ObjectiveTo investigate the mechanism by which the Zishen Huoxue prescription （ZSHXP） ameliorates cognitive dysfunction in rats with vascular dementia （VD） induced by the bilateral common carotid artery ligation （2-VO model rats） through regulating the glucose-regulated protein 78 （GRP78）/protein kinase R-like endoplasmic reticulum kinase （PERK）/activating transcription factor 4 （ATF4） signaling pathway. MethodsA VD rat model was established via the 2-VO method. A total of 72 male Sprague-Dawley （SD） rats were randomly divided into six groups： Sham group， Model group， donepezil hydrochloride group （0.45 mg·kg^-1）， and ZSHXP groups at low （8.90 g·kg^-1）， medium （17.80 g·kg^-1）， and high （35.60 g·kg^-1） doses，with 12 rats in each group. The Morris Water Maze test was utilized to assess spatial learning and memory abilities of rats， and the Novel Object Recognition test was used to evaluate cognitive performance. Hematoxylin-eosin （HE） and Nissl staining were applied to observe the histological and morphological changes in hippocampal tissues. Transmission electron microscopy （TEM） was used to observe the morphological changes of endoplasmic reticulum in rat hippocampal neurons. Immunofluorescence staining was adopted to detect the colocalization of neuronal nuclei antigen （NeuN） with GRP78 and βⅢ Tubulin with gasdermin D （GSDMD） in hippocampal neurons. Western blot was used to detect the expression levels of endoplasmic reticulum stress （ERS）-related proteins including GRP78， PERK， ATF4， phosphorylated protein kinase R-like endoplasmic reticulum kinase （p-PERK）， C/EBP homologous protein （CHOP）， NOD-like receptor protein 3 （NLRP3）， Caspase-1 and GSDMD. ResultsCompared with the sham operation group， the model group showed a significantly prolonged escape latency （P<0.01）， a significant decrease in the number of platform crossings and the residence time in the target quadrant （P<0.01）， and a markedly reduced recognition index （P<0.01）. Histological observations revealed that the hippocampal neurons in the model group were disorderly arranged with reduced quantity， deformed and shrunken cell bodies， and pyknotic and hyperchromatic nuclei. The number of Nissl bodies decreased significantly. The number of endoplasmic reticula reduced obviously， accompanied by abnormal dilation and swelling， and the loss of normal folding structure. The fluorescence colocalization of NeuN with GRP78 and βⅢ Tubulin with GSDMD in the hippocampus was significantly increased in the model group. The protein expression levels of GRP78， p-PERK/PERK， ATF4， CHOP， NLRP3， GSDMD and Caspase-1 in the model group were significantly elevated （P<0.01）. Compared with the model group， the donepezil hydrochloride group and the ZSHXP medium- and high-dose groups had a significantly shortened escape latency （P<0.01） and an increased number of platform crossings （P<0.05， P<0.01）. The residence time in the target quadrant was increased in the donepezil hydrochloride group and all ZSHXP groups （P<0.05， P<0.01）， with a significantly improved recognition index （P<0.01）. In the donepezil hydrochloride group and all ZSHXP groups， the number of hippocampal neurons increased with a more compact arrangement and reduced nuclear hyperchromasia. The number of Nissl bodies increased with morphological structures tending to be normal. In the ZSHXP high-dose group， the number of endoplasmic reticula increased and the folding structure was restored. The fluorescence colocalization of NeuN with GRP78 and βⅢ Tubulin with GSDMD in the hippocampus was significantly weakened in the treatment groups. In the donepezil hydrochloride group， the protein expressions of GRP78， ATF4 and CHOP were increased （P<0.01）， while the expression of p-PERK/PERK was decreased （P<0.05）. In the ZSHXP low-dose group， the expressions of GRP78， p-PERK/PERK and CHOP were elevated （P<0.05， P<0.01）. The ZSHXP medium- and high-dose groups showed a significant decrease in the protein expressions of p-PERK/PERK， ATF4 and CHOP （P<0.01）， and the high-dose group had a markedly reduced GRP78 protein expression （P<0.01）. In the donepezil hydrochloride group， the Caspase-1 protein expression was increased （P<0.01） and the NLRP3 protein expression was decreased （P<0.01）. In the ZSHXP low-dose group， the GSDMD expression was elevated （P<0.01） while the NLRP3 protein expression was reduced （P<0.01）. After treatment with medium and high doses of ZSHXP， the protein expression levels of NLRP3， GSDMD and Caspase-1 were significantly decreased （P<0.01）. ConclusionThe ameliorative effect of ZSHXP on cognitive function in 2-VO model rats may be associated with its regulation of the GRP78/PERK/ATF4 signaling pathway， which ameliorates ERS and inhibits neuronal pyroptosis.

ObjectiveTo investigate the mechanism by which the Zishen Huoxue prescription （ZSHXP） ameliorates cognitive dysfunction in rats with vascular dementia （VD） induced by the bilateral common carotid artery ligation （2-VO model rats） through regulating the glucose-regulated protein 78 （GRP78）/protein kinase R-like endoplasmic reticulum kinase （PERK）/activating transcription factor 4 （ATF4） signaling pathway. MethodsA VD rat model was established via the 2-VO method. A total of 72 male Sprague-Dawley （SD） rats were randomly divided into six groups： Sham group， Model group， donepezil hydrochloride group （0.45 mg·kg^-1）， and ZSHXP groups at low （8.90 g·kg^-1）， medium （17.80 g·kg^-1）， and high （35.60 g·kg^-1） doses，with 12 rats in each group. The Morris Water Maze test was utilized to assess spatial learning and memory abilities of rats， and the Novel Object Recognition test was used to evaluate cognitive performance. Hematoxylin-eosin （HE） and Nissl staining were applied to observe the histological and morphological changes in hippocampal tissues. Transmission electron microscopy （TEM） was used to observe the morphological changes of endoplasmic reticulum in rat hippocampal neurons. Immunofluorescence staining was adopted to detect the colocalization of neuronal nuclei antigen （NeuN） with GRP78 and βⅢ Tubulin with gasdermin D （GSDMD） in hippocampal neurons. Western blot was used to detect the expression levels of endoplasmic reticulum stress （ERS）-related proteins including GRP78， PERK， ATF4， phosphorylated protein kinase R-like endoplasmic reticulum kinase （p-PERK）， C/EBP homologous protein （CHOP）， NOD-like receptor protein 3 （NLRP3）， Caspase-1 and GSDMD. ResultsCompared with the sham operation group， the model group showed a significantly prolonged escape latency （P<0.01）， a significant decrease in the number of platform crossings and the residence time in the target quadrant （P<0.01）， and a markedly reduced recognition index （P<0.01）. Histological observations revealed that the hippocampal neurons in the model group were disorderly arranged with reduced quantity， deformed and shrunken cell bodies， and pyknotic and hyperchromatic nuclei. The number of Nissl bodies decreased significantly. The number of endoplasmic reticula reduced obviously， accompanied by abnormal dilation and swelling， and the loss of normal folding structure. The fluorescence colocalization of NeuN with GRP78 and βⅢ Tubulin with GSDMD in the hippocampus was significantly increased in the model group. The protein expression levels of GRP78， p-PERK/PERK， ATF4， CHOP， NLRP3， GSDMD and Caspase-1 in the model group were significantly elevated （P<0.01）. Compared with the model group， the donepezil hydrochloride group and the ZSHXP medium- and high-dose groups had a significantly shortened escape latency （P<0.01） and an increased number of platform crossings （P<0.05， P<0.01）. The residence time in the target quadrant was increased in the donepezil hydrochloride group and all ZSHXP groups （P<0.05， P<0.01）， with a significantly improved recognition index （P<0.01）. In the donepezil hydrochloride group and all ZSHXP groups， the number of hippocampal neurons increased with a more compact arrangement and reduced nuclear hyperchromasia. The number of Nissl bodies increased with morphological structures tending to be normal. In the ZSHXP high-dose group， the number of endoplasmic reticula increased and the folding structure was restored. The fluorescence colocalization of NeuN with GRP78 and βⅢ Tubulin with GSDMD in the hippocampus was significantly weakened in the treatment groups. In the donepezil hydrochloride group， the protein expressions of GRP78， ATF4 and CHOP were increased （P<0.01）， while the expression of p-PERK/PERK was decreased （P<0.05）. In the ZSHXP low-dose group， the expressions of GRP78， p-PERK/PERK and CHOP were elevated （P<0.05， P<0.01）. The ZSHXP medium- and high-dose groups showed a significant decrease in the protein expressions of p-PERK/PERK， ATF4 and CHOP （P<0.01）， and the high-dose group had a markedly reduced GRP78 protein expression （P<0.01）. In the donepezil hydrochloride group， the Caspase-1 protein expression was increased （P<0.01） and the NLRP3 protein expression was decreased （P<0.01）. In the ZSHXP low-dose group， the GSDMD expression was elevated （P<0.01） while the NLRP3 protein expression was reduced （P<0.01）. After treatment with medium and high doses of ZSHXP， the protein expression levels of NLRP3， GSDMD and Caspase-1 were significantly decreased （P<0.01）. ConclusionThe ameliorative effect of ZSHXP on cognitive function in 2-VO model rats may be associated with its regulation of the GRP78/PERK/ATF4 signaling pathway， which ameliorates ERS and inhibits neuronal pyroptosis.

ObjectiveIn the realm of forensic science, dust is a valuable type of trace evidence with immense potential for intricate investigations. With the development of DNA sequencing technologies, there is a heightened interest among researchers in unraveling the complex tapestry of microbial communities found within dust samples. Furthermore, striking disparities in the microbial community composition have been noted among dust samples from diverse geographical regions, heralding new possibilities for geographical inference based on microbial DNA analysis. The pivotal role of microbial community data from dust in geographical inference is significant, underscoring its critical importance within the field of forensic science. This study aims to delve deeply into the nuances of fungal community composition across the urban landscapes of Beijing, Fuzhou, Kunming, and Urumqi in China. It evaluates the accuracy of biogeographic inference facilitated by the internal transcribed spacer 2 (ITS2) fungal sequencing while concurrently laying a robust foundation for the operational integration of environmental DNA into geographical inference mechanisms. MethodsITS2 region of the fungal genomes was amplified using universal primers known as 5.8S-Fun/ITS4-Fun, and the resulting DNA fragments were sequenced on the Illumina MiSeq FGx platform. Non-metric multidimensional scaling analysis (NMDS) was employed to visually represent the differences between samples, while analysis of similarities (ANOSIM) and permutational multivariate analysis of variance (PERMANOVA) were utilized to statistically evaluate the dissimilarities in community composition across samples. Furthermore, using Linear Discriminant Analysis Effect Size (LEfSe) analysis to identify and filter out species that exhibit significant differences between various cities. In addition, we leveraged SourceTracker to predict the geographic origins of the dust samples. ResultsAmong the four cities of Beijing, Fuzhou, Kunming and Urumqi, Beijing has the highest species richness. The results of species annotation showed that there were significant differences in the species composition and relative abundance of fungal communities in the four cities. NMDS analysis revealed distinct clustering patterns of samples based on their biogeographic origins in multidimensional space. Samples from the same city exhibited clear clustering, while samples from different cities showed separation along the first axis. The results from ANOSIM and PERMANOVA confirmed the significant differences in fungal community composition between the four cities, with the most pronounced distinctions observed between Fuzhou and Urumqi. Notably, the biogeographic origins of all known dust samples were successfully predicted. ConclusionSignificant differences are observed in the fungal species composition and relative abundance among the cities of Beijing, Fuzhou, Kunming, and Urumqi. Employing fungal ITS2 sequencing on dust samples from these urban areas enables accurate inference of biogeographical locations. The high feasibility of utilizing fungal community data in dust for biogeographical inferences holds particular promise in the field of forensic science.

Objective To analyze the application effect of acetaminophen preemptive analgesia combined with intercostal nerve block in thoracoscopic lobectomy.Methods A total of 120 patients with lung cancer who underwent thoracoscopic lobectomy admitted to Lu'an Traditional Chinese Medicine Hospital from January 2021 to September 2023 were selected as the study objects,and they were divided into the control group and the observation group according to random number table method,with 60 cases in each group.Patients in the control group were given acetaminophen preemptive analgesia before anesthesia induction,while patients in the observation group were given intercostal nerve block on the basis of the control group.The visual analogue scale(VAS)score,Ramsay sedation score,serum β-endorphin level and prostaglandin E2 level 3,12,24 and 48 hours after operation of patients in the two groups were compared.The stress response indexes such as norepinephrine(NE),epinephrine(E)and serum cortisol(Cor),as well as immune function indexes such as CD3+,CD4+and CD4+/CD8+before anesthesia induction and after extubation of patients in the two groups were compared.The incidence of adverse reactions after extubation of patients in the two groups were compared.Results The VAS scores of patients after surgery in the two groups gradually increased with time,and the Ramsay sedation scores gradually decreased with time.The VAS scores of patients in the observation group were lower than those in the control group at each postoperative time point,and the Ramsay sedation scores were higher than those in the control group,with statistically significant differences(P<0.05).The levels of serum β-endorphin and prostaglandin E2 of patients after surgery in the two groups gradually decreased with time.The levels of serum β-endorphin of patients at each postoperative time point in the observation group were higher than those in the control group,and the levels of prostaglandin E2 of patients at each postoperative time point in the observation group were lower than those in the control group,with statistically significant differences(P<0.05).The levels of NE,E,and Cor after extubation of patients in the two groups were significantly decreased(P<0.05),and those in the observation group were lower than those in the control group(P<0.05).The levels of CD3+,CD4+,and CD4+/CD8+after extubation of patients in the two groups were significantly decreased(P<0.05),and those in the observation group were higher than those in the control group(P<0.05).The total incidence of adverse reactions in the observation group was lower than that in the control group,with statistically significant difference(P<0.05).Conclusion The application of acetaminophen preemptive analgesia combined with intercostal nerve block in thoracoscopic lobectomy has good analgesic and sedative effects on patients,which is helpful to improve patients'immune function and reduce postoperative adverse reactions.

Objective:To explore the protective effect and mechanism of Rougan Tongluo Decoction on ischemic stroke induced motor disorder rats based on NOD-like receptor thermal protein domain associated protein 3(NLRP3)/Gasdermin D(GSDMD)/Cysteinyl aspartate specific proteinase 1(Caspase-1)pathway.Methods:Establishing a rat model of ischemic stroke with motor disorders using the modified suture method.The rats were randomly divided into model control group,Rougan Tongluo Decoction low,medium and high dose groups and butylphthalide soft capsule group,with 10 rats in each group,Another 10 rats were selected as sham surgery group.After 28 days of administration,the neurological function of rats in each group was evaluated by the Zea-Longa scoring method;The forelimb grasping force of rats in each group was detected by grip tester;The coordination ability of rats was evaluated by rat-mouse rotarod instrument;The expression of NLRP3,GSDMD,Caspase-1 protein and Interleukin-1β(IL-1β)was detected by immunohistochemistry.Results:The NLRP3,Caspase-1,GSDMD protein and IL-1β expression Zea-Longa score in the cerebral cortex of the model control group were significantly higher than those in sham surgery group,the forelimb grasping force was lower than that in sham surgery group,and the latency period for turning the baton was shorter than that in sham surgery group(P＜0.05).The Zeba-Longa score,NLRP3,Caspase-1,GSDMD protein and IL-1 β expression in the cerebral cortex the butylphthalide soft capsule group,low dose,medium dose,high dose Rougan Tongluo decoction group were lower than those in model control group,the forelimb grasping force was higher than that in model control group,and the latency period for turning the baton was longer than that in model control group(P＜0.05).Conclusion:Rougan Tongluo Decoction may alleviate inflammatory response by regulating the NLRP3/Caspase-1/GSDMD signaling pathway to improve neurological function and motor ability in ischemic stroke induced motor disorder rats.

Objective:To compare the clinical efficacy of autologous bone grafting or bioceramic bone grafting combined with locking compression plate (LCP) internal fixation in the treatment of Schatzker type II and III tibial plateau fractures.Methods:A retrospective analysis was conducted on 104 patients with Schatzker type II and III tibial plateau fractures who underwent surgical treatment at the Department of Orthopedics, PLA Central Theater Command General Hospital from January 2010 to December 2021. The cohort comprised 55 males and 49 females, with an average age of 49.13±13.80 years (range 18-73 years). All fractures were unilateral: 55 on the left and 49 on the right. According to the Schatzker classification, 59 were Type II and 45 were Type III. Causes of injury included traffic accidents (48 cases), falls from height (3 cases), sprains or falls (45 cases), and other causes (8 cases). During surgery, bioceramic material or allograft bone tissue was implanted into the collapsed tibial plateau region to restore articular surface flatness. Based on graft type, patients were divided into the allograft bone group (63 cases) and the bioceramic group (41 cases). All cases underwent proximal lateral tibial LCP internal fixation. The two groups were compared in terms of operative time, intraoperative blood loss, bone graft volume, length of hospital stay, fracture healing time, and postoperative complications. The Rasmussen radiographic collapse score was used to evaluate fracture reduction, and the Hospital for Special Surgery (HSS) score system was used to assess knee joint function.Results:All patients were followed up for 12(12, 13) months (range 12-16 months). The fracture healing time in the allograft bone group was 13.70±1.36 weeks (range 11-16 weeks), which was significantly shorter than that in the bioceramic group: 14.59±1.73 weeks (range 11-19 weeks) ( t=2.911, P=0.004). The time to full weight-bearing in the allograft group was 15.0(14.0, 17.0) weeks (range 13-23 weeks), which was shorter than the 16.0 (15.5, 18.5) weeks (range 12-24 weeks) in the bioceramic group, showing a statistically significant difference ( Z=-3.019, P=0.002). At 12 months postoperatively, the Rasmussen radiographic collapse score was 1(0, 1) in the bioceramic group, significantly lower than the 1(1, 2) score in the allograft group ( Z=-2.083, P=0.037). No statistically significant differences were observed between the two groups in bone graft volume, surgical duration, intraoperative blood loss, hospitalization duration, or HSS scores at 6 and 12 months postoperatively ( P>0.05). The complication rate was 6.3% (4/63) in the allograft group and 2.4% (1/41) in the bioceramic group, with no statistically significant difference (χ 2=0.830, P=0.362). Conclusions:For Schatzker type II and III tibial plateau fractures, the use of allograft bone or bioceramic combined with LCP internal fixation can achieve good results. Allograft bone has advantages in terms of fracture healing speed and early weight-bearing recovery, while bioceramic is more effective in maintaining joint surface stability.

Objective:To explore the association between serum magnesium levels during catheterization in peritoneal dialysis (PD) patients and the failure of PD technology.Methods:It was a retrospective study. The baseline data, laboratory tests and clinical events of inpatients with end-stage renal disease aged ≥18 years who received PD catheterization for the first time from April 1, 2005 to February 29, 2024 were collected, and the follow-up was conducted until June 1, 2024. PD technique failure was defined as extubation for conversion to hemodialysis or patient death. The optimal cut-off value of serum magnesium (0.782 mmol/L) was determined based on the Youden index of the receiver operating characteristic curve for predicting the failure of PD technology. The patients were divided into high serum magnesium group and low serum magnesium group, and differences of baseline clinical data and follow-up outcomes between the two groups were compared. Kaplan-Meier method was used to compare the differences of PD technical survival rates between the two groups. Logistic regression model was used to analyze the related factors of baseline increased serum magnesium levels (0.785 mmol/L) in PD patients. Cox proportional hazards regression model was used to analyze the risk factors for the failure of PD technology.Results:A total of 706 PD patients were included in this study, with age of 43.89 (33.43, 53.70) years. Among them, 339 (48.02%) patients were male. The serum creatinine was (800.45±238.81) μmol/L. The follow-up time was 726.00 (216.00, 1 344.00) days. The incidence of peritonitis was 0.072 times per patient-year, and the failure rate of PD technique was 15.58% (110/706). There were 551 patients (78.05%) in the high serum magnesium group and 155 patients (21.95%) in the low serum magnesium group. Compared with the high serum magnesium group, the low serum magnesium group had significantly lower levels of serum creatinine ( t=-2.743, P=0.006), blood urea nitrogen ( t=-2.428, P=0.004), serum uric acid ( t=-2.346, P=0.005), red blood cell count ( t=-4.100, P<0.001), hemoglobin ( Z=-4.195, P<0.001), serum albumin ( t=-4.400, P<0.001), platelet count ( Z=-2.428, P=0.015), platelet-to-monocyte ratio ( Z=-2.541, P=0.011), serum calcium ( t=-7.463, P<0.001), serum phosphorus ( t=-3.052, P=0.001), prothrombin activity ( t=-3.052, P=0.005) and proportion of hyperphosphatemia ( χ2=6.924, P=0.009), and higher male proportion ( χ2=8.984, P=0.030), proportion of conversion to hemodialysis ( χ2=6.098, P=0.014), neutrophil percentage-to-albumin ratio ( Z=2.875, P=0.004), serum chloride ( Z=4.011, P<0.001), alkaline phosphatase ( Z=2.850, P=0.040), D-dimer ( Z=3.166, P=0.002), proportion of hypoalbuminemia ( χ2=7.543, P=0.006), and proportion of hypocalcemia ( χ2=39.836, P<0.001). Kaplan-Meier survival analysis showed that the PD technical survival rates in the peritonitis group and the low serum magnesium group were significantly lower than those in the control group and the high serum magnesium group, respectively (Log-rank test, χ2=9.332, P=0.002; χ2=7.856, P=0.005). Multivariate logistic regression analysis showed that the serum calcium ( OR=23.237, 95% CI 3.807-141.845) and serum chlorine level ( OR=0.919, 95% CI 0.858-0.985) were independently correlated with the increased serum magnesium. Multivariate Cox regression analysis showed that elevated baseline serum magnesium was an independent protective factor of PD technique failure ( HR=0.351, 95% CI 0.188-0.653). Conclusions:Elevated serum magnesium is an independent protective factor of PD technology failure. Maintaining an appropriate serum magnesium level may improve the prognosis of PD patients.

Objective:To investigate the effectiveness of predictive nursing based on root cause analysis in patients undergoing cesarean section.Methods:A convenience sampling method was used to select 180 women who underwent cesarean section under combined spinal-epidural anesthesia in the Affiliated Hospital of Jining Medical University from September 2021 to October 2022. According to the random number table method, they were divided into a control group ( n=90) and an observation group ( n=90). The control group received routine nursing care, while the observation group received predictive nursing based on root cause analysis. Compared the pain intensity at 24 hours after cesarean section and the incidence of postoperative complications between the two groups of parturients. Results:The Visual Analog Scale scores at 24 hours post-cesarean section and the overall incidence of postoperative complications were lower in the observation group than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Predictive nursing based on root cause analysis can effectively relieve postoperative pain and reduce the incidence of complications in patients undergoing cesarean section with combined spinal-epidural anesthesia.

Objective:To compare the clinical efficacy of autologous bone grafting or bioceramic bone grafting combined with locking compression plate (LCP) internal fixation in the treatment of Schatzker type II and III tibial plateau fractures.Methods:A retrospective analysis was conducted on 104 patients with Schatzker type II and III tibial plateau fractures who underwent surgical treatment at the Department of Orthopedics, PLA Central Theater Command General Hospital from January 2010 to December 2021. The cohort comprised 55 males and 49 females, with an average age of 49.13±13.80 years (range 18-73 years). All fractures were unilateral: 55 on the left and 49 on the right. According to the Schatzker classification, 59 were Type II and 45 were Type III. Causes of injury included traffic accidents (48 cases), falls from height (3 cases), sprains or falls (45 cases), and other causes (8 cases). During surgery, bioceramic material or allograft bone tissue was implanted into the collapsed tibial plateau region to restore articular surface flatness. Based on graft type, patients were divided into the allograft bone group (63 cases) and the bioceramic group (41 cases). All cases underwent proximal lateral tibial LCP internal fixation. The two groups were compared in terms of operative time, intraoperative blood loss, bone graft volume, length of hospital stay, fracture healing time, and postoperative complications. The Rasmussen radiographic collapse score was used to evaluate fracture reduction, and the Hospital for Special Surgery (HSS) score system was used to assess knee joint function.Results:All patients were followed up for 12(12, 13) months (range 12-16 months). The fracture healing time in the allograft bone group was 13.70±1.36 weeks (range 11-16 weeks), which was significantly shorter than that in the bioceramic group: 14.59±1.73 weeks (range 11-19 weeks) ( t=2.911, P=0.004). The time to full weight-bearing in the allograft group was 15.0(14.0, 17.0) weeks (range 13-23 weeks), which was shorter than the 16.0 (15.5, 18.5) weeks (range 12-24 weeks) in the bioceramic group, showing a statistically significant difference ( Z=-3.019, P=0.002). At 12 months postoperatively, the Rasmussen radiographic collapse score was 1(0, 1) in the bioceramic group, significantly lower than the 1(1, 2) score in the allograft group ( Z=-2.083, P=0.037). No statistically significant differences were observed between the two groups in bone graft volume, surgical duration, intraoperative blood loss, hospitalization duration, or HSS scores at 6 and 12 months postoperatively ( P>0.05). The complication rate was 6.3% (4/63) in the allograft group and 2.4% (1/41) in the bioceramic group, with no statistically significant difference (χ 2=0.830, P=0.362). Conclusions:For Schatzker type II and III tibial plateau fractures, the use of allograft bone or bioceramic combined with LCP internal fixation can achieve good results. Allograft bone has advantages in terms of fracture healing speed and early weight-bearing recovery, while bioceramic is more effective in maintaining joint surface stability.

Background: Kidney transplant recipients (KTRs) are at risk of coronavirus disease 2019 (COVID-19) complications and mortality. This study examined factors associated with moderate, severe, or critical COVID-19 infection among KTRs during the Omicron-predominant period. Methods: This single-center retrospective study included KTRs aged ≥18 years diag-nosed with COVID-19 between January 1, 2022, and December 31, 2023. Mild infection was defined as symptomatic illness without lower respiratory tract infection (LRTI);moderate infection as LRTI without hypoxia; severe infection as oxygen saturation <94% on room air; and critical infection as respiratory failure, septic shock, or multiple organ dysfunction. We compared the characteristics of KTRs with asymptomatic or mild COVID-19 versus those with moderate to critical disease. Logistic regression analysis was performed to identify factors associated with moderate to critical illness. Results: Most KTRs (94.4%) had received three or more vaccine doses. Of 603 episodes of COVID-19 infection during the study period, 554 (91.9%) were asymptomatic or mild, while 49 (8.1%) were moderate to critical. Multivariate analysis revealed that older age (adjusted odds ratio [aOR], 1.037; 95% confidence interval [CI], 1.006–1.069) and longer symptom duration before seeking care (aOR, 1.288; 95% CI, 1.155–1.436) were associated with higher odds of moderate to critical disease. Protective factors included receiving a vaccine booster within the past year (aOR, 0.414; 95% CI, 0.212–0.809) and higher glomerular filtration rate (aOR, 0.971; 95% CI, 0.956–0.986). Conclusions KTRs should seek care early if infected with COVID-19 and keep their COVID-19 vaccine boosters updated within 1 year of the last dose.