Objective:To evaluate the efficacy of eculizumab in treating hematopoietic stem cell transplantation-associated thrombotic microangiopathy (TA-TMA) .Methods:This retrospective study included 11 patients who developed TA-TMA after allogeneic hematopoietic stem cell transplantation and subsequently received eculizumab treatment at Peking University People′s Hospital between June 2018 and May 2024. The incidence of TA-TMA, treatment details, and clinical outcomes were analyzed.Results:Among the 11 included patients [4 males, 7 females; median age: 29 years (range: 9-56) ], underlying diseases were severe aplastic anemia (SAA) in 5 patients, acute lymphoblastic leukemia (ALL) in 3 patients, and acute myeloid leukemia (AML) in 3 patients. The median time to TA-TMA diagnosis was 48 days post-transplantation (range: 4-213 days), and all patients met the diagnostic criteria for high-risk TA-TMA. The median interval from TA-TMA diagnosis to the initiation of eculizumab treatment was 12 days (range: 1-56 days). Patients received a median of 3 doses of eculizumab (range: 1-14). Ten of the 11 patients were assessed as having no response (NR) to eculizumab at the end of treatment or at death. One patient achieved a partial response (PR) but subsequently died after TA-TMA relapsed due to infection. At the last follow-up, all patients were either lost to follow-up or had died. The median follow-up duration was 88 days (range: 33-326 days), and the median time from TA-TMA diagnosis to the last follow-up was 31 days (range: 21-113 days) .Conclusion:Eculizumab demonstrated poor efficacy in this TA-TMA cohort. This might be attributable to the critical and complex condition of the patients, delayed initiation of eculizumab treatment, and insufficient dosage.

Objective:To evaluate the diagnostic value of targeted next-generation sequencing (tNGS) of throat swab samples for detecting community-acquired respiratory viruses (CARV) in patients with hematological diseases.Methods:Clinical and laboratory data from 64 episodes involving patients with hematological diseases and suspected infections—who underwent both pharyngeal swab tNGS and CARV polymerase chain reaction (PCR) testing concurrently—were retrospectively analyzed. The cases were drawn from the Department of Hematology, Peking University People’s Hospital, between September 2023 and April 2024. Concordance between tNGS and CARV PCR results, as well as the diagnostic performance of tNGS in detecting CARV, were evaluated.Results:Among the 64 episodes, 29 were clinically diagnosed with respiratory tract infections, including one case of cytomegalovirus pneumonia and 28 CARV-positive cases. The remaining 35 episodes involved patients with fever or respiratory symptoms attributed to other causes, including 14 with extrapulmonary infections and 21 with noninfectious etiologies. The median follow-up duration was 215.5 days (range: 7-271 days). PCR detected 24 strains of seven CARV types, whereas tNGS detected 25 strains of eight CARV types. Using PCR results as the reference standard, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of tNGS were 85.0%, 88.6%, 77.3%, 92.9%, and 87.5%, respectively. The two methods showed good concordance (Kappa=0.717, P<0.001) . Conclusion:Pharyngeal swab tNGS may serve as a viable alternative to PCR for diagnosing CARV infections in patients with hematological diseases.

Chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH) are both chronic progressive respiratory diseases that cannot be completely cured. COPD is characterized by irreversible airflow limitation, chronic airway inflammation, and gradual decline in lung function, whereas PH is characterized by pulmonary vasoconstriction, remodeling, and infiltration of inflammatory cells. These diseases have similar pathological features, such as vascular hyperplasia, arteriolar contraction, and inflammatory infiltration. Despite these well-documented observations, the exact mechanisms underlying the occurrence and development of COPD and PH remain unclear. Evidence that mitochondrial dynamics imbalance is one major factor in the development of COPD and PH. Mitochondrial dynamics is precisely regulated by mitochondrial fusion proteins and fission proteins. When mitochondrial dynamics equilibrium is disrupted, it causes mitochondrial and even cell morphological dysfunction. Mitochondrial dynamics participates in various pathological processes for heart and lung disease. Mitochondrial dynamics may be different in the early and late stages of COPD and PH. In the early stages of the disease, mitochondrial fusion increases, inhibiting fission, and thereby compensatorily increasing adenosine triphosphate (ATP) production. With the development of the disease, mitochondria decompensation causes excessive fission. Mitochondrial dynamics is involved in the development of COPD and PH in a spatiotemporal manner. Based on this understanding, treatment strategies for mitochondrial dynamics abnormalities may be different at different stages of COPD and PH disease. This article will provide new ideas for the potential treatment of related diseases.
Humans ; Mitochondrial Dynamics/physiology* ; Pulmonary Disease, Chronic Obstructive/metabolism* ; Hypertension, Pulmonary/metabolism* ; Mitochondria/metabolism* ; Animals

Objective:This study evaluated the efficacy of the PST technique: Preservation of the left colic artery (P), suture reinforcement (S), and transanal tube (T) combined with selective fecal diversion via end ileostomy, in preventing anastomotic leakage following laparoscopic anterior resection (LAR) for mid-to-low rectal cancer.Methods:We retrospectively collected data for this descriptive case series from patients who underwent laparoscopic LAR with complete or partial application of the PST technique, some of whom received prophylactic ileostomy, at the Department of Colorectal Surgery, Zhongshan Hospital Affiliated to Fudan University, and its Xiamen Branch between July, 2022 and December, 2024. "Partial PST" was defined as the implementation of PS (Preservation of the left colic artery + suture reinforcement), PT (Preservation of the left colic artery + transanal tube), ST (suture reinforcement + transanal tube), or a single T procedure (Transanal tube). The primary outcome measures were the proportion of patients who received the PST technique and terminal ileostomy, as well as the incidence of anastomotic leaks.Results:Among 198 patients, 145 received complete PST. Fifty-three patients underwent partial PST (PT) because anastomotic reinforcement was not feasible due to an excessively low anastomosis or obesity. All patients achieved R0 resection. Postoperative pathology showed that 108 patients (54.5%) were at T3-T4 stage, and 81 patients (40.9%) had poorly differentiated adenocarcinoma or mucinous adenocarcinoma. A total of 19.7% (39/198) of patients developed grade II or higher postoperative complications, including 11 cases (5.6%) of surgical site infection and 7 cases (3.5%) of urinary retention. Five patients were rehospitalized within 30 days after surgery, among whom 2 had intestinal obstruction, and 3 developed grade C anastomotic leaks that required reoperation for salvage enterostomy. The overall incidence of anastomotic leakage was 3.0% (6/198). Fifty-three patients (26.8%) received protective ileostomy, with an anastomotic leak incidence of 1.9% (1/53). Methylene blue leakage occurred in 20 patients (10.1%), all of whom received prophylactic ileostomy and had no anastomotic leakage postoperatively. Among 61 patients who received neoadjuvant chemoradiotherapy before surgery, 28 underwent prophylactic ileostomy, and none developed anastomotic leaks after surgery.Conclusions:Routine application of the PST technique during laparoscopic low anterior resection, along with prophylactic enterostomy for ultra-high-risk populations, can effectively control the incidence of anastomotic leakage.

Objective:This study evaluated the efficacy of the PST technique: Preservation of the left colic artery (P), suture reinforcement (S), and transanal tube (T) combined with selective fecal diversion via end ileostomy, in preventing anastomotic leakage following laparoscopic anterior resection (LAR) for mid-to-low rectal cancer.Methods:We retrospectively collected data for this descriptive case series from patients who underwent laparoscopic LAR with complete or partial application of the PST technique, some of whom received prophylactic ileostomy, at the Department of Colorectal Surgery, Zhongshan Hospital Affiliated to Fudan University, and its Xiamen Branch between July, 2022 and December, 2024. "Partial PST" was defined as the implementation of PS (Preservation of the left colic artery + suture reinforcement), PT (Preservation of the left colic artery + transanal tube), ST (suture reinforcement + transanal tube), or a single T procedure (Transanal tube). The primary outcome measures were the proportion of patients who received the PST technique and terminal ileostomy, as well as the incidence of anastomotic leaks.Results:Among 198 patients, 145 received complete PST. Fifty-three patients underwent partial PST (PT) because anastomotic reinforcement was not feasible due to an excessively low anastomosis or obesity. All patients achieved R0 resection. Postoperative pathology showed that 108 patients (54.5%) were at T3-T4 stage, and 81 patients (40.9%) had poorly differentiated adenocarcinoma or mucinous adenocarcinoma. A total of 19.7% (39/198) of patients developed grade II or higher postoperative complications, including 11 cases (5.6%) of surgical site infection and 7 cases (3.5%) of urinary retention. Five patients were rehospitalized within 30 days after surgery, among whom 2 had intestinal obstruction, and 3 developed grade C anastomotic leaks that required reoperation for salvage enterostomy. The overall incidence of anastomotic leakage was 3.0% (6/198). Fifty-three patients (26.8%) received protective ileostomy, with an anastomotic leak incidence of 1.9% (1/53). Methylene blue leakage occurred in 20 patients (10.1%), all of whom received prophylactic ileostomy and had no anastomotic leakage postoperatively. Among 61 patients who received neoadjuvant chemoradiotherapy before surgery, 28 underwent prophylactic ileostomy, and none developed anastomotic leaks after surgery.Conclusions:Routine application of the PST technique during laparoscopic low anterior resection, along with prophylactic enterostomy for ultra-high-risk populations, can effectively control the incidence of anastomotic leakage.

Objective:To evaluate the efficacy of eculizumab in treating hematopoietic stem cell transplantation-associated thrombotic microangiopathy (TA-TMA) .Methods:This retrospective study included 11 patients who developed TA-TMA after allogeneic hematopoietic stem cell transplantation and subsequently received eculizumab treatment at Peking University People′s Hospital between June 2018 and May 2024. The incidence of TA-TMA, treatment details, and clinical outcomes were analyzed.Results:Among the 11 included patients [4 males, 7 females; median age: 29 years (range: 9-56) ], underlying diseases were severe aplastic anemia (SAA) in 5 patients, acute lymphoblastic leukemia (ALL) in 3 patients, and acute myeloid leukemia (AML) in 3 patients. The median time to TA-TMA diagnosis was 48 days post-transplantation (range: 4-213 days), and all patients met the diagnostic criteria for high-risk TA-TMA. The median interval from TA-TMA diagnosis to the initiation of eculizumab treatment was 12 days (range: 1-56 days). Patients received a median of 3 doses of eculizumab (range: 1-14). Ten of the 11 patients were assessed as having no response (NR) to eculizumab at the end of treatment or at death. One patient achieved a partial response (PR) but subsequently died after TA-TMA relapsed due to infection. At the last follow-up, all patients were either lost to follow-up or had died. The median follow-up duration was 88 days (range: 33-326 days), and the median time from TA-TMA diagnosis to the last follow-up was 31 days (range: 21-113 days) .Conclusion:Eculizumab demonstrated poor efficacy in this TA-TMA cohort. This might be attributable to the critical and complex condition of the patients, delayed initiation of eculizumab treatment, and insufficient dosage.

Objective:To evaluate the diagnostic value of targeted next-generation sequencing (tNGS) of throat swab samples for detecting community-acquired respiratory viruses (CARV) in patients with hematological diseases.Methods:Clinical and laboratory data from 64 episodes involving patients with hematological diseases and suspected infections—who underwent both pharyngeal swab tNGS and CARV polymerase chain reaction (PCR) testing concurrently—were retrospectively analyzed. The cases were drawn from the Department of Hematology, Peking University People’s Hospital, between September 2023 and April 2024. Concordance between tNGS and CARV PCR results, as well as the diagnostic performance of tNGS in detecting CARV, were evaluated.Results:Among the 64 episodes, 29 were clinically diagnosed with respiratory tract infections, including one case of cytomegalovirus pneumonia and 28 CARV-positive cases. The remaining 35 episodes involved patients with fever or respiratory symptoms attributed to other causes, including 14 with extrapulmonary infections and 21 with noninfectious etiologies. The median follow-up duration was 215.5 days (range: 7-271 days). PCR detected 24 strains of seven CARV types, whereas tNGS detected 25 strains of eight CARV types. Using PCR results as the reference standard, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of tNGS were 85.0%, 88.6%, 77.3%, 92.9%, and 87.5%, respectively. The two methods showed good concordance (Kappa=0.717, P<0.001) . Conclusion:Pharyngeal swab tNGS may serve as a viable alternative to PCR for diagnosing CARV infections in patients with hematological diseases.

Objective:To investigate the efficacy of lightroom therapy on depressive mood and sleep problems in patients with depression, and the potential effects on physiological indices related to circadian rhythms.Methods:From October 2021 to July 2023, 54 patients with acute-phase depression hospitalized in the Mental Health Center of the First Hospital of Hebei Medical University were recruited. The participants were randomly assigned to either medication combined with the bright light therapy group (bright light group, n=36) or medication combined with the dim light therapy group (dim light group, n=18). Both groups received light therapy for 2 weeks, at 10 000 lx in the bright light group and 300 lx in the dim light group. Both groups received 30 minutes of light therapy from 7:30-8:00 a.m daily over two weeks, followed up for 1 week post-treatment. The Hamilton Depression Rating Scale (HAMD 17) was used to assess patients′ depressive symptoms, and the Pittsburgh Sleep Quality Index (PSQI) was used to assess patients′ sleep quality at baseline, at the end of every week. The 32-Item Hypomania Checklist (HCL-32) was used at the end of week 2 to assess the risk of manic switching after treatment. Daily measurements of body temperature, heart rate, and blood pressure were taken before and after light therapy, along with recording adverse events related to the therapy. Paired t- tests were used to compare changes in physiological indicators before and after treatment, and repeated measures ANOVA was applied to compare clinical symptom changes between the two groups. Results:Thirty-one and fifteen patients completed this study in the bright light and dim light groups, respectively, with no statistically significant difference in dropout rates( P>0.05). There were significant interaction effects between the time and group for HAMD 17 and PSQI score( F=5.51,4.11, both P<0.05). Both groups showed significant reductions in HAMD 17 and PSQI scores at baseline, week 1, week 2, and week 3 ( P<0.001). In the bright light group, body temperature increased significantly post-treatment on days 1-4, day 7, and day 12 (all P<0.05). Heart rate elevated on day 5 ( P<0.05).Systolic blood pressure decreased on days 4, 5, 11, and 12 compared to the pre-treatment baseline(all P<0.05). In the dim light group, systolic blood pressure increased on day 11 ( P<0.05). Diastolic blood pressure in the bright light group decreased on days 1, 5, and 6( P<0.05). No serious adverse events, vision loss, ocular structural changes occurred in either group. No hypomania or mania episodes were observed. The incidence of adverse events did not differ significantly ( P>0.05). Conclusion:Medication combined with indoor bright light is more effective than the combination of dim light for depressive symptoms and sleep problems in patients with depression. Patients receiving bright light also may exhibit a higher body temperature, accelerated heart rate, and reduced blood pressure.

Objective:To explore the effects of childhood trauma on resting blood pressure, heart rate, and heart rate variability in patients with depression.Methods:A cross-sectional study was designed to prospectively collect clinical data on a total of 163 patients with depression, including 47 males and 116 females, aged 18-50 years,with mean[ M( Q1, Q3)] [29.0, (21.0, 37.0)]years, who were either the outpatients or the inpatients in the Mental Health Center of the First Hospital of Hebei Medical University from September 2022 to June 2024. The Childhood Trauma Questionnaire-Short form (CTQ-SF) was used to assess the experience of abuse and neglect during childhood. According to the CTQ-SF score, the subjects were divided into a trauma group ( n=80) and a non-trauma group ( n=83). The 17-item Hamilton Depression Scale (HAMD 17) and Hamilton Anxiety Scale (HAMA) were used to assess depressive and anxiety symptoms in the participants, respectively. A digital blood pressure monitor and an autonomic nervous system response detector were employed to measure resting blood pressure, heart rate, and heart rate variability (HRV). Spearman correlation analysis was used to examine the relationships between childhood trauma and resting blood pressure, heart rate, and HRV. Multiple linear regression analysis was performed to analyze factors influencing these parameters. The Bootstrap method was employed to test the potential mediating role of parasympathetic nervous system activity in the relationships between childhood trauma and resting blood pressure, and heart rate. Results:No significant difference was observed in resting heart rate between the trauma and non-trauma groups ( P>0.05). However, the trauma group exhibited higher resting systolic and diastolic blood pressure [(123.3±9.1) mmHg (1 mmHg=0.133 kPa) vs(116.9±10.8) mmHg, (80.0±8.6) mmHg vs (77.0±8.0) mmHg; Z=4.08, 2.24, all P<0.05]. HRV indices, including the standard deviation of normal to normal interval (SDNN), root mean square of successive differences (RMSSD), total power (TP), low frequency (LF), and high frequency (HF), were significantly lower in the trauma group [25.3 (19.4, 30.4) me vs 36.3 (27.4, 49.0) ms, 18.3 (12.9, 27.2) me vs 26.2 (19.0, 38.5) ms, 6.0(5.4, 6.5)ms 2vs 7.0(6.3, 7.4)ms 2,4.4(3.7,5.3)ms 2vs 5.8(4.9,6.3)ms 2, 4.2(3.4, 5.2)ms 2vs 5.2(4.6, 6.1)ms 2, respectively; all P<0.001]. Spearman correlation analysis showed that childhood trauma experiences in patients with depression were positively correlated with resting systolic blood pressure and diastolic blood pressure ( r=0.309, 0.236; P<0.01), childhood trauma was negatively correlated with HRV (SDNN, RMSSD, TP, LF, HF) ( r=-0.264, -0.274, -0.271, -0.235, -0.279; all P<0.01). Multiple linear regression analysis showed that childhood trauma was positively correlated with resting-state systolic blood pressure and resting-state diastolic blood pressure ( β=0.305, 0.291; all P<0.001). Childhood trauma was negatively correlated with RMSSD, TP, LF, and HF( β=-0.244, -0.249, -0.233, -0.263; all P<0.01). Mediation effect analysis showed that parasympathetic activity partially mediated the relationship between childhood trauma and resting systolic blood pressure (effect size 0.04, standard error 0.02, 95% CI=0.01-0.09), accounting for 14.29% (0.04/0.28) of the total effect. Conclusion:Childhood trauma experiences are associated with elevated resting blood pressure and reduced HRV in patients with depression. Decreased parasympathetic activity partially mediates the relationship between childhood trauma and elevated resting systolic blood pressure in these patients.

Objective:To explore the effects of the deep Theta burst stimulation (dTBS) applied to the bilateral dorsolateral prefrontal cortex on depressive symptoms and executive functions in patients with depression.Methods:The clinical data of a total of 98 patients with depression who were outpatients and inpatients in the Mental Health Center of the First Hospital of Hebei Medical University from June 2023 to October 2024 were prospectively collected, including 37 males and 61 females, aged 18-65 (37.4±13.3) years. Patients were randomly assigned to one of three groups: an active dTBS+drug therapy group (active stimulation group, n=33), a sham dTBS+drug therapy group (sham stimulation group, n=32), and a drug therapy group ( n=33). A shielding cover was added over the sham dTBS coil to increase the distance between the coil and the cortical surface, thereby achieving the sham stimulation effect. During each treatment, both active and sham dTBS were first applied by 1, 200 pulses of intermittent dTBS (diTBS) to the left dorsolateral prefrontal cortex, followed by 600 pulses of continuous dTBS (dcTBS) to the right dorsolateral prefrontal cortex. Before treatment and two weeks after treatment, the Hamilton Anxiety Scale (HAMA) and 17-Item Hamilton Depression Scale (HAMD 17) were used to evaluate patients′ depression and anxiety, and the Symbol Digit Coding Test of the Chinese Brief Cognitive Test (C-BCT) was used to assess the executive functions. The 32-item Hypomania Checklist (HCL-32) as well as the Mood Disorder Questionnaire (MDQ) were used to evaluate the risk of treatment-emergent mania. The primary outcomes included reduction rate in HAMD 17 and HAMA scores, as well as changes in the Symbol Digit Coding Test of the C-BCT. Secondary outcomes encompassed HAMD 17 treatment response rate, adverse events, and the risk of treatment-emergent mania. The differences in efficacy between the three groups were compared using one-way ANOVA and LSD post-hoc analysis (reduction rate in HAMD 17 scores, reduction rate in HAMA scores, and changes in the Symbol Digit Coding Test of the C-BCT). Results:At the end of the 2nd week of the treatment, the HAMD 17 reduction rate in the active stimulation group was higher than the sham stimulation group and the drug therapy group, with a significant difference (59.4 (46.9, 80.2) % vs 47.6 (31.2, 58.3) %, H=18.95, P=0.006; 59.4 (46.9, 80.2) % vs 35.5 (20.0, 50.0) %, H=31.10, P<0.001). The HAMA reduction rate in the active stimulation group and the sham stimulation group were higher than the drug therapy group, with a significant difference (52.6 (43.5, 65.7) % vs 2.1 (21.1, 58.8) %, H=21.31, P=0.002; 52.9 (41.7, 62.5) % vs 32.1 (21.1, 58.8) %, H=14.4, P=0.037). The changes in the symbol digit coding test of the C-BCT in the active stimulation group were significantly higher than the sham stimulation group and the drug therapy group (6.3±2.1 scores vs 2.9±3.2 scores, F=5.02, P=0.011; 6.3±2.1 scores vs 2.8±3.1 scores, F=5.02, P=0.009). The incidence rate of adverse events in the active stimulation group was 12.1% (4/33) and 3.1% (1/32) in the sham stimulation group, and there was no significant difference in the incidence of adverse events between the two groups (χ 2=0.17, P=0.355). Conclusion:Bilateral dTBS stimulation of the dorsolateral prefrontal cortex combined with drug therapy can improve depressive symptoms and executive functions, such as information processing speed, attention and working memory.