Objectives:To investigate the incidence and related risk factors of mid-term postoperative cognitive impairment by a single cognitive function test among heart transplant recipients.Methods:The heart transplant recipients who visited our heart transplant outpatient department from May to October of 2019 were recruited and received cognitive function test.Their heart transplantation,anesthesia,cardiopulmonary bypass and immunosuppressive therapy were performed by the same heart transplant team.Mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA)were used to test the study population and diagnose cognitive impairment.The patients were divided into cognitive impairment group and non-cognitive impairment group,and the clinical characteristics,perioperative characteristics of heart transplantation,hospital outcomes and donor characteristics were compared between the two groups.After excluding those with missing data(n=34),48 patients in the cognitive impairment group and 50 patients in the non-cognitive impairment group were analyzed.Univariate and multivariate logistic regression were used to analyze the potential influencing factors of cognitive impairment diagnosed by a single assessment after heart transplantation.Results:The median time of cognitive test after surgery was 2(1,4)years.The incidence of mid-term postoperative cognitive impairment by a single test among heart transplant recipients was 50.0%(66/132).Compared with the non-cognitive impairment group,patients in the cognitive impairment group were older at heart transplant([40.2±13.4]years vs.[46.4±11.0]years)and at cognitive test([42.3±13.0]years vs.[49.2±11.2]years),with a higher proportion of males(68.0%vs.87.5%),a higher proportion of those with lower education(less than high school)(31.9%vs.63.8%),and a longer postoperative hospital stay(32.0[26.0,38.8]d vs.38.0[20.3,50.0]d),and the differences between groups were statistically significant(all P<0.05).Multivariate logistic regression analysis showed that older age at cognitive test(OR=1.067,95%CI:1.019-1.117,P=0.005),longer postoperative in-hospital stay(OR=1.051,95%CI:1.006-1.097,P=0.025)were associated with higher risk of mid-term postoperative cognitive impairment by a single test,while the education level higher than high school was an independent protective factor(OR=0.132,95%CI:0.029-0.607,P=0.009)of mid-term postoperative cognitive impairment.Conclusions:The incidence of mid-term postoperative cognitive impairment by a single test among heart transplant recipients is high.Patients with an older age,low education level,long postoperative in-hospital stay face increased risk of mid-term postoperative cognitive impairment,these patients need to be monitored for cognitive function during follow up to achieve early recognition and treatment of cognitive decline.

Objective:To establish a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the determination of N-desalkylquetiapine, hydroxybupropion, N-desmethyl clozapine, N-desmethyl clomipramine, O-desmethyvenlafaxine and dehydro aripiprazole in human plasma.Methods:In June 2023, plasma samples were treated with methanol-acetonitrile (volume ratio of 1∶1) for protein precipitation and then detected by LC-MS/MS. It was separated by C18 column and eluted with 5 mmol/L ammonium acetate water and 5 mmol/L ammonium acetate methanol solution as mobile phase gradient. The metabolites of six psychotropic drugs were qualitatively and quantitatively by using electrospray positive ion multi-reactive ion monitoring scanning mode (MRM) .Results:The linear relationships of six psychotropic drug metabolites were good in the concentration range of 2-100 μg/L. The linear correlation coefficients were 0.9971-0.9999, the limits of quantification of the method were 0.10-6.00 μg/L, and the inter-and intra-day precision were 4.6%-9.8% and 1.5%-8.6%, with the recoveries of the spiked standards ranged from 90.0% to 106.1%.Conclusion:The LC-MS/MS method for the determination of metabolites of six psychotropic drugs in human plasma is simple, rapid and sensitive, and can be used for the qualitative and quantitative determination of metabolites in plasma samples of patients suspected of psychotropic drug poisoning.

Objective:To evaluate the effect of value orientation brief therapy(VBT)combined with selective serotonin reuptake inhibitors(SSRIs)on clinical symptoms,rumination,decision-making ability,and cognitive func-tion in patients with mild to moderate depression.Methods:Eighty patients meeting the DSM-5 diagnostic criteria for mild to moderate depression were randomly assigned to either a medication(SSRIs)group(36 completed)or a VBT combined group(38 completed)for a 6-week intervention.Baseline and post-intervention assessments includ-ed the Hamilton Depression Scale(HAMD),Hamilton Anxious Scale(HAMA),Ruminative Response Scale-Chi-nese Version(RRS-CV),Iowa Gambling Test(IGT),number of eye fixation(NEF),responsive search score(RSS)in exploratory eye trajectory movement were used to evaluate patients'anxiety and depression symptoms,ru-minative thinking,decision-making function,and cognitive function.Results:The VBT combined group showed sig-nificantly better therapeutic effects than the medication group(P＜0.05).Compared to baseline and the medication group,the VBT combined group had significantly lower post-intervention scores in HAMD,HAMA,symptom rumi-nation,introspective reflection,compulsive meditation,and RRS-CV total scores after intervention(Ps＜0.05),and significantly higher scores in IGT net profit scores,NEF,and RSS scores(Ps＜0.05).Compared with the medica-tion group,the VBT combined group demonstrated a greater reduction in HAMD,HAMA,symptom rumination,in-trospective reflection,compulsive meditation,and RRS-CV total scores before and after intervention(Ps＜0.05),and a larger increase in IGT net profit scores,NEF,and RSS scores(Ps＜0.05).Conclusion:VBT combined with SSRIs effectively improves the symptoms of depression,anxiety,decision-making ability,rumination thinking,and cognitive function in patients with mild to moderate depression.

Lacking therapeutic targets highlights the crucial roles of chemotherapy and radiotherapy in the clinical management of triple-negative breast cancer (TNBC). To relieve the side effects of the chemoradiotherapy combination regimen, we design and develop a self-assembled micelle nanosystem consisting of perfluorocarbon chain-modified cisplatin prodrug. By incorporating perfluorodecalin, this nanosystem can effectively carry ozone and promote irradiation-derived reactive oxygen species (ROS) production. By leveraging the perfluorocarbon sidechain, the nanosystem exhibits efficient internalization by TNBC cells and effectively escapes from lysosomal entrapment. Under X-ray irradiation, ozone-generated ROS disrupts the intracellular redox balance, thereby facilitating the release of cisplatin in a reduction-responsive manner mediated by reduced glutathione. Moreover, oxygen derived from ozone decomposition enhances the efficacy of radiotherapy by alleviating tumor hypoxia. Notably, the combination of irradiation with ozone-loaded cisplatin prodrug nano system synergistically prompts antitumor efficacy and reduces cellular/systemic toxicity in vitro and in vivo. Furthermore, the combo regimen remodels the tumor microenvironment into an immune-favored state by triggering immunogenic cell death and relieving hypoxia, which provides a promising foundation for a combination regimen of immunotherapy. In conclusion, our nanosystem presents a novel strategy for integrating chemotherapy and radiotherapy to optimize the efficacy and safety of TNBC clinical treatment.

Objective:To explore the relationship between childhood trauma and anxiety symptom among high school students,as well as the mediating role of social support and the moderating role of stressful life events.Methods:A total of 3 075 high school students were selected.The Short Form of the Childhood Trauma Questionnaire(CTQ-SF),Social Support Rate Scale(SSRS),Adolescent Self-Rating Life Events Checklist(ASLEC)and Chinese Secondary School Students Anxiety Scale(CSSAS)were used to assess the levels of child-hood trauma,social support,stressful life events,and anxiety symptom severity.The SPSS PROCESS 3.3 macropro-gram was used to test the mediating effect and moderated mediation effect.Results:The CTQ-SF scores were posi-tively correlated with CSSAS scores(r=0.26,P＜0.001).The SSRS scores and the subjective support(S2)scores and availability of support(S3)scores in the SSRS played partial mediating effects between CTQ-SF scores and CSSAS scores.The mediating effects were 0.11(95％CI:0.09-0.12,P＜0.001),0.08(95％CI:0.06-0.09,P＜0.001),0.04(95％CI:0.03-0.06,P＜0.001)respectively,which accounted for 44.00％,32.00％,16.00％of the total effect respectively.The ASLEC scores moderated the relationship between CTQ-SF scores and CSSAS scores(β=0.02,P=0.044),and the relationship between SSRS scores and CSSAS scores(β=0.08,P＜0.001).Conclusion:Among high school students,social support and the subjective support and availability of support in so-cial support play partial mediating effects between childhood trauma and anxiety symptom,and stressful life events moderates the relationship between childhood trauma,social support and anxiety symptom.

Objective To explore the protective effects of genetically modified porcine erythrocyte suspension as a subnormothermic normoxic mechanical perfusate on hypoxic-ischemic brain injury in cynomolgus monkeys caused by traumatic hemorrhage.Methods Cynomolgus monkeys were randomly divided into positive and negative control groups(a total of 3 monkeys,with 3 left cerebral hemispheres as the positive control group and 3 right cerebral hemispheres as the negative control group)and the subnormothermic perfusion group(n=3).The positive control group was directly sampled 1 hour after circulatory arrest,while the negative control group was placed at subnormothermic conditions for 6 hours after circulatory arrest.The subnormothermic perfusion group underwent 6 hours of subnormothermic normoxic mechanical perfusion of the bilateral common carotid arteries of the cynomolgus monkey hypoxic-ischemic brain injury model using genetically modified porcine erythrocyte suspension 1 hour after circulatory arrest.Before perfusion,cross-matching experiments were conducted between the six genetically modified pig and the cynomolgus monkeys.After the start of perfusion,the levels of routine blood indicators in the perfusate were detected at 0,1,2,3,4,5 and 6 hours.Blood oxygen saturation was recorded,and the levels of Na+,K+,Ca2+,glucose and blood pH in the perfusate were measured,as well as the levels of IgG and IgM in the perfusate.After 6 hours of perfusion,the water content of the brain tissue was measured.Nissl staining was performed on the frontal cortex and hippocampal regions,and immunofluorescence staining was used to detect the expression of glial fibrillary acidic protein(GFAP),ionized calcium-binding adapter molecule 1(Iba1)and neuronal nuclear antigen(NEUN).Results The cross-matching results between the six genetically modified pig and the cynomolgus monkeys were negative.The number of red blood cells in the perfusate decreased significantly at 3 hours of perfusion,and the hemoglobin level showed a downward trend at 1,3,5 and 6 hours.The number of white blood cells and platelets decreased at all time points.The blood oxygen saturation in the subnormothermic perfusion group remained stable at 95%-98%,and the levels of blood oxygen saturation,Na+,Ca2+,glucose and pH were stable,while the K+level first increased and then decreased.There was no significant difference in the levels of IgG and IgM before and after perfusion.The water content of brain tissue at the end of perfusion in the subnormothermic perfusion group was significantly higher than that in the positive control group(P<0.001).Nissl staining results showed that compared with the positive control group,the pyramidal neurons in the prefrontal cortex of the subnormothermic perfusion group maintained better morphological integrity,with no significant increase in enlarged and deformed cells.In the hippocampal CA1 region,there was a slight increase in enlarged and deformed cells,and a few cells with undamaged structures showed reduced cell size.In the hippocampal dentate gyrus,fewer granule neurons had compromised structural integrity,with increased cell edema.NEUN immunofluorescence staining showed that compared with the positive control group,the pyramidal neurons in the prefrontal cortex and hippocampal CA1 region of the subnormothermic perfusion group had better morphological states,with clear axons.The granule cells in the hippocampal dentate gyrus were well preserved,but the nuclei were less well protected.GFAP immunofluorescence staining showed that compared with the positive control group,the subnormothermic perfusion group had sparser protrusions that were more tightly associated with neurons.Iba1 immunofluorescence staining showed that compared with the positive control group,the subnormothermic perfusion group had thicker and fewer protrusions.Conclusions Compared with the positive control group,subnormothermic normoxic mechanical perfusion with genetically modified porcine erythrocyte perfusate increases brain tissue edema in cynomolgus monkeys,but better preserves the morphological integrity of neurons and glial cells.The protective effects may be related to the continuous oxygen and energy supply,maintenance of ion homeostasis and perfusate pH,reduced rejection,and low metabolic state of the whole brain.

Objective:To explore the relationship between childhood trauma and anxiety symptom among high school students,as well as the mediating role of social support and the moderating role of stressful life events.Methods:A total of 3 075 high school students were selected.The Short Form of the Childhood Trauma Questionnaire(CTQ-SF),Social Support Rate Scale(SSRS),Adolescent Self-Rating Life Events Checklist(ASLEC)and Chinese Secondary School Students Anxiety Scale(CSSAS)were used to assess the levels of child-hood trauma,social support,stressful life events,and anxiety symptom severity.The SPSS PROCESS 3.3 macropro-gram was used to test the mediating effect and moderated mediation effect.Results:The CTQ-SF scores were posi-tively correlated with CSSAS scores(r=0.26,P＜0.001).The SSRS scores and the subjective support(S2)scores and availability of support(S3)scores in the SSRS played partial mediating effects between CTQ-SF scores and CSSAS scores.The mediating effects were 0.11(95％CI:0.09-0.12,P＜0.001),0.08(95％CI:0.06-0.09,P＜0.001),0.04(95％CI:0.03-0.06,P＜0.001)respectively,which accounted for 44.00％,32.00％,16.00％of the total effect respectively.The ASLEC scores moderated the relationship between CTQ-SF scores and CSSAS scores(β=0.02,P=0.044),and the relationship between SSRS scores and CSSAS scores(β=0.08,P＜0.001).Conclusion:Among high school students,social support and the subjective support and availability of support in so-cial support play partial mediating effects between childhood trauma and anxiety symptom,and stressful life events moderates the relationship between childhood trauma,social support and anxiety symptom.

Epidermal growth factor receptor inhibitor (EGFRI) -related paronychia is a condition clearly related to EGFRI therapy, characterized by periungual erythema, edema, purulent exudates, periungual or subungual granulomatous lesions, and sometimes accompanied by thinning, fragility or even splitting and seperation of nail plates. Inhibition of epidermal function, inflammation and secondary infections, as well as angiogenesis are the core processes in the occurrence and development of EGFRI-related paronychia. This review summarizes epidemiology, pathogenesis, clinical manifestations, prevention and treatment of EGFRI-related paronychia.