Diabetic kidney disease （DKD）， a prevalent microvascular complication of diabetes mellitus， is characterized by intricate pathophysiological mechanisms and persistent clinical management challenges. Historically， glomerular injury has been regarded as the central pathological hallmark of DKD， with research predominantly focusing on hyperfiltration， glomerular basement membrane thickening， and podocyte dysfunction. Emerging evidence， however， underscores the renal tubule-not merely as a passive bystander but as an early initiator and pivotal driver-in DKD pathogenesis. Hyperglycemia， metabolic dysregulation， and chronic low-grade inflammation induce tubular epithelial cell injury at early disease stages. Such injury disrupts tubuloglomerular feedback， thereby elevating intraglomerular pressure and sustaining hyperfiltration. Concurrently， injured tubular cells secrete pro-inflammatory cytokines and profibrotic factors， promoting epithelia-mesenchymal transition， interstitial hypoxia， and progressive tubulointerstitial fibrosis that ultimately culminate in irreversible decline of renal function. This "tubule-first" paradigm represents a fundamental shift from the classical glomerulocentric model and redefines the conceptual framework of DKD progression. Traditional Chinese medicine（TCM）， with its inherent advantages of multi-component synergy， multi-target engagement， and systemic homeostatic regulation， has demonstrated compelling renoprotective effect， particularly in preserving tubular integrity and function， mitigating tubular cellular stress， and indirectly alleviating glomerular hemodynamic burden. Accumulating preclinical and clinical evidence supports the efficacy of numerous single herbs and standardized formulae of TCM in attenuating tubulointerstitial injury and slowing down DKD progression. This review systematically delineates the sequential pathogenic cascade-from initial tubular insult to secondary glomerular deterioration-and critically evaluates the mechanism basis and translational potential of TCM-based interventions targeting tubular resilience. We aim to provide a refined pathophysiological rationale and actionable insights for optimizing clinical strategies and accelerating the development of novel therapeutics for DKD.

Diabetic kidney disease （DKD）， a prevalent microvascular complication of diabetes mellitus， is characterized by intricate pathophysiological mechanisms and persistent clinical management challenges. Historically， glomerular injury has been regarded as the central pathological hallmark of DKD， with research predominantly focusing on hyperfiltration， glomerular basement membrane thickening， and podocyte dysfunction. Emerging evidence， however， underscores the renal tubule-not merely as a passive bystander but as an early initiator and pivotal driver-in DKD pathogenesis. Hyperglycemia， metabolic dysregulation， and chronic low-grade inflammation induce tubular epithelial cell injury at early disease stages. Such injury disrupts tubuloglomerular feedback， thereby elevating intraglomerular pressure and sustaining hyperfiltration. Concurrently， injured tubular cells secrete pro-inflammatory cytokines and profibrotic factors， promoting epithelia-mesenchymal transition， interstitial hypoxia， and progressive tubulointerstitial fibrosis that ultimately culminate in irreversible decline of renal function. This "tubule-first" paradigm represents a fundamental shift from the classical glomerulocentric model and redefines the conceptual framework of DKD progression. Traditional Chinese medicine（TCM）， with its inherent advantages of multi-component synergy， multi-target engagement， and systemic homeostatic regulation， has demonstrated compelling renoprotective effect， particularly in preserving tubular integrity and function， mitigating tubular cellular stress， and indirectly alleviating glomerular hemodynamic burden. Accumulating preclinical and clinical evidence supports the efficacy of numerous single herbs and standardized formulae of TCM in attenuating tubulointerstitial injury and slowing down DKD progression. This review systematically delineates the sequential pathogenic cascade-from initial tubular insult to secondary glomerular deterioration-and critically evaluates the mechanism basis and translational potential of TCM-based interventions targeting tubular resilience. We aim to provide a refined pathophysiological rationale and actionable insights for optimizing clinical strategies and accelerating the development of novel therapeutics for DKD.

This consensus will introduce the characteristics of fillers used in the surgical cavities of domestic nasal surgery patients based on relevant literature and expert opinions. It will also provide recommendations for the selection of cavity fillers for different nasal diseases, with chronic sinusitis as a representative example.
Humans ; Nasal Cavity/surgery* ; Nasal Surgical Procedures ; China ; Consensus ; Sinusitis/surgery* ; Dermal Fillers

Objective To investigate the effects of early statin therapy on collateral circulation,responsible vessel improvement,and thromboxane B2(TXB2)/prostaglandin F1(PGF1α)in acute ischemic stroke with large vessel occlusion(AIS-LVO).Methods From May 2021 to May 2023,105 AIS-LVO patients treated with statins within 3 days of admission were selected as the statin group from the Neurology Department of Taiyuan Iron and Steel(Group)General Hospital.Concurrently,105 early AIS-LVO patients not treated with statins were selected as the non-statin group.The study compared symptom scores[National Institutes of Health Stroke Scale(NIHSS),modified Rankin Scale(mRS),Swallowing Standard Assessment(SSA),and Functional Oral Intake Scale(FOIS)scores],responsible vessel improvement,TXB2/PGF1α levels,and endothelial function indicators[basic fibroblast growth factor(bFGF)and circulating endothelial cells(CECs)].Results Af-ter 1 and 2 weeks,the statin group showed lower NIHSS,mRS,and SSA scores,and higher FOIS scores compared to the non-statin group(P<0.02).The statin group demonstrated higher rates of responsible vessel velocity increase,collateral circulation compensation,and superior CTA collateral circulation grading(P<0.05).At 1 and 2 weeks,the statin group had lower TXB2 and TXB2/PGF1α levels,and higher PGF1α levels compared to the non-statin group(P<0.02).The statin group showed lower bFGF levels and higher CECs levels(P<0.02).After 3 months,the statin group had a higher proportion of mRS scores of 0～2(P<0.05).Conclusion Early statin therapy in AIS-LVO patients can improve responsible vessel blood flow and endothelial function,regulate TXB2/PGF1α levels,promote collateral circulation compensation,and enhance swallowing and neurological function recovery.

BACKGROUND: The American Heart Association recently released a new cardiovascular health (CVH) metric, Life's Essential 8 (LE8), for health promotion. However, the association between LE8 scores and the risk of chronic kidney disease (CKD) remains uncertain. We aimed to explore the association of LE8 scores with new-onset CKD and examine whether socioeconomic deprivation and genetic risk modify this association. METHODS: A total of 286,908 participants from UK Biobank and without prior CKD were included between 2006 and 2010. CVH was categorized using LE8 scores: low (LE8 scores <50), moderate (LE8 scores ≥50 but <80), and high (LE8 scores ≥80). The study outcome was new-onset CKD, ascertained by data linkage with primary care, hospital inpatient, and death data. Cox proportional hazard regression models were used to investigate the association between CVH categories and new-onset CKD. RESULTS: During a median follow-up of 12.5 years, 8857 (3.1%) participants developed new-onset CKD. Compared to the low CVH group, the moderate (adjusted hazards ratio [HR], 0.50; 95% confidence interval [CI]: 0.47-0.53) and high CVH (adjusted HR, 0.31; 95% CI: 0.27-0.34) groups had a significantly lower risk of developing new-onset CKD. The population-attributable risk associated with high vs. intermediate or low CVH scores was 40.3%. Participants who were least deprived ( vs.  most deprived; adjusted HR, 0.75; 95% CI: 0.71-0.79) and with low genetic risk of CKD ( vs.  high genetic risk; adjusted HR, 0.89; 95% CI: 0.85-0.94) had a significantly lower risk of developing new-onset CKD. However, socioeconomic deprivation and genetic risks of CKD did not significantly modify the relationship between LE8 scores and new-onset CKD (both P -interaction >0.05). CONCLUSION Achieving a higher LE8 score was associated with a lower risk of developing new-onset CKD, regardless of socioeconomic deprivation and genetic risks of CKD.
Humans ; Renal Insufficiency, Chronic/epidemiology* ; Male ; Female ; Middle Aged ; Genetic Predisposition to Disease/genetics* ; Aged ; Risk Factors ; Adult ; Proportional Hazards Models ; Socioeconomic Factors

Objective:To explore the feasibility and effect on the reconstruction of whole hand degloving injury by transfer of nerved tissue flaps in staged surgery.Methods:A retrospective study was conducted on the clinical data of 5 patients who suffered whole hand degloving injury and underwent staged reconstructive surgery with nerved tissue flaps, from December 2018 to December 2022 in the Department of Hand Surgery, Longgang Orthopaedics Hospital of Shenzhen. The patients were 4 males and 1 female, aged 22-45 years. Two of the whole-hand degloved injuries were left hands and 3 of right. Two patients had the whole-hand degloving injury combined with a fracture of distal phalangeal tuberosity, and 1 was complicated with partial rupture of the extensor tendon insertion. Areas of the whole hand degloving injury ranged from 215 cm 2 to 480 cm 2, the size of the hallux nail flaps for reconstruction of thumbs ranged from 54 cm 2 to 104 cm 2, the size of the hallux nail flaps for reconstruction of index fingers ranged from 65 cm 2 to 133 cm 2, and the size of the flaps for reconstruction of all the defects of hands ranged from 119 cm 2 to 255 cm 2. In primary surgery, the thumbs, index fingers and the first webs were reconstructed with bilateral hallux nail flaps to shape the appearance and gain the sensation function. Meanwhile, a single and large defect was created from the defects of hand by bundling up the middle, ring and little fingers together with the all the defects in both palmar and dorsal hand. Then an anterolateral thigh flap (ALTF) was used to have the created single defect wrapped together. Donor sites of the bilateral hallux nail flap were reconstructed with a lobulated ALTF from the other side or with bilateral peroneal artery perforator flaps. Donor sites of the ALTF and peroneal artery perforator flap were pulled and sutured. After the hallux nail flaps and ALTFs of the affected hands had survived and stabilised, multiple staged surgery were then carried out to firstly reconstruct the ring and little fingers, and followed by the middle and ring fingers in turns from the artificial syndactyly created in the primary surgery. In the final stage of surgery, skin of the radial side of middle and ring finger-pulps and the ulnar little finger-pulp were replaced by lateral toe flaps to reconstruct the sensations of the main sensory zones of middle, ring and little finger-pulps. Thereafter, the shape, TPD and finger extension and flexions were observed and evaluated through the postoperative follow-up, at the outpatient clinic according to the Evaluation Standard of Thumb and Finger Reconstruction Function of the Hand Surgery Society of the Chinese Medical Association. The appearance and function of the donor sites in both feet were evaluated with the Maryland foot score. Results:All flaps survived after surgery. Postoperative follow-up lasted up to 14 to 48 months after the last surgery. The appearance of fingers was satisfactory with good function. TPD of thumbs and index finger-pulps had achieved up to 6-8 mm, and 3-8 mm in the main sensory zones of middle, ring and little finger-pulps. TPD in the non-major sensory zones of middle, ring and little finger-pulps was found at 10-14 mm, which scored 13 to 14 and rated as excellent according to the Evaluation Standard of Thumb and Finger Reconstruction Function of the Hand Surgery Society of the Chinese Medical Association. Only a linear scar left in the donor site of thigh. As the appearance of the flaps on the feet was not bloated and there was no obvious abnormality in walking and running, therefore the function of feet scored up to 96 to 97 and rated excellent according to the Maryland foot score.Conclusion:A multi-staged reconstruction of a whole hand degloving injury with nerved tissue flaps not only achieves satisfactory digital and hand appearance, but also with good function. There is no obvious effect on the appearance and function of the donor sites. This surgical strategy is novel in the reconstruction of a whole hand degloving injury.

Objective To observe the clinical efficacy of belimumab combined with glucocorticoids in the treatment of children with systemic lupus erythematosus(SLE).Methods A total of 64 children with SLE were randomly divided into the observation group and the control group,with 32 cases in each group.The control group was treated with oral prednisone tablets combined with hydroxychloroquine sulfate tablets,while the observation group was treated with belimumab on the basis of treatment in the control group.After 6 months of treatment,the clinical efficacy,systemic lupus erythematosus disease activity index(SLEDAI)scores and laboratory indicators[complement C3,complement C4,immunoglobulin IgG(IgG),B lymphocytes,white blood cell count(WBC),erythrocyte sedimentation rate(ESR),serum C-reactive protein(CRP),24-hour urine protein quantification(24 h UP),serum creatinine(SCr)and blood urea nitrogen(BUN)]were compared between the two groups.Results After 6 months of treatment,the total effective rate was higher in the observation group than that of the control group(93.8%vs.75.0%,P＜0.05).Compared with before treatment,both groups showed lower SLEDAI scores,IgG,B lymphocytes,ESR,CRP,SCr,24 h UP and BUN after treatment,while C3,C4 levels and WBC were higher.Moreover,the improvement of all indicators was better in the observation group than that in the control group(P＜0.05).Conclusion Belimumab combined with glucocorticoids can improve the clinical efficacy,control disease activity and enhance immune function in children with SLE.

Objectives:To explore the morphological changes of the superficial and deep thoraolumbar paraspinal muscles on both convex and concave sides during rest and contraction states in patients with mod-erate adolescent idiopathic scoliosis(AIS),and their effects on scoliosis angle,to analyze the relations between scoliosis angle and the morphological changes of paraspinal muscles.Methods:21 AIS patients(thoracic Cobb angle 20°-45°,S-shaped with the main curve in thoracic segment,4 males and 17 females,aged 13.9±1.6 years old)treated in our hospital from July 2020 to December 2023 and 21 healthy subjects(7 males and 14 females,aged 14.6±1.4 years old)were prospectively enrolled.The morphological data of thoracolumbar paraspinal muscles were collected with musculoskeletal ultrasound,including the resting thickness and thick-ness during maximum voluntary isometric contraction(MVIC)of superficial erector spinae(ES)and multifidus(MF)muscles of AIS patients on both convex and concave sides(left and right sides of healthy controls).The differences in resting thickness,contraction thickness,change rate of contraction thickness,and total resting thickness and total contraction thickness(ES+MF)of superficial and deep thoracolumbar paravertebral muscles between the two groups were analyzed,and the structural characteristics of the thoracolumbar paravertebral muscles on the convex and concave sides of AIS were analyzed.The correlation between Cobb angle in tho-racolumbar segment and morphological indexes(resting thickness,contraction thickness change rates)of ES and MF muscles was analyzed,and the influence of scoliosis severity on the morphology of superficial and deep paravertebral muscle was further analyzed.Results:In AIS patients,the mean thoracic Cobb angle were 31.62°±7.68°,and mean lumbar Cobb angle were 19.52°±6.48°.Comparing with healthy controls,patients with AIS were significantly different in resting thickness,contraction thickness and thickness change rates of tho-racic paraspinal muscles on both convex and concave sides,and the resting thickness of ES in thoracic seg-ment on concave side was less than that on the convex side,which of MF was less on the convex side than on the concave side(P＜0.01).The contraction thickness of thoracic MF muscles on the convex and concave sides in S-type AIS patients was smaller than that in healthy controls(P＜0.05),while the contraction thickness of thoracic ES muscles on the convex and concave side wasn't statistically different from that of healthy con-trols,and the contraction thickness change rate of ES muscles on the convex and MF on the concave side of thoracic segment in AIS patients was significantly decreased(P＜0.05).There was no significant difference in the total resting thickness of thoracic(convex and concave)paravertebral muscles(ES+MF)between AIS patients and the corresponding segments(left and right)of control group(P＞0.05),and there was no statistically signifi-cant difference in the total resting thickness of thoracic paravertebral muscle between the convex and concave sides of AIS patients(P＞0.05).The total contraction thickness of thoracic paravertebral muscle(ES+MF)in AIS patients was lower than that in control group(P＜0.05).Compared with the control group,the resting thickness,contraction thickness and thickness change rate of lumbar MF muscle on the convex and concave sides in AIS patients were significantly reduced(P＜0.05),and the contraction thickness change rate of the lumbar ES muscle on the concave side was less than that of the control group(P＜0.05).There were no significant differ-ences in resting thickness and contraction thickness between the convex and concave paravertebral muscles in AIS patients(P＞0.05).The total resting thickness(ES+MF)and total contraction thickness(ES+MF)of lumbar(convex and concave)paraspinal muscles in AIS patients were lower than those in control group(P＜0.05).There was a significant negative correlation between the Cobb angle of the main thoracic curve and the rest-ing thickness of the thoracic MF muscle on the concave and the change rate of the contraction thickness of the thoracic ES muscle on the convex in S-type AIS patients(r=-0.53/-0.45,P＜0.05).There was no signifi-cant correlation between the Cobb angle of lumbar segment and the change rates of the resting thickness and contraction thickness of ES and MF muscles on both convex and concave sides(P＞0.05).Conclusions:In pa-tients with moderate S-type AIS,there are different muscle morphological changes in the paraspinal muscles on both convex and concave sides of the main thoracic curve,and the concave paravertebral muscle is more affected by scoliosis;The contraction function of the bilateral deep core stabilizing muscles in the lumbar re-gion is markedly decreased.Different patterns of superficial and deep muscle atrophy and contractility decline may be a key cause of spinal movement disorder and scoliosis progression in AIS patients.

Objective:To explore the anal function and postoperative complications of 2-stage Turnbull-Cutait pull-through coloanal anastomosis (TCA) for low rectal cancer.Methods:Patients undergoing radical rectal cancer resection from Feb 2023 to Nov 2024 in the First Hospital of Jilin University were divided into the TCA surgery group and the low anterior resection combined with prophylactic stoma (LAR) surgery group.Results:Among the 102 patients, there were 50 cases in the TCA group and 52 cases in the LAR group. In the single-arm analysis of the TCA group, the overall complication rate was 44%. The incidence rates of severe LARS at 1 month, 3 months, and 6 months after surgery were 97%, 77%, and 64% respectively. There was no significant difference in the complication rate within 30 days after surgery between the two groups,(44% vs. 38%, χ2=0.135, P>0.05). There was no significant difference in the incidence rate of severe LARS between the TCA group and the LAR group (77% vs. 69%, χ2=0.202, P>0.05), and there was not significant difference in the incidence rate of severe LARS between the two groups at the 6th month after surgery,(64% vs. 48%, χ2=1.132, P>0.05). Conclusion:In patients who underwent TCA surgery, the LARS symptoms gradually decreased over time. Compared with patients undergoing low anterior resection and stoma reversal, there were no significant differences in complications within 30 days after surgery and LARS symptoms within half a year.