Renal fibrosis represents the pivotal pathological process driving the progression of chronic kidney disease (CKD) towards end-stage renal disease. Its core manifestations include chronic inflammation, excessive deposition of extracellular matrix (ECM), and tubulointerstitial injury resulting in functional deterioration. Emerging research on the molecular mechanisms underlying renal fibrosis has established that, beyond the canonical Smad-dependent pathway, transforming growth factor-β1 (TGF-β1) also modulates fibrogenesis through non-canonical signaling pathways, notably the mitogen-activated protein kinase (MAPK) and phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) cascades. These non-canonical pathways engage in crosstalk with the canonical Smad pathway, synergistically regulating key processes such as ECM metabolism, inflammatory responses, and epithelial-mesenchymal transition (EMT), thereby collectively orchestrating the initiation and progression of renal fibrosis. Notably, various active components derived from traditional Chinese medicine have demonstrated anti-fibrotic efficacy by modulating these pathways, highlighting their promising multi-target therapeutic potential. This review aims to systematically summarize recent advances in understanding the roles of TGF-β1-mediated MAPK and PI3K/Akt non-canonical signaling pathways in renal fibrosis and to discuss potential therapeutic strategies targeting these pathways.

ObjectiveTo observe the effects of Yifei Tongluo prescription on the NOD-like receptor protein 3 （NLRP3）/Caspase-1/gasdermin D （GSDMD） pathway and epithelial-mesenchymal transition （EMT） in rats with pulmonary fibrosis. MethodsTracheal instillation of bleomycin was conducted to establish a rat model of pulmonary fibrosis. Thirty Sprague-Dawley （SD） rats were randomly divided into a blank group， a model group， a prednisone acetate group （1.17 mg·kg^-1）， and low- and high-dose Yifei Tongluo prescription groups （10.62 and 21.24 g·kg^-1， respectively）. Administration started on the 7th day after modeling， once a day for 28 consecutive days. The lung coefficient of each group was calculated. The pathological changes of lung tissues in each group were observed by hematoxylin-eosin （HE） staining and Masson staining. The expression of α-smooth muscle actin （α-SMA） and vimentin in rat lung tissues was detected by immunohistochemistry. The expression of NLRP3 inflammasome， E-cadherin （E-cad）， and typeⅠ collagen （ColⅠ） in lung tissues was detected by immunofluorescence. The content of hydroxyproline （HYP）， tumor necrosis factor （TNF）-α， interleukin （IL）-18， and IL-1β in rat serum was detected by enzyme-linked immunosorbent assay （ELISA）. The mRNA expression levels of NLRP3， apoptosis-associated speck-like protein containing a CARD （ASC）， IL-1β， and transforming growth factor （TGF）-β₁ in rat lung tissues were determined by real-time quantitative polymerase chain reaction （Real-time PCR）. The protein expression levels of NLRP3， GSDMD， ASC， and Caspase-1 in rat lung tissues were determined by Western blot. ResultsCompared with the blank group， the model group exhibited a significantly increased lung coefficient （P<0.01） and significantly increased range of pulmonary interstitial inflammation and collagen deposition. In addition， the levels of α-SMA， Vimentin， E-cad， and ColⅠ in lung tissues were significantly increased （P<0.01）. The levels of fibrosis- and inflammation-related factors HYP， TNF-α， IL-18， and IL-1β in serum were significantly upregulated （P<0.01）. The levels of factors related to the activation of NLRP3 inflammasome in lung tissues， including NLRP3， GSDMD， ASC， Caspase-1， IL-1β， and TGF-β₁， were significantly upregulated （P<0.01）. Compared with the model group， the Yifei Tongluo prescription groups showed improved lung coefficients. Additionally， the extent of lung inflammation and collagen deposition was significantly reduced. The expression of α-SMA， Vimentin， E-cad， and ColⅠ in lung tissue was significantly decreased （P<0.01）. The levels of HYP， TNF-α， IL-18， and IL-1β in serum were significantly reduced （P<0.01）. The expression levels of NLRP3， GSDMD， ASC， Caspase-1， IL-1β， and TGF-β₁ in lung tissue were also significantly decreased （P<0.01）. ConclusionYifei Tongluo prescription can regulate the NLRP3/Caspase-1/GSDMD pathway， down-regulate release of pro-inflammatory and pro-fibrotic cytokines， alleviate NLRP3 inflammasome-mediated pyroptosis and EMT， and thereby improve pulmonary fibrosis in rats.

Objective To explore the research hotspots and developmental trends in urological education through a bibliometric analysis. Methods Relevant literature on urological education was retrieved from the Web of Science Core Collection and the China National Knowledge Infrastructure (CNKI) databases, covering all records up to Sep.16, 2025.A comprehensive bibliometric analysis was performed on the retrieved publications. Results A total of 303 Chinese and 290 English articles were collected.The annual number of publications demonstrated an overall upward trend.Harvard University in the United States was the most productive institution in this field. Conclusion Urological clinical education has attracted increasing attention from clinicians and medical trainees.Highly cited studies consistently highlight three actionable priorities for urological education:firstly, improving long-term knowledge retention through structured, spaced, and feedback-rich learning designs; secondly, standardizing simulation-based skills training with validated assessment and staged credentialing; thirdly, strengthening training system resilience while expanding non-technical skills training.These directions provide implementable pathways for optimizing urological teaching practices and the standardized residency training programs.

Objective:To investigate the clinical manifestation, therapy, and prognosis of Susac syndrome and enhance the understanding of this disease.Methods:A case summary was made.The clinical data of two siblings with Susac syndrome treated at Children′s Medical Center, Peking University First Hospital in January 2024 were summarized.Reported cases of pediatric Susac syndrome were reviewed.Results:The onset of the disease in the two siblings was at the age of 3.00 and 6.75 years, with recurrent headaches, tinnitus, hearing loss and encephalopathy symptoms.Cranial magnetic resonance imaging showed multiple cerebral microbleeding and microinfarction lesions, " snowball like" in the corpus callosum and diffuse white matter edema in the brain.Audiometry revealed sensorineural hearing loss.In one case, ophthalmic fluorescein angiography revealed ischemic changes due to branch retinal artery occlusions.No pathogenic variants were detected in gene testing.This child was diagnosed with Susac syndrome, and the symptoms were improved after treatment with Corticosteroids and Rituximab.No relapse was observed during the 9-month follow-up.A total of 20 pediatric cases of Susac syndrome were retrieved, including 18 reported previously and 2 cases from this study.There were 2 boys and 18 girls, with the age of onset ranging from 2.5 to 17.0 years.The common initial symptoms included headache (19 cases), vertigo and tinnitus or hearing loss (9 cases), and vision impairment or visual field defect (4 cases). The symptoms were improved after immunotherapy.Conclusions:With a low incidence, Susac syndrome is rare in children and difficult to diagnose.There may be a genetic predisposition in such disease.Early diagnosis and immunotherapy can low the relapse and improve the prognosis.

Objective:To explore and compare the clinical application value of 8-channel head phased-array coil, an 8-channel temporomandibular joint (TMJ)-specific surface coil, and a single-channel surface coil in TMJ MRI examinations.Methods:A total of 600 temporomandibular disorders (TMD) patients (1 200 joints) who underwent TMJ MRI examination in the First People′s Hospital of Jinzhong from June 2020 to January 2025 were retrospectively screened. Based on inclusion/exclusion criteria, 120 TMD patients (240 joints) with closed-mouth oblique sagittal proton density weighted imaging (OSag PDWI), coronal T2 fat-suppression weighted imaging (OCor fs T2WI) and open-mouth oblique sagittal proton density weighted imaging (OSag PDWI) were included. Patients were divided into groups A, B, and C, with 40 cases in each group. Group A (31female, 9male, median age 24 years old), underwent 8-channel head phased-array coil imaging. Group B (29 female, 11male, median age 23.5 years old) underwent TMJ imaging with an 8-channel surface coil. Group C (29 female, 11male, median age 22.5 years old) underwent single-channel surface coil imaging. There were no significant differences in age, gender, type or disease types among groups ( P>0.05). Six healthy volunteers without TMD (4 female, 2 male, range 19 to 45 years old) underwent imaging with all three coils as self-control. The signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and image quality were compared for five regions of interest (ROI) in both patients and volunteers. Results:Under the same sequence and the same parameters, SNR and CNR in group B were higher than those in group A, and SNR and CNR in group C were also higher than those in group A, the differences were statistically significant ( P<0.05). However, there were significant differences in SNR and CNR between group B and group C in the closed and open positions of ROI1, the open positions of ROI3 and the open positions of ROI5 ( P<0.05), and there were no significant differences in other positions ( P>0.05). Group B had the best image quality, followed by group C and group A had the worst image quality. There were significant differences in the visualization of OSag PDWI in the closed mouth position, OCor T2WI in the coronal position, and OSag PDWI in the open mouth position, such as condyle, anterior attachment, joint disc, double lamina area, joint cavity and lateral pterygoid muscle ( P<0.05). There were significant differences between group B and group C in showing the joint cavity in the closed mouth position and showing the structure of the bilaminar area in the open mouth position ( P<0.05). There was no significant difference in other regions of interest ( P>0.05). The subjective scores of condyle, anterior attachment, articular disc, bilaminar area, articular cavity, lateral pterygos muscle and other structures were medium to high in group A, high in group B, and high or high in group C by two radiologists independently. In the five rois, the 8-channel TMJ surface coil showed more details, especially in the articular disc, condyle and lateral pterygoid muscle regions, and had more advantages in both volunteers and patients. Conclusions:The 8-channel TMJ-specific surface coil provides significantly clearer visualization of critical anatomical details within the ROIs, demonstrating the highest clinical application value and is recommended as the preferred choice.

Objective:To explore the mechanism by which moxibustion improves cold-induced blood stasis pattern(CIBSP)and to uncover the biological basis underlying the correlation between the Conception Vessel(CV),Governor Vessel(GV),Thoroughfare Vessel(TV),and the uterus by investigating the effects of mild moxibustion on the hypothalamic-pituitary-ovary axis(HPOA)in CIBSP model rats.Methods:Forty-eight female Sprague-Dawley rats were divided into a blank group,a model group,a CV group,a GV group,a TV group,and a non-meridian non-point(NMNP)group according to the random number table method,with 8 rats in each group.Except for rats in the blank group,the other rats were subjected to an ice water bath plus epinephrine to prepare CIBSP models.Each intervention group was given mild moxibustion on the first day of modeling.Qihai(CV6),Guanyuan(CV4),and Zhongji(CV3)were selected in the CV group;Huangshu(KI16),Dahe(KI12),and Henggu(KI11)were selected in the TV group;Xuanshu(GV5),Mingmen(GV4),and Yaoyangguan(GV3)were selected in the GV group;three NMNP spots were selected in the NMNP group.Mild moxibustion was administered for 20 min each time,once a day,for 14 consecutive days.The symptom scores of CIBSP and uterine electromyogram were compared among groups;morphological changes in reproductive organs were observed by hematoxylin-eosin staining;enzyme-linked immunosorbent assay was used to detect serum reproductive hormones and neurotransmitters.The mRNA and protein expression levels of estrogen receptor(ER),follicle-stimulating hormone receptor(FSHR),and luteinizing hormone receptor(LHR)were detected by real-time quantitative polymerase chain reaction,immunohistochemistry,or Western blotting assays.Results:Compared to the blank group,the model group showed a significantly increased CIBSP symptom score,an amplified in vivo uterine myoelectric value;decreased ovarian follicles,thinner endometrial epithelium,and disordered structure with the pathological examination,decreased serum levels of reproductive hormones,6-keto-prostaglandin F1α(6-keto-PGF1α),and β-endorphin(β-EP),increased thromboxane B2(TXB2),5-hydroxytryptamine(5-HT),and substance P(SP),and decreased mRNA and protein expression of ovarian ER,FSHR,and LHR(P<0.05 or P<0.01).Compared to the model and NMNP groups,each point-intervention group showed a decreased CIBSP symptom score and uterine myoelectric value;increased ovarian follicles,thickened endometrium,increased glands,up-regulated serum reproductive hormones,6-keto-PGF1α,and β-EP,down-regulated serum TXB2,5-HT,and SP and increased mRNA and protein expression of ovarian ER,FSHR,and LHR(P<0.05 or P<0.01).Conclusion:Moxibustion at points from the CV,GV,and TV("three branches from one source")can improve the reproductive neuroendocrine function of CIBSP rats,and this effect may be mediated through the regulation of the HPOA.These detections suggest that the biological basis of point-uterus correlation may be based on HPOA regulation.

Objective To explore the challenges faced by online appointment nurses during nasogastric intubation and to provide a reference for improvement of the quality and safety of the services provided by online appointment nursing.Methods A purposive sampling was employed to select 13 online appointment nurses from our hospital who had previously provided home nasogastric intubation services for patients.Semi-structured interviews were conducted with the online appointment nurses.The results acquired from the interviews were analysed using Colaizzi's method.Results Two themes were identified.Theme 1 covered the increased risks of nasogastric intubation due to the patients themselves and home environment,which included 4 sub-themes of difficulties in identification and response due to complex conditions of patient,high risk of a sudden asphyxia with poor resuscitation facility,psychological stress from unfamiliar home environment,and more challenges in risk identification due to limited conditions for performing home-based intubation procedures;Theme 2 covered the coping strategies of online-scheduled nurses,which included the improvement of knowledge and skills in emergency nursing to improve comfidence and judge ability of intubation,the strengthening of nurse-patient communication to build a trust and cooperation,the conduct of thorough assessment to ensure procedural safety,and the use of alternative tools and collaboration with family members.Conclusion Online appointment nurses face challenges and risks from both of the procedures and patients themselves during home based nasogastric intubation.Hospitals and relevant management should actively implement corresponding strategies,provide training and guidance for online appointment nurses,develop relevant regulations,and improve the management mechanisms of the internet platform to ensure the safety of home based nasogastric intubation for online appointment nurses and improve the quality of the"Internet Plus Nursing Services."

Objective To investigate the effects of two driving pressure-based methods to set positive end-expiratory pressure on pulmonary mechanics and oxygenation in patients undergoing laparoscopic and thoracoscopic esophagectomy.Methods Sixty patients undergoing laparoscopic and thoracoscopic esophagectomy were divided into two groups(n=30 each):incremental group(group Ⅰ)and decremental group(group D).PEEP titration was performed in both groups during thoracoscopy and laparoscopy.Respiratory mechanics parameters,hemodynamic parameters,and blood gas analysis were collected for analysis before preoxygenation(T0),10 minutes after intuba-tion(T1),20 minutes after PEEP application for one-lung ventilation(T2),20 minutes after PEEP application for two-lung ventilation(T3),before extubation(T4),and 30 minutes after extubation(Ts).The postoperative pulmonary complications within 3 days and 7 days after operation,hospitalization duration,and costs were recorded.Results Compared with group Ⅰ,patients in group D showed higher oxygenation index and pulmonary compliance during surgery(P＜0.05).In both groups,driving pressure decreased and compliance increased after PEEP titration(P＜0.05).Conclusion Both driving pressure-guided incremental and decremental titration of individualized PEEP improved intraoperative respiratory mechanics in patients undergoing laparoscopic and thoracoscopic esopha-gectomy,and decremental titration was more effective in improving intraoperative respiratory mechanics and oxygenation in patients during operation.

Objective:To introduce a surgical technique utilizing suture plate fixation for the treatment of elbow "terrible triad" injuries and to evaluate its clinical outcomes.Methods:A retrospective analysis was conducted on 11 patients (9 males and 2 females; mean age: 40.5±9.0 years, range: 26-53 years) with elbow terrible triad injuries who underwent treatment via a single lateral approach (Kaplan approach) combined with loop plate fixation at the Trauma Emergency Center of the Third Hospital of Hebei Medical University between January 2018 and July 2022. During surgery, coronoid process fractures were stabilized using loop plates. Among the radial head fractures, 7 cases were fixed with headless compression screws, while 4 cases underwent radial head prosthetic replacement. Additionally, the lateral collateral ligament complex and common extensor tendon origin were repaired using one suture anchor in all cases. Postoperative evaluations included elbow range of motion (ROM), encompassing flexion-extension and forearm pronation-supination. Radiographic assessments were performed to evaluate the alignment of the humeroradial and humeroulnar joints, degenerative changes, and heterotopic ossification. Functional outcomes were assessed using the Mayo elbow performance score (MEPS) during follow-up.Results:All surgeries were successfully completed without intraoperative complications such as neurovascular injuries. Primary wound healing was achieved in all cases, with no instances of infection or other early complications. The mean follow-up duration was 15.55±3.78 months (range, 12-24 months). At 2 weeks postoperatively, the mean flexion-extension ROM was 66.82°±6.69°, forearm rotation ROM was 132.55°±10.61°, and MEPS was 62.73±3.44 points. By 3 months postoperatively, these values improved to 99.27°±10.82°, 159.18°±9.18°, and 83.18±10.31 points, respectively. At the final follow-up, further improvements were observed, with flexion-extension ROM reaching 115.18°±4.29°, forearm rotation ROM 164.73°±8.71°, and MEPS 95.45±7.89 points. Statistical analysis revealed significant increases in flexion-extension ROM ( F=268.014, P<0.001), forearm rotation ROM ( F=67.621, P<0.001), and MEPS ( F= 63.100, P<0.001) over time. At the final follow-up, MEPS outcomes were rated as excellent in 9 cases and good in 2 cases, yielding an excellent-to-good rate of 100%. Radiographic evaluation confirmed satisfactory joint alignment and bony union in all patients, with no reports of significant pain, elbow instability, or neurological deficits. Mild heterotopic ossification was observed in 2 cases but did not impair daily activities or necessitate additional treatment. Conclusion:The suture plate technique significantly reduced operative time, minimized surgical trauma, and lowered the risks of elbow infection and stiffness, demonstrating favorable clinical outcomes.

Objective:To introduce a surgical technique utilizing suture plate fixation for the treatment of elbow "terrible triad" injuries and to evaluate its clinical outcomes.Methods:A retrospective analysis was conducted on 11 patients (9 males and 2 females; mean age: 40.5±9.0 years, range: 26-53 years) with elbow terrible triad injuries who underwent treatment via a single lateral approach (Kaplan approach) combined with loop plate fixation at the Trauma Emergency Center of the Third Hospital of Hebei Medical University between January 2018 and July 2022. During surgery, coronoid process fractures were stabilized using loop plates. Among the radial head fractures, 7 cases were fixed with headless compression screws, while 4 cases underwent radial head prosthetic replacement. Additionally, the lateral collateral ligament complex and common extensor tendon origin were repaired using one suture anchor in all cases. Postoperative evaluations included elbow range of motion (ROM), encompassing flexion-extension and forearm pronation-supination. Radiographic assessments were performed to evaluate the alignment of the humeroradial and humeroulnar joints, degenerative changes, and heterotopic ossification. Functional outcomes were assessed using the Mayo elbow performance score (MEPS) during follow-up.Results:All surgeries were successfully completed without intraoperative complications such as neurovascular injuries. Primary wound healing was achieved in all cases, with no instances of infection or other early complications. The mean follow-up duration was 15.55±3.78 months (range, 12-24 months). At 2 weeks postoperatively, the mean flexion-extension ROM was 66.82°±6.69°, forearm rotation ROM was 132.55°±10.61°, and MEPS was 62.73±3.44 points. By 3 months postoperatively, these values improved to 99.27°±10.82°, 159.18°±9.18°, and 83.18±10.31 points, respectively. At the final follow-up, further improvements were observed, with flexion-extension ROM reaching 115.18°±4.29°, forearm rotation ROM 164.73°±8.71°, and MEPS 95.45±7.89 points. Statistical analysis revealed significant increases in flexion-extension ROM ( F=268.014, P<0.001), forearm rotation ROM ( F=67.621, P<0.001), and MEPS ( F= 63.100, P<0.001) over time. At the final follow-up, MEPS outcomes were rated as excellent in 9 cases and good in 2 cases, yielding an excellent-to-good rate of 100%. Radiographic evaluation confirmed satisfactory joint alignment and bony union in all patients, with no reports of significant pain, elbow instability, or neurological deficits. Mild heterotopic ossification was observed in 2 cases but did not impair daily activities or necessitate additional treatment. Conclusion:The suture plate technique significantly reduced operative time, minimized surgical trauma, and lowered the risks of elbow infection and stiffness, demonstrating favorable clinical outcomes.