IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide and a major cause of chronic kidney disease and kidney failure. IgAN exhibits marked heterogeneity in clinical presentation, histopathology, and pathogenic mechanisms, contributing to variable treatment responses and prognosisamong patients. Precise risk assessment and individualized intervention are therefore of critical importance. This review systematically traces the evolution of IgAN management from traditional risk stratification toward biomarker-driven precision medicine. We first review the clinical utility and limitations of established risk stratification tools, including the KDIGO guidelines, the Oxford MEST-C classification, and the International IgAN Prediction Tool. We then discuss emerging biomarkers closely linked to disease pathogenesis, including galactose-deficient IgA1 (Gd-IgA1), anti-Gd-IgA1 autoantibodies, B cell activating factor (BAFF), a proliferation-inducing ligand (APRIL), and complement components, as well as the targeted therapies they have informed. In addition, urinary biomarkers and multi-omics approaches show promise for dynamic disease monitoring and individualized risk stratification.

ObjectiveTo explore the clinical effectivess of Nuangong Tiaojing Decoction （暖宫调经汤） combined with ginger moxibustion at Baliao acupoints （Eight Bone-Holes） for treating premature ovarian failure （POF） of yang-deficiency uterus-coldeness syndrome， based on conventional western medical treatment. MethodsA total of 130 patients diagnosed with POF of yang-deficiency uterus-coldeness syndrome were divided into a treatment group and a control group， with 65 cases in each group， based on patient preference. The control group received conventional western medicine treatment， while the treatment group was additionally given Nuangong Tiaojing Decoction orally one dose per day and underwent ginger moxibustion at Baliao points once daily. Both groups were treated for three months. Before and after treatment， ovarian function indicators， including ovarian volume， follicle count， ovarian peak systolic velocity （PSV）， and endometrial thickness were assessed， and serum sex hormone levels including progesterone （P）， estradiol （E₂）， follicle-stimulating hormone （FSH）， luteinizing hormone （LH）， prolactin （PRL）， and testosterone （T）， as well as anti-Müllerian hormone （AMH） levels were also measured. Additionally， traditional Chinese medicine （TCM） syndrome scores were evaluated， covering symptoms such as reduced libido， lumbosacral pain， fear of cold with cold extremities， fatigue， dull complexion， lower abdominal distension and pain， pale tongue， and deep and rough pulse. After treatment， clinical effectiveness and safety were determined. ResultsCompared with the pre-treatment levels within group， both groups showed significant increases in ovarian volume， follicle count， PSV， endometrial thickness， and levels of P， E₂， and AMH after treatment， while the levels of FSH， LH， PRL， and T， as well as scores of lumbosacral pain， reduced libido， dull complexion， deep and rough pulse， and total TCM syndrome scores significantly reduced after treatment. Furthermore， the treatment group exhibited higher ovarian volume， follicle count， PSV， endometrial thickness， and levels of P， E₂， and AMH compared to the control group， while FSH， LH， PRL， T levels， and all symptom scores， as well as total TCM syndrome scores， were significantly lower in the treatment group than in the control group （P＜0.05 or P＜0.01）. The clinical effectiveness in treatment group was 96.92% （63/65）， significantly higher than 81.54% （53/65） in control group （P＜0.05）. The incidence of adverse reactions in the treatment group was 26.15% （17/65）， while in the control group it was 32.31% （21/65）， with no statistically significant difference （P＞0.05）. ConclusionOn the basis of conventional western medicine treament， Nuangong Tiaojing Decoction combined with ginger moxibustion at Baliao acupoints for patients with POF of yang-deficiency uterus-coldeness syndrome can significantly improve ovarian function and clinical symptoms， regulate hormone levels， and thereby enhance clinical effectiveness.

Objective:To explore differences in dose-adjusted plasma concentrations of valproic acid between different valproate formulations in patients with mental disorders based on therapeutic drug monitoring data.Methods:A retrospective analysis was performed; clinical data, including demographic characteristics, therapeutic drug monitoring results, comorbidities, medication details (daily valproic acid dose, concomitant medications), and liver and kidney function indicators, were collected from 633 patients with bipolar disorder or schizophrenia who were hospitalized at Xi'an Mental Health Center and received different valproates from January 2024 to June 2024 (98 patients receiving sodium valproate and 535 receiving magnesium valproate). Clinical data between a sodium valproate group and a magnesium valproate group were compared. Multivariate linear regression was used to identify independent influencing factors for dose-adjusted plasma concentration of valproic acid. Valproic acid daily doses, and plasma concentrations and dose-adjusted plasma concentrations of valproic acid were compared between the two groups, with subgroup analyses conducted by gender and age categories.Results:A total of 658 measurements of plasma valproic acid concentration were obtained in 633 patients, including 104 measurements in the sodium valproate group and 554 in the magnesium valproate group. Significant differences in proportions of comorbidities and concomitant use of olanzapine, quetiapine and clozapine were observed between the sodium valproate group and magnesium valproate group ( P<0.05). After adjusting for age, gender, body mass index, comorbidities, concomitant medications, and liver and kidney function indicators, the type of valproates remained an independent influencing factor for dose-adjusted plasma concentration of valproic acid (adjusted unstandardized B coefficient=13.814, 95% CI: 8.090-19.540, P<0.001). Daily dose in the sodium valproate group (1.0[1.0, 1.0] g/d) was significantly higher than that in the magnesium valproate group (0.5[0.5, 1.0] g/d), and dose-adjusted plasma concentration of valproic acid in the magnesium valproate group (93.00 [75.60, 117.40] [μg/mL]/[g·d]) was statistically higher than that in the sodium valproate group (78.55 [57.90, 90.00][μg/mL]/[g·d], P<0.05). Subgroup analysis revealed that, among patients stratified by genders and ages (<40 years vs. ≥40 years), the daily dose in the sodium valproate group was significantly higher than that in the magnesium valproate group, while the dose-adjusted plasma concentration of valproic acid in the magnesium valproate group was significantly higher than that in the sodium valproate group ( P<0.05). Conclusion:Significant differences in dose-adjusted plasma concentrations of valproic acid are observed among different valproate formulations for the treatment of mental disorders; therefore, therapeutic drug monitoring should be performed in patients when switching valproates to facilitate precise individualized dosage adjustment.

Objective To explore the impact of organizational innovation climate in public hospitals on doctors'innovation performance,providing a reference for improving doctors'innovation performance.Methods A questionnaire survey was conducted with practicing(assistant)physicians in 22 hospitals in Beijing,and 1 859 questionnaires were effectively recovered.The scores of hospital organizational innovation climate,physicians'individual innovation performance,innovation behavior,and innovation self-efficacy were analyzed by Pearson correlation;the partial least squares structural equation modeling was further used to explore the role of the organizational innovation climate of hospitals on physicians'innovation performance.Results The path of hospital organizational innovation climate on physicians'innovation performance.The difference in path coefficients for the mediating effect of hospital organizational innovation climate significantly affecting physicians'innovation performance,and physicians'innovation self-efficacy between hospital innovation climate and physicians'innovation behavior and innovation performance was statistically significant(P＜0.001).Conclusion The innovation performance of practicing(assistant)physicians in Beijing municipal hospitals is influenced by the organizational innovation climate,physicians'innovation self-efficacy and innovation behaviors,and physicians'innovation self-efficacy and innovation behaviors play a chain-mediated role.It is suggested that public hospitals should strengthen doctors'self-efficacy and consider the fit between the construction of innovation atmosphere and actual needs to stimulate innovation behavior and ultimately improve inno-vation performance.

Objective To analyze the willingness and influencing factors of doctors in Beijing public hospitals to set up clinics in the community,and to provide scientific basis for promoting quality health technicians to go down to the grassroots and realize hierarchical diagnosis and treatment.Methods Doctors from 6 specialized hospita ls and 3 general hospitals in Beijing were selected as subjects for questionnaire survey.By stratified sampling,a questionnaire survey was conducted on 518 doctors from 9 public hospitals in Beijing through stratified sampling method.Descriptive analysis,rank sum test and ordered logistic regression were used to explore doctors'willingness to open clinics and its influencing factors.Results In all survey respondents,212(40.93%)physicians were very or somewhat willing to open a clinic in the community,physicians with higher benefit perception,and greater willingness to publicize relevant policies were more willing to set up clinics.Conclusion Opening of clinics by doctors in public hospitals is affected by perceived benefits and willingness to advocate policies.It is suggested to further improve relevant systems and policies,reduce the risk of doctors opening clinics,and promote doctors in public hospitals to open clinics in communities,so as to realize the sinking of high-quality health human resources to the grassroots.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Objective To explore the effects of oleanolic acid on NF-κB/caspase-9 signaling pathway in kidneys of rat with diabetic nephropathy.Methods The diabetic nephropathy model rats were established,and the model rats were randomly divided intooleanolic acid low,medium and high dose groups,metformin group,and model group,with another 12 healthy SD rats as control group.The levels of blood glucose were measured at weeks 1,2 and 3 post-drug administration,and blood lipid and 24h urine urinary microalbumin(UMA)were measured after entire drug administration.Furthermore,we also detected the renal histopathology of rats,apoptosis of renal tubular,glomerular cells,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and protein expression of NF-κB/caspase-9 signaling pathway.Results Compared with the control group,the model group demonstrated higher levels of blood glucose at weeks 1,2 and 3,blood lipid,UMA,TNF-α and IL-6,higher proportion of apoptotic renal tubular and glomerular,and higher expressions of caspase-9 protein and p-NF-κB p65/NF-κB p65(P＜0.05).Compared with the model group,the pathological damage of renal tissue in the metformin group and oleanolic acid low,middle and high dose groups were alleviated,the levels of blood glucose at weeks 1,2 and 3,blood lipid,UMA,TNF-α and IL-6,the proportion of apoptotic renal tubular and glomerular,and the expressions of caspase-9 proteins and p-NF-κB p65/NF-κB p65 were decreased,and these indexes in oleanolic acid groups showed a dose-dependent manner(P＜0.05).Conclusion Oleanolic acid can improve the metabolism of glucose and lipid,reduce the pathological damage of renal tissue,inhibit the apoptosis of renal tubular and glomerular,and inhibit the NF-κB/caspase-9 pathway in diabetic nephropathy rats.

Objective:To investigate the effects of the Epley and Semont procedures with varying lateral angles of the head on posterior semicircular canal benign paroxysmal positional vertigo （PC-BPPV）. Methods:A total of 115 patients with unilateral PC-BPPV were randomly divided into five groups: Epley group, Semont group, Semont+10° group, Semont+20° group, and Semont+30° group, with 23 patients in each group. Corresponding reduction treatments were performed. Results:The total effective rates for the Epley group, Semont group, Semont+10° group, Semont+20° group, and Semont+30° group were 95.7% （22/23）, 4.3% （1/23）, 30.4% （7/23）, 52.2% （12/23）, and 87.0% （20/23） respectively. The inefficiencies were 4.3% （1/23）, 95.7% （22/23）, 69.6% （16/23）, 47.8% （11/23）, and 13.0% （3/23）. Statistically significant differences were observed in the total effective rates among the five groups （χ²=54.11, P<0.01）. The total effective rates in the Semont group, Semont+10° group, and Semont+20° group were significantly different from that of the Epley group （P<0.01）, while no statistically significant difference was found between the Semont+30° group and the Epley group （P= 0.608>0.012 5）. Conclusion:Among the four Semont methods with different lateral lying angles, the total effective rate of reduction treatment increased with the elevation of the lateral lying angle on the affected side. The efficacy of the Semont+30° group in treating PC-BPPV was not significantly different from the Epley group's reduction effect, which was markedly superior to that of the other four Semont methods at different angles. Therefore, the Semont+30° reduction technique is recommended for the treatment of PC-BPPV.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Benign Paroxysmal Positional Vertigo/therapy* ; Head ; Posture ; Semicircular Canals/physiopathology* ; Treatment Outcome

Objective The aim of this study was to characterize the basic molecular and biochemical parameters for a cyclophilin protein in Cryptosporidium parvum called CpCyP1.Methods CpCyP1 expression patterns during the parasite life cycle were evaluated using qRT-PCR with total RNA isolated from different developmental stages of C.parvum.Native CpCyP1 protein in sporozoites was detected using western blot.The localization of CpCyP1 was performed using the immunofluorescence assay,with an affinity-purified rabbit polyclonal antibody against a synthetic peptide.The peptidyl-prolyl cis-trans isomerase(PPIase)activity of His-tagged recombinant CpCyP1 was evaluated using absorbance colorimetry,and the effect of cyclosporin A(CsA)on the activity of CpCyP1 was determined.Results CpCyP1 was expressed in all parasite developmental stages,whereas CpCyP1 was present mainly in the cytosol of sporozoites,meronts,and gamonts.CpCyP1 displayed Michaelis-Menten kinetics towards N-succinyl-Ala-Ala-Pro-Phe-p-nitroanilide for its PPIase activity(Km=456.4 μmol/L;Vmax=1.981 U).CsA inhibited PPIase activity,showing lower micromolar inhibitory activity and binding affinity(Kd=5.122 μmol/L;IC50=1.004 μmol/L).Conclusions These results imply that CpCyP1 in the parasite may be the target for the previously reported anti-cryptosporidial efficacy of CsA and suggest that C.parvum cyclophilins could be evaluated as candidate drug targets.

Objective To analyze the impact of balloon post-dilation on cardiac conduction in patients undergoing transcatheter aortic valve replacement (TAVR). Methods From June 2021 to December 2022, patients with severe aortic valve stenosis or regurgitation who underwent TAVR surgery using domestically produced valves at Xijing Hospital, Air Force Military Medical University were selected. The occurrence of intraoperative and postoperative cardiac conduction block was recorded. According to whether balloon post-dilation was performed during the surgery, patients were divided into the post-dilation group and the non-post-dilation group. The baseline data, postoperative cardiac conduction block occurrence, and cardiac function of the two groups were analyzed. Results A total of 126 patients were included, including 52 males and 74 females, with an average age of (66.6±7.6) years. There were 30 patients in the post-dilation group and 96 patients in the non-post-dilation group. On the first day after TAVR, the average QRS intervals in the post-dilation group and the non-post-dilation group were (105.6±13.8) ms and (125.9±28.2) ms, respectively (P=0.017). At discharge, the average PR intervals in the two groups were (168.7±36.8) ms and (192.1±44.2) ms, respectively (P=0.024). At discharge, 9 (7.1%) patients developed new atrioventricular block, 5 (4.0%) patients developed new complete right bundle branch block, and 33 (26.2%) patients developed new complete left bundle branch block. During hospitalization, 2 (1.6%) patients received permanent cardiac pacemakers, both of whom were in the non-post-dilation group. There was no statistical difference in postoperative left ventricular structure and function between the two groups (P>0.05). Conclusion Postoperative expansion using domestically produced interventional valves for TAVR do not increase the incidence of early atrioventricular block and permanent cardiac pacemaker implantation after valve implantation, and there are no significant changes in cardiac structure and function in patients with conduction block in the short term after surgery.