ObjectiveTo reveal the active substances and mechanisms of modified Qing'e formula （MQEF） in delaying skin photoaging by ultra-performance liquid chromatography-quadrupole-time of flight mass spectrometry （UPLC-Q-TOF-MS），network pharmacology， and cell experiments. MethodsUPLC-Q-TOF-MS and a literature review were employed to analyze the transdermally absorbed components in mice after the topical application of MQEF. The potential targets of MQEF in treating skin photoaging were retrieved from databases.The compound-potential target network and protein-protein interaction network were constructed to screen the key components and core targets. A photoaging cell model was established by irradiating HaCaT cells with medium-wave ultraviolet B （UVB）. The safe doses of bakuchiol （BAK） and salvianolic acid B （SAB） for treating HaCaT cells and the effects of BAK and SAB on the viability of cells exposed to UVB irradiation were determined by the cell counting kit-8 （CCK-8） method.The reactive oxygen species （ROS） fluorescent probe was used to measure the ROS production in the cells treated with BAK and SAB.The expression levels of genes related to oxidative stress，inflammation，collagen metabolism，and circadian rhythm clock were measured by Real-time PCR. ResultsA total of 24 transdermally absorbed components of MQEF were identified，which acted on 367 potential targets，and 417 targets related to skin photoaging were screened out，among which 47 common targets were predicted as the targets of MQEF in treating skin photoaging. MQEF exerted the anti-photoaging effect via key components such as BAK and SAB，which acted on core proteins such as serine/threonine kinase 1 （Akt1） and mitogen-activated protein kinase 3 （MAPK3） and intervened in core pathways such as the tumor necrosis factor （TNF） and phosphatidylinositol-3-kinase （PI3K）/protein kinase B （Akt） signaling pathways.Compared with the model group，the administration of BAK and SAB increased the survival rate of HaCaT cells （P<0.01），down-regulated the mRNA levels of cyclooxygenase-2 （COX-2），interleukin-6 （IL-6），tumor necrosis factor-α （TNF-α），matrix metalloproteinase-1 （MMP-1），and matrix metalloproteinase-9 （MMP-9） （P<0.01），and up-regulated the mRNA levels of heme oxygenase-1 （HO-1） and NAD（P）H quinone dehydrogenase 1 （NQO-1） （P<0.05，P<0.01） in photoaged HaCaT cells.In addition，it eliminated excess ROS production induced by UVB and up-regulated the mRNA levels of brain and muscle ARNT-like 1 （BMAL1） and circadian locomotor output cycles kaput （CLOCK） associated with circadian clock （P<0.05，P<0.01）. ConclusionMQEF delays skin photoaging through the coordinated effects of various components，multiple targets，and diverse pathways.The key components BAK and SAB in MQEF exhibit anti-photoaging properties，which involve inhibiting oxidative stress，preventing collagen degradation，mitigating inflammation，and maintaining normal skin circadian rhythms by regulating clock gene expression.

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

Osteoporosis(OP)is a refractory metabolic bone disease,with decreased bone mineral mass,weakened bone strength,and systemic bone pain as typical clinical manifestations.Shenzhen Pingle Guo's Orthopedics,an important branch of the Pingle Guo's Orthopedics,has developed their distinct therapeutic approaches to the prevention and treatment of OP:the fifth-generation inheritor,Mr.Guo Chunyuan,advocated for the simultaneous regulation of qi and blood and formulated Shudi Zhuanggu Formula(composed of Rehmanniae Radix Praeparata,Codonopsis Radix,Atractylodis Macrocephalae Rhizoma,Poria,Angelicae Sinensis Radix,Paeoniae Radix Alba,Chuanxiong Rhizoma,Dipsaci Radix,and Achyranthis Bidentatae Radix);the sixth-generation inheritor,Professor Yang Zejin,emphasized zang-fu syndrome differentiation and established Yang's Guwei Formula,which simultaneously tonifies the liver,spleen,and kidney,and simultaneously treats deficiency and blood stasis(composed of Astragali Radix,Rehmanniae Radix Praeparata,Achyranthis Bidentatae Radix,Epimedii Folium,Cistanches Herba,Cuscutae Semen,Drynariae Rhizoma,Angelicae Sinensis Radix,Salviae Miltiorrhizae Radix et Rhizoma,Notoginseng Radix et Rhizoma,Corydalis Rhizoma,and Paeoniae Radix Alba);the seventh-generation inheritor,Professor Gong Chunzhu,proposed a three-stage clinical treatment strategy and stressed the principle of reinforcing acquired foundation of life(i.e.,reinforcing spleen and stomach),and formulated the modified Shudi Zhuanggu Formula with Lingnan characteristics(composed of Rehmanniae Radix Praeparata,Corni Fructus,Dioscoreae Rhizoma,Alismatis Rhizoma,Poria,Moutan Cortex,Astragali Radix,Dipsaci Radix,Cyathulae Radix,Acanthopanacis Cortex,Atractylodis Macrocephalae Rhizoma,Codonopsis Radix,and Chaenomelis Fructus).During the evolution,Shenzhen Pingle Orthopedic Hospital has continuously integrated modern medical achievements,passed down and enriched the clinical experience,and then the theoretical framework of traditional Chinese medicine in the prevention and treatment of OP has been developed.

Objective To discuss the efficacy of transcatheter arterial chemoembolization(TACE)in combination with targeted therapy and immune checkpoint inhibitors for advanced hepatocellular carcinoma(HCC),and to identify the influencing factors.Methods A total of 60 patients with advanced HCC,who were admitted to the Air Force Medical Center of China from January 2016 to December 2022,were enrolled in this study.Thirty patients received TACE combined with targeted therapy and immune checkpoint inhibitors(TACE-L-P group),and the other 30 patients received TACE combined with targeted therapy(TACE-L group).The progression-free survival(PFS),overall survival(OS),disease control rate(DCR),and objective response rate(ORR)were compared between the two groups.Results In the TACE-L group and TACE-L-P group,the median PFS(mPFS)was 7 months and 10 months respectively(P=0.011),the median OS(mOS)was 15.5 months and 29 months respectively(P=0.014).Child-Pugh class B(HR=3.89,95％CI:1.27-11.94,P=0.018)and Barcelona Clinic Liver Cancer(BCLC)stage C(HR=2.83,95％CI:1.32-6.03,P=0.007)were the independent risk factors for OS,while micro wave ablation(HR=0.21,95％CI:0.07-0.63,P=0.005)and TACE-L-P(HR=0.09,95％CI:0.03-0.3,P=0.001)were the independent protection factors for OS.Besides,elevated bilirubin level(HR=1.03,95％CI:1-1.06,P=0.032)and elevated gamma-glutamyl transferase(GGT)level(HR=1.01,95％CI:1-1.01,P=0.002)were the independent risk factors for disease progression,and TACE-L-P(HR=0.27,95％CI:0.09-0.79,P=0.017)was the independent protection factor for disease progression.The ORR and DCR in TACE-L-P group were remarkably higher than those in TACE-L group,which were 43.4％vs 13.3％and 63.4％vs 23.3％respectively,the differences between the two groups were statistically significant(both P＜0.05).Conclusion In treating advanced HCC,TACE combined with targeted therapy and immune checkpoint inhibitors is superior to TACE combined with targeted therapy in therapeutic efficacy.

Objective:To construct the risk management model of ultrasonic scalpel based on logistic regression(LR)algorithm,and to improve the quality of ultrasonic risk management.Methods:Based on the LR algorithm,the risk management model of ultrasonic scalpel use was constructed and the model was verified.A total of 28 ultrasonic scalpels in clinical use in Shanghai Pulmonary Hospital from January 2022 to December 2023 were selected.Based on the time,the conventional management model was adopted during the use of the equipment in 2022,and the LR risk management model(referred to as risk management)was applied during the use of the equipment in 2023.The risk management quality score,risk warning score and experience score of the management personnel involved in the use of the equipment between the two management modes were compare by using the self-made evaluation scale.Results:The average scores of ultrasonic scalpel maintenance record,usage record,data filing,maintenance card hanging and scrapping treatment using risk management were(9.54±0.37),(9.67±0.34),(9.73±0.21),(9.18±0.35)and(9.92±0.31),respectively,which were higher than those of the conventional management,the difference was statistically significant(t=55.666,32.235,49.511,40.311,23.122,P<0.05).The average scores of ultrasonic scalpel risk identification accuracy,early warning timeliness and comprehensive prevention and control using risk management were(9.66±1.20),(9.92±1.48),and(9.87±1.04),respectively,which were higher than those of the conventional management mode,the difference was statistically significant(t=11.840,8.371,8.032,P<0.05).The average scores of ultrasonic scalpel preventive maintenance personnel,maintenance personnel and operators on the use experience of ultrasonic scalpel in risk management mode were(96.61±6.08),(95.07±5.19)and(97.73±5.93),respectively,which were higher than those in the conventional management mode,the difference was statistically significant(t=4.991,4.156,4.870,P<0.05).Conclusion:The application of ultrasonic scalpel risk management model based on LR algorithm to the use management of ultrasonic scalpel can improve the quality of ultrasonic scalpel risk management,avoid risk hazards,and enhance the safety and stability of clinical use of ultrasonic scalpel.

Objective:To investigate the predictive role of relative diffusion-weighted imaging (DWI) signal intensity (DWI-rSI) in outcome in patients with anterior circulation large vessel occlusion cardioembolic stroke and successful recanalization after endovascular therapy (EVT).Methods:Patients with anterior circulation large vessel occlusion stroke due to cardioembolic embolism underwent EVT and successful recanalization at the Affiliated Hospital of Yangzhou University from March 2017 to March 2023 were retrospectively included. According to the modified Rankin Scale score 3 months after procedure, the patients were divided into a good outcome group (0-2 points) and a poor outcome group (3-6 points). Multivariate logistic regression analysis was used to identify independent predictive factors for poor outcome. Results:A total of 59 patients were enrolled, including 29 males (49.2%), median age of 74 years (interquartile range, 68-80 years). The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 15 (12-21), and the median DWI Alberta Stroke Program Early CT Score (ASPECTS) was 8 (5-9). Thirty-two patients (54.2%) had good outcome, and 27 (45.8%) had poor outcome. Among them, 9 patients (15.3%) died (6 died from cerebral herniation after malignant brain edema, 2 died from complications, and 1 died from severe intracranial hemorrhage after procedure). Twenty-one patients (35.6%) experienced hemorrhagic transformation, including 12 (20.3%) with symptomatic intracranial hemorrhage. There were significant differences in baseline systolic blood pressure, NIHSS score, DWI-ASPECTS, DWI-rSI, and incidence of symptomatic intracranial hemorrhage between the good outcome group and the poor outcome group (all P<0.05). Multivariate logistic regression analysis showed that baseline systolic blood pressure (odds ratio 0.977, 95% confidence interval 0.919-0.991; P=0.015) and DWI-rSI (odds ratio 11.809, 95% confidence interval 1.932-72.170; P=0.008) were the independent predictors for poor outcome. Conclusion:DWI-rSI can predict the outcome of patients with anterior circulation large vessel occlusion cardioembolic stroke and successful recanalization after EVT.

Objective:To systematically evaluate the actual experience and needs of family caregivers for cardiac arrest patients.Methods:Qualitative research on the real experience and needs of family caregivers in patients with cardiac arrest was electronically searched in databases such as PubMed, CINAHL, and Embase. Two researchers independently screened the literature, evaluated its quality, and integrated the research results. The search period was from database establishment to May 1, 2023.Results:A total of 15 articles were included, and 51 research results were extracted. The similar results were summarized into nine categories and integrated into three results, including sudden changes in life and substantial impacts; challenges in controlling complex emotions, and multiple psychological experiences; multidimensional needs.Conclusions:Family caregivers' actual experiences and requirements for cardiac arrest patients are diverse. Medical and nursing staff need to pay attention to the emotional experiences of family caregivers and meet their multidimensional needs.

Objective:To investigate the correlation between the triglyceride-glucose index (TyG) and all-cause mortality (ACM) in patients with nondiabetic critical ischemic stroke (IS).Methods:Patient data in Medical Information Mart for Intensive CareⅣ (MIMIC-Ⅳ) database version 3.1 were retrieved retrospectively. According to the quartiles of TyG index, they were divided into four groups ( Q1, Q2, Q3, and Q4). Kaplan-Meier survival analysis was used to compare ACM at different periods (30 days, 90 days, 180 days, and 1 year). The correlation between the TyG index and endpoint events was examined through restrictive cubic spline plot, Cox proportional hazards regression model, subgroup analysis, and sensitivity analysis. Results:A total of 1 491 patients (49% male) were included, with ACM of 18%, 22%, 25%, and 27% at 30 days, 90 days, 180 days, and 1 year, respectively. Kaplan-Meier survival analysis showed that the risk of death was significantly increased in the TyG index Q4 group. The restricted cubic spline plot showed a linear relationship between the TyG index and ACM. Multivariate Cox proportional hazards regression analysis suggests that the increase of TyG index was significantly correlated with the increase of ACM risk. Compared with the Q1 group, after adjusting for various confounding factors, the hazard ratios (95% confidence intervals) of ACM at 30 days, 90 days, 180 days, and 1 year in the Q4 group were 2.35 (1.64-3.37), 2.29 (1.67-3.14), 2.19 (1.62-2.95), and 2.11 (1.59-2.81), respectively. Subgroup analysis showed that the correlation between the TyG index and ACM was more significant in patients without hypertension and those who did not use antiplatelet drugs. The sensitivity analysis conducted by the multivariate logistic regression model showed that its trend and statistical significance were basically consistent with the results of Cox proportional hazards regression analysis. Conclusion:The TyG index is significantly correlated with the ACM of patients with nondiabetic critical IS, which may become a valuable and simple predictive markers for such patients.

High-altitude regions,characterized by their elevated altitude,are subject to a complex set of environmental conditions including intense ultraviolet radiation,low oxygen levels,low temperatures,and low humidity.These distinctive environmental features lead to unique dietary patterns,lifestyles,and physiological adaptations.Notably,individuals who have just moved into high-altitude areas and those who live there on a long-term basis undergo specific adaptive adjustments in glucose metabolism.Typically,newcomers experience transient elevations in blood glucose levels,which gradually decline after prolonged residence at high altitudes to levels even lower than those found at low altitudes.In general,current findings of observational studies generally suggest a decreased risk of diabetes mellitus among populations inhabiting high-altitude regions.However,the glucose metabolism varies among populations from different high-altitude regions across the world,which indicates that the reshaping of glucose metabolism induced by high altitudes is a complicated phenomenon.This article provides an overview of the impact of various components of high-altitude environment,characteristic lifestyle factors,and socioeconomic development levels on glucose metabolism and the related diseases and the potential mechanisms involved.The aim is to offer valuable insights for researchers investigating glucose metabolism in high-altitude settings.

Objective:To study the strategies in the diagnosis and treatment of pancreatic tumors in children.Methods:The clinical data of 18 children with pancreatic tumor managed at the Children's Hospital Affiliated to Chongqing Medical University from March 2015 to September 2020 were retrospectively studied. There were 8 males and 10 females, age ranged from 3 months to 14 years and 11 months, with a median age of 8 years and 2 months. Clinical data including age, gender, pathological data, surgical methods, chemotherapy, tumor location and treatment outcomes were collected. Follow-up was conducted by outpatient visits and by telephone.Results:Abdominal ultrasound, enhanced CT and/or MRI examinations were performed on all these patients, with findings of either a cystic or solid lesion of pancreas. All patients were treated by laparotomy under endotracheal intubation and general anesthesia. The operations were all completed successfully. Among the 18 patients, there were 11 patients with solid pseudopapillary tumors and 7 patients with pancreatoblastoma (PBL). The tumors were located in the head of the pancreas in 13 patients (including 3 patients who underwent pancreaticoduodenectomy, 1 patient who underwent resection of the head of the pancreas with preservation of the duodenum, and 9 patients who underwent resection of the tumors). The tumors were located in the body and tail of the pancrease in 5 patients (including 3 patients who underwent resection of the body and tail of the pancreas with preservation of spleen, and 2 patients who underwent resection of tumors). Because of huge tumors, 1 patient had bilateral lung, left supraclavicular fossa lymph node and retroperitoneal lymph node metastasis, 3 patients were confirmed to have PBL by biopsy, and these tumors were resected completely after neoadjuvant chemotherapy. Postoperative pathology showed that all the 3 patients had PBL and were given systematic chemotherapy. Postoperative pancreatic fistula occurred in 1 patient and chylous fistula in another patient, both were discharged home successfully after conservative treatments. All patients were followed-up for 2-7 years, and all children were tumor-free.Conclusion:It is not difficult to diagnose pediatric pancreatic tumors by ultrasound, CT and MRI before operation, and postoperative pathology was needed to confirm the diagnosis. Function-preserving surgical resection was the treatment of choice for pancreatic tumors in children.