OBJECTIVE To investigate the impact of cerebral ischemia-reperfusion(CIR)injury on glucuronidation of IMM-H004 in the brain.METHODS IMM-H004,a neuroprotective agent,underwent glucuronidation primarily mediated by uridine diphosphate glucuronosyltransferases(UGT)to form IMM-H004G,which was subsequently hydrolyzed back to IMM-H004 by β-glucuronidase.① Cellular experiments:human glial cells(HEB)and human neuroblastoma cells(SH-SY5Y)cell lines were assigned to two groups:a normal control group and an oxygen-glucose deprivation/reoxygenation(OGD/R)model group.An OGD/R model was established by subjecting the cells to one-hour oxygen-glucose deprivation,followed by reoxygenation.Cell viability was assessed using the methylthiazolyldi-phenyl-tetrazolium bromide(MTT)assay.The mRNA levels of UGT and its regulatory factor,nuclear factor erythroid 2 related factor 2(Nrf2),were measured by real-time fluorescence quantitative PCR(RT-qPCR).The content of IMM-H004G glucuronidated from IMM-H004,and the content of IMM-H004 hydrolyzed from IMM-H004G were determined using liquid chromatography-tandem mass spectrometry(LC-MS/MS).② Animal experiments:Male SD rats were randomly assigned to three groups:a normal control group,a CIR model group,and a sham operation group.Rats in the normal control group received no surgical interventions while those in the CIR model group underwent four-vessel occlusion surgery to induce acute CIR injury.Rats in the sham operation group was treated the same way as the CIR model group except for the four-vessel occlusion.The activities of UGT and β-glucuronidase in brain tissues were determined by LC-MS/MS.IMM-H004 was administered via intracerebroventricular injec-tion,and the concentrations of IMM-H004 and IMM-H004G in different regions of the brain were deter-mined using LC-MS/MS to investigate the impact of CIR injury on IMM-H004 metabolism.RESULTS① Cellular experiments:Compared with the control group,OGD/R injury reduced the viability of HEB and SH-SY5Y cells to 72.30%and 53.56%,respectively.In HEB cells,OGD/R injury significantly down-regulated the mRNA expressions of UGT1A1,UGT1A7 and UGT1A8,resulting in a reduction of IMM-H004G production to 50.05%-68.95%of the normal level,while hydrolytic metabolism remained unaf-fected.No significant changes were observed in SH-SY5Y cells.②Animal experiments:CIR injury had no impact on the activity of UGT or β-glucuronidase in rat brain tissues.In addition,the distribution of IMM-H004 and IMM-H004G across different brain regions remained unchanged.CONCLUSION These findings show that OGD/R injury reduces UGT-mediated glucuronidation of IMM-H004,whereas CIR injury does not significantly affect its metabolism in the brain,suggesting the presence of compen-satory mechanisms in brain tissues that help maintain drug homeostasis.

OBJECTIVE To investigate the impact of cerebral ischemia-reperfusion(CIR)injury on glucuronidation of IMM-H004 in the brain.METHODS IMM-H004,a neuroprotective agent,underwent glucuronidation primarily mediated by uridine diphosphate glucuronosyltransferases(UGT)to form IMM-H004G,which was subsequently hydrolyzed back to IMM-H004 by β-glucuronidase.① Cellular experiments:human glial cells(HEB)and human neuroblastoma cells(SH-SY5Y)cell lines were assigned to two groups:a normal control group and an oxygen-glucose deprivation/reoxygenation(OGD/R)model group.An OGD/R model was established by subjecting the cells to one-hour oxygen-glucose deprivation,followed by reoxygenation.Cell viability was assessed using the methylthiazolyldi-phenyl-tetrazolium bromide(MTT)assay.The mRNA levels of UGT and its regulatory factor,nuclear factor erythroid 2 related factor 2(Nrf2),were measured by real-time fluorescence quantitative PCR(RT-qPCR).The content of IMM-H004G glucuronidated from IMM-H004,and the content of IMM-H004 hydrolyzed from IMM-H004G were determined using liquid chromatography-tandem mass spectrometry(LC-MS/MS).② Animal experiments:Male SD rats were randomly assigned to three groups:a normal control group,a CIR model group,and a sham operation group.Rats in the normal control group received no surgical interventions while those in the CIR model group underwent four-vessel occlusion surgery to induce acute CIR injury.Rats in the sham operation group was treated the same way as the CIR model group except for the four-vessel occlusion.The activities of UGT and β-glucuronidase in brain tissues were determined by LC-MS/MS.IMM-H004 was administered via intracerebroventricular injec-tion,and the concentrations of IMM-H004 and IMM-H004G in different regions of the brain were deter-mined using LC-MS/MS to investigate the impact of CIR injury on IMM-H004 metabolism.RESULTS① Cellular experiments:Compared with the control group,OGD/R injury reduced the viability of HEB and SH-SY5Y cells to 72.30%and 53.56%,respectively.In HEB cells,OGD/R injury significantly down-regulated the mRNA expressions of UGT1A1,UGT1A7 and UGT1A8,resulting in a reduction of IMM-H004G production to 50.05%-68.95%of the normal level,while hydrolytic metabolism remained unaf-fected.No significant changes were observed in SH-SY5Y cells.②Animal experiments:CIR injury had no impact on the activity of UGT or β-glucuronidase in rat brain tissues.In addition,the distribution of IMM-H004 and IMM-H004G across different brain regions remained unchanged.CONCLUSION These findings show that OGD/R injury reduces UGT-mediated glucuronidation of IMM-H004,whereas CIR injury does not significantly affect its metabolism in the brain,suggesting the presence of compen-satory mechanisms in brain tissues that help maintain drug homeostasis.

Sound financing mechanism is an important support for the development of health system.In response to the problems exposed in the health system during the COVID-19 pandemic,OECD countries have proposed intervention directions and investment strategies to strengthen the resilience of the health system.The investment allocation in strengthening core public health capabilities,proactive material reserves,and coordinated supply from OECD countries were analyzed,in order to explore the characteristics and effectiveness,which could provide a reference for strengthening the resilience of China's health system.

Sound financing mechanism is an important support for the development of health system.In response to the problems exposed in the health system during the COVID-19 pandemic,OECD countries have proposed intervention directions and investment strategies to strengthen the resilience of the health system.The investment allocation in strengthening core public health capabilities,proactive material reserves,and coordinated supply from OECD countries were analyzed,in order to explore the characteristics and effectiveness,which could provide a reference for strengthening the resilience of China's health system.

Sound financing mechanism is an important support for the development of health system.In response to the problems exposed in the health system during the COVID-19 pandemic,OECD countries have proposed intervention directions and investment strategies to strengthen the resilience of the health system.The investment allocation in strengthening core public health capabilities,proactive material reserves,and coordinated supply from OECD countries were analyzed,in order to explore the characteristics and effectiveness,which could provide a reference for strengthening the resilience of China's health system.

Sound financing mechanism is an important support for the development of health system.In response to the problems exposed in the health system during the COVID-19 pandemic,OECD countries have proposed intervention directions and investment strategies to strengthen the resilience of the health system.The investment allocation in strengthening core public health capabilities,proactive material reserves,and coordinated supply from OECD countries were analyzed,in order to explore the characteristics and effectiveness,which could provide a reference for strengthening the resilience of China's health system.

Sound financing mechanism is an important support for the development of health system.In response to the problems exposed in the health system during the COVID-19 pandemic,OECD countries have proposed intervention directions and investment strategies to strengthen the resilience of the health system.The investment allocation in strengthening core public health capabilities,proactive material reserves,and coordinated supply from OECD countries were analyzed,in order to explore the characteristics and effectiveness,which could provide a reference for strengthening the resilience of China's health system.

Sound financing mechanism is an important support for the development of health system.In response to the problems exposed in the health system during the COVID-19 pandemic,OECD countries have proposed intervention directions and investment strategies to strengthen the resilience of the health system.The investment allocation in strengthening core public health capabilities,proactive material reserves,and coordinated supply from OECD countries were analyzed,in order to explore the characteristics and effectiveness,which could provide a reference for strengthening the resilience of China's health system.

Objective To assess the efficacy of pirfenidone combined with PD-L1 inhibitor for treatment of bladder cancer in a mouse model and its effect on tumor immune microenvironment modulation.Methods Forty C57BL/6 mouse models bearing ectopic human bladder cancer xenografts were randomized into control group,PD-L1 inhibitor group,pirfenidone group and combined treatment group(n=10).After successful modeling,PD-L1 inhibitor treatment was administered via intraperitoneal injection at 12.5 mg/kg every 3 days,and oral pirfenidone(500 mg/kg)was given on a daily basis.The survival rate of the mice and tumor growth rate were compared among the 4 groups.The expressions of CD3,CD8,CD45,E-cadherin and N-cadherin in the tumor tissues were detected with immunohistochemistry after the 21-day treatment,and bone marrow-derived suppressor cells(MDSCs)were observed with immunofluorescence staining;serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),urea nitrogen(BUN),creatinine(CRE)and lactate dehydrogenase(LDH-L)were analyzed using an automated biochemical analyzer.Results Treatment with PD-L1 inhibitor and pirfenidone alone both significantly decreased tumor growth rate and tumor volume at 21 days(P<0.05),but the combined treatment produced an obviously stronger inhibitory effect(P<0.05).PD-L1 inhibitor and pirfenidone alone significantly increased E-cadherin expression and decreased N-cadherin expression in the tumor tissue(P<0.05).The two treatments both significantly increased the percentage of CD3+,CD8 and CD45+ T cells and decreased the percentage of Ly-6G+CD11b+MDSCs in the tumor tissue,and these changes were more obvious in the combined treatment group(P<0.05).No significant differences were found in serum ALT,AST,BUN,CRE or LDH-L levels among the 4 groups(P>0.05).Conclusion Combined treatment with pirfenidone and PD-L1 inhibitor significantly inhibits the progression of bladder cancer in mice possibly by regulating tumor immune microenvironment and inhibiting epithelial-mesenchymal transition of the tumor cells.

Objective:To study the clinical manifestations, genetic profiles and treatment of Kagami-Ogata syndrome (KOS).Methods:A neonate admitted to our hospital was genetically diagnosed of KOS from amniocentesis sampling. The phenotype, genotype and treatment of the neonate were analyzed. Multiple databases were searched using key words including "Kagami-Ogata syndrome", "14q32 microdeletion syndrome", "coat-hanger ribs", "paternal uniparental disomy (pUPD)(14) " from the inception of the databases to Jan. 23th 2023. The clinical features, genotype and treatment of patients from the literature were summarized.Results:The neonate in our hospital was born at 30 weeks gestational age with a birth weight of 2 035 g. Prenatal ultrasound indicated overgrowth, bilateral fetal renal pelvis dilatation (FRPD), dilatation of intestines in lower abdomen, clenched hands with overlapping fingers and polyhydramnios. After birth, the neonate showed progressively worsening respiratory distress, distinct facial features (small jaw, short neck, flat nasal bridge, upward-facing nostrils, small and malformed ears with auricular deformity and narrow external auditory canals), bell-shaped thorax, diastasis recti and abnormal posture (overlapping fingers, clenched fists), as well as feeding difficulties, recurrent fever and dependence of respiratory support. Whole exome sequencing (WES) revealed a 268.2Kb deletion (101034306_101302541) in 14q32.2 region on both the neonate and the mother and the father was otherwise normal. The prognosis was poor and the parents refused further treatment. The neonate died at one month of age after two days of palliative care. A total of 36 articles were identified in the literature review, including 78 KOS cases with complete clinical data (a total of 79 cases adding our case).The primary clinical manifestations included distinctive facial and thoracic abnormalities (79/79, 100%), polyhydramnios (71/75, 94.7%), feeding difficulties (55/63, 87.3%), abdominal wall defects (57/72, 79.2%), joint contractures (39/70, 55.7%) and dependence of respiratory support (29/56, 51.8%). Long-term follow-up revealed 86.8% (59/68) experienced physical, movement and intellectual development delay, 39.7% (25/63) died or gave up treatments within five years. Genetic testing showed pUPD in 44 cases (55.7%), maternal deletions in 23 cases (29.1%), epimutations in 8 cases (10.1%) and unreported variations in 4 cases (5.1%).Conclusions:KOS is a genetic imprinting disorder affecting multiple organs. Prenatal screening can detect abnormalities such as polyhydramnios. Specific clinical signs, radiological findings and 14q32 gene analysis are helpful for the diagnosis of the disease.