Hepatitis B virus (HBV)-specific CD8⁺ T cells play a central role in controlling HBV infection; however, their function is impaired during chronic HBV infection, manifesting as a state of dysfunction. Recent studies have revealed that CD8⁺ T cell dysfunction in chronic HBV infection differs from the classical exhaustion observed in other viral infections or tumors. In 2024, several pivotal studies further elucidated novel mechanisms underlying CD8⁺ T cell dysfunction in chronic HBV infection and identified new therapeutic targets, including 4-1BB and transforming growth factor-beta (TGF-β). This review, while elucidating the dysfunction of CD8⁺ T cells in chronic HBV infection and its underlying mechanisms, focuses on summarizing the key findings from these latest studies and explores their translational value and clinical significance.
Humans ; Hepatitis B, Chronic/virology* ; CD8-Positive T-Lymphocytes/immunology* ; Hepatitis B virus/physiology* ; Animals ; Transforming Growth Factor beta/immunology*

Traumatic brain injury (TBI) is intricately linked to the most severe clinical manifestations of brain damage. It encompasses dynamic pathological mechanisms, including hemodynamic disorders, excitotoxic injury, oxidative stress, mitochondrial dysfunction, inflammation, and neuronal death. This review provides a comprehensive analysis and summary of biomaterial-based tissue engineering scaffolds and nano-drug delivery systems. As an example of functionalized biomaterials, nano-drug delivery systems alter the pharmacokinetic properties of drugs. They provide multiple targeting strategies relying on factors such as morphology and scale, magnetic fields, pH, photosensitivity, and enzymes to facilitate the transport of therapeutics across the blood-brain barrier and to promote selective accumulation at the injury site. Furthermore, therapeutic agents can be incorporated into bioscaffolds to interact with the biochemical and biophysical environment of the brain. Bioscaffolds can mimic the extracellular matrix environment, regulate cellular interactions, and increase the effectiveness of local treatments following surgical interventions. Additionally, stem cell-based and exosome-dominated extracellular vesicle carriers exhibit high bioreactivity and low immunogenicity and can be used to design therapeutic agents with high bioactivity. This review also examines the utilization of endogenous bioactive materials in the treatment of TBI.

OBJECTIVE To evaluate the quality of Mongolian medicine Sendeng-4 based on qualitative and quantitative analysis combined with chemical pattern recognition， in order to provide the reference for its quality control. METHODS The chemical components in Sendeng-4 were analyzed qualitatively by HPLC-Q-Exactive-MS. The contents of 16 components （methyl gallate， ethyl gallate， epicatechin， dihydromyricetin， genipin-1-O-β-D-gentiobioside， caffeic acid， catechin， corilagin， deacetylasperulosidic acid methyl ester， rutin， geniposide， luteolin， myricetin， quercetin， ferulic acid， and toosendanin） in 15 batches of Sendeng-4 （sample S1-S15） were quantitatively analyzed by HPLC-MS/MS. Cluster analysis （CA）， principal component analysis （PCA）， and orthogonal partial least squares discriminant analysis were conducted and variable importance projection （VIP） value greater than 1 was used as the index to screen the differential components. RESULTS A total of 73 chemical components were identified in Sendeng-4， including 20 flavonoids， 16 tannins， 14 organic acids， etc. According to the quantitative analysis， the results exhibited that the average contentsthe of above 16 components in 15 batches of Sendeng-4 were 3.683-7.730， 2.391-6.952， 2 275.538-4 377.491， 2 699.188-3 537.924， 858.266-1 377.393， 3.366-11.003， 140.624-315.683，414.629-978.334， 285.501-1 510.457， 27.799-48.325， 3 625.415-6 309.563， 0.506-0.656， 442.337-649.283， 47.093-59.736， 12.942-15.822， 127.738-326.649 μg/g， respectively. According to the results of CA and PCA， 15 batches of samples could be clustered into two categories: S1-S3， S5-S6， S9-S10 and S13 were clustered into one category； S4， S7-S8， S11-S12， S14-S15 were clustered into one category. VIP values of geniposide， epicatechin， deacetylasperulosidic acid methyl ester and genipin-1-O- β-D-gentiobioside were all greater than 1. CONCLUSIONS HPLC-Q-Exactive-MS and HPLC-MS/MS techniques are employed for the qualitative and quantitative analysis of Sendeng-4. Through chemical pattern recognition analysis， four differential components are identified: geniposide， epicatechin， deacetylasperulosidic acid methyl ester， and genipin-1-O-β-D-gentiobioside.

Objective The aim of this study was to analyze the clinical features,ultrasonographic manifestations,and medication characteristics of shoulder joint involvement in patients with rheumatoid arthritis during the course of the disease,and to explore the impact of shoulder joint involvement on the overall condition of RA,to further provide a basis for clinical diagnosis and treatment.Methods One hundred and forty RA patients who were hospitalized in our department between August 2023 and August 2024 were selected,and they were divided into the RA involving shoulder joint group and the non-involving group according to whether they were combined with shoulder pain or shoulder arthritis manifestations.The clinical data of the two groups were analyzed and compared,including disease activ-ity,imaging characteristics and treatment modalities.Results The RA-involved shoulder group was significantly higher than the non-involved group in pain visual analog scores,swelling,number of tender joints,28 arthropathic activity scores-erythrocyte sedimentation rate and C reactive protein scores,and the differences were statistically significant(P＜0.001).The two groups had significant differ-ences in blood tests,inflammation indexes,Rheumatoid factor and anti-CCP antibody and other laboratory tests were significantly differ-ent in the morning(P＞0.05),suggesting that shoulder joint involvement may not be readily recognized by routine laboratory tests.The ultrasonographic performance of RA involving the shoulder joint was classified into bilateral and unilateral lesions,in which the unilateral lesions were mostly acromioclavicular joint synovitis,and the bilateral lesions were predominantly humeral head bone erosions.Inflamma-tory changes of synovitis were predominantly in the acromioclavicular joint,while structural changes were focused on bone erosion of the humeral head.In patients with structural changes,the erythrocyte sedimentation rate and C-reactive protein level were higher than those of the group with inflammatory changes,and the difference was statistically significant(P＜0.05),while the difference between the rheu-matoid factor and the anti-CCP antibody was not statistically significant(P＞0.05).The proportion of patients with RA involving the shoulder joint using traditional synthetic antirheumatic drugs(csDMARDs)in combination with biologics(bDMARDs)or targeted syn-thetic antirheumatic drugs(tsDMARDs)was significantly higher,especially the proportion of csDMARDs in combination with bDMARDs was the most prominent.Conclusion Patients with RA who have shoulder involvement during the course of the disease usually present with worsening systemic symptoms,high disease activity,and ultrasonographic findings of synovitis and bone erosion in the shoulder joint.However,conventional laboratory tests and imaging methods lack specificity in the diagnosis of shoulder joint involvement,and therefore,clinical attention should be paid to shoulder joint involvement in RA to prevent disease progression from adversely affecting the overall prognosis.

Objective To investigate the feasibility and efficacy of robot-assisted Wallace ileal conduit in the treatment of ureteral obstruction following radical cystectomy.Methods A retrospective analysis was conducted on the clinical data of 8 patients with postoperative distal ureteral obstruction after radical cystectomy treated at the First Affiliated Hospital of Nanjing Medical University during Aug.2018 and Jun.2024.The cohort included 7 males and 1 female,aged 51-68 years(mean:58.8 years).Preoperative imaging confirmed the obstruction site and predicted its etiology.All patients underwent robot-assisted Wallace ileal conduit and were regularly followed postoperatively.Perioperative data were statistically analyzed.Results All 8 procedures were successfully completed.The operation time ranged from 120 to 398 minutes(mean:298.38 minutes),and intraoperative blood loss from 50 to 300 mL(mean:112.5 mL).Postoperative complications occurred in 3 cases according to the Clavien-Dindo classification:one Grade Ⅰ and two Grade Ⅱ,with no major postoperative complications(Grade Ⅲ and above)observed.During a follow-up of 21-77 months,hydronephrosis and renal function showed varying degrees of improvement.Conclusion Robot-assisted Wallace ileal conduit is safe,feasible,and effective in the treatment of ureteral obstruction following radical cystectomy.However,for malignant obstruction caused by tumor recurrence,combined comprehensive therapy is necessary to reduce recurrence risk.

Objective To investigate the feasibility and efficacy of robot-assisted Wallace ileal conduit in the treatment of ureteral obstruction following radical cystectomy.Methods A retrospective analysis was conducted on the clinical data of 8 patients with postoperative distal ureteral obstruction after radical cystectomy treated at the First Affiliated Hospital of Nanjing Medical University during Aug.2018 and Jun.2024.The cohort included 7 males and 1 female,aged 51-68 years(mean:58.8 years).Preoperative imaging confirmed the obstruction site and predicted its etiology.All patients underwent robot-assisted Wallace ileal conduit and were regularly followed postoperatively.Perioperative data were statistically analyzed.Results All 8 procedures were successfully completed.The operation time ranged from 120 to 398 minutes(mean:298.38 minutes),and intraoperative blood loss from 50 to 300 mL(mean:112.5 mL).Postoperative complications occurred in 3 cases according to the Clavien-Dindo classification:one Grade Ⅰ and two Grade Ⅱ,with no major postoperative complications(Grade Ⅲ and above)observed.During a follow-up of 21-77 months,hydronephrosis and renal function showed varying degrees of improvement.Conclusion Robot-assisted Wallace ileal conduit is safe,feasible,and effective in the treatment of ureteral obstruction following radical cystectomy.However,for malignant obstruction caused by tumor recurrence,combined comprehensive therapy is necessary to reduce recurrence risk.

OBJECTIVE To comprehensively evaluate the quality of Sanzi powder from different batches based on 12 components quantitative analysis combined with chemical pattern recognition and entropy weight-TOPSIS method.METHODS The contents of 12 components in 15 batches of Sanzi powder(No.S1-S15)were determined by HPLC-MS/MS,such as ethyl gallate,gallic acid,ferulic acid,corilagin,genipin-1-O-β-D-gentiobioside,toosendanin,geniposide,caffeic acid,methyl deacetylated coumarinate,tannic acid,rutin,quercetin.Cluster analysis(CA),principal component analysis(PCA),and orthogonal partial least squares-discriminant analysis(OPLS-DA)were conducted on the assay results.Using variable importance projection(VIP)value＞1 and P＜0.05 as the evaluation criteria,the quality differential markers in Sanzi powder were screened.The entropy weight method was used to calculate the weight value,and TOPSIS method was used to rank the quality of 15 batches of Sanzi powder from superior to inferior.RESULTS The contents of the 12 components were 13.494-24.292,2 069.608-3 188.100,1.410-3.616,1 065.030-2 630.584,1 404.704-1 838.078,101.640-354.268,9 193.720-14 777.854,1.240-5.060,148.028-5 541.990,4 261.422-5 607.438,107.560-195.512,2.226-4.192 μg/g,respectively.The results of CA,PCA and OPLS-DA indicated that 15 batches of Sanzi powder could be clustered into two groups.Specifically,batches S3,S7,S10 and S15 were grouped into one category,and remaining batches were grouped into one category.VIP values of geniposide,quercetin,caffeic acid,and methyl deacetylated coumarinate were all greater than 1,with corresponding P-values less than 0.05.The results of the entropy weight-TOPSIS analysis revealed that methyl deacetylate exhibited the smallest information entropy and the highest weight.The relative closeness degrees of samples S3,S7,S10 and S15 ranged from 0.789 to 0.973,while the remaining samples ranged from 0.054 to 0.172.CONCLUSIONS The contents of 12 components in Sanzi powder could be determined accurately by using HPLC-MS/MS technology.Methyl deacetylated coumarinate,geniposide,quercetin and caffeic acid were identified as the quality differential markers.It was found that the overall quality of samples S3,S7,S10 and S15 were superior to that of other batches.Notably,the quality of Gardeniae Fructus decoction pieces emerges as a critical factor in ensuring the consistency of the preparation's quality.

Objective The aim of this study was to analyze the clinical features,ultrasonographic manifestations,and medication characteristics of shoulder joint involvement in patients with rheumatoid arthritis during the course of the disease,and to explore the impact of shoulder joint involvement on the overall condition of RA,to further provide a basis for clinical diagnosis and treatment.Methods One hundred and forty RA patients who were hospitalized in our department between August 2023 and August 2024 were selected,and they were divided into the RA involving shoulder joint group and the non-involving group according to whether they were combined with shoulder pain or shoulder arthritis manifestations.The clinical data of the two groups were analyzed and compared,including disease activ-ity,imaging characteristics and treatment modalities.Results The RA-involved shoulder group was significantly higher than the non-involved group in pain visual analog scores,swelling,number of tender joints,28 arthropathic activity scores-erythrocyte sedimentation rate and C reactive protein scores,and the differences were statistically significant(P＜0.001).The two groups had significant differ-ences in blood tests,inflammation indexes,Rheumatoid factor and anti-CCP antibody and other laboratory tests were significantly differ-ent in the morning(P＞0.05),suggesting that shoulder joint involvement may not be readily recognized by routine laboratory tests.The ultrasonographic performance of RA involving the shoulder joint was classified into bilateral and unilateral lesions,in which the unilateral lesions were mostly acromioclavicular joint synovitis,and the bilateral lesions were predominantly humeral head bone erosions.Inflamma-tory changes of synovitis were predominantly in the acromioclavicular joint,while structural changes were focused on bone erosion of the humeral head.In patients with structural changes,the erythrocyte sedimentation rate and C-reactive protein level were higher than those of the group with inflammatory changes,and the difference was statistically significant(P＜0.05),while the difference between the rheu-matoid factor and the anti-CCP antibody was not statistically significant(P＞0.05).The proportion of patients with RA involving the shoulder joint using traditional synthetic antirheumatic drugs(csDMARDs)in combination with biologics(bDMARDs)or targeted syn-thetic antirheumatic drugs(tsDMARDs)was significantly higher,especially the proportion of csDMARDs in combination with bDMARDs was the most prominent.Conclusion Patients with RA who have shoulder involvement during the course of the disease usually present with worsening systemic symptoms,high disease activity,and ultrasonographic findings of synovitis and bone erosion in the shoulder joint.However,conventional laboratory tests and imaging methods lack specificity in the diagnosis of shoulder joint involvement,and therefore,clinical attention should be paid to shoulder joint involvement in RA to prevent disease progression from adversely affecting the overall prognosis.

OBJECTIVE To establish fingerprint,chemical pattern recognition and multi-component quantification analysis of Sanzi powder,and evaluate its quality.METHODS HPLC method was adopted.The fingerprints of 15 batches of Sanzi powder were established by using the Similarity Evaluation System for Chromatographic Fingerprint of Traditional Chinese Medicine(2012 edition).Cluster analysis,principal component analysis and orthogonal partial least squares-discriminant analysis were also conducted.The variable importance in projection(VIP)value greater than 1 was used as the index to screen the differential markers,and the contents of the differential markers were determined by the same HPLC method.RESULTS A total of 21 common peaks in the HPLC fingerprints of 15 batches of Sanzi powder were calibrated,and the similarities of them were 0.994-0.999;6 common peaks were identified,including gallic acid(peak 3),garminoside(peak 10),corilagin(peak 11),chebulinic acid(peak 16),ellagic acid(peak 18),crocin Ⅰ(peak 19).According to the results of cluster analysis,principal component analysis and orthogonal partial least squares-discriminant analysis,15 batches of samples could be clustered into two categories:S1,S5,S7,S9,S14 were clustered into one category;S2-S4,S6,S8,S10-S13,S15 were clustered into one category.VIP values of 11 differential components such as corilagin,chebulinic acid and ellagic acid were higher than 1.Among 15 batches of samples,the contents of corilagin,chebulinic acid and ellagic acid ranged 2.667-5.152,9.506-13.522,0.891-1.811 mg/g.CONCLUSIONS Established HPLC fingerprint and multi-component quantification analysis of Sanzi powder are rapid and simple,and can be used for quality evaluation of Sanzi powder by combining with chemical pattern recognition.Eleven components such as corilagin,chebulinic acid and ellagic acid are differential markers affecting the quality of Sanzi powder.

Objective:To discuss the feasibility and safety of robot-assisted laparoscopic retroperitoneal tumor resection in prone position.Methods:From August 2023 to January 2024, a total of eight patients with retroperitoneal tumors from the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed, including two males and six females. The average age was (47.4±12.5) years, average BMI was (24.4±3.5) kg/m 2 and median ASA grade was 2(2, 3). Retroperitoneal tumors were identified preoperatively through CT or MRI. The imaging revealed 4 cases of adrenal tumors located on the left side, 2 on the right side, and 2 non-adrenal tumors situated on the left side. The preoperative diagnoses included 2 cases of non-functional adrenal tumors, 2 cases of pheochromocytoma, 1 case of Cushing’s syndrome, 1 case of metastatic renal cell carcinoma, and 2 cases of non-adrenal tumors. Robot-assisted laparoscopic retroperitoneal tumor resection was performed with all patients in prone position. The inferior margin of the fourth lumbar vertebra (L4) was determined by the line connecting the highest points of the iliac crests bilaterally. Subsequently, the inferior margins of the L1-L3 vertebrae were sequentially identified. The surgical field was then divided into three equal segments, utilizing the posterior midline of the spine and the midaxillary line as boundaries. The medial division was situated approximately at the lateral border of the vertical spinal muscles, while the lateral division was placed near the tip of the 12th rib. A longitudinal incision of approximately 3 cm in length was created within the lateral division between L2 and L3 for the insertion of a camera trocar. The extraperitoneal space was subsequently dilated using a self-made balloon, and two 8 mm trocars were placed as operative ports along the medial division and the midaxillary line, respectively, under finger guidance. Assistance trocars, one or two 12 mm in diameter, were introduced above the level of the iliac crest. During the operation, the extraperitoneal adipose tissue was removed and the Gerota's fascia was opened. For non-adrenal retroperitoneal tumours, the major blood vessels around the tumour were suspended and fixed, by titanium clips or Hem-o-lok clips to dissect the small arteries and veins, and the tumour was carefully isolated and completely resected. For adrenal tumours, the fat capsule around the upper pole of the kidney were removed, the adrenal gland was exposed, and then the tumour was removed completely along its capsule. If total adrenalectomy is performed, the central adrenal vein was clamped and dissected. The periphery of the adrenal gland was gradually dissected until the adrenal gland was completely removed.The perioperative data, including patient positioning time, trocar placement time, operation time, intraoperative blood loss, postoperative complications, postoperative hospital stay, and postoperative drainage tube removal time, as well as recurrence and metastasis, were recorded.Two patients underwent partial nephrectomy due to renal tumor, and only the time for retroperitoneal tumor resection was included in calculating operation time. Results:All 8 surgeries were successfully completed without dramatic blood pressure fluctuations.There was no conversion to open surgery or abdominal organ injury. The patient positioning time was (5.1±0.4) minutes, trocar placement time was (16.6±1.3) minutes, operation time was (28.8±13.8) minutes, intraoperative blood loss was (65.0±28.7) ml, postoperative hospital stay was (3.6±0.9) days, and drainage tube removal time was (2.8±1.0) days. No intraoperative or postoperative blood transfusions were required. Postoperatively diagnosed pathologies included: 2 cases of adrenal pheochromocytoma, 2 cases of adrenal sebaceous adenoma, 2 cases of retroperitoneal schwannoma, 1 case of adrenal myelolipoma, and 1 case of adrenal metastatic renal cell carcinoma. The average tumor size for all patients was (4.3±1.5) cm. After a follow-up of 2.0-7.2 months, there were no recorded postoperative complications, including haemorrhage, infections, acute hypotension, or adrenocortical insufficiency. Additionally, no evidence of tumor recurrence or metastasis was observed up during foolow-up.Conclusions:Robot-assisted laparoscopic retroperitoneal tumor resection in prone position could be a safe and feasible surgical approach with short operative time, low bleeding, and fast postoperative recovery.