Objective To investigate the efficacy of hydroxychloroquine(HCQ)combined with angiotensin-converting enzyme inhibitor(ACEI)in the treatment of children with non-massive pro-teinuria IgA vasculitis nephritis(IgAVN).Methods A total of 42 children with non-massive pro-teinuria IgAVN in the Guiyang Maternal and Child Healthcare Hospital from August 2023 to August 2024 were collected as the study subjects.They were divided into ACEI group(n=23)and ACEI combined with HCQ group(n=19).The urinary microalbumin level,24-hour urinary protein,rou-tine urinalysis,adverse reactions,electrocardiogram findings,and fundus examination results were compared between the two groups before and after treatment.Results At 0.5,1,3 and 6 months of treatment,the urinary microalbumin,24-hour urinary protein,and urinary red blood cell counts in both groups showed significantly decreasing trend(P＜0.05).At 3 and 6 months of treatment,the urinary microalbumin and 24-hour urinary protein levels in the ACEI combined with HCQ group were significantly lower than those in the ACEI group(P＜0.05).At 0.5,1,3,and 6 months of treat-ment,the urinary red blood cell counts in the ACEI combined with HCQ group were significantly lower than those in the ACEI group(P＜0.05).The total remission rate was 68.4％(13/19)in the ACEI combined with HCQ group and 56.5％(13/23)in the ACEI group,with no significant between-group difference(P＞0.05).In the ACEI combined with HCQ group,there were 2 cases of nausea,1 case of abnormal liver function,and 1 case of respiratory tract infection,with a total incidence rate of 21.1％(4/19).In the ACEI group,there were 2 cases of nausea,2 cases of diz-ziness,1 case of abnormal liver function,and 2 cases of respiratory tract infection,with a total inci-dence rate of 30.4％(7/23).There was significant difference in the total incidence of adverse re-actions between the two groups(P=0.029).No serious adverse events such as arrhythmia or reti-nopathy occurred in children in the two groups.Conclusion HCQ combined with ACEI treatment exhibits a favorable anti-urinary protein effect and good safety.

Objective:To evaluate the effectiveness of an advance care planning (ACP) education intervention based on the respecting choices model for patients with advanced cancer.Methods:A total of 78 advanced cancer patients admitted to Songshan Lake Central Hospital of Dongguan City from April 2022 to September 2023 were selected by convenient sampling and divided randomly into an observation group and a control group (39 patients each). The control group received standard care, while the observation group received the ACP education intervention in addition to standard care, based on the respecting choices model. The ACP Readiness Scale (ACPRS-C), the Palliative Care Attitudes Scale (PCAS-9), and the Functional Assessment of Cancer Therapy-General (FACT-G) scale were used to assess both groups at baseline, immediately post-intervention, and four weeks after the intervention.Results:Post-intervention scores on the ACPRS-C, PCAS-9, and FACT-G were significantly higher in the observation group compared to the control group. Group effects, time effects, and interaction effects were observed ( P<0.01) . Conclusions:The ACP education intervention based on the respecting choices model effectively improves ACP readiness, palliative care attitudes, and quality of life in patients with advanced cancer.

Objective:To evaluate the effectiveness of an advance care planning (ACP) education intervention based on the respecting choices model for patients with advanced cancer.Methods:A total of 78 advanced cancer patients admitted to Songshan Lake Central Hospital of Dongguan City from April 2022 to September 2023 were selected by convenient sampling and divided randomly into an observation group and a control group (39 patients each). The control group received standard care, while the observation group received the ACP education intervention in addition to standard care, based on the respecting choices model. The ACP Readiness Scale (ACPRS-C), the Palliative Care Attitudes Scale (PCAS-9), and the Functional Assessment of Cancer Therapy-General (FACT-G) scale were used to assess both groups at baseline, immediately post-intervention, and four weeks after the intervention.Results:Post-intervention scores on the ACPRS-C, PCAS-9, and FACT-G were significantly higher in the observation group compared to the control group. Group effects, time effects, and interaction effects were observed ( P<0.01) . Conclusions:The ACP education intervention based on the respecting choices model effectively improves ACP readiness, palliative care attitudes, and quality of life in patients with advanced cancer.

Objective:To evaluate the efficacy and related factors of high-flow nasal cannula (HFNC) for the treatment of adult typeⅠ respiratory failure.Methods:The medical records of the subjects with acute hypoxemic respiratory failure supported by HFNC therapy in the medical intensive care unit between October 2017 and February 2019 were reviewed retrospectively. The patients′ baseline characteristics and the serial changes in the respiratory parameters after HFNC therapy at 1 and 24 hours were measured. Therapy success was defined as the avoidance of intubation. The subjects were divided into two groups.Results:Of the 75 eligible patients, 62.7%(47/75) belonged to success group. Overall, HFNC therapy significantly improved the physiologic parameters, such as partial pressure of arterial oxygen (PaO 2), saturation of arterial oxygen (SaO 2), respiratory rate (RR), and heart rate (HR), throughout the first 24 hours. After the adjustment for the other clinical variables, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), sequential organ failure assessment (SOFA), cardiogenic pulmonary edema, and PaO 2 improvement at 1 and 24 hours were associated with therapy success. The overall intensive mortality was 25.3%. However, out of 37.3% of the patients who required belonged to failure group, the mortality was 67.9%. The mortality in the failure group was associated with the use of a vasopressor and a limited PaO 2 improvement at 1 hour. Conclusions:HFNC can significantly improve the physiological parameters of adult patients with acute type I respiratory failure and avoid endotracheal intubation in some patients. The failure to improve oxygenation within 24 hours was a useful predictor of intubation. Among the failure group, the vasopressor use and failed oxygenation improvement were associated with mortality.

Objective To evaluate the effectiveness and safety of Shuangyi Qushi Tongluo Capsules ( SQTC) in treating ankylosing spondylitis (AS), and to explore the synergistic action of SQTC combined with sulfasalazine. Methods A randomized and parallel-controlled trial was carried out in 80 AS patients. The enrolled subjects were evenly randomized into testing group and control group. Both groups were given oral use of sulfasalazine enteric-coated tablets, and the testing group was additionally given oral use of SQTC, which is mainly composed of silky ant (Formica Fusca), black-winged Termitidae, Scorpio, Radix Ginseng, Radix Astragali, Rhizoma Atractylodis Macrocephalae, Radix Angelicae Sinensis, Flos Carthami, Radix Salviae Miltiorrhizae, Radix Achyranthis Bidentatae, Caulis Spatholobi, Herba Epimedii, and Radix Morindae Officinalis. The treatment for the two groups covered 24 weeks. On treatment week 4, 12, 24, we recorded the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), visual analog scale (VAS) scores of rachialgia, patients’ general assessment (PGA), VAS scores of night pain, spondylitis scores, Bath Ankylosing Spondylitis Functional Index ( BASFI) , Bath Ankylosing Spondylitis Metrology Index ( BASMI) , scores of the quality of life ( QOL) , erythrocyte sedimentation rate ( ESR) , C-reactive protein ( CRP). Moreover, the adverse reaction of the two groups was also monitored. Results ( 1) Compared with the control group, testing group had high ASAS 20 percentage on treatment week 4, 12 and 24 (P<0.05 or P<0.01). (2) After treatment for 12, 24 weeks, the observation indexes were much improved in the testing group ( P<0.05 or P<0.01 compared with the control group). ( 3) In the control group, one case ( 2.86%) had slight abnormal hepatic function, and one case (2.63%) in the testing group had slight gastrointestinal discomfort, the difference being insignificant (P>0.05). Conclusion SQTC are effective and safe in treating AS, starting an effect shortly and having synergistic effect on salfasalazine for the treatment of AS.

Objective To study the roles of apoptosis genes bcl 2, bax, and bak in the pathogenesis of hepatitis D. Methods Expressions of HDAg, bcl 2, bax, and bak in liver specimens of 77 patients with hepatitis D were studied by immunohistochemical method. Meanwhile, the relationship of HDAg expression with the expressions of bcl 2, bax, and bak was studied by double labelling. Results Bcl 2 was mainly expressed in the cytoplasm of hepatocytes, and bax and bak mainly in the cytoplasm of hepatocytes and partly in the nucleus of hepatocytes, and HDAg mainly in the nucleus of hepatocytes. Lots of HDAg and bax/bak positive cells were distributed in infiltrating lymphocytes at the periportal region especially at the advancing edges of areas of piecemeal necrosis. Apoptosis of many hepatocytes was found to locate near the HDAg positive cells. There was positive correlation between the expression of bax/bak and HDAg expression ( P

Objective　To investigate the possible relationship between the vitamin E(VE) contents in the plasma and development of hepatosis.Methods　VE and malondialdehyde(MDA) contents in 217 cases infected by various types of viral hepatitis were measured by means of fluorescence and TBA.Moreover,the relationship between both of the contents and the alteration of liver function was observed dynamically.Results　The plasma levels of VE in all cases were decreased obviously.Interestingly,lower the contents of VE were,more severity the disease was.Howevey,the levels of VE recovered step by step when the liver function return to normal in the acute hepatitis cases.Unfortunately,the levels in the chronic hepatitis cases were higher in the recovering phase than in the acute phase,but still lower than normal.Moreover,VE kept low levels and showed a negative relationship to the bilirublin in both worsening and dying cases.Conclusion　To observe the VE contents is helpful to the clinical evaluation of the hepatosis progress and prognosis.

Objective　To study the role of bcl-2 and bax in the pathogenesis of hepatitis D. Methods　Expression of HDAg， bcl-2 and bax in liver specimens of 79 patients with hepatitis D were studied by immunohistochemistry technique. Meanwhile， the relationship between expression of HDAg and that of bcl-2／bax in liver specimens of patients were studied by double labelling technique and serial sections.Results　bcl-2 was mainly expressed in the cytoplasm of hepatocytes， bax mainly in the cytoplasm of hepatocytes and partly in the nucleus of hepatocytes， and HDAg mainly in the nucleus of hepatocytes. Most of HDAg and bax positive cells were distributed among infiltrating lymphocytes at the periportal region especially at the advancing edges of areas of “piecemeal necrosis”. Most of hepatocytes of bax positive was found to locate near to positive cells of HDAg， and there were positive correlations between degrees of bax expression and HDAg expression（P＜0.05）. Conclusions　The distribution and the expression of bax and HDAg are significantly correlated with the activity of inflammation and the severity of the liver damage， and HDV infection may induce the expression of bax in the hepatocytes，and hepatocyte apoptosis mediated by bcl-2／bax may play an important role in the liver cell injury by HDV infection.

Objective　To study the probability of using hepatitis D virus (HDV) ribozyme as a kind of anti-hepatitis-C-virus (HCV) gene thera-py drugs. Methods　The natural HDV genomic ribozyme′s stem Ⅳ was optimized and its substrate-binding region reconstructed, thus three recombinant HCV-specific HDV genomic ribozymes RzC1, RzC2 and RzC3 were obtained. HCV RNA 5'-noncoding region and 5'-fragment of C region (HCV RNA5'-NCR-C) were transcribed from plasmid pHCV-neo by T7 phage RNA polymerase in vitro, and radiolabelled at its 5'-end. The trans-cleaving reaction was performed by mixing the ribozymes and substrate at mol ratio 100∶1 under conditions as follows: 37℃, pH7.5, Mg2+ 20 mmol/L and deionized formamide 2.5 mol/L. Percentage of trans-cleaved products were calculated at different time points and used as the activity indicator of the three ribozymes. Results　RzC1, RzC2 trans-cleaved more substrate when the time extended, and got to 24.9%,20.3% after reac-ting for 90 minutes respectively; RzC3 was not able to trans-cleave its substrate. Conclusion　Recombinant HDV genomic ribozymes have the ability to trans-cleave HCV RNA, but the appropriate target sequence should be selected.

Objective To explore the pathogenesis of hepatitis D virus by analyzing the clinic characteristics of 507 cases of hepatitis B (HB) with hepatitis D virus (HDV) infection. Methods The occurrence of different types of hepatitis, the prognosis, clinical features, major biochemistry results, and hepatitis virus marks were analyzed in 507 cases of HB with positive HDV and compared with 213 cases of HB with negative HDV. Results The incidence and the mortality of serious chronic hepatitis, severe hepatitis, and liver cirrhosis were all higher in the HB patients with positive HDV than negative one. The incidence of bleeding, ascites, hepat-coma complication, and the level of ALT were higher in HDV-positive patients than in HDV-negative patients (P < 0.01,0.05), and the changes of the major biochemistry results were more obvious than the same types of hepatitis B with negative HDV (P < 0.01). The detection rate for HBeAg in serum of the patients positive for HDV was obviously lower than that of the patients negative for HDV(P < 0.01). In patients with acute hepatitis, severe hepatitis, and liver cirrhosis, the expression of positive HDAg and negative HBeAG was obviously higher than that of positive HDAg and HBeAg. Conclusion After HDV infection, the incidences and poor prognosis of serious chronic hepatitis, severe hepatitis, and liver cirrhosis increase. HDV infection can inhibit the replication of HBV DNA or HBeAg expression. The effects of direct cytotoxicity of HDV on hepatocytes may play a major pathogenic role in acute hepatitis and in aggravating illness status to severe type.