OBJECTIVE To assess the efficacy and safety of different treatment modalities for moderate to severe Henoch- Schönlein purpura nephritis （HSPN）. METHODS Literature searches were conducted in the CNKI， VIP， Wanfang Data， SinoMed， PubMed， OVID， Web of Science， Embase， and the Cochrane Library to collect randomized controlled trials （RCTs） and cohort studies on the treatment of moderate to severe HSPN with 12 intervention measures： monotherapy with glucocorticoid （GC）， as well as cyclophosphamide， mycophenolate mofetil （MMF）， Tripterygium wilfordii multiglucoside （TWM）， leflunomide， mizoribine， tacrolimus， cyclosporin A， hemoperfusion， tonsillectomy combined with GC， and double filtration plasmapheresis （DFPP） combined with GC and cyclophosphamide or mycophenolate mofetil. The search period was from the inception of the databases to March 2024. After literature screening， data extraction， and quality assessment， a network meta- analysis was performed using Stata 16.0 software. RESULTS A total of 28 articles were included， with 14 RCTs and 14 cohort studies， involving 1 746 patients. The network meta-analysis results showed the combination of tacrolimus and GC had the highest probability of being the best in overall remission rate， followed by the combination of TWM and GC， and DFPP combined with GC and MMF. The combination of leflunomide and GC had the highest probability of being the best in complete remission rate， followed by the combination of mizoribine and GC， and DFPP combined with GC and cyclophosphamide. The combination of mizoribine and GC had the highest probability of being the best in terms of reducing 24-hour urinary protein quantification， followed by DFPP combined with GC and MMF， and the combination of leflunomide and GC. Moreover， the combination of tacrolimus and GC had the highest probability of being the best in safety， followed by the combination of cyclosporin A and GC， and the combination of leflunomide and GC. CONCLUSIONS Compared to other treatment methods， the combination therapy of tacrolimus and GC shows better efficacy and safety in the treatment of moderate to severe HSPN.

Objective To observe the value of B1 corrected T1 mapping for distinguishing pathological types and differentiation degrees of lung cancers.Methods A total of 74 lesions in 65 patients with lung cancers were prospectively enrolled,including 49 poorly differentiated lesions and 25 moderately or well differentiated ones,i.e.42 adenocarcinomas,14 squamous cell carcinomas and 18 small cell lung cancers(all poorly differentiated).B1 corrected T1 mapping was performed,ROI(ROI1 and ROI2)were delineated using 2 methods,and T1 values of different pathological types and differentiation degrees lung cancers were compared.The receiver operating characteristic(ROC)curves were drawn,and the areas under the curve(AUC)were calculated.Results Significant differences of T1 values were found among different pathological types of lung cancer(all P＜0.05),as well as between small cell lung cancer and the rest 2 types of lung cancer(both P＜0.05).There were significant differences of T1 values between poorly differentiated and moderately well differentiated lung cancer(squamous cell carcinoma+adenocarcinoma)(both P＜0.05).Taken ROI1 T1 value=1 524.21 ms as the cut-off value,the AUC of T1 value for distinguishing poorly differentiated and moderately well differentiated lung cancer(squamous cell carcinoma+adenocarcinoma)was 0.698,with sensitivity of 64.50％and specificity of 76.00％.Taken ROI2 T1 value=1 630.68 ms as the cut-off value,the AUC of T1 value was 0.676,with sensitivity of 54.80％and specificity of 80.00％.Conclusion B1 corrected T1 mapping was helpful for distinguishing pathological types and differentiation degrees of lung cancers.

Objective To compare the value of stack-of-stars-volumetric interpolated breath-hold examination(Star-VIBE)and T1-volumetric interpolated breath-hold examination(T1-VIBE)MRI for displaying peripheral lung cancer.Methods Fifty-two patients with 56 peripheral lung cancer were prospectively enrolled,and chest Star-VIBE and T1-VIBE MRI were acquired.The morphological features were observed,and the subjective scores were recorded.The maximum diameter,signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of lesions were measured based on Star-VIBE and T1-VIBE MRI,respectively.Taken CT as the references,the value of Star-VIBE and T1-VIBE MRI for displaying peripheral lung cancer were compared.Results Star-VIBE MRI had higher scores for displaying spiculation sign,lobulation sign,pleural depression sign and halo sign than T1-VIBE(both P＜0.05).CNR and SNR of Star-VIBE MRI were significantly higher than those of T1-VIBE(both P＜0.001).No significant difference of the maximum diameter of lesions measured based on Star-VIBE and T1-VIBE MRI compared with CT was found,nor between Star-VIBE and T1-VIBE MRI(all P＞0.05).Conclusion Star-VIBE MRI had better value for displaying peripheral lung cancer than T1-VIBE.

In response to the market demand for therapeutic antibodies, the upstream cell culture scale and expression titer of antibodies have been significantly improved, while the production efficiency of downstream purification process is relatively fall behind, and the downstream processing capacity has become a bottleneck limiting antibody production throughput. Using monoclonal antibody mab-X as experimental material, we optimized the caprylic acid (CA) precipitation process conditions of cell culture fluid and low pH virus inactivation pool, and studied two applications of using CA treatment to remove aggregates and to inactivate virus. Based on the lab scale study, we carried out a 500 L scale-up study, where CA was added to the low pH virus inactivation pool for precipitation, and the product quality and yield before and after precipitation were detected and compared. We found that CA precipitation significantly reduced HCP residuals and aggregates both before and after protein A affinity chromatography. In the aggregate spike study, CA precipitation removed about 15% of the aggregates. A virus reduction study showed complete clearance of a model retrovirus during CA precipitation of protein A purified antibody. In the scale-up study, the depth filtration harvesting, affinity chromatography, low pH virus inactivation, CA precipitation and depth filtration, and cation exchange chromatography successively carried out. The mixing time and stirring speed in the CA precipitation process significantly affected the CA precipitation effect. After CA precipitation, the HCP residue in the low pH virus inactivation solution decreased 895 times. After precipitation, the product purity and HCP residual meet the quality criteria of monoclonal antibodies. CA precipitation can reduce the chromatography step in the conventional purification process. In conclusion, CA precipitation in the downstream process can simplify the conventional purification process, fully meet the purification quality criterion of mab-X, and improve production efficiency and reduce production costs. The results of this study may promote the application of CA precipitation in the purification of monoclonal antibodies, and provide a reference for solving the bottleneck of the current purification process.
Cricetinae ; Animals ; Antibodies, Monoclonal/metabolism* ; Caprylates/chemistry* ; Cell Culture Techniques ; Chromatography, Affinity ; CHO Cells ; Cricetulus ; Chemical Precipitation

Objective:To investigate the expression of microRNA-155 (miR-155) in serum and kidney of C57BLKS/db (db/db) mice and its role in the pathogenesis of diabetic kidney disease (DKD).Methods:The db/db mice ( n=24) were divided into 6, 8, and 10 weeks old groups ( n=8) with age increasing according to the random number table, and C57BL/6 mice of the same age were used as control group. The expression of miR-155 in mouse serum and kidney tissue was determined using real-time quantitative PCR. The mRNA and protein expression of Ets-1, eNOS, AGTR1 in renal tissues was verified by real-time quantitative PCR, Western blotting and immunohistochemistry. Results:Compared with the control group, the expression of miR-155 in serum of db/db mice at 6, 8 and 10 weeks of age were significantly increased (all P<0.01), and the increase of miR-155 was most obvious at 10 weeks of age ( P<0.01). Meanwhile the expression of miR-155 in kidney tissues of 6, 8 and 10 weeks old db/db mice was significantly up-regulated (all P<0.01), and the highest expression of miR-155 was at 10 weeks of age ( P<0.01). Immunohistochemistry showed that Ets-1, eNOS and AGTR1 were localized in glomerular endothelial cells. The results of real-time quantitative PCR showed that the mRNA expression of Ets-1, eNOS and AGTR1 were down-regulated in the kidney tissues of db/db mice at 6, 8 and 10 weeks of age compared to the control(all P<0.05), and the level of down-regulation was the most obvious at 10 week. Western blotting results showed that there was no significant change in Ets-1, eNOS and AGTR1 in 6-week-old db/db mice compared to the control group; the eNOS protein expression was down-regulated at 8 weeks of age ( P<0.05); the expression of AGTR1 protein was down-regulated ( P<0.05), and the protein expression of Ets-1 and eNOS were significantly down-regulated at 10-week age (both P<0.01). Conclusions:The expression of miR-155 in serum and kidney tissues of db/db mice increases during the progression of DKD, while the expression of miR-155 target genes Ets-1, eNOS and AGTR1 decreases with the progression of DKD. MiR-155 may participate in the development and progression of DKD by inhibiting its target genes Ets-1, eNOS and AGTR1, affecting endothelial cell function.

Objective: To investigate the incidence of renal insufficiency in solitary kidney patients and analyze the risk factors. Methods: Patients with solitary kidney who were admitted to the Second Hospital of Lanzhou University from January 2012 to January 2019 were retrospectively selected as subjects. According to estimated glomerular filtration rate (eGFR) level, the patients were divided into two groups: eGFR<60 ml·min^-1·(1.73 m²)^-1 group and eGFR≥60 ml·min^-1·(1.73 m²)^-1 group. The data of the general information, laboratory examinations and kidney size were collected, and the differences of the above indicators between the two groups were compared. Logistic regression model was used to analyze the related factors of renal function decline. Results: (1) A total of 323 solitary kidney patients with age of (53.8±15.8) years and median duration of 10.0 years were enrolled in the study, including 203 males (62.8%). There were 150 cases (46.4%) with hypertension, 136 cases(42.1%) with proteinuria, and 134 cases (41.5%) with renal insufficiency, even 29 cases(9.0%) had developed into end-stage renal disease. (2) Compared with those in eGFR≥60 ml·min^-1·(1.73 m²)^-1group, patients in eGFR<60 ml·min^-1·(1.73 m²)^-1 group had higher age, mean arterial pressure, serum creatinine, serum uric acid, fasting blood glucose, and higher proportion of hypertension and proteinuria, but had lower proportion of congenital solitary kidney, hemoglobin, plasma albumin and residual kidney diameter. The differences of above indicators were statistically significant (all P<0.05). (3) Logistic regression analysis showed that increasing age (every ten years, OR=1.752, 95% CI 1.455-2.109, P<0.001), anemia (OR=2.327, 95% CI 1.356-3.994, P=0.002), hyperuricemia (OR=5.097, 95% CI 2.873-9.042, P<0.001) and high urine protein level (every 1+, OR=1.515, 95% CI 1.197-1.919, P=0.001) were independent risk factors for renal dysfunction in solitary kidney patients. Conclusions The incidence of renal insufficiency in solitary kidney patients is 41.5%. Patients with solitary kidney may perform varying degrees of kidney damage, such as hypertension, proteinuria and eGFR decline. Increasing age, anemia, hyperuricemia and high urine protein level are independent risk factors for renal insufficiency in solitary kidney patients.

Objective: To investigate the difference in the clinical efficacy by thoracoscopy or thoracotomy for treating esophageal atresia. Methods: Thirty-one cases of type-Ⅲ esophageal atresia undergoing surgical treatment from February 2015 to May 2018 at the Department of Pediatric Surgery of Fujian Provincial Maternity and Children′s Hospital were included, and according to the different surgical methods they were divided into thoracoscopic group (15 cases) and thoracotomy group (16 cases). The operation duration, blood loss, postoperative chest drainage time, posto-perative hospital stay and postoperative complications were analyzed between 2 groups. Results: The mean time of operation was (181.33±13.86) min in the thoracoscopic surgery group and (139.06±10.98) min in the thoracotomy group, the thoracoscopic group had longer operation duration than thoracotomy group, and there was a significant difference in operation duration between two groups (t=9.44, P=0.000); mean blood loss was (3.07±0.96) mL in the thoracoscopic surgery group and (5.06±1.12) mL in the thoracotomy group, the thoracoscopic group had less amount of blood loss than thoracotomy group, and there was a significant difference in blood loss between two groups(t=-5.29, P=0.000); mean postoperative chest drainage time was(11.67±1.34) d in the thoracoscopic group and (12.25±1.06) d in the thoracotomy group, and there was no significant difference in postoperative chest drainage time between two groups(t=-1.34, P=0.19); mean time of postoperative hospitalization time was(15.20±0.94) d in the thoracoscopic group and (16.00±0.96) d in the thoracotomy group, and there was a significant difference in the postoperative hospitalization time between two groups (t=-2.33, P=0.027); the anastomotic leak rates were 33.33% (5 cases) versus 25.00% (4 cases) with closed or open approaches, respectively; anastomotic stricture rates were 40.00%(6 cases) versus 31.25% (5 cases) with closed or open approaches, respectively.There was no significant difference in postoperative incidence of anastomotic fistula and anastomotic stenosis between two groups. Conclusions Compared with thoracotomy in the treatment of esophageal atresia, thoracoscopic approach has smaller incision and less bleeding, less chest deformity, short hospital stay postoperatively, so it is safe and effective.However, the surgeon must have experience in doing thoracoscopic operation.

Objective To analyze the components of attentional bias on anger and disgust emotional faces in college students with social anxiety disorder.Methods DSM-V was used for clinical diagnosis after the initial screening with Interaction Anxiousness Scale.The subjects meet the inclusion criteria were divided into social anxiety disorder group (SAD group) and healthy control group (HC group).Koster's improved dot-probe paradigm was used in a 2 (group:SAD group,HC group) ×2 (emotion categories:anger,disgust)mixed-design experiment,and the different characteristics of attentional bias between the two groups on different emotional faces were compared.Results In SAD group,under the condition of angry faces,the response times to the probe targets with the same or different positions from the negative faces were (369.7±53.0)ms and (447.2±54.3) ms,while the response times were (429.6±70.2) ms and (444.2±55.8) ms under the condition of disgust faces,and the SAD group showed attentional bias towards both anger and disgust faces (t =24.15 and 2.45,P＜0.05).Under the condition of anger faces,the response time of HC group to the consistent and inconsistent position of probe target were (466.9±40.0) ms and (483.8±43.8) ms,and the HC group had an attentional bias towards anger faces(t=6.58,P＜0.05).The response time under disgust faces was (493.8±43.6)ms and (498.0±46.7)ms in HC group,and did not show an attentional bias towards disgust(t=1.65,P=0.108).The scores of attentional orientation to anger faces in SAD group were significantly higher than those in the HC group(F=19.26,P＜0.001),but there was no significant difference between the two groups towards disgust faces (F=0.02,P=0.897).Compared with disgust faces,the attentional orientation to anger faces was faster in both HC and SAD groups (F=101.66 and 8.00,P＜0.05).Compared with the HC group,the SAD group had an impaired attentional disengagement from anger faces(F=8.66,P=0.004).Conclusion The students with social anxiety disorder have attentional bias towards both anger and disgust facial expressions,which manifested as facilitated attentional orientation and impaired attentional disengagement to anger faces.

Objective To investigate the prevalence of nutritional risk,undernutrition and nutritional support among elderly inpatients with coronary heart disease in 11 tertiary A hospitals in China.Methods Records of elderly patients under the age of 90 with coronary heart disease were collected between March 2012 and May 2012 from 11 tertiary A hospitals in China following the direction of diagnosis related group of Beijing government.Results A total of 1 279 consecutive cases were recruited with the average age 74 years old (65-89).The total nutritional risk prevalence was 28.14％ (360/1 279).The prevalence of nutritional risk and nutritional risk score ≥ 5 increased with age.The prevalence of nutritional risk (12.88％ vs.30.08％ vs.42.28％) and nutritional risk scored ≥5 (10.86％ vs.18.61％ vs.27.78％)increased with age.Judging from BMI,most patients were overweight or obese (BMI ≥ 24 kg/m2),accounting for 53.0％ of the total,and prevalence of nutritional risk in this subgroup was 15.12％ (96/635).The prevalence of nutritional risk in patients with normal BMI was 34.24％.The prevalence of undernutrition defined as BMI＜ 18.5 kg/m2 was 4.25％ (51/1 279),among which patients with score ≥ 5 account for 64.7％ (33/51).The prevalence of undernutrition defined as nutritional impairment score =3 was 7.58％ (97/1 279).In patients with nutritional risk,57 were administrated nutrition support (16.6％);in patients without nutritional risk,21 received nutrition support,mostly parenteral nutrition (16 cases,76.2％).In patients with nutritional risk [(79.46± 7.19) years vs.(76.40± 6.16) years],there were statistically significant difference between those who received nutrition support and those who did not in terms of age and the ratio of patients with nutritional risk scored≥5 (35.1％ vs.17.1％) (P =0.001,P=0.002).Conclusions The prevalence of nutritional risk in patients with coronary heart disease was high.The prevalence of undernutrition was low.Prevalence of overweight and obese was high,but there was still nutritional risk in this group of patients.The patients who received nutrition support were older and had high nutritional impairment score,but the indication is not rationale.

Objective To investigate current knowledge levels of medical staff for hypoglycemia care process in endocrinology department and provide basis for related knowledge training and interventions. Methods A total of 119 medical workers were recruited and investigated using self-made hypoglycemia care process questionnaire via cross-sectional survey.Results The correct rates in knowledge of carbohydrate foods number, first retest time after eating, treatments for patients who were not recover after first eating and retest time of patients who were recover after eating were low (<70%). The correct rates of first retest time after eating in nurses (75.9%, 55.6%) were better than doctors (42.2%, 22.2%). The correct rates of first retest time after eating and treatments for patients who were not recover after first eating were significantly different among patients with individual degrees (P<0.05).Conclusions The knowledge levels of medical staff for hypoglycemia care process in endocrinology department are not high and different among individuals. The training of hypoglycemia care process is necessary.