Objective To explore the number of peripheral blood regulatory T cells (Treg) in patients with chronic kidney disease (CKD) and its correlation with vascular calcification. Methods This was a single-center, cross-sectional, and observational study. Non-dialysis patients with CKD treated at Zhongshan Hospital, Fudan University from March 2021 to March 2022 were enrolled. Abdominal aortic calcification (AAC) was assessed using lateral abdominal X-ray. Number of Treg and cytokine levels were measured by flow cytometry. Logistic regression analysis was performed to evaluate the related factors for AAC in CKD patients. Results A total of 83 patients were included, aged 17–86 years, with 57 males (68.7%). The distribution of CKD stages was as follows: stage G1 in 7 patients (8.4%), stage G2 in 17 patients (20.5%), stage G3 in 21 patients (25.3%), stage G4 in 19 patients (22.9%), and stage G5 in 19 patients (22.9%). No AAC was observed in patients with stages G1 and G2, while the prevalence of AAC in patients with stages G3, G4, and G5 was 23.8%, 21.1%, and 26.3%, respectively. Compared with stage G1 patients, those with stages G3–5 showed decreased number of peripheral blood Treg and elevated levels of interleukin (IL)-6 and IL-17F (P＜0.05). The area under the receiver operating characteristic curve for number of peripheral blood Treg in predicting AAC in CKD patients was 0.766 (95%CI 0.652–0.879, P＝0.002). Logistic regression analysis showed that decreased number of Treg was related factor for AAC in CKD patients (OR＝0.957, 95%CI 0.922–0.992, P＝0.018). Conclusion As CKD progresses, number of peripheral blood Treg significantly decreases, which is correlated with AAC in CKD patients.

OBJECTIVE To analyze the selection and rationales of comparators for pharmaceutical enterprises in their medical insurance access application， so as to provide a reference for promoting communication and consensus between enterprises and medical insurance authorities in this process. METHODS The application materials for drugs outside the catalogue that passed formal review published by the National Healthcare Security Administration from 2021 to 2025 were extracted， and then content analysis was used to systematically sort out relevant information of the declared drugs and comparators； the specific situations and rationales of pharmaceutical enterprises’ selection of comparators were analyzed. RESULTS A total of 1 341 declared drug documents were collected. Data analysis showed that 1 035 （77.18%） were submitted with positive comparators and 306 （22.82%） used blank comparators； 58 drugs （4.33%） took combination therapy as the reference， and 5 drugs （0.37%） referred to non-pharmacological （or non-single pharmacological） treatment regimens. Among competitive drugs declared by multiple enterprises， 50.00% of the enterprises submitted different comparators. A total of 4 basic conditions and 39 additional conditions were extracted as the rationales for selecting positive comparators. For blank comparators， 12 drug-related factors， 2 administrative factors， and 1 other factor were identified. More than 10% of the drugs did not state the rationale for comparator selection， and over 44% of drugs using blank comparators provided only one justification. CONCLUSIONS Pharmaceutical enterprises mainly select comparators based on their own interests in the medical insurance access application， and there are deficiencies in the adequacy and standardization of their selection basis and reasoning. It is recommended that enterprises follow the principled requirements of medical insurance authorities， and fully and normatively explain the reasons for selecting comparators in combination with the characteristics of their own products. Meanwhile， it is advisable to change the current open-ended statement form of selection reasons into a closed-ended answering mode， so as to highlight the priority of selection， standardize the declaration behavior of enterprises， and reduce communication divergences between the two parties.

OBJECTIVE To investigate the improvement effects and mechanism of astragaloside Ⅳ （AS- Ⅳ ） on lipopolysaccharide （LPS）-induced neuroinflammation. METHODS BV2 cells were divided into control group， LPS group， AS-Ⅳ groups at concentrations of 20 and 40 μmol/L， and dexamethasone group （2 μmol/L）. Except for control group， neuroinflammation model was established with LPS （1 μg/mL） in other groups after medication. The levels of inflammatory factors [interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， and nitric oxide （NO）] in cell supernatant were measured in each group. Mice were randomly divided into normal group， model group， positive control group （Aspirin enteric-coated tablet， 20 mg/kg）， AS-Ⅳ low- and high-dose groups （10， 20 mg/kg）， with 6 mice in each group. Mice in each group were administered the corresponding drug/normal saline via gavage/intraperitoneal injection， once a day， for 14 consecutive days. Except for normal group， other groups were intraperitoneally injected with LPS （250 μg/kg） 1 hour after daily administration of the drug/normal saline to establish neuroinflammation model. Serum levels of IL-6 and TNF-α were measured 2 h after the last medication； histopathological morphology of cerebral tissue in mice were observed； the co-localization of inducible nitric oxide synthase （iNOS）/ionized calcium binding adapter molecule 1 （Iba1） and CD206/Iba1 in the cerebral cortex region of mice was observed； the expressions of proteins related to the nuclear factor-κB （NF-κB）/mitogen-activated protein kinase （MAPK） signaling pathway in brain tissue of mice were also determined， including NF-κB p65， phosphorylated NF-κB p65（p-NF-κB p65）， p38 MAPK， phosphorylated p38 MAPK （p-p38 MAPK）， extracellular signal-regulated kinase （ERK）， and phosphorylated ERK （p-ERK）. RESULTS In the cell experiments， compared with control group， the levels of IL-6， TNF- α and NO in the cell supernatant of the LPS group were increased significantly （P＜0.05）； compared with LPS group， the levels of IL-6， TNF-α and NO were decreased significantly in the administration groups （P＜0.05）. In the animal experiments， compared with the normal group， the serum levels of IL-6 and TNF- α， the number of iNOS/Iba1 co-localization positive cells in the cerebral cortex， and the phosphorylation levels of p38 MAPK， NF- κB p65 and ERK proteins in brain tissue were all significantly increased/elevated in model group （P＜0.05）； the number of CD206/ Iba1 co-localization positive cells in the cerebral cortex region significantly decreased （P＜0.05）. The neurons in the cerebral cortex and the CA3 region of the hippocampus displayed a disordered arrangement. Compared with model group， above quantitative indexes of mice were all reversed significantly in administration groups （P＜0.05）； the neuronal cells in the cerebral cortex and the CA3 region of the hippocampus exhibited a relatively orderly arrangement. CONCLUSIONS AS-Ⅳ may inhibit the activation of the NF-κB/MAPK signaling pathway， promote the M2-type polarization of microglia， and thereby suppress neuroinflammatory responses.

Objective:To construct a prognostic model for ovarian cancer based on programmed cell death receptor-1(PD-1)and B lymphocyte infiltration.Methods:A total of 102 patients with ovarian cancer admitted to the First Affiliated Hospital of Gannan Medical College from February 2019 to February 2022 were selected.PD-1 expression and CD20+B cell infiltration degree in cancer tissues were detected,relationship between them and pathological characteristics were analyzed,and correlation between PD-1 expres-sion with B lymphocyte infiltration degree and survival rate of patients were analyzed.Independent influencing factors of poor prognosis of ovarian cancer patients were analyzed,prediction model was built and validated according to independent factors.Results:PD-1 expression and CD20+B cell infiltration degree were closely related to tumor size,FIGO stage,tumor differentiation and lymph node metastasis(P<0.05).PD-1 expression was negatively correlated with B-lymphocyte infiltration degree(P<0.05).Patients with high PD-1 expression and low B-lymphocyte infiltration had higher mortality(P<0.05).FIGO stage,lymph node metastasis,PD-1 expres-sion and CD20+B cell infiltration were independent factors affecting poor prognosis of ovarian cancer patients.Prediction model was constructed by independent influencing factors,which had good differentiation and accuracy.Conclusion:PD-1 expression is closely related to CD20+B cell infiltration degree.There is a close relationship between PD-1 and CD20+B cell infiltration with clinico-pathological characteristics and prognosis of ovarian cancer patients,which are independent influencing factors for poor prognosis of ovarian cancer patients.

Objective:To investigate the expression of serum placental growth factor (PLGF) in the second trimester and its predictive value for preeclampsia.Methods:A retrospective analysis was conducted on 58 pregnant women with preeclampsia (preeclampsia group) who received regular antenatal care and delivered at Beijing Friendship Hospital, Capital Medical University between March 2023 and July 2024. Among them, 17 had early-onset preeclampsia (occurring before 34 weeks of gestation) and 41 had late-onset preeclampsia (occurring after 34 weeks of gestation). Sixty healthy pregnant women who received regular antenatal care and delivered during the same period were selected as the control group. Baseline characteristics and laboratory indicators were compared between the two groups, as well as serum PLGF levels between early-onset and late-onset preeclampsia patients. Factors influencing preeclampsia and the predictive value of various indicators were analyzed. Normally distributed measurement data were expressed as xˉ± s and compared by independent sample t-test. Counting data were expressed as n (%) and compared by χ2 test. Logistic regression analysis was used to identify factors influencing preeclampsia. Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of various indicators for preeclampsia. Results:Women in the preeclampsia group had significantly higher first-trimester BMI, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and a higher proportion of gestational diabetes mellitus compared to the control group [(24.8±3.2) kg/m2 vs. (22.6±2.4) kg/m2, t=4.17, P<0.001; (121±11) mmHg (1 mmHg=0.133 kPa) vs. (104±13) mmHg, t=7.81, P<0.001; (70±9) mmHg vs. (61±8) mmHg, t=5.95, P<0.001; (87±9) mmHg vs. (75±9) mmHg, t=7.37, P<0.001; 31.0% (18/58) vs. 13.3% (8/60), χ2=5.38, P=0.020]. Fasting blood glucose and glycated hemoglobin levels were also significantly higher in the preeclampsia group [(5.1±0.4) mmol/L vs. (4.8±0.5) mmol/L, t=3.92, P<0.001; (5.5±0.6)% vs. (5.2±0.3)%, t=2.60, P=0.011], while serum PLGF levels was significantly lower [(47±22) ng/L vs. (107±46) ng/L, t=9.00, P<0.001]. Serum PLGF level at 16 weeks of gestation was significantly lower in women with early-onset preeclampsia compared to those with late-onset preeclampsia [(14±4) ng/L vs. (60±9) ng/L, t=27.89, P<0.001]. Logistic regression analysis showed that serum PLGF was a protective factor against preeclampsia ( OR=0.940, 95% CI: 0.908-0.974, P=0.001), while mean arterial pressure was a risk factor for preeclampsia ( OR=1.088, 95% CI: 1.018-1.163, P=0.013). The area under ROC curve (AUC) for the combined prediction of preeclampsia using PLGF and mean arterial pressure was significantly higher than that of either indicator alone (0.916 vs. 0.872 and 0.831, both P<0.001). The optimal cutoff value of PLGF for predicting preeclampsia was 79 ng/L, with a sensitivity of 100.0% and specificity of 68.3%. The optimal cutoff value of mean arterial pressure for predicting preeclampsia was 78 mmHg, with a sensitivity of 87.9% and specificity of 73.3%. Conclusions:Decreased serum PLGF levels in the second trimester are significantly associated with the development of preeclampsia, with levels being markedly lower in early-onset preeclampsia. Both serum PLGF and mean arterial pressure can be used to predict the onset of preeclampsia, and their combination provides higher predictive value.

Based on the concept of strategic purchasing,it explores the underlying logic of medical insurance payment for hospital weight management services,including enhancing the cost-effectiveness of health investment,motivating hospitals to improve the quality and efficiency of weight management services,and promoting the supply-side reform of weight management services.By drawing on international experience in medical insurance payment for weight management services and analyzing the current practices of Chinese medical insurance systems,it is found China faces challenges in promoting hospital weight management services,such as incoordination between weight management policy advocacy and medical insurance funding,conflicting DRG grouping schemes,and inadequate insurance coverage.To address these issues,it proposes strategies including:improve the top-level design of medical insurance payment for hospital weight management services,give full play to the incentive role of medical insurance payment on hospitals and individuals,build a diversified medical insurance support system for weight management services,optimize the practice path of medical insurance payment for hospital weight management services,and help promote the Healthy China strategy.

Objective:To investigate the efficacy of venetoclax combined with hypomethylating agents (Ven-HMA), in patients with core binding factor acute myeloid leukemia (CBF-AML) intolerant to intensive induction therapy.Methods:This study retrospectively analyzed patients newly diagnosed with CBF-AML who were aged <60 years and who received Ven-HMA as induction therapy at the Department of Hematology, the First Affiliated Hospital of Soochow University, between January 2020 and June 2023. Baseline characteristics and treatment responses of the patients were collected.Results:A total of 70 treatment-na?ve patients receiving Ven-HMA induction therapy were enrolled, of which 38 were men and 32 women [median age: 43 (34 - 55) years]. Of the 70 patients, 44 (62.9%) achieved complete remission (CR) /CR with incomplete hematologic recovery (CRi), 16 (22.9%) achieved partial remission, and 10 (14.2%) exhibited no response after one induction cycle. Among the 32 t (8;21) -positive patients with AML, only 8 (25.0%) achieved CR/CRi, of whom 3 (37.5%) remained measurable residual disease (MRD) -positive; among the 38 inv (16) -positive patients, 36 (94.7%) achieved CR/Cri, of whom 12 (33.3%) remained MRD-positive. Patients harboring the CBFβ::MYH11 fusion gene showed significantly higher response rates to Ven-HMA induction than those with the RUNX1:: RUNX1T1 fusion gene ( P<0.01) . Conclusion:Ven-HMA represents a novel therapeutic strategy that exhibits significant efficacy in inv (16) -positive patients; however, it demonstrates relatively lower remission rates in t (8; 21) -positive patients.

[Objective] To explore the clinical features of IgG4-related urinary diseases so as to provide reference for the diagnosis and treatment of such diseases. [Methods] The clinical data of 4 cases of IgG4-related urinary system diseases diagnosed and treated in Xijing Hospital of Air Force Medical University during Aug.2019 and Dec.2023 were retrospectively collected.Here, we report on the diagnosis and treatment of these patients, analysing their symptoms, serology, imaging and pathology as well as their treatment and outcomes. [Results] The patients included 2 male and 2 female.The lesions were involved with the retroperitoneum and urinary system.Three patients had symptoms of lumbar pain.The imaging manifestations were complex, including retroperitoneal mass involving urinary system organs in 2 cases, tabdense shadow of the right kidney in 1 case, and simple cystic mass of kidney in 1 case.Serum IgG4 value was not detected before surgery.All patients underwent radical surgical treatment.Postoperative pathology showed fibrous tissue hyperplasia with a large number of plasma cells, lymphocytes, a few neutrophil infiltrates, and lymphoid follicles and obliterated vasculitis in some specimens.The number of IgG4⁺ plasma cells was more than 10 in all tissues under high power microscope.After surgery, 3 patients had symptoms improved, and serum IgG4 value was within the normal range; 1 patient (patem 3) had elevated IgG4 value during follow-up, received subsequent hormone therapy, and the serum IgG 4 level remained stable. [Conclusion] The symptoms of IgG4-related diseases involving the urinary system are non-specific, and the imaging findings are various, easily confused with other diseases.Early detection of serum IgG4 and biopsy pathology can help clinicians make correct diagnosis in the early stage.

BACKGROUND: The primary limitation to kidney transplantation is organ shortage. Recent progress in gene editing and immunosuppressive regimens has made xenotransplantation with porcine organs a possibility. However, evidence in pig-to-human xenotransplantation remains scarce, and antibody-mediated rejection (AMR) is a major obstacle to clinical applications of xenotransplantation. METHODS: We conducted a kidney xenotransplantation in a brain-dead human recipient using a porcine kidney with five gene edits (5GE) on March 25, 2024 at Xijing Hospital, China. Clinical-grade immunosuppressive regimens were employed, and the observation period lasted 22 days. We collected and analyzed the xenograft function, ultrasound findings, sequential protocol biopsies, and immune surveillance of the recipient during the observation. RESULTS: The combination of 5GE in the porcine kidney and clinical-grade immunosuppressive regimens prevented hyperacute rejection. The xenograft kidney underwent delayed graft function in the first week, but urine output increased later and the single xenograft kidney maintained electrolyte and pH homeostasis from postoperative day (POD) 12 to 19. We observed AMR at 24 h post-transplantation, due to the presence of pre-existing anti-porcine antibodies and cytotoxicity before transplantation; this AMR persisted throughout the observation period. Plasma exchange and intravenous immunoglobulin treatment mitigated the AMR. We observed activation of latent porcine cytomegalovirus toward the end of the study, which might have contributed to coagulation disorder in the recipient. CONCLUSIONS 5GE and clinical-grade immunosuppressive regimens were sufficient to prevent hyperacute rejection during pig-to-human kidney xenotransplantation. Pre-existing anti-porcine antibodies predisposed the xenograft to AMR. Plasma exchange and intravenous immunoglobulin were safe and effective in the treatment of AMR after kidney xenotransplantation.
Transplantation, Heterologous/methods* ; Kidney Transplantation/methods* ; Heterografts/pathology* ; Immunoglobulins, Intravenous/administration & dosage* ; Graft Survival/immunology* ; Humans ; Animals ; Sus scrofa ; Graft Rejection/prevention & control* ; Kidney/pathology* ; Gene Editing ; Species Specificity ; Immunosuppression Therapy/methods* ; Plasma Exchange ; Brain Death ; Biopsy ; Male ; Aged