Objective: To systematically review the modeling strategies, primary outcomes, and quantifiable effects in animal models of transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), acute hemolytic transfusion reaction (AHTR), and related transfusion paradigms. Subgroup meta-analysis was designated as the primary analytical framework, with the overall pooled effect treated as exploratory. Methods: We searched PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to December 30, 2025. Eligible studies utilized animal models to simulate transfusion-related adverse reactions and provided extractable quantitative outcomes. The SYRCLE tool was used to assess the risk of bias. Random-effects models were employed to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Prespecified subgroup analyses were conducted for TRALI, TACO, AHTR, and donor sex-related transfusion paradigms. Additional analyses included funnel plots, Egger/Begg tests, leave-one-out sensitivity analyses, and meta-regression based on publication year. Results: Twenty-one studies comprising 24 independent comparisons were included in the quantitative synthesis. The overall pooled estimate was OR=1.07 (95% CI:0.69-1.66), with substantial heterogeneity (I =96%). Subgroup analyses yielded the following estimates: TRALI, OR=0.83 (95%CI:0.57-1.21, I =97%); TACO, OR=1.85 (95%CI:0.54-6.34, I =93%); donor sex-related paradigms, OR=1.49 (95%CI:1.02-2.17, I =85%); and AHTR, OR=0.26 (95%CI:0.10-0.64, I =0%). Between-subgroup differences were statistically significant (P<0.000 1). Publication year was positively correlated with effect size (P=0.001 4). Most studies demonstrated unclear risk of bias across several SYRCLE domains due to incomplete methodological reporting. Conclusion: Animal models of transfusion-related adverse reactions exhibit significant structural heterogeneity across syndrome categories. Therefore, subgroup-specific and narrative syntheses are recommended as the primary presentation framework, rather than relying on a single overall pooled effect. Complement-targeted interventions in AHTR models demonstrated a consistent protective signal. In contrast, TRALI and TACO models require greater standardization in modeling protocols and endpoint definitions to reduce methodological variability.

OBJECTIVE: This study aimed to identify high-risk areas for type 2 diabetes mellitus (T2DM) mortality to provide relevant evidence for interventions in emerging economies. METHODS: Empirical Bayesian Kriging and a discrete Poisson space-time scan statistic were applied to identify the spatiotemporal clusters of T2DM mortality. The relationships between economic factors, air pollutants, and the mortality risk of T2DM were assessed using regression analysis and the Poisson Log-linear Model. RESULTS: A coastal district in East Guangdong, China, had the highest risk (Relative Risk [RR] = 4.58, P < 0.01), followed by the 10 coastal districts/counties in West Guangdong, China (RR = 2.88, P < 0.01). The coastal county in the Pearl River Delta, China (RR = 2.24, P < 0.01), had the third-highest risk. The remaining risk areas were two coastal counties in East Guangdong, 16 districts/counties in the Pearl River Delta, and two counties in North Guangdong, China. Mortality due to T2DM was associated with gross domestic product per capita (GDP per capita). In pilot assessments, T2DM mortality was significantly associated with carbon monoxide. CONCLUSION High mortality from T2DM occurred in the coastal areas of East and West Guangdong, especially where the economy was progressing towards the upper middle-income level.
Diabetes Mellitus, Type 2/epidemiology* ; China/epidemiology* ; Humans ; Risk Factors ; Spatio-Temporal Analysis ; Air Pollutants/analysis* ; Socioeconomic Factors ; Bayes Theorem ; Female ; Male ; Middle Aged

This study investigated the specific immune response of BALB/c mice that was induced by a circular RNA (circRNA) vaccine expressing the herpes simplex virus type II (HSV-2) glycoprotein D (gD). The aim was to evaluate the immunological potential of this vaccine and lay a foundation for developing an mRNA vaccine against HSV-2. PCR and homologous recombination were employed to integrate the gD gene obtained from the pT7AMP-gD ectodomain plasmid into pUC57 to generate the recombinant plasmid pUC57-circ-gD, which was then sequenced and characterized. In vitro transcription and cyclization were performed on the template DNA to generate pUC57-circ-gD mRNA. To validate the formation of circular RNA, we cleaved the pUC57-circ-gD mRNA with RNase R and employed RT-PCR to validate the cyclization. The pUC57-circ-gD mRNA was then transfected into 293T cells. After 72 h, the cell supernatant was collected, and Western blotting was employed to measure the protein level of gD. Subsequently, the mRNA was encapsulated in lipid nanoparticles (LNPs) by microfluidic encapsulation. BALB/c mice were administrated with the encapsulated mRNA, and blood was collected from the fundus venous plexus after 21 and 35 days, and from the enucleated eyeballs after 49 days. Enzyme-linked immunosorbent assay was employed to measure the titers of antibodies, including virus-neutralizing antibodies. After 49 days, spleens were harvested and assessed for secretion of interferon-gamma (IFN-γ) by solid-phase enzyme-linked immunospot. The results showed successful construction and sequencing of the recombinant plasmid. RNase R digestion confirmed the presence of circular RNAs. Western blotting of the 293T cells transfected with the mRNA showed clear specific bands. The quality of the vaccine was tested by size exclusion chromatography-high performance liquid chromatography, which showed that the purity of the vaccine was about 90%. The mRNA-LNP showcased the particle size of 82.76 nm and an encapsulation rate of approximately 98%. Following three-dose vaccination, all immunized mice exhibited steady weight gain with 100% survival rate throughout the 28-day observation period, indicating no significant acute toxicity associated with the vaccine formulation. The immunized mice showed dose-dependent increases in serum IgG antibody titer and IFN-γ secretion by splenocytes and they were resistant to virus attacks. These findings indicate good immunogenicity and persistence of the pUC57-circ-gD mRNA vaccine, providing a reference for further studies on circRNA vaccines.
Animals ; Mice, Inbred BALB C ; RNA, Circular ; Mice ; Humans ; Herpesvirus 2, Human/genetics* ; Viral Envelope Proteins/genetics* ; Antibodies, Viral/blood* ; HEK293 Cells ; Female ; Nanoparticles ; Plasmids

Objective To investigate the effect of ATP synthase inhibitory factor 1 (ATPIF1) on the antitumor activity of chimeric antigen receptor (CAR)-NK92 cells. Methods HER2-targeted CAR-NK92 cells with ATPIF1 overexpression or knockdown were constructed. CAR-positive expression rate was detected by flow cytometry. Cell proliferation capacity was measured using CCK-8 assay. Glycolytic capacity was analyzed by Seahorse metabolic analyzer. Mitochondrial membrane potential levels were detected using JC-1 probe. Target cell lysis rate was evaluated by firefly luciferase reporter assay. Expression levels of CD107a, natural-killer group 2 member D (NKG2D), granzyme B (GzmB), perforin, and interleukin 2 (IL-2) were detected via flow cytometry. Quantitative real-time PCR was used to measure the expression of interferon-induced protein with tetratricopeptide repeats 1 (IFIT1), tumor necrosis factor α (TNF-α), ATPIF1, and hexokinase 1 (HK1). The impact of glycolytic inhibition by 2-Deoxy-D-glucose (2-DG) on CAR-NK92 antitumor capacity was examined. Results Successfully generated HER2-targeting control CAR-NK92 cells, as well as ATPIF1-overexpressing and ATPIF1 knockdown CAR-NK92 cells. The ATPIF1-overexpressing CAR-NK92 cells showed significantly enhanced target cell lysis rate, elevated expression levels of NKG2D and CD107a, increased secretion capacities of Granzyme B (GzmB) and IL-2, and upregulated mRNA expression levels of IFIT1 and TNF-α, while ATPIF1-knockdown cells exhibited opposite effects. ATPIF1 overexpression induced metabolic reprogramming in CAR-NK92 cells, manifested by significantly decreased mitochondrial membrane potential (δpsim), markedly upregulated HK1 mRNA expression, and enhanced basal glycolysis and glycolytic capacity. After glycolysis inhibition with 2-DG (5 μmol/L), both ATPIF1-overexpressing and knockdown CAR-NK92 cells showed no significant differences in NKG2D and CD107a expression levels compared to control cells. Conclusion ATPIF1 regulates the antitumor activity of CAR-NK92 cells through modulating glycolytic metabolism. Overexpression of ATPIF1 can enhance the antitumor efficacy of CAR-NK92 cells.
Humans ; Glycolysis ; Killer Cells, Natural/metabolism* ; Receptors, Chimeric Antigen/immunology* ; Granzymes/genetics* ; Hexokinase/metabolism* ; Cell Line, Tumor ; Interleukin-2/genetics* ; Cell Proliferation ; NK Cell Lectin-Like Receptor Subfamily K/genetics* ; Membrane Potential, Mitochondrial

OBJECTIVE: To investigate the effectiveness of Xuanshen Yishen Decoction (XYD) in the treatment of hypertension. METHODS: Hospital electronic medical records from 2019-2023 were utilized to emulate a randomized pragmatic clinical trial. Hypertensive participants were eligible if they were aged ⩾40 years with baseline systolic blood pressure (BP) ⩾140 mm Hg. Patients treated with XYD plus antihypertensive regimen were assigned to the treatment group, whereas those who followed only antihypertensive regimen were assigned to the control group. The primary outcome assessed was the attainment rate of intensive BP control at discharge, with the secondary outcome focusing on the 6-month all-cause readmission rate. RESULTS: The study included 3,302 patients, comprising 2,943 individuals in the control group and 359 in the treatment group. Compared with the control group, a higher proportion in the treatment group achieved the target BP for intensive BP control [8.09% vs. 17.5%; odds ratio (OR)=2.29, 95% confidence interval (CI)=1.68 to 3.13; P<0.001], particularly in individuals with high homocysteine levels (OR=3.13; 95% CI=1.72 to 5.71; P<0.001; P for interaction=0.041). Furthermore, the 6-month all-cause readmission rate in the treatment group was lower than in the control group (hazard ratio=0.58; 95% CI=0.36 to 0.91; P=0.019), and the robustness of the results was confirmed by sensitivity analyse. CONCLUSIONS XYD could be a complementary therapy for intensive BP control. Our study offers real-world evidence and guides the choice of complementary and alternative therapies. (Registration No. ChiCTR2400086589).
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Antihypertensive Agents/pharmacology* ; Blood Pressure/drug effects* ; Drugs, Chinese Herbal/pharmacology* ; Hypertension/physiopathology* ; Patient Readmission ; Treatment Outcome

In tracheal resection and reconstruction, a technically demanding, complex, and high-risk procedure, management of the anastomotic site significantly impacts postoperative outcomes and long-term quality of life. However, comprehensive studies detailing perioperative anastomotic management strategies in tracheal reconstruction remain scarce. This review summarizes perioperative management strategies for tracheal reconstruction, covering preoperative assessment, surgical techniques, and other key aspects. It also highlights future research directions and challenges, aiming to provide clinicians with a systematic guide to perioperative management in tracheal reconstruction.

Prostate specific membrane antigen (PSMA) PET demonstrates superior accuracy compared to alternative imaging modalities in the diagnosis and treatment of prostate cancer. Nonetheless, subjective interpretation processes still result in false positives and false negatives, leading to erroneous or missed diagnoses, thereby compromising diagnostic efficacy, influencing preoperative grading and risk stratification, and interfering with clinical decision-making. With the rapid advancement of medical imaging technology and artificial intelligence, the role of radiomics is gaining prominence. By leveraging extracted image features and employing quantitative analysis, radiomics based on PSMA PET images holds great potential to enhance the capabilities of diagnosing, grading, quantifying risk, and predicting treatment efficacy in prostate cancer. This article aims to comprehensively review the research progress of PSMA PET radiomics in the clinical diagnosis and treatment of prostate cancer.

Objective To observe the effects of different doses remimazolam during induction of anesthesia in elderly patients with coronary heart disease undergoing non-cardiac surgery.Methods A total of 120 elderly patients with non-cardiac surgery for coronary heart disease and received general anesthesia under tracheal intubation at Luoyang Central Hospital Affiliated to Zhengzhou University from October 2023 to October 2024,aged 60-85 years.The patients were divided into 3groups by random number table:group R1,group R2 and group R3,with 40 cases in each group,with anesthesia was induced with intravenous injection of remimazolam of 0.2,0.25,0.3mg/kg,respectively.Before induction(T1),modified observers assessment of alertness/sedation(MOAA/S)score reached to 0 points(T2),15seconds after intubation(T3),mean arterial pressure(MAP),heart rate(HR),cardiac output(CO),stroke volume variation(SVV),systemic vascular resistance(SVR),and regional cerebral oxygen saturation(rScO2)were compared among the three groups,as well as the time to loss of consciousness,use of vasoactive drugs,and the incidence of hiccups and hypoxemia were recorded.Results Compared with the T1,MAP and SVR decreased significantly in all groups at T2,with group R2 and R3 showing lower values than group R1(P＜0.05);at T3,the MAP and HR in group R,was higher than group R2 and group R3 compared with T1,the MAP and HR in group R1 were significantly increased at T3(P＜0.05).There was no significant difference in CO,SVV and rScO2 among three groups at different time(P＞0.05).The time of loss of consciousness reduced with the increase of the dose of remimazolam.The application pro-portion of esmololhydrochloride in group R1 and group R2 was more than group R3 during induction of general anesthesia(P＜0.05).There was no significant difference in incidence of adverse events among three groups(P＞0.05).Conclusion Remimazolam can be used safely and effectively for the induction of general anesthesia in elderly patients with coronary heart disease undergoing non-cardiac surger-y,and doses of 0.3mg/kg is more effective for anesthesia induction.