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.

ObjectiveTo investigate the epidemiological feature of Mpox infection and genetic characteristics of Mpox viruses (MPXVs), so as to understand the etiological evolution of the pathogen. MethodsThe cases infected with MPXVs were originated from Changning District, Shanghai from July 20 to August 24 in 2023. Epidemiological investigations were conducted, and throat swabs, anal swabs, or vesicle fluid were collected for MPXVs nucleic acid testing. High-throughput sequencing was performed using Miniseq of the Illumina sequencing platform, and thereafter the sequences were concatenated and analyzed using the online analysis tool Nextclade. An evolutionary tree was constructed using the MEGA 11 software. ResultsAll 8 cases were male, with an average age of (35.76±7.00) years. Among them, 6 cases were identified through active hospital visits, and 2 cases were discovered during contact tracing for Mpox cases. Within the 21 days preceding the disease onset, all cases had male-male sexual behaviors, and the incubation period ranged from 6 to 10 days. 3 cases had a history of sexually transmitted diseases (STDs). MPXVs nucleic acid testing indicated that the detection rate of MPXVs was found to be 25.00% for throat swabs, 87.50% for anal swabs, and 100.00% for vesicle fluid, with statistically significant differences (χ²=11.052, P=0.004). Sequencing analyses using the online tool Nextclade indicated that all 8 MPXVs belonged to the West African clade Ⅱb, 4 MPXVs were classified as C.1 sub-lineages, and 4 MPXVs were identified as C.1.1 sub-lineages. Phylogenetic analysis using MEGA 11 indicated that 5 MPXVs were classified as Lineage C.1.1, closely related to the prevalent strains in Portugal and other European regions. ConclusionThe MPXVs sequences from Changning District are clssified into clade Ⅱb, lineage C.1.1. The detection rates of vesicle fluid and anal swabs for MPXVs are significantly higher than that of throat swabs.

Mitochondrial diseases are a group of hereditary disorders characterized by impaired oxidative phosphorylation in the mitochondrial respiratory chain caused by defects in either mitochondrial DNA or nuclear DNA， and such diseases have complex and diverse clinical manifestations and often involve multiple organs and systems， with the main manifestation of lesions in the nervous system and muscles due to their high energy demands. At present， there is still a lack of effective therapies for most mitochondrial diseases， and therefore， multidisciplinary management is essential in clinical practice， integrating various therapeutic approaches to provide personalized treatment regimens for patients with mitochondrial diseases. The primary treatment principle involves the timely correction of pathological and physiological abnormalities through pharmacological interventions， dietary modifications， and exercise management， along with the prompt treatment of system-specific impairments and the prevention of potential complications.
Diagnosis

Objective:To investigate the effects of basal luteinizing hormone(bLH)and different luteinizing hor-mone/follicle stimulating hormone ratio(LH/FSH)on the pregnancy outcome of in vitro fertilization or intracyto-plasmic sperm injection(IVF/ICSI)in patients with polycystic ovary syndrome(PCOS).Methods:From July 2013 to January 2020,424 PCOS patients who underwent flexible gonadotropin-releasing hormone antagonist protocol for ovulation induction in first IVF/ICSI were collected retrospectively from the department of reproductive medi-cine,The First Affiliated Hospital of Nanjing Medical University.The patients were divided into normal bLH(LH≤10 U/L,316 cases)and high bLH(LH>10 U/L,108 cases)group according to different levels of bLH;At the same time,according to the different levels of LH/FSH ratio,they were divided into low ratio(LH/FSH≤1,227 cases)group,median ratio(10.05).②Compared with patients in different LH/FSH ratio groups,the high ratio group had higher AMH and antral follicle count(AFC)than the other two groups,and the differences were statistically significant(P<0.05).In terms of ovulation induction,the high ratio group had lower numbers of retrieved eggs,transferred embryos,and endometrial thickness on HCG day compared to the other two groups,with statistically significant differences(P<0.05).There was no statistically significant difference in pregnancy outcome indicators among the three groups of patients(P>0.05).③Binary Logistic regression analy-sis showed no significant correlation between live birth rate and bLH,LH/FSH ratio(P>0.05),but the live birth rate was related to the number of embryos transferred(P<0.05).Conclusions:Elevated bLH level and LH/FSH ratio may affect the outcomes of ovulation induction in women with PCOS(such as the number of oocytes re-trieved and endometrial thickness on HCG injection day),but there is no significant correlation with live birth rate of assisted reproduction.

【Objective】 To investigate the development of adaptability in children aged 2 - 6, and to explore its influencing factors, so as to provide reference for promoting the development of adaptability in young children. 【Methods】 Data were from the National Nutrition and Health Systematic Survey for Children in China, and 3 319 children aged 2 - 6 and their parents from 28 sites across 14 provinces were recruited in this study.The Development Scale for Children Aged 0 - 6 years (WS/T 580-2017) was used to measure the developmental quotient of children′s adaptive ability, and a survey questionnaire was used to collect relevant information about children and their parents. 【Results】 Among 3 319 children aged 2 - 6, the proportion of slightly low or low level of adaptability, moderate adaptability development, good and excellent adaptability development was 7.68%,66.25% and 26.06%, respectively.The proportion of children aged 5 - 6 with good and excellent adaptability was lower in 3-year-old and 4-year-old groups (χ²=59.29, P<0.05).Multiple stepwise linear regression showed that children′s gender (β=0.06), gestational age of birth (β=-0.05), only child (β=-0.04), left-behind child (β=-0.04), the main caregiver (β=-0.06), and the education level of parents (β=0.09, 0.10), whether parents actively pay attention to children′s emotions (β=-0.06) and whether children play with homemade toys (β=-0.04) were the influencing factors of children′s adaptive development quotient.Girls, full-term children, only children, non-left-behind children, children with parents as main caregivers, parents with a high level of education, parents who often take the initiative to pay attention to children′s emotions, and children who play with homemade toys had a higher level of adaptability development quotient. 【Conclusions】 The development level of adaptability in children aged 2 - 6 in China is mostly above the average level and is related to multiple factors.Targeted intervention work can be carried out on relevant factors in order to promote the development of children′s adaptability.

Objective To explore the ideas,methods and pathways for the registration of Chinese medicine prescriptions in overseas countries,to form a strategy for overseas registration of Chinese medicine,and to provide technical support and reference for China's Chinese medicine prescriptions to go abroad.Methods Five representative countries were selected to form corresponding expert teams and exchange platforms for international cooperation.The laws,regulations,rules,standards,specifications and technical guidance documents related to Chinese medicine prescription preparations of the target countries were used as pathway research materials,and the documents were translated directly,naturalized,proofread and diagrammed,and a problem-oriented mechanism for consultation with domestic and international experts was established to form a pathway for overseas registration of Chinese medicine prescription preparations.Results The path for standardization of overseas registration of Chinese medicines was clarified,and the detailed registration paths and corresponding work strategies of Chinese medicines in five countries were formulated with flow charts,tables and explanatory texts.Conclusion By developing standardized registration pathways for traditional Chinese medicine in target countries,reference can be provided for the internationalization of Chinese herbal formula preparations.

Diabetic kidney disease(DKD)is a severe complication of diabetes.Its incidence increases annually,posing a significant burden on public health.The strategy of symptomatic treatment based on pathogenesis differentiation,focusing on identifying pathogenesis,is particularly meaningful for managing complex and variable chronic diseases like DKD.Within this framework,the state of latent heat persists throughout DKD,with"latent heat causing accumulation"identified as the core pathogenesis affecting and promoting the development and progression of DKD.This paper is centered on the concept of"latent heat causing accumulation"and adopts symptomatic treatment based on pathogenesis differentiation as its guiding principle to explore the role of latent heat in DKD.It highlights that the onset of DKD involves environmental and constitutional pathogenesis associated with"the concealment of latent heat"and"stagnant-heat invading collaterals"as the initial pathogenesis,"latent heat causing accumulation"as the core mechanism,and"secondary turbid heat"as the derivative pathogenesis.These pathogenesis factors collectively influence the symptoms,sequelae,and prognosis of DKD.Moreover,this paper provides commonly used prescriptions for different stages,syndrome types,and complications of the disease,aiming to offer a reference for clinical practice in flexibly addressing changes in disease conditions based on varied pathogenesis.

Perioperative management and protection are inextricably linked to the occurrence of postoperative complications.Higher levels of postoperative inflammation are associated with increased post-operative complications and mortality.Systemic immune-inflammation index(SII)is a newly proposed sys-temic immune inflammatory response marker,which can better respond to the level of inflammation,and maintaining a low level of SII during surgery can greatly reduce the occurrence of postoperative complica-tions,promote disease recovery,and reduce mortality.Norepinephrine(NE)has the function of inhibiting inflammatory response,inhibiting the synthesis and release of pro-inflammatory factors through β2-adrenergic receptors,and promoting the secretion of anti-inflammatory factor IL-10.Therefore,this review e-laborates on the mechanism of action of norepinephrine and the relationship between NE and systemic SII levels,and further explores the effect of norepinephrine on SII by regulating inflammatory cells.

Malignant tumors pose a serious threat to human health and are one of the main causes of human death worldwide.In order to further improve the therapeutic outcomes of malignant tumors and prolong patients'survival time,clarifying the pathogenesis of malignant tumors and searching for new diagnostic and therapeutic targets become particularly important.It has been found that the occurrence and development of malignant tumors are the results of the interaction between tumor cells and the tumor microenvironment(TME).Versican,encoded by the VCAN gene,is a type of chondroitin sulfate proteoglycan belonging to the exogenous lectin proteoglycan family.It is a major component of the extracellular matrix and plays an important role in embryonic development and inflammatory responses.As an important component of TME,versican is abnormally expressed in various tumor tissues such as renal cell carcinoma,hepatocellular carcinoma,and gastric cancer,and is closely related to the clinical pathological characteristics and prognosis of the patients.It is a potential biomarker for early diagnosis and prognostic evaluation of tumors.Further researches have shown that versican can promote tumor development in a number of ways,such as promoting tumor cell proliferation,invasion and metastasis,inhibiting tumor cell apoptosis,promoting tumor angiogenesis,and inhibiting anti-tumor immune responses.This article reviews the current research status of the expression and biological effects of versican in malignant tumors,aiming to provide reference for subsequent research,clinical diagnosis and treatment of tumors.

This paper aims to conduct an in-depth analysis of the current situation of wind and flood prevention safety management in hospitals and propose effective management optimization strategies,providing reliable basis for scientific preven-tion and defense against typhoons and flood disasters in hospitals.To achieve the established goals,the daily safety management work of the hospital can be steadily promoted through the implementation of a series of measures.Specific measures include opti-mizing early warning response plans,emphasizing leadership by cadres and strengthening their awareness,organizing safety man-agement training and practical exercises throughout the hospital,ensuring emergency material reserves,establishing flood preven-tion facilities,accurately identifying and strengthening the weak links and key areas of wind and flood prevention in the hospital,and continuously optimizing monitoring,etc.When facing natural disasters such as typhoons and floods,hospitals and relevant departments need to formulate effective strategies in a timely manner,conduct advance response deployment,and ensure that all established measures can be effectively implemented.Through scientific and reasonable countermeasures,the safety of employees and patients can be guaranteed,and the normal operation of the hospital during disasters can be ensured to maintain the stability of the society.