Objective:To identify and validate the key genes of ferroptosis in phospholipase A2 receptor (PLA2R) associated membranous nephropathy through bioinformatics analysis and in vitro experiments, and to explore the potential role of ferroptosis in PLA2R associated membranous nephropathy (PMN). Methods:The GSE115857 dataset obtained by retrieving the Gene Expression Omnibus (GEO) database and the ferroptosis-related genes obtained by retrieving the FerrDb database were intersected. The intersected genes were subjected to Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. The key ferroptosis genes associated with PMN were identified by intersecting genes selected using support vector machines-recursive feature elimination and least absolute shrinkage and selection operator regression. The results were validate by real-time PCR, cell counting kit-8, Western blotting and immunofluorescence in human renal podocyte line AB 8/13 from both the control group and model group.Results:A total of 25 genes related to ferroptosis of PMN were obtained, and GO and KEGG analysis showed that these genes were mainly involved in cell ferroptosis metabolism. The key ferroptosis genes of PMN obtained by machine learning method were activating transcription factor 3 ( ATF3) and coiled coil domain containing 6 ( CCDC6). The results of in vitro experiments showed that the human renal podocyte line AB 8/13 in the model group was significantly deformed and retracted compared with the control group. The surface area density of foot processes was significantly reduced, and the podocyte cytoskeleton was allosteric. The morphology of F-actin was disordered and the expression of synaptopodin was decreased. The cell proliferation activity was significantly decreased ( P<0.05). The expression of PLA2R protein was increased ( P<0.05), and the expression of GPX4 protein was decreased ( P<0.01). The protein and mRNA levels of ATF3 and CCDC6 were significantly up-regulated (all P<0.05). Conclusions:Ferroptosis may be one of the key mechanisms in the occurrence and development of PMN. In vitro experiments show that ATF3 and CCDC6 are the key genes in the ferroptosis of PMN podocytes, which provides new insights and ideas for the pathogenesis of PMN.

ObjectiveTo observe the clinical efficacy and safety of Mailuoning compound solution in the treatment of hip joint pain via nerve blocks around the hip joint. MethodsFrom March 2015 to March 2019，a total of 136 patients with hip joint pain who met the inclusion criteria were admitted and divided into an observation group and a control group according to the random number table method. Among them，six cases fell off due to failure to complete five treatments，and finally， 130 patients entered clinical observation，with 65 cases in each group. The observation group used Mailuoning compound solution for nerve blocks around the hip joint（including obturator nerve，femoral nerve branch，superior gluteal nerve， and hip fascia）. The control used Mailuoning compound solution for a simple obturator nerve block. The differences in the visual analogue scale （VAS） and Harris score of hip joint of the two groups before and after treatment were observed. Any adverse drug reactions and adverse events during the treatment of the patients were recorded. ResultsThe VAS score of the two groups was significantly decreased after treatment （P<0.01）. The observation group had a more significant decrease compared to the control group（P<0.01）. The total Harris score of hip joint， pain degree，function score， and motion of joint of the two groups were significantly improved after treatment （P<0.01）. Compared with the control group，the improvement in the total Harris score of hip joint， pain degree，and function score was more significant in the observation group （P<0.01）. The clinical efficacy based on the Harris score of hip joint of the two groups was compared. The excellent and good rate of the observation group was 84.62% （55/65）， which was significantly better than that of the control group ［56.92% （37/65）］ （χ²=12.05，P<0.01）. The follow-up results showed that the patients who achieved excellent and good results had stable curative effects and low recurrence rates，and there was no significant difference in recurrence rate between the two groups. Case analysis showed that after treatment of femoral head necrosis，the saccular transparent shadow of the femoral head was significantly reduced，and the number of bone trabeculae increased. The low-density shadow decreased as can be seen on hip X-rays. In patients with hip osteoporosis after treatment，the number of bone trabeculae increased， and the low density shadow reduced. ConclusionThe use of Mailuoning compound solution for nerve blocks around the hip joint gives full play to the synergistic effect of Mailuoning compound solution and nerve block. It can effectively relieve hip joint pain，promote the recovery of hip joint function，reduce the disability rate，and improve the quality of life of patients. Early intervention is an important link in the treatment of hip joint pain diseases，which can effectively control the development of the patient's disease. Mailuoning compound solution is a new idea and method to treat hip joint pain through neuroregulation，which is easy to operate，with high safety and good therapeutic effect. In future studies，a larger sample size is needed，and more in-depth research should be conducted on the imaging changes and mechanisms of action for various hip joint pain diseases.

Objective:To identify and validate the key genes of ferroptosis in phospholipase A2 receptor (PLA2R) associated membranous nephropathy through bioinformatics analysis and in vitro experiments, and to explore the potential role of ferroptosis in PLA2R associated membranous nephropathy (PMN). Methods:The GSE115857 dataset obtained by retrieving the Gene Expression Omnibus (GEO) database and the ferroptosis-related genes obtained by retrieving the FerrDb database were intersected. The intersected genes were subjected to Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. The key ferroptosis genes associated with PMN were identified by intersecting genes selected using support vector machines-recursive feature elimination and least absolute shrinkage and selection operator regression. The results were validate by real-time PCR, cell counting kit-8, Western blotting and immunofluorescence in human renal podocyte line AB 8/13 from both the control group and model group.Results:A total of 25 genes related to ferroptosis of PMN were obtained, and GO and KEGG analysis showed that these genes were mainly involved in cell ferroptosis metabolism. The key ferroptosis genes of PMN obtained by machine learning method were activating transcription factor 3 ( ATF3) and coiled coil domain containing 6 ( CCDC6). The results of in vitro experiments showed that the human renal podocyte line AB 8/13 in the model group was significantly deformed and retracted compared with the control group. The surface area density of foot processes was significantly reduced, and the podocyte cytoskeleton was allosteric. The morphology of F-actin was disordered and the expression of synaptopodin was decreased. The cell proliferation activity was significantly decreased ( P<0.05). The expression of PLA2R protein was increased ( P<0.05), and the expression of GPX4 protein was decreased ( P<0.01). The protein and mRNA levels of ATF3 and CCDC6 were significantly up-regulated (all P<0.05). Conclusions:Ferroptosis may be one of the key mechanisms in the occurrence and development of PMN. In vitro experiments show that ATF3 and CCDC6 are the key genes in the ferroptosis of PMN podocytes, which provides new insights and ideas for the pathogenesis of PMN.

As the incidence of chronic kidney disease (CKD) increases year by year, the number of patients with CKD is increasing year by year before or during pregnancy. Pregnancy management is increasingly important for patients with kidney disease, and women with CKD face a number of challenges during pregnancy, such as the risk of kidney disease progression, fetal growth restriction, the potential teratogenicity of medications, and an increased risk of complications such as preeclampsia and preterm birth. In order to ensure a good outcome for pregnant women and the fetus, it is necessary for multidisciplinary physicians in the department of nephrology, obstetrics, reproductive health and other departments to assess the risk of pregnancy in patients with CKD in a standardized manner, adjust medication in a timely manner, and closely monitor to detect maternal and fetal complications early, stabilize the patient′s condition, and determine the safest time for pregnancy and delivery.

Objective:To analyze the gray-scale ultrasound and contrast-enhanced ultrasound features in secondary hyperparathyroidism (SHPT) to construct a clinical and ultrasound-based model, and to investigate the relationship between this model and serum intact parathyroid hormone(iPTH) level in order to find proper indicators for evaluation of the severity of SHPT.Methods:From February 2016 to March 2021, a total of 59 SHPT patients with 181 parathyroid glands (PTGs) admitted to the First Affiliated Hospital of Sun Yat-Sen University were enrolled. Gray-scale ultrasound and contrast-enhanced ultrasound were performed in every participant. Patients were divided into low-iPTH group ( iPTH<800 ng/L) and high-iPTH group (iPTH≥800 ng/L) according to the serum iPTH level. The characteristics of gray-scale ultrasonic imaging and contrast-enhanced ultrasonic imaging were analyzed by 2 sonographers.Biochemical parameters were collected and combined with ultrasonic characteristics to construct the clinical and ultrasound-based model. The relationship between the model and serum iPTH level was analyzed by multivariate linear regression (stepwise). Independent influencing factors on serum iPTH level was investigated in SHPT patients without iPTH-reducing drugs using history.Results:There were 19 patients in low-iPTH group and 40 patients in high-iPTH group.Serum calcium, serum phosphorus, serum creatinine, PTG number, total PTG volume, blood scores, calcification and cysts scores, CEUS scores (washing-in phase and washing-out phase) were significantly different between two groups(all P<0.05). The multivariate linear regression (stepwise) showed that serum phosphorus, total PTG volume and blood scores were independently related with serum iPTH level (standardized β coefficient were 0.387, 0.254 and 0.242 respectively; all P<0.05). Conclusions:Serum phosphorus, total PTG volume and blood scores are independent influencing factors on serum iPTH level. Ultrasonography combined with clinical parameters can help evaluate the severity of SHPT more accurately.

"Early clinical practice, multiple clinical practice and repeated clinical practice" is the mainstream of the reform of higher medical education in the 21st century. Based on the shortages of the current medical education model, a university started to reform from both theoretical teaching and practical teaching, and constructed a teaching model of "early clinical practice, multiple clinical practice and repeated clinical practice" that fits China's reality. And the teaching effect was evaluated questionnaire survey and OSCE tests. The results showed that this teaching model could promote the all-round development of medical students' knowledge, ability and quality.

Objective To analyze the features of hepatic neuroendocrine neoplasm ( HNEN ) with conventional ultrasound and contrast-enhanced ultrasound sonography (CEUS) ,and to evaluate the value in the diagnosis and differential diagnosis of HNEN by ultrasound . Methods Fifty patients of HNEN confirmed pathologically or clinically were enrolled . All patients underwent conventional ultrasound and CEUS . Among the patients ,5 cases were primary hepatic neuroendocrine neoplasm ( PHNEN) ,and 45 cases were metastatic hepatic neuroendocrine neoplasm ( MHNEN) . Conventional ultrasound and CEUS features of HNEN were analyzed and the distinctions between PHNEN and MHNEN were compared . Results Baseline ultrasound showed that 37 (74％ ) HNEN were multiple lesions located in liver ,23 ( 46％ ) lesions with hyperechoic appearance ,35 ( 70％ ) lesions with homogeneous echoic ,28 ( 56％ ) lesions were clearly marginated ,8 (16％ ) lesions were surrounded by acoustic halo ,and 12 ( 24％ ) lesions with posterior echo attenuation . CEUS showed that the majority of HNEN exhibited the enhanced pattern of rapid wash-in and wash-out" . Forty-six ( 92％ ) lesions showed hyper-enhancement in the arterial phase ,44 ( 88％ ) lesions showed iso-enhancement in the portal phase ,and 47 ( 94％ ) lesions showed hypo-enhancement in the late phase .Feeding vessels were observed in 31 ( 62％ ) lesions ,intralesional non-enhancement zone was observed in 17(34％ ) lesions ,and capsule enhancement in the delay phase was found in 10( 20％ ) lesions . MHNEN had smaller diameter [ ( 3 .92 ± 2 .77) cm vs (12 .82 ± 8 .85) cm , P = 0 .004] and less likely to present cystic structure intralesional than PHNEN ( 1/45 vs 2/5 , P < 0 .001 ) . The differences of other baseline ultrasonographic characteristics ,enhanced characteristics and enhanced time on CEUS between PHNEN and MHNEN were not statistically significant ( all P > 0 .05) . Conclusions HNEN has a certain characteristic that can be identified on ultrasonography . Ultrasound can provide some valuable information to diagnose HNEN . While it′s difficult to differentiate PHNEN and MHNEN owing to their similar ultrasonographic characteristics .

Objective To evaluate the effect of artificial ascites under ultrasonic guidance in the thermal ablation of liver or kidney tumors ,so as to provide basis for successfully creating artificial ascites , increasing the complete ablation rate of the tumors and reducing the damage of important organs . Methods Seven hundred and thirty-six patients with artificial ascites were performed under ultrasonic guidance during the thermal ablation of liver or kidney tumors and six hundred and seventy-nine patients were successfully performed . The success rate of creating artificial ascites at different sites ,time requirement ,the effect of ascites , puncture times were analyzed , while curative effect and complications were evaluated and summarized . Results The success rate of creating artificial ascites was 92 .3％ ;the average time of creating artificial ascites was( 9 .1 ± 1 .3) minutes ;the average puncture times was( 1 .1 ± 0 .2) times ;complete ablation was 98 .7％ ;the complication of ascites creation was 0 .44％ ,minor complications after ablation was 6 .20％ , severe complications was 0 .59％ . The required fluid volume and success rates for the creation of artificial ascites in different sites were different . The volume of fluid needed was relatively high in the liver-gastric space ,and the success rate was relatively low ;the success rate of liver septum and liver -kidney crypts was the highest . Heat injury complications of the important organs such as gastrointestinal tract ,esophagus , diaphragm near the liver or kidney tumors were 0 . Conclusions The establishment of artificial ascites improves the local curative effect and reduces the complication of tumors ablation in difficult locations . The methods and effect of artificial ascites in different parts of liver or kidney are different .

Objective: To compare the diagnostic performance of contrast-enhanced ultrasound (CEUS) with contrast-enhanced computed tomography (CECT) for the maximum diameter ≤2 cm metastatic liver cancer (MLC). Methods: Sixty-nine pathologically diagnosed MLC patients (maximum diameter ≤2 cm) were retrospectively recruited. The lesion detection rate, diagnostic confidence and enhancement pattern of CEUS and CECT for MLC were analyzed. Diagnostic value of CEUS and CECT for MLC were evaluated and compared by using diagnostic test. Results: The cases of 0, 1, 2, multiple lesions detected by CEUS and CECT in these 69 patients with ≤2 cm MLC were 0 case (0%), 41 cases(59.42%), 13 cases(18.84%), 15 cases(21.74%) and 9 cases(13.04%), 29 cases(42.03%), 13 cases(18.84%), 18 cases(26.09%), respectively. The positive cases detected by CEUS and CECT were 69 cases(100%) and 60 cases(86.96%) respectively, with a statistically significant difference between the two groups (P=0.006). However, for the detection rate of non-single-lesion cases, there was no statistical difference between CEUS and CECT (P=0.409). The cases showed typical manifestation in CEUS and CECT were 56 cases(81.16%)and 29 cases(42.03%)(P<0.001). The cases with diagnostic confidence level of 3, 4, 5 in CEUS were 3 cases(0.04%), 11 cases(15.94%), 55 cases(79.71%), and those of CECT were 19 cases(27.54%), 20 cases(28.99%), 20 cases(28.99%), respectively. The diagnostic sensitivity of CEUS and CECT for ≤2 cm MLC were 100% (69/69) and 85.51% (59/69), with statistically significant difference(P=0.001). Conclusions The lesion detection rate and diagnostic value of CEUS for the maximum diameter ≤2 cm MLC might be superior to that of CECT, but the detection rate shows no significant difference in the non-single-lesion cases. CEUS has important clinical value in the diagnosis of ≤2 cm MLC.

Objective To retrospectively compare the safety and local efficacy of multiple-electrode switching based radiofrequency ablation (RFA) and the conventional RFA in treating single early-stage hepatocellular carcinoma (HCC).Methods A total of 82 patients with single early-stage HCC received either RFA with a multiple-electrode switching system (n =43) or conventional RFA (n =39) as the first-line treatment.The rate of initial local complete response,major complications and local tumor progression (LTP) were compared between two groups.Results The total ablation time was significantly shorter in the switching-RFA group [(16.7 ± 3.4) mins] than in the conventional RFA group [(29.8 ± 10.4) mins] (P ＜ 0.05).The rate of initial local complete response was 100％ (43/43) in the switching-RFA group and 94.9％ (37/39) in the conventional RFA group (P ＞0.05).After a mean follow-up period of (26.4 ± 21.8)months (ranging 3.0-91.6 months),the rates of LTP in the switching-RFA group and conventional RFA group were 16.3％ (7/43) and 17.9％ (7/39),respectively.The LTP rates in two groups were 16.1％ versus 11.2％ atyear1,and20.5％ versus 20.6％ at year2 (P=0.666).Conclusions The multiple-electrode switching based RFA is safe and effective with shorter ablation time in treating single early-stage hepatocellular carcinoma.