With the rising incidence of diabetes， diabetic kidney disease （DKD） has become a significant global health burden. Although current prevention and treatment strategies can partially delay the progression of DKD， the risk of patients advancing to end-stage renal disease remains high. Since the concept of the "gut-kidney axis" was first introduced at the International Congress on Dialysis in 2011， research on the role of gut microbiota in the pathogenesis of DKD has received increasing attention. This review summarizes the current research on gut microbiota， explores the mechanisms through which it contributes to DKD development， and outlines clinical approaches for DKD prevention and treatment based on the "gut-kidney axis" theory. Evidence indicates that dietary interventions， intake of probiotics or prebiotics， use of metformin and novel antidiabetic drugs， and application of traditional Chinese medicine （TCM） compound formulas can effectively improve gut microbiota composition， influence metabolite production， and restore the intestinal mucosal barrier. These interventions can further regulate intestinal innate immunity and inflammatory responses， thereby modulating the progression of DKD. Despite challenges posed by the traditional oral administration of water-decocted TCM compound formulas and the complexity of their ingredients， increasing evidence suggests that TCM may indirectly affect the occurrence and development of DKD by modulating gut microbiota. This finding provides a new perspective on the potential mechanisms of TCM in DKD treatment and may offer novel strategies for DKD prevention and therapy.

BACKGROUND:Glucose metabolism plays a crucial role in maintaining the normal physiological function of the body.Glucose metabolism disorder can lead to a range of health problems.At present,the molecular mechanism of glucose metabolism and potential gene targets in osteoarthritis need to be further studied.OBJECTIVE:To analyze the genes related to glucose metabolism in osteoarthritis by bioinformatics methods,and to verify them by cell experiments in vitro,so as to provide new ideas for prevention and treatment of osteoarthritis from the perspective of glucose metabolism.METHODS:Differentially expressed genes and glucose metabolism related genes were screened out from GEO database and GeneCards database.The genes related to both osteoarthritis and glucose metabolism were obtained.Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis were used to screen the functions and pathways of these genes.To further investigate the interactions between these genes,a protein-protein interaction network was constructed and computational methods using Cytoscape software were utilized to identify key genes(Hub genes)for osteoarthritis glucose metabolism.In addition,CIBERSORT algorithm was used to analyze immune cell infiltration in GSE98918 data set.Finally,the expression of Hub gene was verified by cell experiment in vitro.RESULTS AND CONCLUSION:A total of 134 osteoarthritis glucose metabolism-related genes were obtained.GO enrichment analysis showed that GO was mainly involved in the reaction of toxic substances,the positive regulation of inflammatory reaction,the reaction of lipopolysaccharide and so on.KEGG enrichment analysis showed that it was closely related to PI3K-Akt signaling pathway,interleukin-17 signaling pathway,and AGE-RAGE signaling pathway in diabetic complications.Macrophages,monocytes,resting natural killer cells,regulatory T cells,and CD8+T cells were the main infiltrating cells obtained by immune infiltration analysis.In vitro cell experiments showed that the expression of Hub genes SERPINF1,TAC1,GLUL,APOE,and TMEM176A in the experimental group was significantly different from that in the control group.The mRNA expression of HLA-DRA was not statistically significant.The results show that SERPINF1,TAC1,Glul,APOE,and TMEM176A may be the key genes of glucose metabolism in osteoarthritis,and may be potential new targets for the prevention and treatment of osteoarthritis.

Hepatocellular carcinoma(HCC)ranks as the third leading cause of cancer-related death worldwide,characterized by high incidence and mortality.Recent advancements in multidisciplinary comprehensive treatment have accelerated the shift toward personalized therapeutic strategies,with significant progress in combining targeted therapy,immunotherapy,and locoregional therapies,which has achieved remarkable results and significantly improved the prognosis of patients.Moreover,advancements in comprehensive treatment have enabled disease downstaging in selected advanced-stage patients,ultimately qualifying them for curative-intent interventions such as anatomic hepatectomy or liver transplantation.The evolving HCC treatment paradigm continuously reshapes surgical approaches while introducing novel clinical challenges.Moving forward,advancements in HCC diagnosis and treatment must balance technological innovation with rigorous clinical validation,while proactively implementing evidence-based standardization of emerging techniques such as minimally invasive surgery and molecular subtyping.Multicenter clinical research should further define optimal patient cohorts for specific therapeutic strategies,ultimately establishing reliable evidence-based frameworks for clinical practice.

As an important strategy in antiviral drug development, nucleoside analogs (NAs) have attracted considerable attention due to their unique mechanisms of action and favorable safety profile. This review systematically summarizes recent advances in the mechanisms of action of NAs, focusing on the following four aspects: (1) Targeting viral polymerases, inhibiting viral replication through mechanisms such as non-absolute termination, delayed chain termination and induction of viral RNA mutations in addition to classical chain termination, which has been newly discovered; (2) Regulating RNA methylation modifications—for instance, competitively inhibiting methyltransferases, which significantly reduces viral replication efficiency; (3) Depleting nucleotide pools—by affecting host cell purine nucleotide synthesis pathways, thereby indirectly inhibiting viral replication; and (4) Immunomodulatory functions—including activation of the STING pathway to promote interferon production. Furthermore, this review systematically discusses the breakthrough progress in prodrug technologies for addressing key clinical challenges such as drug resistance and off-target toxicity of NAs. These advances provide crucial technical support for the clinical translation of NAs. These advances provide key technical support for the clinical translation of NAs. This review clarifies the multi-target action rules of NAs and provides a theoretical framework for the design of next-generation broad-spectrum antiviral agents.

Objective:Using ecological niche width and situation model,the operation and management of public Traditional Chinese Medicine(TCM)hospitals in 16 cities in Shandong Province were evaluated to put forward countermeasures.Methods:The relevant index data of public TCM hospitals in 16 cities in Shandong Province from 2019 to 2022 were collected to analyze the development status.The ecological niche width model and niche situation model were applied to evaluate the operation and management of public TCM hospitals in 16 cities in Shandong.Results:The top three public TCM hospitals in terms of average ecological niche width were City G,City P and City F.The ecological niche situation value of public TCM hospitals in City K,City A and City J ranked the top three.Conclusion:The dimensions of operation management structure of public TCM hospitals in Shandong need to be enhanced and the development of operation management space needs to be balanced.It is feasible to evaluate operation management by using ecological niche width and situation model.It is suggested to improve the allocation efficiency of health personnel,facilities,funds and other resources;promote the spatial balanced development of operation management;promote the application of ecological niche width and situation model in the field of medicine and health management.

Objective To re-assess the Meta-analyses/network Meta-analyses on baloxavir marboxil in the treat-ment of influenza,and provide evidence-based reference for clinical use of baloxavir marboxil.Methods Meta-ana-lyses/network Meta-analyses on baloxavir marboxil in the treatment of influenza were retrieved from PubMed,Em-base,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang,and VIP databases,with re-trieval time from the inception of each database to December 11,2023.Literatures were screened according to the inclusion and exclusion criteria.Information of included literatures was extracted,and the methodological quality,reporting quality and evidence quality of the included literatures were assessed by assessment of multiple systematic reviews 2(AMSTAR-2)scale,preferred reporting items for systematic reviews and Meta-analyses(PRISMA)statement,as well as grading of recommendations,assessment,development,and evaluation(GRADE)system,respectively.Results A total of 7 Meta-analyses/network Meta-analyses were included.The results showed that in terms of alleviation time of influenza symptoms,the efficacy of baloxavir marboxil was not inferior to oseltamivir,peramivir,and zanamivir.In terms of the decrease in influenza virus titer 48 hours after medication,baloxavir mar-boxil was superior to oseltamivir and zanamivir.In terms of safety,baloxavir marboxil had a lower risk of drug-re-lated adverse events than oseltamivir,and was comparable to peramivir and zanamivir.The overall assessment result of methodological quality of AMSTAR-2 scale was relatively low,with 2 literatures being classified as low-level and 5 as extremely low-level.PRISMA scores ranged 15.5-22.The quality of overall report was moderate.Two lite-ratures were scored＞21,and the reports were relatively complete.There were 5 literatures with scores ranging 15-21,and the reports had certain deficiencies.The GRADE evidence quality grading results showed that among the in-cluded 199 outcome indicators,4 indicators were high-level evidence,49 were moderate-level evidence,118 indica-tors were low-level evidence,and 28 indicators were extremely low-level evidence.Conclusion Baloxavir marboxil is comparable to neuraminidase inhibitors in the alleviation time of influenza symptoms,superior to oseltamivir and zanamisvir in decreasing virus titer,and has a lower risk of adverse drug events(especially nausea)than oseltamivir.

Objective To systematically evaluate the clinical characteristics of Streptococcus gallolyticus(SG)in-fection in children.Methods PubMed,Embase,Web of Science,China National Knowledge Infrastructure(CNKI),Wanfang,and VIP databases were systematically retrieved,retrieval time was from database establish-ment to March 15,2024.Case reports or case series reports of SG infection in children were included,while re-views,abstracts that couldn't obtain the full text,and literatures outside of Chinese and English language were ex-cluded.Two researchers independently evaluated the quality of the included literatures,extracted literature informa-tion,and summarized the clinical characteristics of SG infection by adopting Joanna Briggs Institute(JBI)quality evaluation tools.Results 35 literatures were included in analysis,involving 65 pediatric patients,including 40 males and 22 females,with 3 cases not reporting gender.The age of onset ranges from 20 hours to 3.5 years old.Bacteremia,bacterial meningitis,infective endocarditis,urinary tract infection,and liver abscess were 53,38,4,2 cases,and 1 case,respectively.SG had a high susceptibility rate to penicillin(96.1％).Bacteremia and meningitis were often treated with monotherapy of penicillin G,ampicillin,or cefotaxime,with a few cases using two antimi-crobial combination.Four cases of endocarditis were all treated with two antimicrobial combination,and one case of liver abscess was treated with three antimicrobial combination;60 cases survived,4 cases died,and 1 case had no reported clinical outcome.Seven children with meningitis developed neurological complications,and one child with endocarditis developed glomerulonephritis.Conclusion Low-age children is the main population of SG infection in children,especially neonate,with bacteremia and meningitis being the most common.Most children have good clini-cal outcomes,and minority of children with bacteremia may die from septic shock.

BACKGROUND:Endoplasmic reticulum stress is closely associated with the occurrence and progression of osteoarthritis,but the key genes and regulatory mechanisms remain unclear.OBJECTIVE:Utilizing bioinformatics to identify crucial endoplasmic reticulum stress-related genes in osteoarthritis,followed by experimental validation in cell models,aiming to offer new strategies for the prevention and treatment of osteoarthritis from the perspective of endoplasmic reticulum stress.METHODS:Osteoarthritis-related dataset GSE55235 was downloaded from the GEO database.Differential genes in synovial tissue of osteoarthritis were obtained through WGCNA machine learning algorithm and intersected with endoplasmic reticulum stress-related genes from the GeneCard database to acquire differential endoplasmic reticulum stress-related genes in osteoarthritis(ERSDEGs).These genes underwent GO and KEGG enrichment analysis,construction of a protein-protein interaction network,and validation of diagnostic efficiency in external datasets.Human primary synovioblast model of osteoarthritis was constructed.The control group was not treated,and the experimental group received 20 ng/mL lipopolysaccharide to simulate osteoarthritic synoviocyte modeling.Real-time fluorescence quantitative PCR was then performed to validate the expression level of each differential gene followed by immune infiltration analysis.RESULTS AND CONCLUSION:A total of 27 key endoplasmic reticulum stress-related genes in osteoarthritis were identified.GO enrichment analysis revealed that these genes were mainly enriched in collagen metabolism,chemokine,antigen binding,and immunoglobulin receptor binding processes.KEGG analysis indicated that they were mainly enriched in pathways such as rheumatoid arthritis and relaxin signaling pathways.The protein-protein interaction network was constructed,and the top five genes with the highest scores were identified using the Degree algorithm in Cytoscape software,including matrix metallopeptidase 1,tumor necrosis factor ligand superfamily member 11,matrix metallopeptidase 9,collagen type 1 alpha 1,and chemokine C-X-C motif ligand 12.Immune infiltration analysis showed that immune cells were mainly distributed in M2 macrophages,chemokine C-X-C motif ligand 12 showed a significant positive correlation with resting mast cells(r=0.70,P＜0.001)and a significant negative correlation with resting memory CD4+T cells(r=-0.72,P＜0.001).Matrix metallopeptidase 9 showed a significant positive correlation with MO macrophages(r=0.94,P＜0.001).Collagen type 1 alpha 1 was significantly positively correlated with resting NK cells(r=0.77,P＜0.001)and MO macrophages(r=0.76,P＜0.001).Receiver operator characteristic curve analysis in external datasets GSE77298 and GSE1919 showed that the five key genes had good disease prediction value.In vitro cell experiments demonstrated significant differences in the expression levels of matrix metallopeptidase 1,tumor necrosis factor ligand superfamily member 11,matrix metallopeptidase 9,and chemokine C-X-C motif ligand 12 in the osteoarthritic cell model compared to the control group.These results showed that the key genes related to endoplasmic reticulum stress in osteoarthritis,including matrix metallopeptidase 1,tumor necrosis factor ligand superfamily member 11,matrix metallopeptidase 9,and chemokine C-X-C motif ligand 12,influence the occurrence and development of osteoarthritis through the links of collagen degradation and immune regulation,which are expected to provide new insights into the targeted treatment of osteoarthritis.

Objective:Using ecological niche width and situation model,the operation and management of public Traditional Chinese Medicine(TCM)hospitals in 16 cities in Shandong Province were evaluated to put forward countermeasures.Methods:The relevant index data of public TCM hospitals in 16 cities in Shandong Province from 2019 to 2022 were collected to analyze the development status.The ecological niche width model and niche situation model were applied to evaluate the operation and management of public TCM hospitals in 16 cities in Shandong.Results:The top three public TCM hospitals in terms of average ecological niche width were City G,City P and City F.The ecological niche situation value of public TCM hospitals in City K,City A and City J ranked the top three.Conclusion:The dimensions of operation management structure of public TCM hospitals in Shandong need to be enhanced and the development of operation management space needs to be balanced.It is feasible to evaluate operation management by using ecological niche width and situation model.It is suggested to improve the allocation efficiency of health personnel,facilities,funds and other resources;promote the spatial balanced development of operation management;promote the application of ecological niche width and situation model in the field of medicine and health management.

Objective To re-assess the Meta-analyses/network Meta-analyses on baloxavir marboxil in the treat-ment of influenza,and provide evidence-based reference for clinical use of baloxavir marboxil.Methods Meta-ana-lyses/network Meta-analyses on baloxavir marboxil in the treatment of influenza were retrieved from PubMed,Em-base,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang,and VIP databases,with re-trieval time from the inception of each database to December 11,2023.Literatures were screened according to the inclusion and exclusion criteria.Information of included literatures was extracted,and the methodological quality,reporting quality and evidence quality of the included literatures were assessed by assessment of multiple systematic reviews 2(AMSTAR-2)scale,preferred reporting items for systematic reviews and Meta-analyses(PRISMA)statement,as well as grading of recommendations,assessment,development,and evaluation(GRADE)system,respectively.Results A total of 7 Meta-analyses/network Meta-analyses were included.The results showed that in terms of alleviation time of influenza symptoms,the efficacy of baloxavir marboxil was not inferior to oseltamivir,peramivir,and zanamivir.In terms of the decrease in influenza virus titer 48 hours after medication,baloxavir mar-boxil was superior to oseltamivir and zanamivir.In terms of safety,baloxavir marboxil had a lower risk of drug-re-lated adverse events than oseltamivir,and was comparable to peramivir and zanamivir.The overall assessment result of methodological quality of AMSTAR-2 scale was relatively low,with 2 literatures being classified as low-level and 5 as extremely low-level.PRISMA scores ranged 15.5-22.The quality of overall report was moderate.Two lite-ratures were scored＞21,and the reports were relatively complete.There were 5 literatures with scores ranging 15-21,and the reports had certain deficiencies.The GRADE evidence quality grading results showed that among the in-cluded 199 outcome indicators,4 indicators were high-level evidence,49 were moderate-level evidence,118 indica-tors were low-level evidence,and 28 indicators were extremely low-level evidence.Conclusion Baloxavir marboxil is comparable to neuraminidase inhibitors in the alleviation time of influenza symptoms,superior to oseltamivir and zanamisvir in decreasing virus titer,and has a lower risk of adverse drug events(especially nausea)than oseltamivir.