[Objective] : To predict the autophagy-related pathogenesis and key diagnostic genes of diabetic kidney disease (DKD) through bioinformatics analysis, and to identify related Chinese medicines. [Methods] : Data from sequencing microarrays GSE30528, GSE30529, and GSE1009 in the Gene Expression Omnibus (GEO) were employed. Differentially expressed genes (DEGs) with adjusted P < 0.05 from GSE30528 and GSE30529 were identified. Combining these DEGs with the human autophagy gene database, Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses, and protein-protein interaction (PPI) network analysis were conducted on the obtained DKD autophagy-related genes. Subsequently, the least absolute shrinkage and selection operator (LASSO) regression and support vector machine-recursive feature elimination (SVM-RFE) algorithms were adopted to select autophagy-related genes. The diagnostic capability of these genes was assessed through analysis with the external validation set from microarray GSE1009, and relevant Chinese medicines were inversely predicted using the SymMap database. [Results] : A total of 2 014 DEGs were selected from GSE30528 and GSE30529, leading to the identification of 37 DKD autophagy-related genes. GO analysis indicated 681 biological mechanisms, including autophagy regulation and plasma membrane microdomain activity. KEGG enrichment analysis identified 112 related signaling pathways. PPI network analysis showed a marked enrichment of autophagy-related genes in DKD. Through LASSO regression and SVM-RFE, four core diagnostic genes for autophagy in DKD were identified: protein phosphatase 1 regulatory subunit 15A (PPP1R15A), hypoxia inducible factor 1 alpha subunit (HIF1α), deleted in liver cancer 1 (DLC1), and ceroid lipofuscinosis neuronal 3 (CLN3). The external validation set demonstrated high diagnostic efficiency for these genes. Finally, 146 kinds of potential Chinese medicines were predicted using the SymMap database, with heatclearing and detoxifying medicine and blood-activating and stasis-eliminating medicine accounting for the largest proportion (25/146 and 13/146, respectively). [Conclusion] This study analyzed and validated bioinformatics sequencing databases to elucidate the potential molecular mechanisms of DKD autophagy and predicted key diagnostic genes, potential therapeutic targets, and related Chinese medicines, laying a solid foundation for clinical research and application.

Objective To introduce a partially nested design based on the characteristics of TCM in treating the same disease with different treatments and syndrome differentiation and treatment.Methods Partially nested design was used for standardized treatment of complex interventions.The TCM group was divided into multiple subsets according to"syndrome type-treatment method-prescription"(with nested structure),while the control group was treated with standardized Western medicine(without nested structure);taking a case study of"different treatments for the same disease"data for ulcerative colitis,this design type was applied and analyzed using a multi-level model.Results The partially nested design was consistent with the feature of TCM of"different treatments for the same disease"and met the methodological requirements for evidence-based evaluation.Multilevel models allowed analyses with this type of data.Conclusion The use of partially nested design enables the evaluation of the comprehensive effectiveness of"different treatments for the same disease",which can provide a methodological reference for the assessment of clinical effectiveness of TCM.

Chronic HBV infection is an important phase in the natural history of HBV, but there are still controversies over the treatment of this stage. Traditional Chinese medicine has had unique advantages in the prevention and treatment of viral hepatitis since ancient times and plays an important role in prevention and treatment of viral hepatitis in China. Based on the pathological process of chronic HBV infection, the team of Department of Hepatology in Shenzhen Hospital of Traditional Chinese Medicine believes that the core pathogenesis of chronic HBV infection is "kidney deficiency and epidemic toxin lurking in liver blood" and established kidney-tonifying therapy for the treatment of chronic HBV infection. Under the support of the project of Prevention and Treatment of Major Infectious Diseases such as AIDS and Viral Hepatitis in The Eleventh Five Year Plan, The Twelfth Five Year Plan, and The Thirteenth Five Year Plan, the team has conducted studies on the regularity of syndromes and a series of clinical studies and investigated the clinical efficacy of kidney-tonifying therapy through multicenter, randomized, double-blind, placebo-controlled studies, thereby exploring the application and mechanism of traditional Chinese medicine treatment in patients with chronic HBV infection. However, there are still difficulties in the pathogenesis and treatment of chronic HBV infection, and with the inheritance, innovation, and modernization of traditional Chinese medicine, it is believed that traditional Chinese medicine can provide reliable regimens for the treatment of chronic HBV infection.

Objective:To analyze and summarize the clinical effects of 3D printed porous titanium-alloy prosthesis implantation in the treatment of long bone defects of lower extremities.Methods:We retrospectively studied the clinical cases with lower extremity bone defect treated by 3D printed porous titanium prostheses from December 2017 to November 2021. 18 patients who were followed up for more than 12 months were included in this study. The enrolled patients included 12 males and 6 females, with an average of 48.9±22.5 years (range, 13-79 years), and an average body mass index of 23.1±4.3 kg/m 2 (range, 17.2-27.1 kg/m 2). There were 14 osteomyelitis-derived bone defects and 4 nonunion-derived bone defects. The bone defect locations included 10 cases of femur and 8 cases of tibia. The average bone defect distance was 13.9±9.7 cm (range, 5.8-31.2 cm), and the proportion of the defect length to the long bone (femur of tibia) was average 33.7%±16.8% (range, 15.0%-63.0%). The clinical efficacy was comprehensively evaluated through gross observation, imaging evaluation, changes in the total length of lower extremities and long bones, femorotibial angle (FTA) measurement, lower extremity functional scale (LEFS), satisfaction, complications and other indicators, focusing on the stabilization mechanism of the prosthesis and the regeneration of new bone. Results:All 18 patients were followed up for 12-35 months, with an average of 16.3 months. Postoperative X-rays at 1, 3, 12 and 24 months showed that new bone could gradually creep along the prosthesis surface. The preoperative bone defect length of long bone and total length of lower limb were respectively 39.4±4.0 cm and 80.5±5.7 cm, which were different from those of the healthy side by 1.6±1.0 cm and 1.5±1.1 cm. One week after implantation, the length of long bone and lower limb was 39.9±3.5 cm and 80.9±6.2 cm, respectively, and the average difference was 1.0±0.6 cm and 0.9±1.1 cm compared with the healthy side. At the last follow-up, the length of long bone and lower limb was 39.7±3.6 cm and 80.9±7.8 cm, with an average difference of 1.8±1.1 cm and 1.0±0.7 cm from the healthy side. There were no significant differences in the length of long bone and lower limbs at the three time points before surgery, one week after surgery and the last follow-up ( F=0.12, 0.04; P>0.05). The average FTA of the affected limb was 174.7° (173.9°, 175.5°), 175.2°(173.5°, 176.4°), and 175.0°(173.5°, 176.3°) at three time nodes, before surgery, one week after surgery and the last follow-up, respectively, and there was no significant statistical difference in pairwise comparison ( Z=0.01, P>0.05). Patients had a mean LEFS score of 50 (46, 51) at the last follow-up, significantly higher than the preoperative score of 20 (17, 21) ( Z=-5.56, P<0.001). The mean satisfaction score of the 18 patients at the last follow-up was 9.7. Two patients (11.1%) had screw fractures but all 3D printed porous titanium alloy prostheses remained stable without significant loosening or displacement. Two patients (11.1%) had nail channel infection of external fixator, all patients with channel infection were cured by intravenous antibiotics combined with local disinfection and dressing change. Conclusion:The implantation of 3D printed porous titanium-alloy prosthesis could efficiently and safely repair the long bone defects of the lower extremities. The prosthesis could maintain stable in the early and middle postoperative period. The length of the long bones and lower limbs did not change significantly with the weight-bearing and functional exercise of the limbs. The new bone could gradually crawl and grow from both ends of the defect, and the patient's limb function recovered significantly, and the patient's satisfaction was high.

Objective: To analyze the clinical characteristics of oral candidiasis (OC) in in-patients with rheumatism, in order to provide theoretical basis for the prevention and treatment of OC in rheumatism patients. Methods: One thousand eight hundred and eight in-patients were recruited in the Department of Rheumatology, the Second Hospital of Shanxi Medical University from January 2017 to December 2017. The patients included 607 males and 1 201 females. Their average age was (49.5±15.5) years old with a ranging from 14 to 81 years. According to occurrence of OC or not, the patients were divided into OC group and non-OC group. The differences of general data, primary diseases, laboratory examinations, usage of glucocorticoid and immunosuppressant therapy were compared between the two groups, and the risk factors of OC occurrence were analyzed. Results: Two hundred and sixty-nine patients had OC and 1 539 patients had no OC. Age [(54.9±14.7) years], duration of illness [(9.4±4.4) years] and hospital stay [(15.3±5.7) d] in OC group were significantly longer than those in non-OC group. OC incidence in patients with connective tissue disease (CTD) [17.40% (193/1 109)] was higher than that in non-CTD patients [10.87% (75/699)] (P<0.001). OC most likely occurred in patients with such CTD as Sjögren syndrome (SS) and Behcet syndrome. OC incidence in non-CTD patients with osteoarthritis (OA) was highest. The salivary flow rate in OC group [(0.65±0.45) ml/min] was significantly lower than that in non-OC group [(0.78± 0.39) ml/min] (t=2.394, P=0.017). There was no statistical differences in other laboratory examinations between the two groups, including white blood cells (WBC), lymphocyte, platelet count, liver function, renal function, erythrocyte sedimentation rate, C-reactive protein, procalcitonin, immunoglobulin G, immunoglobulin M, immunoglobulin A, C₃, C₄ and so on. OC incidence in patients using prednisone≥15 mg/d [17.16% (133/775)] was higher than that in patients using prednisone<15 mg/d [12.53% (94/750)] and patients not using prednisone [14.84% (42/283)] (P<0.05). The incidence of OC in patients with immunosuppressant therapy [16.11% (226/1 403)] was statistically higher than that in non-immunosuppressant patients [10.62% (43/405)] (P<0.01). Logistic regression analysis showed that the risk factors of OC occurrence included primary diseases (P<0.001), age (P<0.001), duration of illness (P=0.001) and duration of hospitalization (P=0.002). Conclusions OC occurred commonly in rheumatism in-patients, especially in elder patients, patients with long duration of illness and hospital stay. OC incidence in CTD patients is significantly higher than that in non-CTD patients. Glucocorticoid and immunosuppressant therapy might significantly reduce the anti-fungal immunity of the patients.

This study aims to explore the involvement of c-Jun N-terminal kinase(JNK)-Gap junction regulation in the rat model of bone cancer pain and figure out whether adenosine 5′-monophosphate(AMP)-activated protein kinase(AMPK )activator metformin could attenuate bone cancer pain through this mechanism. Tumor cell implantation(TCI)induced bone cancer pain model in rats was established. The rats were administered, respectively, with 20 μL of metformin(50, 100 μg), JNK inhibitor SP600125(10 μg), gap junction inhibitor(carbenoxolone, CBX)(10 μg)and AMPK inhibitor Compound C(CC)(10 μg). The Von Frey Assay was applied to test the mechanical pain threshold. The activity of Glial fibrillary acidic protein(GFAP), ionized calcium-binding adaptor molecule 1(IBA-1)and Connexin 43(Cx43)in spinal cord was evaluated by immunohistochemistry. Changes of p-JNK expression were detected by Western blot. JNK inhibitor SP600125 relieved TCI-induced bone cancer pain significantly in rats, while this analgesic effect was almost canceled by the blocker of gap junction carbenoxolone(CBX). Various concentration of metformin(50, 100 μg, i. t. )significantly inhibited TCI-induced mechanical allodynia and the changes of p-JNK and p-Cx43 expression were also reversed in spinal cord in rats. Together, these data suggested that activation of AMPK with metformin attenuated TCI-induced bone cancer pain via regulating the function of JNK-Gap junction in rats.

From January 2015 to June 2016,107 patients with varicocele underwent microsurgical varicocelectomy in the First Affiliated Hospital of Xiamen University.The clinical outcomes of microsurgical varicocelectomy with(n=56)or without(n=51)microvascular Doppler ultrasonography were compared. All patients were treated successfully by both methods and no postoperative complications such as testicular atrophy and/or hydrocele were found during 12 months postoperative follow-up.For the group without microvascular Doppler,accidental artery ligation occurred in 2 cases and the internal spermatic vessels were unidentifiable in 4 cases, and recurrence occurred in one case.By contrast, no artery injury or ligation occurred during the operation with microvascular Doppler, and no recurrence occurred postoperatively. Microvascular Doppler ultrasonography, which is reliable for discerning arteries and veins, can effectively and safely assist microsurgical varicocelectomy for treatment of varicocele.

Objective To investigate the optimal HbA1Cthreshold to be used for the diagnosis of diabetes mellitus in Chongming rural area,and further to evaluate the optimal HbA1Ccutoff values in different age stratifications and body mass index classifications.Methods Data from 9,981 individuals aged greater than 40 years who participated in a population-based cross-sectional survey in Shanghai,China,were analyzed.A 2 h 75 g oral glucose tolerance test(OGTT)value was used to diagnose diabetes.The performance of HbA1Cwas evaluated against the results of the OGTTs by using receiver operating characteristic(ROC)curve analysis.Results At the optimal HbA1C cutoff point of 6.15%for newly diagnosed diabetes, sensitivity was 69.73%, and specificity was 89.71%.The optimal HbA1Ccutoff points for diabetes were 6.05%in subject with age less than 60 years(sensitivity was 72.88%, and specificity was 90.25%),and 6.25%in subjects with age≥60 years(sensitivity was 70.89%,and specificity was 92.34%).The optimal HbA1Ccutoff points for diabetes were 6.05% in normal-weight(with sensitivity 70.94%,and specificity 89.93%),6.25%in overweight(with sensitivity 70.21%,and specificity 90.32%), and 6.35% in obese population(with sensitivity 72.33%, and specificity 92.75%).Conclusion An HbA1C threshold of 6.15%was highly specific for detecting undiagnosed diabetes.The HbA1Cdiagnosis cutoff point can be affected by age and overweight/obesity status.

Objective To understand the distribution and antimicrobial resistance of pathogens isolated from blood culture in a hospital in Sanya city.Methods Blood culture specimens and antimicrobial susceptibility testing results in this hospital from January 2013 to December 2015 were analyzed retrospectively.Results A total of 356 isolates of pathogenic bacteria were isolated from 3 195 blood culture specimens,the positive rate was 11.14％,including 215(60.39％)gram-negative bacterial strains,122(34.27％) gram positive bacterial strains,and 19(5.34％) fungi strains.The top 3 gram negative bacteria were Escherichia coli (n =90,25.28％),Klebsiella pneumoniae (n =60,16.85％),and Burkholderia pseudomallei (n =24,6.74％);the most common gram positive bacteria were Staphylococcus aureus (n =42,11.80 ％),coagulase-negative staphylococcus (n =38,10.67 ％),and Streptococcus spp.(n =33,9.27 ％).Resistance rates of Escherichia coli and Klebsiella pneumoniae to cefoperazone/sulbactam,amikacin,and carbapenems were all lower than 10.00％;resistance rates of Burkholderia pseudomallei to most antimicrobial agents were lower than 10.00％.There were no strains of main gram-positive bacteria that were found to be resistant to linezolid and vancomycin.Conclusion Gram-negative bacteria are the main pathogens causing bloodstream infection in this hospital in recent years,especially the isolation rate of Burkholderia pseudomallei is higher,which should arouse more attention in clinic.

Objective To investigate the clinical efficacy of acupuncture combined with back Shu acupoint catgut embedding therapy in treating allergic rhinitis. Methods Totally 66 allergic rhinitis patients were included. Random number table method was used to divide the 66 patients into observation group and control group, with 33 cases in each group. The control group was given Ketotifen Fumarate Nasal Drops nose drops 2 drops each time, 3 times a day, Loratadine Tablets 10 mg orally, once a day for 4 weeks. The experimental group was treated with acupuncture, once a day, 10 d as a treatment course, three courses in total; at the same time, back Shu acupoint catgut embedding therapy was given, 15 d each time, twice treatment in total. After the end of treatment, clinical efficacy, clinical symptom score, life quality score, serum levels of inflammatory factors, serum immunoglobulin, peripheral blood eosinophil count and the incidence of adverse reactionsof the two groups were observed. Results The total effective rate was 93.94％ (31/33) in observation group and 75.76％ (25/33) in the control group, with statistical significance in the two groups (P<0.05). Compared with before treatment, the TNSS score, TNNSS score and RQLQ score of the two groups were significantly lower than after treatment (P<0.05); the IgE and EOS levels significantly decreased (P<0.05); the serum IL-17 and IL-22 levels were significantly lower (P<0.05). Compared with the control group, the TNSS, TNNSS and RQLQ score and the levels of IgE, EOS, IL-17 and IL-22 in the treatment group were lower after treatment (P<0.05). There was no significant difference in adverse reactions between the two groups (P>0.05). Conclusion Acupuncture combined with catgut embedding therapy in the treatment of allergic rhinitis has a significant clinical efficacy, which can improve the level of inflammatory factors in patients with high safety.