Diabetes mellitus, characterized by glucose metabolism disorders and marked by insulin deficiency or insulin resistance, has seen a continuous rise in prevalence. In recent years, islet transplantation has matured as a therapeutic approach for diabetes, becoming an important method for glycemic control and the reduction of diabetes-related complications. Donor selection directly influences transplant outcomes, and various research institutions worldwide have proposed multiple scoring systems to optimize donor assessment, such as the University of Alberta scoring system and the North American Islet Donor Score. This article explores the impact of key factors such as donor age, body mass index and ischemia time on islet transplantation. Combining practical experience in pancreatic donor selection from Shanghai Changzheng Hospital, it proposes screening criteria for pancreatic donors suitable for China, aiming to provide new evidence for improving the success rate of islet transplantation.

Long-term outcomes in non-small cell lung cancer （NSCLC） are challenged by acquired resistance， recurrence and metastasis， as well as an immunosuppressive tumor microenvironment. In recent years， the antitumor effects of ginsenosides Rg 3 ， Rh 2 ， Rh 4 and Re， as well as their metabolite compound K （CK）， in NSCLC have attracted increasing attention. This review summarizes the mechanisms of different ginsenosides with respect to the malignant phenotypes of NSCLC cells， the tumor microenvironment and immune responses， as well as their use in combination therapy. Available evidence indicates that ginsenoside Rg 3 inhibits cell proliferation， epithelial-mesenchymal transition and angiogenesis； reduces programmed death-ligand 1 glycosylation and thereby its stability； and enhances the antitumor effects of certain chemotherapeutic agents， epidermal growth factor receptor tyrosine kinase inhibitors and radiotherapy regimens. Ginsenoside Rh 2 mainly regulates apoptosis， glycolysis and cancer stemness， and modulates tumor-associated macrophages. Ginsenoside Rh 4 is involved in ferroptosis， ginsenoside Re in endoplasmic reticulum stress and M2 macrophage polarization， and CK in autophagy and hypoxic metabolism. At present， ginsenoside Rg 3 combined with chemotherapy has been clinically evaluated， whereas evidence for the other ginsenosides is still mainly preclinical. Future studies should standardize formulations， incorporate molecular features and resistance mechanisms into stratified studies， clarify the dose， sequence and safety of combination regimens， and confirm the long-term benefits of ginsenosides as an adjunctive intervention for NSCLC in well-designed prospective clinical trials.

Objective:To investigate long-term auditory changes and characteristics of Alport syndrome（AS） patients with different degrees of renal injury. Methods:Retrospectively analyzing clinical data of patients diagnosed AS from January 2007 to September 2022, including renal pathology, genetic detection and hearing examination. A long-term follow-up focusing on hearing and renal function was conducted. Results:This study included 70 AS patients, of which 33（25 males, 8 females, aged 3.4-27.8 years） were followed up, resulting in a loss rate of 52.9%.The follow-up period ranged from 1.1to 15.8 years, with 16 patients followed-up for over 10 years. During the follow-up, 10 patients presenting with hearing abnormalities at the time of diagnosis of AS had progressive hearing loss, and 3 patients with new hearing abnormalities were followed up, which appeared at 5-6 years of disease course. All of which were sensorineural deafness. While only 3 patients with hearing abnormalities among 13 patients received hearing aid intervention. Of these patients,7 developed end-stage renal disease（ESRD）, predominantly males （6/7）. The rate of long-term hearing loss was significantly different between ESRD group and non-ESRD group（P=0.013）. There was no correlation between the progression of renal disease and long-term hearing level（P>0.05）. kidney biopsies from 28 patients revealed varying degrees of podocyte lesion and uneven thickness of basement membrane. The severity of podocyte lesion was correlated with the rate of long-term hearing loss（P=0.048）, and there was no correlation with the severity of hearing loss（P>0.05）. Among 11 cases, theCOL4A5mutationwas most common （8 out of 11）, but there was no significant correlation between the mutation type and hearing phenotype（P>0.05）. Conclusion:AS patients exhibit progressive hearing loss with significant heterogeneity over the long-term.. THearing loss is more likely to occur 5-6 years into the disease course. Hearing abnormalities are closely related to renal disease status, kidney tissue pathology, and gene mutations, emphasizing the need for vigilant long-term hearing follow-up and early intervention.
Male ; Child ; Female ; Humans ; Nephritis, Hereditary/pathology* ; Retrospective Studies ; Kidney ; Deafness ; Hearing Loss/genetics* ; Kidney Failure, Chronic/pathology* ; Mutation

Objective:To test and evaluate the reliability and clinical effectiveness of osteoporotic thoracolumbar fracture (OTLF) scoring and classification system.Methods:A multicenter retrospective case series study was conducted to analyze the clinical data of 530 OTLF patients admitted to 8 hospitals including Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2021 to June 2022. There were 212 males and 318 females, aged 55-90 years [(72.6±10.8)years]. There were 4 patients with grade C and 18 with grade D according to American Spinal Injury Association (ASIA) classification. According to the osteoporotic thoracolumbar injury classification and severity (OTLICS) score, all patients had an OTLICS score over 4 points and required surgical treatment. Among them, 410 patients had acute symptomatic OTLF (ASOTLF), including 24 patients with type I, 159 type IIA, 47 type IIB, 31 type IIC, 136 type IIIA, 8 type IIIB, 2 type IV (absence of neurological symptoms) and 3 type IV (presence of neurological symptoms), and 120 patients had chronic symptomatic OTLF (CSOTLF), including 62 patients with type I, 21 type II, 17 type III, 3 type IV (reducible under general anesthesia), 9 type IV (not reducible under general anesthesia), 1 type V (reducible under general anesthesia), 5 type V (presence of neurological symptoms), and 2 type V (not reducible under general anesthesia). Surgical procedures included percutaneous vertebroplasty (PVP), positional repositioning plus PVP, percutaneous kyphoplasty (PKP), posterior open reduction combined with bone graft fusion and bone cement augmented screw internal fixation, posterior open reduction combined with decompression, bone graft fusion and bone cement augmented screw internal fixation, and posterior open reduction combined with osteotomy and orthopedics, bone graft fusion and bone cement augmented screw internal fixation. A weighted Kappa was used to test the interobserver and intraobserver reliability of the OTLICS score, the ASOTLF classification, and the CSOTLF classification. The visual analog scale (VAS), Oswestry disability index (ODI), ASIA classification were compared before, at 1 month after surgery and at the last follow-up. Incidence of postoperative complications was observed.Results:The percentage of mean interobserver agreement for OTLICS staging was 93.4%, with a mean confidence Kappa value of 0.86, and the percentage of mean intraobserver agreement was 93.0%, with a mean confidence kappa value of 0.86. The percentage of mean interobserver agreement for ASOTLF staging was 94.2%, with a mean confidence Kappa value of 0.84, and the percentage of mean intraobserver agreement was 92.5%, with a mean confidence Kappa value of 0.83. The percentage of mean interobserver agreement for CSOTLF subtyping was 91.9%, with a mean confidence Kappa value of 0.80, and the percentage of mean intraobserver agreement was 91.3%, with a mean confidence Kappa value of 0.81. All the patients were followed up for 6-12 months [(9.0±2.1)months]. The VAS and ODI scores were significantly lower in patients with ASOTLF and CSOTLF classifications at 1 month after surgery and at the last follow-up than those before surgery (all P<0.05). The VAS scores in patients with ASOTLF types IIA, IIB, IIC, IIIA, and IV were significantly lower at the last follow-up than that at 1 month after surgery; the ODI scores in patients with ASOTLF types I, IIA, IIB, IIIA, IIIB and IV were significantly lower at the last follow-up than those at 1 month after surgery. The VAS scores in patients with CSOTLF types II, III, IV, and V were significantly lower at the last follow-up than those at 1 month after surgery, and the ODI scores in patients with all CSOTLF types were significantly lower at the last follow-up than those at 1 month after surgery (all P<0.05). Two patients with ASIA grade C recovered to grade D, and the rest recovered to grade E at the last follow-up ( P<0.01). No major vessel or nerve injury or internal fixation failure was found during follow-up. There were 18 patients with cement leakage, none of whom showed relevant clinical symptoms. There were 35 patients with new vertebral fractures, all of whom recovered well after symptomatic treatment. Conclusions:The OTLICS score, ASOTLF classification and CSOTLF classification have a high degree of reliability. Application of stepwise treatment for patients with different levels of injury according to the scoring and classification system can reduce pain, promote recovery of the spinal function, and reduce complications, which is of some significance in guiding the selection of clinical treatment.

Objective:To conduct a Meta-analysis of the efficacy and safety of laparoscopy-assisted pylorus-preserving gastrectomy(LPPG) and laparoscopy-assisted distal gastrectomy(LDG) in early gastric cancer(EGC).Methods:Searched Web of Science, Cochrane library, Embase, Chinese Biomedical Medical Database, CNKI, Wanfang Database to identify all qualified studies comparing LPPG and LDG in EGC. The retrieval time was from the database establishment to October 2020. Measurement data with normal distribution were represented as ( Mean± SD). Comparing two groups by mean difference(MD) with 95% confidence interval(CI) for contious outcomes and odds ratio(OR) with 95% CI for dichotomous data.The RevMan software was used to analyze the perioperative outcome. Results:A total of 10 studies were included, with a total of 1613 patients, 624 in the LPPG group and 989 in the LDG group. Operation time, intraoperative blood loss, postoperative anal exhaust time, hospital stay, and overall complication rate of LPPG were similar to LDG.Compared with the LDG group, the LPPG group had fewer lymph node dissections ( MD=-2.51, 95% CI: -4.31~-0.71, P=0.006), longer postoperative gastric tube indwelling time ( MD=1.05, 95% CI: 0.31~1.80, P=0.006), and a higher incidence of delayed gastric emptying ( P<0.01). There was no statistically significant difference between the two groups in terms of other perioperative complications. Conclusion:LPPG is a safe and feasible surgical method for the treatment of EGC, and can be used as an alternative to LDG.

A 13-year-old male patient presented with skin abnormalities for more than 10 years and slow growth in body height for more than 5 years. Since the age of 6 months, erythema and scales had occurred on the extremities, and gradually spread to the trunk and face; brown pigmentation and punctate depigmentation appeared after subsidance of the erythema and scales, accompanied by dental caries, thickened palms and soles, nail thickening and peeling. Since the age of 6 years, the patient had presented with slow growth in body height, gonadal dysgenesis, sparse eyebrows and eyelashes, flat cheekbones and lameness in walking. In the past 10 years, neutrophil count had been found to be continuously lower than the normal reference value. Blood routine examination showed a neutrophil count of 1.1 × 10 9/L and a neutrophil proportion of 0.345; serum level of testosterone in the patient (< 0.087 nmol/L) was lower than normal levels. DNA was extracted from the peripheral blood of the patient and his parents, and gene mutation analysis was carried out by using whole-exome sequencing technology. Genetic testing showed compound heterozygous mutations in the USB1 gene of the patient, including the c.450-2A>G mutation inherited from his mother and the c.335de1G mutation inherited from his father, and the c.335de1G mutation had not been reported in China and other countries.

Objective:To evaluate the effects of different high pressure on the behavior and physiological indexes of hypothalamic-pituitary-adrenal axis (HPA) in rats, so as to provide a theoretical basis for the stress protection in decompression process.Methods:The rats were divided into four groups according to the random number table method and were separately exposed to air pressure of 0 kPa, 170 kPa, 350 kPa and 700 kPa for 60 mins and given decompression for 45 mins. The behaviors of rats were analyzed by animal open field method and video analysis system of the open field immediately after they were taken from the air pressure chamber, and the contents of adrenocorticotrophic hormone (ACTH) and glucocorticoid (GC) in the serum were measured by the enzyme-linked immunosorbent assay (ELISA).Results:Under different pressure, compared with the 0 kPa group, the total distance traveled by the rats ( F=3.354), the average traveling speed ( F=3.358), the number of standing times and standing time duration ( F=3.739; F=33.332) of the rats in the other 3 groups decreased significantly. The distance traveled in the corner of the 175 kPa group and the 700 kPa group decreased significantly ( F=3.532), while their cleaning time significantly increased ( F=4.581). The standing times and the cleaning time of the 350 kPa group were significantly less than those of the 700 kPa group. All the differences above showed statistical significance ( P<0.05). After exposure to different pressure, the ACTH level of the 175 kPa group was higher than those of the 0 kPa group and the 350 kPa group ( F=5.309) with statistical significance ( P<0.05). The GC level of the 0 kPa group was significantly lower than those of the other 3 groups, and the GC level of the 700 kPa group was especially lower than that of the 175 kPa group, with statistically significant difference ( P<0.05). Conclusion:High pressure exposure at all levels can cause definite stress reaction, and the stress reactions do not correlate with the pressure gradient. Within the physiological bearable range of stress under high pressure, the individual stress level may present a certain steady state. The individual′s behavioral response, ACTH and GC levels may be used as indicators for stress monitoring.

Objective:To evaluate the effects of different high pressure on the behavior and physiological indexes of hypothalamic-pituitary-adrenal axis (HPA) in rats, so as to provide a theoretical basis for the stress protection in decompression process.Methods:The rats were divided into four groups according to the random number table method and were separately exposed to air pressure of 0 kPa, 170 kPa, 350 kPa and 700 kPa for 60 mins and given decompression for 45 mins. The behaviors of rats were analyzed by animal open field method and video analysis system of the open field immediately after they were taken from the air pressure chamber, and the contents of adrenocorticotrophic hormone (ACTH) and glucocorticoid (GC) in the serum were measured by the enzyme-linked immunosorbent assay (ELISA).Results:Under different pressure, compared with the 0 kPa group, the total distance traveled by the rats ( F=3.354), the average traveling speed ( F=3.358), the number of standing times and standing time duration ( F=3.739; F=33.332) of the rats in the other 3 groups decreased significantly. The distance traveled in the corner of the 175 kPa group and the 700 kPa group decreased significantly ( F=3.532), while their cleaning time significantly increased ( F=4.581). The standing times and the cleaning time of the 350 kPa group were significantly less than those of the 700 kPa group. All the differences above showed statistical significance ( P<0.05). After exposure to different pressure, the ACTH level of the 175 kPa group was higher than those of the 0 kPa group and the 350 kPa group ( F=5.309) with statistical significance ( P<0.05). The GC level of the 0 kPa group was significantly lower than those of the other 3 groups, and the GC level of the 700 kPa group was especially lower than that of the 175 kPa group, with statistically significant difference ( P<0.05). Conclusion:High pressure exposure at all levels can cause definite stress reaction, and the stress reactions do not correlate with the pressure gradient. Within the physiological bearable range of stress under high pressure, the individual stress level may present a certain steady state. The individual′s behavioral response, ACTH and GC levels may be used as indicators for stress monitoring.

Objective To investigate the effects of adoptive reinfusion of regulatory T cell (Treg) on the recovery of islet function and graft survival time after islet allograft transplantation. Methods The diabetic model was established using C57BL/6 mice as recipients, and Balb/c mice were chosen as donors for islet allografts transplantation beneath the renal capsule. The recipient mice were divided into 3 groups and 3 mice in each group according to different processing Methods: Treg experiment group (Treg group, 1×10⁶ Treg cells were injected via tail vein at 1 d before operation), positive control group [sirolimus (SRL) group, SRL at a dose of 300 μg/(kg·d) was intragastrically given every day from 1 d before operation] and blank control group (control group, an equivalent volume of normal saline was intragastrically given every day from 1 d before operation). Enzyme-linked immune absorbent assay (ELISA) was used to detect the changes of blood glucose and C-peptide in mice within 14 days after transplantation. In vivo imaging technique was used to dynamically monitor the survival of mice within 14 days after transplantation. Results In each group, the blood glucose levels at postoperative 3 d were significantly decreased compared with those before transplantation (all P < 0.001). At postoperative 1 d, the C-peptide levels showed an explosive rise to varying degree in each group. At postoperative 3 d, the C-peptide levels in each group were significantly higher than that before operation (all P < 0.001). At the end of the observation period at 14 d after operation, the C-peptide levels in the SRL and Treg groups were (427±50) pmol/L and (833±57) pmol/L, relatively higher than that in the control group. But the blood glucose levels were (14.5±0.5) mmol/L and (12.1±0.6) mmol/L, significantly lower than that in the control group (all P < 0.001). Compared with the SRL group, the explosive release amount of C-peptide was significantly lower, the declining trend was more remarkably stable, and the C-peptide level was considerably higher in the Treg group at the end of the observation period (all P < 0.001). At postoperative 14 d, the grafts were almost completely apoptotic in the control group, over 50% of the grafts survived in the SRL group, and over 80% of the grafts survived in the Treg group. Conclusions Adoptive reinfusion of Treg cells can effectively protect islet grafts, prolong the survival time of grafts, and maintain the normal levels of blood glucose and C-peptide in the recipient mice.

Objective To explore the effects of Qa-1 and PD-L1 loaded artificial liposomal treatment in allograft rejection and its outcomes .Methods The extracellular domains of Qa-1 and PD-L1 were loaded on liposome surface by streptavidin-biotin system . Mixed lymphocyte reaction (MLR) was performed for measuring Qa-1/PD-L1 liposome biological function .Then liposome was co-transplanted with allo-islets via portal vein .The levels of blood glucose and C-peptide were detected daily after transplantation .Also hepatic lymphocytes after transplantation were isolated for determining the proportion of activated cells and signaling pathway changes .Results Artificial liposome could be easily loaded with biotinylated peptide and its diameter was between 50 to 500 nm . Qa-1/PD-L1 liposome could significantly suppress lymphocyte proliferation , activation and secretion of IFN-γ in MLR by an activation of SHP1/2 and an inhibition of Syk pathway .Qa-1/ PD-L1 liposomes could suppress the activation of hepatic lymphocytes in vivo by activating SHP1/2 ,protecting islet allografts and maintaining a normal level of blood glucose in recipients .Conclusions Qa-1/PD-L1 loaded liposome can effectively suppress allograft rejection and improve the outcomes of islet transplantation .