Based on the theory of "cold qi generates turbidity" described in the Inner Canon of Yellow Emperor （《黄帝内经》）， together with the physiological characteristics of children， who are considered to have an inherent insufficiency of the lung， spleen， and kidney， and the clinical features of recurrent refractory nephrotic syndrome （RNS）， this article proposes that the pathogenesis of RNS in children is characterized by yang deficiency with internal cold， turbidity arising from cold， latent turbidity transforming into toxin， activation by newly contracted pathogens， and turbid toxins damaging the collaterals. The core pathogenesis is identified as yang deficiency， turbidity coagulation， and collateral damage. Accordingly， the general treatment principle is warming yang and eliminating turbidity， with coordination of three methods including warming yang to strengthen the body's foundation， promoting yang to relieve constraint， and raising yang while replenishing qi. Zhenwu Decoction （真武汤） is employed as the basic prescription with modification according to syndrome differentiation， to achieve an effect eliminating turbidity and arresting leakage， restoring kidney function by unblocking the collaterals， and consolidating recovery to prevent relapse.

Objective:To compare surgical-related indicators between non-inflated subclavian endoscopic surgery and axillary and traditional open surgery for the treatment of right lobe thyroid cancer,as well as their effects on postoperative anterior cervical function and cosmetic outcomes.Methods:This retrospective cohort study analyzed 151 cases of thyroid cancer patients who underwent surgical treatment at the Department of Thyroid Surgery,Zhengzhou Central Hospital Affiliated to Zhengzhou University from June 2024 to October 2024. Based on the surgical approach,patients were divided into three groups:56 cases of traditional open surgery group, 44 cases of non-inflated axillary approach group,and 51 cases of non-inflated subclavian approach group. Comparative indicators included surgical time, parathyroid autotransplantation rate,complete exposure rate of central area, number of lymph node dissections, number of positive lymph nodes, anterior cervical function, and satisfaction with incision beauty. One-way analysis of variance,non-parametric test,Kruskal-Wallis test,Pearson χ2 test and Fisher′s exact probability method were used to compare the results of the three groups and subsequent pairwise comparisons,respectively. Results:All laparoscopic surgeries were successfully completed without conversion to open surgery. (1) Surgical time:the traditional open surgery group had the shortest operative time ( M(IQR))(71.5(16.0)minutes), significantly shorter than both endoscopic groups (both P<0.01); among the endoscopic approaches, the non-inflated subclavian approach group (97.0(10.0)minutes) had a significantly shorter operative time than the non-inflated axillary approach group (115.0(11.0)minutes)( P<0.01). (2) Parathyroid autotransplantation rate:the rates were 53.6%(30/56) in the traditional group, 70.5%(31/44) in the non-inflated axillary approach group, and 66.7%(34/51) in the non-inflated subclavian approach group, with no statistically significant differences ( P>0.05). (3) Complete exposure rate of the central area:the exposure rate was 100%(56/56) in the traditional open surgery group, 86.4%(38/44) in the non-inflated axillary approach group, and 96.1%(49/51) in the non-inflated subclavian approach group. A significant difference was observed between the traditional open surgery group and the non-inflated axillary approach group ( χ2=8.124, P<0.01), but not observed between other groups. (4) Number of lymph node dissection:no significant difference was found among the three groups (8(6)(range:2 to 17) in the traditional open surgery group,7(3)(range:2 to 16) in the non-inflated axillary approach group,7(4)(range:2 to 16) in the non-inflated subclavian approach group)( P=0.078).(5) Number of positive lymph nodes:no significant differences were observed among the three groups( P=0.923). (6) Postoperative anterior cervical function:① Visual analogue scale: there was no significant difference between the non-insufflation transaxillary approach group and the non-insufflation subclavian approach group at 3 days and 1 month postoperatively ( P>0.017). However, the two groups had significantly lower scores than the traditional open group (both P<0.01). ② Neck disability index:at 3 days post-surgery, there were significantly lower in the axillary and subclavian groups compared to the traditional open group ( P<0.01), with no significant difference between the two endoscopic groups( P>0.017); at 1 month postoperatively, the traditional open surgery group, gasless axillary approach group, and gasless subclavian approach group, with statistically significant differences between each group (both P<0.01). ③ Swallowing disorder index: no significant differences were observed at 3 days post-surgery( P>0.05); however, at 1 month post-surgery, the endoscopic groups showed significantly lower scores compared to the traditional open group(both P<0.01).(7) Satisfaction with incision beauty:significant differences were found among the three groups in terms of vancouver scar scores, patient scar assessment scores, and observer scar assessment scores(all P<0.01). Conclusions:Compared to the non-inflated axillary endoscopic thyroidectomy, the non-inflated subclavian approach offers a technically simpler procedure, better exposure of the central lymph node dissection area, and superior protection of anterior cervical function, although it results in less favorable cosmetic outcomes. Under strict preoperative evaluation and appropriate indications,both non-inflated subclavian and axillary approaches can achieve outcomes comparable to traditional open surgery for cN0 thyroid cancer,demonstrating good clinical application value.

Objective To investigate the reliability and validity of the Chinese version of speech,spatial and qualities of hearing scale(SSQ).Methods The SSQ was translated into Chinese using the translation and back-translation method.Self-assessment with the scale was conducted for 50 adults with normal hearing and 28 adults with hearing impairment who had bilateral hearing aids fitted.Two weeks after the initial assessment,10 individuals with bilateral hearing aids fitted were randomly selected to be re-assessed using the same scale.The Cronbach's αcoefficients of the scores of each dimension and the total score of the scale was used to evaluate the internal consis-tency of the scale,and the correlation coefficient of the results of the two assessments was used to test the test-retest reliability of the scale.The expert evaluation method was adopted to test the content validity of the scale,and the correlation coefficients of the scores of each dimension and the total score were used to test the construct validity of the scale.The score differences of each item and each dimension between adults with normal hearing and adults with bilateral hearing aids fitted were compared to test the discriminant validity.Results Valid responses were obtained from all 78 participants.① The test-retest reliability coefficients of the total scale and the three dimensions were all greater than 0.750(P＜0.01),indicating excellent test-retest reliability.The Cronbach's α coefficients of the total scale and the three dimensions were all greater than 0.700,suggesting excellent internal consistency.② All four ex-perts indicated that the content of each item in the three dimensions of the SSQ scale was in line with the measure-ment requirements,showing excellent content validity.The correlation coefficients between the scores of the three dimensions and the total scale were between 0.809 and 0.890,indicating a high degree of correlation.There were statistically significant differences in the scores of the three dimensions between the normal group and the group with bilateral hearing aids fitted(P＜0.05),and the overall discriminant validity of the scale was excellent.Conclusion The Chinese version of the SSQ has good reliability and validity,and can be used as a subjective auditory assessment in clinical practice.

Objective:To compare surgical-related indicators between non-inflated subclavian endoscopic surgery and axillary and traditional open surgery for the treatment of right lobe thyroid cancer,as well as their effects on postoperative anterior cervical function and cosmetic outcomes.Methods:This retrospective cohort study analyzed 151 cases of thyroid cancer patients who underwent surgical treatment at the Department of Thyroid Surgery,Zhengzhou Central Hospital Affiliated to Zhengzhou University from June 2024 to October 2024. Based on the surgical approach,patients were divided into three groups:56 cases of traditional open surgery group, 44 cases of non-inflated axillary approach group,and 51 cases of non-inflated subclavian approach group. Comparative indicators included surgical time, parathyroid autotransplantation rate,complete exposure rate of central area, number of lymph node dissections, number of positive lymph nodes, anterior cervical function, and satisfaction with incision beauty. One-way analysis of variance,non-parametric test,Kruskal-Wallis test,Pearson χ2 test and Fisher′s exact probability method were used to compare the results of the three groups and subsequent pairwise comparisons,respectively. Results:All laparoscopic surgeries were successfully completed without conversion to open surgery. (1) Surgical time:the traditional open surgery group had the shortest operative time ( M(IQR))(71.5(16.0)minutes), significantly shorter than both endoscopic groups (both P<0.01); among the endoscopic approaches, the non-inflated subclavian approach group (97.0(10.0)minutes) had a significantly shorter operative time than the non-inflated axillary approach group (115.0(11.0)minutes)( P<0.01). (2) Parathyroid autotransplantation rate:the rates were 53.6%(30/56) in the traditional group, 70.5%(31/44) in the non-inflated axillary approach group, and 66.7%(34/51) in the non-inflated subclavian approach group, with no statistically significant differences ( P>0.05). (3) Complete exposure rate of the central area:the exposure rate was 100%(56/56) in the traditional open surgery group, 86.4%(38/44) in the non-inflated axillary approach group, and 96.1%(49/51) in the non-inflated subclavian approach group. A significant difference was observed between the traditional open surgery group and the non-inflated axillary approach group ( χ2=8.124, P<0.01), but not observed between other groups. (4) Number of lymph node dissection:no significant difference was found among the three groups (8(6)(range:2 to 17) in the traditional open surgery group,7(3)(range:2 to 16) in the non-inflated axillary approach group,7(4)(range:2 to 16) in the non-inflated subclavian approach group)( P=0.078).(5) Number of positive lymph nodes:no significant differences were observed among the three groups( P=0.923). (6) Postoperative anterior cervical function:① Visual analogue scale: there was no significant difference between the non-insufflation transaxillary approach group and the non-insufflation subclavian approach group at 3 days and 1 month postoperatively ( P>0.017). However, the two groups had significantly lower scores than the traditional open group (both P<0.01). ② Neck disability index:at 3 days post-surgery, there were significantly lower in the axillary and subclavian groups compared to the traditional open group ( P<0.01), with no significant difference between the two endoscopic groups( P>0.017); at 1 month postoperatively, the traditional open surgery group, gasless axillary approach group, and gasless subclavian approach group, with statistically significant differences between each group (both P<0.01). ③ Swallowing disorder index: no significant differences were observed at 3 days post-surgery( P>0.05); however, at 1 month post-surgery, the endoscopic groups showed significantly lower scores compared to the traditional open group(both P<0.01).(7) Satisfaction with incision beauty:significant differences were found among the three groups in terms of vancouver scar scores, patient scar assessment scores, and observer scar assessment scores(all P<0.01). Conclusions:Compared to the non-inflated axillary endoscopic thyroidectomy, the non-inflated subclavian approach offers a technically simpler procedure, better exposure of the central lymph node dissection area, and superior protection of anterior cervical function, although it results in less favorable cosmetic outcomes. Under strict preoperative evaluation and appropriate indications,both non-inflated subclavian and axillary approaches can achieve outcomes comparable to traditional open surgery for cN0 thyroid cancer,demonstrating good clinical application value.

Objective To investigate the reliability and validity of the Chinese version of speech,spatial and qualities of hearing scale(SSQ).Methods The SSQ was translated into Chinese using the translation and back-translation method.Self-assessment with the scale was conducted for 50 adults with normal hearing and 28 adults with hearing impairment who had bilateral hearing aids fitted.Two weeks after the initial assessment,10 individuals with bilateral hearing aids fitted were randomly selected to be re-assessed using the same scale.The Cronbach's αcoefficients of the scores of each dimension and the total score of the scale was used to evaluate the internal consis-tency of the scale,and the correlation coefficient of the results of the two assessments was used to test the test-retest reliability of the scale.The expert evaluation method was adopted to test the content validity of the scale,and the correlation coefficients of the scores of each dimension and the total score were used to test the construct validity of the scale.The score differences of each item and each dimension between adults with normal hearing and adults with bilateral hearing aids fitted were compared to test the discriminant validity.Results Valid responses were obtained from all 78 participants.① The test-retest reliability coefficients of the total scale and the three dimensions were all greater than 0.750(P＜0.01),indicating excellent test-retest reliability.The Cronbach's α coefficients of the total scale and the three dimensions were all greater than 0.700,suggesting excellent internal consistency.② All four ex-perts indicated that the content of each item in the three dimensions of the SSQ scale was in line with the measure-ment requirements,showing excellent content validity.The correlation coefficients between the scores of the three dimensions and the total scale were between 0.809 and 0.890,indicating a high degree of correlation.There were statistically significant differences in the scores of the three dimensions between the normal group and the group with bilateral hearing aids fitted(P＜0.05),and the overall discriminant validity of the scale was excellent.Conclusion The Chinese version of the SSQ has good reliability and validity,and can be used as a subjective auditory assessment in clinical practice.

Ureterosciatic hernia is a rare type of pelvic floor herniation with no typical symptoms. The resulting ureteral obstruction may lead to hydronephrosis and complications such as urinary tract infection and urosepsis.Fewer than 40 ureterosciatic hernia cases have been reported all over the world. Active surveillance, manual reduction, ureteral stenting and surgical repair are common treatment options. Among them, the safety and effectiveness of laparoscopic herniorrhaphy have been recognized. This article review the advances in the diagnosis and treatment of ureterosciatic hernia.

Objective To investigate the effect of adjuvant therapy of Shenfu Injection on NOD-like receptor protein 3 (NLRP3)/cysteine-aspartic acid-specific protease 1 (Caspase-1) mediated pyroptosis signaling pathway and inflammatory factor levels in rats with acute myocardial infarction (AMI). Methods A total of 40 rats were randomly divided into sham operation group, model group, betaloc group (0.9 mg/kg), and combination group (0.9 mg/kg betaloc combined with 6 mL/kg Shenfu Injection), with 10 rats in each group. The rats were treated by gavage continuously for 3 weeks. The levels of serum troponin I (cTnI), creatine kinase-MB (CK-MB), interleukin (IL)-6, IL-1β, and tumor necrosis factor-α (TNF-α) in rats were detected before modeling, after modeling, and at 3 weeks of treatment. Echocardiographic parameters such as left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter(LVESD), left ventricular end-diastolic diameter (LVEDD), and myocardial infarction area were compared among groups after modeling and at 3 weeks of treatment. Real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) and Western blot were used to detect the mRNA and protein expression levels of NLRP3 and Caspase-1 in the myocardium. Results Compared with the sham operation group, the levels of cTnI, CK-MB, IL-6, IL-1β, TNF-α, myocardial infarction area, and the expressions of NLRP3 mRNA and Caspase-1 mRNA in the model group were significantly increased after modeling and at 3 weeks of treatment (P < 0.05); compared with the model group, the levels of cTnI, CK-MB, IL-6, IL-1β, TNF-α, myocardial infarction area, and the expressions of NLRP3 mRNA and Caspase-1 mRNA in the betaloc group and the combination group were significantly decreased at 3 weeks of treatment, and the above indicators in the combination group were significantly lower than those in the betaloc group (P < 0.05). Conclusion Adjuvant therapy of Shenfu Injection for AMI can further alleviate myocardial cell injury, shorten infarction size, and inhibit inflammatory response and pyroptosis activity.

Objective To systematically evaluate the risk of major bleeding and major adverse cardiac events(MACE)in patients with acute coronary syndrome(ACS)after combined use of novel oral anticoagulants(NOAC)and antiplatelet therapy. Methods Randomized controlled trials( RCTs)about NOAC treatment for ACS patients with basic antiplatelet therapy in related databases(up to July 2018)were searched. The outcome indicators included major bleeding events ( safety indicators ) and MACE ( effectiveness indicators). Quality of methodology was evaluated using bias risk assessment tool of Cochrane collaboration networks. Meta﹣analysis was performed using RevMan 5. 3 software. Results A total of 6 RCTs were entered,including comparative studies of single antiplatelet therapy(SAPT)or dual antiplatelet therapy(DAPT)combined with NOAC and combined with placebo or warfarin,involving 20 070 patients. Drugs used in the trial group included apixaban,rivaroxaban,and dabigatran etexilate. The quality evaluation showed that 4 of the 6 RCTs were with low risks of bias and 2 with high risks of bias. The meta﹣ analysis showed that the risk of clinical major bleeding events in patients in the SAPT+NOAC group was significantly higher than that in the SAPT+placebo group[3. 14%(44/1 402)vs. 1. 07%(19/1 770), RR＝3. 47,95% CI:2. 01﹣5. 97,P﹤0. 001]. The incidence of clinical major bleeding events in patients in the DAPT+NOAC group was significantly higher than that in the DAPT+placebo group[5. 72%(387/6 761)vs. 2. 79%(251/8 984),RR＝2. 59,95% CI:1. 73﹣3. 86,P﹤0. 001],but significantly lower than that in the DAPT+warfarin group[17. 22%(422/2 450)vs. 25. 68%(627/2 442),RR＝0. 68, 95% CI:0. 56﹣0. 82,P﹤0. 001]. The risk of MACE in patients in the SAPT+NOAC group was significantly lower than that in the SAPT+placebo group[8. 61%(121/1 405)vs. 12. 20%(217/1 779),OR＝0. 69, 95% CI:0. 55﹣0. 88,P ＝0. 003];there were no significant differences in the risks of MACE between patients in the DAPT+NOAC group and the DAPT+placebo group or DAPT+warfarin group(P﹥0. 05 for both). Conclusions Combination of anticoagulants and SAPT or DAPT in ACS patients may all increase the risk of clinical major bleeding,but combination of SAPT and NOAC may reduce the risk of MACE,and should be used after weighing. For patients who must be treated with triple antithrombotic therapy,DAPT combined with NOAC can be chosen and warfarin should be avoided.

Objective To systematically evaluate the risk of major bleeding and major adverse cardiac events(MACE)in patients with acute coronary syndrome(ACS)after combined use of novel oral anticoagulants(NOAC)and antiplatelet therapy. Methods Randomized controlled trials( RCTs)about NOAC treatment for ACS patients with basic antiplatelet therapy in related databases(up to July 2018)were searched. The outcome indicators included major bleeding events ( safety indicators ) and MACE ( effectiveness indicators). Quality of methodology was evaluated using bias risk assessment tool of Cochrane collaboration networks. Meta﹣analysis was performed using RevMan 5. 3 software. Results A total of 6 RCTs were entered,including comparative studies of single antiplatelet therapy(SAPT)or dual antiplatelet therapy(DAPT)combined with NOAC and combined with placebo or warfarin,involving 20 070 patients. Drugs used in the trial group included apixaban,rivaroxaban,and dabigatran etexilate. The quality evaluation showed that 4 of the 6 RCTs were with low risks of bias and 2 with high risks of bias. The meta﹣ analysis showed that the risk of clinical major bleeding events in patients in the SAPT+NOAC group was significantly higher than that in the SAPT+placebo group[3. 14%(44/1 402)vs. 1. 07%(19/1 770), RR＝3. 47,95% CI:2. 01﹣5. 97,P﹤0. 001]. The incidence of clinical major bleeding events in patients in the DAPT+NOAC group was significantly higher than that in the DAPT+placebo group[5. 72%(387/6 761)vs. 2. 79%(251/8 984),RR＝2. 59,95% CI:1. 73﹣3. 86,P﹤0. 001],but significantly lower than that in the DAPT+warfarin group[17. 22%(422/2 450)vs. 25. 68%(627/2 442),RR＝0. 68, 95% CI:0. 56﹣0. 82,P﹤0. 001]. The risk of MACE in patients in the SAPT+NOAC group was significantly lower than that in the SAPT+placebo group[8. 61%(121/1 405)vs. 12. 20%(217/1 779),OR＝0. 69, 95% CI:0. 55﹣0. 88,P ＝0. 003];there were no significant differences in the risks of MACE between patients in the DAPT+NOAC group and the DAPT+placebo group or DAPT+warfarin group(P﹥0. 05 for both). Conclusions Combination of anticoagulants and SAPT or DAPT in ACS patients may all increase the risk of clinical major bleeding,but combination of SAPT and NOAC may reduce the risk of MACE,and should be used after weighing. For patients who must be treated with triple antithrombotic therapy,DAPT combined with NOAC can be chosen and warfarin should be avoided.

With the completion of large-scale genome sequencing of human beings and other organisms, understanding the expression of control elements on the genome has become an important research task in the post-genome era. The enhancer trapping technology is an effective method for identifying enhancer elements in the genome and understanding its mechanism for gene expression regulation. In this study, we selected the stable enhancer trapping line TK4 (head and trunk specific GFP expression), which is generated with the mediation of Tol2 transposon system, and analyzed the trapped enhancers with the techniques of Splinkerette PCR (sp-PCR), in situ hybridization and comparative genomics. We crossed F1 individuals of TK4 line with wild-type zebrafish, collected fertilized eggs, and then detected the expression pattern of green fluorescent protein reporter gene by fluorescence microscopy at six different developmental stages, 6 hpf (hour post fertilization), 24 hpf, 48 hpf, 3 dpf (day post fertilization), 4 dpf and 5 dpf . The zebrafish genome flank sequence near the insertion site of Tol2 transposon was cloned by sp-PCR, and the results revealed that the insertion located at the position 27749253 of chromosome 23, and the transgene inserted reversely inside the intron 1 of rps26 gene. Within the 100 kb region of the insertion site, totally, seven genes including arf3a, wnt10b, wnt1, rps26, IKZF4, dnajc22 and lmbr1l were identified. Comparative genomic analysis by VISTA program revealed that there were two potential enhancer elements in the downstream of rps26 gene, which were conserved non-coding sequence (CNS) 1 and CNS2. The results of in situ hybridization showed that two transcripts of rps26 gene were maternal expression, the expression of rps26-201 in zygote was earlier than that of rps26-001, and the GFP signal of TK4 line zebrafish was not detectable before 6hpf, the expression patterns of rps26 and GFP at the late stages display similarity, and also represent differences, which suggested that the expression of rps26 and GFP may be controlled by the same enhancer, and also by the different enhancer, and two potential enhancers (CNS1 and CNS2) may play a differential regulation roles on the spatial and temporal expression of nearby genes (including rps26). In this study, we successfully obtained two potential enhancers near rps26 gene for the first time, which laid a foundation for further study of the regulation mechanism between these two enhancers and nearby genes in the genome, and the combination technique used in this study also provides a reference for enhancer analysis.