Volume 105 · Issue 12 · 2025

Type 2 diabetes mellitus and chronic kidney disease (T2DM-CKD) is common in the Chinese population and seriously threatens human health. With the development and application of new drugs, the outcome of T2DM-CKD has been improved in recent years. However, how to combine those drugs effectively and reduce side effects deserves further attention. "Renal triple therapy " (RTT) refers to combined and sequential use of three key medications in treatment of T2DM-CKD, namely renin-angiotensin system inhibitor (RASi), sodium-glucose cotransporter 2 inhibitor (SGLT-2i) and non-steroidal mineralocorticoid receptor antagonist (finerenone), targeting various pathogenic factors in T2DM-CKD. Clinical studies have demonstrated that RTT is superior for protecting the kidney and heart compared with single or dual therapy, and thus improves outcomes of patients with T2DM-CKD. Moreover, RTT can reduce the risk of drug-induced hyperkalemia. Based on research progress at home and abroad and personal clinical experience, this article discusses the origin, theoretical basis, benefits and precautions of RTT in treating T2DM-CKD, aiming to provide a good treatment strategy for primary care physicians and improve the overall level of disease prevention and control.

The number of patients with type 2 diabetes mellitus (T2DM)-related chronic kidney disease (CKD) is substantial, and the disease burden is severe. Despite current treatment options, even with standard therapy, patients still face a high risk of kidney disease progression and cardiovascular events. Finerenone, a novel, highly selective, non-steroidal mineralocorticoid receptor antagonist (nsMRA), can directly and effectively block kidney and cardiovascular damage caused by excessive activation of mineralocorticoid receptors, while maintaining good safety. This article provides a review of the mechanism of action, clinical application value, guideline recommendations, and future prospects of finerenone.

In recent years, the application of high-flow nasal cannula (HFNC) in clinical anesthesia has become increasingly widespread. Its feasibility, effectiveness, and safety in perioperative oxygen therapy have been progressively confirmed and recognized. This technology has demonstrated significant advancements and innovations in airway management within anesthesia, particularly in addressing difficult airways. Patients undergoing eye and ear-nose-throat (ENT) surgeries frequently present with difficult airways, imposing higher demands on airway management techniques. However, there remains a lack of clear evidence-based guidelines and structured recommendations regarding the application of HFNC in ENT anesthesia airway management. Based on relevant research progress both domestically and internationally, as well as Chinese clinical practice, the Otorhinolaryngology Anesthesiology Group of the Chinese Society of Anesthesiology organized an expert team to formulate this consensus. The consensus systematically elaborates on the physiological mechanisms, applicable scenarios, and specific operational methods of HFNC, from theory to practice. It covers multiple aspects, including the induction phase, intraoperative non-intubated anesthesia management, postoperative extubation oxygen therapy, and applications in special populations. Addressing different clinical needs, the consensus clearly outlines the recommendations, contraindications, and precautions for HFNC, further standardizing its application in ENT anesthesia airway management and providing an evidence-based framework for optimizing perioperative airway management. This consensus aims to promote the standardized application of HFNC technology in ENT anesthesia, improve patient safety, and provide theoretical support and practical guidance for future clinical research and technological advancements.

To investigate the correlation of lipid profile and serum osmolality (OsP) with kidney progression in patients with type 2 diabetes mellitus (T2DM).

A nested case-control study was conducted. Inpatients with T2DM who visited Guizhou Provincial People′s Hospital in 2019 were included. Demographic characteristics, laboratory indices, and kidney progression events were collected. The correlation of lipid profile and OsP with kidney progression in T2DM were analyzed using multivariable Cox proportional hazards regression models and causal mediation analysis.

A total of 1 219 patients (714 males and 505 females) were included, aged (59.7±14.6) years. The median (Q₁, Q₃) follow-up duration was 54 (51, 58) months, with a loss to follow-up rate of 11.9% (145/1 219). Kidney progression occurred in 21.3% (260/1 219) of the patients. Cox proportional hazards regression analysis revealed that elevated OsP (HR=1.02, 95%CI: 1.01-1.02, P<0.001), remnant cholesterol (RC) (HR=1.12, 95%CI: 1.02-1.23, P=0.023), apolipoprotein B (ApoB) (HR=1.59, 95%CI: 1.02-2.46, P=0.040), and age (HR=1.02, 95%CI: 1.01-1.03, P<0.001) were identified as risk factors for kidney progression in T2DM. Compared with OsP<310 mmol/L, patients with OsP≥310 mmol/L had a significantly increased risk of kidney progression (HR=1.94, 95%CI: 1.50-2.51, P<0.001). Causal mediation analysis using bootstrap resampling (N=5 000) indicated that RC and ApoB mediated 3.39% (95%CI: 0.98%-5.00%, P=0.020) and 9.54% (95%CI: 8.28%-17.00%, P=0.048) of the effect of OsP on kidney progression, respectively.

Elevated OsP level in T2DM patients is a risk factor for kidney progression, with RC and ApoB mediating the effect of OsP on kidney progression in T2DM.

To investigate the correlation between inflammatory factors and renal function impairment in patients with proliferative diabetic retinopathy (PDR) undergoing pars plana vitrectomy.

The clinical data of patients with PDR who underwent vitreoretinal surgery at Beijing Tongren Hospital, Capital Medical University, from July 2019 to January 2021 were retrospectively analyzed. Using a estimated glomerular filtration rate (eGFR) cut-off value of<60 ml·min^-1· (1.73 m²)^-1, the cohort was stratified into two groups: renal impairment group and non-renal impairment group. The differences between the two groups were compared, and a multivariate logistic regression model was used to examine the factors associated with renal function injury.

A total of 923 patients aged (51.5±11.6) years were enrolled in the study, including 537 males and 386 females. There were 151 patients (16.4%) and 772 patients (83.6%) in renal impairment group and non-renal impairment group, respectively. Compared with the non-renal impairment group, the renal impairment group had higher systolic blood pressure (SBP), neutrophil count, high-sensitivity C-reactive protein (hs-CRP), homocysteine, triglycerides, total cholesterol, and complement C4 levels (all P<0.05). However, glycated hemoglobin (HbA1c), lymphocyte count, serum albumin, high-density lipoprotein cholesterol (HDL-C), and complement C3 levels were lower in the renal impairment group (all P<0.05). Multivariate logistic regression analysis demonstrated that elevated hs-CRP (OR=1.041, 95%CI: 1.002-1.082), reduced complement C3 (OR=0.996, 95%CI: 0.995-0.998), and elevated complement C4 (OR=1.007, 95%CI: 1.005-1.010) were inflammatory-related factors associated with renal impairment in patients with PDR. Other related factors included SBP (OR=1.015, 95%CI: 1.002-1.028), serum albumin (OR=0.842, 95%CI: 0.806-0.879), and homocysteine (OR=1.098, 95%CI: 1.064-1.132).

There is a correlation between inflammatory factors (such as hs-CRP, complement C3, and complement C4) and the occurrence of renal function impairment in PDR patients undergoing vitrectomy.

To explore the mechanism of β-hydroxybutyric acid (β-HB) mediated β-hydroxybutyrylation in glucose-6-phosphate dehydrogenation (G6PDX) on reducing the damage of podocyte induced by high glucose.

Mouse podocytes (MPC-5) were stimulated with high glucose to establish a podocyte injury model of diabetic nephropathy. The cells were divided into three groups: the control group, the high glucose group (stimulated with 30 mmol/L glucose for 48 hours), and the high glucose+β-HB group (stimulated with 30 mmol/L glucose plus 20 mmol/L β-HB for 48 hours). The content of β-HB, cell viability, and the expressions of podocin, Wilms tumor protein 1 (WT-1), and synaptopodin in MPC-5 cells of each group were measured. Liquid chromatography-tandem mass spectrometry was employed to screen for potential protein sites undergoing β-hydroxybutyrylation, and the expression of G6PDX was detected. A mutant vector was transfected to mutate the lysine at position 432 of G6PDX to arginine. The cells were then divided into three groups: the high glucose group (stimulated with 30 mmol/L glucose for 48 hours), the high glucose+β-HB group (stimulated with high glucose and 20 mmol/L β-HB for 48 hours), and the high glucose+β-HB+site mutation group (subjected to high glucose, β-HB, and transfection of a plasmid for lysine site mutation). The cell viability and G6PDX expression in each subgroup were determined.

Compared with the control group, the cell viability in the high glucose group was significantly decreased (34.8%±2.8% vs 100.0%±8.5%, P<0.001). In contrast, the cell viability in the high glucose+β-HB group was significantly higher than that in the high glucose group (72.7%±1.9% vs 34.8%±2.8%, P<0.001). Moreover, β-HB could ameliorate podocyte injury induced by high glucose, as evidenced by the increased expressions of podocin (0.63±0.02 vs 0.39±0.03, P<0.001), WT-1 (0.75±0.04 vs 0.50±0.03, P<0.001), and synaptopodin (0.74±0.02 vs 0.56±0.02, P<0.001). Liquid chromatography-tandem mass spectrometry analysis revealed an increased β-hydroxybutyrylation modification of the lysine at position 432 of G6PDX after β-HB treatment (fold change>1.5). The results of Western blotting (0.68±0.05 vs 0.38±0.01, P<0.001), PCR (0.70±0.10 vs 0.15±0.03, P<0.001), and immunofluorescence all indicated an upregulation of G6PDX expression. After the site mutation, the restoration of cell viability under β-HB treatment was restricted (171.7%±7.1% vs 259.7%±14.6%, P<0.001). Additionally, the results of Western blotting (1.43±0.04 vs 2.22±0.09, P<0.001) and PCR (2.33±0.16 vs 3.60±0.34, P<0.001) showed a decrease in G6PDX expression compared with that with simple β-HB treatment.

β-HB mediated β-hydroxybutyrylation of G6PDX can alleviate podocyte injury induced by high glucose.

To explore the application value of the single-channel contrast agent/tracer injection mode in positron emission tomography/magnetic resonance imaging (PET/MRI) examination.

A total of 65 patients who underwent PET/MRI examination in the Department of Radiology of General Hospital of Eastern Theater from June 2021 to March 2022 were prospectively enrolled as the control group (double-channel contrast/tracer injection mode), and 78 patients examined from April to May 2022 as the test group (single-channel contrast/tracer injection mode).The nursing operation time, the puncture success rate of indwelling needle, the incidence of blood extravasation, and the image quality were analyzed and compared between two groups.

The age of 143 patients was (53.7±16.3) years, and 90 (63.0%) were male. The control group was (54.7±17.0) years, with 43 males (66.2%). The test group was (50.8±18.5) years, with 47 males (60.3%). The nursing operation time of patients in the test group was shorter than that in the control group [3.2 (3.0, 3.3) vs 6.2 (5.4, 6.5) min]. The success rate of indwelling needle puncture in the test group was higher than that in the control group [100.0 (78/78) vs 92.3% (60/65)], and the rate of blood extravasation was lower than that in the control group [0 (0/78) vs 6.2% (4/65)] (all P<0.05). There was no statistically difference in the pass rate of PET/MRI images between two groups [94.9% (74/78) vs 98.5% (64/65), P=0.374].

Compared with the traditional double-channel contrast agent/tracer injection mode, the single-channel contrast agent/tracer injection mode reduces the nursing operation time and the incidence of blood extravasation, increases the success rate of indwelling needle puncture, and does not affect the image quality of PET/MRI.

To explore the construction and clinical value of a predictive model for malignant ventricular arrhythmias (MVA) in children with viral myocarditis (VMC) based on parameters of ventricular repolarization heterogeneity.

We retrospectively analyzed 99 children with VMC admitted to Henan Provincial People′s Hospital from January 2019 to February 2023 as the training set, and 38 children with VMC admitted from March 2023 to May 2024 as the external validation set in a cross-sectional study. Patients were divided into MVA and non-MVA groups based on the occurrence of MVA. We measured QT interval (QT), corrected QT interval (QTc), T-wave peak-end interval (TpTe), and heart rate-corrected TpTe (TpTec) in all children using conventional electrocardiography and Holter monitoring. Multi-variate logistic regression analysis was used to identify factors influencing the occurrence of MVA in children with VMC and the efficacy of models predicting MVA with cardiac troponin I (cTnI) and different electrocardiographic parameters was evaluated using the receiver operating characteristic (ROC) curve. The predictive power of the models was internally and externally validated through C-index, Hosmer-Lemeshow goodness-of-fit test, ROC curves, and decision curve analysis.

There were 99 children in the training set and 38 in the external validation set, with no significant differences in age [(6.9±3.7) vs (6.9±3.4) years] and gender (boys: 46.5% vs 50.0%) between the two groups (all P>0.05). In the training set, there were 47 cases (47.5%) in the MVA group, and there were 20 cases (52.6%) in the MVA group in the external validation set. In both the training and external validation sets, there were statistically significant differences in cTnI, QTc, TpTec, and TpTe/QT between the MVA and non-MVA groups (P<0.01). TpTec [OR (95%CI): 1.123 (1.067-1.183)] and TpTe/QT [OR (95%CI): 1.026 (1.008-1.045)] were both associated with the occurrence of MVA in children with VMC. The Hosmer-Lemeshow goodness-of-fit test showed that there was no statistically significant difference between the predicted and observed values (P=0.294). The area under the ROC curve (AUC) (95%CI) for cTnI to predict MVA in VMC children was 0.651 (0.540-0.763), with a sensitivity of 0.617 and a specificity of 0.865 when the Youden's index was maximized (2 475.000). For TpTec, the AUC (95%CI) was 0.917 (0.859-0.975), with a sensitivity of 0.723 and a specificity of 0.981 when the Youden's index was maximized (110.500). For TpTe/QT, the AUC (95%CI) was 0.825 (0.746-0.905), with a sensitivity of 0.745 and a specificity of 0.750 when the Youden's index was maximized (0.265). The AUC (95%CI) for the combination of TpTec and TpTe/QT was 0.939 (0.892-0.987), with a sensitivity of 0.894 and a specificity of 0.865 when the Youden's index was maximized (0.472), which was higher than that of TpTe/QT (P<0.01). In the validation set, the accuracy and fit of the TpTec combined with TpTe/QT model were also good (P=0.800), and the AUC (95%CI) for predicting MVA was 0.992 (0.972-1.000), with a sensitivity of 0.936 and a specificity of 0.904 when the Youden's index was maximized (0.557).

TpTec≥110.50 ms and TpTe/QT≥0.265 indicate a potential risk of MVA in children with VMC, requiring close clinical attention. The predictive value of the combined TpTec and TpTe/QT for MVA in children with VMC is higher than that of TpTe/QT alone.

To investigate the preoperative anesthesia risk assessment factors in young children with severe recurrent respiratory papillomatosis (RRP).

The clinical data of children aged 0-6 years with RRP who were admitted to Beijing Tongren Hospital Affiliated to Capital Medical University from January 2014 to August 2024 were retrospectively included, and the children were divided into severe group and non-severe group according to whether they experienced dyspnea of grade Ⅱ or more severe. Preoperative clinical data of two groups were compared, including previous surgical history, preoperative presence of vocal cord adhesion, endotracheal tumor dissemination, history of tracheotomy and systemic conditions such as fever and respiratory infections, and American Society of Anesthesiologists (ASA) classification, as well as perioperative anesthesia data such as the ratio of a single successful intubation during anesthetic induction, operative time, hypoxic events, and data of recovery from anesthesia.

A total of 155 young children with RRP were included, including 93 males and 62 females, with the age of first surgery being 3.5 (2.3, 4.8) years, of which 79 (51%) were severe on each occasion, 43 (27.7%) were non-severe on each occasion, and the remaining 33 (21.3%) had both severe and non-severe RRP during the treatment. The number of surgeries per child ranged from 1 to 72 times and the total number was 686. There were 513 cases in the severe group and 173 cases in the non-severe group. Endotracheal tumor dissemination [14.8% (76/513) vs 6.4% (11/173)], vocal cord adhesion [31.9% (164/513) vs 16.2% (28/173)], history of tracheostomy [9.2% (47/513) vs 1.2% (2/173)], ASA grade Ⅲ-Ⅳ [24. 8% (127/513) vs 10.4% (18/173)], fever [5.3% (27/513) vs 0.6% (1/173)] and respiratory tract infections [8.6% (44/513) vs 3.5% (6/173)] of severe group were higher than non-severe group (all P<0.05). The ratio of a single successful intubation [69.6% (357/513) vs 97.7% (169/173)] in severe group was lower than non-severe group. Compared with non-severe group, the severe RRP children had a significantly higher proportion of hypoxia during induction [5.3% (27/513) vs 0.6% (1/173)] and recovery periods [6.0% (31/513) vs 1.2% (2/173)], the operation time [50 (40, 60) versus 38 (30, 50) min], anesthesia recovery time [15 (10, 20) vs 10 (15, 15) min] and post-anesthesia care unit (PACU) recovery time [30(26, 45) vs 30(25, 32) min] (all P<0.05). Two of the severe RRP children were transferred to the intensive care unit with endotracheal tube for respiratory support, and were returned to the ward after 24 h with endotracheal tube removed.

The perioperative anesthesia risk assessment factors of young children with severe RRP include vocal cord adhesion, history of tracheostomy endotracheal tumor dissemination, ASA grade Ⅲ-Ⅳ and systemic conditions such as fever and respiratory infections.

To investigate the detection status of respiratory pathogens with direct-to-consumer testing and the characteristics of the population with human respiratory syncytial virus (HRSV) detection in the winter and spring of 2023-2024.

From October 2023 to April 2024, polymerase chain reaction (PCR) detection of 12 respiratory pathogens was conducted among the general population willing to be tested in the cross-sectional study of 7 cities across the country. Age, gender, and symptom data of the tested population were collected. Chi-square test was used to analyze the differences in HRSV detection rates among different genders, ages, and regions. The temporal distribution of HRSV detection and the situation of co-infection were also analyzed.

A total of 459 972 test samples were included, and the age [M (Q₁, Q₃)] was 30 (9,38) with an age range of 0 to 90 years. The total number of HRSV detections was 17 387, with a total detection rate of 3.78%. The HRSV detection rates in the 0-1 year old (11.56%, 1 669/14 440), 2-5 years old (8.09%, 3 746/46 300), 60-74 years old (3.60%, 807/22 386), and≥75 years old (4.31%, 169/3 921) were higher than those in the 6-17 years old (2.93%, 3 238/110 502) and 18-59 years old (2.96%, 7 758/262 423) (P<0.003 3). The HRSV detection rate in North China (5.51%, 11 648/211 450) was higher than that in East China (2.41%, 3 964/164 806), South China (2.14%, 1 722/80 579), and Southwest China (1.69%, 53/3 137) (P<0.008 3). HRSV in North China showed a single peak epidemic pattern, with an epidemic peak from November 2023 to January 2024; compared with North China, the epidemic period of HRSV in South China started earlier, with epidemic peaks in October 2023 and March-April 2024; in East China, HRSV showed epidemic peaks in early January 2024 and March 2024. Among the HRSV-detected population, the proportion of HRSV co-detected with one pathogen was the highest (46.62%, 8, 106/17, 387), with the highest proportion being HRSV co-detected with one bacterium (43.42%, 7, 549/17, 387).

The findings from the direct-to-consumer testing of respiratory pathogens during the winter and spring of 2023-2024 reveals that HRSV is predominantly detected in children aged 0-5 years old and elderly individuals≥60 years old. The epidemic period for HRSV in South China precedes that in North China. Furthermore, HRSV is frequently associated with a specific type of bacteria.

A retrospective study was conducted on the clinical data of male patients who developed complications after artificial urethral sphincter (AUS) implantation at Beijing Hospital from March 2019 to December 2024. The study evaluated the occurrence, management, and outcomes of these complications. Among the 72 patients who underwent AUS implantation, 10 patients (13.9%), aged 27-85 (64.9±19.4) years old, experienced complications following AUS implantation. Two patients developed painless gross hematuria, which improved after symptomatic treatment. Two patients involved control pump erosion through the skin, leading to device exposure, and were treated with debridement and revision surgery while retaining the AUS device. Among the five patients with urethral erosion, different surgical methods were selected according to the degree of urethral defect: three underwent device removal+partial urethral resection+termino-terminal anastomosis, one underwent cuff removal+urethral repair, and one underwent device removal+partial urethral resection+mucosal transplantation+cystostomy. One patient experienced mechanical failure (system leakage) and underwent AUS replacement surgery. All patients were followed up for [M (Q₁, Q₃)] 5.5 (2.3, 37.5) months. No recurrence of hematuria was observed. Patients with device exposure and mechanical failure achieved social continence, while patients with urethral erosion returned to persistent incontinence. No surgery-related complications occurred. Early identification, accurate diagnosis, and appropriate management are key to diagnosing and treating AUS postoperative complications.

This retrospective study collected the clinical data of patients with benign prostatic hyperplasia (BPH) treated with Rezūm water vapor thermal therapy system between July 2022 and August 2024 in the Department of Urology at the Second Affiliated Hospital of Soochow University. All patients were over 80 years old with comorbid high-risk diseases. The international prostate symptom score (IPSS), quality of life (QOL) score, maximum urinary flow rate (Q_max), and post-void residual urine volume (PVR) were recorded and compared preoperatively and postoperatively at 3 and 6 months. A total of 34 patients were included, with a mean age of (85.4±5.1) years. All patients had at least two chronic diseases, including hypertension, diabetes, cardiovascular and cerebrovascular disease, and chronic obstructive pulmonary disease. Among them, 10 patients required long-term anticoagulation with aspirin and (or) clopidogrel. The differences in IPSS[(13.5±3.2) scores vs (12.6±2.2) scores], QOL score[(2.3±0.6) scores vs (2.2±0.7) scores], Q_max[(14.7±1.8) ml/s vs (15.0±1.2) ml/s], and PVR[50.0(19.0, 81.0) ml vs 45.2(17.5, 63.5) ml] at both 3 and 6 months postoperatively were not statistically significant (all P>0.05). However, statistically significant differences were observed when compared with the preoperative data (all P<0.05). The results suggest that the Rezūm water vapor thermal therapy is safe and feasible for elderly, high-risk patients with BPH, improving lower urinary tract obstruction symptoms with good short-term efficacy.

Chronic obstructive pulmonary disease (COPD) is a common chronic airway disease, and standard medical treatment has limited efficacy for some COPD subtypes or end-stage COPD. In recent years, with the continuous development of respiratory endoscopic interventional technology, endoscopic interventional therapy for some specific subtypes of COPD people has begun to attract the attention of clinicians because of its unique benefits and more significant symptom improvement, and has become a new treatment option after standard treatment of COPD. In order to better understand the operating principle, audience selection and efficacy evaluation of new interventional techniques related to COPD, this paper reviews the current mainstream endoscopic interventional techniques for specific subtypes of COPD based on existing evidence, including various lung volume reduction surgeries for emphysema phenotype and targeted lung denervation and ablation, bronchorheoplasty and metered-dose cryospray for chronic bronchitis phenotype. The background mechanism, evidence-based evidence and safety of various techniques are summarized and analyzed, and suitable populations are recommended according to existing evidence, so as to provide reference and reference for clinical practice.