ObjectiveTo evaluate the efficacy and possible mechanism of Wei's Huoxue Tongluo Formula （韦氏活血通络方，WHTF） in treating atrophic-stage non-arteritic anterior ischemic optic neuropathy （NAION） with qi deficiency and blood stasis. MethodsA total of 82 atrophic-stage NAION patients with qi deficiency and blood stasis were randomly divided into a treatment group and a control group， with 41 cases in each group. The treatment group was given oral administration of WHTF twice a day plus acupoint injection of distilled water 2 ml at Taiyang （EX-HN5） once daily， while the control group received injection of compound anisodine injection 2 ml at Taiyang （EX-HN5） once daily and oral administration of WHTF placebo twice a day. Both groups received treatment for a course of 14 days. The best-corrected visual acuity （BCVA）， optic disc perfusion density （PD）， flux index （FI）， macular superficial PD， vascular density （VD）， and traditional Chinese medicine （TCM） syndrome scores were compared between groups before treatment and on day 7 and day 14 of treatment. Additionally， mean defect （MD） and mean sensitivity （MS） of visual fields were measured before treatment and on day 14， along with safety evaluation. ResultsAfter treatment， both groups showed significant improvement in BCVA， visual field MD and MS， and TCM syndrome scores （P＜0.05 or P＜0.01）. On day 14 of treatment， the TCM syndrome score in the treatment group was significantly lower than that in the control group （P＜0.05）. There was no significant improvement in optic disc PD and FI， and macular superficial PD and VD after treatment in either group （P＞0.05） except that on day 7 the macular superficial foveal PD in the control group was significantly better than that in the treatment group （P＜0.05）. During the treatment period， no serious adverse events occurred in either group. ConclusionWHTF can improve the visual function indicators including visual acuity and visual field， as well as TCM syndrome scores in atrophic-stage NAION patients with qi deficiency and blood stasis. It shows clinical safety， although it does not appear to have a significant effect on optic disc or macular blood flow.

OBJECTIVE To investigate the role of clinical pharmacists in the individualized treatment of a rare case of diffuse pulmonary microabscesses caused by Streptococcus constellatus complicated with organizing pneumonia （OP） in a non-immunocompromised patient. METHODS For a middle-aged， non-immunocompromised patient with a one-year disease course， whose imaging findings showed the coexistence of diffuse microabscesses and OP caused by S. constellatus pulmonary abscess， the clinical pharmacist， based on pharmacokinetics/pharmacodynamics characteristics， assisted the physician in optimizing the previously ineffective anti-infective regimen to Ceftriaxone sodium for injection combined with Metronidazole and sodium chloride injection， so as to enhance coverage of mixed anaerobes and lesion penetration. After the patient’s hemoptysis ceased， the clinical pharmacist recommended timely initiation of low-dose Methylprednisolone sodium succinate for injection to manage OP. Upon discharge， sequential oral therapy with Linezolid tablets， Metronidazole tablets， Methylprednisolone tablets and Omeprazole enteric-coated tablets was prescribed. RESULTS After implementation of the individualized treatment regimen， the patient’s hemoptysis resolved， pulmonary lesions significantly regressed， and the patient was discharged in a stable condition. At the three-month follow-up， the patient remained stable. CONCLUSIONS For chronic persistent pulmonary infection complicated with OP in a non-immunocompromised host， clinical pharmacists assist clinicians in optimizing anti-infective regimens and recommend the timely initiation of anti-inflammatory therapy after infection control， thereby contributing to favorable clinical outcomes. Individualized treatment of such complex cases requires comprehensive consideration of pathogen coverage， pathological barriers， and the timing of anti-inflammatory intervention.

Objective: To characterize perioperative dynamic changes in immune-cell phenotypes and inflammatory cytokines in patients undergoing CPB (cardiopulmonary bypass) cardiac surgery, and to explore their associations with postoperative outcomes. Methods: In this prospective cohort study, 120 adult patients who underwent elective cardiac surgery under CPB at West China Hospital from May 2022 to March 2023 were enrolled. Perioperative immune-cell phenotypes and concentrations of 40 inflammation-related cytokines were measured. The primary outcomes were the sequential organ failure assessment (SOFA) score at 24 h after surgery and ΔSOFA (the peak SOFA score within 48 h after surgery minus the preoperative SOFA score). Secondary outcomes included major adverse cardiovascular events (MACE), acute kidney injury (AKI), respiratory failure, severe liver injury, and infection. Results: The mean age of enrolled patients was 57±10 years. Of these, 52% (62/120) were male and 90% (108/120) underwent valve surgery. During the rewarming to the end of CPB, neutrophil counts rapidly increased (7.39×10 /L vs preoperative 3.07×10 /L, P<0.001), with significant upregulation of CD11b (7.30×10 /L vs preoperative 3.05×10 /L, P<0.001) and CD54 (7.15×10 /L vs preoperative 2.99×10 /L, P<0.001). Lymphocyte counts increased at the end of CPB (1.75×10 /L vs preoperative 1.12×10 /L, P<0.001) but decreased significantly at 24 h after surgery (0.59×10 /L vs preoperative 1.12×10 /L, P<0.001). Plasma analysis showed that multiple pro-inflammatory cytokines increased during CPB and remained elevated up to 24 h after surgery; five chemokines and the anti-inflammatory cytokine IL-10 peaked at the end of CPB. The SOFA score increased from 1 (1, 2) preoperatively to 7 (5, 10) at 24 h after surgery, with a ΔSOFA of 6 (4, 8). Within 30 days after surgery, 48 patients (40.0%) developed AKI, 17 (14.2%) developed infection, 4 (3.3%) developed severe liver injury, 3 (2.5%) developed respiratory failure, and 3 (2.5%) experienced MACE. During the 2-year follow-up, 8 patients (6.7%) experienced MACE and 5 (4.2%) died. Conclusion: Multi-organ dysfunction is common after cardiac surgery under CPB (median ΔSOFA, 6), accompanied by perioperative activation of multiple immune-cell subsets and upregulation of pro-inflammatory, anti-inflammatory, and chemotactic mediators. This study provides data-driven evidence and research clues for further investigation of the associations between CPB-related immune perturbations and postoperative organ dysfunction and clinical outcomes.

Objectives: . The prognostic value of the pretreatment albumin-to-alkaline phosphatase ratio (AAPR) in head and neck cancer (HNC) remains uncertain. This meta-analysis aimed to evaluate the predictive role of AAPR for survival outcomes in patients with HNC. Methods: . A comprehensive search of the Cochrane Library, PubMed, and Embase databases was conducted to identify relevant studies published up to July 30, 2024. We included studies on AAPR and survival outcomes in HNC patients. Results: . Eight studies comprising 1,737 HNC patients were analyzed using random-effects models. Lower AAPR values were significantly correlated with worse overall survival (hazard ratio [HR], 2.08), progression-free survival (HR, 2.00), and disease-free survival (HR, 2.18). Sensitivity analyses confirmed the robustness of these results, with no significant publication bias detected. Conclusion . Our findings suggest that pretreatment AAPR could serve as a valuable and cost-effective prognostic indicator in HNC, potentially aiding clinicians in risk stratification and treatment decision-making. However, additional validation studies are warranted to confirm its clinical applicability.

Objective To investigate the prognostic value of tissue plasminogen activator-inhibitor complex(tPAIC)for mortality in patients with sepsis associated thrombocytopenia(SAT).Methods A retrospective analysis was conducted on the clinical data of 74 patients with SAT admitted to the Intensive Care Unit of the 908th Hospital of the Joint Logistics Support Force of PLA between Septem-ber 2017 and December 2021.Based on 28-day follow-up for outcomes,the patients were divided into survival group(43 cases)and death group(31 cases).The Boruta algorithm based on random forest and Lasso regression algorithm were used to screen the risk fac-tors from a total of 29 candidate variables,including age,sex,SOFA score on admission,APACHE Ⅱ score,and various hematological indexes,(e.g.,white blood cell count).The time-dependent receiver operating characteristic(ROC)curves and the survival analysis were performed for the key variables identified.Results Compared with the survival group,the nonsurvivors in death group had signif-icantly higher SOFA and APACHE Ⅱ scores.The levels of thrombomodulin(TM),thrombin-antithrombin complex(TAT),and tissue plasminogen activator inhibitor complex(tPAIC)were also markedly elevated in death group(P＜0.05).Similarly,PT,APTT,TT,FDP,and D-dimer in the death group were significantly higher than those in survivalroup,whereas the fibrinogen levels were signifi-cantly decreased(P＜0.05).The levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(T-Bil),and lactate(Lac)levels were likewise significantly elevated in the death group.Random forest and Lasso regression analysis identified SOFA score,tPAIC,INR,and Lac as the independent risk factors of mortality in the patients with sepsis-associated thrombo-cytopenia(SAT)patients.Time-dependent ROC curve analysis showed that a higher C-index and average area under the curve(AUC)in tPAIC than any other variables for predicting the prognosis of SAT patients.Kaplan-Meier survival analysis stratified by the optimal cutoff value of tPAIC(38.9 ng/mL)revealed that a 2.31-fold higher 28-day survival rate in the patients with tPAIC＜38.9 ng/mL group compared those with tPAIC ≥38.9 ng/mL.Conclusion tPAIC demonstrates significant predictive value for mortality in SAT patients.

Objective To establish a risk prediction model of continuous renal replacement therapy(CRRT)withdrawal failure in patients with infectious shock complicating acute kidney injury(AKI)based on the decision tree algorithm,and to explore the influencing factors of CRRT withdrawal failure in patients with infectious shock complicating AKI.Methods 220 patients with infectious shock complicating AKI admitted to our hospital from May 2020 to May 2023 were retrospectively analyzed,and divided into success group and failure group according to the success or failure of the withdrawal,univariate and multivariate Logistic regression analysis were used to screen risk factors of CRRT withdrawal failure in patients with septic shock complicated with AKI,C-reactive protein/albumin(CRP/ALB)at admission and sepsis-related organ failure assessment(SOFA)score at withdrawal,acute physiology and chronic health evaluation(APACHE Ⅱ)score,N-terminal B-type natriuretic peptide(NT-proBNP)level at the beginning of CRRT,mean arterial pressure(MAP)grading,urine volume after withdrawal,and serum creatinine(Scr)level after withdrawal were taken into constructing a decision tree model and validating the model efficacy.Results In this study,there were 41.82％of patients failed to withdrawal.Combination of univariate and multivariate Logistic regression analysis showed that SOFA score at withdrawal,APACHE Ⅱ scores,urine volume after withdrawal,Scr level after withdrawal,NT-proBNP at the beginning of CRRT,and MAP grading,CRP/ALB at the time of admission were an independent risk factor for CRRT withdrawal failure in patients with septic shock complicated with AKI(P＜0.05).The results showed that the higher CRP/ALB was the most important influencing factor on the failure of CRRT evacuation in patients with infectious shock complicating AKI,and the area under the receiver operating characteristic curve was 0.965.Conclusion The decision tree model constructed by CRP/ALB at admission,SOFA score at withdrawal,urine volume after withdrawal,Scr level after withdrawal,APACHE Ⅱ score,and MAP grading has a better predictive efficacy of CRRT withdrawal failure in patients with infectious shock complicating AKI,which is a guideline for patients'prognostic assessment.

Objective To establish a risk prediction model of continuous renal replacement therapy(CRRT)withdrawal failure in patients with infectious shock complicating acute kidney injury(AKI)based on the decision tree algorithm,and to explore the influencing factors of CRRT withdrawal failure in patients with infectious shock complicating AKI.Methods 220 patients with infectious shock complicating AKI admitted to our hospital from May 2020 to May 2023 were retrospectively analyzed,and divided into success group and failure group according to the success or failure of the withdrawal,univariate and multivariate Logistic regression analysis were used to screen risk factors of CRRT withdrawal failure in patients with septic shock complicated with AKI,C-reactive protein/albumin(CRP/ALB)at admission and sepsis-related organ failure assessment(SOFA)score at withdrawal,acute physiology and chronic health evaluation(APACHE Ⅱ)score,N-terminal B-type natriuretic peptide(NT-proBNP)level at the beginning of CRRT,mean arterial pressure(MAP)grading,urine volume after withdrawal,and serum creatinine(Scr)level after withdrawal were taken into constructing a decision tree model and validating the model efficacy.Results In this study,there were 41.82％of patients failed to withdrawal.Combination of univariate and multivariate Logistic regression analysis showed that SOFA score at withdrawal,APACHE Ⅱ scores,urine volume after withdrawal,Scr level after withdrawal,NT-proBNP at the beginning of CRRT,and MAP grading,CRP/ALB at the time of admission were an independent risk factor for CRRT withdrawal failure in patients with septic shock complicated with AKI(P＜0.05).The results showed that the higher CRP/ALB was the most important influencing factor on the failure of CRRT evacuation in patients with infectious shock complicating AKI,and the area under the receiver operating characteristic curve was 0.965.Conclusion The decision tree model constructed by CRP/ALB at admission,SOFA score at withdrawal,urine volume after withdrawal,Scr level after withdrawal,APACHE Ⅱ score,and MAP grading has a better predictive efficacy of CRRT withdrawal failure in patients with infectious shock complicating AKI,which is a guideline for patients'prognostic assessment.

Objective To construct a Ca2+/calmodulin-dependent protein kinase Ⅱ(CaMKⅡ)long-fragment fusion protein plasmid;investigate the expression,extraction,and purification of CaMK Ⅱ;and identify its binding to the Cav1.2 channel.Methods The extracted pGEX-6p-1/CaMK Ⅱ long-fragment plasmid was transformed into Escherichia coli BL21 receptor cells and cultured in a shaking incubator for 12 h.Isopropyl β-D-thiogalactoside was added to promote GST fusion protein expression.Next,the GST-CaMK Ⅱ long frag-ment was isolated and purified with GS-4B using dithiothreitol(DTT)combined with ultrasonic crushing.After treatment with the PreScis-sion protease,the GST label was removed to obtain the CaMK Ⅱ long-fragment protein.The molecular weight and relative purity of the CaMKⅡ long-fragment protein were determined using 15％sodium dodecyl sulfate-polyacrylamide gel electrophoresis(SDS-PAGE).The concentration of the purified protein was determined using the Bradford method.The binding ability of the CaMK Ⅱ long-fragment pro-tein to the Cav1.2 channel protein was evaluated using the pull-down method combined with Western blotting.Results The sequencing results showed that the CaMK Ⅱ long fragment was successfully constructed.A CaMK Ⅱ long-fragment protein with high purity and con-centration was obtained using DTT combined with ultrasonic crushing.This protein can bind to the CT1 protein of cardiac Cav1.2 calcium channel.Conclusion In this study,we successfully constructed a CaMKⅡ long-fragment plasmid.The CaMKⅡ long-fragment protein was extracted and purified,and was determined to bind to Cav1.2 channel proteins and exhibit biological activity.Collectively,this study provides a basis for further study of the function of CaMK Ⅱ.

Objective To investigate the prognostic value of tissue plasminogen activator-inhibitor complex(tPAIC)for mortality in patients with sepsis associated thrombocytopenia(SAT).Methods A retrospective analysis was conducted on the clinical data of 74 patients with SAT admitted to the Intensive Care Unit of the 908th Hospital of the Joint Logistics Support Force of PLA between Septem-ber 2017 and December 2021.Based on 28-day follow-up for outcomes,the patients were divided into survival group(43 cases)and death group(31 cases).The Boruta algorithm based on random forest and Lasso regression algorithm were used to screen the risk fac-tors from a total of 29 candidate variables,including age,sex,SOFA score on admission,APACHE Ⅱ score,and various hematological indexes,(e.g.,white blood cell count).The time-dependent receiver operating characteristic(ROC)curves and the survival analysis were performed for the key variables identified.Results Compared with the survival group,the nonsurvivors in death group had signif-icantly higher SOFA and APACHE Ⅱ scores.The levels of thrombomodulin(TM),thrombin-antithrombin complex(TAT),and tissue plasminogen activator inhibitor complex(tPAIC)were also markedly elevated in death group(P＜0.05).Similarly,PT,APTT,TT,FDP,and D-dimer in the death group were significantly higher than those in survivalroup,whereas the fibrinogen levels were signifi-cantly decreased(P＜0.05).The levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(T-Bil),and lactate(Lac)levels were likewise significantly elevated in the death group.Random forest and Lasso regression analysis identified SOFA score,tPAIC,INR,and Lac as the independent risk factors of mortality in the patients with sepsis-associated thrombo-cytopenia(SAT)patients.Time-dependent ROC curve analysis showed that a higher C-index and average area under the curve(AUC)in tPAIC than any other variables for predicting the prognosis of SAT patients.Kaplan-Meier survival analysis stratified by the optimal cutoff value of tPAIC(38.9 ng/mL)revealed that a 2.31-fold higher 28-day survival rate in the patients with tPAIC＜38.9 ng/mL group compared those with tPAIC ≥38.9 ng/mL.Conclusion tPAIC demonstrates significant predictive value for mortality in SAT patients.

Occult hepatitis B virus(HBV)infection(OBI)represents a potential reservoir for HBV transmission,capable of spreading through routes such as blood transfusion.Additionally,OBI can con-tribute to the chronic progression of hepatitis B-related diseases,sustaining a state of chronic HBV infec-tion.In individuals with compromised immune function or undergoing immunosuppressive therapy,OBI may lead to HBV re-activation,potentially triggering severe liver conditions such as acute hepatitis or liv-er failure.As a result,OBI poses a significant public health challenge,profoundly impacting the health and well-being of affected populations and complicating HBV infection control efforts in China.Clinically diagnosing OBI remains challenging,but its hallmark is serum hepatitis B surface antigen negative and the presence of HBV covalently closed circular DNA(cccDNA)in the liver.With the increasing focus on achieving functional cure for chronic hepatitis B,both domestic and international guidelines have re-fined functional cure.Notably,these guidelines acknowledge that cccDNA may persist in the liver tissue of individuals who have achieved functional cure,suggesting resemblance of an occult infection state.Here,we provide a comprehensive overview of OBI,including its definition,classification,public health implications,underlying mechanisms,and clinical reactivation.By updating the understanding of OBI,we aim to raise awareness among clinicians and public health professionals regarding the significance of OBI in the current context and encourage greater attention to this population.