[Objective]To elucidate the pathogenesis of acquired aplastic anemia(AA)by integrating the traditional Chinese medicine(TCM)theory of"congenital deficiency and acquired malnourishment"with contemporary medical advancements.[Methods]Based on the etiological and pathogenesis theory of"congenital deficiency and acquired malnourishment"in TCM,combined with the research results of genetics,immunology,epigenetics,metabolism and other studies of modern medicine,this paper systematically discusses the specific mechanisms of"congenital deficiency",such as genetic predisposition factors and germline mutations,and"acquired malnourishment",such as lifestyle,environmental factors,immune abnormalities,metabolic and epigenetic abnormalities,and analyzes their association with disease onset,progression and treatment response.[Results]Studies have revealed that the occurrence of acquired AA is the result of the combined effect of"congenital deficiency"and"acquired malnourishment".The generalized concept of"congenital deficiency"encompasses non-pathogenic germline genetic variations,such as specific human leukocyte antigen(HLA)haplotypes,heterozygous mutations in genes like Fanconi anemia nucleotide-core complex(FANC)that significantly influence disease susceptibility,response to immunosuppressive therapy(IST),and risk of malignant transformation."Acquired malnourishment"manifests as environmental factor,such as proximity to chemical plants,newly renovated residences,lifestyle including high-fat diet,chronic sleep deprivation,consumption of contaminated water and infectious risk factors.These factors trigger hematopoietic failure through mechanisms including somatic mutations,epigenetic dysregulation involving DNA methyltransferase 3A(DNMT3A),ten-eleven translocation 2(TET2),metabolic disturbances,immune imbalance and gut microbiota dysbiosis,acting alone or synergistically with genetic susceptibility(the"Two-Hit"theory).In treatment,it is necessary to take into account both congenital deficiency and acquired malnourishment:for the"congenital deficiency"caused by germ line mutations(caused by germ line mutations),it is recommended that transplant intervention should be considered for key germline mutations,and transplantation should be considered for key germline mutations.In response to"acquired malnourishment",TCM shows multi-target treatment by improving telomerase through"nourishing the kidney"and"strengthening the spleen"to regulate immune,metabolism and microbiota combined with lifestyle intervention.[Conclusion]A profound understanding of the multidimensional mechanisms underlying the generalized concepts of"congenital deficiency"and"acquired malnourishment"is crucial for precision diagnostics and therapeutics,including optimizing transplant indications and developing targeted TCM/western integrated interventions to improve prognosis.Future research necessitates the integration of disease differentiation and syndrome differentiation to advance personalized treatment strategies.

[Objective]To elucidate the pathogenesis of acquired aplastic anemia(AA)by integrating the traditional Chinese medicine(TCM)theory of"congenital deficiency and acquired malnourishment"with contemporary medical advancements.[Methods]Based on the etiological and pathogenesis theory of"congenital deficiency and acquired malnourishment"in TCM,combined with the research results of genetics,immunology,epigenetics,metabolism and other studies of modern medicine,this paper systematically discusses the specific mechanisms of"congenital deficiency",such as genetic predisposition factors and germline mutations,and"acquired malnourishment",such as lifestyle,environmental factors,immune abnormalities,metabolic and epigenetic abnormalities,and analyzes their association with disease onset,progression and treatment response.[Results]Studies have revealed that the occurrence of acquired AA is the result of the combined effect of"congenital deficiency"and"acquired malnourishment".The generalized concept of"congenital deficiency"encompasses non-pathogenic germline genetic variations,such as specific human leukocyte antigen(HLA)haplotypes,heterozygous mutations in genes like Fanconi anemia nucleotide-core complex(FANC)that significantly influence disease susceptibility,response to immunosuppressive therapy(IST),and risk of malignant transformation."Acquired malnourishment"manifests as environmental factor,such as proximity to chemical plants,newly renovated residences,lifestyle including high-fat diet,chronic sleep deprivation,consumption of contaminated water and infectious risk factors.These factors trigger hematopoietic failure through mechanisms including somatic mutations,epigenetic dysregulation involving DNA methyltransferase 3A(DNMT3A),ten-eleven translocation 2(TET2),metabolic disturbances,immune imbalance and gut microbiota dysbiosis,acting alone or synergistically with genetic susceptibility(the"Two-Hit"theory).In treatment,it is necessary to take into account both congenital deficiency and acquired malnourishment:for the"congenital deficiency"caused by germ line mutations(caused by germ line mutations),it is recommended that transplant intervention should be considered for key germline mutations,and transplantation should be considered for key germline mutations.In response to"acquired malnourishment",TCM shows multi-target treatment by improving telomerase through"nourishing the kidney"and"strengthening the spleen"to regulate immune,metabolism and microbiota combined with lifestyle intervention.[Conclusion]A profound understanding of the multidimensional mechanisms underlying the generalized concepts of"congenital deficiency"and"acquired malnourishment"is crucial for precision diagnostics and therapeutics,including optimizing transplant indications and developing targeted TCM/western integrated interventions to improve prognosis.Future research necessitates the integration of disease differentiation and syndrome differentiation to advance personalized treatment strategies.

Objective To investigate the therapeutic effect hyperbaric oxygen ( HBO) combined with Gubentongluofang on IgA nephropathy ( IgAN) in mice and possible molecular mechanism involved .Methods The murine α1k1-CD89 Tg transgene IgAN model was developed , and the animals were randomly divided into the control group , the model group , the calcitriol group , the Chinese herbal medicine group and the Chinese herbal medicine +HBO group.The expression levels of IgA, abnormal glycosylated IgA1, interleukin 6 ( IL-6 ) and tumor necrosis factor-α( TNF-α) of peripheral blood were detected , and the expressions of C1GalT1 and Cosmc protein in intestinal mucosa , kidney damage ( urine protein, serum creatinine and urea nitrogen) and blood urea nitrogen ( BUN) as well were detected for further analyses .Results As compared with those of the control group before treatment , the levels of IgA, abnormal glycosylation IgA1, IL-6 and TNF-in peripheral blood were significantly increased in the model group , the calcitriol group , the Chinese herbal medicine group and the Chinese herbal medicine +HBO group (P<0.05), and no significant differences could be noted in the levels of Scr and BUN in various groups ( P >0.05).After treatment, the levels of urine protein, IgA1, abnormal glycosylated IgA1, IL-6 and TNF-all significantly reduced in the calcitriol group , the Chinese herbal medicine group and the Chinese herbal medicine +HBO group, as compared with the model group(P<0.05), and the rate of reduction in the Chinese herbal medicine group was greater than that of the calcitriol group, but lower than that of the Chinese herbal medicine +HBO group (P<0.05).Intestinal mucosal tissues of the mice in various groups were collected after treatment for further analyses .As compared with the control group , C1GalT1 and Cosmc expression levels in intestinal mucosa in the model group decreased significantly.When compared with those in the model group , the C1GalT1 and Cosmc expression levels in the calcitriol group , the Chinese herbal medicine group , as well as the Chinese herbal medicine +HBO group increased considerably , with the increase in the Chinese herbal medicine +HBO group being most significant (P<0.05).Conclusion HBO could enhance the therapeutic effect of Gubentongluofang on IgAN , it might be closely associated with the down-regulation of IL-6 and TNF-and inhibition of abnormal activation of B cells and promotion of CIGALT1 and Cosmc expression .

Objective To investigate the therapeutic effect hyperbaric oxygen ( HBO) combined with Gubentongluofang on IgA nephropathy ( IgAN) in mice and possible molecular mechanism involved .Methods The murine α1k1-CD89 Tg transgene IgAN model was developed , and the animals were randomly divided into the control group , the model group , the calcitriol group , the Chinese herbal medicine group and the Chinese herbal medicine +HBO group.The expression levels of IgA, abnormal glycosylated IgA1, interleukin 6 ( IL-6 ) and tumor necrosis factor-α( TNF-α) of peripheral blood were detected , and the expressions of C1GalT1 and Cosmc protein in intestinal mucosa , kidney damage ( urine protein, serum creatinine and urea nitrogen) and blood urea nitrogen ( BUN) as well were detected for further analyses .Results As compared with those of the control group before treatment , the levels of IgA, abnormal glycosylation IgA1, IL-6 and TNF-in peripheral blood were significantly increased in the model group , the calcitriol group , the Chinese herbal medicine group and the Chinese herbal medicine +HBO group (P<0.05), and no significant differences could be noted in the levels of Scr and BUN in various groups ( P >0.05).After treatment, the levels of urine protein, IgA1, abnormal glycosylated IgA1, IL-6 and TNF-all significantly reduced in the calcitriol group , the Chinese herbal medicine group and the Chinese herbal medicine +HBO group, as compared with the model group(P<0.05), and the rate of reduction in the Chinese herbal medicine group was greater than that of the calcitriol group, but lower than that of the Chinese herbal medicine +HBO group (P<0.05).Intestinal mucosal tissues of the mice in various groups were collected after treatment for further analyses .As compared with the control group , C1GalT1 and Cosmc expression levels in intestinal mucosa in the model group decreased significantly.When compared with those in the model group , the C1GalT1 and Cosmc expression levels in the calcitriol group , the Chinese herbal medicine group , as well as the Chinese herbal medicine +HBO group increased considerably , with the increase in the Chinese herbal medicine +HBO group being most significant (P<0.05).Conclusion HBO could enhance the therapeutic effect of Gubentongluofang on IgAN , it might be closely associated with the down-regulation of IL-6 and TNF-and inhibition of abnormal activation of B cells and promotion of CIGALT1 and Cosmc expression .

Objective To study the prevalence,treatment policy and control of hypertension in patients with maintenance hemodialysis, and to analyze the influencing factors of hypertension control.Methods We studied the current status of 1382 patients with maintenance hemodialysis in 11 dialysis centers in Shanghai, among them 809 were male, and 573 were female.Hypertension was defined as systolic blood pressure(SBP) ≥ 140 and/or diastolic blood pressure (DBP) ≥90 mm Hg ( 1 mm Hg = 0.133 kPa).Those who had a history of hypertension and requiring antihypertensive therapy were also diagnosed as hypertension though their blood pressure was within normal range during the survey.Hypertension control was defined as blood pressure ＜ 140/90 mm Hg before each dialysis session.Results The prevalence of hypertension in the hemodialysis patients was 86.3%.The treatment rate and control rate in those patients were 96.8% and 25.5% respectively.More than half (50.4% ) of patients were treated with only one kind of anti-hypertensive drug, and 34.4% with 2 kinds, 14.2% with 3 kinds, 1.0% with 4 kinds or more.Calcium channel blocker (CCB) was the most frequently prescribed drug (61.0%), followed by angiotensin Ⅱ receptor blockers ( 56.4% ), centrally acting anti-hypertensive agent ( 26.4% ), beta blockers and alpha, beta-blockers( 14.0% ).The control rate of hypertension in those hemodialysis people was aggravated by the existence of coronary artery disease.The patients who need more kinds of antihypertensive agents have a poorer control rate of hypertension.The hypertension control rate elevated significantly with the adequate hemodialysis.Conclusions There is a very high prevalence of hypertension in maintenance hemodialysis patients.Although the treatment rate is high, the control rate is unsatisfactory.So the control of hypertension in hemodialysis patient is still a clinical challenge.Appropriate dialysis adequacy, reasonable use of erythropoietin, treatment of heart disease and judicious use of antihypertensive drugs may be helpful to improve the clinical outcome.

Objective: To study the mechanism of safflower injection(红花注射液) on preventing thrombosis after arteriovenous fistula operation in rabbits.Method: Twenty-four rabbits were randomly divided into three groups: safflower injection group,heparin group and control group(each n=8).Rabbit femoral arteryvein side-to-side anastomosis models were performed on both sides of the lower extremities and they were coincided.Safflower injection(5 mg/kg) or heparin injection(6 U/kg) was given from ear edge vein immediately after operation in the respective group,while normal saline(0.9%) was given with the same fashion in the control group,once per day for 14 days.On the 1 st,3 rd,7 th and 15 th day after operation,the nitric oxide(NO) in serum and endothelin(ET) in plasma were determined respectively.Results: The plasma ET contents were significantly lowered in safflower and heparin groups compared with that of control group(both P