ObjectiveTo observe the effect of Qishao capsules on renal injury in db/db mice with diabetic kidney disease （DKD），and explore its mechanism of protecting the kidney by inhibiting podocyte apoptosis. Methodsdb/m mice （7 mice） were used as the normal group，and db/db mice （35 mice） were randomly divided into a model group，a dapagliflozin group （0.001 g·kg^-1·d^-1），and low-，medium-，and high-dose groups of Qishao capsules （0.341 3，0.682 5，and 1.365 g·kg^-1·d^-1，respectively）. Drug intervention lasted for 8 consecutive weeks. After sampling，the serum renal function indicators ［creatinine（SCr），and urea nitrogen（BUN）］，fasting blood glucose （FBG），24 h urinary protein quantification （24 h-UTP）， and other indicators of the mice were measured. The pathological tissue morphology of the kidney was observed by periodic acid-silver methenamine （PASM） and Masson's trichrome （Masson） staining. Immunohistochemical detection of cysteine-dependent aspartate-specific protease （Caspase）-3 and B-cell lymphoma 2 （Bcl-2） was performed. Western blot was used to detect the protein expression of Caspase-8，Caspase-7，Caspase-3， and other molecules. Terminal deoxynucleotidyl transferase dUTP nick End labeling （TUNEL） staining was used to observe apoptosis in renal tissue. Immunofluorescence staining of Wilms tumor suppressor gene-1 （WT-1） was used to observe podocyte injury. Real-time polymerase chain reaction （Real-time PCR） was employed to detect Caspase-8 and Caspase-3 mRNA expression in the kidneys of experimental mice. Data analysis was conducted using statistical software GraphPad Prism 10. ResultsCompared with the normal group，the model group showed significantly increased 24 h-UTP，SCr，BUN，and FBG （P<0.01）. Additionally， PASM staining of renal tissue showed increased glycogen deposition，glomerular hypertrophy，and thickening of the basement membrane. Masson staining showed collagen fiber proliferation in renal tissue. Transmission electron microscopy showed thickening of the renal tissue basement membrane and fusion or loss of foot processes in the model group. The immunohistochemical results showed that Caspase-3 in the kidneys of the mice in the model group significantly increased （P<0.01），while the Bcl-2 protein expression level decreased significantly （P<0.01）. The number of TUNEL positive cells in renal tissue significantly increased （P<0.01）. The positive expression of WT-1 in podocytes was significantly reduced （P<0.01）. Western blot analysis showed significant upregulation of Caspase-8，Caspase-7，and Caspase-3 protein expression in renal tissue （P<0.01）. The mRNA expression levels of Caspase-8 and Caspase-3 in the kidneys increased significantly （P<0.01）. Compared with the model group，the Qishao capsules groups can significantly reduce the levels of 24 h-UTP，SCr，BUN，and FBG （P<0.01）. The pathological damage of renal tissue and podocyte injury were improved to some extent. Immunohistochemistry in the kidney showed a significant decrease in Caspase-3 （P<0.01） and a significant increase in Bcl-2 protein expression level （P<0.01）. Additionally， there were a significant decrease in the number of TUNEL positive cells in renal tissue （P<0.01），a significant increase in WT-1 positive expression in podocytes （P<0.01），marked downregulation of Caspase-8，Caspase-7，and Caspase-3 protein expression in renal tissue （P<0.05，P<0.01），and a significant decrease in Caspase-8 and Caspase-3 mRNA expression levels （P<0.01）. ConclusionQishao capsules can inhibit podocyte apoptosis by regulating the expression of Caspase-8，Caspase-7， and Caspase-3，thereby improving the diabetic renal injury in db/db mice.

ObjectiveTo investigate the feasibility， safety， and efficacy of surgery-assisted transjugular intrahepatic portosystemic shunt （SA-TIPS） in the treatment of portal hypertension comorbid with complex portal vein thrombosis， including cavernous transformation of the portal vein （CTPV）. MethodsAn analysis was performed for the data of 36 patients with portal hypertension and complex portal vein thrombosis who underwent SA-TIPS in Beijing Shijitan Hospital， Capital Medical University， from November 2023 to January 2025， including general status， technical data of the surgical process （surgical success rate， puncture times， time of operation， the number of stents used， and the length of shunt）， perioperative complications， and surgical recovery. The change in portal pressure gradient （PPG） after shunt was compared， and the rate of reaching the standard for PPG reduction was calculated， as well as stent patency rate within 1 week after surgery. The paired samples t-test was used for comparison of continuous data between two groups. ResultsAmong the 36 patients， 34 （94.4%） underwent SA-TIPS successfully. The incidence rate of perioperative complications was 16.7% （6/36）， including 3 cases of thoraco-abdominal hemorrhage， 2 cases of intraoperative arrhythmia， and 1 case of incision infection. There was a significant reduction in PPG after SA-TIPS （t=19.85， P<0.01）， and the patients achieving a ≥50% reduction in PPG accounted for 76.5% （26/34）. Imaging reexamination within 1 week showed a shunt patency rate of 100%. ConclusionSA-TIPS has a high technical success rate， a favorable safety profile， and good efficacy in the treatment of portal hypertension comorbid with complex portal vein thrombosis （including CTPV）， and therefore， it holds promise for clinical application.

The clinical diagnosis and treatment of urinary tract infection has long faced the challenges of insufficient standardization of diagnosis and treatment pathways,irrational use of antimicrobial drugs and high recurrence rate.How to optimize the hierarchical diagnosis and treatment pathway of urinary tract infection,standardize the use of antimicrobial drugs,and reduce the recurrence rate have always been the focus of clinical attention.There is significant heterogeneity in the existing diagnostic criteria for urinary tract infection,which seriously affects the comparability and evidence integration of clinical and research studies.In order to solve the above problems,a consensus on global multidisciplinary diagnostic criteria for urinary tract infection has been formed by international multidisciplinary experts after three rounds of Delphi method.Breaking through the traditional classification framework,the consensus innovatively established a four-dimensional quantitative scoring system including local symptoms and signs,systemic inflammatory response,quantitative analysis of pyuria and urine culture results,and established a hierarchical standard for stepwise urinary tract diagnosis according to the scoring threshold.Based on the key citations related to the consensus,this paper interprets in detail the basis for the selection of core indicators and the establishment of thresholds for the diagnosis of urinary tract infection in the consensus,and focuses on the key issues and implementation paths of the consensus in localization practice.This consensus provides a unified standard for standardizing the clinical diagnosis and treatment of urinary tract infection,improving the homogeneity of clinical research through standardized diagnostic processes,and promoting the standardization of UTI drug research and development and the rational use of antibiotics and precision.

Objective:To explore the mechanism of astaxanthin improving renal damage in diabetic mice by regulating the PI3K/Akt signaling pathway.Methods:C57BL/6J adult male mice (8 weeks, 22-24 g) were provided by Nanjing Junke Biological Co.,Ltd. The mice were divided into control group (mice raised under normal conditions and given phosphate buffered saline injection, n=15), model group (DN mouse model established as mentioned above, n=15), and astaxanthin group (on the basis of model mice,10 mg/kg body weight dose of astaxanthin was given, n=15). The serum urea nitrogen, serum creatinine and 24 h urine protein levels of mice were detected by biochemical kits. The levels of serum inflammatory factors in mice were detected by ELISA. Mesangial matrix expansion and fibrosis in mice were observed by renal histological analysis. Glomerular podocytes were analyzed by TUNEL detection and immunohistochemical staining. Nephrin and CD2AP expression were analyzed by Western blot.The expression of PI3K/Akt signaling pathway was analyzed by Western blot. Results:The levels of serum urea nitrogen, serum creatinine and 24h urinary protein in model group were higher than those in control group ( P<0.05), but the levels of serum urea nitrogen, serum creatinine and 24h urinary protein in astaxanthin group were lower than those in model group ( P<0.05). The serum levels of TNF-α,1L-1β and 1L-6 in model group were higher than those in control group ( P<0.05), while the levels of TNF-α,1L-1β and 1L-6 in astaxanthin group were lower than those in model group ( P<0.05). Compared with the control group, the model group mainly showed different degrees of pancreatic islet lesions and vacuolar degeneration under light microscope ( P<0.05). HE staining showed glomerular sclerosis and dilatation, capillary lumen shrinkage, diffuse mesangial matrix dilatation, and peripheral capillary thickening and hardening ( P<0.05). PAS staining showed an increase in PAS-positive substances (purple plaques) in the model group of mice ( P<0.05), indicating glycogen accumulation in diabetic glomeruli. Masson staining showed accumulation of type Ⅳ collagen and increased fibrosis (blue stained area) in the kidney of the model group ( P<0.05). Astaxanthin treatment can significantly improve these diabetic induced histopathological changes ( P<0.05). Compared with control group,mesangial matrix expansion and fibrosis were increased in model group ( P<0.05), and decreased in astaxanthin group ( P<0.05). Compared with the control group, the apoptosis rate of podocyte in model group was increased ( P<0.05) ,while that in astaxanthin group was decreased ( P<0.05). The number of WT-1 positive podocytes in model group was lower than that in model group ( P<0.05), and the number of WT-1 positive podocytes in astaxanthin group was higher than that in model group ( P<0.05). Compared with the control group, Nephrin and CD2AP proteins in the model group were decreased ( P<0.05), and the expressions of Nephrin and CD2AP proteins in astaxanthin group were increased ( P<0.05). The protein expressions of p85, p-Akt Ser473 and P-mtor Ser2448 in model group were increased compared with those in control group ( P<0.05), while the protein expressions of p85, P-Akt Ser473 and P-mtor Ser2448 in astaxanthin group were decreased compared with those in model group ( P<0.05) . Conclusion:Astaxanthin significantly improves kidney damage in diabetic mice by regulating the PI3K/Akt signaling pathway,which manifests as inhibiting renal cell lesions and reducing inflammation.

Objective This study aims to investigate controversial cases of forensic clinical re-identification of fractures,exploring the characteristics,causes,and countermeasures related to identification errors in primary bone injuries,complications,and subsequent changes.The goal is to provide identification strategies for similar cases regarding the collection of identification materials,timing,and examination method selection,ultimately establishing a paradigm for such identifications.Methods A total of 103 cases of clinical re-identification of fractures accepted by the West China Forensic Identification Center from 2020 to 2024 were collected,and the data from initial identifications and re-identifications were retrospectively analyzed.Results Male cases accounted for 69.90%of the re-identifications,with disability grade(67.96%)and injury degree(30.10%)being the primary concerns.Individual requests represented a high proportion(92.86%)in the initial assessment of disability levels,while unit or joint requests dominated the re-assessment(92.86%).The agreement rates for disability grade and injury degree were 55.26%and 59.38%,respectively.The reassessment of disability grades primarily involved fractures of limb long bones,spine,and ribs,with 75.53%of opinions resulting in downgraded disability levels.Rib,orbital,and nasal bone fractures were the main focus in injury degree reassessments,with 84.62%of opinions indicating aggravated injuries.The consistency rates for fracture identification in disability grade assessments was 92.21%,while rates for injury degree and sequelae were 65.63%and 48.94%,respectively.Inconsistencies in identifying damage facts—including the presence of fractures,distinguishing between fresh and old fractures,and determining the nature of fractures and sequelae—were primarily noted in rib,orbital,and nasal bone fractures.The utilization rate of CT metadata in initial evaluations(25.00%)was significantly lower than in re-evaluations(95.00%).The identification time for joint mobility dysfunction after fracture in re-identifications was significantly longer than in initial identifications(P=0.0002),and the identification time for cases with agreement was significantly shorter than for cases with disagreement(P=0.036).Conclusion Image data type and identification timing are critical factors that may influence the accuracy and consistency of forensic clinical identification of bone injuries.When necessary,dynamic CT metadata in conjunction with image post-processing technology can be routinely employed to identify fractures of the ribs,orbital bones,or nasal bones,thereby reducing the risk of misidentification.

IgA vasculitis is a common childhood vasculitis disorder.Its primary clinical manifestation is cutaneous purpura,which is often accompanied by gastrointestinal and joint symptoms.Renal involvement can present as hematuria or proteinuria.This condition is recurrent and protracted,significantly affecting the health of children.The pathogenic factors in pediatric IgA vasculitis are diverse."Wind-toxin damaging collaterals"is presented as the core pathogenesis based on clinical practice and theoretical exploration.This concept essentially entails the latent attack of wind-toxin,collateral damage leading to blood extravasation,and healthy qi deficiency and lingering toxins,with the disease primarily located in the collateral vessels.The disease course is divided into three stages:acute,lingering,and recovery.Clinical practice should adhere to the pathogenesis principles and apply stage-based pattern differentiation and treatment.The acute stage involves wind-toxin attacking collaterals with dampness-heat accumulation.Treatment focuses on dispersing wind,clearing heat,and eliminating dampness to expel wind-toxin from the muscular exterior.The self-prescribed Qufeng Xiaodian Formula is a frequently selected modified formula.The lingering stage features latent wind-toxin in the collaterals and congealed accumulations in the kidney collaterals.Treatment aims to resolve wind-toxin,disperse stasis,and eliminate accumulation to remove densely accumulated wind-toxin.A modified Taohong Siwu Decoction is selected.The recovery stage involves deficient healthy qi with persistent wind assault and lingering toxins.Emphasis should be placed on cultivating the fundamental,strengthening the root,and nourishing yin,as well as supporting the healthy qi to dispel wind and expel toxins,while conditioning the body to prevent recurrence.A modified Guomin Decoction is selected.Clinical application emphasizes the combination of characteristic medicines,such as wind medicines to expel pathogens,insect medicines to identify collaterals,and vine medicines to unblock the meridians,to enhance the effects of identifying wind,resolving toxins,unblocking collaterals,and dispersing congealed accumulations.This study aims to systematically elaborate on the stage-based treatment strategy from the perspective of"wind-toxin damaging collaterals,"providing a theoretical basis and clinical practice reference for the traditional Chinese medicine diagnosis and treatment of pediatric IgA vasculitis.

BACKGROUND:The asymmetrical biomechanical environment of adolescent idiopathic scoliosis can lead to further wedge deformation of the vertebral body,which may affect cardiopulmonary function and compress nerves in severe cases.Adolescent idiopathic scoliosis with different degrees of scoliosis should be treated with exercise,bracing,and surgery.However,the mechanical mechanism of selecting an orthopedic approach remains unclear due to the individual variability of patients.OBJECTIVE:To investigate the biomechanical mechanism of different orthopedic modalities for the treatment of adolescent idiopathic scoliosis to provide a basis for clinical selection of treatment modalities based on the spine model of adolescent idiopathic scoliosis patients.METHODS:Based on the CT images of an adolescent idiopathic scoliosis patient,a scoliosis model(C7-L5)was reconstructed in Mimics software in three dimensions,and lateral thrust force was applied at the T8/T9 thorax and vertical distraction force was applied over the C7 vertebra with the magnitude of 20,40,60,80,100,and 120 N.The intervertebral disc stress and vertebral displacement in concave and convex sides,and Cobb angle of the spine were analyzed under two orthopedic modalities.RESULTS AND CONCLUSION:(1)With lateral thrust,there was no significant change in the C7T1-T7T8 intervertebral disc.The concave and convex stress of T7T8-L4L5 segment decreased first and then increased with the increase of lateral thrust force.The correction effect of lateral thrust on the segment near T8T9 was obvious and weakened with the extension of the segment to the cephalic and caudal ends.At 120 N of lateral thrust,the thoracic Cobb angle changed from 53.2° to 32.5° and the lumbar Cobb angle changed from 50.2° to 43.9°.(2)With the vertical distraction,the thoracic intervertebral disc stresses first decreased and then increased,and all the lumbar disc stresses decreased.The C7 displacement was the most obvious,and the correction effect gradually diminished with the segment extended to the caudal end.At a vertical distraction force of 120 N,the thoracic Cobb angle changed from 53.2° to 39.4° and the lumbar Cobb angle changed from 50.2° to 47.6°.(3)It is concluded that both orthopedic modalities provide improvement in the degree of scoliosis,with the thoracic correction being greater than the lumbar correction.Also,the asymmetric stress distribution on the concave and convex sides is improved,which contributes to normal bone growth.A vertical distraction approach is appropriate for larger Cobb angles,and a lateral thrust approach is appropriate for smaller Cobb angles.The results of this study help to understand the mechanism of spinal orthosis and provide a theoretical basis for the choice of orthopedic approach.

Diabetic nephropathy(DN),a primary cause of end-stage renal disease(ESRD)in diabetic patients,is pathologically characterized by chronic inflammation and renal fibrosis.Chronic inflammation promotes renal cellular damage,epithelial-mesenchymal transition,and extracellular matrix(ECM)accumulation through mechanisms including immune cell activation,pro-inflammatory cytokine secretion,and initiation of multiple sig-naling pathways.Excessive ECM deposition disrupts renal architecture and drives tubulointerstitial expansion,thereby accelerating renal functional decline.Recent studies demonstrate that chronic inflammation and fibrosis synergistically propagate DN progression via bidirectional crosstalk.Inflammation serves as an early driver of fibro-genesis and further amplifies fibrotic processes through positive feedback mechanisms,establishing a self-perpetu-ating inflammation-fibrosis vicious cycle.However,the precise molecular interplay between chronic inflammation and fibrosis remains incompletely elucidated.Thus,in-depth exploration of their interaction mechanisms is crucial for developing novel DN interventions.This review delineates the pathogenic roles of chronic inflamma-tion and fibrosis in DN to advance mechanistic understanding and provide foundational insights for designing in-novative therapeutic strategies.

Objective:To select low-dose radiation-activated genes with intrinsic radiation protection by developing a model for adaptive responses to low-dose ionizing radiation, in order to explore the mechanisms behind the radiation resistance of the candidate genes.Methods:The cells were divided into adaptive response induction group and whole transcriptome sequencing group. The level of DNA damage was assessed using the γ-H2AX immunofluorescence assay. The low-dose radiation-activated candidate genes with radiation protection were selected through whole transcriptome sequencing and quantitative reverse transcription PCR (RT-qPCR)-based validation. The anti-radiation effect of candidate gene CCND1 was assessed based on CCK-8 cell proliferation and γ-H2AX immunofluorescence assay. After up- and down-regulation of CCND1 expression, the anti-radiation mechanism of CCND1 was preliminarily explored through transcriptome sequencing analysis.Results:A model for low-dose ionizing radiation-induced adaptive responses of lymphocytes was constructed. Using this model, six candidate genes with radiation protection, including CCND1, ZMAT3, MGAT3, DFFB, CYP4F2, ITGA6, were selected. Compared to the control group, overexpressed CCND1 led to significantly enhanced proliferation ability of AHH-1 cells ( t = 7.92-14.76, P < 0.05) and distinctly lowered level of DNA damage ( t = 2.79-9.68, P < 0.05) after 2 Gy of X-ray irradiation. Furthermore, compared to the control group, the CCND1 knockdown caused significantly decreased cell proliferation ability ( t = 13.58-26.25, P < 0.05) and notably elevated level of DNA damage of cells ( t = 2.87-7.61, P < 0.05). Transcriptome sequencing revealed that up- and down-regulation of CCND1 expression resulted in the activation of pathways related to cell growth, death, and damage repair. Conclusions:By selecting six low-dose-activated candidate genes with radiation protection and revealing the function of CCND1 in radiation protection, this study provides a new perspective for the development of radiation protection agents from the perspective of adaptive responses to low-dose radiation.

Objective:To explore the mechanism of astaxanthin improving renal damage in diabetic mice by regulating the PI3K/Akt signaling pathway.Methods:C57BL/6J adult male mice (8 weeks, 22-24 g) were provided by Nanjing Junke Biological Co.,Ltd. The mice were divided into control group (mice raised under normal conditions and given phosphate buffered saline injection, n=15), model group (DN mouse model established as mentioned above, n=15), and astaxanthin group (on the basis of model mice,10 mg/kg body weight dose of astaxanthin was given, n=15). The serum urea nitrogen, serum creatinine and 24 h urine protein levels of mice were detected by biochemical kits. The levels of serum inflammatory factors in mice were detected by ELISA. Mesangial matrix expansion and fibrosis in mice were observed by renal histological analysis. Glomerular podocytes were analyzed by TUNEL detection and immunohistochemical staining. Nephrin and CD2AP expression were analyzed by Western blot.The expression of PI3K/Akt signaling pathway was analyzed by Western blot. Results:The levels of serum urea nitrogen, serum creatinine and 24h urinary protein in model group were higher than those in control group ( P<0.05), but the levels of serum urea nitrogen, serum creatinine and 24h urinary protein in astaxanthin group were lower than those in model group ( P<0.05). The serum levels of TNF-α,1L-1β and 1L-6 in model group were higher than those in control group ( P<0.05), while the levels of TNF-α,1L-1β and 1L-6 in astaxanthin group were lower than those in model group ( P<0.05). Compared with the control group, the model group mainly showed different degrees of pancreatic islet lesions and vacuolar degeneration under light microscope ( P<0.05). HE staining showed glomerular sclerosis and dilatation, capillary lumen shrinkage, diffuse mesangial matrix dilatation, and peripheral capillary thickening and hardening ( P<0.05). PAS staining showed an increase in PAS-positive substances (purple plaques) in the model group of mice ( P<0.05), indicating glycogen accumulation in diabetic glomeruli. Masson staining showed accumulation of type Ⅳ collagen and increased fibrosis (blue stained area) in the kidney of the model group ( P<0.05). Astaxanthin treatment can significantly improve these diabetic induced histopathological changes ( P<0.05). Compared with control group,mesangial matrix expansion and fibrosis were increased in model group ( P<0.05), and decreased in astaxanthin group ( P<0.05). Compared with the control group, the apoptosis rate of podocyte in model group was increased ( P<0.05) ,while that in astaxanthin group was decreased ( P<0.05). The number of WT-1 positive podocytes in model group was lower than that in model group ( P<0.05), and the number of WT-1 positive podocytes in astaxanthin group was higher than that in model group ( P<0.05). Compared with the control group, Nephrin and CD2AP proteins in the model group were decreased ( P<0.05), and the expressions of Nephrin and CD2AP proteins in astaxanthin group were increased ( P<0.05). The protein expressions of p85, p-Akt Ser473 and P-mtor Ser2448 in model group were increased compared with those in control group ( P<0.05), while the protein expressions of p85, P-Akt Ser473 and P-mtor Ser2448 in astaxanthin group were decreased compared with those in model group ( P<0.05) . Conclusion:Astaxanthin significantly improves kidney damage in diabetic mice by regulating the PI3K/Akt signaling pathway,which manifests as inhibiting renal cell lesions and reducing inflammation.