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.

ObjectiveTo study the protective effect of Shoutaiwan-containing serum on the human chorionic trophoblast cells （HTR-8/Svneo） exposed to hydrogen peroxide （H₂O₂） via the nuclear factor erythroid 2-related factor 2 （Nrf2） signaling pathway and to decipher the underlying mechanism. MethodThe H₂O₂ solutions of 25， 50， 100， 200， 400 μmol·L^-1 were used to treated the HTR-8/Svneo cells. The cell counting kit-8 （CCK-8） was employed to measure the proliferation of the cells and further determine the optimal concentration of H₂O₂ solution for modeling and the drug-containing serum. The cells were divided into a blank group， a model group， a dydrogesterone group， and a Shoutaiwan group. The effect of drug-containing serum on H₂O₂-induced proliferation of HTR-8/Svneo cells was detected by CCK-8 assay. The intracellular reactive oxygen species （ROS） in each group was determined by enzyme-linked immunosorbent assay （ELISA）. Western blot was employed to determine the protein levels of Nrf2， heme oxygenase-1 （HO-1）， quinone oxidoreductase 1 （NQO1）， cysteine-containing aspartate-specific protease-3 （Caspase-3）， and B cell lymphoma/leukemia-2 （Bcl-2）. Cellular immunofluorescence was employed to detect the expression of Nrf2 and Bcl-2. Real-time quantitative polymerase chain reaction （Real-time PCR） was carried out to examine the mRNA level of Nrf2， Caspase-3， and Bcl-2 associated X protein （Bax）. ResultThe optimal concentration of H₂O₂ for modeling was 50 μmol·L^-1， and the optimal concentration of drug-containing serum was 10%. Compared with the blank group， the modeling decreased the proliferation of cells （P<0.01）， increased the intracellular ROS （P<0.01）， down-regulated the protein levels of Nrf2， HO-1， NQO1， and Bcl-2 （P<0.05， P<0.01）， up-regulated the protein levels of Caspase-3 and Bax （P<0.01）， down-regulated the mRNA level of Nrf2 （P<0.01）， and up-regulated the mRNA levels of Caspase-3 and Bax （P<0.05， P<0.01）. Compared with the model group， Shoutaiwan-containing serum increased the proliferation of cells （P<0.01）， reduced the intracellular ROS （P<0.01）， up-regulated the protein levels of Nrf2， HO-1， NQO1， and Bcl-2 （P<0.01）， down-regulated the protein levels of Caspase-3 and Bax （P<0.05， P<0.01）， up-regulated the mRNA level of Nrf2 （P<0.05）， and down-regulated the mRNA levels of Caspase-3 and Bax （P<0.05， P<0.01）. ConclusionShoutaiwan-containing serum can inhibit H₂O₂-induced apoptosis by activating the Nrf2 signaling pathway and has protective effect on human chorionic trophoblast cells.

ObjectiveTo observe the effect of Zhuluan decoction on the ovarian reserve function of rats with cyclophosphamide-induced premature ovarian insufficiency， and explore the protective mechanism of Zhuluan decoction in the rat model of premature ovarian insufficiency based on the phosphatidylinositol-3-kinases/protein kinase B/mammalian target of rapamycin （PI3K/Akt/mTOR） signaling pathway. MethodSixty female SD rats were randomly divided into normal group （n=10） and model group （n=50）. The model group was given intraperitoneal injection of cyclophosphamide （50 mg·kg^-1 loading dose on the 1^st day+8 mg·kg^-1 low-dose maintenance on the 2^nd–15^th days）. After successfully modeling， the rats were randomly divided into model group， positive drug （progynova） group （0.1 mg·kg^-1·d^-1）， and low-， medium-， and high-dose Zhuluan decoction groups （14， 28， 56 g·kg^-1·d^-1 ）， with 10 rats in each group. The model group and the normal group were given equal volume of distilled water by gavage， once a day， continuous administration for 21 d. The estrous cycle and body weight of rats in each group were detected， and the ovarian organ index and uterine organ index were calculated. The ovarian tissue pathology and ovarian follicle counts at all levels were determined by hematoxylin-eosin （HE） staining. The content of the serum antimullerian hormone （AMH）， follicle-stimulating hormone （FSH）， luteinizing hormone （LH）， and inhibin-B （INH-B） of rats was determined by enzyme-linked immunosorbent assay （ELISA）， and the protein expression levels of PI3K， Akt， mTOR in the rat ovarian tissue were determined by Western blot. The microtubule-associated protein 1 light chain 3B （LC3B） protein expression in the rat ovarian tissue was determined by immunohistochemistry. ResultAs compared with the blank group， the estrous cycle of rats in the model group was disordered， the body weight， ovarian organ index， and uterine organ index decreased， the number of primordial follicles decreased， and the number of secondary follicles and atretic follicles increased. In the model group， FSH increased （P<0.01）， LH increased （P<0.05）， AMH level decreased （P<0.05）， the protein expression levels of PI3K， Akt， and mTOR in the ovarian tissue decreased （P<0.01）， and the protein expression level of LC3B increased significantly （P<0.01）. As compared with the model group， the above indexes were improved in the progynova group and different doses of Zhuluan decoction groups， the content of AMH increased （P<0.05）， and FSH decreased （P<0.05）. In the progynova group and different doses of Zhuluan decoction groups， the protein expression level of LC3B decreased obviously （P<0.01）， and the protein expression levels of PI3K， Akt， and mTOR all showed an increasing trend. Moreover， there was a statistically significant difference in the progynova group and low- and medium-dose Zhuluan decoction groups （P<0.05）. ConclusionZhuluan decoction may inhibit the occurrence of excessive autophagy in ovarian granulosa cells by activating the PI3K/Akt/mTOR pathway， thereby reversing the effect of modeling on ovarian reserve in rats.

Chloride voltage-gated channel, as an important ion channel in living organisms, has many important physiological functions.The gene encoding chloride voltage-gated channel protein is CLCN, which has nine members(CLCN1~7, CLCNKa, and CLCNKb).The CLCN gene variants lead to abnormal expression of chloride channel proteins, which affect the biological activities of neuronal signaling, ion homeostasis, intracellular transport, and lysosomal protein degradation, thereby altering ion channel gating properties, interfering with the normal developmental process of the nervous system, and causing the development of intellectual disability.In recent years, further studies of the CLCN gene have found that the variants in some members of this family are closely related to intellectual disability.This review will discuss the correlation between the chloride voltage-gated channel and intellectual disability.

Humans ; Critical Illness ; Critical Care ; Intensive Care Units ; Surveys and Questionnaires

ObjectiveTo evaluate the clinical efficacy of Qimai Qinlou prescription in the treatment of elderly community-acquired pneumonia （CAP） （non-severe） with Qi and Yin deficiency and phlegm-heat obstructing lung syndrome and its impact on immune-inflammatory factors. MethodA total of 120 eligible patients were randomly divided into an observation group （60 cases） and a control group （60 cases）. Both groups received intravenous cefoxitin sodium. In addition， the observation group received oral Qimai Qinlou prescription， while the control group received an oral placebo simulating Qimai Qinlou prescription. The treatment course was 14 days. The disappearance time of major clinical symptoms and signs was recorded. Traditional Chinese medicine （TCM） syndrome scores and the Clinical Research Outcome （CAP-CRO） scale scores for pneumonia of the two groups were compared. Chest computed tomography （CT） scans were performed， and peripheral blood levels of procalcitonin （PCT）， interleukin-6 （IL-6）， serum amyloid A （SAA）， high-sensitivity C-reactive protein （hs-CRP）， CD4⁺， CD8⁺， and CD4⁺/CD8⁺ were measured. The conversion rate to severe condition during hospitalization， readmission rate within 30 days after discharge， and safety evaluation were recorded. ResultAfter treatment， the observation group showed significantly shorter time of fever， cough， expectoration， and disappearance time of lung moist rales than the control group （P<0.01）. The TCM syndrome scores， CAP-CRO scores in all dimensions， and total scores in both groups were significantly reduced as compared with those before treatment （P<0.01）. After treatment， the observation group had a more significant reduction than the control group （P<0.01）. The levels of PCT， IL-6， SAA， and hs-CRP in both groups were significantly reduced as compared with those before treatment （P<0.01）. After treatment， the observation group showed a more significant reduction than the control group （P<0.01）. There was no statistically significant difference in the changes of CD4⁺， CD8⁺， and CD4⁺/CD8⁺ in the control group before and after treatment. However， in the observation group， CD4⁺ and CD4⁺/CD8⁺ levels significantly increased （P<0.01）， while CD8⁺ level significantly decreased （P<0.01） after treatment. After treatment， CD4⁺ and CD4⁺/CD8⁺ in the observation group significantly increased （P<0.01）， and CD8⁺ significantly decreased as compared with those in the control group （P<0.01）. At 7， 10， and 14 days after treatment， the curative rates in the observation group were 53.33% （32/60）， 85.00% （51/60）， and 91.67% （55/60）， respectively， which were higher than 31.67% （19/60）， 61.67% （37/60）， and 68.33% （41/60） in the control group （χ²=5.763， 8.352， 10.208， P<0.05）. After treatment， the total effective rate of CT scanning in the observation group was 93.33% （56/60）， higher than 80.00% （48/60） in the control group （χ²=4.615， P<0.05）. The conversion rate to severe condition during hospitalization in the observation group was 3.33% （2/60）， lower than 15.00% （9/60） in the control group （χ²=4.904， P<0.05）. The readmission rate within 30 days after discharge in the observation group was 8.33% （5/60）， lower than 23.33% （14/60） in the control group （χ²=5.065， P<0.05）. No serious adverse drug reactions were observed in either group during the treatment period. ConclusionQimai Qinlou prescription can enhance immune function， alleviate inflammatory reactions， significantly relieve clinical symptoms， shorten the duration of the disease， improve the curative rate and CT scanning efficacy， prevent disease progression， reduce the readmission rate in the short term， and is clinically safe for the treatment of elderly patients with non-severe CAP with Qi and Yin deficiency and phlegm-heat obstructing lung syndrome. It is worthy of further research and application.

Pregnancy ; Female ; Humans ; Placenta ; Nuclear Transfer Techniques ; Embryo, Mammalian ; Cell Nucleus

Objective:To explore the effect of the hospital discharge readiness plan based on deep integration of medical nursing and rehabilitation in children with cerebral palsy.Methods:From January 2020 to September 2021, 60 children with cerebral palsy and their 60 parents admitted to the Children's Rehabilitation Department of Anhui Children's Hospital were selected as the research object. The children and parents were divided into the observation group and the control group by random number table, with 30 children and 30 parents in each group. The control group was given routine nursing, and the observation group was given the hospital discharge readiness plan based on the deep integration of medical nursing and rehabilitation. On the first day of admission and the day before discharge, the effects were evaluated using the Chinese version of the Chinese version of the Readiness for Hospital Discharge Scale (RHDS) -Parent Form, the Chinese version of the Quality of Discharge Teaching Scale (QDTS) -Parent Form, the Activities of Daily Living (ADL) Rehabilitation Nursing Rating Scale for Children with Cerebral Palsy.Results:After the intervention, the scores of the observation group were higher than those of the control group in terms of readiness for hospital discharge, quality of discharge teaching, and the differences were statistically significant ( P<0.05) . Conclusions:The hospital discharge readiness plan based on deep integration of medical nursing and rehabilitation in children with cerebral palsy can effectively improve their discharge readiness, the quality of discharge teaching and the ADL of children with cerebral palsy.

Objective:To investigate the diagnosis and treatment of hepatic artery thrombosis (HAT) after adult orthotopic liver transplantation.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 411 patients who underwent adult orthotopic liver transplantation in the First Affiliated Hospital of Xi ′an Jiaotong University from December 2011 to July 2018 were collected. There were 328 males and 83 females, aged from 21 to 66 years, with a median age of 46 years. Observation indicators: (1) incidence of HAT and its clinical characteristics; (2) diagnosis of HAT; (3) treatment of HAT; (4) follow-up. Follow-up using outpatient service, telephone interview or WeChat group communication was conducted to detect the incidence of biliary stricture and survival of patients up to August 2018. Measurement data with normal distribution were represented as Mean± SD, measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages. Survival rate was estimated using the Kaplan-Meier method. Results:(1) Incidence of HAT and its clinical characteristics: 11 of 411 patients had HAT after orthotopic liver transplantation with the incidence of 2.68%(11/411), including 10 males and 1 female, aged 44 years(range, 22-63 years). The time to occurrence of postoperative HAT was 4 days(range, 1-15 days). The etiologies of 11 patients included 6 cases of hepatitis B virus-related cirrhosis, 1 case of hapatitis related cirrhosis, 1 case of hepato-cellular carcinoma, 1 case of liver cirrhosis, 1 case of alcoholic hepatitis related cirrhosis, 1 case of wilson disease. All the 11 patients were ABO compatible. The cold ischemic time and warm ischemic time of donor liver were (316±89)minutes and (13±4)minutes, respectively. Type Ⅰ arterial anasto-mosis was conducted in 11 patients. The clinical manifestations included asymptomatic type in 10 patients and sepsis type in 1 patient. (2) Diagnosis of HAT: all the 11 patients were confirmed with HAT by endovascular angiography, including 7 cases showed no arterial flow under Color Doppler ultrasound, and contrast-enhanced ultrasound indicated HAT. Two patients showed increased hepatic artery resistance index under Color Doppler ultrasound, and contrast-enhanced ultrasound indicated 1 case of HAT and 1 case of anastomotic stenosis. One patient showed slow velocity of hepatic artery blood flow and low resistance index under color Doppler ultrasound, and contrast-enhanced ultrasound indicated HAT. One patient showed slight blood flow signals under Color Doppler ultrasound, and contrast-enhanced ultrasound indicated HAT. (3) Treatment of HAT: 11 patients received endovascular therapy. Six patients had HAT completely disappeared after thrombolytic therapy, 5 patients with residual thrombosis continued thrombolytic therapy with microcatheter urokinase. Six patients with complications were improved after symptomatic treatment. HAT completely disappeared after (6.7±2.6)days of treatment and the clinical success rate was 11/11. (4) Follow-up: 11 patients were followed up for 19-1 722 days, with a median follow-up time of 46 days. During the follow-up, 4 patients had biliary stricture and underwent stent implantation. Nine patients survived with 1-, 3-, 5-year overall survival rates of 75%, 75%, 75%, and 2 patients died.Conclusions:The incidence of HAT after adult orthotopic liver transplantation is low and clinical manifestations are atypical. Contrast enhanced ultrasound can improve diagnosis of suspected thrombosis. Endovascular therapy is safe and effective, which can significantly improve the blood flow of hepatic artery.

SARS-CoV-2 can cause multiple organ injuries in some susceptible people in a short time, which seriously threatens the health and safety of people, and intensive care and multiple extracorporeal organ support are important means of treatment. Although many experts’ consensus and clinical guidelines have been published, a series of clinical problemsstill exist during the treatment procedure, and no consensushas not been reached until now. Therefore,in this paper wemake some reflections and explorations to provide experience and help for clinicians.