ObjectiveTo observe the clinical efficacy of acupuncture combined with bloodletting and cupping in the treatment of chronic spontaneous urticaria（CSU） and to explore its potential mechanisms of action. MethodsSeventy CSU patients were randomly divided into loratadine group and acupuncture + bloodletting group， with 35 patients in each group. The loratadine group received oral loratadine tablets， 10 mg once daily in the evening. The acupuncture + bloodletting group received acupuncture at Zhongwan （CV 12）， Guanyuan （CV 4）， Tianshu （ST 25）， Zusanli （ST 36）， Sanyinjiao （SP 6）， Xuehai （SP 10）， Quchi （LI 11）， Hegu （LI 4）， Taichong （LR 3）， Baihui （GV 20）， and Shenting （GV 24）， once daily，along with bloodletting and cupping at Dazhui （GV 14） and Geshu （BL 17）， every other day. Both groups were treated for 4 weeks. The 7-day urticaria activity score（UAS7） was assessed before and after the treatment， and levels of serum immunoglobulin E （IgE）， interleukin-4 （IL-4）， interleukin-5 （IL-5）， eosinophil cationic protein （ECP）， plasma tissue factor （TF）， activated factor Ⅶ （FⅦa）， prothrombin fragment 1+2 （F1+2）， D-dimer （D-D） and complement component 5a （C5a） were detected. ResultsA total of 65 patients were included in the final analysis， 32 in the loratadine group and 33 in the acupuncture + bloodletting group. Before treatment， there was no significant difference in UAS7 score， serum IgE， IL-4， IL-5， ECP levels， or plasma TF， FⅦa， F1+2， D-D， C5a levels between groups （P＞ 0.05）. After treatment， both groups showed significant reductions in UAS7 score， serum IgE， IL-4， IL-5， and plasma TF， FⅦa， F1+2， D-D， and C5a levels compared to those before treatment （P＜0.01）. However， after treatment， there was no significant difference in UAS7 score and serum ECP， IgE， IL-4， IL-5 levels between groups （P＞0.05）. The acupuncture + bloodletting group showed lower plasma TF， FⅦa， F1+2， D-D and C5a levels compared to the loratadine group （P＜0.05 or P＜0.01）. ConclusionAcupuncture combined with bloodletting and cupping can effectively improve the skin symptoms of CSU patients and reduce the levels of inflammatory factors. The potential mechanism of action may involve the regulation of the coagulation-complement-mast cell activation axis， thereby inhibiting mast cell degranulation.

It is believed that the cause of recurrent trigeminal neuralgia is mainly physical injuries and emotional distress. The core pathogenesis lies in the blockage of meridians and disharmony between the body and mind. Therefore， it is proposed that the treatment should focus on simultaneously regulating the body and the mind， with the therapeutic methods of unblocking the meridians and collaterals， soothing the liver and moving qi， and regulating the mind to relieve pain. In clinical practice， liver-soothing and mind-regulating acupuncture combined with para-nerve acupuncture are commonly used， and puncturing upto the bone is applied to strengthen the analgesic effect， providing a new diagnosis and treatment idea for clinical treatment of recurrent trigeminal neuralgia with acupuncture.

Objective:To investigate the efficacy and safety of peripheral cutting balloon (PCB) in the treatment of long stenosis of arteriovenous fistula, and to explore the influencing factors of restenosis after PCB treatment.Methods:It was a single-center retrospective study. The patients with long stenosis (>2 cm) of arteriovenous fistula who received PCB treatment of percutaneous transluminal angioplasty (PTA) in Haidian Hospital, the Third Hospital of Peking University from August to November 2021. The clinical and follow-up data after PTA operation were collected and analyzed, and the primary patency rate and primary assist patency rate of fistula at 3, 6 and 12 months after PTA operation were calculated. Kaplan-Meier method was used to draw the survival curve of the primary patency rate of fistula, and log-rank test was used to compare the differences of primary patency rates of fistula between two groups. Multivariate Cox regression analysis was used to analyze the influencing factors of fistula restenosis after PCB treatment.Results:A total of 65 patients aged (62.57±11.55) years old were included in this study, including 42 males (64.62%), 61 (93.85%) autologous arteriovenous fistula and 4 (6.15%) arteriovenous graft. The narrowest diameter of fistula stenosis ( t=-41.731, P<0.001) and brachial artery blood flow ( t=-12.510, P<0.001) after PCB treatment were significantly higher than those before PCB treatment. The resistance index of fistula after PCB treatment was significantly lower than that before PCB treatment ( t=9.241, P<0.001). The technical success rate of PTA was 100% (65/65), and the clinical success rate of PTA was 96.92% (63/65). Only 2 patients failed to complete hemodialysis after PCB treatment, and no serious postoperative complications occurred. The follow-up time was 12 (7, 13) months. Fistula dysfunction occurred in 24 patients (36.92%) within 12 months. Kaplan-Meier survival analysis showed that the primary patency rates were 90.77%, 81.54% and 63.08% at 3, 6, and 12 months, respectively, and the primary assist patency rate at 12 months was 100% (65/65). The risk of fistula restenosis in patients with long stenosis ≥36 mm was significantly higher than that in patients with long stenosis <36 mm (log-rank χ2=6.007, P=0.014). Multivariate Cox regression analysis showed that increased stenosis length ( HR=1.022, 95% CI 1.001-1.045, P=0.042) was an independent influencing factor of fistula restenosis within 12 months after PCB treatment. Conclusions:PCB is safe and effective in the treatment of long segment stenosis associated with fistula. The increased stenosis length is an independent influencing factor of restenosis in fistula after PCB treatment.

Objective This paper aims to construct a scientific and standardized index system for evaluating the applica-tion effect of Diagnosis-Intervention Packet(DIP)in medical institutions.It seeks to determine the weights of indicators at all lev-els to provide a basis for evaluating the effectiveness of DIP used in various regions as well as a reference for improving DIP poli-cy.Methods This paper used literature analysis to develop an indicator pool preliminarily.The Delphi method was used to con-duct a questionnaire survey with 22 experts to establish the index system.It also used the Analytic Hierarchy Process(AHP)to determine the weight of each index.Results A total of two rounds of expert consultation questionnaires were conducted.The questionnaire exhibited high expert positive coefficients by 91.00％and 100.00％and higher authority coefficients of both 0.91 for two rounds.The coordination coefficients of the two rounds of expert consultation met the standard,and the expert opinions reached a consistence.Additionally,the questionnaire established comprised three primary indicators(efficiency of medical in-surance fund,medical service management,patient benefit,and satisfaction),9 secondary indicators,and 38 tertiary indicators.The AHP was used to determine the weight of indicators at all levels.Among the primary indicators,patient benefit and satisfac-tion had the highest weight(0.446 9).Among the secondary indicators,patients'medical cost burden had the highest weight(0.287 6).Among the tertiary indicators,the inpatient satisfaction had the highest weight(0.1592).The Cronbach's α coeffi-cients of the two rounds were＞0.7.Conclusion This paper utilized Delphi method and AHP to establish the evaluation system for assessing the implementation effectiveness of DIP.The approach is highly scientific and authoritative.It can be used to evalu-ate the application effect of DIP and provide an effective tool for medical insurance and hospital managers at all levels to assess DIP payment policies.

Aim To explore the mechanism of oxidized lipoprotein(a)(oxLp(a))inducing pyroptosis of vascu-lar endothelial cells.Methods After incubating human umbilical vein endothelial cells(HUVEC)with 100 mg/L ox-Lp(a)for 24 hours,Western blot and RT-qPCR was used to detect pyroptosis related proteins,pro-inflammatory cytokines,mitochondrial related proteins NRF1,NRF2,PGC-1α and mitochondrial gene cytochrome b(CYTB),ELISA was used to detect the levels of inflammatory factors,scanning electron microscopy was used to detect cell membrane rup-ture,transmission electron microscopy was used to detect mitochondrial morphology,Hoechst33342/PI staining was used to detect cell apoptosis,MitoSOX probe was used to detect mitochondrial reactive oxygen species(mtROS),Flu-4AM probe was used to detect calcium ions,JC-1 probe was used to detect mitochondrial membrane potential(MMP),and Calcein AM staining was used to detect mitochondrial permeability transition pore(mPTP).Transfecting HUVEC with CYTB overexpressing lentivirus and analyzing its effects on oxLp(a)induced pyroptosis and mitochondrial function.Results After treatment with oxLp(a),the expression of NLRP3,pro-Caspase-1,Caspase-1,GSDMD and GSDMD-N proteins re-lated to pyroptosis were significantly increased(P＜0.05);the protein and mRNA levels of CYTB and pro-inflammatory cy-tokine IL-1β,IL-18 were significantly increased(P＜0.05).Small pores appeared on the cell membrane,the percentage of PI stained positive cells significantly increased(P＜0.05).OxLp(a)significantly inhibited the expression of mito-chondrial related proteins NRF1,NRF2 and PGC-1α,and the expression of mitochondrial gene CYTB,promoted an in-crease in mtROS generation,Ca2+overload,a decrease in ATP levels,a decrease in MMP,an increase in mPTP values,and abnormal mitochondrial morphology.After transfection with pHelper 2.0 lentivirus vector overexpressing CYTB,it was found that oxLp(a)induced HUVEC pyroptosis and mitochondrial morphological and functional abnormalities were par-tially reversed by overexpression of CYTB.Conclusion oxLp(a)promotes mitochondrial morphological and functional abnormalities and induces HUVEC pyroptosis by downregulating CYTB.

Immune evasion has made ovarian cancer notorious for its refractory features, making the development of immunotherapy highly appealing to ovarian cancer treatment. The immune-stimulating cytokine IL-12 exhibits excellent antitumor activities. However, IL-12 can induce IFN-γ release and subsequently upregulate PDL-1 expression on tumor cells. Therefore, the tumor-targeting folate-modified delivery system F-DPC is constructed for concurrent delivery of IL-12 encoding gene and small molecular PDL-1 inhibitor (iPDL-1) to reduce immune escape and boost anti-tumor immunity. The physicochemical characteristics, gene transfection efficiency of the F-DPC nanoparticles in ovarian cancer cells are analyzed. The immune-modulation effects of combination therapy on different immune cells are also studied. Results show that compared with non-folate-modified vector, folate-modified F-DPC can improve the targeting of ovarian cancer and enhance the transfection efficiency of pIL-12. The underlying anti-tumor mechanisms include the regulation of T cells proliferation and activation, NK activation, macrophage polarization and DC maturation. The F-DPC/pIL-12/iPDL-1 complexes have shown outstanding antitumor effects and low toxicity in peritoneal model of ovarian cancer in mice. Taken together, our work provides new insights into ovarian cancer immunotherapy. Novel F-DPC/pIL-12/iPDL-1 complexes are revealed to exert prominent anti-tumor effect by modulating tumor immune microenvironment and preventing immune escape and might be a promising treatment option for ovarian cancer treatment.

Objective:To analyze the current research status and hot spots of metabolic syndrome after renal transplantation, and provide reference for domestic research in this field.Methods:Computer retrieval of the literature related to renal transplantation metabolic syndrome in the Chinese Biomedical Literature Service System and the Web of Science core collection database was conducted from January First, 2002 to December 31, 2022. The retrieval results were analyzed using Citespace.6.1.R3c software.Results:After screening, a total of 1024 papers related to metabolic syndrome of renal transplantation were included, including 409 Chinese papers and 615 English papers. In the past 20 years, the number of papers related to metabolic syndrome of renal transplantation in foreign countries has increased progressively, and the overall domestic literature has not increased significantly. Domestic and international research focuses mainly on the epidemiology, pathogenesis, risk factors and related hazards of metabolic syndrome in renal transplantation.Conclusions:The research on metabolic syndrome in renal transplantation has received more and more attention, and still has great research prospects. The risk factors and intervention methods of metabolic syndrome in renal transplantation have been the research focus of scholars at home and abroad in recent years. Chinese scholars can further explore on the basis of previous research, strengthen the exchange and cooperation between different fields, institutions and countries, so as to optimize and improve the related research of metabolic syndrome in kidney transplantation.

Guideline of model-informed drug de-velopment was published by National Medical Products Administration in 2020,which provided technical guidance for the application of modeling and simulation in the process of new drug develop-ment.In July 2022,Center of Drug Evaluation con-ducted a questionnaire survey on the practical abili-ty of pharmaceutical industry to apply model-in-formed drug development(MIDD)in the process of new drug development,in order to investigate the practice of MIDD in China.Based on the feedback data collected from enterprises,this paper analyzes the practice of MIDD in domestic pharmaceutical industry,and briefly discusses several problems that still exist at present.

The latest research findings on bidirectional regulation of neuro-immunity through traditional neural circuits shed new light on the theoretical basis of the role of vidian neurectomy (VN). This article aims to provide a comprehensive understanding of VN, including the history of VN, the principle of neuroimmuno-interaction, the applied anatomy of VN as well as the methods of transnasal endoscopic surgery. Additionally, we introduce the concept of the nose-brain axis, which was proposed based on the advancement in the area of neuro-immune interactions.

Allergic rhinitis is a common allergic disease in children.Its pathogenesis is complex and it is difficult to achieve radi-cal cure or effective and stable long-term treatment goals.Chinese medicine has obvious advantages in preventing and treating allergic rhinitis in children due to its wide range of targets,long-lasting effects and few adverse reactions.This paper proposes that the onset of allergic rhinitis is mostly caused by the dysfunction of the lung,spleen and kidney,the external wind triggering the latent wind,and the combination of the two winds.A staged prevention and treatment strategy of Chinese medicine should be adopted,which includes dispersing external wind,suppressing latent wind,and promoting lung-qi and clearing nasal orifice during the attack period to treat its symptoms,and preventing external wind,calming down latent wind,and regulating and tonifying the lung,spleen,and kidney during the remission period to treat its root cause;meanwhile,attention should be paid to avoiding the adverse effects of congenital endowment factors and the induction of acquired environmental factors,strengthening the body's health to protect against the evil wind,preventing the transformation of existing diseases and the recurrence of allergic rhinitis in children at all stages.