Objective: To evaluate the safety and efficacy of ABO non-identical platelets with reduced plasma (ABO-NPRP) transfusion in patients with hematological diseases. Methods: A retrospective analysis was conducted on 52 therapeutic doses of apheresis platelets with reduced plasma prepared at Chongqing Blood Center of the Chinese People's Liberation Army. The transfusion efficacy (24 h CCI) and the transfusion adverse reactions of these apheresis platelets were also observed in 35 patients with hematological diseases in First Affiliated Hospital of Army Medical University. Comparisons were made with a control group consisting of patients who received only identical apheresis platelets during the same period. Meanwhile, the effect of ABO-NPRP on the subsequent platelet transfusion efficacy was observed. Results: There was no statistically significant difference in PDW, MPV, and PLCR before and after the preparation of apheresis platelets with reduced plasma (P>0.05), while the difference in platelet count was statistically significant [(2.86±0.34)×10 per therapeutic dose vs (2.46±0.28)×10 per therapeutic dose, P<0.001]; there was no statistically significant difference in the 24 h CCI transfusion efficacy between conventional identical apheresis platelets and ABO-NPRP, with transfusion efficacy rates of 76.60% and 78.85%, respectively (P>0.05); there was no statistically significant difference in platelet transfusion efficacy between the group with ABO-NPRP and the group without ABO-NPRP (completely identical transfusion group), with transfusion efficacy rates of 77.78% and 75.25%, respectively (P>0.05). Conclusion: ABO-NPRP transfusion is safe, effective, demonstrating comparable efficacy to conventional identical transfusion. It can serve as an important complementary strategy to optimize the utilization of blood resources.

Objective: To evaluate the safety and efficacy of ABO non-identical platelets with reduced plasma (ABO-NPRP) transfusion in patients with hematological diseases. Methods: A retrospective analysis was conducted on 52 therapeutic doses of apheresis platelets with reduced plasma prepared at Chongqing Blood Center of the Chinese People's Liberation Army. The transfusion efficacy (24 h CCI) and the transfusion adverse reactions of these apheresis platelets were also observed in 35 patients with hematological diseases in First Affiliated Hospital of Army Medical University. Comparisons were made with a control group consisting of patients who received only identical apheresis platelets during the same period. Meanwhile, the effect of ABO-NPRP on the subsequent platelet transfusion efficacy was observed. Results: There was no statistically significant difference in PDW, MPV, and PLCR before and after the preparation of apheresis platelets with reduced plasma (P>0.05), while the difference in platelet count was statistically significant [(2.86±0.34)×10 per therapeutic dose vs (2.46±0.28)×10 per therapeutic dose, P<0.001]; there was no statistically significant difference in the 24 h CCI transfusion efficacy between conventional identical apheresis platelets and ABO-NPRP, with transfusion efficacy rates of 76.60% and 78.85%, respectively (P>0.05); there was no statistically significant difference in platelet transfusion efficacy between the group with ABO-NPRP and the group without ABO-NPRP (completely identical transfusion group), with transfusion efficacy rates of 77.78% and 75.25%, respectively (P>0.05). Conclusion: ABO-NPRP transfusion is safe, effective, demonstrating comparable efficacy to conventional identical transfusion. It can serve as an important complementary strategy to optimize the utilization of blood resources.

OBJECTIVE: To observe the effect of acupuncture at Jiaji (EX-B2) points on upper limb motor dysfunction in patients after stroke. METHODS: A total of 62 patients with upper limb motor dysfunction after stroke were randomly assigned to an observation group (n=31, 3 cases dropped out) and a control group (n=31, 2 cases dropped out). Both groups received routine medical treatment and rehabilitation training. The control group was treated with conventional acupuncture at the affected side's Jianyu (LI15), Quchi (LI11), Shousanli (LI10), Huantiao (GB30), Yanglingquan (GB34), and Zusanli (ST36) etc. On this basis, the observation group received additional acupuncture at the affected side's Jiaji points from C₄ to T₅. Treatment was administered once daily, five times a week, for four weeks. Motor evoked potential (MEP) latency and amplitude of the abductor pollicis brevis and abductor digiti minimi, Fugl-Meyer assessment for upper extremity (FMA-UE), and Wolf motor function test (WMFT) scores were compared before and after treatment in the two groups. RESULTS: After treatment, both groups showed increased MEP amplitudes and decreased latencies of the abductor pollicis brevis and abductor digiti minimi (P<0.05), as well as increased FMA-UE and WMFT scores (P<0.05); the observation group had greater MEP amplitudes, shorter latencies, and higher FMA-UE and WMFT scores compared to the control group (P<0.05). CONCLUSION Acupuncture at Jiaji (EX-B2) points could enhance the excitability of upper limb motor neural pathways in upper limb motor dysfunction after stroke patients, thereby promoting motor function recovery of the upper limb.
Humans ; Acupuncture Therapy ; Male ; Female ; Middle Aged ; Acupuncture Points ; Stroke/complications* ; Upper Extremity/physiopathology* ; Aged ; Adult ; Stroke Rehabilitation ; Treatment Outcome

Background and Aims:Biliary tract cancers(BTCs)are highly aggressive malignancies with dismal prognosis,for which radical resection remains the only potentially curative treatment.Laparoscopic surgery has demonstrated superiority over open surgery in perioperative safety and recovery,yet it is technically limited in complex operations.Robot-assisted laparoscopy,with its high-definition three-dimensional vision and enhanced instrument dexterity,may overcome these limitations.However,comparative evidence balancing baseline differences between laparoscopic and robot-assisted laparoscopic radical resections for BTCs is still lacking.This study aimed to evaluate and compare their short-term safety using propensity score matching(PSM).Methods:A total of 151 patients with biliary tract cancers who underwent radical resection were retrospectively enrolled from the Chinese Biliary Tract Tumor Collaborative Group database,including 128 in the laparoscopic group and 23 in the robotic-assisted laparoscopic group.To balance baseline differences,an initial 1∶1 PSM was performed,yielding 19 laparoscopic and 19 robotic cases.Subsequently,using the robotic group as the reference,a 1∶2 PSM was conducted,resulting in 36 laparoscopic and 18 robotic cases.Primary outcomes(conversion to open surgery,ICU admission,and postoperative complications)and secondary outcomes(operative time,intraoperative blood loss,transfusion,postoperative hospital stay,reoperation,readmission,and hospitalization costs)were compared between the two groups.Multivariate regression analyses were performed to explore factors associated with conversion to open surgery and postoperative hospital stay.Results:After matching,baseline characteristics were well balanced between groups.For primary outcomes,the conversion rate to open surgery was significantly higher in the laparoscopic group than in the robotic group(41.7％vs.0,P=0.001),while ICU admission,overall postoperative complications,and Clavien-Dindo graded complications showed no significant differences(all P＞0.05).For secondary outcomes,the postoperative hospital stay was significantly more extended in the laparoscopic group compared with the robotic group(18.5 d vs.8.0 d,P=0.005),whereas operative time,intraoperative blood loss,transfusion,reoperation,readmission,and hospitalization costs were comparable(all P＞0.05).Logistic regression for conversion did not identify statistically significant predictors,but moderately differentiated tumors,elevated preoperative CA19-9,and higher harvested lymph node counts showed trends toward increased risk.Multivariate linear regression revealed that robotic-assisted surgery was an independent factor for reduced postoperative hospital stay(P=0.024),while preoperative total bilirubin(P=0.020),longer operative time(P=0.000),postoperative complications(P=0.006),and reoperation(P=0.005)were found to be associated with a prolonged hospital stay.Conclusion:Robot-assisted laparoscopic radical resection for BTCs is not inferior to conventional laparoscopy in short-term safety and may further reduce conversion rates and hospital stay.Its technical advantages may be particularly valuable in anatomically complex or challenging cases.Nonetheless,cost-effectiveness and resource allocation should be considered for wider adoption.

The ethical review of clinical research on rare diseases is crucial in ensuring the scientific validity of the research and the rights and interests of the subjects. Starting from the definition of rare diseases， this paper analyzed the current situation of domestic and international regulations and ethical review in clinical research on rare diseases. It also explored the key elements of ethical review from the two dimensions of scientific and ethical aspects of clinical research， including research objectives， methods， risk and benefit assessment， researcher qualifications， research infrastructure， informed consent process， data security and privacy protection， and protection of vulnerable groups such as children. Regarding the ethical review of clinical research on rare diseases， strategies can be adopted such as strengthening the training of ethics review personnel， conducting multi-center collaborative reviews， and focusing on the long-term safety of trials， to improve the quality of ethical review， protect the safety of the subjects， and ensure the efficiency and quality of clinical research.

Objective:To investigate the effects and mechanism of Qiangjin Zhuanggu Capsules in bone remodeling in ovariectomized osteoporotic mice.Methods:Totally 75 8-week-old C57BL/6 female mice were divided into a sham-operation group of 15 mice and a modeling group of 60 mice. The model was created using bilateral ovariectomy (OVX) to replicate a postmenopausal osteoporosis mouse model. The successfully modeled mice were divided into model group, estradiol group, and Qiangjin Zhuanggu Capsules low-, medium-, and high-dosage groups using a random number table method, with 10 mice in each group. The estradiol group was given a 0.013 mg/ml solution of estradiol valerate tablets by gavage; Qiangjin Zhuanggu Capsules low-, medium-, and high-dosage groups were orally administered with Qiangjin Zhuanggu Capsule solution at dosages of 46.0, 92.0, and 184.0 mg/ml. The sham-operation group and model group were orally administered with equal volumes of physiological saline once a day for 8 consecutive weeks. After the intervention, the femoral trabecular bone structure, bone mineral density (BMD), bone volume/total volume (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), bone surface area/bone volume (BS/BV), and trabecular separation (Tb.Sp) were assessed using Micro-CT. Serum levels of bone metabolism markers such as calcium (Ca), phosphorus (P), bone alkaline phosphatase (BALP), osteocalcin (OCN), and cathepsin K (CTSK) were measured by ELISA. Hematoxylin and eosin (HE) and Masson staining were used to observe the morphological changes in femoral trabecular bone structure and collagen fibers. Western blot analysis was employed to detect the protein expression of Runt-related transcription factor 2 (Runx2), alkaline phosphatase (ALP), and bone morphogenetic protein-2 (BMP-2), .Results:Compared with the model group, the levels of BMD, BV/TV, Tb. N, and Tb.Th ( P<0.01 or P<0.05) in estradiol group and Qiangjin Zhuanggu Capsule medium- and high-dosage groups increased ( P<0.01, P<0.05), and BS/BV and Tb.Sp decreased ( P<0.01, P<0.05)serum levels of Ca, P, BALP, and OCN were elevated ( P<0.01, P<0.05), while CTSK was reduced ( P<0.01); the expression of Runx2, ALP and BMP-2 proteins significantly increased ( P<0.01, P<0.05). Conclusion:Qiangjin Zhuanggu Capsules exhibit preventive and therapeutic effects on postmenopausal osteoporosis, potentially through the regulation of Runx2, ALP and BMP-2.

Background and Aims:Biliary tract cancers(BTCs)are highly aggressive malignancies with dismal prognosis,for which radical resection remains the only potentially curative treatment.Laparoscopic surgery has demonstrated superiority over open surgery in perioperative safety and recovery,yet it is technically limited in complex operations.Robot-assisted laparoscopy,with its high-definition three-dimensional vision and enhanced instrument dexterity,may overcome these limitations.However,comparative evidence balancing baseline differences between laparoscopic and robot-assisted laparoscopic radical resections for BTCs is still lacking.This study aimed to evaluate and compare their short-term safety using propensity score matching(PSM).Methods:A total of 151 patients with biliary tract cancers who underwent radical resection were retrospectively enrolled from the Chinese Biliary Tract Tumor Collaborative Group database,including 128 in the laparoscopic group and 23 in the robotic-assisted laparoscopic group.To balance baseline differences,an initial 1∶1 PSM was performed,yielding 19 laparoscopic and 19 robotic cases.Subsequently,using the robotic group as the reference,a 1∶2 PSM was conducted,resulting in 36 laparoscopic and 18 robotic cases.Primary outcomes(conversion to open surgery,ICU admission,and postoperative complications)and secondary outcomes(operative time,intraoperative blood loss,transfusion,postoperative hospital stay,reoperation,readmission,and hospitalization costs)were compared between the two groups.Multivariate regression analyses were performed to explore factors associated with conversion to open surgery and postoperative hospital stay.Results:After matching,baseline characteristics were well balanced between groups.For primary outcomes,the conversion rate to open surgery was significantly higher in the laparoscopic group than in the robotic group(41.7％vs.0,P=0.001),while ICU admission,overall postoperative complications,and Clavien-Dindo graded complications showed no significant differences(all P＞0.05).For secondary outcomes,the postoperative hospital stay was significantly more extended in the laparoscopic group compared with the robotic group(18.5 d vs.8.0 d,P=0.005),whereas operative time,intraoperative blood loss,transfusion,reoperation,readmission,and hospitalization costs were comparable(all P＞0.05).Logistic regression for conversion did not identify statistically significant predictors,but moderately differentiated tumors,elevated preoperative CA19-9,and higher harvested lymph node counts showed trends toward increased risk.Multivariate linear regression revealed that robotic-assisted surgery was an independent factor for reduced postoperative hospital stay(P=0.024),while preoperative total bilirubin(P=0.020),longer operative time(P=0.000),postoperative complications(P=0.006),and reoperation(P=0.005)were found to be associated with a prolonged hospital stay.Conclusion:Robot-assisted laparoscopic radical resection for BTCs is not inferior to conventional laparoscopy in short-term safety and may further reduce conversion rates and hospital stay.Its technical advantages may be particularly valuable in anatomically complex or challenging cases.Nonetheless,cost-effectiveness and resource allocation should be considered for wider adoption.

AIM: To systematically evaluate the efficacy and safety of low-concentrations atropine eye drops in controlling adolescent myopia.METHODS:A computer search was conducted on Wanfang Data, CNKI, VIP, PubMed, Cochrane Library, and Embase databases from January 2010 to March 2024 on clinical studies on low-concentration atropine eye drops for controlling adolescent myopia. Two researchers independently screened trials, extracted data, evaluated risk of bias and quality, and used Review Manager5.4 software to perform Meta-analysis.RESULTS:A total of 17 articles, involving 3 764 cases and 3 952 eyes, were included. The Meta-analysis showed that compared with the control group, low concentrations of atropine could effectively slow down the growth of axial length [MD=-0.15, 95% CI(-0.20, -0.10), P<0.00001], significantly controlled the changes in spherical equivalent [MD=0.39, 95% CI(0.29, 0.48), P<0.00001], and had a significant effect on pupil diameter [MD=0.80, 95% CI(0.33,1.28), P=0.0010] and amplitude of accommodation [MD=-2.54, 95%CI(-4.49, -0.60), P=0.01].CONCLUSION:Low-concentrations atropine are effective in controlling spherical equivalent and axial length of myopia in adolescents, significantly affecting pupil diameter and amplitude of accommodation, and effectively delaying the progression of myopia.

Objective To explore whether Yes-associated protein(YAP)affects occurrence and progression of liver fibrosis by regulating epithelial-mesenchymal transition(EMT).Methods In a 8-week-old C57BL/6 mouse model of CCl4-induced liver fibrosis,the effect of verteporfin(a YAP inhibitor)intervention was assessed with HE staining and by detecting liver biochemistry and expressions of YAP and EMT-related genes using immunohistochemistry and Western blotting.Transcriptome and proteomic sequencing and informatics analysis were used to investigate the main downstream pathways of YAP in liver fibrosis.Serum levels of YAP,N-cadherin,vimentin and Twist were examined in 60 healthy individuals,60 patients with chronic hepatitis B(CHB),and 60 patients with HBV-related liver cirrhosis.In another 24 C57BL/6 mice,the effects of Twist inhibitor alone or in combination with harmine(a YAP activator)on CCl4-induced liver fibrosis were evaluated by histopathological examination and Western blotting.Results The mouse models of liver fibrosis showed obvious structural damages of the liver lobes with formation of pseudolobules,and verteporfin treatment significantly improved these pathologies and lowered plasma ALT and AST levels of the mice.Transcriptome and proteomic sequencing and informatics analysis suggested that N-cadherin and Twist were differentially expressed in liver fibrosis in close correlation with YAP.Inhibition of YAP obviously downregulated hepatic N-cadherin and Twist protein expressions in the mice with liver fibrosis.In patients with CHB and liver cirrhosis,serum levels of YAP elevated obviously with the severity of liver fibrosis and were significantly correlated with N-cadherin,vimentin and Twist levels.In mice with liver fibrosis,inhibiting Twist effectively improved liver inflammation and fibrosis,while the combined treatment with YAP activator worsened hepatic collagen fiber deposition and increased hepatic YAP and α-SMA expressions.Conclusion EMT is an important pathogenic mechanism of liver fibrosis,and inhibiting YAP can alleviate liver fibrosis by reducing EMT.

Objective To explore the effect of glioma stem cells with high expression of protein tyrosin phosphatase receptor type Z1 (PTPRZ1 )on the phenotypic polarization and phagocytosis of tumor-associated macrophages and its regulatory mechanism.Methods GSCs and non-stem tumor cells (NSTCs) were screened out from human glioblastoma (GBM) specimens using flow cytometry,and the PTPRZ1 expression in paired GSCs and NSTCs were detected.Human peripheral blood mononuclear cells (PBMC)-derived CD14+monocytes were exposed to the conditioned medium from glioma cells or recombinant chemokine C-C motif ligand 20 (CCL20)for TAM polarization.Stable PTPRZ1 knockout GSCs (PTPRZ1-KO GSCs) were constructed using CRISPR/Cas9. TAM phagocytosis to GSCs,NSTCs,PTPRZ1-Control GSCs (PTPRZ1-Ctrl GSCs)and PTPRZ1-KO GSCs and the expression of immunosuppressive phenotype (M2) polarization marker CD163 were examined using flow cytometry.Differentially expressed genes (DEGs ) between paired GSCs and NSTCs were determined using a bulk RNA-sequencing dataset (GSE54791 )from Gene Expression Omnibus (GEO).A gene set informing worse outcome of patients with GBM was generated using The Cancer Genome Atlas (TCGA)-GBM cohort.By intersecting the aforementioned gene set with the gene set that encodes for human membrance proteins,the PTPRZ1 gene is obtained.Gene set enrichment analysis (GSEA)was used for pathway enrichment analysis to compare the differentially regulated pathways between GBMs with high or low PTPRZ1 expression.Bulk RNA sequencing,qRT-PCR and Western blotting were used to identify the DEGs between PTPRZ1-KO GSCs and PTPRZ1-Ctrl GSCs.Results GSCs were more capable of escaping from TAM phagocytosis than NSTCs (P<0.05 )and had specifically up-regulated PTPRZ1 expression.PTPRZ1-KO significantly suppressed GSCs escaping from TAM phagocytosis (P<0.01 ). GBMs with high PTPRZ1 expression showed significant inhibition of pathways mediating phagocytosis (P<0.05).The expression of CCL20 as a M2 TAM polarization chemokine was significantly down-regulated in PTPRZ1-KO GSCs (P<0.05 ).Treatment with recombinant CCL20 up-regulated the expression of CD163 as a M2 TAM marker in TAM.Conclusion PTPRZ1+GSCs mediate M2 TAM polarization and inhibit TAM phagocytosis,which may be related to the up-regulation of CCL20 in PTPRZ1+GSCs.