BACKGROUND: Pre-transplant exposure to immune checkpoint inhibitors (ICIs) significantly increases the risk of allograft rejection after liver transplantation (LT); however, whether ICI-related rejection leads to increased graft loss remains controversial. Therefore, this study aimed to investigate the association between ICI-related allograft rejection and perioperative graft loss. METHODS: This was a retrospective analysis of adult liver transplant recipients with early biopsy-proven T-cell-mediated rejection (TCMR) at Liver Transplantation Center of Sun Yat-sen Memorial Hospital from June 2019 to September 2024. The pathological features, clinical characteristics, and perioperative graft survival were analyzed. RESULTS: Twenty-eight patients who underwent early TCMR between June 2019 and September 2024 were included. Based on pre-LT ICI exposure, recipients were categorized into ICI-related TCMR (irTCMR, n = 12) and conventional TCMR (cTCMR, n = 16) groups. Recipients with irTCMR had a higher median Banff rejection activity index (RAI) (6 vs . 5, P = 0.012) and more aggressive tissue damage and inflammation. Recipients with irTCMR showed higher proportion of treatment resistance, achieving a complete resolution rate of only 8/12 compared to 16/16 for cTCMR. Graft loss occurred in 5/12 of irTCMR recipients within 90 days after LT, with no graft loss in cTCMRs recipients. Cox analysis demonstrated that irTCMR with an ICI washout period of <30 days was an independent risk factor for perioperative graft loss (hazard ratio [HR], 6.540; 95% confidence interval [CI], 1.067-40.067, P = 0.042). CONCLUSION IrTCMR is associated with severe pathological features, increased resistance to treatment, and higher graft loss in adult liver transplant recipients.
Humans ; Liver Transplantation/adverse effects* ; Male ; Female ; Middle Aged ; Retrospective Studies ; Graft Rejection/immunology* ; Immune Checkpoint Inhibitors/therapeutic use* ; Adult ; T-Lymphocytes/drug effects* ; Graft Survival/immunology* ; Aged

Objective To analyze the circuit-qi patterns during early embryonic period and at conception in congenital heart disease(CHD)patients based on the five-circuit and six-qi theory,and to explore the pathogenesis and etiology of CHD from a circuit-qi perspective.Methods With 16 400 non-CHD individuals as the healthy control group,a statistical analysis was performed for the circuit-qi patterns during early embryogenesis and at conception in 4 100 CHD patients(CHD group).Results The following factors were identified as significant predisposing factors for CHD:yearly circuit being excessive fire circuit during early embryogenesis,yearly qi being taiyang cold water of celestial qi combined with taiyin damp earth of terrestrial qi during early embryogenesis,yearly circuit being concurrent excessive fire circuit and earth circuit deficiency at conception,and yearly qi being taiyin damp earth of terrestrial qi paired with jueyin wind wood of celestial qi at conception(all P＜0.05 or P＜0.01).Conclusion There is a certain correlation between circuit-qi endowment during embryonic development and the prevalence of CHD.The core pathogenesis of CHD is rooted in heart-spleen insufficiency,with hyperactive heart-fire and cold kidney-water as its manifestations,and spleen deficiency failing in transportation serves as an important contributing factor in the development and progression of CHD.

Objective:To investigate the dynamic cerebral oxygen metabolism characteristics in drug-naive patients with primary insomnia (PI), and analyze the association between the cerebral oxygen metabolism and insomnia symptoms.Methods:A total of 31 drug-naive patients with PI and 36 healthy controls were recruited from July 2024 to February 2025. Insomnia symptoms were assessed by the Pittsburgh sleep quality index (PSQI). Functional near infrared spectroscopy (fNIRS) technique was employed to collect 180 s resting-state oxygenated hemoglobin concentration changes from dorsolateral prefrontal cortex (DLPFC), medial prefrontal cortex, temporal lobe (TL), parietal lobe (PL) and occipital lobe. Sliding time window analysis and K-means clustering algorithm were applied to cluster the oxygenation data into K temporal categories. Statistical analysis, including t-test, Wilcoxon rank-sum test, chi-square test, Pearson/Spearman correlation analysis, and multiple linear regression were performed using SPSS 26.0 software. Results:Clustering analysis revealed 4 characteristic temporal categories (K=4) during the 180 s resting-state. Compared to healthy controls, drug-naive PI patients exhibited higher oxygenation levels in bilateral TLs during the second temporal category(left TL(18.19±6.18)mmol/dL, (16.82±4.47)mmol/dL; right TL(18.20±8.97)mmol/dL, (16.17±5.64)mmol/dL), but lower levels during the third temporal category(left TL(16.54± 5.09)mmol/dL, (17.98±5.34)mmol/dL; right TL(15.82±7.29)mmol/dL, (17.84±5.94)mmol/dL), and exhibited lower oxygenation level in right PL during the second category((16.16±6.56)mmol/dL, (17.60±5.84)mmol/dL) (all P<0.05). Oxygenation levels in the right DLPFC during the first temporal category ( β=0.44, t=2.52, P=0.018), in the left DLPFC during the second temporal category( β=-0.47, t=-2.82, P=0.009), and in the right PL during the second temporal category( β=-0.46, t=-2.78, P=0.010) were influencing factors for the PSQI score. Conclusions:The bilateral TLs and right PL in drug-naive PI patients exhibit phase-specific abnormalities in oxygen metabolism, potentially attributable to the insomnia-induced dysregulation of endogenous neural oscillations. The oxygen concentration changes in bilateral DLPFCs and right TL are associated with insomnia symptoms.

Objective:To investigate the dynamic cerebral oxygen metabolism characteristics in drug-naive patients with primary insomnia (PI), and analyze the association between the cerebral oxygen metabolism and insomnia symptoms.Methods:A total of 31 drug-naive patients with PI and 36 healthy controls were recruited from July 2024 to February 2025. Insomnia symptoms were assessed by the Pittsburgh sleep quality index (PSQI). Functional near infrared spectroscopy (fNIRS) technique was employed to collect 180 s resting-state oxygenated hemoglobin concentration changes from dorsolateral prefrontal cortex (DLPFC), medial prefrontal cortex, temporal lobe (TL), parietal lobe (PL) and occipital lobe. Sliding time window analysis and K-means clustering algorithm were applied to cluster the oxygenation data into K temporal categories. Statistical analysis, including t-test, Wilcoxon rank-sum test, chi-square test, Pearson/Spearman correlation analysis, and multiple linear regression were performed using SPSS 26.0 software. Results:Clustering analysis revealed 4 characteristic temporal categories (K=4) during the 180 s resting-state. Compared to healthy controls, drug-naive PI patients exhibited higher oxygenation levels in bilateral TLs during the second temporal category(left TL(18.19±6.18)mmol/dL, (16.82±4.47)mmol/dL; right TL(18.20±8.97)mmol/dL, (16.17±5.64)mmol/dL), but lower levels during the third temporal category(left TL(16.54± 5.09)mmol/dL, (17.98±5.34)mmol/dL; right TL(15.82±7.29)mmol/dL, (17.84±5.94)mmol/dL), and exhibited lower oxygenation level in right PL during the second category((16.16±6.56)mmol/dL, (17.60±5.84)mmol/dL) (all P<0.05). Oxygenation levels in the right DLPFC during the first temporal category ( β=0.44, t=2.52, P=0.018), in the left DLPFC during the second temporal category( β=-0.47, t=-2.82, P=0.009), and in the right PL during the second temporal category( β=-0.46, t=-2.78, P=0.010) were influencing factors for the PSQI score. Conclusions:The bilateral TLs and right PL in drug-naive PI patients exhibit phase-specific abnormalities in oxygen metabolism, potentially attributable to the insomnia-induced dysregulation of endogenous neural oscillations. The oxygen concentration changes in bilateral DLPFCs and right TL are associated with insomnia symptoms.

Objective:To observe and analyze the risk factors of positive conjunctival capsule microbial culture in patients with intravitreal injection treatment (IVT) before treatment.Methods:A prospective study. A total of 1 092 patients who received IVT at the Vitreous Injection Center of Tianjin Medical University Eye Hospital from February 2021 to February 2024 were included in the study. Among them, 539 were males and 553 were females. The age was (62.29±13.61) years. Hypertension and diabetes were 661 and 576 cases, respectively. There were 742 cases of urban residence and 350 cases of rural residence. Three and one days before IVT, 364 patients received antibiotics and 364 patients did not receive antibiotics. Patients' gender, age, history of hypertension and diabetes, pre-IVT antibiotic eye drops use history, and differences in residence (town/country) were collected in detail. Samples were collected after the conjunctival sac was rinsed, and microbial culture was performed. The differences in conjunctival microbial culture positivity rates was compared between those who did not use antibiotic eye drops before IVT, those who used them 1 day before IVT, and those who used them 3 days before IVT. The positive rate of conjunctival sac microbial culture were compared among individuals of different ages, genders, with/without hypertension, with/without diabetes, with different IVT times, and from different living areas (urban/rural). The clinical baseline of positive conjunctival capsule bacterial culture was compared and observed. χ2 test was used to compare the positive rate of conjunctival capsule microbial culture among different clinical baselines. Logistic binary regression analysis was used to analyze the influencing factors. Results:Among the 1 092 patients, 54 cases (4.95%, 54/1 092) were positive for microbial culture of conjunctival sac. There was no significant difference ( P>0.05) in the positive rate of conjunctival sac microbial culture among patients of different ages ( χ2=5.599), gender ( χ2=0.549), residence ( χ2=0.153), with or without hypertension and diabetes ( χ2=3.545, 0.044), and with or without diabetic macular edema ( χ2=0.180). There was no significant difference ( P>0.05) in the positive rate of conjunctival sac microbial culture between patients with different numbers of IVT ( χ2=0.961) or between those who received antibiotic eye drops before IVT and those who did not ( χ2=5.600). Logistic binary regression analysis showed that none of the above factors were risk factors for positive conjunctival capsule microbial culture ( P>0.05). No infective endophthalmitis occurred in all patients during the observation period. Conclusion:The use of antibiotics before IVT is not the decisive factor for positive microbial culture in conjunctival sac.

The climate on the plateau is characterized by hypobaria and hypoxia,where the natural environment is harsh,which poses a serious threat to the health and combativeness of troops.As a vital organ of the human body,the kidney has a complex vascular structure,large oxygen consumption,and is vulnerable to damage from hypoxia and other factors.This paper outlines the special changes of renal function and current diagnosis and treatment of kidney injury by taking into consideration the actual conditions on the plateau and renal blood and oxygen supply.Meanwhile,related countermeasures are recommended to facilitate the prevention and treatment of kidney injury in warfare on the plateau.

Diabetic cognitive dysfunction （DCD） is one of the complications of diabetes， which is characterized by impaired brain structure and progressively decreased learning and memory ability. With the increasing incidence of diabetes worldwide， DCD has become a serious medical and social problem. However， its pathophysiological mechanisms are not well understood. The occurrence and development of DCD involve multiple pathological links and mechanisms， and the prevention and treatment require multi-link and multi-target therapeutic measures. At present， there is no specific drug to prevent or improve DCD. Hypoglycemic drugs such as metformin and vigagliptin or anti-dementia drug including Donepezil are commonly used in clinical treatment to delay the occurrence and progression of cognitive dysfunction， but these drugs have a single target and obvious side effects. Traditional Chinese medicine has a long history in the prevention and treatment of diabetes and central cognitive diseases， and it has many unique advantages such as multiple components， multiple targets， side effects， and low price. A large number of studies have confirmed that traditional Chinese medicine has a significant prevention and treatment effect on DCD， which can improve insulin resistance， synaptic dysfunction， inflammation， oxidative stress， endoplasmic reticulum stress， and neuronal apoptosis by regulating phosphatidylin-ositol 3-kinase （PI3K）/protein kinase B （Akt）， advanced glycation end products （AGEs）/advanced glycation end products receptor （RAGE）/nuclear transcription factor-κB （NF-κB）， NOD-like receptor thermal protein domain associated protein 3 （NLRP3） inflammasome， and endoplasmic reticulum stress and nuclear factor E₂ related factor 2 （Nrf2）/antioxidant response element （ARE） signaling pathways. This article reviewed the effects and related mechanisms of traditional Chinese medicine on DCD in recent years， so as to provide a reference for the prevention and treatment of DCD by traditional Chinese medicine.

Objective:To observe and analyze the risk factors of positive conjunctival capsule microbial culture in patients with intravitreal injection treatment (IVT) before treatment.Methods:A prospective study. A total of 1 092 patients who received IVT at the Vitreous Injection Center of Tianjin Medical University Eye Hospital from February 2021 to February 2024 were included in the study. Among them, 539 were males and 553 were females. The age was (62.29±13.61) years. Hypertension and diabetes were 661 and 576 cases, respectively. There were 742 cases of urban residence and 350 cases of rural residence. Three and one days before IVT, 364 patients received antibiotics and 364 patients did not receive antibiotics. Patients' gender, age, history of hypertension and diabetes, pre-IVT antibiotic eye drops use history, and differences in residence (town/country) were collected in detail. Samples were collected after the conjunctival sac was rinsed, and microbial culture was performed. The differences in conjunctival microbial culture positivity rates was compared between those who did not use antibiotic eye drops before IVT, those who used them 1 day before IVT, and those who used them 3 days before IVT. The positive rate of conjunctival sac microbial culture were compared among individuals of different ages, genders, with/without hypertension, with/without diabetes, with different IVT times, and from different living areas (urban/rural). The clinical baseline of positive conjunctival capsule bacterial culture was compared and observed. χ2 test was used to compare the positive rate of conjunctival capsule microbial culture among different clinical baselines. Logistic binary regression analysis was used to analyze the influencing factors. Results:Among the 1 092 patients, 54 cases (4.95%, 54/1 092) were positive for microbial culture of conjunctival sac. There was no significant difference ( P>0.05) in the positive rate of conjunctival sac microbial culture among patients of different ages ( χ2=5.599), gender ( χ2=0.549), residence ( χ2=0.153), with or without hypertension and diabetes ( χ2=3.545, 0.044), and with or without diabetic macular edema ( χ2=0.180). There was no significant difference ( P>0.05) in the positive rate of conjunctival sac microbial culture between patients with different numbers of IVT ( χ2=0.961) or between those who received antibiotic eye drops before IVT and those who did not ( χ2=5.600). Logistic binary regression analysis showed that none of the above factors were risk factors for positive conjunctival capsule microbial culture ( P>0.05). No infective endophthalmitis occurred in all patients during the observation period. Conclusion:The use of antibiotics before IVT is not the decisive factor for positive microbial culture in conjunctival sac.

【Objective】 To investigate the clinical characteristics, long-term follow-up rate, level and control rate of low-density lipoprotein cholesterol (LDL-C) in patients with atherosclerotic cardiovascular disease (ASCVD) aged ≥75 years who underwent percutaneous coronary intervention (PCI) during hospitalization. 【Methods】 We selected ASCVD patients aged ≥75 years with PCI from January 2016 to December 2020 in The First Affiliated Hospital of Xi’an Jiaotong University, collected the baseline data of the patients and the follow-up of 1 month, 3 months, 6 months and 12 months after discharge by HIS system, and analyzed their LDL-C and control rate at each follow-up. 【Results】 A total of 1 129 patients were enrolled in this study, aged 78 (ranging from 75 to 89) years. Among them 72.1% were male; myocardial infarction was the main type of ASCVD (71.5% ); hypertension was the most common risk factor, accounting for 85.2% (717/842), followed by diabetes, 58.6% (493/842); 74.6% met the ultra-high risk criteria of the 2020 Chinese Expert Consensus on Lipid Management in Ultra-High Risk ASCVD Patients, and the LDL-C control rate was only 8.1% . The four routine follow-up rates of 1 129 elderly ASCVD patients were 49.5%, 24.1%, 17.1%, and 24.6%, respectively. The detection rates of LDL-C during follow-up were 26.3%, 5.3%, 10.4%, and 13.8%, respectively. LDL-C control rates in ultra-high risk ASCVD were 59.4%, 45.1%, 37.1%, and 17.6%, respectively, while LDL-C control rates in non-ultra-high risk ASCVD patients were 67.3%, 55.6%, 47.4%, and 44.0%, respectively. 【Conclusion】 The elderly patients with ASCVD-PCI were mainly ultra-high risk patients. The routine follow-up rate and the LDL-C compliance rate during follow-up were low and showed a downward trend.

The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.