Sonodynamic therapy (SDT) can potentially induce immunogenic cell death in tumor cells, leading to the release of ATP, and facilitating the initiation of an immune response. Nevertheless, the enzymes CD39 and CD73 can swiftly convert ATP into immunosuppressive adenosine (ADO), resulting in an immunosuppressive tumor microenvironment (TME). This study introduced a nanomedicine (QD/POM1@NP@M) engineered to reprogram TME by modulating the CD39/CD73/ADO pathway. The nanomedicine encapsulated sonosensitizers silver sulfide quantum dots, and the CD39 inhibitor POM1, while also incorporating homologous tumor cell membranes to enhance targeting capabilities. This integrated approach, on the one hand, stimulates the release of ATP via SDT, thereby initiating the immune response. In addition, it reduced the accumulation of ADO by inhibiting CD39 activity, which ameliorated the immunosuppressive TME. Upon administration, the nanomedicine demonstrated substantial anti-tumor efficacy by facilitating the infiltration of anti-tumor immune cells, while reducing the immunosuppressive cells. This modulation effectively transformed the TME from an immunologically "cold" state to a "hot" state. Furthermore, combined with the checkpoint inhibitor α-PDL1, the nanomedicine augmented systemic anti-tumor immunity and promoted the establishment of long-term immune memory. This study provides an innovative strategy for combining non-invasive SDT and ATP-driven immunotherapy, offering new ideas for future cancer treatment.

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Objective To systematically evaluate the risk factors for postoperative delirium after surgery for Stanford type A aortic dissection. Methods We searched the CNKI, SinoMed, Wanfang data, VIP, PubMed, Web of Science, EMbase, The Cochrane Library database from inception to September 2022. Case-control studies, and cohort studies on risk factors for postoperative delirium after surgery for Stanford type A aortic dissection were collected to identify studies about the risk factors for postoperative delirium after surgery for Stanford type A aortic dissection. Quality of the included studies was evaluated by the Newcastle-Ottawa scale (NOS). The meta-analysis was performed by RevMan 5.3 software and Stata 15.0 software. Results A total of 21 studies were included involving 3385 patients. The NOS score was 7-8 points. The results of meta-analysis showed that age (MD=2.58, 95%CI 1.44 to 3.72, P＜0.000 01), male (OR=1.33, 95%CI 1.12 to 1.59, P=0.001), drinking history (OR=1.45, 95%CI 1.04 to 2.04, P=0.03), diabetes history (OR=1.44, 95%CI 1.12 to 1.85, P=0.005), preoperative leukocytes (MD=1.17, 95%CI 0.57 to 1.77), P=0.000 1), operation time (MD=21.82, 95%CI 5.84 to 37.80, P=0.007), deep hypothermic circulatory arrest (DHCA) time (MD=3.02, 95%CI 1.04 to 5.01, P=0.003), aortic occlusion time (MD=8.94, 95%CI 2.91 to 14.97, P=0.004), cardiopulmonary bypass time (MD=13.92, 95%CI 5.92 to 21.91, P=0.0006), ICU stay (MD=2.77, 95%CI 1.55 to 3.99, P＜0.000 01), hospital stay (MD=3.46, 95%CI 2.03 to 4.89, P＜0.0001), APACHEⅡ score (MD=2.76, 95%CI 1.59 to 3.93, P＜0.000 01), ventilation support time (MD=6.10, 95%CI 3.48 to 8.72, P＜0.000 01), hypoxemia (OR=2.32, 95%CI 1.40 to 3.82, P=0.001), the minimum postoperative oxygenation index (MD=−79.52, 95%CI −125.80 to −33.24, P=0.000 8), blood oxygen saturation (MD=−3.50, 95%CI −4.49 to −2.51, P＜0.000 01), postoperative hemoglobin (MD=−6.35, 95%CI −9.21 to −3.50, P＜0.000 1), postoperative blood lactate (MD=0.45, 95%CI 0.15 to 0.75, P=0.004), postoperative electrolyte abnormalities (OR=5.94, 95%CI 3.50 to 10.09, P＜0.000 01), acute kidney injury (OR=1.92, 95%CI 1.34 to 2.75, P=0.000 4) and postoperative body temperature (MD=0.79, 95%CI 0.69 to 0.88, P＜0.000 01) were associated with postoperative delirium after surgery for Stanford type A aortic dissection. Conclusion The current evidence shows that age, male, drinking history, diabetes history, operation time, DHCA time, aortic occlusion time, cardiopulmonary bypass time, ICU stay, hospital stay, APACHEⅡ score, ventilation support time, hypoxemia and postoperative body temperature are risk factors for the postoperative delirium after surgery for Stanford type A aortic dissection. Oxygenation index, oxygen saturation, and hemoglobin number are protective factors for delirium after Stanford type A aortic dissection.

Objective To investigate the influencing factors of nosocomial pneumonia in elderly pa-tients with CHD and HF.Methods A total of 196 elderly CHD patients with HF diagnosed and treated in our department from March 2021 to August 2023 were enrolled,and divided into infec-ted group(n=52)and non-infected group(n=144)based on whether pulmonary infection oc-curred during hospitalization.Logistic regression analysis was used to identify the risk factors af-fecting secondary nosocomial pulmonary infection.Based on these risk factors,a comprehensive in-dex was built.ROC curve was drawn to analyze the diagnostic value of the index for secondary nosocomial pulmonary infection.Results The infected group had significantly advanced age,lar-ger proportions of NYHA grade Ⅲ to Ⅳ,smoking history,diabetes history,mechanical ventila-tion time＞48 h,length of hospital stay＞14 d,and albumin at admission＜30 g/L,and higher RDW at admission when compared with the non-infected group(P＜0.05,P＜0.01).Logistic regression analysis showed that NYHA grade Ⅲ to Ⅳ,diabetes history,mechanical ventilation time＞48 h,length of hospitalization＞14 d,albumin＜30 g/L at admission and RDW at admis-sion were risk factors for secondary nosocomial pulmonary infection in elderly CHD patients with HF(OR=2.398,95％CI:1.157-4.969;OR=2.732,95％CI:1.278-5.839;OR=2.607,95％CI:1.138-5.973;OR=3.368,95％CI:1.567-7.242;OR=2.677,95％CI:1.218-5.886;OR=1.762,95％CI:1.488-61.222).ROC curve analysis indicated that the AUC value of NYHA grade Ⅲ to Ⅳ,diabetes history,mechanical ventilation time＞48 h,length of hospitalization＞14 d,albumin＜30 g/L at admission and RDW at admission in predicting secondary nosocomial pulmonary infec-tion in elderly CHD patients with HF was 0.598,0.620,0.586,0.595,0.615 and 0.850,respectively,and the value of the comprehensive index was 0.743,which is superior to that of above single indi-cator(P＜0.05).Conclusion Age,NYHA grade,smoking history,diabetes history,mechanical ventilation time,hospital stay and albumin and RDW levels at admission have adverse effects on secondary nosocomial pulmonary infection in elderly CHD patients with HF.Our built compre-hensive index based on these risk factors has high efficacy in predicting nosocomial pulmonary in-fection.

Objective:To compare the short-term efficacy of hip arthroscopic surgery assisted by platelet-rich plasma (PRP) and hip arthroscopy alone in the treatment of femoroacetabular impingement (FAI).Methods:A retrospective cohort study was performed on the clinical data of 133 FAI patients admitted to Fourth Medical Center of PLA General Hospital from January 2019 to January 2021. The patients included 86 males and 47 females, aged 19-71 years [(39.1±12.6)years]. A total of 67 patients were treated with hip arthroscopy alone (hip arthroscopy group), and 66 patients were treated with PRP after hip arthroscopy under ultrasound guidance (hip arthroscopy+PRP group). The two groups were compared before, at 12 months after surgery and at the last follow-up regarding the following items: Visual Analogue Scale (VAS), Modified Harris Hip Score, International Hip Outcome Tool-12 (iHOT-12), and Hip Outcome Score Activities of Daily Living Scale (HOS-ADL). The incidence rate of complications after surgery was compared between the two groups.Results:A total of 108 patients were followed up for 24-36 months [(28.5±3.8)months], while 25 patients were lost to follow-up because of withdrawal of consent, wrong telephone number, etc, including 11 patients (16.4%) in the hip arthroscopy group and 14 patients (21.2%) in the hip arthroscopy+PRP group. The values of VAS in the hip arthroscopy group before, at 12 months after surgery and at the last follow-up were 5.00(5.00, 7.00)points, 3.00(2.00, 3.75)points, and 1.00(0.00, 2.00)points, respectively; the values of Modified Harris Hip Score were 49.00(39.00, 57.00)points, 76.00(69.25, 82.00)points, and 86.00(82.00, 88.00)points, respectively; the values of iHOT-12 were 0.45(0.28, 0.58)points, 0.69(0.58, 0.80)points, and 0.81(0.70, 0.92)points, respectively; the values of HOS-ADL were 0.52(0.42, 0.68)points, 0.87(0.75, 0.93)points, and 0.93(0.86, 0.99)points, respectively. The scores of VAS in the hip arthroscopy + PRP group before, at 12 months after surgery and at the last follow-up were 6.00(5.00, 7.00)points, 3.00(2.00, 3.75)points, and 1.00(0.00, 2.00)points, respectively; the values of Modified Harris Hip Score were 46.50(37.00, 56.75)points, 78.00(72.00, 84.00)points, and 84.50(82.00, 88.00)points, respectively; the values of iHOT-12 were 0.42(0.26, 0.51)points, 0.66(0.58, 0.74)points, and 0.81(0.68, 0.88)points, respectively; the values of HOS-ADL were 0.54(0.38, 0.65)points, 0.87(0.72, 0.96)points, and 0.94(0.86, 1.00)points, respectively. In both groups, VAS, Modified Harris Hip Score, iHOT-12, and HOS-ADL were significantly improved at 12 months after surgery and at the last follow-up compared with those before surgery, and were further improved at the last follow-up compared with those at 12 months after surgery (all P<0.01). There were no significant differences in VAS, Modified Harris Hip Score, iHOT-12 and HOS-ADL between the two groups before, at 12 months after surgery and at the last follow-up (all P>0.05). There was no significant difference in the incidence rates of postoperative hip pain and clicking between the two groups (both P>0.05). Conclusion:Hip arthroscopy can considerably improve short-term hip symptoms and function in FAI patients, but the use of PRP treatment after hip arthroscopy cannot further improve its short-term efficacy in FAI patients.

OBJECTIVE To determine the protein binding rates of main effective components in Houpu paiqi mixture as magnolol and honokiol in animal plasma of different species， and compare the differences among species. METHODS The plasma of bovine， rabbit and rat （internal dialysate） was placed in 4.5， 9.0 and 13.5 μg/mL （according to the weight of the decoction pieces of Houpu paiqi mixture） dialysate containing drug for 24 h by equilibrium dialysate method. The concentrations of magnolol and honokiol in dialysis internal and external fluids were determined by ultra-performance liquid chromatography-tandem triple quadrupole mass spectrometry， and the plasma protein binding rates were calculated and compared. RESULTS At the concentrations of 4.5， 9.0 and 13.5 μg/mL， the protein binding rates of magnolol were （68.13±4.52）%， （74.34±1.12）% and （86.22±0.50）% in bovine plasma， （59.55±4.62） %， （72.81±4.56）% and （86.40±1.91）% in rabbit plasma， and （56.63± 2.87）%， （77.81±1.83）% and （83.18±0.65）% in rat plasma， respectively. The protein binding rates of honokiol were （34.82± 1.67）%， （40.29±3.28）% and （63.57±0.59）% in bovine plasma， （34.25±5.62）%， （62.12±7.36）% and （80.86±4.01）% in rabbit plasma， and （37.06±3.28）% ， （52.61±1.69）% and （79.83±7.38）% in rat plasma， respectively. There was generally statistical significance among those groups （P＜0.05 or P＜0.01）. CONCLUSIONS There are significant species differences in plasma protein binding rates of magnolol and honokiol， the main effective components of Houpu paiqi mixture， in a certain concentration-dependent trend.

Drug delivery with customized combinations of drugs, controllable drug dosage, and on-demand release kinetics is critical for personalized medicine. In this study, inspired by successive opening of layered structures and compartmentalized structures in plants, we designed a multiple compartmentalized capsular structure for controlled drug delivery. The structure was designed as a series of compartments, defined by the gradient thickness of their external walls and internal divisions. Based on the careful choice and optimization of bioinks composed of gelatin, starch, and alginate, the capsular structures were successfully manufactured by fused deposition modeling three-dimensional (3D) printing. The capsules showed fusion and firm contact between printed layers, forming complete structures without significant defects on the external walls and internal joints. Internal cavities with different volumes were achieved for different drug loading as designed. In vitro swelling demonstrated a successive dissolving and opening of external walls of different capsule compartments, allowing successive drug pulses from the capsules, resulting in the sustained release for about 410 min. The drug release was significantly prolonged compared to a single burst release from a traditional capsular design. The bioinspired design and manufacture of multiple compartmentalized capsules enable customized drug release in a controllable fashion with combinations of different drugs, drug doses, and release kinetics, and have potential for use in personalized medicine.

Objective:To explore the clinical application and long-term safety of hydroxychloroquine sulfate (HCQ) in the treatment of rheumatic diseases.Methods:A multi-center cross-sectional study was conducted between August 2017 and August 2018 in a random sample of eleven medical institutions of rheumatology and immunology in China. Patients who took HCQ for more than 3 months were enrolled into this study. The cumulative dose and long-term side effects of HCQ were recorded. The changes of laboratory indexes before and after treatment with HCQ were analyzed. Categorical variables were presented with counts and proportions, and evaluated by Chi-square test. Continuous parametric data were presented as Mean±standard deviation, and evaluated by Student's t test or Mann-Whitney U test. P-values less than 0.05 were considered statistically significant. Results:A total of 886 patients with rheumatic diseases were enrolled into this study, including 505 cases with systemic lupus erythematosus (57.0%), 210 cases with rheumatoid arthritis (23.7%), 80 cases with Sj?gren's syndrome (9.0%), 57 cases with undifferentiated connective tissue disease (6.4%), 12 cases of systemic vasculitis (1.4%), 10 cases of mixed connective tissue disease (1.1%), 7 cases of myositis (0.8%) and 5 cases with systemic sclerosis (0.6%). The most common long-term side effects of HCQ was skin or mucous lesions (12.4%) and vision problems (8.0%). Other adverse reactions included problems of digestive system (3.0%), nervous system (2.1%), musculoskeletal system (1.1%) and cardiovascular system (0.9%). 140 cases (15.8%) had stopped taking HCQ during the treatment. More than half of them decided to stop taking medicine by themselves. Fifty-four patients (6.1%) stopped using HCQ due to side effects while 24 of them took it again, and another 12 patients (1.4%) stopped the drug due to remission of illness. Patients were divided into three groups according to the cumulative dose of HCQ: less than 500 g, 500-1 000 g and more than 1 000 g respectively. There was significant difference in the incidence of long-term side effects among the three groups ( χ2=6.382, P=0.041). The last group (more than 1 000 g) suffered the highest incidence of long-term adverse reactions (37.1%). No severe adverse drug reactions were observed in this study. Conclusion:Hydroxychloroquine is widely used in the treatment of rheumatic diseases. The incidence of long-term side effects is 20.4%, is 6.1% lead to drug withdrawal, which are especially related to the cumulative doses. It should be adjusted properly according to the clinical application.

The incidence of immune-related pneumonia caused by programmed death-1/programmed death ligand-1 inhibitors is low, but the risk is high. Patients with non-small cell lung cancer who have pre-existing lung diseases or have received chest radiotherapy are more likely to develop pneumonia, but their clinical symptoms are not typical, which reduces the survival benefit of patients. Delaying immunotherapy early and rationally using glucocorticoids and immunosuppressants can relieve clinical symptoms and improve prognosis.

Objective To investigate the incidence and surgical fixation-related factors of posterior malleolus fracture in the treatment of ankle fractures.Methods A retrospective study was conducted of the 703 inpatients with ankle fracture at Department of Foot and Ankle Surgery,Beijing Jishuitan Hospital from June 1,2017 to May 31,2018.Of them,464 suffered posterior malleolus fracture.The incidence and surgical fixation rate of posterior malleolar fracture were calculated.Of the patients with posterior malleolus fracture,the gender,age,injury energy,Lauge-Hanse classification,Bartonícek classification,talar backward subluxation,fragment area ratio (FAR) of posterior malleolus fracture on X-ray film and CT cross section,fragmental dislocation,and Die-punch fragment were analyzed to screen out the risk factors related to surgical internal fixation for posterior malleolus fracture.Results In this study,the incidence of posterior malleolus fracture was 66.00％ (464/703) and the surgical fixation rate 43.97％ (204/464).The gender,age,injury energy,Lauge-Hanse classification,direction of talar subluxation and displacement of Die-punch fragments were not the risk factors related to the surgical internal fixation for posterior malleolus fracture (P ＞ 0.05) while the Bartonícek classification,talar backward subluxation,FAR of posterior malleolus fracture on X-ray film and CT cross section,lateral fragmental displacement and Die-punch fragment were the risk factors related to the surgical internal fixation for posterior malleolus fracture (P ＜ 0.05).Logistic regression analysis indicated that the talar backward subluxation (OR =5.580,95％ CI:1.623 ～ 19.181,P =0.006) and the FAR ≥ 15％ on CT cross section (OR =9.103,95％ CI:3.342 ～ 24.800,P =0.000) were independent risk factors for surgical internal fixation of posterior malleolus fracture.Conclusions The incidence and surgical fixation rate of posterior malleolar fracture are very high.The talar backward subluxation and the fragment area ratio ≥ 15％ on CT cross-section are independent risk factors for surgical internal fixation of posterior malleolus fracture.