Background/Aims: Natural killer (NK) cell function is generally considered dampened in chronic hepatitis B virus (HBV) infection; however, the NK cell pool exhibits phenotypic and functional heterogeneity, and the antibody--mediated effect of NK cells remains less characterized. This study evaluated the dynamic changes in antibody-mediated NK cell responses and the involvement of distinct NK subsets across disease stages and during antiviral treatment. Methods: A T-cell receptor-like antibody specific for the HBV core 18–27 peptide (cTCRL-Ab) was used to determine the antibody-mediated effect of NK cells, and an array of NK cell surface markers were analyzed in cross-sectional and longitudinal cohorts of patients with chronic HBV infection. Single-cell RNA sequencing (scRNA-seq) was performed to identify the heterogeneity of NK subsets. Results: The cTCRL-Ab enabled the detection of NK cell cytolytic activity and IFNγ production. Notably, cTCRL-Ab-mediated NK cell responses were compromised in chronically HBV-infected patients, particularly in those receiving pegylated interferon-α (Peg-IFNα), which was associated with the downregulation of CD16 expression. Correspondingly, Peg-IFNα inhibited cTCRL-Ab-mediated NK cell function by reducing CD16 expression in vitro. scRNA-seq revealed that CD16 downregulation occurred mainly within a dysfunctional CD16hi NK subset exhibiting exhaustion properties. In contrast, an activated CD16hiNK subpopulation (CX3CR1⁺KLRC2–CD16hi) with high cytotoxicity was enriched in patients who experienced favorable treatment responses. Furthermore, the intrahepatic CX3CR1+KLRC2–CD16hi subset tended to exhibit functional restoration in HBsAg-loss individuals. Conclusions Our data contribute to the understanding of antibody-mediated responses of NK cells in chronic HBV infection, and highlight a previously unappreciated functional CX3CR1+KLRC2–CD16hiNK subset as a potential therapeutic target.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Objective:To retrospectively analyze the clinical efficacy and safety of biological agents in the treatment of psoriasis in the elderly.Methods:A retrospective study was conducted. A total of 124 patients aged ≥ 65 years with moderate-to-severe psoriasis (psoriasis area and severity index [PASI] score ≥ 3 points or body surface area [BSA] ≥ 3%), who were treated with biological agents at the Department of Dermatology and Venereology, People's Hospital of Xinjiang Uygur Autonomous Region, from June 2020 to December 2023, were collected. PASI, BSA, and dermatology life quality index (DLQI) scores were recorded at weeks 0 (pre-treatment), 4, 12, and 24 after the beginning of treatment to evaluate the efficacy. The proportions of patients achieving ≥ 75% and 90% improvements in PASI scores (PASI75 and PASI90, respectively) were calculated, and adverse reactions were recorded. Data were processed using SPSS 29.0 and GraphPad Prism 10.0 software. Normally distributed continuous variables were presented as mean ± standard deviation, while non-normally distributed continuous variables were presented as median with upper and lower quartiles ( Q1, Q3). Wilcoxon signed-rank test was used for comparisons of non-normally distributed data between groups, and chi-square test and Fisher's exact test were used for comparing categorical data. Results:Among the 124 patients, there were 72 males (58.1%) and 52 females (41.9%), and their ages ranged from 65 to 87 years. Treatment regimens included secukinumab for 86 patients (69.4%), ustekinumab for 15 (12.1%), ixekizumab for 14 (11.3%), guselkumab for 5 (4.0%), and adalimumab for 4 patients (3.2%). The pre-treatment PASI, BSA, and DLQI scores [ M ( Q1, Q3) ] were 12.2 (7.8, 19.6) points, 16.0% (10.2%, 25.0%), and 16 (11, 20) points respectively, which significantly decreased to 0.8 (0, 1.2) points, 1.0% (0, 2.0%), and 0 (0, 3) points respectively at week 24 after the start of treatment ( Z = 9.66, 9.66, 9.63, respectively, all P < 0.01). The proportions of patients achieving PASI75 at weeks 4, 12, and 24 were 42.7% (53/124), 80.6% (100/124), and 93.5% (116/124) respectively, and those achieving PASI90 were 13.7% (17/124), 48.4% (60/124), and 85.5% (106/124) respectively. There were no significant differences in the proportions of patients achieving PASI75 and PASI90 between the subgroups with and without comorbidities, as well as between the early-onset psoriasis subgroup and late-onset psoriasis subgroup at weeks 4, 12, and 24 (all P > 0.05). Among the 124 patients, 42 were followed up for over 2 years, and the proportions of patients achieving PASI75 and PASI90 after 2 years of treatment were 71.4% (30 cases) and 54.8% (23 cases), respectively. Adverse reactions occurred in 13 patients, including upper respiratory infections in 4 patients (3.2%), elevated aminotransferase levels in 3 patients (2.4%), eczematoid dermatitis in 2 patients (1.6%), pruritus in 2 patients (1.6%), nodular prurigo in 1 patient (0.1%), and vitiligo in 1 patient (0.1%) . Conclusion:Biological agents showed rapid and marked efficacy in the treatment of moderate-to-severe psoriasis in the elderly, with few and mild adverse reactions, suggesting high safety and overall marked efficacy.

Objective:To retrospectively analyze the clinical efficacy and safety of biological agents in the treatment of psoriasis in the elderly.Methods:A retrospective study was conducted. A total of 124 patients aged ≥ 65 years with moderate-to-severe psoriasis (psoriasis area and severity index [PASI] score ≥ 3 points or body surface area [BSA] ≥ 3%), who were treated with biological agents at the Department of Dermatology and Venereology, People's Hospital of Xinjiang Uygur Autonomous Region, from June 2020 to December 2023, were collected. PASI, BSA, and dermatology life quality index (DLQI) scores were recorded at weeks 0 (pre-treatment), 4, 12, and 24 after the beginning of treatment to evaluate the efficacy. The proportions of patients achieving ≥ 75% and 90% improvements in PASI scores (PASI75 and PASI90, respectively) were calculated, and adverse reactions were recorded. Data were processed using SPSS 29.0 and GraphPad Prism 10.0 software. Normally distributed continuous variables were presented as mean ± standard deviation, while non-normally distributed continuous variables were presented as median with upper and lower quartiles ( Q1, Q3). Wilcoxon signed-rank test was used for comparisons of non-normally distributed data between groups, and chi-square test and Fisher's exact test were used for comparing categorical data. Results:Among the 124 patients, there were 72 males (58.1%) and 52 females (41.9%), and their ages ranged from 65 to 87 years. Treatment regimens included secukinumab for 86 patients (69.4%), ustekinumab for 15 (12.1%), ixekizumab for 14 (11.3%), guselkumab for 5 (4.0%), and adalimumab for 4 patients (3.2%). The pre-treatment PASI, BSA, and DLQI scores [ M ( Q1, Q3) ] were 12.2 (7.8, 19.6) points, 16.0% (10.2%, 25.0%), and 16 (11, 20) points respectively, which significantly decreased to 0.8 (0, 1.2) points, 1.0% (0, 2.0%), and 0 (0, 3) points respectively at week 24 after the start of treatment ( Z = 9.66, 9.66, 9.63, respectively, all P < 0.01). The proportions of patients achieving PASI75 at weeks 4, 12, and 24 were 42.7% (53/124), 80.6% (100/124), and 93.5% (116/124) respectively, and those achieving PASI90 were 13.7% (17/124), 48.4% (60/124), and 85.5% (106/124) respectively. There were no significant differences in the proportions of patients achieving PASI75 and PASI90 between the subgroups with and without comorbidities, as well as between the early-onset psoriasis subgroup and late-onset psoriasis subgroup at weeks 4, 12, and 24 (all P > 0.05). Among the 124 patients, 42 were followed up for over 2 years, and the proportions of patients achieving PASI75 and PASI90 after 2 years of treatment were 71.4% (30 cases) and 54.8% (23 cases), respectively. Adverse reactions occurred in 13 patients, including upper respiratory infections in 4 patients (3.2%), elevated aminotransferase levels in 3 patients (2.4%), eczematoid dermatitis in 2 patients (1.6%), pruritus in 2 patients (1.6%), nodular prurigo in 1 patient (0.1%), and vitiligo in 1 patient (0.1%) . Conclusion:Biological agents showed rapid and marked efficacy in the treatment of moderate-to-severe psoriasis in the elderly, with few and mild adverse reactions, suggesting high safety and overall marked efficacy.

Objective To investigate the factors influencing the efficacy of intravesical Bacille Calmette-Guérin(BCG)instillation after transurethral resection of bladder tumor(TURBT)in patients with intermediate-and high-risk non-muscle invasive bladder cancer(NMIBC),and to construct a prediction model for recurrence after BCG treatment.Methods A retrospective cohort study was conducted on the subjected patients diagnosed with intermediate-and high-risk NMIBC undergoing TURBT followed by standard BCG instillation.The 110 patients treated in Department of Urology of Army Medical Center of PLA from January 2018 to December 2023 were assigned into a training set,while the 52 patients treated at Department of Urology of General Hospital of Central Theater Command from January 2015 to December 2020 were into an external validation set.A total of 17 variables were included and analyzed.Univariate and multivariate Cox regression analyses were performed to identify factors associated with recurrence after BCG instillation,and nomograms were plotted to predict 1-year,3-year,and 5-year recurrence-free survival(RFS).Calibration curve,decision curve analysis(DCA),and receiver operating characteristic(ROC)curve analysis were conducted for internal and external validation to evaluate the predictive performance and clinical utility of the model.Results In the training set,26 patients(23.64%)experienced recurrence during the follow-up period,with a median RFS of 32.00(18.00～50.50)months.Univariate Cox regression analysis suggested that platelet count,eosinophil to lymphocyte ratio(ELR),neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),systemic immune inflammation(SII)index,and neutrophil-monocyte to lymphocyte ratio(NMLR),pathological T1 stage(pT1)tumor and hemoglobin,albumin,lymphocyte,and platelet(HALP)score were potential factors influencing recurrence after BCG instillation.Multivariate Cox regression analysis identified high HALP score(HR=0.185,95%CI:0.046～0.736,P=0.017)as an independent protective factor,while high ELR(HR=3.599,95%CI:1.505～8.608,P=0.004)and pT1 stage(HR=3.240,95%CI:1.191～8.818,P=0.021)were independent risk factors for recurrence.Based on this,a nomogram prediction model was constructed.The calibration curves demonstrated good agreement between predicted and actual 1-,3-,and 5-year recurrence risks.Decision curve analysis indicated clinical utility across a wide threshold probability range.In the training set,the model showed strong predictive performance for 1-(AUC=0.842),3-(AUC=0.847),and 5-year(AUC=0.887)recurrence risks,which was further validated in the external cohort.Conclusion Higher HALP score prior to BCG instillation therapy is a protective factor against tumor recurrence,while higher ELR and pT1 stage are risk factors.Our nomogram prediction model based on HALP score,ELR and pathological T stage,can identify individuals at high risk of recurrence after BCG instillation therapy.

Intentional tooth replantation (ITR) is an advanced treatment modality and the procedure of last resort for preserving teeth with inaccessible endodontic or resorptive lesions. ITR is defined as the deliberate extraction of a tooth; evaluation of the root surface, endodontic manipulation, and repair; and placement of the tooth back into its original socket. Case reports, case series, cohort studies, and randomized controlled trials have demonstrated the efficacy of ITR in the retention of natural teeth that are untreatable or difficult to manage with root canal treatment or endodontic microsurgery. However, variations in clinical protocols for ITR exist due to the empirical nature of the original protocols and rapid advancements in the field of oral biology and dental materials. This heterogeneity in protocols may cause confusion among dental practitioners; therefore, guidelines and considerations for ITR should be explicated. This expert consensus discusses the biological foundation of ITR, the available clinical protocols and current status of ITR in treating teeth with refractory apical periodontitis or anatomical aberration, and the main complications of this treatment, aiming to refine the clinical management of ITR in accordance with the progress of basic research and clinical studies; the findings suggest that ITR may become a more consistent evidence-based option in dental treatment.
Humans ; Tooth Replantation/methods* ; Consensus ; Periapical Periodontitis/surgery*

Radiochemotherapy-induced oral mucositis (OM) is a common oral complication in patients with tumors following head and neck radiotherapy or chemotherapy. Erosion and ulcers are the main features of OM that seriously affect the quality of life of patients and even the progress of tumor treatment. To date, differences in clinical prevention and treatment plans for OM have been noted among doctors of various specialties, which has increased the uncertainty of treatment effects. On the basis of current research evidence, this expert consensus outlines risk factors, clinical manifestations, clinical grading, ancillary examinations, diagnostic basis, prevention and treatment strategies and efficacy indicators for OM. In addition to strategies such as basic oral care, anti-inflammatory and analgesic agents, anti-infective agents, pro-healing agents, and photobiotherapy recommended in previous guidelines, we also emphasize the role of traditional Chinese medicine in OM prevention and treatment. This expert consensus aims to provide references and guidance for dental physicians and oncologists in formulating strategies for OM prevention, diagnosis, and treatment, standardizing clinical practice, reducing OM occurrence, promoting healing, and improving the quality of life of patients.
Humans ; Chemoradiotherapy/adverse effects* ; Consensus ; Risk Factors ; Stomatitis/etiology*

Pelvic organ prolapse (POP), whose etiology is influenced by genetic and clinical risk factors, considerably impacts women's quality of life. However, the genetic underpinnings in non-European populations and comprehensive risk models integrating genetic and clinical factors remain underexplored. This study constructed the first polygenic risk score (PRS) for POP in the Chinese population by utilizing 20 disease-associated variants from the largest existing genome-wide association study. We analyzed a discovery cohort of 576 cases and 623 controls and a validation cohort of 264 cases and 200 controls. Results showed that the case group exhibited a significantly higher PRS than the control group. Moreover, the odds ratio of the top 10% risk group was 2.6 times higher than that of the bottom 10%. A high PRS was significantly correlated with POP occurrence in women older than 50 years old and in those with one or no childbirths. As far as we know, the integrated prediction model, which combined PRS and clinical risk factors, demonstrated better predictive accuracy than other existing PRS models. This combined risk assessment model serves as a robust tool for POP risk prediction and stratification, thereby offering insights into individualized preventive measures and treatment strategies in future clinical practice.
Humans ; Female ; Pelvic Organ Prolapse/epidemiology* ; Middle Aged ; Risk Assessment/methods* ; China/epidemiology* ; Multifactorial Inheritance ; Aged ; Risk Factors ; Genome-Wide Association Study ; Genetic Predisposition to Disease ; Case-Control Studies ; Adult ; Polymorphism, Single Nucleotide ; Genetic Risk Score ; East Asian People