Diabetic nephropathy (DN) is one of the most common microvascular complications in diabetes mellitus patients and is characterized by thickened glomerular basement membrane,increased extracellular matrix formation,and podocyte loss.These phenomena lead to proteinuria and altered glomerular filtration rate,that is,the rate initially increases but progressively decreases.DN has become the leading cause of end-stage renal disease.Its prevalence shows a rapid growth trend and causes heavy social and economic burden in many countries.However,this disease is multifactorial,and its mechanism is poorly understood due to the complex pathogenesis of DN.In this review,we highlight the new molecular insights about the pathogenesis of DN from the aspects of immune inflammation response,epithelial-mesenchymal transition,apoptosis and mitochondrial damage,epigenetics,and podocyte-endothelial communication.This work offers groundwork for understanding the initiation and progression of DN,as well as provides ideas for developing new prevention and treatment measures.

Objective To retrospectively analyze the treatment results and prognostic factors in patients with primary bone lymphomas (PBL).Methods Thirty-one patients with PBL treated between April 1994 and May 2009 at Sun Yat-sen University Cancer Center were analyzed.All patients were diagnosed by pathology.Twenty-two patients had stage Ⅰ E, 4 patients had stage Ⅱ E and 5 patients had stage ⅣE diseases.One patient was treated with surgical resection alone, 1 patient with radiotherapy (RT) alone, 2 patients with chemotherapy (CT) alone and 4 patients with resection followed by chemotherapy.The remaining 23 patients received CT combined with RT.The median radiation dose was 50 Gy.Results The median follow-up time was 45.2 months.The follow-up rate was 83.9%.Nine patients had a follow-up time of 10 years.The 5-year and 10-year overall survival rates were 92% and 92%, respectively.The 5-year and 10-year disease-free survival rates were 79% and 70%, respectively.In the group who received non-combined chemoradiotherapy, the complete response rate was 50%, the incidence of progression or recurrence was 2/8 and the median recurrence time was 6.8 months.In the group who received combined chemoradiotherapy, the complete response rate was 65%, the incidence of progression or recurrence was 13% and the median recurrence time was 39.1 months.In univariate analyses, favorable prognostic factors for survival included age≤50 years (χ2=5.32,P=0.021) and ECOG PS score 0-1(χ2=5.48,P=0.019).Favorable prognostic factors for DFS included IPI score≤1(χ2=7.81,P=0.005) and ECOG PS score 0-1(χ2=18.70,P=0.000).Conclusions Treatment results of patients with PBL can be generally well.CT combined with RT appears to be the treatment of choice.RT dose ≥40 Gy is safe and feasible.Younger age and better performance status are associated with a better outcome.

Objective To investigate the tendency of quality of life in patients with nasopharyngeal carcinoma (NPC) treated with conventional radiotherapy. Methods Quality of life in NPC patients was assessed using FACT-H&N and NPC-QOL Patients were divided into nine groups according to the treatment period :before treatment group, 0 -20 Gy group, 20 -50 Gy group, > 50 Gy group, 0 -6 months after treatment group, 6 - 12 mouths group, 1 -2 years group, 2 -3 years group and 3 -5 years group. Scores of FACT-H&N and NPC-QOL were compared between the either two groups. Results 450 NPC patients were assessed. The total score of FACT-H&N decreased during the treatment and then increased six months after the treatment. The tendencies of physical and functional well-being were similar. The social/family and emotional well-being did not change significantly along with the treatment but the scores of head and neck well-being and NPC-QOL decreased obviously. Xerotomia was aggravated from the initiation of treatment and became the most severe at 6 - 12 months after treatment. 50% - 60% of the patients with disease-free reported severe xerotomia at 3 -5 years after radiotherapy. Incidence of severe trismus increased up to 14% at 3 -5 years after treatment. Conclusions Quality of life of NPC patients with conventional radiotherapy deteriorates during the treatment period, but recovers to the normal level six months after the treatment. Xerotomia and trismus can affect the quality of life of NPC patients.

Objective:To summarize the clinical experiences of pediatric en-bloc kidney transplantation (EBKT) at a single center and explore the measures of improving its efficacy.Methods:Clinical data and outcomes retrospectively analyzed for 38 EBKT children between September 2014 and November 2019 from Department of Urology Affiliated Union Hospital Tongji Medical College Huazhong University of Science & Technology. The pediatric donors were aged (63.6±5.7) days with a weight of (4.1±0.2) kg. And the transplant recipients were aged (28.1±1.4) years with a weight of (48.7±4.9) kg. Serum levels of creatinine and basic profiles of both donors and recipients were recorded at Day 0/7/30/90/80/360 post-EBKT. The postoperative occurrences of such complications such as thrombosis, urine leakage, delayed graft function (DGF), proteinuria and hematoma were measured.Results:The one-year graft survival rate was 76.3%(29/38) and the recipient survival rate 100.0%(38/38). Among 29 recipients with long-term graft survival, no dialysis was required at Week 2 post-EBKT and the serum level of creatinine dropped to normal at Year 1. Thrombosis was a major post-EBKT complication with an incidence of 18.4%(7/38). The other complications included urine leakage (20.7%, 6/29), hematoma (6.9%, 2/29) and primary non-functioning kidney (2.6%, 1/38).Conclusions:As an effective way of expanding the pool of donors, pediatric EBKT is clinically feasible.

Objective: To identify potential categories of problematic social networks use for college students and further analyze the association of different categories with online social anxiety and depressive symptoms, and to provide reference for formulating preventive measures to promote college students rational use of social networks. Methods: From May to June 2021, 1 082 college students from 3 universities in Shenyang, Liaoning Province were selected by convenient sampling. Students completed the Problematic Mobile Social Media Usage Assessment Questionnaire(PMSMUAQ), the Social Anxiety Scale for Social Media Users (SAS SMU) and Center for Epidemiologic Studies Depression Scale (CES D), the latent profile analysis (LPA) and R3STEP were used to analyze the data. Results: College students problematic social network use was divided into three potential categories: moderate use group (31.98%, 346), mild dependence group (49.26%, 533), and deep addiction group (18.76%, 203). Logistic regression analysis showed that urban students had a greater proportion in the deeply addicted group ( OR =1.62, P <0.05). The incidence ratios of the mildly dependent and deeply addicted groups gradually increased as daily time spent online increased ( OR =1.11，1.20， P < 0.01). There were significant differences in online social anxiety and depressive symptoms among college students with different problematic social network use types( χ 2=188.70, 62.60, P <0.01), and the deeply addicted group scored higher on online social anxiety and depressive symptoms. Conclusion There is heterogeneity in problematic social network use among college students. And to reduce the emergence of online social anxiety and depressive symptoms, college educators and parents should pay more attention to students with higher levels of problematic social network use.

Objective:To systematically evaluate the qualitative research on self-management experience of enterostomy patients at home and abroad, comprehensively understand the self-management behavior of enterostomy patients, so as to assist patients in managing stomas and provide evidence-based basis for further promoting self-management of enterostomy patients.Methods:Qualitative studies on the self-management experience of patients undergoing enterostomy were systematically searched in Cochrane Library, Joanna Briggs Institute (JBI) Evidence-Based Healthcare Center in Australia, CINAHL, PubMed, Web of Science, Scopus, EBSCO, China Biology Medicine disc, China National Knowledge Infrastructure (CNKI), VIP and WanFang Data. The search period was from database establishment to November 30, 2021. The quality of article was evaluated using the quality evaluation criteria for qualitative study of the Australian JBI Evidence-Based Healthcare Center. The results were integrated using an aggregative integration method.Results:A total of 11 articles were included and 37 clear and comprehensive research results were extracted. The similar results were categorized into 8 new categories and merged into 3 integrated results, including many misconceptions and obstacles in self-management of daily life after discharge, desire for social support systems and continuous nursing guidance, and a lot of negative emotions were generated, showing different levels of psychological stress, a few patients could actively cope.Conclusions:Society, healthcare institutions, and patient families should pay sufficient attention to the self-management of patients undergoing enterostomy, and pay attention to the negative psychological reactions such as fear, inferiority, guilt, and social self-isolation reactions they may experience during the self-management. In response to the problems encountered by patients in their daily lives, as well as the confusion they face in terms of work and social limitations, we should provide guidance and support to help stoma patients improve their self-management experience.

Objective:To establish and validate a clinical and CT radiomics combined model for predicting lymph node metastasis (LNM) risk in patients with hilar cholangiocarcinoma (HCCA).Methods:This was a case-control study. Data from 158 pathologically confirmed HCCA patients between January 2016 and January 2022 at the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. Using stratified random sampling, the patients were randomly divided into a training set ( n=95) and an internal validation set ( n=63) at a 6∶4 ratio. According to postoperative pathology, 31 LNM-positive cases and 64 LNM-negative cases were in the training set, and 22 LNM-positive cases and 41 LNM-negative cases were in the internal validation set. A cohort of 50 HCCA patients was retrospectively collected from West China Hospital of Sichuan University between October 2018 and June 2021 as an external validation set, including 21 LNM-positive and 29 LNM-negative cases. Clinical features were selected by multivariate logistic regression analysis to establish a clinical model. Radiomics features were extracted from portal venous phase CT images using 3D Slicer software. A radiomics model was developed using the least absolute shrinkage and selection operator regression algorithm. A clinical-radiomics model was constructed by integrating clinical features and Radscore, and a nomogram was developed. The prediction performance of models was evaluated by the area under the receiver operating characteristic curve (AUC). The AUC values were compared using the DeLong test. Calibration curves and decision curves were plotted to assess calibration and clinical net benefit. Results:Clinical N (cN) staging was an independent risk factor for LNM ( OR=6.86, 95% CI 2.70-18.49, P<0.001). Totally 12 optimal features were selected to construct the radiomics model, and the clinical-radiomics nomogram model was constructed by combining cN staging and Radscore. In the external validation set, the AUC (95% CI) of the clinical model, radiomics model, and clinical-radiomics nomogram were 0.706 (0.576-0.836), 0.768 (0.637-0.899), and 0.803 (0.680-0.926), respectively. The nomogram achieved higher AUC than clinical and radiomics models with statistical significance ( Z=2.01, 2.21; P=0.044, 0.027). The calibration and decision curves demonstrated good model fit, providing clinical net benefits for patients. Conclusion:The clinical-radiomics nomogram model combining cN staging and CT radiomics features can effectively predict LNM risk in HCCA patients.

Combined vaccines contain two or more antigens. Research suggested that combined vaccines could prevent multi diseases and reduce the frequency of vaccination. This article focus on combined vaccines for children used both at home and abroad, such as diphtheria-pertussis-tetanus vaccine (DTaP), measles-rubella-mumps vaccine (MMR), etc. and summarizes their immunogenicity, safety and social values, including benefits to families, vaccination workers and health services, to provide evidence for promoting the research, development and use of combined vaccines in China. We found that combined vaccines can not only ensure the immunogenicity and safety, but also give convenient and lower cost vaccination to families, and using combined vaccines can improve the work efficiency of vaccination workers, reduce the impact of the epidemic on immunization services and improve vaccination coverage and timeliness. At present, the promotion of combined vaccines in China is restricted by many technical bottlenecks, high prices, and low awareness among people. It is recommended that research on the safety, effectiveness and health economics of combined vaccines should be strengthened, and the value of combined vaccines should be scientifically evaluated; the public's awareness and trust in combined vaccines should be enhanced, as well as the development and application of multi-linked multivalent vaccines should be promoted. The government should improve regulations to assist the development and application of combined vaccines.

An improved method for extracting high quality and quantity RNA from a jelly mushroom and a dimorphic fungus—Tremella fuciformis which is especially rich in polysaccharides, is described. RNA was extracted from T. fuciformis mycelium M1332 and its parental monokaryotic yeast-like cells Y13 and Y32. The A260/280 and A260/230 ratios were both approximately 2, and the RNA integrity number was larger than 8.9. The yields of RNA were between 108 and 213 µg/g fresh wt. Downstream molecular applications including reverse transcriptional PCR and quantitative real-time PCR were also performed. This protocol is reliable and may be widely applicable for total RNA extraction from other jelly mushrooms or filamentous fungi rich in polysaccharides.
Agaricales* ; Fungi ; Humans ; Methods* ; Mycelium ; Parents ; Polymerase Chain Reaction ; Polysaccharides* ; Real-Time Polymerase Chain Reaction ; RNA*

Objective:To evaluate the role of Toll-like receptor 4(TLR4)/Src signaling pathway in activation of nucleotide-binding oligomerization domain-like receptor containing pyrin domain 3 (NLRP3) inflammasomes in hippocampus in a rat model of hepatic ischemia-reperfusion (I/R).Methods:Thirty-two clean-grade healthy Sprague-Dawley rats, aged 8 weeks, weighing 200 g, were divided into 4 groups ( n=8 each) using a random number table method: sham operation group (Sham group), hepatic I/R group (HIR group), Toll-like receptor 4 (TLR4) inhibitor TAK-242 treatment group (TAK-242 group), and Src inhibitor PP2 treatment group (PP2 group). Hepatic I/R model was established by clamping hepatic vessels for 1.5 h followed by reperfusion in anesthetized rats.TAK-242 0.5 mg/kg was injected via the tail vein at 30 min before establishing the model in group TAK-242.PP2 0.03 mg/kg was intraperitoneally injected for 3 consecutive days before establishing the model in group PP2.The animals were sacrificed at 6 h of reperfusion, and hippocampal tissues were extracted for determination of interleukin-1β (IL-1β) and interleukin-18 (IL-18) contents (by enzyme-linked immunosorbent assay), malondialdehyde (MDA) content (by TBA method), superoxide dismutase (SOD) activity (using total superoxide dismutase assay), and expression of NLRP3, apoptosis-associated speck-like protein containing CARD (ASC), c-Src, pro caspase-1, cleaved caspase-1, TLR4 and phosphorylated Src (p-Src) (Western blot). Results:Compared with Sham group, the contents of IL-1β, IL-18 and MDA were significantly increased, the SOD activity was decreased, and the expression of NLRP3, cleaved caspase-1, ASC, TLR4 and p-Src was up-regulated in the other three groups ( P<0.05). Compared with HIR group, the contents of IL-1β, IL-18 and MDA were significantly decreased, the SOD activity was increased, and the expression of NLRP3, cleaved caspase-1, ASC, TLR4 and p-Src was down-regulated in TAK-242 group and PP2 group ( P<0.05). There was no significant difference in each index between TAK-242 group and PP2 group ( P>0.05). Conclusion:The mechanism underlying activation of NLRP3 inflammasomes in hippocampus is related to activating TLR4/Src signaling pathway in a rat model of hepatic I/R.