AIM:To investigate the effects of Zhenwu decoction ( ZWD) on the expression of α-smooth muscle actin (α-SMA) and NF-κB in diabetic nephropathy ( DN) rats.METHODS:Diabetic rat model was induced by intrape-ritoneal injection of streptozotocin ( STZ) , and the animals were randomly divided into STZ group ( n=22) and STZ+ZWD group (n=23).The normal rats served as control (n=16).All rats were sacrificed on 8 weeks after modeling.Biochemical assay and pathological observation ( HE staining and transmission electron microscopy ) were used to evaluate the effects of Zhenwu decoction on the renal function and pathological morphology .The body weight , renal index , blood glucose , total urinary protein in 24 h, and superoxide dismutase ( SOD ) , malondialdehyde ( MDA ) , inducible nitric oxide synthase ( iNOS) were determined as well .Western blotting was used to observe the effects of Zhenwu decoction on the expression ofα-SMA and NF-κB in diabetic nephropathy ( DN) rats.RESULTS:Compared with normal group , the renal index , blood glucose concentration, total urinary protein in 24 h, blood urea nitrogen (BUN), serum creatinine (SCr) and MDA were significantly higher and body weight was lower in DN rats (P<0.05).Pathological examination of the kidneys in DN group showed glomerular hypertrophy , glomerular basement membrane thickening , tubular epithelial cell degeneration , me-sangial matrix proliferation , protein cast formation in some renal tubules .The protein expression levels of α-SMA and NF-κB were markedly increased (P<0.05).After ZWD treatment, the level of renal index, total urinary protein in 24 h, BUN, SCr and the expression of α-SMA and NF-κB at the protein level were significantly decreased (P<0.05).The renal histological injury in ZWD group was significantly ameliorated .CONCLUSION: Zhenwu decoction might protect kidney against STZ-induced injury via decreasing the expression of α-SMA and NF-κB.

Objective To evaluate the efficacy and safety of higenamine hydrochloride(HG) stress echocardiography for diagnosis of coronary artery disease (CAD). Methods The study was designed as prospective,randomized,open-labled,positively controlled and crossover phase II multi-center clinical research.Ninety subjects who were suspected to have CAD were enrolled.HG dosage was titrated at 0.5,1, 2,4 μg.kg -1.min-1every 3 min.Adenosine was injected 140 μg.kg -1.min-1for 6 min with total dosage 0.8 mg/kg.Visual assessment of the left ventricle wall motionand 17-segment model were used for analysis of stress echocardiography.CAD was defined as identifying >50% diameter stenosis in at least one major coronary artery by coronary angiogram.All adverse reaction were recorded. Results For HG group,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 28.9%,89.7%, 57.1%,76.5% and 47.8%,respectively;for adenosine group,they were 26.7%,94.9%,58.3%,85.7%and 47.1%,respectively. There was no significant difference between the two groups( P > 0.05). The diagnostic sensitivities of HG and adenosine echocardiography for single vessel stenosis were 11.1% and 5.6%,respectively( P >0.05).Both HG and adenosine echocardiography have the same sensitivity with 37.5% for double vessel stenosis and 44.4% for triple vessel stenosis.Advers reaction rate was 84.4% in HG group and 92.2% in adenosine group( P >0.05).Conclusions HG stress echocardiography for CAD diagnosis has high specificity,good safety and low sensitivity,which are similar to adenosine echo.

To observe the effect of different R‐R interval on left ventricular systolic function measured by echocardiography in patients with persistent atrial fibrillation ( AF ) ,and assess the clinical feasibility of the use of an index that is based on the RR1/RR2 ratio to accurately estimate left ventricular systolic function during AF . Methods T wenty‐one patients with persistent AF received echocardiographic examination ,left ventricular ejection fraction ( LVEF ) and stroke volume ( SV ) were recorded at least 10－20 consecutive cardiac cycles for each patient . T he effects of different R‐R intervals on LVEF and SV determined by echocardiography were analyzed . Bland‐Altman analysis was used to assess the correlation and agreement between the systolic parameters of a single beat method based on the ratio of preceding R‐R intervals approaching to 1 and the average value of multiple cardiac cycles as the golden standard . Results In the same patient with AF ,LVEF and SV measured in different cardiac cycles were unstable with great variation . LVEF and SV were not only correlated with heart rate ,showing significantly positive correlations with RR interval ( all r ＞ 0 .4 , P ＜ 0 .05 ) ; w hich were also affected by heart rate variability ,w hen the heart rate variability was high ( heart rate standard deviation ≥ 30 beats/min ) ,the measured SV was better correlated with RR 1/RR2 ( r :0 .581 vs 0 .835 , P ＝ 0 .009 ) . Bland‐Altman analysis showed excellent correlation and agreement between the LVEF and SV of a single beat with identical RR1and RR2 intervals and measured average values over all cardiac cycles ( r ＝0 .897 ,0 .918 ; all P ＜ 0 .001 ) . Conclusions LV systolic function is significantly correlated with RR interval and is also affected by heat rate variability . Single beat based on ratio of RR 1/RR2 to assess LV systolic function in patients with AF is as accurate as the time‐consuming method of averaging multiple cardiac cycles .

Glaucoma is one of the most common optic neuropathies, featuring progressive retinal ganglion cell damage and visual field loss (Tham et al., 2014; Xu et al., 2020). Currently, the only effective treatment for this condition is the reduction of intraocular pressure (IOP) (Palmberg, 2001; Heijl et al., 2002). Canaloplasty is a proven bleb-independent surgery with good efficacy and safety profiles in primary open-angle glaucoma (POAG) (Gołaszewska et al., 2021). However, early transient postoperative IOP elevation has been reported in up to 30% of cases (Riva et al., 2019), similar to that commonly observed in other internal drainage glaucoma surgeries such as implantation using iStent (0%-21.0%), CyPass (10.8%), and Hydrus (4.8%-6.5%) (Lavia et al., 2017). This complication may be a predictor of poor reserve in the outflow system and is potentially associated with surgical failure. Nonetheless, the exact pathophysiology of glaucoma remains unknown, and studies clarifying the risk factors for postoperative IOP elevation have been scarce.
Humans ; Intraocular Pressure ; Glaucoma, Open-Angle/surgery* ; Incidence ; Treatment Outcome ; Risk Factors

Tuberous sclerosis complex(TSC)is a rare genetic disease that can lead to benign dysplasia in multiple organs such as the skin, brain, eyes, oral cavity, heart, lungs, kidneys, liver, and bones. Its main symptoms include epilepsy, intellectual disabilities, skin depigmentation, and facial angiofibromas, whilst incidence is approximately 1 in 10 000 to 1 in 6000 newborns. This case presents a middle-aged woman who initially manifested with epilepsy and nodular depigmentation. Later, she developed a lower abdominal mass, elevated creatinine, and severe anemia. Based on clinical features and whole exome sequencing, the primary diagnosis was confirmed as TSC. Laboratory and imaging examinations revealed that the lower abdominal mass originated from the uterus. CT-guided biopsy pathology and surgical pathology suggested a combination of leiomyoma and abscess. With the involvement of multiple organs and various complications beyond the main diagnosis, the diagnostic and therapeutic process for this patient highlights the importance of rigorous clinical thinking and multidisciplinary collaboration in the diagnosis and treatment of rare and challenging diseases.