Objective:To evaluate the clinical significance of morular metaplasia (MM) in fertility-preserving treatment for young patients with endometrial hyperplasia and grade 1 endometrial endometrioid carcinoma.Methods:Clinical data was retrospectively collected from patients diagnosed with endometrial hyperplasia or grade 1 endometrial endometrioid carcinoma under 40 years old who underwent progestin-based fertility-sparing treatmentat in Tianjin Medical University General Hospital between January 2018 and November 2022.Patients were divided into the MM group (37 cases) and the non-MM group (63 cases) based on pathological findings. Clinical characteristics, hysteroscopic features, treatment efficacy and fertility outcomes were compared between the two groups. The MM group was further stratified into three subgroups based on the timing of MM occurrence:(1) MM-Bef group ( n=10): MM was present in the initial endometrial curettage or hysteroscopic biopsy pathology before fertility-sparing treatment and disappeared after treatment; (2) MM-Sus group ( n=14): MM persisted consistently before and after therapy;(3) MM-Aft group ( n=13): MM was absent before therapy but appeared after treatment. The risk factors which had impact on the treatment outcomes of the patients were analyzed using univariate and multivariate Cox regression analysis. Results:The rate of polycystic ovary syndrome were higher in the MM group than the non-MM group [51% (19/37) vs 27% (17/63), P=0.014]. The complete response (CR) rate was significantly lower in the MM group than in the non-MM group [73% (27/37) vs 95% (60/63), P=0.006], and the median time to CR was significantly longer in the MM group (6.0 vs 5.0 months, P=0.005).Multivariate analysis identified that MM-Sus ( HR=0.355, 95% CI:0.174-0.723; P=0.004) and MM-Aft ( HR=0.314, 95% CI:0.145-0.681; P=0.003) were independent risk factors for delayed CR in fertility-sparing treatment. The patients in the MM group and non-MM group underwent hysteroscopic biopsy for 76 and 131 times. "Gravel-like change" was a more frequent hysteroscopic manifestation in the MM group than that in the non-MM group [18% (14/76) vs 2% (2/131), P<0.001]. Conclusions:Patients in the MM group have poorer treatment outcomes than patients in the non-MM group. MM-Sus and MM-Aft are risk factors for fertility-preserving treatment in young patients with endometrial hyperplasia or grade 1 endometrial endometrioid carcinoma. "Gravel-like change" is the characteristic hysteroscopic manifestations of MM.

Immunoglobulin A (IgA) nephropathy is a globally prevalent type of primary glomerulonephritis, characterized by complex symptoms and diverse clinical manifestations. The internationally recognized " multiple hit hypothesis" explains the systemic immune disease features of IgA nephropathy. However, current treatment strategies primarily focus on local pathological changes, inadequately addressing its complex systemic mechanisms. The " qi cycle in round" theory, an integral concept of the academic thought of HUANG Yuanyu, a prominent medical expert from the Qing Dynasty, offers a concise and insightful framework for understanding complex pathologies. For example, this theory provides valuable insights for elucidating the pathogenesis of IgA nephropathy and guiding its clinical management by simplifying intricate systemic processes. This study applies the " qi cycle in round" theory to postulate that patients with IgA nephropathy experience disrupted qi flow owing to spleen-stomach qi deficiency and dampness-heat accumulation. These imbalances manifest as internal symptoms, such as diarrhea; external vulnerability to illness; upper body symptoms, like sore throat; and lower body symptoms, such as hematuria and proteinuria. Pathologically, the condition is characterized by immune complex deposition. This article also emphasizes strategies that prioritize tonifying spleen-stomach qi to enhance the pivotal functions of transportation and transformation. Regulating qi and relieving stagnation are emphasized to harmonize ascending and descending dynamics. Additionally, eliminating turbidity and unblocking collaterals are highlighted to promote qi transformation. These approaches aim to restore the harmonious operation of organ qi dynamics and harmonious qi transformation functions. This study aims to provide a reference for syndrome differentiation and IgA nephropathy treatment using traditional Chinese medicine based on the " qi cycle in round" theory.

Diabetic kidney disease (DKD) is a common microvascular complication of diabetes. "Internal heat leading to zheng" is the core pathogenesis of DKD, while "glucose toxicity" is transformed from subtle substances through "internal heat" and the cementation of various pathological products, which is pivotal to the transformation of diabetes to DKD. "Glucose toxicity" is characterized by deep and widespread heat, caused by various pathological factors, and its sticky nature makes it difficult to resolve, which can cause severe damage to the kidney collaterals. In the early stage of "glucose toxicity", it is yang pathogen, which can be transformed into yin pathogen in the later stage with disease progression. In clinical practice, treatment should be based on disease staging, with attention on grasping the pathogenesis of "internal heat leading to zheng" and identifying the nature of "glucose toxicity". During the diabetic period, clearing heat is the primary method, often using modified Yueju Pill and Dachaihu Decoction. In the early stage of DKD, treatment primarily focuses on clearing and penetrating latent heat to treat DKD, aiming to prevent toxic heat from transitioning from qi to blood. The approach emphasizes clearing heat and re-penetrating, detoxification, and re-clearing, often using a self-made modified Qingre Xiaozheng Decoction. In the middle and late stages of DKD, the focus shifts to clearing heat, eliminating zheng, strengthening vital qi, and dispelling turbidity, with commonly used treatments including the self-made modified Xiezhuo Xiaozheng Formula, Jingui Shenqi Pill, and Zhenwu Decoction.

Objective:To evaluate the clinical significance of morular metaplasia (MM) in fertility-preserving treatment for young patients with endometrial hyperplasia and grade 1 endometrial endometrioid carcinoma.Methods:Clinical data was retrospectively collected from patients diagnosed with endometrial hyperplasia or grade 1 endometrial endometrioid carcinoma under 40 years old who underwent progestin-based fertility-sparing treatmentat in Tianjin Medical University General Hospital between January 2018 and November 2022.Patients were divided into the MM group (37 cases) and the non-MM group (63 cases) based on pathological findings. Clinical characteristics, hysteroscopic features, treatment efficacy and fertility outcomes were compared between the two groups. The MM group was further stratified into three subgroups based on the timing of MM occurrence:(1) MM-Bef group ( n=10): MM was present in the initial endometrial curettage or hysteroscopic biopsy pathology before fertility-sparing treatment and disappeared after treatment; (2) MM-Sus group ( n=14): MM persisted consistently before and after therapy;(3) MM-Aft group ( n=13): MM was absent before therapy but appeared after treatment. The risk factors which had impact on the treatment outcomes of the patients were analyzed using univariate and multivariate Cox regression analysis. Results:The rate of polycystic ovary syndrome were higher in the MM group than the non-MM group [51% (19/37) vs 27% (17/63), P=0.014]. The complete response (CR) rate was significantly lower in the MM group than in the non-MM group [73% (27/37) vs 95% (60/63), P=0.006], and the median time to CR was significantly longer in the MM group (6.0 vs 5.0 months, P=0.005).Multivariate analysis identified that MM-Sus ( HR=0.355, 95% CI:0.174-0.723; P=0.004) and MM-Aft ( HR=0.314, 95% CI:0.145-0.681; P=0.003) were independent risk factors for delayed CR in fertility-sparing treatment. The patients in the MM group and non-MM group underwent hysteroscopic biopsy for 76 and 131 times. "Gravel-like change" was a more frequent hysteroscopic manifestation in the MM group than that in the non-MM group [18% (14/76) vs 2% (2/131), P<0.001]. Conclusions:Patients in the MM group have poorer treatment outcomes than patients in the non-MM group. MM-Sus and MM-Aft are risk factors for fertility-preserving treatment in young patients with endometrial hyperplasia or grade 1 endometrial endometrioid carcinoma. "Gravel-like change" is the characteristic hysteroscopic manifestations of MM.

Chiral drugs are closely related to the safety and effectiveness of drug use.Most dihydropyridine drugs have chiral carbon atoms,which are used as racemes and produce stereoselective disposal characteristics after entering the body,and may affect the safety and effectiveness of drugs.Therefore,based on the chiral resolution and pharmacokinetic characteristics of this class of drugs,the selection rules of chiral HPLC and CE methods and in vivo analysis applications of this class of drugs in recent years were reviewed.The stereoselective pharmacokinetics of this class of drugs were listed and compared.It was found that some of these drugs had obvious differences in stereoselective pharmacokinetics,and the pharmacokinetics and toxicity in vivo were also different.

The core pathogenesis of membranous nephropathy is spleen-kidney depletion and dampness-stasis blocking collaterals， in which spleen-kidney depletion runs through the whole process of membranous nephropathy. Spleen and kidney depletion often occurs in the early stage of membranous nephropathy， accompanied by the progression of the disease and the stagnation of deficiency and qi， which leads to the obstruction of kidney collaterals by patho-logical products such as phlegm， blood stasis and water-dampness， and then the formation of stasis obstruction in kidney collaterals over time. Huangqi （Radix Astragali） as an important herb for supplementing spleen and boosting kidney can be used to fortify spleen， consolidate kidney and generate essence， and to boost qi， expel blood and unblock collaterals when treating membranous nephropathy. With combined medicinals， it can dispel and remove wind， astringe， store and consolidate essence， unblock stagnation and remove excess， strengthen efficiency and supplement deficiency， raise yang and lift the sunken. Besides， it is emphasized that caution should be taken against the drawbacks that excessive sweet may constrain the stomach， and the sweet and the warm may assist heat in the treatment of membranous nephropathy. The degree at which the spleen is supplemented and the kidney boosted should be chosen properly， and the medication contraindications should be cautioned.

We summarize our clinical experience with the use of wind herbs for membranous nephropathy treatment.The pathology of membranous nephropathy is mainly based on the spleen and kidney,with wind pathogen,dampness-heat,and blood stasis as the main pathological factors.The imbalance of the spleen ascending clear and kidney-transforming qi is the fundamental pathogenesis of membranous nephropathy.Wind herbs are light and gentle in nature,and they can dispel wind,assist in raising the spleen yang,aid in kidney qi transformation,and promote the unblocking of qi and blood stasis.This corresponds to the pathogenesis of membranous nephropathy,which involves wind invasion,deficiency of the spleen and kidney,failure to ascend clear yang,and stagnation of qi and blood.In the clinical treatment of membranous nephropathy,the use of wind herbs such as ephedra,cassia twig,mulberry leaf,chrysanthemum flower,and other herbs,along with blood-activating and collateral-opening herbs such as incised notopterygium rhizome and root,rhizome ligustici,zedoray rhizome,and pangolin scales,is proposed.Chinese thorowax root,largetrifoliolious bugbane rhizome,divaricate saposhnikovia,incised notopterygium rhizome and root,and other pungent herbs combined with ginseng,membranous milkvetch root,and other sweet-tonifying herbs can tonify yang and benefit the spleen,enhancing the tonifying effect.Ephedra,cassia twig,fresh ginger,prepared common monkshood branched root,manchurian wildginger,and other pungent-warm herbs can warm the kidney,support yang,and promote qi transformation and water metabolism.In clinical treatment of membranous nephropathy,satisfactory result have been achieved by making use of the characteristics of wind herbs.

Lumbar spinal stenosis is a common clinical syndrome in orthopedics, frequently occurring in the elderly, and can affect the physical and mental health as well as daily life of patients. Surgery is the primary treatment measure for lumbar spinal stenosis, among which laminoplasty has received widespread attention in recent years. This article reviewed the current application status and research progress of laminoplasty for lumbar spinal stenosis in the elderly, aiming to provide reference for technical research and clinical practice in this field.

Objective:To evaluate the dosimetric characteristics, safety and effectiveness of magnetic resonance-guided fractionated stereotactic radiotherapy (FSRT) for brain tumors.Methods:Clinical data of 8 brain tumor patients treated with magnetic resonance-guided FSRT in the Radiotherapy Department of the First Medical Center of the PLA General Hospital from July 2023 to February 2024 were retrospectively analyzed. Online adaptive radiotherapy was adopted for all patients. Adapt-to-position (ATP) or adapt-to-shape (ATS) radiotherapy was chosen by radiologists. Each adaptation was initiated after the radiotherapy plan was re-examined. The radiotherapy fractionation plan was 21-30 Gy/3-5 F. Clinical characteristics, radiotherapy plans and plan parameters were analyzed by statistical description. Median ( Q1， Q3) was used to describe continuous data and percentage was used to describe categorical data. Results:In this study, 9 lesions were treated a total of 41 times, including 20 times (49%) of ATP plan and 21 times (51%) of ATS plan. The median target area coverage rate was 95.1% (95%, 99.8%), the median target area maximum dose rate was 1.15 (1.07, 1.31), the median conformity index (CI) was 0.75 (0.69, 0.86), the median homogeneity index (HI) was 1.09 (1.06, 1.21), and the median gradient index (GI) was 4.73 (3.36, 8.45), respectively. After ATS plan, the median reduction in gross target volume (GTV) was 8.22 cm3 (1.2, 10.1 cm3), and the median reduction in brain tissue V12 Gy was 30.46 cm3 (8.34, 31.13 cm3).The median follow-up was 3.2 months (1.4, 6.1 months). No radiation necrosis was found in any patient. There were 2 cases of acute brain edema during radiotherapy (both were mild). Except for 1 case who died due to systemic disease progression, the remaining patients had no local recurrence, and achieved good quality of life. Conclusions:The parameters of the treatment plan of magnetic resonance-guided FSRT are generally acceptable. The adaptive plan can effectively reduce the dose of normal brain tissues. It is safe and feasible to use the magnetic resonance-guided FSRT for brain tumors.

Objective:To develope and analyze and optimize the performance of some kinds of environmentally friendly flexible X-ray protective materials in attempt to tackle the various environmental and high energy consumption problems in the development of traditional medical X-ray protective clothing.Methods:The Monte Carlo program was used to establish a simplified model of medical X-ray tube. The aim was to carry out numerical simulation and prediction of the shielding materials′ performance against X-ray, prepare the flexible X-ray shielding materials through experiments and test and verify the their shielding performances The development and optimization path was also obtained by comparing the result between simulation and experiment.Results:Bi was the preferred alternative to toxic Pb elements, while W was able to compensate for weak X-ray absorption zone of Bi. The shielding efficiency of the composite material doped with 25% Bi+ 25% W was able to reach 77.8% and 66.3% at 80 and 120 kV p tube voltages, respectively. Conclusions:With both the selection of elements and the optimization of functional particles, the combination of W and Bi is an economical, environmentally friendly, and efficient shielding way within the energy range of medical diagnostic X-rays. The numerical simulation helps reduce experimental costs, shorten the research period, and improve the design efficiency of X-ray shielding materials.