Background/Aims: Natural killer (NK) cell function is generally considered dampened in chronic hepatitis B virus (HBV) infection; however, the NK cell pool exhibits phenotypic and functional heterogeneity, and the antibody--mediated effect of NK cells remains less characterized. This study evaluated the dynamic changes in antibody-mediated NK cell responses and the involvement of distinct NK subsets across disease stages and during antiviral treatment. Methods: A T-cell receptor-like antibody specific for the HBV core 18–27 peptide (cTCRL-Ab) was used to determine the antibody-mediated effect of NK cells, and an array of NK cell surface markers were analyzed in cross-sectional and longitudinal cohorts of patients with chronic HBV infection. Single-cell RNA sequencing (scRNA-seq) was performed to identify the heterogeneity of NK subsets. Results: The cTCRL-Ab enabled the detection of NK cell cytolytic activity and IFNγ production. Notably, cTCRL-Ab-mediated NK cell responses were compromised in chronically HBV-infected patients, particularly in those receiving pegylated interferon-α (Peg-IFNα), which was associated with the downregulation of CD16 expression. Correspondingly, Peg-IFNα inhibited cTCRL-Ab-mediated NK cell function by reducing CD16 expression in vitro. scRNA-seq revealed that CD16 downregulation occurred mainly within a dysfunctional CD16hi NK subset exhibiting exhaustion properties. In contrast, an activated CD16hiNK subpopulation (CX3CR1⁺KLRC2–CD16hi) with high cytotoxicity was enriched in patients who experienced favorable treatment responses. Furthermore, the intrahepatic CX3CR1+KLRC2–CD16hi subset tended to exhibit functional restoration in HBsAg-loss individuals. Conclusions Our data contribute to the understanding of antibody-mediated responses of NK cells in chronic HBV infection, and highlight a previously unappreciated functional CX3CR1+KLRC2–CD16hiNK subset as a potential therapeutic target.

Objective To observe the efficacy of Hongjin Xiaojie capsules in treating hematoma after Mammotome minimally invasive excision and to determine the common clinical complications such as hematoma and pain after the surgery.Methods A total of 70 patients who developed hematoma within 72 hours after Mammotome minimally invasive excision for breast lumps at our hospital were selected.Based on different treatment methods,patients were divided into the observation group and the control group,with 35 cases in each group.The control group received only external hot compress treatment,while the observation group received local hot compress combined with oral administration of Hongjin Xiaojie Capsule for 4 weeks.Follow-up was conducted every 4 weeks postoperatively for a total of 12 weeks.Color ultrasound was performed to monitor the size of the hematoma.Changes in pain visual analog scale(VAS)scores and traditional Chinese medicine(TCM)syndrome scores for blood stasis were compared between the two groups of patients during follow-up.Results Four weeks after operation,the pain VAS score was significantly lower in the observation group than that in the control group[2(1,3)points vs.3(2,4)points,P＜0.05],and the proportion of hematoma was lower in the observation group than that in the control group(45.7%vs.82.9%,P＜0.05).At 12 weeks after surgery,there were no significant differences in pain scores or hematoma proportions between the two groups.The TCM symptom scores were lower in the observation group than those of the control group at 4 weeks and 12 weeks after operation(P＜0.05).Conclusion Hongjin Xiaojie capsule can promote the absorption of hematoma after Mammotome surgery,effectively alleviate breast hematoma and pain,and have high safety,demonstrating broad clinical application value.

Objective To observe the efficacy of Hongjin Xiaojie capsules in treating hematoma after Mammotome minimally invasive excision and to determine the common clinical complications such as hematoma and pain after the surgery.Methods A total of 70 patients who developed hematoma within 72 hours after Mammotome minimally invasive excision for breast lumps at our hospital were selected.Based on different treatment methods,patients were divided into the observation group and the control group,with 35 cases in each group.The control group received only external hot compress treatment,while the observation group received local hot compress combined with oral administration of Hongjin Xiaojie Capsule for 4 weeks.Follow-up was conducted every 4 weeks postoperatively for a total of 12 weeks.Color ultrasound was performed to monitor the size of the hematoma.Changes in pain visual analog scale(VAS)scores and traditional Chinese medicine(TCM)syndrome scores for blood stasis were compared between the two groups of patients during follow-up.Results Four weeks after operation,the pain VAS score was significantly lower in the observation group than that in the control group[2(1,3)points vs.3(2,4)points,P＜0.05],and the proportion of hematoma was lower in the observation group than that in the control group(45.7%vs.82.9%,P＜0.05).At 12 weeks after surgery,there were no significant differences in pain scores or hematoma proportions between the two groups.The TCM symptom scores were lower in the observation group than those of the control group at 4 weeks and 12 weeks after operation(P＜0.05).Conclusion Hongjin Xiaojie capsule can promote the absorption of hematoma after Mammotome surgery,effectively alleviate breast hematoma and pain,and have high safety,demonstrating broad clinical application value.

Objective To observe the value of mitral annular calcification(MAC)score based on cardiac plain CT for predicting intraoperative surgical procedure change of mitral regurgitation(MR).Methods Totally 182 MR patients were retrospectively enrolled and divided into MAC group(n=57)and non MAC group(n=125)based on the presence or not of MAC,and clinical and imaging data were compared between groups.Logistic regression analysis was used to observe the impact factors of surgical procedure change.The receiver operating characteristic curve was drawn,the area under the curve(AUC)was calculated to explore the efficacy of MAC score for predicting surgical procedure change.Results Significant differences of the proportions of hypertension,atrial fibrillation(AF),mitral valve repair,mitral valve replacement,aortic valve replacement,tricuspid valve repair and surgical procedure change,as well as of admission left atrial diameter(LAD),admission left ventricular end-diastolic volume(LVEDV),admission left ventricular ejection fraction(LVEF),aortic valve stenosis,aortic regurgitation,the proportion of mitral stenosis(MS)and follow-up LAD were found between MAC group and non MAC group(all P＜0.05).Then the patients were divided into surgical procedure change group(n=50)and non-change group(n=132),and significant differences of patients'gender,AF,MAC,MAC score,admission LAD,aortic valve stenosis,MS and MR degree were found between surgical procedure change group and non-change group(all P＜0.05).MAC score was an independent impact factor of intraoperative surgical procedure change of MR(P＜0.001),with AUC of 0.757.Conclusion MAC score based on cardiac plain CT could be used to predict intraoperative surgical procedure change of MR.

Objective To observe the value of mitral annular calcification(MAC)score based on cardiac plain CT for predicting intraoperative surgical procedure change of mitral regurgitation(MR).Methods Totally 182 MR patients were retrospectively enrolled and divided into MAC group(n=57)and non MAC group(n=125)based on the presence or not of MAC,and clinical and imaging data were compared between groups.Logistic regression analysis was used to observe the impact factors of surgical procedure change.The receiver operating characteristic curve was drawn,the area under the curve(AUC)was calculated to explore the efficacy of MAC score for predicting surgical procedure change.Results Significant differences of the proportions of hypertension,atrial fibrillation(AF),mitral valve repair,mitral valve replacement,aortic valve replacement,tricuspid valve repair and surgical procedure change,as well as of admission left atrial diameter(LAD),admission left ventricular end-diastolic volume(LVEDV),admission left ventricular ejection fraction(LVEF),aortic valve stenosis,aortic regurgitation,the proportion of mitral stenosis(MS)and follow-up LAD were found between MAC group and non MAC group(all P＜0.05).Then the patients were divided into surgical procedure change group(n=50)and non-change group(n=132),and significant differences of patients'gender,AF,MAC,MAC score,admission LAD,aortic valve stenosis,MS and MR degree were found between surgical procedure change group and non-change group(all P＜0.05).MAC score was an independent impact factor of intraoperative surgical procedure change of MR(P＜0.001),with AUC of 0.757.Conclusion MAC score based on cardiac plain CT could be used to predict intraoperative surgical procedure change of MR.

ObjectiveTo evaluate the clinical efficacy and safety of Tongluo Mingmu capsules in the treatment of diabetic retinopathy with blood stasis， collateral obstruction， and Qi and Yin deficiency syndrome. MethodA randomized， double-blind， positive-control， and multi-center clinical trial design method was used. 416 patients with diabetic retinopathy with blood stasis， collateral obstruction， and Qi and Yin deficiency syndrome in four test centers were included （the ratio of the treatment group to the control group was 3∶1）. On the basis of standardized hypoglycemic treatment， the treatment group was given both four Tongluo Mingmu capsules and two Calcium Dobesilate capsule agents three times a day， while the control group were given both two Calcium Dobesilate capsules and four Tongluo Mingmu capsule agents three times a day. The course of treatment was 12 weeks. The curative effect of Tongluo Mingmu capsules was evaluated by comparing the comprehensive curative effect of diabetic retinopathy， traditional Chinese medicine（TCM） syndrome score， corrected visual acuity， fundus changes， fundus fluorescence angiography， and other curative effect indexes before and after treatment in the two groups. At the same time， general examination， laboratory examination， and adverse events were performed to evaluate the safety of the drug. ResultThe baseline demographic data and disease characteristics of the treatment group and the control group were balanced and comparable， with the difference not statistically significant. After 12 weeks of treatment， the total effective rate of the comprehensive curative effect of diabetic retinopathy in the treatment group （61.0%， 189/310） was better than that in the control group （44.1%， 45/102）， and the difference was statistically significant （χ²=8.880， P<0.01）. The total effective rate of TCM syndromes in the treatment group （88.4%， 259/293） was better than that in the control group （69.9%， 65/93）， and the difference was statistically significant （χ²=17.927， P<0.01）. The disappearance rate of dry eyes （χ²=8.305）， dull complexion （χ²=4.053）， lassitude （χ²=10.267）， shortness of breath （χ²=8.494）， and dry stool （χ²=8.657） in the treatment group was higher than that in the control group， and the difference between the groups was statistically significant （P<0.05， P<0.01）. In terms of improving corrected visual acuity （χ²=8.382）， fundus changes （χ²=6.026） ， the treatment group was significantly better than the control group （P<0.05）. During the trial， the incidence of adverse events in the treatment group and the control group was 1.3% and 2.9%， respectively. There was no significant difference between the two groups. In addition， there were no serious adverse events and adverse events leading to withdrawal in both groups. ConclusionTongluo Mingmu capsules can improve the comprehensive curative effect of diabetic retinopathy and enhance the efficacy of TCM syndromes， visual acuity， fundus changes， and fundus fluorescein angiography， with great safety. Therefore， it can provide a new alternative therapeutic drug for patients with diabetic retinopathy.

Objective To evaluate the applicability of a modified U-shaped forearm flap for the repair of small-and medium-sized defects in the oral and maxillary areas to provide a reference for clinicians.Methods This study was re-viewed and approved by the Ethics Committee,and informed consent was obtained from the patients.Ten patients with small-and medium-sized defects in the oral and maxillary areas underwent surgical repair using modified U-shaped fore-arm flaps.There were 8 males and 2 females aged 43-72 years.The donor site was apposed primarily after harvesting the modified U-shaped forearm skin flap.The flaps ranged from 6 cm × 4 cm to 8 cm × 5 cm in size.Six months after the operation,hand movements(finger extension,fist clenching,wrist rotation upward and wrist rotation downward),the forearm donor site,hand sensations and the satisfaction score for the postoperative quality of the scar at the donor site were evaluated(0 to 10;0:very unattractive,10:very satisfactory).Results A total of 10 patients with modified U-shaped forearm flaps survived.One patient developed venous crisis 24 hours after surgery and survived after surgical ex-ploration.Delayed healing occurred at the donor site of the forearm in 1 patient,and the wounds at the donor site of the forearm in the other patients all healed in the first stage.One patient presented with dysesthesia in the hand 2 weeks af-ter surgery and recovered within 3 months.Six months after surgery,all patients had no limited hand movement and no paresthesia at the forearm donor site or hand.The patients were basically satisfied with the appearance of the donor site,and the average satisfaction score of the subjective questionnaire was 8.4 points.Conclusion Modified U-shaped fore-arm flaps can directly close forearm donor site wounds,which avoids surgical trauma to the secondary donor site and sig-nificantly reduces related complications.Modified U-shaped forearm flaps provide an alternative to conventional forearm flaps for the repair of small-and medium-sized defects in the oral and maxillary areas.

OBJECTIVE To explore the application effects of the multi-disciplinary treatment (MDT)-based continuous pharmaceutical care system in patients undergoing anti-infection treatment. METHODS This research team innovatively developed an MDT continuous pharmaceutical care system,which was applied to cases of anti-infection treatment following MDT due to infection,aiming to innovate the continuous medication supervision model. A retrospective analysis method was used to collect data from 150 patients in the intensive care unit who underwent conventional anti-infection MDT consultations from January to October 2021 in Banan Hospital Affiliated to Chongqing Medical University,serving as the control group,and 130 patients in the intensive care unit who were under the MDT continuous pharmaceutical care system from January to October 2022 were selected as the intervention group. The general information of the patients,the information continuous tracking management,the outcomes of anti-infection treatment,adverse drug reactions,antibacterial drug management indicators,and the degree of satisfaction of relevant medical staff with the clinical pharmacists' pharmaceutical services were compared between the two groups. RESULTS Comparison of general information between the two groups showed no statistically significant differences (P>0.05). The proportion of continuous tracking management in the intervention group was significantly higher than in the control group (P<0.01),and the differences in the initiators and reasons for continuous tracking management between the two groups were statistically significant (P<0.05). The intervention group had better outcomes in anti-infection treatment compared to the control group (P<0.05). The antibacterial drug management indicators (total length of hospital stay,duration of antibacterial drug use,total drug costs,and amount of antibacterial drugs used) in the intervention group were significantly lower than in the control group,while overall degree of satisfaction among medical staff was significantly higher in the intervention group than in the control group (P<0.05). No statistically significant differences were found in adverse reaction occurrence and antibacterial drug costs between the two groups (P>0.05). CONCLUSIONS The application of this system in patients who underwent anti-infection treatment after MDT can achieve continuous multi-disciplinary tracking management with clinical pharmacists at the core,which is beneficial for promoting the follow-up efficiency of the MDT team,raising the quality of clinical pharmacists' pharmaceutical services,strengthening treatment outcomes,and promoting the rational use of antibacterial drugs in clinical practice.

Objective:To investigate the clinical epidemiological data of children with prolonged mechanical ventilation (PMV) in pediatric intensive care unit(PICU), and analyze the primary disease of children with PMV as well as the disease characteristics and prognosis of children with PMV under different kinds of primary disease.Methods:The clinical data of hospitalized children with PMV in PICU at Children′s Hospital of Fudan University from January 2019 to December 2020 were retrospectively collected.Results:A total of 46 children with PMV were collected.There were 18 males (39.1%) and 28 females (60.9%). The median age was 37 (8, 86) months and the median body weight was 15 (7, 20) kg.The average pediatric critical illness score at admission was 84.2±7.7, PaO 2/FiO 2 was (245.5±99.8)mmHg.The primary diseases leading to PMV were as follows: there were 14 cases of severe pneumonia, eight cases of severe encephalitis, five cases of bronchopulmonary dysplasia, three cases of upper airway obstruction/craniofacial deformity, three cases of myasthenia, three cases of brain stem tumor, three cases of mitochondrial encephalomyopathy, two cases of spinal muscular atrophy, two cases of Prader-Willi syndrome, one case of dermatomyositis, one case of severe brain injury, and one case of central hypoventilation.The causes of unable to withdraw ventilator were respiratory dysfunction in 24 cases, brain dysfunction in 16 cases, and diaphragm dysfunction in six cases.Compared with neuromuscular diseases, children with PMV caused by respiratory diseases had lower month age, higher preterm birth rate, lower PaO 2/FiO 2 ratio, higher parameters for ventilator treatment, and the differences were statistically significant ( P<0.05). Children with PMV caused by neuromuscular diseases had lower Glasgow coma score and higher coma rate, and the differences were statistically significant ( P<0.05). A total of nine (19.6%) cases underwent tracheotomy.A total of 23 (50.0%) cases were successfully extubated from ventilator, six (13.0%) cases were dependent on invasive ventilator, and six (13.0%) cases were breathing with tracheotomy tube.The median mechanical ventilation time was 33 (28, 40) days, the median PICU hospital stay was 42 (34, 56) days, and the median hospital stay was 51 (41, 65) days.A total of 27 (58.7%) cases were improved and discharged, four (8.7%) cases were transferred to rehabilitation hospital, four (8.7%) cases were transferred to local hospital, and 11 (23.9%) cases died in hospital or at home after giving up. Conclusion:The main causes of PMV in PICU children are respiratory dysfunction, brain dysfunction and diaphragm dysfunction.50.0% of the children with PMV could be discharged from the ventilator, and 23.9% died or died after giving up.