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.

To develop a novel polyamino acid-based nanohydrogel drug delivery system for dexamethasone to enhance its delivery efficiency to the inner ear.

Idiopathic pulmonary fibrosis (IPF) is a progressive disease lacking effective therapy. Metformin, an antidiabetic medication, has shown promising therapeutic properties in preclinical fibrosis models; however, its precise cellular targets and associated mechanisms in fibrosis resolution remain incompletely defined. Most research on metformin's effects has focused on mesenchymal and inflammatory responses with limited attention to epithelial cells. In this study, we utilized Sftpc lineage-traced and Fgfr2b conditional knockout mice, along with BMP2/PPARγ and AMPK inhibitors, to explore metformin's impact on alveolar epithelial cells in a bleomycin-induced pulmonary fibrosis model and cell culture. We found that metformin increased the proliferation and differentiation of alveolar type 2 (AT2) cells, particularly the recently identified injury-activated alveolar progenitors (IAAPs)-a subpopulation characterized by low SFTPC expression but enriched for PD-L1. Single-cell RNA sequencing revealed a reduction in apoptosis among mature AT2 cells. Interestingly, metformin's therapeutic effects were not significantly affected by BMP2 or PPARγ inhibition, which blocked the lipogenic differentiation of myofibroblasts. However, Fgfr2b deletion in Sftpc lineage cells significantly impaired metformin's ability to promote fibrosis resolution, a process linked to AMPK signaling. In conclusion, metformin alleviates fibrosis by directly activating AT2 cells, especially the IAAPs, through a mechanism that involves AMPK and FGFR2b signaling, but is largely independent of BMP2/PPARγ pathways.

Objective:To develop a Protection Motivation Questionnaire(PMQ)for frailty management in the elderly based on the Protection Motivation Theory(PMT), and test its reliability and validity.Methods:Guided by PMT, the initial questionnaire items were formulated through literature review, semi-structured interviews, and Delphi expert consultation.A total of 551 elderly patients with frailty from a tertiary hospital in Changsha were investigated.Item screening was conducted via critical ratio method, Cronbach's α coefficient, correlation analysis, and factor analysis.The reliability was assessed through internal consistency and test-retest reliability, while validity was evaluated via content validity and structural validity.Results:The final PMQ comprised 25 items across five dimensions: severity, susceptibility, response efficacy, response cost, and self-efficacy.The overall Cronbach's α coefficient was 0.818, with subscale coefficients ranging from 0.701 to 0.821.The split-half reliability was 0.811, test-retest reliability was 0.929, and content validity indexwas 0.86.Exploratory factor analysis extracted five factors, accounting for 52.0% of the cumulative variance.Confirmatory factor analysis demonstrated good model fit( χ2/df=1.626, RMSEA=0.05, CFI =0.914). Conclusions:The developed questionnaire exhibits strong reliability and validity, serving as an effective tool to assess protection motivation for frailty management in the elderly.

Objective: To investigate the association between dietary quality and overweight / obesity among primary school students, so as to provide a basis for the prevention and control of childhood obesity. Methods: In September 2022, third-grade students from six primary schools in Ningbo City, Zhejiang Province were selected by a random cluster sampling method. Data on gender, age, height, and weight were collected through questionnaire surveys and physical examinations. Body mass index (BMI) was calculated, and overweight and obesity were determined using gender- and age-specific BMI cut-off points. The Chinese dietary quality questionnaires was administered to assess the intake of health-promoting and restricted foods over the past 24 hours, thereby evaluating overall dietary quality. A multivariate logistic regression model was used to analyze the association between dietary quality and overweight / obesity among primary school students. Results: A total of 1 375 primary school students were included, comprising 722 (52.51%) boys and 653 (47.49%) girls, with a mean age of (8.47±0.30) years. Among them, 165 (12.00%) were overweight and 171 (12.44%) were obese. The score for health-promoting foods was (4.29±2.27) points. The median score of restricted foods was 2.00 (interquartile range, 3.00) points. The total dietary quality score was (10.84±2.42) points. Multivariable logistic regression analysis indicated that the restricted food score was positively associated with overweight (OR=1.073, 95%CI: 1.002-1.148), while the total dietary quality score was negatively associated with overweight (OR=0.911, 95%CI: 0.851-0.976). However, no statistically significant associations were observed between the health-promoting food score and overweight or obesity (both P>0.05), nor between the restricted food score or total dietary quality score and obesity (both P>0.05). Conclusion A higher intake of restricted foods was associated with an increased risk of overweight, while a better dietary quality was associated with a decreased risk of overweight among primary school students.

Systematically sort out the successful development experience and current shortcomings of various aspects of combined Chinese and Western medicine first aid,and on this basis,we discuss the development ideas of combined Chinese and Western medicine first aid.Based on the complementary advantages of the combination of Chinese and Western medicines in first aid,it takes the special diseases with bottlenecks in the efficacy of the current single system as an entry point,and further optimizes the combination of Chinese and Western medicines in first aid through the dynamic and sequential coordination of Chinese medicine's holistic conditioning and Western medicine's targeted treatment,and promotes the development of the synergistic strategy of the first aid of Chinese and Western medicines,so as to better play the advantageous roles of the combination of Chinese and Western medicines in first aid to enhance the clinical efficacy,reduce the toxicity and side-effects,and improve the prognosis of the diseases.We also strive to promote the improvement of the dosage form of traditional first aid prescriptions and the technical innovation of the production process,so as to realize the improvement of the key indexes such as the timeliness of the onset of action,the controllability of the quality,and the targeting of the efficacy of the Chinese medicinal preparations in the first aid,in order to better support and guarantee the medicines for the first aid of the combination of traditional Chinese and Western medicines.At the same time,we should also promote the systematic construction of the standardized operation specification and efficacy evaluation system of acupuncture and moxibustion,explore the integration of acupuncture and moxibustion with modern first aid,and optimize acupuncture and moxibustion intervention strategies in emergency departments to enhance the efficacy of first aid under the restriction of medical equipments.The proposal of these suggestions may provide some enlightenment in the development of the idea of integrating Chinese and Western medicine in emergency care,and may have some reference value for the development of emergency medicine model with Chinese characteristics.

Systematically sort out the successful development experience and current shortcomings of various aspects of combined Chinese and Western medicine first aid,and on this basis,we discuss the development ideas of combined Chinese and Western medicine first aid.Based on the complementary advantages of the combination of Chinese and Western medicines in first aid,it takes the special diseases with bottlenecks in the efficacy of the current single system as an entry point,and further optimizes the combination of Chinese and Western medicines in first aid through the dynamic and sequential coordination of Chinese medicine's holistic conditioning and Western medicine's targeted treatment,and promotes the development of the synergistic strategy of the first aid of Chinese and Western medicines,so as to better play the advantageous roles of the combination of Chinese and Western medicines in first aid to enhance the clinical efficacy,reduce the toxicity and side-effects,and improve the prognosis of the diseases.We also strive to promote the improvement of the dosage form of traditional first aid prescriptions and the technical innovation of the production process,so as to realize the improvement of the key indexes such as the timeliness of the onset of action,the controllability of the quality,and the targeting of the efficacy of the Chinese medicinal preparations in the first aid,in order to better support and guarantee the medicines for the first aid of the combination of traditional Chinese and Western medicines.At the same time,we should also promote the systematic construction of the standardized operation specification and efficacy evaluation system of acupuncture and moxibustion,explore the integration of acupuncture and moxibustion with modern first aid,and optimize acupuncture and moxibustion intervention strategies in emergency departments to enhance the efficacy of first aid under the restriction of medical equipments.The proposal of these suggestions may provide some enlightenment in the development of the idea of integrating Chinese and Western medicine in emergency care,and may have some reference value for the development of emergency medicine model with Chinese characteristics.

Objective:To develop a Protection Motivation Questionnaire(PMQ)for frailty management in the elderly based on the Protection Motivation Theory(PMT), and test its reliability and validity.Methods:Guided by PMT, the initial questionnaire items were formulated through literature review, semi-structured interviews, and Delphi expert consultation.A total of 551 elderly patients with frailty from a tertiary hospital in Changsha were investigated.Item screening was conducted via critical ratio method, Cronbach's α coefficient, correlation analysis, and factor analysis.The reliability was assessed through internal consistency and test-retest reliability, while validity was evaluated via content validity and structural validity.Results:The final PMQ comprised 25 items across five dimensions: severity, susceptibility, response efficacy, response cost, and self-efficacy.The overall Cronbach's α coefficient was 0.818, with subscale coefficients ranging from 0.701 to 0.821.The split-half reliability was 0.811, test-retest reliability was 0.929, and content validity indexwas 0.86.Exploratory factor analysis extracted five factors, accounting for 52.0% of the cumulative variance.Confirmatory factor analysis demonstrated good model fit( χ2/df=1.626, RMSEA=0.05, CFI =0.914). Conclusions:The developed questionnaire exhibits strong reliability and validity, serving as an effective tool to assess protection motivation for frailty management in the elderly.

Objective:To investigate the protective effect of naringenin on acute lung injury related with sepsis; To discuss its possible mechanism.Methods:Totally 30 male SD rats were randomly divided into sham-operation group, model group, naringin low-, medium- and high-dosage groups, with 6 rats in each group. The sepsis-related acute lung injury model was established by cecal ligation and puncture in all groups except the sham-operation group. After modeling, naringin low-, medium- and high-dosage groups were given naringin 20 mg/kg, 40 mg/kg and 80 mg/kg, respectively for gavage, while the sham-operation group and the model group were given the same volume of distilled water by gavage, once a day, for 2 days. Pathological changes in lung tissue were observed using HE staining. The levels of 1L-1, IL-6 and IL-18 in bronchoalveolar lavage fluid (BALF) were measured by ELISA; the expression of TNF-α in lung tissue was detected by immunofluorescence histopathology; the expressions of TGF-β1, TGF-βR1 and Smad2 were detected by Western Blot. An agonist group and a naringin plus agonist group were set up, with 6 mice in each group, and the expressions of TGF-β1 and Smad2 protein in the lung tissue of each group were detected by immunohistochemical staining to verify the effect of naringin on the expressions of TGF-β1 and Smad2 protein.Results:Compared with the model group, the pathological injury of lung tissue in naringin groups were obviously alleviated, and the levels of IL-1β, IL-6 and IL-18 in BALF decreased ( P<0.01), the protein expressions of TNF-α, TGF-β1, TGF-βR1 and Smad2 in lung tissue decreased ( P<0.01 or P<0.05). Further verification found that the expressions of TGF-β1 and Smad2 in the agonist group increased ( P<0.01), while the expressions of TGF-β1 and Smad2 in the naringin agonist group decreased ( P<0.01). Conclusion:Naringin can reduce the inflammatory response in the lung of the rats to protect against sepsis-related acute lung injury, and its protective effect could be related to the inhibition of the TGF-β1/Smad2 signaling pathway.

Objective:To study the current status of longitudinal extrauterine growth restriction (EUGR) in extremely preterm infants (EPIs) and to develop a prediction model based on clinical data from multiple NICUs.Methods:From January 2017 to December 2018, EPIs admitted to 32 NICUs in North China were retrospectively studied. Their general conditions, nutritional support, complications during hospitalization and weight changes were reviewed. Weight loss between birth and discharge > 1SD was defined as longitudinal EUGR. The EPIs were assigned into longitudinal EUGR group and non-EUGR group and their nutritional support and weight changes were compared. The EPIs were randomly assigned into the training dataset and the validation dataset with a ratio of 7∶3. Univariate Cox regression analysis and multiple regression analysis were used in the training dataset to select the independent predictive factors. The best-fitting Nomogram model predicting longitudinal EUGR was established based on Akaike Information Criterion. The model was evaluated for discrimination efficacy, calibration and clinical decision curve analysis.Results:A total of 436 EPIs were included in this study, with a mean gestational age of (26.9±0.9) weeks and a birth weight of (989±171) g. The incidence of longitudinal EUGR was 82.3%(359/436). Seven variables (birth weight Z-score, weight loss, weight growth velocity, the proportion of breast milk ≥75% within 3 d before discharge, invasive mechanical ventilation ≥7 d, maternal antenatal corticosteroids use and bronchopulmonary dysplasia) were selected to establish the prediction model. The area under the receiver operating characteristic curve of the training dataset and the validation dataset were 0.870 (95% CI 0.820-0.920) and 0.879 (95% CI 0.815-0.942), suggesting good discrimination efficacy. The calibration curve indicated a good fit of the model ( P>0.05). The decision curve analysis showed positive net benefits at all thresholds. Conclusions:Currently, EPIs have a high incidence of longitudinal EUGR. The prediction model is helpful for early identification and intervention for EPIs with higher risks of longitudinal EUGR. It is necessary to expand the sample size and conduct prospective studies to optimize and validate the prediction model in the future.