BACKGROUND: Pre-transplant exposure to immune checkpoint inhibitors (ICIs) significantly increases the risk of allograft rejection after liver transplantation (LT); however, whether ICI-related rejection leads to increased graft loss remains controversial. Therefore, this study aimed to investigate the association between ICI-related allograft rejection and perioperative graft loss. METHODS: This was a retrospective analysis of adult liver transplant recipients with early biopsy-proven T-cell-mediated rejection (TCMR) at Liver Transplantation Center of Sun Yat-sen Memorial Hospital from June 2019 to September 2024. The pathological features, clinical characteristics, and perioperative graft survival were analyzed. RESULTS: Twenty-eight patients who underwent early TCMR between June 2019 and September 2024 were included. Based on pre-LT ICI exposure, recipients were categorized into ICI-related TCMR (irTCMR, n = 12) and conventional TCMR (cTCMR, n = 16) groups. Recipients with irTCMR had a higher median Banff rejection activity index (RAI) (6 vs . 5, P = 0.012) and more aggressive tissue damage and inflammation. Recipients with irTCMR showed higher proportion of treatment resistance, achieving a complete resolution rate of only 8/12 compared to 16/16 for cTCMR. Graft loss occurred in 5/12 of irTCMR recipients within 90 days after LT, with no graft loss in cTCMRs recipients. Cox analysis demonstrated that irTCMR with an ICI washout period of <30 days was an independent risk factor for perioperative graft loss (hazard ratio [HR], 6.540; 95% confidence interval [CI], 1.067-40.067, P = 0.042). CONCLUSION IrTCMR is associated with severe pathological features, increased resistance to treatment, and higher graft loss in adult liver transplant recipients.
Humans ; Liver Transplantation/adverse effects* ; Male ; Female ; Middle Aged ; Retrospective Studies ; Graft Rejection/immunology* ; Immune Checkpoint Inhibitors/therapeutic use* ; Adult ; T-Lymphocytes/drug effects* ; Graft Survival/immunology* ; Aged

Objective:To evaluate corrective effect of cone beam computed tomography(CBCT)in children with malocclusion during mixed dentition period.Methods:A total of 90 children with malocclusion during mixed dentition period who admitted to 3201th hospital between January and December 2023 were enrolled,and all of them underwent routine orthodontics.Before and after treatment,CBCT scan was performed to obtain oral and maxillofacial imaging data.According to measurement and analysis for imaging data,the corrective effect,the relation indicators between sagittal and vertical directions of jawbone,which included the constructed angle among the center point of sella turcica-nasion-superior alveolar seat(SNA),the constructed angle among the center point of sella turcica-nasion-inferior alveolar seat(SNB),the constructed angle among superior alveolar seat-nasion-inferior alveolar seat(ANB),the constructed angle between occlusal plane and sella-nasion plane(OP-SN),the angle between mandibular plane and extended line of occlusal plane(SN-MP),were assessed.In addition,the other related mandibular indicators included the angle(Y axis angle)between Y axis and orbitoauricular plane,the angle of nasion A point line-orbitale-pterygomaxillary fissure line(NA-Apo),gonion-pogonion length(Go-Pg),the distance values(Wits)between anterior nasal crest and orbitomeatal plane,and between posterior nasal crest and orbitomeatal plane also were assessed.Third,the soft tissue-related indicators,which included the distance(UL-EP)between upper lip protrusion point,nasal protrusion point and soft tissue line,and the distance(LL-EP)between lower lip protrusion point,nasal protrusion point and soft tissue line,and the nasal labial angle(NLA),the lower intersection angle between the line connecting the nasal columella point and the infranasal point,and the lower intersection angle between the line connecting the nasal columella point and upper lip protrusion point,and the angle(H)between H line and soft tissue surface angle,were assessed.Finally,the dentally relative indicators,which included incisor mandibular plane angle(IMPA angle),upper central incisor-sella nasion plane angle(U1-SN),upper central incisor-nasion appoint angle(U1-NA),lower central incisor-nasion B point angle(L1-NB),overbite and coverage,were also assessed.Results:In the 90 children with malocclusion during mixed dentition period after treatment,25 cases(27.78%)were cured,and 56 cases obtained effective treatment(62.22%)and 9 cases(10.00%)did not obtain effective treatment,and effective rate of correction was 90.00%.There was not significant change in SNB angle between before and after treatment,and the difference was not statistically significant(P>0.05).Compared with the indicators before treatment,OP-SN was decreased,while SN-MP,SNA and ANB were all increased after treatment,and the differences were statistically significant(t=6.402,6.135,3.753,50.965,P<0.05).There were not significant changes in Y-axis angle,Wits value,S-Go/N-Me and L1-NB angle between before and after treatment,and the differences were not statistically significant(P>0.05).Compared with the indicators before treatment,the NA-Apo and Go-Pg were increased after treatment,and the differences were statistically significant(t=46.885,7.575,P<0.05).Compared with the indicators before treatment,the NLA,H angle and UL-EP were increased,while LL-EP was decreased after treatment,and the differences were statistically significant(t=2.707,4.163,28.622,3.276,P<0.05).There was not significant change in L1-NB between before and after treatment,and the difference was not statistically significant(P>0.05).Compared with the indicators before treatment,the coverage,U1-SN and U1-NA were increased,while overbite and IMPA were decreased,and the differences were statistically significant(t=16.154,4.723,6.432,4.802,4.106,P<0.05).Conclusion:CBCT can clearly and accurately display three-dimensional morphology and changes of maxillofacial structure of oral cavity,which can provides comprehensive and reliable basis for the assessment for correction effect.Moreover,orthodontic treatment has positive significance in improving dentition occlusion relationship,guiding normal development of jawbone,and optimizing morphology of facial soft tissues,which can provide important reference for the formulation and optimization of the treatment scheme of clinical orthodontics.

Objective To analyze the efficacy and safety of the traditional Chinese medicine(TCM)in the treatment of treating coronary heart disease and their effects on TG levels of patients with dyslipidemia based on the theory of"Spleen failing to disperse essence and combined phlegm and stasis"combined with Western medicine.Methods Eight different electronic databases were searched to include randomized controlled trials(RCTs)of the TCM based on the theory of"Spleen failing to disperse essence and combined phlegm and stasis"for CHD complicated with dyslipidemias published from inception to November 2024.Literature screening and data extraction were performed based on the inclusion and exclusion criteria.Meta-analysis was performed by RevMan 5.4.The GRADE system and TSA 0.9.5.10 Beta were adopted to evaluate the certainty and conclusiveness of the evidence.Results A total of 30 RCTs involving 2798 subjects were included.There were 1402 subjects in the experimental group and 1396 subjects in the control group.Meta-analysis showed that the group of Huatan Quyu therapy was effective in improving the clinical efficacy(RR=1.26,95%CI[1.19,1.33],P<0.00001),angina symptoms(RR=1.25,95%CI[1.14,1.37],P<0.00001),electrocardiogram efficacy(RR=1.27,95%CI[1.17,1.39],P<0.00001),and TCM symptom efficacy(RR=1.32,95%CI[1.23,1.42],P<0.00001).Additionally,TG levels(WMD=-0.44,95%CI[-0.52,-0.36],P<0.00001)and hs-CRP levels(WMD=-2.80,95%CI[-3.15,-2.45],P<0.00001)decreased.Concerning hemorheology,Huatan Quyu therapy effectively reduced WBV(WMD=-1.34,95%CI[-1.65,-1.02],P<0.00001)、PV(WMD=-0.44,95%CI[-0.45,-0.43],P<0.00001)and FIB(WMD=-0.46,95%CI[-0.75,-0.18],P=0.001).In terms of safety,19 studies reported the adverse reactions in detail,but the severity was mild and symptoms disappeared after treatment.TSA showed that the cumulative Z-curve of the clinical efficacy crossed the traditional threshold and TSA threshold,which further affirmed the clinical efficacy.The GRADE graded the evidence of the above outcome indicators as moderate or low.Conclusion TCM based on the theory of"Spleen failing to disperse essence and combined phlegm and stasis"may be effective and safe in the treatment of patients with CHD and lowering TG levels in dyslipidemic patients.Since the quality of the literature included in this study was generally low,there is an urgent need for more RCTs with high quality,low bias risk and sufficient sample size to validate the above conclusions.

This paper reviews gamified mobile applications, summarizes their current application status in nurse training for pressure injury management, and analyzes the functions, uses, and limitations of pressure injury management mobile applications. The aim is to provide a reference for the development of gamified mobile applications for pressure injury management in China.

Objective:To investigate the dynamic cerebral oxygen metabolism characteristics in drug-naive patients with primary insomnia (PI), and analyze the association between the cerebral oxygen metabolism and insomnia symptoms.Methods:A total of 31 drug-naive patients with PI and 36 healthy controls were recruited from July 2024 to February 2025. Insomnia symptoms were assessed by the Pittsburgh sleep quality index (PSQI). Functional near infrared spectroscopy (fNIRS) technique was employed to collect 180 s resting-state oxygenated hemoglobin concentration changes from dorsolateral prefrontal cortex (DLPFC), medial prefrontal cortex, temporal lobe (TL), parietal lobe (PL) and occipital lobe. Sliding time window analysis and K-means clustering algorithm were applied to cluster the oxygenation data into K temporal categories. Statistical analysis, including t-test, Wilcoxon rank-sum test, chi-square test, Pearson/Spearman correlation analysis, and multiple linear regression were performed using SPSS 26.0 software. Results:Clustering analysis revealed 4 characteristic temporal categories (K=4) during the 180 s resting-state. Compared to healthy controls, drug-naive PI patients exhibited higher oxygenation levels in bilateral TLs during the second temporal category(left TL(18.19±6.18)mmol/dL, (16.82±4.47)mmol/dL; right TL(18.20±8.97)mmol/dL, (16.17±5.64)mmol/dL), but lower levels during the third temporal category(left TL(16.54± 5.09)mmol/dL, (17.98±5.34)mmol/dL; right TL(15.82±7.29)mmol/dL, (17.84±5.94)mmol/dL), and exhibited lower oxygenation level in right PL during the second category((16.16±6.56)mmol/dL, (17.60±5.84)mmol/dL) (all P<0.05). Oxygenation levels in the right DLPFC during the first temporal category ( β=0.44, t=2.52, P=0.018), in the left DLPFC during the second temporal category( β=-0.47, t=-2.82, P=0.009), and in the right PL during the second temporal category( β=-0.46, t=-2.78, P=0.010) were influencing factors for the PSQI score. Conclusions:The bilateral TLs and right PL in drug-naive PI patients exhibit phase-specific abnormalities in oxygen metabolism, potentially attributable to the insomnia-induced dysregulation of endogenous neural oscillations. The oxygen concentration changes in bilateral DLPFCs and right TL are associated with insomnia symptoms.

Objective:To investigate the killing effect of the oncolytic virus Rigvir on six different colorectal cancer cell lines in vitro and differences in the sensitivity of different cell lines to Rigvir,to analyze the differentially expressed genes and signaling pathways be-tween sensitive and insensitive cells and the reasons for such differences,to explore the killing mechanism of the oncolytic virus Rigvir on colorectal cancer cells based on experimental results,and to lay a theoretical foundation for the use of the oncolytic virus Rigvir as a novel immunotherapeutic drug for the treatment of colorectal can-cer.Methods:Cell Counting Kit-8(CCK-8)assay was used for quantitative assessment of the inhibition rate of Rigvir on cells,and the Annexin V-FITC\PI method was used to measure the apoptosis rate of sensitive cell lines and preliminarily analyze its killing mechanism.Bioinformatics techniques were used to investigate the differentially expressed genes and signaling pathways between sensitive and insensitive cells,and Western blot experiments were used for validation and detecting the expression of apoptosis factors.High expression of upstream factors in differential signaling pathways,and application of real-time quantitative reverse transcription polymerase chain reaction(RT-qPCR)and WB to detect the effect of Rigvir on the expression levels of target genes and proteins in overexpressing sensitive cell lines.Results:SW480 and HT29 were sensitive to the oncolytic virus Rigvir,others had relatively insensi-tive(P<0.001).However,the inhibitory effect of Rigvir with two concentration gradients on HT29 was more significant(P<0.001).After 48 hours of infection,the cell inhibition rate of SW480 cells no longer increased with the prolongation of infection time(F=52.010,P=0.147),but it was more sensitive to changes in virus concentration(F=13.490,P<0.001).On the contrary,changes in virus concentration had no significant effect on the inhibition rate of HT29 cells(F=8.450,P=0.281),but the inhibition rate continued to in-crease after 48 hours with the prolongation of infection time(F=24.380,P<0.001).The apoptosis rate of sensitive group cells gradually increased with the prolongation of infection time(P<0.001),which mainly characterized by late stage apoptosis and necrotic cells.Through bioinformatics techniques,significant differences were observed in the classic PI3K/Akt/mTOR signaling pathway between the sensitive and insensitive groups.Western blot experiments showed that after the application of Rigvir,the upstream protein expression of PI3K/Akt/mTOR in the sensitive cell group was significantly reduced(P<0.001).The expression levels of apoptosis factors caspase-3 and caspase-8 increased,while the Bcl-2/Bax ratio decreased(P<0.001).The results of RT-qPCR and Western blot showed that after Rigvir was applied to the sensitive cell line HT29 overexpression type,the expression levels of PI3K/Akt/mTOR upstream and downstream signaling molecules(Akt,4EBP1,and p70S6K)were significantly reduced compared to the control group(P<0.05).Conclusion:Rigvir can effectively kill some colorectal cancer cell lines(SW480,HT29)in vitro,its mechanism of action is partially in-duced by the PI3K/Akt/mTOR classical signaling pathway to induce cell apoptosis.

The special natural environment of the plateau brings about great difficulties and challenges to the field medical support.The serious injury treatment group of the field medical team is responsible for the early treatment of the critically injured,which is highly demanding and is more likely to be adversely affected by the plateau environment.Based on the real experiences and current reality,this paper outlines the priorities of work done by the serious injury treatment group on the plateau in terms of personnel selection,professional training,material preparation,site construction,treatment regimens and combat readiness in the hope of providing references for the medical support for China's the military on the plateau.

This paper reviews gamified mobile applications, summarizes their current application status in nurse training for pressure injury management, and analyzes the functions, uses, and limitations of pressure injury management mobile applications. The aim is to provide a reference for the development of gamified mobile applications for pressure injury management in China.

Objective:To investigate the dynamic cerebral oxygen metabolism characteristics in drug-naive patients with primary insomnia (PI), and analyze the association between the cerebral oxygen metabolism and insomnia symptoms.Methods:A total of 31 drug-naive patients with PI and 36 healthy controls were recruited from July 2024 to February 2025. Insomnia symptoms were assessed by the Pittsburgh sleep quality index (PSQI). Functional near infrared spectroscopy (fNIRS) technique was employed to collect 180 s resting-state oxygenated hemoglobin concentration changes from dorsolateral prefrontal cortex (DLPFC), medial prefrontal cortex, temporal lobe (TL), parietal lobe (PL) and occipital lobe. Sliding time window analysis and K-means clustering algorithm were applied to cluster the oxygenation data into K temporal categories. Statistical analysis, including t-test, Wilcoxon rank-sum test, chi-square test, Pearson/Spearman correlation analysis, and multiple linear regression were performed using SPSS 26.0 software. Results:Clustering analysis revealed 4 characteristic temporal categories (K=4) during the 180 s resting-state. Compared to healthy controls, drug-naive PI patients exhibited higher oxygenation levels in bilateral TLs during the second temporal category(left TL(18.19±6.18)mmol/dL, (16.82±4.47)mmol/dL; right TL(18.20±8.97)mmol/dL, (16.17±5.64)mmol/dL), but lower levels during the third temporal category(left TL(16.54± 5.09)mmol/dL, (17.98±5.34)mmol/dL; right TL(15.82±7.29)mmol/dL, (17.84±5.94)mmol/dL), and exhibited lower oxygenation level in right PL during the second category((16.16±6.56)mmol/dL, (17.60±5.84)mmol/dL) (all P<0.05). Oxygenation levels in the right DLPFC during the first temporal category ( β=0.44, t=2.52, P=0.018), in the left DLPFC during the second temporal category( β=-0.47, t=-2.82, P=0.009), and in the right PL during the second temporal category( β=-0.46, t=-2.78, P=0.010) were influencing factors for the PSQI score. Conclusions:The bilateral TLs and right PL in drug-naive PI patients exhibit phase-specific abnormalities in oxygen metabolism, potentially attributable to the insomnia-induced dysregulation of endogenous neural oscillations. The oxygen concentration changes in bilateral DLPFCs and right TL are associated with insomnia symptoms.

Objective:To evaluate corrective effect of cone beam computed tomography(CBCT)in children with malocclusion during mixed dentition period.Methods:A total of 90 children with malocclusion during mixed dentition period who admitted to 3201th hospital between January and December 2023 were enrolled,and all of them underwent routine orthodontics.Before and after treatment,CBCT scan was performed to obtain oral and maxillofacial imaging data.According to measurement and analysis for imaging data,the corrective effect,the relation indicators between sagittal and vertical directions of jawbone,which included the constructed angle among the center point of sella turcica-nasion-superior alveolar seat(SNA),the constructed angle among the center point of sella turcica-nasion-inferior alveolar seat(SNB),the constructed angle among superior alveolar seat-nasion-inferior alveolar seat(ANB),the constructed angle between occlusal plane and sella-nasion plane(OP-SN),the angle between mandibular plane and extended line of occlusal plane(SN-MP),were assessed.In addition,the other related mandibular indicators included the angle(Y axis angle)between Y axis and orbitoauricular plane,the angle of nasion A point line-orbitale-pterygomaxillary fissure line(NA-Apo),gonion-pogonion length(Go-Pg),the distance values(Wits)between anterior nasal crest and orbitomeatal plane,and between posterior nasal crest and orbitomeatal plane also were assessed.Third,the soft tissue-related indicators,which included the distance(UL-EP)between upper lip protrusion point,nasal protrusion point and soft tissue line,and the distance(LL-EP)between lower lip protrusion point,nasal protrusion point and soft tissue line,and the nasal labial angle(NLA),the lower intersection angle between the line connecting the nasal columella point and the infranasal point,and the lower intersection angle between the line connecting the nasal columella point and upper lip protrusion point,and the angle(H)between H line and soft tissue surface angle,were assessed.Finally,the dentally relative indicators,which included incisor mandibular plane angle(IMPA angle),upper central incisor-sella nasion plane angle(U1-SN),upper central incisor-nasion appoint angle(U1-NA),lower central incisor-nasion B point angle(L1-NB),overbite and coverage,were also assessed.Results:In the 90 children with malocclusion during mixed dentition period after treatment,25 cases(27.78%)were cured,and 56 cases obtained effective treatment(62.22%)and 9 cases(10.00%)did not obtain effective treatment,and effective rate of correction was 90.00%.There was not significant change in SNB angle between before and after treatment,and the difference was not statistically significant(P>0.05).Compared with the indicators before treatment,OP-SN was decreased,while SN-MP,SNA and ANB were all increased after treatment,and the differences were statistically significant(t=6.402,6.135,3.753,50.965,P<0.05).There were not significant changes in Y-axis angle,Wits value,S-Go/N-Me and L1-NB angle between before and after treatment,and the differences were not statistically significant(P>0.05).Compared with the indicators before treatment,the NA-Apo and Go-Pg were increased after treatment,and the differences were statistically significant(t=46.885,7.575,P<0.05).Compared with the indicators before treatment,the NLA,H angle and UL-EP were increased,while LL-EP was decreased after treatment,and the differences were statistically significant(t=2.707,4.163,28.622,3.276,P<0.05).There was not significant change in L1-NB between before and after treatment,and the difference was not statistically significant(P>0.05).Compared with the indicators before treatment,the coverage,U1-SN and U1-NA were increased,while overbite and IMPA were decreased,and the differences were statistically significant(t=16.154,4.723,6.432,4.802,4.106,P<0.05).Conclusion:CBCT can clearly and accurately display three-dimensional morphology and changes of maxillofacial structure of oral cavity,which can provides comprehensive and reliable basis for the assessment for correction effect.Moreover,orthodontic treatment has positive significance in improving dentition occlusion relationship,guiding normal development of jawbone,and optimizing morphology of facial soft tissues,which can provide important reference for the formulation and optimization of the treatment scheme of clinical orthodontics.