Objective To observe the effects of lα-hydroxyvitamin D3 on renal tubular function in the patients with IgA ne phropathy(IgAN) accompanied with proteinuria.Methods Forty-eight eligible patients with IgAN were selected as the IgAN group and divided into the treatment group and control group according to the random number table method,meanwhile 30 healthy adults undergoing healthy physical examination were selected as the normal group.On the routine treatment such as maintaining the double dose of renin-angiotensin system(RAS) blocker,the treatment group took oral l α-hydroxyvitamin D3 capsule (0.5 μg,once a day);the control group continued to adopt the original treatment scheme.The treatment course lasted for 12 weeks.The changes of urinary cystatin C(Cys-C),α1-microglobulin(α1-MG),N-acetyl-β-D-glucosaminidase (NAG),24 h urinary total protein (UTP),blood urea nitrogen (BUN),serum creatinine (Scr),serum calcium (Ca),serum phosphorus (P) and intact parathyroid hormone (iPTH) in two groups were respectively compared between before and after treatment.Results Compared with the normal group,urinary Cys-C,αl-MG and NAG levels in the IgAN group were significantly increased (P＜ 0.01).After 12-week treatment,the levels of Cys-C,α1-MG and NAG were obviously declined compared with that before treatment and in the control group,the differences were statistically significant (P＜ 0.05),meanwhile the UTP level had statistical difference between the two groups after treatment and between before and after treatment in the same group (P＜0.05),but the decrease in the treatment group was more significant than that in the control group(P＜0.05).There was no statistically significant difference in BUN,Scr,Ca,P and iPTH between the two groups before and after treatment(P＞0.05).Conclusion There exists tubulointerstitial injury in IgAN with proteinuria.1α-hydroxyvitamin D3 can significantly decrease urine protein and improves the renal tubular function in the patients with IgAN.

Objective To revise looming maladaptive style questionnaire(LMSQ-R) and examine its reliability and validity.Methods 284 undergraduates were measured preparedly with LMSQ-R,281 university students participated in a retest,using LMSQ-R,fear of negative evaluation scale (FNE),Beck anxiety inventory (BAI),Beck depression inventory (BDI).Results ①The item distinguish analysis was acceptable.②Reliability analysis confirmed that Cronbach α coefficient of LMSQ-R was 0.736,Cronbach α coefficient of the two subscales were 0.593 and 0.636.The test-retest reliability of LMSQ-R ranged from 0.564 to 0.700.③Confirmatory factor analysis suggested that the first order six factor-second order two factor model was perfect according to the evaluation criteria.The correlation coefficient between the two subscales was 0.527,the correlation coefficients among the two subscales and the total score ranged from 0.872 to 0.875.The correlation coefficients among the LMSQ-R and FNE,BAI,BDI ranged from 0.872 to 0.875,the results had statistical significance.Conclusion The revised LMSQ-R shows the satisfactory reliability and validity in university students.It can be used as a useful testing tool of LCS in psychological research.

We injected collagenase into the lumbor disc(20 cases)or outside the lumbar disc(230 cases)for treating the patients with lumbar disc herniation from December 1994 to August 1996.200 cases had been followed up.The results were excellent or good in 91%.The authers in- troduced the operative method and its indications in detail,and suggested that chemonucleolysis is sate,good and easy to be operated with littlecomp lieation.Herniation more than 10mm in with cal- cification,lateral recess stenosis or recumance after the laminectomy are not the absolute contraindi- cations.

Objective Preoperative autologous blood donation ( PABD) may reduce the need for allogeneic blood , but it may also cause a short massive blood loss in pregnant women , and its fetal and maternal safety has to be adequately assessed .This study was to evaluate the feasibility and safety of PABD for pregnant women and their fetuses . Methods A prospective observational study was conducted among the women who met the inclusion criteria and gave birth in Nanjing Drum Tower Hospital between January and December 2013 .According to the clinical validation of risk stratification criteria for peripartum hemorrhage of California 2013 , the ca-ses were classified into a low-, a medium-, and a high-risk group.Data on blood donation procedures , obstetric outcomes, and blood transfusions were collected after delivery for analysis . Results Totally, 92 pregnant women accomplished 115 blood donations .The median volumes of the donated blood were 300, 300, and 400 mL in the low-, medium-, and high-risk groups, respectively ( P>0.001).There were no significant changes in HR , SBP and SpO2 during the blood donation procedures (P>0.05) except for the fall of diastolic blood pressure by an average of 3.4 mmHg (P<0.05) at 5 minutes after blood collection, which was restored to normal later.Non-reassuring fetal heart rate patterns were not found in any of the cases .The levels of HB and HCT were remarkably lower af-ter donation than before it (P<0.05) but restored to normal before delivery in the PABD cases who donated once only (P>0.05), which were similar to those in the cases who donated twice , with no significant differences before and after the donation (P>0.05). Homologous blood transfusion was performed for 5 cases (17.9%) in the high-risk group, with the volume of blood loss >2000 mL in all the cases.All the newborns survived without asphyxia and there was no perinatal death . Conclusion PABD can provide timely autologous whole blood donation for pregnant women .Under strict management , PABD is feasible and safe for pregnant patients who are at a high risk for massive blood loss during delivery or have a rare type of blood no readily available .

Objective:To evaluate the clinical application of online adaptive radiotherapy based on iterative cone-beam computed tomography (iCBCT) for the pelvic malignancies.Methods:This was a prospective clinical trial of iCBCT guided online adaptive radiotherapy for pelvic malignancies in Department of Radiation Oncology, Peking Union Medical College Hospital. Clinical data of 13 patients with pelvic malignancies who received online adaptive radiotherapy from August to November, 2022 were preliminarily analyzed (2 cases of cervical cancer, 4 postoperative cervical cancer, 3 postoperative endometrial cancer, 3 bladder cancer and 1 prostate cancer). The feasibility of online adaptive radiotherapy, adaptive radiotherapy time, the frequency and magnitude of edits for organs at risk and target volume, target volume coverage and organs at risk doses were analyzed. Statistical analysis was performed by SPSS software. Data conforming to normal distribution were described by Mean±SD, and data with non-normal distribution were expressed by M ( Q1, Q3). Data with homogeneous variances were analyzed by t-test, and data with non-normal distribution or heterogeneous variances were analyzed by nonparametric test. Results:The average adaptive time was 15 min and 38 s (from acceptance of acquired CBCT scan to completion of the final plan selection). 85.4% (830/972 fractions) of influencer structures (system-defined organs adjacent to and with high impact on the generation of clinical target volume and planning target volume, primarily bladder, rectum and small intestine in pelvic neoplasms) automatically generated by artificial intelligence required no edits or minor editors, and 89.8% (491/547 fractions) of clinical target volume automatically generated by artificial intelligence required no edits or minor editors. The adapted plan was adopted in 98.5% (319/324 fractions) of radiotherapy fractions. Compared with the scheduled plan, the adapted plan showed better target volume coverage and reduced the dose of organs at risk.Conclusions:iCBCT guided online adaptive radiotherapy for the pelvic malignancies can be achieved within clinically acceptable timeslots. In addtion, better dose coverage of target volume shows the advantages of online adaptive radiotherapy.