Autoimmune hepatitis (AIH) is a chronic, immune-mediated liver injury of unknown etiology. The onset of this disease involves the activation and recruitment of diverse immune and non-immune cells, which in turn trigger hepatic damage. Immune checkpoint molecules (ICM) are expressed on the surface of multiple cell types. By regulating cellular functional states, they help limit the intensity and duration of immune responses, thereby preventing excessive inflammation and tissue damage, and maintaining immune homeostasis. In AIH, however, this natural "braking" mechanism is impaired, leading to aberrant activation of both immune and non-immune cells and the breakdown of immune homeostasis. Consequently, ICM are likely to play a critical role in the pathogenesis of AIH. A deeper understanding of the function of ICM in AIH not onlyadvances our insight into the disease mechanism, but also suggests that targeting these molecules may represent a promising therapeutic strategy for the treatment of AIH.

Objective: To develop a RHCE genotyping assay based on kompetitive allele-specific PCR (KASP) and assess its clinical accuracy for RhCE blood group determination. Methods: KASP primers were designed to interrogate three RHCE loci: the 109 bp insertion/deletion in intron 2, c. 307T>C, and c. 676C>G. A total of 1 194 RhD-positive inpatients from Chengdu were typed by both KASP genotyping and manual tube serology. Discordant samples (n=10) were retested by both methods and further resolved by Sanger sequencing. An additional 377 cases were tested for the c. 48C>G locus to evaluate the predictive accuracy of individual loci and combined locus testing for RhC antigen. Results: Genotyping concordance with serology was 100.0% for both the c. 676C>G locus (RhE/Rhe) and the c. 307T>C locus (Rhc). For RhC prediction using the 109 bp insertion, overall accuracy was 99.7% (1 191/1 194); the 3 discordant cases were confirmed by Sanger sequencing to be false negatives attributable to 109 bp deletion in intron 2. Testing the c. 48C>G allele for RhC prediction yielded 7 false positives, with an accuracy of 98.1% (370/377). RhC antigen status was determined by combining the 109 bp insertion and the c. 48C allele. After excluding 10 samples with inconsistent results between the two loci, the accuracy reached 100% in the remaining 367 samples. When both loci were applied in combination, accuracy reached 100% in the 367 cases with concordant results. Among the 1 194 patients, CCee (45.8%) and CcEe (31.7%) were the most common RhCE phenotypes. The e antigen had the highest positivity rate (92.2%), and the Ce haplotype was the most frequent (66.9%). Conclusion: The KASP-based RHCE genotyping method achieves high accuracy for clinical RhCE typing. Combining the 109 bp insertion/deletion with the c. 48C allele significantly improves RhC antigen prediction compared with either locus alone. This method was applied to RhCE genotyping of 1 194 RhD-positive inpatients in Chengdu, providing local RhCE phenotype and haplotype distribution data to support RhCE-matched transfusion practice.

AIM:To observe the effect of cationic nanoemulsion eye drops on the tear film and ocular surface morphology of orthokeratology wearers, and to provide a basis for the clinical selection of eye drops during orthokeratology wear. METHODS:A prospective study was conducted on patients with refractive errors who were fitted with orthokeratology lenses for the first time at Anhui Aier Eye Hospital,from February 2025 to October 2025. Patients were randomly assigned to the experimental group, which received a cationic nanoemulsion eye drops, or the control group, which received a 0.1% sodium hyaluronate eye drops. One drop of the assigned lubricant was instilled in each eye before lens insertion and before lens removal in both groups for 3 consecutive months. Uncorrected visual acuity, spherical equivalent, anterior corneal curvature, tear film break-up time, tear film lipid layer score, and corneal fluorescein staining score were compared between the two groups at baseline and at 1 wk, 1 and 3 mo after lens wear. RESULTS: A total of 64 eyes(all right eyes)from 64 patients with refractive errors were enrolled. Ultimately, 60 patients completed the final follow-up, including 30 in the experimental group(n=30; male/female: 14/16; age: 9.57±1.07 y)and the control group(n=30; male/female: 12/18; age: 9.43±1.01 y). No significant intergroup differences were found in uncorrected visual acuity, spherical equivalent, anterior corneal curvature, or corneal fluorescein staining scores either before or after lens wear(all P>0.05).The tear film break-up time was significantly longer and tear film lipid layer score was significantly better in the experimental group than in the control group at post-wear time point(all P<0.05). Uncorrected visual acuity, spherical equivalent, and anterior corneal curvature improved significantly from baseline at 1 wk, 1 and 3 mo after lens wear in both groups(all P<0.05). Corneal fluorescein staining scores increased significantly from baseline at 1 wk and 1 mo in the control group(both P<0.05), whereas no significant change was observed in the experimental group. No cases of severe corneal injury(score of 3)were found in either group. CONCLUSION: Cationic nanoemulsion eye drops have a similar effect to 0.1% sodium hyaluronate eye drops in improving the visual acuity and corneal morphology of orthokeratology wearers, but have more advantages in stabilizing the tear film and improving the state of the tear film lipid layer, and have good safety, so they can be used as an ideal choice of eye drops for orthokeratology wearers.

OBJECTIVE To explore the influencing factors and improvement pathways for the effectiveness of China’s pharmaceutical information traceability system construction， and to provide references for regulating the pharmaceutical market order， ensuring the security of medical insurance funds， and safeguarding public health.METHODS Based on the technology-organization-environment （TOE） theoretical framework， six conditional variables were selected， including the level of big data development， interdepartmental coordination mechanisms， regulatory exposure intensity， quality of traceability personnel， government financial investment， and degree of public attention. The fuzzy set qualitative comparative analysis （fsQCA） method was employed to collect policies related to pharmaceutical information traceability systems issued by 31 provinces（autonomous regions， municipalities） in China， and to explore the condition configurations and optimization pathways for promoting the construction of pharmaceutical information traceability systems. RESULTS &CONCLUSIONS No single condition exerts a decisive influence on the construction of pharmaceutical information traceability systems. However， the level of big data development， quality of traceability personnel， regulatory exposure intensity， and degree of public attention play key roles in the configuration pathways. There are four pathways for efficiently promoting the construction of pharmaceutical information traceability systems， namely the competence enhancement type， the technological breakthrough type， the technology-focused type， and the environment-driven type； the consistencies of all pathways were higher than 0.750, with an solution consistency of 0.790 and an solution coverage of 0.897. Each province can select an appropriate path according to its own conditions. It is recommended to promote the high-quality construction of pharmaceutical information traceability systems through technological innovation， strengthening interdepartmental coordination and full-chain regulation， and optimizing the environment for system construction. Meanwhile， attention should also be paid to the implementation difficulties faced by medical institutions so as to reduce their implementation costs.

ObjectiveTo analyze the research hotpots and development trends of international nursing ethical decision-making in the past 10 years by bibliometric methods. MethodsLiterature related to nursing ethical decision-making published in the Web of Science core collection database from 2014 to 2023 was retrieved. VOSviewer 1.6.18 software was utilized to visually present and analyze data regarding the number of publications， journal sources， countries of origin， author information， research institutions， key terms， co-cited references， and others. ResultsA total of 149 articles were included， involving 85 source journals， of which Nursing Ethics and BMC Medical Ethics were the most prolific. The number of publications on nursing ethical decision-making showed an overall upward trend， with the United States leading other countries in the number of publications. These publications involved 567 authors from 302 research institutions， and the degree of inter-institutional collaboration was relatively low. Keyword clustering， timeline overlay， and density analysis revealed that current research hotspots and trends included the ethical issues and decision-making in clinical nursing practice， the ethical decision-making level and competence of university nursing undergraduates， the ethical decision-making of nursing managers， and ethical decision-making dilemmas encountered by nursing staff during public health emergencies. ConclusionResearch on nursing ethical decision-making is gradually deepening but remains fragmented， lacking sustainability and collaboration. The ethical decision-making levels and competencies of university nursing students， as well as the field of ethical decision-making among nursing managers， may emerge as novel research hotspots in the future. Henceforth， it is necessary to strengthen in-depth exchanges among authors and institutions， pay close attention to international research frontiers， and enhance both the depth and breadth of research.

ObjectiveTo explore the target of Erzhiwan in reducing myocardial injury in ovariectomized mice through non-targeted myocardial metabolomics combined with experimental verification. MethodsOvariectomized mouse model was selected， 40 female C57BL/6 mice were randomly divided into sham operation group， model group， estrogen group（estradiol valerate， 1.3×10^-4 g·kg^-1）， Erzhiwan low and high dose groups（3.12， 9.36 g·kg^-1）， with 8 mice in each group. Each administration group was given the corresponding dose of Erzhiwan by gavage， and the sham operation group and model group were given equal volume of distilled water by gavage for 12 weeks. Echocardiography was used to detect cardiac function， hematoxylin-eosin（HE） staining was used to observe myocardial morphological changes， and enzyme-linked immunosorbent assay（ELISA） was used to detect the levels of estrogen， N-terminal pro-brain natriuretic peptide（NT-proBNP）， hypersensitive troponin T（hs-TnT）， total cholesterol（TC）， triglyceride（TG）， low density lipoprotein cholesterol（LDL-C）， high density lipoprotein cholesterol（HDL-C）， interleukin（IL）-1β， IL-18 and tumor necrosis factor-α（TNF-α）. The non-targeted metabolomics of mouse myocardium were analyzed by ultra performance liquid chromatography-quadrupole-electrostatic field orbital trap high-resolution mass spectrometry（UPLC-Q-Exactive Orbitrap MS）， and the differential metabolites and corresponding metabolic pathways were obtained. The mRNA expression levels of phosphatidylinositol 3-kinase（PI3K） and protein kinase B（Akt） in mouse myocardial tissues were detected by real-time fluorescence quantitative polymerase chain reaction（Real-time PCR）， and the protein expression levels of PI3K， Akt， phosphorylated（p）-Akt were detected by Western blot. ResultsCompared with the sham operation group， the model group showed abnormal cardiac function， increased myocardial fiber space， cardiomyocyte atrophy， sarcoplasmic aggregation， and occasional dissolution or rupture of muscle fiber， the level of estrogen in the serum was decreased， the levels of NT-proBNP， hs-TnT， IL-1β， IL-18， TNF-α， TG， TC and LDL-C were increased， and the level of HDL-C was decreased（P<0.01）. Compared with the model group， Erzhiwan could increase the level of estrogen， improve the abnormal cardiac function， reduce the pathological injury of myocardial tissue， decrease the levels of myocardial injury markers（NT-proBNP， hs-TnT） and inflammatory factors（IL-1β， IL-18， TNF-α）， decrease the levels of TG， TC， LDL-C， and increased the level of HDL-C（P<0.01）. The results of non-targeted myocardial metabolomics showed that 31 of the 162 differential metabolites between the model group and sham operation group were significantly adjusted after administration of Erzhiwan， which were mainly glycerol phospholipid metabolites. Pathway enrichment results showed that Erzhiwan mainly affected glycerophospholipid metabolic pathway， PI3K-Akt pathway， cyclic guanosine monophosphate（cGMP）-protein kinase G（PKG） pathway and other metabolic pathways. Compared with the sham operation group， the levels of phosphatidylcholine（PC， 11 types） and phosphatidylethanolamine（PE， 5 types） in mouse myocardial tissue of the model group were increased（P<0.05， P<0.01）， and the mRNA and protein expressions of PI3K and p-Akt were decreased（P<0.05， P<0.01）. Compared with the model group， the levels of PC（11 types） and PE（5 types） were decreased（P<0.05， P<0.01） in myocardial tissue of Erzhiwan group， the mRNA and protein expressions of PI3K and p-Akt were elevated（P<0.01）. ConclusionErzhiwan can alleviate the pathological injury of myocardium in ovariectomized mice， improve the abnormal cardiac function， improve lipid metabolism disorder， and reduce the levels of myocardial injury markers and inflammatory factors， which involves a number of signaling and metabolic pathways in the heart， among which glycerophospholipid metabolism pathway and PI3K/Akt pathway may have key roles.

It is believed that the root cause of vascular dementia lies in insufficient primal yang and weakness in the circulation of blood. The key pathological factors are the mutual stagnation of phlegm and blood stasis， and the obstruction of blood vessels. The general treatment principle is to tonify qi and promote yang， expel pathogenic factors， and unblock yang. This involves supplementing the innate and acquired yang qi of the spleen and kidneys， removing pathogenic factors like phlegm， turbidity， and blood stasis， in order to restore the function of yang qi and promote the circulation of blood and qi. The basic prescription for tonifying qi and promoting yang includes Heishunpian （Lycium Ruthenicum）， Zhichuanwu （Aconitum Carmichaelii）， Guizhi （Cinnamomum Cassia）， Renshen （Panax Ginseng）， and Huangqi （Astragalus Membranaceus）. Depending on the type of pathogenic excess， the treatment can be modified with Tongqiao Huoxue Decoction （通窍活血汤）， adding Yujin （Curcuma Longa） and Xiangfu （Cyperus Rotundus） to invigorate blood and promote yang， or with Fabanxia （Pinellia Ternata）， Chenpi （Citrus Reticulata）， Zhishi （Citrus Aurantium） plus Sijunzi Decoction （四君子汤） to resolve phlegm and promote yang. Both the root and branch are treated simultaneously. When yang qi is activated， blood and qi are nourished， and when pathogenic excess is expelled， the blood vessels are unblocked. This approach aims to provide a treatment strategy for vascular dementia.

Objective To observe the clinical efficacy of Dan Qi Yishen Prescription in treating diabetic nephropathy(DN)and explore its renal protective mechanism.Methods A total of 150 patients with DN of qi-yin deficiency complicated with blood stasis syndrome who admitted to Sanya Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine from October 2021 to April 2023 were divided into a control group and an observation group according to the random number table method,with 75 patients in each group.Both groups were given conventional therapies such as dietary treatment,blood glucose control,blood pressure control,lipid-lowering treatment and treatment of complications.Additionally,the control group was given intravenous injection of reduced glutathione,while the observation group was given oral use of the decoction of Dan Qi Yishen Prescription and ionic introduction of Dan Qi Yishen Prescription in renal region.Thirty days constituted one course of treatment,and both groups were treated for three courses.Before and after treatment,the scores of traditional Chinese medicine(TCM)syndrome,and the levels of renal function indicators,renal hemodynamic indicators,coagulation and fibrinolysis indicators,and vascular endothelial function indicators in the two groups were observed.Results(1)After treatment,the scores of TCM symptoms such as fatigue and weakness,palpitations and shortness of breath,dizziness and tinnitus,spontaneous sweating and night sweating,restlessness and insomnia,and thirst with preference for drinks in the two groups were decreased compared with those before treatment(P<0.01),and the decrease in the observation group was significantly superior to that in the control group(P<0.01).(2)After treatment,the levels of renal function indicators such as blood urea nitrogen(BUN),serum creatinine(SCr),collagen Ⅳ(CⅣ),and plasma laminin(LN)of patients in the two groups were improved compared with those before treatment(P<0.01),and the improvement in the observation group was significantly superior to that in the control group(P<0.01).(3)After treatment,the levels of renal hemodynamic indicators such as systolic maximum blood flow velocity(Vsmax)and diastolic minimum blood flow velocity(Vdmin)of the main renal artery(MRA)and interlobar artery(IRA)in the two groups were increased compared with those before treatment(P<0.05 or P<0.01),while the resistance index(RI)and pulsatility index(PI)of MRA and RI of IRA in the two group as well as PI of IRA in the observation group were decreased compared with those before treatment(P<0.05 or P<0.01).The increase of Vsmax and Vdmin of MRA and IRA as well as the decrease of RI and PI of MRA and IRA in the observation group was significantly superior to that in the control group(P<0.05 or P<0.01).(4)After treatment,the levels of coagulation and fibrinolysis indicators such as prothrombin time(PT),activated partial thromboplastin time(APTT),D-dimer(D-D),and fibrinogen(FIB)in the two groups were improved compared with those before treatment(P<0.01),and the improvement in the observation group was significantly superior to that in the control group(P<0.01).(5)The analysis of vascular endothelial function indicators showed that after treatment,the serum vasohibin 1(VASH-1)level in the two groups was increased compared with that before treatment(P<0.01),and the serum vascular endothelial growth factor(VEGF)and endothelin 1(ET-1)levels were decreased compared with those before treatment(P<0.01),and the increase of serum VASH-1 level as well as the decrease of serum VEGF and ET-1 levels in the observation group was significantly superior to that in the control group(P<0.01).Conclusion Dan Qi Yishen Prescription exerts good clinical efficacy in treating patients with DN of qi-yin deficiency complicated with blood stasis syndrome,and it has protective effect on renal function probably by improving the coagulation and fibrinolysis system and vascular endothelial function of the patients.

OBJECTIVE To study the effect and safety evaluation of percutaneous tracheotomy and traditional open tracheotomy in patients with severe pulmonary infection in ICU environment.METHODS A retrospective analysis was conducted on 80 patients with severe pulmonary infections admitted to the ICU of Shangqiu First People's Hospital from July 2019 to June 2022 as the subjects of the study.According to the tracheotomy approach,they were divided into the Percutaneous tracheotomy group(n=40)and the Conventional tracheotomy group(n=40).The Conventional tracheotomy group underwent traditional routine tracheotomy,while the Percutaneous tracheotomy group underwent percutaneous tracheotomy;all tracheotomies were performed by the same physician.The two groups were compared based on different tracheotomy techniques,and the surgical incision time,intraoperative blood loss,complete healing indicators were analyzed to evaluate the surgical outcomes and complication rates in each group.RESULTS Compared with the Conventional tracheotomy group,the Percutaneous tracheotomy group significantly reduced surgical time,intraoperative blood loss,and wound healing time after extubating(P<0.05),and the incidence of complications such as difficult cannulation,pneumothorax and subcutaneous emphysema decreased significantly,and the difference was statistically significant(P<0.05).In the BMI subgroup analysis of complications,it was found that in the BMI≥28.0 kg/m2 subgroup,the incidence of casing difficulty and pneumothorax complications in the Percutaneous tracheotomy group was lower than that in the Conventional tracheotomy group,and the difference was statistically significant(P<0.05).In the 22.0 kg/m2≤BMI<28.0 kg/m2 subgroup and BMI<22.0 kg/m2 subgroup,there was no significant difference in the difficulty of cannulation and pneumothorax complications between the two groups(P>0.05).CONCLUSION In ICU patients with severe pneumonia,early percutaneous tracheotomy can significantly reduce intraoperative bleeding blood volume,shorten the time of tracheotomy,especially in patients with BMI≥28.0 kg/m2,which has a lower incidence of complications.Percutaneous tracheotomy is worth promoting in ICU patients with severe lung infection who need tracheotomy.

Objective To explore the impacts of dietary diary combined with path based eating management on gastrointestinal function and dietary health behavior in postoperative patients with laparoscopic distal gastric cancer.Methods From January 2021 to January 2023,150 patients who underwent laparoscopic distal gastric cancer surgery were randomly divided into two groups.The control group received routine dietary management intervention,while the observation group received dietary diary combined with path based eating management intervention.The gastrointestinal function and dietary health behavior of the two groups were compared.Results The excellent and good rate of gastrointestinal function recovery was 57.33％in the observation group,which was higher than 47.33％in the control group 3 d after operation(P＜0.05);One month after surgery and three months after discharge,the scores of dietary health behaviors in the observation group were higher than those in the control group(P＜0.05);One month after discharge and three months after discharge,the serum albumin level in observation group was(37.68±5.30)g/L,(38.25±4.82)g/L,and the hemoglobin level was(120.08±20.02)g/L,(124.62±24.23)g/L,which was higher than that in control group[1 month after discharge:(30.32±4.17)g/L,(32.99±4.41)g/L;3 months after discharge:(110.75±16.12)g/L,(115.34±18.44)g/L](P＜0.05);The complication rate of the observation group was lower than that of the control group(P＜0.05).Conclusion Dietary diary combined with path based eating management can promote the recovery of gastrointestinal function and improve dietary health behavior in postoperative patients with laparoscopic distal gastric cancer.