ObjectiveTo investigate the optimal termination time for acupuncture in treating patients with acute peripheral facial paralysis and its cost-effectiveness. MethodsA total of 120 eligible patients with acute-stage peri-pheral facial paralysis were randomly assigned to either the mild dysfunction termination group and the complete recovery termination group， with 60 patients in each group. Both groups received the standard acupuncture treatment protocol. Treatment in the mild dysfunction termination group was terminated when the Sunnybrook facial grade scale （SFGS） score first reached or exceeded 83 points， while that in the complete recovery termination group was terminated when the SFGS score first reached or exceeded 95 points. Assessments were conducted before treatment， 6 and 12 months after onset. SFGS， facial disability index （FDI） including physical function （FDIp） and social function （FDIs）， self-rating anxiety scale （SAS）， and self-rating depression scale （SDS） scores were assessed before treatment， and 6 and 12 months after onset. Any acupuncture-related adverse events during treatment were recorded for safety evaluation. Treatment sessions and medical costs including direct costs， indirect costs， insurance coverage， total societal costs， and patient out-of-pocket expenses were also recorded， and an economic evaluation was conducted including cost-effectiveness ratio （CER） and incremental cost-effectiveness ratio （ICER）. ResultsUltimately， 56 patients in the mild dysfunction termination group and 55 in the complete recovery termination group completed the follow-up. At 6 and 12 months after onset， SFGS and FDIp scores in both groups improved significantly while FDIs， SAS and SDS scores decreased （P＜0.05）. Comparison of scores between groups 6 months and 12 months after onset showed no statistically significant differences （P＞0.05）. During the trial， the incidence of adverse events was 13.3% （8/60） in the mild dysfunction termination group and 18.3% （11/60） in the complete recovery termination group， with no statistically significant difference （P＞0.05）. The number of treatment sessions， total social costs， and out-of-pocket expenses in the mild dysfunction termination group were significantly lower than those in the complete recovery termination group （P＜0.05）. The CER of the mild dysfunction termination group in SFGS， FDIp， FDIs， SAS， and SDS scores was lower than that of the complete recovery termination group. The ICER analysis showed that continuing treatment until full recovery incurred an additional cost of 573.30 CNY/point in SFGS improvement， whereas 1-point improvement in FDIp， FDIs， SAS， and SDS required 21,355.25 CNY， 1779.60 CNY， 3713.96 CNY， and 2755.52 CNY， respectively. ConclusionFor acupuncture in treating acute peripheral facial palsy， terminating treatment when mild dysfunction is achieved yields long-term efficacy comparable to that of continuing treatment until complete recovery， while significantly reducing medical costs and socioeconomic burden.

Objective To report the first case of renal calculi in a patient with horseshoe kidney (HSK) treated with simultaneous bilateral minimally invasive percutaneous nephrolithotomy (SB-mPCNL) combined with antegrade flexible ureteroscopy lithotripsy (A-FURS), and to analyze the feasibility of the surgical approach. Case Report A 57-year-old male patient was admitted due to “right lumbago and abdominal pain for 10 days”.Computed tomography urography (CTU) revealed bilateral nephrolithiasis with HSK.The patient underwent SB-mPCNL combined with A-FURS.The operation time was 185 min, with the lithotripsy and stone clearance time accounting for 80 min, and the estimated blood loss being approximately 30 mL.A plain abdominal radiograph conducted on the 4th postoperative day showed complete clearance of stones.Bilateral nephrostomy tubes were removed on the 6th postoperative day.The patient recovered uneventfully and was discharged on the 7th postoperative day.The safety and feasibility of this combined surgical modality were analyzed based on relevant literature. Conclusion SB-mPCNL combined with A-FURS is a safe, effective and feasible therapeutic option for bilateral nephrolithiasis in patients with HSK, which is worthy of further clinical verification.

ObjectiveTo investigate the mechanism by which Wendantang regulates the silent information regulator 3 （SIRT3）/peroxisome proliferator-activated receptor-gamma coactivator-1α （PGC-1α） pathway to influence energy metabolism and thereby prevent and treat myocardial ischemia （MI） in a rat model of hyperlipidemia （HL）. MethodsThirty SD rats were randomly assigned into five groups： control， model， low-dose （3.702 g·kg^-1·d^-1） Wendantang， high-dose （7.404 g·kg^-1·d^-1） Wendantang， and positive control （trimetazidine， 0.006 g·kg^-1·d^-1）， with six rats in each group. The control group was fed normally， while the other groups were fed with a high-fat diet for six weeks for the modeling of HL. Subsequently， the drug intervention groups were administrated with corresponding drugs by gavage， and the control and model groups received an equivalent volume of normal saline for 14 days. One hour after the last gavage， the other groups except the control group were injected intraperitoneally with posterior pituitary hormone （30 U·kg^-1） to induce MI. Electrocardiography （ECG） was employed to detect changes in the electrocardiogram. Hematoxylin-eosin staining was performed to observe cardiac pathological changes. Enzyme-linked immunosorbent assay was employed to measure the serum levels of cardiac troponin I（cTnI）， myoglobin （MYO）， and creatine kinase-MB （CK-MB）. Colorimetry was used to determine the levels of total cholesterol （TC） and triglycerides （TG） in the serum and ATP， malondialdehyde （MDA）， and superoxide dismutase （SOD） in the myocardial tissue. Western blot was employed to determine the protein levels of SIRT3， PGC-1α， adenosine monophosphate-activated protein kinase （AMPK）， and phosphorylated AMPK （p-AMPK） in the myocardial tissue. Real-time PCR was employed to measure the mRNA levels of SIRT3， PGC-1α， and AMPKα in the myocardial tissue. ResultsCompared with the control group， the model group showed significant J-point deviation and elevation in the ECG image， increased heart rate， disarrangement of myocardial fibers with unclear boundaries， elevated levels of CK-MB， cTnI， MYO， TC， and TG （P<0.05， P<0.01）， declined levels of SOD and ATP （P<0.01）， down-regulated mRNA levels of SIRT3， PGC-1α， and AMPK （P<0.05）， and down-regulated protein levels of SIRT3， PGC-1α， and p-AMPK （P<0.05）. Compared with the model group， the low-dose and high-dose Wendantang groups and the trimetazidine group showed inhibited J-point deviation and elevation in the ECG image， slowed heart rate， reduced inflammatory cell infiltration， alleviated disarrangement of myocardial fibers， declined levels of CK-MB， cTnI， MYO， TC， and TG （P<0.05， P<0.01）， elevated level of SOD （P<0.01）， up-regulated mRNA levels of SIRT3， PGC-1α， and AMPK （P<0.05， P<0.01） and up-regulated protein levels of SIRT3， PGC-1α， and p-AMPK （P<0.05， P<0.01）. ConclusionWendantang can effectively intervene in HL-associated MI in rats by reducing oxidative stress in myocardial cells， alleviating lipid metabolism disorders， and improving myocardial energy metabolism via the SIRT3/PGC-1α signaling pathway.

Objective To analyze the efficacy and safety of the traditional Chinese medicine(TCM)in the treatment of treating coronary heart disease and their effects on TG levels of patients with dyslipidemia based on the theory of"Spleen failing to disperse essence and combined phlegm and stasis"combined with Western medicine.Methods Eight different electronic databases were searched to include randomized controlled trials(RCTs)of the TCM based on the theory of"Spleen failing to disperse essence and combined phlegm and stasis"for CHD complicated with dyslipidemias published from inception to November 2024.Literature screening and data extraction were performed based on the inclusion and exclusion criteria.Meta-analysis was performed by RevMan 5.4.The GRADE system and TSA 0.9.5.10 Beta were adopted to evaluate the certainty and conclusiveness of the evidence.Results A total of 30 RCTs involving 2798 subjects were included.There were 1402 subjects in the experimental group and 1396 subjects in the control group.Meta-analysis showed that the group of Huatan Quyu therapy was effective in improving the clinical efficacy(RR=1.26,95%CI[1.19,1.33],P<0.00001),angina symptoms(RR=1.25,95%CI[1.14,1.37],P<0.00001),electrocardiogram efficacy(RR=1.27,95%CI[1.17,1.39],P<0.00001),and TCM symptom efficacy(RR=1.32,95%CI[1.23,1.42],P<0.00001).Additionally,TG levels(WMD=-0.44,95%CI[-0.52,-0.36],P<0.00001)and hs-CRP levels(WMD=-2.80,95%CI[-3.15,-2.45],P<0.00001)decreased.Concerning hemorheology,Huatan Quyu therapy effectively reduced WBV(WMD=-1.34,95%CI[-1.65,-1.02],P<0.00001)、PV(WMD=-0.44,95%CI[-0.45,-0.43],P<0.00001)and FIB(WMD=-0.46,95%CI[-0.75,-0.18],P=0.001).In terms of safety,19 studies reported the adverse reactions in detail,but the severity was mild and symptoms disappeared after treatment.TSA showed that the cumulative Z-curve of the clinical efficacy crossed the traditional threshold and TSA threshold,which further affirmed the clinical efficacy.The GRADE graded the evidence of the above outcome indicators as moderate or low.Conclusion TCM based on the theory of"Spleen failing to disperse essence and combined phlegm and stasis"may be effective and safe in the treatment of patients with CHD and lowering TG levels in dyslipidemic patients.Since the quality of the literature included in this study was generally low,there is an urgent need for more RCTs with high quality,low bias risk and sufficient sample size to validate the above conclusions.

Objective:To investigate the killing effect of the oncolytic virus Rigvir on six different colorectal cancer cell lines in vitro and differences in the sensitivity of different cell lines to Rigvir,to analyze the differentially expressed genes and signaling pathways be-tween sensitive and insensitive cells and the reasons for such differences,to explore the killing mechanism of the oncolytic virus Rigvir on colorectal cancer cells based on experimental results,and to lay a theoretical foundation for the use of the oncolytic virus Rigvir as a novel immunotherapeutic drug for the treatment of colorectal can-cer.Methods:Cell Counting Kit-8(CCK-8)assay was used for quantitative assessment of the inhibition rate of Rigvir on cells,and the Annexin V-FITC\PI method was used to measure the apoptosis rate of sensitive cell lines and preliminarily analyze its killing mechanism.Bioinformatics techniques were used to investigate the differentially expressed genes and signaling pathways between sensitive and insensitive cells,and Western blot experiments were used for validation and detecting the expression of apoptosis factors.High expression of upstream factors in differential signaling pathways,and application of real-time quantitative reverse transcription polymerase chain reaction(RT-qPCR)and WB to detect the effect of Rigvir on the expression levels of target genes and proteins in overexpressing sensitive cell lines.Results:SW480 and HT29 were sensitive to the oncolytic virus Rigvir,others had relatively insensi-tive(P<0.001).However,the inhibitory effect of Rigvir with two concentration gradients on HT29 was more significant(P<0.001).After 48 hours of infection,the cell inhibition rate of SW480 cells no longer increased with the prolongation of infection time(F=52.010,P=0.147),but it was more sensitive to changes in virus concentration(F=13.490,P<0.001).On the contrary,changes in virus concentration had no significant effect on the inhibition rate of HT29 cells(F=8.450,P=0.281),but the inhibition rate continued to in-crease after 48 hours with the prolongation of infection time(F=24.380,P<0.001).The apoptosis rate of sensitive group cells gradually increased with the prolongation of infection time(P<0.001),which mainly characterized by late stage apoptosis and necrotic cells.Through bioinformatics techniques,significant differences were observed in the classic PI3K/Akt/mTOR signaling pathway between the sensitive and insensitive groups.Western blot experiments showed that after the application of Rigvir,the upstream protein expression of PI3K/Akt/mTOR in the sensitive cell group was significantly reduced(P<0.001).The expression levels of apoptosis factors caspase-3 and caspase-8 increased,while the Bcl-2/Bax ratio decreased(P<0.001).The results of RT-qPCR and Western blot showed that after Rigvir was applied to the sensitive cell line HT29 overexpression type,the expression levels of PI3K/Akt/mTOR upstream and downstream signaling molecules(Akt,4EBP1,and p70S6K)were significantly reduced compared to the control group(P<0.05).Conclusion:Rigvir can effectively kill some colorectal cancer cell lines(SW480,HT29)in vitro,its mechanism of action is partially in-duced by the PI3K/Akt/mTOR classical signaling pathway to induce cell apoptosis.

Objective: Accurate evaluation of inflammation severity in ulcerative colitis (UC) can guide treatment strategy selection. The potential value of the pericolic fat attenuation index (FAI) on CT as an indicator of disease severity remains unknown.This study aimed to assess the diagnostic accuracy of pericolic FAI in predicting UC severity. Materials and Methods: This retrospective study enrolled 148 patients (mean age 48 years; 87 males). The fat attenuation on CT was measured in four different locations: the mesocolic vascular side (MS) and opposite side of MS (OMS) around the most severe bowel lesion, the retroperitoneal space (RS), and the subcutaneous area. The fat attenuation indices (FAI MS, FAI OMS, and FAI RS) were calculated as the fat attenuation measured in MS, OMS, and RS, respectively, minus that of the subcutaneous area, and were obtained in the non-enhanced, arterial, and delayed phases. Correlations between the FAI and UC Endoscopic Index of Severity (UCEIS) were assessed using Spearman’s correlation. Predictors of severe UC (UCEIS ≥7) were selected by univariable analysis. The performance of FAI in predicting severe UC was evaluated using the area under the receiver operating characteristic curve (AUC). Results: The FAIMS and FAI OMS scores were significantly higher than FAI RS in three phases (all P < 0.001). The FAIMS and FAI OMS scores moderately correlated with the UCEIS score (r = 0.474–0.649 among the three phases). Additionally, FAI MS and FAI OMS identified severe UC, with AUC varying from 0.77 to 0.85. Conclusion Increased CT attenuation of pericolic adipose tissue could serve as a noninvasive marker for evaluating UC severity. FAI MS and FAI OMS of three phases showed similar prediction accuracies for severe UC identification.

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: Accurate evaluation of inflammation severity in ulcerative colitis (UC) can guide treatment strategy selection. The potential value of the pericolic fat attenuation index (FAI) on CT as an indicator of disease severity remains unknown.This study aimed to assess the diagnostic accuracy of pericolic FAI in predicting UC severity. Materials and Methods: This retrospective study enrolled 148 patients (mean age 48 years; 87 males). The fat attenuation on CT was measured in four different locations: the mesocolic vascular side (MS) and opposite side of MS (OMS) around the most severe bowel lesion, the retroperitoneal space (RS), and the subcutaneous area. The fat attenuation indices (FAI MS, FAI OMS, and FAI RS) were calculated as the fat attenuation measured in MS, OMS, and RS, respectively, minus that of the subcutaneous area, and were obtained in the non-enhanced, arterial, and delayed phases. Correlations between the FAI and UC Endoscopic Index of Severity (UCEIS) were assessed using Spearman’s correlation. Predictors of severe UC (UCEIS ≥7) were selected by univariable analysis. The performance of FAI in predicting severe UC was evaluated using the area under the receiver operating characteristic curve (AUC). Results: The FAIMS and FAI OMS scores were significantly higher than FAI RS in three phases (all P < 0.001). The FAIMS and FAI OMS scores moderately correlated with the UCEIS score (r = 0.474–0.649 among the three phases). Additionally, FAI MS and FAI OMS identified severe UC, with AUC varying from 0.77 to 0.85. Conclusion Increased CT attenuation of pericolic adipose tissue could serve as a noninvasive marker for evaluating UC severity. FAI MS and FAI OMS of three phases showed similar prediction accuracies for severe UC identification.

Objective: Accurate evaluation of inflammation severity in ulcerative colitis (UC) can guide treatment strategy selection. The potential value of the pericolic fat attenuation index (FAI) on CT as an indicator of disease severity remains unknown.This study aimed to assess the diagnostic accuracy of pericolic FAI in predicting UC severity. Materials and Methods: This retrospective study enrolled 148 patients (mean age 48 years; 87 males). The fat attenuation on CT was measured in four different locations: the mesocolic vascular side (MS) and opposite side of MS (OMS) around the most severe bowel lesion, the retroperitoneal space (RS), and the subcutaneous area. The fat attenuation indices (FAI MS, FAI OMS, and FAI RS) were calculated as the fat attenuation measured in MS, OMS, and RS, respectively, minus that of the subcutaneous area, and were obtained in the non-enhanced, arterial, and delayed phases. Correlations between the FAI and UC Endoscopic Index of Severity (UCEIS) were assessed using Spearman’s correlation. Predictors of severe UC (UCEIS ≥7) were selected by univariable analysis. The performance of FAI in predicting severe UC was evaluated using the area under the receiver operating characteristic curve (AUC). Results: The FAIMS and FAI OMS scores were significantly higher than FAI RS in three phases (all P < 0.001). The FAIMS and FAI OMS scores moderately correlated with the UCEIS score (r = 0.474–0.649 among the three phases). Additionally, FAI MS and FAI OMS identified severe UC, with AUC varying from 0.77 to 0.85. Conclusion Increased CT attenuation of pericolic adipose tissue could serve as a noninvasive marker for evaluating UC severity. FAI MS and FAI OMS of three phases showed similar prediction accuracies for severe UC identification.

Objective: Accurate evaluation of inflammation severity in ulcerative colitis (UC) can guide treatment strategy selection. The potential value of the pericolic fat attenuation index (FAI) on CT as an indicator of disease severity remains unknown.This study aimed to assess the diagnostic accuracy of pericolic FAI in predicting UC severity. Materials and Methods: This retrospective study enrolled 148 patients (mean age 48 years; 87 males). The fat attenuation on CT was measured in four different locations: the mesocolic vascular side (MS) and opposite side of MS (OMS) around the most severe bowel lesion, the retroperitoneal space (RS), and the subcutaneous area. The fat attenuation indices (FAI MS, FAI OMS, and FAI RS) were calculated as the fat attenuation measured in MS, OMS, and RS, respectively, minus that of the subcutaneous area, and were obtained in the non-enhanced, arterial, and delayed phases. Correlations between the FAI and UC Endoscopic Index of Severity (UCEIS) were assessed using Spearman’s correlation. Predictors of severe UC (UCEIS ≥7) were selected by univariable analysis. The performance of FAI in predicting severe UC was evaluated using the area under the receiver operating characteristic curve (AUC). Results: The FAIMS and FAI OMS scores were significantly higher than FAI RS in three phases (all P < 0.001). The FAIMS and FAI OMS scores moderately correlated with the UCEIS score (r = 0.474–0.649 among the three phases). Additionally, FAI MS and FAI OMS identified severe UC, with AUC varying from 0.77 to 0.85. Conclusion Increased CT attenuation of pericolic adipose tissue could serve as a noninvasive marker for evaluating UC severity. FAI MS and FAI OMS of three phases showed similar prediction accuracies for severe UC identification.