Diabetic nephropathy （DN） is one of the most common and severe microvascular complications of diabetes， with a complex pathogenesis involving immune inflammatory responses， oxidative stress， apoptosis， glomerulosclerosis， renal interstitial fibrosis， and other pathological processes. In recent years， numerous animal or cell model experiments have revealed that the transforming growth factor-β （TGF-β）/mothers against decapentaplegic homolog （Smad）， phosphoinositide 3-kinase （PI3K）/ protein kinase B （Akt）/mammalian target of rapamycin （mTOR）， mitogen-activated protein kinase （MAPK）， AMP-activated protein kinase （AMPK）， nuclear factor-κB （NF-κB）， Janus kinase （JAK）/signal transducer and activator of transcription （STAT）， neurogenic locus notch homolog protein （Notch）， nuclear factor E₂-related factor 2 （Nrf2）， secretory glycoprotein （Wnt）/β-catenin， and other classical signaling pathways play important roles in the occurrence and development of DN. Traditional Chinese medicines， as natural drugs， possess characteristics such as multiple components， multiple targets， and few adverse reactions， demonstrating unique advantages in regulating the aforementioned signaling pathways and improving renal pathological changes. This review summarized recent research progress on the intervention of DN through the regulation of the aforementioned signaling pathways by single compounds and formulas of traditional Chinese medicine， focusing on their mechanisms of action in regulating immune inflammatory responses， inhibiting renal fibrosis， oxidative stress， improving metabolic disorders， and other aspects. The aim is to provide theoretical references for a deeper understanding of the modern pharmacological basis and clinical application of traditional Chinese medicine in the treatment of DN.

Objective:To explore the clinical characteristics and prognosis of pediatric acute lymphoblastic leukemia with hyperleukocytosis (HL-ALL).Methods:A retrospective case series study was conducted. Clinical data of 153 children with initial diagnosis of HL-ALL from January 2016 to April 2023 in Children's Hospital of Soochow University were retrospectively analyzed. The clinical characteristics, cytogenetic and molecular biological features, immunophenotyping, treatment response and prognosis of the children were recorded. The children were divided into B-lineage and T-lineage groups according to immunophenotyping; the clinical characteristics of the two groups were compared; the overall survival (OS) of children in the two groups was analyzed by the Kaplan-Meier method, and the log-rank test was performed; the factors affecting OS were analyzed by using the Cox proportional hazards model.Results:Among the 153 children, 105 cases were detected with disease-related fusion genes, including 31 cases of Philadelphia chromosome-positive (Ph +)/Philadelphia chromosome-like (Ph-like). Tumor lysis syndrome (TLS) was present during induction therapy in 28 cases, pulmonary infection in 53 cases, intracranial hemorrhage in 6 cases, and sepsis in 12 cases. Immunophenotyping showed 86 cases were lineage B and 67 cases were lineage T. There were statistically significant differences in gender and age of the children between the B-lineage and T-lineage groups (both P < 0.05); the incidence of coagulation abnormalities and the levels of hemoglobin, lactate dehydrogenase and uric acid in the B-lineage group were lower than those in the T-lineage group (all P < 0.001). The positive rates of Ph +/Ph-like, MLL rearrangement, E2A-PBX1 and TEL-AML in the B-lineage group were higher than those in the T-lineage group (all P < 0.05), while the positive rates of SIL-TAL was lower than that in the T-lineage group ( P < 0.05). In terms of early complications, the incidence of TLS in the B-lineage group was lower than that in the T-lineage group ( P < 0.05). The median follow-up time [ M ( Q1, Q3)] was 1 150 (460-2 000) d until 30 April 2024, and the 3-year OS rates of children in the B-lineage and T-lineage groups were 80.6% and 67.1%, respectively; the difference in OS of children between the two groups was not statistically significant ( P = 0.168). The results of univariate Cox analysis showed that white blood cell count, Ph +/Ph-like positivity, occurrence of TLS, pulmonary infection, and intracranial hemorrhage were the influencing factors of OS in B-lineage HL-ALL children (all P < 0.05); white blood cell count and coagulation abnormalities were the influencing factors of OS in T-lineage HL-ALL children (both P < 0.05). Conclusions:There are differences in children's gender, age, laboratory parameters and genetics between the B-lineage and T-lineage groups in HL-ALL. White blood cell count, Ph +/Ph-like positivity, occurrence of TLS, pulmonary infection, and intracranial hemorrhage are the factors affecting OS of B-lineage HL-ALL children; white blood cell count and coagulation abnormalities are the factors affecting OS of T-lineage HL-ALL children.

Objective To investigate the distribution and antimicrobial resistance profiles of clinically isolated Haemophilus influenzae and Moraxella catarrhalis in hospitals across China from 2015 to 2021,and provide evidence for rational use of antimicrobial agents.Methods Data of H.influenzae and M.catarrhalis strains isolated from 2015 to 2021 in CHINET program were collected for analysis,and antimicrobial susceptibility testing was performed by disc diffusion method or automated systems according to the uniform protocol of CHINET.The results were interpreted according to the CLSI breakpoints in 2022.Beta-lactamases was detected by using nitrocefin disk.Results From 2015 to 2021,a total of 43 642 strains of Haemophilus species were isolated,accounting for 2.91％of the total clinical isolates and 4.07％of Gram-negative bacteria in CHINET program.Among the 40 437 strains of H.influenzae,66.89％were isolated from children and 33.11％were isolated from adults.More than 90％of the H.influenzae strains were isolated from respiratory tract specimens.The prevalence of β-lactamase was 53.79％in H.influenzae strains.The H.influenzae strains isolated from children showed higher resistance rate than the strains isolated from adults.Overall,779 strains of H.influenzae did not produce β-lactamase but were resistant to ampicillin(BLNAR).Beta-lactamase-producing strains showed significantly higher resistance rates to these antimicrobial agents than the β-lactamase-nonproducing strains.Of the 16 191 M.catarrhalis strains,80.06％were isolated from children and 19.94％isolated from adults.M.catarrhalis strains were mostly susceptible to both amoxicillin-clavulanic acid and cefuroxime,evidenced by resistance rate lower than 2.0％.Conclusions The emergence of antibiotic-resistant H.influenzae due to β-lactamase production poses a challenge for clinical anti-infective treatment.Therefore,it is very important to implement antibiotic resistance surveillance for H.influenzae and guide rational antibiotic use.All local clinical microbiology laboratories should actively improve antibiotic susceptibility testing and strengthen antibiotic resistance surveillance for H.influenzae.

Objective:To investigate the spatial distribution patterns of local tumor progression（LTP）after microwave ablation（MWA）for colorectal liver metastases（CRLMs）and identify high-risk progression zones.Methods:A total of 471 CRLM lesions from 246 patients treated with MWA at the Chinese PLA General Hospital between September 2009 and March 2022 were retrospectively analyzed. Three-dimensional visualized MRI image fusion technology was employed to evaluate the spatial relationship between ablation margins（AM）and LTP. The liver was partitioned into nine specific anatomical regions. Machine learning（Boruta algorithm）was used to assess the importance of these regions on LTP risk. Multivariate analysis of LTP was performed at the tumor level and at the patient level using the Cox mixed effects model and the Cox regression model，respectively.Results:LTP occurred in 115 lesions，with an LTP rate of 40.0%（80/200）in ablated lesions which were located in the high-risk progression area，and 12.9%（35/271）in low-risk progression area. Multivariate analysis identified AM < 5 mm，tumor size ≥3 cm and location in high-risk zones as independent risk factors for LTP. Notably，LTP in high-risk zones predominantly clustered around the ablation needle tip.Conclusions:Post-MWA LTP in CRLMs exhibits distinct spatial clustering，particularly at the needle tip within high-risk progression zones. These findings provide critical insights for optimizing ablation strategies and improving clinical outcomes.

Hearing loss is the most prevalent disabling disease. Cochlear implantation（CI） serves as the primary intervention for severe to profound hearing loss. This consensus systematically explores the value of genetic diagnosis in the pre-operative assessment and efficacy prognosis for CI. Drawing upon domestic and international research and clinical experience, it proposes an evidence-based medicine three-tiered prognostic classification system（Favorable, Marginal, Poor）. The consensus focuses on common hereditary non-syndromic hearing loss（such as that caused by mutations in genes like GJB2, SLC26A4, OTOF, LOXHD1） and syndromic hereditary hearing loss（such as Jervell & Lange-Nielsen syndrome and Waardenburg syndrome）, which are closely associated with congenital hearing loss, analyzing the impact of their pathological mechanisms on CI outcomes. The consensus provides recommendations based on multiple round of expert discussion and voting. It emphasizes that genetic diagnosis can optimize patient selection, predict prognosis, guide post-operative rehabilitation, offer stratified management strategies for patients with different genotypes, and advance the application of precision medicine in the field of CI.
Humans ; Cochlear Implantation ; Prognosis ; Hearing Loss/surgery* ; Consensus ; Connexin 26 ; Mutation ; Sulfate Transporters ; Connexins/genetics*

Objective:To explore the efficacy and safety of ultrasound-guided radiofrequency ablation for liver metastasis combined with laparoscopic resection of colorectal cancer in the treatment of colorectal cancer liver metastasis (CRLM).Methods:A retrospective cohort study was conducted. Sixty-five CRLM patients who were admitted to Shanxi Province Cancer Hospital from July 2018 to July 2020 were collected and divided into two groups based on different surgical methods: the ultrasound-guided radiofrequency ablation treatment for liver metastasis combined with laparoscopic colorectal cancer resection group (study group) and the total laparoscopic surgery group (control group), with 26 and 39 cases, respectively. The postoperative hospitalization time, surgical cost, intraoperative blood loss, postoperative anal exhaust or defecation time, postoperative feeding time, incidence of postoperative complications, postoperative recurrence and survival status were compared between the two groups of patients.Results:There was no statistically significant difference in age, gender, type of colorectal cancer, number of liver metastasis, and maximum diameter of liver metastasis between the two groups of patients (all P > 0.05). The study group and the control group showed statistically significant differences in postoperative hospitalization time [(5.4±2.2) d vs. (7.0±2.5) d], surgical costs [(4.7±0.8) ten thousand yuan vs. (3.9±0.6) ten thousand yuan], intraoperative blood loss [(104±11) ml vs. (187±20) ml], postoperative anal exhaust or defecation time [(2.2±1.5) d vs. (3.5±1.3) d], and postoperative feeding time [(2.4±1.6) d vs. (3.8±1.2) d] ( t values were 2.82, 4.63, 21.95, 3.57, and 3.65, respectively, all P < 0.01). There was no statistically significant difference in the incidence of subphrenic infection, incision infection, bile leakage, postoperative wound bleeding, liver failure, postoperative 3-year recurrence rate, and postoperative 1-, 2- and 3-year survival rates between the study group and the control group (all P > 0.05). Conclusions:The effect of ultrasound-guided radiofrequency ablation for liver metastasis combined with laparoscopic resection of colorectal cancer for CRLM is comparable to that of total laparoscopic surgery, and the hospitalization time, exhaust or defecation time and feeding time are shortened, the intraoperative bleeding is less, and the surgical complications are not increased.

Objective:To explore the value of deep learning models based on ultrafast dynamic contrast-enhanced MRI (UF-DCE MRI) in predicting malignant breast lesions.Methods:The study was a cross-sectional study. Clinical and imaging data of 347 patients with breast lesions who received treatment at Tianjin Medical University Cancer Institute and Hospital from March 2023 to January 2024 were analyzed retrospectively. A total of 347 lesions were observed in the 347 patients, including 75 benign and 272 malignant lesions. The random number method was used to divide into the training set with 243 cases and the validation set with 104 cases in a ratio of 7∶3. All patients underwent breast UF-DCE MRI and conventional dynamic-enhanced MRI (DCE-MRI). A 27-channel model (27-phase enhancement images of input UF-DCE MRI), a 3-channel model (3-phase enhancement images of input DCE-MRI), and a 1-channel model (1st-phase enhancement images of DCE-MRI) were built based on the pre-trained ResNet18 deep learning model on ImageNet. The efficacy of each model in predicting breast malignant lesions was analyzed using receiver operating characteristic curves and area under the curve (AUC). The differences of AUC were compared using DeLong test.Results:In the training and validation sets, the 27-channel model had the highest AUC for diagnosing malignant breast lesions, which were 0.848 (95% CI 0.818-0.877) and 0.784 (95% CI 0.752-0.817), respectively. DeLong test showed no statistically significant difference in the AUC values of the three models in the validation set for the diagnosis of malignant lesions of the breast in a two-by-two comparison ( P>0.05). UF-DCE MRI scans were 27 phases totaling 81 s with a temporal resolution of 3 s/phase; DCE-MRI scans were 3 phases totaling 270 s with a temporal resolution of 90 s/phase. Conclusions:The model combining UF-DCE MRI with deep learning demonstrates comparable efficacy to DCE-MRI deep learning model in diagnosing breast malignant lesions. However the UF-DCE MRI has the advantages of high temporal resolution and short scanning time, which makes this model valuable for precise diagnosis and treatment of breast cancer.

Renal fibrosis （RF）， characterized by glomerulosclerosis and tubulointerstitial fibrosis， is a central pathological process in chronic kidney disease （CKD）. The nucleotide-binding domain leucine-rich repeat and pyrin domain-containing receptor 3 （NLRP3） inflammasome is closely linked to the occurrence and progression of RF. This review systematically elucidates the mechanisms of the NLRP3 inflammasome in RF， and summarizes the current research on the inhibition of NLRP3 inflammasome activation by single Chinese herbs， active components of traditional Chinese medicine， Chinese herbal compounds， and Chinese patent medicines for the prevention and treatment of RF. The existing studies have demonstrated that single Chinese herbs （Campanumoea lancifolia， Dioscorea zingiberensis）， active components of traditional Chinese medicine （morroniside， liquiritigenin， rosmarinic acid， magnoflorine， fucoidan， etc.）， Chinese herbal compounds （Bushen huoxue formula， Tongluo yishen decoction， Shizhi formula， Bixie fenqing drink）， and Chinese patent medicine （Suyin jiedu granule） can inhibit the activation of the NLRP3 inflammasome to counteract inflammatory damage. This affects multiple pathways（NLRP3/caspase-1/ gasdermin D， NLRP3/interleukin-1β/Smad， etc.） and related upstream and downstream targets of its activation， effectively reducing pyroptosis， mitigating oxidative stress， promoting mitochondrial autophagy， inhibiting fibroblast activation， and reducing excessive extracellular matrix deposition， thereby exerting anti-RF effects.

Allergen-specific Immunotherapy (AIT) is currently the only allopathic treatment capable of modifying the natural course of immunoglobulin E (IgE)-mediated allergic diseases. Currently, there is a lack of recognized clinical markers for evaluating and predicting the efficacy of AIT, and some biological markers may have some potential for application. This article will summarize the currently known indicators for evaluating and predicting the therapeutic effects of AIT, with the aim of providing assistance in evaluating and monitoring the efficacy of AIT.

The prevalence of allergic diseases is on the rise,posing a significant global health challenge.Allergen specific immunotherapy(AIT)is the only treatment capable of altering the natural course of allergic diseases,offering long-term efficacy and the potential to prevent disease progression.However,its widespread application is hindered by factors such as lengthy treatment duration,adverse reactions,and patient compliance issues.In recent years,biologics targeting type 2 inflammatory pathways have played a crucial role at various stages of different allergic diseases.Research indicates that for patients with moderate to severe allergic diseases,using biologics during or prior to AIT can significantly enhance the safety of AIT,reduce the time required to reach maintenance doses,and markedly improve symptom scores.This article elucidates the synergistic mechanisms and recent advancements in the combined application of biologics and AIT in the treatment of allergic diseases.The aim is to provide a reference for the standardized treatment of allergic diseases.