This paper summarizes Professor WANG Yaoxian's experience in treating diabetic kidney disease （DKD） from the perspective of spleen and stomach based on the "internal heat leading to concretions" theory. It is considered that internal heat leading to concretions constitutes the core pathogenesis of DKD， with the spleen and stomach serving as the source of internal heat； therefore， treatment should be based on regulating the spleen and stomach. In the early stage of DKD， dysfunction of the spleen and stomach leads to the initial generation of internal heat. Common syndrome patterns include gastrointestinal heat accumulation and constrained heat in the liver and stomach， for which modified Gegen Qinlian Decoction （葛根芩连汤） can be used to clear heat bind while modified Dachaihu Decoction （大柴胡汤） is used to clear stomach and soothe liver， respectively. In the middle stage of DKD， weakness of the spleen and stomach results in the initial formation of concretions and conglomerations. Common patterns include spleen deficiency with prevalence of dampness and deficiency of both the spleen and kidney. Treatment emphasizes strengthening the spleen and resolving dampness， raising yang and boosting the stomach with modified Shengyang Yiwei Decoction （升阳益胃汤）， or supplementing spleen and boosting kidney， dissipating bind and dispe-ring concretions with modified Shenqi Dihuang Decoction （参芪地黄汤）， respectively. In the late stage of DKD， it is characterized by spleen and stomach depletion， and rampant accumulation of turbidity and toxin， and the common syndrome patterns are damp-turbidity obstruction in the middle jiao （焦） and spleen-kidney yang deficiency. Treatment aims to remove turbidity and harmonize the stomach， or to warm the kidney and strengthen the spleen while elimina-ting turbidity， using modified Dahuang Gancao Decoction（大黄甘草汤） and Jupi Zhuru Decoction （橘皮竹茹汤） or modified Baoyuan Decoction （保元汤） and Lizhong Decoction （理中汤）， respectively. In clinical practice， appropriate formulas and medications are flexibly selected according to specific syndromes.

The Huangdi Neijing proposes the " using bitter herbs to nourish or purge" theory to guide clinical prescription and formulation of herbal remedies based on the physiological characteristics and functions of the five zang viscera, along with the properties and flavors of medicinal herbs. This study explored diabetic kidney disease pathogenesis and treatment based on the " using bitter herbs to nourish or purge" theory. Kidney dryness is a key pathological factor in diabetic kidney disease, and the disharmony of kidney dryness is an essential aspect of its pathogenesis. Strengthening is the primary therapeutic principle, and kidney dryness is a persistent factor throughout the occurrence and progression of diabetic kidney disease. In the early stage, the pathogenesis involves heat-consuming qi and injuring yin, leading to kidney dryness. In the middle stage, the pathogenesis manifests as qi deficiency and blood stasis in the collaterals, resulting in turbidity owing to kidney dryness. In the late stage, the pathogenesis involves yin and yang deficiency, with kidney dryness and disharmony. This study proposes the staging-based treatment based on the " need for firmness" characteristic of the kidney. The aim is to provide new insights for clinical diagnosis and treatment in traditional Chinese medicine by rationally using pungent, bitter, and salty medicinal herbs to nourish and moisturize the kidney. This approach seeks to promote precise syndrome differentiation and personalized treatment for different stages of diabetic kidney disease, thereby enhancing clinical efficacy.

Compulsory medical treatment is considered a necessary means to maintain public health. It faces many ethical dilemmas during its implementation， primarily concerning issues of autonomy. The discussion of autonomy issues is grounded in the concept， which faces difficulties in explanation and challenges in power structures. In addition to conceptual issues， autonomy also encounters various controversies in practice， including rational suicide， interpersonal relationships， bioethical principles， and other aspects. Faced with challenges， Bjorn Hofmann’s polyvalent concept clarifies the concept of autonomy， and the relational ethical approach provides innovative solutions to the practical issues of autonomy.

OBJECTIVE: To identify and validate novel biomarkers for the early diagnosis of sepsis-associated acute kidney injury (SA-AKI) and precise continuous renal replacement therapy (CRRT) using proteomics. METHODS: A prospective multicenter cohort study was conducted. Patients with sepsis admitted to five hospitals in Taizhou City of Zhejiang Province from April 2019 to December 2021 were continuously enrolled, based on the occurrence of acute kidney injury (AKI). Sepsis patients were divided into SA-AKI group and non-SA-AKI group, and healthy individuals who underwent physical examinations during the same period were used as control (NC group). Peripheral blood samples from participants were collected for protein mass spectrometry analysis. Differentially expressed proteins were identified, and functional enrichment analysis was conducted on these proteins. The levels of target proteins were detected by enzyme linked immunosorbent assay (ELISA), and the predictive value of target protein for SA-AKI were evaluated by receiver operator characteristic curve (ROC curve). Additionally, sepsis patients and healthy individuals were selected from one hospital to externally verify the expression level of the target protein and its predictive value for SA-AKI, as well as the accuracy of CRRT treatment. RESULTS: A total of 37 patients with sepsis (including 19 with AKI and 18 without AKI) and 31 healthy individuals were enrolled for proteomic analysis. Seven proteins were identified with significantly differential expression between the SA-AKI group and non-SA-AKI group: namely cystatin C (CST3), β ₂-microglobulin (β ₂M), insulin-like growth factor-binding protein 4 (IGFBP4), complement factor I (CFI), complement factor D (CFD), CD59, and glycoprotein prostaglandin D2 synthase (PTGDS). Functional enrichment analysis revealed that these proteins were involved in immune response, complement activation, coagulation cascade, and neutrophil degranulation. ELISA results demonstrated specific expression of each target protein in the SA-AKI group. Additionally, 65 patients with sepsis (38 with AKI and 27 without AKI) and 20 healthy individuals were selected for external validation of the 7 target proteins. ELISA results showed that there were statistically significant differences in the expression levels of CST3, β ₂M, IGFBP4, CFD, and CD59 between the SA-AKI group and non-SA-AKI group. ROC curve analysis indicated that the area under the curve (AUC) values of CST3, β ₂M, IGFBP4, CFD, and CD59 for predicting SA-AKI were 0.788, 0.723, 0.723, 0.795, and 0.836, respectively, all exceeding 0.7. Further analysis of patients who underwent CRRT or not revealed that IGFBP4 had a good predictive value, with an AUC of 0.84. CONCLUSIONS Based on proteomic analysis, CST3, β ₂M, IGFBP4, CFD, and CD59 may serve as potential biomarkers for the diagnosis of SA-AKI, among which IGFBP4 might be a potential biomarker for predicting the need for CRRT in SA-AKI patients. However, further clinical validation is required.
Humans ; Sepsis/complications* ; Acute Kidney Injury/blood* ; Proteomics ; Prospective Studies ; Biomarkers/blood* ; Male ; Female ; beta 2-Microglobulin/blood* ; Middle Aged ; Cystatin C/blood* ; Aged

This study investigates the pharmacokinetics and metabolic characteristics of three marine-derived piericidins as potential drug leads for kidney disease: piericidin A (PA) and its two glycosides (GPAs), glucopiericidin A (GPA) and 13-hydroxyglucopiericidin A (13-OH-GPA). The research aims to facilitate lead selection and optimization for developing a viable preclinical candidate. Rapid absorption of PA and GPAs in mice was observed, characterized by short half-lives and low bioavailability. Glycosides and hydroxyl groups significantly enhanced the absorption rate (13-OH-GPA > GPA > PA). PA and GPAs exhibited metabolic instability in liver microsomes due to Cytochrome P450 enzymes (CYPs) and uridine diphosphoglucuronosyl transferases (UGTs). Glucuronidation emerged as the primary metabolic pathway, with UGT1A7, UGT1A8, UGT1A9, and UGT1A10 demonstrating high elimination rates (30%-70%) for PA and GPAs. This rapid glucuronidation may contribute to the low bioavailability of GPAs. Despite its low bioavailability (2.69%), 13-OH-GPA showed higher kidney distribution (19.8%) compared to PA (10.0%) and GPA (7.3%), suggesting enhanced biological efficacy in kidney diseases. Modifying the C-13 hydroxyl group appears to be a promising approach to improve bioavailability. In conclusion, this study provides valuable metabolic insights for the development and optimization of marine-derived piericidins as potential drug leads for kidney disease.
Animals ; Male ; Mice ; Aquatic Organisms/chemistry* ; Biological Availability ; Cytochrome P-450 Enzyme System/metabolism* ; Glucuronosyltransferase/metabolism* ; Microsomes, Liver/metabolism* ; Molecular Structure ; Biological Products/pharmacokinetics* ; Pyridines/pharmacokinetics*

Objective:To evaluate the application value of artificial intelligence (AI) and robot of stereotactic surgery (ROSS)-assisted ultra-early thalamic hematoma drainage in elderly patients with minor thalamus and internal capsule hematoma (TICH) and severe hypoperfusion in the internal capsule area.Methods:A retrospective cross-sectional study was performed; 278 patients with TICH and severe hypoperfusion in the internal capsule area identified by AI medical imaging diagnostic system were enrolled from Department of Neurosurgery, Xingtai Central Hospital from January 2023 to August 2024. Among them, 134 patients (study group) received AI and ROSS-assisted ultra-early thalamic hematoma drainage, and 144 patients (control group) received drug treatment. Differences in baseline data and therapy efficiency between the two groups of patients were compared. Multivariate Logistic regression analysis was used to screen the independent influencing factors for prognosis in the study group 180 days after onset (good prognosis: modified Rankin scale scores of 0-3).Results:Compared with the control group, the study group had significantly higher Glasgow coma scale (GCS) score and regional cerebral blood flow (rCBF) in the internal capsule area 14 days after onset, and statistically higher therapy efficiency and good prognosis rate 180 days after onset ( P<0.05). In the study group, 84 patients had a good prognosis and 50 had a poor prognosis 180 days after onset; compared with the good prognosis group, the poor prognosis group had significantly higher proportion of patients with hyper-homocysteinemia history, lower GCS score on admission, larger volume of thalamic hematoma, higher proportions of patients with combined intraventricular hemorrhage and shunt-dependent hydrocephalus, and lower rCBF in the internal capsule area on admission ( P<0.05). Multivariate Logistic regression analysis showed that thalamic hematoma volume ( OR=2.527, 95% CI: 1.504-4.247, P<0.001), combined intraventricular hemorrhage ( OR=2.325, 95% CI: 1.460-3.703, P<0.001), shunt dependent hydrocephalus ( OR=2.371, 95% CI: 1.267-4.078, P=0.006), and rCBF in the internal capsule area on admission ( OR=0.672, 95% CI: 0.314-1.025, P<0.001) were independent risk factors for prognosis of patients in the study group. Conclusion:AI and ROSS-assisted ultra-early thalamic hematoma drainage is effective for elderly patients with minor TICH and severe hypoperfusion in the internal capsule area; patients with large thalamic hematoma volume, combined intraventricular hemorrhage, shunt-dependent hydrocephalus, and low rCBF in the internal capsule area on admission are prone to have a poor prognosis.

Objective To explore the value of low contrast dose and low flow rate one-stop craniocervical CT angiography(CT A)-cerebral CT perfusion(CTP)for detecting carotid atherosclerosis(CAS).Methods Totally 117 CAS patients were prospectively enrolled and divided into group A(n=19),B(n=52),C(n=46),and low contrast dose and low flow rate one-stop craniocervical CTA-brain CTP scanning,low contrast dose and low flow rate craniocervical CT A scanning,as well as conventional craniocervical CT A scanning were performed,respectively.Virtual monoenergetic images(VMI)of 40,50 and 60 keV were reconstructed in group A and B.The subjective and objective evaluations of image quality were compared among 3 groups.Results Subjective scores of image quality and diagnostic confidence of 40 and 50 keV VMI,and the diagnostic confidence of 60 keV VMI in group A and B were not significant different compared with those in group C(all P＞0.05).Signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of each segment of craniocervical blood vessels at 40 and 50 keV VMI in group A and B were all higher than those in group C(all P＜0.05).CNR of cavernous sinus segment of internal carotid artery(C5 segment),horizontal segment of middle cerebral artery(MCA)(A1 segment),lateral sulcus segment of MCA(M2 segment)and basilar artery(BA)segment in group A at 60 keV VMI were all higher than those in group C(all P＜0.05).SNR of C5 segment,A1 segment and BA segment,as well as CNR of BA segment of 60 keV VMI in group B were all higher than those in group C(all P＜0.05).Conclusion Low contrast dose and low flow rate one-stop craniocervical was feasible for detecting CAS.

Objective:To systematically compares the medial plantar venous flap (MPVF) and the lateral toe flap (LTF) reconstruction of digit-pulp defect, aiming to establish whether there exist significant differences between the 2 flaps in flap survival rate, two-point discrimination (TPD), score of Vancouver Scar Scale (VSS) and score of digit-pulp defect reconstruction evaluation.Methods:With a prospective cohort design, this study enrolled 36 patients who were admitted in Department of Hand Surgery, Longgang Eighth People's Hospital of Shenzhen for digit-pulp defects with bone or tendon exposure between January 2024 and September 2024. According to the random grouping method, participants were divided into 2 groups. The MPVF group comprised 18 patients (21 digits) of 13 males (15 digits) and 5 females (6 digits), aged 13-58 (mean 44±12) years. The MPVF group included 9 left and 12 right digits, with distribution as follows: 2 thumbs, 5 index fingers, 7 middle fingers, 5 ring fingers and 2 little fingers. The soft tissue defect area ranged from 2.0 cm × 1.0 cm to 9.2 cm × 3.3 cm (mean 6.69 cm 2± 6.69 cm 2). Flap dimensions ranged from 2.1 cm×1.1 cm to 9.5 cm×3.5 cm (mean 7.54 cm 2±7.22 cm 2). Donor sites were closed primarily or by full-thickness skin grafts harvested from the leg. The LTF group included 18 patients (21 digits) of 15 males (17 digits) and 3 females (4 digits), aged 22-62 (mean 41±12) years. The affected digits in LTF group comprised 12 left and 9 right digits, with a distribution of: 3 thumbs, 9 index fingers, 5 middle fingers, 2 ring fingers and 2 little fingers. The area of soft tissue defect ranges from 1.4 cm × 1.0 cm to 3.9 cm × 1.8 cm (mean 3.93 cm 2± 1.80 cm 2). Flap dimensions ranged from 1.5 cm×1.2 cm to 4.0 cm×1.9 cm (mean 4.52 cm 2±1.89 cm 2). Donor sites were closed primarily, or by full-thickness skin grafts harvested through extension of proximal wound extension or from calf for defect coverage. Patients were contacted for postoperative follow-up by telephone or WeChat to arrange a visit of outpatient clinic or a home visit by surgeon. Statistical analysis was conducted to compare the 2 groups regarding: gender, age and flap dimensions, flap survival rate at 2 weeks after surgery and TPD of flaps, VSS scores, and digit-pulp defect reconstruction evaluation scale scores at 4 months and 6 months postoperatively. P<0.05 indicates a statistically significant difference. Results:The comparative analysis revealed no statistically significant differences between 2 groups in baseline characteristics: gender distribution ( χ2=0.53, P=0.47), mean age ( t=0.75, P=0.46), flap dimensions ( t=1.86, P=0.08), confirming a demographic and surgical parameter equivalence in subsequent outcome comparisons ( P>0.05). All flaps survived at 2 weeks after surgery. All skin grafts at donor sites demonstrated complete viability with uneventful primary wound healing. At 4 months after surgey, the TPD in the MPVF group were 14.71 mm±1.90 mm and 7.81 mm±1.78 mm, respectively, compared to 14.48 mm±1.57 mm and 7.67 mm±1.39 mm in the LTF group at 6 months after surgery. The VSS scores were 1.67±1.11 and 1.29±0.72 for MPVF versus 1.86±1.15 and 1.38±0.81 for LTF at corresponding time points. The digit-pulp defects reconstruction evaluation scale scores showed 88.43±2.62 and 91.43±3.59 for MPVF versus 88.19±2.70 and 91.19±3.50 for LTF. Statistical analysis revealed no significant differences (all P>0.05) at 2 postoperative time points. Conclusion:The MPVF demonstrated non-inferior clinical efficacy to the LTF in reconstruction of digit-pulp defects, with comparable outcomes in flap survival rate at 2 weeks, and in TPD, VSS scores, digit-pulp defect reconstruction evaluation scale scores at 4 months and at 6 month after surgey.

Thoracolumbar spine fracture often leads to severe pain, functional impairments, and neurological deficits, for which open reduction and internal fixation can effectively restore the spinal structural stability. Open decompression and reduction with internal fixation can help relieve spinal cord compression and improve spinal function in cases of concomitant cord injury. Although spinal stability can be restored through surgery, patients often face chronic pain and functional impairments postoperatively. A postoperative rehabilitation program is critical in optimizing therapeutic outcomes, reducing complications, and minimizing the risk of secondary injuries. However, current rehabilitation methods, such as physical therapy, functional training, and pain management, are confronted with problems in clinical practice, including significant variation in efficacy, poor patient adherence, and prolonged rehabilitation period. There is an urgent need for a unified rehabilitation strategy to address these problems. To this end, the Spinal Trauma Group of the Orthopedic Physicians Branch of the Chinese Medical Association and the Spine Health Professional Committee of the Chinese Human Health Technology Promotion Association organized experts from relevant fields to formulate Evidence-based guidelines for rehabilitation treatment after internal fixation of thoracolumbar spine fracture in adults ( version 2025) by integrating evidences from clinical researches and advanced rehabilitation concepts at home and abroad. A total number of 14 recommendations concerning the rehabilitation treatment with multimodal analgesia, psychological intervention, deep vein thrombosis prevention, core muscle and extremity exercise, appropriate use of braces, early weight-bearing, device-aided rehabilitation exercise, neuroregulatory therapy, rehabilitation team were put forward, aiming to standardize the post-operative rehabilitation process following internal fixation, promote the functional recovery, and enhance patients′ quality of life.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.