Diabetic nephropathy （DKD）， as a common microvascular complication of diabetes mellitus （DM）， is a major cause of end-stage renal disease （ESRD）. Its clinical manifestations include increased urinary protein excretion， thickening of the glomerular basement membrane， and renal tubulointerstitial fibrosis. The pathogenesis of DKD is complex and involves multiple factors， including disordered glucose metabolism， hemodynamic alterations， and oxidative stress. Although modern medical approaches can alleviate certain symptoms， they still have limitations such as insufficient therapeutic targeting and prominent adverse effects. The transforming growth factor-β/Smad （TGF-β/Smad） signaling pathway is not only a tissue fibrosis pathway that has attracted considerable attention in recent years， but also regulates multiple protein molecules， including the glomerular podocyte slit diaphragm protein Podocin， interleukin-1β （IL-1β）， and superoxide dismutase （SOD）， thereby participating in various pathological processes and ultimately mediating renal injury. Flavonoid compounds， owing to their sustained pharmacological effects， broad spectrum of action， and high safety profile， have become ideal candidates for targeted therapy research in DKD. Existing studies have shown that these compounds can exert inhibitory effects on renal fibrosis， alleviate inflammatory responses， protect podocytes， and reduce oxidative stress by regulating the interactions between the TGF-β/Smad signaling pathway and the aforementioned protein molecules， thereby maintaining renal structure and function， reducing proteinuria， and significantly improving DKD lesions. This review briefly outlines the composition and functions of the TGF-β/Smad signaling pathway， elucidates the mechanisms by which this pathway regulates DKD， and focuses on summarizing major studies from the past decade on flavonoid-based interventions in DKD through targeted inhibition of the TGF-β/Smad signaling pathway. Furthermore， it discusses the considerable therapeutic potential of flavonoids in the treatment of this disease， aiming to provide a scientific basis for future clinical prevention and treatment of DKD and to promote the development of targeted drugs.

The herb pair Hedysari Radix-Angelicae Sinensis Radix is a classic combination embodying the theory of replenishing Qi and tonifying blood in traditional Chinese medicine. The two herbs are often used together to achieve the effects of replenishing Qi， tonifying blood， activating blood， and unblocking collaterals. Clinically， this herb pair is widely applied in the treatment of blood deficiency syndrome and hematopoietic dysfunction disorders such as myelosuppression induced by radiotherapy and chemotherapy. Modern research indicates that Hedysari Radix-Angelicae Sinensis Radix and their active components can synergistically promote hematopoiesis through multiple targets and pathways. At the cellular level， the active components directly activate hematopoietic stem cells （HSCs） and hematopoietic progenitor cells （HPCs）， promoting their proliferation and differentiation， while simultaneously stimulating the production and release of peripheral blood cells. Regarding molecular regulation， this herb pair can regulate the expression of various hematopoietic-related cytokines， such as stem cell factor and erythropoietin. Additionally， it modulates key signaling pathways， including phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） and Wnt/β-catenin， providing signal support for the hematopoietic process. Furthermore， Hedysari Radix-Angelicae Sinensis Radix can improve the hematopoietic microenvironment， protect bone marrow stromal cells， and eliminate free radicals through antioxidant effects， thereby reducing damage to hematopoietic cells. Furthermore， this herb pair regulates apoptosis-related proteins to inhibit excessive apoptosis of hematopoietic cells and increase their survival rate. Its material basis primarily includes active components such as Hedysarum polybotrys polysacchcrides and flavonoids， as well as Angelica sinensis polysaccharides and ferulic acid， which synergistically contribute to its hematopoietic-promoting effects. By elaborating on the active components and mechanisms of Hedysari Radix-Angelicae Sinensis Radix in promoting hematopoiesis， this paper aims to elucidate the molecular mechanisms underlying their hematopoietic effects and provide a reference for further research and clinical application.

Objective:To investigate the feasibility of DNA tetrahedral framework (DNA-TH) as a carrier and adjuvant for mucosal vaccines, using streptavidin (SA) as a model antigen.Methods:DNA-TH was designed using software, integrating the adjuvant CpG sequence into its structure. After in vitro synthesis, it was conjugated with SA to form SA-DNA-TH nanoparticles. In vitro experiments: free SA and the two-dimensional structure SA-CpG (SA directly conjugated to CpG) were used as controls. The uptake efficiency of SA-DNA-TH by mouse primary macrophages and its ability to activate antigen-presenting cells (APCs) were evaluated. In vivo experiments: following submucosal oral injection, a mixture of free SA and free CpG (mixed group) was used as a control. The distribution of SA within mouse lymph nodes was observed using immunofluorescence staining. Levels of SA-specific antibodies (serum IgG, IgM; salivary sIgA) in serum and saliva were measured to assess humoral and mucosal immune responses.Results:Native polyacrylamide gel electrophoresis confirmed the successful synthesis of DNA-TH and SA-DNA-TH. In vitro experiments: SA-DNA-TH was rapidly taken up by primary macrophages. Its uptake rate (92.65%±4.43%) was significantly higher than that of the SA-CpG group (25.37%±3.56%) and the free SA group (1.80%±1.02%; both P<0.01). SA-DNA-TH also induced significantly stronger APC activation (OD value fold increase: 3.60±0.32) compared to the free SA group (1.13±0.10) and the SA-CpG group (1.21±0.02; both P<0.01). In vivo experiments: lymph node distribution analysis revealed overlapping signals of SA with subcapsular sinus macrophages (SCSMs) and dendritic cells (DCs) in the SA-DNA-TH group, whereas SA signals appeared dispersed and non-overlapping with APCs in the mixed group. Regarding immunogenicity, both serum anti-SA antibody (IgG+IgM) titers and salivary anti-SA sIgA antibody titers induced by SA-DNA-TH were significantly higher than those in the mixed group and the blank control group (both P<0.05). Conclusion:DNA-TH effectively delivers the model antigen SA to antigen-presenting cells, significantly induces the production of serum-specific antibodies, and activates mucosal immune responses. It demonstrates potential as a carrier and adjuvant for developing mucosal vaccines.

Objective:To evaluate the correlation between preoperative platelet function and in-hospital mortality in patients with acute Stanford A aortic dissection(ATAAD) undergoing emergency surgery.Methods:ATAAD emergency surgical patients who underwent preoperative thromboelastography(TEG) examination at three cardiovascular disease hospitals from January 2018 to December 2023 were consecutively selected in this study. The patients were divided into two groups according to whether the patient survived to discharge.Results:867 patients were included in this study. The in-hospital mortality was 11.2%(97 cases). Compared with the DG group(97 cases), the age, pericardial effusion volume, lactate concentration, and MA value of patients in the SG group(770 cases) were higher( P<0.001). Factors independently associated with in-hospital mortality were age(>60 years old), coronary hypoperfusion, pericardial effusion volume(>200.00 ml), and MA value(<60.6 mm). There was a correlation between MA value and in-hospital mortality( P=0.012), and the mediating effect between MA value and platelet count was not significant. Conclusion:There is a correlation between preoperative platelet function and in-hospital in ATAAD patients, and improving platelet function may be one of the important ways to improve the clinical prognosis of those patients.

Objective:To investigate the dynamic changes of inflammatory biomarkers in patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) support after cardiac surgery, and evaluate their predictive value for in-hospital mortality.Methods:The retrospective study included 212 patients who underwent VA-ECMO support following cardiac surgery at Beijing Anzhen Hospital, Capital Medical University, from January 2021 to May 2024. Baseline characteristics and inflammatory markers during ECMO support including procalcitonin (PCT), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and fibrinogen (FBG) were collected. Univariate analysis, ROC curves, and multivariate logistic regression were performed to assess the association of these indicators with outcomes. Results:On day 3 post-ECMO, mean PCT and CRP levels were significantly higher in the deceased group (87 cases) than in the survival group (125 cases). PCT demonstrated an area under the curve ( AUC) of 0.750 (95% CI: 0.680-0.819) for predicting mortality, while CRP had an AUC of 0.701(95% CI: 0.625-0.778). No significant differences were observed in FBG, NLR, or PLR between the two groups. Lactate levels at 24 h post-ECMO ( AUC=0.723) and SOFA scores ( OR=2.511, AUC=0.713) were also significantly associated with mortality risk in the deceased group ( P<0.05). Conclusion:Dynamic increases in PCT and CRP are independent predictors of in-hospital mortality in cardiac surgery patients supported by ECMO. Elevated lactate levels and SOFA scores, aligning with previous studies, reflect severe tissue hypoperfusion and multi-organ dysfunction in non-survivors, underscoring the necessity of dynamic monitoring of inflammatory and organ function markers for prognosis assessment.

Objective:To investigate the relationship between the number of residual tears in visceral artery segment and vascular remodeling after thoracic aortic endovascular repair (TEVAR).Methods:A total of 100 patients diagnosed with complicated Stanford type B aortic dissection (cTBAD) and treated with TEVAR in our hospital from June 2018 to June 2023 were collected retrospectively as study objects, and were divided into benign remodeling group (58 cases) and non-benign remodeling group (42 cases) according to prognosis. The clinical data, imaging indexes before and after operation, and early postoperative morphological characteristics were compared between the two groups. The independent influencing factors of internal artery remodeling after operation were analyzed by multivariate logistic analysis. Cox proportional risk regression was used to analyze the association between the number of residual tears in visceral artery segments and non-benign remodeling at different disease stages. The relationship between the number of residual tears and non-benign remodeling of visceral artery segments was analyzed by the restricted cubic spline method combined with spline function and logistic regression. Results:Compared with the benign remodeling group, the age and disease stage of the non-benign remodeling group were significantly increased ( P<0.05). After operation, the diameter and area of celiac trunk (CAT), superior mesenteric artery (SMA), left renal artery (LRA) and right renal artery (RRA) were significantly increased ( P<0.05), while the diameter and area of CAT, SMA and LRA were significantly decreased ( P<0.05). The maximum diameter of the lumen, the number of residual lacerations in the visceral artery segment and the number of lumen originating from the lumbar artery were significantly increased ( P<0.05). Further logistic regression analysis showed that age, disease stage, plane true lumen area and plane thrombus area of CAT and SMA, plane true lumen area of LRA and RRA, and number of residual tears of visceral artery segment were independent factors influencing the remodeling of internal arteries after surgery. Cox proportional risk regression analysis showed that the number of residual visceral artery segments was significantly correlated with non-benign remodeling under different disease stages. The multiplicative interaction terms of the number of residual visceral artery segments and disease stages were 0.028 and 0.031 in people aged ≤58.7 years old and>58.7 years old, respectively. Restricted cubic spline analysis showed that regardless of age and disease stage, there was a nonlinear dose-response relationship between the number of residual tears in visceral artery segment and the intensity of non-benign remodeling association, and the number of residual tears in visceral artery segment ≥2 significantly increased the risk of non-benign remodeling. Conclusion:The number of residual tears in visceral artery segment was significantly correlated with vascular remodeling after TEVAR, and the correlation strength with non-benign remodeling showed a nonlinear dose-response relationship. When the number of residual tears in visceral artery segment was ≥2, the risk of non-benign remodeling was significantly increased.

Objective To investigate the expression of serum microRNA(miR)-340-5p,miR-155-5p and their relationship with Th1/Th2 cytokines in patients with chronic hepatitis B.Methods A total of 128 pa-tients with chronic hepatitis B in this hospital from October 2021 to October 2023 were selected as the study group,and 96 healthy subjects from the hospital during the same period were selected as the control group.The expression levels of serum miR-340-5p and miR-155-5p were detected by fluorescence quantitative PCR(qPCR),and the expression levels of serum Th1/Th2 cytokines were detected by enzyme-linked immunosor-bent assay(ELISA).The relationship between miR-340-5p,miR-155-5p and Th1/Th2 cytokines was analyzed by Pearson method,and the influence of serum miR-340-5p and miR-155-5p on the occurrence of chronic HPV infection was analyzed by Logistic regression.Results Compared with the reference group,the serum levels of miR-340-5p,miR-155-5p,IL-4,and IL-13 in the study group decreased(P＜0.05),while the levels of IFN-γand IL-12 increased(P＜0.05).Serum miR-340-5p was negatively correlated with IFN-γ and IL-12(r=-0.315,-0.293,both P＜0.05),and positively correlated with IL-4 and IL-13(r=0.413,0.412,both P＜0.05).Serum miR-155-5p was negatively correlated with IFN-γ and IL-12(r=-0.406,-0.375,both P＜0.05),and positively correlated with IL-4 and IL-13(r=0.343,0.407,both P＜0.05).Serum miR-340-5p(OR=0.735,95％CI:Increased expression levels of 0.590-0.915)and miR-155-5p(OR=0.612,95％CI:0.416-0.900)were protective factors for the occurrence of chronic hepatitis B.IFN-γ(OR=1.652,95％CI:1.170-2.333)and IL-12(OR=1.063,95％CI:1.012-1.116)were risk factors for chronic hepatitis B(P＜0.05).Conclusion Serum miR-340-5p and miR-155-5p are usually low expressed in chronic hepatitis B patients,and they are negatively correlated with Th1 cytokine level and positively correlated with Th2 cytokine level.

Objective:To explore the latent pattern characteristics of adolescent prosocial behavior and their relationship with the sense of life meaning.Methods:A total of 1 500 students from primary and secondary schools were selected.The Adolescent Prosocial Behavior Questionnaire and the Meaning in Life Questionnaire were admin-istered.Latent profile analysis was used to investigate the potential categories of prosocial behavior,and variance a-nalysis was employed to compare the relationship between prosocial behavior and life meaning.Results:Adolescent prosocial behavior was classified into 3 latent categories,namely negative prosocial behavior type(5.7％),altruistic relationship behavior type(36.7％),and positive prosocial behavior type(57.6％).The score differences in each dimension of the variables among the 3 categories were statistically significant(P＜0.01).Among the three latent categories,the positive prosocial behavior type scored higher on all dimensions than the altruistic relationship behav-ior type(P＜0.05),and the altruistic relationship behavior type scored higher than the negative prosocial behavior type(P＜0.05).Conclusion:There are three distinct latent profiles in adolescent prosocial behavior,which are closely associated with the sense of life meaning.

Objective To evaluate the accuracy and reproducibility of AlignRT-guided positioning by comparing two positioning workflows for pelvic tumor radiotherapy,and to further explore the feasibility of using it to replace skin marker alignment.Methods Forty cases of pelvic tumor treated with radiotherapy using Infinity accelerator in Sun Yat-sen University Cancer Center between March 2022 and March 2023 were included in the study,with 20 cases using the skin marker alignment workflow and the other 20 adopting AlignRT-guided positioning workflow.The translational errors(LAT,LNG,VRT)and rotational errors(Yaw,Pitch,Roll)were determined by the registration of pre-treatment cone-beam CT(CBCT)with planned CT.Both CBCT shifts and error offset distributions were analyzed;planning target volume(PTV)margins were calculated;and correlation analyses were conducted among six-dimensional errors,and between body mass index and setup errors.Results The median translational and rotational setup errors of skin marker alignment workflow vs AlignRT-guided positioning workflow were 0.19-0.34 cm vs 0.10-0.15 cm and 0.50°-1.30°vs 0.50°-0.70°,with the maximum offset ranges of 1.20-1.70 cm vs 0.42-0.47 cm and 2.00°-5.50° vs 1.80°-2.00°,respectively.Additionally,for skin marker alignment workflow,inter-fractional errors>0.5 cm and>3° were observed in 23.3%and 9.8%of fractions.The PTV margins of AlignRT-guided positioning workflow were 0.37,0.38 and 0.34 cm in the left-right,superior-inferior and anterior-posterior directions,respectively,which were much smaller than those of skin marker alignment workflow(0.67,1.22 and 0.95 cm).No correlation was found between six-dimensional errors in two positioning workflows.When using AlignRT-guided positioning workflow,the setup errors in LAT,LNG and Pitch directions had low correlations with body mass index.Conclusion In pelvic tumor radiotherapy,AlignRT-guided positioning can reduce translational and rotational errors,achieve precise setup and excellent inter-fractional reproducibility and stability,and replace traditional skin marker alignment while being used in conjunction with CBCT.

Objective:To compare the uncertainty of dose calibration systems between EBT4 and EBT3 films, and to evaluate the effectiveness and accuracy of EBT4 films in radiotherapy dose measurements.Methods:EBT4 and EBT3 films were irradiated with clinical 6 MV photon beams at doses ranging from 0 to 1,600 MU. Films were scanned after resting for 0 and 24 h to establish dose calibration functions based on net optical density. The dose uncertainties introduced by function fitting, dose resolution, film non-uniformity, scan repeatability, and scanner non-uniformity during calibration of the two films were obtained through experimental tests and mathematical calculations. Independent-sample t-tests were used to compare differences in fitting uncertainty and dose resolution between the two films, while homogeneity of variance tests were used to compare differences in film non-uniformity and scan repeatability. The combined total uncertainty was then calculated and compared. Finally, the total combined uncertainty was calculated by integrating all individual sources of uncertainty and compared between the two films. Results:Within the absorbed dose range of 1-12 Gy, EBT4 films exhibited significantly lower dose uncertainties from function fitting and dose resolution than EBT3 films at the same standing time ( P<0.01). No significant differences were observed between the two films in terms of non-uniformity and scan repeatability ( P>0.05). The total dose uncertainties of EBT4 and EBT3 films at 0 h standing were 5.65% and 7.87%, respectively, while the total uncertainties at 24 h standing were 4.73% and 6.33%, respectively. Overall, the dose calibration system of EBT4 films demonstrated consistently lower total uncertainty. Conclusion:Under identical conditions, EBT4 films demonstrate superior and more stable dose uncertainty compared with EBT3 films, thereby meeting the clinical requirements for radiation dose measurements with higher precision.