Real-world study (RWS), based on multi-source data from real medical environments, is gradually becoming an important supplement to traditional randomized controlled trials, and its application in the field of transfusion medicine is becoming increasingly widespread. This article systematically reviews the definition and methodological system of RWS, examines its application cases in clinical blood transfusion research, and discusses the advantages, limitations, and future research directions of RWS, aiming to provide a reference for evidence-based research in blood transfusion medicine.

Real-world study (RWS), based on multi-source data from real medical environments, is gradually becoming an important supplement to traditional randomized controlled trials, and its application in the field of transfusion medicine is becoming increasingly widespread. This article systematically reviews the definition and methodological system of RWS, examines its application cases in clinical blood transfusion research, and discusses the advantages, limitations, and future research directions of RWS, aiming to provide a reference for evidence-based research in blood transfusion medicine.

Objectives:The study assessed the relationship between atherogenic index of plasma(AIP)and the rapid progression of coronary non-target lesions.Methods:A total of 1 247 patients with coronary artery disease who underwent two coronary angiography examinations at Fuwai Hospital,Chinese Academy of Medical Sciences between January 2010 and September 2014 were enrolled in this retrospective study.The AIP is defined as the base 10 logarithm of the ratio of the concentrations of triglyceride to high-density lipoprotein cholesterol.Patients were divided into the high AIP group(n=623)and the low AIP group(n=624)based on the median value of AIP.Lesion rapid progression is defined as an increase of more than 10%in the lumen stenosis of the lesion with a stenosis rate of more than 50%,or an increase of more than 30%in the lumen stenosis rate of the lesion with a stenosis rate of less than 50%,or a progression to total occlusion within 2 years.Results:Median AIP was 0.39(0.23-0.56)in this patient cohort.Rapid progression of non-target lesions occurred in 65(5.21%),including 42(6.74%)in the high AIP group.The Kaplan-Meier curve showed that the cumulative incidence of rapid progression of non-target lesions was higher in the high AIP group than in the low AIP group(HR=1.751,95%CI:1.053-2.912,log-rank P=0.028).In univariate cox analysis,the AIP and high AIP correlated with rapid progression of non-target lesions.After multivariate adjustment,AIP was an independent risk factor for rapid progression of non-target lesions(adjusted HR=2.731,95%CI:1.090-6.844,P=0.032).Conclusions:AIP is an independent risk factor for rapid progression of non-target lesions.AIP should be considered as a biomarker for estimating the risk of cardiovascular disease,along with other traditional risk factors.

Objective To explore the microstructural characteristics of white matter in patients with acute ischemic stroke and their relationship with collateral circulation.Methods In all,150 patients with acute ischemic stroke admitted to our hospi-tal from January 2023 to May 2024 were selected as the study subjects,and another 150 healthy volunteers during the same peri-od were selected as the control group to compare the general clinical data of the two groups.All subjects underwent head MRI examination to extract microstructural features of brain white matter and analyze the correlation between microstructural fea-tures of brain white matter and brain white matter lesions.According to the formation status of collateral circulation,150 pa-tients with acuteischemic stroke were divided into good collateralcirculation group(n=91)and poor collateral circulation group(n=59).The general clinical data and microstructure characteristics of white matter were compared between the two groups.The predictive value of microstructurecharacteristics of white matter for stroke,white matter lesions,and poor collater-al circulation were analyzed using ROC curves.Results Comparing the general information between the healthy group and the stroke group,it could be seen that there were significant differences between the two groups in terms of smoking history,hyper-lipidemia history,hypertension history,LDL-C,HDL-C,FIB,and D-D(all P<0.05);The brain white matter fiber bundles with statistically significant FA values in the healthy and stroke groups included:cerebellar peduncle,pontine chiasmatic tract,corpus callosum,fornix column and fornix body,right corticospinal tract,left corticospinal tract,right cerebellar peduncle,left cerebellar peduncle,right anterior radial crown,and left anterior radial crown;The brain white matter fiber bundles with statistically sig-nificant MD values in the healthy and stroke groups included:cerebellar peduncle,pontine chiasmatic tract,right cerebellar pe-duncle,left cerebellar peduncle,right external capsule,left external capsule,and right frontal occipital bundle;The brain white matter fiber bundles with statistically significant RD values in the healthy and stroke groups included:cerebellar peduncle,pon-tine chiasmatic tract,left corticospinal tract,right cerebellar peduncle,left cerebellar peduncle,right cerebellar peduncle,left cer-ebellar peduncle,right external capsule,and left external capsule;The brain white matter fiber bundles with statistically signifi-cant AD values in the healthy and stroke groups included:midcerebellar peduncle,right medial thalamus,left medial thalamus,right superior cerebellar peduncle,left superior cerebellar peduncle,right posterior thalamic radiation,right sagittal layer,right external capsule,left external capsule,right cingulate and left cingulate.Correlation analysis showed that the FA values of the cerebellar peduncle,pontine chiasmatic tract,corpus callosum,fornix column and fornix body,right corticospinal tract,left corti-cospinal tract,right cerebellar peduncle,left cerebellar peduncle,right anterior radial crown,and left anterior radial crown were significantly negatively correlated with the white matter lesion score(all P<0.05);The MD values of the cerebellar peduncle,pontine chiasmatic tract,right cerebellar peduncle,left cerebellar peduncle,right external capsule,left external capsule,and right frontal occipital tract were significantly positively correlated with the white matter lesion score(all P<0.05);The RD values of the cerebellar peduncle,pontine chiasmatic tract,left corticospinal tract,right cerebellar peduncle,left cerebellar peduncle,right cerebellar peduncle,left cerebellar peduncle,right external capsule,and left external capsule were significantly positively correla-ted with the white matter lesion score(all P<0.05);The AD values of the cerebellar peduncle,right cerebellar peduncle,left cerebellar peduncle,right external capsule,and left external capsule were significantly positively correlated with the white matter lesion score(all P<0.05),while the AD values of the right medial thalamus,left medial thalamus,right posterior thalamus radi-ation,right sagittal layer,right cingulate and left cingulate were significantly negatively correlated with the white matter lesion score(all P<0.05).Comparing the general information between good collateral circulation group and poor collateral circulation group,it could be seen that there was a significant difference in the white matter lesion score between the two groups of patients(P<0.05).The ROC analysis showed that FA,MD,RD,and AD values in the cerebellar midfoot had good predictive value for stroke,white matter injury,and collateral circulation disorders,and the combined diagnostic efficacy of the four values was high-er than the diagnostic efficacy of each value alone.Conclusion The microstructure of white matter in patients with acute ische-mic stroke exhibits varying degrees of damage.Changes in FA,MD,AD,and RD values in the white matter of the cerebellar pe-duncle can be used to differentiate collateral circulation status,and the combined diagnostic efficacy of the four is better.

Aim To perform high-throughput screen-ing of immunomodulatory traditional Chinese medicine(TCMs)based on an in vitro B cell differentiation-antibody secretion model,identifying active herbal candidates with immune-enhancing properties to pro-vide novel therapeutic options and theoretical support for influenza virus treatment in immunocompromised in-dividuals.Methods B cells were stimulated with dif-ferent concentrations of cytosine-phosphate-guanine oli-godeoxynucleotide 2006(CpG)and nterleukin-2(IL-2)to promote proliferation,differentiation,and anti-body secretion,and the effects of varying concentra-tions of the solvent DMSO were also evaluated.The op-timal conditions for the B cell differentiation-anti-body secretion model were determined based on the se-cretion levels of three antibody isotypes.The feasibility of the model was further validated using rapamycin,a known B cell function inhibitor.On this basis,a high-throughput screening platform for immunomodulatory a-gents was optimized and established.Subsequently,the immune-enhancing activity of 465 polarity extract from TCMs was evaluated.Results The optimal con-ditions for the model were determined as 2 mg·L-1 CpG,1.67 × 106 nkat·L-1 IL-2,and DMSO with a volume fraction of 0.1％.Rapamycin effectively inhib-ited B cell differentiation into plasmablast and signifi-cantly reduced antibody production,indicating the reli-ability of the model.Multiple rounds of screening re-vealed that the dichloromethane extract of licorice,the dichloromethane extract of Vinegar-processed Curcumae Rhizoma,the cyclohexane extract of Honey-prepared Radix Asteris,and the aqueous extract of Siphonostegia chinensis Benth were identified to significantly promote both B cell proliferation and differentiation and anti-body secretion at a concentration of 600 μg·L-1.Conclusion This study successfully optimizes an in vitro B cell differentiation-antibody secretion model and identifies several TCM extracts,including licorice,with potential immune-enhancing activity.

Aim To perform high-throughput screen-ing of immunomodulatory traditional Chinese medicine(TCMs)based on an in vitro B cell differentiation-antibody secretion model,identifying active herbal candidates with immune-enhancing properties to pro-vide novel therapeutic options and theoretical support for influenza virus treatment in immunocompromised in-dividuals.Methods B cells were stimulated with dif-ferent concentrations of cytosine-phosphate-guanine oli-godeoxynucleotide 2006(CpG)and nterleukin-2(IL-2)to promote proliferation,differentiation,and anti-body secretion,and the effects of varying concentra-tions of the solvent DMSO were also evaluated.The op-timal conditions for the B cell differentiation-anti-body secretion model were determined based on the se-cretion levels of three antibody isotypes.The feasibility of the model was further validated using rapamycin,a known B cell function inhibitor.On this basis,a high-throughput screening platform for immunomodulatory a-gents was optimized and established.Subsequently,the immune-enhancing activity of 465 polarity extract from TCMs was evaluated.Results The optimal con-ditions for the model were determined as 2 mg·L-1 CpG,1.67 × 106 nkat·L-1 IL-2,and DMSO with a volume fraction of 0.1％.Rapamycin effectively inhib-ited B cell differentiation into plasmablast and signifi-cantly reduced antibody production,indicating the reli-ability of the model.Multiple rounds of screening re-vealed that the dichloromethane extract of licorice,the dichloromethane extract of Vinegar-processed Curcumae Rhizoma,the cyclohexane extract of Honey-prepared Radix Asteris,and the aqueous extract of Siphonostegia chinensis Benth were identified to significantly promote both B cell proliferation and differentiation and anti-body secretion at a concentration of 600 μg·L-1.Conclusion This study successfully optimizes an in vitro B cell differentiation-antibody secretion model and identifies several TCM extracts,including licorice,with potential immune-enhancing activity.

Objective:To explore the dynamic trends of family caregivers' supportive care needs and family resilience in enterostomy patients and to analyze the reciprocal predictive relationship between the two.Methods:This study was longitudinal. Convenience sampling was used to select 370 family primary caregivers of colorectal cancer patients with enterostomy in the Affiliated Cancer Hospital of Xinjiang Medical University and the Xinjiang Bazhou People's Hospital from December 2023 to September 2024 as study subjects. Patients were surveyed using the General Information Questionnaire, Family Hardiness Index, and Supportive Care Needs Survey-Partners and Caregivers at four time points of admission (T1), discharge (T2), one month after surgery (T3), and three months after surgery (T4). Spearman correlation was used to analyze the correlation between supportive care needs of family caregivers of enterostomy patients and family resilience at different time points, and a cross-lagged model was constructed to explore the predictive role of supportive care needs on family resilience.Results:A total of 370 questionnaires were distributed and 336 valid questionnaires were finally recovered, with a valid recovery rate of 90.81% (336/370). Supportive care needs of family caregivers and family resilience of 336 family caregivers of enterostomy patients showed an increasing and then decreasing trend during hospitalization to three months after surgery ( P<0.05). Spearman correlation analysis showed that supportive care needs of family caregivers of enterostomy patients were negatively correlated with family resilience ( P<0.01). Cross-lagged model showed that supportive care needs of family caregivers of enterostomy patients at T1, T2, and T3 negatively predicted family resilience in the next period (β=-0.308, -0.204, and -0.243; all P<0.05), but not vice versa. Conclusions:Family caregiver supportive care needs and family resilience of enterostomy patients showed a dynamic trend of increasing and then decreasing during the hospitalization to three months postoperatively, and family caregiver supportive care needs are able to influence subsequent family resilience. Healthcare professionals should assess the supportive care needs of family caregivers and take targeted measures to meet their supportive care needs in a timely manner, in order to enhance the family resilience, create a good family environment for patients' recovery, and improve the quality of life of patients and their family caregivers.

Objective:To investigate the effect of infusing different doses of graft cells on viral infections and survival after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods:Clinical data of 99 patients with hematological diseases who underwent allo-HSCT in Shanxi Bethune Hospital were retrospectively analysed.The proportion of mononuclear cells(MNC)was counted microscopically,the proportions and absolute counts of CD34+cells and lymphocyte subsets(including CD3+T,CD4+T,CD8+T,CD4+CD8+T,B,and NK cells)were detected by flow cytometry,and the infusion dose of each cell types was calculated.The patients were divided into high-dose group and low-dose group based on the median value of the infused cell dose.The effects of different doses of various graft cells on post-transplant viral infections(CMV,EBV,BKV)and survival were analyzed.Results:The low-dose MNC(＜7.97 × 108/kg)and high-dose CD4+CD8+T cell(≥3.02 × 106/kg)groups had a higher Epstein-Barr virus(EBV)infection rate(P=0.031;P=0.020).The high-dose CD34+cell group and low-dose CD3+T,CD8+T and natural killer(NK)cell groups showed a trend toward higher EBV infection rates,but the differences were not statitsically significant(P＞0.05).There was no significant difference in the rates of EBV infection between the high-dose and low-dose groups of CD4+T and B cells(P＞0.05).Multivariate analysis revealed that the doses of MNC and CD4+CD8+T cells in the graft were independent factors influencing EBV infection(P=0.023;P=0.016).The doses of cells in the graft showed no significant impact on CMV and BKV infection,or patient survival(P＞0.05).Conclusion:Infusing a lower dose of MNC and a higher dose of CD4+CD8+T cells increases the risk of EBV infection,but does not affect the survival outcome.

Objective:To investigate the effect of infusing different doses of graft cells on viral infections and survival after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods:Clinical data of 99 patients with hematological diseases who underwent allo-HSCT in Shanxi Bethune Hospital were retrospectively analysed.The proportion of mononuclear cells(MNC)was counted microscopically,the proportions and absolute counts of CD34+cells and lymphocyte subsets(including CD3+T,CD4+T,CD8+T,CD4+CD8+T,B,and NK cells)were detected by flow cytometry,and the infusion dose of each cell types was calculated.The patients were divided into high-dose group and low-dose group based on the median value of the infused cell dose.The effects of different doses of various graft cells on post-transplant viral infections(CMV,EBV,BKV)and survival were analyzed.Results:The low-dose MNC(＜7.97 × 108/kg)and high-dose CD4+CD8+T cell(≥3.02 × 106/kg)groups had a higher Epstein-Barr virus(EBV)infection rate(P=0.031;P=0.020).The high-dose CD34+cell group and low-dose CD3+T,CD8+T and natural killer(NK)cell groups showed a trend toward higher EBV infection rates,but the differences were not statitsically significant(P＞0.05).There was no significant difference in the rates of EBV infection between the high-dose and low-dose groups of CD4+T and B cells(P＞0.05).Multivariate analysis revealed that the doses of MNC and CD4+CD8+T cells in the graft were independent factors influencing EBV infection(P=0.023;P=0.016).The doses of cells in the graft showed no significant impact on CMV and BKV infection,or patient survival(P＞0.05).Conclusion:Infusing a lower dose of MNC and a higher dose of CD4+CD8+T cells increases the risk of EBV infection,but does not affect the survival outcome.

Objective:To investigate the correlation between the types and quantities of immune cells in the graft and early immune reconstitution after allogeneic hematopoietic stem cell transplantation(allo-HSCT)and their influence on clinical prognosis.Methods:The clinical data of 83 patients with hematological diseases who received allo-HSCT in Shanxi Bethune Hospital from September 2020 to June 2023 were retrospectively analyzed.The number of mononuclear cells(MNC),CD34+cells and lymphocyte subsets(including CD3+T,CD3+CD4+T(Th),CD3+CD8+T(Ts),NK cells and B cells)infused into the recipients was counted,and the peripheral blood lymphocytes were detected before conditioning and on days 14,30,60 and 100 post-HSCT.Results:Multivariate analysis showed that the number of MNC in the graft affected the recovery of CD4+T lymphocytes after HSCT,and the number of CD4+T lymphocytes in the graft affected the recovery of NK cells and B cells after HSCT.The patient age,donor sex,stem cell source,degree of HLA matching,use of ATG before HSCT,the occurrence of acute graft-versus-host disease(aGVHD)after HSCT,and viral infection all affect the early cellular immune reconstitution post-HSCT.The number of infused cells had no significant impact on the median engraftment time for neutrophils and platelets after HSCT.Patients with lower numbers of CD3+T,CD4+T and B cells in the graft were more prone to viral infection after HSCT.However,the cells in the graft had no significant effect on disease recurrence or mortality.Conclusion:The recovery rate of lymphocyte count after allo-HSCT varies.The numbers of MNC and CD4+T cells in the graft may be related to the cellular immune reconstitution after HSCT,while the numbers of CD34+,CD3+T,CD8+T,NK and B cells have no significant effect on the cellular immune reconstruction.The numbers of CD3+T,CD4+T and B cells in the graft were negatively correlated with viral infection after HSCT,but the cellular components of the graft have no obvious influence on hematopoietic reconstitution,disease recurrence,death,recurrence-free survival(RFS)and overall survival(OS)after HSCT.