This article reports a case of an elderly male patient presenting with nephrotic syndrome. Renal biopsy pathology indicated membranous nephropathy, with both renal tissue staining for M-type phospholipase A2 receptor (PLA2R) and serum anti-PLA2R antibodies being negative. Nephrotic syndrome achieved remission following treatment with prednisone combined with tacrolimus; however, the patient relapsed during tacrolimus maintenance therapy. Subsequent laboratory evaluation revealed positive anti-nuclear antibodies and anti-double-stranded DNA antibodies, accompanied by decreased complement levels. Exostosin 1 and Exostosin 2 staining performed on the initial renal biopsy specimen yielded positive results, leading to a diagnosis of lupus nephritis. Due to the patient's history of rituximab-related allergic reactions, pulmonary infection, and acute kidney injury, the subsequent treatment regimen consisted of obinutuzumab sequentially combined with belimumab, in addition to prednisone 10 mg/d. During the two-year follow-up period, the patient's anti-double-stranded DNA antibodies converted to negative, complement levels normalized, proteinuria achieved complete remission, and no adverse events such as severe infection occurred. This article reviews the diagnosis, treatment, and relevant literature for this case, aiming to provide clinical insights for the early diagnosis and selection of therapeutic strategies for similar patients.

Immune thrombocytopenia(ITP)is an autoimmune disease characterized primarily by bleeding and fatigue.ITP-related fatigue can substantially affect health-related quality of life and has been recognized as a treatment indication in the latest guidelines.However,its pathogenesis remains unclear,and targeted therapies are lacking.This paper explores the theoretical foundation of the"excessive fire consuming healthy qi"theory,linking two key conceptual pairs:"excessive fire"with inflammation and"healthy qi consumption"with mitochondrial dysfunction.Chronic inflammation leads to continuous"qi consumption"and damage to mitochondrial structure and function,ultimately resulting in symptoms of qi deficiency such as tiredness and fatigue.The imbalance between qi and fire,leading to imbalance of yin and yang,is the primary pathogenesis of ITP-related fatigue,with the disease mainly affecting the spleen.Considering the etiology and pathogenesis of ITP,and relative equilibrium of yin-yang,the therapeutic approach of invigorating spleen and benefiting qi to promote the production of blood serves as a core treatment strategy.Previous research has demonstrated the clinical efficacy of Jianpi Yiqi Shexue Formula,consisting of milkvetch root,tangshen,Indian bread,largehead atractylodes rhizome,India madder root,and ass hide glue in treating patients with ITP-related fatigue.Designed to invigorate the spleen and regulate qi and blood,this formula aligns with the pathogenesis of ITP-related fatigue characterized by deficiency of spleen qi and stomach qi.The formula also modulates the expression levels of key proteins and genes involved in mitochondrial energy metabolism and alleviates the immune dysfunction.These findings highlight the potential for further research into the mechanism of ITP-related fatigue,particularly by using inflammation-mediated mitochondrial energy metabolism as a promising entry point.

Objective To study the syntactic impairment characteristics of wh-question comprehension and expression in Chinese non-fluent aphasic patients.Methods The differences in comprehension and expression be-tween 25 non-fluent aphasic patients and 25 normal subjects were tested in the form of sentence-figure matching and elicitation-repetition to analyze syntactic impairment characteristics related to sentence patterns,question objects,and question words.Results The patients with non-fluent aphasia had impaired comprehension and expression of specific interrogative sentences,and the order of correct comprehension was:(active interrogative sentence,object pseudo-split interrogative sentence)＞(subject pseudo-split interrogative sentence,passive interrogative sentence),and the order of correct expression was:active interrogative sentence＞(pseudo-split interrogative sentence,pas-sive interrogative sentence).Conclusion The pattern of impaired comprehension and expression of wh-question was similar in patients with Chinese non-fluent aphasia.The main influences on syntactic structure included the object of questioning(subject-object)and the type of sentence.Obstacles were more pronounced in sentences with wh-move-ment and non-canonical order.

support the diagnosis.The treatment of PHCC is mainly based on surgery.Due to the characteristics of intact capsule,surgical resection is relatively easy and the cure rate is higher than that of ordinary hepatocellular carcinoma,and the postoperative survival rate is relatively ideal.For unresectable PHCC,palliative treatment based on transcatheter arterial chemoembolization can be used.This article reviews the progress on diagnosis and treatment of PHCC in order to provide reference for clinical practice.

Objective Titanium ions were implanted into Bio-HPP materials using plasma immersion ion implantation(PIII)technology,and the biocompatibility against human gingival fibroblasts(HGFs)and antimicrobial activity against porphyromonas gingivalis(P.g)to the materials were preliminarily evaluated.Methods The cell experiments and antibacterial experiments in vitro were conducted,and the specimens were randomly divided into the modified group and the control group,and the modified specimens were placed in an ion implantation device and implanted with titanium ions by PIII technology.The morphology of the nanostructures on the surface of the materials was observed by scanning electron microscopy.The cytocompatibility of Bio-HPP materials was evaluated by proliferation detection,immunofluorescence staining and cell cycle distribution detection of HGFs.The antibacterial activity of the materials was evaluated by the detection of antibacterial rate of P.g and the expression analysis of pathogenic gene,and the antibacterial mechanism was preliminarily analyzed.Results The surface of Bio-HPP in the control group was relatively flat,and the modified group formed nanopores with diameters of 100 to 300 nm,with smaller nanoparticles distributed in the nanostructures.The cell proliferation rates of HGFs after cultured for 3,5 and 7 days in the modified group were higher than those in the control group(P<0.05).After 4 hours of incubation,the cells spread well on the surface of the both groups,and the cytoskeleton extended further outward,while the spreading area on the surface of the control group was slightly smaller than that of the modified group.After 24 hours of incubation,the cells on the surface of materials in the both groups showed elongated spindle or shuttle shape,with good growth.There was no significant difference in the proportions of cells at stages G1 and G2 between the control group and the modified group(P>0.05).The proportion of cells at stage S in the modified group was higher than that in the control group(P<0.05).After 24 hours of incubation,the number of colonies in the modified group was significantly reduced compared with the control group;the antibacterial rate of the modified group was significantly higher than that of the control group(P<0.05).The relative expression of pathogenic genes fimA on the surface in the modified group was significantly lower than that in the control group(P<0.05).Conclusion Bio-HPP materials modified by titanium plasma implantation promotes the adhesion and proliferation of HGFs,which was conducive to the adhesion of soft tissues around the gingiva,with good antibacterial activity.

Objective To study the syntactic impairment characteristics of wh-question comprehension and expression in Chinese non-fluent aphasic patients.Methods The differences in comprehension and expression be-tween 25 non-fluent aphasic patients and 25 normal subjects were tested in the form of sentence-figure matching and elicitation-repetition to analyze syntactic impairment characteristics related to sentence patterns,question objects,and question words.Results The patients with non-fluent aphasia had impaired comprehension and expression of specific interrogative sentences,and the order of correct comprehension was:(active interrogative sentence,object pseudo-split interrogative sentence)＞(subject pseudo-split interrogative sentence,passive interrogative sentence),and the order of correct expression was:active interrogative sentence＞(pseudo-split interrogative sentence,pas-sive interrogative sentence).Conclusion The pattern of impaired comprehension and expression of wh-question was similar in patients with Chinese non-fluent aphasia.The main influences on syntactic structure included the object of questioning(subject-object)and the type of sentence.Obstacles were more pronounced in sentences with wh-move-ment and non-canonical order.

Objective Titanium ions were implanted into Bio-HPP materials using plasma immersion ion implantation(PIII)technology,and the biocompatibility against human gingival fibroblasts(HGFs)and antimicrobial activity against porphyromonas gingivalis(P.g)to the materials were preliminarily evaluated.Methods The cell experiments and antibacterial experiments in vitro were conducted,and the specimens were randomly divided into the modified group and the control group,and the modified specimens were placed in an ion implantation device and implanted with titanium ions by PIII technology.The morphology of the nanostructures on the surface of the materials was observed by scanning electron microscopy.The cytocompatibility of Bio-HPP materials was evaluated by proliferation detection,immunofluorescence staining and cell cycle distribution detection of HGFs.The antibacterial activity of the materials was evaluated by the detection of antibacterial rate of P.g and the expression analysis of pathogenic gene,and the antibacterial mechanism was preliminarily analyzed.Results The surface of Bio-HPP in the control group was relatively flat,and the modified group formed nanopores with diameters of 100 to 300 nm,with smaller nanoparticles distributed in the nanostructures.The cell proliferation rates of HGFs after cultured for 3,5 and 7 days in the modified group were higher than those in the control group(P<0.05).After 4 hours of incubation,the cells spread well on the surface of the both groups,and the cytoskeleton extended further outward,while the spreading area on the surface of the control group was slightly smaller than that of the modified group.After 24 hours of incubation,the cells on the surface of materials in the both groups showed elongated spindle or shuttle shape,with good growth.There was no significant difference in the proportions of cells at stages G1 and G2 between the control group and the modified group(P>0.05).The proportion of cells at stage S in the modified group was higher than that in the control group(P<0.05).After 24 hours of incubation,the number of colonies in the modified group was significantly reduced compared with the control group;the antibacterial rate of the modified group was significantly higher than that of the control group(P<0.05).The relative expression of pathogenic genes fimA on the surface in the modified group was significantly lower than that in the control group(P<0.05).Conclusion Bio-HPP materials modified by titanium plasma implantation promotes the adhesion and proliferation of HGFs,which was conducive to the adhesion of soft tissues around the gingiva,with good antibacterial activity.

[Objective]To explore the correlation between general anesthesia and mild cognitive impairment in older adults so as to provide new ideas for early prevention and timely intervention of mild cognitive impairment(MCI).[Methods]Based on the baseline survey of the Hubei memory and aging cohort study(2018-2023),the participants completed a thorough neuropsychological assessment and physical examination,and self-reported a history of general anesthesia and surgery.The association of general anesthesia and MCI in the elderly was analyzed using the logistic regression model.In addition,the stratification and interaction analysis of anesthesia history,anesthesia number and physical intellectual exercise were conducted separately.[Results]A total of 5 069 older adults aged 65 and above were included in this study,including 3 692 city dwellers and 1 377 rural people,among whom were 2 584 women(51%).Out of the 1 472 participants with history of general anesthesia,249 people(17.4%)had MCI.After controlling for confounding factors,there was a 39.6%increased risk of MCI in older adults who underwent general anesthesia[OR=1.396,95%CI(1.169,1.668),P<0.001],suggesting that general anesthesia may be an independent influence on MCI.For the older adults who had one general anesthesia[OR=1.235,95%CI(1.001,1.523),P=0.049],two general anesthesia[OR=1.779,95%CI(1.292,2.450),P<0.001],and three OR more general anesthesia[OR=2.395,95%CI(1.589,3.610),P<0.001],their risks of MCI were increased by 23.5%,77.9%,and 139.5%,respectively.Compared with the older adults without a history of general anesthesia who did not exercise,the risk of developing MCI was significantly negatively correlated with the exercise group,cognitive exercise group,and combined exercise and cognitive exercise groups(all P<0.001).The risk of developing MCI in the exercise group was 60.2%of that in the no exercise group[OR=0.602,95%CI(0.456,0.795)],the risk in the cognitive exercise group was 42.4%of that in the no exercise group[OR=0.424,95%CI(0.294,0.613)],and the risk in the combined exercise and cognitive exercise group was 27.0%of that in the no exercise group[OR=0.270,95%CI(0.208,0.353)].In the older adults with a history of general anesthesia,compared with the no exercise group,the risk of developing MCI was significantly negatively correlated with the cognitive exercise group and the combined exercise and cognitive exercise group(all P<0.05).The risk of developing MCI in the cognitive exercise group was 47.7%of that in the no exercise group[OR=0.477,95%CI(0.256,0.892)],the risk in the combined exercise and cognitive exercise group was 34.5%of that in the no exercise group[OR=0.345,95%CI(0.220,0.540)],while the risk in the exercise-only group did not show a significant difference.[Conclusion]The risk of MCI increased significantly in older adults with a history of general anesthesia,and this risk increased with the times of anesthesia.Physical and mental exercise reduces the risk of MCI.it is recommended that older adults with a history of anesthesia incorporate physical and mental exercise into their daily lives to prevent mild cognitive impairment.

The presence of magnetic fields in a magnetic resonance accelerator (MR-linac) can affect the reference dosimetry, and thus the existing Code of Practices (CoPs) are inadequate for MR-linac. In this article, the characteristics of adsorbed dose to water and ionization chamber response in the presence of magnetic fields were introduced and a formalism for reference dosimetry in MR-linac was developed based on the existing CoPs, aiming to provide reference for dosimetric quality control and research work of MR-linac in China.

Objective:To compare the effects of different appointment regimens on the daily waiting time, fixedness of treatment time and lateness rate of radiotherapy patients.Methods:Medical records of 5488 radiotherapy from 332 patients on the same linear accelerator in West China Hospital of Sichuan University from March to June 2022 were selected. Based on the radiotherapy information integration platform of MOSAIQ, all patients were randomly assigned to the morning class, afternoon class and evening class. Traditional manual appointment regimen was adopted for the morning class, 30 min appointment regimen for the afternoon class, and 15 min appointment regimen for the evening class, respectively. The differences in patient waiting time for treatment, fixedness of treatment time, and lateness rate under different appointment regimens were compared. The fixedness of treatment time and waiting time was determined by one-way ANOVA, and the 2×3 Chi-square test was adopted for the lateness rate. Results:The waiting time in the 15 min appointment, the 30 min appointment and manual appointment groups were (27.08 ± 17.21), (34.57± 19.12) and (41.50 ±20.94) min, respectively. There was statistical significance among three appointment regimens ( F=254.97, P<0.001). The waiting time was the shortest in the 15 min appointment group, followed by the 30 min appointment group, and the manual appointment group (all P<0.001 for two-group comparison). The fixedness of treatment time in the 15 min appointment, the 30 min appointment and the manual appointment groups were (15.60±7.87), (18.69±8.94) and (24.30±15.10) min, respectively. There was statistical significance among three groups ( F=25.23, P<0.001). Among them, the fixedness of treatment time in the 15 min appointment group was the highest, followed by the 30 min appointment group, and the manual appointment group (all P<0.001). The lateness rates in the 15 min appointment, the 30 min appointment and the manual appointment groups were 5.7%, 6.2% and 9.6%, respectively. The lateness rate in the manual appointment group was higher than those in the 15 min appointment and the 30 min appointment groups ( χ2=19.24、14.90, both P<0.001), but there was no statistical significance in the lateness rate between the 15 min appointment and 30min appointment groups ( χ2=0.39, P=0.535). Conclusion:In the clinical practice of conventional intensity-modulated radiotherapy technology carried out by conventional linear accelerator, the 15 min appointment regimen can shorten the waiting time for radiotherapy and improve the fixedness of daily radiotherapy time, which is worthy of clinical promotion.