Objective: To investigate the efficacy, safety, and traditional Chinese medicine (TCM) medication patterns of rituximab (RTX) combined with TCM on treating children with steroid-dependent nephrotic syndrome (SDNS). Methods: One hundred and forty-three children with SDNS who visited the Pediatric Nephrology Department of the First Affiliated Hospital of Henan University of Chinese Medicine from January 2018 to December 2022 were enrolled. A cohort study design was adopted, with " RTX treatment" as the exposure factor. Children who met this exposure factor were assigned to the RTX cohort (RTX, glucocorticoid, immunosuppressive agent, combined with traditional Chinese medicine syndrome differentiation treatment), whereas those who did not were assigned to the basic treatment cohort (glucocorticoid, immunosuppressive agent, combined with traditional Chinese medicine syndrome differentiation treatment ), and followed up for 6 months. The frequency of urinary protein recurrences, urinary protein remission duration, proportion and duration of steroid reduction and cessation, cumulative usage of steroids, proportion of recurrence, recurrence amount of steroid used, efficacy of TCM syndrome, and laboratory and safety indicators after treatment, and height and CD19+ B cell count before and after treatment were compared between the two cohorts. The medication patterns of TCM in the two cohorts were analyzed using frequency statistics, association rule analysis, and systematic clustering analysis. Results: Compared with the basic treatment cohort, the RTX cohort showed a decrease in the frequency of urinary protein recurrence, extended sustained remission of urinary protein, an increase in the proportion of steroid reduction and cessation, a shorter duration of steroid reduction and cessation, a decrease in cumulative steroid dosage, a lower recurrence rate, a decrease in CD19+ B cell count, and a decrease in 24-h urinary total protein quantification and the level of cholesterol (P<0.05). No significant difference in the recurrence amount of steroid used, height, TCM syndrome efficacy, albumin, aspartate transaminase, blood urea nitrogen, platelet count, and safety indicators between the two cohorts. Children with SDNS were mostly characterized by qi and yin deficiency syndrome, followed by spleen and kidney yang deficiency syndrome. A total of 175 TCMs were included, including 28 high-frequency drugs such as Huangqi, Fuling, Gancao, Baizhu, Dangshen, and Jiuyurou. The primary use of medication is to nourish the qi and spleen, nourish the kidney, and warm yang. The analysis of association rules yielded eight binary associations and ten three-phase associations, with Huangqi, Baizhu, Fuling, and Dangshen, being the most closely related. Cluster analysis identified four TCM combinations, primarily focusing on tonifying kidney and replenishing essence, benefiting qi and nourishing yin, and removing blood stasis. Conclusion RTX combined with TCM syndrome differentiation treatment can reduce the recurrence frequency of SDNS, prolong the remission period, reduce the glucocorticoid dosage, and have no marked effect on height growth. No apparent adverse reactions were observed. TCM should focus on nourishing qi and yin while removing blood stasis.

ObjectiveTo explore the clinical effectivess of Nuangong Tiaojing Decoction （暖宫调经汤） combined with ginger moxibustion at Baliao acupoints （Eight Bone-Holes） for treating premature ovarian failure （POF） of yang-deficiency uterus-coldeness syndrome， based on conventional western medical treatment. MethodsA total of 130 patients diagnosed with POF of yang-deficiency uterus-coldeness syndrome were divided into a treatment group and a control group， with 65 cases in each group， based on patient preference. The control group received conventional western medicine treatment， while the treatment group was additionally given Nuangong Tiaojing Decoction orally one dose per day and underwent ginger moxibustion at Baliao points once daily. Both groups were treated for three months. Before and after treatment， ovarian function indicators， including ovarian volume， follicle count， ovarian peak systolic velocity （PSV）， and endometrial thickness were assessed， and serum sex hormone levels including progesterone （P）， estradiol （E₂）， follicle-stimulating hormone （FSH）， luteinizing hormone （LH）， prolactin （PRL）， and testosterone （T）， as well as anti-Müllerian hormone （AMH） levels were also measured. Additionally， traditional Chinese medicine （TCM） syndrome scores were evaluated， covering symptoms such as reduced libido， lumbosacral pain， fear of cold with cold extremities， fatigue， dull complexion， lower abdominal distension and pain， pale tongue， and deep and rough pulse. After treatment， clinical effectiveness and safety were determined. ResultsCompared with the pre-treatment levels within group， both groups showed significant increases in ovarian volume， follicle count， PSV， endometrial thickness， and levels of P， E₂， and AMH after treatment， while the levels of FSH， LH， PRL， and T， as well as scores of lumbosacral pain， reduced libido， dull complexion， deep and rough pulse， and total TCM syndrome scores significantly reduced after treatment. Furthermore， the treatment group exhibited higher ovarian volume， follicle count， PSV， endometrial thickness， and levels of P， E₂， and AMH compared to the control group， while FSH， LH， PRL， T levels， and all symptom scores， as well as total TCM syndrome scores， were significantly lower in the treatment group than in the control group （P＜0.05 or P＜0.01）. The clinical effectiveness in treatment group was 96.92% （63/65）， significantly higher than 81.54% （53/65） in control group （P＜0.05）. The incidence of adverse reactions in the treatment group was 26.15% （17/65）， while in the control group it was 32.31% （21/65）， with no statistically significant difference （P＞0.05）. ConclusionOn the basis of conventional western medicine treament， Nuangong Tiaojing Decoction combined with ginger moxibustion at Baliao acupoints for patients with POF of yang-deficiency uterus-coldeness syndrome can significantly improve ovarian function and clinical symptoms， regulate hormone levels， and thereby enhance clinical effectiveness.

ObjectiveTo analyze the clinical treatment plan and traditional Chinese medicine （TCM） medication rule of children with primary nephrotic syndrome （PNS） in the First Affiliated Hospital of Henan University of Chinese Medicine. MethodsThe gender and age of children firstly diagnosed with nephrotic syndrome in the pediatric nephrology department of the First Affiliated Hospital of Henan University of Chinese Medicine from November 2019 to December 2022 were collected， and the use of immunosuppressive agents and related frequencies were counted. According to the inclusion and exclusion criteria， an independent TCM prescription database for children with nephrotic syndrome was established. Excel was used to analyze the relevant information of the literature. The frequency counting， association rule analysis， and cluster analysis were carried out on TCM in the prescription， and the high-frequent drugs were analyzed. Results（1） General information： A total of 711 children were included， consisting of 522 males （73.42%） and 189 females （26.58%）. The ratio of male to female was about 2.76∶1. The disease mainly occurred in infants and preschool age， and the average age of onset was （4.74 ± 3.48） years old. （2） Clinical treatment plan and use of immunosuppressive agents： Of the 711 children with PNS， 237 were treated with hormone alone （32.33%）， and 474 （66.67%） received immunosuppressive agents combined with hormones. In the initial treatment， hormone combined with Tacrolimus （TAC） was the preferred treatment （32.91%）. For children with refractory PNS who exhibited poor clinical efficacy， Rituximab （RTX） was mostly used for treatment， with a ratio of up to 23.63%. （3） TCM syndrome and medication rule： In PNS syndrome differentiation， Qi and Yin deficiency was identified as the main syndrome. This involved a total of 477 cases， accounting for 67.09%. Yang deficiency of spleen and kidney was observed in 118 cases， accounting for 16.60%. A total of 711 children were included， of which 706 children were treated with TCM. This involved a total of 706 prescriptions， 226 TCM， and 9 793 frequencies. There were 30 herbs used more than 95 times. The top five TCM were Radix et Rhizoma Glycyrrhizae （81.16%）， Radix Astragali （71.81%）， Poria （68.84%）， Rhizoma Atractylodis Macrocephalae （63.60%）， and Fructus Corni （57.37%）. The drug association rules and network diagram showed that the combination of ''Radix Astragali-Rhizoma Atractylodis Macrocephalae-Poria'' was the closest， and five types of combinations were obtained by cluster analysis. ConclusionIn the diagnosis and treatment of PNS in children， TAC combined with hormones shows good clinical efficacy and high safety. For children with refractory PNS， RTX combined with hormones can be used. TCM medication for PNS should follow the basic principles of strengthening the body and vital Qi and make good use of drugs such as Radix Astragali， Poria， Rhizoma Atractylodis Macrocephalae， and cornus to regulate the Yin and Yang balance and achieve better clinical efficacy.

ObjectiveTo analyze the clinical treatment plan and traditional Chinese medicine （TCM） medication rule of children with primary nephrotic syndrome （PNS） in the First Affiliated Hospital of Henan University of Chinese Medicine. MethodsThe gender and age of children firstly diagnosed with nephrotic syndrome in the pediatric nephrology department of the First Affiliated Hospital of Henan University of Chinese Medicine from November 2019 to December 2022 were collected， and the use of immunosuppressive agents and related frequencies were counted. According to the inclusion and exclusion criteria， an independent TCM prescription database for children with nephrotic syndrome was established. Excel was used to analyze the relevant information of the literature. The frequency counting， association rule analysis， and cluster analysis were carried out on TCM in the prescription， and the high-frequent drugs were analyzed. Results（1） General information： A total of 711 children were included， consisting of 522 males （73.42%） and 189 females （26.58%）. The ratio of male to female was about 2.76∶1. The disease mainly occurred in infants and preschool age， and the average age of onset was （4.74 ± 3.48） years old. （2） Clinical treatment plan and use of immunosuppressive agents： Of the 711 children with PNS， 237 were treated with hormone alone （32.33%）， and 474 （66.67%） received immunosuppressive agents combined with hormones. In the initial treatment， hormone combined with Tacrolimus （TAC） was the preferred treatment （32.91%）. For children with refractory PNS who exhibited poor clinical efficacy， Rituximab （RTX） was mostly used for treatment， with a ratio of up to 23.63%. （3） TCM syndrome and medication rule： In PNS syndrome differentiation， Qi and Yin deficiency was identified as the main syndrome. This involved a total of 477 cases， accounting for 67.09%. Yang deficiency of spleen and kidney was observed in 118 cases， accounting for 16.60%. A total of 711 children were included， of which 706 children were treated with TCM. This involved a total of 706 prescriptions， 226 TCM， and 9 793 frequencies. There were 30 herbs used more than 95 times. The top five TCM were Radix et Rhizoma Glycyrrhizae （81.16%）， Radix Astragali （71.81%）， Poria （68.84%）， Rhizoma Atractylodis Macrocephalae （63.60%）， and Fructus Corni （57.37%）. The drug association rules and network diagram showed that the combination of ''Radix Astragali-Rhizoma Atractylodis Macrocephalae-Poria'' was the closest， and five types of combinations were obtained by cluster analysis. ConclusionIn the diagnosis and treatment of PNS in children， TAC combined with hormones shows good clinical efficacy and high safety. For children with refractory PNS， RTX combined with hormones can be used. TCM medication for PNS should follow the basic principles of strengthening the body and vital Qi and make good use of drugs such as Radix Astragali， Poria， Rhizoma Atractylodis Macrocephalae， and cornus to regulate the Yin and Yang balance and achieve better clinical efficacy.

Objective To evaluate the overall implementation of the WS 76-2020 standard in Anhui Province, China and identify and analyze the factors affecting the implementation of the standard, and to provide a basis for the effective implementation and revision of WS 76-2020. Methods According to the requirements of the Notice of the Department of Regulations in National Health Commission on the 2024 assessment of implementation of mandatory standards, an evaluation of radiological health standards was organized and conducted in Anhui Province. The evaluation involved the three dimensions of standard implementation status, technical content of the standards, and effectiveness of standard implementation, with subsequent data analysis. Results The total evaluation score for WS 76-2020 was 87.83 points, indicating that the standard effectively guided the quality control testing of medical X-ray diagnostic equipment. However, stability testing was either underutilized or not performed in practice. The qualified rate of X-ray diagnostic equipment in the province was 94.26%, with equipment performance issues identified as the leading contributor to non-qualified instances. Expert discussions highlighted recommendations particularly concerning the operability, applicability, and scientific rigor of the standard. Conclusion It is recommended to strengthen the dissemination and training for the standard, promote medical institutions to voluntarily conduct stability testing, provide supplementary clarifications or revisions for problematic clauses, and standardize quality control testing techniques for radiological diagnostic equipment.

Objective: To describe the association of different sleep characteristics and cardiometabolic risk among college students, so as to provide reference for health promotion of college students. Methods: By random cluster sampling method, a questionnaire survey and physical examination including blood pressure, waist circumference and blood lipid indicators, which were conducted in April and May of 2019 among a total of 1 179 college students from the first grade in two universities in Hefei City of Anhui Province and Shangrao City of Jiangxi Province. A total of 729 college students with valid questionnaires were included into analysis. The Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) were used to investigate sleep behavior, and the Morning And Evening Questionnaire-5 (MEQ-5) was used to investigate sleep characteristics. The cardiometabolic risk score was derived using the sum of the standardized sex specific Z scores of waist circumference, mean arterial pressure, HDL cholesterol (multiplied by -1), triglycerides, and insulin resistance index. The rank sum tests were used to compare differences in cardiometabolic risk scores across demographic characteristics. Generalized linear models were used to compare the association of different sleep characteristics with cardiometabolic risk scores among college students. Results: The average cardiovascular metabolic risk score of college students was -0.32(-2.03, 1.58). There were statistically significant differences in cardiovascular metabolic risk scores among college students in variables such as smoking, health status, and physical activity levels ( t/F=-3.41, 12.88, 51.07, P <0.01). The results of the generalized linear model showed that nighttime preference ( B=1.89, 95%CI =1.02-3.49), insomnia symptoms ( B=3.25, 95%CI =1.79-5.90), and short or long sleep duration ( B=1.92, 95%CI =1.21-3.05) were positively correlated with the cardiovascular metabolic risk score of college students ( P <0.05). Conclusions Poor sleep patterns among college students are positively correlated with the risk of cardiovascular metabolism. The sleep behavior of college students should be actively changed to reduce the risk of cardiovascular disease.

Objective:To explore the effects of canagliflozin on cardiac function and its regulation of ferroptosis in rats with heart failure with preserved ejection fraction (HFpEF).Methods:Thirty-two 7-week-old Dahl salt-sensitive rats were selected and randomly divided into four groups: the control group (fed with low-salt diet), the HFpEF group (fed with high-salt diet), the canagliflozin 20 group (fed with high-salt diet and 20 mg·kg -1·d -1 canagliflozin), and the canagliflozin 30 group (fed with high-salt diet and 30 mg·kg -1·day -1 canagliflozin). Body weight and blood pressure of the rats in each group were monitored. Metabolic cage tests were conducted at the10 th week of the experiment, and echocardiography was performed at the 12 th week, after which the rats were killed. Blood and left ventricular samples were collected. HE staining, Masson staining, Prussian blue iron staining, and reactive oxygen species staining were performed to observe the cardiomyocyte size and shape, degree of interstitial fibrosis, iron staining, reactive oxygen species production under optical microscope. The ultrastructure of cardiomyocytes was observed under electron microscope. Western blotting and real-time fluorescent quantitative reverse transcription polymerase chain reaction (RT-qPCR) were used to detect the expression levels of proteins and mRNA related to ferroptosis in left ventricular myocardial tissue of rats in each group. Results:After 1 week of adaptive feeding, all rats survived. Metabolic cage results showed that compared with control group, rats in the HFpEF group, canagliflozin 20 group and canagliflozin 30 group had more food intake, water intake and urine output, and lower body weight (all P<0.05). These changes were more pronounced in canagliflozin 20 group and canagliflozin 30 group than in HFPEF group, and only the body weight at the 12 th week showed a statistically significant difference between canagliflozin 20 group and canagliflozin 30 group ( P<0.05). The blood pressure of 6 th week and 12 th week, heart weight and left ventricular corrected mass of 12 th week of rats in HFpEF group were higher than those in control group, canagliflozin 20 group and canagliflozin 30 group, while the ratio of early mitral valve peak velocity to late mitral valve peak velocity of 12 th week was lower (all P<0.05). HE and Masson staining showed that compared to control group, the myocardial fibers in the left ventricular myocardial tissue of rats in HFpEF group were disordered, with larger cell diameter ((0.032±0.004) mm vs. (0.023±0.003) mm, P<0.05), irregular shape, obvious proliferation of interstitial collagen fibers, and higher collagen volume fraction (0.168±0.028 vs. 0.118±0.013, P<0.05). Compared with HFpEF group, rats in the canagliflozin 20 group and canagliflozin 30 had more orderly arranged myocardial fibers, more regular cardiomyocyte shape, smaller cell diameter, and lower collagen volume fraction ( P<0.05). It was observed under electron microscopy that, compared to control group, most of the striated muscles in myocardial tissue of HFpEF group were broken, and the Z line and M line could not be clearly distinguished, some changes such as mitochondrial swelling, membrane thickening, cristae reduction or even disappearance occurred. In the canagliflozin 20 group and canagliflozin 30 group, the arrangement of striated muscles in the myocardial tissue of rats tended to be more regular, and the morphological changes of mitochondria were milder. Prussian blue iron staining results showed that the iron content in myocardial tissue of rats in HFpEF group was higher than that in control group, canagliflozin 20 group and canagliflozin 30 group. Reactive oxygen species staining results showed that the reactive oxygen species content in the myocardial tissue of rats in HFpEF group was higher than that of control group, canagliflozin 20 group and canagliflozin 30 group. Biochemical analysis of myocardial tissue showed that Fe 2+ and malondialdehyde content in myocardial tissue of rats in HFpEF group were higher than those in control group, canagliflozin 20 group and canagliflozin 30 group, while glutathione content was lower (all P<0.05). Western blot and RT-qPCR detection results showed that compared to control group, rats in HFpEF group had higher expression levels of transferrin receptor 1 (protein relative expression level: 1.37±0.16 vs. 0.31±0.12), acyl-CoA synthetase long-chain family member 4 (protein relative expression level: 1.31±0.15 vs. 0.63±0.09) protein and mRNA, and lower expression levels of ferritin heavy chain 1 (protein relative expression level: 0.45±0.08 vs. 1.41±0.15) protein and mRNA (all P<0.05). There was no statistically significant difference in these indicators between canagliflozin 20 group and the canagliflozin 30 group (all P>0.05). There was no significant difference in levels of glutathione peroxidase 4 protein and mRNA expression in myocardial tissue of rats in four groups( P>0.05). Conclusion:Canagliflozin improves cardiac function in HFpEF rats by regulating the ferroptosis mechanism.

Objective To explore the current status of clinical inertia in the treatment of patients with type 2 diabetes mellitus (T2DM) in the suburbs of Shanghai and analyze its risk factors. Methods A total of 1, 804 T2DM patients who visited the Endocrinology and Metabolism Clinic of Shanghai Sixth People's Hospital from November 2022 to November 2023 were selected as research objects. Patients were divided into clinical inertia group and non-clinical inertia group based on whether clinical inertia occurred during their treatment, and demographic and clinical data were collected. Logistic regression analysis was used to identify risk factors for clinical inertia in the treatment of T2DM patients. Results The incidence of clinical inertia in T2DM patients was 52.00% (938/1, 804). The results of multivariate Logistic regression analysis showed that longer diabetes duration, high level of glycated hemoglobin (HbA1c), high score of the Problem Areas in Diabetes Scale(PAID) score, taking over two oral medications, shorter life expectancy, and coexisting retinopathy were risk factors for clinical inertia in the treatment of T2DM patients (P < 0.05). Conclusion The incidence of clinical inertia is high in T2DM patients during treatment in the suburbs of Shanghai. T2DM patients with poor glycemic control, longer disease duration, high level of psychological distress, taking over two oral medications, shorter life expectancy, and coexisting retinopathy are more prone to occur clinical inertia.

Objective: The study aimed to describe the prevalence of mobile phone use and depressive symptoms and to examine the bidirectional associations between the two among college students, providinb evidence for mental health promotion among college students. Methods: A longitudinal study with follow up at 6 month intervals was conducted in 1 135 students from 2 universities in Hefei, Anhui Province and Shangrao, Jiangxi Province who were selected between April and May 2019. The last follow up was conducted between April and May 2021 based on questionnaire survey, and 999 valid participants were obtained after matching. The self designed questionnaire was used to investigate the duration of cellular phone use and use of cellular phone functions among college students. The Self rating Questionnaire for Adolescent Problematic Mobile Phone Use (SQAPMPU) and the Patient Health Questionnaire-9 (PHQ-9) were used to assess cellular phone dependence and depressive symptoms among college students. Pearson correlation analysis was used to examine the correlation between cellular phone use behavior and depressive symptoms at baseline and 2 years later; linear regression model was used to analyze the linear association between cellular phone use behavior and depressive symptoms scores; autoregressive cross lagged model was used to analyze the bidirectional associations between cellular phone use behaviors and depressive symptoms among college students over time. Results: The prevalence of mobile phone dependence and depressive symptoms among college students at baseline were 24.3% and 42.4%, respectively. The mean duration of mobile phone use among college students at baseline and the 2 year follow up were (2.84±0.90)h/d and (2.02±1.05)h/d, respectively; the mean scores of mobile phone dependence were (23.30±9.00) and (23.29±10.45), respectively; the mean scores of mobile phone function use were (30.12±6.66) and (29.12±7.27), respectively; and the mean scores of depressive symptoms were (4.51±4.76) and (2.61±4.40), respectively. Pearson correlation analysis showed there were significant positive correlations between duration of cellular phone use, cellular phone dependence, use of cellular phone functions at baseline or 2 years later and depressive symptoms 2 years later( r =0.08-0.50, P <0.05). Linear regression models showed a significant positive association between cellular phone dependence at baseline and depressive symptoms ( β=0.26, 95%CI =0.23-0.29) at baseline and 2 years later ( β=0.12, 95%CI =0.09-0.15). Autoregressive cross lagged models showed that cellular phone dependence at baseline positively predicted depressive symptoms 2 years later ( β =0.04) and depressive symptoms at baseline positively predicted cellular phone dependence 2 years later( β =0.23)( P <0.05). Conclusion There was a bidirectional association between cellular phone dependence and depressive symptoms among college students. Reducing cellular phone dependence is of positive significance for improving college students mental health.

Objective: To describe the prevalence and association of sleep quality and anxiety-depression co-morbid symptoms among nursing students, in order to provide a reference basis for promoting the development of nursing students mental health. Methods: Using a prospective study design, baseline survey was conducted in January 2019 among a random cluster sample of 1 716 individuals in three medical universities in Hefei, Anhui Province, and a follow-up survey was conducted in October 2019, with a valid number of 1 573 individuals after matching with the baseline survey. The Pittsburgh Sleep Quality Index (PSQI) was used to assess nursing students sleep quality, and the Depression Anxiety Stress Scale (DASS-21) to assess the anxiety-depression comorbid symptoms. Results: The detection rates of anxiety-depression co-morbidities among nursing students at baseline and follow-up survey were 16.9% and 18.2%, respectively, and the detection rates of poor sleep quality among nursing students at baseline and follow-up survey were 10.1% and 10.3%, respectively. The results of the binary Logistic regression model showed that baseline PSQI score were positively associated with the risk of anxiety-depression co-morbid symptoms among nursing students at baseline ( OR=1.49, 95%CI =1.40-1.59) and after nine months of follow-up ( OR=1.22, 95%CI =1.16-1.28). Furthermore, the influence of baseline sleep quality on the risk of anxiety-depression co-morbid symptoms were mainly concentrated in the five dimensions of sleep time, sleep efficiency, sleep disorders, hypnotic drugs and daytime dysfunction, and such effects of sleep time, sleep disorders and daytime dysfunction still existed in the follow-up investigation. Conclusion Poor sleep quality of nursing students can increase the risk of anxiety-depression co-morbidities. Improving sleep quality of nursing students has a positive effect on improving their mental health.