Objective: To explore the types and levels of exosomes in cryoprecipitate from donors of different blood types, genders, and age groups, and to preliminarily characterize their specific proteins. Methods: Exosomes were extracted from cryoprecipitate using the polymer precipitation method. The exosomes were identified by particle size analysis, transmission electron microscopy, and Western blot. Finally, the specific proteins CD63, CD81, CD9, Cytochrome C, Syntenin-1, and VLA-4 of exosomes were characterized using Luminex. Results: The purified exosomes exhibited a double-membrane vesicle structure under microscopy, appearing saucer-shaped or as hemispheres with a concave side. They specifically expressed the CD63 and TSG101 proteins, while the endoplasmic reticulum protein Calnexin was not expressed. The particle sizes(nm) of exosomes from blood types A, B, O, and AB were 119.6±47.5, 120.5±47.4, 133.3±54.1 and 103.1±35.3, respectively. Taking the exosomal specific protein CD63 as an example, its expression levels(pg/mL) in cryoprecipitate from female and male donors were 128.22±63.52 and 117.39±40.84, respectively; the expression(pg/mL) levels in the 20-40 and 40-60 age groups were 114.20±37.28 and 131.41±64.98, respectively; and the expression levels(pg/mL) in the four blood types A, B, O, and AB were 109.58±37.79, 127.45±44.46, 131.89±40.59, and 122.29±78.68, respectively. The expression levels of CD63 in exosomes from different blood types, genders, and age groups were similar, with no statistically significant differences (all P>0.05). The distribution of the other five exosomal-specific proteins was also comparable among the normal blood donors. Conclusion: The expression levels of exosomal-specific proteins in cryoprecipitate from normal blood donors are not associated with blood type, gender, and age group.

The incidence of metabolic disorders is relatively high among transplant recipients and is closely related to the use of immunosuppressive agents. Metabolic diseases can trigger or accelerate the progression of cardiovascular conditions, becoming an important factor affecting long-term survival after transplantation. This article discusses the reasons for the high incidence of post-transplant metabolic disorders, and introduces the management strategies for post-transplant diabetes, dyslipidemia, and hyperuricemia, including early screening, timely diagnosis, and continuous management. It also highlights current challenges in the management of metabolic disorders after organ transplantation in China, such as insufficient interdisciplinary collaboration, lack of research data, and low awareness among recipients. It is recommended to establish a multidisciplinary follow-up system, improve the general medical capabilities of follow-up teams, and achieve precise management of transplant recipients.

Objective To investigate the association between early peripheral perfusion index (PPI) and acute kidney injury (AKI) in patients admitted to the intensive care unit (ICU) following major noncardiac surgery. Methods This retrospective cohort study was conducted at a single center. Adult patients consecutively enrolled were those admitted to the ICU after major noncardiac surgery. PPI measurements were collected within the first 6 hours post-surgery. The primary outcome assessed was the occurrence of AKI within 7 days after surgery. Multivariate logistic regression analysis was employed to adjust for confounding factors,while receiver operating characteristic (ROC) curve analysis determined the most predictive cutoff PPI. Results The study included a total of 444 patients who underwent noncardiac surgery. The incidences of postoperative AKI and severe AKI were 9.23％ and 1.13％,respectively. Early postoperative PPI levels exhibited a skewed distribution,with a median value of 3.02 (2.02,4.24). After adjusting for various perioperative variables,PPI was found to be indepen-dently correlated with the occurrence of postoperative AKI (OR=0.734,95％ CI:0.580～0.930,P=0.010),as indicated by an area under the ROC curve of 0.6802 (95％ CI:0.6022～0.7582,P<0.001). Using a cutoff value of ≤ 2 .04 for PPI,the sensitivity and specificity for predicting postoperative AKI were determined to be approximately at 53.7％ and 77.2％ respectively. Further analysis revealed that patients with PPI ≤ 2.04 had a higher incidence of severe postoperative complications as well as prolonged mechanical ventilation duration and hospital stay. Conclusions A prompt reduction in postoperative PPI usage was found to be linked with the inci-dence of AKI occurring within 7 days following major noncardiac surgery.

Pheochromocytoma and paraganglioma(PPGL)are rare neuroendocrine tumors characterized not only by hemodynamic instability but also by fluctuations in blood glucose levels during the perioperative period.These features are closely associated with significant variations in catechromamine secretion.Hypoglycemia is a common postoperative complication in patients with PPGL and is primarily attributed to rebound insulin secretion and enhanced insulin sensitivity following tumor resection.Postoperative hypoglycemia requires heightened clinical attention due to its often subtle presentation and potential for serious complications.Known risk factors include the presence of an epinephrine-secreting tumor,prolonged operative time,larger tumor size,and a history of end-stage renal disease.Therefore,it is essential to identify high-risk patients preoperatively,ensure meticulous intraopera-tive monitoring,and implement timely postoperative interventions.This article provides a comprehensive review of recent advances in the epidemiology,underlying mechanisms,clinical diagnosis,management strategies,and prognosis of postoperative hypoglycemia in PPGL.Importantly,it introduces novel research directions and concep-tual frameworks for the first time,including the optimal timing and dosage of α-receptor antagonists,potential ap-plications of micro-dose glucagon therapy,and molecular mechanisms with targeted interventions in glucose me-tabolism regulation.This review aims to address the current lack of standardized perioperative management proto-cols and to offer innovative and clinically relevant guidance for healthcare professionals.

Peripheral perfusion index(PPI)is an objective and reliable parameter reflecting the peripheral micro-circulation through the ratio of local pulsatile to non-pulsatile blood flow.PPI is widely used in the early identifica-tion of hypotension,guiding volume management,assessing vascular tone,assisting mechanical ventilation settings,early identification of postoperative complications and poor prognosis of critically ill patients.

The incidence of metabolic disorders is relatively high among transplant recipients and is closely related to the use of immunosuppressive agents. Metabolic diseases can trigger or accelerate the progression of cardiovascular conditions, becoming an important factor affecting long-term survival after transplantation. This article discusses the reasons for the high incidence of post-transplant metabolic disorders, and introduces the management strategies for post-transplant diabetes, dyslipidemia, and hyperuricemia, including early screening, timely diagnosis, and continuous management. It also highlights current challenges in the management of metabolic disorders after organ transplantation in China, such as insufficient interdisciplinary collaboration, lack of research data, and low awareness among recipients. It is recommended to establish a multidisciplinary follow-up system, improve the general medical capabilities of follow-up teams, and achieve precise management of transplant recipients.

Pheochromocytoma and paraganglioma(PPGL)are rare neuroendocrine tumors characterized not only by hemodynamic instability but also by fluctuations in blood glucose levels during the perioperative period.These features are closely associated with significant variations in catechromamine secretion.Hypoglycemia is a common postoperative complication in patients with PPGL and is primarily attributed to rebound insulin secretion and enhanced insulin sensitivity following tumor resection.Postoperative hypoglycemia requires heightened clinical attention due to its often subtle presentation and potential for serious complications.Known risk factors include the presence of an epinephrine-secreting tumor,prolonged operative time,larger tumor size,and a history of end-stage renal disease.Therefore,it is essential to identify high-risk patients preoperatively,ensure meticulous intraopera-tive monitoring,and implement timely postoperative interventions.This article provides a comprehensive review of recent advances in the epidemiology,underlying mechanisms,clinical diagnosis,management strategies,and prognosis of postoperative hypoglycemia in PPGL.Importantly,it introduces novel research directions and concep-tual frameworks for the first time,including the optimal timing and dosage of α-receptor antagonists,potential ap-plications of micro-dose glucagon therapy,and molecular mechanisms with targeted interventions in glucose me-tabolism regulation.This review aims to address the current lack of standardized perioperative management proto-cols and to offer innovative and clinically relevant guidance for healthcare professionals.

Objective To investigate the association between early peripheral perfusion index (PPI) and acute kidney injury (AKI) in patients admitted to the intensive care unit (ICU) following major noncardiac surgery. Methods This retrospective cohort study was conducted at a single center. Adult patients consecutively enrolled were those admitted to the ICU after major noncardiac surgery. PPI measurements were collected within the first 6 hours post-surgery. The primary outcome assessed was the occurrence of AKI within 7 days after surgery. Multivariate logistic regression analysis was employed to adjust for confounding factors,while receiver operating characteristic (ROC) curve analysis determined the most predictive cutoff PPI. Results The study included a total of 444 patients who underwent noncardiac surgery. The incidences of postoperative AKI and severe AKI were 9.23％ and 1.13％,respectively. Early postoperative PPI levels exhibited a skewed distribution,with a median value of 3.02 (2.02,4.24). After adjusting for various perioperative variables,PPI was found to be indepen-dently correlated with the occurrence of postoperative AKI (OR=0.734,95％ CI:0.580～0.930,P=0.010),as indicated by an area under the ROC curve of 0.6802 (95％ CI:0.6022～0.7582,P<0.001). Using a cutoff value of ≤ 2 .04 for PPI,the sensitivity and specificity for predicting postoperative AKI were determined to be approximately at 53.7％ and 77.2％ respectively. Further analysis revealed that patients with PPI ≤ 2.04 had a higher incidence of severe postoperative complications as well as prolonged mechanical ventilation duration and hospital stay. Conclusions A prompt reduction in postoperative PPI usage was found to be linked with the inci-dence of AKI occurring within 7 days following major noncardiac surgery.

Objective:To evaluate the clinical efficacy and safety of intense pulsed light combined with fruit acid in the treatment of erythema and pigmentation after facial acne.Methods:From January 2019 to December 2022, 108 patients were selected from Dermatology Hospital of Guangxi Zhuang Autonomous Region, including 30 males and 78 females, aged 20-44 (28.2±5.1) years. The patients were divided into three groups: intense pulsed light group (40 cases), fruit acid group (38 cases) and intense pulsed light combined with fruit acid group (30 cases). The clinical efficacy of the three groups was compared. The facial biological characteristics data of patients were collected with VISIA skin analyzer and the changes compared before and after treatment in each group.Results:The total effective rates of the intense pulsed light group, the fruit acid group and the combination group were 57.5% (23/40 cases), 50.0% (19/38 cases), and 80.0% (24/30 cases), respectively. Comparison of total effective rates among three groups, there were statistically significant differences (χ 2=6.70, P=0.04). Comparison of effective rates among different groups showed that there was no difference between the intense pulsed light group and the fruit acid group (χ 2=0.44, P=0.51); there were significant difference between the intense pulse light group and the combination group (χ 2=3.93, 6.49; P<0.05), and between the fruit acid group and the combination group (χ 2=6.49, P=0.01). After treatment, the VISIA scores of erythema, spots, pores, and purple in three groups of patients significantly decreased compared to before treatment ( P<0.05). The VISIA scores of each observation value showed a decreasing trend with the increase of treatment frequency ( P<0.01). During the treatment, no obvious adverse reactions were observed. Conclusions:Intense pulsed light combined with fruit acid in the treatment of facial erythema postacnes and postinflammatory hyperpigmentation can improve the efficacy and less adverse reactions.

Objective To address the radioactive contamination of wounds caused by transuranic nuclides, wound radiation imaging based on coded aperture imaging technology was investigated. Methods By simulating multiple source terms using Monte Carlo method, the differences in imaging performance between two image reconstruction algorithms under near-field conditions were compared. The effects of detector pixels and detection plane pixels on image resolution were investigated. Results The imaging system was simulated based on the designed dimensions. The simulated imaging field of view was 89.4 mm × 89.4 mm and the simulated angular resolution was 1.98°. Based on the comparison of the average width at half height of the reconstructed point sources under different conditions, it was found that increasing the number of pixels in the detector and detection plane optimized the angular resolution but significantly prolonged the Monte Carlo simulation time. Conclusion According to the simulation results, the parameters of the imaging system can be used to effectively image radioactive contamination. Our results provide methodological support for the measurement of wound contamination caused by transuranic nuclides, and lay the foundation for the development of wound contamination imaging detection systems in the future.