Objective To explore the clinical safety of plasma exchange(PE)combined with early continuous renal replacement therapy(CRRT)and its effects on coagulation and immune functions in patients with polytrauma and hypermyoglobinemia.Methods A non-randomized controlled study was conducted on 60 patients with severe polytrauma and myoglobinemia hospitalized in our department from January 2021 to December 2024.Based on different blood purification,the patients were divided a control group(CRRT)combined with conventional basic treatment,n=30)and an observation group(PE+CRRT and conventional basic treatment,n=30).Biochemical indicators(myoglobin,Mb),inflammation-related indicators,peripheral blood lymphocyte subsets,coagulation indicators,clinical-related indicators,and scores were observed and compared between the 2 groups before and after treatment.Results After 1,2 and 3 d of treatment,the levels of Mb,creatine kinase(CK),creatine kinase-MB isoenzyme(CK-MB),lactate dehydrogenase(LDH),serum creatinine(SCr),blood urea nitrogen(BUN),K+,C-reactive protein(CRP),procalcitonin(PCT),IL-6 and D-dimer(D-D),and white blood cell(WBC)count were significantly decreased in both groups(P<0.05).Among them,the observation group obtained obviously lower levels of all above indicators than the control group at the 3 time points(P<0.05).Additionally,notably shorter average length of total hospital stay,shorter average length of trauma intensive care unit stay,and lower score of acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)was observed in the observation group than the control group(P<0.05).There were no statistical differences in coagulation function indicators or T lymphocyte subsets between the 2 groups.No complications occurred.Conclusion For patients with polytrauma and hypermyoglobinemia,early application of PE+CRRT can effectively reduce serum myoglobin level,improve serum biochemical inicators,renal function and inflammatory status,and maintain homeostasis,but shows no effect on immune or coagulation functions.This approach is worthy of promoting in clinical practice.

[Objective] To investigate the infection and characteristics of hepatitis E virus among blood donors in Hangzhou. [Methods] A total of 5 075 blood samples of blood donors from Zhejiang Provincial Blood Center from September to November 2023 were collected, including 5 037 samples with normal ALT and 38 samples with elevated ALT (>50 U/L). Enzyme-linked immunosorbent assay (ELISA) was used to detect anti-HEV IgM, anti-HEV IgG and HEV-Ag. The Fisher test and Chi-square test were used to evaluate the difference in the reactivity rates of anti-HEV IgM and anti-HEV IgG among different levels of ALT. The distribution characteristics of HEV screening in blood donors were analyzed. Univariate and multivariate logistic regression were used to analyze the susceptibility factors of anti-HEV IgM and anti-HEV IgG seropositivity, and the anti-HEV IgM-reactive blood donors were followed up by telephone. [Results] The reactivity rates of anti-HEV IgM, anti-HEV IgG and HEV-Ag in 5 075 blood samples were 0.45%, 22.98% and 0%, respectively. There was no difference in the reactivity rates of anti-HEV IgM and anti-HEV IgG among different levels of ALT (P>0.05), and the results of univariate and multivariate logistic regression analysis showed that age was a risk factor for anti-HEV IgM and anti-HEV IgG reactivity in blood donors (P<0.05), while no difference in the reactivity rates of anti-HEV IgM and anti-HEV IgG among blood donors was noticed in gender, occupation and education level (P>0.05). [Conclusion] There is a potential risk of transfusion-transmitted HEV (TT-HEV) in Hangzhou, and a cost-effective HEV screening strategy needs to be established to continue regular HEV surveillance in Hangzhou to assess the risk of infection.

Background Injury poses a serious threat to human health. As global warming continues to intensify, there is an urgent need to explore the impact of temperature changes on injury deaths. However limited research has focused on this issue. Objective To investigate the relationship between daily mean temperature change (Tm) and injury death, as well as to estimate the associated future death burden in Hunan Province. Methods We employed an individual-level, time-stratified case-crossing design to establish a conditional logistic regression model to analyze the exposure-response relationship between daily mean temperature change and injury death in Hunan Province from 2013 to 2018. Consequently, we conducted subgroup analysis of gender, age group, and injury type. Finally, we estimated the excess burden of injury death attributable to temperature changes under a sustainable development path [low emission scenario (SSP1-2.6)], regional competition path [high emission scenario (SSP3-7.0)], or fossil fuel development path [very high emission scenario (SSP5-8.5)]. Results The study collected 155577 injury deaths in Hunan Province. The results indicated that for each 1 ℃ increment in daily mean temperature, the cumulative excess risk (CER) of injury mortality among Hunan residents increased by 0.71% (95%CI: 0.53%, 0.90%). Notably, the CER for intentional injuries (1.06%, 95%CI: 0.51%, 1.61%) was higher than that for unintentional injuries (0.66%, 95%CI: 0.46%, 0.87%). Warmer temperatures were positively associated with CER of mortality due to drowning, falls, transport injuries, assaults, and suicides, while they were negatively associated with mortality due to poisoning. Compared with 2010–2019, for 2090–2099, the excess mortality rate (EMR) due to ambient temperature increase in Hunan Province under the SSP5-8.5 scenario (14.62/100000, 95%CI: 10.81/100000, 18.40/100000) would be higher than that of the SSP3-7.0 scenario (10.28/100000, 95%CI: 7.58/100000, 12.97/100000) and the SSP1-2.6 scenario (3.35/100000, 95%CI: 2.46/100000, 4.23/100000); the EMR would be around 2.5 times among men (20.64/100000, 95%CI: 14.44/100000, 26.8/100000) than that among women (8.33/100000, 95%CI: 3.98/100000, 12.6/100000). Among unintentional injuries, the leading contributors to EMR would be drowning (4.46/100000), falls (3.96/100000), and transport injuries (2.96/100000). And among intentional injuries, the EMR for suicide (2.08/100000) would be higher than that for assault (0.47/100000). Conclusion Climate warming will increase the total burden of injury-related deaths among residents in Hunan Province, especially in the absence of effective mitigation strategies and measures. It is necessary to strengthen the prevention and control of severe injuries closely related to temperature changes, such as drowning, falls, traffic, and suicides injuries, in order to reduce injury deaths associated with climate change.

Plant-derived bioactive peptides have become a research hotspot in the fields of food and medicine due to their high source safety,easy absorption and utilization by the human body,and potential edible and medicinal value.Bioactive peptides can be classified into antihypertensive,hypoglycemic,hypolipidemic,anticancer,antioxidant,antimicrobial,and anti-inflammatory peptides according to their functions.Among these,antihypertensive,hypoglycemic,and hypolipidemic peptides are collectively referred to as cardiovascular active peptides,which can be used for the treatment and prevention of cardiovascular diseases and have an important role in the development of modem biomedicine.This review focused on the preparation methods,separation,purification,and identification techniques of bioactive peptides,as well as their mechanisms of action and applications in regulating cardiovascular diseases,aiming to provide a reference for further development and application of plant-derived cardiovascular peptides.

Objective:To explore the application effect of mid-facial autologous fat grafting with an intraoral approach in facial contour remodeling.Methods:A retrospective study was performed for 89 female patients aged (35±10) years who underwent mid-facial autologous fat grafting in the Department of Plastic Surgery, Easysculpt Medical Aesthetic Clinic from October 2019 to October 2022. The filling area was designed according to the patient's facial characteristics. According to the patient's wishes and the actual thickness of subcutaneous fat, the abdomen or thigh were selected as the fat collection area. Nerve block anesthesia with 0.5% lidocaine was performed at the corresponding site. The edge of the hairline was chosen to be the insertion point when filling the frontal, temporal, eyebrow arch, and zygomatic arch depression; An intraoral approach was used when filling the middle and lower parts of the face. The surgical effect and complications were recorded at 3 months after the operation, and the patient satisfaction was evaluated.Results:All the patients completed the operation smoothly. A total of 82 patients received a single injection, 5 patients received two times and 2 patients received three times. Fourteen patients had mild facial swelling after surgery, which subsided spontaneously in 1-2 weeks. None of the 89 patients had complications such as embolism, infection, hematoma, induration, cyst, fat liquefaction, pigmentation, dysesthesia or depression. At the 3-month follow-up, 67 patients were very satisfied with the postoperative results, 14 patients were satisfied, 6 patients were generally satisfied, and 2 patients were not satisfied. The overall satisfaction rate was 91.0% (81/89).Conclusion:The intraoral approach to middle face fat transplantation is safe and effective in facial contour remodeling.

Objective　To investigate the association between neutrophil-to-lymphocyte ratio (NLR) and the state of sustained immune response after hepatitis B vaccination, to explore the possibility to predict the effect of hepatitis B vaccination.Methods　Data were analysed from 10 153 individuals aged 18 years and older who had received three doses of hepatitis B vaccine and met the inclusion criteria in the National Health and Nutrition Examination Survey (NHANES) 1999-2018. They were divided into seropositive and seronegative groups based on the results of post-vaccination hepatitis B marker testing. The association between NLR and sustained immune response status after hepatitis B vaccination was assessed using a variety of methods, including multivariate weighted logistic regression models, generalised linear analysis, and smoothed curve fitting.Results　This study included 10 153 subjects with a mean age of 35.36 years, 42.82% male and 57.18% female. Adjusted multivariate weighted logistic regression models showed that for each unit increase in NLR level, the odds of a sustained immune response after hepatitis B vaccination decreased by 7% (OR=0.93, 95%CI: 0.88-0.97). Stratified analysis of NLR levels showed that the odds of a sustained immune response were 37% lower in the group with the highest NLR levels (T4) compared with the lowest group (T1) (OR=0.63, 95%CI: 0.47-0.85), and the odds of a sustained immune response were 30% lower in the T3 group compared with the T1 group (OR=0.70, 95%CI: 0.53-0.91). Restricted cubic spline analysis showed a non-linear relationship between NLR and sustained immune response status after hepatitis B vaccination (P non-linear<0.05), approximating an 'L' curve. Inflection point analysis showed that when NLR <2.16, elevated NLR significantly reduced the occurrence of sustained immune response status after hepatitis B vaccination; when NLR >2.16, the effect of its elevation on the production of sustained immune response after vaccination leveled off.Conclusion　NLR levels were negatively associated with the development of a sustained immune response after hepatitis B vaccination. Lower NLR levels have a strong positive correlation with sustained immune response after hepatitis B vaccination, whereas higher NLR levels may attenuate the effect of hepatitis B vaccination.

Plant-derived bioactive peptides have become a research hotspot in the fields of food and medicine due to their high source safety,easy absorption and utilization by the human body,and potential edible and medicinal value.Bioactive peptides can be classified into antihypertensive,hypoglycemic,hypolipidemic,anticancer,antioxidant,antimicrobial,and anti-inflammatory peptides according to their functions.Among these,antihypertensive,hypoglycemic,and hypolipidemic peptides are collectively referred to as cardiovascular active peptides,which can be used for the treatment and prevention of cardiovascular diseases and have an important role in the development of modem biomedicine.This review focused on the preparation methods,separation,purification,and identification techniques of bioactive peptides,as well as their mechanisms of action and applications in regulating cardiovascular diseases,aiming to provide a reference for further development and application of plant-derived cardiovascular peptides.

Objective:To explore the application effect of mid-facial autologous fat grafting with an intraoral approach in facial contour remodeling.Methods:A retrospective study was performed for 89 female patients aged (35±10) years who underwent mid-facial autologous fat grafting in the Department of Plastic Surgery, Easysculpt Medical Aesthetic Clinic from October 2019 to October 2022. The filling area was designed according to the patient's facial characteristics. According to the patient's wishes and the actual thickness of subcutaneous fat, the abdomen or thigh were selected as the fat collection area. Nerve block anesthesia with 0.5% lidocaine was performed at the corresponding site. The edge of the hairline was chosen to be the insertion point when filling the frontal, temporal, eyebrow arch, and zygomatic arch depression; An intraoral approach was used when filling the middle and lower parts of the face. The surgical effect and complications were recorded at 3 months after the operation, and the patient satisfaction was evaluated.Results:All the patients completed the operation smoothly. A total of 82 patients received a single injection, 5 patients received two times and 2 patients received three times. Fourteen patients had mild facial swelling after surgery, which subsided spontaneously in 1-2 weeks. None of the 89 patients had complications such as embolism, infection, hematoma, induration, cyst, fat liquefaction, pigmentation, dysesthesia or depression. At the 3-month follow-up, 67 patients were very satisfied with the postoperative results, 14 patients were satisfied, 6 patients were generally satisfied, and 2 patients were not satisfied. The overall satisfaction rate was 91.0% (81/89).Conclusion:The intraoral approach to middle face fat transplantation is safe and effective in facial contour remodeling.

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.

Objective:To analyze the efficacy of allo-HSCT with total body irradiation (TBI) and chemotherapy alone in the treatment of adult ALL and to explore the factors affecting prognosis.Methods:The clinical data of 95 adult patients with ALL who underwent allo-HSCT from January 2015 to August 2022 were included. According to the conditioning regimen, the patients were divided into two groups: the TBI plus cyclophosphamide (TBI/Cy) group ( n=53) and the busulfan plus cyclophosphamide (Bu/Cy) group ( n=42). Hematopoietic reconstitution after transplantation, GVHD, transplantation-related complications, relapse rate (RR), non-relapse mortality (NRM), OS, and LFS were compared, and the factors related to prognosis were analyzed. Results:The median time of neutrophil engraftment was 14 (10-25) days in the TBI/Cy group and 14 (10-24) days in the Bu/Cy group ( P=0.106). The median time of megakaryocyte engraftment was 17 (10-42) days in the TBI/Cy group and 19 (11-42) days in the Bu/Cy group ( P=0.488). The incidence of grade Ⅱ-Ⅳ acute GVHD (aGVHD) in the TBI/Cy and Bu/Cy groups was 41.5% and 35.7%, respectively ( P=0.565). The incidence of grade Ⅲ-Ⅳ aGVHD in these two groups was 24.5% and 4.8%, respectively ( P=0.009). The incidence of severe chronic GVHD in the two groups was 16.7% and 13.5%, respectively ( P=0.689). The incidence of cytomegalovirus infection, Epstein-Barr virus infection, severe infection, and hemorrhagic cystitis in the two groups was 41.5% and 35.7% ( P=0.565), 34.0% and 35.7% ( P=0.859), 43.4% and 33.3% ( P=0.318), and 20.8% and 50.0% ( P=0.003), respectively. The median follow-up time was 37.1 months and 53.3 months in the TBI/Cy and Bu/Cy groups, respectively. The 2-year cumulative RR was 17.0% in the TBI/Cy group and 42.9% in the Bu/Cy group ( P=0.017). The 2-year cumulative NRM was 24.5% and 7.1%, respectively ( P=0.120). The 2-year LFS was 58.5% and 50.0%, respectively ( P=0.466). The 2-year OS rate was 69.8% and 64.3%, respectively ( P=0.697). In the multivariate analysis, the conditioning regimen containing TBI was a protective factor for relapse after transplantation ( HR=0.304, 95% CI 0.135-0.688, P=0.004), whereas the effect on NRM was not significant ( HR=1.393, 95% CI 0.355-5.462, P=0.634). Infection was an independent risk factor for OS after allo-HSCT in adult patients with ALL. Conclusion:allo-HSCT based on TBI conditioning regimen had lower relapse rate and lower incidence of hemorrhagic cystitis for adult ALL, compared with chemotherapy regimen. While the incidence o grade Ⅲ/Ⅳ aGVHD was hgher in TBI conditioning regimen than that in chemotherapy regimen.