Objective:To investigate the effect of nourishing yin and tonifying yang method on inflammatory response and bone metabolism in patients with T2DM complicated with osteoporosis (OP).Methods:A randomized controlled trial. From January 2022 to December 2023,80 patients with T2DM and OP in our hospital were selected as the observation objects, and they were divided into two groups by random number table method, with 40 cases in each group.On the basis of conventional treatment, the control group chewed vitamin D calcium chewable tablets, and the observation group added nourishing yin and tonifying yang Chinese medicine.Both groups were treated for 6 months. TCM syndrome scores were performed before and after treatment ;the levels of fasting blood glucose (FPG), 2 hPG and HbA1c were detected by intelligent blood glucose monitor;the levels of serum neutrophils and lymphocytes were detected by automatic blood analyzer, and the neutrophil/lymphocyte ratio (NLR) was calculated;the levels of serum IL-1β and TNF-α were detected by automatic chemiluminescence analyzer, the levels of type I procollagen amino terminal propeptide (PINP), type I collagen carboxy terminal peptide β special sequence (β-CTX) and 25-hydroxy vitamin D3 [25-(OH)D3] were detected by ELISA;Bone mineral density (BMD) was detected by bone mineral density detector. The adverse reactions during treatment were observed and recorded, and the clinical efficacy was evaluated.Results:The total effective rate was 92.5 %(37/40) in the observation group and 75.0 % (30/40) in the control group,the difference between the two groups was statistically significant ( χ2=4.50, P=0.034).After treatment, the scores of soreness and weakness of waist and knees, soreness and pain of waist and back, clear and long urine, pale tongue and white coating in the observation group were lower than those in the control group ( t=3.11, 3.75, 3.51, 3.74, P<0.01);the levels of serum FPG, 2 hPG and HbA1c in the observation group were lower than those in the control group ( t=3.11,3.20,3.39, P<0.01).The levels of serum NLR (2.63 ± 0.68 vs. 3.24 ± 0.79, t=3.70), IL-1β [(81.65 ± 8.30) ng/L vs. (89.03 ± 8.98) ng/L, t=3.82] and TNF-α [(35.14 ± 5.11) μg/L vs. (39.96 ± 5.38) μg/L, t=4.11] in the observation group were lower than those in the control group ( P<0.01). After treatment, the levels of PINP [(29.83 ± 3.92) ng/L vs. (34.02 ± 4.03) ng/L, t=4.71] and β-CTX [(21.30 ± 3.95 ) ng/L vs. (25.32 ± 4.18) ng/L, t=4.42] in the observation group were lower than those in the control group ( P<0.01), the levels of 25-(OH)D3 [(42.86 ± 5.12) μg/L vs. (38.08 ± 4.55) μg/L, t=4.41] and BMD [(0.90 ± 0.18) g/cm 3vs. (0.78 ± 0.16) g/cm 3, t=3.15] were higher than those in the control group ( P<0.01).During the treatment, the incidence of adverse reactions was 12.5% (5/40) in the observation group and 10.0 % (4/40) in the control group,there was no significant difference between the two groups ( χ2=0.13, P=0.723). Conclusion:The method of nourishing yin and tonifying yang can effectively improve the TCM syndromes of T2DM patients with OP, reduce the levels of blood glucose and inflammatory factors, improve bone metabolism, improve clinical efficacy and have good treatment safety.

Malignant peritoneal mesothelioma (MPM), as a highly aggressive primary malignant tumor of the peritoneum, often leads to structural damage and functional impairment of female reproductive organs during its treatment course. This study presents a clinical case of an MPM patient who underwent cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC), subsequently achieving successful live birth through in vitro fertilization and embryo transfer. A comprehensive review of relevant literature was conducted to analyze both the potential benefits and associated risks. While the possibility of successful pregnancy exists for MPM patients following combined CRS and HIPEC treatment, significant clinical risks during the gestational process cannot be overlooked. Current evidence remains limited, necessitating more robust clinical data to substantiate these findings.

Malignant peritoneal mesothelioma (MPM), as a highly aggressive primary malignant tumor of the peritoneum, often leads to structural damage and functional impairment of female reproductive organs during its treatment course. This study presents a clinical case of an MPM patient who underwent cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC), subsequently achieving successful live birth through in vitro fertilization and embryo transfer. A comprehensive review of relevant literature was conducted to analyze both the potential benefits and associated risks. While the possibility of successful pregnancy exists for MPM patients following combined CRS and HIPEC treatment, significant clinical risks during the gestational process cannot be overlooked. Current evidence remains limited, necessitating more robust clinical data to substantiate these findings.

Objective:To investigate the effects of fluoride exposure on kidney injury in rats and the sirtuin 3 (SIRT3)-fork head protein O3a (FOXO3a)-tensin homolog induced putative kinase 1 (PINK1)/E3 ubiquitin ligase (PARKIN) pathway.Methods:Twenty-four 4-week-old SD rats (clean grade, body mass 100 - 150 g) were selected and divided into three groups according to the randomized numeric table: control group, low fluoride group, and high fluoride group, with eight rats in each group (half male and half female). The control group was given free access to tap water (fluoride ion concentration < 0.5 mg/L), while the low fluoride and high fluoride groups were given free access to tap water and sodium fluoride solutions with fluoride ion concentrations of 5.0 and 50.0 mg/L, respectively, for a period of 180 days. The formation of dental fluorosis in rats was observed and recorded, and the femur, urine and blood samples of rats were collected to measure bone fluoride, urinary fluoride, and blood fluoride levels, and to detect kidney function related indicators (serum uric acid, creatinine, and urea nitrogen contents). Morphological changes of renal tissues stained with hematoxylin-eosin (HE) were observed under a light microscope. Real-time fluorescence quantitative PCR (qRT-PCR) and Western blotting were used to detect the mRNA and protein expression levels of renal SIRT3, FOXO3a, PINK1, PARKIN, microtubule associated protein 1 light chain 3 (LC3), autophagy receptor protein (P62), respectively.Results:Seven and one rats in the low and high fluoride groups were found to haveⅠdegree dental fluorosis, while zero and seven rats were found to haveⅡdegree dental fluorosis. Compared with the control group, rats in the low and high fluoride groups had higher levels of bone fluoride (μg/g: 1.18 ± 0.06, 2.16 ± 0.07 vs 0.52 ± 0.05), urinary fluoride (mg/L: 4.43 ± 0.11, 7.46 ± 0.09 vs 2.58 ± 0.14), blood fluoride (μg/ml: 0.77 ± 0.06, 1.68 ± 0.10 vs 0.52 ± 0.08), serum uric acid (μg/ml: 61.01 ± 4.17, 103.92 ± 5.43 vs 28.68 ± 2.91), creatinine (μg/ml: 74.82 ± 9.61, 132.05 ± 5.35 vs 22.38 ± 4.11), and urea nitrogen (μg/ml: 13.36 ± 1.27, 14.55 ± 0.34 vs 0.29 ± 0.07, P < 0.05). Under the light microscope, the kidneys of the control group showed tight and orderly arrangement of renal tubules and glomerular cells, with complete and clear cell contours. The low fluoride group was similar to the control group and no significant abnormalities were observed. The high fluoride group showed abnormal glomerular structure and atrophy, with some areas of renal tubules showing epithelial cell edema and unclear intercellular boundaries. The results of qRT-PCR assay showed that compared with the control group, the low and high fluoride groups had lower mRNA expression levels of SIRT3 (0.82 ± 0.03, 0.58 ± 0.02 vs 1.00 ± 0.08), P62 (0.75 ± 0.07, 0.28 ± 0.09 vs 1.00 ± 0.07, P < 0.05), and higher mRNA expression levels of FOXO3a (1.35 ± 0.04, 3.01 ± 0.23 vs 1.00 ± 0.08), PINK1 (1.58 ± 0.09, 3.28 ± 0.09 vs 1.00 ± 0.07), PARKIN (1.51 ± 0.04, 1.67 ± 0.10 vs 1.00 ± 0.05), LC3 (1.74 ± 0.07, 2.38 ± 0.18 vs 1.00 ± 0.08, P < 0.05). The results of Western blotting showed that compared with the control group, the low and high fluoride groups had lower protein expression levels of SIRT3 (0.91 ± 0.01, 0.55 ± 0.03 vs 1.00 ± 0.01), P62 (0.94 ± 0.27, 0.66 ± 0.38 vs 1.00 ± 0.19, P < 0.05), and higher protein expression levels of FOXO3a (1.14 ± 0.03, 1.22 ± 0.05 vs 1.00 ± 0.02), PINK1 (1.46 ± 0.03, 1.56 ± 0.03 vs 1.00 ± 0.05), PARKIN (1.98 ± 0.02, 2.33 ± 0.11 vs 1.00 ± 0.06), LC3 (4.10 ± 0.58, 4.93 ± 0.33 vs 1.00 ± 0.13, P < 0.05). Conclusion:Exposure to fluoride can cause renal tissue injury in rats, with downregulation of SIRT3 and P62 expression levels, and upregulation of FOXO3a, PINK1, PARKIN, and LC3 expression levels.

Concurrent chemoradiotherapy (CCRT) refers to the simultaneous treatment of chemotherapy and radiotherapy, and the effect of radiotherapy is enhanced with low-dose chemotherapy, which can reduce tumor recurrence and metastasis and improve clinical prognosis of patients. At present, the main factors for the increase of radiosensitivity of concurrent chemotherapy is that concurrent chemotherapy prevents the repair of tumor cells, and chemotherapy and radiotherapy act on different cell cycles and have synergistic effects. However, even for patients with locally advanced cervical cancer (LACC) who have undergone CCRT, the 5-year survival rate is only 60%, which is still not ideal. In order to improve the efficacy, researchers have conducted a series of exploratory studies, which consist of the combination of targeted drugs and immunodrugs, and neoadjuvant regimens before CCRT, etc. Although targeted or immunologic drugs are effective treatment of LACC, in view of the lack of large-scale evidence-based medical evidence, multi-center prospective and randomized phase III clinical trials and high-level articles are needed to improve the level of evidence-based medicine. This consensus summarizes several key evidence-based medical studies published recently, especially the clinical research progress in targeted and immunological therapies, providing reference for domestic peers.

Objective:To analyze the clinical characteristics and prognosis of patients with primary aldosteronism (PA) associated with subclinical Cushing syndrome (SCS).Methods:This retrospective cohort study was conducted at the First Affiliated Hospital of Chongqing Medical University in China. Patients with PA were included between January 2014 and December 2022. According to the results of 1-mg overnight dexamethasone suppression test, the patients were divided into the PA group and PA associated with SCS (PA/SCS) group. The demographic information, hormone levels, and follow-up results were analyzed. Independent sample t-test, chi-square test and Mann-Whitney U test were used for data comparison. Results:A total of 489 PA patients were enrolled in this study, of which 109 had PA/SCS (22.3%). Patients with SCS were on average older (54.4±10.7 vs . 47.4±11.0, P<0.001); had a larger proportion of women (69.7%, 76/109 vs . 57.4%, 218/380; P=0.020); and a longer duration of hypertension [96 (36, 180) vs . 60 (12, 120) months, P=0.001] than patients without SCS. There were 215 and 51 patients in the PA group and PA/SCS group, who completed adrenalectomy and follow-up, respectively. The remission rate of autonomous cortisol secretion in the PA/SCS group was 85.3% (29/34). There was no significant difference in the remission rate of autonomous aldosterone secretion among patients between the PA/SCS and PA group (94.1%, 48/51 vs. 94.4%, 203/215; P=1.000), while the clinical remission rate in the PA/SCS group was lower than that in the PA group (39.2%, 20/51 vs. 61.9%, 133/215; P=0.003). Conclusions:SCS is common in PA patients (22.3%), and the clinical remission rate is low. Screening using the 1-mg overnight dexamethasone suppression test is recommended for all patients with PA.

Objective: To learn the toxicity of Dendrobium officinale flowers to pregnant rats ( P, F1 ) and offspring rats ( F1, F2 ) before birth, so as to provide toxicological evidence for the safety assessment. Methods : The rats were divided into four groups with 20 female rats and 10 male each. The rats in three dose groups were fed with Dendrobium officinale flowers at the dose of 2.0, 4.0, 6.4g/kgbw. After two generation, the F1a and F2a rats were fed with basal diet; F1b and F2b rats were fed with Dendrobium officinale flowers. The body weights and total weight gains during the gestation, the conception rates, the pregnancy rates, the birth weights and survival rates of offspring rats were examined. Results: There were no statistically significant differences in the body weights and total weight gains during the gestation, the conception rates, and the pregnancy rates in pregnant rats ( P, F1 ) among the four groups ( P>0.05 ). There were also no statistically significant differences in the survival rates and live birth rates in offspring rats (F1, F2) between the dose groups and the control group ( P>0.05 ). Conclusions Dendrobium officinale flowers did not show obviously adverse effects on pregnant rats ( P, F1 ) and offspring rats ( F1, F2 ) before birth.

Objective:To evaluate the clinical efficacy and safety of fractional CO 2 laser for the treatment of vaginal relaxation syndrome. Methods:Twenty-one females with vaginal relaxation syndrome receiced between December 2016 and January 2017 in our department were treated for 3 times at 1 month interval with femilift fractional CO 2 laser. Vaginal palpation, vaginal squeeze pressure test, vaginal ultrasound, pelvic floor MRI, and Incontinence Questionnaire Short-Form (ICIQ-SF) assessments were performed at baseline and at post-treatment. Results:Significant improvement in female sexual dysfunction and stress urinary incontinence was especially seen based on patient＇s feelings after treatments. A noted progressive differences were observed in FSFI and vaginal pressure test, which were much higher after treatment than before treatment ( P<0.01). Moreover, in 13 cases suffering from mild to moderate stress urinary incontinence (SUI), fractional CO 2 laser treatment was associated with a significant improvement of ICIQ-SF scores ( P<0.01). All subjects successfully completed the study with no adverse events such as infections, bleeding and pain, etc. Conclusions:Fractional CO 2 laser treatment is an effective treatment for female sexual dysfunction and stress urinary incontinence caused by vaginal relaxation syndrome.

Objective: To learn the effects of Dendrobium officinale flowers on testivular tissue morphology and sperm quality in parent and offspring rats,so as to provide reference for safety evaluation of Dendrobium officinale flowers. Methods: The 40 SD rats was randomly divided into the low-,middle-,high-dose and the control group,given 2.0,4.0,6.4 and 0 g/kgbw Dendrobium officinale flowers,respectively. After three months,the body weight,mass and organ/body coefficients of testis and epididymis of parent （P） and offspring （F1,F2） rats were measured;the number,activity and deformity of sperms were observed under microscope;the changes of testis and epididymis were observed by hematoxylin eosin staining. Results: There were no significantly statistical differences in the body weight,mass and organ/body coefficients of testis and epididymis,sperm quantity,sperm motility rate among four groups of P、F1、F2 male rats （P>0.05）. There were no significantly statistical differences in sperm malformation rate between the high-dose group and the control group （P>0.05）. There was no significant change in testis and epididymis of P,F1 and F2 male rats. Conclusion Dendrobium officinale flowers did not show obviously adverse effects on testivular tissue morphology and sperm quality in parent and offsping rats.

OBJECTIVE： To provide reference for the clinical use and dosage form development of Strychnos nuxvomica. METHODS： The prescriptions containing S. nuxvomica were collected and sorted from the Dictionary of Traditional Chinese Medicine Prescription， and then formula name， prescription source， name of treatment disease， composition， usage and dosage， medication route were input into Access 2010 and database was established. According to the usage， these prescriptions were divided into internal use and external use， and the frequencies of diseases treated by internal/external use prescriptions were counted respectively. Apriori algorithm of SPSS Modeler 18.0 software was used to analyze the drug combination rule of compound prescription containing S. nuxvomica. RESULTS： A total of 78 prescriptions were included， of which 42 were oral prescriptions， 33 were external prescriptions and 3 were both oral and external prescriptions. Internal prescriptions were used to treat diseases such as atrophy-flaccidity disease， arthralgia， hemorrhoids， anal fistula， bones and muscles pain. The external prescriptions were mainly used to treat skin diseases， tumors， lump. Internal and external prescriptions could treat sore， injuries and fractures. In internal prescriptions， S. nuxvomica was often compatible with Boswellia carterii， myrrha， Daemonorops draco， Manis pentadactyla， pyritum， Angelica sinensis， Ephedra sinica， Aconitum kusnezoffii. In external prescriptions， S. nuxvomica was often compatible with Radix Paeoniae， Rehmannia glutinosa， Phellodendron chinense， Coptis chinensis， Scutellaria baicalensis， Angelica sinensis， Angelica dahurica， Buthus martensii. Most of S. nuxvomica were used after processing， and mainly took sesame oil as an auxiliary material （77.97％）. CONCLUSIONS： Diseases treated with the prescriptions containing S. nuxvomica can be classified into three types of diseases， i.e. polymyalgia rheumatica and paralysis， bruise and bone fracture， carbuncle and stubbornness tinea. In external prescriptions， S. nuxvomica is often compatible with drug for clearing heat and drying dampness， cooling blood and activating blood， and relieving pain. In internal prescriptions， S. nuxvomica is often compatible with the agents for blood-activating and stasis-resolving medicinal. In addition， the processing of S. nuxvomica with sesame oil is an important measure to ensure its safety.