Diabetes mellitus (DM) is a major metabolic disease endangering global health, with diabetic nephropathy (DN) as a primary complication lacking curative therapy. Sporoderm-broken spores of Ganoderma lucidum (GLP), an herbal medicine, has been used for the treatment of metabolic disorders. In this study, DN was induced in Sprague-Dawley rats using streptozotocin (STZ) and a high-fat diet (HFD), and the protective mechanisms of GLP were investigated through transcriptomic, metabolomic, and network pharmacology (NP) analyses. Our results demonstrated that GLP intervention ameliorated renal damage and inflammation levels in DN rats. Integrative metabolomic and transcriptomic analysis revealed that GLP treatment modulated glucose and cellular energy metabolisms by regulating relevant genes. GLP significantly suppressed the inflammations by impacting glucose and energy metabolism-related gene expression (Igfbp1 and Angptl4) and enhanced metabolic biomarkers of 4-Aminocatechol. In addition, NP analysis further indicated that GLP may efficiently alleviate DN via immune-related pathways. In conclusion, this study provides supportive evidence of the anti-inflammatory effects of GLP supplements, highlighting their potential for promising clinical applications in treating DN.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Objective:To investigate the clinical therapy of sacral osteotomy combined with lumbopelvic distraction triangular osteosynthesis for malunion and nonunion of type C longitudinally displaced sacral fracture.Methods:A retrospective study of 9 patients with malunion and nonunion of type C pelvic fractures who had been treated with sacral osteotomy combined with triangular osteosynthesis from April 2015 to January 2020 were analyzed. They were 5 men and 4 women, with an average age of 30.67±10.06 (range 14-45 years). AO/OTA classification at initial pelvic fracture, 8 cases were type C1.3 and one was type C3.3. The period from injury to surgery was 12.8±18.92 months (range 3-60 months). The cranial displacement of one side of the pelvis was 3.8±0.57 cm (range 2.5-4.1 cm). Sacral osteotomy and triangular osteosynthesis were used in all nine patients, combined with osteotomy or no osteotomy of the superior and inferior branches of the anterior ring pubis. The degree of longitudinal displacement of one side of the pelvis was assessed by making a vertical line gap between the acetabular apex on both sides and the central axis of the sacrum on the X-ray of the pelvis. The Majeed scoring and visual analogue scale (VAS) were evaluated preoperatively and at the last follow-up to assess the therapeutic effect of the patients.Results:In all 9 patients, except for 1 case of postoperative pelvic residual displacement 1.5 cm (preoperative 3.2 cm difference compared with the healthy side), the other 8 patients had a postoperative bilateral difference of 0.1-0.7 cm. All the patients were followed up for 12.00±9.95 months. At the last follow-up, the Majeed score of pelvic fracture increased from 44.0(33.5, 76.0) points preoperatively to 91.0(80.5, 92.5) points. The difference before and after operation was statistically significant ( Z=2.67, P<0.001), and the gait was significantly improved. And the VAS score for pain decreased from 6.00±1.41 points preoperatively to 1.22±0.97 points. The difference before and after operation was statistically significant ( t=8.73, P<0.001). None had complications like infection, plate broken, screw loosening, iatrogenic nerve or blood vessel injury, etc. Conclusion:Sacral osteotomy combined with lumbopelvic distraction triangular osteosynthesis for the treatment of pelvic malunion and nonunion caused by sacral fracture can correct pelvic deformity, prolong limb length, and reconstruct the stability of pelvic ring with good clinical results.

Because many therapeutic agents are contaminated by epimeric impurities or form epimers as a result of metabolism, analytical tools capable of determining epimers are increasingly in demand. This article is a proof-of-principle report of a novel DMS-MS/MS method to separate and simultaneously quantify epimers, taking PGF2 and its 8-epimer, 8--PGF2, as an example. Good accuracy and precision were achieved in the range of 10-500 ng/mL with a run time of only 1.5 min. Isopropanol as organic modifier facilitated a good combination of sensitivity and separation. The method is the first example of the quantitation of epimers without chromatographic separation.

Objective To investigate reflectance confocal microscopy (RCM) characteristics of childhood hypopigmented lichen striatus.Methods RCM was performed to image skin lesions and perilesional normal skin in 11 children with hypopigmented lichen striatus.Then,confocal microscopic findings of the skin lesions were compared with pathological findings.Results Histopathological examination of the skin lesions showed mild intercellular and intracellular edema,thickening of prickle cell layer to different extent,local liquefaction degeneration of basal cells,and perivascular infiltration of plenty of lymphocytes and a few melanophages in the superficial dermis.RCM horizontal images showed multifocal liquefaction degeneration of basal cells,which caused indistinct dermo-epidermal junction,incomplete or unclear dermal papillary rings,infiltration of many highly refractive melanophages and slightly to moderately refractive inflammatory cells in papillary and superficial dermis.Conclusion RCM characteristics can serve as strong evidences for the diagnosis and differential diagnosis of childhood hypopigmented lichen striatus.

Objective To analyze and compare reflectance confocal microscopy (RCM) features between Paget's disease and eczema on the scrotum.Methods RCM was performed to image scrotal lesions of 5 male patients with suspected Paget's disease and 5 male patients with eczema.Then,the scrotal lesions were resected and subjected to histopathological examination,and a comparison was conducted between the confocal microscopic and pathological findings.Results RCM imaging for the 5 cases of Paget's disease showed disorganized epidermal structure,absence of normal honeycomb structures,single or clustered pagetoid cells in the prickle cell layer.RCM imaging for the 5 cases of eczema showed intercellular edema in the prickle cell layer,reticular degeneration of blisters in all the cases,and pustule formation in some cases.Conclusion RCM features are obviously different between Paget's disease of the scrotum and scrotal eczema,so RCM imaging can facilitate the early diagnosis of Paget's disease.

Objective To investigate the clinical and reflectance confocal microscopy (RCM) characteristics of hypopigmentation induced by local glucocorticoid injection.Methods A retrospective study was carried out on 26 cases of hypopigmentation induced by local glucocorticoid injection.The clinical manifestations,RCM characteristics and treatment outcomes of hypopigmentation induced by local glucocorticoid injection were analyzed in these cases.Results Of the 26 patients,22 were female and 4 were male.Lesions were round or oval,pale white or white patches with obscure boundaries.Different degrees of localized skin atrophy occurred in 15 patients,and subcutaneous venous networks were observed in 8 of the 15 patients.RCM imaging of lesions in the 26 cases showed different degrees of epidermal thinning in the areas of hypopigmentation,shortening or disappearance of trochanterellus,and decreased number or disappearance of chromocytes in the basal layer,which were totally different from RCM characteristics of vitiligo lesions.Conclusion Hypopigmentation induced by local glucocorticoid injection is a kind of depigmentation disease complicated by skin atrophy with definite inducements,and RCM is of great value to its diagnosis.

Objective To evaluate the level of daily red meat intake and prevalence of excessive red meat intake among employees of floating population in China.Methods 48 511 employees of floating population aged 18 to 59 from 170 counties of 31 provinces (autonomous regions and municipalities) and Xinjiang Production and Construction Corps (District) were selected by stratified cluster sampling method.Information on red meat intake was collected by semiquantitative food frequency questionnaire.Average intake of 100 g/day,recommended by the World Cancer Research Fund,was used as the cut-off point to estimate the prevalence of excessive red meat intake.After performing the complex weighted analysis,level of daily red meat intake and prevalence of excessive red meat intake were calculated by demographic characteristics including age,education,industries and body mass index etc.Results 1) The mean daily red meat intake was 125.9 g(95％CI:116.5 g-132.5 g),higher in men(141.6 g,95％CI:131.3 g-148.9 g) than in women (104.7 g,95％CI:95.8 g-111.2 g) (P＜0.01).Results from the Tendency Test did not show statistically significant changes on the red meat intake related to age,education level or body mass index (P values for trend were all greater than 0.05).The standardized mean daily intake of red meat,adjusted by 2010 census data of China,was 121.0 g(95％ CI:113.4 g-128.7 g).2) The prevalence of excessive red meat intake was 36.2％ (95％ CI:33.0％-39.3％) significantly higher in males (42.4％,95％ CI:38.9％-45.8％) than in females (27.8％,95％CI:27.1％-31.0％) (P＜0.01).The prevalence was estimated to be the highest among the population aged 30-39,with 43.5％ (95％CI:39.7％-47.4％) in males and 30.1％(95％CI:26.5％-33.9％) in females.The standardized prevalence,adjusted by 2010 census data of China,appeared to be 34.6％ (95％CI:31.9％-38.0％).Conclusion The level of daily red meat intake was higher than 1 00 g/d,the standard recommended by the World Cancer Foundation,among floating population of China.Both the mean daily red meat intake and prevalence of excessive red meat intake were higher in floating population than that in the local residents in China.

OBJECTIVE: To retrospectively evaluate the feasibility and effectiveness of three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage (GEAL). MATERIALS AND METHODS: From January 2007 to January 2011, 28 cases of postoperative GEAL after an esophagectomy with intrathoracic esophagogastric anastomotic procedures for esophageal and cardiac carcinoma were treated by the insertion of three tubes under fluoroscopic guidance. The three tubes consisted of a drainage tube through the leak, a nasogastric decompression tube, and a nasojejunum feeding tube. The study population consisted of 28 patients (18 males, 10 females) ranging in their ages from 36 to 72 years (mean: 59 years). We evaluated the feasibility of three-tube insertion to facilitate leakage site closure, and the patients' nutritional benefit by checking their serum albumin levels between pre- and post-enteral feeding via the feeding tube. RESULTS: The three tubes were successfully placed under fluoroscopic guidance in all twenty-eight patients (100%). The procedure times for the three tube insertion ranged from 30 to 70 minutes (mean time: 45 minutes). In 27 of 28 patients (96%), leakage site closure after three-tube insertion was achieved, while it was not attained in one patient who received stent implantation as a substitute. All patients showed good tolerance of the three-tube insertion in the nasal cavity. The mean time needed for leakage treatment was 21 +/- 3.5 days. The serum albumin level change was significant, increasing from pre-enteral feeding (2.5 +/- 0.40 g/dL) to post-enteral feeding (3.7 +/- 0.51 g/dL) via the feeding tube (p < 0.001). The duration of follow-up ranged from 7 to 60 months (mean: 28 months). CONCLUSION: Based on the results of this study, the insertion of three tubes under fluoroscopic guidance is safe, and also provides effective relief from postesophagectomy GEAL. Moreover, our findings suggest that three-tube insertion may be used as the primary procedure to treat postoperative GEAL.
Adult ; Aged ; Anastomosis, Surgical ; Anastomotic Leak/radiography/*therapy ; Decompression, Surgical/instrumentation ; Drainage/instrumentation ; Enteral Nutrition/instrumentation ; Esophageal Neoplasms/*surgery ; Esophagectomy ; Female ; Fluoroscopy ; Humans ; Intubation, Gastrointestinal/*methods ; Male ; Middle Aged ; Postoperative Complications/*radiography/*therapy ; Radiography, Interventional/*methods ; Retrospective Studies ; Stomach Neoplasms/*surgery

Objective To explore the quantity change and significance of CD14-/CD11b+/CD33 + myeloid-derived suppressor cells (MDSCs) in patients with multiple injury. Methods Thirtyfour patients with multiple injury and seven healthy volunteers were enrolled in this study. Peripheral blood was collected and the factors of CD14-/CD1 1 b+/ CD33 + were taken as markers of MDSCs. The percentage of MDSCs was determined by flow cytometry (FCM) and serum interleukin-10 and C-reactive protein levels were determined by ELISA to analyze the quantity change and clinical significance of MDSCs. Results The percentage of MDSCs in peripheral blood of healthy volunteers was (1.13 +0. 25) %. At days 1,2, 3 and 7 after injury, the percentage of MDSCs in peripheral blood were (1.20 +0.22) %, (6.44 + 0.35) %, (13.84 ± 2.07) % and (15.60 ± 1.63) % respectively in patients with infection and multiple injury, whereas (1.29 ±0. 30)%, (4.93 +0. 32)%, (5.15 ±0. 21)% and (3.77 ± 0.34) % respectively in patients without infection. The percentages of MDSCs in two groups showed significant differences at days 2, 3 and 7 after trauma (P＜0.05). No correlation was found between MDSCs percentage in peripheral blood and injury severity score, serum interleukin-10 or C reactive protein in patients with multiple injury (P ＞ 0.05). Conclusions The increase of proportion ofMDSCs in peripheral blood correlates with the onset of infection in patients with multiple injury, indicating that the expansion of MDSCs in peripheral blood may play important roles in immune dysfunction after multiple injury.