OBJECTIVE To evaluate the safety of fondaparinux in pregnancy and provide reference for its rational clinical application. METHODS A search was conducted in databases including CNKI， Wanfang， PubMed， Embase， and Elsevier （the search time was from the construction of the database to December 17， 2024） to collect case report literature on fondaparinux use during pregnancy. Patient demographic information， fondaparinux use during pregnancy， concomitant medications， clinical manifestations， and treatment details were extracted for descriptive statistical analysis. RESULTS A total of 17 case reports regarding the use of fondaparinux during pregnancy were collected， involving 42 patients from 11 countries and 47 pregnancy records. Among these， 20 cases involved the use of fondaparinux for the prevention of pregnancy-related venous thromboembolism （VTE）， while 27 cases were fondaparinux treatment due to related conditions. A total of 29 occurrences of the patients were treated with fondaparinux due to a （family） history of VTE. Nine occurrences of complicated pregnancies were reported， and 35 patients had records of comorbidities or relevant medical histories. The adverse events that occurred during pregnancy with the use of fondaparinux include postpartum hemorrhage （7 cases） and excessive anticoagulation caused by inappropriate dosage （1 case）. Among the 7 cases of postpartum hemorrhage， 3 cases had a blood loss of no less than 1 000 mL （including 2 cases with uterine atony）， 3 cases had a drug discontinuation time of ≤12 h. CONCLUSIONS Based on the existing literature， the safety of fondaparinux during pregnancy is generally manageable， with the main adverse event being postpartum hemorrhage. The dosage， interval between discontinuation，comorbidities/medical history， and concomitant medications of fondaparinux may be the main causes of its adverse events.

Tendon-bone healing is a complex biological process. Multiple signaling pathways are involved in tendon-bone healing， including transforming growth factor-β signaling pathway， bone morphogenetic protein signaling pathway， Wnt signaling pathway， fibroblast growth factor signaling pathway and nuclear transcription factor-κB signaling pathway. This paper summarizes the research status of traditional Chinese medicine regulating related signaling pathways to promote tendon-bone healing. It is found that a variety of traditional Chinese medicine monomers or herbal extracts （such as baicalein， icariin， total flavonoids of Drynaria fortunei， parthenolide， total saponins of Panax notoginseng， etc.） and traditional Chinese medicine compounds （such as Taohong siwu decoction， Liuwei dihuang pill， Xujin jiegu liquid， etc.） can promote bone formation， anti-inflammatory， anti-oxidation， by regulating the above signaling pathways， thereby effectively promoting tendon-bone healing.

Objective:To explore the application effects of a neurosurgical mixed-reality distance teaching (NMDT) model in standardized residency training in neurosurgery.Methods:We built an NMDT system using mixed-reality technology and remote interaction technology, and designed the implementation procedure according to the teaching objectives. After the teaching activities were completed, a teaching satisfaction questionnaire survey was conducted among 20 neurosurgery resident trainees, in which they provided satisfaction scores for the same teaching content with different teaching models (i.e., the NMDT model and traditional teaching model). SPSS 22.0 software was used to perform the t test for data analysis. Results:There were significant differences between the NMDT model and the traditional teaching model in key indicators including the score for "completion of teaching objectives" (9.20±0.68 vs. 8.25±0.70, P<0.001) and the score for "satisfaction with learning gains" score (8.95±0.67 vs. 8.05±0.92, P=0.001). The NMDT model also outperformed the traditional teaching model in the other individual scores and the total score. Conclusions:The NMDT model can improve teaching quality, increase training efficiency, and enrich teaching content, which is worthy of promotion.

Pancreatic fibrosis (PF) is primarily distinguished by the stimulation of pancreatic stellate cells (PSCs) and excessive extracellular matrix deposition, which is the main barrier impeding drug delivery and distribution. Recently, nanomedicine, with efficient, targeted, and controllable drug release characteristics, has demonstrated enormous advantages in the regression of pancreas fibrotic diseases. Notably, paracrine signals from parenchymal and immune cells such as pancreatic acinar cells, islet cells, pancreatic cancer cells, and immune cells can directly or indirectly modulate PSC differentiation and activation. The intercellular crosstalk between PSCs and these cells has been a critical event involved in fibrogenesis. However, the connections between PSCs and other pancreatic cells during the progression of diseases have yet to be discussed. Herein, we summarize intercellular crosstalk in the activation of PSCs and its contribution to the development of common pancreatic diseases, including pancreatitis, pancreatic cancer, and diabetes. Then, we also examine the latest treatment strategies of nanomedicine and potential targets for PSCs crosstalk in fibrosis, thereby offering innovative insights for the design of antifibrotic nanomedicine. Ultimately, the enhanced understanding of PF will facilitate the development of more precise intervention strategies and foster individually tailored therapeutic approaches for pancreatic diseases.

Leber's hereditary optic neuropathy (LHON) is an ocular mitochondrial disease that involves the impairment of mitochondrial complex I, which is an important contributor to blindness among young adults across the globe. However, the disorder has no available cures, since the approved drug idebenone for LHON in Europe relies on bypassing complex I defects rather than fixing them. Herein, PARKIN mRNA-loaded nanoparticle (mNP)-engineered mitochondria (mNP-Mito) were designed to replace dysfunctional mitochondria with the delivery of exogenous mitochondria, normalizing the function of complex I for treating LHON. The mNP-Mito facilitated the supplementation of healthy mitochondria containing functional complex I via mitochondrial transfer, along with the elimination of dysfunctional mitochondria with impaired complex I via an enhanced PARKIN-mediated mitophagy process. In a mouse model induced with a complex I inhibitor (rotenone, Rot), mNP-Mito enhanced the presence of healthy mitochondria and exhibited a sharp increase in complex I activity (76.5%) compared to the group exposed to Rot damage (29.5%), which greatly promoted the restoration of ATP generation and mitigation of ocular mitochondrial disease-related phenotypes. This study highlights the significance of nanoengineered mitochondria as a promising and feasible tool for the replacement of dysfunctional mitochondria and the repair of mitochondrial function in mitochondrial disease therapies.

Osteoarthritis (OA) is a common chronic degenerative disease, and its condition tends to worsen with age. The pathogenesis of OA is complex, and many risk factors can lead to the occurrence of OA. Iron is one of the essential trace elements in the body, and its metabolic balance is extremely important to human health. Iron overload is closely related to the occurrence and development of OA. Excessive iron deposition in joint tissue can easily lead to lesions of articular cartilage and synovium, as well as affect subchondral bone reconstruction and lead to the occurrence of OA. The author reviewed the relevant research literature in recent years, and reviewed the mechanism of iron overload in the occurrence and development of OA, in order to provide new ideas and directions for the research and diagnosis and treatment of OA.

Objective:To investigate the changes and clinical significance of prothrombin time (PT) during chemotherapy for non-Hodgkin lymphoma (NHL) in high-altitude area and low-altitude area, and understand the relationship between NHL and PT.Methods:From August 2018 to September 2019, data of 68 cases of NHL patients in the Fifth People′s Hospital of Qinghai Province in the high-altitude area (average altitude: 2 261 m) and the Tianjin Fourth Central Hospital in the low-altitude area (average altitude: 1.3 m) were collected and compared with those of 20 subjects from health examination. The patients were divided into groups according to the NHL classification, stage and grade (international prognostic index, IPI score), the PT at initial diagnosis was compared. The PT changes before and after chemotherapy (6 cycles) were compared between high-altitude area and low-altitude area.Results:The PT in healthy subjects and PT at initial diagnosis in NHL patients in low-altitude area were lower than those in high-altitude area: (12.3 ± 1.3) s vs. (13.4 ± 1.9) s, (12.2 ± 0.8) s vs. (13.7 ± 1.1) s, and there was statistical difference ( P<0.05). There was no significant difference between NHL patients and healthy patients in the same area ( P>0.05). In NHL patients in high-altitude area and low-altitude area, PT of different NHL classification, stage and grade were statistically significant ( t = 4.611, 8.202, 6.893, 5.345, 3.121, 5.397, 2.838 and 3.720, P<0.05). In the same altitude area, NHL classification, stage and grade of NHL patients had no significant effect on PT, and there were no statistically significant difference ( P> 0.05); in NHL patients, there were statistically significant differences in PT before and after chemotherapy between high-altitude area and low-altitude area: (13.7 ± 1.1) s vs. (12.2 ± 0.8) s, (13.4 ± 1.4) s vs. (12.0 ± 1.3) s, and there were statistical differences ( P<0.05), and no significant changes in PT before and after chemotherapy in the same altitude area ( t = 1.377 and -1.222, P>0.05). Conclusions:PT of NHL patients in low-altitude area is lower than that in high-altitude area, and there is no significant correlation with NHL classification, stage, grade and chemotherapy in NHL patients.

Objective:To investigate the experience of moderate hypothermia(28℃) using in Stanford A aortic dissection.Methods:A retrospective analysis of 100 patients with Stanford A aortic dissection from January 2012 to March 2014, including 50 cases with deep(25℃) hypothermic circulatory surgery and 50 moderate(28℃) hypothermic circulatory surgery. The operation was performed with ascending aortic replacement, inclusiong aortic arch angioplasty, and stent implantation with descending aorta stent. The difference between the 2 groups during and after the operation was compared.Results:2 cases died in the hypothermia group, and 3 cases died in the deep hypothermia group. There were significant differences( P<0.05) between the middle and low temperature groups in the cooling time, the time of stopping circulation, the time of rewarming, the time of cardiopulmonary bypass, the time of operation, the time of operation, the time of conscious, the time of mechanical ventilation and the first day after the operation( P<0.05), but there was no significant difference between the creatinine and the bilirubin( P>0.05). Conclusion:Under the condition of sufficient cerebral perfusion and spinal cord protection, moderate hypothermia is safe, and it can reduce the operation time and postoperative complications. It has certain clinical significance.

Objective:To investigate the correlation between mental health and symptom distress in breast cancer patients.Methods:The clinical data of 110 female breast cancer patients at Shanxi Bethune Hospital from June 2017 to March 2018 were collected. The patients were assessed for symptomatic distress with depression self-rating scale (SDS). Functional assessment of cancer therapy-breast (FACT-B) and the functional assessment of chronic illness therapy-spiritual well-being (FACIT-SP) were used to make the mental assessment. Multiple linear regression analysis was used to analyze the effect of symptom distress on the mental health of the patients.Results:The scores of symptom distress, mental health, FACT-B and FACIT-SP were (19.94±5.78), (50.68±10.64), (16.85±4.75), (33.83±8.33), respectively. Multivariate analysis showed that mental health score of the patients with symptom distress > 18 scores was reduced by 5.15 points ( P=0.01) compared with the patients with symptom distress≤18 scores. Compared with the patients with annual household income < 50 000 yuan, the mental health score of patients with annual household income of 50 000-79 000 yuan was increased by 9.46 points ( P < 0.01), and the mental health score of patients with annual family income ≥ 80 000 yuan was increased by 5.92 points ( P < 0.01); compared with the patients in phase I, the mental health score of the patients in phaseⅡwas decreased by 2.62 points ( P=0.02), and the mental health score of the patients in phase Ⅲ was decreased by 4.98 points ( P < 0.01). Conclusions:Symptom distress is an independent risk factor for affecting mental health of breast cancer patients. Solving symptom distress of patients can improve mental health status of the patients.

Objective To explore the factors affecting the operation of coronary artery bypass grafting with heart beating and improve the effect of the operation. Methods From January 2012 to June 2016, 898 patients with coronary heart disease who received cardiovascular surgery in the Second Affiliated Hospital of Jilin University were analyzed retrospectively. All patients only underwent coronary artery bypass grafting with beating heart. Among them, 797 patients underwent the off-pump coronary artery bypass grafting (an OPCABG group, 592 males and 205 females, with an average age of 60.5±8.4 years); another 101 patients received on-pump beating heart coronary artery bypass grafting (an OPBH group, 77 males and 24 females, with an average age of 61.5±8.2 years). Results The average number of grafts in the OPCABG group was 3.36±0.74, and in the OPBH group was 3.71±0.69 (P<0.05). The postoperative ventilation time (10.8±9.5 hvs. 20.6±12.3 h), ICU stay (28.8±15.5 h vs. 37.4±30.8 h), hospital stay (10.9±4.8 d vs. 14.8±8.6 d), mortality (1.1% vs. 3.0%), the utilization rate of intra-aortic balloon pump (2.4% vs. 8.9%) and extracorporeal membrane oxygenation (0.5% vs. 5.0%) were significantly different between the OPCABG group and OPBH group (all P<0.05). Twelve patients died after surgery, and the total bloodless operation ratio was 91.3%. Conclusion The results show that most patients can achieve good results with the help of apical fixation and myocardial fixator, improved surgical techniques and methods, good anesthesia management as well as flexible and accurate use of vasoactive drugs. But extracorporeal circulation is necessary in the patients with large left ventricle, low ejection fraction and hemodynamic instability after intraoperatively moving the heart.