ObjectiveTo investigate the therapeutic effect of Astragali Radix-mediated changes in gut microbiota on treating type 2 diabetes （T2DM）. MethodsA 12-week randomized， placebo-controlled clinical trial enrolled eighty patients with newly diagnosed type 2 diabetes and poor glycemic control in the Qi deficiency type. All patients received insulin therapy. The observation group （40 cases） was administered with Astragali Radix Granules， while the control group （40 cases） received a placebo. Both treamtents were taken orally twice daily. Changes in gut microbiota were assessed by 16s rDNA sequencing. Serum glucagon-like peptide-1 （GLP-1） levels were measured using enzyme-linked immunosorbent assay （ELISA）. Glucose metabolism indicators including fasting blood glucose （FPG）， 2-hour postprandial blood glucose （2 h PG），glycated albumin（GA）， and glycated hemoglobin （HbA1c） were evaluated. Pancreatic function was evaluated using fasting C-peptide （FCP）， 2-hour postprandial C-peptide （2 h CP）， and C-peptide area under the curve （AUC_cp）. Traditional Chinese medicine （TCM） syndrome scores， clinical efficacy， and safety indicators were also observed. ResultsIn terms of glucose metabolism indicators， compared with the baseline， both groups exhibited significantly lower FPG， 2 h PG， GA and HbA1C （P<0.01），while FCP， 2 h CP and AUC_cp were significantly higher （P<0.01）. Compared with the control group after the treatment， the observation group showed significantly lower FPG， 2 h PG， GA and HbA1C（P<0.05， P<0.01），and significantly higher FCP， 2 h CP and AUC_cp （P<0.05， P<0.01）， indicating that Astragali Radix can improve glucose metabolism. In terms of the diversity of gut microbiota， no significant differences were detected in the Chao1， Shannon and Simpson indexes of the two groups compared with their respective baselines. However， compared with the post-treatment control group， the observation group demonstrated significant increases in the Chao1， Shannon and Simpson indexes （P<0.05， P<0.01）. The β-diversity analysis showed significant separation in gut microbiota composition before and after treatment in both groups， indicating that Astragali Radix can significantly alter the structure and improve the diversity of gut microbiota. At the phylum level， compared with the baseline， both groups showed a significant increase in the relative abundance of Bacteroidota（P<0.01）. The relative abundance of the potentially harmful phylum Proteobacteria was significantly lower in the observation Group after treatment （P<0.01）. Compared with the post-treatment control group， the observation group had a significantly higher relative abundance of Bacteroidota（P<0.01）. No significant difference was found in Firmicutes/Bacteroidota （F/B） ratio between the two groups after treatment， and other phyla showed no significant differences. At the genus level， compared with the baseline， the observation group exhibited a significant increase in Bacteroides （P<0.01） and a significant decrease in Escherichia-Shigella （P<0.01）， whereas no significant difference was seen in the control group . Compared with the control group after treatment， the observation group after treatment had a significantly higher relative abundance of Bacteroides （P<0.01）. No significant differences were seen in other genera. Linear discriminant analysis （LDA） identified potential characteristics taxa： in the observation group， Bacteroidota at the phylum level and Bacteroides and Dubosiella at the genus level， in the control group， Proteobacteria at the phylum level as well as Barnesiella and Staphylococcus at the genus level. Correlation analysis based on a heatmap revealed that GLP-1 levels were positively correlated with Firmicutes， F/B ratio and Fusobacterium， and negatively correlated with Bacteroidota， Proteobacteria， Bacteroides and Escherichia-Shigella. In terms of clinical efficacy， compared with the control group， the total effective rate of the observation group was significantly higher （P<0.05）. Compared with the baseline， the scores for shortness of breath， fatigue， weakness， spontaneous sweating and reluctance to speak significantly decreased in both groups （P<0.01）. Compared with the control group after treatment， the score for weakness was significantly lower in the observation group （P<0.01），indicating that Astragali Radix could improve clinical symptoms and alleviate weakness symptoms. In terms of safety， compared with the baseline， alanine aminotransferase （ALT） levels significantly decreased in both groups （P<0.05，P<0.01），indicating that Astragali Radix did not induce any significant abnormalities in liver and kidney functions. ConclusionAstragali Radix demonstrates the potential to significantly improve the gut microbiota environment in patients of newly diagnosed type 2 diabetes with Qi deficiency. The therapeutic effect may contribute to glycemic control， possibly mediated by an elevation in GLP-1 level. These findings may support its further clinical investigations and potential applications.

Objective:To explore the current status of surgery for portal hypertension to grasp current status and future development of surgery in China.Methods:This study is jointly sponsored by China Hepatobiliary & Pancreatic Specialist Alliance & Portal Hypertension Alliance in China (CHESS).Comprehensive surveying is conducted for basic domestic situations of surgery for portal hypertension, including case load, surgical approaches, management of postoperative complications, primary effects, existing confusion and obstacles, liver transplantation(LT), laparoscopic procedures and transjugular intrahepatic portosystemic shunt(TIPS), etc.Results:A total of 8 512 cases of portal hypertension surgery are performed at 378 hospitals nationwide in 2021.Splenectomy plus devascularization predominated(53.0%)and laparoscopy accounted for 76.1%.Primary goal is preventing rebleeding(67.0%) and 72.8% of hospitals used preventive anticoagulants after conventional surgery.And 80.7% of teams believe that the formation of postoperative portal vein thrombosis is a surgical dilemma and 65.3% of hospitals practiced both laparoscopy and TIPS.The major reasons for patients with portal hypertension not receiving LT are due to a lack of qualifications for LT(69.3%)and economic factors(69.0%).Conclusions:Surgery is an integral part of management of portal hypertension in China.However, it is imperative to further standardize the grasp of surgical indications, the handling of surgical operation and the management of postoperative complications.Moreover, prospective, multi-center randomized controlled clinical studies should be performed.

The dysfunction of T cells, especially the interaction of antigen presenting cells and CD4 + T cells, leads to abnormal activation of CD4 + T cells and the initiation of adaptive immune response.Dysfunction of the immune system plays an important role in the pathogenesis of rheumatoid arthritis.It is always considered as the central link of synovial continuous inflammation, articular cartilage and bone destruction in rheumatoid arthritis patients.Exploring CD4 + T cell differentiation and cell subsets provides a new perspective for understanding of arthritis and helps to identify new drug targets.

Objective To explore the feasibility of extracorporeal membrane oxygenation (ECMO) in protecting the donor liver in donation after citizen's death. Methods Clinical data of 16 donors and recipients undergoing liver transplantation using ECMO to protect the donor liver were retrospectively analyzed. The effect of ECMO on different indicators of the donors was evaluated. The liver function and clinical prognosis of the recipients after liver transplantation were observed. Results Compared with the time before ECMO, the heart rate, total bilirubin (TB), alanine transaminase (ALT) and aspartate transaminase (AST) of the donors after ECMO were significantly reduced, whereas the systolic blood pressure, diastolic blood pressure and partial pressure of arterial oxygen (PaO₂) were remarkably increased (all P < 0.05). The liver function of the recipients was properly recovered after liver transplantation, and gradually restored normal at postoperative 7 to 28 d. Postoperative complications occurred in 3 recipients, including delayed liver function recovery in 1 case, biliary tract stenosis in 1 case and portal vein thrombosis in 1 case. Among them, the patient with portal vein thrombosis died after secondary operation, and the other 2 patients were recovered and discharged after symptomatic treatment. Conclusions The hemodynamics, liver function and other indicators of donors from donation after citizen's death are significantly improved after ECMO, and the liver function of the recipients also recover well.

Objective To explore the clinical application of renal replacement therapy in renal transplan-tation from donation after citizen's death(DCD).Methods A total of 41 cases of the patients with renal replace-ment therapy after renal transplantation from DCD from January 2013 to December 2016 were involved,of which 14 cases received peritoneal dialysis,21 intermittent hemodialysis(IHD)and 6 continuous renal replacement ther-apy(CRRT).The therapeutic effect and complications of three renal replacement therapies were retrospectively ana-lyzed. Results After dialysis treatment,the concentration of blood BUN,Crea,and potassium was significantly lower than that before the treatment(P<0.05);the difference of Crea and BUN before and after the treatment in IHD and CRRT group was higher than that in peritoneal dialysis group(P<0.05)but there was no statistically sig-nificant difference between IHD and CRRT group(P > 0. 05). Conclusion The renal replacement after kidney transplantation from DCD should be based on the patient's condition,which is the key to protect their kidneys even to save patients'lives.

Objective To explore the clinical feasibility and safety of early intervention for severe stenosis of non-infarct related artery(non-IRA)in patients with acute ST-segment elevation myocardial infarction(STEMI) and multi-vessel disease(MVD)after successful primary percutaneous coronary intervention(PCI)for infarct-asso-ciated artery(IRA). Methods From May 1st,2011 to December 30th,2016,165 patients with STEMI and MVD were enrolled in our study. After the completion of primary PCI in IRA ,75 patients still in the hospital agreed to undergo a second staged PCI in severe stenosis of non-infarct arteries. We analyzed the in-hospital adverse events ,the length of hospital stay and clinical outcomes during the follow-up in the study population. Results There was no significant difference in the incidence of adverse events between the two groups during hos-pitalization. However,compared to patients treated with the IRA-only PCI,those treated with early intervention for severe stenosis of non-IRA was associated with greater benefits for clinical outcomes(including rehospitalization for heart failure,rehospitalization for ACS,recurrent angina pectoris,necessity for reintervention)during the follow-up except for the all-cause mortality. Conclusion Early intervention for severe stenosis of non-IRA is a feasible and safe procedure in patients with acute STEMI and MVD after successful primary PCI.

Objective To explore the effect of comprehensive nursing on improving the capacity load, nutritional status and quality of life of patients with peritoneal dialysis.Methods A total of 200 patients underwent peritoneal dialysis were selected as study subjects.According to the different nursing methods, the patients were divided into control group (n=100) with routine nursing and intervention group (n=100) with comprehensive nursing intervention.Capacity load, nutritional status before and after care and quality of life were compared, and related complications after 6 months of discharge were analyzed.Results The blood pressure (systolic blood pressure, diastolic blood pressure, mean pressure) and body mass of the intervention group were lower than those of the control group (P<0.05);There was no significant difference in the type and numbers of antihypertensive drugs between the intervention group and the control group (P>0.05);The scores of serum albumin, hemoglobin level and quality of life in the intervention group were higher, and the incidence of complications was significantly lower than that in the control group (P<0.05).Conclusion Comprehensive care intervention for peritoneal dialysis patients can reduce its capacity load, prevent complications, improve quality of life and nutritional status.

Objective To explore the effect of comprehensive nursing on improving the capacity load, nutritional status and quality of life of patients with peritoneal dialysis.Methods A total of 200 patients underwent peritoneal dialysis were selected as study subjects.According to the different nursing methods, the patients were divided into control group (n=100) with routine nursing and intervention group (n=100) with comprehensive nursing intervention.Capacity load, nutritional status before and after care and quality of life were compared, and related complications after 6 months of discharge were analyzed.Results The blood pressure (systolic blood pressure, diastolic blood pressure, mean pressure) and body mass of the intervention group were lower than those of the control group (P<0.05);There was no significant difference in the type and numbers of antihypertensive drugs between the intervention group and the control group (P>0.05);The scores of serum albumin, hemoglobin level and quality of life in the intervention group were higher, and the incidence of complications was significantly lower than that in the control group (P<0.05).Conclusion Comprehensive care intervention for peritoneal dialysis patients can reduce its capacity load, prevent complications, improve quality of life and nutritional status.

BACKGROUND:Angiotensin II receptor antagonists have been found to exerct a stronger protective effect on bone than angiotensin converting enzyme inhibitors. OBJECTIVE:To investigate the effect of different concentrations of irbesartan (angiotensin II receptor antagonist) on the differentiation and mineralization of mouse preosteoblasts. METHODS:Mouse preosteoblast cel lines MC3T3-E1 in logarithmic phase were selected and cultured in the osteogenic induction medium containing 0 (control group), 0.001, 0.01, 0.1 mmol/L irbesartan, respectively. Ten days later, the cel differentiation was observed by alkaline phosphatase staining. The mineralization was observed by alizarin red staining after 21 days of culture. mRNA expressions of osteocalcin, alkaline phosphatase and Runt-associated transcription factor 2 in osteoblasts were detected by real-time PCR at 1, 4, 7, 14 and 21 days of culture. RESULTS AND CONCLUSION:The activity of alkaline phosphatase in al the irbesartan groups (0, 0.001, 0.01, 0.1) was higher than that in the control group (P<0.05), which was the most obvious in 0.01 mmol/L. The number and area of calcium nodules in each irbesartan group were significantly higher than those in the control group (P<0.05), especial y in 0.01 mmol/L. Compared with the control group, 0.01 mmol/L irbesartan significantly upregulated the mRNA expressions of osteocalcin, alkaline phosphatase and Runt-associated transcription factor 2 (P<0.05). These results suggest that 0.01 mmol/L irbesartan significantly promotes the differentiation and mineralization of osteoblasts.

Objective To summarize the preliminary experience of donor liver protection and function evaluation for organ donation after citizen's death. Methods Clinical data of 35 donors from organ donation after citizen's death and 33 recipients were retrospectively analyzed. Donor liver procurement and clinical prognosis of the recipients were summarized. According to serum level of sodium ion (serum sodium) before organ procurement, all recipients were divided into the serum sodium <155 mmol/L, 155-160 mmol/L and 161-180 mmol/L groups. The incidence of liver graft dysfunction early after liver transplantation was statistically compared among three groups. Results In 35 donors,27 cases were Chinese type Ⅱ and 8 cases were Chinese type Ⅲ. Thirty-three donor livers were used for liver transplantation, and the remaining 2 cases of donor livers were excluded due to congestive cirrhosis. In 33 liver transplantation recipients, 30 cases were successfully recovered. The liver function was gradually restored at postoperative 7-14 d, and normal liver function was obtained during long-term follow-up. Postoperatively, 3 recipients died including 2 cases dying from portal vein thrombosis and 1 case from pulmonary infection complicated with multiple organ failure. The incidence of early liver graft dysfunction of the recipients after liver transplantation was 18%, 23% and 4/5 in the serum sodium <155 mmol/L, 155-160 mmol/L and 161-180 mmol/L groups, respectively. Statistical significance was observed between the 161-180 mmol/L and <155 mmol/L groups (P<0.05). Conclusions Timely protection of donor liver, accurate evaluation and maintenance of liver function play a pivotal role in enhancing the utilization rate of donor liver, maintaining liver function and yielding good efficacy for transplantation.