Objective: To characterize perioperative dynamic changes in immune-cell phenotypes and inflammatory cytokines in patients undergoing CPB (cardiopulmonary bypass) cardiac surgery, and to explore their associations with postoperative outcomes. Methods: In this prospective cohort study, 120 adult patients who underwent elective cardiac surgery under CPB at West China Hospital from May 2022 to March 2023 were enrolled. Perioperative immune-cell phenotypes and concentrations of 40 inflammation-related cytokines were measured. The primary outcomes were the sequential organ failure assessment (SOFA) score at 24 h after surgery and ΔSOFA (the peak SOFA score within 48 h after surgery minus the preoperative SOFA score). Secondary outcomes included major adverse cardiovascular events (MACE), acute kidney injury (AKI), respiratory failure, severe liver injury, and infection. Results: The mean age of enrolled patients was 57±10 years. Of these, 52% (62/120) were male and 90% (108/120) underwent valve surgery. During the rewarming to the end of CPB, neutrophil counts rapidly increased (7.39×10 /L vs preoperative 3.07×10 /L, P<0.001), with significant upregulation of CD11b (7.30×10 /L vs preoperative 3.05×10 /L, P<0.001) and CD54 (7.15×10 /L vs preoperative 2.99×10 /L, P<0.001). Lymphocyte counts increased at the end of CPB (1.75×10 /L vs preoperative 1.12×10 /L, P<0.001) but decreased significantly at 24 h after surgery (0.59×10 /L vs preoperative 1.12×10 /L, P<0.001). Plasma analysis showed that multiple pro-inflammatory cytokines increased during CPB and remained elevated up to 24 h after surgery; five chemokines and the anti-inflammatory cytokine IL-10 peaked at the end of CPB. The SOFA score increased from 1 (1, 2) preoperatively to 7 (5, 10) at 24 h after surgery, with a ΔSOFA of 6 (4, 8). Within 30 days after surgery, 48 patients (40.0%) developed AKI, 17 (14.2%) developed infection, 4 (3.3%) developed severe liver injury, 3 (2.5%) developed respiratory failure, and 3 (2.5%) experienced MACE. During the 2-year follow-up, 8 patients (6.7%) experienced MACE and 5 (4.2%) died. Conclusion: Multi-organ dysfunction is common after cardiac surgery under CPB (median ΔSOFA, 6), accompanied by perioperative activation of multiple immune-cell subsets and upregulation of pro-inflammatory, anti-inflammatory, and chemotactic mediators. This study provides data-driven evidence and research clues for further investigation of the associations between CPB-related immune perturbations and postoperative organ dysfunction and clinical outcomes.

This paper summarizes professor WANG Shouchuan's clinical experience in treating childhood absence epilepsy based on the theory of "five zang （脏） organs storing the spirit". It is believed that dysfunction of the five zang organs in storing the spirit is the key pathogenesis of childhood absence epilepsy， proposing that the fundamental therapeutic principle is regulating the spirit by tonifying the five zang organs. Treatment is performed based on differentiation of heart， liver， spleen， lung， and kidney epilepsy. For heart epilepsy， the treatment focuses on harmonizing qi and blood and regulating heart spirit， with Yangxin Anshen Decoction （养心安神汤） or Daochi Ningshen Decoction （导赤宁神汤） selected according to deficiency or excess syndrome. For liver epilepsy， the treatment aims to subdue wind-yang and calm liver spirit， using Bugan Zhenhun Decoction （补肝镇魂汤） or Gouma Qianhun Decoction（钩麻潜魂汤） based on deficiency or excess syndrome. For spleen epilepsy， the treatment concentrates on resolving phlegm-turbidity and restoring spleen thought， employing Guipi Yangyi Decoction （归脾养意汤） or Changyu Huatan Decoction （菖郁化痰汤） in line with deficiency or excess syndrome. For lung epilepsy， the treatment focuses on expelling exogenous pathogens and consolidating lung corporeal soul， applying Yuping Gupo Decoction （玉屏固魄汤） or Xiebai Anpo Decoction （泻白安魄汤） according to deficiency or excess syndrome. For kidney epilepsy， the treatment aims to strengthen the primordial qi and replenish kidney will， with Dihuang Yuanzhi Decoction （地黄远志汤）. The self-made Dingxian Powder （定痫散） is used dynamically throughout the course， emphasizing the flexible application of decoctions， pills and syrupsis.

This paper summarizes professor WANG Shouchuan's clinical experience in treating childhood absence epilepsy based on the theory of "five zang （脏） organs storing the spirit". It is believed that dysfunction of the five zang organs in storing the spirit is the key pathogenesis of childhood absence epilepsy， proposing that the fundamental therapeutic principle is regulating the spirit by tonifying the five zang organs. Treatment is performed based on differentiation of heart， liver， spleen， lung， and kidney epilepsy. For heart epilepsy， the treatment focuses on harmonizing qi and blood and regulating heart spirit， with Yangxin Anshen Decoction （养心安神汤） or Daochi Ningshen Decoction （导赤宁神汤） selected according to deficiency or excess syndrome. For liver epilepsy， the treatment aims to subdue wind-yang and calm liver spirit， using Bugan Zhenhun Decoction （补肝镇魂汤） or Gouma Qianhun Decoction（钩麻潜魂汤） based on deficiency or excess syndrome. For spleen epilepsy， the treatment concentrates on resolving phlegm-turbidity and restoring spleen thought， employing Guipi Yangyi Decoction （归脾养意汤） or Changyu Huatan Decoction （菖郁化痰汤） in line with deficiency or excess syndrome. For lung epilepsy， the treatment focuses on expelling exogenous pathogens and consolidating lung corporeal soul， applying Yuping Gupo Decoction （玉屏固魄汤） or Xiebai Anpo Decoction （泻白安魄汤） according to deficiency or excess syndrome. For kidney epilepsy， the treatment aims to strengthen the primordial qi and replenish kidney will， with Dihuang Yuanzhi Decoction （地黄远志汤）. The self-made Dingxian Powder （定痫散） is used dynamically throughout the course， emphasizing the flexible application of decoctions， pills and syrupsis.

Background Lead smelting workers are exposed to mixed heavy metals such as lead (Pb) and cadmium (Cd). However, the specific associations and molecular mechanisms by which their combined exposure induces genetic damage remain unclear. Objective To clarify the association between combined Pb-Cd exposure and genetic damage and to explore the possible biological mechanisms through occupational epidemiological investigations and animal experiments. Methods (1) Population study: A cross-sectional study was conducted on 374 lead smelting workers in northern China. Inductively coupled plasma mass spectrometry (ICP-MS) was used to detect urinary levels of 8 metals including Pb and Cd, and graphite furnace atomic absorption spectroscopy (GFAAS) was used to quantify blood levels of Pb and Cd. The cytokinesis-block micronucleus assay (CBMN) was used to assess genetic damage. Poisson regression was used to analyze the association between metal exposure and micronucleus rates. (2) In vivo experiment: Thirty SD rats were randomly assigned to five groups: control (pure water), Pb (300 mg·L⁻¹ lead acetate), Cd (50 mg·L⁻¹ cadmium chloride), combined exposure (Pb + Cd), and resveratrol intervention (Pb + Cd + 50 mg·L⁻¹ resveratrol). After 8 weeks of ad libitum drinking water exposure, liver pathology, oxidative stress indicators [reactive oxygen species (ROS), reduced glutathione (GSH), oxidized glutathione (GSSG), malondialdehyde (MDA), catalase (CAT), and superoxide dismutase (SOD)], genetic damage (Comet assay and γ-H2AX) were evaluated. Furthermore, cell cycle distribution, apoptosis rates, and mRNA expression of DNA damage response (DDR), DNA repair, and apoptosis-related genes were measured. Results (1) The geometric mean (GM, 95%CI) of urinary Pb and Cd were 14.69 (13.14, 16.51) µg·L⁻¹ and 2.11 (1.90, 2.33) µg·L⁻¹, respectively; the blood Pb and Cd levels were 117.10 (105.59, 129.87) µg·L⁻¹ and 4.55 (4.23, 4.89) µg·L⁻¹, respectively among the 374 workers. The mean micronucleus rate was (1.64±0.081) ‰, with significantly higher rates in males (1.65±0.083) ‰ than females (1.53±0.334) ‰ (U=4.166, P=0.041). All Pb and Cd biomarkers were positively correlated with micronucleus rate (FR>1, P<0.05), with a significant interaction effect observed between Pb and Cd (FR>1, P<0.05). (2) In rats, co-exposure to Pb and Cd caused liver tissue damage and inflammatory infiltration. Significant increases were observed in lymphocyte ROS; GSSG and MDA in lung tissue increased, while GSH and CAT activity decreased. Comet assay indicators and γ-H2AX levels were significantly elevated. Co-exposure induced S-phase arrest and increased apoptosis. mRNA levels of DDR (ATM, ATR, Chk2, and P53) and pro-apoptotic genes (Bax and Caspase-3) were upregulated, while the anti-apoptotic gene Bcl-2 and DNA repair genes (BRCA1, BRCA2, RAD51, RAD52, and CtIP) were downregulated. Two-way ANOVA confirmed synergistic effects on GSSG, Comet assay indicators, and ATR/Chk2 mRNA expression. Conclusion Occupational co-exposure to Pb and Cd synergistically induces genetic damage. This damage is mediated by oxidative stress and DNA damage, which activates the DDR pathway and inhibits the expression of DNA repair genes, ultimately leading to cell cycle arrest and apoptosis.

Background Lead smelting workers are exposed to mixed heavy metals such as lead (Pb) and cadmium (Cd). However, the specific associations and molecular mechanisms by which their combined exposure induces genetic damage remain unclear. Objective To clarify the association between combined Pb-Cd exposure and genetic damage and to explore the possible biological mechanisms through occupational epidemiological investigations and animal experiments. Methods (1) Population study: A cross-sectional study was conducted on 374 lead smelting workers in northern China. Inductively coupled plasma mass spectrometry (ICP-MS) was used to detect urinary levels of 8 metals including Pb and Cd, and graphite furnace atomic absorption spectroscopy (GFAAS) was used to quantify blood levels of Pb and Cd. The cytokinesis-block micronucleus assay (CBMN) was used to assess genetic damage. Poisson regression was used to analyze the association between metal exposure and micronucleus rates. (2) In vivo experiment: Thirty SD rats were randomly assigned to five groups: control (pure water), Pb (300 mg·L⁻¹ lead acetate), Cd (50 mg·L⁻¹ cadmium chloride), combined exposure (Pb + Cd), and resveratrol intervention (Pb + Cd + 50 mg·L⁻¹ resveratrol). After 8 weeks of ad libitum drinking water exposure, liver pathology, oxidative stress indicators [reactive oxygen species (ROS), reduced glutathione (GSH), oxidized glutathione (GSSG), malondialdehyde (MDA), catalase (CAT), and superoxide dismutase (SOD)], genetic damage (Comet assay and γ-H2AX) were evaluated. Furthermore, cell cycle distribution, apoptosis rates, and mRNA expression of DNA damage response (DDR), DNA repair, and apoptosis-related genes were measured. Results (1) The geometric mean (GM, 95%CI) of urinary Pb and Cd were 14.69 (13.14, 16.51) µg·L⁻¹ and 2.11 (1.90, 2.33) µg·L⁻¹, respectively; the blood Pb and Cd levels were 117.10 (105.59, 129.87) µg·L⁻¹ and 4.55 (4.23, 4.89) µg·L⁻¹, respectively among the 374 workers. The mean micronucleus rate was (1.64±0.081) ‰, with significantly higher rates in males (1.65±0.083) ‰ than females (1.53±0.334) ‰ (U=4.166, P=0.041). All Pb and Cd biomarkers were positively correlated with micronucleus rate (FR>1, P<0.05), with a significant interaction effect observed between Pb and Cd (FR>1, P<0.05). (2) In rats, co-exposure to Pb and Cd caused liver tissue damage and inflammatory infiltration. Significant increases were observed in lymphocyte ROS; GSSG and MDA in lung tissue increased, while GSH and CAT activity decreased. Comet assay indicators and γ-H2AX levels were significantly elevated. Co-exposure induced S-phase arrest and increased apoptosis. mRNA levels of DDR (ATM, ATR, Chk2, and P53) and pro-apoptotic genes (Bax and Caspase-3) were upregulated, while the anti-apoptotic gene Bcl-2 and DNA repair genes (BRCA1, BRCA2, RAD51, RAD52, and CtIP) were downregulated. Two-way ANOVA confirmed synergistic effects on GSSG, Comet assay indicators, and ATR/Chk2 mRNA expression. Conclusion Occupational co-exposure to Pb and Cd synergistically induces genetic damage. This damage is mediated by oxidative stress and DNA damage, which activates the DDR pathway and inhibits the expression of DNA repair genes, ultimately leading to cell cycle arrest and apoptosis.

Objective:To investigate the clinical manifestations, treatment, and outcomes of Barth syndrome (BTHS).Methods:A retrospective analysis was conducted on 21 pediatric patients diagnosed with BTHS between January 2010 and December 2023 at Beijing Children′s Hospital, Beijing Anzhen Hospital, and Beijing JingDu Children′s Hospital. Clinical data including gender, age at onset, initial symptoms, clinical manifestations, personal history, family genetic history, and laboratory tests (neutrophil count, echocardiography, electrocardiogram and genetic testing) were reviewed.Results:All the 21 patients were male, with the age of onset at 4.1 (1.1, 9.3) months. Main clinical manifestations included heart failure (18 cases), neutropenia (16 cases), respiratory symptoms (15 cases), 3-methylpentenediuria (7 cases),develop retardation (8 cases), gastrointestinal symptoms (7 cases), fatigue and anorexia (6 cases), and recurrent infection (2 cases). Electrocardiogram abnormalities included ST changes (18 cases), flattened T wave and low voltage of limb leads (2 cases), and abnormal Q waves in lead Ⅰ and avL (1 case). Echocardiographic features showed increased trabeculation, interventricular septum and left ventricular wall thickening, and left ventricular enlargement with reduced ejection fraction. Genetic testing identified TAZ gene variations in all 21 patients: 11 missense mutations, 2 nonsense mutations, 2 frameshift mutations, 2 whole code mutations, 2 exon deletions, 1 splicing mutation, and 1 synonymous mutation. Fifteen mutations were maternally inherited, 2 were de novo, and 4 lacked verified variant origin.In terms of treatment, all 18 patients with heart failure received routine heart failure treatment, of whom 11 patients also received intravenous immunoglobulin and corticosteroids. After the follow-up of 91.0 (75.5, 109.5) months, 15 of the 18 patients showed restoration of cardiac function after 4.5 (3.0, 9.8) months of treatment, with one case of significant improvement, while 2 cases suddenly died.Conclusions:BTHS predominantly affects males with early onset, mainly characterized by abnormal cardiac structure and function, along with clinical features including fatigue, delayed growth and development, and neutropenia. Early diagnosis and intervention, including heart failure treatment, intravenous immunoglobulin, and corticosteroids, can lead to significant improvement in cardiac function, though sudden death remains a risk.

Objective:To investigate the clinical efficacy of a self-detachable single-J internal stent drainage tube in the laparoscopic primary suture of the common bile duct for hepatolithiasis.Methods:Clinical data of 36 patients with hepatobiliary duct stones who underwent laparoscopic common bile duct primary suture combined with self-detached single J-type internal stent drainage at the First Affiliated Hospital of Xiamen University from April 2022 to April 2025 were retrospectively analyzed, including 17 males and 19 females, aged (54.3±8.7) years. All 36 patients underwent choledochoscopic stone extraction, primary common bile duct suture, and drainage with the self-expelling single-J internal stent. Total bilirubin, aspartate transaminase, and alanine transaminase before and 3 days after operation, as well as operation time, intraoperative blood loss, postoperative hospital stay, postoperative complications (bile leakage, cholangitis, intestinal obstruction, and stent retention), and stent expulsion time were collected.Results:All 36 patients successfully underwent the operation. Total bilirubin, aspartate transaminase, and alanine transaminase 3 days after operation showed significant improvement compared to preoperative levels (all P<0.05). The operation time was (86.5±22.6) min, intraoperative blood loss was 34.2 (13.7, 56.8) ml, and the postoperative hospital stay was (6.6±1.8) days. All single-J internal stents were spontaneously expelled via the anus between 6 and 21 days postoperatively, with the expulsion time of (10.7±2.1) days. No single J-type internal stent drainage tube was displaced into the bile duct in all cases, and there were no complications such as intestinal obstruction, bile leakage, cholangitis, or residual internal stent drainage tube. Conclusion:The self-detachable single-J internal stent drainage tube has been applied in the laparoscopic primary suture of the common bile duct for patients with hepatolithiasis, which demonstrated a good safety and effectiveness.

In the context of further promoting the construction of an integrated healthcare service system,traditional quantitative indicators for measuring continuity of care may have limitations.The analysis of domestic and foreign studies on the mortality rate associated with service continuity measured by quantitative indicators shows that a lack of correlation or even an inverse correlation between continuity of care and mortality.This phenomenon may be attributed to the fact that the indicators have only single dimension and unable to capture the multidimensional nature of continuity of care.Based on these findings,some ideas are proposed for the improvement of the indicators,which contribute to thoughts and suggestions on the quantitative measurement of continuity of care.

Objective To explore the value of artificial intelligence(AI)based multi-parameter coronary CT angiography(CCTA)features combined with clinical indicators for predicting coronary plaque progression.Methods Totally 143 coronary atherosclerosis(AS)patients were retrospectively enrolled and divided into progression group(arithmetic average annual growth rate of plaque load＞1％,n=73)and non-progression group(arithmetic average annual growth rate of plaque load＜1％,n=70).The baseline clinical data,CT-derived fractional flow reserve(CT-FFR),perivascular fat attenuation index(FAI),and quantitative plaque features were collected and compared between groups.For variables being statistically different between groups,those had collinearity with others were excluded,and then multivariable logistic regression was used to screen independent predictors of plaque progression from the retained variables,and a combined model was constructed.Receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was calculated to evaluate the predictive efficacy of this model.Results Progression group had higher proportions of hypertension and diabetes,higher apolipoprotein A1(ApoA1)and high-sensitivity C-reactive protein(hs-CRP)levels but lower high-density lipoprotein cholesterol(HDL-C)levels than non-progression group(all P＜0.05).Progression group showed smaller minimum lumen area and lower CT-FFR,but greater degree of lumen stenosis,total plaque volume,plaque load,non-calcified plaque volume,lipid-rich plaque volume,fibrolipid plaque volume and FAI values than non-progression group(all P＜0.05).Plaque types were different between groups(P＜0.05).Diabetes,low HDL-C,small minimum lumen area and large lipid-rich plaque volume were all independent predictors of plaque progression in patients with coronary AS(all P＜0.05),and the AUC of the combined model for predicting plaque progression was 0.859.Conclusion Multi-parameter CCTA features based on AI combined with clinical indicators could be used to effectively predict progression of coronary AS plaque.

Objective To investigate the predictive value of combined radiomic features derived from chest CT scans with clinical characteristics for epidermal growth factor receptor(EGFR)gene mutations in non-small cell lung cancer(NSCLC).Methods A multi-center case-control study was conducted on the clinical data and CT images of 1 070 NSCLC patients from the radiology departments of the 3 medical institutions between January 2013 and October 2023.The 719 NSCLC patients from the First Affiliated Hospital of Army Medical University were randomly divided into a training set and an internal validation set in a ratio of 7∶3;The 173 patients in the Eastern Theatre General Hospital and the 178 patients in Army Medical Centre of PLA were assigned into the external validation set 1 and 2,respectively.Least absolute shrinkage and selection operator(LASSO)regression was employed to identify the optimal radiomic features,which were subsequently used to construct a radiomics model.Univariate and multivariate logistic regression analyses were applied to identify clinical features associated with EGFR mutation,thereby developing a clinical model.The radiomic and clinical features were subsequently combined to develop a comprehensive model.All the 3 classification models were built using random forest(RF)machine learning.The area under curve(AUC),accuracy,sensitivity and specificity were utilized to evaluate the predictive performance of the models.Calibration curve was plotted to assess the goodness of fit of the comprehensive model,while decision curve analysis was performed to assess the clinical utility of the model.Results The AUC value of the radiomics model was 0.762 4(95%CI:0.692 4～0.825 1),0.745 4(95%CI:0.671 1～0.814 3),and 0.724 7(95%CI:0.639 7～0.801 6),respectively,in the internal validation set,external validation set 1,and external validation set 2;The AUC value of the clinical prediction model was 0.691 7(95%CI:0.627 9～0.757 6),0.652 5(95%CI:0.576 7～0.729 1),and 0.779 2(95%CI:0.712 5～0.847 3),respectively in the above sets in turn;The comprehensive model constructed based on clinical features and radiomic features showed the best predictive efficacy,with an AUC value of 0.818 0(95%CI:0.757 7～0.874 3),0.782 4(95%CI:0.703 1～0.848 2),and 0.796 6(95%CI:0.718 1～0.868 6),respectively in the above sets.Calibration curve analysis indicated that the comprehensive model had a good fit,while decision curve analysis revealed that the model provided a favorable net benefit.Conclusion Our comprehensive model constructed based on chest CT radiomic features and clinical characteristics shows superior predictive performance for EGFR gene mutations in NSCLC across multiple center datasets,which may be helpful for clinical decision-making for treatment strategies.