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 explore the characteristics and correlation between perivascular spaces (PVS) and diffusion tensor image analysis along perivascular spaces (DTI-ALPS) index in patients with amnestic mild cognitive impairment (aMCI). Methods A retrospective study was conducted on a total of 118 participants, including cognitive normal (CN) healthy controls and aMCI patients, recruited from the Department of Neurology, Zhongshan Hospital, Fudan University from September 2020 to September 2022. All participants underwent structural magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI). An automatic segmentation algorithm was used to quantify PVS metrics in the brain, and DTI-ALPS index was calculated based on DTI. Differences in DTI-ALPS index and PVS metrics between the CN and aMCI groups were compared. Multivariate logistic regression was used to identify independent factors influencing aMCI. Correlation analysis was performed to assess relationships among DTI-ALPS index, PVS metrics, and cognitive scores. Results A total of 80 CN healthy controls and 38 aMCI patients were included. The DTI-ALPS index was significantly lower in the aMCI group compared with the CN group (1.28±0.18 vs 1.37±0.21, P＝0.018), while differences in PVS metrics between groups were not statistically significant. Multivariate logistic regression analysis indicated that DTI-ALPS index was an independent factor affecting aMCI (OR＝0.097, 95%CI 0.011–0.833, P＝0.033). Correlation analysis revealed a positive relationship between DTI-ALPS index and MMSE score (r＝0.210, P＝0.023) as well as PVS length in the centrum semiovale (r＝0.216, P＝0.019). Conclusions The DTI-ALPS index may serve as an imaging biomarker for identifying early cognitive impairment, and patients with aMCI exhibit abnormal DTI-ALPS indices, suggesting that brain glymphatic system dysfunction may occur prior to morphological changes.

Humanistic caring for patients in the operating room refers to providing the whole process of caring medical services for patients in the operating room. In order to standardize humanistic caring services for patients in the operating room of medical institutions, improve the comprehensive service level of the operating room, and enhance the surgical experience of patients, the Chinese Association for Life Care released the group standard " Humanistic Caring Management Standards for Patients in the Operating Room" in December 2023. This article interpreted the basic requirements for humanistic caring of patients in the operating room, the environment and facilities for humanistic caring, the procedures and measures for humanistic caring, and the quality management framework, aiming to assist administrators and clinical practitioners across various levels of medical institutions in accurately understanding and effectively implementing the standard, and to provide essential textual reference and practical guidance for promoting the application of the standard.

Objective:To understand the mental problem in elderly male prisoners and its related factors.Methods:A total of 289 elderly male prisoners from five prisons in Sichuan Province were selected.They were assessed with the self-compiled general situation questionnaire,12-item General Health Questionnaire(GHQ-12,with a total score ≥ 3 indicating a tendency towards mental problem),short-form UCLA Loneliness Scale(ULS-8)and Insomnia Severity Index-Chinese Version(ISI-C).Results:The detection rate of mental problem was 41.52％.Multiple factor logistic regression analysis indicated that having a remaining sentence of≥5 years,educa-tional levels of primary school and below,high school or technical secondary school and above,involvement in drug-related crimes,property crimes,violent crimes,good and poor relationships with spouses,average relationships with fellow inmates,self-assessed blood pressure levels that were low and high,and having insomnia were risk fac-tors for mental problem(OR=9.55,11.75,13.88,82.24,33.96,363.52,5.77,113.27,2.33,1.87,3.80,42.89).Conclusion:The mental problem among elderly male prisoners are related to their sentence,education lev-el,crime type,relationship with spouse and cellmates,self-rated blood pressure and sleep status.

This paper summarizes the perioperative nursing experience of a premature infant with congenital gastroschisis accompanied by malaria and heart disease during a medical aid mission in Africa.Nursing key points include:preoperative observation and protection of the protruding intestines to prevent intestinal injury and infection,timely identification and management of arrhythmias and acute hypoxic episodes;intraoperative close monitoring of vital signs and assisting the surgeon in creating an"artificial abdominal cavity";postoperative intensification of condition monitoring and intra-abdominal pressure surveillance,standardized medication administration and rational blood transfusion to prevent complications related to gastroschisis repair,and to control malaria-related symptoms,while providing nutritional support and reinforcing health education.Through collaborative diagnosis and treatment by a multidisciplinary team along with meticulous nursing care,the infant showed improvement and was discharged after 2 weeks.A follow-up visit 2 months postoperatively revealed normal feeding,good surgical wound healing,no recurrence of acute hypoxic episodes,and a persistent systolic murmur auscultated over the precordium.

Humanistic caring for patients in the operating room refers to providing the whole process of caring medical services for patients in the operating room. In order to standardize humanistic caring services for patients in the operating room of medical institutions, improve the comprehensive service level of the operating room, and enhance the surgical experience of patients, the Chinese Association for Life Care released the group standard " Humanistic Caring Management Standards for Patients in the Operating Room" in December 2023. This article interpreted the basic requirements for humanistic caring of patients in the operating room, the environment and facilities for humanistic caring, the procedures and measures for humanistic caring, and the quality management framework, aiming to assist administrators and clinical practitioners across various levels of medical institutions in accurately understanding and effectively implementing the standard, and to provide essential textual reference and practical guidance for promoting the application of the standard.

OBJECTIVE To explore the risk factors for polymyxin-and carbapenem-resistant Klebsiella pneumoni-ae(PR-CRKP)infection and establish the prediction model.METHODS The clinical data were retrospectively col-lected from the patients with CRKP infection who were treated in the First Affiliated Hospital of Xi'an Jiaotong University from Jan.2023 to Mar.2024.The enrolled patients were divided into the CRKP group and the PR-CRKP group according to the result of drug susceptibility testing for polymyxin B.Totally 203 patients who were treated from Jan.2023 to Dec.2023 were assigned as the modeling group,and 91 patients who were treated from Jan.2024 to Mar.2024 were assigned as the validation group.Multivariate logistic regression analysis was per-formed for the risk factors for PR-CRKP infection,nomogram was built up for prediction of PR-CRKP infection by R software,and the predictive efficacy of the model was evaluated by means of receiver operating characteristic(ROC)curves.RESULTS The result of univariate analysis showed that the proportions of patients who received fi-berobronchoscopy,endotracheal intubation/tracheotomy,were complicated with other carbapenem-resistant or-ganisms(CROs)infections,bloodstream infections,were treated in intensive care unit(ICU)and had the history of exposure to polymyxins and carbapenems 3 months before the admission were higher in the PR-CRKP group than in the CRKP group(P＜0.05);the length of hospital stay and duration of use of polymyxins and carbapene-ms were longer in the PR-CRKP group than in the CRKP group(P＜0.05).Multivariate logistic regression analy-sis indicated that complication with other CROs infections,history of exposure to polymyxins and carbapenems 3 months before the admission,duration of use of polymyxins and ICU stay were the risk factors for the PR-CRKP infection(P＜0.05).The area under the curve(AUC)of the predictive model was 0.898 in the modeling group,with the sensitivity 80.33％,the specificity 84.51％.ROC curve analysis showed that the AUC was 0.901 in the validation group,with the sensitivity 75.00％,the specificity 92.73％.CONCLUSION The prediction model that is established based on the result of multivariate analysis has high value in prediction of PR-CRKP infection.

Objective To observe the value of contrast-enhanced ultrasound(CEUS)for diagnosing malignant adnexal tumors.Methods Totally 112 patients with single adnexal masse were retrospectively enrolled and divided into benign adnexal tumor group(benign group,n=73)and malignant adnexal tumor group(malignant group,n=39).Clinical data,laboratory indicators,ovarian-adnexal ultrasound reporting and data system(O-RADS)classification based on conventional ultrasound(US),CEUS manifestations and CEUS classification of benign and malignant tumors were compared between groups.Multivariable logistic regression analysis of clinical and laboratory indicators being statistically different between groups,as well as US O-RADS classification and CEUS classification was performed to screen the independent predictors of malignant adnexal tumors,and combined models were constructed using forward stepwise regression method.The efficacy of each independent predictor and combined model for diagnosing malignant adnexal tumors was analyzed.Results Statistical differences of carbohydrate antigen 125(CA125),US O-RADS classification,enhancement time and level of CEUS,as well as CEUS classification were found between groups(all P＜0.05).CA125,US O-RADS classification and CEUS classification were all independent predictors of malignant adnexal tumors(all P＜0.05).Combined model Ⅰ,Ⅱ and Ⅲ were constructed based on CA125+CEUS classification,US O-RADS classification+CEUS classification and CA125+US O-RADS classification+CEUS classification,respectively.The area under the curve(AUC)of single CA125 level,US O-RADS classification,CEUS classification and combined model Ⅰ,Ⅱ and Ⅲ for diagnosing malignant adnexal tumor was 0.708,0.809,0.908,0.918,0.945 and 0.954,respectively.AUC of combined model Ⅲ was higher than that of combined model Ⅰ(Z=-2.142,P=0.032),while no significant difference of AUC was found between combined model Ⅱ and Ⅰ nor Ⅱ and Ⅲ(both P＞0.05).Conclusion CEUS could be used to effectively diagnose malignant adnexal tumor.Combining with CA125 level and US O-RADS classification could significantly improve its diagnostic efficacy.

BACKGROUND:Allogeneic hematopoietic stem cell transplantation is currently the most effective method for the radical treatment of thalassemia major,but only half of patients can find compatible bone marrow or peripheral blood stem cells.Sib-derived umbilical cord blood stem cells have different characteristics from bone marrow and peripheral blood stem cells,and are a potential alternative source of hematopoietic stem cells for transplantation in patients with thalassemia major.OBJECTIVE:To investigate the therapeutic effect of human leukocyte antigen matched sibling fresh umbilical cord blood transplantation in the treatment of β-thalassemia major in children.METHODS:Forty-eight children with β-thalassemia major,including 28 males and 20 females,with a median age of 4 years old,were selected from Nanfang Hospital of Southern Medical University from June 2010 to June 2020.All of them received fresh cord blood transplantation from human leukocyte antigen matched sibling.Transplantation conditioning adopted a myeloablative regiment without anti-thymocyte globulin.A combination of cyclosporine A and mycophenolate mofetil with or without short-range methotrexate was administered for graft-versus-host disease.RESULTS AND CONCLUSION:(1)The median infused doses of total nucleated cells and CD34+cells were 8.17×107/kg and 2.40×105/kg,respectively in 48 children.The median follow-up time after cord blood transplantation was 98 months,and 44 cases were successfully engrafted.The median time to neutrophil and platelet engraftment was 28 and 31 days,respectively.Among them,37 cases were found to be donor-type complete chimerism detected as evidence of implantation after transplantation,7 cases were found to be stable mixed chimerism.(2)Among the 44 children with successful implantation,four patients developed acute graft-versus-host disease,and were scored as grade Ⅰ(n=2)and grade Ⅱ(n=2).All the affected organs were skin,and no chronic graft-versus-host disease occurred.(3)After umbilical cord blood transplantation,cytomegalovirus infection and activation occurred in 5 of the 48 cases,sepsis in 12 cases,invasive fungal disease in 3 cases,stomatitis in 21 cases,hemorrhagic cystitis in 8 cases,and hepatic vein occlusion in 1 case.(4)Among 48 children,47 patients survived;1 died of severe pneumonia combined with acute heart failure 28 days after transplantation;43 survived without disease;3 had primary implantation failure,and 1 had pancytopenia after transplantation.The 5-year probabilities of overall survival and disease-free survival were 98％and 89％,respectively.The cumulative incidence of transplant-related deaths at 1 year was 2.1％.(5)The above results indicate that human leukocyte antigen matched sibling fresh umbilical cord blood transplantation is effective in the treatment of β-thalassemia major in children with a low incidence of graft-versus-host disease.

This paper summarizes the perioperative nursing experience of a premature infant with congenital gastroschisis accompanied by malaria and heart disease during a medical aid mission in Africa.Nursing key points include:preoperative observation and protection of the protruding intestines to prevent intestinal injury and infection,timely identification and management of arrhythmias and acute hypoxic episodes;intraoperative close monitoring of vital signs and assisting the surgeon in creating an"artificial abdominal cavity";postoperative intensification of condition monitoring and intra-abdominal pressure surveillance,standardized medication administration and rational blood transfusion to prevent complications related to gastroschisis repair,and to control malaria-related symptoms,while providing nutritional support and reinforcing health education.Through collaborative diagnosis and treatment by a multidisciplinary team along with meticulous nursing care,the infant showed improvement and was discharged after 2 weeks.A follow-up visit 2 months postoperatively revealed normal feeding,good surgical wound healing,no recurrence of acute hypoxic episodes,and a persistent systolic murmur auscultated over the precordium.