To explore the advantages of traditional Chinese medicine （TCM） and integrative TCM-Western medicine approaches in the treatment of diabetic microvascular complications （DMC）， refine key pathophysiological insights and treatment principles， and promote academic innovation and strategic research planning in the prevention and treatment of DMC. The 38th session of the Expert Salon on Diseases Responding Specifically to Traditional Chinese Medicine， hosted by the China Association of Chinese Medicine， was held in Beijing， 2024. Experts in TCM， Western medicine， and interdisciplinary fields convened to conduct a systematic discussion on the pathogenesis， diagnostic and treatment challenges， and mechanism research related to DMC， ultimately forming a consensus on key directions. Four major research recommendations were proposed. The first is addressing clinical bottlenecks in the prevention and control of DMC by optimizing TCM-based evidence evaluation systems. The second is refining TCM core pathogenesis across DMC stages and establishing corresponding "disease-pattern-time" framework. The third is innovating mechanism research strategies to facilitate a shift from holistic regulation to targeted intervention in TCM. The fourth is advancing interdisciplinary collaboration to enhance the role of TCM in new drug development， research prioritization， and guideline formulation. TCM and integrative approaches offer distinct advantages in managing DMC. With a focus on the diseases responding specifically to TCM， strengthening evidence-based support and mechanism interpretation and promoting the integration of clinical care and research innovation will provide strong momentum for the modernization of TCM and the advancement of national health strategies.

Objective:To investigate the diagnostic consistency of extrauterine growth restriction (EUGR) assessed by the Fenton 2013 preterm growth charts (Fenton 2013) and the growth charts by International Fetal and Newborn Growth Consortium for the 21st Century (IG-21).Methods:This multicenter retrospective cohort study included 5 591 preterm infants with a gestational age (GA) at birth of less than 32 weeks admitted to 19 member hospitals of the Neonatal Perinatal Collaborative Network of Suxinyun from January 1 st, 2019, to December 31 st, 2024. Clinical data including baseline characteristics, complications, feeding practices and anthropometrics were processed and analyzed. EUGR was assessed using both the Fenton 2013 and the IG-21. A decrease in weight Z-score at discharge compared to admission by more than 1 was defined as longitudinal EUGR, and discharge weight below the P10 for the corresponding corrected GA was defined as cross-sectional EUGR. Diagnostic consistency was assessed using the Kappa coefficient between the 2 standards, and diagnostic performance of the 2 standards was compared using the McNemar test. Risk factors for EUGR under different definitions were analyzed using univariate analysis and multivariate Logistic regression analysis. Results:A total of 5 591 preterm infants were included, with a GA at birth of (29.7±1.6) weeks and a birth weight of (1 360±315) g and at discharge with a corrected GA of (36.3±2.0) weeks and weight of (2 246±370) g. Detection rates of cross-sectional and longitudinal EUGR diagnosed by Fenton 2013 were both higher than those by IG-21 (37.0% (2 214/5 991) vs. 23.7% (1 324/5 591), 61.1% (3 662/5 991) vs. 30.7% (1 714/5 591), χ2=326.77 and 1 358.05, both P<0.001). Using Fenton 2013 as a reference, IG-21 demonstrated superior diagnostic value and consistency in identifying cross-sectional EUGR compared with longitudinal EUGR (sensitivity of 100.0% (3 377/3 377) vs. 99.6% (1 922/1 929), specificity of 59.8% (1 324/2 214) vs. 46.6% (1 707/3 662), positive predictive value of 79.1% (3 377/4 267) vs. 49.6% (1 922/3 877), negative predictive value of 100.0% (1 324/1 324) vs. 99.6% (1 707/1 714), accuracy of 84.1% (4 701/5 591) vs. 64.9% (3 629/5 591), and Kappa 0.64 vs. 0.37, all P<0.001). In multivariate Logistic regression models, risk factors common to EUGR across both standards included smaller GA at birth, lower birth weight, boy, early-onset sepsis, late-onset sepsis and the elder age at full enteral feeding (all P<0.05). Hemodynamically significant patent ductus arteriosus remained an independent risk factor for longitudinal EUGR regardless of whether by the Fenton 2013 or IG-21 standard (adjust odds ratio ( aOR) =1.25 and 1.27, 95% CI 1.09-1.42 and 1.11-1.45). In addition, under the IG-21 standard, severe bronchopulmonary dysplasia was an independent risk factor for cross-sectional EUGR ( aOR=1.54, 95% CI 1.00-2.38), while severe necrotizing enterocolitis was an independent risk factor for longitudinal EUGR ( aOR=2.18, 95% CI 1.01-4.73). Conclusions:IG-21 showed lower detection rates of both cross-sectional and longitudinal EUGR than Fenton 2013, suggesting greater clinical applicability of IG-21 by reducing overdiagnosis while maintaining sensitivity for predicting complications. Across both standards, cross-sectional EUGR facilitates early identification of growth restriction, whereas longitudinal EUGR better tracks dynamic growth patterns and complications of preterm infants.

Objective:To investigate the diagnostic consistency of extrauterine growth restriction (EUGR) assessed by the Fenton 2013 preterm growth charts (Fenton 2013) and the growth charts by International Fetal and Newborn Growth Consortium for the 21st Century (IG-21).Methods:This multicenter retrospective cohort study included 5 591 preterm infants with a gestational age (GA) at birth of less than 32 weeks admitted to 19 member hospitals of the Neonatal Perinatal Collaborative Network of Suxinyun from January 1 st, 2019, to December 31 st, 2024. Clinical data including baseline characteristics, complications, feeding practices and anthropometrics were processed and analyzed. EUGR was assessed using both the Fenton 2013 and the IG-21. A decrease in weight Z-score at discharge compared to admission by more than 1 was defined as longitudinal EUGR, and discharge weight below the P10 for the corresponding corrected GA was defined as cross-sectional EUGR. Diagnostic consistency was assessed using the Kappa coefficient between the 2 standards, and diagnostic performance of the 2 standards was compared using the McNemar test. Risk factors for EUGR under different definitions were analyzed using univariate analysis and multivariate Logistic regression analysis. Results:A total of 5 591 preterm infants were included, with a GA at birth of (29.7±1.6) weeks and a birth weight of (1 360±315) g and at discharge with a corrected GA of (36.3±2.0) weeks and weight of (2 246±370) g. Detection rates of cross-sectional and longitudinal EUGR diagnosed by Fenton 2013 were both higher than those by IG-21 (37.0% (2 214/5 991) vs. 23.7% (1 324/5 591), 61.1% (3 662/5 991) vs. 30.7% (1 714/5 591), χ2=326.77 and 1 358.05, both P<0.001). Using Fenton 2013 as a reference, IG-21 demonstrated superior diagnostic value and consistency in identifying cross-sectional EUGR compared with longitudinal EUGR (sensitivity of 100.0% (3 377/3 377) vs. 99.6% (1 922/1 929), specificity of 59.8% (1 324/2 214) vs. 46.6% (1 707/3 662), positive predictive value of 79.1% (3 377/4 267) vs. 49.6% (1 922/3 877), negative predictive value of 100.0% (1 324/1 324) vs. 99.6% (1 707/1 714), accuracy of 84.1% (4 701/5 591) vs. 64.9% (3 629/5 591), and Kappa 0.64 vs. 0.37, all P<0.001). In multivariate Logistic regression models, risk factors common to EUGR across both standards included smaller GA at birth, lower birth weight, boy, early-onset sepsis, late-onset sepsis and the elder age at full enteral feeding (all P<0.05). Hemodynamically significant patent ductus arteriosus remained an independent risk factor for longitudinal EUGR regardless of whether by the Fenton 2013 or IG-21 standard (adjust odds ratio ( aOR) =1.25 and 1.27, 95% CI 1.09-1.42 and 1.11-1.45). In addition, under the IG-21 standard, severe bronchopulmonary dysplasia was an independent risk factor for cross-sectional EUGR ( aOR=1.54, 95% CI 1.00-2.38), while severe necrotizing enterocolitis was an independent risk factor for longitudinal EUGR ( aOR=2.18, 95% CI 1.01-4.73). Conclusions:IG-21 showed lower detection rates of both cross-sectional and longitudinal EUGR than Fenton 2013, suggesting greater clinical applicability of IG-21 by reducing overdiagnosis while maintaining sensitivity for predicting complications. Across both standards, cross-sectional EUGR facilitates early identification of growth restriction, whereas longitudinal EUGR better tracks dynamic growth patterns and complications of preterm infants.

OBJECTIVE To investigate the equivalence of different decoction processes based on rat model of hypertension with liver-yang hyperactivity. METHODS Inductively coupled plasma mass spectrometry （ICP-MS） was used to compare the dissolution differences of inorganic elements in the powder-directly-decocted decoction versus the pieces-decocted-first decoction of Ostreae Concha- Haliotidis Concha- Margaritifera Concha drug pair. Six SD rats were included in the normal group. The spontaneously hypertensive rats were given Aconite decoction for six weeks to induce the hypertension model with liver-yang hyperactivity. After successful modeling， 48 rats were randomly divided into the model group， the captopril group [positive control， 8 mL/（kg·d） ] ， as well as low-， medium-， and high-dose groups of pieces decocted first or directly powder decocted [2.02， 4.05， 8.10 mL/（kg·d） ] ， with 6 rats in each group. Each group received the corresponding drug or equal volume of pure water intragastrically， once a day， for two consecutive weeks. After the last administration， the degree of irritability， facial temperature， pressure pain threshold， blood pressure， and pathological changes of the thoracic aorta were observed in each group. Serum nitric oxide （NO） and plasma angiotensin Ⅱ （Ang Ⅱ）， renin， and aldosterone （ALD） levels were also measured. RESULTS ICP-MS analysis results showed statistically significant differences in the contents of macroelements Li， Na， Mg， Ca， Mn， Ga， Sr， Mo， Cd， Sn， and Sb， between the powder-directly-decocted decoction and the pieces-decocted-first decoction （ P ＜0.05） ，the elements P， Cr， Fe， Ni， Zn， Hg， Tl， and Pb were not detected in either decoction. Animal experiments showed that after two weeks of administration， compared with the model group， the facial temperature， and blood pressure decreased in all treatment groups， while the pressure pain threshold increased； plasma levels of Ang Ⅱ， renin and ALD， as well as the serum level of NO were all decreased， and thoracic aortic media thickness was significantly reduced， most of the differences in the above indicators were statistically significant （ P ＜0.05 or P ＜0.01 or P ＜0.001）. Pathological observation showed improvement in thoracic aortic pathological injury. CONCLUSIONS The powder-directly-decocted process for the Ostreae Concha- Haliotidis Concha- Margaritifera Concha drug pair significantly promotes the dissolution of key elements such as Ca， Mg， and Sr without increasing the dissolution of harmful elements. It is equivalent to the traditional pieces-decocted-first in alleviating liver-yang hyperactivity syndrome， lowering blood pressure， and protecting the vascular endothelium， and even shows better performance in some indicators.

Objective To investigatethe relationship between gastroesophageal reflux disease (GERD) symptoms and clinicopathological characteristics, p53 expression, and survival of Chinese patients with esophageal adenocarcinoma. Methods A total of 3882 patients with esophageal adenocarcinoma, 970 matched patients with esophageal squamous cell carcinoma, and 970 matched patients with gastric cardia adenocarcinoma were included to compare the incidence of GERD symptoms. Patients with esophageal adenocarcinoma were divided into two groups according to the presence and absence of GERD symptoms. The differences in clinicopathological characteristics and p53 expression between the two groups were compared by chi-square test, and the differences in survival between the two groups were compared by landmark analysis. Results The incidence of GERD symptoms increased successively in esophageal squamous cell carcinoma, esophageal adenocarcinoma, and gastric cardia adenocarcinoma. In patients with esophageal adenocarcinoma, the proportions of male, less than 65 years old, lower thoracic tumors, tumors without squamous cell carcinoma, poorly differentiation, early tumors (stage 0-I), and p53-positive tumors in the group with GERD symptoms were higher than those in the group without GERD symptoms; moreover, the long-term survival (≥15 years) was better. Conclusion GERD symptom is an important clinical sign of esophageal adenocarcinoma. It is closely related to specific clinicopathological characteristics, p53 overexpression, and good long-term prognosis.

Background China is a major coal producer and consumer country in the world. Coal workers' pneumoconiosis (CWP) is a primary factor endangering the occupational health of coal miners. Research on the disease burden of CWP and its changing trend is significant for disease prevention & control and associated policies. Objective To analyze the disease burden of CWP in China from 1990 to 2021 and its changing trend, and predict the disease burden from 2022 to 2035. Methods Using the Global Burden of Disease Study (GBD) database of 2021, numbers ofincident cases, prevalent cases, deaths, and disability-adjusted life years (DALYs) as well as crude and age-standardized rates of CWP in China were retrieved. Linear regression model was used to calculate the estimated annual percentage change (EAPC) of the age-standardized rates. Joinpoint regression model was used to analyze the temporal trend of disease burden and the disease burden of different sexes and age groups, and Bayesian age-period-cohort (BAPC) model was used to forecast the trend of CWP disease burden. Results In 1990, the incident, prevalent, and deaths cases of CWP in China were 3266, 18872, and 1561, respectively, and the DALYs of CWP were 44614.718 person-years. In 2021, the incident, prevalent, and deaths cases of CWP were 3446, 23975, and 1229, respectively, and the DALYs of CWP were 29610.754 person-years. From 1990 to 2021, the age-standardized incidence, prevalence, mortality, and DALYs rates of CWP in China all showed a downward trend, with the EAPCs of −3.121%, −2.532%, −4.018%, and −4.268%, respectively. The disease burden of CWP in China was mainly concentrated in the male population. The annual average percent change analysis indicated that each standardized rate showed a fluctuating downward trend in different periods. The BAPC model showed that from 2022 to 2035, the age-standardized rates of CWP in China would continue to decline steadily. In 2035, the age-standardized incidence, prevalence, mortality, and DALYs rates of CWP would be reduced to 0.10 per 100000, 0.74 per 100000, 0.03 per 100000, and 0.74 per 100000, respectively. Conclusion The disease burden contributed by CWP in China generally show a downward trend from 1990 to 2021, and it is expected that the age-standardized rates will continue to decline steadily from 2022 to 2035.

BACKGROUND: The primary limitation to kidney transplantation is organ shortage. Recent progress in gene editing and immunosuppressive regimens has made xenotransplantation with porcine organs a possibility. However, evidence in pig-to-human xenotransplantation remains scarce, and antibody-mediated rejection (AMR) is a major obstacle to clinical applications of xenotransplantation. METHODS: We conducted a kidney xenotransplantation in a brain-dead human recipient using a porcine kidney with five gene edits (5GE) on March 25, 2024 at Xijing Hospital, China. Clinical-grade immunosuppressive regimens were employed, and the observation period lasted 22 days. We collected and analyzed the xenograft function, ultrasound findings, sequential protocol biopsies, and immune surveillance of the recipient during the observation. RESULTS: The combination of 5GE in the porcine kidney and clinical-grade immunosuppressive regimens prevented hyperacute rejection. The xenograft kidney underwent delayed graft function in the first week, but urine output increased later and the single xenograft kidney maintained electrolyte and pH homeostasis from postoperative day (POD) 12 to 19. We observed AMR at 24 h post-transplantation, due to the presence of pre-existing anti-porcine antibodies and cytotoxicity before transplantation; this AMR persisted throughout the observation period. Plasma exchange and intravenous immunoglobulin treatment mitigated the AMR. We observed activation of latent porcine cytomegalovirus toward the end of the study, which might have contributed to coagulation disorder in the recipient. CONCLUSIONS 5GE and clinical-grade immunosuppressive regimens were sufficient to prevent hyperacute rejection during pig-to-human kidney xenotransplantation. Pre-existing anti-porcine antibodies predisposed the xenograft to AMR. Plasma exchange and intravenous immunoglobulin were safe and effective in the treatment of AMR after kidney xenotransplantation.
Transplantation, Heterologous/methods* ; Kidney Transplantation/methods* ; Heterografts/pathology* ; Immunoglobulins, Intravenous/administration & dosage* ; Graft Survival/immunology* ; Humans ; Animals ; Sus scrofa ; Graft Rejection/prevention & control* ; Kidney/pathology* ; Gene Editing ; Species Specificity ; Immunosuppression Therapy/methods* ; Plasma Exchange ; Brain Death ; Biopsy ; Male ; Aged

This study investigated the effect of Wuling San on transforming growth factor-β1(TGF-β1)-induced fibrosis, inflammation, and oxidative stress in human renal tubular epithelial cells(HK-2) and its mechanism of antioxidant stress injury. HK-2 cells were cultured in vitro and divided into a control group, a TGF-β1 model group, and three treatment groups receiving Wuling San-containing serum at low(2.5%), medium(5.0%), and high(10.0%) doses. TGF-β1 was used to establish the model in all groups except the control group. CCK-8 was used to analyze the effect of different concentrations of Wuling San on the activity of HK-2 cells with or without TGF-β1 stimulation. The expression of key fibrosis molecules, including actin alpha 2(Acta2), collagen type Ⅰ alpha 1 chain(Col1α1), collagen type Ⅲ alpha 1 chain(Col3α1), TIMP metallopeptidase inhibitor 1(Timp1), and fibronectin 1(Fn1), was detected using qPCR. The expression levels of inflammatory cytokines, including tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β), interleukin-6(IL-6), interleukin-8(IL-8), and interleukin-4(IL-4), were measured using ELISA kits. Glutathione peroxidase(GSH-Px), malondialdehyde(MDA), catalase(CAT), and superoxide dismutase(SOD) biochemical kits were used to analyze the effect of Wuling San on TGF-β1-induced oxidative stress injury in HK-2 cells, and the expression of nuclear factor E2-related factor 2(Nrf2), heme oxygenase 1(HO-1), and NAD(P)H quinone oxidoreductase 1(NQO1) was analyzed by qPCR and immunofluorescence. The CCK-8 results indicated that the optimal administration concentrations of Wuling San were 2.5%, 5.0%, and 10.0%. Compared with the control group, the TGF-β1 model group showed significantly increased levels of key fibrosis molecules(Acta2, Col1α1, Col3α1, Timp1, and Fn1) and inflammatory cytokines(TNF-α, IL-1β, IL-6, IL-8, and IL-4). In contrast, the Wuling San administration groups were able to dose-dependently inhibit the expression levels of key fibrosis molecules and inflammatory cytokines compared with the TGF-β1 model group. Wuling San significantly increased the activities of GSH-Px, CAT, and SOD enzymes in TGF-β1-stimulated HK-2 cells and significantly inhibited the level of MDA. Furthermore, compared with the control group, the TGF-β1 model group exhibited a significant reduction in the expression of Nrf2, HO-1, and NQO1 genes and proteins. After Wuling San intervention, the expression of Nrf2, HO-1, and NQO1 genes and proteins was significantly increased. Correlation analysis showed that antioxidant stress enzymes(GSH-Px, CAT, and SOD) and Nrf2 signaling were significantly negatively correlated with key fibrosis molecules and inflammatory cytokines in the TGF-β1-stimulated HK-2 cell model. In conclusion, Wuling San can inhibit TGF-β1-induced fibrosis in HK-2 cells by activating the Nrf2 signaling pathway, improving oxidative stress injury, and reducing inflammation.
Humans ; Oxidative Stress/drug effects* ; Transforming Growth Factor beta1/metabolism* ; Fibrosis/genetics* ; Cell Line ; Drugs, Chinese Herbal/pharmacology* ; Epithelial Cells/immunology* ; Inflammation/metabolism*

Medical institutions, with their clinical practice foundation and abundant human use experience data, have become important carriers for the inheritance and innovation of traditional Chinese medicine(TCM) and the "cradles" of the preparation of new TCM. To effectively promote the transformation of new TCM originating from the TCM clinical practice in medical institutions and establish an effective evaluation index system for the transformation of new TCM conforming to the characteristics of TCM, consensus experts adopted the literature research, questionnaire survey, Delphi method, etc. By focusing on the policy and technical evaluation of new TCM originating from the TCM clinical practice in medical institutions, a comprehensive evaluation from the dimensions of drug safety, efficacy, feasibility, and characteristic advantages was conducted, thus forming a comprehensive evaluation system with four primary indicators and 37 secondary indicators. The expert consensus reached aims to encourage medical institutions at all levels to continuously improve the high-quality research and development and transformation of new TCM originating from the TCM clinical practice in medical institutions and targeted at clinical needs, so as to provide a decision-making basis for the preparation, selection, cultivation, and transformation of new TCM for medical institutions, improve the development efficiency of new TCM, and precisely respond to the public medication needs.
Medicine, Chinese Traditional/standards* ; Humans ; Consensus ; Drugs, Chinese Herbal/therapeutic use* ; Surveys and Questionnaires