Oxidative stress is a pivotal factor in the onset and progression of diabetic kidney disease （DKD）， and it plays an essential role in the prevention and treatment of DKD. The "Gaozhuo" pathogenesis posits that DKD is characterized by the invasion of Gaozhuo and damage to the kidney collaterals， with the underlying cause being the insufficiency of spleen Qi and the internal formation of Gaozhuo， which provides valuable guidance on oxidative stress. The insufficiency of spleen Qi and the internal formation of Gaozhuo represent a dynamic， evolving process. Gaozhuo invades the kidney collaterals， impairs kidney Qi， and progressively leads to the congealing and stagnation of Gaozhuo and blood， ultimately resulting in the failure of both the spleen and kidneys. The damage caused by Gaozhuo to the kidney collaterals and kidney Qi is analogous to the organ and functional damage of the kidneys induced by excessive reactive oxygen species and oxidative stress. Damage to the kidney collaterals means organic injuries to the glomeruli， renal tubules， and renal interstitium， and the depletion of kidney Qi refers to damage to glomerular filtration and renal tubular reabsorption. The congealing and stagnation of Gaozhuo and blood in the kidney collaterals is similar to oxidative stress-induced thickening of the glomerular basement membrane and fibrosis. The interaction between spleen and kidney Qi deficiency and the congealing and stagnation of Gaozhuo and blood creates a vicious cycle that exacerbates the condition， ultimately evolving into the failure of both the spleen and kidneys. The failure of the spleen and kidneys is analogous to renal failure， and its extreme manifestation is end-stage renal disease and uremia. The treatment of oxidative stress in DKD with traditional Chinese medicine （TCM） is based on the principles of strengthening the spleen and tonifying the kidneys， and dispelling turbidity and removing blood stasis. According to the syndrome type， it is recommended to use methods such as strengthening the spleen and tonifying Qi while dispelling dampness and removing turbidity， strengthening the spleen and tonifying the kidneys while dispelling dampness and removing turbidity， strengthening the spleen and tonifying the kidneys while dispelling turbidity and removing blood stasis， or consolidating the spleen and kidneys while clearing away turbidity and blood stasis.

Objective:To explore the diagnostic value of high frequency ultrasound in the diagnosis of closed penile cavernous rupture.Methods:The ultrasonic examination data of 8 patients with closed penile cavernous rupture treated in Union Medical College Affiliated to Tongji Medical College of Huazhong University of Science and Technology from August 2016 to May 2021 were retrospectively analyzed, and the high-frequency ultrasonic image features were analyzed.Results:Among the 8 patients with closed penile cavernous rupture, 6 were located at the distal end of the corpus cavernosum, one was located at the middle of the corpus cavernosum, and one was located at the proximal end of the corpus cavernosum. All of them were unilateral penile cavernosum rupture, 3 on the left side and 5 on the right side. In all 8 cases, the white membrane of the corpus cavernosum of the penis was continuously interrupted, and the broken end could be clearly displayed. The largest white membrane breach was 16.1 mm, and the smallest was 2.1 mm. Hematoma formed around the rupture of the tunica albuginea of the penis corpus cavernosum, and the maximum range of hematoma was 40.3 mm×15.4 mm, the minimum range of hematoma was 7.9 mm×5.6 mm.Conclusions:High frequency ultrasound is convenient, rapid and accurate, and can be used as the first choice of auxiliary examination for closed penile cavernous rupture.

Objective:To investigate the clinical value of conventional ultrasound combined with contrast-enhanced ultrasound (CEUS) in diagnosis of chromophobe renal cell carcinoma (ChRCC).Methods:We retrospectively analyzed the ultrasound features of 40 cases with ChRCC which were confirmed by operation and pathology from January 2012 to January 2018 in our hospital. The site, shape, size, capsule, internal echo and blood supply of the lesions were observed by routine ultrasound. Then CEUS showed the modality of enhancement, including the arrival time, peak time, peak intensity, distribution and the washout time.Results:Among the 40 cases, 38 cases were single, 2 cases were multiple, 17 cases were left kidney, 22 cases were right kidney, 1 case was double kidney. The tumors were located in the upper part of the kidney in 8 cases (20.0%), the lower part of the kidney in 9 cases (22.5%), and the middle part of the kidney in 23 cases (57.5%). One of the tumors was located in the right renal pelvis, and the lesion invaded the renal capsule in 11 cases (27.5%). The tumor was round, quasi round or oval, with clear boundary in 35 cases (87.5%), unclear boundary in 5 cases (12.5%), and the maximum diameter was 2.0-11.2 (5.1±0.8)cm. The lesions were hypoechoic in 23 cases (57.5%), isoechoic in 7 cases (17.5%), slightly hyperechoic in 7 cases (17.5%), cystic and solid mixed echo in 3 cases (7.5%), homogeneous echo in 23 cases (57.5%), heterogeneous echo in 17 cases (42.5%), and calcification in 5 cases (12.5%). Color Doppler flow imaging (CDFI) showed that blood vessels could be seen around the lesions, and no obvious blood flow signal was detected in 15 cases (37.5%) of the lesions; few star shaped blood flow signals could be detected in 12 cases (30%) of the lesions, short strip shaped blood flow signals could be detected in 7 cases (17.5%) of the lesions, and abundant blood flow signals could be seen in 6 cases (15%) of the lesions. Four patients underwent contrast-enhanced ultrasound examination at the same time. The lesions began to strengthen rapidly and evenly at the same time in the renal cortex, showing slightly low enhancement, and disappeared earlier than the renal cortex, showing a " fast forward and fast backward" perfusion mode. No tumor thrombus in draining vein, perirenal tissue and lymph node metastasis were found in all cases.Conclusions:Conventional ultrasound show ChRCC to be poor blood supply of solid tumors in the renal parenchyma, most of which are hypoechoic or isoechoic, with clear boundaries. CEUS show the lesions taking on high wash-in and wash-out, low enhancement than the surrounding renal cortex. These features are helpful for preoperative ultrasound diagnosis of ChRCC.

Pleural infection is a common disease associated with increasing morbidity and high mortality. Factors such as age, geographical area, settings of infection (hospital or community acquired)or certain underlying diseases can influence the microbiology of pleural infection. Thus, understanding the microbiology of pleural infection is of vital importance to guide therapeutic decisions. Since the positive rate of conventional cultures is low among cases of pleural infection, new diagnostic methods such as 16S ribosomal RNA (16S rRNA)and metagenomic next-generation sequencing(mNGS)have broad prospects in clinical applications. 16S rRNA and mNGS improves the etiologic diagnosis of pleural infection, facilitating the decision of appropriate anti-infection regimens. The treatment of pleural infection includes appropriate anti-infection regimen, pleural drainage, intrapleural therapy and the need for medical thoracoscopy or surgery. It is convinced that the use of intra-pleural DNase and t-PA has exhibited excellent therapeutic effects in pleural infection and reduced the need for surgery. This paper summarizes recent literatures on the microbiologic characteristics of pleural infection and progress of diagnosis and treatment, aimed to provide clinical evidence for the management of pleural infection.

Objective The purpose of this study was to produce cut-off values of fetal pulmonary artery stenosis (PS),allowing the application of Z-scores to evaluate fetal pulmonary artery.Methods A total of 214 normal singleton fetuses and 107 singleton fetuses with PS were included in this study.They were measured for standard biometry:biparietal diameter (BPD) and femoral diaphysis length (FL) and an assessment of gestation age (GA).The standardized fetal echocardiographic measurements included diameters of pulmonary valve annulus (PV),pulmonary artery (PA),ductus arteriosus (DA) and aorta (AO).Then we calculated the Z-scores from parameters of fetal size.The Z-scores differences of PV,PA,DA and AO in PS group were compared.The receiver operator characteristic (ROC) curves of PV and PA Z-scores were obtained by statistical analysis.Results Compared with the normal group,the Z-scores of PV,PA and DA decreased in the PS group,whereas the Z-scores of AO increased (P ＜0.01 for all).The critical values of Z-score for PV in diagnosing PS with BPD,FL and GA as variables were-1.13,-1.33,-1.28,with sensitivity 94.2％,90.3％,93.5％,specificity 60.0％,65.0％,62.5％,respectively.The critical values of Z-score for PA with BPD,FL and GA as variables were-1.01,-0.98,-1.01,with sensitivity 96.8％,96.8％,96.1％,specificity 65.0％,65.0％,62.5％,respectively.Conclusions In the fetus with pulmonary artery stenosis,PV,PA and DA Z-scores decreased,while AO Z-scores increased.The pulmonary artery Z-scores had important application value in quantitative evaluation and diagnosis of mild fetal pulmonary artery stenosis.