The Huangdi Neijing proposes the " using bitter herbs to nourish or purge" theory to guide clinical prescription and formulation of herbal remedies based on the physiological characteristics and functions of the five zang viscera, along with the properties and flavors of medicinal herbs. This study explored diabetic kidney disease pathogenesis and treatment based on the " using bitter herbs to nourish or purge" theory. Kidney dryness is a key pathological factor in diabetic kidney disease, and the disharmony of kidney dryness is an essential aspect of its pathogenesis. Strengthening is the primary therapeutic principle, and kidney dryness is a persistent factor throughout the occurrence and progression of diabetic kidney disease. In the early stage, the pathogenesis involves heat-consuming qi and injuring yin, leading to kidney dryness. In the middle stage, the pathogenesis manifests as qi deficiency and blood stasis in the collaterals, resulting in turbidity owing to kidney dryness. In the late stage, the pathogenesis involves yin and yang deficiency, with kidney dryness and disharmony. This study proposes the staging-based treatment based on the " need for firmness" characteristic of the kidney. The aim is to provide new insights for clinical diagnosis and treatment in traditional Chinese medicine by rationally using pungent, bitter, and salty medicinal herbs to nourish and moisturize the kidney. This approach seeks to promote precise syndrome differentiation and personalized treatment for different stages of diabetic kidney disease, thereby enhancing clinical efficacy.

Immunoglobulin A (IgA) nephropathy is a globally prevalent type of primary glomerulonephritis, characterized by complex symptoms and diverse clinical manifestations. The internationally recognized " multiple hit hypothesis" explains the systemic immune disease features of IgA nephropathy. However, current treatment strategies primarily focus on local pathological changes, inadequately addressing its complex systemic mechanisms. The " qi cycle in round" theory, an integral concept of the academic thought of HUANG Yuanyu, a prominent medical expert from the Qing Dynasty, offers a concise and insightful framework for understanding complex pathologies. For example, this theory provides valuable insights for elucidating the pathogenesis of IgA nephropathy and guiding its clinical management by simplifying intricate systemic processes. This study applies the " qi cycle in round" theory to postulate that patients with IgA nephropathy experience disrupted qi flow owing to spleen-stomach qi deficiency and dampness-heat accumulation. These imbalances manifest as internal symptoms, such as diarrhea; external vulnerability to illness; upper body symptoms, like sore throat; and lower body symptoms, such as hematuria and proteinuria. Pathologically, the condition is characterized by immune complex deposition. This article also emphasizes strategies that prioritize tonifying spleen-stomach qi to enhance the pivotal functions of transportation and transformation. Regulating qi and relieving stagnation are emphasized to harmonize ascending and descending dynamics. Additionally, eliminating turbidity and unblocking collaterals are highlighted to promote qi transformation. These approaches aim to restore the harmonious operation of organ qi dynamics and harmonious qi transformation functions. This study aims to provide a reference for syndrome differentiation and IgA nephropathy treatment using traditional Chinese medicine based on the " qi cycle in round" theory.

Diabetic kidney disease(DKD)is a severe complication of diabetes.Its incidence increases annually,posing a significant burden on public health.The strategy of symptomatic treatment based on pathogenesis differentiation,focusing on identifying pathogenesis,is particularly meaningful for managing complex and variable chronic diseases like DKD.Within this framework,the state of latent heat persists throughout DKD,with"latent heat causing accumulation"identified as the core pathogenesis affecting and promoting the development and progression of DKD.This paper is centered on the concept of"latent heat causing accumulation"and adopts symptomatic treatment based on pathogenesis differentiation as its guiding principle to explore the role of latent heat in DKD.It highlights that the onset of DKD involves environmental and constitutional pathogenesis associated with"the concealment of latent heat"and"stagnant-heat invading collaterals"as the initial pathogenesis,"latent heat causing accumulation"as the core mechanism,and"secondary turbid heat"as the derivative pathogenesis.These pathogenesis factors collectively influence the symptoms,sequelae,and prognosis of DKD.Moreover,this paper provides commonly used prescriptions for different stages,syndrome types,and complications of the disease,aiming to offer a reference for clinical practice in flexibly addressing changes in disease conditions based on varied pathogenesis.

Objective:To investigate the clinical characteristics and outcome of patients with voltage-gated potassium channel complex (VGKCc) antibody associated clinical syndromes complicated with myasthenia gravis (MG) with thymoma.Methods:The clinical history, examinations and follow-up prognosis of 2 cases of VGKCc antibodies associated clinical syndromes with MG complicated with thymoma in Qilu Hospital (Qingdao), Cheeloo College of Medicine,Shandong University in September 2020 and December 2020 were reviewed. Related literatures were summarized at the same time.Results:Case 1, a 64-year-old female clinically presented with cognitive impairment, psychosis, and epilepsy seizures, whose serum autoimmune antibody testing showed positive leucine-rich glioma-inhibited 1 (LGI1) antibody, was diagnosed as anti-LGI1 encephalitis,and had history of MG with thymoma. Her symptoms were improved by immunotherapy. Case 2, a 67-year-old male, was diagnosed as MG, and developed cognitive impairment, myokymia and autonomic dysfunction later. His serum autoimmune antibody testing showed positive contactin associated protein-like 2 antibody. Therefore, Morvan syndrome complicated with MG with thymoma was definitely diagnosed. After admission, the patient was improved with immunotherapy and thymoma resection.Conclusions:Patients with VGKCc antibody-associated clinical syndromes complicated with MG have the clinical characteristics of the two diseases simultaneously, and there is also crossover. Immunotherapy and treatment for thymoma are generally effective.

Objective The objective of this study was to compare the short-term efficacy and adverse reactions of nituzum-ab combined with synchronous radiotherapy and chemotherapy and bevacizumab combined with synchronous radiotherapy and chemo-therapy in the treatment of locally advanced cervical cancer.Methods A total of 100 locally advanced cervical cancer patients with pathological type of squamous cell carcinoma were collected from 1 September 2020 to 31 December 2021.They were divided into a control group(synchronous radiotherapy and chemotherapy group),a nituzumab group(nituzumab combined synchronous radiotherapy group)and a bevacizumab group(bevacizumab combined synchronous radiotherapy and chemotherapy group).The total effective rate of short-term treatment,changes in tumor volume before and after treatment,serum squamous cell carcinoma antigen(SCC)levels be-fore and after treatment,and adverse reactions after treatment were compared among patients of the three groups.Results The short-term total effective rates of the Nitro group,Bevar group and control group were 90.3％,87.2％and 60.0％,respectively.The total effective rates of the Nitro and Bevar groups were significantly higher than those of the control group,and the differences were statisti-cally significant(P＜0.001).There was no statistically significant difference in the total effective rates of the Nitro and Bevar groups(P＞0.05);The degree of tumor volume reduction and SCC reduction in the Nituo group and Bevac group after treatment was higher than those in the control group(P＜0.05),and there was no statistically significant difference between the two groups(P＞0.05).The incidence of hypertension in the Bevar group was 33.4％,significantly higher than that in the control group(10.0％)and the Ni-tro group(12.9％)(P＜0.05).There was no statistically significant difference in the incidence of hypertension between the Nito group and the control group(P＞0.05);There was no statistically significant difference in the incidence of adverse reactions among the three groups except hypertension(P＞0.05).Conclusion Nituzumab combined with synchronous radiotherapy and chemothera-py,as well as bevacizumab combined with synchronous radiotherapy and chemotherapy,can improve the short-term efficacy of locally advanced cervical cancer,effectively reduce tumor volume and inhibit the expression of tumor markers,both of which are superior to synchronous radiotherapy and chemotherapy alone.Compared to bevacizumab,nituzumab has fewer adverse reactions.For patients with locally advanced cervical cancer,the combination of nituzumab and concurrent radiotherapy and chemotherapy is more reliable in terms of safety.

Objective:To objectively evaluate the therapeutic effect of Chinese cupping therapy.Method:Near-infrared spectroscopy (NIRS) was used to evaluate the concentration change in oxygenated hemoglobin ([HbO 2]), deoxy-hemoglobin ([Hb]) and blood volume ([tHb]) in 13 healthy volunteers during cupping therapy for the infraspinatus muscle. Results:During the cupping therapy and its pre- and post-treatment period, it was observed that [Hb] and [tHb] in the tissue surrounding the cupping site decreased significantly (both P<0.05), and [HbO 2] increased significantly ( P<0.05), which showed an increase in oxygen uptake. After the cupping was removed, the above hemodynamic changes could still continue for a period of time. Conclusions:Cupping therapy has potential positive therapeutic effects in promoting the hemodynamics for facilitating muscular functions. Functional NIRS surgery has great application potential in the field of physical rehabilitation therapy such as cupping.

Objective:To investigate the levels of gross radioactivity in drinking water and of 90Sr in food around Sanmen nuclear power plant (NPP) before and after operation. Methods:From 2012 to 2019, 7 drinking water monitoring sites were selected around the Sanmen NPP to collect source water, factory water and peripheral water, respectively, in order to measure and analyze the total radioactivity level in drinking water. Based on the dietary habits of local residents, 4 kinds of food such as grains, vegetables, freshwater fish and marine fish grown locally were sampled to measure and analyze the activity concentration of 90Sr. Results:Before the operation of Sanmen NPP, the total α radioactivity and total β radioactivity in drinking water around the NPP were 0.001-0.063 Bq/L and 0.019-0.210 Bq/L, respectively. After operation, the total α radioactivity and total β radioactivity were 0.001-0.084 Bq/L and 0.025-0.079 Bq/L, respectively. Both were lower than the national standard value given in the GB 5749-2006 " Sanitary standards for drinking water" . There was no significant change in the radioactivity level of source water, factory water and peripheral water during the wet and dry periods. The activity concentration of 90Sr in these four types of food ranged from 0.037 to 1.216 Bq/kg before operation and from 0.049 to 0.692 Bq/kg after operation, all lower than the standard value of " Standard for the concentration in radioactive substances in food" (GB 14882-94). Conclusions:Before and after the operation of Sanmen NPP, the total α and total β radioactivity in drinking water and 90Sr activity concentration in food are stable, below the national standard limit.

Objective The aim of this study was to establish a practical and feasible prevention,and a treatment scheme of cardiovascular toxicity(CVT)induced by chemotherapy in cervical cancer based on known effective measures and to provide scientific guidance and basis for clinical treatment. Methods The risk of pre-chemotherapy CVT and post-chemotherapy CVT were evalua-ted in 164 subjects from November 2016 to January 2018. The Interrupted time series(ITS)model of CVT incidence before and after intervention was established. The CVT biomarkers and results of clinical examination before and after chemotherapy were compared in selected patieds. The effects of measures were evaluated. Results There was no difference in the ITS model of CVT incidence before and after intervention(P>0. 05). Among echocardiography examination results,the E peak velocity of mitral valve and E/A ratio in-creased,and the difference was statistically significant(P<0. 05),LVEF、FS、SV and A peak velocity of mitral valve had no differ-ences(P>0. 05). There were no differences in ECG and double lower extremities arteriovenous ultrasonography results(P>0. 05). The level of sICAM-1,sTM,vWF and h-FABP decreased(P<0. 05),the levels of NO and eNOS increased(P<0. 05);there was no significant difference in the levels of hs-CRP and E-selectin(P>0. 05). Conclusion The comprehensive prevention and treat-ment program established in this study can improve the cervical cancer chemotherapy CVT microscopically, and further research should be carried out by expanding the sample size.

Objective: To investigate the contents of radionuclide ¹³⁷Cs in seafood from coastal areas of Zhejiang province, and to estimate the annual committed effective dose to population in different regions from ingestion of ¹³⁷Cs in seafood. Methods: Three representative monitoring areas were set on the coastaline of Zhejiang province, and the locally popular seafoods were selected as monitoring objectives. The contents of radionuclide ¹³⁷Cs were detected using HPGe γ spectrometry. The committed effective doses were estimated based on monitoring results and consumption data on seafoods in Zhejiang. Results: The detection ratio of ¹³⁷Cs in seafood produced on coastal areas of Zhejiang province was estimated to be 35.3% (36/102). Specific activity detected ranged from 0.004 to 0.140 Bq/(kg, Wet). Committed effective doses from ingestion of ¹³⁷Cs in one year to the population in island region, coastal region and inland region were 3.03×10^-5, 1.63×10^-5, 3.38×10^-6 mSv, respectively, far lower than the world committed effective dose resulting from internal exposure. Conclusions At present, the content level of ¹³⁷Cs in seafood produced on the coastal areas of Zhejiang province is much lower than the national standard limit, and the dose burden to the population is very minor with no health impact to the population.

Objective To investigate the clinical characteristics,immunological features,treatment and follow-ups of Sj(o)gren's syndrome-associated monoclonal gammopathy (SS-MG).Methods A retro-spective,case-control study was conducted for 18 cases diagnosed with SS-MG and 36 age-and sex-matched non-MG-SS patients from Janurary 2010 to Janurary 2017 in Peking University People's Hospital.The clinical and laboratory features,treatment and follow-ups were recorded and compared.Comparisons between groups were made using t test for normally distributed numerical data,Mann-Whitney U test for non-normally distributed numerical data,and Pearson Chi-square,continuity correction or Fisher's exact tests for categorical data.Results SS patients,when complicated with MG,had significantly increased level of TP [(78± 11) g/L,(71±10) g/L,t=-2.382,P=0.021] and erythrocyte sedimentation rate (ESR) [52.5(45.3) mm/1 h,33.0(42.5) mm/1 h,Z=-2.179,P=0.029],higher prevalence of urine NAG positivity [75％(9/12),28％(7/25),x2=7.298,P=0.007],hypoglobulinemia [33％(6/18),3(1/36),x2=7.407,P=0.006] and thrombotic events [17％(3/18),0％(0/36),P=0.033],and less previous exposure to glucocorticoid [22％(4/18),64％(23/36),x2=8.333,P=0.004],compared to the control group.Primary SS patients complicated with MG had significantly higher ESSDAI [26.0(25.0),12.0 (9.0),Z=-2.724,P=0.006] and Clin EULAR Sj(o)gren's syndrome disease activity index (ESSDAI) [24.0(25.0),10.5 (10.0),Z=-2.523,P=0.011].Among the 18 patients,2 were diagnosed with multiple myeloma,1 was diagnosed with non-Hodgkin lymphoma,and the left were diagnosed as MG of undetermined significance (MGUS).Ten patients were followed up,among whom 2 patients with MGUS experienced increased levels of M protein,newly developed genetic abnormalities,and renal involvement.Conclusion SS patients may be complicated with MG.MGUS is the most common form.However,malignant hematologic disorders are revealed as well.In SS patients with high serum TP and ESR,hypoglobulinemia,tubulointerstitial kidney involvement and unexplained thrombotic events,especially in those with high disease activity,so MG should be an alert for further work-ups,monitoring and treatment.