Allergen-specific immunotherapy（AIT） remains the only therapeutic approach with the potential to modify the natural course of allergic rhinitis（AR）. Nevertheless, considerable inter-individual variability exists in patients'responses to AIT. To facilitate more reliable assessment of treatment efficacy, the China Rhinopathy Research Cooperation Group（CRRCG） convened young and middle-aged nasal experts in China to formulate the present consensus. The recommended subjective outcome measures for AIT comprise symptom scores, medication scores, combined symptom and medication scores, quality-of-life assessments, evaluation of disease control, and assessment of comorbidities. Objective indicators may supplement these measures. Currently available objective approaches include skin prick testing, nasal provocation testing, and allergen exposure chambers. However, these methods remain constrained by practical limitations and are not yet appropriate for routine implementation in clinical efficacy evaluation. In addition, several biomarkers, including sIgE and the sIgE/tIgE ratio, sIgG4, serum IgE-blocking activity, IgA, cytokines and chemokines, as well as immune cell surface molecules and their functional activity, have been shown to have associations with AIT outcomes. While these biomarkers may complement subjective assessments, they are subject to significant limitations. Consequently, large-scale multicenter trials and real-world evidence are required to strengthen the evidence base. The present consensus underscores the necessity of integrating patients'subjective experiences with objective testing throughout the treatment process, thereby providing a more comprehensive and accurate framework for efficacy evaluation. Looking forward, future investigations should prioritize the incorporation of multi-omics data and artificial intelligence methodologies, which hold promise for overcoming current limitations in assessment strategies and for advancing both the standardization and personalization of AIT.
Humans ; Allergens/immunology* ; China ; Consensus ; Desensitization, Immunologic ; Immunoglobulin E ; Quality of Life ; Rhinitis, Allergic/therapy* ; Treatment Outcome ; East Asian People

Neddylation is a crucial posttranslational modification that involves the attachment of neural precursor cell-expressed developmentally downregulated protein 8 (NEDD8) to a lysine residue in the substrate via the sequential actions of the E1 NEDD8-activating enzyme (NAE) (E1), E2 NEDD8-conjugating enzyme (E2), and E3 NEDD8-ligase (E3). The most extensively studied substrates of neddylation are members of the cullin family, which act as scaffold components for cullin ring E3 ubiquitin ligases (CRLs). Since cullin neddylation activates CRLs, which are frequently overactive in tumors, inhibiting neddylation has emerged as a promising strategy for developing novel antitumor therapies. This review explores the antitumor effects of inhibiting neddylation that leads to the inactivation of CRLs and provides a summary of known inhibitors that target protein-protein interactions (PPIs) within the neddylation enzymatic cascade.

Objective:To analyze the epidemiological and clinical characteristics of respiratory syncytial virus (RSV) infection in children in Jiangsu Province from 2014 to 2023.Methods:The acute respiratory infection cases in children aged 0-14 years were selected from outpatient/emergency or inpatient departments in 2 surveillance sentinel hospitals, respectively, in Nanjing, Suzhou and Taizhou of Jiangsu from 1 July 2014 to 31 December 2023, and RSV nucleic acid test was conducted and the intensity of the RSV infection was accessed by WHO influenza epidemiological threshold method, and case information and clinical data were collected. χ2 test was used to compare the differences between groups, and the Bonferroni method was used for pairwise comparisons between groups. Results:In 4 946 cases of acute respiratory infections, the RSV positive rate was 8.21% (406/4 946), and the age M( Q1, Q3) of the cases was 1 (0, 3) years. The RSV positive rate was 10.92% (258/2 362) during 2014-2019 and 6.06% (118/1 948) during 2019-2023, the difference was significant ( χ2=31.74, P<0.001). RSV infection mainly occurred from October to March during 2014-2019, with the incidence peak in December and moderate or higher intensity. The seasonality of RSV infection was not obvious during 2019-2023, with low intensity. The RSV positive rate was highest in children in age group 0- years (17.85%, 151/846), and the positive rate declined gradually with age ( χ2=184.51, P<0.001). The RSV positive rate was higher in inpatient cases (9.84%, 244/2 480) than in outpatient/emergency cases (6.57%, 162/2 466) ( χ2=17.54, P<0.001). In the 155 RSV infection cases with complete clinical data, the clinical symptoms mainly included cough (99.35%, 154/155), fever (55.48%, 86/155), and shortness of breath (45.16%, 70/155). In the cases aged <6 months, the proportion of those with fever was low, but the proportion of those with shortness of breath, transferred to intensive care units, and receiving oxygen therapy were higher (all P<0.05). Children aged <6 months and those with underlying diseases were more likely to have severe RSV infection (all P<0.05). Conclusions:RSV infection in children in Jiangsu Province showed seasonal prevalence in winter from 2014 to 2019. Since 2020, the seasonal characteristics of the epidemic have changed, the epidemic period has been dispersed and the epidemic intensity has decreased. Infants <1 year old were at high risk for RSV infection, and those <6 months old and with underlying diseases might have severe infection.

Retrohepatic inferior vena cava (RIVC) begins at the base of renal vein and ends at the right atrium. Left, middle, right hepatic vein, inferior right hepatic vein etc. run into it. The major part of RIVC is wrapped in the caudate lobe of liver. It is adjacent to the abdominal trunk and vertebral body, having important anatomical significance. Inferior vena cava tumor thrombus includes two types. One is tumor thrombus formations in the RIVC. The other is direct invasion of tumor into RIVC wall. These two types correspond to different surgical treatment methods. The cancer thrombus in the vena cava can be treated by thrombus removal, while the tumor invading the vena cava wall requires resection of the invaded vascular wall and vascular reconstruction. Regardless of the types, improper surgical treatment is easy to cause injury and bleeding, leading to severe consequences. In this article, the main points of surgical management of different types of cancer thrombus in RIVC are introduced, providing methods to handle them.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Microglial surveillance plays an essential role in clearing misfolded proteins such as amyloid-beta, tau, and α-synuclein aggregates in neurodegenerative diseases. However, due to the complex structure and ambiguous pathogenic species of the misfolded proteins, a universal approach to remove the misfolded proteins remains unavailable. Here, we found that a polyphenol, α-mangostin, reprogrammed metabolism in the disease-associated microglia through shifting glycolysis to oxidative phosphorylation, which holistically rejuvenated microglial surveillance capacity to enhance microglial phagocytosis and autophagy-mediated degradation of multiple misfolded proteins. Nanoformulation of α-mangostin efficiently delivered α-mangostin to microglia, relieved the reactive status and rejuvenated the misfolded-proteins clearance capacity of microglia, which thus impressively relieved the neuropathological changes in both Alzheimer's disease and Parkinson's disease model mice. These findings provide direct evidences for the concept of rejuvenating microglial surveillance of multiple misfolded proteins through metabolic reprogramming, and demonstrate nanoformulated α-mangostin as a potential and universal therapy against neurodegenerative diseases.

The caudate lobe of liver is anatomically divided into three parts: Spiegel portion, inferior vena cava portion and caudate process. The caudate lobe of the liver is located in the dorsal side of the liver, adjacent to the inferior vena cava, the three hepatic veins, and the left and right portal veins. The location of the caudate lobe depends on the location of anatomical landmarks and the location of staining, especially negative staining techniques. The left approach is suitable for Spiegel resection, and the right approach is suitable for paracentral resection of the inferior vena cava and caudate process. The dorsal approach and anterior approach combined with other approaches can achieve complete caudate resection. This article showed the combination of multimodal approach with total caudate lobectomy, partial caudate lobectomy and laparoscopic caudate lobectomy.

Objective:To investigate the clinical outcome of arthroscopic suture-button Bristow procedure using suture-button fixation for treatment of recurrent anterior shoulder instability.Methods:A retrospective case series study was conducted to analyze 28 patients with recurrent anterior shoulder instability admitted to Shanghai Sixth People’s Hospital from March 2015 to September 2018，including 26 males and 2 females，aged 18-36 years ［（24.1 ± 3.2）years］. Preoperative MRI showed Bankart injury and three-dimensional CT showed glenoid bone defect > 15%. The Hill-Sachs injury was found in 27 patients. Arthroscopic Bristow procedure was used to fix coracoid process graft with the suture-button plate and glenoid labial complex was repaired with the suture anchor to treat anterior instability of the shoulder joint. The visual analogue scale （VAS），American shoulder and elbow surgeon （ASES） scale，Constant score and Rowe score were used to evaluate the shoulder joint function preoperatively，at postoperative 3，6，12 months and at the last follow-up. The postoperative infection，neurovascular injury，redislocation and other complications were recorded，and the incidence rate was calculated. The bone resorption and bone healing of coracoid process graft were analyzed by CT.Results:All patients were followed up for 22 - 36 months ［（24.5 ± 6.3） months］. Three months after operation，the VAS，ASES scale and Constant score were not significantly different from those before operation （ P > 0.05）. In comparison，the Rowe score was significantly higher than that before operation （ P < 0.05）. Six and twelve months after operation，the VAS，ASES scale，Constant score and Rowe score were significantly improved from those before operation （ P < 0.05）. At the last follow-up，the VAS decreased from （2.7 ± 1.5）points preoperatively to （0.8 ± 0.3）points，the ASES scale increased from （78.6 ± 12.7）points preoperatively to （92.4 ± 8.4）points，the Constant score increased from （43.4 ± 5.2） points preoperatively to （81.6 ± 6.7） points，the Rowe score increased from （52.3 ± 7.1）preoperatively to （92.7 ± 5.4） points （ P < 0.05）. During the follow-up，there was no infection，neurovascular injury，re-dislocation and other complications. In addition，24 （86%） out of the 28 patient showed healing of coracoid process grafts，and the overall bone resorption rate was （18.4 ± 6.1）%. No patients had glenohumeral joint osteoarthritis. Conclusion:Arthroscopic Bristow procedure using suture-button fixation for treatment of recurrent anterior shoulder instability has advantages of a low rate of postoperative complications and a high union rate，indicating an effective and safe surgical procedure.

A novel coronavirus pneumonia (NCP) epidemic has occurred in Wuhan, Hubei Province since December 2019, caused by a novel coronavirus (2019-nCoV) never been seen previously in human. China has imposed the strictest quarantine and closed management measures in history to control the spreading of the disease. However, severe trauma can still occur in the NCP patients. In order to standardize the emergency treatment and the infection prevention and control of severe trauma patients with hidden infection, suspected or confirmed infection of 2019-nCoV, Trauma Surgery Branch of Chinese Medical Doctors' Association organized this expert consensus. The consensus illustrated the classification of the NCP patients, severe trauma patients in need of emergency surgery, emergency surgery type, hierarchical protection for medical personnel and treatment places. Meanwhile, the consensus standardized the screening, injury severity evaluation, emergency surgical treatment strategy and postoperative management strategy of severe trauma patients during the epidemic period of NCP, providing a basis for the clinical treatment of such kind of patients.