients were statistical-ly analyzed.Results The median age of 112 patients was 46.5 years(30-80 years),with a maximum tumor diame-ter of 0.35-9.0 cm and an average diameter of 3.2 cm.Most patients showed vaginal bleeding after sexual inter-course.89 cases were HPV-associated adenocarcinoma(HPVAs),18 cases were non HPV-associated adenocarcinoma(NHPVAs).There were 5 cases of other types of adenocarcinomas of the uterine cervix,including 4 cases of endome-trial adenocarcinoma and 1 case of serous adenocarcinoma.There were 5 cases(4.5％)of Silva A pattern,30 cases(26.8％)of Silva B pattern,and 77 cases(68.7％)of Silva C pattern.112 cases were followed up for a median time of 34 months(15-78 months),with 16 deaths and 20 metastases.The progression-free survival(PFS)(P＜0.001)and overall survival(OS)(P=0.001)in the NHPVA group were significantly lower than those in the HPVA group.All cases with Silva A and Silva B pattern had a favorable prognosis and survived without tumor.Of the cases with Silva C pattern,16 died after recurrence.The PFS and OS of patients with Silva C type were lower than those of Silva A type and B type(P＜0.05).Conclusion The fifth edition of WHO classification of cervical adenocarcinoma revealed the correlation between etiology and morphology.Silva classification is of great significance for accurately predicting progno-sis and guiding treatment.

Objective This research aims to establish a scientific research performance evaluation indicator system for public hospital staff,providing evaluation standards and assessment criteria for their research performances.Methods An indica-tor pool was developed through literature review.The indicators were determined through two rounds of Delphi expert consultations.Analytic Hierarchy Process(AHP)was used to calculate their weights and thus establish an indicator system.Results The indica-tor system consists of 8 primary indicators-research projects(0.193 3),talent cultivation(0.264 3),patents(0.046 2),publica-tions(0.118 5),monographs(0.068 1),awards(0.147 2),standards(0.094 3),and research errors(0.068 1)-encompassing 29 secondary indicators.The response rate of the second-round expert consultation was 0.85;the authority coefficient was 0.94;the importance rating of indicators was 4.44,and Kendall's coefficient was 0.260(P＜0.05).The consistency index(CI)and consistency ratio(CR)values were＜0.1,indicating good results.Conclusion The indicator system demonstrates scientifically good validity and feasibility.Thus it can be used to evaluate the research performances of public hospital staff,providing decision support for resource allocation and the optimization of incentive mechanisms.

Objective:To explore the safety and efficacy of intraosseous regional administration (IORA) of vancomycin for preventing infection in primary total knee arthroplasty (TKA).Methods:A total of 124 patients with knee osteoarthritis undergoing TKA between February 2024 and May 2024 at nine hospitals were enrolled. Preoperative infection prophylaxis involved either IORA (0.5 g vancomycin administered via intraosseous regional infusion before incision) or intravenous infusion (1 g vancomycin via peripheral vein). The IORA group included 15 males and 47 females with a median age of 66.5 years (range, 60.0-70.0 years), while the intravenous group included 14 males and 48 females with a median age of 66.0 years (range, 61.8-70.3 years) years. Intraoperative samples were collected including fat and synovium tissues after incision, before prosthesis placement, and after tourniquet release; distal femoral cancellous bone during femoral osteotomy; proximal tibial cancellous bone during tibial osteotomy; proximal intercondylar cancellous bone before prosthesis placement; and peripheral blood from non-infused arms at surgery initiation and after tourniquet release. Vancomycin concentrations were measured using liquid chromatography-tandem mass spectrometry. Vital sign changes were recorded from admission to 5~10 minutes post-IORA (IORA group) or post-incision (intravenous group). Follow-ups were conducted on postoperative day 1 and 3, and at 1 and 3 months, to document complications including IORA-related adverse events, periprosthetic joint infections, surgical site infections, red man syndrome, acute kidney injury, deep vein thrombosis and so on.Results:Vancomycin concentrations in bone, fat, and synovial tissue samples were significantly higher in the IORA group than in the intravenous group ( P<0.05), while vancomycin concentrations in blood samples were significantly lower in the IORA group than in the intravenous group ( P<0.05). Only 7.3%(41/558) of tissue samples in the IORA group had vancomycin concentrations below 2.0 μg/g (the minimum inhibitory concentration of vancomycin against coagulase-negative staphylococcus), compared to 59.3%(331/558) in the intravenous group (χ 2=11.285, P<0.001). In the intravenous group, 16.9%(21/124) of blood samples had vancomycin concentrations exceeding 15.0 mg/L (the threshold associated with a significantly increased risk of nephrotoxicity), while all concentrations in the IORA group were below this threshold, the difference was statistically significant (χ 2=22.943, P<0.001). There were no statistically significant difference ( P>0.05) in vital signs changes before and after vancomycin administration between the two groups. Two patients in the intravenous group experienced incision exudate, while no other related complications occurred in either group. Conclusions:Compared to the traditional intravenous infusion of 1 g vancomycin, intraosseous injection of a low dose (0.5 g) of vancomycin achieves higher local tissue concentrations in the knee joint with a lower incidence of adverse reactions and is safe for infection prophylaxis. Despite guidelines not recommending the routine use of vancomycin for preventing infection after primary TKA, intraosseous injection of 0.5 g vancomycin may be considered intraoperatively for primary TKA in the following scenarios: patients in medical institutions with a high prevalence of methicillin-resistant staphylococcus aureus (MRSA) infections, patients with potential preoperative MRSA colonization, or patients with cephalosporin allergy.