OBJECTIVES: To study the significance of serum 25-hydroxyvitamin D₃ [25-(OH)D₃] level in the clinicopathological characteristics and prognosis of children with immunoglobulin A vasculitis nephritis (IgAVN). METHODS: A retrospective analysis was conducted on the clinical data of children with IgAVN who underwent renal biopsy at Suzhou Hospital Affiliated to Anhui Medical University and Jinling Hospital of the Medical School of Nanjing University from June 2015 to June 2020. Based on serum 25-(OH)D₃ level, the patients were divided into a normal group and a lower group. The clinicopathological characteristics and follow-up data of the two groups were collected and compared. RESULTS: A total of 359 children with IgAVN were included. Compared to the normal group (62 cases), the lower group (297 cases) exhibited higher incidences of hematochezia and gross hematuria, higher levels of serum creatinine, blood urea nitrogen, urinary retinol protein, urinary N-acetyl-β-D-glucosaminidase, and quantitative urinary protein, and a longer duration from renal biopsy to urinary protein becoming negative, as well as lower estimated glomerular filtration rate and albumin level (P<0.05). Renal pathology in the lower group showed a higher occurrence of tubular interstitial injury, crescent formation, segmental sclerosis in glomeruli, and inflammatory cell infiltration in the renal interstitium compared to the normal group (P<0.05). Survival analysis indicated that the cumulative renal survival rate was lower in the lower group (P<0.05). Multivariate Cox regression analysis revealed that low serum 25-(OH)D₃ level is an independent risk factor for poor prognosis in children with IgAVN. CONCLUSIONS Children with IgAVN and low serum 25-(OH)D₃ level have relatively severe clinicopathological manifestations. Low serum 25-(OH)D₃ level is an independent risk factor for poor prognosis in children with IgAVN.
Humans ; Male ; Female ; Child ; Prognosis ; Retrospective Studies ; Calcifediol/blood* ; Child, Preschool ; Adolescent ; Glomerulonephritis, IGA/mortality* ; Vasculitis/pathology* ; IgA Vasculitis/mortality*

The development of medical technology and the extension of lifespan have promoted population aging,and malignant blood diseases are gradually becoming common in the elderly.Among them,the most common is acute myeloid leukemia(AML),with a median age at diagnosis of 68 years old.Due to poor clinical conditions,severe comorbidities,poor tolerance to intensive therapy,as well as unfavorable or complex cytogenetics and multidrug resistance,elderly AML patients have a poorer prognosis and increased risks of treatment-related toxicity and mortality.Allogeneic hematopoietic stem cell transplantation(allo-HSCT)is one of the optimal treatment strategies for elderly AML patients.With improvements in reduced-intensity conditioning(RIC),the expansion of donor selection,the optimization of graft-versus-host disease(GVHD)prevention regimen,and the progress of supportive care,more elderly AML patients have been choosing allo-HSCT.This article reviews the recent applications of allo-HSCT in elderly AML patients.

The clinical significance of immunoglobulin M (IgM) deposition in the glomeruli of children with immunoglobulin A vasculitis (IgAV) nephritis remains unclear. This study aimed to analyze the clinical and pathological characteristics and prognoses of this population. Methods: Patients were divided into three groups according to histopathological IgM deposition intensity: grade A (204 cases); grade B (101 cases); and grade C + D (54 cases). The clinicopathological characteristics and follow-up information of the three groups of patients were collected and compared. Results: This study included 359 children with IgAV nephritis and found that 44.9% of them had IgM deposition in the kidney glomerulus. Children with IgM deposition and IgAV nephritis have relatively severe clinicopathological features. A total of 39 children (10.9%) had entered the end-stage kidney disease stage. Kaplan-Meier analysis showed that cumulative renal survival was significantly lower in children with higher glomerular IgM deposition (log-rank test chi-square = 55.341, p < 0.001). Multivariable Cox regression analysis found that IgM deposition (grade C + D: hazard ratio [HR], 2.04; 95% confidence interval [CI], 1.67–3.93; p = 0.04; grade B: HR, 2.59; 95% CI, 1.08–4.23; p = 0.03) and S1 (HR, 1.76; 95% CI, 0.42–2.98; p = 0.03) were independent risk factors for poor prognoses in children with IgAV nephritis. The receiver operating characteristic curve indicated that IgM deposition presented significant predictive capability. Conclusion: There are differences in the clinicopathological features of IgAV nephritis with different degrees of mesangial IgM deposition. IgM deposition and S1 are independent risk factors for poor prognoses of IgAV nephritis in children.

Objective To observe the effects of melatonin on autophagy in cortical neurons of neonatal rats with hypoxic-ischemic brain damage(HIBD)and to explore its mechanisms via the PI3K/AKT signaling pathway,aiming to provide a basis for the clinical application of melatonin.Methods Seven-day-old Sprague-Dawley neonatal rats were randomly divided into a sham operation group,an HIBD group,and a melatonin group(n=9 each).The neonatal rat HIBD model was established using the classic Rice-Vannucci method.Neuronal morphology in the neonatal rat cerebral cortex was observed with hematoxylin-eosin staining and Nissl staining.Autophagy-related protein levels of microtubule-associated protein 1 light chain 3(LC3)and Beclin-1 were detected by immunofluorescence staining and Western blot analysis.Phosphorylated phosphoinositide 3-kinase(p-PI3K)and phosphorylated protein kinase B(p-AKT)protein expression levels were measured by immunohistochemistry and Western blot.The correlation between autophagy and the PI3K pathway in the melatonin group and the HIBD group was analyzed using Pearson correlation analysis.Results Twenty-four hours post-modeling,neurons in the sham operation group displayed normal size and orderly arrangement.In contrast,neurons in the HIBD group showed swelling and disorderly arrangement,while those in the melatonin group had relatively normal morphology and more orderly arrangement.Nissl bodies were normal in the sham operation group but distorted in the HIBD group;however,they remained relatively intact in the melatonin group.The average fluorescence intensity of LC3 and Beclin-1 was higher in the HIBD group compared to the sham operation group,but was reduced in the melatonin group compared to the HIBD group(P<0.05).The number of p-PI3K+and p-AKT+cells decreased in the HIBD group compared to the sham operation group but increased in the melatonin group compared to the HIBD group(P<0.05).LC3 and Beclin-1 protein expression levels were higher,and p-PI3K and p-AKT levels were lower in the HIBD group compared to the sham operation group(P<0.05);however,in the melatonin group,LC3 and Beclin-1 levels decreased,and p-PI3K and p-AKT increased compared to the HIBD group(P<0.05).The correlation analysis results showed that the difference of the mean fluorescence intensity of LC3 and Beclin-1 protein in the injured cerebral cortex between the melatonin and HIBD groups was negatively correlated with the difference of the number of p-PI3K+and p-AKT+cells between the two groups(P<0.05).Conclusions Melatonin can inhibit excessive autophagy in cortical neurons of neonatal rats with HIBD,thereby alleviating HIBD.This mechanism is associated with the PI3K/AKT pathway.

Targeted therapy is one of the important methods of treatment for non-small cell lung cancer (NSCLC). Tyrosine kinase inhibitors (TKIs) have the characteristics of high efficacy and low toxicity, and are used in the precise treatment in NSCLC patients with gene mutation. Common gene mutations include genes encoding epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK). Different patients have different responses to TKIs. Monitoring the blood concentration of TKIs can help better predict the clinical outcome (efficacy/toxicity) and optimize the treat strategies. In this paper, the relevant literature at home and abroad in the past 10 years are searched, and the relationship between the blood trough concentration of EGFR-TKI and ALK-TKI commonly used in clinic and the efficacy/toxicity are reviewed.

Targeted therapy is one of the important methods of treatment for non-small cell lung cancer (NSCLC). Tyrosine kinase inhibitors (TKIs) have the characteristics of high efficacy and low toxicity, and are used in the precise treatment in NSCLC patients with gene mutation. Common gene mutations include genes encoding epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK). Different patients have different responses to TKIs. Monitoring the blood concentration of TKIs can help better predict the clinical outcome (efficacy/toxicity) and optimize the treat strategies. In this paper, the relevant literature at home and abroad in the past 10 years are searched, and the relationship between the blood trough concentration of EGFR-TKI and ALK-TKI commonly used in clinic and the efficacy/toxicity are reviewed.

Objective To explore the risk factors for renal injury in tumors patients treated with programmed death receptor-1(PD-1)inhibitor,and further construct a column chart model to predict the likelihood of renal injury in patients.Methods The present study is a single center retrospective analysis.447 patients with tumors treated with PD-1 inhibitors in the Third Affiliated Hospital of Soochow University between January 2018 and January 2021 were included and followed up until January 2022.Kidney injury was defined as acute kidney disease(AKD).All patients were divided into AKD group(n=71)and non-AKD group(n=376 according to whether PD-1 inhibitor associated with AKD development at the end of follow-up.Basic information,disease and medication situation,laboratory indicators,and the incidence of extrarenal immune related adverse events(irAEs)during follow-up period were compared between the two groups.Univariate and multivariate logistic regression models were used to identify independent risk factors for PD-1 inhibitor associated AKD.The present study randomly divided all samples(n=447)into training set(n=313)and validation set(n=134)in a 7:3 ratio,built nomogram prediction models in the training set according to the screened independent risk factors,drawn the receiver operating characteristic(ROC)curves to evaluate the discrimination of the models,drawn calibration curves to evaluate the calibration of the models,and drawn clinical decision curve analysis(DCA)to explore the clinical validity and benefit rate of the models.Results The combination of antibiotics,diabetes,hypertension,extrarenal irAEs and cystatin C(Cys C)in AKD group were significantly higher than those in non-AKD group(P<0.05),but hemoglobin(Hb)was significantly lower than that in non-AKD group(P<0.05).Single factor logistic regression analysis showed that combination of antibiotics,diabetes,hypertension,extrarenal irAEs,lower Hb,estimated glomerular filtration rate(eGFR),higher blood urea nitrogen(BUN),serum creatinine(SCr),Cys C,fasting blood glucose(FBG),and alanine transaminase(ALT)were risk factors for PD-1 inhibitor related AKD(P<0.05).Multivariate logistic regression analysis showed that concomitant extrarenal irAEs,lower Hb,higher SCr,and direct bilirubin(DBIL)were independent risk factors for PD-1 inhibitor associated AKD(P<0.05).Based on the independent risk factors mentioned above,a column chart prediction model was further established and validated.The results showed that the area under the ROC curve(AUC)of the training and validation sets of the model were 0.703(95%CI 0.628-0.777)and 0.791(95%CI 0.671-0.911),respectively,indicating good discrimination.The calibration curves of both the training and validation sets hover around the ideal line of 45°,indicating that the model has good calibration.DCA shows that the constructed model curve is far away from the two polar lines(the curve with a net benefit of 0 and the curve with all samples being positive),indicating that the model has good clinical benefits.Conclusion The combination of extrarenal irAEs,lower Hb,higher SCr,and higher DBIL are independent risk factors for the occurrence of PD-1 inhibitor related AKD;The established column chart model has good discrimination and calibration,which can provide guidance for clinical practice.

Child ; Humans ; Manometry ; Esophagus/physiology*

OBJECTIVE: To evaluate the effect of uncemented total hip arthroplasty(THA) on treatment of traumatic arthritis caused by intramedullary nailing interfixation of intertrochanteric fractures. METHODS: Total of 22 patients treated with THA due to traumatic arthritis caused by intramedullary nailing interfixation of intertrochanteric fractures from January 2012 to January 2017 were studied retrospectively, including 10 males and 12 females with a mean age of (72.5±9.8) years old ranging from 61 to 84 years old. Initial internal fixation method:14 patients were treated with Gamma nails and 8 patients were treated wit PFNA.The time from internal fixation surgery to THA was 10 to 68 months with an average of (32.2±21.3) months.Harris scores of the hip joint before and after surgery were compared, and the position of the prosthesis through postoperative imaging at 3, 6, 12 months and the last follow-up were evaluated. RESULTS: One patient was died due to heart failure 1 year after operation. Two patients was died to advanced tumor 2 years after operation. The other 19 patients were followed up for 36 to 64 months with an average of (48.5±11.9) months. At final follow up, 14 patients regained the ability to walk independently, 4 patients needed support of a cane, 1 patient needed assistance of a walker. No serious complications such as joint dislocation, periprosthetic fracture and deep venous thrombosis occurred during follow-up. There were no signs of loosening and subsidence of the prosthesis at the final follow-up. Mean Harris hip score increased from (29.2±12.9) points preoperatively to (74.2±11.2) points at the final follow up(P<0.05);the score was excellent in 9 patients, good in 7 and fair in 3. CONCLUSION Uncemented total hip arthroplasty for traumatic arthritis after intramedullary nail fixation of femoral intertrochanteric fracture can significantly improve hip function and effectively avoid bone cement implantation syndrome. The medium-term effect is satisfactory.
Male ; Female ; Humans ; Middle Aged ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/methods* ; Follow-Up Studies ; Treatment Outcome ; Retrospective Studies ; Bone Nails ; Hip Fractures/surgery* ; Fracture Fixation, Intramedullary/adverse effects* ; Arthritis/surgery*

OBJECTIVE: To review targeted muscle reinnervation (TMR) surgery for the construction of intelligent prosthetic human-machine interface, thus providing a new clinical intervention paradigm for the functional reconstruction of residual limbs in amputees. METHODS: Extensively consulted relevant literature domestically and abroad and systematically expounded the surgical requirements of intelligent prosthetics, TMR operation plan, target population, prognosis, as well as the development and future of TMR. RESULTS: TMR facilitates intuitive control of intelligent prostheses in amputees by reconstructing the "brain-spinal cord-peripheral nerve-skeletal muscle" neurotransmission pathway and increasing the surface electromyographic signals required for pattern recognition. TMR surgery for different purposes is suitable for different target populations. CONCLUSION TMR surgery has been certified abroad as a transformative technology for improving prosthetic manipulation, and is expected to become a new clinical paradigm for 2 million amputees in China.
Humans ; Artificial Limbs ; Muscle, Skeletal ; Neurosurgical Procedures ; Plastic Surgery Procedures ; Prosthesis Implantation