Proteinuria is a common manifestation of primary nephrotic syndrome in children and attributed to podocyte injury. Endocytosis is a biological process for maintaining podocyte function through the internalization and recycling of extracellular material and plasma membrane components. Recently，it has been found that podocyte endocytosis is regulated by podocyte membrane proteins as well as actin cytoskeleton. Endocytosis defects affect the signaling pathways of some podocytes. Protein expression in the slit diaphragm of podocytes is regulated by the actin-dependent endocytic pathway. Studying podocyte endocytosis helps to understand the pathogenesis of proteinuria in chronic kidney disease and provide potential therapeutic targets for glomerular disease.

OBJECTIVE: To compare the efficacy and safety of intravenous colistin sulfate combined with nebulized inhalation versus intravenous monotherapy for pulmonary infections caused by carbapenem-resistant organism (CRO). METHODS: A multicenter retrospective cohort study was conducted. Clinical data were collected from patients admitted to the intensive care unit (ICU) of 10 tertiary class-A hospitals in Henan Province between July 2021 and May 2023, who received colistin sulfate for CRO pulmonary infections. Data included baseline characteristics, inflammatory markers [white blood cell count (WBC), neutrophil count (NEU), procalcitonin (PCT), C-reactive protein (CRP)], renal function indicators [serum creatinine (SCr), blood urea nitrogen (BUN)], life support measures, anti-infection regimens, clinical efficacy, microbiological clearance rate, and prognostic outcomes. Patients were divided into two groups: intravenous group (colistin sulfate monotherapy via intravenous infusion) and combination group ((intravenous infusion combined with nebulized inhalation of colistin sulfate). Changes in parameters before and after treatment were analyzed. RESULTS: A total of 137 patients with CRO pulmonary infections were enrolled, including 89 in the intravenous group and 48 in the combination group. Baseline characteristics, life support measures, daily colistin dose, and combination regimens (most commonly colistin sulfate plus carbapenems in both groups) showed no significant differences between two groups. The combination group exhibited higher clinical efficacy [77.1% (37/48) vs. 59.6% (52/89)] and microbiological clearance rate [60.4% (29/48) vs. 39.3% (35/89)], both P < 0.05. Pre-treatment inflammatory and renal parameters showed no significant differences between two groups. Post-treatment, the combination group showed significantly lower WBC and CRP [WBC (×10⁹/L): 8.2±0.5 vs. 10.9±0.6, CRP (mg/L): 14.0 (5.7, 26.6) vs. 52.1 (24.4, 109.6), both P < 0.05], whereas NEU, PCT, SCr, and BUN levels showed no significant between two groups. ICU length of stay was shorter in the combination group [days: 16 (10, 25) vs. 21 (14, 29), P < 0.05], although mechanical ventilation duration and total hospitalization showed no significant differences between two groups. CONCLUSIONS Intravenous colistin sulfate combined with nebulized inhalation improved clinical efficacy and microbiological clearance in CRO pulmonary infections with an acceptable safety profile.
Humans ; Colistin/therapeutic use* ; Retrospective Studies ; Administration, Inhalation ; Anti-Bacterial Agents/therapeutic use* ; Carbapenems/pharmacology* ; Male ; Female ; Middle Aged ; Gram-Negative Bacteria/drug effects* ; Aged ; Treatment Outcome ; Respiratory Tract Infections/drug therapy*

Diabetes is a chronic disease that requires lifelong medication and long-term management. The longer the duration of the disease, the more likely it is to lead to progressive chronic complications affecting the eyes, kidneys, nervous system, and cardiovascular system. These complications may result in gradual functional decline or even organ failure, and may also trigger severe acute metabolic disorders. The cumulative financial burden on patients and their families can be substantial, giving rise to what is known as financial toxicity, which in turn may negatively affect patients' health outcomes. This review comprehensively explores the concept of financial toxicity in diabetic patients, including its assessment tools, influencing factors, and coping strategies. It also offers targeted suggestions aimed at informing the development of more scientific and effective systemic interventions, with the ultimate goal of improving treatment outcomes and quality of life for individuals living with diabetes.

Objective To establish an inductively coupled plasma-mass spectrometry(ICP-MS)method for the analysis of 29 mineral elements in Artemisiae Argyi Folium(AAF),and to develop a model for judging the origin of AAF based on the elemental fingerprint combined with chemometrics.Methods The variance method was used to compare the contents of 29 mineral elements in AAF samples from Qichun of Hubei province,Hebei province and Henan province,respectively.The discriminant models of AAF from different habitats were established by discriminant analysis,PLS-DA and PCA-Logistic regression algorithms.Results The differences of the 22 elements(V,Cr,Ni,As,Se,Rb,Mo,Cd,Sb,Ba,Hg,Pb,K,Li,B,Mg,Al,P,Ca,Fe,Zn,and Ga)in samples from Qichun of Hubei province,Hebei province and Henan province are extremely significant(P＜0.01).The discriminant analysis model showed that eight kinds of element variables(P,Cr,K,Li,Hg,Ba,Mg,and Mo),which have a significant effect on the origin discrimination are gradually introduced into the discriminant model,and the correct rate of back test is 100％.The correct rate of"leave one method"cross-validation is 96.7％.The PLS-DA model showed good prediction ability,and the variable importance projection values of K,P and Mg elements were greater than one,which could be used as the difference marker of AAF from different habitats.The accuracy of the origin discrimination model constructed by PC A-Logistic regression analysis was 100％.The elements with high first principal component loadings were Li,B,Mg,Al,P,K,Ca,V,Cr,Fe,Ni,Zn,As,Rb,Cd,Sb,and Ba.Conclusion This study shows that elemental fingerprint technology combined with chemometric analysis can identify AAF from Qichun of Hubei province,Hebei province,or Henan,providing technical support for the traceability of the origin of Artemisia argyi.

Objective To investigate the changes and therapeutic effects of Ginkgo biloba extract(GBE),Donepezil and combination therapy on gray matter volume and cortical morphology in patients with cognitive dysfunction.Methods According to different treatment methods,59 patients with mild cognitive impairment and Alzheimer's disease were divided into GBE group(n=20),Donepezil group(n=20)and combined treatment group(n=19).Before and after treatment,the patients were evaluated by MMSE,Alzheimer's disease assessment scale-cognitive subscale(ADAS-cog),instrumental activities of daily living scale(IADL),geriatric depression scale(GDS),neuropsychiatric inventory(NPI),and quality of life-Alzheimer's disease scale(QOL-AD).Before and after treatment,T1-weighted structural sequence images were acquired using cranial MRI,and voxel-based morphometry(VBM)and cortical morphological analyses were performed.Results There was no significant difference in the scores of MMSE,ADAS-cog,GDS,NPI,IADL and QOL-AD among the GBE group,Donepezil group and combined treatment group before and after treatment(all P>0.05).Compared with those before treatment,there were significant differences in MMSE and ADAS-cog scores in the GBE group,MMSE,ADAS-cog,IADL and NPI scores in Donepezil group,and MMSE,ADAS-cog and IADL scores in combined treatment group after treatment(P＜0.05-0.01).The volume of gray matter in the cerebellar region of GBE group was significantly increased(voxel P＜0.005,cluster P＜0.05,GRF corrected,one-tailed test).In the left putamen region,the difference of gray matter volume in the combined treatment group was significantly higher than that in the GBE group and Donepezil group(all P＜0.01).In the right putamen area,there was no significant difference among the three groups(all P>0.05).In the right hippocampus,the difference in gray matter volume between combined treatment group and GBE group was significantly higher than that in Donepezil group(all P＜0.05).In the left hippocampus,the difference in gray matter volume between GBE group and combined treatment group was significantly higher than that in Donepezil group(all P＜0.001).Correlation analysis showed that the volume of left and right hippocampal gray matter was positively correlated with MMSE before treatment(r=0.352,P=0.008;r=0.424,P=0.001),and negatively correlated with ADAS-cog(r=-0.336,P=0.012;r=-0.362,P=0.007)and IADL scores(r=-0.345,P=0.01;r=-0.312,P=0.02);after treatment,the gray matter volume of the left and right hippocampus was strong positively correlated with MMSE(r=0.582,P＜0.001;r=0.560,P＜0.001),strong negatively correlated with ADAS-cog(r=-0.512,P＜0.001;r=-0.567,P＜0.001)and IADL(r=-0.454,P＜0.001;r=-0.435,P＜0.001).The difference of gray matter volume in the right hippocampus before and after treatment was only weakly negatively correlated with GDS score(r=-0.269,P=0.047),the gray matter volume of right hippocampus was positively correlated with GDS score before treatment(r=0.451,P＜0.001),and this correlation disappeared after intervention(r=0.131,P=0.340).There was no correlation between the difference of gray matter volume before and after treatment in the left hippocampus and the neuropsychological test scores(all P>0.05).The cortex of the superior parietal lobule and inferior parietal lobe in the combined treatment group was significantly thickened(all P＜0.05,FWE corrected).Conclusions GBE,Donepezil and the combined therapy have significant effects on the reduction of cognitive function,and the changes of brain gray matter and cortical morphology are different.GBE improve the volume of the posterior superior cerebellum and other regions,and the combined therapy improve the cortical thickness of the superior parietal lobule and the inferior parietal lobule.

Diabetes is a chronic disease that requires lifelong medication and long-term management. The longer the duration of the disease, the more likely it is to lead to progressive chronic complications affecting the eyes, kidneys, nervous system, and cardiovascular system. These complications may result in gradual functional decline or even organ failure, and may also trigger severe acute metabolic disorders. The cumulative financial burden on patients and their families can be substantial, giving rise to what is known as financial toxicity, which in turn may negatively affect patients' health outcomes. This review comprehensively explores the concept of financial toxicity in diabetic patients, including its assessment tools, influencing factors, and coping strategies. It also offers targeted suggestions aimed at informing the development of more scientific and effective systemic interventions, with the ultimate goal of improving treatment outcomes and quality of life for individuals living with diabetes.

Objective To establish an inductively coupled plasma-mass spectrometry(ICP-MS)method for the analysis of 29 mineral elements in Artemisiae Argyi Folium(AAF),and to develop a model for judging the origin of AAF based on the elemental fingerprint combined with chemometrics.Methods The variance method was used to compare the contents of 29 mineral elements in AAF samples from Qichun of Hubei province,Hebei province and Henan province,respectively.The discriminant models of AAF from different habitats were established by discriminant analysis,PLS-DA and PCA-Logistic regression algorithms.Results The differences of the 22 elements(V,Cr,Ni,As,Se,Rb,Mo,Cd,Sb,Ba,Hg,Pb,K,Li,B,Mg,Al,P,Ca,Fe,Zn,and Ga)in samples from Qichun of Hubei province,Hebei province and Henan province are extremely significant(P＜0.01).The discriminant analysis model showed that eight kinds of element variables(P,Cr,K,Li,Hg,Ba,Mg,and Mo),which have a significant effect on the origin discrimination are gradually introduced into the discriminant model,and the correct rate of back test is 100％.The correct rate of"leave one method"cross-validation is 96.7％.The PLS-DA model showed good prediction ability,and the variable importance projection values of K,P and Mg elements were greater than one,which could be used as the difference marker of AAF from different habitats.The accuracy of the origin discrimination model constructed by PC A-Logistic regression analysis was 100％.The elements with high first principal component loadings were Li,B,Mg,Al,P,K,Ca,V,Cr,Fe,Ni,Zn,As,Rb,Cd,Sb,and Ba.Conclusion This study shows that elemental fingerprint technology combined with chemometric analysis can identify AAF from Qichun of Hubei province,Hebei province,or Henan,providing technical support for the traceability of the origin of Artemisia argyi.

Objective To investigate the changes and therapeutic effects of Ginkgo biloba extract(GBE),Donepezil and combination therapy on gray matter volume and cortical morphology in patients with cognitive dysfunction.Methods According to different treatment methods,59 patients with mild cognitive impairment and Alzheimer's disease were divided into GBE group(n=20),Donepezil group(n=20)and combined treatment group(n=19).Before and after treatment,the patients were evaluated by MMSE,Alzheimer's disease assessment scale-cognitive subscale(ADAS-cog),instrumental activities of daily living scale(IADL),geriatric depression scale(GDS),neuropsychiatric inventory(NPI),and quality of life-Alzheimer's disease scale(QOL-AD).Before and after treatment,T1-weighted structural sequence images were acquired using cranial MRI,and voxel-based morphometry(VBM)and cortical morphological analyses were performed.Results There was no significant difference in the scores of MMSE,ADAS-cog,GDS,NPI,IADL and QOL-AD among the GBE group,Donepezil group and combined treatment group before and after treatment(all P>0.05).Compared with those before treatment,there were significant differences in MMSE and ADAS-cog scores in the GBE group,MMSE,ADAS-cog,IADL and NPI scores in Donepezil group,and MMSE,ADAS-cog and IADL scores in combined treatment group after treatment(P＜0.05-0.01).The volume of gray matter in the cerebellar region of GBE group was significantly increased(voxel P＜0.005,cluster P＜0.05,GRF corrected,one-tailed test).In the left putamen region,the difference of gray matter volume in the combined treatment group was significantly higher than that in the GBE group and Donepezil group(all P＜0.01).In the right putamen area,there was no significant difference among the three groups(all P>0.05).In the right hippocampus,the difference in gray matter volume between combined treatment group and GBE group was significantly higher than that in Donepezil group(all P＜0.05).In the left hippocampus,the difference in gray matter volume between GBE group and combined treatment group was significantly higher than that in Donepezil group(all P＜0.001).Correlation analysis showed that the volume of left and right hippocampal gray matter was positively correlated with MMSE before treatment(r=0.352,P=0.008;r=0.424,P=0.001),and negatively correlated with ADAS-cog(r=-0.336,P=0.012;r=-0.362,P=0.007)and IADL scores(r=-0.345,P=0.01;r=-0.312,P=0.02);after treatment,the gray matter volume of the left and right hippocampus was strong positively correlated with MMSE(r=0.582,P＜0.001;r=0.560,P＜0.001),strong negatively correlated with ADAS-cog(r=-0.512,P＜0.001;r=-0.567,P＜0.001)and IADL(r=-0.454,P＜0.001;r=-0.435,P＜0.001).The difference of gray matter volume in the right hippocampus before and after treatment was only weakly negatively correlated with GDS score(r=-0.269,P=0.047),the gray matter volume of right hippocampus was positively correlated with GDS score before treatment(r=0.451,P＜0.001),and this correlation disappeared after intervention(r=0.131,P=0.340).There was no correlation between the difference of gray matter volume before and after treatment in the left hippocampus and the neuropsychological test scores(all P>0.05).The cortex of the superior parietal lobule and inferior parietal lobe in the combined treatment group was significantly thickened(all P＜0.05,FWE corrected).Conclusions GBE,Donepezil and the combined therapy have significant effects on the reduction of cognitive function,and the changes of brain gray matter and cortical morphology are different.GBE improve the volume of the posterior superior cerebellum and other regions,and the combined therapy improve the cortical thickness of the superior parietal lobule and the inferior parietal lobule.

Objective:To summarize the situation of dead newborns and their parents after parents gave up treatment, and analyze the reasons and emotional needs of parents who gave up treatment, so as to provide reference for reducing neonatal mortality and negative emotions of parents.Methods:A retrospective study was conducted to collect the data of neonates and mothers who died after giving up treatment reported in Hunan Children′s Hospital from January 2019 to December 2021. The general information, perinatal risk factors, and the incidence of in-hospital diseases were analyzed. Then, semi-structured interviews were conducted with parents of newborns who died after giving up treatment from February to December 2021. Understand why parents give up treatment and their emotional needs.Results:A total of 172 newborns died after giving up were included in the analysis, including 103 males (59.88%) and 74 premature infants (43.02%); Umbilical cord, placenta and amniotic fluid abnormalities were 21 cases (12.21%), 39 cases (22.67%) and 25 cases (14.53%), respectively. Birth asphyxia was 31 cases (18.02%), including severe asphyxia in 18 cases (10.46%); There were 21 (12.21%), 35 (20.35%) and 30 (17.44%) cases of maternal infection in the third trimester, hypertension in pregnancy and diabetes in pregnancy, respectively. The top three causes of death were septicemia (18.02%), congenital malformation (16.86%) and severe pneumonia (10.47%). The main reason why parents give up treatment was that the child′s disease was critical and irreversible, and parents had strong emotional needs for hospice care in their hearts.Conclusions:There are many high risk factors of perinatal death of newborns after giving up treatment. Sepsis is the primary cause of death, and strengthening perinatal health care is fundamental. Parents have a strong demand for hospice care, so it is of practical significance to implement family-centered hospice care model for such special newborns.

Objective To explore the effects of warming-yang and tonifying-qi needling combined with electromyographic biofeedback therapy(EMGBFT)on brain image structure,surface myoelectric characteristics and neurotransmitters in patients with stroke rehabilitation.Methods A prospective research method was conducted in which 200 stroke rehabilitation patients admitted to the Third Hospital of Xingtai City from February 2021 to February 2022 were selected as the study subjects.According to the random principle,the patients were divided into a control group and an study group,with 100 cases in each group.Both groups received routine treatment for stroke,while the control group received a combination of EMGBFT.The study group received a combination of warming-yang and tonifying-qi acupuncture based on the control group,and both groups continued to receive treatment for 9 weeks.Observe the clinical efficacy of two groups of patients and compare the differences in National Institutes of Health Stroke Scale(NIHSS)scores,traditional Chinese medicine symptom scores,brain image structures,serum neurotransmitter levels,and surface electromyography levels before and after treatment,and observe the occurrence of adverse reactions.Results The effective rate of treatment in the study group was significantly higher than that in the control group(97.00％ vs.87.00％,P<0.05).After treatment,NIHSS score,traditional Chinese medicine symptom score,root-mean-square(RMS)of biceps and triceps,and synergistic contraction rate(SCR)were significantly lower than those before treatment in both groups,and the levels of cerebral blood flow(CBF)in the thalamus and frontal lobe,fractional anisotropy(FA),norepinephrine(NE),5-hydroxytryptamine(5-TH),and dopamine(DA)were significantly higher than those before treatment.After treatment,the NIHSS score(4.18±1.09 vs.6.89±1.54),traditional Chinese medicine symptom score(5.41±1.08 vs.9.46±1.55),and biceps RMS(μV:9.76±3.51 vs.16.36±3.44),triceps brachii RMS(μV:6.79±1.83 vs.10.61±2.87),and SCR[(28.08±8.73)％ vs.33.08±9.31)％]were significantly lower than those control group(all P<0.05),the CBF of the thalamus(mL·kg-1·min-1:278.97±86.32 vs.233.63±84.62),and the CBF of the frontal lobe(mL·kg-1·min-1:299.31±75.54 vs.262.81±87.18),FA(0.57±0.18 vs.0.48±0.14),serum 5-HT(ng/L:352.83±38.93 vs.306.71±32.54),NE(ng/L:160.83±17.25 vs.122.81±12.41),DA(μg/L:9.23±0.92 vs.7.36±0.71)were significantly higher than those of the control group(all P<0.05).The incidence of adverse reactions in the study group was significantly lower than that in the control group(3.00％ vs.14.00％,P<0.05).Conclusion Based on EMGBFT,the combination of warming-yang and tonifying-qi acupuncture can synergistically improve the clinical symptoms and brain image structure in stroke rehabilitation patients,and increase their serum neurotransmitter levels,with fewer adverse reactions,which is worthy of promotion.