Pregnancy with chronic kidney disease (CKD), particularly in stages 4-5, carries high risks of adverse outcomes including maternal renal failure, preeclampsia/eclampsia, fetal growth restriction, and preterm birth. This report described a 26-year-old woman with congenital solitary kidney, polycystic ovaries, and uterine septum due to PAX2 gene variant, complicated by CKD stage 4. Through multidisciplinary team precision management and individualized treatment strategies, including timely initiation of dialysis, the patient successfully maintained pregnancy until 34 +1 weeks and delivered a female infant via cesarean section. This case summarizes key management experiences for end-stage renal disease in pregnancy, highlighting early risk assessment, precise nutritional management, hemodialysis protocol optimization, and the crucial role of multidisciplinary collaboration, providing valuable references for managing CKD-complicated pregnancies.

BACKGROUND: G protein-coupled receptor kinase 2 (GRK2) could participate in the regulation of diverse cells via interacting with non-G-protein-coupled receptors. In the present work, we explored how paroxetine, a GRK2 inhibitor, modulates the differentiation and activation of immune cells in rheumatoid arthritis (RA). METHODS: The blood samples of healthy individuals and RA patients were collected between July 2021 and March 2022 from the First Affiliated Hospital of Anhui Medical University. C57BL/6 mice were used to induce the collagen-induced arthritis (CIA) model. Flow cytometry analysis was used to characterize the differentiation and function of dendritic cells (DCs)/T cells. Co-immunoprecipitation was used to explore the specific molecular mechanism. RESULTS: In patients with RA, high expression of GRK2 in peripheral blood lymphocytes, accompanied by the increases of phosphatidylinositol 3 kinase (PI3K), protein kinase B (AKT), and mammalian target of rapamycin (mTOR). In animal model, a decrease in regulatory T cells (T regs ), an increase in the cluster of differentiation 8 positive (CD8 + ) T cells, and maturation of DCs were observed. Paroxetine, when used in vitro and in CIA mice, restrained the maturation of DCs and the differentiation of CD8 + T cells, and induced the proportion of T regs . Paroxetine inhibited the secretion of pro-inflammatory cytokines, the expression of C-C motif chemokine receptor 7 in DCs and T cells. Simultaneously, paroxetine upregulated the expression of programmed death ligand 1, and anti-inflammatory cytokines. Additionally, paroxetine inhibited the PI3K-AKT-mTOR metabolic pathway in both DCs and T cells. This was associated with a reduction in mitochondrial membrane potential and changes in the utilization of glucose and lipids, particularly in DCs. Paroxetine reversed PI3K-AKT pathway activation induced by 740 Y-P (a PI3K agonist) through inhibiting the interaction between GRK2 and PI3K in DCs and T cells. CONCLUSION Paroxetine exerts an immunosuppressive effect by targeting GRK2, which subsequently inhibits the metabolism-related PI3K-AKT-mTOR pathway of DCs and T cells in RA.
G-Protein-Coupled Receptor Kinase 2/metabolism* ; Arthritis, Rheumatoid/immunology* ; Animals ; Dendritic Cells/metabolism* ; Paroxetine/therapeutic use* ; Proto-Oncogene Proteins c-akt/metabolism* ; Mice ; Humans ; Mice, Inbred C57BL ; Signal Transduction/drug effects* ; Male ; Phosphatidylinositol 3-Kinases/metabolism* ; Lymphocyte Activation/drug effects* ; Female ; T-Lymphocytes/metabolism* ; Middle Aged

Pregnancy with chronic kidney disease (CKD), particularly in stages 4-5, carries high risks of adverse outcomes including maternal renal failure, preeclampsia/eclampsia, fetal growth restriction, and preterm birth. This report described a 26-year-old woman with congenital solitary kidney, polycystic ovaries, and uterine septum due to PAX2 gene variant, complicated by CKD stage 4. Through multidisciplinary team precision management and individualized treatment strategies, including timely initiation of dialysis, the patient successfully maintained pregnancy until 34 +1 weeks and delivered a female infant via cesarean section. This case summarizes key management experiences for end-stage renal disease in pregnancy, highlighting early risk assessment, precise nutritional management, hemodialysis protocol optimization, and the crucial role of multidisciplinary collaboration, providing valuable references for managing CKD-complicated pregnancies.

Objective:The residual cancer burden (RCB) evaluation system was used to analyze the influencing factors of the efficacy of neoadjuvant therapy in breast cancer, and to explore the prognostic value of RCB evaluation in neoadjuvant therapy.Methods:Clinicopathologic data and postoperative RCB grading of 364 breast cancer patients who underwent neoadjuvant therapy in Renmin Hospital of Wuhan University from Nov. 2019 to Nov. 2022 were collected. Chi-square test was used to analyze the relationship between RCB grading and clinicopathological parameters, and Spearman’s rank correlation analysis was performed to evaluate the correlation between RCB grading and clinicopathological characteristics. Factors influencing pathologic complete response (pCR) were analyzed by Logistic regression. Kaplan-Meier survival analysis and log-rank test were used to evaluate cumulative survival.Results:Among the 364 patients who underwent neoadjuvant therapy, 129 cases of RCB grade 0 and 235 cases of RCB gradeⅠ-Ⅲ (including 46 cases of RCB gradeⅠ, 109 cases of RCB grade Ⅱ and 80 cases of RCB grade Ⅲ) were obtained after surgery. Histological classification ( χ 2=21.757, P=0.000), estrogen receptor (ER) ( χ 2=52.837, P=0.000), progesterone receptor (PR) ( χ 2=55.658, P=0.000), human epidermal growth factor receptor-2 (HER2) ( χ2=89.040, P=0.000), Ki67 expression ( χ2=12.927, P=0.005), molecular typing ( χ 2=80.793, P=0.000) and preoperative lymph node status ( χ 2=25.764, P=0.000) were all associated with postoperative RCB grading. Further correlation analysis showed that histological grade ( r=-0.229, P=0.000), HER2 expression ( r=-0.465, P=0.000) and Ki67 expression ( r=-0.179, P=0.000) were negatively correlated with RCB grading, while ER ( r=0.352, P=0.000), PR ( r=0.379, P=0.000) and lymph node metastasis ( r=0.214, P=0.000) were positively correlated with RCB grading. Logistic regression analysis showed that high histological grade, negative expression of ER, PR and AR, positive expression of HER2, high proliferation index of Ki67 and no lymph node metastasis were favorable factors for postoperative pCR, and PR, AR and HER2 were independent predictors of postoperative pCR. Kaplan-Meier survival analysis showed significant differences in postoperative cumulative survival among patients with different RCB grades ( P=0.004) . Conclusions:Postoperative RCB grading of breast cancer is closely related to many clinicopathological features before neoadjuvant therapy and survival prognosis. Clinicopathological factors closely related to RCB grading are also important influencing factors affecting the pCR of patients with neoadjuvant therapy. Therefors, RCB grading has a high prognostic value.

Objective:Objective To explore the special role of nutrition specialists in the one-day-care clinic of gestational diabetes mellitus (GDM), and provide a basis for strengthening the standardized construction of one-day-care clinic.Methods:It was a retrospective observation study that the pregnant women who participated in the one-day-care clinic of GDM in our hospital without nutrition specialists in November and December 2017 were divided into control group (177 cases), and who participated in the one-day-care clinic of GDM in our hospital with nutrition specialists in January and February 2018 were divided into observation group (307 cases). The differences of pregnancy outcomes between the two groups were compared after the propensity score matching.Results:176 pairs of patients were successfully matched with a 1:1 propensity score. The incidence of macrosomia in pregnant women with GDM in the observation group (2.8%) was significantly lower than that in the control group (8.5%) ( P=0.036). There were no significant differences in the weight gain during pregnancy, the gestational week of delivery and the incidences of insulin use, hypertension during pregnancy, preeclampsia, cesarean section, premature infants, premature rupture of membranes, umbilical cord around the neck, and fetal distress between the two groups ( P>0.05). Conclusion:Nutrition specialists are indispensable in the multidisciplinary cooperation of one-day-care clinic of GDM, and they play a key role in considerably lowering the prevalence of macrosomia in GDM pregnant women.

Objective To investigate the diagnostic value and limitations of dual-energy virtual non-con-trast images of dual-source CT in common benign liver diseases. Methods Dual-source CT was performed on 226 upper abdomen pathogenesis patients. The conventional non-contrast (CNC) scan was performed with single-energy mode, the arterial phase and portal phase scans were performed with dual-energy mode. The virtual non-contrast (VNC) images were derived from the portal data using liver virtual non-contrast software. 117 patients with common benign liver diseases were retrospectively analyzed in CNC and VNC. The lesion detectability, effective radiation doses for single-energy mode and dual-energy mode were compared. Results Among 117 patients, there were 28 (73.6%) hemangiomas, 58 (85.3%) calcifications or stones in VNC, but the hemangiomas, calcifications or stones in CNC were 37 (97.3%) and 68 (100%), respectively. The hemangiomas, calcifications or stones in VNC and CNC were significantly different (P < 0.05). The detection of cyst and hepatic steatosis on VNC images were similar as CNC(P > 0.05). The CTDIvol, DLP and ED of dual-energy mode were obviously lower than those of single-energy mode (P < 0.05). Conclusion The detection of hemangiomas, calcifications or stones on VNC images is lower than CNC images. There is no difference in detecting cyst and hepatic steatosis. In addition, radiation dose will be reduced due to adopting VNC.VNC has potential clinical application value.

Objective To investigate the status of tuberculosis (TB)infection among health care workers (HC-Ws)in an infectious diseases hospital,and explore the risk and influencing factors of TB infection.Methods All HCWs in an infectious diseases hospital were surveyed through questionnaire and purified protein derivative (PPD) testing.Results Incidence of TB infection among all HCWs in this hospital was 48.18%.There was no significant difference in TB infection among HCWs in different departments(P >0.05).TB infection among HCWs of different working seniority,different ages,and different job titles were all significantly different (all P <0.05).Risk factors for TB infection were education level,job title,living condition,and working time in TB clinics or wards,OR (95%CI )were 1 .70(1 .03-2.80),1 .95(1 .10-3.45),1 .84(1 .03-3.28),and 2.38(1 .40-4.04)respectively;personal protection was a protective factor for TB infection (OR,0.92 [95% CI ,0.85 - 0.99]).Conclusion HCWs in in-fectious diseases hospital are at high risk of TB infection,they should improve their self-protection consciousness, and take protective measures as early as possible.

OBJECTIVE:To observe the clinical efficacy and safety of sodium hyaluronate combined with glucosamine in the treatment of knee osteoarthritis. METHODS:1 220 patients with knee osteoarthritis were randomly divided into observation group and control group. The patients in control group were treated with Sodium hyaluronate injection alone,once a week;while the ob-servation group was additionally and orally treated with Glucosamine hydrochloride capsules two tablets,three times a day. The course of treatment was 5 weeks in both groups. The relevant physicotherapeutics and oral medication in the treatment of the dis-ease should be stopped. The clinic efficacy,visual analog scale(VAS)and lysholm knee score before and after treatment,and inci-dence of adverse reaction were observed. RESULTS:Total effective rate of observation group was significantly higher than control group,with statistically significant difference(P<0.05). After treatment,VAS and lysholm knee scores in both groups were signifi-cantly lower than before,and observation group was lower than control group,with significant differences(P<0.05). There were no severe adverse reactions during treatment. CONCLUSIONS:Sodium hyaluronate combined with glucosamine has more signifi-cant clinical efficacy in the treatment of knee osteoarthritis than sodium hyaluronate alone,with good safety.

Objective To compare the effectiveness of hyperbaric oxygen (HBO) therapy and normal pressure oxygen inhalation for lung infection in patients with severe brain injury and tracheotomy.Methods Sixty lung infection patients with severe brain injury and tracheotomy were stratified by age and Glasgow coma scale (GCS) score into an HBO group (30) and a conventional therapy group (30).Both groups were given treatments to reduce intracranial hypertension and protect the brain,surgery,antibiotics,and symptomatic and support therapy.In the conventional group the patients received oxygen therapy at normal oxygen pressure by tracheal cannula.In the HBO group,the patients received HBO therapy through self-made oxygen devices by the authors.The body temperature,cough and expectoration,respiratory sounds and white blood cell (WBC) count were compared between the groups.Results There were statistically significant differences in body temperature,cough and expectoration,respiratory sounds and the normalized time for the count and classification of WBC between the groups.Conclusion HBO had good treatment effectiveness for excretion and expectorant in lung infection patients with severe brain injury and tracheotomy.

AIM: To establish a method of fingerprint analysis of Toufengyu Dropping Pill(Radix angelicae dahuricae,Rhizoma chuanxiong and green tea) by HPLC. METHODS: Hypersil ODS2 C_18(4.6 mm?250 mm,5 ?m) column was used,with mixtures of 0.1%TFA solution and acetonitrile as mobile phase in a gradient mode.The flow rate was 1.0 mL/min,the column temperature was at 30 ℃,detection wavelength was at 254 nm. RESULTS: HPLC fingerprint determination with 22 common peaks gained from 10 batches of self-made Tonfengyu Dropping Pill,there were 9 components identified,including caffeine,EGCG,ferulic acid,oxypeucedanin,imperatorin,phellopterin,cnidilin,isoimperatorin and oxypeucedanin hydrate. CONCLUSION: This method is accurate,reliable and can provide more information for the quality control of Toufengyu Dropping Pills.