This paper presents a rare renal biopsy-confirmed case of enoxaparin-induced anticoagulant-related nephropathy (ARN). A 62-year-old male was admitted with microscopic hematuria, massive albuminuria, and elevated serum creatinine following postoperative right shoulder joint infection. The serum creatinine level decreased after surgical debridement and antibiotic therapy. Enoxaparin (4 000 U daily) was initiated for thromboembolism prevention. The patient developed acute kidney injury with serum creatinine 517 μmol/L accompanied by gross hematuria. Renal biopsy revealed characteristic features of ARN coexisting with infection-related glomerulonephritis. After antibiotic therapy, urinary alkalinization, hemodialysis, and glucocorticoids (prednisone acetate 30 mg daily) of therapeutic interventions, the renal function partially recovered with dialysis discontinuation. The paper reviews the relevant literature on the risk factors, clinical manifestations, pathological features, diagnosis and treatment of ARN to improve clinicians' understanding.

Objective To investigate the therapeutic efficacy of inspiratory muscle training(IMT)combined with external diaphragm pacing(EDP)in elderly patients with chronic heart failure(CHF).Methods 147 patients with CHF admitted to the Department of Cardiology of the Second Affiliated Hospital of Xi'an Jiaotong University from March 2024 to October 2024 were selected,of which 38 patients were in the conventional drug therapy group(standard care group),52 patients were in the conventional drug therapy+EDP therapy(dual therapy group),and 57 patients were in the conventional drug therapy+EDP therapy+IMT therapy(triple therapy group).Com-parative analyses were performed for maximum inspiratory pressure(MIP),maximum expiratory pressure(MEP),handgrip strength,6-minute walk distance(6MWD),modified Medical Research Council(mMRC)scores,resting heart rate,and blood pressure before treatment and 4 weeks post-intervention.Results After treatment,The dual therapy group demonstrated higher MIP,6MWD,and lower mMRC scores than the standard care group(P<0.05).The triple therapy group exhibited superior improvements in MIP,MEP,handgrip strength,6MWD,and lower mMRC scores compared to both standard care and dual therapy groups(P<0.05),with additional benefits including lower resting systolic blood pressure versus dual therapy group(P<0.05)and reduced resting heart rate compared to standard care group(P<0.05).Conclusion The combined IMT and EDP significantly enhances respiratory and upper limb muscle strength in CHF patients,effectively improves cardiopulmonary function,alleviates dys-pnea,and reduces resting heart rate and blood pressure,thus improving the quality of life.It is worthy of clinical promotion and application.

Objective To investigate the role of syntaxin 4(STX4)in endoplasmic reticulum(ER)-mitochondria corcinoma in ovarian cancer(OC)cells.Methods The differences in STX4 expression in the OC cell line SKOV-3 and normal ovarian epithe-lial cells HOSEpiC were analyzed by Western blot and real-time fluorescence quantitative polymerase chain reaction(qRT-PCR).SKOV-3 cell lines with stable knockdown of STX4 were constructed by lentiviral transfected cells,and the knockdown efficiency was verified by Western blot and qRT-PCR.The wound healing assay examined the changes in SKOV-3 migratory ability after STX4 knockdown,the Transwell assay examined the changes in SKOV-3 invasive ability after STX4 knockdown.The ER-mito-chondrial contact structure changes in SKOV-3 cells were visualized by transmission electron microscopy.Intracellular phospha-tidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin(PI3K/AKT/mTOR)pathway proteins and their phosphor-ylated proteins were measured at the protein level.Results Both Western blot and qRT-PCR results showed that the expression level of STX4 was significantly higher in SKOV-3 cells than in HOSEpiC cells,and the differences were statistically significant(t=7.86,9.27,all P<0.05).The knockdown efficiency was verified by Western blot and qRT-PCR.Subsequently,the results of the wound-healing assay indicated that the migratory ability of SKOV-3 cells was significantly inhibited upon STX4 knockdown.The results of the Transwell test showed that the invasive capacity of SKOV-3 cells was significantly reduced after STX4 knock-down(t=7.56,8.82,all P<0.05).Endoplasmic reticulum-mitochondrial contact structure was reduced in SKOV-3 cells with STX4 knockdown under TEM.Finally,no significant changes after STX4 knockdown in the overall levels of PI3K/AKT/mTOR pathway proteins in SKOV-3 cells(t=2.77,5.58,2.99,all P>0.05),but their phosphorylated proteins were significantlydecreased(t=4.42,5.01,5.58,all P>0.05).Conclusion STX4 promoted OC cell migration,invasion,and the formation of ER-mitochondrial contact structures through the activation of the PI3K/AKT/mTOR pathway through phosphorylation.

Objective:To investigate the clinical characteristics of residual dizziness（RD） after repositioning in patients with benign paroxysmal positional vertigo（BPPV）, identify its potential risk factors, and develop a predictive risk model. Methods:A total of 137 patients diagnosed with BPPV at the First Affiliated Hospital of Xi'an Jiaotong University between January 2023 and June 2023 were enrolled. Based on the presence or absence of subjective discomfort within 3 months after successful repositioning, patients were divided into the non-RD group（NRD, n=93） and the RD group（n=44）. Differences in demographic characteristics, comorbidities, and disease-related features were compared between groups. Multivariate logistic regression analysis was used to identify independent risk factors for RD, and a nomogram was constructed based on these factors. The predictive performance of the model was assessed using the area under the curve（AUC）. Results:The RD group showed significantly higher values in body mass index, prevalence of diabetes and motion sickness history, dizziness duration before repositioning, history of repositioning at external hospitals, number of treatments, and recurrence（all P<0.001）. Multivariate logistic regression revealed that diabetes（adjusted OR=8.73, P=0.039）, motion sickness history（adjusted OR=23.08, P<0.001）, dizziness duration ≥30 days before repositioning（adjusted OR=15.16, P<0.001）, and recurrence（adjusted OR=15.72, P=0.001） were independent risk factors for RD. The nomogram model based on these variables demonstrated good predictive ability, with an AUC of 0.804（95%CI 0.684-0.924）. Conclusion:Diabetes, motion sickness history, dizziness duration ≥30 days, and recurrence are independent risk factors for RD after repositioning in patients with BPPV. The nomogram model based on these variables shows good predictive performance, with recurrence having the highest predictive value. This model can aid in early identification of high-risk patients and guide individualized intervention strategies.
Humans ; Nomograms ; Benign Paroxysmal Positional Vertigo/therapy* ; Dizziness/etiology* ; Risk Factors ; Risk Assessment ; Multivariate Analysis ; Male ; Female ; Logistic Models ; Middle Aged ; Patient Positioning ; Adult

Objective:To explore the neuropathological characteristics of brain tissues from autopsy of patients with schizophrenia.Methods:Forty-two autopsy cases from National Human Brain Bank for Health and Disease, School of Medicine, Zhejiang University from January 2013 to December 2024 were selected as research subjects, among which, 21 were schizophrenia patients(schizophrenia group) and 21 were non-schizophrenia patients (non-schizophrenia group). Clinical data of patients from the two groups were compared. HE staining was used to detect the pathological changes such as infarction, hemorrhage and arteriosclerosis in the brain tissues, silver-nitrate staining was used to detect the amyloid plaques in the brain tissues, Congo red staining was used to detect the pathological changes related to cerebral amyloid angiopathy (CAA) in the brain tissues, modified Gallyas silver staining was used to detect the neurofibrillary tangles in the brain tissues, and immunohistochemical staining was used to detect the expressions of phosphorylated tau protein, β-amyloid protein (Aβ), TAR DNA binding protein 43 (TDP-43), and α-synuclein in the brain tissues. Alzheimer's disease neuropathologic change (ADNC), primary age-related tauopathy (PART), limbic-predominant age-related TDP-43 encephalopathy (LATE), aging-related tau astrogliopathy (ARTAG), Lewy body disease (LBD), and cerebrovascular disease (CVD)-related pathological changes in the brain tissues were evaluated, and differences in positive rates of the above pathological changes were compared.Results:No significant difference in gender, age of death, brain weight, or apolipoprotein E genotype was noted between the schizophrenia group and non-schizophrenia group ( P>0.05). Six schizophrenia patients exhibited low-to-intermediate ADNC, including 4 with low ADNC and 2 with intermediate ADNC. Compared with the non-schizophrenia group, the positive rates of ADNC- and CVD-related pathological changes in the schizophrenia group were significantly higher (0 vs. 28.6%; 9.5% vs. 47.6%, P<0.05). No significant differences in positive rates of PART-, LATE-, ARTAG-, and LBD-related pathological changes were noted between the schizophrenia group and non-schizophrenia group ( P>0.05). Conclusion:Schizophrenia patients show high proportions of ADNC- and CVD-related pathological changes, but relatively low ADNC severity.

Objective To investigate the role of syntaxin 4(STX4)in endoplasmic reticulum(ER)-mitochondria corcinoma in ovarian cancer(OC)cells.Methods The differences in STX4 expression in the OC cell line SKOV-3 and normal ovarian epithe-lial cells HOSEpiC were analyzed by Western blot and real-time fluorescence quantitative polymerase chain reaction(qRT-PCR).SKOV-3 cell lines with stable knockdown of STX4 were constructed by lentiviral transfected cells,and the knockdown efficiency was verified by Western blot and qRT-PCR.The wound healing assay examined the changes in SKOV-3 migratory ability after STX4 knockdown,the Transwell assay examined the changes in SKOV-3 invasive ability after STX4 knockdown.The ER-mito-chondrial contact structure changes in SKOV-3 cells were visualized by transmission electron microscopy.Intracellular phospha-tidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin(PI3K/AKT/mTOR)pathway proteins and their phosphor-ylated proteins were measured at the protein level.Results Both Western blot and qRT-PCR results showed that the expression level of STX4 was significantly higher in SKOV-3 cells than in HOSEpiC cells,and the differences were statistically significant(t=7.86,9.27,all P<0.05).The knockdown efficiency was verified by Western blot and qRT-PCR.Subsequently,the results of the wound-healing assay indicated that the migratory ability of SKOV-3 cells was significantly inhibited upon STX4 knockdown.The results of the Transwell test showed that the invasive capacity of SKOV-3 cells was significantly reduced after STX4 knock-down(t=7.56,8.82,all P<0.05).Endoplasmic reticulum-mitochondrial contact structure was reduced in SKOV-3 cells with STX4 knockdown under TEM.Finally,no significant changes after STX4 knockdown in the overall levels of PI3K/AKT/mTOR pathway proteins in SKOV-3 cells(t=2.77,5.58,2.99,all P>0.05),but their phosphorylated proteins were significantlydecreased(t=4.42,5.01,5.58,all P>0.05).Conclusion STX4 promoted OC cell migration,invasion,and the formation of ER-mitochondrial contact structures through the activation of the PI3K/AKT/mTOR pathway through phosphorylation.

Objective To investigate the therapeutic efficacy of inspiratory muscle training(IMT)combined with external diaphragm pacing(EDP)in elderly patients with chronic heart failure(CHF).Methods 147 patients with CHF admitted to the Department of Cardiology of the Second Affiliated Hospital of Xi'an Jiaotong University from March 2024 to October 2024 were selected,of which 38 patients were in the conventional drug therapy group(standard care group),52 patients were in the conventional drug therapy+EDP therapy(dual therapy group),and 57 patients were in the conventional drug therapy+EDP therapy+IMT therapy(triple therapy group).Com-parative analyses were performed for maximum inspiratory pressure(MIP),maximum expiratory pressure(MEP),handgrip strength,6-minute walk distance(6MWD),modified Medical Research Council(mMRC)scores,resting heart rate,and blood pressure before treatment and 4 weeks post-intervention.Results After treatment,The dual therapy group demonstrated higher MIP,6MWD,and lower mMRC scores than the standard care group(P<0.05).The triple therapy group exhibited superior improvements in MIP,MEP,handgrip strength,6MWD,and lower mMRC scores compared to both standard care and dual therapy groups(P<0.05),with additional benefits including lower resting systolic blood pressure versus dual therapy group(P<0.05)and reduced resting heart rate compared to standard care group(P<0.05).Conclusion The combined IMT and EDP significantly enhances respiratory and upper limb muscle strength in CHF patients,effectively improves cardiopulmonary function,alleviates dys-pnea,and reduces resting heart rate and blood pressure,thus improving the quality of life.It is worthy of clinical promotion and application.

This paper presents a rare renal biopsy-confirmed case of enoxaparin-induced anticoagulant-related nephropathy (ARN). A 62-year-old male was admitted with microscopic hematuria, massive albuminuria, and elevated serum creatinine following postoperative right shoulder joint infection. The serum creatinine level decreased after surgical debridement and antibiotic therapy. Enoxaparin (4 000 U daily) was initiated for thromboembolism prevention. The patient developed acute kidney injury with serum creatinine 517 μmol/L accompanied by gross hematuria. Renal biopsy revealed characteristic features of ARN coexisting with infection-related glomerulonephritis. After antibiotic therapy, urinary alkalinization, hemodialysis, and glucocorticoids (prednisone acetate 30 mg daily) of therapeutic interventions, the renal function partially recovered with dialysis discontinuation. The paper reviews the relevant literature on the risk factors, clinical manifestations, pathological features, diagnosis and treatment of ARN to improve clinicians' understanding.

Objective:To explore the neuropathological characteristics of brain tissues from autopsy of patients with schizophrenia.Methods:Forty-two autopsy cases from National Human Brain Bank for Health and Disease, School of Medicine, Zhejiang University from January 2013 to December 2024 were selected as research subjects, among which, 21 were schizophrenia patients(schizophrenia group) and 21 were non-schizophrenia patients (non-schizophrenia group). Clinical data of patients from the two groups were compared. HE staining was used to detect the pathological changes such as infarction, hemorrhage and arteriosclerosis in the brain tissues, silver-nitrate staining was used to detect the amyloid plaques in the brain tissues, Congo red staining was used to detect the pathological changes related to cerebral amyloid angiopathy (CAA) in the brain tissues, modified Gallyas silver staining was used to detect the neurofibrillary tangles in the brain tissues, and immunohistochemical staining was used to detect the expressions of phosphorylated tau protein, β-amyloid protein (Aβ), TAR DNA binding protein 43 (TDP-43), and α-synuclein in the brain tissues. Alzheimer's disease neuropathologic change (ADNC), primary age-related tauopathy (PART), limbic-predominant age-related TDP-43 encephalopathy (LATE), aging-related tau astrogliopathy (ARTAG), Lewy body disease (LBD), and cerebrovascular disease (CVD)-related pathological changes in the brain tissues were evaluated, and differences in positive rates of the above pathological changes were compared.Results:No significant difference in gender, age of death, brain weight, or apolipoprotein E genotype was noted between the schizophrenia group and non-schizophrenia group ( P>0.05). Six schizophrenia patients exhibited low-to-intermediate ADNC, including 4 with low ADNC and 2 with intermediate ADNC. Compared with the non-schizophrenia group, the positive rates of ADNC- and CVD-related pathological changes in the schizophrenia group were significantly higher (0 vs. 28.6%; 9.5% vs. 47.6%, P<0.05). No significant differences in positive rates of PART-, LATE-, ARTAG-, and LBD-related pathological changes were noted between the schizophrenia group and non-schizophrenia group ( P>0.05). Conclusion:Schizophrenia patients show high proportions of ADNC- and CVD-related pathological changes, but relatively low ADNC severity.

OBJECTIVE To provide reference for the rational use of antiemetic drugs in tumor chemotherapy patients. METHODS The data of tumor patients who were given antiemetic drugs were collected from 9 departments of our hospital with hospital information system from Oct. 1st to Nov. 30th in 2022， such as oncology department， radiotherapy department， gynecology department， and gastroenterology department. The application of chemotherapy drugs and the use of antiemetic drugs were analyzed statistically， and the irrational use of antiemetic drugs was analyzed. RESULTS A total of 520 patients were included， involving 248 （47.69%） using chemotherapy drugs with a moderate emetogenic risk level and 135 （25.96%） with a high emetogenic risk level. A total of 461 cases （73.06%） of 5-hydroxytryptamine 3-receptor antagonists were used， including palonosetron in 333 cases， ondansetron in 106 cases， tropisetron in 15 cases and granisetron in 7 cases， and only 148 cases of patients were prioritized for the use of nationally procured medicines and national essential medicines （32.10%）. Neurokinin-1 receptor antagonists were used in 170 cases （26.94%）， including fosaprepitant in 112 cases and aprepitant in 58 cases. The use of antiemetic drugs was unreasonable in 162 patients （31.15%）； among the types of irrational drugs， the antiemetic regimen was unreasonable in the largest number of cases （22.40%）， followed by the irrational pharmacoeconomics （19.13%）. CONCLUSIONS The emetogenic risk levels of chemotherapy drugs used for tumor patients in our hospital are primarily moderate to high， and there is irrational use of antiemetic regimen and pharmacoeconomics. Clinicians， nurses， pharmacists and hospital departments should collaborate as multiple teams to strengthen full supervision of the standardization of antiemetic drugs， reasonably select antiemetic drugs based on emetogenicity rating， and improve the compliance of doctors with the guidelines to ensure the safety， effectiveness， and cost-effective of patient medication.