The implementation of the "Regulations on Organ Donation and Transplantation" (hereinafter referred to as the new "Regulations") and supporting documents has laid a solid foundation for improving the organ donation and transplantation work system in accordance with laws and regulations. In order to better publicize, implement, and carry out the new "Regulations" and supporting documents, and in response to the problems and challenges encountered in actual work, combined with the development of the national human organ donation and transplantation work system and the national work on determination of brain death, this article analyzes and discusses the construction of hospitals' organ donation and transplantation work systems and the systematic multidisciplinary collaboration mechanism for organ donation, as well as several issues that need attention by the ethics committees for organ transplantation. The aim is to provide references for the construction of ethics committees for organ transplantation in China and to promote the continuous and healthy development of China's organ donation and transplantation cause.

Objective To explore the optimal duration of long-term mild hypothermia(MHT)for traumatic brain injury(TBI)in rats,and observe its effect on intracranial pressure(ICP)and neurological function.Methods Forty-eight healthy adult male SD rats were divided into the normal temperature treatment(NT)group,the MHT4 h group,the MHT24 h group and the MHT48 h group by random number table method,with twelve rats in each group.The TBI model of rats was prepared by electronic controllable cortical injury device,and ICP monitoring probe was implanted.After modeling,the NT group was treated with normal temperature(37℃),and the other groups were treated with low temperature(33.0±1.0)℃for 4 h,24 h and 48 h,respectively.ICP was monitored and brain water content(BWC)was calculated after MHT treatment in each group.Blood-brain barrier permeability was determined by Evansland(EB)staining.The expression of 5-bromodeoxyuracil nucleoside(BrdU),neuronal nuclear antigen antibody(NeuN)and leukocyte differentiation antigen 86(CD86)positive cells were detected by immunofluorescence staining.The expressions of B-cell lymphoma-2(Bcl-2),Bcl-2 associated X protein(Bax),inducable nitric oxide synthase(iNOS),interleukin(IL)-10 and arginase 1(Arg-1)were detected by Western blot assay.Results Compared with the NT group,levels of BWC,ICP,EB,and CD86 positive cells,Bax and iNOS expression levels were decreased in the MHT4 h group,the MHT24 h group and the MHT48 h group,and the number of BrdU positive cells and BrdU/NeuN double-labeled positive cells were increased in hippocampus.The expression levels of Bcl-2,IL-10 and Arg-1 were increased(P＜0.01).Compared with the MHT24 h group,levels of BWC,ICP and EB,and CD86 positive cells,Bax and iNOS expression were decreased,and the number of BrdU positive cells and BrdU/NeuN double-labeled positive cells were increased in the MHT48 h group,while levels of Bcl-2,IL-10 and Arg-1 expression were increased(P＜0.01).Conclusion Long-term MHT can promote the proliferation and differentiation of neurons,inhibit apoptosis and reduce inflammation by suppressing ICP rebound,further promoting neuroprotection after TBI.

BACKGROUND:Some patients still have unsatisfactory improvement of operative limb fatigue and pain after total knee arthroplasty.Clinical findings show that Jianpi Yiqi Huoxue Formula can promote recovery after total knee arthroplasty,but the specific efficacy remains to be studied. OBJECTIVE:To observe the effect of Jianpi Yiqi Huoxue Formula on the muscle strength and pain of the operated limb after the primary unilateral total knee arthroplasty. METHODS:A total of 74 patients undergoing primary unilateral total knee arthroplasty were randomly divided into a trial group and a control group with 37 patients in each group.All patients received the same prostheses and surgical methods during the operation.Patients in the control group were treated with routine analgesics,anticoagulant drugs and functional exercise after the operation.The trial group received Jianpi Yiqi Huoxue Formula after the treatment in the control group.Both groups were treated continuously and followed up for 1 month.The changes in isokinetic muscle strength(peak torque and total work amount of extensor and flexor),visual analog scale score and the hospital for special surgery score of the two groups were analyzed. RESULTS AND CONCLUSION:(1)The trial group had better improvement in peak torque and total work amount of extensor and flexor and the hospital for special surgery score than the control group 14 days and 1 month after surgery(P<0.05).(2)In contrast to the control group,the visual analog scale score of the trial group improved better at 7 and 14 days and 1 month after surgery(P<0.05).(3)It is indicated that Jianpi Yiqi Huoxue Formula can effectively improve the muscle strength of the operated limb,enhance the degree of postoperative joint pain,and promote functional rehabilitation after total knee arthroplasty.

Objective To discuss the safety and efficacy of arterial embolization combined with local ablation in the treatment of recurrent and refractory chest wall tumors.Methods The clinical data of 11 patients with chest wall tumor that recurred after surgery and progressed after treatment were retrospectively analyzed.On the basis of the original treatment regimen,DSA-guided arterial embolization and CT-guided local ablation were employed.VAS score of pain relief and postoperative complications were recorded,and the therapeutic efficacy was evaluated Results All the patients were follow up for a median time of 18.5 months.Successful DSA-guided arterial embolization was accomplished in all patients.Seven patients(9 lesions in total)initially received CT-guided radiofrequency ablation(RFA),and tumor reoccurred in 2 patients,who had to receive RFA once more.Four patients(5 lesions in total)initially received CT-guided microwave ablation(MWA),and tumor reoccurred in one patient,who had to receive MWA again.According to mRECIST criteria,the 6-month,12-month and 18-month objective response rates(ORR)were 72.7%(8/11),45.5%(5/11)and 18.2%(2/11)respectively,the 6-month,12-month and 18-month overall survival rates were 81.8%(9/11),63.6%(7/11)and 27.3%(3/11)respectively,with a median survival time of 13.2 months.The postoperative one-month and 3-month VAS scores were(2.42±1.25)points and(1.91±1.24)points respectively,which were strikingly lower than preoperative(6.78±1.13)points,the differences were statistically significant(P＜0.05).After surgery,3 patients developed pleural effusion,which disappeared after puncture and drainage treatment,and 2 patients developed fever,which was improved after symptomatic treatment.One patient died of respiratory failure six months after treatment.Conclusion Arterial embolization combined with local ablation can improve the symptoms of pain and prolong the survival time of patients with chest wall tumors.This combination therapy is less traumatic and clinically safe,and it can be used as an effective treatment for patients with recurrent and refractory chest wall tumors.

Objective:To investigate the incidence of radiation pneumonitis (RP) induced by 125I seed implantation for the treatment of malignant lung tumors and analyze related dosimetric parameters. Methods:A retrospective analysis was conducted on 31 cases of malignant lung tumors treated with 125I seed implantation from January 2017 to December 2022 at Hebei Provincial Tumor Radioactive Seeds Implantation Diagnosis and Treatment Center. These cases consisted of eight patients with squamous cell carcinoma, 10 patients with adenocarcinoma, and 13 patients with metastatic cancer in other sites. At 1-6 months after treatment, these patients received postoperative chest CT scans, with the efficacy evaluated based on the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1), including the objective response rate (ORR) and the disease control rate (DCR). The efficacy of RP was evaluated using the Radiation Therapy Oncology Group (RTOG) criteria. Postoperative dosimetric parameters, including D90 (minimum peripheral dose received by 90% of the target volume), V8 (percentage of lung volume receiving 8 Gy), V32 (percentage of lung volume receiving 32 Gy), and Dmean (mean radiation dose) of the affected lung, were statistically analyzed. The relationships of the RP occurrence with postoperative D90, V8, V32, and Dmean were analyzed by comparison with relevant external radiotherapy data, to identify the parameters that are correlated closely with RP occurrence. Results:All the patients underwent successful surgeries. The postoperative efficacy evaluation after six months showed complete response (CR) in 11 cases, partial response (PR) in 11 cases, stable disease (SD) in eight cases, and progressive disease (PD) in one case, with an overall response rate (ORR) of 71.0%, and a disease control rate (DCR) of 96.8%. Three patients suffered RP, with an incidence rate of 9.7%. Postoperative V8, V32, and Dmean could not serve as predictive indicators for RP. Follow-up observation revealed that three RP cases (3/5) exhibited postoperative D90 exceeding 170 Gy and no RP cases (0/26) showed postoperative D90 below 170 Gy. Conclusions:In the treatment of malignant lung tumors with 125I seed implantation, there is a certain correlation between RP and postoperative D90, while there is no correlation between it and V8, V32, and Dmean.

Objective To investigate the dynamics of NK cells and Treg cells,as well as their potential prognostic significance in relation to TKI discontinuation among patients diagnosed with chronic myeloid leukemia(CML).Methods In this study,a total of 200 patients diagnosed with CML were randomly selected and divided into two groups:the discontinuation group(n=100)and the non-discontinuation group(n=100).Within the discontinuation group,patients were further categorized into a recurrence subgroup(n=41)and a non-recurrence subgroup(n=59).Clinical data and follow-up information of these patients were retrospectively analyzed.Logistic regression analysis was performed to investigate the impact of various variables on patient outcomes following drug discontinuation,as well as to explore independent factors influencing recurrence in these individuals.Receiver operating characteristic(ROC)curve analysis was employed to assess the predictive value of NK cells and Treg cells for TKI discontinuation outcomes.A significance level of P<0.05 was considered statistically significant.Results The proportion of patients treated with interferon in the discontinuation group was significantly higher than that in the non-discontinuation group(P<0.05).Moreover,the former group exhibited a significantly higher number of NK cells(P<0.05)and Treg cells(P<0.01)compared to the latter group.Compared to the recurrence group,there was a significant increase in the proportion of patients using interferon in the non-recurrence group(P<0.05),along with longer durations of TKI treatment and deep molecular response(DMR)duration(P<0.05).The number of NK cells and Treg cells in the non-recurrence group was significantly higher than that in the recurrence group(P<0.01).Logistic regression analysis found that the use of interferon(OR=1.25,95%CI:1.11～2.03,P<0.001),duration of DMR(OR=1.16,95%CI:1.08～1.92,P<0.05),NK cells(OR=1.64,95%CI:1.14～2.28,P<0.01),and Treg cells(OR=1.83,95%CI:1.15～2.42,P<0.01)were all influencing factors for the recurrence of patients after drug discontinuation.The results of ROC curve analysis showed that the AUC of NK cells combined with Treg cells for predicting the recurrence of TKI after discontinuation was 0.892(95%CI:0.857～0.927,P<0.001).Conclusion The frequencies of NK cells and Treg cells were significantly elevated in patients who remained recurrence-free following TKI discontinuation,highlighting the potential predictive value of combined NK cell and Treg cell analysis for drug cessation in CML patients.

Objective To explore the impact of sex on the efficacy of first-line programmed death-1(PD-1)blockade plus chemotherapy in patients with advanced lung adenocarcinoma and its potential biological mechanisms.Methods The clinical and pathological characteristics and follow-up data of 163 patients with advanced lung adenocarcinoma without driver gene alterations at Shanghai Pulmonary Hospital affiliated to Tongji University from October 2018 to October 2023 were retrospectively collected.Among them,103 patients received first-line PD-1 blockade plus chemotherapy(51 males and 52 females)and 60 patients received first-line standard platinum-based doublet chemotherapy(39 males and 21 females).Patients were divided into male group and female group.Clinical characteristics,efficacy,progression-free survival(PFS),and overall survival(OS)were compared between the two groups.Kaplan-Meier method was used to plot the survival curves of male and female patients,and log-rank test was used for significance evaluation.Cox proportional hazards model was used to analyze the factors influencing PFS and OS.Multiplex immunofluorescence(mIF)assays were used to analyze the differences of protein expression levels of programmed death-ligand 1(PD-L1),CD8,CD68,CD4,and FOXP3 between male and female groups in baseline tumor sample.Results In patients receiving first-line PD-1 blockade plus chemotherapy,the median PFS in female group and male group was 13.0 months and 6.8 months,respectively(HR=0.39,95% CI 0.25-0.62;P＜0.01).The median OS in female group and male group was 46.2 months and 17.3 months,respectively(HR=0.30,95% CI 0.18-0.50;P＜0.01).In patients receiving first-line chemotherapy,the median PFS in female group and male group was 5.7 months and 5.5 months,respectively(P＞0.05);the median OS in female group and male group was 21.7 months and 17.7 months,respectively(P＞0.05).The results of the Cox proportional hazards model showed that sex was an independent factor influencing PFS and OS in patients receiving first-line PD-1 blockade plus chemotherapy(P＜0.05).The results of mIF showed that pretreatment tumor samples of female patients had a significantly higher expression level of CD8 than male patients(P＜0.05),while the expression level of PD-L1,CD68,CD4 and FOXP3 was similar between female and male groups.Conclusions Compared to male patients,female patients with advanced lung adenocarcinoma benefit more from the first-line PD-1 blockade plus chemotherapy.The increased expression level of CD8 in pretreatment tumor samples of female patients would be the potential mechanism.

Objective Based on the PDCA cycle theory,it explores the application mode of scenario simulation teaching method in clinical basic skills training.Methods The 96 students majoring in clinical medicine from the First Af-filiated Hospital of Harbin Medical University in 2019 were selected as the research objects,and the experimental group and the control group were set up respectively,with 48 students in each group,and skills training was car-ried out from March to December 2022.The control group was trained in the traditional way,and the experimental group was trained in the scenario simulation teaching method based on the PDCA cycle.The training effect and training satisfaction of the control group and the experimental group were compared and analyzed.Results In the sur-vey of the training effect of the students in the experimental group,the evaluation results of the basic clinical skills operation were higher than those in the control group,and the difference between the two groups was statistically significant(P＜0.01).In terms of the appropriate and safe operation mode,There was no significant difference be-tween the two groups(P＞0.05).In the training satisfaction survey,students in the experimental group were signifi-cantly more satisfied with the training than those students who are in the control group.The difference was statistical-ly significant(P＜0.01).Conclusion The application of scenario simulation teaching method based on PDCA cycle in clinical basic skills training helps to improve the quality of clinical basic skills training and student satisfaction.

Objective Based on the PDCA cycle theory,it explores the application mode of scenario simulation teaching method in clinical basic skills training.Methods The 96 students majoring in clinical medicine from the First Af-filiated Hospital of Harbin Medical University in 2019 were selected as the research objects,and the experimental group and the control group were set up respectively,with 48 students in each group,and skills training was car-ried out from March to December 2022.The control group was trained in the traditional way,and the experimental group was trained in the scenario simulation teaching method based on the PDCA cycle.The training effect and training satisfaction of the control group and the experimental group were compared and analyzed.Results In the sur-vey of the training effect of the students in the experimental group,the evaluation results of the basic clinical skills operation were higher than those in the control group,and the difference between the two groups was statistically significant(P＜0.01).In terms of the appropriate and safe operation mode,There was no significant difference be-tween the two groups(P＞0.05).In the training satisfaction survey,students in the experimental group were signifi-cantly more satisfied with the training than those students who are in the control group.The difference was statistical-ly significant(P＜0.01).Conclusion The application of scenario simulation teaching method based on PDCA cycle in clinical basic skills training helps to improve the quality of clinical basic skills training and student satisfaction.

Objective Based on the PDCA cycle theory,it explores the application mode of scenario simulation teaching method in clinical basic skills training.Methods The 96 students majoring in clinical medicine from the First Af-filiated Hospital of Harbin Medical University in 2019 were selected as the research objects,and the experimental group and the control group were set up respectively,with 48 students in each group,and skills training was car-ried out from March to December 2022.The control group was trained in the traditional way,and the experimental group was trained in the scenario simulation teaching method based on the PDCA cycle.The training effect and training satisfaction of the control group and the experimental group were compared and analyzed.Results In the sur-vey of the training effect of the students in the experimental group,the evaluation results of the basic clinical skills operation were higher than those in the control group,and the difference between the two groups was statistically significant(P＜0.01).In terms of the appropriate and safe operation mode,There was no significant difference be-tween the two groups(P＞0.05).In the training satisfaction survey,students in the experimental group were signifi-cantly more satisfied with the training than those students who are in the control group.The difference was statistical-ly significant(P＜0.01).Conclusion The application of scenario simulation teaching method based on PDCA cycle in clinical basic skills training helps to improve the quality of clinical basic skills training and student satisfaction.