Diabetes mellitus, characterized by glucose metabolism disorders and marked by insulin deficiency or insulin resistance, has seen a continuous rise in prevalence. In recent years, islet transplantation has matured as a therapeutic approach for diabetes, becoming an important method for glycemic control and the reduction of diabetes-related complications. Donor selection directly influences transplant outcomes, and various research institutions worldwide have proposed multiple scoring systems to optimize donor assessment, such as the University of Alberta scoring system and the North American Islet Donor Score. This article explores the impact of key factors such as donor age, body mass index and ischemia time on islet transplantation. Combining practical experience in pancreatic donor selection from Shanghai Changzheng Hospital, it proposes screening criteria for pancreatic donors suitable for China, aiming to provide new evidence for improving the success rate of islet transplantation.

Oral squamous cell carcinoma (OSCC) is a common head and neck malignancy. Approximately 50% to 60% of patients with OSCC are diagnosed at a locally advanced stage (clinical staging III-IVa). Even with comprehensive and sequential treatment primarily based on surgery, the 5-year overall survival rate remains below 50%, and patients often suffer from postoperative functional impairments such as difficulties with speaking and swallowing. Programmed death receptor-1 (PD-1) inhibitors are increasingly used in the neoadjuvant treatment of locally advanced OSCC and have shown encouraging efficacy. However, clinical practice still faces key challenges, including the definition of indications, optimization of combination regimens, and standards for efficacy evaluation. Based on the latest research advances worldwide and the clinical experience of the expert group, this expert consensus systematically evaluates the application of PD-1 inhibitors in the neoadjuvant treatment of locally advanced OSCC, covering combination strategies, treatment cycles and surgical timing, efficacy assessment, use of biomarkers, management of special populations and immune related adverse events, principles for immunotherapy rechallenge, and function preservation strategies. After multiple rounds of panel discussion and through anonymous voting using the Delphi method, the following consensus statements have been formulated: 1) Neoadjuvant therapy with PD-1 inhibitors can be used preoperatively in patients with locally advanced OSCC. The preferred regimen is a PD-1 inhibitor combined with platinum based chemotherapy, administered for 2-3 cycles. 2) During the efficacy evaluation of neoadjuvant therapy, radiographic assessment should follow the dual criteria of Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and immune RECIST (iRECIST). After surgery, systematic pathological evaluation of both the primary lesion and regional lymph nodes is required. For combination chemotherapy regimens, PD-L1 expression and combined positive score need not be used as mandatory inclusion or exclusion criteria. 3) For special populations such as the elderly (≥ 70 years), individuals with stable HIV viral load, and carriers of chronic HBV/HCV, PD-1 inhibitors may be used cautiously under the guidance of a multidisciplinary team (MDT), with close monitoring for adverse events. 4) For patients with a poor response to neoadjuvant therapy, continuation of the original treatment regimen is not recommended; the subsequent treatment plan should be adjusted promptly after MDT assessment. Organ transplant recipients and patients with active autoimmune diseases are not recommended to receive neoadjuvant PD-1 inhibitor therapy due to the high risk of immune related activation. Rechallenge is generally not advised for patients who have experienced high risk immune related adverse events such as immune mediated myocarditis, neurotoxicity, or pneumonitis. 5) For patients with a good pathological response, individualized de escalation surgery and function preservation strategies can be explored. This consensus aims to promote the standardized, safe, and precise application of neoadjuvant PD-1 inhibitor strategies in the management of locally advanced OSCC patients.

Objective: To develop a RHCE genotyping assay based on kompetitive allele-specific PCR (KASP) and assess its clinical accuracy for RhCE blood group determination. Methods: KASP primers were designed to interrogate three RHCE loci: the 109 bp insertion/deletion in intron 2, c. 307T>C, and c. 676C>G. A total of 1 194 RhD-positive inpatients from Chengdu were typed by both KASP genotyping and manual tube serology. Discordant samples (n=10) were retested by both methods and further resolved by Sanger sequencing. An additional 377 cases were tested for the c. 48C>G locus to evaluate the predictive accuracy of individual loci and combined locus testing for RhC antigen. Results: Genotyping concordance with serology was 100.0% for both the c. 676C>G locus (RhE/Rhe) and the c. 307T>C locus (Rhc). For RhC prediction using the 109 bp insertion, overall accuracy was 99.7% (1 191/1 194); the 3 discordant cases were confirmed by Sanger sequencing to be false negatives attributable to 109 bp deletion in intron 2. Testing the c. 48C>G allele for RhC prediction yielded 7 false positives, with an accuracy of 98.1% (370/377). RhC antigen status was determined by combining the 109 bp insertion and the c. 48C allele. After excluding 10 samples with inconsistent results between the two loci, the accuracy reached 100% in the remaining 367 samples. When both loci were applied in combination, accuracy reached 100% in the 367 cases with concordant results. Among the 1 194 patients, CCee (45.8%) and CcEe (31.7%) were the most common RhCE phenotypes. The e antigen had the highest positivity rate (92.2%), and the Ce haplotype was the most frequent (66.9%). Conclusion: The KASP-based RHCE genotyping method achieves high accuracy for clinical RhCE typing. Combining the 109 bp insertion/deletion with the c. 48C allele significantly improves RhC antigen prediction compared with either locus alone. This method was applied to RhCE genotyping of 1 194 RhD-positive inpatients in Chengdu, providing local RhCE phenotype and haplotype distribution data to support RhCE-matched transfusion practice.

ObjectiveMigraine is a leading neurological disorder and the fourth most common cause of years lived with disability worldwide, affecting nearly 116 million individuals. Although pharmacological treatments are available, their efficacy is often limited by side effects and variable response rates. Repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral prefrontal cortex (DLPFC) offers a safe, non-invasive alternative for migraine management. However, the neurophysiological mechanisms, particularly how rTMS modulates local cortical excitability and distributed pain-related circuits, remain poorly understood. Elucidating these mechanisms is essential for optimizing treatment protocols and improving clinical outcomes. MethodsThis study employed concurrent transcranial magnetic stimulation and electroencephalography (TMS-EEG) to investigate neuroplastic and neurocircuitry mechanisms of DLPFC-rTMS in migraine. Study 1 compared 30 migraineurs and 28 healthy controls to identify abnormalities in TMS-evoked potentials (TEPs) and significant current density (SCD) within sensory-discriminative regions including the primary somatosensory cortex (S1) and posterior insula (pINS), cognitive-affective regions including the anterior insula (aINS) and midcingulate cortex (MCC), and a descending modulatory region, the periaqueductal gray (PAG). Study 2 used a single-blind, crossover, sham-controlled design in 34 healthy participants. Each participant received both active (10 Hz, 80% RMT, 1 500 pulses) and sham DLPFC-rTMS in counterbalanced order. TMS-EEG and cold pain tolerance were assessed before and after each session. ResultsIn Study 1, migraineurs showed a significantly less negative N120 amplitude compared to healthy controls (P=0.027, Cohen’s d=0.60), indicating local intracortical disinhibition. No group differences were observed for N40, P60, or P180 components. At the source level, migraineurs exhibited significantly higher SCD in the S1, pINS, aINS, and MCC (allQ<0.05), but not in the ventroposterior thalamus (vpTHAL), mediodorsal thalamus (mdTHAL), or PAG. In Study 2, active rTMS significantly reduced SCD from pre- to post-stimulation in the S1, aINS, and MCC (all Q<0.05). Sham stimulation also reduced SCD in the S1 (Q<0.05) but not in the aINS or MCC. Although no significant group-level analgesic effect was observed between active and sham conditions (P=0.107), correlation analyses revealed that greater SCD reductions in the S1 and MCC were significantly associated with higher post-rTMS pain tolerance (R=-0.487 and -0.495, both Q<0.01) and larger improvements in pain tolerance(R=-0.487 and -0.451, both Q<0.05). No such correlations were found following sham stimulation, suggesting that the behavioural relevance of neural changes is specific to active rTMS. ConclusionThis study provides novel evidence that migraineurs exhibit both local neuroplastic abnormalities (reduced N120 amplitude) and hyperactivity in key pain-processing regions (S1, pINS, aINS, MCC). A single session of DLPFC-rTMS reduced hyperactivity in the aINS, MCC, and S1. Notably, greater reductions in the S1 and MCC were associated with improved pain tolerance. These findings identify distinct cortical circuitries, particularly within the cognitive-affective pain network, that may serve as potential biomarkers for optimizing rTMS treatment in migraine and other chronic pain conditions. Future studies should validate these results in patient populations experiencing spontaneous migraine attacks and explore multi-session or accelerated rTMS protocols.

Objective:To explore the efficacy and mechanism of action in Jishengshenqi pill combined with dapagliflozin in the treatment of diabetes nephropathy(DN)based on NOD like receptor protein 3(NLRP3)inflamma tory corpuscles.Methods:140 DN patients were divided into control group(n=70,treated with dapagliflozin)and study group(n=70,treated with Jishengshenqi pill combine with dapagliflozin)used random number table.The TCM syndrome scores,blood glucose index,renal function index,peripheral blood NLRP3 levels,and related factor levels between two groups of patients were compared.Results:The scores of dysuria,fatigue and cold intolerance,edema,soreness and coldness in the waist and knees,abdominal distension,pale complexion and lower five shift diarrhea in the study group after treatment were lower than those in the control group(P＜0.05).Fasting blood glucose(FBG),serum creatinine(SCr),2-hour postprandial blood glucose(2hPG),blood urea nitrogen(BUN),hemoglobin A1c(HbA1c),NLRP3 messenger RNA(mRNA),and cysteine protease 1(Caspase-1)levels in the study group after treatment were lower than those in the control group(P＜0.05).Conclusion:After the treatment of Jishengshenqi pill combined with dapagliflozin in DN patients,the clinical symptoms and blood glucose can be effectively controlled,and renal function can also be improved,it is speculated that this is related to the inhibition of NLRP3 mRNA expression in peripheral blood mononuclear cells and the activation and amplification of downstream inflammatory pathways.

Objective To explore the therapeutic effect and safety of hyperbaric oxygen therapy in the treatment of patients underwent tracheostomy for consciousness disturbance.Methods A total of 60 patients underwent tracheostomy for consciousness disturbance in our hospital from January 2019 to December 2021 were selected and randomly divided into the control group(30 cases)and the treatment group(30 cases).Patients in the control group were treated with tracheotomy and general treatment for primary disease,while patients in the treatment group were treated with hyperbaric oxygen on the basis of the control group.After 1 month of treatment,the total effective rate,Glasgow coma scale(GCS)score,persistent vegetative state(PVS)score,white blood cell count,neutrophil count,hemoglobin,C-reactive protein(CRP),and adverse reactions of patients were compared between the two groups.Results The total effective rate of the treatment group(96.67%)was higher than that of the control group(76.67%),and the difference was statistically significant(P<0.05).The GCS and PVS scores of patients in the two groups increased compared with those before treatment(P<0.05),and the GCS and PVS scores of patients in the treatment group were higher than those in the control group(P<0.05).There was no statistically significant difference in white blood cell count of patients in the two groups before and after treatment(P>0.05).The neutrophil count and CRP level of patients in both groups after treatment were lower than those before treatment(P<0.05),and the neutrophil count and CRP levels of patients after treatment in the treatment group were lower than those in the control group(P<0.05).The hemoglobin level of patients in both groups after treatment increased compared with those before treatment(P<0.05),and the hemoglobin level of patients after treatment in the treatment group was higher than that in the control group(P<0.05).The incidence of adverse reactions in the treatment group(6.67%)was lower than that in the control group(26.67%),and the difference was statistically significant(P<0.05).Conclusion Hyperbaric oxygen therapy has a good therapeutic effect and high safety for patients who treated by tracheostomy for consciousness disturbance.

Objective In order to provide a better reference and basis for the selection of reasonable hypoglycemic drugs for clinical treatment,the study conducted a comprehensive clinical evaluation of the innovator sodium-glucose transporters 2(SGLT-2)inhibitors,based on A Quick Guideline for Drug Evaluation and Selection in Chinese Medical Institutions(the Second Edition).Methods The real-world studies,randomized controlled trials,Meta-analysis/systematic review,drug clinical use guidelines,expert consensus and drug description evaluation evidence were collected,and the included drugs were assigned and evaluated from five dimensions:pharmaceutical characteristics,efficacy,safety,economy and other attributes.Results All SGLT-2 inhibitors had evaluation scores above 75,with dagaglifloztin tablets having the highest score of 84.6,and canaglifloztin having the lowest score of 75.1.Conclusions All five original SGLT-2 inhibitors showed good clinical utility,the difference is that the participating original drugs have different advantageous intervals in clinical use.The results show that dagliflozin has the most ideal clinical utility,and its clinical use should be safer and more effective.Due to the short time on the market and insufficient evidence-based reasons,the advantages of clinical use of proline hemegliflozin are not obvious compared with other evaluated drugs.

Objective To explore the clinical characteristics and treatment methods of female primary enteric adenocarcinoma of the urethra.Methods The diagnosis and treatment of one case were reported.The origin,etiology,imaging findings,diagnosis,treatment,and prognosis were discussed in combination with relevant literature.Results The patient is a 61-year-old female,visited our hospital due to vaginal odor complicated with urethral bleeding for 2 months,and was diagnosed with urethral adenocarcinoma after examination.She underwent partial urethral resection,urethral meatus shaping and temporary bladder fistula surgery,with negative resection margins.However,local recurrence occurred 7 months after surgery.The patient was readmitted for a second time,undergoing laparoscopic total urethral resection,anterior vaginal wall resection,bladder neck resection,and permanent bladder fistulation,followed by chemotherapy.At the 19th month after the first surgery,the patient was admitted due to tumor recurrence,and the third surgery consisted of total bladder and uterus resection,ileal neobladder,and perineal closure.Postoperative pathology indicated urethral adenocarcinoma originating from the intestines.During the 39-month follow-up,the tumor recurred twice.No recurrence or metastasis was observed after the final total pelvic exenteration.Conclusion Enteric adenocarcinoma of the urethra is extremely rare.Comprehensive treatment including surgery,radiotherapy,and chemotherapy may prolong survival,but the overall prognosis is poor,requiring long-term follow-up.

Objective We aimed to evaluate the efficacy and safety of Shengxuebao Mixture in the treatment of cancer-related anemia(CRA)presenting with syndrome of deficiency of liver and kidney combined with syndrome of deficiency of both qi and blood.Methods A randomized,double-blind,placebo-controlled,multicenter clinical trial was conducted.Eligible patients with malignant tumors meeting the inclusion and exclusion criteria were enrolled from 26 hospitals,including Dongzhimen Hospital,Beijing University of Chinese Medicine,Xiaogan Central Hospital,and Yangzhou Hospital of Traditional Chinese Medicine,from June 1,2022,to September 30,2024.Patients were allocated 1:1 to either the experimental group receiving Shengxuebao Mixture or the control group receiving its simulator(placebo)using a block randomization method under double-blind conditions.Both groups received 15 mL orally three times daily for 28 consecutive days.The primary efficacy indicators included the hemoglobin(Hb)improvement rate(RHb)and the traditional Chinese medicine(TCM)syndrome improvement rate(RTCM)at week 4 of treatment.The secondary efficacy indicators encompassed Hb and red blood cell(RBC)count,Karnofsky Performance Status(KPS)score,TCM syndrome score,individual TCM symptom scores,and changes in each of these indicators compared to the baseline period at weeks 2,4,and 6 of treatment.Safety evaluations were conducted at week 4 of treatment.Results A total of 239 patients were enrolled,with 225 cases included in the Full Analysis Set(FAS)(109 in the experimental group vs.116 control group),163 in the Per Protocol Set(PPS)(77 vs.86),and 225 in the Safety Set(SS)(109 vs.116).Baseline characteristics between groups showed no significant differences.Significant differences were observed between the experimental and control groups in RHb at week 4(FAS:49.51%vs.35.24%,P<0.05;PPS:53.25%vs.36.05%,P<0.05)and RTCM at week 4(FAS:61.54%vs.39.62%,P<0.01;PPS:64.94%vs.40.70%,P<0.01).At weeks 2,4,and 6,the experimental group showed greater improvements in Hb and RBC counts than the control group.Additionally,the TCM syndrome scores were lower in the experimental group than in the control group at these time points.Except for week 2 in PPS,the KPS improvement was better in the experimental group than in the control group(P<0.05).The experimental group also demonstrated a greater reduction in scores for individual TCM symptoms such as spiritlessness and weakness,poor appetite and reduced food intake at weeks 4 and 6 compared to the control group(P<0.05,P<0.01).Furthermore,the reduction in vertigo score was more pronounced in the experimental group at week 6(P<0.01).For the score of pale and lusterless complexion,only in the PPS was the reduction from baseline more significant in the experimental group than in the control group at weeks 4 and 6(P<0.05).No significant differences were observed between the experimental and control groups in the incidence of all adverse events or drug-related adverse reactions.Conclusion Shengxuebao Mixture demonstrates significant efficacy in patients with CRA presenting syndrome of deficiency of liver and kidney combined with syndrome of deficiency of both qi and blood,effectively increasing Hb levels,ameliorating TCM syndromes,alleviating clinical symptoms,and enhancing functional status,with no significant difference in adverse drug reactions compared to the placebo.

Objective:To explore the efficacy and mechanism of action in Jishengshenqi pill combined with dapagliflozin in the treatment of diabetes nephropathy(DN)based on NOD like receptor protein 3(NLRP3)inflamma tory corpuscles.Methods:140 DN patients were divided into control group(n=70,treated with dapagliflozin)and study group(n=70,treated with Jishengshenqi pill combine with dapagliflozin)used random number table.The TCM syndrome scores,blood glucose index,renal function index,peripheral blood NLRP3 levels,and related factor levels between two groups of patients were compared.Results:The scores of dysuria,fatigue and cold intolerance,edema,soreness and coldness in the waist and knees,abdominal distension,pale complexion and lower five shift diarrhea in the study group after treatment were lower than those in the control group(P＜0.05).Fasting blood glucose(FBG),serum creatinine(SCr),2-hour postprandial blood glucose(2hPG),blood urea nitrogen(BUN),hemoglobin A1c(HbA1c),NLRP3 messenger RNA(mRNA),and cysteine protease 1(Caspase-1)levels in the study group after treatment were lower than those in the control group(P＜0.05).Conclusion:After the treatment of Jishengshenqi pill combined with dapagliflozin in DN patients,the clinical symptoms and blood glucose can be effectively controlled,and renal function can also be improved,it is speculated that this is related to the inhibition of NLRP3 mRNA expression in peripheral blood mononuclear cells and the activation and amplification of downstream inflammatory pathways.