Aim To investigate the protective effects of curcumin(CUR)on crystal-induced renal injury and its underlying mechanism in the mouse model of neph-rolithiasis.Methods The mouse model of stone for-mation was established via successive intraperitoneal injection of glyoxylate.Proximal tubular epithelial cell line HK-2 treated with calcium oxalate monohydrate(COM)was used as an in vitro model.The protective role of CUR on nephrolithiasis was tested by determina-tion of tubular injury,crystal deposition and adhesion,levels of inflammatory cytokines.In vitro,the effects of CUR on the cell viability and inflammatory factors of HK-2 cells were measured.The proteins in the Toll-like receptor 4(TLR4)/nuclear factor κB(NF-κB)and nuclear factor erythroid 2-related factor 2(NRF2)/hemeoxygenase-1(HO-1)signaling path-ways were measured by Western blot for confirming the relationship between CUR and these pathways.Final-ly,NRF2 inhibitor ML385 and TLR4 activator CCL-34 were respectively used on COM-induced HK-2 cells ex-posed to CUR for the conduction of gain-of-function and loss-of-function assays.Results CUR improves the damage in the mouse model of kidney stone forma-tion,inhibits inflammation and antioxidative effects;promotes the viability of HK-2 cells induced by COM,and inhibits the expression of inflammatory factors.CUR suppresses the expression of proteins in the TLR4/NF-κB pathway,promotes the transfer of NRF2 from the cytoplasm to the nucleus,and enhances the ex-pression of HO-1.ML385 and CCL-34 respectively counteract the anti-inflammatory effects of CUR on COM-induced HK-2 cells.Conclusions Taken togeth-er,our study demonstrates the protective effect of CUR on the deposition of kidney stone and consequent tubu-lar injury.CUR through regulation of the TLR4/NF-κB and NRF2/HO-1 pathways improves renal injury.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To investigate the intervention efficacy of best possible self (BPS)on the mental health of new recruits (including state optimism and pessimism,perceived stress and subjective well-being).Methods A non-randomized controlled trial was conducted on 212 new recruits subjected with cluster sampling from an army unit in a training base for new recruits in September 2023.Based on their organizational structure,they were divided into a study group (n=100,receiving BPS intervention 15 min/d,for 2 consecutive weeks)and a control group[n=112,typical day (TD)intervention,15 min/d,same period].Future Expectancy Scale (FEX),Chinese Perceived Stress Scale (CPSS),Positive and Negative Affect Scale (PANAS ) and Satisfaction with Life Scale (SWLS ) were used to measure the 2 groups of participants at T0 (baseline),T1 (end of the first week of intervention),T2 (end of the second week of intervention)and T3 (1 week after the end of intervention)in order to evaluate the intervention efficacy on above mentioned mental health indicators.Results There were no significant differences in demographic and baseline psychological variables listed above between the 2 groups.However,as the training progressed,obvious differences were observed in the training effects on state pessimism,perceived stress and subjective well-being (including affective and cognitive well-being)between them.When compared with the baseline data (T0),the study group had notably reduced state pessimism (P<0.01)and elevated affective (P<0.001) and cognitive well-being (P<0.001)during T1 and T3,and decreased perceived stress at T1 (P<0.05)and T3 (P<0.001).However,no such changes of above indicators were observed in the control group before and after training.Conclusion A 2-week BPS intervention can effectively reduce state pessimism and perceived stress,promote subjective well-being,and improve mental health in new recruits during new recruit training.

Objective To explore the current situation of the clean operating rooms in Guangdong provincial hospitals of traditional Chinese medicine or integrated Chinese and western medicine to provide references for standardizing the construc-tion of the clean operating room.Methods A questionnaire was designed according to GB 50333-2013 Architectural technical code for hospital clean operating department and WS/T 368-2012 Management specification of air cleaning technique in hospitals,and a questionnaire survey and field investigation were conducted from March to October 2021 on the operating rooms of 64 secondary and above hospitals of traditional Chinese medicine or integrated Chinese and western medicine in Guangdong province,which involved in the basic situation of the operating rooms,general requirements for constructing clean operating rooms,requirements for the layout of clean operating rooms and architectural decorations of the clean operating rooms.Results Of the 64 hospitals surveyed there were 51 ones(79.7％)with clean operating rooms.Tertiary hospitals were mainly equipped with Class Ⅲ clean operating rooms(45.8％),secondary hospitals were provided with general operating rooms(35.0％)and Class Ⅲ clean operating rooms(29.2％),and the differences in the types and classes of the operating rooms in levels of hospitals were statistically significant(P＜0.001).The proportions of tertiary hospitals configured with clean operating rooms and the highest configuration of Class I clean operating rooms were also significantly higher than those of secondary hospitals(94.3％vs 62.1％and 88.6％vs 44.8％,respectively),with statistically significant differences(P＜0.05).There were 66.7％hospitals equipped with negative pressure operating rooms;more than 1/2(56.9％)of the hospitals had the service time of their clean operating rooms longer than 10 years.All the tertiary hospitals did not have air shower rooms in their walkways,while 16.7％secondary hospitals did,with the difference being statistically significant(P＜0.05).Most of the building decorations of clean operating rooms in all the hospitals complied with the specifications(compliance rate＞80.0％),and the difference was not statistically significant between the secondary and tertiary hospitals(P＞0.05);the compliance rate of the decrations of the tertiary hospitals was 78.8％for the requirements of general principle,which was obviously lower than that of the secondary hospitals(100％),with the differences being statistically significant(P＜0.05).Conclusion The clean operating rooms in Guangdong provincial hospitals of traditional Chinese medicine or integrated Chinese and western medicine behave well in configuration,while have some defficiencies in general requirements,layout and building,and necessary guidance,supervision and management have to be involved in to standardize the construction of clean operating rooms.[Chinese Medical Equipment Journal,2024,45(10):77-83]

Objective To investigate the protective effect of Schisandrin B on myocardial infarction in rats and its mechanism.Methods Fifty SD rats were randomly divided into sham group,model group,positive control group(10 mg·kg-1 captopril),experimental-L group(30 mg·kg-1 schisandrin B)and experimental-H(60 mg·kg-1 schisandrin B)group,with 10 rats in each group.Cardiac function related indexes were detected,serum myocardial injury markers and serum inflammatory factors were detected by the kit,myocardial apoptosis was detected by terminal-deoxynucleoitidyl transferase mediated nick end labeling(TUNEL)method,and myocardial tissue related protein expression levels were detected by Western blot method.Results Left ventricular ejection fraction(LVEF)levels in sham group,model group,positive control group,experimental-L group and experimental-H group were(78.42±4.32)％,(41.65±2.94)％,(59.76±5.35)％,(49.13±3.92)％and(67.04±3.00)％;the contents of creatine kinase-MB(CK-MB)were(33.95±2.68),(100.51±3.92),(48.27±3.70),(70.34±2.93)and(49.13±3.67)U·mL-1;interleukin-1 β(IL-1 β)levels were(1.02±0.12),(3.02±0.20),(1.61±0.13),(2.33±0.26)and(1.34±0.14)ng·mL-1;TUNEL positive cell rates were(3.47±0.82)％,(31.79±3.68)％,(11.22±1.02)％,(19.74±1.42)％and(14.38±1.13)％;the expression levels of Nod-like receptor thermal protein domain associated protein 3(NLRP3)protein were 0.35±0.07,1.04±0.10,0.55±0.05,0.85±0.07 and 0.39±0.06;the protein levels of cysteine aspartic acid specific protease 1(caspase-1)were 0.34±0.05,1.05±0.10,0.50±0.06,0.72±0.05 and 0.46±0.03,respectively.The above indexes were compared between model group and sham group,the differences were statistically significant(all P＜0.05).The positive control group,experimental-L group and experimental-H group were compared with model group,the differences were statistically significant(all P＜0.05).The difference between experimental-H group and experimental-L group were statistically significant(all P＜0.05).Conclusion Schisandrin B can mediate inflammatory response and cardiomyocyte apoptosis,improve cardiac function,and protect rats with myocardial infarction,which is related to NLRP3 inflammatory pathway.

Objective:To evaluate the effect of activation of splenic plasmacytoid dendritic cells (pDCs) on myocardial ischemia-reperfusion (I/R) injury in mice.Methods:The experiment was performed in two parts. Animal experiment Thirty-six SPF healthy male C57BL/6J mice, aged 10 weeks, weighing 22-27 g, were assigned to 3 groups ( n=12 each) using a random number table method: sham operation group (Sham group), myocardial ischemia group (MI group) and myocardial I/R group (MI/R group). The myocardial ischemia was induced by occluding the left anterior descending coronary artery for 40 min in MI group, while the model of myocardial I/R was established by occlusion of the left anterior descending coronary artery for 40 min followed by 1-h reperfusion in MI/R group. Following successful preparation of the model, 3 animals from each group were randomly selected, and their hearts were removed for determination of myocardial infarct size through a combination of TTC and methylene blue double staining. Another 3 animals from each group were randomly selected, and their hearts were removed for examination of pathological changes of myocardial tissues using HE staining. Blood samples were collected from the abdominal aorta of 6 mice left in each group for determination of plasma interferon alpha (IFN-α) concentrations by enzyme-linked immunosorbent assay. Then the animals were sacrificed and hearts were harvested for collection of cardiac perfusate (CP). Cell experiment Twelve SPF healthy male C57BL/6J mice, aged 10 weeks, weighing 22-27 g, were selected and the splenic pDCs were isolated using anti-mPDCA-1 MicroBeads according to the manufacturer′s instructions (with a positivity rate of >85% for the isolated cells). The cells were divided into 4 groups: group pDCs stimulated by CP in Sham group (pDCs+ CP-Sham group), group pDCs stimulated by CP in MI group (pDCs+ CP-MI group), group pDCs stimulated by CP in MI/R group (pDCs+ CP-MI/R group) and pDCs stimulated by PBS group (pDCs+ PBS group). The CP in Sham, MI and MI/R groups and PBS were used to induce and culture pDCs for 8 h. Flow cytometry was employed to detect the expression of CD45 and co-stimulatory molecules CD80, CD86 and Major Histocompatibility Complex Ⅱ (MHC Ⅱ) on the surface of pDCs. The levels of IFN-α in the cell culture supernatant were determined using enzyme-linked immunosorbent assay. Results:Animal experiments Compared with Sham group and MI group, the percentage of myocardial infarct size was significantly increased, the concentrations of plasma IFN-α were increased ( P<0.05), and cardiomyocytes displayed evident vacuolar degeneration, severe myocardial fiber rupture, and infiltration of a substantial number of inflammatory cells in MI/R group. There was no significant difference in each parameter between Sham group and MI group ( P>0.05). Cell experiment Compared with pDCs+ CP-Sham group, the expression of CD80, CD86 and MHCⅡ was significantly up-regulated in pDCs+ CP-MI group ( P<0.05), and no significant change was found in the aforementioned parameters in pDCs+ CP-MI/R group ( P>0.05). The expression of aforementioned parameters was significantly up-regulated in pDCs+ CP-MI group as compared with pDCs+ CP-MI/R group ( P<0.05). Compared with pDCs+ CP-Sham group and pDCs+ CP-MI/R group, the concentrations of IFN-α in the cell culture supernatant were significantly increased in pDCs+ CP-MI group ( P<0.05). There was no statistically significant difference in the concentrations of IFN-α between pDCs+ CP-MI/R group and pDCs+ CP-Sham group ( P>0.05). Conclusions:The mechanism underlying myocardial I/R injury may be related to activation of splenic pDCs leading to the production of IFN-α following myocardial ischemia in mice.

Objective:To explore the prevalence and independent associated factors of vascular calcification (VC) in non-dialysis chronic kidney disease (CKD) patients of stage 3-5.Methods:It was a single-center cross-sectional observational study. Non-dialysis stage 3-5 CKD patients ≥18 years old who were admitted to the Department of Nephrology, the First Affiliated Hospital of Sun Yat-sen University from May 1, 2022 to December 31, 2022 with VC evaluation were enrolled. The patients' general information, laboratory examination and imaging data were collected. Coronary artery calcification (CAC), thoracic aorta calcification (TAC), abdominal aorta calcification (AAC), carotid artery calcification and aortic valve calcification (AVC) were evaluated by cardiac-gated electron-beam CT (EBCT) scans, lateral lumbar x-ray, cervical macrovascular ultrasound and echocardiography, respectively. The differences in clinical data and the prevalence of VC at different sites of patients with different CKD stages were compared, and the prevalence of VC at different sites of patients in different age groups [youth group (18-44 years old), middle-aged group (45-64 years old) and elderly group (≥65 years old)] and patients with or without diabetes were compared. Multivariate logistic regression analysis was used to analyse the independent associated factors of VC for different areas.Results:A total of 206 patients aged (51±14) years were included, including 129 (62.6%) males. There were 44 patients with CKD stage 3 (21.4%), 51 patients with CKD stage 4 (24.8%), and 111 patients with CKD stage 5 (53.9%). CKD was caused by chronic glomerulonephritis [104 cases (50.5%)], diabetic kidney damage [35 cases (17.0%)], hypertensive kidney damage [29 cases (14.1%)] and others [38 cases (18.4%)]. Among 206 patients, 131 (63.6%) exhibited cardiovascular calcification, and the prevalence of CAC, TAC, AAC, carotid artery calcification, and AVC was 37.9%, 43.7%, 37.9%, 35.9% and 9.7%, respectively. The overall prevalence of VC in young, middle-aged and elderly patients was 24.6%, 73.6% and 97.4%, respectively. With the increase of age, the prevalence of VC in each site gradually increased, and the increasing trend was statistically significant (all P<0.001). The overall prevalence of VC in CKD patients with diabetes was 92.5% (62/67), and the prevalence of VC at each site in the patients with diabetes was significantly higher than that in the patients without diabetes (all P<0.001). Multivariate logistic regression analysis revealed that age (every 10 years increase, OR=2.51, 95% CI 1.77-3.56, P<0.001), hypertension ( OR=5.88, 95% CI 1.57-22.10, P=0.009), and diabetes ( OR=4.66, 95% CI 2.10-10.35, P<0.001) were independently correlated with CAC; Age (every 10 years increase, OR=6.43, 95% CI 3.64-11.36, P<0.001) and hypertension ( OR=6.09, 95% CI 1.33-27.84, P=0.020) were independently correlated with TAC; Female ( OR=0.23, 95% CI 0.07-0.72, P=0.011), age (every 10 years increase, OR=3.90, 95% CI 2.42-6.29, P<0.001), diabetes ( OR=5.37, 95% CI 2.19-13.19, P<0.001) and serum magnesium ( OR=0.01,95% CI 0-0.35, P=0.014) were independently correlated with AAC. Moreover, age and diabetes were independently correlated with carotid artery calcification, AVC and overall VC Conclusions:The prevalence of VC in non-dialysis CKD patients of stage 3-5 is 63.59%, of which CAC reaches 37.9%, TAC is the most common one (43.7%), while AVC is the least one (9.7%). Age and diabetes are the independent associated factors for VC of all sites except TAC, while hypertension is an independent associated factor for both CAC and TAC.

Background/Aims: Chronic hepatitis C (CHC) patients who failed antiviral therapy are at increased risk for hepatocellular carcinoma (HCC). This study assessed the potential role of metformin and statins, medications for diabetes mellitus (DM) and hyperlipidemia (HLP), in reducing HCC risk among these patients. Methods: We included CHC patients from the T-COACH study who failed antiviral therapy. We tracked the onset of HCC 1.5 years post-therapy by linking to Taiwan’s cancer registry data from 2003 to 2019. We accounted for death and liver transplantation as competing risks and employed Gray’s cumulative incidence and Cox subdistribution hazards models to analyze HCC development. Results: Out of 2,779 patients, 480 (17.3%) developed HCC post-therapy. DM patients not using metformin had a 51% increased risk of HCC compared to non-DM patients, while HLP patients on statins had a 50% reduced risk compared to those without HLP. The 5-year HCC incidence was significantly higher for metformin non-users (16.5%) versus non-DM patients (11.3%; adjusted sub-distribution hazard ratio [aSHR]=1.51; P=0.007) and metformin users (3.1%; aSHR=1.59; P=0.022). Statin use in HLP patients correlated with a lower HCC risk (3.8%) compared to non-HLP patients (12.5%; aSHR=0.50; P<0.001). Notably, the increased HCC risk associated with non-use of metformin was primarily seen in non-cirrhotic patients, whereas statins decreased HCC risk in both cirrhotic and non-cirrhotic patients. Conclusions Metformin and statins may have a chemopreventive effect against HCC in CHC patients who failed antiviral therapy. These results support the need for personalized preventive strategies in managing HCC risk.

Abstract：Objective To optimize the production process of inactivated vaccine of Aeromonas veronii（AV）CA07 strain. Methods The fermentation culture process of AV CA07 strain liquid was determined through the optimization of the culture time（2～16 h），medium（optimized fermentation medium，LB medium and NB medium）and fermentation conditions（in⁃ oculation amount of 1%，5%，10% and 15%；ventilation rate of 2，4，6 and 8 L／min and fermentation time of 6，8，10 and 12 h）. The optimal inactivation process was determined through the comparison of the final concentration of formalde⁃ hyde solution（0. 10%，0. 20%，0. 30% and 0. 40%），inactivation temperature（28 and 37 ℃）and inactivation time（24， 48 and 72 h）. The large⁃scale production process of inactivated vaccine of AV CA07 strain in 500 L fermentor was estab⁃ lished and the prepared vaccines were tested for safety and immunogenicity. Results The optimal inoculation amount of AV CA07 strain was 5%，ventilation rate was 4 L／min and culture time was 10 ~ 12 h. The optimal inactivation condition was adding formaldehyde solution with final concentration of 0. 30% incubating at 37 ℃ for 24 h. The number of viable bacteria in the fermentation broth of AV CA07 strain prepared in 500 L fermentor was more than 8 × 109 CFU／mL. All crucian carps immunized with the inactivated vaccine by abdomen survived. After challenge，the relative immune protection rate was more than 90%. Conclusion AV CA07 strain inactivated vaccine prepared by optimized production process showed good safety and immunogenicity.

As one of the main diseases leading to end-stage renal disease, steroid-resistant nephrotic syndrome(SRNS) can cause serious complications such as infection. Without effective control, this disease can further lead to the malignant development of the renal function, bringing serious social and economic burdens. As previously reported, the formation of SRNS is mostly related to the podocyte injury in the body, i.e., the injury of glomerular visceral epithelial cells. Phosphatidylinositol 3-kinase(PI3K)/protein kinase B(Akt) signaling pathway, nuclear transcription factor-κB(NF-κB) signaling pathway, mammalian target of rapamycin(mTOR)/adenosine monophosphate(AMP)-activated protein kinase(AMPK), transforming growth factor(TGF)-β1/Smads, and other signaling pathways are classical signaling pathways related to podocyte injury. By regulating the expression of signaling pathways, podocyte injury can be intervened to improve the adhesion between podocyte foot processes and glomerular basement membrane and promote the function of podocytes, thereby alleviating the clinical symptoms of SRNS. Through the literature review, traditional Chinese medicine(TCM) has unique advantages and an important role in intervening in podocyte injury. In the intervention in podocyte injury, TCM, by virtue of multi-target and multi-pathway role, can regulate and intervene in podocyte injury in many ways, alleviate the clinical symptoms of SRNS, and interfere with the progress of SRNS, reflecting the unique advantages of TCM. On the other hand, TCM can directly or indirectly inhibit podocyte injury by regulating the above signaling pathways, which can not only promote the effect of hormones and immunosuppressants and shorten the course of treatment, but also reduce the toxic and side effects caused by various hormones and immunosuppressants to exert the advantages of small side effects and low price of TCM. This article reviewed TCM in the treatment of SRNS by interfering with podocyte injury-related signaling pathways and is expected to provide a reference for the in-depth study of TCM in the treatment of SRNS, as well as a theoretical basis and a new direction for the clinical application of TCM to shorten the course of treatment of SRNS and delay the progression to end-stage renal disease.
Humans ; Podocytes ; Nephrotic Syndrome/genetics* ; Medicine, Chinese Traditional ; Phosphatidylinositol 3-Kinases/genetics* ; Signal Transduction ; NF-kappa B ; AMP-Activated Protein Kinases ; Hormones