Diabetic nephropathy (DN) is one of the most common and severe complications of diabetic microangiopa-thy which gradually become the major cause of end-stage renal disease (ESRD) in recent years, even though its patho-genesis remains to be elucidated. Proteinuria is one of important malignant factors leading to the deterioration of DN as well as its mainly clinical feature. Lately experimental evidences show that podocyte phenotypic transformation could be a causative role in the genesis of the early DN proteinuria. In this context, it ’s necessary to review the relative bio-logical characteristics of podocyte phenotypic transformation, its associated signaling pathways, its relationship between proteinuria and the possible mechanism of its medical intervention including valsartan and triptolide.

Objective To explore the influencing factors of poor prognosis after clipping in patients with ruptured intracranial aneurysm and hematoma,and to construct a clinical prediction model.Methods A total of 151 patients with aneurysmal intracranial hematoma in Dongyang People's Hospital were selected from September 2017 to October 2023.3 months after operation,the patients were grouped by modified Rankin scale(mRS),with 93 cases in good prognosis group and 58 cases in poor prognosis group.Univariate analysis and multivariate Logistic regression analysis were used to explore the risk factors affecting the poor prognosis of patients with postoperative prognosis,and a poor prognostic prediction model for patients with intracranial aneurysm rupture and hematoma clamping was constructed,the discriminant validity of the area under the curve(AUC)was evaluated,and the fit of the model was established using the Hosmer-Lemeshow test.Results The Hunt-Hess gradeⅣ-Ⅴ(OR=5.339),modified Fisher grade Ⅲ-Ⅳ(OR=5.145),hematoma volume≥ 50ml(OR=7.426),hematoma clearance rate was≤50％(OR=8.381),size of the responsible aneurysm＞5mm(OR=3.053),operation time window＞5h(OR=2.659),and intraoperative vascular operation time＞3h(OR=2.305)were independent risk factors for poor prognosis after clipping in patients with intracranial aneurysm ruptured and intracranial hematoma(P＜0.05).The AUC of the poor prognosis prediction model of patients with intracranial aneurysm rupture with hematoma after clipping was 0.863(95％CI:0.781-0.946,P＜0.001),the specificity was 79.6％,the sensitivity was 86.2％,and the prediction accuracy was 82.1％.Hosmer-Lemeshow testx2=5.778,P=0.679,and there was no significant difference between the predicted value of the model and the actual observed value.Conclusion Hunt-Hess grade Ⅳ-Ⅴ,the modified Fisher grade Ⅲ-Ⅳ,hematoma volume≥50ml,hematoma clearance rate≤50％,responsible aneurysm size＞5mm,operation time window＞5h,and intraoperative vascular operation time＞3h were independent risk factors for poor prognosis after clipping in patients with intracranial aneurysm ruptured.The model constructed in this study has high predictive performance and can provide guidance for the treatment and postoperative recovery of patients undergoing craniotomy and clipping surgery in clinical practice.