The health of the human body is the result of the dynamic interplay between immunity and various microorganisms. Furthermore, the health of the mitochondrial grid determines the strength of immunity. Mitochondrial imbalance leads to the metabolic remodeling of intracellular nutrients, which accelerates the occurrence and development of tumors. The theory of yin and yang and the theory of visceral outward manifestation are the foundation and core of traditional Chinese medicine (TCM) theory, which guides the clinical diagnosis and treatment of TCM. Yang Qi is the driving force behind the metabolism and physiological functions of the human body; it is also the adenine nucleoside triphosphate produced efficiently by mitochondrial aerobic respiration. The main transport of spleen refers to the biological oxidation process of food in the mitochondria, and its normal function is closely related to the integrity of the mitochondrial structure and function of the cell. Therefore, warming yang and strengthening the spleen essentially means restoring the high production capacity of the mitochondria. Rebuilding damaged mitochondrial function, improving efficiency, and boosting the energy level of the neuro-endocrine-immune network are the key factors contributing to the body’s ability to resist disease and return to health.

Objective:To explore the clinical and genetic characteristics of four children with Kabuki syndrome (KS) due to variants of KMT2D gene. Methods:Four children with KS diagnosed at the Children′s Hospital of Shanxi Province between January 2020 and December 2022 were selected as the study subjects. Whole exome sequencing was carried out for the children and their family members. Candidate variants were verified by Sanger sequencing and pathogenicity analysis.Results:The KS phenotype scores for the four children were 7, 8, 6, and 6, respectively. Child 2 also presented with a rare solitary kidney malformation. Genetic testing revealed that all children had harbored novel de novo variants of the KMT2D gene, including c. 16472_16473del, c. 858dup, c. 11899C>T, and c. 12844C>T, respectively. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), all of the variants were classified as pathogenic. Conclusion:For children showing phenotypes such as distinctive facial features, intellectual disability, developmental delay, cardiac abnormalities, and urinary system anomalies, KS should be considered. Early diagnosis and intervention can be achieved through genetic testing, especially in the presence of KMT2D gene mutations.

Chemical cleaning and disinfection are crucial steps for eliminating infection in root canal treatment.However,irrigant selection or irrigation procedures are far from clear.The vapor lock effect in the apical region has yet to be solved,impeding irrigation efficacy and resulting in residual infections and compromised treatment outcomes.Additionally,ambiguous clinical indications for root canal medication and non-standardized dressing protocols must be clarified.Inappropriate intracanal medication may present side effects and jeopardize the therapeutic outcomes.Indeed,clinicians have been aware of these concerns for years.Based on the current evidence of studies,this article reviews the properties of various irrigants and intracanal medicaments and elucidates their effectiveness and interactions.The evolution of different kinetic irrigation methods,their effects,limitations,the paradigm shift,current indications,and effective operational procedures regarding intracanal medication are also discussed.This expert consensus aims to establish the clinical operation guidelines for root canal irrigation and a position statement on intracanal medication,thus facilitating a better understanding of infection control,standardizing clinical practice,and ultimately improving the success of endodontic therapy.

Objective To investigate the effect of mesenchymal stem cells(MSCs)combined with immunosuppressants(IS)on immune rejection in a rat model of liver transplantation.Methods F344 rats were divided into Normal group(without any intervention),PS group(injected with an equal volume of normal saline),MSC group(injected with MSC),IS group(injected with IS),and MSC+IS group(injected with MSC and IS),with 8 rats in each group.For all rats except those in the Normal group,the Kamada's double-cuff method was used to establish a model of orthotopic liver transplantation,without reconstruction of the hepatic artery.HE staining and Masson staining were performed for rat liver tissue,and the degree of liver fibrosis was analyzed;immunohistochemical experiments were used to measure the infiltration of T cells and NK cells,and immunofluorescence assay was used to analyze macrophage M2 polarization.A one-way analysis of variance was used for comparison of continuous data between multiple groups,and the least significant difference t-test was used for further comparison between two groups.The Kaplan-Meier method was used to plot survival curves,and the log-rank test was used for survival analysis.Results Compared with the PS group,the MSC+IS group had a significantly prolonged survival time(P＜0.01),and the MSC group,the IS group,and the MSC+IS group had a significant improvement in the histological structure of the liver and a significant reduction in the degree of liver fibrosis(all P＜0.000 1),as well as a significant reduction in the infiltration of NK and T cells(all P＜0.000 1)and a significant increase in the degree of macrophage M2 polarization(all P＜0.000 1).The MSC+IS group had a significantly better effect than the MSC group and the IS group.Conclusion MSCs combined with IS can improve liver histopathology,reduce inflammatory cell infiltration,promote macrophage M2 polarization,and exert an immunosuppressive effect in rats after liver transplantation.

Objective:To identify the independent factors of unplanned interruption during continuous renal replacement therapy (CRRT) and construct a risk prediction model, and to verify the clinical application effectiveness of the model.Methods:A retrospective study was conducted on critically ill adult patients who received CRRT treatment in the intensive care unit (ICU) of Zhejiang Hospital from January 2021 to August 2022 for model construction. According to whether unplanned weaning occurred, the patients were divided into two groups. The potential influencing factors of unplanned CRRT weaning in the two groups were compared. The independent influencing factors of unplanned CRRT weaning were screened by binary Logistic regression and a risk prediction model was constructed. The goodness of fit of the model was verified by a Hosmer-Lemeshow test and its predictive validity was evaluated by receiver operator characteristic curve (ROC curve). Then embed the risk prediction model into the hospital's ICU multifunctional electronic medical record system for severe illness, critically ill patients with CRRT admitted to the ICU of Zhejiang Hospital from November 2022 to October 2023 were prospectively analyzed to verify the model's clinical application effect.Results:① Model construction and internal validation: a total of 331 critically ill patients with CRRT were included to be retrospectively analyzed. Among them, there were 238 patients in planned interruption group and 93 patients in unplanned interruption group. Compared with the planned interruption group, the unplanned interruption group was shown as a lower proportion of males (80.6% vs. 91.6%) and a higher proportion of chronic diseases (60.2% vs. 41.6%), poor blood purification catheter function (31.2% vs. 6.3%), as a higher platelet count (PLT) before CRRT initiation [×10 9/L: 137 (101, 187) vs. 109 (74, 160)], lower level of blood flow rate [mL/min: 120 (120, 150) vs. 150 (140, 180)], higher proportion of using pre-dilution (37.6% vs. 23.5%), higher filtration fraction [23.0% (17.5%, 32.9%) vs. 19.1% (15.7%, 22.6%)], and frequency of blood pump stops [times: 19 (14, 21) vs. 9 (6, 13)], the differences of the above 8 factors between the two groups were statistically significant (all P < 0.05). Binary Logistic regression analysis showed that chronic diseases [odds ratio ( OR) = 3.063, 95% confidence interval (95% CI) was 1.200-7.819], blood purification catheter function ( OR = 4.429, 95% CI was 1.270-15.451), blood flow rate ( OR = 0.928, 95% CI was 0.900-0.957), and frequency of blood pump stops ( OR = 1.339, 95% CI was 1.231-1.457) were the independent factors for the unplanned interruption of CRRT (all P < 0.05). These 4 factors were used to construct a risk prediction model, and ROC curve analysis showed that the area under the curve (AUC) predicted by the model was 0.952 (95% CI was 0.930-0.973, P = 0.003 0), with a sensitivity of 88.2%, a specificity of 89.9%, and a maximum value of 1.781 for the Youden index. ② External validation: prospective inclusion of 110 patients, including 63 planned interruption group and 47 unplanned interruption group. ROC curve analysis showed that the AUC of the risk prediction model was 0.919 (95% CI was 0.870-0.969, P = 0.004 3), with a sensitivity of 91.5%, a specificity of 79.4%, and a maximum value of the Youden index of 1.709. Conclusion:The risk prediction model for unplanned interruption during CRRT has a high predictive efficiency, allowing for rapid and real-time identification of the high risk patients, thus providing references for preventative nursing.

Objective:To investigate the efficacy and safety of peripheral cutting balloon (PCB) in the treatment of long stenosis of arteriovenous fistula, and to explore the influencing factors of restenosis after PCB treatment.Methods:It was a single-center retrospective study. The patients with long stenosis (>2 cm) of arteriovenous fistula who received PCB treatment of percutaneous transluminal angioplasty (PTA) in Haidian Hospital, the Third Hospital of Peking University from August to November 2021. The clinical and follow-up data after PTA operation were collected and analyzed, and the primary patency rate and primary assist patency rate of fistula at 3, 6 and 12 months after PTA operation were calculated. Kaplan-Meier method was used to draw the survival curve of the primary patency rate of fistula, and log-rank test was used to compare the differences of primary patency rates of fistula between two groups. Multivariate Cox regression analysis was used to analyze the influencing factors of fistula restenosis after PCB treatment.Results:A total of 65 patients aged (62.57±11.55) years old were included in this study, including 42 males (64.62%), 61 (93.85%) autologous arteriovenous fistula and 4 (6.15%) arteriovenous graft. The narrowest diameter of fistula stenosis ( t=-41.731, P<0.001) and brachial artery blood flow ( t=-12.510, P<0.001) after PCB treatment were significantly higher than those before PCB treatment. The resistance index of fistula after PCB treatment was significantly lower than that before PCB treatment ( t=9.241, P<0.001). The technical success rate of PTA was 100% (65/65), and the clinical success rate of PTA was 96.92% (63/65). Only 2 patients failed to complete hemodialysis after PCB treatment, and no serious postoperative complications occurred. The follow-up time was 12 (7, 13) months. Fistula dysfunction occurred in 24 patients (36.92%) within 12 months. Kaplan-Meier survival analysis showed that the primary patency rates were 90.77%, 81.54% and 63.08% at 3, 6, and 12 months, respectively, and the primary assist patency rate at 12 months was 100% (65/65). The risk of fistula restenosis in patients with long stenosis ≥36 mm was significantly higher than that in patients with long stenosis <36 mm (log-rank χ2=6.007, P=0.014). Multivariate Cox regression analysis showed that increased stenosis length ( HR=1.022, 95% CI 1.001-1.045, P=0.042) was an independent influencing factor of fistula restenosis within 12 months after PCB treatment. Conclusions:PCB is safe and effective in the treatment of long segment stenosis associated with fistula. The increased stenosis length is an independent influencing factor of restenosis in fistula after PCB treatment.

[This corrects the article DOI: 10.1016/j.apsb.2024.04.021.].

OBJECTIVE To explore the mechanism of Cinnamomi Cortex in the treatment of depression based on the network pharmacology method, and to verify the experimental results according to the results. METHODS The potential active components of Cinnamomi Cortex were screened by using the Chinese Medicine System Pharmacology Database Analysis Platform(TCMSP) and literatures related to the active components of Cinnamomi Cortex. The target of action of the active ingredients obtained by screening was predicted; the disease targets of depression were obtained from the DisGeNet database; the STRING database protein-protein interaction was used to construct PPI network; Gene Ontology(GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway enrichment analysis for key targets through DAVID database. Based on the results of network pharmacology, the solid self-microemulsion of Cinnamomi Cortex oil was used as a reagent to establish a chronic unpredictable mild stress(CUMS) depression mice model, and the experimental verification was carried out by measuring the expression levels of neurotransmitters and inflammatory factors in mice. RESULTS A total of 22 active ingredients and 186 potential targets were obtained through screening. A total of 275 GO items were obtained by GO enrichment analysis, including 222 for biological processes, 18 for cellular composition, and 35 for molecular functions. A total of 96 signaling pathways were obtained from KEGG enrichment. The results of network pharmacology indicated that the antidepressant mechanism of Cinnamomi Cortex was related to neurotransmitter components and inflammatory response. The results of animal experiments indicated that Cinnamomi Cortex oil solid self-microemulsion could improve hippocampal damage caused by CUMS, and make neurons in the hippocampus neatly arranged and cell structure intact. At the same time, it could effectively increase the expression levels of 5-hydroxytryptamine(5-HT), NE and DA in the brain of CUMS mice(P<0.05), and reduce the expression levels of serum IL-6, IL-1β and TNF-α(P<0.05). The results of animal experiments were consistent with the results of network pharmacology. CONCLUSION The antidepressant activity of Cinnamomi Cortex has the characteristics of multi-component, multi-target and multi-pathway. Regulating the expression levels of neurotransmitters and inflammatory factors is an important way of its action, which provides a basis for the in-depth study of the antidepressant mechanism of Cinnamomi Cortex.

Objective:To analyze the efficacy of balloon-assisted autologous arteriovenous fistula (AVF) maturation and its effect on patency.Methods:It was a single-center prospective cohort study. The patients who underwent balloon-assisted maturation (BAM) due to poor AVF maturation in Haidian Hospital, the Third Hospital of Peking University from November 2020 to May 2021 were enrolled. The clinical data and relevant data before and after BAM were collected, and then the immediate success rate and primary patency rate at 6 and 12 months after BAM were analyzed. Cox regression analysis method was used to identify the risk factors of restenosis of AVF patency after BAM.Results:A total of 96 patients treated with BAM due to poor AVF maturation were enrolled, with age of (56.98±13.20) years old, 54 males (56.25%) and 42 females (43.75%). The technical success rate of BAM was 100% (96/96), the clinical success rate of BAM was 96.88% (93/96), and there was no related serious complication. The primary patency rates were 83.33% (80/96) and 59.38% (57/96) at 6 and 12 months, respectively. The internal diameter of anastomotic vein ( t=-19.257 , P<0.001), internal diameter of anastomotic artery ( t=-9.131 , P<0.001), internal diameter of brachial artery ( t=-5.445 , P<0.001) and brachial artery blood flow ( t=-22.739 , P<0.001) after BAM were higher than those before BAM. Univariate Cox regression analysis results showed that stenosis number, stenosis length ≤2 cm, high-pressure balloons, local anaesthetic were all correlated with restenosis of AVF after BAM (all P<0.05) . Multivariate Cox regression analysis results showed that stenosis length ≤2 cm was an independent related factor of restenosis of AVF after BAM at 6 months ( HR=0.022, 95% CI 0.006 -0.075, P<0.001) and at 12 months ( HR=0.027, 95% CI 0.009 -0.082, P<0.001). Conclusions:BAM is safe and effective for AVF maturation, and has a high success rate and reliable patency. Preoperative stenosis length >2 cm is an independent risk factor of AVF restenosis after BAM.

ObjectiveTo obtain the status of latent tuberculosis infection （LTBI） among tuberculosis （TB）-related health-care workers （HCWs） in Shanghai， and to explore the risk factors related to TB infection. MethodsA multi-center cross-sectional study was conducted by recruiting medical workers from multiple designated TB hospitals， centers for disease control and prevention， and community health service centers in Shanghai. Each subject was required to complete a questionnaire and to provide a blood sample for TB infection test. Univariate and multivariate analysis ware made in order to find risk factors relating to TB infection. ResultsA total of 165 medical workers were recruited， and the proportion of TB infection was 16.36% （95%CI： 11.49%‒22.76%）. Multivariate logistic analysis showed that clinical doctors and nurses （adjusted OR=9.756， 95%CI： 1.790‒53.188）， laboratory staffs （adjusted OR=78.975， 95%CI： 8.749‒712.918）， and nursing and cleaning workers （adjusted OR=89.920， 95%CI： 3.111‒2 598.930） had higher risk of TB infection. ConclusionThe overall LTBI prevalence among TB-related HCWs is low. However， working as doctors， nurses， laboratory staffs， nursing workers and cleaning workers are risk factors of TB infection. TB-related HCWs who work at hospitals are at risk of TB infection comparing to medical staffs who work outside hospitals.