Based on the viewpoint of "sweat pore-qi and liquid-kidney collaterals"， it is believed that children's nephrotic syndrome is caused by the core mechanism of sweat pore constraint and closure， qi and liquid imbalance， and kidney collaterals impairment， and it is proposed that the treatment principle is to nourish the sweat pore， regulate qi and fluid， and supplement the kidney and unblock the collaterals. In clinic， guided by sequential therapy and according to the different disease mechanism characteristics of the four stages， including early stage of the disease， hormone induction stage， hormone reduction stage， hormone maintenance stage， the staged dynamic identification and treatment was applied. For early stage of the disease with edema due to yang deficiency， modified Zhenwu Decoction （真武汤） was applied to warm yang and drain water； for hormone induction stage with yin deficiency resulting in effulgent fire， modified Zhibai Dihuang Pill （知柏地黄丸） plus Erzhi Pill （二至丸） was used to enrich yin and reduce fire； for hormone reduction stage with qi and yin deficiency， modified Shenqi Dihuang Decoction （参芪地黄汤） was used to boost qi and nourish yin； for hormone maintenance stage， modified Shenqi Pill （肾气丸） was used to supplement yin and yang. Meanwhile， the treatment also attaches importance to the combination of vine-based or worm medicinals to dredge collaterals， so as to providing ideas for clinical treatment.

Disruption of the intestinal mucosal barrier caused by gut dysbiosis and metabolic imbalance is the underlying pathology of inflammatory bowel disease (IBD). Traditional Chinese medicine Wuji Wan (WJW) is commonly used to treat digestive system disorders and showed therapeutic potential for IBD. In this interdisciplinary study, we aim to investigate the pharmacological effects of WJW against experimental colitis by combining functional metabolomics and gut-microbiota sequencing techniques. Treatment with WJW altered the profile of the intestinal microbiota and notably increased the abundance of Lactobacillus, thereby facilitating the conversion of tryptophan into indole-3-acetic acid (IAA) and indoleacrylic acid (IA). These indole derivatives activated the aryl hydrocarbon receptor (AhR) pathway, which reduced colonic inflammation and restored the expression of intestinal barrier proteins. Interestingly, the beneficial effects of WJW on gut barrier function improvement and tryptophan metabolism were disappeared in the absence of gut microbiota. Finally, pre-treatment with the AhR antagonist CH-223191 confirmed the essential role of IAA-mediated AhR activation in the therapeutic effects of WJW. Overall, WJW enhanced intestinal barrier function and reduced colonic inflammation in a murine colitis model by modulating Lactobacillus-IAA-AhR signaling pathway. This study provides novel insights into colitis pathogenesis and presents an effective therapeutic and preventive approach against IBD.

Epidemiological investigations and clinical studies have shown that inappropriate ambient temperatures (high and low temperatures) are the independent risk factors for ischemic stroke, but their underlying physiological mechanisms are not fully understood. This article systematically reviews the potential mechanisms by which inappropriate ambient temperatures promote the occurrence of ischemic stroke through multiple pathways, such as activating the sympathetic-renin-angiotensin system, inducing systemic inflammation and oxidative stress, damaging the integrity of the intestinal barrier and blood-brain barrier, and disrupting coagulation-fibrinolysis balance.

Autoimmune disease is a kind of disease characterized by immune imbalance,abnormal activation of immune cells,massive production of inflammatory factors and immune complexes,which leads to the damage of multiple organs and systems.Autoimmune disease is easy to recur in clinical practice.The previous studies showed that there is a correlation between dampness syndrome in traditional Chinese medicine(TCM)and immune dysfunction.This paper explains the theoretical basis for the correlation between dampness syndrome of TCM and the recurrence of autoimmune diseases,and the similarities between the two in macro appearance,pathogenesis characteristics,etc.,analyzes the possible correlation about biological mechanism between dampness syndrome and autoimmune diseases,and discussed the correlation between pathogenic dampness of TCM and the recurrence of autoimmune diseases such as psoriasis,rheumatoid arthritis,ulcerative colitis,and nephrotic syndrome.It is pointed out that pathogenic dampness of TCM is an important pathogenic factor for the recurrence of autoimmune diseases,and is closely related to the recurrence of autoimmune diseases.Autoimmune diseases can be treated from the perspective of pathogenic dampness in TCM,and therapy of invigorating spleen,replenishing qi and removing dampness is frequently adopted,which is beneficial to alleviating the clinical symptoms of patients and reducing the recurrence of autoimmune disease.

Objective To compare the efficacy and safety of computed tomography (CT)-guided percutaneous versus electromagnetic navigation bronchoscopy (ENB)-guided microwave ablation (MWA) for the treatment of pulmonary nodules. Methods A retrospective analysis was conducted on the data of high-risk pulmonary nodule patients who underwent MWA at the Nanjing Drum Tower Hospital between 2022 and 2023. The pathological diagnosis rate, complications, and progression-free survival (PFS) rate were compared between the CT group and the ENB group. Results There were 61 patients in the CT group, including 30 males and 31 females, with an average age of (67.22±9.13) years. There were 53 patients in the ENB group, including 29 males and 24 females, with an average age of (65.29±13.76) years. The pathological diagnosis rate in the CT group was slightly higher than that in the ENB group (88.52% vs. 71.69%, P=0.03). However, the ENB group exhibited a lower incidence of perioperative complications, including pneumothorax (16.39% vs. 3.77%, P=0.03), hemoptysis (19.67% vs. 5.66%, P=0.05), and pain (22.95% vs. 7.55%, P=0.03). There was no statistically significant difference in PFS rate between the two groups [HR=1.17, 95%CI (0.23, 5.81), P=0.85]. Conclusion Both CT-guided and ENB-guided MWA are effective treatment modalities for high-risk pulmonary nodules.

OBJECTIVE: To explore the prenatal features and genetic etiology of a fetus with Short-rib cage dysplasia (SRTD) due to variants of DYNC2H1 gene. METHODS: A pregnant women presented at Xinxiang Central Hospital in June 2020 for abnormal prenatal ultrasound findings was selected as the study subject. With informed consent obtained, amniotic fluid sample was extracted from the woman, and clinical data of the fetus were collected. Whole exome sequencing (WES) was carried out, and candidate variants were verified by Sanger sequencing. This study was approved by the Medical Ethics Committee of Xinxiang Central Hospital [Ethics No.: 2025-214-01(K)]. RESULTS: At 25⁺⁶ weeks gestation, genetic testing revealed that the fetus has harbored compound heterozygous variants of the DYNC2H1 gene, namely c.10585C>T (p.Arg3529Ter) and c.8954T>G (p.Val2985Gly), which were derived from its father and mother, respectively. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the c.10585C>T (p.Arg3529Ter) and c.8954T>G (p.Val2985Gly) variants were classified as pathogenic (PVS1+PM2_supporting+PM3+PP5) and likely pathogenic (PM1+PM2_supporting+PM3+PP3), respectively. Bioinformatics analysis suggested that both variants may affect the 3D structure of the DYNC2H1 protein. CONCLUSION The compound heterozygous variants of c.10585C>T (p.Arg3529Ter) and c.8954T>G (p.Val2985Gly) of the DYNC2H1 gene probably underlay the pathogenesis of SRTD in the fetus. Above findings had facilitated prenatal diagnosis and genetic counseling for the couple.
Humans ; Female ; Pregnancy ; Cytoplasmic Dyneins/chemistry* ; Prenatal Diagnosis ; Adult ; Short Rib-Polydactyly Syndrome/diagnostic imaging* ; Mutation ; Exome Sequencing ; Fetus/abnormalities* ; Ultrasonography, Prenatal

Objective:To explore the clinical application pathway of the CT generative adversarial networks (CTGANs) algorithm in mandibular reconstruction surgery, aiming to provide a valuable reference for this procedure.Methods:A clinical exploratory study was conducted, 27 patients who visited the Department of Oral and Maxillofacial Surgery, Xiangya Hospital of Central South University between January 2022 and January 2024 and required mandibular reconstruction were selected. The cohort included 16 males and 11 females, with the age of (46.6±11.5) years; among them, 7 cases involved mandibular defects crossing the midline. The CTGANs generator produced 100 images, and the mean squared error (MSE) was calculated for differences between any two generated images. Preoperative cone-beam CT data from 5 patients were used to construct a labeled test database, divided into groups: normal maxilla, normal mandible, diseased mandible, and noise (each group containing 70 cross-sectional images). The CTGANs discriminator was used to evaluate the loss values for each group, and one-way ANOVA and intergroup comparisons were performed. Using the self-developed KuYe multioutcome-option-network generation system (KMG) software, the three-dimensional (3D) completion area of the mandible under cone-beam CT was defined for the 27 patients. The CTGANs algorithm was applied to obtain a reference model for the mandible. Virtual surgery was then performed, utilizing the fibular segment to reconstruct the mandible and design the surgical expectation model. The second-generation combined bone-cutting and prebent reconstruction plate positioning method was used to design and 3D print surgical guides, which were subsequently applied in mandibular reconstruction surgery for the 27 patients. Postoperative cone-beam CT was used to compare the morphology of the reconstructed mandible with the surgical expectation model and the mandibular reference model to assess the three-dimensional deviation.Results:The MSE for the CTGANs generator was 2 411.9±833.6 (95% CI: 2 388.7-2 435.1). No significant difference in loss values was found between the normal mandible and diseased mandible groups ( P>0.05), while both groups demonstrated significantly lower loss values than the maxilla and noise groups ( P<0.001). All 27 patients successfully obtained mandibular reference models and surgical expectation models. In total, 14 162 negative deviation points and 15 346 positive deviation points were observed when comparing the reconstructed mandible morphology with the surgical expectation model, with mean deviations of -1.32 mm (95% CI:-1.33- -1.31 mm) and 1.90 mm (95% CI: 1.04-1.06 mm), respectively. Conclusions:The CTGANs algorithm is capable of generating diverse mandibular reference models that reflect the natural anatomical characteristics of the mandible and closely match individual patient morphology, thereby facilitating the design of surgical expectation models. This method shows promise for application in patients with mandibular defects crossing the midline.

There are a total of 16 couplet medicines of Paeoniae Radix Alba and Glycyrrhizae Radix et Rhizoma in the book FU Qingzhu Nüke, covering a wide range of diseases such as leukorrheal diseases, menopathy, pregnancy, and puerperal diseases, and there is a fine sense of the dosage, processing, and proportion of the couplet medicines. Through analyzing the cases of Paeoniae Radix Alba and Glycyrrhizae Radix et Rhizoma couplet medicines and the characteristics of dosage, processing, and proportion, we conclude that Paeoniae Radix Alba and Glycyrrhizae Radix et Rhizoma couplet medicines are mainly as followed: smoothing liver and strengthening spleen in treating leukorrheal diseases to remove dampness and stop leucorrhoea; regulating liver and tonifying spleen in menopathy to regulate menstruation and relieve pain; nourishing blood and benefiting qi in pregnancy to lower adverse qi and tranquilize fetus to prevent miscarriage; regulating and tonifying qi and blood in puerperal diseases to eliminate pathogenic factors and promote lactation; suppressing hyperactive liver for descending adverse qi, and relieving spasm and pain in cases of miscarriage due to rage. In terms of dosage, Paeoniae Radix Alba is mainly used for three to five qian, and Glycyrrhizae Radix et Rhizoma is primarily used for one qian, and the dosage of the two medicinals is adjusted according to the degree of primary and secondary liver stagnation and spleen deficiency. In terms of processing, wine Paeoniae Radix Alba and raw Glycyrrhizae Radix et Rhizoma are primarily used. Stir-frying with wine can help Paeoniae Radix Alba nourish blood and promote blood circulation, tonifying without stagnation, and it is used in most of the diseases caused by liver qi stagnation or qi and blood deficiency. Glycyrrhizae Radix et Rhizoma used in raw is tonifying without causing stagnation, and it can also have the effect of purging fire. In terms of proportion, the ratio of Paeoniae Radix Alba to Glycyrrhizae Radix et Rhizoma is 5∶1 for liver stagnation restraining spleen, 3∶1 for qi and blood deficiency, and 1∶1 for obvious fire-heat. This paper analyses the application of Paeoniae Radix Alba and Glycyrrhizae Radix et Rhizoma couplet medicines in FU Qingzhu Nüke, aiming to deeply study and inherit the academic thought of FU Qingzhu, and to provide new ideas and method for the precise application of Paeoniae Radix Alba and Glycyrrhizae Radix et Rhizoma couplet medicines in clinical practice and researches.

Objective:To explore the application effect of data envelopment analysis(DEA)model in the safety and quality management of ventilators in intensive care units.Methods:Based on the Chanis-Cooper-Rhodes(CCR)dual model,by adding constraints,the input-oriented Bank-Carnes-Cooper(BCC)model was constructed to construct the DEA model.Among the 124 related items in the DEA model,20 high-level related items were identified to carry out ventilator quality control management related to clinical service efficiency.A total of 33 ventilators in clinical use in the intensive care unit(ICU)of Jiangsu Province Hospital from October 2021 to September 2023 were selected.Among them,the ventilators used from October 2021 to September 2022 were managed by traditional quality control management methods,and the ventilators used from October 2022 to September 2023 were managed by DEA model.The satisfaction scores,management quality scores and clinical efficiency scores of participants in ventilator use management were compared between the two management methods.Results:The satisfaction scores of medical staff,patients and equipment engineers for ventilator management using the DEA model management method were(96.68±2.25)points,(96.32±2.18)points and(95.66±2.54)points,respectively,which were higher than those of the traditional quality control management method,the difference was statistically significant(t=10.940,15.220,6.674,P＜0.05).The average scores of ventilator operation performance,inspection operation safety and timeliness using DEA model management method were(4.44±0.31)points,(4.53±0.37)points and(4.61±0.36)points,respectively,which were higher than those of the traditional quality control management method,the difference was statistically significant(t=12.692,14.979,17.025,P＜0.05).The average scores of ventilator work efficiency,ventilator response time efficiency and ventilator treatment efficiency using the DEA model management method were(4.49±0.32)points,(4.75±0.35)points and(4.68±0.32)points,respectively,which were all higher than those of the traditional quality control management method,with statistically significant differences(t=21.179,16.785,16.347,P＜0.05).Conclusion:The application of the DEA model in the management of ventilators in ICU can improve the efficiency of ventilator clinical service,improve the satisfaction of ventilator management personnel and the quality of ventilator management.

OBJECTIVE To study the ameliorative effect and potential mechanism of curcumin on diabetes model rats with depression based on cAMP response element binding protein （CREB）/brain-derived neurotrophic factor （BDNF） signaling pathway. METHODS The diabetes model rat with depression was established by high fat and high sugar diet+intraperitoneal injection of streptozotocin+chronic unpredictable stress-induced depression. The successfully modeled rats were randomly divided into model group， positive control group （0.18 g/kg metformin and 1.8 mg/kg fluoxetine， gavage）， curcumin low-dose and high-dose groups （30， 60 mg/kg， gavage） and curcumin high-dose+CREB inhibitor group [60 mg/kg curcumin （gavage）+5 mg/kg CREB inhibitor 666-15 （intraperitoneal injection）]， with 12 rats in each group. Another 12 healthy rats were selected as the normal group. Each group was given a corresponding intervention for 4 weeks， the fasting blood glucose level of rats was detected， and the depression of rats was assessed. The levels of corticosterone （CORT） and inflammatory factors [tumor necrosis factor-α （TNF-α）， interleukin- 1β （IL-1β）， IL-6] in serum， and the levels of norepinephrine （NE） and 5-hydroxytryptamine （5-HT） in hippocampal tissue were determined. The pathological changes and neuronal apoptosis were observed in the hippocampal tissue of rats in each group； the expression levels of CREB， BDNF mRNA and protein in hippocampal tissue were detected. RESULTS Compared with the normal group， the hippocampal tissue of rats in the model group was severely damaged， and neurons were scattered， while the fasting blood glucose， the forced swimming immobility time， the tail suspension immobility time， serum levels of CORT， TNF-α， IL-1β and IL-6， and neuron apoptosis indexes were all increased or prolonged significantly （P＜0.05）. The levels of NE and 5-HT， the number of surviving neurons， and the expression levels of CREB and BDNF mRNA and protein in hippocampal tissue were decreased significantly （P＜0.05）. Compared with the 的model group， the damage to hippocampal tissue was relieved in the positive control group and curcumin groups， while the above indexes were improved significantly （P＜0.05）. The improvement effect of curcumin high-dose group was better than that of curcumin low-dose group （P＜0.05）. CREB inhibitor could significantly reverse the ameliorative effect of high-dose curcumin on the model rats （P＜0.05）. CONCLUSIONS Curcumin can improve the depression of diabetes model rats with depression， and relieve neuronal damage and inflammatory response， the mechanism of which may be associated with activating CREB/BDNF signaling pathway.