Objective:To investigate the impact of immunosuppressive therapy on the severity of SARS-CoV-2 infection and cytokine levels in pediatric patients with kidney diseases.Methods:A retrospective analysis was conducted on the clinical data of 40 hospitalized pediatric patients who were diagnosed with SARS-CoV-2 infection at the 900th Hospital of PLA Joint Logistic Support Force from December 2022 to February 2023. Based on their immunosuppressive status prior to SARS-CoV-2 infection, these patients were categorized into immunosuppressive group and non-immunosuppressive group. Independent sample t-tests, Mann-Whitney U tests, and χ2 test were employed to compare the clinical baseline characteristics and laboratory data, the severity of SARS-CoV-2 infection, and the levels of cytokines between the 2 groups. Results:Among the 40 patients, 11 were in the immunosuppressive group (aged 13 (8, 14) years, 9 males and 2 females) and 29 in the non-immunosuppressive group (aged 2 (1, 4) years, 15 males and 14 females). In the immunosuppressive group, 2 were asymptomatic cases, 8 were mild cases, and 1 was moderate case, and there was no severe or critical cases. In the non-immunosuppressive group, 8 were mild cases, 5 were moderate, 15 were severe cases, 1 was critical case, and no asymptomatic cases. The underlying diseases in the immunosuppressive group included nephrotic syndrome (6 cases), IgA vasculitis nephritis (2 cases), lupus nephritis (1 case), post-renal transplantation (1 case), and renal failure (1 case), with a mean total immunosuppression score (TIS) of (3.6±1.4) points. In the non-immunosuppressive group, 2 patients had a history of epilepsy, and the remaining 27 cases had no underlying conditions, all with TIS scores of 0. Compared to the children in the non-immunosuppressive group, those in the immunosuppressive group were more likely to exhibit asymptomatic or mild infection, with lower risks of severe disease, cytokine storm, fever, and cough, but a higher risk of fatigue ( OR=1.22, 2.66, 0.48, 0.12, 0.12, 0.13, 1.22; 95% CI 0.93-1.62, 0.99-7.15, 0.33-0.70, 0.03-0.57, 0.03-0.57, 0.03-0.65, 0.93-1.62; all P<0.05). The levels of cytokine IL-6, interferon-α and interferon-γ in the immunosuppressive group were all lower than those in the non-immunosuppressive group ( Z=2.23, 2.51, 2.92, respectively; all P<0.05). Conclusion:Pediatric patients with kidney diseases receiving appropriate immunosuppressive therapy may mitigate the severity of SARS-CoV-2 infection by suppressing the expression of cytokines.

Objective:To investigate the impact of immunosuppressive therapy on the severity of SARS-CoV-2 infection and cytokine levels in pediatric patients with kidney diseases.Methods:A retrospective analysis was conducted on the clinical data of 40 hospitalized pediatric patients who were diagnosed with SARS-CoV-2 infection at the 900th Hospital of PLA Joint Logistic Support Force from December 2022 to February 2023. Based on their immunosuppressive status prior to SARS-CoV-2 infection, these patients were categorized into immunosuppressive group and non-immunosuppressive group. Independent sample t-tests, Mann-Whitney U tests, and χ2 test were employed to compare the clinical baseline characteristics and laboratory data, the severity of SARS-CoV-2 infection, and the levels of cytokines between the 2 groups. Results:Among the 40 patients, 11 were in the immunosuppressive group (aged 13 (8, 14) years, 9 males and 2 females) and 29 in the non-immunosuppressive group (aged 2 (1, 4) years, 15 males and 14 females). In the immunosuppressive group, 2 were asymptomatic cases, 8 were mild cases, and 1 was moderate case, and there was no severe or critical cases. In the non-immunosuppressive group, 8 were mild cases, 5 were moderate, 15 were severe cases, 1 was critical case, and no asymptomatic cases. The underlying diseases in the immunosuppressive group included nephrotic syndrome (6 cases), IgA vasculitis nephritis (2 cases), lupus nephritis (1 case), post-renal transplantation (1 case), and renal failure (1 case), with a mean total immunosuppression score (TIS) of (3.6±1.4) points. In the non-immunosuppressive group, 2 patients had a history of epilepsy, and the remaining 27 cases had no underlying conditions, all with TIS scores of 0. Compared to the children in the non-immunosuppressive group, those in the immunosuppressive group were more likely to exhibit asymptomatic or mild infection, with lower risks of severe disease, cytokine storm, fever, and cough, but a higher risk of fatigue ( OR=1.22, 2.66, 0.48, 0.12, 0.12, 0.13, 1.22; 95% CI 0.93-1.62, 0.99-7.15, 0.33-0.70, 0.03-0.57, 0.03-0.57, 0.03-0.65, 0.93-1.62; all P<0.05). The levels of cytokine IL-6, interferon-α and interferon-γ in the immunosuppressive group were all lower than those in the non-immunosuppressive group ( Z=2.23, 2.51, 2.92, respectively; all P<0.05). Conclusion:Pediatric patients with kidney diseases receiving appropriate immunosuppressive therapy may mitigate the severity of SARS-CoV-2 infection by suppressing the expression of cytokines.

Objective:To retrospectively analyze the treatment status of tyrosine kinase inhibitors (TKI) in newly diagnosed patients with chronic myeloid leukemia (CML) in China.Methods:Data of chronic phase (CP) and accelerated phase (AP) CML patients diagnosed from January 2006 to December 2022 from 77 centers, ≥18 years old, and receiving initial imatinib, nilotinib, dasatinib or flumatinib-therapy within 6 months after diagnosis in China with complete data were retrospectively interrogated. The choice of initial TKI, current TKI medications, treatment switch and reasons, treatment responses and outcomes as well as the variables associated with them were analyzed.Results:6 893 patients in CP ( n=6 453, 93.6%) or AP ( n=440, 6.4%) receiving initial imatinib ( n=4 906, 71.2%), nilotinib ( n=1 157, 16.8%), dasatinib ( n=298, 4.3%) or flumatinib ( n=532, 7.2%) -therapy. With the median follow-up of 43 ( IQR 22-75) months, 1 581 (22.9%) patients switched TKI due to resistance ( n=1 055, 15.3%), intolerance ( n=248, 3.6%), pursuit of better efficacy ( n=168, 2.4%), economic or other reasons ( n=110, 1.6%). The frequency of switching TKI in AP patients was significantly-higher than that in CP patients (44.1% vs 21.5%, P<0.001), and more AP patients switched TKI due to resistance than CP patients (75.3% vs 66.1%, P=0.011). Multi-variable analyses showed that male, lower HGB concentration and ELTS intermediate/high-risk cohort were associated with lower cytogenetic and molecular responses rate and poor outcomes in CP patients; higher WBC count and initial the second-generation TKI treatment, the higher response rates; Ph + ACA at diagnosis, poor PFS. However, Sokal intermediate/high-risk cohort was only significantly-associated with lower CCyR and MMR rates and the poor PFS. Lower HGB concentration and larger spleen size were significantly-associated with the lower cytogenetic and molecular response rates in AP patients; initial the second-generation TKI treatment, the higher treatment response rates; lower PLT count, higher blasts and Ph + ACA, poorer TFS; Ph + ACA, poorer OS. Conclusion:At present, the vast majority of newly-diagnosed CML-CP or AP patients could benefit from TKI treatment in the long term with the good treatment responses and survival outcomes.

The endovascular exclusion is an effective treatment of aortic aneurysm diseases in frail and elderly patients who cannot suffer the open surgery. However, as the key treatment device of this technique, traditional stent-grafts are not suitable to treat complex aortic aneurysm diseases in emergency. The emergence of the fenestrated stent-graft and in-situ fenestration has brought new dawn to the treatment of these patients. This study reviews the advances in complex aortic aneurysms treated by the fenestrated stent-graft and the in-situ fenestration. In addition, the novel concept of the fabric structure designed for "in-situ fenestrated stent-graft" is proposed for the in-situ fenestration technique. It is expected to break through the bottleneck of the present fenestrated stent-grafts. It would be beneficial to the bailout of complex aortic aneurysm diseases and thereby benefitting more patients.

OBJECTIVETo investigate the effects of total flavonoids from astragalus complanatus (FAC) on paraquat poisoning-induced pulmonary fibrosis in rats.

METHODSThe rats were divided into six groups randomly: control group, paraquat group, prednisolone group and FAC low-dose, middle-dose, high-dose group. Pulmonary fibrosis model was replicated by intratracheal injection of paraquat. In the mext day,the rats were treated by intragastric administration once a day. After 28 days, the rats were sacrificed. The lung index and the levels of HYP and T-AOC were measured, and the pathologic changes of the lung tissue were obtained by HE staining. The levels of TGF-β, Smad2, α-SMA protein were analyzed by Western blot.

RESULTSFAC improved the activity of T-AOC in serum and reduced pulmonary index and the content of HYP as well (P<0.05 or P<0.01), the alveolitis and fibrosis extent were attenuated. The expression of Smad2 significantly decreased in groups of FAC low-dose, middle-dose and high-dose (0.31±0.11, 0.45±0.12 and 0.30±0.05) as compared with that of the PQ group (0.85±0.34) (P<0.05). The expression of α-SMA significantly decreased in groups of FAC low-dose, middle-dose and high-dose (0.31±0.11, 0.35±0.07 and 0.32±0.10) as compared with that of the PQ group (0.45±0.08) (P<0.05). The expression of TGF-β significantly decreased in groups of FAC low-dose, middle-dose and high-dose (0.35±0.04, 0.27±0.05 and 0.18±0.04)as compared with that of the PQ group (0.63±0.11) (P<0.05).

CONCLUSIONFAC can alleviate PQ-induced pulmonary fibrosis in rats through inhibiting TGF-β/Smad signaling pathway.

Actins ; metabolism ; Animals ; Astragalus Plant ; chemistry ; Flavonoids ; pharmacology ; Lung ; pathology ; Paraquat ; poisoning ; Phytochemicals ; pharmacology ; Pulmonary Fibrosis ; chemically induced ; drug therapy ; Rats ; Smad2 Protein ; metabolism ; Transforming Growth Factor beta ; metabolism

BACKGROUND:Cytomegalovirus is relatively common condition pathogenic virus after liver transplantation. It has many direct or indirect effects on the body, and seriously affects the long-term survival of patients. It should be paid more attention.
OBJECTIVE:To analyze and summarize the outcomes of the epidemiology, risk factors, effects on the body, clinical manifestation, diagnosis, treatment and prevention for cytomegalovirus infection after liver transplantation.
METHODS:Fitness database, PubMed database and China National Knowledge Infrastructure database were retrieved by computer for articles on cytomegalovirus infection after liver transplantation published from January 2006 to December 2013, and through manual refer to books. Articles were searched with the key words of“liver transplantation, cytomegalovirus infection, risk factors”in Chinese and English. A total of more than 200 articles were retrieved. Forty articles directly related to cytomegalovirus infection after liver transplantation and those published in authoritative magazines were included to review with good representativeness.
RESULTS AND CONCLUSION:The positive rate of serum cytomegalovirus-IgG is high in the population. Risk factors of cytomegalovirus infection after liver transplantation include donor-recipient cytomegalovirus serologic status, low serum creatinine clearance, female patients, graft rejection, the use of immunosuppressant and donor-recipient MBL-2 and FCN-2 gene polymorphism. There are direct and indirect effects of this posttransplant opportunistic infection, such as cytomegalovirus syndrome, organ invasion lesions, graft loss, accelerated recurrence of hepatitis C, an increased risk of acute or chronic rejection, predisposition to other opportunistic infections, compromised immunity, accelerated atherosclerosis and the interaction between beta herpes virus. Therefore, prevention and early treatment are very crucial. A combination of pp65 antigen assay for screening and real-time RT-PCR methods for confirmation provides an optimal, low-cost diagnostic regimen for cytomegalovirus infection. Ganciclovir is the first selection for antiviral treatment after liver transplantation, but oral valganciclovir and intravenous ganciclovir are safe, feasible options for preemptive treatment of cytomegalovirus infection after liver transplantation. The plasma levels of CXCL16, PTX3 and von Wil ebrand factor at the start of treatment are independently associated with virologic and clinical treatment failure during anti-cytomegalovirus therapy in solid organ transplant recipients. We should choose different prevention programs for the patients of different donor-recipient cytomegalovirus serologic status.

Objective To study the diagnosis and treatment of hepatic focal nodular hyperplasia(FNH).Methods The clinical data of 15 FNH patients proved by pathological examination were retrospectively analyzedResults Most cases of FNH were asymptomatic,and some had nonspecific symptom such as dull pain of upper abdomen.Most cases of FNH showed nodular lesion on liver imaging with isodensity or hypodensity on pre-contrast CT scan and strong enhancement during arterial phase.of the 15 FNH patients,5 eases were diagnosed by needle biopsy pathology,10 cases were diagnosed by postoperative pathology.And 10 cases underwent surgical resection(7 cages with irregular hepatectomy,1 case with resection of segment 7,2 cases with left lateral lobeetomy),2 cases underwent percutaneous transhepafic chemical ablation,3 cases underwent clinical observation.All cases were followed up,and no recurence or malignancy were found.Conclusion FNH is a kind of benign tumor of liver without specific clinical manifestation.Accurate diagnosis needs pathological examination.Surgical treatment is recommended in most cages.Close follow-up is recommended in cases without operation.