Objective To investigate the clinical manifestations,laboratory findings and renal patho logic changes,as well as their relationships in patients with lupus nephritis (LN).Methods According to the latest classification criteria of lupus nephritis,the clinical manifestations,laboratory findings and renal patho logic changes and their relationships of 281 cases of biopsy proven LN were retrospectively analyzed.Results Totally 281 cases of LN patients were enrolled in total.The ratio of male to female was 1∶9.7.Proteinuria ac companied with hematuria (35.2%) and nephrotie syndrome (33.8%) were the main clinical manifestations. The most common renal pathological change was type Ⅳ LN (35.9%) and type Ⅲ,Ⅳ and Ⅴ accounting for 89.0% totally.The main pathologic changes of nephrotic syndrome were type Ⅳ and Ⅴ,while those who ac companied with renal dysfunction were mainly type Ⅵ and Ⅳ.Most simple hematuria cases showed mild renal injury.However,type Ⅳ and Ⅴ accounted for 40.4% in the 47 cases of LN whose 24 hours urine protein＜ 1.0 g and with normal renal function.Most severe proteinuria was found in Type Ⅴ and higher serum creatinine and anti-dsDNA antibody level were found in type Ⅵ and Ⅳ.The lowest lever of serum complement 3 (C3) was found in type Ⅳ.The amount of 24 hours urine protein showed negative correlation with semm C3 but positive correlation with serum creatinine.Serum C3 demonstrated negative relationship with serum creatinine and anti-dsDNA antibody,while serum creatinine was positively related to anti-dsDNA antibody level. Conclusion The major renal pathological lesions of LN are type Ⅲ,Ⅳ and Ⅴ.There are associations be tween clinical and pathological changes,but axe not always consistent.Proteinuria,low serum C3 and high an ti-dsDNA antibody level may provide clue to severe and active LN.Renal biopsy is important in the diagnosis and progression evaluation of LN.

Objective:To investigate the effect of bupivacaine on Apelin/APJ pathway and subsequent gene expression in Sprague-Dawley (SD) rat cardiomyocytes.Methods:H9c2 cardiomyocytes were cultured in vitro and treated with 0-1 mmol/L bupivacaine for 6 h. The concentration of Apelin was detected by enzyme-linked immunosorbent assay (ELISA), and the expression of APJ was detected by Western blot; Fifteen adult male SD rats were randomly divided into sham group (sham group), bupivacaine 30 mg/kg group (Bupi group), bupivacaine 30 mg/kg+ [Pyr 1] apelin-13 0.15 mg/kg (Bupi-A) group. After corresponding treatment, myocardial tissue was taken to detect the expression of Apelin and APJ, and high-throughput sequencing was performed. Results:Western blot and ELISA results showed that bupivacaine down regulated the expression of Apelin and APJ in H9c2 cardiomyocytes (all P<0.05). The expression levels of Apelin and APJ in the myocardial tissue of SD rats in Bupi group were lower than those in sham group (all P<0.05). The expression of Apelin in myocardial tissue of Bupi-A group was higher than that of Bupi group ( P=0.006), but the expression of APJ had no significant difference ( P>0.05). High throughput sequencing revealed that compared with sham group, the top five differentially expressed genes that were significantly upregulated in Bupi group but significantly downregulated in Bupi-A group were ubiquinone NADH dehydrogenase Fe-S protein 3, enolase 1, aquaporin 1, ATP synthase F0 complex C subunit 1 lipid binding protein, and peroxidase 2 (all P<0.001); The top five genes that were significantly down regulated in Bupi group but significantly up-regulated in Bupi-A group were mesothelin, Rho GTPase activating protein 29, sten20 like kinase, carbonic anhydrase, and paraplatelet lysin (all P<0.001). These genes were associated with increased cardiomyocyte apoptosis, energy metabolism disorders and exercise attenuation. Conclusions:bupivacaine can reduce the expression of Apelin, leading to the changes of gene expression related to increased apoptosis, energy metabolism disorder and exercise attenuation in rat cardiomyocytes.

To report a 4-year-old boy with severed right index finger amputations in 2 segments. There were severe contusion on the 2 amputated sections of finger. According to the prevention and control requirement for the novel coronavirus disease(COVID-19), the patient was firstly checked to exclude the COVID-19. Then the replantation surgery was successfully carried out under the strict protective measures. The replanted index finger survived well at 2 weeks after surgery.

Objective:To evaluated the options in selection of surgical procedures for treatment of the patients suffering from diabetic feet with chronic refractory wounds.Methods:From January 2020 to June 2021, 23 patients with diabetic feet complicated with refractory wounds were treated in Department of Hand Surgery, Shunde Heping Surgical Hospital. The patients were 15 males and 8 females, aged 51-86 years old and with an average age of 65 years old. All the patients had Type-II diabetes for over 5 - 22 years. Average blood glucose of the patients was found at 15.6 mmol/L on admission. Free anterolateral thigh perforator flaps (ALTPF) were used for reconstruction of the wound of diabetic feet in 19 patients, 2 patients received vascular bypass surgery and 2 had amputations. Regular outpatient follow-up were conduct on all patients after surgery.Results:Follow-up time lasted for 8 to 30 months, 12 months in average. At the last follow-up, the donor and recipient sites healed well in the 19 patients who received flap reconstruction, without an infection, necrosis and wound recurrence. Pains were significantly relieved after the surgery in the 2 patients who received vascular bypass surgery, and wounds all healed well after symptomatic treatment and dressing change without recurrence of wounds at the last follow-up. Average Maryland score of foot function was 84 for the patients who had limb salvage, and 2 patients were in excellent and 19 in good at the last follow-up. The 2 patients who had amputation successfully survived through the perioperative period, and the wounds healed well at the last follow-up.Conclusion:The treatment is complicated in the patient suffering from diabetic foot with chronic refractory wounds due to factors such as advanced age, co-existing and complicated underlying diseases together with the complex wounds. Most patients can achieve good prognosis in wound treatment of free flap transfer or vascular bypass surgery. However, a limb salvage is recommended with caution for the patients who have severe infections and dry gangrene.