Based on the theory of diseased collaterals and the progression pattern of diabetic kidney disease （DKD）， this paper proposes a staged treatment system based on the "three states of kidney collaterals" including collateral distention， collateral bi （痹） and collateral accumulation. In the collateral distention stage， the primary pathogenesis is heat damaging the kidney collaterals and collateral vessel dilation， corresponding to the early state of DKD characterized by hyperfiltration and microalbuminuria； the clearing method is suggested， and Shenling Jiangtang Formula （参苓降糖方） can be used to promote the remission of proteinuria by ameliorating insulin resistance and regulating intestinal microecology. In the collateral bi stage， the core pathogenesis lies in the binding of phlegm and stasis， and the formation of concretions and conglomerations in the kidney collaterals， corresponding to massive proteinuria and the decline of renal function， for which the unblocking method should be taken， using Jinchan Yishen Tongluo Formula （金蝉益肾通络方） and Qingre Xiaozheng Formula （清热消癥方） to alleviate renal pathological damage by regulating the autophagy-lysosome pathway and repairing mitochondrial energy metabolism. The collateral accumulation stage is characterized by the internal retention of turbid toxins and accumulations of concretions in the kidney collaterals， corresponding to renal fibrosis and end-stage renal disease （ESRD）； the dispersion method is suggested， and Yiqi Tongluo Xiezhuo Formula （益气通络泄浊方） and Shenyan Fangshuai Fluid （肾炎防衰液） can be used to inhibit extracellular matrix accumulation and delay the progressive loss of renal function. Collateral deficiency runs through the entire course of the disease and is closely related to cellular senescence and the imbalance of the ubiquitin-proteasome/autophagy system. The concept of the "three states of kidney collaterals" integrates the evolution of traditional Chinese medicine pathogenesis with modern pathological staging， forming a whole-course intervention system of "staging-syndrome differentiation-target-formula"， thereby providing novel insights for prevention and treatment of DKD using integrated traditional Chinese and western medicine.

BACKGROUND: Whether adherence to a healthy lifestyle is associated with a lower risk of developing pneumonia and a better long-term prognosis remains unclear. This study aimed to investigate associations of individual and combined lifestyle factors (LFs) with the incidence risk and long-term prognosis of pneumonia hospitalization. METHODS: Using data from the China Kadoorie Biobank study, we used the multistate models to investigate the role of five high-risk LFs, including smoking, excessive alcohol drinking, unhealthy dietary habits, physical inactivity, and unhealthy body shape, alone or in combination in the transitions from a generally healthy state at baseline to pneumonia hospitalization or cardiovascular disease (CVD, regarded as a reference outcome), and subsequently to mortality. RESULTS: Most of the five high-risk LFs were associated with increased risks of transitions from baseline to pneumonia and from pneumonia to death, but with different risk estimates. The greater the number of high-risk LFs, the higher the risk of developing pneumonia and long-term mortality risk after pneumonia, with the strength of associations comparable to that of LFs and CVD. Compared to participants with 0-1 high-risk LF, the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for transitions from baseline to pneumonia and from pneumonia to death in those with five high-risk LFs were 1.43 (1.28-1.60) and 1.98 (1.61-2.42), respectively. Correspondingly, the respective HRs (95% CIs) for transitions from baseline to CVD and from CVD to death were 2.00 (1.89-2.11) and 1.44 (1.30-1.59), respectively. The risk estimates changed slightly when further adjusting for the presence of major chronic diseases. CONCLUSION In this Chinese population, unhealthy LFs were associated with an increased incidence and long-term mortality risk of pneumonia.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Cardiovascular Diseases/etiology* ; China/epidemiology* ; Life Style ; Pneumonia/etiology* ; Prognosis ; Risk Factors ; Smoking

Objective:To investigate the efficacy and safety of prednisone combined with standard quadruple antituberculosis therapy (HRZE) in the treatment of tuberculous pleurisy.Methods:A prospective study was conducted involving 120 patients with tuberculous pleurisy who were admitted to the Shaanxi Provincial Tuberculosis Prevention and Control Hospital from February 2021 to February 2023. The patients were randomly assigned to a study group and a control group, with 60 patients in each group, using a computer-generated randomization method. The control group received HRZE alone, while the study group received prednisone therapy and HRZE. The efficacy, clinical indicators, adverse reactions, and serum inflammatory factor levels were compared between the two groups.Results:The total response rate in the study group was significantly higher than that in the control group [93.33% (56/60) vs. 78.33% (47/60), χ2 = 5.55, P < 0.05). In the study group, the time for clinical symptom improvement was (10.34 ± 1.65) days, the time for pleural effusion absorption was (21.37 ± 4.16) days, the pleural thickness measured (2.15 ± 0.35) mm, and the duration of hospitalization was (23.19 ± 4.56) days. They were significantly shorter or smaller than those in the control group [(13.27 ± 2.30) days, (27.25 ± 4.95) days, (2.62 ± 0.40) mm, (28.42 ± 5.60) days, t = 8.02, 7.04, 6.85, 5.61, all P < 0.05]. There was no significant difference in the incidence of adverse reactions between the two groups (χ2 = 2.91, P > 0.05). After 8 weeks of treatment, all serum inflammatory factors improved in both groups compared with baseline levels. In the study group, levels of interleukin-6 [(90.37 ± 12.05) ng/L] and interleukin-18 [(270.94 ± 14.58) ng/L] were significantly lower than those in the control group [(110.59 ± 16.90) ng/L, (296.10 ± 25.29) ng/L, t = 7.55, 6.68, both P < 0.05]. Levels of interleukin-10 [(78.91 ± 8.25) ng/L] and soluble interleukin-2 receptor [(1875.82 ± 359.23) pg/L] in the study group were significantly higher than those in the control group [(70.40 ± 7.16) ng/L, (1566.87 ± 311.02) pg/L, t = -6.03, -5.04, both P < 0.05]. Conclusion:The combination of prednisone and HRZE demonstrates good efficacy and safety, and it is beneficial for improving inflammatory factors.

Engineered probiotics can serve as therapeutics based on their ability of produce recombinant immune-stimulating properties. In this study, we built the recombinant Bacillus subtilis WB800 expressing antimicrobial peptide KR32 (WB800-KR32) using genetic engineering methods and investigated its protective effects of nuclear factor-E2-related factor 2 (Nrf2)‍-Kelch-like ECH-associated protein 1 (Keap1) pathway activation in intestinal oxidative disturbance induced by enterotoxigenic Escherichia coli (ETEC) K88 in weaned piglets. Twenty-eight weaned piglets were randomly distributed into four treatment groups with seven replicates fed with a basal diet. The feed of the control group (CON) was infused with normal sterilized saline; meanwhile, the ETEC, ETEC+WB800, and ETEC+WB800-KR32 groups were orally administered normal sterilized saline, 5×10¹⁰ CFU (CFU: colony forming units) WB800, and 5×10¹⁰ CFU WB800-KR32, respectively, on Days 1‍‒‍14 and all infused with ETEC K88 1×10¹⁰ CFU on Days 15‍‒‍17. The results showed that pretreatment with WB800-KR32 attenuated ETEC-induced intestinal disturbance, improved the mucosal activity of antioxidant enzyme (catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPx)) and decreased the content of malondialdehyde (MDA). More importantly, WB800-KR32 downregulated genes involved in antioxidant defense (GPx and SOD1). Interestingly, WB800-KR32 upregulated the protein expression of Nrf2 and downregulated the protein expression of Keap1 in the ileum. WB800-KR32 markedly changed the richness estimators (Ace and Chao) of gut microbiota and increased the abundance of Eubacterium_rectale_ATCC_33656 in the feces. The results suggested that WB800-KR32 may alleviate ETEC-induced intestinal oxidative injury through the Nrf2-Keap1 pathway, providing a new perspective for WB800-KR32 as potential therapeutics to regulate intestinal oxidative disturbance in ETEC K88 infection.
Animals ; Swine ; Enterotoxigenic Escherichia coli ; Kelch-Like ECH-Associated Protein 1 ; Bacillus subtilis ; NF-E2-Related Factor 2 ; Antioxidants ; Oxidative Stress

Objective:To formulate surgical strategies and guide the implementation of laparoscopic anatomical hepatectomy with preoperative simulative resection.Methods:Twenty-two cases of hepatocellular carcinoma undergoing laparoscopic lobe, segment, subsegment and combined segment liver resection following preoperative simulative resection from Sep 2020 to Jan 2022 were enrolled in this study retrospectively.We observed and analyzed the operation time,intraoperative blood loss,postoperative hospital stay and postoperative complication.Results:All patients underwent laparoscopic hepatectomy successfully according to the preoperative simulative resection plan without conversion, some of them adjusted plan according to preoperative simulative resection. The median operation time was 170.0 min, the median intraoperative blood loss was 150.0 ml, the median times of pringle maneuver was done on 4 episodes, and the median postoperative hospital stay was 6.5 days. There were no severe postoperative complications in all cases.Conclusion:Preoperative simulative resection can plan the range of surgical resection accurately by visualizing important anatomical structures,greatly helping the actual surgical hepatectomy.

This paper reviews the status quo of recent years’ research on autophagy and damage of chondrocytes in Kashin-Beck disease （KBD） and osteoarthritis （OA）. PI3K/AKT signaling pathway and mTOR regulate the autophagy activity of chondrocytes. PI3K/AKT signaling pathway can promote the proliferation of chondrocytes and cause their damage by inhibiting their autophagy activity. This might play an important role in the occurrence and progression of bone and joint diseases such as KBD and OA， and provide scientific basis for revealing the pathogenesis and treatment plan of them.

Objective:To investigate the clinical pathological and epidemiological characteristics of primary esophageal malignant melanoma (PMME).Methods:The clinical pathology data of 180 PMME patients in the esophageal cancer database of the key laboratory of esophageal cancer research in Henan Province from 1973 to 2016 were collected, of which 136 were male, aged (58.5±9.0) years, 44 were female, aged (56.7±12.2) years. Kaplan-Meier and Log rank test were used for survival analysis, Cox regression scale model was used for risk factor analysis.Results:The incidence of PMME is 0.036% (180/500, 000), mostly were male (about 3∶1 for men: female). The common sites of PMME were the lower part of the esophagus (48.9%, 85/174), followed by the middle section of the esophagus (46.0%, 80/174) and the upper part of the esophagus (5.2%, 9/174). No black particles were seen in the PMME cells of 3 patients under microscope, and strong positive expressions of Melan-A and HMB453 were observed in these 3 patients by immunohistochemical results. Of the 129 patients who had a routine preoperative esophageal biopsy, 69 were undiagnosed with PMME (53.5%). The medium survival time of the whole group was 7.9 months, and the survival rates of 1, 2, 3, 5 years were 25.0%, 7.9%, 6.6% and 1.3%, respectively. The univariate analysis showed that N, M, TNM phase and radiotherapy were related to the overall survival of patients ( P<0.05). Multivariate analysis showed that TNM phase and radiotherapy were the independent risk factors for overall survival of patients ( P<0.05). Conclusions:PMME is more common in men, the common site of the disease is the lower part of the esophagus. The preoperatively missed diagnosis rate of Chinese PMME is high. TNM phase and radiotherapy are the independent risk factors for overall survival of patients.

Objective:To investigate the clinical pathological and epidemiological characteristics of primary esophageal malignant melanoma (PMME).Methods:The clinical pathology data of 180 PMME patients in the esophageal cancer database of the key laboratory of esophageal cancer research in Henan Province from 1973 to 2016 were collected, of which 136 were male, aged (58.5±9.0) years, 44 were female, aged (56.7±12.2) years. Kaplan-Meier and Log rank test were used for survival analysis, Cox regression scale model was used for risk factor analysis.Results:The incidence of PMME is 0.036% (180/500, 000), mostly were male (about 3∶1 for men: female). The common sites of PMME were the lower part of the esophagus (48.9%, 85/174), followed by the middle section of the esophagus (46.0%, 80/174) and the upper part of the esophagus (5.2%, 9/174). No black particles were seen in the PMME cells of 3 patients under microscope, and strong positive expressions of Melan-A and HMB453 were observed in these 3 patients by immunohistochemical results. Of the 129 patients who had a routine preoperative esophageal biopsy, 69 were undiagnosed with PMME (53.5%). The medium survival time of the whole group was 7.9 months, and the survival rates of 1, 2, 3, 5 years were 25.0%, 7.9%, 6.6% and 1.3%, respectively. The univariate analysis showed that N, M, TNM phase and radiotherapy were related to the overall survival of patients ( P<0.05). Multivariate analysis showed that TNM phase and radiotherapy were the independent risk factors for overall survival of patients ( P<0.05). Conclusions:PMME is more common in men, the common site of the disease is the lower part of the esophagus. The preoperatively missed diagnosis rate of Chinese PMME is high. TNM phase and radiotherapy are the independent risk factors for overall survival of patients.

Chondroitin sulfate (CS) is a sulfurated glycosaminoglycan, a major component of the extracellular matrix, widely distributed in skin, cartilage and vascular tissue. CS plays an important role in the physiological state regulation of articular cartilage, which affects tensile strength and elasticity of tissues by influencing aggrecan. Previous studies have shown that CS sulfate modification may be related to the growth and development disorders of cartilage tissue and the occurrence of osteoarticular diseases. At the same time, CS is also a common joint supplement, often used in the treatment of osteoarthritis and Kashin-Beck disease. In this paper, the research progress of CS sulfate modification characteristics in Kashin-Beck disease and osteoarthritis and the application of the preparation in the treatment of Kashin-Beck disease and osteoarthritis are reviewed, aiming to provide help for the investigation of the etiology of Kashin-Beck disease and the treatment of osteoarthritis and Kashin-Beck disease.

To study the effect of tTG fully phosphorothioated antisense oligodeoxynucleotides (tTG ASDON) on tTG expression in cultured bovine trabecular meshwork cells (BTMCs) in vitro and explore a new treatment alternative for primary open angle glaucoma (POAG), the ASDON1and ASDON2 complementary to the protein codogram region of tTG were designed, synthesized and phosphorothioated according to the secondary structure of tTG. The ASDON1 and ASDON2 were embedded in Lipofectamine and transfected into BTMCs. The untreated group served as negative controls. The expression of tTG in the mRNA and protein level were measured by semi-quantitative RT-PCR and immunohistochemical technique Supervision method respectively. Our results showed that both the mRNA and the protein of tTG with tTG-ASDON1 and tTG-ASDON2 were significantly decreased as compared with that of the controls (P＜0.05). On the other hand, no significant difference was found between the ASDON1 group and the ASDON2 group. It is concluded that the expression of tTG mRNA and protein in cultured BTMC are down-regulated by tTG ASDON. As a result, tTG ASDON may be used for the treatment of POAG through the inhibitory effect on the expression of tTG.