Objective:To evaluate the safety of patients with hepatic adenoma undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) .Methods:A retrospective analysis of the clinical characteristics and prognosis of eight patients with hepatic adenoma who underwent allo-HSCT in the Hematology Department of Peking University People’s Hospital from January 2010 to March 2024 was conducted.Results:Of the eight patients who underwent allo-HSCT with hepatic adenoma, one patient was considered MDS-h transfusion-dependent and seven had aplastic anemia. The median age of the patients was 23 years (13-48 years). The median time from the diagnosis of AA or MDS to transplantation was 14 years (6-24 years), whereas the median time from taking androgens to diagnosing hepatic adenoma was 9 years (5-13 years). Six cases underwent haplo-HSCT, one case underwent matched unrelated donor HSCT, and one case underwent matched related donor HSCT. All patients achieved neutrophil engraftment at a median time of 11.5 days (11-20 days) and PLT engraftment within 60 days at a median of 19 days (10-37 days) after haplo-HSCT. Moreover, seven patients developed CMV anemia after transplantation, three patients had hemorrhagic cystitis, and two patients developed acute GVHD. During and after transplantation, eight patients did not show severe liver function damage or rupture of hepatic adenoma. In relation to imaging size, four patients showed varying degrees of reduction in hepatic adenoma size after transplantation, whereas four patients did not show significant changes in hepatic adenoma size after transplantation. The median follow-up time was 540.5 (30-2 989) days. Of the eight patients, six survived and two died. Furthermore, no direct correlation was observed between death and hepatic adenoma.Conclusion:Patients with hepatic adenomas undergoing allo-HSCT are not contraindications for transplantation, which will not increase transplant-related mortality.

Objective To analyze the therapeutic effect of self-adhesive absorbent fiber dressing on su-perficial ulcer of stage 2 pressure injury.Methods Sixty patients with stage 2 pressure injury superficial ul-cers(71 sites)in the thoracic surgery ICU of this hospital from October 2020 to October 2023 were selected and divided into the control group(30 cases,36 sites)and experimental group(30 cases,35 sites)according to the random number table method.The control group was added with the exudation absorption dressing on the basis of conventional pressure injury therapy,while the experimental group was added the self-adhesive ab-sorbent fiber on the basis of conventional pressure injury therapy.After 3 weeks,the clinical efficacy,healing time,dressing change times and pain score were observed and compared between the two groups.Results The total effective rate of clinical treatment in the experimental group was 100.0％(30/30),which was significant-ly higher than 90.0％(27/30)in the control group.The cure time of the experimental group was(17.35±4.17)d,which was significantly shorter than(30.58±4.65)d of the control group.The number of dressing changes in the experimental group was(15.43±1.21)times,which was significantly lower than(53.24±3.43)times in the control group.The pain score of the experimental group was(2.33±1.45)points,which was significantly lower than(8.71±0.52)points of the control group.The above indicators had statistical differences between the two groups(P＜0.05).Conclusion The effect of self-adhesive absorbent fiber in the treatment of stage 2 pressure injury superficial ulcer is obvious,which could increase the clinical curative effect,shorten the healing time,reduce the times of dressing change and relieve the pain of the patients,it has good clinical application value.

Objective To investigate associations between three-dimensional(3D)morphology of cervical vertebrae and skeletal mat-uration by cone-beam computed tomography(CBCT)and establish corresponding regression models for quantitatively evaluating cervical vertebral maturation(CVM).Methods The analyzed sample consisted of 358 CBCT images(175 male,183 female),of which 277 images were randomly selected as the model development group and 81 as the performance test group.Twenty-one 3D morphological pa-rameters were defined and measured,incorporating all parts of the cervical vertebrae,including the cervical vertebral bodies,transverse processes,spinous processes,pedicles,lamina,and articular processes.The cervical vertebral maturation index(CVMI)was determined by experienced orthodontists as reference standard.Spearman's rank correlation coefficient and multivariable stepwise regression analysis were used to identify the associations and build regression models.The performance test group was employed to ex-amine each model's reliability.Paired-samples Wilcoxon signed-rank test compared the CVMI of the model prediction with the reference standard.Results Three-dimensional morphological changes in various parts of the cervical vertebrae correlated with CVMI(P＜0.05).Six 3D morphometric parameters were each recognized for male and female models,three of which were identical.The adjusted R2 was 0.899 for males and 0.902 for females,with corresponding accuracies of 85.0%and 85.4%,respectively.These models showed no difference as compared with the reference standard(P＞0.05).Con-clusion New associations were found between 3D morphology of cer-vical vertebrae and skeletal maturation.The 3D-driven morphometric CVM assessment method and corresponding regression models exhibited good credibility and high consistency with experts.

Gynecological diseases are one of the important factors that threaten women's reproductive health.Endoplasmic reticulum(ER)stress is a stress response induced by the accumulation of unfolded or misfolded proteins in ER cavity when the female body is in a disease state,and the effects of different stress levels on the female reproductive system and the increase in the risk of female disease will vary greatly.Studies have shown that ER stress is closely related to the occurrence and development of gynecological diseases.Based on the relevant research reports at home and abroad in recent years,this paper summarizes the role of ER stress in several common gynecological diseases to provide new research ideas for preventing,diagnosing,and treating gynecological diseases.

Objective To mine adverse drug event(ADE)signals of doxycycline using the U.S.Food and Drug Administration Adverse Event Reporting System(FAERS)database,and provide scientific evidence for clinical medication safety.Methods The data from the FAERS database between the first quarter of 2004 and the first quarter of 2024 were extracted.After data cleaning and standardization,ADE reports with doxycycline as the main suspected drug were screened.The system organ class(SOC)of ADE was performed using MedDRA,and the reporting odds ratio method and Medicines and Healthcare products Regulatory Agency method were used to mine ADE signals.The information component method was also used to evaluate signal strength.Results A total of 43 126 ADE reports with doxycycline as the primary suspected drug were collected,involving 14 642 patients,with a higher proportion of female patients(57.32％).There were 555 related ADE signals involving 26 SOC,with the top 5 SOC being gastrointestinal disorders,skin and subcutaneous tissue disorders,injuries,poisonings,and procedural complications,psychiatric disorders,and infections and infestations.The top 5 ADE signals with the highest signal intensity were Hatch reaction,sclerosing cholangitis,esophageal ulcer,gastrointestinal mucosal necrosis,and gastrointestinal injury.Among the ADE signals with the strongest signal strength not listed in the package insert,the top five were sclerosing cholangitis,nephrogenic diabetes insipidus,minimal change glomerular nephritis,diabetes insipidus and Sixth cranial nerve paralysis.Conclusion In clinical practice,particular attention should be paid to the frequent ADEs caused by doxycycline,as well as those not yet documented in the package insert,which involve multiple SOC such as renal and urinary disorders,hepatobiliary diseases,blood and lymphatic system disorders,and endocrine disorders.Therefore,clinical pharmacists should play a key role in assisting clinicians to develop and implement prevention plans for ADEs,thereby improving the safety of doxycycline in clinical use.

Objective:To investigate the risk factors for the relapse of autoimmune pancreatitis (AIP) after steroid therapy.Methods:Clinical data of 72 AIP patients treated with steroids in Nanjing Drum Tower Hospital from January 2012 to December 2023 were collected retrospectively. AIP patients were divided into relapse group ( n=25) and non-relapse group ( n=47) based on the presence or absence of their relapse after steroid therapy. Patients' age of onset, gender, history of diabetes mellitus, first clinical manifestations, serum IgG4 and CA19-9 level, imaging features and other organ involvements were recorded. Oral prednisone was used at an initial dose of 0.6 mg·kg -1·d -1, gradually reduced to 5-10 mg/d and then maintained at a low dose. The follow-up period started from steroid initiation to the last follow-up or relapse. The presence of maintenance steroid treatment, time interval between onset and steroid initiation, the presence of significant IgG4 decrease and the presence of persistently enlarged pancreas after therapy were recorded. The cumulative relapse rate curve after steroid therapy was drawn by Kaplan-Meier method. Univariate and multivariate analyses were performed by Cox proportional hazard regression model. The receiver operator characteristic curves (ROC) were plotted and the area under the curve (AUC) was calculated. The Log-Rank test was used to analyze the differences on the relapse between different groups. The subgroup forest plot was drawn to assess the effect of risk factors on the relapse of AIP in different subgroups. Results:The 72 patients with AIP had a median follow-up of 42 (12-127) months. 34.7% (25/72) of patients relapsed after steroid therapy during the follow-up period. The percentages of patients whose first clinical manifestation was abdominal distension or acute pancreatitis, whose interval between onset and steroid initiation was more than 1 year and whose pancreases were persistently enlarged after steroid therapy in the relapse group were higher than those in the non-relapse group, and the differences were all statistically significant (all P value <0.05). The 1-, 3- and 5-year cumulative relapse rate after steroid therapy was 20.8%, 34.1% and 37.8%, respectively. Univariate analysis found that the first clinical manifestations of abdominal distension or acute pancreatitis, interval between onset and steroid initiation more than 1 year, and persistently enlarged pancreas after steroid therapy were all significantly associated with relapse (all P value <0.05). Multivariate analysis found that interval between onset and steroid initiation more than 1 year and persistently enlarged pancreas after steroid therapy were independent risk factors for relapse of AIP [hazard ratio ( HR)=3.606 and 6.515, 95% confidence interval (95% CI) 1.362-9.854 and 2.088-20.326]. Kaplan-Meier survival curves showed that the relapse rate after steroid therapy was higher in AIP patients whose interval between onset and steroid initiation was more than 1 year than in those whose interval was less than 1 year (55.6% versus 27.8%), and the relapse rate in AIP patients with persistently enlarged pancreas after steroid therapy was higher than that in those without it (77.8% versus 28.6%), and the differences were both statistically significant (both P<0.05). Subgroup forest plot showed that persistently enlarged pancreas after steroid therapy was an independent risk factor for relapse of AIP regardless of the presence of a diabetes mellitus history, the first manifestation of abdominal pain, the diffuse or focal type in pancreatic imaging, and the presence of dilated pancreatic duct or not (all P value <0.05). Conclusions:Time interval between onset and steroid initiation more than 1 year and persistently enlarged pancreas after steroid therapy were independent risk factors for the relapse of AIP after steroid therapy.

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To investigate the risk factors for postoperative fever in patients with negative preoperative urine culture undergoing flexible ureteroscopy (fURS), and construct a nomogram prediction model to predict the risk of postoperative fever.Methods:The clinical data of 308 patients who underwent flexible ureteroscopy (fURS) at the Second Affiliated Hospital of Zhengzhou University from January 2019 to March2023, were retrospectively analyzed. Among these patients, there were 235 males and 73 females, with an average age of (46.4±12.1) years old. Additionally, 86 cases had concomitant hypertension, 41 cases had diabetes, and 12 cases had coronary heart disease. A history of urinary stone surgery was present in 57 cases, and 91 cases exhibited severe hydronephrosis. The distribution of stones included 164 cases on the left side and 144 cases on the right side, with 88 cases of renal stones, 124 cases of ureteral stones, and 96 cases of renal-ureteral stones. Among them, 243 cases had ≤2 stones, while 65 cases had >2 stones, with a maximum stone diameter of 12.0 (9.0, 15.0) mm. Urine leukocyte-positive cases were 109, and urine leukocyte-negative cases were 199. Two cases were positive for nitrite, and 308 cases were negative. The occurrence of postoperative fever within 48 hours was recorded, and differences between the fever and non-fever groups were compared. Logistic regression analysis was employed to identify risk factors for post-fURS fever. A nomogram prediction model based on independent risk factors was constructed, and internal validation was conducted using 1 000 bootstrap resamples. The predictive performance of the model was evaluated using receiver operating characteristic (ROC) curves and the area under the curve (AUC). Model stability was assessed using calibration curves.Results:The surgeries for all 308 cases were successfully completed with a median operative time of 60.0 (40.0, 75.0) minutes. Complete stone clearance was achieved in 221 cases. Among them, 14 cases (4.5%) experienced postoperative fever, while 294 cases did not. The fever group had a higher proportion of females [57.1% (8/14) vs. 22.1% (65/294), P=0.007], more cases with comorbid diabetes [50.0% (7/14) vs. 11.6% (34/294), P<0.001], a higher proportion of renal stones [64.3% (9/14) vs. 26.9% (79/294), P=0.022], a lower intraoperative stone clearance rate [42.9% (6/14) vs. 73.1% (215/294), P=0.031], larger stone diameter [15.5 (12.5, 19.3) mm vs. 11.0 (9.0, 15.0) mm, P=0.004], longer operative time [87.5 (58.8, 106.3) min vs. 55.0 (40.0, 75.0) min, P<0.001], higher platelet count [267.0 (225.8, 354.0) ×10 9/L vs. 233.0 (197.8, 272.0) ×10 9/L, P=0.026], lower creatinine levels [67.5 (52.5, 72.3) umol/L vs. 73.0 (62.0, 84.0) umol/L, P=0.026], and a higher platelet lymphocyte ratio [148.8 (118.3, 189.3) vs. 119.5 (93.2, 156.0), P=0.030]. Results of univariate analysis showed that female gender, diabetes, stone location, incomplete stone clearance, maximum stone diameter, operative time, platelet count, creatinine, platelet lymphocyte ratio, and positive nitrite in urine (all P<0.05)were risk factors for postoperative fever. Multivariate regression analysis revealed that female gender ( OR=11.073, 95% CI 1.623-75.521, P=0.014), diabetes ( OR=5.995, 95% CI 1.441-24.952, P=0.014), and operative time ( OR=1.024, 95% CI 1.003-1.046, P=0.024) were independent risk factors for post-fURS fever. The nomogram exhibited excellent predictive performance (AUC=0.866, 95% CI 0.781-0.935), and the calibration curve demonstrated good consistency. Conclusions:Female gender, longer operative time, and diabetes are risk factors for post-fURS fever in patients with preoperative negative urine culture. The nomogram demonstrates excellent predictive performance.

Ginsenoside Rg5 is a rare ginsenoside showing promising tumor-suppressive effects.This study aimed to explore its radio-sensitizing effects and the underlying mechanisms.Human lung adenocarcinoma cell lines A549 and Calu-3 were used for in vitro and in vivo analysis.Bioinformatic molecular docking prediction and following validation by surface plasmon resonance(SPR)technology,cellular thermal shift assay(CETSA),and isothermal titration calorimetry(ITC)were conducted to explore the binding between ginsenoside Rg5 and 90 kD heat shock protein alpha(HSP90α).The effects of ginsenoside Rg5 on HSP90-cell division cycle 37(CDC37)interaction,the client protein stability,and the downstream regulations were further explored.Results showed that ginsenoside Rg5 could induce cell-cycle arrest at the G1 phase and enhance irradiation-induced cell apoptosis.It could bind to HSP90α with a high affinity,but the affinity was drastically decreased by HSP90α Y61A mutation.Co-immunoprecipitation(Co-IP)and ITC assays confirmed that ginsenoside Rg5 disrupts the HSP90-CDC37 interaction in a dose-dependent manner.It reduced irradiation-induced upre-gulation of the HSP90-CDC37 client proteins,including SRC,CDK4,RAF1,and ULK1 in A549 cell-derived xenograft(CDX)tumors.Ginsenoside Rg5 or MRT67307(an IKKe/TBK1 inhibitor)pretreatment suppressed irradiation-induced elevation of the LC3-Ⅱ/β ratio and restored irradiation-induced downregulation of p62 expression.In A549 CDX tumors,ginsenoside Rg5 treatment suppressed LC3 expression and enhanced irradiation-induced DNA damage.In conclusion,ginsenoside Rg5 may be a potential radiosensitizer for lung adenocarcinoma.It interacts with HSP90α and reduces the binding between HSP90 and CDC37,thereby increasing the ubiquitin-mediated proteasomal degradation of the HSP90-CDC37 client proteins.