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.

Diabetic retinopathy(DR)is one of the most common and severe microvascular complications in diabetic patients and has become one of the leading causes of blindness worldwide. With the continuous rise in the prevalence of diabetes, in-depth exploration of the pathogenesis of DR and effective intervention measures is of great clinical significance. The mechanistic target of rapamycin(mTOR), as a protein kinase, is widely involved in cellular processes such as growth, metabolism, and autophagy. Research indicates that the mTOR signaling pathway plays a crucial regulatory role in the pathological progression of DR, and its abnormal activity can disrupt retinal cell autophagy function, thereby accelerating cellular damage and disease progression. Autophagy, as an important regulatory mechanism for cellular homeostasis, maintains cellular functional balance by clearing damaged organelles and protein aggregates. This article provides a systematic review of the structural and functional aspects of the mTOR signaling pathway, the molecular regulatory mechanisms of autophagy, and their roles in retinal pathological changes. By summarizing current research findings, the article aims to clarify the key regulatory role of the mTOR-autophagy axis in DR, providing theoretical support for elucidating the molecular pathogenesis of DR and offering potential targets and research directions for developing novel targeted therapeutic strategies, thereby holding significant scientific and clinical value.

Objective:To analyze the depressive symptoms of physical and mental workers and the impact of their behavior and lifestyle on their depressive symptoms.Methods:In August 2022, a cross-sectional study design was adopted to select 553 workers as research subjects using cluster sampling. General demographic information, health-related behaviors and lifestyles were collected, and their depressive symptoms were evaluated using the Chinese version of the Patient Health Questionnaire 9 (PHQ-9). The differences in general demographic information, health-related behaviors and lifestyles between physical and mental workers were analyzed, and logistic regression was used to analyze the influencing factors of depressive symptoms in occupational populations.Results:Among the 553 subjects, 317 were physical workers (57.32%) and 236 were mental workers (42.68%). Statistically significant differences were observed between the two groups in terms of education level, monthly income, smoking rate, regular physical exercise rate and appropriate sleep time rate ( P<0.05). The score and the detection rate of depression symptoms among physical workers were (9.67±2.75) points and 20.82% (66/317), respectively, which were higher than those of mental workers [(8.34±2.18) points, 12.71% (30/236) ] ( t=6.13, χ 2=6.20, P<0.05). The results of logistic regression analysis showed that smoking, regular physical exercise, appropriate sleep time and mental work were influencing factors of depressive symptoms among the occupational population ( OR=1.592, 95% CI: 1.316-1.825; OR=0.659, 95% CI: 0.416-0.830; OR=0.502, 95% CI: 0.257-0.717; OR=0.839, 95% CI: 0.522-0.967; P<0.05) . Conclusion:The depressive symptoms of physical workers are more serious than those of mental workers. Low education level, not frequently participating in physical exercise, smoking and sleep disorder are potential risk factors that affect the depressive symptoms of the occupational population.

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.

Objective:To analyze the depressive symptoms of physical and mental workers and the impact of their behavior and lifestyle on their depressive symptoms.Methods:In August 2022, a cross-sectional study design was adopted to select 553 workers as research subjects using cluster sampling. General demographic information, health-related behaviors and lifestyles were collected, and their depressive symptoms were evaluated using the Chinese version of the Patient Health Questionnaire 9 (PHQ-9). The differences in general demographic information, health-related behaviors and lifestyles between physical and mental workers were analyzed, and logistic regression was used to analyze the influencing factors of depressive symptoms in occupational populations.Results:Among the 553 subjects, 317 were physical workers (57.32%) and 236 were mental workers (42.68%). Statistically significant differences were observed between the two groups in terms of education level, monthly income, smoking rate, regular physical exercise rate and appropriate sleep time rate ( P<0.05). The score and the detection rate of depression symptoms among physical workers were (9.67±2.75) points and 20.82% (66/317), respectively, which were higher than those of mental workers [(8.34±2.18) points, 12.71% (30/236) ] ( t=6.13, χ 2=6.20, P<0.05). The results of logistic regression analysis showed that smoking, regular physical exercise, appropriate sleep time and mental work were influencing factors of depressive symptoms among the occupational population ( OR=1.592, 95% CI: 1.316-1.825; OR=0.659, 95% CI: 0.416-0.830; OR=0.502, 95% CI: 0.257-0.717; OR=0.839, 95% CI: 0.522-0.967; P<0.05) . Conclusion:The depressive symptoms of physical workers are more serious than those of mental workers. Low education level, not frequently participating in physical exercise, smoking and sleep disorder are potential risk factors that affect the depressive symptoms of the occupational population.

Tingli Dazao Xiefeitang is a classic formula for treating lung abscesses and thoracic fluid retention， recognized throughout history and included in the Catalogue of Ancient Classic Formulas （Second Batch）. This article employs bibliometric methods to investigate and analyze the source， origin， and key information of Tingli Dazao Xiefeitang， providing a theoretical basis for the development and application of this renowned formula. The results show that Tingli Dazao Xiefeitang first appears in Synopsis of the Golden Chamber （Jin Kui Yao Lue）， where three clinical applications are recorded. The original text clearly states that this formula is used to treat lung abscesses and thoracic fluid retention， with symptoms such as inability to lie down due to wheezing， chest and rib fullness， facial edema， inability to rest due to thoracic fluid retention， and cough inversion. This aligns with findings from ancient application research. In later generations， the methods proposed by ZHANG Zhongjing were predominantly used for medication and formulation. Modern applications of Tingli Dazao Xiefeitang focus primarily on the respiratory system， with pleural effusion being the most common condition. For the preparation and decoction， a single dose of 5 g of Descurainiae Semen Lepidii Semen （dried and mature seeds of Lepidium apetalum） processed as stir-fried seeds and 36 g of Jujubae Fructus （dried and mature fruit of Ziziphus jujuba） prepared as raw materials were recommended. Then 600 mL of water was added and Jujubae Fructus was first boiled until the volume reduced to 400 mL. After filtering out the residue， the supernatant was retained and mixed with stir-fried Descurainiae Semen Lepidii Semen， followed by boiling to 200 mL， which should be consumed all at once. This research provides a theoretical basis for the development and application of this formula.

Due to the increasingly severe situation of pathogen resistance， the efficacy of classical antibiotics has declined， and the difficulty of treating community-acquired pneumonia （CAP） has gradually increased. Omadacycline was approved for marketing in China in December 2021 and has been approved for treating community-acquired bacterial pneumonia and acute bacterial skin and skin structure infection in adults. Based on introducing the pathogen resistance of CAP， this article systematically reviews the antibacterial activity and resistance， pharmacokinetic characteristics， and clinical efficacy of omadacycline. It is found that its antibacterial spectrum is wide， its bioavailability is high， and its safety is good. Its pharmacokinetic parameters are not affected by the patients’ age， gender， liver and kidney function， or drug interactions， and it is effective against multiple drug-resistant bacteria， Gram-negative bacteria producing extended-spectrum β-lactases， atypical pathogens， etc. It can be used as one of the treatment options for CAP. However， due to limited clinical research data and the short clinical application time of the drug， more clinical studies are still needed to verify its efficacy as a monotherapy or in combination with other antibiotics for severe pneumonia patients.

Objective To investigate the relationship between Notch1 and autophagy under high glucose conditions and to explore the effects of Notch1 inhibitor DAPT and autophagy inhibitor 3-MA on human retinal pigment epithelial cells cultured in high glucose conditions.Methods Via preliminary experiment,25 mmol·L-1 glucose was used as the high glucose culture medium of adult retinal pigment epithelial(ARPE)-19 cells,and 5 mmol·L-1 3-MA was adopted as the au-tophagy inhibitor.ARPE-19 cells cultured in vitro were randomly divided into four groups:control group(treated with 5 mmol·L-1 glucose for 48 h),high glucose group(treated with 25 mmol·L-1 glucose for 48 h),high glucose+DAPT group(treated with 40 μmol·L-1 DAPT for 2 h and then 25 mmol·L-1 glucose for 48 h),and high glucose+3-MA group(treated with 5 mmol·L-1 3-MA for 2 h and then 25 mmol·L-1 glucose for 48 h).A transmission electron microscope was used to observe the ultrastructure of cells in each group.Cell proliferation and migration were observed using Cell Counting Kit-8 and scratch assays.Western blot was used to detect the protein expression levels of Notch1 and autophagy-related proteins LC3 and Beclin1.Reverse transcription-polymerase chain reaction was used to measure the relative messenger ri-bonucleic acid(mRNA)expression levels of Notch1,LC3 and Beclin1 of cells in each group.Results Transmission elec-tron microscope showed that cells in the control group had normal structures,with round or oval nuclei and a few autopha-gosomes.In the high glucose group,cells exhibited slightly obvious injury,with uneven cytoplasm and numerous autolyso-somes.Compared to the control group,ARPE-19 cells in the high glucose group had increased proliferation and migration abilities,and higher mRNA and protein expression levels of Notch1,LC3 and Beclin1(all P＜0.05).Compared to the high glucose group,ARPE-19 cells in the high glucose+DAPT group showed decreased proliferation and migration abilities,and lower mRNA and protein expression levels of Notch1,LC3 and Beclin1(all P＜0.05).The high glucose+3-MA group showed reduced proliferation and migration abilities,as well as decreased mRNA and protein expression levels of LC3 and Beclin1(all P＜0.05)compared to the high glucose group.Conclusion High glucose can activate Notch1 and the auto-phagy process,promoting the proliferation of ARPE-19 cells.In the high glucose+DAPT group and high glucose+3-MA group,the autophagy process is inhibited to a certain extent,thereby restraining cell proliferation.

Objective To investigate if Lycium barbarum polysaccharide(LBP)could inhibit the high glucose-in-duced human retinal microvascular endothelial cell(HRMEC)injury by regulating the NOD-like receptor family pyrin do-main containing protein 3(NLRP3)/Caspase-1 pyroptosis pathway.Methods HRMECs cultured in vitro were randomly divided into the control group(5.5 mmol·L-1 glucose),the high glucose group(55.5 mmol·L-1 glucose),the low LBP group(55.5 mmol·L-1 glucose+100 mg·L-1 LBP),the medium LBP group(55.5 mmol·L-1 glucose+500 mg·L-1 LBP),the high LBP group(55.5 mmol·L-1 glucose+1 000 mg·L-1 LBP),the si-NC group(55.5 mmol·L-1glucose after transfection with 20 pmol·L-1 si-NC)and the si-NLRP3 group(55.5 mmol·L-1 glucose after transfection with 20μmol·L-1si-NLRP3).The Cell Counting Kit-8 was used to detect the proliferation of HRMECs in each group and flow cy-tometry was adopted to measure the pyroptosis of HRMECs in each group.The reverse transcription-polymerase chain reac-tion was used to detect the relative messenger ribonucleic acid(mRNA)expression levels of NLRP3,Caspase-1,nuclear factor(NF)-κB,Gasdermin-D(GSDMD)and vascular endothelial growth factor(VEGF)in the HRMECs of each group,Western blot was adopted to detect the relative protein expression levels of HRMEC pyroptosis-related NLRP3,Caspase-1,NF-κB,GSDMD and VEGF in each group,and enzyme-linked immunosorbent assay was used to detect the interleukin(IL)-1β and IL-18 expression levels in downstream pyroptosis in the HRMEC supernatant of each group.Results Com-pared with the control group,the proliferation rate of HRMECs decreased,the pyroptosis rate increased,the relative mR-NA and protein expression levels of NLRP3,Caspase-1,NF-κB,GSDMD and VEGF increased,and the expressions of IL-1βand IL-18 increased in the high glucose group(all P＜0.05).Compared with the high glucose group,the proliferation rate of HRMECs increased,the pyroptosis rate decreased,the relative mRNA and protein expression levels of NLRP3,Caspase-1,NF-κB,GSDMD and VEGF decreased,and the expressions of IL-1β and IL-18 decreased in the si-NLRP3 group(all P＜0.05).There were no significant differences in cell proliferation rate,pyroptosis rate,mRNA and protein expression levels of NLRP3,Caspase-1,NF-κB,GSDMD and VEGF,as well as levels of IL-1β and IL-18,in the si-NC group compared with the high glucose group(all P＞0.05).Compared with the high glucose group,the medium LBP group and high LBP group had increased proliferation rates,lower pyroptosis rates,and declined mRNA and protein expression levels of NLRP3,Caspase-1,NF-κB,GSDMD and VEGF as well as expressions of IL-1β and IL-18(all P＜0.05).Compared with the high glucose group,there was no significant difference in the proliferation rate of HRMECs and various protein expression levels in the low LBP group(all P＞0.05),and other indicators were consistent with those in the medium LBP group and high LBP group.Conclusion LBP has a protective effect on HRMEC injury induced by high glucose,can promote cell prolif-eration and inhibit pyroptosis,and its mechanism is related to inhibiting the activation of NLRP3/Caspase-1 signaling path-way and reducing the expression of related inflammatory factors.

Objective:To explore the utility of combining repeated transcranial magnetic stimulation (rTMS) with action observation therapy (AOT) in improving the upper limb motor functioning of children with hemiplegic spastic cerebral palsy (HSCP).Methods:A total of 66 children with HSCP were randomly divided into a sham stimulation group, an rTMS group and a combination group, each of 22. In addition to routine rehabilitation, the sham stimulation and rTMS groups received the relevant treatment or sham treatment, while the combination group also received action observation therapy (AOT). The treatment was administered daily, five times a week for 12 weeks. Before and after the treatment, everyone′s upper limb muscle tone was evaluated using the modified Ashworth Scale (MAS), and fine motor function, grasping and hand coordination were quantified using the fine component of the Peabody Motor Development Scale (PDMS-FM) and the Carroll upper limb function test (UEFT).Results:After the treatment, significant improvement was documented in the average MAS scores of the bicipital arm and wrist flexors of all three groups, and also in their average PDMS-FM scores, fine motor quotient (FMQ) scores and UEFT scores. After 12 weeks the combination group significantly out-scored the other two groups in terms of their average biceps and wrist flexor MAS scores, PDMS-FM grasping area and visual-motor integration area scores, FMQ score and UEFT score. There was no significant difference between the other two groups in any of the outcome measurements, on average.Conclusions:Supplementing rTMS and routine rehabilitation with AOT more effectively improves the upper limb muscle tension, upper limb functioning and fine finger manipulation of children with hemiplegic spastic cerebral palsy.