AIM:Uterine leiomyoma is the most prevalent benign tumor among women of reproductive age.This study aims to investigate the involvement of vascular endothelial growth factor A(VEGFA)in the progression of uterine leiomyoma through the cell division cycle protein 42(Cdc42)/Wnt/β-catenin signaling pathway.METHODS:Clinical data and tissue samples were collected from 36 patients who underwent either laparoscopic or open hysteromyomectomy at the Gynecology Department of Chizhou People's Hospital between January 2022 and December 2023.Immunohistochemi-cal staining was utilized to assess the expression of VEGFA and Cdc42.Cell viability was evaluated using the CCK-8 as-say,while cell proliferation was measured by EdU staining and flow cytometry.The expression levels of VEGFA,Cdc42,β-catenin,and their downstream targets,cyclin D1 and c-Myc,were analyzed via Western blot.RESULTS:Immunohis-tochemical and Western blot analyses revealed significantly higher levels of VEGFA and Cdc42 in leiomyoma tissues com-pared with normal uterine smooth muscle tissues.Further subgroup analysis via Western blot indicated that the expression levels of VEGFA and Cdc42 were elevated in intermuscular fibroids compared with submucosal and subserous fibroids.The CCK-8 assay demonstrated that VEGF receptor inhibitor axitinib effectively reduced the viability of uterine leiomyoma cells.Moreover,the proliferation capacity of uterine leiomyoma cells was significantly greater than that of normal uterine smooth muscle cells,and axitinib substantially inhibited this proliferation.Western blot results further confirmed signifi-cant increases in the expression of VEGFA,Cdc42,β-catenin,and their downstream proteins,cyclin D1 and c-Myc,in uterine leiomyoma cells.Axitinib was shown to inhibit the expression levels of Cdc42,β-catenin,and their downstream targets,cyclin D1 and c-Myc.The Cdc42 inhibitor ML141 did not affect VEGFA expression,but effectively inhibited the expression of β-catenin and its downstream target proteins,cyclin D1 and c-Myc.CONCLUSION:The VEGFA may play a significant role in the progression of uterine leiomyoma via the Cdc42/Wnt/β-catenin signaling pathway,suggesting that VEGFA could serve as a potential therapeutic target for the treatment of uterine leiomyoma.

AIM:Uterine leiomyoma is the most prevalent benign tumor among women of reproductive age.This study aims to investigate the involvement of vascular endothelial growth factor A(VEGFA)in the progression of uterine leiomyoma through the cell division cycle protein 42(Cdc42)/Wnt/β-catenin signaling pathway.METHODS:Clinical data and tissue samples were collected from 36 patients who underwent either laparoscopic or open hysteromyomectomy at the Gynecology Department of Chizhou People's Hospital between January 2022 and December 2023.Immunohistochemi-cal staining was utilized to assess the expression of VEGFA and Cdc42.Cell viability was evaluated using the CCK-8 as-say,while cell proliferation was measured by EdU staining and flow cytometry.The expression levels of VEGFA,Cdc42,β-catenin,and their downstream targets,cyclin D1 and c-Myc,were analyzed via Western blot.RESULTS:Immunohis-tochemical and Western blot analyses revealed significantly higher levels of VEGFA and Cdc42 in leiomyoma tissues com-pared with normal uterine smooth muscle tissues.Further subgroup analysis via Western blot indicated that the expression levels of VEGFA and Cdc42 were elevated in intermuscular fibroids compared with submucosal and subserous fibroids.The CCK-8 assay demonstrated that VEGF receptor inhibitor axitinib effectively reduced the viability of uterine leiomyoma cells.Moreover,the proliferation capacity of uterine leiomyoma cells was significantly greater than that of normal uterine smooth muscle cells,and axitinib substantially inhibited this proliferation.Western blot results further confirmed signifi-cant increases in the expression of VEGFA,Cdc42,β-catenin,and their downstream proteins,cyclin D1 and c-Myc,in uterine leiomyoma cells.Axitinib was shown to inhibit the expression levels of Cdc42,β-catenin,and their downstream targets,cyclin D1 and c-Myc.The Cdc42 inhibitor ML141 did not affect VEGFA expression,but effectively inhibited the expression of β-catenin and its downstream target proteins,cyclin D1 and c-Myc.CONCLUSION:The VEGFA may play a significant role in the progression of uterine leiomyoma via the Cdc42/Wnt/β-catenin signaling pathway,suggesting that VEGFA could serve as a potential therapeutic target for the treatment of uterine leiomyoma.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To summarize the clinical manifestations of four patients with 46, XY disorders of sex development(46, XY DSD)due to doublesex and mab-3 related transcription factor 1(DMRT1)gene variant/haploinsufficiency, and to improve the understanding of clinicians for this disease.Methods:The medical history, physical examination, endocrine function assessment, gonadal pathology, and genetic data of 4 patients with 46, XY DSD were retrospectively collected.Results:A heterozygous new missense mutation in DMRT1 was found in one child. The chief complain was primary amenorrhoea at the age of 15 years, with the external masculinisation score(EMS)0. The DMRT1 haploinsufficiency was found in 3 cases, 1.2 Mb, 5.1 Mb, and 6.0 Mb fragments were deleted at the 9p, and one of 3 cases had 33.3 Mb repeats in the 5p. All patients visited doctor under 1 year. Two patients were raised as females, and one was raised as male. All chief complains were external genital abnormalities, EMS of them were 1, 0, and 5 respectively. Endocrine evaluation of 2 out of 4 children showed varying degrees of primary hypogonadism, and presented with complete gonadal dysgenesis. One patient showed a well function of Leydig cells and poorly function of Sertoil cells, and presented with mixed gonadal dysgenesis. One of 3 cases was diagnosed with gonadoblastoma at the age of 18 months. Patient No.4 didn′t agree with the gonadal biopsy. The chromosome karyotypes of 4 children were 46, XY.Conclusions:The visiting ages of 46, XY DSD patients caused by DMRT1 variation were older than those of patients caused by DMRT1 haploinsufficiency. The clinical manifestations are complex, and gonadal function can vary from normal to complete gonadal dysgenesis. Such patients are at high risk of gonadoblastoma and young onset. Gonadal biopsy should be performed as early as possible.

Objective To investigate perfusion imaging and parameters of normal pancreas by dual-source CT and to evaluate the appropriate perfusion imaging scan.Methods Sixty-six subjects with normal pancreas underwent low-dose pancreatic perfusion and plain scan.CT images were sent to a separate workstation via a network.The blood flow (BF)and blood volume (BV)of pancreas head,body and tail were measured using the VPCT Body software and analyzed by one-way ANOVA.Then the time-density curve of pancreas was drawn,and the enhancement peak time and the corresponding CT value were also measured.Results The average BF values of pancreas head,body and tail were (1 1 6.09 ± 31.83)mL·100 g-1 ·min-1 ,(1 1 9.72±32.50)mL·100 g-1 ·min-1 , (1 14.65±31.42)mL·100 g-1 ·min-1 ,and the mean BV values were (29.83 ±1 9.07)mL/100 g,(30.39 ± 1 9.38)mL/100 g, (28.82±1 9.22)mL/100 g,respectively.The perfusion parameters in different pancreatic parts were not statistically different.The mean enhancement peak time was (27.92 s±4.52)s,(28.02±5.34)s in pancreas head,(27.40±4.36)s in pancreas body,(27.34±4.57)s in pancreas tail.On plain image,the average CT value of pancreas was (41.43±5.88)HU.However,on enhanced image,the mean CT value was (95.96±18.44)HU in normal pancreas [(96.73±19.71)HU in pancreas head,(98.45±17.52)HU in body,(92.69±18.1 7)HU in tail].Conclusion The perfusion parameters including blood flow and blood volume in pancreatic head,body and tail are identical. The mean enhancement peak time is (27.92±4.52)s,and the corresponding enhancement CT value is (95.96±18.44)HU.