BACKGROUND:How to repair bone defect has been a clinical problem for a long time.The effective ingredients of traditional Chinese medicine have good biological activity and therapeutic effect,and the combination of effective ingredients of traditional Chinese medicine and tissue engineering materials has a broad prospect in the field of bone repair.The combination of different effective ingredients of traditional Chinese medicine and scaffolds has similarities in their functional relationships. OBJECTIVE:To collect the cases of the combinations of effective ingredients of traditional Chinese medicine and scaffolds,then analogize tissue engineering scaffolds and effective ingredients of traditional Chinese medicine into two types of traditional Chinese medicine that generate compatibility relationships based on the inspiration of the compatibility of seven emotions and summarize the relationship between the two based on their functional relationships. METHODS:Relevant articles from January 1998 to January 2024 were searched in PubMed and China National Knowledge Infrastructure(CNKI),using English search terms"traditional Chinese medicine,Chinese medicine,traditional Chinese medicine monomers,bone defect,bone repair,bone tissue engineering,tissue engineering,scaffold"and Chinese search terms"traditional Chinese medicine,effective ingredients of traditional Chinese medicine,traditional Chinese medicine monomers,bone tissue engineering,bone tissue engineering scaffold,scaffold,tissue engineering,bone defect,bone repair."A total of 88 articles were included for review and analysis. RESULTS AND CONCLUSION:(1)Both tissue engineering scaffold materials and active ingredients of traditional Chinese medicine have been widely used in the field of bone repair.Although they have obvious advantages in osteogenesis,there are still many shortcomings.Many studies are dedicated to preparing composite materials from the two,hoping to exert a detoxification and synergism through the interaction between the two.(2)Some drugs and materials can promote each other in osteogenesis,antibacterial,and promoting angiogenesis,enhancing their original effects.Inspired by the traditional concept of prescription compatibility,this article summarized it as a"Mutual promotion"relationship and provided examples to support it.(3)Some drugs can enhance the strength of materials,while some materials can achieve sustained release and controlled release effects,increase drug loading and stability,or achieve targeted delivery of drugs loaded on them.The article summarized this unilateral enhancement effect as a"Mutual assistance"relationship.(4)The combination of some traditional Chinese medicine and materials can reduce the toxic side effects of the other party.The article summarizes this detoxification relationship as"Mutual restraint and detoxification."(5)The article provided a new perspective on traditional Chinese medicine composite scaffolds,inspired by the seven emotions compatibility relationship and based on the classification of action relationships.It introduced traditional Chinese medicine concepts into the field of tissue engineering,providing new research ideas for subsequent researchers of composite scaffolds,and providing certain convenience in material selection and matching.

Objective:To evaluate the clinical efficacy of minimally invasive Chevron-Akin osteotomy (MICA) in the treatment of mild to moderate hallux valgus without addressing the proximal projection.Methods:A retrospective analysis was conducted on 31 patients with unilateral mild to moderate hallux valgus who underwent third-generation MICA surgery at Shanghai Sixth People's Hospital from January 2019 to June 2020. Among these patients, 2 were male and 29 were female, with an average age of 41.13±7.8 years (range: 21-64 years). A total of 12 patients had mild hallux valgus, while 19 patients had moderate hallux valgus. The average body mass index (BMI) was 24.37±1.28 kg/m 2 (range: 22.06-26.13 kg/m 2). Preoperative and postoperative foot X-rays were taken at multiple time points, including 1 day, 1.5 months, 3 months, 12 months, and 24 months after surgery. These X-rays were used to assess the medial eminence width (MEW) of the first metatarsal head, the proximal medial projection width (PMRW) of the first metatarsal, the hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the distal metatarsal articular angle (DMAA). Functional improvements and pain relief were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score and the visual analogue scale (VAS). Results:All 31 patients completed an average follow-up period of 25.67±2.35 months (range: 24-31 months). The average operation time was 39.55±7.31 minutes (range: 32-46 minutes). The number of intraoperative fluoroscopy exposures averaged 16.23±2.38 times (range: 13-21 times). At the two-year follow-up, significant improvements were observed in all measured parameters when compared to preoperative values ( P<0.05). The HVA decreased from 35.18°±3.59° before surgery to 10.93°±0.90° after surgery. The IMA was reduced from 11.47°±0.85° to 6.94°±0.65°, and the DMAA decreased from 15.24°±1.13° to 4.31°±0.56°. The MEW decreased from 4.07±0.70 mm to 0.13±0.11 mm. The PMRW, which was measured at one day postoperatively and at the two-year follow-up, decreased from 3.44±0.66 mm to 0.19±0.11 mm. Functional assessments also showed significant improvements ( P<0.05). The AOFAS forefoot score increased from 57.42±3.93 before surgery to 89.52±3.46 at the two-year follow-up. Pain levels, as assessed by the VAS, decreased from 5.68±1.11 preoperatively to 0.77±0.50 postoperatively. At the two-year follow-up, 97% of patients reported excellent satisfaction with the surgical outcome. During the follow-up period, complications included mild numbness around the wound in two cases, metatarsophalangeal joint stiffness in one case, and hallux valgus recurrence in one case, accounting for 3% of the cohort. Conclusion:Third-generation MICA without addressing the proximal projection is an effective procedure for correcting mild to moderate hallux valgus. This technique significantly improves foot function, reduces pain, and leads to high levels of patient satisfaction.

Objective:To construct and validate a clinical model combining CYP11B2 gene polymorphisms with clinical parameters to predict complete postoperative hypertension remission in primary aldosteronism patients.Methods:The clinical data of a total of 116 patients with primary aldosteronism who underwent unilateral adrenalectomy from April 2018 to August 2024 were retrospectively included. There were 63 males and 53 females，with a body mass index（BMI）of（25.50 ± 2.03）kg/m 2. Genomic DNA was extracted from venous blood leukocytes before surgery，and polymerase chain reaction-restriction fragment length polymorphisms（PCR-RFLP）were used to detect CYP11B2（rs1799998）promoter region 344（C > T）base substitution. The follow-up duration was more than 6 months，with the following parameters recorded at the last follow-up：plasma aldosterone，renin，serum potassium，and sodium levels. Blood pressure progression and antihypertensive medication usage were also assessed. The postoperative outcome was determined according to the Primary Aldosteronism Surgical Outcome score（PASO）for primary aldosteronism，and the specific criteria were as follows. ① Clinical complete remission：the patient's blood pressure returned to normal（< 140/90 mmHg，1 mmHg = 0.133 kPa）and all antihypertensive drugs were discontinued；②Partial clinical remission：blood pressure returns to normal，and the number or dose of antihypertensive drugs is reduced compared with before；③Clinical non-remission：blood pressure does not drop and antihypertensive drugs do not change or increase compared with before surgery. Patients were divided into complete and incomplete remission groups. The chi-square test was used for univariate analysis，followed by binary logistic forward conditional regression for multivariate analysis，and a variety of machine learning algorithms such as random forest，logistic regression，support vector machine and gradient lifter were integrated，and the results of multivariate analysis were included to construct a postoperative blood pressure outcome model，and the predictive performance of the model was evaluated by using receiver operating characteristic（ROC）curve，calibration curve and clinical decision curve. Results:The PCR-RFLP detection results of 116 cases showed the genotype distribution of CYP11B2（344C > T）（rs1799998）as follows：CC type in 50 cases（43.1%），CT type in 46 cases（39.7%），and TT type in 20 cases（17.3%）. There were 74 cases in the complete remission group and 42 cases in the incomplete remission group，and the rate of complete remission with hypertension at the end of the operation was 63.8%. Univariate analysis showed that the the differences between complete remission group and incomplete remission group in body mass index［（24.27 ± 2.90）kg/m 2 vs.（26.98 ± 3.17）kg/m 2， P<0.001］，preoperative hypertension grade（grade 1/2/3：29/29/16 cases vs. 9/13/20 cases， P = 0.012），preoperative antihypertensive drugs（0/1/≥ 2：25/32/17 cases vs. 7/15/20 cases， P = 0.016），and CYP11B2（344C > T）（CC/TT + CT：39/35 cases vs. 11/31 cases， P = 0.006）were statistically significant. Multivariate analysis showed that the type of preoperative antihypertensive drugs［≥ 2： OR = 5.26（95% CI 1.12?24.61， P = 0.016；1： OR = 4.55（95% CI 1.23?22.47）， P = 0.025］was the strongest independent predictor，followed by CYP11B2（344C > T）［ OR = 4.02（95% CI 1.16?13.82）， P = 0.028］and BMI［ OR = 3.96（95% CI 2.26?6.92）， P < 0.001］. Comparing the receiver operating feature（ROC）curves of the four types of machine learning models，the best model was the support vector machine model with an area under the curve（AUC）of 0.88（95% CI 0.82?0.95），followed by the gradient elevator model of 0.83（95% CI 0.76?0.91），the logistic regression model of 0.78（95% CI 0.68?0.88），and the random forest model of 0.77（95% CI 0.68?0.86）. The optimal threshold of the Yoden index of the support vector machine model was 0.588，with a sensitivity of 78.5% and a specificity of 86.5%. The clinical decision curve and calibration curve show that the support vector machine model has a higher net benefit and acceptable stability and reliability. Conclusions:The support vector machine model incorporating CYP11B2 gene polymorphisms，BMI，and types of preoperative antihypertensive medications could effectively predict postoperative hypertension remission in primary aldosteronism patients，providing new evidence for personalized treatment strategies

Objective:To evaluate the clinical efficacy of minimally invasive Chevron-Akin osteotomy (MICA) in the treatment of mild to moderate hallux valgus without addressing the proximal projection.Methods:A retrospective analysis was conducted on 31 patients with unilateral mild to moderate hallux valgus who underwent third-generation MICA surgery at Shanghai Sixth People's Hospital from January 2019 to June 2020. Among these patients, 2 were male and 29 were female, with an average age of 41.13±7.8 years (range: 21-64 years). A total of 12 patients had mild hallux valgus, while 19 patients had moderate hallux valgus. The average body mass index (BMI) was 24.37±1.28 kg/m 2 (range: 22.06-26.13 kg/m 2). Preoperative and postoperative foot X-rays were taken at multiple time points, including 1 day, 1.5 months, 3 months, 12 months, and 24 months after surgery. These X-rays were used to assess the medial eminence width (MEW) of the first metatarsal head, the proximal medial projection width (PMRW) of the first metatarsal, the hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the distal metatarsal articular angle (DMAA). Functional improvements and pain relief were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score and the visual analogue scale (VAS). Results:All 31 patients completed an average follow-up period of 25.67±2.35 months (range: 24-31 months). The average operation time was 39.55±7.31 minutes (range: 32-46 minutes). The number of intraoperative fluoroscopy exposures averaged 16.23±2.38 times (range: 13-21 times). At the two-year follow-up, significant improvements were observed in all measured parameters when compared to preoperative values ( P<0.05). The HVA decreased from 35.18°±3.59° before surgery to 10.93°±0.90° after surgery. The IMA was reduced from 11.47°±0.85° to 6.94°±0.65°, and the DMAA decreased from 15.24°±1.13° to 4.31°±0.56°. The MEW decreased from 4.07±0.70 mm to 0.13±0.11 mm. The PMRW, which was measured at one day postoperatively and at the two-year follow-up, decreased from 3.44±0.66 mm to 0.19±0.11 mm. Functional assessments also showed significant improvements ( P<0.05). The AOFAS forefoot score increased from 57.42±3.93 before surgery to 89.52±3.46 at the two-year follow-up. Pain levels, as assessed by the VAS, decreased from 5.68±1.11 preoperatively to 0.77±0.50 postoperatively. At the two-year follow-up, 97% of patients reported excellent satisfaction with the surgical outcome. During the follow-up period, complications included mild numbness around the wound in two cases, metatarsophalangeal joint stiffness in one case, and hallux valgus recurrence in one case, accounting for 3% of the cohort. Conclusion:Third-generation MICA without addressing the proximal projection is an effective procedure for correcting mild to moderate hallux valgus. This technique significantly improves foot function, reduces pain, and leads to high levels of patient satisfaction.

Objective:To construct and validate a clinical model combining CYP11B2 gene polymorphisms with clinical parameters to predict complete postoperative hypertension remission in primary aldosteronism patients.Methods:The clinical data of a total of 116 patients with primary aldosteronism who underwent unilateral adrenalectomy from April 2018 to August 2024 were retrospectively included. There were 63 males and 53 females，with a body mass index（BMI）of（25.50 ± 2.03）kg/m 2. Genomic DNA was extracted from venous blood leukocytes before surgery，and polymerase chain reaction-restriction fragment length polymorphisms（PCR-RFLP）were used to detect CYP11B2（rs1799998）promoter region 344（C > T）base substitution. The follow-up duration was more than 6 months，with the following parameters recorded at the last follow-up：plasma aldosterone，renin，serum potassium，and sodium levels. Blood pressure progression and antihypertensive medication usage were also assessed. The postoperative outcome was determined according to the Primary Aldosteronism Surgical Outcome score（PASO）for primary aldosteronism，and the specific criteria were as follows. ① Clinical complete remission：the patient's blood pressure returned to normal（< 140/90 mmHg，1 mmHg = 0.133 kPa）and all antihypertensive drugs were discontinued；②Partial clinical remission：blood pressure returns to normal，and the number or dose of antihypertensive drugs is reduced compared with before；③Clinical non-remission：blood pressure does not drop and antihypertensive drugs do not change or increase compared with before surgery. Patients were divided into complete and incomplete remission groups. The chi-square test was used for univariate analysis，followed by binary logistic forward conditional regression for multivariate analysis，and a variety of machine learning algorithms such as random forest，logistic regression，support vector machine and gradient lifter were integrated，and the results of multivariate analysis were included to construct a postoperative blood pressure outcome model，and the predictive performance of the model was evaluated by using receiver operating characteristic（ROC）curve，calibration curve and clinical decision curve. Results:The PCR-RFLP detection results of 116 cases showed the genotype distribution of CYP11B2（344C > T）（rs1799998）as follows：CC type in 50 cases（43.1%），CT type in 46 cases（39.7%），and TT type in 20 cases（17.3%）. There were 74 cases in the complete remission group and 42 cases in the incomplete remission group，and the rate of complete remission with hypertension at the end of the operation was 63.8%. Univariate analysis showed that the the differences between complete remission group and incomplete remission group in body mass index［（24.27 ± 2.90）kg/m 2 vs.（26.98 ± 3.17）kg/m 2， P<0.001］，preoperative hypertension grade（grade 1/2/3：29/29/16 cases vs. 9/13/20 cases， P = 0.012），preoperative antihypertensive drugs（0/1/≥ 2：25/32/17 cases vs. 7/15/20 cases， P = 0.016），and CYP11B2（344C > T）（CC/TT + CT：39/35 cases vs. 11/31 cases， P = 0.006）were statistically significant. Multivariate analysis showed that the type of preoperative antihypertensive drugs［≥ 2： OR = 5.26（95% CI 1.12?24.61， P = 0.016；1： OR = 4.55（95% CI 1.23?22.47）， P = 0.025］was the strongest independent predictor，followed by CYP11B2（344C > T）［ OR = 4.02（95% CI 1.16?13.82）， P = 0.028］and BMI［ OR = 3.96（95% CI 2.26?6.92）， P < 0.001］. Comparing the receiver operating feature（ROC）curves of the four types of machine learning models，the best model was the support vector machine model with an area under the curve（AUC）of 0.88（95% CI 0.82?0.95），followed by the gradient elevator model of 0.83（95% CI 0.76?0.91），the logistic regression model of 0.78（95% CI 0.68?0.88），and the random forest model of 0.77（95% CI 0.68?0.86）. The optimal threshold of the Yoden index of the support vector machine model was 0.588，with a sensitivity of 78.5% and a specificity of 86.5%. The clinical decision curve and calibration curve show that the support vector machine model has a higher net benefit and acceptable stability and reliability. Conclusions:The support vector machine model incorporating CYP11B2 gene polymorphisms，BMI，and types of preoperative antihypertensive medications could effectively predict postoperative hypertension remission in primary aldosteronism patients，providing new evidence for personalized treatment strategies

Objective To explore the role of sulodexide(SDX)in neointimal hyperplasia of arteriovenous fistulas(AVFs)in chronic kidney disease(CKD)rats and its possible mechanism.Methods A total of 18 male rats(weighing 300±50 g)were randomly and equally divided into AVF group,CKD+AVF group(CKD induction followed by AVF surgery and then gavaged with normal saline for 2 months),and CKD+AVF+SDX group[treated as in the CKD+AVF group but with 8 mg/(kg·d)SDX gavage].HE staining was used to observe the degree of neointimal hyperplasia.The expression of Hippo pathway related molecules,Yes-associated protein(YAP),pYAP and connective tissue growth factor(CTGF,YAP downstream target protein,one of mesenchymal marker)was detected by immunofluorescence assay.After human umbilical vein cell fusion EAHy926 cells were treated with 0,2.5,5,10,20 or 40 μg/mL SDX for 24 h,and with 2.5 μg/mL SDXfor24,48 or 72 h,respectively,CCK-8 assay was used to measure cell survival rate.Moreover,the serum sample from CKD rat was used to treat EAHy926 cells,and then the cells were treated with SDX or YAP inhibitor verteporfin.The expression levels of YAP,pYAP,CTGF and endothelial cell marker CD31 were detected by Western blotting.Results HE staining and immunofluorescence assay showed that CKD rats had serious neointimal hyperplasia in AVFs(P＜0.05),and slightly lower expression of pYAP and enhanced expression of CTGF(P＜0.05)when compared with the rats of the AVF group.While,SDX treatment alleviated the neointimal hyperplasia of AVFs,enhanced the expression of pYAP and reduced the expression of CTGF(P＜0.05).CCK-8 assay showed that cell survival rate was decreased significantly in a dose-and time-dependent manner after SDX treatment(P＜0.05).Western blotting revealed that SDX increased the expression of pYAP and CD31 while inhibited the expression of CTGF in EAHy926 cells(P＜0.05),which was consistent with the effect of verteporfin treatment.Conclusion SDX can block YAP activation caused by CKD and attenuate neointimal hyperplasia in AVFs.

Objective To investigate the potential factors influencing the occurrence of major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) and develop an efficient and accurate predictive model. Methods Clinical data of AMI patients treated in the emergency department of Jining Medical University Affiliated Hospital between January and December 2020 were retrospectively collected. Patients were divided into two groups based on the occurrence of in-hospital MACE,the MACE group and the non-MACE group. Clinical indicators of the two groups were compared,and statistically significant variables were selected for inclusion in a multivariate logistic regression analysis. Based on this analysis,a nomogram model was constructed to predict the risk of in-hospital MACE in AMI patients after PCI. The model's predictive accuracy was evaluated using the receiver operating characteristic (ROC) curve,and the goodness of fit was assessed using the Hosmer-Lemeshow test. Results A total of 583 patients were included after screening based on inclusion and exclusion criteria,of whom 85 (14.58％) experienced in-hospital MACE. Univariate analysis showed that compared to the non-MACE group,the MACE group had higher values for age,Killip classification,myoglobin (MYO),brain natriuretic peptide (BNP),white blood cell count (WBC),prothrombin time (PT),T-wave changes on electrocardiogram (ECG),abnormal wall motion on echocardiography,ischemia duration greater than 6 hours,the number of MACE before PCI,and left anterior descending artery stenosis. In contrast,the number of patients with a history of oral antiplatelet medication use,coronary artery disease (CAD),family history of CAD,admission systolic blood pressure,and left ventricular ejection fraction (LVEF) were lower in the MACE group. Multivariate analysis indicated that Killip classification,BNP,ischemia duration greater than 6 hours,and MACE before PCI were independent risk factors for in-hospital MACE in AMI patients after PCI,while pre-onset use of antiplatelet medications and LVEF were independent protective factors. The nomogram model constructed based on independent risk factors demonstrated good predictive ability,with an area under the ROC curve (AUC) of 0.817,a sensitivity of 81.48％,and a specificity of 67.66％. The Hosmer-Lemeshow test confirmed the model's good fit (x2=1.937,P=0.983). Conclusion The nomogram model developed in this study effectively assesses the risk of in-hospital MACE in AMI patients after PCI,providing a valuable tool for predicting patient outcomes post-PCI.

Objective To investigate the potential factors influencing the occurrence of major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) and develop an efficient and accurate predictive model. Methods Clinical data of AMI patients treated in the emergency department of Jining Medical University Affiliated Hospital between January and December 2020 were retrospectively collected. Patients were divided into two groups based on the occurrence of in-hospital MACE,the MACE group and the non-MACE group. Clinical indicators of the two groups were compared,and statistically significant variables were selected for inclusion in a multivariate logistic regression analysis. Based on this analysis,a nomogram model was constructed to predict the risk of in-hospital MACE in AMI patients after PCI. The model's predictive accuracy was evaluated using the receiver operating characteristic (ROC) curve,and the goodness of fit was assessed using the Hosmer-Lemeshow test. Results A total of 583 patients were included after screening based on inclusion and exclusion criteria,of whom 85 (14.58％) experienced in-hospital MACE. Univariate analysis showed that compared to the non-MACE group,the MACE group had higher values for age,Killip classification,myoglobin (MYO),brain natriuretic peptide (BNP),white blood cell count (WBC),prothrombin time (PT),T-wave changes on electrocardiogram (ECG),abnormal wall motion on echocardiography,ischemia duration greater than 6 hours,the number of MACE before PCI,and left anterior descending artery stenosis. In contrast,the number of patients with a history of oral antiplatelet medication use,coronary artery disease (CAD),family history of CAD,admission systolic blood pressure,and left ventricular ejection fraction (LVEF) were lower in the MACE group. Multivariate analysis indicated that Killip classification,BNP,ischemia duration greater than 6 hours,and MACE before PCI were independent risk factors for in-hospital MACE in AMI patients after PCI,while pre-onset use of antiplatelet medications and LVEF were independent protective factors. The nomogram model constructed based on independent risk factors demonstrated good predictive ability,with an area under the ROC curve (AUC) of 0.817,a sensitivity of 81.48％,and a specificity of 67.66％. The Hosmer-Lemeshow test confirmed the model's good fit (x2=1.937,P=0.983). Conclusion The nomogram model developed in this study effectively assesses the risk of in-hospital MACE in AMI patients after PCI,providing a valuable tool for predicting patient outcomes post-PCI.

Objective:To explore the impact of early and late antibody-mediated rejection (AMR) on treatment options and allograft outcomes after kidney transplantation (KT).Methods:From January 2013 to December 2022, the study retrospectively enrolled 141 KT allograft recipients receiving allograft biopsy and diagnosed as AMR according to the Banff 2019 criteria. Recipients with a diagnosis of AMR within 30 days post-KT were classified into early AMR group (n=19) while the remainders assigned as late AMR group (n=122). The outcome endpoints included recipient survival rate, death-censored graft survival rate, follow-up estimated glomerular filtration rate (eGFR) and immunodominant donor-specific antibody (DSA) intensity. Wilcoxon's test was utilized for assessing the differences in eGFR and DSA intensity while Kaplan-Meier curve and Log-rank test were employed for evaluating graft survival impact. Treatment regimens for AMR were collected and categorized.Results:The median follow-up duration was 2.6(1.2, 5.2) year. No graft failure was noted in early AMR group while 44 recipients in late AMR group experienced graft failure, with 34 cases (77.2%) due to AMR progression. The 5-year death-censored graft survival rate was significantly better in early AMR group than that in late AMR group [100% vs 60.1%(50.5%, 71.6%), P=0.002]. The one-year change in eGFR for early AMR group was significantly superior to that of late AMR group [19.3(-2.6, 38.1) vs -3.3(-14.0, 5.4), P=0.001]. One-year mean fluorescent intensity (MFI) of early AMR group was 1 158(401.5, 3 126.5). It was significantly lower than that when diagnosed with early AMR [3 120.5(2 392.8, 9 340.0)] and one-year MFI of late AMR group [8 094(2 251.5, 13 560.5)] ( P=0.005, P<0.001). Early AMR group primarily received standard treatment (3/19, 15.8%) and regimens centered on rituximab and/or bortezomib (7/19, 43.8%). Late AMR group mainly received standard (16/122, 13.1%) or intensified regimens (9/122, 7.4%) and regimens focused upon rituximab and/or bortezomib (32/122, 26.2%) and MP monotherapy (21/122, 17.2%). Conclusion:The outcome for early AMR is significantly better than that for late AMR. For early AMR, early and robust immunosuppression is recommended. For late AMR, early detection and timely treatment are crucial and individualized strategies should be implemented.

This report describs 2 domestic cases of tacrolimus poisoning in kidney transplant recipients due to overexposure of tacrolimus caused by nirmatrelvir/ritonavir for SARS-CoV-2 infection.Phenytoin sodium is prescribed for inducing CYP3A enzyme.It is intended for providing references for formulating and adjusting treatment protocols for tacrolimus overexposure and related toxicity in kidney transplant recipients caused by nirmatrelvir/ritonavir.