Objective: To evaluate the clinical value of a restrictive red blood cell transfusion strategy in orthopedic patients by retrospectively analyzing the current transfusion practices and comparing postoperative outcomes across different transfusion thresholds. Methods: Clinical data of patients who underwent orthopedic surgery and received blood transfusions at a single hospital from 2015 to 2020 were retrospectively collected for descriptive analysis. Patients were then stratified into two groups based on pre-transfusion hemoglobin (Hb) thresholds:70-79 g/L group (n=92) and 80-89 g/L group (n=120), and their data were compared in terms of postoperative hematological parameters, functional recovery, transfusion volume, and adverse events. Results: Among patients receiving orthopedic surgery and transfusion, elderly females accounted for a relatively high proportion. Transfusion requirements varied significantly across different surgical types, with marked differences in red blood cell transfusion volumes (P<0.001). Revision arthroplasty and spinal surgery had higher median volumes (3.5-3.0 U). Subgroup analysis revealed that the 70-79 g/L group had significantly higher postoperative D-dimer and creatinine levels than the 80-89 g/L group (Z=-2.035, P=0.042; Z=-2.523, P=0.012). The pre-transfusion pain score was also significantly higher in the 70-79 g/L group (Z=-2.828, P=0.005), but no significant difference was observed in post-transfusion pain scores between the two groups (P>0.05). Conclusion: This study did not observe significant differences in postoperative adverse events, functional recovery, or transfusion volume-related indicators between the two transfusion thresholds. These findings provide clinical reference data for future studies on the safety and applicability of restrictive transfusion strategies in the orthopedic perioperative setting.

Objective To investigate whether Danshen injection (DSI) can protect human brain organoids from oxidative stress damage by regulating the Nrf2 signaling pathway and its mechanism. Methods A Nrf2 plasmid was constructed, lentivirus was packaged and transfected into human induced pluripotent stem cell (hiPSC) to form a stable cell line. Brain organoids with Nrf2 overexpression (LV-Nrf2 group) and knockdown (sh-Nrf2 group) were constructed using kit. The transfection efficiency was verified by real-time fluorescence quantitative polymerase chain reaction. An oxidative stress injury model was established by inducing hydrogen peroxide (H₂O₂). Intervention was performed either in combination or without DSI pre-treatment. Cell viability was detected by Cell Counting Kit-8 (CCK-8), and the expression levels of Nrf2, malondialdehyde (MDA), interleukin (IL)-1β, sex-determining region Y-box protein 2 (SOX2) and neuronal-specific nuclear protein (NeuN) were detected by Western blot and immunofluorescence staining. Total RNA from human brain organoids was extracted for transcriptome sequencing and analysis. Results LV-Nrf2 group and sh-Nrf2 group brain organoid models were successfully constructed. The CCK-8 results determined that the oxidative stress model was established with 32 mmol/L H₂O₂ intervention conditions. The fluorescence expression of Nrf2 in LV-Nrf2 group was higher than that in control group, and the fluorescence expressions of MDA and IL-1β were lower than those in control group; sh-Nrf2 group showed a damage phenotype of low Nrf2 expression, high MDA and IL-1β expression (all P < 0.05). Compared with H₂O₂ group, the Nrf2 signal in DSI + H₂O₂ group was stronger, and the levels of MDA and IL-1β were lower. Among them, the protective effect of LV-Nrf2 was the most significant. H₂O₂ treatment could down-regulate the protein levels of Nrf2, SOX2 and NeuN, and DSI intervention could effectively reverse the downward trend of these indicators. Sh-Nrf2 could weaken the recovery effect of DSI on SOX2 and NeuN, while LV-Nrf2 could synergistically enhance the regulatory effect of DSI. Conclusions DSI may antagonize oxidative stress damage in human brain organoids through the Nrf2 signaling pathway, and maintaining the stability of the neural cell lineage is its core therapeutic characteristic.

Objective To explore the factors affecting the success rate of operation in patients with end-stage renal disease by analyzing and comparing the differences of patients'basic conditions and clinical laboratory data.Methods A total of 107 patients who underwent forearm autogenous arteriovenous fistula surgery in Nujiang Lisu Autonomous Prefecture People's Hospital from January 2021 to August 2024 were selected and divided into AVF failure group and AVF success group according to whether internal fistula occluded during the operation or within 1 week after the operation.The basic data and clinical laboratory data of enrolled patients were collected.Correlation statistical methods were used to compare whether there were differences between the two indexes.Results Univariate analysis showed that there were statistically significant differences between the two groups in smoking history,diabetes history,nephritic syndrome history,gender,preoperative blood pressure,hemoglobin,low density lipoprotein and total cholesterol(P<0.05).However,There was no significant difference between the two in history,age,white blood cell count,neutrophil count,lymphocyte count,monocyte count,platelet,creatinine,urea nitrogen,triglyceride,blood calcium,blood phosphorus,calcium-phosphorus product,fibrinogen,D-dimer and albumin(P>0.05).Binary Logistic regression analysis showed that gender,diabetes history,nephritic syndrome history,preoperative blood pressure,hemoglobin and low-density lipoprotein were independent risk factors for AVF initiation failure(P<0.05).Conclusion Female patients,history of diabetes mellitus,history of nephrotic syndrome,low hemoglobin,elevated low-density lipoprotein,and poor blood pressure control are independent factors affecting the failure of AVF initiation.

Objective:To explore the impact of the interaction between alcohol consumption and overweight/obesity on the risk of hypertension.Methods:It was a cross-sectional study, and convenient sampling was used to enroll physical examination participants aged 18-60 years from the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, the Affiliated Hospital of Southwest Medical University and Luzhou People′s Hospital from June to November in 2020. All the participants were given questionnaire survey, physical examination and biochemical tests. A total of 5 000 questionnaires were distributed in the study, and 4 878 questionnaires were collected, of which 4 397 (90.14%) were valid. According to the diagnostic criteria for hypertension, the study participants were divided into hypertension group (1 128 cases) and non-hypertension group (3 269 cases), and t-test and chi-square test were used to compare the differences in gender, age, and other data between the two groups; and multivariate logistic regression analysis was used to analyze the association of alcohol consumption, overweight/obesity with the risk of hypertension and the interaction between alcohol consumption and overweight/obesity on the risk of hypertension, and relative excess risk of interaction, attributable proportion of interaction and the synergy index were used to evaluate the impact of the interaction between alcohol consumption and overweight/obesity on the risk of hypertension. Results:Among the 4 397 individuals included in the analysis, 3 116 were male and 1 281 were female, with a mean age of (42.42±8.83) years. The detection rate of hypertension was 25.7% (1 128/4 397). The risk of hypertension in overweight/obese individuals was 2.566 times ( OR=2.566, 95% CI: 2.167-3.038) higher than that of non-overweight/obese individuals, and the risk of hypertension in alcohol consumption individuals was 1.486 times ( OR=1.486, 95% CI: 1.250-1.766) higher than that of non-drinkers. The risk of hypertension in drinking+non-overweight/obesity group, non-drinking+overweight/obesity group, and drinking+overweight/obesity group was 1.468 times ( OR=1.468, 95% CI: 1.112-1.936), 2.538 times ( OR=2.538, 95% CI: 1.968-3.272), and 3.796 times ( OR=3.796, 95% CI: 2.963-4.863) higher than that of non-drinking+non-overweight/obesity group, respectively (all P<0.05). Alcohol consumption and overweight/obesity had an additive interaction effect on the risk of hypertension, and the relative excess risk of interaction, attributable proportion of interaction and the synergy index was 0.791 (95% CI: 0.158-1.424), 0.208 (95% CI: 0.049-0.368), 1.394 (95% CI: 1.030-1.888), respectively. There was no significant multiplicative interaction between alcohol consumption and overweight/obesity on the risk of hypertension ( P>0.05). Conclusions:Alcohol consumption and overweight/obesity are both associated higher risk of hypertension. In addition, there is an additive interaction between alcohol consumption and overweight/obesity on the risk of hypertension.

Objective:To review the literature on surrogate decision making in stroke patients, and to clarify the application status of proxy decision making in stroke patients.Methods:Using the scope review guide as the methodological framework, studies on the application of surrogate decision in stroke patients, PubMed, Medline, CINAHL, Web of Science, Cochrane Library, CNKI, Wanfang, China Biology Medicine databases were searched from the database inception to January 12, 2024.Results:A total of 20 articles were included, including 12 cross-sectional studies, 6 qualitative studies, 1 cohort study, and 1 case report. At present, surrogate decision was mainly used in brain surgery, tube placement and comfort care. The agent had a complicated mood when making a decision and self-doubt after making a decision. Agency decision making was susceptible to demographic factors, disease-related factors, cultural factors, emotional and psychological factors and other factors. Although the outcomes of most proxy decisions were in line with patient preferences, there was a difference in the estimates of prognosis between agents and medical staff.Conclusions:Proxy decision making is widely used in the field of stroke, but the psychological burden of agents is heavy. Developing advance care planning for stroke patients and developing decision aids may help agents make the best decision.

Objective:To explore the effects of Ziyu Ointment on granulation tissue,TGF-β and downstream Smad protein in the process of wound healing in rats by constructing a rat model of back trauma.Methods:A rat model of back trauma was constructed,and 100 SD male rats were separated into healthy group,back trauma group,Ziyu Ointment treatment group,petrolatum treatment group,Ziyu Ointment+TGF-β1 activation group,with 20 per group.Wound formation surgery was performed,and wound healing of rats in each group was recorded at 5th,10th,and 15th day after operation;the levels of IL-6,IL-1β and TNF-α in the serum of rats in each group were detected;the granulation tissue formed by wound healing at 15th day was selected for HE and Masson staining,the proportion of blood vessel area and collagen area of granulation tissue of rats in each group were analyzed and calculated;the mRNA expression levels of TGF-β1 and Smad3 in granulation tissues of rats in each group were detected by fluorescence quantitative PCR;the expression levels of TGF-β1,Smad3 and p-Smad3 in granulation tissues of rats in each group were detected by Western blot.Results:The healthy group rats had complete epidermal tissue;the levels of serum IL-6,IL-1β,TNF-α,the expression of TGF-β1 mRNA and protein in the wound granulation tissue,and the phosphorylation of Smad3 in the back trauma group were obviously higher than the healthy group(P<0.05);compared with back trauma group,the wound healing rate,proportion of collagen area,and propor-tion of blood vessel area in Ziyu Ointment treatment group and petrolatum treatment group were obviously increased,the serum IL-6,IL-1β,TNF-α contents,TGF-β1 mRNA and protein expression,and Smad3 phosphorylation were obviously decreased(P<0.05);compared with Ziyu Ointment treatment group,the petrolatum treatment group,Ziyu Ointment+TGF-β1 activation group had obviously lower wound healing rate,collagen area percentage,and blood vessel area percentage,and obviously lower serum IL-6,IL-1β,TNF-α contents,TGF-β1 mRNA and protein expression and Smad3 phosphorylation(P<0.05).Conclusion:Ziyu Ointment can inhibit the expression of related genes and proteins by regulating the TGF-β/Smad signal pathway,thereby alleviating inflammation and promoting wound healing.

Objective To explore the effects of Dushu pills on cognitive ability and mitochondrial dynamics related proteins in mouse model of Alzheimer's disease(AD)based on network pharmacology.Methods The corresponding targets of Dushu pills and its related targets with AD were predicted using TCMSP database.The intersection targets of Dushu pills and AD were obtained by Venny website.The protein interaction network and drug-disease-target network were mapped using String database and Cytoscape software,respectively.GO and KEGG enrichment analysis were performed for intersection targets using David database.The mouse model of AD was established by injecting Aβ25-35 into bilateral ventricles.The learning and memory ability of the mice was detected by behavioral tests,the mitochondrial damage of neurons in the hippocampus was observed by transmission electron microscopy,and the expression of proteins related to mitochondrial dynamics was detected by Western blot.Results A total of 311 intersection targets related to drugs and diseases were screened out from the database.GO and KEGG analysis showed that the relevant targets were concentrated in mitochondria and other components,and concentrated in the pathways of ATP binding and positive regulation of MAPK activity.Compared with the normal group,the learning and memory ability of the model group was decreased(P<0.05),mitochondrial ridges appeared swelling and fracture(P<0.0001),decreased expression of MAPK,Mfn2 and OPA1 proteins in hippocampus(P<0.01),the expression of DRP1 protein increased(P<0.01).Compared with the model group,the learning and memory ability of mice in the medium and high dose groups of Dushu pills was improved(P<0.05),mitochondrial damage was significantly improved(P<0.01),increased expression of MAPK,Mfn2 and OPA1 in the hippocampus(P<0.01),DRP1 protein expression decreased(P<0.01).Conclusion Dushu pills can reduce mitochondrial damage,maintain mitochondrial homeostasis,and improve the cognitive and memory ability of AD mice.

Objective:To explore the effects of Ziyu Ointment on granulation tissue,TGF-β and downstream Smad protein in the process of wound healing in rats by constructing a rat model of back trauma.Methods:A rat model of back trauma was constructed,and 100 SD male rats were separated into healthy group,back trauma group,Ziyu Ointment treatment group,petrolatum treatment group,Ziyu Ointment+TGF-β1 activation group,with 20 per group.Wound formation surgery was performed,and wound healing of rats in each group was recorded at 5th,10th,and 15th day after operation;the levels of IL-6,IL-1β and TNF-α in the serum of rats in each group were detected;the granulation tissue formed by wound healing at 15th day was selected for HE and Masson staining,the proportion of blood vessel area and collagen area of granulation tissue of rats in each group were analyzed and calculated;the mRNA expression levels of TGF-β1 and Smad3 in granulation tissues of rats in each group were detected by fluorescence quantitative PCR;the expression levels of TGF-β1,Smad3 and p-Smad3 in granulation tissues of rats in each group were detected by Western blot.Results:The healthy group rats had complete epidermal tissue;the levels of serum IL-6,IL-1β,TNF-α,the expression of TGF-β1 mRNA and protein in the wound granulation tissue,and the phosphorylation of Smad3 in the back trauma group were obviously higher than the healthy group(P<0.05);compared with back trauma group,the wound healing rate,proportion of collagen area,and propor-tion of blood vessel area in Ziyu Ointment treatment group and petrolatum treatment group were obviously increased,the serum IL-6,IL-1β,TNF-α contents,TGF-β1 mRNA and protein expression,and Smad3 phosphorylation were obviously decreased(P<0.05);compared with Ziyu Ointment treatment group,the petrolatum treatment group,Ziyu Ointment+TGF-β1 activation group had obviously lower wound healing rate,collagen area percentage,and blood vessel area percentage,and obviously lower serum IL-6,IL-1β,TNF-α contents,TGF-β1 mRNA and protein expression and Smad3 phosphorylation(P<0.05).Conclusion:Ziyu Ointment can inhibit the expression of related genes and proteins by regulating the TGF-β/Smad signal pathway,thereby alleviating inflammation and promoting wound healing.

Objective:To review the literature on surrogate decision making in stroke patients, and to clarify the application status of proxy decision making in stroke patients.Methods:Using the scope review guide as the methodological framework, studies on the application of surrogate decision in stroke patients, PubMed, Medline, CINAHL, Web of Science, Cochrane Library, CNKI, Wanfang, China Biology Medicine databases were searched from the database inception to January 12, 2024.Results:A total of 20 articles were included, including 12 cross-sectional studies, 6 qualitative studies, 1 cohort study, and 1 case report. At present, surrogate decision was mainly used in brain surgery, tube placement and comfort care. The agent had a complicated mood when making a decision and self-doubt after making a decision. Agency decision making was susceptible to demographic factors, disease-related factors, cultural factors, emotional and psychological factors and other factors. Although the outcomes of most proxy decisions were in line with patient preferences, there was a difference in the estimates of prognosis between agents and medical staff.Conclusions:Proxy decision making is widely used in the field of stroke, but the psychological burden of agents is heavy. Developing advance care planning for stroke patients and developing decision aids may help agents make the best decision.

Objective To explore the effects of Dushu pills on cognitive ability and mitochondrial dynamics related proteins in mouse model of Alzheimer's disease(AD)based on network pharmacology.Methods The corresponding targets of Dushu pills and its related targets with AD were predicted using TCMSP database.The intersection targets of Dushu pills and AD were obtained by Venny website.The protein interaction network and drug-disease-target network were mapped using String database and Cytoscape software,respectively.GO and KEGG enrichment analysis were performed for intersection targets using David database.The mouse model of AD was established by injecting Aβ25-35 into bilateral ventricles.The learning and memory ability of the mice was detected by behavioral tests,the mitochondrial damage of neurons in the hippocampus was observed by transmission electron microscopy,and the expression of proteins related to mitochondrial dynamics was detected by Western blot.Results A total of 311 intersection targets related to drugs and diseases were screened out from the database.GO and KEGG analysis showed that the relevant targets were concentrated in mitochondria and other components,and concentrated in the pathways of ATP binding and positive regulation of MAPK activity.Compared with the normal group,the learning and memory ability of the model group was decreased(P<0.05),mitochondrial ridges appeared swelling and fracture(P<0.0001),decreased expression of MAPK,Mfn2 and OPA1 proteins in hippocampus(P<0.01),the expression of DRP1 protein increased(P<0.01).Compared with the model group,the learning and memory ability of mice in the medium and high dose groups of Dushu pills was improved(P<0.05),mitochondrial damage was significantly improved(P<0.01),increased expression of MAPK,Mfn2 and OPA1 in the hippocampus(P<0.01),DRP1 protein expression decreased(P<0.01).Conclusion Dushu pills can reduce mitochondrial damage,maintain mitochondrial homeostasis,and improve the cognitive and memory ability of AD mice.