Objective:To investigate the metabolic pathways and potential molecular targets associated with dapagliflozin in the treatment of type 2 diabetes mellitus.Methods:Plasma samples from patients with type 2 diabetes mellitus were collected before and after 12 months of dapagliflozin treatment and analyzed using UPLC-VION IMS Q-Tof-based metabolomics and timsTOF Pro2 diaPASEF-based proteomics. Multivariate statistical analyses were performed to identify significant differences pre- and post-treatment. Correlation analysis was then conducted to assess relationships between differentially expressed metabolites and proteins closely associated with type 2 diabetes mellitus. Gene Ontology(GO) and Kyoto Encyclopedia of Genes and Genomes(KEGG) enrichment analyses were used to construct metabolic pathway maps and predict therapeutic targets.Results:After 12 months of dapagliflozin treatment, 162 differential metabolites were identified, with 59 upregulated and 103 downregulated. A total of 440 differentially expressed proteins were detected, of which 272 were upregulated and 168 were downregulated. The main classes of differential metabolites included sphingolipids, glycerophospholipids, and glycosphingolipids. Key differentially expressed proteins included importin subunit alpha-11, synemin, Janus kinase 1, and far upstream element-binding protein 2. Correlation analysis revealed 98 shared enriched pathways between differential metabolites and proteins, involving neurotrophin signaling, chemokine signaling, and B cell receptor signaling pathways. Metabolic pathway analysis suggested that dapagliflozin might regulate insulin secretion by modulating glucose-dependent insulinotropic polypeptide, calmodulin-dependent protein kinase, and diacylglycerol levels.Conclusion:Dapagliflozin may exert therapeutic effects in type 2 diabetes mellitus through multiple mechanisms, including the modulation of metabolic and proteomic profiles, participation in key cellular signaling pathways, and regulation of insulin secretion.

Objective:To explore the diagnosis and treatment strategy of emphysematous pyelonephritis (EPN).Methods:The clinical data of 11 cases patients with EPN admitted to 3 hospitals from March 2016 to June 2022 were retrospectively analyzed, among them, 4 cases from Qianhai Shekou Free Trade Zone Hospital, 5 cases from the Second Hospital Affiliated to Kunming Medical University, 2 cases from the Second Affiliated Hospital of Hubei University of Scinece and Technology. Among the 11 patients, 2 were males and 9 were females, aged 50-82 years; the lesions were located on the left side in 6 cases, right side in 4 cases and bilateral in 1 case; all patients had type 2 diabetes and poor glycemic control. The clinical manifestations at admission including back pain in 8 cases, fever in 11 cases, nausea and vomiting in 5 cases, disturbance of consciousness in 3 cases, septic shock in 3 cases, accompanied with ureteral or kidney stones in 5 cases. The pathogenic bacteria were Escherichia coli in 8 cases, Klebsiella pneumoniae in 2 cases and Proteus mirabilis in 1 case. All patients received minimally invasive surgery, anti-infection, subcutaneous injection of insulin, fluid rehydration and nutritional support after admission. 2 cases had a combination of an initial ureteral stenting and second stage percutaneous drainage, 3 patients underwent ureteral stent implantation, 6 patients underwent percutaneous drainage. According to the CT classification of EPN, there were 1 case of type Ⅰ, 3 cases of type Ⅱ, 2 cases of type ⅢA, 4 cases of type ⅢB, and 1 case of type Ⅳ. Results:All 11 cases were cured, 4 cases were admitted to intensive care unit for 2-7 days, 1 case underwent nephrectomy during hospitalization, and 1 case underwent nephrectomy due to renal atrophy during follow-up. After 12 to 18 months of follow-up with urinary CT or B-ultrasound, there were no recurrence cases.Conclusions:EPN is a rare and serious renal parenchymal necrotic infection. Early urinary CT examination is necessary for the diagnosis, and positive minimally invasive surgery combined with comprehensive medical treatment is the preferred treatment strategy. If those above treatment does not work, nephrectomy should be performed.

Objective:To evaluate the efficacy of modified splenic arteriovenous shunt surgery at the distal pancreatic tail in combined pancreas-kidney transplantation.Methods:A retrospective analysis was conducted on 24 recipients who underwent combined pancreas-kidney transplantation with the modified splenic arteriovenous shunt at the pancreatic tail from November 2023 to October 2024 (shunt group) and 231 recipients who received conventional splenic artery and vein ligation since 2016 (ligation group). The incidence of perioperative thrombosis and severe adverse events was compared between the two groups using the chi-square test or Fisher's exact test. Independent sample t-tests were performed to assess postoperative pancreatic and renal function recovery as well as blood perfusion in 15 recipients from the shunt group and 20 from the ligation group who underwent CT perfusion imaging (CTP).Results:The incidence of perioperative splenic arteriovenous thrombosis was lower in the shunt group (0) compared to the ligation group (4.76%, 11/231), though the difference was not statistically significant ( P=0.606). One month postoperatively, the shunt group demonstrated significantly lower serum amylase levels than the ligation group (99.61±19.62 vs. 148.20±70.67 U/L, P=0.018). However, at the time of CTP examination, serum lipase (67.87±32.35 vs. 45.11±17.94 U/L, P=0.014) and creatinine levels (131.79±26.41 vs. 112.1±24.98 μmol/L, P=0.034) were significantly higher in the shunt group. Urea nitrogen levels were also significantly higher in the shunt group both one month postoperatively (11.24±4.64 vs. 8.51±3.01 mmol/L, P=0.043) and at the CTP examination (10.41±1.78 vs. 6.87±1.91 mmol/L, P=0.001). Regarding pancreatic perfusion, blood volume in both the pancreatic head (15.99 ± 3.51 vs. 20.67 ± 5.47 ml/100 g, P = 0.024) and tail (17.19±4.24 vs. 27.40±19.80 ml/100 g, P=0.039) was significantly lower in the shunt group. After one minute of splenic artery perfusion, the shunt group exhibited significantly higher splenic artery blood flow (755.85±101.50 vs. 574.00 ± 142.06 ml·min -1· (100 g) -1, P<0.001) and blood volume (58.90 ±19.93 vs. 23.21±17.02 ml/100 g, P=0.007) compared to the ligation group. These differences persisted after two minutes of perfusion (blood flow: 793.83±68.57 vs. 503.78 ± 130.80 ml·min -1· (100 g) -1, P<0.001; blood volume: 64.22±15.74 vs. 34.32±20.39 ml/100 g, P=0.002). For the transplanted kidney, the shunt group had significantly lower blood flow (113.10±28.55 vs. 232.76±113.37 ml·min -1· (100 g) -1, P<0.001), blood volume (28.95±10.79 vs. 38.36±12.38 ml/100 g, P=0.047), and capillary surface permeability (PS) (26.49±16.57 vs. 43.02±20.37, P = 0.042) in the upper pole. Similar reductions in blood flow, blood volume, and PS were observed in the middle dorsal region ( P=0.018, 0.021, and 0.048, respectively) and lower pole ( P<0.001, P=0.048, and P=0.012, respectively). Conclusion:The modified splenic arteriovenous shunt at the pancreatic tail appears to be a safe and effective approach to reducing the risk of pancreatic graft thrombosis. This technique facilitates effective diversion of pancreatic parenchymal blood flow into the splenic vein, alleviating hyperperfusion of the transplanted pancreas. While renal blood perfusion was reduced postoperatively, it did not adversely affect renal function.

Objective:To summarize domestic and foreign transitional readiness assessment tools for adolescents with chronic diseases and analyze the current status of their application in the clinic, so as to provide references for healthcare professionals to select appropriate tools.Methods:China National Knowledge Infrastructure, Wanfang Data, VIP and China Biomedical Literature Database, PubMed, Web of Science, Embase, Medline, CINAHL, Cochrane Library and scholar.google.com were searched for literature related to the assessment tools of transition readiness in adolescents with chronic illnesses from inception to March 29, 2024. Two researchers independently screened the literature and extracted the data.Results:A total of 491 articles were initially retrieved and 24 were included, involving a total of 8 transitional readiness assessment tools for adolescents with chronic diseases, including the Transition Readiness Assessment questionnaire, the University of North Carolina TRxANSITION Scale, Am I ON TRAC for adult care? Questionnaire, Transition Questionnaire, Self-Management and Transition to Adulthood with Rx=Treatment Questionnaire, Good 2 Go Questionnaire, State Assessment Questionnaire for Transition, and Self-assessment Scale of Transition Readiness for Adolescents. The Transition Readiness Assessment questionnaire and Self-Management and Transition to Adulthood with Rx=Treatment Questionnaire have good reliability and validity, comprehensive evaluation, wide applicability, simple use, and are suitable for clinical use.Conclusions:The quality of existing tools for assessing transitional readiness of adolescents with chronic diseases is mixed. The Transition Readiness Assessment questionnaire and Self-Management and Transition to Adulthood with Rx=Treatment Questionnaire are more appropriate options in the clinic, but they still need to be improved. Future studies need to continue to introduce tools to assess transitional readiness for chronic diseases in adolescents and develop localized assessment tools.

Objective:To explore the current status, research hotspots, and trends of age-friendly home environment modifications, and provide references for future research development in China.Methods:Literature related to age-friendly home modifications was retrieved from the Web of Science Core Collection database, with the search covering publications up to January 27, 2024. VOSviewer 1.6.19 and CiteSpace 6.2.R6 were used to perform visualized analyses of keywords, authors, institutions, publication volume, journals, countries, and publication years.Results:A total of 287 articles were included. The number of publications in this field has shown an increasing trend. Gitlin, Laura N and Iwarsson Susanne were the most productive authors in this field; however, a stable core author group has not yet been established. The United States and the University of Florida/State University System of Florida were the most prolific country and institutions, respectively. The Journal of the American Geriatrics Society had the highest number of publications. Research mainly focused on populations such as older adults with dementia or disabilities, informal caregivers, and occupational therapists. Fall prevention and smart home technologies were also hot topics. Conclusions:Age-friendly home environment modification has become a research hotspot. However, relevant research in China remains at an early stage. Future work should focus on developing targeted and effective modification strategies and technologies tailored to the characteristics of different populations.

Objective To systematically evaluate the assessment tools of adolescent chronic disease patients'transition readiness to adults at home and abroad,and to provide references for medical personnel to choose appropriate tools.Methods CNKI,Wan Fang Data,CBM,PubMed,Web of Science,Embase and Cochrane were searched for literature related to the assessment tools of transition readiness in adolescents with chronic illnesses to adulthood from inception to August,2024.Literature screening and data extraction of the tools were extracted independently by 2 researchers.At the same time,the criteria for the selection of health measurement tools based on consensus(COSMIN)systematic evaluation guidelines were used to evaluate the inclusion assessment tools,and recommendations were finally formed.Results A total of 29 articles were included,involving 9 universal and 5 specific assessment tools of adolescent chronic illnesses transition readiness.The Transition Readiness Assessment Questionnaire has satisfactory content validity and internal consistency,and it is recommended as Grade A.The Grade C included the Am I ON TRAC for adult care?Questionnaire and the State Assessment Questionnaire for Transition,Epilepsy-specific Transition Readiness Assessment Questionnaire and the Readiness for Adult Care in Rheumatology,while the others are recommended as Grade B.Conclusion There are a variety of tools to assess the transition readiness of adolescents with chronic diseases to adults,and there are few tools suitable for adolescents with chronic diseases in China,with few specific tools.After comprehensive consideration,the Transition Readiness Assessment Questionnaire can be recommended temporarily.

Objective To systematically evaluate the assessment tools of adolescent chronic disease patients'transition readiness to adults at home and abroad,and to provide references for medical personnel to choose appropriate tools.Methods CNKI,Wan Fang Data,CBM,PubMed,Web of Science,Embase and Cochrane were searched for literature related to the assessment tools of transition readiness in adolescents with chronic illnesses to adulthood from inception to August,2024.Literature screening and data extraction of the tools were extracted independently by 2 researchers.At the same time,the criteria for the selection of health measurement tools based on consensus(COSMIN)systematic evaluation guidelines were used to evaluate the inclusion assessment tools,and recommendations were finally formed.Results A total of 29 articles were included,involving 9 universal and 5 specific assessment tools of adolescent chronic illnesses transition readiness.The Transition Readiness Assessment Questionnaire has satisfactory content validity and internal consistency,and it is recommended as Grade A.The Grade C included the Am I ON TRAC for adult care?Questionnaire and the State Assessment Questionnaire for Transition,Epilepsy-specific Transition Readiness Assessment Questionnaire and the Readiness for Adult Care in Rheumatology,while the others are recommended as Grade B.Conclusion There are a variety of tools to assess the transition readiness of adolescents with chronic diseases to adults,and there are few tools suitable for adolescents with chronic diseases in China,with few specific tools.After comprehensive consideration,the Transition Readiness Assessment Questionnaire can be recommended temporarily.

Objective:To summarize domestic and foreign transitional readiness assessment tools for adolescents with chronic diseases and analyze the current status of their application in the clinic, so as to provide references for healthcare professionals to select appropriate tools.Methods:China National Knowledge Infrastructure, Wanfang Data, VIP and China Biomedical Literature Database, PubMed, Web of Science, Embase, Medline, CINAHL, Cochrane Library and scholar.google.com were searched for literature related to the assessment tools of transition readiness in adolescents with chronic illnesses from inception to March 29, 2024. Two researchers independently screened the literature and extracted the data.Results:A total of 491 articles were initially retrieved and 24 were included, involving a total of 8 transitional readiness assessment tools for adolescents with chronic diseases, including the Transition Readiness Assessment questionnaire, the University of North Carolina TRxANSITION Scale, Am I ON TRAC for adult care? Questionnaire, Transition Questionnaire, Self-Management and Transition to Adulthood with Rx=Treatment Questionnaire, Good 2 Go Questionnaire, State Assessment Questionnaire for Transition, and Self-assessment Scale of Transition Readiness for Adolescents. The Transition Readiness Assessment questionnaire and Self-Management and Transition to Adulthood with Rx=Treatment Questionnaire have good reliability and validity, comprehensive evaluation, wide applicability, simple use, and are suitable for clinical use.Conclusions:The quality of existing tools for assessing transitional readiness of adolescents with chronic diseases is mixed. The Transition Readiness Assessment questionnaire and Self-Management and Transition to Adulthood with Rx=Treatment Questionnaire are more appropriate options in the clinic, but they still need to be improved. Future studies need to continue to introduce tools to assess transitional readiness for chronic diseases in adolescents and develop localized assessment tools.

Objective:To explore the current status, research hotspots, and trends of age-friendly home environment modifications, and provide references for future research development in China.Methods:Literature related to age-friendly home modifications was retrieved from the Web of Science Core Collection database, with the search covering publications up to January 27, 2024. VOSviewer 1.6.19 and CiteSpace 6.2.R6 were used to perform visualized analyses of keywords, authors, institutions, publication volume, journals, countries, and publication years.Results:A total of 287 articles were included. The number of publications in this field has shown an increasing trend. Gitlin, Laura N and Iwarsson Susanne were the most productive authors in this field; however, a stable core author group has not yet been established. The United States and the University of Florida/State University System of Florida were the most prolific country and institutions, respectively. The Journal of the American Geriatrics Society had the highest number of publications. Research mainly focused on populations such as older adults with dementia or disabilities, informal caregivers, and occupational therapists. Fall prevention and smart home technologies were also hot topics. Conclusions:Age-friendly home environment modification has become a research hotspot. However, relevant research in China remains at an early stage. Future work should focus on developing targeted and effective modification strategies and technologies tailored to the characteristics of different populations.

Objective:To investigate the metabolic pathways and potential molecular targets associated with dapagliflozin in the treatment of type 2 diabetes mellitus.Methods:Plasma samples from patients with type 2 diabetes mellitus were collected before and after 12 months of dapagliflozin treatment and analyzed using UPLC-VION IMS Q-Tof-based metabolomics and timsTOF Pro2 diaPASEF-based proteomics. Multivariate statistical analyses were performed to identify significant differences pre- and post-treatment. Correlation analysis was then conducted to assess relationships between differentially expressed metabolites and proteins closely associated with type 2 diabetes mellitus. Gene Ontology(GO) and Kyoto Encyclopedia of Genes and Genomes(KEGG) enrichment analyses were used to construct metabolic pathway maps and predict therapeutic targets.Results:After 12 months of dapagliflozin treatment, 162 differential metabolites were identified, with 59 upregulated and 103 downregulated. A total of 440 differentially expressed proteins were detected, of which 272 were upregulated and 168 were downregulated. The main classes of differential metabolites included sphingolipids, glycerophospholipids, and glycosphingolipids. Key differentially expressed proteins included importin subunit alpha-11, synemin, Janus kinase 1, and far upstream element-binding protein 2. Correlation analysis revealed 98 shared enriched pathways between differential metabolites and proteins, involving neurotrophin signaling, chemokine signaling, and B cell receptor signaling pathways. Metabolic pathway analysis suggested that dapagliflozin might regulate insulin secretion by modulating glucose-dependent insulinotropic polypeptide, calmodulin-dependent protein kinase, and diacylglycerol levels.Conclusion:Dapagliflozin may exert therapeutic effects in type 2 diabetes mellitus through multiple mechanisms, including the modulation of metabolic and proteomic profiles, participation in key cellular signaling pathways, and regulation of insulin secretion.