To study the abnormal distribution of type Ⅳ collagen and laminin chains in glomerular basement membrane (GBM) in membranous nephropathy (MN).Methods 52 cases of MN were collected and staged according to electron microscopic morphological characteristics,and 10 cases of kidney tissues of minimal change disease were used as normal GBM control.Distribution pattern of or5 (Ⅳ) chain,laminin α5and β2 chains,and laminin α2 and β1 chains were detected using immunofluorescence method.Results In minimal change disease,α5 (Ⅳ) chain,laminin α5 and β2 chains all showed continuously linear positive expression along GBM,and laminin α2 and β1 chains were negatively expressed in GBM.In stage Ⅰ MN,α5 (Ⅳ) chain,laminin α.5 and β2 chains all showed continuous linear positive expression along GBM.In stage ⅡMN,the expression of α5 (Ⅳ) chain was increased and showed abundant spikes on the basis of continuous linear positive staining along GBM,and the expression of laminin α5 and β2chains was increased,and segmental spikes were seen on the basis of continuous linear positive staining along GBM.In stage ⅢMN,the expression of α5 (Ⅳ),laminin α5 and β2 chains was also enhanced and segmental double tracks were seen.The expression of laminin α2 chain was negative in GBM in stage ⅠMN,but granular positive expression along GBM was seen in stage Ⅱ and stage Ⅲ MN.No positive expression of laminin β1chain was seen in GBM in different stages in MN.Conclusion The GBM thickness in MN originates not only from intrinsic type Ⅳ collagen chains and laminin chains,but also from laminin α2chain,which only exist in glomerulus mesangium in normal condition.

Objective To study and explore the application effect of compound ipratropium bromide combined with budesonide in acute severe asthma.Methods 100 emergency patients with severe asthma were selected as study subjects,the patients were divided into two groups by following the principles of randomized single blind,each group had 50 cases.The control group received aminophylline treatment,the observation group was treated with budesonide combined with ipratropium bromide inhalation therapy.The clinical curative effect,relieve symptoms,condition of arterial blood gas and pulmonary function were compared between the two groups.Results The total effective rate of the observation group was 96％,which of the control group was 80％,the difference was statistically significant (x2 =6.061,P ＜ 0.05).The remission time of cough [(5.60 ± 1.35) d],expectoration [(3.54 ± 1.25) d],shortness of breath[(1.93 ± 0.87) d],wheezing [(6.09 ± 1.26) d] and other symptoms in the observation group were significantly shorter than those in the control group [(7.39 ± 1.72) d,(5.17 ± 1.54) d,(3.26 ± 1.08) d,(8.43 ±1.95) d](t =5.789,5.811,6.781,7.127,all P ＜ 0.05).After treatment,the arterial blood gas and lung function in the observation group were significantly improved (all P ＜ 0.05),which were better than those in the control group after treatment (all P ＜ 0.05).Conclusion The clinical curative effect of budesonide combined with ipratropium bromide in the treatment of patients with severe asthma is significant,it can improve the symptoms,pulmonary ventilation function and arterial blood gas.

Objective: To study the efficacy of 1 mg·kg^-1·d^-1 and 2.0 mg·kg^-1·d^-1 of propranolol in the treatment of infantile hemangiomas, so as to provide an ideal dosage for clinical treatment. Methods: From September 2015 to October 2016, there were 89 patients in accordance with the inclusion criteria of infantile hemangiomas. According to randomized and controlled principle, the patients were assigned to receive two propranolol regimens, Group A(n=45): propranolol at a dose of 1 mg·kg^-1·d^-1; Group B(n=44): propranolol at a dose of 2 mg·kg^-1·d^-1. 1 or 2 mg of propranolol base per kilogram per day, divided into two doses.The first dose was taken at 9, next at 15.The effective rate, cure rate and adverse effect rate were compared at the six months after treatment. The duration of the treatment was compared after 12 months′ treatment, and the recurrence rate was compared at the three months after being cured.The data were statistically processed with SPSS 22.0. The sample rate was compared with χ² test, and the data were compared with t test. P<0.05 was statistically significant difference. Results: Group A: Treatment for 6 months, 45 children were evaluated as follows: the effective rate was 91.1%(41/45), the cure rate was 60%(27/45). The incidence of adverse reactions was 13.3%(6/45). The cure rate of group A at 12 months was 86.7%(39/45). The duration of treatment was 7.6±2.7 months.The recurrence rate was 9.5%(4/42). Group B: Treatment for 6 months, 44 children were evaluated as follows: the effective rate was 90.9%(40/44), the cure rate was 72.7%(32/44). The incidence of adverse reactions was 15.9%(7/44). The cure rate of group B at 12 months was 88.6%(39/44). The duration of treatment was 6.2±1.9 months. The recurrence rate was 11.9%(5/42). The effective rate of the two groups at 6 months was not statistically significant(χ²=2.583, P=0.461). The cure rate of the two groups at 6 months was statistically significant(χ²=8.339, P=0.004). The incidence of adverse effects was not statistically significant(χ²=0.118, P=0.731). The cure rate of the two groups at 12 month was not statistically significant(χ²=0.080, P=0.778). The duration of treatment between the groups was statistically significant (t=0.290, P=0.009). The recurrence rate of the two groups after 3 months withdrawal was no statistical difference(χ²=0.124, P=0.724). Conclusions The propranolol doses at 1 mg·kg^-1·d^-1 and 2 mg·kg^-1·d^-1 in the treatment of infantile hemangiomas are safe and effective. The propranolol dose at 1 mg·kg^-1·d^-1 doesn′t decrease the effective and cure rate, not increase the recurrence rate in infantile hemangiomas. Low dose at 1 mg·kg^-1·d^-1 can be used as a common dose of propranolol in infantile hemangiomas.

Objective To observed the clinical efficacy and safety of high pressure-resistant double-lumen peripherally inserted central catheter (Power PICC) and central venous catheter (CVC) in patients with stem cell transplantation.Methods This was a matched cross-sectional study with 60 patients with leukemia who were treated with catheterization of central venous (30 cases receiving Power PICC vs.30 cases receiving CVC) during stem cell transplantation in the First Affiliated Hospital of Chinese PLA General Hospital.Indwelling time,success rate of catheterization,complications,velocity and stem cell engraftment time were recorded and compared between the Power PICC group and CVC group.Results There were significant differences between the two groups on indwelling time [(18.47±4.44) min vs.(14.43± 1.72) min,t =3.719,P＜0.001],complications [6.67％ (2/30) vs.30％ (9/30),x2 =48.445,P=0.002] and velocity.However,no significant difference was found in success rate of catheterization and stem cell engraftment time (P＞0.05).Conclusion Power PICC performed better than CVC with well tolerability and satisfactory efficacy,which is worthy of promotion and application in the future.

Objective To investigate the onset of liver inflammation and related predictive factors in patients with HBeAg-positive chronic hepatitis B virus (HBV) infection who have normal alanine aminotransferase (ALT) and a high viral load. Methods A retrospective analysis was performed for the clinical data of 183 patients with HBeAg-positive chronic HBV infection who had normal ALT and a high viral load and were treated from October 2008 to May 2015, and according to the results of liver biopsy, they were divided into hepatitis group and non- hepatitis group. The t -test or Mann-Whitney U testwas used for comparison of normally distributed continuous data between groups, the chi-square test was used for comparison of categorical data. The predictive factors were analyzed by univariate binary logistic regression, the multivariate binary logistic regression was carried out by stepback method, and the cut-off values were analyzed by receiver operating characteristic curve (ROC) and Jordan index. Results There were 37 patients (20.2%) in the hepatitis group and 146 patients (79.8%) in the non-hepatitis group. Compared with the non-hepatitis group, the hepatitis group had a significantly lower proportion of male patients (45.9% vs 68.5%, χ 2 =6.508, P =0.011), a significantly higher level of aspartate aminotransferase [24 (21.25~35.55) U/L vs 21.2 (18.08~ 24.65) U/L, Z =-3.344, P =0.001], and a significantly lower log(HBsAg) value [4.4(4.28~4.49) vs 4.46(4.4~4.74), Z =-2.184, P =0.029]. Log(HBsAg) value was a predictive factor for hepatitis (odds ratio=0.077, P =0.017), and the cutoff value of HBsAg was 33884.4I U/mL. Conclusion Among the patients with HBeAg-positive chronic HBV infection who have normal ALT and a high viral load, 20.2% have liver inflammation, and HBsAg may be a predictive factor for liver inflammation.

Objective To compare clinical and pathological features between autoimmune hepatitis (AIH) patients with positive and negative autoantibodies, and to summarize the experience in diagnosis. Methods A retrospective analysis was performed for the patients who attended Beijing Ditan Hospital from January 2010 to August 2021 and were diagnosed with AIH by liver histopathology, and according to the presence or absence of autoantibodies, they were divided into positive autoantibody group and negative autoantibody group. The two groups were compared in terms of biochemical parameters, immunological features, histopathological features, disease stage, and clinical symptoms and signs. The t -test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical data. Results A total of 110 patients were enrolled, among whom 78 (71%) had positive autoantibodies and 32 (29%) had negative autoantibodies. Anti-nuclear antibody (ANA), anti-mitochondrial antibody (AMA), and anti-smooth muscle antibody (ASMA) were the main autoantibodies detected, and of all 110 patients, 74 (67.27%) had positive ANA, 1 (0.91%) had positive AMA, 5 (4.55%) had positive ASMA, and 14 (12.73%) had positive anti-Ro-52 antibody. As for clinical and immunological features, compared with the positive autoantibody group, the negative autoantibody group had significantly lower incidence rates of jaundice of the skin and sclera (21.90% vs 50.00%, χ 2 =7.377, P =0.007) and poor appetite (18.80% vs 41.00%, χ 2 =4.979, P =0.026) and significantly lower median levels of direct bilirubin [7.30(4.05~12.10) μmol/L vs 16.80(6.48~69.75) μmol/L, Z =-2.304, P =0.021], IgG [16.40(13.15~18.05) g/L vs 20.30(16.00~27.15) g/L, Z =-2.715, P =0.007], and GLo [30.60(26.00~34.90) g/L vs 37.30(30.50~42.50) g/L, Z =-3.356, P =0.001]. In terms of liver histopathology, compared with the negative autoantibody group, the positive autoantibody group had a significantly higher proportion of patients with lymphocyte infiltration (91.03% vs 68.75%, χ 2 =6.997, P =0.008) and plasma cell infiltration (82.05% vs 50.00%, χ 2 =11.572, P =0.001); compared with the ANA-negative patients, the ANA-positive patients had significantly higher inflammation grade (G1-G4) (9.46%/16.22%/44.59%/29.73% vs 5.56%/27.78%/63.89%/2.78%, Z =-2.179, P =0.029) and fibrosis degree (S1-S4) (37.84%/25.68%/32.43%/4.05% vs 13.89%/41.67%/30.56%/13.89%, Z =-0.082, P =0.037). Conclusion Compared with AIH patients with positive autoantibodies, AIH patients with negative autoantibodies are mostly in the early stage of the disease and tend to have a low level of IgG, with a relatively high rate of missed diagnosis in clinical practice. Early and active liver biopsy is of particular importance.