Diabetic nephropathy（DN） is a common and severe microvascular complication of diabetes. In recent years， the classical herbal formula Shenqi dihuang decoction has demonstrated unique advantages in the clinical treatment of DN. This article conducts a systematic review of the mechanisms of action and clinical applications of Shenqi dihuang decoction in the treatment of DN. It reveals that the mechanism by which this formula improves DN involves multi-target synergistic regulation. For instance, Shenqi dihuang decoction exerts multiple pharmacological effects by regulating signaling pathways including phosphatidy linostiol 3-kinase/protein kinase B， AMP-activated protein kinase/silent information regulator 1/forkhead box O1， and nuclear factor erythroid 2-related factor 2/heme oxygenase-1 pathways.These effects include regulating glucose and lipid metabolism， inhibiting oxidative stress， reducing inflammation， improving insulin resistance， modulating cell death （apoptosis/autophagy/ferroptosis/pyroptosis）， and preventing renal fibrosis. Existing clinical studies indicate that Shenqi dihuang decoction and its modified formulas， alone or in combination with other therapeutic methods， can significantly improve glucose and lipid metabolism， reduce proteinuria， and delay renal function decline in patients with DN. These effects are superior to those of Western medicines such as irbesartan， valsartan， and empagliflozin， and the treatment demonstrates good safety. Future research should leverage systems biology and artificial intelligence technologies to further elucidate the integrated mechanisms in the treatment of DN by Shenqi dihuang decoction， thereby advancing the precision and standardization of its clinical application.

BACKGROUND:Aging of human body may be due to the senescence and depletion of various stem cells in the body.Bone marrow mesenchymal stromal cells have important physiological functions and have shown certain therapeutic effects on various diseases.It is of great significance to study the senescence and mechanism of bone marrow mesenchymal stromal cells.OBJECTIVE:To investigate whether human bone marrow mesenchymal stromal cells exhibit senescence phenotypes with increasing donor age,and further determine whether endogenous retrovirus drives the senescence of bone marrow mesenchymal stromal cells,offering a novel reference for the investigation of stem cell senescence mechanism.METHODS:The senescence of bone marrow mesenchymal stromal cells at different ages was characterized by flow cytometry,β-galactosidase staining,qPCR,western blotting,and EdU fluorescence imaging.Bone marrow mesenchymal stromal cells and cell culture supernatant were collected from donors of different ages.The content of human endogenous retrovirus was detected by qPCR.Furthermore,highly sensitive droplet digital PCR was used to detect the expression of endogenous retrovirus-like particles in the cell culture supernatant.The content of endogenous retrovirus in bone marrow plasma samples of different ages was detected by ELISA.RESULTS AND CONCLUSION:Bone marrow mesenchymal stromal cells exhibited obvious senescence with increasing age,including significant morphological changes,increased proportion of β-galactosidase positive cells,increased expression of senescence markers P16 and P21 protein,decreased expression of LMNB1 protein,and reduced cell proliferation ability.There was no significant difference in the content of endogenous retrovirus in bone marrow mesenchymal stromal cells at different ages,almost no endogenous retrovirus-like particles in the cell culture supernatant.There was no significant difference in endogenous retrovirus-like particles detected in bone marrow plasma samples at different ages.These findings indicate that human bone marrow mesenchymal stromal cells have normal physiological senescence with increasing age,but the mechanism of senescence is not mediated by abnormal activation of endogenous retroviruses,which may have a more complex driving mechanism.

Objective: To characterize longitudinal trajectories of testicular development in boys and breast development in girls, so as to provide reference data for understanding patterns of pubertal sexual maturation. Methods: Based on the Shanghai Pudong New Area Cohort Study on Growth, Development and Health in Children and Adolescents, a baseline survey was conducted in 2020 using a mult stage cluster random sampling method. A total of 2 184 children who completed all follow ups during the primary school period from 13 elementary schools in Pudong New Area,Shanghai,with annual follow ups during 2021-2025. Testicular volume and Tanner stage of breast development were assessed by professional physicians using standardized visual inspection and palpation. The age distribution of testicular volume and breast development was fitted by using cumulative link mixed models and Turnbull s nonparametric maximum likelihood estimation method. Results: Median ages for testicular volumes of 2, 3, 4 and 5 mL in boys were 7.07, 9.24, 10.29, and 11.57 years old, respectively. Median ages for Tanner breast stages Ⅱ, Ⅲ, Ⅳ, and Ⅴ in girls were 8.55 , 10.17, 11.18, and 13.78 years old, respectively. Based on overweight and obesity, stratified analysis showed that earlier pubertal onset among overweight/obesity children, and the key milestones for pubertal initiation were testicular volume reaching 4 mL in boys and breast Tanner II in girls for 10.29, 10.83; 8.18, 9.00 years. Conclusion Overweight and obesity are associated with earlier pubertal initiation,but there are certain gender and developmental stage specific patterns.

Gorham-Stout disease(GSD) is a rare osteolytic disorder characterized by spontaneous and progressive osteolysis, along with abnormal angiogenesis and lymphangiogenesis, with no new bone formation. We present a case of a 15-year-old female admitted due to " recurrent right leg pain for 5 years, 11 months after undergoing right femoral fracture surgery". Through comprehensive integration of the patient's clinical phenotype, laboratory tests, imaging findings, pathological examinations, and molecular biological test results, GSD was considered highly likely. A multidisciplinary treatment approach was conducted, including a combination of zoledronic acid and sirolimus to inhibit osteolysis, along with rehabilitation training and orthopedic intervention, providing a personalized and comprehensive treatment strategy.

Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disorder primarily caused by pathogenic variants in the TSC1 or TSC2 genes. It is characterized by multisystem hamartomatous lesions and neuropsychiatric manifestations. Here we report a young male patient with TSC involving multiple organs, caused by a heterozygous frameshift mutation in TSC2 (c.2071delC, p.Arg691Alafs^*7). The patient initially presented with classic facial angiofibromas and hypomelanotic macules, and subsequently developed psychiatric and behavioral disturbances with auditory hallucinations. Neuroimaging revealed an intracranial mass lesion, which was confirmed as a subependymal giant cell astrocytoma on postoperative histopathology following surgery performed at an outside institution. After admission, the patient underwent a comprehensive diagnostic workup, and multidisciplinary treatment evaluation revealed extensive multisystem involve-ment, including the nervous system, skin, kidneys, lungs, heart, eyes, pancreas, liver and bones. Combined with relevant literature, this article discusses the molecular mechanisms, clinical phenotypes, and comprehensive management of TSC, in order to provide a reference for the standardized and individualized management of this disease.

BACKGROUND:Aging of human body may be due to the senescence and depletion of various stem cells in the body.Bone marrow mesenchymal stromal cells have important physiological functions and have shown certain therapeutic effects on various diseases.It is of great significance to study the senescence and mechanism of bone marrow mesenchymal stromal cells.OBJECTIVE:To investigate whether human bone marrow mesenchymal stromal cells exhibit senescence phenotypes with increasing donor age,and further determine whether endogenous retrovirus drives the senescence of bone marrow mesenchymal stromal cells,offering a novel reference for the investigation of stem cell senescence mechanism.METHODS:The senescence of bone marrow mesenchymal stromal cells at different ages was characterized by flow cytometry,β-galactosidase staining,qPCR,western blotting,and EdU fluorescence imaging.Bone marrow mesenchymal stromal cells and cell culture supernatant were collected from donors of different ages.The content of human endogenous retrovirus was detected by qPCR.Furthermore,highly sensitive droplet digital PCR was used to detect the expression of endogenous retrovirus-like particles in the cell culture supernatant.The content of endogenous retrovirus in bone marrow plasma samples of different ages was detected by ELISA.RESULTS AND CONCLUSION:Bone marrow mesenchymal stromal cells exhibited obvious senescence with increasing age,including significant morphological changes,increased proportion of β-galactosidase positive cells,increased expression of senescence markers P16 and P21 protein,decreased expression of LMNB1 protein,and reduced cell proliferation ability.There was no significant difference in the content of endogenous retrovirus in bone marrow mesenchymal stromal cells at different ages,almost no endogenous retrovirus-like particles in the cell culture supernatant.There was no significant difference in endogenous retrovirus-like particles detected in bone marrow plasma samples at different ages.These findings indicate that human bone marrow mesenchymal stromal cells have normal physiological senescence with increasing age,but the mechanism of senescence is not mediated by abnormal activation of endogenous retroviruses,which may have a more complex driving mechanism.

This case report describes details in treatment of a patient with a severed right upper arm and admitted to the Department of Microsurgery, Sichuan Modern Hospital in September 2024. The injury was caused by a piece of red-hot steel. In emergency surgery, the severed right upper arm was temporarily ectopically fostered in left distal leg. After 27 days of ectopic fostering, a stage-Ⅱ replantation surgery was performed to replant the ectopically fostered limb. A free anterolateral thigh perforator flap (ALTPF) was used to reconstruct the soft tissue defect on right arm after replantation. At 3 months of postoperative follow-up, the flap covering the right upper arm were soft in texture, without a sign of ulceration. Sensation was rated at S 2 on palmar side of first to third digits and as S 1 on palmar sides of fourth to fifth digits and dorsal sides of first to fifth digits. The active movement of the right wrist joint and the joints of the first to fifth fingers was not possible. The wrist joint was passively extended from 0° to 5°, passively flexed from 0° to 20°, the thumb had a passive total range of motion of 45°, the second to fourth fingers had a passive total range of motion of 70°, and the little finger had a passive total range of motion of 45°.

Objective:The performance of GeneXpert MTB/RIF (Xpert), DNA isothermal amplification fluorescence assay (DNA isothermal amplification) and RNA simultaneous amplification and testing (SAT-TB) were evaluated by detecting Mycobacterium tuberculosis in the pus samples of superficial tuberculous lymphadenitis and skeletal tuberculosis, two common extrapulmonary tuberculosis. Methods:Cross-sectional study. A total of 242 patients with suspected superficial tuberculous lymphadenitis and skeletal tuberculosis admitted to Shaanxi Provincial Tuberculosis Prevention and Control Hospital were collected from January 2022 to December 2023 and pus samples were taken from the lesions for examination. Among them, 210 patients were laboratory confirmed or clinically diagnosed with tuberculosis, 108 patients with superficial tuberculous lymphadenitis and 102 patients with skeletal tuberculosis. 32 patients without tuberculosis. Mycobacterium Tuberculosis culture, Xpert, DNA isothermal amplification, and SAT-TB detection were performed on the pus samples of all patients. The detection results were statistically analyzed using SPSS26.0 and MedCalc software. The detection effectiveness of several different detection methods for Mycobacterium tuberculosis in pus samples was compared, and P<0.05 was considered statistically significan. Results:The sensitivity of Mycobacterium Tuberculosis culture, Xpert, DNA isothermal amplification and SAT-TB in TB patients were 25.2% (53/210), 88.6% (186/210), 81.9% (172/210) and 61.0% (128/210), respectively. The area under curve (AUC) values of the four detection methods in the diagnosis of tuberculosis were 0.626, 0.943, 0.910 and 0.805, respectively. The AUC value of tuberculosis culture in the diagnosis of tuberculosis was significantly lower than that of the three molecular diagnostic techniques ( P<0.05). The AUC value of DNA isothermal amplification was significantly higher than that of SAT-TB detection method ( P<0.05). The positive tuberculosis culture was used as a reference standard where the sensitivity of Xpert, DNA isothermal amplification and SAT-TB reached 96.2%(51/53), 90.6%(48/53) and 86.8%(46/53), respectively. There was no significant difference in sensitivity among the three molecular diagnostic techniques ( P>0.05). In Xpert MTB positive patients, the positive rate of DNA isothermal amplification was 90.3% (168/186), and there was good consistency between DNA isothermal amplification and Xpert MTB detection results ( Kappa=0.765, P<0.001). Xpert detected 27 cases of rifampicin resistance, the resistance rate was 12.9% (27/210). Conclusion:GeneXpert and DNA isothermal amplification have high sensitivity and specificity in the samples of extrapulmonary tuberculosis pus, and the results of DNA isothermal amplification and GeneXpert MTB/RIF detection are highly consistent. In tuberculosis screening, DNA isothermal amplification fluorescence detection can be used for preliminary screening to reduce the detection cost.

OBJECTIVE: To assess the impact of vanishing twin syndrome (VTS) on the accuracy of non-invasive prenatal testing (NIPT). METHODS: Three pregnant women who underwent NIPT testing at Guangdong Women and Children's from November 2019 to February 2020 were selected as the study subjects. The three women had either vanish twin syndrome or had undergone fetal reduction for other reasons in one of their twins, and were subsequently subject to NIPT, chromosome karyotyping, chromosome microarray analysis (CMA), and short tandem repeat (STR) analysis. This study has been approved by the Medical Ethics Committee of Guangdong Maternal and Child Health Hospital (Ethics No.: 20230132). RESULTS: Case 1 underwent selective fetal reduction at 8⁺ weeks of gestation. At 17⁺ weeks, NIPT showed a fetal DNA fraction of 2.806%, with results indicating the presence of Y chromosome and abnormal sex chromosome ratios. However, the women had subsequent uncomplicated vaginal delivery of a female infant, and no abnormality noted. Case 2 experienced spontaneous demise of one twin at 13 weeks' gestation. At 19 weeks, NIPT indicated a high risk for chromosome 21 (Z-score 4.671) in the surviving fetus, but subsequent evaluation showed no abnormality. Case 3, a dichorionic diamniotic (DCDA) twin pregnancy, underwent selective reduction at 13⁺ weeks due to fetal abnormalities in one twin. At 22⁺ weeks, NIPT for the surviving fetus indicated a high risk for chromosome 21 (Z-score 17.549), but subsequent evaluation was unremarkable. CONCLUSION In twin pregnancies, the relatively low cell-free fetal DNA (cffDNA) concentration can compromise the success rate and accuracy of NIPT compared to singleton pregnancies. Residual DNA from the demised fetus may persist for weeks following VTS or selective reduction, potentially causing false-positive NIPT results and interfering with sex chromosome prediction for the surviving fetus. Additionally, determining chorionicity is critical for reliable interpretation of NIPT results in twin pregnancies.
Adult ; Female ; Humans ; Pregnancy ; Diseases in Twins/diagnosis* ; Karyotyping ; Noninvasive Prenatal Testing/methods* ; Pregnancy, Twin ; Prenatal Diagnosis/methods*

OBJECTIVE: To provide the experience and demonstration for the transformation of acupuncture-moxibustion techniques standards from Chinese national standards to international standards. METHODS: Questionnaire research, literature research, semi-structured interviews and expert consultation were used. RESULTS: The safety of acupuncture-moxibustion techniques was evaluated through literature research, and based on the results of the questionnaire survey, expert interviews, and expert consultation, 11 main bodies and structure of the former Chinese national standard, Technical Benchmark of Acupuncture and Moxibustion: General Rules for Drafting, were adjusted and optimized in accordance with the requirements of international standard (including the language, normative references, purpose, scope, applicable environment, target population, work team, terms and definitions, general principles and basic requirements, structural elements and text structure, and compilation process); and the first international standard, World Federation of Acupuncture-Moxibustion Societis (WFAS) Technical Benchmark of Acupuncture and Moxibustion: General Rules for Drafting was formulated to specify the general rules for drafting. CONCLUSION The 3 key questions, "international compatibility", "technical operability" and "safety" should be solved technically on the basis of explicit international requirements. It is the core technical issue during transforming the national standards of technical benchmark of acupuncture and moxibustion into international standards.
Moxibustion/methods* ; Acupuncture Therapy/methods* ; Humans ; Translational Research, Biomedical/standards* ; Surveys and Questionnaires ; China ; Benchmarking/standards*