ObjectiveTo investigate the mechanisms by which Bushen Tongluo Jiangzhuo prescription improves renal fibrosis in rats with chronic kidney disease （CKD） through the phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）/mammalian target of rapamycin （mTOR） signaling pathway. MethodsSeventy specific pathogen-free （SPF） Sprague-Dawley （SD） rats were randomly divided into a control group （n=15） and a modeling group （n=55）. Rats in the modeling group were administered a 2.5% adenine suspension at a dose of 200 mg·kg^-1·d^-1 by gavage for 4 weeks to establish a CKD model. Successfully modeled rats were randomly divided into a model group， an irbesartan group （20.25 mg·kg^-1·d^-1）， and Bushen Tongluo Jiangzhuo prescription low-， medium-， and high-dose groups （5.82， 11.64， and 23.28 g·kg^-1·d^-1， respectively）， with 10 rats in each group. Each group was administered an equal volume of physiological saline， the corresponding concentration of irbesartan， or Bushen Tongluo Jiangzhuo prescription by gavage for 12 weeks. Body weight and renal function indices were dynamically monitored. Serum creatinine （SCr）， blood urea nitrogen （BUN）， urine albumin-to-creatinine ratio （ACR）， 24-hour urinary total protein （24 hUTP）， aspartate aminotransferase （AST）， alanine aminotransferase （ALT）， interleukin-1β （IL-1β）， interleukin-6 （IL-6）， and tumor necrosis factor-α （TNF-α） levels were measured using an automatic biochemical analyzer. Renal histopathological changes were observed by hematoxylin-eosin （HE） and Masson staining. Immunohistochemistry （IHC） was used to detect the expression of PI3K， Akt， phosphorylated Akt （p-Akt）， and mTOR in renal tissues. Western blot was performed to assess the protein expression of PI3K， p-Akt， Akt， phosphorylated mTOR （p-mTOR）， and mTOR in renal tissues. Real-time quantitative polymerase chain reaction （Real-time PCR） was used to determine the mRNA expression levels of PI3K， Akt， and mTOR in renal tissues. ResultsCompared with the model group， rats in the irbesartan group and the low-， medium-， and high-dose Bushen Tongluo Jiangzhuo prescription groups showed significantly decreased levels of SCr， BUN， ACR， 24 hUTP， IL-1β， IL-6， and TNF-α （P<0.01）. AST levels were significantly increased （P<0.01）， while no significant difference was observed in ALT levels. Histopathological examination revealed that， compared with the model group， renal tubular epithelial cell edema and necrosis and Bowman's capsule dilation were alleviated， inflammatory cell infiltration was reduced， and interstitial and glomerular fibrosis was markedly improved in all treatment groups， with the most pronounced effect observed in the high-dose Bushen Tongluo Jiangzhuo prescription group. Real-time PCR results showed that mRNA expression levels of PI3K， Akt， and mTOR were significantly downregulated in the high-dose group （P<0.01）. IHC results demonstrated that PI3K and p-Akt expression levels in renal tissues were significantly decreased in the high-dose group （P<0.01）. Western blot analysis further confirmed that the expression levels of PI3K， p-Akt/Akt， and p-mTOR/mTOR were significantly reduced in the high-dose group （P<0.01）. ConclusionBushen Tongluo Jiangzhuo prescription improves renal function indices in CKD rats， reduces collagen deposition in renal tissues， and decreases serum inflammatory factor levels. Its protective effect on renal function may be achieved by activating autophagy through downregulation of the PI3K/Akt/mTOR signaling pathway， thereby alleviating renal fibrosis.

ObjectiveTo investigate the effect of the multidisciplinary team （MDT） management model in improving the prognosis of patients with cirrhotic portal hypertension. MethodsA total of 86 patients with cirrhotic portal hypertension who were admitted to Shenzhen Third People’s Hospital from May 2022 to July 2024 were enrolled， and according to whether the MDT treatment regimen was implemented， they were divided into execution group with 51 patients and non-execution group with 35 patients. Baseline clinical data were collected， and the patients were observed in terms of gastrointestinal bleeding， hepatic encephalopathy， liver cancer， and death from admission to the end of follow-up （January 2025）. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to plot survival curves for the cumulative incidence rates of endpoint events （gastrointestinal bleeding， hepatic encephalopathy， liver cancer， and death）， and the Log-rank test was used for comparison between groups. The Cox proportional-hazards regression model analysis was used to investigate the effect of MDT management on the prognosis of patients. ResultsThere were significant differences between the execution group and the non-execution group in diameter of the portal vein （t=1.216， P=0.017） and ascites （χ²=4.515， P=0.034） at baseline. The patients were followed up for 14.6±6.2 months， and the survival curve analysis showed that there was a significant difference in the cumulative incidence rate of gastrointestinal bleeding between the two groups （χ²=4.573， P=0.024）， while there were no significant differences in the incidence rates of other outcome events between the two groups （all P>0.05）. The Cox regression analysis showed that the execution group had a reduced risk of gastrointestinal bleeding （hazard ratio=0.262， 95% confidence interval： 0.110 — 0.630， P=0.003）. ConclusionImplementation of the MDT treatment regimen can significantly reduce the short-term risk of gastrointestinal bleeding in patients with cirrhotic portal hypertension， while its long-term benefits require further follow-up verification.

Objective:To evaluate the impact of prophylactic cranial irradiation (PCI) on the prognosis of patients with limited-stage small cell lung cancer (SCLC) in the era of widespread application of MRI.Methods:Clinical data were collected from an open-lable prospective clinical trial on thoracic radiotherapy target volumes for limited-stage SCLC conducted in Sun Yat-sen University Cancer Center and Zhejiang Cancer Hospital between June 2002 and January 2017. In this study, patients who achieved complete remission (CR) or partial remission (PR) after definitive chemoradiotherapy (CRT) were retrospectively analyzed. Stratified analysis was performed according to different clinical efficacies. Patients were divided into different groups according to whether PCI was conducted or not. Survival analysis of patients was carried out. Survival data were calculated by Kaplan-Meier method, and Cox proportional hazards model was applied for multivariate prognostic analysis.Results:Among 309 patients with limited-stage SCLC who received CRT, 133 patients achieved CR and 140 cases obtained PR. These 273 patients were enrolled in this study. Among 133 patients with CR, 29 of them did not receive PCI, and 89 (85.6%) of the remaining 104 patients receiving PCI underwent brain MRI to exclude brain metastasis (BM) before PCI. With a median follow-up time of 22.1 months, the cumulative BM rates were 18.3% and 37.9% in patients who received or did not receive PCI ( P=0.020). The median overall survival (OS) was 30.2 and 30.5 months, and the 1-, 3- and 5-year OS rates were 93.3%, 41.9%, 27.7% and 82.8%, 44.8%, 40.8%, respectively ( P=0.910). Multivariate analysis indicated that baseline Karnofsky performance status (KPS) = 90 was a favorable independent prognostic factor for OS in CR patients ( HR=0.93, 95% CI: 0.89-0.98, P=0.006). Among 140 patients achieving PR, 52 cases did not receive PCI and 80 (90.9%) of the remaining 88 patients received brain MRI before PCI. With a median follow-up time of 18.9 months, the cumulative BM rates were 10.2% and 44.2% ( P<0.001). The median OS was 26.0 and 18.0 months, and the 1-, 3-, and 5-year OS rates were 86.4%, 37.9%, 32.2% and 75.0%, 17.3%, 10.8%, respectively ( P=0.001). Baseline KPS = 90 ( HR=0.93, 95% CI: 0.89-0.97, P=0.001) and PCI ( HR=0.54, 95% CI: 0.36-0.80, P=0.002) were favorable prognostic factors for OS in PR patients. Conclusions:PCI significantly reduces the incidence of BM and prolongs the OS in patients with limited-stage SCLC who achieve PR after CRT, but it fails to significantly prolong the OS of CR patients.

Objective: To investigate trends of incidence, mortality, and years of life lost (YLL) rate of lung cancer in cancer registration areas of Guizhou Province from 2017 to 2021, so as to provide references for formulating lung cancer prevention and control strategies and reducing the disease burden of lung cancer. Methods: The qualified lung cancer registration data from cancer registration areas of Guizhou Province from 2017 to 2021 were collected, the crude incidence and mortality of lung cancer were calculated by urban/rural areas, genders and ages. The standardized incidence and standardized mortality was calculated using the age structure of the standard population from the Fifth National Population Census in 2000. YLL was calculated using the standard life table from the Global Burden of Disease Study 2019. The disease burden of lung cancer was assessed using incidence, mortality, and YLL rate, and the trend in the disease burden of lung cancer from 2017 to 2021 was calculated using annual percent change (APC). Results : From 2017 to 2021, the crude incidence, standardized incidence, crude mortality, standardized mortality, YLL and YLL rate in Guizhou Province were 53.13/100 000, 37.58/100 000, 42.77/100 000, 29.44/100 000, 98.19 thousand person-years and 10.95‰, respectively. The standardized incidence and standardized mortality of lung cancer were higher in rural areas than in urban areas (39.45/100 000 vs. 34.23/100 000, 30.68/100 000 vs. 27.18/100 000). The standardized incidence and standardized mortality of lung cancer were higher in males than in females (49.34/100 000 vs. 26.47/100 000, 41.31/100 000 vs. 18.28/100 000). The crude incidence and crude mortality of lung cancer increased with age, peaking in the 80-<85 age group (360.84/100 000) and the ≥85 age group (414.85/100 000), respectively. From 2017 to 2021, the standardized incidence demonstrated downward trends in the total population, urban areas and males (APC=-6.590%, -5.829%, and -6.729%, all P<0.05). The standardized mortality demonstrated downward trends in urban areas and females (APC=-3.710% and -5.378%, both P<0.05). The YLL rate also showed downward trends in urban areas and females (APC=-3.957% and -3.631%, both P<0.05). Conclusions From 2017 to 2021, the overall disease burden of lung cancer in registration areas of Guizhou Province showed a decreasing trend. However, the disease burden remained relatively heavier in rural areas and males, with a relatively gradual change.

Objective:To evaluate the impact of prophylactic cranial irradiation (PCI) on the prognosis of patients with limited-stage small cell lung cancer (SCLC) in the era of widespread application of MRI.Methods:Clinical data were collected from an open-lable prospective clinical trial on thoracic radiotherapy target volumes for limited-stage SCLC conducted in Sun Yat-sen University Cancer Center and Zhejiang Cancer Hospital between June 2002 and January 2017. In this study, patients who achieved complete remission (CR) or partial remission (PR) after definitive chemoradiotherapy (CRT) were retrospectively analyzed. Stratified analysis was performed according to different clinical efficacies. Patients were divided into different groups according to whether PCI was conducted or not. Survival analysis of patients was carried out. Survival data were calculated by Kaplan-Meier method, and Cox proportional hazards model was applied for multivariate prognostic analysis.Results:Among 309 patients with limited-stage SCLC who received CRT, 133 patients achieved CR and 140 cases obtained PR. These 273 patients were enrolled in this study. Among 133 patients with CR, 29 of them did not receive PCI, and 89 (85.6%) of the remaining 104 patients receiving PCI underwent brain MRI to exclude brain metastasis (BM) before PCI. With a median follow-up time of 22.1 months, the cumulative BM rates were 18.3% and 37.9% in patients who received or did not receive PCI ( P=0.020). The median overall survival (OS) was 30.2 and 30.5 months, and the 1-, 3- and 5-year OS rates were 93.3%, 41.9%, 27.7% and 82.8%, 44.8%, 40.8%, respectively ( P=0.910). Multivariate analysis indicated that baseline Karnofsky performance status (KPS) = 90 was a favorable independent prognostic factor for OS in CR patients ( HR=0.93, 95% CI: 0.89-0.98, P=0.006). Among 140 patients achieving PR, 52 cases did not receive PCI and 80 (90.9%) of the remaining 88 patients received brain MRI before PCI. With a median follow-up time of 18.9 months, the cumulative BM rates were 10.2% and 44.2% ( P<0.001). The median OS was 26.0 and 18.0 months, and the 1-, 3-, and 5-year OS rates were 86.4%, 37.9%, 32.2% and 75.0%, 17.3%, 10.8%, respectively ( P=0.001). Baseline KPS = 90 ( HR=0.93, 95% CI: 0.89-0.97, P=0.001) and PCI ( HR=0.54, 95% CI: 0.36-0.80, P=0.002) were favorable prognostic factors for OS in PR patients. Conclusions:PCI significantly reduces the incidence of BM and prolongs the OS in patients with limited-stage SCLC who achieve PR after CRT, but it fails to significantly prolong the OS of CR patients.

Diabetic retinopathy(DR)is one of the most common microvascular complications of diabetes and has become one of the leading causes of blindness and visual impairment in diabetes patients.The pathogenesis of DR is multifaceted,involving inflammation,oxidative stress,neurovascular abnormalities,and other factors that present potential targets for disease management interventions.Currently,anti-vascular endothelial growth factor(VEGF)drugs serve as the primary treatment for advanced stages of DR when irreversible neurovascular damage and visual impairment have occurred.Additionally,some patients show poor or no response to anti-VEGF treatment.There is a lack of early intervention options for the initial phases of the disease.Therefore,there is an urgent need to develop novel local or systemic therapies based on the underlying mechanisms of DR to enable early prevention and treatment with the aim of preserving patients' vision.Medications targeting various pathways including anti-inflammatory agents(corticosteroids and nonsteroidal anti-inflammatory drugs),neurotrophic and neuroprotective drugs,drugs modulating biochemical pathways,antioxidant phytochemicals,and gene therapy can complement each other in terms of therapeutic effects to benefit a larger number of individuals affected by DR.This article reviews previous research reports on the pathogenesis,drug treatment methods,and potential therapeutic targets associated with DR in order to provide guidance for clinical practice.

Objective:To compare the efficacy of stereotactic body radiotherapy(SBRT) and surgery in treating intrapulmonary recurrence of non-small cell lung cancer (NSCLC) after radical surgery.Methods:A retrospective analysis was conducted on NSCLC patients, who underwent radical surgery at the Cancer Hospital Affiliated to University of Chinese Academy of Sciences from November 2012 to December 2018 and then received SBRT or secondary surgery because of postoperative intrapulmonary recurrence. The survival rates of these patients were calculated using the Kaplan-Meier method. The comparison between the two groups was made using the Log-rank method, and the univariate and multivariate analysis was made using the Cox regression method.Results:Among 62 eligible patients, 33 received SBRT and 29 received secondary surgery, and they were divided into the SBRT group and the surgery group accordingly. For the SBRT and surgery groups, the median follow-up time was 45.8 months and 37.4 months, the 3-year locoregional control rate (LRCR) 79.8% and 90.2%, respectively ( P > 0.05), the progression-free-survival (PFS) 58.5% and 42.3%, respectively ( P >0.05), and the overall survival (OS) 78.0% and 85.5%, respectively ( P >0.05). The multivariate analysis suggested that treatment method, Charlson comorbidity index (CCI), and adjuvant drug therapy were independent prognostic factors for PFS ( P = 0.027, 0.013, 0.001). Conclusions:The efficacy of SBRT and surgery is comparable for patients with intrapulmonary recurrence of NSCLC after radical surgery.

Objective:To explore the effect of the application of hierarchical and special quality control in the quality control management of an ultrasound department.Methods:The hierarchical and special quality control method was used to control ultrasonic reports that were related to four quality control areas: basic quality control, deep quality control, obstetrical quality control, and critical value quality control. Changes in the qualified reporting and comprehensive clinical satisfaction rates before and after the implementation of hierarchical and special quality control were examined.Results:After the implementation of hierarchical and special quality control, the qualified rates of basic quality control, deep quality control, obstetrical quality control, and critical value quality control increased significantly. The comprehensive clinical satisfaction score was (90.58±1.79) points, which was higher than before the model was applied [(80.37±2.72) points], and the difference was statistically significant ( P<0.01). Conclusion:The implementation of hierarchical and special quality control measure can effectively improve the quality of ultrasonic diagnoses and comprehensive clinical satisfaction.

Objective To investigate the role of diffusion kurtosis imaging (DKI) in indeterminate solitary pulmonary nodules (SPN) diagnosis and to compare with conventional diffusion weighted imaging (DWI). Methods From March 2016 to Dec 2017, forty-three consecutive patients (30 male, 13 female, age: 56 ± 11 years) with indeterminate SPNs were included. All patients underwent axial multi-b factor DWI (with b values=0, 50, 200, 400, 800, 1400, 2000 s/mm2) examination and were divided into benign group (19 cases) and malignant group (24 cases) according to pathological results of SPN. ADC Kurtosis (K) and Diffusivity (Dk) values were compared between malignant and benign group and among different subtypes of lung cancer using independent t test (normal distribution and homogeneity of variance) and Mann-Whitney U test (skewed distribution or variance). Receiver operating characteristic (ROC) curves were employed to evaluate the diagnostic performance. Results K values were significantly higher for malignant SPNs than for benign SPNs (0.839 ± 0.197 vs. 0.718 ± 0.120;t=2.359, P=0.023). ADC values were found to be significantly higher in benignity than malignant SPNs [(1.605 ± 0.422) × 10-3mm2/s vs. (1.278 ± 0.210) × 10-3mm2/s; t=-3.089, P=0.005). No difference was observed in Dk between the two groups (P=0.922). All parameters cannot differentiate subtypes of lung cancer. The ADC value had higher AUC (area under ROC curve) than that of K value. The sensitivity (70.8％) and accuracy (72.1％) of ADC value was higher than K value, the specificity of both methods was equal. Conclusion DKI is a feasible non-invasive tool which has comparable capability of conventional DWI in SPNs differentiation, although with lower sensitivity and accuracy. DKI can provide additional information for SPNs characterization and has a potential to be a robust way in SPNs interpretation.

Objective: To study dose-response relationships of fractionated irradiation induced pulmonary fibrosis in mice according to radiological imaging changes of lung. Methods: A total of 8-10 week old-female C57BL6 mice were randomized into different groups for whole thoracic irradiation. The prescribed doses were 0, 2.0, 4.0, 6.0, 7.0, 8.5 Gy per fraction in a total of 5 fractions. CT imaging was performed at 24 weeks post irradiation. The averaged lung density and volume changes were obtained by the three-dimensional segmentation algorithm, and further analyzed in Boltzmann regression modeling. Results: At the endpoint of 24 weeks, the dose-dependent pulmonary radiological alternations were revealed by coronal view of CT images. Translational analysis of fibrosis-related gene-signatures as well as histological collagen stainings further corroborated the radiological findings. According to Boltzmann modeling, the E₅₀ of radiation-induced lung density changes was found to be (30.80±0.80)Gy (adjusted R²=0.97); whereas the E₅₀ for radiation-induced lung volume reduction was determined as (31.31±7.07)Gy (adjusted R²=0.92). Both outcomes indicated a remarkable enhancement of tolerance to normal lung tissues after exposure with 5-fraction versus single fraction scheme. Conclusions The radiation-induced lung density and volume changes depend not only on total dose, but also the number and dose of fractions.