Acquired hemophilia A (AHA) is a rare autoimmune bleeding disorder. Its occurrence secondary to hepatobiliary malignancies is even rarer, and without timely diagnosis and treatment, the mortality rate is extremely high. There is a need to raise awareness of this disease. This report describes a case of a 70-year-old female patient diagnosed with AHA 2 months after surgery for cholangiocarcinoma, admitted to the Second Affiliated Hospital of Bengbu Medical College in October 2022. The patient presented with subcutaneous hematoma in both lower limbs. Coagulation function tests showed a markedly prolonged activated partial thromboplastin time (APTT) of 74.5 seconds, with no correction in the APTT mixing test. Coagulation factor assays revealed a severely reduced coagulation factor VIII activity (FVIII:C) of 0.3%, and an inhibitor titer of 25.6 BU/mL was detected. After ruling out other potential causes, the patient was diagnosed with cholangiocarcinoma-associated AHA. With chemotherapy to control the primary tumor, alongside hemostatic and immunosuppressive therapy for inhibitor eradication, AHA was brought under control. The patient had no further coagulation abnormalities or bleeding, enabling timely and full-course chemotherapy for cholangiocarcinoma and significantly improving survival and quality of life. Therefore, in patients with malignancies who present with spontaneous bleeding or unusual bleeding following surgery, trauma, or invasive procedures, clinicians should be alert to the possibility of secondary AHA. Timely diagnosis and treatment can significantly improve prognosis.
Humans ; Cholangiocarcinoma/surgery* ; Female ; Hemophilia A/drug therapy* ; Aged ; Bile Duct Neoplasms/surgery* ; Factor VIII

Extensive epigenetic reprogramming involves in memory CD8+ T-cell differentiation. The elaborate epigenetic rewiring underlying the heterogeneous functional states of CD8+ T cells remains hidden. Here, we profile single-cell chromatin accessibility and map enhancer-promoter interactomes to characterize the differentiation trajectory of memory CD8+ T cells. We reveal that under distinct epigenetic regulations, the early activated CD8+ T cells divergently originated for short-lived effector and memory precursor effector cells. We also uncover a defined epigenetic rewiring leading to the conversion from effector memory to central memory cells during memory formation. Additionally, we illustrate chromatin regulatory mechanisms underlying long-lasting versus transient transcription regulation during memory differentiation. Finally, we confirm the essential roles of Sox4 and Nrf2 in developing memory precursor effector and effector memory cells, respectively, and validate cell state-specific enhancers in regulating Il7r using CRISPR-Cas9. Our data pave the way for understanding the mechanism underlying epigenetic memory formation in CD8+ T-cell differentiation.
CD8-Positive T-Lymphocytes/metabolism* ; Cell Differentiation ; Chromatin/immunology* ; Animals ; Mice ; Immunologic Memory ; Epigenesis, Genetic ; SOXC Transcription Factors/immunology* ; NF-E2-Related Factor 2/immunology* ; Mice, Inbred C57BL ; Gene Regulatory Networks ; Enhancer Elements, Genetic

Objective:To evaluate the clinical value of sacral canal posterior wall reconstruction in the treatment of symptomatic sacral canal cysts.Methods:A retrospective cohort study was conducted.The clinical data of 80 patients with symptomatic sacral cysts who underwent surgical treatment at Beijing Friendship Hospital, Capital Medical University, between June 2018 and September 2024 were collected. There were 19 males and 61 females, with an average age of (49.0±11.3) years (ranged from 23-76 years). The patients were divided into the traditional group ( n=30) and the reconstruction group ( n=50) based on the surgical approach. The traditional group underwent the conventional surgical method without reconstruction of the posterior wall of the sacral canal, while the reconstruction group underwent posterior wall reconstruction of the sacral canal. Postoperative observations included the integrity of the sacral canal posterior wall, wound healing, and symptom improvement in both groups. Measurement data with normal distribution were expressed as mean±standard deviation( ± s). Independent samples t-test was used for comparisons of measurement data between groups. Categorical data were compared using the chi-square test or Fisher′s exact test. Ordinal data were analyzed using the Mann-Whitney U test. Pearson correlation analysis was used to assess the relationship between variables. Results:Among the 80 patients, the sacral bone integrity score in the reconstruction group was (1.42±0.49) scores, compared to (3.00±0.00) scores in the traditional group, the reconstruction group showed significantly better results ( P<0.05). Symptom improvement was also significantly different between the two groups ( P=0.038): in the traditional group, 17 patients experienced complete symptom resolution, 6 partial improvement, 7 no improvement, and 0 worsening; in the reconstruction group, 37 had complete symptom resolution, 11 partial improvement, 2 no improvement, and 0 worsening. The effective improvement rate (complete+ partial improvement) in the reconstruction group was significantly better than that in the traditional group ( P=0.012). In terms of wound healing, 76 cases healed well, 4 had delayed healing, and 0 had infections. In the traditional group, 27 healed well, 3 had delayed healing, 0 infections; in the reconstruction group, 49 healed well, 1 had delayed healing, and 0 infections. There was no significant difference in wound healing rate between the two groups ( P=0.146). A significant positive correlation was found between sacral canal posterior wall integrity and symptom improvement ( r=0.288, P=0.010). Conclusion:Sacral canal posterior wall reconstruction significantly improves postoperative anatomical integrity and clinical outcomes without increasing complications, supporting its adoption as a preferred surgical approach for symptomatic sacral canal cysts.

Objective:Optimizing and upgrading the accounting methods and approaches for each dimension by comparing and analyzing the practical effects of the full-dimension costing path in public hospitals.Methods:List the mainstream accounting paths guided by the current cost accounting plan for public hospitals,to compare the advantages and disadvantages of the results of each type of accounting methods and their degree of difficulty,and to optimize and upgrade the details of accounting in all dimensions.Re-sults:Different accounting methods have their own advantages and disadvantages,and the path selection needs to rely on the scale of public hospitals,management needs,accounting level and information construction degree and other comprehensive factors,that is,with the selection of accounting paths in each dimension from simple to fine,the degree of data refinement and reference strength are correspondingly from weak to strong.Conclusion:Public hospitals should combine their own accounting basic conditions,choose the best accounting methods and paths,build a cost accounting control system,and continuously optimize and upgrade the ac-counting model,in order to provide strong decision-making support for hospitals to find out the asset base,strengthen resource allo-cation and improve data governance capabilities.

Objective:Optimizing and upgrading the accounting methods and approaches for each dimension by comparing and analyzing the practical effects of the full-dimension costing path in public hospitals.Methods:List the mainstream accounting paths guided by the current cost accounting plan for public hospitals,to compare the advantages and disadvantages of the results of each type of accounting methods and their degree of difficulty,and to optimize and upgrade the details of accounting in all dimensions.Re-sults:Different accounting methods have their own advantages and disadvantages,and the path selection needs to rely on the scale of public hospitals,management needs,accounting level and information construction degree and other comprehensive factors,that is,with the selection of accounting paths in each dimension from simple to fine,the degree of data refinement and reference strength are correspondingly from weak to strong.Conclusion:Public hospitals should combine their own accounting basic conditions,choose the best accounting methods and paths,build a cost accounting control system,and continuously optimize and upgrade the ac-counting model,in order to provide strong decision-making support for hospitals to find out the asset base,strengthen resource allo-cation and improve data governance capabilities.

Objective:Optimizing and upgrading the accounting methods and approaches for each dimension by comparing and analyzing the practical effects of the full-dimension costing path in public hospitals.Methods:List the mainstream accounting paths guided by the current cost accounting plan for public hospitals,to compare the advantages and disadvantages of the results of each type of accounting methods and their degree of difficulty,and to optimize and upgrade the details of accounting in all dimensions.Re-sults:Different accounting methods have their own advantages and disadvantages,and the path selection needs to rely on the scale of public hospitals,management needs,accounting level and information construction degree and other comprehensive factors,that is,with the selection of accounting paths in each dimension from simple to fine,the degree of data refinement and reference strength are correspondingly from weak to strong.Conclusion:Public hospitals should combine their own accounting basic conditions,choose the best accounting methods and paths,build a cost accounting control system,and continuously optimize and upgrade the ac-counting model,in order to provide strong decision-making support for hospitals to find out the asset base,strengthen resource allo-cation and improve data governance capabilities.

Objective:Optimizing and upgrading the accounting methods and approaches for each dimension by comparing and analyzing the practical effects of the full-dimension costing path in public hospitals.Methods:List the mainstream accounting paths guided by the current cost accounting plan for public hospitals,to compare the advantages and disadvantages of the results of each type of accounting methods and their degree of difficulty,and to optimize and upgrade the details of accounting in all dimensions.Re-sults:Different accounting methods have their own advantages and disadvantages,and the path selection needs to rely on the scale of public hospitals,management needs,accounting level and information construction degree and other comprehensive factors,that is,with the selection of accounting paths in each dimension from simple to fine,the degree of data refinement and reference strength are correspondingly from weak to strong.Conclusion:Public hospitals should combine their own accounting basic conditions,choose the best accounting methods and paths,build a cost accounting control system,and continuously optimize and upgrade the ac-counting model,in order to provide strong decision-making support for hospitals to find out the asset base,strengthen resource allo-cation and improve data governance capabilities.

[Objective] To evaluate the effects of preoperative ureteroscopy (URS) on the prognosis of patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). [Methods] Data of 712 UTUC patients who received RNU in West China Hospital during May 2003 and Jun.2019 were retrospectively analyzed. Patients were divided into URS group (n=187) and non-URS group (n=525) according to whether URS was performed before RNU. Kaplan-Meier curves were used to analyze the overall survival (OS), cancer-specific survival (CSS), and intravesical recurrence-free survival (IVRFS). Cox proportional risk model was used for risk assessment. Subgroup analysis and interaction test were used to further verify the results. [Results] Significant differences were observed between the two groups in terms of body mass index (BMI), diabetes mellitus, surgical method, hydronephrosis, tumor location, tumor grade, lymph node metastasis, lymphovascular invasion and tumor diameter (P<0.05). Kaplan-Meier survival analysis showed that IVRFS was significantly lower in the URS group than in the non-URS group (P<0.001), and the difference was more pronounced in renal pelvis carcinoma (P<0.001); there were no differences in OS and CSS between the two groups (P>0.05). Cox multivariate regression showed that URS was an independent risk factor for intravesical recurrence (HR=2.12, 95%CI: 1.34-3.36, P<0.001). [Conclusion] Preoperative URS can increase the recurrence rate of UTUC, but it has no effect on the OS and CSS.

Objective:Optimizing and upgrading the accounting methods and approaches for each dimension by comparing and analyzing the practical effects of the full-dimension costing path in public hospitals.Methods:List the mainstream accounting paths guided by the current cost accounting plan for public hospitals,to compare the advantages and disadvantages of the results of each type of accounting methods and their degree of difficulty,and to optimize and upgrade the details of accounting in all dimensions.Re-sults:Different accounting methods have their own advantages and disadvantages,and the path selection needs to rely on the scale of public hospitals,management needs,accounting level and information construction degree and other comprehensive factors,that is,with the selection of accounting paths in each dimension from simple to fine,the degree of data refinement and reference strength are correspondingly from weak to strong.Conclusion:Public hospitals should combine their own accounting basic conditions,choose the best accounting methods and paths,build a cost accounting control system,and continuously optimize and upgrade the ac-counting model,in order to provide strong decision-making support for hospitals to find out the asset base,strengthen resource allo-cation and improve data governance capabilities.

Objective:Optimizing and upgrading the accounting methods and approaches for each dimension by comparing and analyzing the practical effects of the full-dimension costing path in public hospitals.Methods:List the mainstream accounting paths guided by the current cost accounting plan for public hospitals,to compare the advantages and disadvantages of the results of each type of accounting methods and their degree of difficulty,and to optimize and upgrade the details of accounting in all dimensions.Re-sults:Different accounting methods have their own advantages and disadvantages,and the path selection needs to rely on the scale of public hospitals,management needs,accounting level and information construction degree and other comprehensive factors,that is,with the selection of accounting paths in each dimension from simple to fine,the degree of data refinement and reference strength are correspondingly from weak to strong.Conclusion:Public hospitals should combine their own accounting basic conditions,choose the best accounting methods and paths,build a cost accounting control system,and continuously optimize and upgrade the ac-counting model,in order to provide strong decision-making support for hospitals to find out the asset base,strengthen resource allo-cation and improve data governance capabilities.