Objective: To analyze the association between intraoperative blood transfusion and adverse perinatal outcomes(a composite of maternal death, hepatic encephalopathy, etc) in patients with acute fatty liver of pregnancy (AFLP), identify independent risk factors for these outcomes, and develop and validate a risk prediction model for early identification of high-risk patients. Methods: Clinical data of 56 AFLP patients admitted to our hospital from January 2008 to January 2025 were retrospectively analyzed. The chi-square test was used to compare the incidence of adverse perinatal outcomes between the transfusion group and the non-transfusion group. Univariate and multivariate Firth-penalized logistic regression analyses were performed to identify independent predictors of adverse outcomes. Based on the identified independent risk factors, a combined prediction model was developed. Internal validation was performed using the Bootstrap method (1 000 resamplings) to assess the model′s generalizability. Model performance was evaluated using receiver operating characteristic(ROC) curves and calibration curves. Finally, a nomogram for predicting adverse perinatal outcomes in AFLP was constructed. Results: Overall, 57.1%(32/56) of the patients received blood product transfusion during the termination of pregnancy. Multivariate Firth-penalized logistic regression analysis showed that, given the limited sample size, intraoperative blood transfusion had no independent statistical effect on adverse outcomes (OR=0.812, 95%CI:0.133-3.698, P=0.797). Mediation analysis also revealed no significant indirect effect. The independent risk factors were decreased preoperative fibrinogen (OR=14.062, 95%CI:2.389-126.656, P=0.003), pregnancy with infection (OR= 4.536, 95%CI:1.143-22.107, P=0.031), and cesarean section (OR=8.691, 95%CI:1.321-90.081, P=0.023). The combined prediction model achieved an AUC of 0.881 (95% CI:0.793-0.969, P<0.001), indicating good discrimination. At the optimal cut-off value, the sensitivity was 65.6%, specificity 95.8%, positive predictive value 95.5%, and negative predictive value 67.6%. Internal validation by the Bootstrap method showed that the predictive model had good discrimination and no obvious overfitting. The calibration curve demonstrated that the model′s predicted risk was consistent with the actual observed risk. Based on this, an AFLP perinatal adverse outcome nomogram model was constructed. Conclusion: Under the limited sample size of this study, no independent statistical effect of intraoperative blood product infusion on adverse perinatal outcomes in AFLP patients was detected. A multivariate Firth-penalized logistic regression model incorporating decreased preoperative fibrinogen, pregnancy with infection, and cesarean delivery demonstrated good discrimination and calibration. The derived nomogram may serve as an exploratory tool for early risk stratification and proactive intervention.

Objective To assess the efficacy of an innovative operational management model in enhancing the refined operational management of a public hospital.Methods An innovative operational management model,"One Body,Two Wings and Three Drives",was developed,which involved establishing a systematic operational management system,strengthening per-formance and cost control,and reinforcing the supporting roles of discipline construction,scientific and technological innovation,and smart hospital initiatives.This comprehensive approach aimed to systematically promote hospital operational management re-forms and improve overall efficiency and quality.Results After using this model,the hospital presented continuous improve-ments in operational efficiency and medical quality,with key performance indicators trending positively.Over the past three years,the average annual growth rate of outpatient and emergency service visits reached 6.6％,inpatient service visits increased by 5.7％,and the Case Mix Index(CMI)rose by 0.22 over two consecutive years.Conclusion This model is highly systemat-ic,practical,and policy-compatible,providing a replicable path for the high-quality development of public hospitals.

Objective:To investigate the transcriptomic signature of refractory nasal polyps (NP) after endoscopic sinus surgery.Methods:Tissue samples were collected from 36 patients with NP who underwent endoscopic sinus surgery at the Seventh Affiliated Hospital of Sun Yat-sen University and the First Affiliated Hospital of Sun Yat-sen University from January 2020 to December 2021. Raw sequencing data of normal nasal mucosa samples were downloaded from publicly available GEO database (Accession Number: GSE136825). Differential expression genes (DEGs) and Gene Ontology (GO) enrichment analysis were conducted to analyze the differences between refractory NP and normal controls, as well as among refractory, controlled, and partially controlled NP. Hierarchical clustering method was employed to analyze the inflammatory endotypes of NP. Weighted Gene Co-expression Network Analysis (WGCNA) and STRING database were used in combination with Cytoscape software to identify the characteristic transcriptional expression profiles of refractory NP. R software (version 4.3.1) was used for statistical analysis.Results:Refractory NP patients had significantly higher asthma comorbidity rates than controlled/partially controlled groups ( P<0.05). The numbers and percentages of peripheral blood and tissue eosinophilic granulocytes were significantly higher in the refractory subgroup than in the other two subgroups ( P<0.05). Compared to normal mucosa, controlled and partially controlled NP groups, 27 genes were consistently upregulated in refractory NP. Hierarchical cluster analysis showed that the refractory NP exhibited a mixed endotype dominated by type 2 inflammation with co-existing type 1 features. Differential genes were enriched in extracellular matrix organization, leukocyte activation, cytokine receptor activation, cystatin-mediated protease inhibition, granule exocytosis, and olfactory nerve development regulation. Further WGCNA analysis and protein-protein interaction network identified 33 hub genes represented by ITGAM, NCF1, NCF2, CD1C, PTAFR, CLEC10A, SIRPA, TREM2, ALOX5AP, PTGDR2 (officially PTGDR), F13A1, DUOX2, NOS2, CTSG, and SALL1.Conclusion:This study reveals the distinctive transcriptional signature of refractory NP through transcriptomic methods, providing novel research avenues and therapeutic targets for the treatment of refractory NP after surgery.

Objective To assess the efficacy of an innovative operational management model in enhancing the refined operational management of a public hospital.Methods An innovative operational management model,"One Body,Two Wings and Three Drives",was developed,which involved establishing a systematic operational management system,strengthening per-formance and cost control,and reinforcing the supporting roles of discipline construction,scientific and technological innovation,and smart hospital initiatives.This comprehensive approach aimed to systematically promote hospital operational management re-forms and improve overall efficiency and quality.Results After using this model,the hospital presented continuous improve-ments in operational efficiency and medical quality,with key performance indicators trending positively.Over the past three years,the average annual growth rate of outpatient and emergency service visits reached 6.6％,inpatient service visits increased by 5.7％,and the Case Mix Index(CMI)rose by 0.22 over two consecutive years.Conclusion This model is highly systemat-ic,practical,and policy-compatible,providing a replicable path for the high-quality development of public hospitals.

Objective:To investigate the transcriptomic signature of refractory nasal polyps (NP) after endoscopic sinus surgery.Methods:Tissue samples were collected from 36 patients with NP who underwent endoscopic sinus surgery at the Seventh Affiliated Hospital of Sun Yat-sen University and the First Affiliated Hospital of Sun Yat-sen University from January 2020 to December 2021. Raw sequencing data of normal nasal mucosa samples were downloaded from publicly available GEO database (Accession Number: GSE136825). Differential expression genes (DEGs) and Gene Ontology (GO) enrichment analysis were conducted to analyze the differences between refractory NP and normal controls, as well as among refractory, controlled, and partially controlled NP. Hierarchical clustering method was employed to analyze the inflammatory endotypes of NP. Weighted Gene Co-expression Network Analysis (WGCNA) and STRING database were used in combination with Cytoscape software to identify the characteristic transcriptional expression profiles of refractory NP. R software (version 4.3.1) was used for statistical analysis.Results:Refractory NP patients had significantly higher asthma comorbidity rates than controlled/partially controlled groups ( P<0.05). The numbers and percentages of peripheral blood and tissue eosinophilic granulocytes were significantly higher in the refractory subgroup than in the other two subgroups ( P<0.05). Compared to normal mucosa, controlled and partially controlled NP groups, 27 genes were consistently upregulated in refractory NP. Hierarchical cluster analysis showed that the refractory NP exhibited a mixed endotype dominated by type 2 inflammation with co-existing type 1 features. Differential genes were enriched in extracellular matrix organization, leukocyte activation, cytokine receptor activation, cystatin-mediated protease inhibition, granule exocytosis, and olfactory nerve development regulation. Further WGCNA analysis and protein-protein interaction network identified 33 hub genes represented by ITGAM, NCF1, NCF2, CD1C, PTAFR, CLEC10A, SIRPA, TREM2, ALOX5AP, PTGDR2 (officially PTGDR), F13A1, DUOX2, NOS2, CTSG, and SALL1.Conclusion:This study reveals the distinctive transcriptional signature of refractory NP through transcriptomic methods, providing novel research avenues and therapeutic targets for the treatment of refractory NP after surgery.

Objective To investigate the mechanism of Nlrp6 for regulating hepatocellular carcinoma(HCC)progression in light of lipid synthesis regulation.Methods Nlrp6 expression level in HCC tissues of different pathological grades was investigated using RNA-seq data from The Cancer Genome Atlas(TCGA)database,and its correlation with the patients'survival was analyzed with Kaplan-Meier survival analysis.HepG2 cells with adenovirus-mediated Nlrp6 overexpression or knockdown were treated with palmitic acid(PA),and the changes in lipid deposition and cell proliferation were evaluated using Oil Red O staining,CCK-8 assay,EdU staining,and colony formation assay.RT-qPCR and Western blotting were used to detect the changes in expression of lipid synthesis-related genes and the proteins in the AMPK-Srebp1c axis.In a mouse model of hepatic steatosis established in liver-specific Nlrp6 knockout mice by high-fat diet feeding for 24 weeks,liver fibrosis was examined with histological staining,and the changes in expressions of HCC markers and the AMPK-Srebp1c signaling pathway were detected.Results Nlrp6 expression was significantly reduced in HCC tissues with negative correlations with the pathological grades and the patients'survival(P<0.0001).In HepG2 cells,Nlrp6 overexpression significantly inhibited lipid deposition and cell proliferation,whereas Nlrp6 knockdown produced the opposite effects.Nlrp6 overexpression strongly suppressed the expression of lipid synthesis-related genes,promoted AMPK phosphorylation,and inhibited Srebp1c expression.The mice with liver-specific Nlrp6 knockout and high-fat feeding showed increased hepatic steatosis,collagen deposition,and AFP expression with reduced AMPK phosphorylation and increased Srebp1c expression.Conclusion Nlrp6 overexpression inhibits lipid synthesis in HCC cells by regulating the AMPK-Srebp1c axis,which might be a key pathway for suppressing HCC cell proliferation.

Objective To investigate the mechanism of Nlrp6 for regulating hepatocellular carcinoma(HCC)progression in light of lipid synthesis regulation.Methods Nlrp6 expression level in HCC tissues of different pathological grades was investigated using RNA-seq data from The Cancer Genome Atlas(TCGA)database,and its correlation with the patients'survival was analyzed with Kaplan-Meier survival analysis.HepG2 cells with adenovirus-mediated Nlrp6 overexpression or knockdown were treated with palmitic acid(PA),and the changes in lipid deposition and cell proliferation were evaluated using Oil Red O staining,CCK-8 assay,EdU staining,and colony formation assay.RT-qPCR and Western blotting were used to detect the changes in expression of lipid synthesis-related genes and the proteins in the AMPK-Srebp1c axis.In a mouse model of hepatic steatosis established in liver-specific Nlrp6 knockout mice by high-fat diet feeding for 24 weeks,liver fibrosis was examined with histological staining,and the changes in expressions of HCC markers and the AMPK-Srebp1c signaling pathway were detected.Results Nlrp6 expression was significantly reduced in HCC tissues with negative correlations with the pathological grades and the patients'survival(P<0.0001).In HepG2 cells,Nlrp6 overexpression significantly inhibited lipid deposition and cell proliferation,whereas Nlrp6 knockdown produced the opposite effects.Nlrp6 overexpression strongly suppressed the expression of lipid synthesis-related genes,promoted AMPK phosphorylation,and inhibited Srebp1c expression.The mice with liver-specific Nlrp6 knockout and high-fat feeding showed increased hepatic steatosis,collagen deposition,and AFP expression with reduced AMPK phosphorylation and increased Srebp1c expression.Conclusion Nlrp6 overexpression inhibits lipid synthesis in HCC cells by regulating the AMPK-Srebp1c axis,which might be a key pathway for suppressing HCC cell proliferation.

Artificial blood vessels, serving as crucial vascular substitutes, have been widely utilized in vascular interventional therapies and revascularization surgeries. Small-diameter artificial blood vessels (diameter < 6 mm) pose challenges for long-term implantation due to their small diameter, slow flow velocity, low blood pressure, and complex blood flow environment. Bacterial nanocellulose (BNC), a natural polymer material, enhances the regenerative and repair effects of small-diameter artificial blood vessels through composite modification and surface modification. This article reviewed the research progress in the preparation of small-diameter artificial blood vessels using BNC and discussed the advantages and potential application prospects of BNC artificial blood vessels.

Effective budget management is crucial for the internal control of procurements in public hospitals.This paper investigates challenges such as unscientific budget preparation,insufficient market analysis,and inadequate procurement internal control in a tertiary hospital in Shenzhen.In addition,based on a budget inquiry mechanism,the study explores strategies to en-hance internal control management within procurements in public hospitals,focusing on the pilot implementation of budget price review mechanisms in the hospital.The paper proposes such rules as"whoever applies is responsible and conducts research,"departmental checks and balances,continuous feedback,and pre-budget inquiry.These measures are used to improve procure-ment cost control,enhance hospital operational efficiency,and increase economic benefits.

A case of a 69-year-old female patient, with cough, expectoration, chest tightness and shortness of breath for 10 days accompanied by left pleural effusion, was reported. Initially, a large number of suspected malignant lymphoma cells were found in the patient′s pleural effusion through routine cell morphological examination after admission, which was the direction of clinical diagnosis and treatment in the next step. Then the patient was diagnosed as primary pulmonary diffuse large B-cell lymphoma (DLBCL) through imaging, bone marrow and lung biopsy pathology. Finally, the patient was treated effectively with R-CHOP regimen, but she died of respiratory failure 9 weeks later, because she did not receive regular follow-up and treatment after the sixth chemotherapy cycle. Primary pulmonary DLBCL, an extremely rare extranodal lymphoma' lacks specificity clinical manifestations and is easy to be missed and misdiagnosed. DLBCL with a large number of malignant pleural effusion progresses rapidly and has a poor prognosis. The routine cell morphology examination of pleural effusion is simple and intuitive, which can capture key information in the shortest time, preliminarily provide clinical diagnosis and treatment ideas, and provide accurate basis for disease diagnosis.