ObjectiveTo observe the clinical efficacy and safety of Yishen Jiangtang decoction combined with conventional Western medicine treatment in managing stage G3A3 diabetic kidney disease （DKD） in the patients with the pattern of Qi-Yin deficiency combined with dampness-heat and blood stasis， and to explore its mechanism of inhibiting the endoplasmic reticulum stress （ERS）-apoptosis axis and delaying renal fibrosis （RF）. MethodsA single-center， randomized， parallel-controlled clinical trial was conducted. A total of 78 patients diagnosed with stage G3A3 DKD and traditional Chinese medicine （TCM） pattern of Qi-Yin deficiency combined with dampness-heat and blood stasis and treated in the Department of Nephrology and the Department of Endocrinology of the People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine from March 2025 to February 2026 were enrolled. They were randomly assigned at a 1∶1 ratio into a control group （conventional Western medicine treatment） and an experimental group （Yishen Jiangtang decoction combined with conventional Western medicine treatment）， with 39 patients in each group. The treatment lasted for 12 weeks. Basic demographic data and medical history were collected before and after treatment. The two groups before and after treatment were compared in terms of the following parameters： Blood urea nitrogen （BUN）， serum creatinine （SCr）， estimated glomerular filtration rate （eGFR）， urinary albumin-to-creatinine ratio （UACR）， fasting blood glucose （FBG）， triglycerides （TG）， total cholesterol （TC）， and low-density lipoprotein cholesterol （LDL-C）. Enzyme-linked immunosorbent assay （ELISA） kits were used to measure serum glucose-regulated protein 78 （GRP78）， serum cysteinyl aspartate-specific protease-3 （Caspase-3）， and serum and urinary transforming growth factor-β₁ （TGF-β₁） levels before and after treatment. TCM symptom scores， TCM syndrome efficacy， and overall clinical efficacy were evaluated before and after treatment. Spearman correlation analysis was performed to explore the correlations of serum levels of GRP78 and Caspase-3， as well as serum and urinary levels of TGF-β1， with renal function， proteinuria， and glucose and lipid metabolism indicators in patients with DKD. In addition， safety indicators were also monitored. ResultsA total of 75 patients completed the study （38 in the control group and 37 in the experimental group）. ① Baseline data： The two groups were comparable in terms of sex and age， with no statistically significant difference. ② Efficacy outcomes： Compared with baseline levels， both groups showed reductions in BUN， SCr， UACR， FBG， TG， TC， LDL-C， and TCM symptom scores （P<0.01） and increases in eGFR level （P<0.01）. Moreover， the experimental group outperformed the control group in altering the indicators above （P<0.05）. Regarding TCM syndrome efficacy， the total response rate in the experimental group was 83.78%， which was higher than that （57.89%） in the control group （P<0.05）. Regarding overall clinical efficacy， the total response rate in the experimental group was 78.38%， which was higher than that （50.00%） in the control group （P<0.05）. ③ Mechanism outcomes： Compared with baseline levels， both groups showed declined serum levels of GRP78， Caspase-3， and TGF-β₁ and urinary level of TGF-β₁ after treatment （P<0.01）. Moreover， the experimental group showed greater declines than the control group （P<0.05）. The serum levels of GRP78， Caspase-3，and TGF-β₁ and the urinary level of TGF-β₁ in DKD patients showed positive correlations with BUN， SCr， UACR， and FBG and negative correlations with eGFR （P<0.05）. ④ Safety outcomes： Neither group showed drug-related adverse reactions， and laboratory safety parameters remained within normal ranges. ConclusionYishen Jiangtang decoction combined with conventional Western medicine treatment may safely and effectively alleviate clinical symptoms， correct glucose and lipid metabolism disorders， and protect the renal function in patients with stage G3A3 DKD and the pattern of Qi-Yin deficiency combined with dampness-heat and blood stasis. The mechanism may be associated with inhibition of the ERS-apoptosis axis and delay of the RF process.

ObjectiveTo observe the clinical efficacy and safety of Yishen Jiangtang decoction combined with conventional Western medicine treatment in managing stage G3A3 diabetic kidney disease （DKD） in the patients with the pattern of Qi-Yin deficiency combined with dampness-heat and blood stasis， and to explore its mechanism of inhibiting the endoplasmic reticulum stress （ERS）-apoptosis axis and delaying renal fibrosis （RF）. MethodsA single-center， randomized， parallel-controlled clinical trial was conducted. A total of 78 patients diagnosed with stage G3A3 DKD and traditional Chinese medicine （TCM） pattern of Qi-Yin deficiency combined with dampness-heat and blood stasis and treated in the Department of Nephrology and the Department of Endocrinology of the People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine from March 2025 to February 2026 were enrolled. They were randomly assigned at a 1∶1 ratio into a control group （conventional Western medicine treatment） and an experimental group （Yishen Jiangtang decoction combined with conventional Western medicine treatment）， with 39 patients in each group. The treatment lasted for 12 weeks. Basic demographic data and medical history were collected before and after treatment. The two groups before and after treatment were compared in terms of the following parameters： Blood urea nitrogen （BUN）， serum creatinine （SCr）， estimated glomerular filtration rate （eGFR）， urinary albumin-to-creatinine ratio （UACR）， fasting blood glucose （FBG）， triglycerides （TG）， total cholesterol （TC）， and low-density lipoprotein cholesterol （LDL-C）. Enzyme-linked immunosorbent assay （ELISA） kits were used to measure serum glucose-regulated protein 78 （GRP78）， serum cysteinyl aspartate-specific protease-3 （Caspase-3）， and serum and urinary transforming growth factor-β₁ （TGF-β₁） levels before and after treatment. TCM symptom scores， TCM syndrome efficacy， and overall clinical efficacy were evaluated before and after treatment. Spearman correlation analysis was performed to explore the correlations of serum levels of GRP78 and Caspase-3， as well as serum and urinary levels of TGF-β1， with renal function， proteinuria， and glucose and lipid metabolism indicators in patients with DKD. In addition， safety indicators were also monitored. ResultsA total of 75 patients completed the study （38 in the control group and 37 in the experimental group）. ① Baseline data： The two groups were comparable in terms of sex and age， with no statistically significant difference. ② Efficacy outcomes： Compared with baseline levels， both groups showed reductions in BUN， SCr， UACR， FBG， TG， TC， LDL-C， and TCM symptom scores （P<0.01） and increases in eGFR level （P<0.01）. Moreover， the experimental group outperformed the control group in altering the indicators above （P<0.05）. Regarding TCM syndrome efficacy， the total response rate in the experimental group was 83.78%， which was higher than that （57.89%） in the control group （P<0.05）. Regarding overall clinical efficacy， the total response rate in the experimental group was 78.38%， which was higher than that （50.00%） in the control group （P<0.05）. ③ Mechanism outcomes： Compared with baseline levels， both groups showed declined serum levels of GRP78， Caspase-3， and TGF-β₁ and urinary level of TGF-β₁ after treatment （P<0.01）. Moreover， the experimental group showed greater declines than the control group （P<0.05）. The serum levels of GRP78， Caspase-3，and TGF-β₁ and the urinary level of TGF-β₁ in DKD patients showed positive correlations with BUN， SCr， UACR， and FBG and negative correlations with eGFR （P<0.05）. ④ Safety outcomes： Neither group showed drug-related adverse reactions， and laboratory safety parameters remained within normal ranges. ConclusionYishen Jiangtang decoction combined with conventional Western medicine treatment may safely and effectively alleviate clinical symptoms， correct glucose and lipid metabolism disorders， and protect the renal function in patients with stage G3A3 DKD and the pattern of Qi-Yin deficiency combined with dampness-heat and blood stasis. The mechanism may be associated with inhibition of the ERS-apoptosis axis and delay of the RF process.

BACKGROUND:When performing percutaneous minimally invasive transforaminal lumbar interbody fusion to implant an intervertebral cage,due to the narrow operating range of the approach,there is a risk of nerve root injury or poor position of cage. To solve the above problems,a novel mechanical deformable press-fit cage (YP-cage) was invented.OBJECTIVE:To preliminarily evaluate the mechanical strength characteristics of this new lumbar fusion device YP-cage.METHODS:Static axial compression and torsion tests were conducted on 9,11,and 13 mm YP-cages (n=9) and poly (ether ether ketone) (PEEK)-cages (n=9). The force-displacement curves were collected to calculate yield displacement and load,ultimate load displacement and stiffness,yield angular displacement and torque,ultimate load and angle displacement torque and stiffness for comparative analysis. RESULTS AND CONCLUSION:(1) In the static axial compression test,YP-cage was superior to PEEK-cage in terms of stiffness,yield load,ultimate displacement,and load limit in three groups of tests (9,11,13 mm) (P<0.01),but the yield displacement of YP-cage was smaller than that of PEEK-cage (P<0.05). (2) In the static torsion test,there was no significant difference in the ultimate torsion angle between YP-cage and PEEK-cage in 9 mm group. YP-cage was lower thanPEEK-cage in yield torque,yield torsion angle,and ultimate torque (P<0.01),while YP-cage torsional stiffness was greater than PEEK-cage in 9 mm group and 11 mm group (P<0.01). (3) The results show that the novel press-fit mechanical lumbar cage has higher compressive strength than PEEK cage,but the torsional strength is not as good as PEEK-cage.

BACKGROUND:When performing percutaneous minimally invasive transforaminal lumbar interbody fusion to implant an intervertebral cage,due to the narrow operating range of the approach,there is a risk of nerve root injury or poor position of cage. To solve the above problems,a novel mechanical deformable press-fit cage (YP-cage) was invented.OBJECTIVE:To preliminarily evaluate the mechanical strength characteristics of this new lumbar fusion device YP-cage.METHODS:Static axial compression and torsion tests were conducted on 9,11,and 13 mm YP-cages (n=9) and poly (ether ether ketone) (PEEK)-cages (n=9). The force-displacement curves were collected to calculate yield displacement and load,ultimate load displacement and stiffness,yield angular displacement and torque,ultimate load and angle displacement torque and stiffness for comparative analysis. RESULTS AND CONCLUSION:(1) In the static axial compression test,YP-cage was superior to PEEK-cage in terms of stiffness,yield load,ultimate displacement,and load limit in three groups of tests (9,11,13 mm) (P<0.01),but the yield displacement of YP-cage was smaller than that of PEEK-cage (P<0.05). (2) In the static torsion test,there was no significant difference in the ultimate torsion angle between YP-cage and PEEK-cage in 9 mm group. YP-cage was lower thanPEEK-cage in yield torque,yield torsion angle,and ultimate torque (P<0.01),while YP-cage torsional stiffness was greater than PEEK-cage in 9 mm group and 11 mm group (P<0.01). (3) The results show that the novel press-fit mechanical lumbar cage has higher compressive strength than PEEK cage,but the torsional strength is not as good as PEEK-cage.

Objective:To explore the clinical outcome of measured resection combined with gap balancing technique in total knee arthroplasty (TKA).Methods:From January 2016 to October 2017, 61 cases of varus knee joint flexion deformity were applied the procedure of measured resection combined with gap balancing technique in primary total knee arthroplasty, including 24 male and 37 female; the average age was 66.80±8.2 years old (range from 60 to 78 years old). All patients underwent antero-medial incision of knee joint,medial parapatellar approach and posterior stabilized prosthesis. Measurement osteotomy technique was used to localize osteotomy. Gap balancing technique was vitrificated flexion and extension. Operation time, surgical blood loss and osteotomy volume were recorded. Radiographic evaluation included alignment of lower extremity, knee joint linedistance, tibiofemoral joint angle, rotation angle of femoral prothesis and posterior condylar offset (PCO). Joint functions were assessed including KSS scores, ROM and patient satisfaction.Results:The average operation time was 54±12 min (range from 45 to 65 min). The average postoperative drainage was 140±26 ml (range from 120 to 180 ml). The difference in hemoglobin values were 22±8.5 g/L(range from 20 to 30 g/L) between preoperative and postoperative 5 days. The lateral proximal tibial bone mass was 10.2±1.5 mm (range from 9.2 to 11.5 mm). The lateral distal femoral bone mass was 9.1±1.5 mm (range from 8.8 to 10 mm). The bone mass of posterior lateral condyle of femur was 8.6±1.5 mm (range from 7.8 to 10 mm). The bone mass of posterior medial condyle of femur was 9.2±1.2 mm (range from 8.6 to 10 mm), compared with the bone mass of posterior lateral condyle of femur, and the difference was statistically significant ( t=2.44, P=0.006). The intraoperative angle between osteotomy line of gap balanced osteotomy technique (line B) and connecting line of screw hole in measure osteotomy (line A) was 1.15°±0.47° (range from 1.02° to 2°). The external rotation angle was27.8%, the internal rotation angle was72.2%. There was no significant difference between preoperative knee joint line distance 40.55±4.32 mm and postoperative knee prosthesis joint line distance 40.99±3.86 mm. Postoperative knee straight and bent-knee 90° stress X-ray demonstrated that medial-lateral tibiofemoral joint angle showed no significant difference ( P >0.05). Cross-sectional CT of knee joint post operation, rotation angle of femoral prosthesis ≤±2°. Most of them were mainly concentrated in the internal rotation angle. There was no significant difference between preoperative PCO 31.55±3.18 mm and postoperative PCO 31.55±3.18 mm ( P>0.05). The KSS score and patient satisfaction score post operationwere significantly higher than those preoperation. The KSS score and patient satisfaction score at 3 months after operation were 89.2±9.4 points and 7.2±2.6 points, which were higher than that at 1 month after operation (78.0±3.5 points and 5.2±1.8 points), with statistically significant differences ( t=1.897, P=0.026; t=1.753, P=0.038). The KSS score was above 90 at 6 months after operation. The knee ROM after 1 month (94.7°±10.6°) had no statistical significance compared with that preoperation (91.9°±12.5°) ( t=1.286, P=0.245). The knee ROM at 3 months after surgery (105.8°±14.7°) was significantly higher than that before operation (91.9°±12.5°) ( t=1.924, P=0.041). There was no significant difference between the scores of the follow-up time points and those of 3 months after operation ( P >0.05). Conclusion:TKA were performed by using measured resection combined with gap balancing technique. Not only can good alignment of lower extremity be restored, but also flexion-extension gap balance can be obtained. Equal osteotomy with less soft tissue release. There are better ROM of knee and KSS functional scores in the early postoperative period. However, it is easy to cause femoral pseudointernal rotation.

Objective:To establish an automatic segmentation network based on different receptive fields for gross target volume (GTV) and organs at risk in patients with nasopharyngeal carcinoma.Methods:Radiotherapy data of 100 cases of nasopharyngeal carcinoma including CT images and GTV and organs at risk delineated by the physicians were collected. Ninety plans were randomly selected as the training dataset, and the other 10 plans as the validation dataset. Firstly, the images were subject to three data augmentation methods including center cropping, vertical flipping and rotation (-30°to 30°), and then input into MA_net networks proposed in this study for training. The model performance of networks was assessed by the number of network parameters (NP), floating-point number (FPN), the running memory (RM) and Dice index (DI), and eventually compared with DeeplabV3+ , PSP_net, UNet+ + and U_Net networks.Results:When the input image was in the size of 240×240, MA_net had a NP of 23.20%, 20.10%, 25.55% and 27.11% of these 4 networks, 50.02%, 19.86%, 6.37% and 13.44% for the FPN, 40.63%, 23.60%, 11.58% and 14.99% for the RM, respectively. For the DI of GTV, MA_net was 1.16%, 2.28%, 1.27% and 3.59% higher than these 4 networks. For the average DI of GTV and OAR, MA_net was 0.16%, 1.37%, 0.30% and 0.97% higher than these 4 networks.Conclusion:Compared with those four networks, the proposed MA_net network has slightly higher Dice index with fewer parameters, lower FPN and smaller RM.

OBJECTIVE：To explore the mechanism of Hippophae rhamnoides in the treatment of Alzheimer ’s disease （AD）， and to provide theoretic reference for further exploring the material basis. METHODS ：TCMSP，Uniprot，GeneCards database were used to screen the active components of H. rhamnoides ，targets and AD-related target gene. The “ingredients-targets-related diseases”network was constructed by Cytoscape 3.7.1 software. STRING database was adopted to construct protein interaction （PPI）network，molecular docking was conducted between the potential targets with high degree values and active components of H. rhamnoides . The gene ontology （GO）analysis and Kyoto encyclopedia of genes and genomes （KEGG）pathway enrichment analysis were performed by Clue GO for the potential target of H. rhamnoides in the treatment of AD. Totally 50 mice were randomly divided into blank group ，model group [ D-galactose 120 mg/（kg·d），AlCl3 solution 20 mg/（mL·d）]，positive drug group [oxiracetam 260 mg/（kg·d）]，seabuckthorn oil extract group [ 1.6 g/（kg·d）]，seabuckthorn polyphenols group [1.6 g/（kg·d）]，with 10 mice in each group. The mice was given relevant medicine intragastrically and modeling agent ；blank group was given constant volume of distilled water intragastrically ，once a day ，for consecutive 60 d. The learning and memory abilities were detected by Morris water maze test ；the levels of immune factors in hippocampus tissue were measured by ELISA. Pathological morphology of hippocampus tissue was observed by HE staining. The mechanism of H. rhamnoides in the treatment of AD was validated preliminarily. RESULTS ：Totally 22 active components of H. rhamnoides （quercetin，kaempferol，isorhamnetin， β-carotene，β-sitosterol） may affect biological processes such as nuclear receptor activity ，lipopolysaccharide-mediated signal pathway，and may affect 114 methabolism pathways such as IL- 17 signal transduction pathway ，TNF signal transduction pathway by regulating 147 targets such as serine/threonine kinase coding protein （AKT1），amino terminal kinase （JUN）and mitogen activated protein kinase （MAPK1）. The results of molecular docking showed that binding scores of the main active components of H. rhamnoides and the main target proteins were all above 4.25，which showed good binding activity. Results of pharmacology experiment showed that H. rhamnoides extract could shorten the escape latency of AD model mice ，increased the times of crossing platform，relieved hippocampus injury of cerebral tissue ，and decreased the contents of inflammatory factors TNF-α，IL-1β，IL-6 and IL- 17 in hippocampus of cerebral tissue. CONCLUSIONS ：The active components of H. rhamnoides can regulate multiple targets in the important pathway of AD ；animal experiments preliminarily verify that H. rhamnoides can relieve the hippocampus injury and improve the learning and memory ability of AD model mice by inhibiting the expression of inflammatory factors.

Objective:To compare the accuracy and generalized robustness of three predictive models of knowledge-based treatment strategies for radiotherapy for optimized model selection.Methods:The clinical radiotherapy plans of 45 prostate cancer (PC) cases and 25 nasopharyngeal cancer (NPC) cases were collected, and analyzed using three models (Z, L and S model), proposed by Zhu et al, Appenzoller et al and Shiraishi et al, respectively, to predict the dose-volume histogram (DVH) of bladder and rectum on PC cases and that of left and right parotid on NPC cases. The prediction error was measured by the difference of area under the predicted DVH and the clinical DVH curves (|V (pre_DVH)-V (clin_DVH)|), where a smaller prediction error implies a greater prediction accuracy. The accuracies of these three models were compared on the single organ at risk (OAR), and the generalized robustness of models was evaluated and compared by calculating the standard deviation of the prediction accuracy on different OAR. Results:For bladder and rectum, the prediction error of L model (0.114 and 0.163, respectively) was significantly higher than those values of Z and S models (≤0.071, P<0.05); for left parotid gland, the predicted error of S model (0.033) did not present significant difference from those values of Z and L models (≤0.025, P>0.05); for right parotid gland, S model (0.033) demonstrated significantly higher prediction error than those of Z and L models (≤0.028, P<0.05). Regarding different OAR, S model showed a lower standard deviation of prediction accuracy when comparing to Z and L models (0.016, 0.018 and 0.060, respectively). Conclusions:In the prediction of DVH in bladder and rectum of PC, Z and S models were more accurate than L model. In contrast, Z and L models demonstrated higher accuracy than S model in the prediction of left and right parotid glands of NPC. In respect to different OAR, the generalized robustness of S model was superior than the other two models.

Objective:To explore the predictive value of China Nanjing persistent vegetative state scale (CNPVSS) on the curative effect of the patients with chronic disorder of consciousness, by analyzing the curative effect of the rehabilitation treatment combined with hyperbaric oxygen (HBO) for patients with chronic disorder of consciousness.Methods:A total of 48 patients with chronic disorder of consciousness admitted to Nanjing Zijin Hospital to receive rehabilitation treatment combined with HBO from the September of 2016 to the May of 2019 were selected according with the analytical criteria. Before the treatment, the patients were evaluated by CNPVSS and received electroencephalogram (EEG) and evoked potentials (EPs) examinations. The patients′ consciousness was evaluated again before discharge, the results of CNPVSS and electrophysiological examinations were recorded, and the correlation between the results and the changes of the consciousness was analyzed statistically.Results:The results of CNPVSS was positive correlated with near-term curative effect ( r=0.401, P=0.005); the rate of awakening after treatment was 46.2% among those who were scored as minimally conscious state (MCS) by CNPVSS; the rate of awakening after treatment was 17.1% among those who were at vegetative state (VS) or in a coma; the rate of awakening after treatment of the MCS patients was higher than those of the patients at VS or in a coma ( χ2=4.255, P=0.039). The recordings of right somatosensory evoked potentials (SSEPs) N20 was positive correlated with curative effect ( r=0.312, P=0.031); and the left visual evoked potentials (VEPs) V100 was positive correlated with curative effect ( r=0.285, P=0.049). There were no statistical significance found between other electrophysiological recordings with curative effect. Conclusion:CNPVSS can be an important tool to predict the outcome of the rehabilitation treatment combined with HBO for the patients with chronic disorder of consciousness, and the recordings of SSEPs and VEPs also are of a certain reference value in predicting the prognosis.

Objective:To explore the predictive value of China Nanjing persistent vegetative state scale (CNPVSS) on the curative effect of the patients with chronic disorder of consciousness, by analyzing the curative effect of the rehabilitation treatment combined with hyperbaric oxygen (HBO) for patients with chronic disorder of consciousness.Methods:A total of 48 patients with chronic disorder of consciousness admitted to Nanjing Zijin Hospital to receive rehabilitation treatment combined with HBO from the September of 2016 to the May of 2019 were selected according with the analytical criteria. Before the treatment, the patients were evaluated by CNPVSS and received electroencephalogram (EEG) and evoked potentials (EPs) examinations. The patients′ consciousness was evaluated again before discharge, the results of CNPVSS and electrophysiological examinations were recorded, and the correlation between the results and the changes of the consciousness was analyzed statistically.Results:The results of CNPVSS was positive correlated with near-term curative effect ( r=0.401, P=0.005); the rate of awakening after treatment was 46.2% among those who were scored as minimally conscious state (MCS) by CNPVSS; the rate of awakening after treatment was 17.1% among those who were at vegetative state (VS) or in a coma; the rate of awakening after treatment of the MCS patients was higher than those of the patients at VS or in a coma ( χ2=4.255, P=0.039). The recordings of right somatosensory evoked potentials (SSEPs) N20 was positive correlated with curative effect ( r=0.312, P=0.031); and the left visual evoked potentials (VEPs) V100 was positive correlated with curative effect ( r=0.285, P=0.049). There were no statistical significance found between other electrophysiological recordings with curative effect. Conclusion:CNPVSS can be an important tool to predict the outcome of the rehabilitation treatment combined with HBO for the patients with chronic disorder of consciousness, and the recordings of SSEPs and VEPs also are of a certain reference value in predicting the prognosis.