Diabetic kidney disease（DKD） is a chronic kidney structural and functional disorder caused by diabetes. With the global prevalence of diabetes continuing to rise， DKD has gradually become a major cause of chronic kidney disease and end-stage renal disease（ESRD）， posing a serious threat to patients' quality of life and long-term health outcomes. Studies have shown that apoptosis plays a pivotal role in the development and progression of DKD， with its mechanisms involving abnormal activation of multiple signaling pathways such as Toll-like receptor 4（TLR4）/nuclear transcription factor-κB（NF-κB）/B-cell lymphoma-2（Bcl-2）/cysteinyl aspartate-specific proteinase（Caspase）-3， protein kinase R-like endoplasmic reticulum kinase（PERK）/eukaryotic initiation factor 2α（eIF2α）/activating transcript factor 4（ATF4）/CCAAT enhancer-binding protein homologous protein（CHOP）， phosphatidylinositol 3-kinase（PI3K）/protein kinase B（Akt）/glycogen synthase kinase-3β（GSK-3β）， Janus kinase 2（JAK2）/signal transducer and activator of transcription 3（STAT3）， adenosine monophosphate-activated protein kinase（AMPK）/mammalian target of rapamycin（mTOR） and silent information regulator 1（SIRT1）/tumor suppressor protein 53（p53）， thereby accelerating renal pathological damage in DKD. Extensive evidence-based medical studies have confirmed that traditional Chinese medicine（TCM）， leveraging its unique therapeutic advantages of multi-target， multi-component and multi-pathway approaches， has demonstrated remarkable efficacy and favorable safety profiles in treating DKD. Recent studies have demonstrated that active components of TCM can specifically target and modulate key effectors in apoptotic signaling pathways. Meanwhile， traditional compound formulations exert synergistic effects through multiple approaches such as replenishing deficiency and activating blood circulation， detoxifying and dredging collaterals， tonifying kidney essence， and removing stasis and purging turbidity， thereby comprehensively regulating critical pathological processes including endoplasmic reticulum stress and mitochondrial apoptosis pathways. This combined therapeutic approach of molecular targeting and holistic regulation provides novel strategies for delaying the progression of DKD. Based on this， this paper provides an in-depth analysis of key apoptotic signaling pathways and their regulatory mechanisms， while systematically summarizing recent research advances regarding the therapeutic effects of TCM active components， compound formulations， and proprietary Chinese medicines on DKD through modulation of these pathways， with particular emphasis on their underlying molecular mechanisms. These findings not only elucidate the modern scientific connotation and theoretical basis of TCM in treating DKD but also establish a solid theoretical and practical foundation for promoting the wider clinical application and further research of TCM in the field of DKD treatment.

Objective:To compare the anterior long-segment fixation, posterior long-segment fixation, and combined anterior-posterior fixation in the treatment of ankylosing spondylitis with cervical fracture (ASCF).Methods:A retrospective study was conducted to analyze the 153 patients with ASCF who had been treated at Department of Orthopaedics, Peking University Third Hospital and Department of Orthopedics, Luoche Central Hospital between January 2014 and December 2023. The cohort included 86 males and 67 females, with an age of (41.6±11.5) years, a disease duration of (10.0±3.9) years, and an interval from injury to surgery of (3.3±1.4) d. By Frankel's classification for preoperative nerve injury, 57 cases were grade B, 51 grade C, and 45 grade D. Based on the surgical approaches, the patients were divided into 3 groups: an anterior group ( n=63) undergoing the anterior cervical long-segment fixation, a posterior group ( n=51) undergoing the posterior cervical long-segment fixation, and a combination group ( n=39) undergoing combined anterior-posterior cervical fixation. Surgical time, intraoperative blood loss, fracture healing, complications, and changes in Frankel grading for spinal cord injury were compared among the 3 groups. Results:There was no statistically significant difference in the preoperative general data among the 3 groups, indicating comparability ( P > 0.05). All patients were followed up for (33.5±12.0) months after surgery. In the anterior group, the surgical time [(103.0±16.8) min] was significantly shorter than that in the posterior group [(148.4±17.7) min] and that in the combination group [(228.5±23.9) min], the intraoperative blood loss [(92.8±27.8) mL] was significantly less than that in the posterior group [(477.5±109.5) mL] and that in the combination group [(769.5±136.9) mL], and the incidence of complications [9.5% (6/63)] was significantly lower than that in the posterior group [41.2% (21/51)] and that in the combination group [53.8% (21/39)] (all P<0.05). There was no statistically significant difference in the fracture healing time among the 3 groups ( P=0.111). At the last follow-up, X-ray and CT scans showed no loosening or breakage of internal fixation in all the 3 groups. The Frankel grading at the last follow-up: 12 cases of grade C, 15 cases of grade D, and 36 cases of grade E in the anterior group; 3 cases of grade B, 12 cases of grade C, 12 cases of grade D, and 24 cases of grade E in the posterior group; 6 cases of grade C, 12 cases of grade D, and 21 cases of grade E in the combination group. At the last follow-up, all patients showed a significant improvement compared to their Frankel grades before surgery ( P<0.001), but there was no statistically significant difference between the 3 groups ( H=2.238, P=0.327). Conclusions:In the treatment of ASCF, anterior long-segment fixation is advantageous over posterior long-segment fixation and combined anteri-or-posterior fixation due to its shorter surgical time, reduced intraoperative blood loss, and a lower complication incidence. All the 3 surgical approaches demonstrate comparable outcomes in terms of fracture healing time, radiographic stability, and final neurological recovery.

Objective:To establish daily quality assurance workflow based on self-developed phantom to ensure MR-linac performance such as beam accuracy, MR image guidance accuracy, and the clinical treatment workflow to enhance the efficiency of daily quality assurance (QA).Methods:The self-developed phantom was made by 3D printer and used in conjunction with Daily QA-MR detector array. After CT-sim scanning, a treatment plan was designed and transmitted to the accelerator, tests were performed such as image guidance accuracy, beam output and beam quality, the differences in daily QA results between the self-developed phantom and standard phantom recommended by the manufacturer were analyzed by using paired t-test. Results:A total of 24 sets results were collected, the image guide accuracy in the X, Y and Z directions between standard and self-made phantom were (0.1±0.4), (-0.14±0.16), (0.07±0.05) mm and (0±0.02), (-0.02±0.02), (0.02±0.01) mm, respectively, and the differences were statistically significant ( P<0.001, =0.001 and <0.001). Daily QA-MR detector array beam measurement results including output, symmetry, beam quality and field size were -0.11%±0.20%, -0.10%±0.19%, -0.01%±0.08%, (0.4±0.1) mm and (0.2±0.1) mm, respectively. The new process saved 25% (approximately 9 min) of the time compared to the standard process. Conclusions:The new daily QA process for MR-linac is performed based on self-developed phantom and Daily QA-MR detector array. The accuracy and sensitivity meet the requirements and can improve the QA efficiency.

Objective To explore the safety and efficacy of percutaneous sacroiliac screw combined with retrograde pubic ramus screws in the treatment of unstable pelvic fractures.Methods A retrospective analysis was made on clinical data of 32 cases of unstable pelvic fractures treated with percutaneous sacroiliac screws combined with retrograde pubic ramus screws from August 2021 to November 2023.The channel screws were inserted under the guidance of C-arm fluoroscopy.Results A total of 75 channel screws were inserted,including 36 sacroiliac screws and 39 retrograde pubic ramus screws.Each sacroiliac screw underwent fluoroscopy for(32.2±4.6)times,and each pubic ramus screw for(40.3±11.7)times.The operation time was(154.2±43.8)min,and the intraoperative blood loss was(30.5±8.7)ml.There were no iatrogenic vascular or nerve injuries.One case of pubic ramus screw infection occurred after surgery,and a debridement was performed to remove internal fixation.All the fractures had bone union,and the healing time was(13.2±3.7)weeks.The quality of fracture reduction(Matta criteria)was excellent in 27 cases,good in 3 cases,and fair in 2 cases,with an excellent and good rate of 93.8％(30/32).CT images showed the penetration of 73 screws at level 0,1 screw at level 1,and 1 at level 2.All the 32 cases were followed up for 6-42 months(mean,16.3±6.1 months).According to the Majeed functional scoring criteria,28 cases were excellent,3 cases were good,and 1 case was fair,with an excellent and good rate of 96.9％(31/32).Conclusion Percutaneous sacroiliac screws combined with retrograde pubic ramus screws in the treatment of unstable pelvic fractures is easy to operate and safe,and has satisfactory therapeutic effects.

Objective To explore the safety and efficacy of percutaneous sacroiliac screw combined with retrograde pubic ramus screws in the treatment of unstable pelvic fractures.Methods A retrospective analysis was made on clinical data of 32 cases of unstable pelvic fractures treated with percutaneous sacroiliac screws combined with retrograde pubic ramus screws from August 2021 to November 2023.The channel screws were inserted under the guidance of C-arm fluoroscopy.Results A total of 75 channel screws were inserted,including 36 sacroiliac screws and 39 retrograde pubic ramus screws.Each sacroiliac screw underwent fluoroscopy for(32.2±4.6)times,and each pubic ramus screw for(40.3±11.7)times.The operation time was(154.2±43.8)min,and the intraoperative blood loss was(30.5±8.7)ml.There were no iatrogenic vascular or nerve injuries.One case of pubic ramus screw infection occurred after surgery,and a debridement was performed to remove internal fixation.All the fractures had bone union,and the healing time was(13.2±3.7)weeks.The quality of fracture reduction(Matta criteria)was excellent in 27 cases,good in 3 cases,and fair in 2 cases,with an excellent and good rate of 93.8％(30/32).CT images showed the penetration of 73 screws at level 0,1 screw at level 1,and 1 at level 2.All the 32 cases were followed up for 6-42 months(mean,16.3±6.1 months).According to the Majeed functional scoring criteria,28 cases were excellent,3 cases were good,and 1 case was fair,with an excellent and good rate of 96.9％(31/32).Conclusion Percutaneous sacroiliac screws combined with retrograde pubic ramus screws in the treatment of unstable pelvic fractures is easy to operate and safe,and has satisfactory therapeutic effects.

Objective:To compare the anterior long-segment fixation, posterior long-segment fixation, and combined anterior-posterior fixation in the treatment of ankylosing spondylitis with cervical fracture (ASCF).Methods:A retrospective study was conducted to analyze the 153 patients with ASCF who had been treated at Department of Orthopaedics, Peking University Third Hospital and Department of Orthopedics, Luoche Central Hospital between January 2014 and December 2023. The cohort included 86 males and 67 females, with an age of (41.6±11.5) years, a disease duration of (10.0±3.9) years, and an interval from injury to surgery of (3.3±1.4) d. By Frankel's classification for preoperative nerve injury, 57 cases were grade B, 51 grade C, and 45 grade D. Based on the surgical approaches, the patients were divided into 3 groups: an anterior group ( n=63) undergoing the anterior cervical long-segment fixation, a posterior group ( n=51) undergoing the posterior cervical long-segment fixation, and a combination group ( n=39) undergoing combined anterior-posterior cervical fixation. Surgical time, intraoperative blood loss, fracture healing, complications, and changes in Frankel grading for spinal cord injury were compared among the 3 groups. Results:There was no statistically significant difference in the preoperative general data among the 3 groups, indicating comparability ( P > 0.05). All patients were followed up for (33.5±12.0) months after surgery. In the anterior group, the surgical time [(103.0±16.8) min] was significantly shorter than that in the posterior group [(148.4±17.7) min] and that in the combination group [(228.5±23.9) min], the intraoperative blood loss [(92.8±27.8) mL] was significantly less than that in the posterior group [(477.5±109.5) mL] and that in the combination group [(769.5±136.9) mL], and the incidence of complications [9.5% (6/63)] was significantly lower than that in the posterior group [41.2% (21/51)] and that in the combination group [53.8% (21/39)] (all P<0.05). There was no statistically significant difference in the fracture healing time among the 3 groups ( P=0.111). At the last follow-up, X-ray and CT scans showed no loosening or breakage of internal fixation in all the 3 groups. The Frankel grading at the last follow-up: 12 cases of grade C, 15 cases of grade D, and 36 cases of grade E in the anterior group; 3 cases of grade B, 12 cases of grade C, 12 cases of grade D, and 24 cases of grade E in the posterior group; 6 cases of grade C, 12 cases of grade D, and 21 cases of grade E in the combination group. At the last follow-up, all patients showed a significant improvement compared to their Frankel grades before surgery ( P<0.001), but there was no statistically significant difference between the 3 groups ( H=2.238, P=0.327). Conclusions:In the treatment of ASCF, anterior long-segment fixation is advantageous over posterior long-segment fixation and combined anteri-or-posterior fixation due to its shorter surgical time, reduced intraoperative blood loss, and a lower complication incidence. All the 3 surgical approaches demonstrate comparable outcomes in terms of fracture healing time, radiographic stability, and final neurological recovery.

Objective:To establish daily quality assurance workflow based on self-developed phantom to ensure MR-linac performance such as beam accuracy, MR image guidance accuracy, and the clinical treatment workflow to enhance the efficiency of daily quality assurance (QA).Methods:The self-developed phantom was made by 3D printer and used in conjunction with Daily QA-MR detector array. After CT-sim scanning, a treatment plan was designed and transmitted to the accelerator, tests were performed such as image guidance accuracy, beam output and beam quality, the differences in daily QA results between the self-developed phantom and standard phantom recommended by the manufacturer were analyzed by using paired t-test. Results:A total of 24 sets results were collected, the image guide accuracy in the X, Y and Z directions between standard and self-made phantom were (0.1±0.4), (-0.14±0.16), (0.07±0.05) mm and (0±0.02), (-0.02±0.02), (0.02±0.01) mm, respectively, and the differences were statistically significant ( P<0.001, =0.001 and <0.001). Daily QA-MR detector array beam measurement results including output, symmetry, beam quality and field size were -0.11%±0.20%, -0.10%±0.19%, -0.01%±0.08%, (0.4±0.1) mm and (0.2±0.1) mm, respectively. The new process saved 25% (approximately 9 min) of the time compared to the standard process. Conclusions:The new daily QA process for MR-linac is performed based on self-developed phantom and Daily QA-MR detector array. The accuracy and sensitivity meet the requirements and can improve the QA efficiency.

Objective:To assess the effectiveness of a 6-month Ba Duan Jin exercise program in improving the balance of community-dwelling older adults.Methods:A two arms, parallel-group, cluster randomized controlled trial was conducted in 1 028 community residents aged 60-80 years in 40 communities in 5 provinces of China. Participants in the intervention group (20 communities, 523 people) received Ba Duan Jin exercise 5 days/week, 1 hour/day for 6 months, and three times of falls prevention health education, and the control group (20 communities, 505 people) received falls prevention health education same as the intervention group. The Berg balance scale (BBS) score was the leading outcome indicator, and the secondary outcome indicators included the length of time of standing on one foot (with eyes open and closed), standing in a tandem stance (with eyes open and closed), the closed circle test, and the timed up to test.Results:A total of 1 028 participants were included in the final analysis, including 731 women (71.11%) and 297 men (28.89%), and the age was (69.87±5.67) years. After the 3-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 3.05 (95% CI: 2.23-3.88) points ( P<0.001). After the 6-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 4.70 (95% CI: 4.03-5.37) points ( P<0.001). Ba Duan Jin showed significant improvement ( P<0.05) in all secondary outcomes after 6 months of exercise in the intervention group compared with the control group. Conclusions:This study showed that Ba Duan Jin exercise can improve balance in community-dwelling older adults aged 60-80. The longer the exercise time, the better the improvement.

Objective:The objective of this study is to sequence whole genome of the rabies virus in the saliva specimen of a suspected rabies case with onset of rabies from a wildlife (hog badger) bite wound in Sichuan province, where the genetic variation characteristics of the virus was analyzed at the molecular level, so as to understand the prevalence and mutation of wildlife rabies virus in Sichuan province.Methods:Total viral RNA was extracted from the saliva specimen of the suspected rabies case. Then, rabies virus sequences were amplified using PCR with specific primers; the gene fragments obtained were sequenced, and the sequences obtained were spliced using biological software to obtain the whole genome sequence of the rabies virus strain. The genetic variation characteristics of the whole genome were analyzed.Results:The whole genome nucleotide sequence of a strain of rabies virus of hog badger origin (hereinafter referred to as SCR23-052) was obtained by sequencing, and NCBI online BLAST and comparison with several reference sequences showed that the composition and structure of the whole genome sequence of SCR23-052 conformed to the characteristics of the Lyssavirus under the Rhabdoviridae; the highest similarity in nucleotide and amino acid sequences in various gene regions was observed between SCR23-052 and the strains of Ningxia (J) and Chongqing (CQ92, 02050CHI). The sequence variability of SCR23-052 genome was significantly lower at the amino acid level than that at the nucleotide level, which indicated that most of the nucleotide variants in the protein-coding genes belonged to synonymous mutations. Phylogenetic analysis showed that SCR23-052 belonged to genotype V, which did not show any obvious mutation in the major antigenic site of the glycoprotein, underwent amino acid glycosylation at positions 56 and 338 by the online site prediction, and showed the least amino acid difference compared with the signal peptide sequence of the vaccine strain CTN181. The virus in this study has an A→T mutation at position 332 in the nucleoprotein major antigenic site with all reference vaccine strains, and an L→V mutation at position 379 in the B-cell epitope with the CTN181 vaccine strain. SCR23-052 was consistent with both genotype V reference strains at the nucleoprotein study site.Conclusions:The whole genome sequence of a wildlife strain of genotype V rabies virus of hog badger origin was obtained, which was different from that of the genotype I strain of rabies virus of dog origin that previously reported to be prevalent in Sichuan. The genome sequence of SCR23-052 differed from that of the reference vaccine strains to a varying degree, but the main virulence characteristics remained unaltered.

Objective:To evaluate the safety and efficacy of percutaneous transhepatic papillary balloon dilation (PTPBD) combined with flexible ureteroscopy-guided dual-frequency double-pulse ND:YAG (FREDDY) laser lithotripsy (PTPBD-FREDDY) for the treatment of giant (>1.5 cm diameter) common bile duct stones.Methods:A retrospective analysis was conducted on 26 patients with large-diameter difficult choledocholithiasis admitted to two medical centers from December 2017 to October 2021. Among these patients, four could not tolerate surgery or endoscopic treatment, six experienced failure of endoscopic treatment, and 16 refused to undergo endoscopic or surgical treatment. All patients underwent the PTPBD-FREDDY procedure. The FREDDY laser lithotripsy was performed under ureteroscopic guidance, followed by a balloon to push the stones into the duodenum. The primary endpoint was the technical success rate, and the secondary endpoints included the rate of stone recurrence and related complications.Results:All 26 patients successfully completed the operation, achieving a technical success rate of 100%. The average lithotripsy frequency and operation time for bilirubin stones were significantly higher than those of mixed stones and cholesterol stones ( P<0.01). The main postoperative complications included mild fever ( n=3), abdominal pain ( n=3), nausea ( n=2) and vomiting ( n=1). One patient experienced biliary tract bleeding, which improved after conservative treatment. No serious complications such as pancreatitis, sepsis, or biliary perforation were observed. After 2 years of follow-up, no cases of stone recurrence were observed. Conclusions:PTPBD-FREDDY is a safe and effective treatment for patients with giant common bile duct stones. It provides a new therapeutic option for patients with giant choledocholithiasis who can not tolerate surgery or have failed endoscopic treatment, demonstrating promising prospects.