Background/Aims: Natural killer (NK) cell function is generally considered dampened in chronic hepatitis B virus (HBV) infection; however, the NK cell pool exhibits phenotypic and functional heterogeneity, and the antibody--mediated effect of NK cells remains less characterized. This study evaluated the dynamic changes in antibody-mediated NK cell responses and the involvement of distinct NK subsets across disease stages and during antiviral treatment. Methods: A T-cell receptor-like antibody specific for the HBV core 18–27 peptide (cTCRL-Ab) was used to determine the antibody-mediated effect of NK cells, and an array of NK cell surface markers were analyzed in cross-sectional and longitudinal cohorts of patients with chronic HBV infection. Single-cell RNA sequencing (scRNA-seq) was performed to identify the heterogeneity of NK subsets. Results: The cTCRL-Ab enabled the detection of NK cell cytolytic activity and IFNγ production. Notably, cTCRL-Ab-mediated NK cell responses were compromised in chronically HBV-infected patients, particularly in those receiving pegylated interferon-α (Peg-IFNα), which was associated with the downregulation of CD16 expression. Correspondingly, Peg-IFNα inhibited cTCRL-Ab-mediated NK cell function by reducing CD16 expression in vitro. scRNA-seq revealed that CD16 downregulation occurred mainly within a dysfunctional CD16hi NK subset exhibiting exhaustion properties. In contrast, an activated CD16hiNK subpopulation (CX3CR1⁺KLRC2–CD16hi) with high cytotoxicity was enriched in patients who experienced favorable treatment responses. Furthermore, the intrahepatic CX3CR1+KLRC2–CD16hi subset tended to exhibit functional restoration in HBsAg-loss individuals. Conclusions Our data contribute to the understanding of antibody-mediated responses of NK cells in chronic HBV infection, and highlight a previously unappreciated functional CX3CR1+KLRC2–CD16hiNK subset as a potential therapeutic target.

Objective:To investigate the value of triglyceride glucose index(TyG)and monocyte to high-density lipoprotein choles-terol ratio(MHR)in the diagnosis of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated by heart fail-ure(HF),as well as the correlation of TyG and MHR with cardiac function in AECOPD patients.Methods:A retrospective analysis was performed for the clinical data of 298 AECOPD patients who were admitted to The First Hospital of Lanzhou University from January 2020 to December 2021,and according to the clinical manifestation,B-type natriuretic peptide/N-terminal B-type natriuretic peptide precursor,and echocardiography,the 298 AECOPD patients were divided into HF group with 127 patients and non-HF group with 171 patients.Related clinical indicators were compared between the two groups,and a regression analysis was used to identify the pos-sible risk factors for HF in AECOPD patients.The receiver operat-ing characteristic(ROC)curve analysis was used to investigate the value of TyG and MHR alone or in combination in the diagnosis of AECOPD complicated by HF,and a correlation analysis was used to investigate the correlation of TyG and MHR with cardiac function parameters(ejection fraction,ventricular wall thickness,cardiac chamber size,and valve regurgitation velocity)and pulmonary artery pressure in AECOPD patients.Results:The binary logistic regres-sion analysis showed that fasting blood glucose,absolute monocyte count,high-density lipoprotein cholesterol(HDL-C),arrhythmia,TyG,and MHR were independent risk factors for HF in AECOPD patients,and the HF group had significantly higher levels of TyG and MHR than the non-HF group(P<0.001).TyG had an area under the ROC curve(AUC)of 0.805(95%CI=0.754-0.856,P<0.001)in the diagnosis of AECOPD complicated by HF,and MHR had an AUC of 0.762(95%CI=0.707-0.817,P<0.001),while TyG combined with MHR had an AUC of 0.870(95%CI=0.828-0.912,P<0.001).The correlation analysis showed that TyG was negatively correlated with left ventricular ejection fraction and left ventricular fractional shortening and was positively correlated with end-diastolic interven-tricular septal thickness,mitral regurgitation velocity,and left ventricular end-diastolic posterior wall thickness,while MHR was nega-tively correlated with left ventricular stroke volume and left ventricular fractional shortening and was positively correlated with end-diastolic interventricular septal thickness,right ventricular anteroposterior diameter,right ventricular superior-inferior diameter,right ventricular transverse diameter,tricuspid regurgitation velocity,left ventricular end-diastolic posterior wall thickness,and pulmonary artery pressure.Conclusion:Fasting blood glucose,absolute monocyte count,HDL-C,arrhythmia,TyG,and MHR are independent risk factors for AECOPD complicated by HF.Both TyG and MHR have a certain value in the diagnosis of HF,and the combination of TyG and MHR has a better efficacy than each indicator alone in the diagnosis of AECOPD complicated by HF.TyG is correlated with the cardiac function parameters such as left ventricular ejection fraction,ventricular wall thickness,and mitral regurgitation velocity in patients with AECOPD and may have a stronger correlation with the left ventricle;MHR is correlated with right ventricular chamber size,tricuspid regurgitation velocity,and pulmonary artery pressure and may have a stronger correlation with the right ventricle.

Objective To explore the correlation of MET status in patients with advanced prostatic acinar adenocarcinoma with the clinical pathological parameters and prognosis. Methods The specimen from 135 patients with advanced prostatic acinar adenocarcinoma was included. The expression of c-MET protein was detected via immunohistochemistry, and MET gene amplification was assessed by fluorescence in situ hybridization. The relationships of c-MET expression and gene amplification with clinicopathological features and prognosis were analyzed. Results The positive expression rate of c-MET was 52.60% (71/135). Compared with the c-MET expression in adjacent tissues, that in tumor tissues showed lower heterogeneous expression. Among the cases, 1.71% (2/117) exhibited MET gene polyploidy, but no gene amplification was detected. Positive c-MET expression was significantly correlated with high Gleason scores and grade groups (P=0.0073). However, no significant relationship was found between c-MET expression and progression-free survival or post-treatment t-PSA levels. Conclusion c-MET protein is expressed at a relatively low level in advanced prostatic acinar adenocarcinoma, suggesting that c-MET may not be a viable target for ADC drug development in prostatic acinar adenocarcinoma.

Objective:To assess the presence of chemotherapy-induced abnormal myocardial perfusion using SPECT myocardial perfusion imaging (MPI) in patients with malignant hematologic diseases before hematopoietic stem cell transplantation (HSCT), and to explore its predictive value for mid-to-long-term mortality risk after transplantation.Methods:From March 2016 to August 2022, 139 patients with malignant hematologic diseases (80 males, 59 females; age (45.7±13.0) years) who underwent resting MPI to assess the presence of chemotherapy-induced abnormal myocardial perfusion before HSCT at the First People′s Hospital of Changzhou were prospectively included. Baseline-data were collected and patients were followed up for mid-to-long-term (≥100d) adverse outcomes after transplantation. Overall survival (OS) of each patient was recorded. The χ2 test and independent-sample t test were used for data analysis. Cox regression analysis was utilized to identify independent risk factors affecting OS. Kaplan-Meier method and log-rank test were used for survival analysis. Results:The median follow-up time of 139 patients was 41.6(19.5, 65.6) months, with all-cause mortality of 28.8%(40/139), and the cardiovascular mortality was 42.5%(17/40). The prior cardiotoxic therapies rate (anthracycline dose ≥250mg/m 2) was higher in the death group compared to that in the survival group (15.0% (6/40) vs 5.1% (5/99); χ2=3.87, P=0.049). Pre-transplant abnormal myocardial perfusion rate was also higher in the death group compared to that in the survival group (55.0%(22/40) vs 22.2%(22/99); χ2=15.19, P<0.001). But pre-transplant left ventricular ejection fraction (LVEF) was lower in the death group compared to that in the survival group ((60.4±5.2)% vs (62.9±3.9)%; t=-3.07, P=0.003). Cox multivariate regression analysis showed that the abnormal myocardial perfusion indicated by MPI before transplantation was an independent risk factor affecting OS after HSCT in patients with malignant hematologic diseases (hazard rate ( HR)=2.70, 95% CI: 1.33-5.46, P=0.006). Kaplan-Meier analysis showed the 1-, 2-, 5-year OS rates of patients with the abnormal myocardial perfusion and the normal myocardial perfusion were 73.5%, 69.1%, 49.2% and 94.6%, 89.9%, 81.6%, respectively, with significant difference ( χ2=17.01, P<0.001). Conclusions:Patients with abnormal myocardial perfusion detected by MPI before HSCT for malignant hematologic diseases have a poorer prognosis, characterized by lower post-transplantation OS rates. The utilization of MPI for assessing abnormal myocardial perfusion before transplantation in patients with malignant hematologic diseases can aid in predicting the mid-to-long-term mortality risk after transplantation.

Objective:To investigate the efficacy and safety of bendamustine combined with anti-CD20 monoclonal antibody in the first-line treatment of older patients with indolent B-cell non-Hodgkin lymphoma (B-iNHL) .Methods:The clinical data of 159 patients with B-iNHL enrolled in 16 hospitals from Jiangsu Cooperative Lymphoma Group from December 1, 2019, to April 20, 2024, were analyzed for regimen efficacy and safety. Bendamustine plus rituximab (BR) and bendamustine plus obinutuzumab (BG) were administered to 139 (87.4% ) and 20 (12.6% ) patients, respectively.Results:Among the 159 patients, 101 (63.5% ) were male and 58 (36.5% ) were female, with a median age of 69 years (range: 60–84). Efficacy could be assessed in 138 (86.8% ) patients. The efficacy assessment demonstrated that the overall response rate was 92.0% with complete and partial remissions in 75 (54.3% ) and 52 (37.7% ) cases, respectively. With a median follow-up of 24 months (range: 4–64), the progression-free survival rate was (87.5 ± 3.0) % and the overall survival rate was (83.2 ± 3.3) %. Of the 27 patients who died, 6 (22.2% ) died due to disease progression. The mean applied dose of bendamustine per cycle was 73.0 (50.8–89.7) mg/m 2 per day, administered on days 1 and 2. Adverse events of grade 3 or higher were reported in 53 (33.3% ) patients, with infection (30 cases,18.9% ) and neutropenia (24 cases, 15.1% ) demonstrating the highest incidence. Conclusion:Bendamustine combined with anti-CD20 monoclonal antibody demonstrated good efficacy and is well-tolerated in the first-line treatment of elderly patients with B-iNHL.

Objective:To extract, evaluate, and summarize evidence related to family participation in delirium management of ICU patients and provid a reference for clinical practice.Methods:A systematic search was conducted in databases such as UpToDate, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, National Guideline Clearinghouse, Medlive, Cochrane Library, PubMed, Embase, CINAHL, China National Knowledge Infrastructure, and China Biology Medicine disc. The search covered clinical decisions, guidelines, expert consensus, evidence summaries, systematic reviews, and randomized controlled trials related to family participation in ICU delirium management, with a timeframe up to March 20, 2024. Two researchers independently screened literature, assessed quality, extracted evidence, and graded it.Results:A total of 28 articles were included, comprising seven evidence summaries, five guidelines, three expert consensuses, six systematic reviews, and seven randomized controlled trials. The findings were synthesized into five themes: visitation, assessment, non-pharmacological management, psychological and physical care, and health education, with a total of 26 best evidence points.Conclusions:The best evidence summarized in this study provides an evidence-based foundation for ICU healthcare providers to guide and encourage family participation in delirium management, which aida in the prevention of delirium in ICU patients.

Humanistic care is the essence of nursing. The implementation of humanistic care in ICU nursing can alleviate patients' negative psychological experiences, enhance treatment adherence, and improve patient outcomes. This article provides a comprehensive review of the concept of humanistic care, evaluation tools for ICU nursing humanistic care, multi-level current situation, and influencing factors. The aim is to offer insights for developing a multi-dimensional humanistic care framework for ICU patients, nurses, and healthcare institutions, based on the "humanistic care transmission chain".

Objective:To perform a Meta-synthesis of qualitative studies on the positive psychological experiences of cardiac surgery patients post-operation, and to analyze and evaluate these experiences.Methods:A systematic search was conducted in PubMed, Web of Science, CINAHL, Embase, ProQuest, China National Knowledge Infrastructure, Wanfang Data, VIP, and China Biology Medicine disc, with the search period from the establishment of the database to March 10, 2024. The quality of the included literature was assessed using the Australia Joanna Briggs Institute for Evidence-Based Healthcare Centre Database Quality Assessment Criteria for Qualitative Research (2016). Results were integrated using the Meta synthesis method.Results:A total of 13 studies were included, of which one study was rated as Grade A and 12 as Grade B. 46 research outcomes were identified, which were summarized into 10 new categories and integrated into three main results: awakening of self-awareness, changes in health behaviors, and perceived social support.Conclusions:Cardiac surgery patients post-operation exhibit positive psychology. Medical staff should be able to identify and understand the supporting factors for these psychological states, correctly guide and maintain the positive psychological state of patients, and help facilitate active recovery.

Objective:To explore the barriers encountered by nurses in managing cognitive frailty in elderly patients with chronic heart failure (CHF) .Methods:Using purposive sampling, 15 nurses working in the Cardiovascular and Geriatric Departments of Fuyang Hospital of Anhui Medical University were recruited for semi-structured interviews from January to April 2024. The interview guide was developed based on the Theoretical Domains Framework (TDF), and data were analyzed using thematic analysis.Results:The study identified barriers related to five TDF domains: knowledge/skills, beliefs about consequences, motivation and goals, environmental context and resources, and behavioral regulation. Further refinement revealed specific challenges, including a lack of systematic knowledge and skills in cognitive frailty management for elderly CHF patients, inadequate incentive mechanisms, limited policy support from government and healthcare institutions, and the absence of standardized management protocols for cognitive frailty.Conclusions:Nurses face multiple barriers in managing cognitive frailty in elderly CHF patients. Addressing these challenges requires strengthening training on cognitive frailty knowledge and skills, improving incentive mechanisms, enhancing policy support from governments and healthcare institutions, and establishing standardized quality management systems to enhance nurses' ability to manage cognitive frailty in elderly CHF patients.

Objective:To summary the best evidence of integrated traditional Chinese and Western medicine exercise rehabilitation for phase I cardiac rehabilitation after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) and to provide an evidence-based basis for clinical practice.Methods:The literature on integrated Chinese and Western medicine exercise rehabilitation among AMI patients in phase I after PCI was systematically searched in UpToDate, National Guideline Clearinghouse, Guidelines International Network, Scottish Intercollegiate Guidelines Network, Canadian Medical Association Clinical Practice Guideline, Chinese Medical Association, China National Knowledge Infrastructure, Medlive, VIP, China Biology Medicine disc, Wanfang Data, Scops, Cochrane Library, PubMed, and Web of Science, etc. The search period was from database establishment to May 20, 2024. Literature quality assessment and data extraction were performed independently by two researchers.Results:A total of 19 papers were included, including four guidelines, eight expert consensus, six systematic reviews, and one randomized controlled trial. Thirty-two pieces of best evidence were summarized from eight areas containing pre-rehabilitation assessment, timing of exercise, type of exercise, exercise program, exercise monitoring, frequency of exercise, criteria for termination of exercise, and health education and follow-up.Conclusions:The summary of the best evidence of integrated Chinese and Western medicine exercise rehabilitation among AMI patients in phase I after PCI provides an evidence-based basis for standardizing the process and practice standards of exercise rehabilitation among AMI patients in phase I after PCI.