The orientation of the acetabular cup in hip joint anteroposterior radiograph is a key factor in evaluating the postoperative outcomes of total hip arthroplasty (THA). Currently, measurement of the acetabular cup anteversion angle primarily relies on manual drawing of auxiliary lines by orthopedic surgeons and calculations using scientific calculators. This study proposes an automated computer-aided measurement method for the acetabular cup anteversion angle based on hip joint anteroposterior radiograph. The proposed method segments hip prosthesis images using an improved Otsu algorithm, identifies feature points at the acetabular cup opening by combining circle-fitting theory and the cup's geometric characteristics, and fits an ellipse to the cup opening to calculate the anteversion angle. A total of 104 hip joint anteroposterior radiographs, including 71 right-sided and 81 left-sided prostheses, were analyzed. Two orthopedic surgeons independently measured the postoperative anteversion angles, and the results were compared with computer-generated measurements for correlation analysis. Spearman and Pearson correlation analyses demonstrated significant correlations between the proposed method and manual measurements for both the right group ( r = 0.795, P < 0.01) and the left group ( r = 0.859, P < 0.01). This method provides a reliable reference for orthopedic surgeons to assess postoperative prognosis.
Humans ; Acetabulum/anatomy & histology* ; Arthroplasty, Replacement, Hip/methods* ; Algorithms ; Hip Prosthesis ; Hip Joint/diagnostic imaging* ; Radiography ; Image Processing, Computer-Assisted/methods*

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 compare the anesthetic effect of different doses of esketamine combined with propofol in elderly patients underwent endoscopic retrograde cholangiopancreatography(ERCP),and explore the appropriate dose.Methods 105 elderly patients were selected for ERCP.The patients were divided into 3 groups with 35 cases in each group by random number table method.E1 group,E2 group and E3 group were given esketamine 0.15,0.35 and 0.50 mg/kg,respectively,and were given propofol 1.00 mg/kg intravenous injection 15 s later.Heart rate(HR),mean arterial pressure(MAP),and percutaneous arterial oxygen saturation(SpO2)were recorded after left lateral position(T0),at successful induction(T1),endoscope through larynx(T2),sphincter insertion or incision(T3),and at recovery(T4).Operation duration,intraoperative propofol dosage,anesthesia recovery time,visual analogue scale(VAS)score 15 min after anesthesia recovery and occurrence of adverse reactions were recorded.Results Compared with T0,HR and MAP decreased at T1,T2,T3 and T4 time point in E1 group,HR and MAP increased at T1,T2,T3 and T4 time point in E3 group,the differences were statistically significant(P<0.05);HR and MAP had no significant changes at T1,T2,T3 and T4 time point in E2 group(P>0.05);Compared with group E3,HR and MAP decreased at T1,T2,T3 and T4 time point in E1 group and E2 group,and E1 group was lower than E2 group,the differences were statistically significant(P<0.05);There were no significant difference in SpO2 at different time points between the three groups(P>0.05);Compared with E1 group,the dosage of propofol in E2 group and E3 group was decreased,and E3 group was significantly less than E2 group,with statistical significance(P<0.05).Compared with E3 group,the recovery time of E1 group and E2 group was shorter,and E2 group was shorter than E1 group,the differences were statistically significant(P<0.05).Compared with E1 group,pain VAS score 15 min after recovery in E2 group and E3 group was lower,and E3 group was lower than E2 group,the differences were statistically significant(P<0.05).There was no significant difference in operation time among 3 groups(P>0.05).The incidence of hypoxemia,respiratory depression and hypotension in E1 group were higher than that in E2 group and E3 group,the difference was statistically significant(P<0.05).The incidence of psychomimetic symptoms and visual disturbance in E3 group was higher than that in E1 group and E2 group,the difference was statistically significant(P<0.05).There were no significant differences in the incidence of dizziness and nausea vomiting among the 3 groups(P>0.05).Conclusion 0.35 mg/kg esketamine combined with propofol in the operation of ERCP in elderly patients,respiratory circulation is more stable,and adverse reactions do not increase.

Objective To compare the anesthetic effect of different doses of esketamine combined with propofol in elderly patients underwent endoscopic retrograde cholangiopancreatography(ERCP),and explore the appropriate dose.Methods 105 elderly patients were selected for ERCP.The patients were divided into 3 groups with 35 cases in each group by random number table method.E1 group,E2 group and E3 group were given esketamine 0.15,0.35 and 0.50 mg/kg,respectively,and were given propofol 1.00 mg/kg intravenous injection 15 s later.Heart rate(HR),mean arterial pressure(MAP),and percutaneous arterial oxygen saturation(SpO2)were recorded after left lateral position(T0),at successful induction(T1),endoscope through larynx(T2),sphincter insertion or incision(T3),and at recovery(T4).Operation duration,intraoperative propofol dosage,anesthesia recovery time,visual analogue scale(VAS)score 15 min after anesthesia recovery and occurrence of adverse reactions were recorded.Results Compared with T0,HR and MAP decreased at T1,T2,T3 and T4 time point in E1 group,HR and MAP increased at T1,T2,T3 and T4 time point in E3 group,the differences were statistically significant(P<0.05);HR and MAP had no significant changes at T1,T2,T3 and T4 time point in E2 group(P>0.05);Compared with group E3,HR and MAP decreased at T1,T2,T3 and T4 time point in E1 group and E2 group,and E1 group was lower than E2 group,the differences were statistically significant(P<0.05);There were no significant difference in SpO2 at different time points between the three groups(P>0.05);Compared with E1 group,the dosage of propofol in E2 group and E3 group was decreased,and E3 group was significantly less than E2 group,with statistical significance(P<0.05).Compared with E3 group,the recovery time of E1 group and E2 group was shorter,and E2 group was shorter than E1 group,the differences were statistically significant(P<0.05).Compared with E1 group,pain VAS score 15 min after recovery in E2 group and E3 group was lower,and E3 group was lower than E2 group,the differences were statistically significant(P<0.05).There was no significant difference in operation time among 3 groups(P>0.05).The incidence of hypoxemia,respiratory depression and hypotension in E1 group were higher than that in E2 group and E3 group,the difference was statistically significant(P<0.05).The incidence of psychomimetic symptoms and visual disturbance in E3 group was higher than that in E1 group and E2 group,the difference was statistically significant(P<0.05).There were no significant differences in the incidence of dizziness and nausea vomiting among the 3 groups(P>0.05).Conclusion 0.35 mg/kg esketamine combined with propofol in the operation of ERCP in elderly patients,respiratory circulation is more stable,and adverse reactions do not increase.

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 evaluate the efficacy and safety of matched sibling donor allogeneic hematopoietic stem cell transplantation (allo-HSCT) for the treatment of myelofibrosis (MF).Methods:In this case series, the clinical data of 18 patients with MF who received allo-HSCT in the Department of Hematology, Peking University People′s Hospital from December 2008 to December 2023 were retrospectively studied. Kaplan-Meier survival analysis and competitive risk model were used to evaluate the probabilities of 3-year overall survival (OS), disease-free survival (DFS), cumulative incidence of relapse (CIR), and transplant related mortality (TRM). The transplant related complications were also analyzed.Results:Among the 18 patients included, there were 12 males and 6 females, with a median age of 50 (range: 28-64) years. All 18 patients achieved neutrophil engraftment, and the time of neutrophil engraftment [ M ( Q1, Q3)] was 16.0 (11.8, 18.0) days. Twelve patients achieved platelet engraftment, and the platelet engraftment time was 21.0 (16.2, 43.2) days. Six patients had grade Ⅱ to Ⅳ acute graft-versus-host disease (GVHD), and six patients had chronic GVHD. The 3-year OS rate and DFS rate after transplantation were 62.2% and 52.2%, respectively. The 3-year CIR and TRM were 29.7% and 24.6%, respectively. Four patients died during follow-up, with the main cause of death being infections. Conclusion:Matched sibling allo-HSCT is a feasible option for the treatment of MF.

Human parvovirus B19 (HPVB19) belongs to Parvoviridae, a genus of erythrovirus, and has been associated with various human diseases, and HPVB19 infection is one of the most important causes of refractory anemia after allogeneic hematopoietic stem cell transplantation (allo-HSCT). This study retrospectively analyzed 24 patients with HSCT combined with HPVB19 infection to collate and summarize the clinical presentation, treatment, and regression of patients with combined HPVB19 infection after allo-HSCT and provide experience in the management of HPVB19 infection after allo-HSCT. The median age of the patients with HPVB19 infection was 25 years, and the median time of infection occurrence was +107 days after transplantation, and 22 (91.7% ) had anemia with a median hemoglobin (HGB) level of 77.5 (46-149) g/L, and 13 (54.2% ) had new-onset anemia or persistent decline in HGB. The median length of hospital stay was 19 days. Among patients with new-onset anemia or persistent decline in HGB, the mean increase in HGB after treatment with intravenous immunoglobulin and/or antiviral therapy was 15.69 g/L, and treatment was effective in 10 (76.92% ) patients. HPVB19 infection should be alerted to the development of refractory anemia after HSCT; despite the lack of specific treatment, the overall prognosis of HPVB19-infected patients is good.