Objective To explore the mechanism of Tongluo Baoshen Decoction in improving podocyte injury in rats with IgA nephropathy based on Gprc5b/NF-κB/NLRP3 pathway.Methods Totally 130 SPF-grade male SD rats were randomly divided into a normal group(n=20)and a modeling group(n=110).The IgA nephropathy model was established using a compound modeling method,and 100 modeling rats were randomly divided into model group,losartan potassium group(5 mg/kg),and Tongluo Baoshen Decoction low-,medium-,and high-dosage groups(5.3,10.6,21.2 g/kg),with 20 rats in each group.The administration group was given the corresponding dosage of medication by gavage,while the normal group and model group were given an equal amount of distilled water by gavage once a day.After 4 and 8 weeks of administration,urine samples were collected for 24 hours,and blood and kidney tissue specimens were collected.24-hour urinary protein quantification(24 h-UTP),urinary Nephrin,serum creatinine(SCr),blood urea nitrogen(BUN)and blood uric acid(BUA)contents were detected;RT-qPCR and Western blot were used to detect the expressions of G protein coupled receptor C-family 5b(Gprc5b),nuclear factor(NF)-κB p50,NOD like receptor protein 3(NLRP3),Caspase-1,interleukin(IL)-1β,Nephrin mRNA and protein in renal tissue,respectively;HE,PAS,PASM,Masson staining were used to observe the morphology of renal tissue,immunofluorescence was used to observe IgA deposition in the mesangial area of renal tissue,and transmission electron microscopy was used to observe the ultrastructure of podocytes.Results Compared with the normal group,the model group rats showed significantly increased contents of 24 h-UTP,urinary Nephrin and BUA(P<0.01),the mRNA and protein expressions of Gprc5b,NF-κB p50,NLRP3,Caspase-1 and IL-1β in renal tissue were significantly increased(P<0.01),while the mRNA and protein expressions of Nephrin were significantly decreased(P<0.01),with mild to moderate proliferation of mesangial cells in the glomerulus,increased mesangial matrix,and immunofluorescence showed clustered and linear deposition of IgA in the mesangial area,electron microscopy showed partial fusion of the foot processes.Compared with the model group,the 24 h-UTP and urinary Nephrin contents in different dosage groups of Tongluo Baoshen Decoction and the losartan potassium group after 4 and 8 weeks administration significantly decreased(P<0.01),with a decrease in BUA content in Tongluo Baoshen Decoction high-dosage group(P<0.05),the mRNA and protein expressions of Gprc5b,NF-κB p50,NLRP3,Caspase-1 and IL-1β in renal tissue of Tongluo Baoshen Decoction groups and losartan potassium group decreased(P<0.05,P<0.01),while the mRNA and protein expressions of Nephrin increased(P<0.05,P<0.01),with the proliferation of mesangial cells,the increase of mesangial matrix,the deposition of IgA in the mesangial area,and the fusion of foot processes in renal tissue were alleviated to varying degrees in different dosage groups of Tongluo Baoshen Decoction,with the most significant improvement observed in the high-dosage group.Compared with the 4-week administration,Tongluo Baoshen Decoction high-dose group showed further reductions in 24 h-UTP and urinary Nephrin contents after 8 weeks of administration(P<0.01),further decreases in the mRNA and protein expressions of Gprc5b,NF-κB p50,NLRP3,Caspase-1 and IL-1β in renal tissue(P<0.05,P<0.01),and further increases in the mRNA and protein expressions of Nephrin(P<0.01).Conclusion Tongluo Baoshen Decoction can reduce proteinuria,alleviate renal tissue lesions and improve podocyte injury in IgA nephropathy rats,and its mechanism may be related to the inhibition of Gprc5b/NF-κB/NLRP3 pathway in renal tissue.

Objective To observe the therapeutic effects of Tongluo Baoshen Prescription on IgA nephropathy rats;To explore its mechanism.Methods Totally 130 SD rats were randomly divided into a normal group(20 rats)and a modeling group(110 rats).After establishing the IgA nephropathy model,the modeling group was further randomly divided into the model group,losartan potassium group and Tongluo Baoshen Prescription low-,medium-and high-dosage groups,with 20 rats in each group.Tongluo Baoshen Prescription low-,medium-and high-dosage groups were administered at dosages of 5.3,10.6 and 21.2 g/kg respectively,the losartan potassium group was given with the dosage of 5 mg/kg,the normal group and model group were given an equivalent amount of distilled water by gavage once daily.Blood,urine and kidney tissue samples were collected after 4 and 8 weeks of administration.The hemoglobin content was detected,urinary IL-1β,integrin α3β1 and serum albumin contents were detected by ELISA,and the mRNA and protein expressions of NF-κB p52,NF-κB p65,Rel B,c-Rel and Desmin in renal tissue were detected by RT-qPCR and Western blot,the apoptosis of renal tissue at 8 weeks of administration was detected by TUNEL staining,the expression of C3c in renal tissue was detected by immunofluorescence,the co-expression of Gprc5b,Caspase-1,NLRP3 and Nephrin were detected by immunofluorescence double labeling,the expression of Gprc5b and Nephrin in renal tissue were detected by immunohistochemistry.Results Compared with the normal group,the model group rats showed significantly increased contents of urinary IL-1β and integrin α3β1(P<0.01),with further increases in urinary integrin α3β1 over time(P<0.05);the mRNA and protein expressions of NF-κB p52,NF-κB p65,Rel B,c-Rel and Desmin in renal tissue significantly increased(P<0.01),and the proportion of apoptosis-positive cells in renal tissue significantly increased(P<0.01),immunofluorescence results revealed that C3c exhibited granular and clumpy high-intensity deposition in the mesangial area and capillary loops of the glomeruli(P<0.01),immunofluorescence double labeling showed that the expression of Gprc5b,Caspase-1 and NLRP3 in renal tissue increased(P<0.01),while Nephrin expression significantly decreased(P<0.01),immunohistochemistry analysis showed that the positive expression of Gprc5b in renal tissue significantly increased(P<0.01),while Nephrin significantly decreased(P<0.01).Compared with the model group,the urinary IL-1β and integrin α3β1 contents in the losartan potassium group and Tongluo Baoshen Prescription groups reduced after 4 and 8 weeks of treatment(P<0.05,P<0.01);the mRNA and protein expressions of NF-κB p52,NF-κB p65,Rel B,c-Rel and Desmin in renal tissue decreased(P<0.05,P<0.01),and the proportion of apoptosis-positive cells in renal tissue decreased(P<0.05),the C3c deposition in renal tissue was diminished(P<0.05,P<0.01),immunofluorescence double labeling showed that the expression of Gprc5b,Caspase-1 and NLRP3 in renal tissue were decreased(P<0.05,P<0.01),while Nephrin expression increased(P<0.05,P<0.01),immunohistochemistry analysis showed that the positive expression of Gprc5b in renal tissue decreased(P<0.05,P<0.01),while Nephrin expression increased(P<0.05,P<0.01).Conclusion Tongluo Baoshen Prescription has a protective effect on the kidney of IgA nephropathy rats,and it can improve podocyte injury.The mechanism may be related to the inhibition of the Gprc5b/NF-κB/NLRP3 pathway.

Objective To comparatively analyze the disparities in informatization construction between primary healthcare institu-tions in remote and non-remote areas,clarify the causes and manifestations of regional digital divides,and provide empirical evidence for optimizing resource allocation in remote areas and promoting health equity.The study also offers policy insights for advancing the"Internet+Healthcare"strategy based on local conditions.Methods A stratified sampling survey was conducted among 1 255 primary healthcare institutions in Sichuan Province to systematically compare informatization construction differences between remote and non-remote areas.Results Compared with non-remote areas,remote areas exhibited significant gaps in the coverage of informa-tization infrastructure and the construction of core system integration platforms.Remote areas also had higher absence rates of clinical service systems and notable disparities in institutional informatization investment and the allocation of dedicated IT person-nel.However,remote areas demonstrated strengths in the deployment of health terminals(e.g.,integrated health devices,smart follow-up kits,and wearable devices)and the construction of systems for infection control/communicable disease management and patient follow-up management.Conclusion Regional digital divides are primarily constrained by three factors:fiscal invest-ment,talent reserves,and technical adaptability.A differentiated policy support system is needed to address these challenges.

Thermal ablation (TA) is a widely applied minimally invasive treatment for benign thyroid nodules and low-risk papillary thyroid microcarcinoma. Compared to conventional surgery, TA offers advantages such as minimal trauma, rapid recovery, and no scarring. However, this procedure may lead to various complications, including intraoperative pain, nerve injury, hemorrhage, tracheal injury, skin burns, vasovagal reactions, nodule rupture, and thyroid dysfunction. Although TA demonstrates excellent safety and efficacy, further standardization of procedural protocols is necessary to minimize the incidence of complications.

Objective:To evaluate the predictive role of ultrasound, genetic testing, and clinical features in the malignancy risk of Bethesda Ⅲ thyroid nodules, and to explore strategies for optimizing treatment decisions.Methods:This retrospective study included 227 Bethesda Ⅲ thyroid nodules from patients who underwent surgical treatment at the Thyroid Surgery Department of Nanjing Drum Tower Hospital between Jan. 2020 and Dec. 2023. All patients underwent ultrasound evaluation and fine-needle aspiration. For nodules diagnosed as ultrasound, genetic testing, and clinical features were analyzed using univariate and multivariate regression to assess their association with malignancy.Results:Among the 227 nodules, 214 were malignant, resulting in a malignancy rate of 94.2%. The malignancy rate of thyroid nodules was 94.2%. In univariate analysis, age ( P=0.016), BRAF V600E gene mutation ( P<0.001), nodule size ( P=0.002), and TIRADS ( P<0.001) were significantly associated with malignancy in Bethesda Ⅲ thyroid nodules. Multivariate analysis confirmed that age ( OR=0.939, P=0.049) and BRAF V600E gene mutation ( OR=24.641, P<0.001) were significantly associated with thyroid nodule nature and served as independent predictive factors for malignancy. Conclusions:Genetic testing is an important method for predicting the malignancy of Bethesda Ⅲ thyroid nodules, and ultrasound also has high clinical value in assessing the malignancy risk of nodules. While some clinical features are highly correlated with nodule characteristics, they may not be practical in clinical application. For nodules classified as TIRADS 3 through ultrasound evaluation and negative for BRAF mutations, continued observation may be considered, whereas TIRADS 5 nodules or nodules with BRAF mutations should be prioritized for surgical treatment.

Thermal ablation (TA) is a widely applied minimally invasive treatment for benign thyroid nodules and low-risk papillary thyroid microcarcinoma. Compared to conventional surgery, TA offers advantages such as minimal trauma, rapid recovery, and no scarring. However, this procedure may lead to various complications, including intraoperative pain, nerve injury, hemorrhage, tracheal injury, skin burns, vasovagal reactions, nodule rupture, and thyroid dysfunction. Although TA demonstrates excellent safety and efficacy, further standardization of procedural protocols is necessary to minimize the incidence of complications.

Objective:To evaluate the predictive role of ultrasound, genetic testing, and clinical features in the malignancy risk of Bethesda Ⅲ thyroid nodules, and to explore strategies for optimizing treatment decisions.Methods:This retrospective study included 227 Bethesda Ⅲ thyroid nodules from patients who underwent surgical treatment at the Thyroid Surgery Department of Nanjing Drum Tower Hospital between Jan. 2020 and Dec. 2023. All patients underwent ultrasound evaluation and fine-needle aspiration. For nodules diagnosed as ultrasound, genetic testing, and clinical features were analyzed using univariate and multivariate regression to assess their association with malignancy.Results:Among the 227 nodules, 214 were malignant, resulting in a malignancy rate of 94.2%. The malignancy rate of thyroid nodules was 94.2%. In univariate analysis, age ( P=0.016), BRAF V600E gene mutation ( P<0.001), nodule size ( P=0.002), and TIRADS ( P<0.001) were significantly associated with malignancy in Bethesda Ⅲ thyroid nodules. Multivariate analysis confirmed that age ( OR=0.939, P=0.049) and BRAF V600E gene mutation ( OR=24.641, P<0.001) were significantly associated with thyroid nodule nature and served as independent predictive factors for malignancy. Conclusions:Genetic testing is an important method for predicting the malignancy of Bethesda Ⅲ thyroid nodules, and ultrasound also has high clinical value in assessing the malignancy risk of nodules. While some clinical features are highly correlated with nodule characteristics, they may not be practical in clinical application. For nodules classified as TIRADS 3 through ultrasound evaluation and negative for BRAF mutations, continued observation may be considered, whereas TIRADS 5 nodules or nodules with BRAF mutations should be prioritized for surgical treatment.

Objective To comparatively analyze the disparities in informatization construction between primary healthcare institu-tions in remote and non-remote areas,clarify the causes and manifestations of regional digital divides,and provide empirical evidence for optimizing resource allocation in remote areas and promoting health equity.The study also offers policy insights for advancing the"Internet+Healthcare"strategy based on local conditions.Methods A stratified sampling survey was conducted among 1 255 primary healthcare institutions in Sichuan Province to systematically compare informatization construction differences between remote and non-remote areas.Results Compared with non-remote areas,remote areas exhibited significant gaps in the coverage of informa-tization infrastructure and the construction of core system integration platforms.Remote areas also had higher absence rates of clinical service systems and notable disparities in institutional informatization investment and the allocation of dedicated IT person-nel.However,remote areas demonstrated strengths in the deployment of health terminals(e.g.,integrated health devices,smart follow-up kits,and wearable devices)and the construction of systems for infection control/communicable disease management and patient follow-up management.Conclusion Regional digital divides are primarily constrained by three factors:fiscal invest-ment,talent reserves,and technical adaptability.A differentiated policy support system is needed to address these challenges.

Objective To explore the mechanism of Tongluo Baoshen Decoction in improving podocyte injury in rats with IgA nephropathy based on Gprc5b/NF-κB/NLRP3 pathway.Methods Totally 130 SPF-grade male SD rats were randomly divided into a normal group(n=20)and a modeling group(n=110).The IgA nephropathy model was established using a compound modeling method,and 100 modeling rats were randomly divided into model group,losartan potassium group(5 mg/kg),and Tongluo Baoshen Decoction low-,medium-,and high-dosage groups(5.3,10.6,21.2 g/kg),with 20 rats in each group.The administration group was given the corresponding dosage of medication by gavage,while the normal group and model group were given an equal amount of distilled water by gavage once a day.After 4 and 8 weeks of administration,urine samples were collected for 24 hours,and blood and kidney tissue specimens were collected.24-hour urinary protein quantification(24 h-UTP),urinary Nephrin,serum creatinine(SCr),blood urea nitrogen(BUN)and blood uric acid(BUA)contents were detected;RT-qPCR and Western blot were used to detect the expressions of G protein coupled receptor C-family 5b(Gprc5b),nuclear factor(NF)-κB p50,NOD like receptor protein 3(NLRP3),Caspase-1,interleukin(IL)-1β,Nephrin mRNA and protein in renal tissue,respectively;HE,PAS,PASM,Masson staining were used to observe the morphology of renal tissue,immunofluorescence was used to observe IgA deposition in the mesangial area of renal tissue,and transmission electron microscopy was used to observe the ultrastructure of podocytes.Results Compared with the normal group,the model group rats showed significantly increased contents of 24 h-UTP,urinary Nephrin and BUA(P<0.01),the mRNA and protein expressions of Gprc5b,NF-κB p50,NLRP3,Caspase-1 and IL-1β in renal tissue were significantly increased(P<0.01),while the mRNA and protein expressions of Nephrin were significantly decreased(P<0.01),with mild to moderate proliferation of mesangial cells in the glomerulus,increased mesangial matrix,and immunofluorescence showed clustered and linear deposition of IgA in the mesangial area,electron microscopy showed partial fusion of the foot processes.Compared with the model group,the 24 h-UTP and urinary Nephrin contents in different dosage groups of Tongluo Baoshen Decoction and the losartan potassium group after 4 and 8 weeks administration significantly decreased(P<0.01),with a decrease in BUA content in Tongluo Baoshen Decoction high-dosage group(P<0.05),the mRNA and protein expressions of Gprc5b,NF-κB p50,NLRP3,Caspase-1 and IL-1β in renal tissue of Tongluo Baoshen Decoction groups and losartan potassium group decreased(P<0.05,P<0.01),while the mRNA and protein expressions of Nephrin increased(P<0.05,P<0.01),with the proliferation of mesangial cells,the increase of mesangial matrix,the deposition of IgA in the mesangial area,and the fusion of foot processes in renal tissue were alleviated to varying degrees in different dosage groups of Tongluo Baoshen Decoction,with the most significant improvement observed in the high-dosage group.Compared with the 4-week administration,Tongluo Baoshen Decoction high-dose group showed further reductions in 24 h-UTP and urinary Nephrin contents after 8 weeks of administration(P<0.01),further decreases in the mRNA and protein expressions of Gprc5b,NF-κB p50,NLRP3,Caspase-1 and IL-1β in renal tissue(P<0.05,P<0.01),and further increases in the mRNA and protein expressions of Nephrin(P<0.01).Conclusion Tongluo Baoshen Decoction can reduce proteinuria,alleviate renal tissue lesions and improve podocyte injury in IgA nephropathy rats,and its mechanism may be related to the inhibition of Gprc5b/NF-κB/NLRP3 pathway in renal tissue.

Objective To observe the therapeutic effects of Tongluo Baoshen Prescription on IgA nephropathy rats;To explore its mechanism.Methods Totally 130 SD rats were randomly divided into a normal group(20 rats)and a modeling group(110 rats).After establishing the IgA nephropathy model,the modeling group was further randomly divided into the model group,losartan potassium group and Tongluo Baoshen Prescription low-,medium-and high-dosage groups,with 20 rats in each group.Tongluo Baoshen Prescription low-,medium-and high-dosage groups were administered at dosages of 5.3,10.6 and 21.2 g/kg respectively,the losartan potassium group was given with the dosage of 5 mg/kg,the normal group and model group were given an equivalent amount of distilled water by gavage once daily.Blood,urine and kidney tissue samples were collected after 4 and 8 weeks of administration.The hemoglobin content was detected,urinary IL-1β,integrin α3β1 and serum albumin contents were detected by ELISA,and the mRNA and protein expressions of NF-κB p52,NF-κB p65,Rel B,c-Rel and Desmin in renal tissue were detected by RT-qPCR and Western blot,the apoptosis of renal tissue at 8 weeks of administration was detected by TUNEL staining,the expression of C3c in renal tissue was detected by immunofluorescence,the co-expression of Gprc5b,Caspase-1,NLRP3 and Nephrin were detected by immunofluorescence double labeling,the expression of Gprc5b and Nephrin in renal tissue were detected by immunohistochemistry.Results Compared with the normal group,the model group rats showed significantly increased contents of urinary IL-1β and integrin α3β1(P<0.01),with further increases in urinary integrin α3β1 over time(P<0.05);the mRNA and protein expressions of NF-κB p52,NF-κB p65,Rel B,c-Rel and Desmin in renal tissue significantly increased(P<0.01),and the proportion of apoptosis-positive cells in renal tissue significantly increased(P<0.01),immunofluorescence results revealed that C3c exhibited granular and clumpy high-intensity deposition in the mesangial area and capillary loops of the glomeruli(P<0.01),immunofluorescence double labeling showed that the expression of Gprc5b,Caspase-1 and NLRP3 in renal tissue increased(P<0.01),while Nephrin expression significantly decreased(P<0.01),immunohistochemistry analysis showed that the positive expression of Gprc5b in renal tissue significantly increased(P<0.01),while Nephrin significantly decreased(P<0.01).Compared with the model group,the urinary IL-1β and integrin α3β1 contents in the losartan potassium group and Tongluo Baoshen Prescription groups reduced after 4 and 8 weeks of treatment(P<0.05,P<0.01);the mRNA and protein expressions of NF-κB p52,NF-κB p65,Rel B,c-Rel and Desmin in renal tissue decreased(P<0.05,P<0.01),and the proportion of apoptosis-positive cells in renal tissue decreased(P<0.05),the C3c deposition in renal tissue was diminished(P<0.05,P<0.01),immunofluorescence double labeling showed that the expression of Gprc5b,Caspase-1 and NLRP3 in renal tissue were decreased(P<0.05,P<0.01),while Nephrin expression increased(P<0.05,P<0.01),immunohistochemistry analysis showed that the positive expression of Gprc5b in renal tissue decreased(P<0.05,P<0.01),while Nephrin expression increased(P<0.05,P<0.01).Conclusion Tongluo Baoshen Prescription has a protective effect on the kidney of IgA nephropathy rats,and it can improve podocyte injury.The mechanism may be related to the inhibition of the Gprc5b/NF-κB/NLRP3 pathway.