Objective:To explore the efficacy and its related factors of rituximab (RTX) in the treatment of children with frequently relapsing nephrotic syndrome/steroid-dependent nephrotic syndrome (FRNS/SDNS).Methods:It was a single-center retrospective study. The clinical data of FRNS/SDNS children first treated with RTX in the First Affiliated Hospital of Sun Yat-sen University from November 1, 2016 to September 1, 2023 were collected. The number of relapse within 1 year before and after RTX treatment, the time to first relapse after RTX treatment, and the time to B-cell reconstitution were analyzed. At the first treatment, a single dose of RTX was given at 375 mg/m 2, with a maximum dose of 500 mg, once a week, for 1 to 4 doses. The count of CD19 + lymphocytes in the peripheral blood of the children was continuously monitored. If B-cell reconstruction was performed, the decision on whether to proceed to the next course of RTX treatment was made based on clinical manifestations. Kaplan-Meier method was used to analyze relapse-free survival rate after receiving RTX. Cox proportional hazards regression model was used to analyze the related factors of relapse after RTX treatment. Results:A total of 98 FRNS/SDNS children receiving RTX treatment were enrolled, including 75 males (76.5%). The age at onset was 4.0 (1.9, 7.1) years and age of receiving RTX was 11.3 (8.5, 13.5) years. There were 90 children (91.8%) achieving complete remission, while 8 patients (8.2%) did not respond to RTX treatment, and 3 patients (3.1%) progressed to end-stage kidney disease after receiving RTX. The relapse-free survival rates at 6 months and 1 year after RTX treatment were 83.3% (75/90) and 57.9% (22/38), respectively. The frequency of relapse 1 year after RTX treatment decreased compared to 1 year before RTX treatment ( Z=-7.398, P<0.001). Compared with children without relapse during the period of B-cell depletion, relapsed children had a higher number of relapse within one year after RTX treatment ( Z=5.246, P<0.001). The time to first relapse after RTX treatment was 8.3 (4.6, 13.9) months in 51 relapse patients. Compared with children receiving 1 dose of RTX in the first course, those receiving 2 or more doses had a longer time to the first relapse ( Z=2.983, P=0.003). There was no statistically significant difference in time to the first relapse between children who received mycophenolate mofetil therapy after RTX treatment and those who didn't ( P>0.05). The reconstruction time of B cells after the first course of RTX was 6.9 (5.3, 9.0) months. Compared to children receiving one dose of RTX in the first course, those receiving two or more doses had a longer B-cell reconstitution time ( Z=2.739, P=0.006). There was no statistically significant difference in B-cell reconstitution time between children who received mycophenolate mofetil therapy after RTX treatment and those who didn't ( P>0.05). Univariate Cox regression analysis showed that recurrence after calcineurin inhibitor (CNI) treatment before RTX treatment and the number of recurrence in one year before RTX treatment were correlated factors of recurrence after RTX treatment (both P<0.05). Multivariate Cox regression analysis showed that recurrence after CNI treatment before RTX treatment was an independent correlated factor of relapse after RTX therapy ( HR=3.496, 95% CI 1.245-9.818, P=0.018). Infusion reactions occurred in 10 patients (10.2%) and infections were observed in 24 patients (24.5%) during B cell depletion. No serious adverse events occurred. Conclusions:RTX is well tolerated and effective in treating FRNS/SDNS. Recurrence after CNI treatment before RTX treatment may be an independent related factor of relapse after RTX treatment.

Objective:To explore the efficacy and its related factors of rituximab (RTX) in the treatment of children with frequently relapsing nephrotic syndrome/steroid-dependent nephrotic syndrome (FRNS/SDNS).Methods:It was a single-center retrospective study. The clinical data of FRNS/SDNS children first treated with RTX in the First Affiliated Hospital of Sun Yat-sen University from November 1, 2016 to September 1, 2023 were collected. The number of relapse within 1 year before and after RTX treatment, the time to first relapse after RTX treatment, and the time to B-cell reconstitution were analyzed. At the first treatment, a single dose of RTX was given at 375 mg/m 2, with a maximum dose of 500 mg, once a week, for 1 to 4 doses. The count of CD19 + lymphocytes in the peripheral blood of the children was continuously monitored. If B-cell reconstruction was performed, the decision on whether to proceed to the next course of RTX treatment was made based on clinical manifestations. Kaplan-Meier method was used to analyze relapse-free survival rate after receiving RTX. Cox proportional hazards regression model was used to analyze the related factors of relapse after RTX treatment. Results:A total of 98 FRNS/SDNS children receiving RTX treatment were enrolled, including 75 males (76.5%). The age at onset was 4.0 (1.9, 7.1) years and age of receiving RTX was 11.3 (8.5, 13.5) years. There were 90 children (91.8%) achieving complete remission, while 8 patients (8.2%) did not respond to RTX treatment, and 3 patients (3.1%) progressed to end-stage kidney disease after receiving RTX. The relapse-free survival rates at 6 months and 1 year after RTX treatment were 83.3% (75/90) and 57.9% (22/38), respectively. The frequency of relapse 1 year after RTX treatment decreased compared to 1 year before RTX treatment ( Z=-7.398, P<0.001). Compared with children without relapse during the period of B-cell depletion, relapsed children had a higher number of relapse within one year after RTX treatment ( Z=5.246, P<0.001). The time to first relapse after RTX treatment was 8.3 (4.6, 13.9) months in 51 relapse patients. Compared with children receiving 1 dose of RTX in the first course, those receiving 2 or more doses had a longer time to the first relapse ( Z=2.983, P=0.003). There was no statistically significant difference in time to the first relapse between children who received mycophenolate mofetil therapy after RTX treatment and those who didn't ( P>0.05). The reconstruction time of B cells after the first course of RTX was 6.9 (5.3, 9.0) months. Compared to children receiving one dose of RTX in the first course, those receiving two or more doses had a longer B-cell reconstitution time ( Z=2.739, P=0.006). There was no statistically significant difference in B-cell reconstitution time between children who received mycophenolate mofetil therapy after RTX treatment and those who didn't ( P>0.05). Univariate Cox regression analysis showed that recurrence after calcineurin inhibitor (CNI) treatment before RTX treatment and the number of recurrence in one year before RTX treatment were correlated factors of recurrence after RTX treatment (both P<0.05). Multivariate Cox regression analysis showed that recurrence after CNI treatment before RTX treatment was an independent correlated factor of relapse after RTX therapy ( HR=3.496, 95% CI 1.245-9.818, P=0.018). Infusion reactions occurred in 10 patients (10.2%) and infections were observed in 24 patients (24.5%) during B cell depletion. No serious adverse events occurred. Conclusions:RTX is well tolerated and effective in treating FRNS/SDNS. Recurrence after CNI treatment before RTX treatment may be an independent related factor of relapse after RTX treatment.

Eyelid tumor is a serious eye disease that leads to vision loss or even blindness.The similarity between benign and malignant characteristics makes it difficult for ophthalmologists lacking clinical experience to distinguish between them.To address the problem,a method(ResNet101_CBAM)based on two-stage target localization using fully convolutional one-stage object detection(FCOS)and residual network incorporating a dual attention mechanism is proposed to realize the automatic diagnosis of benign and malignant eyelid tumors.FCOS is used to automatically localize the overall contour of the orbit,removing the background and surrounding noise,and then finely localize the tumor lesion inside the orbit.The obtained lesion region is input into ResNet101_CBAM for the automatic diagnosis of benign and malignant eyelid tumors.The experimental results show that the average precision of the target localization algorithm for tumor lesion is 0.821,and that compared with ResNet101,ResNet101_CBAM improves the sensitivity and accuracy in eyelid tumor classification by 4.7%and 3.0%,respectively,indicating that the proposed model has superior performances in the automatic diagnosis of benign and malignant eyelid tumors.

Objective:To explore the intervention effect of sensorimotor training on cognitive function, balance and fall risk of elderly patients with schizophrenia.Methods:The 60 hospitalized elderly schizophrenic patients in Wuxi Mental Health Center were randomly divided into experimental group and control group from June to September 2021, with 30 cases in each group. The control group implemented traditional exercise on the basis of routine nursing. The experimental group received 8-week and 24 times sensorimotor training on the basis of the routine nursing. The Chinese version of the Mini Mental State Examination (MMSE) was used to assess the cognitive level of patients, the Modified Morse Fall Scale (MMFS) was used to assess the risk of falls, and the Berg Balance Scale (BBS) was used to assess the balance function.Results:After 8 weeks of intervention, the total score of MMSE was (26.72 ± 1.71), higher than the total score of the control group (22.36 ± 1.93), the factor scores of temporal orientation, spatial orientation, recollection, attention and calculation, memory and language ability in the experimental group were (4.90 ± 0.31), (4.72 ± 0.53), (2.86 ± 0.35), (4.66 ± 0.61), (2.83 ± 0.47), (6.76 ± 1.09), higher than scores of the control group (4.36 ± 0.56), (3.93 ± 0.66), (2.57 ± 0.50), (3.64 ± 1.03), (2.18 ± 0.67), (5.68 ± 1.02), and the difference was statistically significant( t values were 2.53-9.06, all P< 0.05). The total score of MMFS in the experimental group was (5.93 ± 1.49), which was lower than that in the control group (8.75 ± 2.30). The difference was statistically significant ( t=-5.51, P<0.01). The total score of BBS in the experimental group was (38.83 ± 1.71), which was higher than that in the control group (30.89 ± 1.93). The difference was statistically significant ( t=16.43, P<0.01). Conclusions:Sensorimotor training can improve the level of balance, cognitive function and reduce the risk of falls in elderly patients with schizophrenia.

Background: Antibiotic resistance of Helicobacter pylori (Hp) is an important cause of failure of eradication treatment, the latest national and international consensus have recommended a quadruple regimen based on the use of amoxicillin or tetracycline as the first-line treatment for Hp eradication. Minocycline is a semi-synthetic tetracycline easily available clinically and has a low secondary resistance rate, and can be used in penicillin-allergic patients. Aims: To investigate the efficacy and safety of regimen with minocycline combined with metronidazole, rabeprazole and bismuth potassium citrate for eradication of Hp infection. Methods: Patients with Hp infection from August 2020 to January 2021 at Jiangqiao Hospital in Jiading District having the primary treatment for Hp eradication were selected. All the enrolled patients received rabeprazole enteric-coated tablets 10 mg bid + minocycline capsules 100 mg bid + metronidazole tablets 400 mg tid + bismuth potassium citrate capsules 220 mg bid for 14 days. Symptoms and adverse reactions during treatment were recorded. The eradication of Hp was determined by

Objective:To compare the consistency in diagnosing and staging acute kidney injury (AKI) in children with chronic kidney disease (CKD) according to three criterias.Methods:Children with CKD hospitalized in the First Affiliated Hospital of Sun Yat sen University from January 2013 to December 2019 were analyzed retrospectively. These patients underwent serum creatinine examination more than twice during hospitalization. The AKI diagnosis and staging were performed for each patient according to the 2007 pRIFLE, 2012 KDIGO and 2018 pROCK criteria respectively. All the children were followed up for 1 year after discharge through outpatient visit, re-hospitalization or online consultation. The clinical characteristics and prognosis of CKD children with or without AKI that were diagnosed by 3 criteria were compared. Analysis of variance and chi-squared tests were used for the comparison among groups. Concordance between the different diagnostic criteria was evaluated using Cohen′s kappa coefficient.Result:A total of 2 551 children with CKD were included in this study, with an age of (8±4) years. There were 1 628 boys and 923 girls. Nephrotic syndrome was the most prevalent primary disease (55.4%), followed by lupus nephritis (11.2%) and purpura nephritis (8.2%). Among all stages of CKD, CKD category G1 was the most common type (2 146 cases, 84.1%), followed by CKD category G2 (221 cases, 8.7%). AKI occurence rates according to pRIFLE, KDIGO and pROCK criteria were 33.9% (866/2 551), 26.2%(669/2 551) and 19.5% (498/2 551) respectively (χ2=136.3, P<0.01). The diagnostic consistency within three criteria for AKI was high in children with CKD ( κ=0.702), but AKI staging consistency was low ( κ=0.329). Both the diagnosis and staging consistency of three AKI criteria were poor in children with CKD category G5 (all κ<0.400). The length of hospital stay (LOS), hospitalization costs, the occurence of intensive care unit (ICU) admission and in-hospital mortality were significantly higher in children with AKI diagnosed by different criteria ( P<0.05). After 1-year follow-up, the repeated admission rate and CKD staging progress significantly increased in children with AKI ( P<0.05). In children with baseline serum creatinine≥200 μmol/L, compared with children who did not experience AKI during hospitalization, the LOS and the hospitalization costs in children who were diagnosed AKI according to pRIFLE or pROCK criteria was significantly higher ( P<0.05). However, there was no significant difference in the LOS and hospitalization costs between children with or without AKI who were diagnosed according to KDIGO criteria (all P>0.05). Conclusions:AKI diagnosed by all of the three criteria (pRIFLE, KDIGO and pROCK criteria) was associated with the poor prognosis in children with CKD. However, in those whose baseline serum creatinine≥ 200 μmol/L, AKI diagnosed by pRIFLE and pROCK criteria could better reflect the poor outcomes than by KDIGO criteria.

Objective To investigate maternal risk factors for fetal congenital heart diseases (CHD). Methods A case-control study was conducted on 16 645 pregnant women who underwent cardiovascular malformation screening for fetal cardiovascular system,whose pregnancy outcomes were recorded,and whose newborns were scanned by an echocardiography in Peking University People's Hospital,Haidian,Changping,Mentougou and Daxing Maternal and Child Health Hospital from Nov.2006 to Oct.2009.One hundred and twelve pregnant women whose babies were found to be CHD (40 severe CHD and 72 simple CHD) before or after delivery were taken as study group.Women in control group (n =304) were randomly selected from those pregnant women who had infants without CHD.Logistic regression analysis and x2 test were used to analyze the maternal risk factors for fetal CHD. Results (1) The average age of women whose infants had severe CHD was 28.3 years (21-40 years),and it was 29.9 years (22-39 years) for women whose infants had simple CHD.There were no significant differences between the control group (29.5 years,20-44 years) and the above two groups (t=1.511 and -0.826,P=0.138 and 0.410 respectively).(2) Single factor analysis:during first trimester,the rate of upper respiratory infection (18/39,46.2 ％) and exposure to certain chemicals (13/40,32.5％) of severe CHD group were higher than those of control group [(14.9％ (45/303) and 2.0％ (6/304)] (x2 =22.399 and 62.678,OR=4.895 and 23.753,95％CI:2.419-9.905 and 8.358-67.506,P =0.000 respectively).Compared with control group (0.0％,0/304),the rate of pregnant women with CHD family history in simple CHD group was significantly higher (4.2％,3/72)(Fisher exact test,P=0.007).(3) Logistic regression analysis:maternal upper respiratory infections (OR =5.120,95％CI:2.340-11.206,P =0.000) and exposure to certain chemicals (f)R=23.030,95％CI:7.506-70.665,P=0.000) during first trimester were risk factors for fetal severe CHD. Conclusions Upper respiratory infection and exposure to certain chemicals during first trimester might play important roles in the occurrence of fetal severe CHD.Maternal family history of CHD might associate with fetal simple CHD.