BACKGROUND: Approximately 40% of individuals with diabetes worldwide are at risk of developing diabetic kidney disease (DKD), which is not only the leading cause of kidney failure, but also significantly increases the risk of cardiovascular disease, causing significant societal health and financial burdens. This study aimed to describe the burden of DKD and explore its cross-country epidemiological status, predict development trends, and assess its risk factors and sociodemographic transitions. METHODS: Based on the Global Burden of Diseases (GBD) Study 2021, data on DKD due to type 1 diabetes (DKD-T1DM) and type 2 diabetes (DKD-T2DM) were analyzed by sex, age, year, and location. Numbers and age-standardized rates were used to compare the disease burden between DKD-T1DM and DKD-T2DM among locations. Decomposition analysis was used to assess the potential drivers. Locally weighted scatter plot smoothing and Frontier analysis were used to estimate sociodemographic transitions of DKD disability-adjusted life years (DALYs). RESULTS: The DALYs due to DKD increased markedly from 1990 to 2021, with a 74.0% (from 2,227,518 to 3,875,628) and 173.6% (from 4,122,919 to 11,278,935) increase for DKD-T1DM and DKD-T2DM, respectively. In 2030, the estimated DALYs for DKD-T1DM surpassed 4.4 million, with that of DKD-T2DM exceeding 14.6 million. Notably, middle-sociodemographic index (SDI) quintile was responsible for the most significant DALYs. Decomposition analysis revealed that population growth and aging were major drivers for the increased DKD DALYs in most regions. Interestingly, the most pronounced effect of positive DALYs change from 1990 to 2021 was presented in high-SDI quintile, while in low-SDI quintile, DALYs for DKD-T1DM and DKD-T2DM presented a decreasing trend over the past years. Frontiers analysis revealed that there was a negative association between SDI quintiles and age-standardized DALY rates (ASDRs) in DKD-T1DM and DKD-T2DM. Countries with middle-SDI shouldered disproportionately high DKD burden. Kidney dysfunction (nearly 100.0% for DKD-T1DM and DKD-T2DM), high fasting plasma glucose (70.8% for DKD-T1DM and 87.4% for DKD-T2DM), and non-optimal temperatures (low and high, 5.0% for DKD-T1DM and 5.1% for DKD-T2DM) were common risk factors for age-standardized DALYs in T1DM-DKD and T2DM-DKD. There were other specific risk factors for DKD-T2DM such as high body mass index (38.2%), high systolic blood pressure (10.2%), dietary risks (17.8%), low physical activity (6.2%), lead exposure (1.2%), and other environmental risks. CONCLUSIONS DKD markedly increased and varied significantly across regions, contributing to a substantial disease burden, especially in middle-SDI countries. The rise in DKD is primarily driven by population growth, aging, and key risk factors such as high fasting plasma glucose and kidney dysfunction, with projections suggesting continued escalation of the burden by 2030.
Humans ; Global Burden of Disease ; Risk Factors ; Male ; Female ; Disability-Adjusted Life Years ; Diabetic Nephropathies/epidemiology* ; Middle Aged ; Diabetes Mellitus, Type 2/epidemiology* ; Adult ; Diabetes Mellitus, Type 1/complications* ; Aged ; Adolescent ; Young Adult ; Quality-Adjusted Life Years

OBJECTIVE To establish a comprehensive evaluation system for lipid-lowering drugs aligned with the clinical reality of Liaoning province， and to assess the commonly used lipid-lowering drugs in medical institutions within Liaoning province. METHODS A comprehensive evaluation system for lipid-lowering drugs of Liaoning province was established using literature analysis and the Delphi expert consultation method. A calculation method of “indicator weighted score” to “step-by-step aggregation” to “percentile standardization” was employed to enable horizontal comparison of 49 commonly used lipid-lowering drugs. RESULTS This study successfully established a comprehensive clinical evaluation system for lipid-lowering drugs of Liaoning province， comprising 7 first-level indicators， 35 second-level indicators， and 116 scoring criteria. Among the first-level indicators， effectiveness （23%） had the highest weight， followed sequentially by safety （22%）， innovativeness （15%）， economy （13%）， suitability （13%）， accessibility （10%）， and other attributes （4%）. Among the 49 evaluated lipid-lowering drugs， the top 10 in overall score were all statins， with rosuvastatin calcium tablet B having the highest total score of 79.22. Inclisiran sodium injection had a total score of 57.14， performed outstandingly in safety （16.27） and innovativeness （11.27）. CONCLUSIONS This study established a relatively comprehensive and detailed clinical evaluation system for lipid-lowering drugs of Liaoning province. Statins remain the cornerstone of lipid management. Most patients can primarily choose drugs like rosuvastatin tablet B， while PCSK9 inhibitors and fixed-dose combinations can be considered for patients with conventional treatment failure or statin intolerance.

Background Water serves as an indispensable resource for human survival and constitutes one of the primary means through which humans are exposed to environmental chemicals. Consequently, the safety of drinking water is critical to safeguarding public health. Objective To analyze the levels of the 10 metal/metalloid indicators [Al, Fe, Mn, Cu, Zn, As, Cd, Cr(VI), Pb, and Hg] in drinking water from a region of the Fuchun River Basin, and to evaluate the health risks in drinking water through oral ingestion. Methods In accordance with the national Standard Examination Method for Drinking Water – Part 2: Collection and Preservation of Water Samples (GB/T 5750-2006 and GB/T 5750-2023), a total of 2016 drinking water samples were collected from urban and rural water supply systems in a region of the Fuchun Basin from 2017 to 2024. Two batches of water samples were collected annually during the dry and wet seasons, with each batch comprising 72 samples from the urban water supply system and 54 samples from the rural water supply system. These samples were analyzed according to the Standard Examination Method for Drinking Water – Part 6: Metal and Metalloid Indicators (GB/T 5750-2006 and GB/T 5750-2023) and the results were compared with the limits specified in the Standards for Drinking Water Quality (GB 5749-2022). Health risks were evaluated using the U.S. Environmental Protection Agency (EPA) health risk assessment model. Results All tested metal/metalloid elements in the drinking water samples of the area met the national standards. The results of risk assessment showed that the non-carcinogenic risks associated with oral intake of drinking water, ranked from highest to lowest, were as follows: As>Cr(VI)>Pb>Cd>Hg>Mn>Cu>Zn>Fe>Al, with values of 4.55×10⁻², 2.79×10⁻², 2.06×10⁻², 1.20×10⁻², 4.95×10⁻³, 4.58×10⁻³, 2.85×10⁻³, 1.95×10⁻³, 1.52×10⁻³, and 9.21×10⁻⁴, respectively. The non-carcinogenic risk of each indicator was less than 1, which suggested no potential risk to population health. The carcinogenic risks ranked as Cr(VI)>As>Cd>Pb, with values of 4.18×10⁻⁵, 2.05×10⁻⁵, 3.85×10⁻⁶, and 2.45×10⁻⁷, respectively. The carcinogenic risks of Cr(VI), As, and Cd were between 10⁻⁶ and 10⁻⁴, which suggested an acceptable carcinogenic risk, while the carcinogenic risk of Pb was relatively negligible. Children's total non-carcinogenic/total carcinogenic risks were comparable to those of adult males, both higher than those of adult females. Additionally, rural areas exhibited higher non-carcinogenic/carcinogenic risks for Cr(VI), while those risks for As and Pb were lower than those in urban water samples, and those risks for Cd were comparable between the two. Conclusion The concentrations of the 10 metal/metalloid indicators in drinking water from the studied region in the Fuchun River Basin comply with the national standards from 2017 to 2024. There is a certain carcinogenic risk associated with oral intake of drinking water, but it is still within the acceptable range. In terms of non-carcinogenic risk, no potential threat to population health is anticipated.

OBJECTIVE:To assess the efficacy and safety of acupuncture in treating postmenopausal osteoporosis.METHODS:Clinical randomized controlled trials on acupuncture for postmenopausal osteoporosis were retrieved from databases including CNKI,VIP,WanFang,China Biomedical Literature Service System,Web of Science,PubMed,Embase,and Cochrane Library.The search period was from the inception of the database to July 23,2024.The quality of evidence and risk of bias of the included studies were assessed using the GRADEprofiler and the revised Cochrane risk-of-bias tool for randomized trials(RoB 2.0).Meta-analysis was performed using StataSE 15 and TSA 0.9.5,along with heterogeneity analysis,sensitivity analysis,subgroup analysis,publication bias analysis,trim-and-fill analysis,and trial sequential analysis.RESULTS:The study included 19 randomized controlled trials involving a total of 1 464 patients.(1)The meta-analysis revealed that compared with conventional therapies,acupuncture significantly increased the total effective rate(RR=1.25,95％confidence interval[1.19,1.32],P＜0.001),lumbar spine L2-L4 bone mineral density(mean difference=0.08,95％confidence interval[0.05,0.11],P＜0.001),and estrogen levels(standard mean difference=0.55,95％confidence interval[0.30,0.81],P＜0.001).Additionally,acupuncture increased bone mineral density and gonadotropin levels in the femoral neck,greater trochanter,and Ward's triangle,reduced visual analogue scale scores,and improved bone metabolism without significantly increasing the incidence of adverse events.(2)Subgroup analysis of the main outcome indicators showed no significant difference between the treatment and control groups when the body mass index was greater than 23.9 kg/m2 and the total treatment duration was 6 months.All other treatment subgroups were significantly superior to the control group.(3)Publication bias analysis indicated a significant risk of publication bias in the overall efficacy;however,a trim-and-fill analysis showed that this risk did not significantly impact the reliability of the conclusions.Publication bias analysis showed no significant risk of publication bias in the bone mineral density values of lumbar spine L2-L4 and estradiol levels.(4)The sequential analysis of the trial further confirmed that acupuncture significantly increased the overall effective rate,bone mineral density values at the lumbar spine L1-L4,and estradiol levels.CONCLUSION:Acupuncture is an effective and safe treatment for postmenopausal osteoporosis.More rigorously designed and high-quality studies are needed in the future to verify this conclusion.

The concept of competency-based standardized residency training is gaining global popularity. However, the process of assessing, continuously evaluating, and conducting final competency evaluations remains challenging. The Milestones 2.0 system, developed by the Accreditation Council for Graduate Medical Education, provides a framework for evaluating competencies in radiation oncology residents. The core objective of this system is to assess sub-competencies within core competencies, categorizing them from novice to expert across 5 levels. Evaluation occurs every 6 months, with the expectation that all residents reach level 4 in all sub-competencies by the end of their training. This approach aims to enhance the standardization of residency evaluations across the United States. This article aims to analyze the Milestones 2.0 competency framework and explore its potential applicability and reference value for standardized radiation oncology residency training in China.

OBJECTIVE:To assess the efficacy and safety of acupuncture in treating postmenopausal osteoporosis.METHODS:Clinical randomized controlled trials on acupuncture for postmenopausal osteoporosis were retrieved from databases including CNKI,VIP,WanFang,China Biomedical Literature Service System,Web of Science,PubMed,Embase,and Cochrane Library.The search period was from the inception of the database to July 23,2024.The quality of evidence and risk of bias of the included studies were assessed using the GRADEprofiler and the revised Cochrane risk-of-bias tool for randomized trials(RoB 2.0).Meta-analysis was performed using StataSE 15 and TSA 0.9.5,along with heterogeneity analysis,sensitivity analysis,subgroup analysis,publication bias analysis,trim-and-fill analysis,and trial sequential analysis.RESULTS:The study included 19 randomized controlled trials involving a total of 1 464 patients.(1)The meta-analysis revealed that compared with conventional therapies,acupuncture significantly increased the total effective rate(RR=1.25,95％confidence interval[1.19,1.32],P＜0.001),lumbar spine L2-L4 bone mineral density(mean difference=0.08,95％confidence interval[0.05,0.11],P＜0.001),and estrogen levels(standard mean difference=0.55,95％confidence interval[0.30,0.81],P＜0.001).Additionally,acupuncture increased bone mineral density and gonadotropin levels in the femoral neck,greater trochanter,and Ward's triangle,reduced visual analogue scale scores,and improved bone metabolism without significantly increasing the incidence of adverse events.(2)Subgroup analysis of the main outcome indicators showed no significant difference between the treatment and control groups when the body mass index was greater than 23.9 kg/m2 and the total treatment duration was 6 months.All other treatment subgroups were significantly superior to the control group.(3)Publication bias analysis indicated a significant risk of publication bias in the overall efficacy;however,a trim-and-fill analysis showed that this risk did not significantly impact the reliability of the conclusions.Publication bias analysis showed no significant risk of publication bias in the bone mineral density values of lumbar spine L2-L4 and estradiol levels.(4)The sequential analysis of the trial further confirmed that acupuncture significantly increased the overall effective rate,bone mineral density values at the lumbar spine L1-L4,and estradiol levels.CONCLUSION:Acupuncture is an effective and safe treatment for postmenopausal osteoporosis.More rigorously designed and high-quality studies are needed in the future to verify this conclusion.

The concept of competency-based standardized residency training is gaining global popularity. However, the process of assessing, continuously evaluating, and conducting final competency evaluations remains challenging. The Milestones 2.0 system, developed by the Accreditation Council for Graduate Medical Education, provides a framework for evaluating competencies in radiation oncology residents. The core objective of this system is to assess sub-competencies within core competencies, categorizing them from novice to expert across 5 levels. Evaluation occurs every 6 months, with the expectation that all residents reach level 4 in all sub-competencies by the end of their training. This approach aims to enhance the standardization of residency evaluations across the United States. This article aims to analyze the Milestones 2.0 competency framework and explore its potential applicability and reference value for standardized radiation oncology residency training in China.

Familial glucocorticoid deficiency type 4(FGD4) is a rare autosomal recessive disorder caused by mutations in the nicotinamide nucleotide transhydrogenase(NNT) gene. The article presented clinical data, laboratory results, and genetic mutation findings of a child with FGD4. Additionally, a retrospective analysis of the clinical data of FGD4 patients reported domestically and internationally was conducted, summarizing the types of gene mutations and clinical characteristics. This case identifies novel mutation sites in the NNT gene, providing a basis for the early diagnosis and treatment of FGD4 patients.

Since 2016, a number of studies have been published on standard decoctions used in Chinese medicine. However, there is little research on statistical issues related to establishing the quality standards for standard decoctions. In view of the currently established quality standard methods for standard decoctions, an improvement scheme is proposed from a statistical perspective. This review explores the requirements for dry matter yield rate data and index component transfer data for the application of two methods specified in “Technical Requirements for Quality Control and Standard Establishment of Chinese Medicine Formula Granules,” which include the average value plus or minus three times the standard deviation (X-±3SD) or 70% to 130% of the average value (X-±30%X-). The square-root arcsine transformation method is used as an approach to solve the problem of unreasonable standard ranges of standard decoctions. This review also proposes the use of merged data to establish a standard. A method to judge whether multiple sets of standard decoction data can be merged is also provided. When multiple sets of data have a similar central tendency and a similar discrete tendency, they can be merged to establish a more reliable quality standard. Assuming that the dry matter yield rate and transfer rate conform to a binomial distribution, the number of batches of prepared slices that are needed to establish the standard decoction quality standard is estimated. It is recommended that no less than 30 batches of prepared slices should be used for the establishment of standard decoction quality standards.

We herein describe AncPhore, a versatile tool for drug discovery, which is characterized by pharmacophore feature analysis and anchor pharmacophore (