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.

BACKGROUND:Currently,exercise therapy is an effective non-pharmacological treatment for low back pain,and exercise therapy can maintain lumbar spine stabilization through mechanical-chemical coupling between bones and muscles,but there is no clear description of the research progress and optimal treatment protocols for exercise therapy to relieve chronic non-specific lower back pain through mechanical-chemical coupling. OBJECTIVE:To review the research progress related to the influence of paravertebral muscles on lumbar spine stabilization during exercise therapy through mechanical-chemical coupling,which in turn relieves chronic non-specific lower back pain,as well as the current optimal treatment protocols of exercise therapy for chronic non-specific lower back pain. METHODS:Literature searches were performed in WanFang database,CNKI,VIP,Web of Science,and PubMed database,with search terms of"chronic non-specific low back pain,lumbar spine stabilization,paravertebral muscles,exercise therapy"in Chinese and English.Relevant literature published from database inception to January 2024 was searched and 93 articles were included for final summarization. RESULTS AND CONCLUSION:Exercise therapy can act on the paravertebral muscles and bones through appropriate mechanical stimulation and produce corresponding changes.Exercise therapy is an important intervention for chronic non-specific lower back pain as it improves the quality of the paravertebral muscles,primarily through mechanical-chemical coupling,and thus maintains lumbar spine stabilization for better relief of chronic non-specific lower back pain.However,there are no clear reports on the exact effective protocols for exercise therapy to treat chronic non-specific lower back pain through lumbar spine stabilization.The development of an individualized exercise program is particularly important for the treatment and prognosis of chronic non-specific low back pain.Muscle mass and bone mass of the same individual are closely related,and imaging assessment of paravertebral muscle mass and quantity is important for disease detection and intervention.

In recent years, with continuous advancements in molecular biology and gene testing technologies, the diagnosis and treatment of colorectal cancer have been rapidly transitioning toward precision medicine. The application of molecular classification, target detection, and liquid biopsy technologies has driven ongoing updates to clinical guidelines. Multidisciplinary team colla-boration, innovations in precision surgical techniques, and the widespread adoption of neoadjuvant combination therapies have collectively promoted more individualized and scientific management of colorectal cancer. Looking ahead,the authors believe that as multi-omics biomarkers, organoid models, and artificial intelligence are increasingly integrated into clinical practice, precision diagnosis and treatment of colorectal cancer will deepen further, offering patients more efficient and personalized therapeutic options.

Objective:To analyze the clinical characteristics of locally advanced rectal cancer patients with pathological complete response (pCR) after neoadjuvant chemoradiotherapy combined with immunotherapy.Methods:The retrospective cohort study was conducted. The clinicopatholo-gical data of 46 patients with locally advanced rectal cancer who were admitted to 6 medical centers, including Beijing Friendship Hospital of Capital Medical University et al, from June 2021 to November 2022 were collected. There were 29 males and 17 females, aged (61±4)years. Patients received neoadjuvant chemoradiotherapy combined with immune checkpoint inhibitor therapy, and under-went radical total mesorectal excision during 6-12 weeks after radiotherapy. Observation indicators: (1) comparison of clinical characteristics between pCR and non-pCR patients;(2) postoperative complications and adverse reactions of pCR and non-pCR patients. Comparison of measurement data with normal distribution between groups was conducted using the t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data between groups was conducted using the Mann-Whitney U test. Results:(1) Comparison of clinical characteristics between pCR and non-pCR patients. Before neoadjuvant therapy, there were 14 cases aged ≥50 years and 6 cases aged <50 years in pCR patients, versus 25 cases and 1 case in non-pCR patients, showing a significant difference between the two groups ( P<0.05). After neoadjuvant therapy, cases in clinical stage T0, T1, T2, T3, T4 were 11, 1, 5, 3, 0 for pCR patients versus 7, 4, 2, 11, 2 for non-pCR patients, cases of tumor regression grade 1, 2, 3, 4 were 11, 8, 1, 0 for pCR patients versus 7, 14, 4, 1 for non-pCR patients, cases in low-risk, medium-risk, high-risk of neoadjuvant rectal scoring and grading were 20, 0, 0 for pCR patients versus 4, 18, 4 for non-pCR patients, respectively, showing significant differences in above indicators between the two groups ( Z=-2.256, -2.104, -5.458, P<0.05). (2) Postoperative complications and adverse reactions of pCR and non-pCR patients. Postoperative complications occurred in 2 cases of pCR patients and 5 cases of non-pCR patients, postoperative adverse reactions occurred in 11 cases of pCR patients and 10 cases of non-pCR patients, showing no significant difference between the two groups ( P>0.05). Conclusion:Compared with locally advanced rectal cancer patients aged ≥50 years, those aged <50 years have significant benefits from neoadjuvant chemoradiotherapy combined with immunotherapy. Clinical T staging and magnetic resonance imaging-detected tumor regression grade after neoadjuvant therapy have predictive value for patients with pCR .

Objective:Exploring the association between Life's Crucial 9 (LC9) and the risk of thyroid dysfunction (TD), as well as its potential predictive capacity.Methods:A total of 247 600 TD-free participants from the UK Biobank were enrolled in the study. The LC9 score was divided into three CVH groups: low (0-), medium (50-), and high (80-100). Cox proportional hazards regression models were used to calculate the HRs and 95% CIs of the risk of TD with LC9 CVH status. Calculate Harrell's concordance index ( C-index), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) to evaluate the predictive ability of the LC9 score and Life's Essential 8 (LE8) score. Results:During a median follow-up of 12.3 years, 5 515, 911, and 4 869 new cases of TD, hyperthyroidism, and hypothyroidism were documented, respectively. Participants with a high LE8 CVH group had 57.00% ( HR=0.43, 95% CI: 0.38-0.49), 55.00% ( HR=0.45, 95% CI: 0.34-0.60), and 58.00% ( HR=0.42, 95% CI: 0.37-0.47) lower risk of TD, hyperthyroidism, and hypothyroidism, respectively, than those with low CVH group. Compared with the LE8 score, the improvement in C-index for the LC9 score predicted TD risk was 0.004 (95% CI: 0.001-0.007), the NRI was 0.101 (95% CI: 0.021-0.103), and the IDI was 0.001 (95% CI: 0.000-0.001). Conclusions:The better CVH status, defined by LC9, was associated with a lower risk of TD. Compared to the LE8 score, the LC9 score demonstrated a significant enhancement in both risk discrimination and reclassification capability for TD risk.

Objective To investigate the expression levels and clinical significance of type Ⅰ innate lymphoid cells(ILC1s),T-box transcription factor(T-bet),interleukin(IL)-12,IL-18 and interferon-gamma(IFN-γ)in peripheral blood of patients with primary immune thrombocytopenia(ITP).Methods Thirty-five ITP patients with their first episode were selected as the initial treatment group.Thirteen of these patients were followed up after receiving treatment.Additionally,20 healthy individuals underwent routine physical examinations during the same period were recruited as the control group.Peripheral blood samples were collected for analysis.The proportion of ILC1s was determined by flow cytometry.T-bet mRNA expression was measured using quantitative real-time PCR(qRT-PCR).Serum levels of IL-18,IL-12 and IFN-γ were quantified by enzyme-linked immunosorbent assay(ELISA).The differences in ILC1s proportion,T-bet mRNA expression and cytokine levels were compared between groups.Correlations between ILC1s proportion,T-bet mRNA,cytokine levels and platelet(PLT)counts were also analyzed.Results Compared with the control group,the initial treatment group exhibited significantly elevated levels of peripheral ILC1s,T-bet mRNA and serum IL-18,IL-12 and IFN-γ(P＜0.05).Among the 13 patients who were followed up,all these indices decreased significantly after treatment(P＜0.05).Correlation analysis revealed that the proportion of ILC1s in the initial treatment group was positively correlated with IL-12,IL-18,IFN-γ and T-bet mRNA levels(rs=0.666,0.647,0.677,and 0.750,respectively,P＜0.01),and negatively correlated with PLT count(rs=-0.637,P＜0.01).Conclusion Innate immunity may play a role in the pathogenesis and progression of ITP by regulating the expression levels of ILC1s,T-bet,IL-12,IL-18 and IFN-γ.

Objective:Exploring the association between Life's Crucial 9 (LC9) and the risk of thyroid dysfunction (TD), as well as its potential predictive capacity.Methods:A total of 247 600 TD-free participants from the UK Biobank were enrolled in the study. The LC9 score was divided into three CVH groups: low (0-), medium (50-), and high (80-100). Cox proportional hazards regression models were used to calculate the HRs and 95% CIs of the risk of TD with LC9 CVH status. Calculate Harrell's concordance index ( C-index), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) to evaluate the predictive ability of the LC9 score and Life's Essential 8 (LE8) score. Results:During a median follow-up of 12.3 years, 5 515, 911, and 4 869 new cases of TD, hyperthyroidism, and hypothyroidism were documented, respectively. Participants with a high LE8 CVH group had 57.00% ( HR=0.43, 95% CI: 0.38-0.49), 55.00% ( HR=0.45, 95% CI: 0.34-0.60), and 58.00% ( HR=0.42, 95% CI: 0.37-0.47) lower risk of TD, hyperthyroidism, and hypothyroidism, respectively, than those with low CVH group. Compared with the LE8 score, the improvement in C-index for the LC9 score predicted TD risk was 0.004 (95% CI: 0.001-0.007), the NRI was 0.101 (95% CI: 0.021-0.103), and the IDI was 0.001 (95% CI: 0.000-0.001). Conclusions:The better CVH status, defined by LC9, was associated with a lower risk of TD. Compared to the LE8 score, the LC9 score demonstrated a significant enhancement in both risk discrimination and reclassification capability for TD risk.

Objective To investigate the expression levels and clinical significance of type Ⅰ innate lymphoid cells(ILC1s),T-box transcription factor(T-bet),interleukin(IL)-12,IL-18 and interferon-gamma(IFN-γ)in peripheral blood of patients with primary immune thrombocytopenia(ITP).Methods Thirty-five ITP patients with their first episode were selected as the initial treatment group.Thirteen of these patients were followed up after receiving treatment.Additionally,20 healthy individuals underwent routine physical examinations during the same period were recruited as the control group.Peripheral blood samples were collected for analysis.The proportion of ILC1s was determined by flow cytometry.T-bet mRNA expression was measured using quantitative real-time PCR(qRT-PCR).Serum levels of IL-18,IL-12 and IFN-γ were quantified by enzyme-linked immunosorbent assay(ELISA).The differences in ILC1s proportion,T-bet mRNA expression and cytokine levels were compared between groups.Correlations between ILC1s proportion,T-bet mRNA,cytokine levels and platelet(PLT)counts were also analyzed.Results Compared with the control group,the initial treatment group exhibited significantly elevated levels of peripheral ILC1s,T-bet mRNA and serum IL-18,IL-12 and IFN-γ(P＜0.05).Among the 13 patients who were followed up,all these indices decreased significantly after treatment(P＜0.05).Correlation analysis revealed that the proportion of ILC1s in the initial treatment group was positively correlated with IL-12,IL-18,IFN-γ and T-bet mRNA levels(rs=0.666,0.647,0.677,and 0.750,respectively,P＜0.01),and negatively correlated with PLT count(rs=-0.637,P＜0.01).Conclusion Innate immunity may play a role in the pathogenesis and progression of ITP by regulating the expression levels of ILC1s,T-bet,IL-12,IL-18 and IFN-γ.

Objective To investigate the characteristics of intestinal microbiota and its relationship with insulin resistance(IR)in patients with type 2 diabetes mellitus(T2DM)and obesity.Methods A total of 80 patients with newly diagnosed T2DM were enrolled in this study from The Second Department of Endocrinology,Qinghai Provincial People's Hospital and divided into simple T2DM group(T2DM,n=40)and T2DM combined with obesity group(Obe,n=40)according to the combination of obesity.The differences of diet structure,biochemical indexes and intestinal flora were compared between the two groups,and the relationship between intestinal flora and BMI,IR was analyzed.Results Compared with the T2DM group,BMI,WC,TG,HOMA-IR,and intake of refined grains,poultry and eggs,and cooking oil were significantly higher(P<0.05),while in take of vegetables and fruits was significantly lower in the Obe group(P<0.05).Microbiota analysis showed that there were 647 OTUs in both groups,90 specific to the T2DM group and 114 specific to the Obe group.The difference of intestinal flora was greater between the two groups than that within the group(P<0.05),and the differences within and between the groups were the least at the phylum level(P<0.05).The dominant flora were Bacteroides and Firmicutes.There were significant differences in the relative abundance of flora in 2 phyla,3 classes,5 orders,8 families,17 genera,and 15 species between the two groups(P<0.05).Bacteroides,Clostridium laprosii and Butylum were positively correlated with BMI(P<0.05),Bifidobacterium,Dialisteria,Streptococcus,Rosesia,Escherichia and Leptotrichia were negatively correlated with BMI(P<0.05).Fusobacterium was positively correlated with HOMA-IR(P<0.05).Conclusions Compared with patients with T2DM alone,patients with T2DM and obesity have a decreased proportion of beneficial bacteria and an increased proportion of pathogenic bacteria in the intestinal flora,which may further aggravate IR and affect the progression of T2DM.