OBJECTIVE To investigate the clinical characteristics of euglycemic diabetic ketoacidosis （euDKA） induced by empagliflozin， and provide references for safe medication. METHODS Case reports of euDKA induced by empagliflozin were retrieved and analyzed from PubMed， Web of Science， CNKI， and Wanfang Data. The Naranjo’s scale was adopted to assess the causal relationship between empagliflozin and euDKA. RESULTS A total of 29 patients were enrolled， including 16 males and 13 females，with a median age of 58 years. All patients were diagnosed with type 2 diabetes mellitus； 22 patients had at least one comorbidity. The median time to euDKA onset was 60 days after administration， and 7 cases occurred within 2 weeks of treatment. Perioperative periods，fasting，and low-carbohydrate or ketogenic diets were the main predisposing factors. Common presentations included nausea，vomiting， fatigue， tachypnea，and tachycardia. The causal relationship between empagliflozin and euDKA was assessed as “probable” in all cases. According to adverse reaction severity grading， 13 cases were grade 3 （severe） and 16 cases were grade 4 （life-threatening）. All patients discontinued empagliflozin and recovered after corresponding treatment. CONCLUSIONS euDKA is a serious adverse reaction to empagliflozin， which mostly occurs early in treatment. Perioperative periods， fasting， and ketogenic diets are prone to induce euDKA. Elderly patients and those with comorbidities are at higher risk. Risk assessment should be conducted before clinical administration； blood ketones and acid-base monitoring should be strengthened in the early medication period； withhold the drug before elective surgery， avoid prolonged fasting；upon diagnosis， discontinue empagliflozin and initiate intravenous insulin， provide fluid resuscitation promptly， and use other treatments to improve patient prognosis.

It is believed that there is a pathogenesis of yang deficiency in polycystic ovary syndrome （PCOS） infertility， and it is concluded that warm-yang method has a better effect in improving endometrial abnormality， enhancing the quality of follicles， correcting endocrine disorders， and resolving or alleviating clinical symptoms in PCOS infertility. Based on Yanghe Decoction （阳和汤）， a representative traditional Chinese medicine decoction for warming yang， Yanghe Xiaonang Decoction （阳和消囊汤） was formulated， combining with warm medicinals according to symptoms， and aerobic exercise was also advocated to help generate and develop yang qi， in order to provide ideas for clinical treatments.

BACKGROUND:Low-grade,chronic inflammation is thought to play a central role in the pathogenesis of osteoarthritis.However,the specific molecular mechanisms are still unclear.OBJECTIVE:To screen and explore the potential hub genes and immune cell infiltration in osteoarthritis.METHODS:We merged data from the GSE206848 on the GPL570 and the GSE55235 and GSE55457 on the GPL96 to form the row dataset.Outlier samples were removed using weighted gene co-expression network analysis,followed by the identification of differentially expressed genes,and subsequent functional enrichment analysis of differentially expressed genes.Further,a protein-protein interaction network of differentially expressed genes was constructed,and hub genes were identified using two different algorithms in Cytoscape.Additionally,the CIBERSORT algorithm was employed to assess differences in immune cell infiltration proportions between osteoarthritis samples and normal controls.Finally,the diagnostic efficacy of hub genes for osteoarthritis was validated using quantitative reverse transcription polymerase chain reaction experiments conducted on synovial tissue samples collected from patients with osteoarthritis,in conjunction with the GSE12021 dataset from the GPL96 sequencing platform as an independent dataset.RESULTS AND CONCLUSION:After eliminating 5 outlier samples,we identified a total of 340 differentially expressed genes,comprising 159 up-regulated genes and 181 down-regulated genes.Six hub genes were obtained by weighted gene co-expression network analysis and Cytoscape.CIBERSORT analysis revealed a difference in the proportion of multiple types of immune cell infiltration in osteoarthritic tissues compared with normal tissues.Moreover,the expression levels of the six hub genes exhibited strong correlation with the relative proportion of multiple immune cells in osteoarthritis.The results of RT-qPCR indicated that the relative expression levels of the six genes were down-regulated relative to normal tissues.However,there was no significant difference in the expression of NFKBIA and PTGS2(P>0.05).Simultaneously,receiver operator characteristic curves in both the original and external datasets demonstrated that the six hub genes exhibited strong diagnostic capabilities for osteoarthritis(area under the curve>0.8).To conclude,four hub genes,CDKN1A,MYC,C-X-C motif chemokine ligand 2,and vascular endothelial growth factor A,are finally identified and may serve as molecular targets for future treatment by mediating immune response and inflammatory processes.

Cognitive impairment is the main clinical manifestation of many nervous system diseases such as stroke,multiple sclerosis,and neurodegeneration,and neuroinflammation is one of the key mechanisms for the onset of cognitive disorders.Chemokines are a class of highly conserved small-molecule secretory proteins that bind to the corresponding chemokine receptors located on cell mem-brane,activating downstream signaling pathways and playing an important role in cell migration,proliferation,differentiation,and sur-vival.In the central nervous system,chemokines and their receptors are involved in immune response and can exert a certain regulatory effect on neuroinflammation.This article reviews the research advances in chemokines and their receptors in cognitive disorders,in or-der to provide new insights and targets for the early diagnosis and treatment of related diseases.

Diabetic kidney disease(DKD)is the main cause of end-stage renal disease and the main burden of the health care system.The current understanding of the mechanism of DKD progression recognizes the involvement of oxidative stress,low-grade inflammation,and fibrosis.This article reviews the protective effect of dietary fiber on DKD and its potential molecular mechanism through intestinal flora metabolites-butyric acid and butyrate,in order to provide a new strategy for the prevention and treatment of DKD.

Diabetic kidney disease(DKD)is the main cause of end-stage renal disease and the main burden of the health care system.The current understanding of the mechanism of DKD progression recognizes the involvement of oxidative stress,low-grade inflammation,and fibrosis.This article reviews the protective effect of dietary fiber on DKD and its potential molecular mechanism through intestinal flora metabolites-butyric acid and butyrate,in order to provide a new strategy for the prevention and treatment of DKD.

BACKGROUND:Low-grade,chronic inflammation is thought to play a central role in the pathogenesis of osteoarthritis.However,the specific molecular mechanisms are still unclear.OBJECTIVE:To screen and explore the potential hub genes and immune cell infiltration in osteoarthritis.METHODS:We merged data from the GSE206848 on the GPL570 and the GSE55235 and GSE55457 on the GPL96 to form the row dataset.Outlier samples were removed using weighted gene co-expression network analysis,followed by the identification of differentially expressed genes,and subsequent functional enrichment analysis of differentially expressed genes.Further,a protein-protein interaction network of differentially expressed genes was constructed,and hub genes were identified using two different algorithms in Cytoscape.Additionally,the CIBERSORT algorithm was employed to assess differences in immune cell infiltration proportions between osteoarthritis samples and normal controls.Finally,the diagnostic efficacy of hub genes for osteoarthritis was validated using quantitative reverse transcription polymerase chain reaction experiments conducted on synovial tissue samples collected from patients with osteoarthritis,in conjunction with the GSE12021 dataset from the GPL96 sequencing platform as an independent dataset.RESULTS AND CONCLUSION:After eliminating 5 outlier samples,we identified a total of 340 differentially expressed genes,comprising 159 up-regulated genes and 181 down-regulated genes.Six hub genes were obtained by weighted gene co-expression network analysis and Cytoscape.CIBERSORT analysis revealed a difference in the proportion of multiple types of immune cell infiltration in osteoarthritic tissues compared with normal tissues.Moreover,the expression levels of the six hub genes exhibited strong correlation with the relative proportion of multiple immune cells in osteoarthritis.The results of RT-qPCR indicated that the relative expression levels of the six genes were down-regulated relative to normal tissues.However,there was no significant difference in the expression of NFKBIA and PTGS2(P>0.05).Simultaneously,receiver operator characteristic curves in both the original and external datasets demonstrated that the six hub genes exhibited strong diagnostic capabilities for osteoarthritis(area under the curve>0.8).To conclude,four hub genes,CDKN1A,MYC,C-X-C motif chemokine ligand 2,and vascular endothelial growth factor A,are finally identified and may serve as molecular targets for future treatment by mediating immune response and inflammatory processes.

Pediatric calyceal diverticulum (CD) is a relatively rare entity. Fewer cases were reported in China treated by retroperitoneal laparoscoopic surgery in children. In this paper, 2 cases of children with CD admitted to our hospital were reported. CT urography showed cystic low-density mass without obvious enhancement, and delayed contrast agent was found to enter the lesion. Both cases underwent cystoscopy + retroperitoneoscopy + diverticular neck suture. They were followed up for 15 months and 9 months after the surgery, respectively, with favorable outcomes and no recurrence of CD.

Purpose To explore the value of contrast-enhanced ultrasound(CEUS)in the differential diagnosis of gallbladder polypoid lesions(GPLs)(diameter≥10 mm).Materials and Methods A prospective enrollment of 229 patients with GPLs who underwent cholecystectomy in 17 hospitals from December 1 2021 to June 30 2024 was conducted to analyze the relationship between general data,conventional ultrasound,CEUS characteristics and the nature of GPLs.Multivariate Logistic regression was employed to identify independent risk factors for neoplastic polyps,the differential diagnostic value of different indicators was compared.Results Among 229 patients with GPLs,there were 108 cases of cholesterol polyps,102 cases of adenoma and 19 cases of gallbladder cancer.Age(Z=-4.476,P<0.001),polyp number(χ2=15.561,P<0.001),diameter(Z=-8.149,P<0.001),echogenicity(χ2=9.241,P=0.010),vascularity(χ2=23.107,P<0.001),enhancement intensity(χ2=47.610,P<0.001),enhancement pattern(χ2=6.468,P=0.011),vascular type(χ2=84.470,P<0.001),integrity of gallbladder wall(χ2=7.662,P=0.006)and stalk width(Z=-9.831,P<0.001)between cholesterol polyps and neoplastic polyps were statistically significant.Age,location,diameter,echogenicity,enhancement pattern,vascular type and stalk width between adenoma and gallbladder cancer were statistically significant(Z=-4.333,-3.902,-5.042,all P<0.05).Multivariate Logistic regression analysis showed that hyper-enhancement,branched vascular type and stalk width were independent risk factors for neoplastic polyps(OR=4.563,5.770,3.075,all P<0.001).The combination of independent risk factors was better than single factor and diameter in the differential diagnosis of cholesterol polyps and neoplastic polyps(all P<0.01).Conclusion CEUS can effectively identify the nature of GPLs and provide a valuable imaging reference for the selection of treatment methods.

Objective : To investigate the effect of electroacupuncture (EA) treatment at pinch points (EX⁃B2) on motor function and Notch signaling pathway after spinal cord injury(SCI) . Methods : Seventy⁃two Sprague⁃Dawley (SD) male rats weighing (250 ± 20) g were randomly divided into sham operation group , SCI , electroacupuncture group (SCI + EA) and acupuncture group (SCI + AP) , with 18 rats in each group. A rat acute SCI model of T10 was established by the modified Allen ′s method. The SCI + EA and SCI + AP groups received 15 minutes of electro acupuncture or acupuncture treatment per day. The motor function of the hind limbs of rats was assessed by Basso , Beattie and Bresnahan ( BBB) scoring method , the pathological recovery changes of spinal cord tissues were observed by Hematoxylin⁃eosin (HE) staining , and the mRNA and protein expression levels of Hes 3 , Notch 3 and Notch 4 were detected by real⁃time quantitative PCR and estern blot method , respectively , after 3 , 7 and 14 days of intervention. The expression of glial fibrillary acidic protein (GFAP) was detected by immunohistochemistry after 14 days of intervention. Results : Compared with the sham group , the BBB scores were reduced in rats after SCI surgery and there was significant hemorrhage , structural destruction and degeneration of spinal cord tissue ( P < 0. 05) , while the SCI + EA and SCI + AP groups were milder than the SCI group (P < 0. 05) . The mRNA expression levels and protein expression levels of Hes 3 , Notch 3 and Notch 4 as well as the expression levels of GFAP appeared significantly higher in the SCI group compared with the sham group (P < 0. 05) , while the SCI + EA group appeared lower compared with the SCI group (P < 0. 05) . Conclusion EA of EX⁃B2 can improve the locomotor function of rats with SCI , which may be related to inhibiting the expression of GFAP and the activation of Notch signaling pathway.