AIM:To investigate the predictive value of aqueous humor stromal cell-derived factor-1(SDF-1)and epithelial neutrophil-activating peptide-78(ENA78)for visual impairment following vitrectomy in patients with diabetic retinopathy(DR).METHODS: Patients with DR who underwent vitrectomy in the ophthalmology department of our hospital from March 2022 to March 2024 were enrolled as study group. According to the results of uncorrected visual acuity examination during the 1-year follow-up after surgery, they were further divided into visual impairment group and good visual acuity group. In addition, patients with cataracts who were treated in our hospital during the same period were recruited as control group. The levels of SDF-1 and ENA78 in aqueous humor were detected by enzyme-linked immunosorbent assay(ELISA). Pearson correlation analysis was used to evaluate the correlation of indicators. Multivariate Logistic regression analysis was performed to identify the influencing factors of postoperative visual impairment in DR patients. Relative risk analysis was conducted to assess the impact of different aqueous humor SDF-1 and ENA78 levels on postoperative visual impairment in DR patients. Receiver operating characteristic(ROC)curve analysis was applied to determine the predictive value of aqueous humor SDF-1 and ENA78 levels for postoperative visual impairment in DR patients.RESULTS: Totally 156 cases(156 eyes)were enrolled in the study group, including 87 males and 69 females, with a mean age of 60.65±8.91 years old; and 91 cases(91 eyes)were enrolled in the control group, including 53 males and 38 females, with a mean age of 58.72±8.43 years old. The levels of SDF-1 and ENA78 in aqueous humor of the study group were significantly higher than those of the control group(P<0.001). According to the results of uncorrected visual acuity during the 1-year follow-up after surgery, the study group was further divided into the visual impairment group(n=49)and the good visual acuity group(n=107), including 28 males and 21 females in the visual impairment group, with a mean age of 63.73±7.41 years, and 59 males and 48 females in the good visual acuity group, with a mean age of 59.24±8.47 years. The age and glycated hemoglobin(HbA1c)levels of the visual impairment group were higher than those of the good visual acuity group(all P<0.05). Compared with the good visual acuity group, the levels of SDF-1 and ENA78 in aqueous humor of the visual impairment group were significantly elevated(all P<0.05). A positive correlation was found in the study group between the levels of SDF-1, ENA78 in aqueous humor and HbA1c(r=0.314, 0.362, all P<0.05). Elevated levels of aqueous humor SDF-1(OR=2.936, 95% CI: 1.628-5.296)and ENA78(OR=3.092, 95% CI: 1.738-5.502)were identified as risk factors for postoperative visual impairment in DR patients(all P<0.05). High levels of SDF-1 and ENA78 increased the risk of postoperative visual impairment by 1.958-fold and 2.030-fold compared with the low-level groups, respectively; the area under the curve(AUC)of combined detection of aqueous humor SDF-1 and ENA78 for predicting postoperative visual impairment in DR patients was 0.936, which was superior to the predictive value of SDF-1 or ENA78 alone(Zcombination-SDF-1=2.850, Zcombination-ENA78=2.445, all P<0.05).CONCLUSION: Elevated levels of aqueous humor SDF-1 and ENA78 are risk factors for postoperative visual impairment in DR patients, and the combined detection of SDF-1 and ENA78 has high clinical application value for predicting postoperative visual impairment in DR patients.

AIM: To investigate the correlation of serum leukocyte-derived chemotaxin 2(LECT2)and complement C1q/tumor necrosis factor-related protein 5(CTRP5)with diabetic retinopathy(DR).METHODS:A single-center cross-sectional analysis was conducted on 138 patients with type 2 diabetes mellitus(T2DM)admitted to our hospital from April 2023 to April 2025. According to the diagnostic results, they were divided into a non-DR group(60 cases)and a DR group(78 cases). The DR group was further divided into a proliferative DR(PDR)group(29 cases)and a non-proliferative DR(NPDR)group(49 cases). Pearson correlation analysis was used to assess the correlation of LECT2 and CTRP5 with glucose-lipid metabolism indicators. Logistic regression analysis was conducted to identify the influencing factors for the occurrence of DR in T2DM patients. ROC curve analysis was performed to evaluate the diagnostic value of serum LECT2 and CTRP5 for DR in T2DM patients.RESULTS: A comparison of general patient data between the two groups showed no significant differences. The DR group had higher serum levels of LECT2, CTRP5, total cholesterol(TC), triglycerides(TG), low-density lipoprotein cholesterol(LDL-C), and homeostatic model assessment of insulin resistance(HOMA-IR)than the non-DR group, while high-density lipoprotein cholesterol(HDL-C)was lower(all P<0.05). The serum levels of LECT2 and CTRP5 in the PDR group were higher than those in the NPDR group(all P<0.05). Serum LECT2 and CTRP5 positively correlated with TC, TG, LDL-C, and HOMA-IR, and negatively correlated with HDL-C(all P<0.001). Logistic results showed that duration of diabetes, TC, TG, LDL-C, HOMA-IR, LECT2, and CTRP5 were risk factors for DR occurrence in T2DM patients(all P<0.05). The ROC curve showed that the AUCs for serum LECT2, CTRP5 alone, and combined in diagnosing DR in T2DM patients were 0.830, 0.839, and 0.915, respectively. The AUC for the combined diagnosis was higher than that of LECT2 or CTRP5 alone according to the DeLong test(Z=2.818, 2.824, P=0.015, 0.012).CONCLUSION:Serum LECT2 and CTRP5 levels are closely related to the development of DR in T2DM patients, and joint detection has certain clinical value in diagnosing DR in T2DM patients.

Hepatocellular carcinoma (HCC) develops within a profoundly immunosuppressive tumor immune microenvironment (TIME), which limits the efficacy of immunotherapy. Polarization of tumor-associated macrophages (TAMs) toward a pro-tumorigenic M2 phenotype is a major driver of immune escape. Ferroptosis, an iron-dependent regulated cell death program, intersects with hepatic iron metabolism and immune regulation and thus offers promising points of therapeutic intervention. This review systematically elucidates the mechanistic role of TAM ferroptosis in HCC immune evasion and highlights a “bidirectional regulation” intervention strategy grounded in the Traditional Chinese medicine (TCM) principle of “fortifying healthy qi and eliminating pathogens” (Fuzheng Quxie). This strategy employs “eliminating pathogens” (Quxie) approaches to exploit the metabolic vulnerability of M2-like TAMs and precisely induce their ferroptosis. Moreover, it utilizes “fortifying healthy qi” (Fuzheng) approaches to protect M1-like TAMs and CD8⁺ T cells from oxidative damage. This parallel “induction-protection” paradigm demonstrates the unique advantages of TCM in systemically remodeling TIME through multitarget synergistic actions. Accordingly, precision regulation of TAM ferroptosis based on the Fuzheng Quxie theory represents a promising integrative Chinese-Western medicine strategy for overcoming current bottlenecks in HCC immunotherapy, although its clinical translational potential warrants further validation.

Objective To evaluate the safety and efficacy of a self-developed micro-normothermic machine perfusion (NMP) system (micro-perfusion device) for preserving isolated porcine limbs. Methods Five healthy Landrace pigs were selected, and their left and right forelimbs were randomly divided into the NMP group and static cold storage (SCS) group. The NMP group was perfused with the self-developed micro-perfusion device and polymerized hemoglobin perfusate for 32 hours at normothermia, while the SCS group was preserved at 4 ℃. Hemodynamic parameters such as perfusion pressure and flow were monitored. The pH value, partial pressure of oxygen (PO₂), lactic acid (Lac), creatine kinase (CK) and lactate dehydrogenase (LDH) in the perfusate were measured. Hematoxylin-eosin staining was used to assess the muscle tissue structure, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling was employed to evaluate muscle cell apoptosis, and immunohistochemistry staining was applied to detect the expressions of tumor necrosis factor (TNF)-α and interleukin (IL)-6. A mixed-effects model was used to analyze the effects of time and treatment methods on tissue structure, cell apoptosis and inflammatory factors. Results The device could stably maintain a perfusion pressure of (69±15) mmHg and a flow rate of (117±42) mL/min. The pH value and electrolytes of the perfusate were generally stable, with PO₂ maintained at a high level. Lac was maintained at 5.38(3.81, 6.45) mmol/L, while CK and LDH increased over time. After 32 hours of perfusion in the NMP group, both the myocyte spacing and apoptosis rate were better than those in the SCS group. Mixed-effects model analysis showed that there were statistically significant differences in the effects of NMP treatment and SCS treatment on myocyte spacing and apoptosis rate per unit time (both P < 0.05). There were no statistically significant differences in TNF-α and IL-6 between the two groups, and mixed-effects model analysis showed no statistically significant differences in the effects of NMP treatment and SCS treatment on TNF-α and IL-6 per unit time (both P > 0.05). Conclusions The micro-perfusion device used in this study may achieve 32-hour normothermic preservation in a porcine limb amputation model, maintain basic metabolism and ionic homeostasis, reduce muscle structural damage and cell apoptosis without inducing additional inflammatory responses. This technology is expected to significantly extend the time window for replantation of amputated limbs in disaster rescue and long-distance transportation, providing an important technical basis for clinical translation and subsequent replantation research.

This article reports a case of a male patient with anti-N-methyl-D-aspartate receptor （NMDAR） encephalitis comorbid with early-onset Alzheimer's disease （AD）. The patient presented with depression， hallucinations and delusions syndrome， and cognitive impairment， and was admitted to a psychiatric hospital. Through multidisciplinary consultation， the diagnosis was confirmed based on positive biological and pathological biomarkers. The patient's symptoms improved after receiving a therapeutic regimen comprising high-dose glucocorticoid therapy and psychiatric-related treatments. Based on relevant current research findings domestically and internationally， this article reviews the pathogenesis and clinical manifestations of early-onset AD and anti-NMDAR encephalitis， in order to enhance the discrimination ability of psychiatric specialists for such patients and improve the diagnosis and treatment level. ［Funded by Medical Research Project of Chengdu City （number， 2024403）］

In analytical techniques such as ion mobility spectrometry(IMS)and mass spectrometry(MS),the ionization efficiency of target analytes is primarily constrained by the type of ionization source and factors such as the species and number density of the reactant ions.Systematic investigation into the reactivity differences of various reactant ions under varying conditions can not only significantly enhance the detection sensitivity of target compound product ions but also provide a theoretical foundation for establishing efficient detection methods based on ion-molecule reaction mechanisms.In this study,the pressure of a pressure-tunable photoionization tandem ion mobility spectrometry(PI-tandem-IMS)was reduced from ambient pressure(100 kPa)to low pressure(20 kPa)to systematically examine the reactivity differences between two negative reactant ions,CO3-and CO4-,and methyl salicylate(MeSA)under varying pressures.When the pressure decreased,the increased relative signal intensity of CO4-significantly influenced the detection sensitivity of the characteristic product ion[MeSA·O2]-.Based on differences in ion mobility(k0),the delay time for the opening of TPG2 was adjusted to selectively inject CO-3 and CO-4 in the drift region 2.Independent characterization of the reactivity of these reactant ions with MeSA in the reaction region confirmed that CO4-exhibited superior reactivity toward MeSA.The theoretical model revealed an Arrhenius plot for the ion-molecule reaction between CO4-and MeSA,showing a positive correlation between the reaction rate coefficient(k)and temperature,the activation energy Ea was 62.45 kJ/mol.Furthermore,controlling parameters such as pressure or temperature significantly influenced the progression of this ion-molecule reaction,demonstrating the technical advantages of PI-tandem-IMS in mechanistic studies and regulation of ion-molecule reactions.

The resolving power and sensitivity are critical for on-site detection of hazardous chemicals using stand-alone ion mobility spectrometry(IMS).However,improving the sensitivity and resolving power of IMS has long been a prominent research hot spot.In the commonly used IMS based on the Bradbury-Nielsen gate(BNG),the gating voltage difference(GVD)applied between the two sets of grid wires affects the electric field distribution in the ionization region and the drift region.This,in turn,influences the spatial distribution and temporal width of the injected ion swarm,and has an impact on the ion mobility discrimination,sensitivity,and resolving power of the instrument.This study showed that increasing the GVD could induce an ion converging effect,boosting the ion number density in front of the BNG by nearly 300％.To simultaneously utilize temporal compression and ion converging effects,a novel BNG controlling mode was proposed by adding a chopping state to the conventional controlling mode.This chopping state reduced the mobility discrimination effects between ions with mobility differences up to about 0.90 cm2/(V·s)to 1/22 of their original value.When analyzing hazardous chemical mixtures using the novel BNG controlling mode,compared with conventional mode,the signal intensity of low-mobility methyl salicylate ions(MS·O2)-increased by 18-fold while the resolving power maintained around 100,and the detection limit for MS was improved from 3.75 μg/L to 97 ng/L.This novel BNG controlling mode only added a potential wave to the low voltage wires,with no requirement of changing the structure of the drift tube,and was easy to apply to existing commercial instruments.

Background and aims:Despite growing evidence linking pretransplant exposure to immune checkpoint inhibitors(ICIs)to increased allograft rejection risk after liver transplantation(LT),a lack of comparative studies to definitively establish the correlation between ICI exposure and adverse short-term outcomes after LT exists.This study aimed to analyze the impact of preoperative ICI exposure on short-term post-LT prognosis and allograft rejection risk.Methods:This retrospective cohort study included 121 recipients who underwent LT for hepatocellular carcinoma(HCC)between June 2019 and March 2023.The recipients were categorized into ICI(n=35)and non-ICI(n=86)exposure groups based on pretransplant ICI exposure.Demographics,clinical characteristics,and short-term outcomes were compared between the cohorts.Kaplan-Meier analysis evaluated the impact of ICI exposure on graft survival.Univariate and multivariate logistic regression models assessed the impact of patient characteristics on allograft rejection.Results:Recipients with or without ICI exposure exhibited comparable demographic baseline charac-teristics.The incidences of early allograft dysfunction and biliary and vascular complications were similar between both groups.Post-transplant infection incidence was 37.1％and 20.9％in the ICI and non-ICI groups,respectively(P=0.064).Allograft rejection rates were significantly higher in the ICI group than in the non-ICI group(22.9％vs.5.8％,P=0.015).The ICI group exhibited a higher 90-day post-transplant mortality rate than that of the non-ICI group(14.3％vs.2.3％,P=0.034).Logistic regression analyses demonstrated that allograft rejection independently correlated with 90-day post-transplant mortality,with ICI exposure being an independent risk factor for allograft rejection.In recipients with ICI exposure,a shorter interval between ICIs and LT(washout period)was significantly associated with a higher allograft rejection risk,with the optimal washout period identified as 21 days for predicting 90-day rejection-free survival(P=0.0001).Moreover,in recipients with allograft rejection,the peripheral CD4+/CD8+T cell ratio was much lower in the ICI group than in the non-ICI group.Conclusions:Pretransplant ICI exposure was an independent risk factor for allograft rejection and was significantly associated with 90-day post-transplant mortality after LT for HCC.A ≤21-day washout period was significantly associated with allograft rejection.Future multicenter studies with larger cohorts and prospective designs are essential to validate these findings,confirm causality,and establish standardized clinical guidelines for ICI use before transplantation.Trail registration:ClinicalTrials.gov NCT05913583.

Depression is a common psychiatric disorder characterized by persistent low mood or mental disorders. Current treatments primarily focus on regulating neurotransmitter levels， but their effectiveness is limited. The mechanisms underlying its onset are complex， and there is no unified consensus. Abnormal signaling pathway transmission plays a crucial role in the development of depression， involving multiple pathways， including Toll-like receptor 4/nucleotide-binding oligomerization domain-like receptor protein 3 （TLR4/NLRP3）， nuclear factor-κB （NF-κB）， Janus kinase/signal transducer and activator of transcription （JAK/STAT）， mitogen-activated protein kinase/extracellular signal-regulated kinase （MAPK/ERK）， brain-derived neurotrophic factor/tyrosine kinase receptor B （BDNF/TrkB）， cyclic AMP/protein kinase A/cAMP response element-binding protein （cAMP/PKA/CREB）， and others. Traditional Chinese medicine（TCM） is based on a holistic approach and the principle of treatment based on the differentiation of syndromes， regulating the balance of multiple systems and organ functions from a macroscopic perspective. This approach has shown unique advantages in the treatment of depression. TCM attributes the onset of depression to dysfunction of the organ systems， involving liver Qi stagnation， heart spirit deficiency， kidney essence depletion， and spleen dysfunction. TCM compound treatments focus on soothing the liver， strengthening the spleen， calming the heart， and replenishing essence， with formulas such as Xiaoyaosan， Zishui Qinggan Yin， and Chahu Jia Guizhi Longgu Muli Tang. The active components of Chinese herbs mainly aim to tonify and regulate Qi， such as salidroside， ginsenoside Rb₁， astragaloside， and muscone. External TCM treatments， primarily acupuncture， aim to open the orifices and invigorate the spirit. Acupoints such as Baihui， Shenting， and Yintang are commonly used. Additionally， massage and moxibustion therapy can intervene in depression by regulating signaling pathways. This article reviews the core role of signaling pathways in the development of depression and the mechanism of TCM regulation of signaling pathways to intervene in depression， aiming to discover new therapeutic approaches that can improve the symptoms of depressed patients.

Acute-on-chronic liver failure (ACLF) is an acute deterioration of liver function occurring on the basis of chronic liver disease, accompanied by failure of the liver and extrahepatic organs, and is associated with a high short-term mortality rate. Liver transplantation is the only curative treatment for patients with ACLF. However, the shortage of donor livers and limitations of the organ allocation system mean that only a minority of patients can receive transplants. The current organ allocation system based on the model for end-stage liver disease (MELD) score may underestimate the urgency of liver transplantation for ACLF patients. Therefore, it is urgent to develop better assessment tools to determine which ACLF patients are most likely to benefit from liver transplantation. This article reviews the current mainstream definitions of ACLF, the selection of candidates for liver transplantation in ACLF, and the prognostic scoring systems for liver transplantation in ACLF, both domestically and internationally, in order to provide a reference for the prognostic assessment of liver transplantation in ACLF patients.