Renal fibrosis is the common pathological endpoint of many forms of chronic kidney disease (CKD), yet the mechanisms determining effective repair versus persistent fibrotic remodeling remain incompletely understood. Peritubular capillaries (PTCs) are not merely passive targets of fibrotic injury, but form a dynamic vascular microenvironment linking regional perfusion, oxygen delivery, tubular metabolism, endothelial barrier integrity, pericyte support, immune-cell trafficking, and extracellular matrix (ECM) remodeling. We propose that PTC abnormalities should not be interpreted simply as reduced capillary density, but as a multidimensional disturbance of microvascular structure and function. Structural vascular preservation does not necessarily indicate effective microcirculation: anatomically detectable capillaries may still exhibit impaired perfusion, barrier dysfunction, abnormal endothelial-pericyte interactions, disturbed oxygen metabolism, or reduced network connectivity. Conversely, increased angiogenesis does not necessarily signify successful vascular repair if vessels remain immature, poorly perfused, or inadequately integrated into the existing network. To organize these abnormalities, we conceptualize PTC remodeling into four predominant but nonexclusive states: endothelial barrier disruption with inflammatory adhesion; endothelial-pericyte uncoupling with no-reflow; dysregulated angiogenesis with network simplification; and capillary rarefaction with fibrotic matrix locking. These states are not sequential stages of CKD. They may coexist within the same kidney, overlap within the same anatomical region, and vary with disease etiology, injury phase, vascular compartment, and treatment exposure. We further propose six dimensions for evaluating PTC status—structural presence, functional perfusion, barrier integrity, pericyte coupling, oxygen metabolism, and network connectivity—so that vascular quantity, function, and reparative capacity are assessed separately rather than inferred from a single endothelial marker or capillary-density measurement. Mechanistically, these states converge on a bidirectional microvascular-fibrotic feedback loop. Barrier disruption facilitates leukocyte recruitment and alters vascular paracrine signaling. Endothelial-pericyte uncoupling compromises capillary stability, whereas abnormal pericyte contraction may increase local vascular resistance and contribute to no-reflow before overt capillary loss. Dysregulated angiogenesis may generate vessels that fail to mature or connect to an effective perfusion network. Progressive capillary rarefaction compromises oxygen delivery, while sustained tubular transport demand and mitochondrial dysfunction may aggravate regional oxygen supply-demand mismatch. Injured tubules, immune cells, endothelial cells, pericytes, and fibroblasts communicate through soluble mediators, extracellular vesicles, direct cell contact, and cell-matrix signaling. Importantly, fibrosis is not merely a downstream consequence of microvascular injury. Altered ECM may increase diffusion distance, modify mechanotransduction, impair endothelial survival and migration, and restrict capillary reopening and regeneration. We use the term matrix locking to describe this sustained constraint on vascular repair, while emphasizing that current evidence does not establish irreversible disease in humans. This framework also has therapeutic implications. PTC-directed treatment should not be reduced to increasing vessel number or uniformly promoting angiogenesis. Instead, intervention should be matched to the dominant and potentially reversible abnormality: preserving endothelial barrier function; restoring endothelial-pericyte stability and reducing pathological microvascular resistance; normalizing angiogenesis so that vascular growth is accompanied by maturation, barrier competence, network integration, and effective perfusion; and, in advanced rarefaction, relieving matrix-related constraints while supporting vascular regeneration. The context- and time-dependent effects of signaling through VEGF, Tie2, PDGF-B/PDGFRβ, eNOS/NO, and related pathways indicate that the same molecular signal may exert different effects depending on disease context and timing. Therapeutic efficacy should therefore be evaluated by restoration of effective microcirculation and tissue function rather than by isolated molecular changes or capillary counts alone. Despite increasing mechanistic evidence, the translational basis for this framework remains limited. Most causal and interventional data derive from animal or cell models, whereas human evidence is largely limited to pathological observations, patient-sample associations, and prognostic studies. Currently available circulating and urinary candidate biomarkers generally lack sufficient specificity for PTC injury or state assignment, and no standardized quantitative thresholds have been externally validated. The four-state model should therefore be regarded as a hypothesis-generating analytical framework rather than a clinicopathological classification system. Future studies should integrate spatially resolved tissue phenotyping, blood and urine biomarkers, and dynamic microcirculatory assessment in longitudinal cohorts. They should test reproducibility, assess prognostic value beyond conventional pathology, estimated glomerular filtration rate, and proteinuria, and determine whether changes in PTC status precede or mediate therapeutic benefit. Linking reproducible microvascular phenotypes to defined mechanisms, treatment response, and long-term renal outcomes will be essential to determine whether state-directed assessment and restoration of the PTC microenvironment can ultimately inform patient stratification and therapeutic decision-making.

Objective:To assess the changes of cost,operation and clinical efficacy of large-scale equipment of hospital under the background of the Diagnosis-Related Groups(DRG)payment of disease,so as to provide evidences for finely managing the benefit of equipment.Methods:Full-scale operating data of four large-scale medical equipment that were used in Sichuan Cancer Hospital during January 2023 and December 2024 were selected.The payment of using equipment during January and December 2023 adopted the payment method as item,which included the case data of 21743 patients.The payment of using equipment during January and December 2024 adopted the payment method as DRG payment,which included the case data of 31187 patients.The input-oriented Charnes-Cooper-Rhodes(CCR)-data envelopment analysis(DEA)was adopted to judge the efficiency,the instant effect and trend effect of the separated net-income by interrupted time series(ITS).The incremental cost-effectiveness ratio(ICER)was used to assess the economic value of increasing diagnostic concordance.Results:The average monthly detection amount of 4 large-scale medical equipment of adopting DRG payment method was(2 218±297)cases,which was more than(2 113±311)cases of adopting payment method as item,and the difference was significant(t=3.07,P<0.05).The average monthly reexamination rate was(4.4±1.0)%,which was lower than(6.2±1.1)%of payment method as item,and the difference was significant(t=3.90,P<0.05).After the DRG payment method was implemented,the mean of CCR efficiency of equipment increased 0.09-0.13,and the intercept of monthly net income increased 5.60 million CNY,and the subsequent slope increased 0.245 million CNY again in each month.The ICER increased accuracy rate of 0.115 million CNY/1%,and the acceptable probability was large than 60%at economic aspect when the willingness of payment was larger or equal to 0.2 million CNY.Conclusions:DRG payment method can effectively decrease re-examination rate,and increase diagnostic consistence and CCR efficiency,and enhance net benefit and return on investment(ROI).However,the difference of efficiency among equipment still exists,and the enhancement of utilization rate of the part of equipment is limited.Therefore,the grouping weight and performance incentive should be improved,and the utilization rate of the resource of large-scale medical equipment should be further enhanced.

Objective:To assess the changes of cost,operation and clinical efficacy of large-scale equipment of hospital under the background of the Diagnosis-Related Groups(DRG)payment of disease,so as to provide evidences for finely managing the benefit of equipment.Methods:Full-scale operating data of four large-scale medical equipment that were used in Sichuan Cancer Hospital during January 2023 and December 2024 were selected.The payment of using equipment during January and December 2023 adopted the payment method as item,which included the case data of 21743 patients.The payment of using equipment during January and December 2024 adopted the payment method as DRG payment,which included the case data of 31187 patients.The input-oriented Charnes-Cooper-Rhodes(CCR)-data envelopment analysis(DEA)was adopted to judge the efficiency,the instant effect and trend effect of the separated net-income by interrupted time series(ITS).The incremental cost-effectiveness ratio(ICER)was used to assess the economic value of increasing diagnostic concordance.Results:The average monthly detection amount of 4 large-scale medical equipment of adopting DRG payment method was(2 218±297)cases,which was more than(2 113±311)cases of adopting payment method as item,and the difference was significant(t=3.07,P<0.05).The average monthly reexamination rate was(4.4±1.0)%,which was lower than(6.2±1.1)%of payment method as item,and the difference was significant(t=3.90,P<0.05).After the DRG payment method was implemented,the mean of CCR efficiency of equipment increased 0.09-0.13,and the intercept of monthly net income increased 5.60 million CNY,and the subsequent slope increased 0.245 million CNY again in each month.The ICER increased accuracy rate of 0.115 million CNY/1%,and the acceptable probability was large than 60%at economic aspect when the willingness of payment was larger or equal to 0.2 million CNY.Conclusions:DRG payment method can effectively decrease re-examination rate,and increase diagnostic consistence and CCR efficiency,and enhance net benefit and return on investment(ROI).However,the difference of efficiency among equipment still exists,and the enhancement of utilization rate of the part of equipment is limited.Therefore,the grouping weight and performance incentive should be improved,and the utilization rate of the resource of large-scale medical equipment should be further enhanced.

Protein as the allergens could lead to allergy. In addition, a widespread class of allergens were known as glycans of N-glycoprotein. N-glycoprotein contained oligosaccharide linked by covalent bonds with protein. Recently,studies implicated that allergy was associated with glycans of heterologous N-glycoprotein found in food, inhalants, insect toxins, etc. The N-glycan structure of N-glycoprotein allergen has exerted an influence on the binding between allergens and IgE, while the recognition and presentation of allergens by antigen-presenting cells (APCs) were also affected. Some researches showed thatN-glycan structure of allergen was remodeled by N-glycosidase, such as cFase I, gpcXylase, as binding of allergen and IgE partly decreased. Thus, allergic problems caused by N-glycoproteins could potentially be solved by modifying or altering the structure ofN-glycoprotein allergens, addressing the root of the issue. Mechanism of N-glycans associated allergy could also be elaborated through glycosylation enzymes, alterations of host glycosylation. This article hopes to provide a separate insight for glycoimmunology perspective, and an alternative strategy for clinical prevention or therapy of allergic diseases.

Objective:To investigate the influencing factors of increased tube bleeding within 24 h after coronary artery bypass grafting(CABG) and its correlation with perioperative complications.Methods:This study was a prospective observational study. The patients with CABG surgery were enrolled in Beijing Anzhen Hospital affiliated to Capital Medical University from May 2018 to December 2021. The age, sex, complications, blood tests and other clinical data of outpatients were collected. Left ventricular ejection fraction(EF) and left ventricular enddiastolic diameter(LVED) were detected by echocardiography. MGF and PI of grafts were recorded during CABG. Perioperative troponin Ⅰ, blood clotting pentathlon, all-cause death, perioperative myocardial fraction, atrial fibrillation and stroke were collected. According to the tube bleeding within 24 h after operation, the patients were divided into increased group(tube bleeding>1 000 ml) and normal group(tube bleeding≤1 000 ml). The preoperative baseline data, intraoperative indexes and perioperative complications were compared between the two groups. Logistic regression, Spearman and linear regression models were used to analyze the correlation between tube bleeding within 24 h and clinical data.Results:304 patients underwent CABG were enrolled. There were 185 cases(60.9%) in the increased group and 119 cases(39.1%) in the normal group. After adjusting for age, sex and BMI, multivariate logistic regression analysis showed that male( OR=2.40, 95% CI: 1.38-4.18, P=0.002), history of stroke( OR=2.37, 95% CI: 1.07-5.26, P=0.034), and history of myocardial infarction( OR=1.81, 95% CI: 1.13-2.91, P=0.014) could significantly increase the risk of tube bleeding within 24 h after surgery. The average blood flow of the anterior descending branch( OR=0.99, 95% CI: 0.99-1.00, P=0.022) and the circumflex branch( OR=0.99, 95% CI: 0.98-1.00, P=0.003) during the operation was significantly negatively correlated with the increase of tube bleeding within 24 h after surgery, while the PI of anterior descending branch( OR=1.81, 95% CI: 1.26-2.61, P=0.001), circumflex branch( OR=1.45, 95% CI: 1.07-1.97, P=0.017), right coronary artery( OR=1.84, 95% CI: 1.29-2.62, P=0.001) were positively correlated with the increase of tube bleeding within 24 h after operation. In addition, prothrombin time significantly increased the risk of increased tube bleeding within 24 h after surgery( OR=1.16, 95% CI: 1.03-1.30, P=0.018). Linear regression analysis showed that there was a significant positive linear correlation between ICU time and tube bleeding within 24 h after surgery( OR=0.17, 95% CI: 0.96-4.58, P=0.003), and a significant negative linear correlation between postoperative ejection fraction and tube bleeding within 24 h( OR=-0.25, 95% CI: -33.18--13.07, P<0.001). Conclusion:Increased tube bleeding within 24 h after CABG is most common in males and patients with a history of cardiovascular and cerebrovascular infarction. Better graft hemodynamic parameters can reduce the tube bleeding within 24 h after the operation, further improve cardiac function and reduce ICU time.

Objective:To investigate the causal correlation between depression and stress urinary incontinence(SUI)using Mendelian randomization(MR)analysis.Methods:We searched the FinnGen Consortium database for genome-wide association studies(GWAS)on depression and obtained 23 424 case samples and 192 220 control samples,with the GWAS data on SUI provided by the UK Biobank,including 4 340 case samples and 458 670 control samples.We investigated the correlation between depression and SUI based on the depression data collected from the Psychiatric Genomics Consortium(PGC).We employed inverse-variance weighting as the main method for the MR study,and performed sensitivity analysis to verify the accuracy and stability of the findings.Results:Analysis of the data from the UK Biobank and FinnGen Consortium showed that depression was significantly correlated with an increased risk of SUI(P=0.005),but not SUI with the risk of depression(P=0.927).And analysis of the PGC data verified the correlation of depression with the increased risk of SUI(P=0.043).Conclusion:Depression is associated with an increased risk of SUI,while SUI does not increase the risk of depression.

Objective: To analyze the incidence and related factors of drug resistance in HIV-infected pregnant and postpartum women in some areas of three western provinces of China from 2017 to 2019. Methods: From April 2017 to April 2019, face-to-face questionnaires and blood sample testing were conducted in all health care institutions providing maternal and perinatal care and midwifery-assisted services in 7 prevention of mother-to-child transmissi project areas in Xinjiang, Yunnan and Guangxi provinces/autonomous regions. Information was collected during the perinatal period and viral load, CD4⁺T lymphocytes and drug resistance genes were detected at the same time. The multivariate logistic regression model was used to analyze the relationship between different factors and drug resistance in HIV-infected pregnant and postpartum women. Results: A total of 655 HIV-infected pregnant and postpartum women were included in this study. The incidence of drug resistance was 3.4% (22/655), all of whom were cross-drug resistant. The rate of low, moderate and high drug resistance was 2.1% (14/655), 1.2% (8/655) and 0.8% (5/655), respectively. The drug resistance rate in the people who had previously used antiviral drugs was 1.9% (8/418), and the drug resistance rate in the people who had not used drugs was 5.9% (14/237). The NNRTI drug resistance accounted for 2.8% (18/655) and the NRTI drug resistance rate was 2.5% (16/655). The multivariate logistic regression model showed that the risk of HIV resistance was lower in pregnant women who had previously used antiviral drugs (OR=0.32, 95%CI: 0.11-0.76). Conclusion: Strengthening the management of antiviral drug use and focusing on pregnant and postpartum women who have not previously used antiviral drugs can help reduce the occurrence of drug-resistant mutations. Personalized antiviral therapy should be considered to achieve viral inhibition effects in clinical practice.
Female ; Humans ; Pregnancy ; HIV Infections/drug therapy* ; Incidence ; China/epidemiology* ; Infectious Disease Transmission, Vertical/prevention & control* ; Postpartum Period ; Drug Resistance, Viral/genetics* ; Antiviral Agents/therapeutic use*

Objective: To analyze the incidence and related factors of drug resistance in HIV-infected pregnant and postpartum women in some areas of three western provinces of China from 2017 to 2019. Methods: From April 2017 to April 2019, face-to-face questionnaires and blood sample testing were conducted in all health care institutions providing maternal and perinatal care and midwifery-assisted services in 7 prevention of mother-to-child transmissi project areas in Xinjiang, Yunnan and Guangxi provinces/autonomous regions. Information was collected during the perinatal period and viral load, CD4⁺T lymphocytes and drug resistance genes were detected at the same time. The multivariate logistic regression model was used to analyze the relationship between different factors and drug resistance in HIV-infected pregnant and postpartum women. Results: A total of 655 HIV-infected pregnant and postpartum women were included in this study. The incidence of drug resistance was 3.4% (22/655), all of whom were cross-drug resistant. The rate of low, moderate and high drug resistance was 2.1% (14/655), 1.2% (8/655) and 0.8% (5/655), respectively. The drug resistance rate in the people who had previously used antiviral drugs was 1.9% (8/418), and the drug resistance rate in the people who had not used drugs was 5.9% (14/237). The NNRTI drug resistance accounted for 2.8% (18/655) and the NRTI drug resistance rate was 2.5% (16/655). The multivariate logistic regression model showed that the risk of HIV resistance was lower in pregnant women who had previously used antiviral drugs (OR=0.32, 95%CI: 0.11-0.76). Conclusion: Strengthening the management of antiviral drug use and focusing on pregnant and postpartum women who have not previously used antiviral drugs can help reduce the occurrence of drug-resistant mutations. Personalized antiviral therapy should be considered to achieve viral inhibition effects in clinical practice.
Female ; Humans ; Pregnancy ; HIV Infections/drug therapy* ; Incidence ; China/epidemiology* ; Infectious Disease Transmission, Vertical/prevention & control* ; Postpartum Period ; Drug Resistance, Viral/genetics* ; Antiviral Agents/therapeutic use*

Humans ; Consensus ; Hypersensitivity ; Desensitization, Immunologic/adverse effects* ; Immunotherapy/adverse effects* ; Injections, Subcutaneous ; Allergens

As an important element of medical and health sector innovation, the translation of scientific and technological achievements plays a key role in promoting their clinical application and meeting the medical needs of the people. The authors sorted out the problems in such translation at these affiliated hospitals in terms of " people", " finance", " material", and " system". Starting from 2017, the Tenth People′s Hospital Affiliated to Tongji University has explored such practices as establishing hospital-led clinical medical science and technology innovation parks and technology service limited companies. These practices aimed to address the issues of insufficient hospital scientific and technological innovation capabilities and the gap between the hospital′s operation mechanism to translate its scientific and technological achievements and the enterprises and the market. The clinical medical science and technology innovation park integrating administration, industry, education, research, medicine and application, has taken multiple measures to attract excellent research talents and projects from within and beyond the hospital, promote the implementation of innovative scientific research projects. The hospital also established a health industry mode with engagement of social capital from large enterprises. The Technology Services Co., Ltd. was based on the incubation and translation of hospital achievements, combining market and clinical needs, promoting multi-party cooperation between hospitals and external enterprises, improving the chain operation mechanism of hospital scientific and technological achievements translation work, and alleviating the problem of insufficient research pilot funds and productibility funds by means of hospital-led fundraising. The number of patent authorizations of hospitals had increased from 23 cases in 2018 to 105 in 2022, and the amount of patent conversion had increased from 2 million yuan in 2020 to 11 million yuan in 2022. It is recommended that affiliated hospitals of universities further improve the organizational structure of achievement translation, strengthen their professional talent teams, improve their operation mechanism of achievement translation, build a platform for medical school-enterprise cooperation, and improve the evaluation mechanism of translation assessment, in order to promote a virtuous cycle of hospital′s scientific and technological achievement translation work.