Objective: To investigate the efficacy, nursing characteristics, and management of different desensitization strategies before allogeneic hematopoietic stem cell transplantation (allo-HSCT) among patients with high level of human leukocyte antigen (HLA) antibodies. Methods: A retrospective analysis was conducted on 82 patients with high levels of HLA antibodies who underwent allo-HSCT at the First Affiliated Hospital of Soochow University and Suzhou Hopes Hematonosis Hospital between January 2020 to November 2023. Patients were divided into two groups based on the desensitization strategy they received: the anti-CD20 monoclonal antibody combined with therapeutic plasma exchange (TPE) group (n=50) and the anti-CD20 monoclonal antibody combined with Protein A immunoabsorption group (n=32). The differences of efficacy between the desensitization strategies were analyzed. The safety of both desensitization strategies were assessed by close monitoring of adverse events throughout the treatment. The nursing characteristics and interventions specific to these strategies were comprehensively summarized. Results: There were no significant differences in age, gender, and diagnosis between the two groups of patients receiving different desensitization strategies (P>0.05). Following desensitization in the immunoadsorption group, the mean fluorescence intensity (MFI) levels of anti-HLA Class I antibody decreased significantly compared to initial screening (P=0.048), while the decrease in MFI values of anti-HLA Class II antibody was not statistically significant (P=0.173). In the TPE group, the MFI levels for both anti-HLA Class I and II antibodies after desensitization decreased significantly compared to initial screening (P=0.025 and 0.028, respectively). Monitoring of adverse events during desensitization treatment, found that patients in the immunoadsorption group experienced mild decreases in blood pressure during the process, with two patients developing severe hypotension. No allergic reactions occurred, and no damage of liver or kidney function was observed after the immunoadsorption. In the immunoadsorption group, a total of 19 patients underwent sera immunoglobulin assays before and after immunoadsorption. Compared to the initial screening, the immunoglobulin G (IgG) levels significantly decreased after immunoadsorption (P<0.001). In TPE group, 12 patients experienced mild hypotension during the plasma exchange process, but no severe hypotension was observed. One patient developed an allergic reaction. After the TPE treatment, no damage of liver or kidney function was observed, nor any decrease of IgG levels. In terms of safety of intravenous access, neither group experienced severe complications such as catheter-related bloodstream infections or deep vein thrombosis. In the TPE group, catheter occlusion occurred during the process of plasma exchange in 2 patients, while no such incident was observed in the immunoadsorption group. Patients of both groups exhibited anxiety and depression before treatment. After psychological care, the scores for anxiety and depression significantly decreased (P<0.001). Conclusion: Both desensitization strategies significantly decreased the HLA antibodies in highly sensitized patients with high level of HLA antibodies undergoing allo-HSCT. For patients receiving immunoabsorption, nursing care should focus on preventing and managing hypotension and implementing infection-prevention measures due to IgG depletion. In contrast, for those undergoing TPE, vigilant monitoring and prompt management of potential allergic reactions are essential components of nursing practice.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Colorectal cancer is one of the most common malignant tumors of the digestive system in clinical practice.The early detection of colorectal cancer based on artificial intelligence and its further assistance in clinical diagnosis and treatment hold significant clinical importance for achieving long-term benefits for patients.The development and validation of artificial intelligence software rely on high-quality,large-volume,and annotated colorectal cancer imaging datasets.This paper aims to provide a reference for constructing a high-quality colorectal cancer CT database,taking the construction of the database as an example.It discusses the complete process of database establishment,including database description,lesion annotation and storage,database quality evaluation and maintenance.The purpose is to ensure the high quality and exploitability of the source materials in the database,promote the sustainable and healthy development of the medical imaging artificial intelligence industry ecosystem,and accelerate the research,development,and application of industries related to artificial intelligence in colorectal cancer CT imaging.

Colorectal cancer is one of the most common malignant tumors of the digestive system in clinical practice.The early detection of colorectal cancer based on artificial intelligence and its further assistance in clinical diagnosis and treatment hold significant clinical importance for achieving long-term benefits for patients.The development and validation of artificial intelligence software rely on high-quality,large-volume,and annotated colorectal cancer imaging datasets.This paper aims to provide a reference for constructing a high-quality colorectal cancer CT database,taking the construction of the database as an example.It discusses the complete process of database establishment,including database description,lesion annotation and storage,database quality evaluation and maintenance.The purpose is to ensure the high quality and exploitability of the source materials in the database,promote the sustainable and healthy development of the medical imaging artificial intelligence industry ecosystem,and accelerate the research,development,and application of industries related to artificial intelligence in colorectal cancer CT imaging.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Objective:To investigate the efficacy and safety of protein A immunoadsorption (PAIA) combined with rituximab (RTX) in highly sensitized patients who underwent haplo-hematopoietic stem cell transplantation (haplo-HSCT) .Methods:The clinical data of 56 highly sensitized patients treated with PAIA and RTX before haplo-HSCT at the First Affiliated Hospital of Soochow University and Soochow Hopes Hematonosis Hospital between March 2021 and June 2023 were retrospectively analyzed. The number of human leukocyte antigen (HLA) antibody types and the mean fluorescence intensity (MFI), humoral immunity, adverse reactions during adsorption, and survival within 100 days before and after adsorption were measured.Results:After receiving the PAIA treatment, the median MFI of patients containing only HLA Ⅰ antibodies decreased from 7 859 (3 209-12 444) to 3 719 (0-8 275) ( P<0.001), and the median MFI of HLA Ⅰ+Ⅱ antibodies decreased from 5 476 (1 977-12 382) to 3 714 (0-11 074) ( P=0.035). The median MFI of patients with positive anti-donor-specific antibodies decreased from 8 779 (2 697-18 659) to 4 524 (0–15 989) ( P<0.001). The number of HLA-A, B, C, DR, and DQ antibodies in all patients decreased after the PAIA treatment, and the differences were statistically significant (A, B, C, DR: P<0.001, DQ: P<0.01). The humoral immune monitoring before and after the PAIA treatment showed a significant decrease in the number of IgG and complement C3 ( P<0.001 and P=0.002, respectively). Forty-four patients underwent HLA antibody monitoring after transplantation, and the overall MFI and number of antibody types decreased. However, five patients developed new antibodies with low MFI, and nine patients continued to have high MFI. The overall survival, disease-free survival, non-recurrent mortality, and cumulative recurrence rates at 100 days post-transplantation were 83.8%, 80.2%, 16.1%, and 4.5%, respectively. Conclusions:The combination of PAIA and RTX has a certain therapeutic effect and good safety in the desensitization treatment of highly sensitive patients before haplo-HSCT.

Objective To identify the potential differently expressed genes and microRNAs(mi-RNAs)in sepsis survivors and non-survivors through bioinformatics-based research based on gene expression omnibus(GEO).Methods Two gene expression profile microarray datasets of human blood samples(GSE48080 and GSE54514)were downloaded from the GEO database.The differential expression genes(DEGs)between sepsis survivors and non-survivors at two time points(diagnosis of sepsis,course of sep-sis)were screened with the GEO2R online tool.The gene ontology(GO)and Kyoto encyclopedia of genes and genomes(KEGG)pathway enrichment analysis were used to study the pathophysiological processes and potential signaling pathways involved in sepsis related death DEGs.STRING online tool was used to construct the DEGs protein-protein interaction(PPI).Cytoscape with CytoHubba was used to investigate the potential hub genes.NetworkAnalyst was used to construct targeted miRNAs of the hub genes.Real-time quantitative PCR(RT-qPCR)was established to evaluate the expression of potential hub genes in our sepsis survivors and non-survivors.Results During the course of sepsis,there was heterogeneity in gene expre-ssion between sepsis survivors and non-survivors.Fifteen DEGs were found to be remarkably differentially expressed between sepsis survivors and non-survivors during the course of sepsis.Four KEGG pathways,in-cluding staphylococcus aureus infection,NOD-like receptor signaling pathway,sulfur metabolism and col-lecting duct acid secretion,were significantly enriched.In combination with the results of the PPI network and CytoHubba,ten hub genes(SLC4A1,EPB42,LTF,LCN2,DEFA4,HBM,HBG1,GMPR,CAMP,OLFM4)were selected as potential biomarkers for sepsis-associated mortality.With NetworkAnalyst analysis,ten miRNAs were predicted as potential key miRNAs.RT-qPCR confirmed that the expressions of five of these genes(SLC4A1,EPB42,LCN2,DEFA4,OLFM4)were in accordance with the microarray results.Conclusion Bioinformatics analysis based on GEO database showed DEGs between sepsis suvivors and non-survivors in the course of sepsis,which contributed to identification of potential biomarkers and risk factors for sepsis-associated mortality.

Objective:To conduct scoping review on relevant studies on the application of telehealth in the disease prevention of pre-diabetic patients, in order to identify the main forms, content elements and application effects of telehealth and provide evidence for medical workers to carry out relevant intervention.Methods:Relevant studies were systematically searched in PubMed, Web of Science, Embase, Cochrane Library, National Knowledge Infrastructure, VIP, Wanfang database and China Biology Medicine disc. The search time was from the establishment of the databases to December 6, 2023. The included studies were summarized and analyzed.Results:A total of 33 literatures were included. The results showed that the main forms of telehealth included network communication software, applications, portable electronic devices, website platforms and artificial intelligence. The contents of telehealth mainly involved health education, data monitoring, peer support, personalized programs and psychological guidance. The outcome indexes of telehealth were physiological indexes, disease management indexes, exercise indexes, diet indexes, experience indexes and psychological indexes.Conclusions:Network communication software and application programs are the main forms of telehealth for pre-diabetic patients and multi-element and all-round telehealth services can enhance the application experience of patients. The effect of telehealth has initially appeared, but it needs to be verified for a long time.

Objective:To improve the aqueous solubility, biocompatibility, fluorescence, and sonosensitivity of curcumin, this study aims to transform curcumin into curcumin-derived carbon dots (Cur-CDs) to enhance the efficacy of sonodynamic therapy (SDT) of atherosclerosis (AS).Methods:Cur-CDs were synthesized via a hydrothermal method. The morphology was characterized by transmission electron microscopy, while Fourier transform infrared spectroscopy and X-ray photoelectron spectroscopy were applied to analyze the chemical composition and surface functional groups. Optical properties were examined by UV-visible spectrophotometry and fluorescence spectroscopy. Cell proliferation and viability assay and a hemolysis experiment were performed to assess biocompatibility. The sonosensitivity of Cur-CDs was determined by the measurement of reactive oxygen species (ROS) produced by Cur-CDs.To verify the effect of Cur-CDs-mediated SDT on macrophage phenotype, the M1 and M2 macrophage marker genes were detected via real-time fluorescence quantitative polymerase chain reaction. The ability of Cur-CDs in plaque detection was assessed through in vivo fluorescence imaging and ex vivo aortic fluorescence imaging. Atherosclerotic plaque mice were divided into five groups: control group, curcumin group, Cur-CDs group, curcumin + low-intensity pulsed ultrasound (LIPUS) group, and Cur-CDs+ LPIUS group. Aortic Oil red O staining and blood lipid level measurements were conducted to evaluate the therapeutic efficacy of SDT on the plaques.Results:Cur-CDs exhibited a spherical morphology and a distinct lattice structure with the diameter of (1.87±0.35)nm. The aqueous solubility of Cur-CDs was about 10 5 times that of curcumin because of their abundant oxygen-containing hydrophilic functional groups.Cur-CDs at concentrations up to 500 mg/L had no significant impact on cell proliferation and viability, with a negligible hemolysis rate of <1%, indicating good biocompatibility of Cur-CDs. Cur-CDs exhibited a stable and excellent fluorescence with the maximum excitation and emission wavelengths of 420 nm and 530 nm, respectively. Cur-CDs had the potential to be used for plaque fluorescence imaging, with the fluorescence intensity at the plaque being significantly greater than that of curcumin( P<0.01). It was observed that Cur-CDs activated by LIPUS were capable of producing ROS, including 1O 2, ·OH, and ·O 2-, with the total amount of ROS exceeding that of curcumin( P<0.05). Cur-CDs-mediated SDT facilitated the transformation of macrophage phenotype from M1 to M2, with a more pronounced effect than that observed with curcumin-mediated SDT. Oil red O staining revealed the most significant reduction in plaque area and lipid content in the Cur-CDs+ LIPUS group, which was about three times greater than that in the curcumin+ LIPUS group, confirming the excellent efficacy of Cur-CDs-mediated SDT on plaques. Conclusions:The successfully prepared Cur-CDs exhibit superior aqueous solubility, biocompatibility, fluorescence, and sonosensitivity than curcumin, contributing to the significant improvement in sonodynamic efficacy on plaques.

Objective:To explore the value of difference value and relative value of pulmonary vascular quantitative parameters of biphasic CT in diagnosis of chronic obstructive pulmonary disease (COPD) and high-risk groups.Methods:The study was a cross-sectional study. A retrospective study of 624 patients who underwent biphasic chest CT scanning in the Second Affiliated Hospital of PLA Naval Medical University from August 2018 to December 2020. Subjects were divided into three groups according to pulmonary function test: normal group ( n=321), preserved ratio impaired spirometry (PRISm) ( n=204) and COPD group ( n=99). The pulmonary vascular quantitative parameters were obtained by the workstation, including the number of pulmonary vessels (N total), cross-sectional area less than that of 5 mm 2 (N CSA5), vessel area (VA total) of 9, 12, 15, 18, 21 mm from the pleura, total blood vessels volume (TBV) and total blood vessels volume under 5 mm 2 (BV5) at expiratory and inspiratory phase. The difference value, relative value of biphasic CT were calculated. ANOVA test or Kruskal-Wallis H test was used to compare the differences of pulmonary vascular quantitative parameters among the three groups, and LSD or Bonferroni tests were used for multiple comparisons. Results:The N total, N CSA5, VA total of the whole lung in the inspiratory phase at the level of 9, 12, 15, 18 and 21 mm from the pleura and TBV, BV5 in the normal group, PRISm group and COPD group, showed an overall trend of decreasing and then increasing, and the PRISm group was lower than those of the normal group ( P<0.05). The differences in N total, N CSA5, VA total between the COPD group and the normal group at the level of 9 and 21 mm from the pleura were not statistically significant ( P>0.05), while the N total, N CSA5, V Atotal of biphasic difference value and relative value in COPD group demonstrated a significant difference from those in normal group ( P<0.05). Conclusion:The difference value and relative value of pulmonary vascular quantitative parameters in biphasic CT are more useful than single inspiratory-phase vascular parameters to differentiate the changes in pulmonary vascular remodeling between COPD patients and the normal population, and also to complement the pulmonary vascular characteristics of the PRISm population, which can provide a basis for early warning of COPD and high-risk populations.