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Yihui Yu,1 Wei Li,1,2 Qian Li,1,2 Wenyan Liu,1,2 Sanquan Zhang,1,2 Xibao Zhang,1,2 Jingyao Liang1,2 1Institute of Dermatology, Guangzhou Medical University, Guangzhou, 510095, People’s Republic of China; 2Department of Dermatology, Guangzhou Dermatology Hospital, Guangzhou, 510095, People’s Republic of ChinaCorrespondence: Jingyao Liang; Xibao Zhang, Email ljy20221228@163.com; gzpfbfzs@163.comAbstract: Vitiligo is a chronic autoimmune disorder characterized by depigmented patches of the skin. The treatment of vitiligo remains challenging, partly owing to the lack of efficient drug delivery system. Microneedles (MNs), an ideal transdermal drug delivery system, have emerged as promising drug delivery platform for vitiligo. Recently, the emergence of novel MNs with increased biocompatibility, including hydrogel and hollow MNs, further enhance the translational value of MNs in the treatment of vitiligo. However, up-to-date review of these advancements remains lacking. This review aims to summarize the most recent studies of MN-based drug delivery systems for vitiligo, highlighting the translational potential of MNs as a therapeutic platform for the treatment of vitiligo in the near future. Keywords: vitiligo treatment, microneedle design, advanced applications

Qian Wang,1,2,&ast; Guimin Huang,3,&ast; Ruikun Wang,4 Zhilong Cao,5 Jieqiong Liang,1 Mengyao Li,1 Qinglong Gu1,2 1Department of Otolaryngology-Head and Neck Surgery, Capital Institute of Pediatrics, Beijing, People’s Republic of China; 2Graduate School of Peking Union Medical College, Beijing, People’s Republic of China; 3Child Health Big Data Research Center, Capital Institute of Pediatrics, Beijing, People’s Republic of China; 4Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, People’s Republic of China; 5School of Software, Beihang University, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Qinglong Gu, Department of Otolaryngology-Head and Neck Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, People’s Republic of China, Tel +86-13146836613, Email gql71@163.comPurpose: This study investigates the prevalence, risk factors, and clinical characteristics of positional obstructive sleep apnea (POSA) among pediatric patients diagnosed with obstructive sleep apnea (OSA).Patients and Methods: A total of 1,236 children aged 0 to 17 years who underwent nocturnal polysomnography (PSG) and completed the Sleep Questionnaire were included. After excluding those with an AHI < 1, neurological or muscular disorders, or insufficient sleep time in specific positions, 908 patients remained: 158 with POSA and 750 with non-positional OSA (NPOSA). Propensity score matching (PSM) was applied at a 1:2 ratio, resulting in a final sample of 153 POSA and 306 NPOSA patients. Data analyses were performed using R software (version 4.2.3).Results: The prevalence of POSA was 12.8%. After PSM, patients with POSA had a lower overall AHI (8.66 vs 10.30), REM-AHI (14.30 vs 17.40), and NREM-AHI (7.43 vs 8.77) compared to those with NPOSA. POSA patients also had a shorter total sleep time (411 vs 427 minutes), spent less time in the supine position (168 vs 225 minutes), and more time in non-supine positions (241 vs 202 minutes) than NPOSA patients. Additionally, while the supine AHI was higher in POSA patients (15.60 vs 10.30), the non-supine AHI was lower (5.00 vs 11.00) compared to NPOSA patients. The minimum oxygen saturation was slightly higher in POSA patients (0.88 vs 0.87). All differences were statistically significant (P < 0.05). Risk factors for POSA included mild OSA, allergic rhinitis, non-allergic rhinitis, and obesity.Conclusion: The prevalence of POSA in children is lower than in adults, and its severity is less than that of NPOSA. Compared to NPOSA patients, POSA patients had significantly higher AHI during supine sleep and lower AHI during non-supine sleep. POSA patients also spent more time in non-supine positions, suggesting that avoiding supine sleep may help reduce apnea events. These findings highlight the importance of monitoring and managing sleep posture in POSA patients.Keywords: obstructive sleep apnea, pediatric patients, risk factors, polysomnography, sleep position, sleep-disordered breathing

Qian Xie, Jiarou Chen, Hongyan Yang, Jianlong Liang, Rong Ma, Jialiang Guo, Xuxin Zeng School of Medicine, Foshan University, Foshan, 528000, People’s Republic of ChinaCorrespondence: Rong Ma; Xuxin Zeng, School of Medicine, Foshan University, Foshan, 528000, People’s Republic of China, Email 648510213@qq.com; adhesion2002@163.comAbstract: Herbal pairs are unique combinations of two relatively fixed herbs that are used in clinical practice. This is the most fundamental and straightforward form of multiple herbal treatment that aims to attain specific efficacy through unique methods. Coptidis Rhizoma (“Huanglian” in Chinese) and Magnoliae Officinalis Cortex (“Houpo” in Chinese) which are commonly used in combination and could also be used as important components of other prescriptions to treat damp-heat dysentery, splenic and stomach disorders, and qi stagnation in clinical practice. However, there is currently no summary on the compatibility of Huanglian and Houpo about traditional use, phytochemistry, and pharmacological activity. It was found the combination or separate extraction of the two drugs may affect the main active components, and new components may be produced after the combined extraction. At the same time, Huanglian and Houpo herb pair exhibited antiviral, anti-inflammatory, antibacterial and other pharmacological effects. At present, research mainly focuses on the indicator components of Huanglian and Houpo, such as berberine, magnolol, and magnolol. The models used for pharmacological validation are limited, mainly including ulcerative colitis, pneumonia, bacterial infections, etc. In order to verify the pharmacological activity of the combination of Huanglian and Houpo, it is necessary to try more in vitro and in vivo models. It’s still need to study the compatibility mechanism of the Huanglian and Houpo drug pair, including but not limited to the interactions between different components and the impact of compatibility on efficacy, bioequivalence studies, and the impact of different dosage forms on pharmacokinetics in the future. It’s believed that the systematic review provided comprehensive information for the study of Huanglian-Houpo drug pair, which will help highlight the importance of the Huanglian-Houpo herb pair and provide some clues for future research on this herb pair.Keywords: Coptidis Rhizoma, Magnoliae Officinalis Cortex, drug pair, chemical constituents, pharmacological effects

Lifen Lu,1 Di Sheng,1 Xiaowei Xia,2 Guanghui Chen,3 Jiali Liang,4 Xiulan Shen,1 Gui Zheng1 1Department of Nursing, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 2Ministry of Health, the Third Hospital of Ninghai County, Ningbo, Zhejiang, People’s Republic of China; 3Ministry of Health, the Liangzhu Street Community Health Service Center, Yuhang District, Hangzhou, Zhejiang, People’s Republic of China; 4Department of Nursing, the First People’s Hospital of Yuhang District, Hangzhou, Zhejiang, People’s Republic of ChinaCorrespondence: Xiulan Shen; Gui Zheng, Department of Nursing, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China, Email shenxl@zju.edu.cn; zhenggui1119@zju.edu.cnAim: To investigate the emotional response of hospital staff to the Depression Anxiety Stress Scale-21 (DASS-21) over the COVID-19 pandemic and after the relaxation of prevention and control measures in Zhejiang Province, China, and identify influencing factors.Design: Multicenter online cross-sectional design.Methods: From January 10, 2023, to January 20, 2023, 1054 hospital employees in Zhejiang, China, were recruited using WeChat. Data was gathered via online, self-administered surveys. T-tests and one-way analyses of variance, Pearson’s correlation analysis, and multiple linear stepwise regression analyses were used to examine the data.Results: More than 90% of hospital employees were infected with COVID-19. Through regression analysis, the following variables were found to be independent predictors of emotional response to DASS-21: resilience (− 13.346, P < 0.0001), sleep (14.689, P < 0.0001), friend support (− 4.278, P < 0.0001), education level (2.699, P = 0.007), and marriage (− 2.214, P = 0.027). The emotional responses were not as severe as predicted, but they were still well above the Chinese norm. A longitudinal comparison of DASS-21 emotional responses with similar studies showed a parabolic downward trend over time.Conclusion: Our results identified education level, marriage, friend support, resilience, and sleep as independent predictors of emotional responses to the DASS-21 among hospital workers in this outbreak. Improving the mental resilience and sleep status of staff is a key target. Unmarried medical personnel with higher education should be given greater attention and support by management. In addition, there is still room for further improvement in the government and societal responses to similar outbreaks. The study also found a parabolic downward trend in DASS-21 emotional responses among hospital workers during the COVID-19 outbreak over time.Keywords: COVID-19, hospital staff, DASS-21 emotional response, influencing factors, trajectory of change

Weixiong Chen,1,2,&ast; Jianqiang Liang,3,&ast; Shuang He,1,4,5 Qingsong Liang,1,4,5 Wenting Tian,6 Aobo Lu,1 Demin Li,1 Zhicheng Huang,1 Guanyi Wu1,4,5 1College of Basic Medicine, Guangxi University of Chinese Medicine, Nanning, Guangxi, 530299, People’s Republic of China; 2School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, People’s Republic of China; 3Department of Dermatology, the First People’s Hospital of Yulin, Yulin, Guangxi, 537000, People’s Republic of China; 4Key Laboratory for Complementary and Alternative Medicine Experimental Animal Models of Guangxi, Nanning, Guangxi, 530299, People’s Republic of China; 5Guangxi Key Laboratory of Translational Medicine for Treating High-Incidence Infectious Diseases with Integrative Medicine, Nanning, Guangxi, 530299, People’s Republic of China; 6College of Pharmacy, Guangxi University of Chinese Medicine, Nanning, Guangxi, 530299, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Guanyi Wu, College of Basic Medicine, Guangxi University of Chinese Medicine, Nanning, Guangxi, 530299, People’s Republic of China, Email wugy@gxtcmu.edu.cnPurpose: Psoriasis is an immune-related disorder characterized by silver scales, epidermis thickness, and itching. She-Chuang-Si-Wu-Tang (SSWT), a traditional Chinese medicine decoction, has been used clinically for 400 years. Although it benefits psoriasis treatment, the mechanism of action is still unclear. This study explores SSWT’s molecular mechanism in treating psoriasis through network pharmacology analysis and experiments.Methods: We identified relevant SSWT and psoriasis targets using network pharmacology and conducted SSWT quality control with high-performance liquid chromatography (HPLC). A mouse model of psoriasis was established using imiquimod (IMQ), with the drug administered continuously for seven days, spanning an eight-day period. During the experiment, we observed spontaneous scratching behaviors and assessed the Psoriasis Area and Severity Index (PASI) scores. At the conclusion of the experiment, we examined skin tissue pathology under an optical microscope and measured epidermal thickness. Additionally, we used enzyme-linked immunosorbent assay (ELISA) and quantitative reverse transcription polymerase chain reaction (qRT-PCR) to measure interleukin (IL)-23, IL-17A, IL-17F, and interferon (IFN)-γ levels in the mice’s serum and their mRNA expression in the skin. Western blot analysis was conducted to assess protein levels related to signaling pathways.Results: Results indicate that SSWT may target IL-17 signaling pathways and T helper (Th) 17 cell differentiation, as predicted by network pharmacology. SSWT significantly improved the PASI and Baker scores, reduced epidermal thickness, and decreased spontaneous scratching in IMQ-induced mice. Additionally, SSWT treatment significantly lowered the concentrations of inflammatory factors in the serum and skin lesions, as well as mRNA expression levels, compared to the IMQ group. Furthermore, SSWT significantly inhibited the phosphorylation of both the signal transducer and activator of transcription 3 (STAT3) and mitogen-activated protein kinase (MAPK) pathways.Conclusion: In summary, this study unveiled the potential anti-psoriatic mechanism of SSWT, offering new evidence for its clinical application. Keywords: She-Chuang-Si-Wu-Tang, psoriasis, inflammation, itch, STAT3, MAPK

Xue Li,1,&ast; Dianhui Peng,2,&ast; Xinbo Wu,2 Xiaolin Li,2 Junwen Liang,2 Hongjun Yin,2 Le Liu,2 Qian Yang,2 Weixin Dong,2 Chunxia Lu2 1College of Sports and Art, Shandong Sport University, Jinan City, Shandong Province, People’s Republic of China; 2Department of Sport Education, Hunan Normal University, Changsha City, Hunan Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Weixin Dong; Chunxia Lu, Email dongweixin@hunnu.edu.cn; luchunxia@hunnu.edu.cnObjective: Loneliness is a prevalent issue among rural left-behind children in China, adversely affecting their physical and mental well-being, as well as social stability. However, the influencing factors and potential mechanisms of loneliness have not yet been fully clarified. This study aims to validate the mediating roles of social anxiety and psychological resilience by examining the association between affective/cognitive empathy and loneliness among Chinese rural left-behind children.Methods: This cross-sectional survey employed a convenience sampling approach among Chinese left-behind children. A total of 540 participants aged 6 to 11 years old (Average age = 8.54, SD = 1.682) from 3 primary schools in Hunan Province completed the Children’s Loneliness Scale, Social Anxiety Scale for Children, The Chinese version of Connor-Davidson Resilience Scale, and Basic Empathy Scale. Data analysis was conducted using SPSS 27.0, Origin 2020, and Mplus 8.3.Results: Pearson correlation analyses suggested strong significant correlations among affective/cognitive empathy, loneliness, social anxiety, and psychological resilience. Path analyses indicated that the chain mediation effect size of social anxiety and psychological resilience was 0.016 between affective empathy and loneliness, while the chain mediation effect size between cognitive empathy and loneliness was − 0.011.Conclusion: Affective empathy positively correlates with loneliness among Chinese left-behind children through social anxiety and resilience, while cognitive empathy negatively correlates with loneliness. These findings suggest that left-behind children should enhance their cognitive empathy and psychological resilience to reduce their social anxiety, thereby mitigating their loneliness.Keywords: left-behind children, empathy, loneliness, social anxiety, resilience

Hao Jiang,1,&ast; Xiaomin Zhang,2,&ast; Jian Zhang,1 Jie Liang,1 Liping Wang1 1Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, People’s Republic of China; 2Department of Anesthesiology, Beidahuang Industry Group General Hospital, Harbin, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Liping Wang; Jie Liang, Department of Anesthesiology, Harbin Medical University Cancer Hospital, No. 150 of Haping Road, Nangang District, Harbin, Heilongjiang, 150081, People’s Republic of China, Email applew708@126.com; 830625@hrbmu.edu.cnBackground: Opioids and benzodiazepines are frequently prescribed for managing pain and anxiety in chronic obstructive pulmonary disease (COPD) patients. This study aimed to determine whether opioid use, with or without benzodiazepine use, is associated with increased all-cause mortality in COPD patients.Methods: This prospective cohort study included adults aged ≥ 20 years with COPD from the US National Health and Nutrition Examination Survey 2007– 2012. The primary outcome was all-cause mortality, which were obtained through linkage to registries. Weighted Cox proportional hazards regression models were used to evaluate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality. Additionally, subgroup and sensitivity analyses were used to evaluate the robustness of our findings.Results: This study enrolled 811 participants, representing 10.84 million COPD individuals in the United States (mean [standard error] age, 58.7 [0.6] years). During a median follow-up of 9.6 years, mortality rates were 57.8 per 1000 person-years in patients using only opioids, 41.3 per 1000 person-years in patients using only benzodiazepines, 45.7 per 1000 person-years in patients using both opioids and benzodiazepines, and 27.0 per 1000 person-years in patients using neither. In the fully adjusted model, COPD patients prescribed both opioids and benzodiazepines (HR: 1.76; 95% CI: 1.11– 2.78) and those prescribed opioids only (HR: 1.68; 95% CI: 1.13– 2.49) had significantly higher all-cause mortality compared to non-users. After adjusting for propensity scores, the mortality risk for opioid-only users slightly increased (HR: 1.87; 95% CI: 1.25– 2.81). Further, subgroup analysis revealed an elevated mortality risk in patients over 60 years receiving coprescriptions or opioids only, but not in younger participants. In contrast, benzodiazepine-only users aged 60 or younger showed increased mortality risk.Conclusion: Opioid use, with or without benzodiazepine use, was associated with higher mortality in COPD patients over 60, while benzodiazepine-only use was associated with higher mortality aged 60 or younger.Keywords: opioid, benzodiazepine, chronic obstructive pulmonary disease, mortality, national health and nutrition examination survey, NHANES

Jingyao Liang,1,2,&ast; Wei Li,1,2,&ast; Wenyan Liu,1,2 Yihui Yu,1,2 Hui Ye,1,2 Xibao Zhang1,2 1Institute of Dermatology, Guangzhou Medical University, Guangzhou, Guangdong, 510095, People’s Republic of China; 2Department of Dermatology, Guangzhou Dermatology Hospital, Guangzhou, Guangdong, 510095, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xibao Zhang, Department of Dermatology, Guangzhou Dermatology Hospital, 56 Hengfu Road, Guangzhou, Guangdong, 510095, People’s Republic of China, Tel +8620-83593476, Email gzpfbfzs@163.comAbstract: Prurigo nodularis (PN) is a debilitating chronic neuroimmunologic skin condition due to the intense pruritus and difficult to treat. The pruritogenic cytokines, particularly IL-4, IL-13, IL-22, IL-31, and oncostatin M (OSM), play a crucial role in the pathogenesis of PN, potentially involving the JAK1-STAT pathway. An oral JAK1 inhibitor, abrocitinib, is presently undergoing Phase 2 trials for the treatment of PN. We evaluated the efficacy of abrocitinib at a daily dosage of 100 mg in treating two patients with PN affecting both lower limbs: a 50-year-old male with a 16-year disease history and a 38-year-old female with over three years of disease history, both of whom had failed to respond to multiple conventional treatments. Both patients responded rapidly after one week of treatment and exhibited a marked improvement. Following eight weeks of therapy, near-complete resolution of both pruritus and lesions was achieved, and no adverse effects were reported. Additionally, there were no reported side effects during the initial four months of continued treatment. Abrocitinib is an effective targeted therapy for PN, offering a promising new option for refractory patients.Keywords: prurigo nodularis, abrocitinib, pruritus

Yin Cao,1– 4 Qingrong Xia,1– 4 Jun Liang,1– 4 Jiequan Wang,1– 4 Feng Shan,1– 4 Biao Dai1– 4 1Department of Pharmacy, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China; 2Department of Pharmacy, Hefei Fourth People’s Hospital, Hefei, People’s Republic of China; 3Psychopharmacology Research Laboratory, Anhui Mental Health Center, Hefei, People’s Republic of China; 4Department of Clinical Pharmacy, Anhui Clinical Research Center for Mental Disorders, Hefei, People’s Republic of ChinaCorrespondence: Jun Liang, Department of Pharmacy, Hefei Fourth People’s Hospital, 316 Huangshan Road, Hefei, 230000, People’s Republic of China, Email amhcliangj@163.comObjective: The present study aims to investigate the effect of common cold on the serum clozapine concentrations in hospitalized patients with schizophrenia.Methods: A total of 65 schizophrenic patients with common cold receiving clozapine treatment were retrospectively enrolled. The demographic data, medication situation, clozapine concentration, and parameters of routine haematological and biochemical laboratory tests were obtained from the medical record system. The serum clozapine concentration and clozapine concentration/dose (C/D) ratios between the baseline period and cold period were compared by paired-sample t tests. Association between the changes in serum concentration and C/D ratios of clozapine and changes in white blood cell (WBC) and neutrophil (NE) counts was evaluated using Pearson correlation analysis.Results: The serum clozapine concentration (t = − 9.856, P < 0.001) and clozapine C/D ratios (t = − 10.071, P < 0.001) were found to be significantly elevated in the cold period compared to the baseline period. Moreover, the changes in the serum clozapine concentration were found to be significantly elevated in female patients compared to male patients (t = − 2.483, P = 0.017). Furthermore, changes in the serum clozapine concentration were positively correlated to the changes in WBC (r = 0.303, P = 0.014) and NE (r = 0.315, P = 0.011) counts. Similarly, changes in clozapine C/D ratios were positively correlated to the changes in WBC (r = 0.275, P = 0.027) and NE (r = 0.328, P = 0.008) counts.Conclusion: The serum clozapine concentrations in patients with schizophrenia during the common cold period were increased, which might by related to the elevated WBC and NE counts.Keywords: clozapine, blood drug concentration, schizophrenia, white blood cell count, neutrophil count, common cold

Hao Jiang,1,&ast; Xiaomin Zhang,2,&ast; Jie Liang1 1Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, 150081, People’s Republic of China; 2Department of Anesthesiology, Beidahuang Industry Group General Hospital, Harbin, Heilongjiang, 150000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jie Liang, Department of Anesthesiology, Harbin Medical University Cancer Hospital, No. 150 of Haping Road, Nangang District, Harbin, Heilongjiang, 150081, People’s Republic of China, Tel +86-13766864831, Email 830625@hrbmu.edu.cnPurpose: To explore the combined effects of sleep disorders and depression on chronic low back pain (CLBP) in American adults.Material and methods: In this cross-sectional study, the data of all participants were obtained from the National Health and Nutrition Examination Survey (NAHNES) between 2009 and 2010. CLBP was defined as persistent LBP for a consecutive three-month period. Sleep disorders were self-reported and were diagnosed by a doctor before. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms by trained personnel. Potential covariates were selected using weighted univariate logistic regression models. Weighted univariate and multivariate logistic regression models were used to evaluate the separate and combined effects of sleep disorders and depression on CLBP, respectively. Results were presented as odds ratios (ORs) and 95% confidence intervals (CIs). Associations were further explored in the subgroups of age, chronic kidney disease (CKD), diabetes, and having pain outside the low back.Results: A total of 5275 participants were included. Among them, 542 (10.28%) had CLBP. The mean age of all participants was 47.19 (0.53), and 50.65% (n=2668) were female. Sleep disorder (OR=1.52, 95% CI: 1.17– 1.98) or depressive symptoms (OR=3.06, 95% CI: 2.41– 3.88) were associated with higher odds of CLBP. Compared to participants without sleep disorders and depression symptoms, participants in both conditions had an increased risk of CLBP (OR=3.95, 95% CI: 2.58– 6.05, P for trend < 0.001). The combined effects of sleep disorders and depressive symptoms were also found in the population aged < 45 years, ≥ 45 years, with and without CKD, with and without diabetes, and no pain outside the low back.Conclusion: Sleep disorders and depressive symptoms may increase the odds of reporting CLBP. Further research is necessary to explore the effectiveness of multidisciplinary interventions targeting sleep disorders, depressive symptoms, and CLBP.Keywords: chronic low back pain, sleep disorders, depression, combined effect, the national health and nutrition examination survey

Shuping Zhang,1,&ast; Yamei Ma,1,&ast; Xiu Zang,2 Hao Heng,2 Xuekui Liu,2 Gangshan Peng,3 Ran Liu,3 Jun Liang,1,2,&ast; Houfa Geng1,2,&ast; 1Graduate School, Bengbu Medical University, Bengbu, Anhui, People’s Republic of China; 2Department of Endocrinology, Xuzhou Central Hospital, Xuzhou, Jiangsu, People’s Republic of China; 3The Affiliated Xuzhou Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Houfa Geng; Jun Liang, Email genghoufa@xzhmu.edu.cn; liangjun@xzhmu.edu.cnAbstract: Maturity Onset Diabetes of the Young (MODY) is an autosomal dominant inherited disorder prevalent among adolescents. Typically, it manifests with hyperglycemia before the age of 25. MODY5 is attributed to a mutation in the Hepatocyte Nuclear Factor-1β (HNF-1β) gene. A complete absence of HNF-1β is observed in 50% of those with MODY5. The 17q12 microdeletion syndrome closely linked with MODY5. Its incidence in the general population is around 1 in 14,500 and is linked with facial deformities, diabetes, polycystic kidneys, pancreatic hypertrophy, liver anomalies, and neuropsychological impairments. The most primary clinical signs are predominantly associated with the HNF-1β gene deletion. We chronicle the case of a male of 19 years of age diagnosed with diabetes, who, alongside persistent liver damage and polycystic kidneys, was referred from a community hospital to the Xuzhou Central Hospital. His clinical presentation included diabetes, liver dysfunction, polycystic kidneys, lipid irregularities, insulin resistance, and fatty atrophy. Subsequent genetic screening unveiled a 17q12 chromosomal deletion and an absence of the Hepatocyte Nuclear Factor-1β (HNF-1β) gene. Hence, for adolescent patients lacking a familial diabetes history but exhibiting symptoms like polycystic kidneys, liver damage, lipid irregularities, and fatty atrophy, a thorough assessment for the 17q12 microdeletion syndrome becomes imperative.Keywords: 17q12 microdeletion syndrome, HNF-1β gene, special-type diabetes, MODY5, polycystic kidneys, liver damage

Jing Liang,1 Yu Wang,2 He Wang,3 Yu-Hsin Chen,3 Yu-Wei Wu,4 Wen-Jing Yan5 1College of Education, Hebei Normal University, Shijiazhuang, 050024, People’s Republic of China; 2Department of Education and Psychology, Tianjin University of Sport, Tianjin, 301617, People’s Republic of China; 3School of Mental Health, Wenzhou Medical University, Wenzhou, 325035, People’s Republic of China; 4Student Affairs Division, Wenzhou Business College, Wenzhou, 325035, People’s Republic of China; 5Zhejiang Provincial Clinical Research Centre for Mental Illness, Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, People’s Republic of ChinaCorrespondence: Yu-Wei Wu, Student Affairs Division, Wenzhou Business College, Wenzhou, 325035, People’s Republic of China, Email wyw@wzbc.edu.cn Wen-Jing Yan, Zhejiang Provincial Clinical Research Centre for Mental Illness, Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, People’s Republic of China, Email yanwj@wmu.edu.cnBackground: Shame-proneness, particularly in adolescence, is a critical psychological construct linked to aggressive behavior. This study addresses the gap in understanding the specific mechanisms of this relationship within the cultural context of Chinese adolescents.Aim: The study aims to explore the mediating roles of hostility and externalization of blame in the connection between shame-proneness and aggression among Chinese adolescents.Methods: A comprehensive sample of 1489 Chinese adolescents participated in the study. They completed the Test of Self-Conscious Affect for Adolescents to assess shame-proneness and an aggression questionnaire to measure aggressive behaviors. The study utilized network analysis and mediational analysis, to unravel the complex interactions between shame-proneness, externalization of blame, hostility, anger, and aggression.Results: The results identified two distinct pathways linking shame-proneness to aggression: one mediated by hostility and the other by externalization of blame. The pathway via hostility was particularly pronounced, marking it as a central node in the shame-aggression relationship. Interestingly, the study also revealed a direct, though less pronounced, inhibitory effect of shame-proneness on aggression, indicating a dualistic role of shame in adolescent behavior. These findings were consistent across different demographic subgroups, suggesting a generalizable pattern in the studied population.Conclusion: The dual nature of shame-proneness, as both an inhibitor and a facilitator of aggression, underscores the need for culturally sensitive approaches in psychological interventions and future research. The central role of hostility in this relationship points to potential targets for therapeutic interventions aimed at mitigating aggression in adolescents.Keywords: shame-proneness, aggression, network analysis, hostility, externalization of blame

Zhaoyong Li,1,&ast; Yanping Lin,1,&ast; Ting Qiu,2,&ast; Junsheng Liang,1 Yintao Lan,3 Fan Meng,4 Chaohao Liang,4 Yiqing Zhang,4 Qingyun Wang,1 Da Shi,1 Changli Zhang,1 Yanan Shi,1 Liujun Liu,1 Yanlan Yang,1 Jian Zhang4,5 1Department of Radiology, DongGuan Tungwah Hospital, Dongguan Key Laboratory of Radiology and Molecular Imaging, DongGuan, Guangdong, 523000, People’s Republic of China; 2Department of Radiology, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, Guangdong, 519000, People’s Republic of China; 3Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, Guangdong, 510030, People’s Republic of China; 4School of Biomedical Engineering, Guangzhou Medical University, Guangzhou, Guangdong, 511436, People’s Republic of China; 5Department of Oncology, the Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Qingyuan, Guangdong, 511500, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jian Zhang; Zhaoyong Li, Email jianzhang@gzhmu.edu.cn; lizhaoyong2003@163.comBackground: Photothermal therapy (PTT) guided by photoacoustic imaging (PAI) using nanoplatforms has emerged as a promising strategy for cancer treatment due to its efficiency and accuracy. This study aimed to develop and synthesize novel second near-infrared region (NIR-II) absorption-conjugated polymer acceptor acrylate-substituted thiadiazoloquinoxaline-diketopyrrolopyrrole polymers (PATQ-DPP) designed specifically as photothermal and imaging contrast agents for nasopharyngeal carcinoma (NPC).Methods: The PATQ-DPP nanoparticles were synthesized and characterized for their optical properties, including low optical band gaps. Their potential as PTT agents and imaging contrast agents for NPC was evaluated both in vitro and in vivo. The accumulation of nanoparticles at tumor sites was assessed post-injection, and the efficacy of PTT under near-infrared laser irradiation was investigated in a mouse model of NPC.Results: Experimental results indicated that the PATQ-DPP nanoparticles exhibited significant photoacoustic contrast enhancement and favorable PTT performance. Safety and non-toxicity evaluations confirmed the biocompatibility of these nanoparticles. In vivo studies showed that PATQ-DPP nanoparticles effectively accumulated at NPC tumor sites and demonstrated excellent tumor growth inhibition upon exposure to near-infrared laser irradiation. Notably, complete elimination of nasopharyngeal tumors was observed within 18 days following PTT.Discussion: The findings suggest that PATQ-DPP nanoparticles are a promising theranostic agent for NIR-II PAI and PTT of tumors. This innovative approach utilizing PATQ-DPP nanoparticles provides a powerful tool for the early diagnosis and precise treatment of NPC, offering a new avenue in the management of this challenging malignancy.Keywords: nasopharyngeal carcinoma, photoacoustic imaging, photothermal therapy, PATQ-DPP nanoparticles

Jieyang Yu,1,2 Yanan Zhang,1 Lijia Cai,1 Qingqing Sun,1 Wanru Li,1 Junfang Zhou,1 Jianmin Liang,2 Zan Wang1 1Sleep Centre, Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China; 2Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of ChinaCorrespondence: Jianmin Liang, Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, People’s Republic of China, Email liangjm@jlu.edu.cn Zan Wang, Sleep Centre, Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, People’s Republic of China, Email wangzan@jlu.edu.cn; wangzanprof@163.comPurpose: This study aimed to evaluate nocturnal sleep structure and anxiety, depression, and fatigue in patients with narcolepsy type 1 (NT1).Methods: Thirty NT1 patients and thirty-five healthy controls were enrolled and evaluated using the Epworth sleepiness scale (ESS), Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Fatigue Severity Scale (FSS), polysomnography, multiple sleep latency test, and brain function state monitoring. Statistical analyses were performed using SPSS Statistics for Windows, version 23.0. Benjamini-Hochberg correction was performed to control the false discovery rate.Results: Apart from typical clinical manifestations, patients with NT1 are prone to comorbidities such as nocturnal sleep disorders, anxiety, depression, and fatigue. Compared with the control group, patients with NT1 exhibited abnormal sleep structure, including increased total sleep time (Padj=0.007), decreased sleep efficiency (Padj=0.002), shortening of sleep onset latency (Padj< 0.001), elevated wake after sleep onset (Padj=0.002), increased N1% (Padj=0.006), and reduced N2%, N3%, and REM% (Padj=0.007, Padj< 0.001, Padj=0.013). Thirty-seven percent of patients had moderate to severe obstructive sleep apnea-hypopnea syndrome. And sixty percent of patients were complicated with REM sleep without atonia. Patients with NT1 displayed increased anxiety propensity (Padj< 0.001), and increased brain fatigue (Padj=0.020) in brain function state monitoring. FSS scores were positively correlated with brain fatigue (Padj< 0.001) and mean sleep latency was inversely correlated with FSS scores and brain fatigue (Padj=0.013, Padj=0.029). Additionally, ESS scores and brain fatigue decreased after 3 months of therapy (P=0.012, P=0.030).Conclusion: NT1 patients had abnormal nocturnal sleep structures, who showed increased anxiety, depression, and fatigue. Excessive daytime sleepiness and fatigue improved after 3 months of treatment with methylphenidate hydrochloride prolonged-release tablets in combination with venlafaxine.Keywords: narcolepsy, sleep structure, excessive daytime sleepiness, anxiety, depression, fatigue

Jianqiang Liang,1,&ast; Weixiong Chen,2,&ast; Yanhui Zhou,3 Weijia Meng,3 Man Xie,3 Yunying Weng,1 Luxuan Qin,1 Jianmin Li,4 Guanyi Wu1,5,6 1College of Basic Medicine, Guangxi University of Chinese Medicine, Nanning, People’s Republic of China; 2School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, People’s Republic of China; 3College of Pharmacology, Guangxi University of Chinese Medicine, Nanning, People’s Republic of China; 4Department of Dermatology, The Third Affiliated Hospital, Guangxi Medical University, Nanning, People’s Republic of China; 5Key Laboratory for Complementary and Alternative Medicine Experimental Animal Models of Guangxi, Nanning, People’s Republic of China; 6Guangxi Key Laboratory of Translational Medicine for Treating High-Incidence Infectious Diseases with Integrative Medicine, Nanning, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Guanyi Wu, School of Basic Medicine, Guangxi University of Chinese Medicine, 13 Wu He Road, Nanning, Guangxi, 530299, People’s Republic of China, Email wugy@gxtcmu.edu.cnPurpose: This study seeks to investigate the effect of evodiamine on psoriasis and psoriatic pruritus.Methods: Imiquimod-induced psoriasiform dermatitis in mice was used as a model, and evodiamine was topically applied for seven days. The mice were observed daily for skin damage on the back, clinical score and their scratching behavior was recorded. Blood samples were collected on the final day of the experiment, and the serum levels of pruritus-associated inflammatory cytokines tumor necrosis factor (TNF) -α, interleukin (IL) − 23, and IL-17A were measured using enzyme-linked immunosorbent assay. Histopathological changes were observed in Hematoxylin and Eosin-stained skin specimens. The expression levels of transient receptor potential vanilloid (TRPV) 1, TRPV3, TRPV4, and the pruritus-related mediators Substance P (SP), nerve growth factor (NGF), and calcitonin gene-related peptide (CGRP) in the skin lesions were analyzed using Western blot and qRT-PCR. The effect of evodiamine on the exploratory behavior, motor, and coordination abilities of mice was assessed using open field, suspension, and Rota-Rod experiments. Molecular docking was utilized to verify the binding of evodiamine to the residues of TRPV1, TRPV3, and TRPV4.Results: Evodiamine reduced pruritus and inhibited inflammation by decreasing the levels of inflammatory mediators TNF-α, IL-23, and IL-17A in the serum of Imiquimod-induced mice and attenuated the mRNA and protein expression levels of SP, NGF, CGRP, TRPV1, TRPV3, and TRPV4 in the skin.Conclusion: Evodiamine is an effective treatment for psoriasis and pruritus, due to its ability to inhibit immune inflammation and pruritic mediators.Keywords: evodiamine, TRP channel, psoriasis

Liwen Feng,1 Junbo Liang,1 Naiguo Wang,2 Qingyu Zhang2 1Department of Orthopedics, Weihaiwei People’s Hospital, Weihai, Shandong Province, 264200, People’s Republic of China; 2Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, 250021, People’s Republic of ChinaCorrespondence: Qingyu Zhang, Tel +86-13296402823, Email zqy2008512@163.com; zqy2008512@126.com; zhangqingyu@sdfmu.edu.cn Naiguo Wang, Tel +86-13505319917, Email naiguow@outlook.comPurpose: The purpose of this study is to preliminarily assess the change in perioperative systemic inflammatory markers and clinical outcomes between open TLIF and BE-TLIF procedures.Patients and Methods: In total, 38 patients who underwent single-level lumbar fusion surgery (L4-5 or L5-S1) were retrospectively reviewed. 19 patients were treated by the BE-TLIF technique, while the other patients were managed using open TLIF. The perioperative serum C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), lymphocyte/monocyte ratio (LMR), and platelet/lymphocyte ratio (PLR) of the two groups were compared to determine if there was a statistical difference. Meanwhile, clinical evaluations were conducted to assess various factors including operative duration, estimated blood loss (EBL), drainage catheter stay, length of hospitalization, visual analogue scale (VAS), and Oswestry disability index (ODI) scores.Results: The perioperative analysis revealed that BE-TLIF cases experienced a longer operative duration than open TLIF cases (open TLIF: 138.63 ± 31.59 min, BE-TLIF: 204.58 ± 49.37 min, p < 0.001). Meanwhile, the EBL showed an increased trend in the BE-TLIF group (260.7 ± 211.9 mL) in comparison with the open TLIF group (200.9 ± 211.9 mL) (p =0.485). In terms of systemic inflammatory markers, the mean postoperative CRP, NLR, LMR, and PLR were lower in the BE-TLIF group than in the open TLIF group, although these differences were not statistically significant (p > 0.05). The VAS and ODI scores in both groups were significantly improved after surgery (p < 0.05).Conclusion: There was no significant difference found between BE-TLIF and open TLIF in terms of systemic inflammatory markers, and clinical outcomes. Overall, BE-TLIF can be considered a viable choice for lumbar canal decompression and interbody fusion for less invasion. It is worth noting that BE-TLIF does have a longer operation time, indicating that there is still potential for further improvement in this technique.Keywords: transforaminal lumbar interbody fusion, unilateral biportal endoscope, systemic inflammatory markers

Wenjuan Wang,1 Juanjuan Liang,1 Rong Fan,2 Yuanqing Cai,3 Baisong Yin,1 Yangyi Hu1 1School of Government, Central University of Finance and Economics, Beijing, 100081, People’s Republic of China; 2Peking University Cancer Hospital & Institute, Beijing, 100142, People’s Republic of China; 3Chinese Academy of Social Sciences Evaluation Studies, Beijing, 100732, People’s Republic of ChinaCorrespondence: Yangyi Hu, School of Government, Central University of Finance and Economics, 39 South College Road, Beijing, 100081, People’s Republic of China, Email yangyi.hu@outlook.comPurpose: The medical–pharmaceutical separation (MPS) reform is a healthcare reform that focuses on reducing the proportion of drug expenditure. This study aims to analyze the impact of the MPS reform on hospitalization expenditure and its structure in tertiary public hospitals.Methods: Using propensity score matching and multi-period difference-in-difference methods to analyze the impact of the MPS reform on hospitalization expenditure and its structure, a difference-in-difference-in-difference model was established to analyze the heterogeneity of whether the tertiary public hospital was a diagnosis-related-group (DRG) payment hospital. Of 22 municipal public hospitals offering tertiary care in Beijing, monthly panel data of 18 hospitals from July 2011 to March 2017, totaling 1242 items, were included in this study.Results: After the MPS reform, the average drug expenditure, average Western drug expenditure, and average Chinese drug expenditures per hospitalization decreased by 24.5%, 24.6%, and 24.1%, respectively (P < 0.001). The proportions of drug expenditure decreased by 4.5% (P < 0.001), and the proportion of medical consumables expenditure increased significantly by 2.7% (P < 0.001).Conclusion: The MPS reform may significantly optimize the hospitalization expenditure structure and control irrational increases in expenditure. DRG payment can control the tendency to increase the proportions of medical consumables expenditure after the reform and optimize the effect of the reform. There is a need to strengthen the management of medical consumables in the future, promote the MPS reform and DRG payment linkage, and improve supporting measures to ensure the long-term effect of the reform.Keywords: diagnosis-related-group, provider payment reforms, healthcare expenditure, propensity-score-matching, difference-in-difference-in-difference, China

Yuqing Bu,1,&ast; Junye Wen,2,&ast; Fayan Wang,1,3 Shibo Dong,4 Liya He,1 Yang Li,1,5 Jinlong Liang,1,3 Hongzhen Zhang1,3,5 1Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei Province, 050051, People’s Republic of China; 2Department of Hepatobiliary Surgery, Hebei General Hospital, Shijiazhuang, Hebei Province, 050051, People’s Republic of China; 3Department of Medicine, Hebei North University, Zhangjiakou, Hebei Province, 075000, People’s Republic of China; 4Department of Imaging, Hebei General Hospital, Shijiazhuang, Hebei Province, 050051, People’s Republic of China; 5Department of Medicine, North China University of Science and Technology, Tangshan, Hebei Province, 063210, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hongzhen Zhang, Email hongzhenzhang456@sohu.comAbstract: This study presents a case of dual primary liver cancer involving small cell neuroendocrine carcinoma and hepatocellular carcinoma. The 58-year-old Chinese male patient, who has a medical history of viral hepatitis B, presented with right upper abdominal pain persisting for one month. Imaging studies indicated the presence of multiple liver masses in segments V and VII–VIII, as well as a mass in the left lung. Subsequent hepatic biopsy performed on both segments confirmed the presence of hepatocellular carcinoma in segment V and small cell neuroendocrine carcinoma in segment VII–VIII. After undergoing one cycle of chemotherapy, the lung mass exhibited a reduction in size, while the liver masses showed an inadequate response. Subsequently, the patient underwent Transcatheter Arterial Chemoembolization (TACE) and Hepatic Artery Infusion Chemotherapy (HIAC), resulting in partial remission (PR). However, the patient was diagnosed with brain metastasis and subsequently treated with Sorafenib and Tirelizumab, a Programmed Death 1 (PD-1) immune checkpoint inhibitor. The efficacy evaluation indicated stability, and no severe adverse effects were observed at the time of writing. The patient’s survival time was 16 months.Keywords: synchronous tumor, liver tumor, primary tumor, small cell neuroendocrine carcinoma, hepatocellular carcinoma

Anbing Zhang,1,&ast; Xiaoli Lao,1,2,&ast; Jinguang Liang,3 Xiuqiong Xia,1 Lei Ma,4 Jianping Liang1,2 1Department of Respiratory and Critical Care Medicine, Zhongshan People’s Hospital, Zhongshan, People’s Republic of China; 2Guangdong Medical University, Zhanjiang, Guangdong, People’s Republic of China; 3Department of Respiratory and Critical Care Medicine, Zhongshan Huangpu People’s Hospital, Zhongshan, People’s Republic of China; 4Department of Respiratory and Critical Care Medicine, Fuyang Second People’s Hospital, Fuyang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jianping Liang, Department of Respiratory and Critical Care Medicine, Zhongshan People’s Hospital, No. 2, Sunwen East Road, Zhongshan, 528400, People’s Republic of China, Tel +86 15989107884, Fax +86 760-89880255, Email ljpzhongshan@163.comAbstract: This study presents a rare case of pneumonia caused by a co-infection of Chlamydia psittaci and Cryptococcus, confirmed by metagenomic next-generation sequencing (mNGS). The patient, who had underlying chronic hepatitis B, had adopted a stray pigeon before the onset of the disease. The primary symptoms were fever, and a productive cough. The patient recovered following treatment with moxifloxacin and itraconazole. C. psittaci and Cryptococcus infections may both have been transmitted from the stray pigeon. This report highlights the potential for infections caused by multiple zoonotic pathogens and the value of mNGS for making the diagnosis of these infections.Keywords: pneumonia, Chlamydia psittaci, Cryptococcus, co-infection, metagenomic next-generation sequencing

Chao Hong,1,2,&ast; Anni Wang,1,&ast; Jiaxuan Xia,1 Jianming Liang,1,3 Ying Zhu,1 Dan Wang,1,4 Huaxing Zhan,4 Chunbo Feng,5 Xinnan Jiang,5 Junjie Pan,6 Jianxin Wang1,7 1Department of Pharmaceutics, School of Pharmacy, Fudan University & Key Laboratory of Smart Drug Delivery, Ministry of Education, Shanghai, 201203, People’s Republic of China; 2School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People’s Republic of China; 3Institute of Tropical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510006, People’s Republic of China; 4Xiamen Ginposome Pharmaceutical Co., Ltd, Xiamen, 361026, People’s Republic of China; 5R&D Center, Shanghai Jahwa United Co., Ltd, Shanghai, 200082, People’s Republic of China; 6Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, 200040, People’s Republic of China; 7Institute of Integrated Chinese and Western Medicine, Fudan University, Shanghai, 200040, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Junjie Pan; Jianxin Wang, Email junjie112@163.com; jxwang@shmu.edu.cnBackground: Most solid tumors are not diagnosed and treated until the advanced stage, in which tumors have shaped mature self-protective power, leading to off-target drugs and nanomedicines. In the present studies, we established a more realistic large tumor model to test the antitumor activity of a multifunctional ginsenoside Rh2-based liposome system (Rh2-lipo) on advanced breast cancer.Methods: Both cholesterol and PEG were substituted by Rh2 to prepare the Rh2-lipo using ethanol-water system and characterized. The effects of Rh2-lipo on cell uptake, penetration of the tumor spheroid, cytotoxicity assay was investigated with 4T1 breast cancer cells and L929 fibroblast cells. The 4T1 orthotopic-bearing large tumor model was established to study the targeting effect of Rh2-lipo and inhibitory effect of paclitaxel loaded Rh2-lipo (PTX-Rh2-lipo) on advanced breast tumors.Results: Rh2-lipo exhibit many advantages that address the limitations of current liposome formulations against large tumors, such as enhanced uptake in TAFs and tumor cells, high targeting and penetration capacity, cytotoxicity against TAFs, normalization of the vessel network, and depletion of stromal collagen. In in vivo study, PTX-Rh2-lipo effectively inhibiting the growth of advanced breast tumors and outperformed most reported PTX formulations, including Lipusu® and Abraxane®.Conclusion: Rh2-lipo have improved drug delivery efficiency and antitumor efficacy in advanced breast cancer, which offers a novel promising platform for advanced tumor therapy. Keywords: nanomedicine, tumor microenvironment, chemotherapy, tumor-associated fibroblast

Anbing Zhang,1,&ast; Jinguang Liang,2,&ast; Xiaoli Lao,1,3 Xiuqiong Xia,1 Jianping Liang1,3 1Department of Respiratory and Critical Care Medicine, Zhongshan People’s Hospital, Zhongshan, Guangdong Province, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, Zhongshan Huangpu People’s Hospital, Zhongshan, Guangdong Province, People’s Republic of China; 3Graduate School, Guangdong Medical University, Zhanjiang, Guangdong Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jianping Liang, Department of Respiratory and Critical Care Medicine, Zhongshan People’s Hospital, 2 Sunwen East Road, Zhongshan, 528400, People’s Republic of China, Tel +86-159-8910-7884, Fax +86-760-8988-0256, Email ljpzhongshan@163.comAbstract: We report a case of pneumonia caused by coinfection with Chlamydia psittaci and the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron XBB.1 variant, confirmed using metagenomic next-generation sequencing (mNGS) and quantitative polymerase chain reaction (qPCR). C. psittaci and SARS-CoV-2 were detected in bronchoalveolar lavage fluid using mNGS. Additionally, mNGS detected C. psittaci in blood and nasopharyngeal specimens and was more sensitive than qPCR. The patient recovered after treatment with moxifloxacin. This report highlights the use of coinfections of C. psittaci and SARS-CoV-2, as mNGS has already been recognized to be a diagnostic tool for identifying coinfections.Keywords: coinfection, quantitative reverse-transcription polymerase chain reaction, bronchoalveolar lavage fluid, zoonoses

Hui Feng,1 Yang Yue,1 Yan Zhang,1 Jingqi Liang,1 Liang Liu,1 Qiong Wang,1 Qian Feng,2 Hongmou Zhao1 1Department of Foot and Ankle Surgery, Honghui Hospital of Xi’an Jiaotong University, Xi’an City, Shaanxi, 710054, People’s Republic of China; 2Key Laboratory of Biorheological Science and Technology Ministry of Education College of Bioengineering, Chongqing University, Chongqing, 400044, People’s Republic of ChinaCorrespondence: Hongmou Zhao, Department of Foot and Ankle Surgery, Honghui Hospital of Xi’an Jiaotong University, Xi’an City, Shaanxi, 710054, People’s Republic of China, Email zhaohongmou@xiyi.edu.cn Qian Feng, Key Laboratory of Biorheological Science and Technology Ministry of Education College of Bioengineering, Chongqing University, Chongqing, 400044, People’s Republic of China, Email qianfeng@cqu.edu.cnAbstract: Tissue engineering holds great potential for tissue repair and rejuvenation. Plant-derived exosome-like nanoparticles (ELNs) have recently emerged as a promising avenue in tissue engineering. However, there is an urgent need to understand how plant ELNs can be therapeutically applied in clinical disease management, especially for tissue regeneration. In this review, we comprehensively examine the properties, characteristics, and isolation techniques of plant ELNs. We also discuss their impact on the immune system, compatibility with the human body, and their role in tissue regeneration. To ensure the suitability of plant ELNs for tissue engineering, we explore various engineering and modification strategies. Additionally, we provide insights into the progress of commercialization and industrial perspectives on plant ELNs. This review aims to highlight the potential of plant ELNs in regenerative medicine by exploring the current research landscape and key findings.Keywords: plant, exosome-like nanoparticles, nanomedicine, tissue engineering, cartilage, wound, bone