Objective To investigate the effect of two treatment regimens combining Tacrolimus(TAC)with different Rituximab(RTX)dosages,and to provide clinical reference for treatment strategies.Methods A retrospective analysis was conducted on patients diagnosed with idiopathic membranous nephropathy(IMN)and treated with RTX combined with TAC regimen(RTX+TAC group and low-dose RTX+TAC group)in The First Affiliated Hospital of Xinxiang Medical University.Propensity score matching(PSM)was performed at a 1:1 ratio,and a total of 60 patients were enrolled,with 30 in each group.In low-dose RTX(375 mg/m2 at the first and fifteenth day respectively)+TAC group,if circulating B cells(CD19?)exceeded 5 cells/μL after 3 months,a 200 mg RTX infusion was administered.In RTX(1g at the first and fifteenth day respectively)+TAC group,if complete remission(CR)was not achieved by 6 months,an additional 1000 mg RTX infusion was administered.The incidence of CR,partial remission,and adverse events were followed up for 12 months after medication in both groups.Results(1)Both groups showed significant reductions in 24-hour proteinuria,with the RTX+TAC group demonstrating a notably higher decrease compared to the low-dose RTX+TAC group.Statistical differences were observed between the two groups at the 1st and 3rd months of treatment(P<0.05).Albumin levels gradually increased,and there were differ-ences between the two groups at both the 1st and 3rd months(P<0.05).The anti-phospholipase A2 antibody levels decreased significantly after one month of treatment[3.45(1.90,22.10)vs.3.28(8.30,23.08)RU/mL],P>0.05.At 3 months of treatment,the overall clinical remission rate was 63.3％for the RTX+TAC group compared to 36.7％for the low-dose RTX+TAC group(P<0.05).At 12 months,the RTX+TAC group achieved an overall remission rate of 86.7％,while the low-dose RTX+TAC group reached 83.3％,showing no statistical significance(P>0.05).After one month of treatment,the RTX+TAC group achieved a complete serological immunological remission rate of 33.3％,significantly higher than the 3.3％in the low-dose RTX+TAC group(P<0.05).(2)The cumulative remission rate of the RTX+TAC group was higher than that of the low-dose RTX+TAC group during the first 6 months of follow-up.The remission rate in the low-dose RTX+TAC group increased significantly after 6 months.Log-rank test showed no statistical difference between the survival curves of the two groups(P=0.37).(3)Based on a multifactorial COX regression analysis of factors related to remission in patients with IMN,for every unit increase in serum immunological remission time,the risk of patients achieving remission decreased by 13.5％(HR=0.87,P=0.016).The risk of remission for patients with high titers of anti-PLA2R antibodies decreased by 60.2％(HR=0.39,P=0.018).Conclusions Different RTX dosages yielded comparable overall clinical remission rates without significantly increasing adverse events.RTX+TAC regimen achieves higher early CR rate.Serological remission time and high titer anti-PLA2R antibodies are associated with clinical outcomes.

The morphological characteristics of hepatocellular carcinoma(HCC)tumor margins are pivotal in influencing patient's prognosis and the selection of therapeutic strategies.This paper re-viewed the classification methods of HCC tumor margins,ranging from traditional macroscopic classifi-cations to refined classification systems based on multi-omics analysis,and analyzed the role of these classification methods in guiding the formulation of personalized treatment plans.Additionally,this paper emphasized the crucial role of three-dimensional imaging techniques in assessing tumor margin morphology and outlined future research directions,including validating the effectiveness of multi-omics classification systems and developing new imaging and molecular biomarkers to achieve more precise treatment plans and prolong patient survival.

Objective:To evaluate the effectiveness of anti-G straining maneuver (AGSM) in pilots by surface electromyography (sEMG), and to explore the relationships between characteristics of sEMG and anti-G endurance in pilots.Methods:Thirty-eight male high-performance fighter pilots who completed the human centrifuge test at the Air Force Medical Center were selected. Among them, 25 completed the 8.0 G for 10 s anti-G endurance test and 13 completed the 9.0 G for 10 s anti-G endurance test. The sEMG tester was used to keep track of the changes of sEMG in rectus abdominis, rectus femoris, anterior tibial and gastrocnemius muscles while pilots were engaged in AGSM. The anti-G endurance was evaluated according to the changes of visual fields and consciousness. The pilots were divided into 3 groups: the good vision and consciousness group, peripheral visual field narrowing group and endurance endpoint group. The differences in the integral electromyogram (iEMG), mean power frequency (MPF) and muscle input rates between the 3 groups were investigated.Results:A total of 25 pilots completed the 8.0 G for 10 s anti-G endurance test. Among them, 8 (32.0%) were in the good vision and consciousness group, 13 (52.0%) in the peripheral visual field narrowing group and 4 (16.0%) reached the endurance endpoint. Among the 13 pilots who completed the 9.0 G for 10 s anti-G endurance test, 3 (23.1%) were in the good vision and consciousness group, 6 (46.1%) in the peripheral visual field narrowing group, and 4 (30.8%) in the endurance endpoint group. The results of sEMG showed that the iEMG values of the anterior tibialis muscle in pilots under the 9.0 G for 10 s load were significantly different across endurance groups ( H=7.54, P=0.023), and that the iEMG values of the tibialis anterior muscle in the good vision and consciousness group were higher than those in the endurance endpoint group ( P=0.036). The negative slopes of MPF for the rectus abdominis, rectus femoris, anterior tibialis, and gastrocnemius muscles were higher in the good vision and consciousness group than in the other 2 groups, but the differences were not statistically significant ( P>0.05). During the 8.0 G for 10 s anti-G endurance test, there were significant differences in lower limb muscle contribution rates between the 3 groups ( F=4.19, P=0.029). The endurance endpoint group exhibited a lower contribution rate than the good vision and consciousness group ( P=0.025). During the 9.0 G for 10 s anti-G endurance test, there were significant differences in tibialis anterior muscle contribution rates between the 3 groups ( F=4.16, P=0.049). The endurance endpoint group demonstrated a lower contribution rate than the good vision and consciousness group ( P=0.049). Conclusions:The full and balanced activation of abdominal muscles and lower limb muscles, especially the effective mobilization of calf muscles, plays a pivotal role in improving pilots′ AGSM efficiency in high G environments.

Objective:To find out whether the performance of a China-made high performance human centrifuge can satisfy the need of high G training by conducting physiological experiments.Methods:The dynamic physical performance of the anti-G equipment with the human centrifuge was tested before 5 subjects underwent the gradual-onset rate (GOR) run and rapid onset rate (ROR) run experiments. The G onset rate of GOR was 0.1 G/s. The relaxed G-tolerance under GOR (GOR tolerance 1) and the anti-G straining maneuver aided G-tolerance under GOR (GOR tolerance 2) were tested respectively. The G onset rate of ROR was 3 G/s, and the closed-loop mode and pre-programed mode were employed respectively. The closed-loop mode involved 5 G 10 s and 8 G 10 s, where the subjects were required to manipulate the joystick to ensure that the real-time curve of the load matched the target curve. In the pre-programmed mode, the subjects were exposed to 8 G 10 s passively, without any operation requirements. A subjective evaluation form was filled out by subjects after the experiments, in which the 14 indexes for evaluation were about the gondola facilities and environment, running processes, medical monitoring and overall assessment.Results:Both the oxygen mask and anti-G suit achieved full pressurization within 2.0 s. The GOR tolerance 1 was [4.0(3.8, 4.6)] G while the GOR tolerance 2 was (6.2±0.5) G, suggesting a statistically significant difference ( Z=-2.63, P=0.008). The HP anti-G straining maneuver effect was (2.0±0.6) G. All the 5 subjects finished the 5 G 10 s experiment in a closed-loop mode. Three of them attempted 8 G 10 s in the closed-loop mode (1 subject achieved only 7.6 G peak acceleration, and the other 2 achieved full 8 G 10 s exposure), while the remaining 2 completed the 8 G 10 s in the pre-programmed mode. In the closed-loop mode, it was found that the stick force was too strong, the guiding G and real time G curve were not easy to distinguish for some of the subjects because the curve colors were similar, and that the subjects could not see the G curves clearly in case of a grayout. Both seat comfort and the voice quality of communication got the highest subjective assessment score [5.0(4.0, 5.0)] while the sensation of tumble got the lowest score (2.8±0.8). The median or mean scores of other subjective evaluation indexes ranged from 3.0 to 4.6 points. The overall score of subjective assessment was [4.0(3.5, 4.0)] points. Conclusions:The China-made high performance human centrifuge can meet the requirements of 8.0 G high G training, which can be made more effective and comfortable if the strong stick force and feeling of tumble during stop running are overcome.

Objective To investigate the effect of two treatment regimens combining Tacrolimus(TAC)with different Rituximab(RTX)dosages,and to provide clinical reference for treatment strategies.Methods A retrospective analysis was conducted on patients diagnosed with idiopathic membranous nephropathy(IMN)and treated with RTX combined with TAC regimen(RTX+TAC group and low-dose RTX+TAC group)in The First Affiliated Hospital of Xinxiang Medical University.Propensity score matching(PSM)was performed at a 1:1 ratio,and a total of 60 patients were enrolled,with 30 in each group.In low-dose RTX(375 mg/m2 at the first and fifteenth day respectively)+TAC group,if circulating B cells(CD19?)exceeded 5 cells/μL after 3 months,a 200 mg RTX infusion was administered.In RTX(1g at the first and fifteenth day respectively)+TAC group,if complete remission(CR)was not achieved by 6 months,an additional 1000 mg RTX infusion was administered.The incidence of CR,partial remission,and adverse events were followed up for 12 months after medication in both groups.Results(1)Both groups showed significant reductions in 24-hour proteinuria,with the RTX+TAC group demonstrating a notably higher decrease compared to the low-dose RTX+TAC group.Statistical differences were observed between the two groups at the 1st and 3rd months of treatment(P<0.05).Albumin levels gradually increased,and there were differ-ences between the two groups at both the 1st and 3rd months(P<0.05).The anti-phospholipase A2 antibody levels decreased significantly after one month of treatment[3.45(1.90,22.10)vs.3.28(8.30,23.08)RU/mL],P>0.05.At 3 months of treatment,the overall clinical remission rate was 63.3％for the RTX+TAC group compared to 36.7％for the low-dose RTX+TAC group(P<0.05).At 12 months,the RTX+TAC group achieved an overall remission rate of 86.7％,while the low-dose RTX+TAC group reached 83.3％,showing no statistical significance(P>0.05).After one month of treatment,the RTX+TAC group achieved a complete serological immunological remission rate of 33.3％,significantly higher than the 3.3％in the low-dose RTX+TAC group(P<0.05).(2)The cumulative remission rate of the RTX+TAC group was higher than that of the low-dose RTX+TAC group during the first 6 months of follow-up.The remission rate in the low-dose RTX+TAC group increased significantly after 6 months.Log-rank test showed no statistical difference between the survival curves of the two groups(P=0.37).(3)Based on a multifactorial COX regression analysis of factors related to remission in patients with IMN,for every unit increase in serum immunological remission time,the risk of patients achieving remission decreased by 13.5％(HR=0.87,P=0.016).The risk of remission for patients with high titers of anti-PLA2R antibodies decreased by 60.2％(HR=0.39,P=0.018).Conclusions Different RTX dosages yielded comparable overall clinical remission rates without significantly increasing adverse events.RTX+TAC regimen achieves higher early CR rate.Serological remission time and high titer anti-PLA2R antibodies are associated with clinical outcomes.

Objective:To evaluate the effectiveness of anti-G straining maneuver (AGSM) in pilots by surface electromyography (sEMG), and to explore the relationships between characteristics of sEMG and anti-G endurance in pilots.Methods:Thirty-eight male high-performance fighter pilots who completed the human centrifuge test at the Air Force Medical Center were selected. Among them, 25 completed the 8.0 G for 10 s anti-G endurance test and 13 completed the 9.0 G for 10 s anti-G endurance test. The sEMG tester was used to keep track of the changes of sEMG in rectus abdominis, rectus femoris, anterior tibial and gastrocnemius muscles while pilots were engaged in AGSM. The anti-G endurance was evaluated according to the changes of visual fields and consciousness. The pilots were divided into 3 groups: the good vision and consciousness group, peripheral visual field narrowing group and endurance endpoint group. The differences in the integral electromyogram (iEMG), mean power frequency (MPF) and muscle input rates between the 3 groups were investigated.Results:A total of 25 pilots completed the 8.0 G for 10 s anti-G endurance test. Among them, 8 (32.0%) were in the good vision and consciousness group, 13 (52.0%) in the peripheral visual field narrowing group and 4 (16.0%) reached the endurance endpoint. Among the 13 pilots who completed the 9.0 G for 10 s anti-G endurance test, 3 (23.1%) were in the good vision and consciousness group, 6 (46.1%) in the peripheral visual field narrowing group, and 4 (30.8%) in the endurance endpoint group. The results of sEMG showed that the iEMG values of the anterior tibialis muscle in pilots under the 9.0 G for 10 s load were significantly different across endurance groups ( H=7.54, P=0.023), and that the iEMG values of the tibialis anterior muscle in the good vision and consciousness group were higher than those in the endurance endpoint group ( P=0.036). The negative slopes of MPF for the rectus abdominis, rectus femoris, anterior tibialis, and gastrocnemius muscles were higher in the good vision and consciousness group than in the other 2 groups, but the differences were not statistically significant ( P>0.05). During the 8.0 G for 10 s anti-G endurance test, there were significant differences in lower limb muscle contribution rates between the 3 groups ( F=4.19, P=0.029). The endurance endpoint group exhibited a lower contribution rate than the good vision and consciousness group ( P=0.025). During the 9.0 G for 10 s anti-G endurance test, there were significant differences in tibialis anterior muscle contribution rates between the 3 groups ( F=4.16, P=0.049). The endurance endpoint group demonstrated a lower contribution rate than the good vision and consciousness group ( P=0.049). Conclusions:The full and balanced activation of abdominal muscles and lower limb muscles, especially the effective mobilization of calf muscles, plays a pivotal role in improving pilots′ AGSM efficiency in high G environments.

Objective:To find out whether the performance of a China-made high performance human centrifuge can satisfy the need of high G training by conducting physiological experiments.Methods:The dynamic physical performance of the anti-G equipment with the human centrifuge was tested before 5 subjects underwent the gradual-onset rate (GOR) run and rapid onset rate (ROR) run experiments. The G onset rate of GOR was 0.1 G/s. The relaxed G-tolerance under GOR (GOR tolerance 1) and the anti-G straining maneuver aided G-tolerance under GOR (GOR tolerance 2) were tested respectively. The G onset rate of ROR was 3 G/s, and the closed-loop mode and pre-programed mode were employed respectively. The closed-loop mode involved 5 G 10 s and 8 G 10 s, where the subjects were required to manipulate the joystick to ensure that the real-time curve of the load matched the target curve. In the pre-programmed mode, the subjects were exposed to 8 G 10 s passively, without any operation requirements. A subjective evaluation form was filled out by subjects after the experiments, in which the 14 indexes for evaluation were about the gondola facilities and environment, running processes, medical monitoring and overall assessment.Results:Both the oxygen mask and anti-G suit achieved full pressurization within 2.0 s. The GOR tolerance 1 was [4.0(3.8, 4.6)] G while the GOR tolerance 2 was (6.2±0.5) G, suggesting a statistically significant difference ( Z=-2.63, P=0.008). The HP anti-G straining maneuver effect was (2.0±0.6) G. All the 5 subjects finished the 5 G 10 s experiment in a closed-loop mode. Three of them attempted 8 G 10 s in the closed-loop mode (1 subject achieved only 7.6 G peak acceleration, and the other 2 achieved full 8 G 10 s exposure), while the remaining 2 completed the 8 G 10 s in the pre-programmed mode. In the closed-loop mode, it was found that the stick force was too strong, the guiding G and real time G curve were not easy to distinguish for some of the subjects because the curve colors were similar, and that the subjects could not see the G curves clearly in case of a grayout. Both seat comfort and the voice quality of communication got the highest subjective assessment score [5.0(4.0, 5.0)] while the sensation of tumble got the lowest score (2.8±0.8). The median or mean scores of other subjective evaluation indexes ranged from 3.0 to 4.6 points. The overall score of subjective assessment was [4.0(3.5, 4.0)] points. Conclusions:The China-made high performance human centrifuge can meet the requirements of 8.0 G high G training, which can be made more effective and comfortable if the strong stick force and feeling of tumble during stop running are overcome.

Objective To establish a scientific training program that takes into account both anaerobic and aerobic training for pilots,and to explore the appropriate ratio of aerobic and anaerobic training.Methods According to the physical examination standards for pilots,a total of 16 healthy subjects aged 18-24 were selected from two batches.The two batches of subjects were trained with different aerobic and anaerobic ratios.Training period was 3 months.The changes in cardiopulmonary function of the subjects before and after training were evaluated using the cardiopulmonary function exercise testing system(CPET),and the changes in anaerobic capacity were evaluated using changes in strength as an indicator.Results After training,the weight load of the subjects in the two training programs,including barbell squats,leg flexion and hard pull,and barbell under 10RM and 3RM,was significantly increased(P<0.001),and there was no statistically significant difference in anaerobic strength growth between the two groups.The results of CPET showed that the maximum load,maximum heart rate,and respiratory quotient in the two groups were significantly increased after than before the training(P<0.01).The maximum load(Experiment group 1:29.12±19.69,Experiment group 2:72.00±46.24)and respiratory quotient(Experiment grouop 1:0.11±0.09,Experiment group 2:0.28±0.16)of the subjects in experiment group 2 before and after training were greater than those in experiment group 1.The difference was statistically significant(P<0.05).Conclusion The anaerobic and aerobic capacities of the subjects in the experiment group 2 are effectively improved,indicating that ratio of aerobic and anaerobic of the training scheme is better.

Objective To study the changes of serum metabolites in the patients with chronic kidney disease osteoporosis(CKD-OP)to provide the new biomarkers for the early diagnosis of CKD-OP.Methods A total of 22 patients with definitely diagnosed CKD visiting in this hospital from April to Novem-ber 2023 were selected as the study subjects,and 22 subjects with physical examination in this hospital at the same period were included for conducting the control study.With the lumbar vertebral T value ≤-2.5 as the standard,the subjects were divided into the CKD-OP group(n=11),CKD non-OP group(CKD-NOP group,n=11),simple osteoporosis group(OP group,n=11)and healthy control group(NC group,n=11).The liq-uid chromatography-mass spectrometry(LC-MS)coupling technique was used to analyze the differences in se-rum metabolites among the four groups,the potential biomarkers of CKD-OP was screened,and the correla-tion between the potential biomarkers with lumbar vertebra bone mineral density(BMD),serum bone-derived alkaline phosphatase(BALP)and serum tartrate-resistant acid phosphatase-5b(TRACP-5b)was studied.Re-sults With the receiver's operating characteristic(ROC)curve's area under curve(AUC)＞0.9 as the con-dition,and four potential biomarkers of CKD-OP were screened,which were phosphorylcholine,lysophosphati-dylcholine(18∶2/0∶0),capric acid,and allantoin respectively.Serum phosphorylcholine was positively corre-lated with lumbar vertebra BMD(r=0.601,P＜0.05)and negatively correlated with serum BALP and TRACP-5b(r=-0.729,-0.623,P＜0.05).Serum allantoin was positively correlated with lumbar vertebra BMD(r=0.483,P＜0.05)and negatively correlated with serum BALB(r=-0.494,P＜0.05).Serum lyso-phosphatidylcholine(18∶2/0∶0)was positively correlated with lumbar vertebra BMD(r=0.640,P＜0.05),and negatively correlated with serum BALP and TRACP-5b(r=-0.628,-0.548,P＜0.05).Serum capric acid was negatively correlated with lumbar vertebra BMD(r=-0.444,P＜0.05)and positively corre-lated with serum BALB(r=0.587,P＜0.05).Conclusion The screened four endogenous potential biomarkers provide the new research ideas for the early diagnosis and treatment efficacy monitoring of CKD-OP.

Objective:To discuss the application of gradual-onset rate run (GOR) of human centrifuge on G-tolerance evaluation and training by analyzing the training results of (student) pilots in GOR centrifuge run.Methods:The G-tolerance and anti-G straining maneuver effect of 440 student pilots and 368 pilots participated centrifuge training in recent years were analyzed. The (student) pilots were grouped by age (20-25 years,26-30 years,31-35 years,36-40 years, >40 years). The 392 student pilots and 335 pilots who completed rapid onset rate run (ROR) were divided into 8 G 10 s training high G tolerance group (group A), 8 G 10 s training low G tolerance group (group B), 9 G 10 s training high G tolerance group (group C) and 9 G 10 s training low G tolerance group (group D) according to pass the 8 G 10 s or 9 G 10 s run one-time or not. The relation of G-tolerance and anti-G straining maneuver effect of GOR to ROR was discussed.Results:The average distribution range of relaxed G-tolerance under GOR (GOR tolerance 1) was (4.1±0.7) G, and the average distribution range of anti-G straining maneuver aided G-tolerance under GOR (GOR tolerance 2) was (6.2±0.8) G. The average HP anti-G straining maneuver effect was (2.1±0.6) G. There was a significant difference in GOR tolerance 1 ( H=11.94, P=0.018), no significant difference in GOR tolerance 2 ( H=4.80, P=0.308), and a significant difference in the effect of HP anti-G straining maneuver among pilots in different age groups ( F=3.01, P=0.018). The effect of HP anti-G straining maneuver in the age group over 40 years old was greater than that in other age groups ( P=0.027, 0.034, 0.009, 0.006). There was no significant difference in GOR tolerance 1, GOR tolerance 2 and HP anti-G straining maneuver effect between pilots and student pilots (all P>0.05). There were significant differences in GOR tolerance 2 ( H=15.38, P=0.002) and the effect of HP anti-G straining maneuver ( H=8.22, P=0.041) among group A, group B, group C and group D. The GOR tolerance 2 of group B was lower than that of other anti-G tolerance groups ( P=0.003, 0.001, 0.040). Conclusions:The centrifuge GOR training could reflect the G-tolerance and anti-G straining maneuver effect of (student) pilots and provide references for predicting the human centrifuge training result and improving accelerate training and tolerance evaluating.