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.

Objective:To correlate blood lipids and body mass index (BMI) with Helicobacter pylori (Hp) infection. Methods:A total of 303 participants who underwent physical examinations at The 903 Hospital of PLA Joint Logistics Support Force from May 2022 to May 2023 were included in this case-control study. These patients were divided into an Hp-infected group ( n = 97) and a non-Hp-infected group ( n = 206) based on whether they had Hp infection or not. Participants' body height and weight were recorded, and BMI was calculated. The levels of four blood lipid indicators were determined using an automatic biochemical analyzer. The distribution of different BMIs and abnormal statuses of these four blood lipid indicators were compared between the two groups. Spearman correlation analysis was used to analyze the correlation between Hp infection and these four blood lipid indicators. A multivariate logistic regression model was applied to analyze the influential factors for Hp infection. Results:The number of participants who had 24 kg/m 2 ≤ BMI < 28 kg/m 2 [39.17% (38/97)] and the number of participants who had BMI ≥ 28 kg/m 2 [10.31% (10/97)] in the Hp-infected group was significantly higher than those in the non-Hp-infected group [19.90% (41/206) and 2.43% (5/206), χ2 = 12.71, 7.11, P < 0.001, 0.008]. The decrease rate of high-density lipoprotein cholesterol (HDL-C), increase rate of low-density lipoprotein cholesterol (LDL-C), increase rate of triglyceride (TG), and increase rate of total cholesterol (TC) in the Hp-infected group were 23.71% (23/97), 31.96% (31/97), 17.53% (17/97), and 22.68% (22/97), respectively, which were significantly higher than 9.22% (19/206), 11.17% (23/206), 7.28% (15/206), and 8.74% (18/206) in the non-Hp-infected group ( χ2 = 11.59, 19.47, 7.33, 11.19, P = 0.001, < 0.001, 0.007, 0.001). The Spearman analysis showed that Hp infection was linearly positively correlated with BMI, LDL-C, TG, and TC ( r = 0.571, 0.519, 0.473, 0.535, all P < 0.001), while it was linearly negatively correlated with HDL-C ( r = -0.628, P < 0.001). Multivariate logistic regression analysis showed that BMI ≥ 24 kg/m 2, decreased HDL-C, increased LDL-C, elevated TG, and elevated TC are independent risk factors for Hp infection. Conclusion:Blood lipids and BMI are closely associated with Hp infection, and abnormal blood lipids and elevated BMI are independent risk factors for Hp infection.

ObjectiveTo explore the risk of different levels of pre-pregnancy obesity on trimester-specific thyroid dysfunction. MethodsQuestionnaire information， blood samples， and urine samples from a 2017 pregnancy cohort study in Shanghai， China were collected. A total of 2 455 pregnant women were included in the analysis. Pre-pregnancy BMI was calculated based on the height and self-reported pre-pregnancy weight. Serum TSH， total thyroxine （TT4）， free thyroxine （FT4）， total triiodothyronine （TT3）， free triiodothyronine （FT3）， thyroid globulin antibody（TgAb）， and Thyroid peroxidase antibody （TPOAb） were measured using the electrochemiluminescence method. Urine iodine levels were measured using the acid digestion method. Levels of thyroid function indexes of pregnant women with different degrees of obesity during pre-pregnancy were compared， and trimester-specific thyroid dysfunction was evaluated according to the reference range of trimester-specific thyroid hormone established by this cohort. Multivariate logistic regressions analysis was used to assess the correlation between pre-pregnancy obesity and trimester-specific thyroid dysfunction. ResultsAs the degree of obesity increased， maternal levels of FT3 and TT3 gradually increased during pregnancy （P<0.001， P=0.001）， while FT4 levels gradually decreased （P=0.001）. Multivariate logistic regression analysis showed that compared with the normal weight group， pregnant women who were overweight or obesity before pregnancy had a significantly higher risk of hypothyroxinemia （OR=3.85， 95%CI： 2.08‒7.14， P<0.001） and high TT3 （OR=2.78， 95%CI： 1.45‒5.26， P=0.002） during pregnancy. ConclusionPre-pregnancy overweight or obesity can increase the risk of thyroid dysfunction during pregnancy.

Objective:To investigate the effects of montelukast sodium combined with compound methoxyphenamine on airway inflammation, intercellular adhesion molecule-1 (ICAM-1), toll-like receptor 4 (TLR4), and soluble programmed death ligand 1 (sPD-L1) levels in patients with post-infection cough.Methods:A total of 200 patients with post-infection cough who received treatment at The 903 Hospital of the PLA Joint Logistics Support Force from January to December 2023 were included in this randomized controlled study. The patients were divided into an observation group ( n = 100) and a control group ( n = 100) using the random number table method. The control group received oral administration of compound methoxyphenamine capsules, while the observation group received oral administration of montelukast sodium in addition to compound methoxyphenamine capsules. Both groups were treated for 7 days. The therapeutic effects as well as daytime and nighttime cough scores, airway inflammation change, serum ICAM-1, TLR4, and sPD-L1 levels, and Leicester Cough Questionnaire scores were compared between the two groups. Results:The total effective rate in the observation group was 95% (95/100), which was significantly higher than that in the control group [84% (84/100), Z = 2.49, P < 0.05]. After treatment, the daytime and nighttime cough scores in the observation group were (1.24 ± 0.31) points and (1.02 ± 0.31) points, respectively, which were significantly lower than those in the control group [(2.17 ± 0.65) points, (1.94 ± 0.47) points, t = 12.91, 16.34, both P < 0.001]. Serum levels of hypersensitive C-reactive protein, interleukin-8, tumor necrosis factor-alpha in the observation group were (8.84 ± 2.21) mg/L], (82.34 ± 13.24) mg/L, and (78.94 ± 13.24) ng/L, respectively, which were significantly lower than those in the control group [(12.76 ± 2.53) mg/L, (127.18 ± 35.17) mg/L, (102.31 ± 21.08) ng/L, t = 11.67, 11.93, 9.39, all P < 0.001]. The ICAM-1 and TLR4 levels in the observation group were (178.32 ± 21.23) μg/L and (7.45 ± 2.32) ng/L, respectively, which were significantly lower than those in the control group [(247.18 ± 25.64) μg/L, (19.98 ± 4.53) ng/L, t = 20.69, 24.62, both P < 0.001], while sPD-L1 level in the observation group [(2.34 ± 0.37) ng/L] was significantly higher than that in the control group [(1.72 ± 0.41) ng/L, t = -11.23, P < 0.001]. The quality-of-life scores in the observation group for social [(2.61 ± 0.25) points], psychological [(6.56 ± 0.45) points], physical [(7.65 ± 0.72) points], and total score [(16.81 ± 2.51) points] were significantly higher than those in the control group [(2.14 ± 0.30) points, (5.44 ± 0.52) points, (6.07 ± 0.65) points, (13.74 ± 2.68) points, t = 12.04, 16.29, 16.29, 8.36, all P < 0.001]. Conclusion:Montelukast sodium combined with compound methoxyphenamine is highly effective in treating post-infection cough in patients. The combined therapy can reduce airway inflammation, lower ICAM-1 and TLR4 levels, and increase sPD-L1 levels.

Background::The epidemic of overweight and obesity has become a worldwide public health problem. Cardiometabolic diseases may originate in childhood. We investigated the association between percent body fat (PBF) measured by the bioelectrical impedance assay and cardiometabolic risk (CMR) in pediatrics.Methods::This cross-sectional study involved 3819 subjects (6–17 years old) in Shanghai. We assessed the association between PBF and body mass index (BMI) with multiple CMR factors. We examined the risk for cardiometabolic abnormalities attributable to overweight and obesity based on age- and sex-specific PBF Z-scores and BMI Z-scores, respectively. Results::PBF, but not BMI, was positively associated with multiple CMR factors in males and females except for total cholesterol in females (all p < 0.05). Compared with the non-overweight group based on PBF, over-weight and obese subjects had increasingly higher odds ratio of dyslipidemia (2.90 (1.99–4.23), 4.59 (2.88–7.32) for males and 1.82 (1.20–2.75), 2.46 (1.47–4.11) for females) and elevated blood pressure (BP) (3.26 (2.35–4.51), 4.55 (2.92–7.09) for males and 1.59 (1.07–2.34), 3.98 (2.27–6.17) for females). Obesity females showed a higher likelihood for hyperglycemia (2.19 (1.24–3.84)) than non-overweight females. In both sexes, the predictive effect of PBF on dyslipidemia and elevated BP in adolescents was better than that in children. For hyperglycemia, the predictive effect of PBF was better in male adolescents and female children. There was no risk difference for cardiometabolic abnormalities attributable to BMI-based obesity categories. Conclusions::PBF but not BMI was associated with CMR. Overweight and obesity categories based on PBF had an increased risk for cardiometabolic abnormalities in children and adolescents.

Background::The epidemic of overweight and obesity has become a worldwide public health problem. Cardiometabolic diseases may originate in childhood. We investigated the association between percent body fat (PBF) measured by the bioelectrical impedance assay and cardiometabolic risk (CMR) in pediatrics.Methods::This cross-sectional study involved 3819 subjects (6–17 years old) in Shanghai. We assessed the association between PBF and body mass index (BMI) with multiple CMR factors. We examined the risk for cardiometabolic abnormalities attributable to overweight and obesity based on age- and sex-specific PBF Z-scores and BMI Z-scores, respectively. Results::PBF, but not BMI, was positively associated with multiple CMR factors in males and females except for total cholesterol in females (all p < 0.05). Compared with the non-overweight group based on PBF, over-weight and obese subjects had increasingly higher odds ratio of dyslipidemia (2.90 (1.99–4.23), 4.59 (2.88–7.32) for males and 1.82 (1.20–2.75), 2.46 (1.47–4.11) for females) and elevated blood pressure (BP) (3.26 (2.35–4.51), 4.55 (2.92–7.09) for males and 1.59 (1.07–2.34), 3.98 (2.27–6.17) for females). Obesity females showed a higher likelihood for hyperglycemia (2.19 (1.24–3.84)) than non-overweight females. In both sexes, the predictive effect of PBF on dyslipidemia and elevated BP in adolescents was better than that in children. For hyperglycemia, the predictive effect of PBF was better in male adolescents and female children. There was no risk difference for cardiometabolic abnormalities attributable to BMI-based obesity categories. Conclusions::PBF but not BMI was associated with CMR. Overweight and obesity categories based on PBF had an increased risk for cardiometabolic abnormalities in children and adolescents.

Objective To analyze the current status of studies related to home enteral nutrition (HEN) in China,and provide scientific basis for the research and management of HEN in China.Methods We searched CNKI and WanFang Data since it built to January 1st,2018.The included studies were screened and categorized by publication information,study type,subjects of the study,topic,interventions and outcomes.Descriptive analysis was conducted after extraction of information.Results A total of 153 studies were included,of which 37 were observational studies,102 were experimental studies,12 were case report,and 2 were exploring articles.Since 2012,the number of studies has been increasing.Most of the subjects were elderly people who were diagnosed with diseases of digestive system,head and neck tumors and diseases of nervous system.These studies were featured as small sample size and short intervention time,follow-ups by telephone and home visit,less than 1/4 providing professional nutrition support team,and outcomes mainly as complication,nutritional biochemical indices,anthropometric indices and prognosis.Conclusion HEN in China is still in its infancy.The number of relative studies is still small and quality of literatures is very low,but it has been increasing.At present,there are some problems in the implementation of HEN in China,such as lack of standardized management model and professional team,short-term intervention,and single follow-up mode.The elderly and patients with digestive disease,head and neck tumors and nervous disease are the key subjects;more professional nutrition support team and scientific management model should be established in the future.

Objeetive To explore the clinical application value of new modified paracalculous ureteral catheter in ureteroscopic holmium laser lithotripsy for the treatment of large middle and lower ureteral stone.Methods From January 2014 to January 2017,86 patients with unilateral middle and lower ureteral large stone were treated in Jingzhou Central Hospital.By adopted to random digital table,86 patients were randomly separated into two groups,all of whom were treated with ureteroscopic holmium laser lithotripsy.Forty-three cases were underwent new modified laser lithotripsy with ureteral catheter inserted beneath the stone.Normal saline was injected continuously through the catheter during lithotripsy procedure (modified lithotripsy group).Forty-three cases were underwent direct ureteroscopic holmium laser lithotripsy (direct lithotripsy group).The outcome data were compared between the two groups,such as the operation time,stone clearance rate,ureteral perforation,transit to open surgery,postoperative urinary sepsis,perirenal hematoma,ureterostenosis and other complications.Measurement data were expressed as ((x) ± s),and t test was used for comparison between groups.Results All the patients in the modified lithotripsy group were completed successfully without ureteral perforation,rupture,loss of lithotripsy channel,transit to open surgery,perirenal hematoma,and urinary sepsis and so on.In the direct lithotripsy group,there were 5 cases of ureteral perforation,4 cases of lithotripsy channel loss,6 cases of transit to open surgery,2 cases of perirenal hematoma,1 case of urinary sepsis.The operation time of the two groups was (39.5 ± 7.2) min and (47.2 ± 11.6) min,respectively,t =-4.975,P =0.001.Stone clearance rate was 100％,91.1％.The patients in both groups received an average of 1 year out-patient follow-up.There were 3 cases of mild ureterostenosis in the modified lithotripsy group,which were not re-operated.In the direct lithotripsy group,there were 5 cases of mild ureterostenosis,and 2 cases of severe ureterostenosis,which were re-operated.Conclusion It is safe and effective to use the new modified paracalculous uteteral catheter in the ureteroscopic holmium laser lithotripsy of large middle and lower ureteral stone,which can shorten the total operation time and reduce the occurrence of complications.It has a higher clinical value.

Objective To evaluate the effectiveness and safety of direct-acting antiviral agents (DAA) treatment in Chinese chronic hepatitis C (CHC) patients with genotype (GT) 1b HCV infection in a real world setting .Methods The consecutive GT1b CHC Chinese patients treated with sofosbuvir (SOF) plus daclatasvir (DCV) (n＝62) or SOF plus ledipasvir (LDV) (n＝171) were enrolled from July 2014 to December 2016 at 302 Military Hospital of China .The treatment duration for all the patients was 12 weeks .All the clinical parameters were measured at baseline and then 4-weekly till 12 weeks after the end-of-treatment (EOT ).Baseline clinical characteristics ,treatment efficacy ,safety and tolerance were compared .Serum HCV RNA concentration was detected by means of COBAS TaqMan assay with a lower detection limit of 15 IU/mL ,and liver stiffness was measured using FibroScan?.Sustained virologic response (SVR) was defined as HCV RNA under the lower limit of quantification 12 weeks after EOT (SVR12).Students′t-test ,pearson χ2 test ,Spearman rank correlation analysis and Fisher exact test were used for comparison between groups when appropriate .Results Among 233 patients ,173 cases had baseline HCV RNA level ≥ 6 .0 lg IU/mL and 97 cases hade liver stiffness measurement (LSM )≥17.5 kPa.The baseline liver inflamation ,liver fibrosis ,and HCV RNA load of patients in the two groups were not significantly different (all P＞0 .05).The HCV RNA of all the 233 patients was undetectable at the end of 12-week treatment ,while 2 patients relapsed after 12 weeks of EOT with the overall SVR12 of 99.1% .HCV RNA decline was significantly faster in patients with lower LSM than those with higher LSM (ρ＝0 .233 ,P＝0 .001) ,and SVR12 was higher in those with lower LSM .In terms of other clinical characteristics of SOF+DCV and SOF+LVD groups ,alanine transaminase declined from (68 .0 ± 60 .1) and (70 .1 ± 56 .1) U/L to (21 .1 ± 10 .9) U/L and (15 .3 ± 9 .5) U/L ,respectively ,total bilirubin declined from (21 .3 ± 17 .3) and (18 .2 ± 14 .0) μmol/L to (13 .2 ± 6 .7) and (10 .2 ± 4 .6) μmol/L , respectively ,AFP declined from 19 .6 (10 .6 ,62 .3) and 15 .0 (12 .0 ,25 .0) μg/L to 6 .5(4 .5 ,18 .7) and 7 .8(5 .3 ,15 .4) μg/L ,respectively ,LSM declined from 17 .6 (8 .9 ,25 .4) and 15 .7 (7 .8 ,23 .9) kPa to 13.9(6 .5 ,21 .4) and 9 .1(5 .6 ,19 .9) kPa ,respectively ,serum album elevated form (37 .5 ± 5 .8) and (38 .7 ± 5 .5) g/L to (41 .3 ± 4 .7) and (42 .8 ± 5 .1) g/L ,respectively ,platelet elevated from (120.9 ± 78 . 2)×109/L and (136 .6 ± 65 .8 )× 109/L to (139 .5 ± 71.8 )× 109/L and (149 .7 ± 71.4 )× 109/L , respectively .Reports of adverse events were low in both groups .Conclusions Both SOF + DCV and SOF/LDV therapy are highly effective with ＞ 98% of SVR12 and reduce LSM value significantly with good safety for CHC GT1b Chinese patients .

Asian-pacific area,especially China,is Hepatitis B high epidemic area.Since 2011,the first generation of oral direct anti-HCV agents (DAAs) came to clinical use,the treatment of chronic hepatitis C has switched from interferon-based regimen era to DAA era.There is an increased awareness of hepatitis B (HBV) reactivation in chronic hepatitis C (CHC) patients coinfected with HBV treated with pan-oral direct-acting antivirals(DAAs).Compared with interferon-based regimen,HBV reactivation occurred earlier and more severe among patients received DAA regimen,and even fetal cases or case end up with liver transplantation was reported.Thus,association of liver diseases called to alert the occurrence of HBV reactivation among CHC patients who received DAAs regimen.It is hence important to have HBV serology screened in all CHC patients before initiation of pan-oral DAAs therapy and the usefulness of preemptive administration of effective anti-HBV nucleos(t) ide analogues in coinfected patients need to be further studied.