Objective To investigate the cross-sectional associations between different fatty liver classifications and cardiac structure and function in people undergo health examination. Methods A total of 6 545 adults who underwent health examinations at the Health Management Center of Zhongshan Hospital, Fudan University between January 1 and December 31, 2017, were retrospectively included. Demographic characteristics and laboratory data were collected. The hepatic steatosis was graded by ultrasonography. And patients with fatty liver were further stratified according to alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels, as well as the degree of liver fibrosis. Cardiac morphology and function were assessed by transthoracic echocardiography, and left ventricular geometric patterns were classified accordingly. Multivariate logistic regression analysis was performed to evaluate the associations between fatty liver classifications and cardiac abnormalities. Results There were 2 795 patients (42.7%) with fatty liver, of whom 832 (29.8%) had significant cardiac structural alterations and 1 500 (53.7%) had diastolic dysfunction. Severe fatty liver was risk factor for concentric remodeling and increased relative wall thickness (RWT), with odds ratios (ORs) of 1.27 (P＝0.012) and 1.27 (P＝0.009), respectively. Fatty liver accompanied by elevated ALT or AST was risk factor for concentric remodeling (OR＝1.45,1.56; P＝0.001, 0.001), increased RWT (OR＝1.48,1.57; P＜0.001, ＜0.001), and diastolic dysfunction (OR＝1.27, 1.32; P＝0.035, 0.040), respectively. Fatty liver with liver fibrosis was risk factor for concentric remodeling (OR＝1.83, P＝0.046) and diastolic dysfunction (OR＝2.64, P＝0.034). Conclusions Advanced fatty liver, including severe hepatic steatosis, accompanied by elevated liver enzymes or liver fibrosis, could increase risks of cardiac remodeling and diastolic dysfunction, while systolic function is preserved. For patients with fatty liver, it is recommended to undergo regular ultrasonography examination.

As one of the common systemic vasculitides in children， IgA vasculitis is closely associated with the interaction of "Wind pathogen" and "turbid stasis" in its pathogenesis. Based on the blood turbidity theory， this paper proposes "wind agitating blood turbidity and collateral damage" as the core pathogenesis. Regarding treatment， the sequential therapeutic principle of "stanch bleeding， activating blood circulation， and nourishing blood" is adopted， and combined with the dynamic application of wind-dispelling medicinals to "expel， search， and guard against wind"， turbidity-removing method is applied throughout all stages. In the acute stage，it is recommended to clear heat and purify turbidity， stanch bleeding and secure the collaterals. In the prolonged stage， the method of dissipating stasis and clearing up turbidity should be used， as well as activating blood circulation and unblocking the collaterals. In the recovery stage， it is advised to nourish blood to flourish the collaterals， reinforce healthy qi and resolve turbidity. This therapeutic system integrates the elimination of pathogens and the reinforcement of healthy qi to clear and resolve blood turbidity， ultimately achieving holistic collateral repair through securing， unblocking， and nourishing the collaterals， which provides new insights into the treatment of this disease in traditional Chinese medicine.

Based on the view that wind pathogen runs through the entire course of the occurrence and development of nephrotic syndrome， it is proposed that the core pathogenesis of refractory nephrotic syndrome （RNS） in children involves imbalance of the lung， spleen， and kidney， invasion of wind pathogen， and stagnation of turbidity and stasis， and that directing the turbid downward with wind medicinals is the key therapeutic strategy. In clinical practice， according to the distinct pathogenic characteristics of three patterns， including defensive qi insecurity of the lung， yang deficiency with loss of regulation， and binding of turbidity and stasis， three corresponding methods are applied， which are diffusing the lung to consolidate defensive qi， elevating yang to supplement the spleen and kidney， and activating blood to unblock turbidity and stasis. For the pattern of defensive qi insecurity of the lung， wind medicinals are used to penetrate and disperse external pathogens， such as fangfeng （Radix Saposhnikoviae） and mahuang （Herba Ephedrae） for diffusing the lung， dispersing wind， and consolidating defensive qi. For yang deficiency with loss of regulation pattern， wind medicinals are employed to elevate yang and assist transformation， such as shengma （Rhizoma Cimicifugae） and gegen （Radix Puerariae Lobatae） for raising clear yang， warming and activating the spleen and kidney. For binding of turbidity and stasis pattern， wind medicinals with scurrying and collateral‑unblocking properties are used， such as jixueteng （Caulis Spatholobi）， luoshiteng （Caulis Trachelospermi）， and chuanshanlong （Rhizoma Dioscoreae Nipponicae） for dispelling wind， activating blood， resolving stasis， and directing turbidity downward. In all these methods， the core principle is to use wind medicinals to regulate qi movement， open and unblock the sweat pores， and separately eliminate turbid pathogens， thereby providing a theoretical and practical basis for the traditional Chinese medicine diagnosis and treatment of RNS in children.

Based on the view that wind pathogen runs through the entire course of the occurrence and development of nephrotic syndrome， it is proposed that the core pathogenesis of refractory nephrotic syndrome （RNS） in children involves imbalance of the lung， spleen， and kidney， invasion of wind pathogen， and stagnation of turbidity and stasis， and that directing the turbid downward with wind medicinals is the key therapeutic strategy. In clinical practice， according to the distinct pathogenic characteristics of three patterns， including defensive qi insecurity of the lung， yang deficiency with loss of regulation， and binding of turbidity and stasis， three corresponding methods are applied， which are diffusing the lung to consolidate defensive qi， elevating yang to supplement the spleen and kidney， and activating blood to unblock turbidity and stasis. For the pattern of defensive qi insecurity of the lung， wind medicinals are used to penetrate and disperse external pathogens， such as fangfeng （Radix Saposhnikoviae） and mahuang （Herba Ephedrae） for diffusing the lung， dispersing wind， and consolidating defensive qi. For yang deficiency with loss of regulation pattern， wind medicinals are employed to elevate yang and assist transformation， such as shengma （Rhizoma Cimicifugae） and gegen （Radix Puerariae Lobatae） for raising clear yang， warming and activating the spleen and kidney. For binding of turbidity and stasis pattern， wind medicinals with scurrying and collateral‑unblocking properties are used， such as jixueteng （Caulis Spatholobi）， luoshiteng （Caulis Trachelospermi）， and chuanshanlong （Rhizoma Dioscoreae Nipponicae） for dispelling wind， activating blood， resolving stasis， and directing turbidity downward. In all these methods， the core principle is to use wind medicinals to regulate qi movement， open and unblock the sweat pores， and separately eliminate turbid pathogens， thereby providing a theoretical and practical basis for the traditional Chinese medicine diagnosis and treatment of RNS in children.

Based on the theory of "cold qi generates turbidity" described in the Inner Canon of Yellow Emperor （《黄帝内经》）， together with the physiological characteristics of children， who are considered to have an inherent insufficiency of the lung， spleen， and kidney， and the clinical features of recurrent refractory nephrotic syndrome （RNS）， this article proposes that the pathogenesis of RNS in children is characterized by yang deficiency with internal cold， turbidity arising from cold， latent turbidity transforming into toxin， activation by newly contracted pathogens， and turbid toxins damaging the collaterals. The core pathogenesis is identified as yang deficiency， turbidity coagulation， and collateral damage. Accordingly， the general treatment principle is warming yang and eliminating turbidity， with coordination of three methods including warming yang to strengthen the body's foundation， promoting yang to relieve constraint， and raising yang while replenishing qi. Zhenwu Decoction （真武汤） is employed as the basic prescription with modification according to syndrome differentiation， to achieve an effect eliminating turbidity and arresting leakage， restoring kidney function by unblocking the collaterals， and consolidating recovery to prevent relapse.

Epidemiological investigations and clinical studies have shown that inappropriate ambient temperatures (high and low temperatures) are the independent risk factors for ischemic stroke, but their underlying physiological mechanisms are not fully understood. This article systematically reviews the potential mechanisms by which inappropriate ambient temperatures promote the occurrence of ischemic stroke through multiple pathways, such as activating the sympathetic-renin-angiotensin system, inducing systemic inflammation and oxidative stress, damaging the integrity of the intestinal barrier and blood-brain barrier, and disrupting coagulation-fibrinolysis balance.

Autoimmune disease is a kind of disease characterized by immune imbalance,abnormal activation of immune cells,massive production of inflammatory factors and immune complexes,which leads to the damage of multiple organs and systems.Autoimmune disease is easy to recur in clinical practice.The previous studies showed that there is a correlation between dampness syndrome in traditional Chinese medicine(TCM)and immune dysfunction.This paper explains the theoretical basis for the correlation between dampness syndrome of TCM and the recurrence of autoimmune diseases,and the similarities between the two in macro appearance,pathogenesis characteristics,etc.,analyzes the possible correlation about biological mechanism between dampness syndrome and autoimmune diseases,and discussed the correlation between pathogenic dampness of TCM and the recurrence of autoimmune diseases such as psoriasis,rheumatoid arthritis,ulcerative colitis,and nephrotic syndrome.It is pointed out that pathogenic dampness of TCM is an important pathogenic factor for the recurrence of autoimmune diseases,and is closely related to the recurrence of autoimmune diseases.Autoimmune diseases can be treated from the perspective of pathogenic dampness in TCM,and therapy of invigorating spleen,replenishing qi and removing dampness is frequently adopted,which is beneficial to alleviating the clinical symptoms of patients and reducing the recurrence of autoimmune disease.

Objective To compare the efficacy and safety of computed tomography (CT)-guided percutaneous versus electromagnetic navigation bronchoscopy (ENB)-guided microwave ablation (MWA) for the treatment of pulmonary nodules. Methods A retrospective analysis was conducted on the data of high-risk pulmonary nodule patients who underwent MWA at the Nanjing Drum Tower Hospital between 2022 and 2023. The pathological diagnosis rate, complications, and progression-free survival (PFS) rate were compared between the CT group and the ENB group. Results There were 61 patients in the CT group, including 30 males and 31 females, with an average age of (67.22±9.13) years. There were 53 patients in the ENB group, including 29 males and 24 females, with an average age of (65.29±13.76) years. The pathological diagnosis rate in the CT group was slightly higher than that in the ENB group (88.52% vs. 71.69%, P=0.03). However, the ENB group exhibited a lower incidence of perioperative complications, including pneumothorax (16.39% vs. 3.77%, P=0.03), hemoptysis (19.67% vs. 5.66%, P=0.05), and pain (22.95% vs. 7.55%, P=0.03). There was no statistically significant difference in PFS rate between the two groups [HR=1.17, 95%CI (0.23, 5.81), P=0.85]. Conclusion Both CT-guided and ENB-guided MWA are effective treatment modalities for high-risk pulmonary nodules.

OBJECTIVE: To explore the prenatal features and genetic etiology of a fetus with Short-rib cage dysplasia (SRTD) due to variants of DYNC2H1 gene. METHODS: A pregnant women presented at Xinxiang Central Hospital in June 2020 for abnormal prenatal ultrasound findings was selected as the study subject. With informed consent obtained, amniotic fluid sample was extracted from the woman, and clinical data of the fetus were collected. Whole exome sequencing (WES) was carried out, and candidate variants were verified by Sanger sequencing. This study was approved by the Medical Ethics Committee of Xinxiang Central Hospital [Ethics No.: 2025-214-01(K)]. RESULTS: At 25⁺⁶ weeks gestation, genetic testing revealed that the fetus has harbored compound heterozygous variants of the DYNC2H1 gene, namely c.10585C>T (p.Arg3529Ter) and c.8954T>G (p.Val2985Gly), which were derived from its father and mother, respectively. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the c.10585C>T (p.Arg3529Ter) and c.8954T>G (p.Val2985Gly) variants were classified as pathogenic (PVS1+PM2_supporting+PM3+PP5) and likely pathogenic (PM1+PM2_supporting+PM3+PP3), respectively. Bioinformatics analysis suggested that both variants may affect the 3D structure of the DYNC2H1 protein. CONCLUSION The compound heterozygous variants of c.10585C>T (p.Arg3529Ter) and c.8954T>G (p.Val2985Gly) of the DYNC2H1 gene probably underlay the pathogenesis of SRTD in the fetus. Above findings had facilitated prenatal diagnosis and genetic counseling for the couple.
Humans ; Female ; Pregnancy ; Cytoplasmic Dyneins/chemistry* ; Prenatal Diagnosis ; Adult ; Short Rib-Polydactyly Syndrome/diagnostic imaging* ; Mutation ; Exome Sequencing ; Fetus/abnormalities* ; Ultrasonography, Prenatal

Objective:To explore the predictive value of human cartilage glycoprotein 39 (YKL-40) and growth differentiation factor 15 (GDF-15) for clinical outcomes of patients with Parkinson disease (PD).Methods:A total of 109 patients with PD admitted to Xinxiang Central Hospital from February 2021 to February 2023 were selected and treated with regular anti-PD medications for 4 weeks, with dosage appropriately adjusted according to clinical status and individual response.Clinical outcomes were evaluated after 2 months of treatment, and the predictive value of serum YKL-40 and GDF-15 at admission for clinical outcomes was analyzed.Data were analyzed by independent sample t-test, χ2 test and Logistic regression using SPSS 26.0. Results:PD patients with poor outcomes exhibited higher serum levels of YKL-40((3.18±0.67)mg/L, (2.34±0.41)mg/L) and GDF-15((457.82±142.83)pg/mL, (282.95±105.96)pg/mL) than those with good outcomes, and the differences were statistically significant ( t=8.082, 7.349, both P<0.05).Logistic regression analysis showed that elevated serum levels of YKL-40( B=0.664, OR=1.943, 95% CI=1.237-3.052) and GDF-15( B=0.185, OR=1.787, 95% CI=1.145-2.789) both influenced the clinical outcomes of PD patients(both P<0.05).Serum YKL-40 combined with GDF-15 demonstrated a predictive sensitivity of 87.23%, specificity of 90.32%, and AUC of 0.927(95% CI=0.861-0.968) for clinical outcomes in PD patients.The AUC was significantly higher than that achieved by either indicator alone (YKL-40: AUC (95% CI)=0.722 (0.628-0.804); GDF-15: AUC (95% CI)=0.797 (0.709-0.868)). Conclusion:The elevated levels of YKL-40 and GDF-15 in PD patients are associated with clinical outcomes, which may be the potential markers for predicting clinical outcomes of patients with PD.