Objective: To compare the biological characteristics of human induced pluripotent stem cell-derived platelet exosomes (hiPSC-Plt-Exos) with those of conventional apheresis platelet exosomes (Plt-Exos), specifically focusing on their differential abilities to enhance the proliferation and migration of human umbilical cord mesenchymal stem cells (hUC-MSCs). Methods: Exosomes were isolated from hiPSC-derived Plt and apheresis Plt concentrate using size exclusion chromatography. These exosomes were then characterized through nanoparticle tracking analysis (NTA), transmission electron microscopy (TEM), and Western blotting. Co-culture experiments into hUC-MSCs were conducted with hiPSC-Plt-Exos and apheresis Plt-Exos, respectively. Their effects on the proliferation and migration of hUC-MSCs were assessed via cell proliferation assays and scratch tests. Results: hiPSC-Plt-Exos and apheresis Plt-Exos exhibited comparable particle sizes, morphological features (such as the characteristic cup-shaped structure), and surface markers (including CD9 and HSP70). Notably, hiPSC-Plt-Exos demonstrated a significantly greater ability to enhance the proliferation and migration of hUC-MSCs compared to apheresis Plt-Exos (P<0.05). These differences provide critical comparative data for their application in various clinical contexts. Conclusion: This study establishes a theoretical foundation for developing precise therapeutic strategies based on hiPSC-Plt-Exos. Furthermore, it underscores the necessity of selecting the appropriate type of exosomes according to the specific disease microenvironment to achieve optimal therapeutic outcomes.

With the rapid development of artificial intelligence, computational pathology has been seamlessly integrated into the entire clinical workflow, which encompasses diagnosis, treatment, prognosis, and biomarker discovery. This integration has significantly enhanced clinical accuracy and efficiency while reducing the workload for clinicians. Traditionally, research in this field has depended on the collection and labeling of large datasets for specific tasks, followed by the development of task-specific computational pathology models. However, this approach is labor intensive and does not scale efficiently for open-set identification or rare diseases. Given the diversity of clinical tasks, training individual models from scratch to address the whole spectrum of clinical tasks in the pathology workflow is impractical, which highlights the urgent need to transition from task-specific models to foundation models (FMs). In recent years, pathological FMs have proliferated. These FMs can be classified into three categories, namely, pathology image FMs, pathology image-text FMs, and pathology image-gene FMs, each of which results in distinct functionalities and application scenarios. This review provides an overview of the latest research advancements in pathological FMs, with a particular emphasis on their applications in oncology. The key challenges and opportunities presented by pathological FMs in precision oncology are also explored.
Humans ; Precision Medicine/methods* ; Medical Oncology/methods* ; Artificial Intelligence ; Neoplasms/pathology* ; Computational Biology/methods*

OBJECTIVE: To explore the construction method of a resistant multiple myeloma (MM) patient-derived xenotransplantation (PDX) model. METHODS: 1.0×10⁷ MM patient-derived mononuclear cells (MNCs), 2.0×10⁶ MM.1S cells and 2.0×10⁶ NCI-H929 cells were respectively subcutaneously inoculated into NOD.CB17-Prkdc^scid Il2rg^tm1/Bcgen (B-NDG) mice with a volume of 100 μl per mouse to establish mouse model. The morphologic, phenotypic, proliferative and genetic characteristics of PDX tumor were studied by hematoxylin-eosin staining, immunohistochemical staining (IHC), cell cycle analysis, flow cytometry and fluorescence in situ hybridization (FISH). The sensitivity of PDX tumor to bortezomib and anlotinib monotherapy or in combination was investigated through cell proliferation, apoptosis and in vitro and in vivo experiments. The effects of anlotinib therapy on tumor blood vessel and cell apoptosis were analyzed by IHC, TUNEL staining and confocal fluorescence microscope. RESULTS: MM PDX model was successfully established by subcutaneously inoculating primary MNCs. The morphologic features of tumor cells from MM PDX model were similar to those of mature plasma cells. MM PDX tumor cells positively expressed CD138 and CD38, which presented 1q21 amplification, deletion of Rb1 and IgH rearrangement, and had a lower proliferative activity than MM cell lines. in vitro, PDX, MM.1S and NCI-H929 cells were treated by bortezomib and anlotinib for 24 hours, respectively. Cell viability assay showed that the IC₅₀ value of bortezomib were 5 716.486, 1.025 and 2.775 nmol/L, and IC₅₀ value of anlotinib were 5 5107.337, 0.706 and 5.13 μmol/L, respectively. Anlotinib treatment increased the apoptosis of MM.1S cells (P < 0.01), but did not affect PDX tumor cells (P >0.05). in vivo, there was no significant difference in PDX tumor growth between bortezomib monotherapy group and control group (P >0.05), while both anlotinib monotherapy and anlotinib combined with bortezomib effectively inhibited PDX tumor growth (both P < 0.05). The vascular perfusion and vascular density of PDX tumor were decreased in anlotinib treatment group (both P < 0.01). The apoptotic cells in anlotinib treatment group were increased compared with those in control group (P < 0.05). CONCLUSION Bortezomib-resistant MM PDX model can be successfully established by subcutaneous inoculation of MNCs from MM patients in B-NDG mice. This PDX model, which retains the basic biological characteristics of MM cells, can be used to study the novel therapies.
Animals ; Bortezomib ; Humans ; Multiple Myeloma/pathology* ; Mice ; Apoptosis ; Drug Resistance, Neoplasm ; Cell Line, Tumor ; Xenograft Model Antitumor Assays ; Mice, Inbred NOD ; Disease Models, Animal ; Cell Proliferation ; Transplantation, Heterologous

ObjectiveTo explore the current status and issues regarding the application of ancient books in clinical practice guidelines and expert consensus of traditional Chinese medicine （TCM） published in China， and to provide methodological recommendations for the incorporation of ancient books in the development of TCM guidelines. MethodsWe searched China National Knowledge Infrastructure （CNKI）， WanFang Data， VIP， SinoMed， PubMed， Embase， as well as six industry websites including China Association of Chinese Medicine， National Group Standards Information Platform， and Chinese Association of the Integration of Traditional and Western Medicine，etc. TCM clinical practice guidelines or expert consensus issued during January 1st， 2017， to November 26th， 2022 were searched. Clinical practice guidelines or expert consensus that explicitly referred to ancient books were included， and the content regarding the searching for ancient books， sources of access to ancient books， methods of evaluating the level of evidence， methods of evaluating the level of recommendation， and methods of evaluating the evidence for the ancient books were analysed. ResultsA total of 1,215 TCM clinical practice guidelines or expert consensus were retrieved， with 442 articles explicitly mentioning the application of ancient books， including 300 （67.87%） clinical practice guidelines and 142 （32.13%） expert consensus. Sixty of the 442 publications explicitly reported that ancient books searching had been conducted （13.57%）； among these 60 publications 27 （45.00%） explicitly reported ancient books searching strategies， and the most frequent method was manual searching with a total of 24 articles （40.00%）. The most popular search source was Chinese Medical Dictionary， a TCM classics database， with a total of 18 articles. 197 articles （44.57%） explicitly reported the evaluation criteria for the level of evidence， of which 141 articles （71.57%） involved the evaluation criteria for the ancient books； 413 articles （93.44%） mentioned ancient books in the recommendations， and only the source of formula name was mentioned in 409 （99.03%） of the publications. ConclusionThe current application of ancient books in TCM clinical practice guidelines and expert consensus is limited， with issues of non-standard searching and evaluation methods. Standar-dization and uniformity are needed in evidence grading and recommendation standards. Future research should clarify the scope and methods of applying ancient book， emphasize their integration with modern research evidence， and enhance their value and quality in the development of TCM clinical practice guidelines.

Objective To investigate the efficacy of flupentixol combined with ondansetron in preventing postoperative nausea and vomiting(PONV)in patients receiving sufentanil and dezocine patient-controlled intravenous analgesia(PCIA).Methods Surgical patients receiving sufentanil and dezocine PCIA were randomly divided into treatment and control groups using a random number table.The control group received sufentanil 150 μg,dezocine 20 mg,and ondansetron 8 mg for PCIA,while the treatment group received sufentanil 150 μg,dezocine 20 mg,flupentixol 5 mg,and ondansetron 8 mg for PCIA.The incidence of PONV,severity of PONV,heart rate(HR),mean arterial pressure(MAP),blood oxygen saturation(SPO2)levels at different time points after surgery,surgery-related indicators,visual analogue scale(VAS)scores,Ramsay scores,PCIA pressing times,and incidence of adverse drug reactions were compared between the two groups.Results The incidence of PONV in the treatment group and the control group at 2,12,24,36 and 48 hours after surgery were 1.64％,4.84％,6.56％,3.28％,0 and 14.75％,18.03％,19.67％,16.39％,9.84％,respectively.The HR at 24 hours after surgery in the treatment group and the control group were(91.42±8.75)and(98.13±9.62)beat·min-1,respectively;the MAP were(91.98±4.56)and(99.05±4.17)mmHg;SPO2 were(98.13±1.65)％and(98.95±1.82)％;VAS scores were 2.68±0.49 and 2.97±0.63;Ramsay scores were 2.27±0.65 and 2.05±0.32;PCIA pressing times were(2.14±0.37)and(4.36±0.78)times,respectively.The differences in the above indicators between the treatment group and the control group were statistically significant(all P＜0.05).The incidence of total adverse drug reactions after surgery in the treatment group and the control group were 13.12％and 8.20％,respectively,with no statistically significant difference(P＞0.05).Conclusion Flupentixol combined with ondansetron can reduce the risk of PONV caused by sufentanil combined with dezocine PCIA after surgery,ensuring good analgesic effects and safety.

Objective:Based on the relevance risk analysis of medical equipment,to formulate process management strategies to improve the clinical operation efficiency of medical equipment.Methods:The risk matrix was evaluated from the perspectives of subject,quality,environment,system and diagnosis and treatment perspective,the comprehensive evaluation model of relevance risk was established,and multiple process management countermeasures were formulated.400 sets of medical equipment in clinical use in Shanghai Eighth People's Hospital from April 2021 to March 2022 were selected and divided into the control group and the observation group by the digital table method,with 200 sets in each group.The control group adopted the individualized risk analysis method for process management,and the observation group adopted the relevance risk analysis method for process management.The risk level and operation benefits of the two groups of medical equipment were compared and analyzed.Results:The high risk rates of medical imaging diagnostic and auxiliary equipment,surgical treatment equipment,life support and first aid equipment,extracorporeal circulation and blood processing equipment,health monitoring and rehabilitation equipment in the observation group were 17.39%(4/23),14.58%(7/28),12.24%(6/49),5.55%(1/18)and5.06%(5/62),respectively,which were lower than those in the control group,the difference was statistically significant(x2=4.132,4.009,6.275,4.833,4.859,P<0.05).The scores of cost benefit,social benefit,diagnosis and treatment benefit and development benefit of medical equipment in the observation group were(91.37±6.15)points,(92.78±3.80)points,(95.25±2.09)points and(90.51±3.82)points,respectively,which were higher than those in the control group,the difference was statistically significant(t=2.392,3.877,4.841,2.504,P<0.05).Conclusion:The relevance risk analysis method can reduce the probability and hazard degree of medical equipment safety risks,improve the clinical operation efficiency of medical equipment,and the process management strategy is in line with the actual needs of the medical equipment lifecycle management.

Objective To retrieve,evaluate and summarize the best evidence of early mobilization in awake patients on extracorporeal membrane oxygenation,and to provide a reference for clinical practice.Methods UpToDate,BMJ Best Practice,Registered Nurses'Association of Ontario,National Guideline Clearinghouse,National Institute for Health and Care Excellence,Yimaitong,Joanna Briggs Institute Library,Cochrane Library,CINAHL,PubMed,SinoMed,CNKI,Wanfang Database,Vip Database and Extracorporeal Life Support Organization Website were researched to collect the literature,including clinical guidelines,expert consensuses,evidence summaries,systematic reviews,and well-designed original studies.The time limit for retrieval was until June 2023.The quality of literature and the level of evidence were evaluated by the evaluation criteria and evidence grading system of J BI Evidence-Based Health Care Center.Results 14 pieces of the literature were included,including 2 clinical guidelines,4 expert consensuses,5 systematic reviews,2 cohort studies and 1 case series.Totally 33 pieces of evidence were summarized,covering 7 aspects:adaptation conditions for the implementation of awake ECMO,team composition,comprehensive assessment,pre-mobilization preparation,mobilization content,prevention and control of adverse events,and effect evaluation.Conclusion The study summarizes the best evidence of early mobilization in awake patients on extracorporeal membrane oxygenation.It is suggested that medical institutions establish a professional team for the early mobilization of awake ECMO patients,apply the best evidence to standardize the early mobilization process,and formulate an individualized mobilization program.

Objective To identify the factors associated with frailty in lung transplant patients by a meta-analysis.Methods Computerized search was performed for studies on the influencing factors of frailty in lung transplant patients in the CNKI,WanFangData,VIP,CBM,PubMed,Web of Science,Embase,Elsevier ScienceDirect and CINAHL databases.The search was conducted from the time of database construction to November 2023.Literature screening,quality assessment,and data extraction were performed independently by 2 investigators,and Meta-analysis was performed using Stata 17.0 software.Results 10 cohort studies,including 1 999 patients,were finally included,and 13 influencing factors were extracted,including advanced age(OR=1.05),female(OR=2.50),BMI(OR=0.38),diagnosis of primary pulmonary disease(OR=2.90),6MWD(OR=0.34),and lung allocation score(OR=0.69),FVC(OR=0.60),pre-transplant frailty(OR=0.81),hypoproteinemia(OR=4.12),hemoglobin(OR=0.50),anemia(OR=4.37),length of ICU stay(OR=1.24),and total length of stay(OR=1.05).Short Physical Performance Battery is an assessment tool for frailty in lung transplant patients,with an incidence of frailty in 24％before transplantation and 50％in post-transplantation.Fried Frailty Phenotype is an assessment tool for frailty in lung transplant patients,with a pre-transplant frailty incidence of 30％.Conclusion There are many factors involved in the incidence of frailty in lung transplant patients,and nursing staff should dynamically evaluate the frailty of lung transplant patients,and give individualized and precise interventions in combination with a multidisciplinary model to improve or delay the progression of frailty.

Objective To evaluate the effect of remote interventions with digital health technologies in lung transplant patients.Methods Databases,including CKNI,Wangfang,VIP,CMB,Cochrane Library,PubMed,Embase,Web of Science,Scopus and BMJ Best Practice were searched from their inception to July 2023.There were 2 researchers who independently screened and extracted the literature,and then evaluated quality of the included studies.Meta-analysis was performed using RevMan 5.2.Results 10 studies with 1 262 patients were included.The results of meta-analysis showed that compared with conventional intervention,remote intervention based on digital health technology could improve self-monitoring compliance of lung transplant patients[0R=0.64,95％CI(0.46,0.88),P=0.006],improve quality of life including mental health status[OR=3.08,95％CI(0.41,5.74),P=0.020]and physical health status[OR=3.81,95％CI(1.19,6.43),P=0.004].In terms of the intervention forms,the application-based remote intervention had better self-monitoring compliance,and the difference was statistically significant(P=0.007).However,in terms of the comparison of readmission rate[OR=1.73,95％CI(0.98,3.04),P=0.060],anxiety[OR=-0.12,95％CI(-1.36,1.11),P=0.850],and depression[OR=0.62,95％CI(-0.80,2.03),P=0.390],the effect of intervention was unclear.Conclusion Remote intervention based on digital health technology can improve self-monitoring compliance and quality of life in lung transplant patients;applications are the optimal form of intervention.Limited by the quality and quantity of included studies and the heterogeneity of study results,more high-quality studies are needed to further verify the effects of digital health technology on readmission rates,anxiety and depression of lung transplant patients.

Objective To explore the status quo and potential profile of self-management in elderly patients with venous leg ulcers,analyse the differences and influencing factors in different profiles,and provide references for clinical nursing.Methods Convenient sampling method was used to select patients who were followed up in the department of vascular surgery and vascular department of 3 tertiary A hospitals in Shanghai from October 2022 to May 2023 as the study subjects.General data questionnaire,Chronic Wound Patient Self-management Behavior Questionnaire,Health Literacy Management Scale,Brief Illness Perception Questionnaire,Social Support Rating Scale,Chronic Disease Self-Efficacy Scale and Geriatric Depression Scale-15 were used for investigation.Mplus 8.3 was used for potential profile analysis,and SPSS 25.0 was used for univariate analysis and multiple Logistic regression analysis.Results A total of 316 valid questionnaires were collected,and the patients were divided into 3 potential profiles according to their self-management level:low management-inefficient wound response,middle management-highly effective compliance and high management-efficient wound response,accounting for 25.63％,46.84％and 27.53％respectively.Multiple Logistic regression analysis showed that duration of illness,depression,health literacy,self-efficacy and illness perception were factors influencing the potential profile of self-management in elderly patients with venous leg ulcers.Conclusion The self-management level of elderly patients with venous leg ulcers is at a medium level and has obvious classification characteristics.Clinical nurses can take targeted nursing measures according to different characteristics of patients to improve their self-management ability.