Objective: To investigate the efficacy and safety of centrifugal and membrane double plasma molecular adsorption systems (DPMAS) combined with low-dose plasma exchange in the treatment of liver failure. Methods: A retrospective analysis was performed on 60 patients with liver failure treated in our hospital from April 2024 to June 2025. Based on different plasma separation methods, they were divided into the centrifugal DPMAS group (n=30) and the conventional membrane DPMAS group (n=30). The operational parameters, laboratory indicators, and adverse reactions were compared between the two groups. Results: Under the same plasma volume for adsorption and exchange (P>0.05), the centrifugal group showed lower total circulating blood volume, total blood flow rate, and treatment duration compared to the membrane group [10 794 (9 532, 12 637) vs 19 000 (19 000, 21 000) mL, 60 (60, 65) vs 125 (120, 130) mL/min, 169 (141, 193) vs 207 (183, 210) min, P<0.001]. The centrifugal group also had a lower rate of central venous catheter use [(24/30, 80.00%) vs (30/30, 100.00%), P=0.024] and required more calcium supplementation due to sodium citrate anticoagulation [6 (6, 8) vs 2 (2, 2) g, P<0.001]. No significant changes were observed in WBC, Hb, HCT, and PLT levels before and after treatment with the centrifugal group (P>0.05). There was no statistically significant difference in WBC levels before and after membrane group treatment (P=0.199), but the values of Hb, HCT, and PLT showed significant decreases post-treatment compared to pre-treatment [106.50 (102.75, 126.75) vs 123.00 (109.75, 132.00) g/L, 33.20 (29.90, 34.92) vs 34.85 (31.55, 37.52)%, 85.00 (43.25, 139.50) vs 93.00 (61.50, 145.00)×10 /L, P<0.05]. There was no significant difference in coagulation function indexes before and after treatment with centrifugal group (P>0.05). The membrane group showed reduction in fibrinogen (Fib) levels post-treatment [1.50 (1.20, 1.60) vs 1.60 (1.25, 1.80) g/L, P=0.033]. Both groups demonstrated significant decreases in total bilirubin (TBil) and direct bilirubin (DBil) levels after treatment (centrifugal group: 194.70 (107.50, 276.00) vs 239.15 (173.00, 304.17) μmol/L, 101.00 (64.00, 182.30) vs 157.00 (101.00, 195.00) μmol/L; membrane group: 211.50 (118.00, 240.00) vs 263.50 (204.75, 314.00) μmol/L, 188.00 (122.75, 232.25) vs 219.00 (178.50, 267.25) μmol/L, P<0.05]. The incidence of catheter-related complications was lower in the centrifugal group [(2/30, 6.67%) vs (8/30, 26.67%), P=0.038]. Conclusion: The centrifugal DPMAS system demonstrates advantages such as lower blood flow velocity requirements, shorter treatment duration, minimal impact on platelets, and reduced adverse event rates, indicating promising clinical applications.

A 23-year-old male patient was diagnosed with congenitally corrected transposition of great arteries (ccTGA) at the age of 3 years during a routine physical examination. Due to the absence of significant symptoms, the patient was managed conservatively with follow-up without surgical treatment. He developed chest tightness one year prior to admission, with symptom exacerbation in the recent month. Echocardiography demonstrated significantly worsened morphological tricuspid regurgitation. The patient presented to Guangdong Provincial People’s Hospital for surgical evaluation. Given the patient’s age and clinical presentation, a totally thoracoscopic morphological tricuspid valve replacement was performed. Postoperative assessment showed good prosthetic valve function, with no regurgitation or paravalvular leakage; the electrocardiogram confirmed sinus rhythm without atrioventricular block. Extubation occurred within 12 hours postoperatively, and the patient was transferred from the intensive care unit (ICU) on postoperative day 2. At the three-month follow-up, the patient was asymptomatic and had resumed normal activities. This report describes the first case of a totally thoracoscopic morphological tricuspid valve replacement in a ccTGA patient in China. This initial experience suggests that the totally thoracoscopic approach for morphological tricuspid valve replacement in ccTGA patients is a feasible, safe, and effective minimally invasive option associated with rapid recovery.

Objective:To analyze the clinical characteristics of immune checkpoint inhibitor (ICI)-induced type 1 diabetes (T1D).Methods:This was a retrospective case series study of clinical data from 24 patients with ICI-T1D admitted to People′s Hospital of Henan Provincial between January 2018 and December 2024. The data collected included demographic characteristics, ICI usage, clinical manifestations, laboratory test results, and clinical outcome. Patients were categorized into mild and severe groups based on disease severity. Clinical characteristics between the two groups were compared using the Mann-Whitney U test. Results:Of the 24 patients, 21 (87.5%) were male and 3 (12.5%) were female, with an average age of (62.0±10.6) years. Patients in the severe disease group were significantly older than those in the mild disease group [(68.0±9.5) years vs. (58.4±9.8) years, P<0.05]. Compared to patients with mild disease, those with severe disease had significantly higher rates of impaired consciousness (9/9 vs.2/15), shorter ICI treatment cycles [3 (2, 6) vs. 6 (5, 8)], shorter time from ICI initiation to diabetes diagnosis [68 (31, 168) d vs. 162 (135, 235) d], and shorter time from the onset of diabetes symptoms to medical consultation [4 (2, 5) d vs. 8 (4, 26) d] (all P<0.05). The severe disease group also showed significantly higher blood glucose levels [43.0 (39.1, 57.3) mmol/L vs. 24.6 (19.6, 29.6) mmol/L] and a lower glycated hemoglobin level [6.8% (6.3%, 7.6%) vs. 7.9% (7.6%, 8.6%)], along with a higher incidence of fulminant T1D (8/9 vs. 2/15, all P<0.05). All patients received insulin injection therapy. After discharge, fasting C-peptide levels in 3 patients with mild disease showed a transient increase to 0.26, 0.43, 0.49 nmol/L but declined again after six months. Conclusions:ICI-T1D is characterized by acute onset and rapid progression. Older patients are more likely to develop severe disease. All patients require insulin therapy.

Objective To explore the effects of different sealing methods in the treatment of liver failure patients using a dual plasma molecular adsorption system combined with plasma exchange.Methods A total of 120 patients with liver failure admitted between January 2022 and October 2024 were enrolled in the study and randomly divided into an observation group and a control group,each consisting of 60 patients.Both groups received treatment with a dual plasma molecular adsorption system combined with plasma exchange.The control group was administered heparin sodium for catheter sealing,whereas the observation group received protamine prior to hepa-rin sodium catheter sealing.The study compared the two groups in terms of liver function indicators—including aspartate aminotransferase(AST),alanine aminotransferase(ALT),and bilirubin—coagulation function indicators such as fibrinogen and international normalized ratio(INR),hemoglobin(HGB)levels,catheter blockage rates,and the incidence of adverse reactions.Results No statistically significant differences were observed in liver function,coagulation function,or routine blood parameters between the two patient groups following treatment(P>0.05).However,the incidence of blockage in the observation group(3.33%)was significantly lower than that in the control group(20.00%),with the difference being statistically significant(P<0.05).Additionally,no significant differences were found in the occurrence of adverse reactions between the two groups(P>0.05).Conclusions The treatment of liver failure involves the use of a dual plasma molecular adsorption system combined with plasma exchange.Administering protamine prior to heparin sodium sealing has minimal impact on the patient's liver function,blood parameters,coagulation profile,and incidence of adverse reactions,yet it effectively reduces the risk of circuit clotting.

Objective To explore a standardized approach for indicating dosages in Chinese patent medicines(CPM)instructions.Methods A review of 1 378 classic formulas of traditional Chinese medicine in the 2020 edition of the Pharmaco-poeia of the People's Republic of China(Chinese Pharmacopoeia)was conducted,focusing on three aspects:overdose,different dosage forms,and inclusion of toxic herbs.Approximately 50 representative formulas were selected,and their daily dosage of herbal pieces and the corresponding dosage of individual herbs were calculated.These results were then compared and analyzed against the dosages stipulated in the Chinese Pharmacopoeia.Results ①Overdose:Among the 1 378 reviewed formulas,146(10.60％)were found to involve overdose.Specifically,eight formulas were identified as having an overdose of approximately 3 to 5 times the recommended dose,including Duanxueliu tablets and Zhixue Fumai mixture.②Dosage variations across dosage forms:Based on the conversion of the Ming-Qing dynasty dosage of one liang(Chinese traditional weight unit)to 36 g,the estimated dai-ly dose per component of crude herbs in Yinqiao powder was close to the upper limit specified in the Chinese Pharmacopoeia.The total daily dose of crude herbs(75.60 g)was approximately five times that of the Yinqiao powder(15 g)listed in the Chinese Pharmacopoeia and three times that of the Japanese Kampo Yinqiao powder(23.868 g).Significant differences in dosage were ob-served among Yinqiao Jiedu preparations of different dosage forms.In terms of total daily dose of crude herbs,granules(52.50 g)had the highest dose,approximately 3-5 times that of tablets/capsules(11.20 g),soft capsules(13.44 g),and powders(15.00 g),but still 30％ lower than the original prescription from ancient texts(75.6 g).Comparing the daily dose per compo-nent,granules fell within the Chinese Pharmacopoeia dose range,while tablets,capsules,soft capsules,and powders were all below the Chinese Pharmacopoeia dose.③Inclusion of toxic herbs:Among the 20 oral formulations containing Strychnos nux-vomica(Maqianzi)listed in the Chinese Pharmacopoeia,seven species exceeded the pharmacopoeial dose of 0.3-0.6 g per day.Notably,Shenjin Huoluo pill and Shufeng Dingtong pill exceeded the Chinese Pharmacopoeia dose by 1.5-2 times.The daily dose of strych-nosine in Shenjin Huoluo pill was 21.3 mg,exceeding the toxic dose range of 5-10 mg.Conclusions The dosage indications in CPM instructions must adhere to a unified format,clearly stating the daily dose per component of crude herbs,the total daily dose of crude herbs,and the total number of administrations under the"Dosage and Administration"section.For instance,"Yinqiao Jiedu granules,with a total daily dose equivalent to 60 g of crude herbs taken in four doses(including:Flos Lonicerae 10.71 g,Fructus Forsythiae 10.71 g,Radix Platycodi 6.43 g,Herba Menthae Haplocalycis 6.43 g,Fructus Arctii 6.43 g,Semen Sojae Preparatum 5.36 g,Radix Glycyrrhizae 5.36 g,Herba Lophatheri 4.29 g,Herba Schizonepetae 4.29 g)."For CPM containing tox-ic herbs,dosage indications are even more crucial,such as specifying the daily dose of Maqianzi powder/processed Maqianzi and strychnosine in formulations containing this herb.

Objective To explore the effects of different sealing methods in the treatment of liver failure patients using a dual plasma molecular adsorption system combined with plasma exchange.Methods A total of 120 patients with liver failure admitted between January 2022 and October 2024 were enrolled in the study and randomly divided into an observation group and a control group,each consisting of 60 patients.Both groups received treatment with a dual plasma molecular adsorption system combined with plasma exchange.The control group was administered heparin sodium for catheter sealing,whereas the observation group received protamine prior to hepa-rin sodium catheter sealing.The study compared the two groups in terms of liver function indicators—including aspartate aminotransferase(AST),alanine aminotransferase(ALT),and bilirubin—coagulation function indicators such as fibrinogen and international normalized ratio(INR),hemoglobin(HGB)levels,catheter blockage rates,and the incidence of adverse reactions.Results No statistically significant differences were observed in liver function,coagulation function,or routine blood parameters between the two patient groups following treatment(P>0.05).However,the incidence of blockage in the observation group(3.33%)was significantly lower than that in the control group(20.00%),with the difference being statistically significant(P<0.05).Additionally,no significant differences were found in the occurrence of adverse reactions between the two groups(P>0.05).Conclusions The treatment of liver failure involves the use of a dual plasma molecular adsorption system combined with plasma exchange.Administering protamine prior to heparin sodium sealing has minimal impact on the patient's liver function,blood parameters,coagulation profile,and incidence of adverse reactions,yet it effectively reduces the risk of circuit clotting.