Objective: To analyze the timeliness of antir-etroviral therapy (ART) and its influencing factors among newly reported HIV/AIDS cases in Wenzhou City, Zhejiang Province from 2016 to 2023, so as to provide a reference for improving the ART effect of HIV/AIDS cases. Methods: Newly reported HIV/AIDS cases in Wenzhou City from 2016 to 2023 were selected as the research subjects. Demographic information, the situation of the first CD4+ T lymphocyte (CD4 cell) test, baseline CD4 cell count, and ART situation were collected through the Chinese Disease Prevention and Control Information System. The timely rate of ART was analyzed, and the influencing factors for timely ART among HIV/AIDS cases were analyzed using a multivariable logistic regression model. Results: A total of 4 500 newly reported HIV/AIDS cases in Wenzhou City from 2016 to 2023 were included, among which 3 679 were males, accounting for 81.76%, and 821 were females, accounting for 18.24%. The median age was 46.24 (interquartile range, 26.23) years. Among these cases, 3 606 received timely ART, with a timely rate of 80.13%. The timely rate of ART increased from 57.54% in 2016 to 91.97% in 2023 (P<0.05). Multivariable logistic regression analysis showed that unmarried/divorced/widowed (OR=0.769, 95%CI: 0.641-0.922), detainees (OR=0.492, 95%CI: 0.269-0.900), untimely first CD4 cell test (OR=0.278, 95%CI: 0.234-0.330), baseline CD4 cell count ≥200 cells/µL (OR=0.709, 95%CI: 0.595-0.843) or undetected (OR=0.131, 95%CI: 0.080-0.213) were associated with a lower timeliness for ART among HIV/AIDS cases. Conclusion From 2016 to 2023, the timely rate of ART among newly reported HIV/AIDS cases in Wenzhou City showed an upward trend, which was mainly affected by marital status, case source, timeliness of the first CD4 cell test, and baseline CD4 cell count.

Diabetic kidney disease （DKD） is a common microvascular complication of diabetics mellitus （DM） and the leading cause of end-stage renal disease （ESRD）. Renal interstitial fibrosis （RIF） is the primary pathological basis for DKD progression to ESRD， which significantly increases the mortality rate of DKD patients and burdens patients and society， and it is thus a clinical problem that needs to be solved urgently. The pathogenesis of RIF is complex and mainly associated with excessive deposition of extracellular matrix （ECM）， epithelial-mesenchymal transition （EMT）， oxidative stress， inflammation， and autophagy. Multiple signaling pathways such as transforming growth factor-β₁/Smad （TGF-β₁/Smad）， nuclear transcription factor-κB （NF-κB）， p38 mitogen-activated protein kinase （p38 MAPK）， secretory glycoprotein/β-catenin （Wnt/β-catenin）， mammalian target of rapamycin （mTOR）， Janus kinase/signal transducer and activator of transcription （JAK/STAT）， neurogenic site-gap homologous protein （Notch）， and nuclear factor E₂-associated factor 2 （Nrf2） mediate the development of RIF， which are currently novel targets for DKD therapy. Due to the complexity of its pathogenesis， the current Western medical treatment mainly focuses on essential treatment to improve metabolism， which has poor efficacy and is difficult to prevent the progression of DKD， so it is significant to find new treatment methods clinically. In recent years， many studies have proved that traditional Chinese medicine can alleviate oxidative stress， inhibit inflammatory response， and regulate cellular autophagy by modulating relevant signaling pathways， so as to treat RIF in DKD， which has the advantages of multi-pathway， multi-targeting， multi-linking， and significant therapeutic efficacy. However， there is still a lack of relevant summary. By reviewing the latest research reports in China and abroad， this article examines the roles of the signaling pathways mentioned above in the occurrence and development of RIF in DKD and the recent research progress in the intervention of RIF in DKD by traditional Chinese medicine via these pathways， aiming to provide new ideas and references for further scientific research and clinical practice.

Diabetic kidney disease(DKD)is one of the serious microvascular complications of diabetes.Immune disorder-mediated chronic inflammation is an essential mechanism underlying the occurrence of DKD.Macrophages,as important participants in the immune-inflammatory response,can polarize into the pro-inflammatory M1 phenotype and anti-inflammatory M2 phenotype under different microenvironments.The two are functionally antagonistic to each other.They can be transformed into each other in different developmental stages of DKD,which is similar to the connotation of yin and yang in the theory of"yin-yang theory"in TCM,such as restriction of opposites,mutual root and mutual use,balance of growth and decline,and mutual transformation.The imbalance of M1 and M2 macrophages is an important factor leading to DKD inflammatory response and renal fibrosis.Therefore,based on the yin-yang theory in TCM,this article clarified the effects of macrophage polarization on DKD,and proposed that the basic treatment method is to"tonify deficiency and damage excess"to adjust the polarization of macrophages and restore the balance of yin and yang,in order to provide ideas for the clinical treatment of DKD.

Objective To explore the effects of peer assistance model based on mini-clinical evaluation exercise (Mini-CEX) combined with direct observation of procedural skill (DOPS) in the teaching of autoimmune liver diseases (AILDs). Methods A total of 115 residents receiving training in the Department of Gastroenterology of Xijing Hospital were selected and divided into a control group and an experimental group according to the order in which they came to the department. The control group received traditional teaching mode, while the experimental group underwent peer assistance model based on Mini-CEX combined with DOPS. Results The experimental group showed significantly higher scores in both clinical competence and medical record documentation compared to the control group. In addition, the experimental group reported higher satisfaction levels in terms of self-learning ability, learning interest, communication skills and cooperation ability. The overall satisfaction of the experimental group is higher than that of the control group. Conclusion The use of peer assisted learning mode based on Mini-CEX and DOPS in the AILD teaching could improve the teaching effects.
Humans ; Autoimmune Diseases/therapy* ; Liver Diseases/therapy* ; Male ; Female ; Peer Group ; Clinical Competence ; Adult ; Teaching ; Learning

Background: Gastric mucosal atrophy and intestinal metaplasia (IM) are precancerous conditions of gastric cancer. Although Moluodan has been used in the treatment of chronic atrophic gastritis (CAG), there is little study on efficacy evaluation of Moluodan based on pathological stages. Aims: To assess the efficacy of Moluodan on reversal of gastric mucosal atrophy and IM based on OLGA and OLGIM staging systems, and to analyze the related factors. Methods: A total of 104 patients with CAG and IM from October 2019 to January 2022 at Xijing Hospital of Air Force Medical University were enrolled retrospectively in this study. All the patients received Moluodan treatment (one bag each time, three times daily) for 6 months. Changes of OLGA and OLGIM stages before and after treatment, and the related factors affecting the efficacy were analyzed. Results: After treatment with Moluodan for 6 months, the reversal rates for gastric mucosal atrophy and IM were 47.1% (49/104) and 51.0% (53/104), respectively, and the overall efficacy was 65.4% (68/104). There were 49.3% (34/69) and 52.4% (22/42) of patients with higher OLGA and OLGIM stages (III-) reversed to lower stages (0-Ⅱ), respectively. In addition, patients with OLGA and OLGIM stage III- showed a higher reversal rate than those with stage -Ⅱ (all P<0.01). No correlations were found between the demographic data, life and dietary styles, family history of gastric cancer, operation history, comorbidities, severity of mucosal inflammation and the efficacy of Moluodan (all P>0.05). Conclusions: Moluodan could reverse gastric mucosal atrophy and IM effectively in patients with CAG, which suggests that Moluodan has good potential in prevention of gastric cancer.

Objective:To investigate the efficacy and related factors of lamb′s tripe extract and vitamin B12 capsule (LTEVB12) in the treatment of chronic atrophic gastritis.Methods:From October 1st 2016 to April 30th 2021, 240 patients with chronic atrophic gastritis visited the Department of Gastroenterology at Xijing Hospital, Air Force Medical University were retrospectively analyzed. All patients regularly took LTEVB12 (110 U/day, 3 times/day) for six months. At the end of treatment, endoscopy and gastric mucosal biopsy were conducted. The therapeutic effects were evaluated by comparing the changes of operative link on gastritis assessment (OLGA) and operative link on gastritis assessment based on intestinal metaplasia (OLGIM) staging before and after treatment. The related factors affecting the efficacy of the drug were analyzed. Multivariate logistic regression analysis was used for statistical analysis.Results:After half a year of treatment, the reversal efficiency of atrophy and intestinal metaplasia was 45.4% (109/240) and 37.9% (91/240), respectively, and the total efficiency was 62.9% (151/240). The reversal efficiency of OLGA and OLGIM staging reversed from high stage (stage Ⅲ to Ⅳ) to low stage (stage 0 to Ⅱ) was 53.4% (63/118) and 54.5% (36/66), respectively. The results of multivariate analysis showed that female, vitamin supplementation (≥3 times/week), negative or successful eradication of Helicobacter pylori and mild inflammatory status (inflammation score: 1 to 2) were associated with improving the efficacy of LTEVB12 (odds ratio=1.798, 3.730, 2.817 and 4.631, 95% confidence interval 1.055 to 3.064, 1.197 to 11.627, 1.171 to 6.779, 1.480 to 14.493; all P<0.05). High consumption of pickled food (≥3 times/week) was associated with reducing efficacy of LTEVB12 (odds ratio=0.384, 95%confidence interval 0.200 to 0.740). Conclusion:LTEVB12 has better reversal therapeutic effect on atrophy and intestinal metaplasia, and may reduce the risk of gastric cancer in patients with chronic atrophic gastritis.

This study aimed at investigating the effects of Chinese herbal compound Qi Kui granules on urine protein and inflammatory markers in patients with type 2 diabetic nephropathy (DN) based on the treatment of regular western medication.A randomized,parallel controlled method was involved in the present trial,and patients diagnosed with type 2 DN were randomly divided into the Chinese herb group and the control group.Regular treatment of angiotensin Ⅱ receptor blocker (ARB) in western medicine was administered in the two groups with the additional treatment of Qi Kui granules for the Chinese herb group.All the patients revisited the doctor every 4 weeks during the observation period within a 12-week course of the observation.Urinary albumin to creatinine ratio (UACR),urinary albumin excretion rate (UAER) and inflammatory cytokines in the two groups were determined.As a result,seventy-two patients in aggregate were included in the study,while 32 patients of the control group and 31 patients of the Chinese herb group effectively accomplished the observation.After the 12-week treatments,UACR and UAER were significantly decreased in the two groups (P ＜ 0.01),while the efficacy of the Chinese herb group was better than that of the control group (P ＜ 0.05).Compared with the control group,the levels of serum IL-6,tumor necrosis factor α (TNF-α),transforming growth factor f1 (TGF-f1) and urinary monocyte chemoattractant protein (MCP-1) / Cr significantly decreased after the 12-week treatment (P ＜ 0.01).It was concluded that the Chinese herbal compound Qi Kui granules successfully mitigated proteinuria in DN patients.The improvement of glomerular inflammation for renoprotection should be the mechanism behind this.

Objective To evaluate the efficacy and safety of epalrestat, an aldose reductase inhibitor, and epalrestat plus methylcobalamine on diabetic peripheral neuropathy, as compared with methylcobalamine. Methods A total of 444 subjects with diabetic neuropathy were enrolled in the study, and divided into methylcobalamine group ( n= 145 ) , epalrestat group ( n = 143 ) , and methylcobalamine combined with epalrestat group ( n = 156 ) . Therapeutic efficacay was assessed in terms of clinical symptoms and physical examinations by using Michigan Neuropathy Screening Instrument ( MNSI ) , and electrophysiological assessments. Results After 4 to 12-weeks′treatment, symptoms and signs of neuropathy ( using MNSI ) are significantly improved in the three groups ( P<0. 01). The mean changes of MNSI ( questionnaire) score from baseline were higher in epalrestat group and methylcobalamine combined with epalrestat group as compared with that of methylcobalamine group(P<0. 05), but no difference was detected in the change of MNSI ( physical examination ) score from baseline among three groups. After treatment for 12 weeks, motor nerve conduction velocity ( MNCV ) was significantly improved in epalrestat group and methylcobalamine combined with epalrestat group(P<0. 05), but no difference was detected in MNCV at 12 week among three groups(P>0. 05). Conclusion Epalrestat is effective and safe in the treatment of diabetic neuropathy. Furthermore, epalrestat is more efficacious in ameliorating symptoms and MNCV of neuropathy than methylcobalamine. However, while no improved efficacy is shown with the combined treatment.

Primary biliary cirrhosis (PBC) is a chronic progressive cholestatic liver disease associated with immunity, with unknown etiology and pathogenesis. This article reviews the origin of its name, recent advances in research on PBC, and the prospect of treatment. Ursodeoxycholic acid is considered to be effective in improving cholestasis among PBC patients, but its naming and risk factors, as well as the response criteria and treatment, still need further research.

Sclerosing cholangitis can be divided into primary sclerosing cholangitis (PSC) and secondary sclerosing cholangitis according to the etiology and pathogenesis, and the pathogenesis of PSC may be associated with immunity. In recent years, a new type of sclerosing cholangitis has been found, which is characteristic of elevated levels of IgG4 in serum and tissue and good response to steroid therapy. PSC and IgG4-related sclerosing cholangitis can be collectively referred to as autoimmune sclerosing cholangitis. This article explores the similarities and differences between various diseases with manifestations of sclerosing cholangitis in the new concept, which will provide new ideas and directions for immune-related diseases.