This study aims to explore the medication rules and mechanisms of treating chronic renal failure(CRF) by Jinling medical school based on data mining, network pharmacology, and experimental validation systematically and deeply. Firstly, the study selected the papers published by the inherited clinicians in Jinling medical school in Chinese journals using the subject headings named "traditional Chinese medicine(TCM) + chronic renal failure", "TCM + chronic renal inefficiency", or "TCM + consumptive disease" in China National Knowledge Infrastructure, Wanfang, and VIP Chinese Science and Technology Periodical Database and screened TCM formulas for treating CRF according to inclusion and exclusion criteria. The study analyzed the frequency of use of single TCM and the four properties, five tastes, channel tropism, and efficacy of TCM used with high frequency and performed association rule and clustering analysis, respectively. As a result, a total of 215 TCM formulas and 235 different single TCM were screened, respectively. The TCM used with high frequency included Astragali Radix, Rhei Radix et Rhizoma, Salviae Miltiorrhizae Radix et Rhizoma, Poria, and Atractylodis Macrocephalae Rhizoma(top 5). The single TCM characterized by "cold properties, sweet flavor, and restoring spleen channel" and the TCM with the efficacy of tonifying deficiency had the highest frequency of use, respectively. Then, the TCM with the rules of "blood-activating and stasis-removing" and "diuretic and dampness-penetrating" appeared. In addition, the core combination of TCM [(Hexin Formula, HXF)] included "Astragali Radix, Rhei Radix et Rhizoma, Poria, Salviae Miltiorrhizae Radix, and Angelicae Sinensis Radix". The network pharmacology analysis showed that HXF had 91 active compounds and 250 corresponding protein targets including prostaglandin-endoperoxide synthase 2(PTGS2), PTGS1, sodium voltage-gated channel alpha subunit 5(SCN5A), cholinergic receptor muscarinic 1(CHRM1), and heat shock protein 90 alpha family class A member 1(HSP90AA1)(top 5). Gene Ontology(GO) function analysis revealed that the core targets of HXF predominantly affected biological processes, cellular components, and molecular functions such as positive regulation of transcription by ribonucleic acid polymerase Ⅱ and DNA template transcription, formation of cytosol, nucleus, and plasma membrane, and identical protein binding and enzyme binding. Kyoto Encyclopedia of Genes and Genomes(KEGG) analysis revealed that CRF-related genes were involved in a variety of signaling pathways and cellular metabolic pathways, primarily involving "phosphatidylinositol 3-kinase(PI3K)-protein kinase B(Akt) pathway" and "advanced glycation end products-receptor for advanced glycation end products". Molecular docking results showed that the active components in HXF such as isomucronulatol 7-O-glucoside, betulinic acid, sitosterol, and przewaquinone B might be crucial in the treatment of CRF. Finally, a modified rat model with renal failure induced by adenine was used, and the in vivo experimental confirmation was performed based on the above-mentioned predictions. The results verify that HXF can regulate mitochondrial autophagy in the kidneys and the PI3K-Akt-mammalian target of rapamycin(mTOR) signaling pathway activation at upstream, so as to alleviate renal tubulointerstitial fibrosis and then delay the progression of CRF.
Data Mining ; Drugs, Chinese Herbal/chemistry* ; Network Pharmacology ; Humans ; Kidney Failure, Chronic/metabolism* ; Medicine, Chinese Traditional ; China

Objective:To evaluate the practical value of ultrasound, ultrasound new technologies (ultrasound elastography, contrast enhanced ultrasound) and computed tomography (CT) examination alone or the combination of both of the four in the clinical diagnosis of lymph node metastasis of thyroid cancer by meta-analysis system.Methods:This study screened relevant literature on ultrasound, new ultrasound technologies, and CT in the diagnosis of lymph node metastasis of thyroid cancer by searching Chinese and English databases from January 2006 to August 2023. Two scholars independently assessed the quality of the literatures and scored them using the QUADAS scale. Then, the diagnostic ratio of single and combined examinations was analyzed by Meta-Disc software, and the heterogeneity test and meta-analysis were performed to calculate the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic ratio, accuracy, and area under curve (AUC). Finally, the diagnostic efficacies of different diagnostic techniques and their combination in identifying lymph node metastasis of thyroid cancer were assessed by calculating OR and P values by two-by-two comparisons. Results:Sixty-nine diagnostic studies totaling 30, 666 lesions were finally included. The meta-analysis study showed that contrast enhanced ultrasound had the highest sensitivity[0.83(0.77-0.87)], ultrasound specificity was the highest [0.84(0.79-0.88)], the highest AUC was for contrast enhanced ultrasound (0.90), and contrast enhanced ultrasound and ultrasound elastography had high accuracies (0.81, 0.80, respectively) both of them were higher than those of ultrasound (0.77) and CT (0.69). Contrast enhanced ultrasound and ultrasound elastography were both more sensitive than CT, with statistically significant differences between them ( P<0.01); contrast enhanced ultrasound + ultrasound elastography had the highest accuracy, while ultrasound + contrast enhanced ultrasound and contrast enhanced ultrasound + ultrasound elastography were both more sensitive, with no statistically significant differences between them ( P>0.05), but the latter had the highest specificity [0.90(0.88-0.92)], which were statistically significantly different from each other ( P<0.05), ultrasound+ contrast enhanced ultrasound and contrast enhanced ultrasound+ ultrasound elastography had higher sensitivities than ultrasound+ CT, which were statistically different from each other ( P<0.05), and ultrasound+ CT had the lowest specificity [0.76(0.70-0.81)]. Conclusions:The diagnostic efficacy of thyroid cancer lymph node metastasis is highest with contrast enhanced ultrasound. The new ultrasound technique for diagnosing thyroid cancer lymph node metastasis has a higher diagnostic value than CT, and it can be used as a complementary examination to conventional ultrasound.When the two techniques are used in combination, contrast enhanced ultrasound + ultrasound elastography has the highest accuracy, contrast enhanced ultrasound + ultrasound elastography and ultrasound + contrast enhanced ultrasound both have high sensitivity and specificity, and the diagnostic performance of both is higher than that of ultrasound + ultrasound elastography and ultrasound + CT, and in actual clinical practice when ultrasound elastography combined with contrast enhanced ultrasound is limited in the examination, ultrasound combined with contrast enhanced ultrasound can effectively serve as an alternative means to provide a good diagnostic support.

Objective:To compare the differences in surgical safety and postoperative cosmetic effects between endoscopic nipple-sparing mastectomy with immediate prepectoral prosthesis breast reconstruction and conventional nipple-sparing mastectomy with immediate subpectoral prosthesis breast reconstruction.Methods:The clinical data of early breast cancer patients admitted to the Department of Breast Surgery of Peking University Peoples Hospital from Oct 1, 2022 to Sep 13, 2023 was retrospectively analyzed.Results:According to the surgical method, the patients were divided into endoscopic surgery group (30 cases) and traditional surgery group (46 cases). There were no significant differences in the basic clinicopathological data, and the number of sentinel lymph nodes taken and axillary lymph nodes dissected between the patients in two groups (all P>0.05). Compared with that in traditional surgery group, the patients in endoscopic surgery group had longer operation time and more wound drainage volumes 3 days after surgery (all P<0.05). There was no significant differences in the probability of postoperative complications between the patients in two groups (all P>0.05), however, the proportion of nipple-areola complex necrosis in patients of endoscopic surgery group (10.0%) was lower than that of traditional surgery group (26.1%). Conclusions:The single-port insufflation technique-assisted endoscopic nipple-sparing mastectomy with immediate prepectoral prosthesis breast reconstruction maximize the cosmetic effect. Under the premise of strict selection of indications, it can be an optional surgical method.

A 49-year-old female examinee, employed at a paper company in Guigang, Guangxi (engaged in the production of napkins), visited the Qintang District People′s Hospital in Guigang on June 11, 2023, to apply for a health certificate. Salmonella was isolated during a physical examination screening for enteric pathogens ( Salmonella, Shigella), and repeated use of empirical antibacterial drugs failed to eradicate the pathogen. A reference laboratory identified the two isolates as S. Kentucky ST198 by performing serotyping, drug resistance phenotyping, and whole genome sequencing. Based on the regional serotype database of Salmonella in China, a phylogenetic tree of S. Kentucky ST198 resistance genotypes was constructed, defining both isolated strains as high-level drug-resistant ST198.2-1 subclade clones. Following a multidisciplinary consultation and based on antimicrobial susceptibility test results, the treatment was adjusted to amoxicillin/clavulanate and azithromycin. On August 19, three consecutive negative test results confirmed the eradication of Salmonella Kentucky.

Recent studies have shown that the occurrence and development of common liver diseases, including non-alcoholic fatty liver disease, cirrhosis, and liver cancer, are related to liver aging(LA). Therefore, to explore the effect and mechanism of Dahuang Zhechong Pills(DHZCP), a traditional classic prescription in improving LA with multiple targets, the present study randomly divided 24 rats into a normal group, a model group, a DHZCP group, and a vitamin E(VE) group, with six rats in each group. The LA model was induced by continuous intraperitoneal injection of D-galactose(D-gal) in rats. For the LA model rats, the general situation was evaluated by aging phenotype and body weight(BW). LA was assessed by the pathological characteristics of hepatocyte senescence, hepatic function indexes, the staining characteristics of phosphorylated histone family 2A variant(γ-H2AX), and the expression levels of cell cycle arrest proteins(P21, P53, P16) and senescence-associated secretory phenotype(SASP) in the liver. The activation of the reactive oxygen species(ROS)-mediated phosphatidylinositol-3 kinase(PI3K)/protein kinase B(Akt)/forkhead box protein O4(FoxO4) signaling pathway was estimated by hepatic ROS expression feature and the protein expression levels of the key signaling molecules in the PI3K/Akt/FoxO4 signaling pathway. The results showed that after the treatment with DHZCP or VE for 12 weeks, for the DHZCP and VE groups, the characterized aging phenotype, BW, pathological characteristics of hepatocyte senescence, hepatic function indexes, relative expression of ROS in the liver, protein expression levels of key signaling molecules including p-PI3K, p-Akt, and FoxO4 in the liver, staining characteristics of γ-H2AX, and the protein expression levels of P16, P21, P53, interleukin-6(IL-6), and tumor necrosis factor-α(TNF-α) in the liver were improved, and the effects of DHZCP and VE were similar. Based on the D-gal-induced LA model in rats, this study demonstrates that DHZCP can ameliorate LA with multiple targets in vivo, and its effects and mechanism are related to regulating the activation of the ROS-mediated PI3K/Akt/FoxO4 signaling pathway in the liver. These findings are expected to provide new pharmacological evidence for the treatment of DHZCP in aging-related liver diseases.
Animals ; Rats ; Proto-Oncogene Proteins c-akt/genetics* ; Phosphatidylinositol 3-Kinases/genetics* ; Reactive Oxygen Species ; Tumor Suppressor Protein p53/genetics* ; Signal Transduction ; Liver ; Aging ; Cell Cycle Proteins ; Interleukin-6

Objective:To analyze the clinical outcome of nasal symptoms in patients with pituitary lesions after transsphenoidal surgery by microscope.Methods:A perspective study was performed; 53 patients with pituitary lesions treated by transsphenoidal microsurgery in our hospital from March 2012 to January 2013 were enrolled. Sinonasal outcome test (SNOT)-22 was used to evaluate the nasal symptoms in these patients before surgery, and 1 week, 1 month and 4 months after surgery; Toyota and Takagi (T&T) olfactometer was used to evaluate the olfaction before surgery, and 1 week and 4 months after surgery.Results:Among the 53 patients, 47 were with pituitary adenoma and 6 were with Rathke cysts. The common postoperative nasal symptoms included olfactory disorder, nasal obstruction, runny nose, pain in the nasal cavity and dizziness. The total scores and 5-items scores of SNOT-22 in patients 1 week and 1 month after surgery were significantly higher as compared with those before surgery ( P<0.05); there were no significant differences in these scores between before surgery and 4 months after surgery ( P>0.05). The incidence of olfactory disorder in patients 1 week and 4 months after surgery was significantly higher than that before surgery ( P<0.05); the incidence of olfactory disorder in patients 4 months after surgery was decreased as compared with that 1 week after surgery, without significant difference ( P>0.05). Conclusion:Olfactory disorder can occur to some extent after transsphenoidal approach with slow recovery, which deserves the attentions.

Objective:To investigate the surgical treatment efficacy and experience of invasive thalamus cavernous malformations (CMs).Methods:A retrospective analysis was performed. The clinical and follow-up data of 8 patients with invasive thalamus CMs, admitted to our hospital from July 2007 to June 2020, were chosen. These patients accepted minimally invasive resection via sylvian fissure-insular approach after the second rapture hemorrhage; follow up was performed for 8 months-10 years. Results:The lesions of these 8 patients were near the lateral thalamus, and the lesions were completely removed during the surgery. Within 24 h of surgery, the lower limb muscle strength of one patient was improved to grading 2, and that of 2 patients was improved to grading 1. Follow up results 6 months after treatment showed that the modified Rankin scale scores were 1-3 in 5 patients and 4 in 3 patients; and there were no recurrence during the follow-up of (49.7±37.8) months.Conclusion:The resection via sylvian fissure-insular approach is safe and effective for patients with invasive thalamus CMs after the second rapture hemorrhage.

Objective:To explore the possible associated factors and parameters of obstructive sleep apnea hypopnea syndrome (OSAHS) among the elderly in Changsha.Methods:In the investigation of chronic diseases among the elderly in Changsha and the promotion and popularization of community standardized prevention and control, 500 elderly people >65 years old in Yuhua District of Changsha City were selected by multi-stage sampling method. Polysomnography (PSG) was used to detect sleep apnea hypopnea syndrome and collect physical examination indexes. A total of 70 cases met the diagnostic criteria of OSAHS apnea hypopnea index were divided into mild (42 cases), moderate (16 cases) and severe (12 cases). 20 cases of non OSAHS were selected as control group. The general information, PSG level and dynamic blood glucose level were compared between the two groups. Pearson correlation analysis was performed between ambulatory blood glucose level and sleep apnea hypopnea index in OSAHS patients.Results:There were significant differences in body mass index (BMI), girth ratio, smoking history, drinking history, apnea frequency, longest duration of hypoventilation, lowest oxygen saturation, supine apnea index and non supine apnea index between OSAHS group and control group ( P<0.05). The amplitude of blood glucose fluctuation was positively correlated with sleep apnea hypopnea index ( P<0.05). Conclusions:Among the many associated factors on OSAHS, BMI and the ratio of neck circumference to length and body position have the most notable influence. Patients with OSAHS are more prone to blood glucose fluctuations, and gradually worsen with the progression of OSAHS. Therefore, we should take targeted intervention measures.

Objective: To verify the safety and efficacy of IONTRIS particle therapy system (IONTRIS) in clinical implementation. Methods: Between 6.2014 and 8.2014, a total of 35 patients were enrolled into this trial: 31 males and 4 females with a median age of 69 yrs (range 39-80). Ten patients had locally recurrent head and neck tumors after surgery, 4 cases with thoracic malignancies, 1 case with hepatocellular carcinoma, 1 case with retroperitoneal sarcoma, and 19 cases with non-metastatic prostate carcinomas. Phantom dose verification was mandatory for each field before the start of radiation. Results: Twenty-two patients received carbon ion and 13 had proton irradiation. With a median follow-up time of 1 year, all patients were alive. Among the 16 patients with head and neck, thoracic, and abdominal/pelvic tumors, 2, 1, 12, and 1 cases developed complete response, partial response, stable disease, or disease progression, respectively. Progression-free survival rate was 93.8% (15/16). Among the 19 patients with prostate cancer, biological-recurrence free survival was 100%. Particle therapy was well tolerated in all 35 patients. Twenty-five patients (71.4%) experienced 33 grade 1 acute adverse effects, which subsided at 1 year follow-up. Six (17.1%) patients developed grade 1 late adverse effects. No significant change in ECOG or body weight was observed. Conclusions IONTRIS is safe and effective for clinical use. However, long term follow-up is needed to observe the late toxicity and long term result.

Objective To verify the safety and efficacy of IONTRIS particle therapy system ( IONTRIS) in clinical implementation. Methods Between 6.2014 and 8.2014, a total of 35 patients were enrolled into this trial:31 males and 4 females with a median age of 69 yrs ( range 39?80) . Ten patients had locally recurrent head and neck tumors after surgery, 4 cases with thoracic malignancies, 1 case with hepatocellular carcinoma, 1 case with retroperitoneal sarcoma, and 19 cases with non?metastatic prostate carcinomas. Phantom dose verification was mandatory for each field before the start of radiation. Results Twenty?two patients received carbon ion and 13 had proton irradiation. With a median follow?up time of 1 year, all patients were alive. Among the 16 patients with head and neck, thoracic, and abdominal/pelvic tumors, 2, 1, 12, and 1 cases developed complete response, partial response, stable disease, or disease progression, respectively. Progression?free survival rate was 93.8％ (15/16). Among the 19 patients with prostate cancer, biological?recurrence free survival was 100％. Particle therapy was well tolerated in all 35 patients. Twenty?five patients (71.4％) experienced 33 grade 1 acute adverse effects, which subsided at 1 year follow?up. Six ( 17.1％) patients developed grade 1 late adverse effects. No significant change in ECOG or body weight was observed. Conclusions IONTRIS is safe and effective for clinical use. However, long term follow?up is needed to observe the late toxicity and long term result.