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.

Background and Aims:Surgical treatment is a cornerstone of breast cancer management;however,the physical trauma and psychological burden associated with surgery may adversely affect patients'quality of life(QoL).Based on data from a prospective cohort,this study was conducted to evaluate changes in postoperative QoL among breast cancer patients and to identify mediating factors influencing QoL,thereby providing evidence for perioperative rehabilitation strategies.Methods:Female breast cancer patients who underwent local surgical treatment at Suining Central Hospital between June 2024 and January 2025 were enrolled.The Constant-Murley Shoulder Score,EORTC QLQ-C30,and QLQ-BR23 questionnaires were used pre-and postoperatively to assess shoulder joint function,and QoL.Paired t-tests were used to analyze changes in scores before and after surgery.A mediation model was applied to explore the indirect pathways through which surgery impacts QoL.Additionally,subgroup analyses were conducted to compare QoL changes across different surgical modalities.Results:A total of 148 patients were included,with median age of 54(46-60)years old Postoperative psychological health significantly improved,while shoulder function and overall QoL scores markedly declined(all P<0.001).According to QLQ-C30,functional domains such as physical and role functioning worsened,while symptom burden increased.The QLQ-BR23 revealed significantly higher scores for breast and upper limb symptoms postoperatively(both P<0.001).Subgroup analyses showed that patients undergoing axillary lymph node dissection experienced greater declines in shoulder function and QoL compared to those receiving sentinel lymph node biopsy(both P<0.05).QoL deterioration was comparable between mastectomy and breast-conserving surgery,although the former was associated with more prominent pain and breast symptoms.Mediation analysis indicated that shoulder function,breast symptoms,and physical functioning served as mediators in the impact of surgery on QoL,while better psychological health exerted a protective effect.Conclusion:Surgical treatment significantly affects postoperative QoL in breast cancer patients,with local functional impairment and symptom exacerbation serving as key mediators.Different surgical approaches have varying impacts on QoL.Enhancing postoperative shoulder rehabilitation,symptom management,and psychological support may improve patients'QoL.

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*

Objective To explore the correlation between the pulmonary artery diameter(PAD),PAD/aortic diameter(AOD),right ventricular diameter(RVD),RVD/left ventricular diameter(LVD)measured on pulmonary artery CT angiography(CTPA)cross-sectional images and the degree of embolism,cardiac biomarkers in patients with medium-to-high risk acute pulmonary embolism(APE).Methods The clinical data of 53 patients with medium-to-high risk APE,who received interventional treatment at the Putian Municipal First Hospital of China From January 2021 to December 2023,were retrospectively analyzed.The PAD,PAD/AOD,RVD,and RVD/LVD were measured on CTPA cross-sectional images.The correlations of the above indexes with CT embolism index(CTEI),N terminal pro B type natriuretic peptide(NT-proBNP),and cardiac troponin Ⅰ(cTnⅠ)were analyzed.Results A weak-moderate positive correlation existed between PAD,RVD,RVD/LVD and CTEI(r=0.506,r=0.310,r=0.452 respectively,P＜0.001,P=0.024,P=0.001 respectively),while no correlation existed between PAD/AOD and CTEI(r=0.247,P=0.075).Compared with the NT-proBNP negative group,in the NT-proBNP positive group the values of PAD,PAD/AOD and RVD/LVD were higher(all P＜0.05),and there was no statistically significant difference in RVD value between the two groups(P＞0.05).A weak-moderate positive correlation existed between NT-proBNP and PAD,PAD/AOD,RVD,RVD/LVD(r=0.454,r=0.326,r=0.302,r=0.405 respectively,P=0.001,P=0.017,P=0.028,P=0.003 respectively).There were no statistically significant differences in PAD,PAD/AOD,RVD and RVD/LVD values between the cTnⅠ negative group and the cTnI positive group(all P＞0.05).No correlation existed between cTnⅠ and PAD,PAD/AOD,RVD,RVD/LVD(r=0.188,r=0.042,r=-0.021,r=0.139 respectively,and P=0.195,P=0.772,P=0.884,P=0.342 respectively).Conclusion CTPA cross-sectional quantitative indicators are helpful in evaluating the embolism degree of APE and right heart function,but it cannot be used to assess myocardial injury.

Objective To investigate the role of high-temperature requirement factor A2(HTRA2)in the mitochondrial unfolded protein response(mtUPR)model induced by the neurotoxin 1-methyl-4-phenylpyridinium(MPP+)and the compensatory effects of other proteases.Methods The mtUPR cell model was established by treating SH-SY5Y cells with MPP+.Cell viability was assessed using the Cell Counting Kit-8(CCK-8)assay,and mitochondrial morphological changes and intracellular reactive oxygen species(ROS)levels were examined under transmission electron microscopy and fluorescence microscope,respectively.Western blot(WB)was used to detect the expression levels of C/EBP Homologous Protein(CHOP),Heat shock protein family E member 1(HSPE1),YME1-like 1 ATPase(YME1L1),Caseinolytic mitochondrial matrix peptidase proteolytic subunit(CLPP),and Lon peptidase 1,mitochondrial(LONP1).Lentivirus-mediated knockdown(KD)of the HTRA2 gene in SH-SY5Y cells was performed.The mRNA and protein expression levels of HTRA2 were detected by quantitative real-time polymerase chain reaction and WB,respectively.After induction of mtUPR in HTRA2-KD SH-SY5Y cells with 400 μmol/L MPP?,cell viability and protein expression levels of HTRA2,YME1L1,CLPP,and LONP were evaluated using the CCK-8 assay and WB,respectively.Results mtUPR cell model was successfully established following treatment of SH-SY5Y cells with 400 μmol/L MPP+for 24 hours.Compared to the control group,there was no significant change in cell viability.Under electron microscopy,there were no remarkable alterations in the mitochondrial cristae and size in the mtUPR group.The average fluorescence intensity of ROS in the mtUPR group was 1.25±0.08 fold that of the PBS group,and the difference was statistically significant(P=0.001).The expression levels of CHOP,HSPE1,HTRA2,CLPP,and LONP were significantly higher in the mtUPR group than in the control group,which were 2.68±0.94、2.83±0.89、1.67±0.20,1.65±0.28,and 1.66±0.13 times that of control group,respectively(all P<0.05).The expression level of YME1L1 in the mtUPR group was 1.28±0.27 times that of the control group,with no statistical significance(P>0.05).After knockdown of the HTRA2 gene in SH-SY5Y cells,the expression levels of CLPP,YME1L1,and LONP1 increased to 1.46±0.79,1.41±0.12,and 1.32±0.25 times that of the empty virus group,respectively(all P<0.05).Following treatment with 400 μmol/L MPP+for 24 hours in HTRA2-KD SH-SY5Y cells,cell viability in HTRA2-KD group decreased to 88.4%±6.1%of the empty virus group(P<0.05).In the HTRA2 group,there were no significant changes in the expression levels of YME1L1 and LONP1 compared to the empty virus group(all P>0.05),while the expression level of CLPP increased to(1.88±0.62)times that of the empty virus group(P=0.033).Conclusion HTRA2 is an important mitochondrial protease in the MPP+-induced mtUPR response,and other mitochondrial proteases partially compensate for the function of HTRA2.

Background and Aims:Surgical treatment is a cornerstone of breast cancer management;however,the physical trauma and psychological burden associated with surgery may adversely affect patients'quality of life(QoL).Based on data from a prospective cohort,this study was conducted to evaluate changes in postoperative QoL among breast cancer patients and to identify mediating factors influencing QoL,thereby providing evidence for perioperative rehabilitation strategies.Methods:Female breast cancer patients who underwent local surgical treatment at Suining Central Hospital between June 2024 and January 2025 were enrolled.The Constant-Murley Shoulder Score,EORTC QLQ-C30,and QLQ-BR23 questionnaires were used pre-and postoperatively to assess shoulder joint function,and QoL.Paired t-tests were used to analyze changes in scores before and after surgery.A mediation model was applied to explore the indirect pathways through which surgery impacts QoL.Additionally,subgroup analyses were conducted to compare QoL changes across different surgical modalities.Results:A total of 148 patients were included,with median age of 54(46-60)years old Postoperative psychological health significantly improved,while shoulder function and overall QoL scores markedly declined(all P<0.001).According to QLQ-C30,functional domains such as physical and role functioning worsened,while symptom burden increased.The QLQ-BR23 revealed significantly higher scores for breast and upper limb symptoms postoperatively(both P<0.001).Subgroup analyses showed that patients undergoing axillary lymph node dissection experienced greater declines in shoulder function and QoL compared to those receiving sentinel lymph node biopsy(both P<0.05).QoL deterioration was comparable between mastectomy and breast-conserving surgery,although the former was associated with more prominent pain and breast symptoms.Mediation analysis indicated that shoulder function,breast symptoms,and physical functioning served as mediators in the impact of surgery on QoL,while better psychological health exerted a protective effect.Conclusion:Surgical treatment significantly affects postoperative QoL in breast cancer patients,with local functional impairment and symptom exacerbation serving as key mediators.Different surgical approaches have varying impacts on QoL.Enhancing postoperative shoulder rehabilitation,symptom management,and psychological support may improve patients'QoL.

Objective To investigate the role of high-temperature requirement factor A2(HTRA2)in the mitochondrial unfolded protein response(mtUPR)model induced by the neurotoxin 1-methyl-4-phenylpyridinium(MPP+)and the compensatory effects of other proteases.Methods The mtUPR cell model was established by treating SH-SY5Y cells with MPP+.Cell viability was assessed using the Cell Counting Kit-8(CCK-8)assay,and mitochondrial morphological changes and intracellular reactive oxygen species(ROS)levels were examined under transmission electron microscopy and fluorescence microscope,respectively.Western blot(WB)was used to detect the expression levels of C/EBP Homologous Protein(CHOP),Heat shock protein family E member 1(HSPE1),YME1-like 1 ATPase(YME1L1),Caseinolytic mitochondrial matrix peptidase proteolytic subunit(CLPP),and Lon peptidase 1,mitochondrial(LONP1).Lentivirus-mediated knockdown(KD)of the HTRA2 gene in SH-SY5Y cells was performed.The mRNA and protein expression levels of HTRA2 were detected by quantitative real-time polymerase chain reaction and WB,respectively.After induction of mtUPR in HTRA2-KD SH-SY5Y cells with 400 μmol/L MPP?,cell viability and protein expression levels of HTRA2,YME1L1,CLPP,and LONP were evaluated using the CCK-8 assay and WB,respectively.Results mtUPR cell model was successfully established following treatment of SH-SY5Y cells with 400 μmol/L MPP+for 24 hours.Compared to the control group,there was no significant change in cell viability.Under electron microscopy,there were no remarkable alterations in the mitochondrial cristae and size in the mtUPR group.The average fluorescence intensity of ROS in the mtUPR group was 1.25±0.08 fold that of the PBS group,and the difference was statistically significant(P=0.001).The expression levels of CHOP,HSPE1,HTRA2,CLPP,and LONP were significantly higher in the mtUPR group than in the control group,which were 2.68±0.94、2.83±0.89、1.67±0.20,1.65±0.28,and 1.66±0.13 times that of control group,respectively(all P<0.05).The expression level of YME1L1 in the mtUPR group was 1.28±0.27 times that of the control group,with no statistical significance(P>0.05).After knockdown of the HTRA2 gene in SH-SY5Y cells,the expression levels of CLPP,YME1L1,and LONP1 increased to 1.46±0.79,1.41±0.12,and 1.32±0.25 times that of the empty virus group,respectively(all P<0.05).Following treatment with 400 μmol/L MPP+for 24 hours in HTRA2-KD SH-SY5Y cells,cell viability in HTRA2-KD group decreased to 88.4%±6.1%of the empty virus group(P<0.05).In the HTRA2 group,there were no significant changes in the expression levels of YME1L1 and LONP1 compared to the empty virus group(all P>0.05),while the expression level of CLPP increased to(1.88±0.62)times that of the empty virus group(P=0.033).Conclusion HTRA2 is an important mitochondrial protease in the MPP+-induced mtUPR response,and other mitochondrial proteases partially compensate for the function of HTRA2.

Objective To investigate the feasibility,safety and efficacy of transcatheter drug-loaded microsphere embolization(DLME)in treating patients with advanced bladder cancer with bleeding(ABCB).Methods A total of 26 ABCB patients who underwent DLME for tumor supply arteries were retrospectively selected.The postoperative efficacy and related complications were observed.The recurrence of hematuria and survival situation were followed up.Results All 26 surgeries achieved success with a technical success rate of 100.0％.There were 21 cases(80.8％)of bilateral bladder artery embolism and 5 cases(19.2％)of unilateral bladder artery embolism.Three days after the operation,24 patients(92.3％)had hematuria remission.And the other two patients(7.7％)had no hematuria remission,they were relieved after interventional embolization again.Compared with that before operation,the blood transfusion rate,blood transfusion volume,hematocrit and hemoglobin at one week after operation were significantly improved(P＜0.05).One month after the last intervention,there were 2 cases of complete response,19 cases of partial response,3 cases of stable disease,and 2 cases of progressive disease.The objective remission rate was 80.8％,and the disease control rate was 92.3％.Compared with that before operation,the T stage was significantly improved at one month after operation(P＜0.05).No patients had severe complications such as ectopic embolism.After follow-up for 3-36 months,5 cases(19.2％)had a recurrence of hematuria.Conclusion Transcatheter DLME is feasible,safe,and effective in the treatment of patients with ABCB.It is an optional,minimally invasive palliative measure.

Objective To explore the clinical effect of endovascular stent-graft exclusion in the treatment of acute Stanford B-type aortic dissection(AD)with distal left subclavian artery(LSA)rupture accompanied by arch intramural hematoma.Methods A total of 12 patients with acute AD treated by the endovascular stent-graft exclusion alone were retrospectively selected.All patients had primary rupture at the distal end of LSA with arch intramural hematoma and received endovascular treatment after 2 to 3 weeks of conservative treatment.The technique success rate and related complications were observed.Postoperative computed tomography angiography(CTA)of the aorta was reviewed to evaluate the remodeling of the true and false lumen,the absorption of the arch intramural hematoma,to observe whether there was a new rupture and endoleak,and to understand the position and shape of the stent and the blood supply of the branch arteries.Results All patients completed the operation with a technical success rate of 100％.Two patients partially blocked the opening of LSA,and one patient had type Ⅰ internal leakage after the operation,but the amount of internal leakage was small and was not treated.Other patients did not had serious complications such as aortic rupture,new rupture,paraplegia,stent displacement,stroke,upper limb ischemia or vertebral artery ischemia,internal leakage,and abdominal organ ischemia during and after the operation.The patients were followed up for 19 to 66 months,with an average follow-up of(36.7±13.9)months.During the follow-up period,no patient died.The aortic remodeling was satisfactory in all patients,the arch intramural hematoma was absorbed,and there were no new rupture,internal leakage,upper limb ischemia or vertebral artery ischemia,or other serious complications.One patient with type Ⅰ internal leakage showed no significant change in internal leakage after regular postoperative reexamination.Conclusion Endovascular stent-graft exclusion is safe and feasible in the treatment of acute AD patients with distal LSA rupture accompanied by arch intramural hematoma,and it is worth promoting and applying clinically.

Paternal chronic stress can not only cause damage to multiple organs and systems of the paternal itself, but also transmit the harm to the offspring. Moreover, the harm caused by paternal chronic stress to the offspring is related to reprogramming of germ cells. The current views believe that the epigenetic modification is responsible for the transformation of germ cell fate and maintenance of developmental potential. Therefore, once the stress factors lead to epigenetic modification of the paternal germ cells in a certain period, it reprogram the germ cells, which can further transmit the harm to the offspring or even multiple generations. However, the mechanism of reprogramming of germ cells caused by chronic paternal stress has not been fully elucidated. This article reviewed the harm of paternal chronic stress to the paternal itself and its offspring for multiple generations, and combined the latest research progress to explore the mechanism by which paternal chronic stress affects reprogramming of reproductive cells, with a view to provide more theoretical basis for paternal-originated diseases.