Diabetic nephropathy（DN） is a common and severe microvascular complication of diabetes. In recent years， the classical herbal formula Shenqi dihuang decoction has demonstrated unique advantages in the clinical treatment of DN. This article conducts a systematic review of the mechanisms of action and clinical applications of Shenqi dihuang decoction in the treatment of DN. It reveals that the mechanism by which this formula improves DN involves multi-target synergistic regulation. For instance, Shenqi dihuang decoction exerts multiple pharmacological effects by regulating signaling pathways including phosphatidy linostiol 3-kinase/protein kinase B， AMP-activated protein kinase/silent information regulator 1/forkhead box O1， and nuclear factor erythroid 2-related factor 2/heme oxygenase-1 pathways.These effects include regulating glucose and lipid metabolism， inhibiting oxidative stress， reducing inflammation， improving insulin resistance， modulating cell death （apoptosis/autophagy/ferroptosis/pyroptosis）， and preventing renal fibrosis. Existing clinical studies indicate that Shenqi dihuang decoction and its modified formulas， alone or in combination with other therapeutic methods， can significantly improve glucose and lipid metabolism， reduce proteinuria， and delay renal function decline in patients with DN. These effects are superior to those of Western medicines such as irbesartan， valsartan， and empagliflozin， and the treatment demonstrates good safety. Future research should leverage systems biology and artificial intelligence technologies to further elucidate the integrated mechanisms in the treatment of DN by Shenqi dihuang decoction， thereby advancing the precision and standardization of its clinical application.

This article introduced TCM master Zhang Zhen's experience of using theory of"one body with two wings,regulating qi movement"in the treatment of thyroid nodules.The onset of thyroid nodules is due to liver depression and qi stagnation,and the booster of the onset is spleen and kidney dysfunction.The main pathogenesis is liver depression and qi stagnation,spleen deficiency and phlegm coagulation,kidney deficiency and blood stasis.The disease is located in the liver,spleen,and kidney.The general principle for treating thyroid nodules is to regulate the liver to regulate"the body",while the key points for treating thyroid nodules are to supplement the spleen and kidneys to supplement"the two wings".The combination of promoting blood circulation and dispersing nodules is the target for treating thyroid nodules.The clinical treatment of thyroid nodules with Shutiao Xiaohe Decoction has a significant therapeutic effect.

Acute pancreatitis often progresses rapidly, and if it is not controlled in time, it may lead to multiple organ injury and even death due to organ failure. At present, there is still a high proportion of patients with acute pancreatitis who died due to liver failure. The liver and the pancreas are interrelated physiologically and affect each other pathologically. This article elaborates on the molecular mechanism of liver injury in acute pancreatitis from the six aspects of the physiological relationship between the pancreas and the liver, cytokines, inflammatory response, oxidative stress, microcirculation disturbance, and intestinal flora translocation.

Metabolic disorders are observed in women after menopause, and the postmenopausal women suffering from chronic liver diseases have an increased risk of progression to liver fibrosis, with a higher risk than male patients of the same age, which may be associated with the decline of ovarian function and the reduction of estrogen level after menopause. This article summarizes the research advances in the molecular mechanism of progression to liver fibrosis from the aspects of estrogen and oxidative stress, activation of hepatic stellate cells, accumulation of extracellular matrix, and immune regulation. It is pointed out supplementation with an appropriate amount of estrogen in the perimenopausal period and the early menopausal period can reduce the risk of liver fibrosis and delay or even reverse the process of liver fibrosis, thereby improving quality of life and prolonging survival time in elderly female patients.

Objective To investigate the therapeutic effect of anteromedial ankle approach for talus fracture.Methods From January 2012 to October 2018,the data of 28 cases of talus fracture treated by anteromedial ankle approach were retrospectively analyzed,including 26 males and 2 females,aged 24-61 years with an average of 38.6 years.All 25 cases of closed injuries and 3 cases of open injuries were fresh injuries.There were 16 cases of traffic injuries,8 falling injuries,2 heavy object injuries and 2 sprains.Among the 28 patients,17 were talus neck fractures,and according to Hawkins talus neck fracture classification,there were 1 case of type Ⅰ,12 type Ⅱ,and 4 type Ⅲ.There were 11 cases of talus fracture,which were classified according to Sneppen talus fracture types:2 cases of type Ⅰ,8 cases of type Ⅱ and 1 case of type Ⅴ.Among them,2 cases of talus neck fracture complicated with T12 vertebral body fractures and 2 cases complicated with calcaneal fractures.The time from injury to operation for 3 patients with open fracture was 3-6 hours.25 cases of closed fracture injuries took 2-10 hours to operate,with an average time of 5.6 hours.All patients were fixed with cannulated screws through the anteromedial ankle approach.The weight-bearing time and strength of lower limbs were determined according to fracture healing after surgery.The ankle function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) Score.Results All 28 patients were followed up for 23 to 82 months,with an average of 37.5 months.All fractures healed.The healing time of talus neck fracture was 3.5-8 months,with an average of 5 months.The healing time of talus fracture was 3-7 months,averaging 4.5 months.At the latest follow-up,AOFAS score ranged from 68 to 100,with an average of 82.5 points,including excellent in 15 cases,good in 8 cases,fair in 4 cases and poor in 1 case,with the excellent and good rate of 82.1％ (23/28).There were no signs of fracture displacement,malunion,loosening and prolapse of internal fixation,fracture and ischemic necrosis of talus after operation.Traumatic arthritis occurred in 9 patients,with an incidence rate of 32.1％ (9/28).Tibial joint was involved in 5 cases,talus joint in 3 cases,tibialis in 1 case and talus joint in 1 case.Among them,traumatic arthritis occurred in 2 cases of open injury.Nine patients (32.1％) suffered from traumatic arthritis 6-10 months after operation,with an average of 8 months.According to conservative treatments such as weight control,ankle immobilization,physiotherapy,anti-inflammatory and analgesic,nutrition of articular cartilage drugs,joint traction and plasty were given.The patients' conditions improved to different degrees and could tolerate walking and normal life and work.Conclusion The anteromedial ankle approach has the advantages of minimal vessel injuries,clear exposure for direct reduction,low rate of necrosis of talus and satisfactory curative effect.

Objective To explore the in vitro spermostatic effects and the mechanisms of ceritinib,a novel candidate from the active compound pools previously screened for the regulation of sperm function.Methods The vigor sperm of human and mouse were incubated with ceritinib for 20seconds,and the sperm motility was evaluated by computer assistant sperm analysis (CASA).The integrity of the sperm plasma membrane and the survival ratio of sperm was assessed by hypo-osmotic swelling (HOS) assay and SYBR-14/PI staining.The damage of sperm plasma membrane was detected by electron microscope.The cytotoxicity of ceritinib to VK2/E6E7,End1/E6E7 and Ect1/E6E7 cells was measured by CCK-8 assay and fluorescent staining.Results The minimal effective concentration (MEC) of ceritinib to (5-10) × 106/mL human sperm within 20 seconds was (74.87 ± 31.46)μmol/L,which was significantly lower than the MEC of nonoxynol-9 (219.75 ± 20.89) μmol/L measured in the same condition.The time-dose related spermostatic effects of ceritinib were measured by CASA system.Ceritinib was able to damage sperm membrane and caused sperm death with HOS and SYBR-14/PI staining.With electron microscopy,the sperm membrane was observed to be ruptured,and the heads and tails of sperm were separated by ceritinib.Ceritinib was also able to damage the epithelial cells.Conclusions Ceritinib has acute spermostatic effects and potential contraceptive effects.

Objective To investigate the current situation on the infection of Acinetobacter baumannii in ICU and evaluate the efficiency of resistance control project which was performed in Xiaolan hospital,so as to provide scientific basis for clinical rational use of antibiotics.Methods Used VITEK-2 microbiology analysis system for the pathogen identification and drug sensitivity.Compared drug resistance of Acinetobacter baumannii isolated from the samples of ICU patients in 2012 (before the project executed)with that in 2013 (after the project executed).Results 71 strains and 57strains Acinetobacter bauman-nii were isolated from the ICU in 2012 (before the project executed)and in 2013 (after the project executed)respectively, which majorly isolated from the samples of respiratory system,and occupied 94.4% and 84.2% respectively.The infection rate of multi-resistant Acinetobacter baumannii was decreased from 77.5% to 66.7%,and the resistance rate of Acinetobact-er baumannii to cefepime,ceftazidime,cefatriaxone,tobramycin and cotrimoxazole decreased distinctly after the implementa-tion of drug resistance control management (χ2 > 3.84,P <0.05).Conclusion The drug resistance rates of Acinetobacter baumannii to 14 kinds of routine antibacterial drugs in 2013 were lower than that in 2012 in ICU.Among them,the drug re-sistance rates of Acinetobacter baumannii to 5 kinds of antibacterial drugs decreased distinctly.

Objective To investigate the relationship of sperm morphology with seminal plasma zinc and sperm acrosin activity in male infertile patients.Methods 455 patients with male infertility were divided into 5 groups and 8 groups according to age and sperm morphology respectively.The sperm morphology,seminal plasma zinc and sperm acrosin activity were detected by the Diff-Quik stain,modified 5-Br-PAPS and modified Kennedy methods respectively.Results The percentages of morphologically normal sperm and seminal plasma zinc concentration in the infertile men groups were not different in various age groups(P >0.05 ).The sperm acrosin activity in the age group of 36-50 years was remarkably decreased (P <0.05),while which in other age groups had no statistical difference(P >0.05).Seminal plasma zinc concentration in the infertile men groups were not different in the 8 groups (P >0.05 ).Sperm acrosin activity was decreased with the percentage decrease of morphologically normal sperm (r =0.93,P <0.01).Conclusion The percentage of morphologically normal sperm is not affectd by the age and the seminal plasma zinc,which is positively correlated with the sperm acrosin activity.

Objective To diagnose a rare variant Hb Shaare Zedek in a Chinese family,and describe its clinical feature.Methods Blood samples of seven members of three generation were collected.Standard blood routine analysis,hemoglobin electrophoresis and blood gas analysis were used for phenotype analysis.Gap-PCR and reverse dot blot analysis were used to detect common thalassemia mutations.DNA sequence analysis of the human α and β globin genes were used to identify the mutation site of these samples.Results The result of blood routine analysis was normal in the proband,but a abnormal hemoglobin band (22.4％,capillary assay) was found by hemoglobin electrophoresis.In the blood gas analysis,the partial pressure of oxygen and blood oxygen saturation were 72.0 mm Hg ( 1 mm Hg =0.133 kPa) and 93.0％ in the proband.The heterozygous mutations in αl globin gene at codon 56 ( AAG ＞ GAG)which leaded Glu substitution to Lys were identified in the proband.Other family members who carried the same mutation showed similar phenotype,with abnormal hemoglobin band ( 22.4％ - 23.9％,capillary assay),low partial pressure of oxygen (59.0 - 72.0 mm Hg) and blood oxygen saturation (91.0％ -93.0％).Conclusions The heterozygote of Hb Shaare Zedek leads to slight symptoms with abnormal hemoglobin band,decreased partial pressure of oxygen and blood oxygen saturation.Discovery of this mutation enriches the abnormal hemoglobin spetrum of Chinese people,and it is useful for the clinical diagnosis and genetic counseling of hemoglobinopathies.