BACKGROUND:Traditional surgery for lumbar disc herniation involves extensive excision of tissue surrounding the nerve for decompression and removal of protruding lumbar intervertebral discs,which poses various risks and complications such as nerve damage causing paralysis,lumbar instability,herniation recurrence,intervertebral space infection,and adjacent vertebral diseases. OBJECTIVE:To propose the symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous technique for lumbar spine symmetrically decompression,showing the induced resorption of herniated nucleus pulpous phenomenon and early clinical efficacy,and then analyze its decompression mechanism. METHODS:214 patients with lumbar disc herniation at Department of Orthopedics,First Affiliated Hospital of Zhengzhou University from March 2021 to May 2023 were enrolled in this study.Among them,81 patients received conservative treatment as the control group,and 133 patients received symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous treatment as the trial group.Before surgery,immediately after surgery(7-14 days),and early after surgery(over 1 year),MRI images were used to measure the volume changes of lumbar disc herniation.CT images were used to measure the posterior displacement distance of the lumbar spinous process ligament complex,as well as the width and height of the lateral recess.Japanese Orthopaedic Association scores were used to evaluate the patient's neurological function recovery. RESULTS AND CONCLUSION:(1)Control group:81 patients with lumbar disc herniation were treated conservatively,with a total of 171 herniated lumbar discs.The average follow-up time was(22.7±23.1)months.The first and second MRI measurements of 171 herniated lumbar discs showed herniated lumbar disc volumes of(551.6±257.9)mm3 and(792.2±330.4)mm3,respectively,with an average volume increase rate of(53.2±44.4)%,showing statistically significant differences(P<0.001).Out of 171 herniated lumbar discs,4 experienced natural shrinkage,with an absorption ratio of 2.3%(4/171)and an absorption rate of(24.5±9.9)%.(2)Trial group:133 patients with lumbar disc herniation had a total of 285 herniated lumbar discs.(1)Immediately after surgery:All patients were followed up immediately after surgery.229 out of 285 herniated lumbar discs experienced retraction,with an absorption ratio of 80.3%(229/285)and an average absorption rate of(21.5±20.9)%,with significant and complete absorption accounting for 6.5%.There were a total of 70 herniated lumbar discs in the upper lumbar spine,with an absorption ratio of 85.7%(60/70),an average absorption rate of(23.1±19.5)%,and a maximum absorption rate of 86.6%.There were 215 herniated lumbar discs in the lower lumbar spine,with an absorption ratio of 78.6%(169/215),an average absorption rate of(21.0±21.3)%,and a maximum absorption rate of 83.2%.Significant and complete absorption of the upper and lower lumbar vertebrae accounted for 5.7%and 6.5%,respectively,with no statistically significant difference(P>0.05).The average distance of posterior displacement of the spinous process ligament complex immediately after surgery was(5.2±2.8)mm.There were no significant differences in the width and height of the left and right lateral recess before and immediately after surgery(P>0.05).The Japanese Orthopaedic Association score immediately after surgery increased from(10.1±3.4)before surgery to(17.0±4.8),and the immediate effective rate after surgery reached 95.6%.(2)Early postoperative period:Among them,46 patients completed the early postoperative follow-up.There were 101 herniated lumbar discs,with an absorption ratio of 94%(95/101)and an average absorption rate of(36.9±23.7)%.Significant and complete absorption accounted for 30.6%,with a maximum absorption rate of 100%.Out of 101 herniated lumbar discs,3 remained unchanged in volume,with a volume invariance rate of 2.97%(3/101).Out of 101 herniated lumbar discs,3 had an increased volume of herniated lumbar discs,with an increase ratio of 2.97%(3/101)and an increase rate of(18.5±18.4)%.The Japanese Orthopaedic Association score increased from preoperative(9.3±5.1)to(23.5±4.0),with an excellent and good rate of 93.4%.(3)The early postoperative lumbar disc herniation absorption ratios of the control group and trial group were 2.3%and 85.9%,respectively,with statistically significant differences(P<0.001).(4)Complications:There were two cases of incision exudation and delayed healing in the trial group.After conservative treatment such as dressing change,no nerve injury or death occurred in the incision healing,and no cases underwent a second surgery.(5)It is concluded that symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous is a new method for treating lumbar disc herniation that can avoid extensive excision of the"ring"nerve and achieve satisfactory early clinical efficacy.It does not damage the lumbar facet joints or alter the basic anatomical structure of the lateral recess,fully preserves the herniated lumbar discs,and can induce significant or even complete induced resorption of herniated nucleus pulpous.Symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous provides a new basis and method for the clinical treatment of lumbar disc herniation.

BACKGROUND: The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China. METHODS: This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences. RESULTS: Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [ n  = 278] vs . 43.7% [ n  = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45-0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs . 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82-2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses. CONCLUSION This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.
Humans ; Percutaneous Coronary Intervention/methods* ; Male ; Female ; Coronary Artery Disease/drug therapy* ; Retrospective Studies ; Renal Dialysis/methods* ; Middle Aged ; Aged ; China ; Proportional Hazards Models ; Treatment Outcome

The Keap1-Nrf2 pathway has been shown to be an important defense mechanism against oxidative stress, which may be an effective therapeutic strategy for many diseases. The research progresses on Keap1-Nrf2 pathway in inflammatory diseases were mainly reviewed. The basic components and activation mechanism of Keap1-Nrf2 pathway were introduced. The relationship between Keap1-Nrf2 pathway and the crosstalk between NF-κB pathway and HO-1 pathway, the expression of inflammatory mediators and enzymes, and inflammatory bodies were expounded. Natural product-derived inhibitors, small molecule inhibitors targeting Keap1-Nrf2 pathway and their clinical progress were introduced, and the potential application value of Keap1-Nrf2 pathway in the treatment of inflammation was discussed.

Objective:To investigate the correlation of neutrophil-to-albumin ratio (NAR) and glucose-to-lymphocyte ratio (GLR) with in-hospital death in patients with acute myocardial infarction (AMI).Methods:The clinical data of 2 657 patients with AMI from January 2017 to December 2022 in Xuanwu Hospital, Capital Medical University were retrospectively analyzed. Using receiver operating characteristic (ROC) curve to determine the optimal cutoff values of GLR and NAR (6.02 and 0.25) for predicting in-hospital mortality in patients with AMI, the patients were divided into high GLR group (GLR≥6.02, 768 cases) and low GLR group (GLR<6.02, 1 889 cases), high NAR group (NAR≥0.25, 547 cases) and low NAR group (NAR<0.25, 2 110 cases) according the optimal cutoff values. The baseline characteristics and occurrence of in-hospital major adverse cardiovascular events (MACE) were recorded. Multivariate Logistic regression was used to analyze the independent risk factors for in-hospital death in patients with AMI.Results:Among the 2 657 patients with AMI, 265 patients had in-hospital MACE (10.0%), and 50 patients (1.9%) died. The age, proportion of Killip≥ 2 grade, proportion of diabetes, proportion of myocardial infarction, proportion of cerebral infarction history, proportion of ST-elevation myocardial infarction (STEMI), thrombolysis in myocardial infarction clinical trial score (TIMI score), global registry of acute coronary event score (GRACE score), fibrinogen, fasting blood glucose, glycated hemoglobin, high-density lipoprotein cholesterol (HDL-C), cardiac troponin I (cTnI) peak, N-terminal B-type natriuretic peptide (NT-proBNP), hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), NAR, GLR, neutrophil count, left ventricular end-diastolic diameter (LVEDD) in high GLR group were significantly higher than those in low GLR group, the proportion of males, body mass index (BMI), proportion of smoking history, proportion of non-ST elevation myocardial infarction (NSTEMI), albumin, estimated glomerular filtration rate (eGFR), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), lymphocyte count, monocyte count and left ventricular ejection fraction (LVEF) were significantly lower than those in low GLR group, and there were statistical differences ( P<0.01 or <0.05). The proportion of Killip≥2 grade, proportion of STEMI, TIMI score, GRACE score, fibrinogen, fasting blood glucose, TC, LDL-C, cTnI peak, hs-CRP, IL-6, NAR, GLR, white blood cell count, neutrophil count and monocyte count in high NAR group were significantly higher than those in low NAR group, the age, proportion of myocardial infarction history, proportion of NSTEMI, albumin, lymphocyte count, left atrial diameter (LAD) and LVEF were significantly lower than those in low NAR group, and there were statistical differences ( P<0.01 or <0.05). The incidences of in-hospital MACE, death, ventricular fibrillation or pulseless ventricular tachycardia, atrial fibrillation, cardiac arrest and bleeding in high GLR group were significant higher than those in low GLR group: 15.2% (117/768) vs. 7.8% (148/1 889), 4.6% (35/768) vs. 0.8% (15/1 889), 5.3% (41/768) vs. 2.9% (54/1 889), 6.9% (53/768) vs. 4.0% (75/1 889), 4.7% (36/768) vs. 1.4% (26/1 889) and 2.3% (18/768) vs. 0.7% (13/1 889), and there were statistical differences ( P<0.01); there was no statistical difference in the incidence of heart rupture between two groups ( P>0.05). The incidence of in-hospital MACE, death, ventricular fibrillation or pulseless ventricular tachycardia, cardiac arrest, cardiac rupture and bleeding in high NAR group were significantly higher than those in low NAR group: 16.6% (91/547) vs. 8.2% (174/2 110), 5.9% (32/547) vs. 0.9% (18/2 110), 8.0% (44/547) vs. 2.4% (51/2 110), 5.9% (32/547) vs. 1.4% (30/2 110), 1.6% (9/547) vs. 0.4% (9/2 110) and 2.4% (13/547) vs. 0.9% (18/2 110), and there were statistical differences ( P<0.01); there was no statistical difference in the incidence of atrial fibrillation between two groups ( P>0.05). Multivariate Logistic regression analysis result showed that the Killip 3 and 4 grades, high NAR, high GRACE score, high fasting glucose and low LVEF were independent risk factors for in-hospital death in patients with AMI ( OR = 3.827, 4.660, 3.779, 1.020, 1.095 and 0.962; 95% CI 1.158 to 12.649, 1.184 to 18.344, 1.856 to 7.649, 1.009 to 1.032, 1.027 to 1.167 and 0.932 to 0.993; P<0.05 or <0.01). Conclusions:The NAR can independently predict the risk of in-hospital death in patients with AMI.

Objective:To investigate the incidence of hypomineralized second primary molars (HSPM) and deciduous teeth caries in school-aged children of Kaifeng City, and to discuss the association between HSPM and deciduous teeth caries, providing scientific guidance for clinical prevention and treatment.Methods:A cross-sectional study was carried out on first-grade children aged 6-7 years in five primary schools chosen from the eastern, western, southern, northern, and central areas of Kaifeng City by cluster random sampling method. The European Academy of Pediatric Dentistry criteria was used for scoring HSPM. The International Caries Detection and Assessment System (ICDAS-Ⅱ) was used to evaluate caries status.Results:This cross-sectional study was with a sample of 913 children. The prevalence of HSPM was 8.76% (80/913), with 39 boys and 41 girls, the most common type of which was atypical caries [35.00% (28/80)]. Regarding the distribution of HSPM, the incidence in maxilla [6.13% (56/913)] showed no statistically significant difference with that in the mandible [5.70% (52/913)] (χ2=0.16, P=0.692). In terms of severity, 56 cases were severe and 24 cases were mild. The association between HSPM and deciduous teeth caries was analyzed. The results showed that 56 had caries on their second primary molars among the 80 HSPM children. Children with HSPM had an increased risk of second deciduous molar decay compared to non-HSPM children ( OR=1.94, 95 %CI: 1.18-3.19, P<0.05); meanwhile, the deciduous teeth of HSPM children were more prone to suffer caries than those of non-HSPM children ( OR=2.33, 95 %CI: 1.26-4.29, P<0.05). Conclusions:The HSPM prevalence in school-aged children of Kaifeng City was 8.76%. Child with HSPM was more likely to have deciduous teeth caries than non-HSPM child. Special attention should be paid to children with HSPM after the eruption of affected molars.

Allogeneic haemopoietic stem cell transplantation (allo-HSCT)-related nephrotic syndrome is a rare complication, recognized as a clinical manifestation of chronic graft versus host disease (GVHD). T cell dysfunction is thought to play a significant role in the pathogenesis of allo-HSCT-related nephrotic syndrome, but the precise mechanism remains unclear. This paper reported a case of X-linked adrenoleukodystrophy (X-ALD) who had good control of the disease after allo-HSCT, but developed proteinuria and progressed to nephrotic syndrome after immunosuppressive therapy was tapered. Kidney biopsy revealed secondary membranous nephropathy, which responded well to treatment with glucocorticoids and tacrolimus. Limited literature exist on allo-HSCT-related nephrotic syndrome in children. This study provides a comprehensive summary of its mechanism, clinical features, pathology, diagnosis,and treatment, offering valuable insights for diagnosing and managing allo-HSCT-related nephrotic syndrome in pediatric patients.

This article reports a case of membranous nephropathy in an adolescent accompanied by monoclonal IgG1-κ deposition. The 16-year-old female patient was hospitalized for experiencing proteinuria and hematuria for more than 20 days. The patient had a history of mycoplasma infection and acute kidney injury, and renal pathology revealed glomerular membrane lesions accompanied by crescent formation. Electron microscopy showed electron dense deposits in the subepithelial and mesangial regions, and immunofluorescence demonstrated monotypic IgG1-κ deposits in the glomerulus. Bone marrow examination did not find any abnormal plasma cells, nor were there significant abnormalities in serum or urine free light chain κ/λ ratio. The diagnosis was proliferative glomerulonephritis characterized by membranous lesions with monoclonal IgG1-κ deposits. This disease is rare in children and adolescents, and currently there is limited understanding of its mechanism, with limited clinical treatment experience. This article aims to provide clinical insights through case analysis and literature review.

Tacrolimus is an immunosuppressant that was clinically used for organ transplantation in the 1990s. In the early 2000s, tacrolimus began to be used to treat pediatric kidney diseases in China. This article reviews the therapeutic effects, clinical dosages, and treatment methods of tacrolimus in the treatment of steroid-resistant, steroid-dependent, frequently relapsing, different pathological types, and monogenic mutation-related childhood nephrotic syndrome. It explores the clinical guiding role of machine learning in tacrolimus treatment for childhood nephrotic syndrome, aiming to provide references for the clinical research and application of tacrolimus in pediatric kidney diseases.

Objective:To investigate the association between anti-rituximab antibodies (ARA) and relapse after rituximab (RTX) therapy in children with frequently relapsing or steroid-dependent nephrotic syndrome (FRNS or SDNS).Methods:A retrospective cohort study was conducted. Clinical and laboratory data were collected from 48 FRNS or SDNS children treated with RTX in the Department of Pediatrics, General Hospital of Eastern Theater Command, between April 2024 and October 2024. Data included RTX dosing frequency, relapse events, peripheral CD20? B-cell counts, and ARA levels. With a 6-month observation period after the last RTX therapy, the children were divided into an ARA-positive group and an ARA-negative group based on ARA test results. Chi-square test, independent sample t-test, or Mann-Whitney U test were used to compare relapse rates and laboratory indicators between the two groups. The predictive value of ARA levels for relapse was evaluated using univariate receiver operating characteristic (ROC) curve analysis. Results:Among the 48 children (36 males, 12 females), the age of disease onset was 3.5 (2.0, 6.0) years, the ages at the first and last RTX treatments were 7.0 (5.0, 12.0) years and 9.5 (7.0, 13.0) years, respectively. The overall ARA positive rate was 29% (14/48). The relapse rate in the ARA-positive group was significantly higher than that in the negative group ( P<0.05). The ARA level was 0.01 (0.01, 5.88) μg/L, and all 12 children with ARA levels >5.88 μg/L relapsed. ROC curve analysis showed that ARA levels predicted relapse after RTX treatment in FRNS or SDNS children with an area under the curve (AUC) of 0.73, sensitivity of 0.50, specificity of 1.00, and an optimal cut-off value of 5.02 μg/L. All children received single-dose RTX therapy, with no significant difference in treatment frequency between the two groups ( P>0.05). At 3 months after the last rituximab therapy, CD20? B cell counts were significantly higher in the ARA-positive group ( P<0.05). During follow-up, 15% (7/48) of the children experienced infusion-related adverse reactions, with no significant difference in incidence between the two groups ( P>0.05). Conclusion:ARA is significantly associated with relapse in FRNS or SDNS children after RTX therapy.