Diabetic kidney disease （DKD）， a common complication of diabetes mellitus， is a leading global cause of end-stage renal disease （ESRD）. Current therapeutic strategies primarily focus on symptomatic management but exhibit limited efficacy in halting disease progression to ESRD， and some drugs carry non-negligible toxic side effects. Traditional Chinese medicine （TCM） has a long history in treating DKD， with single TCM and TCM compounds demonstrating unique advantages in multi-target， multi-pathway， and multi-effect therapeutic interventions. Tripterygium wilfordii （TW）， known for its effects in promoting blood circulation， dredging collaterals， dispelling wind， removing dampness， reducing swelling， and alleviating pain， contains bioactive components such as Tripterygium glycosides （TWG）， triptolide （TPL）， tripdiolide （TPD）， and celastrol （CEL）. The active ingredients possess various functions， including regulating immune-inflammatory balance， ameliorating renal fibrosis and glomerulosclerosis， combating oxidative stress， protecting podocytes， and improving glucose and lipid metabolism， all of which play a significant role in the treatment of DKD. This review summarized the mechanisms underlying the therapeutic effects of T. wilfordii and its active ingredients on DKD， aiming to provide insights for clinical management and novel drug development of DKD.

Nephrotic syndrome （NS） is a glomerular disease characterized by massive proteinuria， hypoalbuminemia， edema， and hyperlipidemia. Tripterygium wilfordii exhibits remarkable efficacy in the prevention and treatment of renal diseases； however， its hepatotoxicity， nephrotoxicity， and other factors limit its clinical application. This article systematically reviews the mechanisms of pharmacological effects and detoxification of T. wilfordii and its active ingredients in the treatment of NS. The results show that the main active components of T. wilfordii include tripterygium glycosides， triptolide， and triptriolide， etc. T. wilfordii and its active ingredients exert significant renal protective effects by protecting glomerular podocytes， repairing the glomerular filtration barrier， regulating abnormal immune and inflammatory responses， inhibiting oxidative stress injury， and blocking renal fibrosis， thereby effectively reducing proteinuria， improving renal function， and lowering the recurrence rate of NS. Traditional Chinese medicine compatibility （e.g. T. wilfordii combined with Lysimachia christinae ， Cuscuta chinensis ethanol extract， and Paeonia lactiflora ， respectively） can regulate anti-inflammatory and antioxidant levels and optimize drug metabolic pathways. Combined with modern preparation technologies （e.g.， triptolide self-microemulsion drug delivery system）， these strategies can effectively antagonize the hepatotoxicity， nephrotoxicity， and other factors of T. wilfordii .

Objective To analyze the current status of clinical trial registration in the TCM treatment of diabetic nephropathy(DN);To provide references for the registration and implementation of relevant clinical trials.Methods Clinical trials about TCM treatment for DN registered in the Chinese Clinical Trial Registry(ChiCTR)and the U.S.Clinical Trial Registry(ClinicalTrials.gov)from their inception to August 18,2024 were retrieved.The following information was analyzed:registration year,geographical distribution,funding sources,TCM syndrome patterns of participants,number of research centers,sample size,study type,study design,randomization method,blinding method,intervention measures,outcome indicators and safety indicators.Results A total of 88 clinical trials were included,comprising 79 interventional studies and 9 observational studies.The number of registrations has increased annually.The domestic registered trials were distributed across 17 provincial-level administrative regions in China,with Beijing and Shanghai having the highest number of registrations.The primary sources of funding were local and national government funds.The most common TCM syndrome pattern among participants was qi-yin deficiency with blood stasis.Most trials were single-center studies,with the majority having a sample size between 31 and 60.The predominant study type was interventional,mostly randomized controlled trials(RCTs),with simple randomization being the most frequently used method.31 trials reported blinding methods,with double-blinding being the most common.The intervention measures were mostly oral Chinese patent medicines or TCM compounds,and the outcome indicators were mainly efficacy indicators,with less safety indicators.Conclusion The number of registered clinical trials on TCM treatment for DN has increased annually;however,the overall number remains limited.There is uneven regional distribution and incomplete registration information for various factors such as randomization methods,blinding methods,number of research centers,intervention measures,and outcome indicators.

Objective:To evaluate the effects of different combinations of digital single-lens reflex cameras and macro lenses, aperture settings, and focusing points on depth-of-field sharpness and image distortion in dental clinical photography, and to provide evidence-based guidance for standardizing dental clinical photography.Methods:Full-frame and advanced photo system type-C (APS-C) digital single-lens reflex cameras were paired with 105 mm and 60 mm macro lenses. Photography was performed under eight preset aperture values (F16, F18, F20, F22, F25, F29, F32, and F36) on a standard oral model, focusing separately on three points simulating the central incisor, canine, and first molar. Five attending physicians, who had completed standardized training in dental esthetic clinical photography and calibration training (with over 5 years of dental clinical photography experience), evaluated the depth-of-field sharpness of the photographs using a double-blind method. Image distortion was assessed by measuring the width-to-length ratio of the central incisor.Results:Photographs taken with the APS-C digital single-lens reflex camera combined with the 105 mm macro lens showed significantly higher depth-of-field sharpness scores (2.756±0.357) compared to other camera-lens combinations ( P<0.05). Photographs taken at aperture settings of F25, F29, F32, and F36 demonstrated significantly higher depth-of-field sharpness scores than those taken at F16, F18, F20, and F22 ( P<0.05). Images focused on the simulated canine achieved the highest depth-of-field sharpness scores, followed by the central incisor, with the first molar showing the lowest scores ( P<0.05). Main effect and interaction effect tests revealed that camera-lens combinations significantly affected image distortion ( F=2.79, P=0.042), while focusing points and aperture settings showed no significant effect on image distortion ( F=0.40, P=0.671; F=1.27, P=0.270). Conclusion:Based on experimental data analysis, using an APS-C digital single-lens reflex camera with a 105 mm macro lens, setting the aperture value between F25 and F36, and focusing on the canine can ensure sufficient depth-of-field sharpness while avoiding image distortion, thereby achieving optimal results in dental clinical photography.

Immunoglobulin A nephropathy （IgAN） is a common primary glomerular disease and a frequent cause of chronic renal failure. Tripterygium wilfordii is a traditional Chinese herbal medicine， which possesses the effects of promoting blood circulation， relieving swelling and pain， and dispelling wind and dampness. Modern pharmacological studies have shown that T. wilfordii multiglucoside exhibit anti-inflammatory and immunomodulatory effects， inhibit mesangial cell proliferation， protect podocytes， ameliorate endothelial cell injury， and regulate gut microbiota disturbances. Triptolide also possesses anti-inflammatory and immunomodulatory properties， suppresses mesangial cell proliferation， and protects podocytes. Celastrol demonstrates anti- inflammatory and immunomodulatory functions as well as the ability to improve endothelial cell damage. Through these mechanisms， T. wilfordii and its active components can play a role in alleviating clinical symptoms and delaying disease progression in the treatment of IgAN. Future research should focus on in-depth analysis and mechanistic investigation of these active ingredients， promote high-quality clinical studies， systematically evaluate the synergistic effects among them， and emphasize strategies for reducing toxicity and enhancing efficacy， thereby providing more comprehensive and reliable evidence-based foundations for the clinical treatment of IgAN.

Objective:To evaluate the effects of different combinations of digital single-lens reflex cameras and macro lenses, aperture settings, and focusing points on depth-of-field sharpness and image distortion in dental clinical photography, and to provide evidence-based guidance for standardizing dental clinical photography.Methods:Full-frame and advanced photo system type-C (APS-C) digital single-lens reflex cameras were paired with 105 mm and 60 mm macro lenses. Photography was performed under eight preset aperture values (F16, F18, F20, F22, F25, F29, F32, and F36) on a standard oral model, focusing separately on three points simulating the central incisor, canine, and first molar. Five attending physicians, who had completed standardized training in dental esthetic clinical photography and calibration training (with over 5 years of dental clinical photography experience), evaluated the depth-of-field sharpness of the photographs using a double-blind method. Image distortion was assessed by measuring the width-to-length ratio of the central incisor.Results:Photographs taken with the APS-C digital single-lens reflex camera combined with the 105 mm macro lens showed significantly higher depth-of-field sharpness scores (2.756±0.357) compared to other camera-lens combinations ( P<0.05). Photographs taken at aperture settings of F25, F29, F32, and F36 demonstrated significantly higher depth-of-field sharpness scores than those taken at F16, F18, F20, and F22 ( P<0.05). Images focused on the simulated canine achieved the highest depth-of-field sharpness scores, followed by the central incisor, with the first molar showing the lowest scores ( P<0.05). Main effect and interaction effect tests revealed that camera-lens combinations significantly affected image distortion ( F=2.79, P=0.042), while focusing points and aperture settings showed no significant effect on image distortion ( F=0.40, P=0.671; F=1.27, P=0.270). Conclusion:Based on experimental data analysis, using an APS-C digital single-lens reflex camera with a 105 mm macro lens, setting the aperture value between F25 and F36, and focusing on the canine can ensure sufficient depth-of-field sharpness while avoiding image distortion, thereby achieving optimal results in dental clinical photography.

Objective To analyze the current status of clinical trial registration in the TCM treatment of diabetic nephropathy(DN);To provide references for the registration and implementation of relevant clinical trials.Methods Clinical trials about TCM treatment for DN registered in the Chinese Clinical Trial Registry(ChiCTR)and the U.S.Clinical Trial Registry(ClinicalTrials.gov)from their inception to August 18,2024 were retrieved.The following information was analyzed:registration year,geographical distribution,funding sources,TCM syndrome patterns of participants,number of research centers,sample size,study type,study design,randomization method,blinding method,intervention measures,outcome indicators and safety indicators.Results A total of 88 clinical trials were included,comprising 79 interventional studies and 9 observational studies.The number of registrations has increased annually.The domestic registered trials were distributed across 17 provincial-level administrative regions in China,with Beijing and Shanghai having the highest number of registrations.The primary sources of funding were local and national government funds.The most common TCM syndrome pattern among participants was qi-yin deficiency with blood stasis.Most trials were single-center studies,with the majority having a sample size between 31 and 60.The predominant study type was interventional,mostly randomized controlled trials(RCTs),with simple randomization being the most frequently used method.31 trials reported blinding methods,with double-blinding being the most common.The intervention measures were mostly oral Chinese patent medicines or TCM compounds,and the outcome indicators were mainly efficacy indicators,with less safety indicators.Conclusion The number of registered clinical trials on TCM treatment for DN has increased annually;however,the overall number remains limited.There is uneven regional distribution and incomplete registration information for various factors such as randomization methods,blinding methods,number of research centers,intervention measures,and outcome indicators.

Objective To determine the role of programmed cell death-ligand l(PD-L1)and cluster of differentiation 8(CD8)in judging the prognosis of human epidermal growth factor receptor 2(HER2)positive breast cancer patients,through evaluating the expression of PD-L1 and CD8 in the tumor microenvironment,and their correlation with clinicopathological data.Methods A total of 65 HER2 positive breast cancer patients were collected admitted to Tengzhou Central People's Hospital in Shandong Province from October 2016 to October 2018,all of whom were women.Theparaffin slices of cancer tissue were labeled with PD-L1 and CD8 using immunohistochemical methods.Collect clinicopathological data of patients,including 7 prognostic parameters,such as age,histological grade,P53,KI-67,estrogen receptor,progesterone receptor and tumor node metastasis classification(TNM)staging.Statistical analysis was conducted to determine whether the expression of PD-L1 and CD8 were correlated with the above clinicopathological data.Results PD-L1 positive rate was 21.5％,the positive expression of PD-L1 was correlated with histological grading and TNM staging,and the difference in results was statistically significant(x2=6.250,P=0.044;x2=13.730,P=0.001);CD8 positive rate was 32.3％,the expression of CD8 cells was correlated with histological grading and TNM staging,and the difference in results was statistically significant(x2=8.023,P=0.018;x2=6.117,P=0.047).Conclusion PD-L1 and CD8 expression are correlated with breast cancer histological grade and TNM stage.PD-L1 and CD8 expression may be important prognostic markers for HER2 positive breast cancer patients.

Objective:To investigate the serum lactate level in patients with rheumatoid arthritis(RA)and its relationship with disease activity,and to analyze the effect of sodium lactate on the activation of CD4+T cells,the ability of secreting cytokines and CD4+T cell subsets in peripheral blood of the RA patients.Methods:The peripheral blood of healthy controls(HC)and RA patients was collected,and the content of lactate in the supernatant was detected by lactate detection kit,the correlation between the content of lactate and the disease score of the RA patients was analyzed;the activation level of CD4+T cells,the proportion of CD4+T cell subsets and the cytokines secreted by CD4+T cells in peripheral blood of all the RA patients were detected by flow cytometry after being stimulated with sodium lactate.Results:The serum lactate level in the RA patients(n=66)was significantly higher than that in the HC(n=60,P＜0.001),and there was a certain correlation with disease activity score in 28 joints(DAS28)-C-reactive protein(CRP)(r=0.273,P=0.029),The levels of rheumatoid factor[RF,197.50(26.03,783.00)IU/mL vs.29.30(0.00,102.60)IU/mL,P＜0.01],CRP[37.40(11.30,72.60)mg/L vs.5.83(2.36,12.45)mg/L,P＜0.001],were increased in patients with the lactate concentration greater than 5 mmol/L were significantly higher than those in patients with the lactate concentration less than or equal 5 mmol/L,however,there was no significant difference in the expres-sion of erythrocyte sedimentation rate[ESR,42.00(19.00,77.00)mm/h vs.25.00(12.50,45.50)mm/h,P＞0.05]and anti-cyclic citrullinated peptied(CCP)antibody[82.35(17.70,137.00)RU/mL vs.68.60(25.95,119.70)RU/mL,P＞0.05].Compared with the control group,the expression of PD-1(46.15％±8.54％vs.41.67％±9.98％,P＜0.001),inducible costimulatory molecule(ICOS,5.77％±8.60％vs.18.65％±7.94％,P＜0.01)and CD25(25.89％±5.80％vs.22.25％±4.59％,P＜0.01)on the surface of CD4+T cells in the RA patients treated with sodium lactate was significantly increased.Compared with the control group,the proportion of Th17(4.62％±1.74％vs.2.93％±1.92％,P＜0.05)and Tph(28.02％±6.28％vs.20.32％±5.82％,P＜0.01)cells in CD4+T cells of the RA patients in the sodium lactate treatment group increased.Compared with the con-trol group,the expression of IL-21(5.73％±1.59％vs.4.75％±1.71％,P＜0.05)inCD4+Tcells was up-regulated in the RA patients treated with sodium lactate.Conclusion:The level of serum lactate in RA patients is increased,which promotes the activation of CD4+T cells and the secretion of IL-21,and up-regulates the proportion of Th 17 and Tph cells in the RA patients.

OBJECTIVE To evaluate the efficacy and safety of rituximab （RTX） in the treatment of children with refractory nephrotic syndrome （RNS） based on the real world by meta-analysis. METHODS A systematic search was conducted on CNKI， Wanfang， VIP， PubMed， Embase， Web of Science， the Cochrane Library， and CINAHL databases to strictly screen the literature and evaluate their quality. A meta-analysis was performed on the extracted literature data using R 4.2.2 and RStudio software. RESULTS A total of 26 real-world studies were included in this study， involving 996 children with steroid-dependent nephrotic syndrome/frequente-relapse nephrotic syndrome （SDNS/FRNS） and 205 children with steroid-resistant nephrotic syndrome （SRNS）. The results of the meta-analysis showed that the complete remission （CR） rate of RTX treatment for RNS was 46% （95%CI： 37%-56%）， the partial remission （PR） rate was 22% （95%CI： 14%-31%）， and the discontinuation rate was 35% （95%CI： 25%-44%）. The results of subgroup analysis showed that the CR rate of RTX treatment in SDNS/FRNS children was 49% （95%CI： 37%-62%）， PR rate was 25% （95%CI： 0-50%）， discontinuation rate was 41% （95%CI： 29%-52%）； the CR rate in SRNS children was 42% （95%CI： 27%-56%）， PR rate was 22%（95%CI： 12%-32%）， discontinuation rate was 21% （95%CI： 4%-38%）. The recurrence rate in children with SDNS/FRNS was 39% （95%CI： 21%-57%） within 1 year or less， 18% （95%CI： 18%-98%） in 2 years and more. As for safety， the majority of adverse reactions were mild infusion reactions， with an incidence of 13% （95%CI： 8%-22%）. Sensitivity analysis suggested that the results were robust. There was publication bias in mild infusion 20210908-BZ-CACM） reaction rate. CONCLUSIONS RTX is effective and safe in the treatment of RNS in children.