Objective: To provide evidence for improving emergency blood supply protocols by analyzing the clinical characteristics and disease distribution of emergency transfusion patients, especially those receiving≥10 units of red blood cells (RBCs). Methods: The data of 4 157 patients who urgently applied for large-volume blood transfusion in various hospitals in Shanghai from May 2024 to April 2025 were selected and analyzed statistically. Results: Tertiary gradeA hospitals accounted for the largest proportion of total transfusion volume (U) (48.79%, 8 420/17 256.5), with no statistically significant differences in RBC transfusion volumes among hospitals of different grades (P>0.05). All blood products are most widely used in tertiary hospitals. Obstetric blood transfusion (U)(19.07%, 3 277.5/17 190.5) was the most frequent. A-mong the hospitals of patients who received emergency blood transfusion with red blood cell suspension≥10 U, tertiary gradeA hospitals also had the largest transfusion volume (U)(47.19%, 1 107/2 346). In terms of disease types, the top three diseases in terms of blood transfusion volume (U) were obstetric transfusion (24.59%, 572/2 326), digestive diseases (14.53%, 338/2 326) and tumors (14.19%, 330/2 326). Conclusion: Tertiary grade A hospitals are the main demand units for emergency blood transfusion, with pregnant women and cancer patients being the core blood-using groups. It is suggested that the safety, timeliness and sufficiency of emergency blood transfusion be guaranteed by establishing a hierarchical blood supply mechanism, formulating single-disease blood transfusion plans and promoting precise blood transfusion guided by thromboelastography.

Objective:To explore a new surgical approach [anteromedial approach of the hip (AMA)] for Pipkin Ⅰ and Ⅱ femoral head fractures through an imaging and anatomical study.Methods:The hip imaging data were collected of the 38 patients who had undergone lower limb CT angiography for open tibiofibular fractures at Department of Orthopaedics, The Sixth People’s Hospital, School of Medicine, Shanghai Jiao Tong University from June 2023 to January 2024. There were 20 males aged (40.9±3.5) years and 18 females aged (41.5±3.3) years. The origins and shapes of the femoral artery and its main branches were observed. The distances between the femoral head and the femoral artery, the medial femoral circumflex artery, and the lateral femoral circumflex artery were measured. Four fresh adult cadavers were collected, including 2 males and 2 females. Their ages of death were 56, 65, 72 and 78 years old, respectively. An incision was made along the axis of the limb at the midpoint of the inguinal ligament at the 4 fresh cadavers. After the femoral head was exposed through the gap between the femoral artery and the femoral nerve, the range of the femoral head exposed was marked.Results:The femoral artery ran along the anteromedial side of the femoral head. The shortest distance between the medial femoral circumflex artery and the femoral head was (13.1±5.7) mm, and the shortest distance between the origin of the lateral femoral circumflex artery and the femoral head (21.6±8.6) mm. On the lateral view of CT angiography, the distance between the femoral artery and the femoral head was (20.6±4.9) mm at the level of the apex of greater trochanter. Gross observation on the cadavers found only small branches of vessels between the femoral artery and the femoral nerve. After the femoral artery and femoral nerve were respectively pulled medially and laterally, the anterior-inferior part of the femoral head was exposed directly by pulling the muscles to open the joint capsule. The exposure range of the femoral head was further expanded through internal and external rotation of the hip joint under traction. The anatomical gap between the femoral artery and the femoral nerve was named the AMA.Conclusion:AMA utilizes the potential gap between the femoral artery and the femoral nerve, providing a new surgical approach for exposure and fixation of Pipkin type Ⅰ and Ⅱ femoral head fractures.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.

Objective:To investigate the value of tumor and adipose tissue metabolic parameters from baseline 18F-FDG PET/CT in predicting the efficacy and prognosis of immunotherapy in patients with advanced nasopharyngeal carcinoma (NPC). Methods:From February 2019 to February 2022, 112 patients (91 males, 21 females, age 21-73 years) with advanced NPC who were treated with programmed death-1 (PD-1) inhibitors at Sun Yat-Sen University Cancer Center were retrospectively included. All patients underwent baseline PET/CT examination. Tumor and adipose tissue metabolic parameters were measured and calculated. Patients were divided into clinical benefit and non-clinical benefit groups, and Mann-Whitney U test or χ2 test was used to assess the differences between groups. Prognostic analysis of progression-free survival (PFS) was performed using multivariate Cox proportional hazards regression model and a prognostic stratification system was constructed. Results:Of the 112 patients, 85 were in the clinical benefit group and 27 were in the non-clinical benefit group. In non-clinical benefit group and clinical benefit group, the metabolic tumor volume (MTV) of primary tumor (PT-MTV) were 47.7(7.7, 81.2) and 14.0(5.7, 27.1)cm 3, total lesion glycolysis (TLG) of primary tumor (PT-TLG) were 228.9(27.4, 492.8) and 72.7(20.4, 165.5)g, whole-body MTV (WB-MTV) were 94.2(45.9, 215.4) and 61.3(31.6, 104.3)cm 3, whole-body TLG (WB-TLG) were 605.5(214.1, 1 402.5) and 319.2(172.4, 632.8)g, SUV max of visceral adipose tissue (SUV max-VAT) were 0.77(0.55, 0.91) and 0.62(0.48, 0.76), respectively ( Z values: from -2.72 to -1.96, all P<0.05). The proportion of patients with lung metastasis in non-clinical benefit group was higher than that in clinical benefit group (44.4%(12/27) vs 23.5%(20/85); χ2=4.39, P=0.036). PT-MTV (hazard ratio ( HR)=2.807, 95% CI: 1.540-5.118, P=0.001) and the presence of lung metastases ( HR=1.691, 95% CI: 1.012-2.823, P=0.045) were independent predictive factors for PFS in multivariate analysis. The prognostic prediction model based on the two predictive factors was able to significantly differentiate the prognosis in patients. Conclusions:Baseline tumor metabolic parameters and SUV max-VAT are associated with the efficacy of immunotherapy in patients with advanced NPC. PT-MTV and lung metastasis can independently predict PFS. The constructed prediction model can stratify patients′ prognosis.

Objective:To compare the effects of the endoscopic retrograde appendicitis therapy (ERAT) assisted with 3 different methods in the diagnosis and treatment of children with uncomplicated appendicitis, and to explore the most effective ERAT.Methods:A case series study was made.The clinical data of 206 children with uncomplicated appendicitis who underwent ERAT in Ji′nan Children′s Hospital from January 2019 to December 2023 were retrospectively analyzed.The patients were divided into 3 groups according to the auxiliary treatment method adopted.There were 13 cases receiving X-ray guided ERAT (ERAT-X) group, 109 cases receiving B-ultrasound guided ERAT(ERAT-B) group and 84 cases receiving dong cha endoscope guided ERAT (ERAT-DC) group.Appendix cavity exploration, irrigation and fecalith removal were performed by ERAT.Perioperative data such as endoscopic manifestations, abdominal pain and the success rate of intubation and follow-up data were recorded and compared among the three groups of patients.The one-way ANOVA method, Wilcoxon sign rank sum test and Kruskal-Wallis H test were used to analyze measurement data, and the χ2 test was used to analyze enumeration data. Results:A total of 201 cases were successfully intubated, including 12 in the ERAT-X group, 106 in the ERAT-B group, and 83 in the ERAT-DC group.The mucosa of the appendix showed different inflammatory changes under the endoscope.There were no significant differences in abdominal pain score before treatment, abdominal pain score after treatment, success rate of intubation, effective rate of treatment, complication rate, antibiotic use rate and length of hospital stay among the three groups (all P>0.05).The abdominal pain score after treatment was significantly lower than that before treatment in all the 3 groups[0(1.00) points vs.4(1.50) points/0(1.00) points vs.4(2.00) points/0(1.00) points vs.4(1.75) points, Z=-3.082, -8.939, -8.009, all P<0.05].The diagnostic rate of the ERAT-DC group was lower than that of the ERAT-B group (75.0% vs.95.4%, P<0.05).The diagnostic specificity of ERAT-DC group was better than that of the ERAT-B group.The operation time of the ERAT-DC group was significantly reduced, compared with that of ERAT-X and ERAT-B groups[38.5(34.3) min vs.85.0(42.5) min vs.67.0(27.0) min, Z=80.075, 55.865, all P<0.05].The hospitalization cost of the ERAT-DC group was significantly higher than that of ERAT-X and ERAT-B groups[(17 269±1 035) yuan vs.(12 081±921) yuan vs.(11 609±1 479) yuan, Z=-89.308, -104.633, all P<0.05].Follow-up results showed that the recurrence rate of abdominal pain (9.1%, 16.7%, 14.8%) and the rate of unplanned reoperation (9.1%, 10.8%, 8.6%) showed no significant difference among the 3 groups(ERAT-X/ERAT-B/ERAT-DC) (all P>0.05). Conclusions:ERAT is a safe and effective therapy in treating children with uncomplicated appendicitis.EART-DC is more accurate and reliable method for the diagnosis and treatment of pediatric appendicitis, so it is worthy of widespread clinical application.

Phosphodiesterase type 5(PDE5)participates in the physiological functions of multiple organs by regulating the nitric oxide(NO)-cyclic guanosine monophosphate(cGMP)pathway.As a long-acting PDE5 inhibitor,tadalafil has been used clinically for over 20 years and is approved for the treatment of male erectile dysfunction and lower urinary tract symptoms associated with benign prostatic hyperplasia.Furthermore,tadalafil maintains cGMP levels by inhibiting PDE5,thereby activa-ting the downstream NO-cGMP signaling pathway to exert multiple effects,including relaxing smooth muscle,exerting antioxidant actions,regulating apoptosis,and modulating metabolism.Clinical evidence indicates that tadalafil shows promising therapeutic potential in multi-organ system diseases such as pulmonary arterial hypertension,heart failure,type 2 diabetes,cognitive impair-ment,female infertility,and fetal growth restriction.This article systematically reviews the action mechanisms and research pro-gress of tadalafil in treating diseases beyond erectile dysfunction,aiming to summarize its potential for cross-disease system clini-cal applications and provide references for optimizing treatment strategies for patients with chronic diseases.

Objective:To explore the effect of ginsenoside Rg1 on spermatogenic dysfunction in mice caused by diabetes and its mechanism of action.Methods:Eighteen male C57BL mice were randomly divided into control group, the model group and the ginsenoside Rg1 group by completely random method, with 6 mice in each group. Type 2 diabetes models were established in the model group and the ginsenoside Rg1 group by a high-fat diet combined with intraperitoneal injection of streptozotocin, while control group was injected with the same amount of normal saline. After successful modeling, control group was given a regular diet for 8 weeks, while the model group and ginsenoside Rg1 group were given a high-fat diet for 8 weeks. The ginsenoside Rg1 group was also treated with ginsenoside Rg1 medication. Reproductive hormone levels were detected by enzyme-linked immunosorbent assay test kits, and Western blotting was used to detect the expressions of apoptosis-related proteins (Bcl2 protein, Caspase-3 protein, Bax protein), autophagy-related proteins (P62, LC3Ⅰ, LC3Ⅱ, Beclin1), β-Catenin protein, mTOR protein, LAMP1 protein and transcription factor EB. The body weight, blood glucose levels, testicular index of mice in each group were compared, as well as the testicular injury status.Results:The body weight [(18.77±1.14) g], testosterone level [(141.07±8.47) ng/L], follicle-stimulating hormone level [(9.19±0.74) U/L], and luteinizing hormone level [(1 497.91±99.57) pg/L] of mice in the model group were significantly lower than those in the control [(31.57±2.35) g, P<0.001; (171.50±11.76) ng/L, P<0.001; (12.46±1.54) U/L, P<0.001; (1 807.29±92.76) pg/L, P<0.001]; fasting blood glucose level [(20.82±1.11) mmol/L], glycosylated hemoglobin (12.67%±1.03%), the testis index (0.65%±0.03%) were significantly higher than those in the control [(6.40±1.34) mmol/L, P<0.001; 5.17%±1.17%, P<0.001; 0.48%±0.04%, P<0.001]. Compared with the model group, the body weight [(22.62±0.92) g, P=0.023], testosterone level [(172.63±9.20) ng/L, P<0.001], follicle-stimulating hormone level [(12.37±1.15) U/L, P<0.001], and luteinizing hormone level [(1 847.80±108.80) pg/L, P<0.001] of mice in the ginsenoside Rg1 group increased significantly, fasting blood glucose level [(18.63±1.14) mmol/L, P=0.017], glycosylated hemoglobin (8.50%±1.05%, P<0.001) and testicular index (0.54%±0.02%, P<0.001) decreased significantly. Compared with the control, the expressions of P62 ( P=0.039), LC3Ⅱ/LC3Ⅰ( P<0.001), Beclin1 ( P=0.002) and mTOR ( P=0.036) in the testicular tissue of mice in the model group all increased, the expression of β-Catenin ( P<0.001), LAMP1 ( P=0.005), transcription factor EB ( P<0.001) all decreased. Compared with the model group, the expressions of autophagy-related proteins P62 ( P=0.048), LC3Ⅱ/LC3Ⅰ( P<0.001) , Beclin1 ( P=0.023) and mTOR ( P=0.005) in the ginsenoside Rg1 group all decreased, while the expression of β-Catenin ( P=0.001), LAMP1 ( P=0.011) and transcription factor EB ( P=0.022) all increased. Transmission electron microscopy detected a decrease in the number of autophagosomes in the testicles of mice in the model group, and it improved after drug intervention. The HE staining showed that the testes of mice in the model group exhibited phenotypes such as the shedding and disorganization of spermatogenic cells, while ginsenoside Rg1 was able to improve these phenotypes. Conclusion:Ginsenoside Rg1 can improve testicular injury caused by diabetes in mice by regulating autophagy.

Objective:To explore the effect of ginsenoside Rg1 on spermatogenic dysfunction in mice caused by diabetes and its mechanism of action.Methods:Eighteen male C57BL mice were randomly divided into control group, the model group and the ginsenoside Rg1 group by completely random method, with 6 mice in each group. Type 2 diabetes models were established in the model group and the ginsenoside Rg1 group by a high-fat diet combined with intraperitoneal injection of streptozotocin, while control group was injected with the same amount of normal saline. After successful modeling, control group was given a regular diet for 8 weeks, while the model group and ginsenoside Rg1 group were given a high-fat diet for 8 weeks. The ginsenoside Rg1 group was also treated with ginsenoside Rg1 medication. Reproductive hormone levels were detected by enzyme-linked immunosorbent assay test kits, and Western blotting was used to detect the expressions of apoptosis-related proteins (Bcl2 protein, Caspase-3 protein, Bax protein), autophagy-related proteins (P62, LC3Ⅰ, LC3Ⅱ, Beclin1), β-Catenin protein, mTOR protein, LAMP1 protein and transcription factor EB. The body weight, blood glucose levels, testicular index of mice in each group were compared, as well as the testicular injury status.Results:The body weight [(18.77±1.14) g], testosterone level [(141.07±8.47) ng/L], follicle-stimulating hormone level [(9.19±0.74) U/L], and luteinizing hormone level [(1 497.91±99.57) pg/L] of mice in the model group were significantly lower than those in the control [(31.57±2.35) g, P<0.001; (171.50±11.76) ng/L, P<0.001; (12.46±1.54) U/L, P<0.001; (1 807.29±92.76) pg/L, P<0.001]; fasting blood glucose level [(20.82±1.11) mmol/L], glycosylated hemoglobin (12.67%±1.03%), the testis index (0.65%±0.03%) were significantly higher than those in the control [(6.40±1.34) mmol/L, P<0.001; 5.17%±1.17%, P<0.001; 0.48%±0.04%, P<0.001]. Compared with the model group, the body weight [(22.62±0.92) g, P=0.023], testosterone level [(172.63±9.20) ng/L, P<0.001], follicle-stimulating hormone level [(12.37±1.15) U/L, P<0.001], and luteinizing hormone level [(1 847.80±108.80) pg/L, P<0.001] of mice in the ginsenoside Rg1 group increased significantly, fasting blood glucose level [(18.63±1.14) mmol/L, P=0.017], glycosylated hemoglobin (8.50%±1.05%, P<0.001) and testicular index (0.54%±0.02%, P<0.001) decreased significantly. Compared with the control, the expressions of P62 ( P=0.039), LC3Ⅱ/LC3Ⅰ( P<0.001), Beclin1 ( P=0.002) and mTOR ( P=0.036) in the testicular tissue of mice in the model group all increased, the expression of β-Catenin ( P<0.001), LAMP1 ( P=0.005), transcription factor EB ( P<0.001) all decreased. Compared with the model group, the expressions of autophagy-related proteins P62 ( P=0.048), LC3Ⅱ/LC3Ⅰ( P<0.001) , Beclin1 ( P=0.023) and mTOR ( P=0.005) in the ginsenoside Rg1 group all decreased, while the expression of β-Catenin ( P=0.001), LAMP1 ( P=0.011) and transcription factor EB ( P=0.022) all increased. Transmission electron microscopy detected a decrease in the number of autophagosomes in the testicles of mice in the model group, and it improved after drug intervention. The HE staining showed that the testes of mice in the model group exhibited phenotypes such as the shedding and disorganization of spermatogenic cells, while ginsenoside Rg1 was able to improve these phenotypes. Conclusion:Ginsenoside Rg1 can improve testicular injury caused by diabetes in mice by regulating autophagy.

Objective:To compare the effects of the endoscopic retrograde appendicitis therapy (ERAT) assisted with 3 different methods in the diagnosis and treatment of children with uncomplicated appendicitis, and to explore the most effective ERAT.Methods:A case series study was made.The clinical data of 206 children with uncomplicated appendicitis who underwent ERAT in Ji′nan Children′s Hospital from January 2019 to December 2023 were retrospectively analyzed.The patients were divided into 3 groups according to the auxiliary treatment method adopted.There were 13 cases receiving X-ray guided ERAT (ERAT-X) group, 109 cases receiving B-ultrasound guided ERAT(ERAT-B) group and 84 cases receiving dong cha endoscope guided ERAT (ERAT-DC) group.Appendix cavity exploration, irrigation and fecalith removal were performed by ERAT.Perioperative data such as endoscopic manifestations, abdominal pain and the success rate of intubation and follow-up data were recorded and compared among the three groups of patients.The one-way ANOVA method, Wilcoxon sign rank sum test and Kruskal-Wallis H test were used to analyze measurement data, and the χ2 test was used to analyze enumeration data. Results:A total of 201 cases were successfully intubated, including 12 in the ERAT-X group, 106 in the ERAT-B group, and 83 in the ERAT-DC group.The mucosa of the appendix showed different inflammatory changes under the endoscope.There were no significant differences in abdominal pain score before treatment, abdominal pain score after treatment, success rate of intubation, effective rate of treatment, complication rate, antibiotic use rate and length of hospital stay among the three groups (all P>0.05).The abdominal pain score after treatment was significantly lower than that before treatment in all the 3 groups[0(1.00) points vs.4(1.50) points/0(1.00) points vs.4(2.00) points/0(1.00) points vs.4(1.75) points, Z=-3.082, -8.939, -8.009, all P<0.05].The diagnostic rate of the ERAT-DC group was lower than that of the ERAT-B group (75.0% vs.95.4%, P<0.05).The diagnostic specificity of ERAT-DC group was better than that of the ERAT-B group.The operation time of the ERAT-DC group was significantly reduced, compared with that of ERAT-X and ERAT-B groups[38.5(34.3) min vs.85.0(42.5) min vs.67.0(27.0) min, Z=80.075, 55.865, all P<0.05].The hospitalization cost of the ERAT-DC group was significantly higher than that of ERAT-X and ERAT-B groups[(17 269±1 035) yuan vs.(12 081±921) yuan vs.(11 609±1 479) yuan, Z=-89.308, -104.633, all P<0.05].Follow-up results showed that the recurrence rate of abdominal pain (9.1%, 16.7%, 14.8%) and the rate of unplanned reoperation (9.1%, 10.8%, 8.6%) showed no significant difference among the 3 groups(ERAT-X/ERAT-B/ERAT-DC) (all P>0.05). Conclusions:ERAT is a safe and effective therapy in treating children with uncomplicated appendicitis.EART-DC is more accurate and reliable method for the diagnosis and treatment of pediatric appendicitis, so it is worthy of widespread clinical application.

Phosphodiesterase type 5(PDE5)participates in the physiological functions of multiple organs by regulating the nitric oxide(NO)-cyclic guanosine monophosphate(cGMP)pathway.As a long-acting PDE5 inhibitor,tadalafil has been used clinically for over 20 years and is approved for the treatment of male erectile dysfunction and lower urinary tract symptoms associated with benign prostatic hyperplasia.Furthermore,tadalafil maintains cGMP levels by inhibiting PDE5,thereby activa-ting the downstream NO-cGMP signaling pathway to exert multiple effects,including relaxing smooth muscle,exerting antioxidant actions,regulating apoptosis,and modulating metabolism.Clinical evidence indicates that tadalafil shows promising therapeutic potential in multi-organ system diseases such as pulmonary arterial hypertension,heart failure,type 2 diabetes,cognitive impair-ment,female infertility,and fetal growth restriction.This article systematically reviews the action mechanisms and research pro-gress of tadalafil in treating diseases beyond erectile dysfunction,aiming to summarize its potential for cross-disease system clini-cal applications and provide references for optimizing treatment strategies for patients with chronic diseases.