Dysfunction of drug transporters significantly affects therapeutic outcomes and drug efficacy in patients with liver injury. Clinical and experimental evidence demonstrates that liver injury involves complex inter-organ interactions among the brain, eye, liver, intestine, and kidney. Recent advances in basic and clinical research have illuminated the physiologic and molecular mechanisms underlying transporter alterations in liver injury, particularly those associated with bilirubin, reactive oxygen species, ammonia, bile acid, and inflammatory factors. Notably, the influence of these transporter modifications on drug pharmacokinetics in liver injury patients remains inadequately understood. Additional research is necessary to fully comprehend these effects and their therapeutic implications. The documented alterations of transporters in distant organs across various liver diseases indicate that dosage modifications may be required when administering transporter-substrate drugs, including both traditional Chinese and Western medicines, to patients with liver dysfunction. This strategy helps maintain drug concentrations within therapeutic ranges while reducing adverse reactions. Furthermore, when utilizing transporter inducers or inhibitors clinically, consideration of their long-term effects on transporters and subsequent therapeutic impact is essential. Careful attention must be paid to avoid compromising the elimination of toxic metabolites and proteins when inhibiting these transporters. Similarly, prudent use of inducers or inducer-type therapeutic drugs is necessary to prevent enhanced drug resistance. This review examines recent clinical and experimental findings regarding the inter-organ interaction of drug transporters in liver injury conditions and their clinical relevance.
Humans ; Liver/drug effects* ; Animals ; Chemical and Drug Induced Liver Injury/metabolism* ; Membrane Transport Proteins/metabolism* ; Biological Transport ; Liver Diseases/drug therapy* ; Pharmaceutical Preparations/metabolism*

Objective:To explore the bidirectional relationship between adaptability and insomnia symptoms in college students.Methods:A longitudinal study was conducted across three phases over a span of two years,invol-ving a sample of 13 861 students from a comprehensive university in Shandong Province.The Adaptability Scale(APAS)and the Insomnia Symptoms Scale(ISI)were used to measure adaptability and insomnia symptoms,re-spectively.A latent variable structural equation model was applied to assess the cross-lagged associations between a-daptability and insomnia symptoms over time.Results:The Baseline APAS scores negatively predicted the ISI scores one year later(β=-0.05,P＜0.001),and the APAS scores at one year negatively predicted the ISI scores at the two-year mark(β=-0.04,P＜0.001).Similarly,the baseline ISI scores negatively predicted the APAS scores one year later(β=-0.06,P＜0.001),and the ISI scores at one year negatively predicted the APAS scores two years later(β=-0.03,P＜0.01).Conclusion:The study demonstrates that adaptability helps prevent insom-nia symptoms in students,while insomnia negatively impacts students'adaptability.

Objective:To explore the bidirectional relationship between adaptability and insomnia symptoms in college students.Methods:A longitudinal study was conducted across three phases over a span of two years,invol-ving a sample of 13 861 students from a comprehensive university in Shandong Province.The Adaptability Scale(APAS)and the Insomnia Symptoms Scale(ISI)were used to measure adaptability and insomnia symptoms,re-spectively.A latent variable structural equation model was applied to assess the cross-lagged associations between a-daptability and insomnia symptoms over time.Results:The Baseline APAS scores negatively predicted the ISI scores one year later(β=-0.05,P＜0.001),and the APAS scores at one year negatively predicted the ISI scores at the two-year mark(β=-0.04,P＜0.001).Similarly,the baseline ISI scores negatively predicted the APAS scores one year later(β=-0.06,P＜0.001),and the ISI scores at one year negatively predicted the APAS scores two years later(β=-0.03,P＜0.01).Conclusion:The study demonstrates that adaptability helps prevent insom-nia symptoms in students,while insomnia negatively impacts students'adaptability.

Objective To investigate the effects of time in range(TIR)and microRNA-2245P(miR-2245P)interac-tions on the susceptibility and severity of diabetic retinopathy(DR)in the target range of glucose.Methods A prospec-tive study was conducted on 259 patients with DR(DR group)and 259 patients with type 2 diabetes mellitus(T2DM group)admitted to the Ophthalmology Department of Yantai Yeda Hospital from April 2022 to June 2024.TIR and miR-2245P were compared between the two groups,and the multivariate Logistic analysis was used to identify the factors associated with DR susceptibility.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of TIR,miR-2245 P,and their combination for DR.The interaction coefficient γ was used to analyze the effect of the interaction between TIR and miR-2245P on DR susceptibility.The Spearman correlation analysis was used to evaluate the correlation of TIR and miR-2245P with DR staging.Results The TIR and miR-2245P levels in the DR group were lower than those in the T2DM group(both P＜0.05).The multivariate logistic regression analysis showed that Logit(P)=0.083-0.470 × TIR-0.584 × miR-2245P,high levels of TIR and miR-2245P were independent protective factors of DR susceptibility(all P＜0.05).The areas under the ROC curve(AUC)of TIR,miR-2245P,and their combination for predicting DR were 0.76,0.79,and 0.91,respectively.The AUC of TIR combined with miR-2245P was greater than that of TIR and miR-2245P(both P＜0.05).The interaction analysis showed that the OR values of DR caused by low levels of TIR and miR-2245P alone were 2.05 and 1.92,respectively.The OR value of the interaction between TIR and miR-2245P was 10.69,greater than the prod-uct of OR values of TIR and miR-2245P alone.It indicates that the effect of the interaction of TIR and miR-2245P on suscep-tibility to DR is a super-multiplication model.The interaction coefficient was γ=3.31＞1,indicating a positive relationship of the interaction between the two factors with DR susceptibility.The Spearman correlation analysis showed that TIR and miR-2245P were negatively correlated with DR staging(both P＜0.001).Conclusion Both TIR and miR-2245P are asso-ciated with DR and its severity,and they have interactive effects on DR susceptibility.Combined detection can improve the predictive value of DR.This study provides a new idea and target for the prevention and treatment of DR.

Objective To investigate the effects of time in range(TIR)and microRNA-2245P(miR-2245P)interac-tions on the susceptibility and severity of diabetic retinopathy(DR)in the target range of glucose.Methods A prospec-tive study was conducted on 259 patients with DR(DR group)and 259 patients with type 2 diabetes mellitus(T2DM group)admitted to the Ophthalmology Department of Yantai Yeda Hospital from April 2022 to June 2024.TIR and miR-2245P were compared between the two groups,and the multivariate Logistic analysis was used to identify the factors associated with DR susceptibility.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of TIR,miR-2245 P,and their combination for DR.The interaction coefficient γ was used to analyze the effect of the interaction between TIR and miR-2245P on DR susceptibility.The Spearman correlation analysis was used to evaluate the correlation of TIR and miR-2245P with DR staging.Results The TIR and miR-2245P levels in the DR group were lower than those in the T2DM group(both P＜0.05).The multivariate logistic regression analysis showed that Logit(P)=0.083-0.470 × TIR-0.584 × miR-2245P,high levels of TIR and miR-2245P were independent protective factors of DR susceptibility(all P＜0.05).The areas under the ROC curve(AUC)of TIR,miR-2245P,and their combination for predicting DR were 0.76,0.79,and 0.91,respectively.The AUC of TIR combined with miR-2245P was greater than that of TIR and miR-2245P(both P＜0.05).The interaction analysis showed that the OR values of DR caused by low levels of TIR and miR-2245P alone were 2.05 and 1.92,respectively.The OR value of the interaction between TIR and miR-2245P was 10.69,greater than the prod-uct of OR values of TIR and miR-2245P alone.It indicates that the effect of the interaction of TIR and miR-2245P on suscep-tibility to DR is a super-multiplication model.The interaction coefficient was γ=3.31＞1,indicating a positive relationship of the interaction between the two factors with DR susceptibility.The Spearman correlation analysis showed that TIR and miR-2245P were negatively correlated with DR staging(both P＜0.001).Conclusion Both TIR and miR-2245P are asso-ciated with DR and its severity,and they have interactive effects on DR susceptibility.Combined detection can improve the predictive value of DR.This study provides a new idea and target for the prevention and treatment of DR.

Objective:The purpose of this study was to examine the clinical features and initial treatment outcomes of elderly individuals with idiopathic membranous nephropathy.Methods:This study retrospectively analyzed the clinical characteristics and therapeutic effect of hospitalized patients aged 60 years or older with renal-biopsy-proven idiopathic membranous nephropathy for at least one year.Results:This study enrolled a total of 91 elderly patients with IMN, consisting of 51 males(56.0%)and 40 females(44.0%). The median age of the patients was 67 years.The urinary protein creatinine ratio(uPCR)and urinary albumin creatinine ratio(uACR)of the patients were 4 454.3 mg/g and 2 258.5 mg/g, respectively.The median 24-hour urinary protein and urinary albumin levels were 5 098.2 mg/24 h and 2 800.6 mg/24 h, respectively.The average estimated glomerular filtration rate(eGFR)was(60.5±20.4)ml·min -1·1.73 m -2.Out of the total of 61 patients, 67.0% achieved remission, including complete and partial remission, within a year of renal biopsy.The levels of uPCR and uACR were significantly higher in the non-remission group compared to the remission group(5 462.5 vs.2 271.1 mg/g, P<0.001; 2 774.4 vs.1 320.0 mg/g, P=0.001). Additionally, the levels of 24h urinary protein and urinary albumin were significantly higher in the non-remission group compared to the remission group(6 526.4 vs.3 210.4 mg/g, P=0.002; 3 067.7 vs.2 102.4 mg/g, P=0.007). The remission group had a higher proportion of patients receiving immunosuppressive therapy(85.2% vs.33.3%, P<0.001). The remission rates were higher in patients treated with glucocorticoid combined with cyclophosphamide, glucocorticoid combined with calcineurin inhibitors, or glucocorticoid combined with mycophenolate mofetil compared to those receiving conservative treatment(88.2% vs.31.0%, P=0.001; 80.0% vs.31.0%, P<0.001; 100.0% vs.31.0%, P=0.007). There was no significant difference in remission rate between the three immunosuppressive therapy groups( P>0.05). However, upon further analysis, it was found that the levels of uPCR, uACR, and serum cystatin C(CysC)were higher in the immunosuppressive therapy groups compared to conservative treatment.Additionally, serum total protein and albumin were lower in the immunosuppressive therapy groups, and these differences were statistically significant( P<0.05). Conclusions:The majority of elderly patients diagnosed with IMN have multiple comorbidities.For those at high risk with elevated urinary protein levels, early initiation of immunosuppressive therapy may lead to a higher initial urinary protein remission rate.Therefore, it is advisable to develop individualized treatment plans for elderly patients with IMN based on their clinical characteristics, as well as the risks and benefits associated with immunosuppressive therapy.

Objective To investigate the role of macrophages in the process of fine particulate matter (PM2.5)exposure induced damage to pulmonary blood-air barrier.Methods Eighteen male BALB/C mice (aged of 10 weeks,weighing 24～27 g)were randomly divided into control group and low-and high-dose PM2.5 exposure groups (receiving 1 .8 and 16.2 mg/kg,respectively),with 6 mice in each group.The control group received tracheal instillations of normal saline on days 1,4,and 7,whereas the exposure groups were administered corresponding dose of PM2.5 exposure at the same time points.In 24 h after last exposure,pathological changes in the lung tissues were observed,and the contents of total protein (TP ),lactate dehydrogenase (LDH ),and alkaline phosphatase (AKP ) in bronchoalveolar lavage fluid (BALF ),and F4/80 protein level in lung tissue were measured to evaluate the blood-air barrier damage and macrophage infiltration within the lung tissues.Additionally,an in vitro model of the blood-air barrier was established using A549 alveolar epithelial cells and EA.hy926 vascular endothelial cells.In combination with a THP-1 macrophage model,the supernatant PM2.5 supernatant,macrophage supernatant,and PM2.5-macrophage supernatant were incubated with the barrier model for 24 h,respectively.Transmembrane electrical resistance (TEER),sodium fluorescein permeability of the barrier model,and LDH release from the barrier cells were measured to ascertain the extent of macrophage-mediated enhancement in barrier damage induced by PM2.5 exposure.Furthermore,the expression of inflammatory cytokines,such as TNF-α,IL-1β,IL-6,and IL-8 in the macrophages after PM2.5 exposure was analyzed with quantitative real-time PCR (qPCR)and enzyme-linked immunosorbent assay (ELISA).Results PM2.5 exposure induced lung tissue damage in mice in a dose-dependent manner,significantly elevated the contents of TP,LDH and AKP in the BALF and caused marked infiltration of macrophages into the lung tissue,especially the high-dose exposure when compared with the mice from the control group (P<0.01 ).In vitro barrier model exposure experiments showed that in comparison with the treatment of 150 and 300 μg/mL PM2.5 and macrophage supernatant,the same doses of PM2.5-macrophage supernatant resulted in notably decreased TEER and significantly enhanced permeability in the barrier model (P<0.01 ),and markedly increased LDH release from epithelial and endothelial barrier cells (P<0.01 ).Additionally,the exposure of 150 and 300μg/mL PM2.5 led to a significant up-regulation of TNF-α,IL-1β,IL-6,and IL-8 in the macrophages (P<0.01 ).Conclusion Macrophages deteriorate PM2.5-induced functional impairment of the pulmonary blood-air barrier.

In order to standardize the clinical diagnosis and treatment of upper airway cough syndrome (UACS) for children in China, Dongzhimen Hospital of Beijing University of Chinese Medicine and Affiliated Hospital of Liaoning University of Traditional Chinese Medicine initiated the development of this Traditional Chinese Medicine Diagnosis and Treatment Guidelines for Children with Upper Airway cough Syndrome based on evidence-based medical evidence. This guideline will process registration, write a plan, and develop relevant processes and writing norms, develop and publish official documents. This plan mainly introduces the scope of the guidelines, the purpose and significance, the composition of the guidelines working group, the management of conflicts of interest, the collection, selection and determination of clinical problems, the retrieval, screening and rating of evidence, and the consensus of recommendations. Registration information: This study has been registered in the international practice guidelines registry platform with the registration code of PREPARE-2023CN087.

Non-small cell lung cancer(NSCLC)is a prevalent and aggressive global malignancy.Conventional sur-gical treatments,radiotherapy,chemotherapy,and targeted therapies often fall short in halting disease progression due to inher-ent limitations,resulting in suboptimal prognosis.Despite the advent of immunotherapy drugs offering new hope for NSCLC treatment,current efficacy remains insufficient to meet all patient needs.Therefore,actively exploring novel immunotherapeu-tic approaches to further reduce mortality rates in NSCLC patients has become a crucial focus of NSCLC research.This article aims to systematically review the anti-tumor effects ofinterleukin-21 and follicular helper T cells in NSCLC immunotherapy by summarizing and analyzing relevant literatures from both domestic and international sources,as well as exploring the potential for enhancing NSCLC treatment prospects through immune checkpoint regulation via immunotherapeutic means.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.