Primary membranous nephropathy (PMN) is one of the common causes of nephrotic syndrome in adults and is characterized by the deposition of immune complexes, resulting in thickening of basement membrane. With the identification of more autoantibodies, the understanding of the pathogenesis of PMN has expanded. Currently, supportive therapy and immunosuppressive therapy are the primary treatments for PMN, which mainly consists of cyclophosphamide, calcineurin inhibitors, rituximab, and so on. With the advent and application of an increasing number of biological agents, a subset of refractory or drug-resistant PMN patients can be effectively treated and achieve remission. This article reviews recent advances in the management of PMN. It covers pretreatment assessment, immunosuppressive therapy, complement- targeted therapy, and anticoagulant therapy and deliberates on the management of rituximab- resistant patients. The review aims to provide clinicians with an up-to-date basis for individualized clinical decision-making.

Glaesserella parasuis is the causative agent of Gl?sser's disease in pigs.However,the pathogenic mechanisms underlying its virulence is not yet fully understood.The RuvB protein,a member of the AAA+superfamily,is implicated in various cellular processes,yet its specific role in the virulence of Glaesserella parasuis has not been fully characterized.In this study,we con-structed a RuvB gene deletion mutant,designated ΔRuvB,using the serotype 13 Glaesserella pa-rasuis strain ZJ1208 and a suicide plasmid-mediated natural transformation approach.To elucidate the functional role of the RuvB gene,we comprehensively evaluated the biological characteristics of the ΔRuvB strain through a series of assays,including growth kinetics,colony morphology,bac-terial staining,transmission electron microscopy(TEM),osmotic stress tolerance,high-tempera-ture tolerance,heat shock resistance,UV resistance,capsular polysaccharide quantification,serum bactericidal assays,and murine virulence experiments.Our findings revealed that the growth rate of ΔRuvB showed no significant difference compared to the parental strain.TEM revealed a notable increase in bacterial cell length;however,the number of outer membrane vesicles(OMVs)on the surface of ΔRuvB did not significantly increase.Notably,the ΔRuvB strain displayed a significant reduction in capsular polysaccharide production and serum resistance,as well as diminished toler-ance to UV radiation and high temperatures.Significant alterations were observed in its resistance to osmotic stress or oxidative stress.In the mouse toxicity challenge experiment,in com-parison with the parental strain ZJ1208,the mortality rate dropped by 20 percentage points,suggesting that the virulence of ΔRuvB has been weakened to some extent.Collectively,these results underscore the critical role of the RuvB gene in enhancing the environmental adaptability of Glaesserella parasuis.

Hemorrhagic fever with renal syndrome(HFRS)is a zoonotic disease caused by hantavirus.Inflammatory cytokine storm is closely associated with HFRS development.This review describes the anti-inflammatory and pro-inflammatory cytokines,and findings from clinical studies of these cytokines in patients with HFRS,to provide a comprehensive understanding of the roles of cyto-kines in renal syndrome hemorrhagic fever,and a reference for clinical diagnosis and assessment of the condition.

The aim of this paper was to investigate the serotypes,virulence factors and drug resist-ance of clinical isolates of Pasteurella rnultocida of porcine origin in recent years.Morphological screening and polymerase chain reaction(PCR)were used to isolate and identify 119 isolates from nasal swabs and lung tissue samples sent from swine farms in Zhejiang Province from 2010 to 2024.The isolates of Pasteurella multocida were subjected to capsular polysaccharide serotyping,lipopolysaccharide serotyping,virulence factor detection and drug resistance analysis by PCR and Kirby-Bauer disc agar diffusion method(K-B).The results showed that there were 64 strains(53.7％)of A-type,54 strains(45.3％)of D-type and 1 strain(0.9％)of F-type among the capsu-lar polysaccharide serotypes,and 10 strains(8.4％)of L1-type,20 strains(16.8％)of L3-type,86 strains(72.2％)of L6-type,and 3 strains(2.6％)of undetermined type among the lipopolysaccha-ride serotypes.The amplification results of 10 virulence genes showed that the detection rate of virulence genes hgbA,higbB and fimA was over 86.0％,the detection rate of toxA was 8.4％,while the virulence gene tbpA was not detected.There were also differences in the distribution vir-ulence genes in different capsular polysaccharide serotypes.Virulence factor pfhA was detected in type A and F but not in type D.The detection rate of adhesin gene tadD in serotype A(92.2％)was significantly higher than that of type D(9.3％),and,on the contrary,the detection rate of ad-hesin gene hsf-l in serotype D(90.7％)was significantly higher than that of type A(20.3％).Drug resistance analysis revealed that Pasteurella multocida showed high susceptibility to antimi-crobial drugs such as amoxicillin,ampicillin,cephalosporins,doxycycline,fosfenicol and ciprofloxa-cin,and showed strong resistance to antimicrobial drugs such as lincomycin,cotrimoxazole,genta-micin and amikacin,and there were 54 multi-drug resistant strains(78.3％).In summary,capsular polysaccharide serotypes were dominated by type A and D,lipopolysaccharide serotypes were dom-inated by L6,the distribution of some virulence genes varied greatly among different serotypes,and the proportion of multi-resistant strains was high,which provide reference for the prevention and control of this disease.

Objective To identify potential quality risks of Xiaoer Huatan Zhike Granules(Pediatric Phlegm-Resolving and Cough-Relieving Granules)through National Drug Sampling and Inspection,evaluate their overall quality,and propose improvements to the quality standards.Methods Samples from 34 manufacturers were tested using official standards.Exploratory methods were developed to enhance risk analysis,including thin-layer chromatography(TLC)identification,content uniformity testing,quantitative assays,and screening for unauthorized additives(e.g.,colorants).Results All batches met the official standards(100.0%compliance rate).However,deficiencies were observed:most manufacturers lacked controls for ephedrine hydrochloride content uniformity and quantification,omitted key ingredient identifications(e.g.,herbal components),and exhibited insufficient TLC specificity(e.g.,TLC of Ipecac tincture showed only one spot instead of multiple alkaloid-specific spots).Exploratory studies revealed risks in total emetine/cephaeline content,morroniside A/platycodin D content,ephedrine hydrochloride uniformity,and unauthorized colorant addition.Conclusions The overall quality of this variety is good,but the enterprise should improve the quality control measures throughout the entire process and establish stricter internal control standards;The official standards,unchanged for approximately 30 years,fail to address current regulatory requirements.The statutory quality standards need to be revised and improved.Qualitative or quantitative indicators for all drug flavors in the prescription should be added,and the content uniformity inspection of ephedrine hydrochloride should be increased.

Hemorrhagic fever with renal syndrome(HFRS)is a zoonotic disease caused by hantavirus.Inflammatory cytokine storm is closely associated with HFRS development.This review describes the anti-inflammatory and pro-inflammatory cytokines,and findings from clinical studies of these cytokines in patients with HFRS,to provide a comprehensive understanding of the roles of cyto-kines in renal syndrome hemorrhagic fever,and a reference for clinical diagnosis and assessment of the condition.

Objective To observe the value of contrast-enhanced ultrasound(CEUS)for evaluating DeBakey Ⅰ aortic dissection involved renal artery.Methods Totally 137 patients with DeBakey Ⅰ aortic dissection involved renal artery were retrospectively enrolled,including 132 cases involved unilateral and 5 cases involved bilateral renal arteries.The opening of totally 274 renal arteries in bilateral kidneys were observed.Taken CT angiography(CTA)as reference standard,the renal artery opened in true lumen was considered as unaffected,while opened in false lumen or true-false lumen were both considered as affected.Relative CEUS manifestations were observed,and their value for evaluating involved renal artery or not were analyzed.Results CTA showed that 132 renal arteries opened in true lumens,90 opened in false lumens and 52 opened in true-false lumens.CEUS diagnosed 131 renal arteries opened in true lumens,111 opened in false lumens and 32 opened in true-false lumens,and the sensitivity for diagnosing DeBakey Ⅰ aortic dissection involved renal artery was 90.84％,81.08％and 90.63％,respectively.The consistency between CEUS and CTA for evaluating renal artery opened in true lumen or false lumen was good(Kappa=0.786).Logistic regression analysis showed that the time to peak(TTP)and peak intensity(PI)of time intensity curve(TIC)were both impact factors for differentiating renal artery opened in true lumen or false lumen,as well as true lumen or true-false lumen(both P＜0.05),while the area under the curve(AUC)of TIC was impact factor for differentiating renal artery opened in true lumen or false lumen(P＜0.05).The AUC of receiver operating characteristic curve of the combination of TTP,PI and AUC of TIC for differentiating renal artery opened in true lumen or false lumen,true lumen or true-false lumen and false lumen or true-false lumen was 0.703,0.686 and 0.493,respectively.Conclusion CEUS was helpful for evaluating DeBakey Ⅰ aortic dissection involved renal artery.

Glaesserella parasuis is the causative agent of Gl?sser's disease in pigs.However,the pathogenic mechanisms underlying its virulence is not yet fully understood.The RuvB protein,a member of the AAA+superfamily,is implicated in various cellular processes,yet its specific role in the virulence of Glaesserella parasuis has not been fully characterized.In this study,we con-structed a RuvB gene deletion mutant,designated ΔRuvB,using the serotype 13 Glaesserella pa-rasuis strain ZJ1208 and a suicide plasmid-mediated natural transformation approach.To elucidate the functional role of the RuvB gene,we comprehensively evaluated the biological characteristics of the ΔRuvB strain through a series of assays,including growth kinetics,colony morphology,bac-terial staining,transmission electron microscopy(TEM),osmotic stress tolerance,high-tempera-ture tolerance,heat shock resistance,UV resistance,capsular polysaccharide quantification,serum bactericidal assays,and murine virulence experiments.Our findings revealed that the growth rate of ΔRuvB showed no significant difference compared to the parental strain.TEM revealed a notable increase in bacterial cell length;however,the number of outer membrane vesicles(OMVs)on the surface of ΔRuvB did not significantly increase.Notably,the ΔRuvB strain displayed a significant reduction in capsular polysaccharide production and serum resistance,as well as diminished toler-ance to UV radiation and high temperatures.Significant alterations were observed in its resistance to osmotic stress or oxidative stress.In the mouse toxicity challenge experiment,in com-parison with the parental strain ZJ1208,the mortality rate dropped by 20 percentage points,suggesting that the virulence of ΔRuvB has been weakened to some extent.Collectively,these results underscore the critical role of the RuvB gene in enhancing the environmental adaptability of Glaesserella parasuis.

Objective To observe the value of contrast-enhanced ultrasound(CEUS)for evaluating DeBakey Ⅰ aortic dissection involved renal artery.Methods Totally 137 patients with DeBakey Ⅰ aortic dissection involved renal artery were retrospectively enrolled,including 132 cases involved unilateral and 5 cases involved bilateral renal arteries.The opening of totally 274 renal arteries in bilateral kidneys were observed.Taken CT angiography(CTA)as reference standard,the renal artery opened in true lumen was considered as unaffected,while opened in false lumen or true-false lumen were both considered as affected.Relative CEUS manifestations were observed,and their value for evaluating involved renal artery or not were analyzed.Results CTA showed that 132 renal arteries opened in true lumens,90 opened in false lumens and 52 opened in true-false lumens.CEUS diagnosed 131 renal arteries opened in true lumens,111 opened in false lumens and 32 opened in true-false lumens,and the sensitivity for diagnosing DeBakey Ⅰ aortic dissection involved renal artery was 90.84％,81.08％and 90.63％,respectively.The consistency between CEUS and CTA for evaluating renal artery opened in true lumen or false lumen was good(Kappa=0.786).Logistic regression analysis showed that the time to peak(TTP)and peak intensity(PI)of time intensity curve(TIC)were both impact factors for differentiating renal artery opened in true lumen or false lumen,as well as true lumen or true-false lumen(both P＜0.05),while the area under the curve(AUC)of TIC was impact factor for differentiating renal artery opened in true lumen or false lumen(P＜0.05).The AUC of receiver operating characteristic curve of the combination of TTP,PI and AUC of TIC for differentiating renal artery opened in true lumen or false lumen,true lumen or true-false lumen and false lumen or true-false lumen was 0.703,0.686 and 0.493,respectively.Conclusion CEUS was helpful for evaluating DeBakey Ⅰ aortic dissection involved renal artery.

The aim of this paper was to investigate the serotypes,virulence factors and drug resist-ance of clinical isolates of Pasteurella rnultocida of porcine origin in recent years.Morphological screening and polymerase chain reaction(PCR)were used to isolate and identify 119 isolates from nasal swabs and lung tissue samples sent from swine farms in Zhejiang Province from 2010 to 2024.The isolates of Pasteurella multocida were subjected to capsular polysaccharide serotyping,lipopolysaccharide serotyping,virulence factor detection and drug resistance analysis by PCR and Kirby-Bauer disc agar diffusion method(K-B).The results showed that there were 64 strains(53.7％)of A-type,54 strains(45.3％)of D-type and 1 strain(0.9％)of F-type among the capsu-lar polysaccharide serotypes,and 10 strains(8.4％)of L1-type,20 strains(16.8％)of L3-type,86 strains(72.2％)of L6-type,and 3 strains(2.6％)of undetermined type among the lipopolysaccha-ride serotypes.The amplification results of 10 virulence genes showed that the detection rate of virulence genes hgbA,higbB and fimA was over 86.0％,the detection rate of toxA was 8.4％,while the virulence gene tbpA was not detected.There were also differences in the distribution vir-ulence genes in different capsular polysaccharide serotypes.Virulence factor pfhA was detected in type A and F but not in type D.The detection rate of adhesin gene tadD in serotype A(92.2％)was significantly higher than that of type D(9.3％),and,on the contrary,the detection rate of ad-hesin gene hsf-l in serotype D(90.7％)was significantly higher than that of type A(20.3％).Drug resistance analysis revealed that Pasteurella multocida showed high susceptibility to antimi-crobial drugs such as amoxicillin,ampicillin,cephalosporins,doxycycline,fosfenicol and ciprofloxa-cin,and showed strong resistance to antimicrobial drugs such as lincomycin,cotrimoxazole,genta-micin and amikacin,and there were 54 multi-drug resistant strains(78.3％).In summary,capsular polysaccharide serotypes were dominated by type A and D,lipopolysaccharide serotypes were dom-inated by L6,the distribution of some virulence genes varied greatly among different serotypes,and the proportion of multi-resistant strains was high,which provide reference for the prevention and control of this disease.